bluuebunny/crossref_metadata_2025 huggingface dataset:
A Changing World Demands Care That Takes a Consumer-Centric Approach
Authors: Robinson Edmondo
Published: November 2019

Consumerism is a buzzword in healthcare. Consumers expect personalized healthcare journeys, a standard consistent with their interactions in other industries. The opportunity to build consumer-focused approaches to healthcare has emboldened disruptors, investors, and innovative incumbents alike. A consumerism strategy embraces the concepts of convenience, access, and transparency. Digital tools and technologies are an important accelerant in the move to healthcare consumerism; leveraging data to create value from the customer’s perspective is another critical component.

In the face of increasing competition, regulatory challenges, and cost pressures, healthcare must work to engage and empower the consumer. CEOs must initiate and champion the shift to consumerism in their own organizations. The barriers to organizational transformation in this regard are similar to those associated with any other enterprise change initiative; addressing people, processes, and culture is essential to laying the groundwork for innovation. Healthcare consumers see impressive technological solutions, and they understand that these new technologies can improve both their medical experiences and their overall health.
Risk of new-onset autoimmune diseases in primary aldosteronism: a nation-wide population-based study
Authors: Er Leay Kiaw , Chen Likwang , Tsai Yao-Chou , Lin Yen-Hung , Huang Wei-Chieh , Chang Chin-Chen , Lu Ching-Chu , Huang Kuo-How , Chueh Jeff S. , Wu Kwan-Dun , Wu Vin-Cent
Published: November 2019

Objective:

The association between hyperaldosteronism and autoimmune disorders has been postulated. However, long-term incidence of a variety of new-onset autoimmune diseases (NOAD) among patients with primary aldosteronism has not been well investigated.

Methods:

From Taiwan's National Health Insurance Research Database with a 23-million population insurance registry, the identification of primary aldosteronism, essential hypertension and NOAD as well as all-cause mortality were ascertained by a validated algorithm.

Results:

From 1997 to 2009, 2319 primary aldosteronism patients without previously autoimmune disease were identified and propensity score-matched with 9276 patients with essential hypertension. Among those primary aldosteronism patients, 806 patients with aldosterone-producing adenomas (APA) were identified and matched with 3224 essential hypertension controls. NOAD incidence is augmented in primary aldosteronism patients compared with its matched essential hypertension (hazard ratio 3.82, P < 0.001, versus essential hypertension). Furthermore, NOAD incidence is also higher in APA patients compared with its matched essential hypertension (hazard ratio = 2.96, P < 0.001, versus essential hypertension). However, after a mean 8.9 years of follow-up, primary aldosteronism patients who underwent adrenalectomy (hazard ratio = 3.10, P < 0.001, versus essential hypertension) and took mineralocorticoid receptor antagonist (MRA) still had increased NOAD incidence (hazard ratio = 4.04, P < 0.001, versus essential hypertension).

Conclusion:

Primary aldosteronism patients had an augmented risk for a variety of incident NOAD and all-cause of mortality, compared with matched essential hypertension controls. Notably, the risk of incident NOAD remained increased in patients treated by adrenalectomy or MRA compared with matched essential hypertension controls. This observation supports the theory of primary aldosteronism being associated with a higher risk of multiple autoimmune diseases.
Angle Anatomy and Glaucoma in Patients With Boston Keratoprosthesis
Authors: Nascimento e Silva Rafaella , Taniguchi Elise V. , Cruzat Andrea , Paschalis Eleftherios I. , Pasquale Louis R. , Colby Kathryn A. , Dohlman Claes H. , Chodosh James , Shen Lucy Q.
Published: November 2019

Purpose:

To quantitatively analyze the angle anatomy in eyes with a Boston type 1 keratoprosthesis (KPro) using anterior segment optical coherence tomography (AS-OCT) and to assess the diagnostic ability of AS-OCT in KPro-associated glaucoma.

Methods:

AS-OCT (RTVue) images from KPro eyes with and without glaucoma were reviewed. The angle opening distance at 500 μm from the scleral spur (AOD500), trabecular–iris angle at 500 μm from the scleral spur (TIA500), and trabecular–iris surface area at 500 μm from the scleral spur (TISA500) were measured by 2 observers masked to the diagnosis. The measurements for each visible quadrant were compared between KPro eyes with and without glaucoma.

Results:

Twenty-two eyes with glaucoma and 17 eyes without glaucoma from 39 patients with KPro were included. Of the 4 quadrants imaged, the temporal angle was the most visible (79.5%) and angle measurements of the temporal quadrant were the only ones that differentiated the 2 groups: the mean AOD500, TIA500, and TISA500 were significantly lower in KPro eyes with glaucoma than without glaucoma (388.2 ± 234.4 μm vs. 624.5 ± 310.5 μm, P = 0.02; 26.1 ± 14.0 degrees vs. 39.1 ± 17.1 degrees, P = 0.03; and 0.15 ± 0.09 mm2 vs. 0.23 ± 0.12 mm2, P = 0.03; respectively). The highest area under the receiver operating characteristic curve for detecting glaucoma was 0.75 for temporal TIA500 (95% confidence interval 0.57–0.94, P = 0.02) with 50% specificity at 80% of sensitivity and a cutoff value of 37 degrees.

