bluuebunny/crossref_metadata_2025 huggingface dataset:
Satisfactory postoperative alignment following retrograde SIGN Fin nailing for femoral shaft fractures
Authors: Wilson Nathaniel M. , Shaw Jordan T. , Malaba Mbonisi , Yugusuk Fasto L.T. , Nyambati Philemon , Siy Alexander B. , Galat Daniel D. , Koech Kiprono , Nugent Dylan , Whiting Paul S.
Published: April 2019

Purpose:

In developing countries, long bone fractures following trauma are a significant contributor to morbidity, and operating room resources are often limited in these settings. The Surgical Implant Generation Network (SIGN) Fin nail may reduce the challenges of retrograde intramedullary nailing of femoral fractures without fluoroscopy. In contrast to the traditional SIGN nail placed in a retrograde fashion, the Fin nail does not require proximal interlocking screws. Instead, the nail achieves stability through an interference fit within the proximal femoral canal. The purpose of this study is to compare postoperative alignment in femoral shaft fractures treated with either a retrograde SIGN Fin nail or a standard retrograde SIGN nail.

Method:

Using the SIGN online surgical database, we identified all femoral shaft fractures treated with a retrograde SIGN Fin nail at 2 African hospitals. Two examiners independently classified fracture patterns using the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification system. Using an on-screen protractor tool, postoperative coronal and sagittal plane alignment were measured and recorded as deviation from anatomic alignment (DFAA), with units in degrees. Available patient demographics and surgical details were also recorded. Fin nail cases were matched in a 1:1 ratio to retrograde standard SIGN nail cases based on AO/OTA fracture type.

Results:

Twenty-eight retrograde Fin nail cases were identified, and 28 matched retrograde SIGN nail cases were selected. The Fin nail and retrograde SIGN nail groups were well matched in terms of demographics, AO/OTA fracture type, and surgical characteristics. There was no significant difference in postoperative coronal or sagittal plane alignment between the groups. There were no cases in either group of average postoperative malalignment >5° in any plane.

Conclusion:

The SIGN Fin nail appears to achieve satisfactory radiographic alignment without the need for proximal interlocking screws, making it an attractive implant for retrograde femoral shaft fracture fixation in resource-limited settings. Further research is required to validate these findings and determine long-term Fin nail clinical outcomes.
Increased litigation burden among tibia, pelvis, and spine fractures
Authors: Working Zachary M. , El Naga Ashraf N. , Slocum Joshua , Tucker Allison , Hoogervorst Paul , Marmor Meir T.
Published: April 2019

Objectives:

To analyze a series of claims from a large national malpractice insurer associated with fracture care to understand what parameters are associated with claims, defense costs, and paid indemnity.

Design:

Review of claims in fracture care settings from a national database; case series.

Setting:

Database draws from insured pool of 400,000 medical malpractice cases from 400 healthcare entities across the country, representing 165,000 physicians; both academic and private.

Patients/Participants:

Fracture care patients bringing legal suit.

Main Outcome Measurements:

Cost of legal proceedings and indemnity, ICD-9 codes, and contributing causes toward claims.

Results:

A total of 756 fracture claims were asserted between 2005 and 2014 regarding fracture care within the database; 70% were brought for inaccurate, missed, or delayed diagnosis, while 22% addressed medical treatment and 8% were for surgical management. Orthopaedics was the primary service in 22%. Total cost (expenses and indemnity) to orthopaedic providers totaled $13.1MM (million). The most common claim against orthopaedics was for fractures of the tibia and fibula (11.4%). Impact factor (IF) analysis (as described by Matsen) of indemnity in these cases reveals 3 fracture regions of highest indemnity burden: fractures of the tibia and fibula (IF: 1.86, 11.4%), pelvis (IF: 1.77, 6.6%), and spine (IF 1.33, 6.6%). Analysis of contributing factors identifies the category of clinical judgement as the most common category (62%). Other common factors include patient noncompliance (31%), communication (28%), technical skill (17%), clinical systems (11%), and documentation (10%). The single most common specific cause of a claim in orthopaedic fracture care was misinterpretation of diagnostic imaging (25%).

Conclusion:

This study is the first of its kind to identify fractures of the tibia and fibula as high risk for litigation against orthopaedic providers and provides general counseling of legal pitfalls in fracture care. Finally, we are able to identify the act of patient assessment as a key issue in over half of all fracture-related claims against orthopaedic providers. Providers in general and specialty settings can use this information to help guide their treatment and care ownership decisions in the care of patients with fractures.

Level of Evidence:

Economic - Level III.
Mortality Rate-Dependent Variations in the Timing and Causes of Death in Extremely Preterm Infants Born at 23–24 Weeks’ Gestation*
Authors: Park Jae Hyun , Chang Yun Sil , Sung Sein , Park Won Soon
Published: April 2019

Objectives:

To determine mortality rate-dependent variations in the timing and causes of death, and to subsequently identify the clinical factors associated with decreased mortality in extremely preterm infants born at 23–24 weeks’ gestation.

Design:

A retrospective cohort study.

Setting:

Korean Neonatal Network registry that includes all level greater than or equal to 3 neonatal ICUs in Korea.

Patients:

Eligible, actively treated infants born at 23–24 weeks’ gestation (n = 574) from January 2014 to December 2016 were arbitrarily categorized based on institutional mortality rates of less than or equal to 50% (group I, n = 381) and greater than 50% (group II, n = 193). The primary outcome was mortality before discharge and the timing and causes of death according to the mortality rate.

