bluuebunny/crossref_metadata_2025 huggingface dataset:
Appositive compounds in dialectal and sociolinguistic varieties of French
Authors: Bauer Brigitte L. M.
Published: August 2020

Over the last 100 years, appositive compounding—combining two nouns in apposition—has become one of the most productive word formation processes in French. In an attempt to account for this dramatic spread and building on existing diachronic research, this article examines the occurrence of appositive compounds in non-standard French during the twentieth century, in a number of Gallo-Romance dialects and in Poilu, a sociolect from the early twentieth century, bringing together historical, dialectal, and sociolinguistic data. Analysis includes the identification of the different types of appositive compound and their underlying structure. Moreover word order patterns and their potential geographic correlates will be investigated as well as the role of metaphors and metonymy. Data reflecting geographic variation and sociolinguistic stratification will thus help to determine what factors were at play in the expansion of appositive compounding in contemporary French.
The verbs ‘rain’ and ‘snow’ in Gallo-Romance, and other morphological mismatches in diachrony
Authors: Maiden Martin
Published: August 2020

The historical morphology of the verb ‘snow’ in Francoprovençal presents a conundrum, in that it is clearly analogically influenced by the verb ‘rain’, for obvious reasons of lexical semantic similarity, but the locus of that influence is not the ‘root’ (the ostensible bearer of lexical meaning) but desinential inflexion-class members, which are in principle independent of any lexical meaning. Similar morphological changes are also identified for other Gallo-Romance verbs. It seems, in effect, that speakers can identify exponents of the lexical meaning of word-forms in linear sequences larger than the apparent ‘morphemic’ composition of those word-forms, even when such a composition may seem prima facie transparent and obvious. It is argued that these facts are inherently incompatible with ‘constructivist’, morpheme-based, models of morphology, and strongly compatible with what have been called ‘abstractivist’ (‘word-and-paradigm’) approaches, which generally take entire word-forms as the primary units of morphological analysis.
Soft-Collinear Effective Theory
Authors: Becher Thomas
Published: August 2020

The lectures that appear within this chapter provide an introduction to soft-collinear effective theory (SCET). It begins by discussing resummation for soft-photon effects in QED, including soft photons in electron–electron scattering and the expansion of loop integrals and the method of regions event-shape variables. It then covers SCET specifically, including the method of regions for the Sudakov form factor, effective Lagrangians, the vector current in SCET, and resummation by renormalization group (RG) evolution. It covers applications of SCET in jet physics, describes the characteristic feature in jet processes of Sudakov logarithms, and discusses factorization for the event-shape variable thrust and factorization and resummation for jet cross sections.
1 Paediatric Transport Safety Collaborative (PTSIC): Critical Events with Family Presence During Paediatric Critical Care Transport
Authors: Ali Aaisham , Miller Michael , Cameron Saoirse , Gunz Anna
Published: August 2020

Background

Health care of children in Canada is regionalized; thus, critically ill paediatric patients require transfer to a tertiary care centre for definitive medical and surgical management. There are risks inherent to transporting critically ill patients, and there is a body of literature looking to mitigate risk, which includes tracking and benchmarking quality metrics. One accepted metric is family accompaniment of a child during transport, with some studies suggesting that family accompaniment could compromise care. Currently, there has been no research that examines patient safety and outcomes during paediatric critical care transport with family presence.

Objectives

The primary objective of this study was to compare the rate of critical events (CEs) during the transport of paediatric patients by a specialized paediatric critical care transport team on transports with parental/caregiver accompaniment (P/CA) to those without P/CA. Secondary objectives included whether peak heart rate (HR), systolic blood pressure (SBP), and clinically relevant patient outcomes varied between groups.

Design/Methods

We conducted a retrospective cohort study of all patients (<18 years old) who were admitted to a Paediatric Critical Care Unit and transported by the local neonatal paediatric transport team between April 1st, 2018 and June 1st, 2019, inclusive. The primary outcome was CE occurrence using the composite definition of CE that was previously identified and defined by a national consensus process, which included patient-, transport provider-, laboratory- and system/vehicle- related safety factors. Secondary outcomes included peak and trough HR/SBP, and clinically relevant outcomes (including length of stay, mechanical ventilation free days, and severity of illness and organ dysfunction scores).

Results

There were a total of 178 transports eligible for analysis, and of those, 55 were with P/CA and 123 were without P/CA. The occurrence of CE was not significantly different between transports with and without P/CA (66% vs. 65%, respectively). Similarly, patient HR, SBP, and all measured clinical patient outcomes did not vary significantly between groups.

Conclusion

This study is the first to objectively measure CEs and relate them to patient clinical outcomes with regard to presence of P/CA during paediatric critical care transport. There was no identified increased risk to the patient or crew if parents/caregivers accompanied their child during transport. Areas of future study include whether parental/caregiver presence during transport affects patient anxiety and well-being.
65 Mama na Mtoto: Health Outcome Achievements Following Implementation of Comprehensive Maternal Newborn Programming in Rural Tanzania
Authors: Brenner Jennifer L , Matovelo Dismas , Maendaelo Boniphace , Mweteni Wemaeli , Singhal Nalini , Nettel-Aguirre Alberto , Subi Leonard
Published: August 2020

Introduction/Background

Preventable deaths in pregnant women and newborns remain unacceptably high in East Africa. Limited antenatal, delivery and postnatal care-seeking combined with service delivery gaps at government facilities contribute to high mortality. Between 2016-2019, partners from Tanzania, Uganda, and Canada jointly developed, implemented, and evaluated a comprehensive, district-wide maternal, newborn, and child health (MNCH) ‘package’ in Lake Zone, Tanzania. Known locally as ‘Mama na Mtoto’, the scale-up programming involved training and capacity building for district managers, health facility staff and a network of volunteer community health workers selected by their own communities.

