bluuebunny/crossref_metadata_2025 huggingface dataset:
Birth weight is inversely correlated with blood pressure: population-based study
Authors: Al Salmi Issa , Hannawi Suad
Published: July 2020

Background and method:

The current representative national cross-sectional study examines the association of birth weight and blood pressure (BP) among the adult Australian population.

Questions about birth weight were added to the second round of AusDiab study. Hypertension was defined based on WHO (≥140/90), and NCEP-ATPIII (≥130/85). Both definitions were examined against the continuous birth weight and dichotomous variable of low birth weight (LBW); less than 2.5 kg, adjusting for age, BMI, physical activity, smoking, alcohol intake and socioeconomic factors.

Results:

A total of 4502 respondents reported their birth weights with a mean (SD) of 3.37 (0.7) kg. Females with LBW had significantly higher mean SBP and DBP than those with normal birth weight. This relationship persisted with adjustments for various confounding factors. Males with LBW showed a trend towards a higher SBP and DBP, though NS, than normal birth weight more than 2.5 kg. LBW individuals, less than 2.5 kg were at higher risk for having high SBP hypertension at least 140/90 mmHg and at least 130/85 mmHg compared with those with normal birth weight. Among females, for each kilogramme of birth weight, there was a predicted decrease of 1.59 (0.7, 2.5) mmHg in SBP, P = 0.001 and 0.85 (0.2, 1.5) mmHg in DBP, P = 0.001; after adjustments for age, body size, physical activity, smoking status, alcohol intake and socioeconomic factors. Among males, for each kilogramme of birth weight, there was a decrease of 1.74 (0.7, 2.8) mmHg in SBP, P = 0.002 and 1.06 (0.3, 1.9) mmHg in DBP, P = 0.008 after adjustments for all confounding factor.

Conclusion:

This study has examined the association of birth weight and BP in a representative adult population. LBW was significantly associated with the risk of developing high BP.
The pharmacological management of malignant hypertension
Authors: Gosse Philippe , Boulestreau Romain , Brockers Camille , Puel Charlotte , Rubin Sebastien , Cremer Antoine
Published: July 2020

Malignant hypertension (MHT) still remains a severe condition that requires early recognition and treatment. Over the years, the prevention and treatment of MHT have significantly advanced through the introduction of modern antihypertensive agents. However, in the absence of robust clinical trials, there remain no formal guidelines on the treatment of MHT. This review summarizes the historical background and pathophysiological evidence of MHT, which has led to common practices in its pharmacological management but can also introduce challenges. The current consensus for treatment involves early intravenous infusion of antihypertensive agents, but oral blockers of the renin–angiotensin system may improve the management of MHT, and it offers a suitable treatment option in low-income countries where the condition remains relatively prevalent.
Prognostic importance of long-term SBP variability in high-risk hypertension
Authors: Del Pinto Rita , Pietropaoli Davide , Dobre Mirela , Ferri Claudio
Published: July 2020

Objective:

In addition to high blood pressure variability (BPV), low BPV was associated with adverse cardiovascular prognosis in selected high-risk patients. We explored this issue in the Systolic Blood Pressure Intervention Trial (SPRINT) using a nonlinear approach with BPV as a continuous variable.

Methods:

Long-term systolic BPV (SBPV) (coefficient of variation, CoV %) was calculated on quarterly visits until a fatal/nonfatal cardiovascular event or all-cause mortality, excluding titration period and patients with missing visits. We used Cox proportional hazard models with penalized smoothing splines to shape the risk of outcomes against the continuum of SBPV (independent variable). Adjusted hazard ratios (aHR, 95% CI) were calculated using the reference range derived from the nonlinear model. Sensitivity analysis based on propensity score matching (PSM) was performed.

Results:

The association of SBPV with fatal/nonfatal cardiovascular events was J-shaped, whereas that with all-cause mortality was linear. After multivariate adjustment, however, the only significant associations remained that of low SBPV (CoV <5%) with cardiovascular events (hazard ratio 1.85, 95% CI 1.24–2.75, P = 0.003), and of high SBPV (CoV >10%) with the composite of cardiovascular events and all-cause mortality (hazard ratio 1.35, 95% CI 1.02–1.80; P = 0.037). Low SBPV was associated with ischemic heart disease (hazard ratio 2.76, 95% CI 1.55–4.91; P < 0.001). There was a significant U-shaped association of SBPV with cardiovascular events in the PSM cohort.

Conclusion:

Nonlinear modeling indicates that low and high long-term SBPV have prognostic relevance in high-risk hypertensive individuals from SPRINT. Randomized trials are needed to test these findings and their potential therapeutic implications.
Intrauterine Transmission of SARS-COV-2 Infection in a Preterm Infant
Authors: Sisman Julide , Jaleel Mambarambath A. , Moreno Wilmer , Rajaram Veena , Collins Rebecca R.J. , Savani Rashmin C. , Rakheja Dinesh , Evans Amanda S.
Published: July 2020

We present a preterm infant who developed a fever and mild respiratory disease on the second day of life. Infant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nasopharyngeal testing was positive at 24 and 48 hours of life. Placenta histopathology revealed SARS-CoV-2 infection by electron microscopy and immunohistochemistry. Further understanding of the risk factors that lead to in utero transmission of SARS-CoV-2 infection is needed.
Better endovascular mechanical thrombectomy outcome in atrial fibrillation patients with acute ischemic stroke: A single-center experience
Authors: Lin Chun-Jen , Luo Chao-Bao , Chien Chun , Chang Feng-Chi , Lin Chung-Jung , Lee I-Hui , Hsu Li-Chi , Chung Chih-Ping , Liu Hung-Yu , Chi Nai-Fang , How Chorng-Kuang , Wang Shuu-Jiun , Guo Wan-Yuo , Lin Yung-Yang
Published: July 2020

Background:

Endovascular thrombectomy (EVT) has become the standard treatment for acute ischemic stroke with large vessel occlusion. Atrial fibrillation (AF) is one of the major causes. However, the impact of AF on the treatment has not yet been clearly discussed. This study is to evaluate the influence of AF on the outcomes of EVT in patients with acute ischemic stroke.

