bluuebunny/crossref_metadata_2025 huggingface dataset:
TIPSS as a bridge to extrahepatic abdominal surgery: a case report
Authors: Kapeleris Audrey Pamela , Venkatachalapathy Suresh
Published: April 2022

Severe portal hypertension in cirrhosis is a relative contraindication to major surgical intervention. Pre-surgical placement of a transjugular intrahepatic portosystemic shunt (TIPSS) can potentially reduce portal hypertension and the risk of intraoperative bleeding. Two patients in our service, with cirrhosis and portal hypertension, required abdominal surgery and underwent TIPSS placement as a potential bridging therapy. Patient 1, a 56-year-old female, successfully underwent surgery with no intraoperative complications. Patient 2, a 36-year-old male, experienced liver decompensation post-TIPSS and is currently awaiting a liver and bowel transplant. Prophylactic TIPSS placement may allow some patients with decompensated cirrhosis to successfully undergo major extrahepatic abdominal surgery. However, careful patient selection and preoperative counselling for decompensation is necessary.
Giant hydronephrosis secondary to an ectopic ureter associated with bilateral duplex collecting system: a case report
Authors: Muhamad Muhamad Sinan , Mousa Mohammad Anas , Oukan Majdy , Razzok Ali
Published: April 2022

Giant hydronephrosis is an ultimate rare urologic entity; even rarer when it is secondary to a duplex collecting system. Duplex collecting system is a common urologic anomaly with a wide range of clinical symptoms and a variety of associated urologic abnormalities such as an ectopic ureter, ureterocele, vesicoureteral reflux and ureteropelvic junction obstruction. This report presents a case of an 8-year-old boy who had a bilateral duplex collecting system that was revealed accidentally by a bilateral severe hydronephrosis. The duplication was complete on the left side and partial on the right with a right ectopic ureteral orifice, in addition to a bilateral vesicoureteral reflux. The vesicoureteral reflux retreated completely in the left side after using a urethral catheter for 6 months, while the decision of performing a surgical operation for the right side was made.
Sacral osteomyelitis as a rare cause of anorectal pain several years following treatment for rectal carcinoma
Authors: Fernandes Darren C R , Srinivasan Sangeetha , Andreyev Hubert Jervoise N
Published: April 2022

A 66-year-old man was treated for a moderately differentiated T3 N1 M0 adenocarcinoma of the rectum in 2015 with preoperative short course radiotherapy, anterior resection and then adjuvant chemotherapy with oxaliplatin and capecitabine. Following ileostomy reversal, he complained of intense, unremitting anorectal pain. After repeated scans, computed tomography (CT) showed findings suggestive of a longstanding anastomotic leak. Subsequent, magnetic resonance imaging (MRI) revealed osteomyelitis of the sacrum, with the development of sacral osteomyelitis in this context unusual. Our case highlights the importance of appropriate radiological imaging and that clinicians should consider osteomyelitis as a differential diagnosis in patients presenting with severe anorectal pain after treatment for rectal cancer.
A case of tongue cancer manifesting from oral leukoplakia after long-term administration of pegylated liposomal doxorubicin
Authors: Nishimura Mai , Nomura Hidetaka , Omi Makiko , Netsu Sachiho , Sato Yukiko , Kanao Hiroyuki
Published: April 2022

We present a case of tongue cancer manifestation from oral leukoplakia after administration of pegylated liposomal doxorubicin (PLD). A 56-year-old woman was diagnosed with ovarian cancer. After preoperative chemotherapy with paclitaxel and carboplatin (TC), she underwent interval debulking surgery. Five cycles of TC therapy were carried out as adjuvant chemotherapy; however, recurrence was observed. Despite administration of gemcitabine-carboplatin therapy, the patient’s condition was judged as advancing to a progressive disease. PLD treatment was completed at a total dose of 1140 mg/m2. Two months after the end of treatment, the patient was diagnosed with leukoplakia. The leukoplakia lesion became thicker at each 3-month follow-up. She was diagnosed with tongue cancer and underwent a partial resection 2 years and 3 months after the completion of PLD treatment. Our report suggests that the risk of malignant transformation to tongue cancer persists even after the completion of treatment with PLD.
Sintilimab in Patients with Previously Treated Metastatic Neuroendocrine Neoplasms
Authors: Jia Ru , Li Yi , Xu Nong , Jiang Hai-Ping , Zhao Chuan-Hua , Liu Rong-Rui , Shi Yue , Zhang Yao-Yue , Wang Shu-Yan , Zhou Hui , Xu Jian-Ming
Published: April 2022

Background

Neuroendocrine neoplasms (NENs) are a group of diseases that show high heterogeneity but have limited treatment options. This phase I study evaluated the safety and efficacy of sintilimab, anti-PD-1 monoclonal antibody, in treating advanced NENs.

Methods

We prospectively enrolled patients pathologically diagnosed with NENs after standard treatment failure. Neuroendocrine neoplasms were classified into well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine cancers (NECs). Every patient received sintilimab, and response was assessed every 9 weeks.

