bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness and safety of the use of antifibrinolytic agents in total-knee arthroplasty
Authors: Ma Qi-ming , Han Guo-song , Li Bo-wen , Li Xiao-jing , Jiang Ting
Published: May 2020

Background:

Antifibrinolytic agents have been successfully used to reduce blood transfusion demand in patients undergoing elective knee arthroplasty. The purpose of this study was to investigate different antifibrinolytic agents for patients undergoing total-knee arthroplasty (TKA).

Methods:

We searched the randomized controlled trials assessing the effect of antifibrinolytic agents on TKA in MEDLINE, PubMed, Embase, and the Cochrane Library. Participants are divided into antifibrinolytic agent group and control group under TKA. Double extraction technology is used and the quality of its methodology is evaluated before analysis. Outcomes analyzed included blood loss, number of blood transfusions, rates of blood transfusion, and deep vein thrombosis (DVT).

Results:

A total of 28 randomized controlled trials involving 1899 patients were included in this study. Compared with the control group, the antifibrinolytic agents group exhibited significantly reduced the amounts of total blood loss (weighted mean difference [WMD] with 95% confidence interval [CI]: −272.19, −338.25 to −206.4), postoperative blood loss (WMD with 95% CI: −102.83, −157.64 to −46.02), average units of blood transfusion (risk ratio with 95% CI: 0.7, 0.12 to 0.24), and average blood transfusion volumes (WMD with 95% CI: −1.34, −1.47 to −1,21). Antifibrinolytic agents significantly reduced the rate of blood transfusions and did not increase the occurrence risk of intraoperative blood loss and DVT. Several limitations should also be acknowledged such as the heterogeneity among the studies.

Conclusion:

The application of antifibrinolytic agents can significantly reduce blood loss and blood transfusion requirements. Additionally, these agents did not increase the risk of DVT in patients undergoing TKAs.
A prospective observational study to explore the correlation of peripheral arterial pulse/resistance index, organ function, and inflammation in patients with septic shock
Authors: Hu Lirong , Leng Bo , Wu Changxue , Xue Yuting
Published: May 2020

Introduction:

The evaluation of the functional status of blood vessels, especially the arterial system, plays a very important role in the judgment of the condition of septic shock patients and the guidance of resuscitation programs and the judgment of the therapeutic effect. We aimed to design an observational study protocol to explore the correlation of peripheral arterial pulse/resistance index, organ function and inflammation in patients with septic shock.

Methods and analysis:

A total of 60 patients with septic shock in the Affiliated Hospital of Southwest Medical University from June 2020 to September 2020 and 20 healthy volunteers will be enrolled. Total of 60 patients with septic shock will be randomly divided into 20 groups by lot method. Group 1: fluid resuscitation; Group 2: fluid resuscitation + norepinephrine; Group 3: fluid resuscitation + norepinephrine + ulinastatin; Group 4: healthy control group. Fluid resuscitation is an early goal-directed fluid resuscitation in which norepinephrine is adjusted by a senior intensive care unit specialist for clinical presentation and ulinastatin is pumped at 20,000 U/h. Index including vascular ultrasound, inflammatory factors, organ function will be collected and analyzed.

Discussion:

Existing studies on septic shock focus on hemodynamics of the heart, brain, and kidney, while the differences in blood flow between peripheral blood vessels and protective renal vessels may be consistent, and imaging analysis is still lacking. This study protocol aims to explore the correlation of peripheral arterial pulsation index/resistance index, organ function, and inflammation in patients with septic shock.

Trial registration:

Chinese Clinical trial registry: ChiCTR2000031565
Does benralizumab effectively treat chronic obstructive pulmonary disease? A protocol of systematic review and meta-analysis
Authors: Chen Ru , Wang Ke-xin , Meng Xue , Zhou Wen
Published: May 2020

Background:

This study aims to investigate the efficacy and safety of benralizumab for the treatment of patients with chronic obstructive pulmonary disease (COPD).

Methods:

This study will systematically and comprehensively search relevant literatures in electronic databases (MEDLINE, EMBASE, Cochrane Library, Global health, PsycINFO, Scopus, WANGFANG, and CNKI) from inception to the present without language and publication time restrictions. Two reviewers will independently carry out literature identification, data collection, and study quality assessment. Any disagreement will be settled down by a third reviewer through discussion and a consensus will be reached. RevMan 5.3 software will be used for statistical analysis performance.

Results:

This study will summarize up-to-date evidence to assess the efficacy and safety of benralizumab for the treatment of COPD.

Conclusion:

The findings of this study will provide helpful evidence to determine whether benralizumab is effective or not for the treatment of COPD.

Systematic review registration:

INPLASY202040039.
Efficacy of total hip arthroplasty for the treatment of patients with femoral head avascular necrosis
Authors: Qiao Xiao-feng , Xue Yu , Liu Shi-chen , Ji Qing-hui
Published: May 2020

Background:

Femoral head avascular necrosis (FHAN) is a very common condition among elderly population. Previous studies have reported that total hip arthroplasty (THAP) can benefit patients with such condition. However, no study systematically addressed this topic. Thus, this study will systematically explore the efficacy and safety of THAP for the treatment of patients with FHAN.

Methods:

We will search the following electronic bibliographic databases from inception to the February 29, 2020: MEDLINE, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, and Chinese Scientific Journal Database. Randomized controlled trials of THAP for the treatment of patients with FHAN will be included, which were reported in any language. All process of study selection, data collection, and study quality assessment will be performed independently by 2 authors independently. Any divergences will be solved by discussion with another author. RevMan 5.3 software will be carried out for data synthesis and analysis.

