bluuebunny/crossref_metadata_2025_split huggingface dataset:
Eosinophilic esophagitis as a complication of food oral immunotherapy
Authors: Jin Hope , Trogen Brit , Nowak-Wegrzyn Anna 
Published: September 2020

Purpose of review
Food oral immunotherapy (OIT) has emerged as way to mitigate serious allergic reactions including life-threatening anaphylaxis related to accidental ingestion. However, gastrointestinal-related adverse effects of OIT have been reported and are often cited as reasons for discontinuation of therapy. We summarize recent research on the prevalence of eosinophilic esophagitis (EoE) in patients undergoing OIT.

Recent findings
We examined 12 recent studies on OIT for peanut, milk, walnut, egg, and wheat, which enrolled a total of 620 patients. Gastrointestinal symptoms were common during OIT, and while generally mild, 24 (3.9%) patients from the reviewed studies reported gastrointestinal symptoms that were significant enough to prompt discontinuation of OIT. Of these, two (0.3% of the total 620 patients or 8.3% of those with gastrointestinal symptoms) patients had biopsy-confirmed EoE. One of these patients was subsequently found to also have ulcerative colitis that had been previously undiagnosed.

Summary
EoE is a rare but concerning side effect of OIT. More research is needed to better elucidate both the OIT-related and patient-related factors that may predispose individuals to develop EoE. The presence of comorbid conditions and/or preexisting subclinical esophageal eosinophilia may account for some of cases of EoE identified during OIT.
Suicide Probability Among Tramadol Addicts
Authors: Saad Mohamed Ahmed , Ibrahim Nesreen M. , Mazloum Ayat , Naguib Rehab M. , Azzam Lobna 
Published: September 2020

Objectives:
Tramadol addiction is one of the major addiction problems in growing countries, especially in Egypt. Moreover, there is a strong relation between suicidality and addiction even after exclusion of personality disorders; the burden of suicide adds to the burden of substance abuse in those individuals and their families.

Materials and Methods:
A cross-sectional descriptive study was conducted on 72 tramadol-dependent patients who were recruited randomly in this study from the addiction outpatient clinic of Okasha Institute of Psychiatry of Ain Shams University, after obtaining an informed consent. They are assessed by (1) Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders for diagnosis of substance use disorder, (2) Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis II Disorders for exclusion of personality disorders, (3) suicide probability scale, and (4) Addiction Severity Index.

Results:
Regarding suicidal probability, 44.44% of the sample showed risk of suicide, which was severe among 19.44%, moderate among 11.11%, and mild among 13.89% of the sample. Regarding “Addiction Severity Index,” most patients had no real medical problem. In the employment domain, 38.89% had a slight problem. In the drug use domain, 80.56% had a moderate problem.
There is a significant relation between the degree of medical, drug use, and legal problem and the severity of suicidal risk. Moreover, the longer duration of addiction and the advanced age of patients are risk factors for suicidal probability.

Conclusions:
There is a suicide probability among tramadol addicts. The duration of tramadol use could be considered a strong risk factor for suicide, as the longer the duration of tramadol, the higher the suicidal risk.
Risk Factors for Increased Postoperative Pain and Recommended Orderset for Postoperative Analgesic Usage
Authors: Armstrong April D. , Hassenbein Susan E. , Black Sarah , Hollenbeak Christopher S. 
Published: September 2020

Objective:
An interdisciplinary pain team was established at our institution to explore options for improving pain control in patients undergoing orthopedic surgery by identifying traits that put a patient at increased risk for inadequate pain control postoperatively.

Materials and Methods:
The interdisciplinary pain team identified 7 potential risk factors that may lead to inadequate pain control postoperatively including (1) history of physical, emotional, or sexual abuse; (2) history of anxiety; (3) history of drug or alcohol abuse; (4) preoperative nonsteroidal anti-inflammatory drug, or disease-modifying antirheumatic drug use; (5) current opioid use; (6) psychological conditions other than anxiety; and (7) current smoker. Statistical analysis determined which risk factors were associated with increased preoperative and postoperative pain scores.

