bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Heart Failure Readmission in a High-Risk Primarily Hispanic Population in a Rural Setting
Authors: Carlson Beverly , Hoyt Helina , Gillespie Kristi , Kunath Julie , Lewis Dawn , Bratzke Lisa C.
Published: March 2019

BACKGROUND

High risk for readmission in patients with heart failure (HF) is associated with Hispanic ethnicity, multimorbidity, smaller hospitals, and hospitals serving low-socioeconomic or heavily Hispanic regions and those with limited cardiac services. Information for hospitals caring primarily for such high-risk patients is lacking.

OBJECTIVE

The aim of this study was to identify factors associated with 30-day HF readmission after HF hospitalization in a rural, primarily Hispanic, low-socioeconomic, and underserved region.

METHODS

Electronic medical records for all HF admissions within a 2-year period to a 107-bed hospital near the California-Mexico border were reviewed. Logistic regression was used to identify independent predictors of readmission.

RESULTS

A total of 189 unique patients had 30-day follow-up data. Patients were primarily Hispanic (71%), male (58%), and overweight or obese (82.5%) with 4 or more chronic conditions (83%) and a mean age of 68 years. The 30-day HF readmission rate was 5.3%. Early readmission was associated with history of HF, more previous emergency department (ED) and hospital visits, higher diastolic blood pressure and hypokalemia at presentation, shorter length of stay, and higher heart rate, diastolic blood pressure, and atrial fibrillation (AF) at discharge. Using logistic regression, previous 6-month ED visits (odds ratio, 1.5; P = .009) and AF at discharge (odds ratio, 5.7; P = .039) were identified as independent predictors of 30-day HF readmission.

CONCLUSIONS

Previous ED use and AF at discharge predicted early HF readmission in a high-risk, primarily Hispanic, rural population in a low-socioeconomic region.
Dietary Sodium Intake is Predicted by Antihypertensive Medication Regimen in Patients With Heart Failure
Authors: Smith Jennifer L. , Lennie Terry A. , Chung Misook L. , Mudd-Martin Gia
Published: March 2019

Background

Low-sodium diet adherence is foundational to heart failure (HF) self-management. Altered salt taste perception caused by angiotensin-converting enzyme (ACE) inhibitors commonly prescribed to patients with HF may increase sodium consumption. We hypothesized sodium intake, indicated by dietary sodium density, would be significantly higher among patients with HF prescribed ACE inhibitors compared with those not prescribed the drug.

Objective

The aim of this study was to assess the association between prescribed ACE inhibitors and dietary sodium density in patients with HF.

Methods

We conducted a secondary analysis of baseline data from patients with HF in an observational longitudinal study. Sodium density was derived by dividing averaged daily sodium intake from 4-day food diaries by averaged kilocalories consumed. Medical chart review was conducted to ascertain prescribed medications. Patients were categorized as prescribed and not prescribed an ACE inhibitor. t Tests were conducted to compare sodium intake between groups, and linear regression was conducted to examine whether prescribed ACE inhibitors independently predicted sodium density controlling for age, gender, New York Heart Association class, prescribed diuretics, and β-blockers.

Results

Analyses included 255 patients with HF aged 61 ± 12 years, with 67% male, 44% New York Heart Association class III/IV, and 68% prescribed an ACE inhibitor. Compared with those not prescribed an ACE inhibitor, 13% more sodium per kilocalorie was consumed by patients prescribed an ACE inhibitor. Prescribed ACE inhibitor independently predicted dietary sodium density (β = 0.238, P = .009).

Conclusions

Sodium intake was higher among patients prescribed ACE inhibitors. Interventions to assist patients with HF with dietary sodium adherence can be informed by assessing medication regimens.
Validity and Reliability of a Chinese-Language Instrument for Continuous Assessment of Exercise Stages of Change in Adults
Authors: Chen Shih-Hui , Lai Hsiang-Ru , Chen Su-Ru , Lin Pi-Chu , Chou Kuei-Ru , Lee Pi-Hsia
Published: March 2019

Background

Single- and five-item measures have been used prevalently to assess exercise stages of change. Few studies have investigated the development of instruments that are able to continuously measure exercise stages of change and have conducted associated psychometric analyses.

Purpose

This study aimed to translate the original, English-language version of the University of Rhode Island Change Assessment-Exercise 2 (URICA-E2), a continuous exercise stages of change assessment instrument, into Chinese and then to test the validity and reliability of the translated version.

Methods

A cross-sectional descriptive study was conducted. Participants consisted of 325 adults from Taipei, Taiwan. The URICA-E2 was translated into Chinese using a standardized procedure. Psychometric analyses, including validity, reliability, and cluster analysis, of the Chinese-version instrument were conducted.

Results

The content validity index was .987. Confirmatory factor analysis confirmed that the overall model fit was standardized, as the factor loadings of all of the items and the composite reliability and average variance extracted for the six exercise stages of change satisfied the convergent validity criteria. The average variance extracted for each construct of the stages of behavior change satisfied the discriminatory validity criteria. Values of Cronbach's α for the six exercise stages ranged from .80 to .94. The intraclass correlation coefficients for test–retest reliability after 2 weeks ranged between .74 and .87.

