bluuebunny/crossref_metadata_2025 huggingface dataset:
Blepharoptosis and Cholesterol-Lowering Medications: A Retrospective Study
Authors: Lam Aimee N. , Thayer Jessica N. , Rahman Effie Z. , Martinez Andre N. , Fry Constance L.
Published: October 2019

Anticholesterol medication may induce or exacerbate myogenic ptosis in some individuals

Purpose:

To investigate the prevalence and frequency of patients with blepharoptosis who take anticholesterol therapies. To our knowledge, this is the first large single-center series to evaluate this association.

Methods:

A retrospective chart review of adult patients presenting with ptosis on concomitant anticholesterol medications.

Results:

Two hundred ninety-three adult patients with ptosis taking anticholesterol therapy were identified from October 2011 to October 2016. Forty-seven patients (16.0%) reported muscle weakness. Laboratory markers including creatine kinase (CK) and myoglobin levels were obtained. Of the 47 patients, 13 patients (4.4%) were identified to have ptosis and laboratory confirmed anticholesterol therapy-induced myopathy. Two additional patients with statin-induced myositis and rhabdomyolysis were identified from the period 2008–2011. All patients had measurably elevated CK and/or myoglobin levels. All patients experienced improvement in ptosis or systemic symptoms after discontinuation or changing medications. Nine patients (60%) demonstrated statistically significant improvement in the ptosis.

Conclusions:

Many patients with involutional ptosis also have both cardiovascular disease and hyperlipidemia and thus take cholesterol-lowering medication. Our study demonstrates a World Health Organization-defined probable association between ptosis and anticholesterol-induced myopathy. The frequency of anticholesterol-induced myopathy in adult ptosis was 4.4%, which is substantially higher than previously predicted. Anticholesterol-induced myositis can cause a reversible ptosis, and thus, a thorough evaluation of adult patients presenting with involutional ptosis includes inquiry into the use of anticholesterol drugs and associated muscle weakness.
The Heart Failure Clinic: Improving 30-Day All-Cause Hospital Readmissions
Authors: Taklalsingh Nicholas , Wengrofsky Perry , Levitt Howard
Published: October 2019

Heart failure–related recurrent hospitalizations are widely recognized as a source of burden to both patients and the health system. Hospital discharges represent a transition of care and can often become a catalyst for readmission. One strategy in reducing this burden is the implementation of dedicated heart failure clinics. We conducted a retrospective review of all patients discharged from an inner city safety-net public hospital with a discharge diagnosis of heart failure. Patients followed in the Heart Clinic (HC) were compared to those with standard follow-up. All included cases were followed for 30 days after discharge to determine whether an all-cause readmission occurred. There were 258 patient discharges with an overall sicker population in the HC cohort. The HC group had a better event-free survival with a 67.1% reduction in readmission (log rank *p < .05). In concluding, a dedicated heart failure clinic reduced 30-day readmissions for patients who were discharged after having an acute exacerbation of heart failure.
An Algorithm to Calculate Socket Volume Changes of Adjustable Sockets for Transtibial Prosthesis Users
Authors: Vamos Andrew C. , Gurrey Clement J. , Cagle John C. , Brzostowski Jacob T. , McLean Jake B. , Sanders Joan E.
Published: October 2019

Introduction

The objective of this effort was to develop and evaluate an algorithm that used socket and panel dimensions and cable length measurements to quantify socket volume changes of cabled-panel, adjustable socket systems.

Methods

Adjustable sockets were fabricated for three participants with transtibial amputation. An apparatus was constructed to measure socket volume under controlled cable length changes using the water displacement method. Socket volume calculations from the algorithm were compared with results from water displacement testing.

Results

For the three sockets tested, the algorithm predicted minimum socket volumes that ranged from −7.1% to −6.1% less than the neutral volume (flush panels) and maximum volumes that ranged from +1.7% to +3.6% more than the neutral volume. Root mean square error between model and experimental results for socket volumes less than the neutral volume ranged from 0.3% to 0.5% socket volume.

Conclusions

If the algorithm was incorporated into adjustable socket mechanisms and measured users' socket size adjustments, the data may help practitioners identify relationships between patients' clinical status and their socket volume adjustments. Data may also be useful toward the design and operation of automatically adjusting cabled-panel sockets.
Left Ventricular Filling Pressures Contribute to Exercise Limitation in Patients with Continuous Flow Left Ventricular Assist Devices
Authors: Koshy Aaron , Bouzas-Cruz Noelia , Okwose Nduka C. , Fernandez Oscar Gonzalez , Green Thomas , Woods Andrew , Robinson-Smith Nicola , Tovey Sian , McDiarmid Adam , Parry Gareth , Schueler Stephan , Jakovljevic Djordje G. , MacGowan Guy A.
Published: October 2019

