bluuebunny/crossref_metadata_2025 huggingface dataset:
Intensive Training of Spatial Hearing Promotes Auditory Abilities of Bilateral Cochlear Implant Adults: A Pilot Study
Authors: Coudert Aurélie , Verdelet Grégoire , Reilly Karen T. , Truy Eric , Gaveau Valérie
Published: August 2022

Objective:

The aim of this study was to evaluate the feasibility of a virtual reality-based spatial hearing training protocol in bilateral cochlear implant (CI) users and to provide pilot data on the impact of this training on different qualities of hearing.

Design:

Twelve bilateral CI adults aged between 19 and 69 followed an intensive 10-week rehabilitation program comprised eight virtual reality training sessions (two per week) interspersed with several evaluation sessions (2 weeks before training started, after four and eight training sessions, and 1 month after the end of training). During each 45-minute training session, participants localized a sound source whose position varied in azimuth and/or in elevation. At the start of each trial, CI users received no information about sound location, but after each response, feedback was given to enable error correction. Participants were divided into two groups: a multisensory feedback group (audiovisual spatial cue) and an unisensory group (visual spatial cue) who only received feedback in a wholly intact sensory modality. Training benefits were measured at each evaluation point using three tests: 3D sound localization in virtual reality, the French Matrix test, and the Speech, Spatial and other Qualities of Hearing questionnaire.

Results:

The training was well accepted and all participants attended the whole rehabilitation program. Four training sessions spread across 2 weeks were insufficient to induce significant performance changes, whereas performance on all three tests improved after eight training sessions. Front-back confusions decreased from 32% to 14.1% (p = 0.017); speech recognition threshold score from 1.5 dB to −0.7 dB signal-to-noise ratio (p = 0.029) and eight CI users successfully achieved a negative signal-to-noise ratio. One month after the end of structured training, these performance improvements were still present, and quality of life was significantly improved for both self-reports of sound localization (from 5.3 to 6.7, p = 0.015) and speech understanding (from 5.2 to 5.9, p = 0.048).

Conclusions:

This pilot study shows the feasibility and potential clinical relevance of this type of intervention involving a sensorial immersive environment and could pave the way for more systematic rehabilitation programs after cochlear implantation.
Open Fractures in Pediatric Orthopaedics—Can Pathways Improve Care? A 1-Year Pre and Postimplementation Analysis
Authors: Makarewich Christopher A. , McNeely Lia W. , Gohel Shivani , Baldwin Keith D.
Published: August 2022

Background:

In the care of open fractures, time to antibiotic administration has been shown to be a critical factor in preventing infection. To help improve outcomes at our institution we designed and implemented an open fracture pathway with the goal of reducing the time from emergency department (ED) arrival to antibiotic administration. Here we evaluate the success of this pathway, propose improvements in the protocol, and provide a framework for initiation at other institutions.

Methods:

We compared a retrospective prepathway cohort with a prospective postpathway cohort for 1-year pre and postpathway implementation. First, we analyzed the number of patients from outside facilities who had received antibiotics before transfer. For patients who had not received antibiotics before arriving at our institution, we reviewed pathway metrics including time from ED arrival to the ordering and administration of antibiotics, whether the correct antibiotic type was selected, and time to surgical debridement.

Results:

There were 50 patients in the prepathway cohort and 29 in the postpathway cohort. Prepathway 60.5% of transfers (23 of 38) received antibiotics before transfer, whereas post-pathway 90.0% of transfers (18 of 20) received antibiotics (P=0.032). For patients who had not received antibiotics before arriving at our institution and were included in pathway metric analysis, there were no differences in demographics or fracture characteristics. Time from ED arrival to antibiotic order decreased from 115.3 to 63.5 minutes (P=0.016). Time from antibiotic order to administration was similar between groups (48.0 vs. 35.7 min, P=0.191), but the overall time from ED arrival to antibiotic administration decreased from 163.3 to 99.2 minutes (P=0.004). There were no significant differences in whether the correct antibiotic type was chosen (P=0.354) or time from ED arrival to surgery (P=0.783).

Conclusions:

This study provides evidence that for pediatric patients presenting with open fractures, a care pathway can successfully decrease the time from ED arrival to antibiotic administration.

Level of Evidence:

Therapeutic level III—retrospective comparative study.
Trends in the Utilization of Implants in Index Procedures for Early Onset Scoliosis From the Pediatric Spine Study Group
Authors: Murphy Robert F. , Neel Garret B. , Barfield William R. , Anari Jason B. , St Hilaire Tricia , Thompson George , Emans John , Akbarnia Behrooz , Smith John ,   Pediatric Spine Study Group, Mooney James F.
Published: August 2022

Introduction:

Because of the relative rarity of Early Onset Scoliosis (EOS) cases, patient registries were developed to combine clinical information from multiple institutions to maximize patient care and outcomes. This study examines the history and trends regarding the use of growth-friendly devices for index surgical procedures in EOS patients within the Pediatric Spine Study Group database.

Methods:

All index growth-friendly implants were queried from registry inception until October 2020. EOS etiology, device/implant type, and geographic area/institution for each procedure were recorded.

