bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined effect of laser acupuncture and electroacupuncture in knee osteoarthritis patients
Authors: Wu Szu-Ying , Lin Chien-Hung , Chang Nai-Jen , Hu Wen-Long , Hung Yu-Chiang , Tsao Yu , Kuo Chun-En Aurea
Published: March 2020

Background:

Knee osteoarthritis (KOA) is a common degenerative joint disorder that affects 250 million people globally. KOA can lead to disability and is often associated with cardiovascular disease, poor quality of life, and mortality. The most common treatment for KOA is non-steroidal anti-inflammatory drug administration. However, the analgesic effect is limited and often accompanied by multiple side effects. Hence, many KOA patients opt for complementary and alternative medicine. Acupuncture is one of the most popular complementary treatments with great analgesic effect and minimal side effect. Electroacupuncture (EA) and laser acupuncture (LA) have been known to reduce pain in KOA patients. However, to date, no study has assessed the benefits of combining these two therapies.

Methods:

Fifty participants diagnosed with KOA, aged 50 years or older, and with consistent knee pain for more than 3 months were recruited and randomly assigned to the treatment group (EA plus LA) or control group (EA plus sham LA without laser output). All subjects in the treatment group will undergo a combined EA and LA treatment thrice a week for 4 weeks. The acupuncture will be performed on GB33, GB34, SP9, SP10, and ST36 sites. The treatment group will receive acupuncture with a transcutaneous electrical nerve stimulator at GB33, GB34, SP9, and SP10 sites and with LA at EX-LE5, ST35, and BL40 sites. The subjects in the control group will undergo the same treatment modality as the treatment group, except these subjects will not be exposed to laser output. Outcome measurements will include visual analog scale, Western Ontario McMaster Universities Osteoarthritis Index, Knee injury and osteoarthritis outcome, body composition analysis, knee range of motion, quadriceps muscle stiffness, one-leg standing with eyes open test, and the 30-s chair stand test before and after 4 weeks of intervention.

Objectives:

This protocol aims to investigate the combined effect of EA and LA in KOA patients.
Photobiomodulation by low-level laser therapy in patients with obstructive sleep apnea
Authors: de Camargo Fernanda Cristina Ferreira , DeMoura José Roberto , Cepeda Felipe Xerez , de Almeida Correia Marilia , Nascimento Reginaldo Ceolin , Fortes-Queiroz Lucas , Ferreira Fabiana Gonçalves , Palma Renata Kelly da , Hussid Maria Fernanda , Chavantes Maria Cristina , Trombetta Ivani Credidio
Published: March 2020

Obstructive sleep apnea (OSA) increases morbidity and mortality and it is associated with an increased cardiovascular risk. The gold standard treatment for OSA is positive airway pressure therapy (CPAP). However, it is an expensive treatment and several patients do not adapt to CPAP.

Goal:

The researchers will verify the effects of low-level laser therapy (LLLT) on OSA, when applied to the soft palate and on the tongue base.

Methods:

The researchers will select individuals of both sexes aged 30 to 60 years old who are sedentary and that present a high risk of OSA by the Berlin questionnaire. The evaluations pre and post interventions will be polysomnography; anthropometric and body composition measurements (Bioimpedance); metabolic syndrome risk factors (International Diabetes Federation); physical capacity (VO2 peak at the cardiopulmonary exercise test, CPET); endothelial function (flow-mediated dilatation, FMD); autonomic control (heart rate variability and sympathovagal balance). Those diagnosed with moderate and severe OSA (apnea/hypopnea index, AHI ≥15 events/h) will be invited to participate in the study and they will be randomized into 2 groups: LLLT treatment or placebo (C). The LLLT group will receive applications at 8 points on the soft palate and on the base of the tongue for 8 seconds for each point. The applications of LLLT will occur twice a week, with a minimum interval of 2 days between the applications for 2 months, when using a Therapy Plus NS 13678 Laser. The C group will have similar applications, but with the device turned off.

Expected Results:

In the individuals with OSA, photobiomodulation through LLLT will decrease the AHI. Additionally, when LLLT is applied in the oral cavity, a highly vascularized region, this may cause improvements in the vascular function and in the autonomic and hemodynamic control.

Ethics and Dissemination:

This protocol was approved by the Research Ethics Committee of the Nove de Julho University, São Paulo, Brazil, on the date of March 11, 2019 (CAAE: 06025618.2.0000.5511 - Acceptance Number: 3.191.077). This trial has been registered with the Brazilian Registry of Clinical Trials (REBEC TRIAL RBR-42v548). This study is not yet recruiting. Issue date: November 4, 2019.
Risk factors of cage nonunion after anterior cervical discectomy and fusion
Authors: Ren Bao , Gao Wenshan , An Jilong , Wu Menghui , Shen Yong
Published: March 2020

The aim of our study was to explore risk factors of cage nonunion after anterior cervical discectomy and fusion (ACDF).

295 patients underwent ACDF in our hospital between Jan. 2014 and Jan. 2017. Of them, 277 patients suffered cage union (union group, UG) after 6-month follow-up and 18 did not (nonunion group, NG). We collected possible factors including gender, history of smoking, alcohol, hypertension, heart disease, diabetes, body mass index, diagnose, and preoperative visual analog scale -neck, visual analog scale-arm, neck disability index (NDI) and Japanese Orthorpaedic Association, surgical duration, blood loss, fusion levels, superior fusion segment, angle of C2–C7, range of motion for C2–C7, C2–C7 sagittal vertical axis and T1 slope. We performed univariable and multivariable analysis to compare data in 2 groups.

