bluuebunny/crossref_metadata_2025 huggingface dataset:
A randomized controlled trial of the effect of supervised progressive cross-continuum strength training and protein supplementation in older medical patients: the STAND-Cph trial
Authors: Pedersen Mette Merete , Petersen Janne , Beyer Nina , Juul-Larsen Helle Gybel , Jensen Pia Søe , Andersen Ove , Bandholm Thomas
Published: July 2019

Background: During hospitalization, older adults (+65) are inactive, which puts them at risk of functional decline and loss of independence. Systematic strength training can prevent loss of functional performance and combining strength training with protein supplementation may enhance the response on muscle mass and strength. However, we lack knowledge about the effect of strength training commenced during hospitalization and continued after discharge in older medical patients. This assessor-blinded, randomized study investigated the effect of a simple, supervised strength training program for the lower extremities, combined with post-training protein supplementation during hospitalization and in the home setting for 4 weeks after discharge on change in mobility in older medical patients.
Methods: Older medical patients (≥65 yrs) admitted acutely from their home to the Emergency Department were randomized to either standard care or supervised progressive strength training and an oral protein supplement during hospitalization and at home 3 days/week for 4 weeks after discharge. The primary outcome was between-group difference in change in mobility from baseline to 4 weeks after discharge assessed by the De Morton Mobility Index, which assesses bed mobility, chair mobility, static and dynamic balance, and walking. Secondary outcomes were 24-hour mobility, lower extremity strength, gait speed, grip strength and Activities of Daily Living.
Results: Eighty-five patients were randomized to an intervention group (N=43) or a control group (N=42). In the intervention group, 43% were highly compliant with the intervention. Our intention to treat analysis revealed no between-group difference in mobility (mean difference in change from baseline to 4 weeks: -4.17 (95 % CI: -11.09;2.74; p=0.24) nor in any of the secondary outcomes. The per protocol analysis showed that the intervention group increased significantly more in the daily number of steps taken compared to the control group (mean difference in change from baseline to 4 weeks: 1024.7 steps (95 % CI: 0.7;2048.6); p<0.05; adjusted for mobility at baseline).
Conclusions: Simple supervised strength training for the lower extremities, combined with protein supplementation initiated during hospitalization and continued at home for 4 weeks after discharge was not superior to usual care on change in mobility at 4 weeks in older medical patients. For the secondary outcome, daily number of steps, high compliance with the intervention resulted in a higher daily number of steps. Less than half of the patients were compliant with the intervention indicating that a simpler intervention might be needed.
Trial registration: NCT01964482, https://clinicaltrials.gov/ct2/show/NCT01964482, registration date: October 14, 2013, trial protocol: PubMed ID (PMID): 27039381.
Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy
Authors: Gawęcki Maciej , Jaszczuk-Maciejewska Agnieszka , Jurska-Jaśko Anna , Kneba Małgorzata , Grzybowski Andrzej
Published: July 2019

Purpose
Central serous chorioretinopathy(CSCR) is a complex ocular entity that, in its chronic form, can lead to serious visual impairment and morphological damage to the retina.
The aim of the current retrospective study was to evaluate the damage present after long-standing but resolved central serous chorioretinopathy and refer it to healthy individuals. Correlations between measurable factors—for example, duration of the disease, baseline retinal morphological parameters, or patient age and/or their degree of impairment—were also assessed.
Materials and methods
The study group consisted of thirty-two eyes (13 female and 19 male, mean age 49.6 years SD +/- 10.5) with chronic central serous chorioretinopathy ( mean duration 18.9 months SD +/- 15.4) in which complete resolution of subretinal fluid was achieved after subthreshold micropulse laser treatment. Inclusion criterion was a lack of subretinal fluid within the whole area of the central retina scanned by the spectral domain optical coherence tomography. The group was extracted out of 51 cases of chronic CSCR that were treated with that method. They were analyzed according to final best-corrected visual acuity and retinal morphological parameters as measured by spectral optical coherence tomography with angiography option (OCTA). Results were compared with the outcomes of a control group, which consisted of 40 eyes of healthy individuals with full distance visual acuity (0.0 logMAR, 1.0 Snellen) never treated with subthreshold micropulse laser. Statistical analysis included regarding correlation between final visual acuity and final central retinal thickness and retinal and functional parameters prior to treatment.
Results
Final best-corrected visual acuity after chronic central serous chorioretinopathy was 0.23 logMAR (0.6 Snellen) and central retinal thickness was 39.32 µm smaller than in controls. No correlation was found between final visual acuity and retinal thickness and duration of the disease, patient age, and baseline morphological retinal parameters. OCTA scans revealed impaired choriocapillaries flow signal even following resolution of the disease.
Conclusion
Chronic central serous chorioretinopathy is a potentially damaging clinical entity that results in serious visual impairment, retinal thinning, and choroidal flow defects. Further research is needed to determine precisely the timepoint of this damage.
In vitro examination of the thrombolytic efficacy of tenecteplase and therapeutic ultrasound compared to rt-PA
Authors: Frühwald Tobias , Gärtner Ulrich , Stöckmann Nils , Marxsen Jan-Henning , Gramsch Carolin , Roessler Florian Carolus
Published: July 2019

Background: Optimizing thrombolytic therapy is vital for improving stroke outcomes. We aimed to develop standardized thrombolysis conditions to evaluate the efficacy of tenecteplase (TNK) compared to the current gold standard rt-PA (alteplase), with and without additional ultrasound treatment. We also wanted to introduce a new analytical approach to quantify fibrin fiber density in transmission electron microscopy (TEM).