Results

Twenty-four patients with a median age of 57.0 years were enrolled from November 2016 to 2017. The median Ki-67 index was 60%. Five patients had NET, 1 had NET G3, 17 had NEC, and 1 had mixed adenocarcinoma-neuroendocrine carcinoma. The most common primary tumor sites were the pancreas and gastrointestinal tract in 7 and 10 patients, respectively. In phase Ia trial, 2 patients received sintilimab 1 mg/kg every 2 weeks, one received 3 mg/kg every 2 weeks, and 21 patients enrolled in the phase Ib trial received 200 mg every 3 weeks. The objective response rate was 20.8% in all enrolled patients and 27.8% in NEC patients. The median progression-free survival was 2.2 and 2.1 months in patients with NET and NEC, respectively. The median OS was not applicable (NA) and 10.8 months (95% CI, 4.3, NA) with NET and NEC, respectively. The duration of response (DOR) was not reached, with a median follow-up time of 20.7 months. Treatment-related adverse events (TRAE) occurred in 17 (70.8%) patients. The most frequent TRAE was thyroid dysfunction (41.7%), and a grade 3 pulmonary infection occurred in 1 patient. The programmed cell death 1-ligand 1 (PD-L1)-positive (tumor proportion score ≥1%) rate was 18.8% (3 out of 16) and the expression of PD-L1 did not correlate with response.

Conclusion

Sintilimab was well-tolerated and showed encouraging response in NECs.

ClinicalTrials.gov Identifier

NCT02937116.
Designing of small organic non-fullerene (NFAs) acceptor molecules with an A−D−A framework for high-performance organic solar cells: A DFT and TD-DFT method
Authors: Numbury Surendra Babu
Published: April 2022

The main objective of this research was to design non-fullerene acceptors (NFAs) A–D–A framework, using carbazole and benzothiazole derivatives. Density functional theory (DFT) was used to calculate the geometry optimized structures and electronic properties at B3LYP functional with a 6-311G basis set in the gas and solvent phase. The frontier molecular orbitals (FMO), bandgap, open-circuit voltage (VOC) and dipole moments of these developed acceptors have been calculated. The theoretical UV absorption spectra were calculated from time-dependent DFT with the same level of theory used DFT method. They show a suitable bandgap (2.24–2.93 eV) and dipole moment (1.8–10.8 Debye). The maximum wavelength (λmax) for all studied molecules in the range is 665.17–679.97 in both gas and solvent. A slight redshift was observed in all acceptors selected for chlorobenzene compared with gas phase absorption. The NFA A11 has the lowest bandgap energy (2.24 eV), gas-phase excitation energy (1.86 eV) and chlorobenzene excitation energy (1.86 eV). As a result, A11 is predicted to be a good contender for organic NFAs in the future. The open-circuit voltage (VOC) values range from 1.53 to 2.56 eV. Consequently, the optoelectronic, molecular orbital distribution and A11 and A12 molecules were suitable acceptors for NFAs.
Women and the Fight for Urban Change in Late Francoist Spain
Authors: Webster Roseanna
Published: April 2022

This article explores how Spanish women formed grassroots groups to fight for the transformation of their neighbourhoods in the late 1950s and 1960s — the latter years of Francisco Franco’s dictatorship. In contrast to most histories of feminism, which focus on literate, secular groups in universities or the centres of cities, its subjects are activists based on the outskirts of Madrid and in the industrial areas of Asturias, many of whom were Catholic, came from rural areas and left school before the age of 14.

Histories of feminism have tended to overlook completely movements in the southern European dictatorships, while accounts of modern Spain often see male politicians and experts as the driving forces shaping the built environment under Franco. But photographs, archival material and oral history interviews show that women demanded ‘cosas básicas’ (basic resources) on a widespread scale in Asturias and Madrid. They made these claims in the context of unprecedented internal migration, industrial unrest and the spread of social Catholic movements: factors often neglected in studies of social movements. The women involved have sometimes struggled, however, to take pride in their actions in later life. Patterns in their life stories suggest why, and offer insight into what agitating under Franco has meant for how they understand their lives, identities and relationships.
SMAX1 potentiates phytochrome B-mediated hypocotyl thermomorphogenesis
Authors: Park Young-Joon , Kim Jae Young , Park Chung-Mo
Published: April 2022

Plant thermosensors help optimize plant development and architecture for ambient temperatures, and morphogenic adaptation to warm temperatures has been extensively studied in recent years. Phytochrome B (phyB)-mediated thermosensing and the gene regulatory networks governing thermomorphogenic responses are well understood at the molecular level. However, it is unknown how plants manage their responsiveness to fluctuating temperatures in inducing thermomorphogenic behaviors. Here, we demonstrate that SUPPRESSOR OF MAX2 1 (SMAX1), known as a karrikin signaling repressor, enhances the thermosensitivity of hypocotyl morphogenesis in Arabidopsis thaliana. Hypocotyl thermomorphogenesis was largely disrupted in SMAX1-deficient mutants. SMAX1 interacts with phyB to alleviate its suppressive effects on the transcription factor activity of PHYTOCHROME-INTERACTING FACTOR 4 (PIF4), promoting hypocotyl thermomorphogenesis. Interestingly, the SMAX1 protein is slowly destabilized at warm temperatures, preventing hypocotyl overgrowth. Our findings indicate that the thermodynamic control of SMAX1 abundance serves as a molecular gatekeeper for phyB function in thermosensitizing PIF4-mediated hypocotyl morphogenesis.
Differential effects of an experimental model of prolonged sleep disturbance on inflammation in healthy females and males
Authors: Besedovsky Luciana , Dang Rammy , Engert Larissa C , Goldstein Michael R , Devine Jaime K , Bertisch Suzanne M , Mullington Janet M , Simpson Norah , Haack Monika
Published: April 2022