Conclusions

The Chinese-language version of the URICA-E2 developed in this study exhibited excellent validity and reliability. This instrument may be used by healthcare professionals and the academic community to effectively and continuously measure the intentions and attitudes of adults at various exercise stages of change and to guide the provision of appropriate interventions.
Women With Amenorrhea and Men With Menstruation: The Qualitative Experiences of People With Disorders of Sex Development in Nigeria
Authors: Sani Abdurrahman Muhammad , Arif Ismi Ismail , Arshad Mohd Mursyid , Mungadi Ismaila Arzika , Soh Kim Geok , Soh Kim Lam
Published: March 2019

Background

Disorders of sex development (DSD) affect the quality of life of people who live with this condition. In developing countries, diagnoses of DSD are associated with a delay in presentation until the patients developed ambiguous physical traits and features.

Purpose

This study explores the menstrual experiences of people with DSD and sex reassignment in Nigeria.

Methods

A qualitative approach with a phenomenological study design was employed in this study to explore and describe the experiences of people with DSD at the Usmanu Danfodiyo University Teaching Hospital in Sokoto, Nigeria. The data were collected using face-to-face interviews, transcribed verbatim, and analyzed using NVivo software.

Results

The findings show that the participants experienced menstrual problems: men with menstruation and women with amenorrhea. The female participants generally described amenorrhea as a disappointment and linked menstruation with womanhood. Amenorrhea evinced both emotional and psychological effects. However, some of the female participants considered amenorrhea in a positive light and were happy with their lives without menstruation. The menstrual experiences of male participants included menarche, lower abdominal pain, regular monthly bleeding, and ovulation. The male participants described menstruation as a disaster in their lives and a source of anxiety, suicidal ideation, and depression. Menstruation negatively affected their psychosocial well-being.

Conclusions

The menstrual experience of individuals with DSD negatively affects their quality of life. The women with DSD in this study showed a generally poor knowledge of menarche, menstruation, and puberty, indicating that their parents had ignored the initial symptoms of DSD. DSD were only recognized at puberty because of the development of ambiguous physical traits and of the onset of menstruation in men and the confirmation of amenorrhea in women.
An Exploration of Factors Related to Quality of Life in Indonesian Care Workers in Home-Based Care Settings
Authors: LO Shu-Fen , CHANG Li-Jung , HAYTER Mark , O YANG An-Chi
Published: March 2019

Background

Indonesians constituted 79% of foreign care workers for long-term care in Taiwan in 2015. Therefore, it is crucial to explore the effect of work stress and quality of life (QoL) on this population.

Purpose

This study aims to explore stress levels, social support requirements, and perceived QoL among Indonesian care workers (ICWs) who work in home care settings.

Methods

A cross-sectional design was used. Data were collected between 2014 and 2016 from a convenience sample of ICWs working in eastern Taiwan using a self-administered questionnaire that comprised the Stress Perception Scale (SPS), Social Support Scale (SSS), and World Health Organization Quality of Life-Brief scale. One hundred fifty-seven valid questionnaires were collected. The response rate was 80.51%. Data were analyzed using descriptive statistics, one-way analysis of variance, Pearson's correlation coefficient, and multiple regression analysis.

Results

The results found that the average SPS of the sample was 70.50, with low QoL scores and requirements for more social support. In addition, significant and positive correlations were found between QoL and SPS, SSS, duration of patient care, and hours of care per week. Stepwise regression analysis showed that the most predictive variables for QoL were time spent caring, preservice training, psychological stress, and emotional support, which together accounted for 60.9% of the total variance.

Conclusions/Implications for Practice

This study facilitated understanding of the stress on ICWs and the impact of social support on their QoL. The findings suggest that new immigrants in Taiwan should be introduced to foreign care workers or nursing attendants. Moreover, long-term-care-related teachers should work with home care institutions or agencies to develop a teaching model for innovative care skills to relieve the perceived stress of ICWs.
Safety and Effectiveness of Cochlear Implantation of Young Children, Including Those With Complicating Conditions
Authors: Hoff Stephen , Ryan Maura , Thomas Denise , Tournis Elizabeth , Kenny Hannah , Hajduk John , Young Nancy M.
Published: March 2019

Objective:

Determine safety and effectiveness of cochlear implantation of children under age 37 months, including below age 12 months.

Study Design:

Retrospective review.

Setting:

Tertiary care children's medical center.

Patients:

219 children implanted before age 37 mos; 39 implanted below age 12 mos and 180 ages 12–36 mos. Mean age CI = 20.9 mos overall; 9.4 mos (5.9–11.8) and 23.4 mos (12.1–36.8) for the two age groups, respectively. All but two ≤12 mos (94.9%) received bilateral implants as did 70.5% of older group. Mean follow-up = 5.8 yrs; age last follow-up = 7.5 yrs, with no difference between groups.

Interventions:

Cochlear implantation.

Main outcome measures:

Surgical and anesthesia complications, measurable open-set speech discrimination, primary communication mode(s).

Results:

Few surgical complications occurred, with no difference by age group. No major anesthetic morbidity occurred, with no critical events requiring intervention in the younger group while 4 older children experienced desaturations or bradycardia/hypotension. Children implanted under 12 mos developed open-set earlier (3.3 yrs vs 4.3 yrs, p ≤ 0.001) and were more likely to develop oral-only communication (88.2% vs 48.8%, p ≤ 0.001). A significant decline in rate of oral-only communication was present if implanted over 24 months, especially when comparing children with and without additional conditions associated with language delay (8.3% and 35%, respectively).

