bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond pain: can antidepressants improve depressive symptoms and quality of life in patients with neuropathic pain? A systematic review and meta-analysis
Authors: Caruso Rosangela , Ostuzzi Giovanni , Turrini Giulia , Ballette Francesca , Recla Elisabetta , Dall'Olio Riccardo , Croce Enrico , Casoni Beatrice , Grassi Luigi , Barbui Corrado
Published: May 2019

Neuropathic pain can be a predictor of severe emotional distress, up to full-blown depressive states. In these patients, it is important to move beyond the sole treatment of pain, to recognize depressive symptoms, and to ultimately improve the quality of life. We systematically searched for published and unpublished clinical trials assessing the efficacy and tolerability of antidepressants vs placebo on depression, anxiety and quality of life in patients with neuropathic pain, and pooled data in a meta-analysis. A total of 37 studies fulfilled eligibility criteria and 32 provided data for meta-analysis. Antidepressants were more effective than placebo in improving depressive symptoms (standardized mean difference −0.11; 95% confidence interval −0.20 to −0.02), although the magnitude of effect was small, with a number needed to treat of 24. No significant difference emerged between antidepressants and placebo in reducing anxiety. Quality of life seemed improved in patients on antidepressants, as did pain. Acceptability and tolerability were higher in patients on placebo. To the best of our knowledge, this is the first meta-analysis specifically focusing on the effect of antidepressants on psychiatric symptoms and quality of life in patients with neuropathic pain. Our findings suggest that despite their potential benefit in patients with neuropathic pain, antidepressants should be prescribed with particular care because they might be less tolerable in such a fragile population. However, our findings warrant further research to explore how a correct use of antidepressants can help patients to cope with the consequences of neuropathic pain on their psychosocial health and quality of life.
Investigating intraindividual pain variability: methods, applications, issues, and directions
Authors: Mun Chung Jung , Suk Hye Won , Davis Mary C. , Karoly Paul , Finan Patrick , Tennen Howard , Jensen Mark P.
Published: May 2019

Pain is a dynamic experience subject to substantial individual differences. Intensive longitudinal designs best capture the dynamical ebb and flow of the pain experience across time and settings. Thanks to the development of innovative and efficient data collection technologies, conducting an intensive longitudinal pain study has become increasingly feasible. However, the majority of longitudinal studies have tended to examine average level of pain as a predictor or as an outcome, while conceptualizing intraindividual pain variation as noise, error, or a nuisance factor. Such an approach may miss the opportunity to understand how fluctuations in pain over time are associated with pain processing, coping, other indices of adjustment, and treatment response. The present review introduces the 4 most frequently used intraindividual variability indices: the intraindividual SD/variance, autocorrelation, the mean square of successive difference, and probability of acute change. In addition, we discuss recent development in dynamic structural equation modeling in a nontechnical manner. We also consider some notable methodological issues, present a real-world example of intraindividual variability analysis, and offer suggestions for future research. Finally, we provide statistical software syntax for calculating the aforementioned intraindividual pain variability indices so that researchers can easily apply them in their research. We believe that investigating intraindividual variability of pain will provide a new perspective for understanding the complex mechanisms underlying pain coping and adjustment, as well as for enhancing efforts in precision pain medicine. Audio accompanying this abstract is available online as supplemental digital content at http://links.lww.com/PAIN/A817.
Effects of smoking on patients with chronic pain: a propensity-weighted analysis on the Collaborative Health Outcomes Information Registry
Authors: Khan James S. , Hah Jennifer M. , Mackey Sean C.
Published: May 2019

Tobacco smoking is associated with adverse health effects, and its relationship to pain is complex. The longitudinal effect of smoking on patients attending a tertiary pain management center is not well established. Using the Collaborative Health Outcomes Information Registry of patients attending the Stanford Pain Management Center from 2013 to 2017, we conducted a propensity-weighted analysis to determine independent effects of smoking on patients with chronic pain. We adjusted for covariates including age, sex, body mass index, depression and anxiety history, ethnicity, alcohol use, marital status, disability, and education. We compared smokers and nonsmokers on pain intensity, physical function, sleep, and psychological and mood variables using self-reported NIH PROMIS outcomes. We also conducted a linear mixed-model analysis to determine effect of smoking over time. A total of 12,368 patients completed the CHOIR questionnaire of which 8584 patients had complete data for propensity analysis. Smokers at time of pain consultation reported significantly worse pain intensities, pain interference, pain behaviors, physical functioning, fatigue, sleep-related impairment, sleep disturbance, anger, emotional support, depression, and anxiety symptoms than nonsmokers (all P < 0.001). In mixed-model analysis, smokers tended to have worse pain interference, fatigue, sleep-related impairment, anger, emotional support, and depression over time compared with nonsmokers. Patients with chronic pain who smoke have worse pain, functional, sleep, and psychological and mood outcomes compared with nonsmokers. Smoking also has prognostic importance for poor recovery and improvement over time. Further research is needed on tailored therapies to assist people with chronic pain who smoke and to determine an optimal strategy to facilitate smoking cessation.
Alterations in evoked and spontaneous activity of dorsal horn wide dynamic range neurons in pathological pain: a systematic review and analysis
Authors: Zain Maham , Bonin Robert P.
Published: May 2019

