bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of polydimethylsiloxane-based biomimetic scaffolds with cylinder micropillars for retinal pigment epithelial cell cultivation
Authors: Lin Yi-Ying , Yang Yi-Ping , Lai Wei-Yi , Chien Chian-Shiu , Chen Shih-Jen , Hwang De-Kuang , Lai Ying-Hsiu , Lin Tai-Chi , Chiou Shih-Hwa , Lo Yu-Li , Huo Teh-Ia , Chien Yueh
Published: September 2020

Background:

Age-related macular degeneration (AMD) is one of the leading causes of vision loss. Once the retinal pigment epithelium (RPE) layers are destroyed, the poor visual acuity and recognition are generally irreversible. Cell therapy that possesses enormous potential in regenerative medicine may provide an alternative treatment for several incurable diseases such as AMD. In this study, we developed an innovative polydimethylsiloxane (PDMS)-based biomimetic scaffolds with cylinder micropillars for the cultivation of induced pluripotent stem cell–derived RPEs (iPSC-RPEs). RPEs were cultured on the PDMS-based biomimetic scaffolds and validated the cells gene expression.

Methods:

The biomimetic PDMS scaffold was fabricated through spin coating and lithography method. It was further modified on surface with biomolecules to improve cell affinity and stability. The iPSC-RPEs were seeded on the scaffold and analyzed with characteristic gene expression.

Results:

PDMS biomimetic scaffold was analyzed with Fourier transform infrared spectroscopy and proved its chemical composition. iPSC-RPEs demonstrated confluent cell monolayer on the scaffold and maintained RPE-specific gene expression, which proved the PDMS-based biomimetic scaffold to be supportive for iPSC-RPEs growth.

Conclusion:

The PDMS interface allowed regular growth of iPSC-RPEs and the design of cylinder micropillars further provided the bioscaffold high motion resistance may improve the engraftment stability of iPSC-RPEs after transplantation. Taken together, this innovative PDMS-based biomimetic scaffold may serve as an ideal interface for in vitro iPSC-RPE cultivation and subsequent transplantation in vivo. This novel device exhibits better bioavailability than conventional injection of donor cells and may be an alternative option for the treatment of AMD.
Management of Severe Cochlear Implant Infections—35 Years Clinical Experience
Authors: Weder Stefan , Shaul Chanan , Wong Amy , O’Leary Stephen , Briggs Robert J.
Published: September 2020

Objective:

Infectious complications occurring in cochlear implant (CI) recipients is of potentially major impact. A better understanding of severe infections in this cohort is necessary.

Design:

Single-center, retrospective cohort study. Level of Evidence 2B.

Setting:

Single-center, retrospective cohort study at a tertiary referral hospital.

Participants and interventions:

We included all patients who received a CI at our institution between 1983 and end of 2018 (4,622 implantations).

Main Outcomes:

Prevalence, incidence, risk factors, and functional outcomes in severe implant infections.

Results:

There was an overall prevalence of 0.65% of severe CI infections. The cumulative incidence decreased after the year 2000, with lower infection rates with newer implant models. Patients with local risk factors were more susceptible to implant infection. In most patients, delayed re-implantation was successful. Speech-perception after re-implantation was comparable to pre-revision performance.

Conclusions:

Modified implant design and improved surgical technique has led to a decrease in the prevalence and incidence of infected implants. In severe implant infections, active surgical and antimicrobial management is required, to achieve good long-term results.
History of Mastoidectomy: PubMed, Best Matches, Secondary References, and Inaccuracies
Authors: Mudry Albert
Published: September 2020

Objective:

PubMed is the world's largest online collection of biomedical literature citations. A PubMed search (October 11, 2019) using the medical subject heading terms “history” and “mastoidectomy” was conducted. The heading “best matches” listed as first article “A brief history of mastoidectomy,” a very relevant free full text. The aim of this study is to validate or not the relevance attributed to this study as the first article listed in best matches.

Methodology:

All the references of the article mentioned before 1860 were checked, further completed with other original sources, and studied again, with particular attention to their extracted quotes.

Results:

Surprisingly, this article contains many inaccuracies, notably concerning Galen, Lucas van Leyden, Paré, Riolan the Younger, Justus von Berger, Jasser, Dezeimeris, Wilde and Toynbee. This was most certainly related to blind trust of some secondary references.

Conclusion:

Never trust secondary references. This article also raises questions on the validity and the relevance of the best matches algorithm in PubMed.
Trans-canal Endoscopic Repair of Cerebrospinal Fluid (CSF) Leak Following Vestibular Schwannoma Resection
Authors: Manzoor Nauman F. , Nassiri Ashley M. , Rivas Alejandro
Published: September 2020

Video Summary:
http://links.lww.com/MAO/B51
Endoscopic Decompression of the Labyrinthine Segment of the Facial Nerve
Authors: Cornu Nicolas , Marchioni Daniele , Eliezer Michael , Verillaud Benjamin , Hautefort Charlotte , Green Andrew , Marc Morgane , Bresson Damien , Froelich Sebastien , Herman Philippe , Kania Romain
Published: September 2020

Objective:

To describe the outcome and feasibility of an exclusive endoscopic transcanal transpromontorial approach (ETTA) for decompression of the labyrinthine segment of the facial nerve (LSFN).

Patient:

A 60-year-old man with a left-sided transverse fracture of temporal bone involving the LSFN, resulting in a grade VI House–Brackmann (HB) facial palsy, associated with ipsilateral total sensorineural hearing loss.

