bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety of anti-inflammatory drugs in children with asthma
Authors: de Benedictis Fernando Maria , Carloni Ines , Guidi Roberto
Published: January 2021

Purpose of review

Inhaled corticosteroids (ICS) are widely used as the first-line treatment of asthma. When the disease is not controlled by standard doses of ICS, other anti-inflammatory drugs should be considered. The aim of this report is to review the main adverse events induced by anti-inflammatory drugs in children with asthma and discuss possible actions to prevent or mitigate these effects.

Recent findings

Proper interpretation of ICS safety studies requires knowledge of the pharmaceutical properties and delivery device systems of the different ICS available. Genetic variants affecting susceptibility to corticosteroid-induced adrenal suppression were found in children and adults who use ICS to treat their asthma. There is evidence of the association between montelukast use and neuropsychiatric events.

Benefits of ICS, properly prescribed and used, outweigh their potential adverse effects. There is substantial evidence that the combination of ICS with long-acting beta2 agonists is safe for asthmatic children. Awareness of the potential risks of neuropsychiatric events in children taking montelukast should inform the clinicians’ prescribing practices. Omalizumab is generally well-tolerated, but the evidence on the safety of other biologic agents in children is scanty. The risk of systemic adverse events with anti-inflammatory drugs must be balanced against the risks of uncontrolled asthma and/or frequent oral steroid use.
Inadvertent Burst Suppression During Total Intravenous Anesthesia in 112 Consecutive Patients Undergoing Spinal Instrumentation Surgery: A Retrospective Observational Quality Improvement Project
Authors: Lele Abhijit V. , Furman Michele , Myers Jonathan , Kinney Greg , Sharma Deepak , Hecker James
Published: January 2021

Introduction:

The incidence and quantification of inadvertent electroencephalographic burst suppression during total intravenous anesthesia (TIVA) for spine instrumentation surgery has not previously been reported.

Methods:

The primary aim of this retrospective observational quality improvement project was to establish the prevalence of burst suppression during spine instrumentation surgery with TIVA. The secondary outcome was the incidence of postoperative delirium.

Results:

One hundred twelve consecutive patients, aged between 20 and 88 years, underwent spinal instrumentation surgery. Seventy-eight (69.6%) patients experienced inadvertent burst suppression; the maximal degree of burst suppression ratio was 20% to 100%. Median (interquartile range [IQR]) time spent in burst suppression was 44 (77) minutes, and burst suppression was present for 22% (range: 2% to 93%) of the monitoring period. Average (±SD) propofol dose was lower in patients with burst suppression (87±19 vs. 93±15 µg/kg/min, P=0.04). Ten (8.9%) patients experienced postoperative delirium. Intraoperative burst suppression was more prevalent in those that experienced delirium (100% vs. 66.7%, P=0.03, relative risk: 1.5, 95% confidence interval: 1.3-1.7). The proportion of the monitoring period spent in maximal burst suppression (15.3 [25.9]% vs.11.7 [21.7]%) was similar between those that did, and did not, experience delirium.

Conclusions:

High rates and prolonged periods of inadvertent burst suppression may be prevalent during spine instrumentation surgery with TIVA. Our findings suggest that usage of electroencephalography alone is incomplete without prompt interpretation and intervention, mandating close communication between neuromonitoring and anesthesia teams. The dose-response relationship between burst suppression, total time spent in maximal burst suppression, and their association with delirium warrants further evaluation.
First Metatarsophalangeal Joint Polyvinyl Alcohol Hydrogel Implant Hemiarthroplasty: Current Operative Technique
Authors: Younger Alastair S.E. , Glazebrook Mark A. , Daniels Timothy R. , Wapner Keith L. , DiGiovanni Christopher W. , Baumhauer Judith F.
Published: January 2021

Polyvinyl alcohol hydrogel implant hemiarthroplasty for the first metatarsophalangeal joint has been shown to be an effective, safe, motion-preserving, surgical treatment alternative to fusion for hallux rigidus in a level I, randomized controlled trial. To obtain optimal results, however, surgeons must be sure to perform the appropriate surgical technique as well as educate patients regarding pertinent risks, benefits, and the associated recovery process. Achievement of results commensurate with those published in the randomized controlled trial is predicated on an understanding of the various technical aspects of the surgical procedure, such as avoiding excessive heat during reaming, ensuring appropriate implant positioning, and appreciating the need for performing associated procedures when anatomically appropriate, as well as their potential effect on clinical outcome. This paper will review the initial technique described in 2013 and provide key clinical care suggestions resulting from the 10 years of experience with polyvinyl alcohol hydrogel implant hemiarthroplasty for the surgical treatment of hallux rigidus.

Levels of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Orthogonal Locked Plating for Tibiotalocalcaneal Arthrodesis
Authors: Ciufo David J. , Grant Allan M.
Published: January 2021

Management of concomitant tibiotalar and subtalar arthrosis, particularly in the setting of talar avascular necrosis or deformity, is a challenging problem. There are poor union rates and risk of stress fracture at the proximal aspect of intramedullary devices. Fixation can be poor in the calcaneus and talus with current methods. This study describes the technique of orthogonal plating, using an anatomic precontoured plating system, for tibiotalocalcaneal arthrodesis, with and without bulk allograft. We feel this technique provides increased construct stability and good outcomes, and 2 of our cases are presented that underwent arthrodesis using this construct at a single academic center.

