bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal Exposure to Bisphenol A, E, and S Induces Transgenerational Effects on Male Reproductive Functions in Mice
Authors: Shi Mingxin , Whorton Allison E , Sekulovski Nikola , MacLean James A , Hayashi Kanako
Published: September 2019

This study was performed to examine the transgenerational effects of bisphenol (BP) A analogs, BPE, and BPS on male reproductive functions using mice as a model. CD-1 mice (F0) were orally exposed to control treatment (corn oil), BPA, BPE, or BPS (0.5 or 50 µg/kg/day) from gestational day 7 (the presence of vaginal plug = 1) to birth. Mice from F1 and F2 offspring were used to generate F3 males. Prenatal exposure to BPA, BPE, and BPS decreased sperm counts and/or motility and disrupted the progression of germ cell development as morphometric analyses exhibited an abnormal distribution of the stages of spermatogenesis in F3 males. Dysregulated serum levels of estradiol-17β and testosterone, as well as expression of steroidogenic enzymes in F3 adult testis were also observed. In the neonatal testis, although apoptosis and DNA damage were not affected, mRNA levels of DNA methyltransferases, histone methyltransferases, and their associated factors were increased by BP exposure. Furthermore, BP exposure induced immunoreactive expression of DNMT3A in Sertoli cells, strengthened DNMT3B, and weakened H3K9me2 and H3K9me3 in germ cells of the neonatal testis, whereas DNMT1, H3K4me3, and H3K27ac were not affected. In adult testis, stage-specific DNMT3B was altered by BP exposure, although DNMT3A, H3K9me2, and H3K9me3 expression remained stable. These results suggest that prenatal exposure to BPA, BPE, and BPS induces transgenerational effects on male reproductive functions probably due to altered epigenetic modification following disruption of DNMTs and histone marks in the neonatal and/or adult testis.
Mucinous Ovarian Carcinoma
Authors: Morice Philippe , Gouy Sebastien , Leary Alexandra
Published: September 2019

(Abstracted from N Engl J Med 2019;380:1256–1266)

Mucinous ovarian cancer is a rare form of epithelial ovarian cancer, accounting for approximately 3% of all cases. New understanding of the biological features of this unique disease requires an update to traditional diagnostic and therapeutic protocols that have been historically based on guidelines for serous ovarian carcinoma.
Association of Domestic Responsibilities With Career Satisfaction for Physician Mothers in Procedural vs Nonprocedural Fields
Authors: Lyu Heather G. , Davids Jennifer S. , Scully Rebecca E. , Melnitchouk Nelya
Published: September 2019

(Abstracted from JAMA Surg, doi:10.1001/jamasurg.2019.0529)

Despite equal enrollment of women in medical schools, they are underrepresented in surgical and procedural specialties. Compared with 33% of men, only 14% of women graduating medical school apply to surgical residencies.
Preventability Review of Severe Maternal Morbidity
Authors: Lawton Beverley A. , MacDonald E. Jane , Stanley James , Daniells Karen , Geller Stacie E.
Published: September 2019

(Abstracted from Acta Obstet Gynecol Scand 2019;98(4):515–522)

Severe maternal morbidity (SMM) is defined as life-threatening complications in pregnancy, or within 42 days of the termination of the pregnancy. The rate of SMM is rising globally, and minorities have higher rates; in high-resource countries, the reported prevalence is reported as 3.8 to 13.8 per 1000 deliveries.
Monthly Sulfadoxine–Pyrimethamine Versus Dihydroartemisinin-Piperaquine for Intermittent Preventive Treatment of Malaria in Pregnancy: A Double-blind, Randomised, Controlled, Superiority Trial
Authors: Kajubi Richard , Ochieng Teddy , Kakuru Abel , Jagannathan Prasanna , Nakalembe Miriam , Ruel Theodore , Opira Bishop , Ochokoru Harriet , Ategeka John , Nayebare Patience , Clark Tamara D. , Havlir Diane V. , Kamya Moses R. , Dorsey Grant
Published: September 2019

(Abstracted from Lancet 2019;393:1428–1439.)

In Africa, malaria in pregnancy presents a risk to 50 million women each year due to Plasmodium falciparum infection. Although women in endemic areas are typically asymptomatic when infected with malaria parasites, the infection is associated with maternal anemia and adverse birth outcomes including miscarriage, stillbirth, preterm birth, low birth weight, and infant mortality.
Population-Based Trends in Invasive Prenatal Diagnosis for Ultrasound-Based Indications: Two Decades of Change From 1994 to 2016
Authors: Lostchuck E. , Poulton A. , Halliday J. , Hui L.
Published: September 2019

(Abstracted from Ultrasound Obstet Gynecol 2019;53:503–511)

Ultrasound examination, particularly the midtrimester morphology scan, and fetal chromosome analysis provide opportunities for specialist assessment, genetic testing, and perinatal management of pregnancies complicated by fetal anomalies. Advances such as fetal nuchal translucency measurement as part of the combined first-trimester screening (CFTS) test for trisomies 21, 13, and 18; maternal plasma cell-free (cf) DNA-based screening for common aneuploidies; and prenatal diagnosis with chromosomal microarray (CMA) analysis have helped further genetic testing of fetal anomalies.
Oral and sublingual immunotherapy for food allergy
Authors: Nowak-Wegrzyn Anna , Sato Sakura , Fiocchi Alessandro , Ebisawa Motohiro
Published: September 2019

Purpose of review

To critically appraise the recent most relevant studies in the rapidly advancing field of food oral and sublingual immunotherapy.