Intervention:

Surgical decompression of the LSFN by ETTA.

Main Outcome Measure:

The patient underwent ETTA which allowed complete exposure and decompression of the LSFN.

Results:

One year postoperatively, the patient had recovered with House–Brackmann grade II facial function.

Conclusion:

ETTA can be considered a valuable and appropriate technique for posttraumatic decompression of LSFN, associated with unilateral total sensorineural hearing loss. The procedure resulted in significant facial nerve function improvement. ETTA should be considered both a scarless, mastoid conserving and less invasive surgical technique for posttraumatic LSFN decompression associated with pre-existing cochlear impairment.
Quinine in Otology and Neurotology: Ototoxicity and Historic Role in Therapy
Authors: Semedo Maria Guilherme , Dias-Silva Nuno , Miguéis Jorge , Pita João Rui
Published: September 2020

Objectives/Hypothesis:

Quinine, a cinchona bark-derived antimalarial alkaloid, is a known ototoxic. Isolated and named in 1820 by the French scientists Pierre-Joseph Pelletier and Joseph-Bienaimé Caventou, it has since been employed in the treatment of different maladies. Quinine was also recommended as a local anesthetic in surgical procedures in the early 20th century. This article aims to identify early ototoxicity reports regarding quinine and to investigate if quinine was previously used in otology as an anesthetic agent or as an actual therapy.

Method:

Historical review of medical and pharmaceutical literature from the 19th and 20th centuries in databases (PubMed; Web of Science), as well as medical books on ototoxic drugs, quinine, and therapies in otology.

Results:

The first identified reference of quinine ototoxicity was from 1824. Quinine also had a therapeutic role in otology and neurotology and was employed for its analgesic properties. It was used in Menière's disease, vertigo, otalgia, purulent otitis media, neuralgia of the plexus tympani, furuncles in the auditory canal, and herpes zoster in the auricle.

Conclusion:

Quinine was acknowledged as an ototoxic drug in the 19th century. Quinine was used in several otologic disorders, both as an analgesic (for herpes zoster, otalgia) and as a therapeutic agent (Menière's disease, vertigo, purulent otitis media, furuncles in the auditory canal). This research demonstrates that, analogously to gentamicin, quinine was used in Menière's disease specifically due to its ototoxic effects.
A Qualitative Appraisal of Neurotology Fellowship Websites
Authors: Hakimi Amir A. , Loanzon Roberto S. , Azhdam Ariel M. , Liu Yuan , Simental Alfred
Published: September 2020

Objective:

To assess the accessibility and breadth of online information regarding neurotology fellowship programs by appraising individual fellowship websites as well as two popular online databases.

Methods:

The American Neurotology Society Program Information Page (ANSPIP), the American Medical Association's Fellowship and Residency Electronic Interactive Database (FREIDA), and three online search engines (Google, Yahoo, Bing) were assessed for accessibility to individual fellowship websites. Each program's ANSPIP data sheet and fellowship-specific website were then evaluated for the presence of 18 characteristics of interest to the neurotology fellowship applicant.

Results:

All three search engines yielded 23 (96%) Accreditation Council for Graduate Medical Education (ACGME)-accredited neurotology fellowship websites. Searching “Neurotology fellowships” in Google, Yahoo, and Bing required exploring up to nine pages of search results to identify all of the ACGME-accredited program-specific websites. Direct links to program websites were found on 12 (55%) and 3 (13%) of the ANSPIP and FREIDA fellowship pages, respectively. Of the 18 characteristics of interest, the ANSPIP data sheet and individual program websites on average delineated 8.0 and 7.8 characteristics, respectively. Ninety-one percent of fellowship websites included program coordinator information, general program description, and breadth of surgical exposure. In contrast, work/life balance, postfellowship placement, and current fellow(s) were least commonly displayed (4%, 9%, 13% respectively). One-hundred percent of ANSPIP data sheets included program coordinator information, number of fellows, and affiliated hospital(s), whereas none of the pages included selection criteria, application requirements, description of location, or work/life balance.

Conclusion:

Although most neurotology fellowship programs have websites or ANSPIP data sheets, many of them lack information that has been previously demonstrated to be valued by applicants. Furthermore, incongruence of information between these sources may lead to confusion, applicant stress, and reflect poorly on fellowship programs. Perhaps a standardized list of ACGME-required data points to be posted on websites would facilitate the application process.
Postoperative Course of Pars Flaccida Cholesteatoma Patients With Habitual Sniffing
Authors: Endo Shiori , Mizuta Kunihiro , Takahashi Goro , Arai Maki , Nakanishi Hiroshi , Takizawa Yoshinori , Hosokawa Kumiko , Yamatodani Takashi , Misawa Kiyoshi , Hosokawa Seiji , Mineta Hiroyuki
Published: September 2020

Objective:

To investigate the effects of habitual sniffing on the postoperative course of pars flaccida cholesteatoma.

Study Design:

Retrospective case series study.

Setting:

University hospital.

Patients:

Forty-nine patients (53 ears) with pars flaccida cholesteatoma and history of habitual sniffing before the initial operation.

Interventions:

Patients were divided into a “sniffing cessation group” characterized by sniffing cessation and a “continual sniffing group” characterized by continuation of sniffing despite instructions for conscious cessation.

Main Outcome Measures:

Hearing level, tympanic membrane findings, tympanograms, mastoid cell development before the operation, and pneumatization 1 year postoperatively.

