bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical outcomes of Watchman vs. Amplatzer occluders for left atrial appendage closure (WATCH at LAAC)
Authors: Kleinecke Caroline , Yu Jiangtao , Neef Philip , Buffle Eric , de Marchi Stefano , Fuerholz Monika , Nietlispach Fabian , Valgimigli Marco , Streit Samuel R , Fankhauser Mate , Duenninger Erich , Windecker Stephan , Meier Bernhard , Gloekler Steffen
Published: January 2020

Aims

This study compares clinical outcomes of Watchman vs. Amplatzer devices for left atrial appendage closure (LAAC).

Methods and results

Of two real-world registries, the Watchman registry Lichtenfels, Germany, and the Amplatzer registry Bern-Zurich, Switzerland, 303 and 333 consecutive patients, respectively, were included. After a 1:1 propensity score matching, 266 vs. 266 patients were compared by use of the predefined primary efficacy endpoint of stroke, systemic embolism and cardiovascular/unexplained death, the primary safety endpoint of major peri-procedural complications and major bleeding events at follow-up, and the combined hazard endpoint, a composite of all above-mentioned hazards. Mean age was 75.3 ± 7.8 (Watchman) vs. 75.1 ± 9.9 (Amplatzer) years, CHA2DS2-VASc score 4.5 ± 1.7 vs. 4.5 ± 1.5, and HAS-BLED score 3.2 ± 1.0 vs. 3.2 ± 1.0. At a mean follow-up of 2.4 ± 1.3 vs. 2.5 ± 1.5 years and 1.322 patient-years, the primary endpoints of efficacy [40/646, 6.2% [Watchman] vs. 43/676, 6.4% [Amplatzer]; hazard ratio (HR), 1.02; 95% confidence interval (CI), 0.66–1.58; P = 0.92] and safety (33/646, 5.1% vs. 30/676, 4.4%; HR, 0.57; 95% CI, 0.29–1.11; P = 0.10), as well as the combined hazard endpoint (69/646, 10.7% vs. 66/676, 9.8%; HR, 0.80; 95% CI, 0.55–1.12; P = 0.26) were similar for both groups.

Conclusion

This study suggests comparable efficacy and safety of the Watchman and Amplatzer devices.
Premature ventricular contractions cause a position shift in 3D mapping systems: analysis, quantification, and correction by hybrid activation mapping
Authors: De Potter Tom , Iliodromitis Konstantinos , Bar-On Tal , Silva Garcia Etel , Ector Joris
Published: January 2020

Aims

Using a modified CARTO 3D mapping system, we studied if premature ventricular contractions (PVCs) cause position shifts within the 3D co-ordinate system. We quantified magnitude of the phenomenon and corrected for it, by creating both an activation map that represents the conventional local activation time (LAT) and one corrected for this position shift (hybrid LAT map).

Methods and results

We prospectively enrolled patients planned for PVC ablation. Distances between the earliest LAT, the earliest hybrid-LAT, and the best pacemap positions were calculated in a 3D model. Ablation was performed at the best hybrid-LAT location. Efficacy was evaluated by acute response to ablation as well as clinical outcome on 24-h Holter at 1 year. One hundred and twenty-seven LAT-hybrid pairs were studied in 18 patients (age 48.3 ± 18.0 years, 12 female). Baseline PVC burden was 16 ± 12%. The mean position shift between LAT-hybrid and its associated LAT position was 8.9 ± 5.5 mm. The mean position shift between best LAT-hybrid and best pacemap was 6.2 ± 5.0 mm and the mean shift between best conventional LAT and best pacemap was 13.5 ± 7.0 mm (P < 0.0001 for all pairwise comparisons). Exclusive targeting of best LAT-hybrid position resulted in acute abolition of PVC activity in all patients. After 1-year follow-up, mean PVC burden reduction was 16% (baseline) to <1%.

Conclusion

Premature ventricular contractions cause a position shift in 3D mapping systems compared with the same endocardial position in sinus rhythm. An approach to account for this phenomenon, correct it and target exclusively the adjusted 3D position is feasible and highly efficient in terms of acute and 1-year clinical outcome after radiofrequency ablation.
A Biomarker for Concussion: The Good, the Bad, and the Unknown
Authors: Reece Jenna T , Milone Michael , Wang Ping , Herman Daniel , Petrov Dmitriy , Shaw Leslie M
Published: January 2020

Background

Traumatic brain injury (TBI) is a significant cause of morbidity, mortality, and disability in the US, with >2.8 million patients presenting to the emergency department (ED) annually. However, the diagnosis of TBI is challenging and presents a number of difficulties, particularly at the mildest end of the spectrum: concussion. A number of groups have researched biomarkers to aid in the evaluation of TBI, and most recently in 2018 the Food and Drug Administration approved a new blood-based immunoassay biomarker using ubiquitin carboxyl hydrolase L1 and glial fibrillary acidic protein to aid in head computed tomography (CT) triage.

Content

This review clarifies the practical challenges in assessing and implementing a new blood biomarker. It then examines the clinical context and need, as well as the evidence used to validate this new immunoassay.

