bluuebunny/crossref_metadata_2025 huggingface dataset:
Glucose deprivation enhances resistance to paclitaxel via ELAVL2/4-mediated modification of glycolysis in ovarian cancer cells
Authors: Park Ga Bin , Jeong Jee-Yeong , Choi Sangbong , Yoon Yoo Sang , Kim Daejin
Published: August 2021

The dysregulation of glycolysis regardless of oxygen availability is one of the major characteristics of cancer cells. While the drug resistance of ovarian cancer cells has been extensively studied, the molecular mechanism of anticancer drug resistance under low-glucose conditions remains unknown. In this study, we investigated the pathway mediating drug resistance under low-glucose conditions by examining the relationship between embryonic lethal abnormal vision Drosophila homolog-like (ELAVL) protein and glycolysis-related enzymes. Ovarian cancer cells resistant to 2.5 nM paclitaxel were exposed to low-glucose media for 2 weeks, and the expression levels of ELAVL2, ELAVL4, glycolytic enzymes, and drug resistance-related proteins were elevated to levels comparable to those in cells resistant to 100 nM paclitaxel. Gene silencing of ELAVL2/4 using small interfering RNA prevented the upregulation of glycolysis-related enzymes, reduced lactate production, and sensitized 2.5 nM paclitaxel-resistant ovarian cancer cells to anticancer agents under hypoglycemic conditions. Furthermore, pharmacological inhibition of glycolytic enzymes with 2-deoxyglucose, a specific inhibitor of glycolysis, triggered caspase-dependent apoptosis, reduced lactate generation, and blocked the expression of drug resistance-related proteins under low-glucose conditions. These results suggest that the level of ELAVL2/4 is responsible for the development of chemoresistance through activation of the glycolysis pathway under glucose deprivation conditions.
Molecular characteristics of single patient-derived glioma stem-like cells from primary and recurrent glioblastoma
Authors: Shi Jia , Dong Xuchen , Han Wei , Zhou Peng , Liu Liang , Wang Haiyang , Jiang Qianqian , Li Haoran , Cheng Shan , Li Suwen , Yuan Jiaqi , Qian Zhiyuan , Dong Jun
Published: August 2021

Glioblastoma has high recurrence, while the sensitivity of recurrent glioblastoma to chemotherapy is lower than that of primary glioblastoma. Moreover, there is no standardized treatment for recurrent glioblastoma. Unfortunately, the biological mechanism of recurrent glioblastoma is still unclear, and there are few related studies. We compared the phenotypes of clinical glioblastoma specimens, in-vitro cultured glioma stem-like cells (GSCs) and patient-derived xenograft tumor (PDX) models to explore the molecular genetic characteristics of primary and recurrent glioblastoma from the same patient. In vitro, SU5-2, GSCs derived from recurrent glioblastoma specimens, had stronger proliferative activity and self-renewal ability. Meanwhile, SU5-2 was more resistant to temozolomide and invasive than SU5-1, which derived from primary glioblastoma specimens. Further analysis of the expression of costimulatory molecules showed that the expression of B7-H1, B7-H2 and B7-H3 of SU5-2 were upregulated. In vivo, Kaplan–Meier survival curve analysis showed that the median survival of the recurrent PDX group was worse. The results of gene detection in vitro, PDX model and clinical samples were consistent. Our results showed that the GSCs based on glioblastoma specimens and the PDX models could replicate the main molecular genetic characteristics of original tumors, which provided a reliable experimental platform for both tumor translation kinds of research and screening of molecular therapeutic targets.
Impact of KMN network genes on progression and prognosis of non-small cell lung cancer
Authors: Gao Han , Pan Qing-yun , Wang Ying-ju , Chen Quan-fang
Published: August 2021

The Knl1-Mis12-Ndc80 (KMN) network genes (including KNL, MIS12 and NDC80 complexes) encode a highly conserved network of protein complexes that act in cell mitosis. In recent years, multiple studies revealed that KMN network genes also play a vital role in tumor appearance and growth. However, the role of the KMN gene network in non-small cell lung cancer (NSCLC) remains unknown. In this study, we analyzed the effects of KMN genes expression and clinical phenotype in patients with lung adenocarcinoma (LUAD). The expression of KMN network genes and related clinical information was extracted from The Cancer Genome Atlas. The samples were classified into cluster I and II by consistent clustering. We analyzed the gene distribution by principal component analysis, and the potential risk characteristics were analyzed using the least absolute shrinkage and selection operator Cox regression algorithm. Univariate and multivariate Cox regression analyses were used to analyze the clinical information. The Database for Annotation, Visualization, and Integrated Discovery, Gene MANIA and gene set enrichment analysis were used to analyze function and correlation among genes of the KMN network. The expression levels of nine out of ten KMN genes were significantly up-regulated in LUAD and were associated with poor overall survival (OS). Higher expression of NDC80 and KNL1 was related to low OS in both univariate and multivariate analyses. According to two independent prognostic KMN network genes (KNL1 and NDC80), a risk signature was established to predict the prognosis of patients with LUAD. Additionally, the genes NDC80 and KNL1 were considerably enriched in pathways associated with signaling pathways, biological processes, and the cell cycle. The results indicate that KMN network genes are intimately related to lung adenocarcinoma. KMN network genes are involved in the malignant process of LUAD. Assessment of NDC80 and KNL1 might be helpful for prognostic stratification and treatment strategy development.
The role of autologous stem-cell transplantation in multiple myeloma in 2021
Authors: Mina Roberto , Gay Francesca
Published: August 2021

Purpose of review

In this review, we discuss the most important aspects of the role of high-dose melphalan (HDM) and autologous stem-cell transplantation (ASCT) in the treatment of multiple myeloma (MM).

