bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sacral Pressure Injury Prevention in Trauma Patients: Silicone-Bordered Multilayered Foam Dressing
Authors: Serrano Jan , Paiva Christopher Fernandes , Dong Fanglong , Wong David , Neeki Michael 
Published: July 2020

Background:
Hospital-acquired pressure injuries are a chronic phenomenon in health care, and their prevention is an ongoing challenge. This study aims to investigate whether the application of a silicone-bordered multilayered foam dressing during the initial trauma resuscitation reduces sacral hospital-acquired pressure injury occurrence in trauma patients.

Methods:
This is a single-center quality improvement study using a nonequivalent control group posttest-only design to study the effect of silicone-bordered multilayered foam dressing on the incidence of hospital-acquired pressure injuries. The study population included admitted, highest tier trauma activations, age 18 years and older. Preimplementation 2014 data were compared with postimplementation 2018 data.

Results:
The result showed no statistically significant reduction in hospital-acquired pressure injury occurrence between the control and intervention groups. Incident rates for sacral hospital-acquired pressure injuries were 0.23% (2014) compared with 0.21% (2018). No statistically significant difference was found in the hospital and intensive care lengths of stay or injury severity. Preventive dressing costs were $7,689 annually compared with the estimated treatment costs of $70,000 per hospital-acquired pressure injury.

Conclusion:
Although this study's hospital-acquired pressure injury reduction rate was not significant, the inclusion of multidisciplinary team members in the quality improvement project led to the cultural hardwiring of hospital-acquired pressure injury prevention among all team members beyond that of just nursing.
Virtual Quality Control in Middle Ear Surgery: Is Image-guided Tympanoscopy a Valuable Tool for Depicting Borderline Situations?
Authors: Jakob Till F. , Zaoui Karim , Kromeier Jan , Baumann Tobias , Becker Christoph , Lasurashvili Nikoloz , Neudert Marcus , Beleites Thomas , Offergeld Christian 
Published: July 2020

Hypothesis:
Before modern imaging was introduced, revision surgery was the only way to evaluate possible reasons for inadequate improvement in hearing after ossicular replacement during reconstructive middle ear surgery.

Background:
The aim of this study was to evaluate freely navigable virtual tympanoscopy using different computed tomographic modalities. We compared cone-beam computed tomography (CBCT), flat panel computed tomography (FPCT), and conventional computed tomography in helical mode (CTH), volume mode (CTV), and ultra high resolution mode (CTD).

Methods:
Four temporal bone specimens were reconstructed with partial or total ossicular replacement prostheses. The best functional results for prosthetic coupling were achieved under the control of laser Doppler vibrometry (LDV). Afterward, a progressive step-by-step decoupling of the prostheses was carried out. Different prosthesis positions were evaluated by LDV as well as different computed tomographic modalities with 3D reconstruction of each dataset.

Results:
Anatomical structures were better depicted and the best position and coupling of inserted prostheses were achieved using CBCT. All imaging techniques could be used to control the position of middle ear prostheses, but CBCT provided the highest resolution and the best image quality in both 2D and 3D reformations and in 3D-animated video representation.

Conclusion:
Compared with several other imaging modalities, CBCT was best at depicting miscellaneous coupling problems. Noninvasive detection of coupling problems caused by minimal loss of contact between prostheses and middle ear ossicles will influence the clinical outcome. This early detection will help to determine whether revision surgery is needed.
Risk Factors and Management of Postoperative Infection Following Cochlear Implantation
Authors: Nisenbaum Eric J. , Roland J. Thomas , Waltzman Susan , Friedmann David R. 
Published: July 2020

Objective:
To determine factors associated with infection, management, and resultant outcomes following pediatric cochlear implantation.

Study Design:
Retrospective cohort study with nested case series.

Setting:
Tertiary academic medical center.

Patients:
Children who underwent either unilateral or bilateral cochlear implantation between June 2011 and September 2016 and were under the age of 18 at the time of surgery.

Intervention(s):
Subjects were compared based on age, cochlea malformation, revision surgery, operative time, device manufacturer, and antibiotic use. Infections were compared based on location, time, bacteria, management, and resolution.

Main Outcome Measure(s):
Rate of infection, rate of device explantation.

