bluuebunny/crossref_metadata_2025 huggingface dataset:
103 Pediatric resident knowledge and comfort in providing care to transgender youth: A single centre needs assessment
Authors: Paciocco Helen , Johnson Natasha , Hunter Andrea
Published: August 2020

Background

Transgender youth experience high rates of health disparities and inequities. There is currently no formal curriculum for transgender health within our centre’s pediatric residency program. This gap in training is similar to other programs across the country. With the drastic rise in trans youth patients seeking care, general pediatricians will be the first point of contact for many. Pediatricians therefore need to be equipped with the proper knowledge and skill to provide care to these patients.

Objectives

We conducted a needs assessment to assess pediatric residents’ comfort with the health care needs of transgender patients, and to assess knowledge about the medical management of transgender youth. The goal was to identify learning gaps within our centre’s residency program to guide future curriculum.

Design/Methods

A survey with Likert scale and case-based questions, based on literature review, identified key components of trans care. The study was granted an exemption from ethics review.

Results

We achieved a 50% response rate (24/58) from pediatric residents, and 50% of these residents were in their senior years (PGY3 and PGY4). All residents felt it was important to have trans specific training during residency. While the majority of senior residents received training during their residency, the total duration was estimated to be ≤ 5 hours. Despite the training received, only 50% [95% CI: 30, 70] of residents felt comfortable asking patients about their gender identity, and only 8% [0, 19] and 33% [14, 52] of residents were comfortable diagnosing gender dysphoria in children and teens, respectively. Most residents felt uncomfortable addressing trans specific health care needs, and 83% [62, 100] of senior residents were uncomfortable counselling patients on available gender affirming pharmacologic agents. Similarly, 92% [77, 100] of senior residents felt uncomfortable prescribing either GnRH analogs or hormonal therapy for trans youth. Lastly, only 58% [30, 86] of senior residents felt comfortable performing Tanner staging in trans patients.

Conclusion

In order to help narrow the gap in care for trans patients, we need to better educate pediatric residents on trans specific health care. Future curriculum should focus on discussing gender identity, identifying gender dysphoria, performing Tanner staging, and counselling patients on gender affirming pharmacologic therapies. These skills are critical for general pediatricians to adequately provide care to trans youth.
104 House Rules and Clean Kids: The down-low on Tobacco
Authors: Zhang Caseng , Hicks Alex , Osornio-Vargas Alvaro , Brennan Lesley , Hicks Matt , Hicks Anne
Published: August 2020

Background

Despite multiple published guidelines outlining the potential health risks caused by tobacco smoke, young children continue to be exposed to the detrimental effects of household smoking. Environmental factors also have the potential to influence levels of tobacco exposure in children. Many factors such as comfort can influence the decisions of smoking parents to smoke indoors, increasing potential harm for children. Understanding the correlation between various locations within the household and tobacco exposure is helpful in informing a harm reduction strategy for smokers. This project compared the location of reported tobacco use to detection of the nicotine byproduct cotinine in children’s urine samples.

Objectives

To determine the impact of smoking location on unintentional tobacco exposure in children.

Design/Methods

This prospective cross-sectional study focused on children under age ten, since 13% of Canadian children in grades 6 and up have tried a cigarette at least once. Of 286 parents approached during a pediatrician visit, 231 agreed to complete an exposure questionnaire and 132 children were able to provide a urine sample during the visit. A standard ELISA assay was used to measure urine cotinine.

Results

About half of the 31% of households that reported smoking had an indoor smoking ban. Some indoor smokers isolated their activity to the garage (56%). Of the 84 children with detectable urine cotinine, 62 lived in homes that reported smoking. This suggests that some children were exposed to tobacco smoke through other sources or the underestimation of potential tobacco exposure. Fifteen percent of children from smoking homes had cotinine levels similar to nonsmoking homes. Children of indoor smokers were more likely to have detectable cotinine than those of outdoor smokers.

Conclusion

Roughly 50% of smokers with children have an indoor smoking ban as a harm reduction strategy. In our study, children of smokers with an indoor smoking ban were less likely to have detectable urine cotinine. Although not smoking is the best strategy, limiting smoking to outside is an optimal harm mitigation strategy. For families with indoor smokers, encouraging them to isolate smoking to a single space like the garage may decrease unintentional pediatric exposure.
107 A Novel Transition Clinic For Adolescents and Young Adults With Non-Malignant Blood Disorders
Authors: Jegathesan Thivia , Roth Megan , Florence Melissa , Mistry Niraj , Bonifacio Herbert J , Sgro Michael , Baker Jillian
Published: August 2020

Background

Transition clinics have been introduced as a way to address the unique needs of adolescent and young adult populations (AYA). AYA transition clinics for non-malignant blood disorders that require continuous care and management such as chronic immune thrombocytopenia (ITP) and Hereditary Spherocytosis (HS), have not been evaluated to date. In addition, the concerns and barriers to accessing care among this population have not been previously described.

Objectives

To explore the needs of AYA patients with a non-malignant hematological condition in order to improve their transition to the adult healthcare system through a transition clinic.

