bluuebunny/crossref_metadata_2025 huggingface dataset:
Bacterial meningitis and cauda equina syndrome after trans-sacral epiduroscopic laser decompression
Authors: Jung Yong Jae , Chang Min Cheol
Published: March 2019

Rationale:

Trans-sacral epiduroscopic laser decompression (SELD) is a noninvasive pain-relieving procedure for treatment of herniated lumbar disc (HLD), and is known to have positive effects in alleviating lower back pain or radicular leg pain after HLD. However, little is known about the possible complications of SELD.

Patient concerns:

A 51-year-old woman received SELD with a holmium:yttrium-aluminum-garnet laser for controlling radicular pain due to HLD on L5-S1. However, 5 days after SELD, she complained of headache, and 9 days after the SELD, cauda equine syndrome (CES) symptoms, including motor weakness of both lower extremities (manual muscle testing—left: 3, right: 4), voiding and defecation difficulties, and neuropathic pain, were manifested.

Diagnoses:

Cerebrospinal fluid (CSF) analysis performed 15 days after the SELD revealed elevated white blood cell count 7560 cells/μL. Staphylococcus hominis sensitive to vancomycin was cultured from CSF. The gadolinium-enhanced magnetic resonance imaging showed diffuse leptomeningeal enhancement along the distal cord and cauda equina. The latency of electrically induced bulbocavernosus reflex (BCR) was delayed in the right side and no response of BCR was presented in the left side. Based on the patient's symptoms and the results of the clinical evaluation, we diagnosed the patient as having a bacterial meningitis and CES.

Interventions:

The patient received 2 g per day of intravenous vancomycin for 2 months.

Outcomes:

After treatment with intravenous vancomycin for 2 months, all the CES symptoms were completely resolved.

Lessons:

In this study, we described a patient who had bacterial meningitis after SELD. During SELD, clinicians should keep in mind the possibility of infection.
Interproximal caries and premature tooth loss in primary dentition as risk factors for loss of space in the posterior sector
Authors: Lucas-Rincón Salvador Eduardo , Robles-Bermeo Norma Leticia , Lara-Carrillo Edith , Scougall-Vilchis Rogelio José , Pontigo-Loyola América Patricia , Rueda-Ibarra Vicente , Loyola-Rodríguez Juan Pablo , Escoffié-Ramirez Mauricio , Medina-Solís Carlo Eduardo
Published: March 2019

Dental caries—a highly prevalent public health problem in preschoolers and school children—is the main cause of premature dental loss during childhood, and this may be related to loss of space in the posterior sector. The objective of this study was to evaluate whether interproximal caries and premature tooth loss (D and/or E) are risk factors for loss of space in the posterior sector.

A comparative cross-sectional study (split-mouth type) was performed in schoolchildren (6–8 years old). Seventeen gypsum models were evaluated. These children presented with unilateral loss of a dental organ or interproximal caries (teeth D and/or E) and without such affectations on the other side. Measurements were made with a digital Vernier caliper. The dependent variable was the difference (loss of space, mm) between the control and case sides. The independent variables were type of affectation (interproximal caries or tooth loss), sex, age, arcade, and number of interproximal surfaces affected.

The mean age was 6.82 ± 0.44 years and 64.7% were boys. The average space loss was 1.09 ± 0.18 mm (control vs case; P < .0001). A greater loss of space was observed among those who lost a dental organ than those with interproximal caries (P = .0119). A correlation was observed between the variable loss of space and the number of interproximal surfaces affected (r = 0.5712, P = .0166).

Interproximal caries and tooth loss were risk factors for loss of space in the posterior segment in this sample of Mexican schoolchildren.
Intratumoral heterogeneity as measured using the tumor-stroma ratio and PET texture analyses in females with lung adenocarcinomas differs from that of males with lung adenocarcinomas or squamous cell carcinomas
Authors: Koh Young Wha , Lee Dakeun , Lee Su Jin
Published: March 2019

We compared intratumoral stromal proportions and positron emission tomography (PET) textural features between females and males with lung adenocarcinoma (ADC) or squamous cell carcinoma (SCC).

We retrospectively evaluated 167 consecutive patients (male 122, female 45) who underwent pretreatment fluorodeoxyglucose PET/CT and surgical resection. The tumor-stroma ratios (TSRs) of primary tumors were estimated on hematoxylin-and-eosin-stained histological sections, and higher-order textural features were extracted on PET. We compared the histological and PET features between the sexes.

More females than males had ADC. Age and pathological tumor size did not significantly differ between females and males. Females with ADC had more stroma-rich tumors than males with ADC (P = .016) or SCC (P = .047). In addition, some PET textural features significantly differed between females with ADC and males with ADC and SCC; short run emphasis, long run emphasis, coarseness, strength, short-zone emphasis, zone percentage and high-intensity large-zone percentage were the commonly differed textural features. However, the TSRs and PET textural features did not significantly differ between males with ADC or SCC.

Intratumoral heterogeneity in females with lung ADC differs from that in males with lung ADC or SCC.
The effect of early cardiopulmonary rehabilitation on the outcomes of intensive care unit survivors
Authors: Lai Chih-Cheng , Chou Willy , Cheng Ai-Chin , Chao Chien-Ming , Cheng Kuo-Chen , Ho Chung-Han , Chen Chin-Ming
Published: March 2019

This study aims to compare the impact of early and late post-discharge cardiopulmonary rehabilitation on the outcomes of intensive care unit (ICU) survivors.

The retrospective, cohort study used a sub-database of the Taiwan National Health Insurance Research Database (NHIRD) that contained information of all patients had ICU admission between 2000 and 2012. Early group was defined if patients had received cardiopulmonary rehabilitation within 30 days after ICU discharge, and late group was define as if patients had received cardiopulmonary rehabilitation between 30 days and 1 year after ICU discharge. The end points were mortality and re-admission during the 3-year follow-up.

