Controversy exists about how much, if any, weight obese pregnant women should gain. While the revised Institute of Medicine guidelines on gestational weight gain (GWG) in 2009 recommended a weight ...gain of 5-9 kg for obese pregnant women, many studies suggested even gestational weight loss (GWL) for obese women.
A systematic review was conducted to summarize pregnancy outcomes in obese women with GWL compared to GWG within the 2009 Institute of Medicine guidelines (5-9 kg).
Five databases were searched from 1 January 2009 to 31 July 2014. The Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA Statement were followed. A modified version of the Newcastle-Ottawa scale was used to assess individual study quality. Small for gestational age (SGA), large for gestational age (LGA) and preterm birth were our primary outcomes.
Six cohort studies were included, none of which assessed preterm birth. Compared to GWG within the guidelines, women with GWL had higher odds of SGA <10th percentile (adjusted odds ratio AOR 1.76; 95% confidence interval CI 1.45-2.14) and SGA <3rd percentile (AOR 1.62; 95% CI 1.19-2.20) but lower odds of LGA >90th percentile (AOR 0.57; 95% CI 0.52-0.62). There was a trend towards a graded relationship between SGA <10th percentile and each of three obesity classes (I: AOR 1.73; 95% CI 1.53-1.97; II: AOR 1.63; 95% CI 1.44-1.85 and III: AOR 1.39; 95% CI 1.17-1.66, respectively).
Despite decreased odds of LGA, increased odds of SGA and a lack of information on preterm birth indicate that GWL should not be advocated in general for obese women.
To evaluate the effectiveness of antenatal corticosteroids compared with placebo or no treatment in neonates born before 24 weeks of gestation.
We searched MEDLINE, EMBASE, Cumulative Index to ...Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials databases from 1990 to March 13, 2015, and ClinicalTrials.gov.
Studies considered were published randomized or quasirandomized controlled trials and observational studies that compared outcomes between neonates who received or did not receive antenatal corticosteroids born before 24 weeks of gestation.
We performed duplicate independent assessment of the title and abstracts, full-text screening, inclusion of articles, and data abstraction. We performed meta-analyses using random-effects models and quality assessment with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. There were 17 observational studies, and our primary outcome, mortality to discharge in neonates receiving active intensive treatment, had a total of 3,626 neonates. The adjusted odds of mortality to discharge were reduced by 52% in the antenatal corticosteroid group compared with the control group (crude adjusted odds ratio OR 0.45, 95% confidence interval CI 0.36-0.56; adjusted OR 0.48, 95% CI 0.38-0.61; mortality to discharge 58.1% intervention compared with 71.8% control) with a "moderate" quality of evidence based on the GRADE system. There were no significant differences between the groups for severe morbidity.
The available data, all observational, show reduced odds of mortality to discharge in neonates born before 24 weeks of gestation who received antenatal corticosteroids and active intensive treatment. Antenatal corticosteroids should be considered for women at risk of imminent birth before 24 weeks of gestation who choose active postnatal resuscitation.
Risk of melanoma is increased with potentially worse outcomes after solid organ transplant.
To estimate the incidence, stage, and survival in transplant recipients with melanoma.
Population-based, ...retrospective, observational study using linked administrative databases. Adults receiving their first solid organ transplant from 1991 through 2012 were followed to December 2013.
We identified 51 transplant recipients with melanoma, 11 369 recipients without melanoma, and 255 matched patients with melanoma from the nontransplant population. Transplant recipients were at increased risk of melanoma (standardized incidence ratio, 2.29; 95% confidence interval CI, 2.07-2.49) and more likely to be diagnosed at stages II through IV (adjusted odds ratio, 4.29; 95% CI, 2.04-9.00) compared with the nontransplant population. Melanoma-specific mortality was increased in transplant recipients compared with the nontransplant population (adjusted hazard ratio, 1.93; 95% CI, 1.03-3.63). Among transplant recipients, all-cause mortality was increased after melanoma compared with those without melanoma (stage T1/T2: adjusted hazard ratio, 2.18; 95% CI, 1.13-4.21; T3/T4: adjusted hazard ratio, 4.07; 95% CI, 2.36-7.04; III/IV: adjusted hazard ratio, 7.92; 95% CI, 3.76-16.70).
The databases did not contain data on immunosuppressive drugs; ascertainment of melanoma metastasis relied on pathology reports.