Results:

The sniffing cessation and continual sniffing groups comprised 35 patients (38 ears) and 14 patients (15 ears), respectively. The average postoperative hearing was slightly better in the continual sniffing group. In the sniffing cessation group, retractions were evident in significantly fewer cases. Retractions were observed in all continual sniffing group cases, with a high percentage of severe retractions, wherein the bottom was not visible. Type A tympanogram was predominant in the sniffing cessation group. Mastoid cell development was not significantly different between the two groups. Satisfactory pneumatization was significantly more common in the sniffing cessation group (Fisher's exact test, ∗∗
p < 0.005).

Conclusion:

Conscious cessation of the sniffing habit could reduce the risk of postoperative retraction and improve pneumatization in patients with pars flaccida cholesteatoma. The presence or absence of the sniffing habit after surgery is a defining factor in postoperative prognosis (retraction, recurrence), and may be a determinant for decisions regarding surgical approach.
Bimodal Stimulation in Children With Bilateral Profound Sensorineural Hearing Loss: A Suitable Intervention Model for Children at the Early Developmental Stage
Authors: Chen Ying , Huang Meiping , Li Bei , Wang Zhaoyan , Zhang Zhihua , Jia Huan , Hu Lingxiang , Cai Yun , Li Yun , Huang Zhiwu , Wu Hao
Published: September 2020

Objective:

To evaluate the auditory and speech benefit of bimodal stimulation for prelingual deafened cochlear implantation recipients.

Study Design:

Retrospective and comparative study.

Setting:

Tertiary referral center.

Patients:

Fifty-six children with bilateral prelingual profound sensorineural hearing loss were enrolled, including 28 consecutive children with unilateral cochlear implantation (CI group), and 28 consecutive children with bimodal stimulation (BI group) who used an additional hearing aid (HA) in the contralateral ear.

Main Outcome Measures:

Hearing assessments included the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and Categories of Auditory Performance (CAP). Speech evaluations included the Meaningful Use of Speech Scale (MUSS), and Speech Intelligibility Rating (SIR). These measurements were evaluated at the first mapping of cochlear implants and 0.5, 1, 3, 6, 12, 18, 24 months after. Data were analyzed by repeated measures analysis.

Results:

The mean ages of BI and CI groups were similar (17.6 ± 6.87 vs 19.0 ± 8.10 months, p = 0.497). The initial scores for hearing and speech assessments showed no differences between the two groups, apart from IT-MAIS (2.46 ± 0.631 in BI group vs 0.50 ± 0.279 in CI group, p = 0.004). The auditory and speech development over time were different in the two groups as seen in IT-MAIS (p < 0.001), CAP (p = 0.029), MUSS (p < 0.001), and SIR (p < 0.001). A continuing but stable difference was observed in CAP, MUSS, and SIR at 3, 18, and 12 months after the first mapping, respectively. In addition, the BI group had better IT-MAIS scores at 3 and 6 months compared with the CI group; however, the difference was not significant after 12 months.

Conclusion:

Bimodal stimulation is beneficial for prelingually deafened CI recipients who have minimal contralateral residual hearing when bilateral CIs are not available. Hearing aid use in the contralateral ear might be recommended for children after unilateral cochlear implantation to facilitate the development of auditory and speech skills.
Assessment of Angular Insertion-Depth of Bilateral Cochlear Implants Using Plain X-ray Scans
Authors: Sokolov Meirav , Zavdy Ofir , Raveh Eyal , Ulanovski David , Attias Yoseph , Hilly Ohad
Published: September 2020

Objective:

To evaluate in cochlear implant patients, the feasibility and reliability of angular depth of insertion (aDOI) measurements using plain x-ray scans.

Study Design:

Retrospective study where three observers independently evaluated and compared intraoperative anterior-posterior and oblique x-ray scans.

Setting:

A tertiary pediatric medical center.

Patients:

Included were 50 children (100 ears) who underwent bilateral simultaneous cochlear implantation during 2008 to 2015.

Main Outcome Measures:

Inter-rater agreement of aDOI measured in plain x-ray scans; effect of head position on measured aDOI; and symmetry of aDOI between patients’ ears in bilateral simultaneous cochlear implantations.

Results:

Differences in the average aDOI measurements among the three observers ranged between 2 and 7 degrees. There was high inter-rater agreement (R = 0.99, p < 0.01) among all observers, and strong correlations between each pair of observers (0.92–0.99). Head rotation of 45 degrees (between the two views) resulted in a median difference in aDOI of 14 degrees, with excellent correlation among the observers. The rate of asymmetry was high, with a median difference of 39 degrees and up to 220 degrees between ears.

Conclusions:

Assessment of aDOI using intraoperative plain x-rays is efficient and reliable. The effect of head positioning on measurement is small. Further studies are needed to evaluate the effect of aDOI and insertion symmetry on functional outcomes.
Absence of Endolymphatic Sac Ion Transport Proteins in Large Vestibular Aqueduct Syndrome—A Human Temporal Bone Study
Authors: Eckhard Andreas H. , Bächinger David , Nadol Joseph B.
Published: September 2020

Hypothesis:

Epithelial ion transport pathologies of the endolymphatic sac (ES) are associated with large vestibular aqueduct syndrome (LVAS).

Background:

LVAS is defined by the pathognomonic features of a widened bony vestibular aqueduct (VA) and an enlarged ES. The underlying cause of its associated cochleovestibular symptoms remains elusive. Disturbances in epithelial ion transport in the enlarged ES, affecting inner ear fluid regulation, were proposed as a possible pathophysiology. However, although respective epithelial ion transport pathologies have been demonstrated in the enlarged ES from transgenic LVAS mouse models, these pathologies have not been investigated in human LVAS cases.

