bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening for Postpartum Depression in a Neonatal Intensive Care Unit
Authors: Brownlee Maggie Hughes
Published: December 2021

Background:

Postpartum depression (PPD) is a common mental health condition that affects approximately 13% of postpartum women in the United States. However, the prevalence in the neonatal intensive care unit (NICU) has been shown to be higher. Routine screening for maternal PPD is recommended at infant primary care well-child visits up to 6 months of age. The absence of a routine PPD screening program in a level IV NICU created a large gap in screening in an at-risk population.

Purpose:

To develop and implement a screening program in the NICU to increase the identification of maternal PPD symptoms and to develop both a referral algorithm for NICU staff to follow and a referral resource packet to be given to mothers with positive PPD screenings.

Methods:

Mothers with infants in the NICU were screened for PPD using the Edinburgh Postnatal Depression Scale (EPDS). Bedside nurses administered the screening tool and used a referral algorithm to determine appropriate follow-up. EPDS scores of 10 or more were considered positive and indicated a need for referral.

Results:

The overall EPDS screening compliance was 66% with a positive rate of 26%. Nurses followed the referral algorithm appropriately 100% of the time. It was confirmed that 93% of the mothers with positive EPDS screenings sought help from a mental health provider.

Implications for Practice and Research:

Routine maternal PPD screening should be implemented in all NICU settings. Postpartum mental health issues should not be the sole responsibility of obstetricians, mental health providers, or maternal primary care providers.
Distortion of Spectral Ripples Through Cochlear Implants Has Major Implications for Interpreting Performance Scores
Authors: Winn Matthew B. , O’Brien Gabrielle
Published: December 2021

The spectral ripple discrimination task is a psychophysical measure that has been found to correlate with speech recognition in listeners with cochlear implants (CIs). However, at ripple densities above a critical value (around 2 RPO, but device-specific), the sparse spectral sampling of CI processors results in stimulus distortions resulting in aliasing and unintended changes in modulation depth. As a result, spectral ripple thresholds above a certain number are not ordered monotonically along the RPO dimension and thus cannot be considered better or worse spectral resolution than each other, thus undermining correlation measurements. These stimulus distortions are not remediated by changing stimulus phase, indicating these issues cannot be solved by spectrotemporally modulated stimuli. Speech generally has very low-density spectral modulations, leading to questions about the mechanism of correlation between high ripple thresholds and speech recognition. Existing data showing correlations between ripple discrimination and speech recognition include many observations above the aliasing limit. These scores should be treated with caution, and experimenters could benefit by prospectively considering the limitations of the spectral ripple test.
Prelinguistic Consonant Production and the Influence of Mouthing Before and After Cochlear Implantation
Authors: Fagan Mary K. , Vu Minh-Chau
Published: December 2021

Objectives:

The goal of the study was to investigate prelinguistic consonant production and the influence of vocalizations that co-occurred with object mouthing on consonant production in infants with profound sensorineural hearing loss before and after cochlear implantation to advance knowledge of early speech development in infants with profound hearing loss.

Design:

Participants were 43 infants, 16 infants with profound sensorineural hearing loss and 27 hearing infants. In the mixed longitudinal and cross-sectional design, infants with profound hearing loss and age-matched hearing infants participated before cochlear implantation, at an average age of 9.9 mo, and/or after cochlear implantation, at an average age of 17.8 mo. Mean age at cochlear implantation for infants with profound hearing loss was 12.4 mo; mean duration of cochlear implant use at time of testing was 4.2 mo.

Results:

Before and after cochlear implantation, infants with profound hearing loss produced significantly fewer supraglottal consonants per consonant-vowel vocalization than hearing peers and had smaller overall consonant inventories. Before, but not after cochlear implantation, infants with profound hearing loss produced proportionally more vocalizations, supraglottal consonant-vowel vocalizations, and different supraglottal consonants in vocalizations during mouthing than did hearing infants.

Conclusions:

The results document consonant production before cochlear implantation in a larger group of infants with profound hearing loss than previously examined. The results also extend evidence of early delays in consonant production to infants who received cochlear implants at 12 mo of age, and show that they likely miss the potential benefits of auditory-motor feedback in vocalization-mouthing combinations that occur before they have access to sound through cochlear implants.
Wideband Tympanometry Findings in School-aged Children: Effects of Age, Gender, Ear Laterality, and Ethnicity
Authors: Downing Cerys , Kei Joseph , Driscoll Carlie , Choi Robyn , Scott Dion
Published: December 2021

Objectives:

Wideband tympanometry (WBT) measures middle-ear function across a range of frequencies (250 to 8000 Hz) while the ear-canal pressure is varied from +200 to –300 daPa. WBT is a suitable test to evaluate middle-ear function in children, but there is a lack of age-, ear-, gender-, or ethnicity-specific data throughout the literature. The purpose of this study was to investigate the effects of age, ear laterality, gender, and ethnicity on the WBT data retrieved from children aged 4 to 13 years determined to have normal middle-ear function.

Design:

Data were collected cross-sectionally from 924 children aged 4 to 13 years who passed a test battery consisting of 226-Hz tympanometry, ipsilateral acoustic stapedial reflexes, and pure-tone screening, and without significant history of middle-ear dysfunction. Participants were grouped according to their age: 4 to 6 years, 7 to 9 years, 10 to 13 years. Wideband absorbance values were extracted at 0 daPa (WBA0) and tympanometric peak pressure (WBATPP).

