bluuebunny/crossref_metadata_2025 huggingface dataset:
Retinal vascular manifestations of obstructive sleep apnea
Authors: D'Souza Haley , Kapoor Kapil G.
Published: September 2020

Purpose of review

The aim of this article is to summarize up-to-date research on the effects of obstructive sleep apnea (OSA) on retinal vascular conditions.

Recent findings

OSA is associated with the development of diabetic retinopathy, retinal vein occlusion, and central serous chorioretinopathy. The severity of OSA and biomarkers such as the apnea–hypopnea index (AHI) correlate with the severity of retinal disease. Dysregulation of circadian locomotor output cycles kaput (CLOCK) genes that govern circadian rhythm is associated with development of proliferative retinal disease.

OSA and retinal vascular disease have a high cost burden on the healthcare system. OSA creates systemic changes and hypoxic conditions that may incite or exacerbate retinal vascular diseases. Retinal changes may be the first clinical manifestation of otherwise undiagnosed OSA, so it is important to refer patients with new-onset retinal vascular disease for appropriate sleep testing.
Orbital disease in neuro-ophthalmology
Authors: Dohlman Jenny C. , Cestari Dean M. , Freitag Suzanne K.
Published: September 2020

Purpose of review

Orbital disease represents a diverse spectrum of pathology and can result in a variety of neuro-ophthalmic manifestations. The aim of this review is to provide updates on recent advances in our understanding of orbital disease secondary to thyroid eye disease, myositis, IgG4-related disease, sarcoidosis, granulomatosis with polyangiitis and various tumours.

Recent findings

With regards to thyroid eye disease, there have been recent advances in the development of steroid-sparing therapies, new modalities for objectively monitoring disease activity and increased understanding of the role of environmental risk factors. There has been interest in characterizing the clinical course and underlying mechanism of optic nerve disease secondary to orbital disorders, which has led to advances in how we monitor for and prevent permanent vision loss. Increased knowledge of orbital tumour subtype histopathology and the development of novel classification systems has had prognostic value and aided medical decision-making.

Orbital disease occurs secondary to a wide variety of diseases and can lead to neuro-ophthalmic manifestations with significant morbidity. Advances in our understanding of different subtypes of orbital disease have improved our ability to treat these potentially debilitating conditions.
Optic nerve sheath meningioma
Authors: Douglas Vivian Paraskevi , Douglas Konstantinos A.A. , Cestari Dean M.
Published: September 2020

Purpose of review

Optic nerve sheath meningiomas (ONSMs) are rare benign tumors of the anterior visual pathway which present with slowly progressive and painless vision loss and account for approximately 2% of all orbital tumors. This article provides an overview as well as an update on the ONSMs with regards to cause, epidemiology, clinical presentation, diagnosis, and management in adults and pediatric population.

Recent findings

The clinical presentation and prognosis of ONSMs can vary and largely depend on the location of tumor as well as the histologic type. Overall, the diagnosis is based on clinical presentation, examination, and neuroimaging findings. Nevertheless, delays in diagnosis or misdiagnosis are not uncommon and can result in higher morbidity rates. Recent advances in diagnostic as well as more effective and less-invasive treatment options are discussed in this review.

ONSMs are a rare cause of slowly progressive and inexorable visual loss. Although ONSM diagnosis depends on the characteristic clinical and radiologic findings, prompt diagnosis, and appropriate management is critical for favorable visual outcomes. Thus, current focus is optimizing diagnostic as well-treatment methods for patients with ONSMs.
Visual hallucinations in psychiatric, neurologic, and ophthalmologic disease
Authors: Coerver Katherine A. , Subramanian Prem S.
Published: September 2020

Purpose of review

Recent studies have increased our understanding of the biochemical and structural bases of visual hallucinations in patients with a variety of underlying causes.

Recent findings

Visual hallucinations may be related to disruption of functional connectivity networks, with underlying biochemical dysfunction such as decreased in cholinergic activity. Structural abnormalities in primary and higher order visual processing areas also have been found in patients with visual hallucinations. The occurrence of visual hallucinations after vision loss, the Charles Bonnet syndrome, may have more functional similarity to psychiatric and neurodegenerative causes than previously suspected despite retained insight into the unreal nature of the phenomena.

Visual hallucinations are common, and patients may not report them if specific inquiries are not made. Presence or absence of hallucinations may be of diagnostic and therapeutic importance, especially in patients with neurodegenerative conditions that have overlapping features. Treatment of visual hallucinations remains challenging and must be tailored to each patient based on the underlying cause and comorbid conditions.
Eye pain in the white and quiet eye
Authors: Kulenkamp Jerome , McClelland Collin M. , Lee Michael S.
Published: September 2020

Purpose of review

Eye pain is one of the most common presenting symptoms in ophthalmology. It can range from bothersome to debilitating for patients, and it can be vexing for clinicians, especially in the white and quiet eye. The purpose of this review is to provide updates of recent literature regarding eye pain and to communicate our current understanding regarding the evaluation and management of conditions that cause eye pain with a relatively normal examination.

Recent findings

This review concerns recent literature regarding eye pain in the white and quiet eye. It is arranged by cause of pain and discusses dry eye syndrome, recurrent corneal erosion, postrefractive surgical pain, eye strain, intermittent angle closure, benign essential blepharospasm, trochleodynia, trochleitis and trochlear headache, and posterior scleritis.

