bluuebunny/crossref_metadata_2025 huggingface dataset:
Potential effects of virtual interventions for menopause management: a systematic review
Authors: Zou Ping , D'Souza Daniel , Luo Yan , Sun Winnie , Zhang Hui , Yang Yeqin
Published: August 2022

Importance

Menopausal women are one of the fastest growing demographic groups globally. Virtual interventions have emerged as alternate avenues for menopausal women to manage and cope with their symptoms.

Objective

The purpose of this review is to summarize existing research on the potential effects of virtual interventions for menopause management.

Evidence Review

This systematic review was written in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, PsychINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsychARTICLES, and Sociology Database were used for literature search and searched from conception to December 2021. Original studies, including randomized controlled trials and quasi-experimental studies, were included if they evaluated a virtual intervention for menopause management and investigated the effects of these interventions on physical and psychosocial outcomes and/or the feasibility of these interventions among menopausal women. Included studies were published in peer-reviewed journals and assessed for quality using the Critical Appraisal Skills Program Checklists.

Findings

A total of 16 articles were included in this review. Virtual interventions have the potential to improve physical health outcomes including body weight/body mass index/waist circumference, pain, blood pressure, and cholesterol. However, conflicting results were identified for the outcomes of vasomotor and endocrine symptoms, sleep, and sexual functioning. Virtual interventions might also improve psychosocial outcomes, including knowledge and patient-physician communication, although conflicting results were again identified for treatment decision-making ability, quality of life, and anxiety and depression. Virtual interventions were feasible in terms of being usable and cost-effective, and eliciting satisfaction and compliance among menopausal women.

Conclusions and Relevance

Virtual interventions might have the potential to improve the physical and psychosocial health outcomes of menopausal women, although some conflicting findings arose. Future studies should focus on including diverse menopausal women and ethnic minorities, conducting research within low- to middle-income countries and communities, further exploring intervention design to incorporate features that are age and culture sensitive, and conducting full randomized controlled trials to evaluate the effects of the interventions.
Guideline Awareness Disparities in Plastic Surgery: A Survey of American Society of Plastic Surgeons
Authors: Rames Jess D. , Lane Whitney O. , Phillips Brett T.
Published: August 2022

Background:

The American Society of Plastic Surgeons (ASPS) clinical practice guidelines were constructed to help direct evidence-based surgical management in plastic surgery. Societal member awareness of the recommendations for breast reconstruction has yet to be studied among ASPS members.

Methods:

Univariate and multivariate analyses were performed using electronic survey data from 243 ASPS members. Characteristics, including respondent demographics, practice distribution, and geographic locations, were correlated to the awareness of autologous and expander/implant-based reconstruction guidelines.

Results:

Of the respondents, 52% and 35.7% reported awareness for autologous breast reconstruction and expander/implant-based reconstruction guidelines, respectively. Surgeons who performed more general and autologous breast reconstruction were more likely to be aware of autologous breast reconstruction and expander/implant-based guidelines (P = 0.0034 and 0.032). Autologous breast reconstruction guideline awareness was geographically disparate (P = 0.031), with greater awareness in the Northeast (OR, 4.5; 95% CI, 1.63–12.53; P = 0.01) and Southwest (OR, 3.91; 95% CI, 1.18–13.83; P = 0.01). Respondents with larger practice percentages of breast reconstruction and those with higher annual academic meeting attendance reported greater awareness of expander/implant-based guidelines (P = 0.044 and 0.040). Meeting attendance (OR, 2.14; 95% CI, 1.15–8.91; P = 0.022) and practice-based (OR, 3.14; 95% CI, 1.52–8.91; P = 0.027) awareness disparities were also appreciated on multivariate analysis.

Conclusions:

Guideline awareness in plastic surgery varies by practice composition and geography. These findings can be used to help inform more targeted educational and implementation strategies in breast reconstruction.

Clinical Question/Level of Evidence:

Quality Improvement/Level IV
Telemonitoring and protocolized case management for hypertensive community dwelling older adults (TECHNOMED): a randomized controlled trial
Authors: Lau Darren , Ringrose Jennifer , McAlister Finlay A. , Fradette Miriam , Wood Peter W. , Boulanger Pierre , Klarenbach Scott , Holroyd-Leduc Jayna M. , Alagiakrishnan Kannayiram , Rabi Doreen , Padwal Raj
Published: August 2022

Background:

Home blood pressure (BP) telemonitoring combined with case management leads to BP reductions in individuals with hypertension. However, its benefits are less clear in older (age ≥ 65 years) adults.

Methods:

Twelve-month, open-label, randomized trial of community-dwelling older adults comparing the combination of home BP telemonitoring (HBPM) and pharmacist-led case management, vs. enhanced usual care with HBPM alone. The primary outcome was the proportion achieving systolic BP targets on 24-h ambulatory BP monitoring (ABPM). Changes in HBPM were also examined. Logistic and linear regressions were used for analyses, adjusted for baseline BP.

Results:

Enrollment was stopped early due to coronavirus disease 2019. Participants randomized to intervention (n = 61) and control (n = 59) groups were mostly female (77%), with mean age 79.5 years. The adjusted odds ratio for ABPM BP target achievement was 1.48 (95% confidence interval 0.87–2.52, P = 0.15). At 12 months, the mean difference in BP changes between intervention and control groups was −1.6/−1.1 for ABPM (P-value 0.26 for systolic BP and 0.10 for diastolic BP), and −4.9/−3.1 for HBPM (P-value 0.04 for systolic BP and 0.01 for diastolic BP), favoring the intervention. Intervention group participants had hypotension (systolic BP < 110) more frequently (21% vs. 5%, P = 0.009), but no differences in orthostatic symptoms, syncope, non-mechanical falls, or emergency department visits.

