bluuebunny/crossref_metadata_2025 huggingface dataset:
A
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with A, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Abacavir, Acetylcysteine (N-acetylcysteine), Aciclovir = Acyclovir (USAN), Adenosine, Adrenaline = Epinephrine (rINN), Albendazole, Alginate compounds (Gaviscon®), Alimemazine (trimeprazine— former BAN and USAN), Alteplase (tissue-type plasminogen activator [rt-PA]), Amikacin, Amiodarone, Amlodipine, Amodiaquine with artesunate, Amoxicillin = Amoxycillin (former BAN), Amphotericin B, Ampicillin, Anti-vascular endothelial growth factors (for ROP), Arginine (L-arginine), Artemether with lumefantrine, Aspirin = acetylsalicylic acid (INN), Atosiban, Atracurium, Atropine, and Azithromycin
H
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with H, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Haemophilus influenzae type b (Hib) vaccine, Heparin, Hepatitis B vaccine, Hyaluronidase, Hydralazine, and Hydrocortisone
O
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with O, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Octreotide, Omeprazole, Ondansetron, Oral rehydration solution (ORS), Oseltamivir, Oxygen, and Oxytocin
S
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with S, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Salbutamol = Albuterol (USAN), Sildenafil, Skin care and skin sterility, Sodium phenylbutyrate and glycerol phenylbutyrate, Sodium benzoate, Sodium bicarbonate, Sodium chloride, Sodium fusidate (fusidic acid), Sodium valproate, Sotalol, Spiramycin, Spironolactone, Stiripentol, Streptokinase, Sucrose, Sulfadiazine = Sulphadiazine (former BAN), Surfactants, and Suxamethonium = Succinylcholine (USAN)
Mechanistic insights into m6A modification of U6 snRNA by human METTL16
Authors: Aoyama Tomohiko , Yamashita Seisuke , Tomita Kozo
Published: March 2020

The N6-methyladenosine modification at position 43 (m6A43) of U6 snRNA is catalyzed by METTL16, and is important for the 5′-splice site recognition by U6 snRNA during pre-mRNA splicing. Human METTL16 consists of the N-terminal methyltransferase domain (MTD) and the C-terminal vertebrate conserved region (VCR). While the MTD has an intrinsic property to recognize a specific sequence in the distinct structural context of RNA, the VCR functions have remained uncharacterized. Here, we present structural and functional analyses of the human METTL16 VCR. The VCR increases the affinity of METTL16 toward U6 snRNA, and the conserved basic region in VCR is important for the METTL16–U6 snRNA interaction. The VCR structure is topologically homologous to the C-terminal RNA binding domain, KA1, in U6 snRNA-specific terminal uridylyl transferase 1 (TUT1). A chimera of the N-terminal MTD of METTL16 and the C-terminal KA1 of TUT1 methylated U6 snRNA more efficiently than the MTD, indicating the functional conservation of the VCR and KA1 for U6 snRNA biogenesis. The VCR interacts with the internal stem-loop (ISL) within U6 snRNA, and this interaction would induce the conformational rearrangement of the A43-containing region of U6 snRNA, thereby modifying the RNA structure to become suitable for productive catalysis by the MTD. Therefore, the MTD and VCR in METTL16 cooperatively facilitate the m6A43 U6 snRNA modification.
Periprocedural Pain and Outcome Difference of Local Anesthetic vs Mechanodesensitization During Lumbar Facet Blocks for Low Back Pain
Authors: Aleem Bilal , Mubashir Muhammad Muslim , Clark Erin , Vardeh Daniel
Published: March 2020

Objective

To compare periprocedural pain from mechanodesensitization (MD) with local anesthetic (LA) during medial branch blocks (MBBs), with a secondary outcome to compare diagnostic responses during the five hours postprocedure.

Methods

Forty-four patients with low back pain underwent three level bilateral MMBs. For the LA technique, 0.5 mL of 1% lidocaine was injected subcutaneously on one side, and for MD the skin was stretched using the index finger and thumb on the other. A 25-gauge 3.5-inch spinal needle was inserted over each target area, and the periprocedural pain was recorded on the numeric rating scale (NRS). After fluoroscopic positioning, the patient’s side preference was recorded. Patients were discharged with a pain diary to record pain scores every 30 minutes for five hours.

Results

Despite reporting higher pain scores with LA vs MD (P = 0.0462, mean difference ± SEM = 0.4924 ± 0.2459), global comparison favored LA. Pain scores with LA dropped from an average baseline of 6.11 to a mean NRS ± SEM of 2.461 ± 0.615, and with MD from 6.11 to 2.599 ± 0.552 (P ≤ 0.001). While there was no significant difference in area under the curve comparison over five hours (P = 0.3341), there was a trend toward lower pain scores with LA use.

Conclusions

LA before needle insertion for MBBs appears to be more painful compared with MD. Additionally, subcutaneously administered local anesthetic may have a therapeutic effect on nonspecific low back pain, resulting in a potentially false-positive test in the evaluation of lumbar facet pain.
Thinking Parts and Embodiment
Authors: Tzinman Rina
Published: March 2020

According to the thinking parts problem, any part sufficient for thought—e.g. a head—is a good candidate for being a thinker, and therefore being us. So we can’t assume that we—thinkers—are (or are constituted by) human beings rather than their proper parts. Many solutions to this problem have been proposed. However, I will show that the views currently on the market all face serious problems. I will then offer a new solution that avoids these problems. The thinking parts problem arises from considerations that seem to be empirically substantiated. One virtue of my solution is that in addition to its theoretical apparatus it appeals to empirically substantiated considerations.
Statin use and myopathy. Not always guilty
Authors: Antoniol Maria N , Moreno Pedro J , Milisenda José C , Selva O’Callaghan Albert , Grau Josep M , Padrosa Joan
Published: March 2020

Objectives

Statins are the cornerstone of the treatment and prevention of cardiovascular disease but have been associated with muscular side effects, among others. If patients are not properly evaluated, statin discontinuation may take place, leaving patients’ symptoms unresolved and precluding an effective cardiovascular treatment. The present study aims to describe the clinical characteristics, the diagnostic process and the final diagnosis of selected patients with suspected statin-induced myopathy, with quite different alternative diagnoses.

