bluuebunny/crossref_metadata_2025 huggingface dataset:
Rhizopus Infection in a Preterm Infant: A Novel Use of Posaconazole
Authors: Fatemizadeh Roxana , Rodman Emily , Demmler-Harrison Gail J. , Dinu Daniela
Published: February 2020

Posaconazole is a triazole antifungal with activity against Rhizopus, but data on its use and pharmacokinetics in preterm infants are scarce. In this case, a 24 4/7-week neonate’s Rhizopus infection is successfully treated with debridement and combination antifungal therapy with amphotericin B, micafungin and enteral posaconazole. This is the first reported posaconazole use in a preterm neonate with Rhizopus.
Pediatric HIV Care Cascade in Southern Mozambique: Missed Opportunities for Early ART and Re-engagement in Care
Authors: Fernández-Luis Sheila , Nhampossa Tacilta , Fuente-Soro Laura , Augusto Orvalho , Casellas Aina , Bernardo Edson , Ruperez Maria , Gonzalez Raquel , Maculuve Sonia , Saura-Lázaro Anna , Menendez Clara , Naniche Denise , Lopez-Varela Elisa
Published: February 2020

Background:

There are 170,000 children living with HIV in 2017 in Mozambique. Scaling-up HIV care requires effective retention along the cascade. We sought to evaluate the pediatric cascade in HIV care at the Manhiça District Hospital.

Methods:

A prospective cohort of children <15 years was followed from enrollment in HIV care (January 2013 to December 2015) until December 2016. Loss to follow-up (LTFU) was defined as not attending the HIV hospital visits for ≥90 days following last visit attended.

Results:

From the 438 children included {median age at enrollment in care of 3,6 [interquartile range (IQR): 1.1–8.6] years}, 335 (76%) were antiretroviral therapy (ART) eligible and among those, 263 (78%) started ART at enrollment in HIV care. A total of 362 children initiated ART during the study period and the incidence rate of LTFU at 12, 24, and 36 months post-ART initiation was 41 [95% confidence interval (CI): 34–50], 34 (95% CI: 29–41), and 31 (95% CI: 27–37) per 100 children-years, respectively. Median time to LTFU was 5.8 (IQR: 1.4–12.7) months. Children 5–9 years of age had a lower risk of LTFU compared with children <1 year [adjusted subhazard ratio 0.36 (95% CI: 0.20–0.61)]. Re-engagement in care (RIC) was observed in 25% of the LTFU children.

Conclusions:

The high LTFU found in this study highlights the special attention that should be given to younger children during the first 6 months post-ART initiation to prevent LTFU. Once LTFU, only a quarter of those children return to the health unit. Elucidating factors associated with RIC could help to fine tune interventions which promote RIC.
Epidemiology of Serratia Bloodstream Infections Among Hospitalized Children in the United States, 2009–2016
Authors: Johnson Angelia , Watson Dave , Dreyfus Jill , Heaton Phillip , Lampland Andrea , Spaulding Alicen B.
Published: February 2020

Serratia can cause serious bloodstream infections (BSIs). This retrospective cohort study identified 5,312 pediatric inpatient encounters with BSIs from 2009 to 2016, of which 82 (0.01%) had Serratia BSIs. The rate among hospitalized patients increased significantly from 0.4 in 2009 to 1.0 in 2016 per 10,000 admissions. Risk factors differed and outcomes were worse for Serratia BSIs compared with non-Serratia BSIs.
Endoscopic revision tympanoplasties: our experience
Authors: Sun Yu , Wang Enhao , Yu Jintao , Wang Miao , Kong Weijia , Xiao Hongjun
Published: February 2020

Objective:

The aim of this study was to analyze the outcomes and complications of endoscopic tympanoplasties and review the strategies for endoscopic revision surgeries.

Methods:

Revision endoscopic surgeries are performed on patients with unsatisfactory outcomes after endoscopic tympanoplasties. This study was approved by the Ethics Committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, China (approval No. 2020-0045-1).

Results:

Residual or recurrent tympanic membrane marginal perforation is treated by autogenous fat and cartilage grafting; graft collapse is treated using tissue from the tragus; and graft displacement is treated by endoscopic fixation of the cartilage-perichondrium complex. Lateral healing of the tympanic membrane, prosthesis fracture, prosthesis extrusion, middle ear adhesions, and recurrent perforation also required revision surgeries.

Conclusion:

Residual or recurrent tympanic membrane marginal perforation is the most common cause of unsatisfactory outcomes after endoscopic tympanoplasty; fat grafting is effective only for small perforations. Small cartilage grafts are an effective means of dealing with residual marginal perforation; the cartilage and perichondrium complex should be fixed securely. Patients with prosthesis implants require regular examination.
Cardiovascular Risk and Outcomes in Women Who Have Experienced Intimate Partner Violence
Authors: Liu Xiaoyue , Logan Jeongok , Alhusen Jeanne
Published: February 2020

Background

Cardiovascular disease (CVD) and intimate partner violence (IPV) are 2 major chronic problems that prevalently affect women's health and quality of life in the United States. However, whether female IPV survivors are at risk for developing adverse cardiovascular outcomes has not been clearly understood.

Objective

This integrative review was conducted to bridge the literature gap by examining cardiovascular health in female adults with a history of IPV experience.

Methods

Three electronic databases including PubMed, CINAHL, and Web of Science were used to search for studies published between 1998 and 2019. The search process followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.