Methods:

Histological and immunohistochemical analysis of the enlarged ES epithelium in postmortem temporal bones from two individuals with a clinical diagnosis of LVAS.

Results:

The enlarged ES epithelium demonstrated an overall atypical epithelial differentiation and a lack of the immunolocalization of signature ion transport proteins. Notably, in both cases, a rudimentary branch of the ES with a typically differentiated ES epithelium was present.

Conclusions:

The described cellular and molecular pathologies of the enlarged ES in humans provide evidence of epithelial transport pathology as one potential cause of cochleovestibular symptoms in LVAS. The present findings also emphasize the clinical relevance of already established LVAS mouse models.
Audiologic Outcomes of Cochlear Implantation in Cochlear Malformations: A Comparative Analysis of Lateral Wall and Perimodiolar Electrode Arrays
Authors: Schwartz Nofrat , Brown Kevin D. , Park Lisa R.
Published: September 2020

Objective:

Cochlear implantation in children with inner ear malformations has been shown to be beneficial. The aims of this study are to evaluate open set word recognition outcomes among children with cochlear implants who have cochlear malformations, and to further assess if either the lateral wall (LW) or perimodiolar (PM) electrode arrays confer any performance outcome advantages.

Study Design:

Retrospective case series.

Setting:

Tertiary referral center.

Patients:

Pediatric cochlear implant recipients with cochlear malformations who were implanted at our institution within the last 10 years and had speech perception scores were eligible for inclusion in the study. Potential participants were excluded if they had less than 1 year of listening experience with the cochlear implant or suspected cochlear nerve deficiency.

Intervention:

None.

Main Outcome Measure:

Most recent consonant-nucleus-consonant word score.

Results:

ANOVA analysis demonstrated that the type of cochlear malformation was significantly associated with speech perception outcome (p = 0.006). Those with IP2 malformations had significantly better word recognition outcomes than the remaining cochlear malformations. Array type (LW or PM) was not associated with better word recognition outcomes in long-term follow-up of patients with IP2 malformations (p = 0.13).

Conclusions:

In children who have cochlear malformations, cochlear implantation results in varying word recognition outcomes based on the type of malformation. While the participants in this study demonstrated postoperative open set word recognition skills, those with IP2 malformations demonstrated the most benefit. Electrode type was not found to significantly impact outcomes in this cohort.
The Natural Course of Tympanic Membrane Retractions in the Posterosuperior Quadrant of Pars Tensa: A Watchful Waiting Policy
Authors: Bayoumy Ahmed B. , Veugen Christianne C.A.F.M. , Rijssen L. Bengt , Yung Matthew , Bok Jan-Willem M.
Published: September 2020

Introduction:

Tympanic membrane retraction (TMR) is a relatively common otologic finding. Currently, there is no consensus on the optimal treatment of TMR. Some ENT-surgeons advocate surgical correction while others opt for a watchful-waiting policy. Our aim was to investigate the natural course of retraction pockets in the posterosuperior quadrant of the pars tensa in a large cohort of patients.

Methods:

An observational retrospective cohort study was conducted including patients of all ages with a posterosuperior pars tensa retraction. Primary outcome measure was difference between audiometry at first and last visits. Secondary outcomes were patients’ complaints, otoscopic outcomes (Sade classification), and complications (perforation, ossicular chain damage, and/or cholesteatoma).

Results:

A total of 71 patients with 81 ears and a median age of 23 years (IQR 14–47) were included. The median duration of follow-up was 64 months (IQR 44–102). The mean air-bone gap at first and last visits was 17.9 dB (SD 11.3) and 15.5 dB (SD 12.9), respectively, with a mean improvement of 2.4 dB (p = 0.08). In 10 ears (12%) the hearing level (air-bone gap) deteriorated with 10 dB or more. Patients who presented with a TMR Sade grade I at first visit had significantly better audiometric outcomes than patients presenting with Sade grade III (p = 0.001). Progression to cholesteatoma occurred in one patient (1%), progression to perforation occurred in five patients (6%), and progression to ossicular chain damage occurred in five patients (6%).

Conclusions:

Otoscopic findings and audiometric results remained stable in most TMRs without treatment. Additionally, audiometry did not worsen during last follow-up. Progression to cholesteatoma, perforation, or ossicular chain damage was rare. Shared decision making regarding TMRs should include a discussion of a wait-and-see policy.
Benign Paroxysmal Positional Vertigo: Canal Switching Affecting All Canals During a Single Session
Authors: Zanotti Estefanía , Yacovino Darío Andrés
Published: September 2020

SDC Video Link:
http://links.lww.com/MAO/B86.
Bilateral Sudden Sensorineural Hearing Loss and Intralabyrinthine Hemorrhage in a Patient With COVID-19
Authors: Chern Alexander , Famuyide Akinrinola O. , Moonis Gul , Lalwani Anil K.
Published: September 2020

Objective:

To describe a case of bilateral sudden sensorineural hearing loss (SSNHL) and intralabyrinthine hemorrhage in a patient with COVID-19.

Study Design:

Clinical capsule report.

Setting:

Tertiary academic referral center.

Patient:

An adult woman with bilateral SSNHL, aural fullness, and vertigo with documented SARS-CoV-2 infection (IgG serology testing).

Interventions:

High-dose oral prednisone with taper, intratympanic dexamethasone.

Main Outcome Measures:

Audiometric testing, MRI of the internal auditory canal with and without contrast.

