bluuebunny/crossref_metadata_2025 huggingface dataset:
Genotype–immunophenotype analysis reveals the immunogenomic subtype and prognosis of multiple myeloma
Authors: Wang Yue , Feng Wanjing , Liu Peng
Published: April 2020

Immune dysfunction plays an important role in tumour development, recurrence, therapeutic responses and overall survival (OS). Multiple myeloma (MM) is a clonal B-cell malignancy which characterized by anti-tumoural immune dysfunction. In this study, we analysed 28 tumour-immune-related pathways and calculated the immune pathway score through published microarray data from the Gene Expression Omnibus (GEO) data portal. A training set of 345 patients and a validation set of 214 patients with primary MM were chosen. We performed least absolute shrinkage and selection operator (LASSO) analysis to identify prognostic factors. Then, we used cluster analysis to divide patients into three immunogenomic subtypes, which named abnormal immune activated type, common type and anti-myeloma immune activated type. Log‑rank tests showed that anti-myeloma immune activated type had the best prognosis and abnormal immune activated type had the shortest OS (P = 0.000) and event-free survival (EFS) (P = 0.000). Multivariate Cox also indicated that the immunogenomic subtype was an independent predictor of OS (P = 0.001) and EFS (P = 0.000). We also analysed the characteristics and the immune-response patterns of different subtypes. Then, we established a mathematical model to classify patients in the validation set. In the validation set, patients with different immunogenomic subtypes also had a significantly different OS (P = 0.001) and EFS (P = 0.005). Our study explored tumour-immune-related pathways at a multi-dimensional level and found the immunogenomic subtype of MM. Potential mechanisms on the genetic level of how tumour-immunity influences the prognosis and therapeutic responses are provided. The immunogenomic subtype may be feasible for deciding clinical treatment in the future.
Prevalence, Predictors, and Severity of Lean Nonalcoholic Fatty Liver Disease in Patients Living With Human Immunodeficiency Virus
Authors: Cervo Adriana , Milic Jovana , Mazzola Giovanni , Schepis Filippo , Petta Salvatore , Krahn Thomas , Lebouche Bertrand , Deschenes Marc , Cascio Antonio , Guaraldi Giovanni , Sebastiani Giada
Published: April 2020

Background

The burden of nonalcoholic fatty liver disease (NAFLD) is growing in people living with human immunodeficiency virus (HIV). NAFLD is associated with obesity; however, it can occur in normoweight (lean) patients. We aimed to investigate lean NAFLD in patients living with HIV.

Methods

We included patients living with HIV mono-infection from 3 prospective cohorts. NAFLD was diagnosed by transient elastography (TE) and defined as controlled attenuation parameter ≥248 dB/m, in absence of alcohol abuse. Lean NAFLD was defined when a body mass index was <25 kg/m2. Significant liver fibrosis was defined as TE ≥7.1 kPa. The presence of diabetes, hypertension, or hyperlipidemia defined metabolically abnormal patients.

Results

We included 1511 patients, of whom 57.4% were lean. The prevalence of lean NAFLD patients in the whole cohort was 13.9%. NAFLD affected 24.2% of lean patients. The proportions of lean NAFLD patients who were metabolically abnormal or had elevated alanine aminotransferase (ALT) were higher than among those who were lean patients without NAFLD (61.9% vs 48.9% and 36.7% vs 24.2%, respectively). Lean NAFLD patients had a higher prevalence of significant liver fibrosis than lean patients without NAFLD (15.7% vs 7.6%, respectively). After adjusting for sex, ethnicity, hypertension, CD4 cell count, nadir CD4 <200µ/L, and time since HIV diagnosis, predictors of NAFLD in lean patients were age (adjusted OR [aOR], 1.29; 95% confidence interval [CI], 1.04–1.59), high triglycerides (aOR, 1.34; 95% CI, 1.11–1.63), and high ALT (aOR, 1.15; 95% CI, 1.05–1.26), while a high level of high-density lipoprotein cholesterol was protective (aOR, 0.45; 95% CI, .26–.77).

Conclusions

NAFLD affects 1 in 4 lean patients living with HIV mono-infection. Investigations for NAFLD should be proposed in older patients with dyslipidemia and elevated ALT, even if normoweight.
The VACCINES Act: Deciphering Vaccine Hesitancy in the Time of COVID-19
Authors: McAteer John , Yildirim Inci , Chahroudi Ann
Published: April 2020

Since the COVID-19 pandemic first hit Wuhan, China, in December 2019, scientists have been racing to develop and test novel vaccines to protect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The speed of scientific discovery related to COVID-19 is unprecedented. With several vaccine candidates already being tested in clinical trials, we pose the question: what will the vaccine hesitant do in the face of this pandemic?
Triggering relationships between magmatic and faulting processes in the May 2018 eruptive sequence at Kīlauea volcano, Hawaii
Authors: Kundu Bhaskar , Yadav Rajeev Kumar , Bürgmann Roland , Wang Kang , Panda Dibyashakti , Gahalaut Vineet K
Published: April 2020

