bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival outcomes in esophageal cancer patients with a prior cancer
Authors: Pan Deqiang , Xu Wenbo , Gao Xingcai , Yiyang Feng , Wei Shuai , Zhu Guang
Published: February 2021

To achieve a deeper understanding of patients who developed esophageal cancer (EC) as a second primary malignancy, which may help guide in clinical practice for these patients in the future.

In the primary cohort, EC patients with a prior malignancy were identified from the surveillance, epidemiology, and end result 18 database. The 5 most common types of prior cancers were picked out based on the frequency of occurrence. In addition, Kaplan–Meier and log-rank tests were performed to investigate the survival impacts of prior cancers on EC patients. Besides, a competing-risk model was constructed to explore the relationship between EC-treatment and EC-specific mortality. In the secondary cohort, patients with stage I–III (N0M0) EC from 2004 to 2014 were enrolled. After propensity score matching, univariate and multivariate Cox analyses were developed to determine the prognostic factors for EC patients.

A total of 1199 EC patients with a prior cancer were identified in the primary cohort. The 5 most common sites of prior cancers were prostate, female breast, bladder, lung and bronchus, and larynx. Kaplan–Meier analyses revealed that EC patients with prior prostate cancer and bladder cancer had the best overall survival (OS), while those with prior cancers of larynx and lung and bronchus had the worst OS. Fine and Gray competing risks analysis indicated that the administration of surgery was closely associated with better EC-specific survival (P < .001). In the secondary cohort, multivariate Cox analyses found that age at diagnosis, race, tumor grade, tumor extent, nodal status and metastasis stage, histology, and the administration of surgery were prognostic factors for OS and cancer-specific survival in EC patients. Besides, the existence of a prior cancer was an independent prognostic factor for cancer-specific survival.

EC remains to be the most important cause of death in EC patients with a prior cancer. EC related treatment should be actively adopted in patients with a prior cancer, as they were more likely to die from EC than the prior cancer. EC patients with a prior cancer had comparable OS than those without.
Comparative efficacy and safety of complementary and alternative therapies for tubal obstructive infertility
Authors: Dong Shuang-Qian , Zhao Xing-Long , Sun Ying , Zhang Jian-Wei
Published: February 2021

Background:

Infertility is a kind of global disease. Fallopian tubal obstruction is one of the most important causes of female infertility. Complementary and alternative therapies are effective in treating tubal obstructive infertility, but there is no study on a comprehensive comparison among them. So, the purpose of this paper is to evaluate the efficacy and safety of different complementary and alternative therapies for tubal obstructive infertility.

Methods:

We will search for randomized controlled trials (RCTs) from the following databases: PubMed, Cochrane Library, EMBASE, Web of Science, Chinese Biomedical Literature Database (SinoMed), Chinese National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database. We will assess the risk of bias of the included studies with the Cochrane tool, and the strength of evidence with the GRADE approach. Both pairwise meta-analyses and network meta-analyses will be performed to examine the relative efficacy and safety of complementary and alternative therapies in the treatment of tubal obstructive infertility.

Conclusion:

Our findings will provide clear evidence based on current available studies, which may lead to some proposals for both patients and researchers.

INPLASY registration number:

INPLASY202110076.
Association between Alpha B-crystallin expression and prognosis in patients with solid tumors
Authors: Yang Minglan , Li Yufan , Tian Feng
Published: February 2021

Background:

Alpha B-crystallin (CRYAB), as a small heat shock protein, may play critical roles in the tumorigenesis and progression of several kinds of human cancers. However, the prognostic value of CRYAB in solid malignancies remains controversial. The aim of the present study was to investigate the association between CRYAB expression and clinicopathology and prognosis of solid tumor patients.

Methods:

PubMed, Web of Science, EMBASE, Chinese National Knowledge Infrastructure, and WanFang databases were systematically searched to retrieve studies that investigated the prognostic value of CRYAB expression in various solid tumors. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to determine the strength of association between CRYAB expression and survival in patients with solid tumors. Odds ratios (ORs) with 95% CIs were pooled to assess the correlation between CRYAB expression and clinicopathological characteristics of patients with solid tumors.

Results:

A total of 17 studies, including 18 cohorts with 6000 patients, were included in this meta-analysis. Our results showed that increased CRYAB expression could predict poor overall survival (HR = 1.81, 95% CI: 1.50–2.19, P < .001), disease-free survival (HR = 1.47, 95% CI: 1.16–1.86, P = .001), and disease-specific survival (HR = 1.40, 95% CI: 1.19–1.63, P < .001) in patients with cancer. Furthermore, the high expression level of CRYAB was associated with certain phenotypes of tumor aggressiveness, such as lymph node metastasis (OR = 2.46, 95% CI: 1.48–4.11, P = .001), distant metastasis (OR = 3.34, 95% CI: 1.96–5.70, P < .001), advanced clinical stage (OR = 2.24, 95% CI: 1.24–4.08, P = .008), low OS rate (OR = 4.81, 95% CI: 2.82–8.19, P < .001), and high recurrence rate (OR = 1.38, 95% CI: 1.11–1.72, P = .004).

