bluuebunny/crossref_metadata_2025 huggingface dataset:
Chitin in Strawberry Cultivation: Foliar Growth and Defense Response Promotion, but Reduced Fruit Yield and Disease Resistance by Nutrient Imbalances
Authors: De Tender C. , Vandecasteele B. , Verstraeten B. , Ommeslag S. , De Meyer T. , De Visscher J. , Dawyndt P. , Clement L. , Kyndt T. , Debode J.
Published: November 2020

Strawberry cultivation is associated with high mineral fertilizer doses and extensive use of chemical plant protection products. Based on previous research, we expected that chitin application to peat substrate would increase the nutrient availability and activate the plant systemic defense response, resulting in higher strawberry yields and fewer disease symptoms. We set up two experiments in which the temporal variability and differences in initial nutrient concentrations of the growing media were taken into account. Chitin treatment resulted in the attraction of plant growth–promoting fungi toward the plant root, such as species from genera Mortierella and Umbelopsis. In addition, by the end of the experiments 87 mg of mineral nitrogen (N) per liter of substrate was mineralized, which can be related to the observed increase in plant shoot biomass. This, however, led to nutrient imbalances in plant shoots and fruit; N concentration in the leaves increased over 30%, exceeding the optimal range, while phosphorous (P) and potassium (K) deficiencies occurred, with concentrations lower than 50% of the optimal range. This may explain the decreased fruit yield and disease resistance of the fruit toward Botrytis cinerea. In contrast, chitin caused a clear defense priming effect in the strawberry leaves, with a strong induction of the jasmonic acid response, resulting in fewer foliar disease symptoms. Chitin causes positive effects on shoot growth and foliar disease resistance, but caution needs to be taken for nutrient imbalances leading to negative influences on root growth, fruit production, and disease susceptibility toward B. cinerea.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Survival of Fusarium oxysporum f. sp. lactucae on Crop Residue in Soil
Authors: Paugh Kelley R. , Gordon Thomas R.
Published: November 2020

Fusarium oxysporum f. sp. lactucae, the cause of Fusarium wilt of lettuce, can survive on crop residue in soil. Persistence of the pathogen over time will be influenced by the rate at which residue decomposes. We evaluated the effect of drying and fragmenting crop residue on the rate of decomposition and survival of F. oxysporum f. sp. lactucae. In a controlled experiment that represented optimal drying conditions, fragmenting and oven drying infested lettuce taproots at 30°C significantly reduced the frequency of recovery of the pathogen, compared with untreated tissue. However, in a field experiment, drying infested crop residue on the soil surface prior to incorporation did not significantly reduce survival of F. oxysporum f. sp. lactucae after 1 year. Regardless of treatment, there was not a significant decrease in soil inoculum density between 1 and 12 months after residue was incorporated. In a greenhouse experiment, fragmenting crop residue prior to incorporation in pathogen-free soil resulted in significantly higher inoculum densities of F. oxysporum f. sp. lactucae after 1 year. The increase in inoculum levels was associated with a faster rate of residue decomposition, which may be beneficial in the long run but not where lettuce will be replanted within the next year.
Comparison of outcome between idiopathic and non-idiopathic congenital vertical talus treated with soft tissue release
Authors: Malhotra Monish , Shah Hitesh
Published: November 2020

The aim of the study was to compare the clinical, radiological and functional outcomes between idiopathic and non-idiopathic congenital vertical talus (CVT) treated with soft tissue release. All the consecutive cases with CVT treated with soft tissue release were prospectively followed up. Indication for soft tissue release was either late presented or failed serial manipulation and cast application. Nineteen children (33 feet) with a minimum follow-up of 2 years following the soft tissue release (the mean 5.5 years follow-up) were included. The children without any other joint involvement with the normal spine without syndromic association were categorized as idiopathic (15 feet) and the rest were categorized as non-idiopathic (18 feet). Clinical and radiological scoring was done using Adelaar and Kodros scores. The morphological, functional and radiological outcomes were assessed using the International Clubfoot Study Group evaluation scale. The clinical, radiological and functional outcomes of the idiopathic and non-idiopathic groups were compared. The range of motion was significantly higher in the idiopathic group. The functional outcome was satisfactory in both groups. All the radiological parameters improved significantly in both groups. The functional outcome was considerably better in the idiopathic group. There was no significant difference in clinical and radiological outcomes among the two groups. Soft tissue release is an effective surgery for deformity correction in children with CVT. A good clinical outcome is observed in both groups. The range of motion was significantly higher in the idiopathic group. The overall outcome was similar in both groups.
Protrusio acetabulae as a sequel to septic arthritis of the hip with obturator internus pyomyositis
Authors: Gupta Gaurav , Rabbi Qaisur , Bohra Vikas , Shah Maulin M.
Published: November 2020

