bluuebunny/crossref_metadata_2025 huggingface dataset:
6-Hydroxydopamine disrupts cellular copper homeostasis in human neuroblastoma SH-SY5Y cells
Authors: Kondo Mao , Hara Hirokazu , Kamijo Fuka , Kamiya Tetsuro , Adachi Tetsuo
Published: June 2021

Copper (Cu) is an essential trace element that plays an important role in maintaining neuronal functions such as the biosynthesis of neurotransmitters. In contrast, exposure to excess Cu results in cell injury. Therefore, intracellular Cu levels are strictly regulated by proteins related to Cu-trafficking, including ATP7A. Parkinson's disease (PD) is a neurodegenerative disorder and is characterized by the loss of dopaminergic neurons in the substantia nigra. Recently, the abnormality of Cu homeostasis was demonstrated to be related to the pathogenesis of PD. However, the association between Cu dyshomeostasis and PD remains unclear. In this study, we examined the effects of 6-hydroxydopamine (6-OHDA), a neurotoxin used for the production of PD model animals, on cellular Cu trafficking in human neuroblastoma SH-SY5Y cells. 6-OHDA reduced the protein levels of the Cu exporter ATP7A and the Cu chaperone Atox1, but not CTR1, a Cu importer; however, it did not affect the expression of ATP7A and Atox1 mRNAs. The decreased levels of ATP7A and Atox1 proteins were restored by the antioxidant N-acetylcysteine and the lysosomal inhibitor bafilomycin A1. This suggests that 6-OHDA-induced oxidative stress facilitates the degradation of these proteins. In addition, the amount of intracellular Cu after exposure to CuCl2 was significantly higher in cells pretreated with 6-OHDA than in untreated cells. Moreover, 6-OHDA reduced the protein levels of the cuproenzyme dopamine β-hydroxylase that converts dopamine to noradrenaline. Thus, this study suggests that 6-OHDA disrupts Cu homeostasis through the dysregulation of cellular Cu trafficking, resulting in the dysfunction of neuronal cells.
Surgery of Insular Diffuse Gliomas—Part 1: Transcortical Awake Resection Is Safe and Independently Improves Overall Survival
Authors: Pallud Johan , Zanello Marc , Moiraghi Alessandro , Peeters Sophie , Trancart Bénédicte , Edjlali Myriam , Oppenheim Catherine , Varlet Pascale , Chrétien Fabrice , Dhermain Frédéric , Roux Alexandre , Dezamis Edouard
Published: June 2021

BACKGROUND

Insular diffuse glioma resection is at risk of vascular injury and of postoperative new neurocognitive deficits.

OBJECTIVE

To assess safety and efficacy of surgical management of insular diffuse gliomas.

METHODS

Observational, retrospective, single-institution cohort analysis (2005-2019) of 149 adult patients surgically treated for an insular diffuse glioma: transcortical awake resection with intraoperative functional mapping (awake resection subgroup, n = 61), transcortical asleep resection without functional mapping (asleep resection subgroup, n = 50), and stereotactic biopsy (biopsy subgroup, n = 38). All cases were histopathologically assessed according to the 2016 World Health Organization classification and cIMPACT-NOW update 3.

RESULTS

Following awake resection, 3/61 patients had permanent motor deficit, seizure control rates improved (89% vs 69% preoperatively, P = .034), and neurocognitive performance improved from 5% to 24% in tested domains, despite adjuvant oncological treatments. Resection rates were higher in the awake resection subgroup (median 94%) than in the asleep resection subgroup (median 46%; P < .001). There was more gross total resection (25% vs 12%) and less partial resection (34% vs 80%) in the awake resection subgroup than in the asleep resection subgroup (P < .001). Karnofsky Performance Status score <70 (adjusted hazard ratio [aHR] 2.74, P = .031), awake resection (aHR 0.21, P = .031), isocitrate dehydrogenase (IDH)-mutant grade 2 astrocytoma (aHR 5.17, P = .003), IDH-mutant grade 3 astrocytoma (aHR 6.11, P < .001), IDH-mutant grade 4 astrocytoma (aHR 13.36, P = .008), and IDH-wild-type glioblastoma (aHR 21.84, P < .001) were independent predictors of overall survival.

CONCLUSION

Awake surgery preserving the brain connectivity is safe, allows larger resections for insular diffuse gliomas than asleep resection, and positively impacts overall survival.
High rates of anticoagulant rodenticide exposure in California Barred Owls are associated with the wildland–urban interface
Authors: Hofstadter Daniel F , Kryshak Nicholas F , Gabriel Mourad W , Wood Connor M , Wengert Greta M , Dotters Brian P , Roberts Kevin N , Fountain Emily D , Kelly Kevin G , Keane John J , Whitmore Sheila A , Berigan William J , Peery M Zachariah
Published: June 2021

