bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-diabetic end-stage renal disease in Saudis associated with polymorphism of MYH9 gene but not UMOD gene
Authors: Adam Khalid Mohamed , Mohammed Ali Mahmoud , Elamin Abubakr Ali
Published: January 2020

The prevalence of risk factors of chronic kidney disease in Saudi Arabia has augmented an already serious public health problem, therefore, determination of genetic variants associated with the risk of the disease presents potential screening tools that help reducing the incidence rates and promote effective disease management.

The aim of the present study is to determine the association of UMOD and MYH9 genetic variants with the risk of non-diabetic end-stage renal disease (ESRD) in the Saudi population.

Two single nucleotide polymorphisms (SNP), rs12917707 in gene UMOD and rs4821480 in gene MYH9 were genotyped in 154 non-diabetic ESRD Saudi patients and 123 age-matched healthy controls using Primers and Polymerase chain reaction conditions (PCR), Sanger sequencing, and TaqMan Pre-designed SNP Genotyping Assay. The association of these genetic variants with the risk of the disease and other renal function determinants was assessed using statistical tools such as logistic regression and One-way Analysis of Variance tests.

The genotypic frequency of the two SNPs showed no deviation from Hardy–Weinberg equilibrium, the minor allele frequency of UMOD SNP was 0.13 and MYH9 SNP was 0.08. rs4821480 in MYH9 was significantly associated with the risk of non-diabetic ESRD (OR = 3.86; 95%CI: 1.38–10.82, P value .010), while, rs12917707 showed lack of significant association with the disease, P value .380. and neither of the 2 SNPs showed any association with the renal function determinants, serum albumin, and alkaline phosphatase enzyme.
A meta-analysis of bridging anticoagulation between low molecular weight heparin and heparin
Authors: Tao Ende , Luo Yun Long , Tao Zhe , Wan Li
Published: January 2020

Background:

Patients with mechanical heart valves (MHV) have an increased risk of thromboembolic complications. Low molecular weight heparin (LMWH) and unfractionated heparin (UFH) are often recommended for bridging anticoagulation; however, it is not clear which strategy is more beneficial.

Methods:

The PubMed, EMBASE, and Cochrane databases were searched from January 1960 to March 2019. Randomized controlled trials and observational studies were analyzed. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the studies. Stata 11.0 was used for the meta-analysis.

Results:

A total of 6 publications were included; 1366 events were selected, involving 852 events with LMWH and 514 events with UFH. The thromboembolism risk of the LMWH group was lower than that of the UFH group (risk ratio [RR] = 0.34, 95% confidence interval [CI] 0.12–0.95, P = .039). The incidence of major bleeding was lower in the LMWH group than in the UFH group, albeit without statistical significance (RR = 0.94, 95% CI 0.68–1.30, P = .728), as was mortality (RR = 0.52, 95% CI 0.16–1.66, P = .271). Subgroup analysis showed that LMWH cardiac surgery patients had a higher risk of major bleeding compared with UFH cardiac surgery patients (RR = 1.17, 95% CI 0.72–1.90, P = .526); but among non-cardiac surgery patients, the LMWH group had a lower risk of major bleeding than the UFH group (RR = 0.79, 95% CI 0.51–1.22, P = .284), although the difference was not statistically significant.

Conclusion:

Our meta-analysis suggests that LMWH not only reduces the risk of thromboembolism in patients with MHV but also does not increase the risk of major bleeding. LMWH may provide safer and more effective bridging anticoagulation than UFH in patients with MHV. It is still necessary to conduct future randomized studies to verify this conclusion.
Long-term functional prognosis of patients with aneurysmal subarachnoid hemorrhage treated with rehabilitation combined with hyperbaric oxygen
Authors: Wang Yong , Gao Yali , Lu Minjie , Liu Yuewei
Published: January 2020

The long-term prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) has received increasing attention in recent years. Hyperbaric oxygen and rehabilitation are already used in clinical treatment of patients with aSAH, but it is unclear whether it can improve the long-term prognosis of patients postoperation. The purpose of this study was to evaluate the long-term prognosis and prognostic factors associated with combined rehabilitation and hyperbaric oxygen therapy for patients with aSAH.

Information were retrospectively collected from patients with aSAH treated from October 2014 to July 2017, including demographics, history of hypertension, Hunt–Hess Grade at the time of onset, location of aneurysm, surgical treatment, status of delayed cerebral ischemia and tracheotomy, level of consciousness impairment (Glasgow Coma scale [GCS], neurologic function damage (National Institutes of Health Stroke Scale [NIHSS]), status of hydrocephalus, time of initial hyperbaric oxygen and rehabilitation therapy, as well as duration and frequency of hyperbaric oxygen therapy, and so on. Long-term functional prognosis was measured by modified Rankin scale (mRS), and mRS ≤3 was defined as good prognosis. Univariate and multivariate logistic regression were used to analyze predictors associated with poor prognosis.

