bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations of loneliness and social isolation with actigraph and self-reported sleep quality in a national sample of older adults
Authors: Benson Jade A , McSorley V Eloesa , Hawkley Louise C , Lauderdale Diane S
Published: July 2020

Study Objectives

To examine associations of social isolation and loneliness with sleep in older adults and whether associations differ for survey and actigraph sleep measures.

Methods

This study used data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of community-dwelling older adults born 1920–1947. A random one-third of participants in 2010–2011 were invited to participate in a sleep study (N = 759) that included survey questions, 72 hours of wrist actigraphy, and a sleep log. Perceived loneliness was measured using three questions from the UCLA Loneliness Scale. An index of social isolation was constructed from nine items that queried social network characteristics and social interactions. We used ordinary least squares and ordinal logistic regression to examine whether sleep measures were associated with loneliness and social isolation adjusted for potential sociodemographic confounders.

Results

Social isolation and loneliness had a low correlation (Spearman’s correlation = 0.20). Both loneliness and social isolation were associated with actigraphy measures of more disrupted sleep: wake after sleep onset and percent sleep. Neither was associated with actigraph total sleep time. Increased loneliness was strongly associated with more insomnia symptoms and with shorter sleep duration assessed by a single question, but social isolation was not. More isolated individuals spent a longer time in bed.

Conclusions

We found that both loneliness and social isolation were associated with worse actigraph sleep quality, but their associations with self-reported sleep differed. Only loneliness was associated with worse and shorter self-reported sleep.
Shoelace Technique Plus Negative-Pressure Wound Therapy Closure in Fasciotomy Wounds
Authors: Eceviz Engin , Çevik Hüseyin Bilgehan
Published: July 2020

BACKGROUND

Fasciotomy incision closure is often performed with skin grafts that can lead to cosmetic and functional complications after surgical intervention. Because fasciotomy incisions do not result in skin loss, the authors hypothesized that better closure can be achieved by reducing tissue edema with negative-pressure wound therapy (NPWT) and reducing stress on the skin with the shoelace surgical technique.

METHODS

This 1-year prospective study included eight patients with acute compartment syndrome after extremity fractures and/or blunt injuries. Patients were treated with fasciotomies closed with the shoelace technique and NPWT for wound margin approximation. The NPWT device was changed every second day; the shoelace traction tension was tightened at the same time.

MAIN RESULTS

The mean time from fasciotomy to wound closure was 11.8 days (range, 5–30 days). There was no need for a skin graft or flap in any patient.

CONCLUSIONS

The shoelace technique plus NPWT may be successful in closing skin fasciotomies after acute compartment syndrome without causing additional morbidity.
Pathologic Scarring after Eyebrow Micropigmentation: A Case Report and Systematic Review
Authors: Motoki Thamy Harumi Cardoso , Isoldi Felipe Contoli , Ferreira Lydia Masako
Published: July 2020

BACKGROUND

Skin tattooing and cosmetic eyebrow definition and reshaping (micropigmentation) have been growing exponentially in popularity. The pigment used in these procedures can activate the skin’s inflammatory response, promoting the formation of pathologic scars.

OBJECTIVE

To carry out a systematic review of the literature on this topic and report a case of pathologic scarring on the eyebrows after micropigmentation.

METHODS

A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline in the MEDLINE, Lilacs, and SciELO databases using the keywords “scar; scar, hypertrophic; eyebrows; pigmentation; skin pigmentation; coloring agents; tattooing” and their synonyms.

RESULTS

The systematic literature review did not identify any study reporting pathologic scarring on eyebrows after micropigmentation. This is likely because eyebrow pathology is uncommon, although these results are limited by the comprehensiveness of the systematic review. The case of a 50-year-old woman undergoing eyebrow micropigmentation who presented with hypertrophic scarring after the procedure is also reported.

CONCLUSIONS

Eyebrow micropigmentation may be a risk factor for pathologic scarring, but further research is needed.
Functional Benefits of Fitness Boxing for Survivors Diagnosed With Breast or Ovarian Cancer: A Pilot Study
Authors: Doherty Deborah , Felisky Paige , Morton Kaitlyn , Sumner Kaitlyn
Published: July 2020

Background and Purpose:

Fitness boxing has been shown to improve strength, balance, endurance, and quality of life (QOL) in persons diagnosed with Parkinson disease and multiple sclerosis. The purpose of this pilot study was to explore the functional benefits of an upper extremity (UE) fitness boxing program for women diagnosed with breast and ovarian cancer.

Methods Design:

Prospective pilot study. Participants: Ten women diagnosed with breast or ovarian cancer. Pre/Postintervention Measurements: 6-Minute Walk Test (6MWT), 30-second chair stand, 4-step balance, scapular strength, hand grip, B-tracks balance, and Functional Assessment Chronic Illness Therapy–Fatigue specific (FACIT-F) survey. Intervention/Setting: Instructor-led 8-week UE fitness boxing program (3 times per week). Descriptive statistics completed.

Results:

Nine participants (breast cancer, n = 6; ovarian cancer, n = 3) completed 8 weeks of UE fitness boxing. In total, 77% of participants increased 6MWT distance, 55% improved in 30-second chair stand, 66% improved in bilateral middle and left lower trapezius strength, and 55% (right hand) and 66% (left hand) improved in grip strength. FACIT-F: Twenty-two percent reported decreased pain from “a little bit/somewhat” to “not at all”; 44% reported a decrease in being bothered by the side effects of treatment from “a little bit” to “not at all”; 44% reported an improvement in sleeping well from “somewhat/quite a bit” to “very much”; and 44% reported decrease in fatigue from “a little bit/somewhat” to “not at all.”

