bluuebunny/crossref_metadata_2025 huggingface dataset:
Varieties of Social Construction
Authors: Srivastava Swati
Published: January 2019

This article presents social construction as a research framework, rather than an explanatory theory in constructivism, to outline different research strategies. Varieties of constructivism thus far conceived in international relations prefer cleavages where scholars are regarded as thin/thick, conventional/critical, or mainstream/radical. In contrast, I introduce a new landscape of social construction to show unique mechanisms for socially constructing international politics. The new landscape varies on two dimensions. The first, source of socialization, asks whether scholars treat social context as fixed in discrete, observable forms or as fluid in indiscrete, shifting arrangements. The second dimension, focus of analysis, asks whether scholars primarily study social structures, social subjects, or some interaction of the two. The dimensions make visible a multitude of research strategies with implications for the stability of social processes and the potential for causal analysis. Moreover, within this landscape, the article focuses on four processes of social construction—aggregating, assembling, internalizing, and performing—as seen inductively through examining prominent constructivist projects. Disaggregating the many processes avoids the misuse of social construction as a catchall mechanism. Finally, the article applies the select processes to the social construction of international norms to better grasp the relative payoffs of constructivist IR scholarship for research and teaching.
Examining the Association Between Referral Quality, Wait Time and Patient Outcomes for Patients Referred to an IBD Specialty Program
Authors: Mathias Holly , Heisler Courtney , Morrison, Julia , Currie Barbara , Phalen-Kelly Kelly , Jones Jennifer
Published: January 2019

Background

Most speciality inflammatory bowel disease (IBD) care can only be accessed through a referral. Timely access to specialty care has been associated with improved disease-related outcomes. To receive appropriate care, the referral needs to include high-quality information. To date, no research has explored the association between referral quality and IBD patient outcomes. The study objectives were to determine if the quality of referrals to a collaborative IBD program influenced triage accuracy, wait times and patient outcomes.

Methods

Two hundred referrals to a collaborative IBD program in Canada for patients with confirmed or suspected IBD were reviewed. Referral quality was evaluated using an evidence- and consensus-based metric. The association between referral quality and patient outcomes (wait time, hospitalizations, disease flares and additional referrals) for semi-urgent referrals was assessed through multivariate analysis.

Results

The majority of referrals for IBD speciality care were categorized as being low quality. Referral quality was not significantly associated with any of the patient outcomes; however, longer wait times significantly increased the occurrence of disease flares, hospitalizations and additional referrals while waiting for an IBD specialist appointment.

Conclusion

Prolonged wait times for IBD patients are significantly associated with poor patient outcomes and increased costs for the health care system. Although there is literature that suggests that referral quality may be associated with wait time, it is still unclear how it relates to wait time and patient outcomes. Moving forward, the current referral process needs to be critically addressed in order to improve wait times and patient outcomes.
Copulation Exerts Significant Effects on mRNA Expression of Cryptochrome Genes in a Moth
Authors: Xu Jin , Gao Bo , Shi Min-Rui , Yu Hong , Huang Ling-Yan , Chen Peng , Li Yong-He
Published: January 2019

It is recognized that the behavioral rhythms of organisms are controlled by the circadian clock, while the reverse direction, i.e., whether changes in physiology and behavior react to the internal rhythms, is unclear. Cryptochromes (CRYs) are photolyase-like flavoproteins with blue-light receptor function and other functions on circadian clock and migration in animals. Here, we cloned the full-length cDNA of CRY1 and CRY2 in Spodoptera litura (Fabricius, 1775) (Lepidoptera: Noctuidae). Sl-CRYs show high similarity to orthologs from other insects, and their conserved regions contain a DNA photolyase domain and a FAD-binding seven domain. The expression levels of both genes were relatively low during the larval stage, which increased during the pupal stage and then peaked at the adult stage. The expression of Sl-CRY1 and Sl-CRY2 showed differences between males and females and between scotophase and photophase. Further, our study demonstrated that copulation has a significant effect on the expression of Sl-CRYs. More interestingly, the changes in the expression of Sl-CRY1 and Sl-CRY2 due to copulation showed the same trend in both sexes, in which the expression levels of both genes in copulated males and females decreased in the subsequent scotophase after copulation and then increased significantly in the following photophase. Considering the nature of the dramatic changes in reproductive behavior and physiology after copulation in S. litura, we propose that the changes in the expression of Sl-CRYs after copulation could have some function in the reproductive process.
Clinical Characteristics and Outcome of Children Hospitalized With Scrub Typhus in an Area of Endemicity
Authors: Wangrangsimakul Tri , Greer Rachel C , Chanta Chulapong , Nedsuwan Supalert , Blacksell Stuart D , Day Nicholas P J , Paris Daniel H
Published: January 2019

Background

Scrub typhus, caused by Orientia tsutsugamushi, is a major cause of acute febrile illness in children in the rural tropics.

Methods

We recruited 60 febrile pediatric patients with a positive scrub typhus rapid diagnostic test result and 40 healthy controls from Chiang Rai Province in northern Thailand. Diagnosis was confirmed by the detection of (1) O. tsutsugamushi–specific DNA in blood or eschar samples with a polymerase chain reaction assay, (2) a fourfold rise in immunoglobulin M (IgM) titer to ≥1:3200 in paired plasma samples with an indirect immunofluorescence assay (IFA), or (3) a single IgM titer of ≥1:3200 in an acute plasma sample with an IFA. Demographic, clinical, and laboratory data were collected, and patients were followed up for 1 year.

