bluuebunny/crossref_metadata_2025 huggingface dataset:
Revision Single-Stage Anterior Cruciate Ligament Reconstruction Using an Anterolateral Tibial Tunnel
Authors: Keyhani Sohrab , Hanafizadeh Behzad , Verdonk René , Sajjadi Mohammadreza Minator , Soleymanha Mehran
Published: February 2019

Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding enterprise. Management of widened or previously malpositioned tunnels is challenging and often requires innovative approaches. The purpose of this study was to evaluate the function and clinical results of revision single-stage ACL surgery using an anterolateral tibial tunnel (ALTT). A consecutive series of knees with arthroscopic ACL revision surgery were analyzed prospectively between April 2012 and September 2015. Among the 93 patients presented with revision ACL reconstruction, 25 patients met the study inclusion criteria for the ALTT technique and were followed up for a minimum of 2 years (range: 24–51 months). The clinical results were evaluated by means of the Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity level scale, and the knee stability was assessed by the Lachman test, pivot shift test, and anterior drawer test. Magnetic resonance imaging (MRI) of the index knee before the surgery and 2 years after revision surgery was assessed. The mean IKDC subjective score, mean Tegner activity level scale, and mean Lysholm score significantly improved in all study participants. This study showed that ACL revision surgery with ALTT can reliably restore stability and provide fair functional outcomes in patients with ACL retear. One could expect acceptable lateral tibial tunnel length compared with medial tibial tunnel in classic ACL revision, intact bony surround, and good graft fixation. This technique is clinically relevant in that making an anterolateral tunnel in one-stage ACL revision surgery had a good subjective result with low complication rate in midterm follow-up.
Gender Disparity between Donor Sites of the Trochlea Used for Autologous Osteoarticular Transfer: An MRI Analysis
Authors: Rogers Kelly M. , Berman Daniel C. , Griffin Justin W. , Bonner Kevin F.
Published: February 2019

The purpose of this study was to assess potential gender differences in size of the lateral and medial trochlea of the male and female knee as well as the variation within gender of potential osteochondral autograft transfer (OAT) donor site area. Two hundred and twelve skeletally mature patients, 106 males and 106 females, who underwent a 3T magnetic resonance imaging of the knee for a variety of indications were utilized for analysis. Exclusion criteria included degenerative arthritis, trochlear dysplasia, and poor image quality. Medial and lateral femoral trochlear cartilage width was obtained using a linear radiologic measurement tool. Widths were measured from a reproducible anatomic location representing the maximal trochlear dimension in a region where donor plugs are commonly harvested. Trochlear width was also plotted as a function of patient height. Statistical analysis was performed using a two-sample t-test. The mean and standard deviation of the lateral trochlear cartilage width (mm) for males and females were 23.38 +/− 2.14 and 20.44 +/− 2.16, respectively (p < 0.00001). The mean and standard deviation of the medial trochlear cartilage width (mm) for males and females were 14.16 +/− 2.17 and 11.78 +/− 2.03, respectively (p < 0.00001). The overall range in trochlear width for both the lateral and medial sides was 22.22 and 19.73 mm for males and females, respectively. A graft measuring 10 mm could represent as little as 34% of the lateral trochlea in males versus as much as 65% in females. Our results indicate that donor OAT plug diameter relative to available trochlear cartilage width will vary significantly both between genders and individual patients. Trochlear width variability and its potential implications on donor site morbidity may be an important consideration when contemplating osteochondral plug harvest for OAT or other indications. The level of evidence is IV.
Biomechanical Properties of Bioabsorbable Fixation for Osteochondral Shell Allografts
Authors: Thomas Dimitri M. , Stannard James P. , Pfeiffer Ferris M. , Cook James L.
Published: February 2019

This study compares bioabsorbable nail to metal screw fixation of shell osteochondral allograft (OCAs) for compression and shear strength. Cadaveric distal femurs (n = 5) yielding six 1.5 cm shell grafts (n = 30) were used. Three different fixation methods (2.0 and 2.4 mm headed screws, and copolymer absorbable nail) were compared for statistically significant differences (p < 0.05) in contact area, contact pressure, and shear load-to-failure. No significant differences in contact areas existed among groups (224 ± 33.5 mm2; 233.9 ± 20.8 mm2, 220.6 ± 22.7 mm2; p = 0.509 for 2.4, 2.0 mm screw, and nail, respectively). No significant differences in contact pressures existed (1.7 ± 0.6 MPa/mm2, 1.5 ± 0.8 MPa/mm2, 1.4 ± 0.9 MPa/mm2; p = 0.73 for 2.4, 2.0 mm screw, and nail, respectively). Load-to-failure for each was: 280.7 ± 48.4 N for 2.4 mm screws, 245.1 ± 70.6 N for 2.0 mm screws, and 215.2 ± 39.4 N for nails. There were no statistically significant differences in load-to-failure between 2.4 and 2.0 mm screws (p = 0.29) or between 2.0 mm screws and nails (p = 0.23); however, load-to-failure in shear was significantly higher for 2.4 mm screws compared with nails (p = 0.036). Fixation of shell OCAs using a copolymer headed nail provides initial graft-recipient compression similar to fixation using 2.0 and 2.4 mm headed screws. Nails failed in shear at significantly lower load than 2.4 mm screws but not 2.0 mm screws which have proven adequate for clinical healing. This study has clinical relevance, as a copolymer bioabsorbable headed nail (SmartNail) has graft-recipient compression and shear load-to-failure properties that suggest it is viable for shell OCA fixation.
Eptacog Alfa (Activated) Is Physically and Chemically Stable over 24 Hours when Administered as Bolus Injections in an Automated Infusion Pump
Authors: Rexen Per , Jensen Jane , Schwerin Nina , Kozina Elena
Published: February 2019

Introduction Eptacog alfa (activated) is a recombinant activated factor VII (rFVIIa) used for the treatment and prevention of bleeding episodes in patients with congenital hemophilia with inhibitors. Frequent dosing requirements make the use of an automated bolus infusion pump a promising alternative to manual administration.

