bluuebunny/crossref_metadata_2025 huggingface dataset:
Mothers' Decision Making Concerning Safe Sleep for Preterm Infants
Authors: Capper Beverly , Damato Elizabeth G. , Gutin-Barsman Sarah , Dowling Donna
Published: December 2021

Background:

Parental decisions regarding infant sleep practices vary widely, resulting in a lack of adherence to the American Academy of Pediatrics safe sleep recommendations (SSR) and consequently an increased risk of sudden infant death syndrome (SIDS). Preterm infants are among those at a highest risk for SIDS, yet few studies focus on parental decision-making surrounding sleep practices for preterm infants.

Purpose:

The purpose of this study was to identify factors influencing decisions concerning infant sleep practices of mothers of preterm infants.

Methods:

This study used a mixed-methods design. Recruitment was through social media messaging by 2 parent support organizations. An online survey was used to assess factors influencing mothers' decisions regarding sleep practices for preterm infants.

Findings/Results:

Survey participants (n = 98) were from across the United States. Mothers of preterm infants (mean gestational age at birth = 29.42 weeks) most often reported positioning infants on their back to sleep (92.3%) and a low (15.4%) use of a pacifier at sleep time. Three themes emerged for the decisions made: adherence to SSR; nonadherence to SSR; and infant-guided decisions. Regardless of the decision, mothers indicated that anxiety over the infant's well-being resulted in a need for sleep practices that facilitated close monitoring of the infant.

Implications for Practice and Research:

The findings of this study indicate the need for understanding the underlying anxiety preventing mothers from adhering to SSR despite knowing them, along with tailoring infant sleep messaging and education to improve safety of sleep practices for preterm infants. Research is needed to examine decision making in more diverse populations.
Micro-preemie Parents' Perceptions of Trauma-Informed Developmental Neuroprotective Care and Nursing Support
Authors: Couper Jeannie
Published: December 2021

Background:

Preterm birth is traumatic for both the infant and parents. Trauma-informed developmental neuroprotective care (TIDNC) may positively influence the outcomes for micro-preemie infants (infants born before 26 weeks' gestation) as well as support parents in crisis.

Purpose:

To explore how TIDNC influences micro-preemie parents' perceptions of nursing care and support.

Methods:

A descriptive cross-sectional study was conducted at a 56-bed level III neonatal intensive care unit (NICU). A convenience sample of micro-preemie parents (n = 16, 46%) completed the Nurse Parent Support Tool (NPST) questionnaire, which included 2 open-ended questions.

Results:

These parents scored high scores on the NPST (mean = 4.62 ± 0.24), indicating most parents felt support from the nursing staff and perceived individualized family-centered high-quality nursing care. Subscale scores were higher than all previous studies. Parents perceived high levels of support most of the time to almost always. Although 4 themes were closely associated with the subscales, the fifth theme, Praise has not been previously documented. Parents were grateful for nurses who provided compassionate care and support during one of the most difficult times of their lives.

Implications for Practice:

TIDNC encourages robust nurse–parent authentic caring relationships, which are foundational to the parents' perceptions of nursing care and support. These relationships, built on mutual trust, respect, and genuine listening, appear to foster an exceptionally high degree of support.

Implications for Research:

More research is needed to examine how unit culture, characteristics of nurses, parents, and infants as well as infant outcomes influence micro-preemie parents' perception of care and further explore the nature of support.
Femoral Lengthening in Children—A Comparison Between Magnetic Intramedullary Lengthening Nails and External Fixators
Authors: Hafez Mohamed , Nicolaou Nicolas , Offiah Amaka , Giles Stephen N. , Madan Sanjeev S. , Fernandes James A.
Published: December 2021

Background:

Femoral lengthening can be achieved using external fixators or intramedullary lengthening nails. The purpose of this research was to compare the outcome of femoral lengthening in children using PRECICE magnetic lengthening nails with lengthening external fixators.

Methods:

Retrospective analysis of 50 children who had femoral lengthening. Group A included patients who had lengthening with external fixation, patients in Group B had lengthening with PRECICE intramedullary lengthening nails. Each group included 25 patients. The sample strictly included children aged between 11 and 17 years. Patients in each group were matched according to age and indication for lengthening whether congenital or acquired conditions. The outcomes focused on the ability to achieve target length, healing index, residual malalignment, length of hospitalization following the osteotomy surgery, and encountered complications.

Results:

Mean patient age was 14.7 years for each group. The length gain was 42±12 mm for Group A and 41.6±8 mm for Group B (P=0.84). Lengthening nails achieved the target length more accurately compared with external fixation (P=0.017). The healing index was significantly higher in group A with 53.2±19 days/cm compared with 40.2±14 days/cm in group B (P=0.03). Group A had significantly higher complications than group B (P<0.0001). There was no statistically significant difference in the final coronal malalignment between the 2 groups (P=0.2). The mean length of stay was 9.2±5.8 days for group A and 4.2±3.3 days for group B (P=0.0005).

Conclusion:

Magnetic lengthening nails are clinically effective for femoral lengthening in the pediatric population. Compared with external fixation, healing index and complications were more favorable with PRECICE nails. Further research is required to study the cost-effectiveness of this technique.