Level of Evidence: Therapeutic level IV, case series. See Instructions for Authors for a complete description of levels of evidence.
Traumatic Hallux Varus: Operative Technique Guide
Authors: Kadakia Rishin J. , Sharma Akhil , Sam Jerry , Parekh Selene G.
Published: January 2021

Traumatic hallux varus, although rare in occurrence, requires thoughtful clinical attention due to its disabling nature and the natural progression of this deformity. Although there is abundant literature on capsuloligamentous injuries, the traumatic hallux varus variant of this injury type currently exists solely as isolated case reports. Because of its infrequent presentation and limited research on the pathology, there exists a paucity in management options and surgical techniques. Conventional treatment methods listed in management of traumatic hallux varus are limited to tenodesis of the adductor tendon using suture imbrication of the capsuloligamentous complex, extensor split tenodesis, and soft tissue anchors. These come with various limitations, including the inability to identify the adductor tendon and restore its length to successfully perform a primary repair. In the present techniques report, a novel method for treatment of both subacute and chronic traumatic hallux varus is described that allows the surgeon to best restore the lateral capsuloligamentous complex anatomy via dual lateral capsuloligamentous reconstruction with a medial percutaneous soft tissue release.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
The Proximal Opening Wedge Osteotomy: A Review of the Evidence and Technique
Authors: Watson Troy S. , Hsiao Mark S. , Harasym Chris , Walsh John P.
Published: January 2021

The treatment of symptomatic, moderate-to-severe hallux valgus deformities offers numerous challenges to the foot and ankle surgeon. Many surgical procedures have been described for the correction of metatarsus primus varus with moderate-to-severe hallux valgus deformity. For the larger deformity, surgeons typically turn toward a shaft or basilar osteotomy or opt for a Lapidus-type procedure. The proximal opening wedge osteotomy has become popular with the recent development of specifically designed, low-profile, opening wedge, proximal metatarsal systems. Despite initial success and popularity, a reported 3% to 11% recurrence rate has been described in the literature. In this paper, we review the evidence, our indications, contraindications, technique, and pearls for success. We believe that the proximal opening wedge osteotomy technique provides excellent correction, is technically reproducible, easy to perform, and should be an option in every surgeon’s toolbox. As techniques continue to evolve, we have added a closing wedge or distal biplanar osteotomy in those cases presenting with an increased distal metatarsal articular angle, to better achieve an isometric correction of the first metatarsal and prevent a late recurrence.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Diagnosis and Treatment of Persistent Problems After Ankle Sprains: Surgical Management of Osteochondral Lesions of the Talus
Authors: Hansen Oliver B. , Eble Stephanie K. , Drakos Mark C.
Published: January 2021

Ankle sprains are common injuries that can lead to persistent disability and pain for many patients. Such symptoms are often a result of damage to the articular cartilage of the talar dome and the subchondral bone, an injury broadly classified as an osteochondral lesion of the talus. Lesions indicated for surgery can be treated with a range of methods. These generally fall into the categories of reparative treatment, which is suitable for smaller lesions and can typically be performed arthroscopically, or replacement strategies, which can provide superior outcomes for large lesions but often require an open approach. In recent years, many treatment options have incorporated stem cells and other biologics that seek to improve healing. We will provide an overview of indications for the treatment of talar osteochondral lesions and current treatment strategies before discussing our favored technique, outcomes, and potential complications.
Prevention of Proximal Junctional Kyphosis or Failure: Soft Landings and Tension Band Augmentation
Authors: Mehta Vikram A. , Wang Timothy Y. , Sankey Eric W. , Goodwin C. Rory , Abd-El-Barr Muhammad M. , Karikari Isaac O.
Published: January 2021

As adult spinal deformity surgery becomes more prevalent, the rates of proximal junctional kyphosis (PJK) will rise proportionally. The exact mechanism of PJK is unknown. However, it is thought to be multifactorial and includes violation of the facets and disruption of the posterior ligamentous complex. There are multiple techniques that are aimed at reducing the pathologic forces at the interface of the proximal aspect of the construct and normal anatomy. In this review, the authors shall discuss the causes of PJK and new techniques such as spinous process hooks, transitional rods, and tethering that have been developed to reduce the rates of PJK.
Functional Effects of Intervening Illnesses and Injuries After Critical Illness in Older Persons
Authors: Gill Thomas M. , Han Ling , Gahbauer Evelyne A. , Leo-Summers Linda , Murphy Terrence E. , Ferrante Lauren E.
Published: January 2021

OBJECTIVES:

Intervening illnesses and injuries have pronounced deleterious effects on functional status in older persons, but have not been carefully evaluated after critical illness. We set out to evaluate the functional effects of intervening illnesses and injuries in the year after critical illness.

DESIGN:

Prospective longitudinal study of 754 nondisabled community-living persons, 70 years old or older.

SETTING:

Greater New Haven, CT, from March 1998 to December 2018.