Results:

From 1994 to 2020, 2786 patients underwent index surgery at a mean age of 6.2±2.9 years. There were 908 traditional growing rods (TGR) (32.3%), 922 vertical expandable prosthetic titanium rib devices (VEPTR) (33.1%), 5 hybrid VEPTR/TGR (0.18%), and 951 magnetically controlled growing rods (MCGR) (34.2%) index implants. Fifty-six different institutions reported an index implant, and 5 accounted for 823 (30%) of the cases during the study period. Institutions in the Northeast accounted for more index implants than other regions of the United States. There was a 40% increase in index implant insertions annually when comparing 1994 (3 implants/1 center) to 2018 (234 implants/56 centers), (P<0.001). Beginning in 2009, there was a 90.9% decrease in the number of TGR/VEPTR procedures (2009: 156 implants/32 centers; 2019: 22 implants/49 centersP=0.001), and a 479% increase in MCGR (2009: 1 implant/1 center; 2018: 197 implants/34 centers (P=0.005). The overall number of growth-friendly index procedures performed in 2019 (150/49 centers) decreased 34.5% when compared to 2018 (234/48 centers).

Conclusion:

The number of growth-friendly implants reported in the Pediatric Spine Study Group registry as the initial surgical management of EOS increased markedly over the past 20 years. MCGR is currently the predominant type of device utilized for index surgical procedures by group members, surpassing the use of VEPTR and TGR in 2014. There was a significant decrease in index growth-friendly procedures in 2019 compared to 2018.

Level of Evidence:

Level IV
Sex-based Difference in Response to Recombinant Human Bone Morphogenetic Protein-2 in a rat Posterolateral Fusion Model
Authors: Foley James P. , Fred Elianna J. , Minardi Silvia , Yamaguchi Jonathan T. , Greene Allison C. , Furman Andrew A. , Lyons Joseph G. , Paul Jonathan T. , Nandurkar Tejas S. , Blank Kenneth R. , Havey Robert M. , Muriuki Muturi , Patwardhan Avinash G. , Hsu Wellington K , Stock Stuart R. , Hsu Erin L.
Published: August 2022

Study Design.

Pre-Clinical

Objective.

Evaluate sex-dependent differences in the bone healing response to rhBMP-2 in a rat posterolateral spinal fusion model.

Summary of Background Data.

Minimal and conflicting data exist concerning potential sex-dependent differences in recombinant human bone morphogenetic protein-2 (rhBMP-2)-mediated bone regeneration in the context of spinal fusion.

Methods.

Forty-eight female and male Sprague-Dawley rats (N=24/group), underwent L4-L5 posterolateral fusion with bilateral placement of an absorbable collagen sponge, each loaded with 5 µg of BMP-2 (10 µg/animal). At 8 weeks post-operative, 10 specimens of each sex were tested in flexion-extension with quantification of range of motion (ROM) and stiffness. The remaining specimens were evaluated for new bone growth and successful fusion via radiography, blinded manual palpation and microcomputed tomography (microCT). Laboratory microCT quantified bone microarchitecture, and synchrotron microCT examined bone microstructure at the one micrometer level.

Results.

Manual palpation scores differed significantly between sexes, with mean fusion scores of 2.4±0.4 in females versus 3.1±0.6 in males, P<0.001. Biomechanical stiffness did not differ between sexes, but ROM was significantly greater and more variable for females versus males (3.7°±5.6° vs. 0.27°±0.15°, P<0.005, respectively). Laboratory microCT showed significantly smaller volumes of fusion masses in females versus males (262±87 mm3 vs. 732±238 mm3, respectively, P<0.001) but significantly higher bone volume fraction (0.27±0.08 vs. 0.12±0.05, respectively, P<0.001). Mean trabecular thickness was not different, but trabecular number was significantly greater in females (3.1±0.5 mm−1 vs. 1.5±0.4 mm−1, respectively, P<0.001). Synchrotron microCT showed fine bone structures developing in both sexes at the eight-week time point.

Conclusions.

This study demonstrates sex-dependent differences in bone regeneration induced by rhBMP-2. Further investigation is needed to uncover the extent of and mechanisms underlying these sex differences, particularly at different doses of rhBMP-2.
Treatment of Osteochondritis Dissecans of the Capitellum Using BioCartilage in Adolescent Athletes Results in Safe and Timely Return to Play
Authors: Blickenstaff Baylor , Torres LeeAnne , Giangarra Charles
Published: August 2022

Objectives:

Osteochondritis dissecans (OCD) is a condition affecting the capitellum in adolescent overhead athletes causing separation of articular cartilage from the subchondral bone. Multiple treatment strategies addressing these lesions have been described. The purpose of this study was to report a novel technique using BioCartilage® (Arthrex, Naples, FL) to augment microfracture of OCD lesions of the capitellum in adolescent athletes with the prediction that this would lead to favorable clinical outcomes.

Methods:

A retrospective review was performed of 5 patients with OCD lesions of the capitellum who underwent open surgical intervention with BioCartilage implantation through a lateral approach to the elbow. There were 4 female patients and 1 male patient. The mean age was 13 years. The average follow-up was 55.8 months.

Results:

Each patient returned to their original sport at 6 months with a painless range of motion and full strength. American Shoulder and Elbow Scores and Mayo Elbow Performance Scales postoperatively were 100, and Visual Analog Scales were 0/10 for each patient. There were no complications or reoperations. Radiographs obtained at 6 to 8 months postoperatively showed healing of the lesions with no further evidence of an osseous defect.