Results:

This study will provide a detailed summary of current evidence related to the efficacy and safety of THAP for the treatment of patients with FHAN through assessing pain intensity of hip or knee joints, function and limitation of attacked femoral head, health-related quality of life, and complications.

Conclusion:

The findings of this study may provide helpful guidance of THAP for the treatment of patients with FHAN.

Systematic review registration:

INPLASY202040067.
Statin use and risk of acute diverticulitis
Authors: O’Grady Michael , Clarke Louise , Turner Gregory , Doogue Matt , Purcell Rachel , Pearson John , Frizelle Frank
Published: May 2020

The goal of the study was to examine the association between statin use and the development of acute diverticulitis requiring hospital admission.

Acute diverticulitis is a common and costly gastrointestinal disorder. Although the incidence is increasing its pathophysiology and modifiable risk factors are incompletely understood. Statins affect the inflammatory response and represent a potential risk reducing agent.

A retrospective, population-based, case-control study was carried out on a cohort of adults, resident in Canterbury, New Zealand. All identified cases were admitted to hospital and had computed tomography confirmed diverticulitis. The positive control group comprised patients on non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs), and the negative control group were patients on selective serotonin reuptake inhibitors (SSRIs). Medicine exposure was obtained from the Pharmaceutical Management Agency of New Zealand. Subgroup analysis was done by age and for complicated and recurrent diverticulitis.

During the study period, there were 381,792 adults resident in Canterbury. The annual incidence of diverticulitis requiring hospital presentation was 18.6 per 100,000 per year. Complicated disease was seen in 37.4% (158) of patients, and 14.7% (62) had recurrent disease. Statins were not found to affect the risk of developing acute diverticulitis, nor the risk of complicated or recurrent diverticulitis. Subgroup analysis suggested statin use was associated with a decreased risk of acute diverticulitis in the elderly (age >64 years). NSAIDs were associated with a decreased risk of acute diverticulitis (risk ratio = 0.65, confidence interval: 0.26–0.46, P < .01), as were SSRIs (risk ratio = 0.37, confidence interval: 0.26–0.54, P < .01).

This population-based study does not support the hypothesis that statins have a preventative effect on the development of diverticulitis, including complicated disease. We also found a decreased risk of diverticulitis associated with NSAID and SSRI use.
Effects of artemisinin on proliferation and apoptosis of human liver cancer HepG2 cells
Authors: Li Jing , Liu Zhi-ye , Yu Hai-bo , Xue Qing , Qu Xiu-sheng
Published: May 2020

Background:

This study will examine the effects of artemisinin on proliferation and apoptosis of human liver cancer HepG2 cells (HLCHG-2C).

Methods:

This study will systematically retrieve potential literatures in MEDLINE, Scopus, Web of Science, Cochrane Library, EMBASE, WANGFANG, and China National Knowledge Infrastructure from their initiation to the February 29, 2020. There are not limitations related to the language and publication time. All case-controlled studies (CCSs) or randomized controlled studies (RCSs) will be included in this study which investigated the effects of artemisinin on proliferation and apoptosis of HLCHG-2C. Two independent investigators will examine searched records, collect data from included studies, and will identify their methodological quality. Any divergences will be disentangled by discussion with another investigator. RevMan 5.3 software will be placed to pool the data and to carry out data analysis.

Results:

This study will summarize all eligible studies to test the effects of artemisinin on proliferation and apoptosis of HLCHG-2C.

Conclusion:

The results of this study will exert evidence to examine the effects of artemisinin on proliferation and apoptosis of HLCHG-2C, and it may benefit further research, patients, and healthcare providers.

Systematic review registration:

INPLASY202040075.
An investigation into the impact of enteric coated of aspirin in patients with newly diagnosed ischemic stroke (ECASIS)
Authors: Elshafei Mohamed Nabil , Imam Yahia , Mohamed Mouhand F.H. , AlSaud Arwa Ebrahim , Ahmed Mohamed Sayed , Obeidat Khaldun , Saeid Razan , Ali Mohamed , Abdallah Ibtihal M. , Parray Aeijaz Sultan , Danjuma Mohammed Ibn-Masoud
Published: May 2020

Introduction:

Uncertainty remains regarding the impact of enteric-coated (EC) aspirin as it relates to the reduction of cardiovascular risk. We hypothesize that EC formulation based on a previous report may blunt aspirin response as evidenced by reduced Thromboxane A2 (TXA 2) levels in diabetic patients. Thus, it was imperative to ascertain and validate the effect of the EC formulation of Aspirin on the Thromboxane B2 (TXB2) level.

Methods/design:

An open-label consecutive randomized interventional controlled trial. Patients with newly diagnosed ischemic stroke who are just about to start Aspirin were assessed for eligibility and inclusion in our trial. Consecutive patients (admitted to the stroke unit of Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar) will be randomized to receive either EC aspirin or plain Aspirin. They will be required to continue taking them throughout the study (3 days). Demographics and laboratory records of the study participants will be abstracted from online records. Further study variables will be obtained manually in designated case record forms (CRF). The primary outcomes are the incidence of aspirin non-responders (level of residual serum TXB2 associated with elevated thrombotic risk (<99.0% inhibition or TXB2 >3.1 ng/mL) within 72 h after three daily aspirin doses). Whereas secondary outcomes are the incidence of GIT bleeding of various preparations of Aspirin. The study was approved by MRC and IRB of Hamad Medical Corporation (MRC number: 01-18-156).

