bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Care Utilization of Menthol and Non-menthol Cigarette Smokers
Authors: Wang Yingning , Watkins Shannon Lea , Sung Hai-Yen , Yao Tingting , Lightwood Jim , Max Wendy
Published: June 2020

Introduction

To study the association between health care utilization and menthol cigarette use and whether the association differed between African American (AA) and non-AA smokers.

Methods

We analyzed the three most recent 2005, 2010, and 2015 National Health Interview Survey Cancer Control Supplements. After incorporating propensity score weights adjusting for observed differences between menthol and non-menthol users, we estimated Zero-Inflated Poisson models on hospital nights, emergency department visits, doctor visits, and home visits as a function of menthol use status and other covariates separately for current cigarette smokers and recent quitters (former smokers quitting cigarette smoking ≤ 4 years).

Results

Although current menthol smokers smoked fewer cigarettes per day than current non-menthol smokers, they did not differ from current non-menthol smokers in health care utilization. Among recent quitters, those who used to smoke menthol cigarettes had higher odds of having hospital nights than those who used to smoke non-menthol cigarettes. However, we did not find any significant association between menthol use and other health care utilization—emergency department visits, doctor visits, and home visits—among recent quitters. Moreover, compared with non-AA recent quitters, AA recent quitters had higher odds of having home visits, but fewer home visits, if they used to smoke menthol cigarettes.

Conclusion

Menthol use was associated with greater hospitalization among recent quitters, and the association between home visits and menthol use differed between AA and non-AA recent quitters.

Implications

This is the first study that used econometric models to study the association between health care utilization and menthol cigarette use and examine whether the association differed between AA and non-AA smokers. Our study found health care utilization did not differ by menthol use status for current smokers, although current menthol smokers smoked fewer cigarettes per day than current non-menthol smokers. However, we found menthol use was associated with higher odds of having hospital nights for recent quitters. We also found AA recent quitters had a different association between home visits and menthol use compared with non-AA recent quitters.
Technology entry in the presence of patent thickets
Authors: Hall Bronwyn H , Graevenitz Georg von , Helmers Christian
Published: June 2020

We analyse how patent thickets affect entry into patenting. A model of entry into patenting that allows for variation in technological opportunity, technological complexity and the extent of patent thickets is developed and analysed. Using UK data we then show that patent thickets are associated with a reduction of first time patenting in a technology controlling for the level of technological complexity and opportunity. Technologies characterized by more technological complexity and opportunity attract more entry into patenting. Our evidence indicates that patent thickets raise entry costs, which leads to less entry into technologies regardless of a firm’s size.
A NOTE ON RATIONAL HOMOLOGICAL STABILITY OF AUTOMORPHISMS OF MANIFOLDS
Authors: Krannich Manuel
Published: June 2020

By work of Berglund and Madsen, the rings of rational characteristic classes of fibrations and smooth block bundles with fibre $D^{2n}\sharp (S^n\times S^n)^{\sharp g}$, relative to the boundary, are for $2n\ge 6$ independent of $g$ in degrees $*\le (g-6)/2$. In this note, we explain how this range can be improved to $*\le g-2$ using cohomological vanishing results due to Borel and the classical invariant theory. This implies that the analogous ring for smooth bundles is independent of $g$ in the same range, provided the degree is small compared to the dimension.
Savings Gluts and Financial Fragility
Authors: Bolton Patrick , Santos Tano , Scheinkman Jose A
Published: June 2020

We propose an incentive-based theory of how a savings glut produces financial fragility. Originators must be incentivized to produce high-quality assets. Assets are distributed to informed intermediaries or uninformed investors. A savings glut reduces origination incentives by compressing spreads between the prices paid for high-quality assets by informed intermediaries and prices paid by uninformed investors for generic assets. The narrowing of spreads relaxes intermediaries’ borrowing constraints, resulting in higher leverage. This generates financial fragility: intermediaries are more likely to become insolvent if unforeseen losses arise. Our model offers a coherent narrative of the run-up to the Global Financial Crisis.
Cross Validation of the Prodromal Questionnaire 16-Item Version in an Adolescent Help-Seeking Population
Authors: de Jong Yvonne , Mulder Cornelis L , Boon Albert , Coenders Elias , van der Gaag Mark
Published: June 2020

The Prodromal Questionnaire 16-item version (PQ-16) is used as a screener in the early detection of psychosis. We wished to cross-validate it in a help-seeking population of adolescents aged 12–17 who had been referred for assessment and treatment to an outpatient Center for Child and Adolescence Psychiatry (CCAP). To examine the psychometric properties of the PQ-16 for adolescents, we used reliability analysis and receiver-operating-characteristic (ROC) curves. The internal consistency of the 16-item version was good, with Chronbach’s α = 0.84. A cutoff of 7 or more items marked as true, showed good sensitivity (.85) and acceptable specificity (.42). Half (51.3%) of the above cutoff sample were classified by the Comprehensive Assessment of At-Risk Mental States (CAARMS) assessment as having Ultra-High Risk (UHR) status or as having reached the psychosis threshold. Choosing a higher cutoff of 8 produces less false positives, but also loses 8% false negatives. Differentiation between boys and girls showed that the use of distress scores improved sensitivity and specificity values for girls but worsened them for boys. When a cutoff score of 7 or more items marked as true is used, the PQ-16 is a feasible instrument with acceptable screening properties for UHR and psychosis in boys and girls aged 12–17 attending a CCAP.
Research on emergency rescue technology and equipment for train operation accidents on a heavy-haul railway network
Authors: Zhou Xianping , Wei Xiang , Ma Lin , Bai Fuwei , Huang Hongwei
Published: June 2020