The rate of cage nonunion after ACDF was 6.1% (18 of 295) in our study. The outcome of univariable analysis showed that age (63.5 ± 10.1), angle of C2–C7 (18.0 ± 4.6), range of motion of C2–C7 (32.5 ± 7.7), C2–C7 sagittal vertical axis (17.9 ± 4.3) and T1 slope (22.1 ± 5.3) were higher in NG than these (59.4 ± 9.2, 16.2 ± 4.5, 30.2 ± 6.9,16.1 ± 4.0, 20.9 ± 4.9) in UG. Additionally, patients with osteoporosis had markedly higher rate of cage nonunion after ACDF than those without. What's more, the multivariable analysis implied the same results with univariable analysis.

Many factors could predict cage nonunion after ACDF. Cervical sagittal parameters play an important role in cage nonunion after ACDF. We hope that we can provide some guidance for spine surgeon before performing ACDF.
Long-term outcomes of patients with gastric adenoma in Korea
Authors: Park Tae Young , Jeong Su Jin , Kim Tae Hyung , Lee Jin , Park Jongha , Kim Tae Oh , Park Yong Eun
Published: March 2020

New endoscopic resection techniques are constantly being developed for gastric adenoma, which can be classified as low or high grade according to the Vienna classification. However, long-term data on gastric adenoma (e.g., removal or follow-up after resection via endoscopy) remain lacking.

We retrospectively analyzed 133 cases with gastric adenoma that underwent endoscopic resection from January 2010 to November 2018. We analyzed the risk factors and frequency of patients with synchronous and metachronous lesions after endoscopic resection for gastric adenoma and followed them for more than 2 years.

One hundred six (79.7%) and 27 patients (20.3%) received endoscopic resection (ER) once and more than twice, respectively. Compared with the initial endoscopic biopsy pathological results, the upgraded and downgraded histological discrepancy rates were 10.5% (n = 14) and 3.0% (n = 4) after resection, respectively. The mean time to synchronous/metachronous recurrence was 2.23 years. The average lesion size at first procedure was larger in the multiple ER group than in the single ER group (2.00 vs 1.10 cm; P = .040). Eleven (8.3%) and 16 patients (12.0%) had recurred synchronous and metachronous lesions, respectively. In the multivariate Cox analysis of the recurrence group, intestinal metaplasia (hazard ratio, 2.761; 95% confidence interval, 1.117–6.820; P = .028) and lesion size (hazard ratio, 1.607; 95% confidence interval, 1.082–2.385; P = .019) were independent factors for receiving endoscopic resection more than twice.

If patients have severe intestinal metaplasia or large size of lesion at endoscopic resection for gastric adenoma, periodic observation is necessary.
Combined mutations of NKX2-1 and surfactant protein C genes for refractory low oxyhemoglobin saturation and interstitial pneumonia
Authors: Gu Rui , Ye Guangyong , Zhou Yimin , Jiang Zhou
Published: March 2020

Rationale:

Mutations of the NKX2-1 gene are associated with brain-lung-thyroid syndrome, which is characterized by benign hereditary chorea, hypothyroidism, and pulmonary disease with variable presentation. Surfactant protein C (SFTPC) gene mutations result in chronic interstitial lung disease in adults or severe neonatal respiratory distress syndrome.

Patient concerns:

Recurrent hypoxemia was observed shortly after birth in a baby at a gestational age of 40 weeks and birth weight of 3150 g. The need for respiratory support gradually increased. He had hypothyroidism and experienced feeding difficulties and irritability.

Diagnosis:

Genetic examination of the peripheral blood revealed combined mutations of the NKX2-1 and SFTPC genes.

Interventions:

The patient was administered respiratory support, antibiotics, low-dose dexamethasone, supplementary thyroxine, venous nutrition, and other supportive measures.

Outcomes:

The patient's guardian stopped treatment 3 months after commencement of treatment, due to the seriousness of his condition and the patient died.

Lessons:

Combined mutations of NKX2-1 and SFTPC genes are very rare. Thus, idiopathic interstitial pneumonia with hypothyroidism and neurological disorders require special attention.
The Challenging Road to Clinical Competence for New Graduate RNs
Authors: Herleth Anne , Virkstis Katherine , Renfroe Julia , Rewers Lauren
Published: March 2020

Despite increased onboarding and training for new graduate RNs, it is taking longer for nurses to develop clinical competence in today's complex care environment. At the same time, hospitals and health systems are facing a shortage of experienced nurses. If left unaddressed, patient quality and safety could be at risk.
Automated Pupillary Measurements Inversely Correlate With Increased Intracranial Pressure in Pediatric Patients With Acute Brain Injury or Encephalopathy
Authors: Freeman Ashley D. , McCracken Courtney E. , Stockwell Jana A.
Published: March 2020

Objectives:

The purpose of this study was to determine correlation and temporal association between automated pupillary measurements and intracranial pressure in pediatric patients with brain injury or encephalopathy requiring intracranial pressure monitoring. We hypothesized that abnormal pupillary measurements would precede increases in intracranial pressure.

Design:

A prospective cohort study was performed. Automated pupillometry measurements were obtained at the same frequency as the patients’ neurologic assessments with concurrent measurement of intracranial pressure, for up to 72 hours. Pupillary measurements and the Neurologic Pupil index, an algorithmic score that combines measures of pupillary reactivity, were assessed for correlation with concurrent and future intracranial pressure measurements.

Setting:

Single-center pediatric quaternary ICU, from July 2017 to October 2018.