Interventions:

None.

Measurements and Main Results:

The overall mortality rate was significantly lower in group I (40.7%) than in group II (79.3%). Regarding causes of death, mortalities due to cardiorespiratory, infectious, and gastrointestinal causes were significantly lower in group I than in group II. Mortality rates were significantly lower in group I, including all the subgroups that were categorized according to the timing of death, than in group II. The multivariate analyses showed that antenatal corticosteroid use, absence of oligohydramnios, birth weight, and body temperature at admission to the neonatal ICU were significantly associated with reduced mortality.

Conclusions:

The reduced mortality rate among the infants born at 23–24 weeks’ gestation was attributable to decreased mortality ascribed to cardiorespiratory, infectious, and gastrointestinal causes, and it was associated with antenatal steroid use and body temperature at admission to the neonatal ICU.
Nalbuphine Reduces Opioid-Associated Urinary Retention in Pediatric Patients
Authors: Reiter Pamela D. , Clevenger Amy C.
Published: April 2019

Objectives:

To evaluate the effect of nalbuphine administration on urine output in critically ill children with opioid-associated urinary retention.

Design:

Institutional review board approved, single center, retrospective medical chart review.

Setting:

Large medical-surgical PICU within a free-standing, tertiary care children’s hospital.

Patients:

Patients admitted to the PICU between October 1, 2014, and February 29, 2016, who received IV nalbuphine after meeting criteria for opioid-associated oliguria (defined as urine output below 1 mL/kg/hr and received at least one dose of opioid therapy within the preceding 12 hr).

Interventions:

None.

Measurement and Main Results:

Seventeen patients who received 21 doses of nalbuphine were analyzed. The median age and weight of patients were 6 years (interquartile range, 3–11.5 yr) and 18 kg (interquartile range, 12–35 kg), respectively. Two distinct dosing strategies became evident, specifically 0.05 mg/kg (n = 11 doses) and 0.1 mg/kg (n = 10 doses). Urine output increased significantly from baseline (median, 0 mL/kg/hr; interquartile range, 0–0.53 mL/kg/hr) to 6 hours post nalbuphine administration (median, 1.48 mL/kg/hr; interquartile range, 0–2 mL/kg/hr; p = 0.0002). Patients who received 0.1 mg/kg/dose had a greater urine output response compared with those who received 0.05 mg/kg/dose. Five patients (29%) had a catheter inserted into their bladder after administration of nalbuphine. Pain scores (grouped 6 hr before and after nalbuphine administration and single pain scores documented immediately before and after nalbuphine administration) were unchanged.

Conclusions:

Nalbuphine administration, at a dose of 0.1 mg/kg, improved urine output in a cohort of children with opioid-associated urinary retention. Pain control did not appear influenced by the provision of nalbuphine. Additional studies are needed to determine the influence of nalbuphine on urinary catheter insertion rates and catheter-associated urinary tract infections.
The Fragility of Statistically Significant Findings in Pediatric Critical Care Randomized Controlled Trials*
Authors: Matics Travis J. , Khan Nadia , Jani Priti , Kane Jason M.
Published: April 2019

Objectives:

The Fragility Index measures the number of events on which the statistical significance of a result depends and has been suggested as an adjunct statistical assessment for interpretation of trial results. This study aimed to assess the robustness of statistically significant results from pediatric critical care randomized controlled trials with dichotomous outcomes.

Data Sources:

A previously published scoping review of pediatric critical care randomized controlled trials (www.PICUtrials.net).

Study Selection:

A total of 342 trials were screened for inclusion. After applying inclusion/exclusion criteria, 43 fulfilled eligibility criteria and were included in the analysis.

Data Extraction:

Calculation of Fragility Index for trials reporting a statistically significant dichotomous outcome, and analysis of the relationship between trial characteristics and Fragility Index.

Data Synthesis:

The median Fragility Index was 2 (interquartile range, 1–6). The median sample size was 98 (interquartile range, 50–148) and sample size demonstrated a strong correlation with the Fragility Index (r = 0.729; n = 43; p < 0.001). The median number of outcome events was 8 (interquartile range, 4–15) and the total number of outcome events also showed a strong correlation with the Fragility Index (r = 0.728; n = 43; p < 0.001).

Conclusions:

Results from pediatric critical care randomized controlled trials with dichotomous outcomes reporting statistically significant findings often hinge on a small number of outcome events. Clinicians should exercise caution when interpreting results of trials with a low Fragility Index.
Clinical Profile and Predictors of Outcome of Pediatric Acute Respiratory Distress Syndrome in a PICU: A Prospective Observational Study*
Authors: Yadav Bharti , Bansal Arun , Jayashree Muralidharan
Published: April 2019

Objectives:

To study the clinical profile, predictors of mortality, and outcomes of pediatric acute respiratory distress syndrome.

Design:

A prospective observational study.

Setting:

PICU, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Patients:

All children (age > 1 mo to < 14 yr) admitted in PICU with a diagnosis of pediatric acute respiratory distress syndrome (as per Pediatric Acute Lung Injury Consensus Conference definition) from August 1, 2015, to November 2016.

Interventions:

None.

