bluuebunny/crossref_metadata_2025 huggingface dataset:
Organizational Identity and Culture Change
Authors: Ravasi Davide , Schultz Majken
Published: June 2021

In this chapter, we build on research on the interplay between organizational culture and identity to propose a teleological model of culture change that acknowledges the multiple ways in which organizational identity may influence the process. Based on prior studies, we identify three change pathways. The first is characterized by the use of new identity claims to consolidate new and emerging practices, and incorporate them into the organizational culture. The second acknowledges how members may be pushed to alter established cultural practices by a severe misalignment between image and identity. The third draws attention to the role of new identity claims, articulating a new vision for the distant future, to stimulate the incorporation of new elements in the organizational culture.
Social preferences correlate with cortical thickness of the orbito-frontal cortex
Authors: Fariña Andrea , Rojek-Giffin Michael , Gross Jörg , De Dreu Carsten K W
Published: June 2021

Humans differ in their preferences for personal rewards, fairness and others’ welfare. Such social preferences predict trust, public goods provision and mutual gains bargaining and have been linked to neural activity in regions involved in reward computation, cognitive control and perspective-taking. Although shaped by culture, social preferences are relatively stable across time, raising the question whether differences in brain anatomy predict social preferences and their key components—concern for personal outcomes and concern for others’ outcomes. Here, we examine this possibility by linking social preferences measured with incentivized economic games to 74 cortical parcels in 194 healthy humans. Neither concerns for personal outcomes nor concerns for the outcomes of others in isolation were related to anatomical differences. However, fitting earlier findings, social preferences positively scaled with cortical thickness in the left olfactory sulcus, a structure in the orbital frontal cortex previously shown to be involved in value-based decision-making. Consistent with work showing that heavier usage corresponds to larger brain volume, findings suggest that pro-social preferences relate to cortical thickness in the left olfactory sulcus because of heavier reliance on the orbital frontal cortex during social decision-making.
Potential Susceptibility of Six Aquatic Plant Species to Infection by Five Species of Phytophthora
Authors: Bell Natasha L. , Jeffers Steven N. , Hitchcock Daniel R. , White Sarah A.
Published: June 2021

Investigations of the susceptibility of aquatic plants to species of Phytophthora are limited. Therefore, the objective of this study was to assess the potential susceptibility of six aquatic plant species, frequently used in constructed wetlands or vegetated channels, to infection by five species of Phytophthora commonly found at nurseries in the southeastern United States. In a greenhouse experiment, roots of each plant species (Agrostis alba, Carex stricta, Iris ensata ‘Rising Sun’, Panicum virgatum, Pontederia cordata, and Typha latifolia) growing in aqueous solutions were exposed to zoospores of each of the species of Phytophthora (Phytophthora cinnamomi, Phytophthora citrophthora, Phytophthora cryptogea, Phytophthora nicotianae, and Phytophthora palmivora). Zoospore presence and activity in solution were monitored with a standard baiting bioassay with rhododendron leaf discs as baits. Experiments were initiated in 2016 and repeated in 2017 and 2018. During the 2016 trials, Phytophthora spp. were not isolated from the roots of any of the plants, but some roots of C. stricta, P. virgatum, and T. latifolia were infected with multiple species of Phytophthora during trials in 2017 and 2018. Presence of plant roots reduced the percentage of rhododendron leaf discs infected by zoospores of four of the species of Phytophthora but not those infected by P. cinnamomi, which suggested that roots of these plants negatively affected the presence or activity of zoospores of these four species of Phytophthora in the aqueous growing solution. Results from this study demonstrated that certain aquatic plant species may be sources of inoculum at ornamental plant nurseries if these plants are present naturally in waterways or used in constructed wetlands treating water flowing off production areas, which could be of concern to plant producers who recycle irrigation water.
Lumbar Thecal Sac Dimensions and Axial Spinal Cord Areas on Magnetic Resosnace Imaging in 626 Healthy Subjects
Authors: Nakashima Hiroaki , Ito Keigo , Katayama Yoshito , Matsumoto Tomohiro , Tsushima Mikito , Ando Kei , Kobayashi Kazuyoshi , Machino Masaaki , Imagama Shiro
Published: June 2021

Study Design.

A cross-sectional study.

Objective.

The aim of this study was to investigate the lumbar thecal sac dimensions and spinal cord area on magnetic resonance (MR) imaging in healthy volunteers.

Summary of Background Data.

There are few reports regarding lumbar spine MRI in healthy subjects, and the difference in spinal canal dimensions by age remains unclear.

Methods.

A total of 629 healthy volunteers were enrolled, including ≥50 males, females, and subjects in each of the 20s to 70s age decades. The anteroposterior and transverse diameters of the thecal sac and axial areas of the thecal sac and spinal cord were measured at the disc levels on T2-weighted axial MR images. The anteroposterior-to-transverse ratio of the thecal sac (APTR) was calculated.

Results.

The thecal sac area from T12/L1 to L4/5 was reduced in older age group, but there was no significant difference in L5/S1. The thecal sac area was significantly reduced in older age group: 89.9%, 86.0%, 84.6%, 80.3% at T12/L1, L1/2, L2/3, and L3/4, respectively, and 79.9% at L4/5 in subjects in their 70 s relative to that in subjects in their 20 s. The APTR was significantly reduced in older age group from T11/12 to L2/L3 in males and at T10/11, L3/4 and from T11/12 to L2/3 in females. Narrow thecal sac areas <80 mm2 were found in 10 subjects. The spinal cord area was significantly reduced in older age group at T10/11 in males and at T9/10, T10/11, and T11/12 in females. The area was 92.0% at T10/11 in subjects in their 70s relative to the area of subjects in their 20s.