Design/Methods

A prospective cross-sectional survey study was conducted with AYA patients with a new or existing non-malignant hematological condition attending an AYA clinic in Toronto. Patients were prospectively provided a survey prior to their clinic appointment via text message.

Results

Twenty eight patients completed the survey. Most of the patients were female (84.6%) and between 16-25 years of age. Patients were in school (57%) or working (25%). Over half of the patients (53%) reported to seeing a doctor at least once a year. In order to attend clinic appointments, 61% reported taking public transportation, 10% of patients receive a ride from their family and 29% of patients either drove themselves or walked/biked to clinic. Twenty-seven percent of patients were unsure of their condition, 50% did not know the cause of their condition, and over 70% of patients were concerned about their health at least once a day. Almost all patients had concerns about transitioning to adult care with concerns including 1) Adult care not understanding their needs, 2) Increased responsibility of their care and 3) Working with a new clinical care team. Despite their concerns of transition to an adult healthcare system, 67% of patients reported taking on most of the responsibility of their health including booking appointments, and taking their medication. However, the proportion of patients who wanted their parents at their appointments equaled those that did not. Finally, patients reported the following areas of their life their health has negatively impacted; 1) School, 2) Social interactions with family and friends, and 3) Work.

Conclusion

As seen in other diseases, AYA patients with non-malignant hematological conditions have concerns about transitioning to adult care. Young adults have varying degrees of interest and abilities regarding self-care, and are particularly vulnerable to the impact of health issues. Several factors need to be considered when caring for this unique population, that if addressed can improve the transition experience.
108 Palliative care for neonates: Retrospective mixed methods review of infant death in the Neonatal Intensive Care Unit
Authors: Journault Marina , Stenekes Simone , McClure Robin , Ruth Chelsea
Published: August 2020

Background

Neonatal palliative care is an under researched yet growing field in the provision of intensive care to neonates. There are currently no studies which explore infant death in the Neonatal Intensive Care Unit (NICU) itself where a shift from intensive to palliative care may occur.

Objectives

The purpose of this study was to explore the circumstances of infant death in the NICU and understand current utilization of specialist palliative care in this area. It aimed to characterize the infants’ clinical course and add unique understanding by analyzing documentation related to end of life care.

Design/Methods

A retrospective chart review of infants who died in a single centre NICU between January 2017 and March 2018 was undertaken. Infants of any gestational and post-natal age were included, excluding infants who died prior to arrival to the NICU or were discharged or transferred prior to death. Chart notes relating to prognosis, advanced care planning, and palliative interventions were sampled, coded, and collated for thematic analysis.

Results

Twenty-five infants met study criteria. Of these, 92% were preterm with more than half below 28 weeks gestation. Median age at death was 5.2 days (IQR 1, 26.2). All infants required ventilator support with planned withdrawal occurring in 60%. Specialist palliative care was involved in 28%; these infants tended to be older (mean age at death = 78 days). Most infants were labelled as “critical” 2-5 days prior to death. Seventy-six percent of infants were held on their last day of life with 72% of families having memory making documented as part of their care. Qualitative excerpts revealed themes of hope and acceptance, parental presence, and framed discussion. Within these emerged concepts of “parental agreement” and “palliative language/approach”.

Conclusion

There is a growing need for both primary and specialist palliative care in the NICU. This study highlights an under researched area and generates many more important questions. By exploring documented language, we aim to understand and improve the ability to frame the discussion while ensuring quality end of life care for dying infants and their families in the NICU.
109 Near-fatal suicide attempts among Canadian Youth: A CPSP Study
Authors: Mitchell Rachel , Ani Cornelius , Irvine James , Cyr Claude , Joffe Ari , Skinner Robin , Stang Antonia , Wong Sam , Yao Xiaoquan , Korczak Daphne J
Published: August 2020

Background

Suicide is the second leading cause of death among Canadian adolescents. Youth who make near fatal suicide attempts, such as those requiring intensive care unit (ICU) level care, are the closest proxy to those that die by suicide; however, there is limited data on this group.

Objectives

To evaluate the minimum incidence rate and patterns of presentation of youth (under 18 years of age) admitted to the ICU for medically serious self-inflicted injury.

Design/Methods

From January 2017 to December 2018, over 2,700 paediatricians/subspecialist members of the Canadian Paediatric Surveillance Program were electronically surveyed on a monthly basis regarding cases of medically serious self-harm. Participants completed a detailed questionnaire about the reported case and descriptive statistics were used for analyses.

