bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and Associated Factors of Iron Deficiency and Iron Deficiency Anemia Among Under-5 Children: A Systematic Review and Meta-Analysis
Authors: Gedfie Solomon , Getawa Solomon , Melku Mulugeta
Published: July 2022

Background. Iron deficiency anemia is a common health problem that affects children under the age of five. Children’s cognitive performance is impaired by iron deficiency, which impacts their psychomotor development. Therefore, the aim of this study was to determine the global prevalence and associated factors of iron deficiency and iron deficiency anemia among under-5 children. Methods. Relevant publications published till March 30, 2021 were identified in databases such as Medline/PubMed, Science Direct, Popline, EMBASE, African Journals Online, Scopus, and Google Scholar. The STATA version 11 software was utilized for the analysis. To determine the level of heterogeneity, I2 test statistics were used. To detect publication bias, funnel plots analysis and the Egger weighted regression test were used. Results. The global pooled prevalence of iron deficiency anemia and iron deficiency was 16.42% (95% CI: 10.82, 22.01) and 17.95% (95% CI: 13.49, 22.41), respectively. Age less than 2 years (OR = 1.26; 95% CI: 1.14, 1.38) and living in a large family size (OR = 1.38; 95% CI: 1.18, 1.58) were associated with iron deficiency anemia. Children born from anemic mother, low birth weight, and do not drink iron fortified milk (OR = 1.20; 95% CI: 1.05, 1.36), (OR = 1.15; 95% CI: 1.01, 1.36) and (OR = 1.28; 95% CI: 1.10, 1.46), respectively were associated factors of iron deficiency in under-5 children. Conclusion. The prevalence of iron deficiency anemia and iron deficiency was significant across the globe, particularly in Asia and Africa. Therefore, regular screening and treatment of iron deficiency and iron deficiency anemia are required especially in high-risk children to reduce their complication.

PROSPERO registration number: CRD42021267060
Communication Gaps Between Providers and Caregivers of Patients in a Pediatric Emergency Department
Authors: Dorsey Bridget F. , Kamimura Akiko , Cook Lawrence J. , Kadish Howard A. , Cook Heather K. , Kang Ashley , Nguyen Jacqueline B.T. , Holsti Maija
Published: July 2022

Communication gaps between the healthcare team and caregivers of pediatric patients can result in negative consequences. This study aims to identify specific words and phrases used in a pediatric emergency department (ED) that are unclear or confusing to caregivers. Research assistants at the Primary Children’s Hospital recorded caregivers’ responses to the question, “ What words or phrases have been used during this visit that are unclear or don’t make sense to you?” Across all steps in the care process, 62 of 220 participants (28.2%) reported unclear words and phrases used by the healthcare team. Responses recorded after the discharge step had the highest proportion of communication problems, followed by the initial evaluation and then the update step ( χ2 [2, N = 220] = 6.30, P = .043). Themes among responses included ED logistics, signs/symptoms, the diagnostic process, treatment/procedures, general confusion, and language barriers. These results provide feedback to pediatric emergency medicine providers about potential communication gaps and point to a need for further efforts to train providers in the practice of high-quality communication.
Structured, Timely, and Individualized Patient Feedback to Residents and its Effect on HCAHPS Scores
Authors: Nabeel Muhammad , Prasad Rohan Madhu , Kemnic Tyler , Wang Ling , Khan Nazia Naz S
Published: July 2022

Physician communication is integral for improving patients’ experience and clinical outcomes. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are used by the Centers for Medicare & Medicaid Services to assess the quality of care provided to the patients. We conducted a prospective pre–post-intervention study from March 2018 to March 2020 and included patients and residents of the community-based university-affiliated Internal Medicine Residency Program. Residents’ communication was evaluated through resident surveys and results were shared with them and attending physicians within 48 h. To correlate with the effect over a 4-year period, 839 HCAHPS surveys were obtained for attending physicians as an outcome measure. The mean overall HCAHPS score and doctor's communication scores increased by 8.52 and 6.06 points post-intervention. The doctor's performance score for respect increased by 6.18 points, listening increased by 3.12 points, and explanation increased by 8.23 points. This study demonstrates that timely, structured, and individualized resident feedback in an academic medicine service can result in a sustainable increase in the attendings’ overall HCAHPS and doctor's communication scores.
Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN
Authors: Döhner Hartmut , Wei Andrew H. , Appelbaum Frederick R. , Craddock Charles , DiNardo Courtney D. , Dombret Hervé , Ebert Benjamin L. , Fenaux Pierre , Godley Lucy A. , Hasserjian Robert P. , Larson Richard A. , Levine Ross L. , Miyazaki Yasushi , Niederwieser Dietger , Ossenkoppele Gert , Röllig Christoph , Sierra Jorge , Stein Eytan M. , Tallman Martin S. , Tien Hwei-Fang , Wang Jianxiang , Wierzbowska Agnieszka , Löwenberg Bob
Published: July 2022

The 2010 and 2017 editions of the European LeukemiaNet (ELN) recommendations for diagnosis and management of acute myeloid leukemia (AML) in adults are widely recognized among physicians and investigators. There have been major advances in our understanding of AML, including new knowledge about the molecular pathogenesis of AML, leading to an update of the disease classification, technological progress in genomic diagnostics and assessment of measurable residual disease, and the successful development of new therapeutic agents, such as FLT3, IDH1, IDH2, and BCL2 inhibitors. These advances have prompted this update that includes a revised ELN genetic risk classification, revised response criteria, and treatment recommendations.
Endothelial PHD2 deficiency induces nitrative stressviasuppression of caveolin-1 in pulmonary hypertension
Authors: Liu Bin , Peng Yi , Yi Dan , Machireddy Narsa , Dong Daoyin , Ramirez Karina , Dai Jingbo , Vanderpool Rebecca , Zhu Maggie M. , Dai Zhiyu , Zhao You-Yang
Published: July 2022

Background

Nitrative stress is a characteristic feature of the pathology of human pulmonary arterial hypertension. However, the role of nitrative stress in the pathogenesis of obliterative vascular remodelling and severe pulmonary arterial hypertension remains largely unclear.