Discussion:

This trial will determine potential differences in the efficacy of EC Aspirin and plain Aspirin on the Thromboxane B2 level. Additionally, it will ascertain the tolerability and safety of both formulations of Aspirin in patients with newly diagnosed ischemic stroke. These results will either support the current notion of no difference between the two formulations. However, if a difference is found, this will invite for future trials exploring clinical outcomes occurrence between various formulations.

Clinical trial registration:

Clinicaltrials.gov NCT04330872 registered on April 2, 2020
Is postoperative hyponatremia a real threat for total hip and knee arthroplasty surgery?
Authors: Sinno Ennio , De Meo Daniele , Cavallo Armando Ugo , Petriello Luisa , Ferraro Daniele , Fornara Gianluca , Persiani Pietro , Villani Ciro
Published: May 2020

Postoperative hyponatremia (POH) is thought to be a fearsome complication of orthopedic surgery. Primary aim of this cohort study was to evaluate the incidence of POH and its clinical relevance in elective surgery, outlining differences between total knee arthroplasty (TKA) and total hip arthroplasty, looking for the presence of any risk factor commonly related to POH.

Four hundred two patients that underwent total hip arthroplasty and total knee arthroplasty performed between 2016 and 2017 were retrospectively examined. Serum electrolytes, hemoglobin, hematocrit, glucose, and creatinine were evaluated preoperatively and at day 0-I-II from surgery. Age, sex, body mass index, comorbidities, drugs, surgery data, transfusions, postoperative symptoms, and length of stay (LOS) were determined. All surgeries were performed by the same equipe. Patients had the same perioperative management, excluded those that took thiazides, already at risk of POH.

Patients were divided in 2 groups: group A, patients with normal postoperative natremia (294 patients) and group B, patients who developed POH (108, 26.9%); 66.7% of these developed POH within 24 hours postoperatively. In group B mean postoperative natremia was 133.38 (127.78–134.85) mmol/L. Two patients (1.8%) developed moderate hyponatremia, no severe hyponatremia was documented. Type of surgery, operation time, LOS, and presence of postoperative symptoms did not show statistically significant differences within groups. At multivariate logistic analysis chronic use of thiazides was the only variable associated to a decreased risk of developing POH (OR = 0.39; P = .03). Hemoglobin postoperative values (OR = 1.22; P = .03), the need of postoperative transfusion (OR = 2.50; P = .02) and diabetes (OR = 2.70; P = .01) were associated to an increased risk of POH.

Although 26.9% of our patients exhibited POH, the onset of this disorder had no implication on postoperative symptoms and on LOS. Diabetes and transfusion are factors most often associated to POH.
Fibroblast growth factor receptor as a potential candidate for phosphate sensing
Authors: Takashi Yuichi , Fukumoto Seiji
Published: May 2020

Purpose of review

Phosphate plays essential roles in many biological processes. Serum phosphate level needs to be regulated because hypophosphatemia and hyperphosphatemia cause rickets/osteomalacia and ectopic calcification, respectively. Fibroblast growth factor (FGF) 23 is the principal hormone to regulate serum phosphate level. FGF23 is produced by the bone and works to reduce serum phosphate level by binding to FGF receptor (FGFR) 1c and α-Klotho complex in the kidney. It has been unclear how the bone senses the changes of serum phosphate level and how the bone regulates the production of FGF23.

Recent findings

Our recent results indicate that high extracellular phosphate activates FGFR1c. Its downstream intracellular signalling pathway regulates the expression of GALNT3 encoding a protein involved in the regulation of the posttranslational modification of FGF23 protein. This FGFR1c-GALNT3 axis is considered to be the main regulatory mechanism of enhanced FGF23 production in response to high phosphate.

We propose that FGFR1c works as a phosphate-sensing molecule in the regulation of FGF23 production and serum phosphate level. Feedback system is present in the regulation of serum phosphate involving FGFR1c and FGF23. These findings uncover so far unrecognized function of FGFR and molecular basis of phosphate sensing.
Relation between pharmacological stress ECG, 13NH3-PET/CT outcome and the occurrence of cardiac events during follow-up in women with chest pain
Authors: van der Zant Friso M. , Maurits Wondergem , Lazarenko Sergiy V. , Broos Wouter A.M. , Umans Victor A.W.M. , Cornel Jan Hein , Knol Remco J.J.
Published: May 2020

Aim

Evaluation of major adverse cardiovascular events (MACE) in women referred for 13NH3-PET/CT in relation to scan outcome and pharmacological stress ECG (PxECG) results.

Patients and methods

Six hundred twenty-four women, referred for 13NH3-PET/CT between 2012 and 2016, were included. Demographic data and MACE during follow-up (407 ± 207 days) were retrieved from electronic patient charts. 13NH3-PET/CT was scored as either normal or abnormal. PxECG was scored as negative, non-diagnostic or positive. PxECG was compared with 13NH3-PET/CT and related to MACE.

Results

The 13NH3-PET/CT was normal in 482/624 (77%) and abnormal in 142/624 (23%). PxECG was negative in 234/624 (38%), non-diagnostic in 365/624 (58%) and positive in 25/624 (4%). 13NH3-PET/CT was normal in 87, 71 and 72% with normal, nondiagnostic and positive PxECG, respectively. 41/624(7%) experienced a MACE, 38 with abnormal 13NH3-PET/CT versus three with normal 13NH3-PET/CT (P < 0.001). MACE occurred in 5/234 (0.9%), 31/365 (8%) and 5/25 (20%) with normal, non-diagnostic and positive PxECG, respectively (P < 0.001). No MACEs were seen in 204 with both normal PxECG and 13NH3-PET/CT versus 5/30(17%) with normal PxECG but abnormal 13NH3-PET/. No MACE occurred in 3/260(1%) with non-diagnostic PxECG and normal 13NH3-PET/CT versus 28/105(27%) with non-diagnostic PxECG and abnormal 13NH3-PET/CT. 0/18 with positive PxECG and normal 13NH3-PET/CT showed MACE versus 5/7(71%) with a positive PxECG and abnormal 13NH3-PET/CT.