Aims The objective of this in vitro study was to evaluate the physical and chemical stability of room temperature–stable rFVIIa at 25°C over 24 hours in an automated bolus infusion pump.

Methods An automated bolus infusion pump with preset bolus injection intervals of 2 to 6 hours was used. Samples of rFVIIa were analyzed for critical quality parameters, presence of leachables, and microbiological growth. The infusion system was evaluated visually.

Results rFVIIa is physically and chemically stable when used in an automated bolus infusion pump system for up to 24 hours at 25°C. All critical quality parameter results were within the shelf-life limits and complied with the acceptance criteria. Leachables were observed at concentrations within their respective acceptance criteria. No visual changes in the syringe or infusion tube were observed; inherent particles in the reconstituted rFVIIa similar in size and description to those previously found in rFVIIa were seen. No microbiological growth was detected.

Conclusions rFVIIa is stable in a bolus infusion pump system for up to 24 hours at 25°C. Bolus injection intervals of 2 to 6 hours can be used without physical or chemical changes to rFVIIa. This study supports the use of an automated bolus infusion pump in the hospital setting, across all indications for rFVIIa.
Liquid electromigration in gallium-based biphasic thin films
Authors: Michaud Hadrien O. , Lacour Stéphanie P.
Published: February 2019

Liquid metals have recently gained interest as a material of choice for soft and stretchable electronic circuits, thanks to their virtually infinite mechanical failure strain and high electrical conductivity. Gallium-based thin films are obtained by depositing gallium in the vapor phase to form a class of liquid metal conductors. The films, with an average thickness below 1 µm, withstand mechanical strain in excess of 400%. However, modes of failure other than mechanical ones have not yet been thoroughly investigated. In particular, electromigration, a well-known cause of failure in solid thin film traces for integrated circuits, also occurs in bulk liquid metals. In this work, microscopic observation of the thin conductive traces reveals that gallium is displaced from the anode terminal toward the cathode terminal after direct current stressing. This results in a catastrophic increase in the trace resistance and electrical failure. The mean time to failure decreases with increasing current density, following Black’s equation, an empirical mathematical model originally developed to describe failure in solid metal thin-film tracks due to electromigration. We show that using alternating current, e.g., symmetric square wave, rather than direct current can extend the lifetime of the thin liquid metal film conductor by several orders of magnitude. These results may help stretchable circuit designers who select liquid metal thin-film conductors as the stretchable interconnect technology to predict devices’ lifetime and implement mitigation strategies at the system level or at the material level.
Temperature dependence of the Seebeck coefficient of epitaxial β-Ga2O3 thin films
Authors: Boy Johannes , Handwerg Martin , Ahrling Robin , Mitdank Rüdiger , Wagner Günter , Galazka Zbigniew , Fischer Saskia F.
Published: February 2019

The temperature dependence of the Seebeck coefficient of homoepitaxial metal organic vapor phase grown, silicon doped β-Ga2O3 thin films was measured relative to aluminum. For room temperature, we found the relative Seebeck coefficient of Sβ-Ga2O3-Al=(−300±20) µV/K. At high bath temperatures T > 240 K, the scattering is determined by electron-phonon-interaction. At lower bath temperatures between T = 100 K and T = 300 K, an increase in the magnitude of the Seebeck coefficient is explained in the frame of Stratton’s formula. The influence of different scattering mechanisms on the magnitude of the Seebeck coefficient is discussed and compared with Hall measurement results.
Novelty and educational experience
Authors: Ingman Benjamin C.
Published: February 2019

Using the method of educational criticism and connoisseurship, I interviewed and observed 41 participants of adventure education (AE) programmes. Through these efforts, novelty was revealed as a central quality of the experience. In this work, this quality is characterised as it manifest in AE with an eye towards the educational value of novelty. The relationship of novelty to conceptions of educational experience is explored, and implications for schooling are offered.
Pulse-wave velocity and benign paroxysmal positional vertigo (BPPV)
Authors: Ruggeri Roberta , Brandolini Cristina , Del Vecchio Valeria , Pirodda Antonio
Published: February 2019

Background:

The aetiology of the BPPV is still uncertain. Some factors have been individualized that could explain partly the onset or the tendency to the recurrence, among which traumas, osteoporosis, viral infections and cardiovascular factors of risk. With particular reference to the influence that the cardiovascular factors of risk can practice on the genesis and persistence of the BPPV, it needs to keep in mind that, despite these introduces a role largely sustained in literature, it concerns considerations that hear again of very controversial interpretations however.

Purpose:

The objective of the study is to try to furnish a good definition of the existing relationship between the VPPB and the rigidity of the arterial tree, reliable expression of the conditions of the vascular circle and easily measurable with the appeal to recent technologies. Primary objective: the definition of possible differences of the profile of rigidity of the vascular system among subjects affections from BPPV and subjects without otologic diseases. Objective secondary: the definition of possible relationships between recidivist of BPPV and profile of vascular rigidity in a population of adults and elderly.