Objectives

To quantitatively assess changes in MNCH health outcomes following the Mama na Mtoto intervention.

Design/Methods

MNCH household-level care-seeking outcomes were assessed using a pre/post coverage survey adapted from the Demographic Health Survey. Households and women (15-49 years), selected through cluster sampling (cluster unit=hamlet), were surveyed by local, trained research assistants using tablet-based surveys. MNCH service outcomes were assessed at all government health facilities using a comprehensive pre/post cross-sectional audit tool; key measures included staff, equipment, infrastructure, supplies, and medication availability. Descriptive statistics for antenatal care (ANC), health facility delivery (HFD), and postnatal care (PNC)-related indicators were analyzed pre- and post-intervention using R software. Composite health facility ‘Readiness Scores’ were calculated through tallies of relevant itemized facility-based measures for each core MNCH service area across the district. Absolute percentage differences, confidence intervals and design effect are presented where relevant.

Results

In total, 1,977 households, 2,438 women, and 45 health facilities were surveyed pre-intervention and 1,835 homes, 2,073 women, and 49 health facilities were surveyed post. Care-seeking indicators with statistically significant changes were ANC 4+ (+11%), ANC <12 weeks (+7%), HFD (+17%), and PNC for mothers (+9%); PNC for babies was not significant. Increases in composite MNCH Service Readiness Scores were as follows: ANC +24%, essential newborn care +42%, newborn resuscitation +37%, and labour and delivery +27%.

Conclusion

The comprehensive MnM package was associated with important improvements in the demand (care-seeking) and service (facility readiness) health outcomes. Attribution is complicated by an uncontrolled health system and lack of district controls; however, the extensive scope, reach, and positive changes are promising and consistent with sustained Ugandan experiences. Best practice documentation is critical to facilitate scale-up and progress acceleration of MNCH programs in Tanzanian and East African settings.
71 Predictors of children anxiety and association with parental anxiety in the preoperative setting at a tertiary pediatric center
Authors: Bastarache Amelie , Normand Genevieve
Published: August 2020

Background

Preoperative anxiety is a prevalent phenomenon in the pediatric population. The impact of anxiety can be seen in the children and accompanying family and have significant consequences during anesthesia, the perioperative and postoperative period. Previous studies examining risk factors of anxiety were contradictory and a few studied children aged under 5.

Objectives

The aim of this study is to evaluate the association between parental anxiety and child anxiety in patients undergoing elective surgery in a tertiary pediatric center. The secondary objectives were to identify the cohort characteristics and the risk factors associated with higher anxiety.

Design/Methods

In this prospective cohort study, 166 children aged from 2 to 12 years old, who had a surgery between March and June 2019, were analyzed. Children’s anxiety at induction was assessed by the anesthesiologist with the Modified Yale Preoperative Scale Short form (mYPAS-SF). Anxiety level of children over 8 years old was self-assessed by the State-Trait Anxiety Inventory-Child form (STAIC) during the preoperative evaluation. Parents’ anxiety was measured with the State-Trait Anxiety Inventory form (STAI). Data recorded included personal, familial and sociodemographic details, past healthcare history and prior separations. Unadjusted and adjusted logistic regression were performed to identify possible risk factors of children’s anxiety and association between child and parent anxiety.

Results

The prevalence of significant anxiety at induction was 39.8%. No significant association was observed between the level of anxiety of parents compared to their children except in the group of children aged over 8. In this population, statistically significant correlation was observed between the STAIC and the STAI score, with a Pearson coefficient of 0.4. Children aged 2 to 5 years old and parents aged 15 to 35 years old, being an only child and no anterior history of separation were all associated with higher anxiety at induction. In the adjusted analysis, being five years or older was a protective factor (OR 0.23, 95% CI 0.12;0.45, p<0.001).

Conclusion

Parent anxiety does not seem to be a good indicator of children’s anxiety even if an association was observed in the group of 8 to 12 years old. Children under 5 are more at risk of preoperative anxiety and could benefit from new technologies and preparative strategies to lower their anxiety level. Anxiety at induction remains difficult to predict and more studies on the subject need to be carried out.
99 Newly approved IV acetaminophen in Canada: Should we switch from oral to IV? A systematic review
Authors: Ulrich Maxime , Chamberland Martine , Bertoldi Christel , Garcia-Bournissen Facundo , Kleiber Niina
Published: August 2020

Background

Acetaminophen is the most commonly used drug in children. In 2019, an IV formulation became available in Canada, but with a price tag >500 times higher than oral acetaminophen. Acetaminophen use has been growing in the US since its approval in 2011, leading to a significant health cost increase. Therefore, strict criteria for IV acetaminophen administration are needed to guide clinicians with a rational choice for route of administration and contain costs.

Objectives

To undertake a systematic review of available evidence comparing oral versus IV acetaminophen use in children.

Design/Methods

A systematic literature search was conducted on 5 databases until October 2019. All prospective interventional studies comparing IV to oral acetaminophen in patients <18 years old were included. Study selection, data collection and analysis were done according to PRISMA guidelines.

