bluuebunny/crossref_metadata_2025 huggingface dataset:
A case report of successful elimination of recurrent ventricular tachycardia by repeated stereotactic radiotherapy: the importance of accurate target volume delineation
Authors: Peichl Petr , Sramko Marek , Cvek Jakub , Kautzner Josef
Published: December 2020

Background

Stereotactic body radiotherapy (SBRT) has emerged recently as a novel therapeutic alternative for patients with ventricular tachycardias (VTs) resistant to convetional treatment. Nevertheless, many aspects related to SBRT are currently unknown.

Case summary

A 66-year-old man with ischaemic heart disease, a history of coronary artery bypass graft surgery and left ventricular dysfunction was referred for recurrent symptomatic episodes of slow VT (108 b.p.m.). The arrhythmia was resistant to antiarrhythmic drug therapy with amiodarone and repeated catheter ablation. The patient was scheduled to SBRT, however, the first session failed to suppress VT recurrences. After 20 months, the patient underwent re-do ablation procedure that revealed a newly developed scar with its core adjacent to the presumed critical part of the VT substrate. Catheter ablation again failed to eliminate VT and the second session of SBRT was scheduled. To improve targeting of the VT substrate for SBRT, we applied our recently developed original method for integration of data from the electroanatomical mapping system with computer tomography images. The second session of SBRT with precise targeting using the novel strategy led within 3 months to the successful elimination of VT.

Discussion

This case report describes a patient in whom the recurrent VT was abolished only by properly targeted SBRT. Above all, the case highlights the importance of precise identification and targeting for SBRT. Our case also documents in vivo, by electroanatomical voltage mapping, the development of SBRT-related myocardial lesion. This represents an important mechanistic proof of the concept of SBRT.
A predictive model for early recurrence of colorectal-cancer liver metastases based on clinical parameters
Authors: Dai Siqi , Ye Yao , Kong Xiangxing , Li Jun , Ding Kefeng
Published: December 2020

Background

The prognosis for patients with colorectal-cancer liver metastases (CRLM) after curative surgery remains poor and shows great heterogeneity. Early recurrence, defined as tumor recurrence within 6 months of curative surgery, is associated with poor survival, requiring earlier detection and intervention. This study aimed to develop and validate a bedside model based on clinical parameters to predict early recurrence in CRLM patients and provide insight into post-operative surveillance strategies.

Material and methods

A total of 202 consecutive CRLM patients undergoing curative surgeries between 2012 and 2019 were retrospectively enrolled and randomly assigned to the training (n = 150) and validation (n = 52) sets. Baseline information and radiological, pathological, and laboratory findings were extracted from medical records. Predictive factors for early recurrence were identified via a multivariate logistic-regression model to develop a predictive nomogram, which was validated for discrimination, calibration, and clinical application.

Results

Liver-metastases number, lymph-node suspicion, neurovascular invasion, colon/rectum location, albumin and post-operative carcinoembryonic antigen, and carbohydrate antigen 19–9 levels (CA19–9) were independent predictive factors and were used to construct the nomogram for early recurrence after curative surgery. The area under the curve was 0.866 and 0.792 for internal and external validation, respectively. The model significantly outperformed the clinical risk score and Beppu’s model in our data set. In the lift curve, the nomogram boosted the detection rate in post-operative surveillance by two-fold in the top 30% high-risk patients.

Conclusion

Our model for early recurrence in CRLM patients after curative surgeries showed superior performance and could aid in the decision-making for selective follow-up strategies.
Short Leukocyte Telomeres, But Not Telomere Attrition Rates, Predict Memory Decline in the 20-Year Longitudinal Betula Study
Authors: Pudas Sara , Josefsson Maria , Nordin Adolfsson Annelie , Landfors Mattias , Kauppi Karolina , Veng-Taasti Line Marie , Hultdin Magnus , Adolfsson Rolf , Degerman Sofie
Published: December 2020

Leukocyte telomere length (LTL) is a proposed biomarker for aging-related disorders, including cognitive decline and dementia. Long-term longitudinal studies measuring intra-individual changes in both LTL and cognitive outcomes are scarce, precluding strong conclusions about a potential aging-related relationship between LTL shortening and cognitive decline. This study investigated associations between baseline levels and longitudinal changes in LTL and memory performance across an up to 20-year follow-up in 880 dementia-free participants from a population-based study (mean baseline age: 56.8 years, range: 40–80; 52% female). Shorter baseline LTL significantly predicted subsequent memory decline (r = .34, 95% confidence interval: 0.06, 0.82), controlling for age, sex, and other relevant covariates. No significant associations were however observed between intra-individual changes in LTL and memory, neither concurrently nor with a 5-year time-lag between LTL shortening and memory decline. These results support the notion of short LTL as a predictive factor for aging-related memory decline, but suggest that LTL dynamics in adulthood and older age may be less informative of cognitive outcomes in aging. Furthermore, the results highlight the importance of long-term longitudinal evaluation of outcomes in biomarker research.
Abbreviated Breast MRI for Screening High-risk Women: Comparison with the Full Clinical Protocol
Authors: Osei Kendrah V , Mehta Anita K , Thigpen Denise M , Rapelyea Jocelyn , Friedman Steven , Brem Rachel F
Published: December 2020

Objective

To compare cancer detection rate (CDR), patient recall, and interpretation time of a full protocol MRI (fpMRI) to an abbreviated MRI protocol (abMRI) in high-risk women.

