bluuebunny/crossref_metadata_2025 huggingface dataset:
Incision size changes after cataract surgery with intraocular lens implantation: comparison of 2 preloaded IOL implantation injectors
Authors: Haldipurkar Suhas S. , Shetty Vijay , Haldipurkar Tanvi , Dhamankar Rita , Sehdev Nancy , Khatib Zain , Nagvekar Pranoti , Mhatre Paresh , Setia Maninder Singh
Published: January 2020

Purpose:

To compare incision size enlargement at different times of cataract surgery and visual outcomes after surgery in 2 different intraocular lens (IOL) delivery systems (Vivinex iSert and UltraSert Preloaded IOL Delivery System).

Setting:

Tertiary care eye institution.

Design:

Prospective nonrandomized comparison study.

Methods:

All eyes had uneventful temporal clear corneal phacoemulsification cataract surgery. The surgery was done by standard direct horizontal chop with a bimanual irrigation aspiration of the cortex. The primary incision size was measured after clear corneal incision, after the completion of phacoemulsification, and after IOL implantation.

Results:

The study comprised 276 eyes of 220 patients. The mean initial corneal incision was similar in both groups (2.2 mm). There was no significant difference in the mean incision size after phacoemulsification between the 2 groups (2.250 mm ± 0.068 mm [SD] vs 2.251 ± 0.066 mm [SD], P > .99). There was no significant difference in the mean (SD) incision size after IOL insertion between the 2 groups (2.367 ± 0.066 mm vs 2.369 ± 0.062 mm [SD], P = .815. The corrected distance visual acuity was 6/6 at 1 month in 80% of the participants in the UltraSert group and 86% in the Vivinex group. After adjusting for age, sex, grade of cataract, and IOL power, no significant difference was found in the magnitude of surgically induced astigmatism (SIA) in the Vivinex group compared with the UltraSert group (0.06, 95% CI, −0.11 to 0.24; P = .47).

Conclusions:

No significant difference was found in the change in the incision size, visual acuity, and SIA between UltraSert and Vivinex IOL delivery systems. This suggests that both IOL delivery systems are comparable in terms of post-IOL delivery incision enlargement for incisions of 2.2 mm.
Medical management and visual rehabilitation of limbal niche dysfunction
Authors: Grodsky Jacob D. , Doshi Rutvi , Riaz Kamran M.
Published: January 2020

Limbal niche dysfunction (LND) has been described as a medically reversible form of limbal stem cell deficiency. The current literature is sparse regarding therapeutic options to improve visual function after stabilization of the disease. A 61-year-old monocular woman with an extensive medical and ocular history presented with long-standing recalcitrant epitheliopathy in both eyes. History and examination findings on presentation led to a diagnosis of LND, and medical therapy was initiated. After 8 months, her ocular surface had improved and corrected distance visual acuity (CDVA) was 20/40. She was fit with a scleral contact lens because of its ability to promote ocular surface healing and improve visual acuity. She maintained symptom resolution and her CDVA improved to 20/20. LND is a distinctive and reversible epitheliopathy that responds favorably to appropriate medical therapy. To the authors’ knowledge, this is the first reported case of using the scleral contact lens as an adjunctive visual rehabilitation therapy to complement medical treatment for LND.
Safety of intracameral moxifloxacin in the pediatric population: an equivalence study
Authors: Khalili Sina , Imtirat Ahed , Williams Sara , Ali Asim , Tehrani Nasrin , Mireskandari Kamiar
Published: January 2020

Purpose:

To investigate whether the safety of intracameral moxifloxacin (IC-Mox) was equivalent to subconjunctival antibiotics (SC-Abs) in pediatric lens surgery.

Setting:

The Hospital for Sick Children, Toronto, Canada.

Design:

Retrospective consecutive cohort study.

Methods:

This equivalence study compared 95% CI in the difference between the preoperative and postoperative safety variables of best corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell density (ECD), corneal edema, and anterior chamber (AC) inflammation in IC-Mox with SC-Abs. The zone of clinical equivalence for BCVA was set at ±0.2 logarithm of the minimum angle of resolution, IOP at ±3 mm Hg, CCT at ±30 μm, and ECD at ±400 cells/mm2.

Results:

The charts of 358 patients undergoing lens-related surgeries were reviewed. Of 317 eyes (215 patients) included, 170 eyes received IC-Mox and 147 eyes had SC-Abs. The mean age was 4.9 and 5.1 years with a mean follow-up of 19 and 34.4 months (P < .001) in IC-Mox and SC-Ab groups, respectively. The 95% CIs for the change from preoperative to postoperative safety parameters between IC-Mox and SC-Abs were all in the zones of clinical equivalence (BCVA, P = 0.75; highest IOP in the first 6 weeks postoperatively, P = 0.27; IOP at the last visit, P = 0.74; CCT, P = 0.89; and ECD, P = 0.76). During the first 6 weeks postoperatively, there was no difference in corneal edema (P = .69) and AC flare (P = .4) between IC-Mox and SC-Ab groups, whereas AC cellular activity was significantly higher in the SC-Ab group (P = .028).

Conclusions:

IC-Mox prophylaxis in pediatric patients showed equivalent postoperative safety outcomes when compared with SC-Abs. The use of IC-Mox (250 μg) for endophthalmitis prophylaxis appears to be safe in the pediatric population.
Factors predicting successful customized excimer laser treatment in irregular corneas
Authors: Hanna Rana , Mimouni Michael , Plaza Ana Belen , Alió Jorge L.
Published: January 2020

Purpose:

To identify factors associated with a successful wavefront-guided customized treatment (WG-CT) with an excimer laser in highly aberrated corneas.

