bluuebunny/crossref_metadata_2025 huggingface dataset:
A Randomized, Controlled, Evaluator-Blinded, Multi-Center Study of Hyaluronic Acid Filler Effectiveness and Safety in Lip Fullness Augmentation
Authors: Weiss Robert , Beer Kenneth , Cox Sue E. , Palm Melanie , Kaufman-Janette Joely , Bassichis Benjamin , Biesman Brian , Joseph John , Almegård Birgitta , Nilsson Anna , Edwartz Carolina
Published: February 2021

BACKGROUND

HARK was recently approved in the US for lip augmentation and correction of upper perioral rhytids.

OBJECTIVE

To demonstrate noninferiority of HARK versus a control (HAJV) in lip fullness augmentation at Week 8 after last injection (blinded evaluation). Secondary objectives were to evaluate the effectiveness and safety of HARK in lip fullness augmentation and correction of upper perioral rhytids.

METHODS AND MATERIALS

Treatment with HARK or control (randomized 2:1) was administered on Day 1 in this 48-week, evaluator-blinded study with optional touch-up at Week 4. Primary endpoint was change from baseline to Week 8 in lip fullness. Secondary endpoints included lip fullness, wrinkle severity, aesthetic improvement, subject satisfaction, adverse events, and local tolerability (subject diary entries).

RESULTS

The primary objective was met; HARK was noninferior to control in lip fullness augmentation at Week 8. Lip fullness and wrinkle severity improvement persisted at Week 48, and was accompanied by high aesthetic improvement and subject satisfaction scores. The mean volume of HARK injected was approximately 20% lower than control. Treatment-related adverse events and local tolerability symptoms were predominantly mild and transient.

CONCLUSION

HARK was noninferior to control in lip fullness augmentation at Week 8, well-tolerated, and effective throughout this 48-week study.
Validation of LexisNexis Accurint in the Georgia Cancer Registry’s Cancer Recurrence and Information Surveillance Program
Authors: Woolpert Kirsten M. , Ward Kevin C. , England Cameron V. , Lash Timothy L.
Published: February 2021

Background:

LexisNexis Accurint is a database of ~84 billion public records that includes an individual’s location of residence. Its ability to track residences longitudinally has not been validated. This study used the Georgia Cancer Registry’s (GCR’s) Cancer Recurrence and Information Surveillance Program (CRISP) to validate the U.S. state of residence and to examine characteristics of patients not included or who had an inaccurate entry in LexisNexis.

Methods:

The GCR is routinely linked to the National Death Index (NDI), providing information regarding the state of residence in which the patient died. We compared the state of residence reported in LexisNexis with the NDI gold standard state of residence at death. Multivariate logistic regression analyses estimated associations between demographic information and: (1) having a mismatch between LexisNexis and NDI and (2) being missed in LexisNexis.

Results:

Of the 69,494 patients in the CRISP cohort, 65,890 (95%) were found in LexisNexis and 9,597 (14%) had died. Among a subset of patients who were deceased, the sensitivity of LexisNexis for identifying persons who left Georgia was 42% and the specificity was 89%. Minority groups were more likely to be missed in the LexisNexis database as well as to have discordance between LexisNexis and NDI state of residence at death.

Conclusions:

LexisNexis Accurint failed to identify the emigration of more than half of deceased CRISP patients who had left Georgia but correctly identified most who had remained. The validity of the state of residence is important for studies using LexisNexis as a tool for follow-up.
HIV Viremia and Risk of Stroke Among People Living with HIV Who Are Using Antiretroviral Therapy
Authors: Harding Barbara N. , Avoundjian Tigran , Heckbert Susan R. , Whitney Bridget M. , Nance Robin M. , Ruderman Stephanie A. , Kalani Rizwan , Tirschwell David L. , Ho Emily L. , Becker Kyra J. , Zunt Joseph , Chow Felicia , Huffer Andrew , Mathews W. Christopher , Eron Joseph , Moore Richard D. , Marra Christina M. , Burkholder Greer , Saag Michael S. , Kitahata Mari M. , Crane Heidi M. , Delaney Joseph C.
Published: February 2021

Background:

Rates of stroke are higher in people living with HIV compared with age-matched uninfected individuals. Causes of elevated stroke risk, including the role of viremia, are poorly defined.

Methods:

Between 1 January 2006 and 31 December 2014, we identified incident strokes among people living with HIV on antiretroviral therapy at five sites across the United States. We considered three parameterizations of viral load (VL) including (1) baseline (most recent VL before study entry), (2) time-updated, and (3) cumulative VL (copy–days/mL of virus). We used Cox proportional hazards models to estimate hazard ratios (HRs) for stroke risk comparing the 75th percentile (“high VL”) to the 25th percentile (“low VL”) of baseline and time-updated VL. We used marginal structural Cox models, with most models adjusted for traditional stroke risk factors, to estimate HRs for stroke associated with cumulative VL.

Results:

Among 15,974 people living with HIV, 139 experienced a stroke (113 ischemic; 18 hemorrhagic; eight were unknown type) over a median follow-up of 4.2 years. Median baseline VL was 38 copies/mL (interquartile interval: 24, 3,420). High baseline VL was associated with increased risk of both ischemic (HR: 1.3; 95% CI = 0.96-1.7) and hemorrhagic stroke (HR: 3.1; 95% CI = 1.6-5.9). In time-updated models, high VL was also associated with an increased risk of any stroke (HR: 1.8; 95% CI = 1.4-2.3). We observed no association between cumulative VL and stroke risk.

