bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic effects and optimal dosage of strength training on SBP and DBP: a systematic review with meta-analysis
Authors: Oliver-Martínez Pedro A. , Ramos-Campo Domingo J. , Martínez-Aranda Luis M. , Martínez-Rodríguez Alejandro , Rubio-Arias Jacobo Á.
Published: May 2020

Background and objectives:

Hypertension is a disease affecting a large part of the world's population that causes millions of deaths annually. Physical exercise is proposed as an alternative to pharmacologic therapies used to reduce blood pressure. The main objective was to compare the effect of different types of strength training in blood pressure, as well as to analyse several variables that can modify the effect of strength training not combined with medication in SBP and DBP (SBP-DBP).

Methods:

The search was carried out in two scientific databases: PubMed and Web of Science. Articles were included following three criteria: analysing the chronic effect of strength training in blood pressure; the studies were conducted at least during 4 weeks; and the articles were published in English.

Results:

The analysis showed a significant decrease of blood pressure for all types of training. The effect on SBP was greater when training without medication was carried out with isometric exercises than when training was performed with dynamic exercises. Moreover, the effects were no longer significant when the duration of the training programme exceeded 20 weeks as well as when training frequency was lower than three times per week were found.

Conclusion:

Strength training is effective in reducing both blood pressures (SBP-DBP). Training programmes, consisting of dynamic strength training without medication at a moderate intensity and with a frequency of three times per week, seem to be optimal in order to reduce blood pressure.

Prospective register of Systematic Reviews: CRD42019122421
Severe Marginal Ulcerative Keratitis Induced by an Insect Foreign Body in the Cornea
Authors: Wang Minshu , Wang Haikun , Xiao Gege , Lin Jinyong , Wang Wei , Li Yingyu , Hong Jing
Published: May 2020

Purpose:

To report an uncommon case in which an insect foreign body (FB) in the cornea induced severe marginal ulcerative keratitis.

Methods:

The insect body was removed during an eye examination. A shaped deep lamellar keratoplasty was then performed on the ulcerous corneal tissue and pseudopterygium. The insect FB was identified as a member of the nontoxic Diptera insect order, belonging to either the Chloropidae or Sphaeroceridae family.

Results:

The patient recovered well after the keratoplasty, and her corneal graft was clear with significantly improved visual acuity after 2 months.

Conclusions:

Long-time retention of a nontoxic insect FB in the cornea could induce severe noninfectious keratitis. Individually designed deep lamellar keratoplasty successfully restored the transparency of the cornea and visual function.
A Predictive Risk Model for Infection-Related Hospitalization Among Home Healthcare Patients
Authors: Shang Jingjing , Russell David , Dowding Dawn , McDonald Margaret V. , Murtaugh Christopher , Liu Jianfang , Larson Elaine L. , Sridharan Sridevi , Brickner Carlin
Published: May 2020

Infection prevention is a high priority for home healthcare (HHC), but tools are lacking to identify patients at highest risk of developing infections. The purpose of this study was to develop and test a predictive risk model to identify HHC patients at risk of an infection-related hospitalization or emergency department visit. A nonexperimental study using secondary data was conducted. The Outcome and Assessment Information Set linked with relevant clinical data from 112,788 HHC admissions in 2014 was used for model development (70% of data) and testing (30%). A total of 1,908 patients (1.69%) were hospitalized or received emergency care associated with infection. Stepwise logistic regression models discriminated between individuals with and without infections. Our final model, when classified by highest risk of infection, identified a high portion of those who were hospitalized or received emergent care for an infection while also correctly categorizing 90.5% of patients without infection. The risk model can be used by clinicians to inform care planning. This is the first study to develop a tool for predicting infection risk that can be used to inform how to direct additional infection control intervention resources on high-risk patients, potentially reducing infection-related hospitalizations, emergency department visits, and costs.
An overview of pancreatic trauma
Authors: Agarwal Harshit , Gupta Amit , Kumar Subodh
Published: May 2020

Pancreatic trauma remains a challenge to a trauma surgeon even with extensive advancement in medicine. The mortality and morbidity associated with this injury remain high. A high index of suspicion, mechanism of injury, and early identification hold key in the final outcome. The management of pancreatic injury should involve a multidisciplinary team comprising of trauma surgeons, radiologists, and gastroenterologists. This review highlights the burden of the pancreatic injury and its management.
Electrolyte Analysis and Replacement: Challenging a Paradigm in Surgical Patients
Authors: Dammann Kyle , Timmons Mary , Edelman Mitchell , Pierce Catherine A. , Higdon Emily , Bernard Andrew C.
Published: May 2020

