bluuebunny/crossref_metadata_2025 huggingface dataset:
General Pediatricians' Performance of Accreditation Agency's Recommended Procedures: A Complementary Analysis Using Administrative Data and the Knowledge Translation Model
Authors: Iyer Maya S. , Lo Charmaine B. , Stanley Rachel M.
Published: March 2020

Introduction:

The Accreditation Council for Graduate Medical Education provided guidelines, in 2013, regarding 13 clinical procedures pediatric residents should learn. Previous studies show that, when asked, general pediatricians (GPeds) self-report performing these procedures infrequently. When examined using the knowledge translation model, this low procedural performance frequency, especially by GPeds, may indicate a problem within the primary care landscape.

Methods:

This was a descriptive study using the Partners For Kids, an accountable care organization, database to obtain how frequently each of the procedures was performed for a geographically representative sample of GPeds in central Ohio.

Results:

A total of 296 physicians participated in Partners For Kids. Nearly one-third practiced for more than 15 years (n = 83, 28%) and one-third also lived in a rural region (n = 78, 26.4%). The most commonly billed procedure was administering immunizations (n = 79,292, 92.3%); the least was peripheral intravenous catheter placement (n = 2, 0.002%). Most procedures were completed in the office-based setting.

Discussion:

General pediatricians in central Ohio do not frequently perform the 13 recommended procedures of Accreditation Council for Graduate Medical Education. Evaluation of this problem using the knowledge translation model shows that potential barriers could be inadequate training during or after residency or more likely that these procedures are not necessary in GPeds' current scope of practice. The next step should be to see, from the practitioner's perspective, what procedures are important to their daily practice. Adapting this knowledge to the local context will help target continuing medical education/continuing professional development interventions.
Clinical utility of characterizing intestinal flora in septic kidney injury
Authors: Yuan Jiao-Jiao , Chang Xue-Ni , Li Min , Yuan Qi-Xi , Yang Xiao-Ling
Published: March 2020

The incidence of septic acute kidney injury (AKI) is increasing, it has become a major threat to human health because of its acute onset, poor prognosis, and high hospital costs. The most common cause of AKI in critical-care units is sepsis. Septic AKI is a complex and multi-factorial process; its pathogenesis is not fully understood. In sepsis, the destruction of mucosal barriers, intestinal flora disorders, intestinal ischemia/reperfusion injury, use of antibiotics, and lack of intestinal nutrients lead to an inflammatory reactions that in turn affects the metabolism and immunity of the host. Such changes further influence the occurrence and development of AKI. New technology is enabling various detection methods for intestinal flora. Clinical application of these methods in septic renal injury is expected to clarify the relationship among pathogenesis, disease progression mechanism, and intestinal flora.
Quantification of atherosclerotic plaque volume in coronary arteries by computed tomographic angiography in subjects with and without diabetes
Authors: Hou Zhi-Hui , Lu Bin , Li Zhen-Nan , An Yun-Qiang , Gao Yang , Yin Wei-Hua , Budoff Matthew J.
Published: March 2020

Background

Diabetes mellitus (DM) is considered a cardiovascular risk factor. The aim of this study was to analyze the prevalence and volume of coronary artery plaque in patients with diabetes mellitus (DM) vs. those without DM.

Methods

This study recruited consecutive patients who underwent coronary computed tomography (CT) angiography (CCTA) between October 2016 and November 2017. Personal information including conventional cardiovascular risk factors was collected. Plaque phenotypes were automatically calculated for volume of different component. The volume of different plaque was compared between DM patients and those without DM.

Results

Among 6381 patients, 931 (14.59%) were diagnosed with DM. The prevalence of plaque in DM subjects was higher compared with nondiabetic group significantly (48.34% vs. 33.01%, χ
2 = 81.84, P < 0.001). DM was a significant risk factor for the prevalence of plaque in a multivariate model (odds ratio [OR] = 1.465, 95% CI: 1.258–1.706, P < 0.001). The volume of total plaque and any plaque subtypes in the DM subjects was greater than those in nondiabetic patients significantly (P < 0.001).

Conclusion

The coronary artery atherosclerotic plaques were significantly higher in diabetic patients than those in non-diabetic patients.
Perceptions of Health Promotion and Maintenance Among Latinos in Faith Communities
Authors: Mikell Martin J. , Snethen Julia
Published: March 2020

Faith communities provide a place for Latino congregants to discuss health information. A pilot study using focus groups and semistructured interviews explored how Latino faith community members define the meaning of health and examined their perceptions and attitudes surrounding health promotion and maintenance. Four themes emerged that reflect participants' health beliefs, with faith as a uniting force. Results support the faith community as a means of fostering health promotion for Latinos.
PD-L1 Expression in Extramammary Paget Disease: A Case Series
Authors: Fowler Mark R. , Flanigan Kendall L. , Googe Paul B.
Published: March 2020