Results:

A patient presented with bilateral SSNHL, bilateral aural fullness, and vertigo. Serology testing performed several weeks after onset of symptoms was positive for IgG COVID-19 antibodies. MRI showed bilateral intralabyrinthine hemorrhage (left worse than right) and no tumor. The patient was treated with two courses of high-dose oral prednisone with taper and a left intratympanic dexamethasone injection, resulting in near-resolution of vestibular symptoms, a fluctuating sensorineural hearing loss in the right ear, and a severe to profound mixed hearing loss in the left ear.

Conclusions:

COVID-19 may have otologic manifestations including sudden SSNHL, aural fullness, vertigo, and intralabyrinthine hemorrhage.
Disparities in Liver Cancer Surveillance Among People With Disabilities
Authors: Seo Jae Youn , Shin Dong Wook , Yu Su Jong , Jung Jin Hyung , Han Kyungdo , Cho In Young , Kim So Young , Choi Kui Son , Park Jong Heon , Park Jong Hyock , Kawachi Ichiro
Published: September 2020

Goal:

The goal of this study was to determine disparities in liver cancer surveillance among people with disabilities is the goal of this study.

Background:

Using the linked administrative database in Korea, we sought to investigate (1) whether there are disparities in liver cancer surveillance according to degree and type of disability and (2) temporal trends in liver cancer surveillance among people with disabilities.

Materials and Methods:

We linked national disability registration data with national cancer surveillance data. We analyzed age-standardized participation rates for each year during the 2006-2015 period according to presence, type, and severity of the disability. We also examined factors associated with liver cancer surveillance by multivariate logistic regression using the most current data (2014-2015).

Results:

The age-adjusted and sex-adjusted surveillance rate for liver cancer in people with disabilities increased from 25.7% in 2006 to 49.6% in 2015; however, during the same period, surveillance rate among people without disabilities increased from 24.9% to 54.5%. As a result, disparities in surveillance for liver cancer increased over time. The surveillance participation rate among people with disabilities was 12% lower than among people without disabilities. Surveillance rates were markedly lower among people with severe disabilities [adjusted odds ratio (aOR)=0.71] and people with renal disease (aOR=0.43), brain injuries (aOR=0.60), ostomy problems (aOR=0.60), and intellectual disabilities (aOR=0.69).

Conclusions:

Despite the availability of a national liver cancer surveillance program, a marked disparity was found in liver cancer surveillance participation, especially among people with severe disabilities, renal disease, or brain-related or mental disabilities.
Efficacy and Safety of Full-thickness Resection Device (FTRD) for Colorectal Lesions Endoscopic Full-thickness Resection
Authors: Fahmawi Yazan , Hanjar Abrahim , Ahmed Yasir , Abdalhadi Haneen , Mulekar Madhuri S. , Merritt Lindsey , Kumar Manoj , Mizrahi Meir
Published: September 2020

Background and Aims:

Endoscopic full-thickness resection (eFTR) is a field of increasing interest that offers a minimally invasive resection modality for lesions that are not amenable for resection by conventional methods. Full-thickness resection device (FTRD) is a new device that was developed for a single-step eFTR using an over-the scope-clip. In this meta-analysis, we aim to assess the efficacy and safety of FTRD for eFTR of colorectal lesions.

Methods:

A Comprehensive literature review of different databases to identify studies reporting FTRD with outcomes of interest was performed. Studies with <10 cases were excluded. Rates of histologic complete resection (R0), technical success, and complications were extracted. Efficacy was assessed by using the technical and the R0 rates whereas safety was assessed by using the complications rates. Weighted pooled rates (WPRs) and the 95% confidence interval (CI) were calculated depending on the heterogeneity (I
2 statistics).

Results:

Nine studies including 551 patients with 555 lesions were included in this study. The WPR for overall R0 was 82.4% (95% CI: 79.0%-85.5%),with moderate heterogeneity (I
2=34.8%). The WPR rate for technical success was 89.25% (95% CI: 86.4%-91.7%), with low heterogeneity (I
2=23.7%). The WPR for total complications rate was 10.2% (7.8, 12.8%) with no heterogeneity. The pooled rate for minor bleeding, major bleeding, postpolypectomy syndrome, and perforation were 3.2%, 0.97%, 2.2%, and 1.2%, respectively. Of 44 periappendicular lesions, the pooled rate for acute appendicitis was 19.7%.

Conclusions:

FTRD seems to be effective and safe for eFTR of difficult colorectal lesions. Large prospective studies comparing FTRD with conventional resection techniques are warranted.
The Impact of COVID-19 Pandemic on Neurogastroenterologists in Latin America
Authors: Schmulson Max , Gudiño-Zayas Marco , Hani Albis
Published: September 2020

Background:

The COVID-19 pandemic has affected medical practice in fields not related to the infection. Neurogastroenterology is a subspecialty of gastroenterology focused on motility and functional gastrointestinal disorders, including consultations, and conducting procedures (eg, endoscopies, manometries/pH-monitoring).

Aim:

The aim of this study was to determine the impact of COVID-19 on Neurogastroenterology in Latin America.

Methods:

Members of the Latin American Society of Neurogastroenterology were invited by e-mail and social networks to participate in an online anonymous survey. It included 24 questions on demographics, clinical practice and procedure characteristics, impact of the pandemic, Telemedicine, and involvement in COVID-19 patient care.