Results:
There were 16 infections among 246 surgeries, an infection rate of 6.5%. There was a significant age difference between infected and noninfected patients overall (n = 246, 1.4 versus 4.3 years, p = 0.005), but not within the cohort of patients five or younger (n = 172, 1.4 versus 1.8 years, p = 0.363). The most common infectious complication was skin infection, followed by device infection. No cases of meningitis were seen. The most common organism was S Aureus. The implant was salvaged in 9 of 16 patients (56.3%), with higher rates in patients treated with IV versus oral antibiotics (70 versus 40%).

Conclusions:
Postoperative infection is positively associated with younger age overall, but not in patients below the age of 5. With modern devices and surgical practices, risk of meningitis—though a concern—may be lower than cited in the literature. Prompt and aggressive therapy with IV antibiotics and operative intervention can allow for high rates of device salvage.
Balloon Eustachian Tuboplasty (BET) in Children: A Retrospective Multicenter Analysis
Authors: Tisch Matthias , Maier Susanne , Preyer Serena , Kourtidis Savvas , Lehnerdt Goetz , Winterhoff Sebastian , Dalchow Carsten V. , Mueller-Jenckel Friederike , Sudhoff Holger H. , Schröder Stefanie , Koitschev Assen , Amrhein Peter , Bruchhage Karl-Ludwig , Leichtle Anke , Güldner Christian , Grulich-Henn Juergen , Jensen Katrin , Pohl Moritz , Plinkert Peter K. , Euteneuer Sara 
Published: July 2020

Objective:
Generation of pilot data for planning of prospective BET-studies for treatment of dilatory Eustachian tube (ET) dysfunction in children.

Study Design:
Retrospective multicenter analysis.

Setting:
Nine ENT departments at tertiary care teaching hospitals.

Patients:
4–12-year-old children with chronic otitis media with effusion (COME) for more than 3 months or more than 3 episodes of acute otitis media during the last year, having failed standard surgical therapy at least once.

Intervention:
BET with or without paracentesis, ventilation tube insertion, or tympanoplasty.

Main outcome measures:
Tympanic membrane appearance, tympanometry, and hearing threshold.

Results:
Two hundred ninety-nine ETs of 167 children were treated. Mean age was 9.1 years (95% confidence interval [95% CI]: 8.7–9.4 yr). In 249 ears (83.3%), COME and/or retraction of the tympanic membrane were the indication for BET. Median hearing threshold was 20 dB HL (95% CI: 0–46 dB). One hundred fifty-five ears (51.8%, 95% CI: 46.1–57.4%) showed a tympanogram type B. Treatment consisted of BET without other interventions (“BET–only”) in 70 children, 128 ears. Median length of follow-up for 158 (94.6%) children was 2.6 months (95% CI: 0.3–16.1 mo). After treatment, the tympanic membrane appeared normal in 196 ears (65.6%, 95% CI: 60.0–70.8%, p < 0.001). Median hearing threshold improved to 10 dB HL (95% CI: 0–45 dB, p < 0.001). Tympanograms shifted toward type A and C (type A: 39.1%, 95% CI: 33.7–44.7, p < 0.001). These improvements were also observed in subgroup analyses of “BET-only” treatment and the indication of “COME” respectively.

Conclusion:
BET is improving a variety of dilatory ET dysfunction-related ear diseases in children. This study provides detailed data for design and planning of prospective studies on BET in children.
Leukocyte Rho kinase activity and serum cystatin C affect cardiovascular events in acute coronary syndrome
Authors: Ma Li , Dai Wenqin , Lin Yongbo , Zhang Zhongyuan , Pan Yunhong , Han Hongyan , Jia Haizhen , Peng Jun , Zhao Jinhe , Xu Liang 
Published: July 2020