Limitations:

Small sample size, only female participants, and not being able to generalize to other cancer groups.

Conclusion:

UE fitness boxing has the potential to be a safe and effective option to improve strength, endurance, and QOL for women diagnosed with breast or ovarian cancer.
A matched-cohort study comparing outpatient total knee arthroplasty in an ambulatory surgery center with inpatient total knee arthroplasty in a hospital
Authors: Littleton Travis W. , Mascioli Anthony A. , Throckmorton Thomas W. , Mihalko William M. , Toy Patrick C.
Published: July 2020

Background:

The authors compared a matched cohort of outpatient total knee arthroplasties (TKA) performed in a free-standing ambulatory surgery center (ASC) with those performed in a standard inpatient hospital setting to determine the safety, efficacy, and expense associated with both locations.

Methods:

Retrospective review identified 82 patients who had TKA, 41 at an ASC and 41 in an inpatient hospital. The cohorts were matched according to age and American Society of Anesthesiologists (ASA) physical status classification.

Results:

There were no statistically significant differences in age, gender, body mass index, or ASA scores. There were no readmissions or major complications, including deep infection, periprosthetic fracture, or venous thromboembolism, in either cohort. Minor wound issues occurred in four (9.8%) hospital patients and one (2.4%) ASC patient. All ASC patients were discharged the day of surgery without an overnight stay. The average length of stay for the hospital group was 2.5 days. The average total facility charge for ASC patients was $26,800.00 compared to the national average of $31,124.

Conclusions:

No significant differences were noted between TKA performed in an ASC and a hospital for major complications or hospital readmissions at 90 days. The average length of stay in the hospital was 2.5 days, however, which might indicate a higher cost than day surgery. Although not statistically significant, the ASC cohort had fewer minor complications than the inpatient cohort. In select patients TKA performed outpatient in an ASC appears to be as effective and safe as that performed in a hospital, with the caveat that some patients may not be candidates. Careful patient selection, preoperative screening and counseling, and the use of multimodal pain regimens are critical to minimizing complications and reducing costs.

Level of Evidence:

Level III.
External Fixator–Assisted Reduction of Distal Femur Fractures: A Technical Trick
Authors: Shymon Stephen J. , Ulitto Joseph , Barei David P. , Sirkin Michael S. , Reilly Mark C. , Adams Mark R.
Published: July 2020

Restoration of anatomical alignment while preserving the soft-tissue envelope around the fracture site remains a challenge during distal femur fracture fixation. Although the lateral distal femoral locking plate allows surgeons to achieve adequate bony stability, their application has been associated with malalignment leading to inferior outcomes. We propose a biologically friendly, percutaneous technique that sequentially reduces and aligns distal femur fractures with an anterior external fixator before definitive fixation with a lateral distal femoral locking plate.
Tibial tubercle fractures in children and adolescents: a large retrospective case series
Authors: Haber Daniel B. , Tepolt Frances A. , McClincy Michael P. , Hussain Zaamin B. , Kalish Leslie A. , Kocher Mininder S.
Published: July 2020

To report patient characteristics, fracture types, treatment methods, early clinical outcomes and complications of children and adolescents treated for tibial tubercle fractures. Retrospective case series of patients 18 years old and younger treated for tibial tubercle fractures at a single institution from 1995 to 2015. Clinical and radiographic outcomes were reported at minimum six-month follow-up. In 228 patients, 236 tibial tubercle fractures were identified, of whom, 198 (87%) were males. Mean age and BMI was 14.3 years and 25.0, respectively. Pre-existing Osgood-Schlatter disease was identified in 31% cases and was most commonly associated with type I fractures (P < 0.001). Most fractures occurred while participating in athletics (86%). Initial treatment was surgical for 67% fractures. Type III fractures were most common (41%), followed by type I (29%). Type I fractures were most commonly treated nonoperatively (91%) and types II-V fractures were most commonly treated surgically (89%, P < 0.001). Compartment syndrome was identified in 4 (2%) patients, 3 of which had type IV fractures. Most patients returned to sports (88%). Tibial tubercle fractures are sports-related injuries and occur most commonly in adolescent males. They can be associated with pre-existing Osgood-Schlatter disease, a higher than average BMI, and a small but relevant risk of compartment syndrome. Following treatment, most patients return to sports participation.
Prospective study of pediatric medial humeral epicondyle fractures nonoperatively treated. Clinical, radiologic, and functional evaluation at long term
Authors: García-Mata Serafín , Arbeloa-Gutierrez Lucas , Brun Miriam , Sánchez-Guardamino Daniel
Published: July 2020

