bluuebunny/crossref_metadata_2025 huggingface dataset:
β-Escin alleviates cobalt chloride-induced hypoxia-mediated apoptotic resistance and invasion via ROS-dependent HIF-1α/TGF-β/MMPs in A549 cells
Authors: Paneerselvam Chermakani , Ganapasam Sudhandiran
Published: March 2020

Hypoxia is contributed in various pathophysiological conditions including obesity, cardiovascular diseases, and cancer. In cancer, hypoxia is a salient phenomenon and has been correlated with tumor progression, metastasis, and provoke resistance to therapies in cancer patients, which exert with stabilization of main effector, hypoxia inducible factor-1 alpha (HIF-1α). Therefore, therapeutic targeting of hypoxic responses in cancer is the potential approach to improve the better treatment efficacy. In the present study, we evaluated the effect of β-Escin (β-Es) on hypoxia-induced resistance to apoptosis and metastasis in human non–small-cell lung cancer cells. The MTT assay revealed that β-Es treatment decreased the A549 cells viability under cobalt chloride-induced hypoxia. Apoptotic proteins were analyzed by western blot that showed cancer cells treated with β-Es induced cell death in hypoxia condition as proteins compared with normoxia. Moreover, we observed that cobalt chloride induced hypoxia through the generation of intracellular reactive oxygen species and stabilized the transcriptional factor HIF-1α, which leads to cancer metastasis. This notion was supported by the migration, invasion, and adhesion assays. Furthermore, hypoxia increased the expression of transforming growth factor-β, and the activation of matrix metalloproteinases were suppressed by the treatment of β-Es as well as pretreatment with N-acetylcysteine (NAC). Therefore, we demonstrate that a concurrent activation of HIF-1α, transforming growth factor-β, and matrix metalloproteinases participate in hypoxia-induced metastasis and that β-Es prevent A549 cells metastasis by inhibition of reactive oxygen species.
Associations Among Skin Surface pH, Temperature, and Bacterial Burden in Wounds
Authors: Maliyar Khalad , Persaud-Jaimangal Reneeka , Sibbald R. Gary
Published: March 2020

GENERAL PURPOSE

To present a cross-sectional cohort study conducted to assess the association between wound pH, local infection, and deep/surrounding infection.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant should be better able to:

1. Synthesize the background information associated with the study assessing the association between wound pH, local infection, and deep/surrounding infection.

2. Summarize the results of the study presented here.

BACKGROUND

Wounds with a higher pH often demonstrate lower rates of healing. Local and deep/surrounding infection can be diagnosed with the validated NERDS and STONEES clinical signs, respectively. This study assessed the association between wound pH, local infection, and deep/surrounding infection.

METHODS

A 100-patient prospective cross-sectional cohort study was conducted with leg and foot wounds. Wound pH was measured using pH indicator strips. The wounds were assessed for clinical signs of local or deep/surrounding infection with the NERDS and STONEES criteria, respectively. Temperature measurements were documented with a handheld infrared skin thermometry device at the wound/periwound site, the equivalent site on the opposite side of the same leg/foot, and the wound mirror image site on the opposite leg/foot.

RESULTS

There was no significant difference in the mean wound bed pH in patients with superficial critical colonization and those without (P = .837). The wound and periwound maximum temperature measurements were compared with an equivalent temperature on the mirror image on the opposite leg. There was a statistically significant difference in the mean temperature (ΔT) value between patients with deep/surrounding wound infection and three or more positive STONEES criteria (P = .002).

CONCLUSIONS

Nontouch infrared thermometry comparing maximum mirror image wound temperatures versus the opposite extremities when combined with two or more other STONEES criteria is a significant indicator of deep and surrounding infection. Surface wound bed pH indicator strip measurements do not correlate with local wound infection using the NERDS criteria.
Chronic fatigue syndrome
Authors: Bush Marianne
Published: March 2020

Chronic fatigue syndrome (CFS) is a long-term, often misunderstood disorder that involves the nervous, immune, metabolic, endocrine, and digestive systems. This article describes the pathophysiology of CFS, signs and symptoms of CFS in adults, diagnostic criteria for CFS, and nursing considerations for patients with CFS.
Volatile Anesthetics versus Propofol for Cardiac Surgery with Cardiopulmonary Bypass
Authors: Bonanni Alice , Signori Alessio , Alicino Cristiano , Mannucci Irene , Grasso Maria Antonietta , Martinelli Luigi , Deferrari Giacomo
Published: March 2020

Background

The aim of this systematic review and meta-analysis was to assess the effect of anesthesia maintenance with volatile agents compared with propofol on both short- and long-term mortality (primary outcomes) and major clinical events in adults undergoing cardiac surgery with cardiopulmonary bypass.

Methods

Randomized clinical trials on the effects of current volatile anesthetics versus propofol in adults undergoing cardiac surgery with cardiopulmonary bypass were searched (1965 to September 30, 2019) in PubMed, the Cochrane Library, and article reference lists. A random effect model on standardized mean difference for continuous outcomes and odds ratio for dichotomous outcomes were used to meta-analyze data.

