bluuebunny/crossref_metadata_2025 huggingface dataset:
Health and Neurodevelopment of Children Born to Opioid-Dependent Mothers at School Entry
Authors: Lee Samantha J. , Pritchard Verena E. , Austin Nicola C. , Henderson Jacqueline M. T. , Woodward Lianne J.
Published: August 2019

Objective:

To examine the school readiness of a regional cohort of prenatally methadone-exposed children across 5 domains and to examine factors contributing to impairment risk.

Methods:

Data were drawn from a single-center, prospective longitudinal study. One hundred children born to women in methadone maintenance treatment and 110 randomly identified non–methadone-exposed children were studied from birth (2003–2008) to age 4.5 years. At 4.5 years, children underwent comprehensive assessment of their physical/motor development, social-emotional skills, approaches to learning, language development, and cognitive functioning. Predictors of children's overall school readiness were examined, including the extent of prenatal substance exposure (number and quantity of different substances), social risk, maternal mental health, infant clinical factors, and the quality of the home environment at age 18 months Home Observation for Measurement of the Environment (HOME) score.

Results:

Methadone-exposed children had higher rates of delay/impairment across all outcome domains (odds ratios 4.0–5.3), with 72% impaired in at least 1 domain. Multiple problems were also common, affecting 48% of methadone-exposed children compared with 15% of control children. The mean number of school readiness domains impaired increased, with increasing prenatal substance exposure (rate ratio [RR] = 1.05 [1.01–1.11]), higher social risk (RR = 1.35 [1.20–1.53]), male sex (RR = 1.69 [1.27–2.25]), and lower HOME scores indicating a poorer quality postnatal environment (RR = 0.96 [0.94–0.99]).

Conclusion:

Children born to opioid-dependent mothers are at high risk of impaired school readiness, with multiple domain problems being common. Impaired school readiness was associated with greater maternal prenatal substance use, higher social risk, male sex, and lower‐quality caregiving environments.
Emerging Nonsteroid-Based Procedural Therapies for Alopecia Areata: A Systematic Review
Authors: Marchitto Mark C. , Qureshi Azam , Marks Dustin , Awosika Olabola , Rengifo-Pardo Monica , Ehrlich Alison
Published: August 2019

BACKGROUND

Alopecia areata (AA) is a common form of patchy, nonscarring hair loss. Although intralesional steroid injections are currently the mainstay procedural therapy for AA, other nonsteroid-based procedural therapies, including platelet-rich plasma (PRP), ultraviolet radiation (UVR), and laser-based modalities, are emerging as practical options.

OBJECTIVE

To systematically review nonsteroid-based procedural therapies for AA and recapitulate the available clinical data.

MATERIALS AND METHODS

A systematic review of the literature was performed searching PubMed/MEDLINE databases identifying studies investigating PRP, UVR, and laser-based modalities for AA treatment.

RESULTS

Literature search yielded 644 articles encompassing PRP, UVR, and laser treatment modalities for AA. Of the 644 articles, 46 met inclusion criteria. Although numerous reports demonstrate strong potential for PRP, UVR, and laser modalities in treating AA, high-quality evidence supporting their efficacy is still lacking.

CONCLUSION

There is an abundance of evidence for nonsteroid-based procedural therapies in the treatment of AA. Randomized control trials comparing these treatment options head-to-head should be performed to better understand the true efficacy of these treatments.
Teledermatology as a Tool for Preoperative Consultation Before Mohs Micrographic Surgery Within the Veterans Health Administration
Authors: Lee Steven , Dana Ali , Newman Jessica
Published: August 2019

BACKGROUND

Telemedicine is improving access to subspecialty care within the Veterans Health Administration (VHA). Mohs micrographic surgery (MMS) is a surgical modality used to treat nonmelanoma skin cancers.

OBJECTIVE

This study evaluates the use of teledermatology for preoperative consultation for MMS.

METHODS AND MATERIALS

A retrospective analysis of interfacility MMS referrals to the Bronx Veterans Affairs Medical Center (VAMC) was conducted. The consult failure rates (CFRs), treatment follow-through rates, time to treatment, and travel savings for “face-to-face” preoperative consults were compared with store-and-forward “teledermatology” preoperative consults.

RESULTS

Although both “teledermatology” and “face-to-face” preoperative consults resulted in an equivalent percentage of treated lesions, teledermatology had a significantly decreased CFR. In addition, teledermatology decreased the time to treatment by 2 weeks, increased the percentage of lesions treated within 60 days, and resulted in average travel savings of 162.7 minutes, 144.5 miles, and $60.00 per person.

CONCLUSION

This study demonstrates that teleconsultation is effective for preoperative consults for MMS within the VHA system. Teledermatology improved access measures such as time to treatment and travel burden. This program may serve as a model not only for other VAMCs that accept interfacility MMS consults, but also for VAMCs that provide other types of access-limited subspecialty care.
A Critical Appraisal of Adult Trigger Finger: Pathophysiology, Treatment, and Future Outlook
Authors: Brozovich Nikolas , Agrawal Devandra , Reddy Gangadasu
Published: August 2019

Background:

Trigger finger (TF) is a common referral to a hand surgeon, with people with diabetess being the most at-risk population. Abnormal thickening, scarring, and inflammation occur at the A1 pulley and flexor tendon, and histological changes correlate well with the clinical severity of TF. Corticosteroid injections decrease the thickness of the A1 pulley and are considered a first-line treatment. However, corticosteroids are only moderately effective, especially for people with diabetes. Patients may elect for surgery if nonoperative treatments prove ineffective; some may choose immediate surgical release instead. To release the A1 pulley, patients have the option of an open or percutaneous approach. The open approach has a greater risk of infection and scar tissue formation in the short run but an overall superior long-term outcome compared with the percutaneous approach.