A total of 44 patients with aSAH were enrolled, and 25 patients (56.8%) had a good functional prognosis 6 months after disease onset. Univariate analysis showed age (P = .028), hyperbaric oxygen and rehabilitation start time (P = .039), NIHSS (P = .000), hydrocephalus (P = .024), frequency of hyperbaric oxygen therapy (P = .016), GCS ≤8 points (P = .000), and tracheotomy (P = .007) were associated with prognosis. Multivariate logistic regression analysis showed that only a higher NIHSS score was an independent predictor of poor prognosis (odds ratio = 1.59; 95% confidence interval, 1.10–2.30).

More than 50% of patients with aSAH can achieve a good functional prognosis after combined rehabilitation and hyperbaric oxygen therapy. The severity of neurological impairment before treatment is closely related to poor prognosis.
Intestinal ulcers as an initial finding in EBV-associated lymphoproliferative disorder
Authors: Wang Sizhu , Dai Yinghuan , Zhang Jie , Ou Dalian , Ouyang Chunhui , Lu Fanggen
Published: January 2020

Rationale:

Epstein-Barr virus (EBV)-associated T-cell lymphoproliferative disorder (LPD) usually occurs in children and young adults. Gastrointestinal involvement is rare. EBV-associated T-cell lymphoproliferative disorder manifesting as intestinal ulcers poses diagnostic challenges clinically and pathologically because of the atypical manifestations. We concluded that some indicators according to our case and literatures, which might be helpful to the diagnosis of EBV-associated LPD manifested as intestinal ulcers.

Patient concerns:

Here we present a 26-year-old man with complaints of diarrhea and abdominal pain that had persisted for 1 year. Multiform and multifocal deep ulcers were discovered in the colonoscopy. Cell atypia was not obvious but colitis with crypt distortion was found in pathology.

Diagnoses:

According to the symptoms, laboratory examinations, colonoscopy and pathology results, Crohn Disease was diagnosed.

Interventions

Infliximab therapy was initiated based on the diagnosis of Crohn Disease.

Outcomes:

After the fifth course of therapy, intermittent fever and hematochezia occurred. Physical examination revealed swollen tonsils and ulcers, and purulent exudate from the right tonsil and palatoglossal arch were observed. Biopsies obtained through colonoscopy and nasopharyngoscopy demonstrated EBV-associated T-cell proliferation disease (level 3). After that, the tissue sample from the first colonoscopy was reexamined immunohistochemically. The result suggested EBV-associated T-cell proliferation disease (level 1).

Lessons:

When we confront with patients with multiform and multifocal deep intestinal ulcers, not only the common diseases such as Crohn Disease and intestinal tuberculosis should be considered, EBV-associated T-cell proliferation disease should be considered as well. Repeated multiple biopsy, gene rearrangement, EBV DNA quantitative analysis result, EBV-encoded RNA(EBER) and experienced pathologists might be helpful to the diagnosis.
Effect of isolation practice on the transmission of middle east respiratory syndrome coronavirus among hemodialysis patients
Authors: Park Hayne Cho , Lee Sang-Ho , Kim Juhee , Kim Do Hyoung , Cho AJin , Jeon Hee Jung , Oh Jieun , Noh Jung-Woo , Jeong Da-Wun , Kim Yang-Gyun , Lee Chang-Hee , Yoo Kyung Don , Lee Young-Ki
Published: January 2020

Hemodialysis (HD) patients had a high rate of infection transmission and mortality during the middle east respiratory syndrome coronavirus (MERS-CoV) outbreak in Saudi Arabia. A standardized guideline on isolation technique for exposed HD patients is not available. Thus, this study aimed to evaluate the effect of different isolation strategies on the prevention of secondary viral transmission and clinical outcomes among exposed HD patients.

During the 2015 MERS-CoV outbreak in Korea, 116 patients in 3 HD units were incidentally exposed to individuals with confirmed MERS-CoV infection and underwent different types of isolation, which were as follows: single-room isolation (n = 54, 47%), cohort isolation (n = 46, 40%), and self-imposed quarantine (n = 16, 13%). The primary outcome was rate of secondary viral transmission. The secondary outcome measures were changes in clinical and biochemical markers during the isolation period, difference in clinical and biochemical markers according to the types of isolation practice, and effect of isolation practice on patient survival.

During a mean isolation period of 15 days, no further cases of secondary transmission were detected among HD patients. Plasma hemoglobin, serum calcium, and serum albumin levels and single-pool Kt/V decreased during the isolation period but normalized thereafter. Patients who were subjected to self-imposed quarantine had higher systolic and diastolic blood pressure, lower total cholesterol level, and lower Kt/V than those who underwent single-room or cohort isolation. During the 24-month follow-up period, 12 patients died. However, none of the deaths occurred during the isolation period, and no differences were observed in patient survival rate according to different isolation strategies.

