bluuebunny/crossref_metadata_2025 huggingface dataset:
Aerobic and resistance exercise improve patient-reported sleep quality and is associated with cardiometabolic biomarkers in Hispanic and non-Hispanic breast cancer survivors who are overweight or obese: results from a secondary analysis
Authors: Dieli-Conwright Christina M , Courneya Kerry S , Demark-Wahnefried Wendy , Sami Nathalie , Norris Mary K , Fox Frank S , Buchanan Thomas A , Spicer Darcy , Bernstein Leslie , Tripathy Debu
Published: April 2021

Study Objectives

Poor sleep quality affects nearly one-third of breast cancer survivors and is associated with insulin resistance. The purpose of this secondary analysis was to examine the effects of a 16-week exercise intervention on patient-reported sleep quality among breast cancer survivors and assess whether changes in patient-reported sleep quality were associated with cardiometabolic biomarkers. We explored Hispanic ethnicity as a moderator of the effects of exercise on patient-reported sleep quality.

Methods

Breast cancer survivors who were overweight or obese were randomized to exercise (n = 50) or usual care (n = 50). The 16-week intervention included aerobic and resistance exercise. Patient-reported sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and biomarkers of cardiometabolic health were assessed at baseline and post-intervention. Within- and between-group differences were assessed using general linear models repeated-measures analyses of variance and mixed-model repeated-measure analysis, respectively. Associations between changes in PSQI and cardiometabolic biomarkers were computed using Pearson correlations. Linear mixed-models were used to evaluate effect modification by ethnicity.

Results

Participants were 52 ± 10.4 years old, and over half were of Hispanic ethnicity. As compared to usual care, PSQI global scores improved significantly in the exercise group (mean between-group difference −2.2; 95% CI −3.2 to −0.6). Change in PSQI was inversely associated with changes in all cardiometabolic biomarkers (p < 0.01) among the exercise group. Ethnicity was found to moderate the effects of exercise training on global sleep quality (p < 0.001).

Conclusions

An aerobic and resistance exercise intervention effectively improved patient-reported sleep quality in breast cancer survivors. Hispanic ethnicity as a moderator showed greater improvement in patient-reported sleep indicating Hispanic versus non-Hispanic breast cancer survivors may derive larger sleep benefits.

Clinical Trail Information

NCT01140282.
Impact of Flexible Work Arrangements on Key Challenges to Work Engagement Among Older Workers
Authors: Allen Joanne , Alpass Fiona M , Szabó Ágnes , Stephens Christine V
Published: April 2021

As workforces age, organizations are challenged to provide human resource management policies and practices that are responsive to the needs of older workers. Flexible work arrangements (FWAs)—practices that allow workers to influence when, where, and how work is completed—have been promoted as enabling older workers to maintain work engagement by decreasing demands of the work role, providing the autonomy to balance work and nonwork commitments, and signalling the value of workers to employers. The current study aimed to examine whether FWAs were effective in alleviating key challenges to work among older workers by assessing the impact of FWAs on the associations of physical health, mental health, and negative age-related stereotypes about older workers, with work engagement. Data were obtained from 1,834 workers aged 55–82 (age M = 63.3, 54% female) from a general random sample of older adults. Greater mental health and lower negative stereotypes predicted higher work engagement. Greater physical and mental health conveyed an indirect impact on engagement via lower perception of negative stereotypes. Greater FWAs displayed a weak negative association with the perception of negative stereotypes about older workers and reduced the association of negative stereotypes with work engagement. Access to FWAs may have a minor role in alleviating key risks to work engagement associated with mental and social challenges for an aging workforce. Considerations for future investigations of FWAs and their impact on risks to engagement among older workers are discussed.
Vestibular Function in Older Adults With Cognitive Impairment: A Systematic Review
Authors: Bosmans Joyce , Jorissen Cathérine , Gilles Annick , Mertens Griet , Engelborghs Sebastiaan , Cras Patrick , Van Ombergen Angelique , Van Rompaey Vincent
Published: April 2021

Importance:

Given the rising prevalence of patients with dementia and those at risk for it, early identification is prioritized. As vestibular dysfunction is associated with Alzheimer’s disease (AD) and may contribute to its onset, vestibular assessment may yield an opportunity in early dementia screening.

Objective:

This systematic review structures and compares the different raw outcome measures used to assess vestibular function while comparing older adults with preserved cognition to individuals with cognitive impairment, either suffering from mild cognitive impairment (MCI) or AD.

Design:

Two investigators independently and systematically searched publications performing objectively measured vestibular testing in a patient population consisting of either MCI or AD, compared with a control group of older adults with preserved cognition. No limitations regarding language or publication date were applied. References of the retrieved articles were hand searched for relevant articles.

Results:

Seven articles were included for analysis. A total of 235 older adults with impaired cognition (150 AD, 85 MCI) were compared with a control group of 481 older adults with preserved cognition. Evaluation of the peripheral vestibular function included video head impulse test (vHIT), videonystagmography (VNG), electronystagmography (ENG) including bithermal caloric irrigation and vestibular evoked myogenic potentials (VEMP). The VEMP test, assessing otolith function and the elicited vestibulocollic reflex (VCR), was able to differentiate subjects with AD and its prodromal stage from healthy controls, with p13 latency (p < 0.05) and amplitude (p < 0.05) having the most discriminating power.

