bluuebunny/crossref_metadata_2025 huggingface dataset:
13 Juvenile idiopathic arthritis and cardiovascular risk factors
Authors: Tbini Houssem , Rahmouni Safa , Boussaid Soumaya , Ammou Ahlem Ben , Jemmali Samia , Rekik Sonia , Zouaoui Khaoula , Sahli Hela , Elleuch Mohammed
Published: October 2022

Background

Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease. Although, some patients achieve remission, some cases of JIA may persist into adulthood. Patients with JIA and other inflammatory joint diseases have increased cardiovascular disease risk compared with the general population.

Objectives

To study the cardiovascular risk factors in JIA and their association with disease parameters.

Methods

This was a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years (1994–2022). We collected sociodemographic and anthropometric parameters, clinical data, results of biological assessments, and data on prescribed therapies.

We studied the following cardiovascular risk factors: family history of cardiovascular event, physical inactivity, smoking, arterial hypertension, diabetes, dyslipidaemia and obesity.

Results

We included 29 patients. The M/F sex ratio was 0.71, the mean age was 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years. The mean BMI was 21.20 ± 4.88 kg/m2 [14.17–27.55].

The polyarticular form was the most frequent, noted in 55.2% of cases (n = 16). Extra-articular manifestations were observed in 55.2% of cases. Mean CRP was 42.74 ± 63.37 [2–218] mg/l and biological inflammatory syndrome was present in 19 cases. Rheumatoid factor, ACPA and anti-nuclear antibodies were observed in 12, 7 and 5 cases respectively.

Corticosteroid therapy and NSAIDs were prescribed to 18 of the subjects.

Cardiovascular risk factors were present in 41.4% (n = 12) of cases: family history of cardiovascular event (n = 2 cases), physical inactivity (n = 5 cases), smoking (n = 3 cases), arterial hypertension (n = 4 cases), diabetes (n = 4 cases), dyslipidaemia (n = 4), and BMI ≥ 25 kg/m² (n = 4).

Following parameters were significantly higher in patients with cardiovascular risk factors: the presence of a biological inflammatory syndrome (81.8% vs 35.3%; p = 0.016), the frequency of prescription of corticosteroids (91.7% vs 52.9%; p = 0.026) and NSAIDs (83.3% vs 47.1%; p = 0.047).

However, no significant difference was noted when comparing these parameters: gender, age, age of disease onset, disease duration and presence of extra-articular manifestations. Moreover, cardiovascular risk factors were not associated with the presence of rheumatoid factor, ACPA, and antinuclear antibodies.

Conclusion

Inflammation, corticosteroid therapy and NSAIDs are associated with the presence of cardiovascular risk factors in JIA. The evaluation and control of this risk must be regular during patient follow-up. Control of inflammation and rationalization of treatment are necessary.
16 Spectrum of infections during juvenile idiopathic arthritis
Authors: Dissem Nouha , Rahmouni Safa , Boussaid Soumaya , Tbini Houssem , Jemmali Samia , Rekik Sonia , Zouaoui Khaoula , Sahli Hela , Elleuch Mohammed
Published: October 2022

Background

The incidence of infections in patients with chronic inflammatory rheumatic disease is increased. It is often due to the disease itself and to the immunosuppressive treatments used.

Objectives

To assess the incidence of infections during JIA.

Methods

We conducted a repeated cross-sectional study including 29 patients followed for JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period from 1994 to 2022. Sociodemographic and anthropometric parameters, clinical data, biological assessments, and prescribed therapies were collected. We identified patients who had at least one infectious episode during their follow-up.

Results

There were 17 women and 12 men. The mean age was 35.69 ± 11.72 [18–61] years. The polyarticular form was seen in 55.2% of cases. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average disease duration was 24.48 ± 12.76 [1–47] years.

Diabetes and arterial hypertension were the main comorbidities associated with JIA, observed in 13.8% of cases each. At least one extra-articular manifestation was noted in 16 cases: pulmonary (3 cases), cardiac (4 cases), renal (2 cases), cutaneous (4 cases) and ocular (7 cases).

The most prescribed DMARDs was Methotrexate in 79.3% (n = 23), biotherapy was used in 3 (10.3%), NSAIDs and corticosteroids were used in 62.1% (n = 18) and 69% (n = 20) respectively.

All the infections observed in our population were of community origin. Urinary tract infection was the most common infection (n = 5). Bronchopulmonary infections were observed in 2 cases including a case of tuberculosis. Sub periosteal abscess of the femur was also seen in one of the patients.

Regarding the SARS-CoV-2 infection, 6 patients were infected, 2 of whom required hospitalization, including one in the intensive care.

Conclusion

The risk of infections is increased during JIA. This is due to the immunosuppression induced by the disease, the treatment, and comorbidities.
31 Oligoarticular juvenile idiopathic arthritis in a Tunisian pediatric population
Authors: Dghaies C , Guedri R , Rebhi M , Hrizi H , Essaddam L , Dahmouni M , Abdelaali A , Fitouri Z , Ben Becher S
Published: October 2022

Background

Juvenile idiopathic arthritis (JIA) is an acquired autoinflammatory disease characterised by arthritis of unknown origin with onset before age of 16 years. JIA comprises a group of heterogeneous diseases further divided into various categories based on shared clinical presentation, laboratory markers, and disease prognosis. Oligoarticular JIA is the most common group of JIA. The region of Africa constitutes a diverse group of ethnicities, socioeconomic conditions, and climates which influence the prevalence of oligoarticular JIA.

