bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiopulmonary coupling-derived sleep quality is associated with improvements in blood pressure in patients with obstructive sleep apnea at high-cardiovascular risk
Authors: Magnusdottir Solveig , Hilmisson Hugi , Thomas Robert J.
Published: July 2020

Objective:

Investigate if changes in objective sleep quality index (SQI) assessed through cardiopulmonary-coupling analysis impacts blood pressure (BP) in patients with obstructive sleep apnea at high-cardiovascular risk.

Methods:

Secondary analysis of ECG and pulse-oximetry-[oxygen saturation (SpO2)] data from the Heart Biomarker Evaluation in Apnea Treatment study, multicenter, controlled trial in patients with cardiovascular disease and moderate-severe obstructive sleep apnea, randomly assigned to intervention of healthy lifestyle and sleep hygiene education (HLSE; control group), continuous positive airway pressure (CPAP) or nocturnal supplemental oxygen (NSO). Participants with good-quality ECG-signal and SpO2-signal (n = 241) were included.

Results:

CPAP-therapy significantly improved BP, with net average improvement in mean arterial blood pressure during sleep (MAPSleep) when compared with nocturnal supplemental oxygen-therapy or healthy lifestyle and sleep education-therapy, −3.92 (P = 0.012) and −3.83 (P = 0.016), respectively. When stratified on the basis of baseline-SQI, CPAP-therapy improves 24-h MAP24 −3.02 (P = 0.030) and MAPSleep −5.00 (P = 0.001), in patients with compromised baseline-SQI (SQI < 55). Stratifying the cohort based on changes in SQI during the study period (SQIBaseline-SQIFollow-up), controlling for sex, age over 60, apnea–hypopnea index, SpO2 less than 80%, baseline BP and cardiovascular disease, significant differences are observed comparing the groups that Improved-SQI (SQIBaseline < 55, SQIFollow-up ≥ 55) and Declined-SQI (SQIBaseline ≥ 55, SQIFollow-up < 55) in MAP24 −4.87 (P = 0.046) and mean diastolic blood pressure (MDP24) −4.42 (P = 0.026) as well as MAPWake −6.36 (P = 0.015), mean systolic blood pressure wake (MSPWake) −7.80 (P = 0.048) and MDPWake −5.64 (P = 0.009), respectively. Improved SQI reflects the magnitude of positive effect on BP which is reached mostly through initiation of CPAP-therapy.

Conclusion:

Cardiopulmonary coupling-derived sleep quality impacted 24-h MAP and MDP, as well as BP during wake, in patients participating in the Heart Biomarker Evaluation in Apnea Treatment-study.
Race modifies the association between animal protein metabolite 1-methylhistidine and blood pressure in middle-aged adults: the Bogalusa Heart Study
Authors: Razavi Alexander C. , Bazzano Lydia A. , He Jiang , Whelton Seamus P. , Rebholz Casey M. , Fernandez Camilo , Krousel-Wood Marie , Li Changwei , Shi Mengyao , Nierenberg Jovia L. , Li Shengxu , Kinchen Jason , Mi Xuenan , Kelly Tanika N.
Published: July 2020

Objective:

Dietary factors mediate racial disparities in hypertension. However, the physiological mechanisms underlying this relationship are incompletely understood. We sought to assess the association between 1-methylhistidine (1-MH), a metabolite marker of animal protein consumption, and blood pressure (BP) in a community-based cohort of black and white middle-aged adults.

Methods:

This analysis consisted of 655 participants of the Bogalusa Heart Study (25% black, 61% women, aged 34–58 years) who were not taking antihypertensive medication. Fasting serum 1-MH was measured using liquid chromatography-tandem mass spectroscopy. Animal food intakes were quantified by food-frequency questionnaires. Multivariable linear regression assessed the association between 1-MH and BP in combined and race-stratified analyses, adjusting for demographic, dietary, and cardiometabolic factors.

Results:

A significant dose--response relationship was observed for the association of red meat (P-trend <0.01) and poultry (P-trend = 0.03) intake with serum 1-MH among all individuals. Serum 1-MH, per standard deviation increase, had a significant positive association with SBP (β=3.4 ± 1.6 mmHg, P = 0.04) and DBP (β=2.0 ± 1.1 mmHg, P = 0.05) in black participants, whereas no appreciable association was observed in white participants. Among a subgroup of black participants with repeat outcome measures (median follow-up = 3.0 years), one standard deviation increase in 1-MH conferred a 3.1 and 2.2 mmHg higher annual increase in SBP (P = 0.03) and DBP (P = 0.03), respectively.

Conclusion:

Serum 1-MH associates with higher SBP and DBP in blacks, but not whites. These results suggest a utility for further assessing the role of dietary 1-MH among individuals with hypertension to help minimize racial disparities in cardiovascular health.
Adoption of Lean management and hospital performance: Results from a national survey
Authors: Rundall Thomas G. , Shortell Stephen M. , Blodgett Janet C. , Henke Rachel Mosher , Foster David
Published: July 2020

Background

Despite being adopted by a large number of hospitals, the relationship between Lean management and hospital performance is mixed and not well understood.

Purpose

We examined the relationships between Lean and hospital financial performance, patient outcomes, and patient satisfaction in a large national sample of hospitals, controlling for relevant organizational and market factors.

