bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvement of a Radon Dosimetry System for Miners by Replacing Reference Dosimeters with Radonproof Boxes Containing Activated Carbon Cartridges
Authors: Dehnert Jörg , Guhr Andreas , Engelhardt Jörg
Published: November 2019

In 1168, the first silver was found in the Saxon Erzgebirge. Mining began shortly thereafter and continues to this day at varying intensities. About 250 miners are permanently engaged in rehabilitation work at old mining sites so that houses and roads are safe and the mine water can drain through galleries. The radon potential in the Erzgebirge is high. Despite radiation protection measures, exposures to more than 6 mSv occurred among 22 miners in 2016 alone. For this reason, the miners are monitored with personal radon dosimetry. The dosimeters consist of diffusion chambers with CR-39 nuclear track detectors. Outside the miners’ working hours, the dosimeters must be stored together with a reference dosimeter. After a 3 mo wearing period, the dosimeters are replaced and the miners’ exposures are determined. For this purpose, the exposures of the reference dosimeters that have occurred outside working hours are subtracted from the exposures of the miners’ dosimeters. In mining practices, this method has caused problems. The conditions of use (storing dosimeters along with a reference dosimeter) were often not met by the miners. To solve the problems, reference dosimeters were replaced by radonproof boxes with activated carbon cartridges inside. The miners stored their dosimeters in the boxes outside working hours. A uniform reference value for the radon activity concentration of 50 Bq m−3 was used for all boxes to determine the exposure of miners during working hours. The associated error was small. In future, reference dosimeters and the measurement of a reference value will not be necessary.
Pressure-Induced Interlamellar Stromal Keratitis After Small-Incision Lenticule Extraction Procedure: A Case Report
Authors: Moshirfar Majid , Somani Anisha N. , Vaidyanathan Uma , Ronquillo Yasmyne C. , Hoopes Phillip C.
Published: November 2019

Purpose:

To report a case of pressure-induced interlamellar stromal keratitis (PISK) after small-incision lenticule extraction (SMILE) for the correction of myopic astigmatism in the United States.

Methods:

We report the case of a 27-year-old man who underwent uneventful SMILE surgery and presented with pressure-induced stromal keratitis. Anterior and posterior segment examination, uncorrected distance visual acuity, refraction, intraocular pressure, and pachymetry values are reported from this time period.

Results:

Three weeks postoperatively, examination revealed new-onset central corneal haze and edema in both eyes, more significant in the right eye. The patient was given a presumptive diagnosis of diffuse lamellar keratitis. Intensive corticosteroid treatment was administered, causing a significant decline in uncorrected distance visual acuity OD from 20/25 to 20/250 and OS from 20/20 to 20/60, with a significant myopic shift of −3.0 D and −1.0 D, respectively. In our case, pachymetry measurements revealed 78 μm OD and 43 μm OS of additional corneal thickness. Pressure readings were 25 mm Hg OD and 19 mm Hg OS, respectively. He was diagnosed with PISK, and after 4 days of steroid discontinuation and Brimonidine-Timolol administration, his symptoms had improved with resolution of corneal edema.

Conclusions:

Clinicians should be aware that PISK is a potential complication of SMILE. Postoperative intraocular pressure measurements are an important aspect of the management of postcorneal refractive surgery patients because the differentiation of PISK from diffuse lamellar keratitis, as well as the early detection and treatment of PISK, can avoid severe complications.
Efficacy and Safety of Repeated Ultrasound Cycloplasty Procedures in Patients With Early or Delayed Failure After a First Procedure
Authors: Aptel Florent , Tadjine Mehdi , Rouland Jean-François
Published: November 2019

Precis:

Repeated ultrasound cycloplasty (UCP) procedures are valuable options in patients with early or delayed intraocular pressure (IOP) increase after a first procedure. The safety of a second procedure is similar to that of the first one.

Purpose:

The purpose of this study was to evaluate the efficacy and safety of repeated UCPs in patients with early or delayed IOP increase after a first procedure.

Patients and Methods:

Thirty-one eyes with open-angle glaucoma, with an IOP decrease,>20% after a first UCP procedure (1 and/or 2 mo visit), and with an early or delayed IOP increase (IOP decrease<20% compared with baseline before or after the first 6 mo, respectively), underwent a second UCP procedure. Examinations were performed at 1 day, 1 week, 1, 2, 3, 6, and 12 months. Primary outcomes were surgical success (IOP reduction≥20% and IOP>5 mm Hg) at the last follow-up and vision-threatening complications. Secondary outcomes were mean IOP at each visit, medication use, and other surgical interventions.

Results:

In the group with early IOP increase, IOP was reduced (P<0.05) from a mean value of 29.8±8.2 mm Hg before retreatment (n=3.3 medications) to 18.5±7.4 mm Hg at the last follow-up (n=3.5 medications) (−34%). Success was achieved in 52.6% of eyes (10/19) at the last follow-up visit. In the late IOP increase group, IOP was reduced (P<0.05) from a mean value of 31.9±6.6 mm Hg before retreatment (n=4.0 medications) to 16.2±5.2 mm Hg at the last follow-up (n=4.0 medications) (−43%). Success was achieved in 55.5% of eyes (5/9) at the last follow-up visit. No major intraoperative or postoperative complications occurred.