Results:

The results allow to affirm that an association exists among BPPV and increase of the arterial vascular rigidity, shown from the presence of more elevated values both of cfPWV (carotido-femoral Pulse Wave Velocity) that of differential arterial pressure or pulsatry pressure (PP) in the patients with BPPV in comparison to those measured in the healthy subjects of the same age. Moreover, an association exists between recurrence of the episodes of BPPV and increase of the arterial vascular rigidity in the patients of superior age to 60, shown by the presence of more elevated values of cfPWV in the patients with recurring BPPV in comparison to those measured in the subjects
A Scoping Review of Nonpharmacological Interventions to Reduce Disability in Older Adults
Authors: Wu Chao-Yi , Rodakowski Juleen L , Terhorst Lauren , Karp Jordan F , Fields Beth , Skidmore Elizabeth R
Published: February 2019

Background and Objectives

Minimizing disability is critical to reduce the costly health care associated with disability and maintain quality of life into old age. We examined the effect sizes of nonpharmacological intervention studies in reducing disability and explored the active ingredients of interventions.

Research Design and Methods

A scoping review was conducted via PubMed, PsycINFO, and CINAHL databases. Thirty-one randomized controlled trials were included. Eight active ingredients were identified by three experts (exercise, problem-solving, cognitive behavioral therapy, environmental modification, education, goal setting, comprehensive geriatric assessment, and cognitive training).

Results

The range of Cohen’s d was –0.85 to 1.76 across 31 studies (included 33 interventions); 67% studies (n = 22) obtained small-to-negative effect sizes (d = –0.85 to 0.18), accounting for 83% participants across studies. Interventions that incorporated exercise, problem-solving, cognitive behavior therapy, and environmental modification were associated with stronger effect sizes. Interventions that incorporated comprehensive geriatric assessment obtained small effect sizes.

Discussion and Implications

Majority of intervention studies found little or no effect in reducing disability for older adults. To optimize the effects of nonpharmacological interventions, we recommend researchers to (i) develop a screening tool for “risk of disability” to inform those who are early on the disability progression, yet not experience any difficulties in activities of daily living and instrumental activities of daily living; (ii) specify the active ingredients embedded in complex interventions to facilitate change in disability; and (iii) select sensitive tools to capture the progression of disability in late life.
Invasive Meningococcal Disease: What We Should Know, Before It Comes Back
Authors: Cabellos Carmen , Pelegrín Ivan , Benavent Eva , Gudiol Francesc , Tubau Fe , Garcia-Somoza Dolores , Verdaguer Ricard , Ariza Javier , Fernandez Viladrich Pedro
Published: February 2019

Background

Invasive meningococcal disease (IMD), sepsis and/or meningitis continues to be a public health problem, with mortality rates ranging from 5% to 16%. The aim of our study was to further knowledge about IMD with a large series of cases occurring over a long period of time, in a cohort with a high percentage of adult patients.

Methods

Observational cohort study of patients with IMD between 1977 hand 2013 at our hospital, comparing patients with only sepsis and those with meningitis and several degrees of sepsis. The impact of dexamethasone and prophylactic phenytoin was determined, and an analysis of cutaneous and neurological sequelae was performed.

Results

A total of 527 episodes of IMD were recorded, comprising 57 cases of sepsis (11%) and 470 of meningitis with or without sepsis (89%). The number of episodes of IMD decreased from 352 of 527 (67%) in the first to 20 of 527 (4%) in the last quarter (P < .001). Thirty-three patients died (6%): 8 with sepsis (14%) and 25 with meningitis (5%) (P = .02). Cutaneous and neurological sequelae were present in 3% and 5% of survivors of sepsis and meningitis, respectively. The use of dexamethasone was safe and resulted in less arthritis, and patients given prophylactic phenytoin avoided seizures.

Conclusions

The frequency of IMD has decreased sharply since 1977. Patients with sepsis only have the highest mortality and complication rates, dexamethasone use is safe and can prevent some arthritis episodes, and prophylactic phenytoin might be useful in a selected population. A rapid response and antibiotic therapy may help improve the prognosis.
First-in-Human Experience With Integration of a Hydrocephalus Shunt Device Within a Customized Cranial Implant
Authors: Gordon Chad R , Wolff Amir , Santiago Gabriel F , Liebman Kenneth , Veznedaroglu Erol , Vrionis Frank D , Huang Judy , Brem Henry , Luciano Mark
Published: February 2019

BACKGROUND

Implantable shunt devices are critical and life saving for hydrocephalus patients. However, these devices are fraught with high complication rates including scalp dehiscence, exposure, and extrusion. In fact, high shunt valve profiles are correlated with increased complications compared to those with lower profiles. As such, we sought a new method for integrating shunt valves for those challenging patients presenting with scalp-related complications.

OBJECTIVE

To safely implant and integrate a hydrocephalus shunt valve device within a customized cranial implant, in an effort to limit its high-profile nature as a main contributor to shunt failure and scalp breakdown, and at the same time, improve patient satisfaction by preventing contour deformity.

METHODS

A 64-yr-old male presented with an extruding hydrocephalus shunt valve and chronic, open scalp wound. The shunt valve was removed and temporary shunt externalization was performed. He received 2 wk of culture-directed antibiotics. Next, a contralateral craniectomy was performed allowing a new shunt valve system to be implanted within a low-profile, customized cranial implant. All efforts were made, at the patient's request, to decrease the high-profile nature of the shunt valve contributing to his most recent complication.

RESULTS

First-in-human implantation was performed without complication. Postoperative shunt identification and programming was uncomplicated. The high-profile nature of the shunt valve was decreased by 87%. At 10 mo, the patient has experienced no complications and is extremely satisfied with his appearance.