Results

In total, 37 full-text articles (42 studies, 8,197 participants) were included. The class of volatile anesthetics compared with propofol was associated with lower 1-yr mortality (5.5 vs. 6.8%; odds ratio, 0.76 [95% CI, 0.60 to 0.96]; P = 0.023), myocardial infarction (odds ratio, 0.60 [95% CI, 0.39 to 0.92]; P = 0.023), cardiac troponin release (standardized mean difference, −0.39 [95% CI, −0.59 to −0.18], P = 0.0002), need for inotropic medications (odds ratio, 0.40 [95% CI, 0.24 to 0.67]; P = 0.0004), extubation time (standardized mean difference, −0.35 [95% CI, −0.68 to −0.02]; P = 0.038), and with higher cardiac index/output (standardized mean difference, 0.70 [95% CI, 0.37 to 1.04]; P < 0.0001). The class of volatile anesthetics was not associated with changes in short-term mortality (1.63 vs. 1.65%; odds ratio, 1.04 [95% CI, 0.73 to 1.49]; P = 0.820) and acute kidney injury (odds ratio, 1.25 [95% CI, 0.77 to 2.03]; P = 0.358).

Conclusions

In adults undergoing cardiac surgery with cardiopulmonary bypass, the class of volatile anesthetics was superior to propofol with regard to long-term mortality, as well as to many secondary outcomes indicating myocardial protection.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Intubation and Ventilation amid the COVID-19 Outbreak
Authors: Meng Lingzhong , Qiu Haibo , Wan Li , Ai Yuhang , Xue Zhanggang , Guo Qulian , Deshpande Ranjit , Zhang Lina , Meng Jie , Tong Chuanyao , Liu Hong , Xiong Lize
Published: March 2020

The COVID-19 outbreak has led to 80,409 diagnosed cases and 3,012 deaths in mainland China based on the data released on March 4, 2020. Approximately 3.2% of patients with COVID-19 required intubation and invasive ventilation at some point in the disease course. Providing best practices regarding intubation and ventilation for an overwhelming number of patients with COVID-19 amid an enhanced risk of cross-infection is a daunting undertaking. The authors presented the experience of caring for the critically ill patients with COVID-19 in Wuhan. It is extremely important to follow strict self-protection precautions. Timely, but not premature, intubation is crucial to counter a progressively enlarging oxygen debt despite high-flow oxygen therapy and bilevel positive airway pressure ventilation. Thorough preparation, satisfactory preoxygenation, modified rapid sequence induction, and rapid intubation using a video laryngoscope are widely used intubation strategies in Wuhan. Lung-protective ventilation, prone position ventilation, and adequate sedation and analgesia are essential components of ventilation management.
Subungual exostosis – treatment results with preservation of the nail bed
Authors: Pascoal Diogo , Balacó Inês , Alves Cristina , Cardoso Pedro Sá , Ling Tah Pu , Matos Gabriel
Published: March 2020

Subungual exostosis is a rare benign osteocartilaginous tumor, of unknown etiology, that affects the subungual part of the distal phalanx and predominantly affects adolescent females. The objective of this study is to evaluate the results of surgical treatment of subungual exostosis in pediatric patients by means of surgical excision and nail preservation. We present a retrospective study, including pediatric patients with subungual exostosis who underwent surgical treatment in a single institution, over a 6-year period, We describe the surgical technique used, the characteristics of the patients and lesions, and evaluate the results obtained in terms of function, satisfaction and complications. Thirteen patients were included in this study, seven female (54%) and six male (46%), median age 11 years old. The most common location was the hallux, in eight patients (73%). Patients had good functional results with a median American Orthopedic Foot & Ankle Society score of 100 [80; 100] and a median personal satisfaction score of 9. The median follow-up was 30 [3;68] months. In our patients, subungual excision with nail bed preservation, allows a good balance between the radical excision of the exostosis and the preservation of the natural protection granted by the native nail, yielding good functional results and patient satisfaction.
Ultrasound-guided Cubital Tunnel Injection: A Review and Exploration of Utility as a Diagnostic Aid in Mild or Nonclassic Cubital Tunnel Patients
Authors: Gronbeck Christian , Wolf Jennifer , Rodner Craig M.
Published: March 2020

Cubital tunnel syndrome (CuTS) is a common and potentially debilitating neuropathy that results from chronic forces on the ulnar nerve at the elbow. First-line treatment options such as physiotherapy and nighttime splinting are effective in many patients, with refractory patients often benefiting from in situ ulnar nerve decompression or ulnar nerve decompression and transposition. However, identification of the most ideal surgical candidates can often present a clinical challenge, particularly in patients with a nonclassic presentation, significant comorbidities, or a negative nerve conduction study. Current literature suggests that there may be both a therapeutic and diagnostic benefit of ultrasound (US)-guided corticosteroid injections into the cubital tunnel among this population, although existing study designs have differed in terms of injection technique and outcome measurements. A descriptive case series at our institution examined 63 patients (66 arms) with mild CuTS symptoms over the course of 6 years and suggested a potential diagnostic benefit of US-guided injections in this population. In this series, those patients who experienced transient relief after US-guided injection also exhibited good long-term outcomes from surgical decompression. Randomized, controlled studies that further investigate the therapeutic and diagnostic value of US-guided cubital tunnel injections for certain patients with mild or nonclassic presentations of CuTS are recommended.
Immune escape mechanisms in head and neck squamous cell carcinoma and implication for new immunotherapy approach
Authors: Merlano Marco C. , Denaro Nerina , Garrone Ornella
Published: March 2020

Purpose of review

The aim of this review is to describe the major steps leading to the immunosuppressive tumor microenvironment and to summarize some of the new immunotherapies that interfere with these mechanisms.

Recent findings

Immunotherapy has improved the outcome of relapsed/metastatic head and neck squamous cell carcinoma (HNSCC). However, most patients still do not respond to treatment and median overall survival remains short with a modest rate of long-term survivors. There is a growing awareness that tumor immune-escape is a complex process that involves many redundant mechanisms other than immune check-points. They interfere with the innate immune response, activation of adaptive immune response, homing of effector T cells, their clonal expansion, viability, and efficiency. This abundance of immunosuppressive mechanisms explains the limited results achieved by immune checkpoint inhibitors. Combined treatments targeting different mechanisms of escape are in development to further improve the outcome of patients with HNSCC.

