bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of stereopsis on the ability to perform simulated microsurgery
Authors: Dutton James , Watkins Alice , Henderson Jack , Burgess Frederick R. , Tint Naing L. , Dhillon Baljean , Tatham Andrew J.
Published: February 2020

Purpose:

To determine whether impaired or absent stereopsis affects the ability to perform simulated microsurgical tasks.

Setting:

University of Edinburgh, United Kingdom.

Design:

Prospective randomized cross-over study.

Methods:

Visual acuity and stereoacuity were measured. A band-pass filter was placed over the nondominant eye to reduce stereoacuity to 150 seconds of an arc (partial stereopsis), or the nondominant eye was completely occluded (absent stereopsis). Participants completed a computerized surgical simulator task 3 times with a randomized testing order (normal stereopsis, absent stereopsis, and partial stereopsis). The task involved using forceps to grasp and position objects in the anterior chamber. Outcomes included area of ocular injury, time to task completion, and overall score.

Results:

Ocular damage area was significantly worse with partial stereopsis (P = .002) and worse still when stereopsis was absent (P < .001 for normal vs absent stereopsis and P = .005 for partial vs absent stereopsis). The median ocular damage area was 3.55 mm2 (interquartile range [IQR], 1.21-5.88 mm2) with normal stereopsis, increasing to 6.10 mm2 (IQR, 3.96-12.47 mm2) with stereopsis reduced to 150 seconds of an arc and to 9.25 mm2 (IQR, 4.93-18.70 mm2) with no stereopsis. Time taken to complete the task increased and overall score decreased as stereopsis was reduced. The overall score decreased from 53% (IQR, 22.5-82%) under normal stereopsis to 0% (IQR, 0-43.5%) with absent stereopsis.

Conclusions:

Impaired stereopsis was associated with worse microsurgical performance, which may have implications for surgical training. The absence of stereopsis resulted in worse performance than partial reduction in stereopsis.
Refractive lens exchange with a trifocal intraocular lens in Fuchs endothelial dystrophy
Authors: Nanavaty Mayank A. , Ashena Zahra
Published: February 2020

A 57-year-old man with myopia presented with advanced Fuchs endothelial dystrophy, a refraction of −6.00 diopters (D) and −6.25 D, an endothelial cell count of 1100 cells/mm2 and 1000 cells/mm2 in right and left eyes, respectively, and corrected distance visual acuity of 20/30 in each eye. The patient was deemed unsuitable for excimer or femtosecond laser–based refractive surgery or refractive lens exchange (RLE) with a trifocal intraocular lens (IOL) alone because of the advanced Fuchs endothelial dystrophy and high risk of corneal decompensation and reduced optical quality postoperatively. A successful RLE with a hydrophobic trifocal IOL and Descemet membrane endothelial keratoplasty in both eyes was performed at an interval of 2 months between the eyes. At 12 months, the uncorrected distance visual acuity was 20/16 in each eye, with uncorrected near visual acuity of 20/20 for 40 to 60 cm from the face. The endothelial cell count at 12 months was 2250 cells/mm2 and 2120 cells/mm2 in right and left eyes, respectively.
Cataract phacoemulsification performed by resident trainees and staff surgeons: intraoperative complications and early postoperative intraocular pressure elevation
Authors: Oliveira-Ferreira Cláudia , Leuzinger-Dias Mariana , Tavares Ferreira João , Macedo João Paulo , Falcão-Reis Fernando
Published: February 2020

Purpose:

To determine the incidence of intraoperative complications of phacoemulsification cataract surgery in a teaching hospital and to compare the intraoperative complication rate between resident trainees and staff ophthalmologists, to ascertain the overall rate of intraocular pressure (IOP) elevation on postoperative day 1 (POD1), and, again, to compare this value between resident trainees and staff surgeons.

Setting:

Centro Hospitalar São João, Oporto, Portugal.

Design:

Retrospective study.

Methods:

This study included eyes submitted for phacoemulsification cataract surgery from January 1, 2017, to December 31, 2017. There were no exclusion criteria. Data collected included the type of surgeon, level of resident training, case complexity, and intraoperative complications. From all noncomplicated surgeries, preoperative IOP and IOP-POD1 were collected.

Results:

A total of 2937 surgeries were included; 25.6% were performed by resident trainees. The complication rate was 6.3% with resident trainees and statistically significantly lower (3.3%) in staff surgeons. The complication rate of resident trainees did not differ according to their level of residency. There was a significantly increased incidence of IOP-POD1 elevation in the resident trainee group compared with the staff surgeon group. Surgeries performed by resident trainees, a preexisting history of glaucoma, and pseudoexfoliation were significant risk factors for IOP elevation.

Conclusions:

To our knowledge, this is the first European study comparing the incidence of intraoperative and postoperative complications in cataract surgery performed by resident trainees and staff surgeons. We report a significantly higher rate of intraoperative complications and IOP elevation on POD1 in resident trainees vs staff surgeons.
One-year visual and astigmatic outcomes of keratoconus patients following sequential crosslinking and topography-guided surface ablation: the TOPOLINK study
Authors: Nattis Alanna S. , Rosenberg Eric D. , Donnenfeld Eric D.
Published: February 2020

Purpose:

To evaluate long-term visual and astigmatic outcomes of sequential corneal crosslinking (CXL) followed by topography-guided photorefractive keratectomy (PRK).

