bluuebunny/crossref_metadata_2025 huggingface dataset:
Can an End-to-End Telesepsis Solution Improve the Severe Sepsis and Septic Shock Management Bundle-1 Metrics for Sepsis Patients Admitted From the Emergency Department to the Hospital?
Authors: Gaieski David F. , Carr Brendan , Toolan Melanie , Ciotti Kimberly , Kidane Amy , Flaada Drew , Christina Joseph , Aggarwal Rajesh
Published: October 2022

IMPORTANCE:

Early detection and treatment for sepsis patients are key components to improving sepsis care delivery and increased The Severe Sepsis and Septic Shock Management Bundle (SEP-1) compliance may correlate with improved outcomes.

OBJECTIVES:

We assessed the impact of implementing a partially automated end-to-end sepsis solution including electronic medical record-linked automated monitoring, early detection, around-the-clock nurse navigators, and teleconsultation, on SEP-1 compliance in patients with primary sepsis, present at admission, admitted through the emergency department (ER).

DESIGN, SETTING AND PARTICIPANTS:

After a “surveillance only” training period between September 3, 2020, and October 5, 2020, the automated end-to-end sepsis solution intervention period occurred from October 6, 2020, to January 1, 2021 in five ERs in an academic health system. Patients who screened positive for greater than or equal to 3 sepsis screening criteria (systemic inflammatory response syndrome, quick Sequential Organ Failure Assessment, pulse oximetry), had evidence of infection and acute organ dysfunction, and were receiving treatment consistent with infection or sepsis were included.

MAIN OUTCOMES AND MEASURES:

SEP-1 compliance during the “surveillance only” period compared to the intervention period.

RESULTS:

During the intervention period, 56,713 patients presented to the five ERs; 20,213 (35.6%) met electronic screening criteria for potential sepsis; 1,233 patients had a primary diagnosis of sepsis, present at admission, and were captured by the nurse navigators. Median age of the cohort was 68 years (interquartile range, 57–79 yr); 55.3% were male; 63.5% were White/Caucasian, 26.3% Black/African-American; was 16.7%, and 879 patients (71.3%) were presumed bacterial sepsis, nonviral etiology, and SEP-1 bundle eligible. Nurse navigator real-time classification of this group increased from 51.7% during the “surveillance only” period to 71.8% during the intervention period (p = 0.0002). Five hospital SEP-1 compliance for the period leading into the study period (July 1, 2020–August 31, 2020) was 62% (p < 0.0001), during the “surveillance only” period, it was 68.4% and during the intervention period it was 78.3% (p = 0.002).

CONCLUSIONS AND RELEVANCE:

During an 11-week period of sepsis screening, monitoring, and teleconsultation in 5 EDs, SEP-1 compliance improved significantly compared with institutional SEP-1 reporting metrics and to a “surveillance only” training period.
Outcomes of Extracorporeal Membrane Oxygenation in COVID-19–Induced Acute Respiratory Distress Syndrome: An Inverse Probability Weighted Analysis
Authors: Raasveld Senta Jorinde , Taccone Fabio Silvio , Broman Lars Mikael , Hermans Greet , Meersseman Philippe , Quintana Diaz Manuel , Delnoij Thijs S. R. , van de Poll Marcel , Gouvea Bogossian Elisa , van Baarle Floor L. F. , Durak Koray , Zayat Rashad , Oude Lansink-Hartgring Annemieke , Meuwese Christiaan L. , van der Heijden Joris J. , de Troy Erwin , Dauwe Dieter , Scholten Erik , van der Velde Franciska , Maas Jacinta J. , Dos Reis Miranda Dinis , Kuijpers Marijn , van den Brule Judith , van den Bergh Walter M. , Vlaar Alexander P. J.
Published: October 2022

IMPORTANCE:

Although venovenous extracorporeal membrane oxygenation (VV ECMO) has been used in case of COVID-19 induced acute respiratory distress syndrome (ARDS), outcomes and criteria for its application should be evaluated.

OBJECTIVES:

To describe patient characteristics and outcomes in patients receiving VV ECMO due to COVID-19–induced ARDS and to assess the possible impact of COVID-19 on mortality.

DESIGN, SETTING AND PARTICIPANTS:

Multicenter retrospective study in 15 ICUs worldwide. All adult patients (> 18 yr) were included if they received VV ECMO with ARDS as main indication. Two groups were created: a COVID-19 cohort from March 2020 to December 2020 and a “control” non-COVID ARDS cohort from January 2018 to July 2019.

MAIN OUTCOMES AND MEASURES:

Collected data consisted of patient demographics, baseline variables, ECMO characteristics, and patient outcomes. The primary outcome was 60-day mortality. Secondary outcomes included patient characteristics, COVID-19–related therapies before and during ECMO and complication rate. To assess the influence of COVID-19 on mortality, inverse probability weighted (IPW) analyses were used to correct for predefined confounding variables.

RESULTS:

A total of 193 patients with COVID-19 received VV ECMO. The main indication for VV ECMO consisted of refractory hypoxemia, either isolated or combined with refractory hypercapnia. Complications with the highest occurrence rate included hemorrhage, an additional infectious event or acute kidney injury. Mortality was 35% and 45% at 28 and 60 days, respectively. Those mortality rates did not differ between the first and second waves of COVID-19 in 2020. Furthermore, 60-day mortality was equal between patients with COVID-19 and non-COVID-19–associated ARDS receiving VV ECMO (hazard ratio 60-d mortality, 1.27; 95% CI, 0.82–1.98; p = 0.30).

