bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of full-time vs volunteer faculty supervision on resident cataract surgery complications
Authors: Saifee Murtaza , Zhu Ivy , Lin Ying , Oldenburg Catherine E. , Ramanathan Saras
Published: February 2020

Purpose:

To examine the effect of teaching experience of supervising surgeons on resident cataract surgery intraoperative complication rates.

Setting:

Zuckerberg San Francisco General Hospital, University of California San Francisco, USA.

Design:

Retrospective chart review.

Methods:

Cataract surgeries performed by University of California San Francisco (UCSF) ophthalmology residents from 2010 to 2017 were reviewed. Only cases supervised by anterior segment attendings with more than 10 years of postresidency surgical experience were included. Cases were categorized as being supervised by either full-time UCSF teaching attendings or volunteer private practice attendings. Cases were graded as low risk (0 risk factors), intermediate risk (1 risk factor), or high risk (≥2 risk factors) based on 8 preoperative and intraoperative risk factors. Complication rates were compared between the 2 attending groups among varying risk grades.

Results:

Of 1377 cases, 101 developed complications. Among low-risk cases, full-time teaching attendings (25/619 [4.04%]) had a similar complication rate to volunteer attendings (17/387 [4.39%]) (odds ratio [OR] 0.92; P = .79). In intermediate-risk cases, full-time teaching attendings (28/195 [14.36%]) had slightly worse complication rates than volunteer attendings (10/88 [11.36%]) (OR 1.63; P = .45). High-risk cases had the highest complication rates, with the complication rates of full-time teaching attendings (16/72 [22.22%]) somewhat lower than those of volunteer attendings (5/16 [31.25%]) (OR 0.64; P = .48).

Conclusions:

For low-risk resident-performed cataract surgeries, supervision by full-time faculty and volunteer attendings yielded similar complication rates; thus, residency programs might safely recruit volunteer attendings to supervise low-risk cataract surgeries to support resident training. The analysis of higher-risk cases was limited by a low surgical volume.
Twist and out intraocular lens removal
Authors: Pandit Rahul T. , Devgan Uday , Chapman Jack M.
Published: February 2020

Foldable acrylic posterior chamber intraocular lenses (PC IOLs) can be removed via a variety of methods. In this technique, the PC IOL is freed from its position in the capsular bag or sulcus space and raised into the anterior chamber. The IOL is manipulated such that a haptic is externalized through a 2.2 mm corneal incision. A spatula is inserted through a paracentesis incision and placed above the PC IOL. Straight forceps are inserted through the main incision and the haptic/optic junction closest to the paracentesis is grasped with the hand completely supinated. The hand is then pronated while rolling the PC IOL around the forceps using the spatula to guide the PC IOL and guard the cornea. The forceps are then retracted through the main wound, enveloped by the PC IOL, thereby removing an acrylic PC IOL in its entirety using standard intraocular instruments through a 2.2 mm incision.
Ivermectin Topical
Authors: Thomas Suravi , Luke Janiene D.
Published: February 2020

Medications are chemical substances utilized in clinical practice to create an identified physiological outcome in patients. In the field of dermatology, medications can be given via specified routes (topical, oral, intravenous, intramuscular, etc.) or as various vehicles (creams, gels, ointments, patches, etc.) to treat conditions that manifest in the skin. This column highlights the use of topical ivermectin as a viable treatment option for the inflammatory lesions associated with papulopustular rosacea. We will discuss its mechanism of action, administration and dosing, adverse effects, and viable alternatives to both newer and more commonly employed medications.
Transtibial Prosthetic Socket Strength: The Use of ISO 10328 in the Comparison of Standard and 3D-Printed Sockets
Authors: Owen Meredith K. , DesJardins John D.
Published: February 2020

Introduction

Prosthetic sockets must withstand instances of maximum loading without failure. The goal of the present study is to evaluate the strength at failure and the failure mechanism for 3D-printed transtibial sockets, thermoplastic transtibial check sockets, and carbon-fiber definitive laminated transtibial sockets.

Materials and Methods

Three clinically available materials (carbon fiber, PETG thermoplastic, and 3D print polylactic acid [PLA]) were used to produce identically shaped sockets. In final assembly, the carbon-fiber sockets were designed for use both with and without a pin-lock system. Thermoplastic sockets and 3D-printed sockets were designed for use without a pin-lock system. These socket systems were then tested following International Standards Organization (ISO) 10328. Ultimate strength (US) at failure, maximum deflection at failure, and failure mechanism were determined.

Results

Both designs of carbon-fiber sockets had higher US values at failure than thermoplastic sockets and 3D-printed PLA sockets. Thermoplastic sockets had a slightly higher average US than 3D-printed sockets, but 3D-printed sockets exhibited a greater strength-to-weight ratio. Four distinct socket failure mechanisms were determined.

Conclusions

Failure mechanisms and US values differed for all socket types. Carbon-fiber sockets exhibited the highest US, but 3D-printed PLA sockets showed comparable strength to current thermoplastic sockets. Although the ISO 10328 testing standard was sufficient to complete these evaluations, the method lacked some socket-specific measures and loading conditions that could have improved comparisons between socket types.
Oral Intake of Lactobacilli Can Be Helpful in Symptomatic Bacterial Vaginosis: A Randomized Clinical Study
Authors: Reznichenko Halyna , Henyk Nataliya , Maliuk Viktor , Khyzhnyak Tetyana , Tynna Yevhenia , Filipiuk Ihor , Veresniuk Nataliia , Zubrytska Larysa , Quintens Johan , Richir Karl , Gerasymov Sergiy
Published: February 2020

Objective

The aim of the study was to explore a role of oral intake of a mixture of 3 Lactobacillus species in recurrence of bacterial vaginosis (BV).