Many mechanisms favor tumor immune-escape. Each tumor exploits preferably some of them and the challenge is to understand which are the best targets in each tumor. This knowledge is an important tool to design future combination strategies based on strong biological rationales, which could offer better results than simple empirical combinations.
CCL20 mediates the anti-tumor effect of vitamin D3 in p38MAPK/NF-κB signaling in colitis-associated carcinogenesis
Authors: Xin Yu , Wang Hongjuan , Wang Yanan , Xu Weihua , Teng Guoxin , Han Fuyan , Guo Jianqiang
Published: March 2020

Vitamin D3 is beneficial in ameliorating or preventing inflammation and carcinogenesis. CCL20 is a potential therapeutic target in carcinogenesis, which mediates the protective effect of vitamin D or vitamin D analogue in autoimmune and cancer diseases. Here we aim to evaluate whether vitamin D3 plays a protective role in colitis-associated colorectal cancer (CAC) by affecting CCL20 and the molecular mechanism. Administration of azoxymethane (AOM) followed with dextran sulfate sodium (DSS) was used to simulate CAC in mouse. After 5-day DSS treatment, vitamin D3 supplementation was for 9 weeks at 60 IU/g/w. We found that dietary vitamin D3 significantly reduced the tumor number and tumor burden in mouse. In-vivo and -vitro, vitamin D3 reduced the levels of CCL20, phospho-p38 MAPK (p-p38) and phospho-NF-κB p65 (p-p65), and the transcriptional activity of NF-κB. Further studies showed that CCL20 mediated the inhibition of vitamin D3 in p38MAPK-mediated NF-κB signaling in vitro. Taken together, vitamin D3 effectively suppressed colonic carcinogenesis in AOM-DSS mouse model. Downregulation of CCL20 may contribute to the preventive effect of vitamin D3 on NF-κB activity. It may merit further clinical investigation as a therapeutic agent against CAC in humans.
Paraneoplastic Encephalitis and Enteric Neuropathy Associated With Anti-Hu Antibody in a Patient Following Immune-checkpoint Inhibitor Therapy
Authors: Kang Kai , Zheng Kai , Zhang Yanwen
Published: March 2020

Paraneoplastic neurological syndromes (PNSs) are uncommon complications of immune-checkpoint inhibitor (ICI) therapy. This article reports a case of paraneoplastic encephalitis and enteric neuropathy associated with anti-Hu antibody in a patient with advanced small cell lung cancer. Symptoms presented in the third week after the second dose of sintilimab therapy and manifested as focal seizures and intestinal pseudo-obstruction. The patient’s neurological symptoms improved significantly after treatment with intravenous infusion of methylprednisolone and sequential oral prednisone. This is the first report of sintilimab-related neurological adverse events. On the basis of this case, we speculate that ICIs may induce PNSs. Identifying relevant biomarkers may be instructive for the diagnosis and treatment of small cell lung cancer patients, and discontinuing ICIs and treatment with immunosuppressive in the early stages of PNSs may contribute to a better prognosis.
Rosuvastatin Reverses Hypertension-Induced Changes in the Aorta Structure and Endothelium-Dependent Relaxation in Rats Through Suppression of Apoptosis and Inflammation
Authors: Lv Qingbo , Wang Yao , Li Ya , Zhao Liding , Gong Yingchao , Wang Meihui , Wang Min , Fu Guosheng , Zhang Wenbin
Published: March 2020

Vascular remodeling is one of the most critical complications caused by hypertension. Previous studies have demonstrated that rosuvastatin has anti-inflammatory, antioxidant, and antiplatelet effects and therefore can be used to treat cardiovascular disease. In this study, we explored the beneficial effects of rosuvastatin in reversing aortic remodeling in spontaneously hypertensive rats. After treating with different doses of rosuvastatin, its antilipid, antiapoptosis, and anti-inflammatory effects were determined. We also examined whether rosuvastatin can improve the structure and function of the aorta. We found that rosuvastatin treatment of spontaneously hypertensive rats for 2 months at 2 different doses can effectively reduce the media thickness of the aorta compared with the control group. Similarly, rosuvastatin improved the vascular relaxation function of the aortic rings at a high level of acetylcholine in vitro. Mechanistically, it was found that rosuvastatin increased the expression of endothelial nitric oxide synthase and plasma nitrite/nitrate levels. Besides, rosuvastatin suppressed the apoptosis and inflammation and upregulated the expression of gap-junction complex connexin 43 both in media and endothelium. Finally, rosuvastatin inhibited the AT1R/PKCα/HSP70 signaling transduction pathway. In summary, these findings demonstrated that rosuvastatin could improve the vascular structure and function mainly by increasing endothelial nitric oxide synthase expression and preventing apoptosis and inflammation. This study provided evidence that rosuvastatin has beneficial effects in reversing the remodeling of the aorta due to hypertension.
Simplifying Facial Feminization Surgery Using Virtual Modeling on the Female Skull
Authors: Hoang Han , Bertrand Anthony A. , Hu Allison C. , Lee Justine C.
Published: March 2020

