bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Citation Rate in the Spine Literature
Authors: Yom Kelly H. , Jenkins Nathaniel W. , Parrish James M. , Brundage Thomas S. , Hrynewycz Nadia M. , Narain Ankur S. , Hijji Fady Y. , Haws Brittany E. , Singh Kern
Published: January 2020

The number of citations a publication receives has been regarded as one measure of its importance and clinical impact. However, studies have yet to investigate which characteristics are predictors of citation rates within the spine subspecialty literature. To explore this topic, all articles published in 2010 in Spine and from 2010 to 2011 in The Spine Journal and the Journal of Neurosurgery: Spine were reviewed. The Web of Science search engine was used to determine the number of times each article was cited in the 5 years following its publication. Sample characteristics were collected and were compared with a χ2 test for differences Multivariate logistic regression was utilized to determine if collected study characteristics were associated with achievement of citation frequency higher than the median for the entire study sample. Among the 927 articles analyzed, the 5-year citation number ranged from 0 to 125, with a median of 8 (interquartile range: 4–16). Upon multivariate analysis, the following were identified as predictors of citation number higher than the median: North American origin (P=0.014), sample size >30 (P<0.001), study topic (P<0.050), and publication in the Journal of Neurosurgery: Spine (P<0.001). Practitioners and research personnel can use these findings to help elucidate which factors might affect the potential impact and overall reach of their work in the spine literature.
Current Strategies for Reconstruction of Soft Tissue Defects of the Spine
Authors: Dolan Roisin T. , Butler Joseph S. , Vaccaro Alexander R. , White Andrew P. , Giele Henk P.
Published: January 2020

Spinal surgery has been revolutionized by advances in instrumentation, bone graft substitutes, and perioperative care. Extensive dissection, creation of large areas of dead space, and the use of instrumentation in compromised patients, however, predisposes to high rates of wound complications. Postoperative wound complications in patients undergoing complex spinal surgery can have devastating sequelae, including hardware exposure, meningitis, and unplanned reoperation. Recognition of high-risk patients and prediction of wound closure difficulties, combined with preemptive reconstructive surgical strategies may prevent complications. The purpose of this review is to discuss the principles of spine wound management and provide a synopsis of the soft tissue reconstructive strategies utilized in spinal surgery. We review the senior author’s preferred reconstructive algorithm for the management of these complex wounds, in addition to outcomes data relating to the timing of reconstructive surgery.
Clinical efficacy of irinotecan plus raltitrexed chemotherapy in refractory esophageal squamous cell cancer
Authors: Liu Min , Jia Qingqing , Wang Xiaolin , Sun Changjiang , Yang Jianqi , Chen Yanliang , Li Ying , Min Lingfeng , Zhang Xizhi , Zhu Caiyun , Gubat Johannes Artiaga , Chen Yong
Published: January 2020

Our retrospective study assessed the efficacy and safety of irinotecan plus raltitrexed in esophageal squamous cell cancer (ESCC) patients who were previously treated with multiple systemic therapies. Between January 2016 and December 2018, records of 38 ESCC patients who underwent irinotecan plus raltitrexed chemotherapy after at least one line of chemotherapy were reviewed. Efficacy assessment was performed every two cycles according to the RECIST version 1.1. A total of 95 cycles of chemotherapy were administered, and the median course was 3 (range 2–6). There was no treatment-related death. Nine patients had partial response, 21 had stable disease and eight had progressive disease. The overall objective response rate was 23.68% (9/38) and the disease control rate was78.94% (30/38). After a median follow-up of 18.5 months, the median progression-free survival and overall survival were 105 and 221 days, respectively. There were five patients (13.15%) with grade 3/4 leukopenia, three patients (7.89%) with grade 3/4 neutropenia and one patient (2.63%) with grade 3/4 diarrhea. The combination of irinotecan plus raltitrexed was effective for pretreated ESCC patients. Further studies are needed to determine the optimal dose of the two drugs.
Compliance With Evidence-Based Processes of Care After Transitions Between Staff Intensivists
Authors: Angriman Federico , Pinto Ruxandra , Friedrich Jan O. , Ferguson Niall D. , Rubenfeld Gordon , Amaral Andre Carlos Kajdacsy-Balla
Published: January 2020

Objectives:

We sought to evaluate the impact of transitions of care among staff intensivists on the compliance with evidence-based processes of care.

Design:

Cohort study using data from the Toronto Intensive Care Observational Registry.

Setting:

Seven academic ICUs in Toronto, Ontario.

Patients:

Critically ill mechanically ventilated adult patients.

Interventions:

We explored the effects of the weekly transition of care among staff intensivists on compliance with three evidence-based processes of care (spontaneous breathing trials, lung-protective ventilation, and neuromuscular blocking agents). Two practices that are less guided by evidence (early discontinuation of antibiotics and extubation attempts) served as positive controls. We conducted the analysis using generalized estimating equations to account for clustering at the patient level.

Measurements and Main Results:

The cohort consisted of 10,570 patients admitted between June 2014 and August 2018. Compliance varied for each practice (63.6%, 42.5%, and 21.1% for lung-protective ventilation, spontaneous breathing trials, and neuromuscular blockade, respectively). There was no effect of transitions of care on compliance with spontaneous breathing trials (odds ratio, 1.00; 95% CI, 0.95–1.07), lung-protective ventilation (odds ratio, 1.07, 95% CI, 0.90–1.26), or neuromuscular blockade use (odds ratio, 0.95; 95% CI, 0.75–1.20). However, early antibiotic discontinuation was more likely (odds ratio, 1.23; 95% CI, 1.06–1.42) and extubation attempts were less frequent (odds ratio, 0.77; 95% CI, 0.65–0.93) after a transition of care.