Pyomyositis is defined as a pyogenic infection of skeletal muscles principally caused by Staphylococcus aureus. It can present either primarily without any associated soft tissue or bone infection or secondary to any surrounding or distant infection focus. Hip pericapsular pyomyositis is one of the most common types of primary pyomyositis. Although many cases are increasingly being described both in tropical and temperate climates, there is no published study regarding the sequelae of untreated pericapsular pyomyositis around the hip joint. The purpose of this study is to describe the sequelae of unaddressed obturator internus abscesses in four adolescent patients and compare their outcome with patients where obturator abscess was also drained using Vanderbilt medial approach. A retrospective study was done with eight patients divided equally into two groups. All the patients were diagnosed as septic arthritis with pyomyositis of obturator internus. Group 1 includes patients treated in between 2012 and 2014 with only hip arthrotomy through anterior approach. Group 2 includes patients treated after 2014 with anterior hip arthrotomy along with drainage of obturator internus abscess. All patients in group 1 had frequent episodes of pain in the first postoperative year with persistent restriction of hip range of motion. Two patients required re-drainage of the hip joint within the first month of indexed surgery. Final follow-up (average 6 years) X-rays revealed grade 2 protrusio acetabuli in three cases and grade 3 in one case as per the Sotelo-Garza and Charnley classification. In contrast to the group 1, group 2 patients had an excellent outcome with an average Iowa Hip Score of 93 at average follow-up of 4.25 years with near normal range of motion, no radiological deterioration and residual pain. The possibility of pericapsular pyomyositis should always be kept in mind, in older children with acute hip pain. A high index of suspicion is required for its early diagnosis. MRI is the gold standard investigation for confirming diagnosis and planning the preferred early surgical treatment. Safe and effective surgical drainage of obturator internus abscess through a minimally invasive Vanderbilt medial approach may prevent long-term sequelae of chronic pain, protrusio acetabuli and secondary osteoarthritis.
Septic sequelae of hip in children: long-term clinicoradiological outcome study
Authors: Agarwal Anil , Rastogi Prateek
Published: November 2020

The presented retrospective study is a report of 18 patients (23 hips) with infantile post sepsis hip sequelae. There were two groups of patients. The observation group comprised of 6 patients (8 hips). The intervention group included 12 patients (15 hips) of which 12 hips had been surgically intervened for the sequelae and 3 contralateral hips which were again serially observed. The sequelae hips were classified by Choi’s radiological types. The clinical evaluation was done by modified Moon’s criteria. The average patient age at follow-up was 9.3 years. There were 3 type I (13%), 10 type II (43%), 2 type III (8%), and 8 Choi type IV (35%) at presentation. The Choi radiological type showed propensity to change over time/following intervention. At follow-up, there 3 type I (13%), 17 type II (74%), and 3 type IV (13%) hips. At follow-up, there were seven excellent, seven good, and four fair results. The observation group had mostly type I or II and intervention group IIIB or IV Choi types. Findings common to both groups: same Choi radiological type fared different clinically, multiple joint involvement contributed to deterioration of function and late changes in acetabulum or proximal femur lead to deterioration of clinical function. The sequelae of septic hips likely to be kept under supervised observation were Choi type I or II. In select types, intervention changed the natural history of septic sequelae significantly.
Circular RNA circTP63 enhances estrogen receptor-positive breast cancer progression and malignant behaviors through the miR-873-3p/FOXM1 axis
Authors: Deng Yibin , Xia Jing , Xu Yue-e
Published: November 2020

Circular RNAs (circRNAs) have been shown to play a functional role in a variety of cancers. However, few studies on circRNAs in estrogen receptor-positive breast cancer have been conducted. Here, we investigated the role of circRNA circTP63 in estrogen receptor-positive breast cancer progression and malignant behaviors. First, we observed increased expression of circTP63 in MCF7 cells relative to normal human mammary epithelial cell lines, such as DU4475 and MCF-10A, and the changed oncogenicity of MCF7 cells correlated with circTP63 overexpression and downregulation. Interestingly, a series of gain- and loss-of-function assays revealed that a higher level of FOXM1 was closely associated with MCF7 malignant behaviors induced by circTP63 overexpression. Further investigations showed that circTP63 sponged to miR-873-3p, which targeted FOXM1 mRNA and inhibited its expression. Mechanistically, circTP63 binds to miR-873-3p and prevents the targeting of FOXM1, thus inducing the progression and malignant behaviors of estrogen receptor-positive breast cancer, such as cell proliferation, cell cycle dysregulation, invasion, migration and even tumor growth. CircTP63 might be a potential biomarker or target to treat estrogen receptor-positive breast cancer patients in the future.
Acceptance of e-Learning Programs for Maternity Health Care Professionals Implemented by the Italian Obstetric Surveillance System
Authors: D'Aloja Paola , Maraschini Alice , Lega Ilaria , Andreozzi Silvia , Sampaolo Letizia , Valetto Maria Rosa , Dri Pietro , Donati Serena
Published: November 2020

Introduction:

Distance learning efficacy on physician performances and patient health outcomes has been demonstrated. This study explored the participation and evaluation of CME e-learning courses for Italian health care professionals addressing leading causes of maternal mortality identified by the Italian Obstetric Surveillance System (ItOSS) at the Italian National Health Institute, namely postpartum hemorrhage and pregnancy hypertensive disorders.

Methods:

A model for two online free 12-hour case-based training courses was used. Data on participants were collected, anonymized, and transferred to the Italian National Health Institute for later analysis. Participants were requested to sign an online informed consent form.

Results:

Twenty-one thousand five hundred thirty-two health care professionals enrolled to the courses from 2014 to 2017 as follows: midwives (14,187, 65.9%); obstetricians (3,716, 17.2%); anesthesiologists (1,896, 8.8%); and other medical specialists (1,733, 8.0%). Overall, 85% of participants acquired CME credits. Participants' satisfaction on quality, efficacy, and relevance was very high.