Level of Evidence:

Level IV—case series.
The Effect of L5-S1 Degenerative Disc Disease on Outcomes of L4-L5 Fusion
Authors: Conaway William , Karamian Brian A. , Mao Jennifer Z. , Kothari Parth , Canseco Jose A. , Bowles Daniel R. , DiMaria Stephen L. , Semenza Nicholas C. , Massood Alec J. , Gebeyehu Teleale F. , Kheir Nadim , Yen Winston W. , Woods Barrett I. , Lee Joseph K. , Rihn Jeffrey A. , Kaye I. David , Kepler Christopher K. , Hilibrand Alan S. , Vaccaro Alexander R. , Schroeder Gregory D.
Published: December 2021

Study Design:

Retrospective cohort study.

Objective:

The aim was to investigate the clinical relevance of preoperative caudal adjacent segment degeneration (ASD) in patients undergoing isolated L4-5 fusion to determine a threshold of degeneration at which a primary L4-S1 fusion would be warranted.

Summary of Background Data:

Increased motion and biomechanical forces across the adjacent caudal segment in isolated L4-L5 fusion leads to concerns regarding the increased incidence of revision surgery because of the development of ASD.

Methods:

Patients who underwent isolated L4-L5 fusion between 2014 and 2019 were reviewed. Pfirrmann grading and the disc heights of the caudal level relative to the rostral level were used to quantify preoperative adjacent degenerative disc disease. To assess the influence of preoperative caudal degenerative disc disease, preoperative disc height ratios (DHRs) were compared for patients who reported minimal, moderate, and severe Oswestry disability index (ODI) sores on postoperative assessment. For each patient-reported outcome measure (PROM), adjacent DDD was compared for those who did and did not meet MCID. An area under curve analysis was used to identify a threshold of degeneration impacting outcomes from the preoperative DHR.

Results:

A total of 123 patients were studied with an average follow-up of 2.11 years. All patients demonstrated a significant improvement in all PROMs after surgery. When categorizing patients based on the severity of postoperative ODI scores, there were no preoperative differences in the L5-S1 Pfirrmann grading or DHRs. There was a significant association between greater preoperative anterior DHR and an increased number patients who met MCID for visual analog scale back. There were no radiographic differences in preoperative L5-S1 Pfirrmann grade or DHR for ODI, visual analog scale leg, MCS-12, or PCS-12. area under curve analysis was not able to identify a preoperative DHR threshold that reflected worse MCID for any PROM.

Conclusion:

No preoperative radiographic indicators of caudal ASD were predictive of worse clinical outcomes after isolated L4-5 fusion.

Level of Evidence:

Level III.
Diagnostic value of aldosterone to renin ratio calculated by plasma renin activity or plasma renin concentration in primary aldosteronism: a meta-analysis
Authors: Liu Zhenjie , Deng Xiaohong , Luo Li , Li Shaopeng , Li Man , Deng Qinqin , Zhong Weiguo , Luo Qiang
Published: December 2021

Background:

Since the diagnostic value of aldosterone to renin ratio (ARR) calculated by plasma renin concentration (PRC) or plasma renin activity (PRA) is still inconclusive, we conducted a meta-analysis by systematically reviewing relevant literature to explore the difference in the diagnostic efficacy of ARR calculated by PRC or PRA, so as to provide guidance for clinical diagnosis.

Methods:

We searched PubMed, Embase, and Cochrane Library from the establishment of the database to March 2021. We included studies that report the true positive, false positive, true negative, and false negative values for the diagnosis of primary aldosteronism, and we excluded duplicate publications, research without full text, incomplete information, or inability to conduct data extraction, animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data.

Results:

The pooled results showed that ARR (plasma aldosterone concentration [PAC]/PRC) had a sensitivity of 0.82 (95% confidence interval [CI]: 0.78–0.86), a specificity of 0.94 (95% CI: 0.92–0.95), a positive-likelihood ratio (LR) of 12.77 (95% CI: 7.04–23.73), a negative LR of 0.11 (95% CI: 0.07–0.17), and symmetric area under the curve (SAUC) of 0.982, respectively. Furthermore, the diagnostic odds ratio (DOR) of ARR (PAC/PRC) was 180.21. Additionally, the pooled results showed that ARR (PAC/PRA) had a sensitivity of 0.91 (95% CI: 0.86–0.95), a specificity of 0.91 (95% CI: 0.90–0.93), a positive LR of 7.30 (95% CI: 2.99–17.99), a negative LR of 0.10 (95% CI: 0.04–0.26), and SAUC of 0.976, respectively. The DOR of ARR (PAC/PRA) was 155.52. Additionally, we conducted a subgroup analysis for the different thresholds (<35 or ≥35) of PAC/PRC. The results showed that the DOR of the cut-off ≥35 groups was higher than the cut-off <35 groups (DOR = 340.15, 95% CI: 38.32–3019.66; DOR = 116.40, 95% CI = 23.28–581.92).