Conclusions:

Implantation of children under 37 months of age can be done safely, including those below age 12 mos. Implantation below 12 mos is positively associated with earlier open-set ability and oral-only communication. Children implanted after age 24 months were much less likely to use oral communication exclusively, especially those with complex medical history or additional conditions associated with language delay.
Efficacy and Safety of AM-111 in the Treatment of Acute Unilateral Sudden Deafness—A Double-blind, Randomized, Placebo-controlled Phase 3 Study
Authors: Staecker Hinrich , Jokovic Galina , Karpishchenko Sergey , Kienle-Gogolok Andrea , Krzyzaniak Andrzej , Lin Chia-Der , Navratil Pavel , Tzvetkov Ventzislav , Wright Nida , Meyer Thomas
Published: March 2019

Objective:

To confirm the efficacy and safety of AM-111 (brimapitide), a cell-penetrating c-Jun N-terminal Kinase (JNK) inhibitor, in patients suffering from severe to profound acute unilateral idiopathic sudden sensorineural hearing loss (ISSNHL).

Study design:

Prospective, double-blind, randomized, placebo-controlled phase 3 study with follow-up visits on Days 3, 7, 28, and 91.

Setting:

Fifty-one European and Asian sites (tertiary referral centers, private ENT practices).

Patients:

Two hundred fifty-six patients aged 18 to 65 years presenting within 72 hours following ISSNHL onset with mean hearing loss ≥ 40 dB and mean threshold ≥ 60 dB at the 3 worst affected contiguous test frequencies.

Interventions:

Single-dose intratympanic injection of AM-111 (0.4 or 0.8 mg/ml) or placebo; oral prednisolone as reserve therapy if hearing improvement < 10 dB at Day 7.

Main outcome measures:

Hearing improvement to Day 28 was the primary efficacy endpoint; complete hearing recovery, frequency of reserve therapy used, complete tinnitus remission, improvement in word recognition were secondary endpoints. Safety was evaluated by the frequency of clinically relevant hearing deterioration and adverse events.

Results:

While the primary efficacy endpoint was not met in the overall study population, post-hoc analysis showed a clinically relevant and nominally significant treatment effect for AM-111 0.4 mg/ml in patients with profound ISSNHL. The study drug and the administration procedure were well tolerated.

Conclusions:

AM-111 provides effective otoprotection in case of profound ISSNHL. Activation of the JNK stress kinase, AM-111's pharmacologic target, seems to set in only following pronounced acute cochlear injury associated with large hearing threshold shifts.
Primary alveolar rhabdomyosarcoma of retrorectal-presacral space in an adult patient
Authors: Zhu Xiu-Liang , Su Wei-Wei , Tang Jin-Long , Yao Li-Ding , Lu Liang-Ji , Sun Xiu-Juan
Published: March 2019

Rationale:

Rhabdomyosarcoma (RMS) has known as a highly malignant soft tissue sarcoma, representing 5% to 10% of all solid tumors in childhood. Alveolar rhabdomyosarcoma (ARMS) of the retrorectal-presacral space is an extremely rare lesion for adult, no study has been reported in the English literature.

Patient concerns:

A 51-year-old male presented with abdominal pain for 1 month, significantly worse when having a bowel movement.

Diagnosis:

Computed tomography (CT) and magnetic resonance imaging (MRI) of the pelvis showed a solid-cystic, enhancing lesion of dimension located in retrorectal-presacral space. The surgical specimen was reported as ARMS after pathological evaluation.

Interventions:

The tumor was complete surgical resection, and after surgery, the patient was treated with combination chemotherapy.

Outcomes:

At 23 months follow up, the patient was asymptomatic with no evidence of metastases or local recurrence.

Lessons:

Improvements in imaging in addition to early surgical intervention and chemotherapy treatment are crucial to improve survival chances against RMS.
Diagnostic value of high b-value (2000 s/mm2) DWI for thyroid micronodules
Authors: Wang Qingjun , Guo Yong , Zhang Jing , Ning Haoyong , Zhang Xiliang , Lu Yuanyuan , Shi Qinglei
Published: March 2019

The aim of the study was to assess the diagnostic value of high b-value (2000 s/mm2) diffusion-weighted imaging (DWI) in differentiating malignant from benign thyroid micronodules.

Consecutive patients with thyroid micronodules scheduled for Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) or surgery were underwent high b-value DWI with 3 b-values: 0, 800, and 2000 s/mm2. Signal intensity ratios (SIRs) of thyroid micronodules to adjacent normal thyroid tissue on DWI were measured as SIRb0, SIRb800 and SIRb2000. Apparent diffusion coefficients (ADCs) according to the three different b-values were acquired as: ADCb0–800, ADCb0–2000 and ADCb0–800–2000. The 6 diagnostic indicators were evaluated by receiver operating characteristic (ROC) and diagnostic ability was compared between the high b-value DWI and US.

Sixty-two malignant thyroid micronodules (48 patients, 13 men and 35 women, aged 44.8 ± 11.7 years) and 57 benign thyroid micronodules (40 patients, 6 men and 34 women, aged 49.6 ± 12.5 years) were enrolled into the final statistical analysis. Among the alone diagnostic indicators, SIRb2000 had the highest diagnostic ability in differentiating malignant from benign thyroid micronodules with area under curve (AUC) of 0.975, sensitivity of 90.32% and specificity of 96.49%. Compared to US, SIRb2000 had a significantly better diagnostic ability US for thyroid micronodules (P < .001) with dramatically raised positive predict value (96.6% vs 78.9%) and reduced false-positive rate (3.51% vs 26.32%).

