bluuebunny/crossref_metadata_2025 huggingface dataset:
Nordic Guidelines for Germline Predisposition to Myeloid Neoplasms in Adults: Recommendations for Genetic Diagnosis, Clinical Management and Follow-up
Authors: Baliakas Panagiotis , Tesi Bianca , Wartiovaara-Kautto Ulla , Stray-Pedersen Asbjørg , Friis Lone Smidstrup , Dybedal Ingunn , Hovland Randi , Jahnukainen Kirsi , Raaschou-Jensen Klas , Ljungman Per , Rustad Cecilie F. , Lautrup Charlotte K. , Kilpivaara Outi , Kittang Astrid Olsnes , Grønbæk Kirsten , Cammenga Jörg , Hellström-Lindberg Eva , Andersen Mette K.
Published: November 2019

Myeloid neoplasms (MNs) with germline predisposition have recently been recognized as novel entities in the latest World Health Organization (WHO) classification for MNs. Individuals with MNs due to germline predisposition exhibit increased risk for the development of MNs, mainly acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). Setting the diagnosis of MN with germline predisposition is of crucial clinical significance since it may tailor therapy, dictate the selection of donor for allogeneic hematopoietic stem cell transplantation (allo-HSCT), determine the conditioning regimen, enable relevant prophylactic measures and early intervention or contribute to avoid unnecessary or even harmful medication. Finally, it allows for genetic counseling and follow-up of at-risk family members. Identification of these patients in the clinical setting is challenging, as there is no consensus due to lack of evidence regarding the criteria defining the patients who should be tested for these conditions. In addition, even in cases with a strong suspicion of a MN with germline predisposition, no standard diagnostic algorithm is available. We present the first version of the Nordic recommendations for diagnostics, surveillance and management including considerations for allo-HSCT for patients and carriers of a germline mutation predisposing to the development of MNs.
Corneal Collagen Cross-Linking With Photoactivated Chromophore for Infectious Keratitis After Penetrating Keratoplasty
Authors: Ozbek-Uzman Selma , Yalniz-Akkaya Zuleyha , Burcu Ayse
Published: November 2019

Purpose:

To evaluate the efficacy and safety of corneal collagen cross-linking with photoactivated chromophore (PACK-CXL) plus medical treatment in comparison with the non-CXL group in the management of graft infections after penetrating keratoplasty.

Methods:

Forty eyes of 40 patients, 18 eyes in the PACK-CXL group and 22 eyes in the non-CXL group, with graft infections were retrospectively reviewed. Patients with microbial keratitis who were resistant to medical treatment for at least 1 week were treated with PACK-CXL in conjunction with medical treatment. The non-CXL group received only medical treatment.

Results:

The median (interquartile range) size of the infiltrate was 11 (3–12.7) versus 7.5 (3.5–12.7) mm2 (P = 0.37), the epithelization time was 3 (2.7–5) versus 6 (3–11.2) days (P = 0.06), the complete healing time was 23.5 (17.7–33.5) versus 34 (27.7–41.2) days (P = 0.02), and the best-corrected distance visual acuity was 2.5 (0.5–3) versus 2.0 (0.9–3) logarithm of the minimum angle of resolution (P = 0.79) at presentation and 1 (0.3–3) versus 3 (1–3) logarithm of the minimum angle of resolution (P = 0.19) at the final visit for the PACK-CXL and non-CXL groups, respectively. Resolution of infiltrates was observed in 83.3% and 68.2% of cases in the PACK-CXL and non-CXL groups, respectively (P = 0.28). Graft failure was observed in 5 (27.8%) and 12 (54.5%) patients in the PACK-CXL and non-CXL groups, respectively (P = 0.08).

Conclusions:

PACK-CXL appears to be a promising adjuvant procedure in the management of resistant graft infections by reducing both the duration required for complete healing and rates of graft failure.
Biomedical ontologies and their development, management, and applications in and beyond China
Authors: Pan Hongjie , Zhu Yan , Yang Sheng , Wang Zhigang , Zhou Wei , He Yongqun , Yang Xiaolin
Published: November 2019

Since the boom of biomedical big data studies, various big data processing technologies have been developed rapidly. As an important form of knowledge representation, ontology has become an important means for the utilization and integration of biomedical big data. The emergence of new technologies for ontology development has resulted in the generation of many biomedical ontologies by many ontology development communities. The Open Biological and Biomedical Ontology Foundry, an academic organization for bio-ontology developers, has provided a set of principles to guide community-based open ontology construction. The Open Biological and Biomedical Ontology Foundry have also built many widely used ontologies, such as Gene Ontology, Human Phenotype Ontology, and Chemical Entities of Biological Interest. Other various ontology repositories have also been created and used to support ontology reuse. Many efficient tools for ontology applications, such as data annotation and terms mapping, have also been developed. High quality ontologies are also being used to develop new methods and tools for biomedical data analysis. The applications of Gene Ontology and Human Phenotype Ontology for data analysis and integration in recent years are reviewed here. To promote the development and applications of biomedical ontologies in China, a research community, OntoChina, was founded recently. OntoChina aims to support the development of reference ontologies, especially bilingual and Chinese translated ontologies. OntoChina also encourages ontology developers to follow the Open Biological and Biomedical Ontology Foundry principles.
Development of microRNA-based therapy for pancreatic cancer
Authors: Fesler Andrew , Ju Jingfang
Published: November 2019