Setting:

VISSUM Alicante Spain.

Design:

Retrospective consecutive noncomparative case series.

Methods:

Treatment was performed with the WG-CT Amaris excimer laser using the ORK-CAM software for the calculation of the ablation profile. Eyes of patients with significantly aberrated corneas, including postrefractive and keratoplasty procedures or high irregular astigmatism with significant higher-order aberrations (HOAs) that had WG-CT were included. Refractive outcomes, HOAs, and visual outcomes were recorded. Statistical analysis was performed to identify factors associated with technical (based on HOAs) or refractive outcome success.

Results:

The study included 55 treatments of 51 eyes (35 patients). The postoperative uncorrected distance visual acuity was 0.2 logarithm of the minimum angle of resolution or better in 72% of the eyes, and the postoperative residual manifest refraction spherical equivalent was ±0.50 diopter in 56% of the eyes, whereas 11% of the eyes lost 1 line or more in corrected distance visual acuity. Successful reduction in the total root mean square (RMS) of HOAs occurred in 36 eyes (65%), and these eyes had a significantly higher preoperative RMS of HOAs (1.45 ± 0.93 μ vs 0.91 ± 0.34 μ, P = .003) and preoperative coma-like aberrations (1.09 ± 0.83 μ vs 0.55 ± 0.28 μ, P = .001). In multivariate analysis, posthyperopic treatment eyes were less likely to achieve refractive outcome success (odds ratio = 0.09, P = .02).

Conclusions:

WG-CT in highly aberrated corneas had a limited refractive predictability. Eyes with preoperative coma-like aberrations are more likely to benefit from a reduction in HOAs. Posthyperopic treatment is associated with a higher rate of refractive surprises.
Safety and efficacy of a small-aperture capsular bag–fixated intraocular lens in eyes with severe corneal irregularities
Authors: Shajari Mehdi , Mackert Marc J. , Langer Julian , Kreutzer Thomas , Wolf Armin , Kohnen Thomas , Priglinger Siegfried , Mayer Wolfgang J.
Published: January 2020

Purpose:

To implant a small-aperture intraocular lens (IOL) (IC-8) in eyes with severe corneal irregularities to reduce higher-order aberrations and provide better central visual acuity.

Setting:

University Hospital, LMU Munich, Germany.

Design:

Prospective nonrandomized interventional case series.

Methods:

Eyes with severe corneal irregularities due to keratoconus, previous penetrating keratoplasty, status postradial keratotomy, or scarring after ocular trauma were enrolled. Exclusion criteria were progressive keratoconus, pseudoexfoliation, glaucoma, maculopathy, reduced endothelial cells (<1800 cells/mm2), and central corneal opacity. Conventional phacoemulsification with implantation of the small-aperture IOL was performed. The primary efficacy endpoint was corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). Secondary endpoints were life quality assessment using the Visual Function Questionnaire-25 and determination of the refractive defocus curve.

Results:

Seventeen eyes of 17 patients were enrolled. In all 17 patients, CDVA improved from 0.37 ± 0.09 to 0.19 ± 0.06 logarithm of the minimum angle of resolution (logMAR) 3 months postoperatively (P < .0001). Similarly, postoperative UDVA, UIVA, and UNVA improved significantly in 100%, 88%, and 88%, respectively. The defocus curve showed best results at 0.17 logMAR with a defocus of −0.5 diopter. In addition, overall life quality analyses reported less difficulty with activities under reduced optical phenomena conditions.

Conclusions:

The small-aperture IOL was a useful option in eyes with severe corneal irregularities, had a high safety index and a high satisfaction rate, and can lead to better visual quality in these cases. Further studies are needed to improve power calculation of this IOL.
Structural integrity of intraocular lenses with eyelets in a model of transscleral fixation with the Gore-Tex suture
Authors: Pollmann André S. , Lewis Darrell R. , Gupta R. Rishi
Published: January 2020

Purpose:

To compare fracture characteristics of intraocular lenses (IOLs) used in transscleral fixation with the Gore-Tex suture.

Setting:

Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.

Design:

Experimental study.

Methods:

A model was designed to compare the eyelet fracture characteristics of enVista MX60 IOL (model available before June 2018), the enVista MX60E IOL (current model), the Akreos AO60 IOL, and the CZ70BD IOL. Tension was applied through the Gore-Tex suture and measured with a digital force gauge. Two suture configurations (radial and nonradial) were tested using the MX60E IOL.

Results:

A total of 25 trials were conducted. The mean eyelet fracture force was 1.666 newtons (N) for the MX60 IOL (range, 1.000–2.000), 1.000 N for the MX60E IOL (range, 1.000–1.000), 2.330 N for the AO60 IOL (range, 2.000–3.000), and 0.998 N for the CZ70BD IOL (range, 0.990–1.000). When compared with the MX60E IOL, a greater eyelet strength was observed with the MX60 (P = .024) and AO60 (P = .004) IOLs. Radial and nonradial suture configurations did not affect the MX60E eyelet fracture force.