Methods: In vitro clots that are similar to ex vivo clots concerning their histological condition and their durability were generated from whole blood. For five treatment groups we compared relative clot weight loss (each n=60) and fibrin fiber density in TEM (each n=5). The control group (A) was treated only with plasma. Two groups were designated for each rt-PA (B+C) and TNK (D+E). Groups C and E were additionally treated with ultrasound. Dosages were 50µg/ml for rt-PA and 30µg/ml for TNK. Results were evaluated by using analyses of variance (ANOVA) and post-hoc t-tests.

Results: Weight loss was increased significantly for all groups compared to the control group. Both TNK groups showed significantly increased weight loss compared to their counterpart rt-PA group (p≤0.001). For TEM only group D showed significantly decreased fibrin fiber density (p<0.05) compared to both rt-PA groups. Ultrasound did not significantly increase dissolution of clots with either method (best p=0.16).

Conclusions:
Tenecteplase dissolved clots more effectively than rt-PA with and without ultrasound. A higher sample size could provide more convincing results for TEM.
Effects of motor imagery training of gait in Parkinson´s disease: a protocol for a randomized clinical trial
Authors: Nascimento Isaíra Almeida Pereira da Silva , Santiago Lorenna , De Souza Aline Alves , Pegado Camila De Lima , Ribeiro Tatiana , Lindquist Ana Raquel
Published: July 2019

Background

Gait disorders in individuals with Parkinson’s Disease (PD) may be associated with alterations in the motor control system and aggravated by psychoemotional and cognitive issues. Therapeutic strategies aimed at self-perception and motor regulation seem to be promising. Motor imagery (MI) has been shown to be one of these strategies, but there is still no clear evidence of its applicability in this population. The aim of this trial is to determine the effects of motor imagery training on the gait and electroencephalographic activity of individuals with PD.

Methods/Design

The sample consisted of 40 individuals, aged between 45 and 75 years, in the mild and moderate phase of the disease, with the ability to generate voluntary mental images. They will be assessed for cognitive level, degree of physical disability, mental image clarity, kinematic gait variables, electroencephalographic activity and mobility. Next, subjects will be randomly assigned to an experimental (EG) and control group (CG). The EG will perform motor imagery and gait, while the CG will only engage in gait exercises. Twelve training sessions will be conducted lasting up to 90 minutes each, 3 times a week, for 4 weeks. They will be reassessed on the kinematic variables of gait, electroencephalographic activity and mobility, one, seven and thirty days after the final training session.

Discussion

The results may provide an important advance in neurological rehabilitation. An easy-access and low-cost intervention may help improve gait, electroencephalographic activity and mobility in individuals with PD.
Pragmatic randomised trial of a smartphone app (NRT2Quit) to improve effectiveness of nicotine replacement therapy in a quit attempt by improving medication adherence - results of a prematurely terminated study
Authors: Herbec Aleksandra , Brown Jamie , Shahab Lion , West Robert , Raupach Tobias
Published: July 2019

Background: Nicotine replacement therapy (NRT) bought over the counter (OTC) appears to be largely ineffective for smoking cessation, which may be partially explained by poor adherence. We developed and evaluated the NRT2Quit smartphone app (for iOS) designed to improve quit attempts with OTC NRT by improving adherence to the medications.

Methods: A pragmatic double-blind randomized controlled trial with remote recruitment through leaflets distributed to over 300 UK-based community pharmacies. The study recruited adult daily smokers (≥10 cig/day) who bought NRT, wanted to quit smoking, downloaded NTR2Quit and completed the registration process within the app. Participants were automatically randomized within the app to the intervention (full) version of NRT2Quit or to its control (minimal) versions. The primary outcome was biochemically-verified 4-week abstinence assessed at 8-week follow-up using Russell Standard criteria and intention-to-treat. Bayes factors were calculated for the cessation outcome. Secondary outcomes were self-reported abstinence, NRT use, app use and satisfaction with the app.

Results: The study under-recruited with only 41 participants (3.5% of the target sample) randomly assigned to NRT2Quit (n=16) or the control (n=25) app versions between March 2015-September 2016. The follow-up rate was 51.2%. The intervention participants had numerically higher biochemically-verified quit rates (25.0% vs 8.0%, p=0.19, OR=3.83,0.61-24.02). The Bayes factor calculated was 1.92 showed the data were insensitive to test for the hypothesis that the intervention app version aided cessation. The intervention participants had higher median logins (2.5 vs. 0, p=0.01), were more likely to use NRT at follow-up (100.0% vs. 28.6%, p=0.03) and recommend NRT2Quit to others (100.0% vs. 28.6%, p=0.01).