Conclusions:

The research results suggest that the determination of ARR (PAC/PRC) and ARR (PAC/PRA) was all effective screening tools for PA. The diagnostic accuracy and diagnostic value of ARR (PAC/PRC) are higher than ARR (PAC/PRA). In addition, within a certain range, the higher the threshold, the better the diagnostic value.
Indeterminant Cell Histiocytosis in a Patient With Hemophagocytic Lymphohistiocytosis
Authors: Berman Hannah S. , Uzzell Jamar , Smart Chandra
Published: December 2021

Indeterminant cell histiocytosis is a rare disorder, which often presents as a benign, papular eruption without age or sex predilection. It is diagnosed based on histologic findings that are similar to those seen in Langerhans cell histiocytosis without the characteristic Birbeck granules. Hemophagocytic lymphohistiocytosis is a potentially life-threatening disease of immune overactivation that may present with severe symptoms and multiorgan involvement. It can develop because of a primary genetic mutation or secondary to a trigger. Despite their widely different clinical manifestations, both diseases originate from the monocyte-macrophage cell lineage. In this article, we describe the unique case of a 2-year-old patient presenting with both of these histiocytic pathologies.
Epidermolytic Hyperkeratosis in an Epidermoid (Infundibular) Cyst
Authors: Prestwood Courtney A. , Vandergriff Travis
Published: December 2021

Epidermolytic hyperkeratosis (EHK) is an uncommon histopathologic reaction pattern that may represent a primary pathological process or a coincidental finding in a variety of neoplasms. We present a case of EHK in an epidermoid (infundibular) cyst. Histopathologically, EHK demonstrates vacuolar degeneration of keratinocytes in the spinous and granular cell layers, with disrupted cellular boundaries, enlarged basophilic keratohyalin-like granules and amorphous eosinophilic inclusions, along with massive hyperkeratosis. In addition to the morphologic description of EHK, we summarize the diagnoses in which EHK has been reported. Prior cases of EHK in an epidermoid (infundibular) cyst are summarized to compare findings. The significance of incidental EHK in skin lesions is unknown.
Cutaneous Involvement of Angioimmunoblastic T-Cell Lymphoma Masquerading as B-Cell Reactive Lymphoid Hyperplasia
Authors: Pesqué David , Marcantonio Orianna , Vázquez Ivonne , Papaleo Natalia , Sánchez-González Blanca , Gallardo Fernando , Colomo Luis , Pujol Ramon M.
Published: December 2021

A 59-year-old woman presented with a persistent eruption manifested as multiple agminated miliary facial papules. Histopathological examination showed prominent nodular dermal lymphoid infiltrates with hyperplastic follicles that were initially interpreted as B-cell reactive lymphoid hyperplasia. Several years later, an additional biopsy showed a dense perifollicular infiltrate with reactive primary and secondary follicles. Accompanying T cells corresponded to CD3/CD4/PD1/CXCL13-positive cells and scattered Epstein–Barr virus–positive B cells were identified by in situ hybridization. A monoclonal T-cell population was demonstrated by TCRγ and TCRβ Polymerase Chain Reaction amplification, as well as a minor abnormal circulating T-cell population by flow cytometry (0.62% of the white blood cells, CD4+CD3s-CD7−). A biopsy specimen from an enlarged right supraclavicular lymph node disclosed nodal involvement by angioimmunoblastic T-cell lymphoma. The observation of B-cell dermal nodular infiltrates with well-demarcated lymphoid aggregates forming primary lymphoid follicles may lead to overlook the T-cell component in some cases of angioimmunoblastic T-cell lymphoma. In such cases, a careful assessment of the apparently minor T-cell component is important to establish a correct diagnosis.
Dermoscopic Aspects of Traumatized Nevi After Dermabrasion
Authors: Dal`Forno Taciana , Milman Laura de Mattos , Bakos Lúcio , Bakos Renato Marchiori
Published: December 2021

BACKGROUND

Melanocytic nevi submitted to trauma can undergo clinical, dermoscopic, and even histological changes, making it difficult to differentiate them from a melanoma.

OBJECTIVE

The aim of this study is to evaluate the dermoscopic changes of traumatized nevi after dermabrasion.

METHODS

Dermoscopic images of acquired melanocytic nevi were compared before and 4 weeks after half of their area had undergone dermabrasion.

RESULTS

The sample consisted of 50 lesions from 15 patients. The homogeneous pattern was the most frequent, followed by the reticular, cobblestone, and globular patterns. After dermabrasion, nearly half of the lesions (46%) became dermatoscopically asymmetric. Among all lesions, structureless areas, dotted vessels and erythema were the most frequent new dermoscopic structures.

CONCLUSION

Trauma after dermabrasion may induce significant dermoscopic changes in melanocytic nevi. Although the global pattern did not change, most of the lesions became asymmetric, with the appearance or fading of dermoscopic structures and colors. A history of recent trauma should be investigated when evaluating pigmented lesions.
Risk factors for cervical cancer among distinct populations in low-resource countries: feasibility of cervical cancer screen-and-treat program on ukerewe island of lake victoria, Tanzania
Authors: Hari Anjali Y. , Bernstein Megan , Temko Jamie , Brabender Danielle E. , Shen Aricia , Tewari Krishnansu S.
Published: December 2021

Purpose of review

A mass cervical cancer screening using World Health Organization-endorsed visual inspection with acetic acid (VIA) and cryotherapy triage was conducted over 5 days at Nansio District Hospital on Ukerewe Island, Tanzania in Lake Victoria. The aim was to evaluate the feasibility of a pilot screen-and-treat on a lower resource island and compare the results to previously held screen-and-treats in higher resource mainland settings.

Recent findings

Two hundred and eight-two women underwent VIA on Ukerewe Island during July 2017. The frequency of abnormal VIA screens was nearly twice that observed on the mainland in 2016 (18.4% vs 10.7%, respectively; P = 0.0091). Island women had lower rates of grand multiparity (19.8% vs 26.8%, P = 0.02) and more island women did not know their HIV status (80% vs 50%, P < 0.0001). Overall, 31% of abnormal VIA screens occurred among women under 30 years between the two sites. Due to the cost of transporting CO2 tanks, cryotherapy was nearly twice as expensive on the island as compared to the mainland.