Concussion is a multifaceted diagnosis with a need for biomarkers to assist in diagnostic and prognostic assessment. Recent articles in the lay press have revealed misunderstanding about the function of this new test, expressing hopes that this biomarker serves patients at the mildest end of the spectrum and is useful for athletes and children. None of these assumptions are correct, as this biomarker has been evaluated in patients only at the moderate end of the spectrum and has been validated only in adults presenting to the ED who have already been triaged to receive head CT, not in athletes or children. The next steps for this assay should consider clinical work flow and clarifying its intended use, including integration with existing triage methods, and validating the assay for a broader population.
Innovative Burn Treatment Using Tilapia Skin as a Xenograft: A Phase II Randomized Controlled Trial
Authors: Lima Júnior Edmar Maciel , De Moraes Filho Manoel Odorico , Costa Bruno Almeida , Rohleder Andréa Vieira Pontes , Sales Rocha Marina Becker , Fechine Francisco Vagnaldo , Forte Antonio Jorge , Alves Ana Paula Negreiros Nunes , Silva Júnior Francisco Raimundo , Martins Camila Barroso , Mathor Mônica Beatriz , de Moraes Maria Elisabete Amaral
Published: January 2020

Skin substitutes are considered a useful alternative for occlusive dressings in the treatment of superficial burns as they reduce the frequency of dressing replacement. This phase II randomized controlled trial aimed to evaluate the efficacy of Nile tilapia (Oreochromis niloticus) skin as an occlusive xenograft dressing for the treatment of burn wounds in humans. In order to assess the use of tilapia skin, the following variables were evaluated: number of days for wound healing, the number of times the occlusive dressing was changed, use of anesthetics or analgesics, pain assessment using the Visual Analogue Scale, and evaluation of burn improvement on the day of dressing removal. In total, 62 participants completed the study. It was found that in participants treated with tilapia skin, complete reepithelialization occurred in significantly fewer days; reported pain intensity was lower (study arms B and C), the amount of anesthetics/analgesics required was lower (study arms B and C), and the necessity of dressing changes was significantly reduced in comparison with volunteers treated with silver sulfadiazine. In our study, the tilapia skin xenograft showed good efficacy as an occlusive biological dressing for burn wound treatment in humans.
Evaluation of anticoagulants and hemocyte-maintaining solutions for the study of hemolymph components in the spiny lobster Panulirus argus (Latreille, 1804) (Decapoda: Achelata: Palinuridae)
Authors: Perdomo-Morales Rolando , Montero-Alejo Vivian , Rodríguez-Viera Leandro , Perera Erick
Published: January 2020

Functional studies on humoral or cellular responses in the hemolymph of crustaceans require the selection of suitable anticoagulant- and hemocyte-maintaining solutions. We studied the suitability of several anticoagulant- and hemocyte-maintaining solutions in the spiny lobster Panulirus argus (Latreille, 1804), with emphasis in the preservation of hemocyte number and viability. It was found that the modified Alsever solution was the ideal anticoagulant, while modified L-15 medium and Panulirus argus saline (PAS) were the best hemocyte-maintaining solutions. It is striking that whereas avoiding plasma clotting is relatively simple to achieve, avoiding lysis and aggregation of hemocytes could be challenging and variable among closely related crustaceans. The reasons are hardly known and might indicate different composition or sensitivity of both membrane-bound and soluble mediators in any of the three types of hemocytes identified among decapod crustaceans. Hemolymph volume average in P. argus was 10.5% of fresh body weight (more than 50 ml per adult individual), which makes this species an attractive model for functional studies of hemolymph components in crustaceans.
JPOS/JASCC clinical guidelines for delirium in adult cancer patients: a summary of recommendation statements
Authors: Matsuda Yoshinobu , Tanimukai Hitoshi , Inoue Shinichiro , Inada Shuji , Sugano Koji , Hasuo Hideaki , Yoshimura Masafumi , Wada Saho , Dotani Chikako , Adachi Hiroyoshi , Okamoto Yoshiaki , Takeuchi Mari , Fujisawa Daisuke , Kako Jun , Sasaki Chiyuki , Kishi Yasuhiro , Akizuki Nobuya , Inagaki Masatoshi , Uchitomi Yosuke , Matsushima Eisuke , Okuyama Toru
Published: January 2020

Background

The Japanese Psycho-Oncology Society and Japanese Association of Supportive Care in Cancer recently launched the clinical practice guidelines for delirium in adult cancer patients. The aim of the guidelines was to provide evidence-based recommendations for the clinical assessment and management of delirium in cancer patients. This article reports the process of developing the guideline and summarizes the recommendations made.

Methods

The guidelines were developed in accordance with the Medical Information Network Distribution Service creation procedures. The guideline development group, consisting of multidisciplinary members, formulated nine clinical questions. A systematic literature search was conducted to identify relevant articles published prior to through 31 May 2016. Each article was reviewed by two independent reviewers. The level of evidence and the strength of the recommendations were graded using the grading system developed by the Medical Information Network Distribution Service, following the concept of The Grading of Recommendations Assessment, Development and Evaluation system. The modified Delphi method was used to validate the recommendation statements.

Results

This article provides a summary of the recommendations with rationales for each, as well as a short summary.

Conclusions

These guidelines will support the clinical assessment and management of delirium in cancer patients. However, additional clinical studies are warranted to further improve the management of delirium.
Retrospective DVH analysis of point A based intracavitary brachytherapy for uterine cervical cancer
Authors: Someya Masanori , Hasegawa Tomokazu , Tsuchiya Takaaki , Kitagawa Mio , Gocho Toshio , Fukushima Yuuki , Hori Masakazu , Miura Katsutoshi , Takada Yu , Nakata Kensei , Sakata Koh-ichi
Published: January 2020

