bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term weight loss maintenance, sex steroid hormones, and sex hormone-binding globulin
Authors: Duggan Catherine , Tapsoba Jean de Dieu , Stanczyk Frank , Wang Ching-Yun , Schubert Karen Foster , McTiernan Anne
Published: November 2018

Objective:

We tested the effects of weight loss on serum estradiol, estrone, testosterone, and sex hormone-binding globulin (SHBG) in overweight/obese women 18 months after completing a year-long, 4-arm, randomized-controlled dietary weight loss and/or exercise trial.

Methods:

From 2005 to 2008, 439 overweight/obese, postmenopausal women (BMI >25 kg/m2), 50 to 75 years, were randomized to a year-long intervention: diet (reduced calorie, 10% weight loss, N = 118), exercise (225 min/wk moderate-to-vigorous activity, N = 117), combined diet + exercise (N = 117), or control (N = 87). At 12 months, 399 women provided blood; of these, 156 returned at 30 months and gave a blood sample. Hormones and SHBG were measured by immunoassay. Changes were compared using generalized estimating equations, adjusting for confounders.

Results:

At 30 months, participants randomized to the diet + exercise intervention had statistically significant increases in SHBG levels versus controls (P = 0.001). There was no statistically significant change in SHBG in the exercise or diet intervention arms. Hormone levels did not vary by intervention arm from baseline to 30 months. Participants who maintained weight loss at 30 months had statistically significantly greater decreases in free estradiol and free testosterone (P
trend = 0.02 and P
trend = 0.04, respectively) and increases in SHBG (P
trend < 0.0001) versus those who did not have sustained weight loss. Levels of other analytes did not vary by weight loss at 30 months.

Conclusions:

Sustained weight loss results in reductions in free estradiol and testosterone and increases in SHBG 18-month post-intervention.
An Atypical Presentation of Pacinian Corpuscles on Bilateral Guyon’s Tunnel
Authors: Shturman Sirota Isaac , Olivares Ronces Andrés
Published: November 2018

Guyon’s syndrome results from a lesion of the ulnar nerve at the wrist caused by several conditions. The most common causes are ganglion, lipomas, fractures of the radius or pisiform bone, occupational trauma, neuritis, musculotendinous arch, and diseases of the ulnar artery. The clinical presentation varies with the site of lesion, as described by Sean and McClain in 1969, and can involve combined sensory and motor deficits, motor deficit alone, or sensory deficit alone. We present a case of bilateral Guyon’s canal syndrome caused by a lipoma with Pacinian corpuscles on both wrists. Patient presented with sensory deficit as it is described by Shea and McClain with a negative electroneuromyography for ulnar compression. Articles correlating clinical presentation, etiology, and electrophysiological findings relating to ulnar nerve compression on the wrist are still uncommon in the literature.
Selecting the Appropriate Patient for Opioid Therapy: Risk Assessment and Treatment Strategies for Gynecologic Pain
Authors: FINDLEY AUSTIN D. , KEMNER EMILY
Published: November 2018

Chronic pelvic pain is a commonly encountered clinical entity, and many women with this chronic pain condition will be treated at some point in time with opioids for management of their pain. Clinicians in women’s health are frequently asked and expected to participate in the care of women with chronic pelvic pain, as well as other gynecologic pain conditions, and should be familiar with the role of opioid therapy for these conditions. The goal of this article is to help determine which patients may be appropriate candidates for the initiation or continuation of opioid therapy for gynecologic pain. In addition, this article will help the clinician to establish treatment goals, select appropriate medications, monitor the efficacy of treatment, and to determine when discontinuation of medications is appropriate.
Patient Perception of How Smoking Status Influences Cardiac Rehabilitation Attendance After an Acute Cardiac Hospitalization
Authors: Riley Hayden , Headley Samuel , Lindenauer Peter K. , Goff Sarah , Szalai Heidi , Gaalema Diann E. , Pack Quinn R.
Published: November 2018

Purpose:

Patients hospitalized with a cardiac condition are less likely to attend cardiac rehabilitation (CR) if they are smokers despite the benefits of doing so. The present study sought to investigate how, if at all, a patient's decision to attend CR was influenced by his or her tobacco use post-discharge.

Methods:

We surveyed smokers during their hospitalization for a cardiac condition. Four to 8 wk after discharge, a follow-up survey assessed self-reported CR attendance, smoking cessation (SC), and patient opinion of how their smoking status influenced CR attendance.

Results:

Of the 81 patients who completed the baseline survey (68% male, 57 ± 10 y), 62 (77%) completed the follow-up survey. Consistent with prior findings, there was a substantial correlation between SC and CR attendance (OR: 16.0, P < .001) with 36 (44%) patients attending CR overall and 38 (47%) abstaining from smoking. Patients reported a wide variety of reasons for not attending CR, but most patients (n = 39, 63%) reported that their smoking status did not influence their decision to attend CR. However, 5 patients (8%) reported attending CR because they successfully quit smoking, and 5 (8%) attended CR anticipating support with SC.

