bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review
Authors: Sfakianaki Ioanna , Binos Paris , Karkos Petros , Dimas Grigorios G. , Psillas George
Published: September 2021

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.
First-Line Anaplastic Lymphoma Kinase (ALK) Inhibitors for ALK-Positive Lung Cancer in Asian Populations: Systematic Review and Network Meta-Analysis
Authors: Wu Kuan-Li , Chen Hsiao-Ling , Tsai Ying-Ming , Lee Tai-Huang , Chang Hsiu-Mei , Tsai Yu-Chen , Chuang Cheng-Hao , Chang Yong-Chieh , Tu Yu-Kang , Yang Chih-Jen , Hung Jen-Yu , Chong Inn-Wen
Published: September 2021

Various anaplastic lymphoma kinase inhibitors (ALKIs) have been approved for first-line use in treating anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC). To date, no head-to-head comparison of these newer generation ALKIs has been made, and different efficacies of ALKIs may present across ethnicity. This study aims to compare newer generation ALKIs for treatment efficacy in Asian groups using network meta-analysis. Phase II/III trials that enrolled treatment-naïve Asian ALK-rearranged NSCLC patients treated by ALKIs were included. Progression-free survival (PFS) and overall response rate (ORR) of each trial were extracted as indicators of drug efficacy. Surfaces under cumulative ranking curves (SUCRAs) were calculated as a numeric presentation of the overall ranking associated with each agent. After a systematic literature review, six phase III clinical trials were included. Our results showed that newer generation ALKIs, such as alectinib, brigatinib, ensartinib, and lorlatinib, all demonstrated superior efficacy to crizotinib. Among those, ensartinib exhibited the best overall SUCRA value and ranked first among all agents. According to our network meta-analysis, ensartinib may currently be the most effective first-line treatment for Asian patients with ALK-positive NSCLC. However, this conclusion needs further validation by a larger scale of clinical trials or posthoc analysis of Asian populations. Moreover, in our comparison, low-dose alectinib (300 mg twice daily) exhibited an efficacy profile similar to a higher dose regimen in Asian populations.
Current Knowledge on the Background, Pathophysiology and Treatment of Levodopa-Induced Dyskinesia—Literature Review
Authors: Hutny Michał , Hofman Jagoda , Klimkowicz-Mrowiec Aleksandra , Gorzkowska Agnieszka
Published: September 2021

Levodopa remains the primary drug for controlling motor symptoms in Parkinson’s disease through the whole course, but over time, complications develop in the form of dyskinesias, which gradually become more frequent and severe. These abnormal, involuntary, hyperkinetic movements are mainly characteristic of the ON phase and are triggered by excess exogenous levodopa. They may also occur during the OFF phase, or in both phases. Over the past 10 years, the issue of levodopa-induced dyskinesia has been the subject of research into both the substrate of this pathology and potential remedial strategies. The purpose of the present study was to review the results of recent research on the background and treatment of dyskinesia. To this end, databases were reviewed using a search strategy that included both relevant keywords related to the topic and appropriate filters to limit results to English language literature published since 2010. Based on the selected papers, the current state of knowledge on the morphological, functional, genetic and clinical features of levodopa-induced dyskinesia, as well as pharmacological, genetic treatment and other therapies such as deep brain stimulation, are described.
The Impact of Morbid Obesity on the Health Outcomes of Hospital Inpatients: An Observational Study
Authors: Fusco Kellie , Thompson Campbell , Woodman Richard , Horwood Chris , Hakendorf Paul , Sharma Yogesh
Published: September 2021

Morbid obesity poses a significant burden on the health-care system. This study determined whether morbid obesity leads to worse health-outcomes in hospitalised patients. This retrospective-study examined nutritional data of all inpatients aged 18–79 years, with a body-mass-index (BMI) ≥ 18.5 kg/m2 admitted over a period of 4 years at two major hospitals in Australia. Patients were divided into 3 groups for comparison: normal/overweight (BMI 18.5–29.9 kg/m2), obese (BMI 30–39.9 kg/m2) and morbidly-obese (BMI ≥ 40 kg/m2). Outcome measures included length-of-hospital-stay (LOS), in-hospital mortality, and 30-day readmissions. Multilevel-mixed-effects regression was used to compare clinical outcomes between the groups after adjustment for potential confounders. Of 16,579 patients, 1004 (6.1%) were classified as morbidly-obese. Morbidly-obese patients had a significantly longer median (IQR) LOS than normal/overweight patients (5 (2, 12) vs. 5 (2, 11) days, p value = 0.012) and obese-patients (5 (2, 12) vs. 5 (2, 10) days, p value = 0.036). After adjusted-analysis, morbidly-obese patients had a higher incidence of a longer LOS than normal/overweight patients (IRR 1.04; 95% CI 1.02–1.07; p value < 0.001) and obese-patients (IRR 1.13; 95% CI 1.11–1.16; p value < 0.001). Other clinical outcomes were similar between the different groups. Morbid obesity leads to a longer LOS in hospitalised patients but does not adversely affect other clinical outcomes.
Clinical Characteristics of Newborns Born to Mothers with COVID-19
Authors: Wróblewska-Seniuk Katarzyna , Basiukajć Agnieszka , Wojciechowska Dobrochna , Telge Mayanthi , Miechowicz Izabela , Mazela Jan
Published: September 2021