CONCLUSION

This first-in-human experience suggests that a high-profile hydrocephalus shunt device may be safely integrated within a customized cranial implant.
NSV 1440: first WZ Sge-type object in AM CVn stars and candidates
Authors: Isogai Keisuke , Kato Taichi , Monard Berto , Hambsch Franz-Josef , Myers Gordon , Starr Peter , Cook Lewis M , Nogami Daisaku
Published: February 2019

In 2015 and 2017, the AM CVn candidate NSV 1440 showed superoutbursts that had the characteristic features of WZ Sge-type dwarf novae (DNe). By analogy with hydrogen-rich cataclysmic variables (CVs), we can interpret these outbursts as “double superoutbursts” which are composed of a first superoutburst with early superhumps and a second superoutburst with ordinary superhumps. The object also showed multiple rebrightenings after the main superoutbursts. Early superhumps had never before been observed in AM CVn stars and candidates, thus NSV 1440 is the first confirmed WZ Sge-type AM CVn candidate. We obtained an early superhump period of 0.0252329(49) d and a growing (stage A) superhumps period of 0.025679(20) d from the 2015 superoutburst. We regarded the early superhump period as the orbital one. By using these periods we estimated the mass ratio q = 0.045(2). This value suggests that NSV 1440 is indeed an AM CVn star and that the secondary is a semi-degenerate star.
Outcomes and resource usage of infants born at ≤ 25 weeks gestation in Canada
Authors: Shafey Amy , Bashir Rani Ameena , Shah Prakesh , Synnes Anne , Yang Junmin , Kelly Edmond N ,   Canadian Neonatal Network and Canadian Neonatal Follow-Up Network Investigators, Shah Prakesh S , Harrison Adele , Synnes Anne , Ting Joseph , Yee Wendy , Aziz Khalid , Toye Jennifer , Fajardo Carlos , Kalapesi Zarin , Sankaran Koravangattu , Daspal Sibasis , Seshia Mary , Alvaro Ruben , Shivananda Sandesh , Da Silva Orlando , Nwaesei Chuks , Lee Kyong-Soon , Dunn Michael , Lemyre Brigitte , Dow Kimberly , Pelausa Ermelinda , Barrington Keith , Drolet Christine , Piedboeuf Bruno , Claveau Martine , Faucher Daniel , Bertelle Valerie , Masse Edith , Canning Roderick , Makary Hala , Ojah Cecil , Monterrosa Luis , Deshpandey Akhil , Afifi Jehier , Kajetanowicz Andrzej , Lee Shoo K , Pillay Thevanisha , Synnes Anne , Sauvé Reg , Hendson Leonora , Reichert Amber , Bodani Jaya , Sankaran Koravangattu , Moddemann Diane , Nwaesei Chuks , Daboval Thierry , Dow Kimberly , Lee David , Ly Linh , Kelly Edmond , el Helou Salhab , Church Paige , Pelausa Ermelinda , Riley Patricia , Levebrve Francine , Demers Charlotte , Bélanger Sylvie , Canning Roderick , Monterrosa Luis , Makary Hala , Vincer Michael , Murphy Phil
Published: February 2019

Objectives

To determine the outcomes and resource usage of infants born at ≤ 25 weeks gestational age (GA).

Methods

Retrospective study of infants born between April 2009 and September 2011 at ≤ 25 weeks’ GA in all neonatal intensive care units in Canada with follow-up in the neonatal follow-up clinics. Short-term morbidities, neurodevelopmental impairment, significant neurodevelopmental impairment, and resource utilization of infants born at ≤ 24 weeks were compared with neonates born at 25 weeks.

Results

Of 803 neonates discharged alive, 636 (80.4%) infants born at ≤ 25 weeks’ GA were assessed at 18 to 24 months. Caesarean delivery, lower birth weight, and less antenatal steroid exposure were more common in infants born ≤ 24 weeks as compared with 25 weeks. They had significantly higher incidences of ductus arteriosus ligation, severe intracranial hemorrhage, retinopathy of prematurity as well as longer length of stay, central line days, days on respiratory support, days on total parenteral nutrition, days on antibiotics, and need for postnatal steroids. Neurodevelopmental impairment rates were 68.9, 64.5, and 55.6% (P=0.01) and significant neurodevelopmental impairment rates were 39.3, 29.6, and 20.9% (P<0.01) for infants ≤ 23, 24, and 25 weeks GA, respectively. Postdischarge service referrals were higher for those ≤ 23 weeks. Nonsurviving infants born at 25 weeks GA had higher resource utilization during admission than infants born less than 25 weeks.

Conclusions

Adverse outcomes and resource usage were significantly higher among infants born ≤ 24 weeks GA as compared with 25 weeks GA.
State Responsibility and Differential Inclusion: Addressing Honor-Based Violence in the Netherlands and Germany
Authors: Yurdakul Gökçe , Korteweg Anna C
Published: February 2019

From 2004, the Dutch parliament developed a comprehensive response to honor-based violence, initially in consultation with immigrant and nonimmigrant political actors, while German politicians used honor-based violence to justify the restriction of immigrants from membership, portraying them as problematic subjects. More recently, the influence of immigrant actors on Dutch policy has waned, while in Germany policy continues to develop haphazardly with generally limited support for gendered violence services. Analyzing media and policy debates, we turn to the concepts of state responsibility and differential inclusion to show how actors engaged with these policies intersectionally produce national membership along gendered and racialized lines.
Menopausal Symptoms and Surgical Complications After Opportunistic Bilateral Salpingectomy, A Register-based Cohort Study
Authors: Collins Elin , Strandell Annika , Granåsen Gabriel , Idahl Annika
Published: February 2019