Conclusions:

Home BP telemonitoring and pharmacist case management did not improve achievement of target range ambulatory BP, but did reduce home BP. It did not result in major adverse consequences.
Are you as old as your arteries? Comparing arterial aging in Japanese and European patient groups using cardio-ankle vascular index
Authors: Kirkham Frances A. , Mills Charlotte , Fantin Francesco , Tatsuno Ichiro , Nagayama Daiji , Giani Anna , Zamboni Mauro , Shirai Kohji , Cruickshank John Kennedy , Rajkumar Chakravarthi
Published: August 2022

Background:

Most comparisons of arterial stiffness between ethnic groups focus on pulse wave velocity. This study used the cardio-ankle vascular index (CAVI) in European compared to Japanese individuals to investigate how cardiovascular risk factors affect arterial aging across geographic regions.

Methods:

Four hundred and ninety-four European and 1044 Japanese individuals underwent measurements of CAVI, blood pressure and information on cardiovascular risk factors. Both datasets included individuals with 0–5 cardiovascular risk factors.

Results:

Average CAVI was higher in the Japanese than the European group in every age category, with significant differences up to 75 years for males and 85 for females. The correlation of CAVI with age, controlled for cardiovascular risk factors, was slightly higher in Japanese females (r = 0.594 vs. Europeansr = 0.542) but much higher in European males (r = 0.710 vs. Japaneser = 0.511). There was a significant correlation between CAVI and total cardiovascular risk factors in the Japanese (r = 0.141,P < 0.001) but not the European group. On linear regression, average CAVI was significantly dependent on age, sex, diabetes, BMI, SBP and geographic region. When divided into ‘healthy’ vs. ‘high risk’, the healthy group had a steeper correlation with age for Europeans (r = 0.644 vs. Japaneser = 0.472, Fisher'sZ P < 0.001), whereas in the high-risk group, both geographic regions had similar correlations.

Conclusion:

Japanese patient groups had higher arterial stiffness than Europeans, as measured by CAVI, controlling for cardiovascular risk factors. Europeans had greater increases in arterial stiffness with age in healthy individuals, particularly for males. However, cardiovascular risk factors had a greater impact on the Japanese group.
Decreasing the Rate of Antibiotics Administration to Newborns of Mothers With Prolonged Rupture of Membranes and Unknown Group B Streptococcus Status Using the Plan-Do-Study-Act Quality Improvement Model
Authors: Alaaraj Bayan , Irshaid Ayah , Al-lawama Manar
Published: August 2022

Background

Prolonged rupture of membranes (PROM) and maternal group B Streptococcus (GBS) colonization are major risk factors for early-onset sepsis. Managing asymptomatic newborns remains burdensome, as exposing them to unnecessary antibiotics or withholding them when needed is potentially harmful. Decreasing the rate of antibiotics administration to newborns of mothers with PROM and unknown GBS status is important.

Methods

A quality improvement project applying the Plan-Do-Study-Act model was conducted to test the efficacy of a proposed protocol to lower the rate of antibiotics administration. This protocol uses information on clinical status and biochemical markers, as well as the recommendation of the neonatal early-onset sepsis calculator, to decide whether to start antibiotics administration to newborns of mothers with PROM and unknown GBS status who are asymptomatic at birth. Neonates born at ≥34 weeks' gestation to mothers with PROM and unknown GBS status were included in this work.

Results

Sixty-six babies were included, 2 (3%) of whom had positive blood cultures, and a total of 24 (41.8%) newborns did not receive antibiotics. The rate of antibiotics administration for 2 days only was 55 times lower than the current practice. The rate of no antibiotics administration was 35 times higher than the current practice (P < 0.0001). None of the included newborns were readmitted because of sepsis.

Conclusions

The rate of antibiotics administration was significantly decreased. None of the infants were readmitted because of sepsis, proving protocol safety. The implemented protocol will be adopted, as the aim of this quality improvement project was achieved.
Predictors of VA Primary Care Clerical Staff Burnout Using the Job Demands-Resources Model
Authors: Medich Melissa , Rose Danielle , McClean Michael , Nelson Karin , Stewart Gregory , Ganz David A. , Yano Elizabeth M. , Stockdale Susan E.
Published: August 2022

Primary care clerical staff may experience burnout if not adequately prepared and supported for patient-facing customer service tasks. Guided by the Job Demands-Resources (JD-R) model, we use national survey data from 707 primary care clerks at 349 VA clinics (2018; response rate: 12%) to evaluate associations between clerks' perceptions of tasks, work environment, training, and burnout. We found challenges with customer-facing tasks contribute to higher burnout, and supportive work environment was associated with lower burnout. Although perceptions of training were not associated with burnout, our results combined with the JD-R model suggest that customer service training may protect against burnout.
Therapists Predict Discharge Destination More Accurately Than the AM-PAC “6 Clicks” at Evaluation and Discharge for Patients With Isolated Coronary Artery Bypass Graft
Authors: Bradley Rebecca , Tecson Kristen M. , Schuchert Jerry , Topping Michele
Published: August 2022

Background:

Clinicians and hospital care coordinators seek effective tools to assist with reducing length of stay, delivering appropriate postacute care services, and reducing readmissions for patients following coronary artery bypass grafting (CABG) surgery.

Objective:

To evaluate whether the discharge recommendation by the Activity Measure for Post-Acute Care (AM-PAC) “6 Clicks” Inpatient Basic Mobility and Daily Activity Short Forms agreed with therapists' recommendation and actual discharge disposition for patients who underwent isolated CABG.