Conclusions:

Our findings are consistent with the hypothesis that elevated HIV VL may increase stroke risk, regardless of previous VL levels.
Transversus abdominis plane block in urological procedures
Authors: Zayed Mohamed , Allers Katharina , Hoffmann Falk , Bantel Carsten
Published: February 2021

BACKGROUND

Transversus abdominis plane (TAP) blocks have been shown to successfully reduce pain and opioid consumption after general and gynaecological surgery.

OBJECTIVE

To evaluate whether TAP blocks alleviate pain and opioid consumption after urological procedures.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase and CENTRAL.

ELIGIBILITY CRITERIA

Without language restriction, randomised controlled trials (RCTs) that compared the effects of TAP blocks with placebo or no treatment in urological surgery.

MAIN OUTCOME MEASURES

Primary outcomes were pain intensities at rest and movement at 6, 12 and 24 h after surgery. Secondary outcomes were postoperative opioid consumption in the first 24 h after surgery and postoperative nausea and vomiting. We performed meta-analyses using random effects models. Effect sizes were expressed as mean differences for continuous variables. We used the Cochrane risk of bias tool (RoB 2.0) to assess risk of bias.

RESULTS

We analysed 20 RCTs comprising a total of 1239 patients. The risk of bias of the studies was relatively high. TAP blocks significantly reduced postoperative pain at all time points compared with placebo or no treatment. Mean differences on an 11-point pain intensity scale were between 0.55 (95% CI: −0.90, to −0.21; P = 0.002; I
2 = 94%) to 1.13 (95% CI: −1.62 to −0.65; P < 0.001; I
2 = 95%) less at rest and 0.74 (95% CI: −1.25 to −0.23; P = 0.005; I
2 = 79%) to 1.32 (95% CI: −1.83 to −0.81; P < 0.001; I
2 = 68%) less on movements. TAP blocks also reduced opioid consumption in the first 24 h after surgery significantly by 12.25 mg (95% CI: −17.99 to −6.52 mg; P < 0.001; I
2 = 99%) morphine equivalents. Possibly, this had no influence on postoperative nausea and vomiting (risk ratio: 0.98; 95% CI: 0.66 to 1.45; P = 0.91; I
2 = 30%).

CONCLUSION

TAP blocks seem to offer improved analgesia when used after urological surgery. However, due to the large heterogeneity between and the considerable risk of bias within the included studies results should be viewed with caution.

SYSTEMIC REVIEW REGISTRATION

PROSPERO CRD42018112737.
Activation of L-type calcium channels and attenuation of oxidative stress are involved in the improving effect of methyl jasmonate on learning and memory and its anxiolytic property in rats
Authors: Hemati Tahereh , Abbasnejad Mehdi , Mollashahi Mahtab , Esmaeili-Mahani Saeed , Shahraki Ali
Published: February 2021

The present study was designed to evaluate the effect of plant bioactive compound methyl jasmonate on learning and memory, anxiety-like behaviors, and brain oxidative stress in rats. It has been indicated that methyl jasmonate stimulates calcium-binding protein expression and increases intracellular calcium (Ca2+). Therefore, we investigated the potential role of L-type calcium channel on methyl jasmonate effects. The animals were intracerebroventriculary (i.c.v.) injected with different doses of methyl jasmonate (0.5, 2.5, and 5 µg/rat). L-type calcium channel blocker (nifedipine 5 µg/rat, i.c.v.) was injected 30 min before methyl jasmonate (5 µg/rat). Shuttle box apparatus was used to evaluate passive avoidance memory. Anxiety-like behaviors were assessed by open field and elevated plus maze tests. Lastly, oxidative stress-related indices were assessed in hippocampus and prefrontal cortex. The data showed that methyl jasmonate dose-dependently could improve passive avoidance learning and memory and reduce anxiogenic behaviors. The methyl jasmonate effects were significantly prevented by nifedipine. Furthermore, central microinjection of methyl jasmonate significantly decreased hydrogen peroxide concentration, and increased reactive oxygen species scavenger activity (catalase and peroxide enzymes) in rats’ hippocampus as well as prefrontal cortex. Indeed, the results indicated that the beneficial effects of methyl jasmonate on learning and memory and anxiety might be partly associated with L-type calcium channel and partly on the inhibition of oxidant indices.
Effect of Negative Pressure Wound Therapy in Electrical Burns
Authors: Gómez-Ortega Viviana , Vergara-Rodriguez María José , Mendoza Bibiana , García Tatiana
Published: February 2021

Electrical burns are capable of damaging cells through both thermal and nonthermal mechanisms. The complexity of these wounds, the deterioration in time, and the conversion during the first days make managing them a challenge. Negative pressure wound therapy (NPWT) is a technology that can be used as a tool to improve outcomes in patients with burns in the acute and reconstructive phases of the treatment. We describe 2 cases in which we apply this technology in electrical injuries. We present 2 cases of patients with electrical burns who underwent NPWT with instillation (NPWTi) with saline solution in the acute phase, to block the conversion of the burn and to improve the granulation tissue and in the reconstructive phase, as a tool to improve the grafts take. Both patients showed early formation of granulation tissue adequate for surgical reconstruction, and neither of them presented loss of skin grafts. In the acute phase, NPWT with instillation when applied in these patients showed fast formation of granulation tissue adequate for early reconstruction, whereas NPWT in the reconstructive phase when applied to bolster grafts showed improvements in grafts take. NPWT is a useful tool to support the surgical management of the electrical injuries during the acute phase to prepare the wound for early reconstruction and after the skin grafts reconstruction to improve the grafts take.
A Modification to Enhance the Survival of the Island FDMA Flap by Adding a Skin Bridge
Authors: Al Lahham Salim , Ahmed Mohamed Badie , Aljassem Ghanem , Sada Ruba , Alyazji Zaki T. N. , Thomas Jimmy
Published: February 2021