Although 116 participants in 3 HD units were incidentally exposed to MERS-CoV during the 2015 outbreak in Korea, strict patient surveillance and proper isolation practice prevented secondary transmission of the virus. Thus, a renal disaster protocol, which includes proper contact surveillance and isolation practice, must be established in the future to accommodate the needs of HD patients during disasters or outbreaks.
Primary pigmented meningeal melanocytoma originating in Meckel cave in a patient with carney complex
Authors: Al-Abdulwahhab Abdulrahman Hamad , Al-Sharydah AbdulAziz Mohammad , Al-Suhibani Sari Saleh , Al-Shayji Hadeel , Al-Saad Ibtihal , Al-Issawi Wissam
Published: January 2020

Rationale:

Primary melanin-producing tumors are rare extra-axial neoplasms OPEN of the central nervous system. In the literature, few case reports have discussed neoplasms involving the cavernous sinus; of these, only 4 have reported on neoplasms originating in Meckel cave. The diagnostic approach, including clinical and radiological analysis, is challenging, and cytopathological assessment with a molecular basis is the best approach to discriminate between these lesions. Herein, we discuss the pathophysiology, diagnostic approach, intraoperative features, and postoperative management in a unique case of primary pigmented meningeal melanocytoma originating in Meckel cave in a patient who was diagnosed with Carney complex (CCx) and sickle cell disease (SCD).

Patient concerns:

A 23-year-old man diagnosed with SCD had also been diagnosed previously with CCx, without any familial history or neurocutaneous melanosis. He had experienced headaches accompanied by left facial pain and paresthesia for 2 months.

Diagnosis:

The initial computed tomography scan and magnetic resonance imaging (MRI) revealed a mass arising from the left Meckel cave. On MRI, it followed the signal intensity of melanin. He underwent subtotal resection of the mass. Considering the patient's history of CCx, melanocytic schwannoma was the most relevant diagnosis. A postoperative histopathological examination was suggestive of benign pigmented meningeal melanocytoma.

Interventions:

The patient underwent an uneventful subtotal resection of the mass through a left temporal linear incision.

Outcomes:

The patient showed progressive improvement of neurologic deficits, and after 2 years of follow-up, he did not present with any new complaints.

Lessons:

To the best of our knowledge, this is the first report of the unusual presentation of both SCD, as well as of primary pigmented meningeal melanocytoma in a patient with CCx. Complete surgical resection can be curative in most cases of melanocytoma. The presence of CCx with SCD suggests potential shared genetic contributions that will require further exploration.
Evaluation of the age-related and gender-related differences in patients with primary insomnia by fractional amplitude of low-frequency fluctuation
Authors: Wang Yu-Kai , Shi Xiao-Hua , Wang Ying-Ying , Zhang Xin , Liu Hong-Yu , Wang Xin-Tong , Mang Jing , Xu Zhong-Xin
Published: January 2020

Insomnia patients with different gender and age usually had different sleep experience. Primary insomnia (PI) has been considered to be a disorder of hyper-arousal in the physiologic, emotional, or cognitive network. Although the hyper-arousal brain regions can be shown by comparing the brain activity of PI patients with normal people at rest, whether the brain activity of PI patients varied according to age and gender and whether age and gender could affect the distribution of hyper-arousal brain regions are still worthy of further exploration. Hence, a resting state functional magnetic resonance imaging study (No. NCT02448602) was designed to observe the brain activity of thirty PI patients and 15 healthy controls (HCs). The brain activity in resting state was measured by calculating the fractional amplitude of low-frequency fluctuations (fALFF), which reflected the idiopathic activity level of neurons. Multiple regression was performed to investigate the age and gender-related differences of brain activity in PI patients (P < .001, Family Wise Error (FWE) correct P = .05, cluster size >50) with age and gender as covariates. The hyper-arousal brain regions were measured by comparing the fALFF of PI patients and HCs. Multiple regression (P < .001, FWE correct P = .05, cluster size >50) was also performed for PI patients and HCs with group, age, and gender as covariates.

The results suggested that the gender-related difference of brain activity mainly existed in superior temporal gyrus, cerebellum posterior lobe, middle frontal gyrus, and the age-related difference mainly existed in cerebellum anterior lobe, superior temporal gyrus, brainstem, parahippocampa gyrus, anterior cingulate, cingulate gyrus. In addition, the altered fALFF regions between PI and HCs mainly existed in superior temporal gyrus, posterior cingulate, anterior cingulate, cingulate gyrus, middle frontal gyrus. Furthermore, the gender factor could not influence the distribution of the altered regions. While the age factor could affect the distribution of the altered regions.
C5 palsy after C5/6/7 posterior foraminal decompression
Authors: Oshina Masahito , Segawa Tomohide , Oshima Yasushi , Tanaka Sakae , Inanami Hirohiko
Published: January 2020

Rationale:

Although C5 palsy is a common complication of cervical spine surgery, its cause has not been confirmed. There are various hypotheses for its mechanism, including spinal cord impairment and nerve involvement. Therefore, prophylactic foraminotomy is one of the methods recommended for preventing C5 palsy. However, we describe a patient who experienced C5 palsy after microendoscopic foraminotomy between the left C5/6 and C6/7 levels.

Patient concerns:

A 43-year-old man presented with a 14-month history of progressive numbness in the left upper limb. We performed microendoscopic left foraminal decompressions at the C5/6/7 levels to treat the left C6 and C7 radiculopathy. On the postoperative day 1, we observed weak motor strength of the left deltoid, left biceps, and left forearm pronator, while the motor strength of the other muscles was normal.

Diagnoses:

C5 palsy following C5/6/7 left foraminotomy.

Intervention:

Follow-up rehabilitation with muscle strength training and range of motion training.