PATIENTS:

The analytic sample included 250 ICU admissions from 209 community-living participants who were discharged from the hospital.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Functional status (13 activities) and exposure to intervening illnesses and injuries leading to hospitalization, emergency department visit, or restricted activity were assessed each month. Comprehensive assessments (for covariates) were completed every 18 months. In the year after critical illness, recovery of premorbid function was observed for 169 of the ICU admissions (67.6%), and the mean (sd) number of episodes of functional decline (from 1 mo to the next) was 2.2 (1.6). The adjusted hazard ratios (95% CI) for recovery were 0.18 (0.09–0.39), 0.46 (0.17–1.26), and 0.75 (0.48–1.18) for intervening hospitalizations, emergency department visits, and restricted activity, respectively. For functional decline, the corresponding odds ratios (95% CI) were 2.06 (1.56–2.73), 1.78 (1.12–2.83), and 1.25 (0.92–1.69). The effect sizes for hospitalization and emergency department visit were larger than those for any of the covariates.

CONCLUSIONS:

In the year after critical illness, intervening illnesses and injuries leading to hospitalization and emergency department visit are strongly associated with adverse functional outcomes, with effect sizes larger than those of traditional risk factors. To improve functional outcomes, more aggressive efforts will be needed to prevent and manage intervening illnesses and injuries after critical illness.
A Perfect Match? A Scoping Review of the Influence of Personality Matching on Adult Mentoring Relationships—Implications for Academic Medicine
Authors: Huggett Kathryn N. , Borges Nicole J. , Blanco Maria A. , Wulf Karyn , Hurtubise Larry
Published: January 2021

Introduction:

Mentoring is a widely regarded faculty development strategy in academic medicine. However, the lack of understanding about mentoring relationship dynamics limits effective recruitment, implementation, and evaluation. Despite decades of publications describing adult mentoring initiatives, few studies examine personality influence in mentoring relationships. This scoping review examined the extent, range, and nature of the research on personality matching in mentoring relationships, and identified research gaps in the literature.

Methods:

Scoping review methodology guided a search of six databases representing higher education, health sciences education, and professional contexts where mentoring is used. Consistent with the inclusive approach of a scoping review, authors included academic papers and other article types.

Results:

The scoping review yielded 39 articles. Literature mostly originated in the United States, publication sources represented multiple disciplines, and the context for the majority of articles was the workplace. The most common publication type was a research report. Although all articles addressed personality or mentoring, only three articles examined personality matching and its contribution to the mentoring relationship. Finally, although the Big Five personality traits were cited in multiple studies, other personality frameworks were used.

Discussion:

Academic medicine expends resources developing and supporting mentoring programs but there remains limited understanding of how best to identify and match mentors and protégés. Further understanding of the role of joint and unique personality traits in academic medicine mentoring relationships seems necessary, if the field continues to invest, time, money, and resources for mentoring programs.
A Systematic Review and Narrative Synthesis: Determinants of the Effectiveness and Sustainability of Measurement-Focused Quality Improvement Trainings
Authors: Khurshid Zuneera , De Brún Aoife , Martin Jennifer , McAuliffe Eilish
Published: January 2021

Introduction:

The ability of health care professionals to measure change is critical for successful quality improvement (QI) efforts. Currently, there are no systematic reviews focusing on continuing education for health care professionals in data skills for QI. The purpose of this systematic review is to define effectiveness and sustainability of QI programs for health care professionals containing a measurement skills component and to identify barriers and facilitators to effectiveness and sustainability.

Methods:

The systematic review involved study identification, screening, full text review, and data extraction. Four electronics databases and grey literature sources were searched to identify studies published between 2009 and 2019 (11 years). A customized data extraction form was developed. Mixed methods appraisal tool was used for quality assessment and a thematic analysis was conducted for narrative synthesis.

Results:

Fifty-three studies from 11 countries were included. Most study designs were quantitative descriptive (17/53) and used a blended learning approach (25/53) combining face-to face and distance learning modes. The programs included basic, intermediate, and advanced data skills concepts. Overall, studies reported positive outcomes for participant reaction, learning, and behavior, but reported variable success in sustainability and spread of QI.

Discussion:

Studies discussed measurement as a key competency for clinical QI. Effectiveness definitions focused on the short-term impact of the programs, whereas sustainability definitions emphasized maintenance of outcomes and skills in the long-term. Factors that influenced effectiveness and sustainability of the included studies were strategic approach to QI, organizational support, intervention design, communication, accountability, leadership support, and learning networks.
Immune-related genes STIM1, ITPKC and PELI1 polymorphisms are associated with risk of colorectal cancer
Authors: Zhu Lei , Zheng Yuqin , Wu Tao , He Jiaxing , Fang Xiongchao , Zhou Shuai , Wang Ke , Wang Nan
Published: January 2021

Objectives

STIM1, ITPKC and PELI1 are all immune-related genes that take part in the T cell activation, toll-like receptor and IL1 receptor pathways. The goal of this study was to evaluate the associations between STIM1, ITPKC and PELI1 polymorphisms and colorectal cancer (CRC) risk.

Methods

Six single nucleotide polymorphisms (SNPs) in STIM1, ITPKC and PELI1 were genotyped using a MassARRAY platform in a discovery cohort including 480 CRC cases and 480 healthy individuals and validated in a replication cohort including 505 CRC cases and 510 controls.

