bluuebunny/crossref_metadata_2025 huggingface dataset:
Adjusting the Effect of Integrating Antiretroviral Therapy and Tuberculosis Treatment on Mortality for Noncompliance
Authors: Yende-Zuma Nonhlanhla , Mwambi Henry , Vansteelandt Stijn
Published: February 2019

Background:

Using intent-to-treat comparisons, it has been shown that the integration of antiretroviral therapy (ART) and tuberculosis (TB) treatment improves survival. Because the magnitude of the effect of ART initiation during TB treatment on mortality is less well understood owing to noncompliance, we used instrumental variables (IV) analyses.

Methods:

We studied 642 HIV-TB co-infected patients from the Starting Antiretroviral Therapy at Three Points in Tuberculosis trial. Patients were assigned to start ART either early or late during TB treatment or after TB treatment completion. We used 2-stage predictor substitution and 2-stage residuals inclusion methods under additive and proportional hazards regressions with a time-fixed measure of compliance defined as the fraction of time on ART during TB treatment. We moreover developed novel IV methods for additive hazards regression with a time-varying measure of compliance.

Results:

Intent-to-treat results from additive hazards models showed that patients in the early integrated arms had a reduced hazard of -0.05 (95% confidence interval [CI]: -0.09, -0.01) when compared with the sequential arm. Adjustment for noncompliance changed this effect to -0.07 (95% CI: -0.12, -0.01). An additional time-varying IV analysis on the overall effect of ART exposure suggested an effect of -0.29 (95 % CI: -0.54, -0.03).

Conclusion:

IV analyses enable assessment of the effectiveness of TB and ART integration, corrected for noncompliance, and thereby enable a better public health evaluation of the potential impact of this intervention.
Effects of Water-Based Aerobic Interval Training in Patients With COPD
Authors: Gallo-Silva Bruna , Cerezer-Silva Viviane , Ferreira Danilo Gullo , Sakabe Daniel Iwai , Kel-Souza Luana Daniele , Bertholo Vanessa Cristina , Brasil Mayara Thaysa Ferreira , Ladeia Alessandra de Oliveira Amoroso , Moreno Marlene Aparecida
Published: February 2019

Purpose:

Chronic obstructive pulmonary disease promotes systemic repercussions, which can be minimized with physical exercise. This study investigated the effects of a water-based aerobic interval training program on the autonomic modulation of heart rate (HR), quality of life (QoL), and functional capacity (FC) of patients with chronic obstructive pulmonary disease.

Methods:

Nineteen patients with chronic obstructive pulmonary disease were enrolled in this randomized clinical trial and allocated to either the usual care group (n = 9) or training group (n = 10). Before and after 24 sessions of water-based physical training, the patients underwent evaluation of autonomic modulation of HR by analyzing the HR variability, QoL using the St George's Respiratory Questionnaire, and FC using 6-min walk test distance.

Results:

The results showed significant improvement when comparing the variables of HR variability, QoL, and FC in the training group in the pre- and post-training conditions (P < .05). In the usual care group, there was no significant difference for any of the variables. Negative correlations were found between HR variability and QoL (r =−0. 55; P = .01) and 6-min walk test distance and QoL (r =−0.49; P = .02).

Conclusion:

Water-based physical training promoted beneficial adaptations in the autonomic modulation of HR, QoL, and FC of patients with chronic obstructive pulmonary disease.
Do London Chest Activity of Daily Living Scale and St George's Respiratory Questionnaire Reflect Limitations During Activities of Daily Living in Patients With COPD?
Authors: Barusso-Grüninger Marina Sallum , Gianjoppe-Santos Julia , Sentanin Anna Claudia , Pires Di Lorenzo Valéria Amorim
Published: February 2019

Purpose:

It is unclear whether activities of daily living (ADL) and quality-of-life scales reflect real ADL limitations. The aim of the study was to assess the limitation during ADL simulation and to identify whether the London Chest Activity of Daily Living (LCADL) Scale and St George's Respiratory Questionnaire (SGRQ) are able to reflect the patient's real limitations during ADL simulation.

Methods:

Forty-eight patients with chronic obstructive pulmonary disease (age = 69 ± 8 y; forced expiratory volume in the first second of expiration [FEV1] = 1.37 ± 0.49 L) were assessed by SGRQ and LCADL Scale. Activities of daily living simulations were performed: showering (ADL1); lifting and lowering containers above the shoulder girdle (ADL2); and raising and lowering pots below the pelvic girdle (ADL3).

Results:

Spo
2 and ΔSpo
2 in ADL2 were statistically lower than in ADL3. Ventilatory demand was statistically higher in ADL2 and ADL3 than in ADL1. Metabolic equivalent values were similar between the ADLs with values above 3.6. Oxygen desaturation was present in 41.7% (ADL1) and 33.3% (ADL2) of the patients. The LCADL% showed a moderate positive correlation with dyspnea in ADL3 and metabolic demand in ADL1. The SGRQ score presented a moderate positive correlation with dyspnea in all ADL simulations and metabolic demand in ADL1 and ADL3. Dyspnea in ADL3 and metabolic demand in ADL1 explained 33% of the variability in LCADL%. The dyspnea and metabolic demand in ADL3 explained 67% of the variability in SGRQ.