Recent findings

Food allergen-specific immunotherapy via oral (OIT) and sublingual route (SLIT) increases the threshold of reactivity to peanut, cow's milk, egg, wheat, and many other foods in the majority of the treated individuals. This desensitized state is contingent upon the continued ingestion of the maintenance doses of the food. Permanent oral tolerance is achievable in a smaller subset of the treated individuals. The optimal duration of therapy has not been firmly established but is likely dependent on the phenotype (severity and persistence). Efficacy of food-OIT is superior compared with SLIT, whereas the safety of OIT is less favorable. Standardization of treatment protocols, maintenance dosing, duration of therapy, target populations and harmonization of the outcomes are top priorities at this stage.

OIT and SLIT represent two different routes of food allergen-specific immunotherapy. Although significant progress has been made in the last decade, both treatment modalities are still in the very early stages of development and further investigations are necessary to optimize the protocols and improve safety while maximizing efficacy.
Effect of asymptomatic bacteriuria treatment prior to total hip or knee arthroplasty on hospital outcomes: A retrospective cohort study
Authors: Peters Michael J. , Twilla Jennifer , Swanson Heather R. , Jacobs Anna
Published: September 2019

Background:

Although treatment of asymptomatic bacteriuria (ASB) in patients undergoing total hip (THA) or knee (TKA) arthroplasty does not seem to effect the rate of secondary joint infections (SJI), the effect on hospital outcomes has yet to be evaluated. This study aimed to determine the clinical effect of ASB treatment in TKA or THA on hospital outcomes.

Methods:

A retrospective evaluation of patients undergoing TKA or THA with the presence of ASB was conducted. Inclusion criteria were TKA or THA and presence of ASB. Patients were excluded if symptomatic, receiving nonspecified antibiotics, catheterized, or pregnant. The primary outcome was comparing differences in time from admission to TKA or THA procedure in groups treated for ASB versus an untreated group. Secondary outcomes were length of stay (LOS) and rates of SJI.

Results:

A total of 1683 patients were screened, and 133 patients with ASB were included (53 treated; 80 untreated). Median time from admission to procedure was not statistically different between groups (3.63 hr [3.10-5.57 hr] treated vs. 3.68 hr [3.07-5.17 hr] untreated; P=0.412). An increase in LOS was observed in the treated group (3.4 days [3.15-4.36 days] treated vs. 2.36 days [2.21-3.35 days] untreated; P<0.0001). Rates of SJI were not different between groups (P=0.646).

Conclusions:

Although time from admission to TKA or THA procedure was not different between groups, a longer LOS was identified in the treated group. There was no difference in rates of SJI between groups. Larger studies are needed to determine if treating ASB for TKA or THA should be discontinued.

Level of Evidence:

Level III.
Early results of proximally inserted minimally invasive plate osteosynthesis for distal fibular fractures in unfavorable skin conditions: A case series
Authors: Zawam Sherif Hamdy , Shaheen Ayman Abdelsamee , Elnahal Walid A. , ElJeady Ibrahim Taha
Published: September 2019

Background:

Operative fixation of fractures of the lateral malleolus may be complicated by skin complications and wound infection, especially in patients with an unfavorable skin condition or soft-tissue injury. The goal of this study was to assess a technique of minimally invasive, proximally inserted plate fixation for distal fibular fractures in unfavorable skin conditions, including superficial abrasions, blisters, and contusions.

Methods:

This prospective case series study included 20 patients with syndesmotic and suprasyndesmotic fractures of the distal fibula, with unfavorable skin conditions, presenting to the emergency department of a major trauma center between May, 2015 and May, 2016. All patients were followed for an average of 1 yr (range, 6 mo-2 yr).

Results:

All fractures united at an average of 9.4 wk (range, 8-12 wk). Functional assessment according to the American Orthopaedic Foot And Ankle Society Scoring system was 93.9 (range, 78-100). None of the cases was complicated by wound dehiscence or deep infection.

Conclusions:

Minimally invasive, proximally inserted plate fixation is a viable and safe technique that can avoid an incision over the skin of the distal fibula in patients with unfavorable skin conditions.

Level of Evidence:

Level IV.
Occupational Therapy in the ICU: A Scoping Review of 221 Documents
Authors: Costigan F. Aileen , Duffett Mark , Harris Jocelyn E. , Baptiste Susan , Kho Michelle E.
Published: September 2019

Objectives:

Occupational therapists have specialized expertise to enable people to perform meaningful “occupations” that support health, well-being, and participation in life roles. Given the physical, cognitive, and psychologic disability experienced by ICU survivors, occupational therapists could play an important role in their recovery. We conducted a scoping review to determine the state of knowledge of interventions delivered by occupational therapists in adult ICU patients.

Data Sources:

Eight electronic databases from inception to 05/2018.

Study Selection:

We included reports of adult patients receiving direct patient care from an occupational therapist in the ICU, all study designs, and quantitative and qualitative traditions.

Data Extraction:

Independently in duplicate, interprofessional team members screened titles, abstracts, and full texts and extracted report and intervention characteristics. From original research articles, we also extracted study design, number of patients, and primary outcomes. We resolved disagreements by consensus.

Data Synthesis:

Of 50,700 citations, 221 reports met inclusion criteria, 74 (79%) published after 2010, and 125 (56%) appeared in critical care journals. The three most commonly reported types of interventions were mobility (81%), physical rehabilitation (61%), and activities of daily living (31%). We identified 46 unique original research studies of occupational therapy interventions; the most common study research design was before-after studies (33%).