Results

Ninety-four cases (71 female; mean age 15.2 years) of confirmed (n=87) and suspected/probable (n=7) medically serious self-harm were reported. The majority (87%) of cases were reported from 4 out of 13 provinces and territories in Canada (Alberta, British Columbia, Ontario, Quebec). There were 11 deaths by suicide (M>F; p<.05). Medication ingestion was the most common method of self-harm among females (76% F vs. 52% M; p=.03) compared with hanging among males (14% F vs. 39% M; p=.009). More females than males had a prior suicide attempt (62% F vs. 32% M; p=.07) and a history of non-suicidal self-injury (NSSI) (65% F vs. 14% M; p<.05), although only history of NSSI reached significance. More females than males had a past psychiatric diagnosis (77% F vs. 55% M; p=.05), and past use of mental health services (69% F vs. 30% M; p<.001), although only service use reached significance. Half of the youth left evidence of intent (54%) and 33% of parents of included youth were aware that their child was considering suicide. Family conflict was the most common precipitating factor for suicide attempt in both females and males (46%).

Conclusion

These Canadian findings are consistent with international epidemiologic data that observe a gender paradox of higher rates of suicide attempts in females and greater mental health care engagement but increased suicide mortality in males with decreased involvement with mental health care. This study suggests that family conflict is a potential target for suicide prevention interventions among youth. Future research focusing on gender-specificity in risk factor identification and effectiveness of primary prevention interventions among youth is warranted.
113 Patient navigation for improving outcomes in child and youth development and mental health: A prospective cohort study comparing patients who did and did not receive navigator services after program referral
Authors: Santarossa Alanna , Steckle Valerie , Yaseen Wid , Vojvoda Dorjana , Sgro Michael , Barozzino Tony , Suleman Shazeen
Published: August 2020

Background

Mental health and developmental conditions are common among Canadian children and youth and require multiple supports in both clinical and community settings. However, many families may find it difficult to access all of the appropriate services available to them. Thus, pediatric patient navigator programs have been developed to help families connect to resources that will support their child’s diagnosis. However, little is known about what barriers may prevent families from actually connecting with the patient navigator following an appropriate referral.

Objectives

The purpose of this study was to evaluate a Canadian Pediatric Patient Navigation Program (PPNP) for children with a formal or provisional mental health or developmental diagnosis. The primary objective was to determine which physician-identified barriers may prevent families from connecting with the pediatric patient navigator (PPN) once an appropriate referral has been made. Of those who did not connect, we were interested in families who booked but did not attend their appointment (i.e., no-show) and families who were unable to be contacted by administrative staff to schedule an appointment despite contact attempts (i.e., no-contact).

Design/Methods

This prospective cohort study included patients referred to a Canadian PPNP between October 1st 2017 and October 31st 2018. Data was collected via standardized PPNP referral forms. Statistical analyses were conducted using chi-square tests of independence.

Results

Of those who met the inclusion criteria (n=524), 78% connected with the PPN and 22% did not connect with the PPN. Of those who did not connect, 41% were classified as no-show and 40% were classified as no-contact. There were no significant differences between groups in terms of sex, diagnosis and time since diagnosis. Those who connected with the PPN were significantly more likely to have a settlement barrier identified compared to those who did not connect (29% vs. 18%, p<.05). Those who no-showed were significantly more likely to have parental mental health identified as a barrier compared to those who connected (15% vs. 5%, p<.05). Finally, families were significantly more likely to have a language/literacy barrier identified if there was no-contact compared to if they no-showed (35% vs. 15%, p<.05).

Conclusion

Parental mental health issues may prevent families from showing up to booked appointments, highlighting the importance of ensuring concurrent parental mental health support. Additionally, language/literacy barriers are a key factor contributing to the inability of administrative staff to contact families, highlighting the need for interpreter services to aid in booking appointments.
115 An Evidence-Based Model of Care for Newcomer Children with Special Health Care Needs
Authors: Rizwan Ayesha , Suleman Shazeen
Published: August 2020

Background

In 2018, Canada resettled the most refugees in the world, in response to the greatest migration crisis in global history. The refugee and resettlement experience at critical stages of children’s development places children at risk for a number of chronic illnesses. Newcomer children with chronic illnesses or special health care needs (NCSHCN) require services and care providers across many systems, but face greater barriers to healthcare access and are at an increased risk of unmet needs, yet no research has been done to identify best practices for this vulnerable population.

Objectives

To develop an evidence-based model for high-quality, patient-centered care for NCSHCN and identify areas of need in a large Canadian city with a high density of newcomers.

Design/Methods

Using formative research design, a literature review and thematic analysis was performed to develop a conceptual model of care for NCSHCN. Next, a local environmental scan was conducted to identify and evaluate current clinics serving newcomers in a large urban Canadian city. Variables collected included the constructs identified in the conceptual model, and information about population served, providers and services offered including access to paediatrics.

Results

326 studies were identified, of which 43 studies underwent full-text review and 21 were included in the final synthesis. Six key components were identified to best support NCSHCN: access to interpreters and appropriately translated resources; delivery of culturally competent care; access to care coordination and system navigation; longer appointment times; family-centered care through medical homes and home-based services; and an enhanced knowledge and understanding of health insurance processes. The environmental scan identified 50 clinics and programs serving newcomers, with 88% providing referrals to paediatric services but only 12% with a paediatrician on-site. Eighty-eight percent offered some form of interpreter services and while 71% offered patient navigation/care coordination services, only one program was specific to navigating child health services and programs.

