bluuebunny/crossref_metadata_2025 huggingface dataset:
One-year follow-up of heart transplant recipient with cardiac rehabilitation
Authors: Choi Hee-Eun , Kim Chul , Park Se-Heum
Published: April 2020

Introduction:

Heart transplantation (HT) is known to be the final therapy for patients with advanced heart failure; however, the exercise capacity of these patients remains under the aged-predicted value after HT. Many studies have described the effectiveness and safety of cardiac rehabilitation (CR) in HT recipients. Nevertheless, long-term follow-up data of HT recipients undergoing CR are insufficient, and there is a lack of evidence on the long-term effects of CR. In this case report, we present the long-term benefits of CR in an HT recipient, including serial follow-up clinical data over 1 year.

Patient concerns:

A 48-year-old female patient underwent HT because of advanced dilated cardiomyopathy.

Diagnosis:

Cardiopulmonary exercise test showed reduced exercise capacity and pulmonary function. The grip power and quadriceps muscle strength were also decreased after HT.

Interventions:

The patient underwent a phase I CR program for 3 months, followed by a phase III CR program for 7 months. In the beginning, moderate-intensity continuous training was conducted. Thereafter, high-intensity interval training was implemented after a period of adjustment for interval training.

Outcomes:

The exercise capacity, 6-min walk distance, muscle strength, and vital capacity were improved after CR.

Conclusion:

CR in HT recipients may improve muscle strength and pulmonary function as well as exercise capacity, without serious cardiovascular complications. Phase III CR may help maintain exercise capacity in these patients.
Cesarean section rates in Brazil
Authors: Rudey Edson Luciano , Leal Maria do Carmo , Rego Guilhermina
Published: April 2020

Cesarean section (CS) is a surgical procedure used to deliver babies that is medically indicated to prevent maternal and neonatal mortality. However, it is associated with short- and long-term risks. CS rates have increased, and efforts are being made to ensure that CS is performed only when necessary. The Robson classification system is considered useful for studying, evaluating, monitoring, and comparing CS rates within and between healthcare facilities. In Brazil, there are few studies on this subject, and no large epidemiological studies on this topic utilizing the Robson classification have been reported. This study aimed to report and analyze CS rates in Brazil using the Robson classification system, and subsequently suggest possible measures to address it.

Data were collected from the Brazilian Live Birth Information System (Sistema de Informações sobre Nascidos Vivos) that contains data of the entire obstetric population, from 2014 to 2017. All births in the country during this period were analyzed according to the Robson classification.

A total of 11,774,665 live births were reported in Brazil during 2014 to 2017, most of which were mostly via CS (55.8%). Regions with high human development indexes had significantly higher CS rates than those with low human development indexes. The Robson group (RG) 1 to 4 accounts for 60.2% of live births and 47.1% of all CSs. RG5 was larger than all the other groups and contributed to the highest global rate of CS (31.3%), in addition to being the group who presented the largest growth.

Although RG 1 to 4 present favorable initial conditions for vaginal delivery, CS accounted for almost half of births in these groups. The size of RG1 and RG2 in Brazil was comparable to that in countries with low CS rates; however, CS rates in these groups were 3 times higher in Brazil. Nulliparous women in RG1 and RG2 who undergo CS are subsequently categorized into RG5, increasing the global CS rate by 1% annually.

We suggest the implementation of health policies to avoid the unnecessary performance of CS in RG1 and RG2 to decrease the CS rates in Brazil.
Identification of gastrointestinal stromal tumors from leiomyomas in the esophagogastric junction
Authors: Yin Xiaonan , Yin Yuan , Liu Xijiao , Yang Caiwei , Chen Xin , Shen Chaoyong , Chen Zhixin , Zhang Bo , Cao Dan
Published: April 2020

To identify significant clinical and CT features for the differentiation of gastrointestinal stromal tumors (GISTs) from leiomyomas in the esophagogastric junction (EGJ).

One hundred thirty six patients with pathologically proven GISTs (n = 87) and leiomyomas (n = 49) in the EGJ were enrolled. And preoperative CT images were available in 73 GISTs cases and 34 leiomyoma cases. Two radiologists reviewed the CT images by consensus with regard to tumor size, shape, growth pattern, surface, enhancement pattern, enhancement degree, attention at each phasic image and the presence of surface ulcer, calcification, and intralesional low attention.

Eight significant clinical and CT features were identified for differentiating GISTs from leiomyomas: older age (>46.5 years), tumor long diameter >4.5 cm, heterogeneous enhancement, high degree enhancement, mean CT attenuation >69.2 HU, presences of intralesional low attenuation and surface ulcer, absences of calcification (P < .05). On the receiver operating characteristic curve analysis, an optimal cutoff score of 3.5 was achieved for differentiating GISTs from leiomyomas with an AUC of 0.844 (sensitivity: 76.7%, specificity: 76.5%).

older age (>46.5 years), tumor long diameter >4.5 cm, heterogeneous enhancement, high degree enhancement, mean CT attenuation >69.2 HU, presences of intralesional low attenuation and surface ulcer, absence of calcification are significant features highly suggestive of GISTs in differentiation from leiomyomas in the EGJ.
Ultrasound-guided continuous thoracic paravertebral block alleviates postoperative delirium in elderly patients undergoing esophagectomy
Authors: Jin Liang , Yao Rui , Heng Lei , Pang Bo , Sun Fu-Guo , Shen Ying , Zhong Jun-Feng , Zhao Pan-Pan , Wu Cong-You , Li Bei-Ping
Published: April 2020

Background:

Delirium is a common postoperative complication in older patients undergoing thoracic surgery and presages poor outcomes. Postoperative pain is an important factor in the progression of delirium. The purpose of this study was to test whether continuous thoracic paravertebral block (PVB), a more effective approach for analgesia, could decrease the incidence of delirium in elderly patients undergoing esophagectomy.