Pesticide use is pervasive and the exposure of non-target wildlife has been well documented over the past half-century. Among pesticides, anticoagulant rodenticides (AR) have emerged as a particularly important threat in forests of the western United States, with exposure and mortality reported for several species of conservation concern. To further quantify this threat, we collected specimens of Barred Owls (Strix varia) and Barred Owl x Spotted Owl hybrids from the Klamath and Cascade Mountains and Sierra Nevada in California, USA to use as indicator species for environmental contamination with AR and to infer exposure of closely related and ecologically similar Northern and California Spotted Owls (S. occidentalis caurina, and S. o. occidentalis, respectively). We tested 115 Barred Owl and 12 Barred Owl x Spotted Owl hybrid livers for 8 AR compounds and found high rates of exposure (62%) across our study area, and greater than previous studies in the Pacific Northwest. In addition, we sampled 7 ovaries from 7 females and 100% tested positive for AR. Female Barred Owls were more likely than males to be exposed (78% and 50%, respectively). Unlike previous studies, we found no clear link between illegal cannabis cultivation and AR exposure. However, Barred Owls sampled in proximity to the wildland–urban interface (WUI) were more likely to be exposed to AR. Though the exact source (e.g., cannabis cultivation or application around human dwellings) and location are unknown, the association of AR exposure with the WUI was supported from GPS data from Barred Owls, Northern and California Spotted Owls, and hybrids using the WUI for foraging. The high rate of AR exposure in Barred Owls and hybrids provides mounting evidence of an additional stressor that ARs may pose to Spotted Owls—including the first evidence for California Spotted Owls—and fauna native to western forest ecosystems.
Creditor Control of Corporate Acquisitions
Authors: Becher David A , Griffin Thomas P , Nini Greg
Published: June 2021

We examine the impact of creditor control rights on corporate acquisitions. Nearly 75$\%$ of loan agreements include restrictions that limit borrower acquisition decisions throughout the life of the contract. Following a financial covenant violation, creditors use their bargaining power to tighten these restrictions and limit acquisition activity, particularly deals expected to earn negative announcement returns. Firms that do announce an acquisition after violating a financial covenant earn 1.8$\%$ higher stock returns, on average, and do not pursue less risky deals. We conclude that creditors use contractual rights and the renegotiation process to limit value-destroying acquisitions driven by managerial agency problems.
Self-perceived sleep during the Maintenance of Wakefulness Test: how does it predict accidental risk in patients with sleep disorders?
Authors: Sagaspe Patricia , Micoulaud-Franchi Jean-Arthur , Bioulac Stéphanie , Taillard Jacques , Guichard Kelly , Bonhomme Emilien , Dauvilliers Yves , Bastien Célyne H , Philip Pierre
Published: June 2021

Study Objectives

To determine whether the feeling of having slept or not during the Maintenance of Wakefulness Test (MWT) is associated with the occurrence of self-reported sleep-related traffic near misses and accidents in patients with sleep disorders.

Methods

This study was conducted in patients hospitalized in a French sleep center to perform a 4 × 40 min MWT. Relationship between mean sleep latency on the MWT, feeling of having slept or not during MWT trials and sleep-related near misses and accidents reported during the past year was analyzed.

Results

One hundred and ninety-two patients suffering from OSAS, idiopathic hypersomnia, narcolepsy, restless leg syndrome or insufficient sleep syndrome were included. One hundred and sixty-five patients presented no or one misjudgment of feeling of having slept during MWT trials while 27 presented more than two misjudgments. Almost half of the latter (48.1%) reported a sleepiness-related traffic near miss or accident in the past year versus only one third (27.9%) for the former (p < 0.05). Multivariate logistic regression showed that patients with more than two misjudgments had a 2.52-fold (95% CI, 1.07–5.95, p < 0.05) increase in the risk of reporting a sleepiness-related near miss/accident.

Conclusions

Misjudgment in self-perceived sleep during the MWT is associated with the occurrence of self-reported sleepiness-related traffic near misses and accidents in the past year in patients suffering from sleep disorders. Asking about the perception of the occurrence of sleep during the MWT could be used to improve driving risk assessment in addition to sleep latencies.
Maintaining constants amongst variable factors: the challenge of equitable accounting in the property context
Authors: Chung Benny , Yeon Thomas
Published: June 2021

Cheung Lai Mui v Cheung Wai Shing and Ors is a recent Hong Kong Court of Final Appeal judgment which concerns a family feud over the ownership of properties. In this article, we will focus on the part of the judgment which concerns the issue of equitable accounting. Although this judgment did not break new legal ground, we believe that it has several important implications which warrant attention. We will first unpack and explain the judgment and supplement the discussions with the relevant legal principles and concepts. We will then discuss the judgment’s implications for cases involving equitable accounting and where courts are given the option to exercise wide, flexible discretionary powers.
Comparative Analysis of Cortical Auditory Evoked Potential in Cochlear Implant Users
Authors: Távora-Vieira Dayse , Mandruzzato Giacomo , Polak Marek , Truong Belinda , Stutley Alex
Published: June 2021

Objectives:

The primary goal of the study was to investigate electrical cortical auditory evoked potentials (eCAEPs) at maximum comfortable level (MCL) and 50% MCL on three cochlear implant (CI) electrodes and compare them with the acoustic CAEP (aCAEPs), in terms of the amplitude and latency of the P1–N1–P2 complex. This was achieved by comparing the eCAEP obtained with the method described and stimulating single electrodes, via the fitting software spanning the cochlear array and the aCAEP obtained using the HEARLab system at four speech tokens.

Design:

Twenty MED-EL (MED-EL Medical Electronics, Innsbruck, Austria) CI adult users were tested. CAEP recording with HEARLab System was performed with speech tokens /m/, /g/, /t/, and /s/ in free field, presented at 55 dB SPL. eCAEPs were recorded with an Evoked Potential device triggered from the MAX Programming Interface (MED-EL Medical Devices) with 70 msec electrical burst at 0.9 Hz at the apical (1), middle (6), and basal (10 or 11) CI electrode at their MCL and 50% MCL.