Methods

This retrospective study was approved by the IRB. All sequential high-risk screening MRI examinations performed between January 1, 2013, and December 31, 2016, were included. Breast radiologists reviewed patient history, prior images, and abMRI images and recorded their interpretation. Time for interpretation reflected review of the MRI study but not dictation or report generation. Following a minimum 30-day washout period, radiologists interpreted the fpMRI, with interpretation and timing recorded. Data collected included CDR, interpretation time, and patient recall rate. Statistical analyses utilized were Cohen’s kappa coefficient, Student’s t-test, and McNemar’s test.

Results

Included were 334 MRI examinations of 286 women. Interpretation time was 60.7 seconds for the abMRI compared to 99.4 seconds for the fpMRI, with an average difference of 38.7 ± 5.4 seconds per patient (P < 0.0001). Recall rates were comparable: the abMRI recall rate was 82/334 (24.6%) and the fpMRI 81/334 (24.3%). All five cancers included were detected by both protocols with equal recall rate. However, there were more recommendations for biopsy with the fpMRI, although this difference was not statistically significant.

Conclusion

The abMRI demonstrated comparable CDR to fpMRI, with shortened interpretation time and similar recall rates. Implementing an abMRI to screen high-risk women reduces imaging and interpretation time, thereby improving cost-effectiveness and the patient experience without reduction in cancer detection.
Mental Money Laundering: A Motivated Violation of Fungibility
Authors: Imas Alex , Loewenstein George , Morewedge Carey K
Published: December 2020

People exploit flexibility in mental accounting to relax psychological constraints on spending. Four studies demonstrate this in the context of moral behavior. The first study replicates prior findings that people donate more money to charity when they earned it through unethical versus ethical means. However, when the unethically earned money is first “laundered”—the cash is physically exchanged for the same amount but from a different arbitrary source—people spend it as if it was earned ethically. This mental money laundering represents an extreme violation of fungibility. The second study demonstrates that mental money laundering generalizes to cases in which ethically and unethically earned money are mixed. When gains from ethical and unethical sources were pooled, people spent the entire pooled sum as if it was ethically earned. The last two studies provide mixed support for the prediction that people actively seek out laundering opportunities for unethically earned money, suggesting partial sophistication about these effects. These findings provide new evidence for the ease with which people can rationalize misbehavior, and have implications for consumer choice, corporate behavior, and public policy.
Playing the Ethnic Card: Diversion, Transborder Ethnic Ties, and Sponsorship of Rebel Movements
Authors: Jones Benjamin T , Linebarger Christopher
Published: December 2020

Under what circumstances do third-party states oppose governments that marginalize their ethnic kin in foreign civil conflicts? We argue that the effect of transborder ethnic ties on third-party support for rebel movements depends upon two factors: (1) a constellation of ethnic power relations in which an ethnicity with access to political power in a potential intervener but is marginalized in a civil conflict state and (2) the political insecurity of leaders in a potential intervener. Said leaders facing a high probability of removal from office are willing to undertake risky foreign policies, including support for rebel movements, hoping that such actions will generate an ethnically tinged rally effect. We draw upon the literature on diversionary theory to develop an empirical expectation. We then assemble a dataset of potential intervener–civil conflict state dyad-years to model this expectation. The political insecurity of leaders is measured with a variety of proxies. Our findings suggest that the well-known diversionary theory can be applied to a novel dependent variable that of third-party state sponsorship of rebel movements.
Faster Initial Viral Decay in Female Children Living With HIV
Authors: Domínguez-Rodríguez Sara , Serna-Pascual Miquel , Foster Caroline , Palma Paolo , Nastouli Eleni , De Rossi Anita , Seoane Javier , Rossi Paolo , Giaquinto Carlo , Tagarro Alfredo , Rojo Pablo
Published: December 2020

Limited data exist regarding sex bias and viral decay in children with HIV. We investigated the sex differences in viral decay in 25 perinatally HIV-infected children. Females presented faster phase I viral decay regardless of their age at antiretroviral therapy (ART) initiation, baseline CD4 percentages, or baseline RNA levels. Also, for each month elapsed under ART, females had faster viral decay than males.
Risk factors for mortality, ICU admission and bacteremia in patients suspected of sepsis at the Emergency department. A prospective cohort study
Authors: D’Onofrio Valentino , Meersman Agnes , Vijgen Sara , Cartuyvels Reinoud , Messiaen Peter , Gyssens Inge C
Published: December 2020

Background

There is a clear need for a better assessment of independent risk factors for in-hospital mortality, ICU admission, and bacteremia in patients presenting with suspected sepsis at the ED.

Methods

A prospective observational cohort study including 1690 patients was performed. Two multivariable logistic regression models were used to identify independent risk factors.

Results

SOFA score of ≥2 and serum lactate of ≥2mmol/L were associated with all outcomes. Other independent risk factors were individual SOFA variables and SIRS variables but varied per outcome. MAP<70 mmHg negatively impacted all outcomes.