(1) Background: According to the literature, most outcomes of neonates born to mothers infected with SARS-CoV-2 are favorable. This study aimed to assess the clinical characteristics of newborns born to infected women in a tertiary center in Poznan, Poland. (2) Methods: The study comprised 101 newborns delivered by women infected with SARS-CoV-2. The control group consisted of 101 newborns born before the pandemic. Data were collected retrospectively from the medical records. (3) Results: Most newborns of SARS-CoV-2-positive mothers were delivered by cesarean section—83.17% vs. 40.59% in the control group (p < 0.05). The groups did not differ in Apgar scores and the need for resuscitation. Newborns of SARS-CoV-2-positive mothers were more likely to present with respiratory distress and require respiratory support. The most common diagnosis was transient tachypnea of the newborn, not correlated with the mode of delivery. Newborns of the study group were never exclusively breastfed, 0% vs. 64.36% (p < 0.05). None of the patients in the study group was tested positive for the virus. (4) Conclusions: Infants born to SARS-CoV-2-positive mothers seem to be more at risk of moderate respiratory failure than other newborns. Separation of mother–baby dyads results in a dramatic fall in breastfeeding in the short-term post-partum period.
Effects of 0.01% Atropine Instillation Assessed Using Swept-Source Anterior Segment Optical Coherence Tomography
Authors: Mitsukawa Tadahiro , Suzuki Yumi , Momota Yosuke , Suzuki Shun , Yamada Masakazu
Published: September 2021

In this paper, we assessed the short-term effects of 0.01% atropine eye drops on anterior segment parameters by performing ocular biometry using a swept-source anterior segment optical coherence tomography system (AS-OCT). We recruited 17 healthy volunteers (10 men and 7 women aged 24–35 years) with no history of eye disease. Participants without accommodative demand demonstrated significant mydriasis 1 h after the atropine instillation (4.58 ± 0.77 to 5.41 ± 0.83 mm). Pupil diameters with a 5 diopter (D) accommodative stimulus at 1 h (4.70 ± 1.13 mm) and 24 h (4.05 ± 1.06 mm) after atropine instillation were significantly larger than those at baseline (3.71 ± 0.84 mm). Barring pupil diameter, no other biometric parameters significantly changed at any point in time after atropine instillation without accommodative demand. However, with an accommodative stimulus, anterior chamber depth (ACD) at 1 h and posterior curvature of the lens at 1 and 24 h were both significantly larger than those before atropine instillation. Using AS-OCT, we detected a slight decrease in the accommodation response of ocular biometric components evoked by 0.01% atropine instillation. Morphologically, our measurements suggested a change in the ACD and horizontal radius of the lens’ posterior surface curvatures due to the subtle reduction of accommodation.
Association between Serum Phosphate Levels and the Development of Aortic Stenosis in Patients Undergoing Hemodialysis
Authors: Torigoe Miki , Kitamura Mineaki , Yamaguchi Kosei , Uchino Takumi , Torigoe Kenta , Harada Takashi , Funakoshi Satoshi , Yamamoto Kazuko , Maemura Koji , Eishi Kiyoyuki , Mukae Hiroshi , Nishino Tomoya
Published: September 2021

We aimed to investigate the factors associated with the development of aortic stenosis (AS) in patients undergoing hemodialysis (HD), and to elucidate the prognosis of HD patients with AS. Patients on HD that had also undergone echocardiography at Nagasaki Renal Center between July 2011 and June 2012 were included. Patients with AS at the time of inclusion were excluded. The diagnosis of AS was based on an annual routine or additional echocardiography. The patients were followed up until June 2021. The association between patient background and AS was also evaluated. Of the 302 patients (mean age, 67.4 ± 13.3 years; male, 58%; median dialysis history, 4.7 years), 60 developed AS and 10 underwent aortic valve replacement. A Cox proportional hazards model revealed that age (hazard ratio (HR), 1.07; 95% confidential interval (CI), 1.04–1.10; p < 0.001) and serum phosphate levels (HR, 1.40; 95%CI, 1.16–1.67, p < 0.001) were independent risk factors for developing AS. Incidentally, there was no significant mortality difference between patients with AS and those without (p = 0.53). Serum phosphate levels are a risk factor for developing AS and should be controlled. Annual echocardiography may contribute to the early detection of AS and improves the prognosis of patients undergoing HD.
Comprehensive Review of Fluorescence Applications in Gynecology
Authors: Polom Joanna , Kalinowski Leszek , Diana Michele , Chand Manish , Caballero Carmela , Sawicki Sambor , Polom Karol
Published: September 2021

Since the introduction of indocyanine green (ICG) as a fluorophore in near-infrared imaging, fluorescence visualization has become an essential tool in many fields of surgery. In the field of gynecology, recent new applications have been proposed and found their place in clinical practice. Different applications in gynecology were investigated, subcategorized, and overviewed concerning surgical applications and available dyes. Specific applications in which fluorescence-guided surgery was implemented in gynecology are described in this manuscript—namely, sentinel node biopsy, mesometrium visualization, angiography of different organs, safety issues in pregnant women, ureters visualization, detection of peritoneal metastases, targeted fluorophores for cancer detection, fluorescent contamination hysterectomy, lymphography for lower limb lymphedema prevention, tumor margin detection, endometriosis, and metastases mapping. With evolving technology, further innovative research on the new applications of fluorescence visualization in cancer surgery may help to establish these techniques as standards of high-quality surgery in gynecology. However, more investigations are necessary in order to assess if these innovative tools can also be effective to improve patient outcomes and quality of life in different gynecologic malignancies.
Circadian Characteristics in Patients under Treatment for Substance Use Disorders and Severe Mental Illness (Schizophrenia, Major Depression and Bipolar Disorder)
Authors: Serrano-Serrano Ana Belén , Marquez-Arrico Julia E. , Navarro José Francisco , Martinez-Nicolas Antonio , Adan Ana
Published: September 2021