Conclusions:

We observed no significant impact of transitions of care between individual staff physicians on evidence-based processes of care for mechanically ventilated adult patients. However, transitions were associated with a lower likelihood of extubation and higher odds of earlier discontinuation of antibiotics.
Renal Function–Adjusted d-Dimer Levels in Critically Ill Patients With Suspected Thromboembolism*
Authors: Schefold Joerg C. , Gerber Joël L. , Angehrn Michelle C. , Müller Martin , Messmer Anna S. , Leichtle Alexander B. , Fiedler Georg M. , Exadaktylos Aristomenis K. , Pfortmueller Carmen A.
Published: January 2020

Objectives:

Diagnosing thromboembolic disease typically includes d-dimer testing and use of clinical scores in patients with low to intermediate pretest probability. However, renal dysfunction is often observed in patients with thromboembolic disease and was previously shown to be associated with increased d-dimer levels. We seek to validate previously suggested estimated glomerular filtration rate–adjusted d-dimer cutoff levels. Furthermore, we strive to explore whether the type of renal dysfunction affects estimated glomerular filtration rate–adjusted d-dimer test characteristics.

Design:

Single-center retrospective data analysis from electronic healthcare records of all emergency department patients admitted for suspected thromboembolic disease.

Setting:

Tertiary care academic hospital.

Subjects:

Exclusion criteria were as follows: age less than 16 years old, patients with active bleeding, and/or incomplete records.

Interventions:

Test characteristics of previously suggested that estimated glomerular filtration rate–adjusted d-dimer cutoff levels (> 333 µg/L [estimated glomerular filtration rate, > 60 mL/min/1.73 m2], > 1,306 µg/L [30–60 mL/min/1.73 m2], and > 1,663 µg/L [< 30 mL/min/1.73 m2]) were validated and compared with the conventional d-dimer cutoff level of 500 µg/L.

Main Results:

A total of 14,477 patients were included in the final analysis, with 467 patients (3.5%) diagnosed with thromboembolic disease. Renal dysfunction was observed in 1,364 (9.4%) of the total population. When adjusted d-dimer levels were applied, test characteristics remained stable: negative predictive value (> 99%), sensitivity (91.2% vs 93.4%), and specificity (42.7% vs 50.7%) when compared with the conventional d-dimer cutoff level to rule out thromboembolic disease (< 500 µg/L). Comparable characteristics were also observed when adjusted d-dimer cutoff levels were applied in patients with acute kidney injury (negative predictive value, 98.8%; sensitivity, 95.8%; specificity, 39.2%) and/or “acute on chronic” renal dysfunction (negative predictive value, 98.0%; sensitivity, 92.9%; specificity, 48.5%).

Conclusions:

d-Dimer cutoff levels adjusted for renal dysfunction appear feasible and safe assessing thromboembolic disease in critically ill patients. Furthermore, adjusted d-dimer cutoff levels seem reliable in patients with acute kidney injury and “acute on chronic” renal dysfunction. In patients with estimated glomerular filtration rate less than 60 mL/min/1.73 m2, the false-positive rate can be reduced when estimated glomerular filtration rate–adjusted d-dimer cutoff levels are applied.
Early Impact of the Affordable Care Act and Medicaid Expansion on Racial and Socioeconomic Disparities in Cancer Care
Authors: Mahal Amandeep R. , Chavez Janice , Yang David D. , Kim Daniel W. , Cole Alexander P. , Hu Jim C. , Trinh Quoc-Dien , Yu James B. , Nguyen Paul L. , Mahal Brandon A.
Published: January 2020

Objectives:

We sought to evaluate sociodemographic disparities in insurance coverage among nonelderly adults with a common cancer after Affordable Care Act (ACA) implementation.

Patients and Methods:

In total, 109,182 patients aged 18 to 64 years diagnosed with a common cancer (lung, breast, or prostate cancer) were identified from 2010 to 2014. Multivariable logistic regressions analyzed associations between ACA implementation and uninsured rates on the basis of state approach to Medicaid expansion, stratified by race (black, white), and income (stratified at 138% Federal Poverty Line).

Results:

Uninsured rates declined after ACA implementation, with the greatest rate reductions associated with traditional Medicaid expansion (P
interaction <0.001). Racial disparities in insurance coverage were eliminated with traditional Medicaid expansion where the uninsured rate went from 10.0% to 0.95% among black patients (adjusted odds ratio [AOR]pre-aca 1.52 to AORpost-aca 0.47) but persisted with other state approaches (AORpre-aca 1.15 to AORpost-aca 1.12) (P
interaction =0.002). Furthermore, socioeconomic coverage gaps were eliminated with traditional Medicaid expansion, where the uninsured rate went from 8.4% to 1.4% among low-income (≤138% Federal Poverty Line) patients, but not with other state approaches (P
interaction <0.001).

Conclusions:

Traditional Medicaid expansion was associated with the elimination of racial and socioeconomic insurance coverage gaps. These results highlight the potential benefits and challenges of the ACA and its provisions, and could instruct ongoing policy.
Low Frequency of Mutation Testing in the United States
Authors: Florindez Jorge , Trent Jonathan
Published: January 2020

Objective:

The objective of this study was to determine whether there were survival differences associated withKITmutation testing, type ofKITmutations, and other clinical variables in patients with localized or metastatic gastrointestinal tumor (GIST).

