bluuebunny/crossref_metadata_2025 huggingface dataset:
Hematological indices as indicators of silent inflammation in achalasia patients
Authors: López-Verdugo Fidel , Furuzawa-Carballeda Janette , Romero-Hernández Fernanda , Coss-Adame Enrique , Valdovinos Miguel A. , Priego-Ranero Angel , Olvera-Prado Héctor , Narváez-Chavez Sofía , Peralta-Figueroa José , Torres-Villalobos Gonzalo
Published: March 2020

Complete blood count (CBC)-derived parameters such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), eosinophil-to-lymphocyte (ELR) ratio, and platelet-to-lymphocyte ratio (PLR) are sensitive markers of occult inflammation and disease activity for systemic lupus erythematosus, rheumatoid arthritis, psoriasis, esophageal cancer, etc. We assessed NLR, PLR, MLR, and ELR as indicators of inflammation in achalasia patients.

This cross-sectional study included 103 achalasia patients and 500 healthy blood donor volunteers (HD). Demographic, clinical and laboratory information was collected. NLR, MLR, ELR and PLR were calculated. Peripheral Th22, Th17, Th2 and Th1 subsets were determined by flow cytometry. Correlation between hematologic indices and clinical questionnaires scores, HRM parameters and CD4+ T-cells were assessed. Hematologic parameters associated with the different achalasia subtypes were evaluated by logistic regression analysis.

Hemoglobin, leukocytes, lymphocytes, monocytes, and platelets counts were significantly lower in achalasia patients vs controls. NLR (P = .006) and ELR (P < .05) were higher in achalasia patients vs controls. NLR was significantly associated with achalasia in multivariate analysis (P < .001). Compared to HD, the achalasia group was 1.804 times more likely to have higher NLR (95% CI 1.287–2.59; P < .001). GERD-HRQL score had statistically significant correlations with PLR (Pearson's rho:0.318, P = .003), and ELR (Pearson's rho:0.216; P = .044). No correlation between CD4+ T-cells and hematologic indices were determined. NLR with a cut-off value of ≥2.20 and area under the curve of 0.581 yielded a specificity of 80% and sensitivity of 40%, for the diagnosis of achalasia.

NLR is increased in achalasia patients vs HD. Sensitivity and specificity achieved by NLR may contribute to a clinical and manometric evaluation. We suggest these indices as potential indicators of silent inflammation and disease activity.
Acupoint catgut embedding for insomnia
Authors: Wang Xiaotong , Huang Yinna , Li Minting , Lin Haixiong , Lin Chunni , Yang Weiqin , Ye Xiaopeng
Published: March 2020

Background:

Insomnia is a common sleep disorder characterized by chronically disturbed sleep or loss of sleep, and even cognitive dysfunction. Acupoint catgut embedding is widely used to treat sleep disorders. However, there is no systematic review and data mining of the effectiveness and potential acupoints prescription of acupoint catgut embedding for insomnia.

Methods:

Randomized controlled trials (RCTs) from the Web of Science, PubMed, Cochrane Library, Springer, Wanfang database, China National Knowledge Infrastructure, VIP Chinese Science and Technology Journals Database, and 2 clinical trial registration center will be included. The search time will be established from each database to December 30, 2019. The outcome measures will be Pittsburgh sleep quality index (PSQI), clinical effective rate, International Unified Sleep Efficiency Value (IUSEV) and adverse events. Data from RCTs that meets the inclusion criteria will be analyzed through RevMan V.5.3 software. Risk of bias and publication bias will be analyzed to identify the quality of the included studies. Besides, Traditional Chinese Medicine inheritance support system (TCMISS) will be used to analyze the potential acupoints prescriptions.

Results:

This study will clarify PSQI, IUSEV, clinical effective rate, adverse events, and potential acupoint prescriptions of acupoint catgut embedding for patients with insomnia.

Conclusion:

Our study will provide evidence of acupoint catgut embedding for insomnia, which may be beneficial to practitioners in the field of non-pharmacological interventions.

PROSPERO registration number: CRD42019144636.
Relationship between ataxia and inferior cerebellar peduncle injury in patients with cerebral infarct
Authors: Jang Sung Ho , Lee Han Do
Published: March 2020

Introduction:

The inferior cerebellar peduncle (ICP) is a major neural tract in the cerebellum and is involved in coordination of movement and proprioceptive; therefore, ICP injury can be accompanied by poor coordination of movement, including ataxia. In this study, using diffusion tensor tractography (DTT), we investigated the relationship between ataxia and ICP injury in patients with cerebral infarct.

Methods:

We recruited 14 stroke patients with ataxia after the onset of stroke and 12 normal subjects. The Score of Assessment and Rating of Ataxia (SARA) was used to evaluate ataxia. The values of fractional anisotropy (FA), apparent diffusion coefficient, and fiber number (FN) of the ICP were measured for the diffusion tensor imaging parameters.

Results:

Significant differences were observed in the FA and FN values of the ICP in the affected hemisphere between the patient and control groups (P < .05). In addition, the FN value of the ICP in the affected hemisphere showed a negative correlation with SARA (r = −0.538, P < .05). However, parameters of the ICP in the unaffected hemisphere or the FN value in the unaffected hemisphere showed no correlation with SARA (P > .05).