Results

Of the 229 records retrieved from the literature, 19 met the criteria for review. All included studies were quantitative research. Although the overall findings showed a mixed relationship between IPV and CVD, women who experienced abuse were more likely to engage in unhealthy behaviors, have higher levels of CVD biomarkers, experience cardiovascular symptoms, and exhibit long-term cardiovascular complications when compared with nonabused women.

Conclusions

Intimate partner violence is a stressor that directly and indirectly influences women's cardiovascular health. Therefore, it is essential for healthcare providers to routinely screen IPV status in clinical practice. Targeted interventions, such as assessing women's coping strategies and evaluating their cardiovascular health using a total risk factor approach, are recommended to prevent or reduce the deleterious effects of violence on this large, vulnerable group of women.
Validity and Reliability of the Caregiver Contribution to Self-Care of Heart Failure Index Version 2
Authors: Vellone Ercole , Barbaranelli Claudio , Pucciarelli Gianluca , Zeffiro Valentina , Alvaro Rosaria , Riegel Barbara
Published: February 2020

Background

Lay caregivers are important in contributing to self-care of patients with heart failure (HF). The Caregiver Contributions to Self-Care of Heart Failure Index (CC-SCHFI) measures these contributions, but after developing the Situation-Specific Theory of Caregiver Contributions to Heart Failure Self-Care, the CC-SCHFI needed updating to reflect the theory.

Objective

The aim of this study was to test the psychometric characteristics of the CC-SCHFI 2 that measures caregiver contributions (CC) to HF self-care with 3 scales: CC to self-care maintenance, CC to symptom perception, and CC to self-care management.

Methods

This is a cross-sectional study. We tested the CC-SCHFI 2 with confirmatory factor analysis, internal consistency, item-total correlations, and test-retest reliability. With the CC-SCHFI 2, we also administered the Self-Care of Heart Failure Index v.7.2 to patients and the Caregiver Contribution to Heart Failure Self-Care Scale to caregivers to assess concurrent validity.

Results

A sample of 277 caregivers was enrolled (mean [SD] age, 52.7 [14.9] years; 70.4% female). In confirmatory factor analysis, each CC-SCHFI 2 scale had supportive fit indices: comparative fit index ranged between 0.94 and 0.95, and root mean square error of approximation ranged between 0.05 and 0.07. Internal consistency of the 3 scales was evident with a Cronbach α between .81 and .83 and a global reliability index between 0.79 and 0.86. Item-total correlations were all greater than 0.30. In concurrent validity testing, there were significant correlations between the CC-SCHFI 2 and the Self-Care of Heart Failure Index v.7.2 and the Caregiver Contribution to Heart Failure Self-Care Scale. Test-retest reliability showed intraclass correlation coefficients between 0.72 and 0.91.

Conclusions

Testing of the CC-SCHFI 2 supported validity and reliability, indicating that the instrument can be used in clinical practice and research to evaluate CC to the self-care of patients with HF.
Assessing Gait After Changing Prosthetic Foot: Contribution of Subjective and Objective Measurements. A Pilot Study
Authors: Gouteron Anaïs , Casillas Jean-Marie , Calistri Laurine , Morisset Claire , Laroche Davy , Gueugnon Mathieu
Published: February 2020

Introduction

Although the choice of a prosthetic foot is crucial for the locomotion of individuals with limb loss, it partly reposes on the subjective perception of the patient without evaluating systematically the objective foot performance in gait laboratory. However, it is still unclear whether subjective perception is sufficient to evaluate foot performance and if it is in accordance with objective foot performance during gait.

Materials and Methods

We aimed to address these questions by asking five unilateral transtibial prosthesis users to rate their habitual energy-storage-and-return foot (ESAR foot) and a new ESAR foot and to perform a three-dimensional gait analysis with each foot.

Results

Our results revealed that perception is globally associated with objective gait performance. More specifically, gait stability seems to be the most relevant parameter for patient perception.

Conclusions

This pilot study highlights the value of the subjective perception for the fitting of a prosthetic foot and suggests that pooling together subjective and objective evaluations provides substantial benefit.
Evaluation of Semicircular Canal Function by Video Head Impulse Test in Patients With Facial Nerve Schwannoma
Authors: Fujiwara Keishi , Morita Shinya , Furuta Yasushi , Yanagi Hiroko , Hoshino Kimiko , Fukuda Atsushi , Nakamaru Yuji , Homma Akihiro
Published: February 2020

Objectives:

The aim of the present study was to evaluate semicircular canal function by video Head Impulse Test (vHIT) in patients with facial nerve schwannoma (FNS).

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Seven patients with FNS underwent vHIT examination.

Main Outcome Measures:

The gain in vestibulo-ocular reflex and the presence of catch-up saccade were examined for the semicircular canals including the vertical canals.

Results:

Dysfunction of the semicircular canals was detected by vHIT in three of seven cases. Nystagmus beating toward the non-affected side was observed in all three cases with semicircular canal dysfunction. Dysfunction was observed in a case with no direct compression of the vestibular nerve or semicircular canals by FNS.

