bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomarkers in acute coronary syndromes
Authors: Boeddinghaus Jasper , Nestelberger Thomas , Twerenbold Raphael , Mueller Christian
Published: March 2021

Biomarkers, particularly high-sensitivity cardiac troponin T/I (hs-cTnT/I), play a major role in the early diagnosis and risk stratification of patients presenting with symptoms suggestive of an acute coronary syndrome such as acute chest pain. As heart specific markers of cardiomyocyte injury, hs-cTnT/I complement clinical assessment and the 12-lead electrocardiogram in the diagnosis of myocardial infarction, the risk stratification for life-threatening arrhythmias and death, and the triage towards early revascularization. Hs-cTnT/I allow the reliable measurement of cTnT/I concentrations around the 99th-percentile and in the normal range and increased the diagnostic accuracy for myocardial infarction at presentation. Absolute short-term changes in hs-cTnT/I within 1h or 2h further increase the diagnostic accuracy for myocardial infarction. The ESC hs-cTnT/I 0/1h-algorithms are assay-specific early triage algorithms optimized for the early rule-out and/or rule-in of myocardial infarction. They triage patients towards rule-out (about 60%), observe (about 25%), and rule-in (about 15%). Triage towards rule-out provides very high sensitivity (99%) and negative predictive value (>99%) for the safe rule-out of myocardial infarction, while triage towards rule-in provides high specificity (about 96%) and positive predictive value (about 75%) for myocardial infarction. Other biomarkers quantifying cardiomyocyte injury (e.g. CK-MB, CK, LDH, myosin-binding protein C) or other pathophysiological processes involved in acute coronary syndromes (e.g. copeptin, BNP, NT-proBNP) provide no or only very little incremental diagnostic value for myocardial infarction on top of the ESC hs-cTnT/I 0/1h-algorithms. However, the later provide incremental prognostic value for death and heart failure. Therefore, the use of BNP or NT-proBNP, as quantitative markers of hemodynamic stress and heart failure, should be considered.
Atherosclerosis and thrombosis
Authors: Badimon Lina , Vilahur Gemma
Published: March 2021

Atherosclerosis is the main underlying cause of heart disease. The continuous exposure to cardiovascular risk factors induces endothelial activation/dysfunction which enhances the permeability of the endothelial layer and the expression of cytokines/chemokines and adhesion molecules. This results in the accumulation of lipids (low-density lipoprotein particles) in the intimal layer and the triggering of an inflammatory response. Accumulated low-density lipoprotein particles attached to the extracellular matrix suffer modifications and become pro-atherogenic, enhancing leucocyte recruitment and further transmigration across the endothelium into the intima. Infiltrated pro-atherogenic monocytes (mainly Mon2) differentiate into macrophages which acquire a specialized phenotypic polarization (protective/M1 or harmful/M2), depending on the stage of the atherosclerosis progression. Once differentiated, macrophages upregulate pattern recognition receptors capable of engulfing modified low-density lipoprotein, leading to foam cell formation. Foam cells release growth factors and cytokines that promote vascular smooth muscle cell migration into the intima, which then internalize low-density lipoproteins via low-density lipoprotein receptor-related protein-1 receptors becoming foam cells. As the plaque evolves, the number of vascular smooth muscle cells decline, whereas the presence of fragile/haemorrhagic neovessels and calcium deposits increases, promoting plaque destabilization. Disruption of this atherosclerotic lesion exposes thrombogenic surfaces rich in tissue factor that initiate platelet adhesion, activation, and aggregation, as well as thrombin generation. Platelets also participate in leucocyte and progenitor cell recruitment are likely to mediate atherosclerosis progression. Recent data attribute to extracellular vesicles (mainly microvesicles) a role in all stages of atherosclerosis development and evidence their potential use as systemic biomarkers of thrombus growth. This chapter reviews our current understanding of the pathophysiological mechanisms involved in atherogenesis, highlights platelet contribution to thrombosis and atherosclerosis progression, and provides new insights into how atherothrombosis may be prevented and modulated.
Non-ST-segment elevation acute coronary syndromes
Authors: Bueno Héctor , Barrabés José A
Published: March 2021

Non-ST-segment elevation acute coronary syndromes are potentially life-threatening disorders, usually caused by acute coronary thrombosis and subsequent myocardial ischaemia, presenting without persistent ST-segment elevation in the initial electrocardiogram. According to the occurrence of myocardial necrosis, non-ST-segment elevation acute coronary syndromes are divided into non-ST-segment myocardial infarction or unstable angina. The management of non-ST-segment elevation acute coronary syndromes requires an early diagnosis and risk stratification, urgent hospitalization, monitoring, and medical treatment, including antithrombotic therapy with dual antiplatelet therapy (aspirin plus one P2Y12 inhibitor) and parenteral anticoagulation, anti-ischaemic treatment, and preventative therapies. After the initial medical therapy is established, an invasive strategy, consisting of coronary angiography with coronary revascularization (either percutaneous coronary intervention or coronary bypass graft surgery), as appropriate, should be decided. The timing of the invasive strategy should be adjusted according to the patient's risk. Given the high event rate of patients with non-ST-segment elevation acute coronary syndromes after hospital discharge, an aggressive long-term preventative therapy should be put in place to improve prognosis.
Acute heart failure: epidemiology, classification, and pathophysiology
Authors: Farmakis Dimitrios , Filippatos Gerasimos
Published: March 2021