Conclusion:

Activities of daily living lead to oxygen desaturation and high ventilatory demand. London Chest Activity of Daily Living Scale reflected 33% and SGRQ reflected 67% of the functional limitation during ADL simulation, such as dyspnea and the metabolic demand during ADL.
Cardiac Rehabilitation Quality Improvement
Authors: Moghei Mahshid , Oh Paul , Chessex Caroline , Grace Sherry L.
Published: February 2019

Purpose:

Despite evidence of the effectiveness of cardiac rehabilitation (CR), there is wide variability in programs, which may impact their quality. The objectives of this review were to (1) evaluate the ways in which we measure CR quality internationally; (2) summarize what we know about CR quality and quality improvement; and (3) recommend potential ways to improve quality.

Methods:

For this narrative review, the literature was searched for CR quality indicators (QIs) available internationally and experts were also consulted. For the second objective, literature on CR quality was reviewed and data on available QIs were obtained from the Canadian Cardiac Rehabilitation Registry (CCRR). For the last objective, literature on health care quality improvement strategies that might apply in CR settings was reviewed.

Results:

CR QIs have been developed by American, Canadian, European, Australian, and Japanese CR associations. CR quality has only been audited across the United Kingdom, the Netherlands, and Canada. Twenty-seven QIs are assessed in the CCRR. CR quality was high for the following indicators: promoting physical activity post-program, assessing blood pressure, and communicating with primary care. Areas of low quality included provision of stress management, smoking cessation, incorporating the recommended elements in discharge summaries, and assessment of blood glucose. Recommended approaches to improve quality include patient and provider education, reminder systems, organizational change, and advocacy for improved CR reimbursement. An audit and feedback strategy alone is not successful.

Conclusions:

Although not a lot is known about CR quality, gaps were identified. The quality improvement initiatives recommended herein require testing to ascertain whether quality can be improved.
Delineating the Effects of Ionizing Radiation on Erythropoietic Lineage—Implications for Radiation Biodosimetry
Authors: Nimker Shwetanjali , Sharma Kanupriya , Saraswathy Radha , Chandna Sudhir
Published: February 2019

The overall lethality/morbidity of ionizing radiation exposure involves multiple forms of inhibitory or cytotoxic effects that may manifest in different tissues with a varying dose and time response. One of the major systemic effects leading to lethality of radiation includes its suppressive effect on hematopoiesis, which could be observed even at doses as low as 1–2 Gy, whereas effects on gastrointestinal and nervous systems appear at relatively higher doses in the same order. This article reviews the effects of radiation on the three distinct stages of erythropoiesis—formation of erythroid progenitor cells, differentiation of erythroid precursor cells, and terminal maturation. During these stepwise developmental processes, erythroid progenitor cells undergo rapid expansion to form terminally differentiated red blood cells that are continuously replenished from bone marrow into the circulating peripheral blood stream. Cellular radiation response depends upon many factors such as cell lineage, rate of proliferation, and differentiation status. Therefore, we discuss radiation-induced alterations during the progenitor, precursor, and terminal maturation stages and the implications thereof. Since biomarkers of ionizing radiation exposure in human populations are of great interest for assessing normal tissue injury as well as for biodosimetry in the event of accidental or incidental radiation exposures, we also highlight blood-based biomarkers that have potential utility for medical management.
Radiation Exposure of Workers and Volunteers in Shelters and Community Reception Centers in the Aftermath of a Nuclear Detonation
Authors: Anderson Jeri L. , Failla Gregory , Finklea Lauren R. , Charp Paul , Ansari Armin J.
Published: February 2019

After a nuclear detonation, workers and volunteers providing first aid, decontamination, and population monitoring in public shelters and community reception centers will potentially be exposed to radiation from people they are assisting who may be contaminated with radioactive fallout. A state-of-the-art computer-aided design program and radiation transport modeling software were used to estimate external radiation dose to workers in three different exposure scenarios: performing radiation surveys/decontamination, first aid, and triage duties. Calculated dose rates were highest for workers performing radiation surveys due to the relative proximity to the contaminated individual. Estimated cumulative doses were nontrivial but below the occupational dose limit established for normal operations by the Occupational Safety and Health Administration.
The Impact of the Cellular Origin in Acute Myeloid Leukemia: Learning From Mouse Models
Authors: Fisher James Neil , Kalleda Natarajaswamy , Stavropoulou Vaia , Schwaller Juerg
Published: February 2019

Acute myeloid leukemia (AML) is a genetically heterogeneous disease driven by a limited number of cooperating mutations. There is a long‐standing debate as to whether AML driver mutations occur in hematopoietic stem or in more committed progenitor cells. Here, we review how different mouse models, despite their inherent limitations, have functionally demonstrated that cellular origin plays a critical role in the biology of the disease, influencing clinical outcome. AML driven by potent oncogenes such as mixed lineage leukemia fusions often seem to emerge from committed myeloid progenitors whereas AML without any major cytogenetic abnormalities seem to develop from a combination of preleukemic initiating events arising in the hematopoietic stem cell pool. More refined mouse models may serve as experimental platforms to identify and validate novel targeted therapeutic strategies.
The Need for a Consensus Next‐generation Sequencing Panel for Mature Lymphoid Malignancies
Authors: Sujobert Pierre , Le Bris Yannick , de Leval Laurence , Gros Audrey , Merlio Jean Philippe , Pastoret Cedric , Huet Sarah , Sarkozy Clémentine , Davi Frédéric , Callanan Mary , Thieblemont Catherine , Sibon David , Asnafi Vahid , Preudhomme Claude , Gaulard Philippe , Jardin Fabrice , Salles Gilles , Macintyre Elizabeth
Published: February 2019

Supplemental Digital Content is available in the text
Long-term Side Effects Including Blepharitis Leading to Discontinuation of Ripasudil
Authors: Saito Hitomi , Kagami Shinji , Mishima Koichi , Mataki Naomi , Fukushima Atsuki , Araie Makoto
Published: February 2019

Precis:

Blepharitis was the most common side effect leading to discontinuation of ripasudil therapy. Prior allergic reactions to other topical glaucoma were found to be a risk factor for ripasudil-induced blepharitis.