Results:

The effects of age, frequency, and pressure (WBA0 versus WBATPP) were statistically significant. There were significant differences between WBA0 and WBATPP for all age groups such that WBA0 had lower absorbance at low frequencies (250 to 1600 Hz) and greater absorbance at mid to high frequencies (2500 to 8000 Hz). Statistically significant effects of age were present for WBA0 and WBATPP such that absorbance generally increased with age from 250 to 1250 Hz and decreased with age from 2000 to 5000 Hz. There were no significant main effects of gender, ear, or ethnicity.

Conclusions:

Gender-, ear-, and ethnicity-specific clinical WBA0 and WBATPP norms are not required for diagnostic purposes; however, age-specific norms may be necessary. Age-related changes in middle-ear function were observed across WBA0 and WBATPP. The data presented in this study are a suitable clinical reference for evaluating the outer- and middle-ear function of school-aged children.
A Rare Case of Pediatric Xanthoma Disseminatum With Diabetes Insipidus and BRAF p.V600E Mutation
Authors: Luo Shuaihantian , Tan Yixin , Zhang Guiying
Published: December 2021

Xanthoma disseminatum (XD) is a rare non-Langerhans cell histiocytosis characterized by xanthomatous lesions in the absence of hyperlipidemia. XD usually develops in young adults, and there are rare cases among children. BRAF mutations are frequent in Langerhans cell histiocytosis and Erdheim–Chester disease but absent or only rarely detected in other histiocytosis. Herein, we described a 6-year-old Chinese girl presented with generalized skin lesions and diabetes insipidus for 5 months. There were multiple periorbital xanthelasma with histopathological features of foamy histiocytes infiltration with Touton cells. Pituitary magnetic resonance imaging showed pituitary enlargement and pituitary stalk thickening. The presence of BRAF p.V600E mutation makes this case distinctive and also offers a potential therapeutic target. According to our review of the literature, this is the first pediatric XD with diabetes insipidus and BRAF mutation.
Use of Neuromuscular Electrical Stimulation for Abdominal and Quadriceps Muscle Strengthening: A Randomized Controlled Trial
Authors: Spring Leah K. , Petrell Kathleen , Depina Joaninha , Dover Jeffrey S.
Published: December 2021

BACKGROUND

Radiographic imaging has demonstrated muscle hypertrophy after treatment with noninvasive body contouring devices that target skeletal muscles.

OBJECTIVE

This pilot study sought to evaluate whether increased muscle mass translated to improved functional strength and endurance.

METHODS

A prospective, single-center, randomized open-label controlled study included 26 subjects randomized into 3 groups: 2 treatment groups and 1 control group. Both treatment groups received 4 neuromuscular electrical stimulation (NMES) treatments over a 2-week period. Muscle performance testing was conducted at baseline and 2-week and 4-week posttreatment. Anthropometric measurements were assessed at baseline and at 4-week posttreatment. Study participants completed subject satisfaction surveys and a personal experience assessment.

RESULTS

Treatment with NMES resulted in statistically significant improvements in abdominal and quadriceps strength and endurance from baseline through 4-week posttreatment. Mean waist circumference decreased and quadriceps circumference increased, both nonsignificantly. Subject satisfaction regarding abdominal and quadriceps strength was reported as “satisfied or very satisfied” in 89% and 92% at 4-week and 8-week posttreatment, respectively.

CONCLUSION

Treatment of the abdomen and quadriceps with NMES leads to significant improvements in muscular strength and endurance.
Assessment of Radiological Hazard of Radioactive Waste Using Effective or Organ Doses: How This May Affect Final Waste Disposal
Authors: Ivanov V.K. , Chekin S. Yu. , Lopatkin A.V. , Menyajlo A.N. , Maksioutov M.A. , Tumanov K.A. , Kashcheeva P.V. , Lovachev S.S.
Published: December 2021

The radiological hazard of spent nuclear fuel and radioactive waste slows down further development of nuclear energy systems. The authors evaluate timescales required to reduce the radiological hazard of accumulated waste to the reference level of natural uranium that had been consumed by the nuclear energy system. The estimate of this time scale depends on the radiological hazard metric used in the calculations. In this study, two metrics are compared: (1) the committed effective dose based on ICRP Publication 72 and (2) the lifetime radiation risk calculated with use of organ doses and recent radiation risk models recommended by ICRP. The effective dose of the waste reaches the reference level 300 y after the accumulation of waste, while lifetime attributable risk of waste converges to natural uranium in 100 y. Thus, the lifetime attributable risk (LAR) metric is more appropriate to estimate the time requirements for radioactive waste storage and disposal. The effective dose metric significantly overestimates this timescale as it is not intended for quantifying radiation-related risks.
Changes in the Epidemiology of Zoonotic Infections in Children
Authors: Kuitunen Ilari , Renko Marjo
Published: December 2021

Objectives:

Zoonotic infections are difficult to recognize in children. The age distributions and seasonal occurrences of these infections vary substantially, even among those transmitted by the same vectors, and their epidemiology may change over time. The aim was to report the incidences and trends of Borrelia burgdorferi, Puumala virus, Francisella tularensis and tick-borne encephalitis (TBE) virus infections in the pediatric population (age 0–19) of Finland.