Sleep disturbances, including disrupted sleep and short sleep duration, are highly prevalent and are prospectively associated with an increased risk for various widespread diseases, including cardiometabolic, neurodegenerative, chronic pain, and autoimmune diseases. Systemic inflammation, which has been observed in populations experiencing sleep disturbances, may mechanistically link disturbed sleep with increased disease risks. To determine whether sleep disturbances are causally responsible for the inflammatory changes reported in population-based studies, we developed a 19-day in-hospital experimental model of prolonged sleep disturbance inducing disrupted and shortened sleep. The model included delayed sleep onset, frequent nighttime awakenings, and advanced sleep offset, interspersed with intermittent nights of undisturbed sleep. This pattern aimed at providing an ecologically highly valid experimental model of the typical sleep disturbances often reported in the general and patient populations. Unexpectedly, the experimental sleep disturbance model reduced several of the assessed proinflammatory markers, namely interleukin(IL)-6 production by monocytes and plasma levels of IL-6 and C-reactive protein (CRP), presumably due to intermittent increases in the counterinflammatory hormone cortisol. Striking sex differences were observed with females presenting a reduction in proinflammatory markers and males showing a predominantly proinflammatory response and reductions of cortisol levels. Our findings indicate that sleep disturbances causally dysregulate inflammatory pathways, with opposing effects in females and males. These results have the potential to advance our mechanistic understanding of the pronounced sexual dimorphism in the many diseases for which sleep disturbances are a risk factor.
The genomic prehistory of the Indigenous peoples of Uruguay
Authors: Lindo John , De La Rosa Rosseirys , Santos Andre L C d , Sans Mónica , DeGiorgio Michael , Figueiro Gonzalo
Published: April 2022

The prehistory of the people of Uruguay is greatly complicated by the dramatic and severe effects of European contact, as with most of the Americas. After the series of military campaigns that exterminated the last remnants of nomadic peoples, Uruguayan official history masked and diluted the former Indigenous ethnic diversity into the narrative of a singular people that all but died out. Here, we present the first whole genome sequences of the Indigenous people of the region before the arrival of Europeans, from an archaeological site in eastern Uruguay that dates from 2,000 years before present. We find a surprising connection to ancient individuals from Panama and eastern Brazil, but not to modern Amazonians. This result may be indicative of a migration route into South America that may have occurred along the Atlantic coast. We also find a distinct ancestry previously undetected in South America. Though this work begins to piece together some of the demographic nuance of the region, the sequencing of ancient individuals from across Uruguay is needed to better understand the ancient prehistory and genetic diversity that existed before European contact, thereby helping to rebuild the history of the Indigenous population of what is now Uruguay.
Association of insomnia and short sleep duration, alone or with comorbid obstructive sleep apnea, and the risk of chronic kidney disease
Authors: Beaudin Andrew E , Raneri Jill K , Ahmed Sofia , Hirsch Allen A J , Nocon Andrhea , Gomes Teresa , Gakwaya Simon , Sériès Frédéric , Kimoff John R , Skomro Robert , Ayas Najib , Hanly Patrick J
Published: April 2022

Study Objectives

Obstructive sleep apnea (OSA), sleep fragmentation, and short sleep duration (SD) have been associated with chronic kidney disease (CKD). However, these potential mechanisms for CKD have not been compared in the same cohort. This study investigated the independent and combined impact of OSA and insomnia with short sleep duration on the risk of CKD progression in a sleep clinic population.

Methods

In a cross-sectional study design, adults with suspected OSA completed an overnight sleep study and a questionnaire that included the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI). They also provided blood and urine samples for measurement of the glomerular filtration rate and urine albumin:creatinine ratio, from which the risk of CKD progression was determined.

Results

Participants (n = 732, 41% female, 55 ± 13 years) were categorized into four groups: no/mild OSA without insomnia (NM-OSA, n = 203), insomnia with SD without OSA (Insomnia-SD, n = 104), moderate-to-severe OSA without insomnia (MS-OSA, n = 242), and comorbid insomnia and OSA with SD (COMISA-SD, n = 183). After stratification, 12.8% of NM-OSA, 15.4% of Insomnia-SD, 28.9% of MS-OSA, and 31.7% of the COMISA-SD participants had an increased risk of CKD progression. Compared to NM-OSA, the odds ratio (OR) for an increased risk of CKD progression was not increased in Insomnia-SD (OR 0.95, confidence interval [CI]: 0.45–1.99) and was increased to the same degree in MS-OSA (OR 2.79, CI: 1.60–4.85) and COMISA-SD (OR 3.04, CI: 1.69–5.47). However, the ORs were similar between the MS-OSA and COMISA-SD groups across all statistical models (p ≥ .883).