Setting:

Single-practice outpatient setting.

Design:

Retrospective case review.

Methods:

This is a single-surgeon retrospective case review of eyes with keratoconus undergoing sequential CXL and then topography-guided PRK. Change in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), topographic, refractive, and keratometric astigmatism was analyzed using power vector analyses at baseline, 6 months, and 12 months after topography-guided PRK. Changes in higher-order aberrations (HOAs), posterior astigmatism, spherical equivalent (SE), and central corneal thickness (CCT) were also analyzed. Correlations between age, time between CXL and PRK, sex, manifest SE, CCT, maximum and average keratometric values, and HOAs were evaluated for significance.

Results:

Of the 62 eyes studied, regardless of refractive treatment, topography-guided PRK following CXL in patients with keratoconus improved CDVA (mean 20/30; 2-line improvement) and UDVA (mean 20/50; 4-line improvement). Over 12 months, visual acuity continued to improve across all eyes treated (P < .001). Overall, there were significant improvements in corneal astigmatism, maximum keratometry, mean keratometry, SE, posterior astigmatism, and total HOAs. No significant correlations were found between age, sex, time elapsed between CXL and PRK, and age at the time of either procedure on final visual acuity.

Conclusions:

Results of this study reinforced previous findings that topography-guided PRK in previously cross-linked keratoconus eyes proves to be an efficacious and safe method for improving visual acuity and reducing irregular corneal astigmatism, with continued improvement.
Femtosecond laser-assisted anterior and posterior capsulotomies in children with persistent hyperplastic primary vitreous
Authors: Tereshchenko Aleksandr V. , Trifanenkova Irina G. , Vladimirovich Vlasov M.
Published: February 2020

Anterior and posterior capsulotomies were performed in 12 eyes of 12 patients (age range 3 months to 6 years) with congenital cataracts and primary persistent hyperplastic primary vitreous (PHPV) syndrome using a femtosecond laser. The procedure was performed in 8 eyes with PHPV severity level 1 and 4 eyes with severity level 2 (Sudovsky classification). Surgeries were performed at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Russia. Postoperative follow-up was between 8 months and 36 months. The use of a low-energy femtosecond laser–assisted posterior capsulotomy in this pediatric population provided safe and predictable results with a reduced number of intraocular manipulations, and reduced the risk for complications.
Management of acute corneal hydrops after laser in situ keratomileusis
Authors: Hirayama Masatoshi , Fukui Masaki , Yamaguchi Takefumi , Shimazaki Jun
Published: February 2020

A 43-year-old man developed acute corneal hydrops after laser in situ keratomileusis (LASIK). A persistently fluid-filled interface between the corneal flap and stroma (without flap dehiscence or wound leakage) did not respond to the conservative treatment. To avoid keratoplasty, the subflap fluid was drained by an air injection into the anterior chamber; the surgery also included suturing of the corneal flap and stroma. The corrected distance visual acuity improved rapidly after resolution of the fluid-filled interface and corneal stromal edema, and no leakage was observed. Thus, a minimally invasive surgery to drain the subflap fluid by an air injection was effective for treating a persistently fluid-filled interface in a case of acute corneal hydrops after LASIK.
A Biopsychosocial Approach to Analyzing Inpatient Falls
Authors: Noonan Rebecca , Bath Jessica , Fitzsimmons Amber
Published: February 2020

Purpose:

While research exists identifying factors that contribute to inpatient falls, patients in hospitals continue to fall. We suggest this is influenced by a lack of consistency in the implementation and documentation of evidence-based fall precautions, and that existing fall screens and protocols do not consistently identify potential fallers or prevent falls. This study examines biopsychosocial factors not commonly investigated that may affect falls. We analyzed patient mobility level, polypharmacy, mental status, language spoken, insurance type, and substance use on fall incidence and fall precaution protocol implementation in an urban, academic health care system.

Materials/Methods:

Using the incident reporting system, postfall huddles and electronic medical records, a comprehensive aggregate database was created of 217 inpatient fall incidents and 100 randomized nonincidents. Variables included insurance type, primary spoken language, history of substance use, mental status, polypharmacy, mobility level, and whether the fall precaution protocol was implemented. Chi-square tests, z tests of proportions, and absolute risk reduction (ARR) and increase (ARI) were calculated to assess associated fall potential for each predictor.

Results:

55.2% of patients screened to be at risk for falls did not have a fall precaution protocol in place when they fell. The predictor with the largest effect (ARI 30%) on fall incidence was whether the fall precaution protocol was missing. Patients requiring Supervision through Minimal Assist for mobility were associated with an ARI of 18%; nonintact mental status (ARI 20%) and history of substance use (ARI 10%) were also associated with fall incidences. Having a history of substance use or having Medicaid insurance each reduced fall precaution protocol implementation by 15%.

Conclusions:

Novel results suggest that patients requiring less assistance for mobility experienced higher incidences of falls, and patients with a history of substance use and Medicaid insurance had a higher risk for not having fall precaution protocols implemented. Patients would benefit if physical therapists and nurses shared mobility assessment tools and communication methods, potentially improving mobilization triaging between the professions.
The Symptom Experience of Patients With Atrial Fibrillation Before Their Initial Diagnosis
Authors: Wilson Ryan E. , Rush Kathy L. , Hatt Linda , Reid R. Colin , Laberge Carol G.
Published: February 2020

Background

Atrial fibrillation (AF), the most common form of dysrhythmia, steadily increases in prevalence with age. If left untreated, AF significantly increases the risk of stroke, heart failure, and death. Despite the increasing prevalence, there are significant research gaps in the prediagnosis symptom experiences of patients with AF.