Patients:

Pediatric patients 18 years or younger with a diagnosis of acute brain injury or encephalopathy requiring an intracranial pressure monitor.

Interventions:

None.

Measurements and Main Results:

Twenty-eight patients were analyzed with a total of 1,171 intracranial pressure measurements. When intracranial pressure was elevated, the Neurologic Pupil index, percent change in pupillary size, constriction velocity, and dilation velocity were significantly lower than when intracranial pressure was within normal range (p < 0.001 for all). There were mild to moderate negative correlations between concurrent intracranial pressure and pupillary measurements. However, there was an inconsistent pattern of abnormal pupillary measurements preceding increases in intracranial pressure; some patients had a negative association, while others had a positive relationship or no relationship between Neurologic Pupil index and intracranial pressure.

Conclusions:

Our data indicate automated assessments of pupillary reactivity inversely correlate with intracranial pressure, demonstrating that pupillary reactivity decreases as intracranial pressure increases. However, a temporal association in which abnormal pupillary measurements precede increases in intracranial pressure was not consistently observed. This work contributes to limited data available regarding automated pupillometry in neurocritically ill patients, and the even more restricted subset available in pediatrics.
Pediatric Critical Care Medicine Fellowship Simulation Use Survey*
Authors: Henricksen Jared W. , Troy Lindsey , Siefkes Heather
Published: March 2020

Objectives:

Simulation-based education is used in the U.S. Pediatric Critical Care Medicine fellowship programs, yet the prevalence and types of simulation used is unknown. A survey was developed to determine the prevalence, the perceived importance, and barriers associated with simulation-based education in these programs.

Design:

A 43-item survey instrument was sent to all 66 U.S. Accreditation Council for Graduate Medical Education–accredited Pediatric Critical Care Medicine fellowship programs during the summer of 2018. We defined simulation broadly as “any type of simulation that involved mannequins, task trainers, standardized actors, team training, etc.”

Setting:

An online survey was used to obtain information regarding simulation used in Pediatric Critical Care Medicine fellowship programs.

Subjects:

All sixty-six U.S. Accreditation Council for Graduate Medical Education–accredited Pediatric Critical Care Medicine fellowship programs were sent a survey request.

Measurements and Main Results:

Forty-four of the 66 U.S. Accreditation Council for Graduate Medical Education–accredited Pediatric Critical Care Medicine fellowship programs (67%) responded to the survey. Ninety-eight percent of responding programs (n = 43) use simulation-based education in their Pediatric Critical Care Medicine fellowship curriculum. Most programs (56%) have incorporated simulation training into their Pediatric Critical Care Medicine fellowship curriculum in the last 4–10 years (range, <1 to >15 yr, median 4–6 yr). A variety of principles, concepts, and programs were reported as used in their simulation programs. The most commonly reported barriers to Pediatric Critical Care Medicine fellowship simulation-based education were lack of funding (56%) and lack of faculty with simulation experience (56%). The majority of programs (64%; N = 28) think simulation-based education is absolutely necessary to Pediatric Critical Care Medicine fellowship training.

Conclusions:

Nearly, all responding U.S. Accreditation Council for Graduate Medical Education–accredited Pediatric Critical Care Medicine fellowship programs use simulation-based education to train Pediatric Critical Care Medicine fellows with the majority perceiving simulation as absolutely necessary to Pediatric Critical Care Medicine fellow training. The reported types of simulation used in fellow training varied, as did training theories and concepts in the simulation programs. More research is needed to understand how to optimize and perhaps standardize parts of Pediatric Critical Care Medicine fellowship simulation training to improve the impact and outcomes of such training.
Repeatedly in Rhabdomyolysis
Authors: Gooch Catherine , Dean Sarah Joy , Marzullo Laurie
Published: March 2020

Repeated presentations of a rare symptom in a patient should make a physician stop and evaluate for rare conditions. This is a report of a teenager with multiple episodes of rhabdomyolysis and weakness. He was eventually diagnosed as having McArdle muscular dystrophy, or glycogen storage disease type V. His rhabdomyolysis has been severe, with a creatinine kinase level of >320,000 U/L, myoglobinuria, transaminitis, and elevated bilirubin. He has a low threshold for triggering rhabdomyolysis, such as doing an hour of aerobic exercise 2 days in a row. McArdle disease is a glycogen storage disorder in which the skeletal muscle cannot convert glycogen to glucose. Unlike other glycogen storage disorders, McArdle muscular dystrophy only affects the skeletal muscle, sparing the brain and visceral organs, leading to a vague phenotype. These patients have exercise intolerance, muscle cramps, and rhabdomyolysis. Many patients report loading with simple carbohydrates before exercise, as they have learned that this can increase their stamina. The vague symptoms can lead to decades of delay in diagnosis and significant mismanagement. Rhabdomyolysis is the most dangerous sign of McArdle disease, and it can lead to acute kidney injury, resulting in renal failure requiring dialysis in the severest cases.