Results

The minor alleles of rs3794050, rs3750996 and rs2607420 were associated with an increased CRC risk (P < 0.05). In contrast, the minor allele of rs329497 was correlated with reduced disease risk (P = 0.025). Genetic model analysis showed that rs3794050 was related to an increased risk of disease in recessive and log-additive models (P < 0.05); rs3750996 had a strong correlation with CRC risk under all genetic models (P < 0.02); rs2607420 was correlated with an increased risk of disease in dominant and log-additive models (P < 0.01); whereas the protective effect of rs329497 on CRC risk was observed in dominant and log-additive models (P < 0.05). Finally, the association between the above SNPs and CRC risk was validated in a replication cohort (P < 0.05).

Conclusions

Our results could be helpful for the early screening of individuals with high CRC risk.
Investigation of the current situation of nipple-sparing mastectomy: a large multicenter study in China (CSBrs-003)
Authors: Zhu Li , Yan Yang , Tian Lin , Yang Li , Bao Bao-Shi , Kang Hua , Wang Jian-Dong
Published: January 2021

Background:

Mastectomy techniques have been extended to nipple-sparing mastectomy (NSM). This study aimed to assess the actual application of NSM in China and identify the factors influencing postoperative complications.

Methods:

The clinical data of 615 patients (641 surgeries) undergoing NSM from January 1st, 2018 to December 31st, 2018 at 28 centers nationwide were retrospectively analyzed to obtain the rate of NSM and investigate factors related to NSM surgery.

Results:

The proportion of NSM surgery performed in this study was 2.67% (17/641). Malignant breast tumors accounted for the majority of NSM surgery (559/641, 87.2%). A total of 475 (77.3%) patients underwent NSM combined with reconstructive surgery. The rate of reconstruction decreased with age in our study, and implants were the most common option (344/641, 53.7%) in reconstruction. Radial incision was the most selected method regardless of reconstruction. However, for those who underwent reconstruction surgery, 18.4% (85/462) of cases also chose curvilinear incision, while in the simple NSM surgery group, more patients chose circumareolar incision (26/136, 19.1%). The tumor-to-nipple distance (TND) influenced postoperative complications (P = 0.004). There were no relationships between postoperative complications and tumor size, tumor location, histologic grade, molecular subtype, nipple discharge, and axillary lymph nodes.

Conclusions:

NSM surgery is feasible and only TND influenced postoperative complications of NSM surgery. But the proportion of NSM surgery performed is still low in nationwide centers of China. The selection criteria for appropriate surgical methods are important for NSM in clinical practice. To optimize clinical applications of NSM, further multicenter prospective randomized controlled studies are needed.

Trial Registration:

ChiCTR.org.cn, ChiCTR1900027423; http://www.chictr.org.cn/showprojen.aspx?proj=38739
Neural control of pressure support ventilation improved patient-ventilator synchrony in patients with different respiratory system mechanical properties: a prospective, crossover trial
Authors: Liu Ling , Xu Xiao-Ting , Yu Yue , Sun Qin , Yang Yi , Qiu Hai-Bo
Published: January 2021

Background

Conventional pressure support ventilation (PSP) is triggered and cycled off by pneumatic signals such as flow. Patient-ventilator asynchrony is common during pressure support ventilation, thereby contributing to an increased inspiratory effort. Using diaphragm electrical activity, neurally controlled pressure support (PSN) could hypothetically eliminate the asynchrony and reduce inspiratory effort. The purpose of this study was to compare the differences between PSN and PSP in terms of patient-ventilator synchrony, inspiratory effort, and breathing pattern.

Methods

Eight post-operative patients without respiratory system comorbidity, eight patients with acute respiratory distress syndrome (ARDS) and obvious restrictive acute respiratory failure (ARF), and eight patients with chronic obstructive pulmonary disease (COPD) and mixed restrictive and obstructive ARF were enrolled. Patient-ventilator interactions were analyzed with macro asynchronies (ineffective, double, and auto triggering), micro asynchronies (inspiratory trigger delay, premature, and late cycling), and the total asynchrony index (AI). Inspiratory efforts for triggering and total inspiration were analyzed.

Results

Total AI of PSN was consistently lower than that of PSP in COPD (3% vs. 93%, P = 0.012 for 100% support level; 8% vs. 104%, P = 0.012 for 150% support level), ARDS (8% vs. 29%, P = 0.012 for 100% support level; 16% vs. 41%, P = 0.017 for 150% support level), and post-operative patients (21% vs. 35%, P = 0.012 for 100% support level; 15% vs. 50%, P = 0.017 for 150% support level). Improved support levels from 100% to 150% statistically increased total AI during PSP but not during PSN in patients with COPD or ARDS. Patients’ inspiratory efforts for triggering and total inspiration were significantly lower during PSN than during PSP in patients with COPD or ARDS under both support levels (P < 0.05). There was no difference in breathing patterns between PSN and PSP.

Conclusions

PSN improves patient-ventilator synchrony and generates a respiratory pattern similar to PSP independently of any level of support in patients with different respiratory system mechanical properties. PSN, which reduces the trigger and total patient's inspiratory effort in patients with COPD or ARDS, might be an alternative mode for PSP.