Methods

Among the 86 patients referred to our unit for evaluation since 2012, 6 patients with suspected statin-induced myopathy that was finally ruled out were selected as examples because of their illustrative value. All patients were evaluated in a Muscular Diseases Unit by myology experts, and additional testing was performed according to clinical suspicion.

Results

Of the six selected patients with suspected statin-induced myopathy, three had a neurogenic aetiology, two had vacuolar myopathies and one had severe hypothyroidism. Statins were permanently discontinued in two cases, with the treatment of one of the latter patients being continued with a protein convertase subtilisin/kexin type 9 (PCSK9) inhibitor.

Conclusion

Not all patients taking statins who develop muscle complaints have statin-related myopathy. A thorough clinical evaluation and appropriate testing is warranted to avoid an unnecessary increase in cardiovascular risk.
Hail-Induced Infections of the Chestnut Blight Pathogen Cryphonectria parasitica Depend on Wound Size and May Lead to Severe Diebacks
Authors: Lione Guglielmo , Giordano Luana , Turina Massimo , Gonthier Paolo
Published: March 2020

This study combined phytosanitary surveys, laboratory analyses, and mathematical modeling to show how hail-induced wounds can foster the infections of the blight pathogen Cryphonectria parasitica, locally associated with extensive dieback of chestnut (Castanea sativa). Orchards and coppices located within and outside the assessed dieback area in a single location in the North West of Italy were inspected to appraise the abundance of hail-induced wounds and C. parasitica infections. The incidence of C. parasitica was significantly higher within the dieback area compared with outside (92% versus 60%; P < 0.05). Hail-induced wounds were observed on small branches and shoots of all trees sampled within the dieback area, whereas they were less abundant outside (20% of trees), suggesting either that the dieback was directly associated with the injuries caused by the hailstorms or that those injuries may have facilitated infections of C. parasitica. Isolations conducted on 359 branches and shoots showed that hail-induced wounds served as infection courts for C. parasitica and that infections depended on the size rather than on the number of hail wounds. We fitted a logistic model showing that hail-induced wounds whose perimeter was larger than 66 mm were at particular risk of C. parasitica infection. A newly designed geometrical-based model is proposed to relate hailstones size, hail wound perimeter, and the risk of infection. We established that hail-induced wounds are entry points for virulent and hypovirulent strains of C. parasitica, since 6.5% of isolates were infected by Cryphonectria hypovirus-1.
Nurses as Global and Planetary Citizens
Authors: Rosa William E.
Published: March 2020

A call for a vision of interconnectedness.
New Drug Approved for HER2-positive Metastatic Breast Cancer
Authors: Aschenbrenner Diane S.
Published: March 2020

Enhertu (fam-trastuzumab deruxtecan-nxki) is approved to treat unresectable or metastatic HER2-positive breast cancer after other treatments have been unsuccessful.
Testosterone Therapy Raises Risk of Venous Thromboembolism
Authors: Rosenberg Karen
Published: March 2020

According to this study:

Testosterone therapy is associated with an increased short-term risk of venous thromboembolism in both men who have hypogonadism and men who do not.
Is Consulting in Your Future?
Authors: Morin Karen
Published: March 2020

Nurses' expertise, developed over time and through education, positions them to assume new careers such as independent nurse consultants. Although it's an exciting proposition, nurses may not understand what it means to be a consultant, know whether consulting is a good fit for them, or be familiar with how to establish and run a consulting business. This article defines consulting, discusses key competencies, and presents important considerations for starting and running a consulting business. Selected resources to assist in developing skills as a nurse consultant are also provided.
Going the Extra Mile for Seniors
Authors: Szulecki Diane
Published: March 2020

Chicago NP Dwayne Dobschuetz makes house calls—often on bike—to improve his patients' health and well-being.
A Diabetes Screening and Educational Event in Rural Alabama
Authors: Brown Lynn Greenleaf , Prather Caitlin
Published: March 2020

Type 2 diabetes mellitus is an increasingly urgent public health issue in the United States. Prevention through early detection and education can help decrease the prevalence and complications of the disease. A nursing faculty member and a postgraduate year one pharmacy resident collaborated to provide diabetes screening and education at a local festival in rural Alabama. The prevalence of diabetes in Alabama is approximately 1.6 times higher than the national average. A glycated hemoglobin (HbA1c) test is the gold standard for diabetes diagnosis and is relatively quick and inexpensive. At the event, 38 participants received point of care HbA1c testing, results, and counseling. Seven participants had an HbA1c level of 5.7% to 6.4%, which indicates prediabetes, and one participant had an HbA1c level of 6.5% or higher, which indicates possible diabetes mellitus. Many patients were surprised by their results and by the simplicity of the test. The purpose of this article is to describe a cost-effective interdisciplinary educational event to increase diabetes awareness in a rural community.
Risk of Recurrence and 10-Year Outcomes in Surgically Treated Nonmelanoma Skin Cancer in Cardiac and Liver Transplant Recipients
Authors: Yu Nathan Y. , DeWees Todd A. , Alam Mustafa , Ochoa Shari A. , Mangold Aaron R. , Steidley David E. , Vargas Hugo E. , Golafshar Michael A. , Schild Steven E. , Halyard Michele Y. , Patel Samir H.
Published: March 2020

Objectives:

To report long-term outcomes of nonmelanoma skin cancer (NMSC) in immunosuppressed cardiac and liver transplant recipients (CLTR).