No correlation between cognitive decline and vestibulo-ocular reflex measurements in different frequency ranges of the semicircular canals (using vHIT, rotatory chair testing, and caloric irrigation) was found. Because of the limited number of available studies and the large heterogeneity in outcome measures, these results have to be interpreted with caution.

Conclusions:

Measurements of the VCR, as evoked by the VEMP test, discriminate between patients with cognitive impairment (MCI and AD) and older adults with preserved cognition, whereas measurements of the vestibulo-ocular reflex do not. More studies are needed to further elaborate on these findings.
Cytomegalovirus—A Risk Factor for Childhood Hearing Loss: A Systematic Review
Authors: Vos Bénédicte , Noll Dorie , Whittingham JoAnne , Pigeon Marie , Bagatto Marlene , Fitzpatrick Elizabeth M.
Published: April 2021

Objective:

Permanent hearing loss is an important public health issue in children with consequences for language, social, and academic functioning. Early hearing detection, intervention, and monitoring are important in mitigating the impact of permanent childhood hearing loss. Congenital cytomegalovirus (CMV) infection is a leading cause of hearing loss. The purpose of this review was to synthesize the evidence on the association between CMV infection and permanent childhood hearing loss.

Design:

We performed a systematic review and examined scientific literature from the following databases: MEDLINE, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), Embase, and CINAHL. The primary outcome was permanent bilateral or unilateral hearing loss with congenital onset or onset during childhood (birth to 18 years). The secondary outcome was progressive hearing loss. We included studies reporting data on CMV infection. Randomized controlled trials, quasi-experimental studies, nonrandomized comparative and noncomparative studies, and case series were considered. Data were extracted and the quality of individual studies was assessed with the Qualitative Assessment Tool for Quantitative Studies (McMaster University). The quality and strength of the evidence were graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). A narrative synthesis was completed.

Results:

Sixty-five articles were included in the review. Prevalence of hearing loss at birth was over 33% among symptomatic CMV-infected newborns and less than 15% in asymptomatic infections. This difference in prevalence was maintained during childhood with more than 40% prevalence reported for symptomatic and less than 30% for asymptomatic CMV. Late-onset and progressive hearing loss appear to be characteristic of congenital CMV infections. Definitions of hearing loss, degree of loss, and reporting of laterality varied across studies. All degrees and both bilateral and unilateral loss were reported, regardless of symptomatic and asymptomatic status at birth, and no conclusions about the characteristics of hearing loss could be drawn. Various patterns of hearing loss were reported including stable, progressive, and fluctuating, and improvement in hearing (sometimes to normal hearing) was documented. These changes were reported in children with symptomatic/asymptomatic congenital CMV infection, presenting with congenital/early onset/late-onset hearing loss and in children treated and untreated with antiviral medication.

Conclusions:

Symptomatic and asymptomatic congenital CMV infection should be considered a risk factor for hearing loss at birth and during childhood and for progressive hearing loss. Therefore, CMV should be included as a risk factor in screening and surveillance programs and be taken into account in clinical follow-up of children with hearing loss.
Actein antagonizes colorectal cancer through blocking PI3K/Akt pathways by downregulating IMPDH2
Authors: Yan Liwei , Wang Dandan , Liu Xiaoming , Gu Chao , Gao Shanyu
Published: April 2021

Actein, a triterpene glycoside, isolated from rhizomes of Cimicifuga foetida, was reported to exhibit anticancer effects in vitro and in vivo. However, the effects of actein on colorectal cancer (CRC) remains unclear. As one of the most popular cancers all over the world, CRC ranked third place in both men and women. Recently, we investigated the potential anti-CRC effects of actein and its mechanisms. The Cell counting kit-8 cell proliferation assays, cell cycle detection, apoptosis detection, reactive oxygen species and mitochondrial membrane potential evaluation, western blot, as well as SW480 xenograft mice model were conducted to illustrate the mechanisms of action on anti-CRC effects of actein. Actein could significantly inhibit the human CRC cell lines SW480 and HT-29 proliferation, whereas less antiproliferation effects were found in normal colorectal cell lines HCoEpiC and FHC. Administration of actein resulted in G1 phase cell cycle arrest in both SW480 and HT-29 cells. Moreover, mitochondria-mediated apoptosis was also observed after treatment with actein in SW480 and HT-29 cell lines. Further investigation of mechanisms of action on actein-mediated anti-CRC proliferation effects indicated that the phosphoinositide 3-kinases (PI3K)/Akt pathways were involved. Actein significantly downregulated the phosphorylation of key molecules in PI3K/Akt pathways, including mTOR, glycogen synthesis kinase 3β (GSK-3β), as well as FOXO1. In addition, inosine 5′-monophosphate dehydrogenase type II (IMPDH2) was also observed decreasing in both SW480 and HT-29 cell lines after actein treatment, suggesting that actein may inhibit the PI3K/Akt pathways by decreasing IMPDH2. Finally, our SW480 xenograft model verified the anti-CRC effects and the safety of actein in vivo. Our findings suggest actein is worthy of further investigation as a novel drug candidate for the treatment of CRC.
Evaluation of a Health Professions Teaching Academy Through the Lens of Social Capital
Authors: Blanchard Rebecca D. , Belforti Raquel K.
Published: April 2021

Introduction:

Academies of health professions educators can amplify members' social capital, promoting educational innovation and organizational change. However, research in this area is limited. This article attempts to close the gap in literature with the results of a program evaluation of our interprofessional teaching academy through the lens of social capital and organizational culture.