Conclusion:

Our technique shows promising mid-term results. A safe and timely return to play was achieved in each case. This technique offers advantages by providing an excellent range of motion and return to sport using a familiar open approach.
Novel treatment approaches for HER2 positive solid tumors (excluding breast cancer)
Authors: Gaye Elisabeth , Penel Nicolas , Lebellec Loïc
Published: August 2022

Purpose of review

Human epidermal growth factor 2 (HER2) alterations (protein overexpression, gene amplification and mutation) play a key role in oncogenesis and are more likely correlated to poorer outcome in solid tumors. We reviewed recently published studies in the last 18 months on novel treatment approaches for HER2 positive solid tumors (excluding breast cancer).

Recent findings

Results of clinical studies assessing anti-HER2 therapies have been recently issued.

One of the most promising drugs is transtuzumab deruxtecan, an antibody–drug conjugate which demonstrated clinically meaningful activity in gastric or gastroesophageal junction cancer and colorectal cancers.

Small molecules such as poziotinib, pyrotinib, neratinib, which target both epidermal growth factor receptor (EGFR) and HER2 also showed promising activity, especially in heavily pretreated ERRB2-mutated non-small cell lung cancer (NSCLC) cancer patients. Yet, these findings need to be confirmed in confirmatory randomized trials with larger cohorts.

Trastuzumab-based combinations with chemotherapy or immune checkpoint inhibitors are under development with promising results, but not in all HER2 tumors. Emerging adverse events with anti-HER2 are interstitial pneumopathy and diarrhea.

Tyrosine kinase inhibitors, antibody drug conjugate in monotherapy and combinations are emerging strategies in many HER2-positive cancers; HER2 therapies are now part of standard of care of HER2-amplified gastric or gastroesophageal junction cancer. Data are pending on several unmet medical needs.
Less is more in endometrial cancer (SLN, conservative treatment, radical hysterectomy, molecular classification)
Authors: Parpex Guillaume , Lieng Chloé , Koskas Martin
Published: August 2022

Purpose of review

The management of endometrial cancer has known many evolutions within the last decades. In this review, we aim to summarize recent evolutions (mainly toward less aggressive management) that have occurred in the management of endometrial cancer.

Recent findings

Enhanced by molecular classification, the determination of lymph node status, in young women, in case of cervical invasion, the treatment is evolving toward a less aggressive strategy.

The predictive value and the safety of sentinel lymph node biopsy explain why most societies propose to abandon systematic pelvic and para aortic lymphadenectomy. For young women, the safety of fertility preservation is now well established and efficient protocols have been validated. In stage II endometrial cancer (stromal cervical invasion), radical hysterectomy appears excessive. The Cancer Genome Atlas classification increases prognostic evaluation in association with the traditional pathological classification and permits to tailor adjuvant treatment more accurately.
Cross-Sectional Survey of Views on COVID-19 and Its Vaccines Among Pregnant Women
Authors: Li Yan Yu , Lok Wing Yi , Poon Liona C. , Kong Choi Wah , To William W.K.
Published: August 2022

Objective

The objective of this study is to evaluate the acceptance of pregnant women with regards to coronavirus disease 2019 (COVID-19) vaccination during pregnancy and to identify any significant changes in their anxiety and knowledge on COVID-19 compared to our previous study.

Methods

This cross-sectional survey was performed in the antenatal clinics of United Christian Hospital and Tseung Kwan O Hospital of Hong Kong, China. Questionnaires were distributed to pregnant women for self-completion when attending follow-up from August to October 2021. Apart from basic demographic data, the questionnaire comprised of questions including knowledge on COVID-19 and its vaccines in pregnancy as well as attitudes and behaviors of pregnant women and their partners toward COVID-19. Continuous variables were analyzed by Student’s test and Levene’s test was used to confirm normal distribution and homogeneity of variance for continuous variables, whereas categorical variables were analyzed by the Chi-squared test or Fisher’s exact test as appropriate. A P value of <0.05 was considered to be statistically significant.

Results

A total of 816 completed questionnaires were included for analysis. Pregnant women were less worried about COVID-19 in the current survey as compared to the last survey (393/816, 48.2% vs. 518/623, 83.1%, P<0.001). Fewer pregnant women believed that pregnancy were more susceptible to contract SARS-CoV-2 as compared to the last survey (265/816, 32.5% vs. 261/623, 41.9%, P<0.001). They have significant knowledge gap and concerns about COVID-19 vaccines. Nearly half of the participants believed that pregnant women cannot have COVID-19 vaccination (402/816, 49.3%) and it is unsafe to fetus (365/816, 44.7%). Around a third of women perceived that they were more prone to the side effects and complications of COVID-19 vaccines than the general population (312/816, 38.2%) and did not recognize that maternal COVID-19 vaccination could effect transferral of antibodies to the fetus to promote postnatal passive immunity (295/816, 36.2%). Most of them had not been vaccinated (715/816, 87.6%) and only (12/715) 1.7% of them would consider vaccination during pregnancy.

