bluuebunny/crossref_metadata_2025 huggingface dataset:
Age and menopausal status are important factors influencing the serum human epididymis secretory protein 4 level: a prospective cross-sectional study in healthy Chinese people
Authors: Cheng Hong-Yan , Zeng Lin , Ye Xue , Ma Rui-Qiong , Tang Zhi-Jian , Chu Hong-Ling , Zhao Yi-Ming , Zhu Li-Rong , Gao Yu-Nong , Chang Xiao-Hong , Cui Heng
Published: May 2020

Background:

Human epididymis secretory protein 4 (HE4) is a new ovarian cancer biomarker. The factors influencing HE4 levels are not clear, and the reference data in China are limited. Here, we aim to evaluate the effects of menopause and age on HE4 levels and to provide a possible reference value for HE4 in healthy Chinese people.

Methods:

A total of 2493 healthy females aged 40 years or older were recruited from March 2013 to March 2017 with the cooperation of four medical institutions across Beijing, China. The serum levels of HE4 and cancer antigen 125 (CA125) were measured by enzyme-linked immunosorbent assay. The Wilcoxon rank-sum test of variance and a stratified analysis were used to analyze the relationships among age, menopausal status, and levels of HE4 or CA125. Confidence intervals (5%–95%) were determined for reference ranges in different populations.

Results:

There was a statistically significant difference in median HE4 levels between the post-menopausal (n = 2168) and pre-menopausal groups (n = 325) (36.46 vs. 24.04 pmol/L, Z = −14.41, P < 0.001). HE4 increased significantly with age in the post-menopausal groups (H = 408.18, P < 0.001) but not in the pre-menopausal subjects (Z = −0.43, P = 0.67). The upper 95th percentile of HE4 levels were 44.63 pmol/L for pre-menopausal women, 78.17 pmol/L for post-menopausal women, and 73.3 pmol/L for all women. In the post-menopausal population, the HE4 reference ranges were 13.15 to 47.31, 14.31 to 58.04, 17.06 to 73.51, 24.50 to 115.25, and 35.71 to 212.37 pmol/L for different age groups from forty divided by decade. The CA125 level was affected mainly by menopausal status and not age.

Conclusions:

Menopausal status and age were both important factors influencing the level of HE4, and age affected HE4 levels mainly in post-menopausal women. The HE4 level was higher in the post-menopausal population than in the pre-menopausal population and increased with age.
Positron emission computed tomography/single photon emission computed tomography in Parkinson disease
Authors: Yao Nian-Ting , Zheng Qian , Xu Zi-Qian , Yin Jian-Hong , Lu Lin-Guang , Zuo Qi , Yang Su , Zhang Chun-Lin , Jiao Ling
Published: May 2020

Parkinson disease (PD) is the second-most common neurodegenerative disorder. Its main pathological mechanism is the selective degeneration and deletion of dopaminergic neurons in the dense part of the substantia nigra and the damage of dopaminergic neurons caused by the abnormal deposition of a Lewy body, leading to a decreased dopamine level. Positron emission computed tomography (PET)/single photon emission computed tomography (SPECT) is a molecular imaging technology that can directly or indirectly reflect changes in molecular levels by using a specific tracer. With the research and development on the tracers of related enzymes for labeling dopamine transporter and dopamine receptor and for being involved in dopamine formation, this imaging technology has been applied to all aspects of PD research. It not only contributes to clinical work but also provides an important theoretical basis for exploring the pathological mechanism of PD at a molecular level. Therefore, this review discusses the application value of PET/SPECT in PD in terms of early diagnosis, disease severity evaluation, clinical manifestations, differential diagnosis, and pathological mechanism.
Cardiac output estimation by pulse wave analysis using the pressure recording analytical method and intermittent pulmonary artery thermodilution
Authors: Greiwe Gillis , Luehsen Katharina , Hapfelmeier Alexander , Rogge Dorothea , Kubik Mathias , Schulte-Uentrop Leonie , Saugel Bernd
Published: May 2020

BACKGROUND

Invasive pulse wave analysis is used in peri-operative settings to estimate cardiac output (CO). The ‘pressure recording analytical method’ (PRAM) implemented in the MostCareUp CO monitor is an invasive pulse wave analysis method using high-frequency sampling and analysis of the pulse wave to directly estimate the arterial impedance as a key variable of the proprietary CO estimation algorithm.

OBJECTIVE

To compare CO estimated by PRAM (PRAM-CO; test method) with CO measured by pulmonary artery thermodilution (PATD-CO; reference method).

DESIGN

Prospective observational method comparison study. PRAM-CO and PATD-CO were assessed simultaneously at five time points with at least 20 min between measurements. Arterial pressure waveforms were carefully checked for damping artefacts and a proprietary electronic filter of the MostCareUp CO monitor was used to optimise waveform quality.

SETTING

ICU of a German university hospital from August 2018 until April 2019.

PATIENTS

We included adult patients admitted to the ICU after elective off-pump coronary artery bypass surgery who were monitored with a radial arterial catheter and a pulmonary artery catheter. Patients with severe heart valve insufficiency or persistent arrhythmia were excluded.

MAIN OUTCOME MEASURES AND ANALYSIS

PATD-CO and PRAM-CO were compared using Bland-Altman analysis accounting for repeated measurements, the percentage error and trending analysis (four-quadrant plot, concordance rate).