Results

Diagnosis was confirmed in 35 (58%) of 60 patients, and all controls tested negative for scrub typhus. Patients with confirmed scrub typhus had clinical symptoms, including fever (35 of 35 [100%]), eschar (21 of 35 [60%]), cough (21 of 35 [60%]), tachypnea (16 of 35 [46%]), lymphadenopathy (15 of 35 [43%]), and headache (14 of 35 [40%]). Only 4 (11%) of 35 patients received appropriate antibiotic treatment for scrub typhus before admission. The median fever-clearance time was 36 hours (interquartile range, 24–53 hours). Complications observed include hepatitis (9 of 35 [26%]), severe thrombocytopenia (7 of 35 [20%]), pneumonitis (5 of 35 [14%]), circulatory shock (4 of 35 [11%]), and acute respiratory distress syndrome (3 of 35 [9%]). Treatment failure, defined by failure to defervesce within 72 hours of antibiotic treatment initiation, was noted in 8 (23%) of 35 patients, and 1 (3%) of the 35 patients died. No evidence of relapse or reinfection was found.

Conclusion

Pediatric scrub typhus in northern Thailand is often severe and potentially fatal with delays in treatment a likely contributing factor. Additional studies to investigate the bacterial, pharmacologic, and immunologic factors related to treatment outcome along with measures to improve public awareness should be prioritized.
The Walls of Carthage and the Date of Augustine’s De Trinitate
Authors: Wilson Andrew
Published: January 2019

This article calls attention to a hitherto overlooked piece of evidence that securely dates the completion of Book IX and subsequent books of Augustine’s De Trinitate to ad 424/425 or later: in it Augustine refers to having seen the moenia (defensive walls) of Carthage, which were not built until ad 424/425. The essay reviews the evidence for and previous scholarship on the chronology of the composition and completion of the De Trinitate, and considers the implications of the new dating for the circumstances of its completion, situating it within the production of Augustine’s other major works in the mid- to late 420s.
Timing of Carotid Endarterectomy for Symptomatic Carotid Stenosis: A Snapshot of Current Trends and Systematic Review of Literature on Changing Paradigm towards Early Surgery
Authors: Savardekar Amey R , Narayan Vinayak , Patra Devi P , Spetzler Robert F , Sun Hai
Published: January 2019

Carotid revascularization has been recommended as the maximally beneficial treatment for stroke prevention in patients with recently symptomatic carotid stenosis (SCS). The appropriate timing for performing carotid endarterectomy (CEA) within the first 14 d after the occurrence of the index event remains controversial. We aim to provide a snapshot of the pertinent current literature related to the timing of CEA for patients with SCS. A systematic review of literature was conducted to study the timing of CEA for SCS. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were followed. A total of 63 articles were identified as relevant to this topic. A summary of 15 articles favoring urgent CEA (within 48 h) for SCS within 48 h of index event and 9 articles not favoring urgent CEA is presented. A consensus is still to be achieved on the ideal timing of CEA for SCS within the 14-d window presently prescribed. The current literature suggests that patients who undergo urgent CEA (within 48 h) after nondisabling stroke as the index event have an increased periprocedural risk as compared to those who had transient ischemic attack (TIA) as the index event. Further prospective studies and clinical trials studying this question with separate groups classified as per the index event are required to shed more light on the subject. The current literature points to a changing paradigm towards early carotid surgery, specifically targeted within 48 h if the index event is TIA, and within 7 d if the index event is stroke.
Quality of Clinical Practice Guidelines for Management of Limb Amputations: A Systematic Review
Authors: Kwah Li Khim , Green Jordan , Butler Jane , Lam Lawrence
Published: January 2019

Background

The quality of clinical practice guidelines (CPGs) is important to ensure guideline adoption by clinicians.

Purpose

The aim of this review was to identify CPGs for the management of limb amputations, appraise the quality of CPGs, and synthesize recommendations from comprehensive CPGs of high quality.

Data Sources

MEDLINE, EMBASE, CINAHL, PEDro, guideline-specific websites, websites for associations or networks for people with amputations, and Google Scholar were searched from April 2007 to April 2017.

Study Selection

Publications were included if they were CPGs or consensus statements/standards endorsed by a certified organization, covered the management of limb amputations, were freely accessible, and were written in English.

Data Extraction

Two reviewers independently screened titles and abstracts for eligible CPGs and rated the quality of CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE-II) instrument.

Data Synthesis

Of the 15 included CPGs, 11 were of low to moderate quality and 4 were of high quality. Mean (or median) domain scores on AGREE-II were as follows: 83% for domain 1 (scope and purpose), 61% for domain 2 (stakeholder involvement), 7% for domain 3 (rigor of development), 65% for domain 4 (clarity and presentation), 24% for domain 5 (applicability), and 21% for domain 6 (editorial independence). Strong recommendations from comprehensive and high-quality CPGs were few and focused on the development of individualized treatment plans, exercises for improving physical function and the ability to perform activities of daily living, and the assessment of physical function and prognostic factors.

Limitations

CPGs that were not written in English were excluded. Final recommendations from CPGs might differ if different criteria were used. Low domain scores on the AGREE-II might be due to poor reporting rather than poor methodology in the CPG development process.