Methods:

Data from our Stroke Registry Database from April 2015 to July 2018 were reviewed. Technical efficacy, functional, and safety outcomes were reported and compared between patients with and without AF. A multivariate logistic regression model was performed to identify the predictors of the good functional outcome.

Results:

We reviewed 83 eligible patients receiving EVT. Patients (51.8%) were eventually found to have AF. The substantial reperfusion rate (modified thrombolysis in cerebral infarction 2b-3) was 72.1% and 55.0% in patients with and without AF, respectively, inclusive of a learning curve (p = 0.12). The good functional outcome (90-day modified Rankin scale: 0 to 2) rate was 55.8% and 17.5% in patients with and without AF, respectively (p < 0.01). A multivariable logistic regression analysis showed that age <70 years, the substantial reperfusion, and the presence of AF were three significant predictors for a good functional outcome.

Conclusion:

Our study showed that patients with AF responded significantly better to EVT than those without AF did. Intracranial atherosclerotic diseases in patients without AF which were especially refractory to EVT may contribute to the difference of the functional outcomes between the two groups.
Health-related quality of life in patients with abdominal aortic aneurysm undergoing endovascular aneurysm repair: A cross-sectional study
Authors: Shih Chia-Wen , Shih Chun-Che , Wu Chu-Chih , Ho Shung-Tai , Chen Tzeng-Ji , Lin Kuan-Chia , Liang Chun-Yu , Wang Kwua-Yun
Published: July 2020

Background:

Endovascular aneurysm repair (EVAR) has become a common surgical treatment for abdominal aortic aneurysm (AAA), and postoperative health-related quality of life (HRQoL) is drawing increasing attention. Most studies compare HRQoL in EVAR patients and open aneurysm repair patients, while few studies have investigated HRQoL in EVAR patients versus the general population. This study aimed to investigate whether HRQoL differs between patients with EVAR patients and the general population.

Methods:

EVAR patients were recruited from a medical center in northern Taiwan. General population subjects and the EVAR patients were paired based on age and sex, and a simple random sampling method was used for sampling at 2:1. In this study, we used the World Health Organization Quality of Life Scale Abbreviated Version, Taiwan Version to investigate HRQoL. A multivariate regression model was used to analyze intergroup differences related to facets and domains.

Results:

A total of 58 patients with EVAR and 116 individuals from the general population were included in this study. The EVAR patients’ mean scores for overall QoL and the physical domain, psychological domain, social relations domain, and environment domain were 3.79, 15.53, 15.00, 14.93, and 15.57, respectively, and all of these scores were significantly higher than those in the general population. In addition, the β values (β = 0.21, 0.73, 1.83, 0.81, and 2.62, respectively) of the EVAR patients were also significantly higher in the multivariate analysis. The findings showed that a high education level and nonsmoking status were associated with higher HRQoL, while unemployment was associated with lower HRQoL.

Conclusion:

EVAR patients had higher HRQoL than the general population, indicating that patients with AAA have a high likelihood of recovering and enjoying high HRQoL if they receive appropriate medical procedures and nursing education.
Post endoscopic retrograde cholangiopancreatography cholecystitis: The incidence and risk factors analysis
Authors: Ting Po-Hsiang , Luo Jiing-Chyuan , Lee Kuey-Chung , Chen Tseng-Shing , Huang Yi-Hsiang , Hou Ming-Chih , Lee Fa-Yauh
Published: July 2020

Background:

For decades, endoscopic retrograde cholangiopancreatography (ERCP) has been widely performed as a diagnostic and therapeutic procedure for biliary and pancreatic diseases. Complications of ERCP include pancreatitis, hemorrhage, perforation, cholangitis, and cholecystitis. There are few studies that focus on the incidence of post-ERCP cholecystitis and its potential risk factors.

Methods:

A retrospective single-center study was performed in 1345 ERCP procedures after excluding patients with current cholecystitis or post-cholecystectomy between January 2009 and December 2011. Potential risk factors for post-ERCP acute cholecystitis, including age, gender, biochemistry, imaging data, procedures such as endoscopic sphincterotomy (EPT), or endoscopic retrograde biliary drainage (ERBD), were obtained and analyzed by multivariate logistic regression analysis.

Results:

Cholecystitis developed after 13 (0.96%) of the 1345 ERCP procedures. Univariate and multivariate logistic regression analyses showed that cystic duct stones (odds ratio [OR] = 198.26; 95% CI, 5.12-7835.44) and ERBD (OR = 37.58; 95% CI, 3.25-445.56) were important potential risk factors for post-ERCP cholecystitis. The percentage of ERBD procedures and cystic duct stones in patients with post-ERCP cholecystitis was 76.9% and 39.8%, respectively. The 13 patients with post-ERCP cholecystitis all received antibiotics, and four of them also received percutaneous gallbladder drainage. All patients recovered without significant clinical event or mortality.