The objective of the study is to evaluate the natural history of the medial epicondyle avulsion in children with nonoperative treatment (NOPT) on different magnitude of displacement and long-term follow-up. A prospective study of 34 patients with medial epicondyle avulsion with (NOPT) was performed. Clinical test (stability, strength, atrophy, tenderness, Tinel test, and range of motion), subjective scores [Visual Analog Scale (VAS), Likert scale, side-to-side valgus test], and objective four scores were performed. Age at the time of injury was 8.9 ± 2.81 years. Follow-up was 7 ± 2.81 years. Four of the patients had anterior displacement. Displacement varied between 3 and 26 mm (10.49 ± 6.16 mm). Subjective: VAS and ordinal three-point Likert scale were excellent. Objective results were also excellent Mayo Elbow Score: 98.67 ± 4.31 (85–100), Oxford Elbow Score: 59.35 ± 1.68 (51–100), Elbow Assessment Score System: 96.27 ± 9.77 (57–100), Disabilities of the Arm, Shoulder, and Hand (DASH) score 0.64 ± 1.001 (0–4.16). We did not find any differences in strength or forearm diameter. There was an extension deficit in seven cases with a significant association with the magnitude of displacement (P = 0.02) and with the presence of concomitant lesions or anterior displacement of the medial epicondyle >5 mm. All except one were stable clinically on valgus stress. There is a significant association between the objective outcomes (scores) and concomitant lesions but not with regards to the DASH score P = 0.102). There is no association between the magnitude of medial epicondyle displacement or the follow-up and the objective outcomes. Instability was associated with valgus stress activities. There is no association between the magnitude of displacement of the medial epicondyle or the follow-up and the objective outcomes. NOPT produces excellent subjective and objective outcomes that worsened when there were associated lesions, anterior medial epicondyle displacement, or in patients who performed activities with repeated valgus stress. Based on our study, NOPT is suitable except for Open Reduction Internal Fixation indications: absolute indications, high energy injury with associated lesions, medial humeral epicondyle fracture in the dominant elbow in patients subject to activities with chronic valgus stress, and anterior displacement.
Minimally displaced pediatric humerus lateral condyle fractures: risk factors for displacement and outcomes of delayed surgery
Authors: Edmonds Eric W. , Bland Daniel C. , Bastrom Tracey P. , Smith M. Morgan , Upasani Vidyadhar V. , Yaszay Burt , Pennock Andrew T.
Published: July 2020

The purpose of this study was to identify risk factors for management failure in pediatric minimally displaced lateral condyle fractures of the distal humerus (LCHFx) and compare outcomes between initial nonoperative and operative cohorts. A retrospective chart review of LCHFx was conducted to identify children treated with displacement <2 mm and initial nonoperative management. Classification and Regression Trees (CART) were constructed to identify predictors for failure of nonoperative management (further displacement requiring operative intervention). One hundred forty nonoperative children met initial inclusion. CART analysis identified the internal oblique measurement of pre-treatment fracture displacement of >1.2 mm to be the most predictive of nonoperative failure. Fractures with displacement of >1.2 mm had a 58.3% rate of failure compared to 1.3% for those <1.2 mm of initial displacement (P < 0.001). Thirty-seven percent of nonoperative children required revision treatment compared to only 12% of operative children (P = 0.034). LCHFx with minimal displacement (1–2 mm) have a relatively high risk for failure when initially managed without surgery and should either be monitored closely or considered for early operative management when appropriate.
Hemiepiphysiodesis: when should it be considered a day-case procedure?
Authors: Barrett Matthew C. , Manoukian Dimitrios , Tzatzairis Themistoklis , Segaren Neil , Firth Gregory. B. , Ramachandran Manoj
Published: July 2020

Hemiepiphysiodesis is usually planned as a day-case but patients may stay overnight for pain control. In this study, we assessed the required level of analgesia (LOA) and length of stay (LOS) in patients undergoing hemiepiphysiodesis about the knee joint. We conducted a retrospective cohort study of patients that underwent temporary hemiepiphysiodesis of the distal femur or proximal tibia using hemiepiphysiodesis plates (eight-plates) for coronal plane deformities between January 2012 and October 2019. Demographics, type of procedure, anatomical site, anaesthetic time, preoperative, intraoperative and postoperative analgesia, and time of surgery were collected. Anterior hemiepiphysiodesis and permanent drill epiphysiodesis procedures were excluded. In this series of 79 patients, those with increased American Society of Anesthesiologists Score >1 and patients that were operated on >2 sites required increased LOA, (P < 0.05) and prolonged LOS (P < 0.05). The timing of surgery (morning vs. afternoon list) did not influence LOS or LOA. Patient-controlled analgesia (PCA) was required in 8 of 14 (57%) patients with four growth plates operated on. All (n = 12) patients that received PCA remained in hospital for at least one night. The use of local infiltration intraoperatively played a significant role in early discharge of the patients and t lower the LOA postoperatively (P < 0.05). Parameters including the number of growth plates operated on, use of tourniquet and intraoperative local infiltration can independently influence LOS and LOA postoperatively and at discharge. These parameters should be taken into consideration when consulting with the patient and family and when planning the postoperative course.
Clinical and Radiologic Outcomes of Thoracolumbar Fusions Using Intraoperative CT Guidance and Stereotactic Navigation in a Spinal Trauma Population
Authors: Domino Joseph S. , Smith Kyle A. , Arnold Paul M.
Published: July 2020

Study Design:

Retrospective review of prospectively collected single-institution database.

Objective:

To analyze the clinical and radiographic outcomes of posterior thoracolumbar fusions using intraoperative computed tomography (CT)-guidance and stereotactic navigation in thoracolumbar spinal trauma.

Summary of Background Data:

Pedicle screw instrumentation is utilized for stabilization in thoracolumbar fusions. Suboptimal placement may lead to neurovascular complications, pseudarthrosis, postoperative pain, and the need for revision surgery. Image-guided spinal surgery is commonly used to improve accuracy, particularly for complex anatomy such as encountered with traumatic fractures.