Recent findings

Almost 40 years after the publication of the first study on safety and efficacy of HDM and ASCT in MM patients, and despite the introduction of several drugs and combinations with various targets on the plasma cell and the surrounding microenvironment, HDM–ASCT still stands as a standard of care for the upfront treatment of newly diagnosed MM patients. Indeed, all attempts to replace HDM–ASCT with novel-agent-based, non-transplant strategies have failed to demonstrate their efficacy, at least in terms of progression-free survival.

Despite such a long history in MM, a number of open issues regarding HDM–ASCT still exist, from the choice between using transplant in first-line therapy or at relapse to the use of tandem HDM–ASCT in high-risk patients. With the introduction of more and more effective multidrug regimens and of novel immunotherapeutic approaches, the challenge between transplant and non-transplant is not over yet.
Management of recurrent miscarriages: an overview of current evidence
Authors: Tsonis Orestis , Balogun Stephanie , Adjei Jennifer Owusu , Mogekwu Oluremi , Iliodromiti Stamatina
Published: August 2021

Purpose of review

Recurrent miscarriage (RM) or recurrent pregnancy loss (RPL) is defined as the consecutive loss of two or more pregnancies before the age of viability. The exact prevalence of RM is unknown, but it has been reported between 1% and 2%. The objective of this review is to provide a critical summary of the latest evidence for the investigation and management of women with RM.

Recent findings

RMs are associated with multiple factors including increased female age and lifestyle habits, as well as genetic factors, hereditary and acquired thrombophilia and infections. Metabolic and endocrine factors, in addition to anatomical causes such as uterine malformations have also been suggested as a causative factors of RM.

The management of RM would be expected to cause specific, however, in the majority of the cases no cause is identified, and the factors associated with RM may not be causally related with the condition.
Effects of the COVID-19 pandemic on family planning services
Authors: Stanton Taylor , Bateson Deborah
Published: August 2021

Purpose of review

The COVID-19 pandemic has highlighted existing healthcare disparities worldwide and has challenged access to family planning (FP) services.

Recent findings

Research has identified ways in which government regulations and healthcare programs have inhibited or increased access to FP services, as well as how the pandemic has changed individuals’ sexual and reproductive health behaviors and intentions.

The pandemic has had both positive and negative effects on access to FP services. Innovations in various delivery services, extended use of contraception, telehealth for medication abortion, and a no-test medication abortion protocol have decreased the need for in-person visits and improved access to FP services.
Cardiovascular prognosis in patients admitted to an emergency department with hypertensive emergencies and urgencies
Authors: Paini Anna , Tarozzi Luca , Bertacchini Fabio , Aggiusti Carlo , Rosei Claudia Agabiti , De Ciuceis Carolina , Malerba Paolo , Broggi Alberto , Perani Cristiano , Salvetti Massimo , Muiesan Maria Lorenza
Published: August 2021

Background:

At present, few data are available on the prognosis of hypertensive emergencies and urgencies admitted to emergency departments.

Aim:

The aim of our study was to evaluate the incidence of total and cardiovascular events during follow-up in hypertensive patients admitted to the emergency departments of Brescia Hospital (Northern Italy) with hypertensive emergencies or urgencies from 1 January to 31 December 2015.

Methods:

Medical records of patients aged more than 18 years, admitted to the emergency department with SBP values at least 180 mmHg (SBP) and/or DBP values at least 120 mmHg (DBP) were collected and analysed (18% of patients were classified as ‘hypertensive emergency’ and 82% as ‘hypertensive urgency’). Data in 895 patients (385 men and 510 women, mean age 70. 5 ± 15 years) were analysed; the mean duration of follow-up after admission to the emergency department was 12 ± 5 months.

Results:

During the follow-up, 96 cardiovascular events (28 fatal) occurred (20 cardiac events, 30 cerebrovascular events, 26 hospital admission for heart failure, 20 cases of new onset kidney disease). In 40 patients (4.5%), a new episode of acute blood pressure rise with referral to the emergency department was recorded. Cardiovascular mortality and morbidity were greater in patients with a previous hypertensive emergency (14.5 vs. 4.5% in patients with hypertensive emergency and urgency, respectively, chi-square, P < 0.0001). Similar results were obtained when the occurrence of cerebrovascular or renal events were considered separately.

Conclusion:

Admission to the emergency department for hypertensive emergencies and urgencies identifies hypertensive patients at increased risk for fatal and nonfatal cardiovascular events. Our findings add some new finding suggesting that further research in this field should be improved aiming to define, prevent, treat and follow hypertensive urgencies and emergencies.
Optimal target blood pressure for major adverse cardiovascular and cerebrovascular events in hypertensive patients: a nationwide population-based study
Authors: Kim Seon-Mi , Kim Do-Hyang , Ryu Dong-Ryeol , Lee Soojin , Kim Yaerim , Park Sehoon , Cho Semin , huh Hyuk , Hwang Jinseub , Lee Jung-Pyo , Han Seung-Seok , Lee Hajeong , Kim Dong-Ki , Joo Kwon-Wook , Lim Chun-Soo , Kim Yon-Su , Oh Hyung Jung
Published: August 2021

Background: Generalizing an ‘optimal’ blood pressure (BP) level for individuals with hypertension remains controversial due to the implementation of different medical guidelines. This study investigated the association of BP with major adverse cardiovascular and cerebrovascular events (MACCE) and determined the optimal BP for patients with hypertension.

