bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastroschisis Complicated by Colonic Atresia
Authors: Everett Hayley M. , Bhattacharya S. Dave 
Published: November 2021

Introduction: Gastroschisis with colonic atresia is a rare association. Due to its rarity and variation in presentation, no standardized surgical treatment option exists. Complicated gastroschisis is associated with a higher morbidity and mortality than intestinal atresia or gastroschisis alone. Methods: This is a case report of a neonate with congenital gastroschisis. On day of life 1, a silo was placed. On day of life 4, the upper portion of silo contents appeared more congested with dusky discoloration and the patient was oliguric. She was taken to the operating room for exploration. Results: The patient required resection of the terminal ileum and an atretic portion of the cecum due to necrosis. Four days later, primary closure of the gastroschisis defect was performed with creation of an end ileostomy. Elective ileostomy takedown was performed 5 months later. She returned to the operating room for anastomotic revision and gastrostomy tube placement for intestinal dysmotility and prolonged ileus. Tube feedings were discontinued 3 months post-operatively. Conclusions: Gastroschisis with intestinal atresia is associated with increased hospital length of stay, longer duration of parenteral nutrition, more severe intestinal dysfunction, increased surgical complications, and higher mortality than gastroschisis or intestinal atresia alone. With associated colonic atresia, loss of a significant length of bowel due to necrosis, including the ileocecal region, is almost unavoidable. An already compromised blood supply to the atretic bowel is further impaired by a tight abdominal wall defect and postnatal increases in gravitational force. Complicated gastroschisis remains a complex surgical challenge requiring further discussion.
Renoduodenal Fistula Following Penetrating Abdominal Injury
Authors: Hohenleitner Julien , Yu Yasong , Gore Amy , Traupman Frank , Jackson Maya , Kunac Anastasia 
Published: November 2021

Renoduodenal fistula is an uncommon occurrence and usually results as a complication of injury or inflammatory process. Here, we describe a case of renoduodenal fistula formation after traumatic injury via gunshot wound to the abdomen. The patient suffered right renal and ureteral injury, complicated by urine leak, managed by surgery, interventional radiology, and urology. His post-hospital course was complicated by recurrent urinary tract infections and was found to have a renoduodenal fistula 3 months after the initial operation. Patient underwent uncomplicated right nephrectomy and repair of fistula. Etiology, presentation, diagnosis, and treatment options of renoduodenal fistula are discussed.
Laparoscopic Colectomy for Acute Diverticulitis in the Urgent Setting is Associated with Similar Outcomes to Open
Authors: Hajirawala Luv N , Moreci Rebecca , Leonardi Claudia , Bevier-Rawls Elyse R , Orangio Guy R , Davis Kurt G , Barton Jeffrey S , Klinger Aaron L 
Published: November 2021

Purpose/Background The role of minimally invasive surgery (MIS) for the surgical treatment of diverticular disease is evolving. The aim of this study is to compare the outcomes of MIS colectomy to those of open surgery for patients with acute diverticulitis requiring urgent surgery. Methods The American college of Surgeons National Surgical Quality Improvement Project database was queried for all patients undergoing an urgent colectomy for acute diverticulitis between 2013 and 2018. The patients were then divided into 2 groups: MIS and open. Baseline characteristics and short-term outcomes were compared using univariable and multivariable regression analyses. Results/Outcomes 3487 patients were included in the analysis. Of these, 1272 (36.5%) underwent MIS colectomy and 2215 (63.5%) underwent open colectomy. Patients undergoing MIS colectomy were younger (58.7 vs 61.9 years) and less likely to be American Society of Anesthesiologists Classification (ASA) III (52.5 vs 57.9%) or IV (6.3 vs 10.5%). After adjusting for baseline differences, the odds of mortality for MIS and open groups were similar. While there was no difference in short-term complications between groups, the odds of developing an ileus were lower following MIS colectomy (OR .61, 95% CI: .49, .76). Both total length of stay (LOS) (12.3 vs 13.9 days) and post-operative LOS (7.6 days vs 9.5 days) were shorter for MIS colectomy. Minimally invasive surgery colectomy added an additional 40 minutes of operative time (202.2 vs 160.1 min). Conclusion/Discussion Minimally invasive surgery colectomy appears to be safe for patients requiring urgent surgical management for acute diverticulitis. Decreased incidence of ileus and shorter LOS may justify any additional operative time for MIS colectomy in suitable candidates.
Docking protein 1 and free fatty acids are associated with insulin resistance in patients with type 2 diabetes mellitus
Authors: Ha Xiaoqin , Cai Xiaoling , Cao Huizhe , Li Jie , Yang Bo , Jiang Ruru , Li Xin , Li Bin , Xin Yuan 
Published: November 2021

