bluuebunny/crossref_metadata_2025 huggingface dataset:
George Chance and Frank Holdsworth: Understanding Spinal Instability and the Evolution of Modern Spine Injury Classification Systems
Authors: Thakur Jai Deep , Wild Elizabeth , Menger Richard , Hefner Matthew , Adeeb Nimer , Kalakoti Piyush , Nanda Anil
Published: March 2020

The concept of spinal cord injury has existed since the earliest human civilizations, with the earliest documented cases dating back to 3000 BC under the Egyptian Empire. Howevr, an understanding of this field developed slowly, with real advancements not emerging until the 20th century. Technological advancements including the dawn of modern warfare producing mass human casualties instigated revolutionary advancement in the field of spine injury and its management. Spine surgeons today encounter “Chance” and “Holdsworth” fractures commonly; however, neurosurgical literature has not explored the history of these physicians and their groundbreaking contributions to the modern understanding of spine injury. A literature search using a historical database, Cochrane, Google Scholar, and PubMed was performed. As needed, hospitals and native universities were contacted to add their original contributions to the literature. George Quentin Chance, a Manchester-based British physician, is well known to many as an eminent radiologist of his time who described the eponymous fracture in 1948. Sir Frank Wild Holdsworth (1904-1969), a renowned British orthopedic surgeon who laid a solid foundation for rehabilitation of spinal injuries under the aegis of the Miners' Welfare Commission, described in detail the management of thoraco-lumbar junctional rotational fracture. The work of these 2 men laid the foundation for today's understanding of spinal instability, which is central to modern spine injury classification and management algorithms. This historical vignette will explore the academic legacies of Sir Frank Wild Holdsworth and George Quentin Chance, and the evolution of spinal instability and spine injury classification systems that ensued from their work.
On the origin and continuing evolution of SARS-CoV-2
Authors: Tang Xiaolu , Wu Changcheng , Li Xiang , Song Yuhe , Yao Xinmin , Wu Xinkai , Duan Yuange , Zhang Hong , Wang Yirong , Qian Zhaohui , Cui Jie , Lu Jian
Published: March 2020

The SARS-CoV-2 epidemic started in late December 2019 in Wuhan, China, and has since impacted a large portion of China and raised major global concern. Herein, we investigated the extent of molecular divergence between SARS-CoV-2 and other related coronaviruses. Although we found only 4% variability in genomic nucleotides between SARS-CoV-2 and a bat SARS-related coronavirus (SARSr-CoV; RaTG13), the difference at neutral sites was 17%, suggesting the divergence between the two viruses is much larger than previously estimated. Our results suggest that the development of new variations in functional sites in the receptor-binding domain (RBD) of the spike seen in SARS-CoV-2 and viruses from pangolin SARSr-CoVs are likely caused by natural selection besides recombination. Population genetic analyses of 103 SARS-CoV-2 genomes indicated that these viruses had two major lineages (designated L and S), that are well defined by two different SNPs that show nearly complete linkage across the viral strains sequenced to date. We found that L lineage was more prevalent than the S lineage within the limited patient samples we examined. The implication of these evolutionary changes on disease etiology remains unclear. These findings strongly underscores the urgent need for further comprehensive studies that combine viral genomic data, with epidemiological studies of coronavirus disease 2019 (COVID-19).
Derivation of a Model to Guide Empiric Therapy for Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection in an Endemic Area
Authors: Weston Gregory , Jahufar Fathima , Sharma Nikhil , Su Christopher , Bellin Eran , Ostrowsky Belinda
Published: March 2020

Background

Appropriate therapy for carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) is often given late in the course of infection, and strategies for identifying CRKP BSI earlier are needed.

Methods

A retrospective case–control study was performed at a tertiary care hospital, university hospital, and community hospital in Bronx, New York. All participants had a blood culture sent and received an antibiotic within 48 hours of the culture. The case group (n = 163) had a blood culture with CRKP. The control group (n = 178) had a blood culture with carbapenem-susceptible Klebsiella. Data were obtained by electronic or conventional medical record abstraction. A multiple logistic regression model was built to identify associated factors and develop a clinical model for CRKP BSI. Model performance characteristics were estimated using a 10-fold cross-validation analysis.

Results

A prior nonblood culture with carbapenem-resistant Enterobacteriaceae, skilled nursing facility (SNF) residence, mechanical ventilation, and admission >3 days were strongly associated risk factors. A significant interaction led to development of separate clinical models for subjects admitted <3 days at the time of positive blood culture from those admitted at least 3 days. The derived models had a good ability to discriminate between subjects with and without CRKP BSI. A clinical classification rule to guide therapy can prioritize sensitivity or specificity.