Method: A total of 934 179 individuals who received antihypertensive medications were selected from the National Health Insurance Service Examination Database between 2003 and 2011 in Korea. Their BP was measured at the index date, which was the first health examination. The study outcomes were MACCE, including acute myocardial infarction, heart failure, stroke, and all-cause mortality. The participants were monitored until in December, 2017. The hazard ratios were calculated using Cox proportional hazard models. The cumulative incidence of MACCE for each BP group was estimated using the Kaplan–Meier method.

Results: A lower risk of MACCE was observed at a SBP of 120–129 mmHg and a DBP of 80–89 mmHg. The endpoint-specific incidence rates and hazard ratios for acute myocardial infarction, heart failure, stroke, and all-cause mortality were the lowest at a SBP of 120–129 mmHg and a DBP of 80–89 mmHg.

Conclusion: Even though this observational study did not support inference of a causal relationship, a SBP of 120–129 mmHg and a DBP of 80–89 mmHg may be safely recommended considering the possibility of MACCE in Korean patients with hypertension. In addition, the target BP should be tailored individually according to age, sex, and comorbidities.
Predicted cardiovascular risk for United States adults with diabetes, chronic kidney disease, and at least 65 years of age
Authors: Jaeger Byron C. , Sakhuja Swati , Hardy Shakia T. , Akinyelure Oluwasegun P. , Bundy Joshua D. , Muntner Paul , Whelton Paul K.
Published: August 2021

Background:

The 2017 American College of Cardiology/American Heart Association blood pressure (BP) guideline recommends using 10-year predicted atherosclerotic cardiovascular disease (ASCVD) risk to guide decisions to initiate antihypertensive medication.

Methods:

We included adults aged 40–79 years from the National Health and Nutrition Examination Survey 2013–2018 (n = 8803). We computed 10-year predicted ASCVD risk using the Pooled Cohort risk equations. Clinical CVD was self-reported. Analyses were conducted overall and among those with stage 1 hypertension, defined by a mean SBP of 130–139 mmHg or DBP of 80–89 mmHg. In subgroups defined by diabetes, chronic kidney disease (CKD), and age at least 65 years, we estimated the proportion of United States adults with high ASCVD risk (i.e. 10-year predicted ASCVD risk ≥10% or clinical CVD) and estimated age-adjusted probability of having high ASCVD risk.

Results:

Among United States adults, an estimated 72.3, 64.5, and 83.9 of those with diabetes, CKD, and age at least 65 years had high ASCVD risk, respectively. Among United States adults with stage 1 hypertension, an estimated 55, 36.7, and 72.6% of those with diabetes, CKD, and age at least 65 years had high ASCVD risk, respectively. The probability of having high ASCVD risk increased with age and exceeded 50% for United States adults with diabetes and CKD at ages 52 and 57 years, respectively. For those with stage 1 hypertension, these ages were 55 and 64 years, respectively.

Conclusion:

Most United States adults with diabetes, CKD, or age at least 65 years had high ASCVD risk. However, many with stage 1 hypertension did not.
Effect of parental arterial stiffness in offspring: the Kailuan study
Authors: Wu Yuntao , Liu Qian , Ma Yihan , Han Xu , Zhao Xiaohong , Zhao Haiyan , Song Mingzhu , Sun Junyan , Wang Xingyu , Wu Shouling
Published: August 2021

Objective:

The aim of this study was to examine effect of parental arterial stiffness in offspring.

Methods:

The individuals who participated in the second or subsequent follow-up and had parent-offspring relationship and completed measurements of brachial-ankle pulse wave velocity (baPWV) from the Kailuan study were recruited. The individuals were divided into groups by the 10-year intervals and sex. Arterial stiffness was defined as the 75th percentiles in each age category. Multivariable generalized estimating equations was used to analyse the effect of parental baPWV and blood pressure in offspring. Multivariable logistic regression using generalized estimating equations was used to analyse the effect of parental arterial stiffness in offspring.

Results:

A total of 4514 parents and offspring who met the inclusion criteria, including 1785 paternal offspring and 625 maternal offspring was recruited. Mean age of paternal offspring and maternal offspring were 36.26 (SD 7.86) and 36.42 (SD 7.57) years, while their mean baPWV were 1294.40 (SD 225.32) and 1270.74 (SD 241.42) cm/s, respectively. In multivariate linear regression analyses, after adjusted for the covariate risk factors, an increase of 1 cm/s in the paternal and maternal baPWV of resulted in an increase of 0.05 and 0.30 cm/s in offspring, respectively. In multivariate logistic regression analyses, the risk of arterial stiffness in the offspring of paternal and maternal arterial stiffness increased by 50 and 77%, respectively.

Conclusion:

Paternal and maternal baPWV are linear positively correlated with baPWV in offspring. Parental arterial stiffness is a risk factor for arterial stiffness of offspring and is independent of traditional risk factors of offspring arterial stiffness.
Sirtuin1 contributes to the overexpression of Giα proteins and hyperproliferation of vascular smooth muscle cells from spontaneously hypertensive rats
Authors: Li Yuan , Hossain Ekhtear , Arifen Nahida , Srivastava Ashok K. , Anand-Srivastava Madhu B.
Published: August 2021

Background:

We earlier demonstrated that vascular smooth muscle cells (VSMC) from spontaneously hypertensive rats (SHR) exhibit the overexpression of Giα proteins and hyperproliferation that is attributed to the enhanced levels of endogenous angiotensin II (Ang II). In addition, the implication of Sirtuin1 (Sirt1) a histone deacetylase class III family in Ang II-induced hypertension has also been shown. We recently demonstrated that Ang II increased the expression of Sirt1 in aortic VSMC that contributed to the overexpression of Giα proteins. However, whether Sirt1 is overexpressed in VSMC from SHR and is linked to the enhanced expression of Giα proteins and hyperproliferation remains unexplored.