Materials and Methods

A phase 2 randomized parallel group prospective placebo-controlled study conducted at 7 clinical centers enrolled 18- to 45-years-old women with recent symptomatic BV cured with metronidazole. Within 48 hours after completion of metronidazole therapy, eligible women received 1 capsule of the verum (5.4 billion Lactobacillus crispatus LMG S-29995, Lactobacillus brevis, and Lactobacillus acidophilus in proportion of 60%, 20%, and 20%, respectively), or the placebo supplement 2 times daily for the first 7 days and 1 time daily for the next 8 to 120 days. The primary outcome measure was the percentage of recurrence of BV, which was defined as 3 of 4 Amsel criteria plus abnormal vaginal discharge/vulvar odor during 4 months of intake of the test dietary supplement. Differences between the groups were assessed with Z test for proportions.

Results

One hundred sixty-six women were analyzed in the verum (82 patients) and the placebo group (82 patients). Recurrence of BV was documented in 15 (18.3%) of 82 women in the verum group and 27 (32.1%) of 84 in the placebo group (p = .014). Rates of survival without BV rates were higher in the verum group (Cox F test, p = .018). Both verum and placebo supplements were well tolerated.

Conclusions

Oral intake of L. crispatus LMG S-29995, L. brevis, and L. acidophilus can significantly decrease percent of recurrences of BV in recently treated women and prolong time to recurrence of the disease.
Evaluation of Renal Disease in Patients With Cirrhosis
Authors: Lum Erik L. , Homkrailas Piyavadee , Bunnapradist Suphamai
Published: February 2020

Renal dysfunction in cirrhosis is common and is associated with increased mortality. Identifying and treating reversible causes of renal disease can significantly improve outcomes. The etiology, approach, and evaluation of renal disease in this group of patients is similar to the noncirrhosis patient, with a few specific caveats. Renal disease may be unrelated to the cause of cirrhosis (eg, prerenal acute kidney injury, acute tubular necrosis), occur as a manifestation of the same systemic disease responsible for the liver disease (eg, chronic viral hepatitis B and C infection) or as a consequence of cirrhosis (hepatorenal syndrome). Kidney impairment may be underrecognized in patients with cirrhosis due to over-reliance on creatinine-based glomerular filtration rate equations used in clinical practice. The first steps of evaluation for the renal disease include a thorough medical history to identify the underlying cause of cirrhosis and any potential trigger for renal dysfunction, physical examination, and review of prior laboratory records for baseline renal function. Renal imaging and urinalysis should be performed on all cirrhotic patients with renal dysfunction to establish the presence of urinary obstruction, chronicity and intrinsic renal disease.
Urgent Versus Standard Colonoscopy for Management of Acute Lower Gastrointestinal Bleeding
Authors: Anvari Sama , Lee Yung , Yu James , Doumouras Aristithes G. , Khan Khurram J. , Hong Dennis
Published: February 2020

Background:

Acute lower gastrointestinal bleeding (LGIB) is a common indication for hospitalization. However, the optimum timing of colonoscopy following patient presentation remains unclear. This systematic review and meta-analysis aims to evaluate the effect of urgent versus standard colonoscopy timing on management of acute LGIB.

Materials and Methods:

Medline, EMBASE, CENTRAL, and PubMed were searched up to January 2020. Randomized controlled trials were eligible for inclusion if they compared patients with hematochezia receiving urgent (<24 h) versus standard (>24 h) colonoscopy. Nonrandomized observational studies were also included based on the same criteria for additional analysis. Pooled estimates were calculated using random effects meta-analyses and heterogeneity was quantified using the inconsistency statistic. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Results:

Of 3782 potentially relevant studies, 4 randomized controlled trials involving 463 patients met inclusion criteria. Urgent colonoscopy did not differ significantly to standard timing with respect to length of stay (LOS), units of blood transfused, rate of additional intervention required, or mortality. Colonoscopy-related outcomes such as patient complications, rebleeding rates, and diagnosis of bleeding source did not differ between groups. However, meta-analysis including nonrandomized studies (9 studies, n=111,950) revealed a significantly higher rate of mortality and complications requiring surgery in the standard group and shorter LOS in the urgent group. Overall GRADE certainty of evidence was low in the majority of outcomes.

Conclusions:

Timing of colonoscopy in acute LGIB may not significantly affect patient outcomes. Timing should therefore be decided on a case-by-case basis.
Liver steatosis is a risk factor for hepatotoxicity in inflammatory bowel disease patients treated with azathioprine
Authors: Phillips Jennifer , Preskey Rebecca , Penfold Chris , Gordon Fiona , Tyrrell-Price Jonathan
Published: February 2020

Background and aims

The literature demonstrates that hepatic steatosis reduces the tolerance of immunosuppression in people with inflammatory bowel disease. It also shows that elevated methylmercaptopurine may be responsible for thiopurine-induced hepatitis. This exploratory study investigates the relationship between hepatic steatosis, methylmercaptopurine and alanine transaminase.