Methods:

Physical therapists (PTs) and occupational therapists (OTs) recorded their respective AM-PAC “6 Clicks” score on a cohort of consecutive patients admitted for isolated CABG between March and April 2020. The level of agreement was compared between AM-PAC-projected discharge disposition, therapists' recommendation, and actual discharge disposition.

Results:

There were 58 patients who received discharge recommendations from PTs and OTs following isolated CABG. Upon PT initial evaluation, the AM-PAC “6 Clicks” Basic Mobility tool recommended postacute placement in all 58 (100%) cases, whereas PTs recommended postacute placement for only 1 (2%). Similarly, the AM-PAC “6 Clicks” Daily Activity tool recommended postacute placement in all 58 (100%) cases, whereas OTs recommended discharge to home for 44 (76%) cases and recommended further assessment of discharge needs on the remaining 14 (24%). At the final session, the AM-PAC “6 Clicks” Basic Mobility tool recommended postacute placement in 56 (98%) cases and PTs recommended discharge to home in all 58 (100%) cases. The AM-PAC “6 Clicks” Daily Activity tool recommended postacute placement for 25 (43%) cases, whereas OTs recommended discharge to home for 55 (95%) cases. Nearly all (56; 97%) patients were discharged to home, with the remaining 2 (3%) discharged to postacute placement. The 30- day readmission rate was 2%.

Conclusion:

We found the PT/OT recommendations were strongly associated with discharge disposition, but that the AM-PAC “6 Clicks” scores had poor agreement with therapists' recommendations and with actual discharge dispositions for patients with isolated CABG. The utility of this tool should be explored in other cardiac patient populations, such as valve replacements with and without sternotomy, and heart failure, to corroborate the results.
Voluntary Unemployment Is Associated With Increased Prevalence of Stroke and its Risk Factors in Middle-Aged Adults
Authors: Błaż Michał , Banaszkiewicz Krzysztof , Michalski Michał , Sarzyńska-Długosz Iwona
Published: August 2022

Objective

The aim of the study is to investigate the association between the prevalence of stroke, its risk factors, and occupational status, with a differentiation between voluntary and involuntary unemployment.

Methods

This is a cross-sectional study, which included 3013 individuals aged 40 to 65 years. We compared the prevalence of stroke, comorbidities, self-reported stroke-like symptoms, healthy behaviors, and knowledge about stroke among the voluntarily and involuntarily unemployed versus the employed.

Results

Voluntary unemployment was associated with increased chances of stroke (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.05–3.57), hypertension (OR, 1.18; 95% CI, 1.06–1.32), diabetes (OR, 1.16; 95% CI, 1.01–1.35), and obesity (OR, 1.16; 95% CI, 1.05–1.29). Involuntary job loss was associated with increased odds of hypertension (OR, 1.69; 95% CI, 1.16–2.50) and more frequent self-reported stroke-like symptoms.

Conclusions

We found higher chances of stroke among the voluntarily unemployed middle-aged adults, presumably because of increased prevalence of hypertension, diabetes, and obesity.
Pressure Reduction Management System in Three-Dimensional-Printed Transtibial Prosthetic Socket during Stance Phase
Authors: Subih Murad , Arifin Nooranida , Al-Fakih Ebrahim A.
Published: August 2022

Introduction

High pressure on sensitive areas of the residual limb while wearing a prosthetic socket must be minimized to avoid injury and uncomfortable fitting. The purpose of this study was to reduce the peak pressures on sensitive regions within a three-dimensional (3D)-printed transtibial prosthetic socket.

Materials and Methods

This study proposed a 3D-printed socket with three built-in tiny air bladders integrated within the interface between the liner and socket and electronically managed by a pressure and volume control system. A pseudo-artificial residual limb was fabricated to mimic the transtibial residual limb. The interface pressure in the 3D-printed socket was evaluated using F-socket transducers during inflation and deflation of the air bladders in the stance phase through universal tensile machine load.

Results

Based on the statistical analysis, the highest significant pressure reduction (P < 0.05) was 5.71%, which was recorded at the posterior region, and 4.68% (P < 0.05) at the medial region during posterior and medial air bladders inflation, respectively.

Conclusion

Peak pressures were reduced at the lateral tibia condyle, tibia tuberosity, tibia crest, anterior distal end of tibia, fibula head, distal end of fibula, medial femoral condyle, lateral femur condyle, and patellar of the artificial residual limb.

Clinical Relevance

This system has the potential to minimize high pressures at the subregions of the residual limb in clinical settings and in day-to-day activities. Thus, this design could provide an excellent pressure and volume control at the bony areas, which improves satisfaction and socket fit for persons with amputation.
Hearing Aids Enhance Music Enjoyment in Individuals With Hearing Loss
Authors: Chern Alexander , Denham Michael W. , Leiderman Alexis S. , Sharma Rahul K. , Su Irene W. , Ucci Amanda J. , Jones Jennifer M. , Mancuso Dean , Cellum Ilana P. , Galatioto Jessica A. , Lalwani Anil K.
Published: August 2022

Objective

To investigate music appreciation in hearing aid (HA) users with varying levels of hearing loss (HL).

Study Design

Cross-sectional, within-subjects design.

Setting

Tertiary medical center, community.

Patients

Adults (≥18 yr) bilateral HA users.

Interventions

HA usage.

Main Outcome Measures

Outcome variables included self-reported music enjoyment measures (pleasantness, musicality, naturalness) with and without HAs assessed with visual analogue scales (10 indicates highest level of enjoyment, 0 the least). Exposure variables include HL (better ear pure-tone average) and speech discrimination (word recognition scores [WRS]). Demographic information was collected.