Conclusion:

A second UCP procedure could be considered in subjects with early or delayed failure after a first procedure.
A Case of Recurrent Pericarditis in Association With Asymptomatic Urethral Chlamydia trachomatis Infection
Authors: Czeresnia Jonathan Mamber , Alsaggaf Mohammed , Akselrod Hana
Published: November 2019

Extragenital manifestations of Chlamydia trachomatis infection can be challenging to diagnose. A previously healthy 33-year-old man presented with pericarditis recurring despite anti-inflammatory therapy and progressing to cardiac tamponade. Pericardiocentesis yielded bloody-appearing fluid with increased neutrophils and negative standard cultures. The patient reported recent unprotected sexual exposure, and urine nucleic acid amplification test detected C. trachomatis. He had no urogenital, ocular, or joint symptoms. The result of an extensive workup for other causes of pericarditis was negative, including HLA-B27 testing. He was treated with an extended course of doxycycline with full resolution of symptoms. We found 4 previously reported cases of chlamydial myopericardial disease, all of which shared key features with ours. Differentiating disseminated C. trachomatis from reactive phenomena is currently difficult owing to the limited availability of molecular tests and lack of their validation for clinical use. The diagnosis remains one of the clinical suspicions and circumstantial pieces of evidence, and further diagnostic developments are needed.
Epidemiology and Outcome of Hospitalized Infants With Pertussis
Authors: Beltramo Fernando , Raszynski Andre , Totapally Balagangadhar R.
Published: November 2019

Background

Pertussis during infancy is associated with significant morbidity and mortality. The objective of this study was to review the epidemiology and outcome of infants with pertussis.

Methods

We identified infants with diagnosis of pertussis and compared demographic and outcome data with others who did not have pertussis. Infants with pertussis were matched 1:1 with correlative propensity score using sex, hospital region, income quartiles, race, ventilation status, and All Patients Refined Diagnosis Related Groups severity score.

Results

A total of 2920 pertussis cases were identified (prevalence: 4.7/1000 discharges). Females (49% vs 43%), Hispanics (35% vs 25%), and lower income quartile group (39% vs 36%) represented more frequently among pertussis cases (P < 0.001). Mechanical ventilation (6% vs 4.7%, P = 0.001), pulmonary hypertension (PHTN) (36% vs 1%, P < 0.001), and extracorporeal membrane oxygenation (ECMO) use (0.65% vs 0.08%, P < 0.001) were common among pertussis patients. In the intubated patients with pertussis, 50% had PHTN, 10% required ECMO, and 1 patient received leukapheresis. The mortality rate was significantly higher among ventilated (10.9% vs 0.04%, P < 0.001), PHTN (1.4% vs 0.3%, P < 0.001), and ECMO (60% vs 0.3%, P < 0.01) patients with pertussis. The mean length of stay was longer (5.96 ± 8.3 vs 4.53 ± 10.6 days, P < 0.01) among pertussis patients. Comparing with matched controls, the mortality rate was higher (0.72% vs 0.34%, P = 0.048), PHTN was common (36.4% vs 0.82%, P < 0.01), and ECMO usage was more frequent (0.65% vs 0%, P < 0.01) among pertussis cases.

Conclusions

Pertussis is more prevalent among females, Hispanics, and lower income quartile groups. This large sample study shows lower mortality than recent studies in infants with pertussis.
Fecal Microbiota Transplantation After Oral Vancomycin for Recurrent Clostridium difficile Infection
Authors: Alghamdi Ahlam Ali , Tabb Deanne
Published: November 2019

Purpose

Clostridium difficile infection (CDI) is one of the most common hospital-acquired infections in developed countries. Since 2000, there has been a significant increase in the incidence and severity of CDI. Treating recurrent CDI (rCDI) is challenging because the risk of recurrence increases with each subsequent episode. Several studies have demonstrated the benefit of fecal microbiota transplantation (FMT) in patients with rCDI with a cure rate ranging between 80% and 100%. The aims of this study were to review the FMT procedure and to identify the success rate of using 2-week oral vancomycin treatment before the FMT.

Methods

We performed a retrospective chart review for patients with rCDI who underwent an FMT procedure between 2014 and 2017. This study included patients who were diagnosed with rCDI and received 2-week oral vancomycin treatment before the FMT at Piedmont Columbus Regional Hospital.

Results

During the study period, 31 patients underwent 34 FMT procedures for rCDI. Twenty-nine patients were included in the study. Two patients (6.9%) had confirmed recurrence within 8 weeks after FMT, and 27 patients (93.1%) were considered treatment successes. No adverse events were noted. Both patients with FMT failures were offered treatment with a repeat FMT. Thirty-nine percent had mild to moderate rCDI. Most patients (69%) received upper FMT and 58.6% had fresh stool transplanted.