Measurements and Main Results:

Out of 1,215 children admitted to PICU, 124 (11.4%) had pediatric acute respiratory distress syndrome. Fifty-six children (45.2%) died. Median age was 2.75 years (1.0–6.0 yr) and 66.9% were male. Most common primary etiologies were pneumonia, severe sepsis, and scrub typhus. Ninety-seven children (78.2%) were invasively ventilated. On multiple logistic regressions, Lung Injury Score (p = 0.004), pneumothorax (p = 0.012), acute kidney injury at enrollment (p = 0.033), Fio
2-D1 (p = 0.018), and Pao
2/Fio
2 ratio-D7 (p = 0.020) were independent predictors of mortality. Positive fluid balance (a cut-off value > 102.5 mL/kg; p = 0.016) was associated with higher mortality at 48 hours. Noninvasive oxygenation variables like oxygenation saturation index and saturation-Fio
2 ratio were comparable to previously used invasive variables (oxygenation index and Pao
2/Fio
2 ratio) in monitoring the course of pediatric acute respiratory distress syndrome.

Conclusions:

Pediatric acute respiratory distress syndrome contributes to a significant burden in the PICU of a developing country and is associated with significantly higher mortality. Infection remains the most common etiology. Higher severity of illness scores at admission, development of pneumothorax, and a positive fluid balance at 48 hours predicted poor outcome.
Inter-Rater Reliability Between Critical Care Nurses Performing a Pediatric Modification to the Glasgow Coma Scale*
Authors: Kirschen Matthew P. , Snyder Megan , Smith Katherine , Lourie Kristen , Agarwal Kenya , DiDonato Pamela , Doll Ashlee , Zhang Bingqing , Mensinger Janell , Ichord Rebecca , Shea Judy A. , Berg Robert A. , Nadkarni Vinay , Topjian Alexis
Published: April 2019

Objectives:

Estimate the inter-rater reliability of critical care nurses performing a pediatric modification of the Glasgow Coma Scale in a contemporary PICU.

Design:

Prospective observation study.

Setting:

Large academic PICU.

Patients/Subjects:

All 274 nurses with permanent assignments in the PICU were eligible to participate. A subset of 18 nurses were selected as study registered nurses. All PICU patients were eligible to participate.

Interventions:

None.

Measurements and Main Results:

PICU nurses were educated and demonstrated proficiency on a pediatric modification of the Glasgow Coma Scale we created to make it more applicable to a diverse PICU population that included patients who are sedated, mechanically ventilated, and/or have developmental disabilities. Each study registered nurse observed a sample of nurses perform the Glasgow Coma Scale, and they independently scored the Glasgow Coma Scale. Patients were categorized as having developmental disabilities if their preillness Pediatric Cerebral Performance Category score was greater than or equal to 3. Fleiss’ Kappa (κ), intraclass correlation coefficient, and percent agreement assessed inter-rater reliability for each Glasgow Coma Scale component (eye, verbal, motor) and age-specific scale (≥ 2 and < 2-yr-old). The overall percent agreement between study registered nurses and nurses was 89% for the eye, 91% for the verbal, and 79% for the motor responses. Inter-rater reliability ranged from good (intraclass correlation coefficient = 0.75) to excellent (intraclass correlation coefficient = 0.96) for testable patients. Agreement on the motor response was significantly lower for children with developmental disabilities (< 2 yr: 59% vs 95%; p = 0.0012 and ≥ 2 yr: 55% vs 91%; p = 0.0012). Agreement was significantly worse for intermediate range Glasgow Coma Scale motor responses compared with responses at the extremes (e.g., motor responses 2, 3, 4 vs 1, 5, 6; p < 0.05).

Conclusions:

A pediatric modification of the Glasgow Coma Scale performed by trained PICU nurses has excellent inter-rater reliability, although reliability was reduced in patients with developmental disabilities and for intermediate range Glasgow Coma Scale responses. Further research is needed to determine the effectiveness of this Glasgow Coma Scale modification to detect clinical deterioration.
Infections on Extracorporeal Life Support in Adults and Children—A Survey of International Practice on Prevention, Diagnosis, and Treatment*
Authors: Farrell Deborah , MacLaren Graeme , Schlapbach Luregn J.
Published: April 2019

Objectives:

To assess nosocomial infection management practices in pediatric and adult patients supported with extracorporeal life support.

Design:

A 23-question online survey was developed to assess practices related to infection prevention, surveillance, diagnosis, and treatment in patients managed on extracorporeal life support. The survey was distributed internationally to intensivists via online newsletters and e-mail from June to December 2017.

Setting:

Extracorporeal life support centers.

Subjects:

Intensivists working in extracorporeal life support centers.

Interventions:

None.

Results:

We analyzed 147 responses from 25 countries. Most centers have bundles implemented as standard of care to prevent against ventilator-associated pneumonia (77%) and central catheter–associated bloodstream infections (91%). Prophylactic antibiotics beyond cannulation are at least occasionally used by 61% of respondents. Daily C-reactive protein (35%) and white cell count (80%) are the most commonly used surveillance biomarkers, and 25% of respondents reported collecting daily surveillance cultures. Participants responded that new onset of hemodynamic instability and rising C-reactive protein (49%) or rising procalcitonin (30%) are the most common triggers to commence antibiotics.