CONCLUSIONS AND RELEVANCE:

Mortality for patients with COVID-19 who received VV ECMO was similar to that reported in other COVID-19 cohorts, although no differences were found between the first and second waves regarding mortality. In addition, after IPW, mortality was independent of the etiology of ARDS.
Digital Educational Interventions for the Development of Advanced Care Planning Skills for Medical Practitioners: A Scoping Review
Authors: Shah Kavisha , Janssen Anna , Donnelly Candice , Shaw Tim
Published: October 2022

Background:

Medical practitioners are important facilitators of advanced care planning but are often reluctant to engage in these conversations with patients and their families. Barriers to participation can be addressed through medical education for medical practitioners.

Introduction:

The primary objective was to examine the extent to which digital educational interventions are used to foster advanced care planning skills. Secondary objectives include understanding the acceptability of these interventions and whether electronic health records can be used to personalize learning.

Methods:

Online databases were used to identify relevant articles published from 2008 to 2021. Nine articles which evaluated the impact of digital learning for medical practitioners were selected. Studies eligible for inclusion in the review assessed changes in knowledge, attitudes, and practice regarding skills used in advanced care planning.

Results:

All publications used a pre-post study design with education delivered solely online. Only three studies focused on completing advance care plans or directives (33%). All but two studies recorded improvements in knowledge and/or attitudes toward planning (78%) while three studies recorded improvements in clinical practice (33%). The review suggests prior clinical or personal experiences could be used to personalize education.

Discussion:

The literature revealed that using digital education to develop advanced care planning skills is relatively unexplored despite the ability of this type of learning to improve professional knowledge and confidence. Digital devices can also improve access to relevant information at the point-of-care. Personalized interventions that incorporate prior clinical experiences, potentially extracted from health records, could be used to optimize outcomes.
Acute opioid-induced gastroparesis successfully treated with naloxone: a case report
Authors: Seet Hao Rui , Rotella Joe-Anthony
Published: October 2022

A 56-year-old man presented to the emergency department after an intentional overdose of oxycodone and ethanol. He was previously opioid-naive with no other medical history. He subsequently developed acute abdominal pain with nausea and vomiting. A computed tomography scan of his abdomen and pelvis revealed distension of his stomach with no other abnormalities suggestive gastroparesis. He was subsequently treated with intravenous naloxone with complete resolution of his symptoms soon after. This case highlights the association between opioids and acute gastrointestinal mobility disorders contrary to the traditional association with chronic opioid use, as well as the utility of naloxone as a treatment.
Visit-to-visit SBP variability and risk of atrial fibrillation in middle-aged and older populations
Authors: Wang Chi , Sun Yizhen , Xin Qian , Han Xu , Cai Zefeng , Zhao Maoxiang , Yun Cuijuan , Zhang Sijin , Hou Ziwei , Chen Shuohua , Wu Shouling , Xue Hao
Published: October 2022

Objective:

We sought to examine the relationship between visit-to-visit variability of SBP and incident atrial fibrillation in middle-aged and older population.

Methods:

This prospective cohort study included 26 999 participants aged 50 years or older at study entry. Visit-to-visit variability of SBP was defined as the average real variability (ARV) of three values of SBP from the examinations of 2006, 2008, and 2010. We categorized participants into four groups according to the quartiles of ARV. Incident atrial fibrillation cases were identified via ECG during biennial resurveys, and reviewing medical insurance record and discharge registers. We used Cox regression models to evaluate the hazard ratios and 95% confidence intervals (CI) for incident atrial fibrillation.

Results:

After an average follow-up of 9.24 years, a total of 420 atrial fibrillation cases were identified. The incidence of atrial fibrillation from the lowest to the highest quartiles of SBP variability were 1.23, 1.53, 1.81 and 2.19 per 1000 person-years, respectively. After adjusting for potential confounders, including mean blood pressure, we found a graded association between SBP variability and risk of atrial fibrillation. Participants in the third quartile and the highest quartile were associated with 35 and 53% higher risk of developing atrial fibrillation, respectively, compared with participants in the lowest quartile [hazard ratio (95% CI), 1.35 (1.01–1.82) and 1.53 (1.15–2.04)]. The results persisted across sensitivity analyses.

Conclusion:

Increased visit-to-visit variability of SBP is a strong predictor of incident atrial fibrillation in middle-aged and older population. Evaluation of long-term SBP variability could help to identify individuals at higher risk of atrial fibrillation.
Preliminary Application of High-Frequency Ultrasound in the Differentiation of Pemphigus and Bullous Pemphigoid: An Observational Study
Authors: Liu Yang-Ai , Cao Rong , Da Mei-Hong , Dong Zheng-Bang , Wang Fei
Published: October 2022

Objective:

Ultrasonography is a diagnostic imaging technique used to visualize subcutaneous body structures for identification of possible pathologies. In this study, we aimed to explore the clinical significance of high-frequency ultrasound in differentiating the location of blisters between pemphigus and bullous pemphigoid.

Methods:

Eighteen patients were recruited in Department of Dermatology, Zhongda Hospital from 2020 to 2021 and divided into a pemphigus group (n = 8) and a bullous pemphigoid group (n = 10) according to the diagnostic criteria for each. Ultrasonographic images were collected using a 50-MHz high-frequency ultrasound system. The indexes of ultrasonic evaluation were the layer (epidermis or dermis), size, shape, internal echo, and boundary of the blister. Categorical variables are expressed as n (%), and differences were compared using Fisher’s exact test.