Conclusions:

The temporal angle was the most visible on AS-OCT in eyes with a KPro. Significant narrowing of the temporal angle detected on AS-OCT was associated with glaucoma in these eyes.
Changes in Distribution of Dry Eye Diagnostic Status Among Visual Display Terminal Workers According to the Revised Criteria of the Asia Dry Eye Society
Authors: Yamanishi Ryutaro , Uchino Miki , Uchino Yuichi , Kawashima Motoko , Dogru Murat , Yokoi Norihiko , Tsubota Kazuo
Published: November 2019

Purpose:

The present study aimed to compare the prevalence of dry eye disease (DED) among visual display terminal users using the revised and previous DED criteria.

Methods:

This cross-sectional study included 561 participants (187 women).

Results:

The distribution of diagnostic status according to the previous DED criteria was as follows: definite DED (n = 65, 11.6%), probable DED (n = 303, 54.0%), and non-DED (n = 193, 34.4%). According to the revised criteria, 329 participants (58.6%) were classified as DED and 232 participants (41.4%) were classified as non-DED.

Conclusions:

The prevalence of DED among visual display terminal users has increased to 58.6% from 11.6%, according to the revised DED diagnostic criteria of the Asia Dry Eye Society.
Relationship Between Foveal Threshold and Macular Structure/Function/Vessel Density in Glaucoma
Authors: Jeong Daun , Won Hun Jae , Jo Youn Hye , Song Min Kyung , Shin Joong Won , Kook Michael S.
Published: November 2019

Purpose:

To investigate the hypothesis that macular structure, function, and vessel density (VD) measurements can predict foveal threshold (FT) outcomes in glaucomatous eyes.

Materials and Methods:

One hundred ninety-five eyes from 195 subjects (134 subjects with early-to-moderate stage open-angle glaucoma and 61 healthy controls) who underwent optical coherence tomography angiography imaging and 24-2 visual field (VF) testing with FT measurements on the same day were retrospectively enrolled in this study. The association of FT with macular structural/functional/VD measurements was evaluated using partial correlation analyses with adjustment for age and linear regression analyses.

Results:

FT showed significant correlations between the thickness of the macular ganglion cell-inner plexiform layer (mGCIPL) (r=0.330, P<0.001) and the mean sensitivity (MS) of the central 5 and 10 degrees VF points (r=0.448, P<0.001 and r=0.361, P<0.001). Significant correlations were also found between FT and VD measurements at the inferior and superior parafoveal sectors (r=0.455, P<0.001 and r=0.438, P<0.001). In multivariate linear regression analyses controlling the covariates, the thickness of the mGCIPL, central 5 degrees VF MS, and parafoveal VD were significantly associated with FT (all P<0.001). There was also a significant association between FT and logMAR best-corrected visual acuity (β=−5.647, P<0.001).

Conclusions:

Macular VD along with mGCIPL thickness and central 5 degrees VF MS independently predict FT outcomes even in the eyes of patients with early-to-moderate stage open-angle glaucoma.
Even-number Measurement Bias With Goldmann Applanation Tonometry
Authors: Rozwat Anne , Roberts Daniel K.
Published: November 2019

While working with a large data set of Goldmann applanation tonometry (GAT) intraocular pressure (IOP) measurements for a separate investigation, we observed that the IOP distribution favored even-numbered values. Study of this phenomenon has been limited, and this larger data set enabled inquiry that showed new insight concerning the manner in which this bias may vary according to IOP level. This analysis of 69,537 right eyes measured via GAT demonstrated that even-number preference was essentially absent in the 21 to 24 mm Hg range, but then the bias gradually strengthened as it moved away from this range in a lower or higher IOP direction. These data suggest that there is an examiner proclivity to measure and/or record GAT readings as even-numbered values, but that this tendency varies depending on IOP level.
Reducing the use of opioids by patients with chronic pain: an effectiveness study with long-term follow-up
Authors: Nicholas Michael K. , Asghari Ali , Sharpe Louise , Beeston Lee , Brooker Charles , Glare Paul , Martin Rebecca , Molloy Allan , Wrigley Paul J.
Published: November 2019

This study addresses the problem of long-term opioid use by chronic pain patients. The study involved a secondary analysis of unanalyzed data from a published study of 2 versions of cognitive-behavioural therapy-based interdisciplinary treatment for chronic pain. In this study, we examined whether the use of opioids by 140 chronic pain patients could be ceased sustainably over 12 months after participation in the comprehensive interdisciplinary pain management program aimed at enhancing pain self-management. On admission to the treatment, there were no significant differences between those patients taking or not taking opioids on usual pain, pain interference in daily activities, pain-related disability, depression severity, as well as in pain cognitions. After the treatment, the use of opioids was significantly reduced, both in numbers taking any and in mean doses, and these gains were maintained over the 12-month follow-up. Finally, cessation of opioids during treatment was associated with more substantial and consistent improvements in usual pain, depression severity, pain interference, pain-related disability, and pain cognitions, relative to those who reduced their opioids but did not cease them. These findings support the idea of using training in pain self-management strategies as a viable alternative to long-term opioid use by patients with chronic pain.
Evaluating a Fall Risk Assessment Tool in an Emergency Department
Authors: Luo Shuhong , Kalman Melanie , Haines Pamela
Published: November 2019

Introduction:

A hospital's emergency department (ED) used the Johns Hopkins fall risk assessment tool (JHFRAT), which was not developed to assess the ED patients. The ED committee recommended the memorial ED fall risk assessment tool (MEDFRAT) plus a “nursing judgment” category. However, the modified MEDFRAT needed to be evaluated before implementation. This research evaluated the modified MEDFRAT in ED patients and nurses' perception of the tool.