Combining external beam radiotherapy (EBRT) with intracavitary brachytherapy (ICBT) is important for definitive treatment of cervical cancer. In cervical cancer patients receiving radiotherapy, we evaluated treatment outcomes in relation to dose–volume histogram parameters, including the computed tomography (CT)-based high-risk clinical target volume (HR-CTV) for ICBT. Between 2010 and 2015, 89 consecutive cervical cancer patients were mostly treated with 40 Gy of EBRT in 20 fractions and 18 Gy of ICBT prescribed to point A in 3 fractions. CT scans were obtained during ICBT. The HR-CTV D90 was calculated and the total doses of ICBT and EBRT were converted to the equivalent dose in 2 Gy fractions (EQD2). When the patients were divided into four groups according to EQD2 of the HR-CTV D90, the 3-year local recurrence-free survival rates were 95.2, 78.4, 52.7 and 42.9% for patients receiving >80 , 70–80 , 60–70 and <60 Gy, respectively. There was a significant negative correlation between EQD2 of the HR-CTV D90 and the HR-CTV volume at first ICBT (r = −0.713). Local recurrence was more frequent when the HR-CTV volume was ≥22 cc and EQD2 of the HR-CTV D90 was <70 Gy. Multivariate analysis showed that EQD2 of the HR-CTV D90 and concurrent chemotherapy (≥4 cycles) were significant determinants of overall survival. HR-CTV D90 was an important prognostic indicator for local recurrence. HR-CTV D90 >70 Gy is required for the better local control, especially in patients with a larger HR-CTV (≥22 cc at initial ICBT).
A rare case of acquired benign tracheoesophageal fistula
Authors: Bouayyad Sarah , Beena Meera , Nigam Ajay
Published: January 2020

Acquired benign tracheoesophageal fistula (TOF) is a rare medical condition that usually results from trauma, foreign bodies or granulomatous infections. This is an unusual presentation of a male patient with a history of laryngectomy who has had over a period of several years inappropriately and vigorously used valve cleaning brushes to clean tracheal secretions, which has led to the formation of a TOF. Due to the patient’s obsessive habit, we could not manage him using conventional surgical methods. Instead, we opted for the placement of a salivary bypass tube, which yielded good results and recovery. To the best of our knowledge, no other case of similar aetiology has been published. We would like to highlight the importance of appropriate patient selection and education prior to performing a tracheoesophageal puncture to avoid developing life-threatening complications as demonstrated in our case report.
DNA methylation is involved in the regulation of pepper fruit ripening and interacts with phytohormones
Authors: Xiao Kai , Chen Jie , He Qixiumei , Wang Yixin , Shen Huolin , Sun Liang
Published: January 2020

There is growing evidence to suggest that epigenetic tags, especially DNA methylation, are critical regulators of fruit ripening. To examine whether this is the case in sweet pepper (Capsicum annuum) we conducted experiments at the transcriptional, epigenetic, and physiological levels. McrBC PCR, bisulfite sequencing, and real-time PCR demonstrated that DNA hypomethylation occurred in the upstream region of the transcription start site of some genes related to pepper ripening at the turning stage, which may be attributed to up-regulation of CaDML2-like and down-regulation of CaMET1-like1, CaMET1-like2, CaCMT2-like, and CaCMT4-like. Silencing of CaMET1-like1 by virus-induced gene silencing led to DNA hypomethylation, increased content of soluble solids, and accumulation of carotenoids in the fruit, which was accompanied by changes in expression of genes involved in capsanthin/capsorubin biosynthesis, cell wall degradation, and phytohormone metabolism and signaling. Endogenous ABA increased during fruit ripening, whereas endogenous IAA showed an opposite trend. No ethylene signal was detected during ripening. DNA hypomethylation repressed the expression of auxin and gibberellin biosynthesis genes as well as cytokinin degradation genes, but induced the expression of ABA biosynthesis genes. In mature-green pericarp, exogenous ABA induced expression of CaDML2-like but repressed that of CaCMT4-like. IAA treatment promoted the transcription of CaMET1-like1 and CaCMT3-like. Ethephon significantly up-regulated the expression of CaDML2-like. Treatment with GA3 and 6-BA showed indistinct effects on DNA methylation at the transcriptional level. On the basis of the results, a model is proposed that suggests a high likelihood of a role for DNA methylation in the regulation of ripening in the non-climacteric pepper fruit.
Sustained Long-Term Outcomes With Closed-Loop Spinal Cord Stimulation: 12-Month Results of the Prospective, Multicenter, Open-Label Avalon Study
Authors: Russo Marc , Brooker Charles , Cousins Michael J , Taylor Nathan , Boesel Tillman , Sullivan Richard , Holford Lewis , Hanson Erin , Gmel Gerrit Eduard , Shariati Nastaran Hesam , Poree Lawrence , Parker John
Published: January 2020

BACKGROUND

Spinal cord stimulation (SCS) activates the dorsal column fibers using electrical stimuli. Current SCS systems function in fixed-output mode, delivering the same stimulus regardless of spinal cord (SC) activation.

OBJECTIVE

To present long-term outcomes of a novel closed-loop SCS system that aims to maintain the SC activation near a set target level and within a therapeutic window for each patient. SC activation is measured through the evoked compound action potential (ECAP) generated by each stimulus pulse.

METHODS

Fifty patients with lower back and/or leg pain who were successfully trialed received a permanent system (Evoke; Saluda Medical, Sydney, Australia). Ratings of pain (visual analog scale), quality of life, function, sleep, and medication use were collected at baseline and at each visit. SC activation levels were reported in summary statistics. The therapeutic window for each individual patient was defined as the range of ECAP amplitudes between sensation threshold and uncomfortably strong stimulation.

