bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic review and meta-analysis of the efficacy and safety of vibegron vs antimuscarinic monotherapy for overactive bladder
Authors: Su Shunye , Liang Liqin , Lin Jinlei , Liu Ludong , Chen Zhipeng , Gao Yuan
Published: February 2021

Background:

Vibegron is a new β3-adrenergic receptor agonist which has been demonstrated for the treatment of overactive bladder (OAB). We carried out meta-analysis to evaluate the efficiency of vibegron vs antimuscarinic monotherapy for treating OAB.

Methods:

Randomized controlled trials (RCTs) of Vibegron vs antimuscarinic monotherapy for OAB were searched systematically by using EMBASE, MEDLINE, and the Cochrane Controlled Trials Register. The RevMan version 5.3.0. was used to analysis the data.

Results:

Three RCTs involving a total of 1751 patients were studied in the Systematic review and Meta-analysis. Efficacy end points: the mean number of micturitions episodes/d (P = .16); the mean number of urgency episodes/d (P = .05); mean number of urgency incontinence episodes/d (P = .11) and mean number of incontinence episodes/d (P = .14) indicated that vibegron and antimuscarinic had no significant differences in terms of OAB treatment. Mean volume voided/micturition showed a distinct difference in the two groups (P = .009). With regard to dry mouth and drug related treatment-emergent adverse event (TEAE), vibegron showed better tolerance than antimuscarinic. Serious adverse event (SAE) and discontinuations due to adverse event (AE) did not show a significant difference between the two groups.

Conclusions:

The therapeutic effect of vibegron is similar to that of antimuscarinic, but vibegron does not increase the risk of AE.
A retrospective study on the short-term effect of high-dose spironolactone (80 mg/d) on chronic congestive heart failure
Authors: Tao Pan , Zhitao Tu , Jiming Liu
Published: February 2021

To explore the short-term effect of high-dose spironolactone (80 mg/d) on chronic congestive heart failure (CHF).

The general clinical data of 211 patients with CHF from February 2016 to August 2019 were collected and analyzed. Patients were divided into Low-dose group (taking 40 mg/d spironolactone) and High-dose group (taking 80 mg/d spironolactone) according to the patient's previous dose of spironolactone. The changes of B-type brain natriuretic peptide (BNP), NT-pro BNP (N terminal pro B type natriuretic peptide), echocardiography, 6-minute walking test (6MWT), and comprehensive cardiac function assessment data were collected for analysis.

Compared with before treatment, the blood potassium of the two groups increased significantly (P < .05), but the blood potassium did not exceed the normal range. Compared with before treatment, BNP, NT-pro BNP, LVEDD, LVEDV and NYHA grading were significantly decreased (P < .05), LVEF and 6-MWT were significantly increased (P < .05). Compared with the Low-dose group, the high-dose group BNP (117.49 ± 50.32 vs 195.76 ± 64.62, P < .05), NT-pro BNP (312.47 ± 86.28 vs 578.47 ± 76.73, P < .05), LVEDD (45.57 ± 5.69 vs 51.96 ± 5.41, P <.05), LVEDV (141.63 ± 51.14 vs 189.85 ± 62.49, P < .05) and NYHA grading (1.29 ± 0.41 vs 1.57 ± 0.49, P < .05) were significantly reduced, but, 6-MWT (386.57 ± 69.72 vs 341.73 ± 78.62, P < .05), LVEF (41.62 ± 2.76 vs 36.02 ± 2.18, P < .05) and total effective rate (92.68% vs 81.39%, P < .05) increased significantly.

Compared with 40 mg spironolactone, 80 mg spironolactone can rapidly reduce BNP and NT-pro BNP concentration, enhance exercise tolerance, improve clinical signs and cardiac function classification, and has better efficacy.
COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP)
Authors: Tjia Jennifer , Pugnaire Michele , Calista Joanne , Esparza Nancy , Valdman Olga , Garcia Maria , Yazdani Majid , Hale Janet , Terrien Jill , Eisdorfer Ethan , Zolezzi-Wyndham Valerie , Chiriboga Germán , Rappaport Lynley , Puerto Geraldine , Dykhouse Elizabeth , Potts Stacy , Sifuentes Andriana Foiles , Stanhope Sylvia , Allison Jeroan , Duodo Vennesa , Sabin Janice
Published: February 2021

Background:

Healthcare professionals have negative implicit biases toward minority and poor patients. Few communication skills interventions target implicit bias as a factor contributing to disparities in health outcomes. We report the protocol from the COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP), a trial evaluating a novel educational and training intervention targeting graduate medical and nursing trainees that is designed to mitigate the effects of implicit bias in clinical encounters. The CONSULT-BP intervention combines knowledge acquisition, bias awareness, and practice of bias mitigating skills in simulation-based communication encounters with racially/ethnically diverse standardized patients. The trial evaluates the effect of this 3-part program on patient BP outcomes, self-reported patient medication adherence, patient-reported quality of provider communication, and trainee bias awareness.

