bluuebunny/crossref_metadata_2025 huggingface dataset:
Advances in the rehabilitation of intensive care unit acquired weakness
Authors: Chillura Antonino , Bramanti Alessia , Tartamella Francesco , Pisano Maria Francesca , Clemente Elvira , Lo Scrudato Marzia , Cacciato Giuseppe , Portaro Simona , Calabrò Rocco Salvatore , Naro Antonino
Published: July 2020

Introduction:

Traditional physiotherapy is currently the best approach to manage patients with intensive care unit acquired weakness (ICUAW). We report on a patient with ICUAW, who was provided with an intensive, in-patient regimen, that is, conventional plus robot-assisted physiotherapy. Aim of this case study was to assess the efficacy of a combined approach (conventional plus robot-assisted physiotherapy), on muscle strength, overall mobility, and disability burden in a patient with ICUAW in post-ICU intensive rehabilitation setting.

Patient concerns:

A 56-years-old male who was unable to stand and walk independently after hospitalization in an Intensive Care Unit. He initially was provided with daily sessions of conventional physiotherapy for 2 months, with mild results.

Diagnosis:

The patient was affected by ICUAW.

Intervention:

Given that the patient showed a relatively limited improvement after conventional physiotherapy, he was provided with daily sessions of robot-aided training for upper and lower limbs and virtual reality-aided rehabilitation for other 4 months, beyond conventional physiotherapy.

Outcomes:

At the discharge (6 months after the admission), the patient reached the standing station and was able to ambulate with double support.

Conclusions:

Our case suggests that patients with ICUAW should be intensively treated in in-patient regimen with robot-aided physiotherapy. Even though our approach deserves confirmation, the combined rehabilitation strategy may offer some advantage in maximizing functional recovery and containing disability.
Wilson disease patient with rare heterozygous mutations in ATP7B accompanied by distinctive nocturnal enuresis
Authors: Zhang Shijie , Li Liangyong , Wang Jiuxiang
Published: July 2020

Introduction:

Wilson disease (WD) is an autosomal-recessive disorder of copper metabolism, which exhibits various symptoms due to the combination of environmental and genetic factors. Here, we report a WD patient who displayed distinctive symptom of nocturnal enuresis.

Patient concerns:

The patient was a 31-year old woman, who recently developed nocturnal enuresis, combined with hand tremors, trouble speaking, and panic disorder at night.

Diagnosis:

The patient had been diagnosed with WD by Kayser-Fleischer rings, abnormal copper metabolism, neuropsychiatric symptoms, and magnetic resonance imaging when she was 17. The diagnosis was further confirmed by genetic analysis, which revealed a compound heterozygous mutations in ATP7B gene (c.2195T>C and c.3044T>C). The patient exhibited nocturnal enuresis, but the ambulatory electroencephalogram, routine urinalysis, residual urine detection, color doppler ultrasound of kidney, ureter, and bladder all displayed no abnormality.

Interventions:

The patient was treated with sodium dimercaptosulphonate, supplemented with Glutathione and Encephalin-inosine.

Outcomes:

The urinary copper excretion level decreased gradually, and the nocturnal enuresis was alleviated along with the neuropsychiatric symptoms by copper chelation therapy.

Conclusion:

In this study, we proved that variants c.2195T>C and c.3044T>C is involved in pathogenesis of WD, and revealed that nocturnal enuresis may be a symptom of WD.
Household financial burden among multidrug-resistant tuberculosis patients in Guizhou province, China
Authors: Wang Yun , McNeil Edward B. , Huang Zhongfeng , Chen Ling , Lu Xiaolong , Wang Chengqiong , Chen Huijuan , Chongsuvivatwong Virasakdi
Published: July 2020

Multidrug-resistant tuberculosis (MDR-TB) threatens global public health. Poor access to health care due to financial hardship contributes to further transmission of the disease. The study aimed to:

A cross-sectional study was conducted in 2 hospitals designated for MDR-TB from January to August 2018. Data were collected by interviewing eligible MDR-TB outpatients and reviewing the medical records. The magnitude of financial burden was documented by total cost and distribution of cost components. Catastrophic payments were measured by 2 indicators: catastrophic health expenditure (CHE) and catastrophic total costs (CTC), both of which were estimated by incidence and intensity. Their associated factors were determined using logistic regression models.

Of 161 households affected by MDR-TB, the average total costs due to MDR-TB treatment in the first year was US$ 8266 and consisted of 72% direct medical costs, 5% direct non-medical costs and 23% indirect costs (income loss). Thirty seven percent of direct medical costs were covered by insurance. Overall, the incidence of CHE and CTC was 68.3% and 87.0%, respectively. Both incidence and intensity for the 2 defined catastrophic costs increased when a households income decreased. Five significant factors of catastrophic costs were low household income, absence of students in a family, hospital length of stay, male gender, and job/productivity loss.

Households with MDR-TB patients shouldered a high financial burden which was mainly driven by direct medical costs and income loss in Guizhou. Greater catastrophic payments were associated with hospital length of stay and socioeconomic status, especially had a dose-response relationship with households income. Our findings suggest that financial and social protection of local policies for MDR-TB should be improved by preparing a uniform and comprehensive insurance package to cover sufficiently direct medical costs, and introducing social pro-poor assistance policies for risk families to protect them from financial hardship.
Neighborhood socioeconomic status and risk of hospitalization in patients with chronic kidney disease
Authors: Saunders Milda R. , Ricardo Ana C. , Chen Jinsong , Anderson Amanda H. , Cedillo-Couvert Esteban A. , Fischer Michael J. , Hernandez-Rivera Jesus , Hicken Margaret T. , Hsu Jesse Y. , Zhang Xiaoming , Hynes Denise , Jaar Bernard , Kusek John W. , Rao Panduranga , Feldman Harold I. , Go Alan S. , Lash James P.
Published: July 2020

Patients with chronic kidney disease (CKD) experience significantly greater morbidity than the general population. The hospitalization rate for patients with CKD is significantly higher than the general population. The extent to which neighborhood-level socioeconomic status (SES) is associated with hospitalization has been less explored, both in the general population and among those with CKD.

