bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal diagnosis of de novo monosomy 18p deletion syndrome by chromosome microarray analysis
Authors: Qi Hong , Zhu Jianjiang , Zhang Shaoqin , Cai Lirong , Wen Xiaohui , Zeng Wen , Tang Guodong , Luo Yao
Published: April 2019

Rationale:

Monosomy 18p deletion syndrome refers to a rare chromosomal disorder resulting from the part deletion of the short arm of chromosome 18. Prenatal diagnosis of de novo 18p deletion syndrome is a challenge due to its low incidence and untypical prenatal clinical presentation.

Patient concerns:

Three cases received amniocentesis due to increased nuchal translucency (INT), high risk for Down syndrome, and INT combined intrauterine growth retardation (IUGR), respectively.

Diagnosis:

The 3 cases were diagnosed with de novo monosomy 18p deletion syndrome by amniocentesis and chromosome microarray analysis (CMA).

Interventions:

Karyotype analysis and CMA were used to analyze the abnormal chromosome.

Outcomes:

Case 1 and case 2 revealed 13.87 and 12.68 Mb deletions by array-CGH analysis, respectively. Case 3 revealed 6.9 Mb deletions in 18p11.32p11.31 and 7.5 Mb deletions in 18p11.23p11.21 by single nucleotide polymorphism array. All of the pregnancies were terminated due to the abnormal chromosome.

Lessons:

The fetal phenotype of monosomy 18p deletion syndrome shows great variability and may not be evident during the pregnancy. CMA may be served as an effective tool for the diagnosis of prenatal monosomy 18p deletion syndrome diagnosis.
Efficacy of ivabradine for heart failure
Authors: Xue En-zhong , Zhang Ming-hui , Liu Chun-li
Published: April 2019

Background:

Previous clinical trials have reported that ivabradine can effectively treat heart failure (HF). However, no systematic review has explored its efficacy and safety for HF. This systematic review will aim to evaluate the efficacy and safety of ivabradine for the treatment of patients with HF.

Methods:

We will search the literature from the following electronic databases from inception to the January 31, 2019: Cochrane Central Register of Controlled Trials, EMBASE, MEDILINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data. All randomized controlled trials (RCTs) of ivabradine for HF will be fully considered for inclusion without any restrictions. Additionally, grey literature including clinical trial registries, dissertations, and reference lists of included studies, conference abstracts will also be searched. Two researchers will review these literatures, extract data, and assess risk of bias of included RCTs separately. Data will be pooled by either fixed-effects model or random-effects model, and meta-analysis will be conducted if it is appropriate.

Results:

The primary outcome is all-cause mortality. The secondary outcomes comprise of change in body weight, urine output, change in serum sodium, and all adverse events.

Conclusions:

The results of this study will summary provide up-to-dated evidence for assessing the efficacy and safety of ivabradine for HF.

Ethics and Dissemination:

It is not necessary to acquire ethical approval for this systematic review, because no individual patient data will be used in this study. The results of this systematic review will be published through peer-reviewed journals.

Systematic review registration:

PROSPERO CRD42019120814.
Elastic stabile intramedullary nailing (ESIN) of diaphyseal femur fractures in children and adolescents
Authors: Frei Benjamin , Mayr Johannes , de Bernardis Gaston , Camathias Carlo , Holland-Cunz Stefan , Rutz Erich
Published: April 2019

Elastic stabile intramedullary nailing (ESIN) is a well-established method to stabilize diaphyseal fracture of the femur (DFF) in children. We aimed to evaluate the minimal medullary canal diameter (MMCD) of the fractured femur relative to the diameter of the nails. We also analyzed the real anteversion angle (AVA) of the affected femur in comparison to the healthy femur.

We retrospectively reviewed the medical records and plain X-ray images of children aged 2–15 years treated with ESIN for unstable femoral shaft fractures between 2004 and 2012. We measured MMCD on preoperative plain X-ray images. Nail diameter (ND) and any postoperative complications were extracted from the medical records. At follow-up conducted at a median of 40 months (range: 4–103 months) after the operation, we obtained Dunn X-ray images of both hips. Particular emphasis was placed on postoperative torsional differences in relation to age, weight, and maturity of the growth plate.

We analyzed the relationship between postoperative rotational malalignment and the ratio of ND to MMCD.

Median age of the 22 children at the time of injury was 7.5 years (range: 2–15 years). Median body weight was 25 kg (range: 13–57 kg). Median MMCD amounted to 8.6 mm (range: 5.5–11.0 mm). Median ND/MMCD was 36.9% (range: 27.3%–47.4%). Radiological analyses revealed a median of 27.0° (range: −22.0° to +49.0°) of real AVA in the affected leg and 32.5° (range: 18.0°–48.0°) in the healthy leg.

Three children (13.6%) experienced a grade III complication (Clavien–Dindo classification of surgical complications; CDCSC). Two of these children suffered retrotorsion of the femoral neck, while the third child experienced diminished anteversion.

Overall, 3 of 22 children (13.6%) suffered a CDCSC-grade III complication (i.e., retrotorsion of the femoral neck in two children and diminished anteversion of the femoral neck in one child). We recommend obtaining Dunn images at the end of the operation to confirm correct rotational alignment after stabilization with ESIN. Further prospective studies are required to confirm our findings.
Uterine-preserving pelvic organ prolapse surgery using the UPHOLD LITE vaginal support system
Authors: Chang Chia-Pei , Hsu Fang-Kuo , Lai Man-Jung , Chang Wen-Hsun , Lee Na-Rong , Lee Hui-Ling , Horng Huann-Cheng , Wang Peng-Hui
Published: April 2019

This article aims to evaluate the safety and outcome of women with pelvic organ prolapse (POP) treated by a minimally invasive bilateral sacrospinous hysteropexy (UPHOLD LITE Vaginal Support System, Boston Scientific) without concomittent anti-incontinence surgery.