Conclusion:

The incidence of post-ERCP cholecystitis was 0.96% in the 1345 ERCP procedures performed. Cyst duct stones and ERBD were found to be risk factors for post-ERCP cholecystitis.
The effects of a Chinese herbal medicine (VGHBPH0) on patients with benign prostatic hyperplasia: A pilot study
Authors: Yeh Hsin-Fu , Li Tsai-Feng , Tsai Cheng-Hung , Wu Pei-Wen , Huang Yi-Hsiu , Huang William J. , Chen Fun-Jou , Hwang Shinn-Jang , Chen Fang-Pey , Wu Ta-Peng
Published: July 2020

Background:

The current Western medicine treatment options for benign prostatic hyperplasia (BPH) have various degrees of documented effectiveness. However, the uses of these interventions are limited to specific patient populations or have certain side effects that interfere with patient quality of life. This study evaluated the clinical effects of a Chinese herbal medicine (CHM) on patients with BPH.

Methods:

This was a single-arm pilot study. Twenty BPH patients were enrolled, and they were required to take the investigated CHM three times a day for 8 weeks, along with their Western medicine. Patients returned to clinics as scheduled and completing international prostate symptoms scores (IPSS), aging male symptoms score, international index of erectile function, and body constitution questionnaire of traditional Chinese medicine. Uroflowmetry and sonography were also applied to evaluate the changes in urinary velocity and post-voiding residual urine volume from the baseline to the end of the study.

Results:

The mean IPSS total score was significantly decreased by 2.5 points after 8 weeks of treatment with the CHM (from 17.5 to 15.0, p = 0.03). The mean IPSS voiding subscore was decreased by 1.7 points (from 10.1 to 8.4, p = 0.02), and the mean incomplete emptying subscore was decreased by 0.8 points (from 2.9 to 2.1, p = 0.02), with both decreases being statistically significant. A descending trend in the post-voiding residual urine volume was also observed (from 52.9 to 30.8 mL, p = 0.07).

Conclusion:

This trial indicated that the add-on CHM treatment (VGHBPH0) might be a potential treatment for improving the lower urinary tract symptoms of BPH patients.
The application of novel segmentation software to create left atrial geometry for atrial fibrillation ablation: The implication of spatial resolution
Authors: Chin Chye-Gen , Chung Fa-Po , Lin Yenn-Jiang , Chang Shih-Lin , Lo Li-Wei , Hu Yu-Feng , Tuan Ta-Chuan , Chao Tze-Fan , Liao Jo-Nan , Lin Chin-Yu , Chang Ting-Yung , Wu Cheng-I , Liu Chih-Min , Vicera Jennifer Jeanne B. , Chen Chun-Chao , Chuang Chieh-Mao , Chen Yi-Jen , Hsieh Ming-Hsiung , Chen Shih-Ann
Published: July 2020

Background:

The application of new imaging software for the reconstruction of left atrium (LA) geometry during atrial fibrillation (AF) ablation has not been well investigated.

Methods:

A total of 27 patients undergoing AF ablation using a CARTO Segmentation Module system were studied (phase I). High-density LA mapping using PentaRay was merged with computed tomography-based geometry from the auto-segmentation module. The spatial distortion between the two LA geometries was analyzed and compared using Registration Match View. The associated contact force on the two LA shells was prospectively validated in 16 AF patients (phase II).

Results:

Of the five LA regions, the roof area had the highest quality score between the two LA shells (1.7 ± 0.6). In addition, among the pulmonary veins (PVs), higher quality scores were observed in bilateral PV carinas (both 1.8 ± 0.1, p < 0.05) than in the anterior or posterior PV regions. Furthermore, surrounding the PV ostium, the on-surface points had a significantly higher contact force when targeting the high-density fast anatomical mapping shell than for the auto-segmentation module (right superior pulmonary vein, 20.7 ± 5.8 g vs 12.5 ± 4.4 g; right inferior pulmonary vein, 19.3 ± 6.8 g vs 11.8 ± 4.8 g; left superior pulmonary vein, 22.5 ± 7.3 g vs 11.2 ± 4.5 g; left inferior pulmonary vein, 15.7 ± 6.9 g vs 9.7 ± 4.4 g, p < 0.05 for each group).

Conclusion:

The CARTO Segmentation Module and Registration Match View provide better anatomic accuracy and less regional distortion of the LA geometry, and this can prevent excessive contact and potential procedural complications.
Factors Associated With Cognitive Impairment in Heart Failure With Preserved Ejection Fraction
Authors: Faulkner Kenneth M. , Dickson Victoria Vaughan , Fletcher Jason , Katz Stuart D. , Chang Patricia P. , Gottesman Rebecca F. , Witt Lucy S. , Shah Amil M. , D'Eramo Melkus Gail
Published: July 2020

Background

Cognitive impairment is prevalent in heart failure and is associated with higher mortality rates. The mechanism behind cognitive impairment in heart failure with preserved ejection fraction (HFpEF) has not been established.

Objective

The aim of this study was to evaluate associations between abnormal cardiac hemodynamics and cognitive impairment in individuals with HFpEF.

Methods

A secondary analysis of Atherosclerosis Risk in Communities (Atherosclerosis Risk in Communities) study data was performed. Participants free of stroke or dementia who completed in-person assessments at visit 5 were included. Neurocognitive test scores among participants with HFpEF, heart failure with reduced ejection fraction (HFrEF), and no heart failure were compared. Sociodemographics, comorbid illnesses, medications, and echocardiographic measures of cardiac function that demonstrated significant (P < .10) bivariate associations with neurocognitive test scores were included in multivariate models to identify predictors of neurocognitive test scores among those with HFpEF. Multiple imputation by chained equations was used to account for missing values.