Conclusions:

CRYAB may serve as a valuable prognostic biomarker and therapeutic target in human solid tumors.
Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia
Authors: Lee Seong Geun , Song Juhyun , Park Dae Won , Moon Sungwoo , Cho Han-jin , Kim Joo Yeong , Park Jonghak , Cha Jae Hyung
Published: February 2021

The 2016 Surviving Sepsis Campaign guidelines suggest guiding resuscitation to normalize lactate levels in patients with sepsis-associated hyperlactatemia as a marker of tissue hypoperfusion. This study evaluated the prognostic value of lactate levels and lactate clearance for 30-day mortality in patients with sepsis and septic shock diagnosed in the emergency department.

We performed a retrospective cohort study of sepsis patients with initial lactate levels of ≥2 mmol/L. All patients met the Sepsis-3 definitions. The prognostic value of 6-hour lactate levels, 6-hour lactate clearance, 6-hour lactate metrics (≥2 mmol/L), and lactate clearance metrics (<10%, <20%, and <30%) was evaluated. We compared the sensitivity and specificity between metrics.

Of the 363 sepsis and septic shock patients, 148 died (30-day mortality: 40.8%). Nonsurvivors had significantly higher 6-hour lactate levels and lower 6-hour lactate clearance than those of survivors. Six-hour lactate levels and 6-hour lactate clearance were associated with 30-day mortality after adjusting for potential confounders (odds ratio, 1.191 [95% confidence interval (CI), 1.097–1.294] and 0.989 [0.983–0.995], respectively). Six-hour lactate levels had better prognostic value than 6-hour lactate clearance (area under the curve, 0.720 [95% CI, 0.670–0.765] vs 0.656 [0.605–0.705]; P = .02). Six-hour lactate levels of ≥3.5 mmol/L and 6-hour lactate clearance of <24.4% were the optimal cut-off value in predicting the 30-day mortality. The prognostic value of 6-hour lactate metrics and 6-hour lactate clearance metrics did not differ. Six-hour lactate levels (≥2 mmol/L) had the highest sensitivity (89.2%).

Six-hour lactate levels proved to be more accurate in predicting 30-day mortality than 6-hour lactate clearance and initial lactate levels.
Association of autonomic symptoms with cerebrospinal fluid biomarkers in Parkinson disease and scans without evidence of dopaminergic deficit
Authors: Yu Zhenwei , Li Yang
Published: February 2021

Dysautonomia is common in patients with Parkinson disease (PD) since disease early phase. Scales for Outcomes in Parkinson's disease – Autonomic (SCOPA-AUT) is a well-designed scale assessing the autonomic dysfunctions of PD patients. Our objectives were to examine the autonomic dysfunction in PD and scan without evidence of dopaminergic deficit (SWEDD) patients and to assess the correlation of autonomic dysfunctions with cerebrospinal fluid (CSF) biomarkers.

An analysis of the Parkinson's Progression Markers Initiative (PPMI) data including 414 PD patients, 60 SWEDD patients, and 170 healthy controls (HCs) with baseline CSF biomarker measurements and SCOPA-AUT assessments was presented. Autonomic symptoms including gastrointestinal, urinary, cardiovascular, pupillomotor, thermoregulatory and sexual dysfunctions were assessed by SCOPA-AUT scales. Spearman correlation test was used to examine the correlations between CSF measurements and each section of SCOPA-AUT scales in HCs and subjects with PD or SWEDD.

More severe autonomic dysfunctions were observed in patients with SWEDD than those with PD (P < .001). Specifically, patients with PD have lower scores on the urinary scale [4 (0–17) vs 5 (1–18)], pupillomotor scale [0 (0–3) vs 0 (0–3)], thermoregulatory scale [0 (0–4) vs 1.5 (0–10)] and sexual scale [1 (0–6) vs 2 (0–6)] compared with SWEDD patients. Thermoregulatory dysfunction scores were found correlated with CSF α-syn levels in SWEDD group, and gastrointestinal dysfunction scores were correlated with CSF Abeta1–42 in PD group. Additionally, urinary dysfunction scores were correlated with CSF total tau and tau phosphorylated at threonine 181(p-tau181) levels in both HCs and PD patients.
A cross-sectional study of latent tuberculosis infection, insurance coverage, and usual sources of health care among non-US-born persons in the United States
Authors: Annan Esther , Stockbridge Erica L. , Katz Dolly , Mun Eun-Young , Miller Thaddeus L.
Published: February 2021

More than 70% of tuberculosis (TB) cases diagnosed in the United States (US) occur in non-US-born persons, and this population has experienced less than half the recent incidence rate declines of US-born persons (1.5% vs 4.2%, respectively). The great majority of TB cases in non-US-born persons are attributable to reactivation of latent tuberculosis infection (LTBI). Strategies to expand LTBI-focused TB prevention may depend on LTBI positive non-US-born persons’ access to, and ability to pay for, health care.

To examine patterns of health insurance coverage and usual sources of health care among non-US-born persons with LTBI, and to estimate LTBI prevalence by insurance status and usual sources of health care.

Self-reported health insurance and usual sources of care for non-US-born persons were analyzed in combination with markers for LTBI using 2011–2012 National Health and Nutrition Examination Survey (NHANES) data for 1793 sampled persons. A positive result on an interferon gamma release assay (IGRA), a blood test which measures immunological reactivity to Mycobacterium tuberculosis infection, was used as a proxy for LTBI. We calculated demographic category percentages by IGRA status, IGRA percentages by demographic category, and 95% confidence intervals for each percentage.