Objective Insulin resistance (IR) is a key defect in type 2 diabetes mellitus (T2DM); therefore, effective means of ameliorating IR are sought. Methods We performed a retrospective cohort study of 154 patients with T2DM and 39 with pre-diabetes (pre-DM). The effects of IR and a high concentration of FFA on gene expression were determined using microarray analysis and quantitative reverse transcription polymerase chain reaction (RT-qPCR) in patients with T2DM or pre-DM. Results Serum FFA concentration and homeostasis model assessment of IR (HOMA-IR) were significantly higher in patients with T2DM but no obesity and in those with pre-DM than in controls. HOMA-IR was significantly associated with T2DM. RT-qPCR showed that the expression of FBJ murine osteosarcoma viral oncogene homolog ( FOS) and AE binding protein 1 ( AEBP1) was much lower in the circulation of participants with obesity and diabetes. RT-qPCR showed that the expression of docking protein 1 ( DOK1) was significantly lower in the blood of participants with diabetes but no obesity and in those with pre-DM than in controls. Conclusions FFA and DOK1 are associated with IR in patients with T2DM but no obesity or pre-DM. The downregulation of DOK1 might inhibit lipid synthesis and induce lipolysis, inducing or worsening IR.
Hypertriglyceridemia Induced Pancreatitis: plasmapheresis or conservative management?
Authors: Dichtwald S. , Meyer A. , Zohar E. , Ifrach N. , Rotlevi G. , Fredman B. 
Published: November 2021

Introduction Hypertriglyceridemia-induced acute pancreatitis (HIAP) may result in severe morbidity and mortality. The most effective management strategy is unknown. While plasmapheresis is often performed, it is possible that a conservative approach which includes fasting, intravenous fluids and high-dose insulin, may be successful. Objectives To compare the 28 day mortality and morbidity parameters among patients admitted to the intensive care unit (ICU) due to HIAP when treated conservatively, as compared to patients who were treated with plasmapheresis. Materials and Methods A retrospective study was performed, including all patients at least 18 years of age who were admitted to the ICU between the years 2010 to 2020 with diagnosis of HIAP. Patients underwent plasmapheresis or were managed conservatively. Collected data included patient demographics, chronic illness and medications, hospital and ICU admission times, 28-day mortality, need for ventilation, number of ventilation days, need for inotropic support, daily triglyceride levels, APACHE II score, lactate on admission, need for dialysis, antibiotic treatment, surgical or percutaneous intervention. Results The study included 29 patients. Twenty two patients were treated conservatively and 7 patients with plasmapheresis. There were no significant statistical differences between the groups regarding demographic parameters, chronic disease and medications. Furthermore, on ICU admission and during the subsequent 4 days APACHE score, serum lactate and triglyceride levels were similar between the groups. There was no significant difference in mortality. However, plasmapheresis was associated with greater morbidity (longer admission times, need for ventilation and number of ventilation days, need for inotropic support and dialysis, and invasive surgical intervention). Finally, when compared to conservative management, the rate of serum triglyceride decrease was not improved following plasmapheresis. Conclusion Efficacy of conservative treatment in lowering the serum triglyceride level in HIAP is similar to plasmapheresis. Due to the small patient cohort further prospective studies are needed to confirm these findings.
Job Satisfaction Among Public Sector Doctors and Nurses in India
Authors: Purohit Bhaskar , Lal Sham , Banopadhyay Tathagata 
Published: November 2021