Conclusion:

There is considerable variability surrounding practices on prevention and diagnosis of infection in patients treated with extracorporeal life support. In view of the impact of infections acquired during extracorporeal life support, further research to inform recommendations on prevention, diagnosis, and management of infection on extracorporeal life support is urgently needed.
Gastric Residual Volume Measurement in U.K. PICUs: A Survey of Practice*
Authors: Tume Lyvonne N. , Arch Barbara , Woolfall Kerry , Latten Lynne , Deja Elizabeth , Roper Louise , Pathan Nazima , Eccleson Helen , Hickey Helen , Brown Michaela , Beissel Anne , Andrzejewska Izabela , Gale Chris , Valla Frédéric V. , Dorling Jon
Published: April 2019

Objectives:

Despite little evidence, the practice of routine measurement of gastric residual volume to guide both the initiation and delivery of enteral feeding in PICUs is widespread internationally. In light of increased scrutiny of the evidence surrounding this practice, and as part of a trial feasibility study, we aimed to determine enteral feeding and gastric residual volume measurement practices in U.K. PICUs.

Design:

An online survey to 27 U.K. PICUs.

Setting:

U.K. PICUs.

Subjects:

A clinical nurse, senior doctor, and dietician were invited to collaboratively complete one survey per PICU and send a copy of their unit guidelines on enteral feeding and gastric residual volume.

Interventions:

None.

Measurement and Main Results:

Twenty-four of 27 units (89%) approached completed the survey. Twenty-three units (95.8%; 23/24) had written feeding guidelines, and 19 units (19/23; 83%) sent their guidelines for review. More units fed continuously (15/24; 62%) than intermittently (9/24; 37%) via the gastric route as their primary feeding method. All but one PICU routinely measured gastric residual volume, regardless of the method of feeding. Eighteen units had an agreed definition of feed tolerance, and all these included gastric residual volume. Gastric residual volume thresholds for feed tolerance were either volume based (mL/kg body weight) (11/21; 52%) or a percentage of the volume of feed administered (6/21; 29%). Yet only a third of units provided guidance about the technique of gastric residual volume measurement.

Conclusions:

Routine gastric residual volume measurement is part of standard practice in U.K. PICUs, with little guidance provided about the technique which may impact the accuracy of gastric residual volume. All PICUs that defined feed tolerance included gastric residual volume in the definition. This is important to know when proposing a standard practice arm of any future trial of no-routine gastric residual volume measurement in critically ill children.
A Single-Arm, Multicenter Validation Study of Prostate Cancer Localization and Aggressiveness With a Quantitative Multiparametric Magnetic Resonance Imaging Approach
Authors: Maas Marnix C. , Litjens Geert J.S. , Wright Alan J. , Attenberger Ulrike I. , Haider Masoom A. , Helbich Thomas H. , Kiefer Berthold , Macura Katarzyna J. , Margolis Daniel J.A. , Padhani Anwar R. , Selnæs Kirsten M. , Villeirs Geert M. , Fütterer Jurgen J. , Scheenen Tom W.J.
Published: April 2019

Objectives

The aims of this study were to assess the discriminative performance of quantitative multiparametric magnetic resonance imaging (mpMRI) between prostate cancer and noncancer tissues and between tumor grade groups (GGs) in a multicenter, single-vendor study, and to investigate to what extent site-specific differences affect variations in mpMRI parameters.

Materials and Methods

Fifty patients with biopsy-proven prostate cancer from 5 institutions underwent a standardized preoperative mpMRI protocol. Based on the evaluation of whole-mount histopathology sections, regions of interest were placed on axial T2-weighed MRI scans in cancer and noncancer peripheral zone (PZ) and transition zone (TZ) tissue. Regions of interest were transferred to functional parameter maps, and quantitative parameters were extracted. Across-center variations in noncancer tissues, differences between tissues, and the relation to cancer grade groups were assessed using linear mixed-effects models and receiver operating characteristic analyses.

Results

Variations in quantitative parameters were low across institutes (mean [maximum] proportion of total variance in PZ and TZ, 4% [14%] and 8% [46%], respectively). Cancer and noncancer tissues were best separated using the diffusion-weighted imaging-derived apparent diffusion coefficient, both in PZ and TZ (mean [95% confidence interval] areas under the receiver operating characteristic curve [AUCs]; 0.93 [0.89–0.96] and 0.86 [0.75–0.94]), followed by MR spectroscopic imaging and dynamic contrast-enhanced-derived parameters. Parameters from all imaging methods correlated significantly with tumor grade group in PZ tumors. In discriminating GG1 PZ tumors from higher GGs, the highest AUC was obtained with apparent diffusion coefficient (0.74 [0.57–0.90], P < 0.001). The best separation of GG1–2 from GG3–5 PZ tumors was with a logistic regression model of a combination of functional parameters (mean AUC, 0.89 [0.78–0.98]).

Conclusions

Standardized data acquisition and postprocessing protocols in prostate mpMRI at 3 T produce equivalent quantitative results across patients from multiple institutions and achieve similar discrimination between cancer and noncancer tissues and cancer grade groups as in previously reported single-center studies.
Gender and Age Estimation Using the Morphometric Analysis of Odontoid Process: Is There a Relationship With Dental Maturation?
Authors: Magat Guldane , Ozcan Sevgi
Published: April 2019

Objective:

The purposes of this study were to show that differences in odontoid process related to age and gender using cone beam volumetric tomography, develop regression formulae based on metric data for gender and age estimation in a Turkish population and investigate whether there is a relationship between the odontoid process and dental maturation for usefulness in forensic and bioarchaeological studies.

Material and Method:

The study sample included a total of 77 subjects in the age group of 8–22 years. The anterior–posterior and transverse diameters of the odontoid process were measured. Regression formulae were performed for age and gender estimation. The dental maturation levels were determined according to Demirjian's method.