The May 2018 activity at Kīlauea Volcano, Hawaii involved magma transport and dyke intrusion along the East Rift Zone (ERZ) and nucleation of the 4 May 2018 M 6.9 earthquake along the basal décollement of Kīlauea's mobile south flank. Combined Global Positioning Systems (GPS) and Interferometric Synthetic Aperture Radar (InSAR) measurements captured the deformation sequence associated with the dyke intrusion, main shock and eruption episode along the ERZ. The earthquake was encouraged by static stress changes from the preceding magma reservoir inflation, ERZ expansion and fault creep on the décollement downdip of the rupture. Slip models derived from the inversion of GPS displacements indicate peak coseismic slip of 2–3 m. Our model analyses, including of the pre-May 2018 deformation, suggest that prior to this event there was no slip on the section of the décollement that ruptured in the earthquake. The observed magma inflation, rapid fault creep on the décollement and coseismic rupture reflect complex cyclic interactions between the magmatic and faulting processes.
Response of Male Queensland Fruit Fly (Diptera: Tephritidae) to Host Fruit Odors
Authors: Tasnin Mst Shahrima , Silva Rehan , Merkel Katharina , Clarke Anthony R
Published: April 2020

The surveillance and management of Dacini fruit fly pests are commonly split by fly gender: male trapping focuses on the dacine ‘male-lures’, whereas female trapping focuses on lures based on host-fruit volatiles. Although the males of several Dacini species have been reported to be attracted to host fruit volatiles, the option of using host-fruit traps for males has, to date, been ignored. Males of the cue-lure responsive fruit fly Bactrocera tryoni (Froggatt) have been recorded as responding to host-fruit volatile blends, but it is not known how frequently this happens, if it is age-dependent, or the strength of the response relative to cue-lure throughout the year. Here, we conducted an olfactometer experiment to test the lifetime (weeks 1–15) response of B. tryoni males to the odor of tomato, a known host of this fly, and compare catches of wild males to tomato-based traps and cue-lure traps in the field. Bactrocera tryoni males started to respond to tomato odor as they sexually matured (2 to 3 wk olds) and thereafter showed consistent olfactory response until advanced age (15 wk). In the field, wild males were captured by tomato-based traps throughout the year at a level not significantly different from cue-lure traps. The reason for the consistent B. tryoni male response to host fruit odor at this stage is not known, but it certainly occurs at a level greater than can be continued to be ignored for both basic and applied research.
Pathological Tumor Response Following Immune Checkpoint Blockade for Deficient Mismatch Repair Advanced Colorectal Cancer
Authors: Ludford Kaysia , Cohen Romain , Svrcek Magali , Foo Wai Chin , Colle Raphael , Parc Yann , Thomas Jane Varkey , Morris Van Karlyle , Kopetz Scott , Chang George J , Overman Michael , Andre Thierry
Published: April 2020

Immune checkpoint inhibition (CPI) for metastatic colorectal cancer (mCRC) with deficient mismatch repair (dMMR) demonstrates high clinical activity that appears durable, but the impact of CPI on pathological tumor response is unknown. In this retrospective analysis, our objective was to assess pathological response and clinical outcomes in dMMR mCRC patients treated with CPI prior to surgical resection of primary and/or metastatic tumor. Among 121 advanced dMMR mCRC patients treated with CPI at 2 institutions between November 2016 and December 2018, 14 underwent surgery. Pathologic complete response was noted in the resected specimens of 13 patients despite the presence of residual tumor on preoperative imaging in 12 of those patients. With median follow-up of 9 months, no patients have had disease relapse or progression. For this small retrospective study, the data suggest that residual radiographic tumor may not require systematic resection following response to anti-PD1–based therapy. However, larger prospective studies are warranted.
Home Health Use Following a Cancer Diagnosis Among Patients Enrolled in Medicare Advantage and Traditional Medicare: Findings From the Newly Linked SEER-Medicare and Home Health OASIS Data
Authors: Thomas Kali S , Schwartz Margot L , Boyd Eric , White Dolly P , Mariotto Angela B , Barrett Michael J , Warren Joan L
Published: April 2020

Background

This article describes characteristics of patients receiving home health following an initial cancer diagnosis, comparing those enrolled in Medicare Advantage (MA) and Traditional Medicare (TM), using the newly linked 2010–2014 National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER)-Medicare and home health Outcome and Assessment Information Set (OASIS) data.

Methods

We identified SEER-Medicare beneficiaries with at least one OASIS assessment within 3 months of cancer diagnosis in 2010-2014, and summarized their demographic and clinical characteristics. Demographic and diagnostic data were obtained from the SEER-Medicare data, while further details about cognitive status, mood, function, and medical history were obtained from OASIS. We assessed differences between MA and TM beneficiaries using chi-square tests for independence, t-tests, and Kruskal-Wallis tests.

Resutls

We identified 104 023 patients who received home health within 3 months of cancer diagnosis: 81 587 enrolled in TM and 22 436 enrolled in MA. TM cancer patients had higher unadjusted rates of home health use than MA patients (16.3% vs 10.3%, P < .001). TM cancer patients receiving home health had more limitations in their cognitive function than their MA counterparts and longer lengths of service (mean = 42.2 days vs 39.4 days, P < .001; median = 27 vs 26 days, interquartile range = 42).

Conclusion

This study demonstrates the large number of cancer patients in the SEER-Medicare-OASIS data and describes characteristics for TM and MA patients. These newly linked data can be used to assess home health care among older patients with cancer.
Cigarette Use, E-Cigarette Use, and Dual Product Use Are Higher Among Adults With Serious Psychological Distress in the United States: 2014–2017
Authors: Weinberger Andrea H , Zhu Jiaqi , Barrington-Trimis Jessica L , Wyka Katarzyna , Goodwin Renee D
Published: April 2020

Introduction

Cigarette use is declining yet remains common among adults with mental health conditions. In contrast, e-cigarette use may be on the rise. This study investigated the relationship between serious psychological distress (SPD) and the exclusive and dual use of cigarettes and e-cigarettes among US adults from 2014 to 2017.