Conclusions

In a sleep clinic population, insomnia with short sleep duration does not increase the risk of CKD progression; nor does it further increase the risk of CKD progression associated with moderate-to-severe OSA.
Honoring Nurses Where They Need It
Authors: Moffa Christine
Published: April 2022

System-level changes must address issues such as staffing and burnout.
Teaching Elementary School Students to Be Emergency Responders
Authors: Goedde Elizabeth , Combe Laurie G. , Bowlen Brandy , Kerry Bonnie
Published: April 2022

School nurses from the Klein Independent School District in Harris County, Texas, have educated students, some as young as kindergarteners, on cardiopulmonary resuscitation (CPR) and how to recognize and use automatic external defibrillators and provide basic first aid. Through a collaboration with community partners and CPR-certified high school students, these school nurses are empowering the next generation with lifesaving skills.
Improving ABCDEF Bundle Compliance and Clinical Outcomes in the ICU: Randomized Control Trial to Assess the Impact of Performance Measurement, Feedback, and Data Literacy Training
Authors: Brown Joan C. , Querubin Jynette A. , Ding Li , Mack Wendy J. , Chen-Chan Kai , Perez Fabiola , Barr Juliana , Peden Carol J. , Cobb J. Perren
Published: April 2022

OBJECTIVES:

Describe the effects of data literacy training and continuous performance reports on ICU staff compliance with the 6-element ICU quality bundle approach known as the ABCDEF (A–F) bundle and patient outcomes.

DESIGN:

Stepped-wedge cluster randomized trial conducted during an institutional A–F bundle implementation program.

SETTING:

Single-center study conducted in eight adult ICUs.

PATIENTS:

Adult patients admitted for at least 24 hours, not undergoing active withdrawal of life support or palliative care.

INTERVENTIONS:

Four ICUs in the intervention group received bundle-related staff education, data literacy training, and weekly bundle performance reports during the 12-month study period. The four ICUs in the nonintervention group received none of these interventions. Bundle compliance and patient outcomes were tracked, including ICU and hospital mortality, transfer and discharge, discharge disposition, mechanical ventilation, and ICU delirium.

MEASUREMENT AND RESULTS:

In the intervention group, staff education alone increased bundle compliance from 9% to 16% (p < 0.0001); data literacy training further increased compliance from 16% to 21% (p = 0.03). This improvement was sustained throughout the study period including the onset of the COVID-19 pandemic and was greater than improvement in the nonintervention group (p < 0.001). Full A–F bundle compliance was associated with a lower likelihood of next-day ICU and hospital mortality, discharge to a facility other than home, and was associated with a higher likelihood of next-day extubation in patients. Next-day ICU and hospital discharge likelihood decreased, and delirium frequency was not affected.

CONCLUSIONS:

This is the first study demonstrating that the combination of staff education, data literacy training, and access to performance data improves A–F bundle compliance, sustains performance, and improves ICU patient outcomes (ICU and hospital mortality, mechanical ventilation duration, and home discharge rates). In contrast to previous studies, increased bundle compliance did not hasten ICU or hospital discharges or reduce delirium frequency in patients.
A Proposal to Modify the 8th IASLC System
Authors: Ruan Tian , Jiang PengFei , Li Changsheng , Pan Gaofeng , Zhou Xuefeng
Published: April 2022

Purpose:

The International Association for the Study of Lung Cancer (IASLC) of TNM staging system has been well accepted as a precise model. However, the latest American Joint Committee on Cancer (AJCC) staging system to solve the different survival and prognosis of lung adenocarcinoma in the same period is still controversial. Therefore, it is necessary to thoroughly explore the applicability between the new system and survival prediction in terms of lung adenocarcinoma.

Methods:

We recruited 52,517 patients with lung adenocarcinoma from the Surveillence, Epidemiology, and End Results database. Cox regression analysis was performed to determine survival related factors. The mortality rate per 1000 persons per year of the T4N2M0 lung adenocarcinoma stage and other stages were compared. Survival curves were obtained using the Kaplan-Meier analysis and log-rank test.

Results:

The results of Cox proportional hazards regression analysis showed that age at diagnosis, race, T stage, distant metastasis, extrathoracic extension, radiotherapy, chemotherapy, and surgery are independent factors related to cancer-specific survival (CSS) and all-cause survival. Furthermore, patients with stage IIIA disease (P<0.001) and IIIB disease (P<0.001) excluding stage at T4N2M0 had a significantly lower risk of CSS and all-cause survival than those staged with T4N2M0 disease. The mortality rates per 1000 person-years with patients staged at T4N2M0 lung adenocarcinoma had higher mortality than patients in the same period. The CSS curves of patients with stage T4N2M0 reflected an obvious decline compared with those of stages IIIA disease and IIIB excluding T4N2M0, and there is no significant difference between this curve and stage IIIC patients (P>0.05).

Conclusion:

The survival rate of patients with T4N2M0 stage was significantly lower than that of patients with IIIA and IIIB stages excluding T4N2M0, there was no significant difference between T4N2M0 and IIIC. It was suggested that this group of patients with stage T4N2M0 were upgraded in the 8th IASLC system.
Changes in satisfaction with female genital self-image and sexual function after a Qigong exercise intervention in Spanish postmenopausal women: a randomized-controlled trial
Authors: Carcelén-Fraile María del Carmen , Aibar-Almazán Agustín , Martínez-Amat Antonio , Brandão-Loureiro Vânia , Jiménez-García José Daniel , Castellote-Caballero Yolanda , Hita-Contreras Fidel
Published: April 2022

Objective:

To analyze the effectiveness of a Qigong exercise program on satisfaction with female genital self-image and female sexual function in postmenopausal Spanish women.