Conclusion

These readily available measurements can help with early risk stratification and prediction of prognosis.
Use of Infliximab to Treat Paradoxical Tuberculous Meningitis Reactions
Authors: Marais Ben J , Cheong Elaine , Fernando Shelanah , Daniel Santhosh , Watts Matthew R , Berglund Lucinda J , Barry Simone E , Kotsiou George , Headley Alex P , Stapledon Richard A
Published: December 2020

We documented dramatic responses to infliximab in 4 tuberculous meningitis cases with severe paradoxical reactions after effective antibacterial treatment, despite high-dose steroids. In every instance, infliximab was used as a last resort after all other options were exhausted, resulting in delayed initiation that may have adversely affected patient outcomes.
Human Challenge Studies With Wild-Type Severe Acute Respiratory Sydrome Coronavirus 2 Violate Longstanding Codes of Human Subjects Research
Authors: Spinola Stanley M , Broderick Camilla , Zimet Gregory D , Ott Mary A
Published: December 2020

This manuscript explores the ethics of human inoculation experiments in young healthy adults with wild-type severe acute respiratory sydrome coronavirus 2 (SARS-CoV-2) as a tool to evaluate vaccine efficacy in the context of the Nuremberg Code, the Declaration of Helsinki, and the Belmont Report, and in the context of dose-response relationships with infectious agents. Despite societal pressure to develop a SARS-CoV-2 challenge model to evaluate vaccines, we argue that there are substantial risks that cannot be adequately defined because the dose of SARS-CoV-2 that causes severe disease in young adults is unknown. In the absence of curative therapy, even if a volunteer consents, longstanding ethical codes governing human subjects research preclude the conduct of such experiments.
Histological Evidence of Pulmonary Microthrombosis and Vasculitis in Life-Threatening Respiratory Virus Diseases
Authors: Dolby Heather W , Potey Philippe , Wilder-Smith Annika B , Clohisey Sara , Millar Jonathan E , Baillie J Kenneth , Dorward David A , Lucas Christopher D , Russell Clark D
Published: December 2020

Pulmonary microthrombosis and vasculitis occur in fatal coronavirus disease 2019. To determine whether these processes occur in other life-threatening respiratory virus infections, we identified autopsy studies of fatal influenza (n  =  455 patients), severe acute respiratory syndrome ([SARS] n  =  37), Middle East respiratory syndrome (n  =  2), adenovirus (n  =  34), and respiratory syncytial virus (n  =  30). Histological evidence of thrombosis was frequently present in adults with fatal influenza and SARS, with vasculitis also reported.
Aorto-cavitary fistula to the left ventricle with severe aortic regurgitation as a complication of prosthetic valve infective endocarditis: a novel report
Authors: Sanchez-Nadales Alejandro , Celis-Barreto Valentina , Khan Amir , Anampa-Guzman Andrea , Olanipekun Olalekan
Published: December 2020

Infective endocarditis can present in different clinical forms and lead to a variety of complications depending on the affected valvular and perivalvular structures. We describe a case of a 74-year-old male who developed an aortic-cavitary fistulous tract as a complication of prosthetic aortic valve infective endocarditis. Transesophageal echocardiography (TEE) revealed an aorto-cavitary fistula (ACF) connecting the aortic root with the left ventricle, creating an intracardiac shunt, which resulted in severe aortic regurgitation physiology. The patient underwent surgery with successful exclusion of the ACF. ACF is an unusual complication of infective endocarditis that creates an abnormal communication between the aortic root and the heart chambers, establishing an intracardiac shunt. This case highlights that physicians should be aware of the possibility of rare cardiac complications in infective endocarditis. TEE is a valid diagnostic test for ACF.
Butane-induced acute global myocardial ischemia without coronary artery pathology
Authors: Grigorov Vladimir , Grigorov Mladen , Grigorov Evgeni , Nocheva Hristina
Published: December 2020

The case report describes a case of acute myocardial ischemia precipitated by propane butane inhalation. The dependency of this substance around the world is still moderate but is increasing due to the easy availability of the substance and the facility with which the effects can be concealed. The toxicity of the substance is significant; affecting the heart, the brain and the liver. The most common outcome is sudden death. In this article, we describe a survivor after an episode of acute poisoning and his interesting cardiac pathology.
An unusual cause of recurrent pediatric vomiting (an extraluminal pyloric duplication cystic): A case report
Authors: Doya Leen Jamel , Hassan Naya Talal , Bijow Fareeda Wasfy , Mansour Hanin Ahmed , Ahmad Sawsan , Nooh Fedaa , Ibrahim Ali
Published: December 2020

Vomiting is a common symptom of a multitude of diseases in children. It is usually part of benign illness and can occur at any age. Recurrent vomiting can be a symptom of life-threatening medical or surgical emergencies. It can be rarely caused by an extraluminal pyloric duplication cyst. Early recognition is essential for preventing delays in management and potential complications.