Although transfer of an entire pilot screen-and-treat program to Ukerewe Island is feasible and well-received, expenses associated with ferrying equipment may be prohibitive to long-term sustainability. Higher VIA positivity rates were observed on the island.
Dispersion Simulations of Radon Discharges between Neighboring Buildings and Their Sensitivity to Meteorology, Discharge Rate, and Building Geometry
Authors: Lebel Luke , John Aneesh , Korolevych Volodymyr
Published: December 2021

In northern climates, it is common to install the discharges of radon sub-slab depressurization systems near ground level. However, this also elevates the ground level outdoor radon concentrations and raises the possibility of radon re-entrainment into homes. The study aims to assess outdoor radon concentrations near above-ground-level discharges along the surfaces of an emitting building and its close neighbor and identify parameters that most influence the dilution. This study employs a series of computational fluid dynamics calculations to assess concentrations along the exhaust-facing and non-exhaust-facing surfaces of the buildings. Different meteorological, venting, and building geometry parameters are explored. Boundary conditions for the CFD calculations are based on field measurements of the ground-level wind speeds and seasonal air temperatures and atmospheric stabilities. Outdoor concentrations can be as high as 7% of the discharge gas, although these become smaller at greater distances from the vent. The direction of the prevailing wind is a particularly important parameter, as it influences the formation of circulating building cavities and building wakes where radon could accumulate. The wind speed, atmospheric stability, and season (plume buoyancy) also have important influences on the outdoor radon concentrations, as do the velocity of the vent system and the size of the buildings. The study has assessed the dilution of the radon-laden exhaust gas and determined the outdoor concentrations that can be expected under a variety of conditions. These results can be used to inform regulators about the potential for radon re-entrainment into homes.
Why Does the Severity of COVID-19 Differ With Age?
Authors: Zimmermann Petra , Curtis Nigel
Published: December 2021

Although there are many hypotheses for the age-related difference in the severity of COVID-19, differences in innate, adaptive and heterologous immunity, together with differences in endothelial and clotting function, are the most likely mechanisms underlying the marked age gradient. Children have a faster and stronger innate immune response to SARS-CoV-2, especially in the nasal mucosa, which rapidly controls the virus. In contrast, adults can have an overactive, dysregulated and less effective innate response that leads to uncontrolled pro-inflammatory cytokine production and tissue injury. More recent exposure to other viruses and routine vaccines in children might be associated with protective cross-reactive antibodies and T cells against SARS-CoV-2.

There is less evidence to support other mechanisms that have been proposed to explain the age-related difference in outcome following SARS-CoV-2 infection, including pre-existing immunity from exposure to common circulating coronaviruses, differences in the distribution and expression of the entry receptors ACE2 and TMPRSS2, and difference in viral load.
Economic Evaluation of Universal Varicella Vaccination in Mexico
Authors: Chacon-Cruz Enrique , Meroc Estelle , Costa-Clemens Sue Ann , Clemens Ralf , Verstraeten Thomas
Published: December 2021

Background:

Universal varicella vaccination has proven to be cost-effective (CE) in countries where implemented. However, this has not been evaluated for Mexico.

Methods:

The yearly disease burden (varicella cases/deaths, outpatient visits, and hospitalizations) was derived from Mexican seroprevalence data adjusted to the 2020 population. The yearly economic burden was calculated by combining disease with Mexican unit cost data from both health care and societal perspectives. Four different vaccination strategies were evaluated: (1) 1 dose of varicella vaccine at 1 year old; (2) 2 doses at 1 and 6 years; (3) 1 dose of varicella vaccine at 1 year, and quadrivalent measles-mumps-rubella-varicella vaccine at 6 years; (4) 2 doses of measles-mumps-rubella-varicella vaccine at 1 and 6 years. We developed an economic model for each vaccination strategy where 20 consecutive birth cohorts were simulated. Vaccination impact (number of avoided cases/deaths) was evaluated for a 20-year follow-up period based on vaccine effectiveness (87% and 97.4% for 1 and 2 doses), and assuming a 95% coverage. We estimated annual costs saved, incremental cost-effectiveness ratio, and costs per life year gained.

Results:

Avoided cases during the 20-year follow-up with 1, and 2 doses were 20,570,722 and 23,029,751, respectively. Strategies 1 and 2 were found to be cost saving, and strategy 3 to be CE. Strategy 4 was not CE. Strategies 1 and 2 would allow saving annually $53.16 and $34.41 million USD, respectively, to the Mexican society.

Conclusions:

Universal varicella vaccination, using 1 dose or 2 doses, would result in a cost-beneficial and CE public health intervention in Mexico.
Immature sword bean pods (Canavalia gladiata) inhibit adipogenesis in C3H10T1/2 cells and mice with high-fat diet–induced obesity
Authors: Hwang Hye-Jeong , Hwang Yu Jin , Kim Young Jun , Kim Mina , Hwang Kyung-A
Published: December 2021

Background:

Sword bean (SB; Canavalia gladiata) is a perennial vine used as a food and medicinal plant in Asia. SB is rich in nutrients, such as flavonoids and urease, and has various functions, including beneficial effects on dysentery, nausea, and hemorrhoids, as well as anti-inflammatory and antioxidant activity. Various plant parts are used; however, little is known about the physiological effects of SB pods (SBP). In this study, the anti-obesity effects of SBP extract were evaluated.

