bluuebunny/crossref_metadata_2025 huggingface dataset:
Public health ethics: a flawed view of Kant’s argument from autonomy
Authors: Canning Una P
Published: November 2019

Background

This work explores the concept of morality as self-governing autonomy that has its origins in Immanuel Kant’s ethics. It investigates how a mistaken view of Kant’s ethics underpins a strand of debate in public health policy that is used to justify individual responsibility for health and well-being.

Method

Literature review.

Results

Applying a mistaken view of Kant’s ethics to current day public health problems is inappropriate. The work discusses the social determinants of health and the call by some in the field to adopt a Kantian approach to tackle the problems of poor health resulting from lifestyle choices.

Conclusion

The paper ends by arguing for a public health policy that is grounded in collaboration and for the adoption of Health in All Policies (HiAP).
The spectral fingerprint of sleep problems in post-traumatic stress disorder
Authors: de Boer M , Nijdam M J , Jongedijk R A , Bangel K A , Olff M , Hofman W F , Talamini Lucia M
Published: November 2019

Study Objectives

Sleep problems are a core feature of post-traumatic stress disorder (PTSD). The aim of this study was to find a robust objective measure for the sleep disturbance in patients having PTSD.

Methods

The current study assessed EEG power across a wide frequency range and multiple scalp locations, in matched trauma-exposed individuals with and without PTSD, during rapid eye movement (REM) and non-REM (NREM) sleep. In addition, a full polysomnographical evaluation was performed, including sleep staging and assessment of respiratory function, limb movements, and heart rate. The occurrence of sleep disorders was also assessed.

Results

In patients having PTSD, NREM sleep shows a substantial loss of slow oscillation power and increased higher frequency activity compared with controls. The change is most pronounced over right-frontal sensors and correlates with insomnia. PTSD REM sleep shows a large power shift in the opposite direction, with increased slow oscillation power over occipital areas, which is strongly related to nightmare activity and to a lesser extent with insomnia. These pronounced spectral changes occur in the context of severe subjective sleep problems, increased occurrence of various sleep disorders and modest changes in sleep macrostructure.

Conclusions

This is the first study to show pronounced changes in EEG spectral topologies during both NREM and REM sleep in PTSD. Importantly, the observed power changes reflect the hallmarks of PTSD sleep problems: insomnia and nightmares and may thus be specific for PTSD. A spectral index derived from these data distinguishes patients from controls with high effect size, bearing promise as a candidate biomarker.
The burden of extended-spectrum β-lactamase-producing Enterobacteriaceae in Nigeria: a systematic review and meta-analysis
Authors: Musa Baba M , Imam Hassana , Lendel Anastasia , Abdulkadir Isa , Gumi Halima S , Aliyu Muktar H , Habib Abdulrazaq G
Published: November 2019

Antibiotic resistance on account of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) has become a major public health concern in developing countries. The presence of ESBL-PE is associated with increased morbidity, mortality and healthcare costs. There is no active antimicrobial surveillance mechanism in Nigeria. The aim of this study is to determine a precise estimate of the burden of ESBL-PE in Nigeria. We employed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and searched electronic databases for suitable studies. We derived pooled prevalence estimates using random effects models and assessed trends with meta-regression. We found 208 studies, with 38 satisfying our inclusion criteria. The overall pooled prevalence of ESBL-PE in Nigeria was 34.6% (95% CI 26.8 to 42.3%) and increased at a rate of 0.22% per year (p for trend=0.837). In summary, we found the prevalence of ESBL-PE in Nigeria to be high and recommend a robust national survey to provide a more detailed picture of the epidemiology of ESBL-PE in Nigeria.
Evolution and phylogeography of Culex pipiens densovirus
Authors: Altinli Mine , Lequime Sebastian , Courcelle Maxime , François Sarah , Justy Fabienne , Gosselin-Grenet Anne-Sophie , Ogliastro Mylene , Weill Mylene , Sicard Mathieu
Published: November 2019

Viruses of the Parvoviridae family infect a wide range of animals including vertebrates and invertebrates. So far, our understanding of parvovirus diversity is biased towards medically or economically important viruses mainly infecting vertebrate hosts, while invertebrate infecting parvoviruses—namely densoviruses—have been largely neglected. Here, we investigated the prevalence and the evolution of the only mosquito-infecting ambidensovirus, Culex pipiens densovirus (CpDV), from laboratory mosquito lines and natural populations collected worldwide. CpDV diversity generally grouped in two clades, here named CpDV-1 and -2. The incongruence of the different gene trees for some samples suggested the possibility of recombination events between strains from different clades. We further investigated the role of selection on the evolution of CpDV genome and detected many individual sites under purifying selection both in non-structural and structural genes. However, some sites in structural genes were under diversifying selection, especially during the divergence of CpDV-1 and -2 clades. These substitutions between CpDV-1 and -2 clades were mostly located in the capsid protein encoding region and might cause changes in host specificity or pathogenicity of CpDV strains from the two clades. However, additional functional and experimental studies are necessary to fully understand the protein conformations and the resulting phenotype of these substitutions between clades of CpDV.
Five Principles for Using Educational Theory: Strategies for Advancing Health Professions Education Research
Authors: Samuel Anita , Konopasky Abigail , Schuwirth Lambert W.T. , King Svetlana M. , Durning Steven J.
Published: November 2019