Results:

The ultrasonographic images in the pemphigus group showed an intraepidermal semi-arc or irregular anechoic or hypoechoic areas. The inferior borders were situated above the characteristic thin linear hyperechoic bands of the epidermis. A linear hypoechoic band was present at the dermoepidermal junction in some cases. In the ultrasonographic images of the bullous pemphigoid group, the linear hyperechoic bands of the epidermis were continuous and intact. An oval fluid anechoic area (subepidermal blister) was present immediately below the bands. The location of the blisters in the ultrasonographic images was significantly different between the 2 groups (P < 0.001).

Conclusion:

High-frequency ultrasound can be used as an auxiliary means to differentiate the location of blisters between pemphigus and bullous pemphigoid.
Community-based, Hospital-Affiliated Medical Group Becomes a Successful Accountable Care Organization
Authors: Madden Kathleen , DoRosario Arnold , O’Connell Ryan , Aberizk William , Brown Karen , Guttman Carrie , Goldstein Richard , Logue Peter , Varkey Prathibha
Published: October 2022

Leadership of a multispecialty group practice within a health system recognized in 2015 that population health management requires quality performance improvement and organizational culture change. While blueprints for building successful Accountable Care Organizations (ACOs) exist in the literature, few describe the journey to achieving both shared savings and high quality outcomes achieved by a medical group within an academic health system. Clinician education and engagement, prioritizing prevention and achieving benchmarks, developing supportive roles, more precise documentation of accurate diagnostic coding, and risk stratification constituted the approach. When first participating as an ACO, the medical group built programs and teams to improve quality, while CMS simultaneously changed quality measurements from pay-for-reporting to pay-for-performance. Quality scores initially dipped, though scores have since risen to 98.44% in 2020. Between 2015 and 2017, financial results were more than $10 million below the threshold, while in performance years 2018 to 2020, Northeast Medical Group achieved $24 million in aggregate in shared savings.
Artery encasement on preoperative CT scan does not preclude radical surgery: a case report utilizing sub-adventitial divestment for artery-involving pancreatic cancer
Authors: Cai Baobao , Lu Zipeng , Miao Yi
Published: October 2022

Pancreatic cancer was most lethal malignancy and artery involvement was the most common clinic scenario that hindered radical resection for non-metastatic lesions. While artery resection and reconstruction combined pancreatectomies were significantly complicated, artery-sparing techniques were of interest. A patient was reported with pancreatic cancer encasing major abdominal arteries. Sub-adventitial divestment technique was performed to achieve curative-intend resection, indicating that artery encasement did not preclude radical surgery. Surgical maneuver as well as the rationale of this technique were presented and discussed in detail. In conclusion, technical resectability of artery-involving pancreatic cancer was determined by invasion depth of the lesion to tumor rather than the involving circumference. Surgical innovations were to increase the chance of curative resection.
The potential benefit of endothelin receptor antagonists’ therapy in idiopathic pulmonary fibrosis: A meta-analysis of results from randomized controlled trials
Authors: Li Shuang , Pan Yong-li , Xin Wenqiang , Yan Chunhua
Published: October 2022

Background:

Fibrotic diseases take a very heavy toll in terms of morbidity and mortality equal to or even greater than that caused by metastatic cancer. This meta-analysis aimed to evaluate the effect of endothelin receptor antagonists on idiopathic pulmonary fibrosis.

Method:

A systematic search of the clinical trials from the Medline, Google Scholar, Cochrane Library, and PubMed electronic databases was performed. Stata version 12.0 statistical software (Stata Crop LP, College Station, TX) was adopted as statistical software.

Result:

A total of 5 studies, which included 1500 participants. Our analysis found there is no significant difference between using the endothelin receptor antagonists’ group and placebo groups regarding the lung function via estimating both the change of forced vital capacity from baseline and DLco index. Exercise capacity and serious adverse effects are taken into consideration as well; however, there is still no significant change between the 2 groups.

Conclusion:

This meta-analysis provides insufficient evidence to support that endothelin receptor antagonists’ administration provides a benefit among included participants who encounter idiopathic pulmonary fibrosis.
Prevalence of elevated alanine aminotransferase (ALT) in pregnancy: A cross-sectional labor and delivery-based assessment
Authors: Kushner Tatyana , Park Claire , Masand Dana , Rosenbluth Emma , Carroll Carin , Grace Marie , Rodriguez-Rivas Clara , De La Cruz Hernis , Overbey Jessica , Sperling Rhoda
Published: October 2022