Methods:

A nationwide survey based on the National Infectious Disease Register was conducted from 1996 to 2019 and all laboratory-confirmed cases were included. Age-stratified incidences per 100,000 person-years were calculated.

Results:

Cumulative incidences were B. burgdorferi 11.2, TBE 0.4, Puumala virus 6.4 and F. tularensis 2.5 per 100,000 person-years. An increasing trend in the incidences of B. burgdorferi and TBE was observed. Borrelia expanded geographically northward and inland. Tularemia follows a 2–4-year epidemic cycle and rates are similar across age groups. Puumala incidences are highest in the older children.

Discussion:

Borrelia infections increased most rapidly in children 5–9 years of age and overall expanded geographically in Finland. Tularemia epidemic cycles were shorter than those previously reported. These results will help clinicians to identify these infections in different geographic areas and age groups in Finland.
Adolescent pain: appraisal of the construct and trajectory prediction-by-symptom between age 12 and 17 years in a Canadian twin birth cohort
Authors: Battaglia Marco , Garon-Carrier Gabrielle , Rappaport Lance , Brendgen Mara , Dionne Ginette , Vitaro Frank , Tremblay Richard E. , Boivin Michel
Published: December 2021

Adolescent pain is common and continues into adulthood, leading to negative long-term outcomes including substance-related morbidity: an empirical definition of its construct may inform the early detection of persistent pain trajectories. These secondary analyses of a classical twin study assessed whether headaches, back pains, abdominal pain, chest pains, stabbing/throbbing pain, and gastric pain/nausea, measured in 501 pairs across 5 waves between age 12 and 17 years, fit a unitary construct or constitute independent manifestations. We then assessed which symptoms were associated with a steady, “frequent pain” trajectory that is associated with risk for early opioid prescriptions. Item response theory results indicated that all 6 pain symptoms index a unitary construct. Binary logistic regressions identified “back pain” as the only symptom consistently associated with membership in the “frequent adolescent pain” trajectory (odds ratio: 1.66-3.38) at all 5 measurement waves. Receiver operating characteristic analyses computed the discriminating power of symptoms to determine participants' membership into the “frequent” trajectory: they yielded acceptable (0.7-0.8) to excellent (0.8-0.9) area under the curve values for all 6 symptoms. The highest area under the curve was attained by “back pain” at age 14 years (0.835); for multiple cut-off thresholds of symptom frequency, “back pain” showed good sensitivity/false alarm probability trade-offs, predominantly in the 13 to 15 years age range, to predict the “frequent pain” trajectory. These data support a unitary conceptualization and assessment of adolescent pain, which is advantageous for epidemiological, clinical, and translational purposes. Persistent back pain constitutes a sensitive indicator of a steady trajectory of adolescent pain.
Combination of inhaled nitrous oxide and oral opioids induces long-lasting analgesic effects in patients with neuropathic pain: ProtoTOP study post hoc exploratory analyses
Authors: Bouhassira Didier , Perrot Serge , Attal Nadine , Ramirez-Gil Juan Fernando , Delval Cécile , Schaller Manuella , Bessière Baptiste , Houéto Patrick , Sommer Claudia
Published: December 2021

Experimental studies have suggested that nitrous oxide-induced analgesia depends on interactions with opioids. On the basis of these results, we hypothesized that the effects of inhaled nitrous oxide/oxygen (N2O/O2) 50%-50% equimolar mixture (EMONO) on patients with neuropathic pain would be higher in those receiving concomitant opioids. To test this hypothesis, we did exploratory post hoc analyses of our recently published ProtoTOP study to compare the effects of EMONO and placebo in patients with or without concomitant opioid treatment. A total of 92 patients of the 221 (ie, 41.6%) included in the ProtoTOP study were concomitantly treated with opioids. In contrast with our previous analyses, average pain intensity was significantly decreased in comparison with placebo one week after the last treatment administration in patients treated with opioids, but not in those treated without opioid, and this effect was maintained over the 4-week follow-up period. Neuropathic pain symptom inventory (NPSI total and subscores) was also significantly more decreased after inhalation of EMONO in comparison with placebo only in patients receiving opioids. The proportion of patients with at least 30% pain reduction and of those reporting an overall improvement with the Patient Global Impression of Change were significantly higher only in this population of patients. In conclusion, these results complement our previous analyses with the identification of a specific population of responders to EMONO inhalation in patients with neuropathic pain. As suggested by experimental studies, we hypothesized that these long-lasting analgesic effects could depend on the anti-N-methyl-D-aspartate properties of N2O.
Barriers and Facilitators of Implementing Injury Prevention Practices by Massage Therapists
Authors: Friedman Lee S. , Madigan Dana , Cambron Jerrilyn A.
Published: December 2021

Objective:

Massage therapy involves pervasive ergonomic hazards with the majority of massage therapists (MTs) experiencing adverse musculoskeletal health issues. A variety of barriers and facilitators exist that can impact the efficacy of safety programs.

Methods:

A longitudinal study to characterize individual and organizational barriers and facilitators that influence the implementation of self-care techniques designed to reduce musculoskeletal health issues.