Despite extensive research efforts on diagnosis and treatment, pancreatic ductal adenocarcinoma (PDAC) remains a devastating disease and the third leading cause of cancer-related death in the United States. Resistance to current therapeutic approaches is a major reason for the poor survival of pancreatic patients. In order to overcome this major challenge and improve patient outcomes, we are in desperate need of novel therapeutic approaches. PDAC chemoresistance mechanisms are complex and multifaceted. Novel therapeutics must be equipped to deal with this challenge. microRNAs (miRNAs) have emerged as strong candidates to fill this role due to their multitargeted function. miRNAs have been shown to have important roles in pancreatic cancer resistance. In this review, we summarize the recent advancement in miRNA research related to PDAC therapeutic resistance mechanisms and the potential of miRNAs as therapeutic agents for future clinical management of PDAC.
Comparison between blood pressure readings using a mercury versus an aneroid sphygmomanometer
Authors: Farhan Kinaan , Naqvi S. Tahira Shah , Rizvi Syed Asad Hasan , Zafar Amara , Rawala Muhammad Shabbir
Published: November 2019

Objective

For more than a century since its introduction, mercury sphygmomanometer (HgS) had been the mainstay for office measurement of blood pressure (BP). In light of the environmental and health hazards associated with mercury, there is a need to replace it with mercury-free alternatives all over the world. We aimed to validate the widely used aneroid sphygmomanometer (AnS) by comparing its BP readings against BP readings taken with an HgS.

Methods

We compared the BP readings using AnS vs. HgS on a sample of 300 patients of 18 years or older age admitted to a tertiary care hospital in Karachi, Pakistan.

Results

The differences between mean HgS and AnS BP readings were found to be statistically significant (P-value <0.01). The mean systolic blood pressure (SBP) readings of the two devices were still significantly correlated (r = 0.989; P < 0.01). Similarly, the mean diastolic blood pressure (DBP) readings were also significantly correlated (r = 0.988; P < 0.01). The aneroid device identified a higher proportion of hypertensive participants compared to the mercury device.

Conclusion

The difference in the two devices used was found to be significant; however, the readings were correlated with each other. The AnS significantly overestimated BP readings, thereby identifying a higher proportion of hypertensives as compared to the HgS. There is a considerable room for improvement in the accuracy of the AnS, only then an accurate and a well-calibrated AnS could provide an acceptable alternative to the use of the HgS.
Evolving targets for sedation during mechanical ventilation
Authors: Pearson Steven D. , Patel Bhakti K.
Published: November 2019

Purposes of review

Critically ill patients frequently require mechanical ventilation as part of their care. Administration of analgesia and sedation to ensure patient comfort and facilitate mechanical ventilation must be balanced against the known negative consequences of excessive sedation. The present review focuses on the current evidence for sedation management during mechanical ventilation, including choice of sedatives, sedation strategies, and special considerations for acute respiratory distress syndrome (ARDS).

Recent findings

The Society of Critical Care Medicine recently published their updated clinical practice guidelines for analgesia, agitation, sedation, delirium, immobility, and sleep in adult patients in the ICU. Deep sedation, especially early in the course of mechanical ventilation, is associated with prolonged time to liberation from mechanical ventilation, longer ICU stays, longer hospital stays, and increased mortality. Dexmedetomidine may prevent ICU delirium when administered nocturnally at low doses; however, it was not shown to improve mortality when used as the primary sedative early in the course of mechanical ventilation, though the majority of patients in the informing study failed to achieve the prescribed light level of sedation. In a follow up to the ACURASYS trial, deep sedation with neuromuscular blockade did not result in improved mortality compared to light sedation in patients with severe ARDS.

Light sedation should be targeted early in the course of mechanical ventilation utilizing daily interruptions of sedation and/or nursing protocol-based algorithms, even in severe ARDS.
Thromboelastography Better Reflects Hemostatic Abnormalities in Cirrhotics Compared With the International Normalized Ratio
Authors: Hum Justine , Amador Deron , Shatzel Joseph J. , Naugler Willscott E. , Ahn Joseph , Zaman Atif , Chang Michael , Jou Janice H.
Published: November 2019

Goal:

The goal of this study was to describe potential key differences in thromboelastography (TEG) variables in hospitalized cirrhotics compared with a healthy population, identify patterns of hematologic disturbance with disease progression, and assess the value of traditional tests such as international normalized ratio (INR) and platelet count to determine coagulopathy in cirrhotics.

Background:

TEG, a functional assay of coagulation, has emerged as a useful tool for predicting bleeding risk in cirrhosis.

Study:

Hospitalized cirrhotics who received a TEG before any blood products between January 2017 and February 2018 at a liver transplant center were included. Reaction time (r-time), coagulation time (k-time), angle-rate of clot polymerization (α) and maximum clot strength (maximum amplitude) were measured with kaolin-activated citrated blood TEG assays.

Results:

A total of 106 cirrhotic patients (Child-Turcotte-Pugh A, B, C; n=25, 25, 56) were identified for comparison against data from 53 healthy controls. TEG parameters in cirrhotics were statistically different from controls. Mean INR and platelet count for all cirrhotics were largely outside the normal reference range, contrary to TEG parameters which demonstrated parameters mostly within the normal reference ranges. The r-time, k-time, and α values in the cirrhotics progressively increased and maximum amplitude values progressively decreased as the liver disease progressed. Regression analysis showed no significant correlations between INR and r-time across any Child-Turcotte-Pugh class (r=0.01, 0.18, 0.23; P=0.95, 0.39, 0.08, respectively).