RESULTS

We analysed 195 paired CO values of 41 patients. Mean PATD-CO and PRAM-CO were 4.99 ± 1.02 and 4.92 ± 1.05 l min−1, respectively. PATD-CO and PRAM-CO ranged from 3.04 to 8.74 and 2.79 to 8.01 l min−1, respectively. The mean of the differences between PATD-CO and PRAM-CO was −0.08 ± 0.74 l min−1 with 95% limits of agreement of −1.55 to +1.40 l min−1. The percentage error was 29.8%. The concordance rate in four-quadrant plot analysis was 92%.

CONCLUSION

Using the system's electronic waveform filter PRAM-CO shows good agreement and trending ability compared with PATD-CO in adults after off-pump coronary artery bypass surgery.
Prophylactic norepinephrine infusion or leg wrapping for postspinal hypotension in elective caesarean delivery
Authors: Sundararajan Monisha , Ravindran Charulatha , Ponnusamy Rani , Murugesan Ravishankar
Published: May 2020

BACKGROUND

Because of its alpha and beta agonist properties, norepinephrine infusion is currently being studied for the prevention of spinal hypotension during caesarean delivery. Vasopressor infusions are not always possible if there is an unavailability of infusion pumps. Leg wrapping with crepe bandage is an effective technique for prevention of postspinal hypotension and could be useful in resource-poor settings.

OBJECTIVE

The aim of this study was to compare the incidence of hypotension with norepinephrine infusion or leg wrapping with a control group in women undergoing caesarean delivery with spinal anaesthesia.

DESIGN

Randomised, double-blind, controlled trial.

SETTING

Single centre, tertiary level institute, India.

Study period 3 April 2018 to 31 March 2019.

PATIENTS

One hundred and forty-four women aged 19 to 40 years with a singleton pregnancy.

INTERVENTION

In group Leg Wrapping, crepe bandage was applied tightly from metatarsus to groin. Group Norepinephrine and the control group received sham leg wrapping. In group Norepinephrine, the women received a norepinephrine infusion according to their body weight, while group Leg Wrapping and the control group received a 0.9% normal saline infusion at a similar rate. All three groups received a 500 ml co-load of Ringer's solution over 15 min. Noninvasive SBP was monitored every 2 min until delivery, and every 5 min thereafter. Any hypotensive event (SBP < 20% of baseline) was treated with an intravenous bolus of norepinephrine (7.5 μg).

MAIN OUTCOME MEASURES

The primary outcome was the incidence of hypotension. The secondary outcomes were performance error measurements, and the incidences of hypertension, bradycardia, norepinephrine rescue bolus and neonatal outcomes.

RESULTS

The incidences of hypotension were significantly lower in the norepinephrine infusion group and the leg wrapping groups than the control group (P values 0.021 for both). Performance error calculations showed that SBP was maintained closer to baseline with the norepinephrine infusion.

CONCLUSION

Norepinephrine infusion and leg wrapping can both reduce the incidence of postspinal hypotension during elective caesarean delivery compared with saline infusion alone.

TRIAL REGISTRATION

Clinical trial number and registry URL: CTRI/2018/04/012917 registered at Clinical Trial Registry of India http://www.ctri.nic.in/Clinicaltrials/login.php.
Pharmacokinetics of Oral Treprostinil in Children With Pulmonary Arterial Hypertension
Authors: Hopper Rachel K. , Ivy D. Dunbar , Yung Delphine , Mullen Mary P. , Hanna Brian D. , Kirkpatrick Edward , Hirsch Russel , Austin Eric D. , Fineman Jeffrey , Solum Derek , Deng C. Q. , Feinstein Jeffrey A.
Published: May 2020

As part of a clinical trial, this study examined the pharmacokinetics (PK) of oral treprostinil (TRE) in children with pulmonary arterial hypertension. The trial consisted of the following 3 cohorts: transition from parenteral (cohort 1) or inhaled (cohort 2) TRE, or de novo addition (cohort 3). Oral TRE was dosed 3 times daily. PK samples were obtained before an oral TRE dose, and at 2, 4, 6, and 8 hours thereafter. The PK parameters were calculated using noncompartmental analysis. Thirty-two children (n = 10 in cohorts 1 and 2, n = 12 in cohort 3) were enrolled; the median age was 12 years (range 7–17 years), and the median weight was 42.2 kg (range 19.3–78 kg). The median oral TRE dose for all subjects was 3.8 mg (5.9, 3.5, and 4.0 mg for cohorts 1, 2, and 3, respectively). The TRE concentration versus time profile demonstrated a peak concentration at a median of 3.8 hours with wide variability. In cohort 1, oral dosing led to higher peak (5.9 ng/mL) and lower trough (1 ng/mL) concentrations than parenteral (peak 5.4 ng/mL and trough 4.2 ng/mL), but a lower mean concentration (3.61 vs. 4.46 ng/mL), likely due to variable metabolism and noncomparable dosing. Both the area under the curve and average concentration were linearly correlated with oral TRE dose and dose normalized to body weight, but not with weight or age alone. In pediatric patients, an increased oral TRE dose or dose frequency may be required to minimize PK variability and achieve greater correlation with parenteral dosing.
Acute Effects of Interleukin-1 Blockade Using Anakinra in Patients With Acute Pericarditis
Authors: Wohlford George F. , Buckley Leo F. , Vecchié Alessandra , Kadariya Dinesh , Markley Roshanak , Trankle Cory R. , Chiabrando Juan Guido , de Chazal Horacio Medina , Van Tassell Benjamin , Abbate Antonio
Published: May 2020

