bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral mite anaphylaxis: who, when, and how?
Authors: Sánchez-Borges Mario , Capriles-Hulett Arnaldo , Fernandez-Caldas Enrique
Published: January 2020

Purpose of review

To present an update on the recent advances in the understanding of the mechanisms and practical management of oral mite anaphylaxis (OMA, pancake syndrome).

Recent findings

Among novel observations regarding OMA, this review highlights the increased prevalence of aspirin/NSAID hypersensitivity inpatients affected by OMA, the association of OMA with exercise-induced anaphylaxis, the presentation of OMA simulating acute asthma, the occurrence of OMA in childhood, the high severity and lethal potential of OMA, the contamination of other foods, such as oat and corn flour with mites, and the simultaneous induction of OMA symptoms in more than one individual exposed to the same food source.

OMA is a severe, potentially lethal, acute allergic condition that should be suspected whenever symptoms begin soon after the intake of mite-contaminated foods. Physician awareness on this clinical picture is of paramount importance to establish a correct diagnosis and to implement adequate preventive measures to help patients at risk to avoid its occurrence.
Investigating the Effect of Perioperative Chlorzoxazone on Acute Postoperative Pain After Total Hip and Knee Replacement Surgery
Authors: Skrejborg Peter , Petersen Kristian K. , Beck Jacob , Ulrich Michael , Simonsen Ole , Nielsen Poul T. , Arendt-Nielsen Lars , Laursen Mogens
Published: January 2020

Background and Aims:

Severe preoperative and acute postoperative pain have been associated with the development of chronic postoperative pain. Chlorzoxazone (a muscle relaxant) has been suggested to enhance acute postoperative pain recovery, but the lack of larger randomized controlled trials has, however, questioned the continued use. Despite this, chlorzoxazone is still used for acute postoperative pain management following total knee replacement (TKR) or total hip replacement (THR). The current randomized, double-blinded, placebo-controlled, parallel-group, clinical trial aimed to assess the effect of chlorzoxazone for postoperative pain management following TKR or THR.

Methods:

A total of 393 patients scheduled for TKR or THR were included in the trial. Patients were assigned to 250 mg chlorzoxazone 3 times daily for the first 7 days postoperatively or to placebo. The primary outcome was pain after 5 m walk assessed 24 hours postoperatively. Secondary outcomes included changes in preoperative pain at rest, worst pain in the last 24 hours, and Oxford Knee or Hip Score compared with 12 months’ follow-up. In addition, adverse events were assessed in the perioperative period.

Results:

No significant differences were found for any of the outcome parameters after TKR or THR. As regards TKR or THR, no effects were demonstrated for pain after 5 m walk 24 hours after surgery (P>0.313), or for any of the secondary outcomes (P>0.288) or adverse events (P>0.112) in the group receiving chlorzoxazone compared with placebo.

Conclusion:

The current study demonstrated no analgesic effects of postoperative chlorzoxazone administration compared with placebo on acute or chronic postoperative pain 12 months following TKR and THR.
Assessment of Somatosensory and Psychosocial Function of Patients With Trigeminal Nerve Damage
Authors: Pillai Rajath S. , Pigg Maria , List Thomas , Karlsson Pall , Mladenović Živko , Vase Lene , Nørholt Sven E. , Pedersen Thomas K. , Bengtsson Martin , Costa Yuri M. , Svensson Peter , Baad-Hansen Lene
Published: January 2020

Objective:

The present study assessed somatosensory changes related to trigeminal nerve damage using extensive evaluation tools and assessed the effect of such damage on the patients’ psychosocial status and quality of life compared with healthy participants.

Methods:

In 37 patients with intraorally or extraorally presenting trigeminal nerve damage diagnosed as painful or nonpainful posttraumatic trigeminal neuropathy, psychophysical tests like quantitative sensory testing (QST) and qualitative sensory testing and the electrophysiological “nociceptive-specific” blink reflex were performed. The patients and 20 healthy participants completed a set of questionnaires assessing their psychosocial status and quality of life.

Results:

A loss or gain of somatosensory function was seen in at least 1 QST parameter in >88.9% of the patients. Patients in whom extraoral QST was performed showed an overall loss of somatosensory function, whereas intraoral QST showed a general gain of somatosensory function. Qualitative sensory testing identified a side-to-side difference in the tactile and pinprick stimulation in >77% of the patients. An abnormal “nociceptive-specific” blink reflex response was seen in 42.1% to 71.4% of patients dependent on the trigeminal branch stimulated, though comparisons with healthy reference values showed ambiguous results. Compared with the healthy participants, patients showed higher scores for pain catastrophizing, symptoms of depression and anxiety, limited jaw function, more somatic symptoms, and significantly impaired oral health-related quality of life (all P<0.038).

Discussion:

The results from the present study showed presence of varied somatosensory abnormalities when assessed using psychophysical and electrophysiological investigations and a significantly impaired psychosocial status.
A Systematic Review of Clinical Practice Guidelines for Acute Procedural Pain on Neonates
Authors: Balice-Bourgois Colette , Zumstein-Shaha Maya , Vanoni Federica , Jaques Cécile , Newman Christopher J. , Simonetti Giacomo D.
Published: January 2020

Objectives:

During hospitalization in neonatal intensive care units, neonates are exposed to many painful procedures within a stressful environment. To date, many evidence-based guidelines are available. However, the quality of these guidelines and their clinical application remain unclear. This systematic review aimed to determinie the quality of existing guidelines on the management of procedural pain in neonates and to summarize the recommendations provided by these guidelines.