Method

Our recently identified novel mouse model (Egln1Tie2Cre, Egln1encoding prolyl hydroxylase 2 (PHD2)) has obliterative vascular remodelling and right heart failure, making it an excellent model to use in this study to examine the role of nitrative stress in obliterative vascular remodelling.

Results

Nitrative stress was markedly elevated whereas endothelial caveolin-1 (Cav1) expression was suppressed in the lungs ofEgln1Tie2Cremice. Treatment with a superoxide dismutase mimetic, manganese (III) tetrakis (1-methyl-4-pyridyl) porphyrin pentachloride or endothelialNos3knockdown using endothelial cell-targeted nanoparticle delivery of CRISPR–Cas9/guide RNA plasmid DNA inhibited obliterative pulmonary vascular remodelling and attenuated severe pulmonary hypertension inEgln1Tie2Cremice. Genetic restoration of Cav1 expression inEgln1Tie2Cremice normalised nitrative stress, reduced pulmonary hypertension and improved right heart function.

Conclusion

These data suggest that suppression of Cav1 expression secondary to PHD2 deficiency augments nitrative stress through endothelial nitric oxide synthase activation, which contributes to obliterative vascular remodelling and severe pulmonary hypertension. Thus, a reactive oxygen/nitrogen species scavenger might have therapeutic potential for the inhibition of obliterative vascular remodelling and severe pulmonary arterial hypertension.
Prediction and Analysis of the Force and Shape Parameters in Variable Gauge Rolling
Authors: Liu Yuanming , Wang Zhenhua , Wang Tao , Sun Jie , Zheng Xianguang , Zhang Dianhua , Huang Qingxue
Published: July 2022

Variable gauge rolling is a new process to obtain a plate for which the thickness changes continuously by continuously and dynamically adjusting the roll gap upward and downward in the rolling process. This technology is an effective method for producing lightweight, low-cost, and economical plates. However, variable gauge rolling is an unsteady process, and the changes in the force and deformation parameters are complex. In this research, based on the minimum energy theory of the variational principle and considering the characteristics of the roll movement and workpiece deformation comprehensively, the internal plastic deformation, friction, shear and tension powers, and the minimum result of the total power functional in upward and downward rolling are obtained with the first integral and then with a variation of adopting the specific plastic power and strain rate vector inner product. The analytical results of the deformation and force parameters are also established using the variational method. Then the precision of this model is certified using the measured values in a medium plate hot rolling plant and the experimental data for Tailor Rolled Blank rolling. Good agreement is found. Additionally, the variation rule of bite angle, neutral angle, and location neutral points are shown, and the change mechanism of the friction parameter on the stress state effect coefficient is given in variable gauge rolling. This research proposes a new mathematical model for rolling process control that provides a scientific basis and technical support for obtaining an accurate section shape in variable gauge rolling production.
Recent Advances in Soft Biological Tissue Manipulating Technologies
Authors: Liu Zhihua , Liao Zhirong , Wang Dong , Wang Chengyong , Song Chengli , Li Haonan , Liu Yao
Published: July 2022

Biological soft tissues manipulation, including conventional (mechanical) and nonconventional (laser, waterjet and ultrasonic) processes, is critically required in most surgical innervations. However, the soft tissues, with their nature of anisotropic and viscoelastic mechanical properties, and high biological and heat sensitivities, are difficult to manipulated. Moreover, the mechanical and thermal induced damage on the surface and surrounding tissue during the surgery can impair the proliferative phase of healing. Thus, understanding the manipulation mechanism and the resulted surface damage is of importance to the community. In recent years, more and more scholars carried out researches on soft biological tissue cutting in order to improve the cutting performance of surgical instruments and reduce the surgery induced tissue damage. However, there is a lack of compressive review that focused on the recent advances in soft biological tissue manipulating technologies. Hence, this review paper attempts to provide an informative literature survey of the state-of-the-art of soft tissue manipulation processes in surgery. This is achieved by exploring and recollecting the different soft tissue manipulation techniques currently used, including mechanical, laser, waterjet and ultrasonic cutting and advanced anastomosis and reconstruction processes, with highlighting their governing removal mechanisms as well as the surface and subsurface damages.
Persistence, use of resources and costs in patients under migraine preventive treatment: the PERSEC study
Authors: Irimia Pablo , García-Azorín David , Núñez Mercedes , Díaz-Cerezo Sílvia , de Polavieja Pepa García , Panni Tommaso , Sicras-Navarro Aram , Sicras-Mainar Antoni , Ciudad Antonio
Published: July 2022

Background

Migraine represents a serious burden for national health systems. However, preventive treatment is not optimally applied to reduce the severity and frequency of headache attacks and the related expenses. Our aim was to assess the persistence to traditional migraine prophylaxis available in Spain and its relationship with the healthcare resource use (HRU) and costs.