Overall, 15.9% [95% confidence interval (CI) = 13.5, 18.7] of non-US-born persons were IGRA-positive. Of IGRA-positive non-US-born persons, 63.0% (95% CI = 55.4, 69.9) had insurance and 74.1% (95% CI = 69.2, 78.5) had a usual source of care. IGRA positivity was highest in persons with Medicare (29.1%; 95% CI: 20.9, 38.9).

Our results suggest that targeted LTBI testing and treatment within the US private healthcare sector could reach a large majority of non-US-born individuals with LTBI. With non-US-born Medicare beneficiaries’ high prevalence of LTBI and the high proportion of LTBI-positive non-US-born persons with private insurance, future TB prevention initiatives focused on these payer types are warranted.
The application of the Chinese version of the Body Image Disturbance Questionnaire in patients with systemic lupus erythematosus
Authors: Chen Haoyang , Chen Xin , Yan Hongyan , Ben Jielin , Yao Xiaoyan , Yang Pingyu , Zhang Minhua , Jin Tiantian , Shen Biyu
Published: February 2021

This study aimed to translate the Body Image Disturbance Questionnaire (BIDQ) into Chinese and evaluate its reliability and validity in a sample of patients with systemic lupus erythematosus (SLE).

Following the translation and revision of the Chinese version of the BIDQ, 169 patients with SLE were chosen as respondents to test the questionnaire's reliability and validity. We tested the content's validity through expert group evaluation. It is structural validity was examined through exploratory factor analysis and confirmatory factor analysis, and reliability was evaluated using Cronbach's α and test-retest reliability.

The Chinese version of the BIDQ showed a content validity of .92. A two-factor structure was revealed by exploratory factor analysis, which explained 67.83% of the variance and proved by confirmatory factor analysis. Its overall Cronbach's α was .82 (P 
< .001), and the Cronbach's α for each item ranged from .76 to .83. The test-retest reliability was .82, with the Cronbach's α for each item ranging from .76 to .84.

Thus, adequate reliability and validity of the Chinese version of the BIDQ were demonstrated for use in patients with SLE.
The efficacy and safety of glucokinase activators for the treatment of type-2 diabetes mellitus
Authors: Gao Qian , Zhang Wenjun , Li Tingting , Yang Guojun , Zhu Wei , Chen Naijun , Jin Huawei
Published: February 2021

Background:

Glucokinase activators are a novel family of glucose-lowering agents used for the treatment of type-2 diabetes mellitus (T2DM). Glucokinase activators blind to GK activate the enzyme allosterically. Treatment with different GKAs has been shown to reduce fasting and postprandial glucose in patients with type 2 diabetes. We compared the efficacy/safety of glucokinase activators in T2DM patients through a meta-analysis.

Methods:

We searched PubMed, Excerpt Medica Database, and Cochrane Central Register of Controlled Trials databases for articles published before December 30, 2020. Two independent reviewers extracted the information from article. The quality of articles were assessed by 2 independent reviewers using the 5 items of scale proposed by Jadad. We computed the weighted mean difference and 95% confidence interval (CI) for a change from baseline to the study endpoint for glucokinase activators vs placebo. Egger test and Begg test were used to assess the possible publication bias caused by the tendency of published studies to be positive.

Results:

The present meta-analysis will compare the efficacy and safety of glucokinase activators and placebo for the treatment of T2DM.

Conclusions:

This meta-analysis will provide advanced evidence on the efficacy and safety of glucokinase activators for the treatment of T2DM.

Ethics and dissemination:

Ethical approval and patient consent are not required because this study is a literature-based study. This systematic review and meta-analysis will be published in a peer-reviewed journal

PROSPERO registration number:

CRD42021220364.
Videomics: bringing deep learning to diagnostic endoscopy
Authors: Paderno Alberto , Holsinger F. Christopher , Piazza Cesare
Published: February 2021

Purpose of review

Machine learning (ML) algorithms have augmented human judgment in various fields of clinical medicine. However, little progress has been made in applying these tools to video-endoscopy. We reviewed the field of video-analysis (herein termed ’Videomics’ for the first time) as applied to diagnostic endoscopy, assessing its preliminary findings, potential, as well as limitations, and consider future developments.

Recent findings

ML has been applied to diagnostic endoscopy with different aims: blind-spot detection, automatic quality control, lesion detection, classification, and characterization. The early experience in gastrointestinal endoscopy has recently been expanded to the upper aerodigestive tract, demonstrating promising results in both clinical fields. From top to bottom, multispectral imaging (such as Narrow Band Imaging) appeared to provide significant information drawn from endoscopic images.

Videomics is an emerging discipline that has the potential to significantly improve human detection and characterization of clinically significant lesions during endoscopy across medical and surgical disciplines. Research teams should focus on the standardization of data collection, identification of common targets, and optimal reporting. With such a collaborative stepwise approach, Videomics is likely to soon augment clinical endoscopy, significantly impacting cancer patient outcomes.
Current status of adult liver transplantation: utilization of living donor versus deceased donor graft
Authors: Tran Lillian , Humar Abhinav
Published: February 2021

Purpose of review

This article will summarize prior and recent studies comparing outcomes between living donor and deceased donor liver transplantation (LT) in adults and provide a rationale and framework for expanding living donor liver transplantation (LDLT) in Western countries to address the growing critical organ shortage.

Recent findings

There is a growing body of evidence demonstrating superior survival outcomes in LDLT in addition to a multitude of other advantages including shorter cold ischemia times, opportunity for pretransplant medical optimization, and expansion of transplant eligibility. Additionally, these outcomes continue to improve with center volume and experience.

