bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of host immune cells on the development of neurofibromatosis type 1: The abnormal immune system provides an immune microenvironment for tumorigenesis
Authors: Wei Cheng-Jiang , Gu Shu-Chen , Ren Jie-Yi , Gu Yi-Hui , Xu Xiang-Wen , Chou Xin , Lian Xiang , Huang Xin , Li Hai-Zhou , Gao Ya-Shan , Gu Bin , Zan Tao , Wang Zhi-Chao , Li Qing-Feng
Published: October 2019

AbstractThe immune system plays an essential role in the development of tumors, which has been demonstrated in multiple types of cancers. Consistent with this, immunotherapies with targets that disrupt these mechanisms and turn the immune system against developing cancers have been proven effective. In neurofibromatosis type 1 (NF1), an autosomal dominant genetic disorder, the understanding of the complex interactions of the immune system is incomplete despite the discovery of the pivotal role of immune cells in the tumor microenvironment. Individuals with NF1 show a loss of the NF1 gene in nonneoplastic cells, including immune cells, and the aberrant immune system exhibits intriguing interactions with NF1. This review aims to provide an update on recent studies showing the bilateral influences of NF1 mutations on immune cells and how the abnormal immune system promotes the development of NF1 and NF1-related tumors. We then discuss the immune receptors major histocompatibility complex class I and II and the PD-L1 mechanism that shield NF1 from immunosurveillance and enable the immune escape of tumor tissues. Clarification of the latest understanding of the mechanisms underlying the effects of the abnormal immune system on promoting the development of NF1 will indicate potential future directions for further studies and new immunotherapies.
Experiences from the first 10 years of a perinatal palliative care program: A retrospective chart review
Authors: Doherty Megan E , Power Liam , Williams Robin , Stoppels Nahal , Grandmaison Dumond Lynn
Published: October 2019

Background

Perinatal palliative care is a relatively new component of paediatric palliative care which supports families who are expecting the birth of a child with a life-limiting condition. This study seeks to understand the characteristics of the infants and families referred for perinatal palliative care and the context for referrals in terms of diagnoses, referral characteristics, interventions, and outcomes.

Methods

A retrospective chart review of infants with prenatally diagnosed life-limiting conditions that were referred for perinatal palliative care.

Results

Eighty-five referrals were made for perinatal palliative care during the 10-year period, of which, 84 chose to continue with the service. Average gestational age at diagnosis was 23 weeks, and the mean time between diagnosis and referral to palliative care was 7 weeks. Stillbirths were common, occurring in 29% cases. Of livebirths, 59% of the infants survived for 2 days, and 80% died within 30 days. The most commonly referred conditions were trisomy 13 or 18 (24%), severe central nervous system malformations (20%), and severe congenital cardiac disease (16%). Referrals were most often made by neonatologists (39%), and maternal–fetal medicine specialists (36%).

Discussion

Our study confirms previously observed characteristics of diagnosis, referrals, and outcomes, while providing the most detailed account of lifespans for particular diagnoses to date. Our findings validate the need for perinatal palliative care, as 99% of those referred continued with the service. Future research should adopt a prospective approach to identify critical factors affecting decision making of families and physicians in the wake of a life-limiting diagnosis.
The role of epigenetics in allergy and asthma development
Authors: Alashkar Alhamwe Bilal , Alhamdan Fahd , Ruhl Andreas , Potaczek Daniel P. , Renz Harald
Published: October 2019

Purpose of review

Epigenetic mechanisms are known to play a crucial role in the pathogenesis of asthma, allergic rhinitis, atopic dermatitis, food allergy, and other allergic disorders, especially through mediating the effects of the environmental factors, well recognized allergy-risk modifiers. The aim of this work was to provide a concise but comprehensive review of the recent progress in the epigenetics of allergic diseases.

Recent findings

Recent few years have substantially expanded our knowledge on the role of epigenetics in the pathogenesis and clinical picture of allergies. Specifically, it has been shown that epigenetic marks, especially DNA methylation, possess a diagnostic potential for atopic sensitization, asthma, allergic rhinitis, and food allergy. DNA methylation can be a predictor of clinical responses in controlled allergen challenges, including oral food challenges. Furthermore, direct or indirect targeting epigenetic mechanisms, this time especially histone modifications, was able to favorably affect expression of the genes underlying allergies and generally improve airway biology in allergic diseases or their animal models.

Further studies are needed to explore the diagnostic and therapeutic potential of epigenetic modifications in allergies and to develop respective clinical tools.
Preinjury Narcotic Use Does Not Affect Treatment for Compartment Syndrome
Authors: Chen Stephen R. , Abblitt William Parker , Knoll Olivia M. , Cooper Seth A. , Backstrom Zachary K. , Jahangir Amir A. , Sethi Manish K.
Published: October 2019

Objectives:

To determine the association of preinjury opioid use on incidence of fasciotomy after lower extremity trauma.

Design:

Retrospective case–control study.

Setting:

Level 1 trauma center.

Patients/Participants:

We identified 245 consecutive patients treated with fasciotomy for compartment syndrome of the lower extremity from 2011 to 2016. Of these, 115 were excluded for isolated vascular injury without fracture, age younger than 18 years, out-of-state residence, nontraumatic etiology, and/or incomplete opioid records. Three hundred ninety age- and sex-matched patients with tibial fractures not requiring fasciotomy were selected for comparison.

Intervention:

Review of demographics, injury characteristics, and opioid prescriptions.