Methods:

A program evaluation using a cross-sectional survey was conducted with all members of the Baystate Education Research and Scholarship of Teaching (BERST) Academy. The survey drew on a conceptual framework from previous literature on social capital, communities of practice, and faculty development evaluation. Data were analyzed with descriptive statistics and analysis of variance.

Results:

Overall survey response rate was 54%. More than 90% of respondents have applied the skills learned through BERST Academy into their practice. Social capital was defined with five items (Cronbach alpha = 0.87), and we found no significant difference between profession and social capital, suggesting that perceptions of social capital did not significantly differ by membership in a specific profession.

Discussion:

Our results showed that BERST Academy members were able to cultivate social capital through high-quality connections. An academy can serve as a unique culture within an institution to foster collaborative relationships that increase social capital, for members of different professions. In addition, an academy can also provide members with a community that benefits them in the greater organizational culture.
School Readiness of Young Children Enrolled in Preschool in the United States
Authors: Kriegel Elana R. , Singer Miriam R. , Keim Sarah A. , Rapoport Eli , Adesman Andrew
Published: April 2021

Objective:

As preschool enrollment increases, it is important to know whether children enrolled in preschool are more likely to be “healthy and ready to learn (HRTL).” Our objective was to assess whether there are detectable school readiness differences between children enrolled in preschool and those who are not in a large, cross-sectional, nationally representative US sample.

Methods:

Caregivers of 4931 3- to 4-year-old children in the 2016 National Survey of Children's Health indicated whether their child had started school and completed questions forming the “HRTL” School Readiness National Outcome Measure and its domains: early learning skills, self-regulation, social-emotional development, and physical health/motor development. Propensity score–matched logistic regression models estimated prevalence ratios (PRs) comparing children in versus not in preschool.

Results:

49.1% of children had started preschool. After matching, children in preschool did not differ from children not in preschool on the composite (PR = 1.21; 95% confidence interval [CI]: 0.92–1.58) or any domains. Children in preschool were more likely to be “on track” with rhyming words (PR = 1.48; 95% CI: 1.11–1.96), writing their name (PR = 2.36; 95% CI: 1.82–3.08), and holding a pencil (PR = 1.55; 95% CI: 1.12–2.14) but less likely with explaining things they have seen/done (PR = 0.59; 95% CI: 0.44–0.79) and overall health (PR = 0.57; 95% CI: 0.33–0.97). Some associations were sex specific.

Conclusion:

The largely null findings of this study underscore the need for further research that incorporates information regarding the extent and quality of preschool exposure when evaluating the developmental benefits of preschool on a national level.
Postoperative Outcomes of Local Skin Flaps Used in Oncologic Reconstructive Surgery of the Upper Cutaneous Lip: A Systematic Review
Authors: Nicholas Mathew N. , Liu Annie , Chan Airiss R. , Jia Jocelyn , Fuller Kaitlin , Eisen Daniel B.
Published: April 2021

BACKGROUND

Despite many options for upper lip reconstruction, each method's advantages and disadvantages are unclear.

OBJECTIVE

To summarize complications and functional and aesthetic outcomes of localized skin flaps for oncological reconstruction of the upper cutaneous lip (PROSPERO CRD42020157244).

METHODS

The search was conducted in Ovid MEDLINE, Ovid EMBASE, and CENTRAL on December 14, 2019. Two reviewers screened 2,958 results for eligibility. Bias assessment was conducted using ROBINS-I criteria.

RESULTS

Our search identified 12 studies reporting outcomes of V-Y advancement, ergotrid, rotation, Karapandzic, alar crescent, and propeller facial artery perforator flaps. Flap complications (infection, hemorrhage/hematoma, wound dehiscence, and flap necrosis) ranged from 0% to 7.69%. Functional outcomes (salivary continence, microstomia, and paresthesia) were poorest for Karapandzic flaps. Aesthetic outcomes, when reported, stated satisfaction rates greater than 90%. V-Y advancement flaps reported the highest rates of poor scarring (0%–20%) and need for revision surgery (0%–46.7%).

CONCLUSION

Our results provide dermatologic surgeons an overview of upper cutaneous lip flap outcomes reported in the literature. In general, we noted high patient satisfaction rates and low complication rates. Additional research into outcomes of other commonly used flaps is needed. Standardization of reported outcomes could allow further comparison across different flaps or across studies of the same flap.
Paying for Pediatric Home Health Care
Authors: Raisanen Jessica C. , Ruth Alexandra , Donohue Pamela K. , Detwiler Kathryn , Fratantoni Karen , Huff Susan M. , Boss Renee D.
Published: April 2021