Conclusions:

The enVista MX60E eyelet may be less resistant to Gore-Tex suture tear out compared with the MX60 and AO60 IOLs. Altering suture configuration did not affect enVista eyelet resistance to fracture. During off-label use in transscleral fixation, extra caution should be taken when handling IOLs and applying tension on sutures.
The Association Between Patient Outcomes and the Initial Emergency Severity Index Triage Score in Patients With Suspected Acute Coronary Syndrome
Authors: Frisch Stephanie O. , Faramand Ziad , Leverknight Brandi , Martin-Gill Christian , Sereika Susan M. , Sejdić Ervin , Hravnak Marilyn , Callaway Clifton W. , Al-Zaiti Salah
Published: January 2020

Background

The Emergency Severity Index (ESI) is a widely used tool to triage patients in emergency departments. The ESI tool is used to assess all complaints and has significant limitation for accurately triaging patients with suspected acute coronary syndrome (ACS).

Objective

We evaluated the accuracy of ESI in predicting serious outcomes in suspected ACS and aimed to assess the incremental reclassification performance if ESI is supplemented with a clinically validated tool used to risk-stratify suspected ACS.

Methods

We used existing data from an observational cohort study of patients with chest pain. We extracted ESI scores documented by triage nurses during routine medical care. Two independent reviewers adjudicated the primary outcome, incidence of 30-day major adverse cardiac events. We compared ESI with the well-established modified HEAR/T (patient History, Electrocardiogram, Age, Risk factors, but without Troponin) score.

Results

Our sample included 750 patients (age, 59 ± 17 years; 43% female; 40% black). A total of 145 patients (19%) experienced major adverse cardiac event. The area under the receiver operating characteristic curve for ESI score for predicting major adverse cardiac event was 0.656, compared with 0.796 for the modified HEAR/T score. Using the modified HEAR/T score, 181 of the 391 false positives (46%) and 16 of the 19 false negatives (84%) assigned by ESI could be reclassified correctly.

Conclusion

The ESI score is poorly associated with serious outcomes in patients with suspected ACS. Supplementing the ESI tool with input from other validated clinical tools can greatly improve the accuracy of triage in patients with suspected ACS.
A Survey of Stress and Burnout in Forensic Mental Health Nursing
Authors: Newman Claire , Jackson Jane , Macleod Shona , Eason Michelle
Published: January 2020

Background

Although it is known that forensic mental health nurses (FMHNs) work in a stressful environment, their experience of stress and burnout remains largely unexplored.

Aim

The study aimed to measure levels of burnout and workplace stressors experienced by FMHNs.

Methods

A survey of 205 FMHNs was undertaken. Respondents completed the Maslach Burnout Inventory and the Nursing Stress Scale.

Findings

Fifty-seven FMHNs completed the survey, representing a response rate of 27.8%. Only five respondents (8.8%) experienced high levels of burnout across all three Maslach Burnout Inventory subscales. The most reported workplace stressors were related to “workload,” “conflict with other nurses,” and “conflict with physicians.” A correlation between total Nursing Stress Scale score and both “emotional exhaustion” and “cynicism” were found (r = 0.45, p < 0.001, and r = 0.34, p < 0.011, respectively), indicating that FMHNs who reported higher workplace stress are at an increased risk of burnout.

Conclusion

Most FMHNs in the current study experienced moderate levels of burnout, although they continued to feel self-assured in their practice and found their work rewarding. Consistent with other nursing populations, the FMHNs in this study reported feeling stressed by their workload and as the result of conflict with other nurses and physicians.

Implications for Clinical Forensic Nursing Practice

Reduced well-being, associated with stress and burnout, may lead to increased absences from work and the delivery of poor-quality forensic mental health consumer care. The implementation of staff well-being strategies is recommended to address stress and burnout in FMHNs.
Experiences of Family Violence Committed by Relatives With Severe Mental Illness: A Grounded Theory
Authors: Paradis-Gagné Etienne , Holmes Dave , Perron Amélie
Published: January 2020

In forensic psychiatry, family violence perpetrated by a loved one suffering from severe mental illness is a significant problem thought to affect nearly half of families. To examine this poorly documented issue, a qualitative study using a grounded theory research strategy was conducted with family members who have experienced violence committed by a relative with severe mental illness. Semistructured interviews were conducted with 14 participants who had experienced this type of violence. The works of poststructuralist thinkers Jacques Donzelot and Michel Foucault inform the theoretical framework. Qualitative analysis of the data led to the emergence of five major themes: medicolegal apparatus, experience of violence, family's responsibility toward the violent relative, exclusion and stigmatization, and suffering and resilience. The main results of this qualitative study indicate that families are governed through specific mechanisms, including instrumentalization of the family's role and transfer of the violent person's care to the family. Obstacles preventing families from being included in their relative's care were also raised. This research contributes to nursing by shedding light on clinical interventions and health policy in family care. It also offers insight into the provision of appropriate quality care in particularly complicated family situations.
Respiratory Diseases in Post-9/11 Military Personnel Following Southwest Asia Deployment
Authors: Krefft Silpa D. , Wolff Jenna , Zell-Baran Lauren , Strand Matthew , Gottschall Eva Brigitte , Meehan Richard , Rose Cecile Stephanie
Published: January 2020

Objective:

Persistent respiratory symptoms following post-9/11 military deployment to Iraq and Afghanistan are well-recognized, but the spectrum of respiratory diseases remains poorly characterized. This study describes deployment-related respiratory diseases and the diagnostic utility of resting and exercise pulmonary function testing.

Methods:

Between 2009 and 2017, 127 consecutive military workers (“deployers”) with new-onset respiratory symptoms underwent clinical evaluation. Deployment-related respiratory diseases were classified as proximal and/or distal. Using descriptive statistics and logistic regression, we analyzed lung function parameters associated with deployment-related distal lung disease (DDLD).

