bluuebunny/crossref_metadata_2025 huggingface dataset:
Coaching Versus Competency to Facilitate Professional Identity Formation
Authors: Sawatsky Adam P. , Huffman Brandon M. , Hafferty Frederic W.
Published: January 2020

Professional identity formation, with its focus on the development of professional values, actions, and aspirations, is the ideal goal of medical education. Medicine is a community of practice, and medical education is a socialization process by which novice trainees become full community members. The authors believe coaching provides an ideal means for promoting this socialization process to develop a learner’s identity as they engage in the community. Coaching involves an orientation toward growth and development, valuing reflection and nurturing continuous reflection, and embracing failure as an opportunity for learning. However, there are challenges to implementing coaching in medical education. Competency-based medical education has provided clear outcomes (competencies) for medical education and programs of assessment around these competencies. Yet, there is a tension in medical training between professional identity formation (the process of socialization into the profession) and the formal assessment process. The ideal of multiple low-stakes assessments and written evaluations, intended as formative assessments, are perceived by residents as high-stakes evaluations with significant consequences for their future. The authors present a resident story that highlights this tension. They outline Goffman’s theory of impression management, postulating that medicine’s assessment system encourages residents to stage a performance for evaluators that displays their competence and conceals their perceived weaknesses. This performance hinders coaching and the formation of an appropriate professional identity. Coaching, the authors believe, provides a model that aligns assessment and professional identity formation. Given the challenges to implementing coaching in medical education, the authors propose several questions to contemplate when integrating coaching into medical education to facilitate the goal of professional identity formation.
Dabrafenib plus trametinib is effective in the treatment of BRAF V600-mutated metastatic melanoma patients: analysis of patients from the dabrafenib plus trametinib Named Patient Program (DESCRIBE II)
Authors: Atkinson Victoria , Sandhu Shahneen , Hospers Geke , Long Georgina V. , Aglietta Massimo , Ferrucci Pier F. , Tulyte Skaiste , Cappellini Gian Carlo Antonini , Soriano Virtudes , Ali Sayed , Poprach Alexandr , Cesas Alvydas , Rodriguez-Abreu Delvys , Lau Mike , de Jong Egbert , Legenne Philippe , Stein Dara , King Brianna , van Thienen Johannes V.
Published: January 2020

In clinical trials, dabrafenib plus trametinib improved overall survival (OS) compared with single-agent BRAF inhibitors (BRAFi) in patients with BRAF V600-mutant unresectable or metastatic melanoma. We investigated dabrafenib plus trametinib therapy in a compassionate-use setting [Named Patient Program (NPP); DESCRIBE II]. A retrospective chart review of patients with BRAF V600-mutated unresectable stage III/IV melanoma receiving dabrafenib plus trametinib as compassionate use was conducted. Treatment patterns and duration, clinical outcomes, and tolerability were evaluated. Of 271 patients, 92.6% had stage IV melanoma, including 36.5% with brain metastases. Overall, 162 patients (59.8%) were BRAFi naive and 171 (63.1%) received first-line dabrafenib plus trametinib. Among BRAFi-naive patients, the overall response rate (ORR) was 67.3%, median OS (mOS) was 20.0 months, and median progression-free survival (mPFS) was 7.5 months. In BRAFi-naive patients with known brain metastases (n = 62), ORR was 61.3%, mOS was 15.5 months, and mPFS was 6.2 months. Eighty-four patients received BRAFi monotherapy for >30 days and switched to dabrafenib plus trametinib prior to progression. Of these 84 patients, 63 had known disease status at the time of switch, and 22 improved with the combination therapy. No new safety signals were identified, and dabrafenib plus trametinib was well tolerated. Dabrafenib plus trametinib showed substantial clinical activity in NPP patients with BRAF V600-mutated unresectable or metastatic melanoma. Analysis of treatment patterns demonstrated the effectiveness of the combination in patients with brain metastases and across lines of therapy with a well tolerated and manageable safety profile.
Genetic Variations of CYP19A1 Gene and Stroke Susceptibility: A Case–Control Study in the Chinese Han Population
Authors: Cai Qing , Zheng Jianwen , Bai Mei , He Xue , Wang Li , He Yongjun , Yuan Dongya , Huang Tingqin , Zhao Junjie , Wu Yuan , Ma Xudong , Zhang Ming , Jin Tianbo , Gao Guodong
Published: January 2020

Objective:

This study aimed to explore the association between genetic variations of CYP19A1 and stroke susceptibility in the Chinese Han population.

Methods:

A total of 477 stroke patients and 480 healthy controls were recruited in this study. The genotyping of CYP19A1 polymorphisms (rs4646, rs6493487, rs1062033, rs17601876, and rs3751599) was performed by the Agena MassARRAY platform. Under logistic regression models, we evaluated the associations of CYP19A1 polymorphisms and stroke susceptibility by odds ratio and 95% confidence interval.

Results:

Our study showed that rs4646 (codominant: P = 0.020; recessive: P = 0.016) and rs17601876 (allele: P = 0.044; codominant: P = 0.011; dominant: P = 0.009; recessive: P = 0.046) significantly decreased the risk of stroke. In the stratification analysis, rs4646 is associated with decreased stroke risk among the individuals older than 64 years (codominant: P = 0.028; recessive: P = 0.010) and women (codominant: P = 0.029; recessive: P = 0.029), whereas rs1062033 increased stroke risk in the subgroup of age 64 years and younger (recessive: P = 0.042). The rs17601876 polymorphism has a strong relationship with stroke susceptibility, which is age and gender dependent. In haplotype analysis, we found a block (rs17601876 and rs3751599), and Ars17601876Grs3751599 haplotype is related to an increased stroke risk (P < 0.05). In addition, CYP19A1 variations had effects on clinical characteristics.