Conclusion.

The thecal sac area was reduced in older age group from T12/L1 to L4/5, and the thecal sac area was reduced in the anteroposterior and all directions in the upper and lower lumbar area in age group, respectively. Approximately, 3.0% of healthy population in their 50s or older will have severe asymptomatic stenosis.

Level of Evidence: 2
Epidemiological and Clinical Characterization of Superinfections in Critically Ill Coronavirus Disease 2019 Patients
Authors: Signorini Liana , Moioli Giovanni , Calza Stefano , Van Hauwermeiren Evelyn , Lorenzotti Silvia , Del Fabro Giovanni , Renisi Giulia , Lanza Paola , Saccani Barbara , Zambolin Giulia , Latronico Nicola , Castelli Francesco , Cattaneo Sergio , Marshall John C. , Matteelli Alberto , Piva Simone
Published: June 2021

OBJECTIVES:

To describe the epidemiology of superinfections (occurring > 48 hr after hospital admission) and their impact on the ICU and 28-day mortality in patients with coronavirus disease 2019 with acute respiratory distress syndrome, requiring mechanical ventilation.

DESIGN:

Retrospective analysis of prospectively collected observational data.

SETTING:

University-affiliated adult ICU.

PATIENTS:

Ninety-two coronavirus disease 2019 patients admitted to the ICU from February 21, 2020, to May 6, 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The prevalence of superinfection at ICU admission was 21.7%, and 53 patients (57.6%) had at least one superinfection during ICU stay, with a total of 75 (82%) ventilator-associated pneumonia and 57 (62%) systemic infections. The most common pathogens responsible for ventilator-associated pneumonia were Pseudomonas aeruginosa (n = 26, 34.7%) and Stenotrophomonas maltophilia (n = 14, 18.7%). Bloodstream infection occurred in 16 cases, including methicillin-resistant Staphylococcus epidermidis (n = 8, 14.0%), Enterococcus species (n = 6, 10.5%), and Streptococcus species (n = 2, 3.5%). Fungal infections occurred in 41 cases, including 36 probable (30 by Candida albicans, six by C. nonalbicans) and five proven invasive candidiasis (three C. albicans, two C. nonalbicans). Presence of bacterial infections (odds ratio, 10.53; 95% CI, 2.31–63.42; p = 0.005), age (odds ratio, 1.17; 95% CI, 1.07–1.31; p = 0.001), and the highest Sequential Organ Failure Assessment score (odds ratio, 1.27; 95% CI, 1.06–1.63; p = 0.032) were independently associated with ICU or 28-day mortality.

CONCLUSIONS:

Prevalence of superinfections in coronavirus disease 2019 patients requiring mechanical ventilation was high in this series, and bacterial superinfections were independently associated with ICU or 28-day mortality (whichever comes first).
Carotid Doppler Measurement Variability in Functional Hemodynamic Monitoring: An Analysis of 17,822 Cardiac Cycles
Authors: Kenny Jon-Émile S. , Barjaktarevic Igor , Mackenzie David C. , Elfarnawany Mai , Math Zhen Yang B. , Eibl Andrew M. , Eibl Joseph K. , Kim Chul Ho , Johnson Bruce D.
Published: June 2021

OBJECTIVES:

Carotid Doppler ultrasound is used as a measure of fluid responsiveness, however, assessing change with statistical confidence requires an adequate beat sample size. The coefficient of variation helps quantify the number of cardiac cycles needed to adequately detect change during functional hemodynamic monitoring.

DESIGN:

Prospective, observational, human model of hemorrhage and resuscitation.

SETTING:

Human physiology laboratory at Mayo Clinic.

SUBJECTS:

Healthy volunteers.

INTERVENTIONS:

Lower body negative pressure.

MEASUREMENTS AND MAIN RESULTS:

We measured the coefficient of variation of the carotid artery velocity time integral and corrected flow time during significant cardiac preload changes. Seventeen-thousand eight-hundred twenty-two cardiac cycles were analyzed. The median coefficient of variation of the carotid velocity time integral was 8.7% at baseline and 11.9% during lowest-tolerated lower body negative pressure stage. These values were 3.6% and 4.6%, respectively, for the corrected flow time.

CONCLUSIONS:

The median coefficient of variation values measured in this large dataset indicates that at least 6 cardiac cycles should be averaged before and after an intervention when using the carotid artery as a functional hemodynamic measure.
Cutting Edge: Novel Treatment Options Targeting Corneal Neovascularization to Improve High-Risk Corneal Graft Survival
Authors: Cursiefen Claus , Hos Deniz
Published: June 2021

Purpose:

Corneal neovascularization is an important risk factor for graft rejection after keratoplasty, although its role in posterior lamellar keratoplasty is not yet well defined. The aim of this work was to describe clinically available approaches that target corneal neovascularization preoperatively to improve graft survival after subsequent penetrating keratoplasty (PK) and to present findings on Descemet membrane endothelial keratoplasty (DMEK) in eyes with neovascularization.

Methods:

Recent work on the use of anti-vascular endothelial growth factor agents, fine needle diathermy (FND), and corneal collagen crosslinking (CXL) to regress corneal neovascularization before PK is summarized. Furthermore, studies that have investigated the outcome of DMEK in vascularized eyes are presented.