Results:

Common deployment-related respiratory diseases included asthma (31.5%), intermittent laryngeal obstruction (14.2%), rhinosinusitis (15%), and DDLD (68.5%). Decreased diffusion capacity (odds ratio [OR] = 4.6, 95% confidence interval [CI]: 1.4 to 15.1, P = 0.01) was significantly associated with DDLD.

Conclusions:

A comprehensive diagnostic approach may identify a spectrum of proximal and distal respiratory diseases that can occur in symptomatic post-9/11 deployers, requiring a personalized approach to care.
Alterations of chromosome 3p in 24 cases of gastrinomas and their correlations with clinicopathological and prognostic features
Authors: Chen Yuan-Jia , Ojeaburu Jeremiah V. , Vortmeyer Alexander , Yu Shuang , Jensen Robert T.
Published: January 2020

Purpose:

The pathogenesis of gastrinomas is largely unknown, and there is a lack of reliable genetic determinants that are useful to distinguish malignant and benign forms of this tumor or predict the prognosis of patients with this disease. Loss of heterozygosity (LOH) on chromosome 3p is reported to occur in pancreatic neuroendocrine tumors (PNETs) as well as in non-PNETs and its presence is reported to correlate with tumor prognosis in non-endocrine tumors. However, little data are available from prospective studies on gastrinomas.

Experimental design:

We assessed occurrence of 3p LOH in 24 gastrinomas and correlated its presence with tumor biological behavior and other clinicopathological features of gastrinomas.

Results:

Either 3p LOH or microsatellite instability involving 3p occurred in 11 of 24 tumors (46%). Seven (29%) gastrinomas had 3p LOH. Of the 7 gastrinomas with 3p LOH, 5 (71%) had 3p12 LOH with the marker D3S2406, which was the shortest region of highest overlap (SRO). Chromosome 3p LOH was not associated with aggressive biological behavior of gastrinomas or with poor prognosis of patients with gastrinoma. Similarly, 3p12 LOH (SRO) was not correlated with aggressive growth of tumors and/or liver metastases.

Conclusion:

Gastrinomas have a relative high frequency of 3p12 LOH suggesting this area may harbor putative tumor suppressor gene(s), which may play a role in the tumorigenesis, but not aggressiveness, of a subset of these tumors.
Posterior Semicircular Canal Dehiscence: Case Series and Systematic Review
Authors: Lee Joshua A. , Liu Yuan F. , Nguyen Shaun A. , McRackan Theodore R. , Meyer Ted A. , Rizk Habib G.
Published: January 2020

Objective:

To conduct a systematic review of posterior semicircular canal dehiscence (PSCD) and to present a series of patients with PSCD with and without classic third-window symptoms.

Data Sources:

PubMed, Scopus, and the Cochrane Library from inception until April 2019. Case series of five patients seen in a multidisciplinary, vestibular-focused, neurotology clinic.

Study Selection:

Inclusion criteria: PSCD studies of symptomatology, diagnostic testing, radiology, and histopathology. Exclusion criteria: non-English articles, reviews, letters, animal studies.

Data Extraction:

Quality evaluated according to Oxford Center for Evidence-Based Medicine criteria and funnel plot via the Stern and Egger method.

Data Synthesis:

Two hundred five studies were found, and 58 studies were included. In 47 total patients, sound-induced vertigo, mixed hearing loss, and tinnitus were the most common presenting symptom. A meta-analysis of proportions using eight radiological and histopathological studies revealed an incidence of 0.38% adult ears [95% CI 0.08, 0.89] and 2.16% of adult patients [0.64, 4.54]. The incidence in pediatric patients ranged from 1.3 to 43%. Jugular bulb abnormalities were common. In our case series, four of five patients presented without third-window symptoms, while one had sound- and pressure-induced vertigo. Hearing loss in these patients was not salvageable.

Conclusions:

PSCD is a rare phenomenon most commonly presenting with third-window type symptoms. However, PSCD might also present with dizziness and hearing loss inconsistent with third-window symptomatology. One should be conscious of potentially poorer prognosis for hearing recovery in these patients.
Pediatric Extracorporeal Membrane Oxygenation Reach-Out Program: Successes and Insights
Authors: Erell Yair , Dagan OVADIA , Shostak Eran , Manor Orit , Amir Gabriel , Frenkel Georgy , Shukrun Golan , Kaplan Eytan , Schiller Ofer
Published: January 2020

The shortage of dedicated pediatric extracorporeal membrane oxygenation (ECMO) centers and the expanding indications for pediatric ECMO necessitate a regional program for transport of ECMO-supported patients. Data about feasibly and safety of pediatric ECMO transport are scarce. Our aim is to describe our experience with a pediatric ECMO reach-out program and review pertinent literature. Demographic, clinical, and outcome data were collected retrospectively from the charts of all patients cannulated onto ECMO at referring centers and transported to our center from 2003 to 2018. Similar data were recorded for patients who were referred for ECMO support from within the hospital. The cohort included 80 patients cannulated at 17 referring centers. The transport team included a senior pediatric cardiac surgeon and an ECMO specialist. All transfers but one were done by special emergency medical service ambulance. No major complications or deaths occurred during transport, and all patients were stable upon arrival to our unit. Mortality was lower in the ECMO reach-out cohort than in-house patients referred for ECMO support. This is the first study from Israel and one of the largest to date describing a dedicated pediatric ECMO transport program. Extracorporeal membrane oxygenation transport appears to be feasible and safe when conducted by a small, highly skilled mobile team. Successful reach-out program requires open communication between the referring physician and the accepting center. As survival correlates with ECMO volume, maintaining a large ECMO center with 24/7 retrieval capabilities may be the best strategy for pediatric mechanical circulatory support program.
Alcoholism and nutrition: a review of vitamin supplementation and treatment
Authors: Lewis Michael J.
Published: January 2020

Purpose of review

This is a review of the research on the effectiveness of vitamin supplementation for alcoholism and alcohol-related illnesses. The focus is on research, both clinical and basic on alcohol treatment and nutritional effectiveness of these vital nutrients.