Results:

MTs who reported time as abarrier implemented 0.9 fewer selfcare items despite wanting to make these changes (P 
= 0.003) and 1.4 fewer self-care items when management was identified as a barrier (P < 0.001). Almost 20% of the MTs reported switching jobs which was associated with implementing 1.1 fewer self-care items (P = 0.002).

Conclusions:

Our findings show that organizational factors plays a critical role in workplace safety which can be used to improve working conditions faced by MTs.
Relationship Between Psychosocial Work Environment Factors and Presenteeism Among Workers With Diarrhea/Constipation Symptoms
Authors: Inoue Shunsuke , Nagata Tomohisa , Nagata Masako , Tateishi Seiichiro , Fujino Yoshihisa , Mori Koji
Published: December 2021

Objectives:

This study aimed to investigate the relationship of diarrhea/constipation symptoms with presenteeism and psychosocial work environment factors.

Methods:

This study analyzed 16,975 workers of 10 Japanese companies. Presenteeism was measured using a work functioning impairment scale. Odds ratios (ORs) and 95% confidence intervals (cis) for the relationship between diarrhea/constipation and presenteeism were estimated using a logistic model, adjusting for the psychosocial work environment.

Results:

Diarrhea/constipation symptoms were related to presenteeism. This relationship was weakened, but remained significant after adjusting for psychosocial work environment factors.

Conclusions:

Diarrhea and constipation, which are highly prevalent in the workplace, are important pathological factors for presenteeism. Presenteeism can be partially suppressed by improving the psychosocial work environment.
Does the Application of a Lycra Arm Sleeve Change Shoulder Biomechanics in People With Stroke?—A Preliminary Study
Authors: Kumar Praveen
Published: December 2021

Introduction

Glenohumeral subluxation (GHS) is reported in up to 81% of patients with stroke. Our previous studies found that a Lycra sleeve can reduce acromion-greater tuberosity (AGT) distance (used for assessment of GHS) in people with chronic stroke (n = 5). In a recent study on able-bodied people (n = 31), we report reduction in AGT, change in scapula measurements, and change in muscle activity after the application of Lycra sleeve. The aim of this study was to investigate the effect of Lycra sleeves on the AGT distance, muscle activity around the shoulder region, and scapular position in people with stroke.

Method

People with stroke who gave informed consent were recruited. Measurements were taken before and immediately after application of the sleeve. Portable diagnostic ultrasound, electromyography, and a tape measure were used to measure AGT distance, muscle activity (biceps, triceps, deltoid, and supraspinatus), and position of the scapula, respectively.

Results

Six participants with a mean age of 53 ± 8 years were recruited. There was a mean reduction of 0.13 cm (95% confidence interval, −0.01 to 0.28 cm) in AGT distance measurements but this was not statistically significant (t = 3.503, df = 5, P = .062). The inferior scapula measurements showed a mean reduction of 1 cm (95% confidence interval, 0.07-1.92 cm) and this was statistically significant (t = 2.781; df = 5, P = .039) when compared without and with sleeve application.

Conclusions

The application of Lycra arm sleeves did not significantly reduce the AGT distance but altered scapula mechanics by putting it in a mechanically advantaged position in a small sample of people with chronic stroke. A properly designed definitive trial would be required to confirm the effectiveness of the Lycra sleeve in reducing GHS in people with both acute and chronic stroke.

Clinical Relevance

Lycra sleeve may have potential to alter biomechanics and influence neuromuscular activity in the arm.
Robotic Emulation of Candidate Prosthetic Foot Designs May Enable Efficient, Evidence-Based, and Individualized Prescriptions
Authors: Caputo Joshua M. , Dvorak Evan , Shipley Kate , Miknevich Mary Ann , Adamczyk Peter G. , Collins Steven H.
Published: December 2021

Introduction

The design and selection of lower-limb prosthetic devices is currently hampered by a shortage of evidence to drive the choice of prosthetic foot parameters. We propose a new approach wherein prostheses could be designed, specified, and provided based on individualized measurements of the benefits provided by candidate feet. In this manuscript, we present a pilot test of this evidence-based and personalized process.

Methods

We previously developed a “prosthetic foot emulator,” a wearable robotic system that provides users with the physical sensation of trying on different prosthetic feet before definitive fitting. Here we detail preliminary demonstrations of two possible approaches to personalizing foot design: 1) an emulation and test-drive strategy of representative commercial foot models, and 2) a prosthetist-driven tuning procedure to optimize foot parameters.

Results

The first experiment demonstrated large and sometimes surprising differences in optimal prosthetic foot parameters across a variety of subjects, walking conditions, and outcome measures. The second experiment demonstrated a quick and effective simple manual tuning procedure for identifying preferred prosthetic foot parameters.

Conclusions

Emulator-based approaches could improve individualization of prosthetic foot prescription. The present results motivate future clinical studies of the validity, efficacy, and economics of the approach across larger and more diverse subject populations.

Clinical Relevance

Today, emulator technology is being used to accelerate research and development of novel prosthetic and orthotic devices. In the future, after further refinement and validation, this technology could benefit clinical practice by providing a means for rapid test-driving and optimal selection of clinically available prosthetic feet.
Prognosis of Human Papillomavirus–Negative Compared to Human Papillomavirus–Positive Cervical Cancer
Authors: Kugelman Nir , Siegler Efraim , Mackuli Lena , Lavie Ofer , Schmidt Meirav , Shaked-Mishan Pninit , Segev Yakir
Published: December 2021

Objectives

The aims of the study were to evaluate the prevalence and prognosis of human papillomavirus (HPV)-negative cervical cancer (CC) and to compare these to data for HPV-positive CC.