The PD-1/PD-L1 pathway plays a critical role in the physiologic inhibition and modulation of the immune response in normal tissue. Many tumors evade immune detection and response by upregulating PD-L1 expression. Humanized monoclonal PD-1 and PD-L1 antibodies have proven as both tolerable and effective treatment in many neoplasms. Extramammary Paget disease (EMPD) is a deformative and debilitating cutaneous malignancy in which definitive treatment options are limited with high recurrence rates after surgical excision. To the best of our knowledge, there is little published information regarding EMPD and PD-L1 expression. We evaluated 18 EMPD surgical pathology cases for tumor cell and tumor-associated inflammatory (TAI) cell PD-L1 expression. We identified PD-L1 tumor cell expression in 3 (17%) of the cases: 2 of 4 invasive cases (50%) and 1 of 14 (7%) noninvasive cases. One invasive case had lymph nodal metastasis with PD-L1 tumor cell expression. The host inflammatory response intensity and PD-L1 expression were variable in cases negative for tumor cell PD-L1 expression; however, a marked inflammatory response and TAI PD-L1 expression were present in all cases positive for tumor cell PD-L1 expression. In conclusion, 1 in 14 (7%) in situ EMPD cases showed tumor cell PD-L1 expression and 2 of 4 invasive cases (50%) showed tumor cell PD-L1 expression. TAI cells were more often positive (83%) than tumor cells (17%) for PD-L1 expression.
Serum uric acid is independently associated with diabetic nephropathy but not diabetic retinopathy in patients with type 2 diabetes mellitus
Authors: Xia Qun , Zhang Shu-Hua , Yang Sheng-Mei , Zhu Xiao-Li , Su Shuang , Hu Ai-Ping , Zhu Jian , Li Dong-Mei
Published: March 2020

Background:

This study aims to investigate the relationship between serum uric acid (SUA) and the severity of diabetic nephropathy (DN) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).

Methods:

A total of 2961 patients were enrolled in the present cross-sectional study. The severity of DN was determined by 24-hour urinary albumin excretion (UAE), which was classified as normal (UAE <30 mg/24 h), microalbuminuria (UAE: 30-299 mg/24 h), and macroalbuminuria (≥300 mg/24 h). The severity of DR was determined by non–mydriatic retinal photography and was classified as non–diabetic retinopathy (NDR), non–proliferative diabetic retinopathy (NPDR), and proliferative DR (PDR).

Results:

Patients with high SUA levels (≥420 μmol/L for males and ≥360 μmol/L for females) had a significantly higher prevalence of DN (UAE ≥30 mg/24 h, 39.3% vs 26.3%; p < 0.001), higher UAE levels (140 ± 297 vs 63 ± 175 mg/24 h; p < 0.001), and lower estimated glomerular filtration rate (eGFR; 79.3 ± 26.8 vs 96.8 ± 19.6 mL/min/1.73 m2; p < 0.001), when compared with patients with normal SUA levels. However, the prevalence of DR, NPDR, or PDR did not differ. Furthermore, the concentration of SUA was higher in patients with higher severity of DN (all, p < 0.001) and patients with PDR (compared with NDR or NPDR, p < 0.05). SUA levels were positively associated with male gender, body mass index, the use of diuretics, triglyceride, low-density lipoprotein, and UAE levels, whereas they were negatively correlated with high-density lipoprotein, fasting blood glucose, glycosylated hemoglobin, and eGFR. After adjustment, SUA remained significantly associated with UAE (r = 0.069, p < 0.001).

Conclusion:

For patients with T2DM, higher SUA levels are associated with higher UAE, lower eGFR, and higher prevalence of DN, but not DR.
The Effects of Meditation, Race, and Anxiety on Stroke Survivor Resilience
Authors: Love Mary F. , Sharrief Anjail , LoBiondo-Wood Geri , Cron Stanley G. , Sanner Beauchamp Jennifer E.
Published: March 2020

BACKGROUND: Significant gaps exist in the identification and management of psychological effects of stroke on survivors. Interventions to enhance resilience, the ability to rebound from stress or adversity, could positively impact stroke recovery. The purpose of this study was to test the effect of meditation on resilience of community-dwelling stroke survivors and to identify resilience predictor variables in these survivors. METHODS: This was a substudy with secondary analysis of existing data from the parent study, MEditatioN for post stroke Depression. The effect of meditation on stroke survivor resilience in the intervention group (n = 20) was evaluated with a paired samples t test, with measures at baseline and immediately after the 4-week intervention. Baseline resilience predictor variables for all stroke survivors (n = 35) were evaluated with univariable analysis and multiple linear regression modeling. RESULTS: The increase in stroke survivor resilience scores from baseline (mean [SD], 3.46 [0.81]) to intervention completion (mean [SD], 3.58 [1.02]) was not statistically significant (t = 0.60, df = 19, P = .56). One-way analysis of variance with Tukey post hoc analysis revealed that baseline resilience was significantly lower (P = .02) for non-Hispanic black participants than for non-Hispanic white participants. Multiple linear regression with resilience as the dependent variable, race as a fixed factor, and trait anxiety as a covariate was significant (F
3,33 = 6.32, P = .002) and accounted for nearly 33% of the variance in baseline resilience. CONCLUSION: The effects of meditation on stroke survivor resilience should be tested in larger clinical trials that would explore the influence of social determinants of health, perceived stress, race-related stress, and anxiety subtypes on resilience.
Urban-Rural Differences in the Duration of Injury-Related Work Disability in Six Canadian Provinces
Authors: Macpherson Robert A. , Amick Benjamin C. , Collie Alex , Hogg-Johnson Sheilah , Koehoorn Mieke , Smith Peter M. , McLeod Christopher B.
Published: March 2020

Objective:

To examine associations between injury-related work disability duration and urban-rural place of residence and whether associations differed across the disability distribution and by industry sector.

Methods:

Workers’ compensation claims from six Canadian provinces were extracted between 2011 and 2015. Multivariable quantile regression models tested the associations between urban-rural place of residence and disability days paid between the 50th and 95th percentiles of the distribution.

Results:

Compared to workers residing in metropolitan areas, those in all other areas experienced more disability days paid. Urban-rural differences increased toward the upper end of disability distribution and were largest in the construction, and transportation and warehousing sectors.