Conclusion:

A strong relationship exists between SC and CR attendance following a cardiac hospitalization; however, most patients did not feel that their smoking status was a factor in their decision to attend CR. Regardless of the reason, it appears that success with one behavior may be related to the other and that both SC and CR attendance should be encouraged.
Examining the role of value congruence, professional identity, and managerial job engagement in the budgetary participation–performance link
Authors: Macinati Manuela S. , Nieddu Luciano , Rizzo Marco Giovanni
Published: November 2018

Background:

In health care, important phenomena of perceived incompatibility between professional and managerial values have emerged as consequences of New Public Management reforms. Although there is a growing evidence on the variation in the enactment of hybrid roles by medical managers, existing research in health care management is mostly descriptive with little emphasis on the conditions under which hybrid roles are enacted and, importantly, on the effects of this variation on performance.

Purpose:

In this article, we seek to fill this research gap by empirically examining (a) whether budgetary participation aligns professional and organizational values, (b) the impact of this alignment on employees’ work-related feelings and managerial performance, and (c) the effect of professional identity on value congruence.

Methodology:

Data were collected by a survey conducted in an Italian hospital, and partial least square was used to test the relationships among variables.

Results:

Overall, results show that (a) high involvement in budgeting is instrumental in facilitating medical managers’ value congruence, and this, in turn, positively effects managerial job engagement; (b) the effect of budgetary participation on value congruence depends on the extent of professional identity; and (c) as a result of enhanced value congruence and managerial job engagement, employees tend to deliver superior role performance.

Practice implication:

Findings of this study provide some guidance for managers on how organizations can take steps to guarantee effective support to hybrid professionals.
Cigarette Smoking on Severity of Primary Angle Closure Glaucoma in Malay Patients
Authors: Niven Teh Chong Seong , Azhany Yaakub , Rohana Abdul J. , Karunakar Tirmandas V.N. , Thayanithi Sandragasu , Jelinar Noor Mohd N. , Norhalwani Husain , Zuraidah Mustari , Siti Azrin Ab H. , Ahmad Mt S. , Aung Tin , Liza-Sharmini Ahmad T.
Published: November 2018

Purpose:

The purpose of this study was to determine the association between cigarette smoking and the severity of primary angle closure glaucoma (PACG) in Malay patients residing in Malaysia.

Methods:

A cross-sectional study was conducted involving 150 Malay PACG patients between April 2014 and August 2016. Ocular examination was performed including Humphrey visual field (HVF) 24-2 analysis assessment. On the basis of the 2 consecutive reliable HVFs, the severity of glaucoma was scored according to modified Advanced Glaucoma Intervention Study (AGIS) by 2 masked investigators and classified as mild, moderate, and severe. Those with retinal diseases, neurological diseases, memory problem, and myopia ≥4 diopters were excluded. Their smoking status and details were obtained by validated questionnaire from Singapore Malay Eye Study (SiMES). The duration of smoking, number of cigarettes per day, and pack/year was also documented. Multiple linear regression analysis was conducted.

Results:

There was a significant association between education level and severity of PACG (P=0.001). However, there was no significant association between cigarette smoking and severity of glaucoma (P=0.080). On the basis of multivariate analysis, a linear association was identified between cigarette smoked per day (adjusted b=0.73; 95% CI: 0.54, 1.45; P<0.001) and body mass index (adjusted b=0.32; 95% CI: 0.07, 1.35; P=0.032) with AGIS score.

Conclusions:

There was no significant association between cigarette smoking and severity of PACG. Cigarette smoked per day among the smokers was associated with severity of PACG. However, because of the detrimental effect of smoking, cessation of smoking should be advocated to PACG patients.
A Retrospective Study of 199 Xen45 Stent Implantations From 2014 to 2016
Authors: Heidinger Astrid , Schwab Christoph , Lindner Ewald , Riedl Regina , Mossböck Georg
Published: November 2018

Purpose:

The aim of this study is to determine the postoperative course after Xen45 Gel Stent implantation at the Medical University of Graz from 2014-2016.

Methods:

Single-center, retrospective study. All patients with Xen implantation between 2014 and 2016 were included. Clinical records and reports received from supervising ophthalmologists were used for evaluations. Investigated parameters were intraocular pressure (IOP), the number of medications, visual acuity, and the number of previous operations, IOP-follow-up, intraoperative and postoperative complications, the rate of interventions (needling), and additionally performed surgeries.

Results:

Xen was implanted in 199 eyes of 160 patients. Mean preoperative IOP was 22.8±6.9 mm Hg on 2.9±1.0 IOP-lowering medication. After 12 months follow-up, mean IOP was 17.1±5.9 mm Hg (n=89, P<0.0001; mean reduction of 22.7%) on 1.8±1.4 (n=87; P<0.0001) IOP-lowering medications. There were no intraoperative complications and in two cases (1.0%) severe postoperative adverse events occurred (aqueous misdirection and late-onset endophthalmitis). Postoperative needling was indicated in 44 cases (22.1%), while in 28 cases (14.1%) an additional glaucoma surgery was performed.

Conclusions:

Our results indicate that Xen implantation is an effective surgical intervention leading to a significant reduction of IOP and number of medications with a low rate of complications. An attentive postoperative management seems to be mandatory.
Adult-onset Buphthalmos in Down Syndrome
Authors: Faria-e-Sousa Sidney J. , Marques Alexandre G. , Vieira Juliana , Antunes-Foschini Rosalia
Published: November 2018

Purpose:

To report a peculiar case of adult-onset buphthalmos.

Methods:

Review of the medical record of a 24-year-old patient with Down syndrome who developed buphthalmos in the left eye after corneal transplantation for keratoconus.

