bluuebunny/crossref_metadata_2025 huggingface dataset:
The Upper Instrumented Vertebra Horizontalization
Authors: Wang Yu , Shi Benlong , Liu Zhen , Sun Xu , Qiao Jun , Wang Bin , Qiu Yong , Zhu Zezhang
Published: May 2020

Study Design.

A retrospective study.

Objective.

To determine the significance of postoperative upper instrumented vertebra (UIV) horizontalization on the evolution of proximal compensatory curve after hemivertebra resection and short fusion in young patients with lumbosacral hemivertebra (LSHV).

Summary of Background Data.

Postoperative compensatory curve progression (CCP) is an undesired complication in patients undergoing spinal fusion. Posterior-only hemivertebra resection and short fusion has gradually become a preferred treatment for young patients with LSHV. Postoperative UIV horizontalization might play an important role in the behavior of compensatory curve after surgery.

Methods.

This study reviewed a consecutive series of patients undergoing posterior-only LSHV resection and short fusion from August 2006 to June 2016. The radiographic parameters were measured at preoperation, immediately postoperation, and the last follow-up. Based on the immediately postoperative UIV tilt, patients were divided into horizontal group (UIV tilt < 5°) and inclined group (UIV tilt ≥5°). Postoperative CCP was defined as the Cobb angle of compensatory curve increased more than 10° than the immediately postoperative value.

Results.

Forty-eight patients (8.1 ± 3.4 yrs) were recruited. Seventeen patients with immediately postoperative UIV tilt more than or equal to 5° constituted the inclined group, while the other 31 patients were in horizontal group. The two groups had similar age, fusion levels, preoperative spinal curvatures, and sagittal profiles. Compared with horizontal group, patients in inclined group had greater CBD (20.7 ± 14.8 mm vs. 13.2 ± 9.9 mm, P = 0.041) and greater Cobb angle of compensatory curve (17.7 ± 8.2° vs. 9.1 ± 5.3°, P < 0.001) at the last follow-up. Thirteen patients of inclined group experienced postoperative CCP, which was more prevalent than that in horizontal group (76.5% vs. 9.7%, P < 0.001).

Conclusion.

Horizontalizing the UIV can reduce the risk of postoperative CCP in LSHV patients undergoing posterior-only hemivertebra resection and short fusion.

Level of Evidence: 3
Outcomes of Minimally Invasive versus Open Surgery for Intermediate to High-grade Spondylolisthesis
Authors: Lak Asad M. , Abunimer Abdullah M. , Rahimi Amina , Tafel Ian , Chi John , Lu Yi , Groff Michael , Zaidi Hasan A.
Published: May 2020

Study Design.

Retrospective cohort study.

Objective.

The primary objective of our study was to evaluate the surgical outcomes and complications of minimally invasive surgery (MIS) versus open surgery in the management of intermediate to high grade spondylolisthesis, and secondarily to compare the outcomes following MIS in-situ fusion versus MIS reduction and open in-situ fusion versus open reduction subgroups.

Summary of Background Data.

High-grade spondylolisthesis is a relatively rare spine pathology with unknown prevalence. The optimal management and long-term prognosis of high-grade spondylolisthesis remain controversial.

Methods.

A multicenter, retrospective cohort study of adult patients who were surgically treated for grade II or higher lumbar or lumbosacral spondylolisthesis from January 2008 until February 2019, was conducted.

Results.

A total of 57 patients were included in this study. Forty cases were treated with open surgery and 17 with MIS. Specifically, seven patients underwent MIS in-situ fusion, 11 patients open in-situ fusion, an additional 10 patients underwent MIS reduction, and 29 had open reduction. Patients who underwent open surgery had significantly better pain relief at short-term follow-up with no statistically significant difference in the rate of complications (25% vs. 35.2%, P = 0.44), as compared with MIS. The most common complications were related to instrumentation (17.7%), followed by neurological complications (14.5%), wound infection/dehiscence (6.5%), and post laminectomy syndrome (1.6%). The average follow-up time was 9.1 ± 6.2 months. In a subgroup comparison, the complication rate in the open in-situ fusion (36.3%) versus open reduction (20.6%) subgroup was non-significant (P = 0.42). However, complication rate in the MIS reduction group (55%) was significantly higher than MIS in-situ fusion (P = 0.03).

Conclusion.

MIS reduction is associated with a higher rate of complications in the management of grade II or higher lumbar or lumbosacral spondylolisthesis. The management of this complex pathology may be better addressed via traditional open surgery.

Level of Evidence: 3
Intra- and Post-Complications of Cervical Laminoplasty for the Treatment of Cervical Myelopathy
Authors: Mesregah Mohamed Kamal , Buchanan Ian A. , Formanek Blake , Wang Jeffrey C. , Buser Zorica
Published: May 2020

Study Design.

Retrospective database study.

Objective.

To assess the intra- and postoperative complications of cervical laminoplasty and to evaluate the effect of intraoperative neuromonitoring use on postoperative limb paralysis incidence.

Summary of Background Data.

Cervical laminoplasty is a known procedure for the management of cervical spondylotic myelopathy (CSM).

Methods.

This was a retrospective study of 532 patients with CSM who underwent cervical laminoplasty between 2007 and the first quarter of 2016 using the Humana subset of the PearlDiver Database. The database was queried using the relevant International Classification of Diseases (ICD-9 and ICD-10) codes for CSM and Current Procedural Terminology (CPT) codes for cervical laminoplasty. The intra- and postoperative incidence of surgical and medical complications and reoperations was then determined and was compared with a propensity score-matched cohort of patients who had posterior laminectomy and fusion (490 patients in each group), using multivariate logistic regression analysis.