Conclusion:

Tailored interventions for workers in rural areas, particularly those in sectors associated with mobile work environments, may be warranted to reduce inequities in injury-related work disability duration by place of residence.
Advancing Front Oxygen Transfer Model for the Design of Microchannel Artificial Lungs
Authors: Ukita Rei , Potkay Joseph A. , Khanafer Khalil , Cook Keith E.
Published: March 2020

Microchannel artificial lungs may provide highly efficient, long-term respiratory support, but a robust predictive oxygen transfer (VO2) model is needed to better design them. To meet this need, we first investigated the predictive accuracy of Mikic, Benn, and Drinker’s advancing front (AF) oxygen transfer theory by applying it to previous microchannel lung studies. Here, the model that included membrane resistance showed no bias toward overprediction or underprediction of VO2 (median error: −1.13%, interquartile range: [−26.9%, 19.2%]) and matched closely with existing theory. Next, this theory was expanded into a general model for investigating a family of designs. The overall model suggests that, for VO2 = 100 ml/min, fraction of delivered oxygen (FDO2) = 40%, wall shear stress (

JOURNAL/asaio/04.03/00002480-202009000-00015/inline-graphic1/v/2023-08-21T225305Z/r/image-tiff

) = 30 dyn/cm2, and blood channel height = 20–50 μm, a compact design can be achieved with priming volume (

JOURNAL/asaio/04.03/00002480-202009000-00015/inline-graphic2/v/2023-08-21T225305Z/r/image-tiff

) = 5.8–32 ml; however, manifolding may be challenging to satisfy the rigorous total width (

JOURNAL/asaio/04.03/00002480-202009000-00015/inline-graphic3/v/2023-08-21T225305Z/r/image-tiff

) requirement (

JOURNAL/asaio/04.03/00002480-202009000-00015/inline-graphic4/v/2023-08-21T225305Z/r/image-tiff

= 76–475 m). In comparison, 100–200 μm heights would yield larger dimensions (

JOURNAL/asaio/04.03/00002480-202009000-00015/inline-graphic5/v/2023-08-21T225305Z/r/image-tiff

122–478 ml) but simpler manifolding (

JOURNAL/asaio/04.03/00002480-202009000-00015/inline-graphic6/v/2023-08-21T225305Z/r/image-tiff

4.75–19.0 m). The device size can be further adjusted by varying FDO2,

JOURNAL/asaio/04.03/00002480-202009000-00015/inline-graphic7/v/2023-08-21T225305Z/r/image-tiff

, or VO2. This model may thus serve as a simple yet useful tool to better design microchannel artificial lungs.
Increased risk of dementia after distal radius, hip, and spine fractures
Authors: Kim So Young , Lee Joon Kyu , Lim Jae-Sung , Park Bumjung , Choi Hyo Geun
Published: March 2020

This study aimed to evaluate the risk of dementia after distal radius, hip, and spine fractures.

Data from the Korean National Health Insurance Service-National Sample Cohort were collected for the population ≥ 60 years of age from 2002 to 2013. A total of 10,387 individuals with dementia were matched for age, sex, income, region of residence, and history of hypertension, diabetes, and dyslipidemia with 41,548 individuals comprising the control group. Previous histories of distal radius, hip, and spine fractures were evaluated in both the dementia and control groups. Using ICD-10 codes, dementia (G30 and F00) and distal radius (S525), hip (S720, S721, and S722), and spine (S220 and S320) fractures were investigated. The crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of dementia in distal radius, hip, and spine fracture patients were analyzed using conditional logistic regression analyses. Subgroup analyses were conducted according to age, sex and region of residence.

The adjusted ORs for dementia were higher in the distal radius, hip, and spine fracture group than in the non-fracture group (adjusted OR = 1.23, 95% CI = 1.10 –1.37, P < .001 for distal radius fracture; adjusted OR = 1.64, 95% CI = 1.48 – 1.83, P < .001 for hip fracture; adjusted OR = 1.31, 95% CI = 1.22 – 1.41, P < .001 for spine fracture). The results in subgroup analyses according to age, sex and region of residence were consistent.

Distal radius, hip, and spine fractures increase the risk of dementia.
The effect of transcranial direct current stimulation of pharyngeal motor cortex on swallowing function in patients with chronic dysphagia after stroke
Authors: Li Yabin , Feng Haixia , Li Jiao , Wang Hongxia , Chen Ning , Yang Jiali
Published: March 2020

About 11% to 13% of patients with acute dysphagia induced by stroke remain chronic dysphagia 6 months after stroke which usually leads to many severe complications and poor quality of life.

To investigate the effect of transcranial direct current stimulation (tDCS) on swallowing function in the patients with chronic dysphagia after stroke.

26 post-stroke patients with chronic dysphagia who received tDCS were identified by electronic medical records between July 2016 and April 2018. Of which, 13 were treated by unilateral hemispheric anodal tDCS at affected pharyngeal motor cortex. 13 eligible patients only treated by conventional therapies but without tDCS were randomly selected by matching on date of admission (±2 weeks) of the patients receiving unilateral tDCS. The swallowing function and quality of life were evaluated before and 2 weeks after treatment.

The patients in three groups were comparable. The swallowing function and quality of life of the patients in all the 3 groups had been improved over time. Comparing to the group without tDCS, both the groups with unilateral or bilateral tDCS had shorter oral transit time (1.69 ± 0.95, 0.97 ± 0.71 seconds, respectively) and higher scores of quality of life (159.76 ± 12.59, 179.69 ± 11.81, respectively) after treatment.

