bluuebunny/crossref_metadata_2025 huggingface dataset:
Galaxy evolution on resolved scales: ageing and quenching in CALIFA
Authors: Corcho-Caballero P , Casado J , Ascasibar Y , García-Benito R
Published: September 2021

This work investigates the fundamental mechanism(s) that drive galaxy evolution in the local Universe. By comparing two proxies of star formation sensitive to different time-scales, such as EW($\rm H\,\alpha$) and colours like g − r, one may distinguish between smooth secular evolution (ageing) and sudden changes (quenching) in the recent star formation history of galaxies. Building upon the results obtained from a former study based on 80 000 Sloan Digital Sky Survey (SDSS) single-fibre measurements, we now focus on spatially resolved (on kpc scales) galaxies, comparing with a sample of 637 nearby objects observed by the Calar Alto Legacy Integral-Field Area survey. In general, galaxies cannot be characterized in terms of a single ‘evolutionary stage’. Individual regions within galaxies arrange along a relatively narrow ageing sequence, with some intrinsic scatter possibly due to their different evolutionary paths. These sequences, though, differ from one galaxy to another, although they are broadly consistent with the overall distribution found for the (central) SDSS spectra. We find evidence of recent quenching episodes (relatively blue colours and strong $\rm H\,\alpha$ absorption) in a small fraction of galaxies (most notably, low-mass ellipticals), on global scales and individual regions (particularly at high metallicity). However, we argue that most of the systems, over their entire extent, are compatible with a secular inside-out scenario, where the evolutionary stage correlates with both global (mass, morphology, and environment) and local (surface brightness and metallicity) properties.
Relationship between genetically determined telomere length and glioma risk
Authors: Saunders Charlie N , Kinnersley Ben , Culliford Richard , Cornish Alex J , Law Philip J , Houlston Richard S
Published: September 2021

Background

Telomere maintenance is increasingly recognized as being fundamental to glioma oncogenesis with longer leukocyte telomere length (LTL) reported to increase risk of glioma. To gain further insight into the relationship between telomere genetics and risk of glioma, we conducted several complementary analyses, using genome-wide association studies data on LTL (78 592 individuals) and glioma (12 488 cases and 18 169 controls).

Methods

We performed both classical and summary Mendelian randomization (SMR), coupled with heterogeneity in dependent instruments tests, at genome-wide significant LTL loci to examine if an association was mediated by the same causal variant in glioma. To prioritize genes underscoring glioma-LTL associations, we analyzed gene expression and DNA methylation data.

Results

Genetically increased LTL was significantly associated with increased glioma risk, random-effects inverse variance weighted ORs per 1 SD unit increase in the putative risk factor (odds ratio [OR]SD) 4.79 (95% confidence interval: 2.11-10.85; P = 1.76 × 10−4). SMR confirmed the previously reported LTL associations at 3q26.2 (TERC; PSMR = 1.33 × 10−5), 5p15.33 (TERT; PSMR = 9.80 × 10−27), 10q24.33 (STN1 alias OBFC1; PSMR = 4.31 × 10−5), and 20q13.3 (STMN3/RTEL1; PSMR = 2.47 × 10−4) glioma risk loci. Our analysis implicates variation at 1q42.12 (PSMR = 1.55 × 10−2), 6p21.3 (PSMR = 9.76 × 10−3), 6p22.2 (PSMR = 5.45 × 10−3), 7q31.33 (PSMR = 6.52 × 10−3), and 11q22.3 (PSMR = 8.89 × 10−4) as risk factors for glioma risk. While complicated by patterns of linkage disequilibrium, genetic variation involving PARP1, PRRC2A, CARMIL1, POT1, and ATM-NPAT1 was implicated in the etiology of glioma.

Conclusions

These observations extend the role of telomere-related genes in the development of glioma.
Intraoperative Methadone Use in Cardiac Surgery: A Systematic Review
Authors: Lobova Veronika A , Roll John M , Roll Marshall L C
Published: September 2021

Objective

To investigate the effects of intraoperative methadone in comparison with those of standard-of-care intraoperative opioids, such as fentanyl and morphine, on pain scores, opioid consumption, and adverse effects in adults undergoing cardiothoracic surgery.

Methods

The literature was reviewed in PubMed, Embase, Cochrane Library, and Google Scholar, followed by a manual search of the reference lists of the identified articles. Search terms included a combination of “intraoperative methadone,” “methadone,” and “cardiac surgery.” Our review includes four studies published between 2011 and 2020. Quality assessment of the studies was performed.

Results

The initial search identified 715 articles, from which 461 duplicates were removed and 236 were eliminated on the basis of inclusion and exclusion criteria. Eighteen articles underwent full-text review. Four studies evaluating a total of 435 patients with various cardiothoracic procedures were included in this review. We found that intraoperative methadone decreased acute postoperative pain and reduced postoperative opioid consumption in the first 24 postoperative hours in patients who received 0.1–0.3 mg/kg intraoperative methadone in comparison with morphine and fentanyl. No difference was found in adverse effects between the groups. Quality assessment of the studies showed a low risk of bias in three of the randomized controlled trials and a high risk of bias in the retrospective review because of the baseline confounding bias in the study design.

Conclusions

Intraoperative methadone use reduces acute postoperative pain and lowers opioid consumption in comparison with morphine and fentanyl. Initial results suggest that methadone may be an equivalent opioid to be administered during cardiothoracic procedures to reduce acute postsurgical pain, though further research is warranted.
Multivalve infective endocarditis in intravenous drug using patients: an epidemiological study
Authors: Khan Isa , Brookes Elizabeth , Yaftian Nima , Wilson Andrew , Darby Jonathan , Newcomb Andrew
Published: September 2021

Background

Infective endocarditis (IE) remains a life-threatening condition. Intravenous drug use (IVDU) adds to the clinical challenge associated with IE due to clinical aberrations caused by the social issues associated with this population.