RESULTS

At 12 mo, the proportion of patients with ≥50% relief was 76.9% (back), 79.3% (leg), and 81.4% (overall), and the proportion with ≥80% pain relief was 56.4% (back), 58.6% (leg), and 53.5% (overall). Patients spent a median of 84.9% of their time with stimulation in their therapeutic window, and 68.8% (22/32) eliminated or reduced their opioid intake. Statistically significant improvements in secondary outcomes were observed.

CONCLUSION

The majority of patients experienced more than 80% pain relief with stable SC activation, as measured by ECAP amplitude at 12 mo, providing evidence for the long-term effectiveness of the Evoke closed-loop SCS system.
Responsiveness and Interpretability of 2 Measures of Physical Function in Patients With Spondyloarthritis
Authors: Fongen Camilla , Dagfinrud Hanne , Bilberg Annelie , Pedersen Elisabeth , Johansen Melissa Woll , van Weely Salima , Hagen Kåre Birger , Sveaas Silje Halvorsen
Published: January 2020

Background

Maintenance or improvement of physical function is an important treatment target in the management of patients with axial spondyloarthritis (axSpA); measurement tools that can detect changes in physical function are therefore important.

Objectives

The objective of this study was to compare responsiveness and interpretability of the patient-reported Bath Ankylosing Spondylitis Functional Index (BASFI) and the Ankylosing Spondylitis Performed-Based Improvement (ASPI) in measuring change in physical function after exercise in patients with axSpA.

Design

This was a sub-study of 58 patients nested within a randomized controlled trial comparing the effect of 12 weeks of exercise with usual care.

Methods

Responsiveness and interpretability were assessed according to the Consensus-based Standards for the selection of health status Measurement Instrument. Responsiveness was assessed by testing 8 predefined hypotheses for ASPI and BASFI. Interpretability was assessed by: (1) using patients’ reported change as an anchor (“a little better” = minimal important change) and (2) by categorizing patients with a 20% improvement as responders.

Results

For ASPI and BASFI, 5 of 8 (63%) versus 2 of 8 (25%) of the predefined hypotheses for responsiveness were confirmed. The minimal important change values for improvement in physical function were 3.7 seconds in ASPI and 0.8 points (on a scale from 0 to 10) for BASFI. In the intervention group, 21 of 30 (70%) and 13 of 30 (43%) of the patients were categorized as responders measured with ASPI and BASFI, respectively. There was a tendency towards a floor effect in BASFI, as 8 of 58 (14%) patients scored the lowest value at baseline.

Limitations

This study was limited by its moderate sample size.

Conclusions

Our findings suggest that ASPI is preferable over BASFI when evaluating physical function after exercise interventions in patients with axSpA.
Doctor and healthcare workers strike: are they ethical or morally justifiable: another view
Authors: Chima Sylvester C.
Published: January 2020

Purpose of review

This review analyzed legal and ethical issues surrounding recent doctor and healthcare worker (HCW) strikes and considered whether HCW strikes are legally and morally justifiable, underlying causes, and impact of such strikes on healthcare service delivery.

Recent findings

Recent reports show that doctor and HCW strikes are an ongoing phenomenon globally, occurring in both developed and developing countries. The main reasons for HCW strikes are failed employer–employee negotiations regarding fair wages and working conditions, policy issues, infrastructural deficiencies in poorer countries, and concerns by HCWs regarding personal security in the workplace. The main impact of HCW strikes is disruption of healthcare service delivery, such as canceled outpatients’ appointments, hospital admissions, and elective surgeries. There was no clear evidence of increased patients’ mortality during strikes, except in isolated cases, where emergency services were also withdrawn during strikes.

Doctors and HCWs strikes are lawful deadlock-breaking mechanisms when collective bargaining negotiations have reached an impasse. Doctors’ strikes appear to create an ethical conflict with the Hippocratic tradition and obligation to place patients’ best interests as the primary moral consideration in medical practice. However, the rise of consumerism in healthcare, and loss of power by doctors, many of whom now work as employees, subject to regulations imposed by different stakeholders, including governments, health-maintenance organizations, and healthcare insurers, has impacted on modern medical practice. Therefore, doctors, like other employees may occasionally resort to strikes to extract concessions from employers. Mortality is rarely increased during HCW strikes, especially where emergency healthcare services are provided.
Clinical results and complication rates of lower limb lengthening in paediatric patients using the PRECICE 2 intramedullary magnetic nail: a multicentre study
Authors: Nasto Luigi Aurelio , Coppa Valentino , Riganti Simone , Ruzzini Laura , Manfrini Marco , Campanacci Laura , Palmacci Osvaldo , Boero Silvio
Published: January 2020

Implantable intramedullary nail lengthening devices (e.g., PRECICE 2 system) have been proposed as alternative method to external fixation for lower limb lengthening surgery. The aim of this study was to analyse our outcomes and complications using the PRECICE 2 (P2) nail system and review them in light of the existing literature. A retrospective multicentre study was conducted on patients <18 years, who were treated for limb lengthening using the P2 system. The inclusion criteria were a limb length discrepancy ≥ 30 mm and a follow-up ≥6 months after the end of treatment. A total of 26 (15 males) patients were included, average age was 14.7 ± 2.3 years; 26 nails (21 femur, 5 tibia) were implanted. The average goal lengthening was 49.4 ± 12.4 mm, while average achieved lengthening was 44.4 ± 11.6 mm. Average distraction and consolidation indexes were 11.9 ± 2.1 days/cm and 25.1 ± 8.1 days/cm, respectively. Nail accuracy and reliability were 91.1% and 88.5%, respectively. A total of five problems (joint contractures), one obstacle (femur fracture) and three complications (hip joint subluxation, deep infection and nail running back) were encountered. The P2 nail system is a valid alternative to external fixator for limb lengthening in young patients with no significant angular or rotation deformities. Our study confirms a favourable complication rate and available evidence from literature suggests a lower complication rate than external fixator systems. Nevertheless, surgeons should keep a watchful eye on risk of joint subluxation and mechanical complications with intramedullary lengthening.
Progressing Flexion Deformity of the Middle, Ring, and Small Fingers With a Rare Congenital Anatomic Difference of Flexor Digitorum Profundus
Authors: Li Hui , Guan Shibing
Published: January 2020

Background:

A flexion deformity caused by a congenital anomaly of the flexor digitorum profundus (FDP) of the middle, ring, and small fingers is extremely rare, and it has previously been described only in isolated case reports. Hence, there has been no consensus with regard to the clinical presentation, etiology, and treatment.