Conclusions

Fecal microbiota transplantation preceded by a standard 2-week vancomycin regimen for the treatment of patients with rCDI seems to be safe and effective. Further research is needed to explore optimal pretreatment regimens before the FMT to prevent FMT failure.
Nocardia farcinica Brain Abscess Mimicking Progression of Malignancy in a Patient With Posterior Fossa Glioma
Authors: Jarrin Tejada Claudia D.
Published: November 2019

A patient presented with visual changes raising suspicion of progression of underlying brain cancer requiring craniotomy. Final results showed Nocardia farcinica brain infection instead. Nocardiosis should be considered in patients receiving corticosteroids as management can be lifesaving.
Perinephric Abscess and Bacteremia Due to Lactobacillus Species in a Diabetic Adult
Authors: De Freitas Gerson , Toor Amit , Bekele Yididia , Patel Neel , Kannangara Saman
Published: November 2019

Lactobacillus species are a group of anaerobic or facultatively anaerobic, catalase-negative, gram-positive non–spore-forming rods that are usually considered benign commensal organisms present in the human mouth and gastrointestinal and genital tracts. Given their indolent nature, the presence of Lactobacillus species in cultures is often considered contaminants. In rare occasions, however, Lactobacillus species have been reported as pathogens causing a broad range of clinically significant conditions including bacteremia, endocarditis, dental abscesses, meningitis, and intra-abdominal infections such as peritonitis, endometritis, and splenic and liver abscesses. Pyelonephritis has only been seldomly reported in literature, and perinephric abscess has never been reported in literature to date. When infection happens, it usually occurs in immunosuppressed individuals such as those with cancer, transplant recipients, chronic steroid use, or human immunodeficiency virus/AIDS. Despite being gram-positive, the bacteria are usually resistant to vancomycin, and treatment with a penicillin-based regimen is preferred. We describe a case of a diabetic and morbidly obese, but otherwise healthy man, who developed bacteremia and perinephric abscess due to Lactobacillus species.
Invasive Aspergillosis of the Liver in an Immunocompetent Patient
Authors: Nauriyal Varidhi , Ueberroth Benjamin , Zakhia Adjoa , Herc Erica
Published: November 2019

Invasive Aspergillus is a well-established cause of invasive fungal disease in the immunosuppressed host. The traditional risk factors identified for disseminated aspergillosis are hematological malignancies, organ transplantation, persistent neutropenia, and immunosuppressed states secondary to chronic granulomatous disease, human immunodeficiency virus/AIDS, and prolonged corticosteroid use. In recent years, there has been increased recognition of Aspergillus infection in critically ill patients and in patients with liver disease. There are rare case reports of invasive aspergillosis in immunocompetent hosts. We present a case of invasive hepatic aspergillosis in an immunocompetent patient. We aim to highlight the challenges faced in the diagnosis and management of hepatic aspergillosis in an immunocompetent host and also review the available literature.
The Effect of Valproic Acid on Olanzapine Serum Concentration
Authors: Tveito Marit , Smith Robert Løvsletten , Høiseth Gudrun , Molden Espen
Published: November 2019

Background

The combination of olanzapine and valproic acid (VPA) is regularly prescribed in the treatment of bipolar or schizoaffective disorders. The VPA has been shown to reduce olanzapine concentration, but the mechanism behind this interaction remains unknown. We aimed to investigate the effect of VPA on olanzapine concentration during oral versus long-acting injectable (LAI) formulation in a real-life setting.

Methods

From a therapeutic drug monitoring service, prescribed doses and serum concentrations from 2791 olanzapine-treated patients (9433 measurements) were included.

Results

The number of patients on olanzapine-LAI treatment was 328, whereas 2463 were using oral olanzapine. The frequency of patients comedicated with VPA was 9.4% for olanzapine tablets and 5.8% for olanzapine-LAI. The VPA had no effect on olanzapine dose-adjusted concentrations in LAI users (1.6 vs 1.7 [ng/mL]/[mg/d]; P = 0.38), whereas in the oral group the dose-adjusted olanzapine concentration was lower in VPA users (2.2 vs 2.7 [ng/mL]/[mg/d]; P < 0.001). For smokers in the oral olanzapine group using VPA, 8.7% of the measurements were in the subtherapeutic range (<10 ng/mL) compared with 6.0% in nonusers (P = 0.003).

Implications

These findings show that the VPA-olanzapine interaction involves a presystemic mechanism and is therefore restricted to oral olanzapine treatment. For oral treatment of olanzapine, comedication with VPA implies a risk of insufficient effect, which may be of clinical relevance in smokers in particular. Thus, it is important to be aware of the interaction potential with VPA during oral olanzapine use, whereas for LAI-treated patients fewer precautions are required from a pharmacokinetic point of view.
Phosphodiesterase 10A Inhibitor Monotherapy Is Not an Effective Treatment of Acute Schizophrenia
Authors: Walling David P. , Banerjee Anindita , Dawra Vikas , Boyer Stacey , Schmidt Christopher J. , DeMartinis Nicholas
Published: November 2019

Background

Current treatments for psychotic symptoms associated with schizophrenia often provide inadequate efficacy with unacceptable adverse effects. Improved therapeutics have long been a goal of research. Preclinical testing suggests that phosphodiesterase 10A (PDE10A) inhibitors may provide a novel approach to treating psychosis associated with schizophrenia.

Methods

The efficacy and safety of a highly selective PDE10A inhibitor, PF-02545920, was evaluated in a phase 2 multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Eligible patients (18–65 years) with an acute exacerbation of schizophrenia were randomized 2:2:1:2 to PF-02545920 (5 or 15 mg every 12 hours [Q12H] titrated), risperidone (3 mg Q12H), or placebo for 28 days (n = 74:74:37:74). The primary objectives were to evaluate the efficacy of PF-02545920 using the Positive and Negative Syndrome Scale (PANNS) and safety/tolerability.