Methodology/Approach

A mixed effects linear regression analysis was performed to assess the relationships between adoption of Lean and 10 measures of hospital performance using data from 1,152 hospitals that responded to the 2017 National Survey of Lean/Transformational Performance Improvement in Hospitals. Hospital performance, organizational, and market data over the period 2011–2015 come from the 2015 American Hospital Association Annual Hospital Survey and the respective annual Centers for Medicare & Medicaid Services (CMS) Medicare Cost Report, CMS Hospital Compare, CMS MEDPAR, and the CMS Hospital Service Area File.

Results

Lean adoption was significantly associated at alpha < .05, with lower Medicare spending per beneficiary (b = −.005, p = .027). None of the other nine associations were statistically significant, although eight of them were in the predicted direction.

Conclusion

Lean adoption is not associated with most measures of hospital performance. It is likely Lean implementation varies greatly across hospitals. Future research should examine the relationships among the various dimensions of Lean implementation and performance.

Practice Implications

If Lean management is to contribute to hospital performance improvement, leaders must be highly cognizant of what “adoption of Lean” actually means in their hospital. Although limited, single-unit Lean initiatives in an emergency room or other patient care unit may improve performance on some unit-specific measures, improvement on hospital-wide measures of performance requires a broad, sustained commitment to the implementation of Lean practices and tools.
SUCCESSFUL CLOSURE OF A LARGE FULL-THICKNESS MACULAR HOLE SECONDARY TO AN IDIOPATHIC RETINAL VASOPROLIFERATIVE TUMOR USING THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE
Authors: Grondin Christelle , Lorenzi Umberto , Beral Laurence , Morane Sarah , Guillaumie Tremeur , David Thierry
Published: July 2020

Purpose:

To report a case of large full thickness macular hole (MH) as an uncommon complication of an idiopathic retinal vasoproliferative tumor (RPVT) and the successful closure of the full-thickness MH by the inverted internal limiting membrane Flap technique.

Methods:

A case report. A 40-year-old woman was referred for a progressive and profound visual loss on the right eye. The fundus examination showed a full-thickness MH and the presence of an idiopathic RPVT surrounding by numerous exudates in the inferior temporal of the peripheral retina. In addition, the spectral domain optical coherence tomography imaging confirmed the large size of the full-thickness MH (740 μm-diameter). First, we treated the RPVT using the transconjunctival cryotherapy. Then, we performed the macular surgery including 25 Gauge vitrectomy, inverted internal limiting membrane flap technique, and gas tamponade.

Results:

In the postoperative period, the RPVT remained inactive with no recurrence of the MH or excessive gliosis proliferation on the internal limiting membrane flap area. Moreover, visual acuity rose up from 20/100 (0.2) at 1-month follow-up to 20/40 (0.5) at 6-month follow-up.

Conclusion:

In our patient, the full-thickness MH was precisely large and secondary to an RPVT. The treatment of the tumor by transconjunctival cryotherapy had been efficient and the postoperative follow-up after the macular procedure involving the inverted internal limiting membrane flap technique showed the anatomical and functional recovery of the macula.
Contact Lens Discomfort Management: Outcomes of Common Interventions
Authors: Arroyo-del Arroyo Cristina , Fernández Itziar , Novo-Diez Andrea , Blanco-Vázquez Marta , López-Miguel Alberto , González-García María Jesús
Published: July 2020

Purpose:

To assess the consecutive implementation of habitual contact lens discomfort (CLD) management strategies: lid hygiene, daily disposable CL (DDCL) fitting, and artificial tear (AT) supplementation.

Methods:

Contact lens (CL) wearers with CLD symptoms (CLDEQ-8 ≥12 points) were included in the study. Subjects with Meibomian gland dysfunction (MGD) were instructed to perform lid hygiene. All participants were fitted with a DDCL (delefilcon A) and evaluated 1 month later. After, half of them were randomly assigned to use AT (Povidone-2%) at least three times/day, and all participants were evaluated 1 month later. Tests performed were: lower tear meniscus area (LTMA), bulbar, limbal, and tarsal hyperemia, noninvasive tear break-up time (NITBUT), and corneal and conjunctival staining. Weighted combined clinical scores (CS) were created to analyze signs. Changes in symptoms (CLDEQ-8) and CS were analyzed using linear mixed models.

Results:

Forty-two subjects (mean age: 23.2±4.9 years) completed the study. Two CS were created, CS 1 was composed of bulbar, limbal, and tarsal hyperemia and corneal staining, and CS 2 by NITBUT, LTMA, and conjunctival staining. CLDEQ-8 was reduced after lid hygiene (mean: −2.73±2.13; P=0.012) and DDCL use (mean: −10.1±3.54; P<0.01), but not after AT use (P=0.62). CS 1 did not change after any intervention. CS-2 was higher (P=0.04) in DGM subjects after lid hygiene, it decreased (P=0.04) after DDCL use.

Conclusions:

Lid hygiene is effective for reducing CLD symptoms in MGD patients. Refitting subjects with delefilcon A is an effective intervention for CLD to reduce symptoms and achieve a healthier ocular surface. Simultaneous administration of AT did not further improve CLD.
Zonisamide-induced Choroidal Effusion: A Case Report
Authors: Baradad Jurjo Maria C. , Sanz Moreno Sílvia , Moix Gil Eugènia , Lillo Sopena Juan , Caminal Mitjana Josep M.
Published: July 2020

Purpose:

To describe a case of zonisamide-induced bilateral choroidal effusion.