This retrospective study was conducted between 2014 and 2016. Evaluated items included surgical parameter and postoperative outcome.

Three hundred thirteen women with POP were eligible and 22 were excluded because of history of either or more following situations, such as hysterectomy, mesh augmentation, previous anti-incontinence procedures, and radical pelvic surgery before. With a median follow-up of 26 months, surgery-related morbidity rate was 23.7% (69/291), including 1 with bladder injury (0.3%), 2 with hematoma (0.7%), 8 with urinary tract infection (2.8%), 48 with voiding dysfunction (16.5%) and 10 with mesh problems (3.4%). Among these morbidities, 12 patients (4.1%) needed surgical intervention, including 6 for mesh problems, 1 for bladder injury, 2 for hematoma, and 3 for anti-incontinence surgery. The difference of pelvic organ prolapse quantification (POP-Q) stage before and after surgery showed a statistical significance (anterior portion from 1.36 ± 2.60 to −2.69 ± 0.26, posterior portion from −1.29 ± 2.08 to −2.46 ± 0.62, and cervix portion from 2.03 ± 4.80 to −6.98 ± 2.26, all P < .001). At the end of August 2018, re-intervention rate for POP recurrence was 2.1% (n = 6), including abdominal sacrocolpopexy (n = 1), anterior repair (n = 1), vaginal total hysterectomy and uterine-sacral ligament suspension (n = 1), vaginal total hysterectomy and LeFort (n = 1), LeFort (n = 1), and pessary support (n = 1).

Because some women developed postoperative lower urinary tract symptom, preoperative evaluation, including careful and detailed history taking, and urodynamic evaluation is suggested. After adequate counseling, uterine-preserving sacrospinal ligament suspension by UPHOLD LITE Vaginal Support System surgery could be considered in the management of women with POP, because of its high successful rate (97.9%) and low morbidity rate.
Postoperative adverse events in patients with diabetes undergoing orthopedic and general surgery
Authors: Wang Jinjing , Chen Kang , Li Xueqiong , Jin Xinye , An Ping , Fang Yi , Mu Yiming
Published: April 2019

Factors that may result in the occurrence of adverse clinical events in diabetic patients during the postoperative period are not entirely clear. This study evaluated factors that may cause adverse events following elective orthopedic or general surgery.

Patients with diabetes who underwent orthopedic or general surgery between January 2010 and October 2015 were retrospectively selected from the General Hospital of People's Liberation Army database. Factors associated with postoperative adverse events were analyzed using multivariable logistic regression.

Among 1525 patients included, mean age was 63.5 ± 10.8 years and mean duration of diabetes was 8.8 ± 6.6 years. Among them, 49.9% underwent orthopedic surgery and 50.1% underwent general surgery. Postoperatively, 118 (7.7%) patients had adverse events, including delayed extubation (n = 43, 36.4%), circulatory disorder (n = 15, 12.7%), respiratory and circulatory abnormalities (n = 23, 19.5%), nonhealing of the incision (n = 11, 9.3%), infections at other sites (n = 15, 12.7%), other complications (n = 8, 6.8%), and death (n = 3, 2.5%). Multivariable regression analysis showed that age >65 years old [odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.25–3.98], male sex (OR = 2.14, 95% CI: 1.24–3.38), postoperative peripheral blood glucose (OR = 1.13, 95% CI: 1.13–1.82), diabetic complications (OR = 2.41, 95% CI: 1.36–4.28), abnormal kidney function (OR = 2.73, 95% CI: 1.13–6.58) and general surgery (OR = 1.48, 95% CI: 1.11–5.26) were associated with the occurrence of postoperative adverse events.

In patients with diabetes undergoing intermediate or major elective surgery, older age, male sex, high postoperative peripheral blood glucose, diabetic complications, abnormal kidney function, and general surgery type were associated with the occurrence of postoperative adverse events.
Efficacy of carboplatin plus S-1 for the treatment of non-small cell lung cancer
Authors: Han Lei , Wei Zhou-Xia , Lv Yu-Feng , Jiang Ai-Ying
Published: April 2019

Background:

Non-small cell lung cancer (NSCLC) is the most common lung cancer. Numerous clinical studies have reported that the combination of carboplatin and S-1 (CS) can be used to treat NSCLC effectively. However, no systematic review has been conducted to assess its efficacy and safety for NSCLC. This systematic review aims to evaluate the efficacy and safety of CS for treatment of patients with NSCLC.

Methods:

This study will retrieve the following electronic databases from inception to the February 1, 2019: Cochrane Library, EMBASE, MEDILINE, CINAHL, AMED, and 4 Chinese databases without any language limitations. This systematic review will include randomized controlled trials (RCTs) and case-control studies for assessing the efficacy and safety of CS for the treatment of NSCLC. Cochrane risk of bias will be used as methodological quality assessment for each qualified study. The RevMan V.5.3 software will be utilized to synthesize the data and conduct the meta-analysis if it is allowed. The data will be pooled by using the random-effects model or fixed-effects model.

Results:

The primary outcome is overall response rate. The secondary outcomes are overall survival, progression-free survival, the disease control rate, and any adverse events.