Result:

The mean values of anterior–posterior diameters were significantly larger than those of transverse diameters (P < 0.05). Those values were statistically higher for men than for women (P < 0.05). The lowest correlations were observed for the all measurements of the odontoid process in all cases. There were no significant correlations between the dental maturation levels and all measurements of the odontoid process.

Conclusion:

The findings of the present study state that measurements of the odontoid process can be utilized for age and gender estimation in the Turkish population.
Evaluation of Noninvasive Thermometers in an Endoscopy Setting
Authors: Blake Stacie , Fries Kellie , Higginbotham Lauren , Lorei Carol , McGee Michael , Murray Robert , Priest Melissa , Rangel Julie , Remick-Erickson Kara , Schneider Lise , Vodopest Barbara , Moore Aline
Published: April 2019

The measurement of body temperature is an important aspect of assessment prior to invasive procedures. The purpose of the study was to determine the level of agreement between temporal artery, noncontact infrared, and disposable oral electronic thermometers to a clinical reference device (nondisposable oral electronic thermometer) in outpatients prior to an endoscopic procedure. A descriptive, method-comparison study design was used to compare 3 noninvasive thermometers with a clinical reference device. Four noninvasive temperatures were measured with 3 test devices (temporal artery with ear tap; temporal artery without ear tap; disposable oral electronic; and noncontact infrared), followed by measurement with the clinical reference device (nondisposable, oral electronic). Differences (bias) and limits of agreement (±1.96 SD) were calculated for the test devices and graphed using Bland–Altman method. Clinically acceptable levels of agreement were set at a bias of 0.54 °F or less and precision of 0.90 °F or less. A total of 25 endoscopy patients (N = 14 female; N = 11 male) were studied, with temperatures ranging from 97.5 to 98.9, averaging 98.1 ± 0.3 °F. All thermometers, with the exception of the noncontact infrared (0.66 °F), had acceptable ranges for use in clinical practices. Findings from this study support the use of both temporal artery and disposable oral electronic thermometers in afebrile outpatients but not the noncontact infrared thermometer.
Nurse-Led Telephone Advice Line for Patients With Inflammatory Bowel Disease
Authors: Correal Ester Navarro , Leiva Olga Benítez , Galguera Angelina Dosal , Barrero Marta Gallego , Pastor Elena Sánchez , Gonzalo M. Francisca Murciano
Published: April 2019

Telephone helplines is an effective method for helping patients with chronic diseases, including inflammatory bowel disease (IBD). The objective of this cross-sectional multicenter study was to assess reasons for consultation by patients with IBD to a nurse-led telephone service. The sample included 7,273 IBD patients from 6 public hospitals in Barcelona, Spain. Data collected included calls registered during 50 working days including caller characteristics, reason for consultation, patient's diagnosis, and action recommended. The most common reasons for consultation were suspicion of relapse, doubts regarding medication, drug monitoring, side effects, visit appointment, and request of test results. In 63.7% of cases, telephone calls were solved solely by nurses, and in 35.9% in collaboration with a physician. Patient's questions were resolved via telephone in 89.3%. Findings from this study add support of the nurse's role for providing an effective telephone service for resolution of a wide range of patient queries in IBD. Helplines managed by IBD nurses may be a key element for patient-centered care.
A National Analysis of Short-term Outcomes and Long-term Survival Following Thoracoscopic Versus Open Lobectomy for Clinical Stage II Non-Small-Cell Lung Cancer
Authors: Yang Chi-Fu Jeffrey , Kumar Arvind , Deng John Z. , Raman Vignesh , Lui Natalie S. , D’Amico Thomas A. , Berry Mark F.
Published: April 2019

Objective:

To compare outcomes after open versus thoracoscopic (VATS) lobectomy for clinical stage II (cN1) non-small-cell lung cancer (NSCLC).

Background:

There have been no published studies evaluating the impact of a VATS approach to lobectomy for N1 NSCLC on short-term outcomes and survival.

Methods:

Outcomes of patients with clinical T1-2, N1, M0 NSCLC who underwent lobectomy without induction therapy in the National Cancer Data Base (2010–2012) were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis.

Results:

Median follow-up of 1559 lobectomies (1204 open and 355 VATS) was 43.2 months. The VATS approach was associated with a shorter median hospitalization (5 vs 6 d, P < 0.001) than the open approach. There were no significant differences between the VATS and open approach with regard to nodal upstaging (12.0% vs 10.5%, P = 0.41), 30-day mortality (2.3% vs 3.1%, P = 0.31), and overall survival (5-yr survival: 48.6% vs 48.7%, P = 0.76; multivariable-adjusted HR for VATS approach: 1.08, 95% CI: 0.90–1.30, P = 0.39). A propensity score-matched analysis of 334 open and 334 VATS patients who were well matched by 14 common prognostic covariates, including tumor size, and comorbidities, continued to show no significant differences in nodal upstaging, 30-day mortality, and 5-year survival between the VATS and open groups.

Conclusion:

In this national analysis, VATS lobectomy was used in the minority of N1 NSCLC cases but was associated with shorter hospitalization and similar nodal upstaging rates, 30-day mortality, and long-term survival when compared to open lobectomy. These findings suggest thoracoscopic techniques are feasible for the treatment of stage II (cN1) NSCLC.
System Factors Affecting Intraoperative Risk and Resilience
Authors: Kolodzey Lauren , Trbovich Patricia , Kashfi Arash , Grantcharov Teodor P.
Published: April 2019

Objective:

To identify and categorize system factors in complex laparoscopic surgery that have the potential to either threaten patient safety or support system resilience.