AbstractObjective:This study was designed to investigate the effects of leukocyte Rho kinase activity and serum Cystatin C (Cys C) on cardiovascular events in patients with acute coronary syndrome (ACS).Methods:A total of 48 patients with ST-segment elevation myocardial infarction (STEMI), 23 patients with non-ST-segment elevation myocardial infarction (NSTEMI), 25 patients with unstable angina (UA) and 20 patients with no-acute coronary syndrome as control from January 2017 to June 2018 in Tianyou Hospital affiliated to Wuhan University of Science and Technology were selected in this study. Western blot was used to detect the leukocyte Rho kinase activity and Elisa kit was used to measure serum Cys C. Univariate and multivariate analysis were used to analyze the influencing factors of cardiovascular events in ACS patients.Results:The activity of leukocyte Rho kinase and serum Cys C were gradually reduced in the STEMI, NSTEMI and UA patients, but all significantly higher than that in No-ASC patients, and there was a positive correlation between leukocyte Rho kinase activity and serum Cys C in ACS patients (r = 0.516,P < .001). The activity of leukocyte Rho kinase was positively correlated with the levels of serum TNF-α (r = 0.634,P < .001), IL-6 (r = 0.578,P < .001), IL-8 (r = 0.582,P < .001) in ACS patients, and the level of Cys C was positively correlated with the levels of serum TNF-α (r = 0.634,P < .001), IL-6 (r = 0.578,P < .001), IL-8 (r = 0.582,P < .001) in ACS patients. Univariate and multivariate analysis showed that the leukocyte Rho kinase activity (HR = 2.994, 95%CI = 1.328–6.054,P < .0001) and the levels of serum Cys C (HR = 1.692, 95%CI = 1.028–2.124,P < .0001) were independent influencing factors of cardiovascular events in ACS patients.Conclusion:The leukocyte Rho kinase activity and serum Cystatin C are high in acute coronary syndrome patients, and are the independent influencing factors of cardiovascular events in ACS patients.
A case of mammary analogue secretory carcinoma of the parotid gland
Authors: Kim Seong Hwan , Hong Min Eui , Lee Dong Jin 
Published: July 2020

Abstract

Rationale:
Mammary analogue secretory carcinoma is a low grade salivary gland malignancy, first described by Skalova et al in 2010. The histological, immunohistochemical, and molecular characteristics of this tumor resemble those of secretory carcinoma of the breast.

Patient concerns:
A 40-year-old male patient without any specific past history came with complaints of 4 cm-sized hard, fixed, right infra-auricular mass without tenderness. There was no enlarged or enhancing lymph node in both neck.

Diagnoses:
Fine needle aspiration biopsy was done for right parotid mass and pathologic report was ”lymphocytes only” that suggested benign or low-grade malignant parotid tumor.

Interventions:
Partial parotidectomy including mass excision was performed. Operative finding showed hard bluish mass located in deep lobe of right parotid gland.

Outcomes:
Final pathologic report revealed secretory carcinoma of parotid gland. Homogenous eosinophilic secretions were identified inside microcystic structure. The immunophenotype was positive for epithelial membrane antigen, vimentin, S-100 protein. After 15 months of the surgery, the patient showed negative evidence of disease state.

Lessons:
We present here a case of mammary analogue secretory carcinoma of the parotid gland to help further characterize this rare tumor.
Downregulation of serum survivin correlates with increased inflammation, enhanced disease severity and worse prognosis in sepsis patients
Authors: Zhang Yanmin , Feng Qiang , Zhou Shaoying , Chen Huimin 
Published: July 2020

Abstract
This study aimed to determine the role of survivin in sepsis patients.
Serum samples of 288 sepsis patients and 290 healthy individuals (as healthy controls) were collected 24 hours within enrollment. Serum survivin and inflammatory cytokines were detected by enzyme-linked immunosorbent assay, and biochemical indexes were recorded. In sepsis patients, acute pathologic and chronic health evaluation II score and sequential organ failure assessment score were evaluated, and 28-day mortality was recorded.
Survivin was greatly decreased in sepsis patients compared to healthy controls (P < .001) and it predicted decreased sepsis risk (area under curve (AUC): 0.921, 95% confidence interval (CI): 0.900–0.942). For clinical characteristics of sepsis patients, survivin was negatively correlated with acute pathologic and chronic health evaluation II score (P < .001), score and sequential organ failure assessment score (P < .001), serum creatinine (P < .001), white blood cell (P = .037), C-reactive protein (P < .001), tumor necrosis factor-α (P < .001), interleukin (IL)-1β (P < .001), IL-6 (P < .001), and IL-8 (P < .001), while positively correlated with albumin (P < .001). For prognosis of sepsis patients, survivin was decreased in deaths compared to survivors (P < .001), and it predicted decreased death risk (AUC: 0.625, 95% CI: 0.558–0.692). Meanwhile, accumulating mortality was decreased in survivin high patients compared to survivin low patients (P = .006). However, multivariate logistic regression revealed survivin was not an independent predictive factor for 28-day mortality, indicating it might interact with other independent factors to affect prognosis of sepsis patients.
Survivin was decreased in sepsis patients and predicted decreased sepsis risk. Meanwhile, survivin was correlated with declined inflammation, reduced disease severity, and favorable prognosis in sepsis patients.
Segmental zoster paresis of unilateral upper extremity
Authors: Chen Guan-Bo , Tuan Sheng-Hui , Liou I-Hsiu , Huang Hung-Ya , Hu Ya-Chun , Wu Shin-Yi 
Published: July 2020

Abstract

Rationale:
Segmental zoster paresis (SZP) is a relatively rare neurologic complication of herpes zoster (HZ), and is characterized by focal asymmetric motor weakness in the myotome that corresponds to skin lesions of the dermatome. The upper extremities are the second most commonly involved regions after the face, and predominantly involve proximal muscles. The pathogenesis of SZP remains unclear; however, most of the reports indicate that it is the inflammation because of the spread of the herpes virus.

