bluuebunny/crossref_metadata_2025_split huggingface dataset:
Update on nutritional assessment and therapy in critical care
Authors: Reintam Blaser Annika , Rice Todd W. , Deane Adam M. 
Published: February 2020

Purpose of reviewTo summarize recent data regarding nutritional assessment and interventions in the ICU.Recent findingsCurrent methods to assess nutritional risk do not allow identification of ICU patients who may benefit from specific nutritional intervention. Early full energy delivery does not appear to improve outcomes at the population level. Specific nutrient composition of formula has been shown to improve glycemic outcomes in patients with hyperglycemia but patient-centered outcomes are unaffected.SummaryBased on recent studies, full energy feeding early during critical illness has no measurable beneficial effect, and may even be harmful, when applied to entire populations. The mechanisms underlying this are unknown and remain proposed theories. Tools to assess nutritional risk in the ICU that identify patients who will benefit from a specific nutritional intervention are lacking. The optimal composition of feeds, and indications for specific interventions for enteral feeding intolerance remain uncertain.
Minimally invasive surgery for intracerebral hemorrhage
Authors: Vitt Jeffrey R. , Sun Chung-Huan , Le Roux Peter D. , Hemphill J. Claude 
Published: February 2020

Purpose of review
Spontaneous intracerebral hemorrhage (ICH) is common, associated with a high degree of mortality and long-term functional impairment, and remains without effective proven treatments. Surgical hematoma evacuation can reduce mass effect and decrease cytotoxic effects from blood product breakdown. However, results from large clinical trials that have examined the role of open craniotomy have not demonstrated a significant outcome benefit over medical management. We review the data on minimally invasive surgery (MIS) that is emerging as a treatment modality for spontaneous ICH.

Recent findings
The use of MIS for supratentorial ICH has increased significantly in recent years and appears to be associated with decreased mortality and improved functional outcome compared with medical management. The role of MIS for posterior fossa ICH is ill-defined. Currently available MIS devices allow for stereotactic aspiration and thrombolysis, endoport-mediated evacuation, and endoscopic aspiration. Clinical series demonstrate that MIS can facilitate significant hematoma volume reduction and may be associated with less morbidity than conventional open surgical approaches.

Summary
MIS is an appealing treatment modality for supratentorial ICH and with careful patient selection and technologic advances has the potential to improve neurologic outcomes and reduce mortality. Early and extensive hematoma evacuation are important therapeutic targets and current studies are underway that have the potential to change the management for ICH patients.
Evaluation and management of intraabdominal hypertension
Authors: Allen Rebecca , Sarani Babak 
Published: February 2020

Purpose of review
The purpose of this review is to provide an overview of the pathophysiology of intraabdominal hypertension/compartment syndrome and to review the recent advances in the areas of evaluation and management of this disorder.

Recent findings
The incidence of intraabdominal hypertension (IAH) in intensive care units is as high as 45%, an incidence much higher than initially suspected. Despite decompressive laparotomy as a treatment, mortality in patients who developed abdominal compartment syndrome (ACS) requiring this procedure is as high as 50%. Some patients may be treated by fewer invasive methods, such as paracentesis, thereby avoiding the morbidity of laparotomy. Protective lung ventilation is key to managing the pulmonary sequalae of ACS. Point-of-care ultrasound can be used as an adjunctive decision-making tool.

Summary
IAH is common in critically ill patients and portends a high mortality rate. Prevention and early recognition are key in minimizing adverse events.
Extracranial complications after traumatic brain injury: targeting the brain and the body
Authors: Robba Chiara , Bonatti Giulia , Pelosi Paolo , Citerio Giuseppe 
Published: February 2020

Purpose of review
The aim of this review is to provide an update on the pathophysiology and treatment of severe traumatic brain injury (TBI)-related complications on extracranial organs.

Recent findings
Extracranial complications are common and influence the outcome from TBI. Significant improvements in outcome in a sizeable proportion of patients could potentially be accomplished by improving the ability to prevent or reverse nonneurological complications such as pneumonia, cardiac and kidney failure. Prompt recognition and treatment of systemic complications is therefore fundamental to care of this patient cohort. However, the role of extracranial pathology often has been underestimated in outcome assessment since most clinicians focus mainly on intracranial lesions and injury rather than consider the systemic effects of TBI.