Methods:

We are conducting a cluster randomized trial of the intervention among cohorts of internal medicine (IM), family medicine (FM), and nurse practitioner (NP) trainees at a single academic medical center. We are enrolling entire specialty cohorts of IM, FM, and NP trainees over a 3-year period, with each academic year constituting an intervention cycle. There are 3 cycles of implementation corresponding to 3 sequential academic years. Within each academic year, we randomize training times to 1 of 5 start dates using a stepped wedge design. The stepped wedge design compares outcomes within training clusters before and after the intervention, as well as across exposed and unexposed clusters. Primary outcome of blood pressure control is measured at the patient-level for patients clustered within trainees. Eligible patients for outcomes analysis are: English-speaking; non-White racial/ethnic minority; Medicaid recipient (regardless of race/ethnicity); hypertension; not have pregnancy, dementia, schizophrenia, bipolar illness, or other serious comorbidities that would interfere with hypertension self-control; not enrolled in hospice. Secondary outcomes include trainee bias awareness. A unique feature of this trial is the engagement of academic and community stakeholders to design, pilot test and implement a training program addressing healthcare.

Discussion:

Equipping clinicians with skills to mitigate implicit bias in clinical encounters is crucial to addressing persistent disparities in healthcare outcomes. Our novel, integrated approach may improve patient outcomes.

Trial registration:

NCT03375918

Protocol version:

1.0 (November 10, 2020)
Empowerment in Chinese primary caregivers of post-stroke patients with disability
Authors: Liu Youhua , Guo Hong
Published: February 2021

To investigate the status quo of empowerment ability of primary caregivers in post-stroke patients with disability and its influencing factors.

A cross-sectional design and a convenience sample were used. Participants (N = 189) from 3 hospital in Beijing were recruited from October 2018 to June 2019. The following measurement tools were used in this study: Barthel index, Main Caregiver Empowerment Measurement, General Self-Efficacy Scale, Simplified Coping Style Questionnaire and Social Support Rating Scale. Multiple linear stepwise regression analysis was used to statistically infer the influencing factors of empowerment ability of primary caregivers.

The total score of main caregivers’ empowerment measurement among the participants was 161.03 ± 14.678, the median (interquartile range) score was 162.00 (150.00–171.50). The average scores of each dimension ranged from high to low: relationship with the person being cared for, goodwill care, expectation for care outcomes, subjectivity of caregiver, faith in care, understanding of care role, knowledge and skills of care, scruples about the surroundings, personal resources. The single factor analysis showed that the patient's payment method for medical expenses, whether the patient accompanied by other chronic diseases and the gender of the caregiver had an effect on the empowerment ability of primary caregivers, and the positive coping style, negative coping style, self-efficacy and subjective support of primary caregivers were positively correlated with their empowerment ability (P < .05). Multiple linear stepwise regression analysis showed that the type of payment for treatment of patients (b = 7.449, P < .01), and gender of caregivers (b = 5.039, P < .05), subjective support of caregivers (b = 0.439, P < .05), positive coping style of caregivers (b = 0.585, P < .01), self-efficacy of caregivers (b = 6.456, P < .01) were the main influencing factors of empowerment ability of primary caregivers.

The empowerment ability of the primary caregivers of post-stroke patients with disability in China is at the upper middle level. However, there are more scruples about the surrounding and less personal resources, which deserve attention. Furthermore, the identification of the factors related to empowerment lays a foundation for clinical nursing practitioners to further develop targeted interventions on empowerment of caregivers.
DNA methylation patterns–based subtype distinction and identification of soft tissue sarcoma prognosis
Authors: Li Kai , Wu Zhengyuan , Yao Jun , Fan Jingyuan , Wei Qingjun
Published: February 2021

Soft tissue sarcomas (STSs) are heterogeneous at the clinical with a variable tendency of aggressive behavior. In this study, we constructed a specific DNA methylation-based classification to identify the distinct prognosis-subtypes of STSs based on the DNA methylation spectrum from the TCGA database. Eventually, samples were clustered into 4 subgroups, and their survival curves were distinct from each other. Meanwhile, the samples in each subgroup reflected differentially in several clinical features. Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis was also conducted on the genes of the corresponding promoter regions of the above-described specific methylation sites, revealing that these genes were mainly concentrated in certain cancer-associated biological functions and pathways. In addition, we calculated the differences among clustered methylation sites and performed the specific methylation sites with LASSO algorithm. The selection operator algorithm was employed to derive a risk signature model, and a prognostic signature based on these methylation sites performed well for risk stratification in STSs patients. At last, a nomogram consisted of clinical features and risk score was developed for the survival prediction. This study declares that DNA methylation-based STSs subtype classification is highly relevant for future development of personalized therapy as it identifies the prediction value of patient prognosis.
The effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia
Authors: Lim Byung Gun , Won Young Ju , Kim Heezoo
Published: February 2021

Background:

There have been conflicting results regarding clinical dexamethasone-sugammadex interactions in adults and pediatric patients under general anesthesia.

Methods:

This study used a systematic review with meta-analysis of randomized controlled trials and non-randomized studies based on the Cochrane Review Methods. A comprehensive literature search was conducted to identify clinical trials that investigated the effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia.

Results:

Among the 314 patients in the 6 studies, 147 received intravenous dexamethasone (dexamethasone group), and 167 received intravenous saline or other antiemetics (control group). The primary outcome, the time to recovery after sugammadex administration (the time to recovery of the train-of-four ratio to 0.9 after sugammadex administration; s) was comparable between the 2 groups, the weighted mean difference (95% confidence interval [CI]) being –2.93 (–36.19, 30.33) (I
2 = 94%). The time to extubation after sugammadex administration (s) and incidence of postoperative nausea and vomiting was not different between the 2 groups, the weighted mean difference (95% CI) being 23.31 (−2.26, 48.88) (I
2 = 86%) and the pooled risk ratio (95% CI) being 0.25 (0.03, 2.11), respectively. The time to recovery after sugammadex administration might be different according to the study design or study region.