Results

Among 6417 abstracts, 29 full text articles were assessed, of which only 3 were retained. Indication for acetaminophen use in these studies was: analgesia (2 studies) and fever (1 study).

Studies focused on:

- Pharmacokinetics: In 2019, the first determination of oral bioavailability (F) of acetaminophen in children was reported in 47 stable PICU patients (microtracer study design with a population pharmacokinetic study). It showed an F=72% with a high inter-individual variability (range: 11%-91%).

- Pharmacodynamics studies:

• Analgesia: Analgesic efficacy after cleft palate repair was compared in 45 children (median age: 8 month) divided in three arms receiving either oral (15mg/kg every 6h), IV (12.5mg/kg every 6h) or placebo in a double-blind randomized controlled trial. No difference in pain scores and opioids requirements was found between the oral and IV acetaminophen groups.

• Fever: An open-label prospective observational study reported the effect of IV (15mg/kg) versus oral acetaminophen (15mg/kg) on the evolution of temperature in children with fever >39.5°C in hospital and outpatient settings. Two hundred patients (mean age 6.7 years) were included in each arm. Temperature decreased quicker with IV administration but 4 hours after administration, temperature was similar in each group.

Conclusion

Despite the widespread use of IV acetaminophen, there is little evidence to suggest that it improves analgesia compared to the oral formulation. Similarly, fever weans faster but whether this translates into any meaningful clinical outcome is unknown. Available data is insufficient to guide clinicians with a rational choice of route of administration, but the significantly higher costs do not seem justified by the small (if any) benefits of IV vs oral acetaminophen.
111 Kawasaki disease in Ontario children from 1995-2017: A population-based descriptive analysis
Authors: Schlorff Megan , Robinson Cal , Mondal Tapas , Demers Catherine , Darling Elizabeth , Brar Sandeep , Parekh Rulan , Seowh Hsien , Chanchlani Rahul , Batthish Michelle
Published: August 2020

Background

Kawasaki disease (KD) is a common pediatric vasculitis with rising global incidence. Associated coronary artery aneurysms (CAA) can result in significant long-term morbidity and mortality. However, our understanding of the trends in incidence along with patient and disease characteristics for North American children over the past two decades remains limited, particularly in universal health care systems. This understanding can inform healthcare resource planning and identify knowledge gaps for educational initiatives.

Objectives

The objectives of this study were to: 1) compare patient, hospital and disease characteristics for children diagnosed with KD between two eras (1995-2001 and 2002-2017) and three age groups (0-4yr, 5-9yr, 10-18yr) and 2) determine trends in KD incidence across Ontario, Canada between 1995 to 2017.

Design/Methods

We used healthcare administrative databases housed at the Institute for Clinical Evaluative Sciences (ICES) to identify a population-based cohort of Ontario children (0-18 years) diagnosed with KD during hospital admission between April 1995 and March 2017. We excluded children with previous KD diagnosis. We compared eras and age groups by Chi-squared test. We determined the annual incidence of KD in Ontario, compared by Cochrane-Armitage test.

Results

We identified 4346 Ontario children diagnosed with KD between 1995-2017. The mean (SD) age at diagnosis was 3.4 years (± 2.9) and male:female ratio was 1.5:1. Median (IQR) length of hospital admission was 3 days (2-4) and 104 children (2.4%) required PICU admission. No child died within 90 days of diagnosis. Baseline CAA were observed in 106 children (2.4%). There was no difference in baseline CAA by era (2.3% [1995-2001] vs 2.5% [2002-2017], p=0.72). CAA were significantly more common in children aged 10-18 years (5.3% vs 2.4% [0-4yr] and 2.2% [5-9yr], p=0.03). Myo-/pericarditis occurred in 71 children (1.6%). Red blood cell transfusions were administered to 51 children (1.2%) and were significantly more common during 2002-2017 (≤0.5% vs 1.5%, p<0.001). The standardized incidence of KD increased significantly over the study period (p<0.0001), from 6.5 cases per 100,000 person-years (1995-2000) to 8.4 cases (2012-2017). Significant seasonal variation was observed; incidence was highest from November to March (OR 1.7 – 2.1, using August as reference month) and peaked in January (OR 2.1).

Conclusion

The incidence of KD has increased significantly over the past 20 years in Ontario, Canada which may reflect increased awareness and improved diagnosis. However, the frequency of baseline CAA has not changed. Baseline CAA are more common in children 10-18 years. This may suggest delayed diagnosis in this age group.
The Crosstalk between MicroRNAs and Gibberellin Signaling in Plants
Authors: Yu Sha , Wang Jia-Wei
Published: August 2020

Gibberellin (GA) is an integral phytohormone that plays prominent roles in controlling seed germination, stem elongation, leaf development and floral induction. It has been shown that GA regulates these diverse biological processes mainly through overcoming the suppressive effects of the DELLA proteins, a family of nuclear repressors of GA response. MicroRNAs (miRNAs), which have been identified as master regulators of gene expression in eukaryotes, are also involved in a wide range of plant developmental events through the repression of their target genes. The pathways of GA biosynthesis and signaling, as well as the pathways of miRNA biogenesis and regulation, have been profoundly delineated in the past several decades. Growing evidence has shown that miRNAs and GAs are coordinated in regulating plant development, as several components in GA pathways are targeted by miRNAs, and GAs also regulate the expression of miRNAs or their target genes vice versa. Here, we review the recent advances in our understanding of the molecular connections between miRNAs and GA, with an emphasis on the two miRNAs, miR156 and miR159.
Stability, Strategy-Proofness, and Cumulative Offer Mechanisms
Authors: Hatfield John William , Kominers Scott Duke , Westkamp Alexander
Published: August 2020