We sought to determine hemodynamic mechanisms of exercise intolerance in a group of patients with the HeartWare ventricular assist device (VAD) compared to a group of heart failure patients. Twenty VAD and 22 heart failure patients underwent symptom-limited active straight leg raising exercise during right heart catheterization with thermodilution (TD), and upright cycling cardiopulmonary stress testing with cardiac output measurement by inert gas rebreathing (IGR) method. The TD and IGR exercise cardiac indexes were higher in VAD compared with heart failure group (both P < 0.05), although there was only a borderline increase in peak exercise oxygen consumption (VO2) (P = 0.06). Baseline and exercise right heart catheterization pressures were not significantly different between the two groups. The only significant independent predictors of peak VO2 in the heart failure group were exercise heart rate and cardiac index (both P < 0.05). In contrast, for the VAD group only, resting pulmonary arterial wedge and pulmonary arterial mean pressures were independently related to peak VO2 (both P < 0.05). Thus, in heart failure, exercise cardiac index is an important limitation to exercise capacity, and VADs increase exercise cardiac index. However, in VAD patients, this only produces limited benefits as increased pulmonary and pulmonary wedge pressures limit increases in exercise capacity.
Hyponatremia is associated with poor prognosis among patients with chest pain discharged from internal medicine wards following acute coronary syndrome-rule-out
Authors: Topaz Guy , Pereg David , Gur Efrat , Kitay-Cohen Yona , Ben-Zvi Elad , Eitan Mayan , Benchetrit Sydney , Cohen-Hagai Keren
Published: October 2019

Background

Hyponatremia is the most common electrolyte abnormality observed in clinical practice. Among patients with acute coronary syndrome (ACS), serum sodium levels are inversely associated with mortality risk. We assessed associations of serum sodium level with ACS and mortality in patients with chest pain.

Methods

This retrospective cohort study used clinical data from a large, academic hospital. All adults admitted with chest pain and without hypernatremia and discharged after ACS rule-out from January 2010 through June 2016 were included. The primary endpoint was the composite of 30-day ACS and mortality. Secondary endpoints were a hospital admission due to ACS and mortality in the first year following discharge.

Results

Included were 12 315 patients (mean age 58.2 ± 13 years, 60% male). Patients were classified according to the serum sodium (Na) level: hyponatremia, defined as less than 135 mEq/L (n = 289, 2.3%); 140 > Na ≥ 135 mEq/L (n = 8066, 65.5%), and 145 > Na ≥ 140 mEq/L (n = 3960, 32.2%). Patients with serum sodium more than 145 mEq/L were excluded. Among patients with hyponatremia, low-normal, and high-normal levels, rates of the composite outcome of unadjusted 30-day all-cause mortality and ACS admission were 4.5, 1.0, and 0.7%, respectively (P < 0.001). Unadjusted one-year ACS rates were 3.8, 1.5, and 1.4%, respectively (P < 0.01).

Conclusion

Hyponatremia is associated with higher mortality and ACS risk among patients with chest pain who were discharged from internal medicine wards following ACS-rule-out. Sodium level may be included in the risk stratification of patients with chest pain.
Review of massive transfusion protocols in the injured, bleeding patient
Authors: Abuzeid Adil M. , O’Keeffe Terence
Published: October 2019

Purpose of review

Massive haemorrhage is a significant cause of mortality and morbidity in a variety of clinical settings, although most research has been related to trauma patients. Military studies from recent conflicts found that higher ratios of plasma to red blood cells (RBCs) were associated with increased survival in injured soldiers, and subsequent trials in civilian populations showed similar decreased mortality. Over the last decade, massive transfusion protocols (MTPs) have become an important component in the treatment of the massively bleeding patient. This review is intended to summarize the more recent findings and trends in massive transfusion.

Recent findings

There have been several observational studies suggesting that higher ratios of plasma to RBC and platelets to RBC are associated with improved survival but there is a paucity of randomized studies relating to specific ratios, dosages, timing, and guidance. Other studies have developed and assessed scoring systems used to initiate MTPs and specific tests used to guide MTPs. Finally, the specific blood components and adjuncts that constitute a MTP are the subject of further ongoing research.

The absence of a universal definition of massive bleeding or massive transfusion, heterogeneity in patients suffering from massive bleeding, and the difficulty in predicting which patients will require a massive transfusion all contribute to the difficulty of studying massive transfusion. However, there is evidence that higher plasma : RBC ratios correlate with improved survival, and that adjuncts to transfusion play a key role. Furthermore, recent validations of massive haemorrhage scoring systems should allow more consistent and appropriate triggering of massive transfusions.
Shen fu injection for patients with septic shock
Authors: Wang Xiaojun , He Canfeng , Cai Yinhe , Sun Dazhong , Hu Guangyun , Zhou Jian
Published: October 2019

Background:

Septic shock is a serious disease with high morbidity, which will lead to organ dysfunction. Shen fu injection (SFI) has been widely used for septic shock as a treatment in China. Many clinical trials have been reported that it could assess the efficacy and safety of SFI to cure septic shock and accelerate resuscitation. Reassessing the efficacy and safety of SFI as a treatment of patients with septic shock is the objective of this updated systematic review.

Methods:

The following electronic databases major in English and Chinese will be conducted a systematic search until September 2018: PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, Chinese BioMedical Literature Database, and Wan-fang Database. Randomized controlled trials of SFI will be included. Review Manager 5.2 software will be used for assessment of risk of bias, data synthesis, and subgroup analysis. We will conduct the GRADE system to assess the quality of evidence, if possible.

Results:

This study will provide a rational synthesis of current evidences for SFI on septic shock.

Conclusion:

We hope our research results will provide an objective and reliable evidence to patients, clinicians and healthcare policymakers who are concerning the treatment options of SFI in septic shock.