Melanoma after solid organ transplant is more often diagnosed at a later stage and leads to increased mortality, even for early-stage tumors.
Thrombotic occlusion of central venous catheters (CVCs) is a common problem in newborns. There is no guideline that systematically addresses the diagnosis, management, and prevention of this ...complication. The objective of this review is to establish evidence-based guidance for the management of CVC-related thrombosis. A comprehensive search of the scientific literature was conducted from 1948 to 2012. Twenty-six articles fulfilling four criteria - humans, neonates aged below 28 days, CVC insertion, and English language - were included for analysis. The incidence of thrombosis was 9.2% (308/3332). Singly inserted umbilical venous catheters (UVCs) and peripherally inserted central catheters accounted for over 80% of all CVCs. Frequently reported thrombotic sites were the hepatic vein, right atrium, and inferior vena cava. Symptoms included distal swelling of affected areas and thrombocytopenia. Increased length of catheter stay, infusion of blood products and malpositioned UVCs were identified as risk factors. The commonest diagnostic investigations to confirm thrombosis were echocardiography and ultrasonography. Spontaneous resolution may occur in UVC-related thrombosis, but this warrants close monitoring. Thrombolysis with urokinase alone or combined with low-molecular-weight heparin might be effective and well tolerated as treatment strategies. Prophylactic heparin increases the duration of catheter usability (P < 0.005, 95% confidence interval 0.35-0.81), decreases catheter occlusion, but may not uniformly prevent thrombosis. CVL-related thrombosis is an underreported complication because events in the majority occur silently. Currently, solid evidence-based recommendations for diagnosis and treatment are not possible. Well designed prospective studies are urgently required to establish a concrete investigational approach to CVC-related thrombosis and to institute safe therapeutic modalities.
Abstract
We present our follow-up observations to search for an electromagnetic counterpart of the IceCube high-energy neutrino IceCube-170922A. Monitoring observations of a likely counterpart, ...TXS 0506+056, are also described. First, we quickly took optical and near-infrared images of seven flat-spectrum radio sources within the IceCube error region right after the neutrino detection and found a rapid flux decline of TXS 0506+056 in Kanata/HONIR J-band data. Motivated by this discovery, intensive follow-up observations of TXS 0506+056 were continuously performed, including our monitoring imaging observations, spectroscopic observations, and polarimetric observations in optical and near-infrared wavelengths. TXS 0506+056 showed a large-amplitude (∼1.0 mag) variability in a time scale of several days or longer, although no significant variability was detected in a time scale of a day or shorter. TXS 0506+056 also showed a bluer-when-brighter trend in optical and near-infrared wavelengths. Structure functions of the variabilities were examined and indicate that TXS 0506+056 is not a special blazar in terms of optical variability. Polarization measurement results of TXS 0506+056 are also discussed.
An early detection of impaired functional performance is critical to enhance symptom management for patients with chronic obstructive pulmonary disease (COPD). However, conventional functional ...measures based on walking assessments are often impractical for small clinics where the available space to administrate gait-based test is limited. This study examined the feasibility and effectiveness of an upper-extremity frailty meter (FM) in identifying digital measures of functional performance and assessing frailty in COPD patients.
Forty-eight patients with COPD (age = 68.8 ± 8.5 years, body mass index BMI = 28.7 ± 5.8 kg/m2) and 49 controls (age = 70.0 ± 3.0 years, BMI = 28.7 ± 6.1 kg/m2) were recruited. All participants performed a 20-s repetitive elbow flexion-extension test using a wrist-worn FM sensor. Functional performance was quantified by FM metrics, including speed (slowness), range of motion (rigidity), power (weakness), flexion and extension time (slowness), as well as speed and power reduction (exhaustion). Conventional functional measures, including timed-up-and-go test, gait and balance tests, and 5 repetition sit-to-stand test, were also performed.
Compared to controls, COPD patients exhibited deteriorated performances in all conventional functional assessments (d = 0.64-1.26, p < 0.010) and all FM metrics (d = 0.45-1.54, p < 0.050). FM metrics had significant agreements with conventional assessment tools (|r| = 0.35-0.55, p ≤ 0.001). FM metrics efficiently identified COPD patients with pre-frailty and frailty (d = 0.82-2.12, p < 0.050).