Summary
Robust evidence about pathophysiology and treatment of extracranial complications in TBI are lacking. Further studies are warranted to precisely understand and manage the multisystem response of the body after TBI.
Impact of Tilt-Down Positioning Compared With Left Lateral Positioning on Ease of Colonoscope Insertion During Colonoscopy
Authors: Early Dayna , Larue Sara , Weinstock Leonard , Kushnir Vladimir , Gyawali Prakash , Sullivan Shelby , Thyssen Erik , Hollander Thomas , Elsner Jeffrey , Vyhmeister Ross , Bhat Trisha , Gaddam Srinivas 
Published: February 2020

Goals:
The aim of this study was to evaluate the efficacy of tilt-down (TD) versus left lateral (LL) positioning in speed and ease of colonoscope insertion in women with risk factors for difficult colonoscopy.

Background:
Risk factors for difficult colonoscopy in women include pelvic surgery, diverticulosis, and thin body habitus.

Study:
Female patients with body mass index (BMI) under 25, diverticulosis and history of pelvic surgery were randomized to TD or LL positioning. Five colonoscopists performed all studies at a single center. Time to splenic flexure and cecum, type and amount of medication administered, Boston Bowel Prep Score (BBPS), adverse events, and findings were recorded. The Mann-Whitney U test was used to evaluate the primary endpoint.

Results:
A total of 150 women were enrolled (81 TD, 69 LL). The mean age was 60.1 (SD 10.5) and the mean BMI was 23.9 (SD 3.5). In total 98 (65.3%) women had prior pelvic surgery, 94 (62.7%) had BMI <25 and 60 (40.0%) had diverticulosis. There was no statistically significant difference in time to the splenic flexure overall but insertion to the splenic flexure was significantly faster in the TD position as compared with the LL position in patients with diverticulosis (124 s for TD, 160 s for LL, P=0.022). In a linear regression analysis, lower BMI, diverticulosis and lower BBPS were significantly associated with a longer insertion time to the splenic flexure. There were no adverse events.

Conclusion:
TD positioning represents a straightforward maneuver to facilitate advancement through the sigmoid colon and may be beneficial in women with diverticular disease.
N − 3 fatty acids during chemotherapy: toward a higher level of evidence for clinical application
Authors: Klassen Pamela , Cervantes Mayra , Mazurak Vera C. 
Published: February 2020

Purpose of review
Recommendations for intakes of n − 3 fatty acids (FAs) in patients who are receiving chemotherapy for cancer are based on weak evidence. This review highlights themes within the emergent literature to suggest improvements in the design of studies that provide n − 3 FA supplements concurrent with cytotoxic agents.

Recent findings
Following earlier research in animal models and human pilot studies, recent human studies have evaluated the effect of providing n − 3 FAs during delivery of single agent and multiagent chemotherapy regimens for breast and gastro-intestinal cancers. Regimens were based on platinum compounds, fluoropyrimidines or both, and a variety of additional agents. Tumor location and stage, supplement dose and duration, and endpoints were dissimilar across studies. Overall, the recent research continues to support the safety and tolerability of n − 3 FA supplementation with chemotherapy and provides additional evidence, albeit weak, for enhanced tumor response, maintenance of weight and muscle, and reduction in inflammation and toxicities in the host across multiple cancer sites and chemotherapy regimens.

Summary
The barriers to implementation in practice remain small study sizes, variations in supplement dosage and methodology, and differences in primary endpoints. Randomized, blinded trials with a justifiable sample size, adequate doses, monitored compliance and measures of clinically important endpoints are required to move these findings to a higher level of evidence for implementation into clinical practice.
One-year outcome of low dose laser cyclophotocoagulation for capsular tension ring-induced malignant glaucoma
Authors: Lin Haishuang , Zhou Guangming , Zhang Shaodan , Huang Fang , Liang Yuanbo 
Published: February 2020

Abstract

Rationale:
Malignant glaucoma is a refractory glaucoma which often relentlessly worsened despite conventional therapy. Ultrasonographic biomicroscopy always cannot show the ciliary-block of malignant glaucoma. We report a case of capsular tension ring induced ciliary-block and successfully treated by low dose laser cyclophotocoagulation, with 1-year follow-up.

Patient concerns:
A 75-year-old woman was referred for glaucoma with a history of cataract and lens zonular laxity, and surgery with combined phacoemulsification and capsular tension ring implantation. She subsequently underwent trabeculectomy for uncontrolled intraocular pressure on maximal medical therapy. One day later, the patient presented as shallow anterior chamber of Shaffer grade 1 and an elevated intraocular pressure of 51.0 mmHg in the right eye.