Rhabdomyolysis has numerous causes, but when it is recurrent, especially with seemingly insignificant triggers, one needs to develop a broader differential and pursue advanced testing. This testing can include specific exercise tests, genetic sequencing, and muscle biopsy. This case report will guide the clinician through the process of evaluating recurrent rhabdomyolysis, working through the differential diagnosis and testing options.
1
Two Cases Illustrating the Diagnostic Challenge of Pediatric Blastomycosis Presenting as Osteomyelitis
Authors: Gusland Danièle Y. , Livermore Andrew T. , Sterkel Alana K. , Nguyen Jie C. , Conway James H.
Published: March 2020

Blastomyces dermatitidis is a dimorphic fungus endemic to the United States and Canada. Although both Histoplasma and Blastomyces are found in similar geographic regions, Blastomyces is many times more likely to cause dissemination in the immunocompetent host, frequently involving the bone. However, given the indolent nature of this fungal infection and more prevalent bacterial etiologies of osteomyelitis, diagnosis and treatment are often significantly delayed. We review 2 pediatric cases that initially presented with isolated orthopedic symptoms without documented fever or pulmonary complaints, although both had signs of pulmonary infection on imaging. These cases demonstrate the importance of a high level of suspicion as well as appropriate diagnostic workup, including surgical pathology with fungal stains, when evaluating osteomyelitis in patients exposed to a Blastomyces-endemic region.
Computed Tomography Scan Utilization in Pediatric Trauma
Authors: Edwards Mary J. , Jenkel Timothy , Weller Brandon , Weber Alexis , Zhu Karen , Parikh Raina , Ata Ashar , Danziger Carrie
Published: March 2020

Introduction

Computerized tomography (CT) scans are the mainstay of diagnostic imaging in blunt trauma. Particularly in pediatric trauma, utilization of CT scans has increased exponentially in recent years. Concerns regarding radiation exposure to this vulnerable population have resulted in increased scrutiny of practice. What is not known is if liberal imaging practices decrease length of stay by eliminating the need for clinical observation, and the impact of false-positive rates from liberal use of CT scanning on clinical outcomes.

Methods

Medical records from a nonaccredited pediatric trauma center with a practice of liberal imaging were reviewed over a 2-year period. Total CT scans obtained were recorded, in addition to length of stay, age, and Injury Severity Score (ISS). Rates of clinically significant imaging findings were recorded, as were false positive findings and complications of imaging.

Results

Out of 735 children, 58% underwent CT scanning, and if scanned, received an average of 2.4 studies. Clinically significant findings were documented in 20% of head CTs, 2% of cervical spine CTs, 3.5% of chest CTs, 24% of facial CTs, and 14.7% of abdominal CTs. False-positive findings were found in 1.5% of head CTs, 1.2% of cervical spine CTs, 2.4% of chest CTs, and 2.5% of abdominal CTs. Liberal CT scanning was not associated with decreased length of stay. In contrast, obtaining CT scans on more than 4 body regions was independently predictive of longer length of stay, independent of ISS.

Conclusions

False-positive rates of CT scans for trauma were low in this cohort. However, when scanning the cervical spine or the chest, for every 2 clinically significant findings obtained, there was at least one false positive result, calling into question the practice of liberal imaging of these regions. Liberal utilization of CT scan did not allow for more rapid discharge home, and for more than 4 CTs was independently associated with longer hospital stay.
Injectable Biologics
Authors: Kubrova Eva , D’Souza Ryan S. , Hunt Christine L. , Wang Qian , van Wijnen Andre J. , Qu Wenchun
Published: March 2020

Injectable biologics have attracted considerable interest in the field of musculoskeletal medicine. Biologics encompass a broad and diverse group of human tissue–derived therapeutics. The most commonly reported biologics for use in musculoskeletal conditions include platelet-rich plasma, bone marrow aspirate concentrate, mesenchymal stem cells, microfragmented fat, stromal vascular fraction, amniotic membrane–based products, and autologous conditioned serum. The benefits of biologics in tissue healing and regeneration are thought to be derived from their trophic, paracrine, and immunomodulatory functions. The purpose of this review is to define commonly used injectable biologics and to appraise current evidence on its efficacy in the treatment of musculoskeletal disease.
Outcomes of Immediate Implant-Based Mastectomy Reconstruction in Women with Previous Breast Radiotherapy
Authors: Olinger Thomas A. , Berlin Nicholas L. , Qi Ji , Hamill Jennifer B. , Kim Hyungjin M. , Pusic Andrea L. , Wilkins Edwin G. , Momoh Adeyiza O.
Published: March 2020

Background:

The objective of this study was to determine whether women with a history of radiation therapy before mastectomy experience a risk for postoperative complications and patient-reported outcomes similar to those of women undergoing postmastectomy radiation therapy in the setting of immediate implant reconstruction.

Methods:

The cohort included patients undergoing immediate implant reconstruction at 11 centers across North America. Women were categorized into three groups: prior breast conservation therapy, postmastectomy radiation therapy, and no radiation therapy. Mixed effect logistic regressions were used to analyze the effects of radiation therapy status on complication rates and patient-reported outcomes.

Results: One thousand five hundred ninety-four

patients were analyzed, including 84 women with prior breast conservation therapy, 329 women who underwent postmastectomy radiation therapy, and 1181 women with no history of radiation therapy. Compared with postmastectomy radiation therapy, breast conservation was associated with lower rates of all complications and major complications (OR, 0.65; 95 percent CI, 0.37 to 1.14; p = 0.13; and OR, 0.61; 95 percent CI, 0.33 to 1.13; p = 0.12). These differences were not statistically significant. Rates of reconstructive failure between the two cohorts were comparable. Before reconstruction, satisfaction with breasts was lowest for women with prior breast conservation therapy (p < 0.001). At 2 years postoperatively, satisfaction with breasts was lower for women with postmastectomy radiation therapy compared with breast conservation patients (p = 0.007).