Methods

Retrospective observational study with retrospective cohort design of individuals with migraine treated with oral preventive medication for the first time from 01/01/2016 to 30/06/2018. One-year follow-up information was retrieved from the Big-Pac™ database. According to their one-year persistence to oral prophylaxis, two study groups were created and describe regarding HRU and healthcare direct and indirect costs using 95% confidence intervals (CI). The analysis of covariance (ANCOVA) was performed as a sensitivity analysis. Patients were considered persistent if they continued on preventive treatment until the end of the study or switched medications within 60 days or less since the last prescription. Non-persistent were those who permanently discontinued or re-initiated a treatment after 60 days.

Results

Seven thousand eight hundred sixty-six patients started preventive treatment (mean age (SD) 48.2 (14.8) and 80.4% women), of whom 2,545 (32.4%) were persistent for 6 months and 2,390 (30.4%) for 12 months. Most used first-line preventive treatments were antidepressants (3,642; 46.3%) followed by antiepileptics (1,738; 22.1%) and beta-blockers (1,399; 17.8%). The acute treatments prescribed concomitantly with preventives were NSAIDs (4,530; 57.6%), followed by triptans (2,217; 28.2%). First-time preventive treatment prescribers were mostly primary care physicians (6,044; 76.8%) followed by neurologists (1,221; 15.5%). Non-persistent patients required a higher number of primary care visits (mean difference (95%CI): 3.0 (2.6;3.4)) and days of sick leave (2.7 (0.8;4.5)) than the persistent ones. The mean annual expenditure was €622 (415; 829) higher in patients who not persisted on migraine prophylactic treatment.

Conclusions

In this study, we observed a high discontinuation rate for migraine prophylaxis which is related to an increase in HRU and costs for non-persistent patients. These results suggest that the treatment adherence implies not only a clinical benefit but also a reduction in HRU and costs.
Potentiation of endocannabinoids and other lipid amides prevents hyperalgesia and inflammation in a pre-clinical model of migraine
Authors: Greco Rosaria , Demartini Chiara , Zanaboni Anna Maria , Francavilla Miriam , Reggiani Angelo , Realini Natalia , Scarpelli Rita , Piomelli Daniele , Tassorelli Cristina
Published: July 2022

Targeting fatty acid amide hydrolase (FAAH) is a promising therapeutic strategy to combat certain forms of pain, including migraine headache. FAAH inhibitors, such as the O-biphenyl-3-yl carbamate URB597, have been shown to produce anti-hyperalgesic effects in animal models of migraine. The objective of this study was to investigate the behavioral and biochemical effects of compounds ARN14633 and ARN14280, two URB597 analogs with improved solubility and bioavailability, in a migraine-specific rat model in which trigeminal hyperalgesia is induced by nitroglycerin (NTG) administration. ARN14633 (1 mg/kg, i.p.) and ARN14280 (3 mg/kg, i.p.) were administered to adult male Sprague-Dawley rats 3 hours after NTG injection. One hour after the administration of either compound, rats were subjected to the orofacial formalin test. ARN14633 and ARN14280 attenuated NTG-induced nocifensive behavior and reduced transcription of genes encoding neuronal nitric oxide synthase, pain mediators peptides (calcitonin gene-related peptide, substance P) and pro-inflammatory cytokines (tumor necrosis factor-alpha, interleukin-1beta and 6) in the trigeminal ganglion, cervical spinal cord and medulla. Finally, both compounds strongly elevated levels of endocannabinoids and/or other FAAH substrates in cervical spinal cord and medulla, and, to a lesser extent, in the trigeminal ganglia. The results indicate that the novel global FAAH inhibitors ARN14633 and ARN14280 elicit significant anti-hyperalgesic effects in a migraine-specific animal model and inhibit the associated peptidergic-inflammatory response. Although the precise mechanism underlying these effects remains to be elucidated, our results support further investigational studies of FAAH blockade as a potential therapeutic strategy to treat migraine conditions.
Grade follicles transcriptional profiling analysis in different laying stages in chicken
Authors: Sun Tiantian , Xiao Cong , Yang Zhuliang , Deng Jixian , Yang Xiurong
Published: July 2022

During follicular development, a series of key events such as follicular recruitment and selection are crucially governed by strict complex regulation. However, its molecular mechanisms remain obscure. To identify the dominant genes controlling chicken follicular development, the small white follicle (SWF), the small yellow follicle (SYF), and the large yellow follicle (LYF) in different laying stages (W22, W31, W51) were collected for RNA sequencing and bioinformatics analysis. There were 1866, 1211, and 1515 differentially expressed genes (DEGs) between SWF and SYF in W22, W31, and W51, respectively. 4021, 2295, and 2902 DEGs were respectively identified between SYF and LYF in W22, W31, and W51. 5618, 4016, and 4809 DEGs were respectively identified between SWF and LYF in W22, W31, and W51. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis indicated that extracellular matrix, extracellular region, extracellular region part, ECM-receptor interaction, collagen extracellular matrix, and collagen trimer were significantly enriched (P < 0.05). Protein–protein interaction analysis revealed that COL4A2, COL1A2, COL4A1, COL5A2, COL12A1, ELN, ALB, and MMP10 might be key candidate genes for follicular development in chicken. The current study identified dominant genes and pathways contributing to our understanding of chicken follicular development.
The usefulness of dual channel elastomeric pump for intravenous patient-controlled analgesia in geriatrics: a randomized, double-blind, prospective study
Authors: Lee Chung Hun , Cho Soo Ah , Oh Seok Kyeong , Choi Sang Sik , Kong Myoung Hoon , Kim Young Sung
Published: July 2022

Background

Intravenous patient-controlled analgesia (IV-PCA) is often used in the postoperative period. However, determining an appropriate opioid dose is difficult. A previous study suggested the usefulness of variable-rate feedback infusion. In this study, we used a dual-channel elastomeric infusion pump to provide changes in PCA infusion rate by pain feedback.