Discussion:

ItOSS courses were able to reach a substantial number of different professional profiles involved in perinatal care all over the country; ItOSS courses can be considered an effective way to spread evidence-based good clinical practices. Nevertheless, further studies are needed to verify the improvement in professional health care skills and patient outcomes.
Toward Practice-Based Continuing Education Protocols
Authors: Armson Heather , Roder Stefanie , Wakefield Jacqueline , Eva Kevin W.
Published: November 2020

Introduction:

Using assessment to facilitate learning is a well-established priority in education but has been associated with variable effectiveness for continuing professional development. What factors modulate the impact of testing in practitioners are unclear. We aimed to improve capacity to support maintenance of competence by exploring variables that influence the value of web-based pretesting.

Methods:

Family physicians belonging to a practice-based learning program studied two educational modules independently or in small groups. Before learning sessions they completed a needs assessment and were assigned to either sit a pretest intervention or read a relevant review article. After the learning session, they completed an outcome test, indicated plans to change practice, and subsequently documented changes made.

Results:

One hundred twelve physicians completed the study, 92 in small groups. The average lag between tests was 6.3 weeks. Relative to those given a review article, physicians given a pretest intervention: (1) reported spending less time completing the assigned task (16.7 versus 25.7 minutes); (2) performed better on outcome test questions that were repeated from the pretest (65.9% versus 58.7%); and (3) when the learning module was completed independently, reported making a greater proportion of practice changes to which they committed (80.0% versus 45.0%). Knowledge gain was unrelated to physicians' stated needs.

Discussion:

Low-stakes formative quizzes, delivered with feedback, can influence the amount of material practicing physicians remember from an educational intervention independent of perceptions regarding the need to engage in continuing professional development on the particular topic.
Health care Professionals' Reflections on Their Learning as Spiritual Generalists and Integration Into Practice
Authors: Thiel Mary Martha , Luff Donna , Kerr Emma E. , Robinson Mary R. , Meyer Elaine C.
Published: November 2020

Introduction:

Meeting spiritual needs of patients is an important aspect of quality health care, but continuing professional development and training to provide spiritual care remains inadequate. The purpose was to identify participants' learning from simulation-based spiritual generalist workshops and application to practice.

Methods:

Interdisciplinary participants completed self-report demographic questionnaires before the workshops and questionnaires after workshops that listed open-ended take-home learning. Responses were analyzed using qualitative content analysis. A subgroup was surveyed 3 to 9 months after training to examine whether and how participants had incorporated workshop learning into clinical work.

Results:

Workshop participants 181/211 (85.8%) reported learning in four categories: core values and skills of spiritual generalists, understanding spirituality/religion and its role in health care, interfacing with chaplaincy, and interprofessional teamwork. Of the subsample, 73.5% (25/34) completed surveys 3 to 9 months after training. Of those, 25/25 (100%) reported drawing on what they learned in workshops, and 24/25 (96%) reported making clinical practice changes.

Discussion:

One-day spiritual generalist simulation-based workshops can improve continuing professional development learning experiences to provide generalist level of spiritual care. Workshops offered valuable learning and resulted in applicable clinical skills across professional roles. At 3 to 9 months after training, participants reported improved spiritual screening, recognition of spiritual distress, and referral to chaplaincy.
CDKN2B-AS1 Aggravates the Pathogenesis of Human Thoracic Aortic Dissection by Sponge to miR-320d
Authors: Zhao Xin , Cheng Shaopeng , Li Shouming , Li Jialiang , Bai Xiao , Xi Jie
Published: November 2020

In the present study, the role and molecular mechanism of long noncoding RNA CDKN2B-AS1 in human thoracic aortic dissection (TAD), a highly lethal cardiovascular disease, was investigated. The expression of CDKN2B-AS1 in human TAD and normal aortic tissues of donors were examined by quantitative real-time polymerase chain reaction. RNA pull-down assay and a series of luciferase reporter assays were performed to predict the relationships between CDKN2B-AS1, miR-320d, and STAT3. Cell counting kit 8 (CCK-8), TUNEL, and western blot assays were applied to validate the biological functions of CDKN2B-AS1 in rat aortic vascular smooth muscle cells. Results showed that CDKN2B-AS1 was expressed at a higher level in human TAD than in normal aortic tissues. CDKN2B-AS1 overexpression significantly promoted apoptosis and suppressed the proliferation of vascular smooth muscle cells. CDKN2B-AS1 silence exhibited the opposite effects. Mechanistically, CDKN2B-AS1 was identified as a molecular sponge for miR-320d and positively modulated STAT3 expression via repressing miR-320d. In conclusion, our study revealed that CDKN2B-AS1 was dysregulated and displayed multiple potential functions in human TAD. These findings suggested that CDKN2B-AS1 was a novel potential therapeutic target for human TAD.
COVID-19 will forever change the landscape of telemedicine
Authors: Cohen Emmie , Cohen Mitchell I.
Published: November 2020

Purpose of review

The COVID-19 pandemic has had unprecedented global effects, yet the rapid emergence of telehealth across the globe has allowed healthcare professionals to connect virtually with patients and families while following safe social distancing guidelines. Telehealth has been used relatively well in patients from remote regions with limited access to subspecialty healthcare providers. This article discusses novel ways of using telehealth during the current pandemic and measures that would need to be taken to sustain telehealth and teleconsultations.