Aim

To improve survival, this study aimed to characterize the contemporary IVDU-associated IE population seen at our tertiary hospital, determine their long-term outcomes and find risk factors associated with mortality.

Design

Retrospective observational cohort study.

Methods

A total of 79 patients accounting for 89 presentations were treated for IVDU-associated IE at St Vincent’s Hospital Melbourne (SVHM) between 1999 and 2015. Patients were followed-up until death or January 2021. The primary outcome was all-cause mortality and Kaplan–Meier survival analysis was used to calculate long-term survival estimates. Cox proportional hazards analysis was used to examine risk factors for mortality.

Results

The IVDU population treated at SVHM had a high rate of multivalvular IE, at 18.98%. Multivariate analysis revealed that multivalvular IE is significantly associated with an increased risk of mortality in a dose–dependent relationship (two valves affected: HR = 4.73, P = 0.006, three valves affected: HR = 14.19, P = 0.014). The IVDU population has survival estimates of 83.78% (95%CI: 73.21–90.45%) at 1-year and 64.98% (95%CI: 50.94–75.92%) at 15-years.

Conclusion

IVDU patients have high rates of multivalvular endocarditis, which is associated with increased risk of mortality and difficult to identify on echocardiography. Clinicians should be suspicious of multivalve involvement in the IVDU population and decisions related to medical management/intervention should be made with the understanding that these patients are at a higher risk of death.
Administration of Venous Thromboembolism Chemoprophylaxis Within 12 Hours of Pelvic and Acetabular Surgery Has No Effect on Estimated Blood Loss, Perioperative Change in Hemoglobin, or Need for Transfusion
Authors: Keil Lukas G. , Flannigan Sean A. , Ostrum Robert F. , Hahn Jesse C.
Published: September 2021

Objective:

To determine if preoperative administration of venous thromboembolism (VTE) chemoprophylaxis (PPx) before pelvic and acetabular fracture surgery affects estimated blood loss (EBL), perioperative change in hemoglobin (ΔHgb), or transfusion rates.

Design:

Retrospective cohort study.

Setting:

Level 1 trauma center, southeastern United States.

Patients/Participants:

All pelvic and acetabular surgeries performed between April 2014 and February 2020.

Main Outcome Measurements:

EBL, immediate and 24-hour postoperative ΔHgb, and intraoperative/postoperative transfusion.

Results:

In all, 267 surgeries were included: 97 prechange and 170 postchange. Median injury severity score was 17 before versus 14 after the change. One surgeon retired and two started during the study, producing differences in acetabular approaches. Median surgical duration was longer postchange. Cohorts were otherwise similar. No differences were observed in EBL, ΔHgb, or transfusion rates. Rates of VTE and surgical site complications were unchanged. No VTE-related deaths occurred. In the as-treated analysis (63 patients given low-molecular-weight heparin <12 hours preoperatively vs. 190 patients not given PPx), no differences were observed.

Conclusions:

Administration of VTE PPx within 12 hours of pelvic and acetabular surgery had no effect on perioperative blood loss. This study is limited by changes in faculty, but it suggests that traumatologists need not advocate for holding VTE PPx before pelvic and acetabular trauma surgery.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Reamer Irrigator Aspirator Versus Iliac Crest Bone Grafting and Proximal Tibial Curettage: Is There a Difference in Blood Loss and Transfusion Rates?
Authors: Martella Anthony , Schumaier Adam P. , Sirignano Michael N. , Sagi Henry C. , Wyrick John D. , Archdeacon Michael T.
Published: September 2021

Objectives:

To compare blood loss and transfusion rates among reamer irrigator aspirator (RIA), iliac crest bone graft (ICBG), and proximal tibial curettage (PTC) for autograft harvest.

Design:

Retrospective comparative study.

Setting:

Level 1 trauma center.

Patients/Participants:

The study included 139 adult patients treated between 2011 and 2018.

Interventions:

Nonunion repair of the femur or tibia using either RIA (n = 64), ICBG (n = 59), or PTC (n = 16) for autograft.

Main Outcome Measurements:

Estimated blood loss and transfusion rates.

Results:

Patient demographics, surgical indications, and medical comorbidities that affect bleeding did not differ among the groups. Estimated blood loss (mL) was significantly higher in the RIA group [RIA: 388 ± 368 (50–2000), ICBG: 286 ± 344 (10–2000), PTC: 196 mL ± 219 (10–700), P < 0.01]. The transfusion rate was also significantly higher in the RIA group (RIA 14%, ICBG 0%, PTC 0%, P < 0.01). The amount of graft obtained was higher in the RIA group (RIA = 48.3 mL, ICBG = 31.0 mL, PTC = 18.8 mL, P < 0.01), and the operative time (hours) was longer in the RIA group (RIA = 2.8, ICBG = 2.6, PTC = 1.9, P = 0.04).