Conclusion

We propose a data-driven model of care for NCSHCN that can reduce the intersecting disparities these families face by promoting equitable access to health and community services, thereby improving child outcomes and quality of life. While many programs for newcomers exist, access to paediatric services remains elusive and training in cultural competency and insurance processes is variable. More programs that integrate paediatric services into the community to make quality care more accessible and family-centered are required.
Dissipative dynamical Casimir effect in terms of complex spectral analysis in the symplectic Floquet space
Authors: Tanaka Satoshi , Kanki Kazuki
Published: August 2020

The dynamical Casimir effect of the optomechanical cavity interacting with a one-dimensional photonic crystal is theoretically investigated in terms of complex spectral analysis of the Floquet–Liouvillian in the symplectic Floquet space. The quantum vacuum fluctuation of the intra-cavity mode is parametrically amplified by a periodic motion of the mirror boundary, and the amplified photons are spontaneously emitted to the photonic band. We have derived the non-Hermitian effective Floquet–Liouvillian from the total system Liouvillian using the Brillouin–Wigner–Feshbach projection method in the symplectic Floquet space. The microscopic dissipation process of the photon emission from the cavity has been taken into account by the energy-dependent self-energy. We have obtained the discrete eigenmodes of the total system by nonperturbatively solving the nonlinear complex eigenvalue problem of the effective Floquet–Liouvillian, where the eigenmodes are represented by the multimode Bogoliubov transformation. Based on the microscopic dynamics, the nonequilibrium stationary eigenmodes are identified as the eigenmodes with vanishing values of their imaginary parts due to the balance between the parametric amplification and dissipation effects. We have found that the nonlocal stationary eigenmode appears when the mixing between the cavity mode and the photonic band is caused by indirect virtual transition, where the external field frequency causing the dynamical Casimir effect can be largely reduced by using the finite-bandwidth photonic band.
DOSIMETRY WITH THE ABILITY TO DISTINGUISH PULSED AND NON-PULSED DOSE CONTRIBUTIONS
Authors: Makarevich Krystsina , Beyer Roland , Henniger Jürgen , Ma Yuzhen , Polter Sarah , Sommer Marian , Teichmann Tobias , Weinberger David , Kormoll Thomas
Published: August 2020

The concept of an active dosimetry system for pulsed radiation dose rate measurements is presented. Real-time distinction of pulsed and non-pulsed radiation contributions is based on the time structure of a single interaction. A fast tissue equivalent plastic scintillator is exploited to minimize the pile-up effect influence on absorbed energy measurements. Being connected to a fully digital signal processing board, the detector creates an active dosimetry system with adjustable parameters. With this system, absorbed dose rate measurements were carried out in a photon field with a time structure mimicking a radiotherapeutic beam, but also in the presence of a constant radiation field. Measurements show a linear dependence of a pulsed radiation contribution on the accelerator current in the investigated range of the total dose rate up to 8 μGy h−1. While increasing the accelerator current by 1 μA, the pulsed radiation dose rate grows by (26.2 ± 0.9) nGy h−1 when considering pile-up events.
Inter-State Competition and Transnational Capitalists across the North-South Divide: Different Strategies, New Configurations of Power
Authors: Quark Amy , Hopewell Kristen , Alsbergas Elias
Published: August 2020

Existing research emphasizes the rise of new coalitions of states from the global South, such as the BRICS, on one hand, and the rise of a transnational capitalist class on the other. Yet only a small body of work has considered how transnational capitalists shape, and are shaped by, inter-state competition. Research neglects explicitly comparative inquiries: do transnational capitalists in the global North and the global South interact with inter-state competition differently? This article analyzes two cases in which transnational firms in the global North and South attempted to shape state institutions at domestic and international levels to strengthen trade liberalization. We argue that, while firms in the global North and South increasingly share preferences for trade liberalization, the way in which these firms pursue that goal is shaped by their historical relationship to the institutions of U.S.-led hegemony. Transnational firms in the global South seek to foment inter-state competition in order to decenter U.S. leadership, while their counterparts in the North seek to minimize and accommodate inter-state competition to preserve U.S. leadership and their own private authority. Both the North and the South are contributing to the geographical re-centering of institutional power in the world economy.
Red fox viromes in urban and rural landscapes
Authors: Campbell Sarah J , Ashley Wilbur , Gil-Fernandez Margarita , Newsome Thomas M , Di Giallonardo Francesca , Ortiz-Baez Ayda Susana , Mahar Jackie E , Towerton Alison L , Gillings Michael , Holmes Edward C , Carthey Alexandra J R , Geoghegan Jemma L
Published: August 2020