Diagnosis:
Ciliary block caused by capsular tension ring and malignant glaucoma was observed.

Interventions:
Low dose laser cyclophotocoagulation was performed under retrobulbar anesthesia.

Outcomes:
One day later, the patient's intraocular pressure decreased to 14.3 mmHg on topical atropine 1% and 2 classes of intraocular pressure lowering medications. The patient discontinued topical atropine and intraocular pressure lowering medications 4 months postoperatively and her condition had remained stable for 1 year without any medications. The patient had a satisfactory recovery benefited from the low dose laser cyclophotocoagulation.

Lessons:
Low dose laser cyclophotocoagulation in this challenging case of capsular tension ring-induced malignant glaucoma provided an effective and fast recovery of anterior chamber depth over a 1-year period.
Phase 2 randomized placebo controlled double blind study to assess the efficacy and safety of tecfidera in patients with amyotrophic lateral sclerosis (TEALS Study)
Authors: Vucic Steve , Ryder Julie , Mekhael Linda , RD Henderson , Mathers Susan , Needham Merilee , DW Schultz , MC Kiernan 
Published: February 2020

Abstract

Background:
Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disorder of the human motor system. Neuroinflammation appears to be an important modulator of disease progression in ALS. Specifically, reduction of regulatory T cell (Treg) levels, along with an increase in pro-inflammatory effector T cells, macrophage activation and upregulation of co-stimulatory pathways have all been associated with a rapid disease course in ALS. Autologous infusion of expanded Tregs into sporadic ALS patients, resulted in greater suppressive function, slowing of disease progression and stabilization of respiratory function. Tecfidera (dimethyl fumarate) increases the ratio of anti-inflammatory (Treg) to proinflammatory T-cells in patients with relapsing remitting multiple sclerosis and rebalances the regulatory: inflammatory axis towards a neuroprotective phenotype. Consequently, the aim of this study was to assess the efficacy, safety, and tolerability of Tecfidera in sporadic ALS.

Methods:
The study is an investigator led Phase 2 multi-center, randomized, placebo controlled, double blind clinical trial assessing the efficacy and safety of Tecfidera in patients with sporadic ALS. The study duration is 40 weeks, with a 36-week study period and end of study visit occurring at 40 weeks or at early termination/withdrawal from study. The TEALS study has been registered with the Australian and New Zealand Clinical Trials registry (ANZCTR) under the trials registration number ACTRN12618000534280 and has been approved by the Human Research Ethics Committee and Research Governance Office at the lead site (Westmead Hospital) with the ethics number HREC/17/WMEAD/353. The participating sites have obtained site specific ethics and governance approvals from the local institution.

Results:
The primary endpoint is slowing of disease progression as reflected by the differences in the ALS Functional Rating Score-Revised (ALSFRS-R) score at Week 36. The secondary endpoints will include effects in survival, lower motor neuron function, respiratory function, quality of life and safety.

Conclusion:
This Phase 2 multi-center, randomized, placebo controlled, double blind clinical trial will provide evidence of efficacy and safety of Tecfidera in sporadic ALS.
Clinical effects and safety of electroacupuncture for the treatment of allergic rhinitis
Authors: Fu Li , Zhong Juan , Fu Qinwei , Yang Yepeng , Zhang Mengni , Zhang Qinxiu 
Published: February 2020

Abstract

Background:
As the therapy of acupuncture continues to expand, electroacupuncture is increasing used in allergic rhinitis prevention and therapy, and many studies have published that it is effective in the treatment of allergic rhinitis. However, it is unclear if electroacupuncture provides an evidence-based clinical benefit in the allergic rhinitis population.

Methods/design:
We will conduct a systematic review of electroacupuncture and health-related outcomes in allergic rhinitis patients according to the Preferred Reporting Items for Systematic Reviews. The primary objective is to assess the impact of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on clinical outcomes relevant to allergic rhinitis patients, such as effective rate, life-quality evaluation, and adverse events. The Cochrane Risk Assessment Tool will be used to assess the quality of eligible studies according to the Cochrane handbook.

Results:
We will perform a meta-analysis using standard techniques for the outcomes.

