bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of heavy-load resistance training during (neo-)adjuvant chemotherapy on muscle cellular outcomes in women with breast cancer
Authors: Strandberg Emelie , Vassbakk-Svindland Karianne , Henriksson Anna , Johansson Birgitta , Vikmoen Olav , Kudrén David , Schauer Tim , Lindman Henrik , Wärnberg Fredrik , Berntsen Sveinung , Demmelmaier Ingrid , Nordin Karin , Raastad Truls
Published: March 2021

Introduction:

(Neo-)adjuvant chemotherapy for breast cancer has a deleterious impact on muscle tissue resulting in reduced cardiorespiratory fitness, skeletal muscle mass and function. Physical exercise during treatment may counteract some of these negative effects. However, the effects of resistance training (RT) alone have never been explored. The present study aims to investigate if heavy-load RT during (neo-)adjuvant chemotherapy counteracts deleterious effects on skeletal muscle in women diagnosed with breast cancer. We hypothesize that (neo-)adjuvant treatment with chemotherapy will reduce muscle fiber size, impair mitochondrial function, and increase indicators of cellular stress and that RT during treatment will counteract these negative effects. We also hypothesize that RT during (neo-)adjuvant chemotherapy will increase muscle and blood levels of potential antitumor myokines and reduce treatment-related side effects on muscle strength and cardiorespiratory fitness.

Methods:

Fifty women recently diagnosed with breast cancer scheduled to start (neo-)adjuvant chemotherapy will be randomized to either randomized to either intervention group or to control group.

The intervention group will perform supervised heavy-load RT twice a week over the course of chemotherapy (approximately 16-weeks) whereas the control group will be encouraged to continue with their usual activities. Muscle biopsies from m. vastus lateralis will be collected before the first cycle of chemotherapy (T0), after chemotherapy (T1), and 6 months later (T2) for assessment of muscle cellular outcomes. The primary outcome for this study is muscle fiber size. Secondary outcomes are: regulators of muscle fiber size and function, indicators of cellular stress and mitochondrial function, myokines with potential antitumor effects, muscle strength, and cardiorespiratory fitness.

Ethics and dissemination:

Ethical approval has been obtained from the Regional Ethical Review Board in Uppsala, Sweden (Dnr:2016/230/2). Results will be disseminated through presentations at scientific meetings, publications in peer-reviewed journals, social media, and patient organizations.

Trial registration number:

NCT04586517.
Delayed periprosthetic seroma in a male Poland syndrome patient
Authors: Choi Jangyoun , Kim Jung Hyeou , Sung Yeoun Eun , Oh Deuk Young
Published: March 2021

Rationale:

Custom-made implant is an accepted treatment option for treatment of chest deformity in Poland syndrome. Unlike the raised concerns and awareness for the long-term consequences of breast implants, the long-term complications of customized implants for special purposes like Poland syndrome has not been reported in the literature.

Patient Concerns:

A 44-year-old male with Poland syndrome presented to our institution complaining of a large bulge and fluctuation on the right chest wall. This occurred after 14 years from the initial implant surgery for correction of chest wall deformity. Upon failure of resolution by multiple aspirations, workup was carried out under suspicion of implant associated malignancy.

Intervention:

Total Capsulectomy and implant removal was done.

Outcomes:

Histology revealed chronic inflammation with fibrosis. Implant-associated malignancy was not found. He is being followed up with no signs of recurrence.

Lessons:

For rare cases of implant insertion such as Poland syndrome, awareness of delayed complications and workups based on suspicion of implant-associated malignancy is needed. Surgeon awareness and patient education is required.
Clinical acupuncture therapy for chronic cholecystitis
Authors: Zhong Genping , Luo Yinghua , Chi Zhenhai , Zhang Yunxiu , Xu Wei , Zhu DaoCheng , Li Jun , Hu Xingyao , Jiao Lin
Published: March 2021

Chronic cholecystitis is a common chronic disease in clinical practice. The incidence of chronic cholecystitis is gradually increasing due to changes in eating habits and even if acute infections aren’t treated in time, it can cause serious complications, continue to plague people's daily life and become an economic burden to society. Currently, the curative effect of chronic cholecystitis under the control of western medicine is still lacking and there are adverse reactions. However, based on current clinical controlled trials acupuncture therapy for chronic cholecystitis has gradually become a complementary treatment. Therefore, this systematic review aims to explore the safety and feasibility of acupuncture therapy in the treatment of chronic cholecystitis.

Methods:

We will search the following databases: Medline, PubMed, Cochrane Database of Systematic Reviews, Embase, Chinese Biomedical Literatures Database, China National Knowledge Infrastructure, Wang Fang Database, Chinese Scientific Journal Database from inception to February 2021 without any language restriction. At the same time, relevant literature will be searched manually. The main search terms include: “Acupuncture,” “Cholecystitis.” Data entry will be completed by 2 researchers separately. After entry, cross-checking will be performed to ensure the authenticity of the information. The main outcome criteria include: including the total effective rate of the patient; the traditional Chinese medicine symptom score of the patient includes: abdominal pain, tenderness in the right upper abdomen, and so on; secondary outcome criteria include: gallbladder contraction function and gallbladder thickness, VAS scores, recurrence rate, adverse reactions; use Cochrane risk bias assessment to evaluate and score the included randomized controlled trial; meta-analysis will be performed using RevMan 5.4.0 software. The heterogeneity test is based on the thresholds of P and I
2, In order to use solid or random effects models.