Background:

The operating room is a uniquely complex sociotechnical work system wherein surgical successes prevail despite pervasive safety threats. Holistically characterizing intraoperative factors that thus support system resilience in addition to those that threaten patient safety using contextual methodologies is critical for optimizing surgical safety overall.

Method:

In this prospective descriptive interdisciplinary study, 19 audio/video recordings of complex laparoscopic general surgical procedures were directly observed and transcribed. Using a qualitative systems-based approach, intraoperative human factors with the potential to impact patient safety, either as a safety threat or as a support for resilience, were identified. Adverse events were further assessed for shared threats and supports. Data collection was guided by the Systems Engineering Initiative for Patient Safety 2.0 work system model.

Results:

A total of 1083 relevant observations were made over 39.8 hours of operative time, enabling the identification of 79 distinct safety threats and 67 resilience supports within the surgical system. Safety threats associated with the physical environment, tasks, organization, and equipment were prevalent and observed in equal measure, whereas supports for resilience were predominantly attributed to clinician behaviors, including proactive team management and skills coaching. Two subclinical adverse events were identified; shared safety threats included suboptimal technology design, whereas shared resilience supports included calm clinician behavior and redundant intraoperative resourcing.

Conclusions:

Safety threats and resilience supports were found to be systematic in the surgical setting. Identified safety threats should be prioritized for remediation, and clinician behaviors that contribute to fostering resilience should be valued and protected.
A Minimally Invasive Technique for the 1-Stage Treatment of Complex Pelvic Floor Diseases: Laparoscopic-Pelvic Organ Prolapse Suspension
Authors: Boccasanta Paolo , Venturi Marco , Agradi Sergio , Vergani Contardo , Calabrò Giuseppe , Missaglia Claudio , Bordoni Luca , Longo Antonio
Published: April 2019

Objective

The aim of this prospective study was to assess the safety and effectiveness of a new single laparoscopic operation devised to relieve obstructed defecation, gynecologic and urinary symptoms in a large series of female patients with multiorgan pelvic prolapse.

Methods

We submitted 384 female patients to laparoscopic pelvic organ prolapse suspension operation, a new technique based on suspension of the middle pelvic compartment, by using a polypropylene mesh and followed up 368 of them, with defecography performed 12 months after surgery and a standardized protocol.

Results

The 368 patients were followed-up for 36.3 (±4.4) months, Recurrence rate was 4.9% for obstructed defecation syndrome and 3.3% for stress urinary incontinence. Complication rate was 2.9%. The mean period of daily activity resumption was 16.3 days (±4.8 days). Anorectal and urogynecologic symptoms and scores significantly improved after the operation (P < 0.001), with no worsening of anal continence. Incidence of postoperative fecal urgency was 0%. Postoperative defecography showed a significant (P < 0.001) improvement of all parameters in 315 patients (82%). Short Form 36 Health Survey score significantly improved after the operation (P < 0.01). An excellent/good overall Satisfaction Index was reported by 78.0% of patients.

Conclusions

In our experience the Laparoscopic-Pelvic Organ Prolapse Suspension seems to be safe and effective as a 1-stage treatment of associated pelvic floor diseases. Randomized studies with an appropriate control group and longer follow-up are now needed to assess the effectiveness of this promising technique.
The Relationship Between Hypoadiponectinemia and Cardiovascular Events in Liver Transplant Recipients
Authors: Siddiqui Mohammad Bilal , Patel Samarth , Arshad Tamoore , Lee Emily , Albhaisi Somaya , Driscoll Carolyn , Wolver Susan , Reichman Trevor , Bhati Chandra , Siddiqui Mohammad Shadab
Published: April 2019

Background.

Cardiovascular disease (CVD) is an important cause of morbidity and mortality after liver transplantation (LT). Serum adiponectin levels inversely correlate with CVD-related outcomes, but the relationship between hypoadiponectinemia and CVD after LT is unknown. Thus, the aim of the present study was to prospectively evaluate this relationship in LT recipients (LTR).

Methods.

LTR were prospectively enrolled (N = 130) between January 1, 2012, and January 1, 2014. Baseline adiponectin levels were drawn at enrollment and patients were followed for CVD events. Hypoadiponectinemia was defined as serum adiponectin <10 µg/mL. The primary endpoint was a composite CVD outcome consisting of myocardial infarction, angina, need for coronary revascularization, stroke, or cardiac death.

Results.

The mean age was 58 ± 11 years and prevalence of obesity, diabetes, and dyslipidemia was 40%, 35%, and 40%, respectively. A total of 20 CVD events were noted, after median follow up of 45 months. Hypoadiponectinemia was significantly associated with future risk of CVD events (hazard ratio, 3.519; 95% confidence interval, 1.180-10.499, P = 0.024). This association was independent of traditional CVD risk factors including age, gender, obesity, hypertension, diabetes, and choice of immunosuppression.

Conclusions.

Hypoadiponectinemia is a strong independent predictor of future cardiovascular events in LTR, which can be incorporated in clinical practice to assess CVD risk assessment after LT.
Delayed Bleeding of the Transplant Duodenum After Simultaneous Kidney-pancreas Transplantation: Case Series
Authors: Van Mellaert Anke , Gillard Pieter , Jochmans Ina , Demedts Ingrid , Sagaert Xavier , Naesens Maarten , Monbaliu Diethard , Kuypers Dirk , Pirenne Jacques , Sprangers Ben
Published: April 2019

Background.