Conclusions:

Although cirrhotics had TEG parameters within normal ranges, there was a propensity for decreased clot formation as liver function worsened. Importantly, the INR did not correlate with TEG parameters in cirrhotic patients, and given the precarious hemostatic balance in these patients, a TEG may be a better predictor of bleeding risk.
Trends and associated factors of use of opioid, heroin, and cannabis among patients for emergency department visits in Nevada: 2009–2017
Authors: Kim Pearl C. , Yoo Ji Won , Cochran Chris R. , Park Seong-Min , Chun Sungyoun , Lee Yong-Jae , Shen Jay J.
Published: November 2019

To examine trends and contributing factors of opioid, heroin, and cannabis-associated emergency department (ED) visits in Nevada.

The 2009 to 2017 Nevada State ED database (n = 7,950,554 ED visits) were used. Use of opioid, heroin, and cannabis, respectively, was identified by the International Classification of Diseases, 9th & 10th Revisions. Three multivariable models, one for each of the 3 dependent variables, were conducted. Independent variables included year, insurance status, race/ethnicity, use of other substance, and mental health conditions.

The number of individuals with opioid, heroin, cannabis-associated ED visits increased 3%, 10%, and 23% annually from 2009 to 2015, particularly among 21 to 29 age group, females, and African Americans. Use of other substance (odds ratio [OR] = 3.91; 95% confidence interval [CI] = 3.84, 3.99; reference - no use of other substance), mental health conditions (OR = 2.48; 95% CI = 2.43, 2.53; reference – without mental health conditions), Medicaid (OR = 1.41; 95% CI = 1.38, 1.44; reference – non-Medicaid), Medicare (OR = 1.44; 95% CI = 1.39, 1.49; reference – non-Medicare) and uninsured patients (OR = 1.52; 95% CI = 1.49, 1.56; reference - insured) were predictors of all three substance-associated ED visits.

With a steady increase in trends of opioid, heroin, and cannabis-associated ED visits in recent years, the main contributing factors include patient sociodemographic factors, mental health conditions, and use of other substances.
Effect of Yiqi Huayu Jiedu decoction on stages II and III gastric cancer
Authors: Shu Peng , Tang Huijuan , Zhou Bin , Wang Ruiping , Xu Yuanyuan , Shao Jie , Qi Minghao , Xia Yun , Huang Wenjie , Liu Shenlin
Published: November 2019

Background:

This study aimed to explore the effect of YHJD (Yiqi Huayu Jiedu decoction) in patients with stages II and III gastric cancer.

Methods:

A multicenter, prospective, cohort study was conducted in Jiangsu Province Hospital of Traditional Chinese Medicine, Jiangsu Cancer Hospital, Nanjing Drum Tower Hospital, People's Liberation Army Bayi Hospital, Changzhou Traditional Chinese Medicine Hospital, Changzhou Tumor Hospital, Traditional Chinese Medicine Hospital of Kunshan, Yangzhou Hospital of Traditional Chinese Medicine, and Yixing Tumor Hospital. A total of 489 patients with stage II or III gastric cancer were enrolled after radical gastrectomy. Among them, 238 were included in the chemotherapy group (received chemotherapy alone) and 251 in the YHJD group (received chemotherapy combined with YHJD). The DFS (disease-free survival) rate, 5-year survival rate, quality of life, and traditional Chinese medicine (TCM) symptoms of the 2 groups were compared.

Results:

The DFS curve of the YHJD group was higher than that of the chemotherapy group (P = .0042). The HR (hazard ratio) was 0.672, and its corresponding 95% CI (confidence interval) was 0.511 to 0.884. For stage II patients, the P value was .8323, which indicated that the difference was not significant. The risk HR was 0.938, and the corresponding 95% CI was 0.521 to 1.689. For stage III patients, the P value was .0072, indicating a statistically significant difference. The HR was 0.653, and the corresponding 95% CI was 0.477 to 0.893. The 5-year survival rate of the YHJD group was 85.29%, which was higher than that of the chemotherapy group (71.05%). Compared with the chemotherapy group, the YHJD group had better quality of life and lower TCM symptom scores.

Conclusion:

YHJD decoction is effective in improving DFS rate in patients with gastric cancer stage III after radical gastrectomy. Moreover, it can reduce the risk of recurrence and metastasis and improve the quality of life in patients with gastric cancer stage II or III after radical gastrectomy.
Nebulized Ipratropium bromide protects against tracheal and bronchial secretion during bronchoscopy
Authors: Wang Faping , Zheng He , Zhang Yanlin , Zhu Hui , Shi Jingyu , Luo Yunxiao , Zhang Xiang , Mao Hui , Herth Felix J.F. , Luo Fengming
Published: November 2019

Background:

Anticholinergic administration prior to flexible bronchoscopy has been investigated, but studies have not yielded consistent results.

Methods:

Patients were randomized 1:1 to receive nebulized 4 ml ipratropium bromide (1 mg, n = 125) or placebo (n = 125) for 15 minutes as premedication, 20 to 40 minutes before bronchoscopy. Airway secretions, bleeding, patient discomfort, procedure time, and procedure-related adverse events were compared between the groups.

