bluuebunny/crossref_metadata_2025 huggingface dataset:
Low-field thoracic magnetic stimulation increases peripheral oxygen saturation levels in coronavirus disease (COVID-19) patients
Authors: Dominguez-Nicolas Saul M. , Manjarrez Elias
Published: October 2021

Severe acute respiratory syndrome coronavirus-2 may cause low oxygen saturation (SpO2) and respiratory failure in patients with coronavirus disease (COVID-19). Hence, increased SpO2 levels in COVID-19 patients could be crucial for their quality of life and recovery. This study aimed to demonstrate that a 30-minute single session of dorsal low-field thoracic magnetic stimulation (LF-ThMS) can be employed to increase SpO2 levels in COVID-19 patients significantly. Furthermore, we hypothesized that the variables associated with LF-ThMS, such as frequency, magnetic flux density, and temperature in the dorsal thorax, might be correlated to SpO2 levels in these patients.

Here we employed an LF-ThMS device to noninvasively deliver a pulsed magnetic field from 100 to 118 Hz and 10.5 to 13.1 milliTesla (i.e., 105 to 131 Gauss) to the dorsal thorax. These values are within the intensity range of several pulsed electromagnetic field devices employed in physical therapy worldwide. We designed a single-blind, sham-controlled, crossover study on 5 COVID-19 patients who underwent 2 sessions of the study (real and sham LF-ThMS) and 12 patients who underwent only the real LF-ThMS.

We found a statistically significant positive correlation between magnetic flux density, frequency, or temperature, associated with the real LF-ThMS and SpO2 levels in all COVID-19 patients. However, the 5 patients in the sham-controlled study did not exhibit a significant change in their SpO2 levels during sham stimulation. The employed frequencies and magnetic flux densities were safe for the patients. We did not observe adverse events after the LF-ThMS intervention.

This study is a proof-of-concept that a single session of LF-ThMS applied for 30 minutes to the dorsal thorax of 17 COVID-19 patients significantly increased their SpO2 levels. However, future research will be needed to understand the physiological mechanisms behind this finding.

The study was registered at ClinicalTrials.gov (Identifier: NCT04895267, registered on May 20, 2021) retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04895267.
Clinical significance of overweight in patients with hypertrophic cardiomyopathy
Authors: Chen Ziwei , Xu Biao
Published: October 2021

Hypertrophic cardiomyopathy (HCM) is a common genetic heart disease with varying clinical outcomes and it is important to identify new predictors of adverse events and survival in HCM patients.

Overweight may independently predict the clinical outcomes of HCM patients.

This was a retrospective study. Two hundred six HCM patients were compared classified by the normal group (body mass index < 25 kg/m2) and the overweight group (body mass index ≥ 25 kg/m2). We compared major adverse cardiovascular and cerebral events and secondary endpoints between 2 groups. By Cox analysis, we determined whether overweight was an independent predictor of MACCE in HCM patients. Finally, we also explored the prognostic value of overweight on all-cause death in HCM cohorts using Kaplan–Meier analysis.

Overweight patients were associated with more heart failure (HF) rehospitalization in HCM patients (51.3% vs 27.5%, P = .001). Overweight was an independent determinant of MACCE in HCM patients (heart rate = 3.40, 95% confidence interval: 1.79–6.61, P < .001), mainly attributed to HF rehospitalization (heart rate = 3.44, 95% confidence interval: 1.64–6.72, P < .001). However, a prognostic effect of overweight on overall survival was not observed by Kaplan–Meier analysis (P = .23).

These results provide the evidence that overweight could predict the presence of MACCE, especially HF rehospitalization, in HCM patients.
Reconstruction for diverse fronto-orbital defects with computer-assisted designed and computer-assisted manufactured PEEK implants in one-stage operation
Authors: Yang Min , Wu Zhangyi , Yu Hai , Cheng Jun
Published: October 2021

Rational:

Reconstruction of complex craniofacial defects in fronto-orbital region has been reported to be extremely few. In this study, we report 2 cases with fronto-orbital defects of different etiologies in one-stage surgical reconstruction with polyetheretherketone (PEEK) prosthesis using computer-assisted design and computer-assisted manufactured (CAD–CAM) techniques.

Patient concerns:

One patient was a 49-year-old man, who admitted with a depressed and comminuted fracture in the left fronto-orbital region as a result of a motor vehicle collision. The other patient was a 45-year-old woman who was hospitalized with an unexpected diagnosis of a fronto-orbital bone tumor during a head CT examination in a minor traumatic brain injury. None of them had a significant past medical history.

Diagnoses:

The first patient's head computed tomography (CT) showed multiple depressed comminuted fractures in the right fronto-orbital region with localized frontal lobe contusion, and the diagnosis was clear when combined with the mechanism of traumatic head injuries. The second patient's head CT and magnetic resonance image suggested a right lateral orbital neoplastic lesion that distorted peripheral bone, the postoperative pathological examination demonstrated an osteoma with fibromatous hyperplasia, and thus the women's diagnosis was confirmed.

Interventions:

A three-dimensional image of both patients’ skull bone were collected from a high-resolution CT. A virtual surgical planning for lesion excision and defect remodeling based on CAD–CAM techniques was undertaken, and than the reconstruction surgery was performed in a single procedure using PEEK prosthesis. Antibacterial treatment was prescribed routinely.

Outcomes:

Postoperatively, both patients achieved excellent aesthetic restoration as well as functional recovery of the orbital cavity without neurological or infectious complications during an average 22 months follow-up.