Purpose:

To report the incidence proportion of blepharitis and its relating factors due to long-term use of 0.4% riapasudil, a Rho-kinase inhibitor, in glaucoma patients of a clinical setting.

Patients and Methods:

One hundred three eyes of 103 consecutive glaucoma patients who started ripasudil treatment between December 2014 and February 2017 at our institute, and who had a follow-up period of over 6 months were enrolled in this study. Incidence proportion, time required for recovery and risk factors associated with blepharitis and other side effects that led to discontinuation of ripasudil treatment were considered.

Results:

The most frequently observed side effect was blepharitis (25.2%). The 12- and 24-month discontinuation rate due to blepharitis was 21.1%±8.2% and 34.6%±11.8% (average±SE), respectively (Kaplan-Meier analysis). Most patients recovered from blepharitis symptoms within 4 weeks, but 5 patients required over 8 weeks for recovery. Past history of allergic reactions to other topical glaucoma medication was significantly correlated with the manifestation of blepharitis (Cox proportional hazard model, P<0.007) while age, sex, intraocular pressure reduction rate, number of administered eye drops, history of systemic allergic diseases were not.

Conclusions:

Blepharitis was the most common reason for discontinuation of ripasudil treatment. Although most cases were resolved spontaneously, prolonged blepharitis was observed in a few patients. A past history of allergic reaction to other glaucoma medication indicates a higher possibility of blepharitis with ripasudil use and warrants careful administration.
Impact of Cataract Surgery on Filtering Bleb Morphology Identified Via Swept-source 3-dimensional Anterior Segment Optical Coherence Tomography
Authors: Narita Akiko , Morizane Yuki , Miyake Tomoe , Sugihara Kae , Ishikawa Tomoko , Seguchi Jiro , Shiraga Fumio
Published: February 2019

Précis:

Analysis of filtering bleb morphology using swept-source 3-dimensional anterior segment optical coherence tomography (3D AS-OCT) indicates that phacoemulsification can negatively impact the morphology of preexisting filtering blebs.

Purpose:

To identify the cross-sectional morphologic changes in successful filtering blebs after phacoemulsification using swept-source 3D AS-OCT.

Materials and Methods:

In total, 30 phakic eyes of 29 patients with successful filtering blebs after primary trabeculectomy were included in this retrospective cohort study. Success was defined as intraocular pressure (IOP)≤15 mm Hg and a>20% reduction in IOP without glaucoma medication or additional glaucoma surgery after trabeculectomy. The subjects were classified into 2 groups according to whether they had undergone phacoemulsification or not after trabeculectomy: a phaco group and a control group. Filtering blebs were examined using swept-source 3D AS-OCT and evaluated for quantitative parameters, including maximum bleb height, maximum bleb wall thickness, and the ratio of the hyporeflective space of the bleb wall.

Results:

Sixteen eyes were assigned to the phaco group and 14 eyes to the control group. The eyes in the control group showed no significant differences in IOP or in any of the 3D AS-OCT parameters at any of the follow-up timepoints. In the phaco group, the mean IOP increased significantly after phacoemulsification (P=0.003). Furthermore, the eyes in the phaco group showed a significant decrease in maximum bleb height (P=0.030), maximum bleb wall thickness (P=0.006), and the ratio of the hyporeflective space of the bleb wall (P=0.011) between prephacoemulsification and 1-year postphacoemulsification.

Conclusion:

Phacoemulsification can have a negative impact on filtering bleb morphology, which may lead to an IOP increase.
Contact Transscleral Cyclodiode Laser Treatment for Refractory Glaucoma After Penetrating Keratoplasty: Retrospective Long-term Outcomes
Authors: Tabibian David , Wride Nicholas , Birch Michael , Figueiredo Francisco C.
Published: February 2019

Précis:

This is a retrospective study with long-term follow-up using transscleral cyclodiode laser photocoagulation (TCP) with low complication rate and good graft survival and intraocular pressure (IOP) control. Selective 180-degree TCP may offer a good IOP control with reduced complication rates.

Purpose:

To study the long-term safety and efficacy of contact TCP in eyes with refractory glaucoma after penetrating keratoplasty (PKP).

Patients and Methods:

All consecutive patients who were treated with TCP for refractory glaucoma following PKP between March 1996 and February 2017 in a tertiary corneal transplantation service in the United Kingdom. Only patients with a follow-up of 5 years were included. Eligible patients were identified through the corneal transplantation service database. Medical records and database data were retrospectively analyzed and compared at 5 years from baseline.