Conclusion:

CYP19A1 polymorphisms were significantly associated with stroke susceptibility in the Chinese Han population.
PLASMA RICH IN GROWTH FACTORS FOR PERSISTENT MACULAR HOLE: A PILOT STUDY
Authors: Arias Juan D. , Hoyos Andrea T. , Alcántara Betzy , Sanchez-Avila Ronald M. , Arango Francisco J. , Galvis Virgilio
Published: January 2020

Purpose:

Persistent macular hole (PMH) is a challenge for retina surgeons. There are limited surgical techniques described achieving PMH closure. For more than a decade, techniques with blood derivatives have been described without optimal outcomes. The aim of this article is to report the usefulness of the plasma rich in growth factors (PRGF) as a new way to improve PMH closure.

Methods:

This is an observational study. Two patients with PMH were chosen at the FOSCAL Internacional, Floridablanca, Colombia. For each patient, a complete ophthalmological examination before and after treatment was performed. It included best-corrected visual acuity and fundus examination. Features of swept-source optical coherence tomographic angiography (Topcon) at baseline and after treatment were included. Preoperative evaluation included the following: previous vitreoretinal surgery for macular hole, macular hole measurement and classification, and dissociated optic nerve fiber layer in en-face map, confirming a prior internal limiting membrane peeling. Plasma rich in growth factors–Endoret technology is characterized by moderate platelet concentration and absence of leukocytes, which requires calcium chloride for platelet activation. It is obtained from each patient's blood sample, submitted to a series of processes to acquire a three-dimensional fibrin scaffold, rich in hundreds of proteins, which seems to have therapeutic potential. This PRGF membrane is placed into the macular hole with forceps through a pars plana vitrectomy after complete air–fluid exchange. Supernatant was placed on the macula and left it for 2 minutes. It is then aspirated, and gas or silicone oil was left as a tamponade.

Results:

Follow-up period was of 12 months for each patient. Complete macular hole closure was achieved in both cases. Best-corrected visual acuity changed from 20/200 preoperatively to 20/100 postoperatively in Patient #1 and from 20/1,500 to 20/100 in Patient #2.

Conclusion:

Plasma rich in growth factors has been primarily investigated for ocular surface diseases. This is a pilot study using this technology for PMH treatment. The use of PRGF may be an effective and safe surgical technique with satisfactory anatomical and functional results for PMH. Because of its own biomaterials and proteins, PRGF not only allows anatomical closure but also seems to stimulate tissue regeneration.
A 6-Week, Prospective, Randomized, Single-Masked Study of Lifitegrast Ophthalmic Solution 5% Versus Thermal Pulsation Procedure for Treatment of Inflammatory Meibomian Gland Dysfunction
Authors: Tauber Joseph
Published: January 2020

Purpose:

Meibomian gland dysfunction (MGD) is present in most cases of dry eye disease. MGD involves both inflammatory and obstructive etiologies. We compared efficacy and safety of treatment to reduce inflammation (lifitegrast) versus obstruction [thermal pulsation procedure (TPP)] in patients with inflammatory MGD over 42 days.

Methods:

This was a single-center, 6-week, prospective, randomized, single-masked study of adults with inflammatory MGD, defined as having all of the following: burning, stinging, dryness; thickened secretions or occlusion of glands; eyelid redness; and elevated matrix metalloproteinase-9. Patients received lifitegrast ophthalmic solution 5% twice daily for 42 days or one TPP treatment at day 0. Seven symptoms and 8 objective measures of dry eye disease were assessed.

Results:

Overall, 40 of 50 randomized patients (80%) were women with mean (SD) age 65.8 (8.9) years. Lifitegrast-treated (n = 25) versus TPP-treated (n = 25) patients had greater improvement from baseline to day 42 in eye dryness [mean (SD) change from baseline: −1.05 (0.79), lifitegrast; −0.48 (0.96), TPP; P = 0.0340], corneal staining [−0.55 (0.80), lifitegrast; 0.12 (1.09), TPP; P = 0.0230], and eyelid redness [−0.77 (0.43), lifitegrast; −0.38 (0.58), TPP; P = 0.0115]; trend favored lifitegrast for best corrected visual acuity and gland patency. Unexpectedly, TPP treatment did not improve lipid layer thickness or gland patency compared with lifitegrast. No adverse events were reported.

Conclusions:

Although MGD is often considered a disease of gland obstruction, these findings demonstrate antiinflammatory treatment with lifitegrast significantly improved patient symptoms and signs compared with treatment for obstruction (TPP). Lifitegrast should be included in treatment for inflammatory MGD.
Longitudinal Changes in Adult Bony Orbital Volume
Authors: Chon Brian , Zhang Kevin R. , Hwang Catherine J. , Perry Julian D.
Published: January 2020

Purpose:

To our knowledge, no prior study has measured bony orbital volume in a group of subjects over time. This study evaluates longitudinal changes in bony orbital volume with age.

Methods:

A search was created for patients with digitized CT imaging studies of the orbit at least 8 years apart. Charts with a history of prior head trauma, head and neck tumors, sinus disease, head surgery, elevated intracranial pressure, thyroid eye disease, or conditions that could affect bone metabolism were excluded. Three outcome measures were used: orbital volume, medial orbital wall length, and lateral orbital wall length. Categorical data were summarized with frequency (%); normally distributed continuous data are summarized with mean (standard deviation), and non-normally distributed data were summarized with median. Normality was verified with Shapiro–Wilk Test. Paired t-tests were used to analyze the differences in the 3 outcome variables.

