bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of SREBP2 and cholesterol metabolism related genes in TCGA glioma cohorts
Authors: Li Dali , Li Shenglan , Xue Allen Z. , Smith Callahan Laura A. , Liu Ying
Published: March 2020

Diffuse gliomas are the most common primary brain tumors. The Cancer Genome Atlas (TCGA) database provides correlative evidence between altered molecular pathways and gliomas. Dysregulated cholesterol homeostasis emerges as a potential indicator of the pathogenesis of gliomas.

Mining large cohorts from the TCGA together with database from the Chinese Glioma Genome Atlas (CGGA) for confirmation, we compared gene expression of cholesterol synthesis master regulator SREBP2 and its regulatory networks in low grade glioma (LGG) and glioblastoma (GBM).

Our analysis shows that expression of SREBP2 and related genes is lower in GBM than in LGG, indicating that cholesterol metabolism processes, including de novo synthesis, cholesterol uptakes, and cholesterol conversion and efflux, are suppressed in GBM.

Overall, our data suggests that SREBP2 transcript could serve as a potential prognosis marker or therapeutic target in diffuse glioma including GBM.
The effectiveness and safety of acupuncture in the treatment of lumbar disc herniation
Authors: Deng Rong , Huang ZiLing , Li Xun , Pei XingHong , Li ChengXi , Zhao JianXin
Published: March 2020

Background:

Lumbar disc herniation (LDH) is a common disease that seriously affects patients’ quality of life. Although several articles have reported that acupuncture can improve the symptoms of LDH, different guidelines do not evaluate the efficacy of acupuncture consistently, new randomized controlled trials have been published in recent years.

The purpose of this study is to evaluate the efficacy and safety of acupuncture for LDH.

Method:

Electronic resource databases, trial registration platform, and different types of grey literature will be systematically searched for eligible studies by 2 authors independently. The type of trial will be limited to randomized controlled trials on acupuncture treatment for LDH. Search strategy will be a combination of terms associated with LDH (eg, low back pain or sciatica) and study of design (eg, randomized controlled trials or clinical trial). Data from homogeneous studies will be combined in a fixed-effects model, and the evidence level will be measured by grading of recommendations assessment, development, and evaluation.

Results:

This study will provide high-quality evidence to evaluate the relief of pain intensity and improvement of dysfunction of acupuncture in patients with LDH, and to evaluate the safety of acupuncture.

Conclusion:

This study will provide strong evidence for evaluating whether acupuncture therapy is effective and safe for LDH patients.

PROSPERO registration number:

CRD 42019137399.
Effect of continuous positive airway pressure (CPAP) on mild-moderate obstructive sleep apnea (OSA) related dreaminess
Authors: Xue Pei , Zhou Junying , Lei Fei , Tan Lu , Li Xiao , Tang Xiangdong
Published: March 2020

Introduction:

Dreaminess is one of the common symptoms of sleep disorders and often leads to complaint of poor sleep quality and morning fatigue. Literatures on the relationship between obstructive sleep apnea (OSA) and dreams have been reported with contradictory results. In this case report, we identified a moderate OSA related dreaminess that was successfully treated by continuous positive airway pressure (CPAP).

Patient concerns:

We present a case of a 47-year-old woman who was bothered by all-night dreaminess for over 20 years.

Diagnosis:

An overnight polysomnography (PSG) examination showed the apnea-hypopnea index (AHI) was 21.7 events/hour and the rapid eye movement (REM)-AHI was 46.3 events/hour. The patient was diagnosed with moderate OSA.

Interventions:

The patient received auto CPAP therapy.

Outcomes:

The symptoms of dreaminess and daytime functioning significantly improved after CPAP treatment. During the 4-month follow up, 3 CPAP titrations showed that OSA events and OSA related REM interruption almost disappeared. On the night of PSG diagnosis, only 1 non-rapid eye movement sleep 3 (N3) episode occurred before the first REM episode. Nevertheless, N3 episodes were observed before the majority of REM episodes on all three nights of CPAP titration.

Conclusion:

This case suggests that specific REM related OSA could be the main reason for dreaminess symptoms and could be successfully treated by CPAP. The identification of OSA, especially for mild-moderate OSA, has not received enough attention in the management of complaints of dissatisfactory sleep issues. We believe this case has educational value in clinical practice.
Impact of mobile phone text messaging intervention on adherence among patients with diabetes in a rural setting
Authors: Owolabi Eyitayo Omolara , Goon Daniel Ter , Ajayi Anthony Idowu
Published: March 2020

Background:

Nonadherence to prescribed therapy is a significant challenge at the primary healthcare level of South Africa. There are documented evidence of the potential impact of mobile health technology in improving adherence and compliance to treatment. This study assessed the effect of unidirectional text messaging on adherence to dietary and activity regimens among adults living with diabetes in a rural setting of Eastern Cape, South Africa.

Methods:

This was a 2-arm, multicenter, parallel, randomized controlled trial, involving a total of 216 patients with diabetes with uncontrolled glycemic status randomly assigned into the intervention (n = 108) and the control group (n = 108). Participants in the intervention arm received daily educational text messages on diabetes and reminders for 6 months, while the control arm continued with standard care only. A validated, self-developed adherence scale was used to assess participants’ adherence to diets and physical activity. Descriptive statistics and linear regression were used to assess changes in adherence and the effect of the intervention on adherence to therapy.