Results

At day 28, PF-02545920 (either dose) was not significantly different from placebo for mean change from baseline in the PANNS total score (primary end point) or most other end points. Pharmacokinetics exposures seemed adequate for binding/inhibiting PDE10A enzyme. Risperidone was statistically different from placebo for the PANNS total score, demonstrating study sensitivity. Incidence rates for adverse events were similar among the groups. Both doses of PF-02545920 were generally well tolerated. Dystonia occurred in 1, 6, 0, and 3 patients in the PF-02545920 5 mg Q12H, PF-02545920 15 mg Q12H, risperidone, and placebo groups, respectively.

Conclusions

Neither dose of PF-02545920 was superior to placebo for the primary and most secondary end points. This indicates that PDE10A inhibition does not produce an antipsychotic effect in patients with acute exacerbation of schizophrenia.
Dopamine D2 Receptor Occupancy Estimated From Plasma Concentrations of Four Different Antipsychotics and the Subjective Experience of Physical and Mental Well-Being in Schizophrenia
Authors: Veselinović Tanja , Scharpenberg Martin , Heinze Martin , Cordes Joachim , Mühlbauer Bernd , Juckel Georg , Rüther Eckart , Paulzen Michael , Haen Ekkehard , Hiemke Christoph , Timm Jürgen , Gründer Gerhard
Published: November 2019

Background

Impaired subjective well-being in schizophrenia patients treated with antipsychotics has often been linked inter alia to the antidopaminergic effects of medication. Thus, it is important to capture the association between striatal dopamine D2receptor occupancy (D2-RO) and global subjective well-being. We examined this association using data from our multicenter, randomized, double-blind Neuroleptic Strategy Study (NeSSy).

Methods

An innovative double randomization process was used for allocation of patients to the specific treatment groups. Plasma drug concentrations were measured after 6 and 24 weeks of treatment to obtain the estimated D2-RO (eD2-RO) relative to literature values. We made an exploratory analysis of associations between eD2-RO and subjective well-being scores. One hundred two blood samples from 69 patients were available for the analysis. Because of the lack of a satisfactory occupancy model for quetiapine, only haloperidol, flupentixol, and olanzapine treatment groups were pooled, whereas aripiprazole data were analyzed separately, because of its partial agonistic properties.

Results

In the pooled antagonist group, eD2-RO correlated negatively with the summarized well-being score. In a more detailed analysis, this association could be confirmed for all first-generation antipsychotic-treated patients, but not for the separate second-generation antipsychotic groups. In the aripiprazole group, higher eD2-RO was associated with impaired physical well-being, but had no association with mental well-being.

Conclusions

Our results suggest that high plasma levels and consequently high occupancy at D2receptors are disadvantageous for subjective well-being, as distinct from the objective extrapyramidal side effects. To minimize patients' malaise, which disfavors adherence, implementation of therapeutic drug monitoring in the clinical routine may be useful.
Rapid Response Electroencephalography for Urgent Evaluation of Patients in Community Hospital Intensive Care Practice
Authors: Yazbeck Moussa , Sra Parveen , Parvizi Josef
Published: November 2019

INTRODUCTION

Limited access to specialized technicians and trained neurologists results in delayed access to electroencephalography (EEG) and an accurate diagnosis of patients with critical neurological problems. This study evaluated the performance of Ceribell Rapid Response EEG System (RR-EEG), which promises fast EEG acquisition and interpretation without traditional technicians or EEG-trained specialists.

METHODS

The new technology was tested in a community hospital intensive care unit in Northern California. Three physicians (without previous training in EEG) were trained by the manufacturer of the RR-EEG and acquired EEG without the help of any EEG technicians. Time needed from order to EEG acquisition was noted. Quality of EEG and diagnostic information obtained with the new EEG technology were evaluated and compared with the same information from conventional clinical EEG system.

RESULTS

Ten patients were tested with this new EEG technology, and 6 of these patients went on to have conventional EEGs when the EEG technicians arrived at the site. In these cases, the conventional EEG was significantly delayed (11.2 ± 3.6 hours) compared with RR-EEG (5.0 ± 2.4 minutes; P < .005). Use of RR-EEG helped clinicians rule out status epilepticus and prevent overtreatment in 4 of 10 cases. RR-EEG and conventional EEG systems yielded similar diagnostic information.

CONCLUSION

RR-EEG can be set up by nurses, and diagnostic information about the presence or absence of seizures can be appreciated by nurses. The RR-EEG system, compared with the conventional EEG, did not require EEG technologists and enabled significantly faster access to diagnostic EEG information. This report confirms the ease of use and speed of acquisition and interpretation of EEG information at a community hospital setting using an RR-EEG device. This new technology has the potential to improve emergent clinical decision making and prevent overtreatment of patients in the intensive care unit setting while empowering nursing staff with useful diagnostic information in real time and at the bedside.
Predictive Factors of Mortality in Older Adult Residents of Long-Term Care Facilities
Authors: MOON SeolHwa , HONG Gwi-Ryung Son
Published: November 2019

Background

Various factors affect the mortality of older adult residents of long-term care facilities. To provide adequate nursing care for older adults, it is necessary to understand the factors that affect their risk of mortality.

Purpose

This study was designed to (a) evaluate the 24-month survival rate and (b) identify the underlying cause of death in various dimensions, including cognitive, psychological, and physical function; nutritional status; and chronic disease.