Eye pain in the white and quiet eye remains a difficult-to-navigate topic for practitioners. However, a careful history and focused physical examination can elucidate the diagnosis in many cases. Recent updates to the literature have advanced our knowledge of how to identify and treat the underlying causes of eye pain.
Update on neuromyelitis optica spectrum disorder
Authors: Holroyd Kathryn B. , Manzano Giovanna S. , Levy Michael
Published: September 2020

Purpose of review

Neuromyelitis optica spectrum disorder is an autoimmune disease that causes optic neuritis and transverse myelitis. Attacks can cause severe neurological damage leading to blindness and paralysis. Understanding of the immunopathogenesis of this disease has led to major breakthroughs in diagnosis and treatment. In the past 18 months, three successful phase 3 clinical trials have been published using targeted approaches to preventing relapses.

Recent findings

Updates in epidemiology, imaging, quality of life and treatment for acute relapse and prevention have been published in the past 18 months. Epidemiology studies are distinguishing patients based on their antigen specificity for aquaporin-4 and myelin oligodendrocyte glycoprotein, which are increasingly recognized as separate immunological conditions. Imaging by MRI and optical coherence tomography continue to be developed as tools to distinguish neuromyelitis optica spectrum disorders (NMOSD) from other diseases. This is especially relevant as the recent clinical trials showed differences in response between aquaporin-4 seropositive and seronegative patients. The three drugs that were tested for prevention of NMOSD relapses were eculizumab, inebilizumab, and satralizumab. All of the trials were worldwide, placebo-controlled, double-masked studies that demonstrated a clear benefit with each approach.

Recent research in NMOSD has resulted in improved diagnosis and approved treatments.
Ocular manifestations of Blau syndrome
Authors: Suresh Sandip , Tsui Edmund
Published: September 2020

Purpose of review

This article summarizes the systemic and ocular manifestations of Blau syndrome, its genetic basis, and reviews recently published literature.

Recent findings

A large multicenter prospective case series is underway, with 3-year preliminary results indicating the prevalence of uveitis, clinical characteristics and early data on its visual prognosis. Case reports have demonstrated the successful use of newer biologic agents.

Blau syndrome is an exceedingly rare autoinflammatory disorder with skin, joint and eye manifestations. It is caused by autosomal dominant mutations of the NOD2 protein. Eye involvement is typically a chronic bilateral granulomatous iridocyclitis, often with multifocal choroiditis in the posterior segment. Treatment starts with topical and systemic steroids and often requires antimetabolites or biologic agents.
Surgical Site Infection Caused by Salmonella Enteritidis in a Patient With Meningioma
Authors: Gupta Parakriti , Angrup Archana , Ray Pallab , Karthigeyan Madhivanan , Salunke Pravin
Published: September 2020

Salmonella is known to cause gastrointestinal illness globally. Primarily being an enteric pathogen, other extraintestinal infections are often obscured by gastrointestinal disease. However, Salmonella has also been reported to cause wound infections, endovascular infections, pneumonia, abscess, and osteomyelitis. These are more commonly encountered in immunocompromised patients, especially in developing countries. The authors report a case of surgical-site infection caused by Salmonella in a patient with meningioma. Salmonella causes only less than 1% of infections involving bones and joints and is more commonly reported from patients with sickle-cell hemoglobinopathy or autoimmune disorders such as systemic lupus erythematosus. Our patient had no such risk factors. This report highlights the unusual presentation of Salmonella infection in a diabetic patient, which further complicated the ongoing illness, thereby increasing the morbidity.
Cecropins Activity Against Bacterial Pathogens
Authors: Gholizadeh Abdolmajid , Moradi Bagher
Published: September 2020

Today, resistant bacteria are challenges in the treatment of bacterial infections. Cecropins are compounds that kill bacteria by affecting the membrane of microorganisms, such as Acinetobacter, Escherichia coli, and Staphylococcus. This study aimed to evaluate the antibacterial activity of cecropins against bacterial pathogens quantitatively. In this study, articles reporting antimicrobial activity of cecropins were searched in PubMed, Web of Science, and Scopus databases using the Google Scholar search engine. Then, the results of the current study were evaluated quantitatively. In this study, we found 29 studies reporting cecropins antimicrobial activity against major bacterial pathogens. Also, there were 25 studies on cecropin antimicrobial activity against gram-negative pathogens, and it was cleared that cecropin B antibacterial activity on Pseudomonas aeruginosa was lesser than others (minimum inhibitory concentration, 0.4 μg/ML), and we showed that Staphylococcus aureus growth can be inhibited by Cecropin AD more than others (minimum inhibitory concentration, 0.2 μg/Ml). Because cecropin peptides have no adverse effect on the human cells, and also, it has been demonstrated that cecropins have acceptable functions against pathogenic bacteria, we showed that they are potential candidates for research and construction of novel antibiotics.
Cefiderocol as Adjunctive Treatment of Necrotizing Ventilator-associated Pneumonia Due to Extensively Drug-Resistant Pseudomonas aeruginosa
Authors: Roy Amanda M. , Hodgson MacGregor , Brickman Cristina , MacDougall Conan
Published: September 2020

There are few treatment options for patients with extensively drug-resistant gram-negative infections. Cefiderocol is a novel β-lactam with excellent in vitro activity against multidrug-resistant gram-negative isolates, including carbapenem-resistant strains. However, this drug performed poorly versus best available therapy in an open-label randomized study of carbapenem-resistant gram-negative infections. Here, we present a case of a 32-year-old man with necrotizing ventilator-associated pneumonia caused by Pseudomonas aeruginosa who developed resistance to meropenem and ceftolozane/tazobactam while on therapy. Addition of expanded-access cefiderocol to his antimicrobial regimen contributed to successful microbiological cure while limiting exposure to nephrotoxic therapeutic agents.
A Rare Etiology of Right-sided Pseudopneumoperitoneum
Authors: Arroyo Martínez Yadis , Segarra Chanlir , Pagán Bolívar Andrea , Ramsakal Asha , Greene John N.
Published: September 2020