Conclusion:

Estimated blood loss and transfusion rates were significantly higher in patients undergoing RIA compared with those in patients undergoing ICBG and PTC; however, the incidence of transfusion after RIA (14%) was considerably lower than previous reports. These findings suggest that the risk of transfusion after RIA is present and clinically significant but lower than previously believed, and it is likely affected by the amount of graft obtained and complexity of the nonunion repair. The risk of transfusion should be discussed with patients and the choice of RIA carefully evaluated in patients who have anemia or risk factors of bleeding.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Percutaneous Fixation of Posterior Malleolar Fractures in Patients With Unstable Ankle Fractures Treated With a Fibular Intramedullary Nail: A Description of a Technique and Review of Outcomes
Authors: Wordie Sarah J. , Carter Thomas H. , MacDonald Deborah , Duckworth Andrew D. , White Timothy O.
Published: September 2021

Objectives:

To (1) describe the percutaneous technique used to reduce and fix a posterior malleolar fracture with anteroposterior screws in patients managed with a fibular intramedullary nail, (2) describe the selection of patients to whom this technique can be applied, and (3) report the clinical and patient reported outcome of this intervention.

Design:

Retrospective review.

Setting:

Academic orthopaedic trauma center.

Patients:

Thirty-two consecutive patients with a mean age of 65 years (range, 39–90) over a thirteen-year period identified from a prospective database.

Intervention:

Unstable ankle fractures managed surgically with a fibular nail and percutaneous fixation of the posterior malleolar component.

Main Outcome Measurements:

The primary short-term outcome was complications related to posterior malleolar fracture fixation. The primary mid-term outcome was the Olerud–Molander Ankle Score. Secondary outcomes included the Manchester–Oxford Foot Questionnaire, EuroQol-5D, health, pain, and satisfaction.

Results:

Thirty of the 32 (94%) posterior malleolar fractures united uneventfully. Postoperative loss of talar reduction occurred in 2 patients (6.3%), which in 1 patient (3.1%) eventually required a hindfoot nail arthrodesis. There were no soft-tissue complications related to the anteroposterior screws or the fibular nail fixation. At a mean follow-up of 3.7 years (range, 1–8), the median Olerud–Molander Ankle Score, Manchester–Oxford Foot Questionnaire, EuroQol-5D, health, pain, and satisfaction scores were 80.0, 23.4, 0.85, 80.0, 85.0, and 87.5, respectively.

Conclusions:

Percutaneous ankle fracture fixation with a fibular nail and posterior malleolar screws results in reliable fracture stabilization, good patient outcomes, and high treatment satisfaction.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Pilot Study Analysis of Serum Cytokines to Differentiate Pediatric Septic Arthritis and Transient Synovitis
Authors: Clever David , Thompson Dominic , Gosselin Michelle , Brouillet Kirsten , Guilak Farshid , Luhmann Scott J.
Published: September 2021

Background:

In pediatric patients, the presentation of the nontraumatic acutely painful joint/limb poses a diagnostic dilemma due to the similarity of presentations of the most likely diagnoses [septic arthritis (SA), transient synovitis (TS), osteomyelitis]. Current tools employed to differentiate these diagnoses rely on nonspecific inflammatory markers, radiologic imaging, and arthrocentesis. Diagnostic algorithms utilizing these clinical, radiographic, and biochemical parameters have produced conflicting results. The purpose of this study was to identify a serum-based inflammatory signature which can differentiate SA from TS in pediatric patients.

Methods:

Serum samples were collected from 22 pediatric patients presenting with joint/extremity pain whose working diagnosis included SA or TS. Each sample was analyzed for serum abundance of 72 distinct biomarkers and cytokines using enzyme linked immunosorbent assay based arrays. Linear discriminant analysis was performed to identify a combinatorial biomarker panel to predict a diagnosis of SA or TS. Efficacy of the biomarker panel was compared with definitive diagnoses as based on laboratory tests, arthrocentesis results, and clinical scenario.

Results:

At the time of presentation: (1) mean erythrocyte sedimentation rate in the SA group was 56.6 mm/h and 12.4 mm/h in the TS group (P<0.001), (2) mean C-reactive protein was 55.9 mg/dL in the SA group and 13.7 mg/dL in the TS group (P=0.12), and (3) mean white blood cell was 10.9 k/mm3 in the SA group and 11.0 k/mm3 in the TS group (P=0.95). A combined panel of 72 biomarkers was examined using discriminant analysis to identify a limited set of predictors which could accurately predict whether a patient was diagnosed with SA or TS. A diagnostic algorithm consisting of transforming growth factor alpha, interleukin (IL)-7, IL-33, and IL-28A serum concentration correctly classified 20 of the 22 cases with a sensitivity and specificity of 90.9% (95% confidence interval: 73.9%-100.0%).

Conclusion:

This study identifies a novel serum-based 4-cytokine panel that accurately differentiates SA from TS in pediatric patients with joint/limb pain.

Level of Evidence:

Level II—diagnostic study.
MicroRNA-148a/152 cluster restrains tumor stem cell phenotype of colon cancer via modulating CCT6A
Authors: Peng Xin , Chen Guanming , Lv Baozhou , Lv Jiudi
Published: September 2021