Conclusion:

This meta-analysis showed that use of dexamethasone in the perioperative period neither delayed nor facilitated the reversal of rocuronium-induced neuromuscular blockade with sugammadex in patients undergoing elective surgery with general anesthesia. However, given that the results showed high heterogeneity, further randomized controlled trials are needed to confirm these findings.
Is hypoglycemia expensive in China?
Authors: Lan Kuixu , Wang Jian , Nicholas Stephen , Tang Qun , Chang Alison , Xu Junfang
Published: February 2021

Background:

As a common medical emergency in individuals with diabetes, hypoglycemia events can impose significant demands on hospital resources. Based on diabetes patients with and without hypoglycemia, we assess the cost of hypoglycemic events on China's hospital system.

Method:

Our study sample comprised 7110 diabetes episodes, including 1417 patients with hypoglycemia (297 patients with severe and 1120 with non-severe hypoglycemia) and 5693 diabetes patients without hypoglycemia. Data on patient social-demographics, length of hospital stay, and hospitalization costs were collected on each patient from Health Information System in Shandong province, China. The additional hospital costs caused by hypoglycemia were assessed by the cost difference between diabetes patients with and without hypoglycemia, including severe and non-severe hypoglycemia. China-wide hospital costs of hypoglycemia were estimated based on adjusted additional hospital costs, comprising inspection, treatment, drugs, materials, nursing, general medical costs, and other costs, caused by hypoglycemia, the prevalence of diabetes and hypoglycemia events, and the rates of hospitalization. Multiple sensitivity analyses were conducted to assess the impact of variations in the key input parameters on the primary estimates.

Results:

Total hospital costs for patients with hypoglycemia (US$3020.61) were significantly higher than that of patients without hypoglycemia (US$1642.91). The average additional cost caused by hypoglycemia was US$1377.70, with higher average costs of US$1875.89 for severe hypoglycemia and lower average costs of US$1244.76 for non-severe hypoglycemia. The additional hospital cost caused by severe and non-severe hypoglycemia patients was higher for the 60 to 75 year old group, married patients and patients accessing free medical services. Generally, hypoglycemic patients with Urban and Rural Resident Basic Medical Insurance incurred higher additional hospital costs than patients with Urban Employees Basic Medical Insurance. Based on these estimates, the total annual additional hospital costs arising from hypoglycemia events in China were estimated to be US$67.52 million. Sensitivity analyses suggested that the costs of hypoglycemia events ranged up to US$49.99 million to 67.52 million.

Conclusion

: Hypoglycemic events imposed a substantial cost on China's hospital system, with certain subgroups of patients, such as older patients and those with free health insurance, using medical resources more intensively to treat hypoglycemia events. We recommend more effective planning of prevention and treatment regimes for hypoglycemia patients; further reform to China's health insurance schemes; and better hospital cost control for those accessing free hospital services.
Role of plastic surgeons in the trauma center: national level I trauma center startup experience in South Korea
Authors: Lee Il Jae , Cha Bohwan , Park Dong Ha , Hahn Hyung Min
Published: February 2021

Although it is well recognized that other surgical specialties perform various procedures related to trauma care, there is a lack of analyses focusing on the role of plastic surgical management in trauma centers. This retrospective study was designed to investigate the scope of plastic surgery services in acute trauma care, using clinical data obtained from a single, regional, level I trauma center.

This study included patients who presented to a single, regional, level I trauma center between March 1, 2016 and February 28, 2018. Patients with acute trauma to the facial soft tissue and skeleton, soft tissue of the upper and lower limbs, trunk and perineum, and other areas requiring plastic surgical procedures were included in the analysis. Cases requiring consultation for the correction of posttraumatic deformity or secondary deformity and trauma sequelae, such as scars, were excluded. Data on patients’ demographics and detailed surgical procedures were acquired from electronic medical records. The reviewed cases were categorized by the primary anatomical region requiring surgery and the primary procedure performed.

A total of 1544 patients underwent surgery, and 2217 procedures were recorded during the 2-year study period. In 2016, 1062 procedures on 690 patients, and, in 2017, 1155 procedures on 787 patients were registered. The average age of the patients who underwent plastic surgical procedure due to a trauma-related cause was 38.4 years (range, 2 days to 91 years), and 1148 patients (77.7%) were male. The head and neck region was the most commonly observed anatomical area that was operated on. The facial bone requiring the largest degree of surgical intervention was the mandible, followed by the zygomatic bone, nasal bones, orbital floor, and maxilla. Microsurgical procedures, such as flap surgery and microsurgery, were performed in 121 cases. The most commonly elevated free flap was the ALT flap (n = 69).