Results:

In the next 2 years after surgery, the operated eye evolved with chronic anterior uveitis that led to progressive peripheral synechiae, oscillating intraocular pressure, cataract, graft failure, and buphthalmos.

Conclusions:

The finding of buphthalmos of adult-onset in Down syndrome raises important issues concerning the classification of this eye condition and the responsibility for detecting and monitoring eyes with glaucoma in individuals with chromosome 21 trisomy.
Maternal Perinatal HIV Infection Is Associated With Increased Infectious Morbidity in HIV-exposed Uninfected Infants
Authors: Powis Kathleen M. , Slogrove Amy L. , Okorafor Ibeawuchi , Millen Lily , Posada Roberto , Childs Jocelyn , Abrams Elaine J. , Sperling Rhoda S. , Jao Jennifer
Published: November 2018

Background:

The aging population of females with perinatally-acquired HIV (PHIV) are having their own children. HIV-exposed uninfected infants (HEU-N) born to women living with non-perinatally-acquired HIV (NPHIV) experience higher infectious morbidity compared with HIV-unexposed infants (HUU). Little is known about the infectious morbidity risk of HIV-exposed uninfected infants (HEU-P) born to PHIV women.

Methods:

We evaluated prevalence of infectious cause hospitalizations (ICH) during the first year of life among HEU-P, HEU-N and HUU infants in a United States (U.S) tertiary care center. Maternal HIV status was categorized as PHIV vs. NPHIV vs. HIV-uninfected. Generalized Estimating Equation models were fit to evaluate the association between maternal HIV status and infant ICH.

Results:

ICH was evaluated among 205 infants, 28 HEU-P infants, 112 HEU-N infants, and 65 HUU infants. PHIV women were younger compared with NPHIV and HIV-uninfected women (median age 22 years vs. 29 and 23 respectively, p<0.01). Overall, 21% of HEU-P, 4% of HEU-N and 12% of HUU infants experienced at least one ICH event (p<0.01) in the first year of life. After adjusting for confounders, HEU-P infants were at increased ICH risk compared with HEU-N infants [adjusted odds ratio (aOR)=7.45, 95% Confidence Interval (CI):1.58-35.04]. In sub-group analysis of HEU infants, excluding HUU infants, this relationship persisted after adjustment for maternal CD4 and HIV RNA level (aOR=10.24, 95% CI:1.66-63.31)

Conclusions:

In a small U.S. cohort, HEU-P infants experienced increased ICH risk. Differences in intrauterine environments, social factors, or access to care may be important factors to assess in future larger studies.
Manual therapy prevents onset of nociceptor activity, sensorimotor dysfunction, and neural fibrosis induced by a volitional repetitive task
Authors: Bove Geoffrey M. , Delany Sean P. , Hobson Lucas , Cruz Geneva E. , Harris Michele Y. , Amin Mamta , Chapelle Susan L. , Barbe Mary F.
Published: November 2018

Painful and disabling musculoskeletal disorders remain prevalent. In rats trained to perform repetitive tasks leading to signs and dysfunction similar to those in humans, we tested whether manual therapy would prevent the development of the pathologies and symptoms. We collected behavioral, electrophysiological, and histological data from control rats, rats that trained for 5 weeks before performing a high-repetition high-force (HRHF) task for 3 weeks untreated, and trained rats that performed the task for 3 weeks while being treated 3x/week using modeled manual therapy (MMT) to the forearm (HRHF + MMT). The MMT included bilateral mobilization, skin rolling, and long axis stretching of the entire upper limb. High-repetition high-force rats showed decreased performance of the operant HRHF task and increased discomfort-related behaviors, starting after training. HRHF + MMT rats showed improved task performance and decreased discomfort-related behaviors compared with untreated HRHF rats. Subsets of rats were assayed for presence or absence of ongoing activity in C neurons and slow Aδ neurons in their median nerves. Neurons from HRHF rats had a heightened proportion of ongoing activity and altered conduction velocities compared with control and MMT-treated rats. Median nerve branches in HRHF rats contained increased numbers of CD68+macrophages and degraded myelin basic protein, and showed increased extraneural collagen deposition, compared with the other groups. We conclude that the performance of the task for 3 weeks leads to increased ongoing activity in nociceptors, in parallel with behavioral and histological signs of neuritis and nerve injury, and that these pathophysiologies are largely prevented by MMT.
Heart Failure Care Dyadic Typology
Authors: Buck Harleah G. , Hupcey Judith , Juárez-Vela Raul , Vellone Ercole , Riegel Barbara
Published: November 2018

Background

Heart failure (HF) dyadic self-care science is advancing rapidly, as evidenced by recent theoretical work, literature reviews, and multiple empiric studies. Typologies, once considered archaic, are now viewed as person-oriented classification systems that allow a whole-system view of information patterns. This whole-system view is particularly needed to understand complex tasks like dyadic HF self-care.

Purpose

The purpose of this article is to review the initial conceptualization of an HF care dyadic typology and the present advances in our thinking and suggest future directions for this clinically relevant classification system.

Conclusions

Development and testing of the typology across 5 studies resulted in a well-characterized, pragmatic and parsimonious, person-oriented classification system for understanding how patients and informal caregivers conduct patients' HF self-care at home. The 4 types are characterized as 2 individually oriented types—type I, patient oriented; type II, caregiver oriented; and 2 relationally oriented types—type III, collaboratively oriented; and type IV, incongruently oriented. We have devised a single-item measure of typology group that can be assessed in the clinical setting. Once this information is ascertained, the clinician can personalize the plan of care to the realities of the dyad.