Methods

Ninety patients undergoing orthopedic surgery of American Society of Anesthesiologists grade I-III and 65 to 79 years of age participated in the study. All patients were given a dual-chamber PCA. Patients were randomly allocated to a treatment group (Group D; PCA drugs divided into both chambers) or control group (Group C; PCA drugs only in the constant flow chamber with normal saline in the adjustable flow chamber). The primary outcome was the amount of fentanyl consumption via PCA bolus. The secondary outcome variables were pain score, total fentanyl consumption, rescue analgesic use, patient satisfaction, recovery scores, and adverse events including postoperative nausea and vomiting (PONV).

Results

Group D showed decreased fentanyl consumption of the PCA bolus, a decrease in rescue analgesic use, and better patient satisfaction compared with group C. The incidence of PONV was much higher in group C. There was no difference in other adverse events.

Conclusions

We showed the usefulness of dual chamber IV-PCA to change the flow rate related to pain feedback without any complications. Our results suggest a noble system that might improve existing IV-PCA equipment.

Trial registration

The study registered at UMIN clinical trial registry (registered date: 05/03/2020, registration number: UMIN000039702).
Validation and derivation of short-term prognostic risk score in acute decompensated heart failure in China
Authors: Zhao Hong-Liang , Gao Xiao-Li , Liu Ying-Hua , Li Sen-Lin , Zhang Qi , Shan Wei-Chao , Zheng Qun , Zhou Jiang , Liu Yong-Zheng , Liu Li , Guo Nan , Tian Hong-Sen , Wei Qing-Min , Hu Xi-Tian , Cui Ying-Kai , Geng Xue , Wang Qian , Cui Wei
Published: July 2022

Background

Few prognostic risk scores (PRSs) have been routinely used in acute decompensated heart failure (ADHF). We, therefore, externally validated three published PRSs (3A3B, AHEAD, and OPTIME-CHF) and derived a new PRS to predict the short-term prognosis in ADHF.

Methods

A total of 4550 patients from the Heb-ADHF registry in China were randomly divided into the derivation and validation cohorts (3:2). Discrimination of each PRS was assessed by the area under the receiver operating characteristic curve (AUROC). Logistic regression was exploited to select the predictors and create the new PRS. The Hosmer–Lemeshow goodness-of-fit test was used to assess the calibration of the new PRS.

Results

The AUROCs of the 3A3B, AHEAD, and OPTIME-CHF score in the derivation cohort were 0.55 (95% CI 0.53–0.57), 0.54 (95% CI 0.53–0.56), and 0.56 (95% CI 0.54–0.57), respectively. After logistic regression analysis, the new PRS computed as 1 × (diastolic blood pressure < 80 mmHg) + 2 × (lymphocyte > 1.11 × 109/L) + 1 × (creatinine > 80 μmol/L) + 2 × (blood urea nitrogen > 21 mg/dL) + 1 × [BNP 500 to < 1500 pg/mL (NT-proBNP 2500 to < 7500 pg/mL)] or 3 × [BNP ≥ 1500 (NT-proBNP ≥ 7500) pg/mL] + 3 × (QRS fraction of electrocardiogram < 55%) + 4 × (ACEI/ARB not used) + 1 × (rhBNP used), with a better AUROC of 0.67 (95% CI 0.64–0.70) and a good calibration (Hosmer–Lemeshow χ2 = 3.366, P = 0.186). The results in validation cohort verified these findings.

Conclusions

The short-term prognostic values of 3A3B, AHEAD, and OPTIME-CHF score in ADHF patients were all poor, while the new PRS exhibited potential predictive ability. We demonstrated the QRS fraction of electrocardiogram as a novel predictor for the short-term outcomes of ADHF for the first time. Our findings might help to recognize high-risk ADHF patients.
Evaluation of the significance of interleukin-6 in the diagnosis of postoperative pneumonia: a prospective study
Authors: Chen Wei , Zhong Kai , Guan Yan , Zhang Hai Tao , Zhang He , Pan Tuo , Pan Jun , Wang Dong Jin
Published: July 2022

Background

Postoperative pneumonia (PP) is one of the most common complications after cardiac surgery. This study was designed to access the diagnostic value of interleukin-6 (IL-6) for pneumonia within the first 5 days after cardiac surgery in adults.

Method

This prospective observational study enrolled 694 patients who admitted to our center from 10 October 2020 to 30 June 2021. Blood samples were collected after admission and on five consecutive days after surgery to measure IL-6, procalcitonin (PCT), C-reactive protein (CRP) and white blood cells (WBC) respectively. Combined with clinical data, we assessed the diagnostic performance of different biomarkers using univariate and multifactorial analyses as well as receiver operating characteristic curves (ROC) and the area under the curve (AUC).

Result

Finally, 68 patients were diagnosed with PP (PP Group). In addition, 626 cases were assigned to the control group (Non-PP Group). From postoperative day 1 (POD1) to day 5, IL-6 and PCT levels showed higher diagnostic value (P < 0.001, P < 0.05, respectively); meanwhile, there was no difference in white blood cell counts between the two groups; CRP showed some value from POD2 onwards (P < 0.001). Among these biomarkers, IL-6 on POD1 [AUC: 0.78, 95% confidence interval (CI): 0.71–0.83], IL-6 on POD2 (AUC: 0.77, 95% CI: 0.71–0.82) and CRP levels on POD3 (AUC: 0.77, 95% CI: 0.70–0.84) had the highest diagnostic value. Multivariate analysis found that smoking status [odds ratio(OR): 7.79, 95% CI: 3.05, 19.88, p < 0.001], drinking status (OR: 22.68, 95% CI: 9.29, 55.37, p < 0.001) and hypertension (OR: 2.85, 95% CI: 1.28, 6.35, p = 0.011), IL-6 on POD2 (OR: 1.01, 95% CI: 1.00, 1.01, p = 0.018), mechanical ventilation time (OR: 1.03, 95% CI: 1.00, 1.05, p = 0.040) and intensive care unit stay time (OR: 1.01, 95% CI: 1.00, 1.02, p < 0.001) were independent risk factors for postoperative pneumonia.