In most countries, the efforts to attract and retain health workers have been focused on extrinsic measures of motivation, with very less focus on a better understanding of job satisfaction—an important intrinsic factor and construct. The main aim of this study was to assess job satisfaction, its seven dimensions, and motivation among health service providers (doctors and nurses) employed within the public sector in India. The study was conducted in three districts representing two states in India. The study participants represent the doctors and nurses from public health and service delivery centres. Data were collected from a total of 307 healthcare providers (152 doctors and 157 nurses). ‘Measure job satisfaction’ tool was adapted that contained 41 items capturing seven dimensions of job satisfaction on a five-point Likert scale with a higher score indicating a higher level of job satisfaction and vice versa. In addition, one single statement was used to assess motivation. Average scores were calculated for each of the seven dimensions of job satisfaction, motivation and for overall job satisfaction. Parametric tests such as t-test and analysis of variance (ANOVA) were used for comparisons of job satisfaction scores according to the place of work, years of work experience, appointment type and health professional categories. The statistical analysis was carried out using SPSS version 22.0. Exploratory factor analysis was carried out to assess the relationship between job satisfaction and motivation and regression analysis of motivation was carried to assess predictors of job satisfaction, demographic and work-related factors’ effect on motivation. The average scores for most of the dimensions of job satisfaction were low for both doctors and nurses with the lowest scores reported for the dimensions of ‘professional support’ and ‘personal satisfaction’ while the highest score reported for ‘satisfaction with pay’. Significant results in the difference of mean scores were found for all seven dimensions of job satisfaction except for ‘prospects’ at different levels of place of work, ‘standard of care’ at different levels of length of service and ‘training’ for different levels of types of appointment. The mean scores of motivation were found to be significantly different for different levels of place of work and also between the doctors and nurses. The regression analysis of motivation on various predictors of job satisfaction suggests that personal satisfaction and satisfaction in prospect were highly significant while other variables such as gender and place of posting were marginally significant. Understanding of job satisfaction can provide useful insights to both extrinsic as well as intrinsic aspects of work motivation, which arguably is the most critical area of health systems research that could potentially feed into streamlined and improved health workforce management policies aimed at addressing the shortage and retention of the health workforce.
Pharmacological, Biochemical and Immunological Studies on Protective Effect of Mangiferin in 6-Hydroxydopamine (6-OHDA)-Induced Parkinson’s Disease in Rats
Authors: Tiwari Prafulla Chandra , Chaudhary Manju J. , Pal Rishi , Kartik Shipra , Nath Rajendra 
Published: November 2021