Results

One hundred nine bilateral HA users completed the study. Mean (standard deviation) age was 66.6 years (16.8 yr); 52.3% were female patients. Mean (standard deviation) better ear pure-tone average was 51.1 dB (16.3 dB) HL. Increased severity of HL and worse WRS were associated with decreased music enjoyment (p < 0.05) across all measures without HAs, adjusting for sex, age, education, race, HA type, age of HL diagnosis, duration of HL, duration of HA use, musical preference, and musical experience. However, these associations were attenuated or no longer significant with HA usage. Moreover, among all subjects, HAs (vs. no HAs) provided increased music enjoyment in pleasantness (HA, 6.94, no HA, 5.74; p < 0.01), musicality (HA, 7.35; no HA, 6.13, p < 0.01), and naturalness (HA, 6.75; no HA, 6.02; p = 0.02).

Conclusion

HA users report increased music enjoyment with HAs compared with without HAs. Increased severity of HL and worse WRS were independently associated with decreased unaided music enjoyment. HA usage seems to mitigate this effect, particularly for those with worse HL.
Hearing Preservation After Intervention in Vestibular Schwannoma
Authors: Yancey Kristen L. , Barnett Samuel L. , Kutz Walter , Isaacson Brandon , Wardak Zabi , Mickey Bruce , Hunter Jacob B.
Published: August 2022

Objective

This study aimed to assess the durability of audiological outcomes after radiation and surgery in the management of vestibular schwannoma.

Study Design

Retrospective review.

Setting

Tertiary academic center.

Patients

Adults with sporadic vestibular schwannoma and serviceable hearing at the time of intervention.

Interventions

Gamma Knife, middle cranial fossa, or retrosigmoid approaches.

Main Outcome Measures

Pure-tone audiometry and speech discrimination scores.

Results

Postintervention serviceable hearing (class A/B) was preserved in 70.4% (n = 130; mean follow-up, 3.31 yr; range, 0–15.25 yr). Of the 49 patients treated with radiation, 19 (39.6%) had serviceable hearing at last follow-up, compared with 38 (46.9% of 81) who underwent retrosigmoid (n = 36 [44.4%]) and middle cranial fossa (n = 45 [55.6%]) approaches (odds ratio [OR], 1.40; 95% confidence interval [CI], 0.67–2.82; p = 0.47). A matched analysis by age, tumor volume, and preintervention hearing (n = 38) also found no difference in hearing preservation (HP) likelihood between surgery and radiation (OR, 2.33; 95% CI, 0.24–35.91; p = 0.59). After initial HP, 4 (9.5%) surgical versus 10 (37.0%) radiated patients subsequently lost residual serviceable (A/B) hearing (OR, 0.18; 95% CI, 0.06–0.69; p = 0.01) at a mean 3.74 ± 3.58 and 4.73 ± 3.83 years after surgery and radiation, respectively. Overall, 5- and 10-year HP rates (A/B) after initially successful HP surgery were 84.4 and 63.0%, respectively. However, survival estimates declined to 48.9% at 5 years and 32.7% at 10 years when patients with immediate postoperative serviceable hearing loss were also included, which were comparable to radiation-HP rates at 5 and 10 years of 28.0 and 14.2%, respectively (p = 0.75).

Conclusions

After vestibular schwannoma intervention, overall HP was similar between radiated and surgical cohorts. However, when successful, surgical approaches offered more durable hearing outcomes at long-term follow-up.
Harnessing imaging biomarkers to refine individualized cardiovascular disease risk: a case-based discussion
Authors: Almeida Shone , Shaikh Kashif , Memon Saira , Singh Vasvi , Thomas Drew
Published: August 2022

Traditional models of cardiovascular risk assessment rely on population-level risk factors and may not accurately capture individualized risk. Imaging biomarkers such as plaque characterization and pericoronary fat inflammation may offer refined risk prediction and allow physicians to personalize care-plans for cardiovascular disease prevention. The integration of plaque morphology and pericoronary inflammation into clinical care is highlighted using a case-based discussion. This article reviews the existing body of evidence supporting the use of novel biomarkers in an individualized comprehensive risk assessment algorithm.
Comparison of intracoronary versus intravenous tirofiban in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention
Authors: Tang Xiuying , Li Runjun , Zhang Ting
Published: August 2022

Objective

This study aimed to investigate the effect of intracoronary (IC) tirofiban compared to intravenously administered tirofiban in STEMI patients treated with PPCI.

Methods

This study included 180 STEMI patients who were underwent PPCI. Patients were randomized into an IC group (n = 90) and intravenous (IV) group (n = 90). During the procedure, the both groups were administered IC or IV injections of tirofiban, respectively, followed by an IV infusion of tirofiban for 24 hours. Changes in TIMI flow grading, TMP grade 3, Sum-STR two hours after the operation, the number of thrombus aspirations during the operation, myocardial enzyme, inflammatory factors,cardiac functional parameters, MACE and bleeding were investigated.

Results

Following treatment, TIMI flow grading and TMP grade 3 were improved in the IC tirofiban compared to the IV group (P = 0.022 and P = 0.014, respectively). Additionally, the Sum-STR two hours after operation, the incidence of MACEs, levels of AST, CRP, ESR, and TNI in the IC group was improved, compared with the IV group (all P < 0.05). Furthermore. Cardiac function including CO and LVEF were significantly improved in the IC group 6 months after discharge.