Conclusion

Normal 13NH3-PET/CT is most prevalent in women with normal PxECG. The occurrence of MACE during follow-up is more frequently related to an abnormal 13NH3-PET/CT than to PxECG. Furthermore, in women with positive PxECG but normal 13NH3-PET/CT no MACE are to be expected.
Combined role of lymph node ratio and serum thyroglobulin levels in predicting prognosis of papillary thyroid carcinoma
Authors: Jeon Subin , Kwon Seong Young , Ryu Young Jae , Kang Sae-Ryung , Yoo Su Woong , Cho Sang-Geon , Kim Jahae , Song Ho-Chun , Sohn Seok-Joon , Bom Hee-Seung , Min Jung-Joon
Published: May 2020

Objectives

The aim of this study was to evaluate a prognostic value of the extent of metastatic lymph node combined with TSH-stimulated serum thyroglobulin (sTg) measured just before radioactive iodine (RAI) therapy in patients with papillary thyroid cancer (PTC).

Methods

The retrospective study included 468 patients with PTC who underwent total thyroidectomy with neck dissection and postoperative RAI therapy. The extent of metastatic lymph node was evaluated with the lymph node ratio (LNR) which was defined as the number of metastatic lymph nodes out of the number of total removed lymph nodes. We investigated which factors could significantly predict persistent or recurrent disease (PRD).

Results

LNR ≥0.4 (P = 0.002) and sTg ≥6.0 ng/mL (P < 0.001) were associated with PRD in univariate analysis. In multivariate analysis, only male [hazard ratio: 2.35, 95% confidence interval (CI): 1.18–4.66, P = 0.014] and sTg (hazard ratio: 9.35, 95% CI: 4.44–19.67, P < 0.001) were associated with PRD prediction. When we divided patients into two groups (patients with sTg level < 6.0 ng/mL and those with sTg level ≥ 6.0 ng/mL), LNR (≥0.4) was a significant predictor of PRD in patients with sTg <6.0 ng/mL (hazard ratio: 4.38, 95% CI: 1.22–15.72, P = 0.024).

Conclusions

LNR ≥0.4 was a significant predictor of PRD when the sTg level was <6.0 ng/mL. LNR should be used in combination with a relatively low level of serum sTg to predict the prognosis of patients with PTC.
Opioid-induced esophageal dysfunction
Authors: Snyder Diana L. , Vela Marcelo F.
Published: May 2020

Purpose of review

Chronic opioid use is common and can cause opioid-induced esophageal dysfunction (OIED). We will discuss the pathophysiology, diagnosis, and management of OIED.

Recent findings

OIED is diagnosed based on symptoms, opioid use, and manometric evidence of distal esophageal spasm, esophagogastric junction outflow obstruction, achalasia type III, or jackhammer esophagus. Chronic opioid use appears to interfere with inhibitory signals involved in control of esophageal motility, allowing for unchecked excitatory stimuli, and leading to spastic contractility and impaired esophagogastric junction relaxation. Patients may present with dysphagia and chest pain. OIED is significantly more prevalent in patients taking the stronger opioids oxycodone and hydrocodone compared with the weaker opioid tramadol. Based on 24-h morphine equivalent doses, patients with OIED take higher opioid doses than those without OIED. Impaired inhibitory signaling was recently demonstrated in a study showing reduced deglutitive inhibition during multiple rapid swallows in patients taking opioids.

OIED is frequent in chronic opioid users undergoing manometry for esophageal symptoms, especially at higher doses or with stronger opioids. OIED appears to be due to impaired inhibitory signals in the esophagus. Opioid cessation or dose reduction is recommended, but studies examining management of OIED are lacking.
Urological malignancies in neurogenic patients
Authors: Liu Bonnie , Welk Blayne
Published: May 2020

Purpose of review

To review recent literature related to urologic malignancies in patients with neurogenic lower urinary tract dysfunction (NLUTD). We performed a literature search of electronic databases (PubMed, ScienceDirect, Scopus, and CIANHL), with a focus on articles published between January 2015 and December 2019.

Recent findings

Recent reports demonstrate a lower incidence of bladder cancer in the NLUTD population than previously found, although still significantly higher than the general population. Bladder cancer in patients with NLUTD is usually diagnosed at a younger age, and is associated with higher rates of squamous cell cancer, a higher stage at presentation, and increased mortality. Evidence for screening for bladder cancer in NLUTD is conflicting, with no formal protocols proven for general use. NLUTD has been shown to have a lower rate of prostate cancer, and may be associated with an earlier diagnosis of renal cancer.

Genitourinary malignancies, although still rare, are an important source of morbidity and mortality in patients with NLUTD. Physicians should recognize that bladder cancer in NLUTD is often a lethal disease. Further research is needed to assist physicians with early recognition of these malignancies to improve patient outcomes.
Poly(ADP-ribose) polymerase inhibitors in prostate and urothelial cancer
Authors: Brönimann Stephan , Lemberger Ursula , Bruchbacher Andreas , Shariat Shahrokh F. , Hassler Melanie R.
Published: May 2020

Purpose of review

The aim of this article is to give an overview of poly(ADP-ribose) polymerase inhibitors (PARPis) trials in prostate cancer and to discuss emerging approaches with potential future clinical implementation in both prostate and urothelial cancer.