Among 2136 patients received cardiopulmonary rehabilitation after ICU discharge, 994 was classified early group and other 1142 patients were classified as late group. Overall, early group had a lower mortality rate (6.64% vs. 10.86%, P = .0006), and a lower ICU readmission rate (47.8% vs. 57.97%, P < 0.0001) than late group after 3-year follow-up. Kaplan-Meier analysis showed that early group had significantly lower mortality (P = .0009) and readmission rate (P < .0001) than late group. In multivariate analysis, the risk of ICU readmission was found to be independently associated with late group (hazard ratio, [HR], 1.28; 95% confidence intervals, [CI], 1.13–1.47).

Early post-discharge cardiopulmonary rehabilitation among ICU survivors has the long-term survival benefit and significantly decreases the readmission rate.
Incidence and risk of surgical site infection after adult femoral neck fractures treated by surgery
Authors: Ji Chenni , Zhu Yanbin , Liu Song , Li Jia , Zhang Fei , Chen Wei , Zhang Yingze
Published: March 2019

Surgical site infections (SSI) are devastating complications after surgery for femoral neck fractures. There are a lot of literature have shown a strong association between diabetic patients and SSI. This study aimed to identify diabetes as an independent risk factor of SSI, focusing on femoral neck fractures, and to investigate the other potential risk factors for SSI.

We retrospectively collected data from patients who underwent surgery for femoral neck fractures through the medical record management system at a single level 1 hospital between January 2015 and June 2016. Demographic and clinical patient factors and characteristics of SSI were recorded. The case group was defined as patients with SSI and the control group was defined as patients without SSI. Univariate and multivariate analyses were performed to determine the risk factors for SSI.

Data were provided for 692 patients, among whom 26 had SSI, representing an incidence rate of 3.67%. In the SSI group, 24 (3.47%) patients had superficial infection and 2 (0.29%) had deep infection. On multivariate analysis, diabetes (P < .001) was determined an independent risk factor of SSI, so were surgery performed between May and September (P = .04), body mass index (P = .031), corticosteroid therapy (P = .003), anemia (P = .041), and low preoperative hemoglobin levels.

Our results suggest that clinicians should recognize patients with these factors, particularly diabetes. And taking management optimally in the preoperative period will prevent the SSI after femoral neck fracture.
Signet-ring cells in the bone marrow as an indication of cryptic metastasis of breast carcinoma
Authors: Ma Shuang , Jr Bruce D. Leckey , Zhang Wan-Lin , Xu Hong-Tao , Yang Lian-He , Wang Endi
Published: March 2019

Rationale:

Signet-ring cell is a rare morphological finding in bone marrow, which usually indicates metastatic carcinoma from either the gastrointestinal tract or a primary hematolymphoid neoplasm. Here, we present a very unusual case of lobular breast carcinoma with metastasis to the bone marrow.

Patient concerns:

A 67-year-old female with estrogen receptor (ER)-positive lobular breast carcinoma was staged as T3N3M0, and treated with modified radical mastectomy followed by chemotherapy and radiotherapy. One year after treatment, she was noted to have moderate thrombocytopenia on complete blood count with the remainder of the parameters within normal limits. Radiographic examination revealed no evidence of recurrent disease.

Diagnosis:

Bone marrow biopsy was performed to exclude therapy-related myelodysplastic syndrome (MDS), which demonstrated hypercellularity with “hyperplastic” hematopoiesis. Upon closer inspection, a few signet-ring cells were identified which morphologically resembled histiocytes. These formed an interstitial infiltrate among the predominantly hematopoietic elements, and could have been easily overlooked. Immunohistochemistry demonstrated that these signet-ring cells were positive for pancytokeratin as well as ER which confirmed metastatic lobular breast carcinoma. On retrospective review of the aspirate smear, rare signet-ring cells were identified.

Interventions:

The patient was treated with additional chemotherapy.

Outcomes:

The patient eventually succumbed to overt dissemination after 14 months.

Lessons:

Due to the relative discohesiveness of lobular breast carcinoma, the cells frequently assume single-cell infiltration in bone marrow. This attribute, along with small cell size, bland cytologic features and paucity of tissue response, contributes to its escaping from identification on hematoxylin-eosin (H&E) sections. In this case, the signet-ring cells were hidden in apparently hyperplastic hematopoiesis. Careful inspection raised the possibility of occult metastasis which was readily detected and confirmed with immunohistochemistry.
Red blood cell transfusion threshold after pediatric cardiac surgery
Authors: Deng Xicheng , Wang Yefeng , Huang Peng , Luo Jinwen , Xiao Yunbin , Qiu Jun , Yang Guangxian
Published: March 2019

Background:

Restrictive red blood cell transfusion strategy is implemented to minimize risk following allogeneic blood transfusion in adult cardiac surgery. However, it is still unclear if it can be applied to pediatric cardiac patients. The purpose of this systematic review and meta-analysis was to determine the effect of postoperative restrictive transfusion thresholds on clinical outcomes based on up-to-date results of randomized controlled trials (RCTs) and observational studies in pediatric cardiac surgery.

Method:

We searched for RCTs and observational studies in the following databases: the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ClinicalTrials.gov from their inception to October 26, 2017. We also searched reference lists of published guidelines, reviews, and relevant articles, as well as conference proceedings. No language restrictions were applied and no observational study met the inclusion criteria.