Conclusions: Despite very low recruitment there was preliminary but inconclusive evidence that NRT2Quit may improve short-term abstinence and adherence among smokers using nicotine replacement therapy. Well-powered studies on NRT2Quit are needed, but different recruitment methods will be required to engage smokers through community pharmacies or other channels.
PROtective Ventilation with a low versus high Inspiratory Oxygen fraction(PROVIO) and its effects on postoperative pulmonary complications:protocol for a randomized controlled trial
Authors: Li Xue-Fei , Jiang Dan , Jiang Yu-Lian , Yu Hong , Jiang Jia-Li , He Lei-Lei , Yang Xiao-Yun , Yu Hai
Published: July 2019

Background: Postoperative pulmonary complications (PPCs) is the most common perioperative complication following surgical site infection (SSI), which prolongs the hospital stay and increases health care cost. Lung-protective ventilation strategy is considered better practice in abdominal surgery to prevent PPCs. However, the role of inspiratory oxygen fraction (FiO₂) in the strategy remains disputable. Previous trials have focused on reducing SSI by increasing inhaled oxygen concentration but higher FiO₂ (80%) was found to be associated with a greater incidence of atelectasis and mortality in recent researches. The trial aims at evaluating the effect of different FiO₂ added to lung-protective ventilation strategy on the incidence of PPCs during general anesthesia for abdominal surgery.

Methods: PROtective Ventilation with a low versus high Inspiratory Oxygen fraction trial（PROVIO）is a single-center, prospective, randomized, controlled trial planning to recruit 252 patients undergoing abdominal surgery lasting for at least 2 hours. The patients will be randomly assigned to (1) a low FiO₂ (30% FiO₂) group and (2) a high FiO₂ (80% FiO₂) group in lung-protective ventilation strategy. The primary outcome of the study is the occurrence of PPCs within the postoperative 7 days. Secondary outcomes include the severity grade of PPCs, the occurrence of postoperative extrapulmonary complications and all-cause mortality within the postoperative 7 and 30 days.

Discussion: PROVIO trial assesses the effect of low versus high FiO₂ added to lung-protective ventilation strategy on PPCs for abdominal surgery patients and the results will provide practical approaches to intraoperative oxygen management.

Trial registration number: Registered at www.ChiCTR.org.cn on 13 February 2018 with identifier no. ChiCTR18 00014901.

Keywords: Postoperative pulmonary complications, Lung-protective ventilation, Fraction of inspired oxygen, Abdominal surgery.
Choroidal Structural Changes Correlate with Severity of Diabetic Retinopathy in Diabetes Mellitus
Authors: Wang Hui , Tao Yong
Published: July 2019

Background
This study aims to investigate the choroidal thickness and choroidal vascular density parameters and their correlation with severity of diabetic retinopathy (DR) in diabetes mellitus (DM) patients.
Methods
An observational cross-sectional study was conducted of 104 eyes, which were divided into 4 groups: Healthy controls (n = 38), DM with no DR eyes (n = 22), panretinal photocoagulation-untreated non-proliferative DR eyes (PRP-untreated NPDR eyes) (n = 24), PRP-untreated proliferative DR eyes (PRP-untreated PDR eyes) (n = 20). Optical coherence tomography (OCT) was performed. The total choroidal area (TCA), stromal area (SA), the luminal areas (LA) and the ratio of the luminal to choroidal area (L/C ratio) were compared. The choroidal parameters were also compared between PRP untreated and PRP-treated DR eyes.
Results
The L/C ratio values were 0.68 ± 0.06 in controls and 0.63 ± 0.04 in DM eyes (P < 0.001). But there were no statistically significant differences in retinal nerve fiber layer (RNFL) thickness, retinal thickness and subfoveal choroidal thickness (SCT) measurements between the two groups (P = 0.407, P = 0.654 and P = 0.849; respectively). The vessel density values were significantly different in DM with no DR eyes, PRP-untreated NPDR eyes and PRP-untreated PDR eyes (P < 0.001 for SCT, TCA and SA). The L/C ratio values in the three groups were significant different (P = 0.019). There was no significant difference in SCT, TCA, LA, SA and the L/C ratio between PRP-untreated and PRP-treated DR eyes.
Conclusion
Eyes of patients with DM showed the L/C ratio decreased compared with normal controls. The SCT increased, but L/C ratio significantly decreased with severity of DR eyes compared with DM and normal eyes. Changes in the L/C ratio may predict DR development before they are otherwise evident clinically. Choroidal blood flow deficit can be an early pathologic change in DR.
Key Words
Diabetic retinopathy; choroidal vascular density parameter; choroid; macular
Burden, Clinical Outcomes and Predictors of time to in Hospital Mortality among Adult Patients Admitted to Stroke Unit of Jimma University Medical Center: Prospective Cohort Study
Authors: Fekadu Ginenus , Chelkeba Legese , Kebede Ayantu
Published: July 2019