Conclusion:

It will provide latest evidence to determine the efficacy and safety of CS for treatment of patients with NSCLC.

Ethics and dissemination:

No research ethic approval is needed in this study because this study will not analyze individual patient data. The results are expected to disseminate through peer-reviewed journals.

Systematic review registration:

PROSPERO CRD42019124860.
A comparison of the efficacy of Chinese herbal medicines in the treatment of primary dysmenorrhea
Authors: Gao Li , Xiao Zhuoran , Jia Chunhua , Wang Wei
Published: April 2019

Introduction:

Chinese herbal medicines (CHM) have been commonly used in the treatment of primary dysmenorrhea in East Asia. Several systematic reviews have been conducted to assess the clinical efficacy of CHM in the treatment of primary dysmenorrhea. However, their comparative efficacy is still unclear. Therefore, the purpose of this study is to conduct a network meta-analysis (NMA) to systematically compare the advantages of different CHM in the treatment of primary dysmenorrhea.

Methods and analysis:

The following electronic databases will be searched in this study: Web of Science, PubMed, Cochrane Library, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan-fang Database. Search terms include (Chinese herbal medicine or Chinese patent medicine or medicinal plants or phytotherapy or traditional medicine or Chinese herbal drugs or plant extracts or herbal medicine or herbal extract or herb or traditional Chinese medicine) and (primary dysmenorrhea or dysmenorrhea or painful menstruation) and (randomized controlled trial). The language will be limited to Chinese and English, and the search date will be up to May 2019. The included studies must be randomized controlled trials (RCTs) with patients diagnosed with primary dysmenorrhea. CHM must be used as interventions in the experimental group. While in the control group, studies that used a different herbal medicine, nonsteroidal anti-inflammatory drugs (NSAIDs), or placebo will be included. The primary outcomes include clinical efficacy and visual analog scale (VAS), and the secondary outcomes include adverse events and quality of life. Four reviewers will independently extract the data and assess the qualities of the studies. Statistical analysis will be conducted with R package for each outcome.

Ethics and dissemination:

Ethical approval is not required as this NMA is based on published studies. The completed NMA will be published in a peer-reviewed scientific journal.

Trial registration number:

PROSPERO CRD42018095254.
Clinical significance of wound infiltration with ropivacaine for elderly patients in china underwent total laparoscopic radical gastrectomy
Authors: Zhu ZhiPeng , Chen BoRong , Ye WeiPeng , Wang ShengJie , Xu GuoXing , Pan ZiRong , Zeng JunJie , Luo Qi , Jun You , Huang ZhengJie
Published: April 2019

The study aimed to evaluate analgesic effects and postoperative recovery of ropivacaine wound infiltration for elderly patients in China after total laparoscopic radical gastrectomy.

We retrospectively received clinical data of 132 elderly patients who received total laparoscopic gastrectomy and tracheal intubation general anesthesia from cancer center of First Affiliated Hospital of Xiamen University between September 2014 and September 2017, patients were divided into 2 groups according to local injection of drug: group I (ropivacaine group, 0.5% ropivacaine, 40 mL in total, n = 69), group II (control group, no analgesic, n = 63). The demographics, postoperative pain using numeric ratings scale (NRS), rescue analgesics as well as incidence of complications were investigated.

Significantly lower pain scores were observed in group I than in group II at 6, 12, 24, and 48 h postoperatively; the use of remedy analgesia was less in group I than in group II; there was no statistical significance in the incidence of surgical-related complications between the 2 groups. The recovery time were shorter in group I than in group II, meanwhile, postoperative hospital stay, medical expenses, and anesthesia-related complications were significantly less in group I than in group II.

This is a review of ropivacaine infiltration use in the elderly patients underwent total laparoscopic radical gastrectomy. This analysis describes the postoperative analgesic effect and postoperative recovery of wound infiltration with ropivacaine. Multicentered large sample prospective randomized controlled study is needed to evaluate the feasibility, security, and economic practicality.
Role of sortilin in lipid metabolism
Authors: Conlon Donna M.
Published: April 2019

Purpose of review

Sortilin, encoded SORT1 gene at chromosome 1p13.3, is a multiligand receptor that traffics protein from the Golgi to the endosomes, secretory vesicles, and the cell surface. Genome-wide association studies (GWAS) revealed an association between sortilin and reduced plasma LDL-cholesterol (LDL-C) as well as reduced coronary artery disease (CAD). This review explores the various lipid metabolism pathways that are affected by alterations in sortilin expression.

Recent findings

The effects of increased hepatic sortilin on plasma LDL-C levels are mediated by increased clearance of LDL-C and decreased very LDL (VLDL) secretion because of increased autophagy-mediated lysosomal degradation of apolipoproteinB100. Sort1 knockout models have shown opposite VLDL secretion phenotypes as well as whole body lipid metabolism in response to diet challenges, leading to confusion about the true role of sortilin in the liver and other tissues.

The regulation of VLDL secretion by hepatic sortilin is complex and remains incompletely understood. Further investigation to determine the specific conditions under which both hepatic sortilin and total body sortilin cause changes in lipid metabolism pathways is needed.
Cost-effectiveness of Pancreatic Cancer Surveillance in High-Risk Individuals
Authors: Corral Juan E. , Das Ananya , Bruno Marco J. , Wallace Michael B.
Published: April 2019

Objective

The aim of the study was to perform an economic analysis to identify the clinical and cost determinants of pancreatic cancer (PC) surveillance in high-risk individuals (HRIs).