Results:

On a scale of 8, the mean medication adherence level for the intervention group was 6.90 (SD ± 1.34) while that of the control group was 6.87 (SD ± 1.32) with no statistical difference (P = .88). The adjusted mean change in the medication adherence level was 0.02 (−0.33 to 0.43) with no significant difference (P = .79). There was however a low level of adherence to dietary recommendations (1.52 ± 1.62), and physical activity (1.48 ± 1.58) at baseline, and both groups demonstrated a nonsignificant increase in dietary (P = .98) and physical activity adherence (P = .99) from baseline to the follow-up period.

Conclusion:

There is a moderate level of adherence to medication and a low level of adherence to dietary and physical activity recommendation in this setting. The text messaging intervention did not bring about any significant improvement in medication, dietary and physical activity adherence levels. There is a need to design effective strategies for improving adherence to recommended lifestyle changes in this setting.
Clinical effects of Shou-Wu Jiang-Qi Decoction combined acupuncture on the treatment of Polycystic Ovarian Syndrome with kidney deficiency, phlegm and blood stasisness
Authors: Xu Wenting , Tang Mengyu , Wang Jiahui , Wang Lihong
Published: March 2020

Background:

Polycystic ovary syndrome (PCOS) is a female endocrine disease with a high incidence. At present, drug treatment is still the main therapeutic strategy for PCOS. Traditional Chinese medicine has a long history in the treatment of menstrual disorders. Shouwu Jiangqi Decoction (SWJQD) is a traditional herbal medicine prescribed in a clinical setting as a remedy for PCOS. Acupuncture also plays an important role in regulating the menstrual cycle and treating PCOS. This study aims to examine the efficacy and safety of the combination of SWJQD and acupuncture in the treatment of PCOS.

Methods:

This randomized controlled trial will be conducted with a total of 81 participants diagnosed with PCOS. The participants will be randomly divided into 3 treatment groups: group A will receive SWJQD combined with acupuncture; group B, SWJQD combined with sham acupuncture; and group C, metformin. Each treatment will last 3 months. The primary outcomes include the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index and the Oral Glucose Tolerance Test. The secondary outcome measures include sex hormone levels, body mass index, ovulation rate, clinical pregnancy rate, and complete genome sequencing data. Adverse events will be recorded during the intervention and follow-up.

Results:

This study will investigate whether the combination of SWJQD and acupuncture can alleviate the clinical symptoms and improve insulin resistance in patients with PCOS. The results of this study are expected to provide clinical evidence for the application of the combination of SWJQD and acupuncture in patients with PCOS.

Trial registration:

Chinese Clinical Trial Registry: ChiCTR1900028106, ChiMCT1900002826 (registered on December 12, 2019).
Physical Exercise following bariatric surgery in women with Morbid obesity
Authors: Soriano-Maldonado Alberto , Martínez-Forte Sonia , Ferrer-Márquez Manuel , Martínez-Rosales Elena , Hernández-Martínez Alba , Carretero-Ruiz Alejandro , Villa-González Emilio , Barranco-Ruiz Yaira , Rodríguez-Pérez Manuel A. , Torrente-Sánchez María José , Carmona-Rodríguez Lorena , Soriano-Maldonado Pablo , Vargas-Hitos José A. , Casimiro-Andújar Antonio J. , Artero Enrique G. , Fernández-Alonso Ana M.
Published: March 2020

Background:

Severe and morbid obesity are increasing globally, particularly in women. As BMI increases, the likelihood of anovulation is higher. The primary aim of the EMOVAR clinical trial is to examine, over the short (16 weeks) and medium (12 months) term, the effects of a supervised physical exercise program (focused primarily on aerobic and resistance training) on ovarian function in women with severe/morbid obesity who have undergone bariatric surgery. Secondary objectives are to examine the effects of the intervention on chronic inflammation, insulin resistance, arterial stiffness, physical fitness, and health-related quality of life.

Methods:

This is a randomized controlled trial in which ∼40 female bariatric surgery patients, aged between 18 and 45 years old, will be included. Participants assigned to the experimental group will perform a total of 48 sessions of supervised concurrent (strength and aerobic) training (3 sessions/week, 60 min/session) spread over 16 weeks. Patients assigned to the control group will receive lifestyle recommendations. Outcomes will be assessed at baseline, week 16 (i.e., after the exercise intervention) and 12 months after surgery. The primary outcome is ovarian function using the Sex-Hormone Binding Globuline, measured in serum. Secondary outcomes are serum levels of anti-mullerian hormone, TSH, T4, FSH, LH, estradiol, prolactine, and free androgen index, as well as oocyte count, the diameters of both ovaries, endometrial thickness, and uterine arterial pulsatility index (obtained from a transvaginal ultrasound), the duration of menstrual bleeding and menstrual cycle duration (obtained by personal interview) and hirsutism (Ferriman Gallwey Scale). Other secondary outcomes include serum markers of chronic inflammation and insulin resistance (i.e., C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin, glomerular sedimentation rate, glucose, insulin and the HOMA-IR), arterial stiffness, systolic, diastolic and mean blood pressure, body composition, and total weight loss. Physical fitness (including cardiorespiratory fitness, muscular strength, and flexibility), health-related quality of life (SF-36 v2) and sexual function (Female Sexual Function Index) will also be measured.

Discussion:

This study will provide, for the first time, relevant information on the effects of exercise training on ovarian function and underlying mechanisms in severe/morbid obese women following bariatric surgery.