Case Report:

A 72-year-old woman presented with a 4-day history of bilateral blurred vision 9 days after initiating oral zonisamide for essential tremor. Clinical examination revealed an asymmetric choroidal detachment with open anterior chamber angle and intraocular pressure within the normal range. Posterior segment ultrasonography and ultrasound biomicroscopy both confirmed the presence of bilateral ciliochoroidal effusion. Zonisamide treatment was discontinued. One month after treatment discontinuation, the ophthalmological examination was normal and no further treatment was needed.

Conclusion:

Zonisamide can cause an idiosyncratic reaction leading to choroidal effusion with or without acute angle closure. Early withdrawal of the causative agent is the key to reversing this condition. These findings indicate that zonisamide and other sulfa-derived drugs must be ruled out in the differential diagnosis of choroidal effusion of unknown cause.
Quantifying the educational benefit of additional cataract surgery cases in ophthalmology residency
Authors: Liebman Daniel L. , McKay Kenneth Matthew , Haviland Miriam J. , Moustafa Giannis A. , Borkar Durga S. , Kloek Carolyn E.
Published: July 2020

Purpose:

To quantify the resident learning curve for cataract surgery using operative time as an indicator of surgical competency, to identify the case threshold at which marginal additional educational benefit became equivocal, and to characterize heterogeneity in residents' pathways to surgical competency.

Setting:

Academic medical center.

Design:

Large-scale retrospective consecutive case series.

Methods:

All cataract surgery cases performed by resident physicians as primary surgeon at Massachusetts Eye and Ear from July 1, 2010, through June 30, 2015, were reviewed. Data were abstracted from Accreditation Council for Graduate Medical Education case logs and operative time measurements. A linear mixed-methods analysis was conducted to model changes in residents' cataract surgery operative times as a function of sequential case number, with resident identity included as a random effect in the model to normalize between-resident variability.

Results:

A total of 2096 cases were analyzed. A marked progressive decrease in operative time was noted for resident cases 1 to 39 (mean change −0.17 minutes per additional case, 95% CI, −0.21 to −0.12; P < .001). A modest, steady reduction in operative time was subsequently noted for case numbers 40 to 149 (mean change −0.05 minutes per additional case, 95% CI, −0.07 to −0.04; P < .001). No statistically significant improvement was found in operative times beyond the 150th case.

Conclusions:

Residents derived educational benefit from performing a greater number of cataract procedures than current minimum requirements. However, cases far in excess of this threshold might have diminishing educational return in residency. Educational resources currently used for these cases might be more appropriately devoted to other training priorities.
Intraocular lens power calculation in the elderly population using the Kane formula in comparison with existing methods
Authors: Reitblat Olga , Gali Helena E. , Chou Linda , Bahar Irit , Weinreb Robert N. , Afshari Natalie A. , Sella Ruti
Published: July 2020

Purpose:

To assess the accuracy of the Kane formula for intraocualr lens (IOL) power calculation in comparison with established formulas in the elderly population.

Setting:

Shiley Eye Institute, University of California San Diego, USA.

Design:

Retrospective cohort.

Methods:

Retrospective data from 90 patients (90 eyes) aged 75 years or older who underwent uneventful cataract surgery with SN60WF intraocular lens (IOL) implantation were evaluated. The first operated eyes of patients with final corrected distance visual acuity 20/40 or better and axial length 22 to 26 mm were included. Prediction errors were calculated for Barrett Universal (BU) II, Haigis, Hoffer Q, Holladay 1, Kane, and SRK/T formulas. A subgroup analysis based on age (75–84 and ≥85 years old) was performed.

Results:

Use of both BUII and Kane formulas resulted in the highest percentage of eyes with prediction errors within ±0.50 diopters (D) (72% each) and significantly higher than Hoffer Q, Holladay 1, and SRK/T (P = .001). Rates of predictability within ±0.25 D and ±1.00 D were 31% to 38% and 87% to 92%, respectively, with no significant differences between formulas. No statistically significant difference was seen between formulas in the median absolute error. These tendencies remained consistent in both age groups when analyzed separately. Subgroup analysis showed better predictability of all formulas in the younger age group.

Conclusions:

To the authors’ knowledge, this is the first study evaluating the Kane formula exclusively in the elderly population. The Kane formula was found to be of equal accuracy to the BUII and superior to the Hoffer Q, Holladay 1, and SRK/T formulas. Very elderly patients might have reduced refractive precision using all formulas.
The indocyanine green retention test as a noninvasive marker for esophageal varices in patients with hepatocellular carcinoma
Authors: Lu Hsiao-Sheng , Hsin I-Fang , Chen Ping-Hsien , Yang Tsung-Chieh , Chang Chung-Yu , Huang Yi-Hsiang , Hou Ming-Chih
Published: July 2020

Background:

The indocyanine green 15-minute retention (ICG-r15) test was considered as a noninvasive marker of esophageal varices (EV) in cirrhotic patients. However, the performance of ICG-r15 in patients with hepatocellular carcinoma (HCC) has rarely been assessed. The aim of this study is to evaluate the value of ICG-r15 as a noninvasive marker of EV in patients with HCC.

Methods:

From October 2007 to December 2018, the study retrospectively enrolled 137 HCC patients with compensated hepatic function who received ICG-r15 tests and endoscopy screening for EV. The predictive value of the ICG-r15 test and other noninvasive markers was also evaluated for the diagnosis of EV, including the aspartate aminotransferase (AST)/alanine aminotransferase ratio, platelet count/spleen diameter ratio, AST/platelet ratio index, Lok index, FIB-4, and Park index.