Objective

The aim of our study was to assess the incidence of oligoarticular JIA in children and to describe the clinical and evolutionary characteristics of a series of children presenting with oligoarticular JIA.

Results

We retrospectively evaluated 192 consecutive pediatric patients with JIA in the emergency and outpatient paediatric department at the children's hospital in Tunisia between January 2005 and December 2021. A total of 95 cases (49,4%) with oligoarticular JIA were included in the final analysis. The incidence of oligoarticular JIA was 4,11 cases per year.

The median age of the onset of symptoms was 56 months (range 6–156) and the ratio of males to females was 0,24. we noticed the presence of a family history of autoinflammatory or autoimmune disease in 15.7% of cases. Children were referred to a paediatrician specializing in rheumatic diseases of the child within a maximum of 3 years. These children were referred by an orthopaedist in 31.4% of cases. 82.9% of children were eutrophic at the time of diagnosis while 11.4% were found to having a failure to thrive. We noted that the knees were the most frequently affected joint (48,6%). Oligoarticular JIA with positive autoantibodies represented 64.3% of our patients. The evolution was marked by the occurrence of uveitis in 17.1% of cases. Of the 95 children followed for oligoarticular JIA, 21.4% had an extensive form and 7.1% are currently at the stage of joint deformation.

Conclusion

The prevalence of JIA in Africa was observed to be towards the lower range of the global estimate. We observed that the most prevalent subtype in our country was oligoarticular arthritis. The incidence of uveitis and anti-nuclear antibody (ANA) positivity were found to be higher as compared with the incidence from other regions.
34 Subtype frequencies and demographic characteristics of juvenile idiopathic arthritis in Batna, Algeria
Authors: Hadef Djohra , Slimani Samy , Khamari Mohamed Choukri , Mekaoussi Walid , Belot Alexandre , Quartier Pierre
Published: October 2022

Background

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. There is a disparity in the prevalence of Juvenile idiopathic arthritis (JIA) subsets between different geographical areas or ethnic groups. In Arabic and African populations, data describing JIA are scarce. However, the epidemiological studies remain the best tool to understand the disease and to improve its management.

Objectives

To determine subtype, frequency, demographic and clinical features of JIA in Batna -Algeria- and to compare the findings with other JIA populations worldwide.

Methods

A multicentre retrospective descriptive study was conducted in Batna health centers (public and private sectors), over a seven-year period from January 2013 to December 2019, based on data collected on JIA patients. As public sector source, we referred to the department of pediatrics of the university hospital center (CHU Benflis Touhami Batna), and as private sector source, we referred to private adult rheumatologists based in Batna. The studied variables were: gender, age at the initial symptoms, age at diagnosis, JIA subtype based on International League of Associations for Rheumatology (ILAR) criteria, symptoms at onset, disease duration at the latest follow up, presence of uveitis, auto antibodies (antinuclear antibodies, Rheumatoid Factor and anti-CCP) pattern, joint imaging results, JIA status at the time of enrolment and the latest follow-up.

Results

The study included a total of 69 cases of JIA that were being followed in Batna health centers over the study period. The female to male ratio was 1.83. The median age at diagnosis was 9 years (range 1–16). Forty-six patients (72%) were diagnosed within the first year after disease onset. At the latest follow-up, the median disease duration onset was 1 year (range 1–8 years). There were 34 oligoarthritis (49.3%), 9(13%) rheumatoid factor (RF) negative polyarticular JIA, 8(11.6%) RF positive polyarticular JIA, 6(8.7%), systemic arthritis, 6(8.7%) enthesitis-related arthritis, 3(4.3%) psoriatic arthritis and 3(4.3%) undifferentiated arthritis. Nine patients (18.7%) were anti-nuclear antibody (ANA) positive, and 21 patients (30.4%) had indeterminate ANA status.

Conclusion

Oligoarthritis was the most common JIA subtype in our study. The RF positive polyarthritis frequency was higher than in literature. Prospective multicentre studies are necessary to better identify the JIA peculiarities in our country.

Disclosure of Interest

None declared
35 Pharmacologic management of children with juvenile idiopathic arthritis in Batna, Algeria
Authors: Hadef  , Slimani S , Khamari M. C , Mekaoussi W , Belot A , Quartier P
Published: October 2022

Background

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood and is usually treated with non-steroidal anti-inflammatory drugs or disease-modifying anti-rheumatic drugs. The outcome in patients with JIA has markedly improved with the advent of biologic drugs.

Objectives

The aim of this study was to describe treatments prescribed for children with JIA in Batna, Algeria.

Methods

A multicentre retrospective and descriptive study was conducted in Batna health centers (public and private sectors), over a seven-year period from January 2013 to December 2019, based on (JIA patient’s data collection). As public sector source, we referred to the department of pediatrics of the university hospital center (CHU Benflis Touhami Batna), and as private sector source, we referred to private adult rheumatologists based in Batna.

Results

The study included a total of 69 cases of JIA that were being followed in Batna health centers over the study period. Treatment modalities used for these patients included non-steroidal anti-inflammatory drugs (NSAIDs) in 54 patients (79.4%), steroids (prednisolone) in 37 patients (54.4%), conventional disease-modifying anti-rheumatic drug (c-DMARDs) in 51 patients (72.5%), biologic agents in 11 (15.9%) and intra articular injections in 17 patients (24.6%). The most frequently used c-DMARDs was methotrexate 42 (63.7%). The mean maximal dose reached was 7.5 mg (range 2.5–15). It was associated to other c-DMARDs in 2 cases. Sulfasalazine was used in 8 cases, Leflunomide in 1 case, and Hydroxychloroquine in 1 case. Biologics were used in 11 cases (15.9%).