Materials and Methods:

The authors reviewed CLTR at the Mayo Clinic in Arizona from 1986 to 2013. Patient and tumor characteristics were recorded. Survival rates were calculated using the Kaplan-Meier method. Patient-specific and lesion-specific analyses were performed. Univariate and multivariate cox regressions were performed for comparisons.

Results:

Seven-hundred and forty-seven patients underwent cardiac (138) or liver (609) transplantation and of these, 97 patients (13%) developed 382 invasive NMSC. The median follow-up was 11 (range, 3 to 27) years for surviving patients. Primary treatment was mainly surgery alone. At 10 years, the local recurrence (LR) rate was 20% (95% confidence interval, 15%-28%), and 14% of patients had multiple LRs. At 10 years, LR rates were higher for T3/T4 tumors when compared with T1/T2 tumors (32.5% vs. 20%, P=0.05). At 10 years, overall survival was 79% (95% confidence interval, 64%-88%). On multivariate analysis, age 61 years and more demonstrated inferior overall survival (P<0.01).

Conclusions:

This is the first study describing the AJCC 8th edition stage-based patterns of recurrence and long-term outcomes of surgically managed NMSC in a large cohort of immunosuppressed CLTRs. T3 and T4 tumors recur more often than early stage tumors. Further study is required to identify factors related to recurrence and guide upfront treatment intensification in this high-risk population.
Six-Week Interval Between Preoperative Radiation and Surgery Is Associated With Fewer Major Wound Complications in Soft Tissue Sarcoma
Authors: Collier Christopher D. , Su Charles A. , Reich Michael S. , Tu Leigh-Anne , Getty Patrick J.
Published: March 2020

Objectives:

A total of 30% to 40% of soft tissue sarcoma (STS) patients develop major wound complications (MWCs) after preoperative radiation (preRT). The optimal preRT-surgery interval and its association with MWCs is unknown. This study investigated whether a longer preRT-surgery interval is associated with fewer MWCs compared with historical controls.

Methods:

All patients treated by a single surgeon after preRT with limb-sparing wide resection for extremity and trunk STS were retrospectively reviewed from 2004 to 2014. The primary outcome was MWCs defined as a secondary operation, invasive procedure, wound packing, or readmission for wound care. Secondary outcomes of local recurrence and survival were followed and independent variables were analyzed for an association with MWCs.

Results:

Fifty-four patients were included with a median follow-up of 32 months and age of 61 years. The majority of tumors were deep (91%), large (median size of 11 cm), high grade (78%) and within the lower extremity (78%). The median preRT-surgery interval was 43 days and 80% of patients received surgery 35 to 49 days after radiation. MWCs were observed in 15% of patients and 88% occurred within 40 days. Predictors for MWCs on multivariate analysis were peripheral vascular disease (P=0.03), location in the medial compartment of the thigh (P=0.03), and neurovascular involvement (P=0.03).

Conclusions:

This study presents a cohort of STS patients with an extended preRT-surgery interval of ~6 weeks. MWCs in this population occurred at a lower rate than historical controls. Overall these findings support the exploration of a longer interval to reduce MWCs and their associated morbidity.
Comprehensive Overview of Available Donor Sites for Vascularized Lymph Node Transfer
Authors: Chang Edward I. , Chu Carrie K. , Hanson Summer E. , Selber Jesse C. , Hanasono Matthew M. , Schaverien Mark V.
Published: March 2020

The field of lymphedema surgery has grown tremendously in recent years. In particular, the diversity of available donor sites for vascularized lymph node transfer has increased, and new donor sites are emerging. Researchers have explored a number of different donor sites, and their reports have demonstrated promising results with each site. Unfortunately, there are limited studies providing a comprehensive analysis of the available donor sites focusing on both the technical aspects of the harvest, including complications and donor site morbidity, and the efficacy and outcomes following transfer. The present review aims to present a comprehensive analysis of the available donor sites for vascularized lymph node transfer and a summary of the experience from a single center of excellence.
ALGINATE versus NPWT in the Preparation of Surgical Excisions for an STSG: ATEC Trial
Authors: Casanova Dominique , Guerreschi Pierre , Sinna Raphael , Bertheuil Nicolas , Philandrianos Cécile , Chignon-Sicard Bérengère , Duteille Franck , Atlan Michael , Rousseau Pascal , Chatellier Gilles , Boucher Fabien , Pham Dang Nathalie , Cambon-Binder Adeline , Michot Audrey , Pluvy Isabelle , Seigle-Murandi Frédéric , Hu Weiguo , Revol Marc
Published: March 2020

Background:

A calcium alginate dressing (ALGINATE) and negative pressure wound therapy (NPWT) are frequently used to treat wounds which heal by secondary intention. This trial compared the healing efficacy and safety of these 2 treatments.

Methods:

This randomized, non-inferiority trial enrolled patients who underwent skin excision (>30 cm2), which was left open to heal by secondary intention. They received ALGINATE or NPWT by a centralized randomization. Follow-up was performed weekly until optimal granulation tissue was obtained. The primary outcome was time to obtain optimal granulation tissue for a split thickness skin graft take (non-inferiority margin: 4 days). Secondary outcomes were occurrence of adverse events (AEs) and impact of the treatments on the patient’s daily life.