Methods:

We retrospectively identified 58 patients undergoing posterior thoracolumbar fusions using intraoperative CT and stereotactic navigation for traumatic fractures from 2010 to 2017 at a single institution. Pedicle screw accuracy, realignment, clinical outcomes, and ease of use were retrospectively reviewed. Accuracy was assessed on postplacement or postoperative CT. Breach grades included: grade 1 (<2 mm), grade 2 (2–4 mm), and grade 3 (>4 mm).

Results:

A total of 58 patients were identified having undergone 58 operations, which involved placement of 519 pedicle screws. Traumatic fracture patterns and levels of injury were varied. Accurate pedicle screw placement was found in 95.8% and was stable over time. Breach included: grade 1 in 19 screws, grade 2 in 2 screws, and grade 3 in 1 screw. No neurovascular complications were noted. No revision surgery was performed for misplacement. A subgroup of 6 ankylosing spondylitis patients were identified having undergone 6 operations with 63 pedicle screws. Accurate pedicle screw placement was found in 93.7%.

Conclusion:

Intraoperative CT-guidance and stereotactic navigation can overcome the difficulty associated with thoracolumbar trauma resulting in complex anatomy with malalignment and unpredictable trajectories. Intraoperative CT can be used with stereotactic guidance or for intraoperative verification of free-hand screw placement with repositioning as needed. CT-guidance maintains the benefit of reduced fluoroscopic exposure while improving accuracy of instrumentation and reducing reoperation for screw malposition.
Feasibility and Outcome of Routine Use of Concurrent Chemoradiation in HIV-positive Patients With Squamous Cell Anal Cancer
Authors: Leiker Andrew J. , Wang Chiachien J. , Sanford Nina N. , Aguilera Todd A. , Karri Sirisha , Beg Muhammad S. , Kazmi Syed A. , Olson Craig , Matthews Joselin A. , Abdelnaby Abier , Meyer Jeffrey J. , Folkert Michael R.
Published: July 2020

Objectives:

Clinical concerns about hematologic toxicities in human immunodeficiency virus (HIV)+ patients with squamous cell anal cancer (SCAC) may lead to de-escalation of treatment intensity. The objective of this study is to evaluate clinical outcomes including toxicity following standard concurrent curative-intent chemoradiation for HIV+ and HIV− patients with SCAC.

Materials and Methods:

Among 97 evaluable patients treated between 2009 and 2016 (median age 52.2 y), 43 (44.3%) were HIV+ and 54 (55.7%) HIV−. The majority of the radiation was delivered using intensity-modulated radiation therapy and chemotherapy consisting primarily (93%) of 5-fluorouracil and mitomycin C. Clinical outcomes assessed included toxicity, locoregional control (LRC), distant metastasis (DM), progression-free survival (PFS), colostomy-free survival (CFS), overall survival (OS), and cause-specific survival (CSS).

Results:

With a median follow-up of 45 months, HIV+ patients exhibited a trend toward reduced OS compared with HIV− patients (4 y OS 61.2% vs. 78.3%; HR 2.09; 95% CI, 0.97-4.52; P=0.055) on univariable analysis, but HIV status was not significant after adjusting for additional parameters on multivariable analysis. Toxicity rates, LRC, CFS, PFS, freedom from DM, and CSS were similar between the 2 cohorts. On multivariable analysis, tumor size >5 cm impacted all clinical outcomes (trend for LRC) except CFS. Radiation treatment extension beyond 7 days was found to negatively impact LRC and CSS. Male sex was associated with worse CFS.

Conclusions:

Radiation therapy with concurrent 5-fluorouracil and mitomycin C chemotherapy is reasonably well-tolerated as curative treatment for HIV+ patients with SCAC, and no significant difference in outcomes was noted relative to HIV− patients.
Menopause and frailty: a scoping review
Authors: Ruan Haihui , Hu Junping , Zhao Jinzhu , Tao Hongxia , Chi Junting , Niu Xiaodan , Zhang Jing , Wang Yanhong
Published: July 2020

Importance and Objective:

Frailty refers to the decline in physiological reserve capacity caused by the deterioration of multiple physiological systems (brain, endocrine system, immune system, and skeletal muscle), leading to increased vulnerability and decreased stress capacity. Women have a higher prevalence of frailty than men, although the epidemiological factors underlying this phenomenon are not fully understood. Menopause and menopause-related characteristics may be among the contributing factors. Hence, the purpose of this scoping review was to explore the relationship between menopause and frailty. We attempted to summarize information such as the age that menopause occurs, years since menopause, types of menopause, and hormones and inflammatory markers of frailty among postmenopausal women.

Methods:

PubMed, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature and Web of Science, the China National Knowledge Infrastructure, the China Biomedical Literature Service System, Wanfang Database and the WeiPu (VIP) Database were searched from inception until April 3, 2019. Supplementary searches of the references, cited documents, and similar documents of the included literature were also carried out.