RF-positive polyarthritis 4(50%), RF-negative polyarthritis 3 (33.3), systemic arthritis 2 (33.3) were the groups that most commonly needed a biological therapy. Biologics included Rituximab (n = 2), Tocilizumab (n = 1), Anakinra (n = 1), Etanercept (n = 1) and Infliximab (n = 1). The (mean duration of the disease evolution at the initiation of the biological agent) was 4.8 ± 5.4 years (range 0.5–8 years). At the time of enrolment, 31 patients (44.9%) were in remission: 20 patients (29%) were under treatment and 11 patients (15.9%) were not, while 12 patients (17.4%) had active disease.

Conclusion

A high proportion of children presenting with JIA received cDMARDs. Biologics were needed in a few cases.

Disclosure of Interest

None declared
46 Universal calcinosis in juvenile dermatomyositis: a case report
Authors: Bahaz N , Remilaoui A , Mechid F , Hafirassou H , Dahou Makhloufi C
Published: October 2022

Background

Dermatomyositis (DM) is an inflammatory myopathy that is often severe and affects children (juvenile DM) in 50% of cases. Subcutaneous calcinosis is seen in 30–70% of juvenile DM and often poses a problem in terms of treatment.

We report a patient with diffuse subcutaneous calcinosis in juvenile DM.

Observation

The patient is K.S, a 17-year-old girl, with background history of congenital heart disease (atrial septal defect), which was corrected surgically in 2021. Since the age of 13, she has had DM for which she has received corticosteroid therapy at a dose of 2 mg/kg/day and improved clinically. The clinical examination reveals subcutaneous nodules in the arms, forearms, phalanx of the right index finger, inner thigh, knees and legs, associated with reduced range of movement of the right elbow (presence of calcifications) and limitation of internal rotation of the right hip.

Laboratory investigations showed no inflammatory syndrome, the muscle enzymes and electromyogram were normal. Radiographs showed calcifications at the sites with subcutaneous nodules.

Bone densitometry showed a decrease in bone mineral density (Z score= -3.4 standard deviation at the lumbar spine). The thoracic CT scan showed interstitial lung disease.

The patient was managed with pamidronic acid for the diffuse calcinosis. She is also on diltiazem for Raynaud's phenomenon and hydroxychloroquine.

Conclusion

Subcutaneous calcinosis is diffuse in our patient. Treatment with bisphosphonates (pamidronic acid) is recommended.
55 Predictive factors of infection in patients with systemic autoimmune disease on biotherapy
Authors: Manel Boudokhane , Hiba Ben Ayed , Sarra Ben Yaacoub , Rym Bourguiba , Zeineb Teyeb , Mariem Ayari , Taieb Jomni , Imen Abdelaali , Syrine Belakhal , Hedi Dougui Mohamed
Published: October 2022

Introduction

The increasing use of biologics in chronic inflammatory diseases is accompanied by an increased risk of infectious complications. Our objective was to determine the predictive factors for the occurrence of infection in patients on biotherapy.

Methods

We conducted a single-center retrospective study in an internal medicine department over a period of 14-year [2009–2022], including the records of patients treated with a biologic agent presenting at least one infectious episode.

Results

During the study period, 20 patients among 50 treated with biologic agent had at least one infection episode. The patient mean age was 50.8 ± 12.1 [24–76] years and the male to female ratio was 1:2. The mean age at biotherapy first use was 43 ± 12.1 [17–68] years. Infections occurred after a mean duration of 12 months [0.5–36] after the initiation of biotherapy. Eleven patients were followed for chronic inflammatory bowel disease, three patients for ankylosing spondylitis, three patients for vasculitis, two patients for rheumatoid arthritis and one patient for systemic scleroderma. Only three patients were diabetic and two had chronic pulmonary disease. Thirteen patients (65%) were treated by TNFα inhibitors and 35% with anti CD20 (Rituximab). Among TNFα inhibitors, seven infections occurred in patient treated with infliximab (41%), six with adalimumab (35%) and four with etanercept (24%). At the time of infection, half of the patients were treated by corticosteroid with a median dose of 32 mg/d [5–60] and a median duration of 11 months [2–90], while 40% of the patients were on conventional immunosuppressive therapy. The infection was severe, requiring hospitalization in eight cases (40%). A statistically significant correlation was found between the occurrence of infection and a duration of anti-TNFα treatment <6 months (p = 0.003) and history of crohn's disease (p = 004). Age >50 years at the time of biotherapy introduction did not correlate with a higher risk of infection (p = 0.7)

Conclusion

Screening for infections in patient treated with biologic agents must be systematic, especially at the treatment initiation, in order to ensure better compliance and efficacy of the biotherapy.
Favourable effect of a ‘second hit’ after 13 weeks in early RA non-responders: the Amsterdam COBRA treat-to-target randomized trial
Authors: Hartman Linda , Rasch Linda A , Turk Samina A , ter Wee Marieke M , Kerstens Pit J S M , van der Laken Conny J , Nurmohamed Michael T , van Schaardenburg Dirkjan , van Tuyl Lilian H D , Voskuyl Alexandre E , Boers Maarten , Lems Willem F
Published: October 2022

Objective

The aim of this study was to investigate the effect of treat-to-target combination therapy with intensification at 13 weeks in early RA.