Registration:

PROSPERO CRD42016049332.
A noninvasive and highly sensitive approach for the assessment of coronary collateral circulation by 192-slice third-generation dual-source computed tomography
Authors: Chen Kebin , Zhang Xiaoge , Li Daling , Chen Honglei , Zhang Zhixu , Chen Lei
Published: October 2019

The coronary collateral circulation (CCC) is an alternative source of blood supply when the original vessels fail to provide sufficient blood. The accurate detection of CCC is critical for the treatment of ischemic heart disease, especially when the stent surgery is not an option. The assessment of minute vessels such as coronary collateral arteries is challenging. The objective of this study was to assess the feasibility of detection and classification of CCC using the192-slice third-generation dual-source computed tomography angiography (192-slice DSCT CTA).

Eight hundred patients (450 men and 350 women, mean age: 56 ± 11 years) with complete or subtotal occlusion of at least 1 major coronary artery were enrolled for our study. February 2016 and September 2018, the patient both 192-slice DSCT CTA and conventional coronary angiography (CAG) were performed in all enrolled patients. The interval between two approaches for a given patient was 6.1 ± 3.7 days (Range: 1–15). The diagnostic accuracy of 192-slice DSCT CTA was evaluated by comparing it with that of CAG. The identified CCC was graded according to the Rentrop classification.

The prevalence among patients of having at least 1 CCC was 43.8%. The sensitivity for detecting CCC by 192-slice DSCT was 91.7% (95% CI: 88.3% to 94.3%), specificity was 95.5% (95% CI: 93.1% to 97.2%), positive predictive value was 94.3% (95% CI: 91.5% to 96.2%), and negative predictive value was 93.3% (95% CI: 90.9% to 95.3%). Cohen-Kappa analysis showed that the consistency of the correct classification of CCC using CAG and 192-slice DSCT was very high with the kappa coefficient (κ) of 0.94 (95% CI: 0.91–0.96, P value = .01). Additionally, the radiation dose for 192-slice DSCT was as low as 0.42 ± 0.04 mSv (range, 0.35–0.43 mSv).

The 192-slice DSCT CTA is a reliable and sensitive non-invasive method for the evaluation of CCC with low radiation doses.
High-resolution computed tomography of the lung in patients with rheumatoid arthritis
Authors: Salaffi Fausto , Carotti Marina , Di Carlo Marco , Tardella Marika , Giovagnoni Andrea
Published: October 2019

An international consensus for rheumatoid arthritis (RA) patients at risk of developing interstitial lung disease (ILD) is still lacking. The aims of study were to evaluate: the prevalence of ILD involvement in RA over high-resolution computed tomography (HRCT); the relationships between pulmonary function tests (PFTs), patient-centered measurements, and ILD; and the potential risk factors contributing to RA-ILD patients.

Data regarding the clinical characteristics (age, sex, age at onset of RA), laboratory findings (rheumatoid factor [RF] and anti-citrullinated protein antibodies [ACPA]), respiratory functional assessment (forced vital capacity [FVC] and carbon monoxide diffusion capacity [DLCO]), patient-centred measures of dyspnea (PCMD), Health Assessment Questionnaire—Disability Index (HAQ-DI), and HRCT have collected retrospectively. HRCT abnormalities were evaluated using a conventional visual reader-based score (CoVR) and a computer-aided method (CaM). The relationships between the 2 HRCT scores—PFTs and PCMD—were calculated using Pearson correlation. The area under the receiving-operating characteristic (AUC-ROC) curve was calculated to determine the discriminatory performance of measurements between patients with and without ILD. The multivariate regression model was used to evaluate the association force between ILD and RA characteristics.

In all, 151 patients (45 males and 106 females, mean age 53.4 ± 7.6 years) were included. ILD had been detected in 29 patients out of 151 (19.2%). Usual interstitial pneumonia was the most common HRCT. RA-ILD patients were older, and older at RA onset (both P < .01), with a higher HAQ-DI (P < .05) than patients without ILD. ACPA positivity and titer were higher in the RA-ILD group (P = .02). Extent and severity of ILD, and total CoVR and CaM score closely related to DLCO and PCMD (both P < .0001). A reduced DLCO was the most sensitive test for predicting the presence of ILD on HRCT (AUC-ROC 0.811 ± 0.037). Advanced age (P < .0001), age at RA onset (P = .025), ACPA titer (P = .004), and smoking (P = .008) were independent explanatory variables of HRCT damage in multivariate analysis.

The RA-ILD is associated with age and older age of RA onset, smoking, and ACPA titer. DLCO seems to be the most sensitive parameter to predict ILD on HRCT, followed by PCMD.
Immediate effects of the respiratory stimulation on ventilation parameters in ischemic stroke survivors
Authors: Ptaszkowska Lucyna , Ptaszkowski Kuba , Halski Tomasz , Taradaj Jakub , Dymarek Robert , Paprocka-Borowicz Malgorzata
Published: October 2019

Background:

Post-stroke brain damage, which affects the central control of respiration, leads to various respiratory disorders. They can be caused by the weakening of the respiratory muscles and chest movements, which can indirectly contribute to an impairment of the ventilation function. The aim of the study is an objective assessment of the effect of a single-session intervention of respiratory stimulation through Proprioceptive Neuromuscular Facilitation (PNF) on chosen respiratory parameters and the following comparison of these changes with a group in which positioning was used (intra- and intergroup comparison).