(Abstracted from Am J Obstet Gynecol 2019;220:85.e1–85.e10)

Recent studies have suggested that the fallopian tubes may play a critical role in the pathogenesis of various types of ovarian cancer. These findings have led to an increase in opportunistic salpingectomies when performing hysterectomy as a preventive measure for ovarian cancer.
Risks of Ovarian, Breast, and Corpus Uteri Cancer in Women Treated With Assisted Reproductive Technology in Great Britain, 1991–2010: Data Linkage Study Including 2.2 Million Person Years of Observation
Authors: Williams Carrie L. , Jones Michael E. , Swerdlow Anthony J. , Botting Beverley J. , Davies Melanie C. , Jacobs Ian , Bunch Kathryn J. , Murphy Michael F. G. , Sutcliffe Alastair G.
Published: February 2019

(Abstracted from BMJ 2018;362:k2644)

Assisted reproductive therapy such as exposure of women to supraphysiological levels of estradiol, exogenous gonadotropins, and multiple ovarian punctures are suspected to incur an increased risk of cancer. Studies investigating the carcinogenic effects of these exposures are largely inconsistent.
Cell-free Fetal DNA Analysis in Maternal Plasma as Screening Test for Trisomies 21, 18, and 13 in Twin Pregnancy
Authors: Le Conte G. , Letourneau A. , Jani J. , Kleinfinger P. , Lohmann L. , Costa J.-M. , Benachi A.
Published: February 2019

(Abstracted from Ultrasound Obstet Gynecol 2018;52(3):318–324)

Increased use of fertility treatment and advanced maternal age contribute to the increased prevalence of twin pregnancy, which is currently approximately 3% in the United States. Screening for trisomy 21 in twins largely relies on maternal age and nuchal translucency measurement in the first trimester, as well as first- and second-trimester serum screening.
Screening for Syphilis Infection in Pregnant Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force
Authors: Lin Jennifer S. , Eder Michelle L. , Bean Sarah I.
Published: February 2019

(Abstracted from JAMA 2018;320(9):918–925)

Congenital syphilis is an infectious disease caused by the vertical transmission of Treponema pallidum; thus, prevention and detection of congenital syphilis depend on the identification of syphilis in pregnant women. Two screening protocols are commonly used: the traditional screening algorithm (ie, nontreponemal testing with reflex to treponemal testing) and the reverse sequence screening algorithm (ie, treponemal testing with reflex to nontreponemal testing).
Outcome Measures in Adult Spine Surgery
Authors: Slattery Casey , Verma Kushagra
Published: February 2019

The goal of any surgical intervention in spine surgery is to restore function, relieve pain, and improve quality of life. Traditional assessments of patient outcomes failed to accurately reflect patient’s quality of life improvement. Patient-reported outcome measures (PROM) were designed to translate the patients perceived health into quantitative data. The data can help providers gauge the severity of a condition, develop a treatment plan, and follow the patient over time to determine treatment efficacy. Both in clinical practice and research, PROMs are helpful in comparing treatment options and advancing the field of spine surgery. This article discusses the utility and reliability of patient-reported outcomes, utilization in research, and provides examples of the most widely utilized PROMs in spine surgery.
ICU Utilization for Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease Receiving Noninvasive Ventilation
Authors: Myers Laura C. , Faridi Mohammad Kamal , Currier Paul , Camargo Carlos A.
Published: February 2019

Objectives:

We investigated whether patients with chronic obstructive pulmonary disease could safely receive noninvasive ventilation outside of the ICU.

Design:

Retrospective cohort study.

Setting:

Twelve states with ICU utilization flag from the State Inpatient Database from 2014.

Patients:

Patients greater than or equal to 18 years old with primary diagnosis of acute exacerbation of chronic obstructive pulmonary disease and secondary diagnosis of respiratory failure who received noninvasive ventilation.

Interventions:

None.

Measurements and Main Results:

Multilevel logistic regression models were used to obtain hospital-level ICU utilization rates. We risk-adjusted using both patient/hospital characteristics. The primary outcome was in-hospital mortality; secondary outcomes were invasive monitoring (arterial/central catheters), hospital length of stay, and cost. We examined 5,081 hospitalizations from 424 hospitals with ICU utilization ranging from 0.05 to 0.98. The overall median in-hospital mortality was 2.62% (interquartile range, 1.72–3.88%). ICU utilization was not significantly associated with in-hospital mortality (β = 0.01; p = 0.05) or length of stay (β = 0.18; p = 0.41), which was confirmed by Spearman correlation (ρ = 0.06; p = 0.20 and ρ = 0.02; p = 0.64, respectively). However, lower ICU utilization was associated with lower rates of invasive monitor placement by linear regression (β = 0.05; p < 0.001) and Spearman correlation (ρ = 0.28; p < 0.001). Lower ICU utilization was also associated with significantly lower cost by linear regression (β = 14.91; p = 0.02) but not by Spearman correlation (ρ = 0.09; p = 0.07).

Conclusions:

There is wide variability in the rate of ICU utilization for noninvasive ventilation across hospitals. Chronic obstructive pulmonary disease patients receiving noninvasive ventilation had similar in-hospital mortality across the ICU utilization spectrum but a lower rate of receiving invasive monitors and probably lower cost when treated in lower ICU-utilizing hospitals. Although the results suggest that noninvasive ventilation can be delivered safely outside of the ICU, we advocate for hospital-specific risk assessment if a hospital were considering changing its noninvasive ventilation delivery policy.
Coils migrate into the biliary-jejunum anastomosis
Authors: Xu Jianwei , Zhan Hanxiang , Li Feng , Hu Sanyuan , Wang Lei
Published: February 2019

Rationale:

Coils migration following endovascular treatment of arterial bleeding is rare. There was no clear route to deal with this complication.