Methods

Early RA patients were classified as being at high or low risk of worsening RA based on disease activity and prognostic factors. High-risk patients received COBRA-light (prednisolone 30 mg/day tapered to 7.5 mg/day, MTX increasing to 25 mg/week), and low-risk patients received MTX monotherapy increasing to 25 mg/week. The primary outcome (target) was DAS44 < 1.6 or EULAR good response at 26 weeks. At 13 weeks, non-responders were randomized to (open-label) intensification [high-risk patients: prednisolone 60 mg/day tapered to 7.5 mg/day, addition of SSZ (2 g/day) and HCQ (400 mg/day); low-risk patients: prednisolone 30 mg/day tapered to 7.5 mg/day] or continuation.

Results

In the high-risk group (n = 150), 110 patients (73%) reached the target at 13 weeks, and 9 dropped out. Non-responders were randomized to intensification (n = 15) or continuation (n = 16), and after 26 weeks, 12 (80%) vs 7 (44%) of these, respectively, reached the target [difference: 36%, (95% CI 2%, 71%); P = 0.04]. In the low-risk group (n = 40), 17 (43%) reached the target. Non-responders were randomized to intensification (n = 8) or continuation (n = 7); 4 vs 3, respectively, reached the target.

Adverse event rates were higher in the high-risk group, and higher in the intensification subgroup of that group. Serious adverse events were rare. Protocol violations were frequent and mostly led to mitigation of actual treatment intensification.

Conclusion

Initial combination therapy was very successful in high-risk RA, and early intensification was beneficial in patients not reaching the strict target. The low-risk group was too small for drawing conclusions. In routine practice, adherence to early intensification based on strict targets is difficult.

Trial registration

Netherlands Trial Register (NTR), NL4393, https://www.trialregister.nl/.
Fostering a research integrity culture: Actionable advice for institutions
Authors: De Peuter Steven , Conix Stijn
Published: October 2022

Research institutions’ research culture is increasingly recognized as a central driver of research integrity. Institutions are urged to develop research integrity promotion plans to foster a culture of research integrity. A host of guidelines and associated initiatives have been issued but specific, actionable recommendations for institutions are scattered across the scientific literature and generally not acknowledged and implemented (yet). Based on a broad literature review, in the current paper some practical advice for institutions is suggested, grouped into (1) policies, procedures, and processes; (2) dealing with breaches of research integrity; (3) education and training; and (4) monitoring and evaluation. With each section, we formulate specific recommendations.
Recent advances in the treatment of hemophagocytic lymphohistiocytosis and macrophage activation syndrome
Authors: Jesudas Rohith , Nichols Kim E.
Published: October 2022

Purpose of review

The approach to treating patients with hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) has shifted in recent years with the aim to limit exposure to genotoxic agents, such as etoposide, yet dampen hyperinflammation by targeting the activity of specific HLH/MAS-associated cytokines. In this review, we discuss recent efforts to reduce the dose of etoposide and/or incorporate cytokine-targeted therapies for the treatment of HLH/MAS.

Recent findings

There is emerging evidence that reduced-dose etoposide and/or cytokine-targeted therapies, including agents that neutralize or inhibit signaling induced by interferon gamma, interleukin (IL)-1, IL-18, and IL-6, can effectively ameliorate the clinical and laboratory manifestations of HLH/MAS and improve overall outcomes.

The application of novel regimens containing lower doses of etoposide and/or cytokine-directed agents to treat HLH/MAS holds potential to dampen inflammation while minimizing therapy-associated toxicities. Nevertheless, further research is needed to better understand, which patients represent the most appropriate candidates to receive cytokine-targeted therapies, elucidate the optimal timing and dose of these therapies, and decipher whether they should be administered alone or in combination with conventional HLH-directed therapies, such as dexamethasone and standard-dose or reduced-dose etoposide.
Enhancing American Indians’/Alaska Natives’ Knowledge, Confidence, and Community During the Medical School Application Process: Findings From the Northwest Native American Center of Excellence
Authors: Vasquez Guzman Cirila Estela , Taylor Cynthia , Harris Anna , Donald Caitlin , Carney Patricia A. , Rasmussen-Rehkopf Sarah , Bruegl Amanda , Empey Allison , Hoffmann Laurel Murphy , Brodt Erik
Published: October 2022

Purpose

To describe a Medical School Applicant Workshop (MSAW); present lessons learned about its impact on American Indian/Alaska Native (AIAN) participants’ knowledge, confidence, and sense of community; and report on participants’ medical school application progress 1 year after workshop completion.

Method

The Northwest Native American Center of Excellence at Oregon Health & Science University developed and implemented an annual 1-day AIAN MSAW in 2018. The main objectives of the workshop are for participants to gain insights into the medical school application process; learn strategies to competitively apply; receive feedback on their personal statement and mock interviews; and discuss the medical school application process with AIAN faculty, admissions deans, and peer-mentors. Recruitment of AIAN participants occurred via email; social media; text messaging; medical association contacts; and AIAN and science, technology, engineering, and mathematics organizations. Two surveys were administered: one immediately after and another 1-year after the workshop.

Results

Forty AIAN MSAW participants were accepted in 2018–2020. Findings indicate statistically significant increases in participants’ self-reported knowledge of the medical school application process and in their self-reported confidence. Participants reported meeting other AIAN students was highly beneficial and feeling connected to a community of AIAN health professionals after attending the workshop. Among the 25 participants who completed the 1-year follow-up survey, 12 (48.0%) indicated applying to medical school; all 12 of these participants were invited to interview, and 11 were offered acceptance to at least one medical school.