Conclusions:

The role of occupational therapists in ICU rehabilitation is not currently well established. Current interventions in the ICU are dominated by physical rehabilitation with a growing role in communication and delirium prevention and care. Given the diverse needs of ICU patients and the scope of occupational therapy, there could be an opportunities for occupational therapists to expand their role and spearhead original research investigating an enriched breadth of ICU interventions.
Knowledge Discovery With Machine Learning for Hospital-Acquired Catheter-Associated Urinary Tract Infections
Authors: Park Jung In , Bliss Donna Z. , Chi Chih-Lin , Delaney Connie W. , Westra Bonnie L.
Published: September 2019

Massive generation of health-related data has been key in enabling the big data science initiative to gain new insights in healthcare. Nursing can benefit from this era of big data science, as there is a growing need for new discoveries from large quantities of nursing data to provide evidence-based care. However, there are few nursing studies using big data analytics. The purpose of this article is to explain a knowledge discovery and data mining approach that was employed to discover knowledge about hospital-acquired catheter-associated urinary tract infections from multiple data sources, including electronic health records and nurse staffing data. Three different machine learning techniques are described: decision trees, logistic regression, and support vector machines. The decision tree model created rules to interpret relationships among associated factors of hospital-acquired catheter-associated urinary tract infections. The logistic regression model showed what factors were related to a higher risk of hospital-acquired catheter-associated urinary tract infections. The support vector machines model was included to compare performance with the other two interpretable models. This article introduces the examples of cutting-edge machine learning approaches that will advance secondary use of electronic health records and integration of multiple data sources as well as provide evidence necessary to guide nursing professionals in practice.
Updates in the Approach to Chronic Pelvic Pain: What the Treating Gynecologist Should Know
Authors: CAREY ERIN T. , MOORE KRISTIN
Published: September 2019

Chronic pelvic is a multifaceted condition that often has both peripheral and central generators of pain. Despite its high prevalence, the evaluation and management of a pelvic pain patient often present many challenges to the practicing gynecologist. As with many other chronic pain conditions, pain severity does not always correlate with pelvic pathology and standard medical and surgical therapies are not always effective. An understanding of neurobiology and neuropsychology of chronic pelvic pain along with clinical pearls in the history and physical examination should guide management. Successful treatment of pelvic pain is typically multimodal, a combination of pharmacologic treatment strategies directed at the affected pathology and surrounding structures along with behavioral therapy. Evidence for these and other emerging therapies are presented in this article.
Assessment of Ergonomic Strain and Positioning During Bronchoscopic Procedures
Authors: Gilbert Christopher R. , Thiboutot Jeffrey , Mallow Christopher , Chen Alexander , Pastis Nicholas J. , Argento A. Christine , Millar Jennifer , Lavin Robert A. , Lerner Andrew D. , Yu Diana H. , Salwen Ben , Lunz Daniel , Lee Hans J. , Yarmus Lonny B.
Published: September 2019

Background:

Poor ergonomics place health care workers at risk for work-related overuse injuries. Repetitive and prolonged hand maneuvers, such as those performed during endoscopic procedures, may lead to musculoskeletal complaints and work-related injuries. However, the prevalence of health care–related work injuries among physicians is thought to be underreported and there is a paucity of literature investigating the impact of ergonomic strain on bronchoscopy. We designed a feasibility study to explore the differences in ergonomic strain and muscle activity of bronchoscopists.

Materials and Methods:

A prospective study of bronchoscopic procedures was performed in a simulated environment. Preselected target areas were identified and airway sampling was performed with real-time ergonomic assessment utilizing electromyogram (EMG), grip strength, and musculoskeletal use and motion analysis.

Results:

Procedural data was obtained for all procedures (78 bronchoscopies by 13 subjects) for both ergonomic and EMG scores. Experienced bronchoscopists demonstrated less EMG burden (P=0.007) and improved ergonomic positioning (P=0.007) during bronchoscopy when compared with less experienced bronchoscopists. Procedures performed with rotational-head bronchoscopes trended toward improved ergonomics (P=0.15) and lower EMG scores (P=0.88). A significant improvement in ergonomic scores was seen with the rotational-head bronchoscope when targeting the left upper lobe (P=0.036).

Conclusion:

Poor ergonomic positioning and excessive muscle strain appear present within bronchoscopy procedures but may be improved in those with more bronchoscopy experience. Technological advances in bronchoscope design may also have the potential to improve procedural ergonomics. Additional prospective studies are warranted to define the long-term impact on bronchoscopic ergonomics.
The CHADS-VASc score is a predictor of no-reflow in patients with non-ST-segment elevation myocardial infarction
Authors: Barman Hasan Ali , Kahyaoglu Serdar , Durmaz Eser , Atici Adem , Gulsen Kamil , Tugrul Sevil , Isleyen Hasan Burak , Yildirim Mehmet Rifat , Gungor Baris , Okuyan Ertugrul , Sahin Irfan
Published: September 2019

This study was performed to evaluate the relationship between the CHA2DS2-VASc score and no-reflow (NR) phenomena in patients with non-ST-segment elevation myocardial infarction (NSTEMI). A total number of 428 consecutive patients with NSTEMI were assessed for this study. Patients were divided into 2 groups, those with NR, NR(+) (n=84), and those without NR, NR(-) (n=307), according to their post-PCI, no-reflow status. The CHA2DS2-VASc score was significantly higher in the NR(+) group compared to the NR(-) (3.48 ± 1.19 vs 1.81 ± 0.82, P < 0.001). After a multivariate regression analysis, a higher CHA2DS2-VASc score (OR: 6.52, 95% CI: 3.51–12.14, P < 0.001), hs-Troponin (OR: 1.077, 95% CI: 1.056–1.099, P< 0.001) and TTG (OR: 1.563, 95% CI: 1.134–2.154, P=0.006) were independent predictors of NR. CHA2DS2-VASc score is associated with higher risk of no-reflow in patients with NSTEMI undergoing PCI.
Clinical outcomes of SeQuent Please paclitaxel-coated balloons for de novo small coronary artery lesion in a Japanese multicenter post-approval registry
Authors: Funayama Naohiro , Muratsubaki Shingo , Kawahatsu Kandoh , Miyata Masahiro , Katou Yasuhiro , Oikawa Tatsuya
Published: September 2019