In simultaneous pancreas-kidney (SPK) transplant recipients, the majority of complications described in the literature, are early postoperative complications. However, there is growing attention for late complications associated with SPK transplantation.

Methods.

In this case series, we present 3 cases, 2 enterically and 1 bladder-derived SPK transplant patients, with anastomotic hemorrhage of the donor duodenum as a very late complication, >10 years after transplantation (11, 22, and 18 y later, respectively).

Results.

In our center, 122 SPK transplantations have been performed between January 1992 and June 2018. The 3 cases reported here are the only patients in our cohort presenting with delayed anastomotic hemorrhage of the donor duodenum (2.5%). In the first 2 patients, reintervention with reconstruction of the anastomosis was performed. A congestive and friable mucosa was seen, and the resection specimen showed enlarged and congestive submucosal veins in both patients. There was no recurrence of bleeding after reintervention. In the third patient, enteric derivation was not possible because of the extremely fragile intestinal tissue perioperatively, and a conservative approach was taken. As possible precipitating factors are concerned, all 3 of our patients were taking low-dose aspirin and/or clopidogrel as secondary cardiovascular prevention.

Conclusions.

Bleeding of the transplanted donor duodenum can present as a late complication, several years after SPK transplantation. The development of enlarged, congestive submucosal veins could play a role in these late bleedings, and antiplatelet therapy could be a precipitating factor. Further research is necessary to investigate the pathophysiology, the prevalence, optimal treatment, and the consequent influence on mortality, morbidity, and graft loss after SPK transplantation.
Serostatus Testing & Dengue Vaccine Cost-Benefit Thresholds
Authors: Pearson Carl A. B. , Clifford Samuel , Abbas Kaja M. , Flasche Stefan , Hladish Thomas J.
Published: April 2019

The World Health Organisation currently recommends pre-screening for past infection prior to administration of the only licensed dengue vaccine, CYD-TDV. Using a bounding analysis, we show that despite additional testing costs, this approach can improve the economic viability of CYD-TDV: effective testing reduces unnecessary vaccination costs while increasing the health benefit for vaccine recipients. When testing is cheap enough, those trends outweigh additional screening costs and make test-then-vaccinate strategies net-beneficial in many settings.

We derived these results using a general approach for determining price thresholds for testing and vaccination, as well as indicating optimal start and end ages of routine test-then-vaccinate programs. This approach only requires age-specific seroprevalence and a cost estimate for second infections. We demonstrate this approach across settings commonly used to evaluate CYD-TDV economics, and highlight implications of our simple model for more detailed studies. We found trends showing test-then-vaccinate strategies are generally more beneficial starting at younger ages, and that in some settings multiple years of testing can be more beneficial than only testing once, despite increased investment in testing.
Creating a neuroprosthesis for active tactile exploration of textures
Authors: O’Doherty Joseph E. , Shokur Solaiman , Medina Leonel E. , Lebedev Mikhail A. , Nicolelis Miguel A. L.
Published: April 2019

Intracortical microstimulation (ICMS) of the primary somatosensory cortex (S1) can produce percepts that mimic somatic sensation and thus has potential as an approach to sensorize prosthetic limbs. However, it is not known whether ICMS could recreate active texture exploration—the ability to infer information about object texture by using one’s fingertips to scan a surface. Here we show that ICMS of S1 can convey information about the spatial frequencies of invisible virtual gratings through a process of active tactile exploration. Two rhesus monkeys scanned pairs of visually identical screen objects with the fingertip of a hand avatar, controlled via a joystick and later via a brain-machine interface, to find the one with denser virtual gratings. The gratings consisted of evenly spaced ridges that were signaled through ICMS pulses generated when the avatar’s fingertip crossed each ridge. The monkeys learned to interpret these ICMS patterns evoked by the interplay of their voluntary movements and the virtual textures of each object. Discrimination accuracy across a range of grating densities followed Weber’s law of just-noticeable differences (JND), a finding that matches normal cutaneous sensation. Moreover, one monkey developed an active scanning strategy where avatar velocity was integrated with the ICMS pulses to interpret the texture information. We propose that this approach could equip upper-limb neuroprostheses with direct access to texture features acquired during active exploration of natural objects.
Correlates of resting and exertional dyspnea among older adults with obstructive lung disease: a cross-sectional analysis of the Canadian Longitudinal Study on Aging
Authors: Good Joshua , Stickland Michael K , Dogra Shilpa
Published: April 2019

Introduction

In patients with chronic obstructive pulmonary disease (COPD), the perception of dyspnea is related to quality of life, and is a better predictor of mortality than the severity of airway obstruction. The purpose of the current study was to use population-level data from the Canadian Longitudinal Study on Aging (CLSA) to identify potential correlates of dyspnea in adults with obstructive lung disease.

Methods

Data from participants with a self-reported obstructive lung disease (asthma or COPD) were used for analysis (n=2,854). Four outcome variables were assessed: self-reported dyspnea at 1) rest, 2) walking on a flat surface, 3) walking uphill/climbing stairs, 4) following strenuous activity. Potential sociodemographic, health, and health behaviour correlates were entered in to logistic regression models.

Results

Higher body fat percentage, and worse forced expiratory volume in one second were associated with higher odds of reporting dyspnea. Females with an anxiety disorder (OR=1.91, CI: 1.29, 2.83) and males with a mood disorder (OR=2.67, CI: 1.53, 4.68) reported higher odds of experiencing dyspnea walking on a flat surface, independent of lung function and other correlates. Dyspnea while walking uphill/climbing stairs was associated with a slower timed up and go time in females (e.g. OR=1.18, CI: 1.10) and males (OR=1.19, CI: 1.09, 1.30).