Health professions education (HPE) research often involves examining complex phenomena. Theory provides a means for better understanding the mechanics of these phenomena and guiding health professions researchers and educators as they navigate the practical implications for teaching, learning, and research. Engaging with educational theory is, therefore, critical to facilitating this understanding. However, this engagement presents a key challenge for HPE researchers and educators without a background in social science. This article outlines 5 key principles of engaging with theory and offers integration strategies to assist HPE researchers and educators who wish to apply theory to their HPE scholarship and practice. The article concludes with a practical example of how these principles were applied to an HPE research project, demonstrating the value of theory in enhancing research quality. Existing theories can facilitate opportunities for individual researchers to better understand complex phenomena while simultaneously moving forward the field of HPE.
Relationship Between Speech Recognition in Quiet and Noise and Fitting Parameters, Impedances and ECAP Thresholds in Adult Cochlear Implant Users
Authors: de Graaff Feike , Lissenberg-Witte Birgit I. , Kaandorp Marre W. , Merkus Paul , Goverts S. Theo , Kramer Sophia E. , Smits Cas
Published: November 2019

Objectives:

The objective of this study was to identify parameters which are related to speech recognition in quiet and in noise of cochlear implant (CI) users. These parameters may be important to improve current fitting practices.

Design:

Adult CI users who visited the Amsterdam UMC, location VUmc, for their annual follow-up between January 2015 and December 2017 were retrospectively identified. After applying inclusion criteria, the final study population consisted of 138 postlingually deaf adult Cochlear CI users. Prediction models were built with speech recognition in quiet and in noise as the outcome measures, and aided sound field thresholds, and parameters related to fitting (i.e., T and C levels, dynamic range [DR]), evoked compound action potential thresholds and impedances as the independent variables. A total of 33 parameters were considered. Separate analyses were performed for postlingually deafened CI users with late onset (LO) and CI users with early onset (EO) of severe hearing impairment.

Results:

Speech recognition in quiet was not significantly different between the LO and EO groups. Speech recognition in noise was better for the LO group compared with the EO group. For CI users in the LO group, mean aided thresholds, mean electrical DR, and measures to express the impedance profile across the electrode array were identified as predictors of speech recognition in quiet and in noise. For CI users in the EO group, the mean T level appeared to be a significant predictor in the models for speech recognition in quiet and in noise, such that CI users with elevated T levels had worse speech recognition in quiet and in noise.

Conclusions:

Significant parameters related to speech recognition in quiet and in noise were identified: aided thresholds, electrical DR, T levels, and impedance profiles. The results of this study are consistent with previous study findings and may guide audiologists in their fitting practices to improve the performance of CI users. The best performance was found for CI users with aided thresholds around the target level of 25 dB HL, and an electrical DR between 40 and 60 CL. However, adjustments of T and/or C levels to obtain aided thresholds around the target level and the preferred DR may not always be acceptable for individual CI users. Finally, clinicians should pay attention to profiles of impedances other than a flat profile with mild variations.
The Safety of Single and Multilevel Cervical Total Disc Replacement in Ambulatory Surgery Centers
Authors: Cuéllar Jason M. , Lanman Todd H. , Rasouli Alexandre
Published: November 2019

Study Design.

Retrospective cohort.

Objective.

Evaluate the safety profile of single- and multilevel cervical artificial disc replacement (ADR) performed in an outpatient setting.

Summary of Background Data.

As healthcare costs rise, attempts are made to perform an increasing proportion of spine surgery in ambulatory surgery centers (ASCs). ASCs are more efficient, economically and functionally. Few studies have published on the safety profile of multilevel cervical ADR.

Methods.

We have performed an analysis of all consecutive cervical ADR surgeries that we performed in an ASC over a 9-month period, including multilevel and revision surgery. The pre-, intra-, and postoperative data recorded included age, sex, body mass index, tobacco use, and diabetes; level and procedure, operating room time, estimated blood loss (EBL), and complications; and discharge site, occurrence of reoperation, hospital admission, or any medical complication or infection over a 90-day period.

Results.

A total of 147 patients underwent 231 treated levels: 71 single-level, 76 multilevel: 69 two-level, 6 three-level, and 1 four-level. Average age was 50 ± 10 years; 71 women, 76 men. None of the patients had insulin-dependent diabetes, 4 were current smokers, and 16 were former smokers. Average body mass index was 26.8 ± 4.6 (range 18–40). Average total anesthesia time was 88 minutes (range 39–168 min). Average EBL was 15 mL (range 5–100 mL). Approximately 90.3% of patients were discharged directly home, 9.7% to an aftercare facility. In the 90-day postoperative period there were zero deaths and two hospital admissions (1.4%)—one for medical complication (0.7%) and one for a surgical site infection (0.7%).

Conclusion.

In this consecutive case series we performed 231 ADRs in 147 patients in the outpatient setting, including multilevel and revision procedures, with 2 minor postoperative complications resulting in hospital unplanned admissions within 90 days. We believe that these procedures are safe to perform in an ASC. An efficient surgical team and careful patient selection criteria are critical in making this possible.