Results:

Pretreatment of recipient corneas with FND combined with anti-vascular endothelial growth factor agents is an effective method to reduce long-standing corneal neovascularization and results in relatively low rejection rates after subsequent high-risk PK. Peripheral CXL also seems to be a potent method to regress corneal neovascularization, although data on the impact of pretransplant CXL on long-term graft survival are not yet available. There are only limited data on graft rejection rates after DMEK in vascularized eyes, but initial studies indicate that DMEK seems to be a viable therapeutic option when no stromal scars are present. Furthermore, preexisting stromal neovascularization seems to regress after high-risk DMEK.

Conclusions:

Several angioregressive strategies to treat corneal neovascularization before PK have entered the clinic with promising initial results, which warrants larger trials with longer follow-up. Studies will also have to define the precise role of preexisting corneal neovascularization in high-risk DMEK.
Direct oral anticoagulant use in special populations
Authors: Lamarche Michelle C. , Alrajhi Eman , Wells Philip S.
Published: June 2021

Purpose of review

The pivotal phase III trials demonstrating efficacy and safety of direct oral anticoagulants (DOACs) in the treatment of venous thromboembolism (VTE) or nonvalvular atrial fibrillation (NVAF) excluded patients with important and common comorbidities, including obesity, advanced chronic kidney disease, cirrhosis, cancer and antiphospholipid antibody syndrome. Despite the lack of large prospective randomized control trials in these patient populations, the use of DOACs has led to a wealth of efficacy and safety data within these groups.

Recent findings

Retrospective studies, meta-analyses, national databases and pharmacokinetic data have shed light on the efficacy and safety of DOACs in these patient populations. Although DOACs should be avoided in those with high-risk triple positive antiphospholipid antibody syndrome, advanced cirrhosis, advanced kidney disease and intact gastrointestinal cancers, and used with caution in genitourinary cancers, their use extends beyond the inclusion criteria of the initial randomized control trials.

DOACs have revolutionized anticoagulant management and have become the cornerstone for VTE treatment and stroke prevention in NVAF. The decision to use DOACs must be individualized. Patient preference, underlying comorbidities and informed consent must always be considered when selecting the most appropriate anticoagulant.
Effect of aprepitant on kynurenine to tryptophan ratio in cART treated and cART naïve adults living with HIV
Authors: Spitsin Sergei , Pappa Vasiliki , Kinder Annemarie , Evans Dwight L. , Rappaport Jay , Douglas Steven D.
Published: June 2021

Changes in tryptophan metabolism affect human physiology including the immune system, mood, and sleep and are associated with human immunodeficiency virus (HIV) pathogenesis. This study investigates whether the treatment of HIV-infected individuals with the neurokinin-1 receptor antagonist, aprepitant, alters tryptophan metabolism.

This study utilized archival samples from 3 phase 1B clinical trials “Anti-HIV Neuroimmunomodulatory Therapy with Neurokinin-1 Antagonist Aprepitant”-2 double-blinded, placebo-controlled, and 1 open-label study. We tested samples from a total of 57 individuals: 26 combination antiretroviral therapy (cART) naïve individuals receiving aprepitant, 19 cART naïve individuals receiving placebo, and 12 individuals on a ritonavir-containing cART regimen receiving aprepitant. We evaluated the effect of aprepitant on tryptophan metabolism by measuring levels of kynurenine and tryptophan in archival plasma samples and calculating the kynurenine to tryptophan ratio.

Aprepitant treatment affected tryptophan metabolism in both cART treated and cART naïve individuals with more profound effects in patients receiving cART. While aprepitant treatment affected tryptophan metabolism in all HIV-infected patients, it only significantly decreased kynurenine to tryptophan ratio in cART treated individuals. Aprepitant treatment offers an opportunity to target inflammation and mood disorders frequently co-existing in chronic HIV infection.
A comparison of the effects of fire needle and routine acupuncture for myofascitis
Authors: Xiong Wei , Cheng Ling , Zhong Zhiying , Hou Xinju , Zhu Manhua , Zhou Xingchen , Zhu Siyuan , Chen Jun
Published: June 2021

Background:

Myofascitis is a common disease in clinic. The main cause of the disease is aseptic inflammation of local muscles and connective tissues such as myofascial, which can be manifested as paralysis, distension, and other discomfort, local muscle stiffness, spasm or palpable strain-like nodules. Chinese medicine ascribes it to “bi disease” and “Arthralgia disease,” while Western medicine believes that the disease is mainly due to local muscle and fascia edema and exudation caused by trauma or long-term strain, forcing nerves to jam and producing pain and other abnormal feelings. Although the disease is not life-threatening, the pain and distension caused by local inflammatory stimuli can affect the patient's daily life and sleep quality. The purpose of this systematic review is to evaluate the efficacy of fire needle vs routine acupuncture in the treatment of myofascitis.

Methods:

Randomized controlled trials (RCTS) of fire needle vs routine acupuncture for myofascial inflammation will be comprehensively searched from inception to September 2020 on PubMed, Embase, Cochrane Library, China Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), and Wanfang. Additionally, RCT registered sites, including http://www.ClinicalTrials.gov and http://www.chictr.org.cn, also will be the search. Visual analogue scale (VAS) was used to score the pain before and after treatment. The primary outcome will be to compare the difference in pain scores between the 2 interventions. Two independent authors filtered the literature in the above database, extracted the data, and cross-checked it.