Objective

The purpose of this qualitative descriptive study was to explore the prediagnosis symptom experience of patients with AF.

Methods

Participants 19 years or older with AF diagnosed in the previous year were recruited (n = 26) from outpatient cardiac rehabilitation and AF clinics. Semistructured interviews, broadly guided by the Symptom Experience Model, explored perceptions, evaluations, and responses to AF symptoms. Thematic analysis used a 2-step approach, deductively coding for participants' symptom perceptions, evaluations, and responses and inductively coding within these broader Symptom Experience Model concepts.

Results

Perception involved awareness of bodily sensations, ranging from imperceptible noticing to commanding attention, heightened by rest and activity. In evaluation, participants used self-derived theories to explain their symptoms, gathered evidence to support/refute their theories, and formulated alternative theories as symptoms changed over time. Responses consisted of nontreatment, self-treatment, and health seeking; most participants needed repeated healthcare visits before diagnosis.

Conclusions

The current study identified challenges participants experienced in developing awareness of their AF symptoms, the complex cognitive processes associated with evaluation, and barriers that made it difficult to respond to AF symptoms in a timely manner. Understanding the prediagnosis symptom experience from the patient's perspective is essential for the enhancement of current AF screening practices.
Physician Assistant Program Goals: A Thematic Analysis
Authors: Snyder Jennifer A. , Quincy Brenda , Barton Marian , Tallman Kelsey
Published: February 2020

Purpose

The purpose of this study was to provide a descriptive analysis of the goals of the accredited physician assistant (PA) programs across the country in order to obtain a baseline understanding of their themes.

Methods

Initial review of the goals resulted in the identification of recurring themes. The goals were evaluated relative to meeting the requirements specified in Standard A3.14 of the Accreditation Review Commission on Education for the Physician Assistant, including listing the goal with the defined benchmark expected and the program's progress in reaching the goal. Accreditation status was compared.

Results

Of the 238 accredited PA programs at the time of the study, 157 (66%) had Accreditation-Continued status, 56 (24%) were Accreditation-Provisional, and 25 (11%) had Accreditation-Probation status. The median number of 5 goals per program did not vary dependent on accreditation status. Only 43 of 238 PA programs (18%) provided goals with required benchmarks and supporting outcomes on their webpages. Almost all programs included at least one goal (and often more than one) with the theme of student acquisition of knowledge, skills, and attitudes needed to be a PA. Other commonly included themes in programmatic goals included the “capacity” of students to graduate from the PA program and become employed, valuing diversity and cultural differences, a comprehensive and strong curriculum, as well as alumni who are self-directed, lifelong learners.

Conclusion

Program goals should be reviewed to ensure they include benchmarks that define success and report progress or outcomes in achieving those goals. Thematic analysis provides a powerful summary that then can be used to make conclusions across a large set of program data.
Impact of a Longitudinal Medical Spanish Curriculum on Student Communication Skills
Authors: Lie Désirée A. , Nodal Sonia , de la Torre Margarita , Forest Christopher P. , Richter-Lagha Regina , Lohenry Kevin
Published: February 2020

Purpose

This study describes and examines the short- and longer-term impact of a required longitudinal medical Spanish curriculum on physician assistant student preparedness and ability to communicate with patients in Spanish during clinical rotations.

Methods

Fifty-eight preclinical students participated in an 80-hour curriculum delivered weekly over 3 semesters. Teaching followed a framework of second-language acquisition and included structured grammar and medical vocabulary practice with didactic, interactive, and group assignments. Vocabulary and grammar were assessed with quizzes. Oral proficiency was assessed by faculty with Spanish Objective Structured Clinical Examination (OSCE) stations at midpoint and end using the Interagency Language Roundtable (ILR), a 6-level scale (immediate outcome). Students self-rated proficiency and confidence and evaluated curriculum effectiveness for preparing them to care for Spanish-speaking patients (longer-term outcomes).

Results

All students passed the written and oral quizzes. Faculty-scored ILR verbal proficiency at the OSCEs increased by a mean level of 0.5 over 6 months. Student self-assessed proficiency improved on average by one level from baseline to 24 months later. Students rated highly curriculum effectiveness, preparedness to communicate in Spanish during clinical rotations, ability to judge when an interpreter was needed, and the importance of medical Spanish to future practice.

Conclusions

A required integrated longitudinal medical Spanish curriculum was well received. Physician assistant students demonstrated short-term interval progression in Spanish proficiency, with improvements in both faculty and self-rating scores, and readiness to apply the skill to practice. They valued active learning associated with repeated practice with feedback, role playing, and interval assessments throughout the curriculum.
Heparin challenge test in patients undergoing cardiac surgery: dealing with heparin allergy
Authors: Cancian Mauro , Borella Elisabetta , D’Onofrio Augusto , Gerosa Gino , Simioni Paolo , Campello Elena
Published: February 2020