The Red fox (Vulpes vulpes) has established large populations in Australia’s urban and rural areas since its introduction following European settlement. The cryptic and highly adaptable nature of foxes allows them to invade cities and live among humans whilst remaining largely unnoticed. Urban living and access to anthropogenic food resources also influence fox ecology. Urban foxes grow larger, live at higher densities, and are more social than their rural counterparts. These ecological changes in urban red foxes are likely to impact the pathogens that they harbour, and foxes could pose a disease risk to humans and other species that share these urban spaces. To investigate this possibility, we used a meta-transcriptomic approach to characterise the virome of urban and rural foxes across the Greater Sydney region in Australia. Urban and rural foxes differed significantly in virome composition, with rural foxes harbouring a greater abundance of viruses compared to their urban counterparts. We identified ten potentially novel vertebrate-associated viruses in both urban and rural foxes, some of which are related to viruses associated with disease in domestic species and humans. These included members of the Astroviridae, Picobirnaviridae, Hepeviridae, and Picornaviridae as well as rabbit haemorrhagic disease virus-2. This study sheds light on the viruses carried by urban and rural foxes and emphasises the need for greater genomic surveillance of foxes and other invasive species at the human–wildlife interface.
A patient with shortness of breath after total hip replacement
Authors: Marshall Jurga
Published: August 2020

Clinical presentation of pulmonary embolism (PE) frequently is nonspecific, making patient evaluation and diagnosis challenging. Clinicians must be alert for signs and symptoms of PE in patients with risk factors and have a low threshold for ordering appropriate imaging and laboratory tests. Initial treatment concentrates on patient oxygenation and stabilization; further management of PE depends on the patient's hemodynamic stability and right ventricular strain. This article focuses on a minimally symptomatic patient with a history of hip fracture and total hip replacement who was found to have a saddle PE.
Understanding the most commonly billed diagnoses in primary care
Authors: Rogers Julia , Allen Jodi
Published: August 2020

This next installment in the series on the most commonly billed diagnoses in primary care focuses on type 2 diabetes mellitus (T2DM). This article discusses the pathophysiologic processes of T2DM as well as how the clinical manifestations and treatments are linked to the pathogenesis of the disease.
Perspectives on and barriers to research among advanced practice provider and physician hospitalists
Authors: Dugani Sagar B. , Geyer Holly L. , Maniaci Michael J. , Schenzel Holly A. , Burton M. Caroline
Published: August 2020

Advanced practice providers and physicians at an academic healthcare system comprising more than 15 hospitals across four US states were surveyed to identify barriers to participation in research. Overall, barriers reported by advanced practice providers and physicians were more similar than different, highlighting system-level opportunities to build research skills and accelerate academic productivity.
Low voltage on the 12-lead ECG
Authors: Dzikowicz Dillon J.
Published: August 2020

A 12-lead ECG showing low voltage should be a red flag to providers; it can be caused by several serious conditions. This clinical case describes how an NP correctly treated a patient with low voltage on an ECG by discerning and managing the underlying causes.
Analysis of the Incompletely Hoisted Vertebrae in the Anterior Controllable Antedisplacement and Fusion Surgery
Authors: Wang Yingjie , Sun Jingchuan , Zheng Bing , Shi Jiangang , Xu Guanghui , Shi Wentao
Published: August 2020

Purpose:

Anterior controllable antedisplacement and fusion (ACAF) has been reported to be a safe and effective technique. However, incompletely hoisted vertebrae (IV) were found in the postoperative images. This study aims to analyze the causes and prevention of IV.

Methods:

The ACAF-treated case series subjects were retrospectively reviewed. The vertebrae were separated into the IV group and completely hoisted vertebrae (CV) group according to the gap between the vertebrae and plate. The radiographic data, degree of cervical lordosis, bone mineral density, number of hoisted vertebrae, operative time, blood loss, and Japanese Orthopaedic Association score were compared between the patients with IV and the patients without IV.

Results:

A total of 248 vertebrae were hoisted in the enrolled patients. Intervertebral disc height in the IV group was 3.7±0.4 mm, which is significantly lower than that in the CV group. The anterior or posterior overhanging lip, osteoporosis, and oblique osteotomy troughs and hinges existing after osteotomy were found to be impingements preventing the hoisting of the vertebrae. There were no differences in the age, sex, degree of cervical lordosis, number of hoisted vertebrae, and neurological improvement rate between the groups of patients with and without IV.

Conclusions:

Lower intervertebral space height and impingements preventing hoisting were found to be possible causes of IV in ACAF. Measures to prevent the problem should be carried out.
Radiographic Response of Vessel Involvement and Resectability After Neoadjuvant Chemoradiation in Patients With Locally Advanced Pancreatic Cancer
Authors: Naumann Patrick , Ottensmeier Friederike , Farnia Benjamin , Ben-Josef Edgar , Liermann Jakob , Maier-Hein Klaus H. , Hackert Thilo , Debus Jürgen
Published: August 2020

Objectives:

Survival of patients with locally advanced pancreatic cancer (LAPC) is improved when neoadjuvant chemoradiation enables subsequent surgical resection. Here, the authors assess changes in vessel involvement as a possible indicator of resectability.

Methods:

Pancreatic gross tumor and all major abdominal vessels were contoured for 49 patients with unresectable LAPC before and after neoadjuvant chemoradiation. Changes were compared by pairedttests. Tumor-vessel relationships were automatically quantified using Medical Imaging Interaction Toolkit and examined for correlation with resectability and outcome.