Results.

Laminoplasty was associated with a lower incidence of dysphagia (odds ratio [OR] = 0.37, 95% confidence interval [CI] = 0.16–0.79; P = 0.014), 30-day readmission (OR = 0.51, 95% CI = 0.35–0.75; P < 0.001), urinary tract infection (OR = 0.58, 95% CI = 0.37–0.93; P = 0.023), and incision and drainage, exploration or evacuation (OR = 0.28, 95% CI = 0.08–0.79; P = 0.026). The use of intraoperative neuromonitoring was associated with a non-significant lower incidence of limb paralysis within 1 and 3 months postoperatively (OR = 0.52 and 0.51, 95% CI = 0.23–1.19 and 0.23–1.11; P = 0.119 and 0.091, respectively).

Conclusion.

Compared with posterior laminectomy and fusion, laminoplasty had lower rates of dysphagia, urinary tract infection, and 30-day readmission. The use of intraoperative neuromonitoring was associated with a lower risk of postoperative limb paralysis, but it did not achieve statistical significance.

Level of Evidence: 4
Tropomyosin receptor kinase inhibitors in the management of sarcomas
Authors: Wilding Christopher P. , Loong Herbert H. , Huang Paul H. , Jones Robin L.
Published: May 2020

Purpose of review

Genetic aberrations resulting in tropomyosin receptor kinase (TRK) fusion proteins can drive oncogenesis and are postulated to occur in up to 1% of solid tumours. However, TRK fusions in adult sarcomas are rare and there is a significant challenge in identifying patients with sarcomas harbouring TRK fusions in the clinical setting. Despite a recent European Society of Medical Oncology consensus article regarding screening of tumours for TRK fusions, economical and practical limitations present a barrier to widespread screening of sarcomas.

Recent findings

Larotrectinib and entrectinib are pan-TRK inhibitors which have both received FDA approval for the management of solid tumours harbouring NTRK fusions. Initial results of a number of clinical trials have demonstrated promising efficacy and safety data, including dramatic and durable responses in patients with sarcomas. As such, TRK inhibitors represent a promising treatment option in a small cohort of adult sarcoma patients, where currently treatment options are limited. The emergence of acquired resistance is a concern associated with TRK inhibitor therapy and a number of second-generation agents targeting TRK kinase mutations driving acquired resistance have entered early-phase clinical trials.

With the growing appreciation of the implications of TRK fusions, this review will summarize the emerging clinical trial data of TRK inhibitors in sarcomas. Although in their infancy, clinical trial results are encouraging, and as further results and analyses are released, we will have a greater understanding of their impact on clinical practice and the management of patients with sarcomas.
Recent developments and advances in secondary prevention of lung cancer
Authors: Rizzo Stefania , Del Grande Filippo , Wannesson Luciano , Froesch Patrizia , Giannetto Giuliana , Petrella Francesco
Published: May 2020

Lung cancer prevention may include primary prevention strategies, such as corrections of working conditions and life style – primarily smoking cessation – as well as secondary prevention strategies, aiming at early detection that allows better survival rates and limited resections. This review summarizes recent developments and advances in secondary prevention, focusing on recent technological tools for an effective early diagnosis.
Clinical efficacy of the modified Helicobacter pylori eradication therapy for Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma: a meta analysis
Authors: Xie Ya-Lin , He Chun-Yan , Wei Si-Qi , Guan Wen-Ju , Jiang Zheng
Published: May 2020

Background

Helicobacter pylori(HP) has been considered to be one of the primary causes of gastric mucosa-associated lymphoid tissue (MALT) lymphoma since 1993. Low-grade gastric MALT lymphoma with HP is widely treated with HP eradication therapy, according to each specific clinical situation. However, several studies and guidelines indicate that the modified HP eradication therapy is also valid for HP-negative gastric MALT lymphoma. The aim of this study was to perform a meta-analysis of the clinical efficacy of the modified HP eradication therapy for gastric MALT lymphoma without HP.

Methods

We searched studies that reported the response rate of the modified HP eradication therapy regimen for gastric MALT lymphoma without HP by using PubMed, Medline, and Ebsco from January 1971 until February 2019. All statistical analyses were carried out using R 3.5.3 (Mathsoft Company, Cambridge, MA, USA). The pooled response rate was expressed as a decimal. The heterogeneity test was performed using theI-squared (I2) statistic.

Results

A total of 14 studies were selected with a total of 148 patients with HP-negative gastric MALT lymphoma. The overall pooled response rate was 0.38 (95% confidence interval [CI]: 0.29–0.47). The combined estimate isI2 = 57% (P < 0.01). The study subjects were categorized by factors (area of patients). The pooled response rate of the sub-groups (Korea, Japan, China, and Western countries) was 0.63 (95% CI: 0.50–0.76), 0.16 (95% CI: 0.05–0.30), 0.38 (95% CI: 0.20–0.55), and 0.57 (95% CI: 0.08–1.00). The response rate showed that the modified HP eradication therapy was effective for patients with HP-negative gastric MALT lymphoma, especially in Korea and Western countries.