Interleukin-1 (IL-1) receptor antagonist (anakinra) has been shown to be effective in steroid-dependent recurrent pericarditis resistant to nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine. We sought to evaluate the acute efficacy of anakinra given early in patients with acute pericarditis. We enrolled patients within 24 hours of presentation of a first or recurrent episode of acute pericarditis who were experiencing severe pain (≥6 in 11-point Likert scale), despite treatment with at least one dose of NSAIDs and of colchicine. The primary outcome was pain relief at 24 hours. Subcutaneous anakinra 100 mg was administered in all patients, whereas NSAIDs and colchicine were suspended for 24 hours. Serum levels of interleukin-6 (IL-6) were measured at baseline and 24 hours. Data are reported as median (interquartile range). We treated 5 patients (4 male and 1 female; 38 [31–54] years old). Anakinra significantly reduced pain from 6.0 (6.0–7.5) to 4.0 (2.5–4.0) at 6 hours (P = 0.012 vs. baseline) and to 2.0 (1.5–2.5) at 24 hours (P = 0.0025 vs. baseline). No patients required rescue pain medication. IL-6 levels were also significantly reduced from 95.3 (24.2–155.1) to 23.9 (4.5–71.9) pg/mL at 24 hours (P = 0.037). The reduction in pain intensity paralleled the reduction in IL-6 serum levels (R = +0.966, P = 0.007). No adverse events related to treatment occurred. The administration of anakinra given early in acute pericarditis treatment course rapidly and significantly improved chest pain from acute pericarditis. The improvement is correlated with a reduction in IL-6 levels.
Hypertension and race/ethnicity
Authors: Deere Bradley P. , Ferdinand Keith C.
Published: May 2020

Purpose of review

United States racial/ethnic minorities may experience disproportionate hypertension (HTN) morbidity and mortality. This review discusses recent literature regarding the differential impact of HTN, especially among African Americans and Hispanics.

Recent findings

Although disparities in HTN prevalence, control, and outcomes persist in racial/ethnic minorities relative to non-Hispanic Whites, racial/ethnic minorities are frequently underrepresented in genetic and clinical studies. Genomics have improved our understanding of HTN, but with no clinically useful application, the role of social determinants of health in HTN disparities is increasingly recognized. Team-based approaches with targeted, multilevel interventions may overcome barriers that uniquely impact racial/ethnic minorities.

Despite extensive epidemiological research, racial/ethnic minorities remain at higher risk HTN-related morbidity and mortality. Translational efforts may address the differential impact of HTN in racial/ethnic minorities. This review highlights recent research and concepts related to HTN and race/ethnicity.
An Expert Patient Program as a Tool to Empower People With Multiple Sclerosis
Authors: Robles-Sanchez Miguel-Angel , Cruz-Díaz Verónica , Amil-Bujan Paloma , Sastre-Garriga Jaume , Ramió-Torrentà Lluís , Bertran-Noguer Carme
Published: May 2020

BACKGROUND: Multiple sclerosis (MS) affects approximately 50 000 people in Spain, so it is essential to implement health interventions that respond to their needs and demands. Expert patient programs may facilitate health-related empowerment through peer learning, but their particular features need to be tailored to MS. METHODS: Qualitative research was used to examine the needs and demands of people with MS in relation to the management of MS with the aim of designing a specific program to enable empowerment. Data gathered from focus group interviews were coded and grouped using thematic analysis with independent peer review. RESULTS: The identified needs and demands focused on improving MS knowledge and acquiring the skills to promote self-management and autonomy. An MS expert patient program should address the impact of MS, its integrated treatment, and health promotion. The program's design should follow an open script with small groups and the support of healthcare professionals. Participants showing a need for help and an absence of comorbidities that prevent interaction should be included. Expert patients should have a positive outlook on their health, experience-based knowledge, and leadership and communication skills. The identified potential benefits were an improvement in knowledge, quality of life, and the normalization of the patient's health situation. CONCLUSION: The needs and demands of people with MS focused on enhancing knowledge about all aspects of the disease and on acquiring skills to promote self-management, autonomy, and empowerment. Program design and content were identified enabling determination of the characteristics needed to resolve these issues and develop an expert patient program for people with MS in Spain.
Spirometry in Occupational Health—2020
Authors: Townsend Mary C.
Published: May 2020

Spirometry in the occupational health setting plays a critical role in the primary, secondary, and tertiary prevention of workplace-related lung disease. Recognizing the central role of spirometry in workplace respiratory programs, the American College of Occupational and Environmental Medicine (ACOEM) developed three spirometry position statements in the past two decades, which summarized advances of particular relevance to occupational health practice. However, since these statements were published, there have been important developments in federal regulations and in official American Thoracic Society recommendations which affect occupational spirometry testing. This 2020 ACOEM guidance statement incorporates these spirometry testing changes into its recommendations to provide current information for all users of spirometry test results, from those who perform or supervise testing to those who only interpret or review results.
Effectiveness of intravenous immunoglobulin use in heparin-induced thrombocytopenia
Authors: Aryal Madan R. , Gosain Rohit , Donato Anthony , Katel Anjan , Chakradhar Rikesh , Dhital Rashmi , Kouides Peter A.
Published: May 2020