High b-value (2000 s/mm2) DWI can contribute to differentiating malignant from benign thyroid micronodules.
Association between osteoarthritis and increased risk of dementia
Authors: Weber Adrian , Mak Shing hung , Berenbaum Francis , Sellam Jérémie , Zheng Yong-Ping , Han Yifan , Wen Chunyi
Published: March 2019

Objective:

To investigate the possible association between osteoarthritis (OA) and the risk of dementia.

Methods:

Cohort, case-control, and cross-sectional studies were obtained from wide literature search up to 20 April 2018 from following electronic databases: PubMed, Embase, Cochrane, using the MeSH terms: “osteoarthritis” AND “dementia”. The literature search was then expanded to congress abstracts. After screening and selection of relevant studies by two investigators, data was extracted. Estimates were then calculated using a random-effect size model. Sensitivity-analysis was conducted for gender and age adjusted studies and pooled for studies with STROBE quality assessment score ≥75%. Publication bias was assessed by Funnel plot. Analyses were performed using Data Analysis and Statistical Software Version 14.2.

Results:

Nearly 1549 publication references were initially retrieved. Twenty-six publications were checked with full-text. Six observational studies with 388,252 individuals were included. OA was associated with a significantly increased risk for dementia (OR = 1.20; 95% confidence interval (CI), 1.03–1.39, I
2 = 95.6%, P < .05). After pooling the studies with adjustment of age and gender, the risk increased (OR 1.36; 95% CI, 1.22–1.51, I
2 = 75.6%, P < .0001). After pooling the study with a STROBE Quality score ≥75% the risk for dementia was slightly increased (OR 1.33; 95% CI, 1.17–1.5, I
2 = 93.5%, p < 0.0001).

Conclusions:

There is an association between osteoarthritis and the risk of dementia. This meta-analysis does not provide causality. Further prospective cohort studies are needed to clarify, if knee-, hip-, or hand-OA are independent risk factors for Alzheimer's disease and vascular dementia.
Diagnosis and treatment of a penetrating brain injury caused by a welding electrode
Authors: Shi Lin , Sun Yue , Chen Limin , Xue Hang , Zhang Weitao , Yang Hongfa
Published: March 2019

Rationale:

Penetrating brain injury caused by a welding electrode is a rare occurrence. This type of injury requires careful preoperative assessment and timely treatment measures to avoid secondary damage.

Patient concerns:

A 55-year-old male patient fell from a height of approximately 5 m during when a welding electrode in his left hand was inadvertently inserted into his brain. The patient had a GCS score of 15 and complaints of dizziness and headache. CT showed an object of metallic density penetrating the skull and entering the brain parenchyma in the frontotemporal region.

Diagnosis:

According to the clinical findings and preoperative imaging examination, the diagnosis was open craniocerebral injury with intracranial foreign body and left orbital wall fracture.

Intervention:

After definite diagnosis and sufficient preoperative preparation, active surgical treatment was carried out to remove intracranial foreign body. Anti-infection and other symptomatic treatment were given after operation. The signs of infection and changes of vital signs were closely observed.

Outcomes:

After treatment, no obvious adverse reactions were found and the patient was discharged. No complications such as infection occurred during the follow-up period of 6 months.

Lessons:

In treating patient with a welding electrode penetrating the brain, assessments need to be made preoperatively, the welding electrode needs to be removed in a timely manner, complete hemostasis needs to be achieved during surgery with total repair of the damaged area, and anti-inflammatory treatment needs to be administered postoperatively to achieve good results.
A randomized study on the effect of sequential acupoint stimulation on pulmonary function of patients with spontaneous pneumothorax during VATS perioperative period
Authors: Sui Tie-Quan , Zhang Fa-Yue , Jiang Ai-Ling , Zhang Xiu-Qiang , Zhang Zhi-Wei , Yang Yang , Sun Li-Ping
Published: March 2019

This study aims to explore the effect of sequential acupoint stimulation on the postoperative pulmonary function of patients with spontaneous pneumothorax who underwent video-assisted thoracoscopic surgery (VATS).

Using a random number table, the patients were randomly divided into 2 groups: routine nursing group and sequential acupoint stimulation group. Patients in the routine nursing group received standard nursing care of thoracic surgery, while patients in the acupoint group received sequential acupoint stimulation on Shenshu (BL23), Gaohuang (BL43), Feishu (BL13), and Tiantu (CV22). Then, the maximal ventilatory volume (MVV), oxygen saturation (SpO2), postoperative drainage volume, postoperative drainage time, postoperative hospitalization days, and procalcitonin (PCT) were observed on the first, third, fifth and 30th day after VATS operation.

On the fifth day after spontaneous pneumothorax was treated with VATS, MVV, and SpO2 of the sequential acupoint stimulation group were significantly higher than those of the routine nursing group (P < .05). On both the third day and fifth day after VATS, PCT of the sequential acupoint stimulation group was significantly lower than that of the routine nursing group (P < .01). Furthermore, the difference in postoperative drainage volume between the 2 groups was not statistically significant (P > .05), while chest tube drainage time (P < .01) and postoperative hospitalization days (P < .05) of the sequential acupoint stimulation group were significantly lower than those of the routine nursing group.