Patient concerns:

A 55-year-old woman underwent choledochal cyst excision with hepaticojejunostomy. At the 18th day after operation, intra-abdominal hemorrhage occurred. Angiography showed active bleeding of 1 branch of the right hepatic artery and the gastroduodenal artery. That was treated by micro-coils embolization. 122 days after embolization, the patient was readmitted for chills, fever with temperature of 40°C, and jaundice.

Diagnosis:

Obstructive cholangitis.

Interventions:

Endoscopy was performed, which showed the micro-coils were embedded in biliary-jejunum anastomosis. Biliary sludges were adherent around micro-coils that were considered the cause of obstructive jaundice, which were washed by endoscopy.

Outcomes:

Two days later endoscopy therapy, the total bilirubin (TBIL) was decreased to 58.7 μmol/L, and the patient was discharged. After 2 months of follow-up, the level of TBIL was in normal range.

Lessons:

Coils migration following endovascular treatment of arterial bleeding is rare. For cases with coils migrated into the biliary tract, further treatment is often needed because of the secondary cholangitis or stones. Endoscopy might be useful to deal with this intractable problem.
Insufficient education is a key factor of incorrect interpretation of HIV self-test results by female sex workers in Democratic Republic of the Congo
Authors: Tonen-Wolyec Serge , Batina-Agasa Salomon , Longo Jean De Dieu , Mboumba Bouassa Ralph-Sydney , Bélec Laurent
Published: February 2019

We report on field interpretation of HIV self-testing among female sex workers (FSWs) and non-FSWs living in Democratic Republic of the Congo.

Two hundred and eight participants [76 (36.5%) FSWs; 132 (63.5%) non-FSWs] were enrolled in Kisangani and Bunia to evaluate their ability to read and interpret the results of a prototype HIV self-test (Exacto Test HIV, Biosynex, Strasbourg, France), according to WHO recommendations. Thirteen standardized tests (6 positive, 5 negative, 2 invalid) were proposed after successive random selection.

Two thousand seven hundred and four standardized tests (1248 positive, 1040 negative, 416 invalid) were interpreted; 2435 (90.1%) were correctly interpreted, whereas 269 (9.9%) were misinterpreted. In FSWs and non-FSWs, the test results were similarly correctly interpreted in 87.4% (864/988) and 91.6% (1571/1716), respectively. In multivariate logistic regression analysis, only the variable “educational level” remained strongly associated with the interpretation of positive, negative, and invalid HIV self-test results, but not the variables “commercial sex work” and “language chosen for instructions for use.” Incorrect interpretation was significantly higher in participants with insufficient educational level than in those with sufficient education level for positive (13.1% vs 2.6%; adjusted OR: 4.5), negative (22.3% vs 2.6%; adjusted OR: 5.3), and invalid test results (23.8% v 6.4%; adjusted OR: 3.6).

Incorrect interpretation of HIV self-test was as common in FSWs and non-FSWs. The lower was the educational level, the greater was the difficulty to interpret results correctly. These observations point that insufficient education level, rather than commercial sex work by itself, constitutes a key factor of incorrect interpretation of HIV self-test.
Swyer-James-Macleod syndrome as a rare cause of unilateral hyperlucent lung
Authors: Machado Daniela , Lima Filipa , Marques Catarina , Monteiro Regina
Published: February 2019

Rationale:

Swyer-James-Macleod syndrome (SJMS) is a rare lung disorder characterized by unilateral hyperlucent lungs which arises as a complication of bronchiolitis obliterans. It is typically diagnosed during childhood, although some patients may only be diagnosed in adulthood, often as an incidental finding, but others due to recurrent chest infections.

Patient concerns:

Three patients were referred to our institution with complaints of dyspnea on exertion, chronic productive cough, and recurrent pulmonary infections. Two of them had a history of lower respiratory tract infections during childhood.

Diagnosis:

A computed tomography scan was performed and showed unilateral reduced density of the lung and bronchiectasis in the 3 patients. Based on the clinical presentation and radiologic features, the diagnosis of SJMS was established.

Interventions:

Patients started inhaled corticosteroids and long acting beta agonist, vaccines to prevent respiratory infections were administered and airway clearance techniques were taught.

Outcomes:

Two patients became asymptomatic with inhaled therapy and no recurrent chest infections were observed over a 3-year follow-up period, being discharged from our institution to the general practitioner. The 3rd patient had some improvement in the frequency of pulmonary infections and dyspnea, without improvement in respiratory function tests, maintaining vigilance at our center.

Lessons:

These cases highlight the importance of being aware of this condition and its frequent association with bronchiectasis, which may adversely affect the prognosis, to manage patients appropriately and prevent recurrent pulmonary infections.
Successful rescue of antepartum eclampsia in a Chinese patient
Authors: Cao Weiping , Wang Xinzhi , Chen Tingmei , Qin Mingmei , Wang Zuxian , Wang Qin , Xie Bing , Xu Wenlin
Published: February 2019

Rationale:

Eclampsia is a life-threatening complication of pregnancy. Eclampsia is a leading cause of maternal and neonatal morbidity and mortality with most injury being associated with the seizures that mark the onset of the disease. It is vital that medical worker managing eclampsia have an understanding of the disease process.