Conclusion:

We found that the ataxia severity was closely related to the severity of ICP injury in patients with cerebral infarct. Our results suggest that evaluation of the ICP using DTT would be useful for patients with ataxia after cerebral infarct.
Intralobar pulmonary sequestration with cystic degeneration mimicking a bronchogenic cyst in an elderly patient
Authors: Kim Han Joon , Shin Kyung Eun , Park Jai Soung , Lee Heon , Lee Jae Wook , Chin Susie , Shin Hwa Kyun
Published: March 2020

Introduction:

Pulmonary sequestration (PS) is a rare congenital malformation defined as nonfunctioning lung tissue supplied by systemic circulation. It is uncommonly diagnosed in adults. Herein, we describe a clinical case of PS with cystic degeneration mimicking a bronchogenic cyst in an elderly patient.

Patient concerns:

A huge cystic mass was incidentally found in a 65-year-old man on chest computed tomography (CT) scans during preoperative workup for a hand laceration. A 15-cm-sized round cystic mass was detected in the right lower lobe.

Diagnosis:

After reviewing the chest CT scan, we decided to perform contrast-enhanced chest magnetic resonance imaging (MRI) and CT-guided lung aspiration biopsy. On MRI, the lesion had the appearance of a cystic mass with hemorrhagic clots, such as an intrapulmonary bronchogenic cyst. The aspirated specimen was nondiagnostic; thus, we decided to surgically remove the mass.

Interventions:

Upon right lower lobectomy, the mass was diagnosed as a PS. A thin systemic artery supplying the cystic mass was visualized during surgery.

Outcomes:

The patient is undergoing regular follow-up at the outpatient clinic.

Conclusions:

PS should be considered as a differential diagnosis in patients with a cystic lung mass. Identification of a systemic artery on radiologic imaging is important in the diagnosis of PS before preoperative workup to prevent unpredicted massive bleeding during surgery.
Comparison of kidney-tonifying and blood-activating medicinal herbs vs NSAIDs in patients with knee osteoarthritis
Authors: Huang Hetao , Huang Sicong , Liang Guihong , Zeng Lingfeng , Pan Jianke , Yang Weiyi , Chen Hongyun , Liu Jun , Pan Biqi
Published: March 2020

Background:

Knee osteoarthritis (KOA) is one of the most common chronic muscular diseases in old people. In recent years, people are more and more interested in the use of Chinese herbal medicine (CHM) in the treatment of KOA, such as kidney-tonifying and blood-activating medicinal herbs (KTBAMs) in the treatment of KOA. Many studies have confirmed that KTBAMs are effective in the treatment of KOA. However, it is still unknown whether KTBAMs and NSAIDs are more effective in the treatment of KOA. Therefore, we evaluated the efficacy and safety of KTBAMs and NSAIDs in the treatment of KOA.

Methods:

Randomized controlled trials (RCTs) from online databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Data, and Chinese Biomedical Literature Database that compared the efficacy of KTBAMs and NSAIDs in the treatment of KOA were retrieved. The main outcomes included the evaluation of functional outcomes, pain and adverse effects. The Cochrane risk of bias (ROB) tool was used to assess methodological quality.

Results:

The literature will provide a high-quality analysis of the current evidence supporting KTBAMs for KOA based on various comprehensive assessments including the total effective rate, visual analog scale scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequence scores, Knee Society Scale (KSS) scores, and adverse effects.

Conclusion:

This proposed systematic review will provide up-to-date evidence to assess the effect of KTBAMs in the treatment for patients with KOA.

Research Registry registration number

: reviewregistry 783.
Single-incision approach for bilateral inguinal hernia repair in children
Authors: Chongxi Ren , Hongqiao Wang , Fengying Li , Xin Wang , Hongxia Qi , Lijun Xing
Published: March 2020

To introduce the use of a new surgical approach named single-incision bilateral inguinal herniorrhaphy (SBIH) in pediatric surgical population.

This was a STROBE-compliant retrospective cohort study using data from 101 patients who had undergone bilateral inguinal herniorrhaphy in our institution. Children with bilateral inguinal hernias without contraindications for surgery, ranging in age from 6 months to 12 years, were included. Fifty-six children with bilateral inguinal hernias underwent SBIH (SBIH group) and 45 patients underwent laparoscopic bilateral inguinal herniorrhaphy (LBIH) (LBIH group). Differences in operative time, postoperative pain, recurrence, and complications between the 2 groups were analyzed. Patient satisfaction with cosmetic result was also investigated using questionnaires.

There were no statistically significant differences in operative time (P = .2257), postoperative pain (P = .0607), recurrence (P = .8756), and complications (P = .7467) between the 2 groups. Interestingly, the operation time of girls in SBIH group was significantly shorter than that of the boys in this group (P < .0001), but also shorter than that of girls in LBIH group (P = .0038). Postoperative pain for boys was lower in SBIH group than in the LBIH group (P = .0340). No ascending testis, testicular atrophy, and hydrocele occurred in either group. According to the questionnaire, both procedures had equally high levels of satisfaction for cosmetic results (P = .7531).