Conclusion

Smoking, drinking, hypertension, prolonged duration of mechanical ventilation and intensive care unit stay, and IL-6 on POD2 were independent risk factors for pneumonia after cardiovascular surgery. IL-6 level on POD2 may serve as a promising indicator, better than WBC, PCT and CRP.
The prognostic value of admission lymphocyte-to-monocyte ratio in critically ill patients with acute myocardial infarction
Authors: Zhao Yuanyuan , Hao Chunshu , Bo Xiangwei , Lu Zhengri , Qian Hao , Chen Lijuan
Published: July 2022

Background

Inflammation plays a critical role in acute myocardial infarction (AMI). Recent studies have shown the value of hematologic indicators in MI risk stratification and prognostic assessment. However, the association between lymphocyte-to-monocyte ratio (LMR) and the long-term mortality of critically ill MI patients remains unclear.

Methods

Clinical data were extracted from the Medical Information Mart for Intensive Care III database. Patients diagnosed with AMI on admission in the intensive care units were include. The optimal cutoff value of LMR was determined by X-tile software. The Cox proportional hazard model was applied for the identification of independent prognostic factors of 1-year mortality and survival curves were estimated using the Kaplan–Meier method. In order to reduce selection bias, a 1:1 propensity score matching (PSM) method was performed.

Results

A total of 1517 AMI patients were included in this study. The cutoff value for 1-year mortality of LMR determined by X-Tile software was 3.00. A total of 534 pairs of patients were matched after PSM. Multivariate analysis (HR = 1.369, 95%CI 1.110–1.687, P = 0.003) and PSM subgroups (HR = 1.299, 95%CI 1.032–1.634, P = 0.026) showed that 1-year mortality was significantly higher in patients with LMR < 3.00 than patients with LMR ≥ 3.00 in Cox proportional hazard models. The survival curves showed that patients with LMR < 3.00 had a significantly lower 1-year survival rate before (63.83 vs. 81.03%, Log rank P < 0.001) and after PSM (68.13 vs. 74.22%, Log rank P = 0.041).

Conclusion

In this retrospective cohort analysis, we demonstrated that a low admission LMR (< 3.00) was associated with a higher risk of 1-year mortality in critically ill patients with AMI.
Evaluation of the effectiveness and costs of inhaled methoxyflurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study
Authors: Smith Murray D. , Rowan Elise , Spaight Robert , Siriwardena Aloysius N.
Published: July 2022

Background

We aimed to investigate clinical benefits and economic costs of inhaled methoxyflurane when used by ambulance staff for prehospital emergency patients with trauma. Comparison is to usual analgesic practice (UAP) in the UK in which patient records were selected if treatment had been with Entonox® or intravenous morphine or intravenous paracetamol.

Methods

Over a 12-month evaluation period, verbal numerical pain scores (VNPS) were gathered from adults with moderate to severe trauma pain attended by ambulance staff trained in administering and supplied with methoxyflurane. Control VNPS were obtained from ambulance database records of UAP in similar patients for the same period. Statistical modelling enabled comparisons of methoxyflurane to UAP, where we employed an Ordered Probit panel regression model for pain, linked by observational rules to VNPS.

Results

Overall, 96 trained paramedics and technicians from the East Midlands Ambulance Service NHS Trust (EMAS) prepared 510 doses of methoxyflurane for administration to a total of 483 patients. Comparison data extracted from the EMAS database of UAP episodes involved: 753 patients using Entonox®, 802 patients using intravenous morphine, and 278 patients using intravenous paracetamol. Modelling results included demonstration of faster pain relief with inhaled methoxyflurane (all p-values < 0.001). Methoxyflurane’s time to achieve maximum pain relief was estimated to be significantly shorter: 26.4 min (95%CI 25.0–27.8) versus Entonox® 44.4 min (95%CI 39.5–49.3); 26.5 min (95%CI 25.0–27.9) versus intravenous morphine 41.8 min (95%CI 38.9–44.7); 26.5 min (95%CI 25.1–28.0) versus intravenous paracetamol 40.8 (95%CI 34.7–46.9). Scenario analyses showed that durations spent in severe pain were significantly less for methoxyflurane. Costing scenarios showed the added benefits of methoxyflurane were achieved at higher cost, eg versus Entonox® the additional cost per treated patient was estimated to be £12.30.

Conclusion

When administered to adults with moderate or severe pain due to trauma inhaled methoxyflurane reduced pain more rapidly and to a greater extent than Entonox® and parenteral analgesics. Inclusion of inhaled methoxyflurane to the suite of prehospital analgesics provides a clinically useful addition, but one that is costlier per treated patient.
A rare case with multiple arterial variations of the liver complicated laparoscopic pancreaticoduodenectomy
Authors: Yan Yong , Wang Bailin , Yuan Wei , Zhang Jiansong , Xiao Junhao , Sha Yanhua
Published: July 2022

Background

Hepatic arterial variations were fully elaborated in anatomical monographs. Here, we aimed to present a rare case with multiple arterial variations of the liver complicated laparoscopic pancreaticoduodenectomy.