Discussion and Conclusions:

Of 762 papers identified, 15 articles matching the criteria were included. The prevalence of frailty among postmenopausal women ranged from 5.9% to 57.3%. Existing studies suggest that menopause is associated with frailty. Early menopause, hysterectomy, low-free testosterone levels, and high C-reactive protein levels may increase the likelihood of frailty among postmenopausal women. Few original studies have explored the relationship between estrogen and frailty and the results of these studies are conflicting. Changes in hormone and inflammatory cytokine levels may mediate frailty among postmenopausal women. More in-depth research would be required to better understand the physiological and etiological mechanisms of the occurrence of frailty among postmenopausal women.
Recent trends in acute myocardial infarction among the young
Authors: Wu Wanda Y. , Berman Adam N. , Biery David W. , Blankstein Ron
Published: July 2020

Purpose of review

In recent decades, the incidence of myocardial infarction (MI) has declined among the general population. However, MI rates in the young have not decreased as much as has been observed among older individuals. This review will focus on recent trends of MI in young patients, factors that may account for these trends, and implications for future prevention.

Recent findings

MI rates in young patients, particularly in women, have not decreased in the same fashion as they have for their older counterparts, with some studies reporting an increase. The reasons for these findings include underestimation of cardiovascular risk, and accordingly treatment, in the young, as well as an increasing prevalence of risk factors such as obesity and diabetes.

Better recognition and treatment of cardiovascular risk factors among young adults may improve outcomes. There is a need for improved methods to assess and treat cardiovascular risk in young individuals.
A comparative study of ambulatory central hemodynamics and arterial stiffness parameters in peritoneal dialysis and hemodialysis patients
Authors: Alexandrou Maria-Eleni , Loutradis Charalampos , Balafa Olga , Theodorakopoulou Marieta , Tzanis George , Bakaloudi Dimitra , Dimitriadis Chrysostomos , Pateinakis Panagiotis , Gkaliagkousi Eugenia , Papagianni Aikaterini , Sarafidis Pantelis
Published: July 2020

Background:

Ambulatory pulse-wave velocity (PWV), augmentation pressure, and augmentation index (AIx) are associated with increased cardiovascular events and death in hemodialysis. The intermittent nature of hemodialysis generates a distinct ambulatory pattern, with a progressive increase of augmentation pressure and AIx during the interdialytic interval. No study so far has compared the ambulatory course of central hemodynamics and PWV between peritoneal dialysis and hemodialysis patients.

Methods:

Thirty-eight patients under peritoneal dialysis and 76 patients under hemodialysis matched in a 1 : 2 ratio for age, sex and dialysis vintage underwent 48-h ambulatory blood pressure (BP) monitoring with the oscillometric Mobil-O-Graph device. Parameters of central hemodynamics [central SBP, DBP and pulse pressure (PP)], wave reflection [AIx, heart rate-adjusted AIx; AIx(75) and augmentation pressure] and PWV were estimated from the 48-h recordings.

Results:

Over the total 48-h period, no significant differences were observed between peritoneal dialysis and hemodialysis patients in mean levels of central SBP, DBP, PP, augmentation pressure, AIx, AIx(75) and PWV. However, patients under peritoneal dialysis and hemodialysis displayed different trajectories in all the above parameters over the course of the recording: in peritoneal dialysis patients no differences were noted in central SBP (125.0 ± 19.2 vs. 126.0 ± 17.8 mmHg,P = 0.25), DBP, PP, augmentation pressure (13.0 ± 6.8 vs. 13.7 ± 7. mmHg,P = 0.15), AIx(75) (25.9 ± 6.9 vs. 26.3 ± 7.8%,P = 0.54) and PWV (9.5 ± 2.1 vs. 9.6 ± 2.1 m/s,P = 0.27) from the first to the second 24-h period of the recording. In contrast, hemodialysis patients showed significant increases in all these parameters from the first to second 24 h (SBP: 119.5 ± 14.4 vs. 124.6 ± 15.0 mmHg,P < 0.001; augmentation pressure: 10.9 ± 5.3 vs. 13.1 ± 6.3 mmHg,P < 0.001; AIx(75): 24.7 ± 7.6 vs. 27.4 ± 7.9%,P < 0.001; PWV: 9.1 ± 1.8 vs. 9.3 ± 1.8 m/s,P < 0.001). Peritoneal dialysis patients had numerically higher levels than hemodialysis patients in all the above parameters during all periods studied and especially during the first 24-h.

Conclusion:

Central BP, wave reflection indices and PWV during a 48-h recording are steady in peritoneal dialysis but gradually increase in hemodialysis patients. During all studied periods, peritoneal dialysis patients have numerically higher levels of all studied parameters, a fact that could relate to higher cardiovascular risk.
Effect of aerobic and resistance exercise training on inflammation, endothelial function and ambulatory blood pressure in middle-aged hypertensive patients
Authors: Boeno Francesco P. , Ramis Thiago R. , Munhoz Samuel V. , Farinha Juliano B. , Moritz Cesar E.J. , Leal-Menezes Rodrigo , Ribeiro Jerri L. , Christou Demetra D. , Reischak-Oliveira Alvaro
Published: July 2020

Objective:

The current randomized controlled trial tested the hypothesis that both aerobic training and dynamic resistance training will improve inflammation, endothelial function and 24-h ambulatory blood pressure (ABP) in middle-aged adults with hypertension, but aerobic training would be more effective.

Methods:

Forty-two hypertensive patients on at least one antihypertensive medication (19 men/23 women; 30–59 years of age) were randomly assigned to 12 weeks of supervised aerobic training (n = 15), resistance training (n = 15) or a nonexercise control (n = 12) group. Inflammation, endothelial function, 24-h ABP and related measures were evaluated at pre and postintervention.