Conclusion

Therefore, the modified HP eradication therapy can be considered an optional therapy for patients with low-grade HP-negative gastric MALT lymphoma. However, several limitations were revealed in the meta-analysis. Further systematic reviews and research are required.
What's in the Neuromuscular Junction Literature?
Authors: Lacomis David
Published: May 2020

Four retrospective studies from the United States, Europe, and Asia address outcomes in juvenile myasthenia gravis. Common features include earlier onset with ocular myasthenia gravis (MG) and generally good outcomes overall. Patients who were seronegative, had equivocal acetylcholine receptor (AChR) antibodies, or had only clustered AChR antibodies had better outcomes. An article highlighting the utility of median nerve slow-repetitive stimulation is reviewed and another showing the high sensitivity of repetitive nerve stimulation in myasthenic crisis is covered. Two articles address the thymus and thymectomy in non-AChR antibody-positive autoimmune MG. Longer term data on eculizumab as well as studies of cyclophosphamide, rituximab, and tacrolimus are summarized. Other topics include the possible role of statins in MG and central nervous system autoimmune comorbidities.
Infraglottic versus supraglottic jet-ventilation for endobronchial ultrasound-guided transbronchial needle aspiration
Authors: Anwar Maria , Fritze Robert , Base Eva , Wasserscheid Thomas , Wolfram Nadja , Koinig Herbert , Hackner Klaus , Lambers Christopher , Schweiger Thomas , Errhalt Peter , Hoda Mir A.
Published: May 2020

BACKGROUND

For endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) under general anaesthesia, both rigid bronchoscopy and laryngeal masks (LMAs) with superimposed high-frequency jet ventilation can be used. Despite the fact that in Europe rigid bronchoscopy for EBUS-TBNA is still widely used, an increasing number of centres use jet ventilation via the LMA for this procedure. To our knowledge no clinical trials have ever been made to compare these two methods. This trial aimed to evaluate whether patients recover from the procedure more quickly when a LMA is used for ventilation compared with rigid bronchoscopy where muscle relaxants and deep anaesthesia are required.

OBJECTIVES

We wanted to test the hypothesis that there is no difference in the postoperative recovery of patients in the postanaesthesia care unit (PACU) after EBUS-TBNA with jet ventilation via a rigid bronchoscope and a LMA. Secondary outcomes were the difference of duration of anaesthesia, the diagnostic outcome of the procedure and drug quantities for both groups.

DESIGN

Prospective randomised single blinded two centre controlled trial.

SETTING

Two centres in Austria participated. Patients were enrolled from December 2016 until January 2018.

PATIENTS

Ninety patients for elective EBUS-TBNA were enrolled and assigned to one of two intervention groups. Two patients were excluded before and eleven patients were excluded after EBUS-TBNA. Seventy-seven were analysed.

INTERVENTIONS

Patients assigned to group 1 were ventilated with a LMA; those assigned to group 2 were ventilated via a rigid bronchoscope. Vital signs, drug dosage, duration of anaesthesia, recovery, PACU stay and Aldrete score at the PACU were recorded.

MAIN OUTCOME MEASURES

The primary endpoint was an integral over time of a modified Aldrete score. Secondary endpoints were the durations of the interventions, the recovery from anaesthesia and PACU stay, initial and mean Aldrete values at PACU, the effect site concentration of Propofol according to the Schnider pharmacokinetic model, the peak ultiva rates and the diagnostic outcome.

RESULTS

We were not able to show any significant difference regarding the postoperative recovery criteria based on the Aldrete score, the durations measured and the diagnostic outcomes. Vital signs remained stable and in an equal range in both groups. There were no differences in the mean effect site propofol concentration and the peak ultiva rates.

CONCLUSION

EBUS-TBNA under general anaesthesia using a LMA with SHJV is equal to rigid bronchoscopy with superimposed high-frequency jet ventilation for the variables analysed.

TRIAL REGISTRATION

ISRCTN (ISRCTN58911367).
Gynecologic surgery tracking in obstetrics and gynecology residency
Authors: Siedhoff Matthew T. , Truong Mireille D. , Wright Kelly N.
Published: May 2020

Purpose of review

This review aims to describe the influence of changes in obstetrics and gynecology on residency training and how tracking may help address emerging concerns around quality and safety in gynecologic surgery.

Recent findings

As has been shown in a variety of other surgical fields, recent evidence confirms that surgeries with higher volume gynecologists are associated with fewer complications, decreased cost, and an increase in use of minimally invasive surgery. Attending physicians and residents feel graduating obstetrics and gynecology (OB/GYN) trainees are unprepared to perform major surgery independently. Tracking has demonstrated tremendous success in general surgery, enriching trainee careers, allowing for increased operative and clinical experiences, enhancing autonomy, and improving mentorship, all while achieving equivalent or improved milestone achievement, case numbers, and board certification. A majority of medical students, residents, and OB/GYN residency program directors support tracking in OB/GYN. Currently, a single OB/GYN program provides tracking in the United States, with measurable success similar to that seen in general surgery.

Enhanced surgical volume results in better outcomes in gynecologic surgery, but current training models are insufficient to meet these volume demands. Tracking provides an attractive solution to create a more appropriate practicing model for physicians in women's health.
Prelaminated Supraclavicular Island Flap for Total Ear Reconstruction: A New Technique
Authors: Alves Hélio R. N. , de Rodriguez Juan Felippe G. U. M. , Fernandes Thadeu R. R. , Busnardo Fábio F. , Besteiro Júlio M. , Cernea Cláudio Roberto , Gemperli Rolf
Published: May 2020

Major ear reconstruction has progressed over the past years with the emergence of new techniques directed mainly to patients without available or usable local skin. However, microsurgical transfer requires specific training and eligible patients. The authors report a successful ear reconstruction with a prelaminated supraclavicular island flap in 3 stages, which may be a valuable resource for selected patients or when microsurgery is not available. Advantages and disadvantages of this new technique are discussed, and a possible solution to achieve a more satisfactory result is suggested.
Risk Factors for Capsular Contracture: A Retrospective Study in Immediate Reconstruction versus Delayed Reconstruction
Authors: de Kerckhove Maiko , Iwahira Yoshiko
Published: May 2020

Background:

Capsular contracture is a common complication among breast implant reconstruction patients. The aim of this study was to assess the duration of and risk factors associated with capsular contracture by comparing 2 reconstruction methods.