Bridges, tunnels, cuttings and high subgrade account for a relatively large proportion in China's heavy-haul railway system, where 10 000 t of unit trains and 20 000 t of combined trains are in operation. When a train operation accident occurs, it can easily cause vehicle intrusions, slant-span lines, tipping and stacking. Based on the viewpoint of system engineering, rescue methods such as hoisting, lifting, pulling and overturning are integrated, according to the characteristics of heavy-haul transport and the construction practice of train accident rescue system. A scheme of technical research and equipment configuration relating to heavy-haul railway rescue in China is put forward based on the situation—embankment, bridge, tunnel (including cuttings), ramp and curve rescue, and so on—and three-dimensional finite-element modelling and calculation checks on the key components are carried out.
Fiber-Specific Changes in White Matter Microstructure in Individuals With X-Linked Auditory Neuropathy
Authors: Zanin Julien , Dhollander Thijs , Rance Gary , Yu Lan , Lan Lan , Wang Hongyang , Lou Xin , Connelly Alan , Nayagam Bryony , Wang Qiuju
Published: June 2020

Objectives:

Auditory neuropathy (AN) is the term used to describe a group of hearing disorders, in which the hearing impairment occurs as a result of abnormal auditory nerve function. While our understanding of this condition has advanced significantly over recent years, the ability to determine the site of lesion and the extent of dysfunction in affected individuals remains a challenge. To this end, we investigated potential axonal degeneration in the white matter tracts of the brainstem in individuals with X-linked AN. We hypothesized that individuals with X-linked AN would show focal degeneration within the VIII nerve and/or auditory brainstem tracts, and the degree of degeneration would correlate with the extent of auditory perceptual impairment.

Design:

This was achieved using a higher-order diffusion magnetic resonance imaging (dMRI)–based quantitative measure called apparent fiber density as obtained from a technique called single-shell 3-tissue constrained spherical deconvolution and analyzed with the fixel-based analysis framework. Eleven subjects with genetically confirmed X-linked AN and 11 controls with normal hearing were assessed using behavioral and objective auditory measures. dMRI data were also collected for each participant.

Results:

Fixel-based analysis of the brainstem region showed that subjects with X-linked AN had significantly lower apparent fiber density in the VIII nerve compared with controls, consistent with axonal degeneration in this region. Subsequent analysis of the auditory brainstem tracts specifically showed that degeneration was also significant in these structures overall. The apparent fiber density findings were supported by objective measures of auditory function, such as auditory brainstem responses, electrocochleography, and otoacoustic emissions, which showed VIII nerve activity was severely disrupted in X-linked AN subjects while cochlear sensory hair cell function was relatively unaffected. Moreover, apparent fiber density results were significantly correlated with temporal processing ability (gap detection task) in affected subjects, suggesting that the degree of VIII nerve degeneration may impact the ability to resolve temporal aspects of an acoustic signal. Auditory assessments of sound detection, speech perception, and the processing of binaural cues were also significantly poorer in the X-linked AN group compared with the controls with normal hearing.

Conclusions:

The results of this study suggest that the dMRI–based measure of apparent fiber density may provide a useful adjunct to existing auditory assessments in the characterization of the site of lesion and extent of dysfunction in individuals with AN. Additionally, the ability to determine the degree of degeneration has the potential to guide rehabilitation strategies in the future.
Nonverbal Intelligence Predicts Performance of Preschool Children With Hearing Loss on Norm-Referenced Language Measures But Not Language Sample Analysis
Authors: Werfel Krystal L. , Bassard Sydney D. , Squires Courtney
Published: June 2020

Objectives:

The purpose of this study was to explore the effects of nonverbal intelligence on spoken language performance in children with hearing loss who use amplification and spoken language. Specifically, we compared language performance measured by norm-referenced measures compared with spontaneous language sample measures.

Design:

Nonverbal intelligence and spoken language skills were analyzed using norm-referenced nonverbal intelligence and language assessments and language sample analyses in 92 children ages 3 to 6 who varied by hearing and nonverbal intelligence status. All children had nonverbal intelligence within the average or above-average range.

Results:

Regression analyses revealed that, after controlling for maternal education and hearing status, nonverbal intelligence contributed unique variance to norm-referenced language measures but not spontaneous language measures.