We characterize when a stable and strategy-proof mechanism is guaranteed to exist in the setting of many-to-one matching with contracts. We introduce three novel conditions—observable substitutability, observable size monotonicity, and non-manipulability via contractual terms—and show that when these conditions are satisfied, the cumulative offer mechanism is the unique mechanism that is stable and strategy-proof (for workers). Moreover, we show that our three conditions are, in a sense, necessary: if the choice function of some firm fails any of our three conditions, we can construct unit-demand choice functions for the other firms such that no stable and strategy-proof mechanism exists. Thus, our results provide a rationale for the ubiquity of cumulative offer mechanisms in practice.
Baricitinib improves respiratory function in patients treated with corticosteroids for SARS-CoV-2 pneumonia: an observational cohort study
Authors: Rodriguez-Garcia Jose Luis , Sanchez-Nievas Gines , Arevalo-Serrano Juan , Garcia-Gomez Cristina , Jimenez-Vizuete Jose Maria , Martinez-Alfaro Elisa
Published: August 2020

Objectives

The Janus kinase (JAK) inhibitor baricitinib may block viral entry into pneumocytes and prevent cytokine storm in patients with SARS-CoV-2 pneumonia. We aimed to assess whether baricitinib improved pulmonary function in patients treated with high-dose corticosteroids for moderate to severe SARS-CoV-2 pneumonia.

Methods

This observational study enrolled patients with moderate to severe SARS-CoV-2 pneumonia [arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (FiO2) <200 mmHg] who received lopinavir/ritonavir and HCQ plus either corticosteroids (CS group, n = 50) or corticosteroids and baricitinib (BCT-CS group, n = 62). The primary end point was the change in oxygen saturation as measured by pulse oximetry (SpO2)/FiO2 from hospitalization to discharge. Secondary end points included the proportion of patients requiring supplemental oxygen at discharge and 1 month later. Statistics were adjusted by the inverse propensity score weighting (IPSW).

Results

A greater improvement in SpO2/FiO2 from hospitalization to discharge was observed in the BCT-CS vs CS group (mean differences adjusted for IPSW, 49; 95% CI: 22, 77; P < 0.001). A higher proportion of patients required supplemental oxygen both at discharge (62.0% vs 25.8%; reduction of the risk by 82%, OR adjusted for IPSW, 0.18; 95% CI: 0.08, 0.43; P < 0.001) and 1 month later (28.0% vs 12.9%, reduction of the risk by 69%, OR adjusted for IPSW, 0.31; 95% CI: 0.11, 0.86; P = 0.024) in the CS vs BCT-CS group.

Conclusions

. In patients with moderate to severe SARS-CoV-2 pneumonia a combination of baricitinib with corticosteroids was associated with greater improvement in pulmonary function when compared with corticosteroids alone.

Trial registration

European Network of Centres for Pharmacoepidemiology and Pharmacovigilance, ENCEPP (EUPAS34966, http://www.encepp.eu/encepp/viewResource.htm? id = 34967)
Baseline Cortical Thickness Reductions in Clinical High Risk for Psychosis: Brain Regions Associated with Conversion to Psychosis Versus Non-Conversion as Assessed at One-Year Follow-Up in the Shanghai-At-Risk-for-Psychosis (SHARP) Study
Authors: Del Re Elisabetta C , Stone William S , Bouix Sylvain , Seitz Johanna , Zeng Victor , Guliano Anthony , Somes Nathaniel , Zhang Tianhong , Reid Benjamin , Lyall Amanda , Lyons Monica , Li Huijun , Whitfield-Gabrieli Susan , Keshavan Matcheri , Seidman Larry J , McCarley Robert W , Wang Jijun , Tang Yingying , Shenton Martha E , Niznikiewicz Margaret A
Published: August 2020

Objective

To assess cortical thickness (CT) and surface area (SA) of frontal, temporal, and parietal brain regions in a large clinical high risk for psychosis (CHR) sample, and to identify cortical brain abnormalities in CHR who convert to psychosis and in the whole CHR sample, compared with the healthy controls (HC).

Methods

Magnetic resonance imaging, clinical, and cognitive data were acquired at baseline in 92 HC, 130 non-converters, and 22 converters (conversion assessed at 1-year follow-up). CT and SA at baseline were calculated for frontal, temporal, and parietal subregions. Correlations between regions showing group differences and clinical scores and age were also obtained.

Results

CT but not SA was significantly reduced in CHR compared with HC. Two patterns of findings emerged: (1) In converters, CT was significantly reduced relative to non-converters and controls in the banks of superior temporal sulcus, Heschl’s gyrus, and pars triangularis and (2) CT in the inferior parietal and supramarginal gyrus, and at trend level in the pars opercularis, fusiform, and middle temporal gyri was significantly reduced in all high-risk individuals compared with HC. Additionally, reduced CT correlated significantly with older age in HC and in non-converters but not in converters.