Method and results:

In the present study, we show that Sirt1 is upregulated in VSMC from SHR and this upregulation was attenuated by AT1 receptor antagonist losartan. In addition, the inhibition or knockdown of Sirt1 by specific inhibitors EX 527 and NAM and/or siRNA attenuated the enhanced expression of Giα proteins, cell cycle proteins and hyperproliferation of VSMC from SHR. Furthermore, the enhanced levels of reactive oxygen species (ROS), hydrogen peroxide and NADPH oxidase subunits NOX2 and p47phox, increased phosphorylation of EGFR, ERK1/2 and AKT displayed by VSMC from SHR were also attenuated by knocking down of Sirt1 by siRNA.

Conclusion:

In summary, our results demonstrate that Sirt1 is overexpressed in VSMC from SHR which through augmenting oxidative stress contributes to the enhanced expression of Giα proteins, cell cycle proteins and resultant hyperproliferation of VSMC.
Prevention of vision-threatening complications in diabetic retinopathy: two perspectives based on results from the DRCR Retina Network Protocol W and the Regeneron-sponsored PANORAMA
Authors: Nanegrungsunk Onnisa , Bressler Neil M.
Published: August 2021

Purpose of review

The use of intravitreous antivascular endothelial growth factor to prevent center-involved diabetic macular edema (CI-DME) with vision loss and proliferative diabetic retinopathy (PDR) has been investigated and recently reported in two randomized clinical trials. Although both trials showed substantial superiority of aflibercept at preventing the development of vision-threatening complications (VTCs) of CI-DME or PDR compared with sham at 1 or 2 years, without a concomitant benefit in visual acuity outcomes, the interpretation of the results and its application to clinical practice resulted in two disparate opinions. In this review, we discuss these two trials including their similarities and differences, other relevant studies, and considerations regarding the interpretation and the application of these results into clinical practice.

Recent findings

The Diabetic Retinopathy Clinical Research Retina Network Protocol W and the PANORAMA study demonstrated significantly lower probabilities of developing CI-DME or PDR at 2 years with intravitreous aflibercept compared with sham in eyes with moderate (Protocol W) or moderately severe (PANORAMA) to severe non-PDR (NPDR). However, visual acuity outcomes were not different.

Although intravitreous aflibercept injections reduce the risk of VTCs in eyes with moderate-to-severe NPDR, the absence of visual acuity benefits supports the need for four-year results.
Telemedicine in neuro-ophthalmology
Authors: Ramakrishnan Meera S. , Gilbert Aubrey L.
Published: August 2021

Purpose of review

The COVID-19 public health emergency accelerated the adoption of telemedicine in neuro-ophthalmology. This review surveys the current telemedicine landscape and discusses associated limitations and opportunities.

Recent findings

Logistic considerations and regulatory changes related to the COVID-19 pandemic have spurred a proliferation of tele-neuro-ophthalmic practice. One significant benefit of telemedicine is increased access to the limited number of neuro-ophthalmologists in the country. Certain elements of the neuro-ophthalmic examination can be ascertained during a video visit or through the use of mobile applications. However, data quality can be limited and more direct evaluation of the fundus currently requires the implementation of imaging techniques, such as fundus photography and/or optical coherence tomography. For cases that require it, a ‘hybrid’ model can be adopted in which patients physically present to designated locations for testing and subsequently participate in televisit with the physician to discuss the assessment and plan.

Telemedicine provides an alternate pathway for patients to access the limited resource of neuro-ophthalmic care, and it will likely persist beyond the current COVID-19 pandemic. It has some limitations currently but continued progress in technologic, legal, and reimbursement strategies will hopefully facilitate further adoption.
Serologic Diagnosis of Acute Rickettsiosis in Children in Southern Israel
Authors: Sharabi Shiran , Sagi Orli , Ben-Shimol Shalom
Published: August 2021

We assessed serology results of clinically suspected rickettsiosis episodes in the hospital setting. Overall, 322 of 963 (33%) cases were serology positive. Among those, rash rates were low (30%), murine typhus (MT) predominated over spotted fever and IgM positivity rate was higher in MT. These findings suggest that during acute rickettsiosis, serology may reliably identify MT infection but may underdiagnose spotted fever.
Hypotonic-hyporesponsive Episodes After Diphtheria, Tetanus and Acellular Pertussis Vaccination
Authors: Hansen John , Decker Michael D. , Lewis Edwin , Fireman Bruce , Pool Vitali , Greenberg David P. , Johnson David R. , Black Steven , Klein Nicola P.
Published: August 2021

Background:

Hypotonic-hyporesponsive episode (HHE) after whole cell pertussis vaccination is a known adverse event. Less is known about the risk of HHE after administration of acellular pertussis vaccines.

Methods:

Using parental interviews, this study actively surveyed for HHE among infants after doses 1 and 2 of acellular pertussis vaccine.

Results:

We interviewed the parents of 52,531 infants. HHE was reported at a rate of 22.8 per 100,000 doses (95% CI: 11.8–39.9) of acellular pertussis vaccine, approximately 45 episodes per 100,000 children.