Recent findings

Telehealth has expanded to outpatient pediatric cardiology clinics across the globe during the pandemic. Technological advancements in video conferencing and the abundance of readily available wearable devices have allowed cardiologists to establish a preliminary diagnosis and set forth a treatment plan. Additional support by insurance providers and relaxation of mandatory regulations by the government have allowed telehealth to succeed during the pandemic. Although many subdisciplines within pediatric cardiology can be easily adapted into a sustainable telehealth model, some unique patient interactions, such as fetal cardiology, exercise physiology, and echocardiograms cannot be done remotely. The field of telehealth medicine with HIPAA-compliant programs and both insurance and government support should remain in our armamentarium of available resources for all patients and families.

Although not unique to pediatric cardiology, telehealth has emerged as an avenue to perform an initial evaluation and even establish a care pathway for patients. It is well recognized that telehealth visits will not supplant all patient--physician interactions but is a very acceptable first step in the majority of cases and can often steer the patient to subsequently undergo more selective and streamlined care.
THE ANGIOPOIETIN/TIE PATHWAY IN RETINAL VASCULAR DISEASES
Authors: Heier Jeffrey S. , Singh Rishi P. , Wykoff Charles C. , Csaky Karl G. , Lai Timothy Y.Y. , Loewenstein Anat , Schlottmann Patricio G. , Paris Liliana P. , Westenskow Peter D. , Quezada-Ruiz Carlos
Published: November 2020

Purpose:

To provide a concise overview for ophthalmologists and practicing retina specialists of available clinical evidence of manipulating the angiopoietin/tyrosine kinase with immunoglobulin-like and endothelial growth factor–like domains (Tie) pathway and its potential as a therapeutic target in retinal vascular diseases.

Methods:

A literature search for articles on the angiopoietin/Tie pathway and molecules targeting this pathway that have reached Phase 2 or 3 trials was undertaken on PubMed, Association for Research in Vision and Ophthalmology meeting abstracts (2014–2019), and ClinicalTrials.gov databases. Additional information on identified pipeline drugs was obtained from publicly available information on company websites.

Results:

The PubMed and Association for Research in Vision and Ophthalmology meeting abstract search yielded 462 results, of which 251 publications not relevant to the scope of the review were excluded. Of the 141 trials related to the angiopoietin/Tie pathway on ClinicalTrials.gov, seven trials focusing on diseases covered in this review were selected. Vision/anatomic outcomes from key clinical trials on molecules targeting the angiopoietin/Tie pathway in patients with retinal vascular diseases are discussed.

Conclusion:

Initial clinical evidence suggests a potential benefit of targeting the angiopoietin/Tie pathway and vascular endothelial growth factor-A over anti–vascular endothelial growth factor-A monotherapy alone, in part due to of the synergistic nature of the pathways.
NOVEL THREE TYPES OF NEOVASCULARIZATION ELSEWHERE DETERMINE THE DIFFERENTIAL CLINICAL FEATURES OF PROLIFERATIVE DIABETIC RETINOPATHY
Authors: Pan Jiandong , Chen Feng , Chen Ding , Yang Xiaoling , Wang Jie , Chen Zuzheng , He Xiaojie , Zhou Tingye , Zheng Jingwei , Chen Hao
Published: November 2020

Purpose:

To explore the pathological features and clinical significance of three types of neovascularization elsewhere (NVE) in proliferative diabetic retinopathy.

Methods:

Neovascularization elsewhere was classified based on the origins and morphologic features using fluorescein angiography and angiographic and structural optical coherence tomography. The topographical distribution, vitreoretinal interface, and responsiveness to panretinal photocoagulation were compared among three types of NVE.

Results:

One hundred and twenty-seven NVEs were classified into three types. Type 1 NVE was concentrated along or adjacent to vascular arcades; Type 2 was distributed more peripherally than were Types 1 and 3 NVE. The arch bridge–like vitreoretinal interface accounted for 79% of Type 1 NVE. The flat and flat-forward vitreoretinal interface accounted for 95% and 100% in Type 2 and Type 3 NVE, respectively. At 3 months after panretinal photocoagulation, the regression rates for Types 1, 2, and 3 NVE were 82%, 100%, and 80%, respectively. Type 2 NVE showed best regression rate after panretinal photocoagulation (both P < 0.01).

Conclusion:

Three types of NVE determine the distinctly topographical distributions, vitreoretinal interface features, and differential responsiveness to panretinal photocoagulation treatment. This new concept may have important clinical implications in assessing the treatment and prognosis of proliferative diabetic retinopathy.
Comparison of Glaucoma Drainage Device Versus Transscleral Cyclophotocoagulation for Secondary Glaucoma Following Ocular Surface Stem Cell Transplantation
Authors: Denny Matthew R. , Chu Fred B. , Cheung Albert Y. , Holland Edward J.
Published: November 2020

Précis:

Rates of ocular surface failure and glaucoma reoperation were similar between cyclophotocoagulation (CPC) and glaucoma drainage devices (GDDs). CPC is a safe option in the management of secondary glaucoma after ocular surface stem cell transplantation (OSST).

Purpose:

To assess surgical and ocular surface outcomes in patients requiring glaucoma surgery after OSST.