Results:

ALGINATE and NPWT were applied to 47 and 48 patients, respectively. The mean time to optimal granulation was 19.98 days (95% CI, 17.7–22.3) with ALGINATE and 20.54 (95% CI, 17.6–23.5) with NPWT. Between group difference was −0.56 days (95% CI −4.22 to 3.10). The non-inferiority of ALGINATE versus NPWT was demonstrated. No AE related to the treatment occurred with ALGINATE versus 14 AEs with NPWT. There was no difference in the impact of the treatments on the patient’s daily life.

Conclusion:

This trial demonstrates that ALGINATE has a similar healing efficacy to that of NPWT and that is markedly better with regard to patient safety.
Indocyanine Green Angiography in Breast Reconstruction: Utility, Limitations, and Search for Standardization
Authors: Johnson Ariel C. , Colakoglu Salih , Chong Tae W. , Mathes David W.
Published: March 2020

Background:

During reconstructive breast surgery, intraoperative assessment of tissue perfusion has been solely based on subjective clinical judgment. However, in the last decade, intraoperative indocyanine green angiography (ICGA) has become an influential tool to visualize blood flow to the tissue of interest. This angiography technique produces real-time blood flow information to provide an objective assessment of tissue perfusion.

Methods:

A comprehensive literature search of articles pertaining to ICGA in breast reconstruction surgery was performed. The overall findings of the articles are outlined here by surgical procedure: skin-sparing and nipple-sparing mastectomy, implant-based reconstruction, and autologous reconstruction.

Results:

Overall, there were 133 articles reviewed, describing the use of ICGA in breast reconstruction surgery. We found that ICGA can provide valuable information that aids in flap design, anastomotic success, and perfusion assessment. We also included example photographs and videos of ICGA use at our institution.

Conclusions:

ICGA can reduce postoperative tissue loss and aid in intraoperative flap design and inset. Despite the benefits of ICGA, its technical use and interpretation have yet to be standardized, limiting its widespread acceptance.
The Glaucoma Italian Pediatric Study (GIPSy): The Long-term Effect of Topical Latanoprost on Central Corneal Thickness
Authors: Riva Ivano , Galli Francesca , Biagioli Elena , Rulli Eliana , Longo Antonio , Uva Maurizio G. , Oddone Francesco , Michelessi Manuele , Weinreb Robert N. , Quaranta Luciano
Published: March 2020

Precis:

Central corneal thickness (CCT) may increase over time in children affected by primary congenital glaucoma and treated with latanoprost for at least 30 months.

Purpose:

The purpose of this study was to investigate CCT modification over time in a population of primary pediatric glaucoma (PPG) patients prescribed a monotherapy of latanoprost.

Materials and Methods:

The present paper reports the results of a post hoc analysis on patients enrolled in the Glaucoma Italian Pediatric Study (GIPSy). Children affected by PPG, with a postsurgical intraocular pressure between 22 and 26 mm Hg and treated with latanoprost monotherapy for at least 30 months were eligible for the analysis. CCT variation from baseline was investigated over the follow-up using univariable and multivariable longitudinal linear mixed models. The impact of age, sex, and intraocular pressure on CCT variation were evaluated taking into account the interaction of each variable with time.

Results:

Twenty-seven eyes (20 patients) were included in the analysis. Mean duration of latanoprost treatment was 36.6 months (SD 2.5) and mean CCT at baseline was 551 μm (SD 37.7). A significant increase of CCT over time was revealed by multivariable analysis, taking into account the impact of age at baseline and its interaction with time (P=0.03). The interaction between age and time was significant (P=0.04), indicating that older age at baseline was associated with lower increase of CCT over time. No variation of CCT was found in univariable analysis (P=0.28).

Conclusion:

In this population of PPG patients treated with latanoprost for at least 30 months, CCT significantly increased over time, when the impact of age and its interaction with time were considered.
Hippocampal glutamatergic synapses impairment mediated novel-object recognition dysfunction in rats with neuropathic pain
Authors: Xiong Bingrui , Zhang Wen , Zhang Longqing , Huang Xian , Zhou Wenchang , Zou Qian , Manyande Anne , Wang Jie , Tian Yuke , Tian Xuebi
Published: March 2020

Cognitive impairment is one of the most common complications associated with chronic pain. Almost 20% of chronic pain patients suffer from cognitive impairment, which may substantially influence their quality of life. Levels of major excitatory neurotransmitters in the central nervous system and alterations in the glutamatergic system may influence cognitive function and the pain sensory pathway. In this study, we adopted the spared nerve injury model to establish the progress of chronic pain and investigated the mechanism underlying the cognitive aspect related to it. At behavioral level, using the novel-object recognition test, mechanical hypersensitivity was observed in peripheral nerve-injured rats because they exhibited recognition deficits. We showed a dramatic decrease in hippocampal glutamate concentration using nuclear magnetic resonance and reduced glutamatergic synaptic transmission using whole-cell recordings. These were associated with deficient hippocampal long-term potentiation induced by high-frequency stimulation of the Schaffer collateral afferent. Ultra-high-performance liquid chromatography revealed lower levels of D-serine in the hippocampus of the spared nerve injury rats and that D-serine treatment could restore synaptic plasticity and cognitive dysfunction. The reduction of excitatory synapses was also increased by administering D-serine. These findings suggest that chronic pain has a critical effect on synaptic plasticity linked to cognitive function and may built up a new target for the development of cognitive impairment under chronic pain conditions.
Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: Improving Global Outcomes conference
Authors: Lindner Gregor , Burdmann Emmanuel A. , Clase Catherine M. , Hemmelgarn Brenda R. , Herzog Charles A. , Małyszko Jolanta , Nagahama Masahiko , Pecoits-Filho Roberto , Rafique Zubaid , Rossignol Patrick , Singer Adam J.
Published: March 2020