Methods

A longitudinal study was carried out between 2011 and 2013 at seven long-term care facilities. The participants comprised 276 residents who were all older than 65 years old. Baseline measurements included cognitive function (Mini-Mental State Examination for Dementia Screening), psychological function (Cornell Scale for Depression in Dementia), physical function (Barthel Index), nutritional status (Mini Nutritional Assessment, mid-arm circumference, and calf circumference), and chronic disease status (hypertension, diabetes mellitus, chronic respiratory disease, heart disease, and urinary incontinence). Data analysis included univariate and multivariate logistic regression to identify the main factors affecting mortality.

Results

In 2011 (baseline), the mean age of the participants was 80.46 years (SD = 7.08) and most were female (73.6%). At the 24-month follow-up, 94 (34.1%) of the participants had died. The major factors affecting mortality were as follows: cognitive dysfunction (OR = 3.12, 95% CI [1.41, 6.90]), mid-arm circumference (< 22.5 cm; OR = 2.32, 95% CI [1.35, 3.96]), and urinary incontinence (OR = 2.04, 95% CI [1.16, 3.61]).

Conclusions

According to the findings, special attention is needed at the end of life to improve the quality of life of older adults with cognitive dysfunction, malnutrition (low mid-arm circumference), and urinary incontinence who reside in long-term care facilities.
The Americans With Disabilities Act, Reasonable Accommodations, and Medical Education
Authors: Pavlik Daniel L. , Melcher Betsy Quick , Agnew Donna M. , Smith David A. , Marciante Katelyn
Published: November 2019

The number of students with a disability matriculating into institutions of medical education, including physician assistant programs, is increasing. Educational institutions must develop procedures with regard to the Americans with Disabilities Act (ADA) including the provision of reasonable accommodations to provide equal opportunities for all. These procedures must be compliant with federal and state laws while protecting academic integrity, maintaining technical standards, and successfully navigating the institutional and individual faculty barriers. Knowledge of the ADA and the ADA Amendments Act of 2008 as well as some familiarity with the legal precedent regarding these laws will facilitate planning and decision-making for students with disabilities. This is imperative for educating not just those with specific disabilities but also the evolving learners of today. Such knowledge, coupled with the continued prioritization of technical standards and student outcomes, will assist in the curricular development of the future.
Increasing Physician Assistant Students' Team Communication Skills and Confidence Throughout Clinical Training
Authors: Hudak Nicholas M. , Pinheiro Sandro O. , Yanamadala Mamata
Published: November 2019

Purpose

An intervention was designed to increase physician assistant students' team communication skills using the Situation-Background-Assessment-Recommendation (SBAR) tool.

Methods

A variety of learning activities were implemented longitudinally over 9 months of clinical education. Instructional activities included an interactive lecture, deliberate practice of SBAR at clinical training sites, self-assessment, and small group discussion. Evaluation involved survey of students' perceived learning outcomes and direct observation of students' proficiency using SBAR during a simulated patient encounter.

Results

At the beginning of their clinical training, many students (75%) did not have a structured tool for communicating on health care teams. The SBAR tool was readily understood by students following a lecture (89%) and increased their confidence in communicating with preceptors (62%-83%) and nonpreceptors (62%-79%). A majority of students proficiently demonstrated the SBAR components (82%-86%) at the conclusion of the program.

Conclusion

This approach can be adopted and adapted by other programs aiming to teach and evaluate SBAR and other team skills to better prepare new health professionals to effectively communicate on health care teams.
When is Trochleoplasty a Rational Addition?
Authors: Rush Jeremy , Diduch David
Published: November 2019

Trochlear dysplasia has been recognized as a dominant anatomic risk factor in patients with recurrent patellar instability. Sulcus-deepening trochleoplasty is a very effective and powerful procedure for correcting trochlear dysplasia and, specifically, eliminating the supratrochlear spur. However, it must be emphasized that trochleoplasty is not appropriate for patients with mild trochlear dysplasia or those without a large supratrochlear spur or bump. We discuss the characteristics and classification of trochlear dysplasia and discuss specific indications for sulcusdeepening trochleoplasty.
Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football: A Pilot Comparison of Youth Versus High School Football
Authors: Barber Foss Kim D. , Yuan Weihong , Diekfuss Jed A. , Leach James , Meehan William , DiCesare Christopher A. , Solomon Gary , Schneider Daniel K. , MacDonald James , Dudley Jon , Cortes Nelson , Galloway Ryan , Halstead Mark , Walker Gregory , Myer Gregory D.
Published: November 2019

Objective:

Youth athletes are believed to be more susceptible to white matter (WM) degradation resulting from head impact exposure relative to high school (HS) athletes; this hypothesis has not been objectively tested. The purpose of this study was to determine preseason to postseason changes in WM integrity from repetitive head impacts for youth football (YFB) players compared with HS football players during a competitive football season.

Design:

Prospective cohort.

Setting:

One season of YFB (grades 7 and 8) and varsity HS football (grades 10-12).

Patients or Other Participants:

Twelve YFB (13.08 ± 0.64 years) and 21 HS (17.5 ± 0.78 years) athletes.

Interventions:

Participants completed 2 magnetic resonance imaging sessions: preseason and postseason. Head impact exposure was recorded during practice and games using a helmet-mounted accelerometer.