Conclusion:
The results of this systematic review may highlight the gaps in our knowledge of the relevance of electroacupuncture after treatment or after follow-ups.
PROSPERO registration number: PROSPERO CRD42018104080. (https://www.crd.york.ac.uk/PROSPERO/#recordDetails)
Behçet's disease with invasive pulmonary aspergillosis and Aspergillus auriculatus infection
Authors: Sun Fenfen , Cao Hui , Wang Fan , Cao Guoqiang 
Published: February 2020

Abstract

Rationale:
Behçet's disease (BD) is an inflammatory disease that leads to multisystemic immune dysfunction and that involves pulmonary system alterations.

Patient concerns:
A 26-year-old woman presented with dull right chest pain for 30 days and intermittent cough with expectoration for 5 days. She had a history of recurrent oral ulcer and constitutional rash 2 months prior.

Diagnoses:
The patient was diagnosed with BD complicated by IPA and Aspergillus auriculatus infection.

Interventions:
The patient was administered itraconazole oral solution (200 mg b.i.d) to treat the fungal infection. After a diagnosis of BD was made, she received 40 mg of methylprednisolone sodium succinate daily for 1 week.
Then, she also received 24 mg of methylprednisolone sodium succinate daily, which was decreased by 2 mg per half month, until the rash had resolved. The patient continued to receive 200 mg Q. D itraconazole orally for 3 months. Thereafter, itraconazole was stopped, while daily oral administration of 10 mg of methylprednisolone sodium succinate was continued.

Outcomes:
The rash was observed to resolve, and CT revealed that the lesions in both the right and left lung were reduced. During a telephone follow-up performed after 6 months, the patient stated that no symptoms had recurred during the follow-up period.

Lessons:
This case illustrates that for patients with BD, ignoring extrapulmonary symptoms often leads to a delayed diagnosis. Physicians should perform a thorough medical history and physical examination of these patients, as the information obtained in this manner may provide important clues for disease diagnosis and treatment.
Direct acting antivirals treatment for hepatitis C virus infection does not increase the incidence of de novo hepatocellular carcinoma occurrence
Authors: Buonomo Antonio Riccardo , Scotto Riccardo , Coppola Carmine , Pinchera Biagio , Viceconte Giulio , Rapillo Costanza Maria , Staiano Laura , Saturnino Mariarosaria , Scarano Ferdinando , Portunato Federica , Pisaturo Mariantonietta , De Pascalis Stefania , Martini Salvatore , Tosone Grazia , Nappa Salvatore , Coppola Nicola , Gentile Ivan 
Published: February 2020

Abstract
The effectiveness of direct-acting antivirals (DAAs) against hepatitis C virus (HCV) infection is ascertained. However, some authors raised the issue of an increased incidence of de novo hepatocellular carcinoma (HCC) in patients treated with DAAs. Aim of the study was to evaluate the rate of HCC occurrence in a real-life cohort of patients who received anti-HCV treatment with DAAs.
A prospective multicentre study was conducted. All adult patients with HCV infection who received treatment between March 2015 and December 2017 in 4 hospital of Campania region (South Italy) with at least 6 months of follow-up were enrolled.
A total of 323 patients were included in the study. Most patients had HCV genotype 1b (61.8%). The overall SVR12 rate was 95.5%. Median time of observation was 10 months. The incidence rate of HCC was 0.2 per 100 person-months (crude incidence rate 3.4%, 95 confidence interval: 1.5%–5.3%). The median time for HCC occurrence was 11 months. HCC occurrence rate was significantly higher among patients who did not achieve SVR12 compared with patients who did (28.6% vs 2.8%, P < 0.05). No patient with F0-F3 fibrosis developed HCC. Among patients with cirrhosis, at the multivariate time-to-event analysis, no covariates were independently associated with the risk of HCC occurrence.
Treatment with DAAs did not increase the risk of HCC occurrence. Patients who achieved SVR12 had a lower rate of HCC occurrence. Further studies are needed to estimate the incidence and the risk for HCC in the long-term follow-up among patients undergoing treatment with DAAs.
Disparities in National Institute of Health trauma research funding
Authors: Dowd Brianna , McKenney Mark , Boneva Dessy , Elkbuli Adel 
Published: February 2020