Conclusions

These results show for the first time that fronto-temporo-parietal abnormalities characterized all CHR, that is, both converters and non-converters, relative to HC, while CT abnormalities in converters relative to CHR-NC and HC were found in core auditory and language processing regions.
Differences in carbon and nitrogen metabolism between male and female Populus cathayana in response to deficient nitrogen
Authors: Wu Xiaoyi , Liu Jiantong , Meng Qiqi , Fang Shiyan , Kang Jieyu , Guo Qingxue
Published: August 2020

Sexual dimorphism occurs regarding carbon and nitrogen metabolic processes in response to nitrogen supply. Differences in fixation and remobilization of carbon and allocation and assimilation of nitrogen between sexes may differ under severe defoliation. The dioecious species Populus cathayana was studied after two defoliation treatments with two N levels. Males had a higher capacity of carbon fixation because of higher gas exchange and fluorescence traits of leaves after severe long-term defoliation under deficient N. Males had higher leaf abscisic acid, stomatal conductance and leaf sucrose phosphate synthase activity increasing transport of sucrose to sinks. Males had a higher carbon sink than females, because under N-deficient conditions, males accumulated >131.10% and 90.65% root starch than males in the control, whereas females accumulated >40.55% and 52.81%, respectively, than females in the control group. Males allocated less non-protein N (NNon-p) to leaves, having higher nitrogen use efficiency (photosynthetic nitrogen use efficiency), higher glutamate dehydrogenase (GDH) and higher leaf GDH expression, even after long-term severe defoliation under deficient N. Females had higher leaf jasmonic acid concentration and NNon-p. The present study suggested that females allocated more carbon and nitrogen to defense chemicals than males after long-term severe defoliation under deficient N.
Iliac vein stent migration with extensive cardiac damage in a patient with May-Thurner syndrome
Authors: Regan Daniel , Mistrot Sarah , Anderson Curtis , Kypson Alan
Published: August 2020

In May-Thurner syndrome, or iliac vein compression syndrome, the left common iliac vein is compressed between the right common iliac artery and corresponding vertebral body, increasing patient risk for deep vein thrombosis. Iliac vein stenting for patients with symptomatic May-Thurner syndrome has become standard practice in many centers. This article describes a patient whose stent embolized completely to the right ventricle, destroying most structures in its path.
Fecal microbiota transplantation in the treatment of Crohn disease
Authors: Collins Miranda , DeWitt Morgan
Published: August 2020

Fecal microbiota transplantation (FMT) is an alternative treatment option with minimal risk for patients with Crohn disease. This article explains FMT and how it effectively targets the gut microbiota changes associated with the pathogenesis of Crohn disease.
Necrotizing fasciitis
Authors: Chen Leon L. , Fasolka Brian , Treacy Caitlin
Published: August 2020

Necrotizing soft-tissue infections (NSTIs) are rare but rapidly progressive, life-threatening bacterial infections with high morbidity and mortality. NSTIs include necrotizing forms of fasciitis, myositis, and cellulitis. This article focuses on necrotizing fasciitis (NF) and discusses NF classifications, clinical features, diagnostic approaches, evidence-based treatments, and nursing interventions.
Acute kidney injury
Authors: Dinh Nhan L.A.
Published: August 2020

Acute kidney injury (AKI) can be a devastating diagnosis for any patient and can increase mortality during hospitalization. There can be long-term consequences for those who survive the initial insult. This article discusses AKI and its implications for nurses.
Repurposing a Neurocritical Care Unit for the Management of Severely Ill Patients With COVID-19: A Retrospective Evaluation
Authors: Raith Eamon P. , Luoma Astri M.V. , Earl Mark , Dalal Meera , Fairley Sandra , Fox Felicity , Hunt Katharine , Willett Charlotte , Reddy Ugan
Published: August 2020

Background:

The World Health Organisation declared a coronavirus disease 2019 (COVID-19) pandemic on March 11, 2020. Following activation of the UK pandemic response, our institution began planning for admission of COVID-19 patients to the neurointensive care unit (neuro-ICU) to support the local critical care network which risked being rapidly overwhelmed by the high number of cases. This report will detail our experience of repurposing a neuro-ICU for the management of severely ill patients with COVID-19 while retaining capacity for urgent neurosurgical and neurology admissions.

Methods:

We conducted a retrospective process analysis of the repurposing of a quaternary level neuro-ICU during the early stages of the COVID-19 pandemic in the United Kingdom. We retrieved demographic data, diagnosis, and outcomes from the electronic health care records of all patients admitted to the ICU between March 1, 2020 and April 30, 2020. Processes for increase in surge capacity, reduction in ICU demand, and staff redeployment and rapid training are reported.

Results:

Over a 10-day period, total ICU capacity was increased by 21.7% (from 23 to 28 beds) while the capacity to provide mechanical ventilation was increased by 77% (from 13 to 23 beds). There were 30 ICU admissions of 29 COVID-19 patients between March 1 and April 30, 2020; median (range) length of ICU stay was 9.9 (1.3 to 32) days, duration of mechanical ventilation 11 (1 to 27) days, and ICU mortality rate 41.4%. There was a 44% reduction in urgent neurosurgical and neurology admissions compared with the same period in 2019.

