bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of IV High-Dose Vitamin C on Mortality in Patients With Sepsis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials*
Authors: Sato Ryota , Hasegawa Daisuke , Prasitlumkum Narut , Ueoka Miki , Nishida Kazuki , Takahashi Kunihiko , Nasu Michitaka , Dugar Siddharth
Published: September 2021

OBJECTIVES:

The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials to investigate whether IV high-dose vitamin C improves the short-term mortality of patients with sepsis.

DESIGN:

This study is a systematic review and meta-analysis of randomized controlled trials. We searched EMBASE, the Cochrane Central Register of Controlled Trials, and MEDLINE for randomized controlled trials that met inclusion criteria. The protocol was registered at the University hospital Medical Information Network Clinical Trials Registry (UMIN000040528). All analyses were presented with the use of random-effects models. The primary outcome was short-term mortality defined as 28-day, 30-day, or in-hospital mortality.

PATIENTS:

Two authors independently evaluated the following eligibility criteria: 1) randomized controlled trial, 2) patients with sepsis aged ≥18 years, and 3) received intravenous high-dose vitamin C in addition to standard of care, or standard of care alone. Then, two authors independently extracted the selected patient and study characteristics and outcomes from studies that met above eligibility criteria.

MEASUREMENTS AND MAIN RESULTS:

Eleven randomized controlled trials (n = 1,737 patients) were included in this meta-analysis. High-dose IV vitamin C was not associated with a significantly lower short-term mortality (risk ratio, 0.88; 95% CI, 0.73–1.06; p = 0.18; I
2 = 29%) but was associated with a significantly shorter duration of vasopressor use (standardized mean difference, –0.35; 95% CI, –0.63 to –0.07; p < 0.01; I
2 = 80%) and a significantly greater decline in the Sequential Organ Failure Assessment score at 72–96 hours (standardized mean difference, –0.20; 95% CI, –0.32 to –0.08; p < 0.01; I
2 = 16%). One study reported significant association with hypernatremia, but adverse effects were rare, and high-dose vitamin C is deemed relatively safe.

CONCLUSIONS:

In this meta-analysis, the use of IV high-dose vitamin C in patients with sepsis was not associated with lower short-term mortality although it was associated with significantly shorter duration of vasopressor use and greater decline in the Sequential Organ Failure Assessment score at 72–96 hours.
Vaginal symptoms in women who are affected by gynecologic cancer
Authors: Vargas Maldonado Darlene , Madsen Annetta M.
Published: September 2021

Purpose of review

Pelvic floor disorders are common among gynecologic cancer survivors. With improvements in survivorship, quality of life conditions in these women need greater attention and care. This review focuses specifically on vulvovaginal symptoms, which are common and have a negative impact on sexual health and quality of life in women affected by gynecologic cancer.

Recent findings

We review publications on treatment-specific sexual health outcomes, screening and treatment of vulvovaginal symptoms and sexual pain, and surgical management options. Recent evidence regarding the safety of concomitant prolapse repair at the time of surgery for gynecologic malignancies and CO2 laser therapy is discussed and areas needing further research and innovation are highlighted.

Pelvic floor disorders, including vaginal and sexual health concerns, are common in women affected by gynecologic cancer due to both common risk factors and as a side effects of cancer treatment. Gynecologists play a critical role in screening, treatment, and collaboration with other specialists to provide comprehensive care for these women throughout their lifetime.
Clinicopathologic Characteristics, Treatment, and Outcomes of Post-transplant Lymphoproliferative Disorders: A Single-institution Experience Using 2017 WHO Diagnostic Criteria
Authors: King Rebecca L. , Khurana Arushi , Mwangi Raphael , Fama Angelo , Ristow Kay M. , Maurer Matthew J. , Macon William R. , Ansell Stephen M. , Bennani N. Nora , Kudva Yogish C. , Walker Randall C. , Watt Kymberly D. , Schwab Thomas R. , Kushwaha Sudhir S. , Cerhan James R. , Habermann Thomas M.
Published: September 2021

The World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues (WHO 2017) included updated criteria for diagnosis and classification of post-transplant lymphoproliferative disorders (PTLDs). This study evaluated the clinicopathologic spectrum using WHO 2017 criteria and adult PTLD patients’ outcomes over 30 years between 1987 and 2017 at Mayo Clinic (Rochester, MN). Patients were retrospectively reviewed for clinical features, outcomes, and diagnostic pathology material and classified based on WHO 2017 criteria. A total of 227 patients were diagnosed with PTLD, with a median time from transplant to PTLD of 45 months. PTLD occurred >1 year after transplant in 149 (66%) patients. Monomorphic PTLD was the most common subtype (173, 76%), with diffuse large B cell lymphoma as the commonest morphology (n = 137). Epstein-Barr virus was positive in 61% of total cases and 90% of PTLD that developed within 1 year from transplant. The median event-free survival (EFS) and overall survival for the entire cohort were 21 months (95% confidence interval [CI]: 9–35) and 82 months (95% CI: 39–115), respectively. The EFS or overall survival was not impacted by Epstein-Barr virus status but differed based on WHO subtypes and year of diagnosis. Management changed over time with increased use of rituximab or chemotherapy + immunosuppression reduction as initial therapy. When compared to the matched general population and de novo diffuse large B cell lymphoma, patients not achieving EFS 24 status (no progression/treatment or death within 24 mo of diagnosis) had a worse standardized mortality ratio 16.75 (95% CI: 13.91–20) versus SMR 1.72 (95% CI: 1.26–2.28) in those who achieved EFS24. Cause of death was mostly attributed to non-lymphoma–related causes in those achieving EFS 24.
Recent advances in diagnosis and management of sympathetic ophthalmia
Authors: Fromal Ollya V. , Swaminathan Vishal , Soares Rebecca R. , Ho Allen C.
Published: September 2021