Methods

A Markov model was created to compare the following 3 strategies: no screening, endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI) screening. Patients were considered HRIs according to the Cancer of the Pancreas Screening consortium recommendations. Risk for developing PC, survival, and costs data were obtained from the Surveillance, Epidemiology, and End Results and Medicare databases. Surveillance effectiveness was obtained from a recent meta-analysis.

Results

Analysis of a cohort with fivefold relative risk of PC higher than the US population showed that MRI is the most cost-effective strategy. For those with the highest risk (>×20 relative risk), EUS became the dominant strategy. Our model was impacted by cost and imaging performance, but still cost-effective within the range reported in literature. Threshold analysis showed that if MRI increases greater than US $1600, EUS becomes more cost-effective. Once patients reached the age of 76 years, “no screening” was favored. Both surveillance strategies were cost-effective over a wide range of willingness to pay.

Conclusions

Abdominal imaging followed by pancreatectomy is cost-effective to prevent PC in HRIs, favoring MRI in moderate risk cases but EUS in those with highest risk.
Does Etiology of Pancreatitis Matter? Differences in Outcomes Among Patients With Post–Endoscopic Retrograde Cholangiopancreatography, Acute Biliary, and Alcoholic Pancreatitis
Authors: Kamal Ayesha , Akshintala Venkata S. , Kamal Muhammad M. , El Zein Mohammad , Besharati Sepideh , Kumbhari Vivek , Ngamruengphong Saowonee , Shin Eun Ji , Singh Vikesh K. , Kalloo Anthony N. , Khashab Mouen A.
Published: April 2019

Objectives

We compared outcomes of acute alcoholic pancreatitis (AAP), acute biliary pancreatitis (ABP), and post–endoscopic retrograde cholangiopancreatography pancreatitis (PEP).

Methods

This was a retrospective cohort study conducted at a tertiary care center between June 2007 and June 2012.

Results

A total of 300 (68%) patients were diagnosed with AAP, 88 (20%) with ABP, and 55 (12%) with PEP. Longer length of hospital stay (LOHS) was more common in ABP (23%) as compared with AAP (10%) and PEP (7%, P = 0.025). Pseudocyst (P = 0.048), organ failure (OF) (P = 0.01), need for interventions (P ≤ 0.001), and mortality (P = 0.002) occurred more in ABP as compared with other groups. Systemic inflammatory response syndrome was associated with LOHS of more than 10 days (P = 0.01) and multi-OF (P = 0.05). Chronic pancreatitis was associated more with pseudocyst (P < 0.001) and mortality (P = 0.03). Serum urea nitrogen of greater than 25 g/dL predicted LOHS of more than 10 days (P = 0.02), OF (P < 0.001), multi-OF (P < 0.001), and persistent OF (P < 0.001).

Conclusions

Acute biliary pancreatitis is a more severe disease compared with PEP and AAP. Chronic pancreatitis, systemic inflammatory response syndrome, and high serum urea nitrogen are important predictors of morbidity.
Social Determinants of Health: A Timely Topic for Case Management
Authors: Powell Suzanne K.
Published: April 2019

Social determinants are a critical component of our patients' health, affecting people in both tangible and insidious ways. The World Health Organization (2017) defines Social Determinants of Health as those conditions in which people are born, grow, live, work, and age. Finding resources for those at social risk is a prime directive for case managers.
Systems Thinking for Transitions of Care
Authors: Phillips Janet M. , Stalter Ann M. , Ruggiero Jeanne S. , Bonnett Pamela L. , Brodhead Josette , Merriam Deborah H. , Scardaville Debra L. , Wiggs Carol M. , Winegardner Sherri
Published: April 2019

Purpose:

The purpose of this study was to develop a standardized rubric for systems thinking across transitions of care for clinical nurse specialists.

Design:

The design was a mixed-methods study using the Systems Awareness Model as a framework for bridging theory to practice.

Methods:

Content validity was determined using a content validity index. Reliability was established using statistical analysis with Cronbach’s α and intraclass correlation coefficient. Usability of the rubric was established using content analysis from focus group discussions about their experiences in using the rubric.

Results:

Content validity was established with a content validity ratio of 1.0. Statistical analysis showed a high interrater reliability (α = 0.99), and sections of the rubric showed a strong degree of reliability with α’s ranging from 0.88 to 1.00. Content analysis revealed several overall themes for usability of the rubric: clarity, objectivity, and detail. The area for improvement included adding more detail in the scholarly writing section.

Conclusion:

The research team recommends using the rubric to reflect application of systems thinking across transitions of care.
Polycystic Ovary Syndrome: Impact of Lipotoxicity on Metabolic and Reproductive Health
Authors: Brennan Kathleen M. , Kroener Lindsay L. , Chazenbalk Gregorio D. , Dumesic Daniel A.
Published: April 2019

Importance

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy of reproductive-aged women. Women with PCOS are at increased risk of developing several metabolic and reproductive abnormalities, including metabolic syndrome. Underlying the combined metabolic and reproductive dysfunction is lipotoxicity, defined as the ectopic deposition of lipid in nonadipose tissue where it induces oxidative stress linked with insulin resistance and inflammation.

Objective

To examine what metabolic components underlie insulin resistance in PCOS, how lipotoxicity through insulin resistance impairs metabolism and reproduction in these women, and why evidence-based, individualized management is essential for their care.

Evidence Acquisition

PubMed search was performed using relevant terms to identify journal articles related to the subject. Relevant textbook chapters were also used.