Conclusions

Completing the MSAW increased participants’ knowledge, confidence, and sense of community. If other programs and institutions were to consider using the MSAW model to reduce barriers and provide supports specifically designed for AIANs before and during the medical school application process, medical schools may stand to further increase AIAN representation in the physician workforce and ultimately to decrease health inequities among AIANs.
Comparative Analysis of Early Outcomes and Complications of PSO Among Neurosurgeons and Orthopedic Surgeons
Authors: McNeill Ian T. , Neifert Sean N. , Deutsch Brian C. , Martini Michael L. , Shuman William H. , Chapman Emily , Price Gabrielle , Hwang Songhon , Steinberger Jeremy , Caridi John M.
Published: October 2022

Study Design:

Retrospective comparative cohort study using the National Surgical Quality Improvement Program.

Objective:

The aim of this study was to evaluate trends in the annual number of PSOs performed, describe the patient populations associated with each cohort, and compare outcomes between specialties.

Summary of Background Data:

Pedicle subtraction osteotomies (PSO) are complex and advanced spine deformity surgical procedures performed by neurosurgeons and orthopedic surgeons. Though both sets of surgeons can be equally qualified and credentialed to perform a PSO, it is possible that differences in training and exposure could translate into differences in patient management and outcomes.

Methods:

Patients that underwent lumbar PSO from 2005 to 2014 in the American College of Surgeons-National Surgical Quality Improvement Program registry were identified. Relevant demographic, preoperative comorbidity, and postoperative 30-day complications were queried and analyzed. The data was divided into 2 cohorts consisting of those patients who were treated by neurosurgeons versus orthopedic surgeons. Additional data from the Scoliosis Research Society Morbidity and Mortality database was queried and analyzed for comparison.

Results:

Demographic and comorbidity factors were similar between the neurosurgery and orthopedic surgery cohorts, except there were higher rates of hypertension among orthopedic surgeon-performed PSOs (65.66% vs. 48.67%, P=0.004). Except for 2012, in every year queried, orthopedic surgeons reported more PSOs than neurosurgeons. In patients who underwent lumbar fusion surgery, there was a higher rate of PSOs if the surgery was performed by an orthopedic surgeon (OR 1.7824, 95% CI: 1.4017–2.2665). The incidence of deep vein thrombosis after PSOs was higher for neurosurgery compared with orthopedic surgery (8.85% vs. 1.20%, P=0.004). However, besides deep vein thrombosis, there were no salient differences in surgical complication rates between neurosurgeon-performed PSOs and orthopedic surgeon-performed PSOs.

Conclusions:

The number of PSO procedures performed by neurosurgeons and orthopedic surgeons has increased annually. Differences in outcomes between neurosurgeons and orthopedic surgeons suggest an opportunity for wider assessment and alignment of adult spinal deformity surgery exposure and training across specialties.
Trends in percutaneous coronary intervention in China: analysis of China PCI Registry Data from 2010 to 2018
Authors: Liu Zhaoping , Li Jianping , Zhang Yan , Yu Bo , Ma Yitong , Ma Genshan , Wang Jianan , Liu Bin , Su Xi , Li Bao , Zhang Zheng , Chen Yuguo , Chen Jiyan , Chen Lianglong , Chen Yundai , Yuan Zuyi , Jia Shaobin , Gao Chuanyu , Tang Yida , Fu Xianghua , Han Yaling , Ge Junbo , Ma Xudong , Huo Yong
Published: October 2022

Background and purpose:

In the past 30 to 40 years, percutaneous coronary intervention (PCI) in China has greatly improved. The State Ministry of Health established a quality control (QC) system in 2009, and all medical centers were required to report their PCI cases. We analyzed the data from the QC system to describe the current status and development of PCI in China.

Methods:

PCI case data during a period from 2010 to 2018 were extracted from the online QC system. Data quality was audited by QC centers at the provincial level. Statistical analysis was mainly descriptive. Trend analysis was conducted by recoding the year as a continuous variable in linear regression or logistic regression.

Results:

The number of medical centers reporting PCI cases was 941 in 2010, and increased to 1,788 in 2018. Total number of PCI cases reported online to the QC system was 236,717 in 2010, and increased to 705,970 in 2018. Estimate of the actual case number that included those reported offline only (based on offline audit by provincial QC centers) was 284,936 in 2010, and increased to 915,256 in 2018. The most common indication for PCI was unstable angina (52.9%–59.1%), followed by ST elevation myocardial infarction (STEMI; 25.0%–27.4%). Majority of the PCI procedures were performed via the radial artery (65.4% in 2010 and 90.7% in 2018). Angiography detected a left main lesion in 5%, single-vessel disease in 38.7% to 44.4%, two-vessel disease in 22.3% to 27.5%, and three-vessel disease in 27.0% to 28.7% of the patients. The rate of primary PCI for STEMI in all STEMI cases was 28.0% in 2010, and increased to 45.9% in 2018. The average number of stents implanted per case was 1.63 in 2010, and decreased to 1.46 in 2018. There was a trend for decreasing mortality (0.31% in 2010; 0.26% in 2018).

Conclusions:

The number of PCI cases in China increased steadily during a period from 2010 to 2018, with stable mortality rate. Transradial access is the dominant PCI route. The rate of primary PCI for STEMI increased substantially, but remained relatively low.
Baseline platelet count independently predicts long-term adverse outcomes in patients undergoing percutaneous coronary intervention: a single-center retrospective cohort study
Authors: Hou Xiangeng , Zheng Yingying , Wu Tingting , Chen You , Yang Yi , Ma Yitong , Xie Xiang
Published: October 2022

Background

and purpose: The association between platelet counts (PC) with clinical outcomes after percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD) has been reported by some but not all previous studies. The present study aims to investigate the association of PC with the outcomes of CAD patients who underwent PCI.