Materials and Methods:

A structured search was conducted in Embase, PubMed, CINAHL, JBI database, and gray literature resources in November 2018 to identify relevant guidelines published from 2007 onward. Published guidelines and guidelines from complementary searches were included in the treating assessment or management of procedural pain in neonates. The methodological quality was analyzed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument.

Results:

A total of 1154 records were identified. After screening for eligibility, 17 guidelines were included in this review. Among these, 11 were identified to be high-quality guidelines. Besides the usual recommendations for pharmacological and nonpharmacological treatments, the inclusion of parents, improving interprofessional collaboration, and considering the setting were identified as important elements.

Discussion:

The results of this review show that there is a need to improve the methodological quality of guidelines for procedural pain in newborns. The set of recommendations for procedural pain prevention needs to involve not only pharmacological and nonpharmacological pain treatment but also parents and interprofessional collaboration. It is also essential to take into account facilitators, barriers, and the context to improve pain management.
Saline versus Lactated Ringer’s Solution
Authors: Maheshwari Kamal , Turan Alparslan , Makarova Natalya , Ma Chao , Esa Wael Ali Sakr , Ruetzler Kurt , Barsoum Sabri , Kuhel Alan G. , Ritchey Michael R. , Higuera-Rueda Carlos , Kopyeva Tatyana , Stocchi Luca , Essber Hani , Cohen Barak , Suleiman Iman , Bajracharya Gausan R. , Chelnick David , Mascha Edward J. , Kurz Andrea , Sessler Daniel I.
Published: January 2020

Background

Both saline and lactated Ringer’s solutions are commonly given to surgical patients. However, hyperchloremic acidosis consequent to saline administration may provoke complications. The authors therefore tested the primary hypothesis that a composite of in-hospital mortality and major postoperative complications is less common in patients given lactated Ringer’s solution than normal saline.

Methods

The authors conducted an alternating cohort controlled trial in which adults having colorectal and orthopedic surgery were given either lactated Ringer’s solution or normal saline in 2-week blocks between September 2015 and August 2018. The primary outcome was a composite of in-hospital mortality and major postoperative renal, respiratory, infectious, and hemorrhagic complications. The secondary outcome was postoperative acute kidney injury.

Results

Among 8,616 qualifying patients, 4,187 (49%) were assigned to lactated Ringer’s solution, and 4,429 (51%) were assigned to saline. Each group received a median 1.9 l of fluid. The primary composite of major complications was observed in 5.8% of lactated Ringer’s versus 6.1% of normal saline patients, with estimated average relative risk across the components of the composite of 1.16 (95% CI, 0.89 to 1.52; P = 0.261). The secondary outcome, postoperative acute kidney injury, Acute Kidney Injury Network stage I–III versus 0, occurred in 6.6% of lactated Ringer’s patients versus 6.2% of normal saline patients, with an estimated relative risk of 1.18 (99.3% CI, 0.99 to 1.41; P = 0.009, significance criterion of 0.007). Absolute differences between the treatment groups for each outcome were less than 0.5%, an amount that is not clinically meaningful.

Conclusions

In elective orthopedic and colorectal surgery patients, there was no clinically meaningful difference in postoperative complications with lactated Ringer’s or saline volume replacement. Clinicians can reasonably use either solution intraoperatively.

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Association of platelet to lymphocyte ratio with in-hospital major adverse cardiovascular events and the severity of coronary artery disease assessed by the Gensini score in patients with acute myocardial infarction
Authors: Li Xue-Ting , Fang Hao , Li Dong , Xu Feng-Qiang , Yang Bin , Zhang Rui , An Yi
Published: January 2020

Background:

The platelet to lymphocyte ratio (PLR) has recently emerged as a potential inflammatory biomarker and has been shown to be significantly associated with atherosclerotic coronary artery disease (CAD). Therefore, we aimed to explore the association of PLR with in-hospital major adverse cardiovascular events (MACEs) and the severity of CAD assessed by the Gensini score (GS) in patients with acute myocardial infarction (AMI) undergoing coronary angiography.

Methods:

A total of 502 patients with AMI consecutively treated at the Affiliated Hospital of Qingdao University (Qingdao, China) and underwent coronary angiography from August 2017 to December 2018 were recruited in this study. The demographic, clinical, angiographic characteristics, and laboratory parameters were collected. According to the presence of in-hospital MACEs, the included patients were divided into the MACE group (n = 81) and the non-MACE group (n = 421). Further, according to tertiles of the GS, the patients were classified into three groups: the low GS group (GS ≤ 32 points, n = 173), medium GS group (32 points < GS ≤ 60 points, n = 169), and high GS group (60 points < GS ≤ 180 points, n = 160). The main statistical methods included Chi-squared test, non-parametric Mann-Whitney U test, Kruskal-Wallis H test, logistic regression, and receiver operating characteristic curves.

Results:

The PLR in the MACE group was significantly higher than that in the non-MACE group (179.43 [132.84, 239.74] vs. 116.11 [87.98, 145.45], Z = –8.109, P < 0.001). Further, there were significant differences in PLR among the tertiles of GS (110.05 [84.57, 139.06] vs. 119.78 [98.44, 157.98] vs. 140.00 [102.27, 191.83], H = 19.524, P < 0.001). PLR was demonstrated to be an independent risk factor of in-hospital MACEs (odds ratio [OR]: 1.012, 95% confidential interval [CI]: 1.006–1.018, P < 0.001) and severe CAD assessed by the GS (OR: 1.004, 95% CI: 1.002–1.009, P = 0.042). The cutoff value of PLR for predicting the development of in-hospital MACEs was 151.28 with a sensitivity of 66.7% and a specificity of 78.1% (area under the curve [AUC]: 0.786, 95% CI: 0.730–0.842, P < 0.001), and a PLR of 139.31 was also identified to be an effective cutoff point for detecting a high GS (>60 points) with a sensitivity of 49.4% and a specificity of 69.6% (AUC: 0.611, 95% CI: 0.556–0.666, P < 0.001).