Methods:

A two-stage quantitative design was used. Stage 1 was a chart review using both tools for patients who fell (n = 57) in the past 4 years and the control patients (n = 57). Two tools were compared using t-tests, Bland–Altman, predictive abilities, and mismatch rates. Stage 2 was the assessment of all ED patients (n = 435) seen by the ED triage nurses for 1 week using both tools. The chi-squared test and mismatch rates were used to compare the tools. Time to complete both tools and nurses' perceptions to the modified MEDFRAT were analyzed.

Results:

Two tools were significantly different. The modified MEDFRAT had higher predictive ability and lower mismatch rates than the JHFRAT. It needed shorter time to complete and was preferred by most nurses.

Conclusions:

The modified MEDFRAT is adequate to use in the ED.
Inflationary noninvasive blood pressure measurement reduces the incidence of subcutaneous hemorrhage
Authors: Nukita Shizuko , Nakano Sumie , Morimoto Yasuhiro , Shiramoto Hiroko
Published: November 2019

Objective

We verified the hypothesis that in noninvasive blood pressure (NIBP) measurement, inflationary NIBP measurement using the new type of cuff (YP-71xT series, Nihon Koden, Tokyo, Japan) might be associated with a reduced risk of subcutaneous hemorrhage.

Methods

The study involved 30 healthy volunteers (15 males and 15 females). The blood pressure was measured by deflationary NIBP measurement + conventional cuff (control group), deflationary NIBP measurement + cuff (YP-71xT series) (deflationary measurement group), or inflationary NIBP measurement + cuff (YP-71xT series) (inflationary measurement group). NIBP measurement was performed five times in a row, then the presence or of subcutaneous hemorrhage was evaluated. The three different methods were used as cross-over design at 1-week interval for each subject so that all three methods were used for all the subjects.

Results

The measurement time was significantly shorter in the inflationary measurement group than other groups. The incidence of subcutaneous hemorrhage significantly was lower in the inflationary measurement group (3%) than in control group (53%) (P < 0.001) and the deflationary measurement group (37%) (P = 0.002).

Conclusion

This study revealed that inflationary NIBP measurement was associated with a dramatically reduced incidence of subcutaneous hemorrhage. Synergistic effect of the newly designed cuff, short measurement time, and low inflation pressure may allow the risk of subcutaneous hemorrhage.
Techniques to monitor respiratory drive and inspiratory effort
Authors: Telias Irene , Spadaro Savino
Published: November 2019

Purpose of review

There is increased awareness that derangements of respiratory drive and inspiratory effort are frequent and can result in lung and diaphragm injury together with dyspnea and sleep disturbances. This review aims to describe available techniques to monitor drive and effort.

Recent findings

Measuring drive and effort is necessary to quantify risk and implement strategies to minimize lung and the diaphragm injury by modifying sedation and ventilation. Evidence on the efficacy of such strategies is yet to be elucidated, but physiological and epidemiological data support the need to avoid injurious patterns of breathing effort.

Some techniques have been used in research for decades (e.g., esophageal pressure or airway occlusion pressure), evidence on their practical utility is growing, and technical advances have eased implementation. More novel techniques (e.g., electrical activity of the diaphragm and ultrasound) are being investigated providing new insights on their use and interpretation.

Available techniques provide reliable measures of the intensity and timing of drive and effort. Simple, noninvasive techniques might be implemented in most patients and the more invasive or time-consuming in more complex patients at higher risk. We encourage clinicians to become familiar with technical details and physiological rationale of each for optimal implementation.
Association analysis between ARG1 gene polymorphisms and idiopathic dilated cardiomyopathy
Authors: Shah Syed Fawad Ali , Akram Sumaira , Iqbal Tahir , Nawaz Sadia , Rafiq Muhammad Arshad , Hussain Sabir
Published: November 2019

The current study aimed at investigate the potential association of ARG1 polymorphisms in subjects affected by idiopathic dilated cardiomyopathy (IDCM).

We have investigated 352 subjects affected by IDCM and 352 population-matched healthy controls by exploiting case-control study. The serum lipids were quantified using spectrophotometric assay, serum arginase activity was done by enzyme colorimetric assay and 2 polymorphisms (rs2781666 and rs2781667) in ARG1 were typed by polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP) to find out disease associate allele/haplotype segregating in subjects affected by IDCM.

Significantly high arginase activity was found to be associated with IDCM subjects when compared with population-matched healthy controls (P < .0001). The higher arginase level in IDCM subjects is negatively correlated with nitrite and nitrate (r = –0.4687, and r = –0.6435, respectively) in our study. There was a significant difference in the distribution of rs2781666 and rs2781667 genotypes of ARG1 polymorphism in patients and controls (P < .0001). Similarly, variant allele T at both loci showed a significant association with the disease phenotypes (P < .0001). Haplotype TT at rs2781666G/T and rs2781667C/T also showed a significantly association (P < .0001).