Chilaiditi sign is a rare, usually benign intestinal radiographic phenomenon, produced by the interposition of the colon or small bowel in the hepatodiaphragmatic space. Clinically, it can appear as an asymptomatic anatomic abnormality or with an array of gastrointestinal symptoms, most commonly abdominal pain. Diagnosis is usually an incidental finding noted on routine chest x-ray. Identification of Chilaiditi sign is important to recognize to limit unnecessary radiologic and surgical interventions. We present the case of a 71-year-old man with an incidental chest x-ray finding of gaseous distention below the right hemidiaphragm. He was asymptomatic and managed conservatively.
Combination of Remdesivir, Corticosteroid, and Convalescent Plasma for Severe COVID-19 in Periviable Pregnancy
Authors: Lam Helena , Lacasse Alexandre
Published: September 2020

Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may lead to a disease spectrum named COVID-19, including a severe form of pneumonia characterized by an intense inflammatory response similar to acute respiratory distress syndrome. Current management guidelines in pregnancy have been limited. In the setting of severe COVID-19 in pregnancy, including in the periviability period, combination multitargeted therapy should be strongly considered. We report a case of severe COVID-19 pneumonia in a periviable pregnancy treated with concurrent combination of remdesivir, corticosteroids, and convalescent plasma therapy, leading to rapid maternal pulmonary improvement.
Three Properties of SARS-CoV-2 That Promote COVID-19
Authors: Rosenthal Ken S.
Published: September 2020

Much of COVID-19 disease can be attributed to the stable structure of the envelope, which facilitates its transmission; the spike protein and its receptor which determine which tissues get infected and are susceptible to viral and immune cytolysis; and evasion of initiation of type 1 and 3 interferons, which gives the virus a replicative head start and ability to spread while simultaneously compromising the antiviral immune response.
Assessing the Impact of a Pharmacist-Managed Discharge Medication Reconciliation Pilot at a Community Hospital System
Authors: Petrovich Betty , Sweet Michelle , Gillian Sarah , Copenhaver Jennifer
Published: September 2020

Introduction:

With unintended medication discrepancy rates ranging from 30% to 70%, a formal discharge medication reconciliation process must be developed. One strategy shown to reduce medication errors is a pharmacist medication review at discharge. The purpose of this study is to determine the impact of a pharmacist-driven discharge medication reconciliation program.

Methods:

The intervention group included pharmacist-reviewed patients with a high risk of unplanned readmission score and had a discharge order signed during a 2-month period. The control group included eligible patients who were not reviewed by a pharmacist. The after-visit summaries for both groups were then reviewed for additional medication discrepancies.

Results:

This study included 140 patients, with 70 patients in each group. A total of 176 discrepancies were identified in the intervention group and 235 were found in the control group. The median number of discrepancies per patient was not statistically different between groups (2 vs. 2, p-value = .196). There were 22 and 24 30-day hospital readmissions in the intervention and control groups, respectively (p-value = .857).

Conclusions:

More medication discrepancies were identified in the control group compared to pharmacist-reviewed patients. More robust studies including a pharmacist dedicated to discharge medication reconciliation should be conducted to identify the potential benefit.
HeartWare HVAD Flow Estimator Accuracy for Left and Right Ventricular Support
Authors: Stephens Andrew F. , Mapley Martin , Wu Eric L. , Fraser John F. , Steinseifer Ulrich , Bartnikowski Nicole , Gregory Shaun D.
Published: September 2020

This study investigated the accuracy of the HeartWare HVAD flow estimator for left ventricular assist device (LVAD) support and biventricular assist device (BiVAD) support for modes of reduced speed (BiVAD-RS) and banded outflow (BiVAD-B). The HVAD flow estimator was evaluated in a mock circulatory loop under changes in systemic and pulmonary vascular resistance, heart rate, central venous pressure, and simulated hematocrit (correlated to viscosity). A difference was found between mean estimated and mean measured flow for LVAD (0.1 ± 0.3 L/min), BiVAD-RS (−0.1 ± 0.2 L/min), and BiVAD-B (0 ± 0.2 L/min). Analysis of the flow waveform pulsatility showed good correlation for LVAD (r2 = 0.98) with a modest spread in error (0.7 ± 0.1 L/min), while BiVAD-RS and BiVAD-B showed similar spread in error (0.7 ± 0.3 and 0.7 ± 0.2 L/min, respectively), with much lower correlation (r2 = 0.85 and r2 = 0.60, respectively). This study demonstrated that the mean flow error of the HVAD flow estimator is similar when the device is used in LVAD, BiVAD-RS, or BiVAD-B configuration. However, the instantaneous flow waveform should be interpreted with caution, particularly in the cases of BiVAD support.
Hydromorphone Compared to Fentanyl in Patients Receiving Extracorporeal Membrane Oxygenation
Authors: Martin Nathaniel J. , Peitz Gregory J. , Olsen Keith M. , Merritt Helen Mari L.
Published: September 2020