Plastic surgeons play various roles in level I trauma centers, such as in the management of facial injury, performing limb-saving free tissue transfers, and complex wound reconstruction with flaps or skin grafts. Thus, plastic surgeons are an essential part of trauma centers.
Evaluation of contrast-enhanced ultrasound for activity of rheumatoid arthritis
Authors: Zhu Yunpei , Sui Ping , Wang Cong , Wang Hui , Wen Zhihong
Published: February 2021

Background:

Contrast-enhanced ultrasound (CEUS) refers to a technique that uses contrast medium to strengthen the echo of backscatter, which can significantly improve the resolution, sensitivity and specificity of ultrasound diagnosis. As a quantitative imaging examination of blood flow signals, CEUS has allowed detection of synovial microvascularization in the joints of patients with rheumatoid arthritis (RA). However, the results of these studies have been contradictory. Therefore, the purpose of this study is to evaluate the value of CEUS in the activity of RA disease.

Methods:

We will search PubMed, Embase, Cochrane Library, and CNKI from their inception to the December 20, 2020, without restrictions of language and publication status. Two investigators will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. This study will only include high quality clinical cohort or case control studies. Statistical analysis was performed by using the Review Manager version 5.3 and the STATA version 14.0 (Stata Corp, College Station, TX, USA) softwares.

Results:

This systematic review will determine the value of CEUS in RA activity scores.

Conclusion:

The results of this study will provide a useful basis for high-quality CEUS to evaluate RA activity score.

Systematic review registration:

INPLASY2020120125.
Alarmingly high malnutrition in childhood and its associated factors
Authors: Al-zangabila Khaled , Poudel Adhikari Sasmita , Wang Qingzhi , Sunil Thankam S. , Rozelle Scott , Zhou Huan
Published: February 2021

Childhood malnutrition is a serious public health problem in Yemen. However, there is a limited information regarding association of malnutrition with different socio-economic factors. This study examines the correlates of socioeconomic and maternal behavioral factors on malnutrition in Yemeni children under 5 years of age.

Our study focuses on the nutritional status of children under 5 years of age, and uses the data provided by the cross-sectional study namely Yemen National Demographic and Health Survey. Three anthropometric indicators: stunting, wasting, and underweight were selected for the evaluation of malnutrition. Independent variables include personal and maternal characteristics, socioeconomic and behavioral factors, and illness conditions. The study used the Chi-Squared test to test the significant association between independent variables and logistic regression to estimate the odds of being malnourished.

A total of 13,624 Yemeni children under 5 years of age were included in the study. The results show the high malnutrition level – the prevalence of stunting was 47%, wasting was 16%, and underweight was 39%. There is a statistically significant association between socioeconomic status, behavioral factors, and child malnutrition. The odds of malnutrition decreased with the increase in the level of mother's education, economic status, and frequency of prenatal visits. The odds of malnutrition were least for children whose mothers had highest level of education (OR = 0.64; 95%CI = 0.55–0.76), who belonged to highest wealth index (OR = 0.41; 95%CI = 0.36–0.47). Moreover, the likelihood of malnutrition was less among the children whose mother had highest number of prenatal visits during the pregnancy (OR = 0.67; 95%CI = 0.59–0.76).

The high prevalence of stunting, wasting, and undernutrition were found in Yemeni children. Different factors such as regional variations, socio-economic disparities, and maternal education and health care utilization behavior are found to be associated with high malnutrition. These findings provide important policy implications to improving childhood malnutrition in Yemen.
Effectiveness comparisons of Chinese patent medicine on insomnia
Authors: Chao Ruoyu , Wu Chunli , An Hongqiang , Li Bing , Wu Jianlin
Published: February 2021

Background:

In recent years, the incidence of insomnia is increasing. However, the existing therapy methods for cannot fundamentally treat the disease. Meanwhile, Chinese patent medicine (CPM) plays an active role in the treatment of insomnia. However, there is no comparison and ranking of the efficacy of every CPM. Therefore, our study will use network meta-analysis to compare the efficacy of different CPM on insomnia, in order to provide evidence-based medical evidence for clinical treatment.

Methods:

We will search CNKI, Wanfang, VIP, CBM, Pubmed, Cochrane Library, Embase for the randomized controlled trials of CPM in the treatment of insomnia (up to December 31, 2020). We will use RevMan5.3, Stata15.1 and ADDIS software for statistical analysis. We will draw the surface under cumulative ranking area to predict the order of efficacy.

Results:

We aim to rank the efficacy and safety of different CPM for the treatment of insomnia.

Conclusion:

CPM plays a positive role in the treatment of insomnia and can provide evidence support for clinicians and patients

INPLASY registration number:

INPLASY2020120121
Long-term follow-up after rituximab plus bendamustine in a patient with relapsed or refractory hairy cell leukemia variant
Authors: Imoto Naoto , Koyama Daisuke , Sugiura Isamu , Kurahashi Shingo
Published: February 2021

Introduction:

Hairy cell leukemia variant (HCL-v) is a rare lymphoproliferative disorder regarded as a splenic B-cell lymphoma/leukemia, unclassifiable tumor in the 2017 World Health Organization classification of lymphoid tumors. The prognosis of HCL-v is much worse than that of classical hairy cell leukemia and there is no consensus regarding the optimal treatment strategy for HCL-v. For patients with indolent lymphoma, rituximab plus bendamustine (RB) has proven effective in several clinical trials. Thus, RB is expected to be a treatment option for patients with HCL-v, but there have been few reports of its use in these patients.

Patient concerns:

A 64-year-old man presented with leukocytosis and abnormal lymphocytes in peripheral blood in a medical examination. Computed tomography revealed mild splenomegaly, but no lymph node enlargement.