Methods:

This was a randomized interventional study evaluating the respiratory parameters depending on the applied respiratory stimulation in patients after ischemic stroke. The patients qualified to participate in the study were randomly assigned to 1 of 2 groups: PNF-treated group – in which respiratory stimulation through PNF was used, PNF untreated group – in which positioning was used. The research procedure consisted of several stages. First, an interview was conducted with each participant and basic data was collected. Then, spirometry was conducted, after which each patient underwent a single-session intervention according to their assigned group. Finally, the patients were given another spirometry examination. The main outcomes will be to compare the results of a spirometry test (FVC, FEV1, FEV1/ FVC%, PEF) before and after single-session intervention and between groups.

Results:

Based on the inclusion and exclusion criteria for the study, 60 patients took part in the measurement. The values of FEV1/FVC% were higher in PNF-treated group than in PNF-untreated group, if the post-intervention measures (P = .04) are considered. The difference between the pre- and post-intervention results of the FEV1/FVC% values in PNF-untreated group was substantially lower than in PNF-treated group (P = .001).

Conclusion:

A single application of respiratory stimulation through PNF positively affect air flow in the respiratory tract. Application of PNF stimulation contributed to an increase in the FEV1/FVC% parameter. However, no positive changes were noted in the other parameters, which would provide proof of the beneficial effect of facilitation on the respiratory system function.
Pulmonary rehabilitation for people with chronic obstructive pulmonary disease
Authors: Araujo Zênia T.S. , Mendonça Karla M.P.P. , Souza Bruma M.M. , Santos Tacito Z.M. , Chaves Gabriela S.S. , Andriolo Brenda N.G. , Nogueira Patricia A.M.S.
Published: October 2019

Background:

Pulmonary rehabilitation (PR) is an indispensable component in the nonpharmacological management of patients with chronic obstructive pulmonary disease (COPD) with significant improvements in quality of life and exercise capacity. It is strongly supported by systematic reviews (SR) as part of the treatment of these patients. However, it is not known which PR components are essential, such as duration, ideal locations, type and intensity of training, degree of supervision, adherence, cost-effectiveness challenge, and how long the program effects last. This overview aims to evaluate and describe different pulmonary rehabilitation interventions for individuals with COPD.

Methods:

Only systematic reviews of randomized controlled trials (RCTs) published in the Cochrane Database of Systematic Reviews will be included. The following results were analyzed: health-related quality of life, functional capacity, mortality, dyspnea, cost-effectiveness, and adverse events. The risk of bias will be assessed by the Risk of Bias in Systematic Reviews (ROBIS). The methodological quality will be analyzed through the Assessment of Multiple Systematic Reviews (AMSTAR-2). We will use the evaluations of the Classification of Recommendations, Evaluation, Development and Evaluation (GRADE) of the authors of the included systematic reviews. The screening of systematic reviews, eligibility evaluation, data extraction, methodological quality, and quality of evidence will be performed in pairs by independent reviewers. The results that have been reported in the included reviews will be summarized in an “Overview of Reviews” table. The main conclusions about the effects of the interventions studied in the included reviews will be summarized and organized in clinically meaningful categories.

Results:

The article in this overview will be submitted for publication in a peer-reviewed journal. The results will also be included in a doctoral thesis and disclosed in medical conferences.

Conclusions:

We expect to compile evidence from multiple systematic reviews of pulmonary rehabilitation in people with COPD in an accessible and useful document.

Registration number PROSPERO:

CRD42019111564.
Clinical value of soluble urokinase type plasminogen activator receptors in chronic kidney disease
Authors: Ahmed Reem M. , Khalil Mona A. , Ibrahim Amal H. , Eid Hanaa M. , Abdelbasset Walid Kamal , Soliman Gaber S.
Published: October 2019

Chronic kidney disease (CKD) will progress to end stage without treatment, the decline off renal function may not linear. A sensitive marker such as soluble urokinase-type plasminogen activator receptors (suPARs) may allow potential intervention and treatment in earlier stages of CKD.

Objectives:

This study was designed to measure plasma (suPAR) in patients with CKD with different stages and to find its correlation with the disease severity.

Methods:

This study was conducted on 114 subjects, 84 were patients with different stages and different causes of CKD, and 30 healthy subjects as controls. Blood urea, serum creatinine, serum high-sensitive C-reactive protein, estimated glomerular filtration rate, and 24 hours proteinuria were measured, renal biopsy was done for all patients, and plasma (suPAR) was measured using enzyme-linked immunosorbent assay.

Results:

suPAR plasma levels were significantly higher in patients with CKD (7.9 ± 3.82 ng/mL) than controls (1.76 ± 0.77 ng/mL, P < .001). suPAR correlated with the disease severity. In stage 1 to 2 group, it was 3.7 ± 1.5 ng/mL, in stage 3 to 4, it was 10.10 ± 1.22 ng/mL, and in stage 5 group, it was 12.34 ± 0.88 ng/mL; the difference between the 3 groups was highly significant (P < .001). A cutoff point 2.5 ng/mL of suPAR was found between controls and stage 1 group. According to the cause of CKD, although patients with obstructive cause and those with focal glomerulosclerosis had the higher levels 9.11 ± 3.32 ng/mL and 8.73 ± 3.19 ng/mL, respectively, but there was no significant difference between patients with CKD according to the cause of the CKD.