Purpose of review

Sympathetic ophthalmia is a bilateral granulomatous uveitis that occurs following unilateral trauma or surgery and is sight-threatening in the contralateral eye. Despite significant potential morbidity, disease remains poorly understood. Variable presentations and clinical courses, as well as a lack of definitive diagnostic laboratory tests can complicate the diagnosis and result in delayed treatment, which can beget permanent vision loss. This review focuses on recent advances in areas of pathophysiology, classification, diagnosis and treatment.

Recent findings

Sympathetic ophthalmia is thought to involve a cell-mediated immune response to retinal and uveal antigens exposed through trauma or surgery. Multiple mechanisms have been implicated, including activation of the interleukin-23/IL-17 pathway. Ongoing emphasis is placed on early disease recognition and prompt treatment with multimodal imaging. Multiple authors advocate for the routine use of optical coherence tomography (OCT) for screening and disease monitoring. Systemic steroids and steroids sparing-immunosuppressive agents remain the mainstay of treatment.

Understanding pathophysiology may provide useful targets for drug development, as well as allow for identification of patients at risk. OCT is a useful tool in early diagnosis and management of sympathetic ophthalmia, as OCT changes may precede clinical symptoms and signs, allowing for early disease detection and better visual outcomes.
The Impact of Motivational Interviewing on Self-care and Health-Related Quality of Life in Patients With Chronic Heart Failure
Authors: Garcimartín Paloma , Astals-Vizcaino Monica , Badosa Neus , Linas Anna , Ivern Consol , Duran Xavier , Comín-Colet Josep
Published: September 2021

Background

Self-care is an integral component of successful chronic heart failure (HF) management. Structured educational programs have already been shown to be effective in improving self-care, but some patients show resistance and little motivation for change.

Objective

The objective of this study was to compare efficacy in improving self-care and health-related quality of life (HRQoL) for an educational intervention based on motivational interviewing (MI) compared with a conventional educational intervention.

Methods

This experimental pretest-posttest study with an equivalent historical control group included 93 patients in the intervention group and 93 matched patients in the control group. Participants attended a first visit after HF hospitalization discharge and 6 to 7 follow-up visits during 6 months. The European Heart Failure Self-care Behavior scale and the Minnesota Living with Heart Failure Questionnaire were used to assess self-care and HRQoL, respectively. Data on mortality and hospital readmissions were collected as adverse events.

Results

Self-care improved significantly more in the MI-based intervention group than in the control group (P = .005). Although both self-care and HRQoL improved in both groups over time (P < .05), there was no significant between-group difference in terms of HRQoL improvement over time (P = .13).

Conclusions

Our findings suggest that MI delivered by MI-trained nurses is effective in significantly improving self-care by patients with HF. Nonetheless, further studies are required to evaluate the impact of MI on other outcomes, such as HRQoL and adverse clinical events.
The Initial Positive and Negative Impacts of the COVID-19 Pandemic on Rural Healthcare Providers: Associations With Team Culture and Leadership
Authors: Terry Danielle L. , Hui Patricia , Buntoro Shirley
Published: September 2021

EXECUTIVE SUMMARY

This study aimed to use qualitative and quantitative methods to (1) understand the initial positive and negative impacts of the COVID-19 pandemic on rural healthcare providers; (2) explore associations between team culture and leadership and provider distress and job satisfaction after the initial impact of the COVID-19 pandemic; and (3) determine whether changes occurred in perceived stress and burnout. Participants included 213 providers working in rural Pennsylvania. The researchers administered an electronic survey to participants 10 days after the organization issued directives to cancel routine care appointments. Descriptive statistics were used to examine sample characteristics. The researchers used thematic analysis to assess open-ended responses. Correlational analyses were used to examine associations among perceived stress, team culture, job satisfaction, COVID-19 engagement, and team leadership. Most providers reported that the pandemic had the greatest effect on them psychologically, followed by professionally (i.e., changes in workload and conflicts with coworkers) and financially. Statistically significant positive associations were observed among leadership, provider distress, and team culture. Identification of the psychological impact highlights the need to support healthcare providers and address their psychological needs. Moreover, understanding ways in which leaders can effectively lead may help personnel better prepare for a public health crisis.
Risk of Intradialytic Hypotension by Day of the Week in Maintenance Hemodialysis
Authors: Correa Simon , Guerra-Torres Xavier E. , Ravi Katherine Scovner , Mothi Suraj S. , Waikar Sushrut S. , Mc Causland Finnian R.
Published: September 2021

Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD) and is associated with a higher risk of cardiovascular (CV) events and mortality. CV events are more common on the days of HD, especially following the longer interdialytic interval. We investigated the risk of IDH according to day of HD in adults undergoing in-center, thrice-weekly HD in the Hemodialysis (HEMO) Study (N = 1,837 patients; n = 64,474 sessions), and the DaVita Clinical Research biorepository [BioReG]) (N = 952 patients; n = 61,197 sessions). Random effects logistic regression models assessed the risk of IDH (defined as nadir intra-HD systolic blood pressure [SBP] <90 mm Hg if pre-HD SBP <160 mm Hg, or <100 mm Hg if pre-HD SBP ≥160 mm Hg [Nadir90/100 definition]) according to HD day (Mon/Tue [HD1]; Wed/Thu [HD2]; Fri/Sat [HD3]). Alternative definitions of IDH were explored. Nadir90/100 occurred in 14% of HEMO and 18% of BioReG sessions. A monotonic increase in the risk of IDH was observed for HD2 and HD3, compared with HD1, for all IDH definitions in both cohorts. Compared with HD1, HD2 was associated with a 10% higher risk of Nadir90/100 (adjusted odds ratio, 1.10; 95% CI, 1.03–1.17) and HD3 was associated with a 31% higher risk (adjusted odds ratio, 1.31; 95% CI, 1.19–1.45) in HEMO, with consistent results in BioReG. We observed a monotonic increased risk of IDH with later days of the dialytic week in two separate cohorts. Further research to determine the underlying mechanisms is necessary to guide strategies for IDH prevention.
KIDS SAVE LIVES: a narrative review of associated scientific production
Authors: Nakagawa Naomi Kondo , Salles Igor Caitano , Semeraro Federico , Böttiger Bernd W.
Published: September 2021

Purpose of review

In sudden out-of-hospital cardiac arrest, bystander cardiopulmonary resuscitation (CPR) is one of the most important elements of the chain of survival. Since 2015, international health societies and associations have recognized KIDS SAVE LIVES (KSL) as an essential initiative on CPR principles dissemination among schoolchildren. Children can be potential multipliers of the CPR competencies by teaching families, relatives, and friends. This review aimed to determine the main CPR issues raised in the KSL-associated publications.

Recent findings

We found 12 Editorials, 9 Letters, 2 Special Reports, 4 Reviews, 2 Guidelines, 9 Original Articles and 17 Conference Presentations on KSL history, the schoolchildren CPR education, and KSL program implementation in several countries. In nine original studies, the main issues were instructors’ and learners’ CPR knowledge, skills, and retention, gender and physical aspects affecting CPR performance, types of KSL programs and new technologies to teach CPR.

The KSL-associated literature is limited to support KSL benefits. However, the KSL could potentially contribute to improve out-of-hospital CPR performed by lay people at earlier age in different countries. Children are an important target group to diffuse CPR principles (’CHECK-CALL-COMPRESS’), as they are curious, motivated and enjoy teaching others.
Cyclic alternating patterns and arousals: what is relevant in obstructive sleep apnea? In Memoriam Mario Giovanni Terzano
Authors: Parrino Liborio , Rausa Francesco , Azzi Nicoletta , Pollara Irene , Mutti Carlotta
Published: September 2021

Purpose of review

To review main knowledges and gaps in the field of sleep microstructure, represented by the cyclic alternating pattern (CAP), in obstructive sleep apnea (OSA).

Recent findings

The (electroencephalographic and autonomic) ‘intensity’ of arousals in OSA patients, measured through the metrics of CAP, correlate with OSA severity and with disease burden. Continuous positive airway pressure determines variations in sleep architecture (conventional parameters) and at the microstructural level, at different time points.

CAP is not only an ‘attractor’ of arousals, but also organizes distribution of K-complexes and delta bursts in non-rapid eye movement sleep. Although attention is always concentrated on the A-phase of CAP, a crucial role is play by the phase B, which reflects a period of transient inhibition. Respiratory events in OSA are a typical example of phase B-associated condition, as they occur during the interval between successive A-phases. Accordingly sleep microstructure provides useful insights in the pathophysiology and estimation of OSA severity and may be exploited to follow-up treatment efficacy. In the complex relationship among sleep fragmentation, excessive daytime sleepiness, cognition and cardiovascular risk the CAP framework can offer an integrative perspective in a multidisciplinary scenario.
Novel concepts in red blood cell clearance
Authors: Neri Silvia , Swinkels Dorine W. , Matlung Hanke L. , van Bruggen Robin
Published: September 2021

Purpose of review

Red blood cell (RBC) clearance has been studied for decades in many different pathologies, which has revealed different routes of RBC degradation, depending on the situation. This review summarizes the latest mechanistic insights on RBC clearance in different contexts; during homeostatic removal, immune-mediated destruction, and systemic inflammation.

Recent findings

Besides the recognition of a variety of potential ‘eat me’ signals on RBCs, recent evidence suggests that normal RBC degradation is driven by the increase of the adhesive properties of RBCs, mediating the retention in the spleen and leading to RBC hemolysis. Furthermore, immune-mediated degradation of RBCs seems to be fine-tuned by the balance between the density of the antigens expressed on RBCs and the presence of ‘don’t eat me’ signals. Moreover, besides RBC clearance by macrophages, neutrophils seem to play a much more prominent role in immune-mediated RBC removal than anticipated. Lastly, RBC clearance during systemic inflammation appears to be driven by a combination of extreme macrophage activity in response to proinflammatory cytokines as well as direct damage of RBC by the inflammation or inflammatory agent.