Here we report a case of an extraluminal pyloric duplication presenting as progressive gastric outlet obstruction cyst in a 14-month-old Syrian boy. The diagnosis was made through abdominal ultrasound, gastrointestinal endoscopy and abdominal computed tomography scan.
Association of autosomal dominant polycystic kidney disease, asymptomatic multiple giant coronary arteries aneurysms and abdominal aortic aneurysm: a case report
Authors: Hindawy Abdullah Rida , Daboul Baraa , Hanafi Ibrahem , Albitar Sami
Published: December 2020

Autosomal dominant polycystic kidney disease (ADPKD) is a systemic disease characterized by the formation of multiple cysts in several organs. The formation of aneurysms accompanying this disease is being increasingly reported in the literature, and mutations in PKD-1 and PKD-2 are suspected in this etiology. Although the association between ADPKD and multiple coronary arteries aneurysms (CAA) was reported several times, we are presenting a case with the combination of ADPKD, multiple giant CAAs, abdominal aortic aneurysms and a suspected intracranial aneurysm, which has never been reported. The asymptomatic presentation of these multiple aneurysms might support the recommendations for further diagnostic investigations in these patients.
Role of Penicillin-Binding Proteins in the Viability, Morphology, Stress Tolerance, and Pathogenicity of Clavibacter michiganensis
Authors: Chen Xing , Bai Kaihong , Lyu Qingyang , Jiang Na , Li Jianqiang , Luo Laixin
Published: December 2020

Previous research has shown that penicillin-binding proteins (PBPs), enzymes involved in peptidoglycan (PG) assembly, could play an important role during the induction of the viable but nonculturable (VBNC) state, which allows non-spore-forming bacteria to survive adverse environmental conditions. The current study found that Clavibacter michiganensis has seven PBPs. Mutant analysis indicated that deletion of either of the class B PBPs was lethal and that the class A PBPs had an important role in PG synthesis, with the ΔpbpC mutant having an altered cellular morphology that resulted in longer cells that were swollen at one end and had thinner cell walls. The ΔpbpC mutant was also found to produce mucoid colonies in solid culture and a lower final cell titer in liquid medium, as well as having high sensitivity to osmotic stress and lysozyme treatment and surprisingly high pathogenicity. The double mutant, ΔdacB/ΔpbpE, also had a slightly altered phenotype, resulting in longer cells. Further analysis revealed that both mutants had high sensitivity to copper, which resulted in quicker induction into the VBNC state. However, only the ΔpbpC mutant had significantly reduced survivorship in the VBNC state. The study also confirmed that the VBNC state significantly improved the survivorship of wild-type C. michiganensis cells in response to environmental stresses and systemically demonstrated the protective role of the VBNC state in C. michiganensis, which is an important finding regarding its epidemiology and has serious implications for disease management.
Neutrophil to lymphocyte ratio is a prognosis factor for post-operative pneumonia in aneurysmal subarachnoid hemorrhage patients
Authors: Chen Yue , Lian Bao-Qiang , Peng Lei , Ding Chen-Yu , Lin Yuan-Xiang , Yu Liang-Hong , Wang Deng-Liang , Kang De-Zhi
Published: December 2020

Background:

Although a variety of risk factors of pneumonia after clipping or coiling of the aneurysm (post-operative pneumonia [POP]) in patients with aneurysmal subarachnoid hemorrhage (aSAH) have been studied, the predictive model of POP after aSAH has still not been well established. Thus, the aim of this study was to assess the feasibility of using admission neutrophil to lymphocyte ratio (NLR) to predict the occurrence of POP in aSAH patients.

Methods:

We evaluated 711 aSAH patients who were enrolled in a prospective observational study and collected admission blood cell counts data. We analyzed available demographics and baseline variables for these patients and analyzed the correlation of these factors with POP using Cox regression. After screening out the prognosis-related factors, the predictive value of these factors for POP was further assessed.

Results:

POP occurred in 219 patients (30.4%) in this cohort. Patients with POP had significantly higher NLR than those without (14.11 ± 8.90 vs. 8.80 ± 5.82, P < 0.001). Multivariate analysis revealed that NLR remained a significant factor independently associated with POP following aSAH after adjusting for possible confounding factors, including the age, World Federation of Neurosurgical Societies (WFNS) grade, endovascular treatment, and ventilator use. And the predictive value of NLR was significantly increased after WFNS grade was combined with NLR (NLR vs. WFNS grade × NLR, P = 0.011).

Conclusions:

Regardless of good or poor WNFS grade, patients having NLR >10 had significantly worse POP survival rate than patients having NLR ≤10. NLR at admission might be helpful as a predictor of POP in aSAH patients.
Mobility Deterioration During Acute Pneumonia Illness Is Associated With Increased Hospital Length of Stay and Health Service Costs: An Observational Study
Authors: Lloyd Melanie , Callander Emily , Simons Koen , Karahalios Amalia , Maguire Graeme , Janus Edward , Karunajeewa Harin
Published: December 2020

Purpose:

To assess the association of mobility deterioration during community-acquired pneumonia (CAP) illness on length of stay (LOS), readmissions, and institutional costs.

Methods:

This longitudinal observational study included 347 individuals hospitalized with CAP. All were offered routine early mobilization with a physiotherapist within 24 hours of admission and then daily during hospital stay. The exposure of interest was mobility status at time of clinical stability when compared with the premorbid level. Modelling adjusted for factors such as age, residential status, premorbid mobility level, comorbidities, and pneumonia severity.

Results:

One hundred forty-one (41%) individuals met the definition of mobility deterioration during the acute illness. The mean (95% confidence interval [CI]) time from achievement of clinical stability to hospital discharge for the groups with and without mobility deterioration was 5.7 (4.2–7.2) and 2.3 (1.4–3.2) days, respectively, with associated higher hospitalization costs (arithmetic mean ratio [95% CI] 1.61 [1.24–2.10]) in the mobility deterioration group. There was no evidence of an association between mobility deterioration and 90-day readmission (odds ratio [95% CI]: 1.34 [0.81–2.24]).