Methods:

We critically reviewed the efficacy and cost-effectiveness of the treatment methods for TF through a comprehensive search of the PubMed Database from 2003 to 2019.

Results:

To reduce costs, while still delivering the best possible care, it is critical to consider the likelihood of success for each treatment method in each subpopulation. Furthermore, some patients may need to return to work promptly, which ultimately may influence their desired treatment method.

Conclusions:

Currently, there is no universal treatment algorithm for TF. From a purely financial standpoint, women without diabetes presenting with a single triggering thumb should attempt 2 corticosteroid trials before percutaneous release. It is the most cost-effective for all other subpopulations to elect for immediate percutaneous release.
Direct Reprogramming Into Corneal Epithelial Cells Using a Transcriptional Network Comprising PAX6, OVOL2, and KLF4
Authors: Kitazawa Koji , Hikichi Takafusa , Nakamura Takahiro , Nakamura Masahiro , Sotozono Chie , Masui Shinji , Kinoshita Shigeru
Published: August 2019

In its early stages, an embryo polarizes to form cell subpopulations that subsequently produce specific organ cell types. These cell subpopulations are defined by transcription factors (TFs) that activate or repress specific genes. Although an embryo comprises thousands of TFs, surprisingly few are needed to determine the fate of a given cell. The ectoderm divides into the neuroectoderm and surface ectoderm, the latter of which gives rise to epidermal keratinocytes and corneal epithelial cells (CECs). Meanwhile, neuroectoderm cells give rise to other parts of the eye such as the corneal endothelium and retina. To investigate the regulatory role of TFs in CECs, we overexpressed the “core TFs” (PAX6, OVOL2, and KLF4) in human fibroblasts and found that the cells adopted a CEC-like quality. OVOL2 overexpression was even able to directly induce cells with a neuroectoderm fate toward a surface ectoderm fate, designated “direct reprogramming.” Conversely, suppression of OVOL2 or PAX6 expression induced CECs to show qualities consistent with neural lineage cells or epidermal keratinocytes, respectively. This suggests that these core TFs can maintain the CEC phenotype through reciprocal gene regulation. Direct reprogramming has important implications for cell therapies. The potential benefits of cells derived by direct reprogramming compared with induced pluripotent stem cells include the fact that it requires less time than reprogramming a cell back to the pluripotent state and then to another cell type. Further understanding of the reciprocally repressive mechanism of action for core TFs could lead to alternative treatments for regenerative medicine not requiring cell transplantation.
Testing the intergenerational model of transmission of risk for chronic pain from parents to their children: an empirical investigation of social transmission pathways
Authors: Higgins Kristen S. , Chambers Christine T. , Rosen Natalie O. , Sherry Simon , Mohammadi Somayyeh , Lynch Mary , Campbell-Yeo Marsha , Clark Alexander J.
Published: August 2019

Children of parents with chronic pain have higher rates of pain and internalizing (eg, anxiety and depressive) symptoms than children of parents without chronic pain. Parental modeling of pain behaviour and reinforcement of child pain have been hypothesized to underlie these relationships. These mechanisms were tested in a sample of 72 parents with chronic pain and their children (aged 8-15 years). Standardized measures were completed by parents (pain characteristics, pain interference, and child internalizing) and children (pain catastrophizing, pain over previous 3 months, and internalizing). In a laboratory session, children completed the cold pressor task in the presence of their parent, and parent–child verbalizations were coded. Significant indirect effects of parental pain interference on child self-reported (B = 0.12, 95% confidence interval [CI]: 0.01-0.29) and parent-reported (B = 0.16, 95% CI: 0.03-0.40) internalizing symptoms through child pain catastrophizing were found (parental modeling mechanism), and were not moderated by child chronic pain status. Significant indirect effects were found between parent pain-attending verbalizations and child self-reported (B = 2.58, 95% CI: 1.03-5.31) and parent-reported (B = 2.18, 95% CI: 0.93-4.27) cold pressor task pain intensity and tolerance (B = −1.02, 95% CI: −1.92 to −0.42) through child pain-attending verbalizations (parental reinforcement mechanism). Although further understanding of the temporal relationships between these variables is needed, the current study identifies constructs (eg, parent pain interference, child pain catastrophizing, and parent reinforcement of child pain) that should be further examined as potential targets for prevention and intervention of pain and internalizing symptoms in children of parents with chronic pain.
Gait Analysis in Individuals with Transtibial Amputation Walking on Sand: Comparing Everyday Prosthesis with a Water-Activity Prosthesis
Authors: van den Berg Maayken E.L. , Barr Christopher J. , Cavenett Sally , Crotty Maria
Published: August 2019

Introduction

This exploratory descriptive case-control study examined gait characteristics during sand walking in people with unilateral transtibial amputation, comparing patterns between everyday prosthesis with shoe, everyday prosthesis without shoe (EPWS), and a water-activity prosthesis (WAP), and evaluated how users experience the use of the WAP.

Materials and Methods

Three-dimensional gait analysis, using an eight-camera Vicon motion capture system, was completed for 16 participants (mean age, 51.4 ± 5.5; 75% male, amputation etiology 63% trauma) when walking independently over level ground (baseline) and sand (gait adaptation response). Outcome variables were spatiotemporal data and kinematic data for the hip, knee, and ankle, and additionally, a purposefully designed Water Activity Prosthesis Survey was completed.