LDLT in adults emerged in response to an effective donor organ shortage created by the critical discrepancy between donor graft supply and demand. Overcoming this organ shortage and an increasing waitlist mortality requires a liver transplant framework that fully integrates LDLT into liver disease management although continuing to fully maximize deceased donor graft utilization at experience, capable centers. Optimizing both living and deceased donor graft utilization will drastically increase patients’ access to LT.
A Review of Reconstruction for Vulvar Cancer Surgery
Authors: Pavlov Anna , Bhatt Nishant , Damitz Lynn , Ogunleye Adeyemi A.
Published: February 2021

Importance

Vulvar reconstruction may be required after vulvectomy or any vulvar surgery. Providers should be familiar with techniques for reconstruction to improve clinical outcomes.

Objective

This article reviews the different techniques for reconstruction after vulvectomy and describes the decision-making process for selection of appropriate techniques, postoperative care, and expected outcomes.

Evidence Acquisition

A literature search was conducted, focusing on the plastic surgery and gynecologic oncology literature, using the following search terms: “vulvar reconstruction,” “perineal reconstruction,” “vulvectomy,” and “vulvar cancer.” The search was limited to English publications.

Results

Reconstruction after vulvectomy can be performed using a variety of techniques ranging from simple or complex closure to adjacent tissue rearrangement to skin grafting, locoregional, and free flaps. The appropriate technique is best chosen based on the characteristics of the patient and postablative defect, as well as the reconstructive goals. Postoperative complications are usually minor.

Conclusions

Vulvar reconstruction techniques vary widely and offer patients improved outcomes.

Relevance

Knowledge of vulvar reconstruction techniques is necessary for gynecologists performing vulvar surgery to ensure optimal patient outcomes.

Target Audience

Obstetricians and gynecologists, Family Physicians

Learning Objectives

After completing this activity, the learner should be better able to describe 3 different techniques of vulvar reconstruction; explain the factors involved in choosing a technique; and identify possible complications of vulvar reconstruction.
Septum Resection in Women With a Septate Uterus: A Cohort Study
Authors: Rikken J. F. W. , Verhorstert K. W. J. , Emanuel M. H. , Bongers M. Y. , Spinder T. , Kuchenbecker W. , Jansen F. W. , van der Steeg J. W. , Janssen C. A. H. , Kapiteijn K. , Schols W. A. , Torrenga B. , Torrance H. L. , Verhoeve H. R. , Huirne J. A. F. , Hoek A. , Nieboer T. E. , van Rooij I. A. J. , Clark T. J. , Robinson L. , Stephenson M. D. , Mol B. W. J. , van der Veen F. , van Wely M. , Goddijn M.
Published: February 2021

(Abstracted from Hum Reprod 2020;35(7):1578–1588)

The septate uterus has an estimated prevalence of 0.2% to 2.3% in women of reproductive age and is associated with impaired reproductive outcomes, the biologic basis of which is unclear. The standard-of-care treatment for septate uterus is hysteroscopic septum resection.
A clinical primer for the expected and potential post-COVID-19 syndromes
Authors: Walitt Brian , Bartrum Elizabeth
Published: February 2021

In late 2019, a novel coronavirus SARS-CoV-2 (COVID-19) spread unchecked across the world's population. With tens of millions infected, the long-term consequences of COVID-19 infection will be a major health care focus for years after the contagion subsides. Most complications stem from direct viral invasion provoking an over-exuberant inflammatory response driven by innate immune cells and activation of the clotting cascade causing thrombosis. Injury to individual organs and their protective linings are frequent presentations in respiratory, cardiovascular, and neurological systems. Reviewing the historical context of postviral fatiguing symptoms seems relevant to understanding reports of uneven recoveries and persistent symptoms that are emerging as “long-haul COVID-19.” The pandemic is also an unprecedented sociocultural event, transforming how people consider their health, gather in groups, and navigate their daily lives. The unprecedented sociocultural stresses of the pandemic will have an invisible, ubiquitous, and predictable impact on neurologic, endocrine, and immune functioning, even in people untouched by the virus. COVID-19 may also have a surprise or two in store, with unique clinical presentations and novel mechanisms of injury which are yet to clearly emerge. Although challenging and unfortunate, these times also represent a unique opportunity to start to unravel the physiology that underlie how viruses may trigger cancers, neurological disease, and postviral fatiguing syndromes.
Retrospective chart review of perioperative pain management of patients having surgery for closed ankle fractures using peripheral nerve blocks at a level one trauma center
Authors: Mateen Sara , Gandhi Vishal , Meyr Andrew J. , Kwaadu Kwasi Y. , Sethi Anish
Published: February 2021

Introduction:

Chronic opioid use is unfortunately perceived among these postoperative patients, specifically within orthopedic surgery. Patients having orthopedic surgeries are at risk for becoming addicted to opioids, and one benefit of peripheral nerves blocks could be to provide an alternative mode of pain control. This study takes a retrospective look at the use of peripheral nerve blocks for pain control following surgery for isolated traumatic ankle injuries. We hypothesize that when peripheral nerve blocks are administered preoperatively to patients with closed ankle fractures, they will have overall better control of postoperative pain compared to patients who did not receive a peripheral nerve block.

Objectives:

The objective of this investigation was to evaluate the effect of preoperative peripheral nerve blockade on pain outcomes after ankle fracture surgery.