Outcome:

The patient recovered his motor strength completely within 3 months postoperatively.

Lessons:

In this case, the C5 palsy could not be adequately explained by the theory of nerve root impingement or disruption in blood circulation following spinal cord decompression. We hypothesized that the patient had drill heat-induced C5 palsy. Regarding the C5 palsy without C5 nerve root decompression, we hypothesize that the C5 palsy in C5/6/7 foraminotomy could be related to variations in the formation of the brachial plexus. Prophylactic foraminotomy for cervical posterior surgery should be performed with care, limiting its use in patients who are at a risk of developing C5 palsy because the prophylactic procedure can cause C5 palsy. We must also consider that even without decompression at the C4/5 level, there is a possibility of C5 palsy occurring.
Comparison of the immediate analgesic effect of perpendicular needling and transverse needling at SP6 in patients with primary dysmenorrhea
Authors: Afshari Fard Mohammad Reza , Mohammadi Ali , Ma Liang-Xiao , Mu Jie-dan , Yu Wen-Yan , Song Yue , Wang Jun-Xiang , Gan Ying-Ying , Tian Yuan , Qian Xu , Sun Tian-Yi , Iravani Somayeh
Published: January 2020

Background:

Acupuncture has been widely used to treat primary dysmenorrhea (PD) with satisfactory outcomes. Sanyinjiao (SP6) is the most commonly used acupoint for PD. Different needling techniques may influence the effect of SP6, and its underlying mechanism needs to be explored. This randomized controlled parallel trial is designed to evaluate the immediate analgesic effect and hemodynamic responses in uterine arterial blood flow of perpendicular needling and transverse needling at SP6 in patients with PD of cold-dampness stagnation pattern using color doppler ultrasonography.

Methods:

Forty-eight patients who meet inclusion criteria will be randomized in a ratio of 1:1 to either perpendicular needling or transverse needling groups. Every participant will receive 1 session of acupuncture treatment for 10 minutes at bilateral SP6. In the perpendicular needling group, needles will be inserted vertically 1 to 1.2 cun and will be manipulated to achieve needling sensation. In transverse needling group, the needles will be inserted transversely 1 to 1.2 cun toward the abdomen without any manipulation to avoid needling sensation. Color doppler ultrasonography will be performed before, during, and after needling. The primary outcome measure is visual analog scale for pain. The secondary outcome measures include the uterine artery blood flow changes by measuring pulsatility index, resistance index values, and ratio of systolic peak and diastolic peak, the Hamilton anxiety scale, blood pressure, and heart rate. Adverse events in both groups also will be recorded.

Discussion:

This trial will be the first study protocol designed to explore the influence of needling techniques on the analgesia effect of solo acupoint and its hemodynamic responses for PD. It will promote more widespread awareness of the benefits of using suitable needling techniques in acupuncture clinical setting and provide a further explanation of the underlying hemodynamic mechanism.

Trial registration:

This study protocol was registered at the Chinese clinical trial registry (ChiCTR1900026051).
The impact of physicians’ knowledge on outpatient antibiotic use
Authors: Wushouer Haishaerjiang , Wang Zhuangfei , Tian Ye , Zhou Yue , Zhu Dawei , Vuillermin Daniel , Shi Luwen , Guan Xiaodong
Published: January 2020

We designed this study to explore how factors, especially knowledge, influence the use and prescriptions of antibiotics among physicians in China's county hospitals.

A questionnaire was designed to evaluate the knowledge levels of physicians. The rates of antibiotic prescriptions were collected through on-the-spot investigations. The percentage of encounters with antibiotics prescribed and the percentage of encounters with antibiotics combination prescribed were used to measure antibiotics use. Univariate analysis and the generalized linear model were applied to analyze the knowledge levels among physicians as well as their antibiotic prescriptions.

A total of 334 physicians in 60 county hospitals filled out the questionnaires, and 385,529 prescriptions were collected. The mean score of the questionnaire was a pass (62.8). The physicians in the eastern region of China demonstrated higher levels of knowledge than other regions (P = .08). Physicians with a higher score prescribed less antibiotics (P < .01) and less antibiotics combination (P = .07).

The knowledge gap of Chinese physicians is evident and those with a higher degree of knowledge always prescribe fewer antibiotics. Targeted training and courses to educate physicians about the risks of over-prescription of antibiotics should be conducted to improve the practice of antibiotic prescriptions.
Impact of CCL4 gene polymorphisms upon the progression of lung cancer in a Han Chinese cohort
Authors: Hu Weiwei , Chien Szu-Yu , Ying Pengqing , Liu Po-I , Su Chen-Ming , Tang Chih-Hsin
Published: January 2020