Hyperkalemia is a common electrolyte disorder observed in the emergency department. It is often associated with underlying predisposing conditions, such as moderate or severe kidney disease, heart failure, diabetes mellitus, or significant tissue trauma. Additionally, medications, such as inhibitors of the renin-angiotensin-aldosterone system, potassium-sparing diuretics, nonsteroidal anti-inflammatory drugs, succinylcholine, and digitalis, are associated with hyperkalemia. To this end, Kidney Disease: Improving Global Outcomes (KDIGO) convened a conference in 2018 to identify evidence and address controversies on potassium management in kidney disease. This review summarizes the deliberations and clinical guidance for the evaluation and management of acute hyperkalemia in this setting. The toxic effects of hyperkalemia on the cardiac conduction system are potentially lethal. The ECG is a mainstay in managing hyperkalemia. Membrane stabilization by calcium salts and potassium-shifting agents, such as insulin and salbutamol, is the cornerstone in the acute management of hyperkalemia. However, only dialysis, potassium-binding agents, and loop diuretics remove potassium from the body. Frequent reevaluation of potassium concentrations is recommended to assess treatment success and to monitor for recurrence of hyperkalemia.
Theoretical knowledge and self-assessed ability to perform cardiopulmonary resuscitation: a survey among 3044 healthcare professionals in Sweden
Authors: Silverplats Jennie , Södersved Källestedt Marie-Louise , Wagner Philippe , Ravn-Fischer Annica , Äng Björn , Strömsöe Anneli
Published: March 2020

Objective

Theoretical knowledge and ability to perform cardiopulmonary resuscitation (CPR) are unknown with regard to provided training. The aim of this study was to evaluate in-hospital healthcare professionals’ (HCPs) theoretical knowledge of CPR and their self-assessed ability to perform CPR and also to assess possible affecting factors.

Method

A questionnaire was sent to n = 5323 HCPs containing a nine-question knowledge test and a Likert scale measuring self-assessed ability. A factor score of self-assessed ability and a ratio scale of correct answers were dependent variables in multiple linear regression.

Results

Only 41% of the responding HCPs passed the knowledge test with seven or more correct answers. Nurses had the highest pass rate (50%) and the highest attendance rate at CPR training (56%). The ability to perform defibrillation was strongly agreed by 43% and the ability of leadership by only 7%. Working on a monitored ward, CPR training 0–6 months ago and being a nurse or physician were factors associated with more correct answers and higher ratings of abilities.

Conclusion

The overall theoretical knowledge was poor and ratings of self-assessed abilities to perform CPR were low. Working on a monitored ward, recently attended CPR training and being a nurse or physician were factors associated with higher theoretical knowledge and higher ratings of self-assessed ability to perform CPR. These findings imply prioritisation of CPR training.
Safety of Isavuconazonium Sulfate in Pediatrics Patients With Hematologic Malignancies and Hematopoietic Cell Transplantation With Invasive Fungal Infections: A Real World Experience
Authors: Ross Justine A. , Karras Nicole A. , Tegtmeier Bernard , Yamada Chris , Chen Jason , Sun Weili , Pawlowska Anna , Rosenthal Joseph , Zaia John , Dadwal Sanjeet
Published: March 2020

Purpose:

Primary objective is to evaluate safety of isavuconazonium sulfate (ISA) in pediatrics below 18 years old. Exploratory endpoint includes mortality due to probable and proven invasive fungal infection (IFI) and overall morality in this population.

Patients and Methods:

Retrospective review of patients below 18 years receiving ISA for ≥7 days for possible, probable, or proven IFI or prophylaxis between June 2015 and March 2018. Descriptive analysis performed to calculate median, frequency, and percentages.

Results:

Safety analysis included 18 patients and a subgroup of 11/18 patients were assessed for efficacy. Median age 12.5 years (4 to 17 y), median weight 50.25 kg (19 to 118 kg), 50% male, 77% acute leukemias, 94% hematopoietic cell transplant recipients, 50% matched unrelated donors and 78% in remission. Elevated alanine aminotransferase 3 times baseline within 30 days of ISA occurred in 22% (4/18). No patients had elevated bilirubin or increase in serum creatinine. All-cause mortality at 90 days was 22% (4/18) and 27% (3/11) in patients with probable or proven IFI. Clinical response rates: 14-day: 45% (5/11) partial, 27% (3/11) stable; 30-day: 45% (5/11) partial, 36% (4/11) stable; 90-day: 54% (6/11) had either partial (n=3) or complete (n=3) response to ISA.