Conclusions:

Performance on norm-referenced language measures is influenced by nonverbal intelligence, whereas functional language use measured by spontaneous language samples is not. These findings suggest that spontaneous language measures may contribute additional value to language assessment batteries that are independent of nonverbal intelligence.
Granulocyte-macrophage colony-stimulating factor enhances effect of temozolomide on high-grade glioma cells
Authors: Yang Dongyi , Cheng Xue , Bu Xingyao , Yan Zhaoyue , Wu Tao , Zhang Yunke
Published: June 2020

In the present study, to delve into the effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) combined with temozolomide (TMZ) on high-grade glioma cells and related mechanism, six cases of high-grade glioma cells from patient’s tumor tissues were cultured. 3-(4,5)-dimethylthiahiazo (-z-y1)-3,5-di- phenytetrazoliumromide 3-(4,5)-dimethylthiahiazo (-z-y1)-3,5-di- phenytetrazoliumromide (MTT) assay was performed to detect cell proliferation and toxicity. Flow cytometry was performed to ascertain cell cycle and apoptosis rate. To detect the expressions of O6-methylguanine-DNA methyltransferase (MGMT) methylation status and MGMT protein, respectively, specific PCR and immunofluorescence were performed. According to the results of MTT assay, compared with the results of control group, GM-CSF group exhibited enhanced cell viability in varying degrees. In three cases of cells (MGMT gene methylation), the combination group [(67.67 ± 1.16), (68.13 ± 1.06), (68.42 ± 1.73)] had noticeably lower cell viability than the corresponding TMZ group [(90.00 ± 1.73), (82.33 ± 1.53), (82.67 ± 2.11)] (P < 0.01). Nevertheless, the two groups showed no significant difference in another three cases (MGMT gene unmethylated) (P > 0.05). In combination group, the apoptosis rate of the MGMT methylation cells was higher than that in the corresponding TMZ group (P < 0.01), which is consistent with MTT assay results. In all six cases of primary glioma cells, the fraction of cells in G1 phase of GM-CSF-treated group was noticeably down-regulated and was up-regulated in S phase (P < 0.01). GM-CSF could induce high-grade glioma cells to rapidly enter the cell cycle, thereby enhancing the lethal effect of TMZ on glioma cells with MGMT gene promoter methylation. However, this effect is not ideal on glioma cells with MGMT unmethylation.
Toll-Like Receptors Contribute to Sex Differences in Blood Pressure Regulation
Authors: Dela Justina Vanessa , Giachini Fernanda R. , Sullivan Jennifer C. , Webb R. Clinton
Published: June 2020

Toll-like receptors (TLRs) play an important role in the innate immune system, and recently, they have been shown to be involved in the regulation of blood pressure. The incidence of hypertension is higher in men, and it increases in postmenopausal women. In fact, premenopausal women are protected from cardiovascular disease compared with age-matched men, and it is well established that this protective effect is lost with menopause. However, the molecular mechanisms underlying this protection in women are unknown. Whether or not it could be related to differential activation of the innate immune system remains to be elucidated. This review focuses on (1) the differences between men and women in TLR activation and (2) whether TLR activation may influence the regulation of blood pressure in a sex-dependent manner.
Therapeutic Drug Monitoring of Direct Oral Anticoagulants May Increase Their Benefit-Risk Ratio
Authors: Bernier Marjorie , Lancrerot Sarah Line , Parassol Nadège , Lavrut Thibaud , Viotti Julien , Rocher Fanny , Drici Milou-Daniel
Published: June 2020

The attractiveness of direct oral anticoagulants (DOACs) over vitamin K antagonists, in addition to a better benefit-risk ratio, stems from the fact that no therapeutic drug monitoring is deemed necessary. This has been recently mitigated by the fact that increased dabigatran (D) plasma levels have been associated with hemorrhages, and is currently under scrutiny of the European Medicines Agency. We aimed to evaluate, in real conditions of use, whether patients with out-of-range DOAC blood concentrations (too high or too low) were associated with bleeding or thrombosis. Patients treated with D or rivaroxaban (R) were prospectively included in a hospital cohort. D and R plasma levels were measured by high-pressure liquid chromatography—tandem mass spectrometry—at the physician's demand. We defined concentration range as “expected” within the 95% confidence interval of the mean concentration obtained from pivotal trials, and “out of range” when concentrations were outside of that interval. A blind assessment of concentrations versus occurrence of bleeding or thrombosis was performed by means of univariate and multivariate analysis. Three hundred and twenty-two patients (mean age 78.5 years ± 13.1), treated with D or R were included consecutively. They had a mean CHA2DS2-VASc at 4.4 ± 1.7 and a mean HAS-BLED score at 1.7 ± 0.9. Irrespective of the DOAC prescribed, patients presenting with out-of-range concentrations had significantly more bleeding or thrombosis than patients with expected concentrations (P < 0.001). Patients with bleeding were more prone to have concentrations beyond the 95th percentile (N = 62, P < 0.001), whereas patients with thrombosis were more likely to have concentrations below the fifth percentile (N = 26, P < 0.05). The main risks associated with hemorrhages were abnormal concentrations, a high HAS–BLED score, the patient's age, and the creatinine blood level. For thrombosis, a concentration below the fifth percentile was the only risk factor that was significant in our cohort. While D and R under current recommendation have a better benefit-risk ratio than warfarin, their safe usage could be further optimized by some degree of therapeutic monitoring.
Protective Effects of Spermidine Against Cirrhotic Cardiomyopathy in Bile Duct-Ligated Rats
Authors: Sheibani Mohammad , Nezamoleslami Sadaf , Mousavi Seyyedeh E. , Faghir-Ghanesefat Hedyeh , Yousefi-Manesh Hasan , Rezayat Seyed M. , Dehpour Ahmadreza
Published: June 2020