Results

The results demonstrated cautious gait with reduced walking speed (P < 0.05) and decreased ankle range of motion (<0.05) in the prosthetic limb when walking with the EPWS and WAP. Using the WAP resulted in most prominent kinematic adaptational changes on sand. When comparing differences between the EPWS and WAP, significantly less hip extension (−2.92°; 95% confidence interval, −5.56 to −0.28; P = 0.02) and significantly less movement at the ankle (P < 0.05) occurred in the prosthetic limb in walking trials with the WAP. Nevertheless, more than 80% of the participants used the WAP at least twice a week for shower, pool, and beach activities.

Conclusions

This study suggests that, although important for participation in ADL and leisure activities and supporting higher quality of life, the use of the WAP leads to unfavorable biomechanical gait alterations. Therefore, when prescribing the WAP, this trade-off should be taken into consideration.
Does expanded state scope of practice for nurse practitioners and physician assistants increase primary care utilization in community health centers?
Authors: Park Jeongyoung , Han Xinxin , Pittman Patricia
Published: August 2019

Background and purpose:

Expanding state scope of practice (SOP) for nurse practitioners (NPs) and physician assistants (PAs) can boost productivity and improve access to health care services. Existing analyses on regulatory policies in NP or PA SOP have primarily focused on the direct effects on their own professions but have not fully considered the potential cross-professional effects. This study examines the impact of expanded state SOP for NPs and PAs on primary care utilization by NP, PA, and primary care physician (PCP) in community health centers (CHCs).

Methods:

We conducted a difference-in-differences approach using the Uniform Data System for 739 CHCs from 2009 to 2015. During our study period, 12 states liberalized NP SOP laws and 14 states changed their PA SOP regulations. The number of visits per full-time equivalent clinician (NP, PA, and PCP) per year was the outcome of interest and was linked to the degree of state SOP restriction for NPs and PAs in a given year.

Conclusions:

Granting independent practice and prescriptive authority for NPs resulted in statistically significant increases in NP visits, and decreases in both PA and PCP visits, for those CHCs with a high proportion of NPs and PAs along with the increased provision of support staff. PA SOP liberalization had no statistically significant effect on PA visits.

Implications for practice:

As the NP and PA workforce continues to grow, and as SOP laws continue to be liberalized, it is important to advance evidence on how to most efficiently deploy these staff.
Recombined humanized endostatin (Endostar) intravenous infusion in the treatment of refractory nasopharyngeal carcinoma
Authors: Chen Chen , Liu Song-Ran , Zhou Shu , Li Xiao-Hui , Wang Xiao-Hui , Tao Ya-Lan , Chang Hui , Zhang Wen-Wen , Li Wen-Fei , Zhou Si-Lang , Xia Yun-Fei
Published: August 2019

Rationale:

Refractory nasopharyngeal carcinoma is challenging to treat and at present there is no standard treatment or any good choice.

Patient concerns:

Although the three patients in our case reports had already underwent multiple treatments before, they still suffered from disease recurrence of nasopharyngeal carcinoma.

Diagnosis:

They were diagnosed as refractory nasopharyngeal carcinoma.

Interventions:

A continuous infusion of Endostar, an antiangiogenic agent, combined with chemotherapy and radiation therapy was given to treat the patients.

Outcomes:

Patients showed complete or partial response to the combined therapy as evidenced by regression of tumors and decrease in plasma Epstein–Barr virus (EBV) DNA load.

Lessons:

Continuous infusions of Endostar in combination with chemotherapy and/or radiation therapy showed promising efficacy and safety. The combination therapy indicates a new approach to treat refractory nasopharyngeal carcinoma.
Is allograft a more reliable treatment option than autograft in 2-level anterior cervical discectomy and fusion with plate fixation?
Authors: Park Jin-Sung , Park Se-Jun , Lee Chong-Suh , Chung Sung-Soo , Park Hyun-Jin
Published: August 2019

This study aimed to assess the efficacy of allograft in 2-level anterior cervical discectomy and fusion (ACDF) with plate fixation by comparing its clinical and radiological outcomes to those of autograft.

Thirty five patients with femur cortical allografts and 32 patients with tricortical iliac autografts were evaluated. All surgeries were performed by a single senior surgeon. During routine follow-up (at 3 months, 6 months, and annually after the surgery), the fusion rate, subsidence rate, and fused segmental lordosis angle were assessed by radiologic evaluation. Clinical outcomes were assessed using the visual analog scale (VAS), neck disability index (NDI) scores, and Odom criteria. This study was conducted using the results of the 2-year postoperative follow-up.

Among 67 patients, 62 (92.5%) showed successful bone fusion at 2 years postoperatively: 91.4% (32/35) in the allograft group and 93.8% (30/32) in the autograft group. The fusion rate was 37.1% (13/35) in the allograft group and 68.8% (23/32) in the autograft group at 6 months and 68.5% (24/35) in the allograft group and 93.8% (30/32) in autograft group at 1 year. Eight (72.7%) of the remaining 11 patients with allograft achieved bone fusion without any intervention at the 2-year follow-up. The fusion was achieved faster in the autograft group than in the allograft group (P = .003). There was no significant difference in the subsidence rate or change in the fused segmental lordosis angle between the 2 groups; there was also no significant difference in clinical outcomes (NDI scores, VAS scores, Odom criteria) between the 2 groups. However, the intraoperative blood loss was significantly greater in the autograft group, and the operative time was also significantly longer in the autograft group (P < .001). In the autograft group, 6 patients (18.8%) had minor complications at the donor site.