Limited private and public financing of home health care for children with medical complexity can have harmful and costly consequences. Little is known of how parents and professionals in the United States navigate coverage for these services or how payer restrictions are shaping service quality. Qualitative interviews were conducted with families and professionals (eg, prescribers, providers, administrators of pediatric home health care [PHHC]) caring for children with medical complexity. Interview transcripts were analyzed using inductive thematic analysis. In total, 47 families and 45 professionals from across 31 states and the District of Columbia had experiences with the full range of PHHC services. Participants detailed the need to patch together multiple insurances and payment programs to cover a child's home health needs. They described nontransparent eligibility determinations that do not reflect the diagnostic uncertainty and static functional status that is common for many children. Coverage denials are common, leaving gaps in care that can potentiate downstream cost escalation. Evidence-based health care reform must ensure that children get the PHHC needed to maintain function and reduce the need for hospital-based services. Recommendations are offered to improve PHHC financing and care for the most medically vulnerable children and their families.
Angiotensin (1-7) Alleviates Postresuscitation Myocardial Dysfunction by Suppressing Oxidative Stress Through the Phosphoinositide 3-Kinase, Protein Kinase B, and Endothelial Nitric Oxide Synthase Signaling Pathway
Authors: Zhu Li , Liu Zhen , Huang Li-Ping , Zhou Hou-Rong , Cao Yu , Yang Xue-Ping , Wang Bing-Jin , Yang Zi-Li , Chen Jing
Published: April 2021

There is increasing evidence that angiotensin (1-7) [Ang (1-7)] is an endogenous biologically active component of the renin–angiotensin system. However, the role of the Ang (1-7)-MasR axis in postresuscitation myocardial dysfunction (PRMD) and its associated mechanism are still unclear. In this study, we investigated the effect of the Ang (1-7)-MasR axis on myocardial injury after cardiac arrest-cardiopulmonary resuscitation-restoration of spontaneous circulation. We established a model of oxygen/glucose deprivation-reperfusion in myocardial cells in vitro and a rat model of cardiac arrest–cardiopulmonary resuscitation–restoration of spontaneous circulation in vivo. The cell apoptosis rate and the expression of the superoxide anion 3-nitrotyrosine were decreased in the Ang (1-7) group in vitro and in vivo. The mean arterial pressure was decreased, whereas +LVdp/dtmax and −LVdp/dtmax were increased in rats in the Ang (1-7) group. The mRNA and protein levels of Ang II type 1 receptor, MasR, phosphoinositide 3-kinase, protein kinase B, and endothelial nitric oxide synthase were increased in the Ang (1-7) group in vivo. These results indicate that the Ang (1-7)-MasR axis can alleviate PRMD by reducing myocardial tissue damage and oxidative stress through activation of the phosphoinositide 3-kinase–protein kinase B–endothelial nitric oxide synthase signaling pathway and provide a new direction for the clinical treatment of PRMD.
Renal interventions in the management of hypertension
Authors: Bob-Manuel Tamunoinemi , Amoran Olayiwola Emmanuel , Jenkins Christopher , Obafemi Olushola , Tutor Austin , Tafur Jose
Published: April 2021

Purpose of review

In the present comprehensive review, we describe the pathophysiology, indications, and evidence for both renal artery stenting and renal artery denervation. We also discuss the procedural techniques, risks, benefits, and future directions of renal intervention in the management of hypertension (HTN).

Recent findings

Hemodynamic confirmation of lesion severity in severe renal artery stenosis is a resting or hyperemic translesional systolic gradient >20, resting or hyperemic mean translesional gradient >10 and/or renal fractional flow reserve <0.8 are considered severe. Knowing that correct stent size was used is the best predictor of restenosis, intravascular ultrasound is effective and well tolerated for stent sizing. The main categories of renal denervation: radiofrequency ablation, ultrasound, chemical ablation, and brachytherapy have shown impressive outcomes in treating resistant HTN.

Over the past decade, several studies have shown the safety and benefit of catheter-based renal interventions in managing HTN. Renal artery stenting and renal artery denervation are the leading alternative invasive treatment employed in managing HTN.
Tailoring the management of hypertension to comorbidities
Authors: Mendoza Michael F. , Kachur Sergey M. , Lavie Carl J.
Published: April 2021

Purpose of review

In this article, we review the most current evidence for initiation and maintenance of various antihypertension (HTN) drug classes, including other misconceptions with respect to common comorbidities in patients with HTN.

Recent findings

Although the currently available anti-HTN agents have broad applicability in treating HTN, additional agents, such as angiotensin receptor-neprilysin inhibitors and novel nonsteroidal mineralocorticoid antagonists, have recently gained clinical significance. In addition, there have been some anecdotal concerns regarding the adverse effects, indications, and risks of COVID-19 infection/mortality when using certain anti-HTN agents.

Current guidelines currently address the treatment of primary HTN. However, isolated HTN is uncommon and often involves comorbid diseases that require specific regimentation. Several experimental medications are currently in late-stage trials showing potential superiority over current drugs that are available in the market.
Percutaneous management of calcified coronary arteries – review of atherectomy and lithotripsy devices and why it is important
Authors: Burke Lucas , Graham John Joseph
Published: April 2021

Purpose of review

Coronary artery calcification (CAC) predisposes to suboptimal revascularization outcomes after percutaneous coronary intervention (PCI). Despite the availability of several plaque modification devices, their rates of use remain low despite the prevalence of CAC encountered in clinical practice. It is important to understand how each device can be utilized in clinical practice in order to improve outcomes after PCI.

Recent findings

This article summarizes the most recent clinical evidence for each plaque modification device. Although rotational atherectomy is the most frequently used device for plaque modification, the use of orbital atherectomy (OA) has been increasing. Balloon-based strategies including recent studies evaluating a novel intravascular lithotripsy balloon have shed light on the benefits of nonablative devices in modifying CAC during PCI.