Wide dynamic range (WDR) neurons of the spinal dorsal horn respond to a wide range of innocuous and noxious mechanical stimulation and encode the intensity of mechanical stimuli as changes in firing rate. However, there are inconsistent findings regarding whether WDR neuron stimulus encoding activity is altered in pathological pain states. This inconsistency may arise from differences in the pain models used or in the experimental conditions themselves. In this study, we use a meta-regression approach to examine which variables modulate and determine WDR activity. We pooled data from in vivo electrophysiological studies of WDR activity evoked by von Frey filament stimulation of the hind paw in rats across a number of pathological pain models. We observed that WDR firing rate was better predicted by the calculated pressure of von Frey stimulation rather than applied filament force, as reported in all studies. The pressure-evoked firing rate of WDR neurons was not altered by any experimental pain model except for arthritis and inflammation models, where mechanical stimuli evoked a higher firing rate than controls. Conversely, there was a consistent increase in the spontaneous firing rate of WDR neurons in neuropathic pain, arthritis and inflammation, and chemoneuropathy pain models. Overall, these data indicate that changes in WDR encoding of applied pressure are unlikely to significantly contribute to pathological sensory processing but suggest a possible role for these neurons in spontaneous pain.
The prognostic value of pre-treatment prognostic nutritional index in esophageal squamous cell carcinoma
Authors: Li Pengfei , Wang Xin , Lai Yutian , Zhou Kun , Tang Yuxin , Che Guowei
Published: May 2019

Background:

Prognostic nutritional index (PNI) is an easily obtained index inflecting both one's nutritional and inflammatory status. Its clinical role in esophageal squamous cell carcinoma (ESCC) remains still in debate. The aim of this meta-analysis was to assess the prognostic value and the clinical-pathological features of pre-treatment PNI in ESCC patients.

Methods:

A comprehensive search of online databases (PubMed, Embase, Web of Science) was performed. Studies explored the relationship between pre-treatment PNI and long-term survival of ESCC patients were regarded eligible for this meta-analysis. Outcomes were extracted and synthesized. Hazard ratio (HR) and relative ratio (RR) with 95% confidence interval (CI) were used to evaluate the prognostic value of PNI on long-term survival and association with clinical-pathological features, respectively. The heterogeneity levels and publication bias between studies were also estimated.

Results:

Nine observational studies involving 2276 patients were considered eligible for this meta-analysis. The pooled results showed that low PNI score was significantly correlated with poorer overall survival (OS) of esophageal cancer (pooled HR = 1.418 95%CI: 1.200–1.676, P = .000), poorer recurrence free survival (HR = 1.880 95%CI: 1.207–2.929, P = .005) but not cancer specific survival (CSS) (HR = 1.948 95%CI: 0.544–6.977, P = .306). The PNI value was not related with patient age, sex, depth of tumor invasion, nodular metastasis, and differential grade but the TNM stage (III/IV vs 0/I/II, RR = 1.276, 95% CI 1.146–1.420).

Conclusions:

Low pre-treatment PNI was significantly related with OS and recurrence free survival but not CSS for ESCC. PNI was a reliable prognostic factor of ESCC, and higher stage ESCC have higher incidence of low PNI.
Incidence and risk of fatigue in cancer patients treated with MET inhibitors
Authors: Tong Hongxuan , Zhu Yutian , Liu Yihua
Published: May 2019

Background:

The N-methyl-N′-nitroso-guanidine human osteosarcoma transforming gene (MET) inhibitors show a surprising survival benefit in the treatment of numerous tumors especially in MET-high tumor. Besides their impressive efficacy, fatigue reduced by MET inhibitors is still the safety issue during treatment. Thus, an understanding of this risk in the context of expanding MET-inhibitors use is an important cost and patient safety issue.

Methods:

We searched PubMed, Embase, and the Cochrane Library databases for relevant studies up to October 2017. Eligibility criteria included phase II/III trials of MET inhibitors that reported adequate safety profiles of fatigue. The principal summary measures were incidence and relative risk (RR) of all-grade (grade 1–4) and high-grade (grade 3–4) fatigue, respectively. Random-effects model was applied to consider within-study and between-study variation.

Results:

A total of 5028 patients from 17 clinical trials were identified. The results revealed that the incidences of MET inhibitors-associated all-grade and high-grade fatigue were 41.9% and 9.6%, respectively. The RR of high-grade fatigue was (RR = 1.37; 95% confidence interval, 1.14–1.66; P = .0009), whereas the RR of all-grade fatigue was (RR = 1.02; 95% confidence interval, 0.91–1.15; P = .71).

Conclusion:

Our meta-analysis has demonstrated that MET inhibitors-based treatment is associated with an increased risk of high-grade fatigue compared with control.
Full-endoscopic interlaminar discectomy for the treatment of a dorsal migrated thoracic disc herniation
Authors: Hur Jung-Woo , Kim Jin-Sung , Seung Ji-Hoon
Published: May 2019

Rationale:

Thoracic disc herniation (TDH) is an infrequent spinal disease and difficult to treat well. Various surgical approaches and procedures were introduced in many literatures. The authors report a patient with dorsal migrated TDH compressing the spinal cord at T10-11 level.