Main Outcome Measurements:

Rate of preinjury narcotic use.

Results:

There was no significant difference in chronic opioid use between patients requiring fasciotomy and those who did not (odds ratio = 0.80, 95% confidence interval: 0.43–1.50, P = 0.49). There was no significant difference in average morphine milligram equivalents (MME)/day (66.6 vs. 77.4, P = 0.68). There was no significant difference in active opioid use (odds ratio = 0.76, 95% confidence interval: 0.45–1.29, P = 0.30). There was no significant difference in average MME/day (69.3 vs. 75.6, P = 0.80) for active narcotic users.

Conclusion:

There were no differences in the rate or average MME/day of preinjury opioid use between patients with a tibia fracture treated with or without fasciotomy for compartment syndrome. These results indicate that pre-existing opioid use does not interfere with the accurate diagnosis of compartment syndrome in trauma patients. The diagnosis and treatment of compartment syndrome is not affected by preinjury narcotic use and potential associations with opiate-induced hyperalgesia.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Modified Hemihamate Arthroplasty With Oblique Osteotomy of the Middle Phalanx Base to Reconstruct Proper Contour of the Articular Surface
Authors: Kato Naoki , Koike Tomoyuki , Zakaria Amir Fariz
Published: October 2019

Treatments of unstable dorsal fracture dislocations of the proximal interphalangeal (PIP) joint are very challenging. The authors performed modified hemihamate arthroplasty for these injuries in 13 patients (13 fingers). Our surgical technique was unique in the point that we put volarly oblique osteotomy in the coronal plane at the recipient site to create an adequate reconstruction of the volar lip of the articular surface of the middle phalanx. Affected fingers are index in 2, middle in 4, ring in 3, and little in 3, and the mean duration of follow-up was 14 months. Hemihamate arthroplasty was indicated if >30% to 50% of the volar articular surface of the middle phalangeal base showed comminuted fracture which was not large enough to allow open reduction and internal fixation. The average range of motion of the PIP joint was 17.7 degrees preoperatively, which was improved significantly to 71.3 degrees at final follow-up. Radiographically, all grafts were united but 1 showed mild graft absorption. Ten patients demonstrated normal joint space and other 3 showed mild degenerative change of PIP joints. Eleven patients showed good congruency of the PIP joint and other 2 demonstrated slight dorsal subluxation. Four patients complained of mild pain in flexion, but other 9 had no pain at all. The modified hemihamate arthroplasty is a reliable technique to treat comminuted dorsal fracture dislocations of the PIP joint.
An 1H NMR study of the cytarabine degradation in clinical conditions to avoid drug waste, decrease therapy costs and improve patient compliance in acute leukemia
Authors: Cerchione Claudio , Martinelli Giovanni , Pedatella Silvana , De Nisco Mauro , Pugliese Novella , Manfra Michele , Marra Nicoletta , Ronconi Sonia , De Giorgi Ugo , Altini Mattia , Simonetti Giorgia , Di Rorà Andrea Ghelli Luserna , Bravaccini Sara , Catalano Lucio , Dora Iula Vita , Pagano Francesco , Picardi Marco , Bolognese Adele , Pane Fabrizio , Martinelli Vincenzo
Published: October 2019

Cytarabine, the 4-amino-1-(β-D-arabinofuranosyl)-2(1H)-pyrimidinone, (ARA-C) is an antimetabolite cytidine analogue used worldwide as key drug in the management of leukaemia. As specified in the manufacturers’ instructions, once the components—sterile water and cytarabine powder—are unpackaged and mixed, the solution begins to degrade after 6 hours at room temperature and 12 hours at 4°C. To evaluate how to avoid wasting the drug in short-term, low-dose treatment regimens, the reconstituted samples, stored at 25°C and 4°C, were analyzed every day of the test week by reversed-phase HPLC and high-field NMR spectroscopy. All the samples remained unchanged for the entire week, which corresponds to the time required to administer the entire commercial drug package during low-dose therapeutic regimens. The drug solution was stored in a glass container at 4°C in an ordinary freezer and drawn with sterile plastic syringes; during this period, no bacterial or fungal contamination was observed. Our findings show that an cytarabine solution prepared and stored in the original vials retains its efficacy and safety and can, therefore, be divided into small doses to be administered over more days, thus avoiding unnecessary expensive and harmful waste of the drug preparation. Moreover, patients who require daily administration of the drug could undergo the infusion at home without need to go to hospital. The stability of the aliquots would help decrease hospitalization costs.
Trastuzumab in combination with paclitaxel enhances antitumor activity by promoting apoptosis in human epidermal growth factor receptor 2-positive trastuzumab-resistant gastric cancer xenograft models
Authors: Shu Sei , Yamashita-Kashima Yoriko , Yanagisawa Mieko , Nakanishi Hayao , Kodera Yasuhiro , Harada Naoki , Yoshimura Yasushi
Published: October 2019