Results:

Four RCTs on cardiac surgery involving 454 patients were included. There were no differences in the pooled fixed effects of intensive care unit (ICU) stay between the liberal and restrictive transfusion thresholds (standardized mean difference SMD, 0.007; 95% confidence interval CI, −0.18–0.19; P = .94). There were also no differences in the length of hospital stay (SMD, −0.062; 95% CI, −0.28−0.15; P = .57), ventilation duration (SMD, −0.015; 95% CI, −0.25–0.22; P = .90), mean arterial lactate level (SMD, 0.071; 95% CI, −0.22–0.36; P = .63), and mortality (risk ratio, 0.49; 95% CI, 0.13–1.94; P = .31). There was no inter-trial heterogeneity for any pooled analysis. Publication bias was tested using Egger, Begg, or the trim-and-fill test, and the results indicated no significant publication bias.

Conclusion:

Evidence from RCTs in pediatric cardiac surgery, though limited, showed non-inferiority of restrictive thresholds over liberal thresholds in length of ICU stay and other outcomes following red blood cell transfusion. Further high-quality RCTs are necessary to confirm the findings.
Association of polymorphisms in STRA6 gene with gestational diabetes mellitus in a Chinese Han population
Authors: Hu Shimin , Yan Junxia , You Yiping , Yang Guilian , Zhou Hui , Li Xun , Liao Xin , Tan Hongzhuan
Published: March 2019

Cell and animal experiments have found that in addition to being a retinol transporter, Stimulated by Retinoic Acid 6 (STRA6) also functions as a surface signaling receptor by which retinol regulates insulin responses. Several studies revealed that the STRA6 gene may contribute to the pathogenesis of type 2 diabetes mellitus (T2DM). Gestational diabetes mellitus (GDM) and T2DM have some risk factors in common. The present study was directed to investigate whether the 3 single nucleotide polymorphism (SNPs) (rs11633768, rs351219, and rs736118) of STRA6 correlate with the development of GDM in Chinese pregnant women. We also aimed to estimate the relationship between SNPs with fasting blood glucose level, 1-hour and 2-hour blood glucose levels after 75 g oral glucose intake, fasting insulin and insulin resistance levels to better study the relationship between STRA6 and glucose metabolism.

Case–control studies were conducted to compare the GDM and control groups. A total of 334 cases and 367 controls were recruited. Three tagSNPs of STRA6, rs11633768, rs351219, and rs736118, were selected. A chi-square test, logistic regression, and linear regression were used to estimate the relationship between SNPs with GDM risk and oral glucose tolerance test (OGTT), fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) levels. Regression analyses were all adjusted by maternal age, pre-pregnancy BMI, and weekly BMI growth. The Bonferroni correction was applied for multiple comparisons.

After adjusting the maternal age, pre-pregnancy BMI and weekly BMI growth, STRA6 rs736118 was associated with fasting insulin level (Beta = −1.468, P = .036), and the association between rs736118 and HOMA-IR was of borderline significance (Beta = −0.290, P = .093) under the dominance model.

This study found that there is a significant association between STRA6 polymorphism and GDM.
Can surgical treatment be justified for neuroendocrine carcinoma of the gallbladder?
Authors: You Yung Hun , Choi Dong Wook , Heo Jin Seok , Han In Woong , Choi Seong Ho , Jang Kee-Taek , Han Sunjong
Published: March 2019

Clinical features and treatment of GB neuroendocrine carcinoma (GB-NEC) are not well understood. This study aimed to analyze clinical outcomes of GB-NEC and verify the oncologic benefit of surgical treatment.

From October 1994 to December 2014, the medical records of 31 patients with GB-NEC at a single center were retrospectively reviewed. There were 18 inoperable cases due to distant metastasis, including 7 of best supportive care (Tx.1) and 11 of non-operative palliative treatment (Tx.2). 4 patients received non-curative, palliative resection (Tx.3). Only 9 patients were able to undergo curative-intent resection (Tx.4).

Among the 31 patients with GB-NEC, preoperative mean value of carbohydrate antigen 19-9 (CA 19-9) was 74.8 ± 156.1 U/mL and the median overall survival time was 10 months (range 7.0-12.0 months). Of these, 21 (67.7%) patients received systemic treatment. Among 9 patients who underwent curative-intent resection (Tx.4), 9 patients had poorly differentiated cancer cells and 7 patients received radical cholecystectomy. 6 patients had adjuvant treatment including concurrent chemoradiation therapy (CCRT) or chemotherapy alone. The recurrence rate was 88.9%. The median overall survival between 4 groups was as follows: 4.0 (3.0–18.0) months in Tx.1 (n = 7) versus 9.0 (3.0–21.0) months in Tx.2 (n = 11) versus 11.0 (3.0–15.0) months in Tx.3 (n = 4) versus 23.0 (8.0–34.0) months in Tx.4 (n = 9), respectively. Significant differences in median overall survival time existed between Tx.2 and Tx.4; 9 (3.0–21.0) months versus 23.0 (8.0–34.0) months (P = .017).

Most GB-NECs show poor biologic behavior. Nonetheless, curative-intent resection could possibly promote longer survival than other treatment modalities for GB-NEC. Efforts to undergo curative resection through early detection and development of adjuvant treatment are needed.
Effectiveness of peer pressure on computed tomography use for dizziness/vertigo patients
Authors: Chuang Po-Chun , Huang Yi-Syun , Chiang Charng-Yen , Zhang E-Wai , Cheng Fu-Jen
Published: March 2019

Dizziness/vertigo is a common complaint in the emergency department (ED). We aimed to evaluate the effect of peer pressure on decision making in emergency physicians (EPs) to use computed tomography (CT) for patients with dizziness/vertigo.