Methods:

We retrospectively analyzed our 10 cases (5 male individuals and 5 female individuals) for congenital FDP abnormalities. We obtained radiography, computed tomography, and magnetic resonance imaging on our patients. Nerve studies were performed in 7 of 10 patients, except for 3 patients below 5 years of age who were unable to co-operate. We used the grading criteria (Wang classification) to evaluate the restricted extension of the affected fingers and the active flexion function. An abnormal fibrous cord was seen intraoperatively in the proximal part of the belly of the FDP that was destined for the affected fingers. It originated from a bony prominence on the proximal part of the ulna. On resection of the aberrant cord, extension of the affected fingers was immediately improved. Pathologic examination of the removed aberrant cord revealed dense fibrous connective tissue.

Results:

Nerve conduction studies and electromyography revealed that there was no substantial damage to the median and/or ulnar nerves. Plain radiography revealed no bone or joint anomalies. Computed tomography showed a slight bony prominence at the proximal part of the ulna. However, magnetic resonance imaging indicated a demonstrably abnormal fibrous cord in the FDP that originated from a bony prominence at the proximal part of the ulna and extended toward the middle, ring, and small fingers. On the basis of the Wang classification criteria for functional evaluation, 7 were moderate, and 3 were severe. Patients were followed-up for 2 to 36 months with a mean follow-up of 16 months. The postoperative outcomes were excellent in 8 cases and fair in 2 cases. The flexion and extension functions were regained, and there was no relapse of deformity.

Conclusion:

On the basis of its pathologic features, we recommend that this condition be treated by resection of the abnormal cord.

Level of Evidence:

Level IV.
Developmental Dysplasia of the Hip: An Examination of Care Practices of Pediatric Orthopaedic Surgeons in North America
Authors: Taylor Isabel K. , Burlile Jessica F. , Schaeffer Emily K. , Geng Xue , Habib Eva , Mulpuri Kishore , Shea Kevin G.
Published: January 2020

Background:

Developmental dysplasia of the hip (DDH) is a common condition, affecting 1% to 2% of full-term infants. The American Academy of Orthopaedic Surgeons (AAOS) and American Academy of Pediatrics have published guidelines detailing best practices for DDH screening and treatment. The purpose of this survey was to determine DDH treatment practices of pediatric orthopaedic surgeons in North America.

Methods:

We queried orthopaedic surgeon members of the Pediatric Orthopaedic Society of North America (POSNA) about referral patterns, treatment practices, and use of DDH guidelines. The survey included demographics, clinical scenarios, referrals patterns, and ultrasound practices.

Results:

Of the 1392 members of POSNA, we received 432 total responses and included 353 in statistical analyses. Results show that 68% (233/342) of surgeons practice in an institution that does not endorse a standard care pathway for DDH. Of surgeons who personally use a DDH care pathway, the AAOS guidelines were most cited (143/353, 41%). The majority (94%, 316/337) of surgeons do not believe that universal ultrasound screening should be adopted in the United States. Responses regarding ultrasound screening for “high risk” infants as outlined by AAOS varied based on risk factor. Many (57%, 200/353) surgeons have performed initial evaluations for patients over 12 months of age. While 80% (260/327) of orthopaedic surgeons believe that primary care providers are referring patients appropriately, only 57% (183/323) believe that primary care providers are ordering imaging studies appropriately.

Conclusions:

Results from this survey of POSNA membership indicate an opportunity to better distribute and implement DDH guidelines. In addition, the implementation of a care map with a focus on standard referral and imaging practices could improve the care of patients with DDH by: (1) reducing the total cost of care, (2) increasing the use of appropriate imaging, (3) increasing timely referral for DDH care, and (4) reducing the presentation rate of walking age DDH patients.

Level of Evidence:

The level of evidence rating for this survey-based study is level IV.
Iron deficiency in heart failure: getting to the guidelines
Authors: Lavoie Andrea J.
Published: January 2020

Purpose of review

Iron deficiency is a common condition affecting approximately 50% of patients with heart failure. The purpose of this review is to explore the impact of iron deficiency on patients’ quality of life and outcomes. Moreover, how intravenous replacement, even in the absence of anemia, can improve these outcomes.

Recent findings

The role of iron deficiency anemia has long been a part of assessing reversible and treatable contributors to patients’ symptoms in heart failure. Recent studies have demonstrated how vital identifying not only anemic patients but those who are iron deficient without anemia, may allow us to impact their quality of life by several different measures. The latter appears to be the case not only for reduced ejection fraction but also impacts patients with preserved ejection fraction who have very few other modalities which improve symptoms.