Conclusion:

Plasma (suPAR) increased in patients with CKD and correlated with disease severity.
Prognostic impact of preoperative serum alkaline phosphatase level on a composite of morbidity and mortality after thoracic endovascular aortic repair
Authors: Ham Sung Yeon , Nam Sang Beom , Han Dong Woo , You Ann Hee , Lim Won Sik , Song Young
Published: October 2019

Background:

Serum alkaline phosphatase (ALP) is related to vascular calcification and is known to have a prognostic impact in various cohorts. However, evidence in patients undergoing thoracic endovascular aortic repair (TEVAR) is lacking. Thus, we hypothesized that preoperative serum ALP level could be used for predicting adverse events after TEVAR.

Methods:

We retrospectively reviewed 167 patients who underwent TEVAR between February 2013 and December 2016. Patients were classified into tertiles according to preoperative ALP level (<69, 69–92, and >92 IU/L). The composite of morbidity and mortality (composite MM) was defined as the presence of one or more of the following: myocardial infarction, cerebrovascular accident, dialysis requirement, pulmonary complication, infection, and mortality within 1 year after TEVAR. The incidence of composite MM was compared among the 3 tertiles, and stepwise logistic regression analysis was performed to evaluate the predictors for composite MM.

Results:

The incidence of composite MM was 14.5% in the first tertile group, 17.9% in the second tertile group, and 35.7% in the third tertile group (P = .016). The third tertile of ALP level (odds ratio [OR] 1.766, 95% confidence interval [CI] 1.074–2.904, P = .025) and emergency TEVAR (OR 2.369, 95% CI 1.050–5.346, P = .038) remained as independent predictors of composite MM.

Conclusions:

Our data showed an independent relationship between high preoperative ALP levels and adverse outcomes in patients undergoing TEVAR. This finding might suggest a potential role of ALP level as a risk stratification marker.
Effect of Chinese herbal medicine on primary dysmenorrhea
Authors: Xu Lu , Xie Tian , Shen Tao , Zhang Tianfeng
Published: October 2019

Background:

Primary dysmenorrhea (PD), the most common gynecological diseases, seriously affects women's life and work; however, without more effective treatment. Chinese herbal medicine (CHM) has been widely used for relieving dysmenorrheic pain in patients with PD. To assess the effectiveness and safety of CHM in patients with PD, a systematic review and meta-analysis of current published evidence regarding CHM as treatment for PD would be conducted in this study.

Methods:

Literatures related to CHM for PD from the establishment of the database to June 2019 will be retrieved from the following databases: MEDLINE, EMBACE, Wed of Science and Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, and Wanfang Database. There are no language restrictions for retrieving literature. Eligible randomized clinical trials (RCTs) evaluating the effectiveness and safety of CHM in PD patients will be put in the study including outcomes of pain intensity, clinical effectiveness rate, quality of life, and adverse events. By scanning the titles, abstracts and full texts, 2 reviewers will independently select studies, extract data, and assess the quality of study. Meta-analysis of RCTs will be conducted using Review Manager 5.1 software. The results will be presented as risk ratio for dichotomous data, and standardized or weighted mean difference for continuous data.

Result:

This study will provide high-quality available evidence for the treatment of PD with CHM based on pain, clinical efficacy, quality of life, and adverse events.

Conclusion:

The systematic review willto evaluate the efficacy of CHM in treating PD and provide evidence for clinicians.

PROSPERO registration number:

CRD42019121185.
Analysis of prenatal diagnosis before and after implementation of the two-child policy in northeastern China
Authors: Wang Ruixue , Yu Yang , Xi Qi , Jiang Yuting , Zhu Haibo , Li Shibo , Liu Ruizhi , Zhang Hongguo
Published: October 2019

The universal two-child policy has now been fully implemented in China. This change requires adaptations to maternal care and childcare systems, but the features of prenatal diagnosis before and after implementation of the policy have not been reported.

We conducted a retrospective study of 6736 prenatal cytogenetic diagnoses performed on amniotic fluid cells over a 4-year period, including 2 years before and after implementation of the second child policy. Amniotic fluid cells collected through amniocentesis were cultured, harvested, and stained for chromosome analysis using standard laboratory protocols.

The study included 3222 pregnant women referred before implementation of the policy, which we used as a control group, and 3514 pregnant women referred after policy implementation as an investigational study group. There were significantly fewer pregnant women aged <25 years in the investigational group than in the control group (P < .001). There were no significant between-group differences for other pregnant women aged >31 years and 27–28 years old (P > .05). A total of 358 cases with chromosomal abnormalities were diagnosed, including 129 (4%, 129/3222) in the control group which was significantly lower than the 229 (6.5%, 229/3514) in the study group (P < .001). In particular, significantly more trisomy 21 cases were observed in the study group than in the control group (120 vs 59). More pregnant women underwent non-invasive prenatal testing (NIPT) in the study group (46%) than in the control group (20%). In the study group, the average age of pregnant women who underwent NIPT was significantly higher than that of women who did not receive NIPT (P < .05). However, there were no significant between-group differences for the control group (P > .05).