Materials and Methods

This retrospective cohort study compared between HPV-negative CC and HPV-positive CC patients. Primary end points were disease-free survival and overall survival. Secondary end points were demographic and clinical variables including histological diagnosis, stage, and treatment.

Results

Of 233 women with CC, 18 (8%) tested HPV-negative. During a median follow-up of 45 months, 33 (14%) recurrences and 41 (18%) deaths were observed. Eleven of the 18 women (61%) who tested HPV-negative and 41 of the 215 (19%) who tested HPV-positive had only adenocarcinoma (p < .001). In a multivariate logistic regression analysis, advanced age (p = .003) and primary treatment with chemotherapy and/or radiotherapy (p < .001) remained statistically significant for recurrence or mortality (disease-free survival). The factors associated with lower survival were advanced age (p = .008), higher stage at diagnosis (p < .001), and HPV negativity (p = .062). Median overall survival for HPV-positive CC was not reached, compared with 24 months for HPV-negative CC. Kaplan-Meier curves showed lower rates of disease-free survival (p = .008) and overall survival (p = .011), for women with HPV-negative compared with HPV-positive CC.

Conclusions

The relatively poor prognosis of HPV-negative CC is important in light of its relatively high prevalence, which could increase proportionally to HPV-positive CC due to increased HPV screening and vaccination. Further studies are needed to confirm whether HPV status is truly an independent prognostic factor in CC.
Adverse Events Associated with Cardiac Catheterization in Children Supported with Ventricular Assist Devices
Authors: Power Alyssa , Navaratnam Manchula , Murray Jenna M. , Peng Lynn F. , Rosenthal David N. , Dykes John C. , Yarlagadda Vamsi V. , Maeda Katsuhide , Almond Christopher S. , Chen Sharon
Published: December 2021

Children on ventricular assist device (VAD) support can present several unique challenges, including small patient size, univentricular or biventricular congenital heart disease (1V- or 2V-CHD) and need for biventricular VAD (BiVAD) support. While cardiac catheterization can provide valuable information, it is an invasive procedure with inherent risks. We sought to evaluate the safety of catheterization in pediatric patients on VAD support. We performed a retrospective review of patients on VAD support who underwent catheterization at Lucile Packard Children’s Hospital between January 1, 2014 and September 1, 2019. Using definitions adapted from Pedimacs, adverse events (AEs) after catheterization were identified, including arrhythmia; major bleeding or acute kidney injury within 24 hours; respiratory failure persisting at 24 hours; and stroke, pericardial effusion, device malfunction, bacteremia or death within 7 days. AEs were categorized as related or unrelated to catheterization. Sixty procedures were performed on 39 patients. Underlying diagnoses were dilated cardiomyopathy (48%), 1V-CHD (35%), 2V-CHD (8%), and other (8%). Devices were implantable continuous flow (72%), paracorporeal pulsatile (18%) and paracorporeal continuous flow (10%). Catheterizations were performed on patients in the ICU (60%), on inotropic support (42%), with deteriorating clinical status (37%) and on BiVAD support (12%). There were 9 AEs possibly related to catheterization including 6 episodes of respiratory failure, 2 major bleeding events, and 1 procedural arrhythmia. AE occurrence was associated with ICU status (P = 0.01), BiVAD support (P = 0.04) and procedural indication to evaluate worsening clinical status (P = 0.04). Despite high medical acuity, catheterization can be performed with an acceptable AE profile in children on VAD support.
Hemodynamic Effects of Left-Atrial Venous Arterial Extra-Corporeal Membrane Oxygenation (LAVA-ECMO)
Authors: Singh-Kucukarslan Gulmohar , Raad Mohamad , Al-Darzi Waleed , Cowger Jennifer , Brice Lizbeth , Basir Mir B. , O’Neill William W. , Alaswaad Khaldoon , Eng Marvin H.
Published: December 2021

We report a case of a 59-year-old male in post-myocardial infarction cardiogenic shock undergoing left atrial venous arterial extracorporeal membrane oxygenation (LAVA-ECMO) as a bridge to transplantation. The unique feature of this ECMO configuration is use of a single trans-septal cannula to provide biventricular unloading and use of a single arterial access.
Management of Heparin-Induced Thrombocytopenia Using Plasmapharesis in Patients Undergoing HeartMate 3 Left Ventricular Assist Device
Authors: Naqvi Syed Yaseen , Jawaid Anas , Dao Benjamin , Falvey Jennifer , Vidula Himabindu , Gosev Igor , Thomas Sabu
Published: December 2021