Results:

This study will offer a reasonable comprehensive evidence for the treatment of myofascitis with fire needle.

Conclusion:

The conclusion of this study will provide evidence to judge the effectiveness of fire needle on myofascitis.

Registration number:

INPLASY202080034.
Acupoint injection combined with pelvic floor rehabilitation in the treatment of postpartum pelvic floor disorders
Authors: Zheng Ying , Yang Hongying , Yin Xunfu , Ma Xiujuan , Guo Llihua
Published: June 2021

Background:

Female pelvic floor dysfunction is one of the common chronic diseases affecting women's physical and mental health. Pregnancy and delivery are one of the main causes. Pelvic floor rehabilitation is a common method for the treatment of postpartum pelvic floor dysfunction, but it has some defects. Acupoint injection has advantages in the treatment of postpartum pelvic floor dysfunction, but there is a lack of standard clinical research to verify it. Therefore, the purpose of this randomized controlled trial is to evaluate the efficacy and safety of acupoint injection combined with pelvic floor rehabilitation in the treatment of postpartum pelvic floor disorders.

Methods:

This is a prospective randomized controlled trial to study the efficacy and safety of acupoints injection combined with pelvic floor rehabilitation. And it is approved by the Ethics Committee of Clinical Research of our hospital. Patients were randomly divided into observation group (acupoint injection combined with pelvic floor rehabilitation group) or control group (pelvic floor rehabilitation group alone). The patients were followed up for 8 weeks after 12 weeks of treatment. The observation indexes included: pelvic organ prolapse degree, pelvic floor muscle strength, urinary incontinence score, adverse reactions, among others. Data were analyzed using the statistical software package SPSS version 18.0.

Conclusions:

This study will evaluate the efficacy and safety of acupoint injection combined with pelvic floor rehabilitation in the treatment of postpartum pelvic floor dysfunction, and provide reliable reference for the clinical application of this project.

Trial registration:

OSF Registration number: DOI 10.17605/OSF.IO/VC65Z
Anlotinib, a novel TKI, as a third-line or further-line treatment in patients with advanced non-small cell lung cancer in China
Authors: Ye Haiyong , Li Zhaoyi , Liu Kangning , Zhang Feng , Cheng Zhengliang
Published: June 2021

Purpose:

In this meta-analysis and systemic review, we focused on the effectiveness and safety of anlotinib in patients with advanced non-small cell lung cancer(NSCLC).

Methods:

The databases of PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and CBM were searched by 2 investigators up to April 2020. Titles and abstracts of all records were screened and eligible publications were retrieved in full. Review Manager (version 5.2, Cochrane Library) was used for data analysis. The outcomes of interest were disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and treatment-related adverse event (TRAE). Data was pooled for quantitative analysis and the effect size was reported as hazard ratio for survival outcomes and odds ratio (OR) for safety outcomes, both with a random-effects model.

Results:

A sum of 1480 patients were included in 11 trials ranging from 2018 to 2020. Substantial improvements of PFS, OS, and DCR were observed in patients treated with anlotinib alone or in combination with other conventional treatment. Accompanied TRAE included statistically significant higher risk for hypertension (OR = 11.05, 95% confidence interval [CI] = 7.85–15.55, P < .001), hepatic dysfunction (OR = 1.96, 95% CI = 1.29–2.68, P < .001), diarrhea (OR = 2.20, 95% CI = 1.17–4.16, P < .05), and hemoptysis (OR = 2.59, 95% CI = 1.71–3.93, P < .01).

Conclusions:

Our study suggested that anlotinib as maintenance therapy for advanced NSCLC patients is associated with prolonged PFS and OS as well as DCR improvement, but it was accompanied by increased risk of TRAE, such as hypertension, hepatic dysfunction, diarrhea and hemoptysis. Although much effort has been made to clinical trials of anlotinib, further studies are warranted to provide more convincing evidence.
Risk factors associated with postoperative respiratory failure in tuberculous empyema patients
Authors: Ruan Hongyun , Liu FangChao , Gong Changfan , Yang Xinting , Han Ming
Published: June 2021

Our objective was to identify independent risk factors for predicting which patients in the Chinese population would likely develop respiratory failure.

A descriptive analysis was conducted of demographic and clinical data of patients with tuberculous empyema (TE) admitted to the Beijing Chest Hospital, Capital Medical University between January 2001 and January 2020. Risk factors associated with postsurgical respiratory failure in TE patients were identified based on results of analyses based on univariable and multivariable logistic regression models.

A total of 139 TE patients who underwent surgical treatment in the Beijing Chest Hospital, Capital Medical University from January 2001 to January 2020 were enrolled in this study. Cases included 109 male and 30 female patients, with an overall mean age (range 17–73) of 39.3 years. Of 139 TE patients, 26 (18.7%) experienced respiratory failure after surgery. Among significant risk factors for postsurgical respiratory failure, intraoperative blood loss volume greater than 1000 mL had the highest odds ratio value of 6.452. In addition, a pathologic preoperative pulmonary function test result showing a high partial pressure of carbon dioxide level was an independent risk factor for respiratory failure. Moreover, the presence of tuberculosis lesions in the contralateral lung was another significant risk factor for respiratory failure, as determined using multivariate analysis.