Osseous work in facial feminization has been largely developed by comparing the qualitative and quantitative anthropometric differences between male and female cadaveric skulls. While virtual surgical planning has allowed for improved accuracy and ease in osteotomies and recontouring procedures in facial feminization, ultimately, a subjective decision-making process is still required. In this work, we describe a novel method of simplifying facial feminization by virtually modeling all osseous surgical maneuvers for facial feminization with a reference female skull.
Additional Relaxing Suturing Using Absorbable Symmetric Barbed Sutures to Help Close Scalp Defects
Authors: Hosomi Kento , Yuzuriha Shunsuke , Nagai Fumio , Yanagisawa Daisuke
Published: March 2020

Closing a scalp wound with skin defects is challenging because the scalp skin lacks extensibility and closing it tends to result in a remarkable, widespread, hairless scar. Absorbable symmetric barbed suture device (Stratafix Symmetric; Ethicon, USA) allows wound closure using a pulling motion alone and provides a strong and secure closure for the high-tension area. We used this device to close wide scalp defects easily without tension and with minimized sequential scalp alopecia. The aim of this study was to show our experiences with using this technique. From January 2017 to March 2019, our relaxing suture technique was performed in 7 pediatric patients with scalp alopecia due to various lesions that ranged 23.0 ± 6.5 mm. After resecting the lesions, the galea was sutured using the 3-0 absorbable symmetric barbed suture via a running subcutaneous suture technique. The widespread wound edges were approximated by pulling the suture device. Wound closure was completed with galeal suturing and a superficial suture. We evaluated the width of the postoperative hairless scar at the final follow-up. In all 7 patients, we could approximate the widespread wound edges by pulling alone. Subsequently, the wounds could be closed without tension or difficulty. The mean width of the postoperative hairless scar was 3.3 ± 0.8 mm (range: 1.9–4.3 mm), and no complication was detected during the follow-up period. Our new relaxing suture technique using an absorbable barbed suture with symmetric anchors is a supportive and additional way to help close scalp defects.
Complications after Perforated versus Nonperforated Acellular Dermal Matrix Use in Direct-to-Implant Breast Reconstruction: A Propensity Score Analysis
Authors: Wood Kasey Leigh , Margulies Ilana G. , Shay Paul L. , Ashikari Andrew Y. , Salzberg C. Andrew
Published: March 2020

Background:

Acellular dermal matrices (ADMs) were first incorporated into direct-to-implant (DTI) breast reconstruction by the senior author in 2001 and have since become foundational to implant-based reconstruction. ADM composition has evolved recently and now includes perforated types, which some speculate decrease the likelihood of seroma. The authors performed a retrospective review of perforated (P-ADM) and nonperforated (NP-ADM) ADM-assisted direct-to-implant breast reconstruction patients to evaluate differences in complication rates.

Methods:

Retrospective review of direct-to-implant breast reconstruction patients operated on by a single surgeon (CAS) from 2011 to 2018 was conducted. Patient and operative characteristics, including ADM type, were recorded. A propensity score matching algorithm accounting for potentially confounding variables was developed, followed by univariate analysis to evaluate the association between ADM perforation and postoperative complications.

Results:

The review began with 409 patients (761 breasts). Following exclusion of patients with missing demographic information, lack of ADM in their reconstruction, and follow-up times of less than 4 weeks, 364 patients (680 breasts) were included for analysis. A total of 530 (77.94%) and 150 (22.06%) breasts received NP-ADM and P-ADM, respectively. After propensity score matching, there were 294 breasts, composed of equal numbers of P-ADM and NP-ADM recipients. Univariate analysis showed no association between ADM type and any postoperative complication.

Conclusions:

The complication profile of direct-to-implant breast reconstruction appears to be unaffected by the use of P-ADM or NP-ADM. Current understanding of the association between ADM type and clinical outcomes would benefit from multi-institution, prospective, randomized trials.
Hypertension impairs hypoxia-induced angiogenesis in men
Authors: Garcia Vinicius P. , Rocha Helena N.M. , Rocha Marcos P. , Mattos João D. , Campos Monique O. , Mansur Daniel E. , Secher Niels H. , Nóbrega Antonio C.L. , Fernandes Igor A. , Rocha Natália G.
Published: March 2020

Objective:

The inability of the organism to appropriately respond to hypoxia results in abnormal cell metabolism and function. Hypoxia-induced angiogenesis seems to be suppressed in experimental models of hypertension; however, this hypothesis has not been tested in humans. We examined changes in endothelial biomarkers and vascular chemoattraction/angiogenic capacity in response to isocapnic hypoxia in hypertensive men.

Methods:

Twelve normotensive (38 ± 10 years) and nine hypertensive men (45 ± 11 years) were exposed to 5-min trials of normoxia (21% O2) and isocapnic hypoxia (10% O2). During the last minute of each trial, venous blood was drawn. Endothelial progenitor cells (EPCs; CD45dim/CD34+/VEGFR2+), endothelial microvesicles (apoptotic EMVs, CD42b−/CD31+/AnnexinV+; endothelial activation, CD62E+/CD144+), nitrite, vascular endothelial growth factor (VEGF), and stromal cell-derived factor 1 (SDF-1) were measured.

Results:

During normoxia, EPCs, nitrite, endothelial activation, and SDF-1 were similar between groups, whereas VEGF was lower (P = 0.02) and apoptotic EMVs tended to increase (P = 0.07) in hypertensive men. During isocapnic hypoxia, endothelial activation increased in both groups (normotensive, P = 0.007 vs. normoxia; hypertensive, P = 0.006 vs. normoxia), whereas EMVs were higher only in the hypertensive group (P = 0.03 vs. normotensive). EPCs (P = 0.01 vs. normoxia; P = 0.03 vs. hypertensive men), NO (P = 0.01 vs. normoxia; P = 0.04 vs. hypertensive), and VEGF (P = 0.02 vs. normoxia; P = 0.0005 vs. hypertensive) increased only in normotensive individuals in response to isocapnic hypoxia. SDF-1 did not change in either group.