Results:

Sixty-one members mainly from Colombia, Mexico, and Brazil answered the survey. All reported a negative impact on their practice (88.6%: a 61% to 100% decrease), mainly in office consultations and elective endoscopies. Interestingly, emergency endoscopies decreased by 33.3%, while only 4% stopped performing manometries/pH-monitoring. The main reasons were patients’ fear for consulting, country’s lockdown, and physician’s decision to prevent infection spread. Telemedicine was implemented by 83% but only 64.7% were being remunerated. Almost 46% had to reduce salaries and working hours of their personnel. Fifty-nine percent had colleagues diagnosed with COVID-19, 24.6% were involved in these patients’ care, and 11.5% were mobilized to COVID-19 wards. There were country differences: Colombia, lockdown (P=0.001); Mexico, COVID-19 patient-care (P=0.053); Mexico/Colombia, working in COVID-19 wards, (P=0.012); Brazil, less common elective procedures’ ban (P=0.012) and Telemedicine/reimbursement (P=0.034).

Conclusions:

The COVID-19 pandemic has negatively impacted the practice and wellness of Neurogastroenterologists in Latin America. Guidelines to resume activities and policies for Telemedicine practice and reimbursement are warranted.
Novel Bioenhanced Curcumin With Mesalamine for Induction of Clinical and Endoscopic Remission in Mild-to-Moderate Ulcerative Colitis
Authors: Banerjee Rupa , Pal Partha , Penmetsa Amulya , Kathi Pradip , Girish Ganesh , Goren Idan , Reddy D. Nageshwar
Published: September 2020

Background and Aims:

The aim of this study was to assess the efficacy and safety of a novel, hydrophilic, bioenhanced curcumin (BEC) as add-on therapy in inducing clinical and endoscopic remission in mild to moderately active ulcerative colitis (UC).

Design:

Mild to moderately active UC patients (partial Mayo score 2 to 6 with endoscopic Mayo score >1) on standard dose of mesalamine were randomized to either 50 mg twice daily BEC or an identical placebo. Clinical response (≥2 reduction of partial Mayo score), clinical remission (partial Mayo score ≤1), and endoscopic remission (endoscopic Mayo score of ≤1) were evaluated at 6 weeks and 3 months. Responders were followed-up at 6 and 12 months for assessing maintenance of remission.

Results:

Sixty-nine patients were randomly assigned to BEC (n=34) and placebo (n=35). At 6 weeks, clinical and endoscopic remission occurred in 44.1% (15/34) and 35.3% (14/34) patients, respectively, compared with none in the placebo group (P<0.01). Clinical response was also significantly higher in the BEC group (18/34, 52.9%) compared with placebo (5/35, 14.3%) (P=0.001). The clinical remission, clinical response, and endoscopic remission rates at 3 months were 55.9% (19/34), 58.8% (20/34), 44% (16/34) and 5.7% (2/35), 28.6% (10/35), 5.7% (2/35) in BEC and placebo groups, respectively. At 6 and 12 months, 95% (18/19) and 84% (16/19) of the responders to BEC maintained clinical remission. None of the responders to placebo maintained clinical remission at 6 months. BEC appeared safe with no significant side effects.

Conclusion:

A low-dose BEC as add-on therapy was superior to placebo in inducing sustained clinical and endoscopic remission in patients with mild-to-moderately active UC on maximal dose of mesalamine (ClinicalTrials.gov: NCT02683733).
Proton Pump Inhibitor Use, Hypomagnesemia and Risk of Cardiovascular Diseases
Authors: Rooney Mary R. , Bell Elizabeth J. , Alonso Alvaro , Pankow James S. , Demmer Ryan T. , Rudser Kyle D. , Chen Lin Y. , Lutsey Pamela L.
Published: September 2020

Goals:

The goal of this study was to evaluate whether proton pump inhibitor (PPI) use is cross-sectionally associated with hypomagnesemia and whether hypomagnesemia mediates the prospective association between PPIs and cardiovascular disease (CVD) risk.

Background:

Use of PPIs has been associated with hypomagnesemia, primarily in case reports or within insurance databases. Both PPI use and low serum magnesium (Mg) have been associated with modestly higher CVD risk. Yet, the interrelation between PPI use and Mg in relation to CVD risk is unclear.

Study:

The 4436 Atherosclerosis Risk in Communities participants without prevalent CVD at visit 5 (baseline, 2011-2013) were included. Multivariable relative risk regression was used for cross-sectional analyses between PPI and hypomagnesemia prevalence (≤0.75 mmol/L). Incident CVD (defined by atrial fibrillation, coronary heart disease, CVD mortality, heart failure, stroke) was identified through 2017. Multivariable Cox regression was used to examine the PPI-CVD association.

Results:

Participants were mean±SD aged 75±5 years; 63% were women, 23% Black, and 24% were PPI users. PPI users had 1.24-fold (95% confidence interval: 1.08-1.44) higher prevalence of hypomagnesemia than nonusers. Over a median 5 years of follow-up, 684 incident CVD events occurred. PPI users had higher CVD risk [hazard ratio (95% confidence interval) 1.31 (1.10-1.57)] than nonusers. The effect estimate was largely unchanged when hypomagnesemia was added to the model as a potential mediator.