This study proposes the feasibility of using a 20-s repetitive elbow flexion-extension test and wrist-worn sensor-derived frailty metrics as an alternative and practical solution to evaluate functional performance in COPD patients. Its simplicity and low risk for test administration may also facilitate its application for remote patient monitoring. Furthermore, in settings where the administration of walking test is impractical, for example, when ventilator support is needed or space is limited, FM may be used as an alternative solution. Future studies are encouraged to use the FM to quantitatively monitor the progressive decline in functional performance and quantify outcomes of rehabilitation interventions.
Background
Treatment of Helicobacter pylori infection is often empiric; however, current guidelines for management of Helicobacter pylori infection advise against the use of standard triple therapy ...(clarithromycin, amoxicillin, and proton‐pump inhibitor) when clarithromycin resistance exceeds 20%. We developed and tested a new culture‐free assay to detect clarithromycin resistance‐conferring mutations to determine the prevalence of H. pylori clarithromycin resistance in patients from the United States Pacific Northwest.
Materials and Methods
Droplet digital PCR (ddPCR) was used to detect the H. pylori 23S rRNA gene, and resistance‐conferring mutations, in archived, formalin‐fixed, paraffin‐embedded (FFPE) gastric tissue and to retrospectively determine the prevalence of clarithromycin‐resistant H. pylori among 110 patients at an academic medical center in the Northwest United States between 2012 and 2014.
Results
Of 102 patients with the H. pylori 23S rRNA gene detected by the ddPCR assay, 45 (44%) had clarithromycin resistance mutations. Thirty‐three of the 45 patients with clarithromycin resistance mutations had a mix of wild‐type and resistance alleles. Prevalence of clarithromycin resistance mutations differed among racial groups and was highest among Asians, with mutations detected in 14 (67%) of the 21 patient samples.
Conclusions
The prevalence of clarithromycin resistance detected in this region exceeds 20%, indicating that standard triple therapy should not be the first‐line antibiotic treatment for H. pylori infection. Culture‐free assays for detecting clarithromycin resistance mutations can be performed on archived tissue samples and will aid in informing tailored treatment for effective H. pylori eradication.
Although most investigators would agree that including minority races in clinical trials is important, recruitment and retention may differ among these populations. The objective of this review was ...to perform an audit of phase III dermatologic therapy trials to determine representation for minority groups and to explore the possibility of racial allocation bias. In this review of 11 dermatology or general medicine journals in 2015-16, we did not find evidence of systemic racial allocation bias. We did however note variation in the proportion of minority races included in studies; whereas some trials had high success in recruiting minorities, many did not. Furthermore, most studies did not provide information on individual racial groups and rather presented an 'other' category. This supports findings from previous reviews of dermatologic therapy trials that suggest that most participants are white, race data are not included for many studies, and there is underrepresentation of some racial groups. We conclude that although there is no evidence of racial allocation bias in the previous two years, there remains a need for standardization in the reporting of racial groups and for increased participant diversity in dermatologic therapy trials.
Smoking cessation has been reported to be associated with high total gestational weight gain (GWG), which itself is a risk factor for adverse maternal-infant outcomes. Recent studies have criticized ...conventional single measures of GWG, since they may lead to biased results. Therefore, we aimed to compare patterns of GWG based on serial antenatal weight measurements between women who: never smoked, quit during pregnancy, continued to smoke.
Participants (N = 509) of our longitudinal study were recruited from seven antenatal clinics in Southwestern Ontario. Serial GWG measurements were abstracted from medical charts, while information on smoking status was obtained from a self-administered questionnaire at a median gestational age of 32 (27-37) weeks. GWG patterns were assessed by fitting piecewise mixed-effects models. First trimester weight gains and weekly rates for the last two trimesters were compared by smoking status.
During the first trimester, women who never smoked and those who quit during pregnancy gained on average 1.7 kg (95 % CI: 1.4-2.1) and 1.2 kg (0.3-2.1), respectively, whereas women who continued smoking gained more than twice as much (3.5 kg, 2.4-4.6). Weekly rate of gain in the second and third trimesters was highest in women who quit smoking (0.60 kg/week, 0.54-0.65), approximately 20 and 50 % higher than in women who never smoked and those who smoked during pregnancy, respectively.
In this longitudinal study to examine GWG by smoking status based on serial GWG measurements, we found that women who quit smoking experienced a rapid rate of gain during the last two trimesters, suggesting that this high-risk group may benefit from targeted interventions.
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