Background: The global burden of stroke epidemiology is changing rapidly. Over the 1990–2013 periods, there was a significant increase in the absolute number of deaths and incident events of stroke. The burden of stroke varies in Ethiopia between regions and over time. The paucity of data has limited research output and consequently the response to this burden in our country.
Methods: Prospective cohort study was carried at stroke unit of Jimma University Medical Center (JUMC) from March 10- July 10, 2017. The outcome of interest was mortality and time to death. Data was analyzed using SPSS version 20. Multivariable Cox regression was used to identify the predictors of in hospital mortality and time to death from hospital arrival. Predictor variables with P< 0.05 was considered statistically significant.
Results: A total of 116 eligible stroke patients were followed with the mean age of 55.1+14.0 years and males comprised of 73 (62.9%) with male: female ratio of 1.70:1. Stroke accounted for 16.5 % of total medical admissions and 23.6 % of in hospital mortality. Among the total, 91 (78.4%) patients discharged alive making in hospital mortality of rate of 25 (21.6%). The median time of in hospital mortality and length of hospital stay after admission of the patients was 4.38 days and 9.21 days, respectively. The prominent suspected immediate cause for in hospital mortality was increased intracranial pressure 17 (68.0%) followed by respiratory failure secondary to aspiration pneumonia 11 (44.0%). Brain edema (AHR: 6.27, 95% CI: 2.50-15.76), urine incontinence (AHR: 3.48, 95% CI: 1.48-8.17), National Institute of Health Stroke Scale (NIHSS) >13 during hospital arrival (AHR: 22.58, 95% CI: 2.95-172.56) and diagnosis of stroke clinically alone (AHR: 4.96, 95% CI: 1.96-12.54) were the independent predictors of time to in hospital mortality.
Conclusions: The mortality rate of stroke in this set up was comparable with other low- and middle-resource countries. There should be burning need to establish and strengthen the available stroke units which are well-equipped and staffed with intensive health care teams across the country. Additionally, future work must be designed to identify the barriers to improve stroke outcomes and recovery.
Investigation of muscle transcriptomes using gradient boosting machine learning identifies molecular predictors of feed efficiency in growing pigs
Authors: Messad Farouk , Louveau Isabelle , Koffi Basile , Gilbert Hélène , Gondret Florence
Published: July 2019

Background

Improving feed efficiency (FE) is a major challenge in pig production. This complex trait is characterized by a high variability. Therefore, the identification of predictors of FE may be a relevant strategy to reduce phenotyping efforts in breeding and selection programs. The aim of this study was to investigate the suitability of expressed muscle genes in prediction of FE traits in growing pigs. The approach considered different transcriptomics experiments to cover a large range of FE values and identify reliable predictors.

Results

Microarrays data were obtained from longissimus muscles of two lines divergently selected for residual feed intake (RFI). Pigs (n = 71) from three experiments belonged to generations 6 to 8 of selection, were fed either a diet with a standard composition or a diet rich in fiber and lipids, received feed ad libitum or at restricted level, and weighed between 80 and 115 kg at slaughter. For each pig, breeding value for RFI was estimated (RFI-BV), and feed conversion ratio (FCR) and energy-based feed conversion ratio (FCRe) were calculated during the test periods. Gradient boosting algorithms were used on the merged muscle transcriptomes to identify very important predictors of FE traits. About 20,405 annotated molecular probes were commonly expressed in longissimus muscle across experiments. Six to 267 expressed muscle genes covering a variety of biological processes were found as important predictors for RFI-BV (R2=0.63-0.65), FCR (R2=0.61-0.70) and FCRe (R2=0.49-0.52). The error of prediction was less than 8% for FCR. Altogether, 56 predictors were common to RFI-BV and FCR. Expression levels of 24 target genes were further measured by qPCR. Linear regression confirmed the good accuracy of combining mRNA levels of these genes to fit FE traits (RFI-BV: R2=0.73, FRC: R2=0.76; FCRe: R2=0.75). Stepwise regression procedure highlighted 10 genes (FKBP5, MUM1, AKAP12, FYN, TMED3, PHKB, TGF, SOCS6, ILR4, and FRAS1) in a linear combination predicting FCR and FCRe. In addition, FKBP5 and expression levels of five other genes (IGF2, SERINC3, CSRNP3, EZR and RPL16) significantly contributed to RFI-BV.

Conclusion

It was possible to identify few genes expressed in muscle that might be reliable predictors of feed efficiency.
Prospective study of vitrectomy for epiretinal membranes in patients with good best-corrected visual acuity
Authors: Nakashizuka Hiroyuki , Kitagawa Yorihisa , Wakatsuki Yu , Tanaka Koji , Furuya Koichi , Hattori Takayuki , Mori Ryusaburo , Shimada Hiroyuki
Published: July 2019

Backgroud: To evaluate the efficacy of epiretinal membrane removal in patients with good best-corrected visual acuity (BCVA) for improving visual function and quality of life (QOL).
Methods: This prospective case study compared 37 subjects with preoperative BCVA ≦ 0.046 logMAR (Good group) to 35 patients with 0.10 - 0.52 logMAR (Moderate group) at 3 and 6 months. Linear mixed-effect models were used for statistical analysis. The primary outcome was the horizontal metamorphopsia score (MH) at 6 months postoperatively (post-6 M), while secondary outcomes were postoperative BCVA, vertical metamorphopsia score (MV), aniseikonia, stereopsis and central foveal thickness. In the Good group, QOL was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) at 6 and 12 months.
Results: MH was significantly improved at post-3 M and post-6 M in the both groups but there were no significant differences between the two groups. MV showed no improvement at the final observation in either group. LogMAR BCVA was significantly improved at post-6 M in the Good group, which had significantly better vision than the Moderate group. Preoperative vertical and horizontal aniseikonia scores remained unchanged in the Good group at post-6 M but worsened in the Moderate group. The NEI VFQ-25 score improved in the Good group, reflecting improved general health, general vision, and mental health.
Conclusions: Early epiretinal surgery for patients with BCVA ≦ 0.046 logMAR was effective for improvement of HM, BCVA, and QOL and prevented worsening of aniseikonia.
Neural differentiation dynamics controlled by multiple feedback loop motifs in a comprehensive molecular interaction network
Authors: Iwasaki Tsuyoshi , Takiguchi Ryo , Hiraiwa Takumi , Yamada Takahiro G , Yamazaki Kazuto , Hiroi Noriko F. , Funahashi Akira
Published: July 2019