A history of heparin hypersensitivity in patients undergoing cardiopulmonary bypass surgery poses the dilemma of which anticoagulant to use. Here, we report the successful use of a heparin challenge test in a 66-year-old female candidate for coronary artery bypass graft surgery with a past medical history of enoxaparin type I hypersensitivity after pulmonary embolism. Challenge and desensitization protocols are effectively used for essential antibiotics in patients with severe infections and/or allergies, or patients with aspirin intolerance requiring revascularization for coronary disease. A successful use of desensitization protocols to unfractionated heparin has been previously described in four patients undergoing cardiac surgery with various schemes. However, our case report indicates that a challenge test may also offer a quick, safe and effective approach in patients with a history of hypersensitivity reactions to heparin with inconclusive diagnostic tests and/or whenever the use of alternative heparins is tricky.
Venous thromboembolism associated with hyperhomocysteinemia, homozygosity for the methylenetetrahydrofolate reductase 677C>T gene variant, and secondary polycythemia
Authors: Masuda Kazunori , Imashuku Shinsaku
Published: February 2020

The development of pulmonary embolism/deep vein thrombosis (DVT) in the extremities is influenced by various risk factors. Hyperhomocysteinemia is one such risk factor, which may be associated with vitamin B12/folate deficiency, or the methylenetetrahydrofolate reductase gene variant, 677C>T. Here, we report a 47-year-old male who developed pulmonary embolism/DVT, associated with hyperhomocysteinemia (plasma homocysteine: 71.9 nmol/ml; reference range: 6.3–18.9 nmol/ml) and was homozygous (T/T) for the methylenetetrahydrofolate reductase variant. Serum levels of vitamin B12 and folate were within the normal range, while secondary polycythemia (hemoglobin: 18.2 g/dl and hematocrit: 50.8%) may have acted as an additional trigger for the thromboembolism. The pulmonary embolism/DVT was successfully managed and the patient has been doing well for longer than 3 years.
Treatment targets based on autoregulation parameters in neurocritical care patients
Authors: Czosnyka Marek , Hutchinson Peter , Smielewski Peter
Published: February 2020

Purpose of review

This review summarizes the physiological basis of autoregulation-oriented therapy in critically ill patients, with a particular emphasis on individual targets based on parameters that describe autoregulation of cerebral blood flow.

Recent findings

The concepts of optimal cerebral perfusion (CPPopt) and arterial pressures (ABPopt), which both take advantage of continuous measures of cerebral autoregulation, recently have been introduced into clinical practice. It is hypothesized that if both pressures are used as individual targets and followed, the incidence and severity of dysautoregulation will diminish sufficiently to improve outcomes across the spectrum of acute neurological illnesses. These parameters have not been tested in randomized trials. However, a Phase II trial for CPPopt in Traumatic Brain Injury (COGITATE) is underway. Clinical series suggest that delirium following cardiac surgery may be reduced if blood pressure is actively regulated above the lower limit of autoregulation. In traumatic brain injury, using CPPopt as a single target allows monitoring of the upper and lower limits of autoregulation that provide a well tolerated ‘corridor’ for treatment. Pilot studies in which ABPopt is monitored in preterm newborns suggest fewer haemorrhagic events if blood pressure is closer to its optimal target. Brain imaging studies suggest worse tissue outcomes when blood pressure is below ABPopt.

Targeted control of brain and systemic blood pressures to optimize cerebral autoregulation is of substantial interest to the neurocritical care and anaesthesia community, as this strategy may help to avoid secondary brain insults associated with ischemia or hyperaemia. The same strategy can be used outside the ICU (e.g. cardiac surgery, or in stroke patients after mechanical thrombectomy); this requires further research.
Rectal Nonsteroidal Anti-Inflammatory Drugs for Endoscopic Retrograde Cholangiopancreatography Postoperative Pancreatitis Prevention
Authors: Yang Jiahui , Wang Wancong , Liu Chuan , Zhao Yan , Ren Mudan , He Shuixiang
Published: February 2020

Background:

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication of ERCP procedure. Nonsteroidal anti-inflammatory drugs (NSAIDs) are reported to be one protective pharmacological agent with great efficacy regarding this complication. Recently, more trails have addressed this issue and some inconsistent results appeared. Therefore, this study aims to evaluate the efficacy and safety of different rectal NSAIDs schemes to prevent PEP.

Materials and Methods:

Eligible studies published on PubMed, the Cochrane Library, Embase, Web of Science before November 2018 were reviewed, and those which met the inclusion criteria were included in the analysis. The preventions were divided as placebo/no treatment, post-ERCP rectal diclofenac, pre-ERCP rectal diclofenac, post-ERCP rectal indomethacin, pre-ERCP rectal indomethacin, indomethacin using during ERCP, and pre-ERCP rectal naproxen. The main outcomes included the incidence of PEP and its severity. Other complications were also analyzed.

Results:

A total of 23 randomized controlled trials were included. The results of network meta-analysis illustrated that compared with the control, post-ERCP rectal diclofenac, pre-ERCP rectal diclofenac, and indomethacin were significantly associated with lower incidences of PEP. Moreover, it is notable that pre-ERCP rectal NSAIDs might reduce the severity of pancreatitis. Also, rectal NSAIDs may lead to less occurrence of asymptomatic hyperamylasemia. On the basis of the clustered ranking, pre-ERCP diclofenac appeared to be the superior intervention for PEP with satisfying efficacy.