We evaluated the relationship between neighborhood SES and hospitalizations for adults with CKD participating in the Chronic Renal Insufficiency Cohort Study. Neighborhood SES quartiles were created utilizing a validated neighborhood-level SES summary measure expressed as z-scores for 6 census-derived variables. The relationship between neighborhood SES and hospitalizations was examined using Poisson regression models after adjusting for demographic characteristics, individual SES, lifestyle, and clinical factors while taking into account clustering within clinical centers and census block groups.

Among 3291 participants with neighborhood SES data, mean age was 58 years, 55% were male, 41% non-Hispanic white, 49% had diabetes, and mean estimated glomerular filtration rate (eGFR) was 44 ml/min/1.73 m2. In the fully adjusted model, compared to individuals in the highest SES neighborhood quartile, individuals in the lowest SES neighborhood quartile had higher risk for all-cause hospitalization (rate ratio [RR], 1.28, 95% CI, 1.09–1.51) and non-cardiovascular hospitalization (RR 1.30, 95% CI, 1.10–1.55). The association with cardiovascular hospitalization was in the same direction but not statistically significant (RR 1.21, 95% CI, 0.97–1.52).

Neighborhood SES is associated with risk for hospitalization in individuals with CKD even after adjusting for individual SES, lifestyle, and clinical factors.
Risk factors for bone flap resorption after autologous bone cranioplasty
Authors: Yang Jingguo , Sun Tong , Yuan Yikai , Li Xuepei , Zhou Yicheng , Guan Junwen
Published: July 2020

Background:

One of the most common complications following autologous cranioplasty is bone flap resorption (BFR). Severe BFR can lead to revision surgery with implantation of synthetic bone flap and also necessarily lead to higher hospital expenses. This study aims to perform a meta-analysis to summarize available evidence regarding risk factors of BFR requiring a second surgery in patients with autologous cranioplasty.

Methods:

Cohort, case-control, and cross-sectional studies that report the incidence and risk factors of BFR among patients with autologous cranioplasty, published in English, will be considered for selection. Three databases from inception to May 2020 will be searched. The process of data selection, quality assessment, and data extraction will be assessed by 2 authors independently. The study quality will be assessed by Newcastle-Ottawa Scale (NOS) and Agency for Healthcare Research and Quality checklist.

The statistical analysis of this meta-analysis will be calculated by Review manager version 5.3.

Results:

The results of this systematic review and meta-analysis will be disseminated through academic conferences and expected to publish in a peer-reviewed journal

Conclusion:

This study will offer high-quality evidence about risk factors for BFR after autologous cranioplasty.

Registration number:

INPLASY202050063.
Effects of salvianolic acid B on liver fibrosis
Authors: Ma Xiaocong , Tang Meiwen , Lu Liying , Zheng Jinghui , Huang Jingjing , Li Junhong , Luo Weisheng
Published: July 2020

Background:

Liver fibrosis is a pathological change existing in most chronic liver diseases, which leads to abnormal changes in liver tissue structure and affects the normal physiological function of liver. Without effectively control, liver fibrosis can develop into cirrhosis and increase the risk of liver cancer. Salvianolic acid B (Sal B) is the main active component in the water-soluble extract from Salvia miltiorrhiza, which is a traditional Chinese medicine usually used for treating cardiovascular and liver diseases. It is reported that Sal B shown a good action against liver fibrosis via numerous signaling pathways, which indicate that Sal B is a potential candidate drug for the treatment of liver fibrosis.

Methods:

We searched the related researches from the following electronic databases: PubMed, EMBASE, Web of science, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), Wan fang Database for Chinese Technical Periodicals and VIP Database. All the databases were searched from inception to December 2019. No restriction of language, publication date, or publication status. PICO of this systematic review are shown as flowing: P, preclinical studies which evaluated the effects of Sal B on the animal models of liver fibrosis with controlled studies; I, received Sal B as only treat in any dose; C, received normal saline, distilled water, or no treatment; O, the primary outcome include measure will be the decrease in liver fibrosis score, and the secondary outcomes include the index of liver fibrosis. All the included data will be analyzed with the software of Review Manager 5.2 and STATA 14.2.

Discussion:

The purpose of this study is to conduct a systematic review and meta-analysis to assess the effects on anti-liver fibrosis of Sal B, and this will be contribute to drug development and pathological mechanisms of clinical research.

Trial registration:

INPLASY202050101, registered on 28/5/2020.
Comparative efficacy of Chinese herbal injections combined with GP regimen chemotherapy for patients with advanced NSCLC
Authors: Li Juan , Zhu Guang-Hui , Liu Tong-Tong , Xu Bo-Wen , Li Jie
Published: July 2020

Background:

Many research has indicated that some Chinese herb injections (CHIs) might be beneficial in combination with chemotherapy, however, with inconsistent results. Hence, the purpose of this network meta-analysis is to evaluate different CHIs plus cisplatin and gemcitabine (GP) with GP alone in terms of clinical efficacy and safety for treating patients with advanced NSCLC.