Recent findings

PARPis are a class of drugs that can be applied for the treatment of homologous recombination repair (HRR)-deficient tumors. Tumors are potentially sensitive to PARPi harbor mutations in genes relevant for DNA damage repair, such as BRCA1/2 or ATM, which are present to a significant degree in metastatic prostate and urothelial cancer patients. Several PARPis have been successfully tested in clinical trials for HRR-deficient metastatic castration-resistant prostate cancer (mCRPC), and olaparib and rucaparib have recently received breakthrough approval in BRCA1/2 mutated mCRPC. Combination treatment of PARPis with androgen-receptor inhibitors or with checkpoint inhibitors and earlier frontline applications are currently being evaluated, and clinical trials enrolling bladder cancer (BCa) patients with HRR deficiency have recently been initiated.

Approximately 10% of mCRPC patients and 34% of metastatic BCa patients have tumors with HRR deficiency and may benefit from PARPi treatment. Correct identification of these patients as well as determining the most adequate time point for drug administration will be key to successful clinical implementation.
Where do urologists stand in the era of novel coronavirus-2019 disease
Authors: Hughes Thomas , Ho Hui Ching , Shariat Shahrokh F. , Somani Bhaskar Kumar
Published: May 2020

Purpose of review

The novel coronavirus-2019 disease (COVID-19) pandemic has had devastating consequences on healthcare systems globally. The effect this has on urologists and the patients they care for is not fully understood and presents the challenge of prioritizing the most urgent cases. We aim to review the impact on urology services and evaluate strategies to minimize disruption.

Recent findings

Various healthcare systems have been forced to postpone treatment for many urological conditions as resources are dedicated to the treatment of COVID-19. Training has been postponed as staff are reallocated to areas of need. Face-to-face contact is largely minimized and innovative, virtual communication methods are used in the outpatient setting and multidisciplinary team meetings. Surgical practice is changing because of the risks posed by COVID-19 and procedures can be prioritized in a nonurgent, low priority, high priority or emergency category.

Although the COVID-19 pandemic will inevitably affect urological services, steps can be taken to mitigate the impact and prioritize the patients most in need of urgent care. Similarly, in future; simulation, e-learning and webinars will allow interaction to share, discuss and debate focused training and education.
Association of Cow's Milk Protein Allergy Prevalence With Socioeconomic Status in a Cohort of Chilean Infants
Authors: Arancibia María E. , Lucero Yalda , Miquel Isabel , Marchant Pamela , Rodriguez Lorena , Alliende Francisco , Ríos Gloria , Maturana Andrés
Published: May 2020

Objectives:

The aim of the study was to compare the cow's milk protein allergy (CMPA) prevalence in 2 cohorts of children from different socioeconomic strata.

Methods:

Prospective birth cohort that included patients from 2 hospitals providing care for a low‐ and high‐income population, respectively. Healthy newborns ≥34 gestational weeks were recruited and followed up to 12 months by a monthly telephone survey. If ≥2 predefined symptoms/signs suggestive of CMPA were detected, the patient was evaluated by a pediatric gastroenterologist. Diagnosis was confirmed by exclusion diet followed by open oral food challenge.

Results:

Overall the prevalence of CMPA was 5.2%, with a 6 times higher prevalence in the high income cohort (9.2%) compared with the low‐income group (1.5%; relative risk 6.2; 95% confidence interval 1.8–20.7; P = 0.0005). All the cases were non‐immunoglobulin E–mediated with predominantly gastrointestinal symptoms. High‐income cohort did have higher frequency of C‐section, mother's previous chronic disease, mother's history of atopy/food allergy, older age, and higher educational level of parents. Parent smoking and presence of pets at home were more frequent in the low‐income cohort. Multiple logistic regression showed that the high‐income cohort did have older age and higher educational level of both parents.

Conclusion:

In these cohorts the prevalence of CMPA was higher than reported previously in other developing countries and significantly higher in the high‐income group. Our findings were associated with sociodemographic characteristics of the parents.
Assessing Needs and Experiences of Preparing for Medical Emergencies Among Children With Cancer and Their Caregivers
Authors: Mueller Emily L. , Cochrane Anneli R. , Moore Courtney M. , Jenkins Kelli B. , Bauer Nerissa S. , Wiehe Sarah E.
Published: May 2020

Background:

Caregivers of children with cancer can experience stress when seeking care in the emergency department (ED). We sought to assess how caregivers prepare for and manage a medical emergency that arises in the community setting.

Methods:

A qualitative evaluation of ED visit preparations taken by children with cancer and their caregivers using self-reported interactive toolkits. Eligible participants included children with cancer (age: 11 to 21 y) currently receiving therapy for cancer diagnosis with an ED visit (besides initial diagnosis) within the previous 2 months and caregivers of same. Participants received a paper toolkit, which were structured as experience maps with several generative activities. Toolkits were transcribed, thematically coded, and iteratively analyzed using NVivo 12.0 software.

Results:

A total of 25 toolkits were received (7 children, 18 caregivers), with about three quarters of participants living >1 hour from the treating institution. Several important common themes and areas for improvement emerged. Themes included struggles with decision-making regarding when and where to seek ED care, preparing to go to the ED, waiting during the ED visit, repetition of information to multiple providers, accessing of ports, and provider-to-provider and provider-to-caregiver/patient communication.