Results

Scores on tests of attention, language, executive function, and global cognitive function were worse among individuals with HFpEF than those with no heart failure. Neurocognitive test scores were not significantly different among participants with HFpEF and HFrEF. Worse diastolic function was weakly associated with worse performance in memory, attention, and language. Higher cardiac index was associated with worse performance on 1 test of attention.

Conclusions

Cognitive impairment is prevalent in HFpEF and affects several cognitive domains. The current study supports the importance of cognitive screening in patients with heart failure. An association between abnormal cardiac hemodynamics and cognitive impairment was observed, but other factors are likely involved.
Effects of Exercise Therapy for Adults With Coronary Heart Disease
Authors: Chair Sek Ying , Zou Huijing , Cao Xi
Published: July 2020

Background

Exercise therapy has been recommended as a core element for the prevention of coronary heart disease (CHD). However, the independent impact of exercise therapy remains unclear.

Objective

The aim of this study was to assess the effects of exercise therapy compared with no exercise control in patients with CHD.

Methods

We searched 8 electronic databases from January 2000 to March 2020. Randomized controlled trials with at least 6 months of follow-up that evaluated the effects of exercise therapy on hospital admissions, health-related quality of life (HRQoL), mortality, and morbidity in adults with CHD were included. Two reviewers independently screened records for eligibility, extracted data, and assessed risks of bias using the Cochrane tool. Meta-analyses were conducted using the random-effects model.

Results

We included 22 randomized controlled trials involving 4465 participants. Compared with no exercise control, exercise therapy reduced all-cause hospital admissions (10 studies; risk ratio, 0.46; 95% confidence interval, 0.25–0.83; I
2 = 64%) and cardiovascular mortality (9 studies; risk ratio, 0.44; 95% confidence interval, 0.22–0.89; I
2
= 0%) across all studies reporting these outcomes at their longest follow-up. Eight of 14 studies that assessed HRQoL observed a significant improvement in at least 1 domain or overall HRQoL with exercise therapy compared with control. There were no significant reductions in cardiovascular hospital admissions, all-cause mortality, incidence of myocardial infarction, or revascularization.

Conclusions

This review shows the independent benefits of exercise therapy in reducing all-cause hospital admissions and cardiovascular mortality for adults with CHD.
Sex Differences in Prehospital Delay in Patients With Acute Stroke
Authors: Potisopha Wiphawadee , Vuckovic Karen M. , DeVon Holli A. , Park Chang G. , Hershberger Patricia E.
Published: July 2020

Background

In 2009, the window from symptom onset to administration of tissue plasminogen activator for acute ischemic stroke was extended from 3 to 4.5 hours. Yet no systematic review has addressed prehospital delay by sex for stroke symptoms since this change.

Purpose

We aimed to (1) compare prehospital delay times—the time from symptom onset to hospital arrival—between women and men with acute stroke or transient ischemic attack and (2) summarize factors influencing prehospital delay by sex.

Methods

The CINAHL, MEDLINE, PubMed, Scopus, and PsycINFO databases were searched using PRISMA guidelines. Inclusion criteria were as follows: (1) quantitative research articles published between May 2008 and April 2019, (2) investigation of prehospital delay among women and men 15 years or older who were given a diagnosis of acute stroke or transient ischemic attack, and (3) English-language publications. The Crowe Critical Appraisal Tool was used to evaluate the quality of studies.

Results

Fifteen publications (n = 162 856) met inclusion criteria. Most studies (n = 11) showed no sex differences in prehospital delay. Four studies from Asian-Pacific countries and the United States showed that women had significantly longer prehospital delay compared with men. Older age, minority race/ethnicity (black and Mexican American), and underuse of emergency medical services were associated with prolonged prehospital delay in women.

Conclusions

Most study authors found no differences in prehospital delay between women and men; however, women delayed longer in some Asian-Pacific and American studies. Findings of sex differences were inconclusive.
Combination therapy of obeticholic acid and ursodeoxycholic acid in patients with primary biliary cholangitis who respond incompletely to ursodeoxycholic acid: a systematic review
Authors: Li Xuan , Liao Min , Pan Qiong , Xie Qiaoling , Yang Hong , Peng Ying , Li Qiao , Qu Jiaquan , Chai Jin
Published: July 2020

Background:

Although the efficacy of ursodeoxycholic acid (UDCA) and obeticholic acid (OCA) for primary biliary cholangitis (PBC) has been suggested by small trials, a meta-analysis to summarize the evidence has not yet been carried out. The aim of this study was to evaluate the clinical outcomes of the combination therapy of UDCA and OCA compared with UDCA monotherapy in patients with PBC.

Methods and materials:

We searched the PubMed, EMBASE, the web of science, and the Cochrane Library databases for English-language studies published before September 2018. Studies were included if they were randomized controlled trials (RCTs) and reported relative risk (RR) estimates with 95% confidence intervals (CIs) or related data for the clinical outcomes of different therapies in patients with PBC.