Objective

Drug-coated balloon (DCB) angioplasty has emerged as an effective management strategy worldwide. In June 2016, DCB became available for the treatment of de novo small coronary lesions in Japan; however, there has been no multicenter analysis in a post-approval real-world clinical setting to date. The aim of this study was to evaluate the efficacy of DCB for de novo small coronary lesions based on a Japanese multicenter registry.

Methods and results

From June 2016 to July 2017, a total of 111 lesions (102 patients) treated with DCB for de novo small coronary lesions were enrolled at six Japanese institutions. The primary endpoint was the rate of target lesion revascularization (TLR) at 12 months. Angiographic follow-up endpoints were binary restenosis and late lumen loss (LLL). Clinical follow-up data at 12 months were available for 106 lesions, excluding five lesions that required bailout stenting. The TLR rate was 5.7% (6/106 lesions). No cardiac death or target lesion thrombosis was observed. The binary restenosis rate was 14.4% and LLL was 0.0017 ± 0.37 mm.

Conclusions

DCB angioplasty for de novo small coronary lesions in the real-world environment in Japan is effective with acceptable 12-month outcomes.
Status epilepticus - time is brain and treatment considerations
Authors: Der-Nigoghossian Caroline , Rubinos Clio , Alkhachroum Ayham , Claassen Jan
Published: September 2019

Purpose of review

Status epilepticus is a neurological emergency associated with high morbidity and mortality. There is a lack of robust data to guide the management of this neurological emergency beyond the initial treatment. This review examines recent literature on treatment considerations including the choice of continuous anesthetics or adjunctive anticonvulsant, the cause of the status epilepticus, and use of nonpharmacologic therapies.

Recent findings

Status epilepticus remains undertreated and mortality persists to be unchanged over the past 30 years. New anticonvulsant choices, such as levetiracetam and lacosamide have been explored as alternative emergent therapies. Anecdotal reports on the use of other generation anticonvulsants and nonpharmacologic therapies for the treatment of refractory and super-refractory status epilepticus have been described.

Finally, recent evidence has examined etiology-guided management of status epilepticus in certain patient populations, such as immune-mediated, paraneoplastic or infectious encephalitis and anoxic brain injury.

Randomized clinical trials are needed to determine the role for newer generation anticonvulsants and nonpharmacologic modalities for the treatment of epilepticus remains and evaluate the long-term outcomes associated with continuous anesthetics.
Sudden unresponsive patient with normal vital signs: what is going on?
Authors: Smit Lisa , Foks Kelly A. , Hofmeijer Jeannette , van der Jagt Mathieu
Published: September 2019

Purpose of review

To summarize the differential diagnosis and diagnostic approach of sudden unresponsiveness with normal vital signs in various settings, including the ICU.

Recent findings

Sudden unresponsiveness may be either transient or persistent, and may result from primary brain diseases or nonstructural systemic conditions. Life-threatening causes should always be discriminated from those more benign. Regional epidemiology, for example regarding intoxications, and evolving therapeutic management, for example for ischemic stroke, should always be taken into account for optimal opportunity for rapid diagnosis and best management.

Sudden unresponsiveness with normal vital signs should trigger immediate and focused diagnostic evaluation to find or exclude those conditions requiring urgent, and possibly life-saving, management.
Ultrasound in the surgical ICU: uses, abuses, and pitfalls
Authors: Johnson Garrett G.R.J. , Kirkpatrick Andrew W. , Gillman Lawrence M.
Published: September 2019

Purpose of review

Point-of-care ultrasound (POCUS) has become an integral component of daily care in the surgical ICU. There have been many novel advancements in the past two decades, too numerous to count. Many are of critical importance to the intensive care physician, whereas others are still accumulating evidence. Without appropriate training, diligence, and incorporation of the ultrasound findings into the whole clinical picture, this technique can be gravely misused. This review examines POCUS use in the surgical ICU, as well as highlights potential hazards and common pitfalls.

Recent findings

POCUS is essential for guidance of vascular access procedures, as well as in the characterization and treatment of respiratory failure, shock, and unstable blunt abdominal trauma. Ultrasound has growing evidence for rapidly evaluating many other diseases throughout the entire body, as well as guidance for procedures. Using advanced ultrasound techniques should only be done with corresponding levels of training and experience.

Ultrasound in the critical care setting has become an essential component of the assessment of most ICU patients. As more evidence accumulates, along with ever-increasing availability of ultrasound technology, its use will continue to expand. It, thus, behoves clinicians to not only ensure they are adept at obtaining and interpreting POCUS images but also efficiently incorporate these skills into holistic bedside care without delaying lifesaving therapies.
Association Between Helicobacter pylori Infection and Short-segment/Long-segment Barrett’s Esophagus in a Japanese Population
Authors: Usui Genki , Sato Hajime , Shinozaki Tomohiro , Jinno Toyohisa , Fujibayashi Kazutoshi , Ishii Ken , Horiuchi Hajime , Morikawa Teppei , Gunji Toshiaki , Matsuhashi Nobuyuki
Published: September 2019

Goal:

The goal of this study was to investigate the relationship betweenHelicobacter pylori (H. pylori)infection and short-segment and long-segment Barrett’s esophagus (SSBE and LSBE).