Accumulating evidence has presented that microRNA-148a/152 (miR-148a/152) acts as the tumor inhibitor in various cancers. In this article, we aimed to probe the inhibition of colon cancer stem cells by miR-148a/152 cluster via regulation of CCT6A. miR-148a/152 and CCT6A expression in colon cancer tissues and cells was detected. The relationship between miR-148a/152 expression and the clinicopathological features of patients with colon cancer was analyzed. Colon cancer stem cells (CD44+/CD133+) were selected and high/low expression of miR-148a/152 plasmids were synthesized to intervene CD44+/CD133+ colon cancer stem cells to investigate the function of miR-148a/152 in invasion, migration, proliferation, colony formation and apoptosis of cells. The growth status of nude mice was observed to verify the in-vitro results. The relationship between miR-148a/152 and CCT6A was analyzed. CCT6A upregulated and miR-148a/152 downregulated in colon cancer tissues. MiR-148a/152 expression was correlated with tumor node metastasis stage, lymph node metastasis and differentiation degree. Upregulated miR-148a/152 depressed CCT6A expression and restrained invasion and migration ability, colony formation and proliferation, induced cell apoptosis, depressed OCT4, Nanog and SOX2 mRNA expression of colon cancer stem cells, and descended tumor weight and volume in nude mice. CCT6A was a target gene of miR-148a/152. Overexpression of CCT6A protected colon cancer stem cells. Functional studies showed that upregulation of miR-148a/152 can suppress the migration, invasion and proliferation of CD44+/CD133+ colon cancer stem cells, advance its apoptosis via inhibition of CCT6A expression.
Disseminated intravascular coagulation induced by pazopanib following combination therapy of nivolumab plus ipilimumab in a patient with metastatic renal cell carcinoma
Authors: Hashimoto Mamoru , Nakayama Takahito , Fujimoto Saizo , Inoguchi Shunsuke , Nishimoto Mitsuhisa , Kikuchi Takashi , Adomi Shogo , Banno Eri , De Velasco Marco A. , Saito Yoshitaka , Shimizu Nobutaka , Mori Yasunori , Minami Takafumi , Fujita Kazutoshi , Nozawa Masahiro , Nose Kazuhiro , Yoshimura Kazuhiro , Uemura Hirotsugu
Published: September 2021

Recently, combination therapy including immune checkpoint inhibition (ICI) has proven to be effective as first-line therapy for patients with metastatic renal cell carcinoma. Although the first-line combination therapies with ICI have shown clinical benefit, a number of patients require second-line treatment. We report a 60-year-old man with metastatic renal cell carcinoma who was treated with pazopanib soon after nivolumab plus ipilimumab combination therapy. He experienced Grade 3 disseminated intravascular coagulation (DIC). We suspect that this was caused by an interaction between pazopanib and nivolumab even though ICI therapy was discontinued. He was treated with thrombomodulin and platelet transfusion and recovered from DIC. Treatment with pazopanib was subsequently restarted. No evidence of DIC was observed thereafter. This severe adverse reaction may have been induced by an interaction between activated proinflammatory immune cells and cytokines from an exacerbated inflammatory state and pazopanib. This report highlights the need to perform careful monitoring of patients who receive molecular targeted therapy after ICI-based immunotherapy.
Development and validation of a deep learning model to screen hypokalemia from electrocardiogram in emergency patients
Authors: Wang Chen-Xi , Zhang Yi-Chu , Kong Qi-Lin , Wu Zu-Xiang , Yang Ping-Ping , Zhu Cai-Hua , Chen Shou-Lin , Wu Tao , Wu Qing-Hua , Chen Qi
Published: September 2021

Background:

A deep learning model (DLM) that enables non-invasive hypokalemia screening from an electrocardiogram (ECG) may improve the detection of this life-threatening condition. This study aimed to develop and evaluate the performance of a DLM for the detection of hypokalemia from the ECGs of emergency patients.

Methods:

We used a total of 9908 ECG data from emergency patients who were admitted at the Second Affiliated Hospital of Nanchang University, Jiangxi, China, from September 2017 to October 2020. The DLM was trained using 12 ECG leads (lead I, II, III, aVR, aVL, aVF, and V1–6) to detect patients with serum potassium concentrations <3.5 mmol/L and was validated using retrospective data from the Jiangling branch of the Second Affiliated Hospital of Nanchang University. The blood draw was completed within 10 min before and after the ECG examination, and there was no new or ongoing infusion during this period.

Results:

We used 6904 ECGs and 1726 ECGs as development and internal validation data sets, respectively. In addition, 1278 ECGs from the Jiangling branch of the Second Affiliated Hospital of Nanchang University were used as external validation data sets. Using 12 ECG leads (leads I, II, III, aVR, aVL, aVF, and V1–6), the area under the receiver operating characteristic curve (AUC) of the DLM was 0.80 (95% confidence interval [CI]: 0.77–0.82) for the internal validation data set. Using an optimal operating point yielded a sensitivity of 71.4% and a specificity of 77.1%. Using the same 12 ECG leads, the external validation data set resulted in an AUC for the DLM of 0.77 (95% CI: 0.75–0.79). Using an optimal operating point yielded a sensitivity of 70.0% and a specificity of 69.1%.

Conclusions:

In this study, using 12 ECG leads, a DLM detected hypokalemia in emergency patients with an AUC of 0.77 to 0.80. Artificial intelligence could be used to analyze an ECG to quickly screen for hypokalemia.
Persistent inflammatory residual risk despite aggressive cholesterol-lowering therapy: what is next?
Authors: Arnold Natalie , Koenig Wolfgang
Published: September 2021

Purpose of review

To briefly summarize recently published evidence on the possible therapeutic modulation of inflammatory processes in atherosclerotic cardiovascular disease (ASCVD), focusing on the rationale for an additional randomized clinical trial, targeting both persistently elevated cholesterol and inflammatory residual risk and critically discuss still open issues and future perspectives with regard to treatment allocation.

Recent findings

Several large-scale clinical trials over the past few years have advanced our understanding of the role of inflammation in atherosclerosis, demonstrating that targeting the NLRP3 inflammasome and the IL-1β pathway indeed represent a new avenue to reduce residual risk in patients with ASCVD. However, despite optimal lipid-lowering therapy and novel options to modulate residual inflammatory risk, there are still a large number of individuals, being at high risk for recurrent ASCVD events.