Conclusion:

These results suggest that hypertension-induced impairment in angiogenesis in response to isocapnic hypoxia is related to disrupted NO bioavailability, VEGF chemotactic signaling, and EPC mobilization.
The α1D-adrenoreceptor antagonist BMY 7378 reverses cardiac hypertrophy in spontaneously hypertensive rats
Authors: Rodríguez Jessica E. , Saucedo-Campos Alberto D. , Vega Ana V. , Ramírez-Hernández Diana , Martínez-Aguilar Luisa , Jiménez-Flores J. Rafael , Andrade-Jorge Erik , Estrada-Soto Samuel E. , Villalobos-Molina Rafael , Touyz Rhian M. , Gallardo-Ortíz Itzell A.
Published: March 2020

Objective:

The α1D-adrenoreceptor (α1D-AR) is involved in angiotensin II-induced vascular remodeling and hypertension. Whether α1D-AR plays a role in hypertension-associated cardiac hypertrophy is unclear. Here we investigated effects of BMY 7378, a selective α1D-AR antagonist, on cardiac status in aged spontaneously hypertensive rats (SHR).

Methods:

Male SHR were studied during the phase of developing hypertension (5 and 10 weeks old) and once hypertension was established (20 and 30 weeks old) to assess the evolution of cardiac hypertrophy. Age-matched WKY rats were studied as controls. Thirty-week-old SHR were treated for 4 weeks with BMY 7378 (10 mg/kg per day, o.a.), or captopril (angiotensin-converting enzyme inhibitor, 40 mg/kg per day, o.a.) (as a positive control). Blood pressure and cardiac function were measured in vivo, cardiac hypertrophy by histology, and α1D-AR protein expression by immunofluorescence.

Results:

By 30 weeks of age, SHR exhibited significant hypertension and cardiac hypertrophy. BMY 7378 and captopril decreased blood pressure and improved hemodynamic parameters and cardiac function in treated SHR vs. untreated SHR (P < 0.05). Histology showed increased cardiomyocyte size, fibrosis, and left ventricular hypertrophy in SHR hearts. BMY 7378 ameliorated fibrosis and cardiac hypertrophy, but had no effect on cardiomyocyte size in SHR. Effects of BMY 7378 were associated with increased α1D-AR protein expression in SHR.

Conclusion:

Our data indicate that pharmacological antagonism of α1D-AR reduces blood pressure and associated cardiac hypertrophy in aged SHR. These findings suggest that the α1D-AR plays a pathophysiological role in the development of hypertension and cardiac target organ damage in SHR.
IS VAGINAL DELIVERY HARMFUL TO PATIENTS WITH PSEUDOXANTHOMA ELASTICUM?
Authors: Risseeuw Sara , Yildirim Hilin , Spiering Wilko , Imhof Saskia M. , van Leeuwen Redmer , Ossewaarde-van Norel Jeannette
Published: March 2020

Background/Purpose:

To investigate the effect of a vaginal delivery (VD) on retinal pathology in patients with pseudoxanthoma elasticum.

Methods:

Retrospective case series. All 14 consecutive women with pseudoxanthoma elasticum who visited the ophthalmology department during pregnancy and after delivery between 2010 and 2018 were included. Prepartum and postpartum imaging consisted of color imaging, near-infrared imaging, and optical coherence tomography and was assessed on occurrence of (sub)retinal hemorrhages and change in angioid streaks.

Results:

Fourteen patients (15 deliveries) were included, of whom 11 patients (79%) had a VD and three patients (21%) a secondary caesarian section. Data of three patients with VD (four deliveries) could not be assessed for (sub)retinal hemorrhage within 10 weeks postpartum. The median age at delivery was 31 years (IQR 29–37). One patient with VD (9%) had a choroidal neovascularization and was treated with anti-VEGF injections before assisted delivery. All patients had angioid streaks in the central 5,500 µm of the posterior pole of both eyes. After delivery, no patient in the VD or caesarian section group presented with progression of angioid streaks or (sub)retinal hemorrhage.

Conclusion:

Pushing during the expulsion phase of VD seems safe in pseudoxanthoma elasticum patients without active choroidal neovascularization, and the presence of angioid streaks alone should not be an indication for elective caesarian section.
Transcribed ultraconserved noncoding RNA uc.153 is a new player in neuropathic pain
Authors: Zhang Chenjing , Peng Yunan , Wang Yin , Xu Hongjiao , Zhou Xuelong
Published: March 2020

Transcribed ultraconserved regions are a novel class of long noncoding RNAs and are completely conserved in humans, rats, and mice. Transcribed ultraconserved regions have been implicated in diverse biological processes; however, very little is currently known about their role in pain modulation. Here, we found that the level of the spinal transcribed ultraconserved region uc.153 was significantly increased in a mouse model of sciatic nerve chronic constriction injury (CCI)-induced chronic neuropathic pain. The knockdown of spinal uc.153 prevented and reversed chronic constriction injury–induced pain behaviours and spinal neuronal sensitization. By contrast, the overexpression of spinal uc.153 produced pain behaviours and neuronal sensitization in naive mice. Moreover, we found that uc.153 participates in the regulation of neuropathic pain by negatively modulating the processing of pre-miR-182-5p. Collectively, our findings reveal an important role for uc.153 in pain modulation and provide a novel drug target for neuropathic pain therapy.
The Compounding Power of the Clinical Community
Authors: Mariani Angela M. , Morabito Julie
Published: March 2020