Trial Registration

ClinicalTrials.gov, NCT01979627; https://clinicaltrials.gov/ct2/show/record/NCT01979627.
Pain management after complex spine surgery
Authors: Waelkens Piet , Alsabbagh Emissia , Sauter Axel , Joshi Girish P. , Beloeil Hélène
Published: January 2021

BACKGROUND

Complex spinal procedures are associated with intense pain in the postoperative period. Adequate peri-operative pain management has been shown to correlate with improved outcomes including early ambulation and early discharge.

OBJECTIVES

We aimed to evaluate the available literature and develop recommendations for optimal pain management after complex spine surgery.

DESIGN AND DATA SOURCES

A systematic review using the PROcedure SPECific postoperative pain managemenT methodology was undertaken. Randomised controlled trials and systematic reviews published in the English language from January 2008 to April 2020 assessing postoperative pain after complex spine surgery using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, EMBASE and Cochrane Databases.

RESULTS

Out of 111 eligible studies identified, 31 randomised controlled trials and four systematic reviews met the inclusion criteria. Pre-operative and intra-operative interventions that improved postoperative pain were paracetamol, cyclo-oxygenase (COX)-2 specific-inhibitors or non-steroidal anti-inflammatory drugs (NSAIDs), intravenous ketamine infusion and regional analgesia techniques including epidural analgesia using local anaesthetics with or without opioids. Limited evidence was found for local wound infiltration, intrathecal and epidural opioids, erector spinae plane block, thoracolumbar interfascial plane block, intravenous lidocaine, dexmedetomidine and gabapentin.

CONCLUSIONS

The analgesic regimen for complex spine surgery should include pre-operative or intra-operative paracetamol and COX-2 specific inhibitors or NSAIDs, continued postoperatively with opioids used as rescue analgesics. Other recommendations are intra-operative ketamine and epidural analgesia using local anaesthetics with or without opioids. Although there is procedure-specific evidence in favour of intra-operative methadone, it is not recommended as it was compared with shorter-acting opioids and due to its limited safety profile. Furthermore, the methadone studies did not use non-opioid analgesics, which should be the primary analgesics to ultimately reduce overall opioid requirements, including methadone. Further qualitative randomised controlled trials are required to confirm the efficacy and safety of these recommended analgesics on postoperative pain relief.
Pregnancy from mosaic embryo transfer: genetic counseling considerations
Authors: Chen Kelly , Darcy Diana , Boyd Allison
Published: January 2021

Purpose of review

The transfer of mosaic embryos during an IVF procedure is becoming more common. There is limited information regarding the outcomes for such transfers, making it difficult to establish best practices for prenatal counseling of patients considering transfer of mosaic embryos. In addition, genetic counseling may be delivered by different providers in the preimplantation and pregnancy timeframes which can contribute to inconsistent information.

Recent findings

There are many types of aneuploid results from preimplantation genetic testing for aneuploidy (PGT-A), with mosaicism being a possibility. Recent studies have reported normal prenatal diagnostic results, pregnancy and birth outcomes with mosaic embryo transfers. Reproductive and prenatal society guidelines recommend diagnostic testing in pregnancy following a mosaic result by PGT-A. Prenatal genetic counseling providers should consider the available information from the PGT-A result, emphasizing the benefits and limitations of each available prenatal test in detecting the fetal chromosome complement.

While transfer of mosaic embryos can allow couples without euploid embryos to have a chance of a viable pregnancy, further studies are necessary to better guide this decision-making. In addition, better coordination between reproductive providers and prenatal providers could improve prenatal care.
Blood pressure control and progression of arteriosclerosis in hypertension
Authors: Huang Zhe , Wang Guodong , Jonas Jost B. , Ji Chunpeng , Chen Shuohua , Yuan Yu , Shen Chengli , Wu Yuntao , Wu Shouling
Published: January 2021

Objective:

Using the brachial--ankle pulse wave velocity (baPWV) as a biomarker for arteriosclerosis, we studied the effect of blood pressure (BP) and BP control on arteriosclerosis progression.

Methods and results:

The community-based longitudinal Kailuan study included 6552 participants [4938 (75.37%) men] with a mean follow-up of 4.62 ± 2.21 years. Hypertension was defined based on the Joint National Committee (JNC7) criteria and the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines. All study participants had hypertension and were stratified as follows according to BP at baseline and follow-up: the normal--normal [normal BP (under therapy) at baseline and final follow-up], normal--hypertensive, hypertensive--normal, and hypertensive--hypertensive groups. Using the JNC7-based hypertension definition, the annual baPWV increase was the highest (P < 0.001) in the hypertensive--hypertensive group [17.32 cm/s; 95% confidence interval [CI]:9.7--24.9], followed by the normal--hypertensive group (14.44 cm/s; 95% CI:5.5--23.4), and the hypertensive--normal group (0.88 cm/s; 95% CI: −7.84 to 9.60), with the normal--normal group as the reference group in a multivariable model. The model additionally included parameters, such as age, baseline baPWV, heart rate, BMI, serum glucose concentration, prevalence of antihypertensive treatment and alcohol consumption, heart rate, and estimated glomerular filtration rate. Applying the ACC/AHA guidelines and the same multivariable model, the annual baPWV increase was the highest (P < 0.001) in the hypertensive--hypertensive group (43.54 cm/s; 95% CI: 22.54--64.55), followed by the normal--hypertensive group (34.01 cm/s; 95% CI: 10.39--57.62) and the hypertensive--normal group (24.12 cm/s; 95% CI: 1.24--47.00).