Methods:

A total of 180 geriatric patients undergoing esophagectomy were randomly divided into 2 groups and treated with PVB or patient-controlled analgesia (PCA). Perioperative plasma CRP, IL-1β, IL-6, and TNF-α levels were detected in all patients. Pain intensity was measured by a numerical rating scale. Delirium was assessed using the confusion assessment method.

Results:

The incidence of postoperative delirium was significantly lower in the PVB group than in the PCA group. Patients in the PVB group had lower plasma CRP, IL-1β, IL-6, and TNF-α levels and less pain when coughing after surgery.

Conclusions:

Ultrasound-guided continuous thoracic paravertebral block improved analgesia, reduced the inflammatory reaction and decreased the occurrence of delirium after surgery.
The impact of echocardiographic parameter ratio of E/E’ on the late recurrence paroxysmal atrial fibrillation in patients accepted radiofrequency catheter ablation
Authors: Gong Ke-Zeng , Yan Qin-Dan , Huang Rong-Da , Chen Jian-Hua , Chen Xue-Hai , Wang Wei-Wei , Xu Zhe , Chen Liang-Long , Fan Lin , Zhang Fei-Long
Published: April 2020

This study aimed to evaluate the impact of the echocardiographic parameter ratio E/E’ on the late recurrence of paroxysmal atrial fibrillation in patients after receiving radiofrequency catheter ablation.

We retrospectively examined total of 288 paroxysmal atrial fibrillation (PAF) patients that underwent a preliminary radiofrequency catheter ablation (RFCA) in our hospital. During the first phase in this study, the patients were divided into 2 groups upon AF recurrence after RFCA: Recurrent group, n = 67 patients with rapid trial arrhythmia that lasted for more than 30 seconds at 3 months after RFCA and the Nonrecurrent group, n = 221. The clinical conditions were compared between the 2 groups. During the second phase of this study, based on the results in the first phase, the patients were divided into another 2 groups according to whether the ratio of E/E’ ≥13 .45: Higher ratio of E/E’ group, n = 55 and Lower ratio of E/E’ group n = 233. The late AF recurrent rates were also compared between the 2 groups.

During the first phase, the univariate analysis indicated that the risk factors(P < .05)for PAF late recurrence included early recurrence, E’, and the ratio E/E’. The Cox multivariate analysis showed that the ratio of E/E’ and early recurrence were the independent predictors for late PAF recurrence. The ratio of E/E’ that was cut off at 13.45 also predicted atrial tachyarrhythmia recurrence with 40.3% sensitivity and 87.3% specificity. In the second phase, after completing the 1:1 matching, the Kaplan–Meier analysis indicated that the ratio of E/E’ ≥ 13.45 was associated with further recurrences after RFCA (log-rank P = .009), compared to the patients with a ratio of E/E’ < 13.45. The univariate Cox analysis indicated that an elevated ratio of E/E’(≥13.45) was the independent predictor for late PAF recurrence (HR = 3.322, 95%CI: 1.560–7.075, P = .002). However, the ratio of E/E’ cut off at 13.25 predicted atrial tachyarrhythmia recurrence with 75% sensitivity and 62.2% specificity.

The ratio of E/E’ ≥ 13.25 is an important predictor of the late recurrence of paroxysmal atrial fibrillation (PAF) after radiofrequency catheter ablation (RFCA).
Acupuncture for ocular myasthenia gravis
Authors: Zhang Di , Jin Song , Zhang Leixiao , Chen Lin , Liang Fanrong
Published: April 2020

Background:

The aim of this systematic review with meta-analysis is to determine the efficacy and security of acupuncture in treatment of ocular myasthenia gravis and find out whether or not the quick short-term efficacy of acupuncture exists.

Methods:

The following electronic databases will be searched by 2 independent reviewers: PubMed, Cochrane Library, EMBASE, Springer, China National Knowledge Infrastructure, Wanfang, and Chinese Biomedical Literature Database. All randomized controlled trials on acupuncture for ocular myasthenia gravis published in electronic databases from inception to March 1, 2020, with language restricted in Chinese and English will be included in the study.

Methodologic quality is assessed by 2 blinded reviewers independently screen and score the articles using the PEDro scale and the Cochrane Collaboration risk of bias tool. A meta-analysis was performed when there is sufficient clinical homogeneity in at least 2 studies. The Grading of Recommendations Assessment, Development and Evaluation approach is used to rate the body of evidence in each meta-analysis. When the quantitive evaluation is not available, a qualitative description of the results of single study is provided.

Results:

An evidence of variety of acupuncture treatment methods for treating ocular myasthenia gravis will be illustrated using subjective reports and objective measures of performance. The primary outcomes consisted of effective rate, MGFA PIS, QMG, and MG-composite. Secondary outcomes involve clinical absolute and relative score, titers of AchR antibodies, and the side effects. The treatment frequency and courses will be measured.

Conclusion:

This protocol will present the evidence of whether acupuncture is an effective and safe intervention for ocular myasthenia gravis.