In 2-level ACDF with plate fixation, the radiologic and clinical outcomes of autograft and allograft were similar at 2-year follow-up, although fusion was observed earlier in the autograft group.
Analysis of human leukocyte antigen allele polymorphism in patients with non alcoholic fatty liver disease
Authors: Karrar Azza , Hariharan Siddharth , Fazel Yousef , Moosvi Ali , Houry Mohamad , Younoszai Zahra , Jeffers Thomas , Zheng Li , Munkhzul Otgonsuren , Hunt Sharon , Monge Fanny , Goodman Zachary , Younossi Zobair M.
Published: August 2019

The human leukocyte antigen (HLA) genes may play a role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH). The aim of this study was to assess the association of HLA class I and II alleles with NASH and its histological features.

Deoxyribonucleic acid (DNA) was extracted from 140 subjects (85 biopsy-proven NAFLD and 55 controls) and genotyped for HLA (-A, -B, -C, -DR1, -DR3, -DQ, and -DP). Liver biopsies were assessed for presence of NASH, degree of fibrosis and inflammation. Multivariate analysis was performed to assess associations between HLA genes and different histologic features of NAFLD.

Our data for HLA class I showed that HLA-C∗4 was associated with lower risk for histologic NASH and HLA-C∗6 was protective against portal fibrosis. Conversely, HLA-B∗27 was associated with high-grade hepatic steatosis, while HLA-A∗31 was associated with increased risk for advanced fibrosis. Among HLA class II alleles, HLA-DQA1∗01 was associated with lower risk for NASH while HLA-DRB1∗03 was associated with increased risk for NASH.

Our findings indicate that HLA class I and II gene polymorphism may be associated with susceptibility to NASH, fibrosis and other pathologic features and may be involved in the pathogenesis of NAFLD.
Immobilization in external rotation vs internal rotation after shoulder dislocation
Authors: Cui Xin , Liang Long , Zhang Hongyan , Zhao Jing , Li Yongyao , Cheng Hao , Wang Shiheng , Zhang Yue
Published: August 2019

Background:

Dislocation of shoulder joint is the most prone to occurrence in all joints of human body, which is common in young people and has a high recurrence rate. It is mainly treated by conservative treatment. External rotation and internal rotation fixation are 2 common conservative therapies in clinical practice. Therefore, we conduct this systematic review and meta-analysis to evaluate the efficacy and safety of the 2 treatments.

Methods:

Nine electronic databases, PubMed, Web of Science, Embase, Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov, CNKI, Wanfang Database and VIP Database, will be searched to find and include randomized controlled trials that meet inclusion criteria. RevMan5.3 will be used for data analysis and synthesis in this study. Subgroup analysis and sensitivity analysis will also be performed if necessary. In addition, GRADE will be used in the evaluation of evidence hierarchy.

Results:

This study will analyze and integrate the original evidence so far for clinical efficacy and safety of immobilization in external rotation and internal rotation on shoulder dislocation.

Conclusion:

The conclusion of this study will conclude higher evidence and suggestions for the treatment of shoulder dislocation, so as to further guide clinical decision making.

PROSPERO registration number:

CRD42018106030.
Associations between gastric cancer risk and virus infection other than Epstein-Barr virus
Authors: Wang Rui , Liu Kai , Chen Xin-Zu
Published: August 2019

Background:

Gastric cancer is one of the infection associated malignancies. In addition to Helicobacter pylori and Epstein-Barr virus (EBV), other oncoviruses might play potential roles in the development of gastric cancer. Associations of oncoviruses other than EBV with gastric cancer risk are aimed to be comprehensively reviewed and assessed in this systematic review and meta-analysis, to identify any potentially causative oncovirus. It might be informative to identify or deny certain oncoviruses which are candidates of risk factor for gastric cancer. To our knowledge, there is no comprehensive review on oncoviruses other than EBV associated with gastric cancer risk. Positive findings might be helpful to suggest further mechanism investigation and high-risk subpopulation recommendation.

Methods:

PubMed database will be searched up to Dec 31, 2018. The studies, compared the positivity of any oncovirus other than EBV between cases with histologically proven gastric cancer and healthy or nonmalignant controls, are eligible. The detection of oncovirus either in tissue or blood is acceptable. Selection, quality assessment (Newcastle-Ottawa Scale), and data extraction of eligible studies will be performed by 2 independent reviewers. Pooled prevalence of any oncovirus will be combined by meta-analysis for rate. Pooled odds ratio between gastric cancer cases and controls will be estimated by meta-analysis. Heterogeneity and publication bias will be tested. In sensitivity analysis, the leave-one-out method and exclusion of low power studies will be applied where applicable.

Results:

This review was not submitted for any ethical approval due to the literature-based nature. The results will be published in a journal and presented at conferences for academic purposes.

Registration number was CRD42015029703 in the PROSPERO International Prospective Register of Systematic Reviews.

