bluuebunny/crossref_metadata_2025 huggingface dataset:
Calcification of hydrophilic acrylic intraocular lenses following secondary surgical procedures in the anterior and posterior segments
Authors: Darcy Kieren , Apel Andrew , Donaldson Mark , McDonald Robert , Males John , Coote Michael , Werner Liliana , Chan Elsie
Published: February 2019

Aims

To report 15 cases of intraocular lens (IOL) calcification following intraocular surgery and to identify common risk factors.

Methods

A retrospective case review of patients with IOL calcification reported from the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, and six surgeons in private practice in the Australian states of Victoria, New South Wales and Queensland.

Results

15 cases of IOL calcification were identified. Eight cases were in hydrophilic acrylic IOLs and seven in hydrophilic acrylic IOLs with hydrophobic surface properties. Five cases occurred following intraocular injection of gas during endothelial keratoplasties. Two cases occurred following pars plana vitrectomy where gas was used. The remaining eight cases did not involve the injection of any intraocular gas; six cases were following trabeculectomy surgery, and two cases were after insertion of a ‘piggyback’ sulcus IOL. In each case, the calcification had a characteristic pattern, being centrally placed in the pupillary zone, mainly affecting the anterior lens surface.

Conclusion

The aetiology of IOL calcification is not fully understood, although there are known risk factors such as using hydrophilic acrylic materials and the use of intraocular gas. Surgical consideration of a patient’s ocular comorbidities before IOL implantation is an important tool to mitigate some of this risk.
Retinal vessel oxygen saturation is affected in uveitis associated with Vogt-Koyanagi-Harada disease
Authors: Abu El-Asrar Ahmed M , AlBloushi Abdulrahman F , Gikandi Priscilla W , Hardarson Sveinn Hákon , Stefánsson Einar
Published: February 2019

Aims

To discover whether retinal vessel oxygen metabolism is affected in uveitis associated with Vogt-Koyanagi-Harada (VKH) disease.

Methods

41 patients with VKH disease (82 eyes) and 12 healthy subjects (24 eyes) matched in age and gender were prospectively evaluated. Retinal oxygen saturation and vessel calibre were measured with a non-invasive spectrophotometric retinal oximeter (Oxymap T1).

Results

In healthy controls, mean arteriolar oxygen saturation (%) was 93.8±5.9 and venular saturation was 60.1±5.8. In acute VKH uveitic phase associated with exudative retinal detachment (n=12), arteriolar and venular oxygen saturation values were 104.7±7.8 and 67.9±7.7, respectively, and both are significantly higher than the healthy group (p<0.001; p=0.001, respectively). In patients with VKH disease who recovered after immunosuppressive therapy and restored normal anatomy without ‘sunset glow fundus’ (n=13), oximetry values were 96.4±9.6 and 61.6±7.5, respectively, similar to healthy controls. In patients with ‘sunset glow fundus’ and chorioretinal atrophy (n=16), saturation levels were 88.6±7.8 and 50.0±13.1, respectively, significantly lower than healthy controls (p=0.02; p=0.003, respectively). These patients also had significantly smaller diameter of retinal arterioles and venules compared with controls (p=0.035; p=0.001, respectively).

Conclusions

Retinal oxygen metabolism is altered in uveitis associated with VKH disease. Oxygen saturation profile is abnormal in acute uveitic phase of the disease and returns to normal in those who recover with normal fundus appearance, but not in eyes that suffer permanent anatomical damage with ‘sunset glow fundus’ and chorioretinal atrophy. Retinal oximetry may be of value in evaluating vascular and metabolic aspects of posterior uveitis.
Cross-sectional evaluation of the relationship between vitamin D status and supplement use across levels of kidney function in adults
Authors: Moore Linda W , Suki Wadi N , Lunsford Keri E , Sabek Omaima M , Knight Richard J , Gaber A Osama
Published: February 2019

Objectives

The objective of this study was to assess vitamin D status of US non-pregnant adults using a standardised assay across 15 mL/min/1.73 m2increments of kidney function, report the use of dietary supplements containing vitamin D and assess relationships between vitamin D and markers of bone resorption.

Design

This study is a cross-sectional evaluation.

Setting

The study is from the US National Health and Nutrition Evaluation Survey in 2001–2012.

Participants

The participants were non-institutionalised, non-pregnant adults, age ≥20 years.

Primary and secondary outcome measures

The primary outcome measure was serum 25OHD evaluated using liquid chromatography-tandem mass spectroscopy traceable to international reference standards. Secondary outcome measures were use of dietary supplements containing vitamin D and the serum intact parathyroid hormone and bone-specific alkaline phosphatase in a subset of participants.

Results

The median 25OHD concentration in 27 543 US non-pregnant adults was 25.7 ng/mL (range, 2.2–150.0 ng/mL). Vitamin D supplements were used by 38.0%; mean (SE)=757 (43) international units/day. The range of 25OHD concentration across groups, stratified by kidney function, was 23.0–28.1 ng/mL. The lowest concentration of 25OHD observed was in people with higher kidney function (23.0 ng/mL for estimated glomerular filtration rate >105 mL/min/1.73 m2). Only 24% of people not taking a dietary supplement had a 25OHD concentration >30 ng/mL. Serum intact parathyroid hormone inversely correlated with 25OHD within all kidney function groups. Bone-specific alkaline phosphatase was also negatively associated with 25OHD concentration.