Case presentation

We report a 67-year-old woman with a periampullary tumor underwent laparoscopic pancreaticoduodenectomy. Intraoperatively, the aberrant right hepatic artery derived from the gastroduodenal artery (GDA) was observed and had accidentally sacrificed due to untimely ligature of GDA. Three-dimensional reconstruction based on preoperative contrast-enhanced CT performed to better study the anatomy. It demonstrated a replaced right hepatic artery branched from the GDA and supplied right liver lobe. Meanwhile, the middle hepatic artery derived from the common hepatic artery and supplied hepatic segment IV. Additionally, the replaced left hepatic artery emerged from the left gastric artery and fed into left liver lobe.

Conclusions

The origination and course of hepatic arterial anatomy should be thoroughly assessed in planning and performing hepatopancreatobiliary surgeries. Reconstruction images of contrast-enhanced CT are helpful to visualize the vascular variations and its spatial relation with adjacent structures.
Isolated splenic mucormycosis secondary to diabetic ketoacidosis: a case report
Authors: Luo Shuai , Huang Xiang , Li Yao , Wang Jinjing
Published: July 2022

Background

Mucormycosis is a rare but serious opportunistic fungal infection that occurs in immunocompromised individuals, especially those with diabetic ketoacidosis. Presently, early diagnosis of the disease remains a challenge for clinicians.

Case presentation

The patient, a 68-year-old woman with type 2 diabetes mellitus, was admitted with paroxic sharp pain in the left upper abdomen. CT imaging revealed a patchy hypodense shadow of the spleen with wedge-shaped changes. The patient was not considered early for fungal infection. The diagnosis of spleen mucormycosis was not confirmed until pathological biopsy after splenectomy. After surgery, blood glucose level was controlled, acidosis was corrected, and antifungal therapy was effective.

Conclusions

We report here, for the first time ever, a case of isolated splenic mucormycosis secondary to diabetic ketoacidosis that was diagnosed and treated with antifungal drugs and splenectomy. Following splenectomy, the presence of splenic mucormycosis was confirmed when characteristic mycelia were observed in a tissue biopsy. As the location of any fungal infection is extremely relevant for treatment options and prognoses, early diagnosis and clinical intervention can greatly affect outcomes and prognoses for patients.
Cerebral venous sinus thrombosis caused by traumatic brain injury complicating thyroid storm: a case report and discussion
Authors: Gong Shurong , Hong Wenyao , Wu Jiafang , Xu Jinqing , Zhao Jianxiang , Zhang Xiaoguang , Liu Yuqing , Yu Rong-Guo
Published: July 2022

Introduction

Cerebral venous sinus thrombosis (CVST) is an uncommon cerebrovascular disease with diverse predisposing factors. We report a case of CVST caused by a thyroid storm induced by traumatic brain injury.

Case presentation

A 29-year-old male patient with a history of Graves’ disease with hyperthyroidism presented to our hospital with head trauma of cerebral contusion and laceration in both frontal lobes confirmed by admission CT scan. He received mannitol to lower intracranial pressure, haemostatic therapy, and antiepileptic treatment. Eight days later, he presented with signs of thyroid storms, such as tachycardia, hyperthermia, sweating and irritation, and his thyroid function tests revealed high levels of TPO-Ab, TR-Ab, TG-Ab, FT3 and FT4. Then, he entered a deep coma. His brain CT showed a thrombosis of multiple venous sinuses, along with the opening of peripheral collateral vessels, congestive infarction with haemorrhage and brain swelling. He regained consciousness after treatment with antithyroid drugs, anticoagulants, respiratory support and a regimen of sedation/analgesia. After a half-year follow-up, most of the patient’s blocked cerebral venous sinuses had been recanalized, but there were still some sequelae, such as an impaired fine motor performance of the right hand and verbal expression defects.

Conclusions

CVST can be induced by thyroid storms, and trauma-related thyroid storms can develop on the basis of hyperthyroidism. The purpose of this case report is to raise clinicians’ awareness and improve their ability to diagnose CVST early in patients with traumatic brain injury complicating thyroid storms to improve the neurological prognosis among similar patients.
Parenting sense of competence and its predictors among primiparous women: a longitudinal study in China
Authors: Zhu Yi , Zhou Xuan , Yin Xiaoxu , Qiu Lei , Sun Na , An Rongrong , Gong Yanhong
Published: July 2022

Background

Parenting sense of competence significantly affects the quality of parenting behaviours and healthy infant development. However, primiparous women without parenting experience may lack confidence and feel stress. This study aimed to explore the status of parenting sense of competence and identify its predictors among primiparous women.

Methods

A longitudinal study design was used. Primiparous women were recruited by using a convenience sample from two women’s and children’s hospitals in two cities in China. All primiparous women completed questionnaires on demographic characteristics, infant characteristics, family function, and parenting sense of competence at 1 month postpartum. At 3 months postpartum, each women’s parenting sense of competence was re-assessed. Generalised linear regression was applied to identify the predictors of parenting sense of competence at 3 months postpartum.

Results

A total of 743 Chinese primiparous women were included in the analysis. The average parenting sense of competence score of the participants at 3 months postpartum was 70.18 (SD = 12.33). According to the generalised linear regression analysis, higher levels of parenting sense of competence at 3 months postpartum were significantly associated with older age (β = 0.13, P = 0.005), better family function (β = 0.37, P <  0.001), and higher levels of parenting sense of competence (β = 0.35, P <  0.001) at 1 month postpartum. In contrast, lower levels of parenting sense of competence at 3 months postpartum were associated with poorer self-rated economic status (β = − 0.16, P = 0.027), poorer infant health (β = − 0.26, P = 0.007), and mixed or formula feeding (β = − 0.11, P = 0.018) at 1 month postpartum.