Since liver tests are not routinely checked in pregnancy, the prevalence of abnormal liver tests and liver-related abnormalities in pregnancy in a US-based population is not known. We sought to determine the prevalence of abnormal alanine aminotransferase (ALT) among pregnant Individuals who present to labor and delivery for evaluation and to evaluate prevalence of underlying diagnosed liver conditions. Prospective study evaluating liver tests in consecutive samples obtained on the labor and delivery unit. Patient characteristics were compared between those with and without abnormal ALT and those with and without abnormal ALT without a liver-related diagnosis made in clinical practice, using t tests for continuous measures and χ2 or Fisher’s exact tests as appropriate for categorical measures. Logistic regression was utilized to identify factors associated with abnormal ALT in this subcohort to determine predictors of abnormal ALT in those without a known liver-related diagnosis. We collected 1024 laboratory specimens from 996 patients. Of these patients, 131 of 996 (13.2%) had elevated ALT ≥25 IU/L; 20 (2%) had ALT ≥50, 6 (0.6%) had ALT ≥125 and 3 (0.3%) had ALT ≥250. 61/131 (46.6%) of patients with ALT ≥25 IU/L had not had LTs checked during routine pregnancy care. 20 (15%) of individuals with abnormal LT had preeclampsia; 5 (4%) had cholestasis of pregnancy; 1 (0.8%) had hepatitis C; there were no other chronic liver diseases diagnosed. There were no significant demographic or clinical differences between those with and without ALT ≥25, whether liver disease diagnosis was made or not. We identified an over 10% prevalence of abnormal LTs in consecutive pregnant individuals who presented to L&D, most of whom did not have a liver-related condition diagnosed in clinical practice. Among those with liver-related diagnoses, PE and ICP were the most common among individuals with ALT≥25 IU/mL, with chronic liver disease rarely diagnosed. Further evaluation of the role of ALT testing as part of routine prenatal care is needed, particularly in establishing a baseline prevalence of liver test abnormalities in pregnancy and independent association with pregnancy outcomes.
Clinical usefulness of Mac-2 binding protein glycosylation isomer for diagnosing liver cirrhosis and significant fibrosis in patients with chronic liver disease: A retrospective single-center study
Authors: Park Hyun Joon , Seo Kwang Il , Lee Sang Uk , Han Byung Hoon , Yun Byung Cheol , Park Eun Taek , Lee Jinwook , Hwang Hyunyong , Yoon Myunghee
Published: October 2022

Accurate diagnosis of liver cirrhosis (LC) and significant fibrosis in patients with chronic liver disease (CLD) is important. The Mac-2 binding protein glycosylation isomer (M2BPGi) has emerged as a novel serum biomarker for liver fibrosis; however, insufficient clinical data of M2BPGi are available in patients with CLD. Therefore, we performed a retrospective cohort study to investigate the clinical usefulness of serum M2BPGi for assessing LC and significant fibrosis in CLD patients. We retrospectively reviewed the CLD patients with measured serum M2BPGi at Kosin University Gospel Hospital between January 2016 and December 2019. Multivariate logistic regression analyses were conducted to identify the independent factors associated with LC. The diagnostic power of serum M2BPGi for LC and significant fibrosis (≥F2) was evaluated and compared to that of other serum biomarkers using receiver operating characteristic curve and area under the curve (AUC). A total of 454 patients enrolled in this study. M2BPGi (adjusted odds ratio [aOR], 1.77; 95% confidence interval [CI], 1.52–2.07) and fibrosis index based on four factors (aOR, 1.23; 95% CI, 1.11–1.37) were identified as significant independent factors for LC. The AUC of M2BPGi for LC (0.866) and significant fibrosis (0.816) were comparable to those of fibrosis index based on four factors (0.860, 0.773), aspartate aminotransferase-to-platelet ratio index (0.806, 0.752), and gamma-glutamyl transpeptidase-to-platelet ratio (0.759, 0.710). The optimal cut-off values for M2BPGi for LC and significant fibrosis were 1.37 and 0.89, respectively. Serum M2BPGi levels were significantly correlated with liver stiffness measurements (ρ = 0.778). Serum M2BPGi is a reliable noninvasive method for the assessment of LC and significant fibrosis in patients with CLD.
Association between gestational diabetes mellitus and adverse obstetric outcomes among women with advanced maternal age: A retrospective cohort study
Authors: Deng Lijun , Ning Beibei , Yang Hailan
Published: October 2022

To explore the association of gestational diabetes mellitus (GDM) with maternal and neonatal adverse outcomes among women with advanced maternal age. This retrospective cohort study included 1551,140 eligible pregnant women from the National Vital Statistics System database in 2017 to 2019, and all participants were divided into two groups: GDM group (n = 154,646) and non-GDM group (n = 1396,494). Univariate and multivariate logistic regression analyses were used to assess the association of GDM and maternal and neonatal outcomes; additionally, we also adopted subgroup analysis to analyze the association in detail based on gestational weight gain (GWG) levels. The risk of each adverse outcome was presented by using odds ratio (OR) and 95% confidence interval (CI). After adjusted some covariables, GDM increased the risk of neonatal assisted ventilation (OR = 1.380, 95% CI: 1.345–1.417), neonatal intensive care unit (NICU, OR = 1.436, 95% CI: 1.410–1.463) admission, neonatal low Apgar score at the fifth minutes (OR = 1.034, 95% CI: 1.018–1.051), neonatal high birth weight (OR = 1.132, 95% CI: 1.111–1.153), neonatal premature birth (OR = 1.244, 95% CI: 1.223–1.266), mothers entered intensive care unit (ICU, OR = 1.247, 95% CI: 1.107–1.406), and mothers took cesarean section (OR = 1.193, 95% CI: 1.180–1.207) among women with advanced maternal age. The study findings indicated that GDM was the risk factor for obstetric outcomes among women with advanced maternal age, which will have important implications for the management of GDM in women with advanced maternal age.
Efficacy and safety of vedolizumab for inflammatory bowel diseases: A systematic review and meta-analysis of randomized controlled trials
Authors: Qiu Bo , Liang Jia-Xu , Li Cong
Published: October 2022

Background:

Vedolizumab is a humanized monoclonal antibody that inhibits gut-selective α4β7 integrins on the surface of leukocytes, preventing their trafficking into the gastrointestinal tract, and ultimately achieves the effect of suppressing intestinal inflammation. This study aimed to evaluate the efficacy and safety of vedolizumab in the treatment of inflammatory bowel disease.