Results:

CAEP responses were recorded in 100% of the test subjects for the speech token /t/, 95% for the speech tokens /g/ and /s/, and 90% for the speech token /m/. For eCAEP recordings, in all subjects, it was possible to identify N1 and P2 peaks when stimulating the apical and middle electrodes. This incidence of detection decreased to an 85% chance of stimulation at 50% MCL on the same electrodes. A P1 peak was less evident for all electrodes. There was an overall increase in latency for stimulation at 50% MCL compared with MCL. There was a significant difference in the amplitude of adjacent peaks (P1–N1 and N1–P2) for 50% MCL compared with MCL. The mean of the maximum cross-correlation values were in the range of 0.63 to 0.68 for the four speech tokens. The distribution of the calculated time shift, where the maximum of the cross-correlation was found, was distributed between the speech tokens. The speech token /g/ had the highest number of valid cross-correlations, while the speech token /s/ had the lowest number.

Conclusions:

This study successfully compared aCAEP and eCAEP in CI users. Both acoustic and electrical P1–N1–P2 recordings obtained were clear and reliable, with good correlation. Latency increased with decreasing stimulation level, while amplitude decreased. eCAEP is potentially a better option to verify speech detection at the cortical level because it (1) uses direct stimulation and therefore creates less interference and delay of the sound processor and (2) creates more flexibility with the recording setup and stimulation setting. As such, eCAEP is an alternative method for CI optimization.
Coronavirus disease 2019: update on coronavirus disease 2019 outcomes and vaccine efficacy in patients with immune-mediated inflammatory disease
Authors: Sparks Jeffrey A. , Wallace Zachary S. , Robinson Philip C.
Published: June 2021

Purpose of review

Although the literature to date on COVID-19 outcomes in those with immune-mediated inflammatory disease has been largely reassuring there remain many unanswered questions. These include the impact of specific medications on outcomes and the antibody response after COVID-19 vaccination.

Recent findings

We summarized the current literature related to COVID-19 outcomes in immune-mediated inflammatory diseases in rheumatology, gastroenterology, dermatology, and neurology. Overall, we found either no difference or modest differences in risk for severe COVID-19 for people with immune-mediated diseases compared with the general population. When considering disease-specific factors, glucocorticoid use and underlying immune-mediated disease activity were generally associated with worse outcomes. Specific medications varied in associations: tumor necrosis factor inhibitors generally had lower odds for severe COVID-19 outcomes, whereas rituximab use generally had higher odds for severe outcomes. We also detailed the recent reports of antibody response to COVID-19 vaccination in people with immune-mediated inflammatory diseases.

Investigations of immune-mediated inflammatory diseases across several organ systems have offered important insight into the COVID-19 disease course. Overall, these studies have provided reassurance to patients and clinicians while also identifying groups who may be at higher risk for poor outcomes.
Are Orthopaedic Trauma Surgeons Adequately Compensated for Longer Procedures? An Analysis of Relative Value Units and Operative Times From the American College of Surgeons National Surgical Quality Improvement Program Database
Authors: Simcox Trevor , Becker Jacob , Kreinces Jason , Islam Shahidul , Grossman Mark , Gould Jason
Published: June 2021

Background:

The physician work relative value unit (wRVU) scale is the primary determinant of compensation. Operative time, technical skill, effort, and surgical complexity contribute to wRVU allocation. The aim of this study was to identify the relationship between these factors and reimbursement for trauma procedures.

Methods:

The National Surgical Quality Improvement Program database was queried for orthopaedic trauma procedures from 2016 to 2018. Physician wRVU data were obtained from the 2020 Centers for Medicare & Medicaid Services fee schedule. The primary outcome measured was mean wRVU per minute of operative time (wRVU/min). Wilcoxon rank sum test and quantile regression were used to determine the association between wRVU, operative time, complication rate, upper or lower extremity procedure, and wRVU/min.

Results:

Sixty-three current procedural terminology codes or 107,171 cases were queried. Median wRVU/min was significantly lower for longest 50% of procedures (0.119 vs. 0.160, P < 0.001) and higher for the top 50% with regard to complication rate (0.161 vs. 0.124, P < 0.001). Upper extremity procedures were reimbursed less than lower extremity (0.110 vs. 0.145, P < 0.001). Quintile regression showed that adjusted for complication rate, median wRVU/min decreased by 0.0005 (95% confidence interval: 0.0007–0.0003, R1 = 0.27, P < 0.001) for every additional minute of operative time.

Conclusions:

The 2020 wRVU scale does not allocate sufficient wRVUs to orthopaedic trauma procedures with longer mean operative time or to procedures performed on the upper extremity. There is a negative correlation between operative time and hourly reimbursement, equating to a decrease of $64.96/h per hour of operation.
New imaging modalities to distinguish rare uterine mesenchymal cancers from benign uterine lesions
Authors: Causa Andrieu Pamela , Woo Sungmin , Kim Tae-Hyung , Kertowidjojo Elizabeth , Hodgson Anjelica , Sun Simon
Published: June 2021

Purpose of review

Uterine sarcomas are rare and are often challenging to differentiate on imaging from benign mimics, such as leiomyoma. As functional MRI techniques have improved and new adjuncts, such as machine learning and texture analysis, are now being investigated, it is helpful to be aware of the current literature on imaging features that may sometimes allow for preoperative distinction.