To our knowledge, this is the first report to show a significant involvement of ARG1 polymorphisms to produce IDCM symptoms in subjects originating in Pakistan.
Impact of RTN4 gene polymorphism and its plasma level on susceptibility to nasopharyngeal carcinoma
Authors: Yang Fenglian , Yang Shixian , Liu Jin , Pang Xiaoxia , Shi Feng , Qin Haimei , Wang Junli , Tang Renguang
Published: November 2019

The RTN4 gene plays a role in the development and progression of cancer. This case–control study aimed to investigate the association between the RTN4 gene polymorphism and its plasma level with the risk of nasopharyngeal carcinoma (NPC) in a Chinese population.

RTN4 gene polymorphisms (rs2920891, rs17046583, rs117465650, rs10496040, and rs2588519) in 220 patients with NPC and 300 healthy controls were analyzed using Snapshot single-nucleotide polymorphism genotyping assays. The plasma level of RTN4 was measured using the enzyme-linked immunosorbent assay.

The allele frequencies of RTN4 gene polymorphisms showed no significant difference between the patients and controls (P > .05). Nevertheless, the rs2920891 polymorphism in a dominant model (A/C+C/C) and codominant model (A/C) was significantly associated with the susceptibility to NPC (P = .017, odds ratio [OR] = 1.54, 95% confidence interval [CI] = 1.08–2.21 and P = .034, OR = 1.64, 95% CI = 1.13–2.38, respectively). The plasma level of RTN4 was significantly higher in patients with NPC in comparison with the controls (P < .001). Furthermore, we observed that patients with NPC carrying the rs2920891 A/C+C/C genotype had a higher RTN4 level than those carrying the A/A genotype (P < .001).

Our findings indicated that the rs2920891 polymorphism may be associated with increased susceptibility to NPC, possibly by increasing plasma RTN4.
Regional homogeneity and functional connectivity analysis of resting-state magnetic resonance in patients with bipolar II disorder
Authors: Xu Zhe , Lai Jianbo , Zhang Haorong , Ng Chee H. , Zhang Peng , Xu Dongrong , Hu Shaohua
Published: November 2019

To explore the characteristics of local brain activity in patients with bipolar depression and its correlation with clinical features.

In accord with the diagnostic and statistical manual of mental disorders-IV of bipolar disorder, 21 patients were enrolled while 21 healthy controls were matched with similar gender, age, level of educations. A 3.0T GE magnetic resonance scanner was used to collect the imaging data, and a 2-sample t test was performed. Regional homogeneity (ReHo) method was used to estimate regional activation patterns through indices of localized concordance. ReHo values were compared between groups. Seed-based correlation analysis was used to analyze functional connections.

In the patients’ group, ReHo (regional homogeneity) values of resting state functional magnetic resonance imaging data on the right cerebellum 4 and 5 area, cerebellar vermis 6 area, left insula were positively correlated with Hamilton depression scale (HAMD) scores. ReHo values on the left of the triangle of inferior frontal gyrus, right inferior frontal gyrus of orbital region showed negative correlation with HAMD scores. The value of ReHo in the patients’ group was positively correlated with the patients’ Hamilton anxiety scale score in the right fusiform gyrus, and negative correlation was found in the left insula. The ReHo value of the patients’ group was negatively correlated with the patients’ Montgomery Asberg depression rating scale score in regions of the midbrain. The value of ReHo in patients’ group was significantly reduced in the right central front.

The depression and anxiety severity of bipolar depression patients may be associated with the consistency activity of left insula, right cerebellum, and cerebellar vermis related area, fusiform gyrus. In addition, the ReHo of the midbrain neurons activity may be associated with depression level of patients with bipolar II disorder.
The relationship between cognitive impairment and homocysteine in a B12 and folate deficient population in China
Authors: Meng HuaXing , Li Yang , Zhang Wei , Zhao YaRong , Niu XiaoYuan , Guo JunHong
Published: November 2019

Alzheimer disease (AD) is the most common neurodegenerative disease in the world. The relationship between AD and homocysteine (Hcy) is contradictory.

A community-based investigation was conducted to find patients with AD in a vitamin B deficient population (≥55 years old) in Lüliang area in China. Venous blood samples were collected. Serum Hcy, folate, and vitamin B12 were measured. For each case, 4 controls were selected matched with age to evaluate the relationship between Hcy and AD.

The crude prevalence of AD among people ages 55 years or older in this area was 8.60%. There were significant differences in serum Hcy and B12 between the case and control groups. We found that the higher level of serum Hcy was associated with a high risk of AD, and higher education level, higher folate and B12 concentration were protective factors to AD.

Adjustment of diet structure and supplementation of folate and B12 may offer potential therapeutic measures in this area.
Homocysteine as a potential predictive factor for high major adverse cardiovascular events risk in female patients with premature acute coronary syndrome
Authors: Wei Mei , Wang Le , Liu Yong-Sheng , Zheng Ming-Qi , Ma Fang-Fang , Qi Yan-Chao , Liu Gang
Published: November 2019

We aimed to investigate the correlation of homocysteine (Hcy) level with clinical characteristics, and explore its predictive value for major adverse cardiovascular events (MACE) risk in female patients with premature acute coronary syndrome (ACS).