Results:

One hundred and eighty-two subjects, 91 males and 91 females, were included. The median time between CT scans was 9.4 years. Orbital volume was significantly larger at the second scan than the first (p < 0.001). The average difference in orbital volume was 0.91 ml, an increase of 4.1%. Lateral orbital length was significantly shorter in the second scan than in the first (p = 0.046) though the difference was only 0.4 mm. There was no statistically significant change in medial orbital wall length.

Conclusions:

Bony orbital volume increases in individuals with age. This increase in orbital volume occurs in the context of soft tissue changes to contribute to the aging appearance of the periorbital region.
Supernumerary Lacrimal Caruncle: A Case Series
Authors: Slentz Dane H. , Elner Victor M. , Hassan Adam S. , Nelson Christine C.
Published: January 2020

A 12-year-old boy and 63-year-old woman were incidentally found to have a solitary, well-defined, raised, ovoid lesion involving the inferomedial palpebral conjunctiva. Both lesions were separate from the lacrimal caruncle with normal conjunctiva surrounding the lesions. Excisional biopsies were consistent with caruncular tissue. In the English literature, supernumerary lacrimal caruncle has only been previously described in adults despite the congenital nature of the lesion.
Improvements in Workplace Productivity in Working Patients With Major Depressive Disorder
Authors: Chokka Pratap , Tvistholm Anders Holmegaard , Bougie Joanna , Clerzius Guerline , Ettrup Anders
Published: January 2020

Objective:

To assess changes in workplace productivity and functioning in an open-label study in working patients receiving vortioxetine (10 to 20 mg/d) for major depressive disorder (MDD).

Methods:

Associations between items in the Work Limitations Questionnaire (WLQ), the Sheehan Disability Scale (SDS), and the Work Productivity and Activity Impairment (WPAI) questionnaire were assessed at 12 and 52 weeks by Pearson correlation coefficients.

Results:

Significant improvements were observed across all domains of workplace productivity and functioning after 12 and 52 weeks’ vortioxetine treatment. Strong correlations were seen between improvements in WLQ mental domains and WPAI presenteeism and SDS work/school items. Presenteeism showed stronger correlations with other workplace productivity measures than absenteeism.

Conclusions:

Presenteeism and absenteeism impact productivity in working patients with MDD. Vortioxetine confers long-term benefits across all workplace functioning domains.
Employee Health and Blood Pressure Outcomes by Job Family
Authors: Rosemberg Marie-Anne S. , Jun Jin , Jones Lenette M.
Published: January 2020

Objective:

The purpose of the study was to explore the relationship between job families and blood pressure (BP).

Methods:

Subjective (self-report questionnaire) and objective (on-site health screening including blood pressure) data were collected at a large academic institution from employees, which were categorized into 10 job families based on Human Resources career paths. Analysis included descriptive statistics and multivariate logistic regression.

Results:

A total of 20,198 employees participated. Some specific job families were significantly associated with having high BP (P < 0.01). Being 58 years old and older (odds ratio [OR] 2.33, P < 0.01) and being man (OR 2.52, P < 0.01) were the strongest predictors for elevated BP.

Conclusions:

Certain job families may need interventions that target and mitigate particular circumstances in order to reduce and maintain lower BP levels.
Do Mountain Bikers Know When They Have Had a Concussion and, Do They Know to Stop Riding?
Authors: Clark Gregory , Johnson Nathalie A. , Saluja Sanjeet S. , Correa José A. , Delaney J. Scott
Published: January 2020

Objective:

To establish the prevalence of concussions in mountain bikers and to determine factors that increase their risk of concussion. Secondary objectives include determination of whether mountain bikers have undiagnosed concussions, continue to ride after experiencing concussion symptoms, and if they knowingly ride with a broken helmet.

Design:

Retrospective survey.

Setting:

Seven-day mountain bike stage race.

Participants:

Two hundred nineteen mountain bikers.

Main Outcome Measures:

Number of rider concussions diagnosed, number of riders experiencing concussion symptoms without diagnosed concussions, number of riders who continue to ride after experiencing a concussion symptom, and number of riders who rode with a broken helmet.

Independent Variables:

The independent variables studied included age, gender, nationality, number of times riding in past year, style of riding (cross-country, downhill, or freeride), years mountain biking, years mountain bike racing, whether they are a sponsored cyclist, and whether they also ride a road bike.

Results:

Fifteen of 219 mountain bikers (6.9%) had a diagnosed concussion after being hit in the head while mountain biking within the past year, with older riders having a decreased risk [odds ratio (OR), 0.91; P = 0.04], and sponsored riders having a 5-fold increased risk compared with nonsponsored riders (OR, 4.20; P = 0.05). Twenty-eight riders (12.8%) experienced a concussion symptom without being diagnosed with a concussion and 67.5% of the riders who experienced a concussion symptom continued to ride afterward. Overall, 29.2% of riders reported riding with a broken helmet.