Background:

H. pyloriinfection is reported to be inversely associated with Barrett’s esophagus (BE) in western countries. However, the impact of BE segment length on the association between BE andH. pyloriinfection has scarcely been investigated.

Materials and Methods:

The study subjects were 41,065 asymptomatic Japanese individuals who took medical surveys between October 2010 and September 2017. Using this large database of healthy Japanese subjects, we investigated the association betweenH. pyloriinfection and SSBE/LSBE. We used multivariable logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Results:

Among the study subjects, 36,615 were eligible for the analysis.H. pyloriseropositivity was significantly associated with a lower rate of LSBE (OR: 0.42; 95% CI: 0.16-0.91) and a higher rate of SSBE (OR: 1.66; 95% CI: 1.56-1.78) after multivariate adjustment. In the subgroup analysis,H. pyloriseropositivity was significantly associated with a high rate of SSBE in subjects without reflux esophagitis (RE) (OR: 1.73; 95% CI: 1.61-1.85). However,H. pyloriseropositivity was not associated with SSBE in subjects with RE (OR: 1.07; 95% CI: 0.84-1.37).

Conclusion:

In a Japanese population,H. pyloriinfection was inversely associated with LSBE but significantly associated with SSBE only in subjects without RE.H. pylorimay be a risk factor for SSBE, especially in individuals without RE.
Annual contrast-enhanced magnetic resonance imaging is highly effective in the surveillance of hepatocellular carcinoma among cirrhotic patients
Authors: Demirtas Coskun Ozer , Gunduz Feyza , Tuney Davut , Baltacioglu Feyyaz , Kani Haluk Tarik , Bugdayci Onur , Alahdab Yesim Ozen , Ozdogan Osman Cavit
Published: September 2019

Objectives

Biannual ultrasonography, a globally accepted surveillance method, has low sensitivity in detecting early-stage hepatocellular carcinoma (HCC). We aimed to investigate the effectiveness of a surveillance strategy using annual contrast-enhanced MRI to detect HCCs at early-stage.

Materials and methods

We reviewed the data of 294 patients with consistent annual contrast-enhanced MRI and biannual alpha fetoprotein (AFP) surveillance between 2008 and 2017. Patients were stratified for HCC risk as low-intermediate-high risk group using Toronto risk score. HCCs were classified according to Barcelona Clinic Liver Cancer staging system.

Results

Thirty-five (11.9%) HCCs were detected with annual surveillance MRI. Of those, 30 (85.8%) were early-stage and 15 (42.9%) were very early-stage. The majority of patients (82.9%) with surveillance detected HCC were high risk at the entry. MRI had sensitivity of 83.3 and 80% with a specificity of 95.4 and 91.4%, for detecting early and very early-stage HCC, respectively. Addition of AFP to MRI displayed similar sensitivity and specificity rates to detect early and very early HCCs. The area under the curve of MRI alone and combination with AFP was not statistically different (Any-HCC: 0.905 vs. 0.924; Early-HCC: 0.853 vs. 0.885; Very early-HCC: 0.838 vs. 0.885, respectively, all P values >0.2).

Conclusion

Annual MRI strategy demonstrated a satisfactory performance in the surveillance of HCC, in terms of detecting most of the lesions in earlier curable stages and indicating high sensitivity with no additional benefit of biannual AFP. New risk stratified screening algorithms may further increase the yield of HCC surveillance among cirrhotic patients.
Does melatonin addition to indomethacin decrease post endoscopic retrograde cholangiopancreatography pancreatitis? A randomized double-blind controlled trial
Authors: Sadeghi Amir , Abbasinazari Mohammad , Asadzadeh Aghdaei Hamid , Abdi Saeed , Hatami Behzad , Rasoolinezhad Mehrnaz , Jamshidzadeh Shaghayegh , Saadati Saeede
Published: September 2019

Objective

Post-ERCP pancreatitis (PEP) is the most prevalent complication of endoscopic retrograde cholangiopancreatography (ERCP). Melatonin has been mentioned as a protective factor against acute pancreatitis. The present study was conducted to determine whether melatonin addition to indomethacin reduces the rate of PEP occurrence.

Methods

A double-blind randomized clinical trial was conducted on 411 patients undergoing ERCP. Baseline blood samples were collected, and the patients were given melatonin 3 mg tablets plus indomethacin suppository 100 mg or placebo plus indomethacin suppository 100 mg, 1 h before ERCP. The occurrence of PEP was the primary outcome. The concentrations of amylase and lipase were also measured 24 h after ERCP.

Results

Demographic characteristics of patients, characteristics of ERCP procedures, and baseline levels of amylase and lipase were found to be similar in both groups. The overall rate of PEP was equal to 9.5% in intention-to-treat (ITT) and 11.4% in per-protocol (PP) analyses. There was a significant difference in the rate of PEP between the melatonin and placebo groups (8.7% vs. 11.4% in ITT and 9.3% vs. 13.6% in PP, respectively). In addition, after 24 h, amylase and lipase levels were lower in the melatonin group than in the placebo group (P = 0.041 and 0.032, respectively).