Conclusions

Chinese primiparous women have a relatively good parenting sense of competence, but there is still room for improvement. Maternal age, economic status, family function, infant health, and feeding patterns were significant predictors. To improve their parenting sense of competence, more attention should be paid to primiparous women who are young, with poor economic status, having an unhealthy infant, and mixed or formula feeding. In addition, measures should also be taken during the early postpartum period to improve family function.
History of infertility and pregnancy outcomes in Project Viva: a prospective study
Authors: Soria-Contreras Diana C. , Perng Wei , Rifas-Shiman Sheryl L. , Hivert Marie-France , Oken Emily , Chavarro Jorge E.
Published: July 2022

Background

Infertility has been associated with the risk of adverse pregnancy outcomes. It is not clear whether infertility and underlying causes of infertility or the use of medically assisted reproduction (MAR) therapies are responsible for the observed associations. In this study, we aimed to evaluate the association of history of infertility with pregnancy outcomes and identify whether the associations, if present, differed by subgroups defined by the use of MAR.

Methods

Prospective study of 2201 pregnant women from the Boston-area Project Viva cohort. The exposure was history of infertility based on self-reported time to pregnancy ≥12 mo (or ≥ 6 mo if ≥35 y) or use of MAR; a diagnosis of infertility or claims for infertility treatments from medical records. The outcomes included: gestational glucose tolerance (gestational diabetes, impaired glucose tolerance, isolated hyperglycemia vs. normoglycemia), hypertensive disorders (gestational hypertension/preeclampsia vs. normotension), gestational weight gain (inadequate/excessive vs. adequate), systolic (SBP) and diastolic blood pressure, birthweight-for-gestational age z-score (tertile 2 and 3 vs. 1), preterm birth (<37 vs. ≥37 weeks at delivery), and birth outcome (pregnancy loss vs. live birth). We performed linear and logistic/multinomial regression analyses adjusted for age, race/ethnicity, age at menarche, pre-pregnancy BMI, and prenatal smoking.

Results

Mean (SD) age was 32.0 (5.0) years, and 18.8% of women had history of infertility, 32.6% of whom used MAR. SBP across pregnancy was 0.72 mmHg higher in women with vs. without infertility (95% CI 0.02, 1.42). The associations were stronger among women who used MAR (β 1.32 mmHg, 95% CI 0.21, 2.44), especially among those who used gonadotropins or gonadotropin-releasing hormone [GnRH] agonists (β 1.91 mmHg, 95% CI 0.48, 3.35). Other outcomes were not associated with history of infertility.

Conclusions

A history of infertility was associated with higher SBP during pregnancy, with stronger associations among those who used gonadotropins or GnRH agonists. Future studies are needed to confirm these findings and determine their clinical implications.
A cross-sectional study of functional movement quality in school-aged children
Authors: Bagherian Sajad , Ghasempoor Khodayar
Published: July 2022

Background

During the growth period, before and after maturity, considerable biological changes occur. It seems that these changes are related to neuromuscular patterns and have significant differences in the functional movements performed of young boys and girls during the maturation process. The current study aimed to look at the movement quality scores of school-aged girls and boys.

Methods

This Cross-Sectional Study assessed the movement quality of 700 school-aged boys and girls aged 8 to 17, divided into 10 groups of 35 girls and 10 groups of 35 boys. Movement quality was evaluated by the Fusionetics scoring system, which includes 7 tasks: two-leg squat, two-leg squat with heel raise, one-leg squat, push-up, shoulder, trunk, and cervical movements that require a person to complete different movement patterns. The data was analyzed using the Wilcoxon signed-rank and McNemar tests (p <0.05).

Results

This is the first study to our knowledge to examine the movement quality scores in a large school age child with Fusionetics. The overall results showed that the most errors were recorded in all age groups during the double leg squat, double leg squat with heel lift, single leg squat, and push-up and school-age children showed less errors during the shoulder movements, trunk/lumbar spine movements and cervical spine movements. Furthermore, younger girls and boys made more errors than older girls and boys. In relation to gender, this study found that girls scored better on the total Fusionetics score than boys.

Conclusions

The Fusionetics scoring system explains how well school-aged children perform fundamental movements. Under the guidance of coaches and physical educators, students' movement compensation should be assessed and relevant training interventions implemented. Taking steps to address movement compensation could help to avoid injuries and improve school-age children performance.
Effectiveness of emotion focused skills training for parents: study protocol for a randomized controlled trial in specialist mental health care
Authors: Severinsen Linda , Stiegler Jan Reidar , Nissen-Lie Helene Amundsen , Shahar Ben , Zahl-Olsen Rune
Published: July 2022

Background

Emotion-Focused Skills Training (EFST) is a newly developed manualized skill training program for parents to strengthen emotional bonds between parents and children and improve mental health outcomes in children. Results from several preliminary trials indicate that EFST can be quite effective, but more rigorous methods are needed to affirm the evidence of the program. The primary objective of this study is to compare the effectiveness of EFST to treatment as usual (TAU) in a Norwegian outpatient clinic for child and adolescent mental health. Additionally, the study will examine the basic theoretical assumption underlying EFST that increased parental emotional functioning predicts a decline in children’s mental health symptoms. 