CAC poses significant technical challenges in achieving optimal stent results. Several intracoronary plaque modification devices are currently available and understanding the technical aspects, indications and contraindications to the use of each device is essential. Although rotational and OA are most commonly used, laser atherectomy and balloon-based devices may offer an advantage in certain lesion subsets.
Statin intolerance: new data and further options for treatment
Authors: Diaconu Camelia C. , Iorga Roua A. , Furtunescu Florentina , Katsiki Niki , Stoian Anca P. , Rizzo Manfredi
Published: April 2021

Purpose of review

Hypercholesterolemia is a major risk factor for cardiovascular diseases. Administration of statins represents the cornerstone of the prevention and treatment of cardiovascular disease, with demonstrated long-term safety and efficacy. This review aims to revisit statin intolerance mechanisms, as well as to discuss new data and therapeutic options.

Recent findings

Although statins are well tolerated, myopathy and other adverse effects are a challenging problem, being the main reason for poor adherence to treatment and failure in lowering cardiovascular risk. Statin intolerance is the subject of ongoing research, as these drugs are widely used. There are alternative options of treatment if statin intolerance emerges, that is, lowering the dose, intermittent dosages, and/or combining a statin with other drugs, such as ezetimibe, proprotein convertase subtilisin–kexin type 9 inhibitors, bempedoic acid, angiopoietin-like 3 protein inhibitors, and nutraceuticals. If even the lowest statin dose cannot be tolerated, a nonstatin regimen is recommended to reduce LDL cholesterol levels.

Treatment options in statin intolerance include combinations of a lower dose of statin with other lipid-lowering regimens or only nonstatin drugs in the presence of complete intolerance. New hypolipidemic therapies that address gene editing are emerging, and may prove useful in the future.
Manual DALK in Keratoconus: An Ex Vivo Light and Transmission Electron Microscopy Analysis 2 Years After Surgery
Authors: Favuzza Eleonora , Mencucci Rita , Rosa Irene , Cennamo Michela , Manetti Mirko , Marini Mirca
Published: April 2021

Purpose:

The aim of this study was to evaluate the microscopic structure of a human cornea 2 years after manual deep anterior lamellar keratoplasty (DALK) for keratoconus with a recipient residual stromal bed thickness of 100 μm, using light and transmission electron microscopy.

Methods:

A human cornea treated with manual DALK for keratoconus 2 years before was removed during penetrating keratoplasty because of stromal opacity of unknown origin, involving about half of the sample. The transparent half of the specimen was processed for light and transmission electron microscopy.

Results:

Light microscopy examination performed with different staining techniques (hematoxylin and eosin, Picrosirius red, and Masson trichrome) revealed a homogeneous stroma. No interface was detected. Electron microscopy confirmed these findings.

Conclusions:

This study confirmed the available clinical and confocal studies that show progressive stromal remodeling after manual DALK. Two years after surgery, no posterior stromal interface was detected.
Predictors of Peripapillary and Macular Optical Microangiography Measurements in Healthy Eyes
Authors: Bansal Tanima , Dubey Suneeta , Rao Harsha L. , Gandhi Monica , Pegu Julie
Published: April 2021

Precis:

The vessel density (VD) and perfusion density (PD) generated by optical microangiography (OMAG) is significantly affected by the signal strength (SS). Sex, hypertension, diabetes, and axial length did not have any statistically significant effect on these measurements.

Purpose:

The aim was to assess the effect of subject-related factors (age, sex, systemic hypertension, diabetes, and axial length) and machine-related factor (SS) on VD and PD generated by OMAG in peripapillary and macular regions.

Methods:

In an observational, cross-sectional study of 200 eyes of 100 healthy individuals (age: 18 to 80 y), mean and sectoral VD and PD were calculated on disc and macular scans. Effect of subject-related and machine-related factors on VD and PD parameters were evaluated using multivariate mixed effect models.

Results:

Mean±SD peripapillary and macular VD of the study population was 18.56±1.11 and 20.59±1.85 mm−1, respectively. Mean peripapillary and macular PD was 46.43±3.22% and 37.61±3.26%, respectively. Sex, hypertension, diabetes, and axial length did not have any statistically significant effect on the OMAG measurements (P>0.05 for all associations). However, the SS had significant effect on the OMAG measurements. Mean peripapillary and macular VD on scans with SS of 10 was 1.4 and 3.79 mm−1 greater, respectively, than that on scans with SS of 7. Mean peripapillary and macular PD on scans with SS of 10 was 4.43% and 7.85% greater, respectively, than that on scans with SS of 7.

Conclusion:

Significant association exists between SS of the scan and the optical coherence tomography angiography measurements generated by OMAG even when the scans have acceptable SS as recommended by the manufacturer (≥7). This needs to be considered while interpreting optical coherence tomography angiography measurements.
Optic Nerve Head Vessel Density Assessment in Recovered COVID-19 Patients: A Prospective Study Using Optical Coherence Tomography Angiography
Authors: Burgos-Blasco Barbara , Güemes-Villahoz Noemi , Vidal-Villegas Beatriz , Garcia-Feijoo Julian , Donate-Lopez Juan , Martin-Sanchez Francisco J. , Gonzalez-Armengol Juan J. , Mendez-Hernandez Carmen D.
Published: April 2021

Precis:

Vascular diseases have been linked to alterations in optic nerve head perfusion.