Conclusion

Despite the local and international recommendations for pregnant women to be vaccinated, the uptake of COVID-19 vaccines during pregnancy remained extremely low. Efforts should be made to effectively provide information about the safety and benefits of COVID-19 vaccines during pregnancy. There is an urgent need to booster vaccination rates in pregnant women to avoid excessive adverse pregnancy outcomes related to COVID-19.
Hypertension and clinical outcomes in patients with familial hypercholesterolemia
Authors: Liu Ming-Ming , Peng Jia , Xu Rui-Xia , Guo Yuan-Lin , Zhu Cheng-Gang , Wu Na-Qiong , Li Jian-Jun
Published: August 2022

Background:

Hypertension is a known risk factor for cardiovascular disease; however, its impact on clinical outcomes in patients with heterozygous familial hypercholesterolemia (HeFH) is unclear. Hence, we aimed to investigate the effects of hypertension on severity of coronary artery atherosclerosis and cardiovascular outcomes in patients with HeFH.

Methods:

A total of 480 patients with clinical or molecular diagnosis of definite or probable familial hypercholesterolemia according to Dutch Lipid Clinic Network criteria (DLCN score ≥6) were included in the study. They were divided into the two groups according to their blood pressure status: hypertension group and normotension group. The severity of coronary stenosis was assessed by a number of diseased vessels, Gensini, Syntax, and Jeopardy scores. All individuals were followed up for cardiovascular events (CVEs) and cox proportion hazard models were used to evaluate the association of hypertension with cardiovascular outcomes.

Results:

Patients with hypertension had more severe coronary stenosis and a higher incidence of CVEs compared with the ones with normotension (log-rank P < 0.001). After multivariable adjustment, there was a 2.1-fold increased risk of CVEs among patients with hypertension compared with patients with normotension (adjusted hazard ratio 2.06, 95% confidential interval 1.17–3.65, P < 0.01). Hypertension control status was also associated with CVEs even after adjustment of multiple variables. However, no combined effect on increased cardiovascular risks was detected in this HeFH cohort.

Conclusion:

In patients with HeFH, hypertension is an independent risk factor for cardiovascular events. Moreover, blood pressure control status in patients with hypertension is associated with the worse outcomes.
The impact of Sacubitril/Valsartan on cardiac fibrosis early after myocardial infarction in hypertensive rats
Authors: Liu Yihai , Zhong Chongxia , Si Jiayi , Chen Shan , Kang Lina , Xu Biao
Published: August 2022

Background:

Sacubitril/Valsartan, a dual inhibitor of the neprilysin and angiotensin receptor, exerts cardioprotective effects in heart failure. Little is known on the impact of Sacubitril/Valsartan in hypertensive patients early post myocardial infarction.

Methods:

Spontaneously hypertensive rats (SHR) were pretreated by daily angiotensin receptor blocker (ARB; 30 mg/kg intraperitoneally), Sacubitril/Valsartan (ARNI; 60 mg/kg intraperitoneally) or the same dosage of physiological saline for 1 week. Then each group underwent myocardial infarction induction and received the same treatment for another week. The blood pressure and cardiac function were evaluated prior to sacrifice. We performed histological and molecular evaluation of fibrosis in vivo and in vitro.

Results:

The blood pressure was comparable between three groups both 1 week prior to and post myocardial infarction. ARNI and ARB restore the decreased ejection fraction (57.3 ± 7.6 vs. 42.9 ± 5.2%, P < 0.05; 54.3 ± 6.9 vs. 42.9 ± 5.2%, P < 0.01, respectively) and fractional shortening (31.6 ± 5.4 vs. 22.1 ± 3.1%, P < 0.05; 29.4 ± 4.5 vs. 22.1 ± 3.1%, P < 0.05, respectively) post myocardial infarction. The infarct size and collagen deposition were also significantly mitigated in ARNI and ARB groups. In addition, ARNI and ARB treatment reduced the expression of cardiac remodeling-related factors, such as Bnp, α-SMA, Vimentin, and Col1a1 (all P < 0.05 vs. MI group). Finally, ARNI and ARB decreased the expression of α-SMA in cardiac fibroblasts treated with Ang II.

Conclusion:

In conclusion, pretreatment with ARNI maintained cardiac function and reduced myocardial fibrosis in myocardial infarction, probably prior to any anti-hypertensive effect.
MANAGEMENT OF RETINAL DETACHMENT ASSOCIATED WITH MORNING GLORY SYNDROME USING THE HUMAN AMNIOTIC MEMBRANE
Authors: Caporossi Tomaso , Ferrara Silvia , Savastano Alfonso , Gambini Gloria , De Vico Umberto , Savastano Maria Cristina , Rizzo Stanislao
Published: August 2022

Purpose:

This case report describes an innovative procedure for addressing retinal detachment in patients with morning glory syndrome.

Methods:

An 18-year-old woman with unilateral morning glory syndrome complicated by macula-off retinal detachment without any visible peripheral retinal breaks underwent three corrective surgeries. In the first surgery, a 25-gauge pars plana vitrectomy with a 3-mm human amniotic membrane patch positioned on the optic disc and gas endotamponade was performed. When the gas reabsorbed, inferior retinal detachment recurred, and a second vitrectomy with silicone oil endotamponade was conducted. At three months, the retina was still attached under the silicone oil, so the oil was removed. At the second follow-up, retinal detachment had recurred, and a third vitrectomy with a larger amniotic patch and silicone oil endotamponade was performed.

Results:

Three months following the last surgery, the subretinal fluid had totally reabsorbed, and the retina was completely attached. The best-corrected visual acuity was 20/100.