Methods:

After approval from our institutional review board, a Current Procedural Terminology code search was performed of all patients within our institution over a 3-year data collection period (August 2016–June 2019). This resulted in 177 subjects who underwent isolated closed ankle fracture open reduction internal fixation (ORIF), of which 71 subjects met inclusion criteria.

Results:

Results of the primary outcome measures found no difference in the mean postoperative care unit (PACU) pain scores between the groups (2.39 ± 2.91 vs 3.52 ± 3.09; P = 0.1724) nor the frequency of those who reported only mild pain (63.0% vs 47.10%; P = 0.2704). Subjects who received a peripheral nerve block spent more time in the PACU before discharge (2.06 ± 1.05 vs 0.94 ± 1.21 hours; P = 0.0004). Subjects receiving a peripheral nerve block were more likely to be given no analgesics in the PACU (38.9% vs 11.8%; P = 0.042) and less likely to receive a narcotic analgesic in the PACU (53.7% vs 82.4%; P = 0.047).

Conclusion:

Although the results of this investigation demonstrate no significant difference in the mean PACU pain scores, they do demonstrate a significant difference in the amount of pain medication given in the PACU setting. This information will be used for future investigations of this discrepancy between pain perception and need for immediate postoperative pain medications as it relates to multimodal pain control in the setting of ankle fracture surgery.
Evaluation of the POP-UP programme: a multicomponent model of care for people living with HIV with homelessness or unstable housing
Authors: Imbert Elizabeth , Hickey Matthew D. , Clemenzi-Allen Angelo , Lynch Elizabeth , Friend John , Kelley Jackelyn , Conte Madellena , Das Doyel , Rosario Jan Bing Del , Collins Erin , Oskarsson Jon , Hicks Mary Lawrence , Riley Elise D. , Havlir Diane V. , Gandhi Monica
Published: February 2021

Objective:

Homelessness is the greatest risk factor for HIV viremia in San Francisco. Innovative care models for people with HIV (PWH) with homelessness or unstable housing (HUH) are needed to address this inequity. We developed a novel low-barrier clinic-based program for PWH-HUH in an urban safety-net clinic (’POP-UP’) and report outcomes on care engagement and viral suppression.

Design:

A prospective cohort study.

Setting:

San Francisco General Hospital HIV Clinic (Ward 86).

Participants:

We enrolled PWH who are HUH, viraemic and for whom usual care is not working (at least one missed primary care appointment and at least two drop-in visits at Ward 86 in the last year).

Intervention:

POP-UP provides drop-in comprehensive primary care, housing assistance and case management, financial incentives and patient navigation with frequent contact.

Main outcome measures:

We describe uptake of eligible patients into POP-UP, and cumulative incidence of antiretroviral therapy (ART) initiation, return to care and virologic suppression 6 months post-enrolment, estimated via Kaplan--Meier.

Results:

Out of 192 referred patients, 152 were eligible, and 75 enrolled. All 75 were off ART and viraemic; 100% had a substance use disorder; and 77% had a mental health diagnosis. Over three-quarters restarted ART within 7 days of enrolment, and 91% returned for follow-up within 90 days. The cumulative incidence of viral suppression at 6 months was 55% (95% confidence interval 43–68).

Conclusion:

A novel care model for PWH-HUH demonstrates early success in engaging viraemic patients in care and improving viral suppression. Low-barrier, high-contact primary care programmes offering comprehensive services and incentives may improve outcomes for this vulnerable population.
Balance Confidence and Falls Self-Efficacy in Older Breast Cancer Survivors
Authors: Blackwood Jennifer , Rybicki Kateri
Published: February 2021

Purpose

The aim of the study was to examine the reliability, validity, and measurement error of balance confidence and fall-related self-efficacy measures in older breast cancer survivors.

Design

A cross-sectional study was performed.

Methods

The Activities-Specific Balance Confidence Scale (ABC), the shorter, six-item version of the ABC (ABC-6), and the Modified Falls Efficacy Scale (MFES) were completed by 35 older breast cancer survivors. Absolute reliability was examined with Cronbach’s alpha, test–retest reliability with intraclass correlation coefficient, and Pearson’s correlation coefficient for construct validity.

Findings

Absolute reliability was good for the ABC. Test–retest reliability was good for the ABC and the ABC-6 and moderate for the MFES. Construct validity was present for all measures.

Conclusions

Breast cancer survivors’ balance confidence measures should be assessed with either the ABC or the ABC-6, whereas falls self-efficacy should be examined with the MFES.

Clinical Relevance

Nurses and other health professionals who treat breast cancer survivors should include assessing psychological factors associated with falls using the ABC, the ABC-6, or the MFES as low balance confidence or falls self-efficacy contribute to increased falls risk.
Burdens and Educational Needs of Informal Caregivers of Older Adults With Urinary Incontinence: An Internet-Based Study
Authors: Davis Nicole J. , Parker Veronica G. , Lanham Janice , Love Christina R. , Christy Margaret R. , Poetzschke Eve , Wyman Jean F.
Published: February 2021

Purpose

The purpose of this study was to describe the burden and educational needs of informal caregivers of care-dependent older adults with urinary incontinence (UI).

Design

A cross-sectional, descriptive survey of informal caregivers recruited through Google Ads was performed.