Diagnosis:

The patient was initially diagnosed with low-grade B-cell lymphoma. After he experienced a second relapse, his clinical data were reviewed again; subsequently, he was diagnosed with HCL-v on the basis of clinical presentation, flow cytometry findings, and cytogenetic abnormalities.

Interventions:

The patient was first treated with the cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen. After the regimen was ineffective, he received six cycles of RB. After relapse, the patients received an additional six cycles of RB.

Outcomes:

The patients exhibited a slight reduction of the abnormal lymphocyte level but insufficient therapeutic efficacy during CHOP therapy. After the first cycle of RB, the patient exhibited an immediate response with the absence of minimal residual disease. He remained relapse-free for approximately 67 months. After a second relapse, complete response was again achieved with the absence of minimal residual disease following RB re-administration. He remained relapse-free for approximately 29 months after the second RB.

Conclusion:

RB could be a treatment option for patients with relapsed or refractory HCL-v. Further research is needed to establish the optimal treatment regimen for patients of HCL-v.
Efficacy and safety of acupuncture for elderly patients with coronavirus disease 2019 (COVID-19)
Authors: Xia Qingchang , Gao Huawei , Xian Jin , Yan Xiao , Zhou Yue , Lu Yunping , Ma Yuxia
Published: February 2021

Background:

The study aims to evaluate the effectiveness and safety of acupuncture therapy for elderly patients with coronavirus disease 2019 (COVID-19).

Methods:

Relevant articles from December 2019 to December 2020 will be searched in the following electronic databases: Medline, PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), and China Scientific Journals Database. All published randomized controlled trials (RCTs) and credible clinical observations about this topic will be included. Two independent researchers will operate article retrieval, duplication removing, screening and data analysis by EndNote X9.0 and Stata 15.0. We will use the Cochrane risk of bias tool for randomized trials to assess the risk of bias of included studies. Meta-analysis, subgroup analysis, and/or descriptive analysis will be performed according to the data conditions included.

Results:

High-quality synthesis and/or descriptive analysis of current evidence will be provided from mortality rate, cure rate, C-reactive protein (CRP), creatine, troponin, aspartate aminotransferase, alanine aminotransferase, and improvements in chest CT scans, clinical symptoms (including fever, fatigue, cough, nausea, vomiting and diarrhea) and the side effects of acupuncture.

Conclusion:

This study will provide evidence of whether acupuncture is an effective and safe intervention for the elderly with COVID-19.

PROSPERO registration number:

CRD42020225245.
Biliary stent migration: why, how, and what?
Authors: Emara Mohamed H. , Ahmed Mohammed Hussien , Mohammed Ahmed S. , Radwan Mohamed I. , Mahros Aya M.
Published: February 2021

Background and purpose

The frequency, risk factors as well as the sites of biliary stent migration are variable in the literature. This retrospective study investigated the frequency of biliary stent migration, why biliary stents migrated, how the migrated stents affected the patients, and what are the different techniques retrieved the migrated stents.

Patients and methods

Out of 876 stented patients, 74 patients (8.4%) had their stents migrated. Patients with and without migrated stents were compared regarding endoscopy and stent-related parameters. The sequels of stent migrations were reported. Furthermore, the methods used for stent retrieval were reviewed.

Results

Proximal and distal stent migration occurred at a rate of 3 and 5.5%, respectively. The independent predictors for stent migration were moderate to marked common bile duct (CBD) dilation, complete sphincterotomy, the use of balloon dilation, and stent insertion for more than 1 month. Cholangitis and stent obstruction was the most commonly reported adverse event (n = 18, 24.3%). Distal stent migration associated with two cases of bleeding due to duodenal wall injury, and two cases of duodenal perforation. All the retained migrated stents in the current study were retrieved by endoscopy using extraction balloon, Dormia basket, snares, and foreign body forceps.

Conclusion

Biliary stent migration occurs at a rate of 8.4%. Stents do migrate because of dilated CBD, wide sphincterotomy, and biliary balloon dilation. Furthermore, wide, straight stents inserted for more than 1 month easily migrate. The migrated stents migrated intraluminal in the CBD, duodenum or the colon. All the retained migrated stents were retrieved endoscopically.
Impact of endoscopist experience, patient age and comorbidities on dose of sedation and sedation-related complications by endoscopic ultrasound
Authors: Razpotnik Marcel , Bota Simona , Essler Gerolf , Weber-Eibel Jutta , Peck-Radosavljevic Markus
Published: February 2021

Aim

The aim of the study is to investigate the influence of endosonographer experience and patient-related factors on the dose of sedation and sedation-related complications during endoscopic ultrasound (EUS).

Methods

Our retrospective analysis included EUS investigations performed between 2015 and 2018 at our institution. Sedation-related complications were defined as cardiorespiratory instability with oxygen saturation drop below 90% or prolonged low blood pressure or bradycardia.

Results

In total, 537 EUS examinations were analyzed (37.3% interventional). The median dose of propofol and midazolam were: 140 (30–570) and 3(1–7) mg, respectively. Sedation-related complications were documented in 1.8% of cases. All patients had transient, nonfatal respiratory insufficiency. Totally, 60% of the patients who developed complications were >75 years and 70% were male. The presence of cardiac and/or pulmonary comorbidities was associated with an OR = 8.77 [95% confidence interval (CI), 1.8–41.7] and American Society of Anesthesiologists class III with an OR = 7.64 (95% CI, 1.60–36.3) for the occurrence of sedation-related complications. Endosonographer experience did not influence the rate of sedation-related complications. In both diagnostic and interventional EUS, patients with comorbidities and older age received significantly less sedation. Experienced endosonographers used less sedation than trainees.