Methods:

Adult patients with GIST were extracted from the Surveillance Epidemiology and End Results (SEER) database from 2010 to 2015 with follow-up through 2016. Overall survival (OS) and cancer-specific survival (CSS) were the designated endpoints.

Results:

A total of 3866 patients met inclusion criteria. Metastatic disease was found in 656 patients (17%), whereas localized disease was present in 3210 patients (83%).KITmutation testing was performed in 1033 patients (26.7%) with equal distribution in localized and metastatic disease (27% and 26.6%, respectively). Multivariate analysis was performed in localized and metastatic GIST. In localized GIST, black race showed worse OS (hazard ratio [HR]=1.57; 95% confidence interval [CI]: 1.26-1.96), whereas higher mitotic rate (>5/50 HPF) demonstrated poor OS (HR=1.59; 95% CI: 1.24-2.05) and CSS (HR=3.07; 95% CI: 2.07-4.54); tumor size (>10 cm) showed poor CSS (HR=5.73; 95% CI: 2.37-13.8). In metastatic GIST, black race showed poor OS (HR=1.42; 95% CI: 1.04-1.93) and CSS (HR=1.73; 95% CI: 95% CI: 1.18-2.54), whileKITtesting was associated with better OS (HR=0.64; 95% CI: 0.47-0.87) and CSS (HR=0.66; 95% CI: 0.44-0.97); treatment with tyrosine kinase inhibitors showed better OS (HR=0.67; 95% CI: 0.51-0.88). Surgical resection was associated with better OS (HR=0.56; 0.47-0.67) and CSS (HR=0.55; 95% CI: 0.42-0.72) both in localized and metastatic GIST.

Conclusions:

The minority of GIST patients have their tumor tested for anyKITmutation. Yet,KITtesting and therapy with tyrosine kinase inhibitors were associated with better survival in GIST patients with metastatic disease. Surgery, potentially curative for localized GIST, shows benefit in the metastatic setting.
Predictors of Distant Recurrence Following Stereotactic Body Radiation Therapy for Stage I Non–Small Cell Lung Cancer
Authors: Wong Jessica Karen , Shaikh Talha , DeMora Lyudmila , Zhang Eddie , Borghaei Hossein , Hayes Shelly B. , Kumar Sameera , Meyer Joshua E. , Hallman Mark A.
Published: January 2020

Objective:

The objective of this study was to characterize patients at an increased risk of distant metastasis (DM) following stereotactic body radiation therapy (SBRT) for stage I non–small cell lung cancer (NSCLC).

Materials and Methods:

We identified patients undergoing SBRT for stage I NSCLC between 2005 and 2016. Patients with a prior lung cancer diagnosis, receiving a biological effective dose <100 Gy, or receiving chemotherapy were excluded. Patients underwent pretreatment staging and were classified according to the American Joint Committee for Cancer (AJCC) 8th edition staging. The primary endpoint was DM. The Kaplan-Meier method and the Cox proportional hazards model were used for survival analysis and to identify predictors of DM.

Results:

A total of 174 patients were included, with a median age 75 years (range, 49 to 96 y) and a median follow-up of 24 months (range, 3 to 123 mo). The 2- and 4-year cumulative incidences of DM were 14.2% and 19.1%, respectively. Patients who developed DM had worse overall survival versus patients developing a locoregional recurrence (P=0.023). On multivariable analysis, having stage IB disease (hazard ratio: 2.95; 95% confidence interval: 1.06-8.23; P=0.039) or a lower/middle lobe tumor (hazard ratio: 2.67; 95% confidence interval: 1.07-6.69; P=0.036) was associated with increased risk of DM. The 2-year cumulative incidences of DM were 10.9% and 35.7% (P=0.002) for patients with stage IA versus IB tumors, respectively, and 11.3% and 19.7% (P=0.049) for patients with upper lobe versus lower/middle lobe tumors, respectively.

Conclusions:

Patients with stage IB disease or lower/middle lobe tumors may have an increased risk of DM following SBRT. Randomized controlled trials are needed to further identify patients who may benefit from adjuvant systemic therapy after SBRT for stage I NSCLC.
Estimating Serotype-specific Efficacy of Pneumococcal Conjugate Vaccines Using Hierarchical Models
Authors: Warren Joshua L. , Weinberger Daniel M.
Published: January 2020

Pneumococcal conjugate vaccines target 10 or 13 specific serotypes. To evaluate the overall efficacy of these products, the vaccine-targeted serotypes are typically aggregated into a single group. However, it is often desirable to evaluate variations in effects for different serotypes. These serotype-specific estimates are often based on small counts, resulting in a high degree of uncertainty (i.e., large standard errors and wide confidence intervals). An alternative is to use a hierarchical Bayesian statistical model, which estimates overall effectiveness while simultaneously providing estimates of serotype-specific vaccine effects. These shrunken serotype-specific estimators often have smaller mean squared errors (MSEs) than unbiased versions due to a large decrease in posterior uncertainty. We reanalyzed published data from a randomized controlled trial on the efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) against community-acquired pneumonia caused by vaccine-targeted serotype using a hierarchical model. This model provides a potential framework for obtaining estimates of serotype-specific vaccine effects with reduced MSEs.
Controversies in Female Genital Cosmetic Surgeries
Authors: HALDER GABRIELA E. , IGLESIA CHERYL B. , ROGERS REBECCA G.
Published: January 2020