Heparin-induced thrombocytopenia (HIT) syndrome is an immune-mediated disorder producing thrombocytopenia and thrombosis, with or without prior exposure to heparin. Although avoidance of heparin products and nonheparin anticoagulants are used, immune-based therapies including intravenous immunoglobulin (IVIg) have been tried when the thrombocytopenia persists or there is breakthrough thrombosis. We sought to systematically review and analyze the published literature on use of IVIg in the treatment of HIT. A systematic search of PubMed, Google Scholar, EMBASE and SCOPUS for all study designs and reports were carried out from inception until April 2019. Statistical analysis was done using Microsoft Excel and Stata version 13. In 34 patients with HIT, the mean age was 60 years. About 70% cases were by unfractionated heparin exposure and 30% by low-molecular weight heparin. The most common precipitant in the patients without heparin exposure was recent surgery. Average nadir platelet count for which IVIg was used was 28 000/μl. Time from resolution of the thrombocytopenia after IVIg treatment was 3 days with average platelet count recovery to 159 000/μl. Mean time from diagnosis to administration of IVIg was day 18. Thrombosis was identified in 32% of patients. About 77% patients improved (platelet count >100 000/μl or cessation of thrombosis) following use of IVIg. Logistic regression did not identify any factors that predicted IVIg response (P > 0.05). No thrombotic events or other adverse events were noted with use of IVIg. IVIg appears to be a safe and effective treatment option for HIT-related thrombocytopenia and for refractory thrombosis.
Prehabilitation: metabolic considerations
Authors: Chabot Katherine , Gillis Chelsia , Carli Franco
Published: May 2020

Purpose of review

The major components of ERAS attenuate the inflammatory response and modulate metabolism in direction of sparing body protein and preserving function. However, these perioperative interventions might have limited effectiveness on postoperative outcomes if preoperative risk factors are not addressed and optimized.

Recent findings

The preoperative metabolic perturbations characterized by insulin resistance and sarcopenia might predispose patients to a higher degree of postoperative catabolism. High-risk populations for such metabolic disturbances include elderly and frail patients, and patients with metabolic syndrome. Research on the effect of prehabilitation on perioperative metabolism is limited, but recent findings suggest that interventions designed to improve insulin sensitivity prior to surgery might represent a promising therapeutic target to minimize surgical complications.

The present paper will discuss the metabolic implications of modulating preoperative risk factors with elements of multimodal prehabilitation, such as exercise training and nutrition.
Optimal thresholds for ultrasound attenuation parameter in the evaluation of hepatic steatosis severity: evidence from a cohort of patients with biopsy-proven fatty liver disease
Authors: Zhu Sheng-Hao , Zheng Kenneth I. , Hu Di-Shuang , Gao Feng , Rios Rafael S. , Li Gang , Li Yang-Yang , Byrne Christopher D. , Targher Giovanni , Chen Yong-Ping , Zheng Ming-Hua
Published: May 2020

Objective

FibroTouch is a newly developed device to assess ultrasound attenuation parameter (UAP) and liver stiffness measurement to quantify hepatic steatosis and fibrosis, respectively. However, there is currently a lack of defined thresholds of UAP to diagnose different stages of hepatic steatosis. We aimed to assess the optimal thresholds of UAP for hepatic steatosis in individuals with biopsy-proven fatty liver disease (FLD).

Methods

We enrolled 497 adults with FLD undergoing FibroTouch and liver biopsy. Area under the receiver operating characteristic curve (AUROC) was performed to calculate the performance of UAP in staging hepatic steatosis. Hepatic steatosis >33% was defined as significant steatosis. We determined the optimal cutoff values of UAP and the sensitivity or specificity higher than 90%. Sensitivity, specificity, positive predictive value and negative predictive value were subsequently calculated.

Results

The median UAP for the enrolled patients was 308 dB/m. Multivariable logistic regression analysis showed that UAP was associated with significant steatosis [adjusted-odds ratio 1.05, 95% confidence interval (CI), 1.02–1.09; P = 0.001]. The AUROCs for S ≥ 1, S ≥ 2 and S = 3 were 0.88 (95% CI, 0.84–0.91), 0.77 (95% CI, 0.73–0.81), and 0.70 (95% CI, 0.63–0.77), respectively. The optimal UAP cutoffs were 295 dB/m for S ≥ 1, 314 dB/m for S ≥ 2, and 324 dB/m for S = 3. Almost identical results were observed in the subgroup of patients with biopsy-confirmed nonalcoholic fatty liver disease (n = 435).

Conclusion

We found that the AUROC values of UAP by FibroTouch were ranging from 0.70 to 0.88 for assessing hepatic steatosis severity. These UAP cutoffs could be applicable for clinical use.
Incidence of kidney cancer after liver transplantation: a meta-analysis
Authors: Zhou Qiang , Chen Junhong , Pan Weicong , Chen Yongjin , Wen Lijia , Liu Kai
Published: May 2020

