bluuebunny/crossref_metadata_2025 huggingface dataset:
Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*
Authors: Scott John Harwood , Gordon Matthew , Vender Robert , Pettigrew Samantha , Desai Parag , Marchetti Nathaniel , Mamary Albert James , Panaro Joseph , Cohen Gary , Bashir Riyaz , Lakhter Vladimir , Roth Stephanie , Zhao Huaqing , Toyoda Yoshiya , Criner Gerard , Moores Lisa , Rali Parth
Published: February 2021

OBJECTIVE:

Management of patients experiencing massive pulmonary embolism-related cardiac arrest is controversial. Venoarterial extracorporeal membranous oxygenation has emerged as a potential therapeutic option for these patients. We performed a systematic review assessing survival and predictors of mortality in patients with massive PE-related cardiac arrest with venoarterial extracorporeal membranous oxygenation use.

DATA SOURCES:

A literature search was started on February 16, 2020, and completed on March 16, 2020, using PubMed, Embase, Cochrane Central, Cinahl, and Web of Science.

STUDY SELECTION:

We included all available literature that reported survival to discharge in patients managed with venoarterial extracorporeal membranous oxygenation for massive PE-related cardiac arrest.

DATA EXTRACTION:

We extracted patient characteristics, treatment details, and outcomes.

DATA SYNTHESIS:

About 301 patients were included in our systemic review from 77 selected articles (total screened, n = 1,115). About 183 out of 301 patients (61%) survived to discharge. Patients (n = 51) who received systemic thrombolysis prior to cannulation had similar survival compared with patients who did not (67% vs 61%, respectively; p = 0.48). There was no significant difference in risk of death if PE was the primary reason for admission or not (odds ratio, 1.62; p = 0.35) and if extracorporeal membranous oxygenation cannulation occurred in the emergency department versus other hospital locations (odds ratio, 2.52; p = 0.16). About 53 of 60 patients (88%) were neurologically intact at discharge or follow-up. Multivariate analysis demonstrated three-fold increase in the risk of death for patients greater than 65 years old (adjusted odds ratio, 3.08; p = 0.03) and six-fold increase if cannulation occurred during cardiopulmonary resuscitation (adjusted odds ratio, 5.67; p = 0.03).

CONCLUSIONS:

Venoarterial extracorporeal membranous oxygenation has an emerging role in the management of massive PE-related cardiac arrest with 61% survival. Systemic thrombolysis preceding venoarterial extracorporeal membranous oxygenation did not confer a statistically significant increase in risk of death, yet age greater than 65 and cannulation during cardiopulmonary resuscitation were associated with a three- and six-fold risks of death, respectively.
Minimally Invasive Transungual Tumors Enucleation With Nail Preservation for Subungual Glomus Tumors
Authors: Yu Yi-Hsiang , Lee Chih-Hung , Lin Shang-Hung
Published: February 2021

BACKGROUND

Glomus tumors are benign neurovascular neoplasms, most commonly located in the subungual region. These subcutaneous nodules are characterized by intense pain and temperature sensitivity. Although surgical excision is the curative treatment, permanent nail deformity and recurrence are not uncommon after conventional surgery.

OBJECTIVE

This study evaluated the long-term efficacy of a modified transungual approach with nail preservation for removing subungual glomus tumors.

MATERIAL AND METHODS

Thirty-nine patients with clinically diagnosed and histopathologically proven glomus tumors treated at a medical center over a 13-year period (2007–2019) were retrospectively evaluated.

RESULTS

The 39 patients included 28 women and 11 men (ratio, 2.5:1), with a mean age of 48.9 years. Thirty-four tumors were located in the fingers and 5 in the toes. All patients returned to normal activity soon after the surgery. At a mean follow-up of 28.8 months, all were pain free or experienced minimal pain and were satisfied with treatment outcomes. One patient (2.6%) experienced recurrence. No nail deformity was observed.

CONCLUSION

The transungual approach with nail plate preservation is a novel and effective method for removing subungual glomus tumors with reduced postoperative pain and rapid healing, while preserving or improving the configuration of the nail.
5-Fluorouracil in Dermatology: The Diverse Uses Beyond Malignant and Premalignant Skin Disease
Authors: Searle Tamara , Al-Niaimi Firas , Ali Faisal R.
Published: February 2021

BACKGROUND

5-fluorouracil (5-FU) is widely used for treatment of malignant and premalignant skin cancers; however, its use in other common cutaneous conditions has been less widely reported.

OBJECTIVE

We investigated the off-label uses of 5-FU beyond malignant and premalignant skin disease.

METHODS

We conducted a literature review searching multiple databases to evaluate the evidence for the off-label uses of 5-FU. The level of evidence was evaluated and selected accordingly listing the studies with the highest level of evidence first using the Oxford Centre of Evidence-Based Medicine 2011 guidance.

RESULTS

We found underlying evidence to support the use of 5-FU for a wide range of noncancerous cutaneous indications including scarring (keloid, hypertrophic), pigmentary disorders (vitiligo, idiopathic guttate hypomelanosis), cutaneous infections (viral warts, molluscum contagiosum), inflammatory dermatoses (Darier's disease, Hailey-Hailey disease and sarcoidosis), and cosmetic indications (photoaging, treatment of filler nodules and granulomas).