Conclusions

Prior nonblood cultures showing resistance and exposure to SNF and health care settings are factors associated with carbapenem resistance. The clinical classification rules derived in this work should be validated for ability to guide therapy.
Delayed Relapse of Paracoccidioidomycosis in the Central Nervous System: A Case Report
Authors: Rahman Rifat , Davies Leela , Mohareb Amir M , Peçanha-Pietrobom Paula M , Patel Nirav J , Solomon Isaac H , Meredith David M , Tsai Harrison K , Guenette Jeffrey P , Bhattacharyya Shamik , Urday Sebastian , Velásquez Gustavo E
Published: March 2020

Paracoccidioidomycosis is a dimorphic fungal infection endemic in Latin America. We report a patient with a history of pulmonary paracoccidioidomycosis who presented with relapsed disease in the central nervous system 4 years after initial treatment. We review current treatment strategies for paracoccidioidomycosis and neuroparacoccidioidomycosis.
Intuitionism in the Philosophy of Mathematics: Introducing a Phenomenological Account
Authors: Berghofer Philipp
Published: March 2020

The aim of this paper is to establish a phenomenological mathematical intuitionism that is based on fundamental phenomenological-epistemological principles. According to this intuitionism, mathematical intuitions are sui generis mental states, namely experiences that exhibit a distinctive phenomenal character. The focus is on two questions: what does it mean to undergo a mathematical intuition and what role do mathematical intuitions play in mathematical reasoning? While I crucially draw on Husserlian principles and adopt ideas we find in phenomenologically minded mathematicians such as Hermann Weyl and Kurt Gödel, the overall objective is systematic in nature: to offer a plausible approach towards mathematics.
Fast growth of the number of proceedings papers in atypical fields in the Czech Republic is a likely consequence of the national performance-based research funding system
Authors: Vanecek Jiri , Pecha Ondrej
Published: March 2020

This article compares the growth rates of Web of Science indexed research publications in 11 European countries from 2000 to 2015. The growth of publication output in the Czech Republic was very fast: the annual production increased more than threefold. However, the number of articles increased only 2.6-fold, whereas the number of proceedings papers increased eightfold. During 2013–15 almost one-third of the papers published by researchers based in the Czech Republic were proceedings papers, a much higher share than in any other benchmark country. Such a high share is undesirable, because proceedings papers are generally much less often cited than journal articles. The growth of the number of proceedings papers is fastest in 17 fields belonging to the social sciences which usually do not hold proceedings papers in high regard. Our analysis shows that this undesirable development started after the introduction of national performance-based research funding system (PRFS) in the Czech Republic. Hence, the effort made to publish proceedings papers seems to reflect an optimization strategy in the light of the PRFS. In the Czech PRFS, proceedings papers have been rewarded point values similar to articles in refereed journals and a large portion of the institutional funding is allocated according to the evaluation results. As a consequence of very fast growth of proceedings papers in the social sciences, the university institutional funding in these fields has grown faster than in other fields. In conclusion, the fast growth of proceedings papers represents an adaptive behavior to the context of the PRFS.
Consistent Exposure to Psychosocial Stressors and Progressive Intolerance to Stress in Individuals at Clinical High Risk for Psychosis
Authors: Ristanovic Ivanka , Vargas Teresa , Cowan Henry R , Mittal Vijay Anand
Published: March 2020

A body of evidence suggests that exposure to psychosocial stressors and stress sensitivity are involved in psychosis pathogenesis. However, little is known about the temporal course of these domains in those with psychosis-risk syndromes. Furthermore, to date, there have been no studies examining associations between psychosocial stressors and impaired stress tolerance, or how these factors might be implicated in symptom progression prior to psychosis onset. A total of 73 clinical high-risk (CHR) participants and 78 healthy controls (HCs) completed baseline measures of life event (LE) exposure and impaired stress tolerance. Additionally, 54 CHR and 57 HC participants returned to complete the same procedures at a 12-month follow-up assessment. Results indicated that when compared to HCs, CHR individuals exhibited increased LE exposure and impaired stress tolerance at baseline. Longitudinal analyses compared subgroups of CHR participants who exhibited positive symptoms worsening over the 1-year course (CHR-Prog), improved or steady (CHR-Remiss/Persist), and HCs. CHR-Prog individuals showed consistently elevated independent LEs exposure while CHR-Remiss/Persist reported a decline and HCs a steady low level across time. Furthermore, CHR-Prog exhibited increased stress intolerance, while the CHR-Remiss/Persist improved and HCs displayed consistently low levels over time. Analyses examining interrelationships between these domains showed a trend level interaction effect predicting follow-up symptoms. Taken together, results from the present study indicate an important role for exposure to stressors and increasing stress intolerance during psychosis pathogenesis. Additionally, findings indicating that decreases in stress exposure may lead to more favorable outcomes provide a promising target for novel targeted interventions.
The social origins of Christian democracy: rural–urban migration, interest group preemption, and the rise of the Catholic workers’ movement
Authors: Walter André
Published: March 2020

Despite the importance of Christian democracy for economic and social policies throughout the 20th century, we know very little about the incorporation of labor interests into Catholic parties. Existing accounts claim that the formation of Catholic worker organizations is rooted in the process of industrialization and reforms of Catholic social teachings. In contrast, I argue that the integration of the workers’ wing was dependent on the position of farmers’ and business associations within Catholic parties and the integrative capacities of local religious institutions. The migration of Catholics from peripheral to industrialized areas put pressure on Catholic elites in urban centers to integrate workers via class-based associations. In contrast, entrenched interest groups of farmers and businesses, as well as clerical associations, fend off the creation of workers’ associations in rural regions in which industrialization took place. My argument is supported by newly collected district-level and survey data.
Transcriptomic and Exometabolomic Profiling Reveals Antagonistic and Defensive Modes ofClonostachys roseaAction AgainstFusarium graminearum
Authors: Demissie Zerihun A. , Witte Thomas , Robinson Kelly A. , Sproule Amanda , Foote Simon J. , Johnston Anne , Harris Linda J. , Overy David P. , Loewen Michele C.
Published: March 2020