Aims and Methods

Data came from 2014 to 2017 National Health Interview Survey, an annual, cross-sectional survey of nationally representative samples of US adults (total combined analytic sample n = 125 302). Past-month SPD was assessed using the Kessler Psychological Distress Scale (K6) and cigarette and e-cigarette use were assessed at each wave. Logistic regressions examined product use by SPD status in 2017 and trends in product use by SPD status from 2014 to 2017. Analyses adjusted for demographic covariates.

Results

The prevalence of cigarette use, e-cigarette use, and dual use was higher among adults with SPD than without SPD in each year including the most recent data year 2017 (cigarette use, 39.50% vs. 13.40%, p < .001; e-cigarette use, 7.41% vs. 2.65%, p < .001; dual use, 5.30% vs. 1.26%, p < .001). Among adults with SPD, the prevalence of cigarette, e-cigarette, and dual product use did not change from 2014 to 2017 in contrast to a decreasing prevalence in cigarette, e-cigarette, and dual product use among individuals without SPD.

Conclusions

US adults with SPD report higher levels of cigarette, e-cigarette, and dual product use than adults without SPD. Use of these products has not declined over the past several years in contrast to decreasing trends among adults without SPD.

Implications

These data extend our knowledge of tobacco product use and mental health disparities by showing that in addition to higher levels of cigarette use, US adults with SPD also use e-cigarettes and dual products (cigarette and e-cigarette) more commonly than those without SPD. Furthermore, the use of these products has not declined over the past several years in contrast to continuing declines among adults without SPD. More research is needed to understand the potential positive and negative consequences of e-cigarette use among adults with SPD.
Addressing Diversity in Post-unitary Theories of Order
Authors: Dellavalle Sergio
Published: April 2020

The article analyses the presuppositions that lie behind the transition from the unitary conception of order to the view that a multiplicity of orders should not be denounced as a pathology any longer, but accepted on the one hand as a fact and on the other as a desirable phenomenon. The first step of the analysis consists in introducing the fundamental elements of the unitary conception of order in both its variants: the particularistic and the holistic. Three approaches are then outlined which abandon the unitary notion of order: systems theory, post-modernism and discourse theory. Each of these approaches lays the ground for a specific notion of post-unitary legal order: the idea of the existence of a multiplicity of self-reliant, albeit not mutually indifferent, legal systems in the first case; radical legal pluralism in the second; and cosmopolitan constitutionalism in the third.
The medical evaluation of prepubertal children with suspected sexual abuse
Authors: Smith Tanya , Chauvin-Kimoff Laurel , Baird Burke , Ornstein Amy
Published: April 2020

Child sexual abuse is an important and not uncommon problem. Children who have been sexually abused may present to a physician’s office, urgent care centre, or emergency department for medical evaluation. A medical evaluation can provide reassurance to both child and caregiver, identify care needs, and offer an accurate interpretation of findings to the justice and child welfare systems involved. Given the potential medico-legal implications of these assessments, the performance of a comprehensive evaluation requires both current knowledge and clinical proficiency. This position statement presents an evidence-based, trauma-informed approach to the medical evaluation of prepubertal children with suspected or confirmed sexual abuse.
Assessment of the adequacy of counselling regarding reproductive-related issues in women of childbearing age on anti-epileptic drugs
Authors: Murphy O C , Wrigley S , Walsh R A , Freir D B , McCarthy A J , O’Dowd S , McCabe D J H
Published: April 2020

Background

The use of anti-epileptic drugs (AEDs) in women of childbearing age (WCBA) necessitates careful counselling regarding reproductive-related issues.

Aim

(i) To compare documentation of appropriate counselling regarding reproductive-related issues in WCBA prescribed AEDs for non-epilepsy vs. epilepsy indications, and (ii) to examine whether the frequency of counselling improved after introduction of ‘standardized typed advice’.

Design

Retrospective audit and quality assessment and improvement programme.

Methods

We analysed medical records of all WCBA prescribed gabapentin, pregabalin, topiramate, valproate or carbamazepine by a general neurology clinical service before (Study period A) and after (Study period B) introduction of standardized typed passages regarding potential teratogenicity ± interactions with hormonal contraception at a university teaching hospital. The χ2 test or the Fisher’s exact test was employed, as appropriate.

Results

In WCBA prescribed AEDs for non-epilepsy indications, documentation of appropriate counselling regarding potential teratogenicity improved from 49% (17/35 patients) in Period A to 79% (27/34 patients) in Period B (P = 0.008). The frequency of counselling regarding teratogenicity was higher in patients prescribed AEDs for epilepsy compared with non-epilepsy indications in Study period A (100% vs. 49%, P = 0.002), but was no longer significantly different in Study period B (86% vs. 79%, P = 0.64). Documentation of counselling regarding potential interaction of enzyme-inducing AEDs with hormonal contraception did not significantly change between study periods.