Conclusions:

To our knowledge, there is no comprehensive review on oncoviruses other than EBV associated with gastric cancer risk. Positive findings might be helpful to suggest further mechanism investigation and high-risk subpopulation recommendation.
Mid-arm circumference method is invalid to estimate the body weight of elderly Emergency Department patients in the Netherlands
Authors: Opdam Marieke H. , Koekkoek Kristine W.A.C. , Boeije Tom , Mullaart Nieke , van Zanten Arthur R.H.
Published: August 2019

In the Emergency Department (ED) actual body weight (ABW) is essential for accurate drug dosing. Frequently, the ABW is unknown and direct measurement troublesome. A method using the mid-arm circumference (MAC) to estimate ABW has been developed and validated in the United States of America (USA). This study aimed to validate the MAC-formula for estimating ABW in the Dutch population and compare its performance within the American population.

Data were obtained from the Dutch National Institute for Public Health and the Environment (RIVM) and extracted from the American National Health and Nutrition Examination Survey (NHANES) datasets. We included all subjects’ ≥70 years whose MAC and weight were recorded and obtained additional anthropometric data. We used the equation: kg = 4 × MAC-50 to estimate the ABW of all subjects and compared results.

We retrieved 723 and 972 subjects from the Dutch and American dataset, respectively. The MAC is better correlated with ABW in the American dataset when compared with the Dutch dataset (Pearson r = 0.84 and 0.68, respectively). Bland-Altman bias was –7.49 kg (Limits-of-Agreement [LOA] –27.5 to 12.27 kg) and –0.50 kg (LOA –20.99 to 19.99 kg) in the Dutch and American datasets, respectively.

The MAC based formula to estimate ABW is a promising tool for the elderly American population. However it is not accurate within the Dutch elderly ED population. Consequently, it is not applicable to Dutch EDs. This study highlights that the results of anthropometric studies performed within the USA are not per se generalizable to the European population.
Efficacy of denosumab for restoring normal bone mineral density in women receiving adjuvant aromatase inhibitors for early breast cancer
Authors: Sakaguchi Koichi , Ono Hisako , Nakatsukasa Katsuhiko , Ishikawa Takashi , Hasegawa Yoshie , Takahashi Masato , Niikura Naoki , Koizumi Kei , Sakurai Teruhisa , Shigematsu Hideo , Takahashi Shunji , Taira Shinichiro , Suzuki Masato , Narui Kazutaka , Miura Daishu , Yamada Kimito , Yoshimura Mana , Shioya Hisashi , Konishi Eiichi , Isao Yokota , Imai Kojiro , Fujikawa Kei , Taguchi Tetsuya
Published: August 2019

Background:

Osteoporosis is a major side effect of aromatase inhibitors (AIs), which are greatly effective in the treatment of breast cancer. However, there are no satisfactory measures against osteoporosis. In this multicenter, randomized, comparative study, we evaluate the efficacy of denosumab for preventing loss of bone mineral density (BMD) induced by adjuvant therapy with AI s in breast cancer patients with normal BMD.

Patients and methods:

The bone loss-suppressing effect of denosumab will be comparatively evaluated in postmenopausal patients scheduled to receive letrozole or anastrozole as a postoperative endocrine therapy for stage I–IIIA hormone-sensitive breast cancer and a control group. Patients will be administered letrozole 2.5 mg or anastrozole 1 mg once a day, and the treatment will be continued for 5 years unless recurrence, secondary cancer, or unacceptable toxicity develops. Patients in the denosumab group will receive a subcutaneous injection of 60 mg of denosumab every 6 months. The primary endpoint is the rate of change in the lumbar spine (L1–L4) BMD, as determined by dual-energy X-ray absorptiometry (DXA), 12 months after the start of the injection. The secondary endpoints were

Ethics and dissemination:

The protocol was approved by the institutional review boards of Kyoto Prefectural University of Medicine and all the participating faculties. Written informed consent was obtained from all patients before registration, in accordance with the Declaration of Helsinki. Results of the study will be disseminated via publications in peer-reviewed journals.

Trial registration:

Clinical Trials.gov Identifier: NCT03324932, Japan Registry of Clinical Trial (jRCT): CRB5180001.
Transanal endorectal pull-through procedure versus transabdominal surgery for Hirschsprung disease
Authors: Yan Bei-lei , Bi Le-wee , Yang Qian-yu , Wu Xue-si , Cui Hua-lei
Published: August 2019

Objective:

To analyze the clinical results of transanal endorectal pull-through (TERPT) and transabdominal approach (TAB) in the treatment of Hirschsprung disease.

Methods:

We searched all publications in the PubMed, MEDLINE, EMBASE, and Cochrane library databases between January 2003 and November 2018. The study included randomized controlled trials (RCTs) and observational clinical studies (OCSs), to compare the surgery duration, length of postoperative hospital stay, incidence of postoperative incontinence/soiling, constipation, and enterocolitis between the TERPT and TAB groups. Mantel-Haenszel method was used for continuous variables, the combined odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous variables were used.

Results:

In the 87 studies, we include 1 case of RCTs and 9 cases of OCSs. Including 392 cases of TERPT and 332 cases of TAB groups. TERPT has a short postoperative hospitalization [mean difference (MD) = −6.74 day; 95% CIs; −13.26 to −0.23; P = .04], and a low incidence of postoperative incontinence (ORs = 0.54; 95% CIs, 0.35–0.83; P = .006) and constipation (ORs = 0.50; 95% CIs, 0.28–0.90; P = .02). There was no difference in duration of surgery (MD = −30.59 min; 95% CIs, −98.01–36.83; P = .37) and incidence of postoperative enterocolitis (ORs = 0.78; 95% CIs, 0.53–1.17; P = .23).