Lessons:

The CAD–CAM PEEK implants could be a preferred option for reconstruction of patients with various complex fronto-orbital defects.
Pancreatic neuroendocrine tumor producing vasopressin
Authors: Li Jingyan , Zhang Xinxin , He Qing , Feng Wenli , Ding Li , Wang Zhuoqun , Yu Haonan , Chen Qiusong , Lu Ning , Xu Dongbo , Cui Jingqiu
Published: October 2021

Rationale:

Functional pancreatic neuroendocrine tumors (pNETs) rarely produce vasopressin. Here, we reported a case of pNET producing vasopressin in a 78-year-old man with hyponatremia.

Patient concerns:

The patient presented with anorexia approximately 4 years ago, and the laboratory test results indicated hyponatremia. He was hospitalized 3 times subsequently due to anorexia in the past 4 years, during which laboratory tests consistently indicated severe hyponatremia.

Diagnosis:

Upon admission, his serum osmolarity, urine osmolarity, urine sodium level, and 24-hour urine sodium level was 277 mOsm/kg H2O, 465 mOsm/kg H2O, 82.5 mmol/L, and 140.25 mmol, respectively. Gallium-68-labeled tetraazacyclododecanetetraacetic acid-Dphel-Tyr3-octreotate positron emission tomography-computed tomography showed a high uptake lesion measuring approximately 1 cm in diameter in the pancreatic body, and the possibility of pNET was considered. Besides, laboratory tests showed that adrenocorticotropic hormone, follicle-stimulating hormone, and luteinizing hormone released by the pituitary was insufficient in the case of low levels of cortisol, estradiol, progesterone, and testosterone. Thus, the diagnosis of the syndrome of inappropriate antidiuresis (SIAD) was considered along with hypopituitarism.

Interventions:

The patient underwent surgery, and pNET was confirmed by pathology examination. The immunohistochemical study showed that the tumor cells were positive for somatostatin receptors 2 and vasopressin.

Outcomes:

In the last follow-up 17 months after surgery, the patient was in good condition, taking methylprednisolone 4 mg every other day, and had been free of anorexia or hyponatremia episodes.

Lessons:

This case illustrated the potential ectopic production of vasopressin resulting in SIAD in pNETs, highlighting the adoption of gallium-68-labeled tetraazacyclododecanetetraacetic acid-Dphel-Tyr3-octreotate positron emission tomography-computed tomography and vasopressin immunohistochemical staining in the evaluation of the etiology of SIAD.
Hemorrhagic disseminated intravascular coagulation after 177Lu-Dotatate in metastatic midgut neuroendocrine tumor
Authors: Worbe Noémie , Damian Louise , Le Cam-Duchez Véronique , Levesque Hervé , Michel Pierre , Quak Elske
Published: October 2021

Rationale:

Peptide receptor radionuclide therapy with 177Lu-Dotatate represents a major breakthrough in the treatment of metastatic well differentiated neuroendocrine tumors. This treatment is generally well tolerated. Reported severe long-term hematological side effects are rare and include hematopoietic neoplasms and bone marrow failure.

Patients concerns:

We describe the case of a patient presenting spontaneous bleeding and bruising occurring 6 weeks after the first administration of 177Lu-Dotatate. Blood tests showed anemia, thrombocytopenia, prolonged clotting times, profound fibrinolysis and low levels of coagulation factors II and V. There were no signs of tumor lysis syndrome.

Diagnoses:

We made the diagnosis of acute disseminated intravascular coagulation.

Intervention:

Treatment consisted of multiple transfusions of fresh frozen plasma, fibrinogen and platelets, and corticosteroids. Acute disseminated intravascular coagulation (DIC) persisted for 10 days and then resolved.

Outcomes:

Metabolic imaging 5 months after the 177Lu-Dotatate administration showed disease progression. Treatment with 177Lu-Dotatate was not rechallenged due to the occurrence of DIC.

Lessons:

Our case suggests that acute hemorrhagic disseminated intravascular coagulation can be a rare and life-threatening subacute side effect of 177Lu-Dotatate peptide receptor radionuclide therapy.
Prevalence and factors associated with HIV-1 drug resistance mutations in treatment-experienced patients in Nairobi, Kenya
Authors: Scriven Yvonne A. , Mulinge Martin M. , Saleri Norah , Luvai Elizabeth A. , Nyachieo Atunga , Maina Esther N. , Mwau Matilu
Published: October 2021

An estimated 1.5 million Kenyans are HIV-seropositive, with 1.1 million on antiretroviral therapy (ART), with the majority of them unaware of their drug resistance status. In this study, we assessed the prevalence of drug resistance to nucleoside reverse transcriptase inhibitors (NRTIs), nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors, and the variables associated with drug resistance in patients failing treatment in Nairobi, Kenya.

This cross-sectional study utilized 128 HIV-positive plasma samples obtained from patients enrolled for routine viral monitoring in Nairobi clinics between 2015 and 2017. The primary outcome was human immunodeficiency virus type 1 (HIV-1) drug resistance mutation counts determined by Sanger sequencing of the polymerase (pol) gene followed by interpretation using Stanford's HIV Drug Resistance Database. Poisson regression was used to determine the effects of sex, viral load, age, HIV-subtype, treatment duration, and ART-regimen on the primary outcome.