CONCLUSION

In selected patients, 5-FU can be as effective as more established treatments, with fewer side-effects.
Identification and Validation of Anaphylaxis Using Electronic Health Data in a Population-based Setting
Authors: Bann Maralyssa A. , Carrell David S. , Gruber Susan , Shinde Mayura , Ball Robert , Nelson Jennifer C. , Floyd James S.
Published: February 2021

Background:

Anaphylaxis is a life-threatening allergic reaction that is difficult to identify accurately with administrative data. We conducted a population-based validation study to assess the accuracy of ICD-10 diagnosis codes for anaphylaxis in outpatient, emergency department, and inpatient settings.

Methods:

In an integrated healthcare system in Washington State, we obtained medical records from healthcare encounters with anaphylaxis diagnosis codes (potential events) from October 2015 to December 2018. To capture events missed by anaphylaxis diagnosis codes, we also obtained records on a sample of serious allergic and drug reactions. Two physicians determined whether potential events met established clinical criteria for anaphylaxis (validated events).

Results:

Out of 239 potential events with anaphylaxis diagnosis codes, the overall positive predictive value (PPV) for validated events was 64% (95% CI = 58 to 70). The PPV decreased with increasing age. Common precipitants for anaphylaxis were food (39%), medications (35%), and insect bite or sting (12%). The sensitivity of emergency department and inpatient anaphylaxis diagnosis codes for all validated events was 58% (95% CI = 51 to 65), but sensitivity increased to 95% (95% CI = 74 to 99) when outpatient diagnosis codes were included. Using information from all validated events and sampling weights, the incidence rate for anaphylaxis was 3.6 events per 10,000 person-years (95% CI = 3.1 to 4.0).

Conclusions:

In this population-based setting, ICD-10 diagnosis codes for anaphylaxis from emergency department and inpatient settings had moderate PPV and sensitivity for validated events. These findings have implications for epidemiologic studies that seek to estimate risks of anaphylaxis using electronic health data.
Acute pain after serratus anterior plane or thoracic paravertebral blocks for video-assisted thoracoscopic surgery
Authors: Qiu Yuwei , Wu Jingxiang , Huang Qi , Lu Yungang , Xu Meiying , Mascha Edward J. , Yang Dongsheng , Ince Ilker , Sessler Daniel I.
Published: February 2021

BACKGROUND

Serratus anterior plane blocks (SAPBs) and thoracic paravertebral blocks (TPVBs) can both be used for video-assisted thoracic surgery. However, it remains unknown whether the analgesic efficacy of a SAPB is comparable to that of a TPVB.

OBJECTIVE

We tested the primary hypothesis that SAPBs provide noninferior analgesia compared with TPVBs for video-assisted thoracic surgery.

DESIGN

A noninferiority randomised trial.

SETTING

Shanghai Chest Hospital, between August 2018 and November 2018.

PATIENTS

Ninety patients scheduled for video-assisted thoracic lobectomy or segmentectomy were randomised. Patients were excluded if they were unable to perform the visual analogue pain scale, or surgery was converted to thoracotomy.

INTERVENTIONS

Blocks were performed after induction of general anaesthesia. The three groups were paravertebral blocks (n = 30); serratus anterior plane blocks (n = 29); and general anaesthesia alone (n = 30).

PRIMARY OUTCOME MEASURES

Visual analogue pain scores (0 to 10 cm) at rest and while coughing, and Prince-Henry pain scores (0 to 4 points) were used to assess postoperative analgesia at 2, 24 and 48 h after surgery. We assessed the noninferiority of SAPBs with TPVBs on all three primary pain outcomes using a delta of 1 cm or one point as appropriate.

RESULTS

The mean difference (95% confidence intervals) in visual analogue scores between the SAPBs and TPVBs was −0.04 (−0.10 to 0.03) cm at rest, −0.22 (−0.43 to −0.01) cm during coughing and −0.10 (−0.25 to 0.05) for Prince-Henry pain scores. As the upper limit of the confidence intervals were less than 1 (all P < 0.001), noninferiority was claimed for all three primary outcomes. Compared with general anaesthesia alone, the VAS scores at rest and while coughing, and the Prince-Henry pain scores for the two blocks were significantly lower during the initial 2 h after surgery.

CONCLUSIONS

Serratus anterior plane blocks are quicker and easier to perform than paravertebral blocks and provide comparable analgesia in patients having video-assisted thoracic surgery. Both blocks provided analgesia that was superior to general anaesthesia alone during the initial 2 h after surgery.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, identifier: ChiCTR1800017671.
Detailed Case Reports of Surgical Treatment for Intraneural Ganglion Cysts
Authors: Ruiz Samuel , McCoy James , Pulikkottil Benson , Cheng Jonathan
Published: February 2021

Background:

Intraneural ganglion cysts are nonneoplastic mucinous cysts that form by the accumulation of thick mucinous fluid in the epineurium of peripheral nerves. Symptoms arise from mechanical compression of adjacent nerve fascicles from the intraneural ganglion cyst, and include local or radiating pain, paresthesias, weakness, and muscle atrophy.

Methods:

Retrospective review of three cases of symptomatic intraneural ganglion cysts affecting the upper and lower extremity.

Results:

In our cases, the intraneural ganglion cysts were completely decompressed with resection of the articular branches, leading to improvement in the patient’s symptoms.