Postoperative patients are susceptible to alterations in electrolyte homeostasis. Although electrolytes are replaced in critically ill patients, stable asymptomatic non-intensive care unit (ICU) patients often receive treatment of abnormal electrolytes. We hypothesize there is no proven benefit in asymptomatic patients. In 2016, using the electronic medical records and pharmacy database at a university academic medical center, we conducted a retrospective cost analysis of the frequency and cost of electrolyte analysis (basic metabolic panel [BMP], ionized calcium [Ca], magnesium [Mg], and phosphorus [P]) and replacement (potassium chloride [KCl], Mg, oral/iv Ca, oral/iv P) in perioperative patients. Patients without an oral diet order, with creatinine more than 1.4, age less than 16 years, admitted to the ICU, or with length of stay of more than 1 week were excluded. Nursing costs were calculated as a fraction of hourly wages per laboratory order or electrolyte replacement. One hundred thirteen patients met our criteria over 11 months. Mean length of stay was 4 days; mean age was 54 years; and creatinine was 0.67 ± 0.3. Electrolyte analysis laboratory orders (n = 1,045) totaled $6,978, and BMP was most frequently ordered accounting for 36% of laboratory costs. In total, 683 doses of electrolytes cost the pharmacy $1,780. Magnesium was most frequently replaced, followed by KCl, P, and Ca. Nursing cost associated with electrolyte analysis/replacement was $7,782. There is little evidence to support electrolyte analysis and replacement in stable asymptomatic noncritically ill patients, but their prevalence and cost ($146/case) in this study were substantial. Basic metabolic panels, pharmacy charges for potassium, and nursing staff costs accounted for the most significant portion of the total cost. Considering these data, further research should determine whether these practices are warranted.
A Randomized Clinical Trial on the Use of Antiseptic Solutions for the Pin-Site Care of External Fixators: Chlorhexidine–Alcohol Versus Povidone–Iodine
Authors: Sáenz-Jalón María , Sarabia-Cobo Carmen M. , Roscales Bartolome Elena , Santiago Fernández Marta , Vélez Begoña , Escudero Mónica , Miguel M. Eugenia , Artabe Patricia , Cabañas Israel , Fernández Antonio , Garcés Carlos , Couceiro Jose
Published: May 2020

Pin-site infections remain a common clinical complication in patients with external fixators. Pin-site care is commonly performed with either chlorhexidine–alcohol solution or povidone–iodine solution. This study aimed to investigate the superiority of chlorhexidine–alcohol solution versus povidone–iodine solution for external fixator pin-site care in pin-site infection. This prospective randomized clinical trial using an open, parallel-group design was conducted in a single Spanish hospital. Eligible consenting patients from November 2018 to May 2019 who underwent placement of an external fixator were included. Patients were randomly assigned to receive pin-site care using either a 2% chlorhexidine–alcohol solution or a 10% povidone–iodine solution. The primary endpoint was the development of a pin-site infection. In total, 568 pins were analyzed (128 patients, with a mean of 4.3 pins per patient). No significant differences were found between groups. However, statistically significant differences were found regarding time and infection variables. The longer the person had the fixator, the higher the risk of infection, t(x) = 5.49, p = .002. Both chlorhexidine–alcohol and povidone–iodine solutions are equally effective antiseptic agents for the prevention of infections in external fixators.
Trauma Data Quality Improvement: One Center's Experience With Telecommuting and Paperless Data Management
Authors: Seegert Sara , Chapman Bethany , Bork Kelly , Runkle Kimberly , Eickhoff Chandra
Published: May 2020

The American College of Surgeons requires that trauma centers collect and enter data into the National Trauma Data Registry in compliance with the National Trauma Data Standard. ProMedica supports employment of 4 trauma data analysts who are responsible for entering information in a timely manner, validating the data, and analyzing data to evaluate established benchmarks and support the performance improvement and patient safety process. Historically, these analysts were located on-site at ProMedica Toledo Hospital. In 2017, a proposal was developed including modifications to data collection to streamline processes, move toward paperless documentation, and allow for the analysts to telecommute. To measure the effect of these changes, the timeliness of data entry, rate of data validation, productivity, and staff satisfaction were measured. After the transition to electronic data management and home-based workstations, registry data were being entered within 30 days and 100% of cases were being validated, without sacrificing effective and efficient communication between in-hospital and home-based staff. The institution also benefitted from reduced expense for physical space, employee turnover, and decreased employee absenteeism. The analysts appreciated benefits related to time, travel, environment, and job satisfaction.

It is feasible to transition trauma data analysts to a work-from-home situation. An all-electronic system of data management and communication makes such an arrangement possible and sustainable. This quality improvement project solved a workspace issue and was beneficial to the trauma program overall, with the timeliness and validation of data entry vastly improved.
Physiological fluorodeoxyglucose uptake of spinal cord in adults
Authors: Guner Levent A. , Unal Kemal , Vardareli Erkan , Kaya Eser , Temiz Hakan , Dayioglu Tugba
Published: May 2020

Objective

Physiological fluorodeoxyglucose (FDG) uptake of spinal cord needs to be correctly recognized during evaluation of whole-body PET scans, especially for oncological cases. Our aim was to analyze physiological cord FDG uptake and its relation to gender, age, body weight, environmental temperature and time to imaging.

Materials and methods

PET scans of 254 patients in a single year, one patient for every working day were retrospectively selected. Temperature data were obtained from meteorology recordings. Maximum standard uptake value (SUVmax) of spinal cord at cervical and lower thoracic levels were noted. Spinal canal at L5 level, cerebellum and liver were used for normalization. Correlations with age, body weight, time to imaging and environmental temperature were analyzed.

Results

Cervical SUV was higher than thoracic SUV (2.5–2.3). Cervical and lower thoracic SUV’s were strongly correlated, highest when corrected with L5 level vertebral canal and liver (corr coeff 0.84 and 0.75) and lowest with cerebellum (corr coeff 0.4). Cervical spinal cord FDG uptake was higher for females than males (2.6 to 2.4). Temperature and age did not change spinal cord uptake. There were weak positive correlations with body weight (corr coeff 0.16 and 0.28, cervical and thoracic). There was weak negative correlation of cervical uptake with time to imaging (corr coeff −0.17).