HIV-1 drug resistance mutations were found in 82.3% of the subjects, with 15.3% of subjects having triple-class ART resistance and 45.2% having dual-class resistance. NRTI primary mutations M184 V/I and K65R/E/N were found in 28.8% and 8.9% of subjects respectively, while NNRTI primary mutations K103N/S, G190A, and Y181C were found in 21.0%, 14.6%, and 10.9% of subjects. We found statistically significant evidence (P = .013) that the association between treatment duration and drug resistance mutations differed by sex. An increase of one natural-log transformed viral load unit was associated with 11% increase in drug resistance mutation counts (incidence rate ratio [IRR] 1.11; 95% CI 1.06–1.16; P < .001) after adjusting for age, HIV-1 subtype, and the sex-treatment duration interaction. Subjects who had been on treatment for 31 to 60 months had 63% higher resistance mutation counts (IRR 1.63; 95% CI 1.12–2.43; P = .013) compared to the reference group (<30 months). Similarly, patients on ART for 61 to 90 months were associated with 133% higher mutation counts than the reference group (IRR 2.33; 95% CI 1.59–3.49; P < .001). HIV-1 subtype, age, or ART-regimen were not associated with resistance mutation counts.

Drug resistance mutations were found in alarmingly high numbers, and they were associated with viral load and treatment time. This finding emphasizes the importance of targeted resistance monitoring as a tool for addressing the problem.
Acupuncture against chronic postsurgical pain in non-small cell lung cancer patients
Authors: Li Gang , Zhang Changxi , Wang Congyi , Xiao Ling
Published: October 2021

Introduction:

Video-assisted thoracoscopic lobectomy is the prior recommended treatment for non-small cell lung cancer (NSCLC), with the advantages of small trauma, less postoperative pain, and quick recovery. However, a large number of patients may suffer chronic postsurgical pain (CPSP), which makes the patients unwilling to practice pulmonary exercises, and it would directly affect patient's cough, sputum expectoration, and mobility. Opioids could greatly improve the quality of postoperative analgesia and the quality of life after surgery, but it is accompanied with obvious side effects. A number of clinical studies have proved that acupuncture could improve postoperative pain and reduce opioid use. In this study, we try to conduct a randomized controlled study to evaluate the efficacy and safety of plum-blossom needle acupuncture combined with Tramadol in improving CPSP after lobectomy in NSCLC patients.

Methods:

Patients will be randomly divided into treatment group (acupuncture plus Tramadol) and control group (sham acupuncture plus Tramadol) with a random number table in 1:1 ratio. The patients, outcome assessor, and statistician will be blinded. The outcomes are changes of numerical rating scale, Karnofsky performance score, brief pain inventory, blood routine, liver and kidney function. The data will be analyzed by SPSS 22.0.

Conclusions:

The results will help to evaluate the efficacy and safety of plum-blossom needle acupuncture in improving CPSP after lobectomy in NSCLC patients.
Prognostic role of serum neutrophil gelatinase-associated lipocalin in cardiac arrest patients
Authors: Kang Changshin , In Yong Nam , Park Jung Soo , You Yeonho , Min Jin Hong , Jeong Wonjoon , Ahn Hong Joon , Cho Yong Chul , Ryu Seung
Published: October 2021

Accurate neurological prognostication is of the utmost importance to avoid futile treatments in patients treated with targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the prognostic value of serum neutrophil gelatinase-associated lipocalin (NGAL) by comparing with neuron-specific enolase (NSE), which is currently recommended by international guidelines in patients treated with TTM after OHCA.

The study included 85 comatose adult patients with OHCA who underwent TTM between May 2018 and December 2020. Serum NGAL and NSE were measured at 24-hour intervals until 72 hours after return of spontaneous circulation (ROSC). The primary outcome was their prognostic performance for poor neurological outcome at 3 months after OHCA.

Forty-nine patients (57.6%) had a poor neurological outcome; NGAL levels at all time points measured were significantly higher in these patients than in those with a good outcome (P < .01). NGAL showed lower maximal sensitivity (95% confidence interval [CI]) under a false-positive rate of 0% for the primary outcome compared with NSE (18.2% [95% CI 8.2–32.7] vs 66.7% [95% CI 50.5–80.4]). The combination of NGAL with NSE at 48 h showed the highest sensitivity (69.1% [95% CI 52.9–82.4]) and had the highest area under the curve (0.91 [95% CI 0.81–0.96]) for a poor outcome. The prognostic performance of NGAL alone was inadequate at all time points. However, NGAL combined with NSE at 24 and 28 hours after ROSC showed improved sensitivity compared to NGAL alone.

NGAL should be considered a supplementary biomarker in combination with NSE for prognostication in patients with OHCA treated with TTM.
Is intraoperative corticosteroid a good choice for postoperative pain relief in total joint arthroplasty? A meta-analysis of 11 randomized controlled trials
Authors: Zhang Lu-kai , Zhu Fang-bing , Gao Huan-huan , Zhang Lei , Quan Ren-fu
Published: October 2021

Background:

Effective postoperative analgesia is of great significance for postoperative rehabilitation. This meta-analysis aimed to investigate the efficacy of corticosteroid on pain following total joint arthroplasty.

Method:

PubMed (1996–December 2020), Embase (1996–December 2020), and the Cochrane Library (CENTRAL, December 2020) were searched and a total of 11 randomized controlled trials met our inclusion criteria.

Results:

Eleven randomized controlled trials met the inclusion criteria. Pooled data indicated the corticosteroid group was effective compared to the control group in terms of the visual analogue scale at rest (P < .05) and movement (P < .05), the total morphine equivalent consumption (P < .05), and the length of stay (P < .05), without increasing the risk of periprosthetic joint infection (P = .74) and the length of stay (P = .32).