Trial registration number:

ISRCTN registry (ISRCTN27697878).
Sex-specific association of hyperuricemia with cardiometabolic abnormalities in a military cohort
Authors: Lin Yu-Kai , Lin Yen-Po , Lee Jiunn-Tay , Lin Chin-Sheng , Wu Tsung-Jui , Tsai Kun-Zhe , Su Fang-Ying , Kwon Younghoon , Hoshide Satoshi , Lin Gen-Min
Published: March 2020

Hyperuricemia has been associated with metabolic syndrome, and the association with various cardiometabolic risk factors may be affected by sex.

We made a cross-sectional examination in a military cohort of 6738 men and 766 women, aged 18 to 50 years of Taiwan in 2013 to 2014. Hyperuricemia were defined as serum uric acid levels ≥7.0 mg/dL for men and ≥5.7 mg/dL for women, respectively. Multivariable logistic regression analyses were used to determine the associations between hyperuricemia and various metabolic abnormalities.

In the overall population, hyperuricemia was associated with high blood pressure (odds ratio [OR]: 1.59, and 95% confidence intervals: 1.42–1.77), low high-density lipoprotein (OR: 1.75, 1.56–1.97), high triglycerides (OR: 2.14, 1.90–2.42), high low-density lipoprotein (OR: 1.71, 1.51–1.93), high fasting plasma glucose (OR: 1.29, 1.13–1.48), and central obesity (OR: 2.85, 2.55–3.18) after adjusting for age and serum creatinine concentrations. However, the associations with atherogenic lipid profiles including high triglycerides and high low-density lipoprotein were merely significant in men but not in women. In addition, there was a tendency for a sex difference in the association of hyperuricemia and raised blood pressure ≥130/85 mm Hg, which was greater in women than that in men (OR: 2.92, 1.37–6.25 and 1.54, 1.37–1.72, respectively; P for interaction = .059).

Our findings suggest that the association between hyperuricemia and various cardiometabolic abnormalities in young adults may differ by sex, possibly due to a regulation of sex hormones and uneven effects of uric acid at the same levels between sexes on lipid metabolisms and arterial stiffness.
Nationwide cohort study of outcomes of acute myocardial infarction in patients with liver cirrhosis
Authors: Wu Victor Chien-Chia , Chen Shao-Wei , Chou An-Hsun , Wu Michael , Ting Pei-Chi , Chang Shang-Hung , Wang Chao-Yung , Lin Ming-Shyan , Hung Kuo-Chun , Hsieh I-Chang , Chu Pao-Hsien , Wu Cheng-Shyong , Lin Yu-Sheng
Published: March 2020

Liver cirrhotic predisposes patients to coagulopathy and bleeding. Little is known about outcomes of acute myocardial infarction (AMI) in cirrhotic patients.

Data from Taiwan National Health Insurance Research Database during 2001 to 2013 were retrieved for patients admitted with cirrhosis and AMI. We excluded patients with missing information, <20 years old, previous AMI, previous coronary intervention, and liver transplant. Patients were separated into cirrhotic and non-cirrhotic. Primary outcomes included all-cause mortality, recurrent myocardial infarction (MI), major cardiac and cerebrovascular events (MACCE: recurrent MI, revascularization, ischemic stroke, and heart failure), and liver outcomes (hepatic encephalopathy, ascites tapping, spontaneous peritonitis, and esophageal varices bleeding).

A total of 3217 cirrhotic patients and 6434 non-cirrhotic patients were analyzed, with a mean follow up of 2.8 ± 3.3 years. In cirrhotic patients with AMI, subsequent coronary and cerebrovascular events were lower in comparison to non-cirrhotic patients, with higher all-cause mortality observed from adverse liver related outcomes and bleeding. There were significantly lower cumulative incidence of both recurrent MI and MACCE in cirrhotic patients with AMI compared with non-cirrhotic patients with AMI (hazard ratio [HR] 0.82, confidence interval [CI] 0.71–0.94, P = .006 and HR 0.86, 95% CI 0.79–0.92, P < .001, respectively). There was significantly higher cumulative incidence of liver related outcome in cirrhotic patients with AMI compared with non-cirrhotic patients with AMI (HR 2.27, 95% CI 2.06–2.51, P < .001). And there was significantly higher all-cause mortality in cirrhotic patients with AMI compared with non-cirrhotic patients with AMI (HR 1.30, 95% CI 1.23–1.38, P < .001).

In cirrhotic cohort with AMI, a decreased in coronary and cerebrovascular events were observed. However, these patients also had higher all-cause mortality due to adverse liver outcomes and bleeding.
Modified tension band wiring of patellar fracture as a technique to minimize postoperative complications
Authors: Yu Tiecheng , Wu Zhendong , Mohamed Sayid Omar , Ju Weina , Liu Xiuxin , Qi Baochang
Published: March 2020

Rationale:

Tension band wiring is the most widely accepted technique for the treatment of patellar fractures but the technique is associated with common complications like wire migration, prominence, and breakage. To reduce these complications, we developed and propose a modified technique that has a superior biomechanical strength and a potential to reduce such postoperative complications.

Patient concerns:

The patient presented with pain and mild swelling in his left knee after he slipped on the floor and fell on his left knee. He has no significant past medical or surgical history. The patient took the tension band wiring as the first choice because of the wide acceptance. But he worried about the complications.

Diagnoses:

X-ray showed a transverse fracture of the left patella with an inferior pole occult fracture.

Interventions:

The patient was operated with a modified technique of the classic tension band wiring for patellar fractures. In our 4-step procedure, double tension cerclage wires were wrapped under the exposed ends of the Kirschner wires (K-wires) and the tendons in figure-of-8 fashion. The aim was to increase the biomechanical strength so that when one of the tension wires fail, the other one can hold the fragments together.