Implications

Dyads that disagree on who is responsible for self-care may forego or delay action, resulting in self-care failures with subsequent HF advancement, hospitalization, and mortality. As the HF dyadic self-care science has advanced, we have come to appreciate the complexity that arises when 2 individuals work together on 1 complex task—HF self-care.
Filling the Gaps: Predicting Physician Assistant Students' Interest in Practicing in Medically Underserved Areas
Authors: Yuen Cynthia X. , Lessard Donovan
Published: November 2018

Purpose

Physician assistants (PAs) are well situated to provide much-needed care in medically underserved areas (MUAs). Therefore, it is critical to understand the factors that make PA students want to practice in MUAs. The current study investigated how 3 student characteristics—underrepresented minority (URM) status, geographic origin, and family socioeconomic status—were associated with PA students' interest in practicing in MUAs after graduation.

Methods

Upon their matriculation in 2016, 4329 PA students provided key demographic information (ie, gender, age, race, ethnicity, geographic origin, and an indicator of family socioeconomic status) and reported their interest in working in an MUA after graduation. Multiple linear regression was used to predict students' level of interest in practicing in an MUA, and multiple logistic regression was used to predict students' likelihood of expressing interest in practicing in an MUA. All analyses controlled for students' gender and age at matriculation.

Results

All 3 student characteristics were independently associated with interest in practicing in an MUA, such that URM students, students from rural backgrounds, and less affluent students expressed greater interest in practicing in an MUA after graduation compared with their non-URM, suburban, and more affluent counterparts.

Conclusion

Demographic commonalities may drive PA students' interest in practicing in an MUA after graduation.
The Effects of Lycra Arm Sleeve on Glenohumeral Subluxation in Poststroke Hemiplegia—A Preliminary Study
Authors: Kumar Praveen
Published: November 2018

Introduction

The primary aim of this preliminary prospective cross-sectional study was to assess the effects of Lycra arm sleeves on the glenohumeral subluxation (acromiongreater tuberosity distance) in people with poststroke hemiplegia. A secondary aim was to explore patients' perceptions regarding the practicality of applying the Lycra arm sleeve. The setting was community care in South West England. Participants were patients with chronic stroke (n = 5; 2 men, 3 women; mean ± SD age, 51 ± 8 years) with one-sided weakness.

Materials and Methods

Patients were instructed to wear the Lycra arm sleeve for 7 hrs a day for 7 consecutive days. Ultrasound measurements of acromion greater tuberosity (AGT) distance, numerical rating scale for pain, and upper-limb function using the Motor Assessment Scale were recorded before and immediately after application of the sleeve on day 1 and day 8. A questionnaire was completed by patients on day 8 to explore perceptions.

Results

Analysis of the data using an analysis of variance for a 2 × 2 fully repeated measure design suggests that 1) there is no significant mean difference in AGT distance between day 1 and day 8 (F(1,4) = 1.28, MSE = 0.014, P = 0.322) 2); there is a significant mean difference in AGT distance due to wearing of sleeve (F(1,4) = 19.258, MSE = 0.011, P = 0.012); and 3) the change in AGT distance on day 1 due to wearing of sleeve is not statistically different from the change on day 8 (F(1,4) = 0.537, MSE = 0.008, P = 0.504). Three patients experienced decreased pain, and one patient showed improvement in the upper-limb function score. The mean time the Lycra arm sleeve was worn each day was 6.7 hrs. Three patients found the sleeve easy to wear and 4 patients found the sleeve beneficial.

Conclusions

Trends toward reduction in mean AGT distance suggest Lycra arm sleeves may be beneficial in glenohumeral subluxation (GHS) management. Further research is required to establish their effectiveness in acute and chronic settings using a well-designed fully powered randomized controlled trial.
What Do Parents Need to Know About Concussion? Developing Consensus Using the Delphi Method
Authors: Kroshus Emily , Chrisman Sara P. D. , Harmon Kimberly G. , Herring Stanley A. , Broglio Steven P. , Master Christina L. , McGill Catherine A. , Putukian Margot , Register-Mihalik Johna K. , Rivara Frederick P. ,   for the National Delphi Panel on Sports Concussion Knowledge
Published: November 2018

Objective:

Many schools and sports leagues provide preseason concussion education to parents/guardians, and in some jurisdictions, it is required for interscholastic sports participation. However, directives about content are absent or vague. The purpose of this study was to obtain expert consensus about what parents/guardians need to know to about concussion.

Design:

A modified Delphi process with nationally recognized expert panel members was used to obtain consensus about parent/guardian behaviors relevant to concussion prevention, identification, and management and knowledge domains relevant to performance of those behaviors.

Results:

Sixteen parent/guardian behaviors and 24 knowledge domains were identified. However, consensus was not achieved regarding whether it is realistic to expect parents/guardians to perform approximately one-third of the behaviors that experts agreed mattered. This variability may reflect underlying uncertainty about the capacities of some parents/guardians to put knowledge into action or the belief that there are other barriers to action. Furthermore, for most knowledge domains, there was a lack of agreement about whether or not there could be a “correct” answer on the basis of current scientific knowledge.