Results:

In total, 28 eyes of 28 patients presented with a mean IOP of 30.4 mm Hg (SD, 7.5) at baseline despite maximally tolerated topical and systemic antiglaucoma medications. IOP was reduced significantly to 12.8 mm Hg (SD, 3.6) (P<0.0001) at 5 years with 100% of patients with a successfully controlled IOP (defined as ≤21 mm Hg). All patients had a clear graft at the beginning of the study period and at 5 years 60.7% (n=17) still presented clear grafts. The average number of topical glaucoma medication was reduced from 2.8 (SD, 0.8) to 1.7 (SD, 1.2) (P=0.019) at 5 years. Visual acuity remained stable in 67.9% of patients at 5-year endpoint. No complications (ie, hypotony or phthisis bulbi) were reported during the study period and the corneal graft failure rate remained low at 5 years (39.3%).

Conclusions:

Cyclodiode laser treatment with initial selective 180-degree protocol seems to be an efficient therapeutic option in the management of patients with refractory glaucoma post-PKP when compared with other surgical alternatives. A selective 180-degree protocol seems to potentially reduce the rate of complications. Further randomized controlled studies are needed to compare outcomes with modified treatment’s protocols and glaucoma drainage device.
Bleb Morphology After Mitomycin-C Augmented Trabeculectomy: Comparison Between Clinical Evaluation and Anterior Segment Optical Coherence Tomography
Authors: Waibel Soeren , Spoerl Eberhard , Furashova Olga , Pillunat Lutz E. , Pillunat Karin R.
Published: February 2019

Purpose:

The main aim of this article was to study the longitudinal correlation between the clinical, morphological appearance of filtering blebs with anterior segment optical coherence tomography (AS-OCT) in the early postoperative period.

Methods:

Thirty eyes of 30 glaucoma patients scheduled for first-time trabeculectomy with 0.02% mitomycin-C were consecutively enrolled. The filtering blebs were evaluated clinically according to a grading system and with AS-OCT at day 1 and weeks 1, 2, 3, 4, and 12 following surgery. Bleb wall thickness (BWT) and bleb cavity height (BCH) were analyzed by means of horizontal and vertical AS-OCT scans.

Results:

Nineteen eyes (63%) had functioning blebs without any further surgical intervention. intraocular pressure changed from 18.4±1.3 mm Hg with preoperatively applied glaucoma medication to a mean of 9.75±1.4 mm Hg at all follow-ups postoperatively without medication. Mean BWT during follow-up was 575±47 μm; mean BCH was 295±72 μm. Nine filtering blebs (30%) showed encapsulation requiring a bleb needling. This was recognized clinically at week 3 in 4, and at week 4 in 5 cases. The tendency towards encapsulation was seen much earlier with AS-OCT, already showing a statistically thinner BWT (P=0.036) at week 1 and a higher BCH (P=0.005) at week 2 postsurgery, compared with the group with functioning blebs. As of week 3, intraocular pressure increased and was statistically significantly higher (P=0.016) compared with the group with functioning blebs. Two patients (7%) showed early scarring.

Conclusion:

AS-OCT allows an analysis of the clinically invisible deeper layers of the filtering bleb. Characteristics of encapsulation, like higher blebs with thinner bleb walls, are sooner recognized than the clinical appearance. This might benefit the management of the postoperative period after trabeculectomy and the long-term outcome.
Evaluation of a Long-Term, Physical Therapy Service-Learning Partnership in Ecuador: Inclusion of the Community Voice
Authors: Hayward Lorna M. , Schneider Jennifer , Gandhi Sonu , Per Samara , Donat Marcella , Hayward Julia K.
Published: February 2019

Background and Purpose.

International service learning (ISL) is an instructional method used by physical therapist educators to increase the global perspective of students. Research exploring student experiences with ISL is plentiful, but evaluation of service outcomes from the community partner perspective is lacking. The purposes of this work were to evaluate the impact of a long-term community partnership through: (1) identification of benefits, drawbacks, and suggestions for sustaining the partnership and (2) gathering feedback on the immediate and short-term perspective of training provided to orphanage staff.

Method/Model Description and Evaluation.

The model consisted of a curriculum-based ISL experience involving a US-based physical therapy program and a service site at an Ecuadorian orphanage. For the current work, an evaluation component was added to the model. Three complementary approaches: the SOFAR Model, Exchange theory, and the partnership qualities of closeness, equity, and integrity informed the evaluation. Data consisted of 6 interviews conducted and 17 surveys administered to Ecuadorian community partner staff/administration. Data were analyzed using qualitative thematic content analysis, descriptive statistics, and paired t tests.

Outcomes.

Partnership benefits included: iterative pre-trip communication, a respectful and mutually beneficial relationship, capacity building through education, and physical therapy that positively affected the children's quality of life. Drawbacks were the potential for host site dependency due to lack of local capacity, negative impact of new technology on staff workload, and poor treatment carryover. Continued training was identified as critical for building capacity within orphanage staff.

Discussion and Conclusion.

As more US student teams deliver clinical services abroad, intentional evaluation approaches must include the community partner voice to maximize benefits, minimize burdens, build capacity, and addresses issues of vital importance to the service site.
Improving Interprofessional Communication Confidence Among Physical Therapy and Nurse Practitioner Students
Authors: Cooper Denise , Keiser Megan , Berg Karen , Sherman Erica
Published: February 2019

Introduction.