Methods:

The medical charts of patients who received a reconstructed breast implant and underwent a capsule revision surgery were retrospectively reviewed. We examined patients’ background, skin expansion duration, time taken until capsule revision surgery, tissue expander/implant size, and postoperative complications.

Results:

Of the total 74 breasts [42 immediate reconstruction (Immediate) and 32 delayed reconstruction (Delayed) breasts], the age at the revision surgery was significantly older in the Delayed (59 years) than in the Immediate category (50 years; P = 0.002). The time taken until the capsule revision surgery was significantly shorter for the Immediate (63.5 months) than for the Delayed (121 months; P < 0.0001). The postoperative complication rate after expander insertion was significantly higher in the Immediate (62.5%) than in the Delayed (21.1%; P < 0.0001). The size of the expander and implant was significantly smaller in the Immediate (expander, 300 mL; implant, 240 mL) than in the Delayed (expander, 400 mL; implant, 300 mL) (expander, P = 0.008; implant, P = 0.004).

Conclusions:

The immediate reconstruction breasts had a shorter time to capsule revision surgery than the delayed reconstruction breasts. Our study suggested that the shorter time in immediate reconstruction was affected by postoperative complications after mastectomy with expander insertion and by selection of a smaller sized expander and implant.
Succession Planning in Healthcare: Myths, Realities, and Practical Advice
Authors: Schlichting Nancy M.
Published: May 2020

Succession planning appears to be a logical and essential component of human resources and leadership planning. However, the complexities and requirements of a successful succession planning process are significant and generally not well understood. Perhaps for this reason, succession planning often yields disappointing results. It is inherently an imperfect management process—as seen, for example, when an identified internal successor leaves an organization for a more immediate opportunity elsewhere. My experiences as CEO of Henry Ford Health System for 14 years and as chair of three compensation committees (for two public companies and one foundation) have given me a unique understanding of the challenges and opportunities of succession planning. This article highlights the myths, realities, and building blocks of effective succession planning in healthcare organizations.
What is the optimal blood pressure level for patients with atrial fibrillation treated with direct oral anticoagulants?
Authors: Minhas Jatinder S. , Coles Briana , Mistri Amit K. , Eveson David J. , Hussain Shazia T. , Potter John F. , Khunti Kamlesh , Robinson Thompson G.
Published: May 2020

Objective:

Limited data exist to inform blood pressure (BP) thresholds for patients with atrial fibrillation prescribed direct oral anticoagulants (DOAC) therapy in the real world setting.

Methods:

SBP was measured in 9051 primary care patients in England on DOACs for atrial fibrillation with postinitiation BP levels available within the Clinical Practice Research Datalink. The incidence rate for the primary outcome of the first recorded event (defined as a diagnosis of first stroke, recurrent stroke, myocardial infarction, symptomatic intracranial bleed, or significant gastrointestinal bleed) and of secondary outcomes all-cause mortality and cardiovascular mortality were calculated by postinitiation BP groups.

Results:

The Cox proportional hazard ratio of an event [crude and adjusted hazard ratio 1.04 (95% confidence interval (CI) 1.00–1.08), P = 0.077 and 0.071, respectively] did not differ significantly with a 10 mmHg increase in SBP. The hazard of all-cause mortality [crude hazard ratio 0.83 (95% CI 0.80–0.86), P = 0.000; adjusted hazard ratio 0.84 (95% CI 0.81–0.87), P = 0.000] and cardiovascular mortality [crude hazard ratio 0.92 (95% CI 0.85–0.99), P = 0.021; adjusted hazard ratio 0.93 (95% CI 0.86–1.00), P = 0.041] demonstrated a significant inverse relationship with a 10 mmHg increase in SBP. Patients with a SBP within 161–210 mmHg had the lowest all-cause death rate, while patients with SBP within 121–140 mmHg had the lowest cardiovascular death rate.

Conclusion:

SBP values below 161 mmHg are associated higher all-cause mortality, but lower event risk in patients with atrial fibrillation on DOAC therapy. The nadir SBP for lowest event rate was 120 mmHg, for lowest cardiovascular mortality was 130 mmHg and for lowest all-cause mortality was 160 mmHg. This demonstrates a need for a prospective interventional study of BP control after initiation of anticoagulation.
Results from 404 drug-induced sleep endoscopies with probability ramp control: lessons for pharmacokinetic design of DISE protocols
Authors: Mandel Jeff E. , Atkins Joshua H.
Published: May 2020

Introduction:

Drug-induced sleep endoscopy (DISE) employs a drug such as propofol to allow observation of airway collapse to predict success in surgical interventions for obstructive sleep apnea. A number of protocols have been published for the administration of propofol during DISE, but these protocols do not make use of pharmacokinetic modeling to estimate the propofol concentration at airway collapse and the probability distribution for this quantity. We hypothesized that this information could be used to improve the delivery of propofol during DISE.

Methods:

Deidentified data from 404 patients sedated with Probability Ramp Control was analyzed. The estimated effect site concentration at the time of airway collapse (ECac) was fit to a gamma distribution. Correlation between ECac and age/weight were performed using Spearman ρ. This probability distribution was utilized to assess the ability of a published protocol to produce airway collapse in a reasonable duration in a representative cohort of patients.