Level of Evidence: 3
Factors to Consider When Evaluating Rates of Pharmacologic Venous Thromboembolism Prophylaxis Administration Among Trauma Patients
Authors: Sercy Erica , Carrick Matthew M. , Orlando Alessandro , Bar-Or David
Published: November 2019

It is generally believed that pharmacologic prophylaxis for venous thromboembolism (VTE) is underused. However, previous studies have not shown associations between increased prophylaxis administration and reductions in VTE. We here investigated prophylaxis administration and VTE incidence among trauma patients at our facility to determine whether to further increase prophylaxis administration after implementation of a standardized monitoring protocol. Univariate analyses and regression models were used to evaluate the protocol's effect on VTE, identify clinical factors associated with VTE and with receiving prophylaxis, and identify over- or under-prophylaxed patients. A final prophylaxis rate of 71.2% was achieved, an increase from the 40.8% reported by the Trauma Quality Improvement Program in 2015, with no accompanying reduction in VTE (1.5% pre and postintervention). Factors that identified patients at lower probability of receiving prophylaxis were those that increased bleeding risk: severe head injuries (odds ratio [OR] = 0.13) and preexisting bleeding (OR = 0.69) and renal/kidney (OR = 0.46) disorders. A large group of patients was both at increased odds of receiving prophylaxis and at low risk of VTE, representing a group that may be considered for nonpharmacologic options. Examination of current prophylaxis practices and identification of underuse or overuse is beneficial before expending effort to increase prophylaxis administration to reduce VTE.
An innovative course to prepare advanced practice registered nurses to spearhead quality and safety initiatives for older adults
Authors: Zonsius Mary C. , Miller Joanne M. , Lamb Karen V.
Published: November 2019

Current trends dictate that advanced practice registered nurses (APRNs) must be competent to address quality/safety issues specific to older adults. A gap analysis and review of key competencies in an adult–gerontology APRN-Doctorate of Nursing Practice (DNP) curriculum prompted the design and evaluation of an innovative online course, Quality and Safety for the Aging Adult. Course objectives align with key competencies, including graduate-level Quality and Safety Education for Nurses (QSEN) and the DNP Essentials. The course purpose was to prepare adult–gerontology APRN-DNP students as leaders to promote quality/safety outcomes for aging adults. The six-step Knowledge-to-Action Framework guided course development and evaluation. Select graduate-level QSEN competencies were used to construct a 20-item Quality and Safety Survey (4-point Likert scale) (Cronbach's alpha, 0.916). This survey was used during week 1 (pre) and week 15 (post) of the semester to evaluate students' preparation and confidence to perform key QSEN competencies. Significant improvements (p < .000) between pre/post scores on the Quality and Safety Survey were found across five classes. Students felt more prepared and confident to apply selected QSEN competencies on course completion. Moreover, nearly 60% (primary care) and nearly 35% (acute care) adult–gerontology APRN students selected the older adult population for their DNP projects. The Quality and Safety for the Aging Adult course positively influenced five classes of adult–gerontology APRN-DNP students. Integrating QSEN competencies with gerontology and quality/safety content is an effective strategy to prepare APRNs to lead quality/safety initiatives in aging adults. This innovative online course offers a successful model for innovative DNP education of adult–gerontology APRNs.
Assessing and addressing practitioner burnout: Results from an advanced practice registered nurse health and well-being study
Authors: Kapu April N. , Borg Card Elizabeth , Jackson Heather , Kleinpell Ruth , Kendall Jim , Lupear Buffy Krauser , LeBar Kiersten , Dietrich Mary S. , Araya Wendy A. , Delle Janelle , Payne Kate , Ford Jaquelyn , Dubree Marilyn
Published: November 2019

Background:

Numerous nursing and physician studies have reported the effects of workload, environment, and life circumstances contributing to burnout. Effects may include job dissatisfaction, poor quality of life, and associated negative patient outcomes. Although assessing clinician burnout to determine effective interventions has become a topic of great importance, there are minimal studies specific to advanced practice registered nurses (APRNs).

Purpose:

This single-center study was conducted to assess the prevalence and impact of APRN burnout and to recommend targeted interventions toward improvement of overall health and well-being.

Methods:

A cross-sectional, mixed methods design was used. The voluntary, anonymous survey examined perceptions of wellness, inclusion, social support, personal coping mechanisms, and status of burnout.

Results:

The 78-question survey was sent to 1,014 APRNs (94%) and PAs (6%), with a 43.6% response rate (n = 433); 76.4% were nurse practitioners. Participants were identified as currently experiencing burnout, formerly burned out, or never having experienced burnout. Profiles were developed, and similarities and differences between each group were compared. Of 433 respondents, 40.4% (n = 175) reported having never experienced burnout, 33.3% (n = 144) reported they had formerly experienced burnout, and 26.3% (n = 114) reported they were currently experiencing burnout.

Implications for practice:

The results of the study identified that some APRNs report experiencing burnout at different times in their careers. Recommendations by participants to mitigate burnout included self-care, organizational promotion of health and well-being, career development, and leadership support. This study is one of the first to report on burnout among APRNs and potential interventions to build resilience; however, additional research is warranted.
Prognostic significance of neutrophil–lymphocyte ratio (NLR) in patients with ovarian cancer
Authors: Yin Xinming , Wu Ling , Yang Hui , Yang HongBo
Published: November 2019

The prognostic role of neutrophil to lymphocyte ratio (NLR) in patients with ovarian cancer remains inconsistent. This meta-analysis was conducted to evaluate the predictive value of this biomarker for prognoses in ovarian cancer patients.