Conclusions

These data indicate that 25OHD concentrations and supplement use may be suboptimal in a significant proportion of the population, across all kidney function levels. The response of bone resorption markers further suggests that 25OHD levels could be improved. Together, these data support a re-evaluation of the 25OHD concentration associated with health in adults.
Ethnic differences in body mass index trajectories from 18 years to postpartum in a population-based cohort of pregnant women in Norway
Authors: Kinnunen Tarja I , Richardsen Kåre R , Sletner Line , Torgersen Leila , Sommer Christine , Waage Christin W , Mdala Ibrahimu , Jenum Anne Karen
Published: February 2019

Objectives

To explore ethnic differences in changes in body mass index (BMI) from the age of 18 years to 3 months postpartum.

Design

A population-based cohort study.

Setting

Child Health Clinics in Oslo, Norway.

Participants

Participants were 811 pregnant women (mean age 30 years). Ethnicity was categorised into six groups.

Primary outcome measures

The outcome variable was BMI (kg/m2) measured at the age of 18 and 25 years, at prepregnancy and at 3 months postpartum. Body weight at 18 years, 25 years and prepregnancy were self-reported in early pregnancy, while body height and weight at 3 months postpartum were measured. The main statistical method was generalised estimating equations, adjusted for age. The analyses were stratified by parity due to ethnicity×time×parity interaction (p<0.001).

Results

Primiparous South Asian women had a 1.45 (95% CI 0.39 to 2.52) kg/m² higher and Middle Eastern women had 1.43 (0.16 to 2.70) kg/m2higher mean BMI increase from 18 years to postpartum than Western European women. Among multiparous women, the mean BMI increased 1.99 (1.02 to 2.95) kg/m2more in South Asian women, 1.48 (0.31 to 2.64) kg/m2more in Middle Eastern women and 2.49 (0.55 to 4.42) kg/m2more in African women than in Western European women from 18 years to prepregnancy. From 18 years to postpartum, the mean increase was 4.40 (2.38 to 6.42) kg/m2higher in African women and 1.94 to 2.78 kg/m2higher in the other groups than in Western European women.

Conclusions

Multiparous women of ethnic minority origin seem substantially more prone to long-term weight gain than multiparous Western European women in Norway.
Shortening patient-reported outcome measures through optimal test assembly: application to the Social Appearance Anxiety Scale in the Scleroderma Patient-centered Intervention Network Cohort
Authors: Harel Daphna , Mills Sarah D , Kwakkenbos Linda , Carrier Marie-Eve , Nielsen Karen , Portales Alexandra , Bartlett Susan J , Malcarne Vanessa L , Thombs Brett D
Published: February 2019

Objectives

The Social Appearance Anxiety Scale (SAAS) is a 16-item measure that assesses social anxiety in situations where appearance is evaluated. The objective was to use optimal test assembly (OTA) methods to develop and validate a short-form SAAS based on objective and reproducible criteria.

Design

This study was a cross-sectional analysis of baseline data from adults enrolled in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort.

Setting

Adults in the SPIN Cohort in the present study were enrolled at 28 centres in Canada, the USA and the UK.

Participants

The SAAS was administered to 926 adults with scleroderma.

Primary and secondary measures

The SAAS, Brief Fear of Negative Evaluation II (BFNE II), Brief Satisfaction with Appearance Scale (Brief-SWAP), Patient Health Questionnaire-8 (PHQ8) and Social Interaction Anxiety Scale-6 (SIAS-6) were collected, as well as demographic characteristics.

Results

OTA methods identified a maximally informative shortened version for each possible form length between 1 and 15 items. The final shortened version was selected based on prespecified criteria for reliability, concurrent validity and statistically equivalent convergent validity with the BFNE II scale. A five-item short version was selected (SAAS-5). The SAAS-5 had a Cronbach’s α of 0.95 and had high concurrent validity with the full-length form (r=0.97). The correlation of the SAAS-5 with the BFNE II was 0.66, which was statistically equivalent to that of the full-length form. Furthermore, the correlation of the SAAS-5 with the two subscales of the Brief-SWAP, and the SIAS-6, were statistically equivalent to that of the full-length form.

Conclusions

OTA was an efficient method for shortening the full-length SAAS to create the SAAS-5.
Systematic scoping review of frameworks used to develop rehabilitation interventions for older adults
Authors: Booth Vicky , Hood-Moore Victoria , Hancox Jennie E , Logan Phillipa , Robinson Katie R
Published: February 2019

Objectives

Rehabilitation interventions for older adults are complex as they involve a number of interacting components, have multiple outcomes of interest and are influenced by a number of contextual factors. The importance of rigorous intervention development prior to formal evaluation has been acknowledged and a number of frameworks have been developed. This review explored which frameworks have been used to guide the development of rehabilitation interventions for older adults.

Design

Systematic scoping review.

Setting

Studies were not limited for inclusion based on setting.

Participants

Studies were included that featured older adults (>65 years of age).

Interventions

Studies were included that reported the development of a rehabilitation intervention.

Primary and secondary outcome measures

Data were extracted on study population, setting, type of intervention developed and frameworks used. The primary outcome of interest was the type of intervention development framework.