Results:
A total of 1923 patients undergoing elective orthopedic surgery were retrospectively identified. Hip, knee, and shoulder replacements accounted for 76.0% of the procedures. 78.5% of patients had 3 or fewer risk factors and 17.1% had no risk factors. Anxiety, other psychological conditions, current opioid use, and current smoking were significantly associated with higher preoperative and postoperative pain scores.

Discussion:
We found a significant association between anxiety, current smoking, psychological conditions, and current opioid use with increased preoperative and postoperative reported pain score. We propose that identification of these risk factors should prompt more attention to postoperative pain control plans and will improve communication with patients and providers. We recommend a multimodal approach to postoperative pain control, and developed a pain orderset to help guide providers.
Vancomycin Powder Use in Fractures at High Risk of Surgical Site Infection
Authors: Qadir Rabah , Costales Timothy , Coale Max , Mulliken Alexandra , Zerhusen Timothy , Joshi Manjari , Castillo Renan C. , Carlini Anthony R. , O'Toole Robert V. 
Published: September 2020

Objectives:
To determine if the use of intrawound vancomycin powder reduces surgical-site infection after open reduction and internal fixation of bicondylar tibial plateau, tibial pilon, and calcaneus fractures.

Design:
Retrospective analysis.

Setting:
Level I trauma center.

Patients:
All fractures operatively treated from January 2011 to February 2015 were reviewed; 583 high-risk fractures were included, of which 35 received topical vancomycin powder. A previously published prospectively collected cohort of 235 similar high-risk fractures treated at our center from 2007 through 2010 served as a second comparison group.

Intervention:
Topical vancomycin powder at wound closure.

Main Outcome Measurements:
Deep surgical-site infection. Analyses used both univariate comparison of all patients and 1:2 matching analysis using both nearest neighbor and propensity-based matching.

Results:
Compared with a control group of fractures treated during the same time period without vancomycin powder, the infection rate with vancomycin powder was significantly lower [0% (0/35) vs. 10.6% (58/548), P = 0.04]. Compared with our previously published historical infection rate of 13% for these injuries, vancomycin powder was also associated with significantly decreased deep surgical-site infection (0% vs. 13%, P = 0.02). These results agreed with the matched analyses, which also showed lower infection in the vancomycin powder group (0% vs. 11%–16%, P ≤ 0.05).

Conclusions:
Vancomycin powder may play a role in lowering surgical-site infection rates after fracture fixation. A larger randomized controlled trial is needed to validate our findings.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Fate of Patients After a Staged Nonunion Procedure for Known Infection
Authors: Zhang Joanne Y. , Tornetta Paul , Dale Kevin M. , Jones Clifford B. , Mullis Brian H. , Egol Kenneth A. , Robinson Elliot , Bosse Michael J. , Schmidt Andrew H. , Hymes Robert A. 
Published: September 2020

Objectives:
To determine the factors associated with successful union and eradication of infection in the setting of staged procedures to treat obviously infected nonunions of long bones. We hypothesize that patients with positive intraoperative cultures obtained at the time of definitive surgery for infected nonunions are more likely to have persistent nonunion than those with negative cultures.

Design:
Multicenter retrospective review.

Setting:
Eight academic Level 1 trauma centers.

Patients/Participants:
Patients who underwent staged management for obviously infected nonunion of a long bone.

Main Outcome Measurements:
For each patient, initial fracture management, management of retained implants, number of debridements, grafting, bacteriology, antibiotic course, bone defect management, soft-tissue coverage, and definitive surgery performed were reviewed.

Results:
A total of 134 patients were treated with staged procedures for obviously infected nonunion of a long bone (mean age 49 years, 60% open fractures, and mean follow-up 22 months). During definitive procedures, 120 patients had intraoperative cultures taken with 43% having positive cultures. For culture-positive patients, 41 patients achieved eventual union and 10 had persistent nonunion. Of 69 culture-negative patients, 66 achieved eventual union and 3 had persistent nonunion. The number of patients with union versus persistent nonunion was statistically significant between culture-positive and culture-negative groups (P = 0.015).