Recent findings

MRI, with both conventional and functional imaging, is the modality of choice for evaluating uterine mesenchymal tumors, especially in differentiating uterine leiomyosarcoma from leiomyoma through validated diagnostic algorithms. MRI is sometimes helpful in differentiating high-grade stromal sarcoma from low-grade stromal sarcoma or differentiating endometrial stromal sarcoma from endometrial carcinoma. However, imaging remains nonspecific for evaluating rarer neoplasms, such as uterine tumor resembling ovarian sex cord tumor or perivascular epithelioid cell tumor, primarily because of the small number and power of relevant studies.

Through advances in MRI techniques and novel investigational imaging adjuncts, such as machine learning and texture analysis, imaging differentiation of malignant from benign uterine mesenchymal tumors has improved and could help reduce morbidity relating to misdiagnosis or diagnostic delays.
Nurses' Educational Needs Assessment for Hemodynamic Monitoring in Intensive Care Units
Authors: Jeshvaghani Tahereh Arabi , Mofrad Malahat Nikravan , Farahani Ziba Borzabadi , Nasiri Malihe
Published: June 2021

Introduction:

Hemodynamic monitoring is widely accepted as a cornerstone of intensive care units (ICUs). So, the main objective of this study was to evaluate the educational needs assessment of nurses for hemodynamic monitoring in ICUs.

Methods:

The present descriptive–analytical study was conducted to evaluate the educational needs assessment of ICU nurses in terms of the hemodynamic monitoring. The research sample included 100 ICU nurses selected from the hospitals affiliated to Shahid Beheshti University of Medical Sciences, Tehran. For data collection, researcher-made observational checklist and researcher-made questionnaire of clinical reasoning skills were used to assess the educational needs for hemodynamic monitoring.

Results:

The findings from the clinical practice checklists on hemodynamic monitoring revealed that nurses' practice was moderate in all 10 cases of monitoring with a mean of 79.30% (SD = 15.32%). Moreover, the nurses included were given a 9-item questionnaire regarding clinical reasoning skills. Accordingly, the results of this questionnaire indicated that nurses' clinical reasoning skills were at a poor level with a mean of 52.56% (SD = 8.71%).

Discussion:

The findings suggested that the development of continuing education programs in the area of clinical reasoning skills for hemodynamic monitoring should be more emphasized on. Also, nurses need to learn how to examine the patient carefully, find nursing diagnoses, set goals of care, and plan nursing interventions for their patients. They should also be able to assess how they affected the patient after performing the interventions. Furthermore, attention should be paid on improving practical skills for hemodynamic monitoring.
Effects of deprivation and age on staging of breast, colon, rectum and prostate cancer in Umbria region, Italy: a multilevel approach
Authors: Vercelli Marina , Lillini Roberto , Brunori Valerio , Bianconi Fortunato , Stracci Fabrizio
Published: June 2021

Background

Early diagnosis of breast, colon, rectum and prostate cancers improves health outcomes. Low socioeconomic status (SES) is related to advanced stages at diagnosis; inequalities could explain differences in outcomes by age. The influence of SES, age and residence area on staging was explored in the Umbrian population.

Methods

2001–2010 cases were geo-coded by census tract of residence. Stage distribution or Gleason score were analyzed by multilevel multinomial logistic regression with age and SES as the fixed effects and census tract as the random-effect.

Results

For breast and colorectal cancers, the screening age class was advantaged. For breast, age effect was modulated by deprivation and census tract. In the elderly, the richest were advantaged, the poorest disadvantaged; issues emerged for the young. For colon, age effect is modulated by census tract in early stages and deprivation in late stages. The elderly were disadvantaged; the young and the deprived had more stages IV. About rectum, age effect was modulated by deprivation in the late stages. The elderly were disadvantaged; the young and the deprived presented more stages IV. For prostate, age effect was modulated by deprivation and census tract. The intermediate age class was advantaged, the elderly disadvantaged.

Conclusion

Age was not always the determinant of a delayed staging when SES was considered. For breast and colorectal cancers, issues of delayed diagnosis emerged in the young. If the care center was near the residence, the census tract modified the stage at diagnosis. These results are useful to reduce SES barriers by specific programs adapted to the age of the patient and area of residence.
Feasibility of wearable activity trackers in cystectomy patients to monitor for postoperative complications
Authors: Slade Austen D. , Cardinal James R. , Martin Christopher R. , Presson Angela P. , Allen Chelsea D. , Lowrance William T. , Dechet Christopher B. , O’Neil Brock B.
Published: June 2021

Background:

To determine the feasibility of using wearables in patients undergoing radical cystectomy to monitor postoperative heart rate and activity and attempt to correlate these factors to complications and readmissions.

Materials and methods:

We conducted a prospective study of 20 patients undergoing radical cystectomy for bladder cancer between June 2017 and March 2018. Each patient was provided with a Garmin Vívofit heart rate (HR) activity tracker and instructed to wear it on their wrist for 30 days postoperatively. Heart rate, steps, and sleep data were collected during this time. Patients were called at 10-day intervals and surveyed for complications and device compliance. Univariable mixed effects logistic regression models were used to compare daily activity tracker measures with occurrence of an adverse event. Odds ratios, 95% confidence intervals, and p-values were reported.

Results:

Median age was 65 (interquartile range 61–74) years. Patients had usable data for a median of 59.3% (interquartile range 25–71.7%) of the time. Five patients experienced a postoperative event (1 readmission for sepsis from urinary tract source, 1 inpatient rapid response called for tachycardic event, 3 unscheduled visits related to dehydration), where event data was recorded over a total of 17 days. Higher step count was associated with reduced odds of an adverse event (odds ratio 0.31, 95% confidence interval 0.10–0.98 per 1000 steps, p = 0.047).