Results

Thirty-five studies were included. There was a range of underlying medical conditions including mild cognitive impairment and dementia (n=5), cardiac (n=4), stroke (n=3), falls (n=3), hip fracture (n=2), diabetes (n=2), breast cancer (n=1), Parkinson’s disease (n=1), depression (n=1), chronic health problems (n=1), osteoarthritis (n=1), leg ulcer (n=1), neck pain (n=1) and foot problems (n=1). The intervention types being developed included multicomponent, support based, cognitive, physical activities, nursing led, falls prevention and occupational therapy led. Twelve studies (34%) did not report using a framework. Five frameworks were reported with the Medical Research Council (MRC) framework for developing and evaluating complex interventions being the most frequently cited (77%, n=17).

Conclusion

At present, the MRC framework is the most popular for developing rehabilitation interventions for older adults. Many studies do not report using a framework. Further, specific guidance to assist this complex field of rehabilitation research is required.
Trends in comparative efficacy and safety of malaria control interventions for maternal and child health outcomes in Africa: a study protocol for a Bayesian network meta-regression exploring the effect of HIV and malaria endemicity spectrum
Authors: Amimo Floriano , Moon Troy D , Magit Anthony , Sacarlal Jahit , Lambert Ben , Nomura Shuhei
Published: February 2019

Introduction

Unprecedented global efforts to prevent malaria morbidity and mortality in sub-Saharan Africa have saved hundreds of thousands of lives across the continent in the last two decades. This study aims to determine how the comparative efficacy and safety of available malaria control interventions intended to improve maternal and child health outcomes have changed over time considering the varied epidemiological contexts on the continent.

Methods

We will review all randomised controlled trials that investigated malaria control interventions in pregnant women in sub-Saharan Africa and were published between January 1980 and December 2018. We will subsequently use network meta-regression to estimate temporal trends in the relative and absolute efficacy and safety of Intermittent Preventive Treatments, Intermittent Screening and Treatments, Insecticide-treated bed nets, and their combinations, and predict their ranking according to their relative and absolute efficacy and safety over time. Our outcomes will include 12 maternal and 7 child mortality and morbidity outcomes, known to be associated with either malaria infection or control. We will use intention-to-treat analysis to derive our estimates and meta-regression to estimate temporal trends and the effect modification by HIV infection, malaria endemicity and Plasmodium falciparum resistance to sulfadoxine–pyrimethamine, while adjusting for multiple potential confounders via propensity score calibration.

PROSPERO registration number

CRD42018095138.
Health professionals in a changing climate: protocol for a scoping review
Authors: Yang Lianping , Liu Chaojie , Hess Jeremy , Phung Dung , Huang Cunrui
Published: February 2019

Introduction

Climate change will impose significant health impacts. Although we know health professionals should play a critical role in protecting human health from climate change, their preparedness to engage with these issues worldwide is unclear. This study aims to map the range and nature of existing evidence regarding health professionals’ knowledge, attitudes, perceptions and practices regarding climate change and health impacts and the challenges they face, and identify knowledge gaps to guide future development of research, policy and practices.

Methods and analysis

We will perform a scoping review based on the six-stage framework proposed by Arksey and O’Malley. Our study includes peer-reviewed literature focusing on any aspect of health professionals’ work regarding climate change and health since 2002 and indexed in MEDLINE/Pubmed, Web of Science, Scopus or Embase. Identified papers will be described and assessed. Thematic analysis will be applied to evaluate and categorise the study findings.

Implications and dissemination

This is the first scoping review of health professionals’ activities to anticipate and prepare for health impacts attributable to climate change. It will provide evidence regarding the current situations worldwide and gaps in preparedness. The findings can be used to highlight accomplishments to date, identify gaps and further develop good practices for health professionals’ engagement. The results will be published in the peer-reviewed literature and shared at health professional society meetings.
Challenges to achieving universal health coverage through community-based health planning and services delivery approach: a qualitative study in Ghana
Authors: Assan Abraham , Takian Amirhossein , Aikins Moses , Akbarisari Ali
Published: February 2019

Objective

Community-based initiatives have enormous potential to facilitate the attainment of universal health coverage (UHC) and health system development. Yet key gaps exist and threaten its sustainability in many low-income and middle-income countries. This study is first of its kind (following the launch of the Sustainable Developments Goal [SDG]) and aimed to holistically explore the challenges to achieving UHC through the community-based health planning and service (CHPS) initiative in Ghana.

Design

A qualitative study design was adopted to explore the phenomenon. Face-to-face indepth interviews were conducted from April 2017 until February 2018 through purposive and snowball sampling techniques. Data were analysed using inductive and deductive thematic analysis approach.

Setting

Data were gathered at the national level, in addition to the regional, district and subdistrict/local levels of four regions of Ghana. Sampled regions were Central Region, Greater Accra Region, Upper East Region and Volta Region.

Participants

In total, 67 participants were interviewed: national level (5), regional levels (11), district levels (9) and local levels (42). Interviewees were mainly stakeholders—people whose actions or inactions actively or passively influence the decision-making, management and implementation of CHPS, including policy makers, managers of CHPS compound and health centres, politicians, academics, health professionals, technocrats, and community health management committee members.

Results

Based on our findings, inadequate understanding of CHPS concept, major contextual changes with stalled policy change to meet growing health demands, and changes in political landscape and leadership with changed priorities threaten CHPS sustainability.