Recent findings

Most of the research involves basic experiments exploring the impact of vitamin depletion or deficits on physiological systems, especially liver and brain, in rodents. These often include behavioral measures that use cognitive, learning/memory and motivation experiments that model clinical studies. These provide support for hypotheses concerning the impact of such deficiencies in clinical populations. Clinical studies are rare and involve evaluation of the outcome of supplementation usually in the context of a treatment program. Specific vitamins, dosages and treatment programs vary. Deficiencies in retinoids (vitamin A), thiamine (B1) and niacin (B3) are the most frequently investigated. However, there is a greater need for further research on other vitamins, and for more uniform supplementation and treatment procedures.

The literature is primarily basic research on specific vitamins. There are very significant findings with individual vitamin supplementation and combinations that show promise of our understanding of the role of vitamins in the disease of alcoholism and its treatment.
Meta-analysis of modified Stoppa approach and ilioinguinal approach in anterior pelvic ring and acetabular fractures
Authors: Wu Hao , Zhang LiJun , Guo XiaoMin , Jiang XiaoJun
Published: January 2020

Background:

The purpose of this meta-analysis was to compare the efficacy of the modified Stoppa approach (MSA) and ilioinguinal approach (IA) in the treatment of anterior pelvic ring and acetabular fractures.

Methods:

A literature search was conducted using PubMed, Embase, and Cochrane database for articles that compared MSA and IA in the treatment of anterior pelvic ring and acetabular fractures. All the included articles were evaluated by 2 trained reviewers in accordance with the Cochrane Collaboration Handbook for potential risk. The Jadad decision algorithm and Downs and Black scores were also used to assess the quality of the included studies. The extracted data included operative time, intraoperative blood loss, reduction quality, clinical outcome, and complications.

Results:

Five articles were included in this meta-analysis, with 186 patients in the MSA group and 219 patients in the IA group. Compared with IA, MSA significantly shortened the operative time (P = .0002), decreased intraoperative blood loss (P = .002), and provided better reduction quality (P = .03). Meanwhile, this meta-analysis suggests no significant difference between MSA and IA regarding clinical outcomes (P = .63) and complications (P = .34). The subgroup analysis of complications also showed no statistically significant difference between the 2 groups (including infection, and vascular and nerve injuries).

Conclusion:

According to this meta-analysis, the currently available evidence suggests that MSA can significantly shorten operative time, decrease intraoperative blood loss, and provide better reduction quality than IA in the treatment of anterior pelvic ring and acetabular fractures. In addition, in terms of clinical outcomes and complications, no significant differences were found between the 2 groups.

Level of Evidence: Level IV, meta-analysis.
Platelet inhibitory activity, tolerability, and safety of vicagrel, a novel thienopyridine P2Y12 inhibitor
Authors: Li Hui , Chen Hanjing , Chen Weili , Xu Hongrong , Yuan Fei , Yang Mengjie , Sun Hongbin , Yang Jin , Liu Yongqiang , Lai Xiaojuan , Gong Yanchun , Liu Xuefang , Li Yongguo , Sheng Lei , Liu Chao , Li Xuening
Published: January 2020

Vicagrel is a new antiplatelet pro-drug based on clopidogrel sulfur lactone metabolites. The purpose of the study was to evaluate the safety, tolerability, and pharmacodynamics (PD) of vicagrel in healthy Chinese subjects.

This study was designed as a single-center, randomized, double-blind, placebo-controlled, single oral ascending dose study. Fifty nine subjects were assigned to 6 vicagrel dose cohorts (5, 10, 20, 40, 60, and 75 mg), and 8 subjects were assigned to 75 mg clopidogrel. Within each vicagrel dose cohort, the 10 subjects (9 in the 75 mg cohort) were randomized 4:1 to receive vicagrel or placebo. Platelet function was assessed using VerifyNowTM P2Y12. ΔP2Y12 reaction units (ΔPRU) and percent inhibition platelet aggregation (%IPA) were used to evaluate the PD of vicagrel.

Although the number of adverse events (AEs) increased with vicagrel dose, none were considered serious, suggesting that vicagrel is safe and well-tolerated. The ΔPRU and %IPA patterns suggest that inhibition of ADP-induced platelet aggregation increased in a dose-dependent manner across the 10 to 40 mg dose range. The inhibitory effect was nearly complete at 4 hours (mean %IPA 87.9%–93.0%, mean ΔPRU 206.6–240.0) for doses of 40 to 75 mg of vicagrel. In contrast, for 5 mg vicagrel and 75 mg clopidogrel, there were no measurable effects on platelet aggregation throughout the study.

The results suggest that vicagrel at 40 to 75 mg inhibits ADP-induced platelet aggregation, with a fast onset of action and significantly greater potency than clopidogrel. These findings indicate that vicagrel may be a highly effective and well-tolerated antiplatelet agent.
Significant association between methylenetetrahydrofolate reductase gene C677T polymorphism with polycystic ovary syndrome risk
Authors: Li Yin , Zhu Hongqiu , Liu Min , Zeng Zhulan , Zeng Yanling , Xu Xinlei , Ye Min
Published: January 2020

The methylenetetrahydrofolate reductase (MTHFR) may play a pathological role in polycystic ovary syndrome (PCOS). However, the conclusions of published reports on the relationship between the MTHFR C677T polymorphism and PCOS risk remain controversial.