Conclusion:

Lower BP and medical reduction in increased BP were associated with a reduction in the baPWV increase and may delay the progression of arteriosclerosis in hypertensive patients.
Chlorthalidone versus hydrochlorothiazide: major cardiovascular events, blood pressure, left ventricular mass, and adverse effects
Authors: Roush George C. , Messerli Franz H.
Published: January 2021

Background:

There is continuous debate whether chlorthalidone (CTD) and hydrochlorothiazide (HCTZ) differ in reducing major cardiovascular events (MACE). HCTZ is prescribed 10 times more commonly than CTD.

Method:

A systematic literature search yielded 14 references, including two network meta-analyses of randomized trials with MACE and left ventricular mass as outcomes.

Results:

The network meta-analysis of randomized trials showed CTD reducing MACE more than HCTZ, hazard ratio = 0.79 (0.72–0.88), P < 0.0001, and an observational cohort study gave an identical point estimate: hazard ratio = 0.79 (0.68–0.92), P = 0.002. In contrast, two observational cohort studies reported no differences between CTD and HCTZ. However, in the studies showing the superiority of CTD median follow-up was 4.3 and 7.0 years, respectively, whereas in the latter studies showing no difference between the two drugs follow-up was only 0.95 and 0.25 years. As differences in outcomes for MACE in hypertension trials with various interventions only emerge after prolonged (>1 year) therapy, differences in follow-up explain these discrepant results. CTD also more effectively reduced left ventricular mass in observational data and network analysis of trials. These advantages of CTD over HCTZ are consistent with greater reductions in night-time blood pressure, greater reductions in oxidative stress and platelet aggregation, and greater improvements in endothelial function.

Conclusion:

Over the short-term there were no differences in the net clinical benefit between HCTZ and CTD. However, long-term available data document CTD to be significantly more effective in reducing MACE than HCTZ. The Veterans Administration's trial in progress may provide definitive answer to these questions.
Increased pulse wave velocity in patients with an orthostatic blood pressure rise independent of other cardiovascular risk factors
Authors: Nolde Janis M. , Lugo-Gavidia Leslie Marisol , Kannenkeril Dennis , Chan Justine , Matthews Vance B. , Carnagarin Revathy , Azzam Omar , Kiuchi Márcio Galindo , Schlaich Markus P.
Published: January 2021

Background:

Positional changes in blood pressure (BP) have been shown to have effects on long-term outcomes. Although a BP drop with upright posture is frequently observed, an orthostatic rise in BP can also occur. Here, we aimed to investigate whether the phenotype of orthostatic hypertension is associated with more pronounced vascular hypertension-mediated organ damage (HMOD) and whether this is associated with other cardiovascular risk factors.

Methods:

In a cohort of 200 patients referred to our tertiary hypertension clinic, we prospectively assessed unattended seated automated office BP and the response to 1 min of upright posture. The difference in BP after standing up was calculated and pulse wave velocity (PWV) was assessed as a marker of vascular HMOD. Routine clinical cardiovascular risk markers were also assessed. Regression models were used to assess the association between orthostatic BP changes and pulse wave velocity.

Results:

Baseline characteristics and clinic cardiovascular risk factors were similar between orthostatic BP response groups. A U-shaped association was evident between PWV and orthostatic BP changes with elevated PWV in patients with either a fall or a rise in BP in response to upright posture. The regression models remained significant after adjusting for other cardiovascular risk factors, including 24 h ambulatory BP.

Conclusion:

Both an orthostatic BP drop and rise were associated with elevated PWV. Although standing BP is commonly measured in elderly hypertensive patients to exclude significant orthostatic hypotension, this simple measurement may provide an additional independent risk factor for vascular HMOD at any age.
Association of age and blood pressure among 3.3 million adults: insights from China PEACE million persons project
Authors:   The China PEACE Collaborative Group∗
Published: January 2021

Objective:

To assess the association between blood pressure (BP) with age and its heterogeneity across various sociodemographic subgroups in China.

Methods:

In this cross-sectional study, we analysed the data from nearly 3.3 million individuals aged 35–75 years from all 31 provinces in mainland China collected from September 2014 through August 2019. On the basis of possible combinations of eight characteristics and antihypertensive status, subgroups of at least 10 000 individuals were created and the age--blood pressure relationship was determined for each group.

Results:

The study included 3 291 058 participants (59.6% women), with a mean age of 55.8 ± 9.8 years. The prevalence of hypertension was 47.6%, of which 30.0% were taking antihypertensive medications. The mean SBP was 135.9 ± 20.2 mmHg. SBP increased at a mean unadjusted rate of 0.639 ± 0.001 mmHg/year. For 95% of the 25 145 subgroups, the SBP increased by 0.28--0.85 mmHg/year. The most common characteristics in the subgroups with the steepest association were female sex, rural area, low education, low-income family, Tibet region, and farmer occupation. The increase in SBP ranged from 0.13 to 0.41 mmHg/year for 95% of the treated subgroups and from 0.33 to 0.82 mmHg/year for 95% of the untreated subgroups.