Conclusions:
Management of infected nonunion in long bones with staged treatments before definitive fixation are beneficial but ultimately less effective when performed in the setting of positive bacterial cultures at the time of definitive management.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Down-regulation of miR-155 inhibits inflammatory response in human pulmonary microvascular endothelial cells infected with influenza A virus by targeting sphingosine-1-phosphate receptor 1
Authors: Shen Si-Mei , Jiang Hao , Zhao Jiang-Nan , Shi Yi 
Published: September 2020

Abstract

Background:
Endothelial cells play a key role in the cytokine storm caused by influenza A virus. MicroRNA-155 (miR-155) is an important regulator in inflammation. Its role in the inflammatory response to influenza A infection, however, has yet to be elucidated. In this study, we explored the role as well as the underlying mechanism of miR-155 in the cytokine production in influenza A-infected endothelial cells.

Methods:
Human pulmonary microvascular endothelial cells (HPMECs) were infected with the influenza A virus strain H1N1. The efficiency of H1N1 infection was confirmed by immunofluorescence. The expression levels of proinflammatory cytokines and miR-155 were determined using real-time polymerase chain reaction. A dual-luciferase reporter assay characterized the interaction between miR-155 and sphingosine-1-phosphate receptor 1 (S1PR1). Changes in the target protein levels were determined using Western blot analysis.

Results:
MiR-155 was elevated in response to the H1N1 infection in HPMECs (24 h post-infection vs. 0 h post-infection, 3.875 ± 0.062 vs. 1.043 ± 0.013, P = 0.001). Over-expression of miR-155 enhanced inflammatory cytokine production (miR-155 mimic vs. negative control, all P < 0.05 in regard of cytokine levels) and activation of nuclear factor kappa B in infected HPMECs (miR-155 mimic vs. negative control, P = 0.004), and down-regulation of miR-155 had the opposite effect. In addition, S1PR1 was a direct target of miR-155 in the HPMECs. Inhibition of miR-155 enhanced the expression of the S1PR1 protein. Down-regulation of S1PR1 decreased the inhibitory effect of the miR-155 blockade on H1N1-induced cytokine production and nuclear factor kappa B activation in HPMECs.

Conclusion:
MiR-155 maybe modulate influenza A-induced inflammatory response by targeting S1PR1.
Endoscopic or laparoscopic resection for small gastrointestinal stromal tumors: a cumulative meta-analysis
Authors: Cai Xian-Lei , Li Xue-Ying , Liang Chao , Xu Yuan , Zhang Miao-Zun , Yu Wei-Ming , Li Xiu-Yang 
Published: September 2020

Abstract

Background
Despite the recent large number of studies comparing endoscopic and laparoscopic resection for small gastrointestinal stromal tumors (GISTs) (diameter ≤ 5 cm), the results remain conflicting. The objective of this work was to perform a cumulative meta-analysis to assess the advantages and disadvantages of endoscopic resection vs. laparoscopic resection.

Methods
The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched medical databases up to January 2020. Meta-analytical random or fixed effects models were used in pooled analyses. Meta-regression, cumulative meta-analyses, and subgroup analyses were performed to improve the accuracy of the conclusion. Sensitivity analyses were applied to assess the robustness of the results.

Results
A total of 12 cohort studies with 1383 participants comparing endoscopic resection and laparoscopic resection were identified, while three cohort studies with 167 participants comparing endoscopic resection and laparoscopic and endoscopic cooperative surgery were found. We found that endoscopic resection had shorter operation times (weighted mean difference [WMD] = –27.1 min, 95% confidence interval [CI]: –40.8 min to –13.4 min) and lengths of hospital stay (WMD = –1.43 d, 95% CI: –2.31 d to –0.56 d) than did laparoscopic resection. The results were stable and reliable. There were no significant differences in terms of blood loss, hospitalization costs, incidence of complications or recurrence rates. For tumor sizes 2 – 5 cm, endoscopic resection increased the risk of positive margins (relative risk [RR] = 5.78, 95% CI: 1.31 – 25.46). Although operation times for endoscopic resection were shorter than those of laparoscopic and endoscopic cooperative surgery (WMD = –41.03 min, 95% CI: –59.53 min to –22.54 min), there was a higher incidence of complications (RR = 4.03, 95% CI: 1.57 – 10.34).