Materials and Methods:

Retrospective chart review of eyes with previous OSST that underwent either transscleral CPC or implantation of a GDD. Primary outcomes were ocular surface failure (defined as recurrence of corneal conjunctivalization with late fluorescein staining) and glaucoma surgery failure (defined as the need for additional glaucoma surgery, including repeat treatment or revision). Secondary outcomes were changes in intraocular pressure (IOP) and number of glaucoma medications. Additional subgroup analysis was performed for subtypes of CPC and GDD.

Results:

Thirty-six glaucoma surgeries (7 Ahmed, 19 Baerveldt, and 10 CPC) were performed in 31 eyes with a history of prior OSST. The ocular surface failure rate was 19% for GDDs and 10% for CPC (P=0.65). Additional glaucoma surgery was needed for 38% of GDDs and 70% of CPC (P=0.14). The mean IOP reduction was 50% for GDDs and 28% for CPC (P=0.05). The mean drop reduction was 1.6 for GDDs and 0.1 for CPC (P=0.02). All glaucoma failures in the GDD group were related to tube erosion and/or hypotony, whereas all glaucoma failures in the CPC group were because of uncontrolled IOP. There were no significant differences in primary or secondary outcomes between CPC or GDD subgroups.

Conclusion:

Glaucoma is a frequent comorbidity in patients with severe ocular surface disease, and treatment poses unique challenges in those with prior OSST. In this study, ocular surface failure and glaucoma reoperation rates were similar between CPC and GDD groups, suggesting that CPC, including repeat treatment, is a safe option for the management of secondary glaucoma after OSST. A multidisciplinary approach is recommended in the management of these complex eyes.
Variations of Intraocular Pressure Measured by Goldmann Applanation Tonometer, Tono-Pen, iCare Rebound Tonometer, and Pascal Dynamic Contour Tonometer in Patients With Corneal Edema After Phacoemulsification
Authors: Kiddee Weerawat , Tanjana Arunee
Published: November 2020

Précis:

Edematous corneas had lower Goldmann applanation tonometer (GAT) intraocular pressure (IOP) compared with other tonometers. A significant, mild negative correlation between central corneal thickness (CCT) and GAT IOP was found in a group of significant edematous corneas with CCT increases of >100 µm.

Purpose:

To compare the IOP that was randomly obtained with the GAT, Tono-Pen, iCare, and Pascal dynamic contour tonometer in patients with corneal edema after phacoemulsification.

Materials and Methods:

Corneal edema was quantified by CCT measurement. The agreement between IOP measurements assessed by different instruments was evaluated using Bland-Altman plots. The relationship between CCT and IOP was investigated using the coefficient of correlation. The CCT and IOP were compared between the periods of postsurgical edema and after its resolution.

Results:

The mean age of 60 patients was 75.9±7.8 years. CCT increased significantly after surgery, by an average of 96.1±39.9 µm (P<0.001). Relative to the IOPs measured with the GAT in edematous eyes: the mean difference in Tono-Pen IOPs was 4.7 mm Hg; 95% limits of agreement (LOA), −0.3 to 9.6 mm Hg. For iCare, was 2.3 mm Hg; 95% LOA, −2.2 to 6.8 mm Hg. For Pascal dynamic contour tonometer, was 3.0 mm Hg; 95% LOA, −0.4 to 6.5 mm Hg. Edematous corneas had significantly lower GAT IOP than Tono-Pen IOP; 12.3±3.2 versus 16.9±3.1 (P=0.02). Pearson correlation coefficients (r) showed a high correlation between the 4 tonometers in eyes without edema. There was a significant, mild negative correlation between CCT and GAT IOP (r=−0.25, P=0.02) in a group of significant edematous corneas with CCT increases of >100 µm: GAT IOP decreased by 3.1 mm Hg for every 10-µm increase in CCT.

Conclusions:

IOP readings with GAT tended to be lower than those obtained with the other tonometers, especially the Tono-Pen. GAT IOP readings in cases of severe corneal edema should be interpreted with caution.
An Infectious Cause of Congenital Pupillary-Iris-Lens Membrane With Secondary Angle Closure Glaucoma in an Infant
Authors: Maheshwari Devendra , Rao Sanjana , Pawar Neelam , Kadar Mohideen A. , Ramakrishnan Rengappa
Published: November 2020

Purpose:

The aim of the study was to report an infectious cause of congenital pupillary-iris-lens membrane with secondary angle closure glaucoma in an infant.

Design:

This was a case report.

Methods:

Institutional review board exemption for this report was obtained from the Institutional Ethics Committee, Aravind Eye Hospital, Tirunelveli. Informed consent was obtained.

A 3-month-old female infant presented to us with congenital pupillary-iris-lens membrane, iris bombe and raised intraocular pressure in the left eye. She underwent trabeculotomy and trabeculectomy along with membranectomy for the same. An aqueous tap performed a month later was suggestive of coexisting Toxoplasma gondii infection detected by polymerase chain reaction.

Result:

The study provides a description of the course of management of angle closure glaucoma secondary to congenital pupillary-iris-lens membrane with an associated infection. Intraocular pressure reduced from 40 to 20 mm Hg in the left eye.