We systematically searched PubMed, Web of Science, and Embase for eligible studies embracing multivariate results. The Newcastle-Ottawa Scale were used to assess the study quality. Pooled hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated.

Ten studies involving 2919 patients were included in this meta-analysis. In multivariate analysis, the group with higher NLR had worse overall survival (OS) (HR = 1.34, 95% CI = 1.16–1.54) and shorter PFS (HR = 1.36, 95% CI = 1.17–1.57) than the control group. Furthermore, PLR values higher than the cut-off were associated with not only poorer OS (HR = 1.97, 95% CI = 1.61–2.40) but also more unfavorable PFS (HR = 1.79, 95% CI = 1.46–2.20). Univariate analysis also indicated the same results. Additionally, subgroup analysis showed that when the cut-off values for NLR and PLR were higher, their predictive effects became stronger.

This comprehensive meta-analysis suggested that the values of inflammatory marker of NLR was associated with ovarian cancer survival. Therefore, inflammatory markers can potentially serve as prognostic biomarkers.
Tiam1 high expression is associated with poor prognosis in solid cancers
Authors: Ding Jianlong , Yang Fan , Wu WeiFeng
Published: November 2019

Background

: A number of studies have attempted to determine the prognostic value of T-cell lymphoma invasion and metastasis-inducing factor 1 (Tiam1) in patients with solid cancers, but the reported results were of inconsistency. Thus, we performed a systematic review and meta-analysis to exhaustively evaluate the prognostic role of Tiam1 expression in patients with solid cancers.

Methods

: We retrieved literature published in between 1994 and April 22th, 2019 through searching PubMed, Web of Science and China national knowledge infrastructure (CNKI). Hazard ratios (HRs) coupled with 95% confidence intervals (95% CIs) were used to assess the relationship of Tiam1 expression and overall survival (OS), and disease-free survival (DFS).

Results

: A total of 2647 patients with solid cancers in 20 studies were enrolled in our meta-analysis eventually. The pooled results showed that Tiam1 high expression was closely correlated with poor OS (HR = 2.17, 95% CI: 1.80–2.61, P = .000) and DFS (pooled HR = 1.95, 95% CI = 1.58–2.40, P = .000). Moreover, our subgroup analysis and sensitivity analysis demonstrated the reliability and stability of our pooled results.

Conclusion

: In conclusion, this meta-analysis confirmed that Tiam1 higher expression positively correlated with OS and DFS, suggesting that Tiam1 may act as a valuable prognostic predictor and therapeutic target for patients with solid cancers. Nevertheless, in future more homogeneous and prospective studies should be performed to further support our findings.
Optimal interval to surgery after chemoradiotherapy in rectal cancer
Authors: Chen Ya Jing , Zhao Zhen-Jie , Wang Bang Wei , Jing Guang Zhuang , Ma Hai-Kun , Han Xuemei , Wang Jiancheng , Zhao Zhen-Jie
Published: November 2019

Background:

Rectal cancer is the second leading cause of cancer-related death in the Western world. Preoperative neoadjuvant chemoradiotherapy (nCRT) has been widely performed in the treatment of rectal cancer patients. However, there is no consensus on the length of waiting interval between the end of preoperative nCRT and surgery. Present network meta-analysis (NMA) aims to compare the differences of effect between all available interval to surgery after nCRT in rectal cancer in improving overall survival, disease-free survival and pathologic complete response (pCR) rate, and to rate the certainty of evidence from present NMA.

Method:

We will systematically search PubMed, EMBASE, Chinese Biomedical Literature Database, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify studies assessing the interval to surgery after CRT in rectal cancer. We will conduct this systematic review and meta-analysis using Bayesian method and report the full-text according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Extension Vision statement (PRISMA-NMA). We will assess the risk of bias of individual study using the Newcastle–Ottawa Scale and Cochrane Handbook V.5.1.0. We will also use the advance of GRADE to rate the certainty of NMA. Data will be analyzed by using R software V.3.4.1.

Results:

The results of this study will be published in a peer-reviewed journal.

Conclusion:

To the best of our knowledge, this systematic review and NMA will first use both direct and indirect evidence to compare the differences of all available interval to surgery after CRT in rectal cancer. This is a protocol of systematic review and meta-analysis, so the ethical approval and patient consent are not required.
Influence of non-jaundice stage at diagnosis on clinicopathological features and long-term survival of patients with periampullary carcinomas
Authors: Peng Xiaoqian , Jiao Xiaoxiao , Zhao Ping , Zhu Rongtao , Sun Yuling , Zhou Lin
Published: November 2019

The effect of non-jaundice stage at diagnosis on clinicopathological features and prognosis of patients with periampullary carcinomas (PACs) remains uncertain.

The 504 patients who were pathologically diagnosed with PACs between 2012 and 2017 were retrospective analyzed. Kaplan–Meier method was used to estimate survival and log-rank tests were used for comparisons between groups.