Patient concerns:
A 72-year-old man without trauma history of the left shoulder joint developed weakness of the left proximal upper extremity 10 days after vesicular eruption of HZ.

Diagnoses:
His left shoulder girdle paresis was diagnosed with the upper truncus of the brachial plexus as a HZ complication according to a series of tests, including cervical magnetic resonance imaging (MRI), cerebral fluid analysis, sonography, and electrophysiological studies.

Interventions:
Acyclovir and prednisolone were administered during hospitalization to treat SZP. Meanwhile, analgesics and gabapentin were administered to control the patient's neuralgic pain. He also received inpatient (daily) and outpatient (3 times per week) physical therapy along with range of motion and strengthening exercises.

Outcomes:
Partial improvement of the strength of the left shoulder girdle, and no improvement of the left deltoid muscle was observed 2 months after the interventions.

Lessons:
This case emphasizes that HZ infections may be complicated by segmental paresis and they should be considered in the differential diagnosis of acute paresis in the upper limb. Awareness of this disorder is important because it avoids unnecessary invasive investigations and interventions, leading to suitable treatments with favorable prognosis.
A meta-analysis: Internet mindfulness-based interventions for stress management in the general population
Authors: Zhang Yun , Xue Jiaming , Huang Ying 
Published: July 2020

Abstract

Background:
Psychological stress was an important mental health problem among the general population and warrant research to inform strategies for effective prevention. iMBIs provide a possibility to offer easily accessible, efficacious, convenient, and low-cost interventions on a wide scale. However, the efficacy of iMBIs in the general population remains unclear. The aim of this meta-analysis is to evaluate the effects of iMBIs for stress reduction in the general population.

Methods:
A systematic search in PubMed, Embase, Web of Science, Medline, Cochrane Library, CNKI, and Wanfang Data databases was performed up to April 10, 2019. The overall effect sizes of the iMBIs on stress, depression, anxiety, and mindfulness were recorded by the metric of Hedges’ g with 95% confidence interval (CI), Z-value, and P value.

Results:
Sixteen eligible studies were included in the meta-analysis. The overall results indicated that iMBIs had small to moderate effects on stress (Hedges’ g = −0.393) and mindfulness (Hedges’ g = −0.316) compared with the control group. Results from subgroup analyses revealed that the type of sample and delivery mode had a greater impact on heterogeneity across the studies. Meta-regression found that the overall effect might be moderated by guidance for iMBIs.

Conclusion:
The present meta-analysis suggested that iMBIs had small to moderate effects in reducing stress and improving mindfulness of the general population in comparison with the control group. Future research is needed to explore how iMBIs are remolded to improve adherence and suit specific individuals.
Prospective study to optimize the health of patients with TIAS (transient ischemic attack) and stroke admitted to the Hamad General Hospital
Authors: Imam Yahia Z. , Mohamed Mouhand F.H. , Abdelmoneim Mohamed S. , Santos Mark , Alkhawad Nima , Salam Abdul , Amir Numan , Saqqur Maher , Muhammad Ahmad , Elsoutohy Ahmed , Kamran Saadat , Akhtar Naveed , Kiliyanni Abdul Salim , Own Ahmed , Deleu Dirk , Shuaib Ashfaq 
Published: July 2020

Abstract

Introduction:
Recurrent ischemic strokes (IS) make up to one-third of all strokes. Nine out of 10 strokes are due to modifiable risk factors. Thus, it seems that standard management strategies of modifiable risk factors are yet to improve. Hence, we planned a randomized controlled trial assessing nurses or pharmacists-led aggressive control of comorbidities and their prognostic impact on IS and transient ischemic attacks (TIA).