Results:

In the study cohort, 30 (21.9%) patients had EV. The area under the receiver operating characteristic curve for determining EV by ICG-r15 was 0.784 (95% CI: 0.686–0.881, −2 ln (L): 77.889, Akaike information criterion: 79.889), and it had the best predictive value compared with other noninvasive markers. The cutoff value of ICG-r15 to identify EV was 31.0%, and it had 40.0% sensitivity and 98.1% specificity. The cutoff value to exclude EV was 9.5% with 86.7% sensitivity and 50.5% specificity. In the multivariate analysis, ICG-r15 (odds ratio [OR]: 1.062, 1.014–1.114; p = 0.015) and the Park index (OR: 1.535, 1.091–2.159; p = 0.014) were independently related to the presence of EV.

Conclusion:

ICG-r15 is a practical noninvasive marker with cutoff values of 9.5% for excluding EV and 31.0% for identifying EV in patients with HCC.
A Structural Equation Model of Gratitude, Self-efficacy, and Medication Adherence in Patients With Stage B Heart Failure
Authors: Cousin Lakeshia , Buck Harleah , Benitez Bryan , Mills Paul , Redwine Laura
Published: July 2020

Background

Consistent self-care slows the progression of heart failure (HF). Gratitude, the practice of appreciating the positive aspects of life, may influence self-efficacy, which in turn is known to improve self-care. However, little is known about the relationships among gratitude, self-efficacy, and medication adherence in HF.

Objective

The aim of this study was to test a model to determine if self-efficacy mediates the relationship between gratitude and medication adherence in asymptomatic patients with HF.

Method

This is a secondary analysis of data from a prospective observational study. Data were analyzed using a structural equation model to examine associations between gratitude, cardiac-specific self-efficacy, and medication adherence in 153 patients with HF. Gratitude, self-efficacy, and medication adherence were assessed using the Gratitude Questionnaire-6, Cardiac Self-efficacy Scale–Maintain Function Subscale, and the Morisky Medication Adherence Scale, respectively.

Results

Patient mean (SD) age was 66 (11) years, and 95% of the participants were men. Patients were primarily white (79%), black (12%), or Asian (6%). Gratitude exerted an indirect effect on medication adherence through self-efficacy (b = 0.16; P < .05). Gratitude was positively related to self-efficacy (b = 0.50; P < .05), and self-efficacy was positively related to medication adherence (b = 0.31; P < .05). The model fit was acceptable (comparative fit index = 0.92, Tucker-Lewis index = 0.90, root-mean-square error of approximation = 0.08).

Conclusion

In this study, we found evidence that self-efficacy was a mechanism through which gratitude was associated with medication adherence in asymptomatic patients with HF, suggesting a way to improve self-care nonpharmacologically. Future work will examine whether gratitude intervention results in improved self-care.
Effects of an Active Music Therapy Program on Functional Fitness in Community Older Adults
Authors: CHAN Shu-Ya , CHEN Chun-Fei
Published: July 2020

Background

Health problems common among older adults living in community settings include a lack of functional fitness. Many studies have confirmed that exercises and static music therapy improve physical and psychological health problems. Exercise programs involving music have a higher frequency of attendance and motivation than other exercise programs. Active participation in active group music therapy results in better therapeutic effects.

Purpose

This study was designed to test the effectiveness of a 3-month active group music therapy program on the functional fitness of community older adults in Taiwan.

Methods

A quasi-experimental design with repeated measures was applied. A convenience cluster sample of older adults was drawn from seven senior-citizen activity centers in southern Taiwan. All participants were assigned to either an experimental group (n= 77) or a comparison group (n= 69) based on the requests of each senior center. The experimental group participated in the active group music therapy program for 3 months (twice per week and 60 minutes per session). The comparison group maintained their daily activities. Each participant's level of functional fitness was measured at baseline and at 1 and 3 months after the start of the intervention.

Results

Seventy-one participants in the experimental group and 62 participants in the comparison group completed the 3-month study. At the 1-month measurement, the experimental group had greater improvements in cardiopulmonary fitness, upper body flexibility, lower body flexibility, upper limb muscle power, lower limb muscle endurance, and balance than the comparison group (allps < .05). These significant improvements persisted through the 3-month intervention (allps < .05).

Conclusions/Implications for Practice

Active group music therapy is an effective complementary and alternative therapy for improving six items of functional fitness in community-dwelling older adults. Healthcare professionals may incorporate this active group music therapy program as a health promotion activity for older adults living in community settings.
Cone-Beam CT Image Guidance With and Without Electromagnetic Navigation Bronchoscopy for Biopsy of Peripheral Pulmonary Lesions
Authors: Verhoeven Roel L.J. , Fütterer Jurgen J. , Hoefsloot Wouter , van der Heijden Erik H.F.M.
Published: July 2020

Background:

Bronchoscopic diagnosis of small peripheral lung lesions suspected of lung cancer remains a challenge. A successful endobronchial diagnosis comprises navigation, confirmation, and tissue acquisition. In all steps, 3-dimensional information is essential. Cone-beam computed tomography (CBCT) imaging can provide computed tomography information and 3-dimensional augmented fluoroscopy imaging. We assessed whether CBCT imaging can improve navigation and diagnosis of peripheral lesions by 2 clinical workflows with a cross-over design: (1) a primary CBCT and radial endobronchial ultrasound mini probe imaging–based approach and (2) a primary electromagnetic navigation (EMN) and radial endobronchial ultrasound mini probe imaging–based approach.