Conclusions:

Treatment of intraneural ganglion cysts requires an understanding of the underlying anatomy and pathophysiology; accurate early diagnosis is important and can lead to timely treatment and better outcomes.
Adenoid Cystic Carcinoma Developed from the Parotid Gland to the Ear Lobe of a Young Woman
Authors: Nojiri Gaku , Kamimori Tomoki , Uchiyama Mizuki , Tomyo Rei , Suga Yasushi , Takamori Kenji , Higo Ryuzaburo , Hayashi Ayato
Published: February 2021

Adenoid cystic carcinoma (ACC) is a relatively rare malignant tumor. It is more common in women than in men and typically develops in the lacrimal, salivary, and breast glands. ACC of the external auditory canal (EAC) is exceedingly rare, and its invasion into the ear lobe is even more unusual. In this report, we present a case of ACC that presented as a mass on the surface of the ear lobe in a 28-year-old woman and was initially diagnosed as infected atheroma. For wide resection of the tumor, half of the entire auricula was resected and superficial parotidectomy was performed. After confirming no tumor cells on the surface of the facial nerve, the defect was reconstructed by the combination of platysma muscle flap to prevent Frey syndrome and free forearm flap for the ear lobe form. There was no recurrence or metastasis of the tumor, and Frey syndrome did not occur at 2 years and 8 months after surgery. The patient was satisfied with the result, oncologically and cosmetically. Even in young patients, comprehensive treatments (including diagnosis, resection, and reconstruction) are important in painful ear lobe masses.
Long-term Improvements of Neuroplasty and Scalene Muscle Resection in LTN-injured Winged Scapula Patients
Authors: Nath Rahul K. , Somasundaram Chandra
Published: February 2021

Background:

Injuries to the long thoracic nerve, which directly branches off of the C6, C7, and C8 brachial plexus nerve roots, can cause scapular winging and affect shoulder movements. Long thoracic nerve injuries resulting from accidents, violence, or overuse can be severe lesions requiring challenging surgeries. We evaluated the long-term functional outcomes of neuroplasty and the scalene muscle resection procedures in patients with long thoracic nerve injury and winging scapula.

Methods:

All 15 patients who underwent scalene muscle resection with decompression and neurolysis of the long thoracic nerve in a single institution to treat winged scapula and limited shoulder movements between March 2007 and May 2020 with follow-up over 2 years were included in the study.

Results:

Shoulder abduction and arm flexion improved significantly to 158 ± 52 degrees and 165 ± 53 degrees from a mean of 108 ± 54 degrees and 104 ± 52 degrees (P < 0.02) over 2 years after surgery (mean 3.4 years). Overall, there was a significant reduction in the scapular winging, as assessed by estimating the decrease in the angle between the scapular plane and the posterior chest wall. The extent of the score greatly improved post-surgically from a mean of 1.2 ± 0.4 to 3.5 ± 0.9 (range 1–4; 1—severe, 2—moderate, 3—mild, and 4—minimal) (P < 0.01).

Conclusion:

The improvement in shoulder movements and reduced scapular winging was significant and stable over 2 years of surgery in 81% of our study patients.
Acromioclavicular Joint Cyst Treated with Excision and Anterolateral Thigh Flap Reconstruction
Authors: Hattori Yoshitsugu , Imai Shoichi , Nakamura Hara Runa , Niu Atsushi
Published: February 2021

Acromioclavicular joint (ACJ) cysts are a rare clinical entity that can impair patients’ cosmetic appearance as well as activities of daily living. Both nonsurgical and surgical treatments are available, but nonsurgical treatments are often associated with a high recurrence rate. Surgical excision can provide resolution of patients’ symptoms, but excision of the cyst as monotherapy is also associated with recurrence. Therefore, various surgical techniques to prevent recurrence have been described, but there is no general consensus regarding the appropriate surgical methods. We describe the case of an 81-year-old man with a recurrent ACJ cyst. The cyst had been excised twice, but it recurred shortly after the excisions. We performed surgical resection and anterolateral thigh (ALT) flap reconstruction. The deteriorated ACJ capsule was repaired with durable fascia lata and the defect after tumor excision was obliterated with an ALT flap harvested from the same donor site as fascia lata. On the 12-month follow-up, the patient had no recurrence of the ACJ cyst. Our case suggests that excision of ACJ cysts as monotherapy is likely to fail, and fascia lata patch for durable ACJ capsule reconstruction can be a viable alternative preventing cyst recurrence.
Reconstruction of E. coli Osteomyelitis of Costa: A Case Report
Authors: Yamashita Teruyo , Arata Jun , Kumakiri Masanori , Kaito Shuko , Yoon Yong
Published: February 2021

We report a case of E. coli osteomyelitis of the ribs in an immunocompetent 66-year-old man. After radical surgical debridement, bone and soft-tissue defects were covered with a rectus abdominis muscle flap. The postoperative course was uneventful, and there was no recurrence of chest symptoms. Among the various types of osteomyelitis, Gram-negative bacteria such as E. coli osteomyelitis is a relatively rare disease. Osteomyelitis is known to supervene in trauma or postoperative infection and to frequently begin with cellulitis, vascular access, endocarditis, or urinary tract infection, which spreads through the blood to the bone. To add to the difficulty of making a correct diagnosis, the early symptoms of osteomyelitis are often non-specific. We should never forget osteomyelitis in the differential diagnosis of these antecedent infections.
The Impact of Progestin-only Contraception on Adolescents with Macromastia
Authors: Nuzzi Laura C. , Pramanick Tannishtha , Massey Gabrielle G. , Walsh Landis R. , McNamara Catherine T. , Firriolo Joseph M. , DiVasta Amy D. , Labow Brian I.
Published: February 2021

Background:

Progestin-only contraception has become increasingly popular among adolescents. However, patients, parents, and providers share concerns regarding the potential impact that progestin-only contraception may have on breast growth. We sought to explore the impact of progestin-only contraception on breast hypertrophy and symptomatology in adolescents with macromastia.