Respiratory failure is a predominant complication experienced by TE patients undergoing surgery. High intraoperative blood loss, high preoperative high partial pressure of carbon dioxide level, and tuberculosis lesion(s) in the contralateral lung of TE patients were associated with increased risk of postoperative respiratory failure.
Retrospective study of the efficacy of vascularized tissue transfer for treating antibiotic-resistant bacteria-infected wound
Authors: Kim Seong Hwan , Lee Ju Ho , Kim Seong Eun , Shin Se Ho , Kim Hyeon Jo , Lee Seong Joo , Kim Jae Hyun , Suh In Suck
Published: June 2021

If wounds are infected with bacteria resistant to an empirical antibiotic regimen, effective wound treatment will be delayed. This can delay wound healing and lengthen hospital stays, increasing the costs to patients. Long-term antibiotic use can also result in minor and major complications, such as diarrhea, antibiotic resistance, or life-threatening leukopenia. Multidrug-resistant (MDR) bacteria make wound treatment even more difficult. Traditionally, surgeons thought that adequate infection control should be established before soft tissue coverage. However, wounds infected by MDR do not heal well with this traditional method and there are no optimal treatment guidelines for MDR bacteria-contaminated wounds.

We reviewed 203 patients who underwent vascularized flap surgery from 2012 to 2019 to cover wounds. Class IV and I wounds were compared according to the Centers for Disease Control and Prevention classification. Class IV was further classified as antibiotic-resistant (ARB) and antibiotic-sensitive (ASB) bacteria. Wound size, mode, location, pathogens, healing time, and basic demographics were evaluated. Data were compared using Cramer's V and one-way ANOVA or independent t tests.

The average healing time was longer in the ARB (19.7 [range 7–44] days) and ASB (17.9 [range 2–36] days) groups than in the Clean group (16.5 [range 7–28] days). Healing time differed in the 3 groups (P = .036). It was longer in the class IV group than in the class I group (P = .01). However, it was not statistically different between the ARB and ASB groups (P = .164).

In our study the difference in healing time was small when vascularized tissue transfer was done in ARB-infected wound compared with ASB-infected and clean wound. It is necessary to perform surgery using vascularized tissue for the infected wound of antibiotic-resistant bacteria.
Association of smoking with postoperative atrial fibrillation in patients with cardiac surgery
Authors: Wan Qin , Li Siyuan , Hu Jian
Published: June 2021

Background:

Cigarette smoking is an important modifiable risk factor for incident atrial fibrillation. However, the impact of smoking on postoperative atrial fibrillation in patients undergoing cardiac surgery remains controversial. We performed this meta-analysis to explore the association of smoking with postoperative atrial fibrillation in patients with cardiac surgery.

Methods:

We systematically searched 2 computer-based databases (PubMed and EMBASE) up to July 2019 for all relevant studies. A random-effects model was selected to pool the odds ratios (ORs) and 95% confidence intervals (CIs). In this meta-analysis, the protocol and reporting of the results were based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement.

Results:

A total of 36 studies were included in this meta-analysis. Overall, smoking was not associated with an increased risk of postoperative atrial fibrillation in patients undergoing cardiac surgery (odds ratio [OR] = 0.89; 95% confidence interval [CI] 0.79–1.02). The corresponding results were stable in the subgroup analyses. Specifically, smoking was not associated with an increased risk of postoperative atrial fibrillation regardless of the type of cardiac surgery: coronary artery bypass grafting (OR = 0.91; 95% CI 0.77–1.07), valve surgery (OR = 0.15; 95% CI 0.01–1.56), and coronary artery bypass grafting+valve surgery (OR = 0.91; 95% CI 0.70–1.18).

Conclusions:

Based on currently published studies, smoking was not associated with an increased risk of postoperative atrial fibrillation in patients undergoing cardiac surgery.
Vitamin K2 (Menaquinone-7) supplementation does not affect vitamin K-dependent coagulation factors activity in healthy individuals
Authors: Ren Ruijun , Liu Jia , Cheng Guo , Tan Jing
Published: June 2021

Background:

Vitamin K has long been regarded as a procoagulant drug by physicians, and concerns have been raised with regard to its effects on hemostasis. Although many studies have shown that vitamin K supplementation is safe for thrombotic events, the effect of vitamin K supplementation on the activities of vitamin K dependent procoagulation factors in healthy individuals is not available.

Objectives:

This study aimed to investigate whether vitamin K2 supplementation at recommended doses affects the activity of vitamin K dependent procoagulation factors in healthy individuals without any anticoagulation treatment.

Design:

Forty healthy volunteers between 25 and 40 years of age were recruited. Menaquinone-7 (MK-7) was administrated at 90 μg for 30 days. Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and blood coagulation factors II, VII, IX, and X activities and Protein induced by vitamin K absence or antagonist-II (PIVKA-II) were measured on days 0 and 30 after MK-7 administration.

Results:

PT, APTT, and TT showed no significant differences on day 30 when compared with baseline. The activities of coagulation factors II, VII, IX, and X on day 30 showed no significant differences with those at baseline. PIVKA-II levels were unchanged after 30 days of MK-7 supplementation.

Conclusions:

MK-7 supplementation at recommended dosage does not affect vitamin K-dependent coagulation factors’ coagulation activity, and does not enhance the carboxylation of prothrombin in healthy individuals. This indicated that MK-7 administration does not alter hemostatic balance in healthy populations without anticoagulation treatment.
Effects of pain on depression, sleep, exercise tolerance, and quality of life in patients with nontuberculous mycobacterial pulmonary disease
Authors: Mori Kosuke , Tabusadani Mitsuru , Yamane Kazumasa , Takao Satoshi , Kuroyama Yuki , Matsumura Yusuke , Ono Kazuki , Kawahara Kazuma , Omatsu Shunya , Fujiwara Keiji , Furuuchi Koji , Morimoto Kozo , Kimura Hiroshi , Senjyu Hideaki
Published: June 2021

The experience and causes of pain in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) have not been clarified.