The number of cases with chromosomal abnormalities increased in northeastern China in the 2 years after implementation of the two-child policy. The number of pregnant women of advanced maternal age did not increase significantly, perhaps because of the widespread application of NIPT. However, the number of fetuses with Down syndrome increased significantly, suggesting that prenatal screening and diagnosis should be strengthened.
Serum cytokine, chemokine, and growth factor profiles and their modulation in inflammatory bowel disease
Authors: Martinez-Fierro Margarita L. , Garza-Veloz Idalia , Rocha-Pizaña Maria R. , Cardenas-Vargas Edith , Cid-Baez Miguel A. , Trejo-Vazquez Fabiola , Flores-Morales Virginia , Villela-Ramirez Gabriela A. , Delgado-Enciso Ivan , Rodriguez-Sanchez Iram P. , Ortiz-Castro Yolanda
Published: October 2019

Ulcerative colitis (UC) and Crohn disease (CD) are the most common forms of inflammatory bowel disease (IBD). Because these subtypes of IBD are characterized by periods of activity and remission, an understanding of the modulation of biochemical markers with the clinical features of IBD or its treatment, may be useful for determining the correct treatment protocol.

This study aimed to evaluate the serum levels of 27 protein biomarkers to determine their association with IBD, correlation with clinical findings of disease, and modulation according to the pharmacologic therapy.

A case–control study was carried out in Zacatecas, Mexico. The 27 protein profiles of serum from 53 participants (23 UC, 11 CD, and 19 controls) were evaluated using the Pro Human Cytokine 27-Plex immunoassay (Bio-Rad).

Considering the controls as a reference, the group with IBD endoscopic activity showed higher serum levels of granulocyte colony-stimulating factor (G-CSF), interleukin 1 receptor antagonist (IL-1Ra), and platelet-derived growth factor BB (PDGF-BB) (P < .05). Interferon-induced protein 10 (IP-10) was associated with extraintestinal symptoms of disease (P = .041). Both PDGF-BB and interleukin 6 (IL-6) showed the strongest correlations with clinical features of IBD. Levels of IL-6, IL-7, and monocyte chemoattractant protein 1 were higher with 5-aminosalicylic acid (5-ASA) + Azathioprine therapy than controls (P < .05). Combined therapy with 5-ASA + Adalimumab led to the strongest changes in marker modulation: IL-4, IL-5, IL-15, and PDGF-BB, were upregulated (P < .05).

Elevated serum levels of G-CSF, IL-1Ra, and PDGF-BB were associated with IBD endoscopic activity, and of IP-10 with extraintestinal manifestations of IBD. Combined therapy of 5-ASA + Adalimumab produced significant upregulation of IL-4, IL-5, IL-15, and PDGF-BB. This information may be useful for deciding on the course of pharmacologic therapy for patients with IBD and for generating new therapy alternatives to improve the outcome of patients with IBD.
Relationship between corneal deformation amplitude and optic nerve head structure in primary open-angle glaucoma
Authors: Jung Younhea , Park Hae-Young Lopilly , Park Chan Kee
Published: October 2019

The purpose of the study was to investigate the relationship between corneal deformation amplitude (DA), which is the amount of corneal displacement at highest degree of concavity measured by Corvis Scheimpflug Technology (ST), and various optic nerve head parameters in patients with primary open-angle glaucoma (POAG).

Fifty-eight POAG patients were included in this observational study. For each patient, DA with Corvis ST, color optic disc photography, and optic nerve head imaging by enhanced depth imaging with a Heidelberg spectralis optical coherence tomography (OCT), Cirrus OCT, and Heidelberg retina tomograph (HRT) were obtained. Pearson correlation was used to analyze the relationship between DA and optic nerve head parameters before and after adjusting for age, intraocular pressure, central corneal thickness, and axial length.

Corneal DA was negatively associated with lamina cribrosa (LC) depth (r = −0.390, P = .003) after adjusting for confounders. It showed positive relationship with parapapillary atrophy (PPA) area (r = 0.321, P = .046). In addition, the corneal DA was negatively correlated with cup volume (r = −0.351, P = .017) and mean cup depth (r = −0.409, P = .005) measured by HRT.

Corneal DA is related with optic nerve head parameters in patients with POAG. Patients with lower corneal DA showed greater LC depth, greater cup area, deeper cup, and smaller PPA than those with higher corneal DA.
Living-donor liver transplantation following cardiopulmonary bypass
Authors: Oh Min Seok , Sung Jeong Min , Yeon Hyo Jin , Cho Hyung Jun , Ko Justin Sangwook , Kim Gaab Soo , Lim Hyunyoung
Published: October 2019

Rationale:

Liver transplantation is an increasingly common treatment for patients with liver cirrhosis or hepatocellular carcinoma. Liver transplantation in patients with heart disease can pose a significant challenge to the transplant teams.

Patient concerns:

A 46-year-old woman was diagnosed with hepatitis B virus-related hepatocellular carcinoma 3 years ago and had received 3 times transarterial chemoembolization.

Diagnoses:

The patient was diagnosed as end-stage liver disease due to hepatocellular carcinoma and was scheduled to undergo living-donor liver transplantation. The preoperative echocardiogram revealed mass in the right atrium and the inferior vena cava.

Interventions:

The patient underwent mass removal under cardiopulmonary bypass followed by liver transplantation.

Outcomes:

A month later, she was discharged without any complications.