We conducted a before-and-after retrospective case review of patients who visited the ED with dizziness/vertigo. EPs were categorized into 3 groups according to seniority (in years of experience: >12, 7–12, and <7). The rate of CT use for EPs, patient number, and CT use were e-mailed monthly to update the EP team on the benchmark rate and shape of the behavior.

Among the 1657 (preintervention) and 1508 (postintervention) patients with dizziness/vertigo, 320 (19.3%) and 230 (15.3%), respectively, underwent brain CT. A decrease in the rate of CT use was observed in the postintervention group (odds ratio [OR] = 0.743, 95% confidence interval [CI] = 0.615–0.897), especially in junior EPs (years of experience, <7; OR = 0.667, 95% CI: 0.474–0.933) and younger patients (age, <60) (OR = 0.625, 95% CI: 0.453–0.857).

The intervention strategy created peer pressure through e-mail reminders and decreased the rate of CT use for patients with isolated dizziness/vertigo, especially in junior EPs and younger patients.
A multicenter, randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of Huangqi Guizhi Wuwutang granule in patients with rheumatoid arthritis
Authors: Wang Yiru , Liu Yang , Xi Zhijie , Yu Yang , Liu Li , Mao Jianchun , Xiao Lianbo , Gu Xiaohua , Yao Min , Cui Xuejun , Shi Qi , Wang Yongjun , Liang Qianqian
Published: March 2019

Background:

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by swelling, pain, and synovial damage. Effective methods lack in the treatment of RA. A traditional prescription in use for thousands of years in China, Huangqi Guizhi Wuwutang granule (HGWG) is still chosen to relieve pain and prevent joint malformation in RA patients. However, no evidence-based medical research has been organized to assess the effectiveness and safety of HGWG for RA.

Methods/design:

We will conduct a multicenter, randomized, double-blind, placebo-controlled clinical trial to determine whether HGWG can relieve pain and protect joints. We will randomly divide 120 patients with active RA into 2 groups, treated for 12 weeks. Main measurement is the rate of ACR50 score (American College of Rheumatology) from the baseline to 12 weeks. Secondary measurements include rate of ACR20/70, change of Disease Activity Score (DAS) 28, Health Assessment Questionnaire-Disability Index (HAQ-DI), Patient Assessment of Arthritis Pain, Patient Global Assessment of Arthritis, and AIS score. The time points are set as baseline, 2 weeks, 4 weeks, 8 weeks, 12 weeks, 24 weeks, and 48 weeks. In addition, the rate of ACR50 from the baseline to 2 weeks, 4 weeks, 8 weeks, 24 weeks, and 48 weeks’ follow-up are also the secondary outcome measures.

Discussion:

The findings of this research will elucidate the efficacy and safety of HGWG and provide an alternative treatment for RA. In addition, our data will benefit the clinical decision-making on active RA and possibly be incorporated into future guidelines.

Trial registration:

ClinicalTrials.gov ID: NCT03593837.
Effectiveness of therapeutic strategies for patients with neck pain
Authors: Gao Qiang , Gao Weipeng , Xia Qing , Xie Chunyu , Ma Jian , Xie Liangzhen
Published: March 2019

Background:

Neck pain is a common discomfort or more intense forms of pain in the cervical region. Neck pain has a large impact on individuals and their families, communities, healthcare systems, and businesses throughout the world. Therapeutic strategies are widely used for patients with neck pain in clinical practice, but the effectiveness of each therapeutic strategy is still unclear. The aim of this study is to assess the efficacy and safety of therapeutic strategies for neck pain.

Method:

Seven electronic databases will be searched regardless of publication date or language. Randomized controlled trials will be included if they recruited participants with neck pain for assessing the effect of each therapy. Primary outcomes will include pain score. The risk of bias will be assessed by 2 authors using the Cochrane tool of risk of bias. Network meta-analysis in random effects model will be conducted to estimate the indirect and mixed effects of therapeutic strategies for neck pain by R-3.5.1 software. The confidence in cumulative evidence will be assessed by grading of recommendations assessment, development, and evaluation.

Results:

This study will be to assess the effect and safety of therapeutic strategies for neck pain.

Conclusions:

This study will assess the effect of different therapeutic strategies for neck pain and provide reliable evidence for the choice of treatments.

Systematic review registration:

PROSPERO (CRD42019102385).
Nonalcoholic fatty liver disease represents a greater metabolic burden in patients with atherosclerosis
Authors: Han Jie , Wang Yong , Yuan Zhongshang , Liu Lu , Zhao Meng , Guan Qingbo , Zhang Haiqing , Li Qiu , Xu Jin , Gao Ling , Zhao Jiajun , Zhang Xu
Published: March 2019

How nonalcoholic fatty liver disease (NAFLD) is linked to atherosclerosis is still disputed. This study aimed to explore the association between NAFLD and atherosclerosis among adults in Shandong province, China.

A total of 6849 individuals were enrolled in the final analyses for a community-based study. The relationship between NAFLD and atherosclerosis was evaluated after adjusting for common confounding factors.

Hypertension, diabetes, and higher serum low-density lipoprotein cholesterol (LDL-c) level were positively correlated with NAFLD. An odds ratio (OR) (95% confidence interval [CI]) of 1.325 (range 1.157–1.518) for hypertension, 2.153 (range 1.814–2.555) for diabetes, and 1.161 (range 1.071–1.259) for LDL-c was noticed. These factors also were positively correlated with atherosclerosis, with an OR (95% CI) of 1.501 (range 1.286–1.751) for hypertension, 1.716 (range 1.414–2.084) for diabetes, and 1.344 (range 1.231–1.466) for LDL-c. The prevalence of metabolic syndrome was higher in the atherosclerosis+NAFLD group (81.8%) when compared with the NAFLD-only (30.3%), atherosclerosis-only (32.2%), and control (20.3%) groups (P <.01).