Conclusion

This study found that IC administration of tirofiban in patients with STEMI who underwent PPCI improved TIMI, TMP flow and cardiac function 6 months after discharge, and reduced CRP, ESR, and TNI. However, the incidence of bleeding between the two groups was comparable. These findings suggest that IC administration should be applied in certain acute STEMI patients.
The role of proteomics and metabolomics in severe infections
Authors: Póvoa Pedro , Bos Lieuwe D.J. , Coelho Luís
Published: August 2022

Purpose of review

Severe infections are a common cause of ICU admission, with a high morbidity and mortality. Omics, namely proteomics and metabolomics, aim to identify, characterize, and quantify biological molecules to achieve a systems-level understanding of disease. The aim of this review is to provide a clear overview of the current evidence of the role of proteomics and metabolomics in severe infections.

Recent findings

Proteomics and metabolomics are technologies that are being used to explore new markers of diagnosis and prognosis, clarify mechanisms of disease, and consequently discover potential targets of therapy and finally of a better disease phenotyping. These technologies are starting to be used but not yet in clinical use.

Our traditional way of approaching the disease as sepsis is believing that a process can be broken into its parts and that the whole can be explained by the sum of each part. This approach is highly reductionist and does not take the system complexity nor the nonlinear dynamics of the processes. Proteomics and metabolomics allow the analysis of several proteins and metabolites simultaneously, thereby generating diagnostic and prognostic signatures. An exciting future prospect for proteomics and metabolomics is their employment towards precision medicine.
New antimicrobial treatment options for severe Gram-negative infections
Authors: Hetzler Lauren , Kollef Marin H. , Yuenger Valerie , Micek Scott T. , Betthauser Kevin D.
Published: August 2022

Purpose of review

This review will provide rationale for the development of new antibiotics to treat severe or multidrug-resistant (MDR) Gram-negative infections. It will also provide an overview of recently approved and pipeline antibiotics for severe/MDR Gram-negative infections.

Recent findings

MDR Gram-negative infections are recognized as critical threats by global and national organizations and carry a significant morbidity and mortality risk. Increasing antibiotic resistance amongst Gram-negative bacteria, including carbapenem-resistant Acinetobacter baumannii, extended-spectrum β-lactamase-producing Enterobacterales, carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa, with difficult-to-treat-resistance has made both empiric and definitive treatment of these infections increasingly problematic. In recent years, several antibiotics have been approved for treatment of MDR Gram-negative infections and ongoing clinical trials are poised to provide additional options to clinicians’ armamentarium. These agents include various β-lactam/β-lactamase inhibitor combinations, eravacycline, plazomicin and cefiderocol.

Severe/MDR Gram-negative infections continue to be important infections due to their impact on patient outcomes, especially in critically ill and immunocompromised hosts. The availability of new antibiotics offers an opportunity to improve empiric and definitive treatment of these infections.
The Feasibility, Safety, and Long-term Outcomes of Endoscopic Submucosal Dissection for Colorectal Neoplasia in Patients With Inflammatory Bowel Disease
Authors: Akiyama Shintaro , Hamdeh Shadi , Sakamoto Taku , Suzuki Hideo , Tsuchiya Kiichiro
Published: August 2022

Background:

Evidence regarding the utility of endoscopic submucosal dissection (ESD) for neoplasia in patients with inflammatory bowel disease (IBD) is limited. This meta-analysis aims to understand the feasibility, safety, and long-term outcomes of ESD in IBD patients.

Methods:

Electronic databases were searched for observational and case-controlled studies. Primary endpoints were en bloc resection and margin-negative resection of neoplastic lesions. Secondary endpoints included procedure-related bleeding and perforation, local recurrence, and metachronous neoplasia.

Results:

We analyzed 25 studies with a total of 585 neoplastic lesions in 552 patients. The rates of en bloc resection and margin-negative resection were 0.88 [95% confidence interval (CI) 0.82-0.92] and 0.78 (95% CI 0.72-0.83), respectively. Meta-regression analysis showed longer disease duration was significantly associated with the higher rate of en bloc resection. The rates of procedure-related bleeding and perforation were 0.080 (95% CI 0.057-0.11) and 0.055 (95% CI 0.038-0.081), respectively. The rates of local recurrence and metachronous neoplasia were 0.008 events/person-year (95% CI 0.002-0.013) and 0.031 event/person-year (95% CI 0.016-0.046), respectively. Meta-analysis of case-controlled studies found no significant differences in the endpoints between IBD patients treated by ESD and those treated by endoscopic mucosal resection, or non-IBD patients treated by ESD.

Conclusions:

ESD is a feasible and safe procedure to remove neoplastic lesions in IBD patients. Given there is a considerable risk of metachronous neoplasia development, postoperative surveillance colonoscopy with an appropriate consultation with surgeons is essential to monitor not only local recurrence but also neoplastic changes in the remaining colon.
Assessment of Sarcopenia Using Muscle Ultrasound in Patients With Cirrhosis and Sarcopenic Obesity (AMUSE STUDY)
Authors: Dhariwal Sukhpal , Roy Akash , Taneja Sunil , Bansal Akash , Gorsi Ujjwal , Singh Surender , De Arka , Verma Nipun , Premkumar Madhumita , Duseja Ajay , Dhiman Radha , Singh Virendra
Published: August 2022

Background and Aims:

Sarcopenic obesity (SO) marks a confluence of 2 complex entities involving the muscle-liver-adipose tissue axis. Computed tomographic (CT) scan-derived skeletal muscle index (SMI) remains the gold standard for sarcopenia assessment in SO. However, it has intrinsic limitations of cost, radiation, and point of care applicability. We assessed the role of muscle ultrasound (US) in SO.