Conclusions:

PLR as a novel inflammatory marker is significantly and independently associated with the occurrence of in-hospital MACEs and the severity of CAD assessed by the GS in patients with AMI. As an easily available and inexpensive inflammatory indicator, PLR could be widely used as an efficient inflammatory biomarker for identifying high-risk patients and for individualizing targeted therapy to improve the prognosis of AMI.
Adverse Events of Injectable Deoxycholic Acid
Authors: Pham Christine T. , Lee Alfred , Sung Calvin T. , Choi Franchesca , Juhasz Margit , Mesinkovska Natasha A.
Published: January 2020

BACKGROUND

Injectable deoxycholic acid (DCA) may be used to remove excess submental fat and off-label for local adipose reduction. Despite DCA's widespread use, rare incidences of severe, systemic, long-term adverse events (AEs) have been reported.

OBJECTIVE

To evaluate the potential side effects associated with injectable DCA.

METHODS AND MATERIALS

A systematic review was conducted using PubMed, Cochrane, CINAHL, and Web of Science using PRISMA guidelines to gather the literature relating to DCA or deoxycholate-associated AEs and their management.

RESULTS

Twenty-eight manuscripts were included after full article review. Most commonly, patients experienced mild localized AEs, whereas a small number of patients experienced severe pain, alopecia, nasopharyngitis, dysphagia, dizziness/lightheadedness, and gastrointestinal upset. Severe, long-term AEs were reported as rare in the evaluated literature. Deoxycholic acid injections in large volumes were more likely to cause severe adverse effects.

CONCLUSION

Self-resolving, mild side effects and severe but rare adverse effects have been reported with DCA use making it a safe treatment for local adipose reduction. Further studies are necessary to determine its safety profile, especially when using DCA in off-label areas.
From Open to Robotic-assisted Latissimus Dorsi Muscle Flap Harvest
Authors: Fouarge Alessandro , Cuylits Nicolas
Published: January 2020

Background:

The latissimus dorsi muscle is the largest muscle in the body. The classic open flap harvest technique of this muscle results in a long posterolateral thoracic vertical oblique incision that can leave an unappealing scar. The minimally invasive robotic approach has the potential to reduce scar length and to overcome technical limitations of endoscopic techniques.

Methods:

Six robotically assisted latissimus dorsi muscle flaps were harvested by a single surgeon. One was used as reversed turnover pedicled flap based on lumbar perforators for lumbosacral bone coverage, another flap was transposed for a Poland syndrome anterior axillary line reconstruction, and the remaining 4 were dissected as free flaps for upper and lower limb reconstruction. All 6 procedures used a short 5-cm axillary crease incision along the posterior axillary fold and two 8-mm port incisions for robotic access.

Results:

The first robotic flap harvest was converted to the classic open technique due to malposition of the 2 lower port incisions too close to the latissimus dorsi anterior border. The 5 other flaps were successfully transferred without flap or donor site complications. The average flap dissection time was 110 minutes; latter surgeries took less time than the early surgeries as the surgeon became more familiar with the robotic system and due to the use of a newer system.

Conclusion:

Robotic-assisted latissimus dorsi muscle flap harvest is a safe, reproducible, and effective tool that offers precise dissection control and that leaves a minimal thoracic scar.
Are Prophylactic Postoperative Antibiotics Necessary after Masculinizing Mastectomy with Free Nipple Graft? A Single-institution Retrospective Review
Authors: Ganor Oren , Cuccolo Nicholas G. , Jolly Divya , Boskey Elizabeth R.
Published: January 2020

Antibiotic overuse, particularly in the postoperative period, has contributed substantially to increased rates of antibiotic resistance. Despite insufficient evidence to support prolonged prophylactic antibiotics following the majority of plastic surgery operations, and societal recommendations against the practice, many surgeons continue to perpetuate this cycle. Regarding “newer” operations, wherein minimal data pertaining to antibiotic use have been published, decision-making is often based on historical tradition. As such, continued communication of relevant data is essential to inform best practice guidelines. The aim of this case series was to report postoperative outcomes following chest masculinization with free nipple grafts performed according to a strict antibiotic protocol, which restricted prophylaxis to a single preoperative dose, in the absence of specific risk factors indicating a need for postoperative antibiotics. In this case series featuring 62 consecutive patients undergoing chest reconstruction with 124 free nipple grafts, there were no nipple losses or nipple graft infection events.
Easy-to-use tool for evaluating the elevated acute kidney injury risk against reduced cardiovascular disease risk during intensive blood pressure control
Authors: Venäläinen Mikko S. , Klén Riku , Mahmoudian Mehrad , Raitakari Olli T. , Elo Laura L.
Published: January 2020

Objective:

The Systolic Blood Pressure Intervention Trial (SPRINT) reported that lowering SBP to below 120 mmHg (intensive treatment) reduced cardiovascular morbidity and mortality among adults with hypertension but increased the incidence of adverse events, particularly acute kidney injury (AKI). The goal of this study was to develop an accurate risk estimation tool for comparing the risk of cardiovascular events and adverse kidney-related outcomes between standard and intensive antihypertensive treatment strategies.