Conclusions:

Higher postoperative complication rates were observed in women exposed to radiation therapy regardless of timing. Although women with prior breast conservation experienced greater satisfaction with their breasts and fewer complications when compared to women undergoing postmastectomy radiation therapy, there was a similar risk for reconstruction failure.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
High-Intensity Focused Ultrasound Ablation Combined with Electrical Passive Exercise for Fast Removal of Body Fat
Authors: Tan Joo-Shin , Lin Chou-Ching , Cheng Jung-Sung , Chen Gin-Shin
Published: March 2020

Background:

High-intensity focused ultrasound (HIFU) lipolysis still lacks treatment efficacy. The authors hypothesized that electrical stimulation of muscular groups can enhance the metabolism of free lipids released from HIFU-ablated adipocytes.

Methods:

Five-month-old, male Landrace swine, with an average initial weight of 95 kg, were divided randomly into sham, HIFU only, HIFU plus electrical stimulation I, and HIFU plus electrical stimulation II groups. Subcutaneous adipose tissue of the porcine abdomen was treated once by HIFU on days 1 of weeks 1, 3, and 5, and electrical stimulation of the quadriceps was performed once on the day 1 of weeks 1 through 6. The numbers of ultrasonic sonications were 70 per treatment for the HIFU-only and HIFU plus electrical stimulation I groups and 400 for the HIFU plus electrical stimulation II group. The measured data are expressed as medians (ranges).

Results:

The body weights of all pigs increased gradually with time. The waist circumferences below the sheath decreased from 97.7 ± 6.0 cm in week 1 and 97.9 ± 5.3 cm in week 3 to 96.4 ± 10.0 cm in week 6, and from 105.3 ± 5.1 cm and 101.2 ± 7.4 cm to 100.5 ± 6.1 cm for the HIFU plus electrical stimulation I and II groups, respectively, whereas they increased for the sham and HIFU-only groups. The reductions in the adipose tissue thickness were 0.59, 1.46, and 2.18 mm for the HIFU-only, HIFU plus electrical stimulation I, and HIFU plus electrical stimulation II groups, respectively, when the sham group increased by 1.42 mm. Follow-up blood analyses demonstrated no significant changes in lipid panel parameters from baseline values.

Conclusion:

HIFU plus electrical stimulation can induce a substantial reduction in the waist circumference of pigs.
Who Accepts and Who Uses Community-Based Secondary Distribution HIV Self-Testing (HIVST) Kits? Findings From the Intervention Arm of a Cluster-Randomized Trial of HIVST Distribution Nested in Four HPTN 071 (PopART) Communities in Zambia
Authors: Hensen Bernadette , Schaap Albertus J. , Mulubwa Chama , Floyd Sian , Shanaube Kwame , Phiri Mwelwa M. , Bond Virginia , Bwalya Chiti , Simwinga Musonda , Fidler Sarah , Hayes Richard , Mwinga Alwyn , Ayles Helen
Published: March 2020

Background:

HPTN 071 (PopART) was a community-randomized trial of a universal testing-and-treatment intervention on HIV incidence at population level in Zambia and South Africa. In Zambia, a trial of community-based distribution of HIV self-testing (HIVST) kits, including secondary distribution, as an option for HIV-testing was nested within 4 PopART intervention communities. We used data from the intervention arm of the nested trial to measure levels of and factors associated with acceptance and use of secondary distribution HIVST kits.

Methods:

Community HIV care providers offered the PopART combination HIV-prevention intervention door-to-door, systematically visiting all households and enumerating all household members. From 1 February to 30 April 2017, individuals aged 16 years and older consenting to PopART were offered the option to HIV self-test, if eligible for HIV-testing services. Individuals aged 18 years and older who reported a partner absent during household visits were offered an HIVST kit for secondary distribution to this partner. We used two data sources to measure acceptance and use of secondary distribution HIVST kits.

Results:

Among 9105 individuals aged 18 years and older consenting to PopART, 9.1% (n = 825) accepted an HIVST kit for secondary distribution. Approximately 55.8% reported that the kit had been used. Women were more likely to accept, and men more likely to use, secondary distribution HIVST kits. Kits were more likely to be used by individuals aged 30+ and who had not participated in a previous round of PopART. Approximately 6.8% had a reactive result.

Conclusions:

Community-based secondary distribution of HIVST kits reached men absent during community HIV care provider household visits and is a complement to facility- and community-based HIV-testing services, which often miss men.
Cumulative Burden of Depression and Neurocognitive Decline Among Persons With HIV: A Longitudinal Study
Authors: Paolillo Emily W. , Pasipanodya Elizabeth C. , Moore Raeanne C. , Pence Brian W. , Atkinson Joseph Hampton , Grelotti David J. , Grant Igor , Heaton Robert K. , Moore David J.
Published: March 2020

Background:

Higher cumulative burden of depression among people with HIV (PWH) is associated with poorer health outcomes; however, longitudinal relationships with neurocognition are unclear. This study examined hypotheses that among PWH, (1) higher cumulative burden of depression would relate to steeper declines in neurocognition, and (2) visit-to-visit depression severity would relate to fluctuations in neurocognition within persons.

Setting:

Data were collected at a university-based research center from 2002 to 2016.

Methods:

Participants included 448 PWH followed longitudinally. All participants had >1 visit (M = 4.97; SD = 3.53) capturing depression severity (Beck Depression Inventory-II) and neurocognition (comprehensive test battery). Cumulative burden of depression was calculated using an established method that derives weighted depression severity scores by time between visits and total time on study. Participants were categorized into low (67%), medium (15%), and high (18%) depression burden. Multilevel modeling examined between- and within-person associations between cumulative depression burden and neurocognition over time.