The integration of a dual target strategy aimed at lowering the inflammatory burden in combination with aggressive lipid-modifying for those at high/very high ASCVD risk may hold potential to significantly improve patient care. However, a number of questions related to the design of such 2 × 2 factorial trial still needs to be answered.
What does complete revascularization mean in 2021? – Definitions, implications, and biases
Authors: Hosoyama Katsuhiro , Maeda Kay , Saiki Yoshikatsu
Published: September 2021

Purpose of review

Coronary revascularization is known to be an excellent treatment for coronary artery disease. However, whether incomplete myocardial revascularization compromises long-term outcomes, as compared to complete revascularization (CR), remains contentious. Herein, we review the concept of and evidence on CR/incomplete revascularization (ICR) and discuss future perspectives.

Recent findings

When possible, achieving CR in coronary artery bypass grafting is desirable; nonetheless, ICR is also a reasonable option to balance the therapeutic benefits against the risks.

Although angiography-based assessment currently remains the standard of care, fractional flow reserve guidance may reduce the number of lesions requiring revascularization, which may be helpful for an appropriate surgical revascularization strategy. In particular, utilizing this approach may refine hybrid revascularization procedures, especially among high-risk patients.
A moderated moderation analysis of perceived adaptivity and organizational support for innovation in the relationship between role overload and emotional exhaustion
Authors: Apenteng Bettye A. , Boakye Kwabena G. , Opoku Samuel T.
Published: September 2021

Background

Collectively, an individual’s ability and willingness to adjust to uncertain and complex changes in the workplace and an environment that supports employee problem-solving may facilitate individual-level adaptation to changes in the workplace and help mitigate the negative impact of work-related stressors on health care professionals’ work-related behavior and mental health outcomes.

Purpose

This study uses an interactionist perspective to assess how resources such as perceived adaptivity and organizational support for innovation serve as contextual boundary conditions of role overload in mitigating emotional exhaustion among health care workers.

Methodology

A cross-sectional survey design was used to collect data from rural health care workers (n = 310). A moderated moderation analysis was performed to address the aims of the study.

Results

The results indicate that role overload has a significant positive effect on emotional exhaustion. Furthermore, a statistically significant three-way interaction effect of perceived adaptivity, organizational support for innovation, and role overload on emotional exhaustion was observed. Organizational support for innovation was found to mitigate the negative impact of role overload on emotional exhaustion for employees with high perceived adaptivity, but not for those with low perceived adaptivity levels.

Conclusions

The findings from this study suggest that in high-stress work environments, integrating and appropriately matching personal and organizational resources could serve as a buffer against the effects of work stressors on emotional exhaustion.

Practical Implications

Effective strategies to enhance employee emotional well-being may require the joint consideration of individual and organizational factors.
Comparing ProKera With Amniotic Membrane Transplantation: Indications, Outcomes, and Costs
Authors: Zhou Tianwei Ellen , Robert Marie-Claude
Published: September 2021

Purpose:

The aim of this study was to compare the outcomes of ProKera versus amniotic membrane transplantation (AMT) in managing ocular surface disease.

Methods:

This study is a retrospective case series of patients who received either ProKera or sutured AMT for ocular surface disease. Patient demographics, treatment indications, retention time, percentage healed area, changes in visual acuity, and costs to the health care system were analyzed.

Results:

Fourteen patients were identified and analyzed for each group. The main indications for using ProKera and AMT were similar, including corneal ulcer or epithelial defect due to chemical burns, neurotropic state, or herpes zoster keratitis. The average time to dissolution or removal was 24.8 days in the ProKera group, compared with 50.1 days in the AMT group. The average percentage of healed corneal area was 59% for ProKera and 73% for AMT. There was no significant difference between the initial and the final visual acuity within groups and when comparing both groups. In our expense analysis, ProKera had a total cost of 699.00 Canadian dollars (CAD), whereas the cost of suture AMT was 1561.52 CAD. ProKera priced at 11.85 CAD for each percentage healed surface area and at 21.39 CAD for AMT.

Conclusions:

ProKera allowed for a faster corneal healing than sutured AMT, although its total healed area was less than the latter. Moreover, ProKera is more cost-effective than AMT, thus reducing financial burden to our health care system.
Impact of Scleral Lens on Corneal Curvature and Pachymetry in Keratoconic Eyes
Authors: Iqbal Asif , Mahadevan Rajeswari
Published: September 2021

Purpose:

The aim of this study was to evaluate the influence of scleral lens on corneal curvature and corneal thickness in keratoconic patients.

Methods:

Scheimpflug imaging was captured before lens insertion, immediately after removal at 6 hours, and, again, the next day morning. Anterior flat, steep, and maximal keratometry (Kflat, Ksteep, and Kmax, respectively) and pachymetry values were compared.

Results:

Minimal corneal flattening was observed for all 3 curvature parameters immediately after lens removal but was not statistically significant. The average Kflat was 0.28 ± 0.31 (D) flatter (P = 0.37), Ksteep was 0.37 ± 0.09 (D) flatter (P = 0.11), and Kmax was 0.19 ± 0.24 (D) flatter (P = 0.53), which returned to baseline level after one night of lens removal. After 6 hours of a 16-mm scleral lens wear, central corneal pachymetry showed that a marginal thickening of 7.76 ± 3.00 μm (P = 0.06) was causing 1.77 ± 0.67% of corneal edema, which returned to baseline after one night of lens removal. There was no significant correlation noted between corneal flattening and change in corneal thickness (r = 0.09, P = 0.78) and between central corneal clearance and change in corneal curvature (r = −0.23, P = 0.51).