Methods:

A total of 52 patients with cirrhosis and obesity were assessed for sarcopenia using SMI. US assessment of thigh and forearm muscles was done to record quadriceps muscle thickness (QMT), quadriceps feather index (QMFI), forearm muscle thickness (FMT), and forearm feather index (FFI), respectively. Evaluated US parameters were correlated with SMI and assessed for diagnostic accuracy using the area under the curve.

Results:

A total of 40 (76.9%) males and 12 (23.1%) females [mean age: 50.9 y (43.8 to 53.5 y)] were included. QMT [0.45 cm/m2 (0.42 to 0.48 cm/m2) vs. 0.67 cm/m2 (0.63 to 0.70 cm/m2)], QMFI [0.82 cm/m2 (0.77 to 0.87 cm/m2) vs. 1.12 cm/m2 (1.06 to 1.19 cm/m2)], FMT [0.19 cm/m2 (0.17 to 0.20 cm/m2) vs. 0.25 cm/m2 (0.23 to 0.27 cm/m2)], and FFI [0.38 cm/m2 (0.35 to 0.412 cm/m2) vs. 0.47 cm/m2 (0.44 to 0.50 cm/m2)] were significantly lower in patients with SO (P<0.01). A positive correlation with SMI was seen for all parameters in the entire cohort. The strongest correlation was exhibited by QMT (r=0.70) and QMFI (r=0.70) in males. The area under the curve of QMT, QMFI, FMT, and FFI were 0.98 (95% confidence interval: 0.96-1), 0.95 (0.89-1), 0.85 (0.75-0.96), and 0.80 (0.68-0.93), respectively.

Conclusions:

US-based assessment of sarcopenia has excellent diagnostic accuracy and correlates well with computed tomography-SMI in patients with SO. US may serve as an easy-to-use, point of care tool for assessing sarcopenia in SO with the advantage of repeated sequential assessment.
Reproductive and oncological outcomes of fertility-sparing surgery in patients with stage I epithelial ovarian cancer: A systematic review and meta-analysis
Authors: Zhang Yu-fei , Fan Yu , Mu Yi , Zhang Peng , Wang Meng-yao , Li Jin-ke
Published: August 2022

Objective:

We meta-analyzed available evidence on fertility, survival, and cancer recurrence in patients with stage I epithelial ovarian cancer (EOC) after fertility-sparing surgery (FSS).

Methods:

We systematically reviewed PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials to identify studies reporting reproductive and oncological outcomes of patients with stage I EOC who underwent FSS. Random-effects models were used to calculate pooled rates of disease outcomes, along with 95% confidence intervals (CIs). Subgroup and sensitivity analyses were conducted to identify sources of heterogeneity in the data.

Results:

We included 23 observational retrospective studies involving 1126 patients. The pooled pregnancy rate was 30% (95% CI, 0.26–0.34), while the pooled natural conception rate was 26% (95% CI, 0.20–0.33). The pooled live birth rate was 27% (95% CI, 0.22–0.32). The pooled rate of EOC recurrence was 12% (95% CI, 0.09–0.14), which did not differ significantly from the rate among patients who underwent radical surgery (odds ratio, 0.77; 95% CI, 0.45–1.33).

Conclusions:

FSS is associated with good oncological outcomes but less than satisfactory reproductive outcomes. All in all, the procedure appears to be a safe alternative to radical surgery for EOC patients who want to preserve fertility.
Ultrasound-guided 5-in-1 trigger point injection for treating tension-type headache: A case report
Authors: Kim Jun Young , Choo Yoo Jin , Chang Min Cheol
Published: August 2022

Rationale:

Tension-type headache (TTH) is the most common type of primary headache, and trigger point injection (TPI) is frequently used for controlling pain originating from TTHs. In the current report, we introduce a TPI technique involving 4 neck muscles (upper trapezius, splenius capitis, semispinalis capitis, and inferior oblique capitis) and a greater occipital nerve (GON) block within the same sonographic view for the treatment of TTHs.

Patient concerns:

A 44-year-old woman complained with pressing and tightening, nonpulsating, recurrent headaches, mainly in the bilateral occipital area, lasting for approximately 6 months (numeric rating scale: 5). The patient had no nausea, vomiting, photophobia, or phonophobia.

Diagnoses:

The patient was diagnosed as having a TTH.

Interventions:

Under ultrasound (US) guidance, a mixed solution of 2 mL of 2% lidocaine and 5 mL of normal saline was injected layer-by-layer into the 4 target muscles of the neck (upper trapezius, splenius capitis, semispinalis capitis, and inferior oblique capitis) and near the right GON within the same sonographic view bilaterally.

Outcomes:

Two- and 4-week follow-ups after administration of the injections revealed no headache. Our US-guided 5-in-1 TPI technique is viable for treating patients with TTH.

Lessons:

We believe that it can aid in reducing the procedure time and associated pain.
Diagnosis of remnant hyperlipidaemia
Authors: Paquette Martine , Bernard Sophie , Baass Alexis
Published: August 2022

Purpose of review

In recent years, there has been interest for the development of simplified diagnosis algorithms of dysbetalipoproteinemia (DBL) in order to avoid the complex testing associated with the Fredrickson criteria (reference method). The purpose of this review is to present recent advances in the field of DBL with a focus on screening and diagnosis.

Recent findings

Recently, two different multi-step algorithms for the diagnosis of DBL have been published and their performance has been compared to the Fredrickson criteria. Furthermore, a recent large study demonstrated that only a minority (38%) of DBL patients are carriers of the E2/E2 genotype and that these individuals presented a more severe phenotype.