Results

Polycystic ovary syndrome by Rotterdam criteria represents a complex syndrome of heterogeneous expression with variable adverse metabolic and reproductive implications. Women with classic PCOS are often insulin resistant and at greatest risk of developing metabolic syndrome with preferential fat accumulation and weight gain. Moreover, PCOS women may also have an altered capacity to properly store fat, causing ectopic lipid accumulation in nonadipose tissue, including the ovaries, where it can perpetuate insulin resistance and inflammation and harm the oocyte.

Conclusions and Relevance

A personalized approach to managing PCOS is essential to improve the health of all PCOS women through cost-effective prevention and/or treatment, to minimize the risk of pregnancy complications in those individuals wishing to conceive, and to optimize the long-term health of PCOS women and their offspring.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After completing this activity, the learner should be better able to explain the phenotypic variants of PCOS; describe how obesity, preferential abdominal fat accumulation, and lipotoxicity adversely affect the health of PCOS women; and propose a preconception management plan for overweight and obese PCOS women wishing to conceive.
Posterior malleolus exposure
Authors: Meulenkamp Brad , Louati Hakim , Morellato John , Papp Steve , Lalonde Karl Andre
Published: April 2019

Objectives:

Posterior malleolus (PM) fractures are common in rotational ankle injuries, tibial plafond fractures, and distal third tibia fractures. Surgical indications continue to evolve as we improve our understanding of ankle and syndesmotic stability. These fractures remain technically challenging with respect to both exposure and fixation. Our biomechanical cadaveric study compared posterolateral versus modified posteromedial surgical approaches to define the following: maximal surface area exposed, and maximal screw trajectory obtainable for fixation.

Methods:

Twelve fresh-frozen cadaver limbs were thawed at room temperature. Posterolateral and modified posteromedial approaches were performed on each limb. Margins of exposure were marked. A 2.5 mm drill was advanced at the extreme medial and lateral extents of each exposure, standardized at 1 cm proximal to the joint line and perpendicular to the bone. Computed tomography (CT) scans were performed to identify the maximal trajectory. Limbs were stripped of soft tissue, and the exposed bony surface area was measured using a validated laser surface-scanning technique.

Results:

The modified posteromedial approach allowed for a larger exposed surface area compared to the posterolateral exposure (median 99% vs 64%, respectively; P < .05). The modified posteromedial approach allowed for instrumentation of up to a median of 77% of the posterior distal tibia as opposed to 46% through the posterolateral approach (P < .05).

Conclusion:

The modified posteromedial approach allowed for increased exposure and wider access for instrumentation of the PM when compared to the posterolateral approach. We advocate use of this approach when addressing complex PM fractures, in particular the Haraguchi type 2 fracture pattern.
Ultrasound-Guided Femoral Arterial Cannulation in Neonates Undergoing Cardiac Surgery or Catheterization: Comparison of 0.014-Inch Floppy Versus 0.019-Inch Straight Guidewire
Authors: Polat Tugcin Bora
Published: April 2019

Objectives:

Percutaneous femoral artery cannulation can be technically challenging in small infants.

Design:

We designed a prospective randomized trial to compare the use of two different guidewires for femoral arterial cannulation in neonates undergoing cardiac surgery or catheterization.

Settings:

Cardiac ICU in a university hospital.

Patients:

One-hundred twenty-four children were enrolled in this prospective study, with 64 being randomized to the 0.019-inch straight guidewire group and 60 to the 0.014-inch floppy guidewire group.

Interventions:

Femoral artery cannulation.

Measurements and Main Results:

The study period was limited to 10 minutes at the first site of arterial puncture. The time to complete cannulation, number of successful cannulation on first attempt, number of attempts, and number of successful cannulations were compared. The number of successful cannulations and successful cannulations on first attempt were higher in 0.014-inch floppy guidewire group (p = 0.001; p = 0.002, respectively). The time to complete cannulation was significantly shorter, and the number of attempts was lower in 0.014-inch floppy guidewire group (p = 0.001). Among the neonates less than 2000g, the number of attempts and time to complete cannulation were significantly lower (p < 0.001), and number of successful cannulation on first attempt and number of successful cannulations were significantly higher (p < 0.028; p < 0.001, respectively) in the 0.014-inch floppy guidewire

Conclusions:

Using 0.014-inch floppy guidewire for femoral arterial cannulation in particularly very small neonates provides significant improvement in first attempt success, number of successful cannulations, number of attempts, time to complete cannulation.
PICU-Based Rehabilitation and Outcomes Assessment: A Survey of Pediatric Critical Care Physicians*
Authors: Treble-Barna Amery , Beers Sue R. , Houtrow Amy J. , Ortiz-Aguayo Roberto , Valenta Cynthia , Stanger Meg , Chrisman Maddie , Orringer Maxine , Smith Craig M. , Pollon Dorothy , Duffett Mark , Choong Karen , Watson R. Scott , Kochanek Patrick M. , Fink Ericka L.
Published: April 2019

Objectives:

Characterize current practices for PICU-based rehabilitation, and physician perceptions and attitudes, barriers, resources, and outcome assessment in contemporary PICU settings.

Design:

International, self-administered, quantitative, cross-sectional survey.

Setting:

Online survey distributed from March 2017 to April 2017.