Conclusions:

These findings raise practical and ethical questions: how can we expect parents/guardians to help prevent, identify, or manage concussion if they cannot have all the information required to engage in these behaviors due to lack of scientific consensus? This issue is not unique to concussion. Best practices for risk communication and shared decision-making can inform how we think about educating parents/guardians about concussion inside and outside of the health care setting.
Salvianolate injection in the treatment of acute cerebral infarction
Authors: NanZhu Yang , AiChun Ju , Xin Li , XiangHua Yun
Published: November 2018

To evaluate the effectiveness and safety of Salvianolate injection (SI) in the treatment of acute cerebral infarction (ACI).

We electronically searched databases including PubMed, The Cochrane Library, EMBASE, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, and WanFang Data to collect randomized controlled trials (RCTs) focused on SI treating ACI up to August 2017. Two reviewers independently screened literatures, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.

A total of 39 RCTs involving 4516 patients were included. The results of meta-analysis showed that compared with the Western medicine (WM) therapies group [experimental group (EG)], the total effective rate of SI + WM [control group (CG)] was higher (relative risk = 1.29, 95% CI: 1.24–1.35, P < .00001) in 21 RCTs; SI could improve movement function evaluation scores, including National Institute of Health Stroke Scale, Barthel Index, activities of daily living (P < .00001). There was no significant difference in modified Rankin Scale scores between the 2 groups (P = .008) EG was better than CG in improving Montreal Cognitive Assessment scores (P = .001) and Mini-Mental State Examination scores (P < .00001). SI could improved not only the hemorheology indexes, including plasma viscosity, whole blood high-shear viscosity, whole blood low-shear viscosity, fibrinogen (P < .00001), but also high-sensitivity C-reactive protein and C-reactive protein. EG could achieve a better effect on improving the neural deficit scores (P < .00001). There was no significant difference about adverse drug reactions/adverse drug events between the EG and CG (P = .73).

Salvianolate can promote recovery of the motor and cognitive function of patients with ACI. However, due to the limited quality and quantity of included studies, more high-quality studies are needed to verify the above conclusion.
Sotos syndrome
Authors: Kamal Naglaa M. , Althobiti Jwaher M. , Alsaedi Abdulaziz , Bakkar Ayman , Alkaabi Tahani
Published: November 2018

Rationale:

Sotos syndrome is a rare genetic disorder characterized by rapid growth during infancy and childhood; ≥2 SD for height and head circumference; distinctive facial appearance and developmental delay.

Ten clinically diagnosed cases have been reported from Saudi Arabia; none of them was genetically confirmed.

Patient concerns:

A male Saudi patient, who had a birth length and head circumference above 97th centile, presented with abnormal rapid growth, delayed motor and mental milestones, aggressive behavior, obsession to close doors, nail biting, defective attention, and hyperactivity.

Diagnoses:

Sotos syndrome was suspected

Interventions:

Molecular genetic analysis for NSD1 gene was carried for the patient.

Outcomes:

A novel heterozygous deletion of all exons 1 to 23 of the NSD1 gene was detected. Genetic counseling was carried for the family with extended genetic testing for the parents and his siblings with normal results.

Lessons:

Despite its worldwide distribution, Sotos syndrome may be under-reported. Besides its characteristic clinical picture, molecular genetic testing is also extremely recommended.
A meta-analysis and systematic review of percutaneous catheter drainage in treating infected pancreatitis necrosis
Authors: Zhang Zhi-Hua , Ding Yi-Xuan , Wu Yu-Duo , Gao Chong-Chong , Li Fei
Published: November 2018

Background:

In the current meta-analysis, we focus on the exploration of percutaneous catheter drainage (PCD) in terms of its overall safety as well as efficacy in the treatment of infected pancreatitis necrosis based on qualified studies.

Methods:

The following electronic databases were searched to identify eligible studies through the use of index words updated to May 2018: PubMed, Cochrane, and Embase. Relative risk (RR) or mean difference (MD) along with 95% confidence interval (95% CI) were utilized for the main outcomes.

Results:

A total of 622 patients in the PCD group and 650 patients in the control group from 13 studies were included in the present meta-analysis. The aggregated results indicated that the incidence of bleeding was decreased significantly (RR: 0.42, 95% CI: 0.25–0.70) in the PCD group as compared with the control group. In addition, PCD decreased the mortality (RR: 0.76, 95% CI: 0.41–1.42), hospital duration (SMD: −0.22, 95% CI: −0.77 to –0.33), duration in intensive care unit (ICU) (SMD: −0.13, 95% CI: −0.30 to –0.04), pancreatic fistula (RR: 0.73, 95% CI: 0.46–1.17), and organ failure (RR: 0.91, 95% CI: 0.45–1.82) in comparison with the control group, but without statistical significance.

Conclusion:

Our findings provide evidence for the treatment effect of PCD in the decrease of bleeding, mortality, duration in hospital and ICU, pancreatic fistula, organ failure as compared with the surgical treatment. In conclusion, further studies based on high-quality RCTs with larger sample size and long-term follow-ups are warranted for the confirmation of PCD efficacy in treating infected pancreatitis necrosis.
Is dynamic locking plate superior than other implants for intracapsular hip fracture
Authors: Li Tao , Zhang Qing-song
Published: November 2018

Background:

We studied the safety and efficacy of dynamic locking plate vs. other implants (cannulated cancellous screws [CCS] or sliding hip screw [SHS]) in patients undergoing intracapsular hip fracture (ICHF).