Conclusions

Few CPGs for the management of limb amputations were of high quality, and few recommendations were strong. To improve the quality of future CPGs, guideline developers should report funding and competing interests of members, provide information to aid in the practical application of CPGs, and use a systematic approach to search for evidence and derive strength of recommendations.
International Shocks, Variable Markups, and Domestic Prices
Authors: Amiti Mary , Itskhoki Oleg , Konings Jozef
Published: January 2019

How strong are strategic complementarities in price setting across firms? In this article, we provide a direct empirical estimate of firms’ price responses to changes in competitor prices. We develop a general theoretical framework and an empirical identification strategy, taking advantage of a new micro-level dataset for the Belgian manufacturing sector. We find strong evidence of strategic complementarities, with a typical firm adjusting its price with an elasticity of 0.4 in response to its competitors’ price changes and with an elasticity of 0.6 in response to its own cost shocks. Furthermore, we find evidence of substantial heterogeneity in these elasticities across firms. Small firms exhibit no strategic complementarities in price setting and complete cost pass-through. In contrast, large firms exhibit strong strategic complementarities, responding to both competitor price changes and their own cost shocks with roughly equal elasticities of around 0.5. We show that this pattern of heterogeneity in markup variability across firms is important for explaining the aggregate markup response to international shocks and the observed low exchange rate pass-through into domestic prices.
The Family in Minimum Income Benefits in Europe: An Institutional Analysis
Authors: Frericks Patricia , Och Ralf , Höppner Julia
Published: January 2019

Whether and to what extent the means of family members and familial care activities are relevant in the calculation of welfare benefits is often neglected in welfare state analysis. By quantifying qualitative institutional data, we analyze this aspect and how it has changed in regard to minimum-income benefits for persons of pension age and unemployed persons in ten European welfare states. We find no general trend toward individualization of entitlements but a decreasing relevance of family for the entitlements of persons of pension age, and increasing relevance for the unemployed. The evidence underlines significant differences between countries and family-related dimensions.
Factors affecting urinary creatinine in heifers and cows1
Authors: Whittet Kimberly M , Watson Andrea K , Erickson Galen E , Klopfenstein Terry J
Published: January 2019

A series of total urine collections were conducted to evaluate the effects of age, diet, gestation, and body condition score (BCS) on urinary creatinine (UC) and purine derivative (PD) excretion in heifers and cows. For each collection, urine was collected over a 5-d period and composited by animal within day. Daily samples were analyzed for UC and PD concentration and averaged over the 5-d period. All animals were fed in individual stanchions at 2.0% of body weight (BW). To evaluate the relationship between age and UC excretion, 21 animals ranging from 5 to 80 months of age were fed a forage-based diet supplemented with dried distillers grains (DDG). Creatinine excretion (mg/kg BW) was not correlated with age (P = 0.37). To determine if diet alters UC, 11 heifers were sampled for two urine collection periods. In period 1, heifers were fed a forage-based diet supplemented with DDG. In period 2, heifers were fed a finishing diet (90% concentrate, 10% forage). Creatinine excretion (mg/kg BW) and PD:creatinine (PD:C) was greater (P = 0.01) for heifers when fed the forage-based diet than when fed the concentrate-based diet. Eleven cows fed a forage-based diet supplemented with DDG were sampled to determine the effect of gestation on urinary metabolites. Gestation did not affect UC (P = 0.42) or PD:C (P = 0.30). To evaluate the relationship between 12th rib fat thickness and metabolite excretion, 40 heifers were fed a common finishing diet. There was no relationship between UC (mg/kg BW; P = 0.28) or PD:UC (P = 0.47) and 12th rib fat thickness. To evaluate the relationship between BCS and UC, 11 cows were fed a forage diet supplemented with DDG. There was no relationship between BCS and UC (mg/kg BW; P = 0.99) or PD:C (P = 0.84). To evaluate daily and diurnal variation in UC, nine heifers were fed a forage diet supplemented with DDG. Seven of the heifers were fed a finishing diet (90% concentrate, 10% forage) in a second period. Urine was collected every 2 h from 0600 to 1800 hours. When expressed as mg/kg BW, UC excretion was not different across animals fed the forage-based (P = 0.40) or concentrate-based diet (P = 0.18). Stepwise regression indicated that at least 3 d of collection were required to estimate UC. Time within day and day within period effects were observed (P < 0.01) for UC from 2-h interval samples. The UC varies with type of diet and diurnal variation is present. Variation among animals is relatively small.
A new continent in the geographic distribution of the genus Oregoniplana (Platyhelminthes: Tricladida: Maricola), its rediscovery in South Africa and its molecular phylogenetic position
Authors: Li Wei-Xuan , Sluys Ronald , Vila-Farré Miquel , Chen Jia-Jia , Yang Ying , Li Shuang-Fei , Wang An-Tai
Published: January 2019

Here we describe a new species for the genus Oregoniplana from the coast of China, representing the third species for the genus and the first record of this genus for Asia. The other species are known from Oregon, USA, and from South Africa. Specimens of the South African species, Oregoniplana pantherina, were recently rediscovered, forming the second record for the species, which provided the basis for a necessary re-description. Molecular data (18S rDNA and 28S rDNA) obtained for the new Chinese species facilitated determination of the position of the genus Oregoniplana in the phylogenetic tree of the marine triclads. We report molecular data also for species previously discovered in China, viz. Miroplana shenzhensis and Pentacoelum sinensis, thus enabling us to determine for the first time the phylogenetic position of the genus Miroplana. These new molecular data revealed that Pentacoleum sinensis occupies an unexpected position in the phylogenetic tree. Laboratory cultures of the new Chinese species provided information on food preferences and reproduction. Oregoniplana pantherina exhibits a peculiar kind of locomotion and an unusual resting position in which the animal has three points of contact on either side.
Preservation versus non-preservation of left colic artery in colorectal cancer surgery
Authors: Yang Xuyang , Ma Pingfan , Zhang Xubing , Wei Mingtian , He Yazhou , Gu Chaoyang , Deng Xiangbing , Wang Ziqiang
Published: January 2019

Background:

It remains unclear whether or not preservation of the left colic artery (LCA) for colorectal cancer surgery. The objective of this updated systematic review and meta-analysis is to evaluate the current scientific evidence of LCA non-preservation versus LCA preservation in colorectal cancer surgery.