Conclusions:

In this elderly community-based study, PPI users had a higher prevalence of hypomagnesemia than in nonusers. PPI users also had higher CVD risk than nonusers; however, it appears unlikely that hypomagnesemia explains associations of PPIs with CVD risk.
Understanding Gaps in the Hepatocellular Carcinoma Cascade of Care
Authors: Wong Robert J. , Ahmed Aijaz
Published: September 2020

Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality. Existing studies have highlighted significant disparities in HCC outcomes, particularly among vulnerable populations, including ethnic minorities, safety-net populations, underinsured patients, and those with low socioeconomic status and high risk behaviors. The majority of these studies have focused on HCC surveillance. Although HCC surveillance is one of the most important first steps in HCC monitoring and management, it is only one step in the complex HCC cascade of care that evolves from surveillance to diagnosis and tumor staging that leads to access to HCC therapies. In this current review, we explore the disparities that exist along this complex HCC cascade of care and further highlight potential interventions that have been implemented to improve HCC outcomes. These interventions focus on patient, provider, and system level factors and provide a potential framework for health systems to implement quality improvement initiatives to improve HCC monitoring and management.
Dietary lipids and cardiometabolic health: a new vision of structure–activity relationship
Authors: Vors Cécile , Le Barz Mélanie , Bourlieu Claire , Michalski Marie-Caroline
Published: September 2020

Purpose of review

The impact of dietary lipids on cardiometabolic health was mainly studied considering their fatty acid composition. This review aims to present the recent change in paradigm whereby the food matrix, the molecular and supramolecular structures of dietary lipids modulate their digestive fate and cardiometabolic impact.

Recent findings

Epidemiological studies have reported that the metabolic impact of full-fat dairy products is better than predictable upon saturated fatty acid richness. Milk polar lipid supplementation reduced adiposity and inflammation in rodents by modulating gut microbiota and barrier, and decreased lipid markers of cardiovascular disease risk in humans by lowering cholesterol absorption. The metabolic importance of the structure of lipid molecules carrying omega-3 (molecular carrier) has also been documented. Plant lipids exhibit specific assemblies, membrane and molecular structures with potential health benefits. Lipid emulsifiers used to stabilize fats in processed foods are not mere bystanders of lipid effects and can induce both beneficial and adverse health effects.

These findings open new clinical research questions aiming to further characterize the cardiometabolic fate of lipids, from digestion to bioactive metabolites, according to the food source or molecular carrier. This should be useful to elaborate food formulations for target populations and personalized dietary recommendations.
Systematic review and meta-analysis of dermatological reactions in patients with inflammatory bowel disease treated with anti-tumour necrosis factor therapy
Authors: Nigam Gaurav B. , Bhandare Anirudh P. , Antoniou George A. , Limdi Jimmy K.
Published: September 2020

Aim

The role of anti-tumour necrosis factor (TNF) medications in inflammatory bowel disease (IBD) is now established. Recent studies have reported the incidence of dermatological adverse events with use of anti-TNFs in IBD. The aim of this study was to investigate the incidence of dermatological reactions in patients on anti-TNF therapy for IBD.

Methods

We searched MEDLINE, the Cochrane Library and EMBASE to identify studies reporting any dermatological reaction in patients exposed to anti-TNF for treatment of IBD. The incidence of dermatological complications in the entire review population was pooled by meta-analysis of data from individual studies using the random effects model. Pooled estimates in male and female patients and in patients treated with different anti-TNF agents were also calculated. We applied mixed effects (methods of moments) regression models to investigate between-study heterogeneity.

Results

Forty-eight studies reporting a total of 29 776 patients treated with anti-TNF medications for IBD were identified. Gender distribution was available for 18 960 participants with 45.3% females. Data on type of disease were available for 20 226 patients: 74.9% (n = 15 154) Crohn’s disease, 24.2% (n = 4901) ulcerative colitis and 0.9% (n = 171) IBD-unclassified. The type of anti-TNF used was mentioned for 17 085 individuals: 67.5% (n = 11 530) infliximab (IFX), 30.5% (n = 5203) adalimumab (ADA), 1.7% (n = 296) certolizumab and 0.3% (n = 56) golimumab. The pooled incidence of any dermatological reaction from 26 studies was 19.4% [95% confidence interval (CI): 15.2–24.4]. The pooled incidence for IFX and ADA was 23.7% (95% CI: 17.8–30.8) from 12 studies and 33.3% (95% CI 18.8–51.1) from seven studies, respectively. We found a trend of increased event rate with increasing percentage of male population (P = 0.08). The commonest reported event (39 studies) was psoriasis/psoriasiform rash with a pooled incidence of 5.6% (95% CI: 4.2–7.4). The incidence of psoriasis/psoriasiform rashes for IFX and ADA was 6.1% (95% CI 3.4–10.6) from 15 studies and 5.9% (95% CI: 2.5–13.5) from seven studies, respectively. Other reactions reported included eczema with a pooled incidence of 5.5% (95% CI: 3.3–8.9) from 17 studies and skin infections with pooled incidence of 7.9% (95% CI: 5.5–11.2) from 11 studies.

Conclusion

The incidence of dermatological events in patients with IBD treated with anti-TNF medications is high. The most commonly reported reaction is psoriasis/psoriasiform reaction. Clinicians should be vigilant to dermatological side effects following treatment of IBD with anti-TNF.
Exome sequencing as a diagnostic tool in chronic kidney disease: ready for clinical application?
Authors: Leveson James , Oates Thomas M.
Published: September 2020

Purpose of review

Patients who develop chronic kidney disease at an early age, or from an uncertain cause, may benefit from genomic sequencing approaches to define causative mutations and inform subsequent management.

Recent findings

Whole-exome sequencing has been used to investigate the molecular genetic variants associated with chronic kidney disease in both specific phenotypes such as steroid-resistant nephrotic syndrome, and in large cohorts of patients not selected for a certain diagnosis. These studies have shown that whole-exome sequencing is able to find a genetic variant in a significant number of patients. Often these variants may reclassify the diagnosis, the variants may have ramifications for the patient's management, and some variants may be previously undescribed in the literature.