Conclusions:

Semicircular canal function in patients with FNS could be evaluated by vHIT. vHIT has two advantages for the evaluation of vestibular function in patients with FNS. First, vHIT could be used for the patients in whom a tumor exists in the external auditory canal or middle ear, unlike caloric testing. Second, as vHIT could evaluate all three canals, impaired vestibular nerves could be speculated from vHIT results when a tumor exists in internal auditory canal. vHIT should be performed in patients with FNS, especially before surgery, to evaluate vestibular function.
Active Transcutaneous Bone Conduction Implant: Audiometric Outcomes Following a Novel Middle Fossa Approach With Self-Drilling Screws
Authors: Siegel Lauren , You Peng , Zimmerman Kim , Parnes Lorne , Agrawal Sumit K.
Published: February 2020

Objective:

To present surgical and audiometric outcomes of patients implanted with an active transcutaneous bone conduction implant following the novel middle fossa surgical approach with self-drilling screws.

Study Design:

Retrospective review.

Setting:

Tertiary care center.

Patients:

Thirty-seven adults with either conductive or mixed hearing loss that met indications for an active transcutaneous bone conduction implant were consecutively implanted from April, 2013 to May, 2018.

Intervention:

Unilateral middle fossa implantation of an active transcutaneous bone conduction implant.

Main Outcome Measures:

Patient charts were reviewed for surgical outcomes and complications over the 6-year period. Preoperative air conduction, preoperative bone conduction, and 3-month postoperative aided thresholds were recorded. Speech perception was assessed using CNC words and AzBio sentences. Pure-tone averages (PTAs; measured at 0.5, 1.0, 2.0 and 3.0 kHz), air-bone gap, and functional gain were calculated.

Results:

Mean air conduction and bone conduction PTAs (±standard deviation) of the implanted ear were 66.8 dB (±14.9 dB) and 21.9 dB (±14.0 dB), respectively. Mean aided PTA was 26.5 dB (± 8.5 dB). The average functional gain was 40.3 dB (±19.0 dB). Favorable speech perception outcomes were observed. No complications or instances of revision surgery were reported, with a mean follow-up time of 32 months (range, 9–71 mo).

Conclusions:

This is the first paper to describe outcomes of patients implanted with an active transcutaneous bone conduction implant via the middle fossa with self-drilling screws. Favorable surgical outcomes were observed with a follow-up of up to 6 years.
Loss of Pulsatility: Another Cause of Syncope in Patients with Left Ventricular Assist Devices
Authors: Money Joel E. , Al Danaf Jad , Nelson Marisca , Mckellar Stephen H. , Drakos Stavros G. , Kemeyou Line
Published: February 2020

We report a case of a 55-year-old man who presented with recurrent syncope 15 months after HeartWare left ventricular assist device (LVAD) implantation and was found to have diminished LVAD flow and pulsatility on tilt table testing leading to severe orthostatic hypotension (OH). The prevalence of OH is common, but autonomic dysfunction leading to OH has not been well described in patients with chronic LVAD support. The diagnosis of OH in this setting is challenging due to the decreased pulsatility in the flow generated by LVADs, and tilt table testing can be useful in the evaluation of OH in these patients.
Association between vitamin D and prediabetes
Authors: Yu Lu , Zhai Yu , Shen Shanmei
Published: February 2020

Background:

Previous studies showed conflicting results for associations between vitamin D and prediabetes. The study aimed to make a systematic review and meta-analysis for the association between vitamin D and prediabetes.

Methods:

We searched for articles identifying associations between vitamin D and prediabetes published in English until July 2019 in following databases (PubMed, Web of Science, EMBASE, Medline, Google Scholar, and Cochrane databases). Finally, we conducted these analyses (heterogeneities examination, meta-regression analyses, sensitivity analysis, and publication bias examination) using STATA 12.0 software (Stata Corporation, College Station, TX, USA). Q test and I
2 were applied to examine heterogeneities between studies.

Results:

Twelve studies were finally included in the present study. The study included 4 studies to explore the association between serum levels of 25-hydroxy (OH) vitamin D and risks of prediabetes (including 3094 participants). Additionally, the present study included 8 studies (including 865 individuals with prediabetes treated with vitamin D supplementation and 715 patients treated with placebo) to assess differences in therapeutic effects between individuals with prediabetes treated with vitamin D supplementation and those treated with placebo. The present study showed no significant associations between low serum levels of 25(OH) vitamin D and high risk of prediabetes. Additionally, the study showed no significant differences in changes of hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and homeostatic model assessment of insulin resistance (HOMA-IR) between individuals with prediabetes treated with vitamin D and those patients given placebo, whereas meta-analysis showed significantly greater changes in 2-hour oral glucose tolerance test (2HPG) in individuals with prediabetes treated with vitamin D, compared with individuals with prediabetes treated with placebo.

Conclusion:

The study supported that low serum levels of 25(OH) vitamin D increased the risk of prediabetes. In addition, vitamin D supplementation improves impaired glucose tolerance in prediabetes. However, more large-scale clinical trials are essential to explore the association between vitamin D and prediabetes.
Tamoxifen-related endocrine symptoms in Chinese patients with breast cancer
Authors: Chan Carmen Wing Han , Miaskowski Christine , McCarthy Alexandra , Waye Mary Miu Yee , Yeo Winnie , So Winnie Kwok Wai , Choi Kai Chow , Tsui Stephen Kwok Wing , Chan Judy Yuet Wa
Published: February 2020

Background:

Breast cancer is the most prevalent cancer in females and disease recurrence remains a significant problem. To prevent recurrence, tamoxifen is prescribed for at least 5 years. However, among patients who receive tamoxifen, individual responses are highly variable. These responses are affected by the type, frequency, and severity of endocrine symptoms, as well as adherence rates. Polymorphisms in genes involved in the metabolism of tamoxifen (ie, CYP3A4, CYP2D6) may influence responses to tamoxifen. In this study, the inter-relationships among endocrine symptoms, drug adherence, and genetic polymorphisms in Chinese breast cancer patients receiving tamoxifen therapy will be examined. We hypothesize that patients with more severe endocrine symptoms will be less likely to adhere to tamoxifen treatment. In addition, we hypothesize that a relationship will exist between the severity of tamoxifen-induced symptoms and allelic variations in tamoxifen metabolism-related genes. Although many association studies have determined that select genotypes influence the efficacy of tamoxifen, very few studies have investigated for associations between tamoxifen-induced endocrine symptoms and these polymorphisms.