Conclusion:

To the best of our knowledge, the first description of a human amniotic patch associated with vitrectomy in morning glory syndrome complicated with retinal detachment is described. Using human amniotic membranes, positioned onto the optic nerve, and silicone oil endotamponade could be useful for morning glory syndrome complicated by retinal detachment.
Anaplasmosis-Induced Atrial Flutter Resolving With Antibiotic Therapy
Authors: Larson Peter , Steele Christopher
Published: August 2022

Anaplasma phagocytophilum is a rickettsial bacterium that causes human granulocytic anaplasmosis and is carried by the Ixodes scapularis tick. We describe a case of a 56-year-old man with recent tick exposure who presented in atrial flutter with variable atrioventricular block after 3 days of fever, chills, and arthralgias. The patient was successfully treated and stably returned to sinus rhythm after initiation of antibiotics without cardioversion and was found to be positive for A. phagocytophilum but negative for Lyme disease. To our knowledge, this represents the first reported case of anaplasmosis-associated atrial flutter. As infections increase in incidence, clinicians in endemic areas should be aware of the potential manifestations and treatment considerations of tick-borne carditis.
A Novel Gap Staffing Metric for Primary Care in the Veterans Health Administration and Implications for Rural and Urban Clinics
Authors: O'Shea Amy M. J. , Haraldsson Bjarni , Shahnazi Ariana F. , Sterling Ryan A. , Wong Edwin S. , Kaboli Peter J.
Published: August 2022

Primary care providers (PCPs), including physicians and advanced practice providers, are the front line of medical care. Patient access must balance PCP availability and patient needs. This work develops a new PCP staffing metric using panel size and full-time equivalent data to determine whether a clinic is adequately staffed and describes variation by clinic rurality. Data were from the Veterans Health Administration, 2017-2021. Results describe the gap staffing metric, provide summary graphics, and compare the gap staffing between rural and urban clinics. This novel gap staffing metric can inform strategic clinic staffing in health care systems.
Workload and Mental Well-Being of Homeworkers
Authors: Zappalà Salvatore , Swanzy Erasmus Keli , Toscano Ferdinando
Published: August 2022

Objective

Based on the Conservation of Resources theory, this cross-sectional study investigates the relationship between workload experienced by employees when working at home and their mental well-being. Work-family conflict, sleeping problems, and work engagement are proposed as mediators.

Methods

A sample of 11,501 homeworkers was drawn from the sixth wave of the European Working Condition Survey data set.

Results

Unlike the expected, the higher the workload, the higher the mental well-being of employees. However, as expected, high workload was correlated with lower well-being when indirect effects through work-family conflict, sleep problems, and work engagement were considered. Similarly, the total effect of workload on mental well-being was negative.

Conclusions

The study suggests that organizations should pay more attention to the amount of workload experienced by their homeworkers because it may be harmful to their health and well-being.
Productivity Loss, Healthcare Costs, and Habitual Physical Activity Among Adults With Cardiovascular Diseases
Authors: Araujo Monique Yndawe Castanho , de Barros Mauro Virgilio Gomes , Ricardo Suelen Jane , Mantovani Alessandra Madia , Turi-Lynch Bruna Camilo , Codogno Jamile Sanches
Published: August 2022

Objectives

The aims of the study are to quantify the relationship between productivity loss and healthcare costs among adults with cardiovascular diseases and also to verify whether habitual physical activity (HPA) modulates this relationship.

Methods

Information was obtained about healthcare costs, productivity loss, and HPA.

Results

The sample consisted of 278 adults. Active workers who reported presenteeism and absenteeism due to cardiovascular diseases had higher direct costs (P < 0.05) than those who reported other reasons. Those who reported absenteeism spent US $187.33 more on healthcare services annually than those who did not miss work because of health reasons. However, an annual savings of US $53.00 was observed for each increase in the score of HPA.

Conclusions

There was a positive correlation between absenteeism and direct healthcare costs among adults with cardiovascular diseases, and HPA positively affected this relationship.
Alternatives to glucocorticoid monotherapy in the treatment of polymyalgia rheumatica
Authors: Walz Kirsten , Elliott Lydia , Pearson Tamera
Published: August 2022

Background:

Treatment of polymyalgia rheumatica (PMR) can be challenging. The most efficacious and cost-effective treatment of PMR is some type of glucocorticoid (GC), with necessary treatment duration typically one year or longer. This duration of GC use is often associated with significant morbidity. Numerous studies have been and are being conducted that focus on alternative treatment modalities.

Objectives:

This literature review explores alternatives to glucocorticoid monotherapy in the treatment of PMR.

Data Sources:

An integrative literature review was conducted to evaluate peer-reviewed literature on the topic. An electronic literature search was performed in the Cochrane Database of Systematic Reviews, and an EBSCO search identified relevant articles in the following databases: MEDLINE Complete, Academic Search Premier, Cumulative Index of Nursing and Allied Health (CINAHL) Plus, PsycInfo, Education Source, SocINDEX, the CDC, and PubMed.

Conclusions:

Agents such as methotrexate and tocilizumab have been used successfully in conjunction with oral glucocorticoids and have demonstrated steroid-sparing effects. A promising adjunctive treatment is the monoclonal antibody, tocilizumab, which has been studied as both adjuvant and monotherapy. Further research in the efficacy, safety, and affordability of these agents is warranted.