Results:

Tumor volumes were significantly reduced by chemoradiation (41 to 33 mL,P<0.0001). Maximum circumferential vessel involvement decreased for most patients and was statistically significant for the superior mesenteric (P<0.003) and splenic veins (P<0.038). Resection was possible in some patients and correlated positively with survival (28 vs. 15 mo,r=0.40), a decrease in CA 19.9 levels (r=0.48), and reduced involvement of most vessels. Nevertheless, surgical resection with a successful detachment of tumor tissue from major vessels was also achieved in some patients who did not show improvement in radiographic vessel involvement, but rather a reduction in tumor volume and CA 19.9 levels.

Conclusions:

The present analysis demonstrates that neoadjuvant chemoradiation can enable subsequent surgical resection in patients with LAPC. Complete resection substantially prolongs survival. Therefore, surgical exploration should be offered if vessel involvement is improved by chemoradiation and considered in radiographic unchanged vessel involvement if size and CA 19.9 levels decrease, as these factors may indicate resectable disease, too.
A 4-Year Retrospective Analysis of Patients Presenting at the Emergency Department With Synthetic Cannabinoid Intoxication in Turkey
Authors: Altintop Ismail
Published: August 2020

Purpose/Background

The number of patients with acute synthetic cannabinoid intoxication (SCI) has increased in recent years although the prohibition of its legal sale and use in Turkey despite other countries allowing to some extent sale and use. The reported clinical findings of acute SCI are similar to the symptoms of several diseases. The first case of acute SCI seen in our hospital was in 2014. The aim of this study was to share the data of synthetic cannabinoid use in a research hospital in Turkey and to contribute the epidemiologic data globally betwen 2014 and 2017.

Methods/Procedures

A retrospective evaluation was made of patients who presented at emergency department (ED) because of SCI between January 2014 and December 2017. The initial diagnosis of the patients was done either via their self-report or clinician's clinical observation (family history with hallucination, lethargy, convulsions, dizziness, etc.). Totally, 352 patients were included to the study whose cannabioid use was proven with their urine drug analysis.

Findings/Results

Men were predominantly high (93.8%). Nearly all patients (93.5%) were followed up and discharged in 24 hours. Among them, 21 (5.9%) patients were admitted for hospitalization, and mortality was seen in 2 (0.6%). The mean number of previous presentations at ED with a similar diagnosis was 8.6 ± 10.31.

Implications/Conclusions

Great care must be taken in respect of complications related to SCI, which can even result in death. Patients have a tendency to not disclose the substance they have taken because it is illegal. Patients presenting at ED with recurrent symptoms must be referred to relevant legal authorities. For patients presenting with different clinical effects, SCI must be considered.
Case report of Tourniquet ALPPS and simultaneous sleeve gastrectomy
Authors: Brusadin Roberto , López-López Víctor , de Angulo David Ruiz , López-Conesa Asunción , Navarro-Barrios Álvaro , Caballero-Planes Albert , Parrilla-Paricio Pascual , Robles-Campos Ricardo
Published: August 2020

Introduction:

Obesity represents a risk factor in case of major hepatectomy, because the future liver remnant (FLR) must be proportional with body weight. To avoid post-hepatectomy liver failure, and further increase the ratio between FLR and body weight, we performed a bariatric procedure in the first stage of the ALPPS technique.

Patient concerns:

Fifty-four-year-old woman, with morbid obesity (BMI 58.5) and type II diabetes mellitus, was scheduled for a major hepatectomy due to multiple colorectal liver metastases

Diagnosis:

Six months before, the patient was diagnosed with colorectal cancer and synchronous liver metastases. She was initially treated with sigmoidectomy and chemotherapy. After partial response of the liver metastases, we considered a liver resection but the FLR was very low, especially in relation to her BMI.

Intervention:

We planned a novel approach and, for the first time, we performed a sleeve gastrectomy during the first stage of Tourniquet ALPPS (T-ALPPS). After achieving an adequate FLR, we successfully completed the major hepatectomy during the second stage of T-ALPPS.

Outcome:

The association between sleeve gastrectomy and T-ALPPS produced an increase of FLR/body weight ratio up to 0.8 that allowed completing a right trisectionectomy in the second stage of ALPPS. The major hepatectomy was performed without severe complications, and several months after surgery the patient is still alive without any recurrence
Conclusion: Despite obesity represents a risk factor involved in the carcinogenesis, the role of the bariatric surgery in the oncological setting is not well established. In this clinical case, we benefited from the weight loss produced by bariatric surgery combined with an effective hypertrophy technique and chemotherapy. These findings suggest that bariatric surgery could be useful for obese patients with liver malignancy and need for extended hepatectomy.
Vitamin D supplement on prevention of fall and fracture
Authors: Thanapluetiwong Saran , Chewcharat Api , Takkavatakarn Kullaya , Praditpornsilpa Kearkiat , Eiam-Ong Somchai , Susantitaphong Paweena
Published: August 2020

Background:

Vitamin D supplement is one of the current possible interventions to reduce fall and fracture. Despite having several studies on vitamin D supplement and fall and fracture reductions, the results are still inconclusive. We conducted a meta-analysis to examine the effect of vitamin D supplement in different forms and patient settings on fall and fracture.