Conclusions:

It is possible to repurpose a dedicated neuro-ICU for the management of critically ill non-neurological patients during a pandemic response, while maintaining access for urgent neuroscience referrals.
Prevalence and Risk Factors of Burnout Among Chinese Pediatric Orthopedic Surgeons
Authors: Liang Sicong , Zhou Weizheng , Zhao Qun , Li Lianyong
Published: August 2020

Background:

Burnout is an occupational hazard among Chinese pediatric orthopedists, characterized by extreme physical and emotional exhaustion, and reduced professional efficacy; however, it has yet to be studied among this group of professionals in China. Our study aimed to assess the levels of burnout in Chinese pediatric orthopedists, and to identify the potential risk factors for burnout.

Methods:

A 32-question, anonymous, cross-sectional survey was conducted from August to September 2019. Overall, 1392 Chinese pediatric orthopedists participated in the survey.

Results:

Seven hundred valid questionnaires (50.3% response rate) were retrieved from 387 (55.3%) and 313 (44.7%) full-time and part-time pediatric orthopedists, respectively. Overall, 73.7% of the participants experienced burnout, of which 64.7% and 9.0% had some and severe burnout symptoms, respectively. The burnout levels significantly differed based on age (P=0.005), years in service (P=0.006), professional rank (P=0.03), weekly working hours (P<0.001), and monthly income (P=0.03). A binary logistic regression model showed that longer weekly working hours (adjusted odds ratio=1.29, 95% confidence interval: 1.09-1.52, P=0.004) was a risk factor for burnout, while higher monthly income (adjusted odds ratio=0.78, 95% confidence interval: 0.64 to 0.95, P=0.02) was protective against burnout, suggesting that younger pediatric orthopedists were more susceptible. No significant difference between full-time and part-time pediatric orthopedists or between sexes was detected in the adjusted analysis.

Conclusions:

Chinese pediatric orthopedists have a relatively high rate of burnout. Younger pediatric orthopedists have a greater chance of experiencing burnout. These results highlight the need for further policies, especially focused on younger pediatric orthopedists, to assist in better developing Chinese pediatric orthopedics.

Level of Evidence:

Level: IV.
Ambulatory blood pressure variability and combined exercise training: comparison between hypertensive and normotensive postmenopausal women
Authors: Mariano Igor Moraes , Dechichi Juliene Gonçalves Costa , Matias Larissa Aparecida Santos , Rodrigues Mateus de Lima , Batista Jaqueline Pontes , de Souza Tállita Cristina Ferreira , Amaral Ana Luiza , Carrijo Victor Hugo Vilarinho , Puga Guilherme Morais
Published: August 2020

Aim

The aim of the study was to verify the effects of moderate combined aerobic and resistance exercises training in ambulatory blood pressure (ABPM) and its variability in hypertensive and normotensive postmenopausal women.

Methods

Twenty-six participants were divided into two groups: hypertensive (HT = 13) and normotensive (NT = 13). They performed 30 sessions of combined exercises (aerobic and resistance exercises at same session) over 10 weeks. We evaluated: resting BP and 24-h ABPM with systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR). To evaluate blood pressure variability (BPV), the following were considered: 24-h SD (SD24), the mean diurnal and nocturnal deviations (SDdn), average real variability (ARV24).

Results

The two-way analysis of variance showed no difference in ABPM nor BPV responses after training between groups. Both HT and NT groups had similar BP reductions in 24-h DBP (P < 0.01; ΔNT = –3.1 ± 1.1, ΔHT = –1.8 ± 1.2 mmHg), 24-h area under the curve of DBP (P = 0.01; ΔNT = –73±105, ΔHT = –44 ± 115 mmHg), and wake DBP (P < 0.01; ΔNT = –3.4 ± 1.2, ΔHT = –1.8 ± 1.3 mmHg), without differences in BPV responses. Moreover, HT women had higher overall SBP SDdn (P = 0.01), SBP ARV (P = 0.02), and MBP ARV (P < 0.01) than NT women.

Conclusion

Ten-week combined exercise training resulted in similar BP reductions in hypertensive and normotensive postmenopausal women, but not in BPV responses.
Diffuse telangiectasia of the colon
Authors: Li Jun-An , Zhong Li-Li , Li Bo , Jiang Dong-Qiang , Zhao Yin-Long
Published: August 2020

Rationale:

Colonic telangiectasia, also known as colonic angiodysplasia, refers to arteriovenous malformations that occur in the colon, which are common vascular lesions in the GI tract.

Patient concerns:

We report a patient, who was admitted to our hospital for colonoscopy.

Diagnoses:

Under a microscope, all the segments of the whole colon and the varicose veins showed multiple flaky spider-like telangiectasia changes. The blood vessels were radially distributed and converged in the center. The largest blood vessel was about 10 mm in diameter and had a smooth surface with no ulcers, erosion, or bleeding.

Interventions:

It was recommended that the patient undergo a capsule endoscopy to examine small intestine.

Outcomes:

The patient did not agree to endoscopy for personal reasons. During the follow-up half a year later, the patient had no melena with normal range of hemoglobin and red blood cell counts. The fecal occult blood test came out negative.

Lessons:

While the etiology of colonic telangiectasia remains unclear, it is common in the elderly, and is more associated with geriatric conditions and diseases, especially atherosclerotic diseases. Patients who are diagnosed with colonic telangiectasia but are asymptomatic, do not need further treatment. It is usually recommended to monitor the color of stool and check the hemoglobin and fecal occult blood regularly. Colonoscopy is the main method of diagnosis of colonic telangiectasia, and the positive rate is greater than 90%. This procedure should be performed when there is no bleeding or a small amount of bleeding.
The relationship between pistachio (Pistacia vera L) intake and adiposity
Authors: Xia Ke , Yang Ting , An Li-Ya , Lin Yue-Ying , Qi Yu-Xing , Chen Xiong-Zhi , Sun Da-Li
Published: August 2020

Background:

The aim of the study was to conduct a systematic review to comprehensively evaluate the relationship between pistachio intake and obesity.