Methods:

Patients between the ages of 12 and 21 years undergoing reduction mammaplasty were prospectively assessed for baseline and postoperative breast symptomatology and medication use. The medical records of female controls within the same age range were retrospectively reviewed.

Results:

A total of 378 participants with macromastia and 378 controls were included in analyses. A higher proportion of controls used progestin-only methods compared with participants with macromastia (28.0% versus 5.3%, P < 0.001). The most commonly prescribed methods were the depot medroxyprogesterone acetate injection (31.0%), levonorgestrel-containing intrauterine device (31.0%), and subdermal implant (26.2%). Patients with macromastia who used progestin-only contraception had a greater amount of breast tissue resected during reduction mammaplasty (P = 0.04), reported greater musculoskeletal pain (P = 0.008), and were roughly 500% more likely to experience breast pain (odds ratio, 4.94; 95% confidence interval, 1.58–15.47; P = 0.005) than those with macromastia who never used hormonal contraception.

Conclusions:

Adolescents with macromastia who use progestin-only contraception may have greater breast hypertrophy and worse breast and musculoskeletal pain. When appropriate, providers may wish to consider other contraception methods for patients who are at-risk for breast hypertrophy or those who suffer from macromastia-related symptoms.
Intrastromal Allogeneic Inclusions for the Management of Keratoconus: A Review of Current Literature
Authors: García de Oteyza Gonzalo , Benedetti Sandner Mónica , Velazco Casapía Jorge , Triviño Carmen , Salvador-Culla Borja , García-Albisua Ana Mercedes
Published: February 2021

A new therapeutic alternative has been developed in the past 6 years to treat severe keratoconus in young patients. Those patients had only corneal transplantation as an option, but now a variety of surgical alternatives in the form of allogeneic corneal inclusions have bloomed and are becoming more popular. Although Bowman layer transplantation is the most studied technique, recent studies have described different options with very promising preliminary results. Mostly all the techniques described improve corneal curvature, visual acuity, pachymetry, contact lens tolerance, and foremost, manage to avoid or postpone corneal transplantation. Very few complications have been described so far, which makes these techniques not only feasible but also safe. Herein, we focus on reviewing recently published studies describing these techniques and their first results.
Supra-Descemetic Venting Incision in the Management of Spontaneous Descemet Membrane Detachment in an Old Penetrating Keratoplasty Graft
Authors: Ramakrishnan Seema , Devarajan Sathish , Srinivasan Muthiah , Karunakaran Vanishree
Published: February 2021

Purpose:

To report a case of late spontaneous detachment of Descemet membrane (DM) in a donor penetrating keratoplasty (PKP) graft and its successful management using a supra-Descemetic venting incision combined with gas descemetopexy.

Methods:

Case report with review of literature.

Results:

A 56-year-old man who had undergone PKP after acute hydrops in pellucid marginal degeneration 27 years before presentation experienced sudden onset vision loss. Clinical features mimicked acute graft rejection but detailed evaluation and anterior segment optical coherence tomography showed a DM detachment (DMD) of the graft. Ten weeks after the onset of DMD, he underwent descemetopexy with a supra-Descemetic stromal venting incision and sulfur hexafluoride gas tamponade. DM reattached with complete resolution of graft edema.

Conclusions:

Late spontaneous DMD of the graft after PKP is very uncommon and must be differentiated from acute graft rejection. Anterior segment optical coherence tomography may help to diagnose this entity that can be managed successfully despite late intervention. The addition of a venting incision that drains fluid from the supra-Descemetic space can increase the chance of success of descemetopexy when compared with descemetopexy with air or gas alone.
Associated Neurotrophic Keratopathy in Complex Regional Pain Syndrome
Authors: Soifer Matias , Gomez-Caraballo Maria , Venkateswaran Nandini , Jay Gary W. , Perez Victor L.
Published: February 2021

Purpose:

To report a case of neurotrophic keratopathy (NK) in a patient with complex regional pain syndrome (CRPS) with ipsilateral facial involvement.

Methods:

Case report.

Results:

An 18-year old woman with a 5-year history of CRPS type I, a systemic disorder with a neuropathic component with associated limb and right facial involvement, presented with an insidious onset of blurred vision and pain in the right eye. Ocular examination revealed decreased corneal sensation, as measured by Cochet–Bonnet testing, associated with recurrent epithelial defects and whorl-like superficial corneal epitheliopathy. NK was suspected and confirmed by in vivo confocal microscopy (IVCM), which revealed rarefaction of the subbasal nerve plexus in the affected eye. To enhance corneal nerve health, plasma rich in growth factors drops were used. Persistence of NK prompted a superficial keratectomy with placement of an amniotic membrane graft and a course of cenegermin 0.002% (Oxervate; Dompé Farmaceutici SpA, Italy) in the postoperative period. This combination therapy resulted in successful epithelial closure and vision improvement after 8 weeks of therapy with no recurrence of disease for 11 months. Importantly, at that final visit, IVCM demonstrated growth of corneal nerves for the first time in this patient.

Conclusions:

This is the first case report of NK occurring in the context of CRPS, a neuropathy with ipsilateral facial pain involvement. IVCM was important in the diagnosis of NK, which responded successfully to ocular surface treatments focused on nerve health stimulation that ultimately resulted in corneal nerve growth.
Standalone iStent Trabecular Micro-bypass Glaucoma Surgery: A Systematic Review and Meta-Analysis
Authors: Healey Paul R. , Clement Colin I. , Kerr Nathan M. , Tilden Dominic , Aghajanian Lara
Published: February 2021

Precis:

Standalone trabecular micro-bypass glaucoma surgery with the iStent devices is associated with clinically relevant reductions in intraocular pressure (IOP) sustained over a reasonably long-term while simultaneously reducing medication burden and a relatively favorable safety profile.