Results:

We found that aerobic training and resistance training were well tolerated. Both aerobic training and resistance training reduced daytime systolic ABP (−7.2 ± 7.9 and −4.4 ± 5.8 mmHg; P < 0.05) and 24-h systolic ABP (−5.6 ± 6.2 and −3.2 ± 6.4 mmHg; P < 0.05). aerobic training and resistance training both improved brachial artery flow-mediated dilation by 1.7 ± 2.8 and 1.4 ± 2.6%, respectively (7.59 ± 3.36 vs. 9.26 ± 2.93 and 7.24 ± 3.18 vs. 8.58 ± 2.37; pre vs. post P < 0.05). However, only aerobic training decreased markers of inflammation (C-reactive protein, monocyte chemoattractant protein-1, vascular cell adhesion molecule-1 and lectin-like oxidized LDL receptor-1) and endothelin-1 and increased nitrite and nitrate levels (P < 0.05).

Conclusion:

Healthcare providers should continue to emphasize aerobic training for hypertension management given the established role of nitric oxide, endothelin-1 and chronic low-level inflammation in the pathogenesis of cardiovascular disease. However, our study demonstrates that resistance training should also be encouraged for middle-aged hypertensive patients. Our results also suggest that even if patients are on antihypertensive medications, regular aerobic training and resistance training are beneficial for blood pressure control and cardiovascular disease risk reduction.
Artificial intelligence for retinopathy of prematurity
Authors: Gensure Rebekah H. , Chiang Michael F. , Campbell John P.
Published: July 2020

Purpose of review

In this article, we review the current state of artificial intelligence applications in retinopathy of prematurity (ROP) and provide insight on challenges as well as strategies for bringing these algorithms to the bedside.

Recent findings

In the past few years, there has been a dramatic shift from machine learning approaches based on feature extraction to ‘deep’ convolutional neural networks for artificial intelligence applications. Several artificial intelligence for ROP approaches have demonstrated adequate proof-of-concept performance in research studies. The next steps are to determine whether these algorithms are robust to variable clinical and technical parameters in practice. Integration of artificial intelligence into ROP screening and treatment is limited by generalizability of the algorithms to maintain performance on unseen data and integration of artificial intelligence technology into new or existing clinical workflows.

Real-world implementation of artificial intelligence for ROP diagnosis will require massive efforts targeted at developing standards for data acquisition, true external validation, and demonstration of feasibility. We must now focus on ethical, technical, clinical, regulatory, and financial considerations to bring this technology to the infant bedside to realize the promise offered by this technology to reduce preventable blindness from ROP.
Psychological and psychosocial predictors of chronic postsurgical pain: a systematic review and meta-analysis
Authors: Giusti Emanuele M. , Lacerenza Marco , Manzoni Gian Mauro , Castelnuovo Gianluca
Published: July 2020

Knowledge about psychological and psychosocial predictors of chronic postsurgical pain is important to identify patients at risk for poor outcomes. The objective of this systematic review with meta-analysis was to assess the effect of such predictors. A comprehensive search of the available literature on this topic was performed using the electronic databases PubMed, Scopus, Embase, and PsycInfo. Estimates of the effect of each predictor were extracted, and both a narrative synthesis and a quantitative synthesis of these estimates were performed. Multiple imputation was used to take into account the effect of nonsignificant estimates in case they were not reported by original studies. From a sample of 8322 records, 83 articles were included in the narrative synthesis and 41 studies were used to perform the meta-analyses. The narrative synthesis showed that evidence about the effect of psychological predictors is heterogeneous, with few expected predictors, such as optimism, state anxiety and psychological distress, consistently associated with chronic postsurgical pain. By contrast, the meta-analyses showed that state anxiety, trait anxiety, mental health, depression, catastrophizing and, to a lesser extent, kinesiophobia and self-efficacy have a weak but significant association with chronic postsurgical pain. In conclusion, this study showed that psychological predictors have a significant association with chronic postsurgical pain and that state anxiety is the most explicative one.
Chemotherapy-induced peripheral neuropathy in a dish: dorsal root ganglion cells treated in vitro with paclitaxel show biochemical and physiological responses parallel to that seen in vivo
Authors: Li Yan , Marri Tejaswi , North Robert Y. , Rhodes Haley R. , Uhelski Megan L. , Tatsui Claudio E. , Rhines Laurence D. , Rao Ganesh , Corrales German , Abercrombie Taylor J. , Johansson Caj A. , Dougherty Patrick M.
Published: July 2020

The mechanisms underlying chemotherapy-induced peripheral neuropathy have yet to be fully elucidated, but primary afferent neurons have emerged as an especially vulnerable initiating pathophysiological target. An important recent study has also shown that the initial toxicity produced by paclitaxel in patients was highly predictive of long-term outcome. In this study, we therefore focused on defining the mechanisms of acute toxicity produced by paclitaxel treatment on primary sensory neurons under in vitro conditions. In primary rat dorsal root ganglion (DRG) culture with paclitaxel, an increase of pERK and pp38 was observed at 2 hours, and this was accompanied by an increase in expression and release of C-C chemokine ligand 2 (CCL2). There was no change in pJNK. The increase in pERK was sustained at 48 hours of exposure when the expression of TLR4, MyD88, and IL-6 was also increased. IL-6 and CCL2 were colocalized to TLR4-positive cells, and all these responses were prevented by coincubation with a TLR4 antagonist (LPS-RS). Whole-cell patch-clamp recordings revealed that DRG neurons developed spontaneous depolarizing fluctuations (DSFs) in membrane potential and hyperexcitability to current injection but no ectopic action potential activity at 24 and 48 hours of paclitaxel incubation. However, CCL2 applied to cultured neurons not only induced DSFs but also evoked action potentials. Evidence of oxidative stress and mitotoxicity was observed at 48 hours of exposure. These results closely parallel the responses measured in the DRG with paclitaxel exposure in vivo and so indicate that acute toxicity of paclitaxel on the DRG can be modelled using an in vitro approach.
Cryobiopsy With Radial UltraSound Guidance (CYRUS)
Authors: Pannu Jasleen K. , Roller Lance J. , Lentz Robert J. , Rickman Otis B. , Aboudara Matthew C. , Chen Heidi , Maldonado Fabien
Published: July 2020