Methods:

We searched Pubmed, Embase, Web of Science, Cochrane library and Google database from inception to March 25, 2018. We selected any studies comparing dynamic locking plate for treatment ICHF. Non-union rate, osteonecrosis rate, cutout rate, revision rate, the replacement rate, and Harris hip scores were the outcomes. Stata 12.0 was used for meta-analysis.

Results:

Four studies involving 419 patients (143 patients in the dynamic locking plate group and 276 patients in the other implants group) were finally included. Compared with CCS or SHS, dynamic locking plate was associated with a reduction of nonunion rate, revision rate, replacement rate (P <.05). Furthermore, dynamic locking plate was also associated with an increase of the Harris hip scores (P <.05). There was no significant difference between the osteonecrosis rate and cutout rate (P >.05).

Conclusions:

Current meta-analysis revealed that dynamic locking plate has a benefit role in improving postoperative clinical outcome than CCS or SHS in ICHF patients. Further high quality and large-scale randomized controlled trials (RCTs) are needed to further identify the efficacy of dynamic locking plate for ICHF.
Impact of a change in duration of prophylactic antibiotics on infectious complications after radical cystectomy with a neobladder
Authors: Kim Chung-Jong , Kim Kwang Hyun , Song Wan , Lee Dong Hyeon , Choi Hee Jung
Published: November 2018

A profound number of prophylactic antibiotics are used after radical cystectomy with an ileal orthotopic neobladder (RCIONB) despite a negative effect of infection control. We investigated the impact of short-term prophylactic antibiotic use on infectious complications after RCIONB.

We retrospectively reviewed data from 287 patients who underwent RCIONB for bladder cancer between 2012 and 2016 at a tertiary hospital. The patients were divided into 2 groups according to the pattern of prophylactic antibiotics (185 patients in a long-term group, 25-day use of 3-staged multiple antibiotics versus 102 patients in a short-term group, 24-hour use of cefotetan). The onset of complications, including bacteriuria, febrile urinary tract infection (FU), and bacteremia, and the microorganisms responsible for infections were compared between the groups. Of all 287 patients, bacteriuria, FU, and bacteremia were identified in 177 (61.7%), 85 (29.6%), and 18 (6.3%) patients, respectively. Bacteriuria was identified more frequently in the short-term group (49.2% vs 84.3%, P <.001). However, the rates of FU within 60 days of surgery were similar in both groups (28.6% vs 28.4%, P = .969). The rate of FU was not significantly different between the 2 groups. There was no significant difference in the rate of patients with bacteremia (5.4% vs 7.8%, P = .415). The most frequent microorganisms seen in bacteriuria were Enterococcus faecium and Enterococcus faecalis, in the long-term and short-term group, respectively. Antibiotic-resistant Enterococcus species were more frequently present in the long-term group.

Short-term use of prophylactic antibiotics is effective for preventing urinary tract infections after RCIONB and decreasing colonization with multi-drug-resistant organisms.
Phenotypic and genotypic features of a pair of Chinese identical twins with congenital insensitivity to pain and anhidrosis
Authors: Li Ningbo , Sun Jiaoli , Guo Shanna , Liu Yi , Wang Cong , Zhu Changmao , Zhang Xianwei
Published: November 2018

Rationale:

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive genetic disorder characterized by insensitivity to noxious stimulus and the absence of sweating. Fractures and joint destruction are common complications, but detailed studies on mineral and skeletal homeostasis are not available. Mental retardation is often reported, but detailed observations during childhood are lacking.

Patient concerns:

A pair of 46-month-old Chinese identical twin brothers was presented at our hospital. The brothers had the typical manifestations of insensitivity to noxious stimulus, inability to sweat, and recurrent episodes of unexplained fever. Fortunately, they did not present common complications such as self-mutilation, trauma, bruise, and repeated bone fractures.

Diagnoses:

Two novel compound heterozygous variants of NTRK1 (c.632T > A and c.1253_1254delTC) were identified.

Interventions:

The patients were subjected to routine and specialist clinical examinations. Daily care and symptomatic treatment were given.

Outcome:

X-ray films of proband 2 showed a fracture in the first metatarsal. Decreased bone mineral density (BMD) and mild-to-moderate retardation of the Gesell developmental schedules (GDS), especially language and adaptability, were observed. Evaluation results for BMD and GDS in proband 2 were worse than those in his brother.

Lessons:

The current findings expand our knowledge about the spectrum of phenotypic and genotypic features of CIPA, which will help facilitate future genotype–phenotype association studies. Daily care by parents promotes favorable outcomes in patients.
Use of argatroban for extracorporeal life support in patients with nonheparin-induced thrombocytopenia
Authors: Kim Young Su , Lee Heemoon , Yang Ji-Hyuk , Sung Kiick , Suh Gee Young , Chung Chi Ryang , Yang Jeong Hoon , Cho Yang Hyun
Published: November 2018

Unfractionated heparin (UFH) is currently the standard anticoagulant used in extracorporeal life support (ECLS). However, severe thrombocytopenia occurs frequently during ECLS use and it may be difficult to determine whether this represents heparin-induced thrombocytopenia (HIT) or not. In this case, UFH cannot be continued. Because a confirmatory laboratory test requires time, argatroban is empirically used if HIT is suspected. However, many patients are not found to have HIT. In non-HIT patients, the effectiveness and safety of argatroban are unclear. Thus, we investigated whether argatroban was safe and useful in patients who were suspected of having HIT and were started on argatroban, but were ultimately found to have non-HIT.