Conclusion:

Blood pressure is positively associated with age in this study, with almost three-fold variation across subgroups, indicating subgroup differences in biology, behaviour, or exposures. Antihypertension strongly blunts the association of age and blood pressure and diminishes the variation.
Meal patterns and incident hypertension in community-dwelling middle-aged adults: an 11-year follow-up cohort study
Authors: Shang Xianwen , Flehr Alison , Fang Yujie , He Mingguang
Published: January 2021

Objective:

We aimed to examine whether meal patterns, as well as energy intake from three main meals and snacks, were associated with incident hypertension.

Methods:

We included 12 995 participants aged 18–59 years from the China Health and Nutrition Survey in the final analysis. Dietary intake was assessed using weighing methods in combination with 24-h food records. Cox proportional hazards regression models were used to examine the association of meal patterns, and energy intake from different meals with incident hypertension.

Results:

During a mean follow-up of 11.2 years, 4766 new hypertension cases were documented. Four meal patterns were derived according to energy intake: balanced, breakfast dominant, lunch dominant, and dinner dominant patterns. Dinner dominant meal pattern was associated with a lower risk of incident hypertension [hazard ratio (95% confidence interval): 0.90 (0.84–0.98)] compared with the balanced meal pattern. Breakfast energy intake was positively, but dinner energy intake was inversely associated with incident hypertension. The positive association between breakfast energy intake and incident hypertension was observed in rural residents only [1.22 (1.07–1.41) for rural residents, 0.98 (0.82–1.18) for urban residents; P interaction = 0.0348]. A positive association between energy intake from lunch and incident hypertension was observed in the urban residents only.

Conclusion:

Dinner dominant meal pattern was associated with a lower risk of hypertension compared with the balanced meal pattern in Chinese adults. A relatively small breakfast and large dinner may help to prevent or delay the development of hypertension, especially in urban residents.
Endothelial function of healthy adults from 20 to 91 years of age: prediction of cardiovascular risk by vasoactive range
Authors: Königstein Karsten , Wagner Jonathan , Frei Mirijam , Knaier Raphael , Klenk Christopher , Carrard Justin , Schwarz Achim , Hinrichs Timo , Schmidt-Trucksäss Arno
Published: January 2021

Objectives:

Brachial arterial low flow-mediated constriction (L-FMC) and flow-mediated dilation (FMD) are ultrasound-based biomarkers that emerge into scientific and clinical practice indicating cardiovascular effects of medical and lifestyle-based treatment beyond classical risk factors. This study is the first to provide reference values and to assess the predictive value of L-FMC, FMD and their composite endpoint vasoactive range (VAR) in healthy adults.

Methods:

L-FMC, FMD and VAR were measured in 457 nonsmoking adults of 20–91 years without chronic diseases, medication, with normal heart function and very low cardiovascular risk. Sex-specific percentiles were calculated and predictive ability for elevated cardiovascular risk was assessed using receiver-operating characteristic (ROC) curves.

Results:

From 20 to 91 years of age, L-FMC increased 86.1 and 105.3%, FMD decreased 63.6 and 47.1% and VAR decreased 58.3 and 55.2% in women and men, respectively. Area under the ROC curves was 0.54 (95% CI = 0.49–0.54) for L-FMC, 0.67 (95% CI = 0.62–0.67) for FMD and 0.72 (95% CI = 0.67–0.72) for VAR (P < 0.001). Discriminatory cut-offs for elevated risk were 0.24% for L-FMC (sensitivity = 0.42, specificity = 0.67), 6.4% for FMD (sensitivity = 0.71, specificity = 0.60) and 6.3% for VAR (sensitivity = 0.62, specificity = 0.73).

Conclusion:

This study demonstrates reduced endothelial function with aging in healthy men and women with very low cardiovascular risk. Percentiles crossed cut-offs for elevated cardiovascular risk between 50 and 55 years in men and 70 and 75 years in women, indicating higher risk for cardiovascular disease in men. VAR showed the highest ability to identify individuals with elevated cardiovascular risk, and should be included in the monitoring and treatment of accelerated vascular aging even in healthy individuals.
Effect of concomitant use of antihypertensives and immune check point inhibitors on cancer outcomes
Authors: Kichenadasse Ganessan , Miners John O. , Mangoni Arduino A. , Rowland Andrew , Sorich Michael J. , Hopkins Ashley M.
Published: January 2021

Objectives:

Antihypertensives and cancer have a complex relationship. Among the antihypertensives, renin--angiotensin system inhibitors have strong immune modulatory activities that may affect immune check point inhibitors-related outcomes in cancer patients. We evaluated the association between concomitant use of renin--angiotensin system inhibitors and other antihypertensive agents with survival/toxicity outcomes from atezolizumab.

Methods:

A post hoc analysis of individual patient data from seven clinical trials of lung, renal or urothelial cancers was performed. Users and nonusers of antihypertensive classes were compared for overall survival, progression-free survival and immune adverse events. Cox proportional hazards were calculated between the groups and reported as hazards ratio and 95% confidence interval (95% CI).