Objectives:

The aim of this study was to characterize genetic polymorphisms in tamoxifen metabolism-associated genes in Chinese women with breast cancer and to explore the inter-relationships between genetic polymorphisms, endocrine symptoms, and adherence to tamoxifen.

Method:

We will conduct a prospective cohort study that follows 200 Chinese women over 18 months and assess treatment-related symptoms and genetic variations. Endocrine symptoms and drug adherence will be determined through interview-administered standardized questionnaires. Polymorphisms in drug metabolism genes will be determined using real-time polymerase chain reaction based genotyping method. Data will be analyzed to determine associations between allelic variations, endocrine symptoms, and adherence.

Discussion:

The proposed study will evaluate for polymorphisms in gene(s) that are associated with tamoxifen-related endocrine symptoms and adherence with tamoxifen. We will explore the relationships between genotypes, endocrine symptoms, and drug adherence in Chinese breast cancer patients. Findings from this study may assist clinicians to identify patients at higher risk for a worse symptom experience and lower adherence rates and enable them to initiate appropriate interventions. In the long term, the findings from this study may be used to develop and test tailored symptom management interventions for these patients.
Unrestricted use of polymer-free sirolimus eluting stents in routine clinical practice
Authors: Krackhardt Florian , Kočka Viktor , Waliszewski Matthias , Toušek Petr , Janek Bronislav , Trenčan Milan , Krajči Peter , Lozano Fernando , Roman Koldobika Garcia-San , Otaegui Imanol , del Blanco Bruno Garcia , del Olmo Victoria Vilalta , Nofrerías Eduard Fernandez , Wachowiak Lucie , Heang Tay Mok , Ahn Tae Hoon , Jeong Myung Ho , Jung Byung-Chun , Han Kyu-Rock , Piot Christophe , Sebagh Laurent , Rischner Jérôme , Pansieri Michel , Leschke Matthias
Published: February 2020

Stent designs with ultrathin struts may further increase the procedural success of challenging lesion subsets. The objective of this study was to assess the safety and efficacy of ultrathin strut, polymer-free sirolimus eluting stent (PF-SES) implantations in a large scale, unselected patient population.

Adult patients underwent percutaneous coronary interventions (PCI) with a thin-strut PF-SES. Data from two all-comers observational studies having the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled. The accumulated target lesion revascularization (TLR) rate at 9-12 months was the primary endpoint. All dual antiplatelet therapy strategies according to the applicable guidelines were permissible.

In total, 7243 patients were prospectively enrolled for PCI with PF-SES in stable coronary artery disease or acute coronary syndrome (ACS). Major risk factors in the overall cohort were diabetes (37.3%), ST elevation myocardial infarction (18.1%) and non-ST myocardial infarction (24.6%). The follow-up rate was 88.6% in the overall population. The TLR rate in the overall cohort was 2.2% whereas definite/probable stent thrombosis (ST) occurred in 0.7%. In patients with in-stent restenosis lesions, the major adverse cardiac events rate was 6.4% whereas the corresponding rate for isolated left main coronary artery (LMCA) disease was highest with 6.7% followed by patients with culprit lesions in vein bypasses (VB, 7.1%). The mortality rate in patients treated in VB lesions was highest with 5.4%, followed by the isolated LMCA subgroup (3.4%) and ACS (2.6%).

PCI with PF-SES in an unselected patient population, is associated with low clinical event and ST rates. Furthermore, PF-SES angioplasty in niche indications demonstrated favorable safety and efficacy outcomes with high procedural success rates.
Interventions aimed at loneliness and fall prevention reduce frailty in elderly urban population
Authors: Ožić Sanja , Vasiljev Vanja , Ivković Vanja , Bilajac Lovorka , Rukavina Tomislav
Published: February 2020

Frailty is a pronounced symptom of aging associated with multiple comorbid states and adverse outcomes. The aim of this study was to evaluate the impact of 2 interventions, one based on prevention of falls and the other on prevention of loneliness, on total frailty and dimensions of frailty in urban community-dwelling elderly as well as associations with independent living.

This prospective interventional study followed up 410 persons aged 75 to 95. The participants of the control and intervention groups were monitored through a public health intervention programme. The level of frailty was measured by the Tilburg Frailty Indicator (TFI) questionnaire and the factors of independent living were analyzed using validated questionnaires.