Purpose:

While there is a relatively large body of evidence supporting the implantation of the iStent trabecular micro-bypass devices during phacoemulsification in patients with open-angle glaucoma (OAG), its efficacy as a standalone procedure has been less widely reported. The aims of this study were to systematically identify and quantitatively evaluate the efficacy of iStent devices (iStent and iStent inject) when performed independently of cataract surgery in patients with OAG.

Methods:

A systematic review of the literature was undertaken in August 2019 to identify studies of standalone trabecular micro-bypass glaucoma surgery with iStent devices in patients with OAG. All randomized trials were considered and nonrandomized studies that included at least 6 months of follow-up or more than 10 eyes. Key efficacy analyses included postoperative IOP and medication use, which were used to evaluate weighted mean differences from baseline, and the proportion of eyes free of ocular medication. Postoperative adverse events were descriptively summarized.

Results:

A total of 13 studies were identified including 4 randomized controlled trials and 9 nonrandomized or single-arm studies providing data for 778 eyes. In eyes implanted with iStent devices, a weighted mean IOP reduction of 31.1% was observed at 6 to 12 months. In studies reporting longer-term outcomes (36 to 48 mo or 60 mo), the weighted mean IOP reduction was 30.4% and 32.9%, respectively. The pooled weighted mean reduction in IOP from baseline across all studies at 6 to 12 months and 36 to 60 months poststent implantation was 7.01 mm Hg (95% confidence interval: 5.91, 8.11) and 6.59 mm Hg (95% confidence interval: 5.55, 7.63), respectively. Medication burden was reduced by ~1.0 medication at 6 to 18 months and 1.2 medications at 36 to 60 months. Adverse events reported in more than 5% of participants were progression of pre-existing cataract/cataract surgery and loss of best-corrected visual acuity but these rates were no different to those reported in comparator medical therapy study arms.

Conclusions:

The results from these studies support the independent effect of the iStent trabecular bypass devices on IOP and medication burden over a duration of follow-up of up to 5 years.
Changes in Corneal Biomechanics and Glaucomatous Visual Field Loss
Authors: Chan Eric , Yeh Kaileen , Moghimi Sasan , Proudfoot James , Liu Xiongfei , Zangwill Linda , Weinreb Robert N.
Published: February 2021

Precis:

A lower baseline corneal hysteresis and a decrease in corneal resistance factor (CRF) over time are associated with higher risk of visual field progression in glaucomatous and glaucoma suspect eyes.

Purpose:

The aim was to investigate the longitudinal change in CRF and cornea hysteresis (CH) as risk factors for visual field progression.

Materials and Methods:

In this prospective observational cohort study, 72 eyes of 48 glaucoma or glaucoma suspect patients were followed for an average of 4.5 years. Baseline and follow-up CH and CRF measurements were performed with the Ocular Response Analyzer (Reichert Ophthalmic Instruments Inc., Depew, N.Y.). Evaluation of rates of visual field change during follow-up was performed using visual field mean deviation. Univariable and multivariable linear mixed models assessed the relationship of visual field progression with baseline CRF and CH as well as with changes in CRF and CH.

Results:

The mean baseline CH was 9.0 (95% confidence interval: 8.6-9.4)  mm Hg and the mean baseline CRF was 9.3 (95% confidence interval: 8.8-9.9) mm Hg. There was no statistically significant difference in average CH and CRF measurements over time. In multivariable modeling adjusting for age, race, and mean intraocular pressure during follow-up, each 1 mm Hg lower in baseline CH and 1 mm Hg decrease in CRF over time were associated with a 0.12 (P=0.042) and 0.14 dB/year (P=0.007) faster rate of visual field mean deviation loss, respectively. Similar findings were found in glaucoma eyes but not found in glaucoma suspect eyes.

Conclusion:

Visual field progression was associated with a lower baseline CH and a decrease in CRF over time. Assessment of corneal resistance and elasticity at baseline and during follow-up examinations should be considered to identify those eyes at highest risk of visual field progression.
Comparison of Tono-Pen Avia and Handheld Applanation Tonometry in Primary Congenital Glaucoma
Authors: Cronemberger Sebastião , Veloso Artur W.
Published: February 2021

Précis:

Tono-Pen AVIA (TPA) intraocular pressure (IOP) values are different from those taken with handheld Goldmann applanation tonometer (GAT) in primary congenital glaucoma (PCG). These differences indicate both tonometers cannot be used interchangeably for measuring IOP in PCG.

Purpose:

The aim was to compare IOP measurements obtained using TPA and a handheld version of GAT in children with PCG.

Materials and Methods:

Forty-two eyes from 23 patients were evaluated for central corneal thickness (CCT), axial length, biomicroscopy and IOP measurement with TPA and a handheld GAT under inhalation anesthesia. After 1 eye from each patient was randomized, paired the Student t-test and the Pearson correlation were used for analysis. Generalized linear mixed model was used to estimate the difference between tonometers.

Results:

Mean age of children was 28.3±20.5 months. Mean axial length was 24.89±3.33 mm and mean CCT was 605.9±81.0 µm. Mean IOP was 22.1±9.6 for TPA and 14.0±4.5 mm Hg for GAT. There was a significant difference of 8.1±6.9 mm Hg between TPA IOP and GAT IOP (P<0.001). Each 6 months increase in age was associated with 1.32 mm Hg reduction in the difference between tonometers (P=0.002) and each 1 mm Hg higher of mean GAT IOP was associated with −0.73 mm Hg in the difference between TPA and GAT (P=0.002). Also, for every 20 µm increase in CCT an increase of 1.16 mm Hg in the difference between both devices was expected (P=0.003), after adjustment for potentially confounding variables.