Conclusion

Endosonographer experience, patient age and the presence of comorbidities had a significant influence on sedation dose. Sedation-related complications occurred only in 1.8% of cases.
Understanding Regional Variation in the Cost of Breast Cancer Screening Among Privately Insured Women in the United States
Authors: Kunst Natalia , Long Jessica B. , Xu Xiao , Busch Susan H. , Kyanko Kelly A. , Lindau Stacy T. , Richman Ilana B. , Gross Cary P.
Published: February 2021

Background:

Breast cancer screening for women aged 40–49 years is prevalent and costly, with costs varying substantially across US regions. Newer approaches to mammography may improve cancer detection but also increase screening costs. We assessed factors associated with regional variation in screening costs.

Methods:

We used Blue Cross Blue Shield Axis, a large US commercial claims database accessed through secure portal, to assess regional variation in screening utilization and costs. We included screening mammography±digital breast tomosynthesis (DBT), screening ultrasound, diagnostic mammography±DBT, diagnostic ultrasound, magnetic resonance imaging and biopsy, and evaluated their utilization and costs. We assessed regional variation in annual per-screened-beneficiary costs and examined potential savings from reducing regional variation.

Results:

Of the 2,257,393 privately insured women, 41.2% received screening mammography in 2017 (range: 26.6%–54.2% across regions). Wide regional variation was found in the DBT proportion (0.7%–91.1%) and mean costs of DBT ($299; range: $113–714) and 2-dimensional (D) mammograms ($213; range: $107–471). In one-fourth of the regions, the mean DBT cost was lower than the mean 2D mammography cost in the full sample. Regional variation in the per-screened-beneficiary cost (mean: $353; range: $151–751) was mainly attributable to variation in the cost of DBT (accounting for 23.4% of regional variation) and 2D mammography (23.0%). Reducing regional variation by decreasing the highest values to the national mean was projected to save $79–335 million annually.

Conclusions:

The mean mammogram cost for privately insured women ages 40–49 varies 7-fold across regions, driving substantial variation in breast cancer screening costs. Reducing this regional variation would substantially decrease the screening costs.
Evaluation of 68Ga-PSMA PET/CT with volumetric parameters for staging of prostate cancer patients
Authors: Aksu Ayşegül , Karahan Şen Nazli Pinar , Tuna Emine Burçin , Aslan Güven , Çapa Kaya Gamze
Published: February 2021

Background

The aim of this study was to investigate the relationship between volumetric data obtained from staging 68Ga-prostate-specific membrane antigen (PSMA) PET computerized tomography (CT) images with prostate-specific antigen (PSA), risk groups, Gleason Grade (GG) groups and presence of metastasis.

Methods

We performed a retrospective analysis of 68Ga-PSMA PET-CT images from 88 patients undergoing initial staging of prostate adenocarcinoma between January 2015 and September 2018. Images were evaluated in LIFEx software; PSMA involvement above the background activity in prostate gland, lymph node and other distant metastases was plotted with 40% SUVmax threshold, SUVmax, PSMA tumor volume (PSMA-TV) and total lesion PSMA (TL-PSMA) values were obtained.

Results

In all patients, there was a moderate correlation between PSA and PSMA-tumor volume whole-body (PSMA-TVwb) (P < 0.001, r = 0.580) and a high correlation between total lesion-PSMAwb (TL-PSMAwb) (P < 0.001, r = 0.636). Prostate PSMA-TV (PSMA-TVp) and TL-PSMA (PSMA-TVp) values were different in local and locally advanced/metastatic patients (P = 0.020 and 0.006, respectively). PSMA-TVp and TL-PSMAp values were significantly different in low-moderate and high-risk patients (P = 0.003 and <0.001, respectively), and in patients with and without metastasis (P = 0.008 and <0.001, respectively). PSMA-TVp, PSMA-TVwb, TL-PSMAp and TL-PSMAwb values were significantly different in patients with GG ≤3 and >3 (P = 0.030, 0.002, <0.001 and <0.001, respectively).

Conclusion

Pretreatment 68Ga-PSMA PET/CT volumetric parameters provides unique data to use in the clinical decision-making process of patients with adenocarcinoma of the prostate.
Concept proposal for a six-tier integrated dual tracer PET-CT (68Ga-PSMA and FDG) image scoring system (‘Pro-PET’ score) and examining its potential implications in metastatic castration-resistant prostate carcinoma theranostics and prognosis
Authors: Adnan Aadil , Basu Sandip
Published: February 2021

Objectives

To develop and examine a scoring system in metastatic castration-resistant prostate carcinoma (mCRPC) that integrates findings of both 68Ga-prostate-specific membrane antigen (PSMA) and flurodeoxyglucose (FDG) PET-CT imaging in a single combined parameter and referred to as the ‘Pro-PET’ score.