The mycoparasite Clonostachys rosea ACM941 is under development as a biocontrol organism against Fusarium graminearum, the causative agent of Fusarium head blight in cereals. To identify molecular factors associated with this interaction, the transcriptomic and exometabolomic profiles of C. rosea and F. graminearum GZ3639 were compared during coculture. Prior to physical contact, the antagonistic activity of C. rosea correlated with a response heavily dominated by upregulation of polyketide synthase gene clusters, consistent with the detected accumulation of corresponding secondary metabolite products. Similarly, prior to contact, trichothecene gene clusters were upregulated in F. graminearum, while those responsible for fusarielin and fusarin biosynthesis were downregulated, correlating with an accumulation of trichothecene products in the interaction zone over time. A concomitant increase in 15-acetyl deoxynivalenol-3-glucoside in the interaction zone was also detected, with C. rosea established as the source of this detoxified mycotoxin. After hyphal contact, C. rosea was found to predominantly transcribe genes encoding cell wall–degradation enzymes, major facilitator superfamily sugar transporters, anion:cation symporters, as well as alternative carbon source utilization pathways, together indicative of a transition to necrotropism at this stage. F. graminearum notably activated the transcription of phosphate starvation pathway signature genes at this time. Overall, a number of signature molecular mechanisms likely contributing to antagonistic activity by C. rosea against F. graminearum, as well as its mycotoxin tolerance, are identified in this report, yielding several new testable hypotheses toward understanding the basis of C. rosea as a biocontrol agent for continued agronomic development and application.
Congenital Pseudarthrosis of the Fibula: Controlling Ankle Valgus in a Heterogenous Condition
Authors: Wang Kemble K. , Vuillermin Carley B. , Eisenberg Katherine A. , May Collin J. , Kasser James R.
Published: March 2020

Background:

Congenital pseudarthrosis of the fibula (CPF) is a rare disorder characterized by a deficiency in the continuity of the fibula and can lead to progressive ankle valgus malalignment. An existing classification system for CPF is imperfect and may contribute to heterogeneity in reporting and discrepancy of outcomes in the literature.

Methods:

Fifteen patients with CPF treated at our institution between 1995 and 2017 were retrospectively identified. Only patients with dysplasia leading to spontaneous fracture or pseudarthrosis were included in this series. The median age at presentation was 2.5 years (range: 3 mo to 13.4 y). The median duration of follow-up from the initial presentation was 11.8 years (range: 2.0 to 24 y). Chart review and serial radiographs were analyzed to assess natural history and outcomes following surgery.

Results:

The coexistence of tibial dysplasia in CPF is very common. Patients were classified into 3 groups based on the degree of tibial involvement—group 1: no evidence of tibial dysplasia, group 2: mild tibial dysplasia, and group 3: significant tibial dysplasia. Age at presentation and age at which fibular fracture occurred were progressively younger with a greater degree of tibial involvement (P<0.05). In the absence of surgical intervention, group 1 patients did not undergo progressive ankle valgus (defined as the valgus change in tibiotalar angle by ≥4 degrees), whereas all patients in groups 2 and 3 did (P<0.001). Fibular osteosynthesis was performed in 6 patients, with union seen only in group 1 patients. Ten patients underwent distal tibiofibular fusion, with no cases of nonunion seen. Distal tibiofibular fusion with or without medial distal tibial hemiepiphysiodesis halted the progression of ankle valgus in 8 of the 10 patients. Further progression of ankle valgus occurred only in patients who did not undergo concurrent medial distal tibial hemiepiphysiodesis and with considerable wedging of the distal tibial epiphysis at the time of fusion.

Conclusions:

Tibial dysplasia and CPF are intimately related. Grouping patients on this basis may help guide natural history and treatment and may explain discrepancies in findings in the literature. Fibular osteosynthesis, distal tibiofibular fusion, and medial distal tibial hemiepiphysiodesis may all have an important role in the treatment of CPF.

Level of Evidence:

Level IV—case series.
Gemcitabine Plus Cisplatin Chemotherapy Prolongs the Survival in Advanced Hilar Cholangiocarcinoma
Authors: Shin Dong Woo , Kim Min Jae , Lee Jong-chan , Kim Jaihwan , Woo Sang Myung , Lee Woo Jin , Lee Kwang Hyuck , Hwang Jin-Hyeok
Published: March 2020

Objectives:

Gemcitabine plus cisplatin (GC) is recommended as first-line treatment for advanced cholangiocarcinoma. We investigated the impact of GC in patients with unresectable hilar cholangiocarcinoma (HC) based on the time taken for effective biliary drainage (EBD).

Materials and Methods:

We retrospectively enrolled 113 patients with unresectable HC. Thirty-nine and 74 patients received GC chemotherapy and best supportive care (BSC), respectively. EBD was defined as a reduction in total bilirubin >50% or to a value <2 mg/dL after the drainage procedure. Early EBD (eEBD) and delayed EBD (dEBD) were separated by 2 weeks. Overall survival (OS) was estimated.