Background: Parkinson’s disease is a neurodegenerative disorder and is marked by inflammation and death of neurons in the striatum region of the midbrain. It has been reported that expression of NF-κB increases during Parkinson’s disease, which promotes oxidative stress, stimulates release of proinflammatory cytokines, and induces expression of nitric oxide. Therefore, in this study, we have used mangiferin a specific NF-κB inhibitor. Mangiferin is a polyphenolic compound traditionally used for its antioxidant and anti-inflammatory properties. Methods: The study utilized male Wistar rats weighing 200–250 g (56 rats; n = 8/group). On day “0,” stereotaxic surgery of rats was done to induce 6-hydroxydopamine lesioning in rats. Coordinates for substantia nigra were anteroposterior-2 mm, mediolateral-5 mm and dorsoventral-8.2 mm. After 14 days, those rats which show at least 210 contralateral rotations after administration of apomorphine (0.5 mg/kg S.C.) were selected for the study and were given treatment for 28 days. On day 28 of treatment, rats were subjected to behavioral studies to evaluate the effect of mangiferin and their brains were taken out after euthanasia to perform biochemical, molecular and immunological studies. Results: Treatment with mangiferin significantly improves the key parameters of locomotor activity and oxidative stress and reduces the parameters of inflammatory stress. Also, the activity of caspases was reduced. Significant decrease in activity of both cyclooxygenase 1 and 2 was also observed. Maximum improvement in all parameters was observed in rats treated with grouping of mangiferin 45 µg/kg and levodopa 10 mg/kg. Treatment with levodopa alone has no significant effect on biochemical and molecular parameters though it significantly improves behavioral parameters. Conclusion: Current treatment of Parkinson’s disease does not target progression of Parkinson’s disease. Results of this study suggest that mangiferin has protective effect in hemi-Parkinsonian rats. Therefore, the combination therapy of mangiferin and levodopa can be helpful in management of Parkinson’s disease.
Cleft Palate Repair in Robin Sequence following Mandibular Distraction Osteogenesis Compared to Tongue-Lip Adhesion
Authors: Kosyk Mychajlo S. , Carlson Anna R. , Zapatero Zachary D. , Kalmar Christopher L. , Swanson Jordan W. , Bartlett Scott P. , Taylor Jesse A. 
Published: November 2021

Objective To evaluate the timing and safety of cleft palate (CP) repair in patients with Robin sequence (RS) treated with mandibular distraction osteogenesis (MDO) or tongue-lip adhesion (TLA) for airway obstruction. Design Retrospective cohort study. Setting Tertiary Pediatric Hospital during 2004-2020. Patients 148 patients with RS underwent MDO, 66 met inclusion by having MDO and followed by palatoplasty. 26 patients with RS underwent TLA, 14 met inclusion by having TLA and followed by palatoplasty. Main Outcome Measures Patient characteristics, hospital/operative details, postoperative complications, and polysomnographic (PSG) data were compared. Results Groups were well-matched except more patients with syndromes underwent MDO (N = 27, 41%, P ≤ .002). In the MDO and TLA cohorts, mean CP repair age was 12.8 ± 1.9 months and 14.6 ± 1.6 months, respectively ( P ≤ .002). Despite the earlier CP repair in the MDO group, there were no differences in peri-operative complication rates after palatoplasty in either group. All sleep respiratory parameters improved after MDO/TLA prior to palatoplasty P ≤ .050. All PSG parameters remained significantly improved after palatoplasty compared to preoperative values, P ≤ .043. Obstructive apnea hypopnea index and Oxygen saturation nadir further improved after palatoplasty within the MDO group, P ≤ .050, while no changes in the TLA group, P ≥ .500. Conclusions MDO was associated with earlier age at palatoplasty than TLA with a similar perioperative risk profile. In those patients with pre- and post-palatoplasty PSG data, palatoplasty was not associated with a deterioration in PSG parameters, and in fact in the MDO group, PSG data improved.
Radioactive iodine dose and survival in cats with hyperthyroidism (2015–2020)
Authors: Chow Joyce LY , White Joanna 
Published: November 2021