Fentanyl is commonly used in critically ill patients receiving extracorporeal membrane oxygenation (ECMO). Fentanyl’s lipophilicity and protein binding may contribute to a sequestration of the drug in the ECMO circuit. Hydromorphone lacks these characteristics potentially leading to a more predictable drug delivery and improved pain and sedation management among ECMO patients. This study compared hydromorphone to fentanyl in patients receiving ECMO. This retrospective study included adult patients receiving ECMO for ≥48 hours. Patients were excluded if they required neuromuscular blockade, received both fentanyl and hydromorphone during therapy, or had opioid use before hospitalization. Baseline characteristics included patient demographics, ECMO indication and settings, and details regarding mechanical ventilation. The primary outcome was opioid requirements at 48 hours post cannulation described in morphine milligram equivalent (MME). Secondary endpoints included 24-hour opioid requirements, concurrent sedative use, and differences in pain and sedation scores. No differences were noted between the patients receiving fentanyl (n = 32) or hydromorphone (n = 20). Patients receiving hydromorphone required lower MME compared to fentanyl at 24 hours (88 [37–121] vs. 131 [137–227], p < 0.01) and 48 hours (168 [80–281] vs. 325 [270–449], p < 0.01). The proportion of within-goal pain and sedation scores between groups was similar at 24 and 48 hours. Sedative requirements did not differ between the groups. Patients receiving hydromorphone required less MME compared to fentanyl without any differences in sedative requirements, or agitation-sedation scores at 48 hours. Prospective studies should be completed to validate these findings.
Venovenous Versus Venoarterial Extracorporeal Membranous Oxygenation in Inotrope Dependent Pediatric Patients With Respiratory Failure
Authors: Jaber Besma , Bembea Melania M. , Loftis Laura L. , Spinella Philip C. , Zhang Liyun , Simpson Pippa M. , Hanson Sheila J.
Published: September 2020

Patients with respiratory failure requiring inotropes or vasopressors are often placed on venoarterial (VA) extracorporeal membrane oxygenation (ECMO), as venovenous (VV) ECMO does not provide direct circulatory support. This retrospective multicenter study compared outcomes for 103 pediatric patients, with hemodynamic compromise, placed on VV ECMO for respiratory failure to those placed on VA ECMO. The primary outcome was survival to hospital discharge. Fifty-seven (55%) study participants were supported on VV ECMO. The two groups had similar PRISM III scores at pediatric intensive care unit (PICU) admission, and vasoactive-inotropic scores at ECMO cannulation. More VV ECMO patients received inhaled nitric oxide (iNO) (54.4 vs. 34.8%; p = 0.04) and had a higher oxygenation index (median 41.5 vs. 19.5; p = 0.04) pre-ECMO. More VA ECMO patients had cardiac dysfunction and cardiac arrest pre-ECMO (50 vs. 14%; p < 0.0001). In univariable analysis, survival to hospital discharge was higher in the VV vs. VA ECMO group (72 vs. 44%; p = 0.005), however, in multivariable models, cannulation type was confounded by cardiopulmonary resuscitation and was not independently associated with survival. VV survivors had longer ECMO duration compared with VA survivors (median, 7 vs. 4.5 days; p = 0.036) but similar PICU and hospital days. No significant difference was noted in functional outcomes or comorbidities at discharge. Cannulation type is not independently associated with survival to hospital discharge in pediatric patients on vasoactive infusions at the time of ECMO cannulation for respiratory indications.
The Effects of the Combined Argatroban/Nitric Oxide-Releasing Polymer on Platelet Microparticle-Induced Thrombogenicity in Coated Extracorporeal Circuits
Authors: Bellomo Tiffany R. , Jeakle Mark A. , Meyerhoff Mark E. , Bartlett Robert H. , Major Terry C
Published: September 2020

Clotting, anticoagulation, platelet consumption, and poor platelet function are major factors in clinical extracorporeal circulation (ECC). We have shown that nitric oxide-releasing (NOReL) coatings prevent thrombosis in a rabbit model of ECC without systemic anticoagulation. Nitric oxide-releasing prevents platelet adhesion and activation, resulting in preserved platelet count and function. Previous work has shown that activated platelets form platelet-derived microparticles (PMPs). These experiments were designed to determine if PMPs can identify platelet function during ECC. The objective of this study is to investigate the effects of NOReL on platelet activation and PMP formation during ECC. Uncoated ECCs, including with and without systemic heparin, and NOReL-coated ECCs, including DBHD/N2O2 and argatroban (AG)/DBHD/N2O2-coated ECCs without systemic heparin, were tested in a 4-hour rabbit thrombogenicity model. Before and after ECC exposure, platelets were stimulated with collagen, and PMPs were measured using flow cytometry. The uncoated ECCs clotted within the first hour, while the NOReL-coated ECCs circulated for 4 hours. During pre-ECC blood exposure, platelets stimulated with collagen produced PMPs. With post-ECC exposure, platelets from uncoated circuits generated less PMPs than baseline (mean ± SDs: 23246 ± 3611 baseline vs. 1300 ± 523 uncoated post circuit, p = 0.018) when stimulated with collagen. However, platelets from the AG/DBHD/N2O2-coated ECCs generated a greater number of PMPs as baseline values (23246 ± 3611 baseline vs. 37040 ± 3263 AG/DBHD/N2O2 post 4 hours circuit, p = 0.023). Blood exposure during ECC results in platelet activation and clotting in uncoated ECCs. The remaining circulating platelets have lost function, as demonstrated by the low PMP formation in response to collagen. AG/DBHD/N2O2-coated ECCs prevented significant platelet activation and clotting, while DBHD/N2O2 trended towards prevention of platelet activation. In addition, function of the circulating platelets was preserved, as demonstrated by PMP formation in response to collagen. These results indicate that PMPs may be an important measure of platelet activation during ECC. Platelet-derived microparticles may provide a simplified way to measure platelet function during clinical ECC.
The Effects of Preserving Mitral Valve Function on a Left Atrial Assist Device: An In Vitro Mock Circulation Loop Study
Authors: Kado Yuichiro , Polakowski Anthony R. , Kuban Barry D. , Horvath David J. , Miyamoto Takuma , Karimov Jamshid H. , Starling Randall C. , Fukamachi Kiyotaka
Published: September 2020