Background: Computational simulation using mathematical models is a useful method for understanding the complex behavior of a living system. The majority of studies using mathematical models to reveal biological mechanisms use one of the two main approaches: the bottom-up or the top-down approach. When we aim to analyze a large-scale network, such as a comprehensive knowledge-integrated model of a target phenomenon, for example a whole-cell model, the variation of analyses is limited to particular kind of analysis because of the size and complexity of the model.
Results: To analyze a large-scale network of neural differentiation, we developed a hybrid method that combines both approaches. To construct a mathematical model, we extracted network motifs, subgraph structures that recur more often in a metabolic network or gene regulatory network than in a random network, from a large-scale network, detected regulatory motifs among them, and combined these motifs. We confirmed that the model reproduced the known dynamics of HES1 and ASCL1 before and after differentiation, including oscillation and equilibrium of their concentrations. The model also reproduced the effects of overexpression and knockdown of the Id2 gene. Our model suggests that the characteristic change in HES1 and ASCL1 expression in the large-scale network is controlled by a combination of four feedback loops, including a novel large loop discovered in this study.
Conclusion: The model extracted by our hybrid method has the potential to reveal the critical mechanisms of neural differentiation. The hybrid method is applicable to other biological events.
The analgesic efficacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic renal surgery: A randomized controlled study
Authors: Li Xue , Xu Zhen-Zhen , Li Xue-Ying , Jiang Ting-Ting , Lin Zeng-Mao , Wang Dong-Xin
Published: July 2019

Background
Ultrasound-guided lateral transversus abdominis plane (TAP) block can provide definite analgesia to the anterior abdominal wall. However, whether this method is useful in renal surgery involving access through the lateral abdominal wall remains unknown. Therefore, the study aimed to evaluate the analgesic efficacy of lateral TAP block for retroperitoneoscopic partial or radical nephrectomy.

Method
In this prospective, randomized, double-blind, placebo-controlled trial, eligible patients were randomized into the intervention (T) or control (C) groups. After anaesthesia induction, ultrasound-guided lateral TAP block was performed preoperatively with 30 ml of 0.4% ropivacaine and an equivalent amount of normal saline in groups T and C, respectively. The primary outcomes were opioid consumption during surgery and in the first 24 h after surgery. Secondary outcomes were postsurgical pain intensity upon immediately awakening from anaesthesia and at 0.5, 1, 2, 6, 12, and 24 h after surgery as well as recovery quality variables including the incidence of postoperative nausea and vomiting (PONV), sleep quality, time to first ambulation, drainage and length of hospital stay.

Results
A total of 104 patients were enrolled and randomized: 53 and 51 in groups T and C, respectively. Laparoscopic surgery was converted to open surgery in one patient. Thus, he was excluded from the analysis. The median intraoperative and postoperative opioid consumption (oral morphine equivalent dose, o-MED) in the first 24 h after surgery were 105.0 and 32.5 mg in Group C, respectively, and the corresponding values in Group T were 121.0 and 39.7 mg, all of which were not significant (P = 0.284 and 0.311). Postsurgical pain intensity at all time points was comparable between the groups (all P > 0.05). Intergroup differences in the recovery quality variables were not significant (all P > 0.05).

Conclusion
Our findings demonstrated that preoperative lateral TAP could not decrease intraoperative or postoperative opioid consumption or pain intensity in the first 24 h after surgery, nor could it promote postoperative recovery in patients undergoing laparoscopic renal surgery through retroperitoneal access.
Analgesic effect of the ultrasound-guided subcostal approach to transmuscular quadratus lumborum block in patients undergoing laparoscopic nephrectomy: a randomized controlled trial
Authors: Zhu Manhua , Qi Yong , He Huijuan , Lou Jinfeng , Pei Qingqing , Mei Yuliu
Published: July 2019