Conclusion:

This condition is a rare entity of unknown etiology with an increased risk of glaucoma and visual loss. A multidisciplinary approach is needed for the management of these eyes. Infectious associations with these membranes should be ruled out by an aqueous tap with polymerase chain reaction and a close postoperative follow-up is mandatory.
Clinical Efficacy and Safety Outcomes of Micropulse Transscleral Diode Cyclophotocoagulation in Patients With Advanced Glaucoma
Authors: Lim Edward J.Y. , Cecilia Aquino M. , Lim Dawn K.A. , Sng Chelvin C.A. , Loon Seng Chee , Lun Katherine W.X. , Chew Paul T.K. , Koh Victor T.C.
Published: November 2020

Precis:

Micropulse transscleral cyclophotocoagulation (MPTCP) is only moderately effective in lowering intraocular pressure (IOP) and is useful as an adjunct procedure to other glaucoma surgeries. There was a small risk of loss of vision, prolonged hypotony, and phthisis bulbi.

Aim:

The aim of this study was to determine the efficacy and safety of a single MPTCP treatment for an Asian population with advanced glaucoma.

Methods:

This is a retrospective single-center study of 207 eyes (207 patients) with advanced glaucoma which underwent first-time MPTCP between January 1, 2008, and March 31, 2018. Success was defined as IOP of 6 to 21 mm Hg or ≥20% reduction in IOP without an increase in glaucoma medication from baseline, and without glaucoma reoperation. The IOP, best-corrected visual acuity, and number of glaucoma medications were also analyzed.

Results:

The mean (SD) age was 64.9±16.9 years. The mean follow-up duration was 18.7±16.2 months. The rate of success at postoperative years 1 and 2 follow-up was 44.1% and 32.6%, respectively. The median survival time of MPTCP was 9.0 months and 85 (40.9%) eyes received reoperation. The mean IOP decreased from 31.5±12.0 mm Hg preoperatively to 22.1±10.3 and 23.8±11.8 mm Hg at postoperative years 1 and 2, respectively (P<0.0001). The mean number of glaucoma medications was reduced from 3.3±1.0 preoperatively to 2.6±1.1 and 2.4±1.1 at postoperative years 1 and 2, respectively (P<0.0001). Significant complications included prolonged hypotony [1 eye (0.5%)], phthisis bulbi [7 eyes (3.4%)], and best-corrected visual acuity reduction [29 eyes (13.9%)].

Conclusion:

Single first-time MPTCP for advanced glaucoma eyes was moderately effective in lowering IOP but >50% failed by 1 year.
Methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a systematic review
Authors: Shraim Muath A. , Massé-Alarie Hugo , Hodges Paul W.
Published: November 2020

Mechanism-based classification of pain has been advocated widely to aid tailoring of interventions for individuals experiencing persistent musculoskeletal pain. Three pain mechanism categories (PMCs) are defined by the International Association for the Study of Pain: nociceptive, neuropathic, and nociplastic pain. Discrimination between them remains challenging. This study aimed to build on a framework developed to converge the diverse literature of PMCs to systematically review methods purported to discriminate between them; synthesise and thematically analyse these methods to identify the convergence and divergence of opinion; and report validation, psychometric properties, and strengths/weaknesses of these methods. The search strategy identified articles discussing methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system. Studies that assessed the validity of methods to discriminate between categories were assessed for quality. Extraction and thematic analysis were undertaken on 184 articles. Data synthesis identified 200 methods in 5 themes: clinical examination, quantitative sensory testing, imaging, diagnostic and laboratory testing, and pain-type questionnaires. Few methods have been validated for discrimination between PMCs. There was general convergence but some disagreement regarding findings that discriminate between PMCs. A combination of features and methods, rather than a single method, was generally recommended to discriminate between PMCs. Two major limitations were identified: an overlap of findings of methods between categories due to mixed presentations and many methods considered discrimination between 2 PMCs but not others. The results of this review provide a foundation to refine methods to differentiate mechanisms for musculoskeletal pain.
Frailty in Acute Care: Not Just Your Grandparents' Medical Condition
Authors: Exum Emelia
Published: November 2020

Background and Purpose:

Frailty is defined as a clinically recognizable state of increased vulnerability resulting from aging-associated declines in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised. Frailty assessment is commonly reserved for the geriatric population and the outpatient setting. The purpose of this review is to discuss the concept of frailty in the acute care setting and its relevance to those in the adult, nongeriatric population.

Description:

This review describes the characteristics of frailty in the acute care setting, the populations most likely to have non-age-related frailty, how current frailty outcome measures can be used in acute care, and the limitations of these assessments of frailty in the acute care setting.

Outcomes:

Frailty is associated with patients of all ages and is closely correlated with patients who have dysfunction of the heart, kidneys, liver, and lungs. Frailty is also associated with oncology-related diagnoses, critical care, multimorbidity, and obesity. Multiple assessments in the literature are aimed at assessing frailty but many are subjective and only valid with specific populations and criteria.

Discussion:

Frailty is a multidimentional clinical diagnosis that is not reserved solely to those older than 65 years. Many diagnoses have been closely linked to frailty. Clinicians across the spectrum need to recognize and assess for frailty, especially in acute care, as discharge planning is a key component in reducing readmissions. Creating and adapting a treatment plan that meets all the necessary domains of fitness, combined with the appropriate intensity and duration, will provide the greatest chance of reversing patients along the continuum from frail to prefrail to nonfrail.
A Method Model Presentation: Online Clinical Mentoring for Physical Therapists Experiencing Professional Isolation
Authors: Westervelt Karen C. , Kunker Katrina , Patel Radha , Smith Elizabeth , Wolitzer Kaylee
Published: November 2020

Background and Purpose.