Educators identified a deficiency in interprofessional communication education in a midwestern university's Doctor of Physical Therapy (DPT) and Doctor of Nursing Practice (DNP) programs. While several professional organizations stress the importance of interprofessional communication, few studies have focused on such communication between DPT and DNP students. The purpose of this study was to assess DNP and DPT students' knowledge and perception of confidence in interprofessional communication after a simulation-based learning activity conducted via telephone consultation. During the activity, students used the Situation, Background, Assessment, Recommendation (SBAR) method with a clinical case study.

Methods.

The study used a nonrandom sample of 52 first-year DPT and 19 second-year DNP students. Participants completed a questionnaire prior to an educational intervention consisting of SBAR and interprofessional education (IPE) modules. The activity was conducted using an online audio conferencing tool. Students then completed a postintervention questionnaire and reflective questions.

Results.

Data analysis (descriptive statistics, analysis of variance with change scores, and qualitative data analysis) showed that DPT students had significantly higher changes in SBAR combined knowledge and attitude scores compared to DNP students after simulation activity.

Discussion and Conclusion.

Introducing interprofessional communication such as SBAR approach in DPT and DNP curricula using realistic, simulation-based learning activities with clinical case studies may help students improve their confidence in interprofessional communication.
An Intraprocedural Endoscopic Cleansing Device for Achieving Adequate Colon Preparation in Poorly Prepped Patients
Authors: Pérez Jiménez Javier , Diego Bermúdez Lucas , Gralnek Ian M. , Martín Herrera Leopoldo , Libes Michael
Published: February 2019

Background and Aims:

An effective bowel preparation is essential for quality colonoscopy. Inadequate preparation results in missed lesions, need for earlier repeat procedures, prolonged colonoscopy duration, an increased likelihood of adverse events, reduced patient satisfaction, and increased costs. The MOTUS GI Pure-Vu System (Tirat Carmel, Israel) is an Food and Drug Administration-cleared device designed to improve visualization in an inadequately prepared colon by facilitating intraprocedural cleaning. We evaluated the efficacy, safety, and usability of the Pure-Vu System in cleansing poorly prepared colons in human subjects.

Methods:

In total, 50 patients with poorly prepared colons undergoing colonoscopy were prospectively enrolled to evaluate the Pure-Vu System at 2 clinical sites [Spain (N=41) and Israel (N=9)]. Cleansing quality was measured using the Boston Bowel Preparation Score (BBPS).

Results:

In total, 50 patients (64% male individuals), mean age 51.9±10.4 years, and mean body mass index of 26.6±3.1 were enrolled. The Pure-Vu System significantly increased the BBPS median score from 5.0 at baseline to 9.0 after the use of Pure-Vu (P<0.0001). Patients with an adequate cleansing level (BBPS≥2 in each colon segment) increased significantly from 31% (15/49) at baseline to 98% (48/49) after use of Pure-Vu (P<0.001). Cecal intubation was achieved in 48/49 (98%) patients. Colonoscopists were satisfied with the Pure-Vu System. No serious adverse events were reported.

Conclusions:

The Pure-Vu System was found to be safe, efficacious, and easy to use in cleansing inadequately prepared colons, enabling the colonoscopist to conduct a complete examination.
GI Motility Testing
Authors: Lee Allen , Baker Jason , Hasler William L.
Published: February 2019

Symptoms of abdominal pain, nausea, vomiting, bloating, abdominal distention, diarrhea, and constipation are common and may relate to abnormalities in gastrointestinal motility. There are a number of different options to study gastrointestinal motility. This article reviews novel and standard motility tests available in the stomach, small bowel, and colon. The indications for testing, technical details, advantages, and disadvantages of each test will be summarized.
POEM in Latin America
Authors: Kahaleh Michel , Xu Ming-ming , Zamarripa Felipe , Martínez Guadalupe , Arantes Vitor N. , Rodriguez Fernando Casas , Castillo Bismarck , Andalib Iman , Tyberg Amy , Lambroza Arnon , Saumoy Monica , Carames Juan C. , Baptista Alberto , Robles-Medranda Carlos , Lukashok Hanna , Gaidhane Monica , Valencia Juan M.B. , Moura Eduardo T.H.d. , Moura Eduardo G.H.d.
Published: February 2019

Background:

Per-oral endoscopic myotomy (POEM) has become the preferred alternative treatment to standard Heller myotomy for patients with esophageal achalasia, in Latin American countries. The aim of our study was to evaluate the efficacy and safety of a POEM in the management of achalasia with and without Chagas disease in patients receiving POEM.

Methods:

Patients who underwent POEM from tertiary centers in Latin America were included in a dedicated registry. Countries included Brazil, Colombia, Ecuador, Mexico, Nicaragua, and Venezuela. Patients enrolled needed to have a preoperative manometry and swallow contrast study confirming achalasia. Clinical success was defined as significant improvement in Eckardt score after therapy.

Results:

POEM was technically successful in 81/89 (91%) patients (mean age, 44 y). There was a significant decrease in preprocedure and postprocedure Eckardt score from 8.7 (range, 3 to 12) to 2.15 (0 to 10) (P<0.001), preprocedure and postprocedure barium swallow evaluation (98% vs. 89%; P=0.017), and preprocedure and postprocedure lower esophageal sphincter pressure measurement (from 35 to 13.8 mm Hg; P<0.001). Clinical success was achieved in 93% of patients. Patients with Chagas disease (n=58) were 9.5 times more likely to respond to POEM (P=0.0020; odds ratio, 9.5).