Heparin-induced thrombocytopenia (HIT) type-2 is a rare, but life-threatening complication that presents a unique challenge in patients undergoing cardiac surgery. Patients that require cardiac surgery with HIT present a dilemma between intraoperative anticoagulation, perioperative bleeding risk, and perioperative thrombotic events. We describe a case series of four patients who developed HIT in their hospital course before HeartMate 3 (HM3) left ventricular assist device implantation. Following a multidisciplinary approach, all patients did well intraoperatively with an approach of preoperative plasmapheresis, intraoperative unfractionated heparin (UFH), and postoperative conversion to bivalirudin with a bridge to warfarin. However, two patients had postoperative bleeding complications on bivalirudin. This case series details the therapeutic challenges encountered for HM3 implantation in patients with HIT and offers a therapeutic alternative to intraoperative bivalirudin in the effort to decrease perioperative complications in this challenging patient population.
Trends in Body Mass Index and Association With Outcomes in Pediatric Patients on Continuous Flow Ventricular Assist Device Support
Authors: Puri Kriti , Adachi Iki , Bocchini Claire E. , Spinner Joseph A. , Denfield Susan W. , Sisley Stephanie , Elias Barbara A. , Jimenez-Gomez Andres , Price Jack F. , Dreyer William J. , Choudhry Swati , Tunuguntla Hari P.
Published: December 2021

Data are limited regarding body mass index (BMI) in pediatric patients supported by ventricular assist devices (VAD) and associated clinical outcomes and complications. We performed a retrospective single-center cohort study including patients aged ≤21 years on durable continuous-flow VAD support for ≥30 days from 2009 to 2020. Patients were classified based on BMI percentile at implant using the US Centers for Disease Control and Prevention criteria: underweight (<5th percentile), healthy weight (5th–<85th percentile, reference group), overweight (85th–<95th percentile), and obese (≥95th percentile). Primary outcomes were hospital mortality and length of stay (LOS) after implant. Secondary outcomes included infectious complications and pump thrombosis. Seventy-two patients (58 HeartWare, 13 HeartMateII, 1 HeartMate3) were included. At implant, the study cohort comprised 13% underweight, 53% healthy weight, 18% overweight, and 17% obese. BMI increased across all categories during support, with 29% gaining BMI categories. No patients with obesity reduced their BMI category. At explant, the study cohort comprised 1% underweight, 54% healthy weight, 22% overweight, and 22% obese. There was no significant difference in hospital mortality, postoperative LOS, or pump thrombosis. Patients who were overweight had more frequent non-VAD infections. Patients with obesity required longer duration on VAD support and were less likely to be transplanted. We concluded that pediatric patients on VAD support who are overweight or have obesity do not improve their BMI and instead have significant increase. Larger studies are needed to assess the impact of abnormal BMI on VAD complications in pediatric patients.
Small bowel feeding: do you pay the price for bypassing the stomach?
Authors: Bond Ashley , Czapran Adam , Lal Simon
Published: December 2021

Purpose of review

Hydration and nutritional support is a vital part of medical care, thus a clear understanding of the optimal approach is vital for medical professionals. This is a particularly pertinent issue for patients admitted to a critical care setting. This article aims to define the advantages and disadvantages of gastric and postpyloric feeding in the critical care setting, thus aiding decision-making for clinicians.

Recent findings

Within the article, the main themes covered are those relating to enteral feeding tube placement, the impact of enteral feeding route on ventilator-associated pneumonia, optimization of enteral tube feeding in critical care and the impact that a chosen route may have upon gastrointestinal function.

The value of enteral feeding in critical illness is proven beyond doubt and the simplest approach has long been ‘if the gut works, use it’. If gastric feeding is not able to be established or is not tolerated then jejunal feeding should be considered as a preferable alternative to parenteral nutrition. Improving access to service or techniques for postpyloric tube placement would assist in optimizing nutritional support in the critical care setting.
Effectiveness of low-level gallium aluminium arsenide laser therapy for temporomandibular disorder with myofascial pain
Authors: Wu Xuelian , Zhu Jiang , Zheng Bing , Liu Jie , Wu Zonghui
Published: December 2021

Purpose:

Temporomandibular disorder (TMD) causes masticatory muscle pain and mouth opening limitations and affects patients’ ability to eat, practice oral health and perform other activities of daily living. Although the benefits of low-energy lasers in treating TMD have been reported, the results vary greatly depending on the equipment used and the energy output. This study systematically evaluated the efficacy of a low-level gallium aluminium arsenide (GaAlAs) laser treatment for TMD with myofascial pain and maxillary pain.

Methods:

We searched the PubMed, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) published since database inception to April 5, 2020, that compared low-level laser treatment to sham/placebo treatment or no intervention in patients suffering from TMD with myofascial pain. Three reviewers independently screened the literature, extracted data, and assessed the quality of the included studies according to the risk-of-bias tool recommended by the Cochrane Handbook V.5.1.0 (Cochrane Collaboration, London, UK). Then, a meta-analysis was performed using RevMan 5.3 and Stata 15.1 software.

Results:

The data from 8 randomized controlled trials including 181 patients were analyzed. The severity of myofascial TMD pain (measured on a visual analogue scale, VAS) at the end of treatment was significantly different between the control laser therapy and the low-level GaAlAs laser therapy (weighted mean difference [WMD] = −0.76, 95% confidence interval [CI] −1.51 to 0.01, P = .046); at 3 to 4 weeks after treatment, there was no significant difference (WMD = 1.24, 95% CI −0.04 to 2.51, P = .057). In addition, there was no significant improvement in maximum mouth opening (MMO) at the end of treatment (WMD = −0.03, 95% CI −4.13 to 4.06, P = .987) or at 3 to 4 weeks after treatment (WMD = 1.22, 95% CI −2.94 to 5.39, P = .565).