Recent studies on RBC clearance have expanded our knowledge on their destruction in different contexts.
Evidence-Based Medicine in Plastic Surgery: From Then to Now
Authors: Rohrich Rod J. , Cohen Joshua M. , Savetsky Ira L. , Avashia Yash J. , Chung Kevin C.
Published: September 2021

Evidence-based medicine, as described by Dr. Sackett, is defined as the “conscientious, explicit, and judicious use of current best evidence, combined with individual clinical expertise and patient preferences and values, in making decisions about the care of individual patients.” In the late 2000s, seminal articles in Clinics in Plastic Surgery and Plastic and Reconstructive Surgery introduced evidence-based medicine’s role in plastic surgery and redefined varying levels of evidence. The American Society of Plastic Surgeons sponsored the Colorado Springs Evidence-Based Medicine Summit that set forth a consensus statement and action plan regarding the increased incorporation of evidence-based medicine into the field; this key meeting ushered a new era among plastic surgeons worldwide. Over the past decade, Plastic and Reconstructive Surgery has incorporated evidence-based medicine into the Journal through an increase in articles with level I and II evidence, new sections of the Journal, and the introduction of validated tools to help authors perform prospective and randomized studies that ultimately  led to best practices used today. Plastic surgery is a specialty built on problem-solving and innovation, values starkly in-line with evidence-based medicine. Evidence-based medicine is becoming more ingrained in our everyday practice and plastic surgery culture; however, we must work actively to ensure that we continue this trend. In the next decade, we will possibly see that level I and II evidence articles start to inhabit many of our journal issues.
How different is invasive fusariosis in pediatric patients than in adults? A systematic review
Authors: Rossato Luana , Carlesse Fabianne , Nobrega de Almeida João , Kontoyiannis Dimitrios P. , Colombo Arnaldo Lopes
Published: September 2021

Purpose of review

To investigate the peculiarities of invasive fusariosis (IF) in pediatric patients.

Methods

We conducted a systematic literature review to identify human cases of locally invasive and systemic fusariosis documented in children (up to 18 years) published between 1973 (first case report) and 2021.

Recent findings

One hundred and six cases were retrieved, and hematologic malignancy was reported in 64% (68/106) of the cases. The most frequent anatomic sites involved were skin 66% (70/106), blood 47% (50/106), and lungs 35% (37/106), bone and joint (8%, 09/106), and eye/central nervous system involvement (8%, 9/106). Fusarium solani, followed by Fusarium oxysporum, were the most commonly reported species. In disseminated fusariosis, relapsed or refractory baseline disease (P < 0.001, OR=10.555, CI 95% 3.552–31.365) was associated with poor outcome, whereas voriconazole-based therapy was associated with better prognosis (P 
= 0.04, OR = 0.273, CI 95% 0.076–0.978).

Hematologic malignancies and solid tumors requiring intensive immunosuppression are the main conditions related to IF in children where other organs than skin, blood, and lungs were frequently involved. Voriconazole therapy appears to be also effective in children with IF, despite the wide pharmacokinetic variability of this triazole in pediatric patients.
Global Estimates of Capacity for Kidney Transplantation in World Countries and Regions
Authors: Mudiayi Dominic , Shojai Soroush , Okpechi Ikechi , Christie Emily A. , Wen Kevin , Kamaleldin Mostafa , Elsadig Osman Mohamed , Lunney Meaghan , Prasad Bhanu , Osman Mohamed A. , Ye Feng , Khan Maryam , Htay Htay , Caskey Fergus , Jindal Kailash K. , Klarenback Scott , Jha Vivekanand , Rondeau Eric , Turan Kazancioglu Rumeyza , Ossareh Shahrzad , Jager Kitty J. , Kovesdy Csaba P. , O’Connell Philip J. , Muller Elmi , Olanrewaju Timothy , Gill John S. , Tonelli Marcello , Harris David C. , Levin Adeera , Johnson David W. , Bello Aminu K.
Published: September 2021

Background.

Kidney transplantation (KT) is the optimal treatment for kidney failure and is associated with better quality of life and survival relative to dialysis. However, knowledge of the current capacity of countries to deliver KT is limited. This study reports on findings from the 2018 International Society of Nephrology Global Kidney Health Atlas survey, specifically addressing the availability, accessibility, and quality of KT across countries and regions.

Methods.

Data were collected from published online sources, and a survey was administered online to key stakeholders. All country-level data were analyzed by International Society of Nephrology region and World Bank income classification.

Results.

Data were collected via a survey in 182 countries, of which 155 answered questions pertaining to KT. Of these, 74% stated that KT was available, with a median incidence of 14 per million population (range: 0.04–70) and median prevalence of 255 per million population (range: 3–693). Accessibility of KT varied widely; even within high-income countries, it was disproportionately lower for ethnic minorities. Universal health coverage of all KT treatment costs was available in 31%, and 57% had a KT registry.

Conclusions.

There are substantial variations in KT incidence, prevalence, availability, accessibility, and quality worldwide, with the lowest rates evident in low- and lower-middle income countries. Understanding these disparities will inform efforts to increase awareness and the adoption of practices that will ensure high-quality KT care is provided around the world.
Clinical Practice Guideline for Solid Organ Donation and Transplantation During the COVID-19 Pandemic
Authors: Weiss Matthew J. , Hornby Laura , Foroutan Farid , Belga Sara , Bernier Simon , Bhat Mamatha , Buchan C. Arianne , Gagnon Michael , Hardman Gillian , Ibrahim Maria , Luo Cindy , Luong Me-Linh , Mainra Rahul , Manara Alex R. , Sapir-Pichhadze Ruth , Shalhoub Sarah , Shaver Tina , Singh Jeffrey M. , Srinathan Sujitha , Thomas Ian , Wilson Lindsay C. , Wilson T. Murray , Wright Alissa , Mah Allison
Published: September 2021

Background.