Conclusion

UHC is a political choice which can only be achieved through sustainable and coherent efforts. Along countries’ pathways to reach UHC, coordinated involvement of all stakeholders, from community members to international partners, is essential. To achieve UHC within the time frame of SDGs, Ghana has no choice but to improve its national health governance to strengthen the capacity of existing CHPS.
Effects of high-fidelity simulation based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: a systematic review and meta-analysis
Authors: La Cerra Carmen , Dante Angelo , Caponnetto Valeria , Franconi Ilaria , Gaxhja Elona , Petrucci Cristina , Alfes Celeste M , Lancia Loreto
Published: February 2019

Objective

The purpose was to analyse the effectiveness of high-fidelity patient simulation (HFPS) based on life-threatening clinical condition scenarios on undergraduate and postgraduate nursing students’ learning outcomes.

Design

A systematic review and meta-analysis were conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and its reporting was checked against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

Data sources

PubMed, Scopus, CINAHL with Full Text, Wiley Online Library and Web of Science were searched until July 2017. Author contact, reference and citation lists were checked to obtain additional references.

Study selection

To be included, available full-texts had to be published in English, French, Spanish or Italian and (a) involved undergraduate or postgraduate nursing students performing HFPS based on life-threatening clinical condition scenarios, (b) contained control groups not tested on the HFPS before the intervention, (c) contained data measuring learning outcomes such as performance, knowledge, self-confidence, self-efficacy or satisfaction measured just after the simulation session and (d) reported data for meta-analytic synthesis.

Review method

Three independent raters screened the retrieved studies using a coding protocol to extract data in accordance with inclusion criteria.

Synthesis method

For each study, outcome data were synthesised using meta-analytic procedures based on random-effect model and computing effect sizes by Cohen’s d with a 95% CI.

Results

Thirty-three studies were included. HFPS sessions showed significantly larger effects sizes for knowledge (d=0.49, 95% CI [0.17 to 0.81]) and performance (d=0.50, 95% CI [0.19 to 0.81]) when compared with any other teaching method. Significant heterogeneity among studies was detected.

Conclusions

Compared with other teaching methods, HFPS revealed higher effects sizes on nursing students’ knowledge and performance. Further studies are required to explore its effectiveness in improving nursing students’ competence and patient outcomes.
Premarket evaluation of medical devices: a cross-sectional analysis of clinical studies submitted to a German ethics committee
Authors: Sauerland Stefan , Fujita-Rohwerder Naomi , Zens Yvonne , Molnar Sandra
Published: February 2019

Objective

To assess the methodological quality of pre-market clinical studies performed on medical devices (MDs), including in-vitro diagnostic (IVD) MDs, in Europe.

Design

Observational cross-sectional study.

Setting

A large German ethics committee.

Materials

From the consecutive sample of study applications between March 2010 and December 2013, we selected MD study applications requiring approval by an ethics committee and the competent federal authority. These included pre-market studies on devices that had not yet received a CE (Conformité Européenne) mark or had previously been CE marked for a different indication. Also included were post-CE studies requiring federal authority approval because the study entailed additional invasive or otherwise burdensome components.

Primary and secondary outcome measures

Besides the design of the studies, we assessed the planned sample size, study duration and other aspects.

Results

122 study applications were analysed: 98 (80%) concerned therapeutic rather than diagnostic devices and 84 (69%) were pre-market studies. The proportion of studies on class I, IIa, IIb and III devices was 10%, 15%, 28% and 39%, respectively. 10 studies (8%) investigated IVD MDs. A randomised controlled trial (RCT) was planned in 70 (57%) of the 122 applications; studies with non-randomised control groups (n=23; 19%) or without controls (n=29; 24%) were less common. In the sub-group of pre-market studies on therapeutic devices, the proportion of RCTs was 66% (43/65). The median sample size was 120 participants or samples (IQR 53–229). The median study duration was 24 (14–38) months. 87 studies (71%) considered at least one patient-relevant outcome. 12 (17%) and 37 (53%) of the 70 RCTs applied a fully or partially blinded design, respectively.

Conclusion

A large proportion of MD studies in Germany apply a randomised controlled design, thus contradicting the industry argument that RCTs on MDs are commonly infeasible.
Study on risk factors of extrapyramidal symptoms induced by antipsychotics and its correlation with symptoms of schizophrenia
Authors: Weng Jiajun , Zhang Yan , Li Huafang , Shen Yifeng , Yu Wenjuan
Published: February 2019

Background

Extrapyramidal symptoms (EPS) are one of the most common and neglected side effects during the treatment of schizophrenia. The risk factors of EPS in Chinese patients with schizophrenia and its relationship with psychiatric symptoms and mood symptoms of schizophrenia remain unknown.

Aims

The main objective of this study is to explore the risk factors of EPS caused by antipsychotics and the relationship between EPS and psychotic symptoms and mood symptoms of schizophrenia.

Method

This study included 679 patients with schizophrenia who have met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. Patients were divided into the EPS group and the non-EPS group according to the scale rating criteria and whether the anticholinergics have been used. The differences between demographic data and characters of drug intake were compared between the two groups, and the risk factors of EPS were selected between those factors. Correlation analysis was performed on the severity of schizophrenia (Positive and Negative Symptoms Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS) score) and EPS scale (Simpson-Angus Scale (SAS), Barnes Akathisia Rating Scale (BARS), Abnormal Involuntary Movement Scale (AIMS) score) in 679 patients. The differences between the PANSS subscale score and the CDSS score between the EPS group and the non-EPS group were compared.