Dual disorders (substance use and mental illness comorbidity) are a condition that has been strongly associated with severe symptomatology and clinical complications. The study of circadian characteristics in patients with Severe Mental Illness or Substance Use Disorder (SUD) has shown that such variables are related with mood symptoms and worse recovery. In absence of studies about circadian characteristics in patients with dual disorders we examined a sample of 114 male participants with SUD and comorbid Schizophrenia (SZ+; n = 38), Bipolar Disorder (BD+; n = 36) and Major Depressive Disorder (MDD+; n = 40). The possible differences in the sample of patients according to their psychiatric diagnosis, circadian functioning with recordings of distal skin temperature during 48 h (Thermochron iButton®), circadian typology and sleep-wake schedules were explored. MDD+ patients were more morning-type, while SZ+ and BD+ had an intermediate-type; the morning-type was more frequent among participants under inpatient SUD treatment. SZ+ patients had the highest amount of sleeping hours, lowest arousal and highest drowsiness followed by BD+ and MDD+, respectively. These observed differences suggest that treatment for patients with dual disorders could include chronobiological strategies to help them synchronize patterns with the day-light cycle, since morning-type is associated with better outcomes and recovery.
Autonomic Imbalance in Lymphoma Survivors
Authors: Vargas-Román Keyla , Cortés-Martín Jonathan , Sánchez-García Juan Carlos , Rodríguez-Blanque Raquel , De La Fuente-Solana Emilia Inmaculada , Díaz-Rodríguez Lourdes
Published: September 2021

Among the types of blood cancers, non-Hodgkin lymphoma is the most common. The usual treatments for this type of cancer can cause heart failure. A descriptive observational study was conducted that included 16 non-Hodgkin lymphoma survivors and 16 healthy controls matched by age and sex. Vagal tone was evaluated in the short term with a three-channel Holter device, and the time and frequency domains were analyzed following a previously accepted methodology to evaluate cardiac autonomic balance. The results of the analysis revealed that the standard deviation of the NN interval (F = 6.25, p = 0.021) and the square root of the mean of the sum of the differences between NN intervals (F = 9.74, p = 0.004) were significantly higher in healthy subjects than in lymphoma survivors. In the heart rate variability (HRV) index, there were no significant differences between the groups (F = 0.03, p = 0.85), nor in the parameters of the frequency domains LF (F = 1.94, p = 0.17), HF (F = 0.35, p = 0.55), and the ratio LF/HF (F = 3.07, p = 0.09). HRV values were lower in non-Hodgkin lymphoma survivors in the first year after treatment, resulting in autonomic imbalance compared to healthy paired subjects.
Identifying the Location of an Accessory Pathway in Pre-Excitation Syndromes Using an Artificial Intelligence-Based Algorithm
Authors: Senoner Thomas , Pfeifer Bernhard , Barbieri Fabian , Adukauskaite Agne , Dichtl Wolfgang , Bauer Axel , Hintringer Florian
Published: September 2021

(1) Background: The exact anatomic localization of the accessory pathway (AP) in patients with Wolff–Parkinson–White (WPW) syndrome still relies on an invasive electrophysiologic study, which has its own inherent risks. Determining the AP localization using a 12-lead ECG circumvents this risk but is of limited diagnostic accuracy. We developed and validated an artificial intelligence-based algorithm (location of accessory pathway artificial intelligence (locAP AI)) using a neural network to identify the AP location in WPW syndrome patients based on the delta-wave polarity in the 12-lead ECG. (2) Methods: The study included 357 consecutive WPW syndrome patients who underwent successful catheter ablation at our institution. Delta-wave polarity was assessed by four independent electrophysiologists, unaware of the site of successful catheter ablation. LocAP AI was trained and internally validated in 357 patients to identify the correct AP location among 14 possible locations. The AP location was also determined using three established tree-based, ECG-based algorithms (Arruda, Milstein, and Fitzpatrick), which provide limited resolutions of 10, 5, and 8 AP locations, respectively. (3) Results: LocAP AI identified the correct AP location with an accuracy of 85.7% (95% CI 79.6–90.5, p < 0.0001). The algorithms by Arruda, Milstein, and Fitzpatrick yielded a predictive accuracy of 53.2%, 65.6%, and 44.7%, respectively. At comparable resolutions, the locAP AI achieved a predictive accuracy of 95.0%, 94.9%, and 95.6%, respectively (p < 0.001 for differences). (4) Conclusions: Our AI-based algorithm provided excellent accuracy in predicting the correct AP location. Remarkably, this accuracy is achieved at an even higher resolution of possible anatomical locations compared to established tree-based algorithms.
Total Lesion Glycolysis Improves Tumor Burden Evaluation and Risk Assessment at Diagnosis in Hodgkin Lymphoma
Authors: Herraez Ines , Bento Leyre , Daumal Jaume , Repetto Alessandra , Del Campo Raquel , Perez Sandra , Ramos Rafael , Ibarra Javier , Mestre Francesc , Bargay Joan , Lopez Paloma , Garcias-Ladaria Joan , Sampol Antonia , Gutierrez Antonio
Published: September 2021