Outcomes:

The patient recovered very well and without any complications. The patient was followed-up for 1 year and the fracture has united very well, with satisfying knee range of motion.

Lessons:

From this case study, we can detect the biomechanical advantages of our technique which can increase the stability of the fracture and that allows early functional exercise and additionally the micromotion at the fracture site has a beneficial effect of fracture union. Based on the perfect outcomes, our technique is worthy of clinical application.
Inhaled Nitric Oxide Use in Pediatric Hypoxemic Respiratory Failure*
Authors: Berger John T. , Maddux Aline B. , Reeder Ron W. , Banks Russell , Mourani Peter M. , Berg Robert A. , Carcillo Joseph A. , Carpenter Todd , Hall Mark W. , Meert Kathleen L. , McQuillen Patrick S. , Pollack Murray M. , Sapru Anil , Yates Andrew R. , Notterman Daniel A. , Holubkov Richard , Dean J. Michael , Wessel David L.
Published: March 2020

Objectives:

To characterize contemporary use of inhaled nitric oxide in pediatric acute respiratory failure and to assess relationships between clinical variables and outcomes. We sought to study the relationship of inhaled nitric oxide response to patient characteristics including right ventricular dysfunction and clinician responsiveness to improved oxygenation. We hypothesize that prompt clinician responsiveness to minimize hyperoxia would be associated with improved outcomes.

Design:

An observational cohort study.

Setting:

Eight sites of the Collaborative Pediatric Critical Care Research Network.

Patients:

One hundred fifty-one patients who received inhaled nitric oxide for a primary respiratory indication.

Measurements and Main Results:

Clinical data were abstracted from the medical record beginning at inhaled nitric oxide initiation and continuing until the earliest of 28 days, ICU discharge, or death. Ventilator-free days, oxygenation index, and Functional Status Scale were calculated. Echocardiographic reports were abstracted assessing for pulmonary hypertension, right ventricular dysfunction, and other cardiovascular parameters. Clinician responsiveness to improved oxygenation was determined. One hundred thirty patients (86%) who received inhaled nitric oxide had improved oxygenation by 24 hours. PICU mortality was 29.8%, while a new morbidity was identified in 19.8% of survivors. Among patients who had echocardiograms, 27.9% had evidence of pulmonary hypertension, 23.1% had right ventricular systolic dysfunction, and 22.1% had an atrial communication. Moderate or severe right ventricular dysfunction was associated with higher mortality. Clinicians responded to an improvement in oxygenation by decreasing Fio
2 to less than 0.6 within 24 hours in 71% of patients. Timely clinician responsiveness to improved oxygenation with inhaled nitric oxide was associated with more ventilator-free days but not less cardiac arrests, mortality, or additional morbidity.

Conclusions:

Clinician responsiveness to improved oxygenation was associated with less ventilator days. Algorithms to standardize ventilator management may improve signal to noise ratios in future trials enabling better assessment of the effect of inhaled nitric oxide on patient outcomes. Additionally, confining studies to more selective patient populations such as those with right ventricular dysfunction may be required.
Factors Behind Decline of Venovenous Extracorporeal Membrane Oxygenation to Support Neonatal Respiratory Failure
Authors: Lillie Jon , Boot Liz , Speggiorin Simone , Nyman Andrew G.
Published: March 2020

Objectives:

Neonates with respiratory failure are ideally supported with venovenous rather than venoarterial extracorporeal membrane oxygenation due to the reduced rate of neurologic complications. However, the proportion of neonates supported with venovenous extracorporeal membrane oxygenation is declining. We aimed to explore the factors behind this decline.

Design:

We conducted a survey in order to understand current practice across the United Kingdom, exploring barriers to neonatal venovenous extracorporeal membrane oxygenation in addition to collecting U.K.-wide retrospective data from 2000 onwards.

Patients:

Neonates with respiratory failure supported with extracorporeal membrane oxygenation in the United Kingdom.

Setting:

All 11 pediatric U.K. extracorporeal membrane oxygenation centers provided data.

Interventions:

None.

Measurements and Main Results:

The percentage of neonates with respiratory failure supported with venovenous extracorporeal membrane oxygenation has declined from 58% to 16% over the last decade, reflected internationally with a decrease of 1.3% per year. Nine extracorporeal membrane oxygenation centers are able to offer pediatric venovenous extracorporeal membrane oxygenation, but only four offer neonatal venovenous extracorporeal membrane oxygenation. Of those able to provide neonatal venovenous extracorporeal membrane oxygenation, three centers use dual lumen cannulae and one uses neonatal multisite cannulation. The most frequently cited barriers to neonatal venovenous extracorporeal membrane oxygenation were the lack of availability of a suitable dual lumen cannula with concerns of cardiac perforation and challenges of multisite cannulation due to small caliber femoral veins.

Conclusions:

The majority of U.K. centers are unable to provide venovenous extracorporeal membrane oxygenation for neonates due to concerns with availability and suitability of dual lumen cannulae. An alternative to be considered is the use of multisite cannulation, which has been used historically and is currently being used in centers internationally and in the United Kingdom.
Bilateral Pulmonary Embolism With Right Heart Strain in a Patient With Immune Thrombocytopenia—A Case Report and Review of the Literature
Authors: Hui Channing , Brodsky Richard Aaron , Haines Christopher
Published: March 2020

Objectives

Patients with immune thrombocytopenia are at risk of both bleeding complications and venous thromboembolism. There is no standard to treating life-threatening pulmonary embolism in this population. This case illustrates the difficulty of treating significant thromboembolism in pediatric patients who have reduced clotting capacity.