Trastuzumab, a humanized anti-human epidermal growth factor receptor 2 antibody drug, is the first-line therapy for human epidermal growth factor receptor 2-positive breast and gastric cancer. For breast cancer, the benefit of continuous treatment with trastuzumab after it becomes refractory to first-line therapy has been demonstrated. However, it is unclear whether trastuzumab can show similar efficacy as a second-line treatment for gastric cancer. Here, we report that trastuzumab in combination with paclitaxel exhibits increased antitumor efficacy even for trastuzumab-resistant xenografted tumors. We derived the trastuzumab-resistant models from previously established human epidermal growth factor receptor 2-positive gastric cancer patient-derived cells. Human epidermal growth factor receptor 2 expression, PIK3CA mutation, and phosphatase and tensin homolog expression in these resistant models was equivalent to those in the trastuzumab-sensitive parental model, whereas cyclin-dependent kinase inhibitors, such as p16INK4a, p15INK4b, and p21cip1, were downregulated. Trastuzumab in combination with paclitaxel enhanced antitumor activity in both the sensitive and resistant models. In the trastuzumab-sensitive model, the combination of trastuzumab and paclitaxel resulted in suppression of the AKT–p27kip1–retinoblastoma protein pathway and induction of apoptosis. Although this combination did not suppress retinoblastoma protein phosphorylation in the trastuzumab-resistant model, it did markedly decrease epidermal growth factor receptor and human epidermal growth factor receptor 2 phosphorylation and further enhance paclitaxel-mediated apoptosis. These results suggested that trastuzumab in combination with paclitaxel can still exert more potent antitumor efficacy than each agent alone in trastuzumab-resistant models, providing evidence that trastuzumab remains beneficial in the treatment of trastuzumab-resistant tumors.
Interleukin-17D Aggravates Sepsis by Inhibiting Macrophage Phagocytosis
Authors: Yan Xingxing , Tu Hongmei , Liu Yi , Chen Tangtian , Cao Ju
Published: October 2019

Objectives:

Interleukin-17D has been shown to participate in the control of viral infections and cancer. Here we hypothesized that interleukin-17D may play a potential role in sepsis.

Design:

Prospective randomized animal investigation and in vitro human blood studies.

Setting:

Research laboratory from a university hospital.

Subjects:

Female C57BL/6J mice, sepsis patients by Sepsis-3 definitions, ICU patient controls, and healthy individuals.

Interventions:

Serum concentrations of interleukin-17D were measured and analyzed in human sepsis patients, patient controls, and healthy individuals. The contribution of interleukin-17D to sepsis-related survival, bacterial burden, and organ injury was assessed in a murine model of cecal ligation and puncture–induced polymicrobial sepsis by the use of anti–interleukin-17D antibody and recombinant interleukin-17D protein. The effects of interleukin-17D on bacterial phagocytosis by macrophages were also investigated using in vitro cell models.

Measurements and Main Results:

On the day of ICU admission (day 0), septic patients had significantly higher serum concentrations of interleukin-17D than patient controls and healthy individuals. Serum interleukin-17D levels remained significantly elevated in septic patients from ICU admission to day 3 and correlated with Sequential (Sepsis-related) Organ Failure Assessment scores and documented bacteremia on day 0. Furthermore, nonsurvivors of septic patients displayed significantly higher interleukin-17D levels compared with survivors of septic patients on days 0 and 1 of ICU admission. In animal models of sepsis, treatment with anti–interleukin-17D antibody protected mice from cecal ligation and puncture–induced severe sepsis, which was associated with improved bacterial clearance and organ injury. Conversely, administration of recombinant interleukin-17D protein aggravated cecal ligation and puncture–induced nonsevere sepsis. Furthermore, we found that interleukin-17D impaired bacterial phagocytosis by macrophages. Phagocytosis inhibition by interleukin-17D involved its ability to down-regulate the activation of nuclear factor-κB signaling pathway in macrophages upon bacterial infection.

Conclusions:

This study indicates a previously undescribed role of interleukin-17D in sepsis and identifies a new target for antisepsis treatment.
Dermatopathology of Cutaneous Cystic Lesions: A Practical Review With Diagnostic Clues and Pitfalls
Authors: Pérez-Muñoz Noelia , Llamas-Velasco Mar , Castillo-Capponi Gonzalo , Morgado-Carrasco Daniel , Iglesias-Sancho Maribel , Carrasco-García Miguel-Ángel , Fernández-Figueras María-Teresa
Published: October 2019

Background:

Cystic lesions are common in the daily practice of dermatologists and dermatopathologists, and in most cases, a straightforward diagnosis can be done. Yet, some variants and situations may cause diagnostic problems or carry prognostic and/or systemic implications.

Objective:

To review the histopathological features of the most frequent cystic lesions, either true cysts or pseudocysts, and provide some clues and pitfalls to bear in mind for troublesome situations such as solid–cystic tumors; uncommon variants; incidental findings; artifactual, reactive, or infectious cavities; cysts as a warning of systemic and hereditary diseases; and malignant cystic tumors, either primary or metastatic.

Methods:

The histopathological diagnostic criteria of most cystic lesions and their potential caveats will be discussed, offering some diagnostic clues.

Results:

Cystic lesions of the skin can primarily be classified into true cysts and pseudocysts. The most frequent pseudocysts are sinus pilonidalis and mucin-filled cavities. True cysts can be divided according to their epithelial origin or differentiation into epidermal/pilar cysts, cysts from glandular appendages, and from embryonic remnants. Diagnostic dilemmas and possible pitfalls in cystic lesions are reviewed, offering some keys to solve them.

Conclusions:

Knowledge of the histopathology of cystic lesions contributes to their correct diagnosis, improving the management of patients.
Application of the Instrumental Inequalities to a Mendelian Randomization Study With Multiple Proposed Instruments
Authors: Diemer Elizabeth W. , Labrecque Jeremy , Tiemeier Henning , Swanson Sonja A.
Published: October 2019

Background:

Investigators often support the validity of Mendelian randomization (MR) studies, an instrumental variable approach proposing genetic variants as instruments, via. subject matter knowledge. However, the instrumental variable model implies certain inequalities, offering an empirical method of falsifying (but not verifying) the underlying assumptions. Although these inequalities are said to detect only extreme assumption violations in practice, to our knowledge they have not been used in settings with multiple proposed instruments.