Both unilateral and bilateral hemispheric anodal tDCS combined with conventional therapies are helpful for recovery of swallowing function in patients with chronic dysphagia induced by stroke, but bilateral anodal tDCS substantially improve more.
The association between smartphone addiction and thumb/wrist pain
Authors: Baabdullah Ayman , Bokhary Diyaa , Kabli Yousof , Saggaf Omar , Daiwali Motaz , Hamdi Amre
Published: March 2020

Many smartphone users experience pain in the thumb/wrist. This pain can be due to certain types of hand injuries as well as inflammation of the extensor pollicis brevis and the abductor pollicis longus tendon sheaths, known as De Quervain tenosynovitis. The objective of this study was to evaluate the association between smartphone addiction and wrist/thumb pain and to determine the severity of the pain, as well as to calculate the prevalence of De Quervain tenosynovitis among medical students at King Abdulaziz University (KAU) in Jeddah.

A total of 387 medical students were enrolled. The smartphone addiction scale-short version (SAS-SV) was used to divide participants into the smartphone addict group and non-addict group. Both groups completed the self-administered patient-rated wrist and hand evaluation (PRWHE) questionnaire to evaluate wrist/hand pain. The Finkelstein test was administered to those who reported pain in the thumb/wrist.

Two hundred fifty-seven (66.4%) participants were smartphone addicts; 74 (19.1%) had a positive Finkelstein test. There was a significant correlation between smartphone addiction and high PRWHE scores (P = .036).

Our study found the prevalence of smartphones addiction among university students to be high (66%), furthermore a correlation between heavy smartphones usage and hand pain was found which indicates that heavy usage of these devices can cause subclinical effects on the human hand.
A multicenter retrospective investigation on the efficacy of perioperative oral management in cancer patients
Authors: Yamada Shin-Ichi , Soutome Sakiko , Hasegawa Takumi , Tojyo Itaru , Nakahara Hirokazu , Kawakami Mao , Hirose Marina , Fujita Shigeyuki , Komori Takahide , Kirita Tadaaki , Shibuya Yasuyuki , Umeda Masahiro , Kurita Hiroshi
Published: March 2020

Patients develop a number of oral complications during cancer treatments. Oral bacteria are associated with the onset of dental focal infections and the progression of oral mucositis. Dental focal infections are frequently associated with the systemic onset of bacteremia, sepsis, and pneumonia. The degeneration of oral function with these complications may become an obstacle to cancer treatments. Although comprehensive oral management, including oral care, the removal of dental focal infections, and improvements in oral function with dentures, is conducted for cancer patients in Japan, few studies have assessed its efficacy.

The aim of the present study was to investigate the incidence of dental/oral complications in cancer patients with perioperative oral managements (POMs) based on a large number of case series with a multicenter retrospective analysis.

The medical records of cancer patients with POMs were retrospectively reviewed and the incidence of oral complications and efficacy of oral management were investigated.

A total of 2744 cancer patients with POMs (1684 males and 1080 females, mean age 65.9 ± 13.0 years) were included and investigated in the present study. Among these patients, 2097 (76.4%) started POM before the initiation of cancer treatments, with 2130 (77.6%) receiving oral care only and 391 (14.2%) being subjected to invasive treatments, such as tooth extraction. The incidence of dental focal infections during the period of cancer treatments was 8.2%. The most frequent infection was acute periodontitis, including alveolar abscesses (112 patients, 4.1%). The incidence of grade 2 and 3 oral mucositis was 2.8%. Prolonged fever was observed in 113 patients (4.1%), with 7 having dental focal infections (6.2%). These incidence rates were lower than those reported previously.

Based on analyses of a large number of patients, the present results support the efficacy of oral management in cancer patients. However, further studies are needed to establish adequate oral management guidelines for cancer patients.
The value of apolipoprotein E in distinguishing benign and malignant unilateral pleural effusions
Authors: Xue Qing , Fang Guiju , Deng Xinyu , Zhang Canhui , Liu Zhixin , Peng Zhiwen , Lai Zibiao , Peng Yunjuan , Wu Jianhui
Published: March 2020

Pleural effusion (PE) remains insurmountable challenge and public health problem, requiring novel noninvasive biomarkers for accurate diagnosis. The aim of this study was to assess the clinical significance of apolipoprotein E (Apo-E) in PE, in order to determine its potential use as a diagnostic biomarker for malignant PE (MPE).

PE samples were obtained from 127 patients and the etiology of PE was determined by multiple diagnostic techniques. Apo-E levels were then measured in the pleural fluid samples.

58 PE patients were diagnosed with tumors, while 69 were tumor-free. Apo-E levels in MPE patients were significantly higher than those with benign PE (BPE) (P < .05). An Apo-E cut-off of 69.96 ng/mL yielded sensitivity and specificity of 79.31% and 73.91% respectively for MPE detection. The area under the curve for Apo-E was 0.793 (95% confidence interval: 0.712 to 0.860), which was smaller than that of carcinoembryonic antigen (CEA) (Z = 2.081, P<.05). In addition, the combination of Apo-E and CEA detection yielded a higher sensitivity of 87.90% and specificity of 95.65% in diagnosing MPE.