Conclusions:

The results of this study suggest that there is insufficient evidence to indicate an efficacy of low-level GaAlAs laser therapy in improving TMD pain and maximal oral opening. These results suggest that clinicians should make appropriate recommendations to inform patient decision-making.
Successful fluconazole combined with caspofungin treatment of candida bloodstream infection in preterm infant
Authors: Yuan Gaole , Tu Yingqiu , Liu Lili , Xu Tiantian
Published: December 2021

Rationale:

Candida bloodstream infection continues to be a significant cause of mortality in premature infants. Amphotericin B has been recommended as the primary treatment; however, its use is limited due to drug-induced nephrotoxicity and amphotericin B-resistant candidemia.

Patient concerns:

The gestational age was 29 (+6) weeks, and birth weight was 1760 g.

Diagnosis:

The infant was diagnosed with Candida parapsilosis bloodstream infection.

Interventions:

Fluconazole, 12 mg/kg/day, combined with caspofungin (loading dose 3 mg/kg, at a maintenance dose of 2 mg/kg every 24 h) therapy was administered to premature infant with Candida bloodstream infection. When fluconazole or caspofungin was used to treat Candida bloodstream infection in preterm infants, the blood cultures of the infant remained positive for Candida parapsilosis.

Outcomes:

All persistent candidemia resolved on fluconazole combined with caspofungin therapy. There were no adverse effects, hepatotoxicity, nephrotoxicity, anemia, or thrombocytopenia.

Lessons:

Fluconazole combined with caspofungin successfully treated Candida bloodstream infection in premature infants at 29 + 6 weeks’ gestational age, but large-scale clinical trials are required.
The value of conventional manometry in the identification of normal esophageal manometry
Authors: Bilgin Serkan , Kayali Ahmet , Yamanoğlu Adnan , Acar Hüseyin , Karakaya Zeynep , Topal Firdevs , Yüksel Elif Saritaş , Topal Fatih Esad
Published: December 2021

In the last decade, high-resolution esophageal manometry (HREM) is the main device for the management of dysphagia replacing conventional manometry (CM). Conventional manometry still seems to have some space to diagnose major motility disorders and differentiate normal from abnormal esophageal motility. The long term outcomes of patients with normal CM were analyzed in our study.

Participants (patients with dysphagia and normal CM) took a questionnaire via a phone call in February 2021. Impact Dysphagia Questionnaire (IDQ) was used as an assessment tool.

Only 55% (83/151) the individuals with previous normal manometric findings were reached via telephone. The group who have completed the survey was representative of the cohort. 66.2% of the participants were female (P = .40). The mean age was 57.21, mean weight was 70.69 kg, mean height was 163.74 cm and mean body mass index was 26.41. More than 40% of patients were completely asymptomatic at follow up, reflected by an IDQ score of 0. Only 28 out of 83 (33.7%) patients reported significant symptoms as reflected by an IDQ score greater than or equal to 7. The rest of responders admitted as having moderate to mild symptoms.

HREM is a valid technique with comparable precision to CM. HREM measurements differ considerably to CM. The identification of normal motor function in CM is not likely a positive prognostic indicator and must be interpreted precautiously.
Added value of systemic inflammation markers in predicting pulmonary infection in stroke patients
Authors: Zheng Lv , Wen Lv , Lei Wang , Ning Zhang
Published: December 2021

Exploring candidate markers to predict the clinical outcomes of pulmonary infection in stroke patients have a high unmet need. This study aimed to develop machine learning (ML)-based predictive models for pulmonary infection.

Between January 2008 and April 2021, a retrospective analysis of 1397 stroke patients who had CT angiography from skull to diaphragm (including CT of the chest) within 24 hours of symptom onset. A total of 21 variables were included, and the prediction model of pulmonary infection was established by multiple ML-based algorithms. Risk factors for pulmonary infection were determined by the feature selection method. Area under the curve (AUC) and decision curve analysis were used to determine the model with the best resolution and to assess the net clinical benefits associated with the use of predictive models, respectively.

A total of 889 cases were included in this study as a training group, while 508 cases were as a validation group. The feature selection indicated the top 6 predictors were procalcitonin, C-reactive protein, soluble interleukin-2 receptor, consciousness disorder, dysphagia, and invasive procedure. The AUCs of the 5 models ranged from 0.78 to 0.87 in the training cohort. When the ML-based models were applied to the validation set, the results also remained reconcilable, and the AUC was between 0.891 and 0.804. The decision curve analysis also showed performed better than positive line and negative line, indicating the favorable predictive performance and clinical values of the models.

By incorporating clinical characteristics and systemic inflammation markers, it is feasible to develop ML-based models for the presence and consequences of signs of pulmonary infection in stroke patients, and the use of the model may be greatly beneficial to clinicians in risk stratification and management decisions.
Long-term efficacy and patient satisfaction of pulsed radiofrequency therapy in temporomandibular disorders
Authors: Jo Jung Hwan , Jang Yewon , Chung Gehoon , Chung Jin Woo , Park Ji Woon
Published: December 2021

Background:

Pulse radiofrequency (PRF) therapy is one of effective physical therapy modalities for treat temporomandibular disorders (TMD). This prospective randomized controlled trial aimed to evaluate the long-term treatment efficacy and patient satisfaction with PRF therapy in TMD.