Methods:

We applied the instrumental inequalities to an MR analysis of the effect of maternal pregnancy vitamin D on offspring psychiatric outcomes, proposing four independent maternal genetic variants as instruments. We assessed whether the proposed instruments satisfied the instrumental inequalities separately and jointly and explored the instrumental inequalities’ properties via simulations.

Results:

The instrumental inequalities were satisfied (i.e., we did not falsify the MR model) when considering each variant separately. However, the inequalities were violated when considering four variants jointly and for some combinations of two or three variants (two of 36 two-variant combinations and 18 of 24 three-variant combinations). In simulations, the inequalities detected structural biases more often when assessing proposed instruments jointly, although falsification in the absence of structural bias remained rare.

Conclusions:

The instrumental inequalities detected violations of the MR assumptions for genetic variants jointly proposed as instruments in our study, although the instrumental inequalities were satisfied when considering each proposed instrument separately. We discuss how investigators can assess instrumental inequalities to eliminate clearly invalid analyses in settings with many proposed instruments and provide appropriate code.
Perivascular Adipose Tissue Modulation of Neurogenic Vasorelaxation of Rat Mesenteric Arteries
Authors: Chang Hsi-Hsien , Yang Stephen Shei-Dei , Chang Shang-Jen
Published: October 2019

Perivascular sympathetic-sensory interactions have been shown to regulate calcitonin gene-related peptide (CGRP)-mediated vasodilation in rats. We investigated whether perivascular adipose tissue (PVAT) modulates the neurogenic vasorelaxation of isolated rat mesenteric arteries. Mesenteric arterial rings were prepared with or without PVAT (PVAT+ or PVAT−) and with either an intact or denuded endothelium (EC+ or EC−). The results of myography analysis revealed that vasocontraction to phenylephrine was highest in EC−PVAT−, lowest in EC+PVAT+, and intermediate in EC−PVAT+ and EC+PVAT−. Transmural nerve stimulation (TNS) induced the tetrodotoxin-sensitive relaxation of the phenylephrine-precontracted mesenteric arteries. However, nicotine induced minor relaxation in EC−PVAT+, whereas vasorelaxation was significantly enhanced in EC−PVAT−. Nicotine-induced vasorelaxation was insensitive to propranolol and also significantly lower in sympathetically-denervated and guanethidine-treated EC−PVAT−, whereas TNS-induced vasorelaxation persisted. In EC−PVAT− depleted of CGRP via capsaicin, nicotine- and TNS-induced vasorelaxation was almost absent. Lowering the pH of Krebs' solution using HCl led to pH-dependent vasorelaxation that was sensitive to CGRP8-37. Furthermore, nicotine-induced relaxation of EC−PVAT−, which was not affected by leptin, was blocked by methyl palmitate. Methyl palmitate did not affect TNS- or HCl-induced vasorelaxation. These results suggest that PVAT plays a modulatory role in regulating sympathetic-sensory interaction-mediated CGRPergic vasorelaxation via the release of methyl palmitate.
Does early life programming influence arterial stiffness and central hemodynamics in adulthood?
Authors: Sperling Johannes , Nilsson Peter M.
Published: October 2019

Objectives:

We aimed to investigate possible associations between birth weight and adult life carotid–femoral pulse wave velocity (cfPWV) and augmentation pressure index (AIx).

Design and method:

This study included 1598 participants, that is, 340 elderly individuals from the Malmö Birth Data Cohort (MBDC) and 1258 young-middle aged individuals from the Malmö Offspring Study (MOS) with full data on birth weight and gestational age. Participants underwent cfPWV and AIx measurements with Sphygmocor (AtCor, Australia). Analysis of data was performed with multiple linear regression models including adjustments for age, sex, gestational age and risk factors. Furthermore, comparisons were made between participants born prematurely or at term or born small-for-gestational age (SGA) or appropriate-for-gestational age (AGA).

Results:

Birth weight was positively associated with cfPWV after full adjustment (β = 0.057; P < 0.001), a finding that remained significant in the younger age group 18–27 years (β = 0.138, P = 0.008). Furthermore, birth weight was inversely associated with AIx (β = −0.058, P = 0.001). Participants born SGA had significantly higher AIx (P = 0.007) and MAP (P = 0.037) compared with AGA born. Preterm-born participants showed significantly higher SBP compared with term-born (P = 0.034). Finally, birth weight was inversely associated with MAP (β = −0.058, P = 0.017) and SBP (β = −0.047, P = 0.031), respectively.

Conclusion:

Birth weight is positively associated with cfPWV, shown strongest in the youngest individuals, a finding that could possibly be explained by increasing trends for maternal overweight/obesity in recent decades. Furthermore, birth weight is inversely associated with AIx, a risk marker of cardiovascular disease. This calls for screening of risk factors in subjects with adverse conditions at birth.
Identification and Management of Intermediate Risk Patients in the Chest Pain Unit
Authors: Prasad Pooja , Sharma Ajay Nair , Vipparla Navya Sree , Majid Muhammad , Daniela Aro , Howell Stacey J. , Wilson Machelle D. , Amsterdam Ezra A.
Published: October 2019

Objective:

We examined low risk (LR) patients admitted to our chest pain unit (CPU) with negative cardiac injury markers, normal electrocardiogram, and clinical stability. We hypothesized that there is a sub-group of intermediate risk (IR) patients within the larger LR population.