In conclusion, Apo-E levels in PE may be a potential biomarker for the detection of MPE. The combined detection of Apo-E and CEA could improve the diagnostic sensitivity and specificity for MPE. These findings provide a simple and convenient method for clinical screening and detection of PE.
Prognostic significance of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in patients with metastatic gastric cancer
Authors: Zhao Guanghui , Liu Ning , Wang Shasha , Guo Jing , Song Xiaoxu , Qi Yaoyue , Qiu Wensheng , Lv Jing
Published: March 2020

Advanced gastric cancer has a poor prognosis because of advanced gastric cancer is prone to metastasis. It is urgent for us to find an indicator to predict the prognosis of gastric cancer in a timely fashion. Research has revealed that inflammation has an important role in predicting survival in some cancers. The purpose of this study was to evaluate the significance of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) on the prognosis of metastatic gastric cancer (GC).

This was a retrospective review of 110 patients were at presentation diagnosed with stage IV metastatic GC and all patients received palliative chemotherapy between January 2012 and January 2016 at the Affiliated Hospital of Qingdao University. Pretreatment NLR and PLR, as well as clinicopathological characteristics were collected. Patients were divided into high and low groups according to the cutoff values for NLR and PLR. The Kaplan–Meier method was applied to estimate the overall survival (OS) and the Cox proportional hazards model to evaluate the related risk factors for OS. All tests were 2-tailed and a P < .05 was considered to indicate a statistically significant difference.

One hundred ten patients were enrolled. Eighty-four patients were men, 24 patients were women, 61 patients were ≥65 years of age, and 49 patients were <65 years of age. The Eastern Cooperative Oncology Group (ECOG) score of most patients (n = 107) ranged from 0 to 1. Ten patients were human epidermal growth factor receptor 2 (HER2)-positive. Seventy-one patients presented with an elevated carcinoembryonic antigen (CEA) level and 49 patients had an elevated Carcinoembryonic 199 (CA-199) level. Fifty-two patients received first-line chemotherapy only. Nineteen patients received third-line or greater chemotherapy. One hundred patients chose dual drug chemotherapy. The median duration of follow-up was 11.6 months. Based on the receiver operating characteristic (ROC) curve, the optimal cut-off value for NLR and PLR was 2.48 and 143.39. Patients with high NLR and high PLR had poor overall survival compared with those who had low NLR and low PLR (P < .001 and P = .013, respectively). In univariate analysis, old age (P = .013), liver metastasis (P = .001), >1 metastatic sites (P = .028), higher NLR (P = .000), and higher PLR (P = .014) were identified as poor prognostic factors associated with OS. Our multivariate analysis had indicated that high NLR (hazard ratio [HR]: 1.617, 95% CI: 1.032–2.525, P = .036) and peritoneal metastasis (HR: 1.547, 95% CI:1.009–2.454, P = .045) was independent prognostic factors for overall survival; however, the PLR was not shown to be an independent prognostic factor.

Our study suggested that the pretreatment NLR can be used as significant prognosis biomarker in metastatic gastric cancer patients receiving palliative chemotherapy.
Diagnosis and medical care for congenital cytomegalovirus infection
Authors: Lin Chiahsuan , Tomio Jun , Tanaka Hirokazu , Sonoda Masaki , Sano Kazuaki , Kobayashi Yasuki
Published: March 2020

Although early detection and intervention may improve the outcome of the congenital cytomegalovirus (cCMV) infection, few studies assessed the real-world clinical practice for cCMV patients. We analyzed medical claims data to assess the patterns of diagnoses and medical care for cCMV patients.

We used a subset of medical claims database (JMDC Claims Database) in Japan, covering 207,547 newborns between April 2010 and March 2017 and observed for at least 6 months. The diagnosis of cCMV and related symptoms and sequelae and medical care, including essential examinations and antiviral treatment, were identified using standardized codes.

Overall, we identified 53 (25.5 per 100,000 newborns) cCMV patients diagnosed within 6 months after birth; of these, 83% were diagnosed within 1 month and 68% had at least 1 cCMV-related symptom at birth. Objective hearing tests and fundus examinations were performed within 6 months in 60% and 30% of patients, respectively. Antivirals were prescribed in 26% of patients. During the observation period (median = 33 months), sensorineural hearing loss (49%) and developmental problems (28%) were commonly identified as cCMV-related sequelae. The proportions of the patients continuously followed up with objective hearing tests up to 36 months were 30% in total and 56% in antiviral-treated patients, respectively.

The cCMV patients did not necessarily receive a timely diagnosis nor continuous follow-ups in usual clinical practice. Although the universal screening for cCMV may, if implemented, facilitate early diagnosis, it should be accompanied by strategic follow-up plans to support timely interventions.
Comparison between thromboelastography and the conventional coagulation test in detecting effects of antiplatelet agents after endovascular treatments in acute ischemic stroke patients
Authors: Liang Chunyang , Yang Yang , He Zijun , Ma Shang , Qu Xuenan , Luo Yongchun , Shen Chunsen , Xu Ruxiang
Published: March 2020

Antiplatelet agents have been administered to patients with acute ischemic stroke after endovascular therapy. This study was designed to provide initial data to compare thromboelastography (TEG) with the conventional coagulation test (CCT) to analyze the coagulation function of antiplatelet drugs in such patients.

The present retrospective cohort study included 240 patients who received endovascular therapy from September 2012 to December 2017. The baseline and clinical characteristics of these patients were collected with respect to TEG (parameters: R, K, maximal amplitude (MA), and α angle) and CCT (parameters: PT, activated partial thromboplastin time (APTT), fibrinogen (FIB), international normalized ratio (INR), and platelet count (PLT)) on day 5 after aspirin and clopidogrel post-endovascular interventions. The correlation and agreement of these 2 detecting methods were analyzed. Additionally, the area under the receiver operating characteristic curve (AUROC) was used to analyze the effectiveness of these 2 methods in detecting unfavorable clinical outcomes, including symptomatic intracranial hemorrhage and early neurological deterioration.