Whole-exome sequencing is likely to become widely used in the investigation of chronic kidney disease, especially in certain phenotypes.
Fluid management in chronic kidney disease: what is too much, what is the distribution, and how to manage fluid overload in patients with chronic kidney disease?
Authors: de Ruiter Anna , Bello Aminu , Braam Branko
Published: September 2020

Purpose of review

Assessment of fluid status to reach normovolemia in patients with chronic kidney disease (CKD) continues to be a tough task. Besides clinical observation, technological methods have been introduced, yet, the best approach is still uncertain. The present review looks at fluid overload in CKD from three perspectives: the critical fluid threshold leading to adverse cardiovascular outcomes, fluid distribution and its clinical correlates, and direct effect of fluid overload on vascular function related to disturbance of the sodium–skin axis and endothelial glycocalyx dysfunction.

Recent findings

To determine fluid status, both the absolute and relative fluid overload is used as parameter in clinical practice. In addition, the definition of fluid overload is ambivalent and its relation to symptom burden has not been studied well. Studies on the impact of distribution of fluid are scarce and the limited evidence suggests differences based on the cause of CKD. So far, no standardized technologies are available to adequately determine fluid distribution. After discovering the ‘third compartment’ of total body sodium in skin and muscle tissue and its potential direct effect on vascular function, other biomarkers such as VEGF-C are promising.

We propose a multimodal clinical approach for volume management in CKD. Because there are currently no studies are available demonstrating that correction of fluid overload in CKD will lead to better outcome, these are strongly needed.
Extracellular vesicles: a novel window into kidney function and disease
Authors: Sun In O. , Kwon Soon Hyo
Published: September 2020

Purpose of review

There has been an increasing interest in extracellular vesicles as potential diagnostic, prognostic or therapeutic biomarkers for various kidney diseases, as extracellular vesicles mediate cell-cell or intercellular communication. This review explores the current state of knowledge regarding extracellular vesicles as a tool for examining kidney physiology and disease.

Recent findings

Urinary extracellular vesicles may be useful as biomarkers to detect abnormal function in renal endothelial and tubular cells as well as podocytes. Recent studies suggest that urinary extracellular vesicles may facilitate early diagnosis and/or monitoring in acute kidney injury, glomerular disease, autosomal dominanat polycyst kidney disease and urinary tract malignancies. Circulating extracellular vesicles may serve as biomarkers to assess cardiovascular disease.

Urinary and circulating extracellular vesicles have gained significant interest as potential biomarkers of renal diseases. Analysis of extracellular vesicles may serve as a logical diagnostic approach for nephrologists as well as provide information about disease pathophysiology.
Volume management in haemodialysis patients
Authors: See Emily J. , Polkinghorne Kevan R.
Published: September 2020

Purpose of review

Accumulating evidence supports the important contribution of volume-related metrics to morbidity and mortality in patients receiving chronic haemodialysis. The purpose of this review is to summarize recent advances in the understanding and management of volume status in this high-risk group.

Recent findings

Delivery of optimal volume management involves three key components: accurate estimation of volume status, correction of extracellular fluid overload and prevention of intradialytic instability. The lack of a gold standard for assessing volume status makes accurate estimation difficult to achieve; clinical examination has insufficient sensitivity and specificity, while tools to assist in the objective measurement of extracellular fluid volume require further validation. Hypervolemia is common in patients on chronic haemodialysis and substantially increases the risk of morbidity and mortality. Rapid correction of hypervolemia should be avoided due to the risk of precipitating intradialytic hypotension and hypoperfusion of vital end-organs, including the heart, brain, liver, gut and kidneys. Evidence-based interventions to aid in normalizing extracellular fluid volume are urgently needed; several targeted strategies are currently being evaluated. Many centres have successfully implemented local protocols and programmes to enhance volume management.

Achieving normal volume status is a fundamental goal of haemodialysis. Novel methods of assessing and restoring extracellular fluid volume while maintaining intradialytic stability are currently undergoing evaluation. Implementation of volume-related strategies into clinical practice is feasible and may improve patient outcome.
Getting the basics right: the monitoring of arteriovenous fistulae, a review of the evidence
Authors: Bodington Richard , Greenley Sarah , Bhandari Sunil
Published: September 2020

Purpose of review

Despite being the preferred vascular access for haemodialysis, the arteriovenous fistula (AVF) remains prone to a number of complications, the most common of these being thrombosis secondary to stenosis. This has resulted in the widespread use of monitoring and surveillance programmes. Surveillance uses more resources than monitoring and has not been convincingly shown to improve outcomes. The evidence supporting the use of the various monitoring tools has been relatively neglected and has not been the focus of literature review. This narrative review is the first to appraise the evidence for the use of physical examination, access recirculation, Kt/V and dynamic venous pressures (DVP) as monitoring tools in mature AVF.

Recent findings

The vastly increased number of data points for access recirculation, Kt/V and DVP produced as standard by online clearance monitoring (OCM) on modern dialysis machines is likely to have significantly changed the utility of these metrics in the prediction of AVF failure. Algorithms have been developed to highlight those of highest risk of failure.

The evidence supporting the use of monitoring in the prediction of AVF failure is predominantly observational, underpowered and more than 20 years old. Access recirculation and Kt/V appears to have higher utility in AVF than in arteriovenous grafts. We suggest that the development of OCM necessitates the reevaluation of these tools.