Cirrhotic cardiomyopathy is a critical factor that causes morbidity and mortality in crucial conditions such as liver transplantation. In animal model, the common pathophysiologic mechanisms of cirrhotic cardiomyopathy are similar to those associated with bile duct ligation (BDL). Overproduction of inflammatory and oxidant markers plays a crucial role in cirrhotic cardiomyopathy. Spermidine, a multifunctional polyamine, is known for its antioxidant and anti-inflammatory effects. In this study, we investigated the effects of spermidine on development of cirrhotic cardiomyopathy in BDL rats. Rats were randomly housed in 6 groups. Except the normal and sham groups, BDL was performed for all the control and spermidine groups. Seven days after operation, 3 different doses of spermidine (5, 10 and 50 mg/kg) were administrated until day 28, in spermidine groups. At the end of the fourth week, the electrocardiography (ECG) and papillary muscle isolation were performed. The serum level of tumor necrosis factor-a (TNF-α), interleukin-1β (IL-1β), and IL-10 and cardiac level of superoxide dismutase, glutathione (GSH). and malondialdehyde (MDA) were assessed. Furthermore, the nuclear factor-κB (NF-κB) expression was assessed by western blot. Cardiac histopathological changes were monitored. The serum levels of magnesium (Mg2+) and potassium (K+) were investigated. Control group, exhibited exaggerated signs of cirrhotic cardiomyopathy in comparison with the sham group. Co-administration of spermidine at the dose of 10 mg/kg in BDL rats significantly improved the cardiac condition, reduced the inflammatory mediators, and increased antioxidant enzymes. In addition, the histopathologic findings were in accordance with the other results of the study. Besides, there was no significant alteration in serum levels of Mg2+ and K+. This study demonstrates that spermidine at the dose of 10 mg/kg significantly improved the cirrhotic cardiomyopathy in BDL model in rats.
Effects of Hatha Yoga on Cardiac Hemodynamic Parameters and Physical Capacity in Cardiac Rehabilitation Patients
Authors: Grabara Małgorzata , Nowak Zbigniew , Nowak Agata
Published: June 2020

Purpose:

The purpose of the present study was to assess the effect of hatha yoga training that was added to the standard cardiac rehabilitation (CR) program on the cardiac hemodynamic parameters and physical capacity of patients with ST-elevation myocardial infarction (STEMI).

Methods:

The study included 70 male patients aged 45-65 yr with STEMI who were treated by angioplasty. Patients were randomized to standard CR (control group) versus standard CR plus hatha yoga (experimental group). The training program lasted for a total of 24 d for each patient, with day 1 and day 24 used for medical examinations (electrocardiogram, spiroergometric submaximal treadmill test, and echocardiography). The remaining 22 d consisted of the actual training.

Results:

After the CR program the spiroergometric stress test parameters and left ventricular ejection fraction (LVEF) improved in both the experimental and control groups. The most notable changes in echocardiography parameters and physical capacity were in the experimental group. The results showed significant main effect over time, a time-versus-group interaction in LVEF, the duration of the test, and peak oxygen uptake, and a time-versus-group interaction in metabolic equivalents (METs). We also noted the improvement of left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and heart rate over time.

Conclusion:

The results revealed better effectiveness in the CR program with a modified hatha yoga training program. Hatha yoga training could be recommended as an adjunct to standard CR.
Validity and Reliability of a Brief Dietary Assessment Questionnaire in a Cardiac Rehabilitation Program
Authors: Aberegg Ellen Schaaf , Collins Karen K. , Hinderliter Judith M. , Smalling Sharon L. , Fung Teresa T. , Gizlice Ziya , Johnston Larry F. , Ammerman Alice S. , Keyserling Thomas C.
Published: June 2020

Purpose:

Dietary assessment is vital to inform individualized nutrition care and to evaluate the success of interventions aimed at improving diet for participants in cardiac rehabilitation (CR) programs. The purpose of this study was to assess the validity and reliability of an instrument developed to reflect current evidence-informed dietary recommendations advocated to reduce cardiovascular risk.

Methods:

This study was conducted at a single CR program at the University of North Carolina, Chapel Hill. Two dietary assessments were administered: Picture Your Plate (PYP) and a reference instrument, the Harvard/Willett Food Frequency Questionnaire (HWFFQ). The PYP is a modification of a previously validated instrument, the Dietary Risk Assessment-New Leaf (DRA-New Leaf). Concurrent validity was assessed by comparing the PYP total score with 3 diet quality indexes (Alternative Health Eating Index [AHEI], Dietary Approaches to Stop Hypertension [DASH], and Alternative Mediterranean Diet [aMED]) calculated from the HWFFQ and by assessment of agreement in tertile cross-classification. An intraclass correlation (ICC) was calculated to assess test-retest reliability.

Results:

Among the 108 participants, crude and adjusted Spearmen correlation coefficients between the PYP and 3 indexes of dietary quality were AHEI-2010 (0.71-0.72), DASH (0.70-0.71), and aMED (0.52-0.58) (P < .0001, all comparisons). Agreement of tertiles comparing PYP and AHEI-2010 was 67% and the score in opposite tertiles was 6%. The weighted kappa value (κw) = 0.71. The test-retest ICC was 0.91 (95% CI, 0.85-0.93; n = 91).