Iron deficiency in heart failure is common, and with improvements in diagnosis and management, it has led to a better understanding of the importance of iron deficiency in cardiac failure and function.
Glaucoma screening: where are we and where do we need to go?
Authors: Tan Nicholas Y.Q. , Friedman David S. , Stalmans Ingeborg , Ahmed Iqbal Ike K. , Sng Chelvin C.A.
Published: January 2020

Purpose of review

Current recommendations for glaucoma screening are decidedly neutral. No studies have yet documented improved long-term outcomes for individuals who undergo glaucoma screening versus those who do not. Given the long duration that would be required to detect a benefit, future studies that may answer this question definitively are unlikely. Nevertheless, advances in artificial intelligence and telemedicine will lead to more effective screening at lower cost. With these new technologies, additional research is needed to determine the costs and benefits of screening for glaucoma.

Recent findings

Using optic disc photographs and/or optical coherence tomography, deep learning systems appear capable of diagnosing glaucoma more accurately than human graders. Eliminating the need for expert graders along with better technologies for remote imaging of the ocular fundus will allow for less expensive screening, which could enable screening of individuals with otherwise limited healthcare access. In India and China, where most glaucoma remains undiagnosed, glaucoma screening was recently found to be cost-effective.

Recent advances in artificial intelligence and telemedicine have the potential to increase the accuracy, reduce the costs, and extend the reach of screening. Further research into implementing these technologies in glaucoma screening is required.
The expression of Th9 and Th22 cells in rats with cerebral palsy after hUC-MSC transplantation
Authors: Niu Xia , Xu Xiaoyan , Luo Zhihua , Wu De , Tang Jiulai
Published: January 2020

Background:

This study aimed to investigate the expression of Th9 and Th22 cells in rats with cerebral palsy (CP) after human umbilical cord-derived mesenchymal stem cell (hUC-MSC) transplantation.

Methods:

First, hUC-MSCs were isolated from fresh umbilical cords and identified. Rats were divided into the normal group, CP group, and hUC-MSC transplantation group. The Morris water maze and balance beam tests were performed to evaluate the neurobehavioral ability of the rats. The levels of TNF-α, IL-6, IL-9, and IL-22 in rat brain tissues were detected by ELISA. Th9 and Th22 proportions in brain tissues were detected by flow cytometric analysis. The mRNA levels of IL-9, IL-22, PU.1, and AHR in brain tissues were determined by qRT-PCR.

Results:

hUC-MSC transplantation enhanced the neurobehavioral ability of CP rats. Furthermore, Th9 and Th22 proportions were decreased in brain tissues from CP rats after hUC-MSC transplantation. The levels of proinflammatory cytokines (TNF-α and IL-6), Th9-related IL-9 and PU.1, and Th22-related IL-22 and AHR were markedly higher in brain tissues from CP rats than in brain tissues from control rats, but their levels were significantly decreased after hUC-MSC transplantation.

Conclusion:

Our data indicate that Th9 and Th22 proportions are decreased in CP rats after hUC-MSC transplantation.
The roles of m6A RNA modifiers in human cancer
Authors: Liang Yanwen , Zhan Guankai , Chang Kao-Jung , Yang Yi-Ping , Wang Lingfang , Lin Jiebo , Hsu Chih-Hung
Published: January 2020

Like DNA and proteins, RNA is subject to numerous (over 160) covalent modifications which play critical roles to regulate RNA metabolism. Among these modifications, N
6-methyladenosine (m6A) is the most prevalent RNA methylation on mRNA which occurs on around 25% of transcripts. The recent studies demonstrated that m6A participates in many aspects of RNA processing, including splicing, nuclear exporting, translation, stabilization, etc. Therefore, it revealed a new layer of regulatory mechanism for gene expression and has been termed “RNA Epigenetics” or “Epitranscriptomics”. RNA m6A is regulated and exerts its functions by three groups of “m6A RNA modifiers” including m6A methyltransferases (writers), m6A demethylases (erasers), and m6A binding proteins (readers). In this review, we would summarize and discuss the current understandings of the roles of the conventional m6A RNA modifiers in human cancers.
Aberrant sialylation in ovarian cancers
Authors: Lee Wen-Ling , Wang Peng-Hui
Published: January 2020

Sialylation (the covalent addition of sialic acid to the terminal end of glycoproteins or glycans), tightly regulated cell- and microenvironment-specific process and orchestrated by sialyltransferases and sialidases (neuraminidases) family, is one of the posttranslational modifications, which plays an important biological role in the maintenance of normal physiology and involves many pathological dysfunctions. Glycans have roles in all the cancer hallmarks, referring to capabilities acquired during all steps of cancer development to initiate malignant transformation (a driver of a malignant genotype), enable cancer cells to survive, proliferate, and metastasize (a consequence of a malignant phenotype), which includes sustaining proliferative signaling, evading growth suppressor, resisting cell apoptosis, enabling replicative immortality, inducing angiogenesis, reprogramming of energy metabolism, evading tumor destruction, accumulating inflammatory microenvironment, and activating invasion and accelerating metastases. Regarding the important role of altered sialylation of cancers, further knowledge about the initiation and the consequences of altered sialylation pattern in tumor cells is needed, because all may offer a better chance for developing novel therapeutic strategy. In this review, we would like to update alteration of sialylation in ovarian cancers.
One-year outcomes of a suture-less laparoscopic sacral hysteropexy using polypropylene Y-mesh grafts and fibrin sealant spray: A prospective comparative study
Authors: Tsai Ching-Pei , Kao Hui-Fen , Liu Chih-Ku , Shen Pao-sheng , Chen Ming-Jer , Hung Man-Jung
Published: January 2020

Background:

Laparoscopic sacral hysteropexy (SH) is a minimally invasive and effective treatment for uterovaginal prolapse in women who wish to retain the uterus. However, this procedure is limited by a steep learning curve and a long operating time. In this study, we aim to evaluate the surgical outcomes of a modified laparoscopic SH procedure using innovative methods of vaginal mesh attachment, which we hypothesized to be equally effective and time-saving.