Results:

Nebulized ipratropium bromide prior to bronchoscopy could reduce airway secretions and patient discomfort (P = .02; P < .001, respectively), but not tracheobronchial bleeding or procedure time (P = .51, P = .36, respectively). Chest nodule or mass was the most common indication for performing bronchoscopy. The adverse events were higher in ipratropium bromide group, and hypertension was the most common complication.

Conclusion:

Nebulized ipratropium bromide prior to bronchoscopy is a more effective regimen that shows a practical benefit on the airway secretions and patient comfort, though these effects may not translate into any marked reduction in bleeding or of procedure time under general anesthesia. We suggest that routine nebulized ipratropium bromide premedication for bronchoscopy could be useful and beneficial.

Trial Registration:

chictr.org.cn: ChiCTR1800016881.
Spleen stiffness measurements using point shear wave elastography detects noncirrhotic portal hypertension in human immunodeficiency virus
Authors: Ahmad Ayesha K. , Atzori Sebastiana , Taylor-Robinson Simon D. , Maurice James B. , Cooke Graham S. , Garvey Lucy
Published: November 2019

To assess the utility of spleen stiffness as a diagnostic tool in individuals with human immunodeficiency virus (HIV) and non-cirrhotic portal hypertension (NCPH).

The Philips EPIQ7, a new point shearwave elastography (pSWE) technique, was used to assess liver and spleen stiffness in 3 patient groups. Group 1: HIV and NCPH (n = 11); Group 2: HIV with past didanosine (ddI) exposure without known liver disease or NCPH (n = 5); Group 3: HIV without known liver disease or ddI exposure (n = 9).

Groups were matched for age, HIV chronicity, and antiretroviral treatment (including cumulative ddI exposure in Groups 1 and 2). Differences in liver and spleen stiffness (in kPa) between groups were analyzed using the Mann–Whiney U test.

Liver and spleen stiffness were both significantly higher in NCPH versus ddI-exposed (P = .019 and P = .006) and ddI-unexposed controls (P = .038 and P < .001). Spleen stiffness was more effective than liver stiffness at predicting NCPH, area under receiver operating characteristic (AUROC) 0.812 versus 0.948. Combining the 2 variables improved the diagnostic performance, AUROC 0.961. The optimal cut-off for predicting NCPH using splenic stiffness was 25.4 kPa, with sensitivity 91%, specificity 93%, positive predictive value (PPV) 91%, negative predictive value (NPV) 93%, positive likelihood ratio 12.73, negative likelihood ratio 0.10. Spleen and liver stiffness scores were strongly correlated (P = .0004, 95% confidence interval [CI] 18, 59).

Elevated spleen stiffness is observed in HIV with NCPH and can be quantified easily using pSWE with high diagnostic accuracy. Novel strategies such as pSWE for longitudinal monitoring of patients with HIV and NCPH should be considered.
Thyroid metastasis from chondrosarcoma
Authors: Wu Zhi-Hong , Dai Jin-Yao , Shi Jia-Ni , Fang Mei-Yu , Cao Jun
Published: November 2019

For chondrosarcoma, metastasis to the thyroid gland is extremely rare. The diagnosis and treatment of thyroid metastasis from chondrosarcoma are discussed here.

We found a case of thyroid malignancy occurring after treatment of chondrosarcoma. We reviewed patient characteristics, histological presentations on initial chondrosarcoma and thyroid metastasis, treatments, times of recurrence and death. In addition, we searched Embase, PubMed, and ISI Web of Science databases (1996–2018) for articles published in the English language using the key words “chondrosarcoma” and “thyroid” and we reviewed almost all the reports about thyroid metastasis from chondrosarcoma.

Only 5 cases of chondrosarcoma metastases in the thyroid gland have been reported in the literature. We found that most patients are adults, with compression signs or pain, most of whom have poor prognoses. The main examinations are ultrasound, CT and fine needle aspiration biopsy, and primary treatment is surgery.

These rare cases of chondrosarcoma presenting as a metastasis in the thyroid gland highlight the importance of close communication between radiologists, histopathologists, and clinicians to ensure that such exceptional cases are not missed.
Efficacy of sacubitril valsartan sodium tablet for the treatment of chronic heart failure
Authors: Liu Zhe , Wang Jing , Li Yi
Published: November 2019

Background:

This study aims to systematically explore the efficacy of sacubitril valsartan sodium tablet (SVST) for the treatment of chronic heart failure (CHF).

Methods:

Nine electronic databases, including PUBMED, Cochrane Library, EMBASE, PsycINFO, Web of Science, Allied and Complementary Medicine Database, WANGFANG, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be searched. Randomized controlled trials on SVST in the treatment of CHF will be collected. The search time limit will be from the establishment of each electronic database until June 1, 2019. Two authors will independently select the literature, carry out the data, and assess the methodological quality.

Results:

This study will systematically investigate the efficacy and safety of SVST for CHF. The outcomes consist of all-cause mortality, change in body weight, urine output, change in serum sodium; and incidence of any expected and unexpected adverse events.

Conclusion:

The findings of this study will summarize from evidence-based medicine and a scientific basis for the efficacy and safety of SVST in the clinical treatment of CHF.