Acute heart failure (AHF) is defined as the rapid development or change of symptoms and signs of heart failure that requires urgent medical attention and usually hospitalization. it represents the first reason for hospital admission in individuals aged 65 or more and accounts for nearly 70% of the total healthcare expenditure for heart failure. It is generally characterized by adverse prognosis, with an in-hospital mortality rate of 4-7%, a 2 to 3-month post-discharge mortality of 7-11% and a 2 to 3-month readmission rate of 25-30%. The majority of patients have a previous history of heart failure and present with symptoms and/or signs of congestion and normal or increased blood pressure, while about half of them have preserved left ventricular ejection fraction. A high prevalence of cardiovascular or non-cardiovascular comorbidities is further observed, including coronary artery disease, arterial hypertension, atrial fibrillation, diabetes mellitus, renal dysfunction, chronic lung disease, anemia and iron deficiency. Different classification criteria have been proposed for AHF, reflecting the clinical heterogeneity of the syndrome. Classifications according to the past history of heart failure (acutely decompensated chronic or de novo), the systolic blood pressure upon presentation (hypertensive, normotensive or hypotensive) and the presence or absence of congestion and peripheral hypoperfusion are among the most widely used. The pathophysiology of AHF involves several mechanisms, including volume overload, pressure overload, myocardial loss and restrictive filling, while several cardiovascular and non-cardiovascular precipitating factors lead to AHF. Regardless of the underlying mechanism, peripheral and/or pulmonary congestion is present in the vast majority of AHF, resulting from fluid retention and/or fluid redistribution, while a marked reduction in cardiac output with peripheral hypoperfusion occurs in a minority of cases. Myocardial injury and renal dysfunction are important factor involved in the precipitation and progression of the syndrome.
Low cardiac output states and cardiogenic shock
Authors: Thiele Holger , Waha-Thiele Suzanne de
Published: March 2021

Low cardiac output and cardiogenic shock are associated with high mortality. Among the multiple heterogeneous reasons for low cardiac output and cardiogenic shock acute coronary syndromes are the most frequent cause. Mortality is still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical circulatory support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock focussing on acute coronary syndromes, including mechanical complications and shock from right ventricular failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist's and also an intensive care physician's perspective on the advancement of new therapeutical arsenals, both percutaneous mechanical circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
Heart failure surgery and transplantation
Authors: Schoenrath Felix , Klages Jan , Falk Volkmar
Published: March 2021

Cardiac surgery in heart failure (HF) patients is gaining more and more importance as HF prevalence is increasing in the general population. Therefore, surgery offers potential benefits at any stage of HF prognosis and for various HF aetiologies. Since both decision making and treatment options are becoming increasingly complex in our aging population, decisions should be made based on a specialized HF team, to achieve optimal and sustained results for the patient. Currently, most intermediate and long-term treatment options for end stage HF patients result in surgical interventions (LVAD therapy, transplantation). However, both pre- and post-operative as well as outpatient care is often managed by the cardiologist. Therefore, gaining expertise in the field through indications and complication management, as well as the know-how surrounding surgical principles is highly valuable for every cardiologist.
Ventricular tachyarrhythmias
Authors: Dilling-Boer Dagmara , Bella Paolo Della , Baratto Francesca
Published: March 2021

In this chapter on diagnosis and treatment of wide complex tachycardias, we provide a systematic review of current knowledge to enable prompt differentiation between potentially lethal and non-lethal arrhythmias. The importance of documentation of the arrhythmia whenever possible is stressed, as it is vital to establish a correct diagnosis. Electrical storm is the most feared arrhythmic emergency in patients with both structural heart disease and inherited arrhythmia syndromes and a step by step approach has been extensively outlined, emphasizing early installation of general anaesthesia and mechanical ventilation, haemodynamic support and ablation therapy. Finally, the significance of ventricular arrhythmias in patients undergoing revascularization for acute coronary syndromes and in particular ST elevation myocardial infarction is discussed.
Pacemaker and ICDs: troubleshooting
Authors: Starr Neasa , Burri Haran
Published: March 2021

As patients with implanted cardiac devices are commonly encountered in the intensive care unit (ICU), in this chapter we aim to outline the basic premise of how pacemaker and defibrillators function. In order to provide safe and effective care for cardiac device patients in an intensive care setting or who have to undergo surgery, we will discuss management of these patients in these specific contexts.
Acute respiratory failure and acute respiratory distress syndrome
Authors: Gattinoni Luciano , Busana Mattia , Carlesso Eleonora
Published: March 2021

Respiratory failure (RF) is defined as the acute or chronic impairment of respiratory system function to maintain normal oxygen and CO2 values when breathing room air. ‘Oxygenation failure’ occurs when O2 partial pressure (PaO2) value is lower than the normal predicted values for age and altitude and may be due to ventilation/perfusion mismatch or low oxygen concentration in the inspired air. In contrast, ‘ventilatory failure’ primarily involves CO2 elimination, with arterial CO2 partial pressure (PaCO2) higher than 45 mmHg. The most common causes are exacerbation of chronic obstructive pulmonary disease (COPD), asthma, and neuromuscular fatigue, leading to dyspnoea, tachypnoea, tachycardia, use of accessory muscles of respiration, and altered consciousness. History and arterial blood gas analysis is the easiest way to assess the nature of acute RF and treatment should solve the baseline pathology. In severe cases mechanical ventilation is necessary as a ‘buying time’ therapy. The acute hypoxemic RF arising from widespread diffuse injury to the alveolar-capillary membrane is termed Acute Respiratory Distress Syndrome (ARDS), which is the clinical and radiographic manifestation of acute pulmonary inflammatory states.
Perioperative cardiac care of the high-risk non-cardiac patient
Authors: Balik Martin
Published: March 2021