Methods:

A systematic literature research was conducted in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) to compare the effects of vitamin D supplements on fall and fracture outcomes. Random-effect models were used to compute the weighted mean difference for continuous variables and the risk ratio for binary variables.

Results:

Forty-seven RCTs with 58,424 participants were identified reporting on fall outcome. Twenty-four of 47 studies with 40,102 subjects also reported fracture outcome. Major populations were elderly women with age less than 80 years. Overall, vitamin D supplement demonstrated a significant effect on fall reduction, RR = 0.948 (95% CI 0.914-0.984; P = .004, I2 = 41.52). By subgroup analyses, only vitamin D with calcium supplement significantly reduce fall incidence, RR = 0.881 (95% CI 0.821-0.945; P < .001, I2 = 49.19). Vitamin D3 supplement decreased incidence of fall but this occurred only when vitamin D3 was supplemented with calcium. Regarding fracture outcome, vitamin D supplement failed to show fracture lowering benefit, RR = 0.949 (95% CI 0.846-1.064; P = .37, I2 = 37.92). Vitamin D along with calcium supplement could significantly lower fracture rates, RR = 0.859 (95% CI 0.741-0.996; P = .045, I2 = 25.48).

Conclusions:

The use of vitamin D supplement, especially vitamin D3 could reduce incidence of fall. Only vitamin D with calcium supplement showed benefit in fracture reduction.
A comparison of post-transplantation cyclophosphamide versus antithymocyte-globulin in patients with hematological malignancies undergoing HLA-matched unrelated donor transplantation
Authors: Lee Myung-Won , Yeon Sang Hoon , Seo Won-Hyoung , Ryu Hyewon , Lee Hyo-Jin , Yun Hwan-Jung , Jo Deog-Yeon , Song Ik-Chan
Published: August 2020

Post-transplantation cyclophosphamide (PTCy) and antithymocyte-globulin (ATG) are the most commonly used regimens for prophylaxis of graft-versus-host disease (GVHD). We compared these 2 regimens in human leukocyte antigen (HLA)-matched unrelated donor hematopoietic stem cell transplantation (HSCT) patients with hematological malignancies. We retrospectively analyzed consecutive adult patients with hematological malignancies who underwent HLA-matched unrelated donor-HSCT at Chungnam National University Hospital (Daejeon, South Korea) between January 2013 and January 2019. Patients who received a second transplantation or who had refractory disease were excluded. We included 34 patients (12 and 22 in the PTCy and ATG groups respectively). All graft sources were peripheral blood stem cells. The estimated 20-month overall survival rates were 75.0% for PTCy and 81.6% for ATG patients (P = .792), and the 20-month relapse rates were 41.7% and 34.3% (P = .491), respectively. The cumulative incidences of grade 2 to 4 acute GVHD were 16.7% and 30.6% (P = .551), respectively; the estimated 20-month limited and extensive chronic GVHD rates were 59.1% and 78.8% (P = .718), respectively; and the estimated 20-month extensive chronic GVHD rates were 12.5% and 16.7% (P = .718), respectively. The neutrophil engraftment time was similar in both groups [median (range), 15.0 (12.0–17.0) and 14.0 (12.0–19.0) days, respectively; P = .961]. However, ATG was more expensive than PTCy [median (range), US$4,062 (US$2,215–6,647) for ATG vs US$51.80 (US$43.20–69.20) for PTCy; P < .001]. In conclusion, PTCy and ATG afforded similar clinical outcomes after HLA-matched unrelated donor transplantation but PTCy was less expensive.
Short stature with precocious puberty caused by aggrecan gene mutation
Authors: Wang Yuanyuan , Ge Juan , Ma Jianying , Qiao Lingyan , Li Tang
Published: August 2020

Introduction:

The present study is carried out to review the clinical data and gene detection results of a pediatric patient with short stature, and to summarize the relationship between clinical phenotype and genotype of the child with Aggrecan (ACAN) gene mutation.

Patient concerns:

Our study was started with the observation and follow-up of a 5-year-4-month-old full-term child with short stature accompanied by central precocious puberty (CPP).

Diagnosis:

Gene sequencing showed that there was a new heterozygous mutation C.2164C >G(p.P722A) in exon 11 of ACAN gene, which was inherited from her father.

Interventions:

The child was treated by growth hormone for 6 months with mild growth, and accelerated bone age (BA) after the presence of precocious puberty. The child was diagnosed with CPP, and was provided with combined gonadotropinreleasing hormone (GnRH) therapy.

Outcomes:

The height of the pediatric patient was 99.4 cm (-3.13SDS) on admission, which was 111.9 cm (-2.08SDS) at the age of 6 years and 10 months, with a growth rate of 8.1 cm/year. There was no significant increase in BA of the pediatric patient after 1 year of follow-up.