Background:

Distal thumb injuries are common in high construction load regions, and it is a challenging task for the plastic surgeon to find the optimum choice that preserves thumb length and provides a sensory substitute to the lost tissue. Introducing first dorsal metacarpal artery flap has solved the dilemma. One drawback is that the flap is susceptible to distal necrosis, which can happen because of tight tunneling or insufficient venous drainage. We combined Foucher and Holevich characteristics to design a flap that promises to solve the problem.

Methods:

This is a case series that includes 9 patients where we describe a technique that has the potential to enhance the survival of the first dorsal metacarpal artery (FDMA) flap and decreases the rate of distal necrosis via addition of a 5-mm skin bridge to the pedicle and by avoiding tunneling. Distal necrosis of the patients in this study patients was compared with that in a control of 10 patients in whom we did the conventional FDMA flap. Patients were followed for 6 weeks to trace early postoperative complications (infection, dehiscence, and necrosis) and the establishment of protective sensation (pain and temperature).

Results:

None of our patients had distal necrosis, infection, or dehiscence, and all had protective sensation in the flap. In comparison, 4 patients in the control group developed distal necrosis.

Conclusion:

FDMA is one of the best choices when it comes to distal thumb reconstruction, but it has the disadvantage of distal necrosis, which might be avoided when using the technique mentioned in this study.
Cardio-Oncology Rehabilitation (CORE) Exercise Prescription and Programming
Authors: Shultz Adam M. , Squires Ray W. , Shin John Y. , Durani Urshila , Pophali Priyanka A.
Published: February 2021

Background:

Patients with cancer almost universally report diminished health-related quality of life. Many patients experience persistent fatigue and most have below-average exercise capacities. Despite the publication of exercise guidelines for cancer survivors that encourage physical activity, few patients exercise on a regular basis. Cardiovascular disease is a major cause of death in early-stage malignancies. Exercise training has been demonstrated to decrease cardiovascular events in patients with cancer. In addition, regular exercise improves exercise capacity, reduces fatigue, and improves quality of life in cancer survivors.

Clinical Considerations:

A 2019 American Heart Association scientific statement, endorsed by the American Cancer Society, provided a framework and rationale for partnering with existing multidimensional, interdisciplinary outpatient cardiac rehabilitation programs to provide supervised exercise training and risk factor control services for patients with cancer and cancer survivors: cardio-oncology rehabilitation. In addition, the American College of Sports Medicine has published recommendations for cancer exercise training.

This article provides practical suggestions for incorporating patients with cancer into cardiac rehabilitation and for patient-specific exercise prescription. Illustrative patient case examples are provided.
Effects of Acute Exercise on Anxiety Ratings in Patients With Coronary Heart Disease and Elevated Anxiety
Authors: Malian Hannah M. , Smith Patrick J. , Hoffman Benson , Jiang Wei , Ammerman Katharine , Kraus William E. , Hinderliter Alan , Sherwood Andrew , Blumenthal James A.
Published: February 2021

Purpose:

To explore individual differences in state anxiety following a single, acute bout of aerobic exercise among anxious patients with diagnosed coronary heart disease (CHD).

Methods:

One hundred eighteen CHD patients with elevated symptoms of anxiety enrolled in the UNderstanding the Benefits of Exercise and Escitalopram in Anxious Patients WIth coroNary Heart Disease (UNWIND) clinical trial rated their level of anxiety using a 100-mm visual analog scale before and after a symptom-limited exercise treadmill test. A number of exercise (eg, peak oxygen uptake, exercise duration, maximum heart rate, anaerobic threshold) and psychological variables were examined as potential predictors of exercise response. Changes in anxiety and their association with psychological variables were examined using general linear models.

Results:

Fifty patients (42%) rated a reduction in anxiety relative to their pre-exercise ratings following the exercise treadmill test. While a number of factors were examined, the only factor that distinguished those individuals who reported a reduction in anxiety symptoms compared with those who either remained the same or actually reported an increase in anxiety was a higher pre-exercise visual analog scale anxiety rating. No differences were observed as a function of sex, severity of trait anxiety, the presence of an anxiety disorder, exercise test duration, or age.

Conclusions:

Although many variables were examined, only higher baseline anxiety distinguished those who showed a reduction in their visual analog scale ratings from those whose anxiety remained the same or got worse. The extent to which the response to acute exercise predicts the anxiolytic effects of chronic exercise needs further study.
Review of Trials on Exercise-Based Rehabilitation Interventions Following Acute Decompensated Heart Failure
Authors: Babu Abraham Samuel , Arena Ross , Satyamurthy Akhila , Padmakumar Ramachandran , Myers Jonathan , Lavie Carl J.
Published: February 2021

Purpose:

Cardiac rehabilitation is an important intervention for patients with heart failure. However, its clinical application in acute decompensated heart failure (ADHF) remains underutilized with limited research available. An assessment of current research in this area will help guide future investigations. The aim of this review is to summarize the current research focusing on rehabilitation interventions following recovery from ADHF.