The purpose of this systematic review and meta-analysis was to investigate the relationship between liver transplantation and kidney cancer. Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed. PubMed, the Web of Science, and the Cochrane databases were searched for peer-reviewed cohort studies in which standardized incidence of kidney cancer post-transplant was compared to the general population by means of standardized incidence ratio (SIR) with 95% confidence interval (CI). No limits were placed on language or year of publication. A fixed-effects model was used for pooling the data. Of the 937 citations identified from the electronic databases, we included nine cohort studies with 53913 liver transplant patients, a male percentage of 56.8% and a minimum follow-up of 12.4 months and more. The meta-analysis revealed that liver transplant recipients faced a significantly higher risk of developing kidney cancer than the general population with the pooled SIR of 2.02 (95% CI, 1.64–2.50; P < 0.001). No significant between-study heterogeneity was observed (I
2 = 0, P
het = 0.553). On sensitivity analysis after removing the study by Engles et al. with the largest sample size (37 888 liver transplant recipients), the SIR remained stable (SIR 2.75; 95% CI, 1.85–4.10; P < 0.001). Overall, our synthesis of the literature indicates that an increased risk of kidney cancer exists after liver transplantation. Future studies should evaluate the potential risk factors associated with kidney cancer.
Endoscopic drainage in patients with malignant extrahepatic biliary obstruction: when and how
Authors: Mangiavillano Benedetto , Papanikolaou Ioannis S. , Arvanitakis Marianna , Auriemma Francesco , Bianchetti Mario , Tarantino Ilaria , Traina Mario , Deviere Jacques , Repici Alessandro
Published: May 2020

The question of when and how to drain a malignant biliary obstruction (MBO), both intrinsic or extrinsic, remains a controversial point among endoscopists. An important factor that influences the decision to drain an MBO or not is if the patient is a surgical candidate or not and, in the former case, if the patients must undergo neoadiuvant chemotherapy or not. Other questions arising during biliary drainage in MBO patients is which type of stent should be chosen, plastic or metal, and if endoscopic biliary sphincterotomy must be performed or not when a stent is placed. The present review attempts to answer these questions and summarizes the optimal approach toward patients with MBO based on the available evidence.
Calciprotein particles: mineral behaving badly?
Authors: Smith Edward R. , Hewitson Tim D. , Jahnen-Dechent Willi
Published: May 2020

Purpose of review

Calciprotein particles (CPP) are formed in supersaturated solutions of calcium, phosphate and the mineral-binding protein fetuin-A. CPP have garnered considerable interest as potential mediators of mineral stress, but little consideration has been given to their origin, clearance and role in metabolism.

Recent findings

CPP are made whilst buffering the mineral absorbed from the intestine after a meal or during remodelling of bone matrix. The postprandial rise in circulating CPP rise may be sensed by osteoblasts/osteocytes in bone, stimulating the secretion of the master phosphatonin fibroblast growth factor 23. Amorphous calcium phosphate-containing CPP are rapidly cleared by endothelial cells in the liver whereas crystalline apatite-containing CPP are filtered by phagocytic cells of the reticuloendothelial system. Impaired excretory function in kidney disease may lead to accumulation of CPP and its precursors with possible pathological sequalae. Inability to stabilize CPP in fetuin-A-deficiency states can result in intraluminal precipitation and inflammatory cascades if other mineralisation regulatory networks are compromised.

CPP allow efficient transport and clearance of bulk calcium phosphate as colloids without risk of precipitation. As circulating factors, CPP may couple dietary mineral exposure with endocrine control of mineral metabolism in bone, signalling the need to dispose of excess phosphate from the body.
EsoFLIP for esophageal dilation: proposed advantages
Authors: Baumann Alexandra J. , Carlson Dustin A.
Published: May 2020

Purpose of review

The EsoFLIP integrates impedance planimetry technology into a dilator balloon capable of dilating from diameters between 10 and 30 mm via controlled volumetric distension while providing real-time visualization and objective measurement during the dilation procedure, potentially negating the need for fluoroscopy. This review aims to describe the use and application of EsoFLIP and the potential advantages this novel technology may afford.

Recent findings

Small pilot and retrospective studies demonstrate EsoFLIP feasibility and safety, but larger studies are needed to understand its impact on clinical outcomes.

EsoFLIP is an appealing new technology that offers advantages in therapeutic dilation of the lower esophageal sphincter in achalasia or of esophageal strictures because of previous surgery, gastroesophageal reflux disease, or radiation.
The burden of cost in inflammatory bowel disease: a medical economic perspective
Authors: Beard Jonathan A. , Click Benjamin H.
Published: May 2020

Purpose of review

The cost of care for inflammatory bowel disease (IBD) has nearly doubled over the last two decades. With evolving treatment paradigms utilizing costly but efficacious biologic agents earlier and more often, the cost burden is only expected to worsen. The purpose of this review is to explore the current economic landscape and drivers of IBD healthcare costs along with potential mechanisms for improving value and cost-effectiveness of IBD care.

Recent findings

The prevalence of IBD continues to rapidly expand with costs following suit. As compensation models change, the medical community is more incentivized than ever to develop cost reduction strategies including incorporation of high-value care measures, cooperative data aggregation, and technological solutions, with many of these interventions demonstrating promising results.

IBD is an expensive chronic disease with payments only expected to rise. In light of this financial conundrum, new practice models, such as the IBD specialty medical home and remote telemedicine, are being tested with an emphasis on cost reduction. Many of these strategies are demonstrating improved patient outcomes while also curbing expenses. These early successes set the stage for continued cooperation, collaboration, and growth in value-based management of IBD.
Gaining resilience and reducing stress in the age of COVID-19
Authors: Lupe Stephen E. , Keefer Laurie , Szigethy Eva
Published: May 2020

Purpose of review

The world is experiencing the evolving situation associated with the outbreak of the Corona Virus Disease-2019 (COVID-19) virus, and there is more of need than ever for stress management and self-care. In this article, we will define the physiological, psychological and social aspects, stages, and components of stress reactions in the context of COVID-19, review the relevant literature on stress reactions, and offer some guidance on how to help patients mitigate the physiological and psychological impact of the pandemic through resilience-building techniques.