Implications for Practice:

Because PMR is commonly diagnosed and managed in primary care, providers should keep abreast of the most current recommendations concerning optimal treatment options and carefully weigh the risks versus benefits of long-term GC use. This expanding area of research may assist primary care providers to better treat and manage PMR as well as reduce long-term treatment risk by minimizing corticosteroid use when possible.
Prognostic significance of thrombus burden on short- and long-term clinical outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention
Authors: Köktürk Uğur , Somuncu Mustafa Umut , Uygur Begüm , Akgül Özgür , Püşüroğlu Hamdi
Published: August 2022

Objective

Large thrombus burden (LTB) observed during ST-segment elevation myocardial infarction (STEMI) may end up with worse clinical outcomes. The relationship between LTB and long-term mortality and major adverse cardiac events (MACE) in STEMI patients undergoing percutaneous coronary intervention (PCI) is unclear. In this study, we aimed to investigate the relationship of LTB with short- and long-term mortality and MACE in STEMI patients undergoing PCI.

Methods

Thrombus burden (TB) was evaluated in STEMI patients who underwent PCI between December 2010 and April 2012. After infarct-related arterial flow was restored, TB was reclassified. LTB was defined as thrombus with the largest dimension of at least two vessel diameters. Patients were evaluated for 1-month, 1-year, and 10-year follow-ups in terms of MACE and mortality.

Results

Four hundred ninety-nine patients with clinical information and TB classification were analyzed. Three hundred sixty-six patients (73.3%) were in the small TB (STB) group, and 133 patients (26.7%) were in the LTB group. No-reflow (10.6% vs. 5.2%; P = 0.033) and stent thrombosis (7.5% vs. 3.3%; P = 0.042) were observed at a higher rate in the LTB group compared with the STB group. Thirty-day mortality (9.8% vs. 3.8%; P = 0.009) and MACE (16.5% vs. 9.6%; P = 0.030) were higher in the LTB group than in the STB group. Although 10-year MACE (56.4% vs. 46.2%; P = 0.044) was observed higher in the LTB group, no significant difference was observed between the two groups in terms of 10-year mortality (35.3% vs. 32.8%; P = 0.589). LTB was found to be an independent predictor for 10-year MACE (OR, 1.62; 95% CI, 1.01–2.61; P = 0.045).

Conclusion

LTB was associated with short- and long-term clinical events in STEMI patients undergoing PCI, but the mortality effect disappeared at the end of 1 year. Nevertheless, hospitalizations due to heart failure became significant in 10-year follow-up.
Antibiotics: it is all about timing, isn’t it?
Authors: Klompas Michael , Rhee Chanu
Published: August 2022

Purpose of review

Sepsis guidelines and quality measures set aggressive deadlines for administering antibiotics to patients with possible sepsis or septic shock. However, the diagnosis of sepsis is often uncertain, particularly upon initial presentation, and pressure to treat more rapidly may harm some patients by exposing them to unnecessary or inappropriate broad-spectrum antibiotics.

Recent findings

Observational studies that report that each hour until antibiotics increases mortality often fail to adequately adjust for comorbidities and severity of illness, fail to account for antibiotics given to uninfected patients, and inappropriately blend the effects of long delays with short delays. Accounting for these factors weakens or eliminates the association between time-to-antibiotics and mortality, especially for patients without shock. These findings are underscored by analyses of the Centers for Medicaid and Medicare Services SEP-1 measure: it has increased sepsis diagnoses and broad-spectrum antibiotic use but has not improved outcomes.

Clinicians are advised to tailor the urgency of antibiotics to their certainty of infection and patients’ severity of illness. Immediate antibiotics are warranted for patients with possible septic shock or high likelihood of infection. Antibiotics can safely be withheld to allow for more investigation, however, in most patients with less severe illnesses if the diagnosis of infection is uncertain.
Opportunities in digital health and electronic health records for acute kidney injury care
Authors: Selby Nicholas M. , Pannu Neesh
Published: August 2022

Purpose of review

The field of digital health is evolving rapidly with applications relevant to the prediction, detection and management of acute kidney injury (AKI). This review will summarize recent publications in these areas.

Recent findings

Machine learning (ML) approaches have been applied predominantly for AKI prediction, but also to identify patients with AKI at higher risk of adverse outcomes, and to discriminate different subgroups (subphenotypes) of AKI. There have been multiple publications in this area, but a smaller number of ML models have robust external validation or the ability to run in real-time in clinical systems. Recent studies of AKI alerting systems and clinical decision support systems continue to demonstrate variable results, which is likely to result from differences in local context and implementation strategies. In the design of AKI alerting systems, choice of baseline creatinine has a strong effect on performance of AKI detection algorithms.

Further research is required to overcome barriers to the validation and implementation of ML models for AKI care. Simpler electronic systems within the electronic medical record can lead to improved care in some but not all settings, and careful consideration of local context and implementation strategy is recommended.
Endocarditis in the intensive care unit: an update
Authors: Lakbar Ines , Delamarre Louis , Einav Sharon , Leone Marc
Published: August 2022

Purpose of review

The incidence of infective endocarditis (IE) is increasing worldwide, resulting in a higher number of patients with IE being admitted to intensive care units (ICU). Nearly half of patients with IE develop a complication during their clinical course. However, few well conducted studies or reviews are devoted to critically ill IE patients. This review discusses the contemporary perioperative and intensive care literature.