The coronavirus 2019 (COVID-19) pandemic has disrupted health systems worldwide, including solid organ donation and transplantation programs. Guidance on how best to screen patients who are potential organ donors to minimize the risks of COVID-19 as well as how best to manage immunosuppression and reduce the risk of COVID-19 and manage infection in solid organ transplant recipients (SOTr) is needed.

Methods.

Iterative literature searches were conducted, the last being January 2021, by a team of 3 information specialists. Stakeholders representing key groups undertook the systematic reviews and generation of recommendations using a rapid response approach that respected the Appraisal of Guidelines for Research and Evaluation II and Grading of Recommendations, Assessment, Development and Evaluations frameworks.

Results.

The systematic reviews addressed multiple questions of interest. In this guidance document, we make 4 strong recommendations, 7 weak recommendations, 3 good practice statements, and 3 statements of “no recommendation.”

Conclusions.

SOTr and patients on the waitlist are populations of interest in the COVID-19 pandemic. Currently, there is a paucity of high-quality evidence to guide decisions around deceased donation assessments and the management of SOTr and waitlist patients. Inclusion of these populations in clinical trials of therapeutic interventions, including vaccine candidates, is essential to guide best practices.
A Randomized Controlled Trial of a Pretransplant Educational Intervention in Kidney Patients
Authors: Mansell Holly , Rosaasen Nicola , Wichart Jenny , Mainra Rahul , Shoker Ahmed , Hoffert Michele , Blackburn David F. , Liu Juxin , Groot Brianna , Trivedi Paraag , Willenborg Errin , Amararajan Maithiri , Wu Huokai , Afful Annshirley
Published: September 2021

Background.

Poor patient knowledge about transplantation is a significant problem following kidney transplant. A video-based educational intervention was developed to supplement standard education provided by transplant teams.

Methods.

A multicenter randomized controlled trial tested the intervention delivered to patients undergoing assessment or waitlisted for kidney transplant. Adult participants were randomized to the control (standard education) or the intervention group, consisting of electronic access to the videos (or digital video disks if no internet) plus standard education. Differences between groups in changes in transplant knowledge (measured by the Kidney Transplant Understanding Tool), education satisfaction, self-efficacy, and quality of life (secondary outcomes) were evaluated by a preintervention and postintervention survey. Video viewing habits were tracked and described for patients in the intervention group.

Results.

One hundred sixty-two patients were enrolled, with 132 completing both questionnaires (n = 64 intervention and n = 68 control), with similar enrollment from 3 Canadian sites. Video viewing statistics in the complete cases indicated that 78% (50/64) watched the videos, with 70% (45/64) viewing them electronically, while 8% (5/64) received digital video disks and self-reported participation. Baseline knowledge scores in the intent-to-treat population were 55.4 ± 6.5 and 55.7 ± 7.1 in the intervention and control, respectively. The mean knowledge change in the intervention (2.1 ± 3.6) was significantly higher than in the control group (0.8 ± 3.4, P < 0.02). In the per-protocol analysis (patients with objective evidence of watching at least 80% of the videos), the knowledge improvements were 3.4 ± 3.8. Video group participants reported higher satisfaction with education (P < 0.02) and expressed positive comments in open-ended feedback.

Conclusions.

Electronic video education in the pretransplant setting improved knowledge and satisfaction.
Effects of Social Deprivation on the Proportion of Preemptive Kidney Transplantation: A Mediation Analysis
Authors: Calvar Eve , Launay Ludivine , Boyer Annabel , Launoy Guy , Lobbedez Thierry , Châtelet Valérie
Published: September 2021

Background.

Social inequalities in health lead to an increased risk of chronic kidney disease and less access to renal transplantation. The objective of this study was to assess the association between social deprivation estimated by the fifth quintile of the European Deprivation Index (EDI) and preemptive kidney transplantation (PKT) and to explore the potential mediators of this association.

Methods.

This retrospective observational multicenter study included 8701 patients who received their first renal transplant in France between 2010 and 2014. Mediation analyses were performed to assess the direct and indirect effects of the EDI on PKT.

Results.

Among the 8701 transplant recipients, 32.4% belonged to the most deprived quintile of the EDI (quintile 5) and 16% received a PKT (performed either with a deceased- or living-donor). There was a significant association between quintile 5 of the EDI and PKT (total effect: odds ratio [OR]: 0.64 [95% confidence interval (CI): 0.55-0.73]). Living-donor kidney transplantation was the main mediator of this association (natural indirect effect: OR: 0.92 [0.89–0.95]). To a lesser extent, positive cytomegalovirus and hepatitis C serologies and blood group B were also mediators (respective natural indirect effects: OR: 0.98 [95% CI: 0.95-1.00], OR: 0.99 [95% CI: 0.99-1.00], and OR: 0.99 [95% CI: 0.98-1.00], P < 0.05).

Conclusions.

Our study suggests that social deprivation is associated with a decreased proportion of PKT. This association might be mitigated by promoting living-donor transplantation.
Lung Transplantation in Systemic Sclerosis: a Practice Survey of United States Lung Transplant Centers
Authors: Sehgal Sameep , Pennington Kelly M. , Zhao Huaqing , Kennedy Cassie C.
Published: September 2021

Background.

Lung transplantation in patients with systemic sclerosis (SSc) can be complicated by extrapulmonary manifestations of the disease, leading to concerns regarding posttransplant complications and outcomes.

Methods.