Method 

120 patients will be randomly assigned to either EFST or TAU. The main outcome measure is the semi-structured diagnostic interview Schedule for Affective Disorders and Schizophrenia, present and lifetime version (K-SADS-PL) scored by trained assessors administered at pretreatment and repeated after 3 months. The secondary outcome measure is the DSM-IV version of the Strength and Difficulties Questionnaire (SDQ) administered at pretreatment as well as 3, 6, and 12 months after the intervention. To examine the efficacy question, effect sizes and reliable change for each of the treatment arms will be assessed as well as symptom differences between the conditions. To examine the second aim of the study, we will examine (1) how parents relate to emotions in their children assessed by the Emotion-Related Parenting Styles (ERPS), (2) the parents’ emotion regulation capacity assessed by the Difficulties in Emotion Regulation Scale, short-form (DERS-SF), and (3) parents’ sense of self-efficacy and the strength of their relationship with the child will be assessed by the relationship with child scale (RWC) of the systemic inventory of change.

Discussion

This study will provide insights into the effectiveness of EFST in improving children’s mental health and the mechanisms of change responsible for the program’s effectiveness. Impotently, this study may provide information regarding whether children’s mental health issues can be alleviated through therapeutic work provided to the parents alone.

Trial registration

Clinical trials.gov Identifier: NCT04885036. First Posted on May 13, 2021. Trial status: In recruitment.
Stepped care to optimize pre-exposure prophylaxis (PrEP) effectiveness in pregnant and postpartum women (SCOPE-PP) in South Africa: a randomized control trial
Authors: Joseph Davey Dvora Leah , Dovel Kathryn , Cleary Susan , Khadka Nehaa , Mashele Nyiko , Silliman Miriam , Mvududu Rufaro , Nyemba Dorothy C. , Coates Thomas J. , Myer Landon
Published: July 2022

Background

HIV incidence among pregnant and postpartum women remains high in South Africa. Pre-exposure prophylaxis (PrEP) use remains suboptimal in this population, particularly during the postpartum period when women’s engagement with routine clinic visits outside PrEP decreases. Key barriers to sustained PrEP use include the need for ongoing contact with the health facility and suboptimal counseling around effective PrEP use.

Methods

Stepped Care to Optimize PrEP Effectiveness in Pregnant and Postpartum women (SCOPE-PP), is a two-stepped unblinded, individually randomized controlled trial (RCT) that aims to optimize peripartum and postpartum PrEP use by providing a stepped package of evidence-based interventions. We will enroll 650 pregnant women (> 25 weeks pregnant) who access PrEP at a busy antenatal clinic in Cape Town at the time of recruitment and follow them for 15 months. We will enroll and individually randomize pregnant women > 16 years who are not living with HIV who are either on PrEP or interested in starting PrEP during pregnancy. In step 1, we will evaluate the impact of enhanced adherence counselling and biofeedback (using urine tenofovir tests for biofeedback) and rapid PrEP collection (to reduce time required) on PrEP use in early peripartum compared to standard of care (SOC) (n = 325 per arm). The primary outcome is PrEP persistence per urine tenofovir levels and dried blood spots of tenofovir diphosphate (TFV-DP) after 6-months. The second step will enroll and individually randomize participants from Step 1 who discontinue taking PrEP or have poor persistence in Step 1 but want to continue PrEP. Step 2 will test the impact of enhanced counseling and biofeedback plus rapid PrEP collection compared to community PrEP delivery with HIV self-testing on PrEP use (n = up to 325 postpartum women). The primary outcome is PrEP continuation and persistence 6-months following second randomization (~ 9-months postpartum). Finally, we will estimate the cost effectiveness of SCOPE-PP vs. SOC per primary outcomes and disability-adjusted life-years (DALYs) averted in both Step 1 and 2 using micro-costing with trial- and model-based economic evaluation.

Discussion

This study will provide novel insights into optimal strategies for delivering PrEP to peripartum and postpartum women in this high-incidence setting.

Trial registration

NCT05322629: Date of registration: April 12, 2022.
Past, present, and future trends of overweight and obesity in Belgium using Bayesian age-period-cohort models
Authors: De Pauw Robby , Claessens Manu , Gorasso Vanessa , Drieskens Sabine , Faes Christel , Devleesschauwer Brecht
Published: July 2022

Background

Overweight and obesity are one of the most significant risk factors of the twenty-first century related to an increased risk in the occurrence of non-communicable diseases and associated increased healthcare costs. To estimate the future impact of overweight, the current study aimed to project the prevalence of overweight and obesity to the year 2030 in Belgium using a Bayesian age-period-cohort (APC) model, supporting policy planning.

Methods

Height and weight of 58,369 adults aged 18+ years, collected in six consecutive cross-sectional health interview surveys between 1997 and 2018, were evaluated. Criteria used for overweight and obesity were defined as body mass index (BMI) ≥ 25, and BMI ≥ 30. Past trends and projections were estimated with a Bayesian hierarchical APC model.

Results

The prevalence of overweight and obesity has increased between 1997 and 2018 in both men and women, whereby the highest prevalence was observed in the middle-aged group. It is likely that a further increase in the prevalence of obesity will be seen by 2030 with a probability of 84.1% for an increase in cases among men and 56.0% for an increase in cases among women. For overweight, it is likely to see an increase in cases in women (57.4%), while a steady state in cases among men is likely. A prevalence of 52.3% [21.2%; 83.2%] for overweight, and 27.6% [9.9%; 57.4%] for obesity will likely be achieved in 2030 among men. Among women, a prevalence of 49,1% [7,3%; 90,9%] for overweight, and 17,2% [2,5%; 61,8%] for obesity is most likely.

Conclusions

Our projections show that the WHO target to halt obesity by 2025 will most likely not be achieved. There is an urgent necessity for policy makers to implement effective prevent policies and other strategies in people who are at risk for developing overweight and/or obesity.