Methods:

A total of 49 women were randomly assigned to an experimental group (n = 22) that carried out training based on Qigong exercises for 12 weeks and a control group (n = 27) that did not carry out any type of intervention. Female genital self-image was measured through the Female Genital Self-Tmage Scale and female sexual function through the Female Sexual Function Tndex; both variables were measured before and just after the intervention.

Results:

Results showed that women who participated in the Qigong exercise program showed significant improvements with respect to female genital self-image, as well as in the domains of desire, arousal, lubrication, satisfaction, and pain and the total score of the Female Sexual Function Index, but, on the contrary, were not found in the orgasm domain.

Conclusions:

Our results suggest that Qigong has the potential to improve female genital self-image and female sexual function among postmenopausal Spanish women.
RETINAL MICROVASCULAR CHANGES IN PATIENTS WITH ACUTE LEUKEMIA
Authors: Cicinelli Maria V. , Mastaglio Sara , Menean Matteo , Marchese Alessandro , Miserocchi Elisabetta , Modorati Giulio , Bernardi Massimo , Ciceri Fabio , Bandello Francesco
Published: April 2022

Purpose:

To evaluate the retinal circulation in patients with active acute leukemia, to correlate the perfusion metrics with systemic laboratory values, and to assess the vascular perfusion after leukemia remission.

Methods:

Longitudinal study of 22 eyes from 12 patients with acute leukemia; healthy eyes were recruited as control subjects. All patients underwent optical coherence tomography angiography at baseline. Optical coherence tomography angiography was repeated in case of morphologic leukemia remission.

Results:

Patients' age ranged from 37 to 74 years. All participants had a 20/20 vision. In all leukemic eyes, optical coherence tomography angiography detected vascular alterations in the macula and the peripapillary region. Vessel density values in the superficial capillary plexus were lower in patients with leukemia than control subjects (46.8 ± 3.6 vs. 49.2 ± 2%, P = 0.08), irrespective of the presence of leukemic retinopathy (7 eyes, 32%). Lower vessel density was associated with lower white blood cells (P = 0.09) and lower platelets (P = 0.001). Reappearance of small capillaries, increase in vessel density, reduction in vessel diameter, and increase in fractal dimension were seen after remission.

Conclusion:

Subclinical, reversible reduction in vessel density and complexity on optical coherence tomography angiography occurs in patients with active acute leukemia and is presumably associated with bone marrow function failure. Further studies are warranted to explore its functional and prognostic significance.
Titerphilia - The Irresistible Urge to Measure Postimmunization Antibody Values
Authors: Heininger Ulrich , Plotkin Stanley
Published: April 2022

Some physicians and parents request to measure antimeasles serum IgG antibodies after measles-mumps-rubella (MMR) vaccination. Often, vaccine skeptical parents want to know if their child is “immune” after the first dose to avoid the second dose. In the usual healthy child, this should be discouraged for the following reasons. Commercially available antibody assays do not measure functional (neutralizing) antibodies. They cannot reliably measure immunity against measles and were designed to measure naturally acquired antibodies rather than those induced by vaccination. Furthermore, MMR also includes mumps and rubella vaccine viruses, which also require 2 doses for optimal protection; there is no reliable serologic correlate of protection for mumps. Therefore, the 2-dose MMR immunization concept is by far more effective, efficient and reliable than a single dose strategy based on a post-dose 1 positive anti-measles-IgG test. Consequently, physicians should resist the desire to measure antimeasles IgG antibodies unless there is a clear indication (e.g., immunodeficiency) or official recommendation as part of the national immunization program.
A Longitudinal Study of Spontaneous Gut Decolonization of Carbapenem-resistant Gram-negative Bacteria in Neonatal and Pediatric Patients
Authors: Darda Violetta-Magdalini , Iosifidis Elias , Antachopoulos Charalampos , Kirvasilis Fotis , Zarras Charalampos , Simitsopoulou Maria , Papakonstantinou Eugenia , Agakidou Eleni , Sdougka Maria , Roilides Emmanuel
Published: April 2022

Background:

Antibiotic exposure may convert gut microbiome to reservoir of resistant organisms, including carbapenem-resistant Gram-negative bacteria (CRGNB). Little is known about natural history of spontaneous CRGNB decolonization of neonates/children and their risk to develop CRGNB infections.

Methods:

Patients hospitalized in a tertiary care hospital (1 days to 16 years) found to be CRGNB colonized in weekly surveillance cultures during hospitalization (January 2018 to December 2019) were prospectively followed after discharge with monthly rectal cultures for 12 months after colonization until decolonization (3 consecutive negative rectal cultures, ≥1 week apart). Patient demographics, clinical characteristics and CRGNB infections were recorded. Polymerase chain reaction for carbapenemases was performed in patients colonized, after 3 negative cultures, at the day of the last negative and the day of the first new positive culture.

Results:

One-hundred thirty patients (median age, 1.3 months; lower-upper quartile values, 0.8–6.9 months) were studied including 66 neonates (median age, 12.6 days; Q1–Q3, 5–18.5 days). Among patients >30 days old, 51.6% achieved decolonization within 6 months, and among neonates, 91% achieved decolonization within 6 months. By 12th month, 89% of >30 days and 100% of neonates were decolonized. Forty-four (33.9%) patients (59% >30 days and 9% neonates) developed CRGNB infection(s), mainly pneumonia (25%) and bloodstream infection (20.5%). Prolonged colonization (odds ratio [OR], 7.75; 95% confidence interval [CI], 2.10–28.58), duration of broad-spectrum antibiotic use (OR, 1.22; 95% CI, 1.11–1.34) and parenteral nutrition (OR, 4.53; 95% CI, 1.14–17.94) were associated with the development of CRGNB infection. Two patients (1.5%) were found by polymerase chain reaction colonized after 3 negative cultures.