Methods

We performed a retrospective review of patients started on azathioprine treatment at University Hospitals Bristol NHS Foundation Trust between 2014 and 2017. There were 600 patients in total. Ninety-one patients met our inclusion criteria which were at least one ultrasound scan commenting on the appearance of the liver, liver function tests at commencement of azathioprine and liver function tests and a methylmercaptopurine level between 6 and 8 weeks after starting treatment.

Results

Of 91 patients included in our study, 32 patients (32%) were identified as having radiological hepatic steatosis on ultrasound imaging and 59 patients had no evidence of steatosis. We found a positive association between methylmercaptopurine levels and change in alanine transaminase in patients with hepatic steatosis (P < 0.001) but not in those with a normal liver on ultrasound imaging.

Conclusion

We conclude that the higher levels of methylmercaptopurine may be a risk factor for hepatitis in patients with hepatic steatosis but not in those with a normal liver.
The microbiology of necrotizing pancreatitis and its impact on in-hospital and 1-year all-cause mortality
Authors: Biberci Keskin Elmas , Okay Gülay , Muhiddin Duygu , Sharif Rasul , Taşlidere Bahadir , Şentürk Hakan
Published: February 2020

Background/objectives:

The data regarding the microbial spectrum in necrotizing pancreatitis and its impact on mortality is limited. Therefore, in this study, we aimed to investigate the agents identified in cultures and their impact on in-hospital and 1-year all-cause mortality.

Methods:

Patients with necrotizing pancreatitis were retrospectively included in the study. Based on culture results, patients were classified as either negative culture or positive culture necrotizing acute pancreatitis. The main outcomes of the study were the identification of agents isolated in patients with pancreatic necrosis and to assess in-hospital, 30-day and 1-year all-cause mortality according to culture results.

Results:

In total, 109 patients of whom 33 had positive cultures were included in the study. Most positive cultures were polymicrobial (66%) with a marked gram-negative bacterial dominance (63%). Klebsiella spp. were the most common identified pathogens. The patients a with positive culture had worse outcomes in terms of in-hospital, 30-day and 1-year all-cause mortality compared to patients with sterile culture results (n = 9, 27.3% vs. n = 4, 5.3%, P < 0.01 for in-hospital mortality; n = 11, 33.3% vs. n = 5, 6.6%, P < 0.01 for 30-day mortality; and n = 14, 42.4% vs. n = 10, 13.2%, P < 0.01 for 1-year mortality).

Conclusion:

When a microorganism was identified in patients with necrotizing acute pancreatitis, it was mostly polymicrobial in etiology with a gram-negative bacterial dominance. In our cohort, Klebsiella spp. were the most common isolated organisms. Especially the patients with polymicrobial etiology showed a very poor outcome both in-hospital and in the long-term. Local hospital flora may have an impact on culture results.
Dual Diagnosis and Application Problems in the Use of the Construct
Authors: Iudici Antonio , Girolimetto Riccardo , Volponi Giulia , Eletto Alba
Published: February 2020

Dual diagnosis (DD) commonly identifies a condition of co-occurrence of substance use disorders and psychological or psychiatric disorders. Many scholars have tried to explain this phenomenon, yet no agreement has been found: methodologies of intervention and treatment are numerous, but there is no uniformity of methodology. Our work aims to search critical aspects linked to this fragmented framework, to facilitate those who use the construct of DD. We have elaborated a literary review focused on specific critical contributions to the theoretical and methodological complexity of the construct. Scopus, PubMed, and Scholar were used as search engines. Our research reveals significant problems around several thematic areas: Defining, Operative and Treatment; Economic and Policy; Pharmacological Approach; and Patients' Perspectives Issues. Consistent issues are discussed with regard to DD: innovation should start from its limits. Future research should look for alternative theoretical formulations and consequent intervention experiences to provide new perspectives.
Emotional Intelligence and Critical Thinking in Nursing Students
Authors: Christianson Krista L.
Published: February 2020

Background

Emotional intelligence (EI) and critical thinking (CT) are positive attributes for nursing students throughout their nursing education and in future professional practice.

Purpose

The purpose was to review the literature investigating both EI and CT in prelicensure nursing students.

Methods

A systematic literature search of original research articles published between 2003 and 2018 was conducted using electronic databases. Emerging themes were identified using integrative review methodological strategies.

Results

Three themes emerged: (1) EI and CT are interdependent; (2) EI and CT are critical for success in nursing education; and (3) nursing education should enhance EI and CT. Findings are mixed regarding the usefulness of screening applicants for EI prior to admission.

Conclusions

Developing EI and CT skills in nursing students deserves thoughtful consideration. Further research is warranted regarding integrating strategies to enhance EI and CT skills as well as adopting EI as an adjunct admissions criterion for entrance into a prelicensure program.
Integrin β4 Is an Effective and Efficient Marker in Synchronously Highlighting Lymphatic and Blood Vascular Invasion, and Perineural Aggression in Malignancy
Authors: Li Jian , Jiang Yi , Chen Cuimin , Tan Weiwei , Li Ping , Chen Gang , Peng Quanzhou , Yin Weihua
Published: February 2020