PROSPERO registration number:

PROSPERO CRD42019138882.
Effects of Gambisan in overweight adults and adults with obesity
Authors: Jo Dae-Hyun , Lee Seunghoon , Lee Jae-Dong
Published: November 2019

Objective:

A retrospective chart review was conducted to explore the effect of Gambisan, a granular extract of novel herbal medicine, for short-term (≤16 weeks) weight loss in adults who are overweight and those with obesity.

Methods:

Outpatients of Kyung Hee University Korean Medicine Hospital (Seoul, Korea) who took Gambisan and underwent bioelectric impedance analysis were selected (Jan 2011 to Dec 2015); their electronic medical records and clinical charts were retrospectively reviewed. The effectiveness of Gambisan was primarily evaluated by comparing body weight (BW) at baseline and endpoint, using paired t tests; the safety of Gambisan was evaluated on the basis of adverse events (AEs) experienced by patients.

Results:

Two hundred five patients were included in this study. The study population exhibited a significant reduction in BW (73.69 ± 14.49 kg to 69.01 ± 13.20 kg, P < .001) as well as percentage body fat (37.38 ± 5.38% to 34.50 ± 5.83%, P < .001). Moreover, 111 (54.1%) patients achieved modest weight loss (≥5%), while 35 (17.1%) achieved ≥10% weight loss. Furthermore, Gambisan induced significant reduction of BW in all subgroups (body mass index, sex, prescribed duration, and dosage). Among 139 patients with available data, 79 (56.8%) reported loss-of-appetite. In addition, 120 (mostly mild) AEs were reported in 69 (49.6%) patients, and the most frequent AEs were nausea, palpitation, and insomnia.

Discussion:

Despite limitations in interpreting the results of this retrospective medical record review, Gambisan induced statistically and clinically meaningful weight loss with a tolerable level of AEs. Based on the findings of this review, further well-designed clinical trials are warranted.
Epidermal growth factor receptor (EGFR) inhibitor induced purpuric drug eruption
Authors: Fang Szu-Yun , Wu Chieh-Shan , Liu Yi-Shan , Wei Kai-Che
Published: November 2019

Introduction:

Purpuric drug eruption (PDE) is an uncommon, clinically distinct side effect of epidermal growth factor receptor (EGFR) inhibitors.

Patient concerns:

Unlike acneiform eruption, which arises from hair follicles mainly in the head and neck area, PDE starts from xerosis cutis, primarily in the lower extremities and is not associated with hair follicles. Herein, we report 3 cases of 3 patients who had received EGFR inhibitor and were hospitalized for PDE later. The cases were characterized by painful late-onset palpable purpura with identifiable bacterial pathogens.

Diagnosis:

The patients were diagnosed with characteristic clinical presentations, that is, late onset, PDE locations mainly in the lower extremities, nonfollicular centricity, and laboratory findings with identifiable bacterial pathogens.

Interventions:

Systemic antibiotics and intensive moisturizer application were prescribed.

Outcomes:

All the patients were successfully treated within 6 to 9 days without discontinuation of EGFR inhibitors.

Conclusion:

Systemic antibiotics, topical emollient, and skin barrier repair should be included in the treatment regimens for PDE.
Reducing Hospital Readmissions in Upstate New York
Authors: Summers Michele L. , Atav Serdar
Published: November 2019

Purpose of Study:

The study's purpose was to identify hospital programs, organizational characteristics, and levels of nursing involvement in hospital programs that contribute significantly to reductions in readmission rates and reimbursement penalties for hospital systems in upstate New York.

Primary Practice Setting:

Hospitals located in upstate New York.

Methodology and Sample:

No sampling technique was employed because the cohort included hospitals located in upstate New York. Hospitals in upstate New York were selected (
N
= 94), representing 53 counties ranging between metropolitan and rural status. Using an ex post facto design within the framework of the ecological and synergy models, organizational characteristics of hospital systems and educational levels of nursing involvement in hospital programs were analyzed and coded. Independent-samples t tests, analysis of variance, and Pearson correlation tests were conducted.

Results:

Organizational programs that reduce various hospital readmission rates and reimbursement penalties for hospitals in upstate New York are (1) certified home health agencies; (2) telehealth; (3) house calls; (4) advanced practice nurses on care management interdisciplinary discharge teams; and (4) increasing the number of hospital readmission reduction programs (HRRPs) utilized.

Implications for Case Management Practice:

Hospitals should:

Encourage and provide support for their case management departments to increase utilization of certified home health agencies, telehealth, and house calls, which contribute to reductions in readmission rates and decreased reimbursement penalties.

Incorporate advanced practice nurses into case management teams for improvement in the excess readmission ratio for pneumonia.