Conclusion

The results of the present study showed that, administration of melatonin 3 mg tablets plus indomethacin suppository 100 mg 1 h before ERCP could decrease the PEP rate and amylase and lipase levels compared to administration of indomethacin suppository 100 mg alone.
Circulating methylated RUNX3 and SFRP1 genes as a noninvasive panel for early detection of colorectal cancer
Authors: Pasha Heba F. , Radwan Mohamed I. , Yehia Ahmed M. , Toam Mostafa M.
Published: September 2019

Objective

This study was conducted to assess the methylation status of runt-related transcription factor 3 (RUNX3) and secreted frizzled-related protein 1 (SFRP1) genes in paired tissue and serum samples of colorectal cancer (CRC), adenomatous, and control subjects and elucidate the association between methylation status on RUNX3 and SFRP1 mRNA expression.

Methods

Methylation status of RUNX3 and SFRP1 in paired tissue and serum samples and RUNX3 and SFRP1 mRNA expression in tissue from 85 patients with CRC, 40 with adenoma, and 40 healthy controls were determined using methylation-specific PCR and reverse transcription PCR.

Results

The frequency RUNX3 and SFRP1 genes methylation was significantly higher in both tissues and serum of CRC patients and was significantly associated with absence of its corresponding mRNA expression. The concordance between tissue and serum methylation status was 94.4% for RUNX3 and 94.3% for SFRP1. Tissue RUNX3 methylation status detected CRC with 63.53% sensitivity and 80.00% specificity, while serum RUNX3 methylation status detected CRC with 60.00% sensitivity and 82.50% specificity. Tissue SFRP1 methylation status showed a sensitivity of 82.35% and specificity of 65.00%, while serum SFRP1 methylation status showed a sensitivity of 77.65% and specificity of 70.00% in detection of CRC. RUNX3/SFRP1/carcinoembryonic antigen (CEA) panel identified CRC with sensitivity of 89.41% in tissue and 84.71% in serum.

Conclusion

Our results verified the reliability of using serum RUNX3 and SFRP1 methylation status as a noninvasive biomarker for diagnosis of CRC and that combined detection of RUNX3/SFRP1/CEA panel might be a promising strategy for early detection of CRC.
The interaction between current smoking and hemoglobin on the risk of advanced fibrosis in patients with biopsy-proven nonalcoholic fatty liver disease
Authors: Enc Feruze Yilmaz , Ulasoglu Celal , Bakir Alev , Yilmaz Yusuf
Published: September 2019

Background

Higher hemoglobin levels have been associated with an increased risk for nonalcoholic fatty liver disease. Although the mechanism underlying this association is elusive, smoking has been previously related to both higher hemoglobin concentrations and an increased risk of fibrosis in nonalcoholic fatty liver disease. The present study was conducted to investigate formally the interaction among current smoking, hemoglobin levels, and risk for advanced fibrosis in patients with biopsy-proven nonalcoholic fatty liver disease.

Patients and methods

We examined 433 Turkish patients with biopsy-proven nonalcoholic fatty liver disease. Advanced fibrosis (F ≥ 3) was identified on liver biopsy in 80 cases, whereas 84 patients were current smokers. Logistic regression models were used to evaluate the effect of current smoking on risk for advanced fibrosis, after adjusting for the effects of age, sex, BMI, diabetes, and metabolic syndrome.

Results

Preliminary analyses revealed the presence of substantial statistical interaction between current smoking and hemoglobin levels (P < 0.001). In separate multivariable analyses conducted in the entire cohort and in the subgroups of patients with high and low hemoglobin levels (according to median value in the study cohort: 14.4 g/l), current smoking was associated with increased risk for advanced fibrosis in patients with high hemoglobin (odds ratio: 3.32, 95% confidence interval: 1.23−7.21, P < 0.01) but neither in those with low hemoglobin (odds ratio: 0.71, 95% confidence interval: 0.28−1.81, P = 0.52) nor in the entire study cohort (odds ratio: 1.18, 95% confidence interval: 0.73−2.14, P = 0.79).

Conclusion

Hemoglobin acts as a modifier in the association between current smoking and advanced fibrosis in nonalcoholic fatty liver disease.
Shortened acquisition time in simultaneous 99mTc-tetrofosmin and 123I-β-methyl-p-iodophenyl pentadecanoic acid dual-tracer imaging with cadmium–zinc–telluride detectors in patients undergoing primary coronary intervention for acute myocardial infarction
Authors: Yamada Yoshihiro , Nakano Shintaro , Gatate Yodo , Sugi Keiki , Okano Nanami , Muramatsu Toshihiro , Nishimura Shigeyuki , Kuji Ichiei , Fukushima Kenji , Matsunari Ichiro
Published: September 2019

Objective

The use of cadmium–zinc–telluride-based scanners may increase the clinical feasibility of simultaneous dual-isotope imaging. In the current study, we sought to investigate a potential acquisition time in simultaneous 99mTc-tetrofosmin/123I-β-methyl-p-iodophenyl pentadecanoic acid dual-isotope imaging using a Discovery NM/CT 670 cadmium–zinc–telluride.

Methods

Simultaneous 99mTc-tetrofosmin/123I-β-methyl-p-iodophenyl pentadecanoic acid dual-isotope imaging was performed in 29 patients who had undergone primary percutaneous coronary intervention for acute myocardial infarction. Referenced images with an acquisition time of 65 s/view (16.25 min) were reframed to produce images with acquisition times of 33, 16, and 8 s/view. The values for the quantitative-gated single-photon emission computed tomography (SPECT) and the quantitative perfusion SPECT were compared.