Methods:

A comprehensive systematic search of clinical randomized controlled trials (RCTs) published in the PubMed, Embase, Web of Science (ISI), Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure Database (CNKI), Chinese Scientific Journals Full-Text Database (VIP), Wanfang Database and China Biological Medicine Database (CBM) databases will be conducted to identify eligible studies up to the date of May 2020. The primary outcome measures objective response rate and adverse reactions (nausea and vomiting, leukopenia). The secondary outcome measures median survival time (MST), disease control rate, and quality of life. The methodological qualities, including the risk of bias, will be evaluated using the Cochrane risk of bias assessment tool, while confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The network meta-analysis will be performed using WinBUGS 14 and Stata 15.1 software.

Results:

Based on the current evidence, the potential rank of the efficacy and safety of CHIs plus GP chemotherapy for advanced NSCLC will be assessed, and a prioritization regimen will be summarized.

Conclusion:

Evidence from this systematic review could be useful for patients, clinical practitioners, and guideline-makers to select an optimum proposal of CHIs plus GP for advanced NSCLC.

Ethics and dissemination:

It is not necessary for ethical approval because it is based on published studies. The protocol will be disseminated in a peer-reviewed journal or presented at a topic-related conference.

PROSPERO registration number:

CRD42020167142
Late histological findings in symptomatic COVID-19 patients
Authors: Aiolfi Alberto , Bruni Barbara , Biraghi Tullio , Montisci Andrea , Miceli Antonio , Baronio Barbara , Khor Desmond , Cirri Silvia , Donatelli Francesco , Clemente Claudio , Bona Davide
Published: July 2020

Rationale:

Although there have been several studies describing clinical and radiographic features about the novel coronavirus (COVID-19) infection, there is a lack of pathologic data conducted on biopsies or autopsies.

Patient concerns:

A 56-year-old and a 70-year-old men with fever, cough, and respiratory fatigue were admitted to the intensive care unit and intubated for respiratory distress.

Diagnosis:

The nasopharyngeal swab was positive for COVID-19 and the chest Computed Tomography (CT) scan showed the presence of peripheral and bilateral ground-glass opacities.

Interventions:

Both patients developed pneumothoraces after intubation and was managed with chest tube. Due to persistent air leak, thoracoscopies with blebs resection and pleurectomies were performed on 23rd and 16th days from symptoms onset.

Outcomes:

The procedures were successful with no evidence of postoperative air-leak, with respiratory improvement. Pathological specimens were analyzed with evidence of diffuse alveolar septum disruption, interstitium thickness, and infiltration of inflammatory cells with diffuse endothelial dysfunction and hemorrhagic thrombosis.

Lessons:

Despite well-known pulmonary damages induced by the COVID-19, the late-phase histological changes include diffused peripheral vessels endothelial hyperplasia, in toto muscular wall thickening, and intravascular hemorrhagic thrombosis.
Application of stepper in cardiopulmonary exercise test for patients with hemiplegia
Authors: Huang Shu-Chun , Hsu Chih-Chin , Fu Tieh-Cheng , Chen Carl PC , Liao Ming-Feng , Hsu Yi-Hsuan , Wang Jong-Shyan
Published: July 2020

A method to perform exercise testing for patients with hemiplegia is unavailable though over half of them have cardio-pulmonary disorders. We aimed to assess the reliability and validity of using a stepper in cardiopulmonary exercise testing (CPET) in this population.

14 stroke patients with hemiplegia who failed to ride the stationary bike were included. Exclusion criteria included manual muscle strength ≦1 in the lower extremity, and conventional contraindications of CPET. They underwent CPET twice by using a stepper to evaluate test–retest reliability and validity. Additionally, 10 healthy participants underwent CPET twice on the cycle ergometer and stepper respectively.

In the test–retest, the ratio of two-time difference to mean was 5.0, 3, 11.3 and 12.0% on average for peak oxygen consumption, peak heart rate (HR), anaerobic threshold and minute ventilation - carbonic dioxide production slope respectively. Cronbach's alpha coefficient of peak oxygen consumption and anaerobic threshold were 0.992 and 0.919. In the stepper exercise testing of the hemiplegic participants, the ratio of peak HR to age-predicted maximal HR was 75% on average. Peak respiratory exchange ratio (mean ± standard deviation = 1.17 ± 0.08) was not different from that of healthy controls (1.21 ± 0.09). Notably, VO2 trajectory in relation to work rate is nonlinear and different in the rest-retest.

This is the first research to study CPET variables in detail using stepper in patients with hemiplegia. CPET variables associated with peak are valid and reliable; nonetheless, those with sub-maximum are not. The study provides a method to do exercise testing for the patients with hemiplegia and its notice in application.
Comparison of the perioperative parameters between computer navigation and fluoroscopy guidance for pedicle screw placement
Authors: Li Qianchun , Chen Botao , Chen Rigao , Yu Yang , Jiang Leiming , Fan Xiaohong
Published: July 2020

Background:

Computer navigation technology is gradually applied to the placement of pedicle screws, but its security and effectiveness still lack of high-quality evidence-based medical evidence. In this study, we will perform a systematic review of previously published randomized controlled trials to investigate the accuracy and effectiveness of computer navigation vsersus fluoroscopy guidance for pedicle screw placement.