Background:

Major airway bleeding is the most feared complication of transbronchial cryobiopsy (TBC). Radial endobronchial ultrasound (REBUS) has been used to assess the peripheral lung, primarily to identify pulmonary nodules, and also peripheral blood vessels. Using REBUS-guided TBC to avoid peripheral vasculature might reduce bleeding risk. This prospective randomized double-blind pilot trial was designed to investigate the feasibility of study procedures and inform the power calculation and clinical significance of a future large randomized trial.

Methods:

Consecutive TBCs were randomized to be performed with or without REBUS guidance in the same patient. A nonblinded operator obtained each biopsy while a blinded second operator managed the bleeding after each biopsy and determined when hemostasis had been obtained. Feasibility of study procedures and the ability to recruit patients were of primary interest. Time to hemostasis after each biopsy was also examined.

Results:

Forty TBCs were performed in 10 patients (4 biopsies per patient) over an enrollment period of 6 months. The time to control bleeding between biopsies was not statistically different between intervention and control arms [−14.3 (−120.1 to 92.0) s, P=0.7878]. Mean bleeding time was 139.4±59.895 seconds (REBUS 132.25± 89.305 s, non-REBUS 146.55±82.043 s). A trend towards the decreased grade of bleeding and less need for additional interventions was observed with REBUS use, but this difference did not reach statistical significance in this pilot investigation.

Conclusion:

Our findings suggest that REBUS-guided TBC is feasible. We did not observe any statistically significant difference in time to hemostasis or bleeding grade in this pilot study.
Extracorporeal Life Support Organization (ELSO): 2020 Pediatric Respiratory ELSO Guideline
Authors: Maratta Christina , Potera Renee M. , van Leeuwen Grace , Castillo Moya Andrés , Raman Lakshmi , Annich Gail M.
Published: July 2020

Disclaimer:

This guideline describes prolonged extracorporeal life support (ECLS) and extracorporeal membrane oxygenation (ECMO), applicable to Pediatric respiratory failure. These guidelines describe useful and safe practice, prepared by ELSO and based on extensive experience and are considered consensus guidelines. These guidelines are not intended to define standard of care and are revised at regular intervals as new information, devices, medications, and techniques become available.
Preoperative Right Heart Dysfunction and Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices
Authors: Liebo Max , Newman Joshua , Yu Mingxi , Hussain Zeeshan , Malik Sarah , Lowes Brian , Joyce Cara , Zolty Ronald , Basha Haseeb Ilias , Heroux Alain , McGee Edwin , Um John Y. , Raichlin Eugenia
Published: July 2020

Gastrointestinal bleeding (GIB) is a common cause of morbidity among patients supported by left ventricular assist devices (LVADs). The aim of this study was to identify if pre-LVAD right ventricular (RV) dysfunction is associated with risk of GIB after LVAD implantation. Of 398 patients implanted with LVADs between July 2008 and July 2016, 130 (33%) developed GIB at a median of 2.6 months following LVAD implantation. Arteriovenous malformations (AVMs) were found in 42 (34%) GIB patients. Patients with GIB were older and more likely to have hypertension, diabetes, and ischemic cardiomyopathy. On pre-LVAD echocardiography, GIB patients had increased RV diastolic dimension (4.7 ± 0.8 vs. 4.4 ± 0.9 cm, p = 0.02), a higher rate of greater than mild tricuspid valve (TV) regurgitation (73 [60%] vs. 120 [47%], p = 0.006), and underwent TV repair more often (38 [30%] vs. 43 [16%], p = 0.0006) during LVAD implantation. After multivariable adjustment, preoperative greater than mild RV enlargement (hazard ratio [HR] 2.32, 95% CI 1.12-5.03; p = 0.03), TV regurgitation (HR 1.83, CI 1.02-3.44; p = 0.01), and TV repair (HR 3.76, confidence interval [CI] 1.02–4.44; p = 0.01) remained associated with risk of GIB. This finding was driven by the AVM-GIB subgroup. Preoperative RV enlargement and TV regurgitation are associated with post-LVAD AVM-related GIB.
Spontaneous coronary artery dissection: presentation and management options
Authors: Kermali Muhammed , Zahra Syeda Anum , Hewage Savini , Al Nahian Syed , Harky Amer
Published: July 2020

Coronary artery dissection is a serious, life-threatening heart condition. It can occur spontaneously or due to traumatic or iatrogenic causes. Spontaneous coronary artery dissection (SCAD) is often misdiagnosed as most patients present with symptoms resembling those of an acute coronary syndrome. Clinical sequelae of SCAD include debilitating morbidities such as myocardial infarction, myocardial ischaemia, sudden cardiac death, ventricular arrhythmias amongst many other myocardial ischaemia associated complications. There are two main methods of managing patients with SCAD; conservative management with medical therapy or revascularisation by percutaneous coronary intervention or coronary artery bypass grafting.
Short Meal-to-Bed Time Is a Predominant Risk Factor of Gastroesophageal Reflux Disease in Pregnancy
Authors: Quach Duc T. , Le Yen-Linh T. , Mai Ly H. , Hoang Anh T. , Nguyen Tuyen T.
Published: July 2020

Background:

Short meal-to-bed time (MTBT) has been reported to relate to gastroesophageal reflux disease (GERD), but evidence is lacking in pregnant women. We aimed to assess the characteristics of GERD and the association between MTBT and GERD during pregnancy.