Results

The quantitative-gated SPECT values for images with 33, 16, and 8 s/views showed good consistency with those for 65 s/view (the lower 95% confidence intervals for the intraclass correlation were ≥0.80). The quantitative perfusion SPECT values for 99mTc-tetrofosmin images with 33, 16, and 8 s/views also showed good consistency with those for 65 s/view; however, the quantitative perfusion SPECT values for 123I-β-methyl-p-iodophenyl pentadecanoic acid images with an acquisition time of 8 s/view were not consistent with the reference acquisition time of 65 s/view.

Conclusions

The quantitative-gated SPECT and quantitative perfusion SPECT values obtained from images with shorter acquisition times correlated with the values obtained from images with a reference acquisition time of 65 s/view; however, tracer-specific predisposition should be considered. These findings suggest that it is possible to reduce acquisition time when performing simultaneous 99mTc-tetrofosmin/123I-β-methyl-p-iodophenyl pentadecanoic acid dual-tracer imaging with the novel cadmium–zinc–telluride scanner.
Renal Tumors in Children and Young Adults Older Than 5 Years of Age
Authors: Mansfield Sara A. , Lamb Margaret G. , Stanek Joseph R. , Arnold Michael A. , Ranalli Mark , Aldrink Jennifer H.
Published: September 2019

Renal masses are most common in children between ages 1 to 3 years, with less known about renal tumors in older children and young adults. The aim of this study was to review the presentation, demographics, histology, and outcomes in patients over 5 years of age with renal tumors compared with younger children. 111 renal tumors were diagnosed in patients 5 years of age and older (median, 7 y; range, 5 to 31 y) between 1950 and 2017 at a single institution. Wilms tumor (WT) was the most common histology in 84 patients (75%), followed by renal cell carcinoma in 12 patients (10.7%). Abdominal pain was the most common presenting symptom (46%) followed by hematuria (28.8%), and a palpable abdominal mass (24.3%). For WT, older children more commonly presented with advanced-stage disease (stages 3 and 4) than younger children (57.7% vs. 11.5%; P<0.001). Event-free survival (EFS) and overall survival (OS) for favorable histology WT were not different between younger and older children (OS, P=0.43; EFS, P=0.46). In this cohort, older children more frequently present with variable signs and symptoms, less common histopathologies although WT was still most frequent, and more advanced-stage disease compared with younger cohorts, but without differences in EFS or OS.
Diabetes Distress, Depressive Symptoms, and Cardiovascular Health in Adults With Type 1 Diabetes
Authors: McCarthy Margaret M. , Whittemore Robin , Gholson Georica , Grey Margaret
Published: September 2019

Background

The prevalence of adults with Type 1 diabetes (T1D) is increasing, and their risk of cardiovascular disease is high. Comorbid diabetes distress and depressive symptoms may affect their cardiovascular health.

Objectives

The purpose of this study was to describe the relationship between diabetes distress and depressive symptoms with cardiovascular health factors.

Methods

This was a cross-sectional survey of a sample of adults with T1D. Valid and reliable instruments were used to collect the data on sociodemographics, diabetes-related complications, psychological factors, and cardiovascular health factors. Independent-sample t tests, analysis of variance, chi-square analyses, and linear regression were used to compare the cardiovascular health factors among the three levels of diabetes distress scores and the two levels of depressive symptom scores.

Results

Our sample included 83 adults with a mean age of 45.2 years and a mean duration of T1D of 20 years. The majority scored low in the Diabetes Distress Scale, whereas 18% scored moderate and 18% scored high. Twenty-two percent had increased levels of depressive symptoms. There were significant correlations between diabetes distress and fear of hypoglycemia, depressive symptom scores, hemoglobin A1c, and total cholesterol. Depressive symptom scores were significantly correlated with hemoglobin A1c. Hemoglobin A1c and total cholesterol were significantly higher in those with higher levels of diabetes distress. There were no significant differences in cardiovascular health between those who scored below or above the cut point for depressive symptoms, but there was a finding toward higher mean body mass index, hemoglobin A1c, and a lower weekly step count in those who had elevated depressive symptoms. In the linear regression, only diabetes distress was significantly associated with hemoglobin A1c.

Discussion

This is a sample with elevated diabetes distress and depressive symptoms, both of which may affect their risk of cardiovascular disease.
Decreasing Barriers to Research Utilization Among Labor and Delivery Nurses
Authors: Heelan-Fancher Lisa , Edmonds Joyce K. , Jones Emily J.
Published: September 2019

Background

Intermittent fetal monitoring (IFM) is a recommended strategy for intrapartum fetal heart rate assessment in low-risk pregnancies; however, this “high touch, low tech” approach is underutilized.

Objective

The aim of the study was to examine the relationships between labor and delivery nurses’ intellectual capital and their perceptions of barriers to research utilization in the work setting.

Methods

A cross-sectional correlational design using data derived from a larger study of labor and delivery nurses (N = 248) was used. Covell’s theory of nursing intellectual capital was used as the conceptual and analytic framework to examine labor and delivery nurses’ intellectual capital and their perceived barriers to research utilization.

Results

Nurses who receive paid time off from their employer to attend conferences (p < .01) and nurses who do not report nurse-to-patient ratios as a problem in providing IFM (p < .01) perceive fewer barriers to research utilization.

Discussion

Time, especially available time, has an effect on labor and delivery nurses’ attitude toward IFM and their perceptions of barriers to research utilization.
Surrogacy and Pregnancy
Authors: Phillips Amy M. , Magann Everett F. , Whittington Julie R. , Whitcombe Dayna D. , Sandlin Adam T.
Published: September 2019

Importance

Surrogacy allows for parenthood when it is otherwise impossible or exceedingly difficult; however, the risks of surrogate pregnancy for the gestational surrogate and the fetus are not well defined.