Conclusions:

POEM is an efficacious and safe therapeutic modality for treatment of achalasia in Latin America. Chagas disease-related achalasia seems to particularly respond better to POEM when it is performed by experienced endoscopists.
A Comprehensive Review of Patient-reported Outcomes in Patients With Chronic Liver Diseases
Authors: Younossi Zobair M. , Golabi Pegah , Henry Linda
Published: February 2019

Chronic liver disease (CLD) is a global health problem with chronic viral hepatitis, alcohol-related liver disease, and nonalcoholic fatty liver disease being important causes of mortality. Besides its clinical burden, patients with CLD also suffer from impairment of their health-related quality of life and other patient-reported outcomes (PRO). In this context, a combination of both clinical and PROs will allow assessment of the comprehensive burden of liver disease on patients. PROs cannot be observed directly and must be assessed by validated questionnaires or tools. Various tools have been developed to accurately measure PROs in patients with CLD, including generic and disease-specific questionnaires such as Short Form-36, Chronic Liver Disease Questionnaire and its subtypes. It is important to note that PRO instruments can be used to appreciate the impact of the natural history of CLD or of treatment on patients’ experiences. This review summarizes PRO assessment in different types of liver disease and different tools useful to investigators and clinicians who are interested in this aspect of patients’ experience.
Noninvasive Assessment of Portal Hypertension Using Spectral Computed Tomography
Authors: Wang Jun , Gao Feng , Shen Jia Lin
Published: February 2019

Background:

Early diagnosis of portal hypertension is imperative for timely treatment to reduce the mortality rate. However, there is still no adequate method to noninvasively and accurately assess the portal hypertension in routine clinical practice.

Purpose:

We aimed to evaluate the accuracy of parameters measured using dual energy spectral computed tomography (LightSpeed CT750 HD) in assessing portal venous pressure in patients with liver cirrhosis.

Study:

Forty-five patients with liver cirrhosis who underwent percutaneous transhepatic portal vein puncture as part of their treatment for liver disease were enrolled in this study. Measurement of direct portal venous pressure was performed preoperatively. All patients underwent dual energy spectral computed tomography within 3 days before their operations.

Results:

The iodine concentrations of portal vein and hepatic parenchyma during the portal venous phase and the alanine aminotransferase level were found to be independently correlated with the direct portal venous pressure according to stepwise multivariate linear regression analysis (P<0.001, 0.004, and 0.024, respectively). In a receiver operating characteristic analysis, the area under the receiver operating characteristic of iodine concentrations of the portal vein (ICPV) for identifying clinically significant portal hypertension (≥10 mm Hg) was significantly higher than that of iodine concentrations of hepatic parenchyma (ICliver) and the alanine aminotransferase level (0.944, 0.825, and 0.301, respectively). The threshold ICPV of 58.27 yielded a sensitivity of 93.8%, specificity of 69.2%, positive predictive value of 88.2%, and negative predictive value of 81.8%, respectively.

Conclusions:

ICPV values may be a useful tool in noninvasively assessing the portal venous pressure and identifying clinically significant portal hypertension in liver cirrhosis.
Technological advances shaping diabetes care
Authors: Akturk Halis Kaan , Garg Satish
Published: February 2019

Purpose of review

To emphasize the current unmet needs for patients with diabetes and evaluate the recent technological advances in the diabetes field and summarize upcoming technologies in diabetes care. This review highlights emerging diabetes technologies and patient-centered diabetes management.

Recent findings

A review of the literature showed that there is a clear benefit of using diabetes technologies in diabetes care. Recently, the US Food and Drug Administration (FDA) created a new category of Class II integrated continuous glucose monitoring (iCGM) devices and announced new guidelines to accelerate the approval of future products. With the first-generation hybrid-closed loop, a new era opened in automated insulin delivery systems. Diabetes coaching, apps, and remote monitoring technologies eased access to the providers and increased patient's self-confidence for diabetes management.

Improvements in diabetes technologies will hopefully overcome unmet needs for patients with diabetes and improve health outcomes. Patients will benefit from the upcoming technologies in their day-to-day diabetes management while providers may monitor patients remotely with ease and efficiently. These developments will decrease diabetes burden, improve quality of life, and open a new era of personalized diabetes care.
The neurointensive nursery: concept, development, and insights gained
Authors: Glass Hannah C. , Ferriero Donna M. , Rowitch David H. , Shimotake Thomas K.
Published: February 2019

Purpose of review

With the advent of therapeutic hypothermia for treatment of hypoxic ischemic encephalopathy, and improvements in neuroimaging and bedside neuromonitoring, a new era of neonatal brain-focused care has emerged in recent years. We describe the development of the first neurointensive care nursery (NICN) as a model for comanagement of neonates with identified neurologic risk factors by a multidisciplinary team constituted of neurologists, neonatologists, specialized nurses, and others with the goal of optimizing management, preventing secondary injury and maximizing long-term outcomes.

Recent findings

Optimizing brain metabolic environment and perfusion and preventing secondary brain injury are key to neurocritical care. This includes close management of temperature, blood pressure, oxygenation, carbon dioxide, and glucose levels. Early developmental interventions and involvement of physical and occupational therapy provide additional assessment information. Finally, long-term follow-up is essential for any neurocritical care program.