Results:

Of the 3695 patients, 2539 were treated with atezolizumab and the rest with chemotherapy. Twenty-four percent of patients were on a renin--angiotensin system inhibitor at trial commencement. No statistically significant difference in overall survival (hazard ratio 0.92, 95% CI 0.79–1.07, P = 0.29), progression-free survival (hazard ratio 0.95, 95% CI 0.84–1.08, P = 0.42) or immune adverse events (odds ratio 0.94, 95% CI 0.76–1.15, P = 0.55) between renin--angiotensin system inhibitor users and nonusers were identified in the atezolizumab-treated cohort. Other classes of antihypertensives were also not associated with survival.

Conclusion:

Concomitant use of antihypertensives including RASi was not associated with survival and immune-related safety outcomes during atezolizumab therapy for solid cancers. Future studies should evaluate the association between antihypertensives and other ICI as well as ICI combination interventions in clinical trials and real-world settings.
Use of Double vs. Single Radiation Monitoring Badge System for Fluoroscopy Users
Authors: Caracappa Peter F. , Weintraub Joseph , Krieg Kathleen
Published: January 2021

Objective

To analyze historical radiation dose data from fluoroscopy users at a major university medical center and compare the impact of two alternate dose monitoring methodologies.

Materials and Methods

Interventional radiologists have traditionally worn two radiation monitoring badges to estimate their radiation dose. This study evaluates if a single badge monitoring system can reduce the administrative burden of radiation monitoring without negatively impacting safety or compliance. This study reviewed the dose history data for a 10-y period including 114,500 individual dose measurements. These individuals were each issued two badges for each wear period, including one worn at the collar (outside a protective garment) and one worn at the chest or waist (beneath a protective garment). The dose for each of the badges was derived from the database of personnel dose records. Badges that could be clearly identified as improperly worn were excluded from the study. The EDE as assigned from the two-badge system and as derived from the wear of the collar badge only were both compared to the thresholds for ALARA notifications currently in use.

Results

Calculated EDE values are an average of 2.7 times higher when applying a one-badge system as compared to a two-badge system. This is observed to result in a slight increase in the ALARA notification frequency (excluding badges improperly worn in the two-badge system). The overall increase in notification frequency is small because notifications are dominated by dose to the lens of the eye.

Conclusion

Although providing less accurate personnel dose estimates relative to a two-badge system, the use of a one-badge monitoring system for fluoroscopy users may have a minimal effect on radiation dose records and “as low as (is) reasonably achievable” (ALARA) notifications, with potentially significant savings in notifications due to improper badge wear, volume of radiation monitoring badges handled, and cost of the radiation monitoring system.
Compression Sutures to Treat Acute Hydrops in a Case of Bilateral Post-Laser In Situ Keratomileusis Ectasia
Authors: Bevara Akhil , Vaddavalli Pravin K.
Published: January 2021

This a case report of acute hydrops with interface fluid syndrome in a patient with post-laser in situ keratomileusis (LASIK) ectasia treated with compression sutures. A patient with post-LASIK ectasia presented with acute hydrops and fluid accumulation in the LASIK flap–stromal interface sequentially in both eyes. Full thickness compression sutures were applied to appose the edges of the Descemet tear, and this resulted in a rapid resolution of stromal edema and interface fluid. The patient had best distance visual acuities of 20/40 and 20/60 at the last follow-up in the right and left eyes, respectively. Hydrops along with fluid in the interface needed early intervention to prevent complications such as epithelial ingrowth and interface haze. Compression sutures were useful in this case to help bridge the gap between the margins of Descemet tear, hastening the resolution of stromal edema and interface fluid.
Influence of Reading on Smartphone Screens on Visual Optical Quality Metrics and Tear Film Stability
Authors: Bettach Emmanuel , Zadok David , Abulafia Adi , Shoshani Avi , Ghebali Rony A. , Weill Yishay , Smadja David
Published: January 2021

Purpose:

To evaluate the impact of a prolonged reading session on a smartphone screen on optical quality metrics and tear film stability.

Methods:

This prospective study was conducted in 41 healthy volunteers who were asked to read an article on a smartphone screen for 20 minutes. The following tests were performed before the reading task in this consecutive order and repeated after the reading task in the same order: automated noninvasive tear break-up time, optical quality assessment including Objective Scatter Index (OSI), modulation transfer function, Strehl ratio, and tear film dynamic analysis as follows: vision break-up time (VBUT) as a function of OSI changes within 20 seconds, using a double-pass aberrometer imaging system, and fluorescein tear break-up time (FBUT) measured using the slit lamp.

Results:

All break-up time–related parameters (noninvasive tear break-up time, FBUT and VBUT) were significantly reduced after the reading task (P < 0.01). The OSI was significantly worsened after the reading task (P = 0.01), whereas all the other optical quality metrics (modulation transfer function and Strehl ratio) slightly deteriorated, were not statistically significant. A significant correlation was found between the shortening of the FBUT, VBUT, and the worsening of the OSI (r = −0.33, P < 0.05).

Conclusions:

A reading session on a smartphone screen in healthy subjects was found to significantly affect the tear film stability and objectively worsen the retinal image quality.