Conclusions:

Results support the PYP as a valid and reliable dietary assessment tool for use in CR programs. Continued research in additional CR program populations is recommended.
Interval Versus Continuous Aerobic Exercise Training in Overweight and Obese Patients With Chronic Obstructive Pulmonary Disease
Authors: Ercin Dilek Ozge Zincir , Alkan Hakan , Findikoglu Gulin , Dursunoglu Nese , Evyapan Fatma , Ardic Fusun
Published: June 2020

Purpose:

The aim of this study was to compare the efficacy of the supervised pulmonary rehabilitation programs consisting of either an interval or continuous aerobic exercise program, with a home-based exercise program in patients with chronic obstructive pulmonary disease (COPD) who were overweight or obese.

Methods:

In this randomized controlled study, 72 overweight and obese patients diagnosed as having COPD were randomly assigned to 3 groups. Group 1 received an interval-type (IT) aerobic exercise program, group 2 received a continuous-type (CT) aerobic exercise program (both groups performed home exercises as well) and group 3 was only given a home-based exercise (HE) program. For the evaluation of patients, anthropometric measures, cardiopulmonary exercise testing (CPX), 6-min walk test (6MWT), modified-Borg dyspnea and leg fatigue scores, St George's Respiratory Questionnaire, and Hospital Anxiety and Depression Scale were used.

Results:

Both IT and CT groups showed significant improvement on CPX parameters, 6MWT distances, mental health, and health-related quality of life (HRQoL) compared with the HE group in overweight and obese patients with COPD (P < .001). Moreover, the IT group demonstrated a significant decrease in the modified-Borg dyspnea and leg fatigue during the CPX compared with both CT and HE groups (P < .001). Furthermore, the Borg dyspnea and leg fatigue during training were lower in the IT group than in the CT group (P < .05).

Conclusions:

An interval or continuous aerobic exercise program added onto a home-based exercise program improved exercise capacity and HRQoL, and reduced anxiety and depression levels in overweight and obese patients with COPD.
The Journal of Cardiopulmonary Rehabilitation and Prevention at 40 yr and Its Role in Promoting Preventive Cardiology: Part 2
Authors: Franklin Barry A. , Brubaker Peter , Harber Matthew P. , Lavie Carl J. , Myers Jonathan , Kaminsky Leonard A.
Published: June 2020

Aggressive risk factor modification, including smoking cessation, blood pressure management, and more intensive efforts to control hyperlipidemia, as well as stress management training, are associated with improved cardiovascular outcomes and impressive mortality reductions. This commentary addresses these topics, with specific reference to lifestyle modification and complementary cardioprotective medications.
Feasibility and Efficacy of the Pulmonary Rehabilitation Program in a Rehabilitation Center
Authors: Pancera Simone , Galeri Silvia , Porta Roberto , Pietta Irene , Bianchi Luca Nicola Cesare , Carrozza Maria Chiara , Villafañe Jorge Hugo
Published: June 2020

Details of the Clinical Case:

A 51-yr-old man underwent a respiratory rehabilitation program (RRP), after being tracheostomized and ventilated due to acute respiratory distress syndrome (ARDS) from coronavirus disease-2019 (COVID-19) infection. Respiratory care, early mobilization, and neuromuscular electrical stimulation were started in the ad hoc isolation ward of our rehabilitation center. At baseline, muscle function was consistent with intensive care unit-acquired weakness and the patient still needed mechanical ventilation (MV) and oxygen support. During the first week of RRP in isolation, the patient was successfully weaned from MV, the tracheal cannula was removed, and the walking capacity was recovered. At the end of the RRP, continued in a standard department, respiratory muscles strength increased by 7% and muscle function improved as indicated by the quadriceps size enlargement of 13% and the change of the Medical Research Council sum score from 48/60 to 58/60.

Discussion:

Providing RRP in patients with severe COVID-19 ARDS involves risks for operators and organizational difficulties, especially in rehabilitation centers; nevertheless, its continuity is important to prevent the development of permanent disabilities in previously healthy subjects. Limited to the experience of only one patient, we were able to carry out a safe RRP during the COVID-19 pandemic, promoting the complete functional recovery of a COVID-19 young patient.

Most patients who develop serious consequences of COVID-19 infection risk a reduction in their quality of life. However, by organizing and directing specialized resources, subacute rehabilitation facilities could ensure the continuity of the RRPs even during the COVID-19 pandemic.
Lumbar Discectomy and Reoperation Among Workers’ Compensation Cases in Florida and New York
Authors: Ammerman Joshua M. , Wind Joshua J. , Goldsmith Michael E. , Inzana Jason A.
Published: June 2020

Objective:

The aim of this study was to better understand current treatment trends and revision rates for lumbar disc herniation (LDH) in the workers’ compensation (WC) population compared with other payer types.

Methods:

This was a retrospective analysis of outpatient claims data from Florida and New York during 2014 to 2016.

Results:

WC patients were less likely to undergo discectomy in Florida (15% vs 19%; P < 0.001) and New York (10% vs 15%; P < 0.001). The odds of WC patients undergoing revision discectomy were 1.5 times greater than patients covered by private payers or all other non-WC payers (P = 0.002).

Conclusions:

WC patients undergo discectomy significantly less often than non-WC counterparts, which may be related to a higher risk of reoperation. New evidence-based treatments, such as annular repair, may be critical to advancing care in this unique population.
Employee Musculoskeletal Complaints and Supervisor Support
Authors: Jimmieson Nerina L. , Thorpe Lisa
Published: June 2020

Objective:

This research investigated the moderating role of supervisor support for employees with musculoskeletal complaints and their intentions to seek medical advice; take sick leave; transfer jobs; and resign.