Methods:

By applying Lasso regression on the baseline characteristics and health outcomes of 8760 participants with complete baseline information in the SPRINT trial, we developed predictive models for primary cardiovascular disease (CVD) outcome and incidence of AKI. Both models were validated against an independent test set of the SPRINT trial (one third of data not used for model building) and externally against the cardiovascular and renal outcomes available in Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial, consisting of 4733 participants with type 2 diabetes mellitus.

Results:

Lasso regression identified a subset of variables that accurately predicted the primary CVD outcome and the incidence of AKI (areas under receiver-operating characteristic curves 0.70 and 0.77, respectively). Based on the validated risk models, an easy-to-use risk assessment tool was developed and made available as an easy-to-use online tool.

Conclusion:

By predicting the risks of CVD and AKI at baseline, the developed tool can be used to weigh the benefits of intensive versus standard blood pressure control and to identify those who are likely to benefit most from intensive treatment.
Clinical correlates and subclinical cardiac organ damage in different extreme dipping patterns
Authors: Cuspidi Cesare , Facchetti Rita , Quarti-Trevano Fosca , Dell’Oro Raffaella , Tadic Marijana , Gherbesi Elisa , Grassi Guido , Mancia Giuseppe
Published: January 2020

Aim:

Information regarding the association of hypertension-mediated organ damage (HMOD) with extreme dipping pattern is scanty and not univocal. We sought to assess the clinical correlates of this blood pressure (BP) phenotype and its relationship with cardiac HMOD in the general population belonging to Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study.

Methods:

The present analysis included all participants with good-quality ABPM recordings with reliable echocardiography at entry.

Results:

A total of 792 out of 1597 patients (49.6%) exhibited an extreme dipping pattern (155 had a night-time reduction in both SBP and DBP at least 20% compared with daytime values and 637 a night-time reduction in DBP at least 20%); 34.2% were dippers and 16.2% nondippers. Left ventricular mass (LVM) indexed to height2.7 and LV hypertrophy (LVH) prevalence rates increased progressively from diastolic extreme dipping (14%), dipper (17%), systolic/diastolic extreme dipping (21%) to nondipper group (27%). However, after adjusting for confounders, statistical differences in both LVMI and LVH rates among the four groups disappeared. Similar results were obtained for LVM indexed to body surface area and absolute/indexed left atrial diameter.

Conclusion:

Extreme dipping pattern is a BP phenotype highly frequent in the general population largely consisting of middle-aged individuals without prevalent cardiovascular disease. In this population, the extreme dipping pattern is not associated with an increased risk of cardiac HMOD, which suggests that the mechanisms invoked for the potential adverse cardiovascular effects of this condition (i.e. nocturnal hypoxemia, low-grade myocardial inflammation, coronary hypoperfusion, sympathetic activation at early morning, etc.) are not operative.
CASE OF BILATERAL CHOROIDAL DETACHMENTS IN GRAFT-VERSUS-HOST DISEASE AND HYPOALBUMINAEMIA AFTER REDUCED-INTENSITY ALLOGENEIC BONE MARROW STEM CELL TRANSPLANTATION
Authors: Ang Juan L , Angbue Te Nikki Doreen So , Wells Matthew , Ting Eugene , Ho I-Van
Published: January 2020

Purpose:

To report a case of bilateral choroidal detachments in a patient with myelodysplasia who developed graft-versus-host disease and hypoalbuminemia after allogeneic bone marrow transplantation.

Methods:

Case report imaged with ultra–widefield color photographs and B-scans.

Results:

The patient presented with a 3-day history of bilateral visual deterioration, associated with right eye floaters. Fundus examination revealed choroidal detachments in all four quadrants associated with serous retinal detachment in the right eye and in the inferotemporal and inferonasal quadrant of the left eye. Medical history included allogeneic bone marrow transplantation for myelodysplastic syndrome seven months prior and development of symptoms of graft-versus-host disease three weeks prior. His serum albumin and protein levels were severely low. The detachments subsequently resolved with treatment of the hypoalbuminemia and low protein.

Conclusion:

Choroidal detachment is a possible complication of hypoalbuminemia and graft-versus-host disease. Hypoalbuminemia causing a reduction in the gradient for transscleral diffusion of albumin or graft-versus-host disease–related immune reaction is a possible mechanism of this complication.
RETINAL PIGMENT EPITHELIAL IRREGULARITY AND ATROPHY AFTER INTERNAL MEMBRANE PEELING: A REPORT OF TWO CASES
Authors: Shroff Daraius , Agarwal Aniruddha , Saha Indranil , Aggarwal Kanika , Grover Suman , Gupta Vishali , Shroff Cyrus , Querques Giuseppe
Published: January 2020

Purpose:

To report two cases of widespread retinal pigment epithelial clumping, irregularity, and atrophy after uncomplicated 25-gauge pars plana vitrectomy with brilliant blue-green–assisted internal limiting membrane peeling.

Methods:

Retrospective analysis of 2 eyes of 2 patients who underwent 25-gauge pars plana vitrectomy for macular diseases (macular hole with retinal detachment and vitreomacular traction) was performed. Surgical notes and video recordings were reviewed to determine the surgical procedures performed and the duration of the surgery. Multimodal imaging analysis, including fundus photography, fundus autofluorescence imaging, and optical coherence tomography were performed to determine the pathological changes in the postoperative period.

Results:

The mean age of the patients (all females) was 78 years. In all the patients, brilliant blue-green–assisted internal limiting membrane peeling was performed without any intraoperative complications. Four weeks after an uncomplicated surgery, the patients complained of progressive central visual disturbance and metamorphopsia. Retinal imaging demonstrated retinal pigment epithelial clumps and irregularity, which appeared as hyperautofluorescent on fundus autofluorescence, and widespread retinal pigment epithelial atrophy (hypoautofluorescent on fundus autofluorescence) in the posterior pole and peripapillary region, along with retinal and choroidal thinning.