Initial results show that SBIH for pediatric patients, regardless of gender, is a safe and feasible procedure compared with LBIH with an equally low recurrence rate, few complication, and satisfactory cosmetic outcomes.
Two year adverse outcomes of the magnetic levitated centrifugal continuous flow circulatory pump versus the axial continuous-flow pump for advanced heart failure
Authors: Tang Bing , Yang Hua
Published: March 2020

Background:

Due to advances in technology and medical devices, intra-thoracic left ventricular assisted devices such as the fully magnetically levitated centrifugal-flow pump may now prolong the life of patients with advanced heart failure. However, several concerns have been raised about pump thrombosis and durability of the device. We aimed to systematically compare the two year outcomes of magnetic levitated centrifugal continuous flow circulatory pump versus the axial continuous flow pump for advanced heart failure.

Methods:

Following the PRISMA guideline, online databases were searched for relevant trials based on centrifugal continuous flow circulatory pump and axial continuous flow pump in patients with advanced heart failure. The adverse clinical outcomes reported at 2 years follow-up were considered as the endpoints. This analysis was carried out by the RevMan 5.3 software whereby odds ratios (OR) and 95% confidence intervals (CI) were generated.

Results:

A total number of 1011 patients with advanced heart failure was included. At 2 years, pump thrombosis was not significantly different between the two groups, with OR: 0.43, 95% CI: 0.06–3.29; P = .42. However, pump replacement was significantly higher with the axial continuous-flow pump with OR: 0.36, 95% CI: 0.15–0.84; P = .02. Stroke, sepsis and bleeding events were not significantly different. In addition, outcomes such as right heart failure, cardiac arrhythmia, the need for right ventricular assisted device, respiratory failure, renal failure and hepatic dysfunction were also not significantly different.

Conclusions:

At a follow-up time period of 2 years, pump replacement was significantly higher with the axial continuous-flow pump in comparison to the magnetic levitated centrifugal continuous flow circulatory pump. However, no significant difference was observed with the other adverse outcomes.
Wilson disease: 30-year data on epidemiology, clinical presentation, treatment modalities and disease outcomes from two tertiary Greek centers
Authors: Tampaki Maria , Gatselis Nikolaos K. , Savvanis Spyridon , Koullias Emmanouil , Saitis Asterios , Gabeta Stella , Deutsch Melanie , Manesis Emmanouil , Dalekos Georgios N. , Koskinas John
Published: March 2020

Objective:

Wilson disease is a rare genetic disorder of copper metabolism with a wide range of clinical presentations. The aim of this study is to describe the 30-year clinical experience in the management of Wilson disease patients followed at two Greek referral centers.

Methods:

A retrospective chart review was performed to identify past and present Wilson disease patients diagnosed during the last 30 years.

Results:

Sixty-three patients were included. The median age of diagnosis was 19 (3–59) years, while nine (14%) patients were older than 40 years old. Clinical presentation included asymptomatic liver disease (57.1%), neurological disease (20.6%), overt liver disease (12.7%), acute liver failure (6.3%) and other (3.2%). Kayser–Fleischer rings were detected in 27/62 with a higher frequency in neurologic patients (P < 0.001). Ceruloplasmin values were low in 55/63 with significantly lower values in patients with neurological disease (P = 0.048) and in cirrhotic patients (P = 0.017). Increased 24-hour urine copper was measured in 59/63 patients. D-penicillamine was administered in 56/63 patients (88.8%), followed by trientine (6/63, 9.5%), while one patient needed liver transplantation at baseline. At least one treatment switch was performed in 18 patients. By the end of follow-up, all non-cirrhotic patients (25/25) were stable, 3/23 (13%) cirrhotic developed decompensated liver disease, two developed HCC, three received a liver transplant and two died. Five out of 13 neurologic patients had persisting symptoms despite treatment.

Conclusion:

Wilson disease presents with a wide spectrum of clinical manifestations and should be investigated even in older patients, as early diagnosis, close follow-up and treatment monitoring usually provide favorable outcomes.
External validation of the Toronto hepatocellular carcinoma risk index in Turkish cirrhotic patients
Authors: Demirtas Coskun Ozer , Gunduz Feyza , Kani Haluk Tarik , Keklikkiran Caglayan , Alahdab Yesim Ozen , Yilmaz Yusuf , Duman Deniz Guney , Atug Ozlen , Giral Adnan , Aslan Rahmi , Cagatay Nur Sena , Ozkan Bige , Ozdogan Osman Cavit
Published: March 2020

Objectives:

Toronto hepatocellular carcinoma risk index is developed to stratify cirrhotic patients according to 10-year hepatocellular carcinoma risk. We aimed to validate the performance of Toronto hepatocellular carcinoma risk index in a large Turkish cohort.

Materials and methods:

We retrospectively reviewed the database of 1287 cirrhotic patients followed-up in a 10-year period (February 2008 to January 2018). All patients were stratified into three groups based on the Toronto hepatocellular carcinoma risk index score as follows: low-risk, < 120; intermediate risk, 120 to 240; and high risk, > 240. Area under the curve and optimal cutoff value of Toronto hepatocellular carcinoma risk index were obtained from receiver operator curve. To reveal the parameters related with hepatocellular carcinoma development, logistic regression analysis was conducted. The cumulative incidences of hepatocellular carcinoma were calculated using the Kaplan–Meier method, and the curves were compared using the log-rank test.