Methods:

We searched 6 databases and acquired parameters from randomized controlled trials regarding obesity, including body weight, body mass index (BMI), and waist circumference. A fixed-effect model was applied to the meta-analysis for the weighted mean difference (WMD) between a diet with pistachios and a control diet.

Results:

Eleven trials including a total of 1593 subjects met the inclusion criteria. Compared to the group on a control diet, the pistachio diet group showed lower BMI values (WMD: −0.18 kg/m2; 95% confidence interval [CI]: −0.26, −0.11 kg/m2; I
2 = 29.8%) and no differences in body weight (WMD: −0.22 kg; 95% CI: −0.50, 0.07 kg; I
2 = 0.0%) or waist circumference (WMD: 0.76 cm; 95% CI: −0.11, 1.63 cm; I
2 = 7.0%).

Conclusion:

A diet with pistachios reduced BMI and had no significant effects on body weight and waist circumference.
Gastrointestinal endoscopy nurse assistance during colonoscopy and polyp detection
Authors: Liu Aihong , Wang Huashe , Lin Yijia , Fu Liping , Liu Yanan , Yan Shuhong , Chen Honglei
Published: August 2020

Background:

Previous studies showed difference results about the effect of nurse in improvement of the colonoscopy detection rate. This meta-analysis aims to investigate whether nurse participation during colonoscopy can help in improving the detection rate of polyps and adenomas.

Methods:

Original studies in English were searched from the MEDLINE database, PubMed, Web of Science, and the Cochrane Library database. Randomized control trials (RCT) comparing colonoscopy with and without nurse participation for the detection of colorectal polyps and adenomas were identified. A meta-analysis was performed using Revman 5.3 software.

Results:

A total of 2268 patients from 4 RCTs were included in this meta-analysis. Outcomes of colonoscopy with nurse participation were compared with those of colonoscopy without nurse participation. The results showed that nurses’ participation during colonoscopy could significantly increase both, polyp detection rate and adenoma detection rate.

Conclusion:

Nurse assistance during colonoscopy can help improve the rate of detection of polyps and adenomas.
Effect of non-invasive brain stimulation on neuropathic pain following spinal cord injury
Authors: Shen Zhubin , Li Zhongrun , Ke Junran , He Changhao , Liu Zhiming , Zhang Din , Zhang Zhili , Li Anpei , Yang Shuang , Li Xiaolong , Li Ran , Zhao Kunchi , Ruan Qing , Du Haiying , Guo Li , Yin Fei
Published: August 2020

Background:

In recent years, some studies indicated that repetitive transcranial magnetic stimulation (rTMS) could relieve neuropathic pain (NP) following a spinal cord injury (SCI), whereas some studies showed no pain relief effect. In addition, some studies showed the analgesic effect of transcranial direct current stimulation (tDCS) on NP post SCI, whereas other studies showed no effect.

Methods:

We systematically searched on the PubMed, Web of Science, EMBASE, Medline, Google Scholar for studies exploring the analgesic effect of rTMS or tDCS on NP post SCI until November 2019. Meta-analysis was conducted to summarize results of these studies.

Results:

The present quantitative meta-analysis indicated no significant difference in the effect of treatment on NP following SCI between rTMS and sham rTMS over the motor cortex at about 1 week after the end of the rTMS period (standardized mean difference (SMD) = 2.89, 95% confidence interval (CI) = −0.27 to 6.04). However, the study indicated that rTMS showed significantly better pain relief of treatment compared with sham rTMS between 2 and 6 weeks after the end of the rTMS period (SMD = 3.81, 95%CI: 0.80–7.52). However, no sufficient evidence could be provided to make a meta-analysis for the analgesic effect of tDCS on NP following SCI over the primary motor area (M1).

Conclusions:

In conclusion, the present meta-analysis suggested that rTMS did not show early analgesic effect on NP after SCI, but showed better middle-term analgesic effect, compared with sham rTMS. More large scale, blinded randomized controlled trials (RCTs) were needed to explore the analgesic effect of rTMS and tDCS on NP following SCI.
Traumatic vertebral fractures involve the anterior end plate more than the posterior end plate
Authors: Wang Xiaorong , Xu Feirong , Fu Yuan , Chen Huanhuan , Gao Xiang , Huang Qiuli
Published: August 2020

Traumatic end plate fractures (EPFs) refers to the EPF caused by trauma, rather than the pathological status of the end plate (EP). However, some old traumatic EPFs may be mistaken as osteoporotic in the elderly. The objective of this study is to describe the radiological features of traumatic EPF in different traumatic fracture type patients presenting in the Emergency department setting. And to compare the result with osteoporotic vertebral fracture (VF).

This study retrospectively analyzed the anatomical location of acute thoracolumbar vertebral traumatic EPFs in males (age≤55 years) and females (age≤50 years). The anatomic distribution of EPFs, the anterior and posterior wall fracture were analyzed in patients, who were scanned with 1 or more of the following methods: radiography, CT, and magnetic resonance imaging.