Conclusion:

In uncomplicated vitrectomy consisting of brilliant blue-green–assisted internal limiting membrane peeling, a remote risk of widespread retinal pigment epithelial damage exists even with the use of modern endoilluminators and relatively short surgical duration. Retinal phototoxicity seems to be the primary cause; however, dye-related cytotoxicity or a combination of both cannot be ruled out.
Evolving Guidelines for Intracameral Injection
Authors: Liebmann Jeffrey M. , Barton Keith , Weinreb Robert N. , Eichenbaum David A. , Gupta Preeya K. , McCabe Cathleen M. , Wolfe Jeremy D. , Ahmed Iqbal , Sheybani Arsham , Craven E. Randy
Published: January 2020

Purpose:

To review evidence and provide guidelines on intracameral (ICM) injection techniques and monitoring.

Materials and Methods:

A review of published literature on ICM injection and intravitreal injections formed the basis for roundtable deliberations by an expert panel of ophthalmologists.

Results:

ICM injection as a way to deliver medications is growing in popularity. However, there is limited published literature and no standard approach to best practices for ICM injections, particularly when not accompanying another surgical procedure. Fortunately, there is long clinical experience with ICM manipulation and a large body of evidence surrounding intravitreal injections that has provided important guidance. The expert panel formulates several concrete guidelines and many suggested techniques to help physicians safely and effectively employ ICM injections.

Conclusions:

This committee addressed the many considerations surrounding ICM injection of drugs or implants and agree that it is a safe and effective surgical procedure when performed with appropriate training and according to established safe practices.
Morphologic Analysis of Peripapillary Retinal Arteriole Using Adaptive Optics in Primary Open-angle Glaucoma
Authors: Hugo Juliette , Chavane Frédéric , Beylerian Marie , Callet Marie , Denis Danièle , Matonti Frédéric
Published: January 2020

Purpose:

The purpose of this study was to better understand the role of vascular risk factors in the pathogenesis of primary open-angle glaucoma (POAG), a detailed analysis of retinal arterial wall thickness is needed. The purpose of the present study was to make a morphologic analysis of peripapillary arteriole in POAG using adaptive optics (AO) technology.

Patients and Methods:

We included otherwise healthy subjects with an isolated confirmed diagnosis of bilateral POAG. Patients’ clinical characteristics were noted. AO imaging followed by a complete ophthalmic examination was performed. A single operator masked to clinical data performed 5 measurements at different locations of each analyzed vessel. For each location, lumen diameter and wall thickness were measured. Total diameter, wall-to-lumen ratio (WLR), and whole cross-sectional area were calculated.

Results:

Lumen diameter and total diameter were significantly lower in the glaucoma group (n=31) than in the control group (n=29): [median (interquartile ranges)] 88.3 (82.6-99.2) versus 102.3 (87-113.1) (P=0.03) and 121.1 (109.3-130.5) versus 134.4 (112.7-144.4), respectively (P=0.015). Wall thickness, WLR, and whole cross-sectional area were not significantly different. Apart from a significantly higher WLR in subjects with reported high cholesterol levels, we did not observe any correlation between patients’ clinical characteristics and any of the parameters.

Conclusions:

We observed in POAG a narrowing of the arteriolar lumen without modification of the vessel wall thickness. To date, it is the first time that these data are obtained using AO. This suggests that the vascular risk factor in POAG only reduces the vascular caliber without inducing any patent atherosclerosis of the retinal arterial wall.
Comparison of the intermediate distance of a trifocal IOL with an extended depth-of-focus IOL: results of a prospective randomized trial
Authors: Webers Valentijn S.C. , Bauer Noel J.C. , Saelens Isabelle E.Y. , Creten Onne J.M. , Berendschot Tos T.J.M. , van den Biggelaar Frank J.H.M. , Nuijts Rudy M.M.A.
Published: January 2020

Purpose:

To compare visual outcomes, reading ability, and visual quality between the Symfony extended depth-of-focus intraocular lens (IOL) and the trifocal AT LISA tri 839MP IOL.

Setting:

University Eye Clinic Maastricht, The Netherlands.

Design:

Prospective randomized controlled trial.

Methods:

Patients were randomly assigned to bilateral Symfony IOL or AT LISA tri 839MP IOL implantation. The primary outcome measure was uncorrected intermediate visual acuity (UIVA measured at 66 cm). Secondary outcomes included uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), reading ability, and comparison of defocus curves, contrast sensitivity, optical adverse effects, and quality of vision.

Results:

The study enrolled 60 eyes of 30 patients. The mean UIVA was −0.02 ± 0.03 (SD) vs 0.01 ± 0.03 logarithm of the minimal angle of resolution (logMAR) in the Symfony and AT LISA tri 839MP groups, respectively (P = .047). The UDVA was 0.01 ± 0.12 and −0.05 ± 0.07 logMAR (P = .11) and the UNVA was 0.09 ± 0.05 and 0.04 ± 0.07 logMAR (P = .052) in the Symfony and AT LISA tri 839MP groups, respectively. Reading ability was similar in both groups at 40 cm and 66 cm (P = .87 and P = .14, respectively). Less than 10% of patients in both groups experienced disabling glare. Patients experienced disabling halos in the AT LISA tri 839 MP group compared to the Symfony group in 39% and 21% of cases, respectively (P = .12). The mean score for visual functioning was 88.0 ± 14.1 n the trifocal group and 88.2 ± 10.9 for the EDOF group (P = .96).