The 3 pairs of parameters (R and APTT, K and APTT, and α angle and FIB) were in agreement for identifying hypercoagulability, while R and APTT, K and APTT, K and PLT, and α angle and PLT were in agreement for identifying hypocoagulability. The AUROC of parameter R for detecting symptomatic intracranial hemorrhage was 0.817, while that of parameter FIB for predicting early neurological deterioration was 0.887.

Parameter FIB derived from CCT might be advantageous for evaluating early neurological deterioration, while parameter R detected by TEG might be superior for evaluating symptomatic intracranial hemorrhage.
Distinct expression and prognostic value of members of SMAD family in non-small cell lung cancer
Authors: Zeng Zhenguo , Yang Yuting , Qing Cheng , Hu Zhiguo , Huang Yiming , Zhou Chaoqi , Li Dan , Jiang Yanxia
Published: March 2020

Non-small cell lung cancer (NSCLC) is the major cause of cancer mortality worldwide. Though multidisciplinary therapies have been widely used for NSCLC, its overall prognosis remains very poor, presumably owing to lack of effective prognostic biomarkers. SMAD, a well-known transcription factor, plays an essential role in carcinogenesis. Aberrant expression of SMAD have been found in various cancers, and may be regarded as prognostic indicator for some malignancies. However, the expression and prognostic role of SMAD family member, especially at the mRNA level, remain elusive in NSCLC. In the present study, we report the distinct expression and prognostic value of individual SMAD in patients with NSCLC by analyzing several online databases including ONCOMINE, Gene Expression Profiling Interactive Analysis, Human Protein Atlas database, Kaplan–Meier plotter, cBioPortal, and Database for Annotation, Visualization and Integrated Discovery. The mRNA levels of SMAD6/7/9 in NSCLC were significantly down-regulated in NSCLC, and aberrant SMAD2/3/4/5/6/7/9 mRNA levels were all correlated with the prognosis of NSCLC. Collectively, SMAD2/3/4/5/6/7/9 may server as prognostic biomarkers and potential targets for NSCLC, and thus facilitate the customized treatment strategies for NSCLC patients.
Microarray profiling of circular RNAs in steroid-associated osteonecrosis of the femoral head
Authors: Yao Tao , Yin Zong-Sheng , Huang Wei , Ding Zhen-Fei , Cheng Chao
Published: March 2020

The aim of this study was to elucidate the molecular mechanisms and to identify the differential expression of circular RNAs (circRNAs) for steroid-associated osteonecrosis of the femoral head (SONFH) using bioinformatics analysis.

circRNA microarray was performed with 3 SONFH tissues and the adjacent normal tissues, and differentially expressed circRNA were identified by limma package in R. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using the Database for Annotation, Visualization and Integrated Discovery database. In addition, a differentially expressed genes (DEG)-associated circRNA/microRNA (miRNA) interaction was predicted by combination of TargetScan and miRanda, and the circRNA/miRNA interaction network generated by the cytoscape software.

A total of 647 differentially expressed circRNAs, including 433 upregulated and 214 downregulated circRNA were identified. The most enriched GO terms for upregulated and downregulated circRNA were extracellular matrix organization and leukocyte activation in biological process; extracellular matrix and spindle pole in cellular component; integrin binding and ATP binding in molecular function, and KEGG pathway enrichment analyses showed that the upregulated and downregulated circRNA were strongly associated with Protein digestion and absorption and Cell cycle. Moreover, a total of 212 differentially expressed messenger RNAs (mRNAs), including 113 upregulated and 99 downregulated genes were identified. In addition, from the analysis of miRNA, long noncoding RNAs, mRNA, and circRNA networks, we found that hsa_circ_0008136 and hsa_circ_0074758 were respectively the upregulated and downregulated circRNA with highest degrees.

The identified circRNA and mRNA could be implicated in the progression of human SONFH. The findings could lead to a better understanding of SONFH pathogenesis.
Molecular sensitization patterns in birch pollen-sensitized Korean children according to the presence of oral allergy syndrome
Authors: Baek Hey-Sung , Jeong Jae-Won , Lee Ha-Baik , Kwon Jae-Woo
Published: March 2020

The profiles of sensitization based on component-resolved diagnosis (CRD) differ from region to region in populations sensitized to birch pollen. We investigated the endotypes of birch pollen-sensitized Korean children with allergic diseases using CRD and distinguished the endotypes of oral allergy syndrome (OAS) among them.

Thirty-one birch pollen-sensitized children with allergic diseases were enrolled. Specific immunoglobulin E (IgE) to birch pollen and fruit including apple, peach, and kiwi were evaluated via skin prick tests and ImmunoCAP in all subjects. Sensitization profiles based on CRD were evaluated with the Immuno-solid-phase Allergen Chip for birch pollen-sensitization using birch pollen components (Bet v 1, Bet v 2, and Bet v 4), and for OAS using the allergen families pathogenesis-related class 10 proteins (PR-10), lipid transfer proteins, and profilin.

All patients (n = 13) with OAS were sensitive to Bet v 1. However, 61% (11/18) of patients without OAS were sensitized to Bet v 1. The level of specific IgE to Bet v 1 was higher in patients with OAS than in those without OAS. All birch pollen-sensitized Korean children with OAS were sensitized to PR-10, and 69% (9/13) of them were mono-sensitized to PR-10. Among patients without OAS, 33% (6/18) were not sensitized to any of the allergen families.