After 1 year, physical frailty measured in the control group showed a statistically significant increase (r = −0.11), while in the intervention groups physical frailty did not increase (both P > .05). Psychological frailty measured after 1 year in the control group was significantly higher (r = −0.19), as well as in the group where the public health interventions to reduce loneliness were carried out (r = −0.19). Psychological frailty did not increase in the group in which public health interventions to prevent falls were carried out, and social frailty did not increase at all in the study period. The total level of frailty in the control group after 1 year was significantly increased (r = −0.19), while no increase was seen in the overall frailty in the intervention group. Multivariate analysis has shown that both interventions where independently associated with lower end frailty. Additionally, higher baseline frailty and visit to a physician in the last year were positively associated with higher end-study frailty level, while higher number of subjects in the household and higher total psychological quality of life (SF-12) were independently associated with lower end-study frailty. Only in the prevention of falls group there was no increase in restriction in the activities of daily living throughout study follow-up.

Public health interventions to prevent falls and to prevent loneliness have a positive effect on the frailty and independent living of the elderly living in their own homes in an urban community.
The circ_VCAN with radioresistance contributes to the carcinogenesis of glioma by regulating microRNA-1183
Authors: Zhu Chengbin , Mao Xinhui , Zhao Hui
Published: February 2020

Circular RNAs (circRNAs), a widespread type of noncoding RNA, are produced by reverse splicing with a circular loop structure. Circ_VCAN (hsa_circ_0073237) acts as a novel circRNA, although its roles in the progression and radioresistance of glioma remain unknown.

Expressions of circ_VCAN and microRNA-1183 (miR-1183) were analyzed by quantitative real-time PCR, and the functions of circ_VCAN and irradiate in glioma cell proliferation, apoptosis, migration, and invasion were assessed using cell counting kit-8, flow cytometry, Wound healing, and Transwell assays. The interaction between circ_VCAN and miR-1183 was validated dual-luciferase reporter assay.

Our results revealed that circ_VCAN was significantly upregulated in radioresistant glioma tissues compared with radiosensitive tissues, and that circ_VCAN expression was negatively correlated with miR-1183 expression in glioma tissues. We also determined that circ_VCAN expression was decreased and miR-1183 expression was increased in U87 and U251 cells after irradiation. Both knockdown of circ_VCAN and treatment with miR-1183 mimics inhibited proliferation, migration, and invasion, and accelerated apoptosis of the irradiated U87 and U251 cells. In addition, luciferase reporter assays revealed that circ_VCAN might function as a sponge for miR-1183. Finally, overexpression of circ_VCAN expedited carcinogenesis and reduced glioma radiosensitivity by regulating miR-1183.

Circ_VCAN serves as a potential oncogene of glioma by regulating miR-1183, and plays an essential role in the radioresistance of glioma.
Treatment of lateral epicondylitis with acupuncture and glucocorticoid
Authors: Peng Zhiyou , Zhang Mei , Li Yunze , Feng Zhiying
Published: February 2020

Lateral epicondylitis (LE) is a common musculoskeletal disorder for which an effective treatment strategy remains unknown. The goal of this study is to examine whether acupuncture is more effective than injection of glucocorticoid in adults with LE.

Adults with LE received either acupuncture or injection of glucocorticoid were followed-up for 6 months. All patients assessed before treatment, 0, 3 months, and 6 months after the therapy. Outcome measures consisted of visual analog scores (VAS) and the Mayo elbow performance score (MEPS).

The acupuncture group and the corticosteroid group did not differ on demographic or clinical characteristics (P < .05). VAS and MEPS score was not significantly different between 2 groups at 0 and 3 months. MEPS scores were significantly lower in the corticosteroid group at 6 months, compared with those in the acupuncture group (P < .05). However, the VAS score was not significantly different (P > .05). There were no complications related to the use of acupuncture or corticosteroid injection.

We found that both methods were effective for external humeral epicondylitis. However, after 6 months of treatment, patients with chronic LE with acupuncture achieved pain relief and function improve significantly, exceeding the effect of corticosteroid injection.
The maximum standardized uptake value and extent of peritoneal involvement may predict the prognosis of patients with recurrent ovarian cancer after primary treatment
Authors: Jiang Yuanyuan , Hou Guozhu , Wu Fengyu , Zhu Zhaohui , Zhang Wei , Cheng Wuying
Published: February 2020

We investigated the effect of the maximum standardized uptake value (SUVmax) and peritoneal dissemination derived from 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging on prognosis in patients with recurrent ovarian cancer.

We retrospectively analyzed 145 patients with suspected recurrent ovarian cancer who had undergone 18F-FDG PET/CT scans after cytoreductive surgery and chemotherapy. The degree of peritoneal spread was classified as localized (1–3 FDG foci) or diffuse (>3 FDG foci). Receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off values for predicting recurrence.

A total of 145 patients were retrospectively reviewed in this study. 29 patients were excluded as their follow-up results were not available. One hundred sixteen patients were included in the final analysis. The median duration of progression-free survival was 14 months. 18F-FDG PET/CT detected peritoneal carcinomatosis in 82 patients. With a cut-off SUVmax of 2.0 obtained from the ROC curve analysis, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SUVmax of peritoneal carcinomatosis for predicting recurrence were 77.6%, 87.5%, 65.1%, 97.4%, and 38.9%, respectively. The area under the curve was 0.85. In a multivariate analysis, significant independent prognostic variables were SUVmax of peritoneal disease, peritoneal dissemination, and CA125 levels. In patients with peritoneal involvement, the Kaplan-Meier survival curves showed significantly longer PFS in those with localized disease.