Methods

A six-tier integrated dual tracer PET-CT (68Ga-PSMA and FDG) Image Scoring System (‘Pro-PET’ score) was conceptualized, based on the findings of both 68Ga-PSMA-11 and FDG PET-CT in patients of mCRPC. This proposed integrated scoring was examined in a retrospective analytical study assessing mCRPC patients (n = 47) referred for 177Lu-PSMA-617 peptide receptor radioligand therapy (PRLT) and had both FDG and 68Ga-PSMA PET-CT undertaken within 15 days of each other without any interim treatment intervention. The ‘Pro-PET’ score grades and subgrades were assigned and compared with clinical data, such as histopathology, Gleason score, serum prostate-specific antigen (PSA), treatment response (symptomatic, biochemical, metabolic and anatomical) and survival [overall survival (OS) and progression-free survival (PFS)].

Results

The Pro-PET score significantly correlated with symptomatic (P = 0.05), biochemical (P = 0.05), metabolic (P = 0.001) and anatomical (P = 0.012) responses, PFS (P = 0.03) and OS (P = 0.027). On multivariate analysis, histopathology, Gleason score and PSA as individual parameters were not significantly associated with OS and PFS, whereas the Pro-PET score was found to have a significant association (P = 0.001 for PFS and 0.011 for OS).

Conclusion

The ‘Pro-PET’ scoring system integrating dual tracer PET-CT imaging findings in a single parameter appeared as a potentially promising prognostic marker that has the potential to enhance the objectivity and scientific basis of prostate carcinoma theranostics and prognostication.
PET/computed tomography enterography
Authors: Sharma Anshul , Phulia Ankita , Sethi Ravinder Singh
Published: February 2021

Interpretation of gastrointestinal PET/computed tomography (PET/CT) is often complicated by anatomy including bowel folds, flexures, variant redundancy, decompressed bowel segments and physiological uptake. This makes it very difficult to identify both true positives and true negatives, compromising both sensitivity and specificity. CT enterography is increasingly being integrated into the field of nuclear medicine to address these issues. This technique uses the combination of negative/neutral contrast to distend the lumen of the gut and iodinated contrast to enhance the gastrointestinal wall and pathological findings. Apart from augmentation in the diagnostic performance, the technique also improves the quality of the imaging, confidence of the reporting physician and inter-rater agreement. Therefore, this technique has found favor among nuclear medicine physicians, in the imaging of chronic inflammatory disorders and malignancies in and of the gut. It is a feasible and easily executable procedure with minimal and manageable side-effects and should be routinely recommended in cases where interference from physiologic findings is expected.
Edge-preserving adaptive autoregressive model for Poisson noise reduction
Authors: Takalo Reijo , Hytti Heli , Ihalainen Heimo , Sohlberg Antti
Published: February 2021

Autoregressive models in image processing are linear prediction models that split an image into a predicted (i.e. filtered) image and a prediction error image, which extracts data on the image edges. Edge separation is a crucial feature of an autoregressive model. Data on the edges can be processed in different ways and then added to the filtered image. Another basic feature of our method is spatially varying modelling. In this short article, we propose an improved autoregressive model that preserves image sharpness around the edges of the image and focus on the reduction of Poisson noise, which degrades nuclear medicine images and presents a special challenge in medical imaging.
Providing Professionally Meaningful Recognition to Enhance Frontline Engagement
Authors: Zwickel Karen , Koppel Jenna , Katz Marie , Virkstis Katherine , Rothenberger Sarah , Boston-Fleischhauer Carol
Published: February 2021

To achieve transformation in care delivery, frontline nursing staff must be committed to their organization’s mission, engaged in their work, and capable of delivering high-quality care. However, data from Advisory Board Survey Solutions show that, when compared with other frontline staff, nurses are the least engaged and most disengaged. In this article, the authors describe strategies for addressing a top opportunity for improving nurse engagement—ensuring nurses feel meaningfully recognized for their professional impact.
Responding to Emotional Stress in Pediatric Hospitals
Authors: Huetsch Michael , Green Jeremy
Published: February 2021

OBJECTIVE:

The aim of this study was to identify leadership awareness of emotional stress and employee support efforts in pediatric hospitals.

BACKGROUND:

The current pediatric environment has seen increases in treatment intensity, care duration, and acuity of patients resulting in increased likelihood of being exposed to emotional events.

METHODS:

Mail survey was sent to chief nursing officers at 87 pediatric hospitals.

RESULTS:

A total of 49 responses (56%) were received. Hospitals with less than 250 beds were significantly more likely to rate emotional stress as a large to very large problem, whereas ANCC Magnet® hospitals felt better about support efforts after patient deaths. Most commonly used support offerings focused on staff recovery after a traumatic event as opposed to training for prevention of emotional stress.

CONCLUSIONS:

Emotional stress is a well-recognized issue in pediatric hospitals with comparatively large resource commitment. Further focus on caregiver prevention training and unit leadership recognition of stress may be needed.
Incidental Pathologic Findings in Young Adult Reduction Mammaplasty
Authors: Maroney Jenna , Collins K. C. , Dannheim Katelyn , Staffa Steven J. , Saldanha Francesca Y. L. , Labow Brian I. , Rogers-Vizena Carolyn R.
Published: February 2021

Background:

This study aims to characterize incidental microscopic findings in this population to determine whether there is a benefit to routine histopathologic examination of breast tissue in young women.

Methods:

A retrospective review of young women who underwent reduction mammaplasty between June of 2010 and May of 2018 was performed at a single institution to identify demographics, age at the time of surgery, breast cancer risk factors, and pathologic data. Histologic reevaluation was performed when diagnostic clarification was needed. Descriptive, univariate, and multivariable statistical analyses were performed.