Methods:

A systematic search was conducted in the Medline, Embase, PubMed, Cochrane Library, ClinicalTrials, Web of Science, China National Knowledge Infrastructure and Chinese BioMedical Literature Database, and reference without limits. Quality of studies was evaluated by using the Newcastle–Ottawa scale and the Cochrane Collaboration's tool for assessing the risk of bias. Effective sizes were pooled under a random- or fixed-effects model. The funnel plot was used to assess the publication bias. The outcomes of interest were oncologic consideration including the number of apical lymph nodes, overall recurrence, 5-years overall survival, and 5-years disease-free survival (DFS); safety consideration including overall 30-day postoperative morbidity and overall 30-day postoperative mortality; anatomic consideration including anastomotic circulation, anastomotic leakage, urogenital, and defaecatory dysfunction.

Results:

Twenty-four studies including 4 randomized controlled trials (RCTs) and 20 cohort studies with a total of 8456 patients (4058 patients underwent LCA non-preservation surgery vs 4398 patients underwent LCA preservation surgery) were enrolled in this meta-analysis. The preservation of LCA was associated with significantly less anastomotic leakage (odds ratio 1.23, 95% confidence interval 1.02–1.48, P = .03). In term of sexual dysfunction, urinary retention, the number of apical lymph nodes, and long-term oncologic outcomes, there were no significant differences between the LCA non-preservation and LCA preservation group. It was hard to draw definitive conclusions on other outcomes including operation time, blood loss, the first postoperative exhaust time, and perioperative morbidity and mortality for insufficient data and highly significant heterogeneity among studies.

Conclusions:

The pooled data provided evidence to support the LCA preservation preferred over LCA non-preservation in anastomotic leakage. Future more large-volume, well-designed RCTs with extensive follow-up are needed to draw a definitive conclusion on this dilemma.
Extensive small bowel metastasis and peritoneal dissemination 1 year following curative gastrectomy for T1N1 gastric cancer
Authors: Fan Shengxian , Feng Min , Wang Meng , Guan Wenxian
Published: January 2019

Rationale:

Metastasis of T1N1 gastric cancer (GC) at early stage after curative gastrectomy is unusual. Reports on the diagnosis, treatment, and prognosis of peritoneal metastasis following curative gastrectomy for T1N1 GC are lacking.

Patient concerns:

A 54-year-old woman was admitted to our hospital with complaints of mild abdominal distension and failure to pass gas and stool for 2 days. She has a history of distal gastrectomy for T1N1 GC. About 1 year after surgery, she presented with persistent abdominal distension and underwent conservative managements.

Diagnoses:

Imaging tests failed to identify the apparent cause of intestinal obstruction. When conservative managements failed to relieve the symptoms, she underwent emergency laparotomy, which revealed extensive small bowel metastasis and peritoneal dissemination.

Interventions:

Peritoneal irrigation and drainage were performed with the consent of the patient's families.

Outcomes:

The patient abandoned further therapy and died 1 week later during the follow-up period.

Lessons:

Although the metastasis of T1N1 GC is rare, patients with high risk of metastasis after curative surgery should also be closely followed and be considered as candidates for more aggressive screening strategies. In addition, the use of more effective chemotherapeutic drugs as adjuvant chemotherapy after curative surgery in T1N1 patients may also need to be explored.
Expression and role of hScrib in endometrium, endometriosis, and endometrial adenocarcinoma
Authors: Ouyang Zhuo , Chen Minxiu , Sun Jinping , Zhai Jianjun
Published: January 2019

To explore the role of hScrib in the pathogenesis of endometriosis.

This was a retrospective study of 240 women in our hospital between January 2014 and January 2017. The expression of hScrib in endometrium (EM), endometriosis (EMs), and endometrial adenocarcinoma (EC) was investigated, and compared the differences among them. Serum levels, protein expressions, localizations, and correlations of hScrib and E-cadherin were determined.

The levels of serum soluble hScrib and E-cadherin were significantly highest in EC, followed by EMs, and healthy women (P < .05). hScrib protein content was opposite result in 3 tissues (P < .05), and was negatively correlated with r-AFS stage in EMs. The location changed from membrane to cytoplasm. Co-localization of hScrib with E-cadherin was found at extensive cell–cell boundaries in EMs.

hScrib and E-cadherin may be as new diagnostic markers of endometriosis. Low expression of hScrib leads to the loss of cell polarity and stability. Also, hScrib may induce EMT through regulating E-cadherin, might play an important role in pathogenesis of endometriosis.
Horseshoe appendix identified during laparoscopic appendectomy
Authors: Choi Sang-Ji , Chae Gibong , Park Sung-Bae , Hong Seong Kweon , Kim Yang Hee , Moon Suk-Bae , Kim Song-Yi , Kim Hwansoo
Published: January 2019

Rationale:

The horseshoe anomaly of the vermiform appendix is extremely rare. Preoperative confirmation of this anomaly is difficult; therefore, routine procedures, such as appendectomy, may become unexpectedly challenging when such anomalies are encountered during the surgical process.