Results:

The parameters of the gamma distribution were a=8.3 (95% confidence interval, 7.2–9.5), b=0.58 (95% confidence interval, 0.51–0.67). The mean ECac was 4.8±1.7 µg/mL; 95% of ECac fell in the range 2.4–8.5 µg/mL. ECac was uncorrelated with age (ρ=−0.06, P=0.27) and weight (ρ=−0.11, P=0.03). The previously published protocol displayed variability across the cohort and failed to achieve effect site concentrations sufficient for the least sensitive patients in our cohort.

Conclusions:

Effect site propofol concentrations at the time of airway collapse during DISE span a wide range with a skewed distribution. The lack of correlation with either age or weight suggests that the pharmacokinetic model is sufficient for describing the effect of age and weight on propofol dosing. The impact of these factors on propofol dosing during DISE is examined, and workable solutions to this clinical challenge are proposed.
SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IMAGE COMPENSATION OF THE CHORIOCAPILLARIS INDUCES ARTIFACTS
Authors: Ledesma-Gil Gerardo , Fernandez-Avellaneda Pedro , Spaide Richard F.
Published: May 2020

Purpose:

To analyze swept-source optical coherence angiography slab images acquired at the default level for the choriocapillaris from the Zeiss PLEX Elite 9000 before and after using a previously described imaging compensation technique.

Methods:

Eyes of normal subjects, in their 20 seconds and 30 seconds, were evaluated. Angiographic slab images, 20 µm in thickness, were taken at the default location of 29 to 49 µm below the retinal pigment epithelium. These images were evaluated, as were images that underwent a published compensation technique that adjusts for light penetration to the sampled layer. Each set of images was threshold at 1 SD below the mean. Visual comparison of the swept-source optical coherence angiography images along with a quantitative analysis using a novel parameter known as multiscale structural similarity index, a measure of image similarity, was performed.

Results:

Eleven eyes of 11 subjects were evaluated. The default location, 29 µm to 49 µm below the retinal pigment epithelium, showed the granular choriocapillaris appearance. Visual comparison showed that the compensation technique altered the appearance of the thresholded images, creating the appearance of new deficits while causing others to disappear. The mean multiscale structural similarity index for the original versus thresholded images and original versus thresholded compensated was 0.49 and 0.34, respectively, representing a statistically significant difference.

Conclusion:

The findings of this study show that the use of a commonly used imaging compensation technique can have undesired effects on the image, and its use should be carefully considered. A model explaining the cause of such changes in the choriocapillaris swept-source optical coherence angiography images is presented.
Free-Floating DMEK in the Host Anterior Chamber: Surgical Management
Authors: Menassa Nardine , Pagano Luca , Gadhvi Kunal A. , Coco Giulia , Kaye Stephen B. , Levis Hannah J. , Romano Vito
Published: May 2020

Purpose:

To describe a method to visualize and manage a completely detached Descemet membrane endothelial keratoplasty (DMEK) tissue scroll in the anterior chamber.

Methods:

A 56-year-old male patient with pseudophakic bullous keratopathy, who underwent uncomplicated DMEK surgery, had a complete graft detachment diagnosed at 1-week follow-up. The graft was reattached using a new technique, that is, the free-floating graft was stained in the anterior chamber with trypan blue, immediately followed by air injection to separate the host stroma from the dye. The stained DMEK graft was opened by gentle tapping and attached to the host stroma by air tamponade.

Result:

This technique allowed sufficient staining of DMEK tissue to further evaluate and correct the graft orientation inside the anterior chamber without compromising the stroma. The DMEK graft was attached 1 week after the reattachment procedure. The cornea cleared confirming the functionality of the endothelial cells.

Conclusions:

The technique described may be useful in the cases of complete detachment of DMEK tissue and poor visualization of the DMEK tissue orientation. Staining with trypan blue under a “protective” air bubble can provide sufficient visualization to ensure the unfolding of DMEK tissue and reduce the risk of host stromal staining.
Pseudomonas aeruginosa Isolates From a Cohort of Mexican Children With Cystic Fibrosis Show Adaptation to a Chronic Phenotype
Authors: Rosales-Reyes Roberto , Rodríguez-Alvarado Marian , Lezana-Fernández José Luis , Sánchez-Lozano Joselin Yleana , Gayosso-Vázquez Catalina , Jarillo-Quijada Ma Dolores , Toledano-Tableros José Eduardo , Arredondo-Mercado Martha Jimena , Alcántar-Curiel María Dolores , Lincopan Nilton , Vidal Jorge E. , Lascurain Ricardo , Valvano Miguel A. , Santos-Preciado José Ignacio
Published: May 2020

Background:

Long-term persistence of Pseudomonas aeruginosa in the lung of individuals with cystic fibrosis (CF) is associated with progressive selection of diverse genotypes and phenotypes. This bacterial adaptation leads to chronic infection and increased morbidity and mortality. The aim of this study was to establish the prevalence, clonal relatedness, antimicrobial susceptibility and virulence-associated phenotypes of P. aeruginosa isolates in a cohort of 50 Mexican children with CF-associated chronic lung infection.

Methods:

Clonal relatedness of P. aeruginosa isolates was verified by pulsed-field gel electrophoresis. The antimicrobial susceptibility was determined by an automated system that performs bacterial identificación and antibiotic susceptibility testing (VITEK 2) and/or broth microdilution method. Biofilm formation was quantified with the crystal violet method; swarming motility was measured on soft agar, and susceptibility to normal human serum determined by reduction of colony formed units (CFUs).