Patients were divided into the non-jaundice group and the jaundice group according to serum total bilirubin (3 mg/dL) at diagnosis. By comparison with the jaundice group, more patients of the non-jaundice group manifested abdominal pain with longer duration. The degree of deterioration of complete blood count, liver function and CA19-9 in the non-jaundice group was significantly lower (P < .001). The non-jaundice group had larger tumor size (P = .001), more duodenal carcinoma and pancreatic carcinoma (P < .001), lower resection rate (P = .001) and less pancreatic and perineural invasion (P = .017, P = .002). The I stage was significantly more common in the non-jaundice group (P < .001). The cumulative 5-year survival of the non-jaundice group was significantly higher (P = .032). Multivariate analysis for all patients demonstrated that CEA level, cell differentiation, chemotherapy, and recurrence were independent prognostic factors.

Patients with PACs in a non-jaundice stage at diagnosis showed more favorable clinicopathological features and long-term survival than such patients with jaundice.
Application of three-dimensional reconstruction to improve the preoperative measurement accuracy and applicability of femoral neck torsion angle
Authors: Han Qing , Zhang Aobo , Wang Chenyu , Yang Kerong , Wang Jincheng
Published: November 2019

Conventional methods have limitations in measuring femoral neck torsion angle (FNTA) of patients with femoral deformities. A new method of three-dimensional (3D) reconstruction technology based on computer tomography (CT) was proposed to enhance measurement accuracy and applicability in this study.

Bilateral FNTA of 50 developmental dysplasia of the hip (DDH) patients (DDH group) and 81 volunteers (normal group) were measured by Mimics software based on CT data with the marker lines determined by centerline and curvature. Each FNTA was measured by observer A and observer B for twice separately. 50 DDH patients were classified into 3 groups (group I, II, III) according to Hartofilakidis classification. The statistical analysis of the differences was made among the measurements of the FNTA.

The FNTA values were 27.56° ± 12.48° in DDH group and 21.22° ± 8.14° in normal group with significant difference (t = 4.516, P < .001). The FNTA values were 24.53° ± 2.40° in group I, 29.78° ± 1.83° in group II and 39.08° ± 3.13° in group III, with significant difference (F = 7.568, P = .001).

The accuracy, reliability and applicable scope of FNTA measurement can be improved by 3D reconstruction in clinical practice. The applicable scope of this method included normal people and patients with femoral deformities. The FNTA of DDH patients is significantly larger than normal volunteers with a positive correlation between the severity of classification. This study will also provide references for preoperative design of Chinese population.
Expression of CRYAB with the angiogenesis and poor prognosis for human gastric cancer
Authors: Tao Xiaoying , Cheng Lili , Li Yijie , Ci Hongfei , Xu Jing , Wu Shiwu , Tao Yisheng
Published: November 2019

Alpha-B crystallin (CRYAB), as a small heat shock protein, has been found to be highly expressed in various human cancers and significantly associated with the unfavorable prognosis of these tumor. Nevertheless, the clinical significance of CRYAB in gastric cancer (GC) angiogenesis remains to be elucidated. In this study, we evaluated the expression of CRYAB and CD34 in GC tissues and corresponding normal gastric specimens to explore whether high level CRYAB is related with the angiogenesis and the poor prognosis in GC.

In this study, the expression of CRYAB and CD34 were detected in GC tissues and corresponding normal gastric tissues by immunohistochemical (IHC) technique. Furthermore, the relationship of CRYAB with CD34-evaluated microvessel density (MVD) and poor prognosis was also investigated.

CRYAB expression level was significantly higher in GC tissue than in normal gastric mucosa tissue, and clearly mean higher MVD was observed in tumor tissues compared with non-cancerous tissues. Besides, higher MVD value was observed in positive CRYAB expression group than in negative CRYAB expression group. Statistical analysis showed that CRYAB and MVD are associated with clinicopathological features including lymph node metastasis (LNM), tumor differentiation, invasion depth, and TNM stages. Kaplan-Meier method and multivariate survival analysis indicated that high expression of CRYAB, MVD, invasion depth, TNM stages, and tumor differentiation, as well as LNM significantly correlate with poor prognosis of GC patients.

High expression of CRYAB may contribute to angiogenesis, invasion and metastasis of GC. These results indicated that CRYAB was expected to be a promising molecular marker for poor prognosis and potential therapeutic target in patients with GC.
Ultrasound characteristics of cervical lesions in patients with radioiodine refractory differentiated thyroid cancer
Authors: Gao Luying , Lin Yansong , Jiang Yuxin , Li Hui , Gao Qiong , Xi Xuehua , Wang Ying , Yang Xiao , Lai Xingjian , Zhu Shenling , Zhang Xiaoyan , Zhao Ruina , Zhang Bo
Published: November 2019

Radioiodine refractory (RAIR) is the major cause of thyroid cancer-related death. In order to avoid needless Radioiodine (RAI) therapy, recognizing the RAIR cases in time is important for the patients to obtain more time for the effective therapy.

Evaluate the ultrasound features of cervical metastatic lymph node in patients with RAIR differentiated thyroid cancer (DTC).

Seventeen adult patients with histologically confirmed locally advanced or metastatic RAIR-DTC were prospectively enrolled. The ultrasound (US) characteristics of cervical lesions in patients with the RAIR-DTC were compared with cervical lymph node metastasis from 59 non RAIR-DTC cases.

Among the 17 patients, cervical lymph node metastasis was found in 15 patients (88.3%). The cervical lesions of RAIR-DTC (mean size, 2.0 cm) were larger than that in non RAIR-DTC group (mean size, 1.30 cm). More multiple lesions and more lesions with visible flow were found in the RAIR Group, while fewer hyperechogenic punctuations were found in RAIR group (P < .05). The distant metastasis rates showed that RAIR-DTC led to a poorer prognosis than those of patients in the non RAIR Group (P < .01).