Patient concerns:

A 28-year-old female, G4P1, with history of caesarean section was admitted at GA34+6, in addition to headache and severe hypertension (180/120 mm Hg) and proteinuria (+++). The evaluation of coagulation parameters showed positive D-dimer and increased fibrinogen and fibrinogen degradation product (FDP) and PT percent activity. Her biochemical analysis showed a decrease in total protein and an increase in alanine transaminase (ALT) and lactate dehydrogenase (LDH) and high serum uric acid and hyperlipidemia.

Diagnoses:

She was diagnosed with severe preeclampsia (PE).

Interventions:

First, the patient received magnesium sulfate therapy for convulsions control. Next, antihypertensive management of labetalol orally at a dose 100 mg and nifedipine orally at a dose 10 mg and glycerin trinitrate10 mg iv were used to maintain blood pressure in a safe range. Then, corticosteroid was given for enhancing fetal lung maturation. During preparation for cesarean section, the patient experienced suddenly seizures that lasted approximately 2 to 8 minutes. The immediate therapy is to stop the convulsions and reduce blood pressure.

Outcomes:

The patient and her baby were discharged from the hospital on the 7th day after the operation with normal blood pressure and being in a satisfactory condition.

Lessons:

Eclampsia is defined as the occurrence of convulsions superimposed on the preeclampsia. The awareness of eclampsia enhances early diagnosis and timely administration of magnesium sulfate and calmative drug which are critical to avoid feto-maternal complications.
Drug resistance mutations and viral load in human immunodeficiency virus type 2 and dual HIV-1/HIV-2 infected patients in Ghana
Authors: Abana Christopher Z. , Sagoe Kwamena W.C. , Bonney Evelyn Y. , Maina Edward K. , Aziati Ishmael D. , Agbosu Esinam , Mawuli Gifty , Styer Linda M. , Ishikawa Koichi , Brandful James A.M. , Ampofo William K.
Published: February 2019

Antiretroviral therapy (ART) and drug resistance studies worldwide have focused almost exclusively on human immunodeficiency virus type 1 (HIV-1). As a result, there is limited information on ART and drug resistance in HIV-2 patients. In Ghana, the HIV epidemic is characterized by the domination of HIV-1, with cocirculating HIV-2. We, therefore, sought to determine viral load and drug resistance mutations in HIV-2 patients to inform the clinical management of such individuals in Ghana.

We used purposive sampling to collect blood from 16 consented patients, confirmed as HIV-2 or HIV-1/2 dual infections by serology. A 2-step real-time RT-PCR assay was used to determine plasma HIV-2 RNA viral loads. For drug resistance testing, nucleic acids were extracted from plasma and peripheral blood mononuclear cells. The reverse transcriptase and protease genes of HIV-2 were amplified, sequenced and analyzed for drug resistance mutations and HIV-2 group.

HIV-2 viral load was detected in 9 of 16 patients. Six of these had quantifiable viral loads (range: 2.62–5.45 log IU/mL) while 3 had viral loads below the limit of quantification. Sequences were generated from 7 out of 16 samples. Five of these were classified as HIV-2 group B and 2 as HIV-2 group A. HIV-2 drug resistance mutations (M184V, K65R, Y115F) were identified in 1 patient.

This study is the first to report HIV-2 viral load and drug resistance mutations in HIV-2 strains from Ghana. The results indicate the need for continuous monitoring of drug resistance among HIV-2- infected patients to improve their clinical management.
Hybrid repair for a complex infection aortic pseudoaneurysm with continued antibiotic therapy
Authors: Chen Xiyang , Yuan Ding , Zhao Jichun , Huang Bin , Yang Yi
Published: February 2019

Introduction:

Treatment of infection aortic pseudoaneurysm (PSA) is a great challenge to surgeons for 3 reasons: high mortality for rupture or threatened rupture; potential risk for infection of prosthetic material which probably bring a devastating result for patients; and long-term antibiotic therapy requirement. Endovascular repair is an alternative to open surgery for a less invasive, which is a trouble procedure for aortic PSA with complex aortic anatomy. The purpose of this article is to report the novel hybrid repair of an infection aortic PSA and antibiotics therapy.

Clinical finding:

A 61-year-old man with complaints of repeated abdominal pain and fever for 3 months was admitted. He had a fever of 39.0°C and normal blood pressure. The blood leukocyte count was 14.9 × 109/L, C-reactive protein was 132 mg/L. There was no evidence for urinary tract infection. The small effusion was identified in bilateral thoracic cavity and pelvis cavity, and the severe lung function impairment was detected. Klebsiella pneumoniae was identified in blood cultures. Computer tomographic (CT) angiography showed a 6 cm × 6 cm aortic PSA involving bilateral renal arteries and a subhepatic inflammatory mass (identified by percutaneous puncture).

Diagnosis:

According to the symptoms, CT and lab test, the main diagnosis for this patient were: infective aortic PSA involving bilateral renal arteries, and Bacteremia with K pneumoniae.

Intervention and outcomes:

A hybrid procedure combined open surgical and endovascular was performed for managing the paravisceral infection aortic PSA in a 61-year-old man with high risk. To decrease the risk of graft infection, autologous saphenous vein graft was adopted, and long-term antibiotic therapy was used. At 2 years follow-up, the patient was in good clinical condition with continued antibiotic therapy.

Conclusion:

Hybrid procedure is an alternative approach according to high risk patients with complex anatomy for open repair of infection aortic PSA. The postoperative long-time continued antibiotic therapy must be emphasized for infection PSA.
Combined effects of GSTM1 and GSTT1 polymorphisms on breast cancer risk
Authors: Miao Li-Feng , Wang Xiao-Yan , Ye Xiang-Hua , Cui Meng-Shen , He Xiao-Feng
Published: February 2019

Many molecular epidemiology studies have reported an association between the combined effects of glutathione S-transferase M1 (GSTM1) and glutathione S-transferase T1 (GSTT1) polymorphisms on breast cancer risk. However, the results have been controversial.