Results:

High prevalence of P. aeruginosa colonization among Mexican children with CF was confirmed; 20% (10/49) of clones identified showed a multidrug-resistant phenotype and 8.2% (4/49) an extensive drug resistance phenotype; 26.5% (13/49) of the isolates were resistant to colistin, 42.9% (21/49) presented a phenotype of adaptation associated with chronic infection and 79.6% (39/49) showed increased ability to survive in normal human serum.

Conclusions:

This cohort of children with CF reveals that colonizing P. aeruginosa strains predominantly display resistance to several first-line antibiotics, although most isolates were susceptible to meropenem and tobramycin; 42.9% of isolates showed a phenotype consistent with adaptation to chronic lung infection.
Screening Algorithms to Reduce Burden of Pediatric HIV Testing
Authors: Clemens Sara L. , Macneal Kenneth D. , Alons Catharina L. , Cohn Jennifer E.
Published: May 2020

Background:

The accuracy of symptom screening to identify children eligible for further HIV testing in generalized epidemics has been examined in several studies. We performed a systematic review and meta-analysis of these studies.

Methods:

We screened 5 databases and abstracts from 4 HIV/AIDS conferences. Studies were included if they were performed in clinical settings, included children of 0–15 years old, and used a signs/symptoms screen to determine eligibility for HIV testing. The primary outcomes were sensitivity and specificity of the screening tools. A meta-analysis was performed to evaluate the utility of a screening tool in the outpatient setting.

Results:

Our search returned 5529 database results and approximately 6700 conference abstracts, of which 36 articles were reviewed and 7 met criteria for inclusion. All were prospective or cross-sectional studies that developed and/or validated a screening tool to identify children at higher risk for being HIV infected. Sensitivity of the screening tools ranged from 71% to 96%, whereas specificity ranged from 25% to 99%. Meta-analysis of studies evaluating outpatient screening tools revealed a sensitivity of 81.4%, with a specificity of 69.4% for detecting HIV infection.

Conclusions:

Few studies have evaluated the use of screening tools for HIV diagnosis in children. Screening tools that exist showed only moderate sensitivity and specificity and missed a substantial number of HIV-infected children in high-prevalence areas. In outpatient settings, the use of a screening tool may help reduce the number of HIV tests needed to identify an HIV-infected child, but at the cost of missed diagnoses. Further studies are needed to determine whether this represents a resource-saving mechanism.
A disintegrin and metalloproteinase domain 17-epidermal growth factor receptor signaling contributes to oral cancer pain
Authors: Scheff Nicole N. , Ye Yi , Conley Zachary R. , Quan Jen Wui , Lam Yat Vong Ronald , Klares Richard , Singh Kamalpreet , Schmidt Brian L. , Aouizerat Bradley E.
Published: May 2020

Cancer cells secrete pronociceptive mediators that sensitize adjacent sensory neurons and cause pain. Identification and characterization of these mediators could pinpoint novel targets for cancer pain treatment. In this study, we identified candidate genes in cancer cell lines that encode for secreted or cell surface proteins that may drive nociception. To undertake this work, we used an acute cancer pain mouse model, transcriptomic analysis of publicly available human tumor-derived cell line data, and a literature review. Cancer cell line supernatants were assigned a phenotype based on evoked nociceptive behavior in an acute cancer pain mouse model. We compared gene expression data from nociceptive and nonnociceptive cell lines. Our analyses revealed differentially expressed genes and pathways; many of the identified genes were not previously associated with cancer pain signaling. Epidermal growth factor receptor (EGFR) and disintegrin metalloprotease domain 17 (ADAM17) were identified as potential targets among the differentially expressed genes. We found that the nociceptive cell lines contained significantly more ADAM17 protein in the cell culture supernatant compared to nonnociceptive cell lines. Cytoplasmic EGFR was present in almost all (>90%) tongue primary afferent neurons in mice. Monoclonal antibody against EGFR, cetuximab, inhibited cell line supernatant-induced nociceptive behavior in an acute oral cancer pain mouse model. We infer from these data that ADAM17-EGFR signaling is involved in cancer mediator-induced nociception. The differentially expressed genes and their secreted protein products may serve as candidate therapeutic targets for oral cancer pain and warrant further evaluation.
Hemodialysis vascular access care during the COVID-19 pandemic
Authors: Yang Chih-Yu , Wang Yi-Fang , Ho Yang , Wu Cheng-Hsueh , Lee Chiu-Yang , Tarng Der-Cherng
Published: May 2020

Dialysis patients are more vulnerable and susceptible to the severe coronavirus disease 2019 (COVID-19) infection due to multiple comorbidities. Since Taiwan has the highest incidence and prevalence of treated end-stage kidney disease worldwide, it is crucial to act in advance to prevent a potential disaster. In the face of the COVID-19 pandemic, we implement proactive infection control measures to prevent it from spreading without sacrificing the dialysis care quality. In this article, we focused on hemodialysis vascular access (HVA) care in particular. As a life-line of hemodialysis (HD) patients, HVA care has a profound impact on the patient’s quality of dialysis and life. Specifically, in our facility, the working and office areas of the HD units are separated to reduce cross-infection. All elective procedures for HVA are postponed, and operating rooms equipped with a negative-pressure anteroom are used for the suspected or confirmed COVID-19 patients. Herein, we share how we modified our HVA care policy not only to prevent our patients from COVID-19 infection but also to maintain the quality of HVA care.
Cardiogenic shock: role of invasive cardiology
Authors: Feistritzer Hans-Josef , Thiele Holger , Desch Steffen
Published: May 2020

Purpose of review

Early revascularization significantly improved the outcome of patients with cardiogenic shock following acute myocardial infarction (AMI). Nevertheless, the mortality remains substantial, ranging between 40 and 50% after 30 days. The present review summarizes the current evidence regarding revascularization strategies, vascular access site and concomitant antiplatelet and antithrombotic treatment in infarct-related cardiogenic shock.