Conclusion:

There is a significant difference between TPA IOP and GAT IOP in PCG. The difference between TPA and GAT in PCG is influenced by CCT, age and GAT IOP value.
Kelly Punch Punctoplasty and Simple Punctal Dilatation Are Equally Effective for Punctal Stenosis: A Prospective Study
Authors: Zloto Ofira , Weissman Alon , Moroz Iris , Weidenfeld Jonathan , Ben Simon Guy , Sagiv Oded , Rosner Mordechai , Priel Ayelet
Published: February 2021

Purpose:

To examine the clinical, imaging, and histopathologic differences between Kelly punch punctoplasty and punctal dilatation, both with mini Monoka stent insertion.

Methods:

This is a prospective, comparative clinical study. Patients with bilateral punctal stenosis and for whom surgery was advised participated in the study. The right eye underwent Kelly punch punctoplasty and the left eye simple punctal dilatation, both with mini Monoka stents were participated. Data were collected and analyzed before and 3 months following the procedure and included the degree of epiphora (Munk score) and punctal size as measured by anterior segment optical coherence tomography (AC- OCT). All specimens removed by the Kelly punch punctoplasty were sent for histopathologic evaluation, including Masson’s trichome muscle staining.

Results:

The study included 46 eyes of 23 patients (4 males and 19 females) whose mean age at presentation was 60.43 ± 14.81 years (range 19–84 years). There was a significant decrease in the Munk score after both punctoplasties compared with baseline values (P < 0.01, matched pairs). There were no significant differences between groups in the delta Munk score. There was a significant increase in punctal size after both procedures compared with baseline values as measured by AS-OCT. Horner–Duverney’s muscle was visible in only 3 of the 23 (13.04%) specimens from patients who underwent the Kelly punch punctoplasty.

Conclusions:

The Kelly punch punctoplasty and the simple dilator punctoplasty, both with stents, are equally effective treatments for epiphora due to acquired punctal stenosis. Only a few specimens removed during the Kelly punch method show muscle fibers.
Changes of lymphocyte subsets in patients with COVID-19 and clinical significance: a case-control observational study
Authors: Yang Guang , Feng Fan , Li Xue , Zhang Tian , Li Xiang , Li Boan
Published: February 2021

Objective:

To investigate and analyze changes of T lymphocyte and other lymphocyte subsets in the peripheral blood of patients with coronavirus disease 2019 (COVID-19), with the goal of improving clinical understanding and the value of research applications.

Methods:

General data of 66 confirmed COVID-19 patients admitted to the Fifth Medical Center of Beijing PLA General Hospital from January 2 to March 23, 2020 were collected in this retrospective case-control observational study, and they were divided into mild (
n
=26), mid-grade (
n
=19), and severe/critical disease groups (
n
=21) according to disease severity. Neutrophils, lymphocytes, neutrophil/lymphocyte ratios, CD4 absolute counts, CD8 absolute counts, and CD4/CD8 expression ratios of peripheral whole blood among the three patient groups were compared. The study protocol was approved by the Ethics Committee of the Fifth Medical Center, General Hospital of Chinese PLA (approval No. 2020-69-D) on May 5, 2020.

Results:

Among the 66 COVID-19 patients examined, 38 were male and 28 were female, with an average age of 53 ± 17 years. Among patients, 26 cases were mild, 19 cases were mid-grade, and 21 cases were severe/critical. Neutrophils, neutrophil/lymphocyte ratios, and CD4
+
/CD8
+
ratios of the severe/critical group were significantly higher compared with mild and mid-grade groups (
P
< 0.01); however, there was no obvious difference between mid-grade and mild groups (
P
> 0.05). Lymphocytes, CD4 absolute counts, and CD8
+
absolute counts of the severe/critical group were significantly lower compared with mild and mid-grade groups (
P
< 0.01); however, there was no significant difference between mid-grade and mild groups (
P
> 0.05).

Conclusion:

Counts of lymphocytes and T lymphocytes in severe/critically ill patients were decreased, which is of great significance for the identification of severe and critical COVID-19 patients.
Impact of COVID-19 on Heart Failure Self-Care
Authors: Radhakrishnan Kavita , Allen Catherine , DeMain Atami Sagna , Park Linda
Published: February 2021

Background

Difficulties in coping with and self-managing heart failure (HF) are well known. The COVID-19 pandemic may further complicate self-care practices associated with HF.

Objective

The aim of this study was to understand COVID-19's impact on HF self-care, as well as related coping adaptations that may blunt the impact of COVID-19 on HF health outcomes.

Methods

A qualitative study using phone interviews, guided by the framework of vulnerability analysis for sustainability, was used to explore HF self-care among older adults in central Texas during the late spring of 2020. Qualitative data were analyzed using directed content analysis.

Results

Seventeen older adults with HF participated (mean [SD] age, 68 [9.1] years; 62% female, 68% White, 40% below poverty line, 35% from rural areas). Overall, the COVID-19 pandemic had an adverse impact on the HF self-care behavior of physical activity. Themes of social isolation, financial concerns, and disruptions in access to medications and food indicated exposure, and rural residence and source of income increased sensitivity, whereas adaptations by healthcare system, health-promoting activities, socializing via technology, and spiritual connections increased resilience to the COVID-19 pandemic.