Patients or Subjects:

Pediatric critical care physicians who subscribed to email distribution lists of the Pediatric Acute Lung Injury and Sepsis Investigators, the Pediatric Neurocritical Care Research Group, or the Prevalence of Acute Critical Neurological Disease in Children: A Global Epidemiological Assessment study group, and visitors to the World Federation of Pediatric Intensive and Critical Care Societies website.

Interventions:

None.

Measurements and Main Results:

Of the 170 subjects who began the survey, 148 completed it. Of those who completed the optional respondent information, most reported working in an academic medical setting and were located in the United States. The main findings were 1) a large majority of PICU physicians reported working in institutions with no guidelines for PICU-based rehabilitation, but expressed interest in developing and implementing such guidelines; 2) despite this lack of guidelines, an overwhelming majority of respondents reported that their current practices would involve consultation of multiple rehabilitation services for each case example provided; 3) PICU physicians believed that additional research evidence is needed to determine efficacy and optimal implementation of PICU-based rehabilitation; 4) PICU physicians reported significant barriers to implementation of PICU-based rehabilitation across centers; and 5) low routine assessment of long-term functional outcomes of PICU patients, although some centers have developed multidisciplinary follow-up programs.

Conclusions:

Physicians lack PICU-based rehabilitation guidelines despite great interest and current practices involving a high degree of PICU-based rehabilitation consultation. Data are needed to identify best practices and necessary resources in the delivery of ICU-based multidisciplinary rehabilitation and long-term functional outcomes assessment to optimize recovery of children and families affected by critical illness.
Illness Anxiety Disorder: Psychopathology, Epidemiology, Clinical Characteristics, and Treatment
Authors: Scarella Timothy M. , Boland Robert J. , Barsky Arthur J.
Published: April 2019

Illness anxiety disorder is a primary disorder of anxiety about having or developing a serious illness. The core feature is the cycle of worry and reassurance seeking regarding health, as opposed to a focus on relief of distress caused by somatic symptoms (as in Somatic Symptom Disorder). Clinically significant health anxiety is common, with estimates ranging up to 13% in the general adult population. There are evidence-based treatments, including psychopharmacology and cognitive behavioral therapy, that can significantly alleviate symptoms. An understanding of the core psychopathology and clinical features of illness anxiety disorder is essential to fostering a working alliance with patients with health anxiety, as is the maintenance of an empathic, curious, and nonjudgmental stance toward their anxiety. Collaboration between medical providers is essential to avoid the pitfalls of excess testing and medical treatment.
Simultaneous Multislice Echo Planar Imaging for Accelerated Diffusion-Weighted Imaging of Malignant and Benign Breast Lesions
Authors: Ohlmeyer Sabine , Laun Frederik Bernd , Palm Theresa , Janka Rolf , Weiland Elisabeth , Uder Michael , Wenkel Evelyn
Published: April 2019

Objectives

Comparison of the diagnostic value of simultaneous multislice (SMS) accelerated diffusion-weighted echo planar imaging (EPI) of malignant and benign lesions of the breast compared with a reference EPI sequence.

Materials and Methods

The study was approved by the institutional ethics committee. Sixty-eight patients were examined with a diffusion-weighted EPI (reference EPI; TE = 54 milliseconds; TR = 9000 milliseconds; TA, 3:27 minutes) and a diffusion-weighted SMS accelerated EPI (SMS EPI; acceleration factor 2; TE = 58 milliseconds; TR = 4300 milliseconds; TA, 1:53 minutes) in addition to the standard magnetic resonance imaging (MRI) protocol. Further acquisition parameters were as follows: 3 T MAGNETOM Skyra (Siemens Healthcare, Erlangen, Germany), 2.5-mm isotropic resolution, field of view = 185 to 190 × 350 mm2, 62 slices, b = 50 and 800 s/mm2 with 1 and 4 averages, respectively. A dedicated 16-channel bilateral breast coil was used for imaging. Image quality was evaluated with respect to the presence of artifacts, signal voids, and quality of fat suppression. These parameters were rated using a 5-point Likert scale (1 = very strong to 5 = negligible). The apparent diffusion coefficient (ADC) was measured in 72 focal lesions (46 breast carcinomas and 26 benign lesions), and the diagnostic value of the 2 datasets was statistically evaluated and compared. The evaluation was performed a second time excluding cysts.

Results

Artifacts and signal voids were negligible in both sequences (mean on Likert scale for reference EPI 4.68 vs SMS EPI 4.65, P = 0.52, and mean on Likert scale for reference EPI 4.85 vs SMS EPI 4.77, P = 0.14). Fat suppression was significantly better in SMS EPI (mean on Likert scale 3.28 vs 2.97, P < 0.001, Pearson r = 0.49). For benign lesions, the mean ADC in both EPI sequences was 1.86 · 10−3 mm2/s. For malignant lesions, a mean ADC of 0.90 · 10−3 mm2/s for the reference EPI and 0.89 · 10−3 mm2/s for the SMS EPI was found. No significant difference between the EPI sequences was observed for ADC values (P = 0.75) and for the area under the curve (SMS, 0.985; no SMS, 0.975). The cutoff for differentiation of benign and malignant lesions was at ADC = 1.42 · 10−3 mm2/s for SMS EPI (sensitivity, 1; specificity, 0.88) and at 1.23 · 10−3 mm2/s for the reference EPI (sensitivity, 1; specificity, 0.92). Excluding the cysts, the cutoff for differentiation of benign and malignant lesions was at ADC = 1.11 · 10−3 mm2/s for SMS EPI (sensitivity, 0.89; specificity, 0.93) and at 1.23 · 10−3 mm2/s for the reference EPI (sensitivity, 1; specificity, 0.87).