SUVmax of peritoneal disease is valuable in predicting the recurrence of ovarian cancer. SUVmax of peritoneal disease, peritoneal dissemination and CA125 level could be used as independent prognostic factors for ovarian cancer patients.
Total bile acid-to-cholesterol ratio as a novel noninvasive marker for significant liver fibrosis and cirrhosis in patients with non-cholestatic chronic hepatitis B virus infection
Authors: Yan Li-Ting , Wang Li-Li , Yao Jia , Yang Ya-Ting , Mao Xiao-Rong , Yue Wei , Mao Yong-Wu , Zhou Wei , Chen Qing-Feng , Chen Yu , Duan Zhong-Ping , Li Jun-Feng
Published: February 2020

Although serum bile acids and total cholesterol (TC) are closely related to liver cirrhosis, the potential diagnostic value of total bile acid-to-cholesterol ratio (TBA/TC) for liver fibrosis is unclear. The present study aimed to evaluate the value of TBA/TC in the diagnosis of cirrhosis and the relationship between TBA/TC and significant liver fibrosis in chronic hepatitis B virus (HBV) infected patients without cholestasis.

667 patients with alkaline phosphatase (ALP) ≤ 1.5 upper limit of normal (ULN) and gamma-glutamyl transferase (GGT) ≤ 3 ULN were rigorously included in this cross-sectional study. Liver biopsy was performed in 32 patients and METAVIR scoring system was used to evaluate liver fibrosis stage. Liver ultrasound elastography was performed in 138 patients, significant fibrosis was defined as fibrosis ≥ F2. Multiple logistic regression as well as receiver operating characteristic (ROC) curves analyses were performed.

Compared to patients with non-cirrhosis, TBA and TBA/TC were significantly higher in cirrhosis while TC was significantly lower (all P < .001). In multivariate analysis, TBA/TC was also independently associated with cirrhosis [odds ratio (OR) = 1.102, 95% confidence interval (CI): 1.085–1.166]. The area under the curve (AUC) of TBA/TC (0.87) was almost equivalent to the aspartate aminotransferase to platelet ratio index (APRI, AUC = 0.84) and fibrosis 4 score (FIB-4, AUC = 0.80), and the optimal cut-off value for TBA/TC to diagnose cirrhosis was 2.70. Among the patients performed liver biopsy, TBA/TC were significantly higher both in significant fibrosis and cirrhosis as well as significantly correlated with fibrosis stage (all P < .001). Furthermore, In patients performed liver ultrasound elastography, TBA/TC was also independently associated with significant fibrosis (OR = 1.040, 95% CI: 1.001–1.078).

Assessment of TBA/TC could serve as an additional marker of significant liver fibrosis and cirrhosis in non-cholestatic chronic HBV infection.
Characteristics of Stenotrophomonas maltophilia infection in children in Sichuan, China, from 2010 to 2017
Authors: Wang Lili , Zhou Wei , Cao Yang , Yang Chunsong , Liu Hanmin , Chen Ting , Chen Lina
Published: February 2020

Stenotrophomonas maltophilia (S. maltophilia) is an important nosocomial bacterial pathogen. However, the clinical features of children with S. maltophilia infection, the predisposing factors, and the antibiotic susceptibility of the bacteria have not been fully evaluated.

In this study, the data of children with S. maltophilia infection from the West China Second University Hospital of Sichuan University (Chengdu, China) between July 2010 and October 2017 were collected and analyzed. The clinical features of enrolled children, the predisposing factors, and the antibiotic susceptibility were reported.

In total, infection of S. maltophilia was identified in 128 patients. Most of these patients were under 1 year old (67.2%) and were mainly diagnosed as pneumonia (69%). A large proportion had underlying diseases (45.3%), received immunosuppressive therapy (53.1%), had undergone invasive operations (41.4%), had a history of carbapenem antibiotics use within 7 days before culture acquisition (54.7%), history of intensive care unit (ICU) hospitalization within previous 30 days (34.4%), and other risk factors. In particular, invasive operation (95% confidence interval [CI]: 1.125–14.324, P = .032), especially mechanical ventilation (95% CI: 1.277–20.469, P = .021), and ICU admission (95% CI: 1.743–22.956, P = .005) were independent risk factors for the children to develop severe S. maltophilia infection. As for antibiotic susceptibility, trimethoprim sulfamethoxazole (TMP-SMX), piperacillin tazobactam, ticarcillin clavulanate, and ceftazidime exhibited strong antibacterial activities against S. maltophilia, the susceptibility rates were 97.5%, 86.7%, 92.9%, and 81.5%, respectively.

We report the clinical features of children with S. maltophilia infection, the predisposing factors and the antibiotic susceptibility. TMP-SMX can continue to be the first choice for the treatment of S. maltophilia infection. Piperacillin tazobactam, ticarcillin clavulanate, and the third generation cephalosporins can be used as alternative drugs.
Latent composite indicators for evaluating adherence to guidelines in patients with a colorectal cancer diagnosis
Authors: Murtas Rossella , Decarli Adriano , Greco Maria Teresa , Andreano Anita , Russo Antonio Giampiero
Published: February 2020

Evidence-based guidelines for the correct management of cancer patients are developed on the idea that timely care can improve health prognoses and quality of life.

The aim of this paper is to evaluate the adherence of clinical pathways to clinical guidelines provided at the hospital level, for colorectal cancer care.