This study aimed to determine the prevalence and severity of bodily pain (BP) in patients with NTM-PD. We also investigated the clinical indicators that contribute to pain.

We used a retrospective cross-sectional study design. The participants were 114 NTM-PD patients (109 women) with a mean age of 65 years. The prevalence and severity of pain were measured using 2 items from the 36-Item Short Form Survey version 2 (SF-36), and the BP score was calculated. Functional limitation due to dyspnea was quantified using the Modified Medical Research Council Dyspnea Scale (mMRC), depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI); health-related quality of life was assessed using the Leicester Cough Questionnaire (LCQ), and exercise tolerance was measured using the Incremental Shuttle Walk Test (ISWT).

Pain was reported by 70.2% of the patients (n = 80), and of these, 35.7% (n = 25) reported moderate to very severe pain. NTM-PD patients with high levels of pain had significantly higher scores on the mMRC, CES-D, and PSQI scores, and significantly lower performance on the ISWT and LCQ. Multiple regression analysis identified ISWT, CES-D, and PSQI as independent factors that affected BP scores.

Our findings suggest that pain significantly impacts daily life associated with reduced exercise tolerance, the presence of depressive symptoms, and poor sleep quality in patients with NTM-PD.
Performance and educational training of radiographers in lung nodule or mass detection
Authors: Teng Pai-Hsueh , Liang Chia-Hao , Lin Yun , Alberich-Bayarri Angel , González Rafael López , Li Pin-Wei , Weng Yu-Hsin , Chen Yi-Ting , Lin Chih-Hsien , Chou Kang-Ju , Chen Yao-Shen , Wu Fu-Zong
Published: June 2021

The aim of this investigation was to compare the diagnostic performance of radiographers and deep learning algorithms in pulmonary nodule/mass detection on chest radiograph.

A test set of 100 chest radiographs containing 53 cases with no pathology (normal) and 47 abnormal cases (pulmonary nodules/masses) independently interpreted by 6 trained radiographers and deep learning algorithems in a random order. The diagnostic performances of both deep learning algorithms and trained radiographers for pulmonary nodules/masses detection were compared.

QUIBIM Chest X-ray Classifier, a deep learning through mass algorithm that performs superiorly to practicing radiographers in the detection of pulmonary nodules/masses (AUCMass: 0.916 vs AUCTrained radiographer: 0.778, P < .001). In addition, heat-map algorithm could automatically detect and localize pulmonary nodules/masses in chest radiographs with high specificity.

In conclusion, the deep-learning based computer-aided diagnosis system through 4 algorithms could potentially assist trained radiographers by increasing the confidence and access to chest radiograph interpretation in the age of digital age with the growing demand of medical imaging usage and radiologist burnout.
Off-label reduced-dose apixaban does not reduce hemorrhagic risk in Taiwanese patients with nonvalvular atrial fibrillation
Authors: Chen I-Chih , Chang Wei-Ting , Hsu Po-Chao , Yeh Ya-Lan , Zheng Syuan , Huang Yuan-Chi , Lin Chih-Hsien , Tsai Liang-Miin , Lin Li-Jen , Liu Ping-Yen , Liu Yen-Wen
Published: June 2021

East Asians are reportedly at high risk of anticoagulant-related bleeding; therefore, some physicians prefer to prescribe low-dose direct oral anticoagulants (DOACs). Little is known about the therapeutic effectiveness and safety of off-label reduced-dose apixaban in East Asians with nonvalvular atrial fibrillation (AF). We aimed to investigate the effectiveness and safety of off-label reduced-dose apixaban in Taiwanese patients with nonvalvular AF.

This retrospective cohort study enrolled 1073 patients with nonvalvular AF who took apixaban between July 2014 and October 2018 from 4 medical centers in southern Taiwan. The primary outcomes included thromboembolic events (stroke/transient ischemic attack or systemic embolism), major bleeding, and all-cause mortality.

Among all patients, 826 (77%) patients were classified as the “per-label adequate-dose” treatment group (i.e., consistent with the Food and Drug Administration label recommendations) while 247 (23%) patients were the “off-label reduced-dose” treatment group. The mean follow-up period was 17.5 ± 13 months. The “off-label reduced-dose” group did not have a lower major bleeding rate than the “per-label adequate-dose” group (4.8% vs 3.8%, adjusted hazard ratio [HR] 1.20, 95% confidence interval [CI] 0.69–2.09), but had a nonsignificantly higher incidence of thromboembolic events (4.23% vs 3.05%, adjusted HR: 1.29, 95% CI: 0.71–2.34).

An off-label reduced-dose apixaban treatment strategy may not provide incremental benefits or safety for Taiwanese patients with nonvalvular AF.
The tolerance of physiotherapy treatment in patients with COVID-19 and undergoing surgery for fragility hip fracture
Authors: Morri Mattia , Culcasi Antonio , Ruisi Riccardo , Raffa Debora , Sabattini Tania , Bardelli Roberta , Orlandi Antonella Magli
Published: June 2021

The aim of the present work was to evaluate the tolerance of physiotherapy treatment implemented for patients with coronavirus disease (COVID-19) and undergoing hip surgery

Case-control study. During the period between March and May 2020, 9 patients were enrolled in the study with diagnosis of COVID-19 and hip fracture. In order to evaluate the tolerability of physiotherapy treatment a comparison group, involving 27 patients with a hip fracture but in the absence of suspicion of COVID-19 positivity, were put together. Blood saturation and heart rate, number of physiotherapy sessions, start of physiotherapy from surgery, number of healthcare providers, recovery of ambulation, execution of walking training and dyspnea measured by Borg scale were collected before and after each single physiotherapy session to describe the exercise tolerance of the patients.