Conclusions:

The present study showed that pre-ERCP diclofenac is the optimal prevention method for PEP. However, more high quality head-to-head randomized controlled trials and observational studies are expected in the future.
The fat brain
Authors: Montesinos Jorge , Guardia-Laguarta Cristina , Area-Gomez Estela
Published: February 2020

Purpose of review

The purpose of this brief review is to gain an understanding on the multiple roles that lipids exert on the brain, and to highlight new ideas in the impact of lipid homeostasis in the regulation of synaptic transmission.

Recent findings

Recent data underline the crucial function of lipid homeostasis in maintaining neuronal function and synaptic plasticity. Moreover, new advances in analytical approaches to study lipid classes and species is opening a new door to understand and monitor how alterations in lipid pathways could shed new light into the pathogenesis of neurodegeneration.

Lipids are one of the most essential elements of the brain. However, our understanding of the role of lipids within the central nervous system is still largely unknown. Identifying the molecular mechanism (s) by which lipids can regulate neuronal transmission represents the next frontier in neuroscience, and a new challenge in our understanding of the brain and the mechanism(s) behind neurological disorders.
Variant m.1555A>G in MT-RNR1 causes hearing loss and multiorgan mitochondrial disorder
Authors: Finsterer Josef
Published: February 2020

Background:

Mitochondrial disorders (MIDs) are usually multisystem disorders, affecting not only a single organ/tissue but also progressively more than one.

Methods:

Letter to the Editor.

Results:

Though phenotypic manifestations of the m.1555A>G mutation are usually mono-organic, there are indications that short stature, osteoporosis, arterial hypertension, and recurrent headache can be also a manifestation of this variant.

MID patients with apparently single organ involvement need to be prospectively investigated for multisystem disease, as multisystem manifestations can be subtle or even subclinical.

Concerning the phenotypic expression of the m.1555A>G variant it is crucial to know the heteroplasmy rates in various tissues, as they may strongly contribute to the phenotypic expression of the disease. Maternal transmission can be confirmed by running a basic local alignment search tool.

Conclusions:

The m.1555A>G variant is not only associated with hearing loss but with a number of other multiorgan manifestations. Heteroplasmy rate are required for establishing a genotype/phenotype correlation.
The changing modes of human immunodeficiency virus transmission and spatial variations among women in a minority prefecture in southwest China
Authors: Xiao Chenghan , Jike Chunnong , Liu Danping , Jia Peng , Xu Xiaohe , Xiao Lin , Yu Gang , Nan Lei , Sun Xiaxia , Ge Jingjing , Wang Ju , Wang Ke , Liao Qiang , Wang Qixing , Wenwen Zhai , Yang Shujuan
Published: February 2020

Liangshan Yi Autonomous Prefecture in Southwest China has a high human immunodeficiency virus (HIV) prevalence rate. This study examined the changing modes of HIV transmission among women with new HIV infections and explored the spatial heterogeneities in the factors associated with heterosexual transmission in this minority region.

The data consisting of women with new HIV infections from 2011 to 2014 were collected from multiple sources. New infections were identified by BED capture enzyme immunoassay. The Bayesian hierarchical model was used to estimate the proportion of women with new HIV infections via heterosexual transmission across all townships in the Prefecture. A geographically weighted regression (GWR) model was utilized to investigate spatial variations in the sociodemographic characteristics associated with the changing modes of HIV transmission.

An analytical sample of 927 women with new HIV infections was constructed and utilized to investigate the changing mode of HIV transmission. The rate of heterosexual transmission among women with new HIV infections in 2011 was below 20%. However, by 2014 this rate dramatically increased to nearly 80%. Among sociodemographic characteristics, GWR results revealed significant ethnic differences in heterosexual HIV transmission between Yi women and women in other ethnic groups, with Yi women demonstrating a lower risk of infection through heterosexual transmission. However, such ethnic differences were observed only in 30% of the townships in the Prefecture. Moreover, having a primary education decreased the odds of heterosexual transmission, which was observed in about 56% of the townships. Also, being involved in occupations other than agriculture or animal husbandry and being single or married decreased the odds of HIV infection through heterosexual contact among women, which did not significantly vary across the Prefecture.

Heterosexual transmission was the predominant mode of HIV transmission among women in the Prefecture, and this transformation was clearly marked by a fast-growing trend and a spatial diffusion pattern. Spatial variations also existed in sociodemographic factors that were associated with the changing modes of HIV transmission.
Antimicrobial photodynamic chemotherapy mediated by PapaMBlue on chronic periodontal disease
Authors: Anselmo Giuliana Giovinazzo , Tortamano Ana Carolina Alves Camargo , Gonçalves Marcela Letícia Leal , Leal-Rossi Adriana , Godoy-Miranda Bianca Aparecida , Oliveira Márcia Regina Cabral , Oliveira Pedro Henrique Cabral , Alves Carol Brandt , Bussadori Sandra Kalil , Prates Renato Araujo
Published: February 2020

Background:

The elimination of the pathogenic microorganisms of the periodontal pocket is one of the main points for success in periodontal treatment. The objective of this study is to investigate the clinical and antimicrobial effect of papain-mediated photodynamic therapy in the clinical treatment of periodontal disease.