Case

This case focuses on a 16-year-old pediatric patient with a history of immune thrombocytopenia presenting with mild chest discomfort and dyspnea on exertion. The d-dimer was mildly elevated, and the subsequent computed tomography angiogram revealed bilateral pulmonary embolisms with right ventricular strain.

Conclusions

The patient underwent thromboembolectomy by interventional radiology with subsequent administration of intravenous immunoglobulin, high-dose steroids, and enoxaparin therapy. There is no standard of care for patients with life-threatening pulmonary embolism in this population. Several authors suggest medical therapy options, but do not include patients with potential hemodynamic instability.
Functional Outcome after Reconstruction of a Long Nerve Gap in Rabbits Using Optimized Decellularized Nerve Allografts
Authors: Bulstra Liselotte F. , Hundepool Caroline A. , Friedrich Patricia F. , Bishop Allen T. , Hovius Steven E. R. , Shin Alexander Y.
Published: March 2020

Background:

Processed nerve allografts are a promising alternative to nerve autografts, providing an unlimited, readily available supply and avoiding donor-site morbidity and the need for immunosuppression. Currently, clinically available nerve allografts do not provide satisfactory results for motor reconstruction. This study evaluated motor recovery after reconstruction of a long nerve gap using a processed nerve allograft and the influence of storage techniques.

Methods:

Nerve allografts were decellularized using elastase and detergents and stored at either 4° or −80°C. In 36 New Zealand White rabbits, a 3-cm peroneal nerve gap was repaired with either an autograft (group 1, control) or a cold-stored (group 2) or frozen-stored (group 3) processed nerve allograft. Nerve recovery was evaluated using longitudinal ultrasound measurements, electrophysiology (compound muscle action potentials), isometric tetanic force, wet muscle weight, and histomorphometry after 24 weeks.

Results:

Longitudinal ultrasound measurements showed that the cold-stored allograft provided earlier regeneration than the frozen-stored allograft. Furthermore, ultrasound showed significantly inferior recovery in group 3 than in both other groups (p < 0.05). Muscle weight and isometric tetanic force showed similar outcomes in the autograft and cold-stored allograft groups [p = 0.096 (muscle weight) and p = 0.286 (isometric tetanic force)], and confirmed the inferiority of the frozen-stored allograft to the autograft [p < 0.01 (muscle weight) and p = 0.02 (isometric tetanic force)].

Conclusions:

Frozen storage of the nerve allograft significantly impairs functional recovery and should be avoided. The cold-stored optimized nerve allograft yields functional recovery similar to the gold standard autograft in the reconstruction of a 3-cm motor nerve defect. Future studies should focus on further improvement of the nerve allograft.
The Wrist and Radius Injury Surgical Trial: 12-Month Outcomes from a Multicenter International Randomized Clinical Trial
Authors: Chung Kevin C. , Kim H. Myra , Malay Sunitha , Shauver Melissa J.
Published: March 2020

Background:

Optimal treatment for distal radius fractures in older adults remains uncertain. No randomized trials comparing the most frequently used treatments in this population have been conducted. Surgical treatment rates vary widely, and the sustained benefits of surgery are uncertain.

Methods:

The Wrist and Radius Injury Surgical Trial, a randomized, multicenter trial, enrolled 304 adults aged 60 years and older with isolated, unstable distal radius fractures at 24 institutions. Patients who wanted surgery (n = 187) were randomized to internal fixation, external fixation, or percutaneous pinning; patients who preferred conservative management (n = 117) received casting. The primary outcome was the 12-month Michigan Hand Outcomes Questionnaire (MHQ) summary score.

Results:

At 12 months, there were no differences by treatment in primary outcome. Twelve-month MHQ summary scores differed between internal fixation and external fixation by 3 points (97.5 percent CI, 6.0 to 11.5) and between internal fixation and pinning by −0.14 (97.5 percent CI, −9.2 to 8.9). However, at 6 weeks, the mean MHQ summary score for internal fixation was greater than for external fixation by 19 (p < 0.001), pinning by 11 (p < 0.001), and casting by 7 (p = 0.03). Internal fixation participants demonstrated significantly better radiologic alignment throughout the follow-up period. Malunion was experienced by 48 percent of casting participants.

Conclusions:

Recovery was fastest for internal fixation and slowest for external fixation according to most measures, but by 12 months there were no meaningful differences in outcomes. Casting participants experienced satisfactory results despite loss of radiologic alignment.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Putting the Patient in Patient Safety Investigations: Barriers and Strategies for Involvement
Authors: Busch Isolde Martina , Saxena Ankita , Wu Albert W.
Published: March 2020

Objectives

In an adverse event investigation, the patients have the potential to add a unique perspective because they can identify contributing factors that providers may miss. However, patients are rarely included in patient safety investigations. We aimed to identify the barriers to patient involvement in patient safety investigations and propose strategies to overcome them.

Methods

We reviewed literature on active participation by patients in safety investigations to construct a framework for healthcare institutions to use in approaching patients about a potential role in investigating an error in their care. We searched 3 electronic databases (PubMed, PSNet, Web of Science) for the years 1990 to 2018, without restrictions to language. Search terms included: “patient empowerment, “patient involvement,” “patient participation,” “patient safety investigation,” “root cause analysis,” “error analysis.” We also examined reference lists of relevant studies to identify additional articles.