NAFLD and atherosclerosis have common metabolic characteristics, such as hypertension, diabetes, and higher serum LDL-c level. Patients with NAFLD in combination with atherosclerosis were found to have a more severe metabolic burden and greater chances of having hypertension, diabetes, dyslipidemia, and higher metabolic syndrome scores than those in the other groups.
The effects of high impact exercise intervention on bone mineral density, physical fitness, and quality of life in postmenopausal women with osteopenia
Authors: Yu Pei-An , Hsu Wei-Hsiu , Hsu Wei-Bin , Kuo Liang-Tseng , Lin Zin-Rong , Shen Wun-Jer , Hsu Robert Wen-Wei
Published: March 2019

Osteoporosis and osteopenia prevailed in postmenopausal women and predisposed to osteoporotic fractures that increase mortality, morbidity, and the cost of social care. Here, we investigated the effect of 24 weeks of aerobic dancing on the bone miner density, physical fitness and health-related quality of life (HRQoL) in postmenopausal women with osteopenia. Total 80 participants (control [CON]: 40; exercise [EX]: 40) were included in the final analysis. The EX group underwent a 24-week aerobic dance intervention. Bone mineral density (BMD), physical fitness, and SF-36 questionnaire were assessed at baseline and 24-weeks. The BMD change in the femoral neck at the 24-weeks were significantly different between the 2 groups (CON: −1.3 ± 2.7%, EX: 3.1 ± 4.6%, P = .001). Grip strength, sidestep and physical functional domain of HRQoL in the EX group were significantly improved compared to the CON. The results were suggested 24-week aerobic dance intervention could result in the lower the incidence of bone fracture through increasing BMD and decreasing fall risk for postmenopausal women.
Knowledge and attitude of nonpsychiatric physicians regarding suicide in spinal cord injury patients and need for structured psychiatric education for suicide prevention
Authors: Lee Su-Jin , Nam Tae-Woo , Kim Chul-hyun , Hwang Jong-moon
Published: March 2019

Background:

The knowledge and attitude of nonpsychiatric physicians regarding suicide in spinal cord injury (SCI) patients is important to prevent the accident related to suicide. However, most existing studies have focused on perception of and attitudes among psychiatric physician and mental health care worker.

The aim of this study is to investigate awareness and attitude regarding suicide among clinicians treating patients with spinal cord injury, and the necessity of education for suicide prevention.

Methods

A total of 29 subjects (N = 29; surgical group n = 17, nonsurgical group n = 12) participated in the study, 6 fellows and 23 residents. They answered a newly revised questionnaire that incorporated 18 items regarding perception of and attitude toward suicide, awareness of suicide in treatment of spinal cord injury patients, and psychiatric consultation; 13 items regarding education and experience; and 4 subjective items regarding their department. A χ
2 test was performed to investigate differences in sociodemographic factors, awareness of and attitude toward suicide, and clinical experience with spinal cord injury patients. Binary logistic regression analysis was used to identify correlation between the questionnaire items.

Results:

There were significant differences between surgical and nonsurgical clinicians in 1 question (Q6) about awareness of and attitude toward suicide (P < .05) and in 2 questions (Q21, Q25) about psychiatric consultation and experience with suicide-related education (P < .01). The correlation analysis revealed significant differences in certain questions among awareness and attitude (P < .05) and age (P < .05) and specialty (P < .01). Two sets of questions (Q16/Q31, Q17/Q26) showed correlation between clinical experience with spinal cord injury patients and awareness of and attitude toward suicide (P < .05).

Conclusion:

Education regarding suicide prevention and suicide-related clinical experience with spinal cord injury patients is important for nonpsychiatric clinicians, such as those in the fields of orthopedics, neurosurgery, and rehabilitation medicine.
Gestational diabetes mellitus increases the detection rate and the number of oral bacteria in pregnant women
Authors: Yao Han , Xu Dan , Zhu Zhichao , Wang Guoyun
Published: March 2019

In the present study, we aimed to investigate the association between gestational diabetes mellitus (GDM) and the oral microbial imbalance in the second trimester of pregnancy.

Three hundred thirtyone women in the second trimester of pregnancy who underwent prenatal examinations at the Third Affiliated Hospital of Soochow University from February 2018 to August 2018 were included in this study. Personal parameters including the age, education level, and body mass index (BMI) at 28 weeks of gestation were recorded. Gestational diabetes mellitus (GDM) was diagnosed according to the Standards of Medical Care in Diabetes-2011 recommended by American Diabetes Association (ADA). After the significant difference of each parameter was erased by a propensity-score matched (PSM) analysis at a 1:1 ratio, the oral health conditions and the oral flora in pregnant women with GDM were compared with those in nondiabetic pregnant women.

Our data demonstrated that 65 of the 331 pregnant women (19.6%) were diagnosed with GDM. Results from the matched data including 59 matched pairs of pregnant women showed that the gingival index (GI), plaque index (PI), tooth mobility degree (TMD), probing depth (PD), and bleeding on probing (BOP) of pregnant women with GDM were higher or more severe than those of nondiabetic pregnant women (P < .05). The detection rate of tuberculosis bacilli, Black-pigmented bacteria, and Capnocytophaga in pregnant women with GDM was higher than those in nondiabetic pregnant women (P = .000, P = .026, and P = .030, respectively). In addition, pregnant women with GDM had fewer oral streptococci (P = .000) and lactobacilli (P = .000) and more oral anaerobic bacteria (P = .000), tuberculosis bacilli (P = .000), Black-pigmented bacteria (P = .007), Capnocytophaga (P = .000), and actinomycetes (P = .000).