Methods

An online survey, including the Overactive Bladder-Family Impact Measure, was used to assess five areas of the experience of the informal caregiver that may be affected by caring for a person with UI and their educational needs.

Findings

Respondents (n = 77) reported a substantial impact of their care recipients’ UI on their lives, with concern, travel, and social subscales most affected. However, 42% never sought treatment on behalf of their care recipient. Educational needs included UI treatment strategies and guidance to select appropriate supplies.

Conclusions

Caregivers underreported their care recipient’s UI and need substantially more support from healthcare providers to manage the condition.

Clinical Relevance

Nurses should assess for UI among care-dependent older adults and, if present, provide information and strategies to lessen the impact on caregiver lives.
Left Atrial Septal Pouch—Is it Really a New Risk Factor for Ischemic Stroke?
Authors: Michałowska Ilona , Dudzińska Katarzyna , Kowalik Ilona , Kwiatek Paweł , Piotrowski Roman , Kułakowski Piotr , Baran Jakub
Published: February 2021

Purpose:

The atrial septal pouch is an anatomic variant of the interatrial septum caused by incomplete fusion of the septum primum and secundum. It is debatable whether coexistence of septal pouch and atrial fibrillation (AF) increases the risk of stroke. Thus, the aim of the study was to evaluate the coexistence of left atrial septal pouch (LASP) and AF in patients with a history of stroke in comparison with those without an earlier history of stroke.

Materials and Methods:

We analyzed 145 patients with AF (68 in the study group, 77 in the control group). The study group consisted of patients with previous stroke and AF; control group consisted of patients scheduled for AF ablation. All patients underwent computed tomography with the assessment of atrial septum morphology and presence of LASP. The study was a subanalysis of the ASSAM (AssesSment of the left atrial appendage morphoLogy in patients aAfter ischaeMic Stroke) study.

Results:

The prevalence of LASP in the entire group was 38.6%. There were no significant differences in the prevalence of LASP between the study and control groups (33.8% vs. 42.9%, P=0.265). Mean longitudinal and transverse dimensions of LASP were 9.34±3.27 and 2.4±0.6 mm, respectively, and there was no significant difference between the study and controls. Patients from the stroke group were older (P<0.0001), had a higher CHA2DS2-VASc score (5.41±1.93 vs. 1.62±1.46, P<0.0001) compared with controls.

Conclusions:

Presence of LASP is not more prevalent in patients with a history of stroke. Additional information on the presence of LASP do not improve accuracy of risk stratification for stroke in patients with AF.
Recombinant Human Thrombomodulin Has Additive Effects in Septic Patients Undergoing Continuous Hemodiafiltration Due to Intestinal Perforation
Authors: Kono Hiroshi , Hosomura Naohiro , Amemiya Hidetake , Kawaida Hiromichi , Furuya Shinji , Akaike Hidenori , Kawaguchi Yoshihiko , Sudo Makoto , Ichikawa Daisuke
Published: February 2021

Background:

Disseminated intravascular coagulation (DIC) is associated with high mortality in patients with severe sepsis. The purpose of this study was to investigate the effects of recombinant human thrombomodulin (rhTM) in septic patients undergoing continuous hemodiafiltration (CHDF). Furthermore, effects of rhTM in acute lung injury, the first target organ in sepsis, were investigated using a sepsis model in rats.

Methods:

Clinical laboratory data, and the DIC, Sequential Organ Failure Assessment (SOFA), and Acute Physiologic and Chronic Health Evaluation (APACHE) II scores were compared between patients undergoing CHDF alone (rhTM− group; n = 23 cases) and patients undergoing CHDF treated with rhTM (rhTM+ group; n = 21 cases). Rats underwent cecal ligation and puncture (CLP) treated with or without rhTM, and acute lung injury (ALI) was analyzed. Production of TNF-α by isolated tissue macrophages (Mfs) was assessed.

Results:

The numbers of leukocytes, and C-reactive protein and D-dimer levels were significantly suppressed, and platelet counts recovered significantly faster in the rhTM+ group compared with the rhTM− group. The DIC score was reduced in both groups. The SOFA and APACHE II scores gradually reduced in the rhTM+ group. The CHDF treatment and ICU admission periods were shortened in the rhTM+ group compared with the rhTM− group. Treatment of rhTM was an independent factor for CHDF treatment period by multivariate analyses. CLP-induced ALI was significantly improved by rhTM. Increased TNF-α production by tissue Mfs was significantly suppressed by rhTM in vivo and in vitro

Conclusion:

Additive effects of rhTM treatment were observed in septic patients undergoing CHDF.
Cost-effectiveness of Diagnostic Tools to Establish the Presence of Peripheral Arterial Disease in People With Diabetes
Authors: Normahani Pasha , Epstein David M. , Gaggero Alessio , Davies Alun H. , Sounderajah Viknesh , Jaffer Usman
Published: February 2021

Objective:

To evaluate the cost-effectiveness of point-of-care duplex ultrasound (PAD-scan) and other bedside tests for the diagnosis of peripheral arterial disease (PAD) in people with diabetes.

Background:

PAD is a risk factor for cardiovascular disease, diabetic foot ulceration (DFU), and amputation in diabetic patients. Diagnosis enables optimization of therapies to manage these risks. PAD-scan can be performed by frontline staff and has been shown to be the most accurate bedside test. However, its cost-effectiveness has not been investigated.