Patient concerns:

A 65-year-old male patient presented with complaints of severe paresthesia of both legs and progressive motor weakness for 1 week.

Diagnoses:

Magnetic resonance imaging (MRI) of the thoracic and lumbar spine revealed TDH and migration of dorsal side on spinal cord at T10-11 level.

Interventions:

Successful decompressive surgery was performed through a posterior interlaminar approach using only endoscopic instruments.

Outcomes:

After the operation, patient's symptoms, paraparesis and paresthesia, immediately improved.

Lessons:

The successful results of this case suggest that full endoscopic laminotomy and discectomy may be an attractive minimally invasive surgical technique for treating TDH with dorsal migrated fragments.
Targeted therapy with anlotinib for patient with recurrent glioblastoma
Authors: Lv Yajuan , Zhang Jiandong , Liu Fengjun , Song Meijuan , Hou Yong , Liang Ning
Published: May 2019

Rationale:

Glioblastoma (GBM) is the most aggressive malignant brain tumor in adults. The first choice for GBM is surgery, and followed by a combination of radiotherapy and chemotherapy. There are limited treatments for patients with recurrent GBM. Relapsed patients usually have a worse prognosis, and with a median survival time of <6 months. Anlotinib is a novel small molecule multi-target tyrosine kinase inhibitor that can inhibit tumor angiogenesis and inhibit tumor cell growth. This drug has been used to treat advanced lung cancer.

Patient concerns:

We present a case of recurrent GBM was treated with anlotinib in this report. The patient was diagnosed with GBM in August 2016 and treated with surgery and temozolomide (TMZ) chemotherapy. She was diagnosed with recurrence in February 2017 following which she was treated with gamma knife and TMZ chemotherapy. In November 2017, the patient presented with decreased vision in left eye. She was given radiation and her left eye vision returned to normal after radiation. On May23, 2018, the patient reported a decrease in left visual acuity again.

Diagnoses:

Brain magnetic resonance imaging (MRI) showed progression of the disease, and the tumor invaded the left optic nerve.

Interventions:

This patient was administer anlotinib 12 mg po qd (d1–14, 21days as a cycle). Three cycles anlotinib were given to this patient.

Outcomes:

The patient reported her left visual acuity increased over 10 days after first cycle of anlotinib treatment. MRI scan revealed tumor volume shrinks, especially the part that invades the left optic nerve shrinks significantly at 26 days after anlotinib treatment on August 11, 2018. However, the tumor progressed in 2 months after using of anlotinib. From the beginning of the application of anlotinib to death, her survival time was 110 days.

Lessons:

Anlotinib treatment with mild side effects may be a new option for the patients with recurrent glioblastoma.
RhACE2 – playing an important role in inhibiting apoptosis induced by Ang II in HUVECs
Authors: Zhang Hongli , Zhang Xiaocui , Hou Zhaoyu , Deng Fang
Published: May 2019

Background:

Henoch-Schonlein purpura (HSP) is a common hemorrhagic disease, which manifests the inflammation in the body's most microvasculars. Angiotensin II (Ang II) can induce the damage and apoptosis of vascular endothelial cells while angiotensin converting enzyme 2 (ACE2) can antagonist the action of Ang II. However, the effect of ACE2 on Ang II-induced endothelial damage remains unknown.

Objective:

To evaluate the effect of recombinant human angiotensin converting enzyme 2 (rhACE2) on the Ang II-induced damage of human umbilical vein endothelial cells (HUVECs) and the release of inflammatory mediator in vitro.

Methods:

Cultured HUVECs were randomly divided into 6 groups: the control group, rhACE2 group, Ang II group, and Ang II+ rhACE2 groups (3 subgroups). The cell vitality, cell cycle, apoptosis rate of the HUVECs and the levels of reactive oxygen species (ROS), interleukin 8 (IL-8), tumor necrosis factor-α (TNF-α), transforming growth factor-β1 (TGF-β1) and lactate dehydrogenase (LDH) were measured, respectively.

Results:

Compared with the control group, the cell viability and the rate of S phase cells in Ang II group significantly decreased (P < .05) while the apoptosis percentage and the levels of ROS, IL-8, TNF-α, TGF-β1, and LDH in Ang II group significantly increased (P < .05). There were no significant differences between the control group and rhACE2 group. Compared with the Ang II group, the cell viability and the rate of S phase cells in Ang II+rhACE2 groups were higher (P < .05) and the apoptosis percentage, the level of ROS, IL-8, TNF-α, TGF-β1, LDH in Ang II+rhACE2 groups were lower (P < .05).