Conclusions:

Postoperative activity and heart rate monitoring in cystectomy patients is feasible though current wearables are not well suited for this task.
Scrotal base distance: A new key genital measurement in males with hypospadias and cryptorchidism
Authors: Abbas Tariq O. , Ali Mansour
Published: June 2021

Background:

Anogenital distance (AGD) in both humans and animals is a known reflection of fetal endocrine effect on genital virilization and the related abnormalities, including cryptorchidism and hypospadias. However, we introduce here and investigate scrotal base distance (SBD) as a sensitive genital anthropometric biomarker in human infants with cryptorchidism and hypospadias, which are considered early manifestations of testicular dysgenesis syndrome. We aim to assess SBD in patients with cryptorchidism or hypospadias against healthy subjects.

Material and methods:

Patients with hypospadias (n = 61, age 17.4 ± 6.3 months) or cryptorchidism (n = 51, age 11.4 ± 4.8 months) were enrolled for assessment of SBD, AGD, and penile length; and compared with a cohort of 102 full-term healthy boys for standard ritual circumcision by measuring age-specific standard deviation scores.

Results:

Patients having hypospadias had lower mean SBD, AGD, and penile length standard deviation scores than the control group (p < 0.01). These values in patients with cryptorchidism were longer than mean values in boys with hypospadias (p < 0.01) and shorter than mean values in the control group.

Conclusions:

We showed that SBD, AGD, and penile length were lower in patients with cryptorchidism or hypospadias compared to normative data measured from a control group of healthy boys for ritual circumcision. These results enforce the use of SBD as an objective anthropometric measurement and a viable biomarker to assess the effects of fetal endocrine imbalance on male external genitalia development.
Permission to prescribe: do cardiologists need permission to prescribe diabetes medications that afford cardiovascular benefit?
Authors: Sharma Abhinav , Aziz Haya , Verma Subodh , Abramson Beth L. , Choi Richard , Chua Grace L. , Connelly Kim A. , Honos George , Mancini G.B. John , Ramer Sarah A. , Swiggum Elizabeth , Teoh Hwee , Zieroth Shelley , Leiter Lawrence A.
Published: June 2021

Purpose of review

Antihyperglycemic therapies including sodium glucose contransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) have been demonstrated to confer significant cardiovascular benefit and reduce future events in patients with type 2 diabetes mellitus (T2DM). However, despite positive data from cardiovascular outcome trials, these therapies remain underutilized in a large proportion of patients who have clinical indications and meet coverage guidelines for their initiation. One of the causes of the observed gap between scientific evidence and clinical cardiology practice is therapeutic hesitancy (otherwise known as therapeutic inertia). The purpose of this review is to discuss the contributors to therapeutic hesitancy in the implementation of these evidence-based therapies and, more importantly, provide pragmatic solutions to address these barriers.

Recent findings

Recent studies have demonstrated that clinicians may not initiate cardiovascular protective therapies due to a reluctance to overstep perceived interdisciplinary boundaries, concerns about causing harm due to medication side effects, and a sense of unfamiliarity with the optimal choice of therapy amidst a rapidly evolving landscape of T2DM therapies.

Herein, we describe a multifaceted approach aimed at creating a ‘permission to prescribe’ culture, developing integrated multidisciplinary models of care, enhancing trainees’ experiences in cardiovascular disease prevention, and utilizing technology to motivate change. Taken together, these interventions should increase the implementation of evidence-based therapies and improve the quality of life and cardiovascular outcomes of individuals with T2DM.
Impact of social determinants of health on cardiovascular disease prevention
Authors: Mannoh Ivy , Hussien Merna , Commodore-Mensah Yvonne , Michos Erin D.
Published: June 2021

Purpose of review

Social determinants of health (SDOH) describe conditions in one's environment that have an impact on health, quality-of-life, outcomes, and risks. These include income, education, employment, culture, language, healthcare access, social support, race, ethnicity, structural racism, discrimination, social support, neighborhood characteristics, and others. SDOH manifest as persistent inequalities in cardiovascular risk factors and disease, and, therefore, contribute to cardiovascular disease (CVD)-related morbidity and mortality. This article reviews how SDOH affect CVD risk and the role they play in CVD prevention.

Recent findings

The 2019 American College of Cardiology/American Heart Association (AHA) guideline on the primary prevention of CVD recommends that clinicians evaluate SDOH on an individual basis to inform treatment decisions for CVD prevention efforts. Recent evidence shows that low socioeconomic status, adverse childhood experiences, less social support, reduced health literacy, and limited healthcare access are associated with higher CVD risk and poorer health outcomes. A 2020 AHA statement emphasized the role of structural racism as a fundamental driver of health disparities. The AHA 2030 Impact Goals state a desire to achieve health equity by identifying and removing barriers to healthcare access and quality.

SDOH affect CVD prevention efforts. The SDOH that affect cardiovascular risk factors, diseases, and outcomes are complex and intersect. Addressing them can be challenging and will require a multilevel and multidisciplinary approach, involving public health measures, changes in health systems, team-based care, and dismantling of structural racism. More studies are needed to investigate the effect of interventions that improve SDOH and prevent CVD or lower CVD risk.
Improving outcomes after low-risk coronary artery bypass grafting: understanding phase of care mortality analysis, failure to rescue and recent perioperative recommendations
Authors: Yan Weiang , Muller Moran Hellmuth R. , Zelentsov Ivan , Eikelboom Rachel , Lodewyks Carly , Strumpher Johann , Arora Rakesh C.
Published: June 2021

Purpose of review

Avoidable adverse events are responsible for up to 50% of deaths after low-risk coronary artery bypass grafting. This article reviews recent quality improvement efforts to improve outcomes after cardiac surgery.