Hodgkin lymphoma (HL) is a hematological malignancy with an excellent prognosis. However, we still need to identify those patients that could experience failed standard frontline chemotherapy. Tumor burden evaluation and standard decisions are based on Ann Arbor (AA) staging, but this approach may be insufficient in predicting outcomes. We aim to study new ways to assess tumor burden through volume-based PET parameters to improve the risk assessment of HL patients. We retrospectively analyzed 101 patients with HL from two hospitals in the Balearic Islands between 2011 and 2018. Higher metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were significantly associated with a higher incidence of III-IV AA stages, B-symptoms, hypoalbuminemia, lymphopenia, and higher IPS. Standardized uptake value (SUVmax) was significantly related to AA stage and hypoalbuminemia. We found that TLG or the combination of SUVmax, TLG, and MTV significantly improved the risk assessment when compared to AA staging. We conclude that TLG is the best single PET/CT-related tumor-load parameter that significantly improves HL risk assessment when compared to AA staging. If confirmed in a larger and validated sample, this information could be used to modify standard frontline therapy and justifies the inclusion of TLG inside an HL prognostic score.
Surgery for Hypertrophic Obstructive Cardiomyopathy: Comprehensive LVOT Management beyond Septal Myectomy
Authors: Affronti Alessandro , Pruna-Guillen Robert , Sandoval Elena , Pereda Daniel , Alcocer Jorge , Castellà Manuel , Quintana Eduard
Published: September 2021

Hypertrophic cardiomyopathy (HCM) is a complex, underestimated, multifaceted disease frequently associated with left ventricular outflow tract (LVOT) obstruction. It is clearly demonstrated that this is due not only to septal hypertrophy but also to systolic anterior motion (SAM) of mitral valve leaflets secondary to mitral valve/subvalvular apparatus abnormalities. Surgical treatment involves performing an extended septal myectomy, eventually followed by ancillary procedures to those structures responsible for maintaining LVOT obstruction, if necessary. In this review, we describe the spectrum of possible surgical techniques beyond septal myectomy and their pathophysiologic rationale.
Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome
Authors: Díez-Villanueva Pablo , García-Acuña Jose María , Raposeiras-Roubin Sergio , Barrabés Jose A. , Cordero Alberto , Martínez-Sellés Manuel , Bardají Alfredo , Marín Francisco , Ruiz-Nodar Juan M. , Vicente-Ibarra Nuria , Alonso Salinas Gonzalo L. , Cid-Alvárez Belén , Abu Assi Emad , Formiga Frances , Núñez Julio , Núñez Eduardo , Ariza-Solé Albert , Sanchis Juan
Published: September 2021

Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p < 0.001) and more often had a history of hypertension (77% vs. 83.1%, p < 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men (p < 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, p = 0.035), and there was a significant interaction between sex and DM (p = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18–1.78; p < 0.001), but not in men (HR: 0.98, 95% CI = 0.84–1.14; p = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men.
The Role of Complement Component C3 Activation in the Clinical Presentation and Prognosis of IgA Nephropathy—A National Study in Children
Authors: Mizerska-Wasiak Małgorzata , Such-Gruchot Agnieszka , Cichoń-Kawa Karolina , Turczyn Agnieszka , Małdyk Jadwiga , Miklaszewska Monika , Drożdż Dorota , Firszt-Adamczyk Agnieszka , Stankiewicz Roman , Rybi-Szumińska Agnieszka , Wasilewska Anna , Szczepańska Maria , Bieniaś Beata , Sikora Przemysław , Pukajło-Marczyk Agnieszka , Zwolińska Danuta , Pawlak-Bratkowska Monika , Tkaczyk Marcin , Zachwieja Jacek , Drożyńska-Duklas Magdalena , Żurowska Aleksandra , Gadomska-Prokop Katarzyna , Grenda Ryszard , Pańczyk-Tomaszewska Małgorzata
Published: September 2021

The aim of the study was to evaluate the influence of the intensity of mesangial C3 deposits in kidney biopsy and the serum C3 level on the clinical course and outcomes of IgAN in children. The study included 148 children from the Polish Pediatric IgAN Registry, diagnosed based on kidney biopsy. Proteinuria, creatinine, IgA, C3 were evaluated twice in the study group, at baseline and the end of follow-up. Kidney biopsy was categorized using the Oxford classification, with a calculation of the MEST-C score. The intensity of IgA and C3 deposits were rated from 0 to +4 in immunofluorescence microscopy. The intensity of mesangial C3 > +1 deposits in kidney biopsy has an effect on renal survival with normal GFR in children with IgAN. A reduced serum C3 level has not been a prognostic factor in children but perhaps this finding should be confirmed in a larger group of children.
Computed Tomography and Spirometry Can Predict Unresectability in Malignant Pleural Mesothelioma
Authors: Bellini Alice , Dell’Amore Andrea , Giraudo Chiara , Modugno Antonella , Bernardinello Nicol , Terzi Stefano , Zambello Giovanni , Pasello Giulia , Zuin Andrea , Rea Federico
Published: September 2021