Conclusion

Spinal cord FDG uptake at cervical and lower thoracic levels are strongly correlated. Females have slightly higher cervical SUV. Age and temperature does not change spinal cord FDG uptake in adults. Cord SUV’s slightly increased with body weight.
Timing of peptide receptor radiotargeted therapy in relation to cardiac valve surgery for carcinoid heart disease in patients with neuroendocrine metastases and cardiac syndrome. A single-centre study from a centre of excellence
Authors: Davis Laura May , Nicou N , Martin Wendy , Corcoran Ben , Mulholland Nicola , Srirajaskanthan R , Ramage J , Wendler O , Vivian G
Published: May 2020

Introduction

Perioperative mortality of patients who undergo heart valve surgery for carcinoid heart valve disease has been observed to be high (5%–10%). We investigated whether peptide receptor radiotherapy with lutetium-177 dotatate can be used safely in patients with neuroendocrine neoplasm carcinoid heart valve disease and if there is associated survival advantage by reducing overall exposure of the valves to high doses of vasoactive peptides.

Method

Retrospective case notes review was performed on 18 neuroendocrine neoplasm patients (mean 60 years), who underwent heart valve surgery between 2003 and 2017 for carcinoid heart valve disease, 9 of whom received peptide receptor radiotherapy in addition to surgery.

Results

All patients were treated with somatostatin receptor antagonists and underwent cardiac valvular surgery (mean two valves replaced) and three benefitted from additional coronary bypass grafting. Nine patients underwent surgery alone: in this group, the time from surgery to progression was 14 months (mean; SD 13.5 months). Nine were treated with peptide receptor radiotherapy in addition to surgery. Six underwent surgery with peptide receptor radiotherapy on progression. Time to progression from surgery to first peptide receptor radiotherapy was mean 25.1 months (SD 23.6 months). No patients developed peritreatment cardiac complications. There were no deaths within the 30-day postoperative period. Average time from surgery to last follow-up/death was 41 months (6–79) in the surgery + lutetium group and in the surgery only group 17 months (1–24). Nine patients died, five in the surgery + lutetium group and four in the surgery only group, all at greater than 1-year postsurgery.

Discussion

Peptide receptor radiotherapy is safe in the setting of Carcinoid valvular heart disease in patients with controlled heart failure, PPRT can be use in the pre- and post-valve surgery period. There appears to be a survival benefit of having peptide receptor radiotherapy. Further evidence for peptide receptor radiotherapy in the neoadjuvant setting prior to cardiothoracic surgery is required.
Tuberculosis in children: screening, diagnosis and management
Authors: Howard-Jones Annaleise R. , Marais Ben J.
Published: May 2020

Purpose of review

The present review focuses on recent advances and current challenges in screening, diagnosis and management of tuberculosis (TB) in children, encompassing TB infection and TB disease, and public health priorities for screening and family engagement.

Recent findings

Although awareness has improved in recent years that children in TB endemic areas suffer a huge disease burden, translation into better prevention and care remains challenging. Recent WHO guidelines have incorporated screening of all household contacts of pulmonary TB cases, but implementation in high incidence settings remains limited. Improved tests using noninvasive samples, such as the lateral flow urinary lipoarabinomannan assay and the new Xpert Ultra assay applied to induced sputum or stool in young children, are showing promise and further assessment is eagerly awaited. From a treatment perspective, child-friendly dispersible fixed dose combination tablets are now widely available with excellent acceptability and tolerance reported in young children.

High-level government commitment to TB control as a public health priority and feasible strategies to achieve this are required to contain the global epidemic, whereas strong engagement of local TB clinics and affected families in TB prevention is essential to limit secondary cases and protect exposed children.
Pediatric burn care: new techniques and outcomes
Authors: Partain Kristin P. , Fabia Renata , Thakkar Rajan K.
Published: May 2020

Purpose of review

Thermal injury is a leading cause of morbidity and mortality in children. This review highlights the current management of thermal injury and its complications.

Recent findings

Many recent advances in burn care have improved the outcomes of patients with thermal injury; however, variability does exist, and there are many opportunities for improvement. This review will highlight the complexity of issues encountered along the continuum of care for thermal injury patients. Accurate estimation of total burn surface area (TBSA) of a burn continues to be a challenge in pediatric patients. Variability continues to exist surrounding the management of burn resuscitation and complex wounds. Children with extensive burns have profound immune and metabolic changes that can lead to multiple complications, including infections, growth arrest, and loss of lean body mass. Standardization in measurements related to quality of life and psychological stress following pediatric thermal injury is much needed.