Result

Compared with the non-EPS group, the EPS group patients are older, and they have a longer duration since first prescribed antipsychotics. The EPS group patients have higher frequency of atypical antipsychotics polytherapy and typical and atypical antipsychotics polytherapy or combined treatments with mood stabilisers. Logistic regression analysis shows that antipsychotics with high D2 receptor antagonistic effect and illness duration are the risk factors of EPS. The SAS score was significantly correlated with PANSS negative score, PANSS general psychopathological score and PANSS total score. The BARS scale score was significantly correlated with PANSS positive score, PANSS general psychopathological score, PANSS total score and CDSS total score. The AIMS scale score was significantly correlated with PANSS negative score. Compared with the non-EPS group, the EPS group patients have significantly higher PANSS negative score, PANSS general psychopathological score, PANSS total score and CDSS total score.

Conclusion

Antipsychotic drugs with high D2 receptor antagonism and disease duration are risk factors of EPS in Chinese patients with schizophrenia. The severity of various types of EPS is significantly correlated with the psychiatric and mood symptoms of schizophrenia, and psychiatric symptoms and mood symptoms were significantly more severe in the EPS group. The occurrence of EPS is associated with poor treatment outcome of schizophrenia.
MiR-93-5p is a novel predictor of coronary in-stent restenosis
Authors: O'Sullivan John F , Neylon Antoinette , Fahy Eoin F , Yang Pengyi , McGorrian Catherine , Blake Gavin J
Published: February 2019

Aims

MicroRNAs (miRNAs), small non-coding RNAs, have been implicated as regulators of multiple phases of atherothrombosis, and some reports have suggested altered levels in coronary artery in-stent restenosis (ISR). We recently demonstrated that miR-93-5 p was able to discriminate between patients with stable coronary artery disease (CAD) and those with no CAD, after adjusting for traditional risk factors (RFs). Thus, we wanted to determine if circulating miRNAs could predict coronary ISR.

Objective

To determine if circulating miRNAs have diagnostic capability for determining ISR in a cohort of matched patients with and without ISR.

Approach and results

To determine if miRNA plasma levels are elevated in coronary ISR, we conducted a study comprising 78 patients (39 with no ISR and 39 with ISR) and measured plasma miRNAs in each. We then determined the predictive ability of differential miRNAs, adjusting for Framingham Heart Study (FHS) RFs, and stent length and diameter, to discriminate between ISR and no ISR. After correction for multiple testing, two miRNAs—miR425-5p and miR-93-5 p—were differential between patients with ISR and patients without ISR. Only miR-93-5 p remained a strong independent predictor of ISR after correction for FHS RFs (OR 6.30, p=0.008) and FHS RFs plus stent length and diameter (OR 4.80, p=0.02) and improved discriminatory power for ISR over FHS RFs alone in receiver operator characteristic curve analysis.

Conclusion

This novel finding that miR-93-5 p independently predicts ISR extends our recent observation that miR-93-5 p predicted CAD after adjustment for traditional CAD RFs. These data suggest further potential diagnostic utility.
Peculiar mechanical complication of myocardial infarction
Authors: Mathen Pratheesh George , Ghosh Gopal Chandra , Thomson Viji Samuel
Published: February 2019

A 58-year-old man presented to the chest pain unit with crescendo angina over 24 hours and worsening dyspnoea of 10 hours duration. He was a known diabetic and hypertensive on regular treatment for 10 years and a habitual smoker with over 15 pack-years smoking duration. Examination revealed a profusely diaphoretic and dyspnoeic (respiratory rate of 45/min) individual with a blood pressure of 100/60 mm Hg and heart rate of 124 beats/min. He was hypoxic and his oxygen saturation in the ambient air was 64%. His jugular venous pressure was elevated with a prominent V wave. Cardiovascular examination revealed a harsh grade IV/VI systolic murmur over the lower left parasternal border. There were bilateral extensive crepitations heard over the lung fields. ECG on admission revealed presence of Q wave and ST elevation in leads II and III, aVF with ST depression in I and aVL. X-ray chest showed normal cardiac shadow and features of grade III pulmonary venous hypertension. Transthoracic echocardiography is shown in figure 1.

Figure 1

Transthoracic echocardiogram short axis view at mid cavity level, 2D (A) and colour Doppler (B) image.

Question

What is the most likely diagnosis?

A. Left ventricular (LV) true aneurysm

B. LV pseudoaneurysm

C. LV pseudo-pseudoaneurysm

D. Ventricular septal rupture (VSR)

E. LV free wall rupture
Predictors of malignant brain edema after mechanical thrombectomy for acute ischemic stroke
Authors: Huang Xianjun , Yang Qian , Shi Xiaolei , Xu Xiangjun , Ge Liang , Ding Xianhui , Zhou Zhiming
Published: February 2019

Background

Malignant brain edema (MBE) is a devastating complication in ischemic stroke. Data on MBE in patients who have had mechanical thrombectomy (MT) are relatively scarce.

Objective

To investigate the incidence, predictors, and clinical outcomes of MBE in patients after MT.

Methods

We included 130 consecutive patients after MT caused by anterior circulation large vessel occlusion stroke, treated with MT. MBE was defined as a midline shift of ≥5 mm on the follow-up imaging within 72 hours after MT. Characteristics of patients at admission and details of treatment were collected. The 90-day modified Rankin scale score was used as a measure of functional outcomes.