Trial registration number:

CRD42019141325
Effects of clazosentan, cilostazol, and statins on aneurysmal subarachnoid hemorrhage
Authors: He Junfang , Zhang Li , Yu Yao , Luo Xinyue , Wei Min , Chen Gen , Shen Yanfei
Published: April 2020

Background

: Aneurysmal subarachnoid hemorrhage (aSAH) is a disease caused by the infiltration of blood into the subarachnoid space due to the rupture of an intracranial aneurysm. It is a serious cerebrovascular disease, with a mortality rate of about 40% worldwide, which seriously threatens human life and health. Many drugs are used to treat aSAH and its complications, and some have been tested in systematic reviews and have shown good effects. But which drug has the best effect remains unclear. This network meta-analysis (NMA) aims to assess the effectiveness and feasibility of clazosentan, cilostazol, and statins in patients with aSAH.

Methods

: We will search for EMBASE.com, PubMed, the Cochrane Library, and Web of Science from inception to December 2019. Randomized controlled trials (RCTs) reporting efficacy and safety of clazosentan, cilostazol, and statins compared with the control, or compared with each other for the treatment of aSAH will be included. Two independent reviewers will assess the risk of bias of the included RCTs with the Cochrane “Risk of bias” tool. The pairwise meta-analysis will be performed with the random-effects model. The NMA will be performed in a Bayesian hierarchical framework using Markov Chain Monte Carlo method in WinBUGS 1.4.3. Egger test and funnel plot will be used to assess the publication bias. We will evaluate the quality of evidence for each outcome according to the GRADE approach.

Results

: The results of this NMA will be submitted to a peer-reviewed journal for publication.

Conclusion

: This study will summarize up-to-date evidence to compare the efficacy and safety of clazosentan, cilostazol, and statins on aSAH.

PROSPERO registration number: CRD42019147523.
Effects of Photobiomodulation in Children with Down Syndrome and Possible Sleep Bruxism: Protocol For A Randomized, Controlled, Blind, Clinical Trial
Authors: Salgueiro Mônica da Consolação Canuto , Silva Tamiris , Motta Lara Jansiski , Horliana Anna Carolina Ratto Tempestini , Gonçalves Marcela Letícia Leal , Gomes Andréa Oliver , Pinto Marcelo Mendes , Bortoletto Carolina Carvalho , Altavista Olga Maria , Deana Alessandro Melo , Silva Daniela de Fátima Teixeira da , Santos Elaine Marcilio , Castelo Paula Midori , Fernandes Kristianne Porta Santos , Mesquita-Ferrari Raquel Agnelli , Bussadori Sandra Kalil
Published: April 2020

Hypotonia, particularly of the masticatory and oropharyngeal muscles, is 1 of the main characteristics of Down Syndrome (DS), resulting in impaired speech, chewing and swallowing. Moreover, the complete or partial obstruction of the airways during sleep may occur due to hypotonia of the tongue, leading to snoring and sleep disorders, such as obstructive apnea and sleep bruxism.

Objective:

Analyze salivary levels of dopamine and cortisol and muscle activity before and after treatment with low-level laser therapy administered to acupoints in children with DS.

Methods:

A randomized, controlled, clinical trial will be conducted. Individuals 4 to 17 years of age with a diagnosis of DS and possible sleep bruxism will be screened at the Integrated Health Clinic of Nove de Julho University. We will evaluate orofacial dysfunction (Nordic Orofacial Test - Screening questionnaire), Masseter muscle activity during sleep will be assessed by BiteStrip and the masticatory muscles will be evaluated by electromyography (BTS TMJOINT) head posture as well as salivary cortisol and dopamine. After the evaluations, the participants will be randomized into 2 groups: Grupo 1 – treatment with low-level laser therapy at a wavelength of 808 nm; Group 2 – sham treatment (simulated laser therapy). Treatment will be conducted twice per week for a total of 12 sessions. The data will be tabulated and treated using GraphPad Prism version 7.0. The Kolmogorov-Smirnov test will be used to determine the normality of the data. Variables that fit the Gaussian curve will be expressed as mean and standard deviation. The ANOVA 2-way will be used for comparisons between the groups, with the significance level set to 5% (P < .05).

ClinicalTrials registration number: NCT04211870.
Exercise-induced hypertension can increase the prevalence of coronary artery plaque among middle-aged male marathon runners
Authors: Kim Chul-Hyun , Park Yongbum , Chun Min Young , Kim Young-Joo
Published: April 2020

Marathon runners demonstrate a high incidence of coronary artery plaque; however, studies on runners with exercise-induced hypertension (EIH) are sparse. We aimed to investigate the prevalence of coronary artery plaque among marathon runners with EIH.

Veteran male marathon runners (≥40 and <60 years) underwent an exercise stress test. They were divided into 2 groups: normal blood pressure group (NBPG, n = 22), with resting systolic blood pressure (SBP)/diastolic blood pressure <140/90 mm Hg and maximal exercise SBP <210 mm Hg, and EIH group (EIHG, n = 28), with resting blood pressure <140/90 mm Hg and maximal exercise SBP ≥210 mm Hg. Coronary artery plaque and stenosis were compared using multi-detector computed tomography.

The proportion of subjects with a coronary artery calcium (CAC) score ≥10 or ≥100 units, 1 or ≥2 plaques, or plaques in ≥2 blood vessels was higher in the EIHG than in the normal blood pressure group (NBPG) (P<.05). The absolute CAC score was higher in the EIHG (42.6 ± 67.8) than in the NBPG (2.8 ± 6.0; P < .05). The CAC score distribution was higher in the EIHG (5–300 units) than in the NBPG (P < .05). The prevalence of coronary plaques and maximal luminal artery stenosis was higher in the EIHG than in the NBPG (P < .05). The EIHG showed 12 cases of stenosis, whereas the NBPG showed only 1 case (P < .05).