Methods:

To investigate the anti-obesity effects of SBP extract, we confirmed the SBP extract downregulated lipogenesis-related genes and upregulated genes involved in lipolysis and brown adipocyte markers in differentiated C3H10T1/2 adipocytes in vitro. Next, we use a high-fat diet (HFD)–induced obesity mouse model to determine the anti-obesity effects of SBP extract.

Results:

Treatment with SBP extract significantly reduced adipocytes. The extract decreased the HFD-induced increases in body weight and plasma triglyceride levels in mice after 8 weeks. mRNA and protein levels of the adipogenesis and lipogenesis-related factors CCAAT/enhancer binding protein-β, CCAAT/enhancer binding protein-α, peroxisome proliferator-activated receptor-γ (PPARγ), and their target genes Ap2, SREBP-1c, FAS, and SCD-1 were reduced by SBP extract. In contrast, AMP-activated protein kinase and sirtuin1, involved in the thermogenic catabolism of fat, were activated by SBP extract in adipocytes and white adipose tissue, increasing the expression of peroxisome proliferator-activated receptor gamma coactivator-1α, peroxisome proliferator-activated receptor-α (PPARα), and uncoupling protein 1 and activating thermogenic activity.

Conclusion:

SBP extract exerts an anti-obesity effect by inhibiting lipogenesis-related factors and activating fat-catabolizing factors; it is, therefore, a promising functional food and natural anti-obesity agent.
Multimorbidity and Employment Outcomes Among Middle-Aged US Cancer Survivors
Authors: Ekenga Christine C. , Kim BoRin , Kwon Eunsun , Park Sojung
Published: December 2021

Objective

The objective of this study was to evaluate the relationship between multimorbidity and subsequent 2-year employment outcomes among middle-aged United States (US) cancer survivors. In addition, we examined whether the relationship differed by survivor characteristics.

Methods

Data of 633 cancer survivors (ages 51 to 64) from the 2014 Health and Retirement Study were used to identify multimorbidity profiles and evaluate associations between multimorbidity and prolonged unemployment during follow-up.

Results

Approximately 64% of cancer survivors met the criteria for multimorbidity. Latent class analysis revealed three distinct multimorbidity profiles distinguished by the presence or absence of psychiatric disorders. We observed a significant association between high psychiatric multimorbidity and prolonged unemployment after 2-year follow-up (relative risk = 2.78, 95% Confidence Interval = 1.28 to 6.00), with the effect more pronounced among low-income survivors.

Conclusions

Psychiatric multimorbidity was associated with prolonged unemployment among middle-aged cancer survivors, particularly among low-income survivors.
Social Network Lifestyle Interventions Reduce Non-Communicable Diseases Risk Factors in Financial Sector Employees
Authors: Hene Nceba , Wood Paola , Schwellnus Martin , Jordaan Esme , Laubscher Ria
Published: December 2021

Objective:

To determine if scientifically based social network (Facebook) lifestyle interventions reduce 10-year cardiovascular disease (CVD) risk.

Methods:

Financial sector employees (n = 300) were equally randomly assigned: Facebook plus Health Professionals (FB+HP), Facebook (FB), or control (C). We report changes in 10-year Framingham risk score (FRS) for CVD (%) and risk factors over 12 months.

Results:

FRS did not change within and between groups. Overweight (–7.4% vs–5.6%, P 
= 0.005) and diabetes risk (–10.7% vs 0.2%, P 
= 0.011) reduced significantly in FB+HP versus FB and C, respectively. Inadequate fruit/vegetable intake (–9.4% vs 3.6%, P 
= 0.011) and smoking (–0.7% vs 14.9%) reduced significantly in FB versus C. No significant changes in physical activity, central obesity, hypertension, and hypercholesterolemia between groups.

Conclusions:

Scientifically based social network lifestyle intervention programs could be included in workplace health promotional programmes to improve certain non-communicable disease risk factors.
Workplace Outreach Program Improves Management of Chronic Kidney Disease
Authors: Iakoubova Olga A. , Tong Carmen H. , Rowland Charles M. , Arellano Andre R. , Bare Lance A. , Fragala Maren S. , Birse Charles E.
Published: December 2021

Objective

Assess whether an employee outreach program improved management of chronic kidney disease (CKD).

Methods

Participants with suspected CKD (eGFR <60 mL/min/1.73m2) identified in employee health assessments in 2017 and 2018 were contacted by phone and offered physician consultation. Subsequent nephrologist visits at 11 months of follow up were compared between those who were (outreach group) and were not (control group) successfully contacted.