Conclusions:

These rates are lower than HHE rates reported after whole cell pertussis vaccines and within the range of HHE rates reported in other studies of acellular pertussis vaccines.
Implementing Social Determinant of Health Screening in a Family Medicine Clinic: A Pilot Study
Authors: Isaacs Karen
Published: August 2021

While unmet social needs can perpetuate barriers to health equity, health care staff may feel unprepared to address these needs. This article describes a pilot study on implementing a screening process for social determinants of health in a family medicine clinic where there was no prior standard of care. A quality improvement approach was used to frame the implementation and evolution of screening and follow-up strategies for social needs. Social determinant of health screening was successfully implemented during this pilot of 400 encounters, revealing a 26.3% prevalence. Options for addressing social needs grew during the study, although no statistically significant impact was observed on measured short-term health outcomes. Physicians can use quality improvement to counter clinical inertia toward addressing social determinants of health and also to concurrently screen and develop appropriate patient-oriented solutions in their clinics.
Sexual History Taking: An Opportunity to Reduce Health Disparities
Authors: Mintz Laura Janine , Moore Scott Emory
Published: August 2021

Sexual history taking is an important part of caring for any clinical population. However, the topic is often wrapped in discomfort that makes it more challenging than it needs to be for both the provider and the individual providing the history. The act of taking an effective sexual history is more than simply asking all the right questions in the right ways; it requires an awareness of the impact of the clinical environment, the provider's own comfort with the content, and an awareness of any personal biases. In this study, we provide a framework for evaluating and addressing many of these factors as well as providing key points for consideration as a health care provider of any level. We offer several concrete strategies for including these strategies and processes in multiple clinical environments.
Aerosol Transmission of Infectious Disease and the Efficacy of Personal Protective Equipment (PPE)
Authors: Locke Laramie , Dada Oluwabunmi , Shedd Jacob S.
Published: August 2021

Objective:

Health care professionals and governmental agencies are in consensus regarding contact and droplet transmission of infectious diseases. However, personal protective equipment (PPE) efficacy is not considered for aerosol or airborne transmission of infectious diseases. This review discusses the inhalation of virus-laden aerosols as a viable mechanism of transmission of various respiratory infectious diseases and PPE efficacy.

Methods:

The Preferred Reporting Items for Systematic reviews, and Meta-Analysis (PRISMA) guidelines was used.

Results:

The transmission of infectious disease is of concern for all respirable diseases discussed (SARS-CoV-1, SARS-CoV-2, MERS, influenza, and tuberculosis), and the effectiveness of facemasks is dependent on the efficiency of the filter, fit, and proper use.

Conclusion:

PPE should be the last resort in preventing the spread of infectious disease and should only be used for protection and not to control the transmission.
Association Between Abrupt Change to Teleworking and Physical Symptoms During the Coronavirus Disease 2019 (COVID-19) Emergency Declaration in Japan
Authors: Tezuka Masato , Nagata Tomohisa , Saeki Kenta , Tsuboi Yamato , Fukutani Naoto
Published: August 2021

Objective:

We investigated the association between telework frequency and the presence of non-COVID-19–related physical symptoms during the COVID-19 emergency declaration among workers in Japan.

Methods:

Data were collected from 1648 workers via web-based self-reported questionnaires. Multivariate logistic regression models were used to investigate the association between telework frequency per week (0, 1–2, 3–4, and ≥5 days/week) and the presence of stiff shoulders, eyestrain, and low back pain.

Results:

Among 917 participants, telework frequency was significantly associated with stiff shoulders (≥5 days: adjusted odds ratio [aOR] 3.02, 95% confidence interval [CI] 1.37–7.06), eyestrain (≥5 days: aOR 5.31, 95% CI 2.09–13.44), and low back pain (≥5 days: aOR 5.57, 95% CI 2.22–14.00), compared with non-teleworkers.

Conclusions:

Workers who abruptly began telework experienced more physical symptoms than non-teleworkers during the emergency declaration.
Transtympanic Tripod-shaped Angiocatheter Insertion for Patients With Intractable Patulous Eustachian Tube
Authors: Park Jung Mee , Han Jae Sang , Park So Young , Park Shi Nae
Published: August 2021

Objective:

Despite the efforts to treat patients with patulous Eustachian tube (PET), intractable symptoms of PET may require surgical intervention. In this study, we introduce our surgical technique of “transtympanic tripod-shaped angiocatheter” (TTA) insertion and evaluate the safety and efficacy of the procedure in patients with intractable PET.

Study design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

Thirty-two cases (26 patients) diagnosed with intractable PET between the years 2011 and 2019 were included in this study.

Intervention:

All cases were surgically treated with TTA insertion.

Main outcome measures:

The clinical characteristics, surgical results, complication rates, and the level of satisfaction by questionnaires were analyzed for evaluation.

Results:

The mean age of enrolled patients was 40.9 ± 19.5 years, with slight male gender predominance (59.4% vs. 40.6%). Both ears were operated in six patients, simultaneously in three. All patients successfully received the insertion of TTA, with no immediate complication. Eleven cases were re-inserted after the first insertion due to the recurrence of symptoms or spontaneous extrusion of TTA. No major complications were observed during the follow-up period of 1 to 115 months (mean 37.7 mo). The average Visual Analogue Scale score of PET symptoms was significantly decreased (p < 0.05), along with 92% of patients with relief from autophony symptoms.