By using a retrospective observational study, we proposed a method for associating each patient to a healthcare provider and modeling adherence as a latent construct governed by a set of 10 influential indicators. These indicators measure the adherence to specific guidelines for diagnosis, surgical treatment, chemotherapy, and follow-up. The model used was that of the item response theory (IRT). When evaluating providers, the IRT allows for a comparison of indicators in terms of their discriminating ability and difficulty, and in terms of their adherence to guidelines. The IRT results were compared with non-latent methods: numerator-based weight and denominator-based weight.

A strong degree of coherence of the indicators in measuring adherence, and a high level of overall agreement between latent and non-latent methods were noted. The IRT approach demonstrated similar providers’ evaluations between endoscopy and histological assessment indicators. The greatest discriminating ability among providers could be attributed to all diagnostic exams, while the lowest was associated with follow-up endoscopies. The most difficult indicator to achieve was fecal occult blood test, while follow-up imaging was the easiest.

In a decision-making framework, valuable indications can be derived from the use of IRT models rather than weighting methods. Using IRTs, we were able to highlight the principal indicators in terms of strength of discrimination, and to isolate those that merely duplicated information.
Lifelong pulmonary sequelae of bronchopulmonary dysplasia
Authors: Sillers Laura , Alexiou Stamatia , Jensen Erik A.
Published: February 2020

Purpose of review

To summarize the current literature evaluating long-term pulmonary morbidity among surviving very preterm infants with bronchopulmonary dysplasia (BPD).

Recent findings

BPD predisposes very preterm infants to adverse respiratory signs and symptoms, greater respiratory medication use, and more frequent need for rehospitalization throughout early childhood. Reassuringly, studies also indicate that older children and adolescents with BPD experience, on average, similar functional status and quality of life when compared to former very preterm infants without BPD. However, measured deficits in pulmonary function may persist in those with BPD and indicate an increased susceptibility to early-onset chronic obstructive pulmonary disease during adulthood. Moreover, subtle differences in exercise tolerance and activity may put survivors with BPD at further risk of future morbidity in later life.

Despite advances in neonatal respiratory care, a diagnosis of BPD continues to be associated with significant pulmonary morbidity over the first two decades of life. Long-term longitudinal studies are needed to determine if recent survivors of BPD will also be at increased risk of debilitating pulmonary disease in adulthood.
The Discharge Lounge
Authors: Woods Rebecca , Sandoval Rebecca , Vermillion Gregory , Bates-Jackson Brenda , Nwankwo Audrey , Canamar Catherine P. , Sarff Laura
Published: February 2020

Background:

Patient flow, from emergency department admission through to discharge, influences hospital overcrowding. We aimed to improve patient flow by increasing discharge lounge (DL) usage.

Local problem:

Patients need to receive a continuum of nursing care to encourage compliance with follow-up care after discharge from the acute care setting.

Methods:

Baseline data revealed inefficient use of the DL. We targeted the medical-surgical unit with the lowest DL use and trialed interventions over sequential Plan-Do-Study-Act cycles.

Interventions:

After surveying the nursing staff, we assessed the influence of 3 interventions on DL usage: educating staff on patient eligibility, engaging a recruitment scout, and displaying a visual cue notifying staff when a patient's discharge order was written.

Results:

The unit's average DL use increased from 18% to 36%, while hospital overcrowding and discharge turnaround time decreased.

Conclusion:

The DL is an effective tool to improve patient flow and decrease hospital overcrowding.
Outpatient vs Inpatient Total Laparoscopic Hysterectomy: A Randomized Controlled Trial
Authors: Christiansen Ulla J. , Kruse Anne R. , Olesen Peter G. , Lauszus Finn F. , Kesmodel Ulrik S. , Forman Axel
Published: February 2020

(Abstracted from Acta Obstet Gynecol Scand 2019;98:1420–1428)

The minimal invasive procedure, laparoscopic hysterectomy, is safe, has low risk of complications, and requires only a short hospital stay. Within the first 4 weeks after surgery, readmission rates as low as less than 4% have been reported.
Association of Revised WIC Food Package With Perinatal and Birth Outcomes: A Quasi-Experimental Study
Authors: Hamad Rita , Collin Daniel F. , Baer Rebecca J. , Jelliffe-Pawlowski Laura L.
Published: February 2020

(Abstracted from JAMA Pediatr 2019;173(9):845–852)

In October 2009, the US Department of Agriculture revised the Special Supplement Nutrition Program for Women, Infants, and Children (WIC). This federal program provides nutritional support, education, breastfeeding support, and referrals to low-income pregnant women, postpartum women, and children younger than 5 years of age.
Efficacy of Repeat Midurethral Sling for Persistent or Recurrent Stress Urinary Incontinence: A Fellows Pelvic Research Network Study
Authors: Smithling Katelyn R. , Adams-Piper Emily E. , Tran Alexis M. , Davé Bhumy A. , Chu Christine M. , Chan Robert C. , Antosh Danielle D. , Gutman Robert E.
Published: February 2020

(Abstracted from Female Pelvic Med Reconstr Surg 2019;25:430–433)

The criterion-standard treatment for stress urinary incontinence (SUI) is midurethral slings (MUSs) because of high success rates, ease of placement, and durability. However, SUI recurs or persists in up to 23% of patients, and there are only limited data on the efficacy of repeat MUS.
Elevated Plasma Levels of sCD14 and MCP-1 Are Associated With HIV Associated Neurocognitive Disorders Among Antiretroviral-Naive Individuals in Nigeria
Authors: Jumare Jibreel , Akolo Christopher , Ndembi Nicaise , Bwala Sunday , Alabi Peter , Okwuasaba Kanayo , Adebiyi Ruxton , Umlauf Anya , Cherner Mariana , Abimiku Alash'le , Charurat Man , Blattner William A. , Royal Walter
Published: February 2020

Background:

Mononuclear cells play key roles in the pathogenesis of HIV-associated neurocognitive disorders (HAND). Limited studies have looked at the association of markers of monocyte activation with HAND in Africa. We examined this association among HIV-1–infected patients in Nigeria.