Results:

This systematic review only evaluates the safety and limitations of acupuncture therapy in the treatment of chronic cholecystitis. We will report the full text in the near future.

Conclusion:

This study will explore the safety and limitations of acupuncture therapy in the treatment of chronic cholecystitis, so that acupuncture therapy will be more widely used clinically.

Trial registration number:

INPLASY202120020
Strategies adopted to manage physical and psychosocial challenges after returning home among people with stroke
Authors: Lo Suzanne Hoi Shan , Chau Janita Pak Chun , Chang Anne Marie
Published: March 2021

Stroke survivors encounter various physical and psychosocial challenges after hospital discharge. Systematic reviews consistently suggest the importance of self-management in promoting post-stroke recovery. However, stroke survivors’ performance of self-management behaviors after returning home is poorly understood. This study was conducted to explore how stroke survivors manage their life after returning home from the hospital. This was a qualitative study with individual, semi-structured interviews. We recruited a purposive sample of adults who had a first or recurrent ischemic or hemorrhagic stroke and currently lived at home. Participants were asked about their post-stroke experiences, challenges encountered, and strategies adopted for managing post-stroke conditions. Data were transcribed verbatim and analyzed using thematic analysis. A total of 30 stroke survivors (mean age = 61.97 years, SD = 10.20) were interviewed. Most were men (n = 18), married (n = 25), and retired (n = 21). Two-thirds had experienced an ischemic stroke. Five key themes emerged: pursuing lifelong learning to live well after a stroke; reinterpreting unpleasant experiences as new learning opportunities; engaging in life activities to better adapt to post-stroke challenges; being confident in oneself to persevere in self-management behaviors; and continuing to accept the current self and explore the new self. Participants regarded learning as a prerequisite for improving their affected functions and managing uncertainties in recovery. Learning requires self-participation, building self-efficacy and positive outcome expectations, testing and adapting strategies to one's own health conditions, and engaging in leisure or social activities. These findings will guide future development of interventions for enhancing stroke survivors’ recovery outcomes.
Effects of eye-acupuncture combined with rehabilitation training for poststroke dyskinesia
Authors: Wang Qi , Ma Nanting , Wang Pengqin , Wang Mei , Shao Yan , Zhao Xitong
Published: March 2021

Introduction:

Poststroke dyskinesia is the most common clinical symptom after stroke, which greatly affects the patients’ daily life. Eye-acupuncture is an effective method for stroke. And the rehabilitation training has been widely used for patients suffer from stroke. However, whether eye-acupuncture combined with rehabilitation training has greater clinical efficacy for poststroke dyskinesia is still unknown. Our aim in this systematic review was to evaluate the clinical efficacy of eye-acupuncture combined with rehabilitation training (EACRT) as a treatment for dyskinesia after stroke.

Methods and analysis:

We will search the following 4 databases of registered trials and 7 electronic databases from inception to March 2021:Cochrane Stroke Group, Cochrane Central Register of Controlled, the World Health Organization International Clinical Trials Registry Platform, the Chinese Clinical Trial Registry; PubMed, MEDLINE, Embase, CNKI, VIP, WanFang, and CBM. All relevant randomized controlled trials focus on EACRT will be included. The primary outcome will be the Fugl-Meyer Assessment. The Secondary outcomes will include Activity of Daily Living, clinical effective rate and the Visual Analogue Score. Two reviewers will independently conduct the Study selection and data extraction. The data synthesis and assessment of risk of bias will be performed by RevMan5.2.

Ethics and dissemination:

The ethical approval is unnecessary that systematic review is based on published articles other than patients. The results of this meta-analysis will be published in an open access (OA) journal according to the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA).

PROSPERO registration number:

CRD42020168278.
A 10-year observational single-center study of retroperitoneal unicentric Castleman disease
Authors: Wang Wenda , Dong Dexin , Wen Jin , Li Hanzhong
Published: March 2021

Diagnosis of unicentric Castleman disease (UCD) is not easy before the resection and obtainment of pathological result. We retrospectively summarized 10-year experience of clinical evaluation and management for retroperitoneal UCD in Peking Union Medical College Hospital (PUMCH) between December 1, 2009 and December 31, 2019. Seventy two UCD patients with pathological diagnosis after resection were screened out. Among them 25 patients had retroperitoneal UCD. The average age of the 25 patients was 43.80 ± 12.79, and 52.00% were male. No patients had systemic symptoms, and 1 patient got preoperative treatment. The average size of masses was 5.59 ± 2.86 cm. The UCD sites included kidney, adrenal area, perinephric area, pancreas, peripancreatic area, area of descending part of duodenum, periaortic area or beside iliac artery, and others. The masses presented different degree of enhancement on CT scans and hypoecho or isoecho on ultrasound. Increased metabolism could be found on 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT). Some patients had positive results on somatostatin receptor imaging, but none had positive results on 131I-metaiiodo-benzylguanidine (131I-MIBG). Some patients presented the elevated level of interleukin-6 (IL-6), 24hour-urinary catecholamine and tumor markers. All the patients received complete resection of masses and 96.00% had hyaline-vascular type pathology except 1 patient (plasma cell-type). Ninety two percent patients received a long-term follow-up with an average follow-up time of 35.48 ± 33.90 months. No patients died or experienced relapse during follow-up. Differential diagnosis of retroperitoneal UCD may be difficult according to imaging and laboratorial examinations. Differential diagnosis with pheochromocytomas/paragangliomas should be taken into special consideration. Different imaging examinations, such as CT/MRI, 18F-PET/CT, somatostatin receptor imaging and 131I-MIBG, can be combined for differential analysis. Complete resection is the best treatment and could provide a final pathological diagnosis.
Effectiveness and safety of electroacupuncture in treating Parkinson disease
Authors: Xu Wei , OuYang Sha , Chi Zhenhai , Wang ZhiQin , Zhu DaoCheng , Chen RiXin , Zhong GenPing , Zhang FengTing , Zhou GuiQin , Duan SiWei , Jiao Lin
Published: March 2021