Lung cancer is the most common malignancy in China and has a low survival rate amongst Han Chinese. The high mortality is largely attributed to late-stage diagnosis, when treatment is largely ineffective. Identification of genetic variants could potentially assist with earlier diagnosis and thus more effective treatment. Chemokine (C–C motif) ligand 4 (CCL4) plays a critical role as a chemoattractant in tumor development, metastasis and angiogenesis. In this study, we explored three CCL4 single nucleotide polymorphisms (SNPs) (rs1634507, rs1719153, and rs10491121) in 538 patients with lung cancer and 370 healthy, cancer-free controls. Carriers of the GT + TT heterozygote of rs1634507 had a lower risk of lung cancer than wild-type (GG) carriers, while the presence of the AG + GG heterozygote at rs10491121 was associated with a higher risk of lung cancer compared with having the AA genotype. The G/A/G and T/A/A CCL4 haplotypes significantly reduced and increased the risks for lung cancer, respectively. Our study is the first to document correlations between CCL4 polymorphisms and lung cancer development and progression in people of Han Chinese ethnicity.
Correlating Self-directed Learning Abilities to Lifelong Learning Orientation in Baccalaureate Nursing Students
Authors: Kaulback Michelle K.
Published: January 2020

Background

Lifelong learning is an important part of professionalism as nurses need to maintain competency and current knowledge for practice.

Purpose

The purpose of this study was to examine the relationship between baccalaureate nursing students' self-directed learning (SDL) abilities and lifelong learning orientation.

Methods

A quantitative, correlational research design was used. Students (n = 124) completed the Self-Directed Learning Inventory (SDLI) and the Jefferson Scale of Lifelong Learning–Health Professions Students (JeffSLL-HPS).

Results

There was a significant, positive correlation between the SDLI total scores and the JeffSLL-HPS total scores (r = 0.64, P < .0001). There also were positive correlations between the JeffSLL-HPS total scores and 4 SDL domains: interpersonal communication (r = 0.39, P < .0001), planning and implementing (r = 0.52, P < .0001), self-monitoring (r = 0.48, P < .0001), and learning motivation (r = 0. 63, P < .0001).

Conclusion

Nursing faculty should implement teaching and learning strategies that foster SDL abilities to increase lifelong learning orientation in nursing students.
Nursing Care for Hospitalized Older Adults With and Without Cognitive Impairment
Authors: Macieira Tamara G. R. , Yao Yingwei , Smith Madison B. , Bian Jiang , Wilkie Diana J. , Keenan Gail M.
Published: January 2020

Background

The presence of cognitive impairment (CI) among hospitalized older adults (aged 85 years and older) could interfere with the identification and treatment of other important symptoms experienced by these patients. Little is known, however, about the nursing care provided to this group. Contrasting the nursing care provided to patients with and without CI may reveal important insights about symptom treatment in the CI population.

Objective

The aim of this study was to examine the relationship of CI to nursing care provided and length of stay for hospitalized older adults using standardized nursing data retrieved from electronic health records.

Methods

We conducted a comparative secondary data analysis. A data set of standardized nursing plan of care data retrieved from electronic health record data of nine units at four hospitals was analyzed. The plan of care data for this study were previously transformed into one of eight categories (family, well-being, mental comfort, physical comfort, mental, safety, functional, and physiological care). Fisher exact tests were used to compare the differences in the nursing care for hospitalized older adults with and without CI. Mixed-effects models were used to examine associations of patient’s cognitive status and nursing care, and cognitive status and length of stay.

Results

We identified 4,354 unique patients; 746 (17%) had CI. We observed that older adults with CI were less likely to receive physical comfort care than those without CI for seven of nine units. Older adults’ cognitive status was associated with the delivery of mental comfort care. In addition, a worsening in cognitive status was associated with an increase in length of stay for older adults with CI.

Discussion

Older adults with CI appeared to be undertreated for symptoms of pain when compared to those without CI across units. There is a need for further research to improve symptom recognition and management for this population. The presence of CI was associated with variation in nursing care provided and length of stay. Future studies that include the analysis of nursing data merged with elements stored in the electronic health record representing the contributions of other health professions are expected to provide additional insights into this gap.
A National Survey Across Primary Care Pediatricians Regarding Immunization Views and Practices in Children With Rheumatic Diseases
Authors: Papailiou Stayroula , Markade Aikaterini , Eleftheriou Irene , Tsolia Maria N. , Garoufi Anastasia , Maritsi Despoina N.
Published: January 2020

Objective

The aims of this study were to describe the knowledge, attitude, and current practice of general pediatricians working in primary care regarding vaccination in children with rheumatic diseases (RDs) and to identify barriers and facilitators that could be used to promote uptake.

Methods

Cross-sectional survey conducted with an anonymous questionnaire of 34 items distributed to pediatricians via an online platform. Four hundred questionnaires were sent, and 256 were returned and analyzed using STATA 13. Data collection included demographics, questions on knowledge, perceptions, and opinions, as well as advice given to families.

Results

The majority of doctors felt that vaccination in children with RDs is essential. Responders were using a variety of guidelines to reach a clinical decision. Fifty percent were hesitant to adhere to the national vaccination scheme without expert input. Reasons were as follows: not convinced from current literature that the vaccine is safe (32%), afraid to cause disease flare (43%), and unable to deal with parental concerns/refusal (54%). Twelve percent of responders felt that the RD may have been triggered by a vaccine. The majority (82%) of doctors were pro annual influenza vaccination. Seventy percent of doctors were keener to administer booster doses rather than primary ones.