Conclusions:

The UIVA was better in the Symfony group than in the AT LISA tri 839MP group. No significant differences were seen in the binocular UNVA and UDVA, contrast sensitivity, reading ability, incidence of photopic phenomena, and patient satisfaction.
Optimization of implantable collamer lens sizing based on swept-source anterior segment optical coherence tomography
Authors: Nakamura Tomoaki , Isogai Naoki , Kojima Takashi , Yoshida Yoko , Sugiyama Yasuo
Published: January 2020

Purpose:

To optimize the implantable collamer lens (ICL) sizing method using anterior segment optical coherence tomography (AS-OCT).

Setting:

Nagoya Eye Clinic, Nagoya, Japan.

Design:

Interventional case series.

Methods:

A stepwise multiple regression analysis was performed using the optimal ICL size as a dependent variable and preoperative AS-OCT parameters as explanatory variables for 81 eyes of 41 patients, and the NK-formula version 2 (NK-formula V2) was obtained. Thereafter, 68 eyes of 42 patients were implanted with the ICLs selected as closest to the optimal ICL size calculated by the NK-formula V2. At 3 months postoperatively, the achieved vault was measured by AS-OCT to evaluate the optimization of the sizing method.

Results:

The anterior chamber width (ACW) and crystalline lens rise were selected as significant parameters for the regression model (R
2 = 0.61, P < .001), as with the previous NK-formula. Of the 68 eyes, 36 patients/62 eyes (91.2%), 5 patients/5 eyes (7.3%), and 1 patient/1 eye (1.5%) were in the moderate, high, and low vault categories, respectively. In the 68 eyes, the vault showed no correlation with the optimal ICL size (R = 0.0185, P = .269), whereas the vault showed a negative correlation with the optimal ICL size in both the 12.6 mm ICL subgroup (R = −0.409, P = .0088) and the 13.2 mm ICL subgroup (R = −0.818, P = .0013).

Conclusions:

This optimization approach showed excellent ability to select an appropriate ICL to be implanted regardless of the value of other ocular parameters and age, except ACW.
Trans-scleral plugs fixated IOL: a new paradigm for sutureless scleral fixation
Authors: Barca Francesco , Caporossi Tomaso , de Angelis Lorenzo , Giansanti Fabrizio , Savastano Alfonso , Di Leo Laura , Rizzo Stanislao
Published: January 2020

Purpose:

To assess the surgical and refractive outcomes of a new technique of sutureless scleral fixation (SSF) using a single-piece foldable acrylic intraocular lens (IOL) (Carlevale).

Setting:

Department of Translational Surgery and Medicine, Ophthalmology, University of Florence, Careggi, Florence, Italy.

Design:

Prospective observational case series.

Methods:

Thirty-two eyes of 32 patients with aphakia, dislocated IOL, or subluxated lens who underwent SSF with a novel single-piece hydrophilic acrylic IOL were studied. Preoperative and postoperative refractive status and complications during and after surgery were recorded. The IOL tilt was evaluated using anterior segment optical coherence tomography (AS-OCT).

Results:

Twenty-two eyes were IOL/bag luxations, 9 were aphakia, and 3 were subluxated crystalline lens. Mean preoperative corrected distance visual acuity was 0.46 ± 0.29 logarithm of the minimum angle of resolution (logMAR) and improved to 0.13 ± 0.12 logMAR (P < .05) at the 8-month follow-up, with a predictive error spherical equivalent of −0.24 ± 0.81 diopters (D); the IOL tilt was 2.08 ± 1.19 degrees. One patient (3.1%) experienced transient cystoid macular edema, and 1 (3.1%) experienced vitreous hemorrhage; pigment dispersion with AS-OCT findings of reverse pupillary block was found in 2 (6.2%) eyes. IOL dislocation, conjunctival erosion, and plug externalization were not observed in any eye during the follow-up.

Conclusions:

SSF using the novel IOL could be a viable option for the management of aphakia, lens subluxation, and IOL–bag complex dislocation with unique characteristics of stability. The advantages of this technique were the absence of haptic manipulation, self-centration, and firm fixation of the IOL.
Receipt of multiple outpatient opioid prescriptions is associated with increased risk of adverse outcomes in youth: opioid prescribing trends, individual characteristics, and outcomes from 2005 to 2016
Authors: Pielech Melissa , Kruger Eric , Rivers William Evan , Snow Harry E. , Vowles Kevin E.
Published: January 2020

Data on all outpatient opioid prescriptions (N = 71,647) to youth below age 21 (N = 42,020) from 2005 to 2016 were extracted from electronic medical records within a university hospital system in New Mexico (NM) as were demographic details and markers of morbidity/mortality. Relative risk was calculated for markers of morbidity/mortality based on sociodemographic characteristics. The sample was primarily male (55.0%), Hispanic/Latinx (50.1%), English-speaking (88.9%), and publicly insured (50.1%). Mean age was 13.54 (SD = 6.50). From 2005 to 2016, overall frequency of opioid prescriptions increased by 86.6% (from 2470 to 4610) with the largest increase (206.2%) observed from 2005 to 2008 (2470-7562). Patients who were older, white, and non-Hispanic were more likely to receive multiple opioid prescriptions. Large relative increases in morbidity and mortality were documented, although base rates remained low. The percentage of individuals within the sample who experienced an overdose increased steadily from 0 in 2005 to 1.09% in 2016. Incidence of mortality increased from 0.12% of the sample to 1.39% in 2016. The proportion of individuals who received a medication for the treatment of opioid dependence increased from 0.06% in 2005 to 0.44% in 2016. Significantly increased risk of adverse outcomes was observed in patients receiving multiple opioid prescriptions, and in patients who were older, of minority race, received their first prescription in an outpatient clinic, and publicly insured or uninsured. Results add to the growing literature concerning opioid prescription rates over time. They also provide important information on potential additive risks of adverse outcomes when pediatric patients receive multiple opioid prescriptions.
Vertical Integration Into Skilled Nursing Facilities and Hospital Readmission Rates
Authors: Hogan Tory H. , Lemak Christy Harris , Hearld Larry R. , Wheeler Jack , Sen Bisakha (Pia) , Menachemi Nir
Published: January 2020