Methods:

Criteria for IR were the aforementioned 3 indicators of LR and ≥1 of the following: (1) known coronary artery disease (CAD), (2) men ≥45 yo, women ≥55 yo, and (3) ≥3 cardiac risk factors. We compared patient characteristics, use of pre-discharge testing (PDT), and major adverse cardiac events (MACE).

Results:

IR patients numbered 371, whereas LR patients totaled 70. IR patients were older (61 vs 46 years), more had known CAD (28 vs. 0%), had a higher median number of risk factors (2 vs. 1) and were less likely to be women (49 vs. 81%), allP< 0.0001. IR patients received a greater median number of tests compared with LR patients (1 vs. 0,P< 0.0001).

Conclusions:

Among the IR group, 16 patients (4%) had a cardiac event at the index CPU visit, 2 (0.5%) experienced MACE at 30-day follow-up, and 2 (0.5%) had MACE at 6 months follow-up. No LR patients had MACE at any point in the study. Thus, the majority of CPU patients are IR, have more risk factors than LR group, and are more likely to receive PDT. IR patients were managed safely in a CPU, while maintaining low rates of MACE post-discharge.
Effects of Intravitreal Anti-VEGF Therapy on Glaucoma-like Progression in Susceptible Eyes
Authors: Du Jeanette , Patrie James T. , Prum Bruce E. , Netland Peter A. , Shildkrot Yevgeniy (Eugene)
Published: October 2019

Précis:

Intravitreal anti-vascular endothelial growth factor (VEGF) injections may accelerate glaucomatous change in patients with preexisting glaucoma or ocular hypertension (OHT). The safety of long-term injections in this specific population may be reflected in the need for additional glaucoma interventions.

Purpose:

The purpose of this study was to investigate whether repeated anti-VEGF injections accelerate structural and functional glaucomatous change in eyes with preexisting glaucoma or OHT.

Materials and Methods:

This is a retrospective, observational study of injected and noninjected fellow eyes. A total of 28 patients with preexisting glaucoma or OHT, who received ≥6 unilateral anti-VEGF injections for concurrent neovascular retinal disease, were selected for chart review. Primary outcome measures were rate of visual field loss in dB/year, rate of change in retinal nerve fiber layer (RNFL) thickness in microns/year, and need for additional glaucoma medications, surgery, or laser.

Results:

The number of eyes requiring additional glaucoma surgery or laser was 8 of 28 (28.6%) for the injected group and 2 of 28 (7.1%) for the noninjected group. A significantly greater proportion of injected eyes required invasive glaucoma intervention (P=0.034). Average rate of decline in mean deviation and change in pattern standard deviation were both significantly greater in injected eyes (P=0.029; P=0.019). Estimated mean rate of global retinal nerve fiber layer change was −4.27 µm/y for the injected group and −1.17 µm/y for the noninjected group and was significant only for injected eyes (P=0.014). Only the superior quadrant exhibited thinning that was significantly different between groups (P=0.030).

Conclusions:

Intravitreal injections were associated with accelerated functional and structural glaucoma-like change in susceptible eyes. Clinicians should assess the need for glaucoma medications or other interventions over the course of anti-VEGF therapy.
Vitreous Zonule and its Relation to Anterior Chamber Angle Characteristics in Primary Angle Closure
Authors: Shon Kilhwan , Sung Kyung Rim , Kwon Junki , Hye Jo Youn
Published: October 2019

Precis:

Primary angle-closure (PAC) eyes with no vitreous zonule (VZ) appear to have a narrower angle despite similar lens vault and iris configuration than eyes with visible VZ.

Purpose:

To assess the clinical significance of the VZ in PAC.

Methods:

Medical records of 91 eyes of 91 participants with PAC or PAC glaucoma were retrospectively reviewed. Anterior segment parameters were measured using anterior segment optical coherence tomography; presence of the VZ was assessed with ultrasound biomicroscopy. Parameters were compared between eyes with vitreous zonule group (VZG) and no vitreous zonule group (NVZG). Factors associated with VZ presence were determined using logistic regression analysis.

Results:

The NVZG was more likely to have PAC glaucoma than PAC (51.4% vs. 25.0%; P=0.010) and use more glaucoma medications (0.77 vs. 0.36; P=0.004) than the VZG. The NVZG had a smaller anterior chamber area than the VZG (13.6 mm2 vs. 15.1 mm2; P=0.020) but there were no significant between-group differences in anterior chamber depth (1.97 vs. 2.08 mm; P=0.119) and lens vault (1.21 vs. 1.13 mm; P=0.337). NVZG had a smaller scleral spur angle (11.5 vs. 17.4 degrees; P<0.001), angle opening distance at 500 μm (AOD500, 105 vs. 168 μm; P<0.001), and trabecular-ciliary process angle (75.7 vs. 81.9 degrees; P=0.029) than VZG. Older age [odds ratio (confidence interval), 1.087 (1.014-1.164); P=0.018], less AOD500 (0.984 (0.975-0.993); P<0.001), and less trabecular-ciliary process angle (0.938 (0.901-0.977); P=0.002) were independently associated with an absence of VZ.