Results

Most CKD risk factors at baseline were similar in outreach and control groups. At the end of the follow-up, outreach participants had more than 2-fold greater incidence of visiting a nephrologist compared with controls (HR = 2.3; 95% CI 1.2–4.2, P = 0.01), after adjusting for potential confounders. Conclusions: Employee outreach program increased utilization of nephrologist care.
Individual Variability in von Willebrand Factor Fragility in Response to Shear Stress: A Possible Clue for Predicting Bleeding Risk
Authors: Sakatsume Ko , Akiyama Masatoshi , Sakota Daisuke , Hijikata Wataru , Horiuchi Hisanori , Maruyama Osamu , Saiki Yoshikatsu
Published: December 2021

Acquired von Willebrand syndrome (AVWS), characterized by reduced von Willebrand factor (VWF) large multimers, has recently been implicated as the principal mechanism underlying bleeding in patients implanted with left ventricular assist devices (LVADs). Hematological severity of AVWS varies among patients, even if an identical device is implanted. We investigated whether this diversity in hematological severity is due to individual variability in VWF fragility, according to responses to incremental shear stress. Whole-blood samples were sheared at 20,000–40,000 s–1 shear rate, an index of shear stress, using a custom-made shear stressor that could generate shear stress compatible with that produced by an LVAD. The degree of VWF large multimers degradation was evaluated using the VWF large multimer index. A significant inverse correlation was observed between the VWF large multimer index and LVAD-compatible magnitudes of shear stress: the VWF large multimer indices were 68.5 ± 18.3, 48.0 ± 13.9, 33.9 ± 12.1, 23.7 ± 7.9, and 18.7% ± 8.7% at 20,000, 25,000, 30,000, 35,000, and 40,000 s–1 of shear rates, respectively (P < 0.0001). Furthermore, experimental VWF large multimer index values were compatible with those derived from patients with implanted LVADs (median; 28.9%). Finally, reduction in the VWF large multimer index corresponding to shear stress showed individual variation. We demonstrated that the combined use of a novel high shear stress loading device and quantitative evaluation of VWF large multimers may predict risk of bleeding before LVAD implantation.
Colonization with Multidrug-resistant Organisms in Patients with Ventricular Assist Devices
Authors: Roberts Scott C. , Nam Hannah H. , Kumar Rebecca N. , Wu Tingqing , Harap Rebecca S. , Pham Duc Thinh , Rich Jonathan D. , Stosor Valentina
Published: December 2021

Infection is a leading cause of morbidity and mortality in patients with ventricular assist devices (VAD). The impact of colonization with multidrug-resistant organisms (MDRO) on outcomes in this cohort is unknown. Patients on VAD support from July 2008 to September 2018 at a single site were evaluated for MDRO colonization after implantation. MDROs included methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus species, and extended-spectrum beta-lactamase producing gram-negative bacteria. 378 patients with 433 VADs were included. 42.6% (n = 161) of patients were colonized with an MDRO throughout the duration of VAD support. Eighty-two VAD infections occurred, 74.4% (n = 61) of whom were MDRO colonized before infection. MDRO colonization was associated with an increased risk of a subsequent VAD infection (hazard ratio 3.704, p < 0.001). MDRO colonization is common after VAD implantation and is associated with future VAD infections. Further study is needed to determine best management strategies for VAD recipients with MDRO colonization given this increased risk.
Pulmonary Transplant After More Than 1 Year of Continuous Ambulatory Extracorporeal Support
Authors: Hoopes Charles , Diaz Guzman Zavala Enrique
Published: December 2021

While extracorporeal support of patients awaiting pulmonary transplantation is now well-established, extracorporeal membrane oxygenation (ECMO) remains a nondurable technology deployed for short-term support or recovery in patients with progressive disease. Here, we describe an anecdotal experience with pulmonary transplant after more than 1 year of continuous veno-venous ECMO support. The case highlights several issues relevant to the increasing use of bridging technologies: (1) the potential impact of extracorporeal circulation on immune sensitization, (2) the safety and questionable need for anticoagulation in long-term ambulatory veno-venous extracorporeal support, and (3) the increasing durability of contemporary ECMO support technologies.
Utility of Routine Head Ultrasounds in Infants on Extracorporeal Life Support: When is it Safe to Stop Scanning?
Authors: Theodorou Christina M. , Guenther Timothy M. , Honeychurch Kaitlyn L. , Kenny Laura , Mateev Stephanie N. , Raff Gary W. , Beres Alana L.
Published: December 2021

Intracranial hemorrhage (ICH) can be a devastating complication of extracorporeal life support (ECLS); however, studies on the timing of ICH detection by head ultrasound (HUS) are from 2 decades ago, suggesting ICH is diagnosed by day 5 of ECLS. Given advancements in imaging and critical care, our aim was to evaluate if the timing of ICH diagnosis in infants on ECLS support has changed. Patients <6 months old undergoing ECLS 2011–2020 at a tertiary care children’s hospital were included. Primary outcome was timing of ICH diagnosis on HUS. Seventy-four infants underwent ECLS for cardiac (54%) or pulmonary (46%) indications. Venoarterial ECLS was most common (88%). Median ECLS duration was 6 days (range 1–26). Sixteen patients were diagnosed with ICH (21.6%), at a median of 2 days postcannulation (range 1–4). Nearly all were <4 weeks old at cannulation (93.8%). In conclusion, one-fifth of infants developed ICH diagnosed by HUS while on ECLS, all within the first 4 days of ECLS, consistent with previous literature. Despite advances in critical care and imaging technology, the temporality of ICH diagnosis in infants on ECLS is unchanged.
Platelet Transfusion and In-Hospital Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation Patients
Authors: Mazzeffi Michael , Rabin Joseph , Deatrick Kristopher , Krause Eric , Madathil Ronson , Grazioli Alison , Bathula Allison , Jackson Bryon , Taylor Bradley , Plazak Michael
Published: December 2021