Conclusions

Variation in opinion and clinical practice exists. Overall, although general pediatricians are informed regarding efficacy and adverse effects of immunizations in patients with RDs, there are steps to be made from principle to practice. Vaccinating these children is of vital importance, and primary care pediatricians should be updated regarding existing guidelines referring to this field.
“Medial Hemi-Mastopexy”
Authors: Agrawal Amit , Garreffa Emanuele
Published: January 2020

Introduction

Therapeutic mammaplasty is a well-established advanced oncoplastic technique for larger tumors in large breasts. However, the larger the breasts are, the greater is the lower outer parenchymal displacement due to weight resulting in relative emptiness in the medial/cleavage part. Therefore, the default practice of excising the medial wing parenchymal component of Wise pattern (WP) incision may either maintain or worsen such anatomy.

Methods

We present a technical innovation to improve the standard WP technique: instead of excision, the medial wing of the WP incision is deepithelized, and parenchyma is preserved to retain or augment bulk.

Results

Between July 2015 and December 2018, a total of 16 patients (26 breasts) underwent a medial hemi-mastopexy. This technique seems to be safe, with minimal complications even after radiotherapy.

Conclusions

Although its use is limited in lower inner quadrant tumors, “medial hemi-mastopexy” can be safely applied to cancers located in all the other quadrants and potentially in the cosmetic setting as well. This case series is limited by the small numbers and short follow-up; however, the data show promising results.
Patient-reported Outcomes at 6 to 12 Months Among Survivors of Firearm Injury in the United States
Authors: Herrera-Escobar Juan Pablo , de Jager Elzerie , McCarty Justin Conrad , Lipsitz Stuart , Haider Adil H. , Salim Ali , Nehra Deepika
Published: January 2020

Objective:

Assess outcomes in survivors of firearm injuries after 6 to 12 months and compared them with a similarly injured trauma population.

Background:

For every individual in the United States who died of a firearm injury in 2017, three survived, living with the burden of their injury. Current firearm research largely focuses on mortality and short-term health outcomes, while neglecting the long-term consequences.

Methods:

We contacted adult patients with a moderate-to-severe injury from a firearm or motor vehicle crash (MVC) treated at 3 level I trauma centers in Boston between 2015 and 2018. Patients were contacted 6 to 12 months postinjury to measure: presence of daily pain; screening for post-traumatic stress disorder (PTSD); new functional limitations; return to work; and physical and mental health-related quality of life. We matched each firearm injury patient to MVC patients using Coarsened Exact Matching. Adjusted Generalized Linear Models were used to compare matched patients.

Results:

Of 177 eligible firearm injury survivors, 100 were successfully contacted and 63 completed the study. Among them, 67.7% reported daily pain, 53.2% screened positive for PTSD, 38.7% reported a new functional limitation in an activity of daily living, and 59.1% have not returned to work. Compared with population norms, overall physical and mental health-related quality of life was significantly reduced among firearm injury survivors. Compared with matched MVC survivors (n = 255), firearm injury survivors were significantly more likely to have daily pain [adjusted odds ratio (OR) 2.30, 95% confidence interval (CI) 1.08–4.87], to screen positive for PTSD (adjusted OR 3.06, 95% CI 1.42–6.58), and had significantly worse physical and mental health-related quality of life.

Conclusions:

This study highlights the need for targeted long-term follow-up care, physical rehabilitation, mental health screening, and interventions for survivors of firearm violence.
Validating clinical threshold values for a dashboard view of the compensatory reserve measurement for hemorrhage detection
Authors: Convertino Victor A. , Wampler Mallory R. , Johnson Michael , Alarhayem Abdul , Le Tuan D. , Nicholson Susannah , Myers John G. , Chung Kevin K. , Struck Katie R. , Cuenca Camaren , Eastridge Brian J.
Published: January 2020

BACKGROUND

Compensatory reserve measurement (CRM) is a novel noninvasive monitoring technology designed to assess physiologic reserve using feature interrogation of arterial pulse waveforms. This study was conducted to validate clinically relevant CRM values with a simplified color-coded dashboard view.

METHODS

We performed a prospective observational study of 300 injured patients admitted to a level I trauma center. Compensatory reserve measurement was recorded upon emergency department admission. Data collected to complement the analysis included patient demographics, vital signs, lifesaving interventions, Injury Severity Score (ISS), and outcomes. Threshold values of CRM were analyzed for predictive capability of hemorrhage.

RESULTS

A total of 285 patients met the inclusion criteria. Mean age of the population was 47 years, and 67% were male. Hemorrhage was present in 32 (11%), and lifesaving intervention was performed in 40 (14%) patients. Transfusion of packed red blood cells was administered in 33 (11.6%) patients, and 21 (7.4%) were taken to the operating room for surgical or endovascular control of hemorrhage. Statistical analyses were performed to identify optimal threshold values for three zones of CRM to predict hemorrhage. Optimal levels for red, yellow, and green areas of the dashboard view were stratified as follows: red if CRM was less than 30%, yellow if CRM was 30% to 59%, and green if CRM was 60% or greater. Odds of hemorrhage increased by 12-fold (odds ratio, 12.2; 95% confidence interval, 3.8–38.9) with CRM less than 30% (red) and 6.5-fold (odds ratio, 6.5; 95% confidence interval, 2.7–15.9) with CRM of equal to 30% to 59% (yellow) when compared with patients with CRM of 60% or greater. The area under the receiver operating characteristic curve for three-zone CRM was similar to that of continuous CRM (0.77 vs. 0.79) but further increased the ability to predict hemorrhage after adjusting for ISS (area under the receiver operating characteristic curve, 0.87).