Conclusions:

PAC eyes with no VZ had a narrower angle and required more glaucoma medications than eyes with a VZ.
Primary Open-angle Glaucoma and Increased Risk of Chronic Kidney Disease
Authors: Park Sang Jun , Byun Seong Jun , Park Jae Yoon , Kim Martha
Published: October 2019

Precis:

The association between primary open-angle glaucoma (POAG) and subsequent development of chronic kidney disease (CKD) was investigated using a nationwide, population-based, retrospective cohort in South Korea. POAG increases the risk of subsequent CKD development.

Purpose:

The purpose of this study was to investigate the risk of subsequent CKD development in patients with POAG.

Methods:

In this nationwide, population-based longitudinal cohort, 1,025,340 beneficiaries in the 2002-2013 Korean National Health Insurance database were included. We identified patients with incident POAG and evaluated the risk of subsequent CKD development using diagnostic codes from the database after 2-year wash-out periods. We applied time-varying covariate Cox regression analyses to determine the effect of POAG on the development of CKD: Model 1 included only POAG as a time-varying covariate; Model 2 included Model 1 and demographic information; and Model 3 included Model 2, comorbidity, comedication, and the Charlson Comorbidity Index score.

Results:

The fixed cohort included 478,303 eligible subjects, and of these subjects, 1749 suffered incident POAG, and 3157 developed CKD. POAG was associated with an increased risk of CKD development [hazard ratio (HR)=7.63; 95% confidence interval (CI), 5.89-9.87] in Model 1; HR=3.54 (95% CI, 2.73-4.58) in Model 2; and HR=2.90 (95% CI, 2.24-3.76) in Model 3].

Conclusion:

POAG increased the risk of subsequent CKD in the general population, suggesting that POAG and CKD might share a common pathogenic mechanism.
Cerebrospinal Fluid Pleocytosis and Elevated C-X-C Motif Chemokine Ligand 13 Value Predict Lyme Borreliosis in Children With Facial Palsy
Authors: Pöyhönen Heidi , Lähdesmäki Tuire , Hytönen Jukka , Peltola Ville
Published: October 2019

Background:

Lyme borreliosis (LB) is a common cause of acute facial palsy in children living in endemic areas for Borrelia burgdorferi. The need for lumbar puncture in diagnostics of LB in children with facial palsy has been questioned. Our aim was to evaluate the prevalence of LB and the diagnostic value of a cerebrospinal fluid (CSF) sample among children with an acute facial palsy.

Methods:

We collected medical records and laboratory data of children and adolescents 0–16 years of age (n = 94) diagnosed with facial palsy between 2002 and 2016 in the Turku University Hospital. A positive B. burgdorferi serology in serum or CSF or a positive B. burgdorferi polymerase chain reaction in CSF were considered as signs of definite LB. C-X-C motif chemokine ligand 13 (CXCL13) values were measured in CSF samples from 28 children during 2014–2016.

Results:

Lumbar puncture was performed on 84 of 94 children with facial palsy. LB was confirmed in 29 of 42 children with, and in 4 of 42 without, pleocytosis. The sensitivity and specificity of pleocytosis to predict LB were 88% (95% confidence interval, 78%–98%) and 75% (62%–88%), respectively, and the positive and negative predictive values were 69% (55%–83%) and 90% (81%–99%), respectively. An increased CSF CXCL13 value had 67% (51%–83%) sensitivity and 100% specificity for LB.

Conclusions:

Because serum serology can be negative at presentation, lumbar puncture is a valuable tool when diagnosing LB among children with facial palsy. Pleocytosis and increased protein and CXCL13 values in the CSF suggest LB as the cause of facial palsy.
Comparison of Orbital Volume in Young Versus Senescent Human Skulls
Authors: Zhang Kevin R. , Chon Brian H. , Hwang Catherine J. , Jellema Lyman M. , Perry Julian D.
Published: October 2019

Purpose:

To compare bony orbital volumes in young skulls with those of older skulls to elucidate aging-associated changes of the orbit.

Methods:

One hundred Caucasian male skulls from the Hamann-Todd collection of the Cleveland Museum of Natural History were studied. There were 50 young skulls (age range, 19–33 years) and 50 senescent skulls (age range, 79–96 years). Volcanic sand was used to fill each orbit in an identical fashion and weighed as a proxy for volume. Digital calipers were used to perform linear measurements of the orbit. The relationship between orbit measures and skull size was assessed using Pearson’s correlations and 95% CI, and statistical models to compare age groups adjusted for skull size.

Results:

The volume of the orbits (P < 0.001), the horizontal diameter of the orbit (P = 0.015), and the orbital depth (P < 0.001) were significantly larger in the senescent group of skulls after adjusting for skull surface area. No significant differences were found in the vertical diameters of the orbit between the 2 groups. Skull size did not statistically differ between the age groups.

Conclusions:

Increases in the depth and horizontal dimensions of the orbit lead to increasing bony orbital volume with increasing age. These changes in size and shape of the orbit with age may contribute to phenotypic changes of aging and may affect disease processes and management.
A Hierarchical Model of Occupational Burnout in Nurses Associated With Job-Induced Stress, Self-Concept, and Work Environment
Authors: LIAO Ru-Wen , YEH Mei-Ling , LIN Kuan-Chia , WANG Kwua-Yun
Published: October 2019

Background

Nurses may experience different levels of occupational burnout in different unit and hospital settings. However, pooling multilevel data in an analysis ignores independent, environmental, and sociocultural contexts of ecological validity.

Purpose

This study aimed to explore a hierarchical model of occupational burnout that is associated with job-induced stress, nurse self-concept, and practice environment in nurses working in different units and hospitals.