Methods:

A Markov model was constructed to estimate the health outcomes and costs over 5 years of different testing strategies applied to a cohort of diabetic patients. Bedside tests investigated were PAD-scan, ankle-brachial pressure index, toe-brachial pressure index, audible and visual Doppler, transcutaneous pressure of oxygen, and pulse palpation. Health outcomes were incidence of new DFU, major cardiovascular events, amputation, death, and DFU healing rates. Sensitivity analyses were performed.

Results:

PAD-scan was the most cost-effective bedside test with an incremental cost-effectiveness ratio of £11,391/quality-adjusted life years. PADscan had the highest probability (78.7%) of having the greatest net benefit at a willingness to pay threshold of £20,000 per quality-adjusted life years. It reduced the number of amputations by 24% and the number of cardiovascular deaths by 10% over 5 years, compared to toe-brachial pressure index (next best alternative). PAD-scans superiority in incremental cost-effectiveness ratio occurred at a PAD prevalence threshold of 0.24.

Discussion:

PAD-scan is a cost-effective test for the detection of PAD in patients with diabetes.
Clinical and Polysomnographic Characteristics of Nonobese and Obese Chinese Patients With Obstructive Sleep Apnea
Authors: Zou Huili , Jia Qingge , Yang Weiyi , Zhang Zhuo , Miao Jianting
Published: February 2021

Purpose:

Obesity is a risk factor associated with the onset and exacerbation of obstructive sleep apnea (OSA). However, the majority of OSA patients in Asian populations are nonobese. To date, there have been insufficient large-scale studies of the differences in the clinical and polysomnographic features of obese and nonobese OSA patients in this population, and few studies have sought to identify predictors of OSA severity in affected obese and nonobese patients.

Methods:

We conducted a case-matched retrospective study, including 652 consecutive Chinese OSA patients (326 nonobese and 326 obese) to assess differences in demographic, clinical, and polysomnographic data between these two groups. Independent predictors of OSA severity were identified through multivariate linear regression analysis.

Results:

The age and gender distributions of our obese and nonobese OSA patient cohorts did not differ significantly (P > 0.05), and rates of comorbidities were comparable in these two patient groups (P > 0.05). Nonobese patients were more likely to report atypical symptoms of OSA, including insomnia (P < 0.001), irritability (P < 0.05), and depressive symptoms (P < 0.01), whereas obese patients were more likely to report typical symptoms of OSA, such as habitual snoring (P < 0.001), witnessed apnea (P < 0.05), and daytime sleepiness (P < 0.001). Relative to nonobese patients, those who were obese exhibited significantly higher apnea–hypopnea index during total sleep time (P < 0.001), apnea–hypopnea index during nonrapid eye movement sleep (P < 0.001), and apnea–hypopnea index during rapid eye movement sleep (P < 0.001), in addition to lower average oxygen saturation (P < 0.001), minimal oxygen saturation (P < 0.001), and a higher oxygen desaturation index (P < 0.001) and arousal index (P < 0.001). Total sleep time was, on average, shorter for nonobese patients (P < 0.05), who also exhibited decreased sleep efficiency and more frequent awakening relative to obese patients (P < 0.05). A multivariate linear regression analysis revealed that neck circumference and waist circumference were independent predictors of OSA severity in obese patients (P < 0.05).

Conclusions:

On average, OSA was typically less severe in nonobese patients, who were also more likely to experience atypical OSA symptoms relative to obese patients. These results also suggest that the differential contributions of body fat accumulation and distribution to OSA severity may offer insights into the pathogenesis, clinical manifestations, and optimal management of this condition in nonobese and obese patient populations. It is vital that clinicians consider these differences to properly diagnose and treat this debilitating condition.
Impact of COVID-19 on Mental Health: A Longitudinal Study Using Penalized Logistic Regression
Authors: Cui Jingyu , Lu Jingwei , Weng Yijia , Yi Grace Y. , He Wenqing
Published: February 2021

The COVID-19 pandemic has posed significant influence on the public mental health in a stealthy manner. Current efforts focus on alleviating the impacts of the disease on public health and economy, with the psychological effects due to COVID-19 largely ignored. In this paper, we analyze a mental health related dataset from the US to enhance our understanding of human reactions to the pandemic. We are particularly interested in providingquantitativecharacterization of the pandemic impact on the public mental health, on top ofqualitativeexplorations. We employ the multiple imputation by chained equations (MICE) method to deal with missing values and take the logistic regression with least absolute shrinkage and selection operator (Lasso) method to identify risk factors for mental health. The analyses are conducted to a large scale of online survey data from 12 consecutive weeks, so that the longitudinal trend of the risk factors can be investigated. Our analysis results unveil evidence-based findings to identify the groups who are psychologically vulnerable to COVID-19. This study is useful to assist healthcare providers and policy makers to take steps for mitigating the pandemic effects on public mental health.
Hydroxychloroquine for SARS-CoV-2 positive patients quarantined at home: The first interim analysis of a remotely conducted randomized clinical trial
Authors: Amaravadi Ravi K. , Giles Lydia , Carberry Mary , Hyman Matthew C. , Frank Ian , Nasta Sunita D. , Walsh Jennifer , Wileyto E. Paul , Gimotty Phyllis , Milone Michael , Teng Edith M. , Vyas Niraj J. , Balian Steve , Kolansky Jonathan A. , Abdulhay Nabil M. , McGovern Shaun K. , Gamblin Sarah , Doran Olivia , Callahan Paul L. , Abella Benjamin S.
Published: February 2021

Background

Older patients are at risk of increased morbidity and mortality from COVID-19 disease due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). There are few effective treatments for outpatients with COVID-19.