Thrombocytopenia is common during extracorporeal membrane oxygenation (ECMO), and platelets are sometimes transfused to meet arbitrary goals. We performed a retrospective cohort study of veno-arterial (VA) ECMO patients from a single academic medical center and explored the relationship between platelet transfusion and in-hospital mortality using multivariable logistic regression. One hundred eighty-eight VA ECMO patients were included in the study. Ninety-one patients (48.4%) were transfused platelets during ECMO. Patients who received platelet transfusion had more coronary artery disease, lower platelet counts at cannulation, higher predicted mortality, lower nadir platelet counts, more ECMO days, and more red blood cell (RBC) and plasma transfusion. Mortality was 19.6% for patients who received no platelets, 40.8% for patients who received 1–3 platelets, and 78.6% for patients who received 4 or more platelets (P < 0.001). After controlling for confounding variables including baseline severity of illness, central cannulation, postcardiotomy status, RBC and plasma transfusion, major bleeding, and total ECMO days, transfusion of 4 or more platelets remained associated with in-hospital mortality; OR = 4.68 (95% CI = 1.18–27.28), P = 0.03. Our findings highlight the need for randomized controlled trials that compare different platelet transfusion triggers, so that providers can better understand when platelet transfusion is indicated in VA ECMO patients.
Epicardial adipose tissue is a robust measure of increased risk of myocardial infarction – a meta-analysis on over 6600 patients and rationale for the EPIC-ACS study
Authors: Hendricks Stefanie , Dykun Iryna , Balcer Bastian , Totzeck Matthias , Rassaf Tienush , Mahabadi Amir Abbas
Published: December 2021

Background:

Epicardial adipose tissue (EAT) surrounds the heart and the coronary vessels. EAT produces pro- and anti-inflammatory cytokines. Several studies have already documented the association of EAT and cardiovascular risk factors as well as coronary artery disease manifestations. Currently computed tomography (CT) is considered the gold standard for measurement of 3-dimensional volume of EAT. In addition, echocardiography might be an easy accessible alternative in particular in an emergency setting.

Methods:

We performed a metaanalysis of existing studies describing the differences of EAT in patients with and without myocardial infarction. We used established databases and were searching for “epicardial adipose tissue” or “pericardial adipose tissue” and “myocardial infarction”, “coronary events”, or “acute coronary syndrome”. We included over 6600 patients from 7 studies. Random effect models were calculated and all analyses were performed by using the Review Manager 5.3.

Results:

Patients with myocardial infarction had 37% (confidence interval [0.21-0.54], P value <.001)] higher measures of EAT compared to patients without myocardial infarction. Comparing studies using echocardiography vs CT for assessment of EAT thickness, similar relative differences in EAT with wide overlap of confidence intervals were observed (for echocardiography: 0.4 [0.04-0.76], for CT: 0.36 [0.16-0.57], P value <.001 for both).

Conclusions:

Patients with myocardial infarction have more EAT as compared to patients without myocardial infarction independently of the used imaging modality. Further prospective studies are needed to evaluate, how quantification of EAT in clinical routine can improve patients management.
Association between intra-operative hemodynamic changes and corrective procedures during posterior spinal fusion in adolescent patients with scoliosis
Authors: Wada Kanichiro , Kumagai Gentaro , Kudo Hitoshi , Tanaka Sunao , Asari Toru , Fjita Yuki , Ishibashi Yasuyuki
Published: December 2021

Previous reports indicated that a decrease in intra-operative cardiac output and mean arterial pressure occurs due to thoracic cage deformities when patients with scoliosis are placed in the prone position. The aims of this study were to investigate the occurrence of hypotension during posterior spinal fusion in adolescent patients with scoliosis, and the association between hypotension, surgical procedures, changes of thoracic cage morphology.

This retrospective, single-center, case-control study included 106 patients who underwent surgeries for spinal deformity at our institute between June 2014 and March 2020. The inclusion criteria were: age ≤19 years at the time of surgery, lowest instrumented vertebra over L5, posterior spinal fusion as the first surgery for scoliosis, and no severe cardiac or pulmonary disease pre-operatively. Finally, 49 patients met the criteria, and were divided to 3 groups as follows: thoracic constructive curve using a 6.0-mm cobalt-chromium alloy circular rod (T-C group; n = 28); thoracolumbar/lumbar constructive curve using a 6.0-mm cobalt-chromium alloy circular rod (L-C group; n = 8); and thoracic constructive curve using a 5.5-mm cobalt-chromium alloy beam-like rod (T-B group; n = 13). The beam-like rod is characteristic as the rod is mounted to screw heads without cantilever force. Intra-operative changes in circulation associated with corrective procedures, perioperative data, and sagittal depth and sternum deviation of thoracic cage were compared between the 3 groups.

The T-C group had a higher rate of hypotension alarm than did the other groups (7 vs 0 vs 0; P = .047). Corrective procedures included rodding 4 times, rod rotation maneuver once, and direct vertebral rotation twice. Blood pressure was increased by pausing the correction procedures, increasing infusion, and administering vasopressors. The T-C and T-B groups had greater sternum deviation parameters than the L-C group, both before and after surgery. All parameters associated with sagittal depth and sternum deviation decreased significantly after surgery in the T-C and the T-B groups.