Background: Quadratus lumborum block (QLB) is an effective analgesia that lowers opioid consumption after lower abdominal and hip surgeries. The subcostal approach to transmuscular QLB is a novel technique that can provide postoperative analgesia by blocking more dermatomes. The aim of this study is to evaluate the efficacy and viability of subcostal approach to QLB after laparoscopic nephrectomy.
Methods: Sixty patients who underwent laparoscopic nephrectomy were randomly divided into the subcostal approach to QLB group (QLB group, n=30) and the control group (C group, n=30). All patients underwent ultrasound-guided subcostal approach to QLB in an ipsilateral parasagittal oblique plane at the L1–L2 level. The QLB group received 0.4 cc/kg of 0.3% ropivacaine, and the C group received 0.4 cc/kg of 0.9% saline. Postoperatively, a patient-controlled intravenous analgesic pump with sufentanil was attached to all the patients. The primary outcome was sufentanil consumption within the first 24 h after surgery. The secondary outcomes included the Ramsey sedation scale (RSS) scores and Bruggemann comfort scale (BCS) scores 6 h (T1), 12 h (T2), and 24 h (T3) after surgery, intraoperative remifentanil consumption, number of patients requiring rescue analgesia, time to recovery of intestinal function, mobilization time after surgery, and presence of side effects.
Results: Sufentanil consumption within the first 24 h after surgery was significantly lower in the QLB group than in the C group (mean [standard deviation]: 34.1 [9.9] μg vs 42.1 [11.6] μg, P=.006). The RSS scores did not differ between the two groups, and the BCS scores of the QLB group at T1 and T2 time points was significantly higher than those of the C group(P＜0.05). The consumption of remifentanil intraoperatively and the number of patients requiring rescue analgesia were significantly lower in the QLB group (P＜0.05). Time to recovery of intestinal function and mobilization time after surgery were significantly earlier in the QLB group (P＜0.05). The incidence of postoperative nausea and vomiting was significantly lower in the QLB group (P＜0.05).
Conclusions: The ultrasound-guided subcostal approach to QLB is an effective analgesic technique in patients undergoing laparoscopic nephrectomy as it reduces the consumption of sufentanil postoperatively.
A Study Protocol for a Randomised Controlled Trial Evaluating the Effects of Intraoperative Computed Tomography on the Outcomes of Zygomatic Fractures
Authors: Higgins Andrew Michael , Hurrell Michael James Leslie , Harris Richard Ian , Findlay Geoffrey James , David Michael C , Batstone Martin Druce
Published: July 2019

Background

Zygomaticomaxillary complex (ZMC) and zygomatic arch (ZA) fractures are common injuries resulting from facial trauma and frequently require surgical management.1 A substantial number of post-operative functional and cosmetic complications can arise from the surgical management of these fractures. These include scarring, inadequate facial profile restoration, facial asymmetries and diplopia.2-4 Intuitively, most of these aforementioned complications arise as a result of inadequate fracture reduction, however current standard practice is to assess reduction post-operatively through plain radiographs or computed tomography (CT) scans. The role of intra-operative computed tomography (CT) scanning to assess the reduction of ZMC/ZA fractures and the potential impact on complications, has thus far not been established.

Methods

This is a prospective randomised controlled trial currently being undertaken at the Royal Brisbane and Women’s Hospital. All patients who require operative management of their ZMC or ZA fractures are offered enrollment in the trial. The patients are randomised into two groups: interventional (intra-operative CT) and control (no intra-operative CT). All patients from both groups will have post-operative radiographs taken. From these radiographs, the reduction of the ZMC and/or ZA fracture is graded by a blinded assessor. Patients will be reviewed in clinic at one and six weeks post-surgery. During these consultations, all patients will be assessed for scarring, diplopia, facial profile restoration and need for revision surgery.

Discussion

Many complications associated with surgical management of ZMC and ZA fractures involve poor aesthetic results as a direct consequence of inadequate fracture reduction. Inadequate fracture reduction is predictable given that small incisions are used and only limited visualisation of the fractures is possible during the procedure. This is due to a desire to limit scarring and reduce the risk of damage to vital structures in an aesthetically sensitive region of the body. It follows that an intraoperative adjunctive tool such as a CT scan, which can assist in visualisation of the fractures and the subsequent reduction, could potentially improve reduction and reduce complications.
Multivariable prediction model for predicting deaths in severe dengue cases
Authors: S Saiful Safuan Md , Zaid Masliza , Leong Kar Nim , Hawari Rossman , Jelani Anilawati Mat , Abd-Rahman Marzilawati , Ooh Ping Yee , Shanmugarajoo Anusha , Kumar Suresh , Mustafa Mahiran
Published: July 2019

Background. Many predictive models have been developed to predict an outbreak, identify and stratify dengue but none has predicted death in severe dengue cases. To build a predictive model for deaths in severe dengue, a multicentre retrospective cohort study was conducted.

Methods. Patients with severe dengue based on the World Health Organisation (WHO) 2009 classification were studied. Demographic, clinical and laboratory data were collected at diagnosis of severe dengue. Penalised regression was used for variable selection and model-building. Ten-fold cross-validation with 1000 repeats were performed for internal validation.

Results. A cohort of 786 severe dengue cases, including 35 deaths, was analysed. Our model that predicts death in severe dengue cases comprises eight independent predictors: persistent diarrhoea, body mass index, respiratory rate, platelet count, aspartate transaminase, serum bicarbonate, serum lactate and serum albumin. The area under the receiver operating characteristic curve is 89·6% with a sensitivity of 99·6%, specificity of 23·6%, positive predictive value of 96·6%, negative predictive value of 71·1%, positive likelihood ratio 1·45 and negative likelihood ratio 0·01. We also found that the proportion of patients that were in the febrile phase at diagnosis of severe dengue for the overall cohort, decompensated and compensated shock were 74·3%, 73% and 75·4%, respectively.