In marathon runners, EIH was associated with increased prevalence of coronary artery plaques and could be a new risk factor for coronary artery plaque formation. Therefore, preventive measures and EIH monitoring using an exercise stress test, alongside multi-detector computed tomography, are recommended.
Continuous versus single shot adductor canal block for postoperative pain relief after total knee arthroplasty
Authors: Tao Yulin , Mao Qingjun , Wang Jixiang
Published: April 2020

Background:

Adductor canal block has become a popular mode of pain management after total knee arthroplasty. This study compared a single-injection adductor canal block (SACB) with continuous adductor canal block (CACB). The hypothesis was that the 2 groups would have equivalent analgesia at 48 hours post-neural blockade.

Methods:

This is a double-blinded, randomized, controlled, equivalency trial that is conducted at a single university hospital in China. A total of 60 patients who meet inclusion criteria are randomized in a ratio of 1:1 to either CACB (0.5% ropivacaine 20 mL followed by continuous infusion of 0.2% ropivacaine at 5 mL/h for 48 hours) or SACB (0.5% ropivacaine 20 mL) group. The primary outcome is pain scores at 48 hours utilizing the visual analog scale, whereas the secondary outcomes include opioid consumption, Timed Up & Go test, ambulation distances at discharge, length of stay, and maximal flexion at discharge. All pain scores are assessed by an independent observer who is blinded to the allocation of groups.

Results:

This study has limited inclusion and exclusion criteria and a well-controlled intervention. This clinical trial is expected to provide evidence of better therapy for the pain management after total knee arthroplasty.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5431).
Fibrodysplasia ossificans progressiva—a rare disease with distinctive features yet still a diagnostic challenge
Authors: Shi Xiaofei , Zhou Liqing , Shang Jingjing , Wang Ke , Chu Cong-Qiu
Published: April 2020

Rationale:

Fibrodysplasia ossificans progressiva (FOP) is rare genetic disease featuring progressive heterotopic ossification of soft tissues of the musculoskeletal system which leads to severe disability and premature death. Recognition of this disease is important since invasive diagnostic procedures can promote disease progression. However, despite its distinctive clinical manifestations, diagnosis can be difficult because of its rarity

Patient concerns:

A 20-year-old woman was referred to rheumatology clinic for management of “ankylosing spondylitis”. The patent had begun to have hard subcutaneous nodules when she was 1 year old, and subsequently developed hip joint pain and flexion contractures of knees and hips leading to disability.

Diagnoses:

Based on characteristic bilateral great toe deformities and radiographic images of ossification of soft tissues, a clinical diagnosis of FOP was made. This was confirmed by genetic test showing a heterozygous mutation (c.G617A) of the activin receptor 1A gene (ACVR1).

Interventions:

The patient was treated symptomatically and with supportive measures, and her condition remained stable.

Lessons:

Diagnosis of FOP can be difficult, despite its distinctive clinical manifestations, because of its rarity. Recognition of this disease is important to avoid invasive diagnostic procedures which can promote progression.
Brain-derived neurotrophic factor and glutathione peroxidase as state biomarkers in alcohol use disorder patients undergoing detoxification
Authors: Wu Shu-Yu , Chen Chien-Yu , Huang Tiao-Lai , Tsai Meng-Chang
Published: April 2020

The pathophysiology of alcohol use disorder (AUD) is not totally clear. The aim of this study was to investigate the serum levels of brain-derived neurotrophic factor (BDNF) and oxidative stress markers in AUD patients during alcohol detoxification. Evaluation of changes in BDNF, glutathione peroxidase (GPX), catalase, superoxide dismutase, thiobarbituric acid reactive substances, 8-hydroxy 2’-deoxyguanosine, PCC and S100B were carried out.

14 AUD inpatients and 20 healthy control subjects were recruited for this study. The serum BDNF, S100B and oxidative stress markers were measured with assay kits.

Serum levels of catalase, GPX, PCC and 8-hydroxy 2’-deoxyguanosine were significantly higher in the AUD group subjects than in the controls (P < .05). However, BDNF levels were lower in the AUD group than in the controls (P < .05). After alcohol detoxification treatment, the GPX levels in the AUD group dropped (P < .05) and the BDNF levels rose (P < .05).

The results suggest that serum BDNF and GPX levels might be state biomarkers for AUD patients undergoing alcohol detoxification.
Serum uric acid to creatinine ratio and metabolic syndrome in postmenopausal Chinese women
Authors: Tao Jing , Shen Xin , Li Jie , Cha Erdenbat , Gu Pei-Pei , Liu Jun , Zhu Wei , He Lin-Long , Li Guo-Qing , Wang Zhao
Published: April 2020

This study aimed to investigate the association between Serum Uric Acid (UA) to Creatinine (Cr) Ratio (UA/Cr) and metabolic syndrome (MetS) in postmenopausal women.

A total of 455 patients with MetS and 457 age- and gender- matched controls were included in the present retrospective study. Serum levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), Cr, and UA were measured. We employed logistic regression analysis to investigate the association between serum UA/Cr and MetS in postmenopausal women.