Conclusions:

Spontaneous decolonization occurs in most CRGNB colonized >30 days and all neonates within 12 months. One-third of colonized patients develop CRGNB infection(s). These findings may help optimize duration of contact precautions and empirical antimicrobial therapy for CRGNB colonized pediatric patients.
Recognizing Intensive Care Unit Delirium: Are Critical Care Nurses Ready?
Authors: HO Mu-Hsing , CHANG Hui-Chen (Rita) , LIU Megan F. , CHEN Kee-Hsin , SHEN HSIAO Shu-Tai , TRAYNOR Victoria
Published: April 2022

Background

Delirium remains significantly undetected in the intensive care unit (ICU). Little is known regarding the level of delirium care knowledge among critical care nurses in Taiwan.

Purpose

This study was designed to investigate the level of knowledge about delirium care among critical care nurses using a multiple-choice question quiz.

Methods

A descriptive, cross-sectional approach was used, and data were collected using a web-based survey. The demographic characteristics including age, years worked as critical care nurse, gender, advanced ICU training, educational level, and type of ICU, along with a delirium care knowledge quiz, were collected. The quiz consisted of 16 items measuring (a) symptoms, types, and outcomes; (b) high-risk groups; (c) predisposing and precipitating factors; and (d) assessment and detection of delirium. Data were collected between October 6 and November 16, 2020.

Results

In total, 324 critical care nurses completed the survey. The rate of correct response on the delirium care quiz for each domain was measured: (a) symptoms, types, and outcomes: 67.1%; (b) high-risk groups: 76.2%; (c) predisposing and precipitating factors: 78.9%; and (d) assessment and detection: 41.5%. The item with the lowest correct response rate was related to the interpretation of delirium assessments.

Conclusion/Implications for Practice

The findings of this study suggest that future studies and education should focus on the use and interpretation of the assessment using a valid delirium assessment tool to improve the ability of critical care nurses to detect delirium in ICU settings.
Efficacy of different telemonitoring strategies on chronic heart failure care
Authors: Wu Aichun , Li Hongbing
Published: April 2022

Background:

Growing interest on the effects of telemonitoring on patients with chronic heart failure (CHF) has led to a rise in the number of trials addressing the same or very similar research questions with a concomitant increase in discordant findings. Therefore, we conducted a protocol for systematic review and meta-analysis to compare the effects of different telemonitoring strategies on clinical outcomes in patients with CHF.

Methods:

Two individual researchers conducted the platform searches on the PubMed, Cochrane Library, and Embase databases from inception to February 2022. Literature retrieving was carried out through a combined searching of subject terms (“MeSH” on PubMed and “Emtree” on “Embase”) and free terms on the platforms of PubMed and Embase, and through keywords searching on platform of Cochrane Library. Systematic review and meta-analysis of the data will be performed in STATA13.0 software according to the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Two authors independently performed the literature searching, data extraction, and quality evaluation. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials (RCTs).

Results:

The results will be submitted to a peer-reviewed journal.

Conclusion:

This meta-analysis will provide a comprehensive analysis and synthesis that can be used as an evidence map to inform practitioners and policy makers about the effectiveness of telemonitoring interventions for patients with CHF.
A larger sized cup accelerates cartilage erosion of acetabulum after bipolar hemiarthroplasty in elderly with femur neck fracture
Authors: Shah Saumil Ashvin , Kim Jae Young , Cho Hyun-Woo , Shon Won-Yong , Kim Sang-Min
Published: April 2022

Bipolar hemiarthroplasty (BHA) is one of the common procedures done for the treatment of femur neck fracture. One of the frequently encountered complication with this surgery is erosion of the acetabular cartilage. This study was conducted to investigate acetabular erosion after BHA according to the difference in diameter between femoral head and implanted cup at minimum 10-year follow-up.

We retrospectively reviewed 117 patients (117 hips) undergoing BHA with fracture of neck of the femur. Their mean age was 77.8 years (range, 65–96 years) and male: female ratio was 32:85. Patients were divided into 3 groups; Group A – bipolar cup size > actual head size, Group B – cup size < head size, Group C – cup size = head size. The degree of both superior and medial acetabular cartilage erosion was identified and calculated on postoperative radiographs using line of acetabular margin and Kohler line.

The mean superior and medial acetabular erosion were 1.62 ± 1.6 mm (range, 0–4.4) and 4.15 ± 2.7 mm (range, 0–8.2) in Group A, 1.30 ± 1.3 mm (range, 0–3.8) and 4.11 ± 2.7 mm (range, 0–7.8) in Group B, and 0.90 ± 1.1 mm (range, 0–2.6) and 3.16 ± 2.9 mm (range, 0–7.9) in Group C (P = .039 and P = .187, respectively). The superior acetabular erosion showed significant difference between the 3 groups. During mean follow-up period of 12.3 years, 5 patients (5/117, 4.3%) underwent conversion to total hip arthroplasty due to superior acetabular erosion. All of 3 patient underwent BHA with a larger bipolar cup than the actual femoral head.