Review Methods:

A systematic search was carried out on all trials registered in the clinical trial registry database of the World Health Organization—International Clinical Trial Registry Platform (WHO-ICTRP). Studies focusing on ADHF and utilizing any exercise and rehabilitation-based intervention were included.

Results:

A majority of 11 trial protocols, including 3827 participants with low ejection fraction (<40%), were identified from the WHO-ICTRP database. Majority of the protocols (64%) focused on exercise-based interventions with approximately one-quarter (29%) focusing on neuromuscular electrical stimulation and one on noninvasive ventilation during exercise. Irrespective of the mode of exercise, all protocols employed low-moderate intensity training with outcomes focusing on physical function and quality of life.

Conclusion:

Studies on rehabilitative interventions for ADHF are still in their early stages. More research is needed using innovative methodologies and testing for feasibility and fidelity.
Evaluation of the American Association of Cardiovascular and Pulmonary Rehabilitation Exercise Risk Stratification Classification Tool Without Exercise Testing
Authors: Bhat Anusha G. , Farah Michel , Szalai Heidi , Lagu Tara , Lindenauer Peter K. , Visintainer Paul , Pack Quinn R.
Published: February 2021

Purpose:

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommends that patients starting cardiac rehabilitation (CR) undergo stratification to identify risk for exercise-related adverse events (AE), but this tool has not been recently evaluated.

Methods:

Among patients who enrolled in CR in 2016, we used the AACVPR risk stratification tool to evaluate the risk for AE and clinical events (CE). We defined AE as signs or symptoms that precluded or interrupted exercise during CR, and CE as events requiring an urgent evaluation outside of CR exercise sessions.

Results:

During the study period, 657 patients with cardiovascular diagnoses were included and classified as high (58%), medium (31%), or low risk (11%). Over the course of CR (76 d, 17 sessions), there were 63 AE and 33 CE. Adverse events were mostly minor (no cardiac arrests or deaths) and managed by CR staff members. When compared with the low- or medium-risk groups, the high-risk group was more likely to have AE (HR 3.0 [95% CI, 1.7-5.9], P = .002) and CE (HR 3.7 [95% CI, 1.5-10.8], P = .002) with fair model discrimination (area under the curve: 0.637, P < .001).

Conclusion:

The AACVPR risk stratification tool was predictive of both AE and CE with fair discrimination, although event rates were low and mostly minor. Thus, the AACVPR model may require reevaluation to better identify truly at-risk patients for major AE.
Cardiac Rehabilitation Is Essential in the COVID-19 Era
Authors: Van Iterson Erik H. , Laffin Luke J. , Crawford Michael , Mc Mahan Dale , Cho Leslie , Khot Umesh
Published: February 2021

The unprecedented nature of the COVID-19 pandemic has challenged how and whether patients with heart disease are able to safely access center-based exercise training and cardiac rehabilitation (CR). This commentary provides an experience-based overview of how one health system quickly developed and applied inclusive policies to allow patients to have safe and effective access to exercise-based CR.
Von Willebrand Factor Multimer Densitometric Analysis: Validation of the Clinical Accuracy and Clinical Implications in Von Willebrand Disease
Authors: Boender Johan , Atiq Ferdows , Cnossen Marjon H. , van der Bom Johanna G. , Fijnvandraat Karin , de Meris Joke , de Maat Moniek P. M. , van Galen Karin P. M. , Laros-van Gorkom Britta A. P. , Meijer Karina , Eikenboom Jeroen , Leebeek Frank W. G.
Published: February 2021

Von Willebrand factor (VWF) multimer analysis is important in the classification of von Willebrand disease (VWD). Current visual VWF multimer analysis is time consuming and inaccurate in detecting subtle changes in multimer patterns. Although VWF multimer densitometric analysis may be useful, the accuracy needs further investigation before it can be widely applied. In this study we aimed to validate VWF multimer densitometric analysis in a large cohort of VWD patients and to identify patient characteristics associated with densitometric outcomes. Patients were included from the Willebrand in the Netherlands (WiN) study, in which a bleeding score (BS) was obtained, and blood was drawn. For multimer analysis, citrated blood was separated on an agarose gel and visualized by Western blotting. IMAGEJ was used to generate densitometric images and medium-large VWF multimer index was calculated. We included 560 VWD patients: 328 type 1, 211 type 2, and 21 type 3 patients. Medium-large VWF multimer index performed excellent in distinguishing visually classified normal VWF multimers from reduced high-molecular-weight (HMW) multimers (area under the curve [AUC]: 0.96 [0.94-0.98], P < 0.001), normal multimers from absence of HMW multimers (AUC 1.00 [1.00-1.00], P < 0.001), and type 2A and 2B from type 2M and 2N (AUC: 0.96 [0.94-0.99], P < 0.001). Additionally, higher medium-large VWF multimer index was associated with lower BS in type 1 VWD: β = -7.6 (-13.0 to -2.1), P = 0.007, adjusted for confounders. Densitometric analysis of VWF multimers had an excellent accuracy compared with visual multimer analysis and may contribute to a better understanding of the clinical features such as the bleeding phenotype of VWD patients.
Comparison of the Performance of a Novel, Smartphone-based, Head-mounted Perimeter (GearVision) With the Humphrey Field Analyzer
Authors: Pradhan Zia S. , Sircar Tushar , Agrawal Harshit , Rao Harsha L. , Bopardikar Ajit , Devi Sathi , Tiwari Vijay N.
Published: February 2021

Precis:

The agreement between a head-mounted perimeter [GearVision (GV)] and Humphrey field analyzer (HFA) for total threshold sensitivity was a mean difference of −1.9 dB (95% limits of agreement −5 to 1). GV was the preferred perimeter in 68.2% of participants.