We retrospectively reviewed all patients on ECLS who received the anticoagulant argatroban as an alternative to UFH between January 2014 and July 2015. The pretest clinical score (4Ts) was calculated, and a score greater than 4 was considered an indication for argatroban. The target-activated clotting time or activated partial thromboplastin time was 1.5 times the patient's upper normal value. Of 191 patients on ECLS during the study period, 10 (5.2%) were treated with argatroban infusion.

No patients were found to have antiplatelet factor 4/heparin antibodies. The average maintenance dose of argatroban was 0.1 μg/kg/min. Platelet counts increased significantly following argatroban administration (P = .02). There were no anticoagulation-related complications such as bleeding or thrombosis.

Our results suggest that argatroban is a safe alternative to UFH for patients with non-HIT on ECLS. Argatroban may have a more significant platelet-preserving effect than UFH, regardless of whether HIT is present.
Coexistence of anti-HMGCR and anti-MDA5 identified by an unlabeled immunoprecipitation assay in a chinese patient cohort with myositis
Authors: Huang Li , Wang Li , Yang Yang , Chen Huan , Liu Yanjuan , Liu Ke , Liu Meidong , Xiao Yizhi , Zuo Xiaoxia , Li Yisha , Luo Hui , Zhang Huali , Xiao Xianzhong
Published: November 2018

Myositis-specific autoantibodies are important diagnostic and prognostic markers. The aim of our study is to detect anti-3-hydroxy 3-methylutaryl coenzyme A reductase (anti-HMGCR) antibody using novel unlabeled immunoprecipitation (IP) assay and immunoblotting in Chinese patients with myositis and to clarify the features of anti-HMGCR-positive patients. In the present study, we established novel unlabeled IP assay and immunoblotting of HMGCR C-terminus for anti-HMGCR detection. The presence of anti-HMGCR was screened in 181 Chinese patients with myositis. The sera from 12 of 181 patients were positive for anti-HMGCR. The prevalence of anti-HMGCR autoantibody in our cohorts is about 6.6%. Unexpected, coexistence of anti-HMGCR and anti-melanoma differentiation-associated protein (anti-MDA5) were identified in 4 patients with characteristic rash and interstitial lung disease (ILD), but without myasthenia and elevated serum creatine kinase (CK) levels. Other anti-HMGCR positive patients without anti-MDA5 presented with severe proximal muscle weakness. Mean serum CK levels and lactate dehydrogenase (LDH) were significantly higher in anti-HMGCR-positive patients than in antibody-negative patients (P <.05). Muscle biopsies available from 6 anti-HMGCR-positive patients were characterized with prominent myofiber necrosis and regeneration, little or none of inflammatory cell infiltrates. None of anti-HMGCR positive patients in our cohort was exposed to statins. Our data suggested that anti-HMGCR were found to coexist frequently with anti-MDA5 identified by the established unlabeled IP assay and statin exposure is rare in Chinese myositis patients with anti-HMGCR.
Association of muscle strength with cardiovascular risk in Korean adults
Authors: Lee Mee-Ri , Jung Sung Min , Kim Hwa Sung , Kim Yong Bae
Published: November 2018

There are few existing studies that examine the association between muscle strength and cardiovascular disease (CVD) risk stratified by sex. Evaluation of the handgrip strength is a simple, quick, and inexpensive method to measure muscle strength. This study assessed the association of handgrip strength with the risk of CVD in the Korean general population.

Data were derived from a subset of an ongoing nationally representative survey: the Korea National Health and Nutrition Examination Survey (KNHANES), 2014 to 2016, which included 8576 participants aged 40 to 79 years (men: 3807; women: 4769). Individual CVD risk was evaluated by calculating the atherosclerotic cardiovascular disease (ASCVD) risk score and the Framingham risk score (FRS) in subjects aged 40 to 79 years without prior CVD.

Multivariate linear regression analysis revealed a significant inverse association (in both men and women) between relative handgrip strength and cardiovascular risk factors, including blood pressure, levels of fasting glucose and triglycerides, waist circumstance, FRS, high sensitivity C-reactive protein levels, and ASCVD risk. A significant positive association between relative handgrip and a low level of high density cholesterol levels in both men and women was identified. In both men and women, subjects in the lowest quartile of handgrip strength had an increased risk of CVD compared with those within the highest quartile (odds ratio range 2.05–3.03).

The results of this study suggest that increased handgrip is associated with a lower degree of cardiovascular risk in both men and women. Longitudinal studies are needed to examine the association between muscle strength and cardiovascular risk.
Syphilis prevalence and risk factors among young men presenting to the Brazilian Army in 2016
Authors: da Motta Leonardo Rapone , Sperhacke Rosa Dea , Adami Aline de Gregori , Kato Sérgio Kakuta , Vanni Andréa Cristina , Paganella Machline Paim , de Oliveira Maria Cristina Pimenta , Giozza Silvana Pereira , da Cunha Alessandro Ricardo Caruso , Pereira Gerson Fernando Mendes , Benzaken Adele Schwartz
Published: November 2018

The Conscripts Survey has been conducted periodically by the Brazilian Department of Sexually Transmitted Infections (STIs), AIDS, and Viral Hepatitis (DIAHV) in collaboration with the Brazilian Ministry of Defense for over 2 decades. It aims to assess the syphilis prevalence and obtain data on knowledge regarding STIs and their risk factors among conscripts enlisted for the Brazilian Army.