There were 194 cases of acute spine trauma involving at least 1 EPF, including 118 males and 76 females. The involved vertebra was mostly at L1 (29.7%), followed by T12 (18.3%), and then by L2 (12.9%). Excluding those with both upper and lower EP involvements, the ratio of superior EPF to inferior EPF was 33.5 for males and 45.5 for females. With the EP divided into 5 segments of equal length in the anteroposterior direction in different fracture types, fractures occurred mostly at a2 segment (71.48% for superior EPs and 7.60% for inferior EPs), followed by a1 segment (66.16% for superior EPs). The upper third of the anterior and posterior walls were most prone to fracture in traumatic vertebral fracture.

Traumatic EPFs more likely involve the anterior EP more than the posterior EP and is correlated with fracture type. These characteristics may help radiologist differential diagnosis between traumatic and osteoporotic EPF.
Study on the clinical assessment of integrated rehabilitation of Traditional Chinese Medicine and western medication for acute myocardial infarction
Authors: Zhao Zhiqiang , Wang Xianliang , Wang Shuai , Zhou Ruijuan , Liu Yu , Su Lishuo , Li Chenyu , Lin Shanshan , Liu Hua , Zhao Lindan , Mao Jingyuan
Published: August 2020

Objective:

This trial aims to evaluate the efficacy and safety of the Baduanjin exercise in patients with acute myocardial infarction (AMI).

Methods:

A single-center, open, randomized controlled clinical trial will be conducted to evaluate the effectiveness of the Baduanjin exercise on the rehabilitation of AMI patients. It plans to enroll 64 patients. Patients will be divided evenly into 2 groups using a random number table method. There will be 32 cases in each group. Patients in the experimental group will be treated with standardized drug therapy combined with Baduanjin exercise, while patients in the control group will be treated with standardized drug therapy combined with routine exercise. The primary outcome is the peak oxygen consumption (Peak VO2) during cardiopulmonary exercise test (CPET). The secondary outcomes include CPET, echocardiography, Seattle angina pectoris scale, hospital depression and anxiety scale, Pittsburgh Sleep Quality Index scale, scores of 4 examinations, and diagnostic methods of traditional Chinese medicine and composite endpoint events, etc.

Discussion:

This study will be the first to evaluate the effect of the Baduanjin exercise on the Peak VO2 in patients with AMI.

Study registration:

This study has been registered on the Chinese Clinical Trial Registry (No: ChiCTR1800016209, protocol version 1.2).
Treatment of dysphagia after stroke with acupuncture and related therapies
Authors: Xiong Fanjie , Song Kai , Huang Ailing , Zhang Hong
Published: August 2020

Background:

Dysphagia is a common complication after stroke, with high disability rate and high fatality rate. Although several clinical studies and evidence-based medicine have demonstrated the efficacy of acupuncture in the treatment of dysphagia after stroke, there are significant differences in study design and intervention methods. The objective of this study is to compare the efficacy and safety of different acupuncture and related therapies in the treatment of dysphagia after stroke, so as to provide a superior clinical program.

Methods:

We will search 7 databases for randomized controlled trials of acupuncture-related therapies for dysphagia after stroke, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chinese Scientific Journals Database, and wan-fang databases, from the date of the establishment of each database to March 31, 2020. The network meta-analysis will be implemented through Aggregate Data Drug Information System 1.16.8 and Stata 13.0 software. Clinical Efficiency, videofluoroscopic swallowing study score and Kubota Drinking Water Test grade will be the primary outcomes, Swallowing disorder specific quality of life score, Standardized Assessment and Adverse effects will be evaluated as secondary outcomes. Mean differences or odds ratios will be used for statistical analysis. We will ensure the reliability of the results through node-split model and heterogeneity analysis. In addition, methodological quality will be evaluated based on the Cochrane Collaboration's tool, and the quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation system.

Results:

This study will provide a reliable evidence for the selection of acupuncture and related therapies for dysphagia after stroke.

Conclusion:

The results of this study will provide references for evaluating the influence of acupuncture and related therapies for dysphagia after stroke, and provide decision-making references for clinical research.

Ethics and dissemination:

This study did not require ethical approval. We will disseminate our findings by publishing results in a peer-reviewed journal.

OSF registration number:

DOI 10.17605/OSF.IO/TAHND.
Suan-Zao-Ren decoction for insomnia
Authors: Song Zhijian , Fan Ping , Zhang Qi , Yang Yang , Zhan Qinan , Liu Xueyu , Xiong Yurong
Published: August 2020

Background:

Chinese herbal medicine has been widely used to relieve insomnia. Among them, Suan-Zao-Ren decoction (SZRD) has a significant effect in alleviating insomnia. The purpose of this systematic review is to evaluate the effectiveness and safety of SZRD in treating insomnia.

Methods:

Relevant randomized controlled trials (RCTs) will be searched from the databases of Embase, PubMed, the Cochrane Library, the China National Knowledge Infrastructure, Wanfang Database and Chinese Science and Technology Periodical Database from their inception to July 2020. Two independent reviewers will select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. Statistical analysis is processed by RevMan V.5.3 software.

Results:

The results of this systematic review will provide an assessment of SZRD treatment of insomnia, and aims to prove the effectiveness and safety of SZRD.

Conclusion:

This study will provide a credible Evidence-based for the treatment of Insomnia with SZRD.