Purpose:

The main objective was to investigate the changes in peripapillary vessel density (VD) in post coronavirus disease (COVID-19) patients.

Methods:

In this prospective pilot exploratory study, patients with COVID-19 that were attended in the Emergency Department of Hospital Clinico San Carlos (Madrid) were included. All patients underwent optic nerve head optical coherence tomography angiography using the Cirrus HD-OCT 500 with AngioPlex OCTA (Zeiss, Dublin, CA) 4 and 12 weeks after diagnosis by positive reverse transcriptase-polymerase chain reaction test from nasopharyngeal swab at the Emergency Department. Sociodemographic data, medical history, disease severity, and laboratory work-up were collected.

Results:

One hundred and eighty eyes of 90 patients with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection were included. None of the patients reported visual changes. Severe patients were older, more frequently hispanic, dyslipidemic, and presented lower lymphocytes counts, as well as increased ferritin, D-dimer, fibrinogen, and international normalized ratio levels. No changes in optic nerve head vascularization were observed when both visits were compared. No correlation was found between VD and clinical parameters, disease severity and laboratory work-up.

Conclusions:

Changes to peripapillary VD were not observed in patients with COVID-19 in the early months following diagnosis.
Autologous Fat Transfer Harvest-site Complications: Incidence, Risk Factors, and Management
Authors: Homer Natalie A. , Patel Anika S. , Epstein Aliza , Durairaj Vikram D. , Nakra Tanuj
Published: April 2021

Purpose:

Autologous fat transfer is an effective tool for volume restoration to the aging face. Although numerous reports exist regarding injection site complications, there is limited data on donor-site morbidity in the cosmetic surgery literature.

Methods:

This study is a large-scale retrospective review to determine incidence of fat harvest-site complications, identify risk factors, and describe management strategies. Records of all patients who underwent autologous fat harvesting and facial grafting at a single oculofacial plastic surgery practice from 2010 to 2019 were reviewed. Patient demographics and clinical data were collected and assessed. A statistical analysis was performed using a two-tailed T-test with p values of <0.05 considered significant.

Results:

Four-hundred sixteen patients were followed for an average of 6.2 months postoperatively. There was an overall 5.5% harvest-site complication rate. There was no correlation of harvest-site complications with gender (p = 0.249) or age (p = 0.881). Harvest location did not significantly correlate with complication rate. The most common complications were contour irregularities, prolonged induration, and prolonged erythema. Low body mass index was associated with higher complication rate (p = 0.003), even when excluding those patients with contour irregularities (p = 0.001). Various treatment modalities were used to manage donor-site morbidity with consistent improvement.

Conclusions:

Autologous fat transfer used for facial volume augmentation has low donor-site morbidity. Minor harvest-site complications occur more commonly in patients with low body mass index, irrespective of age, gender, or fat source.
Thrombogenicity of Hyaluronic Acid Fillers: A Quantitative Thrombodynamics Study
Authors: Kim Jane S. , Gonzales Luigi , Lester Jacob , Householder Nick , Boxrud Cynthia , Goldberg Robert , Ugradar Shoaib
Published: April 2021

Purpose:

At present, there is a paucity of data regarding the thrombogenicity of hyaluronic acid fillers (HAFs). This article quantitatively analyses the thrombogenicity of 2 commonly used HAFs: Restylane Lyft and Juvéderm Ultra.

Methods:

Thrombogenicity was assessed using the Thrombodynamics Analyzer System and plasma obtained from healthy controls. Following the addition of HAFs or control, spontaneous clot formation time, initial rate of clot growth, average rate of clot growth over 30 minutes, and clot size at 30 minutes was measured for each sample. The median of differences between each group were analyzed.

Results:

Nine individuals with a mean (SD) age of 37 (17) years, participated in the study. Initial rate of clot growth was significantly lower in plasma mixed with Juvéderm compared to control (p = 0.008) or Restylane (p = 0.038). The average rate of clot growth more than 30 minutes was significantly lower in both HAF groups (Restylane vs. control p = 0.038; Juvéderm vs. control p = 0.008), there was no significant difference between HAF groups (p = 0.635). Final clot size was significantly smaller with Juvéderm (p = 0.038 vs. control and p = 0.013 vs. Restylane). Spontaneous clot formation time did not significantly change with the addition of either HAF.

Conclusions:

Juvéderm significantly reduces the initial rate of clot growth, the average rate of clot growth more than 30 minutes, and clot size, whereas the addition of Restylane decreases the average rate of clot growth without affecting overall clot size in healthy individuals.
The Impact of Adverse Events on Functional Capacity and Quality of Life After HeartWare Ventricular Assist Device Implantation
Authors: Samsky Marc D. , Milano Carmelo A. , Pamboukian Salpy , Slaughter Mark S. , Birks Emma , Boyce Steven , Najjar Samer S. , Itoh Akinobu , Reid Bruce , Mokadam Nahush , Aaronson Keith D. , Pagani Francis D. , Rogers Joseph G.
Published: April 2021