The serum Hcy level was detected from 1299 female patients with premature ACS. According to the tertile of Hcy level, patients were divided into 3 groups: lowest tertile group (≤9.1 μmol/L), middle tertile group (9.2–11.6 μmol/L) and highest tertile group (>11.6 μmol/L). MACE incidence was recorded and MACE-free survival was caculated with the median follow-up duration of 28.3 months.

Increased Hcy correlated with older age (P < .001), higher creatinine level (P < .001), and enhanced uric acid level (P = .001), while reduced fasting glucose concentration (P < .001). MACE incidence was 10.7% and it was highest in highest tertile group (22.1%), followed by middle tertile group (7.7%) and lowest tertile group (2.4%) (P < .001). Receiver operating characteristic curve showed that Hcy distinguished MACE patients from non-MACE patients with the area under the curve of 0.789 (95% CI: 0.742–0.835). Kaplan–Meier curves revealed that MACE-free survival was shortest in Hcy highest tertile group, followed by middle tertile group and lowest tertile group (P < .001). Multivariate Cox analyses further showed that higher Hcy level was an independent predictive factor for poor MACE-free survival (middle tertile vs lowest tertile (P = .001, HR: 3.615, 95% CI: 1.661–7.864); highest tertile vs lowest tertile (P < .001, HR: 11.023, 95% CI: 5.356-22.684)).

Hcy serves as a potential predictive factor for increased MACE risk in female patients with premature ACS.
Echocardiographic diagnosis of anomalous origin of the left coronary artery from the pulmonary artery
Authors: Yuan Xin-Chun , Hu Jia , Zeng Xi , Zhou Ai-Yun , Chen Li
Published: November 2019

The aim of this research is to investigate the application value of TTE in the diagnosis of the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).

The echocardiographic findings of 11 patients with ALCAPA confirmed by surgery in our hospital from October 2007 to December 2018 were retrospectively analyzed and compared with the preoperative computed tomography angiography (CTA) diagnosis and intraoperative diagnosis.

Surgery was performed in all of the patients to establish the dual coronary artery system. Four underwent the Takeuchi procedure and 7 had re-implantation of the anomalous left coronary artery. The CTA diagnoses of the 11 patients were consistent with the surgical diagnoses, and the diagnostic accuracy was 100% (11/11). Echocardiographic diagnosis showed consistent results in 10 cases, while one case was misdiagnosed as endocardial fibroelastosis; the diagnostic accuracy was 90.9% (10/11). The echocardiographic features of these patients with ALCAPA included: abnormal left coronary ostium arising from the pulmonary trunk with retrograde coronary artery flow in 10 patients; enlargement of the right coronary artery in 8 patients; abundant intercoronary septal collaterals in 6 patients; and moderate and significant mitral regurgitation in 7 patients. Echocardiography showed that the left ventricular end-diastolic diameter and left ventricular end-systolic diameter before surgery were significantly different from those after surgery (P < .05) and that the left ventricular ejection fraction and fractional shortening before surgery were not significantly different from those after surgery (P > .05).

Transthoracic echocardiography can diagnose ALCAPA in a timely, accurate, and noninvasive manner, and it could be of great significance in guiding clinical operations and in predicting prognosis.
Association of the second derivative of photoplethysmogram with age, hemodynamic, autonomic, adiposity, and emotional factors
Authors: Park Young-Jae , Lee Jin-Moo , Kwon Soon-Hyuk
Published: November 2019

The second derivative of photoplethysmogram (SDPTG) is used as an arterial stiffness marker. This study aimed to examine the associations between SDPTG indices and age, in addition to hemodynamic, autonomic, adiposity, and emotional factors.

This study had a cross-sectional chart review design, and electronic medical records of 262 women outpatients (mean ± SD,|38.57| ± |11.64 years) were reviewed. Among SDPTG measurements, b/a, c/a, d/a, and (b-c-d)/a were considered. Hemodynamic measurements included systolic and diastolic blood pressure (SBP and DBP) and cardiac output. Autonomic measurements included low and high frequency (LF and HF) values of the heart rate variability. Adiposity measurements included body mass index (BMI) and waist-hip ratio (WHR). Tension, anger, depression, fatigue, confusion, and vigor scores using the Profile of the Mood States were included as emotional markers. All data were normalized through the Box-Cox transformation, and 4 hierarchical regression models were constructed.

Age was independently predictive of SDPTG, hemodynamic, autonomic, and adiposity factors (β; 0.143–0.648).

After the adjustment for age, SBP and DBP showed negative correlations with d/a (r = –0.201, –0.262), whereas BMI, WHR, LF, and HF showed positive correlations with c/a (r = 0.126, 0.131, 0.151, 0.234). In the hierarchical regression modeling, age and hemodynamic factors were directly predictive of SDPTG indices (β; 0.103–0.626). Age had moderating effects between diastolic blood pressure, heart rate, depression scores, and SDPTG indices (β; 0.104–0.176).