The detection rate and the number of oral bacteria in pregnant women with GDM were higher than those in nondiabetic pregnant women in the second trimester of pregnancy.
Associations of plasma LP(a), Hcy and D-D levels with the subtype of ischemic cerebrovascular disease
Authors: Tang Yong , Geng Deqin
Published: March 2019

The relevance of LP(a), Hcy, and D-D in ischemic cerebrovascular disease remains undefined. This study aimed to assess the associations of plasma LP(a), Hcy and D-D levels with the subtype of ischemic cerebrovascular disease.

Patients with ischemic cerebrovascular disease admitted to the Taixing People's Hospital were retrospectively enrolled from November 2017 to July 2018. Immunoturbidimetry was used to assess 119 LAA, 107 SAO, and 112 TIA patients for plasma LP(a), Hcy, and D-D levels.

Plasma LP(a), Hcy, and D-D levels in the large artery atherosclerosis (LAA) group were significantly lower than those of the transient ischemic attack (TIA) group (all P < .05). LP(a), Hcy, and D-D levels were significantly reduced in the SAO group compared with the TIA group (both P < .05). The LAA and SAO groups showed comparable values for all the above parameters (P > .05).

LP(a), Hcy, and D-D levels differ according to the subtype of ischemic cerebrovascular disease.
The reciprocal influences of prognosis between two types of surgical interventions and early breast cancer patients with diverse luminal subtypes
Authors: He Lin , Zhao Shengnan , Liu Min , Su Zhumin , Ren Yuanzhong , Song Yuhua
Published: March 2019

Background:

To investigate and compare the effects of breast-conserving therapy (BCT) and mastectomy on the disease recurrence and long-term survival in early-stage luminal breast cancer and the difference in prognosis across diverse luminal subtypes receiving single surgical modality.

Methods:

The databases of PubMed and Embase were retrieved to select eligible trials that were published from inception to 13 November 2018. The clinical trials that offered the details about recurrent disease and/or survival in luminal tumors underwent BCT or mastectomy met the inclusion criteria (n=24). With the random- or fixed-effect model basing on heterogeneity Chi2 test with its significant level of P < .1, pooled odds ratio (OR) with its 95% CI, and P value were identified for endpoints.

Results:

The analyzed data were constituted of 25 qualified trials with 13,032 unique women suffered from luminal cancers. The fixed-effect models were utilized. On the LRR regarding BCT versus mastectomy, the pooled data indicated no significant difference in luminal carcinomas (OR, 0.84; 95%CI, 0.43–1.64; P = .61; n = 867). In BCT cohort, the pooled data showed that there were some significant benefits favoring luminal A over luminal B in LR (OR, 0.61; 95%CI, 0.46–0.81; P = .0007; n = 5406), DM (OR, 0.53; 95%CI, 0.41–0.69; P < .00001; n = 4662), DFS (OR, 0.59; 95%CI, 0.36–0.96; P = .03; n = 776) and OS (OR, 0.65; 95%CI, 0.42–0.99; P = .05; n = 1149), but not in LRR (OR, 0.74; 95%CI, 0.48–1.13; P = .16; n = 3732), coupled with luminal A/B over luminal-HER2 in LRR (OR, 0.43; 95%CI, 0.25–0.76; P = .004; n = 890), DM (OR, 0.56; 95%CI, 0.35–0.90; P = .02; n = 1396), DFS (OR, 0.47; 95%CI, 0.27–0.83; P = .009; n = 532); in mastectomy cohort, there were apparent advantages of LRR (OR, 0.58; 95%CI, 0.36–0.92; P = .02; n = 1768), LR (OR,0.56; 95%CI, 0.38–0.83; P = .004; n = 1209), DM (OR, 0.58; 95%CI, 0.40–0.84; P = .004; n = 652) and OS (OR, 0.62; 95%CI, 0.43–0.89; P = .009; n = 652) in luminal A vs luminal B.

Conclusion:

For early luminal breast cancer, the equality of LRR was achieved in BCT and mastectomy. In comparison, luminal A cancers benefit the most improved tumor re-appearence and survival in luminal diseases regardless of the option of surgical modality, whereas luminal-HER2 is affected by the worst clinical outcomes in them who follows BCT.
The effects of methotrexate and uterine arterial embolization in patients with cesarean scar pregnancy
Authors: Xiao Zhuoni , Cheng Dan , Chen Jiao , Yang Jing , Xu Wangming , Xie Qingzhen
Published: March 2019

In this study, we explored the optimal treatment for cesarean scar pregnancy (CSP). One hundred three women diagnosed with CSP received 1 of the 3 treatments: local or systemic methotrexate (MTX) injection and surgery (MTX + Surg), uterine arterial embolization (UAE) and surgery (UAE + Surg) or surgery only (Surg only). We compared their therapeutic effects and their follow-up results. There was no significant difference between the groups in the baseline of clinical characteristic except for the initial β human chorionic gonadotropin levels, which was highest in the MTX + Surg group (median, [interquartile range]), (120,004 [16,720–181,727] mIU/mL), compared to the UAE + Surg group (38,219 [23,194–100,029] mIU/mL) and Surg only group (22,557 [9113–49,573] mIU/mL). There was no significant difference between groups in the sonographic characteristic of patients. The intraoperative hemorrhage was highest in the Surg-only group (7/42, 16.67%), compared to the MTX + Surg group (4/26, 15.38%) and the UAE + Surg group (0/35, 0%). The incidence of intrauterine adhesions was highest in the UAE + Surg group (20%), compared to the MTX + Surg group (0%) and the Surg only group (0%). The incidence of embryo residue was highest in Surg-only group (21.43%), compared to the MTX + Surg group (0%) and the UAE + Surg group (2.86%). To conclude, MTX injection plus surgery might be the best treatment for CSP patients.
Gestational diabetes mellitus increases the baseline level of procalcitonin in maternal blood but not in umbilical cord blood in late pregnancy
Authors: Ma Yan , Ye Wenfeng , Tang Yanhong
Published: March 2019

To study the effects of gestational diabetes mellitus (GDM) on the level of procalcitonin (PCT) in maternal blood and umbilical cord blood in late-pregnant women.