Conclusions

In addition to traditional predictors such as lung function and body composition, we found that anxiety and mood disorders, as well as functional fitness were correlates of dyspnea. Further research is needed to understand whether targeting these correlates leads to improvements in perceptions of dyspnea.
The rs6505162 C>A polymorphism in themiRNA-423gene exhibits a protective element of coronary artery in a southern Chinese population with Kawasaki disease
Authors: Li Jiawen , Wang Jinxin , Su Xiaoping , Jiang Zhiyong , Rong Xing , Gu Xueping , Qiu Huixian , Zeng Lanlan , Zheng Hao , Gu Xiaoqiong , Chu Maoping
Published: April 2019

Background

Manifesting as acute rash, fever and vasculitis, belonging to autoimmune syndrome, Kawasaki disease(KD) is prone to occur in infants and young children. Males and females is affected by KD at a ratio of 1.4 to 1.7: 1. KD is known to own many common clinical manifestations and complications, like coronary artery lesion(CAL) and coronary artery aneurysm(CAA). Polymorphisms of the rs6505162 locus in themiRNA-423gene are associated with enhancive susceptibility to coronary artery disease and the alterations of the four cytokines IL-4., IL-10, IL-21, IL-22 in the early stages of diabetes. However, no researcher has reported whether rs6505162 is related to KD susceptibility or no. Therefore, we carried out the trial concentrating on the connection betweenmiRNA-423rs6505162 C>A polymorphism and KD susceptibility.

Methods

To obtain the genotypes of rs6505162inobjects enrolled by 532 KD children and 623 control, we applied Taqman real-time PCR and all statistical analyses was carried out by SAS.

Results

The comparison between all cases and all controls hinted that the rs6505162C>A polymorphism has no relationship with KD susceptibility. Nevertheless, a subgroup analysis revealed that the CA/AA genotypes of rs6505162 could reduce the occurrence of CAA (Adjusted age and gender odds ratio=1.30, 95%CI=1.02-1.67,P=0.037) and CAL (Adjusted OR=1.56, 95%CI=1.19-2.03,P=0.001)in KD patients.

Conclusion

Our final results stated clearly thatmiRNA-423rs6505162 polymorphism appears to be a protective element of CAL and CAA in southern Chinese suffers with KD.
Comparison of prokaryotic communities among fields exhibiting different disinfestation effects by anaerobic soil disinfestation
Authors: Lee Chol Gyu , Iida Toshiya , Matsuda Eriko , Yoshida Kayo , Kawabe Masato , Maeda Masayuki , Muramoto Yasunori , Watanabe Hideki , Otani Yoko , Nakaho Kazhiro , Ohkuma Moriya
Published: April 2019

Anaerobic soil disinfestation (ASD) is a chemical-independent fumigation method used for reducing the abundance of pathogens at soil depths of <40 cm. However, its disinfestation efficiency is unstable under field conditions. The microbial community reflects the soil environment and is a good indicator of soil health. Therefore, soil with a good disinfestation efficiency may have a unique microbial community. The aim of the present study was to compare the prokaryotic communities among soils obtained from 17 geographically different greenhouses that experienced tomato bacterial wilt but exhibited different disinfestation efficiencies after ASD treatment with the same substrate. In the present study, soil prokaryotic communities in the field, which indicate difference in disinfestation effects after ASD treatment among several fields, were compared using next-generation sequencing. The prokaryotic communities in the fields showing different disinfestation effects were roughly separated into sampling fields. The relative abundances of Betaproteobacteria and Clostridia were significantly increased in well-disinfested fields. Overall, 25 operational taxonomic units (OTUs) were specifically increased in various well-disinfested soils and 18 OTUs belonged to phylogenetically diversified Clostridia. Other OTUs belonged to aerobic bacteria and were not previously detected in sample collected from ASD-treated fields. The results showed that the changes to the prokaryotic communities did not affect ASD efficiency, whereas changes in the abundance of specific microbes in the community were related to disinfestation.
Assessing Confidence in the Results of Network Meta-Analysis (Cinema)
Authors: Nikolakopoulou Adriani , Higgins Julian PT , Papakonstantinou Theodore , Chaimani Anna , Del Giovane Cinzia , Egger Matthias , Salanti Georgia
Published: April 2019

Evaluation of the credibility of results from a meta-analysis has become an intrinsic part of the evidence synthesis process. We present a methodological framework to evaluate Confidence In the results from Network Meta-Analysis (CINeMA) when multiple interventions are compared. CINeMA considers six domains and we outline the methods used to form judgements about within-study bias, across-studies bias, indirectness, imprecision, heterogeneity and incoherence. Key to judgements about within-study bias and indirectness is the percentage contribution matrix, which shows how much information each study contributes to the results from network meta-analysis. The use of contribution matrix allows the semi-automation of the process, implemented in a freely available web application (cinema.ispm.ch). In evaluating imprecision, heterogeneity and inconsistency we consider the impact of these components of variability in forming clinical decisions. Via three examples, we show that CINeMA improves transparency and avoids the selective use of evidence when forming judgements, thus limiting subjectivity in the process. CINeMA is easy to apply even in large and complicated networks, like a network involving 18 different antidepressant drugs.