Conclusion:

TERPT is superior to TAB in terms of hospitalization time, postoperative incontinence, and constipation. However, there are still a large number of RCTs to verify, and more trials are expected to be testified in the future.
Effects of patient age on outcomes after carotid endarterectomy
Authors: Jeong Min-Jae , Kwon Sun U. , Kim Min-Ju , Han Youngjin , Kwon Tae-Won , Cho Yong-Pil
Published: August 2019

In this single-center, retrospective study, we aimed to compare early and late outcomes after carotid endarterectomy (CEA) between younger and elderly patients and to investigate the impact of patient age on the overall incidence of cardiovascular events after CEA.

A total of 613 patients with 675 CEAs between January 2007 and December 2014 were stratified by patient age into 2 groups: younger (≤60 years, n = 103 CEAs, 15.3%) and elderly (>60 years, n = 572 CEAs, 84.7%) groups. The study outcomes were defined as the occurrence of major adverse events (MAEs), including fatal or nonfatal stroke or myocardial infarction (MI), or any-cause mortality, and overall cardiovascular events (meaning the composite incidence of stroke or MI) during the perioperative period and within 4 years after CEA.

Although there were no significant differences in the incidence of 30-day MAEs and any of the individual MAE manifestations between the 2 groups, the differences in the MAE incidence (P = .006) and any-cause mortality (P = .023) within 4 years after CEA were significantly greater in patients in the elderly group. For overall incidence of cardiovascular events, no significant difference was noted between the 2 groups (P = .096). On multivariate analysis, older age (>60 years) did not affect the incidence of perioperative MAEs and individual MAE manifestations; however, older age was significantly associated with an increased risk of 4-year MAEs (hazard ratio [HR], 3.68, 95% confidence interval [CI], 1.35–10.0; P = .011) and any-cause mortality (HR, 3.26, 95% CI, 1.02–10.5; P = .047). With regard to the 4-year overall incidence of cardiovascular events, older age was not an independent predictor of increased risk of these cardiovascular events.

Our study indicates that the risks of perioperative MAEs and the 4-year overall incidence of cardiovascular events do not significantly differ between younger and elderly Korean patients undergoing CEA, although there was a higher risk of 4-year any-cause mortality in the elderly patients. Older age does not appear to be an independent risk factor for perioperative MAEs and overall cardiovascular events within 4 years after CEA.
Study on the long-term curative effect of repeat percutaneous balloon mitral valvuloplasty in patients with mitral restenosis
Authors: Zhang Ling , Hou Jiliu , Duan Yulong , Chen Junjun , Du Huijuan , Shi Zhengang
Published: August 2019

To study the long-term curative effect of repeat percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral restenosis.

In our study, mitral restenosis developed in 39 patients after PBMV. Repeat PBMV was performed according to the improved Inoue method. All patients were followed up.

Of 39 patients, 36 were successfully treated with repeat PBMV (achievement ratio, 92.3%). Immediately after repeat PBMV, clinical symptoms and left atrial mean pressure (LAP), pulmonary artery systolic pressure (PASP), mitral valve gradient (MVG), and mitral valve orifice area (MVA) improved significantly (24.50 ± 6.54 mmHg vs 9.66 ± 4.21 mmHg for LAP, 1.05 ± 0.19 cm2 vs 2.23 ± 0.22 cm2 for MVA, 17.03 ± 4.52 mmHg vs 7.79 ± 4.07 mmHg for MVG, 58.12 ± 12.68 mmHg vs 31.45 ± 10.02 mmHg for PASP; P <.05). Meanwhile, left atrial end-diastolic dimension (LAD) was altered slightly (4.71 ± 0.75 vs 4.07 ± 0.69, P >.05). The 36 patients were followed up for 69 ± 23 (12–146) months. After long-term follow-up immediately after repeat PBMV, the results did not show a significant change (2.23 ± −0.22 cm2 vs 2.02 ± −0.21 cm2 for MVA, 7.79 ± −4.07 mmHg vs 9.15 ± -4.11 mmHg for MVG; P >.05) and were approximated to those shortly after repeat PBMV (2.23 ± 0.22 cm2 vs 2.02 ± 0.21 cm2 for MVA, 7.79 ± 4.07 mmHg vs 9.15 ± 4.11 mmHg for MVG; P > 0.05). LAD did not change significantly (4.13 ± 0.71 cm vs. 4.07 ± 0.69 cm; P >.05). The long-term follow-up results showed that cardiac function and quality of life were significantly improved in most patients.

It would be safe for patients with mitral restenosis to undergo repeat PBMV. Appropriate cases should be selected, and treatment should be performed cautiously. Short- and long-term curative effects would be satisfactory. We suggested that repeat PBMV be the first choice for patients with mitral restenosis after first PBMV.
Non-steroidal anti-inflammatory drugs and risk of mortality in lung cancer
Authors: Chen Yifei , Kang Lili , Zhu Ying , Jing Chuanhong , Chen Yifei , Kang Lili , Zhu Ying
Published: August 2019

Background:

Non-steroidal anti-inflammatory drugs (NSAIDs) especially aspirin has been gained increasing attention due to its potential therapy against to lung cancer. Previous investigations have showed different findings in this issue. We studied the safety profile and efficacy of NSAIDs in treating lung cancer.

Method:

Embase, Pubmed, and Cochrane Library databases were searched from January 2011 to February 2019. We identified the studies meeting a priori inclusion criteria and it also conducted a secondary review. This meta-analysis of 5 prospective studies was launched to evaluate the effect of NSAIDs for patients with lung cancer on the hazard risk (HR). We used the Random-Effect Model to assess pooled HR and between-study heterogeneity. Application of subgroup analysis, meta-regression, as well as sensitivity analysis was to pinpoint the exact sources of the observed heterogeneity.