Healthcare technology management (HTM) professionals are critical stakeholders in promoting patient safety, regularly troubleshooting medical devices that are unsafe or unable to be used by clinical staff. Healthcare technology management professionals determine, investigate, and often address the root cause (or causes) of medical device concern(s), so that the devices can be used safely and effectively throughout the facility. The HTM professional's investigation, when accompanied by medical device reports, often leads to manufacturer actions, including recalls and corrections, which contribute to continuous improvement of device safety and performance. As highlighted in this case report, healthcare facility reporting teams, which include HTM professionals, provide value to the healthcare community as a whole, affecting real-world outcomes and patient safety.
Exercise Interventions in Cardio-Oncology Populations
Authors: Wang Hsiao-Lan , Cousin Lakeshia , Fradley Michael G. , Donovan Kristine A. , Smith Barbara , Szalacha Laura , Lavoie Smith Ellen M. , Buck Harleah G.
Published: March 2020

Background

Cardiac toxicity in patients with cancer results from treatment-related damage to the cardiovascular system by chemotherapy, targeted agents, or thoracic radiation. Cardio-oncology patients with co-occurring cancer and cardiovascular disease frequently experience fatigue. Exercise is recommended in clinical guidelines to manage fatigue during or after cancer treatment.

Purpose

The purpose of this article is to conduct a scoping review of the exercise randomized clinical trials in cardio-oncology patients, focusing on the components and effects of exercise interventions on patient cardiovascular and fatigue outcomes.

Methods

A scoping review methodological framework was deemed appropriate and used. Key words for search included “cancer,” “oncology,” “cardio-oncology,” “heart failure,” “physical activity,” and “exercise.” Search involved systematic searches of large databases (PubMed, MEDLINE, Cochrane Review, and CINAHL) and hand searches of reference lists, key journals, webpages, and experts in the field using snowballing techniques.

Results

There were 12 randomized clinical trials included in this review. Study characteristics, accordance of exercise protocols with recommendations, specific exercise training components, and cardiovascular and fatigue outcomes were mapped.

Conclusions

Recommendations for addressing the gaps included focusing on non–breast-cancer patients with cardiac toxicity risks, developing precision-based prescriptions based on various medical and physiological characteristics, and adding fatigue symptom experience as an outcome variable.
Nurses' Perspectives of Factors That Influence Therapeutic Relationships in Secure Inpatient Forensic Hospitals
Authors: Stevenson Claire , Taylor James
Published: March 2020

Background

The therapeutic relationship is synonymous with mental health nursing and fundamental to the provision of nursing care, regardless of the setting in which care is provided. This literature review examines, from a nursing perspective, factors influencing the formation and maintenance of therapeutic relationships in forensic mental health settings.

Methods

A systematic search of the literature, using a range of electronic databases, focusing on nurse–patient therapeutic relationships in forensic settings was conducted. Articles were Critical Appraisal Skills Programme quality appraised, followed by a meta-aggregative thematic approach to data analysis and synthesis to identify themes and, finally, a production of an “action” policy statement.

Findings and Implication for Practice

Eight articles met the criteria for review inclusion. Nine themes were identified; seven were categorized as internal/interpersonal factors, and two were categorized as external/environmental factors (with some themes interconnected). Synthesis of findings resulted in the production of a policy statement encouraging forensic mental health nurses to be aware of intrapersonal influences on therapeutic relationships and the need to provide a safe and supportive clinical environment for these relationships to form.
Comparison of Outcomes Between the National Surgical Quality Improvement Program and an Emergency General Surgery Registry
Authors: DesPain Robert W. , Parker William J. , Kindvall Angela T. , Learn Peter A. , Elster Eric A. , Jessie Elliot M. , Rodriguez Carlos J. , Bradley Matthew J.
Published: March 2020

Background:

The National Surgical Quality Improvement Program (NSQIP) has become a prevalent tool for quality improvement. At our tertiary military hospital, NSQIP collects 20% of eligible cases. We implemented an emergency general surgery (EGS) registry to prospectively review all EGS cases. We compared our EGS registry with NSQIP, hypothesizing that NSQIP sampling under-represents EGS outcomes.

Methods:

A formal EGS Process Improvement Program was implemented in 2016. From 2016 to 2018, the four most common operations were laparoscopic appendectomy, laparoscopic cholecystectomy, surgery for small bowel obstruction, and nonelective hernia repair. Outcomes were compared between the EGS registry and NSQIP abstracted cases.

Results:

In 2016, the EGS registry identified 11/112 (9.8%) patients with a complication. National Surgical Quality Improvement Program abstracted 16% of EGS cases with 16.7% (3/18) of patients having a complication. In 2017, the EGS registry identified 10/87 (11.5%) cases with complications. National Surgical Quality Improvement Program abstracted 23% of EGS with zero complications. In 2018, the EGS registry identified 9.5% of 74 cases with complications. National Surgical Quality Improvement Program abstracted 15% of EGS cases with zero complications.