In corrective surgery for constructive thoracic scoliosis, the corrective procedures requiring the application of compression force in the forward direction should be closely monitored in view of their possible influence on circulatory conditions.
The factor influencing the rate of ROSC for nontraumatic OHCA in New Taipei city
Authors: Yu Yi-Chung , Hsu Chin-Wang , Hsu Shih-Chang , Chang Jin-Lin , Hsu Yuan-Pin , Lin Shih-Min , Liu Ying-Kuo
Published: December 2021

Return of spontaneous circulation (ROSC) from out-of-hospital cardiac arrest (OHCA) is critical for the Emergency Medical Services System. When compared to other developed countries, Taiwan has lower rate of ROSC in OHCA patients.

We conducted a retrospective study of cardiac arrest using The Emergency Medical Service Dispatching Center in Northern Taiwan and The Prehospital Care System of New Taipei City Paramedic Service. Patients suffering from nontraumatic OHCA between August of 2019 to February of 2020 were included. We analyzed the cardiopulmonary resuscitation (CPR) quality parameters such as chest compression interruptions, bystander CPR, shockable rhythm, CPR interruption, chest compression fraction (CCF) average, patient transportation in buildings, and adrenaline injection during CPR. Multivariable logistic regression analysis was performed to assess the relationship between potential independent variables and ROSC.

In our study, we involved 1265 subjects suffering from nontraumatic OHCA, among which 587 patients met inclusion criteria. We identified that CCF> 0.8, chest compression interruption greater than 3 times, and patient transportation in the building were the most critical factors influencing ROSC. However, patient transportation in a building was identified as a dependent predictor variable (P = .4752).

We concluded that CCF > 0.8 and chest compression interruption greater than 3 times were essential factors affecting the CPR ROSC rate. The most significant reason for suboptimal CCF and CPR interruption is patient transportation in a building. Improving the latter point could facilitate high-quality CPR.
Comparative efficacy and safety of the minimally invasive ilioinguinal approach for anterior pelvic ring fracture
Authors: Shi Xiaohua , Li Xiang , Wang Aiguo
Published: December 2021

Background:

Anterior pelvic ring contributes up to 40% of the stability of the pelvic ring and is located in close proximity to key pelvic organs, blood vessels, and nerves. An anterior pelvic ring fracture causes severe pain and is a potentially life-threatening condition in trauma patients. Currently available surgical repair methods are highly technical and include high risks of complications. The minimally invasive ilioinguinal approach (MIIA) is an emerging technique that reduces the risk of femoral nerve and external iliac vessel injury. However, the safety and efficacy of this technique have yet to be systematically scrutinized. This study outlines a proposed protocol for a network meta-analysis that investigates the efficacy of MIIA for anterior pelvic ring fracture.

Methods:

This study will utilize both Chinese and English language databases. All randomized controlled trials studying the use of MIIA for anterior pelvic ring fracture from January 2016 to May 2021 will be incorporated. Researchers will screen for literature that fits the inclusion criteria, followed by an assessment of risk bias and, finally, data extraction.

Results:

The Bayesian network meta-analysis will be used to evaluate all available Stata 14.0 and WinBUGS software.

Conclusion:

Our research aims to uncover the clinical utility of the MIIA approach for anterior pelvic ring fractures.

Ethics and dissemination:

Not required

INPLASY registration number:

INPLASY2021110020.
Primary pharyngeal synovial sarcoma in a pediatric patient
Authors: Bae Yun Jung , Kim Hyojin , Cha Wonjae , Choi Byung Se
Published: December 2021

Rationale:

Synovial sarcoma is a rare malignant tumor that typically originates from the soft tissue of the extremities. The occurrence of primary pharyngeal synovial sarcoma is even rarer, and few studies have reported its radiological features. Here, we report a case of pediatric primary pharyngeal synovial sarcoma and describe the conventional and advanced magnetic resonance imaging (MRI) findings with pathologic correlation.

Patient concerns:

An 11-year-old girl presented to the otolaryngologic clinic with dysphagia.

Diagnosis:

Laryngoscopy revealed a large mass in the oropharynx. MRI revealed a well-defined soft tissue mass with a maximal diameter of approximately 5 cm originating from the submucosal space of the oropharynx. The mass was primarily solid and showed homogeneous contrast-enhancement. The mass was hypointense on T1-weighted images and hyperintense on T2-weighted images. The mass showed a homogeneously low apparent diffusion coefficient value on diffusion-weighted imaging, which indicated high tumor cellularity. Dynamic contrast-enhanced MRI revealed a hypovascular tumor with low values of the volume transfer constant between the extracellular extravascular space and blood plasma and blood plasma volume per unit tissue volume. Amide proton transfer-weighted MRI revealed a relatively high amide proton transfer signal in the tumor, indicating a high protein/peptide component. The patient underwent partial surgical resection of the tumor, and the diagnosis of biphasic synovial sarcoma was confirmed on postoperative pathological examination.

Intervention:

The patient was started on chemotherapy with vincristine, ifosfamide, doxorubicin, and etoposide.

Outcomes:

The tumor did not respond to the 3 cycles of the chemotherapy. Thus, the patient underwent second surgery and subsequent radiation therapy. The patient is now under ifosfamide/carboplatin/etoposide chemotherapy.

Lesson:

Synovial sarcoma should be considered in the differential diagnosis of pediatric oropharyngeal submucosal tumors. Multimodal MRI may aid diagnosis, although the final diagnosis should be based on the postoperative pathological examination findings.