Methods:

All study protocols adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed (MEDLINE), The excerpta medica database, Web of Science (science and social science citation index), The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, WanFang, Chinese Biomedical Literature Database will be searched for relevant articles up to 18 April, 2020. We will include randomized controlled trials of computer navigation and fluoroscopy guidance for pedicle screw placement. The Cochrane Handbook (v6) will be used for assessment of study bias and reliability, and a meta-analysis will be performed using STATA 16.0. The main outcome will be the proportion of accurate implanted screws. Additional outcomes including: overall complication rate, radiation dosage, length of surgery, length of stay, estimated blood loss.

Results:

The quality of the assessments will be assessed through Grading of Recommendations Assessment, Development, and Evaluation. Data will be disseminated through publications in peer-reviewed journals.

Conclusion:

We will evaluate the accuracy and other perioperative parameters between computer navigation and fluoroscopy guidance for pedicle screw placement.

Trial registration number:

PROSPERO 2020 CRD42020172087.
A protocol of systematic review and meta-analysis of acupuncture for drug resistant epilepsy
Authors: Wang Ze-Yu , Jiang Yao-Jia , Wang Zeng-Mian , Ren Ming-Yu
Published: July 2020

Background:

This study aims to appraise the effectiveness and safety of acupuncture for drug resistant epilepsy (DRE).

Methods:

We will search all potential randomized controlled trials (RCTs) of acupuncture for patients with DRE from their origin to March 1, 2020: MEDLINE, EMBASE, Cochrane Library, CINAHL, Scopus, WANGFANG, and Chinese Biomedical Literature Database. We will not apply any restrictions to the language and publication date. All RCTs investigating the effectiveness and safety of acupuncture for patients with DRE will be included. Study quality will be appraised by Cochrane risk of bias, and statistical analysis will be scrutinized by RevMan 5.3 software. Whenever possible, a narrative summary to describe study quality and content of the evidence will be performed.

Results:

This study will provide summarize high quality evidence and will utilize a variety of outcome measurements to verify effectiveness and safety of acupuncture for DRE.

Conclusion:

The results of this study will seek to explore the effectiveness and safety of acupuncture for DRE.

Systematic review registration:

PROSPERO CRD42020170517.
Novel airway device Vie Scope in several pediatric airway scenario
Authors: Maslanka Maciej , Szarpak Lukasz , Ahuja Sanchit , Ruetzler Kurt , Smereka Jacek
Published: July 2020

Context:

Endotracheal intubation of pediatric patients is challenging, especially in the pre-hospital emergency setting and if performed by less experienced providers. Securing an airway should be achieved with a single intubation attempt, as each intubation attempt contributes to morbidity and mortality. A new airway device, the VieScope, was recently introduced into clinical market, but efficacy to reduced intubation attempts remains unclear thus far.

Objective:

We aimed to compare endotracheal intubation by paramedics using the Vie Scope in different pediatric airway simulation conditions.

Methods:

We conducted a randomized, cross-over simulation study. Following a theoretical and practical training session, paramedics performed endotracheal intubation in 3 different pediatric emergency scenarios: normal airway; tongue edema; cardiopulmonary resuscitation using the VieScope. Overall intubation success rate was the primary outcome. Secondary outcomes included number of intubation attempts, time to intubation, Cormack-Lehane grade, POGO score, and ease of use (using 1–100 scale).

Results:

Fifty-five paramedics with at least 2 years of clinical experience and without any previous experience with the VieScope participated in this study. The overall intubation success rate was 100% in all 3 scenarios. The median intubation time was 27 (24–34) versus 27 (25–37) versus 29 (25–40) s for scenarios A, B, and C, respectively. In scenario A, all paramedics performed successful intubation with 1 single intubation attempt, whereas 2% of the paramedics had to perform 2 intubation attempts in scenario B and 9% in scenario C.

Conclusions:

Results of this simulation study indicate preliminary evidence, that the VieScope enables adequate endotracheal intubation in the pediatric setting. Further clinical studies are needed to confirm these results.
Different clinical courses of various radiologic findings in fibromuscular dysplasia during a 7-year follow-up
Authors: Park Sangil , Choi Hye-Yeon
Published: July 2020

Rationales:

The natural history of fibromuscular dysplasia (FMD) is unclear. Furthermore, the correlation between radiologic findings and clinical significance has not been documented. Previously, the development of new vascular symptoms was reported in a small number of patients, but some of these symptoms were from other vascular causes. New arterial lesions were rarely observed during follow-up in the previous reports.

Patient concerns:

A 40-year-old man was admitted due to dysarthria and left-sided weakness. He had developed flank pain due to bilateral renal infarction about 10 months earlier. He had no known risk factors for atherosclerosis. Initial neurological examination revealed a mild weakness and central facial palsy on the left side.

Diagnoses:

Diffusion-weighted magnetic resonance imaging revealed a small acute infarction in the right insular cortex. Magnetic resonance angiography and digital subtraction angiography showed a severe stenosis with post-dilatation in the right internal carotid artery (ICA). There was a focal ectatic lesion in the left ICA. On the previous abdominal computed tomography angiography (CTA), there were arterial lesions suggestive of dissection in the bilateral renal arteries and a rod-shaped ectasia in the left common iliac artery (CIA). The pathological diagnosis was mixed-type FMD involving the intima and media.

Interventions:

The patient was prescribed antiplatelet agents for prevention of further ischemic events and followed up regularly.

Outcomes:

Seven years after the initial renal infarction, the patient developed abdominal pain radiating to the back. Abdominal CTA revealed that an aortic dissection had developed in the infrarenal aorta, which was shown as normal previously. The ectasia in the left CIA and left ICA showed no interval changes during follow-up.