Background:

Parkinson disease (PD) is an Extrapyramidal Disease mainly characterized by static tremor, myotonia, bradykinesia and postural gait disorder. As China's population ages, the number of people suffering from PD is increasing. Since there are many side effects of western medicine for Parkinson's patients, and the high price of the drugs make it difficult for many patients to adhere to treat. At present, many clinical studies have shown that electroacupuncture is effective in treating PD. Therefore, this systematic review aims to explore the effectiveness and safety of electroacupuncture in the treatment of PD.

Methods:

Comprehensive search of PubMed, Embase, Medline, Cochrane Database of Systematic Reviews, Chinese Biomedical Literatures Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wang Fang Database from inception to February 2021, the literature selected is not restricted by language. In addition, we will search for unpublished studies and the references that were originally included in the literature manually. There were two reviewers screened the data and cross-checked the information individually, the quality of the literature was assessed by reviewers independently. The outcomes of interest include:the scale of Unifified PD Rating Scales, the Webster scale, the Quality of Life Questionnaire, total effective rate, recurrence rate, adverse events. The laboratory inspection indicators include:the content of lipid peroxidase, Superoxide dismutase activity in plasma and erythrocyte. The relevant randomized controlled trials will be included in this study. And we will evaluate the quality of the selected literature according to the Cochrane Handbook. Meta-analysis will be performed using RevMan 5.4.0 software. The heterogeneity test will be implemented in the included literature, the tests’ thresholds will be P < .1 and I
2 > 50%. We will use either fixed effects model or random effects model according to the size of heterogeneity.

Results:

The results of this systematic review will provide a comprehensive evidence for the clinical treatment of PD, and we will report this result soon.

Conclusion:

This paper will explore whether or not electroacupuncture can be used as a non-drug therapy for PD.

Ethics and dissemination:

Ethical approval is not required for this paper, our plan will be published in the journal.

Trial registration number:

INPLASY202120031
The effects of perioperative oral management on perioperative serum albumin levels in patients treated surgically under general anesthesia
Authors: Yamada Shin-ichi , Koike Kazuyuki , Isomura Emiko Tanaka , Chikazu Daichi , Yamagata Kenji , Iikubo Masahiro , Hino Satoshi , Hibi Hideharu , Katsura Kouji , Nakamura Seiji , Nomura Takeshi , Mori Yoshiyuki , Tojyo Itaru , Kanamura Narisato , Yamamori Iku , Aota Keiko , Fujita Shigeyuki , Tanzawa Hideki , Kurita Hiroshi
Published: March 2021

The purpose of the present study was to investigate the efficacy of perioperative oral managements (POMs) on perioperative nutritional conditions in patients undergoing surgery with general anesthesia. Medical records were retrospectively reviewed and the effects of POMs were investigated based on a large number of cases using a multicenter analysis. The profile of serum albumin levels was assessed and compared between patients with and without POMs using the multivariate analysis. Seventeen Eleven thousand and one hundred sixty patients (4,873 males and 6,287 females) were reviewed. Of these, 2710 patients (24.3%) had undergone POMs. The results of a multivariate analysis revealed the significant positive effect of POMs on perioperative serum albumin level (change between at admission and discharge, (Estimate: 0.022, standard error: 0.012, P < .0001). Patient gender, age, surgical site, performance status, the American Society of Anesthesiologists (ASA) physical status classification, operation time, amount of blood loss, and serum albumin level at admission were also significant predictors. Adjusted multivariate analysis of the effects of POMs on perioperative change of serum albumin level in all subjects reveled the significance of POMs intervention (estimate: 0.022, standard error: 0.012, P < .0001). These results suggest that POMs exerts significant positive effects on perioperative serum albumin levels in patients underwent surgery under general anesthesia.
Effects of SGLT2 inhibitors on cardiovascular and renal outcomes in type 2 diabetes
Authors: Qiu Mei , Ding Liangliang , Zhou Hairong
Published: March 2021

Background:

It is unclear whether there are false positive or negative results in the effects of sodium-glucose transporter 2 (SGLT2) inhibitors on various cardiovascular and renal outcomes in patients with type 2 diabetes. We aimed to explore this issue by a meta-analysis with trial sequential analysis.

Methods:

We included randomized trials evaluating the effects of SGLT2 inhibitors on cardiorenal endpoints in type 2 diabetic patients. Eight endpoints evaluated in the study were fatal or nonfatal myocardial infarction (MI), fatal or nonfatal stroke, major adverse cardiovascular events (MACE), cardiovascular death or hospitalization for heart failure (CVD or HHF), all-cause death (ACD), cardiovascular death (CVD), hospitalization for heart failure (HHF), and kidney function progression (KFP). Meta-analysis and trial sequential analysis was conducted for each endpoint.