Recent findings

IE epidemiology is changing towards elderly and frail patients. ICU patients are at risk of risk of developing IE because they are often in a pro-inflammatory state and many also have several indwelling catheters, which favors infection. Increased performance and recent advances in cardiac imaging allow for easier diagnosis of EI, but the applicability of these techniques to ICU patients is still relatively limited. New developments in antibiotic treatment and adjunctive therapies are explored further in this review.

The lack of evidence on ICU patients with IE highlights the critical importance of multidisciplinary decision-making and the need for further research.
Dietary nitrate, aging and brain health: the latest evidence
Authors: Shannon Oliver M. , Gregory Sarah , Siervo Mario
Published: August 2022

Purpose of review

With an increasing population age, cognitive decline and age-associated neurodegenerative diseases are becoming increasingly prevalent and burdensome in society. Dietary supplementation with inorganic nitrate, which serves as a nitric oxide precursor, has been suggested as a potential nutritional strategy to improve brain health in older adults. In this review, we discuss recent findings in this area.

Recent findings

A number of studies have emerged in the past 12–18 months exploring the effects of dietary nitrate supplementation on cognitive function, with typically (although not exclusively) null findings emerging. This research is characterized by small, acute/short-term studies, although observational studies and longer-duration randomised controlled trials are beginning to emerge. From the limited research reporting benefits of nitrate supplementation on cognitive function, one important discovery has been the identification of a potential pathway through which nitrate could impact cognitive health, involving modulation of the oral microbiome, which warrants further investigation.

Despite some promising early findings, there is currently insufficient evidence to recommend increased dietary nitrate intake for the purpose of improving brain health. However, longer-term, larger-scale trials in potentially responsive groups are warranted to provide definitive evidence in this area.
Peripheral polyneuropathy and acute psychosis from chronic nitrous oxide poisoning: A case report with literature review
Authors: Sood Radhika , Parent Thibault
Published: August 2022

Rationale:

Nitrous oxide (NO) is a commonly used drug in medical practice, restoration, and the automobile industry. Recreational abuse is an emerging public health problem owing to its accessibility and drug properties.

Patient concerns:

A 25-year-old male was hospitalized with acute psychosis and lower-extremity sensorimotor proprioceptive ataxia due to nitrous oxide abuse.

Diagnosis:

Laboratory studies confirmed a vitamin B12 deficiency. Magnetic resonance imaging of the spinal cord showed normal findings. Electrophysiological testing confirmed length-dependent sensorimotor polyneuropathy, with a predominant motor component and axonal degeneration.

Intervention and outcomes:

Abstinence from toxic substances was suggested, and vitamin B12 substitution was introduced. The patient was lost to follow up.

Lessons:

Nitrous oxide toxicity is multisystemic and is thought to result from vitamin B12 inactivation. Recent case reports postulated direct paranodal lesions resulting from nitrous oxide consumption. Neurological, neuropsychiatric, and hematological toxicities are among those explored in this case report. Correction of the functional vitamin B12 status and nitrous oxide abstinence are essential in the treatment process.
Transcatheter arterial embolization for gastrointestinal bleeding: Clinical outcomes and prognostic factors predicting mortality
Authors: Lee Shinhaeng , Kim Taehwan , Han Seung Chul , Pak Haeyong , Jeon Han Ho
Published: August 2022

We evaluated clinical outcome and prognostic factors predicting mortality of transcatheter arterial embolization (TAE) for acute gastrointestinal (GI) bleeding. Fifty-nine patients (42 men, 17 women; mean age 66.1 ± 17.0) who underwent 59 TAE procedures for GI bleeding during 2013–2018 were retrospectively evaluated. Clinical outcomes included technical success, adverse events, and rebleeding and mortality rate within 30 days. The technical success rate was 100%. Angiography showed contrast extravasation in 41 (69.5%) patients and indirect signs of bleeding in 16 (27.1%) patients. Two (3.4%) patients underwent prophylactic embolization. TAE-related adverse events occurred in 7 (11.9%) patients; adverse events were more common for mid GI or lower GI bleeding than for upper GI bleeding (22.6% vs 0%, P = 0.007). Rebleeding within 30 days was observed in 22 (37.3%) patients after TAE. Coagulopathy was a prognostic factor for rebleeding (odds ratio [OR] = 3.53, 95% confidence interval 1.07–11.67, P = .038). Mortality within 30 days occurred in 11 (18.6%) patients. Coagulopathy (OR = 24, 95% confidence interval 2.56–225.32, P = .005) was an independent prognostic factor for mortality within 30 days. TAE is an effective, safe, and potentially lifesaving procedure for GI bleeding. If possible, coagulopathy should be corrected before TAE as it may reduce rebleeding and mortality.
Precut technique using an injection needle: A retrospective study on a new ancillary procedure for pleural biopsy
Authors: Mizumori Yasuyuki , Hirano Katsuya , Hirata Nobuya , Hiraoka Ryota , Takahashi Sayaka , Kominami Ryota , Miyake Kohei , Takenouchi Masaki , Kato Tomohiro , Kume Sachie , Higashino Sachiko , Nakahara Yasuharu , Kawamura Tetsuji
Published: August 2022

The effectiveness of thoracoscopic biopsy as a diagnostic method for pleural diseases has been reported; however, obtaining a sufficient specimen size is sometimes difficult. Therefore, an ancillary technique, the precut technique using an injection needle, was devised to address this problem. This study aimed to evaluate the effectiveness and safety of the novel precut technique in patients with undiagnosed pleural effusion.