Lessons:

We present a patient who developed spontaneous symptomatic dissection of the bilateral renal arteries, right ICA, and abdominal aorta during 7 years of follow-up, which were caused by pathologically confirmed FMD. Besides the symptomatic multifocal dissection, the patient showed an asymptomatic multifocal ectasia on cerebral and abdominal angiographies that had not changed over 7 years.
Lithium toxicity with prolonged neurologic sequelae following sleeve gastrectomy
Authors: Lin Yi-Hsin , Liu Sheng-Wen , Wu Hsein-Lin , Kang Jung-Cheng , Huang Kuo-Yang , Huang Hsuan
Published: July 2020

Rationale:

Lithium is the first-line medication for bipolar disorder, given a narrow therapeutic window of 0.8 to 1.2 mEq/L. Change of lithium pharmacokinetics following bariatric surgery may lead to lithium toxicity, which is particularly concerned.

Patient concerns:

We presented a 39-year-old man with morbid obesity and bipolar affective disorder for 20 years, who was treated with lithium. He developed serious lithium toxicity following sleeve gastrectomy and prolonged neurologic sequelae.

Diagnoses:

He suffered from persistent watery diarrhea, general weakness, and then drowsy consciousness. Lithium level was checked immediately to be 3.42 mEq/L and lithium toxicity was diagnosed.

Interventions:

After 3 courses of hemodialysis, his serum lithium level subsequently declined to 0.63 mEq/L, while his consciousness returned normal. Lithium was replaced by lamotrigine.

Outcomes:

The patient was discharged thirty-five days after admission, while his serum lithium declined to 0.06 mEq/L. Neurologic sequelae were noted by muscle weakness and pain sensation in both feet. The nerve conduction test revealed sensorimotor polyneuropathy with conduction block. He was advised to keep a passive range of motion exercise.

Lessons:

Although the consensus guideline remains lacking, our report reviewed cases of relevance in the literature and highlighted the awareness of the potential risk of lithium toxicity following bariatric surgery. We suggest close monitoring of the lithium levels and perhaps a dosage adjustment for the postoperative period.
Establishing an acquisition and processing protocol for resting state networks with a 1.5 T scanner
Authors: Moreno-Ayure Michela , Páez Cristian , López-Arias María A. , Mendez-Betancurt Johan L. , Ordóñez-Rubiano Edgar G. , Rudas Jorge , Pulido Cristian , Gómez Francisco , Martínez Darwin , Enciso-Olivera Cesar O. , Rivera-Triana Diana P. , Casanova-Libreros Rosangela , Aguilera Natalia , Marín-Muñoz Jorge H.
Published: July 2020

Objective:

The aim of this study was to characterize the capability of detection of the resting state networks (RSNs) with functional magnetic resonance imaging (fMRI) in healthy subjects using a 1.5T scanner in a middle-income country.

Materials and methods:

Ten subjects underwent a complete blood-oxygen-level dependent imaging (BOLD) acquisition on a 1.5T scanner. For the imaging analysis, we used the spatial independent component analysis (sICA). We designed a computer tool for 1.5 T (or above) scanners for imaging processing. We used it to separate and delineate the different components of the RSNs of the BOLD signal. The sICA was also used to differentiate the RSNs from noise artifact generated by breathing and cardiac cycles.

Results:

For each subject, 20 independent components (IC) were computed from the sICA (a total of 200 ICs). From these ICs, a spatial pattern consistent with RSNs was identified in 161 (80.5%). From the 161, 131 (65.5%) were fit for study. The networks that were found in all subjects were: the default mode network, the right executive control network, the medial visual network, and the cerebellar network. In 90% of the subjects, the left executive control network and the sensory/motor network were observed. The occipital visual network was present in 80% of the subjects. In 39 (19.5%) of the images, no any neural network was identified.

Conclusions:

Reproduction and differentiation of the most representative RSNs was achieved using a 1.5T scanner acquisitions and sICA processing of BOLD imaging in healthy subjects.
Prevalence of cardiometabolic risk factors and selected cardiovascular diseases in hypertensive and normotensive participants in the adult Polish population
Authors: Niklas Arkadiusz , Marcinkowska Justyna , Kozela Magdalena , Pająk Andrzej , Zdrojewski Tomasz , Drygas Wojciech , Piwońska Aleksandra , Bielecki Wojciech , Kozakiewicz Krystyna , Tykarski Andrzej
Published: July 2020

Hypertension is one of the most important causes of cardiovascular disease (CVD) incidence and mortality. The aim of the study was to assess the prevalence of metabolic syndrome and its individual components i.e., diabetes, obesity, elevated triglycerides (TG), low HDL (high-density lipoprotein) cholesterol, as well as selected manifestations of CVD i.e., atrial fibrillation (AF), peripheral artery disease (PAD), coronary artery disease (CAD), myocardial infarction (MI), and stroke in persons with and without hypertension in the Polish population.

The analysis included participants of Polish multicentre WOBASZ II Study i.e., 6163 persons aged 19 and above. The Mantel Haenszel anlysis and multidimensional logistic regression model were used to assess the relations between the prevalence of metabolic syndrome and its individual components as well as selected manifestations of CVD with hypertension.