Female genital cosmetic surgery (FGCS) aims to alter the structure and appearance of female genitalia to attain the desired shape, size or look, or to decrease labial interference during intercourse, relieve pain and discomfort with clothing and exercise or decrease vaginal caliber and laxity. In the last 5 years, the number of labiaplasty surgeries performed in the United States rose by 53%. Despite the increasing popularity of FGCS, several divergent opinions regarding the ethics, safety, and efficacy of these procedures exist. Here we provide a brief overview of the terminology and techniques for FGCS and summarize current controversies.
Association of visit-to-visit variability of systolic blood pressure with cardiovascular disease, chronic kidney disease and mortality in patients with hypertension
Authors: Wan Eric Yuk Fai , Yu Esther Yee Tak , Chin Weng Yee , Fong Daniel Yee Tak , Choi Edmond Pui Hang , Lam Cindy Lo Kuen
Published: January 2020

Objective:

This study aimed to evaluate the association between visit-to-visit variability of systolic blood pressure (SBP) and cardiovascular disease, chronic kidney disease, and mortality among hypertensive patients.

Methods:

A population-based cohort included 225 759 Chinese hypertensive adults without diabetes, cardiovascular disease, and chronic kidney disease during 2011–2012. SBP variability was determined based on standard deviations of SBP over the previous 5 years before baseline. Cox regressions adjusted with patients’ baseline characteristics, mean, and temporal trend of SBP was applied to the associations between variability and incident cardiovascular disease, chronic kidney disease and all-cause mortality.

Results:

In all, 25 714 patients with cardiovascular disease, 27 603 with chronic kidney disease, and 16 778 deaths have occurred during the median follow-up of 70.5 months (1.2 million person-years). SBP variability was continuously and positively associated with higher cardiovascular disease, chronic kidney disease and mortality risk among hypertensive patients without evidence of a threshold. Each 10-mmHg increase in SD of SBP was associated with 35% [hazard ratio 1.35, 95% confidence interval (CI) 1.30–1.39], 39% (HR 1.39, 95% CI 1.35–1.43), and 40% (HR 1.40, 95% CI 1.34–1.45) higher risk of cardiovascular disease, chronic kidney disease and mortality, respectively. HRs were attenuated with increased age, mean SBP, and Charlson index, and decreased temporal trend of systolic blood pressure, but it remained significant and consistent in most of the different subgroups.

Conclusions:

Findings suggested that SBP variability is a significant prognostic value, in addition to baseline or mean of SBP for the risk of cardiovascular disease and mortality.
CLINICAL CHARACTERISTICS AND MOLECULAR GENETIC ANALYSIS OF A COHORT OF CHINESE PATIENTS WITH CHOROIDEREMIA
Authors: Han Xiaoxu , Wu Shijing , Li Hui , Zhu Tian , Wei Xing , Zhou Qi , Sui Ruifang
Published: January 2020

Purpose:

To describe the clinical and molecular genetic characteristics of a large cohort of Chinese patients with choroideremia (CHM).

Methods:

Forty-eight Chinese participants from 35 families with a clinical diagnosis of CHM who harbored sequence variants in the CHM gene were enrolled. Comprehensive clinical evaluations and molecular genetic analysis of the CHM gene were performed.

Results:

The median age of the 48 patients was 31.5 years (range, 5–78 years). There were 30 different sequence variants detected in 35 families; of which, 13 sequence variants were novel. The mean (±SD) best-corrected visual acuity best in logarithm of the minimum angle of resolution equivalents was 0.71 (±0.87) (range, 0.00–2.80) or approximately 20/100 in Snellen visual acuity. A significant correlation was revealed between best-corrected visual acuity best and age (P < 0.001). The trend in the change in the best-corrected visual acuity over age showed that relatively good vision remained until 20 years old. The patterns of fundus photography and fundus autofluorescence finding demonstrated that residual retinal pigment epithelium areas significantly declined in patients at the age of 20 years or older. The results of visual field and full-field electroretinography showed that these measures might be of limited value for evaluating the condition of the late stage of CHM in Chinese patients.

Conclusion:

This study described for the first time the clinical and molecular genetic characteristics of a large cohort of Chinese patients with CHM. The findings from best-corrected visual acuity best and visual field showed that the impairment of visual function in CHM might be more severe in Chinese patients than in western patients.
Temporal Wedge Defects in Glaucoma: Structure/Function Correlation With Threshold Automated Perimetry of the Full Visual Field
Authors: Wall Michael , Lee Eric J. , Wanzek Robert J. , Chong Luke X. , Turpin Andrew
Published: January 2020

Precis:

We used the Open Perimetry Interface (OPI) to design a static automated perimetry test of the full visual field. About half of our glaucoma cohort had defects in the far peripheral inferotemporal visual field that correlate well with related damage to the superior nasal optic disc.

Aims:

To test the hypothesis that in glaucoma patients with mild visual loss, perimetric nerve fiber bundle defects present outside 30 degrees will correlate well with areas of Cirrus ocular coherence tomography (OCT) retinal nerve fiber layer thinning.

Methods:

We tested 27 consecutive glaucoma subjects with mild vision loss (mean deviation better than −4 dB) with a SITA standard test, 2 size V custom OPI tests (OPI 30-2 and OPI Peripheral) and Cirrus OCT. Two observers assigned qualitative grades to each type of visual field test based on their level of correlation with OCT retinal nerve fiber layer and ganglion cell thickness.