In spontaneous pneumothorax patients who underwent VATS, sequential acupoint stimulation nursing was significantly more effective than routine postoperative nursing in promoting postoperative recovery of lung function, alleviating inflammatory response and shortening hospitalization days.
Risk factors of the postoperative 30-day readmission of gastric cancer surgery after discharge
Authors: Wu Wei-Wei , Zhang Wei-Han , Zhang Wei-Yi , Yang Lei , Deng Xiao-Qian , Zhu Tao
Published: March 2019

Background:

Readmission is a common postoperative adverse event. This study aimed to analyze potential risk factors for the incidence of postoperative 30-day readmission after discharge for gastric cancer patients with surgical treatment.

Methods:

Those studies that reported the risk factors of gastric cancer patients who have a postoperative 30-day readmission were identified systematically from the PubMed, Cochrane, and Embase databases through July 2018. A systematic review and meta-analysis was performed to estimate the risk factors of postoperative 30-day readmission after gastric cancer surgery.

Results:

Ultimately, 6 studies with 12,586 gastric cancer patients were included in the present study. There were 1473 (11.7%) patients who had postoperative 30-day readmission and 12,586 (88.3%) patients without 30-day postoperative readmission. A greater proportion of the readmission group had cardiovascular comorbidity (P < .001), pulmonary comorbidity (P < .001), and diabetes mellitus (P = .020) than the nonreadmission group. Furthermore, more patients in the readmission group had total gastrectomy (P < .001), combined organ resection (P < .001) and postoperative complications (P < .001) than did patients in the nonreadmission group. Nonhome discharge (odds ratio [OR] 1.580, P = .002), diabetes mellitus (OR 1.181, P = .044), postoperative complications (OR 2.656, P = .006), total gastrectomy (OR 2.242, P < .001), and combined organ resection (OR 1.534, P < .001) were independent risk factors for postoperative readmission.

Conclusion:

Postoperative readmission is influenced by the synthetic action of preparative, intraoperative, and postoperative factors, such as diabetes mellitus, total gastrectomy, combined organ resection, nonhome discharge, and postoperative complications. Extra attention should be paid to those patients with high risk factors during the postoperative follow-up and recovery periods.
Relationship between maternal adverse childhood experiences and infant development
Authors: Ximenes Renata de Barros Bruno , Ximenes José Christian Machado , Nascimento Simony Lira , Roddy Sarah M. , Leite Álvaro Jorge Madeiro
Published: March 2019

Introduction:

Twenty years ago, the first study was conducted to access adverse childhood experiences (ACEs) and their relation to outcomes in adulthood. The effects of exposure to childhood trauma can also be transmitted to other generations. There are some studies that suggest the hypothesis that intergenerational transmission may begin during intrauterine life through the change in placental-fetal physiology due to maternal exposure to adverse events in childhood. Those exposures can lead to a variety of conditions such as altered brain architecture, increase in placental corticotrophin hormone (pCRH) at the end of gestation, or emotional and behavioral changes during childhood and adolescence. The systematic review, therefore, is established to determine if there is a reliable association between maternal ACEs in childhood and altered child development.

Method:

We will conduct a systematic review according to the guidelines of the meta-analysis of observational studies in epidemiology (MOOSE) and with the preferred reporting items for systematic review with a focus on health equity (PRISMA-E). A comprehensive search strategy will be conducted in the following databases: MEDLINE, EMBASE, CINAHL, Web of Science, SCOPUS, Lilacs, and SciELO. Following a 2-step screening process, data including the full reference, objectives, target population, description of the exposure (ACEs), outcome measures, study design, length of follow-up period, and the study results will be extracted, synthesized, and reported. Risk of bias and quality of the studies will also be assessed.

Dissemination and ethics:

The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review has been published, this review does not require ethical approval.

Discussion:

This systematic review of the last 20 years will summarize and present the evidence for the relationship between maternal ACEs and the development of her child.

Systematic Review registration:

PROSPERO #CRD42018111456.
Cocoon devices for transcatheter closure of atrial septal defect and patent ductus arteriosus in children
Authors: Mahmoud Hyam , Nicolescu Alin , Filip Cristina , Duica Gabriela , Nicolae Georgiana , Cinteza Eliza Elena
Published: March 2019

Closure of the atrial septal defect (ASD) and patent ductus arteriosus (PDA) are among the most frequent cardiac interventional procedures. This was a prospective study, which started together with the implementation of a national program of pediatric interventional cardiology in Romania. We used Cocoon devices in 83 consecutive cases from 92 implantations for ASD and PDA. 27 cases were ASD closure and 56 cases PDA closure. Regarding the ASD closure, the median age was 8.5 years (range 3–25 years) and median weight 25 kg (range 11.5–63 kg). The mean follow-up was 17.4 ± 6.7 months (range 3–26 months). The mean ASD diameter by transesophageal echocardiography was 15.2 ± 4.1 mm (range 8–26 mm). The mean device diameter used was 17.3 ± 5.6 mm (range 8–32 mm). Regarding the PDA closure, the median age was 36 months (range 4–192 months) and median weight 14 kg (range 5–58 kg). The mean follow-up was 15 ± 8 months (range 3–28 months). The mean PDA minimum diameter was 2.5 ± 0.8 mm. The success implantation rate for both groups was 97.6% (2 cases of withdrawn for ASD and PDA), while the complication rate was 2.3% (including 2 ASD device embolization). In the first 24 hours, the closure rates were 96.3% for ASD, 98.2% for PDA, and 100% at 1-month follow-up for both procedures. On short and intermediate follow-up (3–28 months), no device-related complications were noted.