Methods:

All patients with a peripheral lung lesion biopsy indication were eligible for study inclusion and randomly assigned to study arms. Commercially available equipment was used. The main study goals were to assess CBCT-confirmed navigation success and diagnostic accuracy. Surgery or unambiguous clinical follow-up served as the gold standard.

Results:

Eighty-seven patients with 107 lesions were included. Lesion mean longest axis size in the CBCT arm was 16.6 mm (n=47) and 14.2 mm in the EMN arm (n=40). The primary CBCT approach and primary EMN approach had 76.3% and 52.2% navigation success, respectively. Addition of EMN to the CBCT approach increased navigation success to 89.9%. Addition of CBCT imaging to the EMN approach significantly increased navigation success to 87.5% per lesion. The overall diagnostic accuracy per patient was significantly lower than the navigation success, being 72.4%.

Conclusion:

CBCT imaging is a valuable addition to navigation bronchoscopy. Although overall navigation success was high, the diagnostic accuracy remains to be improved. Future research should focus on improving the tissue acquisition methodology.
Observer agreement and accuracy of 18F-sodium fluoride PET/computed tomography in the diagnosis of skull-base bone invasion and osseous metastases in newly diagnosed nasopharyngeal carcinoma
Authors: Xiao JingXing , Wang Dong , Guo Bin , Wang Lu , Su Min , Xu Hao
Published: July 2020

Objectives

To evaluate the interobserver agreement and the diagnostic performance in 18F-sodium fluoride (18F-NaF) PET/computed tomography (CT) for the detection of skull-base bone invasion (SBBI) and osseous metastases in patients with newly diagnosed nasopharyngeal carcinoma (NPC).

Methods

One hundred seventeen patients with newly diagnosed NPC between 2017 and 2019 who underwent 18F-NaF PET/CT was in included. Two experienced observers independently evaluated the 18F-NaF PET/CT of SBBI and osseous metastases on a patient level using a two-category scale present on a dichotomous scale, respectively. On a patient level, the diagnostic performance was calculated using a sensitivity analysis.

Results

The interobserver agreement on a patient level of SBBI and osseous metastases were perfect on a patient-level (κ: 0.85), (κ: 0.808), respectively. On a lesion level of detection of osseous metastases, the observers agreed on the number as well as the location of osseous metastases in 101 (86.3%) patients. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of detection of SBBI and osseous metastases were ranged 0.911–0.962, 0.921–0.974, 0.932–0.957, 0.962–0.986, and 0.841–0.923, and ranged 0.917–0.958, 0.899–0.957, 0.906–0.949, 0.863–0.936, and 0.939–0.970, respectively.

Conclusion

The interobserver agreement of 18F-NaF PET/CT for the detection of SBBI and osseous metastases in patients with NPC were both very high among trained observers. Moreover, the diagnostic performance of NaF PET/CT was satisfactory, rendering NaF PET/CT a robust tool in the diagnostic armamentarium.
Production of bla oxa-23 type genes carrying by Acinetobacter baumannii isolated from hospitalized patients in Tehran, Iran
Authors: Rezaei Maryam , vand Yousefi Jalil , Harzandi Naser , Sharifizadeh Monireh , Zahedi bialvaei Abed , Rahbar Mohammad
Published: July 2020

Carbapenems are potent β-lactam antibiotics, including imipenem and meropenem that is used to treat serious infections caused by Acinetobacter baumannii. The aim of this study was to determine the resistance rate of A. baumannii to imipenem and meropenem by producing OXA-23 gene. Sixty A. baumannii isolates were collected from four hospitals. Susceptibility testing of all A. baumannii isolates was determined by disk diffusion method. After bacterial DNA extraction, PCR was used for detection of bla
oxa-51 and bla
oxa-23 beta-lactamase genes. According to the result, 98% of A. baumannii isolates were resistant to amikacin, ceftazidime and ceftriaxone. Resistance rates to imipenem and meropenem was 72%. All isolates were resistant to cefixime; however, were susceptible to colistin. PCR method determined the presence of resistance-encoding class D carbapenemase including bla
oxa-51 like and bla
oxa-23 like in 60 (100%) and 51 (85%) isolates, respectively, which was in agreement with disk diffusion method. Our study revealed a high rate of drug resistance among A. baumannii isolates with presence of bla
oxa-51 and bla
oxa-23 β-lactamase gens. However, colistin were the effective antimicrobial agents, in vitro. Therefore, the rate of carbapenem-resistant A. baumannii susceptibility profiling highlights the need for a comprehensive Iranian national antimicrobial drug resistance survey to monitor A. baumannii isolates from all parts of the country.
Evaluation of probiotic potentials of yeast isolates from traditional fermented rice beverages of Meghalaya, India
Authors: Mishra Birendra K. , Hati Subrota , Brahma Jonali , Das Sujit
Published: July 2020