Birch pollen-sensitized Korean children with allergic diseases showed unique patterns of sensitization to Bet v 1, Bet v 2, and Bet v 4, and the sensitization profiles based on CRD were totally different according to the presence of OAS.
Repair versus nonrepair of medial meniscus posterior root tear
Authors: Lee Jin Kyu , Jung Min , Yang Jae Hyuk , Song Si Young , Shin Young-Soo , Cha Myoungsoo , Jung Dawoon , Seo Young-Jin
Published: March 2020

Background:

The general consensus regarding a rational choice among various treatment strategies for medial meniscus posterior root tears (MMPRTs) has yet to be clearly established. The purpose of this systematic review was to analyze patient selection criteria based on index arthrosis, as well as clinical and radiological outcomes after repair or nonrepair treatment in patients with MMPRTs.

Methods:

A systematic electronic search was performed with established medical databases. Data from the selected studies which were assessed using the modified Coleman methodology score were analyzed in terms of index arthrosis and degree of lower limb alignment, functional and radiologic outcomes after meniscus repair, partial meniscectomy, and conservative treatment.

Results:

In total, 17 studies and 655 patients (665 cases) were enrolled in this study, of which 42% (279 cases) underwent MMPRT repair and 58% (386 cases) were treated using a nonrepair strategy. The mean age and the mean follow-up period were 54.7 years and 32.5 months in the repair group, respectively, and 57.0 years and 49.3 months in the nonrepair group, respectively. Based on the clinical data available in this study, most of the MMPRT repairs were performed in patients with mild arthrosis, mild varus alignment, and mild chondral injury. Although data were limited, the percentage of patients with mild chondral injury was only 40% in the nonrepair group, implying that the nonrepair group may have more advanced arthrosis at the baseline. Based on the available Lysholm score across the studies, good functional outcomes were obtained in the repair group, whereas the results of the nonrepair treatment exhibited fair functional outcomes that were somewhat heterogenous. The radiologic outcomes of the mean 5 years’ follow-up study showed that arthritic change could not be prevented by either nonrepair or repair treatment.

Conclusions:

In general, MMPRT repair led to significant improvement in clinical outcomes. On the contrary, the nonrepair group also showed symptomatic relief in some selected cases, despite the somewhat heterogenous results. Given the subgroup analysis for the functional results reported in this review, strict patient selection is important to obtain satisfactory clinical outcomes, regardless of the treatment option selected.
Otosyphilis: A Review of the Literature
Authors: Ramchandani Meena S. , Litvack Jamie R. , Marra Christina M.
Published: March 2020

The number of cases of syphilis has increased in the United States and in many high-income nations. Otosyphilis is a less recognized complication of syphilis that can lead to irreversible sensorineural hearing loss. Different pathophysiological mechanisms have been proposed to explain hearing loss in otosyphilis. We review the literature on otosyphilis in adults and propose the need for future work in this field to identify better ways to diagnose, treat, and manage this disease. Patients with syphilis should be screened routinely for hearing loss, and all patients with new, sudden, or fluctuating sensorineural hearing loss should be evaluated for syphilis.
Changing Epidemiology of Gonorrhea in Adelaide, South Australia
Authors: Ellis Sally L. , Tsourtos George , Waddell Russell , Woodman Richard , Miller Emma R.
Published: March 2020

Background

Gonorrhea is a significant public health concern. The changing epidemiology of gonorrhea in Australia has highlighted the need for detailed examination of surveillance data to determine population groups at greatest risk for infection.

Methods

We analyzed deidentified gonorrhea notification data for the years 2012 to 2017, in Adelaide (N = 3680), calculating age-adjusted notification and antibiotic resistance rates. Age, gender, year, sexual orientation, and socioeconomic status were assessed for associations with gonorrhea notifications using negative binomial, log binomial and spatial autoregressive models. Maps were generated to examine spatial localization of gonorrhea rates in Adelaide.

Results

Gonorrhea notification rates in Adelaide increased annually, with a 153% adjusted increase in rates from 2012 to 2017, localized to specific areas and inversely associated with income levels. The increase in rates in 2016 and 2017 was associated with young heterosexuals from low income areas. Azithromycin-resistant notifications increased significantly in 2016 in young heterosexuals. Reinfections were significantly more likely in men who have sex with men than other population groups.

Conclusions

This study demonstrates the changing epidemiology of gonorrhea in Adelaide from a largely men who have sex with men profile toward an increase in young heterosexual gonorrhea. This could be seen as a harbinger for future increases in heterosexually transmitted HIV and other sexually transmitted infections in Australia.
Dexamethasone Versus Prednisone or Prednisolone for Acute Pediatric Asthma Exacerbations in the Emergency Department
Authors: Cai Kai-Jin , Su Shi-Qing , Wang Yao-Guo , Zeng Yi-Ming
Published: March 2020

Objective

This study evaluates the efficacy and tolerability of dexamethasone (DEX) as an alternative to prednisone/prednisolone (PRED) for the treatment of pediatric asthma exacerbations in emergency department (ED).

Methods

Fixed-effects meta-analyses of selected endpoints were performed by using data taken from relevant studies identified by following a priori eligibility criteria after a comprehensive literature search in several electronic databases.