Methods/design:
Prospective study to optimize the health of patients with TIAs and stroke admitted to the Hamad General Hospital (PROMOTE HEALTH) is an assessor-blinded, open-label, randomized, two-arm, controlled trial. Eligible patients have IS or TIA, and an additional modifiable risk factor (Hypertension or dyslipidemia) attending the stroke ward or clinic at the Weill Cornell-affiliated Hamad General Hospital. Stroke specialists will offer the control group the currently practiced best risk factor management strategies. Whereas, in the intervention arm, with the assistance of a nurse and a pharmacist, we will make aggressive attempts to meet targets of defined risk factors. The primary outcomes are the mean difference in blood pressure (BP) and low-density lipoprotein. Whereas myocardial infarction, recurrent stroke events, and mortality serve as the study's secondary outcomes. We require 200 patients per study arm to achieve a power of 80% and an alpha level of <0.05. The Medical Research Center and the Institutional Review Board have approved the study, and it was prospectively registered in a trial registry.

Discussion:
A significant proportion of strokes are due to modifiable preventable risk factors. Despite having the right preventive strategies aimed at mitigating these risk factors, a sizeable proportion of strokes are due to recurring events. This prompted the medical community to evaluate aggressive means of addressing these risk factors. The nurse or pharmacist-led management of comorbidities has been proven to be of value in the management of diabetes and hypertension. It will be of value to demonstrate the effectiveness of utilizing this additional task force in aggressively managing IS or TIA patients with an overarching goal of improving their prognosis. If our intervention proves to be efficacious, this would have a substantial impact on the current stroke practices and guidelines. Additionally, it will invite further research in the area.

Clinical trial registration:
Clinicaltrials.gov NCT02868723, last updated on September 2018
Femoral nerve block vs adductor canal block after anterior cruciate ligament reconstruction under general anesthesia
Authors: Xue Qingpei , Jiang Wei , Wang Meng , Sui Jinkui , Wang Yiping 
Published: July 2020

Abstract

Background:
Femoral nerve block (FNB) is considered the preferred analgesia after anterior cruciate ligament reconstruction (ACLR), but leads to weakness in the quadriceps muscles. Adductor canal block (ACB) is a new sensory block technique that effectively relieves postoperative pain while preserving quadriceps strength. The purpose of our study was to compare the efficacy of FNB vs ACB for pain control after ACLR.

Methods:
This prospective, randomized, double-blind, controlled, superiority clinical trial was approved by the institutional review board in our university hospital. We enrolled 120 patients set to undergo ACLR in this randomized therapeutic trial. Sixty patients received FNB and the other 60 received ACB for postoperative pain control. All ACB and FNB were performed using ultrasound-guided single-shot procedures. The primary outcomes included maximum voluntary isovolumetric contraction and postoperative pain score. Secondary outcomes included total opioid consumption, length of hospital stay, complication, and satisfaction score.

Results:
This clinical trial might provide some insights to estimate and compare the safety and efficacy of ACB vs FNB following ACLR.

Trial registration:
This study protocol was registered in Research Registry (researchregistry5569).
Neiguan (PC6)-based acupuncture pretreatment for myocardial ischemia reperfusion injury
Authors: Yang Qiqi , Mao Huifang , Chen Xia , Zhang Yanji , Zhang Xiaolei , Liu Zhenzhen , Jiang Gongdao , Huang Wei 
Published: July 2020

AbstractBackground:Myocardial ischemia reperfusion injury (MIRI) is 1 of the leading causes of disability and mortality worldwide in the cardiovascular diseases. Acupuncture has been widely applied in the treatment and prevention of cardiovascular diseases in recent years. This systematic review protocol aims to provide the methods for evaluating the efficacy of Neiguan (PC6)-based acupuncture pretreatment in animal models of MIRI.Methods and analysis:The electronic databases of PubMed, Embase, Cochrane Library, as well as the Chinese databases such as China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, China Biology Medicine Database and WanFang Database will be searched from inception to November 2019. The outcome measures were myocardial infarct size, the level of ST-segment elevation, left ventricular ejection fraction, shortening fraction, arrhythmia score, cardiac enzymes, and cardiac troponin. Study inclusion, data extraction and quality assessment will be performed independently by 2 reviewers. RevMan 5.3 software will be used for the data synthesis and the quality of each study will be assessed independently by using the Collaborative Approach To Meta-Analysis And Review Of Animal Data From Experimental Studies checklist with minor modification.Results:This review will provide a high-quality synthesis of Neiguan (PC6)-based acupuncture pretreatment for MIRI in animal modelsConclusions:This systematic review will provide conclusive evidence for whether Neiguan (PC6)-based acupuncture pretreatment is an effective intervention in animal models of MIRI.Trial registration number:PROSPERO CRD42020175144.