The care of pediatric patients with thermal injury is complex and multifaceted. This review highlights the most recent advances in pediatric burn care.
Prerehabilitation alanine aminotransferase blood levels and one-year mortality rates in older adults following hip fracture
Authors: Kashkosh Rasekh , Gringauz Irina , Weissmann Jonathan , Segal Gad , Swartzon Michael , Adunsky Abraham , Justo Dan
Published: May 2020

Low alanine aminotransferase (ALT) blood levels prior to rehabilitation are associated with poor function in older adults following hip fracture. We hypothesized that low ALT blood levels prior to rehabilitation were also associated with one-year mortality in this population. Included were 456 older adults (age ≥ 60 years, 82.5% women) admitted for rehabilitation following hip fracture. ALT blood levels were documented between one and six months prior to rehabilitation. Excluded were patients with ALT blood levels over 40 IU/L possibly consistent with liver injury. The main outcome was all-cause mortality one year following rehabilitation admission. The study group included 142 (31.1%) patients with low (≤10 IU/L) ALT blood levels and the control group included 314 (68.9%) patients with high-normal (11–40 IU/L) ALT blood levels. Overall, 52 (11.4%) patients died within one year following rehabilitation admission. Compared with the control group, patients with low ALT blood levels had significantly higher 1-year mortality rates [17.6 vs. 8.6%, odds ratio 2.27, 95% confidence interval (CI) 1.27–4.08]. Cox regression analysis showed that low ALT blood levels prior to rehabilitation were associated with one-year mortality (hazard ratio 1.88, 95% CI 1.08–3.28) together with age (hazard ratio 1.06, 95% CI 1.02–1.11), independent of gender. However, this association was no longer significant following adjustment also for peripheral vascular disease, admission and discharge functional independence measure scores, albumin serum levels, and length of rehabilitation. In conclusion, low ALT blood levels prior to rehabilitation are associated with one-year mortality in older adults following hip fracture. They may be used when only age and gender are known.
A Retrospective Analysis of Factors Impacting Rehabilitation Outcomes in Patients With Spontaneous Intracerebral Hemorrhage
Authors: Zhao Shengjie , Zhang Tong , Zhao Jun , Li Bingjie , Wu Zhangwei
Published: May 2020

Objective

This study aimed to identify the factors associated with motor and activities of daily living recovery after 4-wk rehabilitation in patients with intracerebral hemorrhage.

Design

Eight hundred ten eligible patients were enrolled and engaged in 4-wk rehabilitation. Fugl-Meyer score and Modified Barthel Index were used to measure the motor and activities of daily living function. Multivariate linear regressions were used to investigate the effect of the 23 preexisting conditions in intracerebral hemorrhage patients (eg, scales of functional abilities, spasticity, cognition, and mental disorders) on efficacy outcomes after 4-wk rehabilitation.

Results

The results indicated the following: (1) young age, absence of diabetes mellitus, right hemiplegia, early rehabilitation, elbow spasticity, and higher cognitive and motor function were significantly associated with better prognosis after 4-wk rehabilitation; (2) patients who started rehabilitation within 120 days of stroke onset had significantly better outcomes; (3) activities of daily living function could be further improved for those patients wherein the time since stroke onset was more than 121 days; and (4) improving cognitive function may improve functional ability after rehabilitation in patients with intracerebral hemorrhage.

Conclusions

The results could enable clinicians to predict the intracerebral hemorrhage rehabilitation outcome and achieve the maximum favorable outcome to facilitate personal independence.
Metabolic Evolution of Brain Metastasis After Stereotactic Radiosurgery
Authors: Cicone Francesco , Carideo Luciano , Villani Veronica , Scaringi Claudia , Bozzao Alessandro , Scopinaro Francesco , Minniti Giuseppe
Published: May 2020

The differentiation between radiation-induced changes and tumor recurrence is a major pitfall of magnetic resonance imaging, which can be overcome by the use of PET. Although amino-acid PET tracers showed several advantages over18F-fluorodeoxyglucose in neurooncology, studies comparing these 2 types of radiopharmaceuticals in previously irradiated brain metastases are lacking. Here, we demonstrated a mismatch between 3,4-dihydroxy-6-[18F]-fluoro-l-phenylalanine (F-DOPA) and FDG in the first report of a previously irradiated brain metastasis undergoing a longitudinal evaluation by sequential double tracer PET imaging.
Surgical Treatment of Aggressive Intraosseous Cavernous Hemangioma in Maxilla Through Surgical Resection
Authors: Ribeiro Igor Lerner Hora , Vasconcelos Mariana de Lyra , Panjwani Camila Maria Beder Ribeiro Girish , Silva Hugo Leonardo Madeiro Arcanjo , da Hora Sales Pedro Henrique , Andrade Clarisse Samara de
Published: May 2020

Hemangiomas are benign vascular lesions characterized by endothelial vascular proliferation and may demonstrate aggressive clinical features. Intraosseous hemangiomas are uncommon and the maxillary location rare, with few cases described in the literature. The treatment of these lesions varies, however they have a better prognosis when a surgical treatment through resection is performed. The aim of this study is to report a case of right maxillary cavernous intraosseous hemangioma treated by surgical resection with previous embolization. The diagnosis was made through incisional biopsy and immunohistochemical examination. An aggressive lesion profile was observed through the Ki67 marker. During surgery, a temporary ipsilateral external carotid artery ligation was performed to minimize possible bleeding. Weber-Fergson surgical access was performed and total surgical resection through hemi-maxillectomy. The patient is stable after 30 months of follow-up without relapses. In suspected cases of intraosseous hemangiomas, accurate diagnosis and total surgical resection of the lesion is essential. The use of therapeutic mammoths that minimize sagging during and after the procedure such as embolization and arteriography should always be performed.
An Otalgia Cause: Temporomandibular Joint Herniation From Foramen of Huschke to External Auditory Canal
Authors: Kinar Abdullah , Bucak Abdulkadir , Ulu Şahin
Published: May 2020

Objectives:

The authors presented a rare case of temporomandibular joint hernation into the external auditory canal. The authors discuss 1 cause of otalgia.