Methods:

Eighty-six female patients with TMD were randomly assigned to either pulsed radiofrequency or placebo therapy in combination with other conventional treatments once a week for 12 weeks. A final analysis was performed 12 weeks after the completion of treatment. Clinical parameters and patient satisfaction were analyzed at baseline, 4, 8, and 12 weeks of intervention and at 24 weeks from baseline.

Results:

Pain intensity, comfortable and maximum mouth opening, and pain on capsule and masticatory muscle palpation were significantly improved after treatment in both groups. Notably, the pulsed radiofrequency group showed a significantly lower pain intensity at the final evaluation performed 3 months after the completion of treatment. Significantly more patients reported subjective pain improvement and satisfaction with treatment following intervention at baseline in the PRF group. Most patients did not report any discomfort following treatment in either group. However, significantly more patients in the PRF group reported a burning sensation with intervention.

Conclusion:

Long-term regular pulsed radiofrequency therapy was effective in significantly reducing TMD pain, and the effect was long-lasting following treatment completion. Pulsed radiofrequency therapy should be considered as a supportive physical therapy modality for TMD.
Prospective screening for significant liver fibrosis by fibrosis-4 in primary care patients without known liver disease
Authors: Ouzan Denis , Mosnier Anne , Penaranda Guillaume , Daviaud Isabelle , Joly Helene , Muntlak Monelle , Cohen Jean Marie
Published: December 2021

Background

Fibrosis-4 test (FIB-4) is one of the simplest, free of charge, noninvasive scoring tests. We aimed to prospectively measure the prevalence of liver fibrosis in adults with no previously known liver disease and who consulted a general practitioner by FIB-4 score; compare this test to an NAFLD Fibrosis Score (NFS) and Fibrometer (FM); explore the prevalence of risk factors (obesity, diabetes, alcohol, and hypertension) and reconsider a possible cause of liver disease in patients recognized as FIB-4-positive.

Methods

Over a 6-month period, 40 general practitioners (GPs) offered all their consecutive adult primary care patients with no previously known liver pathology and a liver fibrosis screening via a blood test of three scores.

Results

Among the consecutive 2121 patients included in the study, 39% had a BMI greater than 25 kg/m2, 13% had an alcohol consumption greater than 100 g/week, 10% had type 2 diabetes, and 29% had hypertension. The prevalence of significant liver fibrosis by FIB-4, according to age was 19.1% (95% confidence interval: 17.5–20.9%). By comparison, prevalence was 16.8% (15.0–18.5%) by the NFS and 8.2% (6.9–9.6%) by the FM. A significant relationship was observed between FIB-4 fibrosis risk stages and NFS and FM scores. GPs identified the cause of disease in 2/3 of FIB-4-positive cases, mainly nonalcoholic steatohepatitis.

Conclusion

Liver fibrosis was suspected by FIB-4 score in 19.1% of patients with no previously known liver disease. The detection of significant fibrosis by the FIB-4 allowed the GP to suspect liver disease. The FIB-4 score that can be automatically generated should allow earlier recognition of liver disease in the general population.
Venetoclax combination therapy in acute myeloid leukemia and myelodysplastic syndromes
Authors: Shimony Shai , Stone Richard M. , Stahl Maximilian
Published: December 2021

Purpose of review

Venetoclax is a BCL-2 inhibitor that was approved in combination therapy with hypomethylating agents or low dose cytarabine for newly diagnosed acute myeloid leukemia (AML). The purpose of this review is to outline the most recent venetoclax-based combination therapies in newly diagnosed or relapsed myelodysplastic syndrome (MDS) and AML patients.

Recent finding

Venetoclax has been incorporated in various therapeutic regimens – either with chemotherapy, immunotherapy or targeted therapies. These combinations achieve high remission rates with deep molecular responses, as suggested by measurable residual disease measurements. There are concerns regarding the incomplete count recovery, prolonged cytopenia and infection rates, especially when combined with chemotherapy. There is also limited data concerning durability of these remissions, and the effectiveness in high-risk population (i.e. p53-mutated AML patients).

Venetoclax-based combination therapies encompass novel therapeutic possibilities in MDS and AML with encouraging initial results. However, the exact role of each combination therapy and the long-term effects on patients’ outcome are yet to be defined.
Posterior Reversible Encephalopathy Syndrome in the Setting of Asparaginase-associated Pancreatitis in 2 Pediatric Patients With Acute Leukemia
Authors: Scheuermann Amanda , Harker-Murray Paul , Pommert Lauren
Published: December 2021

Asparaginase, a critical component of current pediatric acute leukemia treatment protocols, is associated with a number of serious side effects, one of which is pancreatitis. Pancreatitis can result in significant morbidity and mortality from necrosis, pseudocyst formation, hemorrhage, systemic inflammation, intestinal perforation, and sepsis. Another rare complication of pancreatitis is posterior reversible encephalopathy syndrome, likely mediated by systemic inflammation secondary to pancreatic autodigestion and proinflammatory cytokine-mediated vascular endothelial damage. Here, we review this association in the literature and report 2 pediatric patients with leukemia who developed posterior reversible encephalopathy syndrome in the setting of asparaginase-associated pancreatitis.