We retrospectively analyzed 37 pregnant women in late pregnancy who had GDM and compared with those of 97 age-matched normal glucose-tolerant (NGT) pregnant women. The PCT level was converted to a value with normal distribution (LG-PCT) by taking the logarithm of each value to the base 10 (log10).

The body mass index (BMI) before delivery, family history of diabetes mellitus (DM), and postpartum blood loss within 24 hours were markedly higher in GDM group than in NGT group, while the gestational age was smaller in GDM group than in NGT group. The maternal blood LG-PCT was significantly higher in GDM group than in NGT group, while the umbilical cord blood LG-PCT was not significantly different between the 2 groups. Multivariate analysis showed that family history of DM, gestational age, and maternal blood LG-PCT were independent risk factors of GDM after adjusting for BMI and postpartum blood loss within 24 hours.

GDM increases the baseline level of maternal blood PCT but has little effect on umbilical cord blood PCT.
Prediction of surgical management for operated adhesive postoperative small bowel obstruction in a pediatric population
Authors: Deng Yuhua , Wang Yongming , Guo Chunbao
Published: March 2019

Abdominal surgery might contribute to postoperative intraperitoneal adhesions, with a high rate of recurrence. In the present study, we aimed to analyze potential factors for the surgical intervention of operated adhesive postoperative small bowel obstruction (SBO) in pediatric patients and compare the outcomes of patients managed by conservative treatment or surgical operation for an episode of SBO.

From January 2007 to January 2017, the records of 712 patients admitted with SBO to Children's Hospital, Chongqing Medical University, were reviewed retrospectively. The patients were divided according to surgical intervention or conservative management. Potential predictors for surgical intervention were investigated, including the initial operation data and the current clinical variables. A Cox regression model was used to determine the independent risk factors of surgical intervention. A systematic follow-up for recurrence was performed based on surgical intervention or conservative management.

Among the 712 patients admitted with SBO, 266 patients were managed surgically and 446 patients were managed conservatively. In the multivariate analysis, the predictors for the surgical intervention included initial surgical features, such as elevated markers of inflammation (WBC, CRP), incision location (HR, 2.31; 95CI, 1.29–5.26; P = .031), and emergency procedure (HR, 1.46; 95%CI, 1.13–3.42; P = .014), and current variables, such as crampy pain (HR, 4.66; 95%CI, 1.69–9.48; P < .001), ascites (HR, 5.43; 95%CI, 1.84–13.76; P < .001) and complete small bowel obstruction (HR, 3.21; 95%CI, 1.45–8.74; P < .001). The median follow-up time (interquartile range) was 3.6 years (range, 1 month-8 years) for the entire study population. Twenty-one patients (9.2%) who had undergone surgical intervention were rehospitalized for a new SBO episode, as were 53 patients (14.9%) who had been managed conservatively (P = .028; OR, 1.72, 95% CI, 1.00–2.95).

Operated adhesive postoperative SBO with the following characteristics should heighten vigilance for surgical intervention: an initial emergency procedure with midline incisions and the current strangulation status. New hospitalizations were lower after surgical management than conservative treatment.
Pain and outcome prediction in muscle strength rehabilitation after knee injury in recreational athletes
Authors: Marn-Vukadinović Dušanka , Bizovičar Nataša , Majdič Neža , Vidmar Gaj
Published: March 2019

Effects of rehabilitation on knee function, activity and health-related quality of life after soft-tissue knee injury have been widely studied in clinical trials, but there is still a lack of data on the relation between knee muscle strength and athlete’s perceived performance to identify sports-risk modifiers. We performed a prospective observational clinical study of knee muscle strength and self-reported health during rehabilitation after unilateral knee soft-tissue injury in recreational sports. Forty-three patients performed isokinetic dynamometry and filled in the Short form Health Survey (SF-36) and the Oxford Knee Score questionnaires before and after 4 months of instructed home strengthening program. We observed significant improvement in peak torque deficit between two limbs during concentric extension (PTDE) and flexion, dynamic control ratio of the involved knee, most of the SF-36 subscales and the Oxford Knee Score values (P ≤ 0.001). Dynamic control ratio of the uninvolved knee values remained below referential values and unchanged. Improvement of PTDE correlated positively with improvement of the bodily pain subscale of SF-36 score (r = 0.51, P < 0.001). Receiver operating characteristic analysis indicated that reduction of pain by at least nine points predicts at least 10% reduction in PTDE, whereby the bodily pain change achieved poor (56%) sensitivity and good (86%) specificity as a rehabilitation success measure for recreational athletes after knee injury. Primary inferior eccentric strength of noninjured knee hamstrings might indicate increased risk of knee injury. Diminished perceived pain predicts strength improvement of the injured knee extensors with poor sensitivity and good specificity.
The International Classification of Functioning, Disability and Health-based factors related to physical activity level in adults with muscle diseases
Authors: Ayvat Fatma , Ayvat Ender , Kilinç Özge Onursal , Kilinç Muhammed , Yildirim Sibel Aksu
Published: March 2019