Meghalaya is a land of unexplored traditional knowledge mainly inhabited by Garo, Khasi and Jaintia tribes. Locally available well known traditionally prepared fermented alcoholic indigenous rice beverage is known as Chubitchi by Garos, kyiad by Khasi and Sadhiar by Jaintias. The objective of this study was to identify functional and potential probiotic yeast involved in the production of rice beverage. Yeast cultures are used since old age with many health attributes and it is also applied in the production of fermented rice beverages traditionally. Five yeast isolates were selected, the isolates were tolerant to a wide range of pH (2.0, 3.0), high concentration of bile salt (0.5%) and also showed zone of precipitation in bile salt hydrolase plates. They showed resistance against broader range of clinically important antibiotics and showed moderate cell surface hydrophobicity. The isolates could produce enzymes viz. amylase and were found to be glucoamylase deficient. The isolates showed antimicrobial activity and were able to scavenge ABTS+ until 3 min. The isolates could also assimilate cholesterol above 85% after 24 h. Exopolysaccharide production was reported in all of the isolates. Further, the yeasts isolated from fermented rice beverage could serve as promising starter cultures with rich probiotic potentiality.
Patient Engagement in Breast Cancer Survivorship Care
Authors: Post Kathryn E. , Berry Donna L. , Shindul-Rothschild Judith , Flanagan Jane
Published: July 2020

Background

Patient engagement (PE) is a key factor for early-stage breast cancer survivors during survivorship, yet little is known about what factors may contribute to PE.

Objectives

The aims of this study were to describe the relationship between sociodemographic factors, survivorship variables, and PE and explore how variations in these variables might contribute to PE in breast cancer survivors.

Methods

A cross-sectional, web-based self-report national survey was conducted to assess sociodemographic factors and survivorship variables: health-related quality of life (HRQOL) as measured by 7-item Functional Assessment of Cancer Therapy–General, fear of cancer recurrence, cancer health literacy, and 2 measures of PE (Patient Activation and Knowing Participation in Change) in breast cancer survivors. One open-ended question assessed additional survivorship concerns. Data were analyzed via bivariate associations and backward linear regression modeling in SPSS.

Results

The sample (N = 303), equally dispersed across the United States, was predominantly middle-aged (mean, 50.70 [SD, 14.01]), white, non-Hispanic women. Knowing Participation in Change and Patient Activation regression models indicate HRQOL was significantly associated with PE (P ≤ .001), whereas findings related to fear of cancer recurrence lacked significance. In the Knowing Participation in Change regression model, HRQOL, social support, and level of education were all significantly associated with PE (P ≤ .001).

Conclusions

Breast cancer survivors with higher HRQOL, greater social support, and higher levels of education were more likely to have higher levels of PE.

Implications for Practice

Findings may provide insight as to which survivors may be ready to engage in SC and those who may need more specific tailoring of resources and support.
Exploring the Positive Thinking of Patients With Prostate Cancer
Authors: Chien Ching-Hui , Chuang Cheng-Keng , Liu Kuan-Lin , Pang See-Tong , Wu Chun-Te , Chang Ying-Hsu
Published: July 2020

Background

Research has explored the effectiveness of positive thinking on individuals, but only a few studies have investigated the factors that influence individual positive thinking, particularly among patients with prostate cancer.

Objectives

The aim of this study was to understand the factors that affect positive thinking among patients with prostate cancer and the mediating role of self-efficacy.

Methods

A cross-sectional design and a convenience sampling method were used to recruit patients with prostate cancer from 2 hospitals in Taiwan. Structured scales were used for data collection, including the General Self-efficacy Scale, Expanded Prostate Cancer Index Composite, Positive Thinking Scale, and Social Support Scale.

Results

The total average score for positive thinking among 201 patients was 66.1 (SD, 9.4). The factors that influenced the positive thinking of patients with prostate cancer included self-efficacy, treatment satisfaction, perceived health status, marital status, and appraisal support. The effects of treatment satisfaction and appraisal support on positive thinking were partly achieved through self-efficacy (partial mediation).

Conclusions

Self-efficacy is a mediator that affects the relationship of treatment satisfaction, appraisal support, and positive thinking.

Implications for Practice

In the course of the disease, healthcare providers can help patients with prostate cancer to promote and maintain appropriate positive thinking by improving treatment satisfaction; increasing appraisal support from family, relatives, and friends; strengthening self-efficacy; and modifying unrealistic expectations.
Motor Vehicle Collision Injuries: An Analysis of Facial Fractures in the Urban Pediatric Population
Authors: Le Thuy-My T. , Oleck Nicholas C. , Liu Farrah C. , Halsey Jordan N. , Hoppe Ian C. , Lee Edward S. , Granick Mark S.
Published: July 2020

Purpose:

Motor vehicle collisions (MVC) are a leading cause of unintentional death and injury in the US pediatric population. Compliance with prevention measures such as seatbelts and child safety seats varies considerably with patient demographics. In this study, the authors examine facial fracture secondary to MVC in an urban pediatric population.

Methods:

A retrospective chart review was performed of all facial fractures as a result of MVC in the pediatric population in a level 1 trauma center in an urban environment (University Hospital in Newark, NJ). Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies.

Results:

Seventy-five patients met inclusion criteria for the authors’ study. Mean age was 14 years old. Common fracture sites included orbital, mandible, nasal bone, and frontal sinus. Patients were more likely to incur fracture of the zygoma, orbit, nasal bone, frontal sinus, and nasoorbitoethmoid (NOE) if involved in an MVC compared to all other etiologies. Common concomitant injuries included traumatic brain injury, intracranial hemorrhage, and skull and long bone fractures. Open reduction and internal fixation with titanium plates was the most common surgical procedure indicated.