Patients and Methods:

A cross-sectional study was carried out on 400 pregnant women aged 18 years and older visiting the antenatal clinic of Gia-Dinh People’s Hospital, Vietnam. GERD was defined as having troublesome heartburn and/or regurgitation at least once a week. Reflux-related insomnia was defined as having difficulties in initiating or maintaining sleep through the night. MTBT was defined as “short” if it was ≤2 hours in more than two thirds of days in a week.

Results:

There were 154 (38.5%) patients with GERD and 20 (13.0%) patients with reflux-related insomnia. In multivariate analysis, there were 3 factors significantly associated with GERD: third trimester [odds ratio (OR)=1.66; 95% confidence interval (CI): 1.03-2.69], previous history of typical reflux symptoms (OR=9.05; 95% CI: 5.29-15.50), and short MTBT (OR=12.73; 95% CI: 2.92-55.45). The frequency of reflux symptoms progressively increased across subgroups of patients with no short MTBT, either daytime or nighttime short MTBT, and with both daytime and nighttime short MTBT. Nighttime MTBT was also a significant risk factor for reflux-related insomnia (OR=4.60; 95% CI: 1.64-12.92).

Conclusions:

We reported for the first time that short MTBT was a predominant risk factor of GERD in pregnancy. This dieting habit was significantly associated with reflux symptom frequency and reflux-related insomnia.
Applying nomograms based on the surveillance, epidemiology and end results database to predict long-term overall survival and cancer-specific survival in patients with oropharyngeal squamous cell carcinomas
Authors: Wang Fengze , Wen Jiao , Yang Xinjie , Jia Tingting , Du Fangchong , Wei Jianhua
Published: July 2020

Few models regarding to the individualized prognosis assessment of oropharyngeal squamous cell carcinoma (OPSCC) patients were documented. The purpose of this study was to establish nomogram model to predict the long-term overall survival (OS) and cancer-specific survival (CSS) of OPSCC patients. The detailed clinical data for the 10,980 OPSCC patients were collected from the surveillance, epidemiology and end results (SEER) database. Furthermore, we applied a popular and reasonable random split-sample method to divide the total 10,980 patients into 2 groups, including 9881 (90%) patients in the modeling cohort and 1099 (10%) patients in the external validation cohort. Among the modeling cohort, 3084 (31.2%) patients were deceased at the last follow-up date. Of those patients, 2188 (22.1%) patients died due to OPSCC. In addition, 896 (9.1%) patients died due to other causes. The median follow-up period was 45 months (1–119 months). We developed 2 nomograms to predict 5- and 8- year OS and CSS using Cox Proportional Hazards model. The nomograms’ accuracy was evaluated through the concordance index (C-index) and calibration curves by internal and external validation. The C-indexes of internal validation on the 5- and 8-year OS and CSS were 0.742 and 0.765, respectively. Moreover, the C-indexes of external validation were 0.740 and 0.759, accordingly. Based on a retrospective cohort from the SEER database, we succeeded in constructing 2 nomograms to predict long-term OS and CSS for OPSCC patients, which provides reference for surgeons to develop a treatment plan and individual prognostic evaluations.
Effects and safety of intranasal phototherapy for allergic rhinitis
Authors: Kang Jeongin , Lee Goeun , Kim Jeonghun , Kim Youngeun , Park Sunju , Lee Donghyo
Published: July 2020

Introduction:

Allergic rhinitis (AR) is an immunoglobulin E (Ig E)-mediated inflammatory disease. Intranasal phototherapy is a promising treatment modality because it has a profound immunosuppressive effect, but the available evidence of its use for AR is insufficient. Therefore, rigorously designed randomized controlled trials (RCTs) are needed. Our objective is to describe the protocol for a feasibility trial to assess the effects and safety of intranasal phototherapy for the treatment of AR.

Methods and analysis:

This is a study protocol for a single-center, randomized, double-blind, parallel, placebo-controlled, investigator-initiated pilot study. A total of 40 patients with AR will be randomly assigned to the medical device or sham device group in a 1:1 ratio. The participants will receive intranasal phototherapy with a medical or sham device for 20 min 5 times a week for 2 weeks. The primary outcome will be the mean change in the Total Nasal Symptom Score (TNSS) from baseline to 2 weeks. The secondary outcomes will include the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, Nasal Endoscopy Index, total serum Ig E level, and eosinophil count.

Discussion:

The findings of this study will provide the basis for subsequent large-scale definitive RCTs to confirm the effects and safety of intranasal phototherapy for the treatment of nasal symptoms in patients with AR who do not respond well to conventional therapy. This study may assist in the development of noninvasive treatment for patients with AR.

Trial registration:

This study was registered at the Korean National Clinical Trial Registry, Clinical Research Information Service (KCT0003253).