Results:

The GC group showed a significantly longer median OS than the BSC group (12.8 vs. 6.1 mo; P<0.001). Moreover, the eEBD group experienced a significantly longer OS than the dEBD group (8.2 vs. 4.3 mo; P<0.001). GC led to improved OS in the eEBD (12.8 vs. 6.8 mo; P=0.003) and dEBD (12.2 vs. 3.4 mo; P=0.009) groups. In multivariate analysis, dEBD (adjusted hazard ratio [aHR], 1.785; 95% confidence interval [CI], 1.183-2.691; P=0.006), BSC (aHR, 2.409; 95% CI, 1.579-3.675; P<0.001), and an ECOG status ≥2 (aHR, 3.721; 95% CI, 2.093-6.615; P<0.001) were associated with poor prognosis. In GC group, the older (70 y and above) patients did not have a higher risk of death than younger patients.

Conclusions:

GC prolongs the survival of patients with unresectable HC, even those with dEBD or elderly.
Yellow Fever Vaccination In EGG-Allergic Children
Authors: Sharma Ketaki , Perrett Kirsten P. , Wood Nicholas
Published: March 2020

Yellow fever vaccine contains ovalbumin, and guidelines for vaccination of egg allergic patients vary widely. We present our experience of administering yellow fever vaccine to 11 egg-allergic children, including 3 with anaphylaxis to egg, in 2 Australian tertiary pediatric hospitals. There was variation in the vaccination protocols used; however, all patients were successfully vaccinated and no serious adverse events were reported.
In Vivo Morphological Study of Common Canalicular Orifice and Its Impact on Lacrimal Probing
Authors: Singh Swati , Curragh David S. , Davis Gary , Selva Dinesh
Published: March 2020

Purpose:

To study the in vivo morphology of common canalicular/lacrimal sac mucosal folds (CLS-MFs) and their relationship with probing findings.

Methods:

Consecutive cases undergoing endoscopic dacryocystorhinostomy had endoscopic examination of the internal canalicular orifice (ICO). Details of CLS-MFs folds, probing findings, and outcomes of dacryocystorhinostomy were analyzed.

Results:

Thirty-six lacrimal systems of 34 patients (mean age, 58 years; 7 males, 27 females) were examined. All 36 lacrimal systems had a single common canalicular orifice entering the lacrimal sac (100%). Overall, 61.1% (22/36) had visible CLS-MFs, out of which only 13.6% (3/22) were overhanging the ICO requiring manipulation of the probe to enter the lacrimal sac. The orientation of folds was superior 180° in 2, posterosuperior in 2, posterior in 6, inferior 180° in 6, and inferior 270° (excluding 10–2′o clock quadrant) in 6 systems. Two cases preoperatively labeled as having common canalicular obstruction, based on lacrimal syringing, had CLS-MFs impacting against the ICO without any anatomical obstruction. One of 5 cases with lacrimal sac mucocele had CLS-MFs located along the posterosuperior edge extending for 270°, which resulted in a soft stop on preoperative lacrimal syringing findings. Only 1 case had a true membrane (2.7%) overlying the ICO, which required excision. No differences in outcomes of dacryocystorhinostomy were observed between cases with CLS-MFs versus without any folds.

Conclusion:

CLS-MFs display a wide variation in terms of morphological location and extent along the ICO. They might be responsible for the false soft stop observed in some cases on preoperative syringing and do not require excision.
Adenoid Cystic Carcinoma of the Eyelid Can Locally Recur and Mimic Basal Cell Carcinoma: Case Report and Review of the Literature
Authors: Ronquillo Cecinio C. , Vegunta Sravanthi , Ellis Nathan , Mamalis Nick , Patel Bhupendra C. K.
Published: March 2020

Adenoid cystic carcinoma (ACC) of the eyelid is a very rare tumor, and only 11 cases have been previously reported in the literature. Here the authors report the 12th case of eyelid ACC that was initially diagnosed as adenoid basal cell carcinoma. This is the first report of local recurrence after wide local excision using the Mohs technique. Additionally, this is the first report that demonstrates that ACC can present clinically and histologically similar to basal cell carcinoma. The authors summarize the previous reports of eyelid ACC to compile a reference for this growing body of literature. It is important for oculoplastic surgeons and dermatopathologists to keep ACC in the differential diagnosis of eyelid tumors and carefully examine histology specimens with this differential in mind.
Acupuncture for lumbar disc herniation
Authors: Yuan Sheng , Huang Chuyu , Xu Yuanyue , Chen Dong , Chen Lei
Published: March 2020

Background:

As development of society and change of modern life style, the prevalence of lumbar disc herniation (LDH) has been increasing. Being a major cause of low back pain, sciatica and radicular leg pain, LDH imposes a heavy burden on both individual and society. Because of high surgically intervene rate, non-invasive (non-surgical) treatments are recommended for most cases. Acupuncture has the advantages of low risk, good effect and low cost which has been proven that could alleviate pain while physical therapy plays a major role in the treatment of LDH in the vast majority of countries. The aim of this systematic review is to evaluate the effectiveness and safety of acupuncture for LDH.

Methods:

RCTs on ACU treating LDH will be searched from the following databases: PubMed, Web of science, EmBase, Cochrane Library, China National Knowledge Infrastructure, Wanfang data, from their inception to May 2020. The primary outcomes are verbal rating scale and functional disability. Two reviewers will independently exclude substandard articles and extract eligible data. The risk of bias will be assessed using the Cochrane Handbook 5.1.0 for Systematic Reviews of Interventions. Egger test will be used to assess the reporting bias. Heterogeneity will be evaluated by the I2 statistic and Q test. We will conduct the meta-analysis using Stata V12.0 to evaluate the effectiveness of ACU for LDH. In case of high heterogeneity, sensitivity analysis of different items and subgroup analysis will be performed. The Grading of Recommendations Assessment, Development, and Evaluation System will be used to assess the quality of evidence.