Conclusion:

Motor vehicle collisions related injury has significant health implications in the urban pediatric population. Orbital, zygoma, and nasal facial fractures and TBI are injuries commonly associated with MVC. The facial fractures are likely due to lack of proper utilization of safety equipment and airbags. Development of effective prevention techniques relies heavily on analysis of injury patterns and management strategies.
Outcomes of Endoscopic Versus Open Spring Assisted Surgery for Sagittal Craniosynostosis
Authors: Runyan Christopher M. , Park Jungwon G. , Blaha Lauren , Gabrick Kyle S. , Townsend Robert K. , Owens Elizabeth , Couture Daniel E. , David Lisa R.
Published: July 2020

Spring-assisted surgery (SAS) has been shown to be an effective technique for correction of isolated sagittal craniosynostosis in patients less than 6 months of age. At their institution, the authors adopted a minimally invasive technique in 2010, using a shorter incision and an endoscope. A retrospective chart review of 101 patients with isolated, nonsyndromic, sagittal craniosynostosis, who underwent SAS, was performed in order to compare perioperative and clinical outcomes of the open (n = 51) and minimally-invasive (n = 50) approaches. Surgeries were performed by 2 neurosurgeons and 3 plastic surgeons, between 2005 and 2018. The pre and postoperative cephalic indices were not significantly different in both groups. Minimally-invasive spring placement required a longer operative time than the open approach, with the mean minimally-invasive operative time at 65 minutes, compared to 53 minutes (P < 0.0001). Spring removal operative time was not significantly different, with the minimally-invasive operative time at 31 minutes versus 29 minutes (P = 0.48). There were no significant differences in major or minor complications when comparing the open and minimally-invasive approaches. In conclusion, both the open and the minimally-invasive SAS techniques are effective for early correction of isolated sagittal craniosynostosis, although the minimally-invasive approach requires a longer operative time for spring placement.
Indications and Outcomes of the Osteoplastic Flap Procedure With or Without Obliteration
Authors: Lee Yan Ho , Lee Jonathan Y. , Lawson William
Published: July 2020

Objective:

To describe the osteoplastic approach and to perform a systematic review of the indications and outcomes of the osteoplastic flap procedure for frontal sinus surgeries with or without obliteration.

Data sources:

PubMed, Medline, Google Scholar, and Cochrane databases.

Review methods:

All published studies in the English language on the osteoplastic flap with or without obliteration were identified from 1905 to 2018. All studies with <20 patients were excluded. The number of patients, technique, indications, follow-up period, symptom relief, revision rates, and complications were recorded and analyzed.

Results:

A systematic review yielded 25 series containing 1374 patients for analysis. Indications for surgery included chronic frontal sinusitis, mucoceles, fractures or traumas, osteomas, neoplasms, and cerebrospinal fluid leak. The mean follow-up period ranged from 12.8 to 144 months. The percentage of patients needing revisions for frontal sinus disease was 6.2%. There was a high rate of symptomatic improvement (85.0%) and a low rate of major complications (0.7%). However, minor complications occurred in 19.4% of patients.

Conclusion:

The osteoplastic flap with or without obliteration has many indications. In an era where endoscopic technique provides excellent access to the frontal sinuses, external approaches remain a useful adjunct, and/or salvage technique. In experienced hands, the osteoplastic flap can yield excellent long-term clinical results, with low rates of complications. Regardless of the surgical approach, long-term follow-up is necessary due to the recurrent nature of frontal sinus disease.
In-House Three-Dimensional Printing Workflow for Face Shield During COVID-19 Pandemic
Authors: Gomes Bruno de Araujo , Queiroz Fabrisia Loise Cassiano , Pereira Pedro Leonardo de Oliveira , Barbosa Thiago Viana , Tramontana Marcelo Borges , Afonso Felipe Alexander Caldas , Garcia Eduardo dos Santos , Borba Alexandre Meireles
Published: July 2020

From the beginning of the year 2020, the world was affected by a coronavirus disease (COVID-19) pandemic, caused by SARS-CoV-2, leading to a shortage of personal protective equipment (PPE) at a global level, and thus generating exposure of health professionals to this extremely contagious virus. Within this context, the present work seeks to present an alternative for the production of face shields “face shields,” in which it recommends its production “in house” through 3D printing, in principle initiated by Prusa Research, where we download your project of support of facial protectors, proceeding with printing through the 3D printer Gtmax3D Core H5. The authors produced a face shield in ABS, in a total time of 3 hours and 44 minutes. Thus, the model presented proved to be feasible, at a low cost, adding to the list of possibilities to produce inputs necessary to maintain the fight against this epidemic.
Gustatory Dysfunction as an Early Symptom in COVID-19 Screening
Authors: Harikrishnan Pandurangan
Published: July 2020

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from Wuhan, China in December 2019 leads to the present coronavirus disease 2019 (COVID-19) pandemic. The various symptoms identified for COVID-19 are fever, dry cough, sore throat, dyspnea, fatigue, myalgia, and headache. Olfactory and gustatory dysfunctions are emerging as a new symptom more in the European patients. Taste disturbances are common in various oral and systemic diseases. Varying severity and onset of taste disturbances are reported in COVID-19 positive patients in this pandemic. But a sudden onset of taste disturbances without an established and recognized cause should raise suspicion of COVID-19. This article will analyze the various studies focusing on taste disturbances as a reliable early symptom for COVID-19 screening.
Finding the “True” N0 Cohort
Authors: Phillips William W. , Weiss Kathleen D. , Digesu Christopher S. , Gill Ritu R. , Mazzola Emanuele , Tsukada Hisashi , Schumacher Lana Y. , Colson Yolonda L.
Published: July 2020

Objective:

To examine technical-, patient-, tumor-, and treatment-related factors associated with NIR guided SLN identification.