Patient concerns:

A 33-year-old man presented with abdominal pain in the right lower abdomen owing to acute appendicitis confirmed via computed tomography. Immediate laparoscopic appendectomy was decided as the method for treatment.

Diagnosis:

Horseshoe anomaly was diagnosed as a gross finding during surgery.

Intervention:

First, the appendiceal base was resected and appendectomy was performed via the retrograde method because the appendiceal tip was curled behind the cecum. However, it was discovered that the appendiceal tip was connected to the lateral part of the ascending colon and showed a horseshoe-shaped anomaly. The second appendiceal base arising from the ascending colon was also ligated, and the appendectomy was completed without any further complications.

Outcomes:

After successful completion of appendectomy, the patient was discharged without any complications 2 days later.

Lessons:

An appendiceal anomaly is rarely seen during appendectomy or other forms of abdominal surgery; however, the ability of surgeons to both recognize and categorize an appendiceal anomaly is crucial if detected during surgery. After successfully recognizing the horseshoe anomaly of the appendix, it is important to know that 2 appendiceal base ligations will be required to complete the surgery successfully.
Distinguishing tuberculosis pleural effusion from parasitic pleural effusion using pleural fluid characteristics
Authors: Tong Shuai , Zhu Yu , Wan Chaomin
Published: January 2019

Tuberculosis pleural effusion (TPE) and parasitic pleural effusion (PPE) present with similar clinical manifestations. We evaluated the pleural fluid features of TPE and PPE.

A total of 76 patients with pleuritis, including 25 patients with TPE and 51 patients with PPE were retrospectively studied. Pleural fluid was sent for analyses of protein, cytology, cell count, acid fast bacilli (AFB) staining, Gram stain, culture, sensitivity, and adenosine dehydrogenase (ADA).

The proportion of eosinophilia present in the PPE group was significantly higher than that in the TPE group (P < .001). However, the proportion of lymphocytes found in the TPE group was significantly higher than that in the PPE group (P < .001). The mean level (SD) of ADA was 46.99 ± 22.09 U/L in the TPE group and 39.08 ± 23.03 U/L in the PPE group. No difference was detected between the study groups in terms of the ADA level of the pleural fluid (P > .05).

When the results of pleural fluid testing reveal marked eosinophilia and a low proportion of lymphocytes, physicians should consider a diagnosis of PPE, especially for patients who live in or have traveled to endemic areas.
Sedation for terminally ill cancer patients
Authors: Kim Young Saing , Song Haa-Na , Ahn Jin Seok , Koh Su-Jin , Ji Jun Ho , Hwang In Gyu , Yun Jina , Kwon Jung Hye , Kang Jung Hun
Published: January 2019

Sedation therapy is a potential solution to providing relief from refractory symptoms at end of life. The aim of this study was to investigate actual sedation practice and physician characteristics associated with the use of sedation for terminally ill cancer patients in South Korea.

A retrospective review was conducted on consecutive patients who had died from cancer at seven tertiary medical centers between January 2010 and October 2015. The use of sedation was defined as the administration of sedative agents to relieve intolerable symptoms within the last 2 weeks preceding death. Patients and physician characteristics and information on the use of sedation were collected.

A total of 8309 patients were included in the study. Sedatives were administered in 1334 patients (16.1%) for the following indications: delirium in 39.3%, intractable pain in 23.1%, and dyspnea in 21.9%. Median duration of sedation from initiation to death was 3 days. The use of sedation depended on physician specialty and experience. Family physicians used sedation most often (57.6%), followed by medical oncologists (13.9%), other internists (10.7%), and surgical oncologists (9.4%). The use of sedation was highest for physicians with >5 to 10 years practice experience (22.1%) and lowest for those in practice for 5 years or less (10.2%). The proportion of patients receiving sedation also varied markedly across participating institutions (range, 7.0%–49.7%).

This large cohort study provides insight into sedation practice for terminally ill cancer patients in South Korea. Our study shows that the use of sedation depends on physician background and institution. A nation-wide guidelines and continued education on end-of-life sedation are required in South Korea.
Comparing the effectiveness of three scoring systems in predicting adult patient outcomes in the emergency department
Authors: Wei Xiaojun , Ma Haoli , Liu Ruining , Zhao Yan
Published: January 2019

This study aimed to evaluate the performance of the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), and the modified early warning score (MEWS) in predicting the outcomes of adult patients presenting to the emergency department (ED).

A retrospective review was undertaken between February 2014 and February 2018 in an adult ED of a 3300-bed university hospital. The RAPS, REMS, and MEWS were calculated to assess their capability to predict hospital admission, length of hospital stay, and in-hospital mortality, using area under receiver operating characteristic analysis. Multivariate analysis was used to identify variables that were independent predictors of the outcomes.

We included 39,977 patients who had presented to the ED during 48 consecutive months, of whom 4857 were admitted and 213 died in hospital. The predictabilities of REMS, RAPS, and MEWS for hospital admission were 0.76, 0.59, and 0.55, respectively; the predictability of REMS, RAPS, and MEWS for hospital mortality were 0.88, 0.72, and 0.73, respectively; and the predictability of REMS, RAPS, and MEWS for length of hospital stay were 0.76, 0.67, and 0.65, respectively. Multivariate analysis showed that the Glasgow coma scale (GCS) (odds ratio (OR), 1.61; P < .001), age (OR, 1.50; P < .001), and MAP (OR, 1.27; P < .001) were independent predictors for hospital admission; GCS (OR, 2.92; P < .001), respiratory rate (RR) (OR, 2.69; P < .001), peripheral oxygen saturation (OR, 2.67; P < .001), MAP (OR, 2.11; P < .001), age (OR, 1.75; P < .001), and pulse rate (PR) (OR, 1.73; P < .001) were independent predictors for in-hospital mortality; and RR (OR, 1.41; P < .001), temperature (OR, 1.05; P = .01), and PR (OR, 0.96; P = .04) were independent predictors for length of hospital stay.