Non-cardiac surgery conveys a cardiac risk related to the status of the patient's cardiovascular system. Cardiac-related risk of surgery can be assessed by integrating the risk and urgency of the procedure with cardiovascular risk factors, which include age, ischaemic heart disease, heart failure, stroke, diabetes mellitus, chronic obstructive pulmonary disease, and renal dysfunction. An individual assessment can include simple multivariate scoring systems, developed with the aim of evaluating cardiac risk prior to non-cardiac surgery. Patient assessment can be extended for indicated additional tests. The indications for further cardiac testing and treatments are the same as in the non-operative setting, but their timing is dependent on the urgency of surgery, and patient-specific and surgical risk factors. A delay in surgery, due to the use of both non-invasive and invasive preoperative testing, should be limited to those circumstances in which the results of such tests will clearly affect patient management. In high-risk patients, the result of the cardiac assessment helps to choose adequate perioperative monitoring and to indicate for an intensive care unit stay perioperatively. Chronic medications can be adjusted, according to the current knowledge on perioperative management. Drugs with the potential to reduce the incidence of post-operative cardiac events and mortality include beta-blockers, statins, and aspirin. Chronic platelet anti-aggregation and anticoagulation therapies have to be adapted by weighing the risk of bleeding against the risk of thrombotic complications.
The detectability of Wolf–Rayet stars in M33-like spirals up to 30 Mpc
Authors: Pledger J L , Sharp A J , Sansom A E
Published: March 2021

We analyse the impact that spatial resolution has on the inferred numbers and types of Wolf–Rayet (WR) and other massive stars in external galaxies. Continuum and line images of the nearby galaxy M33 are increasingly blurred to mimic effects of different distances from 8.4 to 30 Mpc, for a constant level of seeing. We use differences in magnitudes between continuum and He ii line images, plus visual inspection of images, to identify WR candidates via their ionized helium excess. The result is a surprisingly large decrease in the numbers of WR detections, with only 15 per cent of the known WR stars predicted to be detected at 30 Mpc. The mixture of WR subtypes is also shown to vary significantly with increasing distance (poorer resolution), with cooler WN stars more easily detectable than other subtypes. We discuss how spatial clustering of different subtypes and line dilution could cause these differences and the implications for their ages, this will be useful for calibrating numbers of massive stars detected in current surveys. We investigate the ability of ELT/HARMONI to undertake WR surveys and show that by using adaptive optics at visible wavelengths even the faintest (MV = –3 mag) WR stars will be detectable out to 30 Mpc.
Smoke-Free Laws and Disparities in Secondhand Smoke Exposure Among Nonsmoking Adults in the United States, 1999–2014
Authors: Titus Andrea R , Thrasher James F , Gamarel Kristi E , Meza Rafael , Fleischer Nancy L
Published: March 2021

Introduction

Little is known about the relationship between smoke-free laws and persistent disparities in secondhand smoke (SHS) exposure among nonsmoking adults in the United States.

Aims and Methods

We constructed time-varying smoke-free law measures representing whether or not at least 50% of each US county’s population was covered by smoke-free laws in workplaces and hospitality venues (restaurants/bars). We merged these data with restricted data on cotinine-derived SHS exposure among nonsmokers from the National Health and Nutrition Examination Survey, 1999–2014 (N = 25 444). Using logistic regression, we estimated associations between smoke-free law coverage and SHS exposure among all nonsmokers, and within age strata (25–39, 40–59, 60+). We explored differential associations by gender, race/ethnicity, education, and poverty–income ratio (PIR) by testing the significance of interactions terms for the full sample and within age strata.

Results

In adjusted models, hospitality coverage was associated with lower odds of SHS exposure in the full sample (odds ratio [OR] = 0.62; 95% confidence interval [CI] = 0.51–0.76), and within each age group, with ORs ranging from 0.58 (ages 25–39) to 0.67 (ages 60+). Workplace coverage was associated with lower SHS exposure only among younger adults (OR = 0.81; 95% CI = 0.65–0.99). Within the full sample and among adults ages 40–59, hospitality laws were associated with narrowing SHS exposure differentials between males and females. Among adults ages 40–59, workplace laws were associated with narrowing exposure differentials between males and females, but worsening exposure disparities by PIR.

Conclusions

Smoke-free laws may reduce SHS exposure among adult nonsmokers, but may be insufficient to improve disparities in SHS exposure.