Recent findings

There is continued evidence that the fight or flight response involves activation throughout the body at physiological, biochemical and immune levels. This response can be mitigated through increasing parasympathetic nervous system activation as well as cognitive and behavioral interventions.

This article will review the stress, provide a theoretical layout to predict upcoming response, and offer clinicians some practical interventions to employ as the stress of the COVID-19 pandemic continues.
Plant homeodomain finger protein 6 in the regulation of normal and malignant hematopoiesis
Authors: Miyagi Satoru , Iwama Atsushi
Published: May 2020

Purpose of review

Even though an increasing amount of sequencing data on the leukemia genome has highlighted a tumor-suppressive function for plant homeodomain finger protein 6 (PHF6), its role in the hematopoietic system remained elusive until recently. The purpose of this review is to describe the role of PHF6 in normal hematopoiesis and leukemogenesis based on recent findings from knockout mouse models.

Recent findings

In a mouse model, the loss of Phf6 enhanced the bone marrow repopulating capacity of hematopoietic stem cells (HSCs) during serial transplantations without transforming hematopoietic cells, whereas donor mice, which lacked Phf6 expression in the hematopoietic system, did not show any apparent phenotypes in the steady-state. Mechanistically, Phf6 activates effectors in the tumor necrosis factor α (Tnfα) pathway. Therefore, a Phf6 deficiency attenuates the expression of the effectors and confers resistance against Tnfα-mediated growth inhibition to HSCs. Moreover, the loss of Phf6 promoted the development of leukemia induced by aberrant TLX3 expression or an active NOTCH mutation.

Phf6 restricts the self-renewal of HSCs by governing the Tnfα pathway. Phf6 fulfills a tumor-suppressive function, and its loss synergizes with leukemic lesions to promote the onset of hematological malignancies.
Regulation of stress-induced hematopoiesis
Authors: Anderson Georgina A. , Rodriguez Melanie , Kathrein Katie L.
Published: May 2020

Purpose of review

The hematopoietic compartment is tasked with the establishment and maintenance of the entire blood program in steady-state and in response to stress. Key to this process are hematopoietic stem cells (HSCs), which possess the unique ability to self-renew and differentiate to replenish blood cells throughout an organism's lifetime. Though tightly regulated, the hematopoietic system is vulnerable to both intrinsic and extrinsic factors that influence hematopoietic stem and progenitor cell (HSPC) fate. Here, we review recent advances in our understanding of hematopoietic regulation under stress conditions such as inflammation, aging, mitochondrial defects, and damage to DNA or endoplasmic reticulum.

Recent findings

Recent studies have illustrated the vast mechanisms involved in regulating stress-induced hematopoiesis, including cytokine-mediated lineage bias, gene signature changes in aged HSCs associated with chronic inflammation, the impact of clonal hematopoiesis and stress tolerance, characterization of the HSPC response to endoplasmic reticulum stress and of several epigenetic regulators that influence HSPC response to cell cycle stress.

Several key recent findings have deepened our understanding of stress hematopoiesis. These studies will advance our abilities to reduce the impact of stress in disease and aging through clinical interventions to treat stress-related outcomes.
Primary Central Nervous System Posttransplant Lymphoproliferative Disorder After Kidney Transplant
Authors: Stone Trevor , Eskandari Ramin , Baker Tiffany , Antonucci Michael , Yazdani Milad
Published: May 2020

Primary central nervous system posttransplant lymphoproliferative disorder is a rare complication of solid organ transplantation, with increasing incidence in children given a steady rise in pediatric solid organ transplants. Given similar imaging appearance to many opportunistic infections, a high degree of awareness is required for prompt and early diagnosis. We report a case of primary central nervous system posttransplant lymphoproliferative disorder presenting as a single rim enhancing lesion with central restricted diffusion mimicking an intracranial abscess.
Trametinib-based Treatment of Pediatric CNS Tumors: A Single Institutional Experience
Authors: Paul Megan R. , Pehlivan Katherine C. , Milburn Mehrzad , Yeh-Nayre Lanipua , Elster Jennifer , Crawford John R.
Published: May 2020

MEK inhibitors are an emerging therapy with increasing use in mitogen-activated protein kinase-driven central nervous system (CNS) tumors. There is limited data regarding efficacy and toxicity in pediatric patients. We report our clinical experience with trametinib-based therapy for the treatment of 14 consecutive pediatric patients with recurrent low-grade glioma (N=11) or high-grade CNS tumors (N=3) with MAP kinase pathway mutations. Patients received trametinib as monotherapy (N=9) or in combination (N=5) with another antineoplastic agent. Nine patients (64%) were progression free during treatment. Five patients showed a partial response, while 4 had stable disease. Two patients (14%) progressed on therapy. All partial responses were in patients with low-grade tumors. The remaining 3 patients were not evaluable due to toxicity limiting duration of therapy. Two of 3 patients with low-grade glioma with leptomeningeal dissemination showed radiographic treatment response. Five patients reported improved clinical symptoms while on trametinib. Adverse events on trametinib-based therapy included dermatologic, mouth sores, fever, gastrointestinal, infection, neutropenia, headache, and fatigue, and were more common in patients using combination therapy. Trametinib-based therapy demonstrated signals of efficacy in our single institutional cohort of pediatric patients with mitogen-activated protein kinase-driven CNS tumors. Our observations need to be confirmed in a clinical trial setting.
Multifocal Recurrent Microcystic Adnexal Carcinoma
Authors: Teixeira Jeffrey C. , Patel Vishal , Goodman Joseph
Published: May 2020