Conclusions
In general, endoscopic resection is an alternative method for gastric GISTs ≤ 5 cm. Laparoscopic and endoscopic cooperative surgery may work well in combination. Further randomized controlled trials are recommended to validate or update these results.
Patient satisfaction with intravenous regional anaesthesia or an axillary block for minor ambulatory hand surgery
Authors: Teunkens An , Vermeulen Kristien , Belmans Ann , Degreef Ilse , Van de Velde Marc , Rex Steffen 
Published: September 2020

BACKGROUND
Intravenous regional anesthesia (IVRA) and the axillary brachial plexus block are popular alternatives to general anaesthesia in ambulatory hand surgery. Although both have proven their effectiveness, patients’ preferences have never been evaluated.

OBJECTIVES
We investigated patient satisfaction with both techniques and hypothesised that satisfaction after IVRA is noninferior compared with axillary brachial plexus block.

DESIGN
A prospective, randomised controlled trial.

SETTING
Ambulatory surgical day care centre, University Hospitals of Leuven, Belgium, from September 2016 to November 2017.

PATIENTS
One hundred and twenty adults undergoing minor ambulatory hand surgery were included in this study.

INTERVENTION
Patients received either IVRA with 300 mg lidocaine or an axillary block with 280 mg mepivacaine.

MAIN OUTCOME MEASURES
The primary endpoint was the evaluation of patient satisfaction using the ‘Evaluation du Vécu de l’Anésthesie Locoregional’ (EVAN-LR) questionnaire. Secondary outcomes included different procedural times, block quality, tourniquet discomfort, the incidence of block failure and postoperative nausea and vomiting (PONV), the severity of postoperative pain and the need for postoperative analgesics during the first 24 h.

RESULTS
Noninferiority of IVRA was shown for the median [IQR] total score on the EVAN-LR questionnaire, IVRA-group: 92 [87 to 96] vs. axillary brachial plexus block-group: 91[87 to 97]; Hodges--Lehmann estimator (95% confidence interval (CI)] for the shift: −0.25 (−2.60 to 2.20). Induction of anaesthesia and time to discharge, requiring partial recovery of the motor block, were significantly longer in the axillary brachial plexus block group. The IVRA-group had a lower block quality, a higher incidence of tourniquet-discomfort and higher median intra-operative and postoperative pain scores on day 0; 0 [0 to 2] vs. 0 [0 to 0] and 0.8 [0 to 1.8] vs. 0 [0 to 0.25], respectively, but no increase in the need for supplementary analgesics or conversion rate to general anaesthesia.

CONCLUSION
IVRA and axillary brachial plexus block result in comparably high patient satisfaction in ambulatory hand surgery.

CLINICAL TRIAL REGISTRATION
EudraCT 2016-002325-11.
Relationship between psychological factors and spinal motor behaviour in low back pain: a systematic review and meta-analysis
Authors: Christe Guillaume , Crombez Geert , Edd Shannon , Opsommer Emmanuelle , Jolles Brigitte M. , Favre Julien 
Published: September 2020

Abstract
This meta-analysis investigated whether more negative psychological factors are associated with less spinal amplitude of movement and higher trunk muscle activity in individuals with low back pain. Furthermore, it examined whether pain intensity was a confounding factor in this relationship. We included studies that provided at least 1 correlation coefficient between psychological (pain-related fear, catastrophizing, depression, anxiety, and self-efficacy) and spinal motor behaviour (spinal amplitude and trunk muscle activity) measures. In total, 52 studies (3949 participants) were included. The pooled correlation coefficients (95% confidence interval; number of participants) were −0.13 (−0.18 to −0.09; 2832) for pain-related fear, −0.16 (−0.23 to −0.09; 756) for catastrophizing, −0.08 (−0.13 to −0.03; 1570) for depression, −0.08 (−0.30 to 0.14; 336) for anxiety, and −0.06 (−0.46 to 0.36; 66) for self-efficacy. The results indicated that higher levels of pain-related fear, catastrophizing, and depression are significantly associated with reduced amplitudes of movement and larger muscle activity and were consistent across subgroup and moderation analyses. Pain intensity did not significantly affect the association between these psychological factors and spinal motor behaviour and had a very small independent association with spinal motor behaviour. In conclusion, the very small effect sizes found in the meta-analyses question the role of psychological factors as major causes of spinal movement avoidance in low back pain. Experimental studies with more specific and individualized measures of psychological factors, pain intensity, and spinal motor behaviour are recommended.
Prevalence of glaucoma in the elderly population in Taiwan: The Shihpai Eye Study
Authors: Kuo Che-Yuan , Ko Yu-Chieh , Kuang Tung-Mei , Chou Pesus , Chiou Shih-Hwa , Liu Catherine Jui-Ling 
Published: September 2020