Conclusions:

Compared to the control group, intraoperative corticosteroid was benefit to the pain management in total joint arthroplasty.
Obesity and risk for hypertension and diabetes among Kenyan adults
Authors: Temu Tecla M. , Macharia Paul , Mtui James , Mwangi Martin , Ngungi Paul W. , Wanjalla Celestine , Bloomfield Gerald S. , Farquhar Carey , Nyanjau Loise , Gathecha Gladwell K. , Kibachio Joseph
Published: October 2021

Despite the anticipated growth in the global burden of obesity especially in low-income countries, limited data exist on the contribution of obesity to cardiometabolic diseases in Africa.

We examined population-based samples of Kenyan adults who participated in the 2015 national chronic disease risk factor surveillance survey. Weight and height were measured, and body mass index (BMI) was calculated and used as a measure for general obesity. Waist circumference (WC), a clinical measure of central obesity was also measured. Logistic regression was used to assess the association between obesity with hypertension, diabetes, and dyslipidemia risk.

Of the 4276 participants, the median (IQR) age was 36 (27–47) years, 41% were men. One-third (37%) of the participants were centrally obese, whereas 10% were generally obese. The odds for overweight and general obesity were highest among females, adults >40 years, and those in the highest wealth quartile. Central and general obesity, assessed by WC and BMI, were associated with hypertension and dyslipidemia but not diabetes for both sexes. Compared with adults of normal weight, individuals with a BMI of ≥30 kg/m2 had an odds ratio of 2.39 (95% confidence interval [CI], 1.82–3.12) for hypertension and 2.24 (95% CI, 1.70–2.96) for dyslipidemia.

Obesity prevalence is high in Kenya and is associated with hypertension and dyslipidemia but not diabetes. Our findings indicate an urgent need to develop public health interventions to address obesity and prevent the development of comorbid conditions.
Accurate segmentation for different types of lung nodules on CT images using improved U-Net convolutional network
Authors: Zhang Xiaofang , Liu Xiaomin , Zhang Bin , Dong Jie , Zhang Bin , Zhao Shujun , Li Suxiao
Published: October 2021

Since lung nodules on computed tomography images can have different shapes, contours, textures or locations and may be attached to neighboring blood vessels or pleural surfaces, accurate segmentation is still challenging. In this study, we propose an accurate segmentation method based on an improved U-Net convolutional network for different types of lung nodules on computed tomography images.

The first phase is to segment lung parenchyma and correct the lung contour by applying α-hull algorithm. The second phase is to extract image pairs of patches containing lung nodules in the center and the corresponding ground truth and build an improved U-Net network with introduction of batch normalization.

A large number of experiments manifest that segmentation performance of Dice loss has superior results than mean square error and Binary_crossentropy loss. The α-hull algorithm and batch normalization can improve the segmentation performance effectively. Our best result for Dice similar coefficient (0.8623) is also more competitive than other state-of-the-art segmentation algorithms.

In order to segment different types of lung nodules accurately, we propose an improved U-Net network, which can improve the segmentation accuracy effectively. Moreover, this work also has practical value in helping radiologists segment lung nodules and diagnose lung cancer.
Scoring systems for differentiating gastrointestinal stromal tumors and schwannomas from leiomyomas in the stomach
Authors: Okanoue Shotaro , Iwamuro Masaya , Tanaka Takehiro , Satomi Takuya , Hamada Kenta , Sakae Hiroyuki , Abe Makoto , Kono Yoshiyasu , Kanzaki Hiromitsu , Kawano Seiji , Kawahara Yoshiro , Okada Hiroyuki
Published: October 2021

There is no practical predictive model for the diagnosis of gastrointestinal stromal tumors (GISTs). To establish a practical predictive model for the diagnosis of subepithelial lesions in the stomach, we reviewed patients with GISTs (n = 89), schwannomas (n = 7), and leiomyomas (n = 28).

The tumor was more frequently found along the gastric cardia in the leiomyoma group (57.1%) than in the GIST/schwannoma group (2.1%, P < .01). Contrast enhancement (57.3% vs 0%, P < .01) and intra-tumoral necrosis (34.4% vs 0.0%, P < .01) were more frequently observed in the GIST/schwannoma group than in the leiomyoma group. On endoscopic ultrasonography, 58.3% of GISTs/schwannomas showed uneven echogenicity, whereas the echogenicity was uneven in 21.4% of leiomyomas (P < .01). There were no differences between the tumor color and the presence or absence of ulcer formation, tumor bleeding, irregularity of the tumor margin, cystic spaces, and hyperechoic spots between the 2 groups. Based on these results, we developed a 2-step diagnostic algorithm for GISTs/schwannomas. The first step comprises 1 endoscopic feature: a cardiac or non-cardiac location. Tumors with a cardiac location were judged as leiomyomas and those with a non-cardiac location were judged as GISTs/schwannomas, with 96.9% sensitivity and 57.1% specificity for GIST/schwannoma diagnosis. The second step comprises a combination of endoscopic (non-cardiac location), radiologic (positive contrast enhancement and intra-tumoral necrosis), and endosonographic (uneven echogenicity) features for a total of 4 points. We assigned 1 point to each feature. Tumors with scores of 2 to 4 were judged as GISTs/schwannomas, with 81.3% sensitivity and 92.9% specificity for GIST/schwannoma diagnosis.