Conclusions

The study's findings have implications for identifying vulnerabilities in sustaining HF self-care by older adults and empowering older adults with coping strategies to improve overall satisfaction with care and quality of life.
Evaluating Integrated Care for People Living With HIV and Multidrug-Resistant Tuberculosis in South Africa: A Case-Based Approach Using the Chronic Care Model
Authors: Geiger Keri , Bergman Alanna , Farley Jason E.
Published: February 2021

In South Africa, tuberculosis (TB) and multidrug-resistant TB (MDR-TB) frequently occur in people living with HIV. World Health Organization guidelines recommend the integration of MDR-TB and HIV care but, in practice, fully integrated care is difficult to achieve. In this article, we use five elements of the Chronic Care Model as a framework for evaluating a case of integrated MDR-TB/HIV care and to highlight opportunities for nurses to improve care delivery and patient outcomes. We apply the Chronic Care Model framework to a concrete example by examining the case of a 33-year-old man who developed MDR-TB treatment failure while concurrently taking a powerful new MDR-TB antiretroviral therapy regimen for his HIV.
The Effect of Ulnar Deviation Orthosis in Patients with Zigzag Deformity Due to Rheumatoid Hand
Authors: Yazdan Ramaji Reza , Daryabor Aliyeh , Ahmadi Bani Monireh
Published: February 2021

Introduction

Rheumatoid arthritis (RA) is known as a chronic and multisystem disease accompanied by synovial inflammation leading to deformities such as finger ulnar deviation and pain, as well as functional difficulties. Thus, a conservative treatment in this domain includes orthoses, that is, features added to the body that aim to correct deformity, reduce pain, and finally improve functionality.

Objective

The purpose of this quasi-experimental study was to evaluate the effect of ulnar deviation orthosis in patients with zigzag deformity due to RA.

Material and Methods

In total, 12 participants with RA were measured two times: before the start of orthosis use and after 4 weeks of use. The rate of pain, grip strength, and upper-limb function were also measured using a visual analog scale, the Jamar Hydraulic Hand Dynamometer, and the Disability of the Arm, Shoulder, and Hand Questionnaire, respectively.

Results

After 4 weeks of orthosis use, it was found that the scores of pain (P = 0.03), upper-limb function (P = 0.008), and grip strength had significantly improved in the hands treated over time.

Conclusion

The use of an ulnar deviation orthosis by patients with RA could reduce hand pain, improve grip strength, and promote upper-limb function.
Acupuncture as add-on treatment for functional dyspepsia
Authors: Kwon Chan-Young , Ko Seok-Jae , Lee Boram , Cha Jae Myung , Park Jae-Woo
Published: February 2021

Background:

Functional dyspepsia (FD) is a common functional gastrointestinal disease with a high prevalence. However, due to the limitations of conventional Western treatments, such as acid suppressants, prokinetics, Helicobacter pylori eradication treatment, and antidepressants, the popularity of complementary and alternative medicine, such as acupuncture, is steadily increasing. We describe the methods that will be used to evaluate the effectiveness and safety of acupuncture as add-on therapies to conventional Western medications in patients with FD.

Methods and analysis:

A total of 12 English, Korean, and Chinese electronic databases will be searched by 2 researchers from their inception dates to December 2020. Randomized controlled trials assessing the effectiveness and safety of acupuncture as add-on therapies to conventional Western medications in patients with FD will be included. The primary outcome measure will be the symptom score of FD, and secondary outcome measures will be total effective rate, quality of life, level of gut peptide hormones, incidence of adverse events, and recurrence rate. Data analysis will be performed using the Review Manager version 5.3. The risk of bias of the included studies and the quality of evidence for the main findings will be evaluated using the Cochrane Collaborations risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation approach, respectively.

Conclusion:

The findings of this review will provide evidence on the complementary effectiveness and safety of acupuncture for FD for clinicians, patients, and policy makers in decision making.

OSF registration number:

DOI 10.17605/OSF.IO/MXREN (https://osf.io/mxren).
The efficacy and safety of auricular acupuncture versus electroacupuncture in ameliorating chemotherapy-induced nausea and vomiting among patients receiving cisplatin-based regimens
Authors: Liu Meng-yue , Sung Lai , Liao Yan-Sen , Jiao Yi-fei , Sun Chang-sheng , Peng Xiao-dong
Published: February 2021

Background:

Nausea and vomiting are among the most common and distressing side effects of chemotherapy. Difference in views about the effectiveness of auricular acupuncture (AA) versus electroacupuncture (EA) of chemotherapy-induced nausea and vomiting (CINV) lies at the heart of the debate. The aim of this study is to compare the antiemetic efficacy and safety of AA and EA for CINV.

Methods:

One hundred twenty participants, 18 to 75 years old malignant tumors will receiving chemotherapy with cisplatin, will be recruited and randomized into 3 groups equally, Group A (the AA group), Group B (the EA group), and Group C (the control group). The participants in Group A and Group B will receive AA or EA regimens, alternatively, beginning on the day before first day of chemotherapy for a third consecutive cycles. All participants will continue to receive conventional treatment. The incidence and severity of CINV will be assessed using the definition and classification of nausea and vomiting (NCI-CTC AE4.0) and the MASCC (Multinational Association for Supportive Care in Cancer) Antiemesis Tool (MAT). Secondary outcome measures include the degree of abdominal distension, the first time of flatus and defecation, and life quality. Additionally, adverse events will also be documented during the period of the treatment.

Discussion:

This trial may provide evidence regarding the clinical effectiveness and safety of AA versus EA for CINV following cisplatin-based regimens.