To derive a more precise estimation we performed a metaanalysis based on 22 studies that together included 2405 cases and 2419 controls. PubMed, EMBASE, WanFang and the Chinese National Knowledge Infrastructure databases were used to retrieve articles up to up to October 28, 2019. The crude odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated to evaluate the association.

Metaanalysis results showed a significant association between the MTHFR C677T polymorphism and PCOS risk in 3 genetic models (allele model: OR = 1.40, 95% CI = 1.27–1.53; dominant model: OR = 1.47, 95% CI = 1.17–1.85); homozygous model: OR = 1.90, 95% CI = 1.55–2.32). Moreover, significant associations were observed when stratified by ethnicity, source of controls, etiology, and genotype methods.

This metaanalysis suggests that the T-allele of the MTHFR C677T polymorphism is associated with an increased risk of PCOS, especially in Asians further studies with larger population sizes are needed to confirm these results.
Concurrent chemoradiotherapy with raltitrexed and nedaplatin regimen for esophageal squamous cell carcinoma
Authors: Qiu Xiangnan , Li Jing , Zhou Han , Zhang Meng , Jiang Changchen , Shen Zetian , Zhu XiXu , Li Aomei , Che Yuxin , Wu Tiancong , Wang Zhen
Published: January 2020

Background:

The aim of the study reported here was to evaluate the feasibility and safety of raltitrexed and nedaplatin with concurrent radiotherapy in patients with unresectable, locally advanced esophageal squamous cell carcinoma (ESCC).

Methods:

Eligible patients were adults with newly diagnosed untreated, unresectable esophageal cancer in stages I to IV with lymph node metastases or cervical esophageal cancer. Patients received nedaplatin 25 mg/m2 per day on day 1–3, raltitrexed 3 mg/m2 on days 1 repeated every 21 days for 2 cycles, and combined concurrent radiotherapy (2 Gy/fraction, total dose of 60 Gy).

Result:

Thirty patients were included with squamous cell carcinoma. The median follow-up duration was 24 months. The overall response rate was 90%. The 1-year and 2-year overall survival rates for all patients were 70.4% and 55.7% with a median survival time of 30 months, and the median progression free survival was 20 month. The major toxicities were leukopenia and thrombopenia, with grade 3 to 4 leukopenia and thrombopenia were 50% and 30% of patients.

Conclusion:

Concurrent chemoradiotherapy with raltitrexed and nedaplatin agents frequently caused myelosuppression but was highly active and suggested to be a promising treatment option for locally advanced ESCC.
Acquired segmental sigmoid hypoganglionosis
Authors: Pan Zhi-Ping , Huang Lu-Qiao , Cui Jun-Hui
Published: January 2020

Rationale:

Intestinal hypoganglionosis most commonly presents in infancy or childhood, with only a few cases reported in adults. Those are mainly diagnosed after elective surgery for long-standing constipation and megacolon.

Patient concerns:

We report a case of a 48-year-old female from China who presented with symptoms of discontinuation of bowel movements for 2 months. A hard, round mass could be felt in her right lower abdomen.

Diagnosis:

The following examination methods diagnosed acquired segmental sigmoid hypoganglionosis. An abdominal computed tomography revealed a dilatation of the colon and suspicious wall thickening of the sigmoid colon. Anorectal manometry revealed relaxation of the anal sphincter. Histological examination revealed lower numbers and the degeneration of ganglion cells.

Interventions:

Sigmoidectomy and transverse colostomy.

Outcomes:

The patient recovered well from surgery. Three months after the surgery, barium enema revealed a recovery in colorectal dilatation.

Lessons:

This case could help raise awareness of acquired segmental hypoganglionosis. Resection of TZ and enterostomy presents an effective remission strategy for patients at risk of anastomotic leakage due to poor intestinal conditions.
Tai Chi for type 2 diabetes mellitus
Authors: Chen Xixi , Zhang Furong , Li Jian , Zhou Xiujuan , Sun Mingsheng , Liu Xicen , Liu Danyang , Shen Xiaoyu , Jin Rongjiang
Published: January 2020

Background:

Tai Chi is gaining an increasing popularity in rehabilitation management of chronic conditions. Yet no consensus has reached on its efficacy and safety of type 2 diabetes despite that several systematic reviews (SRs) were published on this topic. Therefore, we will conduct an overview to critically evaluate current SRs and implement an updated metaanalysis with recently published randomized controlled trials (RCTs).

Methods:

A systematic literature search of relevant RCTs-based SRs will be conducted in electronic databases including Medline, Embase, the Cochrane Library, the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database from their inceptions to search date without language restrictions. Eligible SRs will be methodologically assessed by the assessment of multiple SRs 2 and Risk of Bias in SRs tool and their RCTs included will be extracted for further evidence synthesis. To update current meta-analysis on this topic, a supplementary search will be implemented for related newly emerged RCTs. Cochrane risk of bias assessment tool will be applied for RCTs quality evaluation. The grading of recommendations assessment, development and evaluation will be utilized for evidence quality assessment of outcomes. Study characteristic information on participants, interventions, outcomes, comparisons and conclusions will be described in detail. Review Manager V5.3 will be used for risk of bias assessment and Stata 14.0 for meta-analysis and sensitivity analysis.