Continue to support government and hospital policies that increase resources for evidence-based HRRP initiatives and that improve Medicare reimbursement formulas.
Pharmacologic Management of Rheumatoid Arthritis
Authors: Srivastava Sneha Baxi , Fluegel Nicole , Mansukhani Rupal Patel
Published: November 2019

Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune inflammatory disease of the joints, which can result in permanent cartilage and bone damage. Although the exact cause of RA is unknown, there are many risk factors that have been associated with RA. When RA occurs, the immune system mistakenly attacks healthy synovial and connective tissue. Available treatment options work to reduce inflammation or slow the disease progression. The American College of Rheumatology published guidelines for the treatment of rheumatoid arthritis in 2015, with an update expected in late 2019/early 2020. Nonpharmacologic therapy for patients with RA includes rest, occupational and physical therapy, and weight reduction and use of assistive devices, as necessary. Pharmacologic options include nonsteroidal anti-inflammatory drugs, corticosteroids, disease-modifying antirheumatic drugs, antitumor necrosis factor agents, and interleukin receptor antagonists.
Long-term outcomes after operative treatment for tibial pilon fractures
Authors: van der Vliet Quirine M.J. , Ochen Yassine , McTague Michael F. , Weaver Michael J. , Hietbrink Falco , Houwert Roderick M. , Leenen Luke P.H. , Heng Marilyn
Published: November 2019

Objectives:

Aims of the present study were to establish generalizable outcome data on long-term functional outcomes and health-related quality of life (HRQoL) after operative treatment of pilon fractures on a large scale. Second, it was aimed to examine factors associated with these outcomes.

Design:

Retrospective cohort study with follow-up by questionnaire.

Setting:

Two level 1 trauma centers.

Patients:

Two hundred twenty-five of 480 eligible patients completed the survey (response rate 47%).

Intervention:

Open reduction internal fixation for tibial pilon fracture.

Main outcome measurements:

Ankle function measured using the Foot and Ankle Ability Measure, physical function using the Patient-Reported Outcomes Measurement System Physical Function (PROMIS PF, Short Form 10a) questionnaire and HRQoL using the EuroQol 5-Dimensions 3-Level (EQ-5D-3L) questionnaire.

Results:

At a medium follow-up of 82 months (82 (interquartile range (IQR), 45–120), median Foot and Ankle Ability Measure was 74 (IQR, 57–82), median PROMIS PF 49 (IQR, 44–57), median EQ-5D-3L 0.81 (IQR, 0.71–0.84). HRQoL was significantly lower compared to a reference population (P < .001). In multivariable regression analyses, smoking was associated with poorer HRQoL. Higher body mass index, deep infection, and lower HRQoL were associated with worse ankle function.

Conclusions:

Long-term patient-reported outcomes after operative treatment of pilon fractures reveal impaired functionality and lower HRQoL compared to an uninjured reference population. As pilon fractures can have significant effects on a patient's life, patients should be counseled about the expected long-term outcomes to set realistic expectations. This study emphasizes the importance of obtaining both general and region-specific measures when evaluating outcomes after injury, in order to evaluate the injury of interest in the accurate context.

Level of evidence:

Prognostic level III.
Prognostic Implication of Histopathologic Indicators in Salivary Duct Carcinoma
Authors: Nakaguro Masato , Sato Yukiko , Tada Yuichiro , Kawakita Daisuke , Hirai Hideaki , Urano Makoto , Shimura Tomotaka , Tsukahara Kiyoaki , Kano Satoshi , Ozawa Hiroyuki , Okami Kenji , Sato Yuichiro , Fushimi Chihiro , Shimizu Akira , Takase Soichiro , Okada Takuro , Sato Hiroki , Imanishi Yorihisa , Otsuka Kuninori , Watanabe Yoshihiro , Sakai Akihiro , Ebisumoto Koji , Togashi Takafumi , Ueki Yushi , Ota Hisayuki , Saigusa Natsuki , Takahashi Hideaki , Ando Mizuo , Hanazawa Toyoyuki , Nagao Toshitaka
Published: November 2019

Salivary duct carcinoma (SDC) is a rare, aggressive malignancy that histologically resembles high-grade mammary duct carcinoma. Because of the rarity of this entity, data verifying the association between histologic features and patient survival are limited. We conducted a comprehensive histologic review of 151 SDC cases and performed an analysis of the association between various histomorphologic parameters and the clinical outcome with the aim of developing a histologic risk stratification model that predicts the prognosis of SDC patients. A multivariate analysis revealed that prominent nuclear pleomorphism (overall survival [OS]: P=0.013; progression-free survival [PFS]: P=0.019), ≥30 mitoses/10 HPF (PFS: P=0.013), high tumor budding (OS: P=0.011; PFS: P<0.001), and high poorly differentiated clusters (OS: P<0.001; PFS: P<0.001) were independent prognostic factors. Patients with vascular invasion demonstrated a marginally significant association with shorter PFS (P=0.064) in a multivariate analysis. We proposed a 3-tier histologic risk stratification model based on the total number of positive factors among 4 prognostically relevant parameters (prominent nuclear pleomorphism, ≥30 mitoses/10 HPF, vascular invasion, and high poorly differentiated clusters). The OS and PFS of patients with low-risk (0 to 1 point) (23% of cases), intermediate-risk (2 to 3 points) (54% of cases), and high-risk (4 points) (23% of cases) tumors progressively deteriorated in this order (hazard ratio, 2.13 and 2.28, and 4.99 and 4.50, respectively; P
trend<0.001). Our histologic risk stratification model could effectively predict patient survival and may be a useful aid to guide clinical decision-making in relation to the management of patients with SDC.
Resistance Mechanisms to Targeted Agents in Chronic Lymphocytic Leukemia
Authors: Kittai Adam S. , Woyach Jennifer A.
Published: November 2019