In conclusion, age, hemodynamic, adiposity, and autonomic factors may be independently associated with SDPTG indices for women. As age has moderating effects between hemodynamic, emotional factors, and SDPTG indices, its moderating effects should be considered when assessing arterial stiffness using SDPTG indices.
Reactive in-stent stenosis of a pipeline embolization device in a child
Authors: Wang Ting , Zhang Chang Wei , Richard Seidu A. , Chaohua Wang , Xie Xiao Dong
Published: November 2019

Rationale

: Pipeline embolization device pipeline embolization device (PLED) is one of the most preferred flow-diverting devices used in treating giant and complex intercranial aneurysms. The occurrence of in-stent stenosis (ISS), which is a partially reversible complication, has been associated with PLED. Trauma around the neck of the aneurysm during our attempts to implant the PLED across the aneurysm resulted into inflammatory reactions, endotheliazation, granular tissue formation, and subsequent ISS.

Patient concerns:

We present an 11-year-old girl with dizziness of 6 days duration on account of which she was admitted at our institution. Physical as well as neurological examinations did not yield much.

Diagnoses:

Cerebral angiography revealed a right cavernous segment giant aneurysm.

Interventions:

We initially implanted Pipeline embolization devices (PLEDs) (ev3, Irvine, California, USA) across the neck of the aneurysm which resulted into ISS 6 months after the operation.

Outcomes:

We also attempted balloon angioplasty which failed during our second operation. She was finally treated with Neuroform stent (Stryker Neurovascular, USA) with no further complication and two years follow-up revealed no ISS.

Lessons subsections as per style:

A combination of multiple kinds of flow diverting devices could reduce the incidence of ISS in selected patients with complex aneurysms. Minimal trauma caused by PLED at aneurysm site could also reduce incidence of ISS.
Whipple’s disease: diagnosis and predictive factors of relapse
Authors: Ferrieres Laurence , Laroche Michel , Bonnet Delphine , Alric Laurent
Published: November 2019

Background

Whipple’s disease is a very rare disease needing a long-term treatment. The most frequent symptoms are recurrent arthralgia or arthritis, chronic diarrhea, abdominal pain, and weight loss.

Objectives

In this article, we have highlighted the main clinical features and diagnostic procedures that lead to the diagnosis and comment on the clinical response, treatment, and the factors of relapse.

Methods

Subjects were recruited from the Internal Medicine and Rheumatologic Departments of an University Hospital from November 1997 to January 2016. Overall, 12 subjects were finally diagnosed.

Results

Mean age was 54.3 years (age range: 30–81), with more male patients (58.3%). Almost all patients had articular symptoms and impaired general condition (91.7%); and a majority had digestive symptoms (75%). Regardless of the symptoms, the most efficient diagnostic tools were the PCR screening on the gastrointestinal biopsies and saliva (83.3 and 72.7% positive results, respectively). More than half of the patients relapsed (55.6%). The relapsing patients were older [63.2 (44–81)] and mostly male with a majority (60%) of digestive symptoms and a delayed diagnosis.

Conclusions

In current practice, it is highly difficult to diagnose Whipple’s disease. In order to decrease the delay between the first symptoms and the diagnosis, effective tools such as saliva and stools PCR should be used because higher delays of diagnosis lead to a higher number of relapses.
Group-based Trajectory Models to Assess Quality of INR Control and Its Association With Clinical Outcomes
Authors: García-Sempere Aníbal , Hurtado Isabel , Bejarano Daniel , Santa-Ana Yared , Rodríguez-Bernal Clara , Peiró Salvador , Sanfélix-Gimeno Gabriel
Published: November 2019

Background:

The Time in Therapeutic Range (TTR) is the gold-standard measure used to assess the quality of oral anticoagulation with vitamin K antagonists. However, TTR is a static measure, and International Normalized Ratio (INR) control is a dynamic process. Group-based Trajectory Models (GBTM) can address this dynamic nature by classifying patients into different trajectories of INR control over time.

Objectives:

The objective of this study was to assess the quality of INR control in a population-based cohort of new users of vitamin K antagonist with a diagnosis of atrial fibrillation using GBTM.

Methods:

We classified patients into different trajectories according to their propensity for being adequately anticoagulated over their first year of treatment using GBTM, and we evaluated the association between trajectories and relevant clinical outcomes over the following year.

Results:

We included 8024 patients in the cohort who fulfilled the inclusion criteria; the mean number of INR determinations over the first year of treatment was 13.9. We identified 4 differential trajectories of INR control: Optimal (9.7% of patients, TTR: 83.8%), Improving (27.4% of patients, TTR: 61.2%), Worsening (28%; TTR: 69.1%), and Poor control (34.9%; TTR: 41.5%). In adjusted analysis, Poor and Worsening control patients had a higher risk of death than Optimal control patients (hazard ratio: 1.79; IC 95%, 1.36–2.36 and hazard ratio: 1.36; IC 95%, 1.02–1.81, respectively). Differences in other outcomes did not achieve statistical significance, except for a reduced risk of transient ischemic attack in the Improving Control group.

Conclusions:

GBTM may contribute to a better understanding and assessment of the quality of oral anticoagulation and may be used in addition to traditional, well-established measures such as TTR.
13N-ammonia PET/CT stress myocardial blood flow compared to fractional flow reserve in coronary artery disease
Authors: Boer Jouke J. , Kappelhof Johan J.J.S. , van der Zant Friso M. , Wondergem Maurits , de Swart Hans(J) B.R.M. , Knol Remco J.J.
Published: November 2019

Aim

In this retrospective study, fractional flow reserve was compared to stress myocardial blood flow derived by 13 N-ammonia (13 N-NH3) myocardial perfusion PET/CT.