Methods:

After a systematic review of relevant studies, the pooled relative risk (RR) and 95% confidence intervals (CIs) were calculated to evaluate the effect. Heterogeneity was explored using sensitivity analysis, univariate meta-regression, and subgroup analysis. Potential publication bias was evaluated using Egger test and trim-and-fill method.

Results:

Nine randomized controlled trials involving 4268 participants were included in the meta-analysis. During induction therapy, vedolizumab was more effective than placebo in treating active ulcerative colitis and Crohn disease in terms of clinical response (RR = 1.55, 95%CI: 1.35–1.78), clinical remission (RR = 1.90, 95%CI: 1.50–2.41), and mucosal healing (RR = 1.53, 95%CI: 1.21–1.95). A superior effect in terms of durable Clinical or Crohn disease Activity Index-100 response (RR = 1.65, 95%CI: 1.20–2.26), clinical remission (RR = 1.92, 95%CI: 1.48–2.50), and glucocorticoid-free remission (RR = 2.22, 95%CI: 1.71–2.90) was found during maintenance treatment. Vedolizumab was not associated with any adverse events and was as safe as placebo in terms of the risk of serious adverse reactions.

Conclusions:

Vedolizumab may be safe and effective as an induction and maintenance therapy for the treatment of inflammatory bowel disease; however, further studies are needed to validate this conclusion.
Epidemiology and clinical features of maternal sepsis: A retrospective study of whole pregnancy period
Authors: Zhong Xuan , Lin Rongfeng , Zhang Wenni , Huang Shan , Luo Yiping , Wang Ding
Published: October 2022

Maternal sepsis results in poor outcomes such as fetal or maternal death. The incidence and mortality rates of maternal sepsis vary in different places because of differences in economic development, race and medical conditions. Identifying the clinical features and determining possible mechanisms for avoiding morbidity and preventing poor outcomes would benefit committed patients. Therefore, this was an epidemiological study at a maternity transfer center in Southeast China that aimed to identify local disease features of maternal sepsis. To investigate the incidence and risk factors associated with maternal sepsis and its progression to severe sepsis in a large population-based birth cohort. This local epidemiological study was conducted in at a tertiary care center in Guangzhou, China, from 2015 to 2019. A total of 74,969 pregnant women experiencing childbirth were included in this study; Of these, 74 patients with maternal sepsis were diagnosed according to the sepsis criterion, and 118 patients without sepsis in the same period were selected randomly as the control group to study possible reasons for postpartum sepsis. This retrospective analysis covered the entire period from the first trimester to puerperium. Clinical data were collected using the hospital’s electronic medical record system. Multivariate logistic regression was used to analyze risk factors for maternal sepsis. The incidences of maternal sepsis, the maternal mortality, and the fetal mortality were 0.099%, 0.004%, and 0.007%, respectively. Septic shock was associated with a higher severity of illness. All poor outcomes (maternal or fetal death) occurred during pregnancy. Postpartum sepsis had the longest onset period, and was associated with premature rupture of fetal membranes and preeclampsia. Sepsis is an important cause of both maternal and fetal mortality. Herein, we describe an epidemiological study that evaluated the incidence, development, and prognosis of local maternal sepsis. Furthermore, the characteristics of maternal sepsis are likely due to unknown pathological mechanisms, and patients would benefit from identifying more effective treatments for maternal sepsis.
Nasal protection strategy reduces the incidence of nasal pressure injuries during nasotracheal intubation: Meta-analysis with trial sequential analysis
Authors: Hoshijima Hiroshi , Mihara Takahiro , Nagumo Takumi , Sato (Boku) Aiji , Shiga Toshiya , Mizuta Kentaro
Published: October 2022

Background:

Nasal pressure injury is a serious problem during nasotracheal intubation. We performed this systematic review and meta-analysis to determine whether use of a nasal protection strategy (a protective dressing or a modified fixation method for the tracheal tube) reduces the incidence of nasal pressure injury during nasotracheal intubation.

Methods:

Literature searches were performed using three electronic databases. Data from each of the eligible trials were combined, and calculations were made using DerSimonian and Laird random effects models. The pooled effect estimates for nasal pressure injury were evaluated using the relative risk and 95% confidence interval, the Cochrane Q statistic, and the I
2 statistic. We also performed trial sequential analysis (TSA) to assess sensitivity to prevent type I error. We separated patients into subgroups to analyze the incidence of nasal pressure injury according to whether a protective dressing or a modified fixation method for the tracheal tube was used.

Results:

The literature search yielded five eligible trials. Meta-analysis of these trials showed that a nasal protection strategy significantly reduced the incidence of nasal pressure injury during nasotracheal intubation (relative risk (RR) 0.34; 95% confidence interval (CI) 0.21–0.56; P < .0001; Cochrane’s Q = 5.86, I
2 = 32%). The TSA boundary for futility could not be calculated because of an insufficient sample size. In subgroup analysis, both methods significantly reduced the incidence of nasal pressure injury during nasotracheal intubation.