Case Report:

A 52 year old male patient complained about his left ear otalgia for 3 months. Patient said that it had occurred after a painful mastication. On physical examination he had a rounded expanded mass in left ear external auditory canal that is located at the anterior-inferior wall of EAC When patient open his mouth the mass turn back to original position and mass was disappeared. Magnetic resonance imaging of the temporomandibular joint was revealed.

Conclusion:

Foramen of Huschke a bony defect in tympanic plate that may cause the spontaneous herniation of temporomandibular joint to external auditory canal. This herniation cause otalgia commonly. Opening and closing the mouth and palpation of temporomandibuler joint should be a part of physical examination when finding out non-otological causes of otalgia.
Effects of Multiple Factors on Treatment Outcome in the Three-Dimensional Maxillary Arch Morphometry of Children With Unilateral Cleft Lip and Palate
Authors: Haque Sanjida , Khamis Mohd Fadhli , Alam Mohammad Khursheed , Ahmad Wan Muhamad Amir Wan
Published: May 2020

Studies have claimed that the maxillary arch dimension of unilateral cleft lip and palate (UCLP) patient is significantly smaller than normal patient. Multiple factors (both congenital and post natal treatment factors) are believed to have an impact on the treatment outcome (maxillary arch retardation) of UCLP patient. The aim of this study was to evaluate the effects of multiple factors on the treatment outcome by assessing the maxillary arch dimension of UCLP Children. Eighty-five Malaysian UCLP children were taken who received cheiloplasty and palatoplasty. Laser scanned 3D digital models of UCLP subjects were prepared before any orthodontic treatment and bone grafting at 7.69 ± 2.46 (mean± SD) years of age. Intercanine width (ICW), intermolar width (IMW), and arch depth (AD) measurements of maxillary arch were measured with Mimics software. Multiple linear regression analyses were used to evaluate the association between multiple factors (gender, UCLP type, UCLP side, family history of cleft, family history of class III malocclusion, techniques of cheiloplasty, and techniques of palatoplasty) and maxillary arch dimensions (ICW, IMW, and AD).Pvalue was set at 5%. Significant association was found between 2 techniques of cheiloplasty and ICW (P = 0.001) and also between 2 techniques of palatoplasty and ICW (P = 0.046) of maxilla. No significant association observed in IMW and AD in relation to all other factors. Modified Millard techniques of Cheiloplasty and Bardach technique of palatoplasty had unfavorable effect on the treatment outcome by assessing the maxillary arch dimension (ICW) using laser scanned 3D digital models in Malaysian UCLP children.
Transient Velopharyngeal Insufficiency After Calcified Stylohyoid Ligament Resection
Authors: Çam Osman Halit , Koçdor Pelin , Özlüoğlu Levent N.
Published: May 2020

Elongation of the stylohyoid process or calcification of the stylohyoid ligament is known as the Eagle syndrome. Mostly, it is seen incidentally on imaging or with extreme suspicion and usually patients are asymptomatic.

Surgery is the preferred method in symptomatic patients. Transcervical or transoral methods may be preferred as surgical route.

A 28-year-old female patient who had formerly underwent tonsillectomy presented with throat and ear pain. A neck computed tomography was performed, and the patient was diagnosed as Eagle Syndrome. Surgery was recommended.

Patient developed transient velopharyngeal insufficiency on postoperative day 4. Ventilation exercise and follow-up was recommended. Complaints of the patient decreased on the 15th day.

It should be kept in mind that stylohyoid ligament may be calcified in young age group and middle age group patients with dysphagia or odynophagia, and differential diagnosis should be performed. Another issue is the condition of velofaringeal insufficiency which may occur due to the damage of the pharynx muscles by deep dissection during surgery.
Study on the Effect of Lidocaine in the Cuff for Endotracheal Tube in Vitro and in Vivo
Authors: Zhan Biming , Song Zhiping , Chen Shibiao , Min Jia , Zhang Yang
Published: May 2020

Objective:

The purpose of this research was to investigate the effectiveness on postoperative pharyngalgia of filling the endotracheal catheter (ETC) cuffs with air, double distilled water, 2% lidocaine hydrochloride, and 1.73% lidocaine carbonate.

Methods:

A group of 80 female patients were divided into 4 groups randomly. The ETC cuffs were filled with air (Group A), double distilled water (Group B), 2% lidocaine hydrochloride (Group C), and 1.73% lidocaine carbonate (Group D) after endotracheal intubation in corresponding patients. Sore throat, hoarseness, bucking, perioperative hemodynamic changes were examined in all participants.

Results:

The Group D had significantly less severity of POST (P < 0.05), postoperative hoarseness (P < 0.05) and bucking on emergence from general anesthesia (P < 0.01) than patients from other groups. The Group D reported significantly less hemodynamic changes after extubation 1, 5, 10 minutes (P < 0.05).