Results:

The high depression burden group demonstrated steeper global neurocognitive decline compared with the low depression burden group (b = −0.100, P = 0.001); this was driven by declines in executive functioning, delayed recall, and verbal fluency. Within-person results showed that compared with visits when participants reported minimal depressive symptoms, their neurocognition was worse when they reported mild (b = −0.12, P = 0.04) or moderate-to-severe (b = −0.15, P = 0.03) symptoms; this was driven by worsened motor skills and processing speed.

Conclusions:

High cumulative burden of depression is associated with worsening neurocognition among PWH, which may relate to poor HIV-related treatment outcomes. Intensive interventions among severely depressed PWH may benefit physical, mental, and cognitive health.
Is HIV Self-Testing a Strategy to Increase Repeat Testing Among Pregnant and Postpartum Women? A Pilot Mixed Methods Study
Authors: Oyaro Patrick , Kwena Zachary , Bukusi Elizabeth A. , Baeten Jared M.
Published: March 2020

Introduction:

Repeat HIV testing among pregnant and postpartum women enables incident HIV infection identification for targeted interventions. We evaluated oral HIV self-testing (HIVST) for repeat HIV testing among pregnant and postpartum women attending busy public clinics in East Africa.

Methods:

Between October 2018 and January 2019, we conducted a pilot mixed methods study to evaluate the acceptability of oral-based HIVST among pregnant and postpartum women within 3 public health facilities in Kisumu County, Kenya. We invited 400 seronegative pregnant and postpartum women to choose between clinic-based oral HIVST and the standard finger prick provider-initiated testing and counseling for repeat HIV testing. We measured the frequency of each choice and described the participants' experiences with the choices, including data from 3 focus group discussions.

Results:

Slightly over half of the women [53.8%, 95% confidence interval (CI): 48.7 to 58.7] chose oral HIVST. Unmarried women were more likely to use HIVST (prevalence ratio: 1.26, 95% CI: 1.01 to 1.57, P < 0.05). The most frequent reason for oral HIVST selection was the fear of the needle prick (101/215, 47.0%). More HIVST than provider-initiated testing and counseling users indicated lack of pain (99.1% vs 34.6%, P < 0.001) and the need for assistance (18.1% vs 1.1%, P < 0.001) as reflective of their HIV testing experiences. Participants choosing HIVST cited privacy, ease, and speed of the procedure as the main reasons for their preference.

Conclusions:

The use of HIVST in Kenyan antenatal and postpartum settings seems to be feasible and acceptable for repeat HIV testing. Future work should explore the practical mechanisms for implementing such a strategy.
A Predictor for Defects in Filling of the Left Atrial Appendage on Cardiac Computed Tomography in Patients With Atrial Fibrillation
Authors: Ouchi Kotaro , Sakuma Toru , Ojiri Hiroya
Published: March 2020

Purpose

The aim of this study was to identify possible predictors for findings of left atrial appendage (LAA) filling defects in patients with atrial fibrillation (AF) on cardiac computed tomography (CT).

Materials and Methods

We retrospectively evaluated findings of LAA filling defects on the early phase of cardiac CT of 63 patients with history of AF and compared those images with those of 63 control subjects. We investigated potential predictors for LAA filling defects.

Results

Filling defects of the LAA correlated significantly with patient history of persistent AF (P = 0.045; odds ratio [OR], 3.17), chicken wing morphology (P = 0.013; OR, 4.12), and with LAA volume (P = 0.0032; OR, 1.19) of 12.53 cm3 or greater (sensitivity, 87.3%; specificity, 69.8%).

Conclusions

We observed persistent AF, the chicken wing type of LAA morphology, and LAA volume as independent predictors of LAA filling defects on cardiac CT. These findings might improve cardiac CT scanning protocol.
Diagnostic Accuracy of Single-Phase Computed Tomography Texture Analysis for Prediction of LI-RADS v2018 Category
Authors: Puttagunta Srikanth , van der Pol Christian B. , Ferri Melanie , Sy Wat Josephine , Kulkarni Ameya , Carrion-Martinez Ivan
Published: March 2020

Objective

The aim of this study was to determine if texture analysis can classify liver observations likely to be hepatocellular carcinoma based on the Liver Imaging Reporting and Data System (LI-RADS) using single portal venous phase computed tomography.

Methods

This research ethics board–approved retrospective cohort study included 64 consecutive LI-RADS observations. Individual observation texture analysis features were compared using Kruskal-Wallis and 2 sample t tests. Logistic regression was used for prediction of LI-RADS group. Diagnostic accuracy was assessed using receiver operating characteristic curves and Youden method.

Results

Multiple texture features were associated with LI-RADS including the mean HU (P = 0.003), median (P = 0.002), minimum (P = 0.010), maximum (P = 0.013), standard deviation (P = 0.009), skewness (P = 0.007), and entropy (P < 0.001). On logistic regression, LI-RADS group could be predicted with area under the curve, sensitivity, and specificity of 0.98, 96%, and 100%, respectively.

Conclusions

Texture analysis features on portal venous phase computed tomography can identify liver observations likely to be hepatocellular carcinoma, which may preclude the need to recall some patients for additional multiphase imaging.
Deep Breathing Increases Heart Rate Variability in Patients With Rheumatoid Arthritis and Systemic Lupus Erythematosus
Authors: Rovsing Cecilie , Rovsing Helene , Liboriussen Caroline Hundborg , Jensen Mette Kjeldsgaard , Andersen Sally Søgaard , Andersen Stine Søgaard , Kristensen Salome , Jochumsen Mads
Published: March 2020

Background/Objective

Autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have been associated with an impaired function of the autonomic nervous system and reduced vagus nerve (VN) tone measured through lower heart rate variability (HRV). Targeting the VN through electrical stimulation has been proposed as a treatment strategy with promising results in patients with RA. Moreover, it has been suggested that the VN can be stimulated physiologically through deep breathing. In this study, the aim was to investigate if the VN can be stimulated through deep breathing in patients with RA and SLE, as measured by HRV.