Our predictive model will be a practical guide for the management of gastric subepithelial lesions.
Impact of pretransplant frailty and sarcopenia on the post-transplant prognosis of patients with liver cirrhosis: a systematic review
Authors: Ferreira Alexandre Pimentel , Machado Mariana Verdelho
Published: October 2021

Introduction

Frailty and sarcopenia associate with increased mortality in patients with liver cirrhosis on the transplant waitlist. We conducted a systematic review on the impact of pretransplant frailty and sarcopenia on post-transplant outcomes in adult patients with liver cirrhosis.

Methods

We performed a search in Medline, Embase and Cochrane Central. Of the 12276 references initially recovered, 34 were included.

Results

Frailty and sarcopenia presented a negative impact on post-transplant outcomes and seemed to associate with an overall two-fold reduction in early and 50% reduction in late survival, for severe conditions, according to the largest cohorts. These patients required longer ICU and hospitalization time, had higher rates of sepsis and respiratory complications and lower graft-survival. The reversibility of frailty depended on the severity of functional impairment and on the co-morbidities contributing to frailty. Reversibility of sarcopenia occurred in only a minority of patients, in unbiased studies.

Conclusion

Frailty and sarcopenia are double-edged swords: patients with frailty/sarcopenia should be prioritized for liver transplantation due to increased mortality on the waitlist; however, severe frailty/sarcopenia may justify delisting because it associates with dismal prognosis post-liver transplantation. Patients presenting mild to moderate frailty/sarcopenia, should be submitted to liver transplantation before those conditions worsen to a level that significantly impacts post-liver transplantation outcomes.
Comparison of 18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT in the staging and restaging of gastric adenocarcinoma
Authors: Gündoğan Cihan , Kömek Halil , Can Canan , Yildirim Özgen Ahmet , Kaplan İhsan , Erdur Erkan , Poyraz Kerem , Güzel Yunus , Oruç Zeynep , Çakabay Bahri
Published: October 2021

Objective

In this study, we aimed to evaluate the diagnostic sensitivities of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in the primary tumor, and nodal, peritoneal and distant organ metastases of primary and recurrent gastric adenocarcinoma (GAc) with patient and lesion-based comparison.

Materials and method

Twenty-one patients with histopathologically proven newly diagnosed or recurrent GAc who underwent 18F-FDG and 68Ga-FAPI-04 imaging were included in the study. Both imaging techniques were evaluated visually according to the intensity of organ-based uptake. SUVmax and tumor-to-background ratio (TBR) values obtained from primary tumor/relapse and metastatic organs were compared statistically.

Results

68Ga-FAPI-04 uptake was positive in all 15 newly diagnosed patients, while two patients among them who had mucinous and signet ring cell carcinoma did not exhibit 18F-FDG uptake. The sensitivity and specificity of 68Ga-FAPI-04 PET/CT in detecting primary gastric were 100%, while the sensitivity and specificity of 18F-FDG were 86.6 and 100%, respectively. 68Ga-FAPI-04 imaging revealed diffuse stomach uptake in seven patients, while 18F-FDG could only show two of them. The sensitivity and specificity of in-patient-based detection of lymph node metastases were 100 and 95.2%, respectively, while these values were 71.4 and 93.7%, respectively, for 18F-FDG. For peritoneal involvement 68Ga-FAPI-04 had a sensitivity and specificity of 100%, whereas 18F-FDG had a sensitivity of 40% and a specificity of 100%.

Conclusion

68Ga-FAPI-04 PET/CT is an imaging modality with the potential of yielding more sensitive and specific findings 18F-FDG PET/CT. This modality may help avoid invasive diagnostic procedures that may be frequently required in GAc.
Diversity in Selected Leadership Positions in United States Academic Pediatric Gastroenterology Programs
Authors: Sanghavi Rinarani , Reisch Joan , Tomer Gitit
Published: October 2021

Women and minorities are underrepresented in leadership positions in academic specialties. We investigated representation of women and minorities in selected leadership positions and in fellowships in North American academic pediatric gastroenterology programs (PGP) via voluntary surveys. We also assessed for factors influencing diversity. We found that 45.8% of Program Directors (PD), 75% of division chiefs (DC), and 71% of Pediatrics department chairs were men. Sixty‐three percentage of the PG fellows were women. Most DCs were male professors. Most PDs, DCs, and department chairs were White (70%, 80%, and 88.3%), with Blacks being the least represented group in leadership and also among fellows. We found a higher likelihood of having a White PD if the department chair was White. We found gender and racial disparities in all PGP leadership positions. This data can serve as a guide in efforts to support diversity for both gender and race at all positions and academic ranks.
Growth of Very Low Birth Weight Infants Who Received a Liquid Human Milk Fortifier
Authors: Masoli Daniela , Mena Patricia , Dominguez Angelica , Ramolfo Pamela , Vernal Patricia , Pantoja Miguel Angel , Esparza Ruth , Hübner Maria Eugenia , Ríos Antonio , Faunes Miriam , Uauy Ricardo , Tapia Jose L. ,   Neocosur Network
Published: October 2021

Objectives:

To evaluate growth (weight, length, head circumference, and knee–heel length [KHL]) in very low birth weight (VLBW) infants (500–1500 g) who received human milk with a liquid fortifier (LHMF) with high protein and fatty acid content versus a traditional powder fortifier (PHMF) for 45 days or until discharge.

Methods:

This was a multicenter, randomized, controlled trial. An intention‐to‐treat analysis was performed to determine adverse events and withdrawal causes. We also performed an efficacy analysis involving the infants who completed at least 2 weeks of study.