Conclusions:

The findings of this meta-analysis suggest that a nasal protection strategy significantly reduces the incidence of nasal pressure injury during nasotracheal intubation. During nasotracheal intubation, the use of a protective dressing or modified fixation method for the tracheal tube can prevent to the incidence of nasal pressure injuries. However, the number of samples in our meta-analysis was too small for TSA and further studies are required.

Trials registration:

PROSPERO (International Prospective Register of Systematic Reviews; registration number 252091).
Factors associated with the prevalence of malnutrition among adult hemodialytic patients: A two-center study in the Jeddah region, Saudi Arabia
Authors: Azzeh Firas S. , Turkistani Waad M. , Ghaith Mazen M. , Bahubaish Lujain A. , Kensara Osama A. , Almasmoum Hussain A. , Aldairi Abdullah F. , Khan Anmar A. , Alghamdi Ahmad A. , Shamlan Ghalia , Alhussain Maha H. , Algheshairy Reham M. , AlShahrani Abdullah M. , Qutob Maysoun S. , Alazzeh Awfa Y. , Qutob Haitham M.H.
Published: October 2022

Chronic kidney disease, one of the most common diseases in the world, is characterized by irreversible impairment of the kidney’s metabolic, excretory, and endocrine functions. During end-stage renal disease, patients require renal replacement therapy, such as hemodialysis (HD). Protein-energy wasting is a common health problem among HD patients. This study aims to assess the nutritional status of HD patients at two HD centers in Jeddah, Saudi Arabia, and to determine its associated factors. A cross-sectional study was conducted at two different dialysis centers in Jeddah, Saudi Arabia; 211 female and male HD patients. Malnutrition was recognized using the modified-subjective global assessment (M-SGA) comprising two parts: medical history and physical examination. Sociodemographic and health status for all patients were also determined. Patients were classified based on their M-SGA score into two groups: normal and malnourished. Overall, 54.5% of the participants showed malnutrition. Unemployment, low muscle strength and mass, high level of medication use, and high dialysis vintage were positively (P < .05) associated with malnutrition. In conclusion, the M-SGA score indicates a high prevalence of malnutrition among HD patients. These results show the importance of regular assessment and follow-ups for HD patients ensuring better health and nutritional status.
Comparison of systematic randomized 12-core transrectal ultrasonography-guided prostate biopsy with magnetic resonance imaging-transrectal ultrasonography fusion-targeted prostate biopsy
Authors: Song Byeongdo , Hwang Sung Il , Lee Hak Jong , Jeong Seong Jin , Hong Sung Kyu , Byun Seok-Soo , Lee Sangchul
Published: October 2022

We aimed to compare the complications and pathological outcomes between systematic 12-core transrectal ultrasonography guided prostate biopsy (TRUS-PB) and magnetic resonance imaging-TRUS fusion targeted prostate biopsy (MRI-TRUS FTPB). We examined 10,901 patients who underwent prostate biopsy from May 2003 to December 2017 retrospectively. Among them, 10,325 patients underwent 12-core TRUS-PB and 576 patients underwent MRI-TRUS FTPB. The clinicopathological features and complications in both groups were compared. After propensity score matching, there were no significant differences in the clinical features and complication rates between both groups (P > .05). In the multivariate analyses, the prostate volume was shown to be the only significant predictor of overall complications, infectious complications, bleeding related complications, and Clavien-Dindo grade ≥ 2 complications after prostate biopsy (P < .001). The present study demonstrates the safety of MRI-TRUS FTPB in terms of complications, compared with that of TRUS-PB. Although the combination of MRI-TRUS FTPB and 12-core TRUS-PB provides enhanced diagnostic power, MRI-TRUS FGB alone could provide a reasonable diagnostic value for prostate cancer if the apparent diffusion coefficient suspicious grade of prostate cancer is ≥4. When the Likert suspicious grade of prostate cancer on the apparent diffusion coefficient map of multiparametric MRI was 3, 13.9% (27/194) of the patients were diagnosed with clinically significant prostate cancer (csPCa); 44.4% (12/27) of them were confirmed as csPCa at the MRI-targeted cores. When the apparent diffusion coefficient suspicious grade was ≥4, 43.0% (108/251) were diagnosed with csPCa; 76.8% (83/108) of them were confirmed to have csPCa at the MRI-targeted cores.
Efficacy of Phellinus linteus extract on immunity enhancement: A CONSORT-randomized, double-blind, placebo-controlled pilot trial
Authors: Ku Yong Ho , Kang Jae Hui
Published: October 2022

Background:

Immunity is a major system that defends the human body from the outside. Recently, interest in foods related to immunity has been increasing.

Methods:

The purpose of this clinical trial was to determine the safety and efficacy of Phellinus linteus (PL) extract in improving immune function. A total of 30 participants were randomly assigned to 3 groups: the PL1000 group (n = 10) took 1000 mg of PL extract and 1000 mg of dextrin per day; the PL2000 group (n = 10) took 2000 mg of PL extract per day; and the placebo group (n = 10) took 2000 mg of dextrin per day. All participants took 2 capsules twice a day for 8 weeks. We measured their natural killer cell activity and cytokine levels in blood before and after consuming the clinical trial food. Variables were also investigated to evaluate safety, such as adverse reactions, vital signs, and abnormal findings. Student t test or the Mann–Whitney U test, a paired t test or the Wilcoxon signed-rank test, a chi-square test, analysis of variance, and Kruskal–Wallis test were conducted according to the characteristics of the data to compare the differences between each group before and after participants ate the clinical trial food.