Conclusions. We developed a high-performance dengue death prediction model comprising clinical and laboratory data, and deployed an open-access web-based tool (www.saifulsafuan.com/REPROSED2017E2) for any centre to utilise for local validation. We additionally found that a large majority of patients developed severe dengue during the febrile phase.

Keywords: Dengue; severe; model; predict; deaths; phase.
Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review.
Authors: Hoyer Carolin , Stein Patrick , Alonso Angelika , Platten Michael , Szabo Kristina
Published: July 2019

Background: Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far.
Methods: A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL).
Results: Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely. DAMA/PL patients were younger (p<.001), and they were more frequently self-presenting (p<0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time.
Conclusions: Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED.
Human Development and Its Effects on Economic Growth and Development
Authors: Appiah Michael , Amoasi Richard , Frowne Doreen Idan
Published: July 2019

The focus of the current study is to empirically examine the impact of Human Development on Economic Growth and Development in African countries, between 1990 and 2015. The key findings and results of the study suggested the existence of a positive and significant impact of human development on economic growth and development in Africa. The study employed Human Development Index as the main variable of interest with GDP considered as the dependent variable with inflation, capital, investment and labour as control variables. The study also came out with the findings that Labour and foreign aid also have a positive and significant relationship with growth as recorded by most researchers. It was recommended that more efforts should be placed on developing the human capacities in all areas.
Predicting wastewater treatment plant performance during aeration demand shifting with a dual-layer reaction settling model
Authors: Giberti Matteo , Dereli Recep Kaan , Flynn Damian , Casey Eoin
Published: July 2019

Demand response (DR) programmes encourage energy end users to adjust their consumption according to energy availability and price. Municipal wastewater treatment plants are suitable candidates for the application of such programmes. Demand shedding through aeration control, subject to maintaining the plant operational limits, could have a large impact on the plant DR potential. Decreasing the aeration intensity may promote the settling of the particulate components present in the reactor mixed liquor. The scope of this study is thus to develop a mathematical model to describe this phenomenon. For this purpose, Benchmark Simulation Model No.1 was extended by implementing a dual-layer settling model in one of the aerated tanks and combining it with biochemical reaction kinetic equations. The performance of this extended model was assessed in both steady-state and dynamic conditions, switching the aeration system off for 1 hour during each day of simulation. This model will have applications in the identification of potential benefits and issues related to DR events, as well as in the simulation of the plant operation where aerated tank settling is implemented.
Estrategias lúdicas para aumentar el conocimiento de un grupo de adolescentes sobre el virus del papiloma humano
Authors: Gómez Sandra Marcela , Agudelo-Ramírez Alexandra , Pradilla Serrano Ányela Sofia , García-Hincapié Juliana
Published: July 2019

El objetivo fue formular y desarrollar un conjunto de estrategias lúdicas para aumentar el conocimiento sobre el Virus del Papiloma Humano y la vacuna en un grupo de adolescentes escolarizados en un corregimiento de Pereira, Colombia. Se utilizó metodología cualitativa con método Acción-Participación, se involucraron 17 estudiantes, como técnicas de investigación se usaron grupos focales y talleres pedagógicos, los discursos de los adolescentes fueron grabados y transcritos; para el análisis de datos se realizó identificación de unidades de sentido, codificación y categorización. Al inicio del proyecto los adolescentes tenían poco conocimiento sobre el Virus del Papiloma Humano, las enfermedades de transmisión sexual en general y desconocían sus manifestaciones clínicas; pero al finalizar el proceso tenían claridad sobre los órganos implicados, factores protectores, la vacuna como método preventivo y la relación del virus con el cáncer. Los adolescentes relacionaron la falta de uso del preservativo y múltiples parejas como factores de riesgo para adquirir una enfermedad de transmisión sexual, especialmente el Virus del Papiloma Humano. Las estrategias lúdicas permitieron a los adolescentes generar nuevo conocimiento por medio de un proceso de interiorización, reflexión y compresión sobre el virus y la vacuna.
Tipologías distintivas de respuestas ante el estrés académico en universitarios: un análisis de clasificación
Authors: Caballero-Domínguez Carmen , Suarez-Colorado Yuly
Published: July 2019

El objetivo de este estudio fue establecer las características distintivas de las respuestas ante el estrés de los estudiantes universitarios del área de la salud. Se utilizó un diseño transversal con una muestra aleatoria y estratificada de 820 estudiantes de Ciencias de la Salud de una Universidad del Caribe Colombiano. Los instrumentos utilizados fueron el MBI-SS, el UWES-S, EEC-M, el STAI y el de depresión de Bechk.  Los resultados señalan que los universitarios presentan diferentes tipologías de respuesta ante el estrés, mediadas por relaciones diversas entre el burnout académico y el engagement con depresión, ansiedad, estrategias de afrontamiento y apoyo social-familiar, que configuran patrones complejos de interrelaciones mutuas entre dichas variables, conformando tres grupos distintivos de estrés, “ los pilos” estudiantes con niveles alto de engagement, “los implicados y estresados”, y “los quemados” estudiantes con niveles alto de burnout.
Coexistence of musculoskeletal disorders in the upper body of labor origin
Authors: Guzmán-Velasco Adriana , Diago-Franco José Luis
Published: July 2019