Main Outcome Measures:

Tract-based spatial statistics were used to evaluate group differences in preseason to postseason changes in diffusion tensor imaging, including fractional anisotropy and mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD).

Results:

The HS group exhibited significant preseason to postseason reductions in MD, AD, and RD (P < 0.05, corrected) in widespread WM areas. Significant WM reductions for the YFB group were only observed for AD (P < 0.05, corrected), but was more limited in extent compared with HS.

Conclusions:

Significant preseason to postseason AD reduction was found in both YFB and HS groups after one season of competitive play. Our results did not confirm recent speculation that younger children are more susceptible to the deleterious effects of repetitive head impacts compared with their older counterparts.
Vanishing White Matter Disease Diagnosis After Athletic Concussion in an Adolescent Male Patient
Authors: Vinogradsky Emillee I. , Otallah Scott I.
Published: November 2019

We report the recognition of a diagnosis of leukoencephalopathy with vanishing white matter, also known as vanishing white matter disease in an adolescent male patient after a sports-related concussion. The patient's atypical symptoms after the concussion led to imaging and subsequent neurological consultation. The objective of this clinical case is to highlight the importance of considering imaging in patients who present with atypical symptoms that may be present after a concussion and to raise awareness of this rare disorder which can present after head trauma.
Novel Minimal Access Bone Anchored Hearing Implant Surgery and a New Surface Modified Titanium Implant, the Birmingham Experience
Authors: Limbrick Jack , Muzaffar Jameel , Kumar Raghu , Mulvihill Daniel , Gaskell Peter , Addison Owen , Monksfield Peter , Banga Rupan
Published: November 2019

Background:

Bone anchored hearing implants (BAHI) are widely used and highly successful, accompanied with a high level of patient satisfaction across most techniques. A large UK teaching hospital switched from the previously used wide diameter titanium fixture and drilling system to the novel minimally invasive technique and laser ablated titanium implant. Before this change the rates of fixture failure and skin problems necessitating abutment change were 1% each.

Methods:

Retrospective case note review of consecutive BAHI patients drawn from an electronic database between January 2015 and October 2016.

Results:

Data from a total of 118 procedures were reviewed, with different combinations of surgical techniques and implant types. Sixty procedures were performed via the novel minimally invasive technique with 21 failures (35%). Fourty-eight modified minimally invasive technique procedures were performed with seven failures. In 64 of the procedures, laser ablated titanium fixtures were placed with 21 failures (32.8%). In 54 procedures wide diameter titanium fixtures were placed with eight failures (5%).

Conclusion:

Initial experience with the novel minimally invasive technique and laser ablated titanium fixture showed significantly higher failure rates than expected. This prompted a change to an open technique and subsequent abandonment of the laser ablated titanium fixture and custom drilling solution in our institution.
Comparison of Opioid Prescription Patterns and Consumption Following Otologic Surgery
Authors: Ngombu Stephany , Hooks Andrea , Rock Alexander N. , Nogan Stephen , Adunka Oliver F. , Dodson Edward E. , Moberly Aaron C. , Mattingly Jameson K.
Published: November 2019

Objective:

To examine opioid prescribing patterns and consumption among patients undergoing common otologic surgeries.

Study Design:

Retrospective cohort study with chart review and telephone survey.

Setting:

Tertiary academic medical center.

Methods:

Retrospective chart review and telephone survey of those undergoing tympanoplasty, tympanomastoidectomy, stapedectomy, and cochlear implantation in 2018. The survey consisted of questions regarding the details of the number of pills taken, duration of opioid use, subjective pain control, the use of over-the-counter pain medications, opioid disposal, and their history of substance abuse.

Results:

Sixty-one patients were able to be contacted and agreed to participate in the study. Fifty-nine (96.7%) stated that their pain was controlled, and 10 (16.4%) did not take any opioids postoperatively despite their prescription. The mean morphine milligram equivalent (MME) prescribed was 99.9 (44.3) and MME taken was 45.2 (SD 46.3) (p < 0.001). Similarly, the mean number of pills prescribed was 17.8 (SD 8.6) and mean taken was 7.9 (SD 8.3) (p < 0.001). Comparison between males and females regarding MME and pills prescribed and taken were not statistically significantly different (p > 0.05). Analysis of the MME and pills prescribed and taken among the different surgeries (tympanoplasty, stapes surgery, tympanomastoidectomy, and cochlear implantation) revealed no statistically significant interactions (p > 0.05). Pain control was achieved for 50% of patients with 5 pills (MME = 25 mg), for 75% with 12 pills (MME = 60 mg), and for 90% with 24 pills (MME = 135 mg).

Conclusion:

The opioid epidemic continues to be an ongoing issue in the United States, and prescription opioid abuse is a large contributor. There is increasing literature to suggest a practice of overprescribing in multiple surgical specialties. This same finding appears to be present in common otologic surgeries, where on average patients took less than half of the prescribed MME/pills, and 75% of patients had their pain controlled with 12 pills or fewer. Otolaryngologists performing otologic surgery should strongly consider adjusting their postoperative regimens to reflect these findings.

Level of Evidence: 2b
The role of frailty and prehabilitation in surgery
Authors: Hanna Kamil , Ditillo Michael , Joseph Bellal
Published: November 2019

Purpose of review

The aging surgical population constitutes a unique challenge to clinicians across the spectrum of care. Frailty is a valuable tool for preoperative risk stratification and may guide targeted interventions, such as prehabilitation. The aim of this review is to revise the recent literature on the role of frailty and prehabilitation to optimize geriatric patients undergoing surgery.