Results:

The natural killer cell activity and interleukin-6 levels of the PL1000 group tended to improve compared to those of the placebo group. Immunoglobulin G1, immunoglobulin G2, and immunoglobulin M levels did not show significant changes, but tended to improve in the PL1000 and PL2000 groups compared to those of the placebo group. Both the Per Protocol and Intention to Treat populations had improved validation parameters. It is safe because no hazards were found in the safety assessment.

Conclusion:

PL extract can help improve immunity. Evidences to conduct the main clinical trial is secured through this pilot study. A future large-scale main trial will be conducted based on this pilot study results.
Survival of women with pregnancy-associated breast cancer according to clinical characteristics: A propensity score matching study
Authors: Gwak Hongki , Woo Sang Seok , Lee Eun-Sook , Park Min Ho , Lee Seokwon , Youn Hyun Jo , Park Seho , Suh In Suck , Kim Seong Hwan
Published: October 2022

In recent years, postponing childbearing has increased the prevalence of pregnancy-associated breast cancer (PABC). PABC has a poorer prognosis than breast cancer not associated with pregnancy (non-PABC) due to delayed diagnosis and aggressive subtype. Additionally, pregnancy itself predicts a poor prognosis; but, this is a subject of debate. Thus, we analyzed the effects of known prognostic factors and pregnancy on the prognosis of PABC. We retrospectively analyzed women aged 20 to 49 years who were diagnosed with breast cancer (BC) between 1989 and 2014. Patients were distributed into PABC and non-PABC groups, and 1:4 propensity score matching was performed to adjust for baseline characteristics. Primary endpoints were overall survival (OS) and BC-specific survival (BCSS). Secondary endpoint was the difference in prognosis according to BC subtype. Of the 34,970 recruited patients with BC, 410 (1.2%) had PABC. Patients with PABC were younger and tended to have triple-negative BC (TNBC) subtype than non-PABC patients. The 1640 matched non-PABC patients showed a significantly worse mean survival rate than the unmatched non-PABC patients. Patients with PABC had a significantly worse OS and BCSS than those with non-PABC. In multivariate analyses, patients with PABC of luminal B (Ki-67 ≥14.0%) and TNBC subtypes had worse OS and BCSS than patients with non-PABC. Patients with PABC had poorer prognosis than non-PABC patients after adjusting for several prognostic factors. This difference was particularly significant in patients with the luminal B and TNBC subtypes.
Robot-assisted rehabilitation for total knee or hip replacement surgery patients: A systematic review and meta-analysis
Authors: Yoo Jun-Il , Oh Min-Kyun , Lee Shi-Uk , Lee Chang Han
Published: October 2022

Background:

This study was performed to update the current evidence and evaluate the effects of robot-assisted rehabilitation (RAR) in comparison with conventional rehabilitation (CR) in patients following total knee (TKR) or hip replacements (THR).

Methods:

PubMed Central, OVID Medline, Cochrane Collaboration Library, and EMBASE for a comprehensive search for all relevant studies, from database inception to July 2022. The following inclusion criteria were used to determine eligibility for studies: randomized and matched controlled trials recruiting men and women who underwent TKR and THR; and studies examining the effect of RAR on outcome measures of physical function and pain.

Results:

A total of 9 studies (230 patients) were included in this review and 4 were included in the meta-analysis. The meta-analysis of 2 studies showed that Hybrid Assistive Limb (HAL) training for 5 days, significantly improved pain measured on a visual analogue scale, compared to CR in patients following TKR (SMD = 1.05, 95% confidence interval [Cl] 0.39–1.71). Heterogeneity for I2 value was lower than moderate (tau^2 = 0.0121; I
2 = 5%; P = .30). There were 2 studies that assessed self-selected walking speed. The meta-analysis of these studies showed that HAL training was significantly superior to CR in patients following TKR (SMD = 48.70, 95% Cl -50.53 to 147.94) at 2 months. A high heterogeneity was detected (P < .01; I
2 = 97%).

Conclusion:

The result of this systematic review and meta-analysis suggest that RAR may be an effective treatment in TKR and THR patients. However, high-quality studies are needed to verify the long-term effect on their recovery.
MicroRNA expression within neuronal-derived small extracellular vesicles in frontotemporal degeneration
Authors: Pounders Jonathan , Hill Emily J. , Hooper Destiny , Zhang Xiang , Biesiada Jacek , Kuhnell Damaris , Greenland Hannah L. , Esfandiari Leyla , Timmerman Emerlee , Foster Forrest , Wang Chenran , Walsh Kyle B. , Shatz Rhonna , Woo Daniel , Medvedovic Mario , Langevin Scott , Sawyer Russell P.
Published: October 2022