Results:

Discrete temporal wedge defects were found on the OPI peripheral V test in 26% of cases whereas more extensive inferior temporal loss (including inferior temporal wedge defect region) was present in 22% of other cases. OCT data correlated best with the OPI peripheral test for 8 glaucoma subjects. The OPI central 30-2 test correlated best for 9 glaucoma subjects; the remainder of subjects had equal central/peripheral correlations.

Conclusions:

About half of our glaucoma cohort have defects in the far peripheral inferotemporal visual field that correlate well with related damage to the superior nasal optic disc. Adding a threshold automated perimetry test of the far periphery improves structure/function correlations and adds useful clinical information.
Cryptococcal Pneumonia Following Influenza in an Immunocompetent Patient
Authors: McNeil Thomas , Daniel Santhosh , Gordon David L.
Published: January 2020

We describe the case of a 42-year-old immunocompetent man who developed severe pneumonia with Cryptococcus neoformans var. grubii following influenza A infection. With the commencement of liposomal amphotericin and flucytosine, his condition dramatically deteriorated. Secondary bacterial infection following influenza is a well-recognized phenomenon and there are increasing reports of invasive aspergillosis occurring in the critically ill; however, secondary infection with cryptococcus in the immunocompetent patient is rare. The absence of an immunological defect in our patient raises the possibility of influenza predisposing to cryptococcal infection. We hypothesize that the cause of our patient's deterioration with antifungal treatment represented either a reaction to amphotericin or a vigorous immunological response to released fungal antigen. Our experience alerts the clinician to the potential for clinical deterioration with antifungal treatment of cryptococcal pneumonia in the immunocompetent host, and raises the question of a link between influenza and cryptococcal infection.
A Case Report
Authors: Maldonado-Díaz Ellis Daniela , Delgado-Hernández Rosa Delia , Salinas-Lara Citlaltepetl , Soto-Hernández José Luis , Cárdenas Graciela
Published: January 2020

Fungal meningitis is often a fatal condition, particularly in immunosuppressed patients. Herein, we describe the case of a previously healthy young woman with a history of epidural anesthesia for a cesarean delivery in another hospital 3 months prior. The patient complained of chronic migraine-like headache before admission to our center. After 5 weeks, a cerebrospinal fluid culture in Sabouraud agar grew a mold, later identified as Aspergillus fumigatus. The patient died after 114 days of hospitalization despite being administered with voriconazole for 45 days. At autopsy, a pigmented mold consistent with phaeohyphomycosis was found, suggesting an unusual case of a mixed mold infection.
The Relationship Between Caregiver Reactions and Psychological Distress in Family Caregivers of Patients With Heart Failure
Authors: Hou Danhua , Chen Yu xia , He Dengxin , Zhang Xiuting , Fan Xiuzhen
Published: January 2020

Background

Providing care often causes negative reactions and psychological distress in family caregivers of patients with heart failure. How these 2 constructs are related has not been fully explored.

Objective

The aims of this study were to describe caregiver reactions to caregiving and psychological distress and to determine the associations between caregiver reactions to caregiving and psychological distress in family caregivers of patients with heart failure.

Methods

In this secondary analysis of a cross-sectional study, the sample included 231 patients and their family caregivers. The Chinese version of the Hospital Anxiety and Depression Scale was used to assess psychological distress (ie, symptoms of anxiety and depression), and the Caregiver Reaction Assessment was used to measure both negative and positive caregiver reactions to caregiving, including financial problems, impact on schedule, health problems, lack of family support, and self-esteem.

Results

Of the participants, 15.2% and 25.5% of caregivers reported symptoms of depression and anxiety, respectively. Impact on schedule was the most common caregiver reaction, followed by financial problems. Impact on schedule was related to both the caregivers' symptoms of depression (odds ratio [OR], 1.705; P = .001) and anxiety (OR, 1.306; P = .035), whereas financial problems were only related to symptoms of anxiety (OR, 1.273; P = .011).

Conclusions

The findings suggest that interventions for reducing the negative impact on schedule of caregiving and helping to solve the caregivers' financial concerns might help to relieve their symptoms of depression and anxiety.
Opioid crisis: Placing blame or fixing the problem
Authors: Snodgrass Brett
Published: January 2020

There is prevalent news media coverage about the opioid crisis in the United States. Overdose deaths are on the rise, but who's fault is it really? Perspective into the crisis is key if we as health care providers ever hope to change the current situation. Although overdose deaths are on the rise, opioid prescribing rates are decreasing. Considering a complex issue requires looking into to the lives of patients and their past experiences to truly identify those at risk for addiction, not just opioid addiction, but addiction as a whole. Nurse practitioners play a vital role in identifying those at greatest risk, making the identification early and assisting patients into treatment to help change the trajectory of their lives.
Trends and predictors of coronary revascularization in patients with coronary artery anomalies and acute myocardial infarction: a nationwide analysis of 8131 patients
Authors: Shah Neeraj , Agarwal Vratika , Olson Peter C. , Naniwadekar Aditi , Agarwal Anand , Patel Nainesh C.
Published: January 2020

Objective

Acute myocardial infarction (AMI) is rarely associated with coronary artery anomalies (CAA). This confluence makes it difficult to identify and treat the culprit lesion with percutaneous coronary intervention (PCI). Our objective was to evaluate trends and predictors of revascularization in patients with CAA and AMI using a large national database.

Methods

We included adult patients with CAA presenting as ST segment elevation myocardial infarction (STEMI) or non-ST segment elevation myocardial infarction (NSTEMI) and undergoing coronary angiography from Nationwide Inpatient Sample from 2000 to 2011, using ICD-9 diagnosis code of 746.85 for CAA. Chi-square test for trend was used to compare revascularization rates over time. Multivariate logistic regression was used to identify predictors of revascularization.