Results:

Of the 158 infants enrolled in the study, 146 completed at least 2 weeks, and 125 completed the entire study. The biodemographic characteristics were similar between groups, with no differences in increments of weight (22.9 vs 22.7 g kg−1 day−1), length (1.03 vs 1.09 cm/week), head circumference (0.91 vs 0.90 cm/week), or KHL (3.6 vs 3.3 mm/week). The KHL increment was greater in infants weighing >1 kg receiving LHMF (3.7 vs 3.2 mm/week, P = 0.027). Although there were no significant differences in serious adverse events, the incidence difference of the composite outcome death/necrotizing enterocolitis between groups warrants attention (1.3% with LHMF and 8.1% with PHMF).

Conclusion:

There were no differences in the overall growth between VLBW infants receiving either fortifier.
Interventions to Improve the Preparedness to Care for Family Caregivers of Cancer Patients
Authors: Bilgin Aylin , Ozdemir Leyla
Published: October 2021

Background

Preparedness for caregiving could balance the negative impacts of caregiving. The interventions aimed at increasing readiness among the caregivers are important during the illness period for both patients and their caregivers.

Objectives

The aims of this study were to review the interventions applied to the caregivers of cancer patients and to examine the effects of these interventions on the preparedness to care.

Methods

The ScienceDirect, Scopus, CENTRAL, Web of Science, MEDLINE, and PubMed were searched for relevant studies published between 2000 and 2020. The methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies. The statistical analyses were performed using the Comprehensive Meta-Analysis software version 3.0. The publication bias was assessed using the Egger test, for funnel plots.

Results

Eleven studies were selected for the meta-analysis, including those about psychoeducation programs (n = 5), education programs (n = 3), supportive programs (n = 2), and a self-care support program for the caregivers (n = 1). The methodological quality assessment revealed 2 studies as “strong.” The results indicated an increase in the caregivers’ preparedness to care after the interventions. The subgroup analysis revealed that the programs with higher ratios of female caregivers were more effective.

Conclusion

The interventions applied to the family caregivers can exert beneficial effects on caregivers’ preparedness to care. Nonetheless, future studies should focus on methodological issues, such as randomization and blinding.

Implications for Practice

Nurse-driven interventions may be used as a useful strategy to improve the preparedness to care among the caregivers of cancer patients. The male caregivers should be closely followed by healthcare professionals for knowledge and support needs.
Case Report: Bilateral Cranial Nerve VI Palsy in Miller Fisher Syndrome
Authors: Malloy Kelly A. , Zeng Tina
Published: October 2021

SIGNIFICANCE

Miller Fisher syndrome, a variant of Guillain-Barré syndrome, is a condition characterized by ophthalmoplegia, ataxia, and areflexia. Diplopia, particularly secondary to a bilateral abduction deficit, is the most common presenting symptom. The telltale neurologic symptoms associated with this condition can easily be overlooked by eye care providers, delaying timely diagnosis and treatment.

PURPOSE

This study aimed to report a case of diplopia secondary to an uncommon condition (Miller Fisher syndrome) and to highlight the eye care provider's role in helping with diagnosis and management of this condition.

CASE REPORT

A 31-year-old woman presented to the emergency eye care service because of a 2-day history of sudden-onset diplopia, for which no cause was found 1 day prior at a local hospital emergency department. She also reported weakness in her legs, difficulty walking, balance problems, and reduced sensation of her left hand for the past 2 days. Clinical testing revealed bilateral abduction deficits, ataxia, and areflexia, the combination of which suggested Miller Fisher syndrome. Because of the acute onset and progressive severity of her neurologic symptoms, she was referred to a different hospital emergency department for confirmatory diagnosis and treatment of Miller Fisher syndrome.

CONCLUSIONS

Diplopia is a symptom commonly encountered by eye care providers, regardless of their mode of practice. Although there are many potential etiologies of diplopia, performing a comprehensive eye examination combined with a neurologic evaluation can potentially pinpoint the specific cause. Miller Fisher syndrome is one such condition in which the diagnostic triad can be uncovered with in-office ocular motility testing and neurologic examination. Eye care providers need to be aware of the clinical features of Miller Fisher syndrome to aid in prompt diagnosis and treatment for patients with this acute condition.
Repeatability of Anterior Eye Surface Topography Parameters from an Anterior Eye Surface Profilometer
Authors: Niyazmand Hamed , Read Scott A. , Atchison David A.
Published: October 2021

SIGNIFICANCE

Anterior eye shape measurements are important for clinical contact lens fitting. The detailed assessment of measurement repeatability using the Eye Surface Profiler (ESP; Eaglet Eye B.V., AP Houten, the Netherlands) allows for more reliable interpretation of eye surface topography measurements.

PURPOSE

This study aimed to determine the repeatability of the ESP for anterior central corneal power and anterior eye surface height measurements.

METHODS

A Badal optometer was mounted on the ESP to provide an external fixation target with appropriate accommodation control and refractive correction. Forty-five healthy young adults underwent two sessions of anterior eye measurements, separated by 20 minutes, using the ESP. In each session, three consecutive scans were captured. Sagittal height data were obtained from 8-mm central cornea and from 8- to 14-mm diameter (encompassing the corneal periphery and anterior sclera). Anterior corneal powers were determined from the central cornea. Intersessional and intrasessional repeatability values were determined as coefficients of repeatability and root mean square error differences.