Results:

The study results will be disseminated through a peer-reviewed journal publication or conference presentation.

Conclusions:

This study finding will provide an updated evidence of Tai Chi for patients with type 2 diabetes mellitus (T2DM), thus to help inform clinical physicians, T2DM patients and their families to develop better rehabilitation plans and to draw more attention of decision-makers in exercise rehabilitation related policy-making.

This study protocol has been applied for registration on PROSPERO platform (https://www.crd.york.ac.uk/PROSPERO/), with an assigned ID: CRD42019140988
Posterior reversible encephalopathy syndrome with ischemic infarction complicated with intrauterine fetal death
Authors: Yeh Wei-Chih , Liou Li-Min , Wu Meng-Ni
Published: January 2020

Rationale:

Posterior reversible encephalopathy syndrome (PRES), a rare neurologic disorder, manifests as headache, altered mental status, seizures, visual disturbances, and other focal neurologic signs with typically reversible clinical symptoms and image changes. Although the underlying mechanism remains unknown, a current theory indicates cerebral autoregulation failure as the primary cause. We report a case of PRES with stroke in an adult with intrauterine fetal death (IUFD).

Patient concerns:

A 35-year-old Asian woman with twin pregnancy underwent cesarean section at 32 weeks of gestation because of IUFD. She presented with focal seizures and visual field defect 2 days after undergoing cesarean section. Her blood pressure and kidney, liver, and coagulation functions were normal without proteinuria.

Diagnosis:

PRES was diagnosed based on a series of brain magnetic resonance imaging findings. Ischemic infarction in the right frontal lobe eventually developed to encephalomalacia.

Interventions:

The patient received levetiracetam and valproate for seizure management.

Outcomes:

Five days after the onset, seizures were under control. All neurologic deficits completely improved after 21 days of admission.

Lessons:

PRES can occur in women with IUFD without preeclampsia or eclampsia symptoms. Although most cases result in vasogenic edema of the brain and exhibit good prognosis, PRES can cause cytotoxic edema and permanently damage the brain.
Stratified meta-analysis by ethnicity revealed that ADRB3 Trp64Arg polymorphism was associated with coronary artery disease in Asians, but not in Caucasians
Authors: Chen Yingjian , Liao Yuanjun , Sun Shengnan , Lin Fan , Li Rang , Lan Shujin , Zhao Xiaolei , Qin Jiheng , Rao Shaoqi
Published: January 2020

Background:

Previous studies demonstrated that ADRB3, beta-3 adrenergic receptor, participated in lipolysis and thermogenesis in adipose tissue. Consequently, this gene has attracted an increasing number of genetic studies examining its association with coronary artery disease (CAD) in different ethnicities in recent years, but no conclusion has been reached so far. The aim of this study was to explore whether the well-studied locus ADRB3 Trp64Arg in this gene confers a race-specific effect to CAD by conducting a stratified meta-analysis involving 15 independent studies and 11,802 subjects.

Methods:

Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the strength of association. Publication bias was quantified and examined with Begg's funnel plot test and Egger's linear regression method. The overall meta-analysis or stratified meta-analysis by ethnicity was performed by using STATA 12.0 software.

Results:

A total of 15 eligible studies involving 5779 CAD cases and 6023 health controls were included in this meta-analysis. The pooled results indicated that ADRB3 Trp64Arg polymorphism was significantly associated with an increased risk of CAD. Further stratified analysis by ethnicity revealed that ADRB3 Trp64Arg polymorphism was significantly associated with CAD in Asians (allelic: OR = 1.48, 95%CI 1.13–1.94, P = .005; homozygous: OR = 2.66, 95%CI 1.87–3.77, P < .001; recessive: OR = 2.46, 95%CI 1.74–3.47, P < .001), but not in Caucasians (allelic: OR = 1.09, 95%CI 0.93–1.27, P = .290; homozygous: OR = 1.31, 95%CI 0.61–2.86, P = .490; recessive: OR = 1.31, 95%CI 0.60–2.84, P = 2.494).

Conclusions:

This meta-analysis suggests that ADRB3 Trp64Arg polymorphism confers a race-specific effect to CAD.
Successful treatment of amniotic fluid embolism complicated by disseminated intravascular coagulation with rivaroxaban
Authors: Wu Hai-Di , Song Zi-Kai , Cao Hong-Yan , Xu Xiao-Yan , Tang Ming-Long , Yang Shuo , Liu Yang , Qin Ling
Published: January 2020

Rationale:

An amniotic fluid embolism (AFE) is a rare, lethal syndrome that is commonly associated with disseminated intravascular coagulation (DIC). Anticoagulation therapy is the most important strategy to inhibit excessive activation of the coagulation cascade in patients with AFE and DIC. At present, treatment of AFE with rivaroxaban has not been reported.

Patient concerns:

We report a 37-year-old woman (gravida 2, para 1) at 39 weeks’ gestation with irregular contractions of the uterus was admitted to the obstetrical department. Ten minutes after the spontaneous rupture of the membranes, the patient complained of dyspnea and dysphoria and exhibited cyanosis of her lips. The patient's blood pressure decreased and heart rate increased rapidly, and 2100 mL of unclotted blood flowed from her vagina within 1 hour. Her platelet count dropped to 21 × 10−9/L, and the results from routine coagulation tests, and D-dimer and fibrin degradation product tests were obviously abnormal.