The Cocoon devices are safe for transcatheter closure of both ASD and PDA, and the initial experience with their use in our emerging center is encouraging.
The optimal bolus dose of sufentanil for satisfactory laryngeal mask airway (LMA) insertion conditions in chinese pediatric patients
Authors: Li Na , Chen Yong , Ouyang Bishan , Li Guige , Lin Guanwen , Li Yan , Li Tiejun
Published: March 2019

Background:

This study aimed to estimate the optimal dose of sufentanil, coadministered with 2.5 mg/kg propofol, for satisfactory laryngeal mask airway (LMA) insertion conditions in Chinese children and to determine the optimal bolus dose.

Methods:

Seventy-five Chinese children aged 2 to 6 years with the American Society of Anesthesiologists physical status I or II, undergoing elective minor surgery were recruited. They were randomly divided into 5 different dosage groups (0, 0.05, 0.1, 0.15, 0.2 μg/kg). A predetermined sufentanil diluted with 5 mL saline was injected 30 s, 200 s later, followed by 2.5 mg/kg propofol over 10 s. After that the insertion conditions were assessed, using a 6-category score. The duration of apnea was recorded. A Probit analysis was performed to determine the ED50 and ED95 with 95% confidence interval for optimal conditions.

Results:

There were less hemodynamic changes in all sufentanil groups than propofol-only group, with 0.2 μg/kg patients showing the most stable cardiovascular responses and best insertion conditions. However, the duration of apnea increased with the increasing dosage of sufentanil. From Probit analysis, the ED50 and ED95 of sufentanil for optimum score were 0.064 μg/kg and 0.177 μg/kg, respectively.

Conclusion:

In combination with propofol for anesthesia induction in Chinese children, sufentanil 0.2 μg/kg could prevent patients from dramatic hemodynamic change, providing satisfactory LMA insertion conditions.
Strong association between the interleukin-8-251A/T polymorphism and coronary artery disease risk
Authors: Wu Ying , Wang Wei , Li Xiao-Yan , Qian Ling-Ling , Dang Shi-peng , Tang Xu , Chen Heng-Jian , Wang Ru-Xing
Published: March 2019

Several reports have suggested a possible association between the interleukin (IL)-8-251A/T single-nucleotide polymorphism (SNP) and the susceptibility to coronary artery disease (CAD). Due to inconclusive results of the studies so far, we conducted a meta-analysis to systematically summarize the studies on the association between this SNP and CAD risk. A systematic literature search identified 9 case-control studies (3752 cases and 4219 controls) on the IL-8-251A/T polymorphism. We observed a significant association between different genetic forms of −251A/T SNP and CAD risk, like the allele model (A vs T: odds ratio [OR] 1.14, 95% confidence interval [CI] 1.02–1.27, P = .02), dominant model (AA + AT vs TT: OR 1.20, 95% CI 1.01–1.43, P = .042), recessive model (AA vs AT + TT: OR 1.15, 95% CI 1.03–1.27, P = .01), and homozygous model (AA vs TT: OR 1.26, 95% CI 1.01–1.56, P = .037), whereas the heterozygote model did not show any significant association (AT vs TT: OR 1.16, 95% CI 0.98–1.38, P = .091). Furthermore, significant heterogeneity was observed among studies in terms of all genetic models, except the recessive model. Analysis of the ethnic subgroups revealed a significantly higher risk of CAD in the East Asian population carrying this SNP, and the heterogeneity among the studies regarding the East Asian population was decreased after subgroup analysis. The results of this meta-analysis suggest that the IL-8-251A/T SNP may increase the risk of CAD, especially in people of East Asian ethnicity. Further large-scale, multicenter epidemiological studies are warranted to validate this finding.
Effect of advanced care on psychological condition in patients with chronic renal failure undergoing hemodialysis
Authors: Guan Yun , He Yu-xia
Published: March 2019

Background:

The protocol of this systematic review will be proposed for assessing the effects of advanced care (AC) on psychological condition in patients with chronic renal failure (CRF) undergoing hemodialysis.

Methods:

We will search the following electronic databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inception to the January 30, 2019. Any randomized controlled trials (RCTs) for assessing the effects of AC on psychological condition in patients with CRF undergoing hemodialysis will be fully considered. The methodological quality will be assessed by using Cochrane risk of bias tool. Two independent reviewers will perform the study selection, data extraction, and methodological quality assessment. A third reviewer will be invited to judge the disagreements between 2 reviewers by discussion.

Results:

The protocol of this proposed systematic review will compare the effects of AC on psychological condition in patients with CRF undergoing hemodialysis. The outcomes will comprise of depression. The secondary outcome includes anxiety, health related quality of life, and any adverse events.

Conclusion:

The findings of this systematic review will summarize the latest evidence of AC on psychological condition in patients with CRF undergoing hemodialysis.

Ethics and dissemination:

All data used in this systematic review will be collected from previous published clinical studies. Thus, no ethic approval is required for this study. The findings of this study will be published at a peer-reviewed journal.