Conclusion:

Lidocaine carbonate injected into the ETC cuffs decreased the severity of postoperative pharyngalgia, postoperative hoarseness and bucking on emergence from general anesthesia.
A Rare Cause of Headache That Should Be Kept in Mind: Isolated Concha Bullosa Fungus Ball
Authors: Gündüz Emrah , Çiçek Mehmet Turan , Bozoğlu Mehmet , Tan Mehmet , Bayindir Tuba
Published: May 2020

Concha bullosa is characterized by pneumotization of the middle turbinate and is a common variation of sinonasal anatomy and is often asymptomatic. The presence of a fungus ball in concha bullosa and the associated clinic symptoms are very rare. Concha bullosa fungus balls are a rare differential diagnosis in a patient presenting to the otorhinolaryngology outpatient clinic with headache.

In this article, the authors aimed to present an isolated fungus ball case in concha bullosa as a rare cause of headache differential diagnosis.
Endoscopically Assisted Open Reduction and Internal Fixation of Sub-Condylar Fractures: Debunking Some of the Myths
Authors: Frenkel Boaz , Abu Shqara Fadi , Berg Tal , Rachmiel Adi
Published: May 2020

Endoscopically assisted open reduction and internal fixation has cumulate advantages over both open and closed techniques. Even though, this approach had not become popular. The study intended to summarize the outcomes and complications from the first 12 consecutive cases of sub condylar fractures that treated by endoscope and trans-buccal trocar. All patients experienced improvement in mouth opening. No postoperative malocclusion was noticed. The learning curve was assessed subjectively regarding the use of the endoscope and objectively by operating time reduction. The significant decrease in operating time and the ease of handling the endoscope were already noticed after the 5th operation. The mean time for endoscopically assisted open reduction and internal fixation in our study was 180 minutes, which was the same as for external approaches open reduction and internal fixation for sub-condylar fracture cases. No special designed instruments except an endoscope and a trans-buccal trocar were used. We can conclude that the learning curve for this technique is not as steep as it was thought to be, and it can be mastered after a relatively small number of operations. There is no difference in mean operation time comparing to external approaches. No need for special designed instruments.
Do Fellows and Faculty Share the Same Perception of Simulation Fidelity? A Pilot Study
Authors: Singh Devika , Kojima Taiki , Gurnaney Harshad , Deutsch Ellen S.
Published: May 2020

Introduction

Simulation is increasingly integrated into graduate medical education, and simulation faculty generally attempt to optimize the fidelity of simulators and simulations on behalf of trainees, so as to approach the realism of actual patient care experiences. As residents and fellows participate as learners in simulations, which faculty design, this investigation sought to address whether fellows and faculty have similar perceptions of fidelity by comparing ratings of 2 types of simulation experiences.

Methods

Prospective single-center observational study comparing surveys completed by fellows and faculty participating in multiple simulation sessions during a one-day simulation-based boot camp.

Results

Overall, both the fellows and the faculty provided moderate to high ratings of fidelity for both a technical skill and a teamwork simulation session. Fellows' ratings of an airway skills session were significantly higher than faculty ratings in 4 of 6 questions but similar to faculty ratings of a teamwork scenario session.

Conclusions

Pediatric anesthesia fellows' ratings of simulation fidelity were at least as high as faculty ratings during an annual boot camp, suggesting that faculty in this setting developed simulations that the fellows found to be realistic. Faculty were relatively more critical of the fidelity of a skill session, compared with a teamwork scenario session. If this finding is generalizable, this may reassure faculty designing simulations for fellows. Continued inspection of the entwined nature of fidelity and simulation will help inform more effective learning for this growing educational modality.
Neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein antibody-associated disease: current topics
Authors: Fujihara Kazuo , Cook Lawrence J.
Published: May 2020

Purpose of review

We reviewed present topics on neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein (MOG)-antibody-associated disease (MOGAD).

Recent findings

The number of NMOSD-related publications have increased year by year after the discovery of aquaporin 4 (AQP4)-antibody, and those on MOGAD started to surge since 2012–2013. Recent clinic-epidemiological surveys in NMOSD suggest that some racial differences in the prevalence and the clinical course. At present, experts feel the 2015 diagnostic criteria of AQP4-antibody-seronegative NMOSD should be revised. Randomized controlled trials of monoclonal antibodies in NMOSD have demonstrated a significant risk reduction of relapse, especially in AQP4-antibody-positive cases. Meanwhile, the efficacy in seronegative NMOSD was unclear. MOGAD can show NMO and other clinical phenotypes, but the clinical manifestations and frequencies are different in children and adults. One pathological study has suggested that MOGAD is distinct from AQP4-antibody-positive NMOSD, but may share some features with multiple sclerosis and acute disseminated encephalomyelitis. Immunosuppressive therapy can reduce relapse in MOGAD, but, unlike AQP4-antibody-positive NMOSD, some MOGAD patients treated with rituximab experience relapses despite a complete B-cell depletion.