Left ventricular assist devices (LVADs) improve quality of life (QoL) and functional capacity (FC) for patients with advanced heart failure. The association between adverse events (AEs) and changes in QoL and FC are unknown. Patients treated with the HeartWare ventricular assist device (HVAD) with paired 6-minute walk distance (6MWD, n = 263) and Kansas City Cardiomyopathy Questionnaires (KCCQ, n = 272) at baseline and 24 months in the ENDURANCE and ENDURANCE Supplemental Trial databases were included. Patients were stratified based upon occurrence of clinically significant AEs during the first 24 months of support and analyzed for the mean change in 6MWD and KCCQ. The impact of AE frequency on change in 6MWD and KCCQ from baseline to 24 months was evaluated. Of the AEs examined, only sepsis was associated with an improvement in 6MWD (109 m vs. 16 m, p = 0.002). Patients without improvement in 6MWD test from baseline to 24 months had significantly more AEs than those with FC improvement (p = 0.0002). Adverse events did not affect the KCCQ overall summary score. In this analysis, patients with fewer AEs had greater improvement in FC during the 24-month follow up. The frequency of AEs did not have a significant impact on QoL after LVAD implantation.
Neurologic Outcomes After Extracorporeal Cardiopulmonary Resuscitation: Recent Experience at a Single High-Volume Center
Authors: Podell Jamie E. , Krause Eric M. , Rector Raymond , Hassan Mubariz , Reddi Ashwin , Jaffa Matthew N. , Morris Nicholas A. , Herr Daniel L. , Parikh Gunjan Y.
Published: April 2021

Extracorporeal cardiopulmonary resuscitation (ECPR)—veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory cardiac arrest—has grown rapidly, but its widespread adoption has been limited by frequent neurologic complications. With individual centers developing best practices, utilization may be increasing with an uncertain effect on outcomes. This study describes the recent ECPR experience at the University of Maryland Medical Center from 2016 through 2018, with attention to neurologic outcomes and predictors thereof. The primary outcome was dichotomized Cerebral Performance Category (≤2) at hospital discharge; secondary outcomes included rates of specific neurologic complications. From 429 ECMO runs over 3 years, 57 ECPR patients were identified, representing an increase in ECPR utilization compared with 41 cases over the previous 6 years. Fifty-two (91%) suffered in-hospital cardiac arrest, and 36 (63%) had an initial nonshockable rhythm. Median low-flow time was 31 minutes. Overall, 26 (46%) survived hospitalization and 23 (88% of survivors, 40% overall) had a favorable discharge outcome. Factors independently associated with good neurologic outcome included lower peak lactate, initial shockable rhythm, and higher initial ECMO mean arterial pressure. Neurologic complications occurred in 18 patients (32%), including brain death in 6 (11%), hypoxic-ischemic brain injury in 11 (19%), ischemic stroke in 6 (11%), intracerebral hemorrhage in 1 (2%), and seizure in 4 (7%). We conclude that good neurologic outcomes are possible for well-selected ECPR patients in a high-volume program with increasing utilization and evolving practices. Markers of adequate peri-resuscitation tissue perfusion were associated with better outcomes, suggesting their importance in neuroprognostication.
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: DIPNECH
Authors: Almquist Daniel R. , Ernani Vinicius , Sonbol Mohamad Bassam
Published: April 2021

Purpose of review

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare premalignant condition. Over the past decade, there has been increased recognition and reporting of DIPNECH in the literature. Currently, our understanding is that DIPNECH has a predilection to nonsmoking females around their sixth decade of life. The patients usually present with chronic cough, dyspnea, and computed tomography (CT) showing multifocal pulmonary nodules with associated mosaic attenuation. The clinic history is largely driven by constrictive obliterative bronchiolitis, which typically has an indolent course with progressive respiratory decline and difficult to treat symptoms.

Recent findings

DIPNECH has been found to be associated with carcinoid tumors. Recent data has found that symptomatic DIPNECH patients respond to somatostatin analog (SSA). SSAs provide improvement in symptoms and pulmonary function tests. According to small studies and case series SSAs can be used in conjunction with steroids and bronchodilators for the treatment of respiratory symptoms.

DINPNECH is a premalignant condition that can transform into carcinoid tumors. Although the recent data suggest the potential efficacy of SSA, further studies are needed to validate such results in prospective fashion in addition to investigating other therapeutic agents.
Severe pulmonary toxicity associated with inhalation of pyrethroid-based domestic insecticides (Bop/Sapolio): a case series and literature review
Authors: Vorselaars Adriane D.M. , van den Berg Paulus M. , Drent Marjolein
Published: April 2021

Purpose of review

The current review focuses on serious pulmonary toxicity after inhalation of over the counter available pyrethroid-based insecticides. Pyrethroid is a synthetic product of pyrethrin, which in turn is the active ingredient of pyrethrum, a flower extract.

Recent findings

On the contrary, a large gap of knowledge exists in the association of interstitial lung disease (ILD) with pyrethroids. So far, two cases of ILD, one associated with pyrethrin and one associated with pyrethrum, were described. Existing literature on both other (pulmo)toxic effects of pyrethroids in human and animals is summarized.