Conclusion

Significant improvements in documentation regarding potential teratogenicity of AEDs prescribed for non-epilepsy indications can be achieved by introducing standardized, typed passages copied to patients. Such a practice change is practical and widely applicable to neurological and non-neurological practice worldwide.
Neural mechanisms supporting emotional and self-referential information processing and encoding in older and younger adults
Authors: Daley Ryan T , Bowen Holly J , Fields Eric C , Parisi Katelyn R , Gutchess Angela , Kensinger Elizabeth A
Published: April 2020

Emotion and self-referential information can both enhance memory, but whether they do so via common mechanisms across the adult lifespan remains underexplored. To address this gap, the current study directly compared, within the same fMRI paradigm, the encoding of emotionally salient and self-referential information in older adults and younger adults. Behavioral results replicated the typical patterns of better memory for emotional than neutral information and for self-referential than non-self-referential materials; these memory enhancements were present for younger and older adults. In neural activity, young and older adults showed similar modulation by emotion, but there were substantial age differences in the way self-referential processing affected neural recruitment. Contrary to our hypothesis, we found little evidence for overlap in the neural mechanisms engaged for emotional and self-referential processing. These results reveal that—just as in cognitive domains—older adults can show similar performance to younger adults in socioemotional domains even though the two age groups engage distinct neural mechanisms. These findings demonstrate the need for future research delving into the neural mechanisms supporting older adults’ memory benefits for socioemotional material.
Temporal Trends of Urogynecologic Mesh Reports to the U.S. Food and Drug Administration
Authors: Sassani Jessica C. , Artsen Amanda M. , Moalli Pamela A. , Bradley Megan S.
Published: April 2020

OBJECTIVE:

To compare temporal trends of urogynecologic mesh medical device reports with sentinel U.S. Food and Drug Administration (FDA) notices and to examine all linked reports of patient death.

METHODS:

The Reed Tech Navigator is an online tool used to extract and analyze data in the Manufacturer and User Facility Device Experience database. We used FDA product codes to search for reports of synthetic mesh for stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Reports with “death” listed as a patient event were queried further.

RESULTS:

There were 43,970 medical device reports involving urogynecologic mesh reported to the FDA between August 2000 and January 2019, with most occurring after the 2011 FDA communication (n=43,018, 97.8%). Of these medical device reports, 64.6% (n=28,422) were for SUI products, 27.0% (n=11,876) were for transvaginal POP products, and 8.4% (n=3,672) were for transabdominal POP products. Peak reporting occurred in 2013, which corresponded with the first major plaintiff verdicts and class action vaginal mesh settlement. There were 645 (1.5%) medical device reports of death, with 49.3% (n=318) having no cause of death identified. Only four (0.6%) could be directly attributed to the initial surgery.

CONCLUSION:

Since 2011, urogynecologic mesh has been the focus of thousands of medical device reports annually, although the data submitted are often incomplete. Few reported deaths are directly attributable to mesh products, and the majority lack sufficient information to draw causal conclusions. A high-quality registry is necessary to improve our understanding of the patient effect from urogynecologic mesh products.
Final Program Data and Factors Associated With Long-Acting Reversible Contraception Removal
Authors: Lathrop Eva , Hurst Stacey , Mendoza Zipatly , Zapata Lauren B. , Cordero Pierina , Powell Rachel , Green Caitlin , Moreno Nilda , Jamieson Denise J. , Romero Lisa
Published: April 2020

OBJECTIVE:

To describe characteristics of the full population of women who participated in the Zika Contraception Access Network program in Puerto Rico during the virus outbreak and to examine factors associated with removal of a long-acting reversible contraception (LARC) method by a Zika Contraception Access Network provider during the program's duration (May 2016–September 2017).

METHODS:

We conducted an observational cohort study. The Zika Contraception Access Network program was designed to increase access to contraception services in Puerto Rico for women who chose to prevent pregnancy during the Zika virus outbreak as a primary strategy to reduce adverse Zika virus–related pregnancy and birth outcomes. Among program participants, an observational cohort of women served by the Zika Contraception Access Network Program, we describe their demographic and program-specific characteristics, including contraceptive method mix before and after the program. We also report on LARC removals by Zika Contraception Access Network providers during the program. We examined factors associated with LARC removal using multivariable logistic regression.

RESULTS:

A total of 29,221 women received an initial Zika Contraception Access Network visit during the program. Ninety-six percent (27,985) of women received same-day provision of a contraceptive method and 70% (20,381) chose a LARC method. While the program was active, 719 (4%) women who chose a LARC at the initial visit had it removed. Women with a college degree or higher were more likely to have their LARC removed (adjusted prevalence ratio [aPR] 1.24); breastfeeding women (aPR 0.67) and those using a LARC method before Zika Contraception Access Network (aPR 0.55) were less likely to have their LARC removed.