Clinical mentoring is essential for the professional development of physical therapists (PTs) and improves confidence and clinical decision making. Physical therapists working in professionally isolated settings with the lack of contact with professional peers face unique challenges, including lack of access to mentors, which can result in diminished job satisfaction, recruitment, and retention. The innovative use of technology, including videoconferencing, can help address the challenges faced by these health care providers by improving access to clinical mentoring. The purpose of this study was to examine the effects of an online model of clinical mentoring on PTs experiencing professional isolation in an outpatient musculoskeletal setting.

Method/Model Description and Evaluation.

Eight professionally isolated and 4 expert PTs were divided into 4 groups. Three 1-hour online case-based mentoring video sessions were held over the course of 5 weeks. Data were collected from pre and postparticipation surveys and postparticipation focus groups. A mixed-methods analysis was used to evaluate data.

Outcomes.

Qualitative results for the mentee group revealed 4 themes: perspective, reflection, perceived clinical benefits, and feasibility. Three themes emerged for the mentor group: accessible model, advancing the profession, and perspective. Quantitative analysis revealed significant improvement in 4 areas of confidence. All participants felt that the intervention supported professional attributes; 75% of participants reported the group size as ideal, and 75% of mentees felt that the program improved both confidence and clinical decision-making skills.

Discussion and Conclusion.

Online clinical mentoring can address several of the barriers faced by PTs who work in professional isolation and allows PTs who would not otherwise have access to postprofessional education to access a mentor remotely.
Effects of ambulatory blood pressure monitoring on sleep in healthy, normotensive men and women
Authors: Gaffey Allison E. , Schwartz Joseph E. , Harris Kristie M. , Hall Martica H. , Burg Matthew M.
Published: November 2020

Objectives

To determine the effect of ambulatory blood pressure monitoring (ABPM) on sleep quality among healthy adults and to explore possible effect modification by demographics.

Methods

We examined data from 192 relatively healthy young (median age: 31; 33% men, 18% with clinic BP >130/80 mmHg) participants in an observational study of sleep and arterial stiffness. Demographic/health questionnaires were completed. A wrist-based accelerometer assessed sleep for seven nights, and sleep duration, wakefulness after sleep onset (WASO), fragmentation (physical restlessness), midpoint, and efficiency were estimated. ABPM was conducted for one 36-h period, including one actigraphy night.

Results

Within-subject comparisons indicated that WASO and fragmentation were higher, midpoint was later, and efficiency was lower on the ABPM night (Ps < 0.001–0.038). Neither age nor sex moderated these associations. Among older adults, a later midpoint and worse fragmentation were observed with ABPM (Ps = 0.002–0.010). There was also a main effect of sex: men demonstrated shorter sleep duration, greater WASO and fragmentation, and less efficiency than women (Ps = 0.002–0.046). With ABPM, women had worse fragmentation and a later midpoint (Ps = 0.002–0.049); for men, WASO and fragmentation were worse (Ps = 0.003–0.023). Importantly, this study does not address whether the effect of wearing ABPM on sleep in turn affects BP during sleep.

Conclusions

ABPM appears to modestly disturb actigraphy-assessed sleep among healthy adults. Researchers and clinicians should consider the downstream effects of performing ABPM and whether these effects are more pronounced in those who typically experience sleep disturbance.
Does Ramadan fasting have effects on sleep, fatigue and blood pressure among patients with hypertension?
Authors: Bener Abdülbari , Al-Hamaq Abdulla O.A.A. , Öztürk Mustafa , Güllüoğlu Semih
Published: November 2020

Aim

The aim of this study was to determine the effect of Ramadan fasting on blood pressure (BP), fatigue, sleeping and physical activity among hypertensive patients.

Subjects and methods

A cross-sectional study was conducted from April 2019 to July 2019. Of the total 1500 hypertensive patients approached, 1118 (74.5%) gave their consent. Data analysis included sociodemographics, lifestyle habits, anthropometric measurements and clinical biochemistry parameters at baseline, and after 3 months.

Results

Out of 1118 subjects, 593(47.6%) were male and 653(52.4%) were female. There were statistically significant differences between males and females regarding age groups in years, educational level, occupational status, income, smoking habits, physical exercise, sports activities and fatigue. There were statistically significant differences for the biochemistry parameters regarding vitamin D, blood glucose, HbA1c level, creatinine, bilirubin, albumin, total cholesterol, triglycerides, HDL-C, LDL-C, uric acid and SBP for both males and females after the holy month of Ramadan as compared to before Ramadan. Also, BMI was significantly lower during the after month of Ramadan as compared to before Ramadan (P < 0.001). Multiple linear regression analysis results revealed that less hours of sleeping (P < 0.001), SBP (mmHg) (P < 0.001), DBP (mmHg) (P < 0.001), family size (P = 0.002), obesity BMI (kg/m2) (P = 0.013), fatigue (P = 0.022) and smoking cigarette (P = 0.029) were identified as statistically significant predictors of hypertensive patients with Ramadan fasting as contributing at higher risk factors.