Lymphovascular invasion (LVI) and perineural invasion (PNI) are 2 important pathologic parameters and need to be accurately assessed in multiple malignancies. Integrin β4, a member of the integrin family, has been reported to be positively expressed in vascular endothelia, peripheral nerves, and a collection of epithelia. However, little is known about the effectiveness of β4 immunostaining on the recognition of LVI and PNI. Herein, we explored the applicability of β4 immunostaining in stomach, thyroid, and breast cancers. Parallel immunostaining of D2-40, CD34, and S-100 was performed as controls for lymphatic endothelia, vascular endothelia, and neural fibers, respectively. The results demonstrated that β4 concurrently stained the lymphatic and vascular endothelia, and the peripheral nerves. Both LVI and PNI were clearly and accurately outlined by β4 immunostaining. β4 was also expressed in the majority of tumor cells, enabling recognition of LVI and PNI encroached by small tumor clusters. In contrast to D2-40 and CD34, β4 staining was not observed in stromal cells, and therefore it facilitated differentiation between the shrinkage cleft and LVI. According to our results, β4 staining strikingly increased the diagnostic accuracy and interobserver concordance for LVI and PNI compared with hematoxylin and eosin staining alone. Finally, the applicability of β4 was confirmed in 9 other types of malignancies, including cancers of the colon, prostate, esophagus, lung, kidney, uterus, tongue, bladder, and liver. Collectively, β4 is a reliable marker for synchronous detection and diagnosis of LVI and PNI.
Report From the International Society of Urological Pathology (ISUP) Consultation Conference On Molecular Pathology Of Urogenital Cancers. II. Molecular Pathology of Bladder Cancer
Authors: Warrick Joshua I. , Knowles Margaret A. , Yves Allory , van der Kwast Theo , Grignon David J. , Kristiansen Glen , Egevad Lars , Hartmann Arndt , Cheng Liang
Published: February 2020

During the 2019 International Society of Urological Pathology Consultation Conference on Molecular Pathology of Urogenital Cancer, the Working Group on Bladder Cancer presented the current status and made recommendations on the diagnostic use of molecular pathology, incorporating a premeeting survey. Bladder cancers are biologically diverse and can be separated into “molecular subtypes,” based on expression profiling. These subtypes associate with clinical behavior, histology, and molecular alterations, though their clinical utility has not been demonstrated at present and use in bladder cancer is not recommended. Mutations in theTERTpromoter are present in the majority of bladder cancers, including the noninvasive stage of tumor evolution, but not in reactive conditions. Mutational analysis of theTERTpromoter thus distinguishes histologically deceptive cancers from their benign mimics in some cases. A minority of pathologists employ this test.FGFR3mutations are common in bladder cancer, and metastatic urothelial carcinoma (UC) with such mutations frequently responds to erdafitinib, anFGFRinhibitor. Testing forFGFR3alterations is required before using this drug. Metastatic UC responds to immune-oncology (IO) agents in 20% of cases. These are approved as first and second-line treatments in metastatic UC. Several biological parameters associate with response to IO agents, including tumor mutational burden, molecular subtype, and infiltration by programmed death-ligand 1–positive lymphocytes, detected by immunohistochemistry. Programmed death-ligand 1 immunohistochemistry is mandatory before administering IO agents in the first-line setting. In conclusion, much has been learned about the biology of bladder cancer, and this understanding has improved the care of patients with the disease.
Eosinophilic Renal Cell Tumors With a TSC and MTOR Gene Mutations Are Morphologically and Immunohistochemically Heterogenous
Authors: Tjota Melissa , Chen Heather , Parilla Megan , Wanjari Pankhuri , Segal Jeremy , Antic Tatjana
Published: February 2020

Eosinophilic renal neoplasms have a wide spectrum of histologic presentations, and several studies have demonstrated a subtype of renal cell carcinomas (RCCs) associated with the tuberous sclerosis complex (TSC)/mammalian target of rapamycin pathway. A review of our institutional archives led to the identification of 18 cases of renal eosinophilic tumors with unusual morphology. Immunohistochemical analysis demonstrated that these could be separated into 3 groups: group 1 had solid architecture and morphology similar to chromophobe RCC but was negative for CK20 and vimentin, and had weak focal staining for CK7 and P504S; group 2 had solid architecture and morphology similar to either renal oncocytoma or chromophobe RCC, eosinophilic variant and had diffuse staining of CK7 and P504S, absent to weak staining of CK20, and negative staining for vimentin; and group 3 had solid, cystic and papillary architecture and was negative for CK7, except for 1 case, along with moderate to strong staining of CK20, P504S, and vimentin. The cases were then sent for next-generation sequencing to determine whether molecular pathogenic variants were present. In group 1, all 3 cases had mutations in TSC2. In group 2, pathogenic variants were identified in 3 genes: TSC1, TSC2, and MTOR. In group 3, genetic alterations and pathogenic variants were identified in TSC1 and TSC2. Our results support TSC/MTOR-associated neoplasms as a distinct group that exhibits heterogenous morphology and immunohistochemical staining.
Chest CT Findings in Patients With Coronavirus Disease 2019 and Its Relationship With Clinical Features
Authors: Wu Jiong , Wu Xiaojia , Zeng Wenbing , Guo Dajing , Fang Zheng , Chen Linli , Huang Huizhe , Li Chuanming
Published: February 2020

Objectives

The aim of this study was to investigate the chest computed tomography (CT) findings in patients with confirmed coronavirus disease 2019 (COVID-19) and to evaluate its relationship with clinical features.

Materials and Methods

Study sample consisted of 80 patients diagnosed as COVID-19 from January to February 2020. The chest CT images and clinical data were reviewed, and the relationship between them was analyzed.