Methods:

We conducted a retrospective cohort study to examine the potential impact of baseline PC with long-term outcomes in patients receiving at least one stent. The final analysis included a total of 6,046 patients. The median follow-up was 32 (1–120) months

Results:

All-cause mortality did not differ significantly among the four groups based on baseline PC (lowest 25%, Quartile 1 [Q1], PC < 173, n = 1,473; 25%–50%, Quartile 2 [Q2], 173 ≤ PC < 208, n = 1,529; 50%–75%, Quartile 3 [Q3], 208 ≤ PC < 250, n = 1,507; and 75%–100%, Quartile 4 [Q4], PC ≥ 250, n = 1,537). The rate of major adverse cardiovascular and cerebrovascular events was 12.8% (188/1,473) in the Q1 group, 12.8% (196/1,529) in the Q2 group, 15.1% (228/1,507) in the Q3 group, and 16.3% (150/1,537) in the Q4 group (P = 0.010). The rate of major adverse cardiovascular events was 11.3% (167/1,473) in the Q1 group, 11.6% (177/1,529) in the Q2 group, 13.9% (210/1,507) in the Q3 group, and 15.0% (231/1,537) in the Q4 group (P = 0.004). Using Q1 as reference, the adjusted hazard ratio (aHR) for major adverse cardiovascular and cerebrovascular events in multivariate Cox regression was 1.212 (95% confidence interval [CI]: 1.004–1.455, P < 0.001) in Q2, 1.455 (95% CI: 1.200–1.766, P < 0.001) in Q3, and 1.754 (95% CI: 1.426–2.118, P < 0.001) in Q4. Using Q1 as reference, the aHR for major adverse cardiovascular events was 1.201(95% CI: 0.968–1.492, P = 0.096) in Q2, 1.489 (95% CI: 1.206–1.837, P < 0.001) in Q3, and 1.847 (95% CI: 1.500–2.275, P < 0.001) in Q4.

Conclusion:

A higher baseline PC was independently associated with an increased risk of major adverse cardiovascular and cerebrovascular events and major adverse cardiovascular events, but not all-cause-mortality in CAD patients after PCI.
Pre-operative distraction using electric ride-on cars for children undergoing elective ambulatory surgery
Authors: Pastene Bruno , Piclet Jules , Praud Camille , Garcia Karine , Louis Katia , Schmidt Claire , Boyadjiev Ioanna , Boucekine Mohamed , Baumstarck Karine , Bezulier Karine , Bouvet Lionel , Zieleskiewicz Laurent , Leone Marc
Published: October 2022

BACKGROUND

Pre-operative anxiety occurs in 18 to 60% of children undergoing surgery and results in poor outcomes. Nonpharmacological methods of distraction are effective in alleviating peri-operative anxiety. In our institution, ride-on electric cars (ride-on e-cars) are routinely used by children undergoing ambulatory surgery as a mean of nonpharmacological distraction.

OBJECTIVES

The aim of this study is to assess the effect of pre-operative distraction with ride-on e-cars on children's pre-operative anxiety when undergoing elective ambulatory surgery.

DESIGN

This was a prospective, randomised, controlled, open-label study.

SETTING

The study was carried out from September 2019 to September 2021 in the ambulatory paediatric surgery unit of our teaching hospital, in Marseille, France.

PATIENTS

Children aged 2 to 10 years and weighing less than 35 kg undergoing elective ambulatory surgery were eligible. One hundred and fifteen children were included, 56 in the control group and 59 in the intervention group.

INTERVENTION

Children in the control group were transported from the operating room (OR) waiting area to the OR using a trolley, while children in the intervention group used the ride-on e-cars, without pharmacological premedication or parental presence.

MAIN OUTCOME MEASURES

The primary outcome was pre-operative anxiety at the end of the transport (prior going into the OR assessed by the modified Yale Preoperative Anxiety Score Short Form (mYPAS-SF). Secondary outcomes were the anxiety levels in children over time, as well as postoperative pain and agitation assessed with the Face Legs Activity Cry Consolability (FLACC) and Paediatric Anaesthesia Emergence Delirium (PAED) scales, respectively.

RESULTS

The mYPAS-SF anxiety scores did not differ between the control group and the intervention group (39 ± 19 vs. 37 ± 21, P = 0.574). The secondary outcomes were similar between the two groups.

CONCLUSIONS

Our randomised controlled trial showed that the use of ride-on e-cars did not alter pre-operative anxiety as compared with standard transport in children undergoing elective ambulatory surgery.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT03961581
Selection of percutaneous mechanical circulatory support in cardiogenic shock: patient-specific considerations and insights from contemporary clinical data
Authors: Acosta Mary E. , Belkin Mark N. , Nathan Sandeep
Published: October 2022

Purpose of review

Cardiogenic shock remains a complex and variable disease process requiring early recognition and prompt, multidisciplinary treatment. Available data link usage of high-dose and/or multiple vasopressors in cardiogenic shock to increased mortality. This review proposes a structured approach to escalation of percutaneous mechanical circulatory support (pMCS) in cardiogenic shock, based on the hemodynamic and metabolic parameters highlighted in the revised SCAI Shock Classification, and supported by the available clinical data.

Recent findings

Intra-aortic balloon pumps (IABP) may improve hemodynamics in early cardiogenic shock (stage B) but offer little benefit in stage C–E shock where percutaneous ventricular assist devices (pVAD) improve cardiac power/index and may improve survival in certain subsets. In stage D–E shock, escalation from standalone pVADs to devices in combination is often appropriate. Left ventricular venting, with IABP or Impella, in conjunction with VA ECMO, appears to be beneficial.