Conclusion

This study confirmed that fasting during Ramadan has no effect on the BP, blood glucose, HbA1C level, sleep quality, fatigue and BMI among hypertensive patients.
Role of ursodeoxycholic acid on maternal serum bile acids and perinatal outcomes in intrahepatic cholestasis of pregnancy
Authors: Roy Akash , Premkumar Madhumita , Mishra Saurabh , Mehtani Rohit , Suri Vanita , Aggarwal Neelam , Singh Surender , Dhiman Radha Krishna
Published: November 2020

Aim

Intrahepatic cholestasis of pregnancy (ICP) is associated with safe maternal outcomes but perinatal outcomes have been variable. We assessed clinical factors and impact of bile acid levels on maternal and neonatal outcomes in ICP.

Methods

Patients with ICP (defined as pruritus with serum bile acids ≥ 10 mmol/l) were included prospectively with an assessment of risk factors, modes of delivery as well as maternal and neonatal outcomes. Mild and severe ICP were diagnosed when serum bile acid was always <40 mmol/l and ≥40 mmol/l, respectively. Patients with gestational pruritus served as controls.

Results

Out of 643 patients, 375 patients (mean age 29 ± 7.6 years, 45.8% primigravida) met inclusion criteria. Pregnancy-induced hypertension [PIH: 10.5%; odds ratio (OR): 4.8; 95% confidence interval (CI): 2.4–8.5; P = 0.0014], gestational diabetes (GDM: 12.5%; OR: 2.6; 95% CI: 2.3–4.1; P = 0.045) and spontaneous preterm labor (15.1%; OR: 2.5; 95% CI: 1.2–3.5; P = 0.040) were higher in patients with ICP. Ursodeoxycholic acid (UDCA) (median dose 900 mg; 600–1800 mg) ameliorated symptoms of cholestasis, bile acid levels and liver aminotransferases in 79% cases. When compared with patients with mild ICP, patients with severe ICP presented at a lower gestational period (26 vs. 32 weeks, P = 0.036), required frequent induction (12.5%; OR: 3.2; 95% CI: 2.1–5.6; P = 0.045) and had increased fetal distress (15%; OR: 1.9; 95% CI: 1.3–4.9; P = 0.048).Overall eight stillbirths were recorded.

Conclusion

Severe ICP is associated with a higher incidence of GDM and PIH, risk of pre-term labor, elective induction and stillbirths. UDCA remains a first-line agent in treating ICP.
Patient-reported experience measure in pancreatobiliary endoscopy: a systematic review to highlight areas for improvement
Authors: Apadula Laura , Capurso Gabriele , Arcidiacono Paolo Giorgio
Published: November 2020

Objective

Increasing attention is paid to measure patient’s experience using specific patient-reported experience measures (PREMs) as tool to assess the overall quality of care provided. The European Society of Gastrointestinal Endoscopy and the United European Gastroenterology have recognized the measure of quality of endoscopy facilities as a priority to provide an adequate service. However, although some studies included patient satisfaction measurement, specific PREMs for gastrointestinal endoscopy are limited, especially in the field of pancreatobiliary endoscopy, with heterogeneous methods and results. This study is aimed at systematically reviewing the literature to summarize the available PREMs for pancreatobiliary endoscopy and to highlight areas of implementation.

Methods

PubMed, Embase and Scopus were searched until February 2020.

Results

The search initially retrieved 1064 articles, but only six were includable. The identified studies employed several methods to measure patient’s experience, with the most frequently used questionnaires being Gastrointestinal Endoscopy Satisfaction Questionnaire and Group Health Association of America-9. The following areas that need implementation were identified: (a) evaluation of pain is one of the most investigated areas but seems marginal, as most pancreatobiliary endoscopic procedures are performed under deep sedation; (b) endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography are considered as a whole, but they have very different indication and contexts (e.g. inpatients or outpatients); (c) ‘experience’ and ‘satisfaction’ are wrongly considered as synonyms; (d) the optimal modality and timing of questionnaire administration are unclear.

Conclusion

There are few tools to measure PREMS in pancreatobiliary endoscopy with several limitations. We have, therefore, started the process of building a specific PREM tool for pancreatobiliary EUS.
Anxiety and depression in patients with Barrett’s esophagus: estimates of disorder rates and associations with symptom load and treatment-seeking
Authors: Treml Julia , Kreuser Nicole , Gockel Ines , Kersting Anette
Published: November 2020

Background

Patients with Barrett’s esophagus (BE) may experience psychological burden from living with a chronic medical condition, which has been identified as the most important risk factor for esophageal adenocarcinoma. The aim of this study was to estimate rates of depression and anxiety in a large sample of patients with BE.

Methods

A total of 794 patients with endoscopically and histologically confirmed diagnosis of BE completed validated screening instruments for depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7). Screening rates in the study sample were compared to general population estimates. Multivariable regression analyses were used to model associations between outcome variables and respondents’ sociodemographic characteristics, BE-related symptom load and incidence of inpatient treatment due to BE in the last 12 months.

Results

Rates of positive screens were 14.2% for depression and 9.9% for anxiety. For several age by sex subgroups, rates of depression and anxiety were about three to five times higher in the study sample than in the general population. BE-related reflux and pain symptoms showed strong associations with higher levels of depressive and anxiety symptoms, while the effect of treatment was small.

Conclusion

Study results indicate that a relevant proportion of patients with BE is at an increased risk for depression and anxiety, compared to general population controls. Lacking information on patients’ disease characteristics limited generalizability of results.