Methods

Fifty-seven patients with RA and SLE performed deep breathing exercises for 30 minutes in this explorative study. Before the breathing exercise, 2 electrocardiogram recordings were obtained to determine the patient's baseline HRV during rest. After the 30-minute breathing exercise, 5 minutes of electrocardiogram recordings were obtained to determine postintervention HRV and used as a measure of vagal activity.

Results

No change was observed in the HRV between the 2 recordings prior the exercise, but the heart rate and HRV significantly decreased and increased, respectively, after the deep breathing exercise.

Conclusions

HRV can be modulated in patients with RA and SLE; this may have implications for future treatment with medications in conjunction with deep breathing. However, the biological and clinical effect of deep breathing must be investigated in future studies.
Catgut and its Use in Plastic Surgery
Authors: Kim Hun , Hwang Kun , Yun Seon Mi
Published: March 2020

The aim of this paper is to review the origin, physical properties, advantages, and usage of catgut in plastic surgery and oral surgery.

In PubMed search, the search terms (“catgut” AND [“plastic surgery” OR “facelift”]) and (“catgut” AND “oral surgery”) were used, resulting in 28 and 30 papers, respectively. Of those 58 papers, 31 papers were excluded. Eight other papers were added; therefore, 35 papers were analyzed.

Catgut has been used in cleft palate surgery since 1938. In 1976, it was used in a superficial wound with anti-tension taping. In the 1970s, 1980s, and 1990s, catgut was used in otoplasty, scrotoplasty, hemostasis of neurofibroma, blepharoplasty, ptosis surgery, and rhytidectomy. From the 2000s until the present day, it has been preferred in many fields of plastic surgery, including pediatric lacerations and conjunctiva sutures. In oral wound repairs and tonsillectomy, catgut has been used from the 1970s to the present. Many studies have compared catgut with other suture materials in terms of wound healing, inflammatory reaction, and longevity, and their respective advantages and disadvantages continue to be discussed.

The advantages of catgut as a suture material are as follows: 1, The fundamental advantage of catgut is its absorbability. 2, Catgut has excellent tensile strength. 3, Sterility, when catgut is taken from a sealed tube, is assured. 4, Hardened, or ‘chromed,’ catgut is preferable to the ‘plain’ variety. 5, The finest possible size should be used in preference to thicker sizes.

Catgut sutures are still widely used in plastic surgery and oral surgery.
The Lima Surgical Protocol for Cleft Palate Repair
Authors: Rossell-Perry Percy , Luque-Tipula Margot
Published: March 2020

Background:

A cleft team experience addressing non-syndromic cleft palate and cleft lip and palate is presented. The purpose of the present study is to compare surgical outcomes using 2 different protocols for cleft palate repair provided by a cleft team in Lima, Perú.

Methods:

This is a comparative study between 2 groups of patients with non-syndromic cleft palate who were operated using different surgical protocols from 1999 to 2014. One hundred twenty-four children with non-syndromic isolated cleft palate and cleft lip and palate treated from 2007 to 2014 using a surgical protocol developed by our cleft team in Lima, Perú were compared with 145 children with cleft palate and cleft lip and palate treated by the same team using different protocol from 1999 to 2007. Data collection was accomplished by evaluation of symptomatic oronasal fistulas, presence of velopharyngeal insufficiency (VPI) and postoperative complications.

Results:

Statistical significant differences were observed between the 2 groups regarding the development of flap necrosis in favor of the Lima protocol. No significant difference in palatal fistula and VPI rate between the 2 protocols was found.

Conclusions:

The Lima Surgical Protocol for cleft palate repair is an alternative strategy which uses the strengths of different surgical techniques based on the severity of the cleft. We observed better surgical outcomes using the Lima protocol with regards to postoperative complications in patients with non-syndromic cleft palate.
Systemic and Cardiac Alterations After Long Bone Fracture
Authors: Weber Birte , Lackner Ina , Knecht Deborah , Braun Christian Karl , Gebhard Florian , Huber-Lang Markus , Hildebrand Frank , Horst Klemens , Pape Hans-Christoph , Ignatius Anita , Schrezenmeier Hubert , Haffner-Luntzer Melanie , Kalbitz Miriam
Published: March 2020

The purpose of this study was to reveal possible consequences of long-bone fracture on cardiac tissue and to analyze the role of systemically elevated danger associated molecular patterns, complement anaphylatoxins and cytokines. Blood samples of mice, pigs, and humans after a fracture were analyzed by ELISAs for complement component 5a (C5a), tumor necrosis factor (TNF), and extracellular histones.In vivoresults were completed byin vitroexperiments with human cardiomyocytes treated with TNF and extracellular histones. The influence of histones and human plasma after fracture on isolated human polymorphonuclear leukocytes (PMNs) was investigated. An elevation of TNF, C5a, and extracellular histones after long bone fracture was measured. Moreover, the appearance of systemic troponin I levels was observed and structural changes in connexin 43 and desmin were detected. Further, the presence of TNF leads to elevation of reactive oxygen species, troponin I release, and histone appearance in supernatant of human cardiomyocytes. Incubation of human PMNs with histones and plasma of patients after fracture lead to formation of neutrophil extracellular traps. Present results suggest that structural alterations in the heart might be consequences of the complement activation, the release of extracellular histones, and the systemic TNF elevation in the context of a long bone fracture.
The association of antidepressant monotherapy and weight change in a Middle Eastern psychiatric population
Authors: El-Khoury Joseph , Beayno Antoine , Elbejjani Martine , Abed Al Ahad Mary , Majari Ghaidaa , Ahmad Amanda , Noufi Paul
Published: March 2020