There are no significant differences between the two groups regarding basic characteristics. Average of Borg scale post treatment for COVID patients was 1.3 (DS = 1.3) compared to 0.6 (DS = 0.7) of non-COVID patients (P < .0005) but the breathing difficulty was light during the treatment, only 9% of COVID patients had a worsening superior of two points with Borg scale compared to 3% of non-COVID patients (P = .138). The incidence of walking recovery was 63% in the non-COVID patients group compared to 44.4% in the COVID group (P = .329).

Physiotherapy treatment of patients with COVID-19 infection and undergoing surgery for hip fracture is well tolerated and should be encouraged and well monitored.
Neutrophil–lymphocyte ratio as a prognostic factor for minute clear cell renal cell carcinoma diagnosed using multi-slice spiral CT
Authors: Chen Li , Qi Lingjun , Zhang Jing , Ma Qian , Chai Xiaoxin
Published: June 2021

Minute clear cell renal cell carcinoma (MccRCC) has a diameter of <1.5 cm and can be diagnosed using multi-slice spiral CT (MSCT). Recently, the role of the neutrophil–lymphocyte ratio (NLR) in the development of MccRCC has attracted attention. This study aimed to further explore the relationship between the NLR and MccRCC.

This was a prospective study of 100 patients who were diagnosed with MccRCC using MSCT at Urumqi Friendship Hospital, China. The study investigated a series of pretreatment factors, including NLR and patients’ general clinical data. Statistical methods employed included Pearson's chi-square test, Spearman-rho correlation test, Cox regression analysis, and receiver operator characteristic curve analysis.

Based on Pearson's χ2, Spearman-rho test, and univariate/multivariate Cox regression analysis, the overall survival of patients with MccRCC was shown to be significantly related to NLR (P < .001). NLR (hazard ratio = 50.676, 95%CI, 17.543–146.390, P < .001) is a significant independent risk-factor for MccRCC. A receiver operator characteristic curve was plotted to examine specificity and sensitivity between NLR and MccRCC (area under curve = 0.958, P < .001).

The level of the NLR plays a crucial role in the survival of patients with MccRCC, as diagnosed with MSCT. The higher the NLR, the worse the prognosis for patients with MccRCC.
Early LSD treatment in Denmark from 1960 to 1974
Authors: Larsen Jens Knud
Published: June 2021

In view of the renewed interest in psychedelics in psychiatry it is timely to analyze psychedelic treatment in historical cohorts. Recently the therapeutic efficacy of psychedelics has been linked to the so-called phenomenon of “connectedness.” The aim of the present study was to explore whether long-lasting personality changes were observed in any of the 151 Danish psychiatric patients who were treated with Lysergic acid diethylamide (LSD) from 1960 to 1974.

The exploration included a reanalysis of a subgroup as well from a 1964 Danish historical cohort. Medical records and other case materials of the above mentioned 151 patients are kept in the Danish State Archives. The present author was granted access to the LSD case materials in the Danish State Archives, and respected confidentiality per the Archives Law. According to the LSD Damages Law from 1986, they all received financial compensation for LSD-inflicted harm.

Analysis did not reveal any personality changes such as “connectedness;” however, other lasting personality changes were observed in 2 to 4 patients and in quite a few patients unwanted effects persisted for weeks or months following acute treatment. In the present analysis of the 1964 cohort, the same percentage of patients improved with LSD treatment as in the historical analysis. In the latter, however, little attention was given to side effects, such as suicide attempts, suicides, and one homicide.

Future psychedelic research with psychiatric patients should respect the potential toxicity of LSD and other psychedelics and meticulously monitor possible side effects.
Thoracoscopic radical esophagectomy combined with left inferior pulmonary ligament lymphadenectomy for esophageal carcinoma via the right thoracic approach
Authors: Huang Shijie , Yang Tianbao , Wang Wu , Huang Guozhong , Chen Boyang , Chen Pengfei , Ke Douli , Huang Wenhua , Xie Jinbiao
Published: June 2021

To evaluate the necessity, safety, and feasibility of left inferior pulmonary ligament lymphadenectomy during video-assisted thoracic surgery (VATS) radical esophagectomy via the right thoracic approach.

Thirty patients (20 men, 10 women) with thoracic esophageal squamous cell carcinoma (ESCC) were recruited for this study. The patients’ age ranged from 50 to 80 years, with an average age of 66.17 ± 7.47 years. After the patients underwent VATS radical esophagectomy and left inferior pulmonary ligament lymph node dissection (LIPLND) via the right thoracic approach, the operative outcomes included operative time, length of hospital stay, postoperative complications, number of lymph nodes removed, and postoperative pathologic results were evaluated.