Results

There were almost 4.7 million subjects with AMI undergoing coronary angiography from 2000 to 2011. Of these, there were 8131 patients with CAA, including 3425 STEMI and 4706 NSTEMI patients. Mean age of the CAA population was 59 years with 63.6% males. Overall PCI rate was 47.8% and coronary artery bypass grafting rate was 8.8%. In STEMI patients with CAA, PCI rate increased from 49.9% in 2000 to 77.8% in 2011 (P < 0.001). In NSTEMI patients with CAA, PCI rate remained unchanged from 33.3% in 2000 to 37.3% in 2011 (P = 0.34). Revascularization trends in AMI patients with CAA mirrored those in AMI patients without CAA.

Conclusion

Despite the technical challenges associated with PCI in CAA, PCI rates in STEMI patients with CAA continue to increase over time. On the contrary, PCI rates continue to remain low in CAA patients with NSTEMI, reflecting overall contemporary NSTEMI treatment trends.
Effect on mortality of different routes of administration and loading dose of aspirin in patients with ST-segment elevation acute myocardial infarction treated with primary angioplasty
Authors: Rossi Rosario , Bagnacani Alessandra , Sgura Fabio , Enrique Monopoli Daniel , Coppi Francesca , Talarico Marisa , Rolando Cristina , Boriani Giuseppe
Published: January 2020

Background:

Aspirin is the cornerstone of the anti-platelet therapy during the acute phase of ST-segment elevation myocardial infarction (STEMI), and it can be administrated orally or intravenously. The oral loading dose of aspirin is well characterized, whereas there are little data on the optimal intravenous (IV) loading dose.

Aim:

To confirm if the mortality of patients treated with a loading dose of IV aspirin was comparable to that of patients treated with the most usual aspirin per os.

Patients and methods:

We analyzed the overall mortality during hospitalization and at 1 year follow-up among 756 consecutive patients with STEMI. Four hundred seventy-eight (63.2%) patients received per os and 278 (36.8%) IV aspirin. We divided the 278 patients of the IV aspirin group into two subgroups, based on the median value of the dose of aspirin used as a load.

Results:

The per os aspirin group took 234 ± 138 mg of aspirin per os at the first medical contact; the IV low-dose group 194 ± 87 mg, and the IV high-dose group 483 ± 194 mg of IV aspirin. No differences were observed in mortality rate after 1-year of follow-up. In-hospital mortality resulted significantly higher (9.3%) in the IV high-dose group respect to the IV low-dose one (5.0%) and per os aspirin group (6.0%) (P < 0.01 for both).

Conclusion:

In this retrospective study, high dose IV aspirin loading in STEMI increased intra-hospital mortality. Further study is necessary to define the optimal dose of intravenous aspirin in STEMI.
An effectiveness study of a wearable device (Clouclip) intervention in unhealthy visual behaviors among school-age children
Authors: Cao Yingpin , Lan Weizhong , Wen Longbo , Li Xiaoning , Pan Lun , Wang Xuan , Yang Zhikuan
Published: January 2020

Introduction:

The study aimed to determine the effectiveness of an intervention for unhealthy visual behaviors of school-age children using a wearable device (Clouclip).

Method:

The design was a self-controlled prospective study. Clouclip, with the vibration alert disabled, was first applied to measure baseline near-work behaviors in the first week. The vibration alert was then enabled to signal unhealthy visual behaviors (near-work distance < 30 cm and >5 seconds, or near-work distance <60 cm for >45 minutes) for 3 weeks. Near-work behaviors were measured again at the first week and the first month after intervention, respectively. The changes in behaviors between the baseline and the first week and the first month after intervention were analyzed.

Results:

Sixty-seven subjects were eligible for this experiment (the mean age 10.45 ± 0.50 years, 34 boys). Children who logged sufficient wearing time (12.30 ± 0.18 hours on weekdays and 12.16 ± 0.23 hours on weekends) were included for analysis. The average daily near-work distance was significantly increased after the vibration intervention. The time ratio of near-work activity <30 cm to the total <60 cm and the frequency of continuous near-work (distance <60 cm and continuous time >30 minutes) were significantly decreased after the intervention. Although some of the effects were reversed with time following the intervention, some were observed to be maintained until the end of the observation period, and the improvement of the behaviors was more prominent in children who had a shorter near-work distance (<30 cm) at baseline.

Conclusions:

In conclusion, Clouclip can significantly modify near-work behaviors in school-age children and it can last a certain period of time. If these behaviors are causes of myopia development and progression, Clouclip might provide a strategy for managing myopia.
Evaluation of parenteral nutrition-associated liver disease in surgical infants for necrotizing enterocolitis
Authors: Zeng Senyan , Li Xiaoyu , Deng Chun , Li Lei , Guo Chunbao
Published: January 2020

The purpose of this study was to determine the factors associated with parenteral nutrition-associated liver disease (PNALD) in infants who underwent surgery for necrotizing enterocolitis (NEC) and followed up the postoperative outcomes for long term parenteral nutrition (PN).

This study included a retrospective review of 87 infants with NEC and managed surgically from July 2007 to May 2017 at the Children's Hospital, Chongqing Medical University. Clinical data and procedure information were collected and analyzed.

Among the infants included, 16.1% of patients developed PNALD. Multivariable logistic regression analysis revealed progressive clinical deterioration (OR, 5.47; 95% CI, 1.10–26.96; P = .037) was independent risk factor for PNALD whereas congenital heart disease (OR, 0.068; 95% CI, 0.008–0.55; P = .012) presentation served as a protective factor.