Results:

5 Prospective Cohorts Studies, including 6017 patients with lung cancer were recruited in the final meta-analysis. In general, using of NSAIDs especially aspirin is not associated with mortality of lung cancer: pooled hazard ratio (HR) of 0.88 [95% confidence intervals (CI): 0.73–1.05] with low heterogeneity (Q = 6.95; I
2 = 42.4%, P = .139). Egger (P = .665) and Begg (P = 1.000) test also showed little trial error in this meta-analysis.

Conclusion:

NSAIDs did not increase the risk of mortality in patients with lung cancer.
Reconstruction of animal bite injuries to the head and neck
Authors: Mendoza Joshua M. , Chi John J.
Published: August 2019

Purpose of review

The aim if this review is to provide an update on the existing literature of animal bite treatment strategies and provide a systematic approach to animal bites from presentation to reconstruction.

Recent findings

Dog bites cause 80–90% of animal bites with 26.8–56.5% occurring in the head and neck. Infection rates may be as low as 5.7–9.7%. Primary closure alone is sufficient in 69.8% of dog bites within the first 24 h.

Animal bite injuries to the head and neck are common, especially in the younger population. Dogs cause a majority of these bite injuries. Injuries can include simple lacerations or punctures, avulsions with tissue present, or avulsions with loss of tissue. The most common locations are the cheek, nose, and lips. It is important to gather the vaccination status of the animal and patient and to administer tetanus/rabies prophylaxis if indicated. Antibiotics are typically prescribed for 3–5 and 7–14 days for uninfected and infected wounds, respectively. These wounds require evaluation, irrigation, and occasionally debridement or repair in the operating room. The type of repair is determined based on the location and extent of injury and can range from primary closure to microsurgical replantation, skin grafts, flaps, or even facial transplantation.
How far can we go with hepatocellular carcinoma in living donor liver transplantation?
Authors: Limkemann Ashley J.P. , Abreu Phillipe , Sapisochin Gonzalo
Published: August 2019

Purpose of review

Living donor liver transplantation (LDLT) in the setting of hepatocellular carcinoma (HCC) has been adopted worldwide over the past decade. Many centers have implemented LDLT because of the limited supply of deceased organs, which has also provided an opportunity for centers to expand the indication for transplantation for patients with HCC.

Recent findings

Center-specific expanded HCC criteria have proven to be well tolerated in terms of overall and disease-free survival when compared with the standard, Milan criteria. There is a need to overcome size and number as the sole limiters. New technologies to better predict outcomes after liver transplantation for HCC, response to treatments and/or bridging therapies while waiting for a liver transplantation, along with determining tumour behaviour are being incorporated into criteria. Improved outcomes of LDLT for all causes has increased utilization of the procedure for HCC patients worldwide.

LDLT has become a great treatment option for HCC patients. Progressively better understanding of tumour behaviour and different surrogates of tumour biology assessments will allow better patient selection for LDLT.
Serologic, but Not Genetic, Markers Are Associated With Impaired Anthropometrics at Diagnosis of Pediatric Crohn's Disease
Authors: Naramore Sara K. , Bennett William E. , Jiang Guanglong , Kugathasan Subra , Denson Lee A. , Hyams Jeffrey S. , Steiner Steven J. ,   PRO‐KIIDS Research Group
Published: August 2019

Objectives:

Children with Crohn's disease may present with malnutrition and linear growth impairment, which can be secondary to insufficient caloric intake, chronic inflammation, malabsorption, and suppression of growth‐promoting hormones. We evaluated clinical, serologic, and genetic data to determine risk factors for impaired anthropometrics in Crohn's disease at diagnosis.

Methods:

Our study evaluated 772 children newly diagnosed with Crohn's disease, inflammatory phenotype, enrolled in the RISK Stratification Project to determine the factors associated with anthropometric impairment. Data were collected on demographics, growth parameters, disease location, serologic and immunologic markers, and disease severity. We performed a genome‐wide association study of genetic polymorphisms associated with inflammatory bowel disease. Regression analysis determined associations between anthropometrics and clinical, serologic, and genetic variables.

Results:

There were 59 (7%) children with height z score <−2, 126 (14%) with a weight z score <−2, and 156 (17%) with a body mass index z score <−2. Linear growth impairment was associated with hypoalbuminemia (P = 0.0052), elevated granulocyte‐macrophage colony stimulating factor autoantibodies (P = 0.0110), and elevated CBir antibodies against flagellin (P = 0.0117). Poor weight gain was associated with female sex (P = 0.0401), hypoalbuminemia (P = 0.0162), and thrombocytosis (P = 0.0081). Malnutrition was associated with hypoalbuminemia (P = 0.0061) and thrombocytosis (P = 0.0011). Children with moderate or severe disease had lower weight (P = 0.02 and P = 1.16×10−6, respectively) and body mass index z scores (P = 2.7 × 10−3 and P = 1.01 × 10−6, respectively) than children with quiescent and mild disease. There was no association between age of diagnosis, Tanner stage, or disease location and having impaired anthropometrics. There was no genome‐wide association between the genetic polymorphisms and the serologic variables and anthropometric measurements.