Preoperative identification of unresectable pleural mesothelioma could spare unnecessary surgical intervention and accelerate the initiation of medical treatments. The aim of this study is to determine predictors of unresectability, testing our impression that the contraction of the ipsilateral hemithorax is often associated with exploratory thoracotomy. Between 1994 and 2020, 291 patients undergoing intended macroscopic complete resection for mesothelioma after chemotherapy were retrospectively investigated. Eligible patients (n = 58) presented a preoperative 3 mm slice-thickness chest computed tomography without pleural effusion or hydropneumothorax. Lung volumes (segmented using a semi-automated method), modified-Response Evaluation Criteria in Solid Tumors (RECIST) measurements, and spirometries were collected after chemotherapy. Multivariable analysis was performed to determine the predictors of unresectability. An unresectable disease was found at the time of operation in 25.9% cases. By multivariable analysis, the total lung capacity (p = 0.03) and the disease burden (p = 0.02) were found to be predictors of unresectability; cut-off values were <77.5% and >120.5 mm, respectively. Lung volumes were not confirmed to be associated with unresectability at multivariable analysis, probably due to the correlation with the disease burden (p < 0.001; r = −0.4). Our study suggests that disease burden and total lung capacity could predict MPM unresectability, helping surgeons in recommending surgery or not in a multimodality setting.
Robotic Surgery for Non-Small Cell Lung Cancer Treatment in High-Risk Patients
Authors: Zirafa Carmelina Cristina , Romano Gaetano , Sicolo Elisa , Cariello Claudia , Morganti Riccardo , Conoscenti Lucia , Hung-Key Teresa , Davini Federico , Melfi Franca
Published: September 2021

Robotic-assisted pulmonary resection has greatly increased over the last few years, yet data on the application of robotic surgery in high-risk patients are still lacking. The objective of this study is to evaluate the perioperative outcomes in ASA III-IV patients who underwent robotic-assisted lung resection for NSCLC. Between January 2010 and December 2017, we retrospectively collected the data of 148 high-risk patients who underwent lung resection for NSCLC via a robotic approach at our institution. For this study, the prediction of operative risk was based on the ASA-PS score, considering patients in ASA III and IV classes as high-risk patients: of the 148 high-risk patients identified, 146 patients were classified as ASA III (44.8%) and two as ASA IV (0.2%). Possible prognostic factors were also analysed. The average hospital stay was 6 days (8–30). Post-operative complications were observed in 87 (58.8%) patients. Patients with moderate/severe COPD developed in 33 (80.5%) cases post-operative complications, while elderly patients in 25 (55%) cases, with a greater incidence of high-grade complications. No difference was observed when comparing the data of obese and non-obese patients. Robotic surgery appears to be associated with satisfying post-operative results in ASA III-IV patients. Both marginal respiratory function and advanced age represent negative prognostic factors. Due to its safety and efficacy, robotic surgery can be considered the treatment of choice in high-risk patients.
Evaluation of the Effect of the First Generation iStent on Corneal Endothelial Cell Loss—A Match Case-Control Study
Authors: Konopińska Joanna , Saeed Emil , Lisowski Łukasz , Gołaszewska Kinga , Kraśnicki Paweł , Dmuchowska Diana Anna , Obuchowska Iwona
Published: September 2021

Glaucoma is the leading cause of irreversible blindness worldwide. The only proven factor in slowing the progression of glaucomatous neuropathy is lower intraocular pressure (IOP), which can be achieved with pharmacology, laser therapy, or surgery. However, these treatments are associated with various adverse effects, including corneal endothelial cell loss (CECL). In recent years, several novel surgeries for reducing the IOP, collectively referred to as minimally invasive glaucoma surgery (MIGS), have been developed, one of which is the iStent. However, the long-term effects of such surgeries remain unknown. We compared a group of patients with open-angle glaucoma and cataract who underwent phacoemulsification alone with a group of patients with similar demographic and clinical characteristics who underwent simultaneous phacoemulsification and iStent implantation. Overall, 26 eyes of 22 subjects who underwent a combined phacoemulsification-iStent procedure and 26 eyes of 24 subjects who underwent cataract surgery were included. Before surgery, endothelial cells accounted to 2228.65 ± 474.99 in iStent group and 2253.96 ± 404.76 in the control group (p = 0.836). After surgery, their number declined to 1389.77 ± 433.26 and 1475.31 ± 556.45, respectively (p = 0.509). There was no statistically significant difference in CECL between the two groups 18–24 months after surgery, despite increased manipulation in the anterior chamber and the presence of an implant in the trabecular meshwork in those with an iStent implant. Thus, iStent bypass implantation is a safe treatment in terms of CECL for mild-to-moderate open-angle glaucoma.
Periodontitis, Halitosis and Oral-Health-Related Quality of Life—A Cross-Sectional Study
Authors: Izidoro Catarina , Botelho João , Machado Vanessa , Reis Ana Mafalda , Proença Luís , Alves Ricardo , Mendes José João
Published: September 2021