Results:

Out of 403 enrolled patients, 57 developed hepatocellular carcinoma. The median Toronto hepatocellular carcinoma risk index value was higher in hepatocellular carcinoma (+) group comparing to hepatocellular carcinoma (−) group [267 (70–366) vs. 224 (36–366), P < 0.001]. Out of 57 detected hepatocellular carcinomas, 45 (78.9%) were high risk, 11 (19.3%) were intermediate risk, and only one (1.8%) was low risk at the entry. The area under the curve of the Toronto hepatocellular carcinoma risk index to predict hepatocellular carcinoma was 0.750 (95% confidence interval, 0.683–0.817, P < 0.001). The optimal cutoff value of Toronto hepatocellular carcinoma risk index was 239.5, giving a sensitivity of 78.9% and specificity of 62.7%. As a result, Toronto hepatocellular carcinoma risk index remained to be the only significant parameter that has an affect on hepatocellular carcinoma development [adjusted-odds ratio: 1.016 (95% confidence interval, 1.007–1.024), P<0.001].

Conclusion:

The present study validated the performance of Toronto hepatocellular carcinoma risk index in Turkish cirrhotic patients to predict hepatocellular carcinoma risk, which can be considered as a tool for personalized surveillance.
A nomogram for discrimination of non-alcoholic fatty liver disease in patients with chronic hepatitis B
Authors: Chen Yanping , Cao Dan , Li Chunyan , Zhang Pingping , Wang Xiaoyun , Li Na , Han Qunying , Liu Zhengwen
Published: March 2020

Objectives:

Comorbid of non-alcoholic fatty liver disease (NAFLD) in chronic hepatitis B (CHB) patients is common but no simple noninvasive diagnostic methods are available for the identification. This study aims to develop a noninvasive nomogram for accurate detection of NAFLD in CHB patients.

Patients and methods:

This study included 535 liver biopsy-proven CHB patients with or without comorbid NAFLD. Independent risk factors of NAFLD were identified by multivariate logistic regression analysis. The risk factors identified were then incorporated into the nomogram. Performance of the nomogram was assessed by calibration, receiver operating characteristic (ROC) curve and decision curve analysis.

Results:

Of the 535 patients, 100 patients (18.69%) were diagnosed as CHB/NAFLD and 435 patients (81.31%) as simple CHB. Body mass index, serum uric acid and low-density lipoprotein cholesterol levels and diabetes mellitus were independent risk factors of NAFLD. The nomogram incorporating these 4 factors had an area under ROC curve (AUC) of 0.864, achieved good concordance index of 0.864 (95% confidence interval: 0.832–0.892) for predicting NAFLD in the patients and had well-fitted calibration curves. The nomogram had a significantly higher AUC than some previously reported models. The decision curve analysis yielded larger net benefit.

Conclusion:

This study developed a simple, noninvasive, effective and convenient nomogram that achieved an optimal detection of NAFLD in CHB patients. Using this nomogram, the risk for an individual patient to have NAFLD could be discriminated, leading to a rational clinical management.
Pediatric Clinician Comfort Discussing Diagnostic Errors for Improving Patient Safety: A Survey
Authors: Grubenhoff Joseph A. , Ziniel Sonja I. , Cifra Christina L. , Singhal Geeta , McClead Richard E. , Singh Hardeep
Published: March 2020

Introduction:

Meaningful conversations about diagnostic errors require safety cultures where clinicians are comfortable discussing errors openly. However, clinician comfort discussing diagnostic errors publicly and barriers to these discussions remain unexplored. We compared clinicians’ comfort discussing diagnostic errors to other medical errors and identified barriers to open discussion.

Methods:

Pediatric clinicians at 4 hospitals were surveyed between May and June 2018. The survey assessed respondents’ comfort discussing medical errors (with varying degrees of system versus individual clinician responsibility) during morbidity and mortality conferences and privately with peers. Respondents reported the most significant barriers to discussing diagnostic errors publicly. Poststratification weighting accounted for nonresponse bias; the Benjamini–Hochberg adjustment was applied to control for false discovery (significance set atP< 0.018).

Results:

Clinicians (n = 838; response rate 22.6%) were significantly less comfortable discussing all error types during morbidity and mortality conferences than privately (P< 0.004) and significantly less comfortable discussing diagnostic errors compared with other medical errors (P< 0.018). Comfort did not differ by clinician type or years in practice; clinicians at one institution were significantly less comfortable discussing diagnostic errors compared with peers at other institutions. The most frequently cited barriers to discussing diagnostic errors publicly included feeling like a bad clinician, loss of reputation, and peer judgment of knowledge base and decision-making.

Conclusions:

Clinicians are more uncomfortable discussing diagnostic errors than other types of medical errors. The most frequent barriers involve the public perception of clinical performance. Addressing this aspect of safety culture may improve clinician participation in efforts to reduce harm from diagnostic errors.
The Clinical and Chest CT Features Associated With Severe and Critical COVID-19 Pneumonia
Authors: Li Kunhua , Wu Jiong , Wu Faqi , Guo Dajing , Chen Linli , Fang Zheng , Li Chuanming
Published: March 2020

Objective

The aim of this study was to investigate the clinical and computed tomography (CT) features associated with severe and critical coronavirus disease 2019 (COVID-19) pneumonia.