PROSPERO registration number:

PROSPERO CRD42019122275.
Comparison of laryngeal mask airway supremeTM as non-inflatable cuff device and self-pressurized air-QTM in children
Authors: Hwang Jagyung , Hong Boohwi , Kim Yoon-Hee , Lee Won Hyung , Jo Yumin , Youn SooKyoung , Lim Chae Seong
Published: March 2019

Background

: Supraglottic airway (SGA) device with non-inflatable cuff reduce the airway complications associated with cuff hyperinflation. The aim of the study is to determine whether the default setting of Supreme is as effective as the non-inflatable cuff devices. The oropharyngeal leak pressure was measured and compared between the Supreme and Air-Q, a typical non-inflatable cuff device. We hypothesized that the default setting of Supreme is non-inferior to the the Air-Q self-pressurized (SP) in respect to the oropharyngeal leak pressure.

Methods

: Eighty-four patients aged 1 to 7 years who were scheduled for general anesthesia, participated in the study. The patients were randomly assigned to Supreme group (n = 41) or Air-Q SP group (n = 43). We considered that the primary outcome, oropharyngeal leak pressure of Supreme group would be non-inferior to the Air-Q SP group, within 3 cmH2O. Other outcomes included tidal volume loss, difficulty of insertion, insertion time, and complications.

Results

: The oropharyngeal leak pressure of the Supreme and Air-Q SP was 19.9 ± 4.1 cm H2O and 17.4 ± 2.9 cm H2O, respectively. The mean differences of 2 devices (Air-Q SP—Supreme) were −2.5 cm H2O, (95% confidence interval [−4.0 to −0.9], P = .002). The upper CI was smaller than the non-inferiorty margin (3 cm H2O). This result suggested that the default setting of Supreme was superior to the Air-Q SP with respect to the oropharyngeal leak pressure. However, there were no significant differences in tidal volume loss over time, ease of device insertion score, insertion time, and complications.

Conclusions

: The Supreme can be used in the default setting in pediatric patients accordingly in terms of tolerable leak pressure and the stability for mechanical ventilation compared with Air-Q SP.
The effects of high-intensity interval training versus moderate-intensity continuous training on fat loss and cardiometabolic health in pediatric obesity
Authors: Liu Jing-Xin , Zhu Lin , Deng Jia-Min
Published: March 2019

Background:

The effects of aerobic exercise on fat loss and cardiometabolic health are well-documented, but it is unknown whether a high-intensity interval training (HIIT) elicit a greater health benefit in obese children and adolescents.

Methods:

Relevant studies in Pubmed, Web of Science, Embase, the Cochrane Library, EBSCO, and CNKI will be searched for studies with language restriction in English and Chinese, which were published from inception to December 1, 2018. Only randomized controlled trials of HIIT on pediatric obesity will be included, and observational studies, prospective cohort studies, and systematic reviews will be excluded. Two reviewers will independently screen the studies; risk of bias assessment and data extraction, and the results are inconsistent when discussed or resolved by a third reviewer. Data analysis and synthesis will be completed by the Revman 5.3 software and Stata 12.0 software. This study will be conducted by following the guideline of the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols.

Conclusion:

This study will be conducted by previously published data, thus ethics approval is not required. This finding will be published in a related peer-reviewed journal and present it at international conferences.

PROSPERO registration number:

CRD42018111308,
Effects of tramadol on emergence agitation after general anesthesia for nasal surgery
Authors: Lee Seok-Jin , Choi Seok Jun , In Chi Bum , Sung Tae-Yun
Published: March 2019

Emergence agitation (EA) is common after nasal surgery. Strong opioids and N-methyl-d-aspartate (NMDA) receptor antagonists prevent EA. Tramadol also acts as an opioid receptor agonist and an NMDA receptor antagonist, but few studies have evaluated the effects of tramadol on EA. This retrospective study investigated whether tramadol is effective for reducing EA in adult patients undergoing nasal surgery.

Of 210 adult patients undergoing a nasal surgical procedure under general anesthesia, the medical records of 113 were analyzed retrospectively. The patients were divided into 2 groups: patients who received tramadol during the operation (tramadol group, n = 52) and patients who did not (control group, n = 61). The incidence of EA, recovery time, changes in hemodynamic parameters, postoperative pain scores, and adverse events were compared between the 2 groups.

The incidence of EA was higher in the control group than in the tramadol group (50.8% [31/61] vs 26.9% [14/52]; odds ratio 2.805; 95% confidence interval, 1.3 to 6.2; P = .010). Changes in systolic blood pressure in the 2 groups were similar, whereas changes in heart rate during emergence differed depending on the group (P = .020), although pairwise comparisons did not reveal any differences between the groups. Recovery time, postoperative pain scores, and adverse events were similar in the 2 groups.

In adult patients undergoing nasal surgery, tramadol infusion decreases the incidence of EA after sevoflurane anesthesia without delaying recovery or increasing the number of adverse events.
The use of Indocyanine green in endocrine surgery of the neck
Authors: Fanaropoulou Nina Maria , Chorti Angeliki , Markakis Markos , Papaioannou Maria , Michalopoulos Antonios , Papavramidis Theodosios
Published: March 2019

Background:

The insufficient reliability of preoperative imaging technology and limited convenience of intraoperative visualizing techniques have been associated with difficulty in surgical navigation in neck endocrine surgery. Indocyanine green (ICG) fluorescence imaging has stood out as the real-time intraoperative guide amidst research for novel modalities, with an emerging use in endocrine surgery.

Methods:

We performed a systematic review of the PubMed, Scopus and Embase databases, to identify published studies on parathyroid and thyroid operations employing ICG. Well-described articles were selected according to 7 criteria and analyzed per operation type and organ structure.