Objective

The aim of this study was to review the literature to examine the prevalence and requirements of surrogate pregnancy and maternal and perinatal outcomes.

Evidence Acquisition

A CINAHL and 2 PubMed searches were undertaken using the terms “surrogate mothers” OR “(surrogate or surrogacy)” AND “(mothers OR pregnancy OR pregnant).” The second search used these terms and pregnancy outcomes. The search was limited to the English language, but the years searched were unlimited.

Results

The search identified 153 articles, 36 of which are the basis for this review. The number of surrogate pregnancies is increasing in the United States. Fetal risks associated with surrogacy include low birth weight, increased risk of multiple gestation, and preterm birth. Maternal complications associated with surrogate pregnancy include hypertensive disorders of pregnancy, postpartum hemorrhage, and gestational diabetes.

Conclusions and Relevance

Surrogacy is a route to parenting that is not without risk to the surrogate or the fetus, and surrogate pregnancy is increasing in frequency in the United States.

Target Audience

Obstetricians and gynecologists, family physician.

Learning Objectives

After completing this activity, the learner should be better able to identify candidates for surrogacy; describe the effects of obesity on surrogacy; and explain the maternal and perinatal complications associated with surrogate pregnancy.
Syphilis in Pregnancy
Authors: Tsai Shelun , Sun Michael Y. , Kuller Jeffrey A. , Rhee Eleanor H. J. , Dotters-Katz Sarah
Published: September 2019

Importance

Since 2013, the United States has seen a rise in cases of congenital syphilis, culminating in a relative increase of 153% from 2013 to 2017 and 918 reported cases in 2017. In all, 50% to 80% of pregnant women with syphilis experience an adverse pregnancy outcome including stillbirth or spontaneous abortion.

Objective

This article aims to review the current evidence and recommendations for management of syphilis in pregnancy.

Evidence Acquisition

Original research articles, review articles, and guidelines on syphilis were reviewed.

Results

In pregnancy, routine screening for syphilis is recommended on initiation of prenatal care. In high-risk populations, repeat testing is recommended in the early third trimester and at delivery. Penicillin remains the recommended treatment in pregnancy. After treatment, nontreponemal titers should be repeated at minimum during the early third trimester and at delivery to assess for serologic response. In high-risk populations, titers should be repeated monthly.

Conclusion and Relevance

Routine screening in pregnancy is essential for identification of syphilis infection and prevention of congenital syphilis. Subsequent adequate treatment with penicillin therapy more than 30 days before delivery and at the correct dosages depending on the stage of infection should be incorporated into clinical practice.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After completion of this educational activity, the obstetrician/gynecologist should be better able to summarize current knowledge of how syphilis impacts maternal and neonatal outcomes; describe the recommended screening and diagnostic tests for syphilis; and outline the treatment regimens and follow-up recommendations for management of syphilis in pregnancy.
Electronic Interventions for Changing Knowledge, Attitudes or Practices Regarding Contraception: A Systematic Review
Authors: Dewart Courtney M. , Serpico Jaclyn , Steiner Markus J. , Gallo Maria F.
Published: September 2019

(Abstracted from Contraception, https://doi.org/10.1016/j.contraception.2019.04.004)

Globally, nearly half of pregnancies are unintended. Sociodemographic factors associated with unintended pregnancy include age, parity, education, and economic status.
In Search of Mobile Applications for Patients With Pelvic Floor Disorders
Authors: Sudol Neha T. , Adams-Piper Emily , Perry Rachel , Lane Felicia , Chen Katherine T.
Published: September 2019

(Abstracted from Female Pelvic Med Reconstr Surg 2019;25: 252–256)

Multiple medical societies have issued guidelines emphasizing the importance of patient education, behavioral therapy, and/or exercise regimens in the initial treatment and management of women with pelvic floor disorders. Even with these well-established recommendations, however, it is often difficult to engage patients and maintain adherence to treatment plans.
Time From Neuraxial Anesthesia Placement to Delivery Is Inversely Proportional to Umbilical Arterial Cord pH at Scheduled Cesarean Delivery
Authors: Rimsza Rebecca R. , Perez William M. , Babbar Shilpa , O'Brien Megan , Vricella Laura K.
Published: September 2019

(Abstracted from Am J Obstet Gynecol 2019;220:389.e1–389.e9)

Risks to the fetus during cesarean delivery, although rare, can include neonatal depression and hypoxic ischemic encephalopathy during nonemergent cesarean delivery. It is known that neuraxial anesthesia–related hypotension can contribute to uterine hypoperfusion and decreased umbilical arterial pH at cesarean delivery.
Dual Trigger With Gonadotropin Releasing Hormone Agonist and Human Chorionic Gonadotropin Significantly Improves Live Birth Rate for Women With Diminished Ovarian Reserve
Authors: Lin Ming-Huei , Wu Frank Shao-Ying , Hwu Yuh-Ming , Lee Robert Kuo-Kuang , Li Ryh-Sheng , Li Sheng-Hsiang
Published: September 2019

(Abstracted from Reprod Biol Endocrinol 2019;17:7)

As the prevalence of fertility treatment increases, research into managing “diminished ovarian reserve” (DOR) remains a challenge. A “dual trigger” consisting of a gonadotropin hormone–releasing hormone agonist (GnRH-a) in combination with a reduced dose of human chorionic gonadotropin (hCG) showed robust evidence of increased pregnancy and live birth rate without ovarian hyperstimulation in in vitro fertilization (IVF) cycles for high responders.