Conclusions:

This is the largest study evaluating growth in treatment‐naïve children with Crohn's disease, inflammatory phenotype. It is the first study to use genome‐wide sequencing to assess for genetic determinants of growth impairment. Granulocyte‐macrophage colony stimulating factor autoantibodies and CBir antibodies are more likely to be elevated in children with growth impairment. Future investigations should evaluate the relationship between genetic polymorphisms, pathologic immune responses, and the biological pathways regulating growth.
The Evolution of State-Based Dental Sealant Programs in Oregon Within the Context of the State Health Care Transformation Process
Authors: Johnson Laurie L. , Schwarz Eli , Rosenberg Kenneth D.
Published: August 2019

Context:

The 2007 Oregon Smile Survey of first, second, and third graders found that, since the first (2002) Smile Survey, all major measures of Oregon children's oral health had worsened. The Centers for Disease Control and Prevention recommends 2 interventions proven effective in preventing dental caries (cavities) in a population: community water fluoridation and school dental sealant programs. Repeated attempts at the state level to mandate water fluoridation had failed. State government therefore moved to increase the number of school dental sealant programs.

Objectives:

The objective of this article is to demonstrate how 2 interventions and subsequent statewide collaboration addressed the deterioration of children's oral health from 2002 to 2007.

Design:

An 11-year observational study to increase the number of schools in Oregon with dental sealant programs in the state of Oregon during health care transformation.

Interventions:

(1) Providing state general funds for a state school dental sealant program and (2) establishing an incentivized sealant metric for the Coordinated Care Organizations contracted to serve the Medicaid population.

Results:

In school year (SY) 2006-2007, only 26% (n = 92) of the state's eligible elementary schools had dental sealant programs. By SY 2013-2014, the use of state general funds increased the number of schools served to 78% (363 schools). By SY 2017-2018, with the establishment of the sealant metric, state and local programs served 92% (n = 473) of the eligible early elementary grades and 65% (n = 172) of the newly eligible middle school grades.

Conclusion:

Providing state general funds and establishing a sealant metric increased the number of schools served by school dental sealant programs and may have contributed to recent improvements in oral health.
Accelerating Initiation of Adequate Antimicrobial Therapy Using Real-Time Decision Support and Microarray Testing
Authors: Tchou Michael J. , Andersen Heidi , Robinette Eric , Mortensen Joel E. , Powell Eleanor A. , Ankrum Andrea , Washam Matthew C. , Haslam David B. , Courter Joshua D.
Published: August 2019

Introduction:

Bloodstream infections (BSI) represent a common cause of sepsis and mortality in children. Early and adequate empirical antimicrobial therapy is a critical component of successful treatment of BSI. Rapid PCR-based diagnostic technologies, such as nucleic acid microarrays, can decrease the time needed to identify pathogens and antimicrobial resistance and have the potential to ensure patients are started on adequate antibiotics as early as possible. However, without appropriate processes to support timely and targeted interpretation of these results, these advantages may not be realized in practice.

Methods:

Our Antimicrobial Stewardship Program (ASP) implemented a quality improvement initiative using the Institute for Healthcare Improvement’s Model for Improvement to decrease the time between a nucleic acid microarray result for Gram-positive bacteremia and the time a patient was placed on adequate antimicrobial therapy. The primary effective intervention was a near real-time notification system to the managing physicians of inadequate antimicrobial therapy via a call from the ASP team.

Results:

Following the intervention, the average time to adequate antimicrobial therapy in patients with Gram-positive BSI and inadequate coverage decreased from 38 hours with the nucleic acid microarray result alone to 4.7 hours when results were combined with an ASP clinical decision support intervention, an 87% reduction.

Conclusions:

The positive effects of rapid-detection technologies to improve patient care are enhanced when combined with clinical decision support tools that can target inadequate antimicrobial treatments in near real time.
Impact of Education and Peer Comparison on Antibiotic Prescribing for Pediatric Respiratory Tract Infections
Authors: Clegg Herbert W. , Bean Rebecca A. , Ezzo Stephen J. , Hoth Alycia N. , Sheedy David J. , Anderson William E.
Published: August 2019

Introduction:

Inappropriate prescribing of broad-spectrum antibiotics is a significant modifiable risk factor for the development of antibiotic resistance. The objective was to improve guideline-concordant care for 3 common acute respiratory tract infections (ARTIs) and to reduce broad-spectrum antibiotic prescribing in ambulatory pediatric patients.

Methods:

Quality measures were developed for 3 ARTIs: viral upper respiratory infection (URI), acute bacterial sinusitis (ABS), and acute otitis media (AOM). Among 22 pediatric clinics, a collaborative of 10 was identified for intervention using baseline data for each ARTI, and 3 plan-do-study-act cycles were planned and completed. Outcomes included guideline-concordant antibiotic utilization and broad-spectrum antibiotic prescribing percentage (BSAP%). Comparison in number of diagnoses for the ARTI measures and total antibiotic prescribing over time served as balancing measures.

Results:

Collaborative clinics had baseline medians for appropriate or first-line treatment of 70% for URI, 53% for ABS, and 36% for AOM. To reach targets for URI, ABS, and AOM required 6, 14, and 18 months, respectively. At 42 months, performance for all 3 ARTIs remained ≥90%. BSAP% decreased from a baseline of 57% to 34% at 24 months. There was a limited effect from financial incentives but a significant decrease was noted in total antibiotic utilization. Diagnosis shifting may have occurred for URI and ABS while the rates for diagnoses for AOM declined over time.

Conclusions:

Through education and peer comparison feedback, guideline-concordant care for 3 ARTIs in collaborative clinics improved and remained beyond above targets and was accompanied by reductions in BSAP% and total antibiotic prescribing.