Conclusions:

ISA is safe in pediatric patients for the treatment of IFI. Prospective, randomized controlled trials are warranted to determine efficacy and safety of ISA in pediatric patients with hematologic malignancies and hematopoietic cell transplant.
Let’s Talk
Authors: Averbeck Julie A. , Gibson Cori , Ziebert Carolyn
Published: March 2020

Nursing professional development practitioners reflect their professional standards when they evaluate outcomes of educational activities. The success case method of evaluation offers a structure to evaluate both behaviors and results when direct observation is not feasible. It provides the evaluator with information about how skills are used in the workplace and what actions help or hinder the transfer of training to practice. This method was used to evaluate a healthcare system safety course.
Vascular Assessment of the Foot Surgery Patient
Authors: Nirenberg Michael , Ansert Elizabeth
Published: March 2020

Foot surgery is common. Orthopaedic nurses charged with evaluating and treating patients who have undergone foot surgery are required to evaluate the vascular status of the patient's foot (or feet). As a result, these nurses are often the first to identify vascular issues. This article provides orthopaedic nurses with the background to understand how the patient's history, the procedure(s) performed, and a thorough assessment of the foot's circulation will allow them to promptly identify circulatory problems and potentially save a patient from having a serious complication.
Fusuma Sliding Flap for Lip Reconstruction of Lower Lip Cancer
Authors: Miyazaki Ryo , Nagasao Tomohisa , Iwasaki Akinori , Tanaka Mao , Nakai Fumi , Miyake Minoru
Published: March 2020

Lower lip cancer is typically treated with surgical excision, and this frequently results in a large defect and severe aesthetic problems. Local flap reconstruction is suitable for restoring appearance and function, and it causes less surgical stress than a vascularized free flap. The Fusuma sliding flap is a local flap technique introduced by Kasai et al in 2008. Here, the authors report their use of this method for lip reconstruction in a 94-year-old Japanese female after the removal of a cancerous mass.
Meta-Analysis of Spinal Anesthesia Versus General Anesthesia During Laparoscopic Total Extraperitoneal Repair of Inguinal Hernia
Authors: Hajibandeh Shahin , Hajibandeh Shahab , Mobarak Shahd , Bhattacharya Pratik , Mobarak Dham , Satyadas Thomas
Published: March 2020

Objectives:

To evaluate comparative outcomes of spinal anesthesia (SA) and general anesthesia (GA) during laparoscopic total extraperitoneal (TEP) repair of inguinal hernia.

Methods:

We systematically searched MEDLINE, EMBASE, CINAHL, CENTRAL, the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, ISRCTN Register, and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Postoperative pain assessed by visual analogue scale (VAS), individual and overall perioperative morbidity, procedure time and time taken to normal activities, were the outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models.

Results:

We identified 5 comparative studies reporting a total of 1518 patients (2134 hernia) evaluating outcomes of laparoscopic TEP inguinal hernia repair under SA (n=1277 patients, 1877 hernia) or GA (n=241 patients, 257 hernia). SA was associated with significantly lower post-operative pain assessed by VAS at 12 hours [mean difference (MD): −0.32; 95% confidence interval (CI), −0.45 to −0.20; P<0.0001] and shorter time to normal activities (MD: −0.30; 95% CI, −0.48 to −0.11; P=0.002) compared with GA. However, it significantly increased risk of urinary retention [odds ratio (OR): 4.02; 95% CI, 1.32-12.24; P=0.01], hypotension (OR: 3.97; 95% CI, 1.57-10.39; P=0.004), headache (OR: 7.65; 95% CI, 1.98-29.48, P=0.003), and procedure time (MD: 3.82; 95% CI, 1.22-6.42; P=0.004). There was no significant difference in VAS at 24 hours (MD: 0.06; 95% CI, −0.06 to 0.17; P=0.34), seroma (OR: 1.54; 95% CI, 0.73-3.26; P=0.26), wound infection (OR: 1.03; 95% CI, 0.45-2.37; P=0.94), and vomiting (OR: 0.84; 95% CI, 0.39-1.83; P=0.66) between the 2 groups. There was a nonsignificant decrease in overall morbidity in favor of GA (OR: 1.84; 95% CI, 0.77-4.40; P=0.17) which became significant following sensitivity analysis (OR: 2.59; 95% CI, 1.23-5.49; P=0.01).

Conclusions:

Although TEP inguinal hernia repair under SA may reduce pain in early postoperative period, it seems to be associated with increased postoperative morbidity and longer procedure time. It may be an appropriate anesthetic modality in selected patients who are considered high risk for GA. Higher level of evidence is needed.
Impact of Cystotomy Location on Cystography Results
Authors: Napoe Gnankang Sarah , Stewart Lauren E. , Myers Deborah L.
Published: March 2020

Objectives

This study aimed to determine if the location of a repaired bladder injury (trigone vs dome) impacts the probability of an abnormal cystography result in obstetric/gynecologic surgical patients undergoing repair of an unanticipated cystotomy.

Methods

We conducted a retrospective review of adult obstetric and gynecologic surgical patients who underwent cystographic evaluation of bladder integrity after repair of iatrogenic cystotomy at a single institution between January 2006 and July 2018. We excluded patients who had undergone repair of genitourinary fistula or urethral diverticulum. Patients were dichotomized into 2 groups based on the location of the repaired bladder injury: trigone versus dome. Fisher exact and Student t tests were used to determine the proportion of abnormal cystogram results and factors associated with an abnormal cystography result.

Results

Two hundred ten cases met the inclusion criteria: 176 in the dome group and 34 in the trigone group. When comparing the dome and trigone groups, respectively, mean age (45.2 ± 12.5 vs 48.4 ± 11.2 years) and cystotomy size (3.2 ± 3.2 vs 2.2 ± 2.4 cm) were comparable. Duration of postoperative bladder catheterization was longer in the trigone group (13.7 vs 12.1 days, P = 0.03). Despite the additional bladder drainage, there were more abnormal cystogram results in the trigone group versus the dome (8.8% vs 1.1%; odds ratio, 8.4).