Methods

A cross-sectional study was conducted, and 2,605 nurses were recruited from seven hospitals. The outcomes were measured using the Maslach Occupational Burnout Inventory-Human Services Survey, Nurses' Self-Concept Instrument, Nurse Stress Checklist, and Nursing Work Index-Revised. Hierarchical Linear Modeling 6.0 software was used to conduct hierarchical analysis on the study data.

Results

On the nurse level, job-induced stress was a significant factor affecting emotional exhaustion (β = 0.608, p < .001) and depersonalization (β = 2.439, p < .001), whereas nurse self-concept was a significant factor affecting emotional exhaustion (β = −0.250, p < .001), depersonalization (β = −1.587, p < .001), and personal accomplishment (β = 4.126, p < .001). Furthermore, emotional exhaustion and depersonalization were significantly related to level of education (β = 0.111, p < .01; β = 0.583, p < .05). No significant unit-level associations were identified between occupational burnout and the factors of job-induced stress, nurse self-concept, and practice environment (p > .05). The intragroup correlation coefficient for emotional exhaustion was 2.86 (p < .001).

Conclusions/Implications for Practice

The findings of this study confirm that individual nurse characteristics are strong predictors of emotional exhaustion, depersonalization, and personal accomplishment as these relate to occupational burnout. In addition, nurse self-concept was identified as the most important predictor of all three aspects. In clinical practice, self-concepts about nursing may reduce occupational burnout. Nursing managers formulating new policies should consider nursing background and offer autonomous control over practice.
Exploration of the Association Between Religious Affiliation and Attitude Toward Spiritual Care in Clinical Nurses
Authors: CHIANG Yi-Chien , LEE Hsiang-Chun , CHU Tsung-Lan , HAN Chin-Yen , HSIAO Ya-Chu
Published: October 2019

Background

Religion is an important cultural asset that is known to affect the thoughts, behaviors, and lifestyles of individuals. However, the impact of religious affiliation, religious activities, and religious beliefs on the attitudes of nurses toward providing spiritual care to their patients is an issue that has been inadequately explored.

Purposes

The aim of this study was to explore the relationship between religion (including religious affiliation, religious activities, and religious beliefs) and attitude toward spiritual care in clinical nurses.

Methods

This study used a cross-sectional correlation study design. Six hundred nineteen nurses were included as participants. The measurements used included a questionnaire on religious affiliation, religious activities, and religious beliefs; the Spiritual Health Scale-Short Form; the Spiritual Care Attitude Scale; and a sociodemographic datasheet. The study employed hierarchical regression modeling to establish the relationships between the aspects and degrees of religious belief and practice as well as the attitudes of participants toward spiritual care.

Results

Most of the participants participated infrequently in religious activities. After controlling for demographic variables and spiritual health, religious belief was found to be an important factor impacting participants' attitudes toward providing spiritual care.

Conclusions/Implications for Practice

The findings indicate that religious belief is an important factor impacting the attitudes of nurses toward providing spiritual care and that the religious/spiritual beliefs of nurses may impact on their fitness to provide spiritual care to patients. Education on religion may be needed to improve the attitude of nurses toward providing spiritual care.
Comparison of a noninvasive 3D force sensor-based method and the invasive arterial cannula in postsurgery intensive care patients: a pilot study
Authors: Földi Sándor , Horváth Tamás , Zieger Flóra , Sótonyi Péter , Cserey György
Published: October 2019

Improvement in sensing technologies is leading to new, accurate noninvasive monitoring devices. However, noninvasive continuous blood pressure (BP) monitoring still faces many challenges, such as: patient's movement, device accuracy and consistency. In this study, the accuracy of a novel noninvasive BP measuring system based on a three-axis force sensor is compared with the invasive arterial cannula taking 21 simultaneous measurements mostly on elderly, postsurgical participants. For the simultaneously recorded invasive and noninvasive signals, the similarity was high, the average correlation was 0.9001 ± 0.0588. The average differences (±SD) for simultaneously recorded systolic, diastolic and mean arterial pressures were: −9.53 ± 4.69, −0.26 ± 3.06 and 1.25 ± 2.26 mmHg, respectively. The results of diastolic and mean arterial pressure satisfy the criteria set by the Association for the Advancement of Medical Instrumentation. These results suggest that this noninvasive system could be a useful tool in continuous noninvasive BP monitoring, but still requires development.
Validation of the InBody BP170 oscillometric home blood pressure monitor in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard
Authors: Kollias Anastasios , Anagnostopoulos Ioannis , Gravvani Areti , Stambolliu Emelina , Bountzona Ioanna , Menti Ariadni , Stergiou George S.
Published: October 2019

Objective

To evaluate the accuracy of the InBody BP170 oscillometric upper-arm home blood pressure (BP) monitor in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018).

Methods

Subjects were recruited to fulfill the age, gender, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. Two cuffs of the test device were used for arm circumference 22–32 (medium) and 32–42 cm (large).

Results

One-hundred five subjects were recruited and 88 were analyzed. For validation Criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 0.9 ± 6.9/0.5 ± 5.5 mmHg (systolic/diastolic). For Criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 5.77/4.80 mmHg (systolic/diastolic).