Results

Totally, 80 patients diagnosed with COVID-19 were included. With regards to the clinical manifestations, 58 (73%) of the 80 patients had cough, and 61 (76%) of the 80 patients had high temperature levels. The most frequent CT abnormalities observed were ground glass opacity (73/80 cases, 91%), consolidation (50/80 cases, 63%), and interlobular septal thickening (47/80, 59%). Most of the lesions were multiple, with an average of 12 ± 6 lung segments involved. The most common involved lung segments were the dorsal segment of the right lower lobe (69/80, 86%), the posterior basal segment of the right lower lobe (68/80, 85%), the lateral basal segment of the right lower lobe (64/80, 80%), the dorsal segment of the left lower lobe (61/80, 76%), and the posterior basal segment of the left lower lobe (65/80, 81%). The average pulmonary inflammation index value was (34% ± 20%) for all the patients. Correlation analysis showed that the pulmonary inflammation index value was significantly correlated with the values of lymphocyte count, monocyte count, C-reactive protein, procalcitonin, days from illness onset, and body temperature (P < 0.05).

Conclusions

The common chest CT findings of COVID-19 are multiple ground glass opacity, consolidation, and interlobular septal thickening in both lungs, which are mostly distributed under the pleura. There are significant correlations between the degree of pulmonary inflammation and the main clinical symptoms and laboratory results. Computed tomography plays an important role in the diagnosis and evaluation of this emerging global health emergency.
Machine Learning and Deep Neural Networks Applications in Coronary Flow Assessment
Authors: Tesche Christian , Gray Hunter N.
Published: February 2020

Coronary computed tomography angiography (cCTA) is a reliable and clinically proven method for the evaluation of coronary artery disease. cCTA data sets can be used to derive fractional flow reserve (FFR) as CT-FFR. This method has respectable results when compared in previous trials to invasive FFR, with the aim of detecting lesion-specific ischemia. Results from previous studies have shown many benefits, including improved therapeutic guidance to efficiently justify the management of patients with suspected coronary artery disease and enhanced outcomes and reduced health care costs. More recently, a technical approach to the calculation of CT-FFR using an artificial intelligence deep machine learning (ML) algorithm has been introduced. ML algorithms provide information in a more objective, reproducible, and rational manner and with improved diagnostic accuracy in comparison to cCTA. This review gives an overview of the technical background, clinical validation, and implementation of ML applications in CT-FFR.
Assessing the Complex Causes of Kidney Allograft Loss
Authors: Van Loon Elisabet , Senev Aleksandar , Lerut Evelyne , Coemans Maarten , Callemeyn Jasper , Van Keer Jan M. , Daniëls Liesbeth , Kuypers Dirk , Sprangers Ben , Emonds Marie-Paule , Naesens Maarten
Published: February 2020

Background.

Although graft loss is a primary endpoint in many studies in kidney transplantation and a broad spectrum of risk factors has been identified, the eventual causes of graft failure in individual cases remain ill studied.

Methods.

We performed a single-center cohort study in 1000 renal allograft recipients, transplanted between March 2004 and February 2013.

Results.

In total, 365 graft losses (36.5%) were identified, of which 211 (57.8%) were due to recipient death with a functioning graft and 154 (42.2%) to graft failure defined as return to dialysis or retransplantation. The main causes of recipient death were malignancy, infections, and cardiovascular disease. The main causes of graft failure were distinct for early failures, where structural issues and primary nonfunction prevailed, compared to later failures with a shift towards chronic injury. In contrast to the main focus of current research efforts, pure alloimmune causes accounted for only 17.5% of graft failures and only 7.4% of overall graft losses, although 72.7% of cases with chronic injury as presumed reason for graft failure had prior rejection episodes, potentially suggesting that alloimmune phenomena contributed to the chronic injury.

Conclusions.

In conclusion, this study provides better insight in the eventual causes of graft failure, and their relative contribution, highlighting the weight of nonimmune causes. Future efforts aimed to improve outcome after kidney transplantation should align with the relative weight and expected impact of targeting these causes.
Pollutants in Hong Kong Soils: Organochlorine Pesticides and Polychlorinated Biphenyls
Authors: Chung M.K. , Hu R. , Cheung K.C. , Wong M.H.
Published: February 2020

Organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) were investigated in 138 soil samples collected in Hong Kong. Results showed that within the selected OCPs, only DDT and its metabolites (DDD and DDE) were frequently detected. Of 138 soil samples, 18% were non-detected for any DDT residues, while 25% were contaminated sporadically with DDT only (non-detected to 1090 µg kg−1) and 57% contained various combinations of DDT, DDD and DDE (2.03 to 1118 µg kg−1). In contrast, total PCBs (∑66 congeners) contamination was distributed more evenly (0.22 to 154 µg kg−1) than DDTs, but serious contamination was found in industrial areas and soils collected near highways. Concentrations of 7 indicator PCBs ranged between non-detected to 34.5 µg kg−1. The ratios of DDT/metabolites were typically greater than 1, thus suggesting recent application of DDT. Medium-range deposition from industrial areas within as well as away from the city is also suspected to be the origins of DDTs and PCBs found in Hong Kong soils. The concentrations of DDTs and PCBs in all soil samples did not exceed the recommended values in soil quality guidelines except 3 samples for DDT from locations far away from densely populated districts such as Tuen Mun and Tin Shui Wai. Therefore, DDTs and PCBs were not of significant concern in terms of their impacts on public health and environment.
Clinical characteristics of 50466 patients with 2019-nCoV infection
Authors: Sun Pengfei , Qie Shuyan , Liu Zongjan , Ren Jizhen , Xi Jianing
Published: February 2020

Objective

We aim to summarize reliable evidences of evidence-based medicine for the treatment and prevention of the 2019 novel coronavirus (2019-nCoV) by analyzing all the published studies on the clinical characteristics of patients with 2019-nCoV.