Conclusions:

The yearly prevalence of diagnosed concussions in mountain bikers is 6.9%. More than one-third of mountain bikers do not recognize when they have had a concussion and continue riding after experiencing concussion symptoms or with a broken helmet. These behaviors increase their risk of worsening concussion symptoms and acquiring a second injury.
Sunburn-related variables, secular trends of improved sun protection and short-term impact on sun attitude behavior in Italian primary schoolchildren
Authors: Stanganelli Ignazio , Naldi Luigi , Cazzaniga Simone , Gandini Sara , Magi Serena , Quaglino Pietro , Ribero Simone , Simonacci Marco , Pizzichetta Maria Antonietta , Spagnolo Francesco , Palmieri Giuseppe , Queirolo Paola
Published: January 2020

Sun protection early in life is an essential issue for primary prevention of skin cancers. The Il Sole per Amico was an educational campaign among 66 Italian primary schools. A total of 12,188 questionnaires were completed at baseline. Overall, 9.4% children reported >1 sunburn during the last year and 44.7% parents a use of sunlamps. Independent factors associated with sunburns were: age, lower level of parents’ education, light eye and skin color, freckles, nevi on arms, intense sun exposure during the last year, sporadic use of sunscreens, and parental use of sunlamps. A total of 7280 (59.7%) questionnaires were completed at the end of the educational intervention. No significant difference was documented about behavior between the pre- and post-intervention periods. A significant reduction was instead found in both prevalence of recent sunburns and total number of sunburn episodes after comparison with the data obtained by identical questionnaire in the same geographic areas in the “Sole Si Sole No” project in 2001.
Long-term complete response to intrathecal trastuzumab in a patient with leptomeningeal carcinomatosis due to her2- overexpressing breast cancer
Authors: García Francisco José Valdivia , Carrión Natalia Palazón , de la Cruz-Merino Luis
Published: January 2020

Introduction:

Leptomeningeal dissemination due to HER2-overexpressing breast cancer is a rare and hard to treat complication with short-term dismal prognosis.

Patient concerns:

A 34-year-old female previously treated because of HER2+ breast cancer is admitted to the Neurology Department in December 2016 due to sensory-motor neurological semiology.

Diagnosis:

A wide set of diagnostic tests is performed and finally cytologic findings after repeated CSF confirm leptomeningeal infiltration by breast carcinoma (panCK+, GATA3+).

Interventions:

Weekly intrathecal triple therapy with methotrexate, cytarabine and hydrocortisone plus trastuzumab is carried out during 4 months.

Outcomes:

Clinical and pathological response that lasts more than 24 months.

Conclusion:

Leptomeningeal carcinomatosis is an oncological situation where conventional therapies have limited activity. In HER2+ advanced breast cancer patients, intrathecal therapy with anti-HER2 therapy (trastuzumab) is feasible and may reach long-term disease control, especially in cases of low-tumor burden.
An open-label continuation trial of tocilizumab for familial Mediterranean fever with colchicine ineffective or intolerance
Authors: Koga Tomohiro , Hagimori Naoko , Sato Shuntaro , Morimoto Shinpei , Hosogaya Naoki , Fukushima Chizu , Yamamoto Hiroshi , Kawakami Atsushi
Published: January 2020

Background:

Colchicine is the first-line treatment for familial Mediterranean fever (FMF), but secondary amyloidosis resulting from persistent inflammation is a concern in patients with colchicine-resistant or colchicine-intolerant FMF. Although tocilizumab (TCZ), which is a recombinant, humanized, anti-human interleukin 6 receptor monoclonal antibody, has been reported to prevent FMF attacks, the long-term safety and efficacy of TCZ on individuals with colchicine-resistant or colchicine-intolerant FMF have not been evaluated.

Methods/design:

In this investigator-initiated, multicenter, open-label trial, the long-term safety of TCZ will be evaluated in patients participating in a placebo-controlled, randomized, double-blind, parallel-group trial on colchicine-resistant or colchicine-intolerant FMF. The study will be conducted in 9 centers in Japan. After the evaluation and examination for 24 weeks in the preceding study, this trial will be started promptly. The trial will be completed by the time the drug is approved for FMF treatment in Japan. The primary endpoint is the incidence of adverse events, and the secondary endpoints include the number of FMF attacks, number of occurrences of accompanying symptoms during attacks, serum C-reactive protein and amyloid A levels, general evaluation by a physician (100 mm visual analog scale [VAS]), general evaluation by a patient (100 mm VAS), and body temperature.

Discussion:

The study is expected to obtain evidence regarding the long-term safety of TCZ as a potential new therapeutic agent for patients with colchicine-resistant or colchicine-intolerant FMF.

Trial registration:

This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037116) as UMIN000032557 on May 30 2018.
Identification of potential key genes for HER-2 positive breast cancer based on bioinformatics analysis
Authors: Lin Yuxiang , Fu Fangmeng , Lv Jinxing , Wang Mengchi , Li Yan , Zhang Jie , Wang Chuan
Published: January 2020

Backgrounds:

HER-2 positive breast cancer is a subtype of breast cancer with poor clinical outcome. The aim of this study was to identify differentially expressed genes (DEGs) for HER-2 positive breast cancer and elucidate the potential interactions among them.

Material and methods:

Three gene expression profiles (GSE29431, GSE45827, and GSE65194) were derived from the Gene Expression Omnibus (GEO) database. GEO2R tool was applied to obtain DEGs between HER-2 positive breast cancer and normal breast tissues. Gene ontology (GO) annotation analysis and Kyoto Encyclopedia of Genes and Genome (KEGG) pathway enrichment analysis was performed by the Database for Annotation, Visualization and Integrated Discovery (David) online tool. Protein-protein interaction (PPI) network, hub gene identification and module analysis was conducted by Cytoscape software. Online Kaplan–Meier plotter survival analysis tool was also used to investigate the prognostic values of hub genes in HER-2 positive breast cancer patients.