Results:

Of the 1169 titles identified, two studies meeting the inclusion criteria were included in the meta-analysis. Approximately 222 patients with PBC were included in this analysis. The results of this study indicated that combination therapy was significantly superior to monotherapy in reducing serum alanine transaminase (mean difference: –15.63 IU/L; 95% CI, –21.59 to –9.68), aspartate transaminase (mean difference: –6.63 IU/L; 95% CI, –11.03 to –2.24), gamma-glutamyl transpeptidase (mean difference: –131.30 IU/L; 95% CI, –177.52 to –85.08), and C-reactive protein (mean difference = –1.17 mg/L; 95% CI, –2.19 to –0.14), but NS in improving primary endpoints of alkaline phosphatase level with 15.0% reduction from baseline, and equal or higher than the upper limit of normal serum total bilirubin (RR = 2.75; 95% CI, 0.43–17.68), conjugated bilirubin (mean difference = –0.06 mg/dL; 95% CI, –0.28 to 0.15), IgM (mean difference = –41.18 mg/dL; 95% CI, –244.45 to 162.09), and adverse events (P > 0.05).

Conclusion:

This meta-analysis demonstrated that combination therapy with UDCA and OCA provided satisfactory clinical outcomes, which may be a promising alternative for patients with PBC who had an inadequate response to UDCA therapy. Therefore, high-quality RCTs on the safety and efficacy of the combination therapy of UDCA and OCA compared with UDCA monotherapy in patients with PBC should be performed in the future.
Risk of recurrent hepatic encephalopathy in patients with liver cirrhosis: a German registry study
Authors: Gabriel Maria M. , Kircheis Gerald , Hardtke Svenja , Markwardt Daniel , Buggisch Peter , Mix Heiko , Grüngreiff Kurt , Welzel Tanja M. , Kälsch Julia , Hartmann Heinz , Gerbes Alexander L. , Karpowitz Maria v. , Seeliger Benjamin , Wedemeyer Heiner , Weissenborn Karin
Published: July 2020

Background and aims

Patients with hepatic encephalopathy (HE) show low quality of life, recurrent hospitalizations and an increased mortality. We aimed to assess the natural course of patients after a recent episode of overt HE and to identify risk factors for HE recurrence in Germany.

Methods

Fifteen sites took part in a prospective, observational study including patients with liver cirrhosis who had been hospitalized for HE within 3 months before recruitment. Clinical data, psychometric hepatic encephalopathy score (PHES) and critical flicker frequency were assessed quarterly for 1 year. Primary endpoint was HE recurrence requiring hospitalization, all-cause-mortality was treated as a competing risk factor.

Results

From January 2014 to March 2016, a total of 115 patients were recruited. Overall 14 premature deaths were documented. For 78 subjects follow-up data were available in accordance with the protocol. After a median of 118 days, more than half of the per-protocol cohort was readmitted to hospital due to HE (N = 34) or died (N = 11). The risk for hospitalization was significantly increased in patients who had been recruited by liver transplant centers (P = 0.003), had had frequent HE relapses prior to recruitment (P = <0.0001) or an abnormal PHES result of <−4 (P = 0.044). Abnormal PHES results barely missed level of significance as an independent risk factor for re-hospitalization in a multivariable competing risk model (P = 0.093).

Conclusion

Patients with a history of HE are at high risk for the development of recurrent overt HE demanding hospitalization. The PHES test may aid in detection, monitoring and risk stratification of recurrent HE.
The utility of 99mTc-mebrofenin hepatobiliary scintigraphy with SPECT/CT for selective internal radiation therapy in hepatocellular carcinoma
Authors: Labeur Tim A. , Cieslak Kasia P. , Van Gulik Thomas M. , Takkenberg R. Bart , van der Velden Sandra , Lam Marnix G.E.H. , Klümpen Heinz-Josef , Bennink Roel J. , van Delden Otto M.
Published: July 2020

Background

Studies assessing the impact of selective internal radiation therapy (SIRT) on the regional liver function in patients with hepatocellular carcinoma (HCC) are sparse. This study assessed the changes in total and regional liver function using hepatobiliary scintigraphy (HBS) and investigated the utility of HBS to predict post-SIRT liver dysfunction.

Methods

Patients treated with SIRT for HCC between 2011 and 2019, underwent 99mTc-mebrofenin HBS with single-photon emission computed tomography/computed tomography (SPECT/CT) before and 6 weeks after SIRT. The corrected mebrofenin uptake rate (cMUR) and corresponding volume was measured in the total liver, and in treated and nontreated liver regions. Patients with and without post-SIRT liver dysfunction were compared.

Results

A total of 29 patients, all Child-Pugh-A and mostly intermediate (72%) stage HCC were included in this study. Due to SIRT, the cMURtotal declined from 5.8 to 4.5%/min/m2 (P < 0.001). Twenty-two patients underwent a lobar SIRT, which induced a decline in cMUR (2.9–1.7%/min/m2, P < 0.001) and volume (1228–1101, P = 0.002) of the treated liver region, without a change in cMUR (2.4–2.0%/min/m2, P = 0.808) or volume (632–644 mL, P = 0.661) of the contralateral nontreated lobe. There were no significant pre-SIRT differences in total or regional cMUR or volume between patients with and without post-SIRT liver dysfunction.

Conclusion

In patients treated with SIRT for HCC, HBS accurately identified changes in total and regional liver function and may have a complementary role to personalize lobar or selective SIRT. In this pilot study, there were no pre-SIRT differences in cMUR or volume to aid in predicting post-SIRT liver dysfunction.
Symptom Disclosure Process Among Iranian Women With Self-discovered Breast Cancer
Authors: Rafii Forough , Momeni Maryam , Taleghani Fariba
Published: July 2020

Background

Breast cancer is the most common malignancy among Iranian women. Symptom disclosure plays an important role in help-seeking behavior among women with self-discovered breast cancer.