Methods

PubMed, Cochrane Library, Embase, and other databases were searched. Several studies on the clinical characteristics of 2019-nCoV infection were collected for Meta-analysis.

Results

Ten studies were included in Meta-analysis, including a total number of 50466 patients with 2019-nCoV infection. Meta-analysis shows that, among these patients, the incidence of fever was 89.1%, the incidence of cough was 72.2%, and the incidence of muscle soreness or fatigue was 42.5%. The incidence of acute respiratory distress syndrome (ARDS) was 14.8%, the incidence of abnormal chest computer tomography (CT) was 96.6%, the percentage of severe cases in all infected cases was 18.1%, and the case fatality rate of patients with 2019-nCoV infection was 4.3%.

Conclusion

Fever and cough are the most common symptoms in patients with 2019-nCoV infection, and most of these patients have abnormal chest CT examination. Several people have muscle soreness or fatigue as well as ARDS. Diarrhea, hemoptysis, headache, sore throat, shock, and other symptoms only occur in a small number of patients. The case fatality rate of patients with 2019-nCoV infection is lower than that of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).
Correlation between renal function and peripapillary choroidal thickness in treatment naïve diabetic eyes using SS-OCT
Authors: Liu Sen , Wang Wei , Tan Yan , He Miao , Wang Lanhua , Li Yuting , Huang Wenyong
Published: February 2020

Purpose

To investigate the association between the estimated glomerular filtration rate (eGFR) and peripapillary choroidal thickness (pCT) and retinal nerve fibre layer (pRNFL) thickness in diabetic patients by using swept-source optical coherence tomography (SS-OCT).

Methods

Ocular treatment-naïve patients with type 2 diabetes mellitus registered in the community health system in Guangzhou, China were recruited to participate in this prospective cross-sectional study. The eGFR was determined using the Xiangya formula, and the renal function was categorized into non-chronic kidney disease (non-CKD), mild CKD, and moderate to severe CKD (MS-CKD) according to the guidelines. The pCT and pRNFL thicknesses at 12 o’clock were obtained using a SS-OCT by a circular scan with a diameter of 3.4 mm centring on the optic nerve head, and the data from only one eye in each patient were used.

Results

This study included 1,408 diabetic patients, with a mean age of 64.4±7.8 years. The average pCT decreased with renal function deterioration, with 126.0 μm ± 58.0 μm for non-CKD, 112.0 μm ± 51.2 μm for mild CKD and 71.0μm ± 22.9 μm for MS-CKD, respectively (P<0.001). The pCT was found to be significantly thinner in CKD patients in all quadrantes (P < 0.05 in all regions) with the exception of the inferior quadrant, and the average pCT was positively correlated with eGFR (β = 0.3, 95%CI = 0.0 to 0.6, p = 0.021) after making adjustments for other factors. The pRNFL thickness in the nasal quadrant was significantly reduced in patients with CKD, and pRNFL thickness was positively correlated with eGFR (β = 0.1, 95%CI = 0.0-0.2, p = 0.009) after adjusting for other factors.

Conclusion

Impaired renal function was associated with a reduction of pCT and pRNFL thickness in patients with type 2 diabetes. The measurement of pCT and pRNFL may provide additional information for predicting renal impairment.
Guangzhou Diabetic Eye Study: rationale, design, methodology and baseline data
Authors: Wang Wei , He Miao , Gong Xia , Wang Lanhua , Meng Jie , Li Yuting , Xiong Kun , Li Wangting , Huang Wenyong
Published: February 2020

Purpose

The incidence and risk factors for diabetic retinopathy (DR) in southern China remains unclear. This project aims to explore the onset and progression of DR and their determinants through a prospective cohort in South China.

Methods

The Guangzhou Diabetic Eye Study (GDES) recruited patients with type 2 diabetic patients registered in the community health centres in Guangzhou, China. Patients with history of ocular treatment, severe refractive opacity, or other systemic diseases were excluded. Comprehensive examinations were performed including visual acuity, refraction, ocular biometry, fundus imaging, blood and urine tests. The biological samples were collected for further study.

Results

A total of 2305 eligible patients were included in the final analysis. In total, 14.58% of the participants had any DR and 4.25% had vision-threatening DR (VTDR), among which 76 (3.30%), 197 (8.55%), 45 (1.95%) and 17 (0.74%) were classified as mild NPDR, moderate NPDR, severe NPDR and PDR, respectively. There were 93 (4.03%) patients of diabetic macular edema (DME). The presence of any DR was independently associated with a longer duration of DM, higher degree of HbA1C, insulin treatment, higher average arterial pressure, higher concentration of serum creatinine, presence of urinary microalbumin, older age, and lower BMI (all P <0.001). For VTDR, 7 factors were significant: older age, a longer duration of DM, higher concentration of HbA1c, use of insulin, lower BMI, higher concentration of serum creatinine, and high albuminuria (all P<0.05). These factors were also independently associated with DME (all P <0.001).