Results:

A total of 54 upregulated DEGs and 269 downregulated DEGs were identified. Among them, 10 hub genes including CCNB1, RAC1, TOP2A, KIF20A, RRM2, ASPM, NUSAP1, BIRC5, BUB1B, and CEP55 demonstrated by connectivity degree in the PPI network were screened out. In Kaplan–Meier plotter survival analysis, the overexpression of RAC1 and RRM2 were shown to be associated with an unfavorable prognosis in HER-2 positive breast cancer patients.

Conclusions:

This present study identified a number of potential target genes and pathways which might impact the oncogenesis and progression of HER-2 positive breast cancer. These findings could provide new insights into the detection of novel diagnostic and therapeutic biomarkers for this disease.
Flexible tip bougie - the new introducer for intubation during cardiopulmonary resuscitation
Authors: Bączek Michał , Zagańczyk-Bączek Michalina
Published: January 2020

Background:

The aim of this study was to compare three intubation methods during cardiopulmonary resuscitation using an adult-manikin.

Methods:

Thirty-nine paramedics were included in this study. Each participant performed endotracheal intubation during continuous chest compressions using 3 different methods: conventional Macintosh laryngoscope without additional intubation aids (MAC), conventional Macintosh laryngoscope with gum-elastic bougie (GEB), or flexible tip bougie (FTB). First attempt intubation success rate and intubation time was measured.

Results:

Intubation success rate was 39% with the use of MAC, 92% with GEB and 95% with FTB. It was statistically lower with MAC than with GEB (P < .001) and FTB (P < .001). There was no difference between GEB and FTB in intubation success rate (P = .644). The mean(SD) intubation time was 28.43 (13.81)s with MAC, 25.69 (5.35)s with GEB and 21.41 (2.88)s with FTB. Intubation time was significantly longer with GEB than with FTB (P < .001).

Conclusions:

Within limitations, results of our study suggest that intubation aids facilitate tracheal intubation during continuous chest compressions. Using flexible tip bougie shortens the duration of the procedure compared to gum elastic bougie.
Early mortality attributable to PICC-lines in 4 public hospitals of Marseille from 2010 to 2016 (Revised V3)
Authors: Bessis Simon , Cassir Nadim , Meddeb Line , Remacle Anne Bonnet , Soussan Jérôme , Vidal Vincent , Fournier Pierre-Edouard , Fenollar Florence , Raoult Didier , Brouqui Philippe
Published: January 2020

Introduction:

Peripherally inserted central catheters (PICC-line) are devices inserted through peripheral venous access. In our institution, this technology has been rapidly adopted by physicians in their routine practice. Bacteremia on catheters remains an important public health issue in France. However, the mortality attributable to bacteremia on PICC-line remains poorly evaluated in France and in the literature in general. We report in our study an exhaustive inventory of bacteremia on PICC-line and their 30 days mortality, over a 7 years period.

Material and methods:

From January 2010 to December 2016, we retrospectively matched PICC-line registers of the radiology department, blood culture records of the microbiology laboratory and medical records from the Hospital Information Systems.

Results:

The 11,334 hospital stays during which a PICC-line was inserted were included over a period of 7 years. Among them, 258 episodes of PICC-line-associated bacteremia were recorded, resulting in a prevalence of 2.27%. Hematology units: 20/324 (6.17%), oncology units: 55/1375 (4%) and hepato-gastro-enterology units: 42/1142 (3.66%) had the highest prevalence of PICC-line related bacteremia. The correlation analysis, when adjusted by exposure and year, shows that the unit profile explains 72% of the variability in the rate of bacteremia with a P = .023. Early bacteremia, occurring within 21 days of insertion, represented 75% of cases. The crude death ratio at 30 days, among patients PICC-line associated bacteremia was 57/11 334 (0.50%). The overall 30-day mortality of patients with PICC-line with and without bacteremia was 1369/11334 (12.07%). On day 30, mortality of patients with bacteremia associated PICC-line was 57/258 or 22.09% of cases, compared to a mortality rate of 1311/11076, or 11.83% in the control group (P < .05, RR 2.066 [1.54–2.75]). Kaplan–Meier survival analysis revealed a statistically significant excess mortality between patients with PICC-line associated bacteremia and PICC-line carriers without bacteremia (P < .0007, hazard ratio 1.89 [1307–2709]).

Conclusion:

Patients with PICC-line associated bacteremia have a significant excess mortality. The implementation of a PICC-line should remain the last resort after a careful assessment of the benefit/risk ratio by a senior doctor.
Clinical features and outcomes of patients with hemophagocytic lymphohistiocytosis at onset of systemic autoinflammatory disorder and compare with Epstein–Barr virus (EBV)-related hemophagocytic lymphohistiocytosis
Authors: Zhao Yunze , Li Zhigang , Zhang Li , Lian Hongyun , Ma Honghao , Wang Dong , Zhao Xiaoxi , Zhang Qing , Wang Tianyou , Zhang Rui
Published: January 2020

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease. In clinical practice, we have observed that some HLH patients who have features of systemic autoinflammatory diseases (SAIDs) exhibit unique clinical manifestations and outcomes different from other HLH patients.

We analyzed data from 25 HLH patients who were considered to have SAIDs; data were collected from patients of our center between January 1, 2015 and September 1, 2018.