Results

Of the 130 patients (age, 68.6±10.9 years; male, 50%), 35 (26.9%) patients developed MBE. The patients with MBE had a lower rate of functional independence (OR=7.831; 95% CI 1.731 to 35.427; p=0.008) and significantly higher mortality at 90 days (OR=7.958; 95% CI 2.274 to 27.848; p=0.001) than patients without MBE. In 104 (80%) patients with successful recanalization (modified Thrombolysis in Cerebral Infarction score of 2b–3), 24 (23.1%) patients exhibited MBE. After adjustment for confounding, ICA occlusion (OR=3.746; 95% CI 1.169 to 12.006; p=0.026) and worse collateral score (grade 1 vs grade 0: OR=0.727; 95% CI 0.192 to 2.753; p=0.638; grade 2 vs grade 0: OR=0.130; 95% CI 0.021 to 0.819; p=0.030) were significantly associated with the development of MBE, despite successful recanalization.

Conclusions

MBE after MT is not uncommon and was related to poor functional outcomes. Localization of a vessel occlusion and collateral status may play a role in the development of MBE.
Use of prophylactic antibiotic in preventing complications for blunt and penetrating chest trauma requiring chest drain insertion: a systematic review and meta-analysis
Authors: Ayoub Firas , Quirke Michael , Frith Daniel
Published: February 2019

Background

Chest drain insertion after chest trauma is often associated with high rate of complications. The use of prophylactic antibiotics in patients with blunt and penetrating chest trauma to prevent empyema and pneumonia after chest drain insertion has been debated.

Objective

To analyze the effectiveness of prophylactic antibiotics versus placebo to prevent complications in patients with blunt and penetrating chest injuries who require the insertion of a chest drain.

Methods

Pubmed, Embase, and grey literature databases were searched during May 2017 for randomized clinical trails comparing prophylactic antibiotic versus placebo in patients with chest injuries requiring chest drain insertion. Good quality randomized studies which met the inclusion criteria were assessed using the Cochrane Collaboration tool for assessing risk of bias and then were included in the systematic review. A meta-analysis of the included studies was concluded using Stata to analyze the relative risk of empyema and pneumonia in these patients.

Results

The study identified 12 randomized studies that included 1263 patients with isolated blunt and penetrating chest trauma. The incidence of empyema after a chest drain insertion was 1% in the antibiotic group and 7.2% in the placebo group. The incidence of pneumonia after a chest drain insertion was 4.4% in the antibiotic group and 10.7% in the placebo group. The use prophylactic antibiotic in those patients was associated with a reduced risk of empyema (relative risk [RR] 0.25; 95% CI 0.13 to 0.49) and pneumonia (RR 0.41; 95% CI 0.24 to 0.71) after chest drain insertion when compared with placebo alone.

Conclusion

Prophylactic antibiotic administration in patients with penetrating and blunt chest injuries requiring the insertion of a chest drain was associated with a reduced risk for post-traumatic empyema and pneumonia. Further studies should evaluate the optimal type, dose, and duration of antibiotic given to patients with chest trauma requiring chest drain insertion.
Causes and outcomes of traumatic brain injuries in Uganda: analysis from a pilot hospital registry
Authors: Zia Nukhba , Mehmood Amber , Namaganda Rukia H , Ssenyonjo Hussein , Kobusingye Olive , Hyder Adnan A
Published: February 2019

Background

Traumatic brain injury (TBI) is an important cause of morbidity and mortality in low/middle-income countries. The objective was to assess causes and outcomes of unintentional and intentional TBI among patients presenting to a tertiary care hospital in Uganda.

Methods

This study was conducted at Mulago National Referral Hospital, Kampala, Uganda, for 15 months in 2016–2017. Patients of all ages, males and females, presenting to the emergency department with suspected or documented TBI were enrolled. Patient demographics, TBI causes and outcomes were recorded. The outcome of interest was unintentional and intentional TBI.

Results

Intent was known for 3749 patients, of these 69.7% were unintentional TBI and 30.3% were intentional TBI. The average age of patients in both groups was similar (28±14 years) with over 70% of patients between 19 and 45 years age group. About 80% were males in both groups. The main causes of unintentional TBI were road traffic injuries (RTI) (88.9%) and falls (11.1%). Pedestrians (42.1%) and motorcycle drivers (28.1%) were the most common road users. Among patients with unintentional TBI, about 43.6% were admitted, 34.0% were sent home. There were 73 deaths: 63 were patients with RTI and 10 had a fall. Although assault (97.1%) was the main cause of intentional TBI, those patients with self-harm were likely to be in severe Glasgow Coma Scale range (39.4%) compared with victims of assault (14.2%). Among patients with intentional TBI, 42.6% were admitted and 37.1% were sent home. There were 30 deaths: 29 were assault victims and 1 of self-harm.

Discussion

Unintentional TBI caused by RTI and intentional TBI caused by assault are common among young males attending Mulago Hospital in Kampala.

Level of evidence

Prospective observational study, level III.
Emergency trauma laparotomy and/or thoracotomy in the emergency department: risks and benefits
Authors: Ito Kaori , Nakazawa Kahoko , Nagao Tsuyoshi , Chiba Hiroto , Miyake Yasufumi , Sakamoto Tetsuya , Fujita Takashi
Published: February 2019

Background

It is not mandatory for Japanese trauma centers to have an operating room (OR) and OR team available 24 hours a day/7 days a week. Therefore, emergency laparotomy/thoracotomy is performed in the emergency department (ED). The present study was conducted to assess the safety of this practice.