We are developing a left atrial assist device (LAAD) to pump blood from the left atrium to the left ventricle for patients who have heart failure with preserved ejection fraction (HFpEF). This study aimed to assess the hemodynamics with the LAAD implanted at two different levels: the mitral valve (MV) level, after removing the MV; and the supravalvular level, preserving MV function conditions using an in vitro mock circulatory loop. Normal heart and mild, moderate, and severe diastolic heart failure conditions were simulated, and the LAAD was set at three different speeds. Without the LAAD support, cardiac output (CO) decreased from 3.7 to 1.1 L/min, aortic pressure (AoP) decreased from 100 to 33 mm Hg, and left atrial pressure (LAP) increased from 16 to 23 mm Hg as the diastolic function became impaired. With high pump support after removing the MV, CO and AoP readings were comparable with those for preserved MV function (CO reached 3.9–4.1 L/min, AoP reached more than 110 mm Hg, and LAP dropped to 16–17 mm Hg under both conditions at high pump speeds). In the mock circulatory loop, our LAAD appeared to have sufficient ability to maintain the hemodynamic status at both positions.
Percutaneous Axillary Intra-aortic Balloon Pump Insertion Technique as Bridge to Advanced Heart Failure Therapy
Authors: Rosenbaum Andrew N. , Jain C. Charles , Shadrin Ilya Y. , El Hajj Stephanie C. , El Sabbagh Abdallah , Behfar Atta
Published: September 2020

In patients with advanced heart failure (HF), temporary mechanical circulator support (TMCS) is used to improve hemodynamics, via left ventricular unloading, and end-organ function as a bridge to definitive therapy. While listed for cardiac transplantation, use of TMCS may be prolonged, preventing adequate mobility. Here, we describe the technique for placement of a percutaneous axillary intra-aortic balloon pump (IABP) using single-site arterial access to facilitate ambulation and subsequent safe removal without surgery or a closure device. Retrospective review of the experience with this approach at a single institution between September 2017 and February 2020 documented feasibility and safety. Baseline demographics, hemodynamic data, and clinical outcomes were collected. Thirty-eight patients had a total of 56 IABPs placed. There were no significant access site or cerebrovascular complications. One fifth of IABPs (21.4%) had balloon failure or migration, requiring placement of a new device, though no patients had significant complications from balloon failure. The majority (81.6%) of patients in the cohort on axillary IABP support were ambulatory and ultimately received the intended therapy (63.2% transplant, 13.2% durable left ventricular assist device, 5.3% other cardiac surgery). Percutaneous, axillary IABP is feasible and associated with an acceptable complication rate as a bridge to definitive therapy.
Fluorescence In Situ Hybridization and Polymerase Chain Reaction to Detect Infections in Patients With Left Ventricular Assist Devices
Authors: Schoenrath Felix , Kursawe Laura , Nersesian Gaik , Kikhney Judith , Schmidt Julia , Barthel Frank , Kaufmann Friedrich , Knierim Jan , Knosalla Christoph , Hennig Felix , Falk Volkmar , Potapov Evgenij , Moter Annette
Published: September 2020

The development of driveline infections following left ventricular assist device (LVAD) implantation remains a major problem. We investigated the impact of fluorescence in situ hybridization (FISH) combined with 16S rRNA gene sequencing on the diagnosis of driveline infections. LVAD drivelines (n = 61) from 60 consecutive patients were obtained during LVAD explantation and subjected to FISH analysis. 16S rRNA gene polymerase chain reaction (PCR) and sequencing to identify the microorganisms were performed. Results were compared with those of a standard microbiological culture. The reasons for pump removal were heart transplantation (n = 22), weaning (n = 14), pump exchange due to pump thrombosis (n = 12), technical problems (n = 7), or death (n = 5). Of the 60 patients, 26 exhibited clinical signs of a VAD-specific infection, while 34 (with 35 drivelines) showed no clinical signs of infection before explantation. The spectrum of identified pathogens differed between FISH/PCR and conventional microbiological diagnostics. In general, the bacterial spectrum was more diverse in FISH/PCR as compared with conventional microbiology, which more often showed only typical skin flora (coagulase-negative staphylococci and Corynebacteriaceae). In addition to identifying the species, FISH/PCR provided information about the spatial distribution and invasiveness of the microorganisms. Cultures usually represent the only source of microbiological information for clinicians and often prove to be unsatisfactory in complex LVAD cases. FISH/PCR not only identified a greater number and variety of microorganisms than standard culture did, but it also provided information about the number, localization, and biofilm state of the pathogens, making it a useful tool for diagnosing the specific cause of LVAD driveline infections.
Natural History of Patients Diagnosed with Cardiac Sarcoidosis at Left Ventricular Assist Device Implantation or Cardiac Transplantation
Authors: Schmidt Tyler J. , Rosenbaum Andrew N. , Kolluri Nikhil , Stulak John M. , Daly Richard C. , Schirger John A. , Elwazir Mohamed Y. , Kapa Suraj , Cooper Leslie T. , Blauwet Lori A.
Published: September 2020