Recent findings

Systematic quality improvement methodology in cardiac surgery has improved significantly over the past decade. Contemporary efforts with phase of care mortality analysis (POCMA) focus on identifying and addressing root causes for mortality. Each patient's perioperative course is an interconnected sequence of clinical events, decisions, interventions, and treatment responses occurring across five perioperative phases. A single seminal event within a specific phase of care has been found to often trigger the eventual death of a patient. Several groups have made significant improvements to perioperative outcomes by addressing these avoidable mortality trigger events. Failing that, failure to rescue (FTR) metrics can be used to identify institutional factors responsible for poor perioperative outcomes. This ongoing focus on quality improvement serves to further improve outcomes after low-risk cardiac surgery.

Modern quality improvement methodology, including POCMA and FTR analysis, has the potential to significantly improve outcomes after cardiac surgery. Larger future studies with multiinstitutional data sharing will be key to facilitate ongoing quality improvement and knowledge translation in this field.
Surgical treatment of severe tricuspid regurgitation
Authors: von Ballmoos Moritz C. Wyler , Reardon Michael J.
Published: June 2021

Purpose of review

Severe tricuspid regurgitation is associated with both significant symptoms as well as decreased survival. Surgical correction is possible in most cases but is markedly under used in this population. The purpose of this manuscript is to review the indications for treating severe tricuspid regurgitation and the surgical options available.

Recent findings

Surgical correction of isolated severe tricuspid regurgitation has been associated with a high mortality in the surgical literature. This occurs generally from right heart failure associated with the late referral of isolated tricuspid regurgitation for correction. Recent outcomes are improving and tricuspid repair appears to be where mitral valve repair was 30 years ago.

Severe tricuspid regurgitation is associated with severe symptoms as well as decreased survival. Tricuspid valve repair (TVr) for severe regurgitation is almost always technically possible. The high mortality thought to be associated with isolated TVr is likely due to late referral when right heart failure is already far advanced. Consideration for earlier referral for isolated severe tricuspid regurgitation should be considered.
CLINICAL FEATURES, DIAGNOSTIC SIGNIFICANCE, AND PROGNOSIS OF VITREORETINAL LYMPHOMA IN YOUNG PATIENTS
Authors: Liu Shixue , Gu Junxiang , Zhang Ting , Ping Bo , Zhou Min , Huang Xin , Jiang Rui , Xu Gezhi , Chang Qing
Published: June 2021

Purpose:

To investigate the clinical features, diagnostic approaches, and outcomes of young patients with vitreoretinal lymphoma.

Methods:

Fifty-one vitreoretinal lymphoma patients (97 eyes) referred to the Eye and ENT Hospital of the Fudan University from 2011 to 2020 were grouped based on their onset age (age ≤50 years and age >50 years). Complete eye examinations, evaluation of systemic conditions, and biological analysis of intraocular fluids were performed.

Results:

Young patients accounted for 31.4% (n = 16) of the cohort. More eyes had retinal/subretinal pigment epithelial infiltration (20 [64.5%] vs. 23 [34.8%]; P = 0.018) in young patients than in elderly ones. The mutation rate of Myeloid Differentiation Factor 88 gene (MYD88) was significantly lower in young patients than in elderly ones (5 [50%] vs. 21 [91.3%]; P = 0.016). The median time to new onset of central nervous system lymphoma was significantly shorter in young patients (11.7 vs. 36.2 months; P = 0.012). However, mean overall survival did not differ between the 2 groups (64.9 vs. 57.5 months; P = 0.871).

Conclusion:

Early diagnosis and central nervous system evaluation are crucial for young vitreoretinal lymphoma patients with rapid central nervous system involvement. Meanwhile, young vitreoretinal lymphoma patients have some unique features, including more retinal/subretinal pigment epithelial infiltrations and lower MYD88 mutation rates.
Filaggrin Expression in the Lid Margin During Contact Lens Wear
Authors: Alghamdi Waleed M. , Markoulli Maria , Papas Eric B.
Published: June 2021

Aim:

To investigate the expression of the keratinization-related protein, filaggrin, in the lid margin epithelium of contact lens (CL) wearers compared with nonwearers.

Methods:

This was a cross-sectional study of 100 individuals with different exposures to CL wear: short, moderate, and long experience; previous CL wearers; and nonwearers as controls. Impression cytology samples were collected from the lid wiper (LW) area of the central upper lid margin. After fixing, an equal, random sample was selected from each group (n=13) for immunocytochemistry analysis using antihuman primary anybody (mouse filaggrin), then stained with secondary antibody (fluorescein isothiocyanate–conjugated donkey anti-mouse immunoglobulin G horseradish peroxidase) to detect filaggrin. Imaging was performed with the 3i-Vivo 2-photon microscope equipped with a Zeiss 20×-objective and SlideBook-reader software.

Results:

Sixty-five samples from 65 participants (37 women; mean age±SD: 25.1±4.1 years) were collected. Filaggrin was detected in all 65 randomly selected immunostained marginal epithelium samples. All samples were similar in showing patchy areas of filaggrin immunostaining, regardless of CL wear, symptoms or epithelium morphology. Because the filaggrin immunostaining showed similar patterns across almost all the observed samples, comparison between subject groups was impractical. The presence of filaggrin in the healthy LW was additionally confirmed by an independent laboratory.