Conclusions:

Mobility deterioration during acute pneumonia illness has a significant impact on hospital LOS and resource use even in a hospital system that has an early mobility program. Further research is needed to investigate these associations and alternative interventions.

Trial registration:

ClinicalTrials.gov, Identifier: NCT02835040.
A Survey of Factors That May Cause Practice Inconsistencies and Impact Care in Pulmonary Rehabilitation
Authors: Pata Rachel W. , Giblin Jillian , Cassata Emily , Cortez Regina , Pascale Alicia , Hall Megan
Published: December 2020

Purpose:

Research about methods implemented in pulmonary rehabilitation is needed. Inconsistencies in this multifaceted intervention may impact care.

Methods:

A survey was administered to outpatient pulmonary rehabilitation programs, addressing program characteristics, and perceived importance and frequency of rehabilitation components. Descriptive statistics and post-hoc correlations were analyzed.

Results:

Clinicians present during exercise included respiratory therapists (72.2%), exercise physiologists (50%), registered nurses (44.4%), physical therapists (11.1%), occupational therapists (5.6%), dieticians (5.6%), and physicians (5.6%). On a scale of 1 to 5 (never vs always), programs provided: exercises for all extremities (5), individualized exercise (4.89, SD = 0.46), resistance training (4.5, SD = 0.83), balance training (3.28, SD = 1.1), alternative exercise methods (1.94, SD = 1.55), home equipment education (3.44, SD = 1.12), social support avenues (3.83, SD = 1.26), and home safety assessments (1.56, SDs = 1.07). All programs offered warm-up, cool down, and breathing exercises; 44% offered inspiratory resistance training, 22% high-intensity aerobic, and 11% high-intensity interval training. Twenty-four varied resources were used for patient education. Smoking cessation and nutritional consults were inconsistently offered. Reported limiting factors included compliance (66.7%), transportation (55.6%), staffing (33.3%), and facility size (33.3%).

Conclusions:

Limited resources, varied personnel, and patient compliance may contribute to practice inconsistencies. Improved resources, transportation, and an inclusive team may improve care standardization.
Successful intubation of a patient with a supraglottic tumor using a novel articulating introducer for precision tracheal access
Authors: Keefe Katherine R. , Cannon Richard B. , Runnels Sean T.
Published: December 2020

Tracheal intubation requires solving 2 problems: visualization of the glottis and navigation of an endotracheal tube into the trachea. Even when visualization is solved, navigation around a tumor can remain a problem while accessing the trachea. We report the successful intubation of a patient with a supraglottic tumor using a modified combined technique involving a video laryngoscope for visualization in combination with a Total Control Introducer for precision tracheal access.
WITH OR WITHOUT INTERNAL LIMITING MEMBRANE PEELING FOR IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Sun Yi , Zhou Rouxi , Zhang Bowen
Published: December 2020

Purpose:

To clarify whether internal limiting membrane (ILM) peeling provides better outcomes for patients with idiopathic epiretinal membrane.

Methods:

Randomized controlled trials comparing epiretinal membrane removal with and without ILM peeling were searched in Embase, PubMed, Web of Science, Cochrane Library, and CNKI before April 15, 2020. The pooled mean difference (MD) for best-corrected visual acuity, central macular thickness, and odds ratio for recurrence were calculated.

Results:

Eight randomized controlled trials involving 422 eyes were included. No significant difference in best-corrected visual acuity (final follow-up: MD, 0.03 logarithm of the minimum angle of resolution [1.5 Early Treatment Diabetic Retinopathy Study letters]; 95% confidence interval [CI], −0.04 to 0.09 [−4.5 to 2 Early Treatment Diabetic Retinopathy Study letters]; P = 0.40) or recurrence rate (odds ratio, 0.21; 95% CI, 0.04–1.05; P = 0.06) between the groups was observed. However, patients with ILM peeling presented thicker central macular thickness at 3 months (MD, 16.36; 95% CI, 1.26–31.46; P = 0.03), 6 months (MD, 22.64; 95% CI, 10.29–34.98; P = 0.0003) and the final follow-up (MD, 25.87; 95% CI, 13.96–37.79; P < 0.0001).

Conclusion:

The study showed that ILM peeling did not significantly improve the postoperative visual outcome or decrease recurrence, but result in thicker central macular thickness, indicating that it is inessential for idiopathic epiretinal membrane.
MICROCYSTIC MACULAR EDEMA AND CYSTOID MACULAR EDEMA BEFORE AND AFTER EPIRETINAL MEMBRANE SURGERY
Authors: Lee Dong Hyun , Park Sung Eun , Lee Christopher Seungkyu
Published: December 2020

Purpose:

To investigate the types of intraretinal cysts that are associated with epiretinal membranes and to evaluate the effects of each type of intraretinal cyst on postoperative outcomes.

Methods:

Retrospective, cross-sectional study design. Patients who underwent preoperative fluorescent angiography and epiretinal membrane surgery from February 2014 to May 2019 were included. Intraretinal cysts were subdivided into cystoid macular edema with angiographic leakage and microcystic macular edema (MME) without angiographic leakage.