Conclusion:

Literature review indicated that the clinical manifestations of ACAN gene mutation are the most common in idiopathic short stature, most of which are familial inheritance and can also be sporadic. Some children may also have osteoarthritis, disc herniation or degeneration. In most cases, children may have advanced BA, and retardation of BA is also found in some cases. To sum up, growth hormone combined with GnRH analogue treatment can effectively improve body height of children by postponing their adolescence. Meanwhile, ACAN gene mutation shall be considered for small-for-gestational-age children without significant growth catch-up and with family history.
Expression of SIRT1 and survivin correlates with poor prognosis in esophageal squamous cell carcinoma
Authors: Yan Li , Zhao Qilong , Liu Lili , Jin Ning , Wang Shuxia , Zhan Xuemei
Published: August 2020

This study assessed the association of sirtuin type 1 (SIRT1) and survivin expression with the clinicopathological features and survival of esophageal squamous cell carcinoma (ESCC) patients after concurrent chemoradiotherapy.

SIRT1 and survivin proteins were immunohistochemically stained in 93 ESCC tissue specimens.

SIRT1 was expressed in ESCC (80.6% vs 25.8% in normal mucosae) and survivin was expressed in 67.7% of ESCC vs 19.4% normal tissues (P < .01), and SIRT1 expression was associated with survivin expression (r = 0.39, P 
< .05). Furthermore, expression of both SIRT1 and survivin was associated with tumor size, depth of tumor invasion, tumor differentiation, lymph node metastasis, advanced clinical stage, and chemoradiotherapy (P < .05) as well as poor progression-free survival (PFS; P 
< .05) of ESCC patients after concurrent chemoradiotherapy (P 
< .05). Patient age, chemotherapy, tumor size, clinical stage, lymph node metastasis, and SIRT1 and survivin expression were independent PFS predictors (P < .05).

Expression of both SIRT1 and survivin was associated with poor ESCC PFS.
The effect of stem cell therapy and comprehensive physical therapy in motor and non-motor symptoms in patients with multiple sclerosis
Authors: Alghwiri Alia A. , Jamali Fatima , Aldughmi Mayis , Khalil Hanan , Al-Sharman Alham , Alhattab Dana , Al-Radaideh Ali , Awidi Abdalla
Published: August 2020

Introduction:

People with multiple sclerosis (PwMS) experience a wide range of disabilities which negatively impact their quality of life (QOL). Several interventions have been used in PwMS such as medication, physical therapy exercises and stem cell therapy to improve their QOL. However, there is a limited evidence on the benefits of combining interventions. The purpose of this study is to explore the effect of combining physical therapy exercises (PTE) and Wharton Jelly mesenchymal stem cell (WJ-MSCs) injections on motor and non-motor symptoms versus each intervention alone in PwMS.

Methods:

Sixty PwMS will be allocated to either PTE, WJ-MSCs, or a combined group, followed up for 12 months and examined using a comprehensive battery of measures. Participants in the PTE group will receive 2 sessions per week of a supervised exercise program for 6 months followed by a home exercise program for another 6 months. The WJ-MSCs group will receive 3 WJ-MSCs injections in the first 6 months then they will be encouraged to follow an active life style. The third group will receive both interventions.

Discussion:

This study will aid in a better understanding of the combined effect of physical therapy and mesenchymal stem cell therapy. The results from this proposed study may reduce disability, improve QOL in PwMS, and consequently, reduce the cost associated with the life-time care of these individuals worldwide.

Trial registration number:

NCT03326505
Investigation of the Psychological disorders in the healthcare nurses during a coronavirus disease 2019 outbreak in China
Authors: Xie Hongling , Cheng Xiaolin , Song Xinyu , Wu Wen , Chen Jun , Xi Zuyang , Shou Kangquan
Published: August 2020

The first case of atypical pneumonia caused by coronavirus disease 2019 (COVID-19) was reported in Wuhan, China in December 2019. Since then, cases of novel coronavirus-infected pneumonia (NCIP) have been reported throughout China as well as in 25 other countries. With the rapid growth of this global outbreak, psychological disorders or impact among the healthcare nurses caused by the COVID-19 pandemic is of great importance and worth to be evaluated. Here, we aimed to determine the levels of stress and psychological disorders of nurses who provided nursing care during the COVID-19 outbreak. A total of 159 nurses who provided healthcare work for COVID-19 patients were enrolled in our study. The psychological disorders and stress level were assessed via a questionnaire implemented by the mobile app. The results showed that the nurses who worked in the non-critical care ward (general ward in which the invasive medical procedure such as mechanical ventilation is absent) scored significantly higher on the traumatization condition (P < .05) and stress level (P < .01) as well as the impact of event scale -revised level (P < .01) compared with those worked in the critical care ward. In contrast to the previous report, our findings revealed that the future intervention for preventing the mental crisis among the healthcare nurses needs to be focusing on the individuals in the non-critical care ward instead of those in the critical care ward under the spreading of COVID-19.