A lager sized cup accelerated superior cartilage erosion of acetabulum after BHA. An optimal cup size should be considered when undergoing BHA in elderly patients.
Curative efficiency and adverse events of alternative therapy and medicine for functional constipation in adults
Authors: Liu Chang , Pang Tingting , Yin Shuang , Li Jiahui , Yao Junjie , Li Hongmei , Lou Huijuan , Lei Siyuan , Zhang Jiangchun , Dong Li , Wang Yufeng
Published: April 2022

Background:

The efficacy of alternative therapies and medications for functional constipation (FC) in adults is well established, however, the efficacy and safety of different alternative therapies and medications for FC in adults is not fully clarified. Due to there are many different alternative therapies and medications available for the treatment of febrile FC in adults, the selection of appropriate alternative therapies and medications has become an urgent issue. The purpose of this study was to evaluate the effectiveness and safety of alternative therapy and medicine for FC in adults.

Methods:

PubMed, Web of Science, Scopus, Cochrane Library, Embase, China National Knowledge Infrastructure, China Science and Technology Journal Database and Wanfang Data were searched to identify randomized controlled trials which focused on alternative therapy and medicine for FC in adults from December 15, 2020 to July 1, 2021. Subsequently, 2 researchers will be independently responsible for literature screening, data extraction, and assessment of their quality. This study uses The R Programming Language 4.0.2 based on Bayesian framework for NMA. Odds ratios or standardized mean differences will be modeled using Markov chain Monte Carlo methods, both with 95% confidence intervals.

Results:

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusions:

The conclusion of this systematic review will provide evidence for selecting an optimal alternative therapy and medicine for patients with FC in adults.

Ethics and dissemination:

The protocol of the systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences.

Systematic review registration:

INPLASY202210091.
Effects of cluster nursing on cardiac function and quality of life in coronary heart disease patients with chronic heart failure
Authors: Jin Qian , Zhou Yi , Yin Delu , He Hong , Liu Yonghua , Wu Yiling
Published: April 2022

Background:

Coronary heart disease (CHD) chronic heart failure has high morbidity and mortality, which poses a serious threat to patients’ quality of life and life safety. For the treatment of chronic heart failure of CHD, in addition to drugs, high quality nursing measures are also very important. Cluster nursing is a high-quality nursing model based on evidence-based evidence. There is no clinical study to evaluate the effect of cluster nursing on cardiac function and quality of life of CHD patients with chronic heart failure.

Methods:

This is a prospective randomized controlled trial to investigate the effects of cluster nursing on cardiac function and quality of life in patients with CHD chronic heart failure. Approved by the Clinical Research Ethics Committee of our hospital, patients will be randomly assigned to either routine nursing or cluster nursing. They will be followed up for 3 months after 4 weeks of treatment. Observation indicators include: The total effective rate of cardiac function improvement, Minnesota Living with Heart Failure Questionnaire, left ventricular ejection fraction, N-terminal pro-brain natriuretic peptide, 6-minute walk test, adverse reaction, etc. Data were analyzed using the statistical software package SPSS version 25.0.

Discussion:

This study will evaluate the effects of cluster nursing on cardiac function and quality of life of CHD patients with chronic heart failure. The results of this study will provide clinical basis for establishing reasonable and effective nursing programs for CHD patients with chronic heart failure.
Transperineal pelvic drainage combined with lateral position to promote perineal wound healing after abdominoperineal resection
Authors: Shang An , Wang Min , Yang Yongping , Zhao Zeyun , Li Donglin , Guo Yu , Qi Rui , Yang Yang , Wang Shuang
Published: April 2022

Background:

For the rectal cancer <5 cm from anal margin, extralevator abdominoperineal resection (eAPR) has been accepted widely by surgeons. However, the rate of perineal infection following up eAPR is approximately 70%. We did the study with the aim of evaluating the effect and safety of transperineal pelvic drainage combined with lateral position (TPDLP) on perineal wound in patients undergoing eAPR.

Methods:

Patients were randomly assigned to N-TPDLP group (standard arm) or TPDLP group (intervention arm). In the standard arm, surgery was completed after abdominal drainage tube was placed in pelvic. Comparatively, an additional transperineal wound drainage tube was applied in the experimental arm. Postoperatively, patients of both 2 groups were informed not to sit to reduce perineal compression until the perineal wound healed. But lateral position was demanded in the intervention arm. The primary endpoint was the rate of uncomplicated perineal wound healing defined as a Southampton wound score of <2 at 30 days postoperatively. Patients were followed for 6 months.

Results:

In total, 60 patients were randomly assigned to standard arm (n = 31) and intervention arm (n = 29). The mean perineal wound healing time was 34.2 (standard deviation [SD] 10.9) days in TPDLP arm, which significantly differ from 56.4 (SD 34.1) in N-TPDLP arm (P = .001). At 30 days postoperatively, 3 (10%) of 29 patients undergoing TPDLP were classified into grade 4 according to Southampton wound score, however, 16 (52%) of 31 patients were classified into grade 4 in control arm, and significantly difference was observed between randomization groups (P = .001). What's more, perineal wound pain was assessed at 30 days postoperatively, and it is discovered that the pain degree of patients in control arm was significantly more severe than the interventive arm (P = .015).