Conclusions

Our data indicate that SMS acceleration can be used for diffusion imaging in breast MRI in clinical practice. Simultaneous multislice EPI achieved the same diagnostic accuracy in breast MRI, but in a substantially reduced scan time.
Physicochemical and Pharmacokinetic Profiles of Gadopiclenol
Authors: Robic Caroline , Port Marc , Rousseaux Olivier , Louguet Stéphanie , Fretellier Nathalie , Catoen Sarah , Factor Cécile , Le Greneur Soizic , Medina Christelle , Bourrinet Philippe , Raynal Isabelle , Idée Jean-Marc , Corot Claire
Published: April 2019

Objectives

We aimed to evaluate gadopiclenol, a newly developed extracellular nonspecific macrocyclic gadolinium-based contrast agent (GBCA) having high relaxivity properties, which was designed to increase lesion detection and characterization by magnetic resonance imaging.

Methods

We described the molecular structure of gadopiclenol and measured the r1 and r2 relaxivity properties at fields of 0.47 and 1.41 T in water and human serum. Nuclear magnetic relaxation dispersion profile measurements were performed from 0.24 mT to 7 T. Protonation and complexation constants were determined using pH-metric measurements, and we investigated the acid-assisted dissociation of gadopiclenol, gadodiamide, gadobutrol, and gadoterate at 37°C and pH 1.2. Applying the relaxometry technique (37°C, 0.47 T), we investigated the risk of dechelation of gadopiclenol, gadoterate, and gadodiamide in the presence of ZnCl2 (2.5 mM) and a phosphate buffer (335 mM). Pharmacokinetics studies of radiolabeled 153Gd-gadopiclenol were performed in Beagle dogs, and protein binding was measured in rats, dogs, and humans plasma and red blood cells.

Results

Gadopiclenol [gadolinium chelate of 2,2′,2″-(3,6,9-triaza-1(2,6)-pyridinacyclodecaphane-3,6,9-triyl)tris(5-((2,3-dihydroxypropyl)amino)-5-oxopentanoic acid); registry number 933983-75-6] is based on a pyclen macrocyclic structure. Gadopiclenol exhibited a very high relaxivity in water (r1 = 12.2 mM−1·s−1 at 1.41 T), and the r1 value in human serum at 37°C did not markedly change with increasing field (r1 = 12.8 mM−1·s−1 at 1.41 T and 11.6 mM−1·s−1 at 3 T). The relaxivity data in human serum did not indicate protein binding. The nuclear magnetic relaxation dispersion profile of gadopiclenol exhibited a high and stable relaxivity in a strong magnetic field. Gadopiclenol showed high kinetic inertness under acidic conditions, with a dissociation half-life of 20 ± 3 days compared with 4 ± 0.5 days for gadoterate, 18 hours for gadobutrol, and less than 5 seconds for gadodiamide and gadopentetate. The pharmacokinetic profile in dogs was typical of extracellular nonspecific GBCAs, showing distribution in the extracellular compartment and no metabolism. No protein binding was found in rats, dogs, and humans.

Conclusions

Gadopiclenol is a new extracellular and macrocyclic Gd chelate that exhibited high relaxivity, no protein binding, and high kinetic inertness. Its pharmacokinetic profile in dogs was similar to that of other extracellular nonspecific GBCAs.
Construction of Bony-Cartilaginous Defects of the Nose
Authors: Çelik Muzaffer , Aktan Erkan
Published: April 2019

Bony and cartilage defects of the nose should be reconstructed for both esthetic and functional purposes. In the past, autogenous bones, such as rib bones, cranial bones, and other bone grafts, have been used to reconstruct bony defects of the nose. Rib and ear cartilage have been used to reconstruct cartilage defects of the nose. A congenital subtotal bony-cartilaginous defect of the nose was reconstructed using cranial bone for the nasal bony defect, ear cartilage for the tip cartilage deficiency, and rib cartilage for the septal defect, in the present patient.
Three-Dimensional Pharyngeal Airway Changes After 2-Jaw Orthognathic Surgery With Segmentation in Dento-Skeletal Class III Patients
Authors: Tan Su Keng , Tang Alexander T.H. , Leung Wai Keung , Zwahlen Roger A.
Published: April 2019

Purpose:

To investigate short- and long-term three-dimensional changes of pharyngeal airway morphology and hyoid bone position in dento-skeletal class III deformity patients after 2-jaw orthognathic surgery with segmentation.

Methods:

A retrospective analysis has been performed on patients with dento-skeletal class III deformity who had undergone orthognathic 2-jaw surgery with segmentations, presenting both pre- and post-surgical cone-beam computed tomographys. Three-dimensional skeletal movements, pharyngeal airway changes and hyoid bone position were measured and correlated.

Results:

The mean short term postsurgical review period for all included 47 patients was 5.8 ± 2.2 months. Thirteen patients among them provided a mean long term period of 26.4 ± 3.4 months. The mean postsurgical maxillary movement was 2.29 ± 2.49 mm in vertical, 2.02 ± 3.45 mm in horizontal direction, respectively, while the mandibular movement was 6.49 ± 4.58 mm in vertical, and −5.85 ± 6.13 mm in horizontal direction. In short-term, the vertical length of nasopharynx was found to be reduced (P = 0.005) but increased for the oropharynx (P < 0.001). Furthermore, the oropharyngeal minimum cross-sectional area has decreased significantly (P = 0.013). The hyoid bone moved posterosuperiorly, however, with only its horizontal movement found to be significant (P = 0.043). No significant result was detected in long-term analyses, neither in postsurgical pharyngeal airway changes nor the hyoid bone movement. There were no significant differences in pharyngeal airway measurements (P > 0.05) detected between patients with and without genioplasty advancement.