Ultrasound can help distinguish metastasized cervical lymph nodes of RAIR-DTC patients from non RAIR-DTC patients. For RAIR-DTC patients, a long-term US evaluation should be performed.
Carbapenem-resistant Klebsiella pneumoniae infection causing rupture of graft artery in solid organ recipients
Authors: Cai Yun-Shi , Xiao Heng , Zhang Shu , Li Mao , Liang Si-Min , Shi Zheng-Rong , Du Cheng-You
Published: November 2019

Rationale:

Donor-derived bacterial infection is a rare cause of morbidity after solid organ transplantation (SOT) but associated with significant morbidity and mortality, deaths caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) infection account for a considerable proportion of postoperation mortality rate in liver and kidney recipients. The arterial rupture as a result of fungal arteritis is occasionally described, while the rupture of graft vascular anastomosis after SOT due to donor-derived CRKP infection is rarely reported.

Patients concerns:

We reported 1 patient with donor-derived CRKP infection following liver transplantation and 2 patients following renal transplantation (1 liver and 2 kidneys were from the same donor), who experienced sudden abdominal pain and abdominal hemorrhage almost at the same time after organ transplantation.

Diagnosis:

The patients were diagnosed as graft arteries rupture due to corrosion caused by CRKP infection based on computed tomography scan, blood culture, laparotomy, and pulse-field gel electrophoresis.

Interventions:

Anti-shock treatment, exploratory laparotomy, broad-spectrum antibiotics, and abdominal puncture and drainage were given.

Outcomes:

The liver recipient survived as well as the liver graft, still under treatment of multiple abdominal infections. The 2 renal recipients were alive after resection of the renal grafts and underwent hemodialysis.

Lessons:

Rupture of graft artery should be foreseen when donor-derived CRKP infection was confirmed and broad-spectrum antibiotics and other interventions need to be considered.
Association between asymmetry in lower extremity lean mass and functional mobility in older adults living in the community
Authors: Lee Eun Jeong , Lee Seung Ah , Soh Yunsoo , Kim Yong , Won Chang Won , Chon Jinmann
Published: November 2019

The asymmetry in lower extremity strength is known to be related to the functional mobility in older adults living in the community. However, little is known about the association between lower extremity lean mass asymmetry and functional mobility in this patient group. Hence, this study aimed to determine whether asymmetry in lower extremity muscle mass has a significant relationship with functional mobility in older adults living in the community.

This cross-sectional study analyzed the pre-existing data from the Korean Frailty and Aging Cohort Study. A total of 435 older people (aged 70–84 years) were divided into the following groups according to their Limb Asymmetry Index (LAsI): low, intermediate, and high asymmetric groups. LAsI is calculated using lower extremity lean mass, and comparisons between groups were conducted. The participants were also further divided into better and worse mobility groups based on their physical performance test results (Timed Up and Go and Short Physical Performance Battery), and comparisons between groups were conducted. Comparisons between fallers and non-fallers were also conducted. In addition, this study investigated the factors that had a significant effect on gait speed and fall experience within the past year among older adults living in the community.

The LAsI was significantly associated with gait speed in older adults living in the community. Older adults in the highest tertile of the LAsI had a slower gait speed than those in the lowest tertile of the LAsI. However, no significant difference was observed in the LAsI between the better mobility group and worse mobility group. Moreover, the LAsI was not a significant predictor of falls.

Asymmetry in lower extremity lean mass was significantly associated with gait speed in older adults living in the community.
Impact of prenatal ultrasound diagnosis for fetal renal abnormalities
Authors: Chen Ying , Liu Wei
Published: November 2019

Background:

This study will evaluate diagnostic accuracy and management outcome studies involving patients assessed with prenatal ultrasound diagnosis (PUD) for fetal renal abnormalities (FRA).

Methods:

We will search the following electronic databases of MEDLINE, EMBASE, Cochrane Library, Web of Science, Springer, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure for diagnostic accuracy studies from inceptions to the present without language restrictions. Two authors will independently screen studies, collect data, and assess methodological quality.

We will use RevMan V.5.3 and Stata V.12.0 software for data pooling and statistical analysis.

Results:

In this study, we will assess sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio to determine the diagnostic accuracy of PUD for the treatment of patients with FRA.

Conclusion:

This study will provide latest evidence for the diagnostic accuracy of PUD for FRA.

Systematic review registration:

PROSPERO CRD42019151306.
A retrospective study of antibacterial iodine-coated implants for postoperative infection
Authors: Shirai Toshiharu , Tsuchiya Hiroyuki , Terauchi Ryu , Tsuchida Shinji , Mizoshiri Naoki , Mori Yuki , Takeuchi Akihiko , Hayashi Katsuhiro , Yamamoto Norio , Ikoma Kazuya , Kubo Toshikazu
Published: November 2019

Postoperative infection is one of the most serious complications in orthopedic surgery. We have developed and use iodine-coated implants to prevent and treat postoperative infection in compromised hosts. This study evaluated outcomes using iodine-coated implants for postoperative infections.