Results:

The results of this review will be submitted to a journal for publication.

Conclusion:

This proposed systematic review will evaluate the effectiveness and safety of acupuncture for LDH.

Registration:

PROSPERO (registration number CRD42019148272).
The significance of arginase-1 expression in the diagnosis of liver cancer
Authors: Wang Xuejiao , Xu Yifei , Wang Ruochong , Dai Ning , Zhang Wei , Li Feng
Published: March 2020

Background:

Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Pathologic distinction between HCC and intrahepatic cholangiocarcinoma (ICC) and metastatic adenocarcinoma can be challenging and sometimes requires immunohistochemical panels. Recently, arginase-1 (ARG-1) has been introduced for differentiation of these tumors.

Methods:

We will search Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure through August 1, 2019, comprehensive collection studies about the diagnostic value of ARG-1 for HCC. Two reviewers will screen literature according to the inclusion and exclusion criteria, extract data, and assess the quality of included studies. Review Manager 5.3 and STATA 15.0 will be used to conduct the meta-analysis.

Results:

The review will provide a high-quality synthesis of current evidence of the diagnostic value of liver cancer. The results will be published in a peer-reviewed journal.

Conclusion:

We hope that the results of this study will provide significant evidence to assess the value of ARG-1 in differential diagnosis of HCC, ICC, and metastatic carcinoma of liver.
Overexpression of miR-17 is correlated with liver metastasis in colorectal cancer
Authors: Lai Hao , Zhang Jie , Zuo Hongqun , Liu Haizhou , Xu Jing , Feng Yan , Lin Yuan , Mo Xianwei
Published: March 2020

Background:

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in men and women. The presence of systemic disease, with metastatic spread to distant sites such as the liver, considerably reduces the survival rate in CRC. Cancer stem cells contribute to the metastatic potential of CRC. However, the mechanism underlying metastasis in CRC remains unclear. Thus, this study aimed to examine the expression of microRNAs (miRNAs) in CRC stem cells in cases of liver metastases and assess their correlation with clinicopathological features.

Methods:

miRNAs showing high expression in liver metastases and primary lesions were selected through data mining of gene expression omnibus datasets, and miRNAs characteristic of stem cells were selected through COREMINE medical text mining. Subsequently, paired formalin-fixed paraffin-embedded tissue samples of primary CRC and liver metastasis from 30 patients were examined for the expression of miRNAs common to these lists (hsa-miR-20a, hsa-miR-26b, hsa-miR-146a, hsa-miR-17, hsa-miR-451, hsa-miR-23a, and hsa-miR-29a) using quantitative real-time polymerase chain reaction. Further, miRNA expression was compared between liver metastases and the primary tumor in each patient and the factors associated with differential expression were analyzed.

Results:

hsa-miR-17 was significantly upregulated in liver metastases (P < .05), but no significant difference in the expression of hsa-miR-26b, hsa-miR-146a, hsa-miR-451, hsa-miR-23a, and hsa-miR-29a was observed between primary tumors and liver metastases. The higher expression of hsa-miR-17 in liver metastases was associated with the administration of neoadjuvant chemotherapy and tumor differentiation (P < .05) but was not associated with age, sex, tumor location, or lymphatic metastasis.

Conclusions:

High expression of miR-17 may contribute to liver metastasis in CRC. Therefore, an in-depth understanding of its downstream pathways could help in elucidating the mechanisms underlying liver metastases in CRC. However, additional studies are warranted to validate these findings.
An acceptability pilot of the facilitating active management in lung illness with engaged surrogates (FAMILIES) study
Authors: Ervin Jennifer N.
Published: March 2020

Approximately half of the surrogate decision makers of critically ill adults are at risk for negative emotional burden. Decision support and effective surrogate-clinician communication buffers against such experiences. The objective of this study is to evaluate the acceptability of a new surrogate-targeted educational tool that promotes engagement with clinicians and advocacy for 2 evidence-based practices in the provision of mechanical ventilation for acute respiratory failure: spontaneous awakening and breathing trials.

A panel of 44 former patients and surrogates of a 20-bed medical intensive care unit in a large academic hospital responded to an online survey. Acceptability was measured on 3 dimensions: attitudes toward the content and delivery of information, objective knowledge translation, and subjective knowledge acquisition.

More than 80% of participants found the tool to be easy to read, and over 90% felt that the tool provided actionable recommendations. A significant number of previously unsure participants were able to identify what spontaneous awakening and breathing trials are and when they occur, and 16% to 36% reported significant improvements in their subjective understanding of the target evidence-based practices, after being exposed to the educational tool.

This line of work seeks to reduce surrogates’ negative emotional burden while also promoting quality critical care. The educational tool provides a promising new way to promote surrogate-clinician communication, by increasing surrogates’ knowledge about and encouraging advocacy for evidence-based practices in the provision of mechanical ventilation.
An analysis of children's clothing-related injuries cases reported by the media in mainland of China from 2003 to 2017
Authors: Cheng Sixiang , Chiwanda Kaminga Atipatsa , Cheng Xunjie , Xu Huilan
Published: March 2020

Background:

Numerous reports in the media have suggested that children could be hurt due to their clothing, yet there are few medical reports that discussed children's clothing-related injuries. This study therefore, aimed to describe the epidemiological characteristics of media-reported injury cases related to children's clothing in Mainland of China.