Trail registration:

This study is registered with the Chinese Clinical Trial Registry: ChiCTR2000040942.
The effect of nurse-led interventions on re-admission and mortality for congestive heart failure
Authors: Qiu Xiaoqin , Lan Chunhan , Li Jinhua , Xiao Xi , Li Jinlian
Published: February 2021

Background:

The European Society of Cardiology guidelines recommend the implementation of nurse-led heart failure programs to achieve optimal management of patients with congestive heart failure (CHF). In this analysis, we aimed to systematically show the impact of nurse-led interventions (NLI) on re-admission and mortality in patients with CHF (reduced ejection fraction).

Methods:

Publications reporting the impact of NLI on readmission and mortality in patients with CHF were carefully searched from electronic databases. Rehospitalization and mortality were the endpoints. For this analysis, the latest version of the RevMan software was used. Risk ratios (RR) with 95% confidence intervals (CI) were used to represent data following analysis.

Results:

A total number of 3282 participants with CHF were included in this analysis. A total of 1571 patients were assigned to the nurse-led intervention group whereas 1711 patients were assigned to the usual care group. The patients had a mean age ranging from 50.8 to 80.3 years. Male patients varied from 27.3% to 73.8%. Comorbidities including hypertension (24.6%–80.0%) and diabetes mellitus (16.7%–59.7%) were also reported. Patients had a mean left ventricular ejection fraction varying from 29.0% to 61.0%. Results of this current analysis showed that rehospitalization (RR: 0.81, 95% CI: 0.74–0.88; P = .00001) and mortality (RR: 0.69, 95% CI: 0.56–0.86; P = .0009) were significantly lower among CHF patients who were assigned to the nurse-led intervention. Whether during a shorter (3–6 months) or a longer (1–2 years) follow up time period, rehospitalization for shorter [(RR: 0.73, 95% CI: 0.65–0.82; P = .00001) vs for longer (RR: 0.81, 95% CI: 0.72–0.91; P = .0003) respectively] and mortality for shorter [(RR: 0.55, 95% CI: 0.38–0.80; P = .002) vs longer follow up time period (RR: 0.76, 95% CI: 0.58–0.99; P = .04) respectively] were significantly lower and in favor of the nurse-led interventional compared to the normal care group.

Conclusions:

This systematic review and meta-analysis of randomized controlled trials showed that NLI had significant impacts in reducing the risk of rehospitalization and mortality in these patients with CHF (reduced ejection fraction). Hence, we believe that nurse-led clinics and other interventional programs would be beneficial to patients with heart failure and this practice should, in the future be implemented to the health care system.
The clinical efficacy of external application of mirabilite and rhubarb combined with intrathoracic chemotherapy in treating malignant pleural effusion
Authors: Zhang Huachun , Jiang Mengyuan , Gao Lirong , Lin Zhen
Published: February 2021

Background:

Malignant pleural effusion (MPE) is one of the commonest causes of an exudative pleural effusion. Breathlessness, dyspnea and other symptoms often seriously distress and affect the quality of life. The external application of mirabilite and rhubarb (EAMR) combined with intrathoracic infusion of cisplatin, as an alternative treatment for MPE, is popular in China. The study aims to assess its effectiveness and safety combined with intrathoracic chemotherapy.

Methods:

This study is a prospective, randomized controlled clinical trial. Patient visits were performed at baseline and days 14 and 28 after treatment. Clinical outcomes were measured after chest drain placement using the criterion of efficacy refer to WHO standard, and QLQ-C30 questionnaire.

Results:

Database records of patients treated in our institution for MPE between October, 2016 and March, 2019. The study included 84 eligible patients. They were categorized with a randomization schedule into treatment group (N = 42) and control group (N = 42). There is statistical significance in the comparison of the total effective rate between these 2 groups (66.67% vs 54.76%, P < .05). Furthermore, there is statistical significance in the comparison of items of Physical (1.95 ± 0.50 vs 2.19 ± 0.58%, P < .05), Pain (1.98 ± 0.42 vs 2.07 ± 0.32, P < .05), and Global Health (1.23 ± 0.64 vs 1.13 ± 0.23%, P < .05) between these 2 groups. None of the patients had adverse reactions such as skin allergy and chest tightness.

Conclusions:

The total effective rate of treatment group using extra external application of mirabilite rhubarb powder is significantly higher than that of control group. The improvement of patients’ clinical symptoms is greater in treatment group and no adverse reactions is found. Therefore, external application of mirabilite and rhubarb combined with intrathoracic infusion of cisplatin is an effective method for the treatment of MPE, which is worth popularizing.
COVID-19 Disruption of Nursing Education and the Effects on Students' Academic and Professional Confidence
Authors: Gaffney Mary K. , Chargualaf Katie A. , Ghosh Santu
Published: February 2021

Background

In spring 2020, the novel coronavirus prompted a sudden shift in nursing education. This study evaluated students' perceptions of their ability to adjust to these challenges.

Methods

A cross-sectional survey of students (n = 286) in BSN programs throughout the United States was conducted via email to examine 3 areas of student confidence (academic success, NCLEX-RN success, and patient care delivery) and to determine how these were affected by the abrupt transition to remote learning.

Results

Variables, including alignment of remote instruction styles with learning styles, ease of transition to distance learning, and educating children at home, were significantly associated with students' confidence in their ability to be successful academically, on NCLEX-RN, and in patient care.

Conclusions

With potential for ongoing challenges due to the coronavirus, faculty need to identify and support students at greater risk of experiencing difficulties and threats to success, thereby preventing attrition and ensuring preparation of a diverse workforce.