Results

Our electronic search produced 10,624 records with 30 potentially eligible articles. However, we identified only 6 relevant published articles. We used these as the basis for a proposed framework that is predicated on the thoughtful disclosure of adverse events and has 3 main levels (i.e., patient, clinician, and institutional level). For each level, we identify barriers to patient participation and potential strategies to overcome them.

Conclusions

The proposed framework can be used as a starting point to promote patient involvement in error investigations. Involving patients in patient safety investigations could increase patient centeredness, patient autonomy, and transparency and make analyses more effective by adding unique and potentially actionable information.
Growth in Proportion and Disparities of HIV PrEP Use Among Key Populations Identified in the United States National Goals: Systematic Review and Meta-analysis of Published Surveys
Authors: Kamitani Emiko , Johnson Wayne D. , Wichser Megan E. , Adegbite Adebukola H. , Mullins Mary M. , Sipe Theresa Ann
Published: March 2020

Background:

Pre-exposure prophylaxis (PrEP) use among populations most vulnerable to HIV as identified in the national HIV prevention goals is not fully known. This systematic review assessed trends of lifetime self-reported PrEP use and disparities among key populations.

Methods:

We used the CDC HIV/AIDS Prevention Research Synthesis cumulative database of electronic and manual searches in MEDLINE, CINAHL, EMBASE, and PsycINFO from 2000 to 2019 to identify English-language primary studies reporting PrEP use. Two reviewers independently screened citations, extracted data, and assessed the risk of bias with the modified Newcastle–Ottawa Scale. We estimated pooled proportions and crude/adjusted odds ratio.

Results:

We identified 95 eligible studies including 95,854 US-based survey respondents. A few studies (6.3%) focused on persons who inject drugs. In 2015–2017, men who have sex with men (MSM) had highest proportion of individuals who used PrEP over their lifetime [13.9% (95% confidence interval: 8.8 to 21.1), k (number of surveys) = 49] followed by Hispanic/Latinos [11.5 (7.1 to 18.1), 12], transgender women [11.2 (5.8 to 20.6), 5], and blacks [9.9 (8.3 to 11.8), 18]. Odds of PrEP use increased by 34%/year [odds ratio = 1.34/year (95% confidence interval: 1.09 to 1.64)] and significantly increased over time among MSM [1.53/year (1.21–1.93)] and blacks [1.44 (1.13–1.83)]. People in the Southern United States [9.9 (4.7–19.7), 8] and youth [7.3 (4.7–11.2), 8] had lower rates and did not demonstrate growth [0.94 (0.29–3.18); 0.82 (0.43–1.55)]. Odds of reporting lifetime PrEP use was twice [2.07 (1.27–3.38)] as great among MSM than non-MSM.

Conclusions:

Proportions of PrEP use in published surveys have been growing, but remain low for people in the Southern United States and youth, and understudied in persons who inject drugs. Limitations include few studies in certain years, whereas strengths include a large number of respondents. Culturally tailored approaches targeting vulnerable populations are essential in increasing PrEP use to reduce disparities in HIV acquisition.
Recombinant Human Growth Hormone Ameliorates Cognitive Impairment in Stroke Patients
Authors: Feng Xuewen , Li Guanwu , Wu Weilin , Xu Yongming , Lin Haiyang , Fan Jingzheng
Published: March 2020

Objective

We aimed to determine the effects of recombinant human growth hormone (rhGH) replacement on cognitive function in subjects with poststroke cognitive impairment using resting-state functional magnetic resonance imaging.

Methods

We included 60 patients with a first-ever stroke for 3 months and a diagnosis of cognitive impairment who were randomized 1:1 to receive either rhGH subcutaneously or placebo injection for 6 months. All subjects were required to receive the same rehabilitative therapy program. Both groups were subjected to pretreatment and posttreatment neuropsychological assessment using the Montreal Cognitive Assessment, serum neurotrophic factors, biomarkers of glucose and lipid metabolism, and functional magnetic resonance imaging during 6 months of the study period. The pattern of brain activity was determined by examining the functional connectivity and amplitude of low-frequency fluctuations (ALFF) of blood oxygen level dependent signal.

Results

Forty-three (82.7%) completed the study. Treatment with rhGH reduced levels of triglycerides and low-density lipoprotein cholesterol but did not significantly altered plasma concentrations of glucose and glycated hemoglobin. We found a significant increase in serum insulin-like growth factor 1 levels (32.6%; P < 0.001) in the rhGH-treated group compared with that in the controls. After 6 months of rhGH treatment, mean Montreal Cognitive Assessment score improved from 16.31 (5.32) to 21.19 (6.54) (P < 0.001). The rhGH group showed significant increased area of activation with increased ALFF values in the regions of the frontal lobe, putamen, temporal lobe, and thalamus (P < 0.05), relative to the baseline conditions. The correlation analysis revealed that the ALFF and functional connectivity of default mode network was positively correlated with the ΔMoCA score and ΔIGF-1 levels; that is, the more the scale score increased, the higher the functional connection strength. No undesirable adverse effects were observed.

Conclusions

The rhGH replacement has a significant impact on global and domain cognitive functions in poststroke cognitive impairment.
Individual Optimization of Contrast Media Injection Protocol at Hepatic Dynamic Computed Tomography Using Patient-Specific Contrast Enhancement Optimizer
Authors: Matsumoto Yoriaki , Higaki Toru , Arataki Keiko , Masuda Takanori , Sato Tomoyasu , Fukumoto Wataru , Nakamura Yuko , Tatsugami Fuminari , Awai Kazuo
Published: March 2020

Objective

We developed a patient-specific contrast enhancement optimizer (p-COP) that can exploratorily calculate the contrast injection protocol required to obtain optimal enhancement at target organs using a computer simulator. Appropriate contrast media dose calculated by the p-COP may minimize interpatient enhancement variability. Our study sought to investigate the clinical utility of p-COP in hepatic dynamic computed tomography (CT).