Results:

A total of 100 eyes from 100 patients were enrolled. Intraretinal cysts were present in 54 (54.0%) eyes before surgery, of which 27 (27.0%) eyes showed MME, 18 (18.0%) eyes showed cystoid macular edema, and 9 (9.0%) eyes showed cystoid macular edema and MME. After surgery, the number of eyes with cystoid macular edema decreased significantly (P < 0.001), whereas the number of eyes with MME did not (P = 0.302). Absence of preoperative MME, poorer initial visual acuity, increased central foveal thickness, and intact ellipsoidal zone were associated with favorable visual recovery (P = 0.035, 0.033, 0.018, and 0.035, respectively).

Conclusion:

Microcystic macular edema associated with epiretinal membranes was a poor prognostic factor for epiretinal membrane surgery. The persistent existence of MME after surgery affirms related chronic structural changes. Further studies should investigate whether earlier surgical intervention (possibly before the development of MME) benefits visual outcomes.
NATURAL COURSE OF VITREOMACULAR TRACTION IN EYES WITH DIABETIC RETINOPATHY AND FACTORS ASSOCIATED WITH SPONTANEOUS RELEASE
Authors: Garip Rüveyde , Çınar Ayça Küpeli , Çınar Abdulkadir Can , Gürlü Vuslat
Published: December 2020

Purpose:

The aim of this study was to determine the natural course of vitreomacular traction (VMT) in patients with diabetic retinopathy and to evaluate the factors associated with VMT relief.

Methods:

Seventy-four eyes of 65 patients with VMT accompanying diabetic retinopathy were evaluated retrospectively. The presence of intravitreal injection and the presence of panretinal photocoagulation were obtained from the medical records of the patients. Spontaneous release of VMT, the horizontal length of vitreomacular traction, the presence of hyperreflective retinal spots, the presence of the epiretinal membrane, and the grade of VMT were evaluated from the spectral-domain optical coherence tomography images. Factors associated with the spontaneous release of VMT were evaluated by logistic regression analysis.

Results:

Spontaneous release was observed in 28 eyes (37.8%). The horizontal length of VMT was lower in the release of the VMT group compared with the persistent VMT group (P = 0.03). The persistent VMT group had a higher rate of hyperreflective retinal spots and epiretinal membrane compared with the release of the VMT group (respectively; P = 0.003 and P = 0.031). No statistically significant difference was observed between the release of VMT and persistent VMT groups in terms of intravitreal injection and panretinal photocoagulation treatment (respectively; P = 0.938 and P = 0.36). The absence of hyperreflective retinal spots was the most important prognostic factor for the spontaneous release of VMT (P = 0.029).

Conclusion:

Spontaneous release of VMT observed higher rates of patients without hyperreflective retinal spots, epiretinal membrane, and patients with lower horizontal length of VMT.
Luminescent probes for luminescence lifetime sensing and imaging in live cells: a narrative review
Authors: Nie Kaixuan , Peng Xiao , Yan Wei , Song Jun , Qu Junle
Published: December 2020

Luminescence (mostly fluorescence and phosphorescence) probes are a powerful tool widely used in the life sciences research. They can be used, for example, in the quantitative analysis of physiological parameters, visualization of different cell organelles, and measurement of drug transportation. The luminescence intensity and lifetime of these probes are among the main signals recorded and evaluated in these applications. Other reviews have discussed optical probes from the perspective of their luminescence intensity. However, the luminescence lifetime, which depends on the molecular microenvironment but not the probe concentration, is another promising metric for biological sensing and imaging applications. In this review, we aim to introduce the basic strategies of FLIM probe design. We also present applications of these probes, including sensing of intracellular pH, cation/anion concentrations, oxygen levels, biomolecule contents, and physiological parameters, as well as live-cell imaging based on luminescence lifetime. Studies based on FLIM imaging of cells or tissues with endogenous organic molecules are not included in this mini review. With the rapid development of microscopy technology for fluorescence lifetime imaging, fluorescence lifetime-based probes have shown great potential in a variety of biological applications.
Reflections of COVID-19 on Dermatology Practice
Authors: Richardson Veronica L. , Garcia-Albea Victoria R. , Bort Nicole L. , Mayne Susan L. , Nolen Mary E. , Bobonich Margaret A.
Published: December 2020

When the COVID-19 pandemic struck the United States in early 2020, few healthcare workers were prepared for what lay ahead. Dermatology nurses, medical assistants, and nurse practitioners experienced rapid changes in the way they conducted their daily practice. This article discusses many of those changes and explores the challenges these healthcare workers faced and continue to face. Almost every aspect of how dermatologic care was delivered prepandemic was affected. Some dermatology nurses, medical assistants, and nurse practitioners were redeployed to COVID-19 testing tents and inpatient hospital units or were asked to perform tasks to help support other healthcare workers. This article explores how clinical practice, dermatology staff, patient care, and education were affected. These changes forced dermatology healthcare workers to be brave, accept risks, and ultimately grow from these experiences.
Improving Inpatient Tobacco Treatment Measures: Outcomes Through Standardized Treatment, Care Coordination, and Electronic Health Record Optimization
Authors: Iannello Justin , Levitt Mary P. , Poetter Daniel , Bromberg David , James Leann , Cruz Melinda , Jean-Baptiste Marie , Henry Monique , Parissis Eleni I. , King Elizabeth D. , Antwi Catherine , Johnson Dawn , Skjerve Patti , Kothari Amit J. , Schweighardt Chris , Reynolds Ericka , Wood Kelley , Reiss Alexander
Published: December 2020

Introduction:

The Centers for Disease Control and Prevention states that tobacco use is the largest and most preventable cause of disease and mortality in the United States. The Joint Commission implemented inpatient tobacco treatment measures (TTMs) in 2012 to encourage healthcare systems to create processes that help patients quit tobacco use through evidence-based care.