There were no massive hemorrhages of the left inferior pulmonary vein during the operation. The operative time of LIPLND was 8.67 ± 2.04 minutes, and the length of postoperative hospital stay was 12.23 ± 2.36 days. The postoperative complications included 2 cases of left pneumothorax, 4 pulmonary infection cases, and no chylothorax. Moreover, 68 LIPLNs were dissected, 5 of which were positive, and the degree of metastasis was 7.4%. The postoperative pathologic results showed that 3 cases of LIPLNs were positive, with a metastasis rate of 10.0%. Among them, 2 cases were SCC of the lower thoracic esophagus, and 1 case was SCC of the middle thoracic esophagus, which involved the lower segment.

Thoracoscopic esophagectomy combined with left inferior pulmonary ligament lymphadenectomy for esophageal carcinoma via the right thoracic approach will not increase the difficulty of operation, increase the incidence of postoperative complications or prolong the postoperative hospital stay, and can theoretically reduce tumor recurrence. Therefore, we believe that LIPLND is necessary, safe, and feasible and is worthy of clinical popularization and application.
Transesophageal echocardiography detection of air embolism during endoscopic surgery and validity of hyperbaric oxygen therapy
Authors: Guo Ji-ling , Wang Han-bing , Wang Hong , Le Yue , He Jian , Zheng Xue-qin , Zhang Zhi-hao , Duan Guang-rong
Published: June 2021

Introduction:

Air embolism has the potential to be serious and fatal. In this paper, we report 3 cases of air embolism associated with endoscopic medical procedures in which the patients were treated with hyperbaric oxygen immediately after diagnosis by transesophageal echocardiography. In addition, we systematically review the risk factors for air embolism, clinical presentation, treatment, and the importance of early hyperbaric oxygen therapy efficacy after recognition of air embolism.

Patient Concerns:

We present 3 patients with varying degrees of air embolism during endoscopic procedures, one of which was fatal, with large amounts of gas visible in the right and left heart chambers and pulmonary artery, 1 showing right heart enlargement with increased pulmonary artery pressure and tricuspid regurgitation, and 1 showing only a small amount of gas images in the heart chambers.

Diagnoses:

Based on ETCO2 and transesophageal echocardiography (TEE), diagnoses of air embolism were made.

Interventions:

The patients received symptomatic supportive therapy including CPR, 100% O2 ventilation, cerebral protection, hyperbaric oxygen therapy and rehabilitation.

Outcomes:

Air embolism can causes respiratory, circulatory and neurological dysfunction. After aggressive treatment, one of the 3 patients died, 1 had permanent visual impairment, and 1 recovered completely without comorbidities.

Conclusions:

While it is common for small amounts of air/air bubbles to enter the circulatory system during endoscopic procedures, life-threatening air embolism is rare. Air embolism can lead to serious consequences, including respiratory, circulatory, and neurological impairment. Therefore, early recognition of severe air embolism and prompt hyperbaric oxygen therapy are essential to avoid its serious complications.
Successful treatment of severe myocardial injury complicated with refractory cardiogenic shock caused by AOPP using extracorporeal membrane oxygenation
Authors: Li Yang , Cao ChunShui , Luo XiaoLong , Huang Liang
Published: June 2021

Rationale:

Acute organophosphorus pesticide poisoning (AOPP) is a common critical illness observed in clinical practice, and severe AOPP can cause serious cardiac toxicity.

Patient concerns:

This patient was a 43-year-old woman who was admitted to the emergency department with acute respiratory failure and hypotension 13 hours after oral consumption of 300 mL of phoxim pesticide.

Diagnoses:

Acute organophosphorus pesticide poisoning, cardiogenic shock.

Interventions:

We conducted veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy as the patient did not respond to conventional measures.

Outcomes:

This patient was successfully rescued with VA-ECMO therapy and discharged.

Lessons:

We suggest that for patients with severe myocardial injury complicated with cardiogenic shock caused by AOPP, the use of VA-ECMO therapy can improve the prognosis.
Implications of Electronic Consultations for Clinician Communication and Relationships
Authors: Anderson Ekaterina , Vimalananda Varsha G. , Orlander Jay D. , Cutrona Sarah L. , Strymish Judith L. , Bokhour Barbara G. , Rinne Seppo T.
Published: June 2021

Background:

Strong relationships and effective communication between clinicians support care coordination and contribute to care quality. As a new mechanism of clinician communication, electronic consultations (e-consults) may have downstream effects on care provision and coordination.

Objective:

The objective of this study was to understand primary care providers’ and specialists’ perspectives on how e-consults affect communication and relationships between clinicians.

Research Design:

Qualitative study using thematic analysis of semistructured interviews.

Subjects:

Six of 8 sites in the VISN 1 (Veterans Integrated Service Network) in New England were chosen, based on variation in organization and received e-consult volume. Seventy-three respondents, including 60 clinicians in primary care and 3 high-volume specialties (cardiology, pulmonology, and neurology) and 13 clinical leaders at the site and VISN level, were recruited.

Measures:

Participants’ perspectives on the role and impact of e-consults on communication and relationships between clinicians.

Results:

Clinicians identified 3 types of e-consults’ social affordances: (1) e-consults were praised for allowing specialist advice to be more grounded in patient data and well-documented, but concerns about potential legal liability and increased transparency of communication to patients and others were also noted; (2) e-consults were perceived as an imperfect modality for iterative communication, especially for complex conversations requiring shared deliberation; (3) e-consults were understood as a factor influencing clinician relationships, but clinicians disagreed on whether e-consults promote or undermine relationship building.

Conclusions:

Clinicians have diverse concerns about the implications of e-consults for communication and relationships. Our findings may inform efforts to expand and improve the use of e-consults in diverse health care settings.