Lessons:

There have only been a few reported cases of anesthetic liver transplantation after a cardiopulmonary bypass. The successful experience described in this case report suggests that some patients may be eligible to undergo a liver transplantation after a cardiopulmonary bypass.
Effectiveness, safety, and economic evaluation of adjuvant moxibustion therapy for aromatase inhibitor-induced arthralgia of postmenopausal breast cancer stage I to III patients
Authors: Shin Seungwon , Jang Bo-Hyoung , Park Seung-Hyeok , Lee Jin-Wook , Chae Min Soo , Kim Namhoon , Suh Hae Sun , Han Sola , Min Sun Young , Baek Sun Kyung , Lim Yu Jin , Hwang Deok-Sang
Published: October 2019

Introduction:

This study is a prospective, assessor-blinded, parallel-group, randomized controlled pilot trial to explore the effectiveness of 12-week adjuvant moxibustion therapy for arthralgia in menopausal females at stage I to III breast cancer on aromatase inhibitor (AI) administration, compared with those receiving usual care.

Methods/design:

Forty-six menopausal female patients with breast cancer who completed cancer therapy will be randomly allocated to either adjuvant moxibustion or usual care groups with a 1:1 allocation ratio. The intervention group will undergo 24 sessions of adjuvant moxibustion therapy with usual care for 12 weeks, whereas the control group will receive only usual care during the same period. The usual care consists of acetaminophen administration on demand and self-directed exercise education to manage AI-related joint pain. The primary outcome is the mean change of the worst pain level according to the Brief Pain Inventory—Short Form between the initial visit and the endpoint. The mean changes in depression, fatigue, and quality of life will also be compared between groups. Safety and pharmacoeconomic evaluations will also be included.

Discussion:

Continuous variables will be compared by an independent t test or Wilcoxon rank-sum test between the adjuvant moxibustion and usual care groups. Adverse events will be analyzed using the chi-square or Fisher exact test. The statistical analysis will be performed by a 2-tailed test at a significance level of .05.
Sphingosine-1-phosphate as an indicator for deciding the use of adjuvant corticosteroids therapy in community-acquired pneumonia (sphingosine-1-phosphate and pneumonia trial)
Authors: Hsu Shih-Chang , Huang Wen-Cheng , Liu Chung-Te , Hsu Yuan-Pin , Chang Jer-Hwa , Huang Shau-Ku , Hsu Chin-Wang
Published: October 2019

Introduction:

Pneumonia is one of the leading causes of death worldwide, represents a potentially life-threatening condition. In recent studies, adjuvant corticosteroids therapy has been shown to improve outcome in severe community-acquired pneumonia (CAP); however, the treatment response to corticosteroids vary. It is important to select patients likely to benefit from the treatment. Currently, the optimal patient selection of corticosteroids treatment is not yet clearly defined.

Methods:

Sphingosine-1-phosphate and pneumonia (SOPN) trial is a double-blinded, randomized, placebo-controlled trial that will investigate if sphingosine-1-phosphate (S1P) can be an indicator for initiating adjuvant corticosteroids therapy in patients with severe CAP. Participants will be recruited from the emergency department and randomized to receive 20 mg of methylprednisolone twice daily or placebo for 5 days. The primary outcome will be “in-hospital mortality.” Secondary outcomes will include intensive care unit (ICU) admission, length of ICU stay, length of hospital stay, and clinical outcomes at Day 7 and Day 14.

Conclusion:

SOPN trial is the first randomized placebo-controlled trial to investigate whether S1P can be a predictive biomarker for adjuvant corticosteroids therapy in patients with severe CAP. The trial will add additional data for the appropriate use of adjuvant corticosteroids therapy in patients with severe CAP. Results from this clinical trial will provide foundational information supporting that if the S1P is appropriate for guiding the patient selection for corticosteroids adjuvant therapy.
Non-pharmacological interventions for patients with dementia
Authors: Lee Go Eun , Kim Ju Yeon , Jung Jin Hyeong , Kang Hyung won , Jung In Chul
Published: October 2019

Background:

This protocol for a systematic review describes the methods that will be used to evaluate the efficacy and safety of non-pharmacological interventions for patients with dementia.

Methods:

We will search ALOIS, the specialized register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), without language or publication status restrictions. Additional separate searches will be run in many of the above six databases to ensure the most up-to-date results are retrieved.

The study selection and data extraction will be performed independently by two authors and only randomized controlled trials will be included. The risk of bias will be assessed independently by two authors following the Cochrane Handbook for Systematic Reviews of Interventions. We will use RevMan software and random-effects models to assess the heterogeneity and data synthesis.

If any plan for documenting important protocol amendments changes, the researchers will make a revision agreement and then register the modification on PROSPERO.

Conclusion:

Through this systematic review, a comprehensive understanding of current non-pharmacological interventions on dementia will be available. Meanwhile, it will provide basic evidence for further clinical research.

Ethics and dissemination:

Ethical approval is not required because no individual patient's data are included in this paper. This study will be disseminated through conference presentation.

Prospero registration number:

CRD42019136435
The inter-relationship between marginal vitamin D deficiency and muscle
Authors: Kamwa Vicky , Hassan-Smith Zaki K.
Published: October 2019

Purpose of review

We review the recent literature on the interplay between mild vitamin D deficiency and skeletal muscle strength and performance.