RESULTS

Sagittal height intersessional coefficients of repeatability for central nasal (5 μm) and central temporal (7 μm) were better than peripheral nasal (24 μm) and peripheral temporal (21 μm) regions. Sagittal height intrasessional coefficients of repeatability were 9, 8, 28, and 31 μm for central nasal, central temporal, peripheral nasal, and peripheral temporal regions, respectively. Intersessional coefficients of repeatability of mean sphere, 90/180° (J
0) astigmatism, and oblique (J
45) astigmatism were 0.67, 0.22, and 0.13 D, respectively, with corresponding intrasessional coefficients of repeatability of 1.27, 0.21, and 0.27 D.

CONCLUSIONS

The modified measuring procedure for the ESP used in this study provides highly repeatable sagittal height measurements in the central cornea but is less repeatable in the corneal periphery and scleral region. Results of the current study can be considered when using ESP in the interpretation of anterior eye surface shape measurements and in contact lens fitting and design.
Emergency Department Initiated Mental Health Interventions for Young People
Authors: Walker Natasha , Medlow Sharon , Georges Amanda , Steinbeck Katharine , Ivers Rebecca , Perry Lin , Skinner S. Rachel , Kang Melissa , Cullen Patricia
Published: October 2021

Objective

Young people (10–24 years old) with mental health concerns are increasingly presenting to hospital emergency departments (EDs). The purpose of this review was to identify the core components and outcomes of mental health interventions for young people that are initiated in the ED, such that they are delivered in the ED and/or by ED health workers.

Methods

Six electronic databases were systematically searched. Primary peer-reviewed qualitative or quantitative studies describing an ED-initiated mental health intervention for young people published between 2009 and 2020 were included.

Results

Nine studies met the inclusion criteria. The included studies demonstrated that compared with traditional ED care, ED-initiated mental health interventions lead to improved efficiency of care and decreased length of stay, and a core component of this care was its delivery by allied health practitioners with mental health expertise. The studies were limited by focusing on service efficiencies rather than patient outcomes. Further limitations were the exclusion of young people with complex mental health needs and/or comorbidities and not measuring long-term positive mental health outcomes, including representations and whether young people were connected with community health services.

Conclusions

This systematic review demonstrated that ED-initiated mental health interventions result in improved service outcomes, but further innovation and robust evaluation are required. Future research should determine whether these interventions lead to better clinical outcomes for young people and staff to inform the development of best practice recommendations for ED-initiated mental health care for young people presenting to the ED.
Motor Developmental Delay After Cardiac Surgery in Children With a Critical Congenital Heart Defect: A Systematic Literature Review and Meta-analysis
Authors: Sprong Maaike C. A. , Broeders Willem , van der Net Janjaap , Breur Johannes M. P. J. , de Vries Linda S. , Slieker Martijn G. , van Brussel Marco
Published: October 2021

Purpose:

To systematically review evidence regarding the severity and prevalence of motor development in children with a critical congenital heart defect (CCHD) without underlying genetic anomalies.

Summary of Key Points:

Twelve percent of all included studies reported abnormal mean motor developmental scores, and 38% reported below average motor scores. Children with single-ventricle physiology, especially those with hypoplastic left heart syndrome, had the highest severity and prevalence of motor delay, particularly at 0 to 12 months. Most included studies did not differentiate between gross and fine motor development, yet gross motor development was more affected.

Recommendations for Clinical Practice:

We recommend clinicians differentiate between the type of heart defect, fine and gross motor development, and the presence of genetic anomalies. Furthermore, increased knowledge about severity and prevalence will enable clinicians to tailor their interventions to prevent motor development delays in CCHD.
Material Hardship and Association With Sexual Risk Behavior Among Adolescent Sexual Minority Males in 3 US Cities—National HIV Behavioral Surveillance—Young Men Who Have Sex With Men, 2015
Authors: Trujillo Lindsay , Robbins Taylor , Morris Elana , Sionean Catlainn , Agnew-Brune Christine ,   for the NHBS-YMSM Study Group
Published: October 2021

Introduction:

Adolescent sexual minority males (ASMMs) are disproportionately affected by HIV relative to other youth within the United States. Social determinants of health have been explored among this population; however, economic determinants, such as material hardship, remain understudied. We examined the relationship between material hardship and sexual behavior among ASMMs aged 13–18 years residing in 3 US cities using 2015 data from CDC's National HIV Behavioral Surveillance among Young Men Who Have Sex with Men.

Methods:

Young men ages 13–18 years residing in 3 US cities were recruited through venue-based, respondent-driven, or Facebook sampling. We estimated adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) for condomless anal intercourse (CAI) with a male sex partner in the past 12 months and with having 4 or more male sex partners in the past 12 months.

Results:

Of 547 ASMMs, 27% reported experiencing material hardship in the past 12 months. After adjusting for demographics, household characteristics, and city, ASMMs who experienced material hardship were more likely to report CAI with a male partner in the past 12 months (aPR: 1.55, 95% CI: 1.25 to 1.93) and to have had 4 or more male sex partners in the past 12 months (aPR: 1.44, 95% CI: 1.08 to 1.91).

Discussion:

More than a quarter of ASMMs experienced material hardship that was associated with increased sexual risk behavior among ASMMs. Incorporating services that address all unmet needs is important to consider for HIV prevention efforts for ASMMs.
Utility of Preoperative Helmet Molding Therapy in Patients With Isolated Sagittal Craniosynostosis
Authors: Zapatero Zachary D. , Slawinski Steven K. , Kosyk Mychajlo S. , Kalmar Christopher L. , Cheung Liana , Carlson Anna R. , Swanson Jordan W. , Taylor Jesse A. , Bartlett Scott P.
Published: October 2021

The purpose of this study was to review our institution's experience using helmet molding therapy in children with isolated non-syndromic sagittal craniosynostosis before placement of cranial springs and provide objective measurements of craniometric changes to help determine its role in treatment.