Materials and Methods

Eighty-three patients with COVID-19 pneumonia including 25 severe/critical cases and 58 ordinary cases were enrolled. The chest CT images and clinical data of them were reviewed and compared. The risk factors associated with disease severity were analyzed.

Results

Compared with the ordinary patients, the severe/critical patients had older ages, higher incidence of comorbidities, cough, expectoration, chest pain, and dyspnea. The incidences of consolidation, linear opacities, crazy-paving pattern, and bronchial wall thickening in severe/critical patients were significantly higher than those of the ordinary patients. Besides, severe/critical patients showed higher incidences of lymph node enlargement, pericardial effusion, and pleural effusion than the ordinary patients. The CT scores of severe/critical patients were significantly higher than those of the ordinary patients (P < 0.001). Receiver operating characteristic curve showed that the sensitivity and specificity of CT score were 80.0% and 82.8%, respectively, for the discrimination of the 2 types. The clinical factors of age older than 50 years, comorbidities, dyspnea, chest pain, cough, expectoration, decreased lymphocytes, and increased inflammation indicators were risk factors for severe/critical COVID-19 pneumonia. Computed tomography findings of consolidation, linear opacities, crazy-paving pattern, bronchial wall thickening, high CT scores, and extrapulmonary lesions were features of severe/critical COVID-19 pneumonia.

Conclusions

There are significant differences in clinical symptoms, laboratory examinations, and CT manifestations between the ordinary patients and the severe/critical patients. Many factors are related to the severity of the disease, which can help clinicians to judge the severity of the patient and evaluate the prognosis.
Renal Hemodynamic Changes and Postsurgical Recovery in Children Treated for Ureteropelvic Junction Obstruction
Authors: Sun Junjie , Deng Gaoyan , Wang Fenghua , Mo Jiacong
Published: March 2020

Objective

The aims of the study were to measure renal hemodynamic indexes and to evaluate postsurgical recovery in children diagnosed with obstructive hydronephrosis using color Doppler ultrasound.

Methods

This study enrolled 36 patients with ureteropelvic junction obstruction who underwent Anderson–Hynes pyeloplasty. The peak systolic velocity (PSV) and the resistive index (RI) of the main renal arteries (MRAs) and interlobar renal arteries (IRAs) were measured using color Doppler ultrasound. Renal hemodynamic indexes were measured before surgery and 2, 4, 6, 8, 10, 12, 14, and 16 weeks after surgery.

Results

Split renal function and renal parenchymal thickness were positively correlated with PSV and negatively correlated with RI. Anterior–posterior diameter had no significant correlation with PSV or RI. The PSV in MRAs and IRAs were lower than those of the contralateral kidneys but increased after surgery. Anderson–Hynes pyeloplasty was successfully performed in all patients, including one patient whose kidney was removed 16 weeks after surgery. The RI in the MRAs and IRAs were higher than those of the contralateral kidneys but decreased within 2 weeks after surgery. Peak systolic velocity and RI were still atypical 16 weeks after surgery. The hemodynamic index of the nonfunctional kidney did not show improvement after surgery.

Conclusions

Peak systolic velocity and RI were correlated with renal function and renal parenchymal thickness but were not correlated with dilatation of the renal pelvis. Peak systolic velocity increased whereas RI decreased after surgery and were stable at 8 weeks, but remained abnormal 16 weeks after surgery. Hemodynamic measurements may be a useful and convenient method to evaluate surgical outcomes after Anderson–Hynes pyeloplasty.
Creating an Outpatient, Local Anesthetic Hand Operating Room in a Resource-Constrained Ghanaian Hospital Builds Surgical Capacity and Financial Stability
Authors: Holoyda Kathleen A. , Farhat Boutros , Lalonde Donald H. , Owusu-Danso Oheneba , Agbenorku Pius , Hoyte-Williams Paa Ekow , Rockwell W. Bradford
Published: March 2020

Introduction

Expanding surgical capacity is very difficult in resource-constrained countries. Financial input and additional physical operating room space are needed. The surgical patient volume exists, but the lack of operating room time causes postponement of cases. Hand surgery is particularly important as it improves patient function and allows for a timely return to the workforce after injury. Some hand surgery cases may be performed under local anesthesia with a very basic instrument set in a procedure room. This arrangement eliminates the need and financial burden of an equipped operating room and the need for an anesthesiologist. We hypothesized that performing hand surgery in a simple procedure room by a surgeon with knowledge of adequate local anesthesia could increase hand surgery capacity significantly in a low-income country.

Methods

This technique has been instituted at Komfo Anokye Teaching Hospital in Kumasi, Ghana, with the use of a single procedure room that was previously used for storage. A surgeon trained in performing wide-awake local anesthesia no tourniquet technique visited Komfo Anokye Teaching Hospital and provided lectures about hand surgery under local anesthesia and evidence-based sterility for 6 years. The number and type of cases performed in the procedure room were recorded for the first 11 months after it opened in 2017.