This cross-sectional study was conducted among conscripts across Brazil aged 17 to 22 years from August to December 2016. It included a self-reported questionnaire and blood testing for syphilis, HIV, and hepatitis B and C.

In total 38,247 conscripts were enrolled; after exclusion due to a lack of information, 37,282 (93.2%) conscripts were included. The estimated syphilis prevalence rates were: 1.63%, 1.09%, and 0.62% for screened, confirmed, and active syphilis, respectively. Among those with active syphilis, 81.1% reported not having syphilis infection in their lifetime. Higher confirmed syphilis prevalence rates were observed in the South region, followed by North and Southeast regions. Independent factors associated with confirmed syphilis infection were: self-reported STIs in one's lifetime (odds ratio [OR] = 7.24; P < .001), same-sex sexual relationships (OR = 3.43; P = .001), and having the 1st sexual intercourse encounter before 15 years of age (OR = 2.62; P = .04). The proportion of conscripts who reported having sex with other men (MSM) was 4.3%, and the estimated syphilis prevalence in this group was 5.23%, 4.61%, and 3.60% for screened, confirmed, and active syphilis, respectively. The sexual behaviors most frequently associated with confirmed syphilis were: sexual relationship with casual partners in the last year (P < .001), same-sex sexual relationships (P < .001), more than 10 partners (P = .006), and having sexual intercourse before 15 years of age (P = .003). Although not significant, only 25.4% of the conscripts who had a confirmed syphilis reported the use of condoms with steady partners, 32.4% with casual partner, and 24.3% with any partner.

We found that syphilis is on the rise among the young Brazilian male population. The increase in its prevalence, particularly among MSM, highlights the need for urgent public health interventions, action plans, and implementation of risk reduction strategies aimed at this population.
Prevalence of the fabella and its association with pain in the posterolateral corner of the knee
Authors: Pop Tudor Sorin , Pop Anca Maria , Olah Peter , Trâmbiţaş Cristian
Published: November 2018

The functions and clinical consequences of the fabella, a sesamoid bone found in the posterolateral aspect of the knee joint, are still a reason of intense debate in the scientific literature. Its incidence was reported to range between 20% and 87% and its presence was usually associated with the persistent pain in the posterolateral region of the knee. The aim of our study was to measure the prevalence, anatomic and clinical features of the fabella within a cross-sectional study, conducted in a Romanian orthopaedic center. Between 2015 and 2017, a consecutive series of 562 patients with knee injuries or persistent knee pain has been examined by radiographs and Magnetic Resonance Imaging and a set of anatomical and clinical parameters have been recorded. Collected data was evaluated with RadiANT DICOM Viewer and statistically analyzed with GraphPad Prism 7. The level of significance was set atP <.05. The incidence of the fabella in our study group was 16.93%, lower than previously reported for Caucasian populations. We found statistically significant differences regarding the possible association of the fabella with pain in the posterolateral corner of the knee (P = .04) and the 2 dimensions of the bone according to gender (P = .03 respectivelyP = .01), but the prevalence was not influenced by gender (P = .6). The anatomic characteristics could be important in differentiating this sesamoid bone from calcifications or loose bodies located in the knee joint region. Due to the high association with the posterolateral knee pain, the fabella should be recorded during knee examination as a differential diagnosis, before any surgical procedure.
The role of serum procalcitonin in the differential diagnosis of pneumonia from pulmonary edema among the patients with pulmonary infiltrates on chest radiography
Authors: Yoon Young Kyung , Kim Min Ja , Yang Kyung Sook , Ham Soo-Youn
Published: November 2018

The aim of this study is to evaluate the usefulness of serum procalcitonin (PCT) as a diagnostic biomarker for distinguishing pneumonia from pulmonary edema in patients presenting with pulmonary infiltrates on chest radiography.

A comparative study was performed retrospectively in a university-affiliated hospital, from May, 2013 to April, 2015. Adult patients (≥18 years) who showed pulmonary infiltrates on chest radiography and had blood tests with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), PCT, and N-terminal pro-b-type natriuretic peptide (NT-proBNP) on admission were included in the study. Clinical parameters collected on admission were compared between the case group (n = 143) with pneumonia and the control group (n = 88) with pulmonary edema alone.

During the study period, a total of 1217 patients were identified. Of them, a total of 231 patients were included in analyses based on exclusion criteria. In the multivariate logistic regression analysis, PCT ≥0.25 ng/mL, ESR ≥35 mm/h, CRP ≥18 mg/L, NT-proBNP ≤200 pg/mL, underlying neurologic diseases, fever, sputum, absence of cardiomegaly, and a low Charlson comorbidity index were independently associated with pneumonia. For this model, the sensitivity, specificity, positive predictive value, and negative predictive value in distinguishing between the 2 groups were 90.2%, 79.6%, 87.8%, and 83.3%, respectively, with an area under the curve of 0.93.

This study suggests that the practical use of PCT in conjunction with clinical data can be valuable in the differential diagnosis of pulmonary infiltrates and guidance for clinicians to prevent antibiotic misuse.