Serum UA/Cr levels were significantly higher in patients with MetS than that in control subjects (P < .05). In the correlation analysis, serum UA/Cr showed a significantly positive correlation with age, hypertension, systolic pressure (SBP), diastolic pressure (DBP), Waist, body mass index (BMI), TG, UA and negative correlation with type 2 diabetes mellitus (T2DM) and Cr (P all < .001). Moreover, multivariate analysis revealed that serum UA/Cr was still an independent risk factor for MetS (OR = 2.928, 95% CI = 2.385–3.596, P < .001) after adjustments for other confounders.

Serum UA/Cr are strongly associated with the risk of MetS in postmenopausal Chinese women.
C.292G>A, a novel glycine receptor alpha 1 subunit gene (GLRA1) mutation found in a Chinese patient with hyperekplexia
Authors: Zhang Yan , Wu Ling-Ling , Zheng Xiao-Lan , Lin Cai-Mei
Published: April 2020

Introduction:

Hyperekplexia is a rare hereditary neurological disorder; only 5 glycine receptor alpha 1 subunit gene (GLRA1) mutations have been reported in 5 Chinese patients. We report a Chinese infant with hyperekplexia and a novel mutation at c.292G > A.

Patient concerns:

A Chinese infant with hyperekplexia and a novel mutation at c.292G > A.

Diagnosis:

All exons of GLRA1 were sequenced in her parents and her, which revealed a mutation at c.1030C > T and another novel mutation at c.292G > A. Her diagnosis was confirmed as hereditary hyperekplexia with GlRA1 hybrid gene mutations based on the sequencing results.

Interventions:

She was treated with clonazepam.

Outcomes:

Her muscle hypertonia recovered rapidly and the excessive startle reflex to unexpected stimuli was significantly reduced.

Conclusion:

Genetic DNA sequencing is a crucial method for diagnosing hyperekplexia-related gene mutation.
Increased risk of incident primary cancer after Staphylococcus aureus bacteremia
Authors: Gotland Nanja , Uhre M.L. , Sandholdt H. , Mejer N. , Lundbo L.F. , Petersen A. , Larsen A.R. , Benfield T.
Published: April 2020

Susceptibility to infectious disease may be a marker of immunodeficiency caused by unrecognized cancer. To test the hypothesis, the risk of incident primary cancer was estimated among survivors of Staphylococcus aureus bacteremia (SAB) and compared to a random population cohort.

Nation-wide population-based matched cohort study. Cases of SAB were identified from a national database and incident primary cancers were ascertained by record linkage. Incidence rate (IR) and ratio (IRR) with 95% confidence interval (CI) of 27 cancers was calculated by Poisson regression.

During the first year of follow-up, 165 and 943 incident cases of cancer occurred in the case cohort (n = 12,918 (1.3%)) and the population cohort (n = 117,465 (0.8%)) for an IR of 3.78 (3.22–4.40) and 2.28 (2.14–2.43) per 100,000 person-years. The IRR was 1.65 (1.40–1.95). Of 27 cancers, 7 cancers occurred more frequently amongst cases than controls: cervical cancer (IRR 37.83 (4.23–338.47)), multiple myeloma (IRR 6.31 (2.58–15.44)), leukemia (IRR 4.73 (2.21–10.10)), sarcoma (IRR 4.73 (1.18–18.91)), liver cancer (IRR 3.64 (1.30–10.21)), pancreatic cancer (IRR 2.8 (1.27–6.16)), and urinary tract cancer (IRR 2.58 (1.23–5.39)). Compared to the control population, the risk of cancer was higher for those without comorbidity and with younger age. The overall risk of cancer during 2 to 5 years of follow-up was not increased (IRR 0.99 (95% CI: 0.89–1.11). However, the risk of pharyngeal cancer was increased (IRR 1.88 (1.04–3.39)) and the risk of liver cancer remained increased (IRR 3.93 (2.36–6.55)).

The risk of primary incident cancer was 65% higher in the SAB cohort compared to the population cohort during the first year of follow-up and included 7 specific cancers. The risk was higher for those without comorbidity and with younger age. Screening for these specific cancers in selected populations may allow for earlier detection.
Clinical event debriefing: a review of approaches and objectives
Authors: Twigg Sonia
Published: April 2020

Purpose of review

This review explores four different approaches and clarifies objectives for debriefing after a clinical event in the emergency department. Psychological debriefing aims to prevent or reduce symptoms of traumatic stress and normalize recovery. Psychological first aid helps team members provide each other with pragmatic social support. Debriefing for simulation-based education promotes learning by team members. Quality improvement approaches and after action reviews focus on systems improvement.

Recent findings

Qualitative studies have begun to explore interactions between clinical staff after a significant clinical event. Clearer descriptions and measurements of quality improvements and the effect of clinical event debriefing on patient outcomes are appearing. An increasing number of studies describe melded, scripted approaches to the hot debrief.

Clinical staff have consistently indicated they value debriefing after a significant clinical event. Differing objectives from different approaches have translated into a wide variety of methods and a lack of clarity about relevant outcomes to measure. Recent descriptions of scripted approaches may clarify these objectives and pave the way for measuring relevant outcomes that demonstrate the effectiveness of and find the place for debriefing in the emergency department.
Novel biomarkers of acute kidney injury in children: an update on recent findings
Authors: Sandokji Ibrahim , Greenberg Jason H.
Published: April 2020

Purpose of review

The clinical diagnosis of acute kidney injury (AKI) relies largely on changes in serum creatinine; a delayed biomarker. Research in children has been focused on developing novel AKI biomarkers, which can improve the prediction, early detection and diagnosis of kidney injury, as well as our understanding of AKI pathophysiology. In this review, we describe recently published studies on urine or blood biomarkers of AKI. The mechanistic relevance of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1, interleukin (IL)-18, liver-type fatty acid binding protein, tissue inhibitor of metalloproteinase (TIMP)-2/insulin-like growth factor-binding protein (IGFBP)-7, uromodulin, as well as other inflammatory biomarkers are discussed in the context of AKI pathophysiology, as well as their performance predicting or diagnosing AKI.