CONCLUSION:

The Zika Contraception Access Network program was designed as a short-term response for rapid implementation of contraceptive services in a complex emergency setting in Puerto Rico and served more than 29,000 women. The Zika Contraception Access Network program had high LARC uptake and a low proportion of removals by a Zika Contraception Access Network provider during the program. A removal-inclusive design, with access to removals well beyond the program period, maximizes women's reproductive autonomy to access LARC removal when desired. This model could be replicated in other settings where the goal is to increase contraception access.
A Conceptual and Adaptable Approach to Hospital Preparedness for Acute Surge Events Due to Emerging Infectious Diseases
Authors: Anesi George L. , Lynch Ylinne , Evans Laura
Published: April 2020

At the time this article was written, the World Health Organization had declared a global pandemic due to the novel coronavirus disease 2019, the first pandemic since 2009 H1N1 influenza A. Emerging respiratory pathogens are a common trigger of acute surge events—the extreme end of the healthcare capacity strain spectrum in which there is a dramatic increase in care demands and/or decreases in care resources that trigger deviations from normal care delivery processes, reliance on contingencies and external resources, and, in the most extreme cases, nonroutine decisions about resource allocation. This article provides as follows: 1) a conceptual introduction and approach to healthcare capacity strain including the etiologies of patient volume, patient acuity, special patient care demands, and resource reduction; 2) a framework for considering key resources during an acute surge event—the “four Ss” of preparedness: space (beds), staff (clinicians and operations), stuff (physical equipment), and system (coordination); and 3) an adaptable approach to and discussion of the most common domains that should be addressed during preparation for and response to acute surge events, with an eye toward combating novel respiratory viral pathogens.
Nontraditional and Home-Based Self-management Interventions in Cancer Patients With Pain
Authors: You Eunhea
Published: April 2020

One or 2 decades ago, oncologists focused on only cancer treatments or acute care related to cancer. Since cancer care is considered as long-term cares, cancer patients require self-management (SM) ability or skill to manage their symptoms and daily cares. This mixed-method review is to evaluate quantitative and qualitative studies, which were conducted using non-traditional SM interventions for cancer pain based. This review also explores the process of SM in the chronic care model (CCM). PubMed, CINAHL, Scopus, and Wiley were used from 2011 to 2018. A total of 16 quantitative and 2 qualitative studies were included for this review. All interventions are divided into 3 types, which are educational and/or counseling programs, complementary and alternative medicine (CAM) therapy, and exercise. Ten of the included 16 studies were statistically significant on pain management: 3 CAM studies (100%), 1 exercise study (100%), and 6 of the 12 educational and/or counseling studies (50%). The CAM and exercise were statistically effective in improving cancer pain in the review. However, uncertainty remains regarding the strength of the evidence, due to the small number of studies included and lack of consistent methodologies. The application (5A) of SM support may help cancer patients to manage their pain.
EPIDEMIOLOGY OF VITREOMACULAR INTERFACE ABNORMALITIES USING MACULAR SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY IN AN ELDERLY POPULATION (THE MONTRACHET STUDY)
Authors: Ben Ghezala Inès , Seydou Alassane , Gabrielle Pierre-Henry , Bouche-Pillon Jacques , Binquet Christine , Delcourt Cécile , Daien Vincent , Bron Alain M. , Creuzot-Garcher Catherine
Published: April 2020

Purpose:

The aim of this study was to investigate the prevalence of vitreomacular interface abnormalities (VMIAs) and to identify associated factors in an elderly population in Europe.

Methods:

The MONTRACHET (Maculopathy Optic Nerve nuTRition neurovAsCular and HEarT diseases) Study is a population-based study, conducted in subjects older than 75 years. Vitreomacular adhesions, vitreomacular tractions, macular holes, epiretinal membranes, and macular cysts were assessed on spectral-domain optical coherence tomography examinations. The prevalence of VMIAs was estimated. We studied the association of demographic and clinical factors with VMIAs.

Results:

The mean age of the participants was 82.3 (SD, 3.8) years, and 37.3% were men. The prevalence rates of VMIAs were vitreomacular adhesions (17.7%), vitreomacular tractions (1.4%), lamellar macular holes (1.0%), full-thickness macular holes (0.2%), macular pseudoholes (0.4%), epiretinal membranes (38.9%), and macular cysts (5.8%). In multivariate analysis, vitreomacular adhesions were positively associated with male sex (P < 0.001) and negatively associated with older age (P < 0.001) and cataract extraction (P < 0.001). Epiretinal membranes were positively associated with older age (P < 0.001) and cataract extraction (P < 0.001).

Conclusion:

The prevalence of VMIAs based on spectral-domain optical coherence tomography analysis was high in subjects older than 75 years.
Endothelial Cell Density Changes in the Corneal Center Versus Paracentral Areas After Descemet Membrane Endothelial Keratoplasty
Authors: Musayeva Aytan , Livny Eitan , Dragnea Diana C. , Ham Lisanne , Vasiliauskaitė Indrė , Ní Dhubhghaill Sorcha , van Dijk Korine , Oellerich Silke , Melles Gerrit R. J.
Published: April 2020

Purpose:

To analyze whether endothelial cell density (ECD) differs between central and paracentral areas after Descemet membrane endothelial keratoplasty (DMEK) and to identify the locations of the highest and lowest ECD.

Methods:

In this retrospective cohort study, central and paracentral ECDs of 30 eyes of 30 patients who underwent DMEK for Fuchs endothelial corneal dystrophy were evaluated. Central, superonasal, superotemporal, and inferior specular microscopic images were analyzed at 1, 3, 6, 9, and 12 months after DMEK. Changes in ECD by location and over time and changes in location for the highest and lowest ECD were evaluated.

Results:

When compared with the preoperative donor ECD, the central ECD decreased by 32 (±11)% at 12 months postoperatively. ECD decline between 1 and 12 months postoperatively in the central, inferior, superonasal, and superotemporal location were 7%, 12%, 16%, and 13%, respectively (P< 0.0001 for all locations). Mean ECD was the highest in the center between the 3- to 12-month follow-up, whereas mean ECD was the lowest in the paracentral superonasal area at all time points (P< 0.001). Mean ECD of the highest and lowest density locations differed at all follow-up time points (P< 0.003).