Objective

The aim of this study was to explain how symptoms are disclosed by Iranian women.

Methods

This study was conducted based on the grounded theory qualitative approach. Twenty-two Iranian women with breast cancer, who discovered the symptoms themselves and were referred to 2 teaching hospitals in Tehran and Qazvin, were included via purposive and theoretical sampling. The data were collected through semistructured interviews and were analyzed based on the Corbin and Strauss approach.

Results

The process of symptom disclosure had 5 stages including identifying the symptoms, evaluating and interpreting the symptoms, weighing the disclosure conditions, selecting the disclosure audience, and disclosing. The perceived threat was identified as the core category. On the basis of the level of threat perception and the seriousness of the symptoms, the 3 patterns of immediate disclosure, delayed disclosure, and nondisclosure were recognized.

Conclusion

Perceived threat is the main motivator for rapid disclosure in Iranian women with potential breast cancer symptoms and leads to a better follow-up of the symptoms. Therefore, increasing women's awareness about breast cancer symptoms, treatments, and non–follow-up consequences leads to a better perception of the threat level.

Implications for Practice

According to these findings, it is very important to increase Iranian women's awareness about the symptoms of breast cancer (especially the nonspecific ones). For this purpose, it is necessary to design educational interventions.
A Protocol to Examine Surgical Team Communication in a Large Military Medical Center
Authors: Stucky Christopher H. , De Jong Marla J. , Kabo Felichism W. , Huffman Sarah L.
Published: July 2020

Background

Preventable clinician communication errors are the most frequent root cause of surgical adverse events. Effective communication among surgical team members is an important overall indicator of clinical nursing excellence and is crucial to promote patient safety and reduce healthcare risk.

Objective

The purpose of this publication is to describe our research protocol, which will comprehensively investigate surgical team communication and surgical team structure. There are two overall study objectives: (a) to characterize the network factors that influence perioperative clinician communication and (b) to identify how team structure shapes communication effectiveness. Specifically, we will study the association among clinician relationships, surgical team familiarity, surgical team size, and communication effectiveness.

Methods

We will use an exploratory, prospective, cross-sectional, network-centric approach using social network analysis to determine how interdependent clinician relationships influence surgical communication patterns. Targeting an 80% response rate, we will use total population sampling to recruit all clinicians (nurses, surgeons, anesthetists, surgical technologists, students, residents) who directly provide surgical care in the operating room at a large military medical center. We will administer an electronic survey to surgical teams at the end of the surgical day to elicit clinician communication assessments and relational preferences. From the survey questions, we will develop six relational networks (interaction, close working relationship, socialization, advice seeking, advice giving, speaking up/voice) and three models that represent communication effectiveness for each participant and team. We will use various statistical methods to characterize the network factors that shape operating room clinician communication and identify how team structure shapes communication effectiveness.

Results

This study will start enrolling participants in 2020.

Discussion

We are among the first to comprehensively investigate operating room communication using social network analysis. The results of this study will provide valuable insight into nurse collaboration and communication in interprofessional teams, enable a thoughtful analysis of surgical staffing and perioperative team building, and inform future-targeted interventions to improve operating room communication weaknesses.
Radiology Education Amid COVID-19 Pandemic and Possible Solutions
Authors: Virarkar Mayur , Jensen Corey , Javadi Sanaz , Saleh Mohammed , Bhosale Priya R.
Published: July 2020

Along with the rest of the world, the United States is inundated by the COVID-19 pandemic. The medical services in the country have been severely affected. The pandemic poses extraordinary challenges to academic institutions including radiology residency and fellowship programs. Herein, we delineate major difficulties faced by our radiology training program and mitigating countermeasures. The primary objective is to discuss the changes in our radiology training programs due to COVID-19 to allow for continued radiology education.
Pyogenic Granuloma of the Hard Palate
Authors: Min Hyun Jin , Kim Kyung Soo
Published: July 2020

As the authors recently experienced a patient with pyogenic granuloma arising from the hard palate, they tried to review all the previously reported literatures with the emphasis on its clinical characteristics that can help the accurate diagnosis of this unusual lesion. Based on our experience and literatures review, clinicians should keep in mind that pyogenic granuloma should be taken into consideration in the differential diagnosis of the hard palatal mass despite its rarity. Although histopathological examination of the mass is the only way to arrive at a definitive diagnosis, the knowledge of the gross appearances of pyogenic granuloma with clinical features may be helpful for differential diagnosis.
Oral Mucosa Reconstruction With a Free Muscle Flap
Authors: Kurosawa Sayuri , Matsumoto Hiroshi , Kimata Yoshihiro
Published: July 2020