Results:

Seven randomized trials of SGLT2 inhibitors were included for pooled analysis. Compared with placebo, SGLT2 inhibitors significantly reduced the risk of MACE (HR 0.89, 95% confidence interval [CI] 0.84–0.94), MI (HR 0.91, 95% CI 0.84–0.99), CVD (HR 0.86, 95% CI 0.79–0.93), CVD or HHF (HR 0.77, 95% CI 0.73–0.82), HHF (HR 0.67, 95% CI 0.62–0.74), KFP (HR 0.63, 95% CI 0.56–0.70), and ACD (HR 0.88, 95% CI 0.83–0.94), whereas SGLT2 inhibitors did not have significant effects on stroke (HR 0.98, 95% CI 0.88–1.09). Trial sequential analyses for MI and stroke showed that cumulative Z curve did not cross trial sequential monitoring boundary and required information size, whereas those for the other 6 endpoints showed that cumulative Z curve crossed trial sequential monitoring boundary and/or required information size.

Conclusions:

Compared with placebo, SGLT2 inhibitors conclusively reduce the risk of MACE, CVD or HHF, ACD, CVD, HHF, and KFP in patients with type 2 diabetes, whereas the effects of SGLT2 inhibitors on MI and stroke are not conclusive and need to be further assessed in future studies with the adequate sample size to reject or accept the effect size.
Clinical significance of prognostic nutritional index in renal cell carcinomas
Authors: Tang Yongquan , Liang Jiayu , Liu Zhihong , Zhang Ruochen , Zou Zijun , Wu Kan , Lu Yiping , Wei Xin
Published: March 2021

Prognostic nutritional index (PNI) could reflect the nutrition and inflammation status in cancer patients. This study aims to identify the prognostic significance of PNI in patients with renal cell carcinoma (RCC).

A total of 694 RCC patients from our institution were included in this study. The prognostic correlation between PNI and overall survival (OS) and recurrence-free survival (RFS) was analyzed respectively using Kaplan–Meier method and univariate and multivariate Cox model. Studies about the association between pretreatment or preoperative PNI and prognosis of RCC were systemically reviewed and a meta-analysis method was performed to further evaluate the pooled prognostic value of PNI in RCC.

267 (38.47%) RCC patients had low PNI according to the cut off value (49.08). Low PNI was associated with poor OS (P < .001) and RFS (P < .001), respectively. In the multivariate Cox analysis, PNI was identified to be an independent prognostic factor for OS (hazard ratio [HR] = 2.13, 95%CI: 1.25–3.62, P = .005). Compared to other nutritional indexes, this risk correlation of PNI is better than that of geriatric nutritional risk index (GNRI; HR = 1.19; P = .531), while is no better than that of neutrophil–lymphocyte ratio (NLR; 1/HR = 2.56; P < .001) and platelet–lymphocyte ratio (PLR; 1/HR = 2.85; P < .001) respectively. Meanwhile, additional 4785 patients from 6 studies were included into pooled analysis. For RCC patients who underwent surgery, low preoperative PNI was significantly associated with worse OS (pooled HR = 1.57, 95%CI: 1.37–1.80, P < .001) and worse RFS (pooled HR = 1.69, 95%CI: 1.45–1.96, P < .001). Furthermore, low PNI (<41–51) was also significantly associated with poor OS (HR = 1.78, 95%CI: 1.26–2.53 P < .05) and poor RFS (HR = 2.03, 95%CI: 1.40–2.95, P < .05) in advanced cases treated with targeted therapies.

The present evidences show that PNI is an independent prognostic factor in RCC. Low PNI is significant associated with poor prognosis of RCC patients.
Mid and long-term effects of a SBIRT program for at-risk drinkers attending to an emergency department. Follow-up results from a randomized controlled trial.
Authors: Bruguera Pol , Barrio Pablo , Manthey Jakob , Oliveras Clara , López-Pelayo Hugo , Nuño Laura , Miquel Laia , López-Lazcano Ana , Blithikioti Chrysanthi , Caballeria Elsa , Matrai Silvia , Rehm Jürgen , Vieta Eduard , Gual Antoni
Published: March 2021

Background and importance

SBIRT programs (Screening Brief Intervention and Referral to Treatment) for at-risk drinkers in emergency departments (ED) have shown to be effective, particularly at short term. In this article, we report mid and long-term follow-up results of a specialized SBIRT program. A short-term follow-up after 1.5 months showed encouraging results, with more than a 20% greater reduction of at-risk drinking in the intervention group and more than double of successful referrals to specialized treatment.

Objective

We aimed to evaluate the mid and long-term efficacy of an SBIRT program conducted by psychiatrist specialists in addictive disorders and motivational interviewing in the ED of a tertiary hospital.

Design, settings and participants

We conducted a secondary analysis of a previously published randomized controlled trial of an SBIRT program conducted by alcohol specialists for at-risk drinkers presenting to the ED, measured with the AUDIT-C scale.

Intervention or exposure

Patients were randomized into two groups, with the control group receiving two leaflets: one regarding alcohol use and the other giving information about the study protocol. The intervention group received the same leaflets as well as a brief motivational intervention on alcohol use and, where appropriate, a referral to specialized treatment.

Outcomes measure and analysis

Long-term assessment primary outcome was the proportion of at-risk alcohol use measured by AUDIT-C scale. The main effectiveness analysis at 18 weeks and 12 months’ follow-up was conducted with multilevel logistic regression analyses. Missing values were imputed with the last observation carried forward.

Main results

Of 200 patients included in the study, 133 (66.5%) and 131 (65.5%) completed 18 weeks and 1-year follow-up respectively. Although the proportion of risky drinkers was substantially lower in the intervention group (38.5 vs. 57.4% at 4.5 months and 58.5 vs 68.2% at 1 year), these results did not reach statistical significance (OR = 2.15; CI, 0.87–5.33).