Recent findings

The concept of frailty became more refined over the past couple of decades, and its various dimensions have been operationalized into an array of different frailty scoring systems. The association between frailty and adverse perioperative events has been demonstrated in many surgical specialties. The use of multimodal prehabilitation of frail patients is expanding, and most prehabilitation programs (which focus on nutritional supplementation, feedback-based exercise regimens, and pulmonary optimization) have promising outcomes.

Frailty is a valuable risk stratification tool that better captures the state of augmented vulnerability of older adults. Frail patients benefit from targeted interventions, such as multimodal prehabilitation. Thus, the implementation of nationwide geriatric surgery standards can address ongoing challenges in performing surgery on older, frail patients.
Small airway disease in chronic obstructive pulmonary disease: insights and implications for the clinician
Authors: Singh Dave , Long Gabriella , Cançado José E.D. , Higham Andrew
Published: November 2019

Purpose of review

Small airway disease (SAD) is a common feature in chronic obstructive pulmonary disease (COPD) patients. Chronic exposure to cigarette smoking causes inflammation, damage, tissue remodelling and eventually airway loss. These features lead to airflow limitation and defective alveolar ventilation. The aim of this review is to provide clinicians with an up-to-date perspective of SAD in COPD.

Recent findings

In this review, we will discuss the key pathological features of SAD. We also review state-of-the-art techniques for measuring SAD, including impulse oscillometry and lung imaging methods. We discuss emerging concepts such as SAD in the earlier stages of COPD and the relationship between SAD and emphysema.

The current review highlights the importance of targeting small airways early in the course of COPD to tackle disease progression.
Epithelial dysfunction in chronic respiratory diseases, a shared endotype?
Authors: Steelant Brecht
Published: November 2019

Purpose of review

Epithelial barrier defects are being appreciated in various inflammatory disorders; however, causal underlying mechanisms are lacking. In this review, we describe the disruption of the airway epithelium with regard to upper and lower airway diseases, the role of epigenetic alterations underlying this process, and potential novel ways of interfering with dysfunctional epithelial barriers as a novel therapeutic approach.

Recent findings

A defective epithelial barrier, impaired innate defence mechanisms or hampered epithelial cell renewal are found in upper and lower airway diseases. Barrier dysfunction might facilitate the entrance of foreign substances, initiating and facilitating the onset of disease. Latest data provided novel insights for possible involvement of epigenetic alterations induced by inflammation or other unknown mechanisms as a potential mechanism responsible for epithelial defects. Additionally, these mechanisms might precede disease development, and represent a novel therapeutic approach for restoring epithelial defects.

A better understanding of the role of epigenetics in driving and maintaining epithelial defects in various inflammatory diseases, using state-of-the-art biology tools will be crucial in designing novel therapies to protect or reconstitute a defective airway epithelial barrier.
SNF2 histone linker PHD RING helicase related Has_circ_0001649 as a diagnostic and prognostic biomarker in solid cancer
Authors: Tian Guangwei , Li Guang , Guan Lin , Wang Zihui , Li Nan
Published: November 2019

Background

Dysregulated circular RNAs have been implicated in the pathogenesis of cancer. Recent studies indicate that has_circ_0001649 lowly expressed in multiple types of cancer. The purpose of this study is to investigate the roles of has_circ_0001649 as a diagnostic and prognostic marker for Chinese patients with cancer.

Methods

Adhering to preferred reporting items for systematic reviews and meta-analyses guidelines, systematic literature searches were performed using Pubmed, Embase, and the web of Science to retrieve articles fulfilled all inclusion criteria. The significance of has_circ_0001649 in diagnosis and prognosis of cancer patients were evaluated. Meta-Disc 1. 4 and STATA 12. 0 were used to analyze the data from collected studies.

Results

Eleven articles with 761 patients were included in present meta-analysis, of which 4 were about diagnosis, 5 were about prognosis, and 6 were about tumor differentiation grade. For the diagnostic value of has_circ_0001649, the pooled results for sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio with their 95% confidential intervals were 0. 78 (0. 73–0. 83), 0. 75 (0. 70–0. 80), 3. 17 (2. 56–3. 93), 0. 29 (0. 23–0. 36), and 11. 41 (7. 80–16. 7), respectively. The area under the curve of summary receiver operator characteristic was 0.8408 (Q = 0. 7725). Meanwhile, the result showed no obvious publication bias in this analysis for the P-value of Deeks’ test was .489. For the prognostic value, the pooled hazard ratio for overall survival was 0.45 (0.324–0.626). Lower expression of has_circ_0001649 was also prone to lower tumor differentiation grade (odds ratio = 2.58, P < .0001).

Conclusions

Has_circ_0001649 could be used as a potential biomarker for diagnosis and prognosis in solid cancer. Further prospective studies are required to validate its clinical application.
Mitral annular calcification is associated with atrial fibrillation and major cardiac adverse events in atrial fibrillation patients
Authors: Li Yimin , Lu Zhiping , Li Xiangyu , Huang Jin , Wu Qinghua
Published: November 2019

Background:

The incidence of atrial fibrillation (AF) varies from 5.4% to 47.1% in patients with mitral annulus calcification (MAC). We conducted a systematic review and meta-analysis on the association between MAC and AF, as well as the relation between MAC and major cardiac adverse events (MACEs) in AF patients.