Objective

To evaluate the efficacy of hydroxychloroquine to reduce time in quarantine for symptomatic ≥40 years-old COVID-19 patients.

Design

A randomized, double-blind, placebo-controlled clinical trial.

Setting

Outpatients with polymerase chain reaction confirmed COVID-19 at a University of Pennsylvania affiliated testing center between April 15, 2020 and, July 14, 2020.

Participants

Out of 5511 SARS-CoV-2 positive patients, 1072 met initial eligibility criteria for telephone-based recruitment, but only 34 subjects were able to be randomized.

Interventions

Hydroxychloroquine 400 mg per twice daily (n=17) or matching placebo (n=17), taken orally for up to 14 days.

Measurements

The primary outcome was the time to release from quarantine. Secondary outcomes included the participant-reported secondary infection of co-inhabitants, hospitalization, treatment-related adverse events, time to symptom improvement, and incidence of cardiac arrhythmia.

Results

The median time to release from quarantine for HCQ-treated vs. placebo-treated participants was 8 days (range 4-19 days) vs. 11 days (4-18 days); z-score +0.58, p=n.s. This did not meet the pre-specified criteria for early termination, however, this study was terminated early due to lack of feasibility. There was no mortality in either study arm.

Limitation

Since this study was terminated early due to a lack of feasibility, no conclusion can be made about the efficacy of hydroxychloroquine as a treatment for COVID-19 patients 40 years of age or older quarantined at home.

Conclusion

The design of this remotely conducted study could guide testing of other more promising agents during the COVID-19 pandemic.

Trial registration

Clinicaltrials.gov identifier: NCT04329923
Specific Thoracic Pain: Red flag screening pathway for Physiotherapists. A Systematic Review
Authors: Erbesato Monica , Mourad Firas , Brindisino Fabrizio , Salomon Mattia , Rossettini Giacomo , Margelli Michele , Barbari Valerio , Storari Lorenzo , Andreoletti Federico , Disarò Jacopo , Maselli Filippo
Published: February 2021

The lifetime prevalence of isolated pain in the thoracic spine is relatively low, approximately 13-17%, compared to neck and low back pain, 40% and 57% respectively. However a patient with thoracic or chest pain is more likely to mask a serious pathology, such as spinal fracture, spinal tumor or metastasis, myocardial ischemia, pneumonia, etc.. A physical therapist is a primary healthcare professional and it is his responsibility to screen and identify serious pathologies outside the scope of practice. That is, differential diagnosis may help in excluding medical pain sources and, most importantly, recognize emergencys scenarios. An in-depth subjective and objective examination are the two pillars for the clinical evaluation that may help clinicians to determine if the pain is of musculoskeletal origin or not. In the literature, there is a lack of knowledge about the red flags (i.e. warning symptoms and signs) that can be useful for the screening for referral, not medical diagnosis, in the thoracic and chest wall pain. The aim of our systematic review is to investigate which findings form the subjective (symptoms and red flags) and objective examination (signs and tests) are valid tools for the differential diagnosis for thoracic pain or chest pain suspected to be caused by a serious pathology.
OBESITY MAY HAMPER SARS-CoV-2 VACCINE IMMUNOGENICITY
Authors: Pellini Raul , Venuti Aldo , Pimpinelli Fulvia , Abril Elva , Blandino Giovanni , Campo Flaminia , Conti Laura , De Virgilio Armando , De Marco Federico , Di Domenico Enea Gino , Di Bella Ornella , Di Martino Simona , Ensoli Fabrizio , Giannarelli Diana , Mandoj Chiara , Manciocco Valentina , Marchesi Paolo , Mazzola Francesco , Moretto Silvia , Petruzzi Gerardo , Petrone Fabrizio , Pichi Barbara , Pontone Martina , Zocchi Jacopo , Vidiri Antonello , Vujovic Branka , Piaggio Giulia , Morrone Aldo , Ciliberto Gennaro
Published: February 2021

Background

The first goal of the study was to analyse the antibody titre 7 days after the second dose of BNT162b2 vaccine in a group of 248 healthcare workers (HCW). The second goal was to analyse how the antibody titre changes in correlation with age, gender and BMI.

Methods

Participants were assigned to receive the priming dose at baseline and booster dose at day 21. Blood and nasopharyngeal swabs were collected at baseline and 7 days after second dose of vaccine.

Findings

248 HWCs were analysed, 158 women (63.7%) and 90 men (36.3%). After the second dose of BNT162b2 vaccine, 99.5% of participants developed a humoral immune response.

The geometric mean concentration of antibodies among the vaccinated subjects after booster dose (285.9 AU/mL 95% CI: 249.5-327.7); was higher than that of human convalescent sera (39.4 AU/mL, 95% CI: 33.1-46.9), with p<0.0001. The antibody titre was found to be higher in young and female participants. A strong correlation of BMI classes with antibody titres was noticed: humoral response was more efficient in the group with under- and normal-weight vs the group with pre- and obesity participants (p<0.0001 at T1).

Interpretation

These findings imply that females, lean and young people have an increased capacity to mount humoral immune responses compared to males, overweight and the older population. Although further studies are needed, this data may have important implications for the development of vaccination strategies for COVID-19, particularly in obese people.

Funding

None