Conclusions:

Postoperative ECD was not found to be uniform across the graft. Contrary to the density distribution in the normal endothelium, paracentral area ECDs were found to be consistently lower than in the central area. These differences were most prominent in the superonasal area and persisted 12 months postoperatively. Central ECD after DMEK might, thus, not represent an accurate proxy for cell density of the entire graft.
Malignant Mixed Tumor (Carcinoma Ex Pleomorphic Adenoma) of the Lacrimal Gland
Authors: Tom Ashley , Bell Diana , Ford Joshua R. , Debnam J. Matthew , Guo Yunxia , Frank Steven J. , Esmaeli Bita
Published: April 2020

Purpose:

To review the clinical presentation, treatment, and prognosis of patients with malignant mixed tumor (carcinoma ex pleomorphic adenoma) of the lacrimal gland.

Methods:

Clinical records and radiographic images were reviewed for patients with malignant mixed tumor of the lacrimal gland treated at the center during 2008–2019.

Results:

The study included 9 patients (6 men, 3 women) aged 17–66 years (median age, 56 years). Six had primary malignant mixed tumor with no history of orbital lesions, and 3 had previously been diagnosed with pleomorphic adenoma. Tumor, Node, Metastasis classification per the eighth edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual were T1aN0M0 in 2 patients, T2aN0M0 in 3 patients, T4bN0M0 in 2 patients, and T4cN0M0 in 2 patients. Two patients underwent orbital exenteration, 6 patients underwent eye-sparing surgery, and 1 patient had an unresectable tumor because of cavernous sinus extension. All patients received radiotherapy (intensity-modulated radiotherapy in 3 and proton therapy in 6). All patients received chemotherapy, 8 concurrently with radiotherapy and 1 after radiotherapy. The median follow-up time was 70 months. At last contact, 6 patients were alive without evidence of disease; 2 had died of disease, 1 of distant metastasis, and the other of cavernous sinus invasion.

Conclusions:

The findings suggest that de novo malignant mixed tumor of the lacrimal gland is more common than disease that results from transformation after incomplete resection of lacrimal gland pleomorphic adenoma. Most cases can be treated with eye-sparing surgery and radiation unless skull base extension is present.
Mast cell activation syndrome
Authors: Vacheron Nathalie , McClinton Tracy , Lynch-Smith Donna J. , Umberger Reba
Published: April 2020

Mast cell activation syndrome (MCAS) is a systemic autoinflammatory disease in which mast cells behave erratically. It is unknown whether MCAS recently evolved or if it has been an unrecognized entity for years. Clinically, the patient may present in a constant to near-constant state of allergic reaction. However, the patient may also present with a variety of nonallergic symptoms. There is currently no curative treatment, and providers must prepare to be persistent in seeking symptom-management strategies. This case study describes the vast array of symptoms a typical MCAS patient may exhibit. There is a need for provider education and awareness of this disease that could affect up to 17% of the population on a spectrum from very mild to debilitating symptoms. MCAS is often either misdiagnosed or the diagnosis is greatly delayed due to a lack of provider awareness. Patients may approach primary care providers as their first line of treatment for their aberrant, mysterious symptoms, and therefore it is imperative that nurse practitioners are aware of the disease. Nurse practitioners can play a vital role in the management of MCAS using their attention to detail to recognize patterns, validate patients' experiences, and have a voice in diagnostic criteria consensus.
Condom use philosophy and behaviors among young men who have sex with men: Variations among HIV pre-exposure prophylaxis users and nonusers
Authors: Fontenot Holly B. , Krakower Douglas , White Bradley Patrick , Marquez Samantha M. , Dormitzer Julian , Psaros Christina , O'Cleirigh Conall , Mayer Kenneth H.
Published: April 2020

Background:

In the United States, sexually transmitted infections, particularly HIV, occur at disproportionally high rates among young men who have sex with men (YMSM). Oral pre-exposure prophylaxis (PrEP) is a highly effective in reducing HIV acquisition. Reduction of condom use has been noted among adult populations of MSM using PrEP. However, less is known about PrEP and condom use among YMSM.

Purpose:

Our objective was to understand condom attitudes/beliefs and behaviors among YMSM in the context of PrEP use and nonuse.

Methodological orientation:

We conducted qualitative interviews between May and November, 2017 in Boston, MA. All YMSM were HIV-negative by self-report. We purposively sampled youth who used PrEP and those who did not use PrEP. Data were analyzed using content analysis.

Sample:

The sample consisted of 31 YMSM aged 17–24 years (mean = 21.5 years).

Conclusions:

Young men who have sex with men provided rich descriptions of their condom-use philosophies and behaviors. Three themes emerged: 1) Different condom philosophies between youth who used PrEP and youth who do not, 2) Inconsistent or absent condom use by PrEP users, and 3) Similar condom behaviors regardless of PrEP use with certain partner types, if low self-efficacy was reported, and when sex occurred during periods of substance use and/or intoxication.