CONCLUSION

A three-zone CRM could be a potentially useful predictor of hemorrhage in trauma patients with added capabilities of continuous monitoring and a real-time ISS assessment. These data substantiate easily interpretable threshold dashboard values for triage with potential to improve injury outcomes.

LEVEL OF EVIDENCE

Diagnostic, level II.
Diagnosis in children with exercise-induced respiratory symptoms: a multi-centre study
Authors: Pedersen Eva SL , Ardura-Garcia Cristina , de Jong Carmen CM , Jochmann Anja , Moeller Alexander , Mueller-Suter Dominik , Regamey Nicolas , Singer Florian , Goutaki Myrofora , Kuehni Claudia E
Published: January 2020

Objective

Exercise-induced respiratory symptoms (EIS) are common in childhood and reflect different diseases that can be difficult to diagnose. In children referred to respiratory outpatient clinics for EIS, we compared the diagnosis proposed by the referring primary care physician with the final diagnosis from the outpatient clinic and described diagnostic tests performed and treatment prescribed after the diagnostic evaluation.

Design

Observational study nested in the Swiss Paediatric Airway Cohort (SPAC), which includes respiratory outpatients aged 0-16 years.

Patients

We included children with EIS as main reason for referral. Information about diagnostic investigations, final diagnosis, and treatment prescribed came from outpatient records.

Results

214 were referred for EIS (mean age 12 years, 99 (46%) female). The final diagnosis was asthma in 115 (54%), extrathoracic dysfunctional breathing (DB) in 35 (16%), thoracic DB in 22 (10%), asthma plus DB in 23 (11%), insufficient fitness in 10 (5%), chronic cough in 6 (3%), and other diagnoses in 3 (1%). Final diagnosis differed from referral diagnosis in 115 (54%). Spirometry, body plethysmography and measurements of exhaled nitric oxide were performed in almost all; exercise-challenge tests in a third. 91% of the children with a final diagnosis of asthma were prescribed inhaled medication and 50% of children with DB were referred to physiotherapy.

Conclusions

Diagnosis given at the outpatient clinic often differed from the diagnosis suspected by the referring physician. Diagnostic evaluation, management and follow-up were inconsistent between clinics and diagnostic groups, highlighting the need for diagnostic guidelines in children seen for EIS.

Mandatory statements for Archives of Disease in Childhood

What is already known on this topic (2-3 statements of max 25 words)

Exercise-induced symptoms are common in childhood but not easy to diagnose because different diagnoses share similar clinical presentations

Only few studies focused on children with exercise-induced symptoms and all have included selected groups of patients with difficult-to-diagnose problems

What this study adds (2-3 statements of max 25 words)

Exercise-induced respiratory symptoms was the main reason for referral in one fifth of the children referred to paediatric respiratory outpatient clinics.

Dysfunctional breathing is an under-recognised diagnosis; it was frequently diagnosed in the outpatient clinic (in 37%) but rarely suspected by the referring physician (6%)

Diagnostic evaluation, management, and follow-up were inconsistent between clinics highlighting the need for diagnostic guidelines in children seen for EIS.
An overview of the quality assurance and quality control of magnetic resonance imaging data for the Ontario Neurodegenerative Disease Research Initiative (ONDRI): pipeline development and neuroinformatics
Authors: Scott Christopher J.M. , Arnott Stephen R. , Chemparathy Aditi , Dong Fan , Solovey Igor , Gee Tom , Schmah Tanya , Chavez Sofia , Lobaugh Nancy , Nanayakkara Nuwan , Liang Shuai , Zamyadi Mojdeh , Ozzoude Miracle , Holmes Melissa F. , Szilagyi Gregory M. , Ramirez Joel , Symons Sean , Black Sandra E. , Bartha Robert , Strother Stephen ,   the ONDRI investigators
Published: January 2020