Our study evaluated and confirmed the REMS as a powerful predictor of ED adult patient outcomes, including hospital admission, length of hospital stay, and in-hospital mortality compared to RAPS and MEWS.
Large deformity correction in medial open-wedge high tibial osteotomy may cause degeneration of patellofemoral cartilage
Authors: Otakara Eigo , Nakagawa Shuji , Arai Yuji , Inoue Hiroaki , Kan Hiroyuki , Nakayama Yusuke , Fujii Yuta , Ueshima Keiichiro , Ikoma Kazuya , Fujiwara Hiroyoshi , Kubo Toshikazu
Published: January 2019

To evaluate retrospectively any association between the degree of deformity correction by medial open-wedge high tibial osteotomy (HTO) and patellofemoral joint degeneration. We hypothesized that development of patellofemoral joint degeneration depended on the degree of intraoperative deformity correction.

Fifty-seven patients who underwent medial open-wedge HTO for treatment of osteoarthritis in one knee were included in this study. Knees were classified into degeneration (D) and non-degeneration (ND) groups according to worsening of the patellar and/or femoral trochlear cartilage at the time of hardware removal (D group, 27 knees) and no degeneration or improvement (ND group, 30 knees). We compared pre- to post-surgery change in hip-knee-ankle angle (HKA) and medial-proximal-tibial angle (MPTA), open-wedge HTO correction angle, and arthroscopic findings between groups.

Mean age, height, weight, and body mass index were 54.1 ± 9.9 years, 160.4 ± 8.7 cm, 66.4 ± 12.1 kg, and 25.7 ± 3.3 kg/m2, respectively. Change in both HKA and MPTA differed significantly between groups. The MPTA cut-off values to predict patellofemoral degeneration were determined to be 10°, associated with an AUC of 0.75 (95% confidence interval [CI] 0.62–0.87).

This study evaluated retrospectively the effect of the correction angle during medial open-wedge HTO on patellofemoral joint degeneration. If deformity correction exceeds an MPTA of 10° during open-wedge HTO, degeneration of patellofemoral joint needs to be considered.

Level of evidence: Level IV.
The related factors for the recovery and maintenance time of sinus rhythm in hospitalized patients with cardiopulmonary resuscitation
Authors: Lv Jun Hua , Wang Dan , Zhang Meng Na , Bai Zheng Hai , Sun Jiang-Li , Shi Yu , Pei Hong Hong , Zhang Zheng-Liang , Wang Hai
Published: January 2019

No matter in or outside hospital, the success rate of cardiopulmonary resuscitation (CPR) is very low. The sign of successful CPR is the recovery of spontaneous circulation. The premise of the recovery of spontaneous circulation is the recovery and maintenance of sinus rhythm, but there is still no related research.

We aim to study the factors for the recovery and maintenance time of sinus rhythm in patients with CPR.

A single-center retrospective case–control study.

Ethical review was obtained (ethical approval number: 20180031).

The second affiliated hospital of Xi’an Jiaotong University, Xi’an Shaanxi, China.

From January 2011 to December 2016, totally 344 cases met the inclusion and exclusion criteria, sinus rhythm recovered group (SR group) (n = 130 cases), sinus rhythm unrecovered group (SUR group) (n = 214 cases).

The multivariate logistic regression analysis showed that red blood cell counts (OR = 1.30, 95% CI:1.04–1.63, P = .02), rescue time (OR = 0.95, 95% CI:0.94–0.97, P <.001), the usage of norepinephrine (OR = 2.14, 95% CI:1.06–4.35, P = .04) were important factor for the recovery of sinus rhythm in patients with CPR. Multivariate linear regression analysis showed that the dosage of epinephrine, the usage of naloxone and diagnosis were important factors for maintenance time of sinus rhythm after resuscitation, P <.05. The rescue time had high accuracy to predict the recovery of sinus rhythm, the area under the receiver operator characteristic (ROC) curve (AUC) was 0.84 (0.80, 0.88), sensitivity and specificity are respectively 71.54% and 93.46%.

Red blood cell counts, the rescue time and the usage of norepinephrine might be important factors for the recovery of sinus rhythm, and the dosage of epinephrine, the usage of naloxone and the diagnosis might be important factors for the maintenance time of sinus rhythm in patients with CPR.
Characteristics of the patients with adnexal torsion and outcomes of different surgical procedures
Authors: Wang Zengyan , Zhang Dan , Zhang Huanxiao , Guo Xu , Zheng Jingxuan , Xie Hongzhe
Published: January 2019

There is no uniform standard to assess the viability of the ovary and choose conservative surgery or radical surgery for patients with adnexal torsion. This retrospective study aims to explore the characteristics of patients with adnexal torsion and the outcomes of different surgical procedures.

A retrospective analysis of 174 cases diagnosed with adnexal torsion at our hospital between January 2005 and October 2014 was performed. Patients’ clinical characteristics, surgical procedures, and postoperative recovery were analyzed.