Genetic and lifestyle factors influence weight changes secondary to antidepressants. However, the association between antidepressants and weight changes is seldom studied in Middle Eastern populations who have a unique genetic, lifestyle and dietary profile. This is a chart-based retrospective longitudinal study that describes the 6-month evolution of weight in outpatient Lebanese adults initiated on serotonin reuptake inhibitor (SRI) antidepressant monotherapy, with the exclusion of confounders with metabolic implications. A linear mixed model was used to estimate the association of weight with time. Demographic factors were tested for interaction with the model. The sample consisted of 200 antidepressant trials. After adjusting for baseline weight, age, and sex, weight did not change significantly from week 1 to week 4 (P = 0.530) but significantly increased by 0.15 kg/week from week 4 to week 24 (P < 0.05). Sex, baseline weight, alcohol use, tobacco use, and presence of metabolic condition(s) did not affect weight change (P > 0.05). The same changes were observed across all SRIs and diagnoses. Our results show that SRI monotherapy is associated with weight gain throughout the treatment course in a Middle Eastern population. We recommend judicious prescription of SRIs and clinical vigilance over weight throughout the course of treatment in these populations.
Streptomyces tailanensis sp. nov., an actinomycete isolated from riverside silt
Authors: Sun Beibei , Xia Zhanfeng , Yuan Linlin , Wan Chuanxing , Zhang Lili
Published: March 2020

A novel actinobacterium, designated TRM68348T, was isolated from the silt collected from the Tailan River in Xinjiang Province, north-west China. The strain was aerobic and Gram-stain-positive. The aerial mycelium was densely straight or tortuous, with a few branches of hyphae and no spores. The whole-cell sugar pattern of strain TRM68348T consisted of ribose and glucose. The diagnostic diamino was ll-diaminopimelic acid. The polar lipids were diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylcholine, phosphatidylinositol, phosphatidylinositol mannose and an unidentified phospholipid. The predominant menaquinones were MK-9 (H10), MK-9 (H6) and MK-9 (H2). The major fatty acids (>5 %) were iso-C14 : 0, iso-C15 : 0, anteiso-C15 : 0, iso-C16 : 0, C16 : 0 and summed feature 6. The G+C content of the genomic DNA was 69.93 mol%. Phylogenetic analysis showed that strain TRM68348T shared 16S rRNA gene sequence similarity of 98.14 % to the closest described species

Streptomyces capitiformicae

1H-SSA4T. Strain TRM68348T had a relatively low DNA–DNA relatedness value with

S. capitiformicae

1H-SSA4T as determined by calculating the average nucleotide identity value (92.78 %). Strain TRM68348T could also be differentiated from

S. capitiformicae

1H-SSA4T based on morphological and physiological characteristics. On the basis of the evidence from this polyphasic study, the strain is concluded to represent a novel species of the genus

Streptomyces

, for which the name Streptomyces tailanensis sp. nov. is proposed. The type strain is TRM68348T (=CCTCC AA 2018086T=KCTC 49274T).
Halomonas montanilacus sp. nov., isolated from hypersaline Lake Pengyanco on the Tibetan Plateau
Authors: Lu Huibin , Xing Peng , Zhai Lei , Li Huabing , Wu Qinglong
Published: March 2020

A Gram-stain-negative, catalase- and oxidase-positive, aerobic, rod-shaped, motile strain (PYC7WT) was isolated from Lake Pengyanco on the Tibetan Plateau. Comparisons based on 16S rRNA gene sequences showed that strain PYC7WT belongs to the genus

Halomonas

, with

Halomonas malpeensis

YU-PRIM-29T and

Halomonas johnsoniae

T68687T as its closest neighbours (96.8 and 96.6 % 16S rRNA gene sequence similarity, respectively), and only 93.1 % 16S rRNA gene sequence similarity to

Halomonas elongata

ATCC 33173T. The predominant respiratory quinone of strain PYC7WT is Q-9, with Q-8 as a minor component. The major fatty acids are C18 : 1
 ω6c and / or C18 : 1
 ω7c, C16 : 0, C16 : 1
 ω6c and/or C16 : 1
 ω7c, and C12 : 0 3OH. The polar lipids of strain PYC7WT include phosphatidylethanolamine, phosphatidylglycerol, diphosphatidylglycerol, phosphatidylinositol and two unidentified phospholipids. Genome sequencing revealed a genome size of 4.79 Mbp and a G+C content of 62.9 mol%. DNA–DNA hybridization values of strain PYC7WT showed 45, 30 and 38 % relatedness with

Halomonas johnsoniae

DSM 21197T,

Halomonas hamiltonii

DSM 21196T and

Halomonas stevensii

DSM 21198T, respectively. Combining phenotypic, biochemical, genotypic and DNA–DNA hybridization data, we propose that strain PYC7WT represents a novel species within the genus

Halomonas

and to have the name Halomonas montanilacus sp. nov.; PYC7WT (=CICC 24506T= KCTC 62529T) is the type strain.