Background:
This study aimed to evaluate the prevalence, characteristics, and the awareness status of glaucoma in an elderly Chinese population.

Methods:
A total of 460 individuals aged ≥72 years were enrolled in this cross-sectional community-based eye disease screening program. Glaucoma was diagnosed according to the diagnostic criteria proposed by the International Society of Geographical and Epidemiological Ophthalmology. Characteristics of subjects with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) were described and compared between groups using Mann-Whitney U and Fisher’s exact tests.

Results:
Forty subjects were diagnosed with glaucoma, including 17 subjects with POAG, 22 with PACG, and one with secondary glaucoma. The estimated prevalence of glaucoma, POAG, and PACG was 8.7%, 3.7%, and 4.8%, respectively. In total, 71% of the subjects with PACG and 77% of POAG subjects presented with a normal intraocular pressure (IOP) of <19 mmHg. The demographic and ocular characteristics were similar between the two groups; however, subjects with POAG had a longer axial length and smaller vertical disc diameter than those with PACG. Further, 95% of the glaucoma subjects ever visited the eye clinic, but only 32.5% of them were aware of the disease.

Conclusion:
Glaucoma is prevalent in the elderly population in Taiwan, but the diagnostic rate and disease awareness are low. Since most subjects with glaucoma presented with normal IOPs, optic disc evaluation is critical for diagnosing glaucoma in the elderly in Taiwan
The clinical outcomes of elderly esophageal cancer patients who received definitive chemoradiotherapy
Authors: Lu Hao-Wei , Chen Chien-Chih , Chen Hsin-Hua , Yeh Hui-Ling 
Published: September 2020

Background:
Neoadjuvant chemoradiotherapy (CRT) followed by an esophagectomy is the standard treatment for locally advanced esophageal cancer, but remains a great challenge for elderly patients. Therefore, we aim to evaluate the efficacy of definitive CRT in elderly patients with esophageal cancer.

Methods:
From December 2007 to October 2017, 40 esophageal cancer patients aged ≥70 years receiving definitive CRT were retrospectively analyzed. All patients received cisplatin-based chemotherapy. Ten patients received standard doses of cisplatin 20 mg/m2 and fluorouracil (5-FU) 800 mg/m2 for 4 days, during the first and fifth weeks of radiotherapy. Eighteen patients received modified doses of cisplatin 16 to 18 mg/m2 and 5-FU 600 to 800 mg/m2. Twelve patients received lower doses of cisplatin 10 to 12 mg/m2 and 5-FU 400 to 600 mg/m2. The endpoints were overall survival (OS), tumor response rate, and treatment compliance.

Results:
The 3-year OS rate was 28.8% The 3-year OS rates for patients receiving standard, modified, and lower doses were 12.5%, 53.8%, and 0.0%, respectively (p = 0.05). There were 87.5% of patients completing the scheduled radiotherapy dose, along with two cycles of concurrent chemotherapy. The response rate (clinical complete response and partial response rate) was 70.0%. Multivariate analysis revealed that no statistical difference was found in the OS among three groups of chemotherapy dosage. The treatment response was the only independent prognostic factor to OS (p < 0.001).

Conclusion:
Definitive CRT with dose modification is a feasible, safe, and reasonable treatment for elderly esophageal cancer patients. Achieving a better compliance to CRT via an optimal dose modification of chemotherapy may provide better clinical outcomes and would be the treatment goal for elderly esophageal cancer patients.