Conclusions:

The information gained from this study has the potential to inform a tool to support this population in planning for and managing emergent medical issues. This tool has the potential to improve patient and caregiver satisfaction, patient-centered outcomes, and clinical outcomes.
L-Selectin P213S and Integrin Alpha 2 C807T Genetic Polymorphisms in Pediatric Sickle Cell Disease Patients
Authors: Shaheen Iman , Khorshied Mervat , Abdel-Raouf Rasha , Gouda Heba , Kamal Dina , Abulata Nelly , Aboukhalil Reham , Meligy Basant
Published: May 2020

Sickle cell disease (SCD) is an autosomal recessive hemoglobinopathy characterized by increased cellular adhesiveness. Vaso-occlusion (VOC) is the most prevalent disease complication of SCD that could be altered by genetic factors. L-Selectin and integrin alpha 2 (ITGA2) are 2 adhesion molecules linked to vasculopathy and inflammation. The current study aimed at detecting the prevalence of genetic variants of L-selectin and ITGA2 as possible molecular modulators and novel therapeutic targets in a cohort of pediatric SCD patients. Genotyping was performed by polymerase chain reaction restriction fragment length polymorphism technique for 100 SCD patients and 100 age and gender-matched unrelated healthy controls. The homomutant genotype of ITGA2 C807T was significantly higher in SCD patients compared with controls (P=0.001) and confirmed almost a 3-fold increased risk of moderate and severe attacks of VOC. There are significant adverse effects caused by the polymorphisms of ITGA2, and hence Egyptian SCD patients could benefit from the targeted therapies specifically against ITGA2 to ameliorate the severe course of the disease and improve the quality of life. However, further studies of genotypes and expression levels of these adhesion molecules during the attacks of VOC are recommended.
Fatigue and Sleep Disturbance in Arabic Cancer Patients After Completion of Therapy
Authors: Al Maqbali Mohammed , Hughes Ciara , Rankin Jane , Dunwoody Lynn , Hacker Eileen , Gracey Jackie
Published: May 2020

Background

Fatigue and sleep disturbance are 2 of the most common and distressing cancer symptoms that negatively affect quality of life.

Objective

The aim of this study was to assess the prevalence of, and factors contributing to, fatigue and sleep disturbance in Arabic-speaking cancer patients in Oman after completion of their cancer treatment.

Methods

A cross-sectional and descriptive correlational design was used. Data were collected using the Pittsburgh Sleep Quality Index where a score of >5 indicated as poorer sleep, the Functional Assessment of Cancer Therapy–Fatigue a score of ≤34 indicating clinically significant fatigue, and the Functional Assessment of Cancer Therapy–General.

Results

Of the 369 patients who participated, 77.5% (n = 286) reported clinically significant fatigue, and 78% (n = 288) reported poor sleep. Fatigue (P < .05) was significantly associated with age, cancer site, months since diagnosis, type of treatment received, and comorbidity. Those experiencing fatigue and poor sleep had the lowest quality of life among the cancer patients studied.

Conclusion

Fatigue and sleep disturbance are significant problems for the Arabic patients diagnosed with cancer. Both fatigue and sleep disturbance should be routinely assessed in the case of such patients.

Implications for Practice

Routine assessments of fatigue and sleep disturbance are recommended so that appropriate interventions and treatment management plans can be introduced to reduce fatigue and improve sleep quality among patients with cancer.
Development of a Nursing Assignment Tool Using Workload Acuity Scores
Authors: Meyer Kathleen R. , Fraser Paulette B. , Emeny Rebecca T.
Published: May 2020

OBJECTIVE

To determine a just and consistent practice for creating nursing assignments.

BACKGROUND

Traditional methods of assigning patients to nurses may lead to unbalanced nursing workload. This article describes the ongoing, hospital-wide effort to evaluate and implement a nursing assignment tool based on electronic health record (EHR) functionality and auto-calculated nursing workload scores.

METHODS

EHR records of individual patient workload scores from all hospital units were collected from August 2017 to June 2018. A nurse-specific total workload score was summed for each staff. Then, each hospital unit's mean nurse workload score and standard deviation, along with the unit's nurse-to-patient ratio, were used to calculate levels of high, medium, and low nursing workload measurement (NWM).

RESULTS

Mean patient-specific workload scores varied greatly across hospital units. Unit-specific nurse-to-patient ratios were factored into NWM scores to create ranges for assignments that were relatively consistent across the institution.

CONCLUSION

The use of objective, electronically generated nursing workload scores, combined with traditional nurse-to-patient ratios, provides accurate real-time nurse staffing needs that can inform best practice in staffing. The confirmation of individual patient workload scores and an appreciation for the complexity of EHR vendor rules are necessary for successful implementation. Automation ensures patient safety, staff satisfaction, and optimal resource allocation.
Testing a Model of Speaking up in Nursing
Authors: Rainer Jennifer Boice , Schneider Joanne Kraenzle
Published: May 2020

BACKGROUND

Speaking up is using one's voice to alert those in authority of concerns. Failure to speak up leads to moral distress; speaking up leads to moral courage.

OBJECTIVE

The purpose of this study was to explore the influences of organizational culture, personal culture, and workforce generation on speaking-up behaviors among RNs.

METHODS

We distributed a cross-sectional electronic survey to several thousand RNs, resulting in 303 usable surveys.