Purpose:

The purpose of this study was to compare reliability indices and threshold sensitivities obtained using a novel, smartphone-based, head-mounted perimeter (GV) with the HFA in normal, glaucoma suspect and glaucoma patients. A secondary objective was to evaluate the subjective experience participants had with both perimeters using a questionnaire.

Methods:

In a prospective, cross-sectional study; 107 eyes (34 glaucoma, 18 glaucoma suspect, and 55 normal) of 54 participants underwent HFA and GV in random order. The main outcome measure was the agreement of threshold sensitivities using Bland and Altman analysis. Participants also completed a questionnaire about their experience with the devices.

Results:

Median false-positive response rate for GV was 7% (4% to 12%), while for HFA it was 0% (0% to 6%, P<0.001). Median false-negative response rate was similar for both tests. In all, 84 eyes with reliable HFA and GV results were included in the final analysis. Median threshold sensitivity of all 52 points on HFA was 29.1 dB (26.5 to 30.7 dB) and for GV was 30.6 dB (29.1 to 32.6 dB; P<0.001). Mean difference (95% limits of agreement) in total threshold sensitivity between HFA and GV was −1.9 dB (−5 to 1 dB). The 95% limits of agreement were fairly narrow (−8 to 2 dB) across the 6 Garway-Heath sectors. Most participants preferred to perform GV (68.2%) if required to repeat perimetry compared with HFA (20.6%, P<0.001).

Conclusions:

There was fairly good agreement between the threshold sensitivities of GV and HFA. GV was also preferred by most patients and could potentially supplement HFA as a portable or home perimeter.
Recurrent, Delayed-Onset Hyphema Following iStent Inject Managed With Device Removal: A Case Report
Authors: Farazdaghi Marybeth K. , Lyons Lance J. , Roddy Gavin W.
Published: February 2021

Minimally invasive glaucoma surgeries have become increasingly popular in recent years, with the iStent Inject trabecular micro-bypass device (Glaukos, Laguna Hills, CA) being a well-tolerated treatment option for mild to moderate glaucoma, available for placement at the time of cataract surgery. While there have been reports of hyphema in the immediate postoperative period, there is little information available regarding etiology and management of delayed-onset, recurrent hyphema following iStent Inject placement. We present a case of recurrent hyphema occurring after iStent Inject placement and describe successful management with surgical removal of the device. Since we observed a reflux of heme originating from the site of stent placement into the anterior chamber intraoperatively when the intraocular pressure was lowered, we hypothesize that placement of the device into a collector channel allowed for influx of heme when the intraocular pressure dropped below episcleral venous pressure.
Candidemia in Children
Authors: Silvester Eloise J. , Watanabe Melissa M. Y. , Pittet Laure F. , Boast Alison , Bryant Penelope A. , Haeusler Gabrielle M. , Daley Andrew J. , Curtis Nigel , Gwee Amanda
Published: February 2021

Background:

Candida species are the most common cause of systemic fungal infections in children. Risk factors for candidemia vary in different patient populations, posing challenges for clinical prediction of infection. We describe the epidemiology and clinical disease of candidemia in children admitted to a tertiary pediatric hospital.

Methods:

Retrospective audit of children ≤18 years of age with candidemia at a tertiary pediatric hospital over a 16-year period.

Results:

There were 139 episodes of candidemia in 124 children. A central venous catheter was present in 94% of episodes, prior antibiotic exposure in 86% and parenteral nutrition in 43%. During the study period, the proportion of candidemia due to non-albicans Candida spp. increased primarily due to a rise in C. krusei. Colonization with Candida spp. in the 30 days before developing candidemia was identified in 40% of episodes and the species was concordant in 60%. Infection at other sites was rare, including pulmonary dissemination (9/38, 24%), renal fungal disease (9/114, 8%), fungal endophthalmitis (8/102, 8%) and hepatosplenic nodules (5/92, 5%). Overall, 8/127 (6%) isolates were fluconazole-resistant (7 C. krusei and 1 C. glabrata) and 7/127 (6%) had intermediate susceptibility to fluconazole. The overall 30-day mortality was 12% and significant risk factors for mortality on multivariate analysis were male sex, liver disease and mucositis.

Conclusions:

Our study outlines low rates of disseminated candidiasis and low mortality associated with candidemia at our institution. Additionally, it suggests that prior colonization may be an important risk factor, however, this should be validated in large prospective controlled studies.
Myositis of an Extraocular Muscle, a Possible Drug Reaction: Histopathologic and Immunopathologic Analysis
Authors: Charles Norman C. , Rebhun Carl B. , Lidder Alcina K. , Coulon Sara J. , Kim Eleanore T.
Published: February 2021