The median age of the patients was 1.75 years. In the early phase, all patients had a fever and 92% of patients had a rash; 96% of patients had high white blood cell count (WBC), C-reaction protein, and erythrocyte sedimentation rate. With progression, the above laboratory results decreased gradually. During the HLH period, we compared SAIDs-related HLH and Epstein-Barr virus (EBV)-related HLH and found that rash was more common (92%, P < .001) and splenomegaly was less common (64%, P = .023) in SAIDs-related HLH. Further, WBC, ferritin, and Interleukin-6 levels in SAIDs-related HLH patients were higher than those in EBV-related HLH patients. In contrast, hemoglobin, triglyceride, sCD25, Interleukin-10, and interferon-γ levels in SAIDs-related HLH patients were lower compared with those in EBV-related HLH patients. SAIDs-related HLH patients received a modified HLH-2004 protocol at our center. Most patients had a good prognosis.

We provide a summary of the unique clinical and laboratory features, treatment protocols, and outcomes of SAIDs patients with HLH at onset. The findings indicate that these patients had a better response to corticosteroids and cyclosporin compared with EBV-related HLH patients.
Refeeding syndrome is associated with increased mortality in malnourished medical inpatients
Authors: Friedli Natalie , Baumann Jessica , Hummel Ramona , Kloter Milena , Odermatt Jonas , Fehr Rebecca , Felder Susan , Baechli Valerie , Geiser Martina , Deiss Manuela , Tribolet Pascal , Gomes Filomena , Mueller Beat , Stanga Zeno , Schuetz Philipp
Published: January 2020

Background:

Whether the occurrence of refeeding syndrome (RFS), a metabolic condition characterized by electrolyte shifts after initiation of nutritional therapy, has a negative impact on clinical outcomes remains ill-defined. We prospectively investigated a subgroup of patients included in a multicentre, nutritional trial (EFFORT) for the occurrence of RFS.

Methods:

In this secondary analysis of a randomized-controlled trial investigating the effects of nutritional support in malnourished medical inpatients, we prospectively screened patients for RFS and classified them as “RFS confirmed” and “RFS not confirmed” based on predefined criteria (i.e. electrolyte shifts, clinical symptoms, clinical context, and patient history). We assessed associations of RFS and mortality within 180 days (primary endpoint) and other secondary endpoints using multivariable regression analysis.

Results:

Among 967 included patients, RFS was confirmed in 141 (14.6%) patients. Compared to patients with no evidence for RFS, patients with confirmed RFS had significantly increased 180-days mortality rates (42/141 (29.8%) vs 181/826 (21.9%), adjusted odds ratio (OR) 1.53 (95% CI 1.02 to 2.29),P < .05). Patients with RFS also had an increased risk for ICU admission (6/141 (4.3%) vs 13/826 (1.6%), adjusted OR 2.71 (95% CI 1.01 to 7.27),P < .05) and longer mean length of hospital stays (10.5 ± 6.9 vs 9.0 ± 6.6 days, adjusted difference 1.57 days (95% CI 0.38–2.75),P = .01).

Conclusion:

A relevant proportion of medical inpatients with malnutrition develop features of RFS upon hospital admission, which is associated with long-term mortality and other adverse clinical outcomes. Further studies are needed to develop preventive strategies for RFS in this patient population.
Clinical significance of urinary obstruction in critically ill patients with urinary tract infections
Authors: Hong Jun Young , Suh Suk-Won , Shin Jungho
Published: January 2020

Urinary obstruction may be a complicating factor in critically ill patients with urinary tract infections (UTIs) and requires efforts for identifying and controlling the infection source. However, its significance in clinical practice is uncertain. This retrospective study investigated the overall hospital courses of patients in the intensive care unit (ICU) with UTIs from the emergency department.

Baseline severity was assessed by the sequential organ failure assessment (SOFA) score; outcomes included probability and inotropic-, ventilator-, renal replacement therapy (RRT)-, and ICU-free days and 28-day mortality.

Of 122 patients with UTIs, 99 had abdominal computed tomography scans. Patients without computed tomography scans more frequently had quadriplegia and a urinary catheter than those without scans (P = .001 and .01). Urinary obstruction was identified in 40 patients who had higher SOFA scores and lactate levels (P = .01 and P < .001). The use and free days of inotropic drugs and ventilator did not differ between the groups. However, patients with obstruction were more likely to require RRT and had shorter durations of RRT-free days (odds ratio 3.8; P = .06 and estimate −3.0; P = .04). Durations of ICU-free days were shorter, but it disappeared after adjustment for initial SOFA scores (estimate −2.3; P = .15). Impact of the timing of urinary drainage on outcomes was evaluated, demonstrating that an intervention within 72 hours lengthened the duration of RRT-free days compared with that after 72 hours (estimate −6.0 days; P = .03). On the other hand, the study did not find the association between other outcomes including 28-day mortality and the timing of urinary drainage.

Urinary obstruction can be a complicating factor, resulting in a higher probability of RRT implementation and shorter durations of RRT- and ICU-free days in critically ill patients with UTIs. Furthermore, delayed intervention for urinary drainage may result in longer durations of RRT. Efforts should be warranted to find the presence of urinary obstruction and to control infection source in critically ill patients with UTIs.
Drug utilization in the Maastricht Study
Authors: Nielen Johannes T.H. , Driessen Johanna H.M. , Dagnelie Pieter C. , Boonen Annelies , van den Bemt Bart , van Onzenoort Hein A.W. , Neef Cees , Henry Ronald M.A. , Burden Andrea M. , Sep Simone J.S. , van der Kallen Carla J. , Schram Miranda T. , Schaper Nicolaas , Stehouwer Coen D.A. , Smits Luc , de Vries Frank
Published: January 2020

Within the southern region of the Netherlands, the Maastricht Study is an on-going observational prospective population-based cohort study that focuses on the etiology of Type 2 diabetes mellitus (T2DM). Representativeness of the participating population is a crucial but often an unknown factor in population-based cohort studies such as the Maastricht Study. We therefore aimed to assess the representativeness of the study population by comparing drug utilization of the participants of the Maastricht Study with the general population of the Netherlands.