Agents that specifically target pathologic mechanisms of survival have now been approved for the treatment of chronic lymphocytic leukemia in both the treatment-naive and relapsed/refractory settings. These 4 agents include the Bruton tyrosine kinase inhibitor ibrutinib, the B-cell leukemia/lymphoma-2 inhibitor venetoclax, and the phosphatidylinositol-3 kinase inhibitors idelalisib and duvelisib. Although clinical outcomes are improved with all of these inhibitors, acquired resistance does occur and leads to progression of disease. Resistance to targeted therapy can occur through direct mutations of the target or through the overexpression of alternative cell survival pathways not affected by the specific inhibitor. Determining which patients will develop resistance, why resistance occurs, how to overcome resistance, and when to test for resistance are all subjects of ongoing research. In this review, we describe the current data relative to the development of resistance to targeted therapies in CLL.
Interactions between analgesic drug therapy and mindfulness-based interventions for chronic pain in adults: protocol for a systematic scoping review
Authors: Park Rex , Mohiuddin Mohammed , Poulin Patricia , Salomons Tim , Edwards Robert , Nathan Howard , Haley Chris , Gilron Ian
Published: November 2019

Introduction:

Most current chronic pain treatment strategies have limitations in effectiveness and tolerability, and accumulating evidence points to the added benefits of rational combinations of different therapies. However, most published clinical trials of treatment combinations have involved combinations of 2 drugs, whereas very little research has been performed to characterize interactions between drug and nondrug interventions. Mindfulness-based interventions (MBIs) have been emerging as a safe and potentially effective treatment option in the management of chronic pain, but it is unclear how MBIs can and should be integrated with various other pain treatment interventions. Thus, we seek to review available clinical trials of MBIs for chronic pain to evaluate available evidence on the interactions between MBIs and various pharmacological treatments.

Methods:

A detailed search of trials of MBIs for the treatment of chronic pain in adults will be conducted on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO from their inception until the date the searches are run to identify relevant randomized controlled trials. Primary outcomes will include the following: (1) what concomitant analgesic drug therapies (CADTs) were allowed; (2) if and how trials controlled for CADTs and analyzed their interaction; and (3) results of available analyses of interactions between the MBI and CADT.

Perspective:

This review is expected to synthesize available evidence describing the interactions between MBIs and various studied drug therapies for chronic pain. Available evidence may help inform the rational integration of MBIs with drug therapy for chronic pain.
Computer-Assisted versus Conventional Freehand Mandibular Reconstruction with Fibula Free Flap: A Systematic Review and Meta-Analysis
Authors: Powcharoen Warit , Yang Wei-fa , Yan Li Kar , Zhu Wangyong , Su Yu-xiong
Published: November 2019

Background:

Computer-assisted mandibular reconstruction facilitates preoperative surgery simulation and transfers the virtual plan to a real operation. This systematic review and meta-analysis aimed to compare the accuracy, efficiency, postoperative complications, and economic viability between computer-assisted mandibular reconstruction and conventional freehand mandibular reconstruction.

Methods:

The PubMed, Embase, Cochrane Library, and Google Scholar databases were searched up to November of 2018. The accuracy, efficiency, postoperative complications, and economic viability of computer-assisted mandibular reconstruction compared to conventional freehand mandibular reconstruction were systematically reviewed. Continuous and dichotomous data were pooled in mean difference (or standardized mean difference if necessary) and odds ratio, subsequently, with 95 percent confidence interval.

Results:

A total of 12 studies were included in the systematic review, and data extracted from 11 of them were combined in meta-analysis. The accuracy of computer-assisted mandibular reconstruction was better than or equal to that of conventional freehand mandibular reconstruction according to qualitative analysis, although the quantitative comparison from meta-analysis was excluded because of the diversity of measurements. As for efficiency, computer-assisted mandibular reconstruction, when compared to conventional freehand mandibular reconstruction, revealed a shorter ischemic time, reconstructive time, total operative time, and length of stay. There was no difference in postoperative complication rate.

Conclusions:

Computer-assisted mandibular reconstruction showed increased efficiency considering the reduced ischemic time, total operative time, reconstructive time, and length of stay. However, the accuracy, reconstruction outcomes, and perioperative cost should be further elucidated because of diverse measurements and the lack of included studies.
The Efficacy of Platelet-Rich Plasma Dressing for Chronic Nonhealing Ulcers: A Meta-Analysis of 15 Randomized Controlled Trials
Authors: Xia YiJun , Zhao Jun , Xie Juan , Lv Yang , Cao Dong Sheng
Published: November 2019

Background:

Several randomized controlled trials comparing platelet-rich plasma to standard wound care for chronic wounds have been published. Previous articles have revealed that the role of platelet-rich plasma in promoting chronic wound healing is uncertain. This quantitative meta-analysis was conducted to evaluate whether superior outcomes can be obtained by using platelet-rich plasma in nonhealing ulcers compared with traditional wound care.

Methods:

The PubMed, EMBASE, EBSCO (Cumulative Index to Nursing and Allied Health Literature), and Cochrane databases were searched through November of 2018 for randomized controlled trials comparing platelet-rich plasma to standard wound care for chronic wounds. For binary outcome measures, we calculated the risk ratio. The continuous outcomes were expressed as the mean differences. Subgroup analyses were also performed according to the type of chronic ulcer.