A 58-year-old man presented with left-sided orbital inflammation, including chemosis and a lateral rectus abduction defect. Initially presumed to represent cellulitis, the condition responded poorly to oral and intravenous antibiotics. CT showed the epicenter of an infiltrate to involve the lateral rectus. The patient improved dramatically when oral prednisone was added. Lateral rectus biopsy displayed intramuscular polyclonal lymphoid infiltrates, rich with eosinophils. Complete resolution of the inflammatory process was confirmed by a follow-up CT. The presumptive diagnosis was idiopathic orbital myositis, an uncommon condition of unknown etiology. However, the patient had taken rosuvastatin, which has been rarely associated with diplopia and ophthalmoplegia, raising the question of whether this case was truly idiopathic.
Predictive factors for disease recurrence in patients with locally advanced renal cell carcinoma treated with curative surgery
Authors: Chang Te-Wei , Cheng Wei-Ming , Fan Yu-Hua , Lin Chih-Chieh , Lin Tzu-Ping , Yi-Hsiu Huang Eric , Chung Hsiao-Jen , Huang William J.S. , Weng Shih-Han
Published: February 2021

Background:

Few prognostic factors have been proposed for patients with locally advanced renal cell carcinoma (RCC). This study aimed to investigate the possible predictive factors for disease-free survival (DFS) after curative surgery for RCC stage T3 or higher.

Methods:

Patients with locally advanced RCC who underwent cure-intended partial or radical nephrectomy, with or without tumor thrombectomy, at our institution from April 1, 2005 to October 31, 2013 were retrospectively reviewed. Those undergoing cytoreductive nephrectomy were excluded. Preoperative data, including surgical and pathologic characteristics, were assessed for correlation with DFS. Chi-square tests, univariate and multivariate Cox regression analysis, and Kaplan–Meier survival curve analyses were performed to determine potential predictive factors. A p value less than 0.05 was considered statistically significant.

Results:

A total of 159 patients were included for analysis. The mean duration of follow-up was 37.9 months, and 119 (74.8%) patients remained disease-free during follow-up. Disease recurrence was found in 40 (25.2%) patients, and pathologic T stage, capsule penetration, Fuhrman grade, thrombocytosis, renal vein thrombosis, and elevated serum alkaline phosphatase, platelet/lymphocyte ratio, and γ-glutamyl transpeptidase levels were significantly associated with disease recurrence on univariate analysis. On multivariate analysis, Fuhrman grade 3 or 4 (HR = 5.70, p = 0.0003, 95% CI = 2.23–14.56) showed significant associations with DFS.

Conclusion:

In patients with locally advanced RCC, Fuhrman grade was associated with worse DFS after curative surgery. Urologists should closely monitor patients with high Fuhrman grades.
Endoscopic management of malignant gastric outlet obstruction
Authors: Ye Bing-Wei , Lee Kuei-Chuan , Hou Ming-Chih
Published: February 2021

Malignant gastric outlet obstruction (MGOO) is a late complication of advanced malignancies, mostly occurring due to gastrointestinal cancers or external compression outside the lumen. It causes nausea, vomiting, poor appetite, weight loss, and decreased quality of life. In the past, surgical bypass was the gold standard for the management of MGOO. However, the introduction of self-expandable metallic stent (SEMS) provides several advantages over surgical bypass, including earlier oral intake, rapid symptom relief, less invasiveness, and shorter hospital stays; therefore, it has replaced surgical bypass as the mainstream management approach in most situations. Although SEMS placement is a safe and effective way for palliation of MGOO, stent dysfunction with obstruction or migration limits the utilization and increases repeated intervention. Endoscopic ultrasound-guided gastroenterostomy with lumen-apposing metal stent has emerged as an alternative way to bypass the obstruction site and restore the oral intake of patients. Although a lower stent dysfunction rate was reported, further prospective studies are warranted to validate its effectiveness and safety.
A novel low-profile external skeletal fixator for type IIIB open tibial fractures: A biomechanical and clinical pilot study
Authors: Tarng Yih-Wen , Lin Kai-Cheng , Lin Kun-Jhih , Yang Yi-Ping , Chien Yeuh , Wei Hung-Wen
Published: February 2021

Background:

Although external fixator is standard for managing staged treatment of open tibial fracture, the main disadvantage of this device is too bulky to be tolerated by most patients for longtime use. The purposes of this pilot study were to compare the biomechanical properties of a novel low-profile external fixator (LP-ESF) with a traditional ESF and also to evaluate its performance in patients with Gustilo type IIIb tibial open fractures.

Methods:

A prospective clinical pilot study started from January 2015 to December 2017, and 18 patients with Gustilo type IIIb open tibial fractures underwent the fixation with a novel LP-ESF system. The biomechanical properties of the LP-ESF were compared with the Synthes External Fixation System according to the standard ASTM F1541-02. These patients were divided into two groups according to the size of bony defect. The postoperative clinical outcomes were subsequently collected.

Results:

The biomechanical properties of the LP-ESF were comparable with those of Synthes External Fixation System and had an improved the axial/torsional stiffness and ultimate strength. In the clinical study, all patients with LP-ESF had fracture union. The duration of application of LP-ESF was 3.5 to 18 months until fracture union. In 10 of 18 patients, their fractures were immobilized with the LP-ESF until bone union, and no pin tract infection and no chronic osteomyelitis were recorded. The 36-Item Short Form Health Survey life quality and health survey were good to excellent in these patients. Notably, the LP-ESF allowed a patient with severe bone and soft-tissue defects to preserve the leg and joints function.