Methods

One hundred thirty patients (74 men, 56 women; median age, 65 years) undergoing hepatic dynamic CT were randomly assigned to 1 of 2 contrast media injection protocols using a random number table. Group A (n = 65) was injected with a p-COP-determined iodine dose (developed by Higaki and Awai, Hiroshima University, Japan). In group B (n = 65), a standard protocol was used. The variability of measured CT number (SD) between the 2 groups of aortic and hepatic enhancement was compared using the F test. In the equivalence test, the equivalence margins for aortic and hepatic enhancement were set at 50 and 10 Hounsfield units (HU), respectively. The rate of patients with an acceptable aortic enhancement (250–350 HU) for the diagnosis of hypervascular liver tumors was compared using the χ
2 test.

Results

The mean ± SD values of aortic and hepatic enhancement were 311.0 ± 39.9 versus 318.7 ± 56.5 and 59.0 ± 11.5 versus 58.6 ± 11.8 HU in groups A and B, respectively. Although the SD for aortic enhancement was significantly lower in group A (P = 0.006), the SD for hepatic enhancement was not significantly different (P = 0.871). The 95% confidence interval for the difference in aortic and hepatic enhancement between the 2 groups was within the range of the equivalence margins. The number of patients with acceptable aortic enhancement was significantly greater in group A than in group B (P < 0.01).

Conclusions

The p-COP software reduced interpatient variability in aortic enhancement and obtained acceptable aortic enhancement at a significantly higher rate compared with the standard injection protocol for hepatic dynamic CT.
Diagnostic Role of 18F-Fluorodeoxyglucose Positron Emission Tomography for the Evaluation of Patients With Inflammation of Unknown Origin
Authors: Bilici Salman Reyhan , Gülbahar Ateş Seda , Satiş Hasan , Tufan Abdurrahman , Akdemir Ümit Özgür , Yapar Dilek , Ataş Nuh , Güler Aslihan Avanoglu , Karadeniz Hazan , Babaoglu Hakan , Aydos Uğuray , Göker Berna , Haznedaroğlu Şeminur , Atay Lütfiye Özlem , Öztürk Mehmet Akif
Published: March 2020

Background

Sometimes, the underlying causes of inflammation cannot be established despite meticulous investigation, including medical history, physical examination, laboratory tests, and radiologic procedures. Rheumatologists are often faced with patients whose condition is known as inflammation of unknown origin (IUO). Differential diagnosis of IUO is diverse, and investigation of these cases is challenging and time-consuming.

Objective

The study aimed to assess the diagnostic role of positron emission tomography/computed tomography (PET/CT) in the evaluation of patients with IUO.

Methods

The study sample consisted of 97 adult patients with IUO who have not been previously diagnosed with an infectious, inflammatory, or malignant disease. The necessary data were collected from January 2015 to June 2018 with a 6-month follow-up period. The patients were screened using PET/CT after a specific diagnosis could not be established with detailed laboratory and radiologic evaluations.

Results

A final diagnosis was established at follow-up, and 47 (54%) of the 97 patients had inflammatory diseases, 30 (34.4%) had malignancies, and 10 (11.4%) had infections. Despite meticulous investigation, 10 patients were left undiagnosed in the follow-up. PET/CT aided diagnosis in 59 patients (60.8%), but it was not helpful in 38 patients (39.2%). PET/CT was positive in 30 (63%) of the 47 patients with inflammatory diseases, whose final diagnosis was inflammatory rheumatic disease, as follows: large-vessel vasculitis in 19 patients, polymyalgia rheumatica in 7 patients, and seronegative arthritis or other rare miscellaneous diseases in 4 patients. The sensitivity of PET/CT was 67% with a specificity and diagnostic accuracy of 100% and 71%, respectively.

Conclusions

Investigation of the underlying etiology of IUO is time-consuming and challenging. PET/CT may help identify the final diagnosis more quickly by locating an obscure inflammatory site; thus, it may reduce the number of unnecessary biopsies, diagnostic time, anxiety, work loss, morbidity, and mortality.
Professional Development for Inexperienced Speakers: Making Effective Oral Presentations and Audience Connections
Authors: Pierce Linda L.
Published: March 2020

This article addresses how inexperienced speakers can prepare and deliver oral presentations that make connections to audiences. Nursing students/providers, university and staff development instructors, or managers may find these tips helpful. Successful content delivery (beginning, middle, and ending “remarks”) depends on setting the right tone, incorporating engaging activities, and concluding with recommendations for audiences. Exemplars are presented for each “remarks section” using a project focused on one nurse’s responses in a web-based caregivers’ support group.
The Accuracy of Maxillary Position Using a Computer-Aided Design/Computer-Aided Manufacturing Intermediate Splint Derived Via Surgical Simulation in Bimaxillary Orthognathic Surgery
Authors: Yamaguchi Yoshihiro , Yamauchi Kensuke , Suzuki Hikari , Saito Shizu , Nogami Shinnosuke , Takahashi Tetsu
Published: March 2020

Purpose:

The purpose of this study was to assess the clinical interventions and the accuracy of maxillary reposition using a computer-aided design/computer-aided manufacturing (CAD/CAM) splint derived via surgical simulation.