Recent findings

Preclinical studies indicate that vitamin D is important in muscle proliferation, differentiation and mitochondrial function, whereas some epidemiological studies demonstrate associations with muscle strength and low physical performance. Recent studies have implicated vitamin D deficiency in the development of frailty and sarcopenia in the older population. Some small studies have assessed its impact on muscle function in special circumstances such as elite sport and critical illness. Advances in liquid chromatography/mass spectrometry technologies have allowed the inter-relationships between the vitamin D metabolome and muscle phenotype to be characterized. There is evidence of distinct effects on human skeletal muscle gene expression between vitamin D metabolites.

Large-scale clinical trials with well defined cohorts and outcomes are needed to provide clinically meaningful insights into this area. Care should be taken to stratify participants by vitamin D status at baseline and over follow-up in addition to observing a range of measures of muscle function.
A Mixed-Methods Study on Patient Safety Insights of New Graduate Registered Nurses
Authors: Murray Melanie , Sundin Deborah , Cope Vicki
Published: October 2019

Background:

New graduate nurses transition with limited experience, and with anxiety and stress. They present an increased risk of contributing to preventable errors or adverse events.

Purpose:

The purpose was to develop an understanding of new graduate registered nurses' (RNs) patient safety knowledge and actions within the first year of registration.

Methods:

The longitudinal mixed-methods study was conducted using a questionnaire delivered at 3 time points (n = 68). Qualitative data were collected by semistructured interviews (n = 11).

Results:

Self-reported knowledge of medical error decreased over the 3 time points. Themes emerging from qualitative data include patient safety and insights, time management, making a mistake, experiential learning, and transition.

Conclusions:

Medical errors and time management persist during transition to the RN role. New graduates reported moderate knowledge of safety and quality issues; however, questioning their own abilities overshadowed growth in their involvement in patient safety.
Pilot Implementation of a Low-Literacy Zone Tool for Heart Failure Self-management
Authors: Weiss Daniel J. , Robertson Sue , Goebel Joy R.
Published: October 2019

Heart failure affects 6.5 million Americans, with 1 million hospitalizations annually, a 22% readmission rate, and $31 billion in health care costs. Palliative care decreases symptom burden, readmissions, and costs. Many elderly patients have difficulty recognizing and reporting heart failure symptoms to their providers in a timely manner. Self-management tools with color-coded zones (green = “all clear,” yellow = “caution,” red = “take action”) help patients recognize and respond to heart failure symptoms and reduce readmissions. The purpose of this quality improvement project was to develop, implement, and evaluate a low-literacy zone tool for heart failure self-management with home-based palliative care patients. An interdisciplinary palliative care team developed this zone tool. Health literacy was prescreened with the Newest Vital Sign instrument. Nurses provided the zone tool to patients and caregivers and instructed them in use of this tool for daily self-monitoring. In postimplementation surveys, participants rated the zone tool as easy to understand and helpful in recognizing and reporting symptoms. This project demonstrated feasibility of a new zone tool for heart failure self-management, resulting in a practice change for this home-based palliative care program. The interdisciplinary team eventually developed similar zone tools for cancer, cirrhosis, chronic obstructive pulmonary disease, dementia, and frailty self-management.
Antiangiogenesis activity test of tin leaf (Ficus carica L.) on the number of blood vessels and VEGF expression of chorioallantoic membrane of embryonated chicken eggs
Authors: Hamid Iwan Sahrial , Aksono Eduardus Bimo , Sukmanadi Mohammad , Purnama Muhammad Thohawi Elziyad
Published: October 2019

This research has been conducted on the antiangiogenesis activity test of the tin leaf (Ficus carica L.) on the number of blood vessels and vascular endothelial growth factor (VEGF) expression of chorioallantoic membrane (CAM) of embryonated chicken eggs. The general objective of this study is the use of natural products from the F. carica L. as chemopreventive in cancer through the mechanism of inhibition of angiogenesis. Inhibition of angiogenesis, supply of nutrients and oxygen to cancer cells will also be inhibited, so that indirectly cancer cells will be stunted. This study used 25 embryonated chicken eggs that divided into 5 treatments and each treatment has 5 repetitions. This treatment includes placebo negative controls, celecoxib-positive controls, and 3 treatment groups were given a water extract of F. carica L. which was divided into several doses of 75, 90, and 110 μg. The result found a significant difference (P < .05) in the macroscopic observation of the number of blood vessels in the CAM loaded with the paper dish. Observation of VEGF expression in vascular endothelial cells in the CAM also had a significant difference (P < .05). The optimal dose of water extract of F. carica L. of 90 μg has been able to inhibit the formation of new blood vessels by 65.51% and reduce VEGF expression by 45% in the chorioallantoic membrane. Thus, it can be concluded that the administration of water extract of F. carica L. can inhibit the formation of new blood vessels and inhibit VEGF expression.
The Evidence on Feeding Initiation After Percutaneous Endoscopic Gastrostomy Tube Placement
Authors: Shellnutt Cathleen
Published: October 2019

Feeding initiation after percutaneous endoscopic gastrostomy tube insertion might occur anywhere from 4 to 24 hours after insertion in the practice setting. A review and appraisal of the literature reveals that feeding initiation is both safe and prudent within 4 hours of placement. Early feeding initiation allows for medications and nutrition to be given by enteral means earlier, resulting in a cost benefit for facilities and allowing patients to be discharged home or transferred to long-term care sooner. Nursing theory supports early feeding after percutaneous endoscopic gastrostomy tube placement. Early feedings provide patients with relief of their hunger and allow the patients and caregivers to move forward with the next level of care in their recovery.