This retrospective study included 22 patients who underwent pleural biopsy using the precut technique to examine exudative pleural effusion of unknown etiology. Thoracoscopy was performed under local anesthesia. The biopsy procedure was performed as follows: a needle was inserted into the pleura around the lesion using a semiflexible thoracoscope; the needle was positioned to make an incision in the pleura while injecting 1% lidocaine with epinephrine and lifting the pleura from the fascia; 2 or 3 precut incision lines were arranged in a triangle; and the specimen was obtained from the parietal pleura using forceps or a cryoprobe. Patient data including age, number of biopsies, biopsy specimen size, pathological and final diagnosis, and postoperative complications were examined.

All patients were male with an average age of 74 years. Pleural effusion was found on the right and left sides in 16 and 6 patients, respectively. The average major axis of the biopsy specimens was 18 mm (range, 10–30 mm), which was sufficient to establish a pathological diagnosis. Only 1 patient experienced minor temporal bleeding as a complication.

The precut technique enabled the procurement of specimens sufficient in size for pleural biopsy.
Application of dual-energy computed tomography in preoperative evaluation of Ki-67 expression levels in solid non-small cell lung cancer
Authors: Tian Shuangfeng , Jianguo Xia , Tian Weizhong , Li Yuan , Hu Jianfeng , Wang Mingjun , Zhang Juntao
Published: August 2022

To investigate whether there were significant differences in dual-energy CT (DECT) in reflecting different quantitative parameters among different levels of Ki-67 expression in patients with solid non-small cell lung cancer (NSCLC). The diagnosis performance of DECT in patients with solid lung adenocarcinoma (LAC) among NSCLC was further discusses. Two hundred fifteen patients confirmed with solid NSCLC were enrolled and analyzed retrospectively in this study. 148 patients were confirmed with LAC among all patients. Three expression levels of Ki-67 were determined by the percentage of Ki-67 positive cancer cells with immunohistochemistry: high-level group (>30%), middle-level group (10%–30%), and low-level group (≤10%). And the latter two levels also known as non-high-level group. The quantitative parameters of enhanced chest DECT (venous phase, VP), including iodine concentration (IC), water concentration (WC), CT value at 40 keV (CT40keV), the slope of energy spectral attenuation curve (λHU) and normalized iodine concentration (NIC) were measured and calculated by gemstone spectral imaging Viewer software. One-way ANOVA was used for the comparison of normal distribution DECT parameters between three levels for patients with NSCLC and patients with LAC. Non-normal distribution data were tested by non-parametric test. In addition, the receiver operating characteristic curve of statistically significant DECT parameters was drawn to distinguish the non-high-level and the high-level of Ki-67. Area under the curve (AUC), sensitivity, specificity was calculated to measure the diagnostic performance of parameter. Both in solid NSCLC and LAC, the IC, NIC, WC, λHU and CT40keV at VP in the high-level group were significantly lower than those in the middle- and low-level group respectively, and the WC at VP in the high-level group was significantly higher than that in the middle- and low-level group respectively (all P < .05). Receiver operating characteristic analysis showed that IC and λHU at VP performed better in distinguishing the high-level and the non-high-level of Ki-67 (NSCLC: AUC = 0.713 and 0.714 respectively; LAC: AUC = 0.705 and 0.706 respectively). Quantitative parameters of DECT provide a new non-invasive method for evaluating the proliferation of cancer cells in solid NSCLC and LAC.
Treatment of melasma by a combination of intense pulsed light with advanced optimal pulse technology and human-like collagen repair dressing: A case series study
Authors: Chen Juping , Liu Jun , Wu Jianhong
Published: August 2022

To observe the efficacy and safety of a combination of intense pulsed light (IPL) with advanced optimal pulse technology (AOPT) and human-like collagen repair dressing in the treatment of melasma.

Ten patients with melasma were treated using IPL with AOPT once a month for a total of 8 times, and received the treatment of external human-like collagen repair dressing after each operation. The efficacy was evaluated with the modified Melasma Area Severity Index (mMASI) score and satisfaction score, respectively, before treatment, after each treatment and at 4 months after the end of the whole treatment course.

The melasma was significantly lightened in all 10 patients after 8 times of treatments. The mMASI score before treatment was (8.6 ± 3.8) points, which decreased significantly to (5.1 ± 2.7) points after 8 times of treatments, and there was a significant difference in mMASI score between before and after 8 times of treatments (P = .001). The mMASI score was (3.3 ± 2.2) points at 4 months after the end of whole treatment course, and there was no significant difference in mMASI score between after 8 times of treatments and 4 months after the end of whole treatment course (P > .05). The satisfaction score was (7.2 ± 1.4) points after 8 times of treatments and (7.1 ± 1.4) points at 4 months after the end of whole treatment course, there was no significant difference in satisfaction score between after 8 times of treatments and 4 months after the end of whole treatment course (P > .05).

A combination of IPL with AOPT and human-like collagen repair dressing can effectively decrease the severity of melasma, and is associated with a higher patient satisfaction score and a lower risk of relapse after discontinuation of treatment.