Conclusion:

In the present study, we found that TPDLP generated a favorable prognosis for perineal wounds with acceptable side-effects.
Joint mobilization for frozen shoulder
Authors: Yao Junjie , Liu Chang , Pang Tingting , Li Jiahui , Lei Siyuan , Zhang Jiangchun , Wang Yufeng , Shang Qiangqiang
Published: April 2022

Background:

The purpose of this study was to evaluate the effectiveness and safety of Joint mobilization in the treatment of frozen shoulder.

Methods:

To collect relevant literature, we will research following databases: Medicine, PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wan-Fang Database, Chongqing VIP Chinese Science and Technology Periodicaols Database, and China Biomedical Database; the time is from its creation to May 2021, and the language is limited to Chinese and English. In addition, we will retrieve other literature resources, including the Chinese Clinical Trial Register and conference articles. Two reviewers will independently complete the literature screen and data extraction and quality assessment of the included studies will be independently completed by 2 other researchers. The primary outcomes included joint ROM and Japanese Orthopedic Association score. Visual Analogue Scale score, Activities of Daily Living score and adverse reactions as secondary outcomes were assessed. RevMan V.5.4.1 software will be used for meta-analysis, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess the quality of evidence.

Results:

This systematic review will provide a high-quality synthesis to evaluate the efficacy and safety of joint mobilization in the treatment of frozen shoulder, providing a reference for the safe and effective treatment of frozen shoulder.

Conclusion:

This study provides evidence that joint mobilization in the treatment of frozen shoulder is effective.

Ethics and dissemination:

The protocol of the systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences.

Systematic review registration:

INPLASY202210075
ω-3 fatty acid-enriched parenteral nutrition shortens hospital stay in acute variceal bleeding cirrhotic patients
Authors: Kim Seong-Jung , Chun In Ae , Cho Ju-Yeon , Lee Jun Hyung , Lee Jun , Kim Young-Dae , Park Chan-Guk
Published: April 2022

Acute variceal bleeding, a crucial complication of liver cirrhosis requires high energy expenditures but gastrointestinal bleeding limits enteral feeding in the acute stage. We investigated the safety and efficacy of ω-3 fatty acid-enriched parenteral nutrition in acute variceal bleeding patients.

In this retrospective study, a total of 208 cirrhotic patients with acute variceal bleeding who underwent parenteral nutrition in the absence of enteral nutrition were enrolled. Among the patients, 86 patients received ω-3 fatty-acid-enriched parenteral nutrition. The primary endpoint was to evaluate the duration of hospital stay and the presence of clinical complications of liver cirrhosis.

The mean age of the patients enrolled was 54.9 years-old and 185 patients (88.9%) were male. The cause of liver cirrhosis, Child-Pugh score and comorbidities were statistically not different. Patients with ω-3 enriched parenteral nutrition had a significantly lower systolic blood pressure and total bilirubin levels. The difference in the in-hospital mortality (P = .813) or rate of complications (P = .880) was not statistically significant. The duration of hospital stay was significantly shorter in the patients who underwent ω-3 fatty acid-enriched parenteral nutrition (10.7 ± 7.3 vs 7.9 ± 4.2 days, P = .001).

In liver cirrhosis patients with acute variceal bleeding, ω-3 fatty acid-enriched parenteral nutrition significantly decreased the length of hospital stay. Further prospective studies to consolidate these findings are warranted.
Effective treatment in lung adenocarcinoma patient with brain metastases harboring novel CLHC1/RNT4 intergenic region- ALK fusion
Authors: Xia Huanling , Liang Binbin , Liu Guoxiang , Qi Yingxue , Luo Ningning , Li Mengmeng
Published: April 2022

Rationale:

Anaplastic lymphoma kinase (ALK) fusion, an important oncogenic mutation, occurs in 3% to 7% of non-small cell lung cancer (NSCLC) cases, and EML4 is the most common partner gene. With the widespread application of next-generation sequencing (NGS), more gene breakpoint fusions have been discovered and functional fusion transcripts can provide targeted clinical benefits.

Patient concerns and diagnosis:

A 40-year-old woman was diagnosed with lung adenocarcinoma with brain metastases. A novel CLHC1/RNT4 intergenic region, ALK (Exon20-29) (abundance 39.97%), was identified using lung puncture tissue by NGS analysis (Simceredx), and results of immunohistochemistry and fluorescence in situ hybridization confirmed ALK fusion.

Interventions and outcomes:

The patient was administered oral crizotinib (250 mg bid) combined with endostar (30 mg d1-7) for 12 cycles from June 18, 2020. The patient's condition was controlled, and the curative effect was evaluated as stable disease (SD). Unfortunately, brain magnetic resonance images showed multiple nodules in the left cerebellar hemisphere, and chest computed tomography showed no significant changes in the progression of the disease. Subsequently, alectinib (600 mg bid) was administered on April 1, 2021. Brain lesions were significantly reduced and partial remission (PR) was achieved. No significant changes were observed in the lung lesions.

Lessons:

ALK fusion is a risk factor for brain metastasis (BM) in patients with advanced non-small NSCLC patients. In our case, a novel CLHC1/RNT4 intergenic region, ALK fusion, was identified for the first time in a lung adenocarcinoma patient with BM, who benefited from crizotinib and endostar sequential alectinib. Our case highlights the advantages of NGS for fusion detection and provides promising treatment options for NSCLC patients with BM harboring ALK fusions.