Conclusions:

Ang II can induce the apoptosis of HUVECs and the release of inflammatory mediator, while rhACE2 can inhibit the detrimental effects of Ang II. The results of this study suggest that rhACE2 has a protective effect on HSP, which is probably a new way for the prevention and treatment of HSP.
Surgical treatment of the severely damaged atlantoaxial joint with C1–C2 facet spacers
Authors: Tominaga Hiroyuki , MacDowall Anna , Olerud Claes
Published: May 2019

Rationale:

Atlantoaxial subluxation (AAS), caused by congenital factors, inflammation such as rheumatoid arthritis, infection, neoplasia, or trauma, is rare and severely erodes and subluxates atlantoaxial (AA) joints. For these patients, surgical reduction, and stabilization are difficult. Surgery, including anterior transoral decompression and posterior fixation, anterior endonasal decompression and fixation, and posterior decompression with AA or occipitocervical fixation, is often the only treatment available. However, there have only been 2 reports of C1–C2 facet spacer use in treating AAS. Here, we report the case histories of 3 patients with severely damaged and subluxated AA joints and symptomatic basilar invagination (BI), malalignment, or C2 root compression.

Patient concerns:

The cases included 2 women with rheumatoid arthritis and 1 man with spondyloarthropathy secondary to ulcerative colitis.

Diagnosis:

Radiographic imaging revealed severely damaged and subluxated AA joints. Their symptoms included worsening pain in the neck or occiput with or without myelopathy and neuralgia.

Interventions:

After realignment with C1–C2 spacers and posterior C1–C2 screw fixation, the patient symptoms were resolved.

Outcomes:

Of note, 2 of the 3 patients were healed without complications. One patient who underwent secondary revision surgery because of rod breakage and obvious nonunion at C0–C2 was determined to be healed at 1-year follow-up after the revision surgery.

Lessons:

We confirmed that C1–C2 facet spacers both reduced BI and occipitocervical coronal malalignment as well as releasing C2 root compression. Therefore, surgical restoration and fixation should be a required treatment in this very rare group of patients.
Epidemiology of pediatric visits to the emergency department due to foreign body injuries in South Korea
Authors: Park Joong Wan , Jung Jin Hee , Kwak Young Ho , Jung Jae Yun
Published: May 2019

Foreign body (FB) injuries mainly occur in young children and may cause serious complications. The purpose of this study was to describe the epidemiological and clinical characteristics of FB injuries among children visiting the emergency department (ED) in South Korea and to compare the incidence and the ED results of FB injuries.

Using data from the National Emergency Department Information System, FB injury-related ED visits among children (<7 years) between January 2010 and December 2014 were included. Epidemiological characteristics were analyzed in different age groups, and metropolises were compared with provinces regarding the incidence of ED visits, admission, and transfer of patients with FB injuries.

In total, 51,406 pediatric patients with FB injuries visited 118 EDs over 5 years, and the annual incidence of FB injuries among children increased throughout the study period (215.1–436.5 per 100,000 population [<7 years], P for trend <.001). The most common anatomical site of the FB injury was the nose (18,479; 36.0%), followed by the pharynx (10,285; 20.0%). The most common age of patients was 1 year for alimentary tract, 2 years for nose, 1 year for respiratory tract, and 4 years for ear FB injuries. The overall admission rate was 1.8%, and the ICU admission rate was 0.04%. Four deaths occurred, and all of them were caused by respiratory FB injuries. The incidence of transfer of patients with FB injuries to other hospitals was higher in provinces than in metropolises.

The incidence of FB injury-related ED visits among children younger than 7 years old in South Korea has been high and has been increasing recently. In particular, the incidence of FB injuries of the alimentary and respiratory tracts was high, especially around the age of 1. Preventive measures should be taken to decrease FB injuries among young children in South Korea.
Adverse events of benralizumab in moderate to severe eosinophilic asthma
Authors: Liu Wanshu , Ma Xuesu , Zhou Weikang
Published: May 2019

Background:

Benralizumab, a humanized, anti-interleukin-5 (anti-IL-5) receptor α monoclonal antibody that directly and rapidly depletes eosinophils, has shown significant efficacy in reducing asthma exacerbations and improving lung function in moderate to severe eosinophilic asthma patients. However, there is some controversy regarding the adverse events (AEs) of benralizumab and a comprehensive analysis of these AEs has not been performed. This study aimed to assess the incidence of these AEs in published randomized controlled trials (RCTs).

Methods:

We searched for RCTs in the Embase, PubMed and Cochrane databases that compared benralizumab with placebo in moderate to severe eosinophilic asthma patients. The outcome was the incidence of AEs during the observation period.

Results:

Eight RCTs were analyzed in this study. Patients treated with benralizumab had a lower risk of overall AEs (risk ratio (RR) 0.94; 95% confidence interval (CI) 0.90–0.98), serious adverse events (SAEs) (RR 0.82; 95% CI 0.68–0.98), asthma exacerbation (RR 0.72, 95% CI 0.61–0.85), bronchitis (RR 0.76, 95% CI 0.59–0.96) and sinusitis (RR 0.64, 95% CI 0.48–0.85), but had a higher risk of headache (RR 1.42, 95% CI 1.07–1.87) and pyrexia (RR 2.26, 95% CI 1.32–3.87) than patients treated with placebo. No increased incidence of death, hypersensitivity, injection-site reactions, nasopharyngitis, rhinitis, upper respiratory tract infection, influenza, cough, nausea, back pain or arthralgia was observed with benralizumab compared with placebo.