Our understanding and therapy of AQP4-antibody-positive NMOSD has made a significant progress, and recent research has identified challenges in seronegative NMOSD and MOGAD.
Honeybee microbiome is stabilized in the presence of propolis
Authors: Saelao Perot , Borba Renata S. , Ricigliano Vincent , Spivak Marla , Simone-Finstrom Michael
Published: May 2020

Honeybees have developed many unique mechanisms to help ensure the proper maintenance of homeostasis within the hive. One method includes the collection of chemically complex plant resins combined with wax to form propolis, which is deposited throughout the hive. Propolis is believed to play a significant role in reducing disease load in the colony due to its antimicrobial and antiseptic properties. However, little is known about how propolis may interact with bee-associated microbial symbionts, and if propolis alters microbial community structure. In this study, we found that propolis appears to maintain a stable microbial community composition and reduce the overall taxonomic diversity of the honeybee microbiome. Several key members of the gut microbiota were significantly altered in the absence of propolis, suggesting that it may play an important role in maintaining favourable abundance and composition of gut symbionts. Overall, these findings suggest that propolis may help to maintain honeybee colony microbial health by limiting changes to the overall microbial community.
On age-specific selection and extensive lifespan beyond menopause
Authors: Pang Tin Yau
Published: May 2020

Standard evolutionary theory of ageing predicts weaker purifying selection on genes critical to later life stages. Prolonged post-reproductive lifespan (PPRLS), observed only in a few species like humans, is likely a result of disparate relaxation of purifying selection on survival and reproduction in late life stages. While the exact origin of PPRLS is under debate, many researchers agree on hypotheses like mother-care and grandmother-care, which ascribe PPRLS to investment into future generations—provision to one’s descendants to enhance their overall reproductive success. Here, we simulate an agent-based model, which properly accounts for age-specific selection, to examine how different investment strategies affect the strength of purifying selection on survival and reproduction. We observed in the simulations that investment strategies that allow a female individual to remain contributive to its own descendants (infants and adults) at late life stages may lead to differential relaxation of selection on survival and reproduction, and incur the adaptive evolution of PPRLS.
The accumulative law and its probability model: an extension of the Pareto distribution and the log-normal distribution
Authors: Feng Minyu , Deng Liang-Jian , Chen Feng , Perc Matjaž , Kurths Jürgen
Published: May 2020

The divergence between the Pareto distribution and the log-normal distribution has been observed persistently over the past couple of decades in complex network research, economics, and social sciences. To address this, we here propose an approach termed as the accumulative law and its related probability model. We show that the resulting accumulative distribution has properties that are akin to both the Pareto distribution and the log-normal distribution, which leads to a broad range of applications in modelling and fitting real data. We present all the details of the accumulative law, describe the properties of the distribution, as well as the allocation and the accumulation of variables. We also show how the proposed accumulative law can be applied to generate complex networks, to describe the accumulation of personal wealth, and to explain the scaling of internet traffic across different domains.
Salinity stress increases the severity of ranavirus epidemics in amphibian populations
Authors: Hall Emily M. , Brunner Jesse L. , Hutzenbiler Brandon , Crespi Erica J.
Published: May 2020

The stress-induced susceptibility hypothesis, which predicts chronic stress weakens immune defences, was proposed to explain increasing infectious disease-related mass mortality and population declines. Previous work characterized wetland salinization as a chronic stressor to larval amphibian populations. Thus, we combined field observations with experimental exposures quantifying epidemiological parameters to test the role of salinity stress in the occurrence of ranavirus-associated mass mortality events. Despite ubiquitous pathogen presence (94%), populations exposed to salt runoff had slightly more frequent ranavirus related mass mortality events, more lethal infections, and 117-times greater pathogen environmental DNA. Experimental exposure to chronic elevated salinity (0.8–1.6 g l
−1
Cl
−
) reduced tolerance to infection, causing greater mortality at lower doses. We found a strong negative relationship between splenocyte proliferation and corticosterone in ranavirus-infected larvae at a moderate elevation of salinity, supporting glucocorticoid-medicated immunosuppression, but not at high salinity. Salinity alone reduced proliferation further at similar corticosterone levels and infection intensities. Finally, larvae raised in elevated salinity had 10 times more intense infections and shed five times as much virus with similar viral decay rates, suggesting increased transmission. Our findings illustrate how a small change in habitat quality leads to more lethal infections and potentially greater transmission efficiency, increasing the severity of ranavirus epidemics.
Role of multiple, adjustable toes in distributed control shown by sideways wall-running in geckos
Authors: Song Yi , Dai Zhendong , Wang Zhouyi , Full Robert J.
Published: May 2020

Remarkable progress has been made characterizing one of nature's most integrated, hierarchical structures––the fibrillar adhesive system of geckos. Nonetheless, we lack an understanding of how multiple toes coordinate to facilitate geckos' acrobatic locomotion. Here, we tested the control function of gecko toes by running them on vertical substrates varying in orientation, friction and roughness. Sideways wall-running geckos realigned the toes of their top feet upward to resist gravity. Toe contact area was not compromised, but redistributed. Geckos aligned all toes upward to resist slipping when encountering low-friction patches during sideways wall-running. Negotiation of intermittent slippery strips showed an increased contribution of particular toes to compensate for toes that lost adhesion. Increasing substrate roughness using discrete rods perpendicular to sideways locomotion resulted in geckos bending and/or rotating toes to conform to and even grasp the rods, with potential forces more than five times body weight. Geckos increase their effectiveness of manoeuvrability in demanding environments by taking advantage of the distributed control afforded by multiple toes. Our findings provide insight on biological attachment and offer inspiration to advance gecko-inspired robotics and other biomimetic applications.
Frequent tumor burden monitoring of esophageal squamous cell carcinoma with circulating tumor DNA using individually designed digital PCR
Authors: Iwaya T. , Endo F. , Yaegashi M. , Sasaki N. , Fujisawa R. , Hiraki H. , Akiyama Y. , Sasaki A. , Suzuki Y. , Masuda M. , Yamada T. , Takahashi F. , Tokino T. , Sasaki Y. , Nishizuka S.S.
Published: May 2020

Background

Circulating tumor DNA (ctDNA) test has not yet been an established tool for monitoring cancer. Sensitive, yet affordable methods should allow frequent ctDNA monitoring that can assist in clinical management.