We treated 72 postoperative infected patients using iodine-coated implants. Of these, 38 were males and 34 were females, with a mean age of 59.3 years. The mean follow-up period was 5.6 years. The patients included 23 with an infection following total knee arthroplasty, 20 following total hip arthroplasty, 11 following osteosynthesis, 11 following spine surgery, 6 following tumor excision, and 1 following osteotomy. Of these, 37 underwent single-stage surgery and 35 underwent staged revision surgery. We performed staged surgery in any case with active infection. The survival of iodine-coated implants was determined using Kaplan-Meier analysis. White blood cell (WBC) and C-reactive protein (CRP) levels were measured pre- and postoperatively. To evaluate the systemic effects of iodine, serum thyroid hormone levels were examined.

Five patients underwent re-revision surgery. In 3 patients, periprosthetic infection recurred at an average of 18 months after surgery. The reinfection rate was 4.2%. These patients recovered following reimplantation of iodine-coated prostheses. No patients required amputation. The survival rate of iodine-coated implants was 91%. There were no signs of infection at the latest follow-up. The median WBC level was nearly in the normal range, and CRP levels returned to normal within 4 weeks after surgery. No abnormalities of thyroid gland function were detected.

Iodine-coated titanium implants can be very effective in the treatment of postoperative infections. An iodine coating can be safely applied to infected regions.
Differentiation of testicular seminoma and nonseminomatous germ cell tumor on magnetic resonance imaging
Authors: Liu Renwei , Lei Zhengxian , Li Aibo , Jiang Yixiang , Ji Jiayin
Published: November 2019

Magnetic resonance imaging (MRI) has excellent soft tissue resolution, as well as multidirectional and multisequence scanning technology, making it an important supplementary method in the diagnosis of testicular tumor.

To explore the utility of preoperative MRI for the differential diagnosis of testicular seminoma and nonseminomatous germ cell tumors (NSGCTs).

The medical records from 39 patients with testicular tumors that were examined preoperatively with MRI and treated with urologic surgery at our institution between January 2015 and March 2019 were retrospectively reviewed. Testicular tumors were confirmed by pathology and classified as seminoma (n = 20) or NSGCT (n = 19). Two radiologists analyzed the testicular tumors on preoperative MRI for morphology: multiple nodules or a single mass; presence/absence of a capsule; signal compared to the normal contralateral testicle (isointense, hypointense, hyperintense, or mixed); enhancement; septa; and hemorrhagic or cystic degeneration. Characteristics of seminomas and NSGCT were compared using the Chi-square or Fischer exact test.

MRI showed that the majority (95%; 19/20) of seminomas were nodular. There were significant differences in the presence/absence of a capsule (P = .001), T1-weighted imaging (T1WI) signal intensity (P = .047), T2-weighted imaging (T2WI) signal intensity (P < .001), septa (P < .001), and hemorrhagic or cystic degeneration (P < .001) between seminomas and NSGCT.

Seminomas were more likely to have no capsule, isointensity on T1WI, hypointensity on T2WI, and had narrow obviously enhanced fibrovascular septa without hemorrhagic or cystic degeneration; NSGCT was more likely to have a capsule, a mainly mixed signal on T1WI and T2WI, most of them had no fibrovascular septa, and hemorrhagic or cystic degeneration was common in malignant NSGCT.

This study suggests that preoperative MRI can distinguish seminoma from NSGCT. We propose that preoperative MRI of the scrotum is an effective technique that should be widely adopted for the management of scrotal disease.
Predictors of Reopening the Sternum in Children After Cardiac Surgery
Authors: Shaath Ghassan A. , Jijeh Abdulraouf M. Z. , Ismail Sameh R. , Hijazi Omar , Abu Sulaiman Riyadh , Almadani Wedad , Hamadah Mohammed Husam , Najm Hani K. , Kabbani Mohamed S.
Published: November 2019

Objectives:

Capillary leak syndrome can be severe in children after open-heart surgery which may hinder sternum closure and described as mediastinal tamponade. Reopening the sternum postoperatively may help maintaining hemodynamics and respiratory function. We looked for predictors that indicate the need for reopening the sternum.

Design:

A retrospective cohort study.

Setting:

A single cardiac center experience from 2009 to end of 2015.

Patients:

All children who required emergent reopening the sternum in the pediatric cardiac ICU after cardiac surgery were grouped as index cases and matched to a control group for age, body weight, cardiac diagnosis, and type of repair (single vs biventricular).

Interventions:

Emergent reopening the sternum.

Measurements and Main Results:

With a ratio of two control cases for each index case, variables related to cardiac output (predictors) were collected in a time line of 12, 6 hours, and just before reopening the sternum. Morbidities and mortality were also reviewed. Thirty-three index cases were compared with 63 control cases. Hospital stay and hospital-acquired infections were the same between the groups. Ventilation hours were longer in the index cases. Temperature gap more than 3°C, inotropic score more than 14, and acute kidney injury indicated by doubled blood urea nitrogen and creatinine were higher in the index group 6 hours before reopening the sternum. Mortality was more in the reopening sternum group with higher risk when extracorporeal membrane oxygenation was needed.