Implications

In a repeated cross-sectional sample of adult nonsmokers, smoke-free laws in hospitality venues were consistently associated with lower odds of SHS exposure and appeared to narrow exposure differentials between males and females. Associations between workplace smoke-free laws and SHS exposure were variable by age. Among adults ages 40–59, workplace laws were associated with narrowing exposure differentials between males and females while exacerbating exposure differentials by PIR. Differential patterns of association highlight the need to examine the impacts of tobacco control policies on downstream health equity.
Posterior Transdural Approach for a Calcified Thoracic Intradural Disc Herniation Using a 3-Dimensional Exoscope: 2-Dimensional Operative Video
Authors: Kim Michael , Wainwright John , Stein Alan , Hanft Simon
Published: March 2021

This video depicts the removal of an intradural thoracic disc herniation through a purely transdural approach. Thoracic disc herniations are rare, and less than 5% are intradural. Though thoracic disc herniations are removed through a posterolateral or transthoracic corridor, there is literature to support a transdural approach for central herniations.
1-3
Although the transdural approach has been selectively adopted for central soft herniations, calcified herniations have been regarded as less suitable.
1,2
Intradural thoracic herniations have not been specifically addressed by a transdural approach in the limited literature, though it has been utilized in conjunction with a larger transthoracic approach.
4
Our case features a 72-yr-old female presenting with worsening left leg weakness. Computed tomography (CT) identified a multilobulated ventral calcified mass at T11-12. Magnetic resonance imaging was not possible because of an incompatible pacemaker. Our impression was that this likely represented an intradural meningioma though a calcified intradural disc herniation was considered. Given the apparent intradural location, we opted for a transdural approach only via T11-12 laminectomy and a midline dural opening. Dentate ligament sectioning allowed a clear corridor to the now apparent disc material. Postoperative CT confirmed near complete resection, and the patient showed neurological improvement. Ultimately, the transdural approach alone led to complete discectomy while avoiding the morbidity of an invasive transthoracic approach and instrumented fusion. To our knowledge, this is the first video documenting a purely transdural approach for resection of an intradural disc herniation. The patient consented to the surgical procedure and to the use of intraoperative video for education purposes.
Vandenberg Vanished: US Congress and the Politicisation of Military Interventions
Authors: Böller Florian
Published: March 2021

This article examines the extent and patterns of politicisation in the field of military interventions for the USA after the end of the Cold War. The analysis shows that key votes on war and peace in the US Congress are contested to a higher degree than in the European parliaments. It finds that Republican members of Congress (MoC) are in general more supportive of military interventions than Democrats. At the same time, party loyalty towards the president influences the level of support. Furthermore, an original content analysis of congressional debates reveals that MoC use specific argumentative frames in line with partisan ideology. Both parts of the analysis point to the relevance of partisanship and partisan ideology for understanding the politicisation of military interventions policies. Thus, the traditional bipartisan spirit, paradigmatically invoked by US Senator Arthur Vandenberg during the Cold War, has almost vanished.
Association Between Dry Eye Syndrome and Osteoarthritis Severity: A Nationwide Cross-Sectional Study (KNHANES V)
Authors: Yoo Tae Keun , Oh Ein
Published: March 2021

Objective

Recently, several researchers reported an association between osteoarthritis and dry eye syndrome (DES) and suggested that they may be related to central sensitization. We investigated the association between DES, osteoarthritis pain, and radiographic severity.

Design

A nationwide, cross-sectional study

Setting

The Fifth Korean National Health and Nutrition Examination Survey.

Subjects

8,664 participants in this survey

Methods

Osteoarthritis-associated radiographic changes were evaluated by trained radiologists. Multivariable logistic regression was performed to examine the relationship between osteoarthritis pain, radiographic severity, and DES. The odds ratios (ORs) of DES were analyzed in accordance with the presence of osteoarthritis-associated factors.

Results

Radiographic knee osteoarthritis was significantly associated with lower ORs for DES (OR = 0.80, P = 0.046, for diagnosed/self-reported DES; OR = 0.84, P = 0.034, for symptoms of DES). Knee pain or stiffness was significantly associated with higher ORs for DES (OR = 1.28, P = 0.020, for diagnosed/self-reported DES; OR = 1.29, P = 0.003, for symptoms of DES). In patients with symptomatic osteoarthritis, DES was not significantly associated with radiographic severity of osteoarthritis. In patients with nonsymptomatic radiographic osteoarthritis, DES was inversely related with radiographic severity (Ptrend = 0.012 for diagnosed/self-reported DES; Ptrend < 0.001 for symptoms of DES).

Conclusions

Radiographic osteoarthritis showed a significant association with decreased DES. Patients with less pain and severe radiographic OA were more likely to have less DES. Our results suggest that the degree of pain caused by osteoarthritis and central sensitization may be closely associated with DES.
Factors associated with fatigue in hip and/or knee osteoarthritis: a systematic review and best evidence synthesis
Authors: Fawole Henrietta O , Idowu Opeyemi A , Abaraogu Ukachukwu O , Dell’Isola Andrea , Riskowski Jody L , Oke Kayode I , Adeniyi Ade F , Mbada Chidozie E , Steultjens Martijn P , Chastin Sebastien F M
Published: March 2021

Objective

The aim was systematically to identify and evaluate factors related to fatigue in individuals with hip and/or knee OA.

Methods

A systematic literature search was conducted using AMED, CINAHL, MEDLINE, ProQuest and Web of Science Core Collections databases. Inclusion criteria comprised cross-sectional, case–control or longitudinal studies on patients with a diagnosis of hip and/or knee OA that included self-reported fatigue measures. Study quality was assessed using the National Heart, Lung and Blood Institute quality appraisal tool, and factors were synthesized within a bio-behavioural framework. Study designs and quality were combined to determine current evidence levels using best evidence synthesis grading. The full review protocol is available from PROSPERO (PROSPERO 2019: CRD42019138571).