Methods:

Twenty patients with chronic periodontitis will be selected. Patients will be randomly divided into 2 groups (n = 10). Group 1 will receive conventional periodontal treatment and group 2 will receive conventional treatment and antimicrobial photodynamic therapy (PACT). Conventional treatment will consist of oral hygiene guidance, with brushing technique instructions and recommendation of daily flossing. The calculus deposits on the teeth will be removed with ultrasound equipment and curettes for scraping and root planning. The PACT will be performed at the end of each periodontal treatment session, at sites with bags ≥4 mm. PapaMblue photosensitizer will be deposited in the periodontal pockets with a syringe and a pre-irradiation time of 1 minute will be adopted. Then, the laser emitting wavelength of 660 nm, with power of 100 mW, for 2 minutes, radiant exposure of 30 J/cm2 and power density of 250 mW/cm2 will be applied. Patients will undergo clinical evaluations before treatment (day 1) at 30, 60, and 90 days after the end of treatment; and microbiological evaluations before and immediately after treatment. The distribution of the data within each group and the homogeneity of the variances will be verified. With this information, the most appropriate statistical test in each evaluation will be used. The sample calculation is based on the literature and the significance level of 5% will be adopted.

Discussion:

The combination of PACT with methylene blue in a papain gel and the conventional treatment may increase the reduction of bacteria in periodontal pockets.
Laser acupuncture for refractory coccydynia after traumatic coccyx fracture
Authors: Lin Chien-Hung , Wu Szu-Ying , Hu Wen-Long , Hung Chia-Hung , Hung Yu-Chiang , Aurea Kuo Chun-En
Published: February 2020

Rationale:

Coccyx fracture is an injury usually caused by trauma. In most cases, the fractures recover after conservative therapy. For refractory cases that exhibit coccydynia after more than 2 months of conservative treatment, coccygectomy is indicated. However, limited information about the efficacy of this procedure is available, and it is known to have a high complication rate. As such, other therapeutic approaches are needed. Here, we report our experience using another conservative treatment option, low-level laser therapy, to successfully reduce refractory coccydynia in a patient with coccyx fracture.

Patient concerns:

A 23-year-old woman had refractory coccydynia and increased pain after a traffic accident-induced coccyx fracture.

Diagnoses:

Initially, the patient reported transient improvement after conservative treatment with non-steroidal anti-inflammatory drugs. However, the pain increased in severity (numerical rating scale score of 8) soon after she resumed work in her office, and progressed in the following 2 months. Surgical intervention was suggested owing to the prolonged coccydynia following the failure of conservative treatment and difficulties in performing daily life activities. However, she sought other conservative therapy options, because she was concerned about the risks associated with the coccygectomy surgery.

Interventions:

The patient received low-level laser therapy once a week, for 24 weeks.

Outcomes:

After 11 weeks of treatment, the patient reported significant improvements in her symptoms; her pain was reduced to a numerical rating scale score of 2 and bone healing was noted on radiographs. The patient could eventually perform her daily activities satisfactorily, without coccydynia, after 24 weeks of treatment.

Lessons:

Laser acupuncture produced analgesic effects in this patient with refractory coccydynia after traumatic coccyx fracture. This is the first case report to apply laser acupuncture for refractory coccydynia after traumatic coccyx fracture. Our findings imply that laser acupuncture may be a good conservative therapy option for coccyx fracture.
Prognostic implications of the eighth edition of the union for international cancer control – classification for gastric cancer patients from specialized treatment centers in Germany and Korea
Authors: Samm Nicole , Han Won Ho , Yoon Hong Man , Ryu Keun Won , Cho Hyunsoon , Lee Sanghee , Novotny Alexander , Friess Helmut , Kim Young Woo , Reim Daniel , Eom Bang Wool
Published: February 2020

The validity of the 8th edition of the Union for International Cancer Control (UICC) staging system for gastric cancer has been evaluated only in Asian cohorts and not in European cohorts. The aim of this study was to evaluate the prognostic performance of the 8th edition of the UICC staging system in German and Korean cohorts independently and compare it with that of the 7th edition.

A total of 6121 patients (526 from Germany and 5595 from Korea) who underwent upfront surgery for gastric cancer were retrospectively reclassified according to the 8th edition. Survival according to the UICC stages was estimated by the Kaplan-Meier method and compared by log-rank tests. A Cox proportional hazards model was fitted after adjusting for clinicopathological factors, and receiver operating characteristics analysis was conducted.

The 8th edition showed significant differences in survival between each adjacent stage in the Korean cohort but not in the German cohort. Multivariate analyses revealed that the 8th edition staging was an independent prognostic factor, and its C-statistics were >0.76 in both German and Korean patients. The results were comparable to those observed with the UICC seventh edition (C-statistics was 0.768 vs 0.767 in the German cohort and 0.789 vs 0.785 in the Korean cohort for the 7th vs the 8th edition).

The 8th edition showed prognostic value in predicting the survival of gastric cancer patients in both German and Korean cohorts. However, the predictive ability of the 8th and 7th edition was similar.
The effectiveness and safety of extracorporeal shock wave therapy (ESWT) on spasticity after upper motor neuron injury
Authors: Liu Dan-Yang , Zhong Dong-Ling , Li Juan , Jin Rong-Jiang
Published: February 2020

Background:

Spasticity is one of the manifestations of motor dysfunction in upper motor neuron syndrome, which is characterized by increased muscle tone. Spasticity seriously affects the motor function and activity of daily life of patients. Some studies have shown that extracorporeal shock wave therapy (ESWT) can relieve spasticity in recent years. However, the effectiveness and safety of ESWT on spasticity after motor neuron injury have not been confirmed. The purpose of this systematic review (SR) is to evaluate the effectiveness and safety of ESWT on spasticity after upper motor neuron injury.