Compared to normotensives, metabolic syndrome was over 5 times more prevalent in participants with hypertension (OR = 5.35, 95% CI:4.71–6.09). Components of the metabolic syndrome and selected manifestations of CVD were more prevalent in participants with hypertension compared to normotensives. The Mantel-Haenszel odds ratios (95% confidence intervals) were as follows: obesity counted as BMI > 30 kg/m2 OR = 2.58 (2.26–2.96), raised triglycerides OR = 2.34 (2.07–2.64), reduced HDL-C OR = 1.81 (1.59–2.06), metabolic syndrome OR = 5.35 (4.71–6.09), diabetes OR = 2.54 (1.98–3.26), AF OR = 1.47 (1.09–2.00), PAD OR = 1.51 (1.14–1.99), CAD OR = 1.94 (1.52–2.49), MI OR = 1.89 (1.32–2.70), hospitalization due to HF OR = 2.02 (1.43–2.87), hospitalization due to exacerbation of CAD OR = 2.13 (1.58–2.86), hospitalization due to revascularization OR = 2.38 (1.49–3.80), hospitalization due to stroke OR = 1.72 (1.1–2.68).

Compared to normotensive participants, persons with hypertension had higher prevalence of diabetes, obesity, MS, PAD, CAD, stroke, MI and AF, and more frequent need for hospitalization due to HF, exacerbation of CAD and for coronary revascularization.
Correlation between the small dense LDL level and nonalcoholic fatty liver disease
Authors: Hwang Ha Won , Yu Jung Hwan , Jin Young-Joo , Suh Young Ju , Lee Jin-Woo
Published: July 2020

Small dense low-density lipoprotein (sdLDL) is a distinct low-density lipoprotein (LDL) cholesterol subclass that has been reported to be associated with metabolic disease. On the other hand, the relationship between the sdLDL level and the nonalcoholic fatty liver disease (NAFLD) severity is unclear. In this study, the sdLDL level was measured in patients with NAFLD to assess its potential as a biomarker for evaluating NAFLD. One hundred and twenty-six patients diagnosed with NAFLD at a single referral hospital from January 2018 to August 2019 were enrolled. The lipoprotein profile was analyzed from a blood test of NAFLD patients, and transient elastography (TE, Fibroscan) was performed to evaluate the degree of NAFLD. Among the 126 patients, 83 patients that could confirm the lipoprotein profile and TE results were finally enrolled in the study. The controlled attenuation parameter (CAP) value obtained from TE did not show any correlation with the total cholesterol, LDL. But, the sdLDL level showed a significant positive correlation with the CAP value (r = 0.237, P = .031), and the sdLDL/LDL ratio also showed a significant positive correlation with the CAP value (r = 0.235, P = .032). The liver stiffness (LS) measured by TE and the sdLDL level were positively correlated in patients with NAFLD (rho = 0.217, P = .049). The sdLDL/LDL ratio also showed a significant positive correlation with the LS value (rho = 0.228, P = .038). In addition, the fatty liver index also showed a significant positive correlation with the sdLDL/LDL ratio (r = 0.448, P = .000). In this study, the sdLDL level measured by a blood test of NAFLD patients showed a positive correlation with the CAP value and LS, which indicate the degree of hepatic steatosis and fibrosis. These results suggest the possibility of the sdLDL level as a new biomarker of NAFLD, but further studies will be needed to support these results.
Blue rubber bleb nevus syndrome with the complication of intussusception
Authors: Hu Zeming , Lin Xuan , Zhong Jianing , He Qingfang , Peng Qin , Xiao Jianbo , Chen Bin , Zhang Jianhong
Published: July 2020

Rationale:

Blue rubber bleb nevus syndrome (BRBNS) is an extremely rare disorder characterized by multifocal venous malformations involving various organs such as the skin and gastrointestinal tract. Severe complications of BRBNS, such as intussusception, volvulus, and intestinal infarction are rarer and require surgery. This report describes a 33-year-old male of BRBNS complicated with intussusception that was successfully diagnosed and treated with surgery.

Patient concerns:

A 33-year-old Chinese man presented with persistent, colicky pain accompanied by nausea, abdominal distension, and dizziness. The patient presented with sporadic bluish nodules on his skin involving his head, neck, thorax, abdomen, and planta pedis.

Diagnoses:

BRBNS with the complication of intussusception.

Interventions:

An emergency laparotomy was performed, and postoperative management included blood transfusions and oral iron supplementation for 2 weeks.

Outcomes:

The patient's postoperative course of hospitalization was uneventful. During the 4-month follow-up, the patient showed no signs of intussusception recurrence.

Lessons:

Patients diagnosed with BRBNS who present with acute abdominal pain and distension should raise suspicion for the presence of intussusception, which requires emergent surgical intervention.
Acute compartment syndrome secondary to anterolateral thigh flap harvesting in a pediatric patient
Authors: Qu Wenrui , Pan Junbo , Jin Hongjuan , Wang Xuejie , Tian Heng
Published: July 2020

Introduction:

The anterolateral thigh (ALT) flap is the most popularly used flap for major soft tissue reconstruction. Although it is widely used, acute compartment syndrome (ACS) in pediatric patients has rarely been reported in the literature. We herein reported a case of ACS in a 6-year-old girl after ALT flap harvest with direct closure of the donor site.

Patient concerns:

A 6-year-old girl was admitted to the Second Hospital of Jilin University with crush injury on the palmar aspect of the right hand and wrist.

Diagnosis:

Examination showed soft tissue defect of the hand and wrist, damage on the thenar muscles, lightly crushed flexor tendons, crushed median nerve, and ulnar artery thrombosis.

Interventions:

The defect was closed with an ipsilateral ALT flap measuring 9 cm in length by 6 cm in width.