Methods

From a large cohort of patients referred for 13 N-NH3 PET/CT, patients who also had fractional flow reserve-measurements within 6 months of the PET study were selected. These fractional flow reserve measurements were compared to PET/CT derived stress myocardial blood flow of the corresponding coronary territory. Results were categorized as concordant or discordant. Patients with discordant results were subdivided into a group with reduced fractional flow reserve but normal stress myocardial blood flow (group A) or into a group with normal fractional flow reserve but reduced stress myocardial blood flow (group B).

Results

From September 2013 through July 2016, 46 patients examined with 13 N-NH3 PET/CT also had fractional flow reserve-measurements within 6 months. A total of 66 measurements were used for comparison. Discordance was found in 32% of the measurements. Group B showed a significant reduction in stress myocardial blood flow of all coronary territories compared to group A (P = 0.000). During follow-up (median 3.96 years), group B showed more visits to the emergency department and newly developed heart failure.

Conclusion

Discordance with stress myocardial blood flow in the corresponding flow territory was found in 32% of the fractional flow reserve-measurements. Patients with reduced stress myocardial blood flow but normal fractional flow reserve showed significantly reduced stress myocardial blood flow in all coronaries and a trend towards more cardiac adverse events.
Registries for study of nonmalignant hematological diseases: the example of the Severe Chronic Neutropenia International Registry
Authors: Dale David C. , Bolyard Audrey Anna , Steele Laurie A. , Zeidler Cornelia , Welte Karl
Published: November 2019

Purpose of review

Registries provide ‘real world’ perspectives on the natural history and outcomes for many clinical conditions. The purpose of this review is to identify registries for nonmalignant hematological disease and to describe the operation of a successful long-term registry for patients with severe chronic neutropenia.

Recent findings

There was an upswing in registries about 20 years ago, based on optimism about their utility to improve patient care. To show value, registries must define outcomes for populations of patients with specific medical conditions and the effects of treatment. This is challenging for many reasons. The Severe Chronic Neutropenia International Registry is an example of a successful registry. This report describes underlying reasons for its success.

Registries are important to organize and analyze clinical information across geographic, ethnic and social boundaries. They are also challenging to organize, administer and support.
Myeloid cell and cytokine interactions with chimeric antigen receptor-T-cell therapy: implication for future therapies
Authors: Sterner Rosalie M. , Kenderian Saad S.
Published: November 2019

Purpose of review

Chimeric antigen receptor (CAR)-T-cell therapy is a revolutionary tool in the treatment of cancer. CAR-T cells exhibit their effector functions through the recognition of their specific antigens on tumor cells and recruitment of other immune cells. However, this therapy is limited by the development of severe toxicities and modest antitumor activity in solid tumors. The host and tumor microenvironment interactions with CAR-T cells play an important role in orchestrating CAR-T-cell functions. Specifically, myeloid lineage cells and their cytokines critically influence the behavior of CAR-T cells. Here, we review the specific effects of myeloid cell interactions with CAR-T cells, their impact on CAR-T-cell response and toxicities, and potential efforts to modulate myeloid cell effects to enhance CAR-T-cell therapy efficacy and reduce toxicities.

Recent findings

Independent studies and correlative science from clinical trials indicate that inhibitory myeloid cells and cytokines contribute to the development of CAR-T-cell-associated toxicities and impairment of their effector functions.

These findings illuminate a novel way to reduce CAR-T-cell-associated toxicities and enhance their efficacy through the modulation of myeloid lineage cells and inhibitory cytokines.
Congenital Factor XIII Deficiency With the Presence of Inhibitor: A Case Study
Authors: Karaman Serap , Akkaya Emre , Genc Sema , Bilgili Fuat , Kendirci Alper S. , Tugcu Deniz , Unuvar Aysegul , Karakas Zeynep , Demirkol Demet , Bayramoglu Zuhal , Omer Beyhan
Published: November 2019

Coagulation factor XIII (FXIII) is a fibrin-stabilizing factor with additional roles in wound healing and interactions between the decidua and fetus. Congenital FXIII deficiency is rare bleeding disorder. Inhibitor development against FXIII in inherited FXIII deficency is also uncommon, but may cause severe, life-threatening bleeding. FXIII is the last step in the coagulation cascade with normal coagulation paramaters (PT, aPTT), the detection of inhibitor to FXIII is quite difficult. The treatment of inhibitor-positive congenital FXIII deficiency is challenging due to the lack of a role of by-pass agents such as FVII. The best known ways of treatment in these cases are the use of high-dose FXIII concentrates and immunosuppression. Herein, we report the management of postoperative bleeding diathesis in a patient with FXIII deficiency who developed inhibitors, and to follow the clinical course of the disease with FXIII concentrate and immunosuppression.
Advancing Complex Case Management Competencies in a Health Care System
Authors: Stark Phyllis
Published: November 2019

Purpose/Objectives:

The purpose of this literature review is to evaluate evidence to support advanced education for hospital-based nurse case managers to address the discharge needs of medically complex patients who have extended hospital stays.

Primary Practice Setting:

Acute care hospital and hospital systems.