The use of cutaneous flaps for oral cavity reconstruction is common. However, physiologic reconstruction is not possible because of the presence of hair, and the thickness of cutaneous flaps causes difficulty when performing alveolar ridge augmentation. The authors found few published studies regarding the usefullness of oral reconstruction with free muscle flaps and no studies of histologic examination of reconstructed mucosa. Therefore, they performed a primary reconstruction of oral cavity defects with muscle flaps and allowed the raw surface to epithelialize in 5 patients who underwent oral cavity reconstruction. All flaps were successfully engrafted, and no complications occurred. Epithelialization occurred within approximately 3 months. The authors performed oral mucosal biopsy with the patient's consent and confirmed that the reconstructed oral mucosa appeared histologically normal. This method is more effective than the use of a cutaneous flap, and the physiologic reconstruction of the oral mucosa and alveolar ridge augmentation can be performed in a single operation. However, it is difficult to use in patients who require radiation therapy after the operation because of the requirement of 3 months for full epithelialization. Additionally, muscle contracture could lead to functional disabilities; thus, this procedure should be performed carefully in patients who exhibit large soft tissue defects or who have hard tissue intervention.
Le Fort I Down-Fracture for Management of Midface Tumors
Authors: Quirino Lilian Caldas , Carvalho Pedro Henrique de Azambuja , Santos José Cleveilton dos , Trento Guilherme dos Santos , Gabrielli Marisa Aparecida Cabrini , Pereira-Filho Valfrido Antonio
Published: July 2020

Objective:

To perform an integrative review associating current literature with a clinical series regarding the use of Le Fort I osteotomy for the removal of tumors located in the midface and central region of the skull base.

Methods:

A systematic review was performed through the PubMed, SCOPUS, and Cochrane databases. In addition, 4 different patients operated using the above-cited technique are described in this study.

Results:

Initially, 123 articles were found. After the removal of duplicates, and title and abstract reading, 27 articles were selected for data extraction. The Le Fort I surgical approach of tumors was performed in 183 patients.

Conclusion:

The Le Fort I surgical approach allows lesion exeresis with good visualization, low rates of recurrences and complications, and without aesthetic compromises for the patient.
Management of Intraoral Surgical Defects Using Sublingual Gland Flap
Authors: Jose Anson , Rawat Aditi , Singh Shagun , Nagori Shakil Ahmed , Roychoudhury Ajoy
Published: July 2020

The aim of the study was to evaluate the effectiveness of sublingual gland flap in the reconstruction of surgical defect following sequestrectomy in medication induced osteonecrosis of jaws (MRONJ), osteomyelitis (OML), and osteoradionecrosis (ORN) of mandible. A total of 6 patients with MRONJ (n = 4) osteomyelitis (n = 1) and ORN (n = 1) underwent sequestrectomy and reconstruction with sublingual gland flap. There were 03 males and 03 females. The age range was 45–71–70 years. All defects were present in the posterior mandible. All patients’ undergone sequestrectomy, debridement, and reconstruction with sublingual gland flap under local anesthesia. Postoperatively patients were followed up at 1, 3, and 6 months. Patients were monitored for complete epithelization of defect, infection, pain, and recurrence of the lesion. Complete epithelization with closure of the defect was achieved in all cases. None of the patients had residual pain or inflammation at the surgical site. None of our patients experienced any donor site morbidities. There was no case of postoperative infection. Reconstruction of intraoral defects using sublingual gland flap is an effective treatment modality to reconstruct small to medium sized defect of oral cavity.
Endoscopic Petrous Apex Surgery: The Utilization of Frontal Sinus Instrumentation
Authors: Zheng Zhong , Otten Marc L. , Bruce Jeffrey N. , Gudis David A.
Published: July 2020

Background:

The petrous apex is a complex anatomic region for which each surgical approach each has distinct limitations. The authors describe the use of frontal sinus instrumentation for the endonasal endoscopic approach to petrous apex lesions

Objective:

To demonstrate that the angled design of frontal sinus instrumentation has pronounced clinical utility for the transsphenoidal transclival approach to the petrous apex.

Methods:

The authors present cases of expansile petrous apex lesions approached endoscopically via transsphenoid and transclival corridors, and highlight the technique of using curved frontal sinus instruments and angled endoscopes for posterolateral reach in the petrous apex dissection.

Results:

As demonstrated in the accompanying video, dissection with frontal sinus instrumentation allows the surgeon to navigate around the internal carotid artery.

Conclusions:

Significant technical and technological advances have been made in the field of expanded endoscopic endonasal skull base surgery in the past 3 decades. Increasing efforts are made to push the boundaries and access more laterally located lesions, such as those in the petrous apex. Surgical trajectory or vector is paramount to safely navigate around the internal carotid artery.
Is Tranexamic Acid Associated With Mortality or Multiple Organ Failure Following Severe Injury?
Authors: Richards Justin E. , Fedeles Benjamin T. , Chow Jonathan H. , Morrison Jonathan J. , Renner Corinne , Trinh Anthony T. , Schlee Caroline S. , Koerner Ken , Grissom Thomas E. , Betzold Richard D. , Scalea Thomas M. , Kozar Rosemary A.
Published: July 2020

Background:

Tranexamic acid (TXA) administration is recommended in severely injured trauma patients. We examined TXA administration, admission fibrinolysis phenotypes, and clinical outcomes following traumatic injury and hypothesized that TXA was associated with increased multiple organ failure (MOF).

Methods:

Two-year, single-center, retrospective investigation. Inclusion criteria were age ≥ 18 years, Injury Severity Score (ISS) >16, admitted from scene of injury, thromboelastography within 30 min of arrival. Fibrinolysis was evaluated by lysis at 30 min (LY30) and fibrinolysis phenotypes were defined as: Shutdown: LY30 ≤ 0.8%, Physiologic: LY30 0.81–2.9%, Hyperfibrinolysis: LY30 ≥ 3.0%. Primary outcomes were 28-day mortality and MOF. The association of TXA with mortality and MOF was assessed among the entire study population and in each of the fibrinolysis phenotypes.