Graded escalation of pMCS support should be considered in SCAI stage B shock patients onwards, with the choice of support allowable by local expertise, matched to the degree and anticipated trajectory of hemodynamic and metabolic compromise. Additional clinical data are required before timing, and escalation of pMCS initiation may be integrated into a single treatment algorithm.
Tea as a natural gift for discovering antiviral candidates
Authors: Wang Changjian , Yang Zhiying , Chai Xin , Wang Yuefei , Wang Weili , Zhang Min
Published: October 2022

Coronavirus disease (COVID-19) remains rampant worldwide and poses a serious threat to human health. Tea is a medicinal and edible homologous plant that exhibits potential anti-SARS-CoV-2 properties via the prevention of virus entry into host cells, inhibition of virus replication, and enhancement of the innate and cellular immune responses. In this review, the properties of six major types of tea were systematically summarized, including green tea, yellow tea, white tea, oolong tea, black tea, and dark tea. We focused on the primary components of tea exhibiting antiviral pharmacological activities, which included (–)-epigallocatechin-3-gallate, (–)-gallocatechin gallate, tannic acid, oolonghomobisflavan A, theaflavins, and white-tip silver needle flavonoids. Among them, (–)-epigallocatechin-3-gallate is proposed to be an antiviral compound that interferes with the entire life cycle of SARS-CoV-2 by balancing inflammation and immunity. Thus, this compound can serve as a promising lead structure for the development of SARS-CoV-2 inhibitors.
RATE OF AND TIME TO COMPLETE RETINAL VASCULARIZATION IN PREMATURE INFANTS AND ASSOCIATED FACTORS
Authors: Lai Tso-Ting , Yang Chung-May , Hsieh Yi-Ting , Yeh Po-Ting , Huang Ching-Wen , Tsai Chia-Ying
Published: October 2022

Purpose:

To evaluate the rate of and time to complete vascularization in premature infants and to explore associated factors.

Methods:

A monocentric, retrospective cohort study including 541 premature infants who underwent screening for retinopathy of prematurity (ROP) between July 2016 and June 2019. Patients underwent regular dilated fundus examinations with indirect ophthalmoscopy until complete vascularization. The worse eye of each patient was included for analyses. The proportion of infants with complete retinal vascularization at the last visit and the time to full vascularization was analyzed.

Results:

Among all infants (average gestational age 31.29 ± 3.12 weeks), 490 (90.57%) had complete records of retinal vascularization outcomes, of whom 439 (89.59%) achieved complete vascularization. The average postmenstrual age for complete vascularization was 45.39 ± 11.04 weeks, and 95.22% achieved completion before 64 weeks of postmenstrual age. Retinopathy of prematurity developed in 118 (22.56%) infants; 33 (6.10%) received antivascular endothelial growth factor treatment. For all infants screened for ROP, lower birth weight, presence of ROP, and antivascular endothelial growth factor therapy predicted delayed complete vascularization; for infants diagnosed with ROP, only lower birth weight predicted delayed complete vascularization. Subgroup analysis showed significant differences between patients without ROP, with untreated ROP, and with treated ROP in time to complete vascularization and its rate (99.7%, 66.2%, and 16.7%, respectively).

Conclusion:

Lower birth weight predicted delayed complete vascularization. Antivascular endothelial growth factor therapy and the presence of ROP, including ROP severity, may also affect time to complete vascularization. These findings should help improve the understanding and management of persistent avascular retina in preterm infants.
Corneal ectasia detection by epithelial pattern standard deviation from OCT
Authors: Salomão Marcella Q. , Hofling-Lima Ana Luisa , Gomes Esporcatte Louise Pellegrino , Correa Fernando Faria , Meneses Erica Ferreira , Li Yan , Huang David , Lopes Bernardo , Sena Nelson , Machado Aydano P. , Ambrósio Renato
Published: October 2022

Purpose:

To test the ability of the corneal epithelial pattern standard deviation (PSD) to distinguish between normal and cases with corneal ectatic condition.

Setting:

Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil.

Design:

Cross-sectional retrospective study.

Methods:

Patients were stratified into 4 groups based on clinical data and corneal tomography. Groups 1 and 2 comprised 1 eye randomly selected from 105 patients with normal corneas (N) and 86 patients with bilateral keratoconus (KC). Groups 3 and 4, respectively, comprised 11 ectatic eyes with no surgical treatment for KC (very asymmetric ectasia [VAE]-E) from patients whose fellow eyes (61) presented with normal topographic patterns (VAE-NT). Corneas were scanned using an OCT system (RT Vue) and Scheimpflug corneal tomography (Pentacam) and also had biomechanical assessment through the Corvis ST. Corneal epithelial thickness maps were analyzed, and the PSD value was calculated. The area under the receiver operating characteristic curve analysis was used to evaluate the diagnostic accuracy of the indices.

Results:

A total of 105 normal eyes, 86 keratoconic eyes, and 11 ectatic eyes whose fellow eyes (61) presented normal topographic patterns were evaluated. Epithelial PSD was significantly different across the 4 groups (P < .0001). The pairwise comparison revealed that the normal group presented significantly lower values than both ectasia groups (KC and VAE-E, P < .0001) and the VAE-NT group (P = .0008). There was no statistical significant difference between KC and VAE-E (P = .4284), while they were significantly higher than the VAE-NT group (P < .0001 and P = .0004).