Conclusion:

Filaggrin expression seems to be a normal part of epithelial cell differentiation in the lid margin and may not be a useful keratinization/stress biomarker in the marginal epithelium. Investigating other keratinization biomarkers that are not detected in the normal mucocutaneous junction/LW may help to understand the keratinization nature of LW epithelium changes in CL wearers.
Increased Endothelial Cell Density in Childhood Patients With Thalassemia Major
Authors: Seyyar Sevim Ayca , Tıskaoğlu Nesime Setge , Gürbostan Gizem , Pekpak Esra , Sayglı Oguzhan
Published: June 2021

Purpose:

We aimed to compare specular microscopy, biometric, refractive, and anterior segment topographic parameters in children with thalassemia major (TM) with normal children of the same age.

Material Method:

This cross-sectional study included 55 eyes of 55 patients with TM and 63 eyes of 63 age–sex-matched healthy children; all patients with TM were receiving treatment with blood transfusions every 3 to 4 weeks and an oral iron chelator deferasirox (DFX) (ICL670) tablet. A comprehensive ophthalmic examination was performed, including refraction (spherical equivalent), best-corrected visual acuity, slit-lamp bio microscopy, specular examination, optical biometry, intraocular pressure, anterior segment topography, and fundus examination.

Results:

Endothelial cell density (ECD) was 3,138 in the TM group and 2,996 in the control group (P=0.003). The mean central corneal thickness was significantly thinner in the TM group (P=0.010). Flat keratometry (K1) was 43.5 D in the study group and 42.9 D in the control group (P=0.039). The mean anterior chamber depth (ACD) was shallower in the TM group (P=0.004); axial length (AL) was significantly shorter in the TM group (P=0.002).

Conclusion:

This study shows that there are differences in ECD, AL, keratometry values, ACD, and anterior segment parameters of pediatric patients with TM compared with healthy controls.
Cationic Surfactant–Natural Clay Complex as a Novel Agent Against Acanthamoeba castellanii Belonging to the T4 Genotype
Authors: Akbar Noor , Siddiqui Ruqaiyyah , Khamis Mustafa , Ibrahim Taleb , Khan Naveed Ahmed
Published: June 2021

Background:

Acanthamoeba is a protozoan pathogen that is widely distributed in the environment. Given the opportunity, it can cause a serious eye infection known as Acanthamoeba keratitis as well as a fatal brain infection known as granulomatous amoebic encephalitis. Inappropriate use of contact lenses can contribute to contracting Acanthamoeba keratitis, and contact lens disinfectants are not always effective in eradicating Acanthamoeba. Therefore, there is a need to develop novel antimicrobial agents with efficient antiamoebic properties.

Objective:

In this study, we tested octadecyltrimethylammonium (ODTMA)-clay (montmorillonite) complex as a novel antiamoebic agent.

Methods:

Using A. castellanii belonging to the T4 genotype of keratitis origin, amobicidal assays were performed to determine the effects of ODTMA-cay complex on the viability of parasites at various concentrations ranging from 10 to 100 μg. Adhesion and cytopathogenicity assays were performed to investigate ODTMA effects on A. castellanii–mediated binding and damage to human cells. Encystation and excystation assays were conducted to establish ODTMA-mediated inhibitory effects against the cyst stage of A. castellanii.

Results:

Using cell survival assays, the results revealed that ODTMA–clay complex exhibited amobicidal activity against keratitis-causing A. castellanii in a dose-dependent manner. Pretreatment of A. castellanii with ODTMA–clay complex inhibited parasite adhesion to as well as parasite-mediated human cell damage. Using encystation and excystation assays, it was revealed that ODTMA–clay complex inhibited A. castellanii cysts at 100 μg (P<0.05).

Conclusion:

To the best of our knowledge, for the first time, it was shown that ODTMA–clay complex exhibited anti-Acanthamoebic activities. The possibility of adding ODTMA–clay in a contact lens cleaning solution to formulate effective disinfectants is discussed further.
Worries About COVID-19 Infection and Psychological Distress at Work and While Commuting
Authors: Uehara Masamichi , Ishimaru Tomohiro , Ando Hajime , Tateishi Seiichiro , Eguchi Hisashi , Tsuji Mayumi , Mori Koji , Matsuda Shinya , Fujino Yoshihisa
Published: June 2021

Objective:

This study examined the relationship between worry about COVID-19 infection in the workplace and while commuting to work and psychological distress in Japan.

Methods:

An internet monitor study was conducted. Out of a total of 33,302 participants, 26,841 people were included. The subjects were asked single-item questions about whether they were worried about COVID-19 infection in general, at work and while commuting to work. K6 was used to assess psychological distress.

Results:

The OR was significantly higher in association with worry about infection in the workplace at 1.71 (95%CI 1.53 to 1.92) and worry about infection while commuting at 1.49 (95%CI 1.32 to 1.67).