We conducted a web-based survey of adult lung transplant programs in the United States regarding their practices in patients with SSc.

Results.

Sixty percent (37/62) of the eligible centers responded to the survey, majority of the respondents were medical directors (81%). Most centers would consider transplanting patients with mild or moderate esophageal disease (92% or 75%, respectively) or gastroparesis (59%). A minority would consider patients with severe esophageal dysmotility (37%), digital ulcers (21%), or low body mass index (19%). Most centers conducted extensive pretransplant gastrointestinal evaluation and use a conservative feeding approach with prolonged nothing by mouth (83%) and postpyloric feeding (89%). Antireflux surgery is commonly considered (40%) with partial fundoplication being the procedure of choice (67%). Most respondents expected similar outcomes of acute or chronic rejection (81% and 51%, respectively), respiratory infections (76%), and 1-year survival (70%).

Conclusions.

Most US lung transplant centers do not universally exclude SSc from lung transplant listing, but most support extensive pretransplant gastrointestinal testing and a conservative approach to feeding in the early posttransplant period.
Clinical and Financial Implications of 2 Treatment Strategies for Donor-derived Hepatitis C Infections
Authors: Stewart Zoe A. , Stern Jeffrey , Ali Nicole M. , Kalia Harmit S. , Khalil Karen , Jonchhe Srijana , Weldon Elaina P. , Dieter Rebecca A. , Lewis Tyler C. , Funches Nur , Crosby Sudara , Seow Monique , Berger Jonathan C. , Dagher Nabil N. , Gelb Bruce E. , Watkins Anthony C. , Moazami Nader , Smith Deane E. , Kon Zachary N. , Chang Stephanie H. , Reyentovich Alex , Angel Luis F. , Montgomery Robert A. , Lonze Bonnie E.
Published: September 2021

Background.

Transplanting hepatitis C viremic donor organs into hepatitis C virus (HCV)-negative recipients is becoming increasingly common; however, practices for posttransplant direct-acting antiviral (DAA) treatment vary widely. Protracted insurance authorization processes for DAA therapy often lead to treatment delays.

Methods.

At our institution, 2 strategies for providing DAA therapy to HCV– recipients of HCV+ transplants have been used. For thoracic organ recipients, an institution-subsidized course of initial therapy was provided to ensure an early treatment initiation date. For abdominal organ recipients, insurance approval for DAA coverage was sought once viremia developed, and treatment was initiated only once the insurance-authorized supply of drug was received. To evaluate the clinical impact of these 2 strategies, we retrospectively collected data pertaining to the timing of DAA initiation, duration of recipient viremia, and monetary costs incurred by patients and the institution for patients managed under these 2 DAA coverage strategies.

Results.

One hundred fifty-two transplants were performed using HCV viremic donor organs. Eighty-nine patients received DAA treatment without subsidy, and 62 received DAA treatment with subsidy. One patient who never developed viremia posttransplant received no treatment. Subsidizing the initial course enabled earlier treatment initiation (median, 4 d [interquartile range (IQR), 2–7] vs 10 [IQR, 8–13]; P < 0.001) and shorter duration of viremia (median, 16 d [IQR, 12–29] vs 36 [IQR, 30–47]; P < 0.001). Institutional costs averaged $9173 per subsidized patient and $168 per nonsubsidized patient. Three needlestick exposures occurred in caregivers of viremic patients.

Conclusions.

Recipients and their caregivers stand to benefit from earlier DAA treatment initiation; however, institutional costs to subsidize DAA therapy before insurance authorization are substantial. Insurance authorization processes for DAAs should be revised to accommodate this unique patient group.
Trends in Heart and Lung Transplantation in the United States Across the COVID-19 Pandemic
Authors: Hallett Andrew , Motter Jennifer D. , Frey Alena , Higgins Robert S. , Bush Errol L. , Snyder Jon , Garonzik-Wang Jacqueline M. , Segev Dorry L. , Massie Allan B.
Published: September 2021

Background.

The coronavirus disease 2019 (COVID-19) pandemic has had a variable course across the United States. Understanding its evolving impact on heart and lung transplantation (HT and LT) will help with planning for next phases of this pandemic as well as future ones.

Methods.

We used Scientific Registry of Transplant Recipients data from before the pandemic to predict the number of waitlist registrations and transplants expected to occur between March 15, 2020, and December 31, 2020 (if no pandemic had occurred), and compared these expectations to observed rates. The observed era was divided into wave 1 (March 15–May 31), wave 2 (June 1–September 30), and wave 3 (October 1–December 31). We used multilevel Poisson regression to account for center- and state-level COVID-19 incidence.

Results.

During wave 1, rates of heart registrations and transplants were 28% (incidence rate ratio [IRR]: 0.72 [95% confidence interval (CI), 0.67-0.77]) and 13% (IRR: 0.87 [95% CI, 0.80-0.93]) lower than expected; lung registrations and transplants were 40% (IRR: 0.60 [95% CI, 0.54-0.66]) and 28% (IRR: 0.72 [95% CI, 0.66-0.79]) lower. Decreases were greatest in states with the highest incidence where registrations were 53% (IRR: 0.47 [95% CI, 0.36-0.62]) and 59% (IRR: 0.41 [95% CI, 0.29-0.58]) and transplants were 57% (IRR: 0.43 [95% CI, 0.31-0.60]) and 58% (IRR: 0.42 [95% CI, 0.29-0.62]) lower than expected. Whereas HT largely recovered during waves 2 and 3, LT continued to fall short of expectations through the end of the year.