Methods:

We conducted comprehensive search for literature on associations between MAC and AF using the following databases: MEDLINE, PubMed, Embase, and the Web of Science. The pooled odds ratio (OR) or relative risk and the corresponding 95% confidence intervals (CIs) were calculated to assess the relationship between MAC and AF, as well as the rates of MACEs in AF patients with or without MAC.

Results:

Thirteen studies met our eligibility criteria on associations between MAC and AF, including 6232 patients with MAC and 15,199 patients without MAC. Moreover, 5 studies met our eligibility criteria on the rates of MACEs in AF patients with or without MAC. The pooled analysis demonstrated a statistically significant increased risk of development of incident AF in patients with MAC than those without MAC (random effects OR: 2.34; 95% CI: 1.91, 2.85; P = .000). And the pooled analysis demonstrated a statistically significant increased risk of development of MACEs in AF patients with MAC (random effects OR: 2.34; 95% CI: 1.24, 4.41; P = .009).

Conclusion:

MAC was independently associated with AF and AF patients with MAC were at greater risk for cardiovascular and cerebrovascular events.
Mechanical chest compression with LUCAS device does not improve clinical outcome in out-of-hospital cardiac arrest patients
Authors: Liu Mao , Shuai Zhuang , Ai Jiao , Tang Kai , Liu Hui , Zheng Jiankang , Gou Junqi , Lv Zhan
Published: November 2019

Background:

Cardiac arrest (CA) is a serious threat to human health. Cardiopulmonary resuscitation (CPR) is an effective treatment for CA. Early and high-quality CPR is closely related to the survival rate of patients with CA. But manual chest compression has a lot of defects. To solve the defects and improve the quality of CPR, mechanical CPR device was invented. However, it has still controversy whether manual chest compression or mechanical chest compression is better. This systematic review was aimed to investigate the difference in clinical outcomes between manual chest compression and Lund University Cardiac Assist System (LUCAS) assisted CPR in patients with out-hospital CA.

Methods:

Original research studies, conducted on adult out-of-hospital CA, were included. PubMed/Medline, EMBASE, Scopus, Cochrane Library, CNKI, and Wanfang database were searched from the setting to February 21, 2019. Odds ratio (OR) with 95% confidence interval (CI) was selected as effect scale index for evaluation of the difference in return of spontaneous circulation (ROSC), survival to hospital admission, survival to hospital discharge, and survival to 30 days. Random effects model was used in this study to estimate overall mean effects.

Results:

A total of 6 articles, including 4 randomized controlled trials and 2 nonrandomized controlled trials, were selected. And 8501 subjects were involved to analyze the clinical outcomes of LUCAS and manual chest compression for patients with out-hospital CA. Comparisons of ROSC (33.3% vs 33.0%, P = .98; OR = 1; 95% CI: [0.89,1.13]), survival to hospital admission (22.7% vs 24.3%, P = .32; OR = 0.86; 95% CI: [0.65,1.15]), survival to hospital discharge (8.6% vs 10.7%, P = .50; OR = 0.92; 95% CI: [0.73,1.17]), and survival to 30 days (7.5% vs 8.5%, P = .50; OR = 0.92; 95% CI: [0.73,1.17]) were made. No significant difference was found.

Conclusion:

The synthesis of available evidence does not support that mechanical chest compression with LUCAS device improves clinical outcome in out-of-hospital CA patients compared with manual chest compression. Large scale studies with improved designs are still needed in the future.
Efficacy and safety of moxibustion in female infertility patients undergoing in vitro fertilization and embryo transfer
Authors: Hou Tinghui , Zheng Qianhua , Feng Xiumei , Liu Ying , Wang Lu , Li Ying
Published: November 2019

Introduction:

The purpose of this paper is to evaluate the efficacy and safety of moxibustion in infertility females/women undergoing in vitro fertilization and embryo transfer (IVF-ET).

Methods and analysis:

We will electronically search PubMed, Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trial, China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wan-fang Database from their inception. Also, we will manually retrieve other resources, including reference lists of identified publications, conference articles, and grey literature. The clinical randomized controlled trials or quasi-randomized controlled trials related to moxibustion in female infertility patients undergoing IVF-ET will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by 2 researchers. Data were synthesized by using a fixed effect model or random effect model depend on the heterogeneity test. The clinical total effective rate and the clinical pregnancy rate will be the primary outcomes. Ovulation rate, endometrial thickness, hormone level, traditional Chinese medicine (TCM) Syndrome Integral Scale and the adverse event will also be assessed as secondary outcomes. RevMan V.5.3 statistical software will be used for meta-analysis, and the level of evidence will be assessed by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Continuous data will be expressed in the form of weighted mean difference or standardized mean difference with 95% confidence intervals (CIs), while dichotomous data will be expressed in the form of relative risk with 95% CIs.

Results:

This study will provide a high-quality comprehensive evaluation of the efficacy and safety of moxibustion in the treatment of female infertility patients undergoing IVF-ET.

Conclusion:

This review will provide evidence to judge for judging whether moxibustion is effective in treating female infertility patients undergoing IVF-ET.

Systematic review registration:

PROSPERO, CRD42019135593