A meta-analysis was performed to clarify this issue.

Meta-analysis of observational studies in epidemiology guidelines was used. Pooled the crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model or fixed-effects model. Several subgroup analyses were conducted by ethnicity, source of control, matching, and menopausal status. In addition, we also performed sensitivity analysis and publication bias. Moreover, a false-positive report probability (FPRP) test was applied to assess positive results.

A significantly increased breast cancer risk was observed in overall population (GSTM1 null/GSTT1 present [− +] vs GSTM1 present/GSTT1 present [+ +]: OR = 1.19, 95% CI: 1.03–1.36, GSTM1 null/GSTT1 null [− −] vs + +: OR = 1.63, 95% CI: 1.29–2.06, (− +) + GSTM1 present/GSTT1 null (+ −) vs + +: OR = 1.17, 95% CI: 1.05–1.31, (− +) + (+ −) + (− −) vs + +: OR = 1.27, 95% CI: 1.12–1.44, and − − vs (− +) + (+ −) + (+ +): OR = 1.39, 95% CI: 1.17–1.66) and several subgroup analyses, such as Caucasians, Indians, postmenopausal women, and so on. However, positive results were only considered noteworthy in overall population (− − vs + +: FPRP = 0.150 and (− +) + (+ −) + (− −) vs + +: FPRP = 0.162). Moreover, no significant association was observed when we used the trim and fill method to adjust the pooled data from all populations. Further, none of positive results of sensitivity analysis were considered noteworthy (FPRP >0.2).

These positive findings should be interpreted with caution and indicate that an increased breast cancer risk may most likely result from false-positive results, rather than from true associations or biological factors on the combined effects of GSTM1 and GSTT1. Future studies should be based on sample sizes well-powered and attention needs to be paid to study design to further identify this issue.
Abnormal pulmonary artery systolic pressure response after exercise in systemic sclerosis patients
Authors: Yang Song , Wu Jing , Lei Si , Song Rong , Cai Ye-yu , Wu Shang-jie
Published: February 2019

Background:

Pulmonary artery systolic pressure (PASP) is an important parameter for detecting pulmonary arterial hypertension (PAH). The difference between rest PASP and post-exercise PASP (ΔPASP) may play a role in predicting and screening resting PAH. The aim of this study is to analyze ΔPASP in systemic sclerosis (SSc) patients with PAH or non-PAH and suggest a cutoff value of ΔPASP for detection of PAH.

Methods:

PubMed, Embase, and Web of Science were searched for relevant publications up to July 7, 2018. Characteristics of control, no PAH, exercise-induced PAH (EIPH) and PAH subgroups in SSc patients were extracted. R 3.5.0 with the “meta” package was used to conduct this meta-analysis.

Results:

Twelve articles involving 1279 patients were included in this study. The subgroups meta-analysis showed pooled mean ΔPASP in different subgroups: control group (8.6 mmHg, 95% CI: 6.9–10.5), no PAH group (12.2 mmHg, 95% CI: 11.2–13.2), EIPH group (26.0 mmHg, 95% CI: 24.2–27.7) and PAH group (36.2 mmHg, 95% CI: 29.7–42.7).

Conclusion:

Combining the results of our study with the previous studies, an abnormal increase in PASP after exercise could indicate the development of PAH in SSc patients. In addition, if ΔPASP>29 mmHg, a high suspicion of PAH should be raised.
Correlation between red blood cell distribution width and cardiovascular events in the patients receiving peritoneal dialysis
Authors: Cao Hui-xia , Zhao Xin-di , Yan Lei , Fan Xiao-guang , Shao Feng-min
Published: February 2019

There are few studies on the correlation between red blood cell distribution width (RDW) and cardiovascular events in the patients receiving peritoneal dialysis (PD). We explored the correlation between RDW and cardiovascular events in PD patients and possible mechanism.

A total of 138 PD patients were divided into RDW < 15% group (n = 104) and RDW ≥ 15% group (n = 34).

The levels of serum C-reactive protein (CRP) [3.05 (0.79, 15.30) mg/L vs 2.15 (1.00, 6.50) mg/L] and parathyroid hormone (PTH) [260.0 (192.7, 352.6) ng/L vs 200.7 (118.0, 319.7) ng/L] were significantly higher, but the levels of serum albumin [30.65 (27.4,32.8) g/L vs 32.3 (29.25,34.95) g/L], prealbumin [(299 ± 96) g/L vs (346 ± 86) g/L], triglyceride [1.24 (0.72, 1.50) mmol/L vs 1.42 (1.12,1.84) mmol/L], and transferrin saturation [27.9 (16.4, 43.6)% vs 37.8 (23.3, 57.2)%] were significantly lower in the RDW ≥ 15% group than in the RDW < 15% group (allP < 0.05). The RDW was negatively correlated with albumin (r = − 0.258,P = 0.002), prealbumin (r = −0.236,P = 0.005), and triglyceride (r = −0.194,P = 0.023), but was positively correlated with CRP level (r = 0.174,P = 0.041). The incidence of cardiovascular events was significantly higher in the RDW ≥ 15% group (6 patients, 17.6%) than in the RDW < 15% group (6.7%) (7 patients,P < 0.01). Cox proportional hazard model showed that elevated RDW level was an independent risk factor for cardiovascular events in PD patients (HR = 1.622, 95% CI: 1.063–2.475,P = 0.025).

The elevated RDW may be served as a risk factor to predict the cardiovascular events in PD patients.