Conclusions:

National Surgical Quality Improvement Program did not capture many important EGS outcomes. In 2 of 3 years, NSQIP did not identify a single complication for EGS. National Surgical Quality Improvement Program alone may be insufficient to target EGS improvements.
Steroid Nomenclature in Inner Ear Therapy
Authors: Salt Alec N. , Plontke Stefan K.
Published: March 2020

Local glucocorticosteroid (“steroid”) therapy is widely used to treat the inner ears of patients with Menière's disease, idiopathic sudden sensorineural hearing loss and in combination with cochlear implants. Applied steroids have included dexamethasone, methylprednisolone, and triamcinolone. In reality, however, this is often not true and the steroid forms commonly applied are dexamethasone-phosphate, methylprednisolone-hemisuccinate, or triamcinolone-acetonide. In each case, the additional component is not a counter-ion but is covalently bound to the molecule to increase aqueous solubility or potency. These drug forms are approved for intravenous or intramuscular delivery and are used “off-label” in the ear. When given systemically, the molecular form of the drug is of minor importance as the drugs are rapidly metabolized. In contrast, when administered intratympanically, the exact form of the drug has a major influence on entry into perilymph and elimination from perilymph, which in turn influences distribution along the cochlear scalae. Dexamethasone-phosphate has completely different molecular properties to dexamethasone and has different pharmacokinetic properties entering and leaving perilymph. Molecular properties and perilymph pharmacokinetics also differ markedly for triamcinolone and triamcinolone-acetonide. Methylprednisolone-hemisuccinate has completely different molecular properties to methylprednisolone. In the ear, different steroid forms cannot therefore be regarded as equivalent in terms of pharmacokinetics or efficacy. This presents a terminology problem, where in many cases the drug stated in publications may not be the form actually administered. The lack of precision in nomenclature is a serious problem for the inner ear drug delivery field and needs to be recognized.
The association between homocysteine and ischemic stroke subtypes in Chinese
Authors: Zhang Tao , Jiang Yuan , Zhang Shuhua , Tie Tingting , Cheng Yan , Su Xiaoming , Man Zhu , Hou Jing , Sun Li , Tian Meiyuan , Zhang Yaogang , Li Jianhua , Ma Yanyan
Published: March 2020

Background:

The findings on the association between elevated plasma homocysteine levels and the risk of the trial of org 10172 in acute stroke treatment (TOAST) of ischemic stroke have been inconsistent in Chinese. So far, there is no meta-analysis about the association between Hcy and the TOAST subtypes of ischemic stroke in Chinese. This study; therefore, aimed to evaluate whether elevated homocysteine levels are associated with the TOAST subtypes of ischemic stroke using a meta-analysis.

Materials and methods:

A systematic search of electronic databases were conducted for studies reporting homocysteine levels in ischemic stroke and the TOAST of ischemic stroke to April 18, 2018. The data were extracted after the application of inclusion and exclusion criteria. All the data were analyzed using Stata software version 9.0 (Stata Corp LP, College Station, TX). The standardized mean difference (SMD) and 95% confidence interval (CI) were used to compare continuous variables.

Results:

Thirteen studies comprising 3114 participants (2243 patients and 871controls) met the eligibility criteria and were included in the meta-analysis. The meta-analysis revealed that the ischemic stroke group had significantly higher levels of homocysteine than controls (SMD = 1.15, 95% CI = 0.85–1.45, P < .05). The subgroup analyses suggested that the groups of patients with large-artery atherosclerosis, small-vessel occlusion, cardioembolism, stroke of other determined etiology and stroke of undetermined etiology had significantly higher levels of homocysteine compared to those in the control group (large-artery atherosclerosis: SMD = 2.12, 95% CI = 1.40–2.84, P < .05; small-vessel occlusion: SMD = 1.10, 95% CI = 0.72–1.48, P < .05; CE: SMD = 1.17, 95% CI = 0.64–1.71, P < .05; stroke of other determined etiology: SMD = 0.88, 95% CI = 0.53–1.24, P < .05; stroke of undetermined etiology: SMD = 1.50, 95% CI = 0.66–2.33, P < .05, respectively).

Conclusion:

This meta-analysis found that ischemic stroke patients and the TOAST of ischemic stroke patients in Chinese had significantly higher homocysteine levels than the controls, suggesting that serum homocysteine levels may be a risk factor for ischemic stroke and the TOAST subtypes of ischemic stroke in Chinese.
Clinical outcomes and cost-effectiveness of massage chair therapy versus basic physiotherapy in lower back pain patients
Authors: Kim Seung-Kook , Min Aran , Jeon Chuljin , Kim Taeyun , Cho Soohyun , Lee Su-Chan , Lee Choon-Key
Published: March 2020

Introduction:

Low back pain is a chronic recurrent symptom, which can lower the patient's quality of life. With technological development of automated home massage systems, now offers a promising alternative to physiotherapy. However, thus far, the effectiveness of such methods has not been evaluated. We aimed to compare the efficacy and cost-effectiveness of a massage chair with those of conventional physiotherapy for the treatment.

Methods:

This was a randomized controlled trial with a two-group parallel design. Following randomization and allocation, 56 participants were enrolled to receive either physiotherapy (n = 25) or mechanical massage using the massage chair (n = 31). Pain severity was measured using a visual analog scale (VAS) and satisfaction assessed with the McGill Pain Questionnaire (MPQ). Quality of life modification was analyzed using the Functional Rating Index (FRI). Cost-effectiveness was analyzed by comparing the sum of physiotherapy fees and monthly rental fees for chair massage.

Results:

Physiotherapy and massage chair were both effective for pain control as assessed with the VAS (P < .001), satisfaction as assessed by MPQ (P < .001) and life quality improvement as assessed by FRI (P < .001) in both groups. Both VAS and FRI scores were significantly higher for physiotherapy than for massage chair (P = .03 and P = .03, respectively). There was no significant difference in MPQ between the two groups. Massage chair therapy was more cost-effective than physiotherapy, at only 60.17% of the physiotherapy cost (P < .001).