The current data suggested the distinct disease process for cardiac patients with NEC, which might help in the prevention and treatment of PNALD for patients with NEC.
Efficacy and safety of So-Cheong-Ryong-Tang in patients with atopic dermatitis and respiratory disorders
Authors: Kang Su-Jin , Cho Han-Baek , Jo Eun-Heui , Yang Geum-Jin , Hong Ji-Eun , Lee Ju-Hyun , Shim Yu-Hwa , Mun Jung-Hyun , Park Min-Cheol
Published: January 2020

Background:

Atopic dermatitis (AD, atopic eczema) is a pruritic, inflammatory, chronic skin disease. Since there is limitation of conventional treatment of AD, traditional herbal medicine can be an attractive therapeutic option in patients having AD for a long time. So-Cheong-Ryong-Tang (SCRT) has been found to inhibit histamine release and degranulation of mast cells, differentiation of basophils, and proliferation of eosinophils. We designed this clinical trial to evaluate the efficacy and safety of SCRT as compared to placebo in patients with AD and respiratory disorders.

Methods/design:

This study is a single-center, randomized, double-blind, placebo-controlled, and investigator-initiated clinical trial. A total of 60 patients between 7 and 65 years of age with AD and respiratory disorders who received a diagnosis of AD by Hanifin and Rajka criteria who scored 15 to 50 in a scoring atopic dermatitis (SCORAD) will be enrolled. Participants will be randomly assigned to the SCRT or placebo group in a ratio of 1:1 and they will have a visit schedule comprising 4 visits including a screening visit during 8 to 10 weeks. The participants will be administered SCRT or placebo 3 times a day for 4 weeks. The primary outcome will be measured by a change of the SCORAD index. The secondary outcomes will be measured by changes in the dose and frequency of usage of the AD ointment, dermatology life quality index scores, pruritus and sleep disorder in visual analog scale, skin moisture content, skin surface temperature, Hamilton anxiety rating scale scores, depression rating scale scores, stress/autonomic nervous function test, and attention deficit hyperactivity disorder survey scores at week 4 as compared to those at the baseline.

Discussion:

To the best of our knowledge, SCRT has rarely been reported for dermatologic diseases. This will be the first clinical trial to assess the efficacy and safety of SCRT in patients with AD and respiratory disorders. We hope that the results of this trial will provide evidence for the use of SCRT as a new treatment for AD with respiratory disorders.

Trial registration:

Korean National Clinical Trial Registry, Clinical Research Information Service. (KCT0004148) (https://cris.nih.go.kr/cris/search/search_result_st01_en.jsp?seq=14981<ype=&rtype=).
Efficacy and safety of core stability training on gait of children with cerebral palsy
Authors: Huang Chuyao , Chen Yijun , Chen Guoming , Xie Yaying , Mo Jiahao , Li Keyi , Huang RuiLan , Pan Guanghua , Cai Yong , Zhou Lei
Published: January 2020

Background:

Cerebral palsy (CP) is a common disability in children featured with pathological gait and limb function limitation due to muscle weakness. Improving limb function and quality of life is currently considered to be highlighted. Physiotherapy is a chief component of rehabilitation for children with CP, correcting gait and improve walking capacity through muscle strength training. Standard rehabilitation programs for CP have not been determined. Core stability training (CST), which coordinates limb balance via trunk control, is widely used in sports competition. And it is gradually introduced into the rehabilitation of children with cerebral palsy with a positive impact on the patients’ gait performance. By screening published literatures, this study aims to conduct a meta-analysis to systematically evaluate the effectiveness and safety of CST in gait of children with CP.

Methods:

Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on CST in the treatment of children with CP were searched from 6 databases. Moreover, the reference lists of conference papers and included literatures will be manually searched to avoid omissions. Literature screening and data extraction were performed independently by 2 researchers. RCTs carry out the risk of bias analysis evaluation from seven aspects through the Cochrane Collaboration's risk of bias tool. Fixed or random effect model will be performed to analyze the outcomes. When higher heterogeneity occurs (I
2 > 50%), the sensitivity or subgroup analysis will also be conducted to find potential factors. And the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is used for assessing the quality of evidence.

Results:

The study will evaluate the effect of CST on gait of children with CP from multiple outcomes, including walking speed, endurance, stride length, and safety.

Conclusion:

Based on evidence-based medicine, the conclusion of this study can demonstrate the effectiveness and safety of CST in gait correction for children with CP.

PROSPERO registration number:

PROSPERO CRD 42019134094.
Association between occupational burnout and heart rate variability
Authors: Lo Ei-Wen Victor , Wei Yin-Hsuan , Hwang Bing-Fang
Published: January 2020

Work stress and burnout have become important issues. Changes in work patterns frequently, long working hours, and too much pressure among workers in high-tech companies may result in the chronic fatigue symptoms and increase the risk of cardiovascular diseases, even leading to sudden death. Changes of heart rate variability (HRV) can be treated as a warning from the autonomic nervous systems and as a long-term monitoring method for chronic disease, for example, cardiovascular diseases and sudden death. The purpose of this study was to explore the association between occupational burnout and HRV.

Proportional stratified convenient sampling was performed and in total, 120 individuals participated in this study. Questionnaires and the “occupational burnout inventory” were used to collect biographical and burnout information. A novel wrist physiological monitor was used to measure autonomic nervous system-related data, including HRV, low-frequency (LF) %, high-frequency (HF) %, and LF/HF ratio. Descriptive statistics and logistic regressions were computed using SPSS 17.0 (Chinese version, IBM Corp., New York, NY).