Conclusions

In this secondary analysis for mid- and long-term effects of a specialized SBIRT program, there was no significant difference in the reduction of risky drinkers at 18 weeks and 1 year. The small size of the studied sample and the low retention rate precluded any significant conclusion, although point estimates suggest a positive effect. Overall, SBIRT programs are an effective tool to reduce alcohol use at short time and to refer patients to specialized treatment; however, its effects seem to decay over time.
The Efficacy of the Geriatric Model of Care in Emergency Housing Programs for Homeless Veterans
Authors: Knapp Jennifer , Betancur Jaime , Nabors Calista , Pascual Fritzie
Published: March 2021

Introduction:

The aging homeless population currently makes up half the general homeless population. However, there are few homeless emergency shelters that can address their needs. This results in an overutilization of inpatient admissions and emergency room services.

Methods:

Homeless service staff from VA Palo Alto Health Care System partnered with a local homeless emergency housing provider, Compassion Residio Services Inc., to implement this new model of care for aging, medically fragile homeless Veterans. This emergency housing model utilizes practices done in geriatric settings. This model aimed to help decrease the utilization of emergency departments and inpatient admissions.

Results:

The average cost of emergency department visits and inpatient admissions was $127,314 per Veteran 6 months before admission. Six months after discharge, the average cost of treatment from emergency department visits and inpatient admissions was roughly $59,546 after discharge, a 53% decrease. Emergency department visits decreased from an average of 5.6 visits per Veteran 6 months before admission to 2.65 visits after 6 months discharge. The number of inpatient nights decreased from an average of 15 days per admission in the 6 months before the program to 13 days. Total admissions decreased by nearly half from 48 the previous 6 months to 25 after 6 months.

Discussion:

Overall, as residents settled into stable environments tailored around geriatric care, the utilization of emergency department visits and inpatient services decreased. Furthermore, the complexity (eg, cost per encounter) also decreased.
Health Care Utilization of Individuals Affected by Homelessness
Authors: Madigan Dana , Friedman Lee S.
Published: March 2021

Objectives:

To describe individuals coded as homeless in state-level data comprising of outpatient and inpatient cases over a multi-year period to provide public health surveillance data on the health care utilization and needs of this population.

Research Design:

In this cross-sectional study, outpatient and inpatient visits coded for homelessness were identified from the Illinois Hospital Discharge Database from January 1, 2011 through December 31, 2018. Demographic characteristics, primary diagnosis and comorbid conditions, and hospital course of treatment were described. Predictors of discharge to a health care facility versus routine discharge to home or self-care were evaluated using multivariable logistic regression.

Results:

There were 154,173 patient visits predominantly involving males, those aged 25–64 years, and non-Hispanic Whites and African Americans. The majority had comorbidities of depression, psychosis, and/or substance abuse (70.2%) and a routine discharge to home or self-care (81.9%). Discharge to home or self-care relative to another health care institution was associated with having charity coverage and being Black/African American.

Conclusions:

Those experiencing homelessness experience a high burden of health concerns. Hospital billing records can be used to prioritize the distribution of limited public health resources for health care programs and interventions among those experiencing homelessness.
Estimating and Evaluating Tuberculosis Incidence Rates Among People Experiencing Homelessness, United States, 2007–2016
Authors: Self Julie L. , McDaniel Clint J. , Bamrah Morris Sapna , Silk Benjamin J.
Published: March 2021

Objectives:

Persons experiencing homelessness (PEH) are disproportionately affected by tuberculosis (TB). We estimate area-specific rates of TB among PEH and characterize the extent to which available data support recent transmission as an explanation of high TB incidence.

Methods:

We estimated TB incidence among PEH using National Tuberculosis Surveillance System data and population estimates for the US Department of Housing and Urban Development’s Continuums of Care areas. For areas with TB incidence higher than the national average among PEH, we estimated recent transmission using genotyping and a plausible source-case method. For cases with ≥1 plausible source case, we assessed with TB program partners whether available whole-genome sequencing and local epidemiologic data were consistent with recent transmission.

Results:

During 2011–2016, 3164 TB patients reported experiencing homelessness. National incidence was 36 cases/100,000 PEH. Incidence estimates varied among 21 areas with ≥10,000 PEH (9–150 cases/100,000 PEH); 9 areas had higher than average incidence. Of the 2349 cases with Mycobacterium tuberculosis genotyping results, 874 (37%) had ≥1 plausible source identified. In the 9 areas, 23%–82% of cases had ≥1 plausible source. Of cases with ≥1 plausible source, 63% were consistent and 7% were inconsistent with recent transmission; 29% were inconclusive.

Conclusions:

Disparities in TB incidence for PEH persist; estimates of TB incidence and recent transmission vary by area. With a better understanding of the TB risk among PEH in their jurisdictions and the role of recent transmission as a driver, programs can make more informed decisions about prioritizing TB prevention strategies.
Arm Motor Recovery After Ischemic Stroke: A Focus on Clinically Distinct Trajectory Groups
Authors: Kline Danielle K. , Lin David J. , Cloutier Alison , Sloane Kelly , Parlman Kristin , Ranford Jessica , Picard-Fraser Matthew , Fox Annie B. , Hochberg Leigh R. , Kimberley Teresa Jacobson
Published: March 2021

Background and Purpose:

Recovery of arm function poststroke is highly variable with some people experiencing rapid recovery but many experiencing slower or limited functional improvement. Current stroke prediction models provide some guidance for clinicians regarding expected motor outcomes poststroke but do not address recovery rates, complicating discharge planning. This study developed a novel approach to defining recovery groups based on arm motor recovery trajectories poststroke. In addition, between-group differences in baseline characteristics and therapy hours were explored.