Conclusions

The GDES is the first large-scale prospective cohort study of the diabetic population in southern urban China, which will help to identify newer imaging and genetic biomarkers for DR in this population.
Macular vessel density in diabetes and diabetic retinopathy with swept-source optical coherence tomography angiography
Authors: Xie Naiqiang , Tan Yan , Liu Sen , Xie Yining , Shuai Shaoshuai , Wang Wei , Huang Wenyong
Published: February 2020

Purpose

Previous studies on the association between macular vessel density (VD) and diabetic retinopathy had conflicting conclusions. This study assessed the alterations of macular VD, as well as other factors, in diabetic patients using swept-source optical coherence tomography angiography (SS-OCTA) in a large-scale sample from Chinese communities.

Methods

Patients with type 2 diabetes without history of ocular treatment were recruited from 2017 to 2018. The average and quadrant parafoveal vessel density (PVD) were obtained with a commercial SS-OCTA device (Triton, Topcan, Japan). Univariate and multivariate linear regression was used to analyse the correlation of PVD with diabetic retinopathy (DR), diabetic macular edema (DME), HbA1c, and other factors.

Results

A total of 919 patients were included in the final statistical analysis. After adjusting for other confounding factors, the DR patients had significantly lower average PVD (β= −1.062, 95% CI = −1.424 to −0.699, P < 0.001) in comparison with those without DR. In addition, the patients with mild DR or vision-threatening diabetic retinopathy (VTDR) also had significantly lower PVD (P < 0.001 for mild DR, and P = 0.008 for VTDR) compared with those without DR. Age and HbA1c were also significantly related to PVD measurements, as shown by multivariable linear regression. Participants with DME had a significantly lower average PVD and temporal PVD than those without DME (P < 0.05).

Conclusions

Reduced PVD was independently associated with more severe DR, older age, higher HbA1c level, and the presence of DME. These findings provide manifest evidence to suggest that macular vessel alterations play a role in the pathogenesis of DR.
Comparative study of the lymphocyte change between COVID-19 and non-COVID-19 pneumonia cases suggesting uncontrolled inflammation might not be the main reason of tissue injury
Authors: Zheng Yishan , Huang Zhen , Yin Guoping , Zhang Xia , Ye Wei , Hu Zhiliang , Hu Chunmei , Wei Hongxia , Zeng Yi , Chi Yun , Cheng Cong , Lin Feishen , Lu Hu , Xiao Lingyan , Song Yan , Wang Chunming , Yi Yongxiang , Dong Lei
Published: February 2020

Disclaimer statement

The authors have withdrawn this manuscript because the statistical methods in our manuscript need to be modified and we are going to improve the statistical methods and try to give more precise model. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.
SARS-CoV-2 infection does not significantly cause acute renal injury: an analysis of 116 hospitalized patients with COVID-19 in a single hospital, Wuhan, China
Authors: Wang Luwen , Li Xun , Chen Hui , Yan Shaonan , Li Yan , Li Dong , Gong Zuojiong
Published: February 2020

Background

Whether the patients with COVID-19 infected by SARS-CoV-2 would commonly develop acute renal function damage is a problem worthy of clinical attention. This study aimed to explore the effects of SARS-CoV-2 infection on renal function through analyzing the clinical data of 116 hospitalized COVID-19-confirmed patients.

Methods

116 hospitalized COVID-19-confirmed patients enrolled in this study were hospitalized in the Department of Infectious Diseases, Renmin Hospital of Wuhan University from January 14 to February 13, 2020. The recorded information includes demographic data, medical history, contact history, potential comorbidities, symptoms, signs, laboratory test results, chest computer tomography (CT) scans, and treatment measures. SARS-CoV-2 RNA in 53 urine sediments of enrolled patients was examined by real-time RT-PCR.

Findings

12 (10.8%) and 8 (7.2%) patients showed mild elevation of blood urea nitrogen or creatinine, and trace or 1+ albuminuria respectively in 111 COVID-19-confirmed patients without basic kidney disease. In addition, 5 patients with chronic renal failure (CRF) were undergone regular continuous renal replacement therapy (CRRT) were confirmed infection of SARS-CoV-2, and diagnosed as COVID-19. Beside the treatment of COVID-19, CRRT was also applied three times weekly. The course of treatment, the renal function indicators showed stable, without exacerbation of CRF, and pulmonary inflammation was gradually absorbed. All 5 patients with CRF were survived. Moreover, SARS-CoV-2 RNA in urine sediments was positive only in 3 patients from 48 cases without renal illness before, and one patient had a positive for SARS-CoV-2 ORF 1ab from 5 cases with CRF.

Interpretation

Acute renal impairment was uncommon in COVID-19. SARS-CoV-2 infection does not significantly cause obvious acute renal injury, or aggravate CRF in the COVID-19 patients.
Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 epidemic in China: a web-based cross-sectional survey
Authors: Huang Yeen , Zhao Ning
Published: February 2020

Background

China has been severely affected by COVID-19 (Corona Virus Disease 2019) since December, 2019. This study aimed to assess the population mental health burden during the epidemic, and to explore the potential influence factors.