Abstract
To evaluate disparities in the National Institute of Health (NIH) trauma research funding.
Traumatic injury has increased in both prevalence and cost over the last decade. In the event of a traumatic injury, patients in the United States (US) rely on the trauma system to provide high-quality care. The current trauma research funding is not commensurate with the extent of the burden of trauma on the US population.
In this qualitative study, the National Institutes of Health's Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC) data were reviewed. The burden of traumatic injury on the US and the NIH trauma research funding was examined and compared with other diseases.
In 2018, the NIH funded an estimated $639 million to traumatic injury research projects, <2% of the NIH budget. Comparatively, the NIH funded an estimated $6.3 billion towards cancer research in 2018. Cancer research receives extensively more funding than trauma research despite that trauma accounts for 24.1% of all years of potential life lost (YPLL) before age 75 compared with 21.3% for cancer.
In the event of traumatic injury, trauma systems in the US should be able to provide high-quality care to patients yet cannot do so without adequate research funding. The federal funding contributed towards trauma research deserves a re-evaluation.
Maximal muscle strength and body composition are associated with bone mineral density in chinese adult males
Authors: Chen Fei , Su Qi , Tu Yulan , Zhang Jun , Chen Xinji , Zhao Tingxiao , Huang Yazeng , Xu Guokang 
Published: February 2020

Abstract
The relationship between maximal muscle strength (MMS) and bone mineral density (BMD) in males remains unclear. Therefore, the aim of this cross-sectional study was to investigate the association of MMS, using 3 fundamental compound exercises, and body composition with BMD in Chinese male adults. One hundred forty-seven Chinese male adults aged 20 to 47 years were recruited. Total and regional BMD and body composition were measured using dual-energy X-ray absorptiometry. Measurements of MMS included bench press, deadlift, and squat 1-repetition maximum (1RM). Bench press, deadlift, squat 1RM, fat mass (FM), and lean mass (LM) had a significant positive association with BMD. Intriguingly, squat 1RM was found to have a stronger association than bench press or deadlift 1RM, whereas bench press 1RM was found as the strongest determinant of BMD at the forearm sites. Furthermore, LM was found to be stronger related with BMD than FM. Our findings identify LM, FM and MMS are positively associated with BMD and squat may serve as a simple, most efficient strategy to optimize peak total body BMD, while bench press fit best for forearm BMD. Our results validate the benefits of MMS training in males and underscores site-specific effects on BMD levels. These findings emphasize the need for prospective studies to investigate the maximum therapeutic potential and sex specific modifiers of MMS training.
Dyskeratotic cells in persistent pruritic skin lesions as a prognostic factor in adult-onset Still disease
Authors: Maeda-Aoyama Natsuki , Hamada-Ode Kazu , Taniguchi Yoshinori , Nishikawa Hirofumi , Arii Kaoru , Nakajima Kimiko , Fujimoto Shimpei , Terada Yoshio 
Published: February 2020

Abstract
Adult-onset Still disease (AOSD), a systemic inflammatory disorder, is characterized by high fever, evanescent rash, arthritis, and hyperferritinaemia. AOSD is also reported to be associated with other skin lesions, including persistent pruritic papules and plaques. This study aimed to assess the significance of dyskeratotic skin lesions in Japanese AOSD patients.
We retrospectively assessed the histology of persistent pruritic skin lesions and evanescent rashes and the relationship between dyskeratotic cells, serum markers, and outcomes in 20 Japanese AOSD patients, comparing AOSD histology with that of dermatomyositis (DM), drug eruptions, and graft-versus-host disease (GVHD).
As the results, Persistent pruritic lesions were characterized by scattered single keratinocytes with an apoptotic appearance confined to the upper layer of the epidermis and horny layer without inflammatory infiltrate. In contrast to AOSD, the histology of DM, drug eruption, and GVHD demonstrated dyskeratotic cells in all layers of the epidermis with inflammatory infiltrate. AOSD with evanescent rash showed no dyskeratotic cells. The dyskeratotic cells in pruritic AOSD lesions stained positive for ssDNA and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling, indicating apoptosis. Serum IL-18 was significantly higher in AOSD patients with dyskeratotic cells than those without, and generally required higher doses of glucocorticoids, immunosuppressants, and biologic agents. Two of ten AOSD patients with dyskeratotic cells died from hemophagocytic lymphohistiocytosis.
In conclusion, Persistent pruritic AOSD skin lesions are characterized by dyskeratotic cells with apoptotic features, involving the upper layers of the epidermis. There may be a link to elevated IL-18. This dyskeratosis may be a negative prognostic indicator.