Methods:

We will search China National Knowledge Infrastructure (CNKI), the Chinese Science and Technology Periodical Database (VIP), Wan Fang Data, China Biology Medicine (CBM), PubMed, Embase, The Cochrane Library, and Web of Science systematically from their inception dates through October 2019 to obtain randomized controlled trials (RCTs) using ESWT to relieve spasticity in patients after upper motor neuron injury. The primary outcome will be the Modified Ashworth Scale (MAS). Secondary outcomes will include Composite Spasticity Scale (CSS), Spasm Frequency Scale, Modified Tardieu Scale (MTS), electrophysiological study (ratio of maximum H reflex to maximum M response, root mean square value, integrated electromyogram, co-contraction ratio, etc.), or other spasticity-related outcomes. In addition, adverse events will also be assessed as safety measurement. Study selection, data extraction, and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be performed using Review Manager software (RevMan, version 5.3.5) and R (version 3.6.1) software.

Results:

We will synthesize current studies to evaluate the effectiveness and safety of ESWT on spasticity after upper motor neuron injury.

Conclusion:

Our study will provide evidence of ESWT on spasticity after upper motor neuron injury.

Ethics and dissemination:

The ethical approval is not required since SR is based on published studies. The results of this SR will be published in a peer-reviewed scientific journal according to the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) guidelines.

PROSPERO registration number:

CRD42019131059
A STROBE cohort study of 755 deep and superficial upper-extremity vein thrombosis
Authors: Ploton Gaetan , Pistorius Marc-Antoine , Raimbeau Alizée , Denis Le Seve Julien , Bergère Guillaume , Ngohou Chan , Goueffic Yann , Artifoni Mathieu , Durant Cécile , Gautier Giovanni , Connault Jérôme , Espitia Olivier
Published: February 2020

Upper extremity vein thrombosis (UE-VT) are more and more frequent pathologies and yet little studied. The aim is to describe the clinical and ultrasound features, UE-VT-related diseases, and the prevalence of pulmonary embolism (PE) and associated deaths.

All UE-VT patients diagnosed by Doppler-ultrasound in Nantes University Hospital, from January 2015 to December 2017, were included retrospectively. UE-VT suspicion patterns, clinical features, UE-VT topography, and prevalence of PE and death were analyzed.

Seven hundred and fifty-five UE-VT were analyzed, including 427 deep thrombosis (UE-DVT) and 328 superficial thrombosis (UE-SVT). In 86.2% (n = 651) UE-VT were related to endovascular devices. Among these thrombosis, one third is in connection with a PICC LINE and one quarter with a peripheral venous line. Forty nine percent (n = 370) of the patients had solid neoplasia or hematological malignancies. An inflammatory or systemic infectious context was found in 40.8% (n = 308) of the cases. The most frequently observed clinical sign at the UE-VT diagnosis was edema (28.6%). Among the UE-SVT it was the presence of an indurated cord (33.2%) and among the UE-DVT the indication of the Doppler-ultrasound was mainly a suspicion of infection on endovascular device (35.1%). In 10.6% (n = 80) of the cases the UE-VT were asymptomatic. The most frequently thrombosed veins were brachial basilic veins (16.7% of all thrombosed segments) followed by jugular (13%) and subclavian (12.3%) veins; 61.3% (n = 463) of UE-VT were in the right upper extremity; 63.3% (n = 478) UE-VT were occlusive. The occurrence of PE is 4% and the death rate is 10.2%, mainly related to the severe comorbidities of patients with UE-VT.

UE-VT occurs in particular clinical contexts (hematological malignancies, solid cancers, systemic infections) and in the majority of endovascular devices (86.2%). The occurrence of PE is low.
Evaluating the feasibility, acceptability and pre testing the impact of a self-management and tele monitoring program for chronic obstructive pulmonary disease patients in Lebanon
Authors: Nohra Rita Georges , Sacre Hala , Salameh Pascal , Rothan-Tondeur Monique
Published: February 2020

Background:

Chronic obstructive pulmonary disease (COPD) has a significant impact on quality of life and is costly to the health care system. It has been demonstrated that a self-management program improves quality of life, but programs are not universally available and telehealth interventions can provide home-based support, but have mixed results.
[1]

Aim:

The aims of this study are to (1) assess the feasibility and acceptability of a 6 weeks’ educational program related to self-management with remote monitoring for Lebanese COPD patients; (2) pre-test its impact on quality of life, emergency visits, and rate of rehospitalization, and (3) to make recommendations for a future randomized trial.

Methods:

Validated questionnaires will be adapted to meet the context of our study in terms of acceptability, adoption, adequacy, fidelity, cost, and coverage. The impact of this program on quality of life will be measured with the COPD assessment test (CAT) and the COPD clinical questionnaire (CCQ), and the Hospital Anxiety and Depression (HAD) scale will be used to measure anxiety. All measures will be delivered pre- and post-intervention. To evaluate the impact of our program on the rate of hospitalization and emergency visits, the number of hospitalizations and emergency room visits during the year preceding the intervention will be collected from the hospital register of each participant.