The current literature supports the fact that the DBL phenotype is more heterogeneous and complex than previously thought. Indeed, DBL patients can present with either mild or more severe phenotypes that can be distinguished as multifactorial remnant cholesterol disease and genetic apolipoprotein B deficiency. Measurement of apolipoprotein B as well as APOE gene testing are both essential elements in the diagnosis of DBL.
Evaluation of the Safety of a GalaFLEX-AlloDerm Construct in Prepectoral Breast Reconstruction
Authors: Sigalove Steven , O’Rorke Erin , Maxwell G. Patrick , Gabriel Allen
Published: August 2022

Background:

Prepectoral implant-based breast reconstruction is gaining in popularity. Acellular dermal matrices (ADMs) are an integral part of prepectoral reconstruction. However, large quantities of ADM are required for total implant coverage and the cost of ADMs could be a deterrent to reconstruction. To minimize the cost, the authors have resorted to the use of a bioabsorbable mesh, GalaFLEX, as a partial replacement to ADMs. This study evaluates the comparative safety of using a GalaFLEX-AlloDerm construct versus AlloDerm alone in prepectoral reconstruction.

Methods:

Consecutive patients who underwent immediate, expander-implant, prepectoral breast reconstruction were included in this retrospective study. Patients were stratified into two groups: those who received GalaFLEX-AlloDerm combination versus AlloDerm alone. In GalaFLEX-AlloDerm reconstructions, the lower third of the expander was covered by the AlloDerm while the rest of the expander was covered by GalaFLEX. Complications following reconstruction were compared between the groups.

Results:

AlloDerm alone was utilized in 128 patients (249 breasts) and GalaFLEX-AlloDerm in 135 patients (250 breasts). Rate of any complication was 7.6% in the AlloDerm alone group and 6.4% in the GalaFLEX-AlloDerm group. Rate of infection, major skin necrosis, seroma, capsular contracture, prosthesis exposure/extrusion, and prosthesis loss were ≤3.0% in the GalaFLEX-AlloDerm group and did not differ significantly from those in the AlloDerm only group.

Conclusions:

GalaFLEX bioabsorbable matrix is a less costly alternative to ADMs in two-staged, prepectoral reconstruction with comparable safety outcomes. Further long-term data and clinical experience are needed to better understand the safety of this matrix for use in breast reconstruction.
Siderophores: a potential role as a diagnostic for invasive fungal disease
Authors: Kriegl Lisa , Havlicek Vladimir , Dichtl Karl , Egger Matthias , Hoenigl Martin
Published: August 2022

Purpose of review

Invasive fungal diseases (IFDs) such as invasive aspergillosis continue to be associated with high morbidity and mortality while presenting significant diagnostic challenges. Siderophores are high-affinity Fe3+ chelators produced by Aspergillus spp. and other fungi capable of causing IFD. Previously evaluated as a treatment target in mucormycosis, siderophores have recently emerged as new diagnostic targets for invasive aspergillosis and scedosporiosis. Here, we review the diagnostic potential of siderophores for diagnosing IFD, with a particular focus on invasive aspergillosis.

Recent findings

The major secreted siderophore of A. fumigatus, triacetylfusarinine C (TAFC), has been successfully detected by mass spectrometry in serum, BALF and urine of patients with invasive aspergillosis, with promising sensitivities and specificities in single-centre studies. Intracellular uptake of siderophores has also been utilized for imaging, wherein fungal siderophores have been conjugated with the easy-to-produce radioactive isotope gallium-68 (68Ga) to visualize infected body sites in PET. For the Scedosporium apiospermum complex, another siderophore N(α)-methyl coprogen B has been shown promising as a marker for airway colonization in early studies.

Siderophores and particular TAFC have the potential to revolutionize diagnostic pathways for invasive aspergillosis and other mould infections. However, larger multicentre studies are needed to confirm these promising performances. Methods that allow rapid and cost-effective measurements in routine clinical practice need to be developed, particularly when TAFC is used as a biomarker in patient specimens.
Melioidosis and Burkholderia pseudomallei: progress in epidemiology, diagnosis, treatment and vaccination
Authors: Currie Bart J.
Published: August 2022

Purpose of review

Melioidosis and its causative bacterium Burkholderia pseudomallei are being found in unexpected locations and bacterial genotyping is providing new insights into global spread and where and how individuals are being infected. This review summarizes recent studies covering the epidemiology, diagnosis, treatment, and prevention of melioidosis.

Recent findings

Whole-genome sequencing of B. pseudomallei from patients and environmental sampling is informing the phylogeography of B. pseudomallei at regional, continental, and global levels, while also defining the epidemiology for individual cases. The situation in Africa remains the most unresolved, while the evolving story of B. pseudomallei in the Americas may establish that B. pseudomallei is endemic in parts of southern USA. Guidelines for diagnosis and treatment of melioidosis are well established, and published mortality has decreased from 50% or higher to 10% or lower in some countries but access to laboratory and therapeutic resources are not available or are extremely limited in many melioidosis-endemic regions.

The enormous clinical diversity of melioidosis and the complexities of laboratory diagnosis and of treatment make it a sentinel disease for highlighting the continuing global disparities in access to and provision of healthcare.
The Effect of a Plastic Barrier Drape on Resuscitation Performance and Provider Contamination
Authors: Young L. Caulette , Lau Jennifer , Buan Joshua , Duty Olivia , Herrera Tanya , Luu Cindy , Rake Alyssa , Chan Margaux , Bragg E. Alexis , Langga Leo , Guerrero Ed , Chang Todd P.
Published: August 2022

Background

Patient barriers to protect health care workers from COVID-19 exposure have been studied for airway management. Few are tested for cardiopulmonary resuscitation (CPR). We sought to determine whether a plastic drape barrier affects resuscitation performance and contamination risks for a simulated cardiopulmonary arrest scenario.