Methods:

This study systematically collected a total of 192 cases of children's clothing-related injuries reported in the news reports and medical literatures published by the Chinese media before December 2017. A content analysis of these cases was conducted to obtain information on the characteristics of these injuries.

Results:

Cases of clothing-related injuries were most common in children aged 3 to 6 years (54.7%); the ratio of the number of boys to the number of girls in the 192 cases was 1.5: 1. In addition, approximately 51% of the cases occurred in the region of East China. The most common location of the incidents was in the home (35%). Furthermore, the zippers are the most common cause of injuries (15.1%), and the most common injured body part was the genital organs (29.2%). Besides, there were 24 cases reported death related to clothing injuries (13%). Moreover, the locations where the injuries occurred, the reasons for the occurrence of the injuries and the injured body parts differed significantly by gender and age (P < .05).

Conclusions:

Our findings suggest that future unintentional injuries could be prevented by implementing 2 major initiatives: improving the promotion of the safety of children clothing design in China and educating consumers on the potential risk associated with children's clothing.
Effect of Banxia Baizhu Tianma Tang for H-type hypertension
Authors: Chen Dongjie , Li Chenyue , Cai Hairong , Zhuang Jieqin , Huang Yonglian , Peng Xiaohong , Li Shaoping , Huang Yaxiu , Wang Ping , Luo Yajie , Zhan Zhenye
Published: March 2020

Background:

H-type hypertension is a kind of cardiovascular disease that threatens human life and health seriously. Banxia Baizhu Tianma Tang (BBTT) has been used widely for H-type hypertension while its effective evidence is not clear. Hence, we provide a systematic review protocol to evaluate the efficacy and safety of BBTT in the treatment of H-type hypertension.

Methods:

Nine databases including Cochrane Library, PubMed, EMBASE, WOS, Medline, CNKI, WangFang, CBM, and VIP will be searched from their inception to October 2019. All randomized controlled trials (RCTs) of BBTT for H-type hypertension will be included. The language is limited to Chinese and English. The primary outcome measure will be the major adverse cardiac and cerebral events (MACCE). The entire process will include study selection, data extraction, assessment of bias risk, data synthesis. Data analysis will be performed using RevMan V.5.3.5 (The Cochrane Collaboration, Oxford, UK).

Results:

This study will evaluate the efficacy and safety of BBTT in the treatment of H-type hypertension from several aspects, including MACCE, blood pressure (BP), blood lipids, inflammation indicators and homocysteine (Hcy).

Conclusion:

This systematic review will provide evidence for determining whether or not BBTT is an effective and safe intervention for H-type hypertension.

PROSPERO registration number:

PROSPERO CRD 42019131491.
Acupuncture and moxibustion for primary osteoporosis
Authors: Xu Guixing , Xiao Qiwei , Zhou Jun , Wang Xu , Zheng Qianhua , Cheng Ying , Sun Mingsheng , Li Juan , Liang Fanrong
Published: March 2020

Primary osteoporosis (PO) is a common disease that was characterized by a systemic impairment of bone mass and microarchitecture that results in fragility fractures and constitutes a pressing public health problem. But the effect of acupuncture or moxibustion treatment for PO is controversial.

To provide a comprehensive systematic overview of current evidence from systematic reviews (SR)/Meta-analysis of acupuncture treatment for PO pertaining to risk of bias, quality of evidence and report quality.

A total of 9 international and Chinese databases were searched for SR/meta-analysis of randomized controlled trials (RCTs). The risk of bias of SR/meta-analysis was appraised using the risk of bias in systematic reviews (ROBIS) instrument, the quality of the evidence was evaluated via Grading of Recommendations Assessment, Development and Evaluation (GRADE), and the report quality of the included studies are estimated by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).

According to ROBIS, only 2 articles were with risk of low bias; according to PRISMA, and most articles were reported incomplete, mainly in Q2, Q7, Q24, and Q27; according to GRADE, a total of 28 outcome indicators were evaluated under 4 different interventions of experimental group and control group: the evidence quality of bone mineral density (BMD) from treatment of acupuncture and moxibustion/acupuncture and moxibustion plus was high or moderate; Visual Analogue Score (VAS) of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was low or very low; clinical effectiveness of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was uncertain.

Acupuncture and moxibustion can improve the BMD of PO patients according to high-quality evidence, and may benefit VAS, pain score, clinical efficacy based on moderate or low-quality evidence. Further research that provides higher quality evidence of SR/RCTs of acupuncture and moxibustion treatment for PO is required.
Incidence of hepatitis B virus infection among human immunodeficiency virus-infected treatment naïve adults in Botswana
Authors: Phinius Bonolo Bonita , Anderson Motswedi , Bokete Resego , Mbangiwa Tshepiso , Choga Wonderful Tatenda , Baruti Kabo , Makhema Joseph , Musonda Rosemary , Blackard Jason T. , Essex Max , Moyo Sikhulile , Marlink Richard , Gaseitsiwe Simani
Published: March 2020

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection is highest in sub-Saharan Africa and results in accelerated clinical outcomes compared with HBV or HIV mono-infection. HBV clearance rates are higher in healthy adults; however, in sub-Saharan Africa, there are limited data on clearance of incident HBV in HIV-infected adults. Therefore, we sought to estimate HBV incidence and HBV surface antigen (HBsAg) clearance in HIV-infected adults in Botswana.