Discussion:

This study is the first to evaluate the application of telehealth to optimize COPD management in Lebanon. The results of this study will provide evidence regarding the efficacy and feasibility of this approach for Lebanese patients with moderate to severe COPD.
Emotional distress and quality of life during folinic acid, fluorouracil, and oxaliplatin in colorectal cancer patients with and without chemotherapy-induced peripheral neuropathy
Authors: Hsu Hsin-Tien , Wu Li-Min , Lin Pei-Chao , Juan Chiung-Hui , Huang Yu-Yen , Chou Pi-Ling , Chen Jyu-Lin
Published: February 2020

When the 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) chemotherapy regimen is used to treat colorectal cancer (CRC), chemotherapy-induced peripheral neuropathy (CIPN) caused by oxaliplatin can substantially affect quality of life (QOL) in the CRC patients. This study compared emotional distress and QOL during FOLFOX in CRC patients with and without CIPN symptoms.

This cross-sectional, descriptive, and comparative study recruited 68 CRC patients receiving FOLFOX at a local teaching hospital and at a medical center in southern Taiwan. Self-reported structured questionnaires (oxaliplatin-associated neuropathy questionnaire, profile of mood states short form, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core 30, version 3.0) were used for 1-time data collection. The Chi-square test, Fisher exact test, and Mann–Whitney U test were used to analyze data, and a P-value < .05 was considered statistically significant.

The CIPN group had 45 (66.2%) patients, and the non-CIPN group had 23 (33.8%) patients. The 5 most common symptoms were coldness-related burning sensation or discomfort in the upper limbs, numbness in the upper limbs, tingling in the upper limbs, impairment of vision, and discomfort in the throat. The CIPN group had more females (P = .013), a more advanced stage of CRC (P = .04) and a higher chemotherapy dosage (P = .006). The 2 groups did not significantly differ in anxiety (P = .065) or depression (P = .135). Compared to the non-CIPN group, the CIPN group had significantly lower functioning (P = .001) and global health status (P < .001) and significantly more symptoms (P < .001).

The CIPN group had significantly lower QOL compared to the non-CIPN group. However, the CIPN group did not have lower emotional distress compared to the non-CIPN group. The results of this study demonstrate the need for in-service courses specifically designed to train health professionals in assessing and managing CIPN symptoms to improve QOL in CRC patients receiving FOLFOX.
Comparison of rigid versus foldable iris-fixed phakic intraocular lens implantation for high myopia
Authors: Wu Qiong , Li Yan , Tang Li , Wu Li-An , Wang Cong-Yi
Published: February 2020

Background:

This study aimed to assess the efficacy of rigid versus foldable iris-fixed phakic intraocular lens (PIOL) implantation in the treatment of high myopia.

Methods:

A systematic search based on electronic databases such as Pubmed, Embase, and Cochrane Library was conducted to identify relevant studies published up to January 11, 2019. The pooled odds ratios and weighted mean differences (WMDs) with corresponding 95% confidence intervals were calculated.

Results:

Eight comparative studies with 835 participants were included in this meta-analysis. The overall WMD showed statistical significance in terms of postoperative uncorrected distance visual acuity (UDVA), mean postoperative spherical equivalence (SE), and mean postoperative intraocular higher-order aberrations (HOA) (μm) for a 6-mm pupil, suggesting that foldable PIOL group showed significant improvement of high myopia, compared to rigid PIOL group. Besides, compared with rigid PIOL group, foldable PIOL group had beneficial effect on the proportion of eyes with central endothelial cell density (ECD) loss in patients with high myopia.

Conclusion:

This meta-analysis provided the up-to-date evidence and found that foldable PIOL group had significant beneficial effect on UDVA, SE, HOA, contrast sensitivity, and ECD, except best spectacle-corrected visual acuity, and safety in the treatment of high myopia over rigid PIOL group.
Mini-fluid challenge test predicts stroke volume and arterial pressure fluid responsiveness during spine surgery in prone position
Authors: Lee Chen-Tse , Lee Tzong-Shiun , Chiu Ching-Tang , Teng Hsiao-Chun , Cheng Hsiao-Liang , Wu Chun-Yu
Published: February 2020

The study was designed to verify if mini-fluid challenge test is more reliable than dynamic fluid variables in predicting stroke volume (SV) and arterial pressure fluid responsiveness during spine surgery in prone position with low-tidal-volume ventilation.

Fifty patients undergoing spine surgery in prone position were included. Fluid challenge with 500 mL of colloid over 15 minutes was given. Changes in SV and systolic blood pressure (SBP) after initial 100 mL were compared with SV, pulse pressure variation (PPV), SV variation (SVV), plethysmographic variability index (PVI), and dynamic arterial elastance (Eadyn) in predicting SV or arterial pressure fluid responsiveness (15% increase or greater).

An increase in SV of 5% or more after 100 mL predicted SV fluid responsiveness with area under the receiver operating curve (AUROC) of 0.90 (95% confidence interval [CI], 0.82 to 0.99), which was significantly higher than that of PPV (0.71 [95% CI, 0.57 to 0.86]; P = .01), and SVV (0.72 [95% CI, 0.57 to 0.87]; P = .03). A more than 4% increase in SBP after 100 mL predicted arterial pressure fluid responsiveness with AUROC of 0.86 (95% CI, 0.71–1.00), which was significantly higher than that of Eadyn (0.52 [95% CI, 0.33 to 0.71]; P = .01).

Changes in SV and SBP after 100 mL of colloid predicted SV and arterial pressure fluid responsiveness, respectively, during spine surgery in prone position with low-tidal-volume ventilation.