Objectives Radioactive iodine (131I) is the preferred treatment for feline hyperthyroidism but neither the optimal 131I dose nor consistent predictors of post-treatment azotaemia have been determined. The aims of the study were to evaluate the relationships between: (1) 131I dose and survival; and (2) pretreatment and post-treatment serum creatinine concentration. Methods Medical records of hyperthyroid cats treated with 131I at a single referral hospital were reviewed. Information regarding signalment, body weight, pretreatment and post-treatment serum total thyroxine concentration (TT4), serum creatinine concentration, 131I dose and survival were determined. Multivariable Cox proportional hazards analysis was used to identify variables associated with survival. Multivariable linear regression analysis was used to identify variables associated with post-treatment serum creatinine concentration. Results One hundred and ninety-eight (79 male, 119 female) cats were treated for hyperthyroidism with 131I (median dose 138 MBq; interquartile range 92–168). Median survival time was 1153 days (range 16–1871). Post-treatment serum creatinine ( P <0.001) and age ( P = 0.049) were significantly associated with survival. Every 10 µmol/l increase in post-treatment serum creatinine concentration and every year increase in age was associated with a 1.07-fold (confidence interval [CI] 1.04–1.11) and 1.17-fold (CI 1.00–1.37) increase in the daily hazard of death, respectively. Pretreatment serum creatinine concentration was directly, and post-treatment serum TT4 concentration was inversely, associated with post-treatment serum creatinine concentration. Every 1 μmol/l increase in pretreatment serum creatinine concentration was associated with an increase in post-treatment serum creatinine concentration of 0.7 μmol/l (SE 0.17; P <0.001). Conversely, every 1 nmol/l decrease in post-treatment serum TT4 concentration was associated with a 1.2 μmol/l (SE 0.61; P <0.001) increase in post-treatment serum creatinine concentration. Conclusions and relevance Post-treatment serum TT4 concentration was associated with post-treatment azotaemia, which was associated with survival. Although 131I dose was not directly associated with survival, dosing strategies that minimise post-treatment hypothyroidism and azotaemia could improve patient survival.
Ultrasound-guided, long-axis, in-plane, infraclavicular axillary vein cannulation: A 6-year experience
Authors: Kosiński Sylweriusz , Podsiadło Paweł , Stachowicz Jakub , Mikiewicz Maciej , Serafinowicz Zofia , Łukasiewicz Katarzyna , Mendrala Konrad , Darocha Tomasz 
Published: November 2021

Background: Despite its potential advantages, ultrasound-guided cannulation of the axillary vein in the infraclavicular area is still rarely used as an alternative to other techniques. There are few large series demonstrating the safety and feasibility of this approach. Methods: Retrospective analysis of data on patients undergoing ultrasound-guided, long-axis, in-plane infraclavicular axillary vein cannulation for the incidence of complications and the failure rate from two secondary-care hospitals. Results: The analysis included 710 successful attempts of axillary vein long-axis, in-plane, US-guided cannulation, and 24 (3.3%) failed attempts. We recorded a 96.7% success rate with an overall incidence of complications of 13%, mainly malposition (8.1%). There was one case of pneumothorax (0.14%), five cases of arterial puncture (0.7%), and two cases of brachial plexus injury. Conclusions: The US-guided axillary central venous cannulation (CVC) access technique can be undertaken successfully in patients, even in challenging circumstances. Taken together with existing work on the utility and safety of this technique, we suggest that it should be adopted more widely in clinical practice.
Broadening the reach of dementia risk-reduction initiatives: strategies from dissemination models
Authors: Fair Hannah L. , Doherty Kathleen V. , Klekociuk Shannon Z. , Eccleston Claire E.A. , Farrow Maree A. 
Published: November 2021

Background: Modifiable risk factors for dementia account for 40% of cases worldwide and exert impacts on risk across the life course. To have maximal public health impact, dementia risk-reduction initiatives need to reach a large and diverse audience, including people from a wide range of ages and socioeconomic backgrounds. Currently, dementia risk-reduction interventions primarily reach a narrow audience, consisting largely of highly educated older adults from high income countries. Methods: In this commentary, we review established dissemination models to identify strategies that could be used to extend and broaden the reach of dementia risk-reduction initiatives. Three potential reach-broadening strategies can be identified from these models: engaging with distinct user groups; focusing on interpersonal communication; and utilising dissemination agents. Results: Engaging with distinct user groups and utilising dissemination agents show promise for broadening the reach of dementia risk-reduction initiatives, while interpersonal communication has received limited attention in this context. Further evaluation of the impact of interpersonal communication may provide avenues to take advantage of this dissemination method. Conclusions: Based on the reviewed models and data from current risk-reduction initiatives, we suggest that utilising all three of these strategies may most effectively broaden the reach of dementia risk-reduction initiatives. This may promote risk reduction among a larger and more diverse audience, more equitably reducing the global impact of dementia.