Conclusions:

Benralizumab reduced the risk of SAEs, asthma exacerbation, bronchitis and sinusitis, and aggravated the risk of headache and pyrexia. Other AEs were comparable between the benralizumab group and placebo group. Therefore, benralizumab is a relatively safe drug, but vigilance regarding AEs is imperative during long-term treatment.
Is hypertriglyceridemia atherogenic?
Authors: Huet Fabien , Roubille Camille , Roubille François
Published: May 2019

Purpose of review

Hypertriglyceridemia occurs mainly because of metabolic disorders secondary to diabetes, alcohol intake, and/or overweight. Genetic factors have also been clearly identified in most severe cases. Triglycerides are generally considered as ‘bystanders’ for cardiovascular diseases. However, biological and basic research provides strong data suggesting that triglyceride-rich lipoproteins could be involved in the pathophysiology of cardiovascular diseases.

Recent findings

The REDUCE-IT trial recently showed that icosapent ethyl reduces major cardiovascular events and related death.

For many years, low-density lipoproteins (LDLs) have been considered the Holy Grail for atherosclerotic cardiovascular disease management. New data from basic research in biology, epidemiology, genetics, and preliminary clinical trials support the hypothesis that triglyceride-rich lipoproteins could be the causal factors for atherosclerotic cardiovascular disease; hence, triglyceride should be taken into consideration in the management of these patients. Omega-3-fatty acids used in the REDUCE-IT trial reduced the residual cardiovascular risk efficiently beyond statins. However, its effect has to be completely understood as it seems to be unrelated to LDLc or triglyceride reduction, but linked to pleiotropic effects involving inflammation, platelet adhesion, and plaque instability reduction, paving the way for trials that will target more specific potential pathophysiologic pathways.
Imaging in congenital hypothyroidism
Authors: Livett T. , LaFranchi S.
Published: May 2019

Purpose of review

Congenital hypothyroidism is a common worldwide condition. Due in part to increasingly widespread newborn screening, the number of patients with this diagnosis is increasing. In this review, we discuss currently available imaging techniques and the benefits and limitations of these techniques in evaluating congenital hypothyroidism.

Recent findings

Recent work has demonstrated an increasing diagnosis of congenital hypothyroidism with normally located glands and mildly decreased thyroid function. Increasingly more genetic abnormalities have been recognized in the hormone synthesis pathways. These cases may have lower or shorter term treatment requirements than the more common severe forms of congenital hypothyroidism, and the ability to distinguish between these situations may become increasingly more important to management and counseling.

Imaging studies for congenital hypothyroidism may be unlikely to change immediate management in the majority of cases. The common modalities of imaging include thyroid ultrasound and radionuclide uptake scanning with either technetium or iodine. These can help establish an etiology for the condition, and in less-common causes of congenital hypothyroidism may have implications on treatment decisions, prognosis, and counseling.
Update on childhood/adolescent obesity and its sequela
Authors: Kohut Taisa , Robbins Jennifer , Panganiban Jennifer
Published: May 2019

Purpose of review

We aim to describe current concepts on childhood and adolescent obesity with a strong focus on its sequela. Childhood obesity is a national epidemic with increasing prevalence over the past three decades placing children at increased risk for many serious comorbidities, previously felt to be only adult-specific diseases, making this topic both timely and relevant for general pediatricians as well as for subspecialists.

Recent findings

Childhood obesity develops through an interplay of genetics, environment, and behavior. Treatment includes lifestyle modification, and now metabolic and bariatric surgery is more commonly considered in carefully selected adolescents. The off-label use of adjunct medications for weight loss in childhood and adolescent obesity is still in its infancy, but will likely become the next logical step in those with lifestyle modification refractory obesity. Obesity can lead to several comorbidities, which can persist into adulthood potentially shortening the child's lifespan.

Efforts should be focused primarily on reducing childhood and adolescent obesity, and when indicated treating its sequela in effort to reduce future morbidity and mortality in this precious population.

Video abstract

http://links.lww.com/MOP/A36.
Reengineering Skilled Nursing Facility Discharge
Authors: Popejoy Lori L. , Wakefield Bonnie J. , Vogelsmeier Amy A. , Galambos Colleen M. , Lewis Alexandria M. , Huneke Diane , Petroski Greg , Mehr David R.
Published: May 2019

Background:

There is a need to adopt evidence-based approaches to discharge planning in the skilled nursing facility (SNF) short stay population.

Purpose:

This article describes implementation of the Reengineered Discharge (RED) process in SNFs and makes recommendations for its future implementation.

Methods:

The methods included a pre- and postanalysis of an 18-month RED implementation with a contemporaneous comparison of 4 Midwestern SNFs randomly assigned to 2 different RED implementation strategies. The Standard facilities received less implementation than Enhanced facilities.

Results:

Standard SNFs made more improvements and were more satisfied with the improved process than Enhanced SNFs. Field notes revealed that corporate willingness to make process changes impacted the Standard group's capacity for change; both groups were heavily influenced by external forces, and turnover was an impediment to RED implementation.