Since T2DM patients were oversampled in this study, a sampling method was applied in order to ensure a similar distribution of T2DM over the study population. Drug use in the study population was compared with drug use in the population of the Netherlands, using a Z-test to compare 2 independent proportions.

In general, drug use in the study was similar compared with national data. However, in the age group 65 to 74 years total drug use was lower in the study population (833/1000 persons) versus nationwide data (882/1000 persons). The use of pulmonary medications was lower (104/1000 persons vs 141/1000 persons) and the use of hypnotics/anxiolytics was higher (90/1000 persons vs 36/1000 persons) in the Maastricht Study as compared with national data.

Drug use in the Maastricht Study population is largely comparable to that in the total Dutch population aged 45 to 74. Therefore, data on drug use by participants in the Maastricht Study can be used to perform studies assessing outcomes associated with drug use.
Association between atopic dermatitis and colorectal cancer risk
Authors: Chou Wan-Yun , Lai Pin-Yu , Hu Je-Ming , Hsu Chih-Hsiung , Chen Yong-Chen , Tian Yu-Feng , You San-Lin , Hsiao Cheng-Wen , Chou Yu-Ching , Sun Chien-An
Published: January 2020

The role of atopic dermatitis (AD) in the development of colorectal cancer (CRC) has been a matter of scientific debate with mixed results. We conducted a nationwide cohort study to assess the association between AD and risk of CRC. Drawing on Taiwan's National Health Insurance Research Database, 46,703 patients with AD (the AD cohort) and 186,812 sex, age, and index year-matched patients without AD (the non-AD cohort) were identified in the period between 2000 and 2008. Follow-up time was calculated from the date of entry in the cohort until the occurrence of a first CRC diagnosis, death, or the end of the observation period (December 31, 2013), whichever occurred first. Hazards ratios (HRs) and accompanying 95% confidence intervals (CIs) derived from the Fine-Gray competing risk model were used to estimate the association between AD and CRC risk. After multivariable adjustment, AD was associated with an increased risk of CRC (adjusted HR, 1.26; 95% CI, 1.14–1.40). Of note, a significant positive association between AD and CRC risk was evident in both men and women and in all age groups. In summary, this population-based cohort study revealed that AD was associated with an increased risk of CRC in an Asian population. It will be of interest for cohort studies with prediagnostic specimens to evaluate the potential relationship between AD and CRC using biomarkers for allergy status.
Efficacy and safety of therapeutic ERCP in patients with ectopic papilla of Vater
Authors: Hong Junbo , Pan Weiping , Zuo Wei , Wang Anjiang , Zhu Liang , Zhou Xiaodong , Zhou Xiaojiang , Li Guohua , Liu Zhijian , Liu Pi , Zhen Hao , Zhu Yong , Ma Jiuhong , Yuan Jianhui , Shu Xu , Zhu Yin , Lu Nonghua , Chen Youxiang
Published: January 2020

It remains challenging for endoscopists to manage pancreaticobiliary diseases in patients with ectopic papilla of Vater by endoscopic retrograde cholangiopancreatography (ERCP). The present study sought to evaluate the efficacy and safety of ERCP for this issue.

Consecutive patients with ectopic papilla of Vater who underwent initial ERCP due to pancreaticobiliary diseases were retrospectively analyzed.

One hundred seven patients with ectopic papilla of Vater were included. The success rate of cannulation was 83.2%. Endoscopic sphincterotomy, endoscopic papillary balloon dilation, and mechanical lithotripsy were performed in 12 (11.2%), 25 (23.4%), and 1 (0.9%) patients, respectively. The technical success rate was 83.2%; of these, endoscopic nasobiliary drainage, endoscopic retrograde biliary drainage, endoscopic retrograde pancreatic drainage, and stone extraction was conducted in 61 (57.0%), 17 (15.9%), 5 (4.7%), and 45 (42.1%) patients, respectively. Bile duct stone size ≥1 cm, number ≥2, and duodenum stenosis were risk factors for stone extraction inability. Adverse events occurred in 20 (18.7%) patients, including post-ERCP pancreatitis (3.7%), hyperamylasemia (12.1%), and infection of biliary tract (2.8%); all of the adverse events were mild and alleviated by conventional therapies.

ERCP is an appropriate choice for pancreaticobiliary diseases in patients with ectopic papilla of Vater due to its high efficacy and safety. Bile duct stone size ≥1 cm, number ≥2, and duodenum stenosis increase difficulties for stone extraction.
Pain relieving effect of dexmedetomidine in patients undergoing total knee or hip arthroplasty
Authors: Yang Qi , Ren Yi , Feng Bin , Weng Xisheng
Published: January 2020

Background

To evaluate the safety and efficacy of dexmedetomidine in patients undergoing total knee and hip arthroplasty for postoperative pain control.

Methods

An updated systematic review and meta-analysis of randomized controlled trials (RCTs) identified in systematic searches of MEDLINE, EMBASE, Google Scholar, the Cochrane Database and the Chinese SinoMed Database.