Method:

A total of 190 HIV-infected treatment-naive participants with immune marker data were included in this cross-sectional study. Plasma levels of soluble CD14 (sCD14), soluble CD163, monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-alpha (TNF-α), and neopterin were measured. Demographically adjusted T scores obtained from a 7-domain neuropsychological test battery were generated, and functional status was assessed using activities of daily living questionnaire. Participants were classified as unimpaired, having asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), or HIV-associated dementia (HAD) in line with the “Frascati” criteria.

Results:

Thirty-two participants (16.8%) had ANI, 14 (7.4%) had MND, whereas none had HAD. In multivariable linear regression analyses, after adjusting for age, gender, education, CD4 count, and viral load, mean levels of sCD14 were higher among those with ANI and MND as compared with the unimpaired (P = 0.033 and 0.023, respectively). Similarly, the mean level of MCP-1 was greater among those with HAND as compared with the unimpaired (P = 0.047). There were also trends for higher levels of sCD163 and TNF-α among females with MND in univariable analyses.

Conclusions:

Levels of monocyte activation markers correlate with the severity of impairment among individuals with HAND. The mechanisms that underlie these effects and the potential role of gender require further study.
The Impact of a Structured, Supervised Exercise Program on Daily Step Count in Sedentary Older Adults With and Without HIV
Authors: Stabell Alex C. , Wilson Melissa , Jankowski Catherine M. , MaWhinney Samantha , Erlandson Kristine M.
Published: February 2020

Background:

People with HIV (PWH) may have lower daily activity levels compared with persons without HIV. We sought to determine the impact of initiating a supervised exercise program on the daily step count of sedentary PWH and uninfected controls.

Methods:

PWH and controls, aged 50–75, were enrolled in a 24-week supervised exercise program. All individuals were given a pedometer and instructed in regular use. A linear mixed model taking into account random effects was used to model daily step count.

Results:

Of 69 participants that began the study, 55 completed and 38 (21 PWH, 17 controls) had complete pedometer data. Baseline daily step count on nonsupervised exercise day was (estimated geometric mean, 95% confidence interval) 3543 (1306 to 9099) for PWH and 4182 (1632 to 10,187) for controls. Both groups increased daily steps on supervised [43% (20 to 69)%, P < 0.001] but not unsupervised exercise days [−12% (−24 to 1)%, P = 0.071]. Compared with controls, PWH had 26% [(−47 to 4)%, P = 0.08] fewer daily steps on days with supervised exercise and 35% [−53 to −10)%, P = 0.011] fewer daily steps on days without supervised exercise. Higher body mass index (per 1 unit) and smoking were associated with fewer daily steps [−5% (−9 to −1)%; −49% (−67 to −23)%; P ≤ 0.012]. Days with precipitation [−8% (−13 to −3)%, P = 0.002] or below freezing [−10% [−15 to −4)%, P < 0.001] were associated with fewer steps.

Conclusion:

Supervised exercise increased daily step counts in sedentary individuals, but at the expense of fewer steps on nonsupervised exercise days.
Brief Report: Long-Term Follow-up of Smokers Living With HIV After an Intensive Behavioral Tobacco Treatment Intervention
Authors: Shuter Jonathan , Kim Ryung S. , Durant Sean , Stanton Cassandra A.
Published: February 2020

Introduction:

Cigarette smoking is extremely common among persons living with HIV (PLWH) in the United States, and it has emerged as a leading killer in this group. No tobacco treatment studied to date has demonstrated long-term efficacy.

Methods:

This was a follow-up study of PLWH adult smokers who completed a randomized controlled trial of positively Smoke Free group therapy from 2014 to 2017. Participants from 2 of the 3 trial sites were recalled to complete a long-term follow-up assessment, at least one year after initial enrollment.

Results:

Of the 342 candidates for this follow-up study, 11 had died before our attempts to contact them, and 194 of the remaining 331 (58.6%) completed the late follow-up assessment. Most (91.2%) of the remaining candidates could not be contacted despite numerous attempts. At a mean of 38.1 months after initial study enrollment, using an intention-to-treat, lost to follow-up = still smoking (worst case scenario) strategy, 12.7% of group therapy vs. 6.6% of control participants had biochemically verified 7-day point-prevalence abstinence, odds ratio = 2.06 (95% CI: 0.96–4.41), P = 0.06, and 10.3% of group therapy vs. 4.2% of control participants had biochemically verified 12-month point-prevalence abstinence, odds ratio = 2.61 (95% CI: 1.05–6.47, P = 0.03). Improvements in abstinence self-efficacy in the positively Smoke Free group observed in the original study were sustained through late follow-up.

Conclusions:

Targeted group therapy for PLWH smokers was associated with increased cessation and sustained improvements in abstinence self-efficacy at a mean of more than 3 years of follow-up. This is the first trial to show long-term efficacy of tobacco treatment for PLWH.