Methods:

A retrospective cohort analysis was conducted where 40 participants with arm weakness were assessed 1 week, 6 weeks, 3 months, and 6 months after an ischemic stroke. Arm recovery trajectory groups were defined on the basis of timing of changes in the Fugl-Meyer Assessment Upper Extremity (FMA-UE), at least the minimal clinically important difference (MCID), 1 week to 6 weeks or 6 weeks to 6 months. Three recovery trajectory groups were defined: Fast (n = 19), Extended (n = 12), and Limited (n = 9). Between-group differences in baseline characteristics and therapy hours were assessed. Associations between baseline characteristics and group membership were also determined.

Results:

Three baseline characteristics were associated with trajectory group membership: FMA-UE, NIH Stroke Scale, and Barthel Index. The Fast Recovery group received the least therapy hours 6 weeks to 6 months. No differences in therapy hours were observed between Extended and Limited Recovery groups at any time points.

Discussion and Conclusions:

Three clinically relevant recovery trajectory groups were defined using the FMA-UE MCID. Baseline impairment, overall stroke severity, and dependence in activities of daily living were associated with group membership and therapy hours differed between groups. Stratifying individuals by recovery trajectory early poststroke could offer additional guidance to clinicians in discharge planning.

(See Supplemental Digital Content 1 for Video Abstract, available at: http://links.lww.com/JNPT/A337.)
Digital Imaging Analysis Reveals Reduced Alveolar α-Smooth Muscle Actin Expression in Severe Asthma
Authors: Jerome Jacob A. , Wenzel Sally E. , Trejo Bittar Humberto E.
Published: March 2021

Expansion of α-smooth muscle actin (α-SMA)-expressing airway smooth muscle of the large airways in asthma is well-studied. However, the contribution of α-SMA-expressing cells in the more distal alveolated parenchyma, including pericytes and myofibroblasts within the alveolar septum, to asthma pathophysiology remains relatively unexplored. The objective of this study was to evaluate α-SMA expression in the alveolated parenchyma of individuals with severe asthma (SA), compared with healthy controls or individuals with chronic obstructive pulmonary disease. Using quantitative digital image analysis and video-assisted thoracoscopic surgery lung biopsies, we show that alveolated parenchyma α-SMA expression is markedly reduced in SA in comparison to healthy controls (mean %positive pixels: 12% vs. 23%, P=0.005). Chronic obstructive pulmonary disease cases showed a similar, but trending, decrease in α-SMA positivity compared with controls (mean %positivity: 17% vs. 23%, P=0.107), which may suggest loss of α-SMA expression is a commonality of obstructive lung diseases. The SA group had similar staining for ETS-related gene protein, a specific endothelial marker, comparatively to controls (mean %positive nuclei: 34% vs. 42%, P=0.218), which suggests intact capillary endothelium and likely intact capillary-associated, α-SMA-positive pericytes. These findings suggest that the loss of α-SMA expression in SA may be because of changes in myofibroblast α-SMA expression or cell number. Further study is necessary to fully evaluate possible mechanisms and consequences of this phenomenon.
Prediction of Nociception in Children Using the Nociceptive Flexion Reflex Threshold and the Bispectral Index—A Prospective Exploratory Observational Study*
Authors: Mauritz Maximilian D. , Uhlenberg Felix , Bashir-Elahi Dario , Werther Tobias , Gottschalk Urda , Ebenebe Chinedu Ulrich , Bergers Marlies , Giordano Vito , Vettorazzi Eik , Singer Dominique , Deindl Philipp
Published: March 2021

Objectives:

The prediction of patient responses to potentially painful stimuli remains a challenge in PICUs. We investigated the ability of the paintracker analgesia monitor (Dolosys GmbH, Berlin, Germany) measuring the nociceptive flexion reflex threshold, the cerebral sedation monitor bispectral index (Medtronic, Dublin, Ireland), the COMFORT Behavior, and the modified Face, Legs, Activity, Cry, Consolability Scale scores to predict patient responses following a noxious stimulus.

Design:

Single-center prospective exploratory observational study.

Setting:

Fourteen-bed multidisciplinary PICU at the University Children’s Hospital, University Medical Center Hamburg Eppendorf, Germany.

Patients:

Children on mechanical ventilation receiving analgesic and sedative medications.

Interventions:

Noxious stimulation by way of endotracheal suctioning.

Measurements and Main Results:

Two independent observers assessed modified Face, Legs, Activity, Cry, Consolability and COMFORT Behavior Scales scores during noxious stimulation (n = 59) in 26 patients. Vital signs were recorded immediately before and during noxious stimulation; bispectral index and nociceptive flexion reflex threshold were recorded continuously. Mean prestimulation bispectral index (55.5; CI, 44.2–66.9 vs 39.9; CI, 33.1–46.8; p = 0.007), and COMFORT Behavior values (9.5; CI, 9.2–13.2 vs 7.5; CI, 6.7–8.5; p = 0.023) were significantly higher in observations with a response than in those without a response. Prediction probability (P
k) values for patient responses were high when the bispectral index was used (P
k = 0.85) but only fair when the nociceptive flexion reflex threshold (P
k = 0.69) or COMFORT Behavior Scale score (P
k = 0.73) was used. A logistic mixed-effects model confirmed the bispectral index as a significant potential predictor of patient response (p = 0.007).