MicroRNAs (miRNAs) are small non-coding RNA that are powerful regulators of gene expression and can affect the expression of hundreds of genes. miRNAs can be packed in small extracellular vesicles (SEV) and released into the extracellular space by neurons and microglia to act locally as well as pass through the blood-brain barrier and act systemically. We sought to understand the differences in neuronal SEV miRNA expression between frontotemporal dementia (FTD), Alzheimer’s disease (AD), and healthy aging. Plasma was obtained from FTD, AD, and healthy aging participants that were matched based on age, sex, and race/ethnicity. Additionally, a subset of participants also provided paired cerebrospinal fluid samples to compare neuronal SEV miRNAs in plasma and cerebrospinal fluid. Neuronal SEV were isolated using differential ultracentrifugation and antibody conjugated Dynabeads® for the neuronal surface marker, L1CAM. RNA sequencing was performed. 12 FTD, 11 with AD, and 10 healthy aging participants were enrolled in the study. In FTD, SEV miRNA-181c was downregulated compared to healthy controls. In AD, miRNA-122 and miRNA-3591 were downregulated compared to those in healthy controls and FTD. Using an FDR <0.2, only miRNA-21-5p was found to have increased expression in the cerebrospinal fluid compared to plasma in a group of AD and FTD participants. SEV miRNA-181c is significantly downregulated in FTD compared to healthy controls and may mediate its effects through microglial-directed neuroinflammation and interaction with TAR DNA-binding protein 43 (TDP-43) based on pathway analysis. Additionally, the FOXO and Hippo pathways may be important mediators of FTD, based on pathway analysis. Lastly, because only one SEV miRNA was differentially expressed between the plasma and cerebrospinal fluid in paired samples, plasma represents an appropriate biofluid for studying neuronal SEV miRNA.
Differentiating benign from malignant gallbladder wall thickening in non-contrast MRI imaging: Preliminary study of a combined diagnostic indicator
Authors: He Wen-Wen , Zhu Jian-Guo , Pylypenko Dmytro , Liu Fei , Wang Mei , Wu Yue-Fei , Tian Jun , Li Hai-Ge
Published: October 2022

To synthetically evaluate the diagnostic accuracy of image features for differentiating benign from malignant gallbladder wall thickening disease with non-contrast MRI and establish the optimal diagnostic indicator. A total of 23 patients with wall thickening type gallbladder carcinoma and 61 patients with benign wall thickening disease were included. The diagnostic performance of six image features including the layered pattern on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) images, T2WI signal intensity, papillary growth, the apparent diffusion coefficient (ADC) value, and the lesion to liver parenchyma ratio (LLR) of gallbladder were evaluated and compared. The receiver operating characteristic (ROC) curve and binary logistic regression analysis were used to construct the optimally combined indicator. All six indicators showed high diagnostic accuracy. The layered pattern on DWI and LLR had the highest area under the curve (AUC) value (0.904), followed by the layered pattern on T2WI (0.883), T2WI signal intensity (0.859), ADC value (0.836), and papillary growth (0.796). There was no statistically significant difference in the AUC among indicators for pairwise comparisons. A combination of layered patterns on DWI and papillary growth was shown to be the optimal indicator by binary logistic regression analysis. The AUC value of the combination (0.972) was higher than the layered pattern on DWI (0.904) and papillary growth (0.796) (P < .001). Non-contrast MRI provides several reliable indicators for differentiating benign from malignant gallbladder thickening disease. The combination of layered patterns on DWI and papillary growth is the optimal indicator.
Clinical intervention of a tighter-than-tolerated fit of aesthetic hand and finger prosthesis via controlled silicone swelling: A novel, speedier and versatile alternative method
Authors: Leow Michael E.L. , Le Lan Anh T. , Chan Yiong Huak , Chong Alphonsus K.S.
Published: October 2022

A tighter-than-tolerated fit of aesthetic hand prosthesis is conventionally rectified by stretching the affected segment to plastic deformation. This method is not only time-consuming, but also ineffective in stretching irregular, non-cylindrical prosthesis segments apart from the “wrist and digits”.

This study investigates controlled silicone swelling as an alternative method of expanding aesthetic hand and finger prosthesis to address a tight fit.

The technique of “controlled” swelling that minimizes oil uptake to as little as is necessary to achieve the desired magnitude of elastomer expansion was demonstrated using experimental test samples. Brush-coats of a cosmetics-grade oil, KF-96A-10CS, 2 a time, were applied on CosmesilTM samples to obtain elastomer expansion. The same technique of staggered oil delivery was used on tight-fitting segments of patients’ prosthesis, with test-fitting of each incremental expansion till satisfactory outcomes were achieved. Percentage circumference increases in swelled test samples and in all rectified/ patients’ prostheses were then compared to validate the effectiveness of the method.

Circumference increases in the test samples after each 2 coats were significantly different (P <.001). Representative (unreinforced) Samples 1, 2, and 3 recorded circumferential increases of 4.0% to 11.4% within 30 minute after swelling by 2.6% to 9.7% from 2 to 6 oil coats. This largely correlated with patient data, where circumferential increases of 3.6% to 9.5% from 2 to 6 oil coats were collectively recorded in all fit-rectified finger prostheses. Swelling in the expanded proximal segment of all 24 finger prostheses was estimated to be within 9.7%. Of these, 22 (92%) required 2 to 4 oil coats, inferring a lower still swelling of 6.5%. The rapid and consistent elastomer expansion enabled prosthetic fit rectification to be achieved in a much shortened time. Clinical outcomes indicated that low swelling magnitudes involving small amounts of 2 to 6 brush-coats of oil have no adverse effects on the prostheses. None of the participating patients had reported any incidence of discernible change in all of the important properties of their prostheses.

Outcomes based on the CosmesilTM-KF-96A-10CS elastomer-oil combination demonstrated that controlled silicone swelling involving minimal use of oil is an effective method of intervention for a tighter-than-tolerated prosthetic fit of silicone hand and fingers.