The aim of this study was to investigate the physical activity (PA) level of adults with muscle diseases and the association of factors affecting PA behaviour. Forty-five adults with muscle diseases and 44 healthy participants were included. The PA was assessed by a SenseWear Armband and the International Physical Activity Questionnaire. The muscle strength, pain, fatigue severity, activity limitations, functional mobility level and quality of life were also assessed. Compared with the healthy group, adults with muscle diseases had significantly lower step counts and duration of moderate and vigorous PA (P < 0.05). The BMI of the patients was related to total energy expenditure (P < 0.05). The total number of steps, energy expenditure and duration of moderate PA of the patients were related to the 6-min walk test (P < 0.05). There was a correlation between total, moderate and vigorous PA and mental health in adults with muscle diseases (P < 0.05). The most important factors in reflecting PA in adults with muscle diseases are considered as BMI from personal factors, functional mobility from activity limitations and quality of life in the dimension of participation.
Prevalence of Obsessive-Compulsive Disorder in Patients With Schizophrenia and Outcome on Positive and Negative Symptoms, Cognition, and Quality of Life
Authors: Wehbé Joelle , Haddad Chadia , Obeid Sahar , Hallit Souheil , Haddad Georges
Published: March 2019

The objectives were to examine the prevalence of obsessive-compulsive disorder (OCD) in hospitalized patients with schizophrenia and to compare the clinical, cognitive, and functional characteristics of schizophrenia patients with and without OCD. This cross-sectional study, performed between May and August 2018, enrolled 308 patients (200 men and 108 women). The prevalence of OCD in patients with schizophrenia was 3.2%. An increase in patients having a mild β was significantly associated with higher social relationship score (β = 1.68) and the Memory Functioning Scale–Informant (MFS-I) version (β = 5.67). OCD did not affect the positive and negative symptoms of these patients. The prevalence of OCD in these patients was low (3.2%). Schizophrenia patients with and without OCD have comparable clinical profiles with few exceptions. The existence of OCD may affect the social relationship quality of life and the MFS-I version.
Depressive Symptom Severity in Individuals With Epilepsy and Recent Health Complications
Authors: Kumar Neha , Lhatoo Rigzin , Liu Hongyan , Colon-Zimmermann Kari , Tatsuoka Curtis , Chen Peijun , Kahriman Mustafa , Sajatovic Martha
Published: March 2019

Identifying relationships between depression severity and clinical factors may help with appropriate recognition and management of neuropsychiatric conditions in persons with epilepsy (PWE). Demographic characteristics, epilepsy variables, and medical and psychiatric comorbidities were examined from a baseline randomized controlled trial sample of 120 PWE. Among demographic characteristics, only inability to work was significantly associated with depression severity (p = 0.05). Higher 30-day seizure frequency (p < 0.01) and lower quality of life (p < 0.0001) were associated with greater depression severity. Comorbid bipolar disorder (p = 0.02), panic disorder (p < 0.01), and obsessive-compulsive disorder (p < 0.01) were correlated with worse depression severity. The literature supports our findings of correlations between worse depression, seizure frequency, and lower quality of life. Less well studied is our finding of greater depression severity and selected psychiatric comorbidities in PWE.
Prevalence of Religious and Spiritual Experiences and the Perceived Influence Thereof in Patients With Bipolar Disorder in a Dutch Specialist Outpatient Center
Authors: Ouwehand Eva , Braam Arjan W. , Renes Janwillem , Muthert Hanneke J.K. , Stolp Hanne A. , Garritsen Heike H. , Zock Hetty T.H.
Published: March 2019

The aim of the current cross-sectional study was to estimate the prevalence of religious and spiritual (R/S) experiences and their perceived lasting influence in outpatients with bipolar disorder (BD; n = 196). A questionnaire with a range of R/S was constructed, building on the results of an earlier qualitative study. Experiences of horizontal transcendence (not necessarily referring to the divine) such as the experience of “intense happiness, love, peace, beauty, freedom” (77%) or “meaningful synchronicity” (66%) were the most prevalent. The experience of “divine presence” (vertical transcendence, referring to the divine) had a prevalence of 44%. Perceived lasting influence of the experiences was 20% to 67% of the total frequency, depending on the type. Most positive R/S experiences were significantly more related to BD I and mania, and on average, persons with BD I had more R/S experiences (mean = 4.5, SD = 2.6) than those with BD II (mean = 2.8, SD = 2.4, p = 0.000). Patient-reported R/S experiences in BD can have both R/S and pathological features.
Predictors of Consent to Treatment and Premature Termination of Treatment in a Sample of Veterans With Military-Related PTSD
Authors: Levi Ofir , Lazarov Amit , Bar-Haim Yair , Lubin Gadi , Wald Ilan
Published: March 2019

This study examined different variables as predictors of treatment entry and treatment dropout among veterans with military-related posttraumatic stress disorder (PTSD). First, we examined predictors of treatment entry versus refusal of treatment. Among the veterans who started therapy, we examined predictors of treatment completion. Symptom severity of PTSD, depression, and anxiety at baseline were measured. Daily functioning at baseline was also measured. Results indicate that the younger the veterans were, the more likely they were to refuse treatment. Dropout from treatment was also predicted by younger age at referral, as well as by past treatment, higher number of years of education, and higher depression levels at baseline. Two conclusions can be drawn from the results. First, it may be beneficial to increase awareness of treatment options for PTSD among younger veterans as this may increase treatment consent rates. Second, to reduce treatment dropout in veteran patients with PTSD, therapists should take into consideration both past treatment and baseline depression levels as risk factors for dropout.
Preparing the Nurse Executive of the Future
Authors: Sanford Kathleen , Janney Michelle
Published: March 2019

This month's edition of AONE Perspectives column discusses the challenges for nurse leaders and particularly nurse executives in the future. How can we prepare ourselves for change and to be effective and what will nurse executive practice look like in the future?