Results

Twenty-four studies were included, of which 19 were high, 4 moderate and 1 low quality. There was strong evidence of an association between poor self-reported physical function and high depressive symptoms with higher fatigue. Moderate evidence of an association was found between severe pain, high numbers of co-morbidities and low physical activity levels with higher fatigue. There was moderate or limited evidence of no association between most sociodemographic factors and radiographic OA severity with fatigue.

Conclusion

Targets for fatigue management might include improving physical function, reducing depressive symptoms, pain and co-morbidities, and increasing physical activity levels. There is a need for more rigorous longitudinal studies to understand the causal effect of fatigue determinants within the hip and knee OA populations.
Osteoporosis and fractures in rheumatoid arthritis
Authors: Wysham Katherine D. , Baker Joshua F. , Shoback Dolores M.
Published: March 2021

Purpose of review

Rheumatoid arthritis (RA) is associated with increased risk for osteoporotic fracture. We highlight RA-specific risk factors for bone mineral density (BMD) loss and fractures and considerations regarding the diagnosis and treatment of osteoporosis in patients with RA.

Recent findings

Anticitrullinated protein antibody (ACPA) positivity, although associated with low BMD in early RA, is not associated with accelerated BMD loss over time when compared to ACPA negative individuals. Studies have found reduced BMD in individuals on low doses of glucocorticoids (GCs). Poor functional status and frailty are additional important risk factors for low BMD and fractures. Heightened fracture risk in RA may be mitigated by tight disease control, and biologic therapies are associated with more stable BMD compared to nonbiologic therapies. Evidence-based guidelines specific for treating osteoporosis in patients with RA do not exist. Thus, treatment decisions are based on general osteoporosis guidelines, taking into account additional RA-specific risk factors.

Recent studies have advanced knowledge of RA-specific risk factors for BMD loss and fractures. Future studies applying these findings to modify established fracture risk algorithms as well as evaluating osteoporosis treatments in RA cohorts are needed to reduce the risk of disabling fractures in these patients.
The association between primary ovarian insufficiency and osteoporosis in the Canadian Longitudinal Study on Aging
Authors: Shea Alison K. , Buwembo Alice , Mayhew Alexandra , Sohel Nazmul , Griffith Lauren E. , Raina Parminder
Published: March 2021

Objective:

The objective of this study is to describe the association of premature ovarian insufficiency (POI) and early menopause on bone mineral density (BMD) and osteoporosis in a large cohort of women living in Canada.

Methods:

Cross-sectional baseline data from a deeply characterized cohort (female participants) of the Canadian Longitudinal Study on Aging was used. Additional bio-psycho-social characteristics that may influence bone health and the development of osteoporosis were explored.

Results:

The mean age of women at the time of baseline assessment was 65 years (N = 12,339). When comparing women with POI to those with early and normal age of menopause, there was no difference in hip BMD between groups, but women in the POI group were more likely to have a higher rate of self-reported osteoporosis (21.9% vs 16.7%) and have used osteoporosis drugs (11.39% vs 7.63%). After adjustment, POI was found to increase the odds of osteoporosis, as diagnosed using BMD. Current cigarette smoking was found to influence this association. Protective factors included obesity and current hormone therapy use, but not the duration of hormone therapy use. Women in the POI group were more likely to be obese, have decreased physical activity, and were more likely to be current smokers.

Conclusion:

These results confirm findings from smaller cohorts illustrating that POI is associated with osteoporosis. Increasing understanding of the sequelae associated with an earlier loss of ovarian function will aid in targeting earlier screening and intervention strategies for women in Canada and abroad.
MULTIMODAL IMAGING OF A CHOROIDAL NEVUS WITH CAVERNS IN THE SETTING OF PACHYCHOROID DISEASE
Authors: Corvi Federico , Corradetti Giulia , Wong Alice , Pulido Jose S. , Shields Carol L. , Freund K. Bailey , Sarraf David , Sadda SriniVas R.
Published: March 2021

Purpose:

To describe the multimodal imaging findings of extensive choroidal caverns within a choroidal nevus in an eye with pachychoroid spectrum disease.

Methods:

A 69-year-old woman was referred with a known history of branch retinal vein occlusion in the right eye and choroidal nevus in the left eye. Fundus examination of both eyes revealed subretinal yellow deposits, suggestive of pachydrusen. Retinal venous collaterals were noted in the temporal macular of the right eye. A lightly pigmented choroidal lesion with nearly confluent overlying drusen and retinal pigment epithelial alterations, consistent with chronic choroidal nevus, was noted in the macula of the left eye.

Results:

Optical coherence tomography B-scans revealed thickened choroid (pachychoroid) with subfoveal choroidal thickness of 504 µm and 580 µm with large hyporeflective spaces suggestive of pachyvessels in both eyes. In the region of the choroidal nevus, the choroidal vascular spaces appeared comparatively large and were classified as “caverns” measuring up to 480 µm in diameter. Optical coherence tomography angiography and indocyanine green angiography demonstrated the absence of flow within the caverns. Indocyanine green angiography further illustrated choroidal vascular hyperpermeability with patchy hyperfluorescent areas in both eyes. Wide-field swept-source optical coherence tomography showed mild posterior scleral bowing, a feature occasionally documented with choroidal nevus, and highlighted greater hyporeflectivity and hypertransmission on optical coherence tomography within the caverns compared with the noncavernous choroidal vessels.