Of the cases, 31 (17.82%) did not have any emergent symptom; adnexal torsion were found during other surgeries. Among all 174 adnexal torsion patients, 14 cases received conservative treatment, including anti-inflammatory treatment, and 8 (58.1%) were pregnant. Of the cases, 160 underwent surgical treatment: 144 (90%) were confirmed to have ovary/ovarian cyst torsion, among whom 26 (18.1%) had their adnexa retained (group A) and 118 (81.9%) underwent adnexectomy (group B). Age, time of torsion, and rounds of torsion in group A were significantly less than in group B. None of the patients with adnexa preservation surgery had any complication, such as abdominal infection or thrombotic diseases.

Patients with ovary/ovarian cyst torsion can attempt to preserve the ovaries without serious clinical complications; there were no severe complications such as embolism after the conservative surgeries in this study.
The role of contrast-enhanced ultrasound in the diagnosis of hepatic alveolar echinococcosis
Authors: Cai Diming , Li Yongzhong , Jiang Yong , Wang Huiyao , Wang Xiaoling , Song Bin
Published: January 2019

To evaluate the value of contrast-enhanced ultrasound (CEUS) compared with ultrasound (US) in the diagnosis of hepatic alveolar echinococcosis (AE).

Thirty-one patients with 43 hepatic AE lesions between January 2010 and September 2017 were included in the study. All lesions which were histopathologically proven to be hepatic AE were retrospectively reviewed. Features of the lesions by CEUS were retrospectively studied.

All lesions were detected by US and CEUS in the 31 patients (17 males and 14 females) with a mean age of 38.5 ± 10.6 years (range: 16–58 years). The size of the lesions ranged from 1.5 × 0.7 cm to 15 × 18 cm. By US, 3 lesions (7%, 3/43) were hypoechoic nodules, 21 (48.8%, 21/43) were hyperechoic, and 19 lesions (44.2%, 19/43) were of mixed echogenicity type (solid-cystic). 27 lesions (62.8%, 27/43) had calcifications. Only 1 lesion was detected blood-flow signals. With CEUS, 23 lesions (53.5%, 23/43) displayed no enhancement in the arterial phase, portal phase and delayed phase on CEUS. 11 lesions (25.6%, 11/43) displayed a slight ring-like hyper-enhancement in the arterial phase and displayed hypo-enhancement in the portal and delayed phase. 6 lesions (14%, 6/43) displayed hyper-enhancement in the arterial phase and hypo-enhancement in the portal and delayed phase. 2 lesions (4.7%, 2/43) showed iso-enhancement in the arterial, portal, and delayed phase. 1 lesion (2.3%, 1/43) showed slight hypo-enhancement in the arterial, portal, and delayed phase.

CEUS is a more valid technique for diagnosing AE than US. It could be a reliable tool in the diagnosis of hepatic AE.
The impact of advanced maternal age on the outcomes of very low birth weight preterm infants
Authors: Tseng Kai-Ti , Peng Chun-Chih , Chang Jui-Hsing , Hsu Chyong-Hsin , Lin Chia-Ying , Jim Wai-Tim , Chang Hung-Yang
Published: January 2019

The association between advanced maternal age and neonatal outcomes remains controversial. This study attempted to determine the short-term and long-term outcomes of very low birth weight (VLBW, <1500 g) preterm infants, born to mothers of advanced age (≥35 years).

In this retrospective cohort study, VLBW infants were divided into the advanced maternal age group and comparison group. We compared the pregnancy complications, demographic factors, short-term morbidities, and neurodevelopmental outcomes using the Bayley Scales of Infant Development-Third Edition, at 24 months of corrected age between the 2 groups.

The study comprised of 536 VLBW infants born to 483 mothers. Mothers of advanced age had a significantly lower rate of primiparity compared to the comparison group (45.8% vs 65.2%, P < .001), and were more likely to have gestational diabetes (13.7% vs 5.5%, P = .002) and to undergo in vitro fertilization (IVF; 18.4% vs 9.9%, P = .01). No significant differences were found between the 2 groups in terms of short-term outcomes. At 2 years of corrected age, advanced maternal age was associated with a higher incidence of severe speech delay (11.3% vs 5.7%, P = .04), neurodevelopmental impairment (NDI; 28.8% vs 18.4%, P = .02), and adverse composite outcome (37.4% vs 27.3%, P = .02). However, the differences in NDI and composite adverse outcomes were not statistically significant between the groups after adjustments for potential confounders.

Advanced maternal age was not associated with major morbidities and long-term NDI among VLBW preterm infants. The association between advanced maternal age and severe speech delay in the infant needs further investigation.
Parathyroid adenoma presenting with spontaneous cervical and anterior mediastinal hemorrhage
Authors: Khan Sohini , Choe Charles C. , Shabaik Ahmed , Bouvet Michael
Published: January 2019

Rationale:

Spontaneous anterior cervical or mediastinal hemorrhage is a rare presentation of parathyroid adenoma.

Patient concerns:

A 69-year-old woman presented with neck hematoma and dysphagia and was found to have a soft tissue mass adjacent to her thyroid gland as seen on MRI and neck ultrasound.

Diagnosis:

Laboratory testing demonstrated elevated calcium and parathyroid hormone supporting diagnosis of parathyroid adenoma.

Interventions:

She underwent right inferior parathyroidectomy and en bloc right hemithyroidectomy due to significant fibrosis.

Outcomes:

Pathology confirmed hypercellular parathyroid and normal thyroid tissue. Postoperatively, patient's calcium and parathyroid hormone levels had normalized.