The results show that participants who were 20 to 25 years old, work overtime because of onerous personal tasks, had a medical history, and recently felt unwell have higher “personal burnout.” “Participants with a graduate degree, with onerous tasks, who were indirect staff, and with a regular-hour job tended to overcommit to their work.” Significant associations were found among medical history, recently feeling unwell, and “work-related burnout.” There was a positive association between HRV and job seniority. LF%, HF%, and LF/HF ratio were significantly correlated with job category. “Work overcommitment” was related to LF/HF ratio among men. Some items in “personal burnout” and “work overcommitment” were also associated with HRV among women.

The findings suggest that the measurement of HRV can be applied in occupational settings to assess burnout. It not only allows administrators to quickly select the colleagues who need health care, but also provides timely and appropriate care, thereby promoting the health of the worker.
Peripheral T cell lymphoma coexisting with Castleman's disease
Authors: Liu Shuyan , Wang Yuanwen , Hu Tonglin , Zhang Chunli , Zheng Zhiyin
Published: January 2020

Rationale:

Peripheral T cell lymphoma, coexisting with Castleman's disease (CD), is rarely seen in clinical practice and is not frequently reported in the literature.

Patient concerns:

A 68-year-old female was admitted to our hospital for the first time due to “multiple lumps in the neck that progressively enlarged over 7 months”. 1.5 years later, the patient returned to our hospital complaining of “ difficulty breathing and purulent blood in the mouth for more than 20 days”.

Diagnosis:

The postoperative pathology from the (right) cervical lymph node biopsy confirmed the diagnosis of Castleman Disease (Vascular follicular type). 1.5 years after the diagnosis of CD, the patient developed secondary peripheral T cell lymphoma of unspecified type (PTCL-U).

Interventions:

The patient received 5 courses of chemotherapy: 2 courses of CHOP, Chidamide combined with GemOx, GDP and Hyper CVAD Bregimen.

Outcomes:

After 3 courses of treatment, the curative effect was partly remitted (PR). The patient was discharged in a good condition and the follow-up was uneventful.

Lessons:

The mechanism responsible for CD concurrent or secondary lymphoma is not clear. Epstein-Barr virus (EBV) infection may be the most common reason of CD and PTCL-U. Further understanding the mechanisms of the condition is needed.
Development of tablet personal computer-based cognitive training programs for children with developmental disabilities whose cognitive age is less than 4 years
Authors: Sung In Young , Jeon Jae Yong , Yun Ki Jeong , Yuk Jin Sook , Byun Eun Me , Yoo Han-Wook , Ko Tae-Sung , Kim Hyo-Won , Jang Dae-Hyun
Published: January 2020

This study was to develop tablet personal computer-based cognitive training programs for children with developmental disabilities whose cognitive age is less than 4 years. Twelve cognitive training programs (named Injini) were designed comprising cognitive domains that included attention, visual and auditory perception, memory, executive function, language, and reasoning. In addition, programs related to learning experiences, such as self-regulation, role play, learning of number, and letter/shape concepts, comparison, classification, and pattern matching, were included. Six of 12 programs comprised approximately 10 levels for each program, with different difficulty levels. Other programs consisted of universal tasks that did not have a difficulty level. To ensure that the difficulty level was appropriate, we pre-tested the pilot version of Injini among 80 children with typical development aged 18 to 41 months. After modifying the pilot version, we developed the final version and tested it among 80 children with cognitive impairment whose cognitive age was 18 to 41 months. All children were assessed using the Bayley Scales of Infant and Toddler Development to determine their development and cognitive age. The difficulty level analyses in children with typical development revealed several inappropriate results wherein the success rate did not decrease with increase in level in some programs. After adjusting the difficulty level, the analyses in children with cognitive impairment demonstrated that the success rate gradually decreased with increasing level in all programs. Cognitive training programs for children with developmental disabilities were successfully developed.
Similar thrombolysis outcomes in acute stroke patients with and without atrial fibrillation if pre-stroke CHA2DS2-VASc score is low
Authors: Wu Hung-Ming , Chung Chih-Ping , Lin Yung-Yang
Published: January 2020

The prognosis of acute ischemic stroke patients treated with intravenous (IV) recombinant tissue plasminogen activator (rtPA) is poorer in patients with atrial fibrillation (AF) than patients without AF, which might be related to the greater stroke severity in AF patients. Higher pre-stroke CHA2DS2-VASc scores are associated with greater stroke severity and poorer outcomes. AF Patients tend to have higher CHA2DS2-VASc scores than the non-AF patients. We thus hypothesized that pre-stroke CHA2DS2-VASc scores can be used to improve outcome stratification of IV thrombolysis therapy in acute stroke patients with and without AF. We retrospectively enrolled ischemic stroke patients who received IV-rtPA and categorized them into 2 groups: low-risk (CHA2DS2-VASc scores ≤ 2) and high-risk (CHA2DS2-VASc scores ≥ 3) groups. We compared the outcomes between AF and non-AF patients and the interactive effects of the levels of CHA2DS2-VASc scores on this outcome difference. In the low-risk group, there was no difference in outcomes between the AF and non-AF patients. In the high-risk group, the AF patients had worse outcomes at 3 and 6 months. Our results suggest that pre-stroke CHA2DS2-VASc scores are a useful outcome predictor of IV thrombolytic therapy in acute stroke patients with AF.