Following the Affordable Care Act (ACA), more hospitals vertically integrated into skilled nursing facilities (SNFs). Hospitals are now being penalized for avoidable readmissions, creating a greater demand for better coordination of care between hospitals and SNF. We created a longitudinal panel data set by merging data from the American Hospital Association's Annual Survey, CMS' Hospital Compare, and the Rural Urban Commuting Area data. Hospital and year fixed-effects models were used to examine the relationship between hospital vertical integration into SNF and 30-day pneumonia and heart failure (HF) readmission rates between 2008 and 2011. Our primary analyses modeled the impact of hospital vertical integration into SNF on 30-day readmissions for both pneumonia and HF using hospital and year fixed effects. Our secondary analyses examined whether hospital vertical integration into SNF was associated with a change in readmissions rates among different types of hospitals. Our results indicate that hospitals that vertically integrated into SNF were associated with a reduction in hospital 30-day pneumonia readmission rates (β = −0.233, p = .039). Vertical integration into SNF was not significantly associated with 30-day HF readmissions. Our secondary analyses found variation in the impact of vertical integration on readmission rates among different hospital organizational types.
Non-Invasive and Minimally Invasive Management of Low Back Disorders
Authors: Hegmann Kurt T. , Travis Russell , Andersson Gunnar B.J. , Belcourt Roger M. , Carragee Eugene J. , Donelson Ronald , Eskay-Auerbach Marjorie , Galper Jill , Goertz Michael , Haldeman Scott , Hooper Paul D. , Lessenger James E. , Mayer Tom , Mueller Kathryn L. , Murphy Donald R. , Tellin William G. , Thiese Matthew S. , Weiss Michael S. , Harris Jeffrey S.
Published: January 2020

Objective:

This abbreviated version of the American College of Occupational and Environmental Medicine's (ACOEM) Low Back Disorders Guideline reviews the evidence and recommendations developed for non-invasive and minimally invasive management of low back disorders.

Methods:

Systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking. A total of 70 high-quality and 564 moderate-quality trials were identified for non-invasive low back disorders. Detailed algorithms were developed.

Results:

Guidance has been developed for the management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 121 specific recommendations.

Conclusion:

Quality evidence should guide treatment for all phases of managing low back disorders.
The Pre-Registry Commercial Driver Medical Examination
Authors: Burks Stephen Vincent , Anderson Jon Eugene , Panda Bibhudutta , Haider Humza Syed , Haider Rebecca , Shi Dongnan , Li Yutao , Cagle Michael , Ostroushko Denis , Sun Zhining , Zaharick John , Hickman Jeffrey , Mabry Erin , Berger Mark , Czeisler Charles , Kales Stefanos Nikolaos
Published: January 2020

Objective:

Use independent diagnostic data to analyze the screening effectiveness of the pre-Registry commercial driver medical examination (CDME) for obstructive sleep apnea (OSA), and its sensitivity for hypertension; analyze certification lengths where relevant.

Methods:

CDME screening results for 1668 drivers were compared to polysomnogram diagnostic test results, and CDME screening results were evaluated for 1155 drivers with at least one insurance claim with a hypertension diagnostic code. Any CDME documentation of the medical condition was considered as detection by screening.

Results:

CDME sensitivity was 20.7% for moderate OSA (AHI ≥ 15). While sensitivity was 77.5% for hypertension, 93.3% of drivers with Stage 3 hypertension were certified, contrary to Federal Motor Carrier Safety Administration standards.

Conclusions:

The pre-Registry CDME was ineffective in screening commercial drivers for OSA. Screening was better for hypertension; incorrect certifications were given to many hypertensive drivers.
The Interaction Between Pain Intensity and Pain Self-Efficacy in Work Functioning Impairment
Authors: Mine Yuko , Fujino Yoshihisa , Matsuda Shinya
Published: January 2020

Objective:

To examine the pain intensity and pain self-efficacy interaction in workers’ work functioning impairment.

Methods:

A cross-sectional study using a self-reporting survey. Of 6657 Japanese construction company employees, 5129 (77.0%) valid responses were analyzed for work functioning impairment. Further analysis using current pain intensity and pain self-efficacy was performed on 1622 employees who experienced physical pain in the past 12 months.

Results:

Pain intensity showed a dose–response relationship with work functioning impairment. Further analysis showed an interaction between pain intensity and pain self-efficacy for work functioning impairment. Stratification by pain self-efficacy showed that high pain self-efficacy was not associated with an increase in work functioning impairment, even in those with severe pain (odds ratio = 1.79; 95% confidence interval = 0.69 to 4.68).

Conclusions:

Pain self-efficacy may be a key determinant for work functioning impairment in workers with pain.
Letrozole and human menopausal gonadotropin for ovulation induction in clomiphene resistance polycystic ovary syndrome patients
Authors: Shi Shaoquan , Hong Ting , Jiang Fangfang , Zhuang Yuan , Chen Le , Huang Xiaoling
Published: January 2020

Objective:

To compare the effects of letrozole and human menopausal gonadotropin (HMG) in the treatment of patients with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate (CC).