Methods:

A tobacco cessation care delivery system was implemented at James A. Haley Veterans' Hospital and Clinics, which included: standardized pathways within the Veterans Health Administration (VHA) electronic health record system to improve nicotine replacement therapy ordering; evidence-based tobacco cessation counseling; and improved care coordination for tobacco cessation treatment through the use of technological innovation.

Results:

Outcomes were obtained from the VHA quality metric reporting system known as Strategic Analytics for Improvement and Learning (SAIL). TOB-2 and TOB-3 (two Joint Commission inpatient TTMs) equivalent to tob20 and tob40 within SAIL improved by greater than 300% after implementation at James A. Haley Veterans' Hospital and Clinics.

Conclusion:

Implementation of a tobacco cessation care system at James A. Haley Veterans' Hospital and Clinics enhanced interdisciplinary coordination of tobacco cessation care and resulted in improvements of The Joint Commission inpatient TTMs by greater than threefold.
Processes for Trauma Care at Six Level I Trauma Centers During the COVID-19 Pandemic
Authors: Harwood Laura , Jarvis Stephanie , Salottolo Kristin , Redmond Diane , Berg Gina M. , Erickson Wendy , Spruell Dana , Deas Shenequa , Sharpe Paul , Atnip Amy , Cornutt David , Mains Charles , Bar-Or David
Published: December 2020

Introduction:

As the COVID-19 pandemic spread, patient care guidelines were published and elective surgeries postponed. However, trauma admissions are not scheduled and cannot be postponed. There is a paucity of information available on continuing trauma care during the pandemic. The study purpose was to describe multicenter trauma care process changes made during the COVID-19 pandemic.

Methods:

This descriptive survey summarized the response to the COVID-19 pandemic at six Level I trauma centers. The survey was completed in 05/2020. Questions were asked about personal protective equipment, ventilators, intensive care unit (ICU) beds, and negative pressure rooms. Data were summarized as proportions.

Results:

The survey took an average of 5 days. Sixty-seven percent reused N-95 respirators; 50% sanitized them with 25% using ultraviolet light. One hospital (17%) had regional resources impacted. Thirty-three percent created ventilator allocation protocols. Most hospitals (83%) designated more beds to the ICU; 50% of hospitals designated an ICU for COVID-19 patients. COVID-19 patients were isolated in negative pressure rooms at all hospitals.

Conclusions:

In response to the COVID-19 pandemic, Level I trauma centers created processes to provide optimal trauma patient care and still protect providers. Other centers can use the processes described to continue care of trauma patients during the COVID-19 pandemic.
Examining the Implementation of Physical Activity and Healthy Eating Policies in a Large, Public Health Organization
Authors: McCardel Rachel E. , Loedding Emily H. , Padilla Heather M.
Published: December 2020

Objective:

To examine the implementation of physical activity and healthy eating policies in eighteen locations of a large, public health organization.

Methods:

We used a mixed-methods design that included a survey of employees to describe location characteristics (ie, number of employees, race/ethnicity of employees), a survey of wellness ambassadors to determine which policies were implemented, and semi-structured, telephone interviews with wellness ambassadors to examine the barriers and facilitators to policy implementation.

Results:

Six locations implemented both policies, nine locations only implemented the physical activity policy, and two locations did not implement either policy. Structural characteristics and geographic spread impeded implementation, whereas leadership engagement and access to information about the policies facilitated implementation.

Conclusions:

Consistent and adequate policy implementation in each location of an organization is critical to providing equity in health promotion programs for employees.
Capsular Management Techniques and Hip Arthroscopy
Authors: Freeman Katie L. , Nho Shane J. , Suppauksorn Sunikom , Chahla Jorge , Larson Christopher M.
Published: December 2020

There has been an increased emphasis on capsular management during hip arthroscopy in the literature in recent years. The capsule plays a significant role in the hip joint stability and studies have demonstrated that capsular closure can restore the biomechanics of the hip back to the native state. Capsular management also affects functional outcomes with capsular repair resulting in better clinical outcomes in some studies. Management of the capsule has evolved in recent years with more surgeons performing routine capsular closure. Management techniques and degree of capsular closure, however, can be quite variable between surgeons. This review will discuss hip capsular anatomy, the importance of the capsule in hip biomechanics, management of the capsule during arthroscopy, and functional outcomes as it relates to the various capsular closure techniques versus leaving the capsulotomy unrepaired.
Influence of the Elipse Intragastric Balloon on Obesity and Metabolic Profile
Authors: Ramai Daryl , Singh Jameel , Mohan Babu P. , Madedor Ogenetega , Brooks Olivia W. , Barakat Mohamed , Ofosu Andrew , Khan Shahab R. , Chandan Saurabh , Dhindsa Banreet , Dhaliwal Amaninder , Facciorusso Antonio , McDonough Stephanie , Adler Douglas G.
Published: December 2020

Background:

Intragastric balloons (IGBs) have been used to bridge the obesity treatment gap with the benefits of being minimally invasive but still required endoscopy. The Elipse IGB is a swallowable balloon that is spontaneously excreted at ∼16 weeks. However, studies are limited by small sample sizes. The authors aim to assess clinically relevant endpoints, namely weight loss outcomes, metabolic profile, balloon tolerability, and adverse events.