To our knowledge, natural history has not been reported for cardiac sarcoidosis (CS) diagnosed by pathologic evaluation of the apical core at left ventricular assist device (LVAD) implantation or cardiac transplantation. We retrospectively identified 232 consecutive patients meeting CS criteria. Of these patients, 54 were diagnosed by pathologic confirmation of CS, 10 after evaluation of the apical core (LVAD implant) or explanted heart (transplant). We compared clinical characteristics at initial evaluation and outcomes for these 10 patients with those of 10 patients with known CS before LVAD implant/transplant. In the study group, five patients (50%) had confirmed extracardiac sarcoidosis before LVAD implant/transplant; five had not been diagnosed with sarcoidosis. Mean (standard deviation) left ventricular ejection fraction at initial evaluation was 23% (16%), and left ventricular end-diastolic dimension was 61 (10) mm. Four patients died during follow-up; however, no survival difference was found for the 10 patients diagnosed incidentally and the group with a previous diagnosis or institutional LVAD/transplant cohorts. Patients diagnosed with CS on pathological examination of the apical core/explanted heart may have severe dilated cardiomyopathy as the initial presentation. Outcomes for patients with CS after advanced heart failure therapies may be comparable with those of non-CS patients.
Use of a Minimally Invasive Approach to Correct Diffuse External Compression of the Left Ventricular Assist Device Outflow Graft
Authors: Salas De Armas Ismael A. , Patel Manish , Akay Mehmet Hakan , Patel Jayeshkumar , Singapurwala Mustafa , Kar Biswajit , Gregoric Igor D.
Published: September 2020

Left ventricular assist devices (LVADs) implanted into patients with heart failure sometimes develop insufficient forward flow due to malfunction of the outflow graft. One increasingly seen source of outflow graft malfunction is the development of external compression of the outflow graft (ECOG) due to the accumulation of material between the flexible outflow graft and the relatively rigid overlying Gore-Tex tubular graft. When there is segmental ECOG, a percutaneous approach with outflow graft stent placement is the treatment of choice. However, we have encountered cases with diffuse ECOG for which surgery appeared to be a superior choice. We, therefore, developed a minimally invasive surgical approach in which a mini-thoracotomy, rather than redo-sternotomy, is combined with unroofing of the Gore-Tex graft and subsequent evacuation of the organized hematoma. We describe this technique in two patients with diffuse ECOG in whom we found the method to be simple, relatively rapid, and very effective.
Severe thrombocytopenia in pregnancy: a retrospective study
Authors: Halici-Ozturk Filiz , Ozturk Merve , Yakistiran Betul , Caglar Ali T. , Engin-Ustun Yaprak , Ozgu-Erdinc Ayşe Seval
Published: September 2020

Thrombocytopenia is defined as a platelet count less than 150 000/μl and it is the most common hematologic disease after anemia in pregnancy. This study aims to investigate pregnant women with severe thrombocytopenia (platelet count <50 000/μl). In the relevant literature, few studies have addressed severe thrombocytopenia in pregnancy. This is a retrospective study based on the data from a reference center in Ankara, Turkey between January 2016 and December 2017. The study group consisted of 51 pregnant women who had two platelet counts lower than 50 000/μl. Descriptive statistical methods were utilized to analyze the results. The study analyzed the causes of severe thrombocytopenia, maternal and fetal–neonatal outcomes, and the management of the patients. The common causes of severe thrombocytopenia were hypertensive disorders (66.7%), immune thrombocytopenia (13.7%), massive obstetric hemorrhage (7.8%), and disseminated intravascular coagulation (5.9%). The preterm delivery occurred in 58.8% of the patients, and 46 live-births (two twins), six stillbirths, and one pregnancy termination emerged. Postpartum hemorrhage occurred in four (0.08%) patients, and blood transfusion was performed in 15 (29.4%) patients. The platelet transfusion was required to increase the platelet count of 30 (58.8%) patients. The study showed that the incidence of causes in severe thrombocytopenia in pregnancy varied considerably from mild and moderate thrombocytopenia. Despite severe thrombocytopenia, maternal and neonatal bleeding complications were infrequent in the study group.
Optimum waveform envelopes and amplitude ratios in oscillometric blood pressure estimation
Authors: Alvarado Alvarez Mariana , Padwal Raj , Ringrose Jennifer , Jalali Afrooz , Hiebert Wayne
Published: September 2020

Objective

To determine if, when using the oscillometric method, there is a specific range of amplitude ratios in the fixed-ratio algorithm that will result in blood pressure estimates that consistently fall within a mean error ≤5 mmHg and a SD of the error <8 mmHg. Additionally, to apply different representations of the oscillometric waveform envelope to verify if this will affect the accuracy of the results.

Methods

SBP and DBP were obtained using the fixed-ratios method applied to a dataset of 219 oscillometric measurements obtained from 73 healthy volunteers and compared to their corresponding auscultation values. Ratio and envelope analysis were done on Matlab (The MathWorks, Inc., Natick, Massachusetts, USA).

Results

Depending on the envelope representation, ratios between 0.44–0.74 for systolic pressure and 0.51–0.85 for diastolic pressure yield results within the limits mentioned above. When a set of optimum envelope representations and ratios are selected based on population mean, the highest percentage of subjects presenting blood pressure estimates within the limits were 72.6% for systolic and 69.9% for diastolic.

Conclusion

The range of ratios presenting optimum results appears to be independent of the degree of arterial stiffness given the wide range of ages of the subjects in the study. Different representations of the oscillometric waveform envelope may improve the accuracy of the method. However, there remains a considerable percentage of the population with unreliable results. It is therefore important to only use devices that have been properly validated according to standard protocol.
Prognostic value of SYNTAX score and SYNTAX score II in an ‘all-comers’ population treated with angoplasty
Authors: Yanes Bowden Geoffrey J. , Bosa Ojeda Francisco , Jiménez Sosa Alejandro , Sánchez-Grande Flecha Alejandro , Méndez Vargas Corabel , Leiva Gordillo Miguel , Miranda Bacallado Julio
Published: September 2020

Objectives

The SYNTAX score and SYNTAX score II have a high predictive capacity for adverse cardiovascular events. We aimed to demonstrate that both scores were good predictors of long-term adverse outcomes in an ‘all-comers’ population treated with a percutaneous coronary intervention (PCI).