We present three cases of severe pulmonary toxicity after inhalation of pyrethroid-based insecticides demanding hospitalization and oxygen therapy. One of these cases died. Although a causal relationship was hard to establish, these cases all demonstrated an obvious history of (repeated) pyrethroid exposure associated with ILD. Moreover, other causes of ILD as well as infections were excluded. Furthermore, studies in mammals as well as aquatic animals confirm (pulmonary) toxicity of pyrethroids. The occurrence of toxicity is dose-dependent but also associated with individual susceptibility. Therefore, we would like to acknowledge that awareness of potential hazards of commercially available insecticides containing pyrethroids to both medical physicians and the public is mandatory.
Adjunctive Ketamine for Sedation in Critically Ill Mechanically Ventilated Patients: An Active-Controlled, Pilot, Feasibility Clinical Trial
Authors: Amer Marwa , Maghrabi Khalid , Bawazeer Mohammed , Alshaikh Kamel , Shaban Mohammad , Rizwan Muhammad , Amin Rashid , De Vol Edward , Baali Mawadah , Altewerki Malak , Bano Mehreen , Alkhaldi Fawziah , Alenazi Sanaa , Hijazi Mohammed
Published: April 2021

Objective

Ketamine has been shown to decrease sedative requirements in intensive care unit (ICU). Randomized trials are limited on patient-centered outcomes. We designed this pilot clinical trial to evaluate the feasibility of using ketamine as an adjunct analgosedative compared with standard of care (SOC) alone and determine preliminary effect size on 28-day mechanical ventilation (MV) duration and ventilator-free days (VFDs).

Design

Pilot, single-center, active-controlled, open-label, randomized clinical trial.

Setting

Medical, surgical, and transplant ICUs at King Faisal Specialist Hospital and Research Center, Saudi Arabia.

Patients and Methods

Adult patients who were intubated within 24 hours, expected to require MV for the next calendar day, and had institutional pain and sedation protocol initiated.

Intervention

Adjunct ketamine infusion 1-2 μg/kg/min for 48 hours versus SOC.

Measurements and Main Results

Total of 83 patients (43 in SOC and 40 in ketamine) were included. Demographics were balanced between groups. Median MV duration was 7 (interquartile range [IQR] 3-9.25 days) in ketamine and 5 (IQR 2-8 days) in SOC, p= 0.15. Median VFDs was 19 (IQR 0-24.75 days) in ketamine and 19 (IQR 0-24 days) in the SOC (p=0.70). More patients attained goal RASS score at 24 and 48 hours in ketamine (67.5% and 73.5%, respectively) compared with SOC (52.4% and 66.7%, respectively). Sedatives and vasopressors cumulative doses, and hemodynamic changes were similar. ICU length-of-stay was 12.5 (IQR 6-21.2 days) in ketamine, compared with 12 (IQR 5.5-23 days) in SOC, p=0.89. Consent and protocol adherence rate were adequate. No serious adverse events were observed in either group.

Conclusions

Use of ketamine as an adjunct analgosedative agent appeared to be feasible and safe with no negative impact on outcomes, including hemodynamics. The protocol of this pilot trial could be improved by modifying ketamine dosing regimen. These findings provide a basis for future, adequately powered, multicenter trial to investigate its association with patient-centered outcomes further.
ASSESSING HOME DELIVERY MODEL OPTION FOR IMPROVING ACCESS TO ANTIRETROVIRAL THERAPY; PROTOCOL FOR A CLUSTER- RANDOMIZED TRIAL IN ANAMBRA STATE, NIGERIA
Authors: Nnenna Ajagu , Ogochukwu Offu , Sunday Nduka , Obinna Ekwunife Ikechukwu
Published: April 2021

Background

Although different antiretroviral (ARV) agents’ delivery models have been explored in Nigeria, yet only about 55% and 35% of affected adults and children respectively are currently on these agents. This, therefore, underscores the need for the identification of newer effective antiretroviral therapy delivery models and best strategies to increase access to ARV therapy in Nigeria.

Method and Analysis

The study will be a cluster randomized controlled trial, which will be conducted in two HIV treatment centers in Anambra State, Nigeria. Participants will be randomized into intervention and control arm. Home delivery personnel will be trained to deliver the ARV drugs at 3months intervals to the homes of those in the intervention group while those in the control group (Facility-based services group) will receive ARVs at the HIV treatment hospital. The primary outcome for the trial will be the difference between groups in the proportion with HIV viral load suppression (≤20 copies/mL) by 12 months and then 24months. Secondary outcome include adherence to ARVs, the cost-effectiveness of home delivery service, and patient satisfaction.

Ethics and dissemination

Nnamdi Azikiwe University Teaching Hospital Health Research Ethics Committee (NAUTHHREC) approved this study (NAUTH/CS/66/VOL.13/VER III/23/2020/011) with a trial registration: Pan African Clinical Trials Registry, ID: PACTR202004535536808 on 8th April 2020. Study dissemination plans include holding advocacy meetings with stakeholders in HIV care, publishing study outcomes in an open-access peer-review journal, and presentation of the outcome at an international conference.

Strength and Limitations of this study

This is the first randomized trial assessing the effectiveness of the home delivery model of antiretroviral therapy.

The primary outcome in this trial will be measured by assessing the difference between baseline HIV viral load and 12/24 months in both the intervention and control arm.

In this study, patients will be assigned to treatment groups and non-treatment groups. This will help us to compare the effect of the home delivery model.

In this study, only one state in Nigeria and two HIV/AIDS treatment hospitals in the state will be used to access the impact of the home delivery model. This may not allow for the generalization of the study findings.

This study could serve as a pilot to a full-fledged national study to access the effectiveness of the home delivery model.