The coexistence of musculoskeletal disorders is common in work activities around the world, however, information on the subject is insufficient both in Latin America and in Colombia despite its impact at the economic and social level. The objective of this research was to determine the coexistence of musculoskeletal disorders of work origin in the upper body in the working population that attends a Service Provider Institution (IPS). An observational, descriptive, quantitative, and cross-sectional design study was conducted between the first of March in 2017 and the first of March in 2018. Four semiological tests were applied for physiotherapists to seek the coexistence of carpal tunnel syndrome, lateral epicondylitis, rotator cuff syndrome, and cervical myofascial syndrome. Among the results, it was found that 92.6% (n=138) of the patients had two or more pathologies, 59.73% (n=89) had the rotator cuff and the myofascial syndrome, 52.35% (n=78) had epicondylitis and myofascial syndrome, and 37.58% (n=56) had carpal tunnel syndrome and lateral epicondylitis. This study highlights the high coexistence of musculoskeletal disorders in the upper body, especially in the female gender.
Caso inusual de un ameloblastoma uniquístico en paciente pediátrico
Authors: Salcedo-Pájaro Andrea Carolina , Fonseca-Martínez María Isabel , Urbano-del Valle Samuel , López-Aparicio Erich , Díaz-Caraballo Antonio
Published: July 2019

El ameloblastoma a pesar de ser un tumor benigno es uno de los más agresivos y destructivos localmente de la región maxilofacial, siendo capaz de generar grandes deformaciones faciales en un corto lapso de tiempo, creciendo dentro del hueso sin perforarlo. La variante uniquística por ser considerada la menos agresiva permite un manejo conservador de esta patología. No es frecuente en niños y los criterios de tratamiento quirúrgico en la infancia son controversiales, debido, en parte, al riesgo de recurrencia cuando se practican métodos conservadores. Se presenta un caso inusual de ameloblastoma uniquístico localizado en la región anterior del maxilar inferior. Este tipo de lesiones se presenta mayormente en adultos jóvenes, principalmente en la segunda década de vida y en este caso se presentó en una niña de 12 años. La lesión fue manejada de manera conservadora con un seguimiento de cuatro años, siendo que ésta no presentó recidiva.
El papel de los médicos generales en la psiquiatría en Colombia
Authors: Campo-Arias Adalberto , Herazo Edwin
Published: July 2019

En Colombia, según el más reciente estudio de salud mental en la población general, la frecuencia de trastornos mentales alguna vez en la vida es del 9,1%; del 4% durante el año más reciente y 1,6% en el último mes. Para una población proyectada de 50,4 millones de habitantes, se estima que durante el mes más reciente 800.000 ciudadanos colombianos presentó alguna necesidad de atención en salud mental1. Sin embargo, el país tiene entre 1.500 y 2.000 psiquiatras activos, de tal suerte, que se cuenta con un psiquiatra por cada 25.200 a 33.600 habitantes. A lo anterior se suma que la totalidad de los psiquiatras ejercen en las grandes capitales2.
Entrevistas en los procesos de selección de estudiantes de medicina
Authors: Rodríguez-De Ávila Ubaldo , Reyes-Rojas Mónica , Campo-Arias Adalberto , Caballero-Domínguez Carmen , Ceballos-Ospino Guillermo
Published: July 2019

Desde hace varias décadas, las entrevistas en los procesos de selección de estudiantes para las escuelas de medicina han sido repetidamente objeto de discusión. No obstante, se ha investigado muy poco sobre la utilidad de la entrevista clásica en la admisión de los futuros médicos1,2.
Medicina y Derecho. Una interdependencia socio-histórica
Authors: Viviescas-Cabrera Raúl
Published: July 2019

Tal vez, la primera duda que asalte al lector frente a este editorial es acerca de las conexiones que pueda tener la ciencia médica y la ciencia del derecho o la ciencia del derecho y la ciencia médica, aunque ciertamente aparentan ser sabidurías muy distantes y cada una presenta tópicos tan apartados como la responsabilidad1, las definiciones del fenómeno terrorista2 y o bacterioterapia preventiva3, existen conexiones innegables que las acercan más de lo que se sospecha.
SGLT2 Inhibitors and Cardiovascular Outcomes: Do They Differ or There is a Class Effect? New Insights from the EMPA-REG OUTCOME trial and the CVD-REAL Study
Authors: Kyriakos Georgios , Quiles-Sanchez Lourdes V. , Garmpi Anna , Farmaki Paraskevi , Kyre Konstantina , Savvanis Spyridon , Antoniou Vasileios K. , Memi Eleni
Published: July 2019

A new group of hypoglycemic drugs has been used to treat diabetes type 2. This group is
active sodium glucose co-transporter (SGLT2) or SGLT2 inhibitors. It has been shown that besides
the treatment of diabetes, this drug class is responsible for the mildness of the cardiovascular events
shown in patients with diabetes type 2. However, there is an intriguing question regarding the range
of SGLT2 inhibitors and if there is a difference between them or if there is a class effect among
their results. EMPA-REG OUTCOME trial and the CVD-study are used to answer this question.
Additional information from the DECLARE-TIMI 58 and Dapa-HF trials is studied.