Results:

A total of 798 young women were included. At the time of surgery, the mean patient age was 17.5 ± 2.0 years, the mean body mass index was 28.7 ± 5.7 kg/m2, and the mean resection weight was 685 ± 339 g/breast. The majority of patients were reported to have pathologically normal tissue [n = 704 (88.2 percent)]. Of the 94 patients (11.8 percent) with abnormal findings, 21 (2.6 percent) had benign nonproliferative changes, 64 (8.0 percent) had proliferative lesions without atypia, nine (1.1 percent) had proliferative lesions with atypia, and a single patient (0.1 percent) had a borderline phyllodes tumor. Univariate and multivariate analyses revealed that age at menarche younger than 12 years was significantly associated with increased incidence of proliferative lesions.

Conclusions:

Over 10 percent of young women with reduction mammaplasty have histopathologic findings. Although this study demonstrated an overall low incidence of atypical lesions, because early identification offers potential for improved surveillance, the authors continue to advocate for routine pathologic evaluation, particularly for women with early menarche.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Does the Textured-Type Tissue Expander Affect the Outcomes of Two-Stage Prosthetic Breast Reconstruction? A Propensity Score Matching Analysis between Macrotextured and Microtextured Expanders
Authors: Lee Kyeong-Tae , Park Hae Yeon , Jeon Byung-Joon , Mun Goo-Hyun , Bang Sa Ik , Pyon Jai Kyong
Published: February 2021

Background:

In two-stage prosthetic breast reconstruction, two types of tissue expanders are used for the first stage: microtextured Siltex and macrotextured Biocell. Despite emerging concerns regarding the safety of macrotextured prostheses, the association between the use of macrotextured expanders and adverse outcomes remains unknown clinically. This study aimed to evaluate potential impacts of the type of tissue expander on the long-term outcomes of implant-based breast reconstruction.

Methods:

Patients who underwent immediate two-stage tissue expander/implant breast reconstruction between 2014 and 2018 were evaluated and categorized into two groups according to the expander type. Those two were propensity score matched for baseline characteristics and compared for complication rates after the first- and second-stage operations. The impacts of several variables, including type of tissue expander used, on outcomes were assessed using multivariable logistic regression analyses.

Results:

Of the 1391 cases in 1294 patients, 276 pairs (552 cases) were successfully propensity score matched. In the first-stage operation, the macrotextured group showed a significantly shorter drain indwelling period and lower rate of seroma than the microtextured group. These differences retained influences after adjusting for other variables. Incidence rates of other complications were similar between the groups. Regarding the second-stage operation, the use of macrotextured expanders showed a significant association, with an increased rate of severe capsular contracture on the multivariable analyses in cases using textured implants. Development of other complications was not affected by the expander type.

Conclusion:

The type of tissue expander might influence the outcomes of two-stage implant-based breast reconstruction, and generally acceptable safety of both microtextured and macrotextured expanders was shown.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Nerve Pain after Burn Injury: A Proposed Etiology-Based Classification
Authors: Klifto Kevin M. , Hultman C. Scott , Dellon A. Lee
Published: February 2021

Background:

Understanding the mechanism of nerve injury may facilitate managing burn-related nerve pain. This proposed classification, based on cause of nerve injury, was developed to enhance the understanding and management of burn-related nerve pain.

Methods:

This retrospective investigation included patients aged 15 years or older admitted to the burn center from 2014 to 2019. Burn-related nerve pain was patient-reported and clinically assessed as pain 6 months or more after burn injury, unrelated to preexisting illnesses/medications. The pain classification consisted of direct nerve injury, nerve compression, electrical injury, and nerve dysfunction secondary to systemic injury. The four categories were statistically analyzed between groups, using 52 variables.

Results:

Of the 1880 consecutive burn patients, 113 developed burn-related nerve pain and were eligible for validation of the classification: direct nerve injury, n = 47; nerve compression, n = 12; electrical injury, n = 7; and nerve dysfunction secondary to systemic injury, n = 47. Factors, significantly increased, that distinguished one category from another were as follows: for direct nerve injury, continuous symptoms (p < 0.001), refractory nerve release response (p < 0.001), nerve repair (p < 0.001), and pruritus (p < 0.001); for nerve compression, Tinel signs (p < 0.001), shooting pain (p < 0.001), numbness (p = 0.003), intermittent symptoms (p < 0.001), increased percentage total body surface area burned (p = 0.019), surgical procedures (p < 0.001), and nerve release (p < 0.001); and for electrical injury, Tinel sign (p < 0.001), intermittent symptoms (p = 0.002), amputations (p = 0.002), fasciotomies (p < 0.001), and nerve release (p < 0.001). Nerve dysfunction secondary to systemic injury was distinguished by significantly less Tinel signs (p < 0.001), shooting pain (p < 0.001), numbness and tingling (p < 0.001), pruritus (p < 0.001), fascial excision (p = 0.004), skin grafts (p < 0.001), amputation (p = 0.004), nerve releases (p < 0.001), and third-degree burns (p = 0.002).

Conclusion:

A classification consisting of direct nerve injury, nerve compression, electrical injury, and nerve dysfunction secondary to systemic injury is presented that may guide patient management and research methods, with the goal of improving pain outcomes in burn-related nerve pain.