Conclusions:

The home massage chair system was cost-effective, but pain control and disability improved more with physiotherapy. However, our results showed that the massage chair is a promising treatment for pain control and quality of life modification, but efficacy is still superior in physiotherapy and the chair is not a replacement for physiotherapy.

Trial registration:

Clinical Research Information Service, KCT0003157. Retrospectively registered August 2, 2018.
Efficacy of extracorporeal shockwave therapy in the treatment of postherpetic neuralgia
Authors: Lee Sung Hyun , Ryu Kyoung-Ho , Kim Pyoung On , Lee Hyo-Won , Cho Eun-Ah , Ahn Jin-Hee , Youn Inyoung , Yang Kyung Seung
Published: March 2020

Established conventional treatments for postherpetic neuralgia (PHN) and postherpetic itch (PHI) are difficult and often disappointing. In this study, the authors investigated the effect and mechanisms of extracorporeal shockwave therapy (ESWT) on pain and itch associated with PHN and PHI.

Thirteen patients, 50 to 80 years of age, with symptoms associated with PHN or PHI (duration of persistent pain >3 months) and complaints of pain or itch rated >4 on a numerical rating scale (NRS), were included. ESWT was administered using a shockwave device (Piezo Shockwave2, Richard Wolf GmbH, Knittlingen, Germany) to skin areas affected by pain or itch. An energy flux density of 0.09 to 0.16 mJ/mm2 at a frequency of 5 Hz and 2000 impulses was administered at 3-day intervals for 6 sessions. The NRS, 5D-Itch Scale, and Patients Global Impression of Change (PGIC) scale were used to evaluate the efficacy of ESWT.

NRS scores of pain and itch and 5D-Itch Scale scores decreased significantly compared with before treatment and at the end of the treatment sessions (P < .0001, P = .001, P = .0002, respectively). There was a statistically significant difference between PGIC scores, which were checked every 2 sessions (P < .0001).

ESWT is a noninvasive modality that significantly reduced PHN-associated pain and itch.
Acupuncture combined with tamsulosin hydrochloride sustained-release capsule in the treatment of chronic prostatitis/chronic pelvic pain syndrome
Authors: Wang Ji-Sheng , Yang Jie , Deng Sheng , Yu Xu-Dong , Bao Bing-hao , Liu Rui-Jia , Li Hai-Song
Published: March 2020

Background:

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common urinary system disease in men. As part of traditional Traditional Chinese medicine, acupuncture has been widely used in clinical practice. In order to evaluate the exact effect of acupuncture on the clinical efficacy of CP/CPPS, this experiment uses randomized controlled experiments.

Methods/design:

This pragmatic randomized controlled trial will recruit 166 patients who are diagnosed with CP/CPPS. Simple randomization to conventional drug treatment with a 1:1 allocation ratio will be used. Ten 30-minute acupuncture sessions will be provided to patients assigned to the Intervention group. All participants will continue to receive conventional drug treatment. The selection of outcomes will be evaluated by Health's Symptom Score Index (NIH-CPSI) score at week 4.

Discussion:

This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of acupuncture for patients with CP/CPPS.

Trial registration:

ClinicalTrials.gov, ChiCTR1900021132, Registered on 29 January 2019
Unusual clinicopathological presentation of nontraumatic cerebral fat embolism
Authors: Lee Hye Seung , Park Jeong-Jin , Roh Hong Gee , Lim So Dug
Published: March 2020

Rationale:

Fat embolism syndrome (FES) is characterized by the classical triad of cerebral, respiratory, and cutaneous manifestations. In contrast, cerebral fat embolism (CFE), corresponding to incomplete pure type FES, is much rarer and usually follows trauma. CFE typically shows a “starfield” pattern on diffusion-weighted magnetic resonance imaging due to the involvement of multiple small arteries. We report 2 unusual cases of CFE that showed a nontraumatic etiology and the involvement of a single dominant cerebral artery.

Patient concerns:

Case 1 was a 33-year-old woman without a history of trauma who visited the emergency room due to hemiparesis and hemisensory deficits. She was a heavy smoker and had used oral contraceptives for several years. Most importantly, she had 2 experiences of autologous fat grafting 2 months previously. Magnetic resonance angiography (MRA) revealed acute occlusion of the right middle cerebral artery. Case 2 was an 80-year-old man suddenly presented with dizziness, ataxia, and left-sided sensorimotor dysfunction. He had a history of hypertension, untreated atrial fibrillation, and chronic alcoholism. MRA demonstrated the occlusion of the distal basilar artery.

Diagnosis:

Case 1: Microscopic findings demonstrated variable sized fat vacuoles intermixed with moderate amounts of thrombi. Case 2: Histologically, mature adipocytes were intermingled with fibrin, blood cells, and a fragment of entrapped soft tissue resembling the vessel wall.

Intervention:

Case 1 and 2 underwent aspirational thrombectomy guided by transfemoral cerebral angiography.

Outcome:

Case 1 recovered well but Case 2 still suffers from gait ataxia.

Lessons:

CFE can rarely occur in various nontraumatic conditions, with or without evident etiology. Furthermore, it may not show characteristic clinicopathological manifestations. Therefore, careful follow up of those who have undergone procedures that are likely to trigger FES or who have hemodynamic or hypercoagulable risk factors is needed.
Conducting Research in Hospitals
Authors: Munn Lindsay Thompson , Jones Cheryl B.
Published: March 2020

Conducting high-quality research in hospitals can be challenging. Surveys are a cost-effective method to collect data and conduct research studies in hospitals. However, survey response rates can present a challenge to researchers. This article explores targeted techniques that can be used to maximize the survey response rates among nurses and nurse managers.