Conclusions.

The COVID-19 pandemic in the US substantially reduced thoracic transplant access. Ongoing evaluation of the risks and benefits of this dramatic practice change is critical to inform clinical decision-making moving forward.
Hyperbaric oxygen therapy improves neurological function via the p38-MAPK/CCL2 signaling pathway following traumatic brain injury
Authors: Jiang Yingzi , Chen Yuwen , Huang Chunling , Xia Anqi , Wang Guohua , Liu Su
Published: September 2021

Objective

The anti-inflammatory mechanisms of hyperbaric oxygenation (HBO) treatment on traumatic brain injury (TBI)-induced neuroinflammation remain unclear. The aim of this study was expected the effect of HBO on CCL2-related signaling pathway following severe TBI in rats.

Methods

The severe TBI model in rats was induced by controlled cortical impact. TBI rats were treated with CCR2 antagonist, p38 inhibitor, or HBO. Modified neurological severity scores and Morris water maze were used to evaluate neurological and cognitive function. The expression levels of CCL2 and CCR2 were measured by ELISA and real-time fluorescence quantitative PCR. Phospho-p38 expression was analyzed by western blotting.

Results

TBI-induced upregulation of CCL2, CCR2, and p38 in the injured cortex. Application of CCR2 antagonist improved neurological and cognitive function of TBI rats. Application of p38 inhibitor decreased expression of CCL2 and CCR2 in the injured of TBI rats, meanwhile improved neurological and cognitive function. HBO improved neurological and cognitive function by decreasing the expressions of CCL2, CCR2, and phospho-p38.

Conclusions

This study indicates that the p38-MAPK–CCL2 signaling pathway could mediate neuroinflammation and HBO therapy can modulate neuroinflammation by modulating the p38-MAPK–CCL2 signaling pathways following TBI. This study may provide theoretical evidence for HBO treatment in the treatment of TBI.
Patterns of brain c-Fos expression in response to feeding behavior in acute and chronic inflammatory pain condition
Authors: Lee Grace J , Kim Yea Jin , Lee Kihwan , Oh Seog Bae
Published: September 2021

Objectives

Feeding behavior is known to have potential to alleviate pain. We recently demonstrated that both 24 h fasting and 2 h refeeding (food intake after 24 h fasting) induce analgesia in inflammatory pain conditions via different brain mechanisms. However, brain structures that distinctly involved fasting- and refeeding-induced analgesia is still unknown. Hence, this study is aimed to reveal brain structures mediating fasting- and refeeding-induced analgesia.

Methods

Mice were given intraplantar (i.pl.) injection of formalin and complete Freund’s adjuvant into the left hind paw to induce acute and chronic inflammatory pain, respectively. We examined changes in c-Fos expression with 24 h fasting and 2 h refeeding under acute and chronic inflammatory pain conditions in the contralateral brain.

Results

Under acute pain condition, c-Fos expression changed with fasting in the anterior cingulate cortex (ACC), central amygdala (CeA), lateral hypothalamus (LH) and nucleus accumbens core (NAcC). Refeeding changed c-Fos expression in the CeA, LH and lateral parabrachial nucleus (lPBN). On the other hand, under chronic inflammatory pain condition, c-Fos expression changed with fasting in the lPBN, medial prefrontal cortex (mPFC) and nucleus accumbens shell (NAcS) while refeeding changed c-Fos expression in the anterior insular cortex, lPBN, mPFC and NAcS.

Conclusion

The present results show that brain regions that participated in the fasting- and refeeding-induced analgesia were completely different in acute and chronic inflammatory pain conditions. Also, refeeding recruits more brain regions under chronic inflammatory pain conditions compared to the acute inflammatory pain condition. Collectively, our findings provide novel insights into brain regions involved in fasting- and refeeding-induced analgesia, which can be potential neural circuit-based targets for the development of novel therapeutics.
Postprostatectomy Incontinence and Self-management for Urinary Incontinence After Laparoscopic Radical Prostatectomy
Authors: Si Longmei , Ding Yanming , Huang Yanbo , Zhang Meng , Zhang Jianfeng
Published: September 2021

PURPOSE:

The purpose of this study was to describe postprostatectomy incontinence (PPI) after laparoscopic radical prostatectomy (LRP), self-management strategies for managing incontinence, and factors influencing self-management.

DESIGN:

A descriptive, cross-sectional study.

SUBJECTS AND SETTING:

The sample comprising 37 males with prostate cancer who underwent LRP was recruited within first 2 years. The study setting was a tertiary care hospital in Beijing, China. An additional 78 individuals who responded to a mailed invitation sent from September 2015 to October 2016 participated in the study.

METHODS:

Participants completed a questionnaire that queried demographic and pertinent clinical data. The questionnaire also included 2 validated instruments. The International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF) was used to assess urinary incontinence (UI) following radical prostatectomy and its severity. The Strategy and Effectiveness of Symptom Self-Management questionnaire of Postprostatectomy Incontinence (SESSM-PPI) was used to evaluate self-management of UI, including strategies used and their perceived effectiveness.

RESULTS:

Data analysis was based on 115 respondents who completed all components of the questionnaire; 95 (82.6%) indicated having UI. Forty-one patients (43.2%) indicated mild UI, 47 (49.5%) indicated moderate UI, and 7 (7.4%) indicated severe UI. The mean score of the SESSM-PPI was 14.04 ± 7.92, indicating a low level of self-management.