We aimed to explore the association between volatile sulfurous compounds (VSCs) and periodontal epithelial surface area (PESA) and periodontal inflamed surface area (PISA) on a cohort of periodontitis patients. Consecutive patients were assessed for periodontitis and halitosis. A full-mouth periodontal status assessment tested probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), bleeding on probing (BoP), PISA and PESA. A halitosis assessment was made using a VSC detector device. Periodontal measures were regressed across VSC values using adjusted multivariate linear analysis. From a total of seventy-two patients (37 females/35 males), the PESA of posterior-lower regions was found to be significantly higher in halitosis cases than their non-halitosis counterparts (p = 0.031). Considering all patients, the PESA of the posterior-lower region (B = 1.3, 95% CI: 0.2–2.3, p = 0.026) and age (B = −1.6, 95% CI: −3.1–0.2, p = 0.026) showed significant association with VSCs. In halitosis patients, the PESA of the posterior-lower region (B = 0.1, 95% CI: 0.0–0.1, p = 0.001), PISA Total (B = −0.1, 95% CI: −0.1–0.0, p = 0.008) and the OHIP-14 domain of physical disability (B = −2.1, 95% CI:−4.1–0.1, p = 0.040) were the most significant variables in this model. The PESA from the posterior-lower region may be associated with VSCs when other causes of extra-oral halitosis are excluded. Further intervention studies are needed to confirm this association.
Fludarabine–Cyclophosphamide-Based Conditioning with Antithymocyte Globulin Serotherapy Is Associated with Durable Engraftment and Manageable Infections in Children with Severe Aplastic Anemia
Authors: Salamonowicz-Bodzioch Małgorzata , Rosa Monika , Frączkiewicz Jowita , Gorczyńska Ewa , Gul Katarzyna , Janeczko-Czarnecka Małgorzata , Jarmoliński Tomasz , Kałwak Krzysztof , Mielcarek-Siedziuk Monika , Olejnik Igor , Owoc-Lempach Joanna , Panasiuk Anna , Gajek Kornelia , Rybka Blanka , Ryczan-Krawczyk Renata , Ussowicz Marek
Published: September 2021

Severe aplastic anemia (SAA) is a bone marrow failure syndrome that can be treated with hematopoietic cell transplantation (HCT) or immunosuppressive (IS) therapy. A retrospective cohort of 56 children with SAA undergoing transplantation with fludarabine–cyclophosphamide–ATG-based conditioning (FluCyATG) was analyzed. The endpoints were overall survival (OS), event-free survival (EFS), cumulative incidence (CI) of graft versus host disease (GVHD) and CI of viral replication. Engraftment was achieved in 53/56 patients, and four patients died (two due to fungal infection, and two of neuroinfection). The median time to neutrophil engraftment was 14 days and to platelet engraftment was 16 days, and median donor chimerism was above 98%. The overall incidence of acute GVHD was 41.5%, and that of grade III-IV acute GVHD was 14.3%. Chronic GVHD was diagnosed in 14.2% of children. The probability of 2-year GVHD-free survival was 76.1%. In the univariate analysis, a higher dose of cyclophosphamide and previous IS therapy were significant risk factors for worse overall survival. Episodes of viral replication occurred in 33/56 (58.9%) patients, but did not influence OS. The main advantages of FluCyATG include early engraftment with a very high level of donor chimerism, high overall survival and a low risk of viral replication after HCT.
Atherosclerosis in Fabry Disease—A Contemporary Review
Authors: Roy Ashwin , Umar Hamza , Ochoa-Ferraro Antonio , Warfield Adrian , Lewis Nigel , Geberhiwot Tarekegn , Steeds Richard
Published: September 2021

Fabry disease (FD) is a lysosomal storage disorder characterised by a deficiency in the enzyme α-galactosidase A resulting in sphingolipid deposition which causes progressive cardiac, renal, and cerebral manifestations. The case illustrates a patient with FD who died suddenly, and medical examination demonstrated myocardial scarring and prior infarction. Angina is a frequent symptom in FD. Our own data are consistent with registry data indicating a high prevalence of risk factors for coronary artery disease (CAD) in FD that may accelerate conventional atherosclerosis. Patients with FD also have a higher high-density lipoprotein (HDL)/total cholesterol (T-Chol) ratio which may further accelerate atherosclerosis through expression of early atherosclerotic markers. Patients with FD may develop CAD both via classical atherosclerosis and through formation of thickened fibrocellular intima containing fibroblasts with storage of sphingolipids. Both mechanisms occurring together may accelerate coronary stenosis, as well as alter myocardial blood flow. Our data supports limited data that, although coronary flow may be reduced, the prevalence of epicardial coronary stenosis is low in FD. Microvascular dysfunction and arterial wall stress from sphingolipid deposition may form reactive oxygen species (ROS) and myeloperoxidase (MPO), key atherosclerotic mediators. Reduced myocardial blood flow in FD has also been demonstrated using numerous imaging modalities suggesting perfusion mismatch. This review describes the above mechanisms in detail, highlighting the importance of modifying cardiovascular risk factors in FD patients who likely develop accelerated atherosclerosis compared to the general population.
Effectiveness of a Primary Care Telerehabilitation Program for Post-COVID-19 Patients: A Feasibility Study
Authors: Dalbosco-Salas Marcelo , Torres-Castro Rodrigo , Rojas Leyton Andrés , Morales Zapata Franco , Henríquez Salazar Elisabeth , Espinoza Bastías Gabriel , Beltrán Díaz María Elizabeth , Tapia Allers Kris , Mornhinweg Fonseca Daniela , Vilaró Jordi
Published: September 2021