Recent findings

Biomarkers of tubular injury, cell cycle arrest and inflammation are presented in this review. NGAL continues to be the most frequently studied biomarker and continues to have good performance in a variety of clinical settings, most notably after cardiopulmonary bypass. We also found promising results with less studied biomarkers for the prediction of AKI in children, including TIMP2, IGFBP7, uromodulin, tumor necrosis factor-α and IL-8.

Identifying new AKI biomarkers is a priority in pediatric nephrology research because of the morbidity associated with AKI, as well as the lack of therapies for AKI. Recent research suggests that novel AKI biomarkers have the potential to predict the development of AKI and diagnose AKI earlier than changes in serum creatinine. The diverse causes of AKI, the different settings where patients develop AKI and the changing biomarker reference ranges throughout childhood remain challenges in biomarker development.
The economics of a pediatric surgical ICU
Authors: Slater Bethany J. , Vogel Adam M.
Published: April 2020

Purpose of review

The purpose of this review is to describe quality and financial economic principles that form the foundation for complex care delivery systems for the critically ill pediatric surgical population.

Recent findings

Advances in neonatology along with innovation in surgical techniques in children led to the need to care for more complex postoperative surgical patients. Several studies have demonstrated improved outcomes in specialized pediatric centers. Furthermore, there is some evidence to suggest that there is overall financial benefit with decreased costs and more efficient resource use to pediatric subspecialty critical care.

As more becomes known regarding the impact of specialized ICU environments, pediatric surgical critical care, and pediatric surgical ICUs have the potential to improve the value of care delivered to these complex patients. Well-designed, prospective, observational studies are needed to assist in defining appropriate outcome and quality measures to inform the development of these specialized units. Currently, there are a variety of models used in children's hospitals to care for critically ill surgical patients. This represents a tremendous opportunity for a collaborative, multidisciplinary effort amongst pediatric medical and surgical intensivists.
Renal replacement therapies for infants and children in the ICU
Authors: Sanderson Keia R. , Harshman Lyndsay A.
Published: April 2020

Purpose of review

Pediatric acute kidney injury (AKI) in critically ill patients is associated with increased morbidity and mortality. Emerging data support that the incidence of pediatric AKI in the ICU is rising. For children with severe AKI, renal replacement therapy (RRT) can provide a lifesaving supportive therapy. The optimal timing to deliver and modality by which to deliver RRT remain a point of discussion within pediatric (and adult) literature. This review discusses the use of RRT for pediatric patients in the ICU. We discuss the most recent evidence-based methods for RRT with a focus on continuous RRT.

Recent findings

The feasibility of dialyzing the smallest infants and more medically complex children in the ICU is dependent on the advancements in dialysis access and circuit technology. At present, data indicate that upward of 27% of children in the ICU develop AKI and 6% require RRT. Newer dialysis modalities including prolonged intermittent hemodialysis and continuous flow peritoneal dialysis as well as newer dialysis technologies such as the smaller volume circuits (e.g., Cardio-Renal Pediatric Dialysis Emergency Machine, Newcastle Infant Dialysis and Ultrafiltration System) have made the provision of dialysis safer and more effective for pediatric patients of a variety of sizes.

Renal replacement in the ICU requires a multidisciplinary team approach that is facilitated by a pediatric nephrologist in conjunction with intensivists and skilled nursing staff. Although mortality rates for children on dialysis remain high, outcomes are improving with the support of the multidisciplinary team and dialysis technology advancements.
Extracorporeal membrane oxygenation in the pediatric population – who should go on, and who should not
Authors: Etchill Eric W. , Dante Siddhartha A. , Garcia Alejandro V.
Published: April 2020

Purpose of review

The role of extracorporeal membrane oxygenation (ECMO), a method of providing cardiorespiratory support in instances of cardiac or respiratory failure, in neonates and children continues to expand and evolve. This review details the current landscape of ECMO as it applies to neonates and children.

Recent findings

Specifically, this review provides the most recent evidence for which patients should be considered for the various forms of ECMO including venovenous ECMO, venoarterial-ECMO, and extracorporeal cardiopulmonary resuscitation. Specific topics to be discussed include indications and contraindications for the different types of ECMO in neonates and children, anticoagulation strategies and ways to monitor end-organ function, outcomes specific to the different types and populations with a focus on meaningful survival to discharge and neurologic outcomes, and consideration of special populations such as low birth weight infants, traumatically injured patients, and children who received recent bone marrow transplants. This review also discusses still unanswered questions surrounding the most appropriate use of ECMO as its role and applications continue to evolve.

With rapidly increasing utilization of ECMO, neonatologists and pediatricians should be aware of the most recent evidence guiding its indications, applications, and limitations.
An update on frailty in lung transplantation
Authors: Varughese Rhea , Rozenberg Dmitry , Singer Lianne G.
Published: April 2020

Purpose of review

Frailty is prevalent in lung transplant candidates, and recent studies have demonstrated associations with increased mortality before and after transplantation. This review highlights important findings on the trajectory of frailty throughout the lung transplant process and provides valuable insight into frailty and some of its modifiable elements.