Microcystic adnexal carcinoma (MAC) is a rare and locally aggressive neoplasm with preponderance for local recurrence but rarely nodal or distant metastasis. A 38-year-old male was referred to our clinic for definitive treatment of known recurrent and concern for multifocal MAC from previous biopsy. The patient was treated with modified Mohs and reconstruction with an anterolateral thigh (ALT) free flap for tissue coverage. This case highlights the rare nature of multifocal MAC, treatment challenges of Mohs clearance versus wide local excision, and reconstructive challenge associated with large post treatment defects.
Central Retinal Artery Occlusion Following Prone Transcranial Surgery for Craniosynostosis and Discussion of Risk Factors
Authors: Roumeliotis Grayson , Campbell Stewart , Das Sumit , Hildebrand Goran Darius , Charbel Issa Peter , Jayamohan Jayaratnam , Lawrence Tim , Magdum Shailendra , Wall Steven , Johnson David
Published: May 2020

Vision loss is a known rare complication of prone positioning during surgery. Vision loss following prone surgery is most commonly attributed to direct pressure on the eye but can also be caused by central retinal artery occlusion (CRAO) in the absence of pressure on the eye. Central retinal artery occlusion has not been previously described following prone transcranial surgery for craniosynostosis. We present two cases of monocular CRAO following prone calvarial expansion. A multidisciplinary root cause analysis suggested that raised intracranial pressure and intraoperative tranexamic acid may have been risk factors for the development of CRAO in these cases as no conventional risk factors for CRAO following prone surgery were present. Because of this, we retrospectively reviewed all prone transcranial procedures performed at the Oxford Craniofacial Unit for the presence of raised intracranial pressure and intraoperative tranexamic acid use. A total of 662 prone procedures have been performed between 1994 and March, 2019. Tranexamic acid has been used routinely in all transcranial procedures since 2012 and in the last 311 consecutive prone cases. Fifty-one (7.7%) prone procedures were performed for raised intracranial pressure, and tranexamic acid was used in the 33 most recent of these. Since the implementation of standard intraoperative administration of tranexamic acid there have been 2 cases of CRAO following prone surgery. The overall incidence of CRAO was 0.3% but was 6% in the context of raised intracranial pressure and tranexamic acid use. Prone positioning raised intracranial pressure and tranexamic acid use together may represent a potent combination of risk factors for CRAO.
COVID-19 Pandemic and its Impact on Craniofacial Surgery
Authors: Andrews Brian T. , Garg Ravi , Przylecki Wojciech , Habal Mutaz
Published: May 2020

In late 2019, a novel coronavirus strain, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), also known as coronavirus disease 2019 (COVID-19), triggered a global pandemic as the virus spread from the Wuhan Province, China, across all continents. Although infrequent, severe respiratory infection and death caused by SARS-CoV-2 is disproportionately high amongst healthcare providers such as craniofacial surgeons who work in the head and neck region. Factors this impact SARS-CoV-2 transmission include: (1) high viral loads in the mucosa of the oral and nasopharynx, (2) limited and/or imprecise disease screening/confirmation testing, (3) access to and appropriate use of personal protective equipment (PPE).
Functional and Cognitive Decline Among Older Adults After High-risk Surgery
Authors: Suwanabol Pasithorn A. , Li Yun , Abrahamse Paul , De Roo Ana C. , Vu Joceline V. , Silveira Maria J. , Mody Lona , Dimick Justin B.
Published: May 2020

Objective:

The aim of this study was to determine whether older adults are at higher risk of lasting functional and cognitive decline after surgery, and the impact of decline on survival and healthcare use.

Summary Background Data:

Patient-centered outcomes after surgery are poorly characterized.

Methods:

Using data from the Health and Retirement Study linked with Medicare, we matched older adults (≥65 years) who underwent one of 163 high-risk elective operations (ie, inpatient mortality of ≥1%) with nonsurgical controls between 1992 and 2012. Functional decline was defined as an increase in the number of activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs) requiring assistance from baseline. Cognitive decline was defined by worse response to a test of memory and mental processing from baseline. Using logistic regression, we examined whether surgery was associated with functional and cognitive decline, and whether declines were associated with poorer survival and increased healthcare use.

Results:

The matched cohort of patients who did not undergo surgery consisted of 3591 (75%) participants compared to 1197 (25%) who underwent surgery. Patients who underwent surgery were at higher risk of functional and cognitive declines [adjusted odds ratio (aOR) 1.52, 95% confidence interval (CI): 1.23–1.87 and aOR 1.32, 95% CI: 1.03–1.71]. Declines were associated with poorer long-term survival [hazard ratio (HR) 1.67, 95% CI: 1.43–1.94 and HR 1.35, 95% CI: 1.15–1.58], and were significantly associated with nearly all measures of increased healthcare utilization (P < 0.001).

Conclusion:

Older adults undergoing high-risk surgery are at increased risk of developing lasting functional and cognitive declines.
Safety of Percutaneous Cholecystostomy Early Removal: A Retrospective Cohort Study
Authors: Di Martino Marcello , Miguel Mesa Diana , Lopesino González José María , de la Hoz Rodríguez Ángela , Martín-Pérez Elena
Published: May 2020

Introduction:

There are no strong recommendations regarding the management of percutaneous cholecystostomy (PC). The aim of this study was to assess the safety of early PC removal in terms of complications and recurrent disease.