This was a retrospective longitudinal study of 442 HIV-1C infected treatment naïve patients enrolled in a previous Botswana Harvard AIDS Institute Partnership study. Archived plasma samples from 435 HIV-infected treatment naïve participants were screened for HBsAg and HBV core antibody (anti-HBc). HBsAg was evaluated annually over a 4-year period, and HBV deoxyribonucleic acid (DNA) levels of HBsAg-positive chronic and incident patients were quantified.

Baseline median CD4+ T-cell count was 458 cells/μL [Q1, Q3: 373, 593], and median HIV viral load was 4.15 copies/mL [Q1, Q3: 3.46, 4.64]. Twenty two HBV incident cases occurred, representing an incidence of 3.6/100 person-years [95% CI: 2.2–5.6]. All incident HBV cases with a follow-up sample available for screening (13/22) cleared HBsAg. Detectable HBV viral loads among chronic and incident cases ranged between 5.15 × 101 to 1.4 × 107 IU/L and 1.80 × 101 to 1.7 × 108 IU/mL, respectively.

We report high HBV incidence associated with elevated HBV DNA levels despite high CD4+ T-cell counts in HIV-infected patients in Botswana. These incidence cases represent a potential source of HBV transmission in the population. Scaling-up of HIV treatment strategies utilizing antiretroviral therapy regimens with anti-HBV activity coupled with screening for HBV infections in households of the HBsAg-positive cases is recommended.
Risk of acute respiratory failure among hospitalized patients with various admission serum albumin levels
Authors: Thongprayoon Charat , Cheungpasitporn Wisit , Chewcharat Api , Mao Michael A. , Thirunavukkarasu Sorkko , Kashani Kianoush B.
Published: March 2020

Serum albumin is a marker of nutritional and frailty status. This study aimed to assess the association between serum albumin at the time of admission and the risk of acute respiratory failure (ARF) in hospitalized patients

This cohort study, performed at a tertiary referral hospital, included all hospitalized adult patients from January 2009 to December 2013 who had serum albumin measurement and were not on mechanical ventilation within 24 hours of hospital admission. Serum albumin was stratified into 2.4, 2.5 to 2.9, 3.0 to 3.4, 3.5 to 3.9, 4.0 to 4.4, and ≥4.5 g/dL. Multivariate logistic regression analysis was performed to obtain adjusted odds ratio (OR) of risk of ARF requiring mechanical ventilation based on various admission serum albumin levels.

Of 12,719 patients, ARF requiring mechanical ventilation occurred in 1128 (8.9%) during hospitalization. Hypoalbuminemia was associated with increased risk of ARF, in particular when serum albumin was ≤2.4 g/dL. Compared with serum albumin of 4.0–4.4 g/dL, serum albumin ≤2.4 g/dL at admission was associated with 2.38-time higher odds of ARF during hospitalization (OR 2.38, 95% confidence interval [CI] 1.84–3.07). In contrast, elevated serum albumin ≥4.5 g/dL was associated with lower odds of ARF (OR 0.68, 95% CI 0.48–0.97).

Admission serum albumin level lower than 3.5 g/dL was associated with a higher risk of ARF requiring mechanical ventilation, whereas elevated serum albumin level at least 4.5 g/dL was associated with a lower risk of ARF. Therefore, admission albumin level at admission might be useful in the prediction of ARF during hospitalization.
The optimal timing of surgical ligation of patent ductus arteriosus in preterm or very-low-birth-weight infants
Authors: Yan Hualin , Ma Fan , Li Yifei , Zhou Kaiyu , Hua Yimin , Wan Chaomin
Published: March 2020

Background:

Patent ductus arteriosus (PDA) is a particularly common problem in preterm infants. Although surgical ligation is rarely performed in many contemporary neonatal intensive care units, it remains a necessary treatment option for preterm infants with a large hemodynamically significant PDA under strict clinical criteria, and it can reduce mortality in preterm infants. However, the optimal timing of surgical ligation is still controversial. We conducted this systematic review and meta-analysis to compare the mortality and morbidity of early and late surgical ligation of PDA in preterm or very-low-birth-weight (VLBW) infants.

Methods:

This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019133686). We searched the databases of PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform up to May 2019.

Results:

This review included 6 retrospective studies involving 397 premature or VLBW infants with PDA. Pooled analysis showed that compared with the late ligation group, the early ligation group had a lower fraction of inspired oxygen (FiO2) at 24 hours postoperatively (mean difference [MD] −6.34, 95% confidence interval [CI] −9.45 to −3.22), fewer intubation days (MD −19.69, 95% CI −29.31 to −10.07), earlier date of full oral feeding (MD −22.98, 95% CI −28.63 to −17.34) and heavier body weight at 36 weeks of conceptional age (MD 232.08, 95% CI 57.28 to 406.88). No significant difference in mortality or other complications was found between the early and late groups.

Conclusion:

Our meta-analysis implies that compared with late surgical ligation, early ligation might have a better respiratory outcome and nutritional status for PDA in preterm or VLBW infants. There was no difference in mortality or postoperative complications between early and late ligation. A randomized prospective clinical trial with a possible large sample size is urgently needed to reinvestigate this conclusion.