Conclusion:

In this study, we found that the novel LP-ESFs had improved clinical outcomes. The long-term LP-ESF application seems to be tolerable in our patients. This novel approach permits better controls in deep infection and faster healing of fractures, and thus may provide a viable alternative treatment for Gustilo type IIIb open tibial fractures.
When pancreas solid mass meets liver cystic lesion: A case report
Authors: Han Haifeng , Yang Jian , Hu Sanyuan , Zhan Hanxiang
Published: February 2021

Pancreatic neuroendocrine tumors are in low incidence compared with other pancreatic tumors, and they present as various pathological forms, including solid, cystic and solid-cystic lesions. Herein, we report a rare case that presents cystic lesions in liver originating from solid pancreatic neuroendocrine tumors. It can be easily misdiagnosed pancreatic ductal adenocarcinoma or primary hepatic cancer according to imaging by surgeons without extensive professional experience. Therefore, it reminders surgeons the privotal role of pathological biopsy to diagnose the disease correctly. The ethical approval and written consent were waived by the institutional review board of our hospital owing to the retrospective nature of the study and routine treatments performed on this patient in clinical practice.
Current situation, consensus and controversy of perioperative nutrition management in pancreatic surgery: A narrative review
Authors: Xu Jingyong , Wei Junmin
Published: February 2021

Pancreatic surgery contains several major procedures of pancreatectomy. Surgical trauma, severe complications and preoperative nutritional disorders will affect postoperative recovery and clinical outcomes of patients. Perioperative whole-course nutrition management focus on rational nutritional care from admission to discharge even post-hospital follow-up, including preoperative nutritional screening, perioperative nutrition assessment and intervention. The whole-course strategy has been validated in some other fields by RCTs and is also seemed to be suitable for pancreatic surgery. However, few high-grade evidences have been published and controversy still exists. This review aims to reflect the current situation, consensus and controversy of perioperative nutrition management in pancreatic surgery, expecting to provide necessary guidance for clinical research and practice.
Validation of the STEP deflation algorithm of the Midmark IQvitals Zone Vital Signs Monitor: part of a novel clinical ecosystem
Authors: Alpert Bruce S.
Published: February 2021

Objectives

Assess the accuracy of the Midmark IQvitals Zone Vital Signs Monitor STEP deflation algorithm according to the ANSI/AAMI/ISO 81060-2 Standard.

Methods

A total of 85 subjects completed the testing protocol. All standard requirements for gender, blood pressure (BP) values, and arm circumferences were met. Manual auscultation was performed by testers blinded to the device; the manual BP values were compared to the device readings.

Results:

The Standard Criterion 1 data analyses showed mean ± SD device minus manual BP values of 1.22 ± 6.3 mmHg for SBP and −1.67 ± 6.09 mmHg for DBP. The SD values for criterion 2 were 5.06 mmHg (SBP) and 4.98 mmHg (DBP).

Conclusions

The device passed all Standard requirements. The Midmark IQvitals Zone device has features to improve accuracy and reduce or eliminate transcription errors and inaccuracy from improper patient positioning.
Advances in revascularization of the left coronary artery
Authors: Bithas Christiana , Harky Amer
Published: February 2021

Ischaemic heart disease is the most common cardiovascular disease worldwide, and it contributes to a significant source of morbidity and mortality internationally. It can be asymptomatic for many years and present suddenly with acute coronary syndrome or can be progressive with angina and eventual acute myocardial infarction. Diseases of the left coronary system can be drastic and fatal if not managed correctly. With ongoing increase in the practice of percutaneous intervention; patient demographics for conventional coronary artery bypass grafting surgery have more risk factors than before. Conventional bypass surgery has also evolved to include minimally invasive and hybrid techniques. Although some evidence supports each approach, controversies remain.
Coronavirus disease 2019 pandemic and alterations of body composition
Authors: Cava Edda , Carbone Salvatore
Published: February 2021

Purpose of review

This manuscript reviews evidence collected during COVID-19 pandemic and provides information on the impact of body composition on severity and outcomes of the disease, analysing methods used for body composition assessment. Malnutrition-screening tools will also be discussed to screen and diagnose the patients at higher risk of COVID-19 severity and related worse outcomes.

Recent findings

COVID-19 can occur in a wide range of presentation, from asymptomatic to severe forms. Among the major risk factors for worse severity, overnutrition, undernutrition and body composition play a role in the ability to respond to SARS-CoV-2 infection. Excess fat accumulation (i.e. obesity) or lean mass loss and functionality (i.e. sarcopenia) or a combination of both (i.e. sarcopenic obesity) can affect whole-body functioning. These body composition alterations in the short-term can influence susceptibility and immunological responses to the virus, inflammatory reaction, metabolic and respiratory distress, while in the long-term can modulate disease outcomes, namely length of stay, time required for recovery, risk of ICU-acquired weakness and long-term disabilities, and potentially increase the risk of death.

Individuals with malnutrition, sarcopenia, obesity, sarcopenic obesity and older adults with abnormal body composition or malnutrition risk may require tailored medical nutrition therapy to improve short and long-term COVID-19 outcomes.
Clinical features and prognostic factors of critically ill patients with COVID-19 in Daegu, South Korea
Authors: Kim Eun Jin , Lee Yong Hoon , Park Jae Seok , Lee Jaehee , Lee Shin Yup , Kim Yeonjae , Kwon Yong Shik , Jang Jong Geol , Shin Kyeong-Cheol , Kim Kyung Chan , Choi Eun Young
Published: February 2021

To describe the clinical and demographic characteristics of critically ill patients with COVID-19 in Daegu, South Korea, and to explore the risk factors for in-hospital mortality in these patients.