Patients who underwent preoperative helmet molding therapy for sagittal craniosynostosis were retrospectively reviewed. Three-dimensional surface tomography scans were used to measure head circumference, cranial width, cranial length, cranial index (CI), and cranial vault asymmetry.

Seventeen patients underwent orthotic helmeting therapy before spring mediated cranial vault expansion. Patients spent a median of 48 days (interquartile range [IQR] 32, 57) in preoperative orthotic helmeting therapy. There were increases in both cranial width and length post-helmeting (median: 107.5 mm [IQR 104.8, 110.4] versus 115.6 mm [IQR 114.5, 119.3]; P < 0.001) (median: 152.8 mm [IQR 149.2, 154.9] versus 156.8 mm [IQR 155.0, 161.5]; P < 0.001), respectively. There was a greater increase in cranial width (P = 0.015). Consequently, patients’ CI improved after preoperative helmeting (median: 0.702 [IQR 0.693, 0.717] versus 0.739 [0.711, 0.752]; P < 0.001). There was no evidence of growth restriction from helmeting (pre-helmeting Head circumference [HC]: median 96.8 percentile [IQR 90.6, 99.9] versus post-helmeting HC: 98.7 percentile [IQR 94.7, 99.8]; P = 0.109).

Preoperative helmeting in patients with non-syndromic isolated sagittal craniosynostosis can be used to improve CI before surgical correction. Significant benefits can be achieved in shorter preoperative helmeting durations than previously reported with no evidence of cranial growth restriction, which supports its feasibility and utility in children undergoing spring mediated cranial vault expansion.
Potential Value of Presepsin Guidance in Shortening Antibiotic Therapy in Septic Patients: a Multicenter, Prospective Cohort Trial
Authors: Xiao Hongli , Wang Guoxing , Wang Yan , Tan Zhimin , Sun Xuelian , Zhou Jie , Duan Meili , Zhi Deyuan , Tang Ziren , Hang Chenchen , Zhang Guoqiang , Li Yan , Wu Caijun , Li Fengjie , Zhang Haiyan , Wang Jing , Zhang Yun , Zhang Xinchao , Guo Wei , Qi Wenjie , Xie Miaorong , Li Chunsheng
Published: October 2021

Introduction:

Long-term use of antibiotics for septic patients leads to bacterial resistance, increased mortality, and hospital stay. In this study, we investigated an emerging biomarker presepsin-guided strategy, which can be used to evaluate the shortening of antibiotic treatment in patients with sepsis without risking a worse outcome.

Methods:

In this multicenter prospective cohort trial, patients were assigned to the presepsin or control groups. In the presepsin group, antibiotics were ceased based on predefined cut-off ranges of presepsin concentrations. The control group stopped antibiotics according to international guidelines. The primary endpoints were the number of days without antibiotics within 28 days and mortality at 28 and 90 days. Secondary endpoints were the percentage of patients with a recurrent infection, length of stay in ICU and hospital, hospitalization costs, days of first episode of antibiotic treatment, percentage of antibiotic administration and multidrug-resistant bacteria, and SOFA score.

Results:

Overall, 656 out of an initial 708 patients were eligible and assigned to the presepsin group (n = 327) or the control group (n = 329). Patients in the presepsin group had significantly more days without antibiotics than those in the control group (14.54 days [SD 9.01] vs. 11.01 days [SD 7.73]; P < 0.001). Mortality in the presepsin group showed no difference to that in the control group at days 28 (17.7% vs. 18.2%; P = 0.868) and 90 (19.9% vs. 19.5%; P = 0.891). Patients in the presepsin group had a significantly shorter mean length of stay in the hospital and lower hospitalization costs than control subjects. There were no differences in the rate of recurrent infection and multidrug-resistant bacteria and the SOFA score tendency between the two groups.

Conclusions:

Presepsin guidance has potential to shorten the duration of antibiotic treatment in patients with sepsis without risking worse outcomes of death, recurrent infection, and aggravation of organ failure.

Trial registration:

ChiCTR, ChiCTR1900024391. Registered 9 July 2019-Retrospectively registered, http://www.chictr.org.cn
Advancing Gastroscope From Intraluminal to Extraluminal Dissection: Primary Experience of Laparo-gastroscopic Esophagectomy
Authors: Shen Yaxing , Zhang Yiqun , He Mengjiang , Fang Yong , Wang Shuai , Zhou Pinghong , Tan Lijie , Lerut Toni
Published: October 2021

Transhiatal esophagectomy facilitates esophageal resection without the need for thoracotomy. However, this procedure carries the risks of blind and blunt dissection within the mediastinum. More recently, video-assisted or mediastinoscopic transhiatal esophagectomy was introduced to mobilize the esophagus under direct visualization. Even though, the procedure is technically demanding and animal studies have shown that the CO2 pneumomediastinum may be associated with hemodynamic instability. By further developing already established techniques, we pioneered the transhiatal esophageal mobilization by using hybrid gastroscope (Fig. 1). Laparo-gastroscopic esophagectomy, which integrates gastroscope and laparoscope for esophageal mobilization, was successfully implemented on an esophageal cancer patient with a history of lung cancer surgery. The operative duration was 240 minutes with an estimated blood loss of 110 mL. The patient experienced an uneventful recovery and was discharged on postoperative day 9. Further studies will be required to confirm the surgical and oncological efficacy of this innovation.