Methods

The data were reviewed from 88 patients who underwent emergency trauma laparotomy and/or thoracotomy performed by our acute care surgery group during the period from April 2013 to December 2017. Operation was performed in the ED for 43 of 88 patients (51%, ED group), and in the OR for 45 of 88 patients (49%, OR group). The perioperative outcomes of the two groups were compared.

Results

Compared with the OR group, the ED group had a higher Injury Severity Score (30±15 vs. 13±10, p<0.01), greater incidence of blunt trauma (74% (32/43) vs. 36% (16/45), p<0.01), larger volume of red blood cell transfusion (18±18 units vs. 5±10 units, p<0.01), higher incidence of new-onset shock after sedation among patients who received sedation in the ED (59% (17/29) vs. 25% (6/24), p<0.01), and higher in-hospital mortality rate (49% (21/43) vs. 0, p<0.01). All five patients who underwent laparotomy followed by thoracotomy died in the ED; none of these patients underwent preoperative placement of resuscitative endovascular balloon occlusion of the aorta (REBOA). Of the 21 patients in the ED group who died, 17 (81%) died immediately postoperatively; furthermore, 12 of the 22 patients who survived (55%) were not in shock prior to operation.

Discussion

Emergency trauma laparotomy and/or thoracotomy outcomes were related to injury severity. The resources for trauma operations in the ED seemed suboptimal. The outcome of trauma operations may be improved by reviewing the protocols for anesthetic care, and by the usage of REBOA rather than aortic cross-clamping.

Level of evidence

IV
Polybenzimidazole/BaCe0.85Y0.15O3-δ nanocomposites with enhanced proton conductivity for high-temperature PEMFC application
Authors: Salehi Artimani Javad , Ardjmand Mehdi , Enhessari Morteza , Javanbakht Mehran
Published: February 2019

The present work reports the synthesis of polybenzimidazole (PBI)/BaCe0.85Y0.15O3-δ nanocomposite membrane. The obtained membranes were investigated to use as novel electrolytes in high-temperature proton exchange fuel cells. The PBCYx membranes were prepared with dispersing BaCe0.85Y0.15O3-δ into the polyimidazole membrane by solution casting method. The obtained membranes were used as novel proton conductors. The thermal stability and structural properties were investigated. The conductivity and morphology of the obtained materials were studied using impedance spectroscopy AC (IS) and a scanning electron microscope (SEM) equipped with energy dispersive X-ray spectroscopy (EDX). The maximum phosphoric acid adsorption (175%) and protonic conductivity (0.092 S/cm at 180 °C under dry conditions) were observed for all of the PBI nanocomposite membranes containing 5 wt.% of BaCe0.85Y0.15O3-δ in the membrane matrix. The polarization and power density curves were studied at 150 and 180 °C operating temperatures. The power density of about 0.42 W/cm2 and current density of about 0.84 A/cm at 0.5 V and 180 °C were achieved under dry conditions. The data obtained from our studies showed that the physicochemical properties of the novel nanocomposites were enhanced for using in the high-temperature proton transfer fuel cells.
Advances in Density-Functional Calculations for Materials Modeling
Authors: Maurer Reinhard J. , Freysoldt Christoph , Reilly Anthony M. , Brandenburg Jan Gerit , Hofmann Oliver T. , Björkman Torbjörn , Lebègue Sébastien , Tkatchenko Alexandre
Published: February 2019

During the past two decades, density-functional (DF) theory has evolved from niche applications for simple solid-state materials to become a workhorse method for studying a wide range of phenomena in a variety of system classes throughout physics, chemistry, biology, and materials science. Here, we review the recent advances in DF calculations for materials modeling, giving a classification of modern DF-based methods when viewed from the materials modeling perspective. While progress has been very substantial, many challenges remain on the way to achieving consensus on a set of universally applicable DF-based methods for materials modeling. Hence, we focus on recent successes and remaining challenges in DF calculations for modeling hard solids, molecular and biological matter, low-dimensional materials, and hybrid organic-inorganic materials.
A 9‐Year Longitudinal Study of Basilar Artery Diameter
Authors: Takeuchi Mariko , Miwa Kaori , Tanaka Makiko , Zhou Yi , Todo Kenichi , Sasaki Tsutomu , Sakaguchi Manabu , Kitagawa Kazuo , Mochizuki Hideki
Published: February 2019

Background

Dilatation of the basilar artery (
BA
) has been recognized as a predictor of cardiovascular events (
CVE
s). However, it is unclear if the longitudinal change in
BA
diameter (Δ
BA
) is associated with
CVE
s.

Methods and Results

In a cohort of Japanese participants with vascular risk factors in an observational study, we evaluated the relationship of Δ
BA
to
CVE
s and the time course of the
BA
diameter. The short axis of the
BA
diameter was measured at the midpons level in T2‐weighted images. Brain magnetic resonance imaging measurements included cerebral small‐vessel disease, lacunars, and white matter hyperintensities. First, 493 patients were analyzed by the time‐dependent Cox proportional hazards model to evaluate the association between Δ
BA
and
CVE
s, with adjustment for age, sex, vascular risk factors, and magnetic resonance imaging parameters. Second, we assessed the longitudinal Δ
BA
in 164 patients who underwent long‐term follow‐up magnetic resonance imaging, by linear regression analysis. In the mean follow‐up of 8.7 years, 105 patients developed
CVE
s. A smaller Δ
BA
was independently associated with the high incidence of
CVE
s (hazard ratio, 0.36; 95% CI, 0.16–0.78;
P
=0.010; n=493). After a mean interval of 9.4 years, the average Δ
BA
was 0.41±0.46 mm (excluding patients with fetal‐type circle of Willis). Progression of
BA
dilatation was associated with men but inversely associated with initial
BA
diameter and fetal‐type circle of Willis (n=164).