Methods

In the study, we included 785 patients who received an angioplasty at our center between January 2011 and December 2012. The patients were distributed in tertiles according to the SYNTAX score and SYNTAX score II values; for the SYNTAX score – low ≤6.5 (n = 225); mid >6.5, <11.5 (n = 229); high  ≥11.5 (n = 221); and for the SYNTAX score II PCI: low ≤20.5 (n = 226); mid >20.5, < 29.6 (n = 221); and high ≥29.6 (n = 218).

Results

The rates of major adverse cardiovascular events, death, cardiac death and new revascularizations at 3 years were significantly higher in the highest tertile of both the scores. For SYNTAX score: major adverse cardiovascular events, 12–15.3–21.7%, P < 0.001; death, 7.6–8.3–14%, P = 0.04; cardiac death, 3.2–2.7–7.5%, P = 0.03; new revascularizations, 4.5–8.6–10.4%, P = 0.001. For SYNTAX score II PCI: major adverse cardiovascular events, 8–10.9–28.9%, P < 0.001; death, 3.1–3.6–21.5%, P < 0.001; cardiac death, 0.9–0.5–11.4%, P < 0.001; new revascularizations, 4.5–8.2–11.3%, P = 0.03.

Conclusion

The SYNTAX score II showed better predictive capacity than the SYNTAX score for major adverse cardiovascular events, death and cardiac death, with no difference noted for new revascularizations, and it was an independent predictor for these events in an ‘all-comers’ population.
18F-FDG-PET brain imaging may highlight brain metabolic alterations in dysautonomic syndrome after human papilloma virus vaccination
Authors: Vadalà Maria , Cistaro Angelina , Quartuccio Natale , Calcagni Maria Lucia , Fania Piercarlo , Margotti Simone , Schiera Irene Giovanna , Laurino Carmen , Palmieri Beniamino
Published: September 2020

Aim

The aim of this study was to evaluate brain glucose metabolism by means of [18F]-fluoro-deoxygluycose (18F-FDG) PET in a group of patients presenting dysautonomic syndrome after human papilloma virus (HPV) immunization.

Methods

Medical records of patients, referred to the ‘Second Opinion Medical Consulting Network’ Medical Centre (Modena, Italy) diagnosed with dysautonomic syndrome were searched. Inclusion criteria were presence in the medical history of adverse drug reactions following HPV vaccine; a Montreal Cognitive Assessment score <25 and good quality of a 18F-FDG-PET brain scan performed within 12 months from the diagnosis of dysautonomic syndrome. 18F-FDG-PET images of patients (HPV-group) were compared to a control group, matched for age and sex, using statistical parametric mapping (SPM).

Results

The 18F-FDG-PET study was available for five female patients. The SPM-group analysis revealed significant hypometabolism (P < 0.05 false discovery rate corrected) in the right superior and medial temporal gyrus (Brodmann areas 22, 21) and insula (Brodmann area 13). At a threshold of P < 0.001 (uncorrected), further hypometabolic regions were revealed in the right superior temporal gyrus (Brodmann area 42) and caudate head and in the left superior temporal gyrus (Brodmann area 22), frontal subcallosal gyrus (Brodmann area 47) and insula (Brodmann area 13). Relative hypermetabolism (P = 0.001) was revealed in the right premotor cortex (Brodmann area 6).

Conclusion

This study revealed the possibility of altered brain glucose metabolism in subjects with dysautonomic syndrome post-immunization with HPV vaccine. These results could reinforce the hypothesis of a causal relationship between HPV vaccine, or some component included in the vaccine and the development of clinical manifestations.
A 5-Year Retrospective Cohort Study
Authors: Pu Wenjing , Luo Gang , Chen Tao , Jing Lihua , Hu Qing , Li Xiaoyun , Xia Hongfen , Deng Mingming , Lü Muhan , Chen Xia
Published: September 2020

Objective

The aim of this study was to evaluate the epidemiology, etiology, severity, and outcomes of acute pancreatitis (AP) in the southern Sichuan region of China.

Methods

All patients with first-attack AP between 2013 and 2018 in the Affiliated Hospital of Southwest Medical University were retrospectively identified. The etiology tendency was analyzed, and the relationship was defined with sex, aging, severity, length of stay, and mortality.

Results

Three thousand twenty-eight patients were enrolled for analysis. Acute biliary pancreatitis had the highest incidence rate; the second and third most common causes were hypertriglyceridemic (14.4%) and alcoholic (14.2%), followed by idiopathic (13.6%), mixed etiology (12.9%), and miscellaneous (2.31%). Patients with alcoholic AP were more likely to be middle-aged males, whereas patients with acute biliary pancreatitis were more likely to be elderly females (P < 0.05). The overall mortality in the hospital was 1%, and there was no difference in each etiological groups (P > 0.05).

Conclusions

Biliary disease was the predominant etiology of AP in southern Sichuan of China, and hypertriglyceridemia ranked second. The proportion of hypertriglyceridemic AP and mixed etiology AP gradually increased, whereas idiopathic AP decreased. There were different etiology proportion of AP according age, sex, and severity.
Syndecan-1 and KRAS Gene Expression Signature Associates With Patient Survival in Pancreatic Cancer
Authors: Wu Yixing , Huang Huatian , Fervers Beatrice , Lu Lingeng
Published: September 2020

Objectives

The purpose of this study was to investigate the association of syndecan-1 (SDC1) and KRAS molecular characteristics with patient survival in pancreatic cancer.