Retrospective cohort study of 110 critically ill patients with COVID-19 admitted to the ICU in Daegu, South Korea, between February 18 and April 5, 2020. The final date of follow-up was April 20, 2020.

A total of 110 patient medical records were reviewed. The median age was 71 years (interquartile range [IQR] = 63–78 years). During the study period, 47 patients (42.7%) died in the hospital. The most common SARS-CoV-2 infection related complication was acute respiratory distress syndrome (ARDS) in 95 patients (86.4%). Of the 79 patients (71.8%) who received invasive mechanical ventilation, 46 (58.2%) received neuromuscular blockade injection, and 19 (24.1%) received ECMO treatment. All patients received antibiotic injection, 99 patients (90%) received hydroxychloroquine, 96 patients (87.3%) received lopinavir-ritonavir antiviral medication, and 14 patients (12.7%) received other antiviral agents, including darunavir-cobicistat and emtricitabine-tenofovir. In the multivariable logistic regression model, the odds ratio of in-hospital death was higher with APACHE II score (OR = 1.126; 95% CI = 1.014–1.252; P 
= .027).

The in-hospital mortality rate of critically ill patients with COVID-19 was approximately 40%. Higher APACHE II score at admission was an independent risk factor for death in these patients.
The effect of coagulation factors in 2019 novel coronavirus patients
Authors: Xiang Guiling , Hao Shengyu , Fu Cuiping , Hu Weiping , Xie Liang , Wu Qinhan , Li Shanqun , Liu Xuhui
Published: February 2021

Background:

The role of coagulation dysfunction in Severe Coronavirus Disease 2019 (COVID-19) is inconsistent. We aimed to explore the impact of coagulation dysfunction amongst patients with COVID-19.

Methods:

We searched PubMed, Cochrane and Embase databases from December 1, 2019 to April 27, 2020 following Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Data about coagulation (Platelets, PT, APTT, fibrin, fibrinogen degradation products, D-dimer), prevalence of coagulation dysfunction and mortality were extracted. Meta regression was used to explore the heterogeneity.

Results:

Sixteen observational studies were included, comprising 2, 139 patients with confirmed COVID-19. More severe COVID-19 cases tended to have higher mean D-dimer (SMD 0.78, 95% CI 0.53 to 1.03, P < .001). The similar pattern occurred with PT and fibrin, with a contrary trend for PLTs. Coagulation dysfunction was more frequent in severe cases compared to less severe (SMD 0.46, 95% CI 0.25 to 0.67, P < .001). Higher mortality was associated with COVID-19-related coagulopathy (RR 10.86, 2.86 to 41.24, P < .001). Prevalence of ARDS was increased in more severe patients than less severe cases (RR 16.52, 11.27 to 24.22, P < .001). PT, fibrin and D-dimer levels elevated significantly in non-survivors during hospitalization.

Conclusion:

Presence of coagulation dysfunction might be associated with COVID-19 severity, and coagulopathy might be associated with mortality. Coagulation markers including PT, fibrin and D-dimer may imply the progression of COVID-19. This illuminates the necessity of effectively monitoring coagulation function for preventing COVID-19-related coagulopathy, especially in severe patients. For the obvious heterogeneity, the quality of the evidence is compromised. Future rigorous randomized controlled trials that assess the correlation between coagulation and COVID-19 are needed.

Trial registration:

PROSPERO (CRD42020183514).
The optimal dosage of pefcitinib for the treatment of active rheumatoid arthritis
Authors: Zhou Yuyi , Sun Chunfang , Chen Chunyan
Published: February 2021

Background:

Previous meta-analyses have indicated that peficitinib was the promising agent for the treatment of rheumatoid arthritis (RA). Meanwhile, a recent network meta-analysis has further investigated the comparative efficacy of different peficitinib regimes. However, pooled results from previous network meta-analysis must be cautiously interpreted because 2 eligible studies were missed. Therefore, we designed this updated network meta-analysis to further establish the optimal dosage of peficitinib in treating RA.

Methods:

We will carry out a network meta-analysis of randomized controlled trials (RCTs) with Markov Chain Monte Carlo method in order to merge direct and indirect evidence. We will identify potentially eligible studies through searching 4 databases including PubMed, Embase, Cochrane Library, and China National Knowledgement Infrastructure (CNKI) until to December 2020. We will make this network meta-analysis following the process recommended by the Cochrane Handbook.

Discussion:

As a systematic and chronic autoimmune disease, RA primarily was characterized by persistent synovitis, progressive joint injury, and deformity. Patients who were identified as RA will experience a series of adverse consequences such as disability and poor quality of life (QoL). Peficitinib, one of the Janus kinases (JAKs) inhibitors, has been suggested to be effective in treating active RA by numerous clinical studies and meta-analyses. Although a recent meta-analysis investigated the comparative efficacy of different dosages of peficitinib, reliable results cannot be obtained because it missed 2 critical eligible studies. We designed this updated network meta-analysis through including all eligible studies to further ask which dosages may be the preferred option for treating active RA.

Ethics and dissemination:

No ethics approval and informed consent will be required in our meta-analysis. Our findings in this updated network meta-analysis will be disseminated via conferences and academic journal.

Open Science Framework (OSF) Registration DOI Number:

This protocol of updated network meta-analysis has been registered in Open Science Framework (OSF) system on January 8, 2021. The unique registration DOI number of 10.17605/OSF.IO/YSPM6 has been approved for our protocol (accessible at: https://osf.io/yspm6).