Conclusions:

Minimal transient alteration in the anterior corneal curvature and corneal thickness was observed after 6 hours of scleral lens wear. These temporary changes regressed to baseline after overnight discontinuation of the lens.
Acute-on-Chronic Liver Failure Precipitated by Severe Acute Respiratory Syndrome Coronavirus 2 Infection in a Patient with Hepatitis B Virus-Related Cirrhosis: A Case Report
Authors: Chen Wanling , Zhang Qiran , Li Shijun , Liang Ruiting , Liang Haiqun , Yu Yiqi , Qiu Chao , Lv Jiannan , Zhang Wenhong
Published: September 2021

We present a case of acute-on-chronic liver failure (ACLF) in a patient with hepatitis B virus (HBV)-related decompensated cirrhosis and coronavirus disease 2019 (COVID-19). A 58-year-old woman with HBV-related and decompensated cirrhosis without any anti-viral treatment previously was admitted to the hospital due to a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. On admission, she was in stable condition. Thoracic computed tomography (CT) and laboratory findings showed no significant abnormalities. Entecavir was initiated promptly for HBV, while antiviral therapy and supportive treatment were initiated for COVID-19. Her lung infection exacerbated after 10 days of recurrent fever despite treatments, and there were signs of HBV reactivation. ACLF and multiple organ dysfunction syndrome developed rapidly from day 10 to day 19. The patient's clinical deterioration was also consistent with pneumonia progression and elevated interleukin 6 levels. SARS-CoV-2 likely precipitated ACLF in cirrhotic patients, either by inducing HBV flare or serving as an acute insult directly. This study discussed the underlying mechanisms of this process and management details. Monitoring HBV status is necessary, and inflammatory parameters might be valuable. HBV suppression should be initiated early, and variceal hemorrhage primary prevention might be beneficial in COVID-19 patients with cirrhosis.
ChAdOx1 nCoV-19 vaccine-associated thrombocytopenia: three cases of immune thrombocytopenia after 107 720 doses of ChAdOx1 vaccination in Thailand
Authors: Uaprasert Noppacharn , Panrong Krissana , Tungjitviboonkun Songphol , Dussadee Kulwara , Decharatanachart Pakanat , Kaveevorayan Peerapat , Shoosanglertwijit Rossanun , Watanaboonyongcharoen Phandee , Bunworasate Udomsak , Rojnuckarin Ponlapat
Published: September 2021

We reported three cases of immune thrombocytopenia (ITP) that developed within 6 weeks after ChAdOx1 nCoV-19 vaccination. Antiplatelet factor 4 antibodies were undetectable in all three cases. Therefore, vaccine-induced immune thrombotic thrombocytopenia was very unlikely. Other potential causes of thrombocytopenia were excluded. Their clinical presentations, severity of thrombocytopenia and outcomes were varied. Only one ITP case, an 80-year-old man, received ITP treatments and achieved complete response after 2 weeks of eltrombopag. An 84-year-old man had spontaneous complete remission, and a 55-year-old woman had partial platelet recovery without ITP treatments. Among 107 720 Thais administered the ChAdOx1 vaccine between 16 March and 10 May 2021, these three ITP cases resulted in an estimated risk of ITP of at least one per 36 000 doses, which was approximately similar to the risk of ITP after measles-mumps-rubella immunization. This raises the concern of an increased risk of ITP after ChAdOx1 vaccination.
Coronary stent infection: a systematic review
Authors: Suryawan I Gde Rurus , Luke Kevin , Agustianto Rafiv Fasya , Mulia Eka Prasetya Budi
Published: September 2021

Coronary stent infection (CSI) is the rarest complication associated with the percutaneous coronary intervention, occurring in less than 0.1% of cases. So far, all reported instances are limited to case reports. CSI presents itself in various, often confusing, ways in clinical settings. Therefore, the current systematic review summarizes reports of CSI’s clinical presentations, causative pathogens, diagnoses and treatments. This systematic review considered three online databases, using reference lists as an additional source. All case reports or case series with stent infection in the coronary artery were included – however, reviews or commentaries, articles not published in English, and articles mentioning a history of hemodialysis or any surgery were excluded. Thirty-two studies on 34 CSI patients were included in the final qualitative analysis. CSI predominantly affected males of a wide range of ages. The most common symptoms were chest pain and fever with various onsets. Interestingly, CSI usually occurred during the first stent implantation. Cultures and coronary angiography were the most common methods used to diagnose CSI. Furthermore, drug-eluting stents had a higher risk of infection than bare-metal stents. Aneurysms were the most frequent abnormalities observed in infected stents. The bacteria that most often caused CSI were Staphylococcus aureus and Pseudomonas aeroginosa. More than 90% of the reports mentioned using various antibiotics, and 74% mentioned carrying out surgery. Finally, a mortality rate of 26.47% among CSI patients was calculated.
Short- and long-term prognosis of acute critically ill patients with systemic rheumatic diseases
Authors: Chabert Paul , Danjou William , Mezidi Mehdi , Berthiller Julien , Bestion Audrey , Fred Abla-Akpene , Guerin Claude , Argaud Laurent , Piriou Vincent , Bonnefoy-Cudraz Eric , Lehot Jean-Jacques , Fellahi Jean-Luc , Rimmele Thomas , Aubrun Frederic , Richard Jean-Christophe , Gallay Laure , Hot Arnaud
Published: September 2021

Patients with systemic rheumatic disease (SRD) share the risks of multi-organ flare-up, cardiovascular diseases, and immunosuppression. Such situations can lead to an acute critical illness. The present study describes the clinical features of SRD patients admitted to the intensive care unit (ICU) and their short- and long- term mortality.