Diagnoses:

According to the current research consensus, AFE with DIC should be considered immediately when sudden cardiovascular collapse occurs around the time of labor and delivery, followed by the development of coagulopathy and hemorrhage.

Interventions:

In addition, the variety of supportive treatments, rivaroxaban was used in anticoagulant therapy.

Outcomes:

At follow-up 30 and 60 days, there were no complaints of discomfort or abnormal laboratory assays. The patient recovered completely.

Lessons

: This case highlights that rivaroxaban, as a direct inhibitor of activated factor Xa, demonstrates a good therapeutic efficacy for treating AFE with DIC.
Management of Hepatitis B Virus Infection and Prevention of Hepatitis B Virus Reactivation in Children With Acquired Immunodeficiencies or Undergoing Immune Suppressive, Cytotoxic, or Biological Modifier Therapies
Authors: Indolfi Giuseppe , Abdel‐Hady Mona , Bansal Sanjay , Debray Dominique , Smets Françoise , Czubkowski Piotr , van der Woerd Wendy , Samyn Marianne , Jahnel Jörg , Gupte Girish , Zellos Aglaia , Mozer‐Glassberg Yael , Verkade Henkjan J. , Sokal Etienne , Fischler Björn
Published: January 2020

Reactivation of hepatitis B virus (HBV) is a known complication of immune‐suppressive, cytotoxic, and biological modifier therapies in patients currently infected with HBV or who have had past exposure to HBV. Nowadays, newer and emerging forms of targeted biologic therapies are available for the management of rheumatologic conditions, malignancies, inflammatory bowel disease, dermatologic conditions and solid‐organ, bone marrow, or haematologic stem cell transplant but there is currently a lack of a systematic approach to the care of patients with or at risk of HBV reactivation. The Hepatology Committee of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) together with a working group of ESPGHAN members with clinical and research expertise in viral hepatitis developed an evidence‐based position paper on reactivation of HBV infection in children identifying pertinent issues addressing the diagnosis, prevention, and treatment of this condition. Relevant clinical questions were formulated and agreed upon by all the members of the working group. Questions were answered and positions were based on evidence resulting from a systematic literature search on PubMed and Embase from their inception to July 1, 2019. A document was produced and the working group and ESPGHAN Hepatology Committee members voted on each recommendation, using a formal voting technique. A recommendation was accepted provided upon agreement by at least 75% of the working group members. This position paper provides a comprehensive update on the diagnosis, prevention and treatment of HBV reactivation in children.
Palliative Cancer Care Stress and Coping Among Clinical Nurses Who Experience End-of-Life Care
Authors: Kim Hyunju , Kim Kisook
Published: January 2020

The increasing number of cancer patients and prolonged periods of illness have led to an increase in nurses' stress and various other problems. This research aimed to identify the stress resulting from caring for cancer patients and the methods for coping with stress among cancer care nurses. The research subjects were 180 clinical nurses caring for cancer patients in a hospital in Korea. Stress caused by excessive workloads, inappropriate compensation, and interpersonal conflicts with physicians was high. There was a difference in stress according to age. Coping strategies differed according to religion, education, occupation, hospice education, job satisfaction, and leisure activities. The higher the stress, the greater the number of coping strategies used. Problem-related coping was associated with more diverse stressors. Stress characteristics differed according to various factors, whereas stress coping strategies depended on the stress characteristics of clinical nurses caring for cancer patients. Future research following a critical approach will be needed to elucidate the compassion fatigue related to the stress strategies of clinical nurses. These findings could contribute to the development of interventions to reduce stress in clinical nurses by providing evidence on the stress and coping methods of nurses who provide palliative care for cancer patients.
Efficacy of Binaural Beat Meditation Technology for Treating Anxiety Symptoms
Authors: Yusim Anna , Grigaitis Justinas
Published: January 2020

The objective of this study was to examine the efficacy of a novel binaural beat meditation technology for the treatment of anxiety symptoms in both psychiatric outpatients and nonpatients. Twenty psychiatric outpatients with anxiety disorder and eight individuals (nonpatients) in the healing professions were given the opportunity to use this meditation technology over the course of 2 weeks to 2 months. The State-Trait Anxiety Inventory scores were measured in all participants over the course of the study. Of the 20 outpatients who took part in the study, nine used the meditations as planned, whereas 11 did not for various reasons (could not download, forgot, did not have time, etc.), resulting in the formation of three treatment groups: psychiatry + meditation (n = 8), psychiatry only (n = 10), and meditation only (n = 8). The psychiatry + meditation group showed a 13.5-point (26.5%) decrease in State-Anxiety (t = 5.28, p = 0.001), a 14.1-point (24.7%) decrease in Trait-Anxiety (t = −5.12, p = 0.001), and a 27.6-point (25.6%) decrease in Total Anxiety (t = 7.63, p ≤ 0.001). The psychiatry-only group showed a 4.2-point (8.4%) decrease in State-Anxiety (t = −2.20, p = 0.05) and a 7.0-point (6.9%) decrease in Total Anxiety (t = −2.61, p = 0.02). The meditation only showed a 3.5-point (9.8%) decrease in Trait-Anxiety (t = −2.47, p = 0.04). In a multiple regression analysis controlling for sociodemographic factors, medications, and treatment-related variables, the only statistically significant improvement in anxiety was seen in the psychiatry + meditation group for the Total Anxiety score (p < 0.01). These findings suggest that use of this meditation technology may exhibit a positive effect on self-reported measures of anxiety in the context of a psychiatry/psychotherapy practice. However, larger-scale randomized, placebo-controlled trials are needed to confirm our findings.