Methods

Using a web-based cross-sectional survey, we collected data from 7,236 self-selected volunteers assessed with demographic information, COVID-19 related knowledge, Generalized Anxiety Disorder-7 (GAD-7), Center for Epidemiology Scale for Depression (CES-D), and Pittsburgh Sleep Quality Index (PSQI). Logistic regressions were used to identify influence factors associated with mental health problem.

Results

Of the total sample analyzed, the overall prevalence of GAD, depressive symptoms, and sleep quality were 35.1%, 20.1%, and 18.2%, respectively. Young people reported a higher prevalence of GAD and depressive symptoms than older people (P<0.001). Compared with other occupational group, healthcare workers have the highest rate of poor sleep quality (P<0.001). Multivariate logistic regression showed that age (< 35 years) and times to focus on the COVID-19 (≥ 3 hours per day) were associated with GAD, and healthcare workers were associated with poor sleep quality.

Conclusions

Our study identified a major mental health burden of the public during COVID-19 epidemic in China. Young people, people who spent too much time on the epidemic, and healthcare workers were at high risk for mental illness. Continuous surveillance and monitoring of the psychological consequences for outbreaks should become routine as part of preparedness efforts worldwide.
On the treatment effect heterogeneity of antidepressants in major depression. A Bayesian meta-analysis
Authors: Volkmann Constantin , Volkmann Alexander , Müller Christian A.
Published: February 2020

Background

The average treatment effect of antidepressants in major depression was found to be about 2 points on the 17-item Hamilton Depression Rating Scale, which lies below clinical relevance. Here, we searched for evidence of a relevant treatment effect heterogeneity that could justify the usage of antidepressants despite their low average treatment effect.

Methods

Bayesian meta-analysis of 169 randomized, controlled trials including 58,687 patients. We considered the effect sizes log variability ratio (lnVR) and log coefficient of variation ratio (lnCVR) to analyze the difference in variability of active and placebo response. We used Bayesian random-effects meta-analyses (REMA) for lnVR and lnCVR and fitted a random-effects meta-regression (REMR) model to estimate the treatment effect variability between antidepressants and placebo.

Results

The variability ratio was found to be very close to 1 in the best fitting models (REMR: 95% HPD [0.98, 1.02], REMA: 95% HPD [1.00, 1.02]). The between-study variance τ2 under the REMA was found to be low (95% HPD [0.00, 0.00]). Simulations showed that a large treatment effect heterogeneity is only compatible with the data if a strong correlation between placebo response and individual treatment effect is assumed.

Conclusions

The published data from RCTs on antidepressants for the treatment of major depression is compatible with a near-constant treatment effect. Although it is impossible to rule out a substantial treatment effect heterogeneity, its existence seems rather unlikely. Since the average treatment effect of antidepressants falls short of clinical relevance, the current prescribing practice should be re-evaluated.
ACP risk grade: a simple mortality index for patients with confirmed or suspected severe acute respiratory syndrome coronavirus 2 disease (COVID-19) during the early stage of outbreak in Wuhan, China
Authors: Lu Jiatao , Hu Shufang , Fan Rong , Liu Zhihong , Yin Xueru , Wang Qiongya , Lv Qingquan , Cai Zhifang , Li Haijun , Hu Yuhai , Han Ying , Hu Hongping , Gao Wenyong , Feng Shibo , Liu Qiongfang , Li Hui , Sun Jian , Peng Jie , Yi Xuefeng , Zhou Zixiao , Guo Yabing , Hou Jinlin
Published: February 2020

Background

Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) outbreaks in Wuhan, China, healthcare systems capacities in highly endemic areas have been overwhelmed. Approaches to efficient management are urgently needed and key to a quicker control of the outbreaks and casualties. We aimed to characterize the clinical features of hospitalized patients with confirmed or suspected COVID-19, and develop a mortality risk index for COVID-19 patients.

Methods

In this retrospective one-centre cohort study, we included all the confirmed or suspected COVID-19 patients hospitalized in a COVID-19-designated hospital from January 21 to February 5, 2020. Demographic, clinical, laboratory, radiological and clinical outcome data were collected from the hospital information system, nursing records and laboratory reports.

Results

Of 577 patients with at least one post-admission evaluation, the median age was 55 years (interquartile range [IQR], 39 - 66); 254 (44.0%) were men; 22.8% (100/438) were severe pneumonia on admission, and 37.7% (75/199) patients were SARS-CoV-2 positive. The clinical, laboratory and radiological data were comparable between positive and negative SARS-CoV-2 patients. During a median follow-up of 8.4 days (IQR, 5.8 - 12.0), 39 patients died with a 12-day cumulative mortality of 8.7% (95% CI, 5.9% to 11.5%). A simple mortality risk index (called ACP index), composed of Age and C-reactive Protein, was developed. By applying the ACP index, patients were categorized into three grades. The 12-day cumulative mortality in grade three (age ≥ 60 years and CRP ≥ 34 mg/L) was 33.2% (95% CI, 19.8% to 44.3%), which was significantly higher than those of grade two (age ≥ 60 years and CRP < 34 mg/L; age < 60 years and CRP ≥ 34 mg/L; 5.6% [95% CI, 0 to 11.3%]) and grade one (age < 60 years and CRP < 34 mg/L, 0%) (P <0.001), respectively.

Conclusion

The ACP index can predict COVID-19 related short-term mortality, which may be a useful and convenient tool for quickly establishing a COVID-19 hierarchical management system that can greatly reduce the medical burden and therefore mortality in highly endemic areas.