Conclusion:

This research revealed that discharge processes are similar across settings and that evidence-based programs such as RED can be adapted to the SNF setting.
The National Network of Sexually Transmitted Disease Clinical Prevention Training Centers Turns 40—A Look Back, a Look Ahead
Authors: Stoner Bradley P. , Fraze Jami , Rietmeijer Cornelis A. , Dyer Janine , Gandelman Alice , Hook Edward W. , Johnston Christine , Neu Natalie M. , Rompalo Anne M. , Bolan Gail
Published: May 2019

Since 1979, the National Network of Sexually Transmitted Disease (STD) Clinical Prevention Training Centers (NNPTC) has provided state-of-the-art clinical and laboratory training for STD prevention across the United States. This article provides an overview of the history and activities of the NNPTC from its inception to present day, and emphasizes the important role the network continues to play in maintaining a high-quality STD clinical workforce. Over time, the NNPTC has responded to changing STD epidemiological patterns, technological advances, and increasing private-sector care-seeking for STDs. Its current structure of integrated regional and national training centers allows NNPTC members to provide dynamic, tailored responses to STD training needs across the country.
Electromyography Evaluation of Bodyweight Exercise Progression in a Validated Anterior Cruciate Ligament Injury Rehabilitation Program
Authors: Zebis Mette Kreutzfeldt , Sørensen Mads Hjorth , Lauridsen Hanne Bloch , Bencke Jesper , Andersen Christoffer Højnicke , Carlsbæk Jacob B. , Jespersen Patrick , Kallehauge Anders H. , Andersen Lars Louis
Published: May 2019

Objectives

Regaining muscle strength is essential for successful outcome after anterior cruciate ligament injury, why progression of exercise intensity in anterior cruciate ligament injury rehabilitation is important. Thus, this study evaluated hamstring and quadriceps muscle activity progression during bodyweight exercises used in a validated anterior cruciate ligament injury rehabilitation program.

Design

The study design involved single-occasion repeated measures in a randomized manner. Twenty healthy athletes (nine females) performed nine bodyweight exercises (three exercises per rehabilitation phase). Surface electromyography signals were recorded for hamstring (semitendinosus, biceps femoris) and quadriceps (vastus medialis, vastus lateralis) muscles and normalized to isometric peak electromyography.

Results

Hamstring muscle activity did not increase from one rehabilitation phase to the next, ranging between 8% and 45% normalized electromyography for semitendinosus and 11% and 54% normalized electromyography for biceps femoris. Only one exercise (Cook hip lift) exhibited hamstring muscle activities more than 60% normalized electromyography. By contrast, quadriceps muscle activity increased, and late-phase exercises displayed high normalized electromyography (vastus lateralis >60% and vastus medialis >90% normalized electromyography).

Conclusions

The examined bodyweight exercises did not progress for hamstring muscle activity but successfully progressed for quadriceps muscles activity. This study highlights the need for consensus on exercise selection when targeting the hamstring muscles in the rehabilitation after anterior cruciate ligament injury.
Personal protective equipment for viral hemorrhagic fevers
Authors: Raj Deepa , Hornsey Emilio , Perl Trish M.
Published: May 2019

Purpose of review

Viral hemorrhagic fevers (VHF) encompass many organisms that have caused sporadic outbreaks with high case fatality rates. This article reviews VHF with reported human-to-human transmission and describes updates about personal protective equipment (PPE) for healthcare personnel (HCP) and others. We summarize existing information about appropriate PPE use, training, and compliance for care of VHF patients in endemic and nonendemic countries, as well as addresses the challenges HCP experience when using PPE.

Recent findings

PPE is essential in protecting HCP from exposure to disease-causing pathogens. Recent evidence shows that anyone involved in care, management, and transport of certain VHF patients must use elements of PPE as part of appropriate infection prevention and control (IPC) practices. Strict adherence to standard precautions has effectively interrupted human-to-human transmission of a number of VHF. However, unclear protocols, inconsistent training, climate challenges, and cultural sensitivities impede proper PPE use. Appropriate PPE use can drastically reduce the risk of HCP exposure to VHF.

Infections caused by certain VHFs can be highly pathogenic and associated with significant morbidity and mortality. Though it is well documented that use of PPE and good IPC practices are critical to reducing transmission, little conclusive evidence exists about the ideal PPE ensemble or components. Concerns with comfort, compliance, training, and usability may impede proper PPE use. Basic PPE elements, used appropriately as part of stringent IPC, must always form the foundation of care for HCP-treating patients with VHF. More research is required to identify the ideal PPE ensemble for caring for VHF patients in various settings.
Comparing Ketorolac With Ibuprofen for Postoperative Pain: A Randomized Clinical Trial
Authors: Dwarica Denicia S. , Pickett Stephanie D. , Zhao Yan D. , Nihira Mikio A. , Quiroz Lieschen H.
Published: May 2019

Objectives

The objective of this study was to identify differences in pain perception and satisfaction with pain control in women receiving nonsteroidal anti-inflammatory drugs postoperatively.

Methods

This was a prospective, randomized controlled trial including urogynecology surgical patients. After surgery, all patients were randomized to receive either intravenous (IV) ketorolac or ibuprofen. The patients completed 3 visual analog scales (VAS) assessing pain at rest, pain with ambulation, and satisfaction with pain control. Postoperative opioid use was also measured.