Conclusion:

Two-jaw orthognathic surgery in dento-skeletal class III patients led to a statistically non-significant reduction of the post-surgical airway volume in both short- and long-term. Although the post-surgical oropharyneal minimum cross-sectional area was decreased significantly in the short term, this finding did not persist in the long term.
Evaluation of 12-Week Shelf Life of Patient-Ready Endoscopes
Authors: Lacey Valerie , Good Karron , Toliver Chris , Jenkins Shirley , DeGuzman Pamela B.
Published: April 2019

Current research suggests that for certain types of gastrointestinal endoscopes, longer shelf life (the interval of storage after which endoscopes should be reprocessed before their reuse) may not increase the likelihood of endoscope contamination. Scope contamination may, in fact, be related primarily to either inadequate disinfection processes or inadvertent contamination during storage, not to duration of storage. The purpose of this study evaluated the presence of bacteria and fungus following liquid chemical sterilization in colonoscopes and gastroscopes, after 12 weeks of shelf life during which time personal protective equipment was used during endoscope storage cabinet access. We stored four colonoscopes and two gastroscopes in a cabinet for 12 weeks after liquid chemical sterilization and the cabinet was only accessed during the 12-week period wearing personal protective equipment (gown and gloves). Scopes were tested for bacteria and fungus at the end of 12 weeks. No bacteria or fungus grew on any of the scopes. This study provides further support that contaminated endoscopes may be related to either inadequate disinfection or contamination during storage, not shelf life.
Effects of Low-FODMAPS Diet on Irritable Bowel Syndrome Symptoms and Gut Microbiome
Authors: Su Han , Li Ya-Ting , Heitkemper Margaret M. , Zia Jasmine
Published: April 2019

Patients with irritable bowel syndrome (IBS) suffer from abdominal pain, bloating, and abnormal defecation. Reducing the dietary intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) has been shown to be beneficial in reducing IBS symptoms. However, diet modification plays an important role in the composition of colonic microbiota. Currently, the effects of a FODMAP diet on the composition of the gut microbiome are not known. We conducted a systematic review to determine (1) the effectiveness of low-FODMAPs diet to reduce symptoms of patients with IBS and (2) the association between a low-FOMAPs diet and the composition of gut microbiome. Four electronic databases were searched using key words “IBS” or “irritable bowel syndrome,” and “FODMAP” or “FODMAPs” or “fermentable oligosaccharides, disaccharides, monosaccharides, and polyols,” and “microbiome.” Two reviewers (H.S. and Y.T.L.) selected and reviewed articles according to our inclusion criteria. A total of 87 articles were reviewed and 7 met inclusion criteria. Based on the systematic review, low FODMAPs appear to reduce gastrointestinal symptoms for a least a subset of patients with IBS. However, due to the heterogeneity of reviewed studies, the influence on patients' gut microbiome composition and/or microbiota metabolites requires additional studies.
Conditional Survival in Patients With Rectal Cancer and Complete Clinical Response Managed by Watch and Wait After Chemoradiation
Authors: São Julião Guilherme P. , Karagkounis Georgios , Fernandez Laura M. , Habr-Gama Angelita , Vailati Bruna B. , Dattani Mit , Kalady Matthew F. , Perez Rodrigo O.
Published: April 2019

Objective:

Analyze conditional recurrence-free survival (cRFS) for rectal cancer patients with complete clinical response (cCR) after neoadjuvant chemoradiation (nCRT) managed nonoperatively after each year without recurrence.

Summary Background Data:

Select patients with cCR after nCRT have been managed nonoperatively. Risk factors for local recurrence, the need for prolonged follow-up, and the risk of recurrence over time are not well defined.

Methods:

Retrospective review of patients with rectal cancer cT2-4N0-2M0 treated with nCRT. Mean follow-up was 64 months. Patients who achieved cCR were managed nonoperatively. cRFS was used to investigate the evolution of recurrence-odds, as patients remain recurrence-free after completion of nCRT. Three-year cRFS was estimated at “x” years after completion of nCRT based on the formula cRFS3 = RFS(x+3)/RFS(x).

Results:

One hundred ninety-seven patients with cCR after nCRT were included. Overall survival and recurrence-free survival (RFS) at 5 years were 81.9% (95% CI 74.0%–87.6%) and 60.4% (95% CI 52.5%–67.4%) respectively. Using cRFS estimates, the probability of remaining disease-free for an additional 3 years if the patient survived without disease at 1, 3, and 5 years, was 77.4% (95% CI 68.8%–83.8%), 91.0% (95% CI 81.9%–95.7%), and 94.3% (95% CI 82.9%–98.2%), respectively. In contrast, actuarial RFS rates for similar intervals were 79.1% (95% CI 72.5%–84.2%), 64.2% (95% CI 56.5%–70.8%), and 60.4% (95% CI 52.5%–67.4%). After 2 years disease-free, 3 year cRFS became similar for T2 and T3 cancers. In contrast, patients undergoing extended nCRT became less likely to develop recurrences only after initial 2 years of successful organ-preservation.

Conclusions:

Conditional survival suggests that patients have significantly lower risks (≤10%) of developing recurrences after 2 years of achieving cCR following nCRT.