Conclusions:

Low cardiac output after cardiac surgery in children in form of temperature gap more than 3°C, inotropic score more than 14, and acute kidney injury may predict the need of reopening the sternum. Rate of mortality was higher in the reopening sternum group when extracorporeal membrane oxygenation was needed.
The Prognostic Value of Somatosensory Evoked Potentials in Children After Cardiac Arrest: The SEPIA Study
Authors: McDevitt William M. , Rowberry Tracey A. , Davies Paul , Bill Peter R. , Notghi Lesley M. , Morris Kevin P. , Scholefield Barnaby R.
Published: November 2019

Purpose:

Absent cortical somatosensory evoked potentials (SSEPs) reliably predict poor neurologic outcome in adults after cardiac arrest (CA). However, there is less evidence to support this in children. In addition, targeted temperature management, test timing, and a lack of blinding may affect test accuracy.

Methods:

A single-center, prospective cohort study of pediatric (aged 24 hours to 15 years) patients in which prognostic value of SSEPs were assessed 24, 48, and 72 hours after CA. Targeted temperature management (33–34°C for 24 hours) followed by gradual rewarming to 37°C was used. Somatosensory evoked potentials were graded as present, absent, or indeterminate, and results were blinded to clinicians. Neurologic outcome was graded as “good” (score 1–3) or “poor” (4–6) using the Pediatric Cerebral Performance Category scale 30 days after CA and blinded to SSEP interpreter.

Results:

Twelve patients (median age, 12 months; interquartile range, 2–150; 92% male) had SSEPs interpreted as absent (6/12) or present (6/12) <72 hours after CA. Outcome was good in 7 of 12 patients (58%) and poor in 5 of 12 patients (42%). Absent SSEPs predicted poor outcome with 88% specificity (95% confidence interval, 53% to 98%). One patient with an absent SSEP had good outcome (Pediatric Cerebral Performance Category 3), and all patients with present SSEPs had good outcome (specificity 100%; 95% confidence interval, 51% to 100%). Absence or presence of SSEP was consistent across 24-hour (temperature = 34°C), 48-hour (t = 36°C), and 72-hour (t = 36°C) recordings after CA.

Conclusions:

Results support SSEP utility when predicting favorable outcome; however, predictions resulting in withdrawal of life support should be made with caution and never in isolation because in this very small sample there was a false prediction of unfavorable outcome. Further prospective, blinded studies are needed and encouraged.
Specific Symptom Profiles are Associated with Distinct Changes in Amygdala Connectivity in Youth
Authors: Stoddard Joel , Kircanski Katharina , Haller Simone P. , Hinton Kendra E. , Sharif-Askary Banafsheh , Brotman Melissa A.
Published: November 2019

Complex clinical presentations are common in youth seeking mental health treatment, complicating attempts to identify specific biological underpinnings to guide precision psychiatry. We defined four classes of such youth based on their symptom profiles and identified unique patterns of amygdala functional connectivity in each class.

Subjects were 215 youth who varied along major symptom dimensions commonly associated with pediatric affective psychopathology: depression, irritability, anxiety, and attention-deficit/hyperactivity (ADHD). We used latent profile analysis to identify classes of symptom patterns. Functional MRI data were obtained while subjects completed a gender identification task of face-emotions that varied in emotion type and intensity. We used generalized psychophysiological interaction analysis to examine associations between the probability of being in each symptom class and amygdala functional connectivity.

The likelihood of being in the class with high parent-reported irritability and ADHD symptoms was associated with amygdala connectivity to the insula and superior temporal gyrus while processing high-intensity angry and fearful faces; to the precuneus while processing intensity across emotions; and to the ventrolateral prefrontal cortex across all task conditions. The likelihood of being in the class with high anxious and depressive symptoms was negatively associated with amygdala-thalamic connectivity across task conditions.

This is the first study to identify distinct associations between symptom profile classes and amygdala connectivity in a transdiagnostic sample of youth. These neural correlates provide external validity to latent classes derived from symptom clusters. This is an essential first step toward identifying the biological basis of common transdiagnostic symptom presentations in youth.
Neonatal white matter tract microstructure and 2-year language outcomes after preterm birth
Authors: Dubner Sarah E. , Rose Jessica , Feldman Heidi M. , Travis Katherine E.
Published: November 2019

Aim

To determine whether variability in diffusion MRI (dMRI) white matter tract metrics, obtained in a cohort of preterm infants prior to neonatal hospital discharge, would be associated with language outcomes at age 2 years, after consideration of age at scan and number of major neonatal complications. Method: 30 children, gestational age 28.9 (2.4) weeks, underwent dMRI at mean post menstrual age 36.4 (1.4) weeks and language assessment with the Bayley Scales of Infant Development–III at mean age 22.2 (1.7) months chronological age. Mean fractional anisotropy (FA) and mean diffusivity (MD) were calculated for 5 white matter tracts. Hierarchical linear regression assessed associations between tract FA, moderating variables, and language outcomes. Results: FA of the left inferior longitudinal fasciculus accounted for 17% (p = 0.03) of the variance in composite language and FA of the posterior corpus callosum accounted for 19% (p = 0.02) of the variance in composite language, beyond that accounted for by post menstrual age at scan and neonatal medical complications. The number of neonatal medical complications moderated the relationship between language and posterior corpus callosum FA but did not moderate the association in the other tract. Conclusion: Language at 2 is associated with white matter metrics in early infancy in preterm children. The different pattern of associations by fiber group may relate to the stage of brain maturation and/or the nature and timing of medical complications related to preterm birth. Future studies should replicate these findings with a larger sample size to assure reliability of the findings.