In many health systems, it is difficult to carry out traditional rehabilitation programs as the systems are stressed. We evaluate the effectiveness of a telerehabilitation program conducted in primary care in post-COVID-19 patients. An observational, prospective study was conducted in seven primary care centers in Chile. We included adult patients (>18 years) with a previous SARS-CoV-2 infection. The telerehabilitation program consisted of 24 sessions of supervised home-based exercise training. The efficacy was measured by the 1-min sit-to-stand test (1-min STST), the 36-Item Short Form Health Survey (SF-36), fatigue, and dyspnea symptoms before and after intervention. We included 115 patients (55.4% female) with a mean age of 55.6 ± 12.7 years. Fifty-seven patients (50%) had antecedents of hospitalization, and 35 (30.4%) were admitted to the ICU. The 1-min STST was improved after the intervention from 20.5 ± 10.2 (53.1 ± 25.0%predicted) to 29.4 ± 11.9 (78.2 ± 28.0%predicted) repetitions (p < 0.001). The SF-36 global score improved significantly from 39.6 ± 17.6 to 58.9 ± 20.5. Fatigue and dyspnea improved significantly after the intervention. Although limited by the absence of a control group, this report showed that a telerehabilitation program applied in primary health care is feasible and was effective in improving physical capacity, quality of life and symptoms in adult survivors of COVID-19.
Parameters Affecting the Retention Force of CAD/CAM Telescopic Crowns: A Focused Review of In Vitro Studies
Authors: Kamel Abdullah , Badr Amr , Fekry Gehan , Tsoi James
Published: September 2021

Telescopic systems constructed using computer aided design and computer aided manufacture (CAD/CAM) can overcome many drawbacks associated with conventionally constructed ones. Since retention is considered the most important function of these retainers, this scoping review aimed to discuss and summarize the parameters that affect this function in CAD/CAM-manufactured telescopic crowns and to compare their retention force values with the recommended retention force. An electronic search was done in Pubmed and Google Scholar databases using different keyword combinations to find the related articles. Seventeen articles that follow the eligibility criteria for this review were selected and analyzed for detection of each of the tested parameters and their effect on retention force. The parameters tested in these articles were divided into parameters related to design, manufacturing, material type, and test condition. Regardless of the effect of these parameters, the retention force values recorded in most of the selected studies laid within or were higher than the recommended retention force (2.5–10 N), which indicated the need to design and set the combination of materials of telescopic systems according to oral biomechanics.
A Review of the Molecular Mechanisms Underlying Cardiac Fibrosis and Atrial Fibrillation
Authors: Sygitowicz Grażyna , Maciejak-Jastrzębska Agata , Sitkiewicz Dariusz
Published: September 2021

The cellular and molecular mechanism involved in the pathogenesis of atrial fibrosis are highly complex. We have reviewed the literature that covers the effectors, signal transduction and physiopathogenesis concerning extracellular matrix (ECM) dysregulation and atrial fibrosis in atrial fibrillation (AF). At the molecular level: angiotensin II, transforming growth factor-β1, inflammation, and oxidative stress are particularly important for ECM dysregulation and atrial fibrotic remodelling in AF. We conclude that the Ang-II-MAPK and TGF-β1-Smad signalling pathways play a major, central role in regulating atrial fibrotic remodelling in AF. The above signalling pathways induce the expression of genes encoding profibrotic molecules (MMP, CTGF, TGF-β1). An important mechanism is also the generation of reactive oxygen species. This pathway induced by the interaction of Ang II with the AT2R receptor and the activation of NADPH oxidase. Additionally, the interplay between cardiac MMPs and their endogenous tissue inhibitors of MMPs, is thought to be critical in atrial ECM metabolism and fibrosis. We also review recent evidence about the role of changes in the miRNAs expression in AF pathophysiology and their potential as therapeutic targets. Furthermore, keeping the balance between miRNA molecules exerting anti-/profibrotic effects is of key importance for the control of atrial fibrosis in AF.
The Effects of Modified Graded Recession, Anteriorization and Myectomy of Inferior Oblique Muscles on Superior Oblique Muscle Palsy
Authors: Huang Yu-Te , Chen Jamie Jiin-Yi , Wu Ming-Yen , Tien Peng-Tai , Tsui Yung-Ping , Hsieh Yi-Ching , Lin Hui-Ju , Wan Lei
Published: September 2021

Background: The aim was to investigate the effect of inferior oblique (IO) operation (IO myectomy or graded recession and anteriorization) for unilateral and bilateral superior oblique muscle palsy (SOP); Methods: A total of 167 eyes undergoing IO surgery by a single surgeon between 2008 and 2015 were retrospectively reviewed. The method for treating symmetric bilateral SOP was bilateral IO myectomy (n = 102) and the method for treating unilateral SOP or non-symmetric bilateral SOP was IO-graded recession and anteriorization (n = 65). Associated clinical results and other factors were analyzed; Results: Head tilt, vertical deviation, IO overaction, SO underaction degree and ocular torsion angle were all clearly changed, but there was no statistically significance between these two procedures. Mean preoperative torsional angle was 15.3 ± 6.4 degree, which decreased to 5.3 ± 2.7 degree after surgery. Preoperative torsional angle, IOOA and SOUA degree were all significantly affected in postoperative torsional angle (p = 0.025, 0.003 and 0.038). Horizontal rectus muscle and IO muscle operation did not interfere with each other’s results (p = 0.98); Conclusions: Symmetric bilateral SOP could be treated with bilateral IO myectomy and IO-graded recession and anteriorization should be reserved for unilateral SOP or non-symmetric bilateral SOP.
Machine Learning Consensus Clustering Approach for Hospitalized Patients with Phosphate Derangements
Authors: Thongprayoon Charat , Dumancas Carissa Y. , Nissaisorakarn Voravech , Keddis Mira T. , Kattah Andrea G. , Pattharanitima Pattharawin , Petnak Tananchai , Vallabhajosyula Saraschandra , Garovic Vesna D. , Mao Michael A. , Dillon John J. , Erickson Stephen B. , Cheungpasitporn Wisit
Published: September 2021