Results

For 11 months, use of this room had increased surgical capacity by 33 cases per month. Patient ages ranged from 2 months to 65 years. There have been 358 total cases performed, 240 of which were hand cases. This included washout of hand wounds (n = 87), tendon repair (n = 54) including a single tendon transfer, fracture pinning (n = 33), amputations (n = 24), trigger finger repair (n = 10), nerve repair (n = 6), congenital hand surgery (n = 4), and other (n = 22). Cost savings per case in the procedure room ranges from 500 cedis (US $100) to 2000 cedis (US $400).

Conclusions

The simple procedure room runs more efficiently and is less costly compared with the main operating rooms. Although the case volume has increased surgical capacity significantly, costs to the hospital and patient have decreased. The hospital is reimbursed in a timely fashion for the procedures directly by the patient using this technique. The creation of a single procedure room for wide-awake local anesthesia no tourniquet hand surgery has helped address the issues of inadequate operating room space, time, and expense in resource-constrained Ghana.
Lymphatic Leaks of the Thigh and Inguinal Region
Authors: Watfa William , Campisi Corrado , Ryan Melissa , Matter Maurice , Cherix Stephane , Sörelius Karl , Raffoul Wassim , di Summa Pietro Giovanni
Published: March 2020

Background

Surgical procedures interfering with the draining nodes in the inguinal region carry the intrinsic risk of lymphatic complications. Lesions of the inguinal lymphatic network can lead to lymphocele or lymphocutaneous fistulas and can eventually be associated to limb lymphedema with consequent high morbidity.

Objectives

This article describes a new surgical algorithm based on wound properties to properly address lymphatic complications of the inguinal area. Based on our experience, surgical solutions ranged from selective lymphatic vessel ligation to microsurgical lymphatic fistula treatment and free tissue transfer.

Methods

Fourteen consecutive patients underwent surgery in our department following failed attempts to address persistent lymphatic leaks. Patient characteristics such as smoking, previous surgeries, comorbidities, and wound properties were considered. Identification of the leak was performed using blue patent dye and indocyanine green fluorescence. Surgical reconstruction occurred, according to our algorithm.

Results

Lymphatic leaks were visualized in 11 of 14 patients. Direct closure of the wound after leak ligation could be performed in 4 of 14 patients. Multilymphatic into vein anastomosis was performed in 3 of 14 patients, and the remaining patients benefited from flap surgery based on the wound defects. All 14 patients had successful outcomes (100%) with early drain removal (average, 6 [SD, 6] days) and definitive wound healing 2 weeks postoperatively. After a mean follow-up of 12 (SD, 2.9) months, no clinical infection, lymphatic complication, or wound breakdown occurred. One patient had a partial recurrence that did not require surgical intervention.

Conclusions

A stepwise approach, combining lymphatic surgery principles and plastic surgery flap techniques, can lead to an effective treatment algorithm where surgical options are wound tailored to guarantee the best functional outcomes.
Comparative Study of Intercostal Nerve and Contralateral C7 Nerve Transfers for Elbow Extension After Global Brachial Plexus Avulsion
Authors: Xiao Feng , Lao Jie
Published: March 2020

Introduction

Elbow extensive reconstruction was essential for the patients with brachial plexus avulsion. Nerve transfer was applied to repair elbow extension, but the ultimate recovery was quite different. The purpose of this study was to compare the effects of elbow extension in patients with global brachial plexus avulsion after repaired by intercostal nerve (ICN) and contralateral cervical 7 (cC7) nerve transfer to the long head branch of triceps and to analyze the possible influencing factors.

Materials and Methods

A retrospective review of 24 patients treated with ICN and cC7 nerve transfer for elbow extension in posttraumatic global brachial plexus avulsion was carried out. Two ICNs were used as donors in 17 patients, and cC7 nerve was used in the other 7 patients. We evaluated the recovery of elbow extension by the British Medical Research Council grading system and electromyography. The correlation between age, preoperative interval, and prognosis was analyzed in this study.

Results

Efficiency of elbow extensor strength in the ICN transfer group was 47.06%, and it was 28.57% in the cC7 nerve transfer group, but there was no significant difference (P = 0.653). The effective recovery of electromyography in ICN transfer group was 82.35%, whereas in the group cC7 nerve transfer, it was 28.57%, there was a statistical difference between the 2 groups (P = 0.021). Age and interval were negatively correlated with prognosis.

Conclusions

Intercostal nerve or cC7 nerve transfer to the long head branch of triceps could reconstruct elbow extension to some extent. Compared with cC7 nerve transfer, ICN transfer had a greater result for elbow extension, but the difference in extension power was not significant, whereas there was difference in electromyography recovery. Patient's age and interval were negatively correlated with the results.
An Alternative Internal Le Fort I Distractor: Early Results With a New Trans-Nasal Device
Authors: Lypka Michael , Hendricks Heather
Published: March 2020

Purpose:

To report the early experience using a new internal trans-nasal Le Fort I distractor in patients with cleft lip and palate.

Methods:

Patients with cleft lip and palate and severe maxillary deficiency, who were treated with the trans-nasal Le Fort I distractor, were retrospectively reviewed. Cephalometric images were evaluated preoperatively and at least 6 months postoperatively. Speech outcomes were measured before and at least 6 months after surgery. Patient experience with the device was documented and complications were recorded.