Recent findings

There have been several frailty indices used in lung transplantation, specifically the Frailty Phenotype, Short Physical Performance Battery (SPPB), and Cumulative Deficits. The two most commonly used measures – Frailty Phenotype and SPPB – reflect physical frailty and have been associated with increased morbidity and mortality pre and post-transplantation. However, there is emerging evidence that physical elements of frailty are reversible with rehabilitation before and after transplantation with improvement in frailty by 6 months after transplantation. The associations of frailty with physical activity levels, exercise capacity, and inflammation are discussed.

Frailty is prevalent before transplant, but physical frailty is modifiable with rehabilitation and transplantation. Thus, physical frailty should not be an absolute contraindication to lung transplantation, but efforts should focus on elements of frailty that are potentially modifiable.
Forgiveness and Health Outcomes in Cancer Survivorship
Authors: Kim Jeongsuk , Hulett Jennifer , Heiney Sue P.
Published: April 2020

Background

Religious and spiritual beliefs including forgiveness are an important aspect of cancer survivorship; however, the relationship between forgiveness and health is not well understood.

Objective

The aim of this study was to conduct a scoping review that examines and maps the current research regarding relationships between forgiveness and health outcomes in individuals with cancer.

Methods

We searched 5 electronic databases using key search terms related to forgiveness and cancer. Using a scoping review framework, we synthesized the existing literature regarding forgiveness and health among individuals with cancer and examined forgiveness as a process for coping with cancer.

Results

We located 277 articles for review; 24 met inclusion criteria. Forgiveness in interpersonal relationships emerged more often as forgiveness coping than other types of forgiveness. Most studies reported a positive association between forgiveness and mental health. Fewer studies were available regarding relationships between forgiveness and physical health, and findings were mixed.

Conclusions

Forgiveness in interpersonal relationships is a spiritual concern for individuals with cancer. Addressing forgiveness needs may promote mental health in cancer survivors. More empirical evidence is needed to understand the role of forgiveness in physical health in individuals with cancer.

Implications for Practice

Acknowledging forgiveness beliefs is a psychosocial-spiritual intervention that nurses can provide to support mental health in individuals with cancer. The potential role of forgiveness in physical health for individuals with cancer requires further study.
Body Image, Sexuality, and Sexual Functioning in Women With Gynecologic Cancer
Authors: Wilson Christina M. , McGuire Deborah B. , Rodgers Beth L. , Elswick R. K. , Temkin Sarah M.
Published: April 2020

Background

Cervical and uterine cancers are common in women. Diagnosis and treatment of these cancers can lead to significant issues with body image, sexuality, and sexual functioning. A comprehensive review can improve understanding of these 3 concepts, in turn enhancing identification and management.

Objectives

To (1) present the qualitative, descriptive, and correlational research literature surrounding body image, sexuality, and sexual functioning in women with uterine and cervical cancer; (2) identify gaps in the literature; and (3) explore the implications of the findings for future research.

Methods

A comprehensive search of the literature was undertaken by searching PubMed, CINAHL, and PsycINFO using predetermined subject headings, keywords, and exploded topics. After a comprehensive evaluation using specific criteria, 121 articles were reviewed.

Results

Qualitative studies provided information about women’s issues with body image, sexuality, and sexual functioning, whereas quantitative studies focused primarily on sexual functioning. The literature lacks correlational studies examining body image and sexuality. Significant issues regarding communication and quality of life were noted, and few studies were based on clear conceptual models.

Conclusion

The state of the science gleaned from this review reveals that while much is known about sexual functioning, little is known about body image and sexuality.

Implications for Practice

Further work is warranted to develop conceptual models and research on body image, sexuality, and sexual functioning as a foundation for interventions to improve quality of life.
3 Dimensions of Treatment Decision Making in Adolescents and Young Adults With Cancer
Authors: Pyke-Grimm Kimberly A. , Franck Linda S. , Halpern-Felsher Bonnie , Goldsby Robert E. , Rehm Roberta S.
Published: April 2020

Background

Adolescents and young adults (AYAs) experience treatment nonadherence rates as high as 60%, which can increase the risk of cancer relapse. Involvement of AYAs in treatment decisions might support adherence to medical treatment.

Objective

The aim of this study was to explore the involvement of AYAs, aged 15 to 20 years, in cancer treatment decision making (TDM).

Methods

Using interpretive focused ethnography, we conducted interviews with 16 AYAs (total of 31 interviews) receiving cancer treatment within 1 year of diagnosis. Participants reflected on a major recent TDM experience (eg, clinical trial, surgery) and other treatment decisions.

Results

Participants distinguished important major cancer treatment decisions from minor supportive care decisions. We identified 3 common dimensions related to AYAs’ involvement in cancer TDM: (1) becoming experienced with cancer, (2) import of the decision, and (3) decision-making roles. The preferences of AYAs for participation in TDM varied over time and by type of decision. We have proposed a 3-dimensional model to illustrate how these dimensions might interact to portray TDM during the first year of cancer treatment for AYAs.

Conclusions

As AYAs accumulate experience in making decisions, their TDM preferences might evolve at different rates depending on whether the decisions are perceived to be minor or major. Parents played a particularly important supportive role in TDM for AYA participants.