Background: The goal of this study was to categorize patients with abnormal serum phosphate upon hospital admission into distinct clusters utilizing an unsupervised machine learning approach, and to assess the mortality risk associated with these clusters. Methods: We utilized the consensus clustering approach on demographic information, comorbidities, principal diagnoses, and laboratory data of hypophosphatemia (serum phosphate ≤ 2.4 mg/dL) and hyperphosphatemia cohorts (serum phosphate ≥ 4.6 mg/dL). The standardized mean difference was applied to determine each cluster’s key features. We assessed the association of the clusters with mortality. Results: In the hypophosphatemia cohort (n = 3113), the consensus cluster analysis identified two clusters. The key features of patients in Cluster 2, compared with Cluster 1, included: older age; a higher comorbidity burden, particularly hypertension; diabetes mellitus; coronary artery disease; lower eGFR; and more acute kidney injury (AKI) at admission. Cluster 2 had a comparable hospital mortality (3.7% vs. 2.9%; p = 0.17), but a higher one-year mortality (26.8% vs. 14.0%; p < 0.001), and five-year mortality (20.2% vs. 44.3%; p < 0.001), compared to Cluster 1. In the hyperphosphatemia cohort (n = 7252), the analysis identified two clusters. The key features of patients in Cluster 2, compared with Cluster 1, included: older age; more primary admission for kidney disease; more history of hypertension; more end-stage kidney disease; more AKI at admission; and higher admission potassium, magnesium, and phosphate. Cluster 2 had a higher hospital (8.9% vs. 2.4%; p < 0.001) one-year mortality (32.9% vs. 14.8%; p < 0.001), and five-year mortality (24.5% vs. 51.1%; p < 0.001), compared with Cluster 1. Conclusion: Our cluster analysis classified clinically distinct phenotypes with different mortality risks among hospitalized patients with serum phosphate derangements. Age, comorbidities, and kidney function were the key features that differentiated the phenotypes.
Evolution Characteristics of Suction-Side-Perpendicular Cavitating Vortex in Axial Flow Pump under Low Flow Condition
Authors: Wang Lin , Tang Fangping , Chen Ye , Liu Haiyu
Published: September 2021

In order to study the evolution characteristics of suction-side-perpendicular cavitating vortex in an axial-flow pump under low flow conditions, model tests, high-speed imaging, and an SST-CC turbulence model were used to simulate the external characteristics and cavitation morphology of the pump. The evolution law of suction-side-perpendicular cavitating vortex (SSPCV) was revealed by turbulent kinetic energy, liutex vortex identification, and vorticity transport equation. The results show that the evolution of suction-side-perpendicular cavitating vortex at low cavitation number can be divided into three stages: generation, development, and breaking stage. In the generation stage, the turbulent kinetic energy, velocity gradient and vortex kinetic energy continue to increase, reaching the maximum at the early stage of development. Afterwards, due to the viscosity of the water, the vortex slowly dissipates and enters the stage of development. Finally, it is affected by the next blade and enters the breaking stage, which accelerates the dissipation of the vortex. The vortex stretching term and vortex expansion term are the main contributors to the vorticity. During the development of the vortex, the vorticity is mainly caused by the deformation of the fluid micelle. The breaking stage mainly affects the stretching term, and the Coriolis force term cannot be ignored in the rotating coordinates.
Planned Pregnancy in Kidney Transplantation. A Calculated Risk
Authors: Ponticelli Claudio , Zaina Barbara , Moroni Gabriella
Published: September 2021

Pregnancy is not contraindicated in kidney transplant women but entails risks of maternal and fetal complications. Three main conditions can influence the outcome of pregnancy in transplant women: preconception counseling, maternal medical management, and correct use of drugs to prevent fetal toxicity. Preconception counseling is needed to prevent the risks of an unplanned untimely pregnancy. Pregnancy should be planned ≥2 years after transplantation. The candidate for pregnancy should have normal blood pressure, stable serum creatinine <1.5 mg/dL, and proteinuria <500 mg/24 h. Maternal medical management is critical for early detection and treatment of complications such as hypertension, preeclampsia, thrombotic microangiopathy, graft dysfunction, gestational diabetes, and infection. These adverse outcomes are strongly related to the degree of kidney dysfunction. A major issue is represented by the potential fetotoxicity of drugs. Moderate doses of glucocorticoids, azathioprine, and mTOR inhibitors are relatively safe. Calcineurin inhibitors (CNIs) are not associated with teratogenicity but may increase the risk of low birth weight. Rituximab and eculizumab should be used in pregnancy only if the benefits outweigh the risk for the fetus. Renin–angiotensin system inhibitors, mycophenolate, bortezomib, and cyclophosphamide can lead to fetal toxicity and should not be prescribed to pregnant women.