Methods:

Cross-sectional questionnaire data were collected from 1024 Australian employees.

Results:

Regressions with bootstrapping revealed no support for the buffering role of supervisor support. In contrast to expectations, high supervisor support heightened, rather than lowered, musculoskeletal complaints on intentions to transfer jobs. For sick leave and resignation intentions, high supervisor support buffered the negative effects of musculoskeletal complaints for full-timers but exacerbated such intentions for part-timers. Furthermore, full-timers with high musculoskeletal complaints appeared more vulnerable to the exacerbating effects of low supervisor support compared with part-timers.

Conclusions:

Supervisor support for employees with musculoskeletal complaints both weakens and strengthens behavioral stress reactions, depending on employment status.
Procalcitonin Clearance, CD64, and HLA-DR as Predictors of Outcome in Febrile Neutropenic Children With Lymphoreticular Malignancies
Authors: Gomber Sunil , Banerjee Anindya , Dewan Pooja , Das Shukla , Ansari M. Ahmad , Rai Gargi , Singh Praveen
Published: June 2020

Background:

Febrile neutropenia (FN) is a dreaded complication of cancer chemotherapy. There has been a lot of improvement in supportive care in FN that has drastically reduced the infection-related mortality in these patients. The focus now is on reducing infection-related morbidity, healthcare costs and optimizing the quality of life of the child as well as their family during these episodes. In this study, biomarkers were studied as predictors of outcome so that outcome can be predicted earlier, and treatment modified accordingly.

Objective:

To measure procalcitonin levels (at baseline and day 3), procalcitonin clearance, neutrophil CD64 expression levels (at baseline) and monocyte HLA-DR expression levels (at baseline), and their correlation with outcome.

Setting:

Tertiary care hospital.

Study Type:

Cross-sectional observational study.

Population/Participants:

Sixty-five episodes of FN in children below 12 years with lymphoreticular malignancies. Children receiving antibacterial and/or antifungal treatment within the last 7 days were excluded from the study.

Methods:

The subjects recruited into the study had undergone complete clinical and laboratory evaluation as per hospital protocol. Procalcitonin (day 0 and 3), neutrophil CD64 expression, and monocytic HLA-DR expression levels were measured in these patients.

Results:

Sixty-five episodes of FN were studied in children with lymphoreticular malignancy. It was found that procalcitonin and HLA-DR are very good markers of outcome, whereas CD64 although a good marker, was inferior to procalcitonin and HLA-DR in predicting outcome. Procalcitonin clearance was found to be superior to single value of procalcitonin. Furthermore, procalcitonin on day 3 was found to be a better predictor of outcome compared with its baseline value. Also, it was found that procalcitonin and HLA-DR had a significant correlation with baseline C-reactive protein levels.

Conclusions:

On the basis of the findings of the study we suggest that serial monitoring of procalcitonin levels be used in febrile neutropenic children with cancer. Procalcitonin levels on day 3 alone can be offered in resource poor setting. The role of HLA-DR and CD64 also seems promising and needs to be further explored in larger multicentric studies.
Potential Risk Factors Associated With Graft Failure of Haploidentical Hematopoietic Stem Cell Transplantation in Children With Sickle Cell Disease
Authors: Yu Jasmin , Black Vandy , Lamba Jatinder , Horn Biljana
Published: June 2020

Nonmyeloablative (NMA) haploidentical hematopoietic stem cell transplantation for sickle cell disease has significantly increased donor availability for transplant and is increasingly used as curative treatment. The authors describe 3 pediatric patients who rejected grafts after an NMA regimen, previously reported to result in good engraftment rates in the mainly adult population. In this manuscript, potential factors contributing to rejection are described and discussed. The authors emphasize the need to further optimize the NMA regimens in pediatric patients and perform haploidentical transplants for sickle cell disease on clinical trials.
Outcome and Prognostic Factors of Childhood Hodgkin Disease: Experience From a Single Tertiary Center in Thailand
Authors: Chotsampancharoen Thirachit , Chavananon Shevachut , Sripornsawan Pornpun , Duangchu Sarapee , McNeil Edward
Published: June 2020

In childhood, Hodgkin disease (HD) has an excellent outcome in developed countries. There are few studies on outcomes of HD from resource-limited countries. This study aimed to assess clinical outcomes and factors associated with survival rates of childhood HD in a tertiary care center in Thailand. We retrospectively reviewed the medical records of pediatric HD patients between March 1985 and August 2017. Seventy-two children diagnosed with HD were identified. Pretreatment clinical and laboratory factors were assessed by Cox regression analysis to predict event-free survival (EFS) and overall survival (OS). The overall 5-year EFS and OS rate was 70.7% and 75.5%, respectively. Multivariate analysis identified 3 factors predicting inferior EFS: high-risk group (stages III-B, IV-B), splenomegaly, and platelet count >400,000/µL. The prognostic markers were assigned a score of 1 for each factor. For a total score of 0, the 5-year EFS and OS rates were 95% and 86%; scores 2 to 3, 33% and 54%, respectively. In conclusion, our study identified 3 factors predicting inferior EFS. These adverse prognostic factors can be used in clinical practice for predicting outcomes in pediatric HD.
Existence of Helicobacter pylori with low virulence rate in dental plaque and gastric mucosa of patients with periodontal disease
Authors: Ghasemian Abdolmajid , Al-Essa Hussein S. , Jassem Raghed M.
Published: June 2020

Objective:

Helicobacter pylori is associated with gastric and peptic ulcer leading to gastric cancer progress. Gingival teeth grooves among patients with chronic periodontitis can act as reservoirs for H. pylori proliferation. The purpose of our study was assessment the association of H. pylori from dental plaques of patients with periodontitis with gastric colonization.