Results

A total of 224 patients (112 in each arm) were included. Pain scores (SD) at rest in all patients who received ketorolac versus those who received ibuprofen was 2.30 (2.1) versus 2.68 (2.34) (P = 0.20). Pain scores (SD) with ambulation was 3.94 (2.57) versus 4.16 (2.73) (P = 0.57) in patients who received ketorolac and ibuprofen, respectively. Patients who received ketorolac rated their satisfaction with their pain regimen similarly to those who received ibuprofen (P = 0.50). The average amount (SD) of hydromorphone used in the ketorolac and ibuprofen arm was 3.68 (4.58) mg and 4.04 (4.97) mg, respectively (P = 0.58). A subgroup analysis based on type of surgery showed decreased pain at rest (VAS, 2.77 vs 4.88; P = 0.04) and increased satisfaction (VAS, 1.69 vs 4.67; P = 0.003) in patients who had laparotomy and received ketorolac.

Conclusions

There was no difference in pain and satisfaction with IV ketorolac compared with IV ibuprofen in patients who underwent all modalities of urogynecologic surgery. A subgroup of patients who underwent laparotomy had less pain with ketorolac.
Pelvic Floor Sensations After the First Vaginal Delivery: A Qualitative Study
Authors: Egger Marlene J. , Sanchez-Birkhead Ana C. , Clark Lauren , Curiel Roxanna , Garcia Gabriela , Fernandez Cecilia , Nygaard Ingrid E.
Published: May 2019

Objectives

Current validated instruments to screen for pelvic organ prolapse and its sequelae address bulge symptoms, bowel and bladder changes, and sexual intimacy. However, sensitivity is lower in younger women, and there is no instrument specifically designed to screen in postpartum, primiparous women for early changes, that is, changes that may be noticed before the symptom of a bulge or signs of pelvic organ prolapse occur. Our goal was to elucidate early sensations of pelvic floor support changes in primiparous women after their first vaginal delivery. These could be the focus of future studies differentiating such sensations from a normal postpartum, aiding identification of women for further follow-up.

Methods

Using comparative focused ethnographic methods, we purposefully sampled and interviewed 17 multiparous women diagnosed with pelvic organ prolapse and 60 primiparous women, half Euro-American and half Mexican American, English or Spanish speaking. Audiotapes were transcribed and then translated. Using inductive coding and matrix analysis, we used constant comparison across transcript data and clustered coded data into body systems–level matrices to arrive at categories of early changes.

Results

We identified early changes by ethnic group in pelvic area sensations and bowel, bladder, and sexual function, including sensations not mentioned in extant questionnaires.

Conclusions

Early changes may be distressing but difficult for women to introduce in a clinical conversation. Querying these changes may enhance patient-provider communication. Future research is needed to validate these items in questionnaires designed to identify women with persistent early changes that may lead to subsequent objective pelvic organ prolapse.
Prophylactic Autologous Slings at the Time of Obstetric Fistula Repair: A Randomized Clinical Trial
Authors: Pope Rachel , Browning Andrew , Chipungu Ennet , George Jeredine O. M. , Tamimu Mariatu , Wilkinson Jeffrey
Published: May 2019

Objective

To compare prophylactic slings for women with obstetric fistulas at high risk of residual incontinence.

Methods

This was a multiple-site randomized controlled trial comparing autologous fascia slings to pubococcygeal (PC) slings at time of fistula repair. Women with a Goh type 3 or 4 vesicovaginal fistula (distal edge of the fistula is ≤2.5 cm from the external urethral orifice) with no prior repair were randomized to receive either a rectus fascia sling or a PC sling while undergoing fistula repair. Interviews were performed before surgery and at follow-up 1 to 6 months later including the Michigan Incontinence Symptom Index and the Incontinence Quality of Life Tool. Pad weights were also collected at this time. Safety analysis was performed after 10 participants were enrolled in each arm.

Results

Eleven participants randomized to a PC sling and 10 to a rectus sling. There was 1 repair breakdown in the PC group and 3 in the rectus group. There was no significant difference noted in pad weights or quality of life scores between groups. Quality of life and Michigan Incontinence Symptom Index scores improved significantly for both groups after surgery. The study was terminated at safety analysis due to the number of breakdowns and difficulty of follow-up at 1 site.

Conclusions

There was no superiority between slings. Randomization proved problematic given the vast heterogeneity between fistula injuries. There is a need for an innovative anti-incontinence technique.

ClinicalTrials.gov identifier: NCT03236922 https://www.clinicaltrials.gov/ct2/show/NCT03236922?cond=vesico-vaginal+fistula&rank=2
Electrophysiological Properties of the Human Diaphragm Assessed by Magnetic Phrenic Nerve Stimulation: Normal Values and Theoretical Considerations in Healthy Adults
Authors: Spiesshoefer Jens , Henke Carolin , Herkenrath Simon , Randerath Winfried , Schneppe Marike , Young Peter , Brix Tobias , Boentert Matthias
Published: May 2019

Purpose:

This study determined normal values for motor evoked potentials (MEPs) and compound muscle action potentials (CMAPs) of the diaphragm following cortical and cervical magnetic stimulation (COMS and CEMS) of the phrenic nerves in healthy adults.