Results:

Five male patients with bilateral cleft lip and palate (ages 11–19) underwent the maximum advancement allowed by the device (25 mm). Follow-up averaged 2 years. Average SNA changed from 75.5°preoperatively to 84.6°postoperatively. Average ANB angle changed from −2.8° to 7.4°, or a tendency to Class 2 overcorrection. There was an overall increase in upper anterior facial height by 7.5 mm. All patients achieved acceptable postoperative occlusions. Two patients with borderline velopharyngeal function preoperatively developed velopharyngeal insufficiency postoperatively that did not resolve 6 months postoperatively, necessitating further surgery. Families reported ease of turning with minimal discomfort reported by patients. All patients maintained normal mouth opening during and after the distraction phase. Two of the patients developed localized pin site infections after the distraction phase that were treated successfully with oral antibiotics.

Conclusion:

The trans-nasal Le Fort I distractor can be an effective device to advance the deficient maxilla and is well tolerated by patients.
Eyes Versus Faces: Morphologic Characteristics of Human Eyes in Different Facial Forms
Authors: Jena Ashok Kumar , Sharan Jitendra , Anusuya Venkatachalapathy
Published: March 2020

Objective:

To evaluate the static eye characteristics of female patients with short, normal, and long faces.

Methods:

Standardized full face frontal photographs of 163 female patients in the age range of 15 to 25 years were screened to evaluate their facial index (FI). Based on FI, 27 were short face (group I), 31 were normal face (group II), and 26 were long face (group III) photographs. All 84 photographs were then analyzed manually to determine various static eye characteristics. Descriptive statistics, 1-way analysis of variance and posthoc test (Bonferroni) for multiple comparisons were used. A P-value of 0.05 was considered as level of significance.

Results:

The eye index was significantly different in group I, group II, and group III patients (P < 0.001). The position of the eyes in relation to width of face was significantly less in short (P < 0.05) faces and more in long (P < 0.001) faces compared to normal faces. The intereye distance was equal to the length of 1 eye in all 3 types of faces. Among all types of faces, the intereye distance was nearly half of the interpupillary distance and approximately one-fourth of the face width. The eye divergence was significantly less in long faces compared to short (P < 0.001) and normal faces (P < 0.05).

Conclusion:

The static morphologic characteristics of eyes were significantly different among females with different facial morphologies.
Current Evidence Related to Intermittent Catheterization
Authors: Engberg Sandra , Clapper Jynae , McNichol Laurie , Thompson Donna , Welch Valre W. , Gray Mikel
Published: March 2020

PURPOSE:

The purpose was to summarize evidence related to adherence to intermittent catheterization (IC), complication rates, satisfaction with IC, and its effect on health-related quality of life.

PROBLEM:

Intermittent catheterization is frequently used to manage lower urinary tract dysfunctions including urinary retention and urinary incontinence, but research suggests that care for patients using IC may not always be based on evidence.

METHODS:

Scoping review.

SEARCH STRATEGY:

We searched the PubMed, EMBASE, CINAHL databases, and the Cochrane Database for Systematic Reviews to identify studies published between January 2009 and March 2019. Seventy studies met inclusion criteria and were evaluated for adherence, complication rates, satisfaction, and health-related quality in adults and children using IC for bladder management.

FINDINGS:

Recent research was variable in both quantity and quality. The evidence suggests that (1) most patients can successfully master IC and that functional status is likely the most important predictor of success; (2) adherence to IC probably decreases over time; (3) urinary tract infections (UTIs) are the most common complication of IC and that prophylactic antibiotic therapy may reduce the risk of recurrent UTIs; (4) urinary incontinence is also a common complication; and (5) other complications such as urethral strictures, bladder stones, hematuria, and urethral false passage do occur but are less prevalent than UTIs and incontinence between catheterizations. Our review also revealed multiple gaps in the evidence to support care for patients using IC.

CONCLUSIONS:

Research priorities include a need for prospective studies of the epidemiology and risk factors for IC-related complications, along with intervention studies to determine how to improve outcomes for patients using IC to manage bladder function.
Carrierless amplitude and phase modulation in wireless visible light communication systems
Authors: Bamiedakis N. , Penty R. V. , White I. H.
Published: March 2020

Visible light communications (VLCs) have attracted considerable interest in recent years owing to the potential to simultaneously achieve data transmission and illumination using low-cost light-emitting diodes (LEDs). However, the high-speed capability of such links is typically limited by the low bandwidth of LEDs. As a result, spectrally efficient advanced modulation formats have been considered for use in VLC links in order to mitigate this issue and enable higher data rates. Carrierless amplitude and phase (CAP) modulation is one such spectrally efficient scheme that has attracted significant interest in recent years owing to its good potential and practical implementation. In this paper, we introduce the basic features of CAP modulation and review its use in the context of indoor VLC systems. We describe some of its attributes and inherent limitations, present related advances aiming to improve its performance and potential and report on recent experimental demonstrations of LED-based VLC links employing CAP modulation.