Outcomes:

After debridement was performed 3 times, the majority of the rectus femoris and lateral femoris were removed. Secondary closure by skin grafting was performed 2 weeks later. Three days after the procedure, necrotic tissues were noted on the edges of the wound. The diagnosis of ACS of the right was made. A second exploration was decided, and an extensive anterior compartment fasciotomy was performed. After 6 weeks of vacuum sealing drainage therapy, the defect was closed with a free latissimus dorsi musculocutaneous flap. At 4 months of follow-up, the right thigh wound had healed. At 6 months of follow-up, quadriceps muscle weakness remained. At 1 year of follow-up, the patient's mobility had been significantly improved, but diminished sensation remained on the lateral aspect of the thigh.

Conclusion:

ACS can occur after ALT flap harvesting in pediatric patients and should be recognized as early as possible to avoid devastating complications.
Durvalumab and tremelimumab combination therapy versus durvalumab or tremelimumab monotherapy for patients with solid tumors
Authors: Wang Bi-Cheng , Li Peng-Cheng , Fan Ji-Quan , Lin Guo-He , Liu Quentin
Published: July 2020

Background:

The combination of durvalumab and tremelimumab results in clinical benefit, with a tolerable safety profile in patients with solid tumors.

Objective:

To evaluate the efficacy and safety of durvalumab in combination with tremelimumab compared with either drug alone.

Methods:

The online databases (PubMed, Web of Science, EMBASE, and Cochrane Library) were searched for potential clinical studies up to Nov 26, 2019. Eligible studies were prospective and registered clinical trials. Pooled odds ratios for objective response rate and disease control rate and pooled risk ratios for treatment-related adverse events were meta-analyzed. A random-effect model was used due to the synthesis of different cancer types.

Results:

Overall, 5 studies were eligible for systematic review, 3 of which were further meta-analyzed. Durvalumab plus tremelimumab was superior to tremelimumab monotherapy in improving disease control rate in head and neck squamous cell carcinoma. However, there were no significant differences between dual immunotherapy and mono-immunotherapy in pancreatic ductal adenocarcinoma and gastric and gastroesophageal junction adenocarcinoma. Additionally, pooled analyses illustrated that no significant differences in treatment-related adverse events were displayed between the 2 groups.

Conclusion:

Durvalumab and tremelimumab combination therapy had a good safety profile and resulted in clinical benefit in head and neck squamous cell carcinoma. Future explorations are needed to further confirm the application of durvalumab plus tremelimumab.
Implementation of a Modified Neonatal Early-onset Sepsis Calculator in Well-baby Nursery: a Quality Improvement Study
Authors: Zayek Michael , Bhat Jayalakshmi , Bonner Katie , Blake Michelle , Peevy Keith , Jha Om Prakash , Gulati Rashmi , Bhat Ramachandra
Published: July 2020

Background:

The use of sepsis risk scores (SRSs), calculated based on the neonatal early-onset sepsis (EOS) calculator, has been shown to limit the unwarranted sepsis evaluations and to reduce the empirical use of antibiotics in neonates.s

Purpose:

To reduce both the sepsis evaluation rate (SER) and antibiotic initiation rate (AIR) by 25% from baseline by incorporating conservative SRS cutoff values into the routine sepsis risk assessment of well-appearing neonates born at 34 weeks and older gestation.

Methods:

During a pre quality improvement (QI) period (June 2016–August 2016), a QI team calculated SRS on all newborn infants to determine safe SRS cutoff values. During the QI-study period (September 2016–November 2017), we implemented an EOS evaluation algorithm based on 2 SRS cutoff values, 0.05 (later increased to 0.1) for sepsis evaluation and 0.3 for the initiation of antibiotic therapy. Monthly SER and AIR were summarized and analyzed by using standard statistical tests and statistical process control charts. During the surveillance phase (January 2019–June 2019), we evaluated whether previously attained improvements in SER and AIR were sustained.

Results:

During the pre-QI period, the mean (±SD) of monthly SER and monthly AIR were 23.8% (±5.7%) and 6.2% (±0.4%), respectively. During the QI-study period, the mean (±SD) of monthly SER and monthly AIR decreased to 15% (±4.7%), P = 0.01, and 3.2% (±1.5%), P = 0.005, respectively. During the surveillance period, both outcome measures were comparable with the QI-study period.

Conclusion:

The implementation of a modified EOS calculator-based EOS algorithm using a conservative approach was successful in reducing antibiotic exposure and the need for blood work in well-appearing neonates.
The Impact of Full-Scale Simulation Training Based on Kolb’s Learning Cycle on Medical Prehospital Emergency Teams
Authors: Secheresse Thierry , Pansu Pascal , Lima Laurent
Published: July 2020

Introduction

Using simulation to train teams in out-of-hospital cardiac arrest management is recommended to improve team effectiveness. The aim of this study was to assess the impact of a specific cardiac arrest management simulation training program inspired by the principles of Kolb’s learning cycle.

Method

All the staff in a medical prehospital emergency unit participated in this program. Both individual and team levels were evaluated: on an individual level, we assessed attitudes toward training and medical knowledge of cardiac arrest management; on a team level, we assessed team behavior during simulated cardiac arrest and learning transfer in clinical practice.

Results

In addition to the satisfaction of the participants, the results showed a positive effect on medical knowledge and team behavior and an improvement in the management of patients suffering cardiac arrest.