Methods:

Among patients with periodontitis admitted to dentistry centers, 250 dental plaque and 250 gastric biopsy samples were obtained during 2016–2019. After bacterial identification, virulence genes including cagA, cagT, cagE, vacA and hrgA were screened using PCR technique.

Results:

Fifty and 75 isolates were identified in periodontitis and biopsy specimens, respectively. In periodontitis strains, the rete of cagA, cagT, cagE, vacA and hrgA were as 18 (36%), 15 (30%), 14 (28%), 6 (12%) and 6 (12%), respectively. Among 75 biopsy strains, prevalence of cagA, cagT, cagE, vacA and hrgA were as 28 (34%), 24 (32%), 19 (25.3%), 11 (14.66%) and 7 (0.14%), respectively. There was higher rate of gastric ulcer among ages more than 45 years compared with age ranges 1–15 and 20–45 years (P < 0.01 and P = 0.004, respectively). No significant difference between men and women (35/75 vs. 40/75) was observed.

Conclusion:

Although the prevalence of virulence genes was low among H. pylori strains from dental plaques, a relatively high-density of H. pylori among both sources was considerable. Accordingly, H. pylori possibly spread from dental plaque into gastric mucosa. Furthermore, the possible role of dental plaques among patients with periodontitis as sources for peptic ulcer by pathogenic H. pylori needs more in-depth verifications.
Cardiorespiratory Fitness, Physical Activity, Walking Speed, Lack of Participation in Leisure Activities, and Lung Cancer Mortality
Authors: Lee Junga
Published: June 2020

Background

Lung cancer (LC) is the most common cause of death in cancer patients. The influence of cardiorespiratory fitness (CF) and physical activity (PA) on LC mortality has not previously been investigated.

Objective

The aim of this study was to investigate through a meta-analysis the associations among CF, PA, walking speed, or leisure activity, and LC mortality and all-cause mortality.

Methods

MEDLINE and EMBASE were used to select relevant studies from January 2000 to August 2019. A total of 6 037 058 study subjects from 11 prospective cohort studies were included in this meta-analysis. Pooled relative risks were calculated using fixed and random-effects models to estimate the associations between CF and PA, and LC mortality. In addition, a subgroup analysis was conducted to investigate associations between walking speed and leisure activity, and LC morality.

Results

Greater than 9.45 metabolic equivalents of CF was associated with reduced LC mortality, compared with low-level CF. Participating in more than 150 minutes per week of PA reduced LC mortality. Slower and same walking speed were associated with increased all-cause mortality compared with age-matched individuals. Finally, moderately inactive and inactive levels of leisure activity increased all-cause mortality.

Conclusions

Moderate to high CF and PA were each associated with reduced risks of LC mortality. In addition, slower and same walking speed, and moderately inactive and inactive levels of leisure activity were each associated with increased risks of all-cause mortality.

Implications for Practice

Greater than 9.45 metabolic equivalents of CF, more than 150 minutes per week of PA, fast walking speed, and keeping active should be recommended to increase LC patient survivorship.
Mindful Moms
Authors: Russell Sasha , Aubry Christine , Rider Amy , Mazzeo Suzanne E. , Kinser Patricia A.
Published: June 2020

Background:

Nearly 20% of women in the United States experience depressive symptoms during the perinatal period, with known detrimental effects for the mother, child, and family. Depressive symptoms affect motivation to engage in healthy behaviors and self-management of symptoms.

Purpose:

The purpose of this study was to explore the experiences of women with depressive symptoms who participated in a 12-week mindful physical activity intervention (Mindful Moms) throughout their pregnancy.

Study Design:

In this qualitative study, we explore the lived experience of women with depressive symptoms who participated in Mindful Moms, a self-management intervention involving nurse-led motivational sessions and group-based mindful physical activity (yoga). Methods: Semistructured interviews conducted at approximately 6 weeks postpartum provided rich qualitative data that was analyzed using a phenomenological approach.

Results:

Twenty-five women participated. Findings suggest that participants in Mindful Moms felt empowered to manage their depressive symptoms through the combination of four key factors: a newly recognized need for help, a felt sense of physical and emotional benefit from participation, the power of shared safe space with other pregnant women, support from study staff, and an overall sense of empowerment.

Clinical Implications:

Mindful Moms appears to be a feasible and acceptable approach to enhancing motivation to self-manage depressive symptoms in pregnant women. Nurses working with childbearing women should be aware of the potential benefits of self-management strategies, such as mindful physical activity and motivational interviewing, for women facing perinatal depressive symptoms.
Increased Rate of Complications following Trigger Finger Release in Diabetic Patients
Authors: Federer Andrew E. , Baumgartner Rita E. , Cunningham Daniel J. , Mithani Suhail K.
Published: June 2020

Background:

The purpose of this study was to investigate the impact of diabetes on complications after open trigger finger release compared with a cohort matched for age, sex, race, and body mass index class.