Results:

Overall, 630 adult patients in 15 randomized controlled trials from 2000 to 2018 were included. The number of ulcers healed in the platelet-rich plasma group was higher than in the control group, and the difference was statistically significant (risk ratio, 1.26; 95 percent CI, 1.11 to 1.42; p = 0.0003). During the fourth week of follow-up, the number of ulcers healed in the platelet-rich plasma group was significantly greater than in the control group (risk ratio, 3.50; 95 percent CI, 1.80 to 6.81; p = 0.0002).

Conclusions:

Platelet-rich plasma is a valuable and safe treatment dressing for chronic nonhealing ulcers; it is simple to prepare and has remarkable effects. Further high-quality prospective studies are necessary to validate these results.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Polydioxanone Threads for Facial Rejuvenation: Analysis of Quality Variation in the Market
Authors: Aitzetmueller Matthias M. , Centeno Cerdas Carolina , Nessbach Phillipp , Foehr Peter , Brett Elizabeth , Thor Dominik , Machens Hans-Guenther , Burgkart Rainer , Duscher Dominik
Published: November 2019

Background:

Beside botulinum-toxin injections and hyaluronic acid fillers, thread lifts have established themselves as the third column of minimally invasive facial rejuvenation. Most commonly, barbed threads for this approach are made out of polydioxanone, a material known for decades from application in resorbable sutures. The clinical efficacy and the putative material safety of polydioxanone have fueled the popularity of thread lifts.

Methods:

The present study highlights significant variation among six commercially available threads in microstructure, tensile strength, elasticity, anchoring capacity in human tissue, and biocompatibility.

Results:

Despite their license to be marketed and sold in the European Union, some products performed significantly worse than others on material testing, and even displayed cytotoxic characteristics.

Conclusion:

The results of this study are highly relevant for clinicians and may be linked to various typical side effects of polydioxanone threads for facial rejuvenation.
Left ventricular diastolic dysfunction in HIV-uninfected infants exposed in utero to antiretroviral therapy
Authors: Lipshultz Steven E. , Sasaki Nao , Thompson Bruce , Eidem Benjamin W. , Cheng Irene , Colan Steven D. , O’Brien Sharon E. , Amdani Shahnawaz , Shearer William T. , Orav Endel John , Miller Tracie L. , Wilkinson James D.
Published: November 2019

Objectives:

To longitudinally measure LV diastolic function in HIV-exposed but uninfected (HEU) children perinatally exposed to ART.

Design:

HEU children who were perinatally exposed to antiretroviral therapy (ART) may be at risk for adverse cardiac effects. We have previously reported that those children have decreased left ventricular (LV) mass, dimension, and septal thickness with increased contractility.

Methods:

Serial echocardiograms were obtained at specific times from birth to 48 months from two groups of HIV-uninfected children: 148 HIV-negative children who were perinatally exposed to ART and 130 non-ART-exposed HIV-unexposed healthy controls. The following LV diastolic indices were obtained: mitral valve early and late diastolic velocity (E and A), tissue Doppler-derived LV-free wall and septal early diastolic velocity (LV e′ and sep e′).

Results:

All echocardiographic indices were significantly different in ART-exposed children compared with ART-unexposed healthy controls. Both E and A were overall lower at all ages by 8.28 cm/s (P = 0.0002) and 13.46 cm/s (P < 0.0001) respectively. E/A ratio was higher by 0.27, 0.46, and 0.28 units at birth, 1 year and 2 years of age, respectively (all P ≤ 0.01). Moreover, LV e′ and sep e′ were overall lower at all ages by 0.84 cm/s (P = 0.01) and 0.47 cm/s (P = 0.02), respectively.

Conclusion:

Children who were exposed to ART in utero have subclinical yet significant differences in specific LV diastolic indices. Follow-up with serial echocardiograms are recommended in this population to further assess the potential cardiac toxicity of perinatal exposure to ART.
Insights for Implementation Science From 2 Multiphased Studies With End-Users of Potential Multipurpose Prevention Technology and HIV Prevention Products
Authors: Minnis Alexandra M. , Montgomery Elizabeth T. , Napierala Sue , Browne Erica N. , van der Straten Ariane
Published: November 2019

Background:

Lower adherence to biomedical HIV prevention and challenges with persistence among young women underscore the need for methods to identify factors that will achieve higher adoption and use of effective prevention options and inform new approaches.

Setting:

South Africa, Kenya, and Zimbabwe.

Methods:

We synthesized findings from 2 multiphased studies (TRIO and Quatro) conducted with young women aged 18–30 years that included a crossover clinical study with placebo products, a discrete-choice experiment, and qualitative interviews with women, male partners, and health providers. TRIO evaluated 3 products (tablets, ring, and injections), and Quatro compared 4 vaginal products (ring, insert, film, and gel) for HIV prevention. Both were designed to assess product preferences, choice, and use.

Results:

Increased experience with placebo products in the crossover study informed young women's product ratings and preferences. Over half changed their mind regarding their most preferred product after trying each one. The integrated qualitative component was vital to understanding what prompted these preference shifts. The discrete choice experiment provided insights on how features not available in placebos, like efficacy and contraception, influence choice and the tradeoffs women may be willing to make to gain a desired product feature.

Conclusion:

The use of multiple research methods allowed for evaluation of varied dimensions of acceptability, preference, and choice in the context of diverse biomedical HIV prevention delivery forms. Findings elucidated the value of product choice with differences in preference within and across settings. Collectively, the 3 methodologies offered important insights about these products informative to enhanced product design development and future implementation.