This article is part of the theme issue ‘Optical wireless communication’.
Capacity of optical wireless communication channels
Authors: Chaaban A. , Hranilovic S.
Published: March 2020

Optical wireless communications are realized by modulating the intensity of a light source and detecting intensity fluctuations at the receiver. This mode of operation, known as intensity modulation and direct detection (IM/DD), is simple to implement in practice. However, computing the channel capacity of the underlying channel is not straightforward because of the amplitude constraints that arise due to IM/DD operation. In particular, the transmit signal must be non-negative, while the peak and average amplitudes are constrained due to practical and safety considerations. Though a closed form for the capacity of IM/DD channels is not known, much work has been done to find capacity bounds and asymptotic capacity expressions. In this paper, a description of the IM/DD channel and its physical constraints is presented, followed by a review of recent progress pertaining to the capacity of IM/DD channels. Additionally, capacity-achieving distributions are discussed along with simple constructions that approach capacity.

This article is part of the theme issue ‘Optical wireless communication’.
Some practical constraints and solutions for optical camera communication
Authors: LIU Weijie , Xu Zhengyuan
Published: March 2020

Mobile wireless communication heavily relies on the radio frequency to convey message and data. However, its limited spectrum can hardly meet the demands for the future high data rate applications. Optical wireless communication, in particular visible light communication, opens up vast optical spectrum for communication, and meanwhile can retrofit the light sources as the communication transmitters in the existing working or living environments. In conjunction with the ubiquitous cameras in hand-held consumer electronics such as smartphones and pads, optical camera communication (OCC) further takes advantages of image sensors as the communication receivers and realizes low-cost communication systems. This article first provides an overview of OCC systems. It then addresses some practical constraints, ranging from sensor low frame rate and instability, rolling shutter readout, to visual qualities of displayed images and videos, and link blockage between the transmitter and receiver. Accordingly, it introduces existing and new solutions to deal with those constraints by data modulation, newly developed camera structures, post-processing of sensed signals and non-line of sight OCC as a new form. In particular, indirect paths by either the indoor surface reflection or the outdoor atmospheric scattering are explored for link connectivity under blockage. Finally, some future research directions are suggested.

This article is part of the theme issue ‘Optical wireless communication’.
Distortion losses of high-speed single-photon avalanche diode optical receivers approaching quantum sensitivity
Authors: Kosman John , Moore Kevin , Haas Harald , Henderson Robert K.
Published: March 2020

The high internal gain of single-photon avalanche diodes (SPADs) operating in Geiger mode allows the quantum limit of detection to be approached. This offers a significantly improved sensitivity for optical communication over existing photodiodes. A fully integrated CMOS SPAD array receiver (RX) is presented which achieves 500 Mb s
−1
four-level pulse amplitude modulation in a visible light communication link within 15.2 dB of the quantum limit. However, SPAD dead time induces around 5.7 dB of transient distortion which restricts error performance and data rate. We propose a model describing a discrete photon counting system which exhibits this nonlinear behaviour and compare it to practical measurements with the RX. A unipolar intensity modulated optical signal is considered, as opposed to bipolar electric fields in conventional radio frequency wireless systems. Intermodulation between the DC and harmonic components of the data-carrying waveform is investigated, and the resulting degradation of signal-to-noise-and-distortion ratio and bit error rate is evaluated. The model is developed as a tool for understanding distortion to ultimately allow rectification through RX architecture, modulation scheme, coding and equalization techniques.

This article is part of the theme issue ‘Optical wireless communication’.
Persistently positive culture of antimicrobial-susceptible Legionella pneumophila despite appropriate therapy
Authors: Rafiei Nastaran , Shaw Briony , Dendle Claire , Opat Stephen , Williamson Deborah , Graham Maryza
Published: March 2020

Legionella pneumophila

is a well-known cause of pneumonia that is infrequently cultured in clinical practice. We report a case of an immunocompromised patient with persistently positive

L. pneumophila

cultures from invasive respiratory samples despite prolonged treatment with appropriate antibiotics. In vitro testing showed that the isolate remained susceptible to ciprofloxacin and azithromycin.
How can a medical educational initiative address the evolving problem of vaccine hesitancy?
Authors: Costello Paul , Bouchet Julien , Boyd Melanie , Oakley Simon
Published: March 2020

Background

Current surveillance data suggests that vaccine coverage rates (VCRs) in children are declining, potentially contributing towards outbreaks of vaccine-preventable diseases at levels not commonplace in the UK in recent years. This observed decline in VCRs can be attributed to a number of reasons, one of which is the increasing momentum in vaccine hesitancy.

Insights we have obtained from healthcare professionals (HCPs) demonstrated a paucity of accessible medical education specifically addressing this complex issue. This led Sanofi Pasteur to develop a contemporary, non-promotional ‘Vaccination Educational Initiative’ for HCPs, called Lumiere, part of which focuses on increasing vaccine confidence and addressing vaccine hesitancy.

Objective

Equip HCPs with evidence-based techniques which help them address the concerns of the public and improve vaccine confidence amongst patients.

Method

Five symposia were held across the UK. The faculty comprised both academic experts and specialist nurses with relevant clinical experience who presented proven techniques that can help increase vaccine confidence.

Attendee feedback from the first symposium suggested additional examples on how to apply these techniques in clinical practice would be helpful. Subsequent symposia were modified to include real life cases.

Summary of results

The symposia attracted a total of 443 attendees of which 37% (162) completed evaluation forms.

92% of respondents rated the symposia as good or excellent with 93% indicating they would change clinical practice based on their learnings.

From the initial roll out of Lumiere we have demonstrated that medical education can help support HCPs play an active role in restoring vaccine confidence.