Conclusions:

TTA insertion is a relatively simple procedure that can be performed in a short period under local anesthesia. Surgical intervention of TTA insertion for patients with intractable PET symptoms seems promising with a high success rate.
Migraine Features in Patients With Isolated Aural Fullness and Proposal for a New Diagnosis
Authors: Risbud Adwight , Muhonen Ethan G. , Tsutsumi Kotaro , Martin Elaine C. , Abouzari Mehdi , Djalilian Hamid R.
Published: August 2021

Objective:

To compare the presence of migraine features between patients with isolated aural fullness (AF) who meet the diagnostic criteria for migraine headache and those who do not, and to propose diagnostic criteria for migraine-related AF based on our results.

Methods:

We performed a retrospective study of patients presenting to a tertiary-care neurotology clinic between 2014 and 2020 with migraine-related AF. This was defined as isolated, prolonged aural fullness concurrent with migraine features once other etiologies were ruled out via examination, audiometry, and imaging. Migraine features were compared between patients meeting the diagnostic criteria for migraine headache and those not meeting the criteria.

Results:

Seventy-seven patients with migraine-related AF were included. The mean age was 56 ± 15 years and 55 (71%) patients were female. Eleven (14%) patients fulfilled the criteria for migraine headache (migraine group). Of the 66 patients who did not meet the criteria (nonmigraine group), 17 (26%) met 4/5 criteria, and 32 (48%) met 3/5 criteria, for a total of 49 (74%) patients. The migraine and nonmigraine groups were only different in 5 of 20 features, including family history of migraine (p = 0.007), sound sensitivity (p < 0.001), mental fogginess (p = 0.008), visual motion sensitivity (p = 0.008), and light sensitivity (p < 0.001).

Conclusion:

There are minimal differences in the overall prevalence of migraine features between patients with migraine-related AF who meet and do not meet the diagnostic criteria for migraine. Our findings suggest that the criteria may be too stringent and exclude many patients from potentially benefitting from treatment with migraine prophylaxis.
Subtotal Petrosectomy with Cochlear Implantation or Osseointegrated Hearing Rehabilitation: A Single Institutional Study
Authors: Zhang Kathy , Yan Flora , Nguyen Shaun A. , Meyer Ted A.
Published: August 2021

Objective:

To examine audiologic outcomes and operative considerations for patients undergoing subtotal petrosectomy (STP) followed by implantable hearing restoration.

Study Design:

Retrospective review.

Setting:

Tertiary academic referral hospital.

Patients:

All patients who underwent STP and implantable hearing restoration from 2014 to 2020.

Interventions:

Single or staged STP with cochlear implantation (CI) or placement of an osseointegrated hearing implant (OHI).

Main Outcome Measures:

Indications for STP and CI or OHI; postoperative complication and reoperation rates; audiologic outcomes through speech recognition thresholds, AzBio sentence scores, and consonant-nucleus-consonant scores.

Results:

Twenty-six adults (age 33–85) and six children (age 1–17) underwent 37 STP procedures with 33 CIs and four OHI. Thirty-one cases were planned single-stage, but six (16%) cases required revision surgery postoperatively due to refractory postauricular infection and breakdown of wound closure. Therefore, 25 cases were single procedures and 12 were staged. Indications for staged procedures included extensive cholesteatoma (n = 5, 42%), chronic middle ear inflammation (n = 5, 42%), and osteoradionecrosis (n = 2, 17%). No patients with OHI required revision surgery. For patients undergoing CI, the mean speech recognition thresholds improved from 80 ± 21 dB to 31 ± 9 dB (p < 0.001), mean aided AzBio scores improved from 11% to 43% (p = 0.002) and aided consonant-nucleus-consonant word scores improved from 6% to 47% (p < 0.001) in quiet.

Conclusions:

Subtotal petrosectomy is effective for creating a safe, dry ear in patients with chronic inflammation or anatomically challenging ears. Rehabilitative hearing options following STP can be achieved safely, restoring hearing to an acceptable level with CI. Careful consideration should be undertaken to approach as a single or staged procedure.
Transmastoid Occlusion Surgery for Superior Semicircular Canal Dehiscence Syndrome Improves Patient-Reported Quality-of-Life Measures and corrects cVEMP Thresholds and Amplitudes
Authors: de Wolf Maarten J. F. , Dawe Nicholas , Jervis Suzanne , Kumar Raghu , Dalton C. Lucy , Lindley Karen , Irving Richard
Published: August 2021

Objective:

To determine the pre- and postoperative clinical, audiological, vestibular, and patient-reported measures in patients undergoing transmastoid occlusion surgery for superior canal dehiscence syndrome (SCDS).

Study Design:

Retrospective case review.

Setting:

Tertiary referral centre, UK.

Patients:

All primary transmastoid occlusion surgeries for SCDS were included (tertiary centre, single-surgeon), January 2008 to July 2019.

Interventions:

Transmastoid superior canal occlusion surgery for SCDS.

Main Outcome Measures:

We collated audiological (pure tone audiogram), vestibular (cervical vestibular evoked myogenic potentials [cVEMPs]), and patient-reported outcome measures (Dizziness Handicap Inventory and subjective symptom grading).

Results:

Fifty-two patients (55 ears) met the inclusion criteria. Thirty-one (56%) were female. Mean age was 47 years (range 29–63) and mean follow-up of 11.2 months. Six patients had bilateral disease, four of whom underwent sequential, bilateral surgery.

Autophony was the most frequent presenting symptom, improving in 92%.

Significant improvements were self-reported in patients’ autophony (p < 0.0001), pressure- and noise-induced dizziness (p < 0.0001 and p < 0.0001), aural fullness (p = 0.0159), pulsatile tinnitus (p < 0.0001), perceived hearing loss (p = 0.0058), and imbalance (p = 0.0303).