Methods:

Using surface electrodes, diaphragmatic MEP and CMAP were recorded in 70 subjects (34 ± 13 years, 25 men) following supramaximal cortical magnetic stimulation and CEMS at functional residual capacity and using a standardized inspiratory pressure trigger (−0.5 kPa). All healthy volunteers underwent standard spirometry and measurement of maximum inspiratory and expiratory pressure.

Results:

At functional residual capacity, upper limit of normal for MEP latency was 25 ms in men and 23 ms in women (p < 0.05), and upper limit of normal for CMAP latency was 6 ms. In contrast to MEP and CMAP amplitude, corresponding latencies showed little interindividual and intraindividual variability. Use of an inspiratory pressure trigger enhanced reproducibility and amplitude of diaphragm MEP. Diaphragm responses to both cortical and cervical magnetic stimulation were symmetrical and independent of age (in our cohort), with higher values for latency and amplitude in men (each p < 0.05). Diaphragm CMAP amplitude showed weak–moderate correlations with forced vital capacity (r = 0.47; p < 0.01), maximum inspiratory pressure (r = 0.39; p < 0.01), and maximum expiratory pressure (r = 0.32; p < 0.01).

Conclusions:

Combination of cortical magnetic stimulation and CEMS of the phrenic nerves is feasible and allows noninvasive assessment of both central and peripheral conductivity of the diaphragm and the inspiratory pathway.
Inferring epidemiological links from deep sequencing data: a statistical learning approach for human, animal and plant diseases
Authors: Alamil M. , Hughes J. , Berthier K. , Desbiez C. , Thébaud G. , Soubeyrand S.
Published: May 2019

Pathogen sequence data have been exploited to infer who infected whom, by using empirical and model-based approaches. Most of these approaches exploit one pathogen sequence per infected host (e.g. individual, household, field). However, modern sequencing techniques can reveal the polymorphic nature of within-host populations of pathogens. Thus, these techniques provide a subsample of the pathogen variants that were present in the host at the sampling time. Such data are expected to give more insight on epidemiological links than a single sequence per host. In general, a mechanistic viewpoint to transmission and micro-evolution has been followed to infer epidemiological links from these data. Here, we investigate an alternative approach grounded on statistical learning. The idea consists of learning the structure of epidemiological links with a pseudo-evolutionary model applied to training data obtained from contact tracing, for example, and using this initial stage to infer links for the whole dataset. Such an approach has the potential to be particularly valuable in the case of a risk of erroneous mechanistic assumptions, it is sufficiently parsimonious to allow the handling of big datasets in the future, and it is versatile enough to be applied to very different contexts from animal, human and plant epidemiology.

This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’. This issue is linked with the subsequent theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control’.
A new mechanistic model of weather-dependent Septoria tritici blotch disease risk
Authors: Chaloner Thomas M. , Fones Helen N. , Varma Varun , Bebber Daniel P. , Gurr Sarah J.
Published: May 2019

We present a new mechanistic model for predicting Septoria tritici blotch (STB) disease, parameterized with experimentally derived data for temperature- and wetness-dependent germination, growth and death of the causal agent,Zymoseptoria tritici. The output of this model (A) was compared with observed disease data for UK wheat over the period 2002–2016. In addition, we compared the output of a second model (B), in which experimentally derived parameters were replaced by a modified version of a publishedZ. triticithermal performance equation, with the same observed disease data. Neither model predicted observed annual disease, but model A was able to differentiate UK regions with differing average disease risks over the entire period. The greatest limitations of both models are: broad spatial resolution of the climate data, and lack of host parameters. Model B is further limited by its lack of explicitly defined pathogen death, leading to a cumulative overestimation of disease over the course of the growing season. Comparison of models A and B demonstrates the importance of accounting for the temperature-dependency of pathogen processes important in the initiation and progression of disease. However, effective modelling of STB will probably require similar experimentally derived parameters for host and environmental factors, completing the disease triangle.

This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’. This issue is linked with the subsequent theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control’.
Assessing the potential impact of vector-borne disease transmission following heavy rainfall events: a mathematical framework
Authors: Chowell G. , Mizumoto K. , Banda J. M. , Poccia S. , Perrings C.
Published: May 2019

Predicting the impact of natural disasters such as hurricanes on the transmission dynamics of infectious diseases poses significant challenges. In this paper, we put forward a simple modelling framework to investigate the impact of heavy rainfall events (HREs) on mosquito-borne disease transmission in temperate areas of the world such as the southern coastal areas of the USA. In particular, we explore the impact of the timing of HREs relative to the transmission season via analyses that test the sensitivity of HRE-induced epidemics to variation in the effects of rainfall on the dynamics of mosquito breeding capacity, and the intensity and temporal profile of human population displacement patterns. The recent Hurricane Harvey in Texas motivates the simulations reported. Overall, we find that the impact of vector-borne disease transmission is likely to be greater the earlier the HREs occur in the transmission season. Simulations based on data for Hurricane Harvey suggest that the limited impact it had on vector-borne disease transmission was in part because of when it occurred (late August) relative to the local transmission season, and in part because of the mitigating effect of the displacement of people. We also highlight key data gaps related to models of vector-borne disease transmission in the context of natural disasters.

This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’. This issue is linked with the subsequent theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control’.