Results:

Twenty-one articles matched our selection criteria. Dosage, equipment, and techniques are well-described in literature. ICG was found to significantly enhance the surgical experience and outcomes. Occasional discrepancy among studies was attributed to the lack of standard quantification of values and divergence of study designs.

Conclusion:

The most successful applications of ICG are:

Future research is needed for standard quantification of fluorescence intensity and objective comparisons.
An evidence-based approach to evaluate the accuracy of amide proton transfer-weighted MRI in characterization of gliomas
Authors: Zhao Jiaying , Huang Songtao , Xie Huan , Li Wenfei
Published: March 2019

Backgroud:

To perform a meta-analysis to evaluate the diagnostic accuracy of the amide proton transfer (APT) technique in differentiating high-grade gliomas (HGGs) from low grade gliomas (LGGs).

Methods:

Medical literature databases were searched for studies that evaluated the diagnostic accuracy of APT in patients suspected of brain tumor who underwent APT MRI and surgery. Only English language studies and published before September 2018 were considered to be included in this project. Homogeneity was assessed by the inconsistency index. Mean difference (MD) at 95% confidence interval (CI) of all parameters derived from APT was calculated. Publication bias was explored by Egger's funnel plot.

Results:

Six eligible studies were included in the meta-analysis, comprising 144 HGGs and 122 LGGs. The APT-related parameter signal intensity (SI) was significantly higher in the HGG than the LGG (WMD = 0.86 (0.61–1.1), P < .0001); A significant difference was also found between grade II and grade III (WMD = 0.6 (0.4–0.8), P < .0001), and between grade II and grade IV (WMD = 1.07 (0.65–1.49), P < .0001).

Conclusions:

APT imaging may be a useful imaging biomarker for discriminating between LGGs and HGGs. However, large randomized control trials (RCT) were necessary to evaluate its clinical value.
The utility of 18F-FDG and 68Ga-DOTA-Peptide PET/CT in the evaluation of primary pulmonary carcinoid
Authors: Jiang Yuanyuan , Hou Guozhu , Cheng Wuying
Published: March 2019

Background:

Pulmonary carcinoids (PC) are histologically classified into typical carcinoid (TC) and atypical carcinoid (AC). The diagnosis of pulmonary carcinoid and possibly the differentiation between TC and AC could make a significant effect on the treatment planning as well as prognosis.
[1]
Several studies have explored the utility of 68Ga-DOTA-Peptide (68Ga-labelled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-peptide) and 18F-flurodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the evaluation of primary pulmonary carcinoids. Therefore, we performed a meta-analysis to evaluate the diagnostic accuracy and prediction efficiency of histological subtypes of these two imaging modalities in primary PC.

Methods:

Relevant studies were identified by searching PubMed, Web of Science, and EMBASE published from 2006 to 2016. Two authors extracted characteristics of patients and their lesions using predefined criteria.

Results:

Fourteen studies comprising 352 patients were included in this meta-analysis. The pooled sensitivity of 68Ga-DOTA-Peptide and 18F-FDG PET/CT in detecting pulmonary carcinoid were 90.0% (95% CI = 82.0–95.0%; P = .07; I
2 = 49.6%) and 71.0% (95% CI = 66.0–76.0%; P < .001; I
2 = 59.3%), respectively. An SUVmax ratio between 68Ga-DOTA-Peptide and 18F-FDG higher than the cutoff value of 4.28 was predictive of TC with 89.3% sensitivity and 100% specificity (AUC, 96.4%; 95% CI, 91.1–100%). The ratio of tumor uptake to atelectatic lung uptake was significantly higher for 68Ga-DOTA-peptide (2.5–91, mean 30.5 ± 28.1) than for 18F-FDG (0.3–10.3, mean 2.1 ± 2.3) (P < .001).

Conclusions:

Both 68Ga-DOTA-peptide and 18F-FDG are highly sensitive in detecting pulmonary carcinoid, while 68Ga-DOTA-peptide is more sensitive than 18F-FDG (90.0% vs 71.0%). The SUVmax ratio was an accurate predictor of the histopathologic variety of the carcinoid tumor, and 68Ga-DOTA-peptide was better than 18F-FDG in cases with atelectasis.
Effects of psychological care in patients with endometriosis
Authors: Gao Juan , Liu Han-Qiao , Wang Yan , Shang Ya-Li , Hu Fang
Published: March 2019

Background:

This systematic review will be proposed for investigating the effects of psychological care (PC) in patients with endometriosis.

Methods:

We will search the following 7 electronic databases from inception to the present: MEDLINE, EMBASE, SinoMed, Web of Science, Cochrane Library, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will include randomized controlled trials for evaluating the effects of PC in patients with endometriosis. Cochrane risk of bias tool will be used to evaluate the methodological quality for each included study. Two authors will independently carry out the study selection, data extraction, and methodological quality evaluation. Any disagreements will be solved by a third author through discussion.

Results:

This proposed systematic review will use high-quality evidence-based medicine to evaluate the efficacy and safety of PC for endometriosis. The primary outcomes include depression and anxiety. The secondary outcomes consist of pain intensity, health-related quality of life, and adverse events.

Conclusion:

The findings of this study will provide convincing evidence to determine whether PC therapy is an effective and safe intervention for patients with endometriosis.

PROSPERO registration number:

PROSPERO CRD42019123292.