Implications for practice:

This study provides understanding of YMSM condom decision-making process in the context of PrEP use or nonuse. Findings are useful to inform development and testing of individually tailored interventions for YMSM based on their personal condom-use philosophies and behaviors to improve risk reduction decision making, use of condoms, and PrEP.
Comparison between teriparatide and bisphosphonates for improving bone mineral density in postmenopausal osteoporosis patients
Authors: Fan Guiyong , Zhao Qun , Lu Pei , Chen Hao , Tan Wei , Guo Weixiao , Liu Chaoqun , Liu Jinlian
Published: April 2020

Background:

We performed a systematic review and meta-analysis of the efficacy and safety of teriparatide and bisphosphonates in managing postmenopausal osteoporosis.

Methods:

PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure were searched for relevant randomized controlled trials that were published before April 2018 and compared teriparatide and bisphosphonates in treating postmenopausal osteoporosis. Stata 12.0 was used for the meta-analysis. The pooled risk ratio (RR) or weighted mean difference and 95% confidence interval (CI) were calculated using a fixed effects or random effects meta-analysis.

Results:

A total of 14 randomized controlled trials were included in this meta-analysis. The teriparatide group was associated with a lower total occurrence of vertebral fractures (RR = 0.55, 95% CI: 0.40–0.77; P = .001) and nonvertebral fractures (RR = 0.65, 95% CI: 0.46–0.90; P = .009) than the bisphosphonate group. Moreover, compared with the bisphosphonate group, the teriparatide group had improved bone mineral density at the lumbar spine and femoral neck at the final follow-up (P < .05). There was no significant difference between the teriparatide and bisphosphonate groups in terms of complications (RR = 1.05, 95% CI: 0.90, 1.22, P = .516).

Conclusions:

Teriparatide significantly reduced the occurrence of vertebral and nonvertebral fractures in osteoporosis patients. More studies should focus on the quality of life of patients using these 2 drugs.
Association of finasteride with prostate cancer
Authors: Wang Lei , Lei Yonghua , Gao Yanyao , Cui Dong , Tang Qisheng , Li Ruixiao , Wang Dong , Chen Yu , Zhang Bo , Wang He
Published: April 2020

Background:

The Prostate Cancer Prevention Trial has shown a protective effect of finasteride on prostate cancer, but it also showed that finasteride can increase the risk of high-grade prostate cancer. Several studies have investigated the relationship between finasteride and prostate cancer, but these studies have shown inconsistent results.

Ethics:

The protocol was approved by the institutional review board of each study center. Written informed consent will be obtained from all patients before registration, in accordance with the Declaration of Helsinki.

Methods:

We performed a systematic literature review and meta-analysis to assess the association between finasteride and prostate cancer. Systematic literature searches were conducted using PubMed, EMBASE, Science Direct/Elsevier, MEDLINE, CNKI, and the Cochrane Library up to October 2018 to identify studies that involved the relationship between finasteride and prostate cancer. Meta-analysis was performed using Review Manager and Stata software. Combined ORs were identified with 95% confidence intervals (95% CI) in a random or fixed effects model.

Results:

Eight studies were identified, including 54,335 cases of patients that used finasteride and 9197 patients who served as placebo controls. Our results illustrate that there is a significant correlation between finasteride use and prostate cancer with combined ORs of 0.70 [0.51, 0.96]. A significant correlation between finasteride use and high-grade prostate cancer was also observed with combined ORs of 2.10 [1.85, 2.38].

Conclusions:

This study confirms that finasteride significantly reduced the risk of prostate cancer; however, the malignant degree of prostate cancer was increased. Studies with larger sample sizes are needed to better clarify the correlation between finasteride use and prostate cancer.
Cytokine Removal in Critically Ill Patients Requiring Surgical Therapy for Infective Endocarditis (RECReATE)
Authors: Gisler Fabian , Spinetti Thibaud , Erdoes Gabor , Luedi Markus M. , Pfortmueller Carmen A. , Messmer Anna S. , Jenni Hansjörg , Englberger Lars , Schefold Joerg C.
Published: April 2020

Introduction:

Infective endocarditis (IE) and other severe infections induce significant changes in the immune response in a considerable number of affected patients. Numerous IE patients develop a persistent functional immunological phenotype that can best be characterized by a profound anti-inflammation and/ or functional “anergy.” This is pronounced in patients with unresolved infectious foci and was previously referred to as “injury-associated immunosuppression” (IAI). IAI can be assessed by measurement of the monocytic human leukocyte antigen-DR (mHLA-DR) expression, a global functional marker of immune competence. Persistence of IAI is associated with prolonged intensive care unit length of stay, increased secondary infection rates, and death. Immunomodulation to reverse IAI was shown beneficial in early immunostimulatory (randomized controlled) clinical trials.

Methods:

Prospective 1:1 randomized controlled clinical study to compare the course of mHLA-DR in patients scheduled for cardiac surgery for IE. Patients will receive either best standard of care plus cytokine adsorption during surgery while on cardiopulmonary bypass (protocol A) versus best standard of care alone, that is, surgery without cytokine adsorption (protocol B). A total of 54 patients will be recruited and randomized. The primary endpoint is a change in quantitative expression of mHLA-DR (antibodies per cell on CD14+ monocytes/ macrophages, assessed using a quantitative standardized assay) from baseline (preoperation [pre-OP], visit 1) to day 1 post-OP (visit 4).