Conclusions:

Epithelial PSD can be used to detect abnormal epithelial thickness patterns. Corneal epithelial thickness changes could be detected accurately in patients with KC, even in the form fruste of the disease.
Outcomes and complications after open reduction and internal fixation of distal humeral fractures with precontoured locking plates
Authors: Rosenlund Anne-Mari N. , Søreide Endre , Madsen Jan Erik , Flugsrud Gunnar B. , Douglass Brenton W. , Midtgaard Kaare S.
Published: October 2022

Objectives:

The aim of this study was to evaluate functional and radiographic results after open reduction and internal fixation of distal humeral fractures using precontoured locking plates. Our main hypothesis was that patients older than 65 years have inferior outcomes compared with younger patients.

Methods:

All patients treated for a distal humeral fracture with precontoured locking plates between 2006 and 2017 at a level 1 trauma center were identified. Included patients underwent a clinical examination, and new radiographs were obtained. Functional outcomes were evaluated using Quick Disability of the Arm, Shoulder and Hand, Mayo Elbow Performance Score, visual analog scale elbow satisfaction, and range of motion. Complications and reoperations were recorded.

Results:

Fifty-seven patients with a median age of 60 years were included in this study. Median Quick Disability of the Arm, Shoulder and Hand was 14, and median Mayo Elbow Performance Score was 85. There was no difference in functional scores in patients younger than 65 years or 65 years or older. However, the median flexion–extension arc was 121 degrees in patients younger than 65 years and 111 degrees in patients 65 years or older (P = 0.01). The overall complication rate was 68%, and 24 patients had at least 1 reoperation. Ulnar neuropathy was the most common complication followed by reduced range of motion.

Conclusions:

Operative management of distal humeral fractures with precontoured locking plates provides good functional outcome. The patient-reported outcomes were good, independent of patient age. The implant failure rate is low with precontoured locking plates; however, the complication rate remains high, and reoperations are common.

Level of Evidence:

Level 4, retrospective study.
Clusters of facilitatory and inhibitory conditioned pain modulation responses in a large sample of children, adolescents, and young adults with chronic pain
Authors: Ocay Don Daniel , Ye Diana-Luk , Larche Cynthia L. , Potvin Stéphane , Marchand Serge , Ferland Catherine E.
Published: October 2022

Introduction:

When investigating the role of facilitatory and inhibitory pain mechanisms such as conditioned pain modulation (CPM) and temporal summation of pain (TSP), it is important to take both into consideration in a single experimental model to provide the most information on subgroups of patients. Therefore, the objective of this study was to identify subgroups in a large population of pediatric patients with chronic pain based on their facilitatory and inhibitory pain mechanisms and compare them with control subjects.

Methods:

Five hundred twenty-one female subjects and 147 male subjects between 8 and 21 years old underwent a CPM assessment using a 2-minute tonic noxious heat stimulation as the test stimulus and a 2-minute cold-pressor task (CPT) (12°C) as the conditioning stimulus.

Results:

The best partition of clusters of patients was 3 clusters accounting for 27.15% of the total variation in the data. Cluster 1 (n = 271) was best characterized by high pain intensity during the CPT, lack of TSP during the test stimuli, and efficient inhibitory CPM. Cluster 2 (n = 186) was best characterized by low pain intensity during the CPT, lack of TSP during the test stimuli, and efficient inhibitory CPM. Cluster 3 (n = 151) was best characterized by high pain intensity during the CPT, presence of TSP during the test stimuli, and inefficient inhibitory CPM.

Discussion:

A single thermal CPM experimental design can identify combinations of facilitatory and inhibitory pain modulation responses. Findings from the current study add to the literature by describing different clinical phenotypes of central pain mechanisms of youth with chronic pain.
Efficacy of Heart Rate Variability Biofeedback for Somatic Symptom Disorder: A Pilot Randomized Controlled Trial
Authors: Krempel Laura , Martin Alexandra
Published: October 2022

Objective

Patients with somatic symptom disorder (SSD) often receive targeted intervention only after a long duration of illness. Moreover, the reported effect sizes of interventions for SSD are small. Therefore, improvement and evaluation of interventions are needed. Preliminary evidence suggests autonomic imbalance, for example, lower heart rate variability (HRV) in SSD. HRV biofeedback (HRV-BF) as a method for self-regulation shows initial positive effects in chronic pain and functional syndromes. The aim of this study was to evaluate the efficacy of a brief HRV-BF intervention for SSD.

Methods

Of a total of 50 participants with SSD (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) who were recruited and randomly assigned to four sessions of HRV-BF (n = 25) or autogenic training (AT; n = 25), 49 participants were analyzed (female, 77.6%; mean [standard deviation] age = 45.3 [14.4] years). The primary outcomes were somatic symptom severity (Screening for Somatoform Disorders, numeric rating scale) and HRV. Secondary outcomes were psychological characteristics of SSD (e.g., the Somatic Symptom Disorder 12 scale, health concerns, emotion regulation). The data were collected before and after intervention and were analyzed with repeated-measures analyses of variance and post hoc t tests.

Results

Symptom severity improved after both, HRV-BF and AT. Standard Deviation of the NN Interval and psychological symptoms improved significantly more strongly in the HRV-BF than in the AT group (e.g., Standard Deviation of the NN Interval: η
p
2 interaction = 0.10, p = .047).

Conclusions

The improvements in somatic symptoms, but specifically in cognitive-affective symptoms and autonomic regulation, suggest that HRV-BF with only four sessions is a potentially useful intervention option for SSD. Thus, adding this short HRV-BF intervention to existing psychological treatments for SSD may be promising.

Trial Registration: German Clinical Trial Register identifier DRKS00017099 (https://www.drks.de).