The top 5 strategies with moderate effectiveness were in the following order: “use pads or adult diapers”; “pelvic floor muscle training”; “avoid extracting heavy objects”; “avoid drinking”; and “eat more fruit to prevent constipation.” The Spearman correlation analysis revealed a positive correlation between the frequency of use of self-management strategies and incontinence severity.

CONCLUSIONS:

Urinary incontinence is prevalent among males with prostate cancer managed by radical prostatectomy. Respondents tended to report mild to moderate UI severity. Self-management of UI among respondents is low.
Patient-Related Factors Associated With Stoma and Peristomal Complications Following Fecal Ostomy Surgery
Authors: Zelga Piotr , Kluska Piotr , Zelga Marta , Piasecka-Zelga Joanna , Dziki Adam
Published: September 2021

PURPOSE:

Ostomy creation is often an integral part of the surgical management of various diseases including colorectal malignancies and inflammatory bowel disease. Stoma and peristomal complications may occur in up to 70% of patients following ostomy surgery. The aim of this scoping literature review was to synthesize evidence on the risk factors for developing complications following creation of a fecal ostomy.

DESIGN:

Scoping literature review.

SEARCH STRATEGY:

Two independent researchers completed a search of the online bibliographic databases PubMed, MEDLINE, Cochrane, Google Scholar, and EMBASE for all articles published between January 1980 and December 2018. The search comprised multiple elements including systematic literature reviews with meta-analysis of pooled findings, randomized controlled trials, cohort studies, observational studies, other types of review articles, and multiple case reports. We screened 307 unique titles and abstracts; 68 articles met our eligibility criteria for inclusion. The methodological rigor of study quality included in our scoping review was variable.

FINDINGS/CONCLUSIONS:

We identified 6 risk factors associated with an increased likelihood of stoma or peristomal complications (1) age more than 65 years; (2) female sex; (3) body mass index more than 25; (4) diabetes mellitus as a comorbid condition; (5) abdominal malignancy as the underlying reason for ostomy surgery; and (6) lack of preoperative stoma site marking and WOC/ostomy nurse specialist care prior to stoma surgery. We also found evidence that persons with a colostomy are at a higher risk for prolapse and parastomal hernia.

IMPLICATIONS:

Health care professionals should consider these risk factors when caring for patients undergoing fecal ostomy surgery and manage modifiable factors whenever possible. For example, preoperative stoma site marking by an ostomy nurse or surgeon familiar with this task, along with careful perioperative ostomy care and education of the patient by an ostomy nurse specialist, are essential to reduce the risk of modifiable risk factors related to creation of a fecal ostomy.
Neonatal Intensive Care Nursing Pressure Injury Prevention Practices
Authors: Razmus Ivy Swanson , Keep Suzanne M.
Published: September 2021

PURPOSE:

The purpose of this study was to explore neonatal nursing practices for neonatal pressure injury (PI) risk assessment, pressure redistribution surface use, and moisture management.

DESIGN:

A descriptive survey.

SUBJECT/SETTINGS:

A sample of 252 neonatal nurses mainly from the United States responded to a survey distributed electronically through the National Association of Neonatal Nurses, the Academy of Neonatal Nurses, and on the Wound Source Web site.

METHODS:

Nurses responded to questions that explored what neonatal nurses used to assess PI risk, types of pressure redistribution surfaces used for neonates, and what moisture management strategies were used to prevent PIs. Descriptive statistics were used to describe nurses' practices.

RESULTS:

When assessing risk, 78% (n = 197/252) reported using a risk assessment scale: the 2 most common scales were the Neonatal Skin Risk Assessment Scale and the Braden Q Scale. Sixty-nine percent (n = 174/252) reported using a rolled blanket or small soft object as pressure redistribution surfaces. In addition, 15% (n = 39) reported the use of different types of positioners such as a fluidized positioner as pressure redistribution surfaces; however, these are marketed as a positioning devices. It appears that these interventions were considered redistribution surfaces by the nurses. For moisture management, petrolatum-based products (6.7%; n = 17/252) and ostomy powders (6%; n = 16/252) were most frequently used.

CONCLUSIONS:

Practices for PI prevention are different for neonatal patients due to their gestational age, size, and level of illness. Findings from this study create a beginning knowledge of and an opportunity for further research to determine how these practices affect outcomes such as PI incidence and prevalence.
Predictors of mental health worsening among children and adolescents during the coronavirus disease 2019 pandemic
Authors: Caffo Ernesto , Asta Lisa , Scandroglio Francesca
Published: September 2021

Purpose of review

Restrictions put in place to contain the spread of coronavirus disease 2019 (COVID-19) have significantly affected the lives of children and adolescents worldwide. School closure, home confinement and social distancing have the potential to negatively impact the mental health of this population. Several risk factors seem to contribute to worsening mental health of children and adolescents, with an increase of anxiety and depression symptoms. This review aims at exploring research available on risk factors that may worsen the mental health among children and adolescents during the pandemic.

Recent findings

Some of these predictors in worsening the effects are social isolation, screen time and excessive social media use, parental stress and poor parent–child relationship, low socioeconomic status, preexisting mental health conditions and/or disabilities.

Further research is needed in order to understand mental health effects of the COVID-19 pandemic, as well as risk factors associated with negative consequences. New findings will help in targeting evidence-based interventions to prevent and mitigate the negative effects of COVID-19 on the mental health of children and adolescents.