Lessons:

In conclusion, imaging may not always be specific in identifying the source of neck hematoma and so laboratory studies should be done to rule out parathyroid adenoma as the underlying etiology.
Coagulation tests and blood glucose before vaginal delivery in healthy teenage pregnant women compared with healthy adult pregnant women
Authors: Covali Roxana , Socolov Demetra , Socolov Razvan
Published: January 2019

The aim of this study was to compare the coagulation tests and blood glucose levels between healthy teenage pregnant patients and healthy adult pregnant patients just before vaginal delivery

In a prospective study, 208 consecutive patients, 3rd trimester healthy pregnant women, underwent blood tests to determine their glucose levels the day before vaginal delivery. Of the 208 patients, 103 also underwent blood coagulation testing performed on the same day.

The median values of the coagulation tests (APTT, prothrombin time, INR, prothrombin activity) and blood glucose were very similar in the healthy pregnant teenagers (32.6; 12.9; 1.02; 97.1; 81) compared with that in the healthy adult pregnant patients (32.45; 13.1; 1.01; 97.5; 81.2). Only the median value for fibrinogen was significantly different in healthy pregnant teenagers (348.9 mg/dL) (interquartile range 21.7) compared with that in healthy adult pregnant patients (359.1 mg/dL) (interquartile range 29.88).

Significantly different median blood glucose levels also occurred in the <20; 20–29; 30–39; >40 age groups, but the glucose levels were still within normal limits.

Even if there was variability between blood values from one age group to another, the median values for coagulation tests and blood glucose were very close in the healthy teenage pregnant patients compared with the median values of the healthy adult pregnant patients, just before vaginal delivery. With very few exceptions, the values for coagulation tests and blood glucose were within normal limits in all age groups of healthy pregnant patients.
Pathomorphological features of metastatic lymph nodes as predictors of postoperative prognosis in pancreatic cancer
Authors: Hoshikawa Mayumi , Ogata Sho , Nishikawa Makoto , Kimura Akifumi , Einama Takahiro , Noro Takuji , Aosasa Suefumi , Hase Kazuo , Tsujimoto Hironori , Ueno Hideki , Yamamoto Junji
Published: January 2019

To investigate the pathological features of metastatic lymph nodes (LN) in pancreatic ductal adenocarcinoma (PDAC) and to determine factors with prognostic implications.

Metastatic LN status is a proven significant factor for predicting postoperative prognosis in pancreatic cancer patients. However, the effective prognostic criteria regarding metastatic LNs for such disease remain unknown.

We retrospectively reviewed 98 patients with R0/1 resection for PDAC. All metastatic LNs were evaluated for the pathomorphological features of metastasis and analyzed in terms of postoperative outcomes. Various morphological patterns of metastasis were assessed in 440 positive LNs and then classified into 4 groups: common type, direct type (continuously invaded by the main tumor), scatter type (multiple tumor clusters among the normal LN tissues), and isolated tumor cell (ITC).

The pathological stage was defined as stage IIA in 10% and IIB in 90% patients. Common-type metastasis was noted in 55% positive LNs of 75% node-positive patients; direct type in 36% LNs of 69% patients; scatter type in 5% LNs of 14% patients; and ITCs in 5% LNs of 18% patients. Significant difference was noted only in recurrence-free survival (RFS) but not in overall survival (OS) in the common-type; only in OS but not in RFS for the scatter type; and neither in RFS nor OS for both direct type and ITC. Multivariate analysis revealed that only LN ratio and curability were independent predictive factors of poor.

The tumor distribution patterns in metastatic LNs are the postoperative prognostic factors in pancreatic cancer.
A randomized controlled trial comparing methohexital and propofol for induction in patients receiving angiotensin axis blockade
Authors: Bonavia Anthony , Verbeek Thomas , Adhikary Sanjib , Kunselman Allen , Budde Arne , Lyn-Sue Jerome , Mets Berend
Published: January 2019

Background:

Pharmacologic angiotensin axis blockade (AAB) has been associated with profound hypotension following anesthetic induction with propofol. To combat this problem, investigators have attempted to withhold angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) preoperatively, or evaluated the effects of different induction agents in conferring greater hemodynamic stability. To date, methohexital has not been compared with the most commonly used induction agent, propofol. Hence, the primary objective was to study the hypothesis that methohexital confers a better hemodynamic profile than propofol for anesthetic induction, in patients receiving AAB. The secondary objective was to investigate the postinduction levels of serum neurohormones in an attempt to explain the mechanisms involved.

Methods:

Forty-five adult, hypertensive patients taking ACEi or ARB and scheduled for elective, noncardiac surgery completed the study. Patients were randomized to receive equi-anesthetic doses of either propofol or methohexital for anesthetic induction. Hemodynamic variables were measured and blood samples were drawn before induction and for 15 minutes afterwards.

Results:

Methohexital resulted in less hypotension compared with propofol (P = .01), although the degree of refractory hypotension was similar (P = .37). The postinduction systolic blood pressure (P = .03), diastolic blood pressure (P < .001) and heart rate (P = .03) were significantly higher in the methohexital group. A nonsignificant elevation of serum norepinephrine and epinephrine levels was observed in the methohexital group, while serum arginine vasopressin and angiotensin II levels did not differ between groups.

Conclusion:

While methohexital was shown to confer greater hemodynamic stability in patients taking ACEi/ARB, the measured hormone levels could not explain the mechanism for this effect.