Patients and Methods

This prospective observational study was conducted in a total of 36 patients with Stage I to IV esophageal squamous cell cancer (ESCC) were enrolled between September 1, 2015 and February 28, 2018. We investigated whether frequent ctDNA monitoring during treatment followed by routine surveillance by digital PCR (dPCR) using tumor-specific mutations offers clinical validity in daily practice for ESCC patients.

Results

Mutation screening of tumors from analyzable 35 patients using a specifically-designed "SCC panel" revealed 221 mutations with variant allele frequency (VAF) >2%. VAF of ctDNA was informative in 34 patients surveillance by dPCR using 58 mutations (1-3 per patient). A total of 569 plasma samples at 332 time points for ctDNA testing were evaluated. In pretreatment plasma, the average VAF was higher in advanced stages than earlier stages (P < .0001); tumor volume was also higher for higher VAF (r = 0.71). The ctDNA-positive rate in the pretreatment plasma of stage II or higher was 85.2% (23/27) whereas 85.7% (6/7) stage I were below the detection limit. Ninety-one % (10/11) patients whose ctDNA increased during chemotherapy showed disease progression. Among patients who recurred, ctDNA elevated with a median lead time of 149 days to the imaging diagnosis. Patients with decreased ctDNA within 3 months of initial treatment (n = 10) showed significantly better outcomes than did patients with ctDNA-positive (n = 11; P < .0001, HR 0.10, 95% CI, 0.03-0.30).

Conclusions

Our results indicate that frequent tumor burden monitoring using a small number of tumor-specific ctDNAs by dPCR enables prediction of relapse and chemotherapeutic efficacy, as well as relapse-free corroboration in management of ESCC patients.
Repeated population-based surveys of antibodies against SARS-CoV-2 in Southern Brazil
Authors: Silveira Mariângela F , Barros Aluísio J D , Horta Bernardo L , Pellanda Lúcia C , Dellagostin Odir A , Struchiner Claudio J , Burattini Marcelo N , Valim Andréia R M , Berlezi Evelise M , Mesa Jeovany M , Ikeda Maria Letícia R , Mesenburg Marilia A , Mantesso Marina , Dall’Agnol Marinel M , Bittencourt Raqueli A , Hartwig Fernando P , Menezes Ana M B , Barros Fernando C , Hallal Pedro C , Victora Cesar G
Published: May 2020

Population based data on COVID-19 are urgently needed for informing policy decisions, yet few such studies are available anywhere, as most surveys rely on self-selected volunteers. In the Brazilian State of Rio Grande do Sul (population 11.3 million), we are carrying out fortnightly household surveys in nine of the largest cities. Multi-stage probability sampling was used in each city to select 500 households, within which one resident was randomly chosen for testing. The Wondfo lateral flow rapid test for detecting antibodies against SARS-CoV-2 has been validated in four different settings, including our own, with pooled estimates of sensitivity (84.8%, 95% CI 81.4%;87.8%) and specificity (99.0%, 95% CI 97.8%;99.7%), which are within the acceptable range for epidemiological studies. In the first wave of the study (April 11-13), 4,188 subjects were tested, of whom two were positive (0.0477%; 95% confidence interval (CI) 0.0058%;0.1724%). In the second round (Apr 25-27) there were six positive subjects (0.1333%; 95% CI 0.0489%;0.2900%). We also tested family members of positive index cases, and nine out of 19 had positive results. Testing of reported COVID-19 cases according to RT-PCR confirmed that the test was highly sensitive under field conditions. The epidemic is at an early stage in the State, as the first case was reported on Feb 28, and by Apr 30, 50 deaths were registered. Strict lockdown measures were implemented in mid-March, and our results suggest that compliance was high, with full or near full compliance rates of 79.4% in the first and 71.7% in the second round. As far as we know, this is the only large population anywhere undergoing regular household serological surveys for COVID-19. The results show that the epidemic is at an early phase, and findings from the next rounds will allow us to document time trends and propose Public Health measures.
Control dynamics of the COVID-19 pandemic in China and South Korea
Authors: Moreira João Manoel Losada
Published: May 2020

Social isolation measures reduce the population’s infection rate with the COVID-19 virus, but its effectiveness is difficult to quantify. The successful control of the pandemic carried out by China and South Korea is studied using a scheme based on the net relative rate of infection which is very sensitive to sudden changes in the epidemic evolution. The net relative rate of infection for China and South Korea without containment measures, that is, with free proliferation of the virus, lies between 10 and 40 %/day or doubling times of infected persons between 3.5 and 2 days. After measures of containment it dropped and stabilized. South Korea stabilized it around 1 %/day and China around 0.05 %/day with doubling times of 70 days and 1400 days, respectively. A discussion is provided about their processes of control and stabilization of the epidemic process and about the scheme used to study them.