We performed a multicentre retrospective study in 10 French ICU in Lyon, France. Inclusion criteria were SRD diagnosis and admission for an acute organ failure. The primary endpoint was ICU mortality.

A total of 271 patients were included. SRD included systemic lupus erythematosus (23.2% of included patients), vasculitis (10.7%), systemic sclerosis (10.7%), idiopathic inflammatory myopathy (6.3%), and other connective tissue disorders (rheumatoid arthritis, Sjögren and Sharp syndromes; 50.9%). Initial organ failure(s) were shock (43.5% of included patients), acute kidney injury (30.5%), and acute respiratory failure (23.2%). The cause(s) of ICU admission included sepsis (61.6%), cardiovascular events (33.9%), SRD-flare up (32.8%), and decompensations related to comorbidities (28%). The ICU mortality reached 14.3%. The factors associated with ICU mortality were chronic cardiac failure, invasive ventilation and admission in ICU for another reason than sepsis or SRD flare-up. The median follow-up after ICU discharge was 33.6 months. During follow-up, 109 patients died. The factors associated with long-term mortality included age, Charlson comorbidity index, and ICU admission for sepsis or SRD flare-up.

The ICU mortality of patients with SRD was low. Sepsis was the first cause of admission. Cardiovascular events and comorbidities negatively impacted ICU mortality. Admission for sepsis or SRD flare-up exerted a negative effect on the long-term outcome.
Efficacy and safety of dual vs single renin–angiotensin–aldosterone system blockade in chronic kidney disease
Authors: Zhao Mingming , Qu Hua , Wang Rumeng , Yu Yi , Chang Meiying , Ma Sijia , Zhang Hanwen , Wang Yuejun , Zhang Yu
Published: September 2021

Background:

To lower albuminuria and to achieve blood pressure (BP) goals, dual renin–angiotensin–aldosterone system (RAAS) inhibitors are sometimes used in clinical practice for the treatment of CKD. However, the efficacy and safety of dual RAAS blockade therapy remains controversial.

Methods:

PubMed, EMBASE, and Cochrane Library were searched, and random effects model was used to calculate the effect sizes of eligible studies. Potential sources of heterogeneity were detected by meta-regression and subgroup analysis.

Results:

The present meta-analysis of 72 randomized controlled trials with 10,296 patients demonstrated that dual RAAS blockade therapy was superior to monotherapy in reducing the urine albumin excretion, urine protein excretion, and BP. These beneficial effects were related to the decrease of glomerular filtration rate, the increase of serum potassium level, and higher rates of hyperkalemia and hypotension. Meanwhile, these effects did not lead to improvements in short-term or long-term outcomes, including doubling of serum creatinine, acute kidney injury, end-stage renal disease, mortality, and hospitalization. Compared with the single therapy, angiotensin-converting enzyme inhibitor (ACEI) in combination with angiotensin-receptor blocker (ARB) was a better dual therapy than ACEI or ARB in combination with renin inhibitor or aldosterone receptor antagonist in decreasing urine albumin excretion, urine protein excretion and BP, and the combination was not associated with a lower glomerular filtration rate.

Conclusion:

Compared with the single therapy, ACEI in combination with ARB was a better dual therapy than ACEI or ARB in combination with renin inhibitor or aldosterone receptor antagonist. Although ACEI in combination with ARB was associated with higher incidences of hyperkalemia and hypotension, careful individualized management and potassium binders may further expand its application (PROSPERO number CRD42020179398).
Assessment of outcomes of elective cancer surgeries in children during coronavirus disease 2019 pandemic
Authors: Qureshi Sajid S. , Ramraj Deepak , Chinnaswamy Girish , Parambil Badira C. , Prasad Maya , Amin Nayana , Ramanathan Subramaniam , Khanna Nehal , Laskar Siddharth
Published: September 2021

To describe the outcomes of elective cancer surgeries and adverse consequences on the patients and medical staff due to the surgical interventions in children during the Coronavirus Disease 2019 (COVID-19) pandemic.

The study included children younger than 15 years who underwent elective cancer surgeries from March 4, 2020 and December 3, 2020.

A total of 121 patients (62% male; median age, 3 years) underwent surgery. The surgical procedures included nephrectomies (n = 18), neuroblastoma (n = 26) and soft tissue tumor resections (n = 24) and complex surgical procedures like extended liver resections (n = 2), intra-atrial thrombectomy under cardiopulmonary bypass (n = 2), pancreatoduodenectomy (n = 1), and free microvascular flaps (n = 7). Clavien-Dindo Grade III complications were 5% (n = 6), and there were no postoperative deaths. Preoperative COVID-19 testing was performed in 82% of children, and only 2% showed severe acute respiratory syndrome coronavirus 2 positivity. Postoperatively, 26 children were tested because of specific symptoms and, 6 tested positive for severe acute respiratory syndrome coronavirus 2. Except for a median delay of 23 days in treatment, none of the patients with COVID-19 required critical hospital management. None of the surgical residents or faculty acquired COVID-19, while 4 each medical and support staff were tested positive in the study period.

COVID-19 was not a deterrent for continued cancer care, and surgeries could be safely performed adopting universal preventive measures without any added morbidity from COVID-19. Caregivers and centers dealing with childhood cancers can be encouraged to sustain or seek early healthcare.
Clinical characteristics of cirrhosis patients with umbilical vein recanalization
Authors: Shi Qing , Xiong Kai , Ding Bin , Ye XiaoLing
Published: September 2021

Umbilical Vein Recanalization (UVR) may occur in patients with long-standing portal hypertension and liver cirrhosis. This study aimed to investigate the clinical significance of UVR.