Conclusion:

Choroidal caverns can occur within choroidal nevus in the setting of pachychoroid disease.
Three-Dimensional Computed Tomography Scan Analysis of Secondary Labial Deformities in Patients With Unilateral Cleft Lip/Cleft Palate After Revisional Surgery
Authors: Wang Ximei , Wang Qiying , Sun Yufeng , Zhang Qiongge , Lin Kant Y.K. , Zhang Jingxia , Peng Qian , Wan Cheng
Published: March 2021

Background

Surgical reconstruction of secondary labial deformities associated with isolated unilateral cleft lip (UCL) and/or UCL and palate (UCLP) is challenging. There have been few studies in the literature looking at labial soft tissues quantitatively to assess surgical results.

Objective

To apply a novel computer-aided, 3-dimensional reconstruction technique based on CT scan images to conduct quantitative preoperative and postoperative assessments in patients with UCL/UCLP undergoing surgical revision of secondary labial deformities.

Methods

Preoperative and postoperative spiral computed tomographic (CT) scans of the face were performed in 21 randomly selected UCL or UCLP patients, who underwent secondary lip revision surgery. The data was then imported to the SimPlant 11.04 software system. Fixed point-to-point, linear distance, and angles were measured, statistically analyzed and used to assess the effect of the surgery.

Results

Preoperative measurements showed that the thickness of the upper vermilion at the apex of the Cupid's bow on the affected side was greater than that on the unaffected side. The distance from the apex of the Cupid's bow to the ipsilateral subnasal point of the affected side was smaller than that of the unaffected side (P < 0.05). After surgery, the subjects were rescanned at an average of 9 months, and the curative effects were evaluated. The statistically significant preoperative differences between the affected and unaffected sides were not found postoperatively indicating surgical success.

Conclusions

This study demonstrates the utility of a novel method to measure and assess results in the surgical revision of UCL/UCLP patients with secondary lip deformities. This knowledge can aid the surgeon in selection of treatment techniques.
A Retrospective Study of Double Eyelid Surgery for Sunken Upper Eyelid in Chinese
Authors: Xie Xiang , An Yang , Xue Hongyu , Xie Hongbin , Zhao Jianfang , Li Dong
Published: March 2021

Objective

The aim of this study was to explore the effective technique of double eyelid surgery for mild, moderate, and severe sunken upper eyelid in Chinese.

Methods

According to the degree of the sunken upper eyelid, different procedures were performed. For mild sunken upper eyelid, the key technique was named eyelid volume redistribution (EVR)-1 technique, which was advancing or folding the pretarsal orbicularis oculi muscle flap toward up to the upper margin of the incision. For moderate sunken upper eyelid, the EVR-2 technique included EVR-1 technique and releasing orbital fat toward the upper margin of the tarsus. The other surgical steps were the same as conventional double eyelid surgery. For severe sunken upper eyelid, 2 steps were needed. The first step was eyelid volume augmentation (EVA). This technique injected fat into the retroorbicularis oculi fat layer. The second step was conventional double eyelid surgery which was performed 3 to 6 months later.

Results

One hundred sixty-seven patients with sunken upper eyelid underwent double eyelid surgery. In addition to the ameliorative recontouring of the sunken deformity, natural double eyelid was created. All patients had no complication, such as infection, skin irregularities, and lumps. The edema, bruising, and temporary ptosis recovered in 2 weeks. The edema resulted from double eyelid surgery, which last about 2 to 3 months.

Conclusions

Our study showed that EVR-1, EVR-2, and EVA techniques have stable surgical results for mild, moderate, and severe sunken upper eyelids in Chinese. The procedures are simple, safe, and have less complications and preferable clinical reference value.
Special Considerations in Chinese Face-Lift Procedure
Authors: Yang Daping , Yang Jenny F.
Published: March 2021

Background

There is extensive literature on different face-lift techniques; however, few articles published in the English language address the particularities of the face-lift for Chinese patients. Because of differences in facial anatomy, facial aging, and patient expectations, facial rejuvenation procedures for Chinese patients can be quite different from those of White patients.

Methods

The study includes 1026 consecutive primary face-lift cases performed by the senior author (D.Y.) from 2006 to 2019. Of these, 1010 patients were female and 16 were male. The average age of the patient at the time of primary face-lift was 40.5 years. The face-lift procedures included midface lift in 108 cases, midface and lower-face lift in 882 cases, and midface and lower-face lift with brow lift in 36 cases. All patients received superficial musculoaponeurotic system (SMAS) treatment, in the form of lateral SMASectomy in 607 cases, high-SMAS technique in 84 cases, modified high-SMAS short-scar technique in 108 cases, minimal access cranial suspension technique in 38 cases, and modified minimal access cranial suspension technique in 189 cases. Photographs of patients were analyzed to assess persistent features of facial aging. Complications such as hematoma, skin slough, infection, and nerve injury were also reviewed.

Results

Most patients obtained consistently good results with minimal risk and complications. All surgical techniques discussed were safe and reproducible, providing various options for surgeons.