Methods:

This was a prospective, parallel, comparative study conducted at a tertiary referral hospital. A total of 34 women with advanced (POPQ [Pelvic Organ Prolapse Quantification] stages ≧ 2) uterine prolapse, who underwent a laparoscopic SH procedure using lightweight polypropylene Y-mesh grafts (ALYTE), were studied. In half (n = 17) of the cases, fibrin sealant spray (TISSEEL) was applied to the meshes fixed at the anterior and posterior vaginal wall with fewer (six vs at least ten) sutures. A detailed comparison of one-year outcomes between groups was performed.

Results:

Patient characteristics and perioperative results were comparable between groups with the exception of a significantly shorter total operating time (247.0 vs 292.9 minutes, p = 0.04) noted in the fibrin group. At 1 year, anatomic success (POPQ stage ≦1) rates (76.5% vs 76.5%) were not different between groups. There were eight patients, with four in each group, who had surgical failure. Notably, most (7/8; 87.5%) surgical failures were at the anterior compartment (i.e, recurrent cystocele). No vaginal mesh extrusions were noted. After statistical analysis, we found “cystocele as the dominant prolapse before operation” was a significant predisposing factor for prolapse recurrence (p = 0.019; odds ratio = 8.04).

Conclusion:

The modified laparoscopic SH procedure using Y-mesh grafts and fibrin sealant spray with fewer vaginal sutures was equally effective as conventional methods but saved time. Laparoscopic SH using Y-mesh grafts might not be as effective in repairing a concomitant dominant cystocele.
Glaucoma assessment in high myopic eyes using optical coherence tomography with long axial length normative database
Authors: Chang Yu-Fan , Ko Yu-Chieh , Hsu Chih-Chien , Chen Mei-Ju , Liu Catherine Jui-Ling
Published: January 2020

Background:

We investigated the performance of glaucoma assessment using RS-3000 spectral domain optical coherence tomography with a long axial length (AL) normative database versus Cirrus HD-OCT in eyes with high myopia.

Methods:

This is a prospective case–control study. Eyes with AL ≥26 mm were enrolled, including 40 control eyes and 41 eyes with primary open-angle glaucoma. Each participant received OCT imaging with both devices at the same visit. We calculated the area under receiver operating characteristic curve (AUROC) for circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell complex (GCC) parameters, and compared the false-positive and false-negative rates between the two devices.

Results:

Both devices performed comparably well in glaucoma assessment regarding cpRNFL parameters, with the best parameter being the average cpRNFL for RS-3000 (AUROC: 0.899) and the clock-hour 7 cpRNFL for Cirrus HD (AUROC: 0.912). Regarding macular GCC parameters, although the nasal-inferior outer sector of the RS-3000 (AUROC 0.873) and the inferior-temporal sector of the Cirrus HD (AUROC 0.840) performed well in glaucoma assessment, generally speaking there was a higher false-positive rate using Cirrus HD when compared with that of RS-3000.

Conclusion:

For eyes with long AL, both OCT devices are comparable in the ability of discriminating glaucoma from non-glaucoma in terms of cpRNFL parameters, while the macular GCC parameters of RS-3000 were less likely to over-diagnose glaucoma in highly myopic eyes.
Cardiovascular Risk Reduction in Rural Women
Authors: Alreshidi Bader G. , Kalman Melanie , Wells Margaret , Fahs Pamela Stewart
Published: January 2020

Background

Cardiovascular disease (CVD) is the leading cause of death in most countries. Lack of awareness of the impact CVD has on women is a continuing problem. Rural women are at a great risk for CVD and have specific barriers to early recognition and to access to treatment.

Objective

The purpose of this systematic review was to identify how the state of the science for rural women and CVD has progressed over the last decade.

Methods

Searches were conducted using the databases Cochrane, PubMed, and CINAHL with 5 major subject headings. The search resulted in the identification of 571 articles. Specific exclusion criteria resulted in an in-depth review of 15 articles. Two of the authors reviewed each article for scientific merit and interrater reliability.

Results

Most studies were conducted in the United States (67%). Four studies focused on CVD knowledge; one, on physical activity; one, on diet plus other factors; one, on the effect of dried curry leaf powder and cucumber slices on hyperlipidemia; and one each, on waist circumference, exposure to smoke from wood stoves, and social support. Five of the 15 studies focused on more than 1 component, most on diet and physical activity.

Conclusions

Depth in a body of knowledge on any 1 topic, such as the most efficacious means to decrease CVD risk factors in rural women and increase health promotion activities in the population, is lacking. Another area of concern is the lack of research articles published in cardiovascular journals that include CVD in rural women.
Self-reported and Accelerometer-Measured Physical Activity in Children With Cardiomyopathy
Authors: Cunningham Chentel , Spence John C. , Stearns Jodie A. , Carson Valerie , Kantor Paul F. , Urschel Simon , Conway Jennifer
Published: January 2020

Purpose

Children with cardiomyopathy are at risk of heart failure with reduced physical activity (PA) as a cardinal manifestation. Clinical assessment of PA in children is challenging due to the limited validity of subjective reports. The aim of the study was to compare accelerometery measurement with parental report and to identify factors associated with movement behavior (PA, sedentary time, steps per day).