Conclusion

The InBody BP170 oscillometric home BP monitor fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in general population and can be recommended for clinical use.
How comorbidities impact Early Warning Score as a predictor of 7-day mortality
Authors: Langsted Sandra Nima Damsholt , Dynesen Jens Jacob , Liesanth Janet Yde , Jessen Marie Kristine , Mackenhauer Julie , Ahrensberg Jette , Kirkegaard Hans
Published: October 2019

Background:

Early Warning Score systems are used to monitor patients at risk of deterioration. How comorbidities impact Early Warning Score’s ability to predict short-term mortality in the emergency department is not fully elucidated. The aim of the study was to investigate how comorbidities impact Early Warning Score as predictor of 7-day mortality.

Methods:

This is an observational cohort study of adult emergency department patients attending one of the five emergency departments in Central Region Denmark from 1 March 2015 to 31 May 2015. Charlson Comorbidity Index was used as a measure of comorbidities. Logistic regression was used to calculate the odds ratio for 7-day mortality. Patients were compared in three groups: Charlson Comorbidity Index: 0, 1–2, 3+.

Results:

A total of 30 060 adult patients attended one of the five emergency departments. Nineteen thousand one hundred twenty-three patients were included. Charlson Comorbidity Index 3+ patients presenting with Early Warning Score 0, 1–2 or 3–4 had significantly higher odds ratio of 7-day mortality compared to Charlson Comorbidity Index 0 patients with equal Early Warning Score. For patients with Early Warning Score 5+, Charlson Comorbidity Index -status had no significant impact on 7-day mortality after adjusting for age.

Conclusion:

In patients presenting with lower acuity (Early Warning Score 0–4) Charlson Comorbidity Index has a significant impact on 7-day mortality regardless of Early Warning Score. Including Charlson Comorbidity Index status in Early Warning Score or adjusting for Charlson Comorbidity Index -status could increase the predictive value of Early Warning Score in predicting 7-day mortality.
Effect of oxygen therapy on the risk of mechanical ventilation in emergency acute pulmonary edema patients
Authors: Chu Michael Yat Sun , Guo Wenjia , Lim Kwee Kwang , Lim Beng Leong
Published: October 2019

Objective:

We investigated the effects of hyperoxemia on morbidity and mortality in acute cardiogenic pulmonary edema (ACPE).

Methods:

We conducted a retrospective cohort study of patients in our emergency department (ED) with ACPE who received arterial blood gases. Patients were classified based on the first PaO2 as hypoxemic (<75 mmHg), normoxemic (75–100 mmHg) and hyperoxemic (>100 mmHg). The primary outcome was the rates of mechanical ventilation (MV). We also reported adjusted odds ratios (AOR) and their 95% confidence intervals (CI) of the primary outcome after adjusting for predictors of MV determined a priori. Secondary outcomes were median hospital length of stay (LOS) and in-hospital mortality.

Results:

We recruited 335 patients; 34.0% had hyperoxemia. The rates of normoxemia and hypoxemia were 27.5% and 38.5%, respectively. The rates of MV were: hypoxemic 60/129 (46.5%) vs. normoxemic 41/92 (44.6%) vs. hyperoxemic 50/114 (43.9%); P = 0.62. The AORs for MV for the hyperoxemic and hypoxemic groups (reference: normoxemic group) were 0.98 (95% CI: 0.53–1.79) and 1.38 (95% CI: 0.77–2.48), respectively. Intubation rates for the groups were: hypoxemic 15/129 (11.6%) vs. normoxemic 6/92 (6.5%) vs. hyperoxemic 12/114 (10.6%); P = 0.43. The secondary outcomes were comparable among the groups. In-hospital mortality rates were: hypoxemic 6/129 (4.7%) vs. 6/92 (6.5%) vs. 10/114 (8.8%); P = 0.42.

Conclusion:

Our exploratory study did not report effects on mechanical ventilation, median hospital LOS and in-hospital mortality from hyperoxemia compared to hypoxemic and normoxemic ED patients with ACPE. Further studies are warranted to prove or disprove our findings.
99mTc DTPA vs. 51Cr EDTA for glomerular filtration rate measurement: is there a systematic difference?
Authors: McMeekin Helena , Barnfield Mark , Wickham Fred , Burniston Maria
Published: October 2019

Aim

The study aimed to investigate whether a systematic difference exists between 51Cr EDTA and 99mTc DTPA for measurement of glomerular filtration rate (GFR).

Methods

The distribution of GFR results from candidates attending the Royal Free Hospital for assessment of suitability for kidney donation was compared before and after the change from 51Cr EDTA to 99mTc DTPA using three-sample slope-intercept GFR calculation with samples at 2, 3, and 4 hours. A second cohort of oncology patients attending Leeds Teaching Hospitals NHS Trust underwent simultaneous GFR measurement with both tracers by full characterisation of the plasma clearance curve with nine samples between 5 minutes and 8 hours post-injection. Three-sample slope-intercept GFR was also calculated for comparison with cohort 1.

Results

From the first cohort, a statistically significant (P = 0.008) systematic difference of 5.8% (95% confidence interval: 1.5%–10.1%) was found in the three-sample slope-intercept GFR, with 99mTc DTPA giving the higher result. From the second cohort, a statistically significant (P = 0.00001) systematic difference of 2.9% (95% confidence interval: 1.8%–3.9%) was found in three-sample slope-intercept GFR, with 99mTc DTPA giving the higher result. There was no statistically significant difference between the tracers when GFR was calculated by full characterisation of the plasma clearance curve.

Conclusion

There is a small systematic difference between GFR measured with 99mTc DTPA and 51Cr EDTA using abbreviated techniques, which is removed when GFR is calculated by full characterisation of the plasma clearance curve. The difference is not clinically significant in the context of intra-patient variability of GFR measurement.