The NICN model aims to optimize evidence-based care of infants at risk for neurologic injury. Results from ongoing hypothermia and neuroprotective trials are likely to yield additional treatments. New technologies, such as functional MRI, continuous neurophysiological assessment, and whole genomic approaches to rapid diagnosis may further enhance clinical protocols and neonatal precision medicine. Importantly, advances in neurocritical care improve our ability to provide comprehensive information when counseling families. Long-term follow-up data will determine if the NICN/Neuro-NICU provides enduring benefit to infants at risk for neurologic injury.
Healthy Body Weights With Corticosteroid‐free Immunosuppression Is the Best Predictor of Cardiovascular Health in Children After Liver Transplantation
Authors: Mager Diana R. , Hager Amber , Siminoski Kerry , Yap Jason K. , Gilmour Susan M.
Published: February 2019

Introduction:

Cardiometabolic dysregulation (CMD) influences morbidity and mortality risk in adults post‐liver transplantation (LTx). CMD is reported in 10% to 25% of pediatric LTx recipients, but no information regarding the longitudinal expression of CMD is available. The study objective was to examine the longitudinal expression of CMD and associations with body composition and growth in children post‐LTx.

Methods:

A retrospective review was conducted in youth (34 F/30 M) who underwent LTx between 1994 and 2015 at the Stollery Children's Hospital. Primary outcomes included serum markers of CMD (insulin, glucose, hemoglobin A1C [A1C], homeostasis model assessment for insulin resistance [abnormal >3], lipid panel triglycerides, total cholesterol, high‐density lipoprotein‐cholesterol, low‐density lipoprotein‐cholesterol) and systolic/diastolic blood pressure (BP: absolute/z scores).

Results:

Mean (±SD) age, weight z, height z, body mass index z was 9.7 ± 3.4 years (3.5–17.9), 0.26 ± 1.03, 0.017 ± 1.2, and 0.41 ± 1.05, respectively. The majority of children had percentage fat mass, percentage fat‐free mass within normal reference ranges. Systolic/diastolic BP was within healthy references ranges in 83.1% and 93.5% of children, respectively. Serum insulin (83.4%) and high‐density lipoprotein‐cholesterol (43.9%) concentrations were low, with abnormal findings of other laboratory markers found in <5% of participants. Abnormal findings for metabolic parameters were independent of weight z, body mass index z, fat mass, and corticosteroids but were positively related to child's age (>9.7 years) and fat‐free mass (total, arms). Insulin levels decreased significantly in the first 4 years post‐LTx, but no changes in lipid panel, A1C and glucose were noted over 10 years.

Conclusions:

Pediatric LTx recipients with healthy body weights and corticosteroid‐free immunosuppression have a low expression of CMD over 10 years.
Prevalence of Gastroesophageal Reflux Disease Symptoms in Infants and Children
Authors: Singendonk Maartje , Goudswaard Eline , Langendam Miranda , van Wijk Michiel , van Etten‐Jamaludin Faridi , Benninga Marc , Tabbers Merit
Published: February 2019

Objectives:

Gastroesophageal reflux disease (GERD) is defined as gastroesophageal reflux causing troublesome symptoms or complications. In this study we reviewed the literature regarding the prevalence of GERD symptoms in infants and children.

Methods:

Databases of PubMed, EMBASE, and Cochrane were systematically searched from inception to June 26, 2018. English‐written studies based on birth cohort, school‐based, or general population samples of ≥50 children aged 0 to 21 years were included. Convenience samples were excluded.

Results:

In total, 3581 unique studies were found, of which 25 studies (11 in infants and 14 in children) were included with data on the prevalence of GERD symptoms comprising a total population of 487,969 children. In infants (0–18 months), GERD symptoms are present in more than a quarter of infants on a daily basis and show a steady decline in frequency with almost complete disappearance of symptoms at the age of 12 months. In children older than 18 months, GERD symptoms show large variation in prevalence between studies (range 0%‐38% of study population) and overall, are present in >10% and in 25% on respectively a weekly and monthly basis. Of the risk factors assessed, higher body mass index and the use of alcohol and tobacco were associated with higher GERD symptom prevalence.

Conclusions:

This systematic review demonstrates that the reported prevalence of GERD symptoms varies considerably, depending on method of data collection and criteria used to define symptoms. Nevertheless, the high reported prevalence rates support better investment of resources and educational campaigns focused on prevention.
Psychologic Distress and Anxiety in Mothers of Children With Gastroesophageal Reflux Undergoing Antireflux Surgery
Authors: Kvello Morten , Åvitsland Tone Lise , Knatten Charlotte K. , Fyhn Thomas J. , Malt Ulrik , Emblem Ragnhild , Bjørnland Kristin
Published: February 2019

Objectives:

Parents of children with a chronic illness are at risk for impaired psychosocial functioning. Gastroesophageal reflux disease (GERD) is such a disease, and no studies have investigated effects of antireflux surgery on parental psychological distress. The aims of this study were to assess psychological distress and state and trait anxiety in mothers of children with GERD, and to explore possible changes after antireflux surgery.

Methods:

Mothers of children referred for antireflux surgery were included in this prospective study. Standardized questionnaires were used to evaluate psychological distress and state and trait anxiety before and 12 months after antireflux surgery.

Results:

Of 87 eligible mothers of children with GERD, 62 (71%) agreed to participate. All children had objectively verified GERD by 24‐hour pH‐monitoring and/or upper gastrointestinal contrast study and unsatisfactory symptom relief of pharmacological treatment. Thirty‐one (50%) mothers returned questionnaires postoperatively. Preoperatively, mothers of children undergoing antireflux surgery reported high levels of psychological distress and state anxiety, and 54% had scores indicating clinically significant psychological distress. None of the preoperative child characteristics were found to significantly influence maternal psychological distress or state anxiety. Twelve months postoperatively, both psychological distress and state anxiety were reduced.