Methods:

A total of 96 clomiphene resistance polycystic ovary syndrome patients infertility were randomly divided into an LE group, and HMG group (n = 48). LE group orally received letrozole at 5.0 mg/d−1 on the 3rd–5th days of menstrual cycle for 5 consecutive days, and 75 U/d−1 HMG was given through intramuscular injection for 5 days starting from the third day of menstrual cycle in HMG group. Number of growing and mature follicles, serum E2 (pg/mL), serum P (ng/mL), endometrial thickness, occurrence of pregnancy and miscarriage were observed.

Results:

There was no significant difference in the number of ovulation cycles between the 2 groups (53.6% vs 64.7%, P > .05). The number of mature follicular cycles in the HMG group was higher than that of the letrozole group (P < .01). There were no significant differences in the clinical pregnancy rate (22.9% vs 27.1%, P > .05) and abortion rate (6.2% vs 10.4%, P > .05). There was no significant difference in the endometrial thickness between the 2 groups on the day of HCG injection [(9.1 ± 0.2) mm vs (10.7 ± 1.6) mm, P > .05]; the serum estradiol (E2) was lower in the letrozole group. The incidence of ovarian cysts was lower than that of HMG group (P < .05). There was2 ovarian hyperstimulation syndrome in the letrozole group; the incidence of ovarian hyperstimulation syndrome in the HMG group was 12.5%.

Conclusion:

Letrozole-induced ovulation can obtain ovulation rate and pregnancy rate similar to gonadotropin, but reduce the risk associated with treatment. It can be used as an effective ovulation option for patients with polycystic ovary syndrome who are resistant to clomiphene.
Clinical manifestations and risk factors of adenovirus respiratory infection in hospitalized children in Guangzhou, China during the 2011–2014 period
Authors: Wu Pei-Qiong , Zeng Sen-Qiang , Yin Gen-Quan , Huang Jian-Jun , Xie Zhi-Wei , Lu Gen , Jiang Wen-Hui
Published: January 2020

To evaluate epidemiology and risk factors of severe adenovirus respiratory infection in hospitalized children in Guangzhou, China.

A retrospective review study was conducted, and 542 children hospitalized for adenovirus respiratory infection, were included from January 2011 to December 2014. Patients were younger than 14 years. Disease severity was classified into severe and mild. Laboratory tests and clinical characteristics were analyzed for risk factors of adenovirus respiratory infection by multivariable logistic regression.

Among these 542 children, 92.1% were aged < 6 years. Clinical diagnoses were upper respiratory infections in 11.6%, bronchiolitis in 16%, and mild pneumonia in 62.0% of children. Severe pneumonia rate was 10.3% (56/542) with a mortality rate of 0.9% (5/542). The cohort comprised 542 patients; 486 patients with mild adenovirus respiratory infection and 56 patients with severe adenovirus respiratory infection. Multivariable logistic regression was used to confirm associations between variables and adenovirus respiratory infection, after age and gender adjustment. Hospital stay, still significantly associated with adenovirus respiratory infection. Patients with longer hospital stay (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.13–1.28, P < .001), lower LYMPH (OR = 0.73 95% CI: 0.55–0.99, P = .039), and increased LDH (OR = 1.002, 95% CI: 1.001–1.003, P =  .001) had a higher risk of severe adenovirus respiratory infection.

Adenovirus is a major pathogen in hospitalized children with respiratory infection. High serum LDH level and low lymphocyte count could be used as predictors of adenovirus respiratory infection severity in children.
Preoperative platelet-lymphocyte ratio is a superior prognostic biomarker to other systemic inflammatory response markers in non-small cell lung cancer
Authors: Huang Qing , Diao Peng , Li Chang-Lin , Peng Qian , Xie Tianpeng , Tan Yan , Lang Jin-Yi
Published: January 2020

Systemic inflammatory response markers are associated with poor survival in many types of malignances. This study aimed to evaluate the prognostic value of preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and C-reactive protein (CRP) in patients with non-small cell lung cancer (NSCLC).

We retrospectively evaluated 254 NSCLC patients who underwent radical surgery between January 2012 and April 2014 in the Sichuan Provincial Cancer Hospital. The cut-off values of NLR, PLR, LMR, and CRP were determined according to the receiver operating characteristic curve, and the correlation of NLR, PLR, LMR, and CRP with prognosis was analyzed based on the cut-off value.

The cut-off value for NLR, PLR, LMR, and CRP were 3.18, 122, 4.04, and 8.8, respectively. Univariate analysis showed that age (P = .022), tumor-node-metastasis (TNM) stage (P < .001), T stage (P = .001), and N stage (P < .001) were significantly correlated with disease-free survival (DFS), while age (P = .011), TNM stage (P 
< .001), T stage (P = .008), N stage (P < .001), and PLR (P = .001) were significantly correlated with overall survival (OS). In multivariate analysis, age (hazard ratio [HR]: 1.564, 95% confidence interval [CI]: 1.087–2.252, P = .016) and TNM stage (HR: 1.704, 95% CI: 1.061–2.735, P = .027) remained independent risk factors affecting DFS, while age (HR: 1.721, 95% CI: 1.153–2.567, P = .008), TNM stage (HR: 2.198, 95% CI: 1.263–3.824, P = .005), and PLR (HR: 1.850, 95% CI: 1.246–2.746, P = .002) were independent risk factors affecting OS.

The preoperative PLR is superior to NLR, LMR, and CRP as a biomarker for evaluating the prognosis of patients undergoing curative surgery for NSCLC.