Results:

Four hundred twenty patients: 144/420 Shutdown (34.2%), 96/420 Physiologic (22.9%), and 180/410 Hyperfibrinolysis (42.9%). There was no difference in 28-day mortality by TXA administration among the entire study population (P = 0.52). However, there was a significant increase in MOF in patients who received TXA (11/46, 23.9% vs 16/374, 4.3%; P < 0.001). TXA was associated MOF (OR: 3.2, 95% CI 1.2–8.9), after adjusting for confounding variables. There was no difference in MOF in patients who received TXA in the Physiologic (1/5, 20.0% vs 7/91, 7.7%; P = 0.33) group. There was a significant increase in MOF among patients who received TXA in the Shutdown (3/11, 27.3% vs 5/133, 3.8%; P = 0.001) and Hyperfibrinolysis (7/30, 23.3% vs 5/150, 3.3%; P = 0.001) groups.

Conclusions:

Administration of TXA following traumatic injury was associated with MOF in the fibrinolysis shutdown and hyperfibrinolysis phenotypes and warrants continued evaluation.
Banded Versus Nonbanded Sleeve Gastrectomy
Authors: Fink Jodok M. , Hetzenecker Andrea , Seifert Gabriel , Runkel Mira , Laessle Claudia , Fichtner-Feigl Stefan , Marjanovic Goran
Published: July 2020

Objective:

The aim of this study was to compare silicone-banded sleeve gastrectomy (BSG) to nonbanded sleeve gastrectomy (SG) regarding weight loss, obesity-related comorbidities, and complications.

Summary Background Data:

As a primary bariatric procedure, SG leads to excellent weight loss, yet weight regain is a relevant issue in mid- to long-term follow-up. Retrospective analyses suggest that banding a sleeve using a silicone ring may decrease weight regain and improve weight loss.

Methods:

The banded versus nonbanded sleeve gastrectomy single-center, randomized controlled trial was conducted from January 2015 to August 2019. The primary endpoint was defined as excess weight loss 3 years after surgery. Secondary endpoints included the surgery's impact on obesity-related comorbidities, quality of life, and complications. The study was registered under DRKS00007729.

Results:

Among 94 patients randomized, 97% completed 3-year follow-up. Mean initial body mass index was 50.9 kg/m2 [95% confidence interval (CI), 49.6–52.2]. Mean adjusted excess weight loss 3 years after SG amounted to 62.3% (95% CI, 56.2–68.5) and 73.9% ( 95% CI, 67.8–80.0) after BSG (difference 11.6%, P = 0.0073). Remission of type 2 diabetes occurred in 66.7% (4/6) after SG and in 91.0% (10/11) following BSG (P = 0.21). Three years after surgery, ring implantation correlated with decreased frequency of symptomatic reflux episodes (P = 0.01) but increased frequency of regurgitation (P = 0.03). The rate of major complications was not different between the study groups (BSG, n = 3; SG, n = 2; P = 0.63). Quality of life was better following BSG (P = 0.001).

Conclusions:

BSG provided better weight loss than nonbanded SG 3 years after surgery. Regurgitation was the main clinically relevant negative effect after BSG.
Quantifying Factors Essential to the Integrity of the Esophagogastric Junction During Antireflux Procedures
Authors: Stefanova Dessislava I. , Limberg Jessica N. , Ullmann Timothy M. , Liu Mengyuan , Thiesmeyer Jessica W. , Beninato Toni , Finnerty Brendan M. , Schnoll-Sussman Felice H. , Katz Philip O. , Fahey Thomas J. , Zarnegar Rasa
Published: July 2020

Objective:

To quantify the contribution of key steps in antireflux surgery on compliance of the EGJ.

Background:

The lower esophageal sphincter and crural diaphragm constitute the intrinsic and extrinsic sphincters of the EGJ, respectively. Interventions to treat reflux attempt to restore the integrity of the EGJ. However, there are limited data on the relative contribution of critical steps during antireflux procedures to the functional integrity of the EGJ.

Methods:

Primary antireflux surgery was performed on 100 consecutive patients with pathologic reflux. Intraoperative EGJ measurements including distensibility index (DI), cross-sectional area (CSA), and HPZ length were collected using EndoFLIP. Data was acquired pre-repair, post-diaphragmatic re-approximation with sub-diaphragmatic EGJ relocation, and post-sphincter augmentation.

Results:

Patients underwent Nissen (45%), Toupet (44%), or LINX (11%). After diaphragmatic re-approximation, DI decreased by a median 0.77 mm2/mm Hg [95%-confidence interval (CI): −0.99, −0.58; P < 0.0001], CSA decreased 16.0 mm2 (95%-CI: −20.0, −8.0; P < 0.0001), whereas HPZ length increased 0.5 cm (95%-CI: 0.5, 1.0; P < 0.0001). After sphincter augmentation, DI decreased 0.14 mm2/mm Hg (95%-CI: −0.30, −0.04; P = 0.0005) and CSA decreased 5.0 mm2 (95%-CI: −10.0, 1.0; P = 0.0.0015), whereas HPZ length increased 0.5 cm (95%-CI: 0.50, 0.54; P < 0.0001). Diaphragmatic re-approximation had a higher percent contribution to distensibility (79% vs 21%), CSA (82% vs 18%), and HPZ (60% vs 40%) than sphincter augmentation.

Conclusion:

Dynamic intraoperative monitoring demonstrates that diaphragmatic re-approximation and sub-diaphragmatic relocation has a greater effect on EGJ compliance than sphincter augmentation. As such, antireflux procedures should address both for optimal improvement of EGJ physiology.