Overall Dizziness Handicap Inventory scores reduced from 45.9 to 27.4 (p < 0.0001), and across all subgroups of functional (p = 0.0003), emotional (p < 0.0001), and physical handicap (p = 0.0005).

A 6.4-dB HL improvement in the air–bone gap (500–1000 Hz) occurred (95% confidence intervals 3.3–9.4 dB HL, p < 0.0001). There were no dead ears. cVEMP thresholds, when recordable, normalized in all except two ears.

Conclusions:

Transmastoid occlusion is effective at improving patient-reported outcomes and normalizing cVEMP thresholds, though some symptoms, notably disequilibrium, persist to a variable degree.
Cost-effectiveness of Inpatient Tympanostomy Prophylaxis
Authors: Yeakel Heather , Pasick Luke J. , Kirchner Gregory J. , McKinnon Brian J. , Chiffer Rebecca C.
Published: August 2021

Objective:

Tympanostomy is the most common pediatric ambulatory surgery. Post-tympanostomy otorrhea is a prevalent complication leading to high costs to patients for treatment. The cost-effectiveness of intraoperative prophylaxis for both patient and institution has not been examined.

Study Design:

An analytical observational study of data collected from the literature and purchasing records.

Methods:

A break-even analysis was performed to determine the required absolute risk reduction (ARR) and final infection rate in post-tympanostomy otorrhea to make intraoperative prophylaxis using ofloxacin and ciprofloxacin dexamethasone otic version cost effective with the following outpatient treatments: ofloxacin, ciprofloxacin-dexamethasone ophthalmic version, and ciprofloxacin-dexamethasone otic version. Absolute risk reduction is a statistic used to express the difference in risk between a treatment and control. The conservative initial infection rate used was 10%.

Results:

Ofloxacin intraoperative prophylaxis was not cost effective when prescribing ofloxacin outpatient treatment with an ARR of 0.20. Ofloxacin intraoperative prophylaxis was cost-effective with an ARR of 0.08 for ciprofloxacin-dexamethasone ophthalmic version outpatient treatment. Ofloxacin intraoperative prophylaxis was cost-effective for ciprofloxacin-dexamethasone otic version outpatient treatment with an ARR of 0.01.

Ciprofloxacin-dexamethasone intraoperative prophylaxis was not cost-effective when prescribing ofloxacin outpatient treatment with an ARR of 1.52. Ciprofloxacin-dexamethasone intraoperative prophylaxis was not cost-effective when prescribing ciprofloxacin-dexamethasone ophthalmic version outpatient treatment with an ARR of 0.60. Ciprofloxacin-dexamethasone intraoperative prophylaxis was cost effective when prescribing ciprofloxacin-dexamethasone otic version outpatient treatment with an ARR of 0.09.

Conclusion:

Intraoperative prophylaxis can be cost effective for preventing post-tympanostomy otorrhea. Physicians can use this economic model to determine the cost-effectiveness of these interventions for their patients and institutions.
The Effects of Percutaneous Left Ventricular Assist Device Placement on Native Valve Competency
Authors: Hironaka Camille E. , Ortoleva Jamel , Zhan Yong , Chen Frederick Y. , Couper Gregory S. , Kapur Navin K. , Kawabori Masashi
Published: August 2021

Impella left ventricular assist devices (LVADs) (Abiomed, Danvers, MA) are implanted in the left ventricle across the aortic valve. Several cases of secondary aortic insufficiency (AI) or mitral regurgitation (MR) after Impella LVAD use have been reported. Secondary valvulopathies can worsen cardiac function. This single center retrospective study sought to characterize the incidence of secondary AI and MR development after Impella LVAD support. One hundred fifty-two patients who underwent Impella LVAD support between April 2014 and August 2019 were included. Patient demographics, implant indications, duration of support, pre- and post-Impella LVAD echocardiograms, and incidence of increased AI/MR were analyzed. Impella 5.0 and Impella CP were subanalyzed. Following exclusion criteria, AI and MR were analyzed in 93 and 78 patients, respectively. An increase in AI and MR was seen in 17.2% and 12.8% of patients with an event per support days of 0.03 and 0.02, respectively. Clinically significant increases in AI and MR were seen in 3.2% (n = 3), 6.4% (n = 5), respectively. The incidences of increased AI (p = 0.33) and MR (p = 0.45) were similar between Impella 5.0 and Impella CP patients. Worsening AI and MR clinically occur at a low incidence with Impella LVAD use. However, careful follow-up is still warranted.
Risk of Renal Dysfunction Following Heart Transplantation in Patients Bridged with a Left Ventricular Assist Device
Authors: Tibrewala Anjan , Khush Kiran K. , Cherikh Wida S. , Foutz Julia , Stehlik Josef , Rich Jonathan D.
Published: August 2021