RESULTS

Organizational culture was a strong predictor of speaking-up behaviors; speaking up partially mediated the relationship between organizational culture and moral distress but was not a mediator between organizational culture and moral courage. Workforce generation did not explain speaking up.

CONCLUSIONS

The role of organizational culture supports efforts toward healthy work environments. Because not speaking up is related to moral distress, efforts must be escalated to empower nurses to use their voices.
Transposition of the Great Arteries—Are We Doing Better? Correlating Outcome to Change in Renal Function Over 2 Decades of Arterial Switch Operation
Authors: Shostak Eran , Dagan Ovadia , Hosh Gassan , Amir Gabriel , Frenkel Georgy , Schiller Ofer
Published: May 2020

Objectives:

It is believed that management of neonates with dextro-transposition of the great arteries is constantly improving. Renal function may play a role in the prognosis of patients after congenital heart surgery. The aim of this study was to describe the outcome of neonates who underwent arterial switch operation during the past 2 decades using renal function as a surrogate marker for morbidity and mortality.

Design:

Retrospective cohort study.

Setting:

Dedicated cardiac ICU of a university-affiliated pediatric medical center.

Patients:

Infants who underwent arterial switch surgery in 1993–2015.

Interventions:

None.

Measurements and Main Results:

The cohort included 336 infants who underwent arterial switch operation for dextro-transposition of the great arteries (n = 169, 50%), transposition of the great arteries/ventricular septal defect (n = 133, 40%), or Taussig-Bing anomaly (n = 34, 10%). Between 1993–1998 and 2012–2015, the mean minimal postoperative estimated glomerular filtration rate rose from 30 mL/min/1.73 m2 to 40 mL/min/1.73 m2 (p < 0.05), and the proportion of patients with estimated glomerular filtration rate less than 30 mL/min/1.73 m2 decreased from 56% to 23% (p < 0.05). The daily furosemide dosage decreased from 4 mg/kg/d to 0.5 mg/kg/d (p < 0.05). Urinary output on operative day 0 decreased over time, but urinary output on operative day 2 significantly increased. Maximal lactate levels and time to lactate normalization decreased steadily. Dialysis was performed in only a few patients in the early periods, and in none in the last 6 years. The mean mortality rate of patients with dextro-transposition of the great arteries and transposition of the great arteries/ventricular septal defect decreased to 2.7% in the last 6 years. The odds ratio of a prolonged hospital stay (≥ 28 d) in a patient with estimated glomerular filtration rate less than 30 mL/min/1.73 m2 was 18.79, and in a patient with transposition of the great arteries/ventricular septal defect, 3.39. The odds ratio of dying after Rashkind atrial septostomy was 4.42.

Conclusions:

During the past 2 decades, there has been significant improvement in outcome of patients undergoing transposition of the great arteries repair. Renal function was found to be a good prognostic marker of morbidity and mortality.
Maternal Bereavement the Year Before or During Pregnancy and Total and Cause-Specific Infant Mortality: A Cohort Study From Denmark and Sweden
Authors: László Krisztina D. , Johansson Stefan , Miao Maohua , Li Jiong , Olsen Jørn , Yuan Wei , Cnattingius Sven
Published: May 2020

Objective

We analyzed the associations between maternal bereavement the year before or during pregnancy and total and cause-specific infant mortality (IM).

Methods

We studied live singleton births from the Danish (1978–2008) and Swedish Medical Birth Registers (1973–2006; N = 5,114,246). Information on maternal sociodemographic, pregnancy-related, and health-related factors, and death of family members was obtained from nationwide registers.

Results

Among children of mothers with register links to family members and without the considered IM risk factors, 110,993 (2.76%) were exposed and 15,199 (0.4%) died in infancy. Death of an older child the year before or during pregnancy was associated with an increased IM risk (adjusted odds ratio [aOR; 95% confidence intervals {CIs}] = 2.05 [1.44–2.92]). Losing an older child the year before pregnancy or during pregnancy was associated with risks of prematurity-related IM (aOR [95% CI] = 2.61 [1.44–4.72] and 3.08 [1.70–5.57]) and with infant death in term-born children due to causes other than sudden infant death syndrome, congenital malformations, or asphyxia (aOR [95% CI] = 3.31 [1.58–6.96] and 5.10 [1.27–20.43]). Losing an older child during pregnancy was also associated with increased risks of sudden infant death syndrome (aOR [95% CI] = 5.41 [1.34–21.83]). Death of a partner during pregnancy was associated with IM (aOR [95% CI] = 1.83 [1.01–3.32]). The number of events was small and CIs were wide in some subanalyses, and caution is needed when interpreting our results.

Conclusions

Severe prenatal stress may increase the risk of several types of IM. Whether less severe but more common maternal stressors shortly before or during pregnancy also increase IM risk warrants further investigation.
HLA-A Locus is Associated With Sepsis and Septic Shock After Traumatic Injury
Authors: Horn Dara L. , Mindrinos Michael , Anderson Kirsten , Krishnakumar Sujatha , Wang Chunlin , Li Ming , Hollenbach Jill , O’Keefe Grant E.
Published: May 2020

Objective:

Determine whether variation in the HLA region is associated with the development of post-traumatic sepsis and septic shock.

Background:

Sepsis-related deaths remain a major source of mortality after traumatic injury. Genetic characteristics may contribute to susceptibility to adverse outcomes including sepsis and septic shock. Recent advances in next-generation sequencing technology now allow comprehensive genotyping of the HLA region.