Methods

This pilot trial randomized in-hospital resuscitation teams of 4 to 6 participants to a plastic drape or without a drape in an in situ cardiopulmonary arrest simulation. The mannequin's airway emanated simulated virus particles (GloGerm, Moab, UT), detectable through UV light. Primary outcomes included airway management and CPR quality measures. Secondary outcomes included visible contamination on personal protective equipment (PPE). We used the Non-Technical Skills (NO-TECHS) instrument to measure perceived team performance and the NASA Task Load Index (NASA-TLX) to measure individual workload. Outcome variables were analyzed using an analysis of covariance (ANCOVA) with participant number as a covariate.

Results

Seven teams were allocated to the intervention (plastic drape) group and 7 to the control. Intubation and ventilation performance (η2 = 0.09, P > 0.3) and chest compression quality (η2 = 0.03–0.19, P > 0.14) were not affected by the plastic drape. However, mean contaminated PPE per person decreased with the drape (2.8 ± 0.3 vs. 3.7 ± 0.3, partial η2 = 0.29, P = 0.05). No differences in perceived workload nor team performance were noted (P > 0.09).

Conclusions

In this pilot study, the use of a plastic drape barrier seems not to affect resuscitation performance on simulated cardiopulmonary arrest but decreases health care worker contamination risk. Further implementation trials could characterize the true risk reduction and any effect on resuscitation outcomes.
Predictive Models for Recurrent Membranous Nephropathy After Kidney Transplantation
Authors: Chung Edmund Y. M. , Blazek Katrina , Teixeira-Pinto Armando , Sharma Ankit , Kim Siah , Lin Yingxin , Keung Karen , Bose Bhadran , Kairaitis Lukas , McCarthy Hugh , Ronco Pierre , Alexander Stephen I. , Wong Germaine
Published: August 2022

Background.

Recurrent membranous nephropathy (MN) posttransplantation affects 35% to 50% of kidney transplant recipients (KTRs) and accounts for 50% allograft loss 5 y after diagnosis. Predictive factors for recurrent MN may include HLA-D risk alleles, but other factors have not been explored with certainty.

Methods.

The Australian and New Zealand Dialysis and Transplant registry was used to develop 3 prediction models for recurrent MN (Group Least Absolute Shrinkage and Selection Operator [LASSO], penalized Cox regression, and random forest), which were tuned using tenfold cross-validation in a derivation cohort with complete HLA data. KTRs with MN but incomplete HLA data formed the validation cohort. Model performance was evaluated using area under the receiver operating characteristic curve (AUC-ROC).

Results.

One hundred ninety-nine KTRs with MN were included, and 25 (13%) had recurrent MN (median follow-up 5.9 y). The AUC-ROCs for Group LASSO, penalized Cox regression, and random forest models were 0.85 (95% confidence interval, 0.76-0.94), 0.91 (0.85-0.96), and 0.62 (0.57-0.69), respectively, in the derivation cohort, with moderate agreement in selected variables between the models (55%-70%). In their validation cohorts, the AUC-ROCs for Group LASSO and penalized Cox regression were 0.60 (0.49-0.70) and 0.73 (0.59-0.86), respectively. Variables of importance chosen by all models included recipient HLA-A2, donor HLA-DR12, donor-recipient HLA-B65, and HLA-DR12 match.

Conclusions.

A penalized Cox regression performed reasonably for predicting recurrent MN and was superior to Group LASSO and random forest models. These models highlighted the importance of donor-recipient HLA characteristics to recurrent MN, although validation in larger datasets is required.
Inflammatory biomarker signatures in post-surgical drain fluid may detect anastomotic leaks within 48 hours of colorectal resection
Authors: Cuff Simone M. , Reeves Nicola , Lewis Eifion , Jones Eleri , Baker Sarah , Karategos Athanasios , Morris Rachel , Torkington Jared , Eberl Matthias
Published: August 2022

Background

The optimal treatment of colorectal cancer is surgical resection and primary anastomosis. Anastomotic leak can affect up to 20% of patients and creates significant morbidity and mortality, a leak is based on clinical suspicion and subsequent radiology. Peritoneal biomarkers have shown diagnostic utility in other medical conditions and could be useful in providing earlier diagnosis. This pilot study was designed to assess the practical utility of peritoneal biomarkers after abdominal surgery utilising an automated immunoassay system in routine use for quantifying cytokines.

Method

Patients undergoing an anterior resection for a rectal cancer diagnosis were recruited. A peritoneal drain was placed in the proximity of the anastomosis during surgery, and peritoneal fluid was collected at day 1 and 2 post-operatively, and analysed using the Siemens IMMULITE platform for IL-1β, IL-6, IL-10, CXCL8, TNF-α and CRP.

Results

42 patients were recruited. Anastomotic leak was detected in 4 patients and a further 5 patients had other intra-abdominal complications. The IMMULITE platform was able to provide robust and reliable results from the analysis of the peritoneal fluid. A metric based on the combination of peritoneal IL-6 and CRP levels was able to accurately diagnose three anastomotic leaks, whilst correctly classifying all negative control patients including those with other complications.

Conclusion

This pilot study has demonstrated that a simple immune signature in surgical drain fluid could accurately diagnose an anastomotic leak at 48 hours post-operatively using instrumentation that is already widely available in diagnostic laboratories.