Discussion:

This randomized controlled clinical trial (RECReATE) will compare 2 clinical treatment protocols and will investigate whether cytokine adsorption restores monocytic immune competence (reflected by increased mHLA-DR expression) in patients with IE undergoing cardiac surgery.

Trial registration:

This protocol was registered in ClinicalTrials.gov, under number NCT03892174, first listed on March 27, 2019.
Importance and safety of autologous sperm cryopreservation for fertility preservation in young male patients with cancer
Authors: Li Yinfeng , Zhang Jian , Zhang Hanfeng , Liu Bo , Wang Guorong , Cao Maoqiu , Fu Bencui , Li Hui , Jiang Qinghua , Yu Lin , Xian Yang , Su Bizhen , Jiang Xiaohui
Published: April 2020

With development of tumor treatment, survival time of patients with cancer is significantly prolonged. Therefore, the current emphasis is not only the survival, but also the quality of life, especially, it is crucial for young male cancer patients who are unmarried and maintaining fertility. However, the awareness of fertility preservation for these patients is currently insufficient.

To give physician and cancer patients more clear understanding of the importance and safety of sperm cryopreservation, so that achieve patient fertility benefits.

First, the knowledge level and attitudes about fertility preservation were investigated by surveying 332 cancer patients and 103 medical staff with questionnaires. Second, 30 male cancer patients (experimental group) and 30 normal donors (control group) were selected and their sperm samples were cryopreserved. The sperm quality was compared between cancer patients and normal donors, before and after antitumor treatment in the cancer patients, and before and after sperm cryopreservation in both groups.

In the questionnaire survey, we found that there were 70% to 80% of medical staffs and cancer patients lacked knowledge of fertility preservation, and 27.7% of patients worried that tumor and sperm cryopreservation might affect their offspring. In the sperm preservative experiment, we found that sperm quality in cancer patients was further damaged after radiotherapy/chemotherapy in addition to tumor itself had a negative effect. However, sperm deoxyribonucleic acid fragments were not affected by sperm cryopreservation although there were significant differences in sperm quality before and after sperm preservation in both groups.

Radiotherapy/chemotherapy would further damage sperm quality of young male cancer patients. Medical staff should be aware of importance of sperm cryopreservation for fertility preservation for these patients. It is also necessary that medical staff should inform the patient about the safety of sperm freezing and guide the patient to participate in sperm cryopreservation.
Effect of puncture sites on pneumothorax after lung CT-guided biopsy
Authors: Zeng Li-Chuan , Liao Hua-Qiang , Wu Wen-Bin , Zhang Yu-Dong , Ren Feng-Chun , Wang Qu , Xie Ming-Guo
Published: April 2020

To determine the influence of puncture site on aspiration in dealing with pneumothorax following CT-guided lung biopsy.

Two hundred thirty-six pneumothorax patients after CT guided lung biopsies were retrospective analyzed from January 2013 to December 2018. Patients with minor asymptomatic pneumothorax were treated conservatively with monitoring of vital signs and follow-up CT to confirm stability. Ninety of the 236 pneumothorax patients, who underwent manual aspiration, were included in this analysis. In first manual aspiration, the needle from the lesion was retracted back into the pleural space after biopsy, and then aspiration treatment was performed. If the treatment is of unsatisfied result, a second attempt aspiration treatment, which puncture site away from initial biopsy one, was conducted. The efficacy of simple manual aspiration and the new method, changing puncture site for re-aspiration was observed.

Immediate success was obtained in 62 out of the 90 patients in the first attempt. The effective rate and failure rate were 68.9% (62/90) and 31.1% (28/90), respectively. Twenty-eight patients in whom first attempt simple aspiration were unsuccessful underwent a second attempt aspiration, which puncture site away from initial biopsy one, was successful in 13 patients with 15 patients undergoing chest tube placement. The effective rate and failure rate were 46.4% (13/28) and 53.6% (15/28), respectively. Applying the modified procedure, total effective rate of aspiration elevated significantly from 68.9% (62/90) to 83.3% (75/90) (P < .05). No serious side effects were detected in the period of aspiration procedure.

Manual aspiration with puncture site away from initial biopsy one is worth trying to deal with post-biopsy pneumothorax. This modified procedure improved the efficiency of treatment significantly, and reduced the rate of pneumothorax requiring chest tube placement.
Effects of risperidone on blood levels of interleukin-6 in schizophrenia
Authors: Feng Ziqiao , Zhang Yunqiao , You Xu , Zhang Wenyu , Ma Yuhan , Long Qing , Liu Zijun , Hao Wei , Zeng Yong , Teng Zhaowei
Published: April 2020

Background:

To evaluate the association between risperidone use and interleukin-6 (IL-6) levels by conducting a meta-analysis of controlled before-and-after studies.

Methods:

Studies were identified through a systematic search of PubMed and Embase. The mean and standardized differences were extracted to calculate the standardized mean differences. IL-6 levels were compared in patients with schizophrenia before and after risperidone treatment.

Results:

Ten studies were included in the final meta-analysis. The primary findings from our study suggest that there was a significant decrease in serum IL-6 levels after risperidone treatment (P = .021). A subgroup analysis revealed the sources of heterogeneity. The sensitivity analysis indicated that the results were stable, and no publication bias was observed.

Conclusions:

The present meta-analysis provides evidence that risperidone can significantly reduce IL-6 levels in schizophrenia. IL-6 is a potential biomarker of the pathophysiology and clinical processes of schizophrenia.