Conclusions

These findings confirm the usefulness of a simulation training program containing the 4 steps of Kolb’s cycle for emergency teams.
“Who Am I and Why Am I Here?” A Scoping Review Exploring the Templates and Protocols That Direct Actors in Their Roles as Simulated (Standardized) Patients
Authors: Davies Ellen L. , Pelentsov Lemuel J. , Montagu Adam , Gordon Andrea L. , Hooper Kenneth J. , Esterman Adrian J.
Published: July 2020

Summary Statement

Simulated patients (SPs) are increasingly used in health education and research. The aim of this article was to investigate templates and protocols that enable SPs to accurately and consistently adopt these roles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guided the search strategy for articles that detailed such templates or protocols. Embase Classic + Embase, ProQuest ERIC, Ovid MEDLINE, Ovid EMCare, psycINFO, and Scopus were searched, and 17 articles were included in the review. The templates and protocols that were located differed in structure, length, and depth and were developed or used in medical, nursing, allied health, and veterinary medicine disciplines. The validity, reliability, and replicability of studies are explored, and the quality of reporting is evaluated using the Simulation Research Rubric. Recommendations for increasing the rigor of programs and the reporting of research where SPs are adopted are considered.
A Novel Immune Modulator for Patients With Necrotizing Soft Tissue Infections (NSTI)
Authors: Bulger Eileen M. , May Addison K. , Robinson Bryce R. H. , Evans David C. , Henry Sharon , Green John M. , Toschlog Eric , Sperry Jason L. , Fagenholz Peter , Martin Niels D. , Dankner Wayne M. , Maislin Greg , Wilfret David , Bernard Andrew C.
Published: July 2020

Background and Objective:

Reltecimod, a CD 28 T-lymphocyte receptor mimetic, inhibits T-cell stimulation by an array of bacterial pathogens. A previous phase 2 trial demonstrated improved resolution of organ dysfunction after NSTI. We hypothesized that early administration of reltecimod would improve outcome in severe NSTI.

Methods:

Randomized, double-blind, placebo-controlled trial of single dose reltecimod (0.5 mg/kg) administered within 6 hours of NSTI diagnosis at 65 of 93 study sites. Inclusion: surgical confirmation of NSTI and organ dysfunction [modified Sequential Organ Failure Assessment Score (mSOFA) score ≥3]. Primary analysis was modified Intent-to-Treat (mITT), responder analysis using a previously validated composite endpoint, necrotizing infection clinical composite endpoint, defined as: alive at day 28, ≤3 debridements, no amputation beyond first operation, and day 14 mSOFA ≤1 with ≥3 point reduction (organ dysfunction resolution). A prespecified, per protocol (PP) analysis excluded 17 patients with major protocol violations before unblinding.

Results:

Two hundred ninety patients were enrolled, mITT (Reltecimod 142, Placebo 148): mean age 55 ± 15 years, 60% male, 42.4% diabetic, 28.6% perineal infection, screening mSOFA mean 5.5 ± 2.4. Twenty-eight-day mortality was 15% in both groups. mITT necrotizing infection clinical composite endpoint success was 48.6% reltecimod versus 39.9% placebo, P = 0.135 and PP was 54.3% reltecimod versus 40.3% placebo, P = 0.021. Resolution of organ dysfunction was 65.1% reltecimod versus 52.6% placebo, P = 0.041, mITT and 70.9% versus 53.4%, P = 0.005, PP.

Conclusion:

Early administration of reltecimod in severe NSTI resulted in a significant improvement in the primary composite endpoint in the PP population but not in the mITT population. Reltecimod was associated with improved resolution of organ dysfunction and hospital discharge status.
A Combination of Biochemical and Pathological Parameters Improves Prediction of Postresection Survival After Preoperative Chemotherapy in Pancreatic Cancer
Authors: Hank Thomas , Sandini Marta , Ferrone Cristina R. , Ryan David P. , Mino-Kenudson Mari , Qadan Motaz , Wo Jennifer Y. , Klaiber Ulla , Weekes Colin D. , Weniger Maximilian , Hinz Ulf , Harrison Jon M. , Heckler Max , Warshaw Andrew L. , Hong Theodore S. , Hackert Thilo , Clark Jeffrey W. , Büchler Markus W. , Lillemoe Keith D. , Strobel Oliver , Castillo Carlos Fernández-del
Published: July 2020

Objective:

To build a prognostic score for patients with primary chemotherapy undergoing surgery for pancreatic cancer based on pathological parameters and preoperative Carbohydrate antigen 19-9 (CA19-9) levels.

Background:

Prognostic stratification after primary chemotherapy for pancreatic cancer is challenging and prediction models, such as the AJCC staging system, lack validation in the setting of preoperative chemotherapy.

Methods:

Patients with primary chemotherapy resected at the Massachusetts General Hospital between 2007 and 2017 were analyzed. Tumor characteristics independently associated with overall survival were identified and weighted by Cox-proportional regression. The pancreatic neoadjuvant Massachusetts-score (PANAMA-score) was computed from these variables and its performance assessed by Harrel concordance index and area under the receiving characteristics curves analysis. Comparisons were made with the AJCC staging system and external validation was performed in an independent cohort with primary chemotherapy from Heidelberg, Germany.

Results:

A total of 216 patients constituted the training cohort. The multivariate analysis demonstrated tumor size, number of positive lymph-nodes, R-status, and high CA19-9 to be independently associated with overall survival. Kaplan-Meier analysis according to low, intermediate, and high PANAMA-score showed good discriminatory power of the new metrics (P< 0.001). The median overall survival for the three risk-groups was 45, 27, and 12 months, respectively. External validation in 258 patients confirmed the prognostic ability of the score and demonstrated better accuracy compared with the AJCC staging system.

Conclusion:

The proposed PANAMA-score, based on independent predictors of postresection survival, including pathologic variables and CA19-9, not only provides better discrimination compared to the AJCC staging system, but also identifies patients at high-risk for early death.