Methods:

White adult trauma patients requiring more than 2 days of mechanical ventilation underwent HLA genotyping, and were followed for the development of sepsis and septic shock. Odds ratios (OR) for the associations between our outcomes and HLA variants were estimated, a correction for multiple comparisons was applied, and significant variants were included in regression models adjusting for potential confounders.

Results:

A total of 1184 patients were included. Patients were severely injured (median injury severity score 33); 33% developed sepsis, 6% septic shock, and in-hospital mortality was 14%. An amino acid variant (156Q) within the HLA-A peptide-binding groove was associated with greater odds of sepsis [OR 1.50, (1.18–1.89)]. HLA-A

∗

02:01 was associated with lower odds of septic shock [OR 0.52, (0.32–0.82)]. These associations remained significant after adjusting for potential confounders.

Conclusions:

This is the first study to apply next-generation sequencing techniques to evaluate associations between immunogenetic factors and post-traumatic sepsis and septic shock. Associations with class I HLA variants are novel as they implicate adaptive immunity in post-traumatic sepsis. These findings are a step towards developing a panel of genetic markers assessing risk of infection-related complications as we move towards more personalized medicine.
Racially Conscious Cancer Screening Guidelines
Authors: Perez Numa P. , Baez Yefri A. , Stapleton Sahael M. , Muniappan Ashok , Oseni Tawakalitu S. , Goldstone Robert N. , Chang David C.
Published: May 2020

Objective:

To review the racial composition of the study populations that the current USPSTF screening guidelines for lung, breast, and colorectal cancer are based on, and the effects of their application across non-white individuals.

Summary of Background Data:

USPSTF guidelines commonly become the basis for establishing standards of care, yet providers are often unaware of the racial composition of the study populations they are based on.

Methods:

We accessed the USPSTF screening guidelines for lung, breast, and colorectal cancer via their website, and reviewed all referenced publications for randomized controlled trials (RCTs), focusing on the racial composition of their study populations. We then used PubMed to identify publications addressing the generalizability of such guidelines across non-white individuals. Lastly, we reviewed all guidelines published by non-USPSTF organizations to identify the availability of race-specific recommendations.

Results:

Most RCTs used as basis for the current USPSTF guidelines either did not report race, or enrolled cohorts that were not representative of the U.S. population. Several studies were identified demonstrating the broad application of such guidelines across non-white individuals can lead to underdiagnosis and higher levels of advanced disease. Nearly all guideline-issuing bodies fail to provide race-specific recommendations, despite often acknowledging increased disease burden among non-whites.

Conclusion:

Concerted efforts to overcome limitations in the generalizability of RCTs are required to provide screening guidelines that are truly applicable to non-white populations. Broader policy changes to improve the pipeline for minority populations into science and medicine are needed to address the ongoing lack of diversity in these fields.
Association Between Cognitive Test Performance and Subjective Cognitive Decline in a Diverse Cohort of Older Adults
Authors: Corlier Fabian W. , Shaw Crystal , Hayes-Larson Eleanor , Mungas Dan , Tomaszewski Farias Sarah , Glymour M. Maria , Whitmer Rachel A. , Mayeda Elizabeth R.
Published: May 2020

Background:

Subjective cognitive decline (SCD) may represent a low-burden indicator of dementia risk. The value of SCD as a proxy marker, however, depends on the consistency of associations between subjective and objective cognitive measures across sociodemographic and psychological factors.

Methods:

We evaluated baseline data from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study (n=1615). SCD was measured using the 12-item Everyday Cognition (ECog) scale. Using linear regression models with interaction terms, we evaluated 6 potential modifiers (age, sex, race/ethnicity, educational attainment, family history of dementia, and depressive symptoms) of the association between cognitive performance (episodic memory, executive function) and SCD.

Results:

Lower episodic memory and executive function scores were associated with higher log(ECog scores) (more SCD). Older age and elevated depressive symptoms were associated with higher log(ECog scores). Age (interaction P=0.002) and education (interaction P=0.01) modified the association between executive function and log(ECog scores). Specifically, associations between executive function and log(ECog scores) were stronger among participants with more education and less pronounced among older participants.

Conclusions:

The association between cognitive performance and log(ECog scores) differed little across sociodemographic and psychological factors. SCD as measured by the ECog may be a valuable proxy for cognitive performance in diverse older adults.
The protective role of Neuregulin1-ErbB4 signaling in a chronic social defeat stress model
Authors: Wang Wenjuan , Qiao Yong , Qu Huiying , Zhu Lin , Mu Linlin , Li Chunyue , Fang Jie , Lian Hong
Published: May 2020

Major depressive disorder (MDD) is a highly prevalent debilitating psychiatric disease and a serious public health problem worldwide. Brain structural MRI and postmortem studies on patients with depression have revealed changes in the anatomy and functionality in various brain regions, including the amygdala, thalamus, hippocampus, and prefrontal cortex (PFC). The alterations in these brain regions could be a result, in part, of the dysregulation of the neurotrophic factors. Neuregulin1 (NRG1) is one of the neurotrophic factors, and our previous study showed that the NRG1-ErbB4 signaling pathway plays a critical role in epilepsy. In this study, we established a chronic social defeat stress (CSDS) model to investigate the role of the NRG1-ErbB4 signaling pathway in depression-like behaviors. In CSDS mice, we found that the NRG1 protein expression levels were significantly decreased both in the medial prefrontal cortex (mPFC) and hippocampus, while phosphorylated ErbB4 only decreased in the mPFC. In addition, lateral ventricle NRG1 administration significantly rescued depression-like behaviors in the susceptible group. The current study suggests that the NRG1-ErbB4 signaling pathway may exert a protective role in MDD.