Recent findings

On the basis of the SHOCK trial, early revascularization is the most relevant procedure to improve the outcome of patients with infarct-related cardiogenic shock. The majority of these patients present with multivessel coronary disease. The randomized CULPRIT-SHOCK trial showed that in the emergency setting, percutaneous coronary intervention (PCI) should be confined to the culprit lesion. Regarding vascular access site, no data derived from randomized controlled trials in cardiogenic shock are available. Emergency coronary artery bypass grafting (CABG) is nowadays rarely performed in cardiogenic shock with rates less than 5% but is still a treatment option if coronary anatomy is not amenable to PCI. Regarding antiplatelet treatment, a randomized trial testing the intravenous P2Y12 inhibitor cangrelor versus an oral P2Y12 inhibitor in infarct-related cardiogenic shock is currently being performed.

Early revascularization is the cornerstone of treatment of infarct-related cardiogenic shock and should be confined to the culprit lesion in the emergency setting.
Propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients
Authors: Jeong Joonho , Jung Kyoungwon , Seo Kwang Il , Yun Byung Cheol , Han Byung Hoon , Lee Sang Uk , Moon Won
Published: May 2020

Background

This study was conducted to determine which type and dose of sedative drugs should be given to cirrhotic patients with compensation or decompensation during esophagogastroduodenoscopy (EGD) to prevent hepatic encephalopathy (HE) after sedation.

Methods

We reviewed the medical records of cirrhotic patients consecutively admitted to the hospital and conducted a number connection test (NCT) before and 2 h after EGD with moderate sedation. Sedation was performed using either propofol alone, midazolam alone, or combined propofol + midazolam.

Results

Sixty-seven patients were admitted for a screening EGD. The NCT before and after sedation were not significantly different in the propofol alone (pre-NCT = 47.3 ± 19.71 seconds vs. post-NCT = 49.4 ± 21.79 seconds, P = 0.6389). In the midazolam alone (pre-NCT = 50.3 ± 20.56 vs. post-NCT = 63.7 ± 33.17, P = 0.0021) and in the combined propofol + midazolam (pre-NCT = 47.4 ± 20.99 vs. post-NCT = 60.0 ± 30.79, P = 0.0002), NCT were significantly delayed. The propofol alone group received 52.3 ± 16.31 mg (0.82 ± 0.29 mg/kg). In 45 (67.2%) decompensated patients, only the propofol alone was not significantly different between pre-NCT (49.2 ± 22.92) and post-NCT (52.3 ± 24.90) (P = 0.4548). Serum sodium level was significantly correlated with delta-NCT (r = 0.3594, P = 0.0028).

Conclusion

Propofol alone could be the best sedation strategy for cirrhotic patients with compensation or decompensation without aggravation of covert or overt HE. Hyponatremia could be a risk factor for developing or worsening HE after EGD with sedation.
Low real-world eligibility rates for nonalcoholic steatohepatitis patients for phase 3 clinical trial criteria application in a large academic health system
Authors: Ilagan-Ying Ysabel C. , Xu Jin , Lim Joseph K. , Do Albert
Published: May 2020

Objective

Nonalcoholic steatohepatitis (NASH) is the most common liver disease in the USA. Clinical trials have stringent study criteria which may limit real-world generalizability. Thus, we studied whether a real-world, university-based cohort of patients could be eligible for a pivotal phase 3 NASH clinical trial.

Methods

We queried Yale-New Haven Health System electronic medical records for patients with a diagnosis of NASH from 2013 to 2017. Of those who received liver biopsy, we extracted demographic, clinical, laboratory, and biopsy data. We compared patient characteristics to enrollment criteria of the Randomized Global Phase 3 Study to Evaluate the Impact on NASH with Fibrosis of Obeticholic Acid Treatment.

Results

Of 14 403 patients with NASH, 478 (3.3%) completed liver biopsy, of whom 237 (49.6%) had histological confirmation by a gastrointestinal pathologist. Histologically-confirmed NASH patients were 51.1 ± 13.2 years old, 56.5% female, 69.6% white race, and 24.6% had cirrhosis. In this group, 68 (28.7%) patients met all inclusion criteria, 87 (36.7%) had no exclusions, and 34 (14.4%) met all enrollment criteria. Other than cirrhosis, common reasons for ineligibility were presence of medical comorbidity (n = 83) or laboratory abnormalities (n = 47). Multiple logistic regression did not reveal significant predictors of eligibility.

Conclusion

Within a university-based cohort of NASH patients, few met phase 3 clinical trial enrollment criteria, mostly due to low rates of liver biopsy. Of those with histologic confirmation, 14.4% met enrollment criteria. Validation of generalizability for safety and efficacy of NASH investigational agents in real-world populations is needed.
Circadian rhythms of mineral metabolism in chronic kidney disease–mineral bone disorder
Authors: Egstrand Søren , Olgaard Klaus , Lewin Ewa
Published: May 2020

Purpose of review

The circadian rhythms have a systemic impact on all aspects of physiology. Kidney diseases are associated with extremely high-cardiovascular mortality, related to chronic kidney disease–mineral bone disorder (CKD–MBD), involving bone, parathyroids and vascular calcification. Disruption of circadian rhythms may cause serious health problems, contributing to development of cardiovascular diseases, metabolic syndrome, cancer, organ fibrosis, osteopenia and aging. Evidence of disturbed circadian rhythms in CKD–MBD parameters and organs involved is emerging and will be discussed in this review.