Conclusions:

Mothers of children undergoing antireflux surgery reported reduced levels of psychological distress and state anxiety 12 months after the operation.
Emotion-Focused Avoidance Coping Mediates the Association Between Pain and Health-Related Quality of Life in Children With Sickle Cell Disease
Authors: Lim Crystal S. , Karlson Cynthia , Edmond Sara N. , Welkom Josie S. , Osunkwo Ifeyinwa , Cohen Lindsey L.
Published: February 2019

Sickle cell disease (SCD) is associated with pain and decreased health-related quality of life (HRQOL). Coping strategies influence pain but have not been evaluated as mediating the relation between pain and HRQOL in pediatric SCD. The current study examined whether pain-related coping mediates the association between pain and HRQOL in children and adolescents with SCD. In total, 104 children and adolescents 8 to 18 years of age (M
age=12.93 y) with SCD attending outpatient clinics completed pain intensity, HRQOL, and pain-related coping measures. Multiple mediation analyses were used to examine whether pain-related coping mediated the pain and HRQOL relation and whether types of coping (ie, approach, emotion-focused avoidance, problem-focused avoidance) were independent mediators. Total indirect effects for models examining physical and psychosocial HRQOL were not significant. After controlling for covariates, emotion-focused avoidance significantly mediated the association between pain and physical HRQOL (effect: −0.023; bootstrapped SE: 0.018; 95% confidence interval: −0.0751, −0.0003) but not the pain and psychosocial HRQOL relation. Approach and problem-focused avoidance were not significant mediators. Coping with pain in pediatric SCD is an important avenue for clinical intervention and additional research. Among children with SCD reporting high pain intensity, interventions should emphasize negative impacts of emotion-focused avoidance coping and integrate other empirically supported coping strategies to improve HRQOL.
Identification of a Novel MYH9 Mutation in a Young Adult With Inherited Thrombocytopenia and Recurrent Seizures by Targeted Exome Sequencing
Authors: Yang Eu Jeen , Park Kyung Mi , Kim Yoo-Mi , Jung Ki Sun , Lim Young Tak , Cheon Chong Kun
Published: February 2019

May-Hegglin anomaly (MHA) is a rare autosomal dominant disorder caused by a mutation in the myosin heavy chain 9 (MYH9) gene. MHA patients have variable clinical manifestations including thrombocytopenia, renal injury, hearing impairment, and cataracts. We describe a 25-year-old man with isolated thrombocytopenia initially. He experienced recurrent seizures with stable thrombocytopenia after the first seizures related to intracranial hemorrhage. He was identified a novel c.3452C>T mutation by targeted exome sequencing. If a patient with thrombocytopenia shows recurrent seizures as well as renal, hearing, visual symptoms, MHA should be suspected and the targeted exome sequencing is considered an effective diagnostic tool.
Differentiation of Brucella species by repetitive element palindromic PCR
Authors: Amoupour Moein , Nezamzadeh Fatemeh , Zahedi bialvaei Abed , Masjedian Jazi Faramarz , Alikhani Mohammad Yousef , Mirnejad Reza
Published: February 2019

Brucellosis is one of the most prevalent zoonotic diseases among animals and humans. It is a well known fact that the differentiation and rapid typing of Brucella spp. is crucial for the early detection of infection, prevention of infection progress, and/or introducing treatment solutions. Analyzing the sequences could be an effective method in achieving these purposes. The aim of this study was to analyze palindromic sequences for Brucella spp., differentiation using the rep-PCR method. The authors collected 80 animal samples, which were suspected to brucellosis infection. After the cultivation of Brucella, identification was performed through standard biochemical, microbiological, and IS711 PCR assays. By designing the specific primers for polymorphism sequence, the rep-PCR was performed. The resultant pattern was compared with the obtained patterns of the standard Brucella melitensis and Brucella abortus samples, which showed dissimilar patterns. For this reason, the PCR products were sequenced, and consequently two new patterns were introduced. This rapid and repeatability assay has the ability to potentially differentiate the B. abortus and B. melitensis species, which could be useful in early diagnosis and treatment of patients with brucellosis.
The “Obsessive Paradox”
Authors: Tonna Matteo , Ottoni Rebecca , Pellegrini Clara , Bettini Elena , Accardi Valeria , Ossola Paolo , De Panfilis Chiara , Marchesi Carlo
Published: February 2019

The objective of the study was to investigate the relationship between cognitive functions and obsessive-compulsive dimension in schizophrenia and a possible moderating effect of schizophrenia symptom dimensions on this association. Sixty-one schizophrenia patients were administered the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive-Compulsive Scale (YBOCS), and the Matrics Consensus Cognitive Battery. A U-shaped curve described a gradual transition from an inverse association to a positive relationship between YBOCS and processing speed scores, along a severity gradient of obsessive dimension. This effect (“the obsessive paradox”) was not moderated by other symptom dimensions. The present study suggests that severe obsessive-compulsive symptoms may participate to counterbalance processing speed impairment independently from other symptom dimensions. These results highlight the complexity of the relationship between cognitive and obsessive dimensions in schizophrenia.