Materials and Methods:

The retrospective study comprised 24 patients who underwent bimaxillary surgery. The patients were assigned to 1 of 2 groups by a way of maxillary repositioning. One group received conventional intermediate wafers and the other CAD/CAM wafers during Le Fort I osteotomy. We recorded operation time, blood loss, the operative accuracy. Accuracy was analyzed by 3-dimensional computed tomography images before and immediately after the operation. The evaluation points were the right maxillary first incisor (U1), the right maxillary second molar (M2-right), and the left maxillary second molar (M2-left).

Results:

The 2 groups did not differ significantly in operation time and blood losses. The vertical axis of U1 data differed significantly between the 2 groups (P = 0.008). None of the horizontal, vertical, or anteroposterior axis of M2-right data differed significantly, and anteroposterior axis of M2-left data differed significantly (P = 0.0296). The CAD/CAM group 3-dimensional distance errors were less than those of the conventional group for all points.

Conclusion:

Placement of CAD/CAM splint allowed highly accurate repositioning; the accuracy exceeded that afforded by conventional model surgery using a facebow and articulator.
The Association of Liposomal Bupivacaine on Opioid Consumption in the Pediatric Alveolar Cleft Population
Authors: Crowley Jiwon Sarah , McLean Paige , Gabriel Rodney A. , Cronin Brendan , Hsieh Sun , Englar Kevin , Said Engy , Lance Samuel , Gosman Amanda
Published: March 2020

Surgical infiltration of liposomal bupivacaine in the adult population has been shown to decrease perioperative use of opioids, but there have been few studies conducted in the pediatric surgical population. The authors’ objective was to assess the effect of liposomal bupivacaine on opioid reduction in the pediatric alveolar cleft population. The authors hypothesized that the use of surgical site infiltration with liposomal bupivacaine would be associated with decreased post-operative opioid requirements following alveolar bone grafting.

The authors performed a retrospective cohort study at a tertiary craniofacial center. Forty-four pediatric patients undergoing alveolar bone grafting from November 2016 to December 2018 by the 2 craniofacial surgeons at Rady Children's Hospital were included in the study. Surgical site infiltration with liposomal bupivacaine was performed and the amount of oral morphine equivalents administered within the first 24 hours was measured.

Patients in the liposomal bupivacaine cohort required 12.0 mg OME less than those patients who received standard bupivacaine or 1% lidocaine. When controlling for age, sex, weight, laterality, and harvest technique, multivariable linear regression analysis demonstrated a difference of 15.7 mg OME in favor of the LB cohort (P = 0.0006).

The authors’ study revealed that intraoperative surgical site infiltration of liposomal bupivacaine was associated with decreased post-operative opioid requirements following alveolar bone grafting. It should be considered as an effective part of multimodal pain therapy in the pediatric surgical population.
Unusual Cause of Hypopituitarism: Sphenoid Mucocele
Authors: Gozgec Elif , Ogul Hayri
Published: March 2020

Paranasal sinus mucocele is cystic, expansile, benign masses that contain mucus surrounded by epithelium. It causes significant locally destruction of the sinus wall and present with various symptoms depending on the pressure on neighboring structures. Sphenoid sinus mucocele constitutes 1% to 2% of all paranasal sinus mucoceles. Headache is the most common symptom that leads to correct diagnosis. In addition, the close proximity of the sphenoid sinus to important structures such as the optic nerve, cavernous sinus and the pituitary gland causes various symptoms. Treatment is surgical drainage of mucocele to reduce pressure.
A Rare Neurologic Disease that Mimics Cranial Hydatid Cyst: Leukoencephalopathy, Cerebral Calcifications, and Cysts
Authors: Alper Fatih , Polat Gökhan , Koçak Mehmet Nuri , Kaya Zülküf , Aydin Mehmet Dumlu
Published: March 2020

A 33-year-old male patient was admitted to the clinic with seizures and progressive neurologic symptoms. In the family history of the patient, a first degree relative had a history of hydatid cyst surgery. Cranial computed tomography images showed intracranial cysts and calcifications. Thus, it was suspected that it might be hydatid cyst. However, the patient was diagnosed with leukoencephalopathy with intracranial calcifications and cysts, a rare neurologic entity by advanced radiologic imaging, serologic and pathologic evaluation.
Endoscopic Transoral Resection of Tongue Base Ancient Schwannoma
Authors: Yaslikaya Serhat , Kizilay Ahmet , Şamdanci Emine
Published: March 2020

Schwannoma is a benign slow growing nerve sheath tumor that is typically encapsulated and composed of well-differentiated schwann cells. Schwannomas may take origin from different nerves such as cranial, spinal nerves, and the sympathetic chain. Approximately 25% to 45% of all occur in the head and neck only 1% of them are located in the oral cavity. However, it is quite rare to for schwannomas to form on the tongue base. Ancient schwannoma is the rarest, and also extremely rare in oropharynx. A 32-year-old female patient was admitted to our clinic with complaints of hoarseness, difficulty in swallowing, throat pain, snoring, and dyspnea. In examination, a smooth surfaced circumscribed mass, which originated from the tongue base was observed. In the magnetic resonance imaging, a 4.5 × 3 cm sized tongue base mass which narrowed the upper airway was detected. An endoscopic transoral excisional biopsy was performed. The histopathological diagnosis was determined as ancient schwannoma. The use of the endoscopic transoral approach can be suitable to protect the important anatomical structures, functions, and reduce the complications and esthetic concerns for the resection of tongue base schwannomas.