Medical records of a cohort of patients with cirrhosis (n = 247) who were hospitalized at the Digestive Medicine Center of the Second Affiliated Hospital of Nanchang University from January 2012 to October 2015 were accessed. The UVR diagnosis was made by ultrasound examination and was confirmed by computerized tomography scan.

The UVR incidence was 20.2% (50/247) in the cohort. The size of UVR was 9.9 ± 4.7 mm (range: 5–26.5 mm) in diameter. The UVR and non-UVR groups showed no difference in grades of hepatic encephalopathy (P = .496), Child-Pugh classification (P = .401), the incidence of moderately severe ascites (26% vs 26%, P = 1), the esophageal variceal bleeding rate (32% vs 39%, P = .402), or portal vein thrombosis (8% vs 12%, P = .580). However, the incidence of cavernous transformation of the portal vein was statistically different, that there was 0 case in the UVR group and 8 cases in the non-UVR group (P < .05).

Our results suggested that UVR had little impact on the clinical manifestations of patients with liver cirrhosis, the significance of UVR as an intervention method requires further studies.
Prevalence and risk of residual viremia after ART in low- and middle-income countries
Authors: Gatechompol Sivaporn , Zheng Lu , Bao Yajing , Avihingsanon Anchalee , Kerr Stephen J. , Kumarasamy Nagalingeswaran , Hakim James G. , Maldarelli Frank , Gorelick Robert J. , Welker Jorden L. , Lifson Jeffrey D. , Hosseinipour Mina C. , Eron Joseph J. , Ruxrungtham Kiat
Published: September 2021

In order to design effective strategies to eradicate the HIV, an understanding of persistent viral reservoirs is needed. Many studies have demonstrated HIV residual viremia prevalence in high income countries, data from low- and middle-income countries (LMIC) are limited. We assessed the prevalence, and factors associated with residual viremia in people with HIV (PWH), who were virally-suppressed on antiretroviral therapy (ART) in LMIC. We also compared residual viremia prevalence between the LMIC and US.

This is a cross-sectional, retrospective study that utilized stored specimen samples from the AIDS clinical trials group (ACTG) studies A5175 and A5208. The last available sample among participants with plasma HIV RNA < 400 copies/mL for ≥3 years were tested by the HIV molecular and monitoring core gag (HMMCgag) single copy assay (SCA). Residual viremia was defined as detectable if ≥1 copy/mL. Spearman's correlation and multivariable stepwise logistic regression were used to assess associations of various factors with SCA.

A total of 320 participants, 246 (77%) from LMIC and 74 (23%) from US, were analyzed. Median (IQR) age was 33 (2840) years; baseline CD4 166 (88,230) cells/mm3; HIV RNA 5.0 (4.5, 5.3) log10 copies/mL; duration of viral suppression 3.4 (3.1, 4.0) years and 48% were male. In 85 participants with information available, 53% were subtype C, 42% subtype B and 5% other subtypes. Overall prevalence of residual viremia was 57% [95% CI, 52–63] with 51% [40–63] in US and 59% [53–65] in LMIC. Among participants with detectable SCA, the median (IQR) HIV RNA was 3.8 (2.2, 8.1) copies/mL. The multivariable model conducted in LMIC participants showed that higher baseline HIV RNA was associated with detectable residual RNA (OR 2.9, 95% CI 1.8, 4.6 for every log10 increase, P < .001). After including both US and LMIC in the final model, baseline HIV RNA remained significant. No difference in SCA detestability was found between US and LMIC sites (OR 1.1 [0.6, 2.0], P = .72) after adjusting for baseline RNA and parent study.

The prevalence of residual viremia between both groups were not different and more than half of the participants had detectable viremia. Higher baseline HIV RNA was independently associated with residual viremia.
Mechanisms and molecular targets of the Yu-Ping-Feng powder for allergic rhinitis, based on network pharmacology
Authors: Yang Shasha , Fu Qinwei , Deng Hua , Liu Zhiqing , Zhong Juan , Zhu Xiaoyu , Wang Qian , Sun Chuanhui , Wu Jing
Published: September 2021

In traditional Chinese medicine (TCM), Yu-Ping-Feng powder (YPFP) has been used to treat allergic rhinitis (AR) for centuries. However, the mechanisms underlying its effects or its molecular targets in AR treatment are yet to be elucidated. Therefore, the active compounds of YPFP and their targets were collected and identified from the Traditional Chinese Medicine Systems Pharmacology database. Moreover, AR-associated targets were acquired from the GeneCards and Online Mendelian Inheritance in Man database. Proteins interactions network of YPFP presumed targets and AR-associated targets were examined and merged to reveal the candidate YPFP targets against AR.

Cytoscape software and BisoGenet Database were employed to perform the Visualization and Integrated Discovery (Cluster Profiler R package, version: 3.8.1). Kyoto Encyclopedia of Genes and Genomes and genome pathway analyses. To identify the key target genes, a gene-pathway network has been constructed.

We identified 44 effective active compounds and 622 YPFP targets. Also 1324 target genes related to AR were identified. Twenty pathways, including those of AGE-RAGE signaling, fluid shear stress, atherosclerosis, PI3K-Akt signaling, and tumor necrosis factor signaling was enriched significantly. MAPK1 was identified as the core gene, while others including RELA, AKT1, NFKBIA, IL6, and JUN, were also important in the gene-pathway network. Clearly, network pharmacology can be applied in revealing the molecular targets and mechanisms of action of complex herbal preparations.

These findings suggested that YPFP could treat AR by regulating immunological functions, diminishing inflammation, and improving immunity through different pathways.