Large scale research studies combining magnetic resonance imaging data generated at multiple sites on multiple vendor platforms are becoming more commonplace. The Ontario Neurodegenerative Disease Research Initiative (ONDRI -http://ondri.ca/), a project funded by the Ontario Brain Institute (OBI), is a recently established province-wide natural history study, which has recruited more than 500 participants from neurodegenerative disease groups including amyotrophic lateral sclerosis, fronto-temporal dementia, Parkinson’s disease, Alzheimer’s disease, mild cognitive impairment, and cerebrovascular disease (previously referred to as the vascular cognitive impairment cohort). Because of its multi-site nature, all captured data must be standardized and meet minimum quality standards to reduce variability. The goal of the ONDRI imaging platform is to maximize data quality by implementing vendor-specific harmonized MR imaging protocols (consistent with the Canadi-an Dementia Imaging Protocol -http://www.cdip-pcid.ca/), monitoring protocol adherence, qualitatively assessing image quality, measuring signal-to-noise and contrast-to-noise, monitoring system stability, and applying corrections based on the analysis of images from two different phantoms regularly acquired at each site. To maximize image quality, this work describes the use of various automatic pipelines and manual assessment steps, integrated within an established informatics and databasing platform, the Stroke Patient Recovery Research Database (SPReD) built on the Extensible Neuroimaging Archive Toolkit (XNAT), and contained within the Brain-CODE (Centre for Ontario Data Exploration) framework. The purpose of the current paper is to describe the steps undertaken by ONDRI to achieve this high standard of data integrity. Data have been successfully collected for the past 4 years with the pipelines and assessments identifying deviations, allowing for timely interventions and assessment of image quality.
The potential cost-effectiveness of controlling dengue in Indonesia using wMel Wolbachia released at scale: a modelling study
Authors: Brady Oliver J. , Kharisma Dinar D. , Wilastonegoro Nandyan N. , O’Reilly Kathleen M. , Hendricx Emilie , Bastos Leonardo S. , Yakob Laith , Shepard Donald S.
Published: January 2020

Background

Release of virus-blocking Wolbachia infected mosquitoes is an emerging disease control strategy that aims to control dengue and other arboviral infections. Early entomological data and modelling analyses have suggested promising outcomes and wMel Wolbachia releases are now ongoing or planned in 12 countries. To help inform potential scale-up beyond single city releases, we assessed this technology’s cost-effectiveness under different programmatic options.

Methods

Using costing data from existing Wolbachia releases, previous estimates of Wolbachia effectiveness, and a spatially-explicit model of release and surveillance requirements, we predicted the costs and effectiveness of the on-going programme in Yogyakarta City and three new hypothetical programmes in Yogyakarta Special Autonomous Region, Jakarta and Bali.

Results

We predicted Wolbachia to be a highly cost-effective intervention when deployed in high density urban areas with gross cost-effectiveness ratios below $1,500 per DALY averted. When offsets from the health system and societal perspective were included, such programmes even became cost saving over 10-year time horizons with favourable benefit-cost ratios of 1.35 to 3.40. Sequencing Wolbachia releases over ten years could reduce programme costs by approximately 38% compared to simultaneous releases everywhere, but also delays the benefits. Even if unexpected challenges occurred during deployment, such as emergence of resistance in the medium-term or low effective coverage, Wolbachia would remain a cost saving intervention.

Conclusions

Wolbachia releases in high density urban areas is expected to be highly cost-effective and could potentially be the first cost saving intervention for dengue. Sites with strong public health infrastructure, fiscal capacity, and community support should be prioritized.
tDCS to the left DLPFC improves cognitive control but not action cancellation in patients with ADHD: a behavioral and electrophysiological study
Authors: Dubreuil-Vall Laura , Gomez-Bernal Federico , Villegas Ana C. , Cirillo Patricia , Surman Craig , Ruffini Giulio , Widge Alik S. , Camprodon Joan A.
Published: January 2020

ADHD is a neurodevelopmental disorder associated with significant morbidity and mortality that affects 5% of children, adolescents and adults worldwide. Pharmacological and behavioral therapies exist, but critical symptoms such as dysexecutive deficits remain unaffected. In this randomized, placebo-controlled, double-blind, cross-over study we assess the cognitive and physiological effects of tDCS in adult ADHD patients in order to understand (1) the role of DLPFC laterality in ADHD dysexecutive deficits, (2) the physiological dynamics sustaining the modulation of executive function by tDCS, and (3) the impact of state-dependent dynamics of tDCS effect. The participants consisted of a random sample of 40 adult patients with a primary diagnosis of ADHD. Each patient performed three experimental sessions in which they received 30 minutes of 2mA tDCS stimulation targeting the left DLPFC (anodal F3, cathodal Fp2), the right DLPFC (anodal F4, cathodal Fp1) and Sham. Before and after each session, half of the patients completed the Flanker task (EFT) and the other half performed the Stop Signal Task (SST), while we assessed cognitive (reaction time, accuracy) and neurophysiological measures (EEG Event-Related-Potentials). Results show that anodal tDCS to the left DLPFC modulated cognitive (reaction time) and physiological measures (P300 amplitude) in the Flanker task in a state-dependent manner, but there were no significant effects in the Stop Signal Reaction Time of the SST. We interpret these results as an improvement in interference cognitive control (captured by the EFT) but not in action cancellation (assessed by the SST), supporting the hypothesis of the existence of different impulsivity constructs with overlapping but distinct anatomical substrates and therapeutic strategies. We conclude that anodal tDCS over the left DLPFC using a simple bipolar montage has pro-cognitive effects in dysexecutive patients with ADHD associated with the modulation of physiological signatures of cognitive control (i.e. treatment target), supporting specific hypotheses and strategies for neuromodulation treatment development under an experimental therapeutics framework aiming to link target engagement (cognitive and physiological) with clinical benefit. In addition, we also provide empirical evidence supporting the value of the P200, N200 and P300 as cross-sectional biomarkers of cognitive performance across tasks. Last, we provide mechanistic support for the state-dependent nature of the effects of tDCS, highlighting the importance of controlling the neural states before and during stimulation as a relevant therapeutic strategy.