Recent findings

Kidney injury induces unstable behavioral circadian rhythm. Potentially, uremic toxins may affect the master-pacemaker of circadian rhythm in hypothalamus. In CKD disturbances in the circadian rhythms of CKD–MBD plasma-parameters, activin A, fibroblast growth factor 23, parathyroid hormone, phosphate have been demonstrated. A molecular circadian clock is also expressed in peripheral tissues, involved in CKD–MBD; vasculature, parathyroids and bone. Expression of the core circadian clock genes in the different tissues is disrupted in CKD–MBD.

Disturbed circadian rhythms is a novel feature of CKD–MBD. There is a need to establish which specific input determines the phase of the local molecular clock and to characterize its regulation and deregulation in tissues involved in CKD–MBD. Finally, it is important to establish what are the implications for treatment including the potential applications for chronotherapy.
Simultaneous management of disordered phosphate and iron homeostasis to correct fibroblast growth factor 23 and associated outcomes in chronic kidney disease
Authors: Courbon Guillaume , Martinez-Calle Marta , David Valentin
Published: May 2020

Purpose of review

Hyperphosphatemia, iron deficiency, and anemia are powerful stimuli of fibroblast growth factor 23 (FGF23) production and are highly prevalent complications of chronic kidney disease (CKD). In this manuscript, we put in perspective the newest insights on FGF23 regulation by iron and phosphate and their effects on CKD progression and associated outcomes. We especially focus on new studies aiming to reduce FGF23 levels, and we present new data that suggest major benefits of combined corrections of iron, phosphate, and FGF23 in CKD.

Recent findings

New studies show that simultaneously correcting iron deficiency and hyperphosphatemia in CKD reduces the magnitude of FGF23 increase. Promising therapies using iron-based phosphate binders in CKD might mitigate cardiac and renal injury and improve survival.

New strategies to lower FGF23 have emerged, and we discuss their benefits and risks in the context of CKD. Novel clinical and preclinical studies highlight the effects of phosphate restriction and iron repletion on FGF23 regulation.
Utility of brain fluorodeoxyglucose PET in children with possible autoimmune encephalitis
Authors: Aydos Uğuray , Arhan Ebru , Akdemir Ümit Özgür , Akbaş Yilmaz , Aydin Kürşad , Atay Lütfiye Özlem , Serdaroğlu Ayşe
Published: May 2020

Purpose

We aimed to explore the utility and additional clinical contribution of brain fluorodeoxyglucose (FDG) PET imaging for the assessment of children with possible autoimmune encephalitis in comparison to brain MRI.

Materials and methods

We conducted a retrospective analysis of six pediatric patients (all seronegative) between 2014 and 2019 with the initial diagnosis of possible autoimmune encephalitis who had brain FDG PET/CT or PET/MRI and brain MRI during the diagnostic period. Diagnosis of possible autoimmune encephalitis was based on clinical consensus criteria defined by Graus et al. Brain FDG PET images were visually evaluated. Semiquantitative evaluation was also performed by using the statistical parametric mapping (SPM) method.

Results

Cerebrospinal fluid pleiocytosis and electroencephalography abnormality were present in all patients. Mean duration between the onset of symptoms and brain FDG PET imaging was 33 ± 16 days (range: 18–62 days). There were a total of eight brain FDG PET scans (six of PET/MRI and two of PET/CT). In two patients, FDG PET imaging was performed at diagnosis and follow-up. Initial FDG PET and SPM analysis findings were abnormal in all patients (100%), with four demonstrating only hypometabolism. Only a hypermetabolic pattern was seen in one patient, and mixed the hypohypermetabolic pattern was seen in one patient. All patients had metabolic abnormalities in temporal lobes. Additionally, visual and semiquantitative FDG PET findings revealed hypometabolism in extratemporal regions. Brain MRI was abnormal in two patients (33.3%) who had also FDG hypermetabolism in mesial temporal lobes.

Conclusions

Our findings support the usage of fluorine-18-FDG PET/computed tomography (CT)/MRI with quantitative analysis early in the diagnostic work-up of possible autoimmune encephalitis, particularly in those with normal or nonspecific MRI findings. However, it remains a purpose of further studies, if and to what extent FDG PET/CT or integrated FDG PET/MRI with quantitative analysis can improve the diagnostic workup of children with possible autoimmune encephalitis.
The effects of pharmacological interventions, exercise, and dietary supplements on extra-cardiac radioactivity in myocardial perfusion single-photon emission computed tomography imaging
Authors: Molavipordanjani Sajjad , Abedi Seyed Mohammad , Hosseinimehr Seyed Jalal , Fatahian Alireza , Mardanshahi Alireza
Published: May 2020

Myocardial perfusion imaging (MPI) as an imaging modality plays a key role in the monitoring of patients with cardiovascular disease. MPI enables the assessment of cardiovascular disease, the effectiveness of therapy, and viable myocardial tissue. However, MPI suffers from some downfalls and limitations, which can influence its clinical applications. These limitations can arise from the patient’s condition, equipment, or the actions of the technologist. In this review, we mainly focused on the different effective parameters on radioactivity uptake of organs including liver, intestines, stomach, and gall bladder and how they affect the quality of the acquired images in nuclear medicine. More importantly, we cover how different suggested medicines, foods and exercise alleviative this problem.