Conclusions

A repaired cystotomy at the trigone is associated with increased odds of an abnormal cystography result. An abnormal cystography result after repair at the bladder dome is rare.
Prevalence of Screening High Risk of Obstructive Sleep Apnea Among Urogynecology Patients
Authors: Myer Emily N.B. , Long Annelise , Cooper Conisha , Fashokun Tola , Abernethy Melinda , Chen Chi Chiung Grace
Published: March 2020

Objectives

There is limited knowledge on the prevalence of obstructive sleep apnea (OSA) among urogynecology patients. The aim of this study was to determine the prevalence of screening high risk of OSA (HR-OSA) in an ambulatory urogynecology clinic.

Methods

Women presenting for a new patient visit to a single outpatient urogynecology clinic for any indication were screened for eligibility. Patients were included if they were 18 years or older, English speaking, nonpregnant, and not using treatment for OSA. Participants completed the STOP-BANG questionnaire to screen for OSA and additional questionnaires to assess the presence and classification of nocturia and urinary incontinence.

Results

Among 130 participants, the prevalence of screening HR-OSA was 38.5%. Characteristics associated with screening HR-OSA included hypertension (P < 0.001), diabetes (P=0.003), untreated sleep apnea (P < 0.001), body mass index ≥30 kg/m2 (P < 0.001), and age >50 years (P < 0.001). Participants who screened HR-OSA were more likely to have bothersome bladder symptoms of nocturia (P < 0.001), nocturnal enuresis (P < 0.001), higher urinary distress inventory scores (P < 0.001), and incontinence severity index scores (P < 0.001). On multivariable analysis, age >50 years (odds ratio [OR], 7.54), hypertension (OR, 4.04), body mass index ≥30 kg/m2 (OR, 3.98), and nocturial enuresis (OR, 2.26) remained significantly associated with screening HR-OSA. Average time to complete the STOP-BANG was 1.2 minutes.

Conclusions

The prevalence of OSA among urogynecology patients is high, and screening is not time prohibitive. Patients who screen HR-OSA have more bothersome bladder symptoms. Providers should consider screening urogynecology patients for OSA, especially patients who are 50 years or older, are obese, and have nocturnal enuresis.
Small Fiber Polyneuropathy in Hunner Lesion and Non-Hunner Lesion Interstitial Cystitis/Bladder Pain Syndrome
Authors: Han Esther , Killinger Kim A. , Turner Katherine M. , Gilleran Jason , Tenney Danielle , Peters Kenneth M.
Published: March 2020

Objective

This study aimed to determine whether small fiber polyneuropathy (SFPN) diagnosis differs between Hunner lesion interstitial cystitis/bladder pain syndrome (HL IC/BPS) and non-Hunner lesion IC/BPS (NHL IC/BPS).

Methods

This was a pilot study of 20 women with IC/BPS. Results from baseline questionnaires, such as Genitourinary Pain Index, Interstitial Cystitis Symptom Index/Interstitial Cystitis Problem Index (ICSI/ICPI), Patient Health Questionnaire-2, were collected.

Two punch biopsies were performed on each patient: distal leg and thigh. The samples were evaluated for intraepidermal nerve fiber density. One intraepidermal nerve fiber density less than the fifth percentile, regardless of site, indicated a positive SPFN diagnosis.

Results

Twenty patients were enrolled; 10 HL IC/BPS and 10 NHL IC/BPS. The HL IC/BPS group was found to be significantly older than the NHL IC/BPS group (63 vs 48 years, P = 0.007). No significant differences were found in employment or relationship statuses, or in levels of education or comorbidities between the 2 groups.

Sixty percent (6/10) of patients had SFPN in the NHL IC/BPS group compared with 40% (4/10) in the HL IC/BPS group. No significant differences were seen in SFPN positivity (P = 0.3) or Genitourinary Pain Index, Patient Health Questionnaire-2, or Interstitial Cystitis Symptom Index/Interstitial Cystitis Problem Index scores between the NHL and HL IC/BPS groups.

Conclusions

Similar to previously published studies, 60% of NHL IC/BPS patients in this cohort were positive for SFPN compared with only 40% of the HL IC/BPS patients. Larger studies may be needed to realize the full impact of SFPN in IC/BPS.
Relationship of Body Composition and Urinary Incontinence in Women: A Cross-Sectional Case-Control Study
Authors: Ferreira Roseny , Sacramento Joselita , Brasil Cristina , Dias Cristiane , Plácido Clarcson , Oliveira Carina , Feitosa Alina , Januário Priscila , Fichera Michele , Lordelo Patricia
Published: March 2020

Objective

To describe the profile of segmental body composition through the bioelectrical impedance analysis (BIA) method in continent and incontinent women and analyze the association between overweight/obesity and urinary incontinence (UI).

Methods

This was a cross-sectional case-control study that included women aged between 20 and 65 years, who were not pregnant, were outside of their menstrual period, without neurological, psychiatric, orthopedic, or cardiac comorbidities. The presence of UI was verified using the International Consultation on Incontinence Questionnaire—Short Form. Segmental body composition was assessed with BIA. The independent Student t test was used to compare body composition means between groups, and multivariate logistic regression was used to test the association between body composition and UI.

Results

The study included 62 women with a mean age of 34.4 ± 11.6 years, of whom 27 (43.5%) had UI. Of these, 15 (55.6%) were nulliparous and had a body mass index of 25.1 ± 4.2 kg/m2, similar to that of continent women, who had a body mass index of 23.6 ± 3.9 kg/m2 (P=0.16). The sociodemographic and obstetric data were similar among continent and incontinent women. With respect to the parameters of segmental body fat, visceral fat, and waist circumference, incontinent women presented higher values than the continent group. In the final multivariate analysis model, women with high levels of visceral fat had a 1.13-times higher likelihood of presenting UI.