PROSPERO registration number:

CRD42019133686.
Comparison of xenogeneic acellular dermal matrix and skin grafts in reconstruction of postoperative defects of hypopharyngeal cancer
Authors: Zang Jian , Feng Shuai , Yang Huijun , Guo Xing
Published: March 2020

Successful reconstruction after tumor resection facilitates rapid recovery and retention of good quality of life, and this is important for a successful operation. This study aimed to analyze and compare the application and efficacy of xenogeneic acellular dermal matrix (xeno-ADM) and abdominal skin graft in hypopharynx reconstruction.

This is a retrospective cohort study that included 25 patients with posterior hypopharyngeal wall cancer who underwent partial hypopharyngectomy with laryngeal preservation. The patients were divided into 2 groups according to the repair materials used. Eleven patients were treated with xeno-ADM, and 14 patients with abdominal skin grafts for repairing hypopharyngeal mucosal defects. The intraoperative data, postoperative recovery time of eating function, graft contraction, infection and pharyngeal fistula rate, and 1-year survival rate of the 2 groups were analyzed and compared.

Compared with skin grafts group (23.1 ± 5.8 days), the recovery time of eating function in xeno-ADM group was shorter (17.3 ± 6.4 days), (P = .026). Also the number of postoperative hospitalization days were less in the xeno-ADM group (18.5 ± 6.7 days) than in the skin grafts group (24.1 ± 5.6 days) (P = .035). Besides, no significant differences were observed in other comparisons between the 2 groups. Also no obvious rejection and severe graft contraction were observed in both the groups. All patients were successfully decannulated.

Both xeno-ADM and abdominal skin grafts demonstrated good effects in the reconstruction of hypopharynx, but the recovery time of eating function in patients with xeno-ADM was faster, which may be due to rapid epithelialization. In addition, it avoids trauma of donor sites.
A clinical prediction rule for acute bilirubin encephalopathy in neonates with extreme hyperbilirubinemia
Authors: Zhang Fanhui , Chen Lihua , Shang Shiqiang , Jiang Kewen
Published: March 2020

To establish a clinical prediction rule for acute bilirubin encephalopathy (ABE) in term/near-term neonates with extreme hyperbilirubinemia.

A retrospective cohort study was conducted between January 2015 and December 2018. Six hundred seventy-three out of 26,369 consecutive neonates with extreme hyperbilirubinemia were enrolled in this study. Data included demographic characteristics, total serum bilirubin (TSB), albumin, bilirubin/albumin ratio (B/A), direct antiglobulin test, glucose-6-phosphate deficiency, asphyxia, sepsis, acidosis. ABE was defined as a bilirubin induced neurological dysfunction score of 4 to 9. We used stepwise logistic regression to select predictors of ABE and devised a prediction score.

Of the 673 eligible infants, 10.8% suffered from ABE. Our prediction score consisted of 3 variables: TSB (as a continuous variable; odds ratio [OR] 1.16; 95% confidence interval [CI], 1.02–1.31; logistic coefficient 0.15), B/A (as a continuous variable; OR 1.88; 95% CI, 1.19–2.97; logistic coefficient 0.67), and sepsis (OR 3.78; 95% CI, 1.40–10.21; logistic coefficient 1.19). Multiplying the logistic coefficients by 10 and subtracting 75, resulted in the following equation for the score: Score = 12 × (if sepsis) + 1.5 × (TSB) + 7 × (B/A) − 75. The model performed well with an area under the curve of 0.871.

The risk of ABE can be quantified according to TSB, B/A, and sepsis in term/near-term neonates with extreme hyperbilirubinemia.
Characteristics and outcome of nosocomial bloodstream infection in patients with acute-on-chronic liver failure
Authors: Su Haibin , Tong Jingjing , Liu Xiaoyan , Li Chen , Chen Jing , Xu Xiang , Guan Chongdan , Peng Yuhui , Yan Lilong , Ning Peng , Li Hui , Zhang Lina , Hu Jinhua
Published: March 2020

Aim

Patients with acute-on-chronic liver failure (ACLF) have a high risk of developing infections while hospitalized. Nosocomial bloodstream infection (BSI) is not uncommon, particular in patients who receive invasive operation, which may have negative impact on prognosis. In this study, we aim to investigate the characteristics and short-term outcome of nosocomial BSI in patients with ACLF.

Methods

Sixty-three patients with ACLF and nosocomial BSI from January 2014 to December 2015 were retrospectively studied. Clinical characteristics and distribution of bacteria at the time of BSI onset and short-term mortality were collected.

Results

The most common etiology of ACLF was hepatitis B virus infection. Eighty-one percent of ACLF patients had other types of infections at BSI onset. Gram-negative bacteria (77.8%) were the main pathogens, among which Escherichia coli was responsible for 46.9%. Staphylococcus epidermidis was the main Gram-positive bacteria. The most prevalent multidrug resistance (MDR) bacteria was extended-spectrum β-lactamase (ESBL)-producing E. coli. The overall 28-day mortality rate was 42.9%. Multivariate analysis found that model for end-stage liver disease (MELD) score and number of organ failures were predictors of 28-day mortality. The area under the receiver operating characteristic of the numbers of organ failures to predict 28-day mortality was higher than MELD score (0.833 vs. 0.784, 0.4099), but without significant difference.

Conclusion

Gram-negative bacteria were the most prevalent pathogens and ESBL-producing bacteria were responsible for most of the MDR bacteria in patients with ACLF and nosocomial BSI. Higher MELD score and multiorgan failure were associated with worse outcomes.