Results

Fourteen RCTs with a total of 1220 patients were included. Overall, dexmedetomidine therapy was associated with significantly decreased pain scores 24 hours after surgery (WMD, −0.36; 95% CI, −0.49 to −0.22; I2 = 90.0%, P < .001) compared with scores in the control group after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Furthermore, the rate of postoperative delirium was also markedly decreased with dexmedetomidine therapy (RR, 0.38; 95% CI, 0.24 to 0.59; I2 = 0.0%, P < .001). Moreover, compared with the control group, dexmedetomidine treatment was associated with a decreased risk of postoperative nausea and vomiting in patients undergoing TKA (RR, 0.34; 95% CI, 0.15 to 0.79; I2 = 0.0%, P = .012), and there was a similar risk of hypotension (RR, 1.03; 95% CI, 0.72 to 1.49; I2 = 24.4%, P = .87) regardless of whether patients underwent TKA or THA. However, the rate of bradycardia was significantly increased with dexmedetomidine treatment in those undergoing TKA (RR, 6.11; 95% CI, 2.35 to 15.91; I2 = 0.0%, P < .001).

Conclusions

Dexmedetomidine therapy seems to be an effective treatment for pain control and postoperative delirium in patients undergoing TKA/THA. However, the incidence of bradycardia is markedly increased in patients undergoing TKA. Hence, much larger prospective clinical studies are warranted to confirm these findings.
Epidemiological and clinical characteristics of 3327 cases of traffic trauma deaths in Beijing from 2008 to 2017
Authors: Wang Tianbing , Wang Yanhua , Xu Tingmin , Li Libing , Huo Mingli , Li Xian , He Yingdong , Lin Qiushi , Mei Bingsong , Zhou Xiaohua , Jiang Baoguo
Published: January 2020

We investigated the epidemiological and clinical characteristics deaths from road traffic injury (RTI) in Beijing, and provided evidence useful for the prevention of fatal traffic trauma and for the treatment of traffic-related injuries.

We retrospectively reviewed death cases provided by the Beijing Red Cross Emergency Center on road traffic injury deaths from 2008 to 2017. We analyzed population characteristics, time distribution, distribution of transportation modes, intervals to death, locations and injured body parts.

From 2008 to 2017, there were 3327 deaths from RTI recorded by the Beijing Red Cross Emergency Center, with mainly males among these deaths. The average age at death was 46.19 ± 17.43 years old (46.19, 0.43–100.24). In accidents with more detail recorded, pedestrians and people using nonmotorized transportation modes suffered the most fatalities (664/968, 68.60%). The most commonly injured body parts were the head (2569/3327, 77.22%), followed by the chest (180/3327, 5.41%), abdomen (130/3327, 3.91%), lower extremities (68/3327, 2.04%), pelvis (67/3327, 2.01%), spinal cord (31/3327, 0.93%), and upper extremities (26/3327, 0.78%). Burns accounted for 0.96% (32/3327), and unknown body parts were affected in 11.28% (365/3327). The average time interval from injury to death was 36.90 ± 89.57 h (36.90, 0–720); 46.7% (1554/3327) died within 10 minutes after injury; 9.02% (300/3327) died between 10 min and 1 hour; 30.33% (1009/3327) died between 1 hour and 3 days; 13.95% (464/3327) died between 3 and 30 days.

In Beijing, RTI is a significant cause of preventable death, particularly among pedestrians and users of non-motorized vehicles. Head trauma was the most lethal cause of RTI deaths. Our findings suggested that interventions to prevent collisions and reduce injuries, and improved trauma treatment process and trauma rescue system could address a certain proportion of avoidable RTI deaths.
The prognostic relevance and expression of progranulin in adult patients with acute myeloid leukemia
Authors: Qin Jiajia , Huang Shigao , Qian Jiao , Xu Chunyan , Li Shixiao , Yu Sufei , Yan Haixi , Wu Mingjiao , Chen Jiaxi , Ren Hanxing , Peng Minfei
Published: January 2020

Progranulin (PGRN) is a secreted protein that can regulate cell cycle progression, cell motility, and tumorigenesis. The PGRN expression in hematological malignancies is limited to multiple myeloma, but its expression and survival prognostic role in acute myeloid leukemia (AML) is still controversial.

To evaluate the PGRN expression and estimate its survival prognostic role in AML patients.

In this study, all patients were divided into three groups, which included 38 newly diagnosed adult AML patients, 33 complete remissions (CR-AML) patients, and 60 healthy control (HC) patients. The endpoints were relapse-free survival (RFS) and overall survival (OS). We investigated plasma PGRN levels by using enzyme-linked immunosorbent assay.

Plasma PGRN levels in AML patients were higher than that in CR-AML and HC groups. After two chemo cycles, 16 patients had complete remission (CR). The level of plasma PGRN in non-CR patients compared to CR patients was obviously different (median 44.19 vs 21.10 ng/mL) (P = .025). In non-M3 (French–American–British classification) patients, 70% (21/30) patients relapsed in 1 year and 80% (24/80) patients died in the observed time. Using the value (median 19.95) as a “cut-off” value, we have divided non-M3 patients into low- and high-PGRN expression groups. High-PGRN expression patients had a poorer RFS with a median of 5.4 months (95% CI 3.7–7.1) and low-PGRN expression patients had a good RFS with a median of 8.9 months (95% CI 6.3–11.5; P = .027). In the survival analyses, high-PGRN expression of AML patients had shorter OS than low-PGRN expression of AML patients (6.2 vs 20.5 months, P = .008).

PGRN is overexpressed in AML, which is a convenient and independent prognostic marker that is measured easily in AML patients.