Methods:

A retrospective chart review was performed of diabetic patients who underwent trigger finger release at an academic institution within the past 10 years. Exclusion criteria included rheumatoid arthritis, malignancy, human immunodeficiency virus/acquired immunodeficiency syndrome, connective tissue disorders, or systemic steroid use. These patients were then matched by age, sex, race, and body mass index class to nondiabetic patients who underwent trigger finger release during the same period. One hundred thirty-seven patients met inclusion criteria and were matched with controls. Complications included superficial or deep infection, delayed wound healing, limited range of motion at 6 weeks, pain requiring medication at 6 weeks, and return to the operating room.

Results:

In adjusted analyses, diabetic patients had a significantly higher rate of all-cause complication following trigger finger release compared with matched nondiabetic controls at an odds ratio of 2.1. Diabetic patients also had a significantly higher rate of limitation in postoperative range of motion compared to the controls with an odds ratio of 2.4.

Conclusion:

This retrospective case-control study identified that diabetic patients undergoing trigger finger release are at increased risk of all-cause postoperative complications and, specifically, range of motion limitation when compared with similar patients without diabetes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
The Latest Evolution in Virtual Surgical Planning: Customized Reconstruction Plates in Free Fibula Flap Mandibular Reconstruction
Authors: Lee Z-Hye , Alfonso Allyson R. , Ramly Elie P. , Kantar Rami S. , Yu Jason W. , Daar David , Hirsch David L. , Jacobson Adam , Levine Jamie P.
Published: June 2020

Background:

Virtual surgical planning has contributed to technical advancements in free fibula flap mandible reconstruction. The authors present the largest comparative study on the latest modification of this technology: the use of patient-specific, preoperatively customized reconstruction plates for fixation.

Methods:

A retrospective chart review was performed on all patients undergoing mandibular reconstruction with virtually planned free fibula flaps at a single institution between 2008 and 2018. Patient demographics, perioperative characteristics, and postoperative outcomes were reviewed. Reconstructions using traditional fixation methods were compared to those using prefabricated, patient-specific reconstruction plates.

Results:

A total of 126 patients (mean age, 48.5 ± 20.3 years; 61.1 percent male) underwent mandibular reconstruction with a free fibula flap. Mean follow-up time was 23.5 months. A customized plate was used in 43.7 percent of cases. Reconstructions with patient-specific plates had significantly shorter total operative times compared with noncustomized fixation methods (643.0 minutes versus 741.7 minutes; p = 0.001). Hardware complications occurred in 11.1 percent of patients, with a trend toward a lower rate in the customized plate group (5.5 percent versus 15.5 percent; p = 0.091). Multivariate regression showed that the use of customized plates was a significant independent predictor of fewer overall complications (p = 0.03), shorter operative time (p = 0.014), and shorter length of stay (p = 0.001).

Conclusions:

Compared to traditional fixation methods, patient-specific plates are associated with fewer complications, shorter operative times, and reduced length of stay. The use of customized reconstruction plates increases efficiency and represents the latest technological innovation in mandibular reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Advantages of a Fixation-Free Technique for Open Retromuscular Ventral Hernia Repair
Authors: Etemad Shervin A. , Huang Li-Ching , Phillips Sharon , Stewart Thomas G. , Pierce Richard A. , Schneeberger Steven J. , Poulose Benjamin K.
Published: June 2020

Background:

In open retromuscular ventral hernia repair, fixation-free mesh placement is increasingly prevalent and may minimize pain; the main concern with this technique is short-term technical failure and hernia recurrence. This study compared outcomes following mechanical mesh fixation (i.e., sutures, staples, tacks) versus fixation-free mesh placement.

Methods:

Adults who underwent open, elective, retromuscular ventral hernia repair of 15 cm width or less with permanent synthetic mesh placement in a clean wound were identified. Propensity score matching was used to compare patients who received mechanical mesh fixation to those who received fixation-free mesh placement. Thirty-day hernia recurrence was the primary outcome, with secondary outcomes of 30-day hospital length of stay and 30-day rates of readmission, reoperation, wound events, pain, and abdominal wall function. One- and 2-year composite recurrence and 3-year cumulative composite recurrence were also evaluated.

Results:

A 3:1 propensity score match was performed on 299 fixation-free patients identifying 897 mechanical fixation patients, with a mean body mass index of 31 kg/m2 and mean age of 57.5 years. There was no difference in 30-day recurrence between mechanical and fixation-free approaches (0.2 percent versus 0 percent; p = 1). Median length of stay was longer for mechanical fixation (4 versus 3 days; p = 0.002). In the mechanical fixation group, pain scores were higher (worse pain, 46 versus 44; p = 0.001), and abdominal wall function scores were lower (worse function, 47 versus 60; p = 0.003), with no differences in rates of hospital readmission, reoperation, or wound events. There were no differences in long-term outcomes of 1- and 2-year composite recurrence, or 3-year cumulative composite recurrence.

Conclusion:

For short-term technical durability, fixation-free mesh placement in open retromuscular ventral hernia repair is an acceptable alternative to mechanical fixation for hernia defects of 15 cm or less.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.