Conclusions:

In our sample of ventilated children in the PICU, bispectral index and nociceptive flexion reflex threshold provided good and fair prediction accuracy for patient responses to endotracheal suctioning.
The Value of Interleukin-10 in the Early Diagnosis of Neonatal Sepsis: A Meta-Analysis
Authors: Wang Qiang , Peng Guoxuan , Gan Lebin , Deng Zhihong , Zeng Ling , Deng Jin
Published: March 2021

Objectives:

Interleukin-10 is a significant marker in neonatal sepsis. This meta-analysis evaluated the accuracy of interleukin-10 expression in the diagnosis of neonatal sepsis.

Data Source:

Summary of literature review.

Study Selection:

A literature search strategy was developed, including PubMed, EMBASE, Web of Science, MEDLINE, and the Cochrane Library. All publications published till October 1, 2020, were retrieved; the key words were “sepsis” and “interleukin-10.”

Data Extraction:

The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were used to evaluate the data, and the heterogeneity of the combined results was tested according to the I2
value.

Data Synthesis:

A total of six articles involving 879 newborns were included in the study. The combined sensitivity was 0.82 (95% CI, 0.78–0.86), the specificity was 0.79 (95% CI, 0.75–0.82), the positive likelihood ratio was 4.17 (95% CI, 2.6–6.69), and the negative likelihood ratio was 0.25 (95% CI, 0.16–0.39). The area under the summary receiver operating characteristic curve was 0.88 (95% CI, 0.86–0.91), and the Q index was 0.81. The combined diagnostic odds ratio was 17.52 (95% CI, 8.95–34.29).

Conclusions:

Based on the results of the meta-analysis, interleukin-10 is a useful biomarker in the early diagnosis of neonatal sepsis. Its sensitivity, specificity, and diagnostic ability are excellent. However, it needs to be combined with clinical history data for comprehensive judgment and should not be used alone for diagnosis.
Explantation in Tissue Expander and Direct-to-Implant Reconstruction with Acellular Dermal Matrix: How to Avoid Early Reconstructive Failures
Authors: Cohen Leslie E. , Bogue Jarrod T. , Jin Julia , Disa Joseph J.
Published: March 2021

Background:

In the United States, approximately 57,000 tissue expander/implant-based breast reconstructions are performed each year. Complete submuscular tissue expander coverage affords the best protection against implant exposure but can restrict lower pole expansion. The benefits of using acellular dermal matrix are enticing, but questions remain as to whether or not its presence increases reconstructive failures. The purpose of this study was to investigate predictors of explantation in those patients with acellular dermal matrix reconstructions and to discuss salvage techniques.

Methods:

An approved retrospective review was conducted of 137 patients undergoing 234 individual breast reconstructions over 4 years performed by a single plastic surgeon (J.D.) at a single institution. Patients who underwent implant-based reconstruction with either immediate placement of a tissue expander that was subsequently exchanged for a permanent implant at a second operation or immediate placement of a permanent implant when indicated were included.

Results:

One hundred thirty-seven patients who underwent 234 implant-based breast reconstructions using acellular dermal matrix met criteria. There was an overall 23 percent complication rate, including any cellulitis, seroma, skin necrosis, and hematoma formation. Significant preoperative risk factors for any postoperative complication included body mass index greater than 25 kg/m2 and a history of radiation therapy before acellular dermal matrix placement. Radiation therapy was found to be a significant risk factor for postoperative skin necrosis. Of explantations, many fluid cultures grew Gram-negative bacteria.

Conclusions:

Skin necrosis is a serious risk factor for explantation in implant-based reconstruction with acellular dermal matrix. The reconstructive surgeon should consider early excision of any skin necrosis as soon as it is identified.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
HIV-1 infection and the lack of viral control are associated with greater expression of interleukin-21 receptor on CD8+ T cells
Authors: Dalel Jama , Ung Seng K. , Hayes Peter , Black S. Lucas , Joseph Sarah , King Deborah F. , Makinde Julia , Gilmour Jill
Published: March 2021

Objectives:

Interleukin-21 (IL-21) has been linked with the generation of virus-specific memory CD8+ T cells following acute infection with HIV-1 and reduced exhaustion of CD8+ T cells. IL-21 has also been implicated in the promotion of CD8+ T-cell effector functions during viral infection. Little is known about the expression of interleukin-21 receptor (IL-21R) during HIV-1 infection or its role in HIV-1-specific CD8+ T-cell maintenance and subsequent viral control.

Methods:

We compared levels of IL-21R expression on total and memory subsets of CD8+ T cells from HIV-1-negative and HIV-1-positive donors. We also measured IL-21R on antigen-specific CD8+ T cells in volunteers who were positive for HIV-1 and had cytomegalovirus-responding T cells. Finally, we quantified plasma IL-21 in treatment-naive HIV-1-positive individuals and compared this with IL-21R expression.

Results:

IL-21R expression was significantly higher on CD8+ T cells (P = 0.0256), and on central memory (P = 0.0055) and effector memory (P = 0.0487) CD8+ T-cell subsets from HIV-1-positive individuals relative to HIV-1-negative individuals. For those infected with HIV-1, the levels of IL-21R expression on HIV-1-specific CD8+ T cells correlated significantly with visit viral load (r = 0.6667, P = 0.0152, n = 13) and inversely correlated with plasma IL-21 (r = −0.6273, P = 0.0440, n = 11). Lastly, CD8+ T cells from individuals with lower set point viral load who demonstrated better viral control had the lowest levels of IL-21R expression and highest levels of plasma IL-21.