Conclusions

BA
diameter increased over time (excluding the patients with fetal‐type circle of Willis), whereas Δ
BA
was inversely associated with the incidence of
CVE
s.
A Percolation-Like Process of Within-Organization Collective Corruption: A Computational Approach
Authors: Kim Sang-Joon , Lee Jegoo
Published: February 2019

This study investigates how collective corruption appears, using a computational method. Specifically, acknowledging that the characteristics of collective corruption process are analogous to percolation phenomena, we illuminate that collective corruption is formed by ongoing social interactions in an organizational boundary. By formulating a percolation-based system dynamics model, we consider the behavioral characteristics of collective corruption in terms of individuals’ corruption preferences governed by personal attributes on corruption. We also propose and examine scenarios regarding the formation of collective corruption.
Parental Incarceration and Social Status Attainment of Hispanic Young Adults
Authors: Ryabov Igor
Published: February 2019

The fact that parental incarceration has become a common event in the life course of many children is troubling. Using structural equation modeling, the present study investigates how immigrant generational status and family socioeconomic background interact with parental incarceration to influence status attainment for Hispanic young adults. Three indicators of status attainment in young adulthood are used as outcome variables—educational attainment, wage, and job quality. Results indicate that parental incarceration has a strong and negative influence on all three indicators of attained status. Most importantly, we found that parental incarceration mediates influence of immigrant generational status and family socioeconomic background on status attainment of Hispanic young adults.
Inequities of Enrollment in Gifted Education: A Statewide Application of the 20% Equity Allowance Formula
Authors: Lamb Kristen N. , Boedeker Peter , Kettler Todd
Published: February 2019

Underrepresentation in gifted education for ethnically diverse student groups has been widely recognized. Two recent federal district court decisions defined the lower limits of equitable participation using the 20% equity allowance formula proposed by Donna Ford. The purpose of this article was to evaluate the application of the 20% rule to identify the prevalence of inequity and associated variables in Texas gifted education programs. Using data from the Office of Civil Rights and Texas Education Agency, the authors applied the 20% rule to demographics of K-12 gifted education programs in Texas to identify inequity and used Bayesian regression with district characteristics to investigate contributing factors of inequity. Only 282 of 994 (28.4%) districts met equity standards for Hispanic students. Second, Bayesian regressions with district-level characteristics of students, teachers, and expenditures were used to identify factors associated with inequitable enrollment of Hispanic students. Overall, the model accounted for 12.9% variance ( R2 = 0.129, 95% highest density interval [0.095, 0.170]), with increasing variance explained by district subsets (i.e., city, suburb, town, rural). Furthermore, the results of the regression models revealed the percentage of Hispanic and White teachers were inversely associated with inequity across all district subsets. It is postulated that the mechanism of inequity is in the teacher referral process, frequently used as a determinant of gifted education enrollment. The authors suggest means of addressing this reality.
Role of Anti-inflammatory Drugs in the Colorectal Cancer
Authors: Sada Oumer , Ahmed Kemal , Jeldo Aliye , Shafi Mensur
Published: February 2019

Objective: The objective of this review was to systematically review and synthesize evidence regarding benefits of using nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of colorectal cancer (CRC). Data Sources: The data sources were MEDLINE, PubMed, NEJM, Google Scholar, and Google searches of references from relevant and eligible trials. Review Methods: We screened abstracts and full-text articles of identified references for eligibility and reviewed randomized controlled trials, cohort studies, and meta-analysis for evidence on benefits of using NSAIDs in CRC treatments. For all extracted data, completeness and relevance were checked. Results: The risk of any adenoma among frequent NSAID users was 26.8% vs 39.9% among placebo subjects who later used NSAIDs sporadically (adjusted relative risk = 0.62, 95% confidence interval [CI] = 0.39-0.98; P trend with NSAID use frequency = .03). Long-term use of aspirin reduces the risk of CRC. Aspirin also reduces the incidence of colon adenomas and mortality, especially when used for >10 years. Rofecoxib is associated with the reduction of CRC; however, it was associated with cardiovascular risk (with an overall unadjusted relative risk of 1.50 [95% CI = 0.76-2.94; P = .24]). Adenoma Prevention with Celecoxib trial shows that, for patients of all genotypes, the estimated cumulative incidence of one or more adenomas by year 3 was 59.8% for those randomized to placebo as compared with 43.3% for those randomized to low-dose (200 mg, twice daily) celecoxib (relative risk [RR] = 0.68; 95% CI = 0.59-0.79; P < .001) and 36.8% for those randomized to high-dose (400 mg, twice daily) celecoxib and 60.7% in placebo group (RR = 0.54; 95% CI = 0.46-0.64; P < .001). Conclusions: The use of COX-2 inhibitors both prior to and after diagnosis of CRC seemed to be mildly associated with the reduction in mortality of patients with CRC. Some literatures state that COX-2 inhibitors might play a synergistic role in adjuvant chemotherapy of FOLFOX regimen. Celecoxib was found to increase the radiosensitization of colon cancer cells.