Background:

Missed nodal disease correlates with recurrence in early stage NSCLC. NIR-guided SLN mapping may improve staging and outcomes through identification of occult nodal disease.

Methods:

Retrospective analysis of 2 phase I clinical trials investigating NIR-guided SLN mapping utilizing ICG in patients with surgically resectable NSCLC.

Results:

In total, 66 patients underwent NIR-guided SLN mapping and lymphadenectomy after peritumoral ICG injection. There was significantly increased likelihood of SLN identification with injection dose ≥1 mg compared to <1 mg (65.2% vs 35.0%, P = 0.05), lung ventilation after injection (65.2% vs 35.0%, P = 0.05), and albumin dissolvent (68.1%) compared to fresh frozen plasma (28.6%) and sterile water (20.0%) (P = 0.01). In patients receiving the optimized ICG injection, there was significantly increased likelihood of SLN identification with radiologically solid nodules compared to sub-solid nodules (77.4% vs 33.3%, P = 0.04) and anatomic resection compared to wedge resection (88.2% vs 52.2%, P = 0.04). Disease-free and overall survival are 100% in those with a histologically negative SLN identified (n = 25) compared to 73.6% (P = 0.02) and 63.6% (P = 0.01) in patients with node negative NSCLC established via routine lymphadenectomy alone (n = 22).

Conclusions:

SLN(s) are more reliably identified with ICG dose ≥1 mg, albumin dissolvent, post-injection lung ventilation, radiologically solid nodules, and anatomic resections. To date, N0 status when established via NIR SLN mapping seems to be associated with decreased recurrence and improved survival after surgery for NSCLC.
Post-discharge Opioid Consumption After Minimally Invasive and Open Colectomy
Authors: Vu Joceline , Cleary Robert K. , Englesbe Michael J. , Brummett Chad M. , Waljee Jennifer F. , Suwanabol Pasithorn A.
Published: July 2020

Objective:

To determine if patients consume less opioid after minimally invasive colectomy compared to open colectomy.

Background:

Opioids are overprescribed after surgery, and surgeons are under increasing pressure to reduce postoperative opioid prescribing. In colorectal surgery, minimally invasive approaches are partly justified by reduced inpatient opioid use, but there are no studies comparing post-discharge opioid consumption between minimally invasive and open colectomy.

Methods:

This was a retrospective observational study of adult patients undergoing colectomy from January 2017 to May 2018 in the Michigan Surgical Quality Collaborative database. After postoperative day 30, patients were contacted by phone or email and asked to report post-discharge opioid consumption. The main outcome measure was post-discharge opioid consumption, and the primary predictor was surgical approach (minimally invasive vs open). Zero-inflated negative binomial regression analysis was used to test for an association between surgical approach and opioid consumption.

Results:

We identified 562 patients who underwent minimally invasive or open colectomy from 43 hospitals. After multivariable adjustment, no significant difference was demonstrated in opioid consumption (P = 0.54) or the likelihood of using no opioids (P = 0.39) between patients undergoing minimally versus open colectomy. Larger prescriptions were associated with more opioid use and a lower likelihood of using no opioids. Age greater than 65 and diagnosis of cancer/adenoma were associated with less opioid use.

Conclusions:

Patients undergoing minimally invasive and open colectomy consume similar amounts of opioid after discharge. The size of the postoperative prescription, patient age, and diagnosis are more important in determining opioid use. Understanding factors influencing postoperative opioid requirements may allow surgeons to better tailor prescriptions to patient needs.
Robotic Assisted Living Donor Nephrectomies
Authors: Spaggiari Mario , Garcia-Roca Raquel , Tulla Kiara A. , Okoye Obi T. , Di Bella Caterina , Oberholzer José , Jeon Hoonbae , Tzvetanov Ivo G , Benedetti Enrico
Published: July 2020

Objective:

To review outcomes after laparoscopic, robotic-assisted living donor nephrectomy (RLDN) in the first, and largest series reported to date.

Summary of Background Data:

Introduction of minimal invasive, laparoscopic donor nephrectomy has increased live kidney donation, paving the way for further innovation to expand the donor pool with RLDN.

Methods:

Retrospective chart review of 1084 consecutive RLDNs performed between 2000 and 2017. Patient demographics, surgical data, and complications were collected.

Results:

Six patients underwent conversion to open procedures between 2002 and 2005, whereas the remainder were successfully completed robotically. Median donor age was 35.7 (17.4) years, with a median BMI of 28.6 (7.7) kg/m2. Nephrectomies were preferentially performed on the left side (95.2%). Multiple renal arteries were present in 24.1%. Median operative time was 159 (54) minutes, warm ischemia time 180 (90) seconds, estimated blood loss 50 (32) mL, and length of stay 3 (1) days. The median follow-up was 15 (28) months. Complications were reported in 216 patients (19.9%), of which 176 patients (81.5%) were minor (Clavien-Dindo class I and II). Duration of surgery, warm ischemia time, operative blood loss, conversion, and complication rates were not associated with increase in body mass index.

Conclusion:

RLDN is a safe technique and offers a reasonable alternative to conventional laparoscopic surgery, in particular in donors with higher body mass index and multiple arteries. It offers transplant surgeons a platform to develop skills in robotic-assisted surgery needed in the more advanced setting of minimal invasive recipient operations.