Results

Data from 10 studies (3208 pediatric asthma patients [1616 DEX treated and 1592 PRED treated], 4.77 years [95% confidence interval, 3.80–5.56 years], 63% [57.76%–62.68%] males) were used. Risk of vomiting drug was significantly lower in DEX group than in PRED group (risk ratio, 0.29 [0.18–0.48]; P ˂ 0.00001). Emergency department stay between DEX and PRED treated patients was statistically different (0.16 [0.03–0.40] hours; P = 0.02) but may not be clinically meaningful. The number of β-agonist therapies received by DEX- and PRED-treated patients was similar. Treatments with both DEX and PRED were associated with improvement in asthma status assessment scores, and there was no significant difference between the groups. There were also no differences between the groups in hospitalization rate, ED revisit rate, and hospital admission rate after relapse.

Conclusions

Dexamethasone is a suitable alternative to PRED for the treatment of pediatric asthma exacerbation in ED.
Discriminative Accuracy of Procalcitonin and Traditional Biomarkers in Pediatric Acute Musculoskeletal Infection
Authors: McMichael Brianna S. , Nickel Amanda J. , Christensen Eric W. , Frenn Kristin A. , Truong Walter H. , Laine Jennifer C. , Kharbanda Anupam B.
Published: March 2020

Objectives

Septic arthritis (SA) is responsible for 20% of pediatric musculoskeletal infections (MSKI) and can have significant consequences. Early detection of SA is critical, and procalcitonin (PCT) has emerged as a promising biomarker. This study assessed the test performance of PCT and traditional biomarkers for suspected SA.

Methods

We conducted a prospective study at two pediatric emergency departments (ED). Data collected measured serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, and PCT. Box and whisker plots were generated to compare the of the biomarkers by positive MSKI or a non-MSKI diagnosis. The diagnostic performance of biomarkers was examined using the area under the receiver operating characteristic curve (AUC), and optimal cut -points were identified using the Liu method.

Results

Procalcitonin performed reasonably well for detection of MSKI (AUC, 0.72; confidence interval [95% CI], 0.59–0.84). However, CRP and ESR performed better (AUC, 0.88 and 0.78, respectively). White blood cell count was not predictive of MSKI. Patients with a PCT value >0.1 ng/mL, ESR values >19.5 mm/h, and a temperature higher than 99.0°F were more than twice as likely to have acute MSKI. A high CRP level was most predictive of acute MSKI, and patients with levels >2.38 mg/dL were 3.5 times more likely to have acute MSKI.

Conclusions

Procalcitonin is a potential biomarker for the clinical differential of MSKI in the pediatric ED. Additional research is warranted to establish the optimal diagnostic level for PCT, to increase sample size, and to examine any impact on cost.
Racial/Ethnic Disparities in Triage Scores Among Pediatric Emergency Department Fever Patients
Authors: Dennis Jeff A.
Published: March 2020

Objectives

Emergency department (ED) triage scores are assigned to patients in a short period based on assessment of need for lifesaving measures, risk and pain levels, resource needs, and vital signs. Racial/ethnic disparities have been found across a number of outcomes but are not consistent across all studies. This study examines pediatric ED cases reporting fever, a commonly reported triage symptom, to explore racial/ethnic and age disparities in triage score assignment.

Methods

This study uses the 2009–2015 National Hospital Ambulatory Medical Care Survey, an annual national sample of ED visits in the United States. Pediatric cases where fever is the sole reported reason for visit are analyzed for racial/ethnic disparities, controlling for sex, age, insurance status, body temperature, region, and hospital type.

Results

Among all pediatric fever cases, temperature is the sole significant predictor of triage scores. However, non-Hispanic (NH) black pediatric patients older than 1 year have approximately 22% greater risk of being given a less urgent triage score relative to NH white patients.

Conclusions

Findings suggest racial disparities in the triage of NH black pediatric patients older than 1 year for fever. Although fever is a single and often non–life-threatening condition, especially after infancy, findings of racial disparities in triage scores suggests a need for further evaluation of the assignment of patient urgency in emergency medicine.
Bilateral Breast Uptake of 99mTc-Pertechnetate in a Neonate With Congenital Hypothyroidism
Authors: Rakshpaul Sonal , Malhotra Gaurav , Rao Sudha C. , Narwade Raj , Utture Alpana , Asopa Ramesh V.
Published: March 2020

A 4-day-old female neonate with raised cord blood thyroid-stimulating hormone (127 μIU/mL) underwent 99mTc thyroid scan to rule out thyroid dysgenesis. The images revealed midline focus of lingual thyroid as the only functioning thyroid tissue. In addition, bilateral focal and symmetrical breast uptake was seen without clinically palpable breast nodule on either side. Transplacental transfer of maternal hormones leading to stimulation of neonatal breasts explains this unusual scan finding. One should be aware of this rare pattern of focal breast uptake in 99mTc-pertechnetate scan in neonates with congenital hypothyroidism to avoid scan misinterpretation.
Liver Steatosis Secondary to PRRT With 177Lu-DOTATATE
Authors: de Lima Beatriz Matheos , de Carvalho Juliana Ribeiro , Gaspar Priscilla Romano , Pujatti Priscilla Brunelli , Gonçalves Rinaldo
Published: March 2020

PRRT (peptide receptor radionuclide therapy) with 177Lu-DOTATATE for neuroendocrine tumor has some well-known adverse effects, concerning specially the bone marrow and kidneys. Hepatotoxicity has been rarely reported, and there are no data regarding hepatic steatosis secondary to PRRT. We reviewed upper abdomen CT and MRI and applied radiologic criteria for the diagnosis of hepatic steatosis on 62 patients treated between the years of 2010 and 2017. Two patients already showed radiologic signs of steatosis in the middle of the treatment and through follow-up all patients showed improvement of the steatosis.