Conclusions:

This study suggests the need for psychological intervention to reduce worry about infection in response to public mental health challenges associated with the COVID-19 pandemic.
A narrative review on endopancreatic interventions: an innovative access to the pancreas
Authors: Frey Michael C. , Eigl Benjamin , Steinemann Daniel C. , Hackert Thilo , Rössler Fabian , Nickel Felix , Müller-Stich Beat P. , Z’graggen Kaspar , Müller Philip C.
Published: June 2021

The natural connection between the duodenum and the pancreatic duct enables a minimally invasive access to the pancreas. Endoscopically this access is already regularly used, mainly for diagnostic and even for certain therapeutic purposes. With per-oral pancreatoscopy the endopancreatic approach allows the direct visualization of the pancreatic duct system potentially improving the diagnostic work-up of pancreatic cystic neoplasms, intrapancreatic strictures and removal of pancreatic duct stones. However, the endopancreatic access can equally be applied for surgical interventions. The objective of this review is to summarize endoscopic and surgical interventions using the endopancreatic access. Endopancreatic surgery stands for a further development of the endoscopic technique: a rigid endoscope is transabdominally introduced over the duodenum and the papilla to enable resections of strictures and inflamed tissue from inside the pancreas under visual control. While the orientation and localization of target structures using this minimally invasive approach is difficult, the development of an accurate image guidance system will play a key role for the clinical implementation and widespread use of endoscopic and surgical endopancreatic interventions.
Association Between Fear of Pain and Sports-Related Concussion Recovery in a Pediatric Population
Authors: Arnold Jennifer T. , Franklin Elizabeth V. , Baker Zachary G. , Abowd Marian , Santana Jonathan A.
Published: June 2021

Objective:

To determine whether an association exists between fear of pain and recovery time from sports-related concussion in a pediatric population.

Design:

Prospective observational study.

Setting:

Primary outpatient sports medicine clinic of a large pediatric hospital.

Patients:

One hundred twenty-eight pediatric patients aged 8 to 18 years who presented to clinic with a primary diagnosis of concussion from September 2018 to March 2020. Inclusion criteria included presentation within 2 weeks of injury and symptomatic on initial visit. Patients who sustained a concussion because of motor vehicle collisions or assault were excluded.

Independent Variables:

There was no intervention. Study participants who met inclusion criteria were administered the Fear of Pain Questionnaire (FOPQ) at their initial visit.

Main Outcome Measures:

Time to clinical recovery was the main outcome measure and was determined by the fellowship-trained sports medicine physician based on resolution of concussion symptoms, resumption of normal physical and cognitive daily activities, no use of accommodations or medications, and normalization of physical exam.

Results:

There was a significant difference in FOPQ scores for those with prolonged recovery (M = 33.12, SD = 18.36) compared with those recovering in fewer than 28 days (M = 26.16, SD = 18.44; t [126] = −2.18, P = 0.036).

Conclusions:

Consistent with the adult literature, we found that pediatric patients are more likely to have a prolonged recovery from concussion when they have higher fear of pain.
Pediatric Revision Anterior Cruciate Ligament Reconstruction: Current Concepts Review
Authors: Malige Ajith , Leska Tomasina , Baghdadi Soroush , Ganley Theodore
Published: June 2021

Objective:

We present a review of revision anterior cruciate ligament (ACL) reconstruction in pediatric patients, discussing risk factors for rerupture, physical examination and imaging, treatment principles and surgical techniques, postoperative rehabilitation, and clinical outcomes.

Data Sources:

PubMed, Cochrane, and Embase databases were queried for relevant articles about revision ACL topics. All types of manuscripts, including clinical studies, basic science studies, case series, current concepts reviews, and systematic reviews were analyzed for relevant information. Current concepts on risk factors for rerupture, physical examination and imaging, treatment principles and surgical techniques, postoperative rehabilitation, and clinical outcomes were synthesized.

Main Results:

Surgical treatment should be individualized, and the graft type, fixation devices, tunnel placement, and complementary procedures (eg, extra-articular tenodesis) should be tailored to the patient's needs and previous surgeries. Rehabilitation programs should also be centered around eccentric strengthening, isometric quadriceps strengthening, active flexion range of motion of the knee, and an emphasis on closed chain exercises. Despite adherence to strict surgical and postoperative rehabilitation principles, graft refailure rate is high, and return to sports rate is low.

Conclusion:

Rerupture of the ACL in the pediatric population is a challenging complication that requires special attention. Diagnostic evaluation of repeat ACL ruptures is similar to primary injuries. Although outcomes after revision ACL reconstruction are expectedly worse than after primary reconstruction, athletes do return to sport after proper rehabilitation. Further research is needed to continue to improve outcomes in this high-risk population, aimed at continued knee stability, graft survivorship, and improved quality of life.
Effect of Intradialytic Aerobic Exercise on Relative Blood Volume in Patients Undergoing Maintenance Hemodialysis
Authors: Yabe Hiroki , Kono Kenichi , Wakayama Koji , Hanafusa Norio , Tsuchiya Ken
Published: June 2021

The purpose of this study was to investigate changes in the relative blood volume because of intradialytic exercise. Twenty patients undergoing hemodialysis (HD) were assigned randomly to exercise or control sessions as a first test by simple randomization. All participants were crossed over and participated in both tests. In the exercise test, each patient underwent 30 minutes of exercise using a cycle ergometer from the initiation of HD. The control session consisted of routine HD without exercise. The blood volume (ΔBV) reduction in both types of sessions was calculated from the area under the curve of the ΔBV (ΔBVAUC) from the initiation of HD to the end of exercise (During Ex), from the end of exercise to the end of HD (Post Ex), and during the entire HD session (Whole HD). The ΔBVAUC of Post Ex in the exercise test (44.9 ± 14.3%h) was significantly smaller than that in the control test (50.3 ± 14.3%h) (p < 0.05), although other parameters such as ΔBVAUC either in the entire HD session or during exercise training did not differ significantly between two groups. This result suggests that intradialytic exercise at the beginning of the HD sessions may be altered the ΔBV in the latter part of the session.