Method

Fifteen patients with cardiomyopathy (mean, 9.7 years; 64% male) were asked to wear an Actigraph GT3X accelerometer in Edmonton, Canada. Demographics, clinical characteristics, parental-reported PA, and health-related quality of life data were also collected.

Results

Participants engaged in a median of 38 minutes of moderate-vigorous PA per day with higher levels in boys versus girls (73.9 [25.03, 78.91] vs 4.13 [2.53, 37.67] minutes, P = .03). Children participating in recreational sports showed a higher level of moderate-vigorous PA (73.92 min/d) compared with those who did not participate (73.9 vs 22.7 min/d, P = .05), and positive family outlook on the child's health was associated with less sedentary time (P = .04).

Conclusion

Accelerometer measurement in children with cardiomyopathy is an achievable and more objective measure of PA compared with parental report alone and highlighted low levels of PA among these children.
Two HEmostasis Methods After TransradIal Catheterization
Authors: dos Santos Simone Marques , Wainstein Rodrigo Vugman , Valle Felipe Homem , Corrêa Camille Lacerda , Aliti Graziella Badin , Ruschel Karen Brasil , Gonçalves Sandro Cadaval , Wainstein Marco Vugman , Rabelo-Silva Eneida Rejane
Published: January 2020

Objective

The aim of this study was to compare the effect of 2 hemostasis devices on the incidence of radial artery occlusion (RAO) after transradial cardiac catheterization.

Background

Radial artery occlusion is the most prevalent ischemic complication after radial artery catheterization. There is still no predictive pattern of vessel patency assessment, and the comparative effectiveness of different hemostasis techniques has yet to be established.

Methods

This study used a randomized clinical trial of adult patients undergoing transradial cardiac catheterization. Participants were randomized into an intervention group (hemostasis with the TR Band device) and a control group (hemostasis with a conventional pressure dressing). The primary end point was the incidence of RAO (at discharge and at 30 days post catheterization).

Results

Among the 600 patients included (301 in the intervention group and 299 controls), immediate RAO occurred in 24 (8%) in the TR Band group and 19 (6%) in the pressure-dressing group; at 30 days, RAO was present in 5 patients (5%) in the TR Band group and 7 (6%) in the pressure-dressing group. On multivariate analysis, peripheral vascular disease was the only independent predictor of RAO at discharge and at 30 days. Conclusions

The incidence of RAO was similar in patients who received hemostasis with a TR Band versus a pressure dressing after transradial cardiac catheterization.
Functional Capacity and Life Satisfaction in Older Adult Residents Living in Long-Term Care Facilities: The Mediator of Autonomy
Authors: LIU Li-Hsing , KAO Chia-Chan , YING Jeremy C.
Published: January 2020

Background

Although relationships among functional capacity, autonomy, and life satisfaction have been identified, little is known about how the mechanism of autonomy mediates functional capacity and life satisfaction in older adult residents of long-term care (LTC) facilities.

Purpose

The objectives of the study were to examine the relationship between functional capacity and life satisfaction in older adult residents living in LTC facilities and to test the extent to which autonomy mediated that relationship.

Methods

A cross-sectional and correlational study was conducted with a convenience sample. Two hundred twenty-eight participants were recruited from 10 LTC facilities in Kaohsiung City. Four structured instruments were used to collect data: the life satisfaction questionnaire, the Chinese version of Perceived Enactment Autonomy Scale, the Barthel Activity Daily Living Index, and a personal profile datasheet. Descriptive statistics, t tests, analysis of variance, Pearson correlations, and both simple and hierarchical linear regression models were analyzed.

Results

Positive associations between life satisfaction and functional capacity (r = .183, p = .003) and autonomy (r = .469, p < .001) were identified. Autonomy and functional capacity were significantly correlated (
r = .278, p < .001). After controlling for autonomy, the beta values reduced from .193 (p = .003) to .08 (p > .05), and the explained variance reduced from 3.7% to 0.1% between functional capacity and life satisfaction. The results indicate that autonomy is significant as a mediator.

Conclusions/Implications for Practice

To improve the life satisfaction of older adult residents of LTC facilities, facility managers and staff should develop a self-support program that encourages older adult residents to participate in physical activities and maintain autonomy.
Distinguishing atypical chronic myeloid leukemia from other Philadelphia-negative chronic myeloproliferative neoplasms
Authors: Sadigh Sam , Hasserjian Robert P. , Hobbs Gabriela
Published: January 2020

Purpose of review

Atypical chronic myeloid leukemia (aCML), BCR-ABL1-negative, is a rare myelodysplastic/myeloproliferative neoplasm (MDS/MPN) characterized by leukocytosis, granulocytic dysplasia, and typically poor patient outcomes. Since its first description as a variant CML lacking the Philadelphia chromosome (Ph), the diagnostic criteria for aCML have evolved significantly. Nevertheless, distinguishing it from other Ph-negative myeloid neoplasms can still be very challenging, and given its generally worse prognosis, this is a clinically important distinction. The purpose of this review is to conceptualize our understanding of aCML molecular genetics based on recent advances, and describe how genetic features can be used in conjunction with clinical and morphologic features to better diagnose this elusive entity.

Recent findings

The classification criteria for aCML have evolved and changed multiple times over the past decades, and is now based on strict application of morphologic, clinical and laboratory criteria. Recent work has elucidated the mutational landscape of aCML, especially with respect to potentially differentiating profiles compared with other Ph-negative myeloid neoplasms.

Atypical CML is a rare MDS/MPN overlap syndrome that can be diagnostically challenging; however, its emerging molecular genetic understanding and clinicomorphologic phenotype can help in distinguishing it from other Ph-negative myeloid neoplasms.