Methods:

A literature search was performed from several databases from inception to July 2020. The pooled means and proportions of our data were analyzed using a random effects model.

Results:

Seven studies involving 2152 patients met our eligibility criteria and were included. The mean baseline body mass index ranged from 32.1 to 38.6. The pooled mean difference (MD) in body mass index was 0.88 [confidence interval (CI): 0.58-1.18, I
2=98%]. Total body weight loss was 12% (CI: 10.1-14.3, I
2=94%) and excess body weight loss was 49.1% (CI: 30.6-67.5, I
2=97%). The MD in waist circumference was 0.89 (CI: 0.72-1.05, I
2=53%). MD in triglyceride level was 0.66 (CI: 0.21-1.1, I
2=96%). Pooled early deflation rate was 1.8% (CI: 0.6-5.1, I
2=74%). Our study also showed that the Elipse balloon was associated with less adverse events when compared with other IGBs.

Conclusions:

This meta-analysis demonstrates that the Elipse intragastric balloon is a safe, effective, and tolerable device for weight loss and obesity with a minimal side effect profile.
How might endotyping guide chronic obstructive pulmonary disease treatment? Current understanding, knowledge gaps and future research needs
Authors: Burkes Robert M. , Panos Ralph J. , Borchers Michael T.
Published: December 2020

Purpose of review

This review discusses emerging therapies directed at chronic obstructive pulmonary disease (COPD) endotypes and pathobiological processes that manifest as the disease.

Recent findings

Specific endotypes have been targeted in COPD. These include eosinophilic inflammation, overproduction of interleukin-17, chronic bronchitis and altered nature of mucous, and chronic infection. Therapies exactly directed at the cause of these endotypes or their resultant clinical findings have been assessed. Although some intermediate outcomes have seemed promising, there have been no findings that shift the paradigm of COPD therapy.

Basic and clinical scientists continue to define endotypes that may be directly addressed with therapeutics. As of the time of this up-to-date review, there is yet to be an endotype-directed therapy to demonstrate great clinical effect.
Impact of obesity on pulmonary function: current understanding and knowledge gaps
Authors: Hegewald Matthew J.
Published: December 2020

Purpose of review

Obesity is an increasing world-wide public health concern. Obesity both causes respiratory symptoms and contributes to many cardiorespiratory diseases. The effects of obesity on commonly used lung function tests are reviewed.

Recent findings

The effects of obesity on lung function are attributed both to mechanical factors and to complex metabolic effects that contribute to a pro-inflammatory state. The effects of obesity on lung function correlate with BMI and correlate even better when the distribution of excess adipose tissue is taken into account, with central obesity associated with more prominent abnormalities. Obesity is associated with marked decreases in expiratory reserve volume and functional residual capacity. Total lung capacity, residual volume, and spirometry are less affected by obesity and are generally within the normal range except with severe obesity. Obesity decreases total respiratory system compliance primarily because of decreased lung compliance, with only mild effects on chest wall compliance. Obesity is associated with impaired gas transfer with decreases in oxygenation and varied but usually mild effects on diffusing capacity for carbon monoxide, while the carbon monoxide transfer coefficient is often increased.

Obesity has significant effects on lung function. The relative contribution of the mechanical effects of obesity and the production of inflammatory cytokines by adipose tissue on lung function needs further study.
Obstructive lung diseases and allergic bronchopulmonary aspergillosis
Authors: Muthu Valliappan , Prasad Kuruswamy T. , Sehgal Inderpaul S. , Dhooria Sahajal , Aggarwal Ashutosh N. , Agarwal Ritesh
Published: December 2020

Purpose of review

Allergic bronchopulmonary aspergillosis (ABPA) is a disease frequently complicating asthma and cystic fibrosis. ABPA is increasingly recognized in other obstructive lung diseases (OLDs), including chronic obstructive pulmonary disease (COPD) and noncystic fibrosis bronchiectasis. Herein, we summarize the recent developments in ABPA complicating OLDs.

Recent findings

Recent research has described the clinical features and natural history of ABPA complicating asthma in children and the elderly. We have gained insights into the pathophysiology of ABPA, especially the role of eosinophil extracellular trap cell death and mucus plugs. The utility of recombinant fungal antigens in the diagnosis of ABPA has been established. Newer, more sensitive criteria for the diagnosis of ABPA have been proposed. Although ABPA is uncommon in COPD and noncystic fibrosis bronchiectasis, aspergillus sensitization is more common and is associated with a higher exacerbation rate.

Several advances have occurred in the diagnosis and treatment of ABPA in recent years. However, there is an unmet need for research into the genetic predisposition, pathophysiology, and treatment of ABPA. Apart from asthma and cystic fibrosis, patients with other OLDs also require evaluation for Aspergillus sensitization and ABPA.