Materials and Methods:

Retrospective observational study of consecutive patients who underwent PC for acute cholecystitis from January 2012 to December 2017. We first evaluated PC-related complications and recurrent disease in patients whose drainage was removed as inpatients (IPR) or as outpatients (OPR). Patients were then divided into 2 groups according to the timing of PC removal: G1 with the PC removed within the first 7 days after its collocation and G2 with the PC removed after 7 days.

Results:

We included 151 patients. Patients in the OPR group had their catheters removed after 52 days (26 to 67 d) while the IPR group after 8 days (6 to 11 d); P<0.001. No difference was seen regarding complications, recurrent disease rate, or readmissions.

G1 was comprised of 56 patients (37.1%), whereas G2 had 95 (62.9%). When G1 was compared with G2, no differences were seen in terms of complications. However, G1 presented a shorter duration of antibiotic treatment with 11 days (8 to 14 d) versus 15 days (12 to 23 d) in G2; P<0.001, but had a higher rate of recurrent disease 32.1% versus 14.7% in G2; P=0.014 and a higher rate of readmission 30.3% versus 13.6% in G2; P=0.019.

Conclusions:

Removal of the PC during the index admission was not associated with a higher risk of complications. However, the PC removal before 7 days could be related to an increase in recurrent disease and readmissions.
Prognostic Significance of Cyclic Seizures in Status Epilepticus
Authors: Zorlu Musab M. , Chuang David T. , Buyukozkan Mustafa , Aydemir Seyhmus , Zarnegar Reza
Published: May 2020

Purpose:

Status epilepticus (SE) is a commonly encountered neurologic condition associated with high mortality rates. Cyclic seizures (CS) are a common form of SE, but its prognostic significance has not been well established. In this retrospective study, the mortality of cyclic versus noncyclic forms (NCSs) of SE are compared.

Methods:

A total of 271 patients were identified as having seizures or SE on EEG reports, of which 65 patients were confirmed as having SE. Based on EEG characteristics, the patients were then classified as cyclic or noncyclic patterns. Cyclic seizures were defined as recurrent seizures occurring at nearly regular and uniform intervals. Noncyclic form included all other patterns of SE. Pertinent clinical data were collected and reviewed for each case.

Results:

Of the 65 patients with SE, 25 patients had CS and 40 patients had NCS. Patients with CS showed a lower rate of in-hospital mortality although not statistically significant (P = 0.19). When looking at patients younger than 75 years, the CS group had significantly lower in-hospital mortality rate (P = 0.007).

Conclusions:

The findings of this study suggest that CS may have a more favorable outcome compared with NCS in patients younger than 75 years. This study is also the first to report the rate of CS among all cases of confirmed SE (38%). Future studies with a larger sample size are needed to further evaluate the difference in outcome between CS and NCS.
The effectiveness, feasibility and scalability of the school platform in adolescent mental healthcare
Authors: Williams Ian , Vaisey Alaina , Patton George , Sanci Lena
Published: May 2020

Purpose of review

Schools are increasingly at the forefront of mental healthcare for young people internationally. This review aims to describe recent developments in school-based mental health activities to respond to mental health needs in adolescents, with a focus on empirical studies aimed at preventing, ameliorating or treating mental disorders.

Recent findings

The field is characterized by substantial heterogeneity in program design and research methods. Evidence for effectiveness of single-faceted school-based mental health programs is equivocal. Recent systematic reviews and meta-analyses have reported mixed findings across a variety of single-faceted universal and targeted programs at post-intervention, short-term and long-term follow-up. The largest and most recent review and network meta-analyses conclude there is limited evidence in support of these forms of school-based anxiety and depression prevention programs. Feasibility studies, which include consideration of appropriate service providers, suggest a need to consider schools as complex systems when designing interventions. Recent models adopting whole-school approaches appear feasible, effective and potentially sustainable with modest levels of resourcing.

Greater evidence is needed regarding long-term impact and sustainability of interventions. Recent trials of multifaceted and multilevel interventions show particular promise. Future research should further explore strategies embedded within school systems and processes.
Nocturnal pollinators strongly contribute to pollen transport of wild flowers in an agricultural landscape
Authors: Walton Richard E. , Sayer Carl D. , Bennion Helen , Axmacher Jan C.
Published: May 2020

Dramatic declines in diurnal pollinators have created great scientific interest in plant–pollinator relationships and associated pollination services. Existing literature, however, is generally focused on diurnal pollinating insect taxa, especially on Apidae (Hymenoptera) and Syrphidae (Diptera) pollinators, while nocturnal macro-moths that comprise extremely species-rich flower-visiting families have been largely neglected. Here, we report that in agricultural landscapes, macro-moths can provide unique, highly complex pollen transport links, making them vital components of overall wild plant–pollinator networks in agro-ecosystems. Pollen transport occurred more frequently on the moths' ventral thorax rather than on their mouthparts that have been traditionally targeted for pollen swabbing. Pollen transport loads suggest that nocturnal moths contribute key pollination services for several wild plant families in agricultural landscapes, in addition to providing functional resilience to diurnal networks. Severe declines in richness and abundance of settling moth populations highlight the urgent need to include them in future management and conservation strategies within agricultural landscapes.