Conclusions

In adult women, there is an association between the level of visceral fat assessed by BIA and complaints of urinary loss, being more evident in overweight and obese women.
Posttransplant Management of Recipients Undergoing Liver Transplantation for Hepatocellular Carcinoma. Working Group Report From the ILTS Transplant Oncology Consensus Conference
Authors: Berenguer Marina , Burra Patrizia , Ghobrial Mark , Hibi Taizo , Metselaar Herold , Sapisochin Gonzalo , Bhoori Sherrie , Kwan Man Nancy , Mas Valeria , Ohira Masahiro , Sangro Bruno , van der Laan Luc J.W.
Published: March 2020

Although liver transplantation (LT) is the best treatment for patients with localized hepatocellular carcinoma (HCC), recurrence occurs in 6%–18% of patients. Several factors, particularly morphological criteria combined with dynamic parameters, known before LT modify this risk and combined in prediction models may be used to stratify patients at need of variable surveillance strategies. Additional variables though likely explain differences in recurrence rates in patients with the same pre-LT HCC status. One of these variables is possibly immunosuppression (IS). Once recurrence takes place, management is highly heterogenous. Within the International Liver Transplantation Society Consensus Conference on Liver Transplant Oncology, working group 4 aim was to analyze the data regarding posttransplant management of recipients undergoing LT for HCC. Three areas of research were considered: (1) cancer prediction models and surveillance strategies; (2) tailored IS for cancer recipients; and (3) new adjuvant therapies for HCC recurrence. Following formulation of several questions, a literature search was undertaken with abstract review followed by article retrieval and full-data extraction. The grading of recommendations assessment, development and evaluation (GRADE) system was used for evidence rating incorporating strength of recommendation and quality of evidence.
Cyclosporin A Administration During Ex Vivo Lung Perfusion Preserves Lung Grafts in Rat Transplant Model
Authors: Haam Seokjin , Noda Kentaro , Philips Brian J. , Harano Takashi , Sanchez Pablo G. , Shigemura Norihisa
Published: March 2020

Background.

Despite the benefits of ex vivo lung perfusion (EVLP) such as lung reconditioning, preservation, and evaluation before transplantation, deleterious effects, including activation of proinflammatory cascades and alteration of metabolic profiles have been reported. Although patient outcomes have been favorable, further studies addressing optimal conditions are warranted. In this study, we investigated the role of the immunosuppressant drug cyclosporine A (CyA) in preserving mitochondrial function and subsequently preventing proinflammatory changes in lung grafts during EVLP.

Methods.

Using rat heart-lung blocks after 1-hour cold preservation, an acellular normothermic EVLP system was established for 4 hours. CyA was added into perfusate at a final concentration of 1 μM. The evaluation included lung graft function, lung compliance, and pulmonary vascular resistance as well as biochemical marker measurement in the perfusate at multiple time points. After EVLP, single orthotopic lung transplantation was performed, and the grafts were assessed 2 hours after reperfusion.

Results.

Lung grafts on EVLP with CyA exhibited significantly better functional and physiological parameters as compared with those without CyA treatment. CyA administration attenuated proinflammatory changes and prohibited glucose consumption during EVLP through mitigating mitochondrial dysfunction in lung grafts. CyA-preconditioned lungs showed better posttransplant lung early graft function and less inflammatory events compared with control.

Conclusions.

During EVLP, CyA administration can have a preconditioning effect through both its anti-inflammatory and mitochondrial protective properties, leading to improved lung graft preservation, which may result in enhanced graft quality after transplantation.
Laser-Evoked Potentials to Pudendal Stimulation in Healthy Subjects: A Pilot Study
Authors: Frasson Emma , Tozzi Maria Chiara , Bordignon Monia , Motti Luisa , Ferrari Francesca , Torre Gabriella , Graziottin Alessandra , Monaco Salvatore , Bertolasi Laura
Published: March 2020

Purpose:

Laser-evoked potentials (LEPs) are useful neurophysiological tools for investigating the A-delta sensory peripheral fibers and the central nociceptive pathway. The current investigation aims to obtain normative values of LEPs via pudendal nerve stimulation in healthy adult volunteers.

Methods:

Laser-evoked potentials were recorded in 16 men and 22 women, 22 to 75 years of age, using neodymium and yttrium and aluminum and perovskite laser bilateral stimulation to the pudendal nerve-supplied skin and the dorsal surface of the hands and feet. We assessed the perceptive threshold, latency, and amplitude of the N1 component and main vertex N2-P2 complex. The relationship between gender, age, height, and site of stimulation was statistically analyzed.

Results:

Both in men and in women, laser perceptive threshold increased from genitalia to foot and from hand to foot (P ≤ 0.001). N1 and N2-P2 latencies progressively increased from pudendal area to hand to foot (P ≤ 0.008). N1 and N2-P2 complex LEP amplitudes progressively decreased from hand to genitalia to foot (P ≤ 0.04). The latencies of N1 component and N2-P2 complex of LEPs correlated with body height, whereas the amplitude of the N2-P2 complex correlated negatively with age; no correlations were observed between the latencies and amplitudes with gender.

Conclusions:

This study provides normative data on pudendal LEPs versus hand and foot LEPs. Incorporation of pudendal LEPs into clinical practice could provide a valuable neurophysiological tool for the study of pelvic pain syndromes.