Conclusions

Special attention should be taken when planning a facial rejuvenation procedure for Chinese patients. Anatomic variations dictate a greater emphasis on the management of tissue ptosis, particularly regarding lateral brow descent and malar fat pad descent. In our practice, various face-lift techniques can produce excellent results. Surgeons must adopt a technique that serves patients well and is, ideally, safe, consistent, easily reproducible, and applicable to various anatomic problems. In addition, every surgery is customized to the patient's anatomy and concerns. Therefore, the surgeon must adopt individualized technique according to the needs and desires of each patient.
The Weekend Effect in Septic Shock Patients Using the Nationwide Emergency Department Sample Database
Authors: Bou Chebl Ralphe , Kattouf Nadim , Assaf Mohamad , Abou Dagher Gilbert , Kassir Alaa , Mahmassani Dina , Bachir Rana , El Sayed Mazen
Published: March 2021

Background:

The weekend effect is the increased mortality in hospitalized patients admitted on the weekend. The aim of this study was to examine the effect of weekend admissions on septic shock patients.

Methods:

This is a retrospective observational study of the 2014 Nationwide Emergency Department Sample Database. Septic shock patients were included in this study using ICD-9-CM codes. Descriptive analysis was done, in addition to bivariate analysis to compare variables based on admission day. Multivariate analysis was conducted to examine the association between admission day and mortality in septic shock patients after adjusting for potential confounding factors.

Results:

A total of 364,604 septic shock patients were included in this study. The average age was 67.19 years, and 51.1% were males. 73.0% of patients presented on weekdays. 32.3% of septic shock patients died during their hospital stay. After adjusting for confounders, there was no significant difference in the emergency department or in-hospital mortality of septic shock patients admitted on the weekend compared with those admitted during weekdays, (OR = 1.00 [95% CI: 0.97–1.03], P value = 0.985).

Conclusion:

There was no statistically significant difference in overall mortality between septic shock patients admitted on the weekend or weekday. Our results are contradictory to previous studies showing an increased mortality with the weekend effect. The previous observations that have been made may not stand up with current treatment protocols.
Utilizing Outpatient Pelvic Reconstructive Surgery in the Era of the COVID-19 Pandemic
Authors: Berger Alexander A. , Tan-Kim Jasmine , Menefee Shawn A.
Published: March 2021

Objective

The COVID-19 pandemic has created a significant strain on the medical system, creating resource scarcity. We sought to demonstrate the reduction in hospital room utilization after implementation of outpatient pelvic reconstructive surgery.

Methods

We included all minimally invasive reconstructive surgical procedures in this retrospective cohort study within a large managed care organization of 4.5 million members (2008–2018). We queried the system-wide medical record for Current Procedural Terminology (CPT), International Classification of Diseases, Ninth Revision (ICD-9), and International Classification of Diseases, Tenth Revision (ICD-10) codes for all included procedures and patient perioperative data. Categorical variables were compared using χ2 test for categorical variables and the Kruskal-Wallis test for continuous variables.

Results

Of the 13,445 patients undergoing pelvic reconstructive surgery, 5,506 were discharged the same day, whereas 7,939 were discharged the next day. Over the 10-year period, patients without hysterectomy had outpatient surgery rates increase from 31.2% to 76.4% (+45.2%), whereas those with hysterectomy increased from 3% to 56.4% (+53.4%). Hospital room utilization decreased by 45,200 room days/100,000 reconstructive procedures without hysterectomy and 53,400 room days/100,000 reconstructive procedures with hysterectomy. When compared to 2008, in 2018 after more widespread adoption of outpatient elective surgery, for the 738 patients undergoing surgery without hysterectomy, 334 less room days were used, whereas 335 less room days were used among the 640 patients who had a surgical procedure with hysterectomy.

Conclusions

The implementation of outpatient pelvic reconstructive procedures leads to a significant reduction in hospital room utilization. Same-day discharge decreases hospital resource utilization, therefore improving hospital access, which may be essential for the delivery of routine care during times of resource scarcity such as the COVID-19 pandemic.
Peribacillus faecalis sp. nov., a moderately halophilic bacterium isolated from the faeces of a cow
Authors: Jiang Lingmin , Jung Won Yong , Li Zhun , Lee Mi-Kyung , Park Seung-Hwan , Kang Se Won , Lee Jung-Sook , Jung Hyunjung , Hur Tai-Young , Kim Hyeun Bum , Kim Jae-Kyung , Lee Ju-Hoon , Lee Ju Huck , Lee Jiyoung
Published: March 2021

A Gram-stain-positive, facultatively anaerobic, endospore-forming, rod-shaped strain, AGMB 02131T, which grew at 20–40 °C (optimum 30 °C), pH 3.0–11.0 (optimum pH 4.0) and in the presence of 0–18 % (w/v) NaCl (optimum 10 %), was isolated from a cow faecal sample and identified as a novel strain using a polyphasic taxonomic approach. The phylogenetic analysis based on 16S rRNA gene sequences along with the whole genome (92 core gene sets) revealed that AGMB 02131T formed a group within the genus

Peribacillus

, and showed the highest sequence similarity with

Peribacillus endoradicis

DSM 28131T (96.9 %), following by

Peribacillus butanolivorans

DSM 18926T (96.6 %). The genome of AGMB 02131T comprised 70 contigs, the chromosome length was 4 038 965 bp and it had a 38.5 % DNA G+C content. Digital DNA–DNA hybridization revealed that AGMB 02131T displayed 21.4 % genomic DNA relatedness with the most closely related strain,