Acute renal failure (ARF) and chronic kidney disease (CKD) are associated with short- and long-term morbidity and mortality following heart transplantation (HT). We investigated the incidence and risk factors for developing ARF requiring hemodialysis (HD) and CKD following HT specifically in patients with a left ventricular assist device (LVAD). We examined the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Transplant Registry for heart transplant patients between January 2000 and June 2015. We compared patients bridged with durable continuous-flow LVAD to those without LVAD support. Primary outcomes were ARF requiring HD before discharge following HT and CKD (defined as creatinine >2.5 mg/dl, permanent dialysis, or renal transplant) within 3 years. There were 18,738 patients, with 4,535 (24%) bridged with LVAD support. Left ventricular assist device patients had higher incidence of ARF requiring HD and CKD at 1 year, but no significant difference in CKD at 3 years compared to non-LVAD patients. Among LVAD patients, body mass index (BMI) (odds ratio [OR] = 1.79, p < 0.001), baseline estimated glomerular filtration rate (eGFR) (OR = 0.43, p < 0.001), and ischemic time (OR = 1.28, p = 0.014) were significantly associated with ARF requiring HD. Similarly, BMI (hazard ratio [HR] = 1.49, p < 0.001), baseline eGFR (HR = 0.41, p < 0.001), pre-HT diabetes mellitus (DM) (HR = 1.37, p = 0.011), and post-HT dialysis before discharge (HR = 3.93, p < 0.001) were significantly associated with CKD. Left ventricular assist device patients have a higher incidence of ARF requiring HD and CKD at 1 year after HT compared with non-LVAD patients, but incidence of CKD is similar by 3 years. Baseline renal function, BMI, ischemic time, and DM can help identify LVAD patients at risk of ARF requiring HD or CKD following HT.
The Impact of COVID-19 in Gastroenterology and Hepatology
Authors: Ramkissoon Resham , Wang Xiao Jing
Published: August 2021

The 2019 coronavirus disease (COVID-19), an airborne infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a global pandemic. SARS-CoV-2 relies on the angiotensin-converting enzyme 2 receptor for cellular entry and the abundance of this receptor in the gastrointestinal (GI) tract may help explain the GI manifestations, including dysgeusia, nausea, vomiting, diarrhea, and abdominal pain, present in over 40% of infected patients. GI tract involvement also raises the concern for oral-fecal transmission which is poorly understood. Outcome studies in COVID-19 patients with preexisting liver disease and inflammatory bowel disease show predominantly mild transaminase elevations and no increased risk from the use of biological agents in inflammatory bowel disease patients. High-dose corticosteroids, however, should be avoided. As endoscopic procedures are aerosol-generating, modifications to clinical practice is necessary to minimize the spread of COVID-19. We have reviewed current literature to describe the impact of COVID-19 in gastroenterology and hepatology as well as targets of future research.
The role of fluorodeoxyglucose-PET/computed tomography as a predictor of breast cancer characteristics and prognosis
Authors: Bae Sung Hun , Kim Ju-Yeon , Jung Eun Jung , Lee Han Shin , Choi Bong-Hoi , Kwag Seung-Jin , Park Ji-Ho , Cho Jin-Kyu , Kim Han-Gil , Ju Young-Tae , Jeong Chi-Young , Lee Young-Joon , Hong Soon-Chan , Kim Jae-Myung
Published: August 2021

Purpose

Fluorodeoxyglucose-PET/computed tomography (FDG-PET/CT) affects the management of patients with breast cancer. Our study aimed to determine the predictive ability of characteristics such as lymph node involvement or subtype and the prognostic value of pretreatment FDG-PET/CT in breast cancer.

Method

A total of 270 patients who were confirmed with breast cancer histopathologically and underwent pretreatment FDG-PET/CT were enrolled in the study. Nuclear medicine specialists obtained the readings and measured the maximum standardized uptake value (SUVmax) of the images. Tumor and lymph node SUVmax were evaluated according to lymph node metastasis and subtype status. Survival outcomes were analyzed by the Kaplan–Meier method.

Results

The lymph node SUVmax and the lymph node/tumor SUVmax ratio were significantly higher in the subgroup of patients with lymph node metastasis than in those without lymph node metastasis. High cutoff lymph node SUVmax value and lymph node/tumor SUVmax ratio were confirmed as significant predictive factors in multivariate analysis. In a comparison of the tumor SUVmax values, the more biological aggressive subtype showed higher tumor SUVmax values. In survival analysis, tumor SUVmax and lymph node SUVmax were significant predisposing factors for disease-free survival in breast cancer. In subgroup analysis, tumor SUVmax was a more significant prognostic factor in patients who had breast cancer with tumor sizes of ≤2 cm. The lymph node SUVmax was more a significant prognostic factor in patients who had breast cancer with lymph node metastasis.

Conclusion

In this study, we showed that the SUVmax of FDG-PET/CT was a useful predictor of lymph node metastasis and breast cancer prognosis.
Gut microbiota and sepsis: from pathogenesis to novel treatments
Authors: Kullberg Robert F.J. , Wiersinga W. Joost , Haak Bastiaan W.
Published: August 2021

Purpose of review

This review summarizes recent progress in our understanding of the role of the gut microbiota in sepsis pathogenesis and outlines the potential role of microbiota-targeted therapies.

Recent findings

The composition of the gut microbiome is profoundly distorted during sepsis, with a loss of commensal bacteria and an overgrowth of potential pathogenic micro-organisms. These alterations also extend to nonbacterial intestinal inhabitants. Disruptions of these intestinal communities are associated with both an increased susceptibility to develop sepsis, as well as a higher risk of adverse outcomes. Preclinical studies have characterized the effects of several microbiota-derived metabolites (such as D-lactate, butyrate, and deoxycholic acid) on enhancing the host immune response during critical illness. Microbiota-targeted therapies (e.g. probiotics or fecal microbiota transplantation) might be of benefit, but can also be associated with increased risks of bloodstream infections.

Emerging evidence display an important role of gut micro-organisms (including bacteria, fungi, eukaryotic viruses, and bacteriophages) and their derived metabolites in both the susceptibility to, as well as outcomes of sepsis. Despite recent progress in the mechanistic understanding of microbiota-mediated protection, clinical breakthroughs in the development of microbiota-based prognostic tools or therapies are thus far lacking in the field of sepsis.