Conclusion:

Our data demonstrates significant associations between IL-21R expression on peripheral CD8+ T cells and viral load, as well as disease trajectory. This suggests that the IL-21 receptor could be a novel marker of CD8+ T-cell dysfunction during HIV-1 infection.
Comprehensive Cleft Care Delivery in Developing Countries: Impact of Geographic and Demographic Factors
Authors: Kantar Rami S. , Abyad Omar Al , Melhem Antonio , Chahine Elsa M. , Kassam Serena N. , Annan Beyhan , Nader Marie K. , Keith Kristen , Breugem Corstiaan C. , Hamdan Usama S.
Published: March 2021

Introduction:

The authors analyzed the insights of participants and faculty members of Global Smile Foundation's Comprehensive Cleft Care Workshops concerning the barriers and interventions to multidisciplinary cleft care delivery, after stratification based on demographic and geographic factors.

Methods:

During 2 simulation-based Comprehensive Cleft Care Workshops organized by Global Smile Foundation, participants and faculty members filled a survey. Surveys included demographic and geographic data and investigated the most relevant barrier to multidisciplinary cleft care and the most significant intervention to deliver comprehensive cleft care in outreach settings, as perceived by participants.

Results:

The total response rate was 57.8%. Respondents reported that the greatest barrier to comprehensive cleft care was financial, and the most relevant intervention to deliver multidisciplinary cleft care was building multidisciplinary teams. Stratification by age, gender, and geographical area showed no statistical difference in reporting that the greatest barrier to cleft care was financial. However, lack of multidisciplinary teams was the most important barrier according to respondents with less than 5 years of experience (P = 0.03). Stratification by gender, years in practice, specialty, and geographical area showed no statistical difference, with building multidisciplinary teams reported as the most significant intervention. However, increased training was reported as the main intervention to cleft care for those aged less than 30 years old (P = 0.04).

Conclusions:

Our study delivers an assessment for barriers facing multidisciplinary cleft care delivery and interventions required to improve cleft care delivery. The authors are hoping that stratification by demographic and geographic factors will help them delineate community-specific road maps to refine cleft care delivery.
Per-oral Endoscopic Myotomy and Other Applications of Third Space Endoscopy: Current Status and Future Perspectives
Authors: Mandavdhare Harshal S. , Mishra Shubhra , Kumar Antriksh , Shah Jimil , Samanta Jayanta , Gupta Pankaj , Singh Harjeet , Dutta Usha
Published: March 2021

Introduction:

The modification of NOTES (natural orifice transluminal endoscopic surgery) by mucosal safety flap has introduced us to the world of third space endoscopy (TSE). POEM (per-oral endoscopic myotomy) for achalasia cardia being its first vista, the realm expanded so that we can now remove en bloc a subepithelial/intramural tumor by POET (per-oral endoscopic tumor resection), perform G-POEM (gastric per-oral endoscopic myotomy) for refractory gastroparesis, restore esophageal continuity in complete obstruction by performing POETRE (per-oral endoscopic tunneling for the restoration of the esophagus), divide the septum in Zenker diverticulum completely with negligible risk of perforation by Z-POEM (Zenker per-oral endoscopic myotomy) and relieve constipation in Hirschsprung disease by PREM (per-rectal endoscopic myotomy). However, the real potential of TSE became evident with the introduction of POEM with fundoplication. TSE has opened the gates of the peritoneal cavity. Improved expertise and equipment will make the role of endoscopist complimentary to the surgeon with the dawn of a new field in therapeutic endoscopy.

Areas Covered:

This review intends to comprehensively discuss the various aspects of POEM for achalasia studied so far followed by a brief discussion about other applications of TSE and the future perspectives in this exciting field.
Advantages of the Left-handed Ultrasonic Shears Technique for Robotic Gastrectomy
Authors: Nishi Masaaki , Shimada Mistuo , Yoshikawa Kozo , Tokunaga Takuya , Kashihara Hideya , Takasu Chie , Yoshikawa Masato , Wada Yuma , Yoshimoto Toshiaki , Nakasu Chiharu
Published: March 2021

Purpose:

The aim of this study was to investigate advantages of the left-handed ultrasonic shears technique in robotic gastrectomy for gastric cancer.

Methods:

We retrospectively analyzed 67 consecutive gastric cancer patients who underwent robotic gastrectomy. Fifty-six patients underwent gastrectomy with the left-handed ultrasonic shears technique (the left hand group), and 11 patients underwent surgery with the conventional approach (the conventional group). Intraoperative and postoperative outcomes were compared between the 2 groups.

Results:

Operative blood loss, morbidity, and mortality were similar between the 2 groups. We observed a trend toward a shorter operation time and higher number of retrieved lymph nodes in the left hand group compared with the conventional group. Console time (docking-gastrectomy) in the left hand group was significantly shorter than in the conventional group (192.20 vs. 218.36 min, P<0.05). In robotic distal gastrectomy, both operation time and console time in the left hand group were significantly shorter than in the conventional group (276.10 vs. 354.80 min, 176.43 vs. 209.20 min, P<0.05 for both). The postoperative intra-abdominal infectious complication (Clavien Dindo≥1) rate in the left hand group was significantly lower than that in the conventional group (0% vs. 20%, P<0.05).

Conclusions:

Use of the left-handed ultrasonic shears technique is safe and provides a technically superior operative environment with satisfactory postoperative results.