P. butanolivorans

DSM 18926T. AGMB 02131T contains all of the conserved signature indels that are specific for members of the genus

Peribacillus

. The major cellular fatty acids (>10 %) of AGMB 02131T were C18 : 1ω9c, C18:0 and C16 : 0. The major polar lipids present were diphosphatidylglycerol, phosphatidylglycerol and phosphatidylethanolamine. On the basis of the phenotypic, phylogenetic, genomic and chemotaxonomic features, AGMB 02131T represents a novel species of the genus

Peribacillus

, for which the name Peribacillus faecalis sp. nov. is proposed. The type strain is AGMB 02131T (=KCTC 43221T=CCTCC AB 2020077T).
Unmasking the Current Scenario of Indian Biomedical Devices Industry: Ventilators being the Heart of the Discussion
Authors: Pramanik Sheersha , Karmakar Sucheta , Mukherjee Shreyas , Dhavale Indraneel , Shrestha Rohan
Published: March 2021

Background

The Indian Biomedical Device Industry has been growing at an unprecedented rate, but several hindrances need to be acknowledged in offering access to quality, budget-friendly medical devices in India. This article explores the current loopholes of the Indian biomedical device industry along with the proposal of various innovative solutions, with emphasis on ventilators.

Methods

An online survey with the help of Google forms was conducted from 1st November to 25th December 2020, addressing the problems of the Indian medical device industry (MDI) along with probable solutions. The survey also provides a glimpse into the complications aroused from the frequent use of ventilators during COVID-19 outburst, along with possible measures.

Results

According to the survey, 51.6%, 46.5%, 55.7%, and 47.5% of respondents have agreed to ‘Stringent laws and implementation,’ ‘Safety testing and strict regulations,’ ‘Unfavorable duty structure,’ and ‘Reducing tax rate on domestic manufacturers,’ as a possible solution to advance the implementation of ISO 13485 and ISO 10651, implementation of ISO 14971, the probable cause of limitations of Indian MDI, possible measure to overcome limitations of Indian MDI, respectively. 46.7%, 47.5%, 46.2%, and 44.6% of respondents have agreed to ‘Surgical decompression,’ ‘Nebulized and broad-spectrum antibiotics,’ ‘PEEP,’ and ‘Adopting lung protective ventilation strategies’ as possible solutions to treat various ventilator complications, respectively.

Conclusion

The study briefs about the people’s perception of the Indian MDI as well as on the ventilator complications. The results complied with our hypothesis as the majority of the respondents have agreed with almost all the probable solutions in both the sections given by us as options.
Utility of a Clinical Scoring System for Point of Care Triaging in COVID-19 Pneumonia
Authors: Gangemi Andrew J , Gupta Rohit , Fernandez-Romero Gustavo , Zhao Huaqing , Patel Maulin , Chowdhury Junad , Zantah Massa , Zheng Matthew , Abramian Osheen , Codella Stephen , Vien Linda , Dominguez-Castillo Eduardo , Buckey Timothy , Earley Charles , Frankovich Jourdan , Jurkowski Mali , Jurkowski Zachary , O’Brien Jenny , Guo Nanzhou , Stanley Paige , Halsey Brenton , Kahlon Jasleen , Kaur Navjot , Prosniak Roman , Kumaran Maruti , Dass Chandra , Fleece David , Jacobs Michael R , Criner Gerard J.
Published: March 2021

Background

Surges in COVID-19 disease cases can rapidly overwhelm healthcare resources; triaging to appropriate levels of care can assist in resource planning. At the beginning of the pandemic, we developed a simple triage tool, the Temple COVID-19 Pneumonia Triage Tool (TemCOV) based on a combination of clinical and radiographic features that are readily available on presentation to categorize and predict illness severity.

Methods

We prospectively examined 579 sequential cases admitted to Temple University Hospital who were assigned severity categories on admission. Our primary outcome was to compare the performance of TemCOV in predicting patients who have the highest likely of admission to the ICU at 24 and at 72 hours to other standard triage tools: the National Early Warning System (NEWS), the Modified Early Warning System (MEWS) and the CURB65 score. Additional endpoints included need for invasive mechanical ventilation (IMV) within 72 hours, total hospital admission charges, and mortality.

Results

26% of patients fell within our highest risk Category 4 and were more likely to require ICU admission at 24 hours (OR 11.51) and 72 hours (OR 8.6). Additionally they had the highest likelihood of needing IMV (OR 29.47) and in-hospital mortality (OR 2.37)., TemCOV performed similar to MEWS in predicting ICU admission at 24 hours (receive operator characteristic (ROC) curve area under the curve (AUC) 0.77 vs. 0.74, p=0.21) but better than NEWS2 and CURB65 (ROC AUC 0.77 vs. 0.69 and 0.77 vs. 0.64, respectively, p<0.01). While all severity scores had a weak correlation to hospital charges, the TemCOV performed the best among all severity scores measured (r=0.18); median hospital charges for Category 4 patients was $170,468 ($96,972-$487,556).

Conclusion

TemCOV is a simple triage score that can be used upon hospitalization in patients with COVID-19 that predicts the need for hospital resources such as ICU bed capacity, invasive mechanical ventilation and personnel staffing.