Findings/Conclusion:

Studies on hospital length of stay are prevalent as are studies of effective case management and the importance of a comprehensive education program. Correlating effective case management to successful disposition of long-stay patients and efficacy of discharge planning education is the focus of this review of evidence. Creation of advanced case management competency education will benefit patients, staff, and the health care system by increasing the skill level to promote early recognition of discharge barriers in complex long-stay patients.

Implications for Case Management Practice:

Continued focus on affordability in health care will keep management of hospital length of stay high on the priority list. Pressure to create efficient patient management strategies leading to timely discharge disposition of medically complex patients through barrier mitigation and intervention requires effective case management tools.
Measurement of Irritability in Cancer Patients
Authors: Zhang Amy Y. , Ganocy Stephen J.
Published: November 2019

Background

Irritability is common among people who are physically ill, but a physical underpinning of irritability is not assessed by existing measures. A measure that assesses multidimensionality of irritability can help nurses and clinicians provide better care for people with cancer and, thus, reduce a risk for developing depression during cancer treatment.

Objectives

We pilot tested a new measure, The Irritability Scale–Initial Version (TISi), for assessing irritability of cancer patients on three dimensions: physical, affective, and behavioral.

Methods

We conducted thee pilot studies to develop the 35-item TISi on a 5-point Likert scale. TISi was tested in 48 early-stage, nonmetastasized breast cancer patients at baseline (before) and 3 months (during chemotherapy). Of these patients, 62.5% received neoadjuvant and 37.5% received adjuvant chemotherapy, but none received hormonal treatment before or during the study. Measures of other correlates, including depression, anxiety, symptom distress, and social disconnectedness, were also administered, and biomarkers of hsCRP, TNF-α, IL-6, and BDNF were obtained from blood draws at both assessments.

Results

TISi has a high internal consistency (Cronbach’s α = .97), satisfactory test–retest reliability (retest r = .69, intraclass correlation coefficient = .86), and moderate correlation with other constructs over time (r ≈ .40–.70). Its physical subscale significantly correlated with hsCRP (r = .32, p = .025) at baseline and TNF-α (r = .44, p = .002) at 3 months. A confirmatory factor analysis yields three factor loadings that are in line with conceptualization of the subscales.

Discussion

The findings support psychometric properties of TISi and its application for assessing cancer patients’ irritability in multiple dimensions. Further investigation using a large study sample is necessary for improving construct and criterion validity and reducing item redundancy.

Conclusion

TISi can be used to measure the level of irritability in cancer patients
Randomized Controlled Trial of a Natural Food-Based Fiber Solution to Prevent Constipation in Postoperative Spine Fusion Patients
Authors: Wittig-Wells Deborah , Sapp Pam , Higgins Melinda , Davis Erica , Carter Jessica , Jacob Ani
Published: November 2019

BACKGROUND:

Constipation after orthopaedic surgery occurs frequently, likely due to a combination of high levels of opioid medications for severe pain management and mobility limitations after surgery. It can result in serious complications, increased cost, and patient discomfort.

PURPOSE:

This study evaluated a natural food-based fiber solution to prevent constipation in postoperative orthopaedic patients.

METHODS:

A posttest control group-randomized study design was used. Dependent variables were presence of postoperative constipation, time to first bowel movement (BM), and total number of postoperative BMs. Descriptive statistics, Student's t tests, and Mann–Whitney nonparametric 2-group tests with chi-square analysis were used. Level of significance for all tests was p < .05. Forty-six participants were evaluated.

RESULTS:

Ages were similar for both the intervention and control groups. Bowel Function Index (BFI) scores were not significantly different (p = .448). No significant group differences were present for the individual BFI item scores (p > .05). The number of patients with a BM during the first 3 days was not significantly different (p = .489). There were no significant differences found between the 2 groups regarding laxative administration (p > .05 for all laxatives).

CONCLUSION:

Further studies are indicated that address natural fibers and pharmaceutical methods for the prevention of constipation after spinal surgery.
The National Epidemic of Gun Violence: The Vermont Department of Health Response
Authors: Novick Lloyd F. , Levine Mark A. , Novick Carole G.
Published: November 2019

This case study details a 2018 “near miss” school mass-shooting event in Vermont that involved a former student and occurred contemporaneously with the Parkland, Florida, tragedy. The situation “jolted” this rural state's governor, lending urgency to the need to enact sensible gun control laws. He comes to support a series of proactive bills already in the legislature and advocate for further preventive strategies. The state's commissioner of health plays public health's traditional role within state government as trusted health promotion and education resource to frame the issue in public health and public safety terms. He portrayed health data on firearm injuries and deaths and formed a public health strategy including surveillance, identification of risk factors, and resources for school- and community-based prevention. On April 11, 2018, Governor Phil Scott signed a package of gun-related legislation that included increasing the legal age for gun purchases, expanding background checks for private gun sales, banning high-capacity magazines and rapid-fire bump stocks, and extreme risk protection orders. The final results were examined from an evidence-based public health standpoint, acknowledging the lack of gun research by federal agencies since the 1996 enactment of the Dickey Amendment that prohibits the Centers for Disease Control and Prevention from conducting firearms-related research. The case study illustrates the paradox of moving forward on gun safety, where more research is needed, but research does not necessarily influence political leaders or policy. It also demonstrates how prevention of gun violence can be portrayed in a public health framework, drawing upon data and strategies used in upstream preventive efforts in areas such as early childhood development, mental health, and substance misuse.