Methods

Both SDC1 mRNA and methylation and KRAS mRNA and somatic mutations, as well as clinical data were retrieved from The Cancer Genome Alta pancreatic cancer data set for survival analyses. Kyoto Encyclopedia of Gene and Genomes pathway analysis for coexpressed genes for either SDC1 or KRAS was performed, respectively.

Results

A significantly negative correlation existed between SDC1 mRNA and DNA methylation. Patients with KRAS somatic mutations had a significantly higher SDC1 mRNA but lower methylation than those without the mutations. Compared with patients with KRAS
low
SDC1
low signature, those with a high level of KRAS and SDC1 alone or both had a significantly elevated mortality. The adjusted hazard ratios (95% confidence interval) were 2.30 (1.16–4.54, P = 0.017) for KRAS
low
SDC1
high, 2.85 (1.48–5.49, P = 0.002) for KRAS
high
SDC1
low, and 2.48 (1.31–4.70, P = 0.005) for KRAS
high
SDC1
high, respectively. Several Kyoto Encyclopedia of Gene and Genomes pathways were shared, whereas there were distinct pathways between KRAS and SDC1 coexpressed genes.

Conclusions

SDC1 interplays with KRAS, and targeting both KRAS and SDC1 in combination may be more beneficial to pancreatic cancer patients.
Impact of the Human Immunodeficiency Viruses Status on Outcomes in Patients Hospitalized With Acute Pancreatitis
Authors: Jiang Yi , Rodgers Brandon , Chowdhury Salil , Ali Hasan , Ahlawat Sushil
Published: September 2020

Objectives

We aimed to examine the clinical characteristics and outcomes of patients admitted for acute pancreatitis (AP) in the population with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS).

Methods

The National Inpatient Sample from 2010 to 2014 was used to identify adult patients admitted with AP. Patients were grouped based on the HIV status. Primary outcomes were mortality, length of stay (LOS), disposition and total hospitalization charges. Secondary outcomes included acute kidney injury, septic shock, respiratory failure and pancreatic procedures.

Results

After matching and weighting, a total of 14,152 HIV-positive patients (6904 with AIDS and 7248 with asymptomatic HIV [aHIV]) with AP were identified. Acute pancreatitis with AIDS were associated with a higher rate of acute kidney injury, longer LOS, higher hospitalization charges, and less routine disposition compared with HIV-negative AP. Patients with aHIV had less septic shock, shorter LOS, and less hospitalization charges compared with HIV-negative patients and less respiratory failure, shorter LOS, and less hospitalization charges compared with AIDS patients.

Conclusions

Patients admitted for AP with AIDS have worse outcomes. On the contrary, aHIV status was not only associated with better outcomes when compared with AIDS, but to HIV-negative status as well.
Acute Pancreatitis in Celiac Disease
Authors: Osagiede Osayande , Lukens Frank J. , Wijarnpreecha Karn , Corral Juan E. , Raimondo Massimo , Kröner Paul T.
Published: September 2020

Objectives

Studies suggest that adults diagnosed with celiac disease (CD) are at higher risk of developing acute pancreatitis (AP). The aim of this study is to explore the relationship between CD and AP in terms of inpatient prevalence, mortality, morbidity, and resource utilization in the past decade.

Methods

Retrospective cohort study using the Nationwide Inpatient Sample (2007–2016). The primary outcome was the occurrence of AP in CD patients. Secondary outcomes were the trend in AP cases in CD patients, and mortality, morbidity, length of stay, and total hospital charges and costs.

Results

Of 337,201 CD patients identified, 7372 also had AP. The mean age was 53 years, 71% were women. The inpatient prevalence of AP in CD was 2.2% versus 1.2% in non-CD cohort (P< 0.01). Patients with CD displayed increased odds of having AP (adjusted odds ratio, 1.92;P< 0.01). Patients with AP and CD displayed lower odds of morbidity and mortality than non-CD patients with AP.

Conclusions

The inpatient prevalence of AP is higher in CD patients, and increased from 2007 to 2016. Patients with CD and AP displayed lower morbidity and mortality, which may suggest that they have a less severe form of AP or lower baseline comorbidity.
The Epidemiology of Pancreatic Cancer and the Association With Acetylsalicylic Acid in the United States
Authors: Khoudari George , Alkhayyat Motasem , Abou Saleh Mohannad , Mansoor Emad , Sarmini Muhammad Talal , Baidoun Firas , Vega Kenneth J. , Sanaka Madhusudhan R.
Published: September 2020

Objectives

Pancreatic cancer (PaC) is the third leading cause of cancer-related death in the United States. Multiple studies have investigated the epidemiology and the association between PaC and acetylsalicylic acid (ASA) use, revealing mixed results. Using a large database, we sought to investigate the epidemiology of PaC.

Methods

Using a commercial database (Explorys Inc, Cleveland, Ohio), which includes electronic health record data from 26 major integrated US health care systems, all patients 18 years and older diagnosed with PaC for 5 years were identified based on Systematized Nomenclature Of Medicine—Clinical Terms. We determined the prevalence of PaC and the potential associated factors using univariable and multivariable analysis.

Results

Of the 32,970,850 individuals, we identified 30,250 individuals with PaC with an overall prevalence of 0.08%. Individuals with PaC were more likely to be males, seniors (age, >65 years), and White, compared with patients without PaC. In subgroup analysis of chronic pancreatitis, individuals on ASA, individuals >65 years, White, and White males were less likely to have PaC, and non-White females were more likely to have PaC.

Conclusions

This is the largest population-based study evaluating the epidemiology of PaC. We observed a protective association of ASA on a subgroup of patients with PaC and chronic pancreatitis.