Implications for Practice

Clinicians should consider the AYAs’ preferences and the role they want to assume in making different decisions in order to support and encourage involvement in their TDM and care.
Prevalence and Risk Factors of Falls in Adults 1 Year After Total Hip Arthroplasty for Osteoarthritis
Authors: Hunter Susan W. , Bobos Pavlos , Somerville Lyndsay , Howard James , Vasarhelyi Edward M. , Lanting Brent
Published: April 2020

Total hip arthroplasty is very successful in alleviating the pain from osteoarthritis. However, deficits in lower limb strength, gait, and balance after surgery has identified this group at risk of falls. Considering the high number of people annually receiving a total hip arthroplasty, further elaboration of factors associated with falls is needed to refine fall prevention guidelines. The objective was to examine the prevalence and circumstances of falling and the risk factors associated with falling in older adults in the first year after total hip arthroplasty surgery. This was a cross-sectional study involving 108 individuals (age of 72.4 ± 6.5 yrs, 60% females) who had unilateral total hip arthroplasty. The primary outcome was falls and their circumstances during the 12 mos after the total hip arthroplasty. Twenty-five people (23.1%) had at least one fall and most falls (56%) occurred 6–12 mos after surgery. Falls resulted in minor injuries for 44% and 12% reported major injuries. The strongest independent predictor for falls was a history of a previous joint replacement with odds ratio of 7.38 (95% CI = 2.41–22.62, P < 0.001). Overall, the information highlights that falls are common after total hip arthroplasty, yet considering the older age of people having this surgery screening for falls risk should follow established guidelines.
Outcome of Quality of Life for Women Undergoing Autologous versus Alloplastic Breast Reconstruction following Mastectomy: A Systematic Review and Meta-Analysis
Authors: Eltahir Yassir , Krabbe-Timmerman Irene S. , Sadok Nadia , Werker Paul M. N. , de Bock Geertruida H.
Published: April 2020

Background:

This review aimed to meta-analyze the quality of life of alloplastic versus autologous breast reconstruction, when measured with the BREAST-Q.

Methods:

An electronic PubMed and EMBASE search was designed to find articles that compared alloplastic versus autologous breast reconstruction using the BREAST-Q. Studies that failed to present BREAST-Q scores and studies that did not compare alloplastic versus autologous breast reconstruction were excluded. Two authors independently extracted data from the included studies. A standardized data collection form was used. Quality was assessed using the Newcastle-Ottawa Scale. The mean difference and 95 percent confidence intervals between breast reconstruction means were estimated for each BREAST-Q subscale. Forest plots and the I
2 statistic were used to assess heterogeneity and funnel plot publication bias. The Z test was used to assess overall effects.

Results:

Two hundred eighty abstracts were found; 10 articles were included. Autologous breast reconstruction scored significantly higher in the five subscales than alloplastic breast reconstruction. The Satisfaction with Breasts subscale indicated the greatest difference, with a mean difference of 6.41 (95 percent CI, 3.58 to 9.24; I

2
= 70 percent). The Satisfaction with Results subscale displayed a mean difference of 5.52. The Sexual Well-Being subscale displayed a mean difference of 3.85. The Psychosocial Well-Being subscale displayed a mean difference of 2.64. The overall difference in physical well-being was significant, with high heterogeneity (mean difference, 3.33; 95 percent CI, 0.18 to 6.48; I

2
= 85).

Conclusion:

Autologous breast reconstruction had superior outcomes compared with alloplastic breast reconstruction as measured by the BREAST-Q.
Immediate Contralateral Mastopexy/Breast Reduction for Symmetry Can Be Performed Safely in Oncoplastic Breast-Conserving Surgery
Authors: Deigni Olivier A. , Baumann Donald P. , Adamson Karri A. , Garvey Patrick B. , Selber Jesse C. , Caudle Abigail S. , Smith Benjamin D. , Hanson Summer E. , Robb Geoffrey L. , Schaverien Mark V.
Published: April 2020

Background:

Oncoplastic breast-conserving surgery expands the indications for breast conservation. When performed using modified mastopexy/breast reduction techniques, the optimal timing of the contralateral symmetrizing mastopexy/breast reduction remains unclear. This study examined the effect of the timing of symmetrizing mastopexy/breast reduction on oncoplastic breast-conserving surgery outcomes.

Methods:

A retrospective study was conducted of all patients who underwent oncoplastic breast-conserving surgery using mastopexy/breast reduction techniques at a single center from 2010 to 2016. Patients who received synchronous (immediate) contralateral breast symmetrizing mastopexy were compared with those who underwent a delayed symmetrizing mastopexy procedure. Demographic, treatment, and outcome data were collected. Descriptive statistics were used and multivariate analysis was performed to evaluate the various relationships.

Results:

There were 429 patients (713 breasts) included in the study; of these, 284 patients (568 breasts) underwent oncoplastic breast-conserving surgery involving mastopexy/breast reduction techniques and immediate symmetrizing mastopexy, and 145 patients underwent delayed contralateral symmetrizing mastopexy. The overall complication rate was similar between the immediate and delayed groups (25.4 percent versus 26.9 percent, respectively; p = 0.82), as was the major complication rate (10.6 percent versus 6.2 percent; p = 0.16). Complications resulted in a delay in adjuvant therapy in 18 patients (4.2 percent); in two patients (0.7 percent), this delay resulted from a complication in the contralateral symmetrizing mastopexy breast. Immediate contralateral symmetrizing mastopexy was not associated with increased risk of complications per breast (p = 0.82) or delay to adjuvant therapy (p = 0.6).

Conclusion:

Contralateral mastopexy/breast reduction for symmetry can be performed at the time of oncoplastic breast-conserving surgery in carefully selected patients without significantly increasing the risk of complications or delay to adjuvant radiation therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.