bluuebunny/crossref_metadata_2025 huggingface dataset:
Time to Initiation of Renal Replacement Therapy Among Critically Ill Patients With Acute Kidney Injury: A Current Systematic Review and Meta-Analysis
Authors: Naorungroj Thummaporn , Neto Ary Serpa , Yanase Fumitaka , Eastwood Glenn , Wald Ron , Bagshaw Sean M. , Bellomo Rinaldo
Published: April 2021

OBJECTIVES:

The optimal time to initiate renal replacement therapy in critically ill patients with acute kidney injury is controversial. We investigated the effect of such earlier versus later initiation of renal replacement therapy on the primary outcome of 28-day mortality and other patient-centered secondary outcomes.

DESIGN:

We searched MEDLINE (via PubMed), EMBASE, and Cochrane databases to July 17, 2020, and included randomized controlled trials comparing earlier versus later renal replacement therapy.

SETTING:

Multiple centers involved in eight trials.

PATIENTS:

Total of 4,588 trial participants.

Intervention:

Two independents investigators screened and extracted data using a predefined form. We selected randomized controlled trials in critically ill adult patients with acute kidney injury and compared of earlier versus later initiation of renal replacement therapy regardless of modality.

MEASUREMENTS AND MAIN RESULTS:

Overall, 28-day mortality was similar between earlier and later renal replacement therapy initiation (38.43% vs 38.06%, respectively; risk ratio, 1.01; [95% CI, 0.94–1.09]; I
2 = 0%). Earlier renal replacement therapy, however, shortened hospital length of stay (mean difference, –2.14 d; [95% CI, –4.13 to –0.14]) and ICU length of stay (mean difference, –1.18 d; [95% CI, –1.95 to –0.42]). In contrast, later renal replacement therapy decreased the use of renal replacement therapy (relative risk, 0.69; [95% CI, 0.58–0.82]) and lowered the risk of catheter-related blood stream infection (risk ratio, 0.50, [95% CI, 0.29–0.86). Among survivors, renal replacement therapy dependence at day 28 was similar between earlier and later renal replacement therapy initiation (risk ratio, 0.98; [95% CI, 0.66–1.40]).

CONCLUSIONS:

Earlier or later initiation of renal replacement therapy did not affect mortality. However, earlier renal replacement therapy was associated with significantly shorter ICU and hospital length of stay, whereas later renal replacement therapy was associated with decreased use of renal replacement therapy and decreased risk of catheter-related blood stream infection. These findings can be used to guide the management of critically ill patients with acute kidney injury.
Association of Sedation, Coma, and In-Hospital Mortality in Mechanically Ventilated Patients With Coronavirus Disease 2019–Related Acute Respiratory Distress Syndrome: A Retrospective Cohort Study*
Authors: Wongtangman Karuna , Santer Peter , Wachtendorf Luca J. , Azimaraghi Omid , Baedorf Kassis Elias , Teja Bijan , Murugappan Kadhiresan R. , Siddiqui Shahla , Eikermann Matthias ,   for the SICU Optimal Mobilization Team (SOMT) Group
Published: April 2021

OBJECTIVES:

In patients with coronavirus disease 2019–associated acute respiratory distress syndrome, sedatives and opioids are commonly administered which may lead to increased vulnerability to neurologic dysfunction. We tested the hypothesis that patients with coronavirus disease 2019–associated acute respiratory distress syndrome are at higher risk of in-hospital mortality due to prolonged coma compared with other patients with acute respiratory distress syndrome matched for disease severity.

DESIGN:

Propensity-matched cohort study.

SETTING:

Seven ICUs in an academic hospital network, Beth Israel Deaconess Medical Center (Boston, MA).

PATIENTS:

All mechanically ventilated coronavirus disease 2019 patients between March and May 2020 were identified and matched with patients with acute respiratory distress syndrome of other etiology.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Using clinical data obtained from a hospital registry, we matched 114 coronavirus disease 2019 patients to 228 noncoronavirus disease 2019–related acute respiratory distress syndrome patients based on baseline disease severity. Coma was identified using the Richmond Agitation Sedation Scale less than or equal to –3. Multivariable logistic regression and mediation analyses were used to assess the percentage of comatose days, sedative medications used, and the association between coronavirus disease 2019 and in-hospital mortality. In-hospital mortality (48.3% vs 31.6%, adjusted odds ratio, 2.15; 95% CI, 1.34–3.44; p = 0.002), the percentage of comatose days (66.0% ± 31.3% vs 36.0% ± 36.9%, adjusted difference, 29.35; 95% CI, 21.45–37.24; p < 0.001), and the hypnotic agent dose (51.3% vs 17.1% of maximum hypnotic agent dose given in the cohort; p < 0.001) were higher among patients with coronavirus disease 2019. Brain imaging did not show a higher frequency of structural brain lesions in patients with coronavirus disease 2019 (6.1% vs 7.0%; p = 0.76). Hypnotic agent dose was associated with coma (adjusted coefficient, 0.61; 95% CI, 0.45–0.78; p < 0.001) and mediated (p = 0.001) coma. Coma was associated with in-hospital mortality (adjusted odds ratio, 5.84; 95% CI, 3.58–9.58; p < 0.001) and mediated 59% of in-hospital mortality (p < 0.001).

CONCLUSIONS:

Compared with matched patients with acute respiratory distress syndrome of other etiology, patients with coronavirus disease 2019 received higher doses of hypnotics, which was associated with prolonged coma and higher mortality.
Comparison of corneal biomechanics among primary open-angle glaucoma with normal tension or hypertension and controls
Authors: Wei Ya-Hui , Cai Yu , Choy Bonnie N.K. , Li Bai-Bing , Li Ruo-Shi , Xing Chen , Wang Xia , Tian Tian , Fang Yuan , Li Mei , Pan Ying-Zi
Published: April 2021

Background:

Normal tension glaucoma (NTG) is a less pressure-dependent type of glaucoma with characteristic optic neuropathy. Recently, the biomechanical mechanism has been thought to account for glaucomatous optic neuropathy to some degree. We intended to compare dynamic corneal response parameters (DCRs) among patients with primary open-angle glaucoma with normal tension or hypertension and controls. The correlations between DCRs and known risk factors for glaucoma were also analyzed.

Methods:

In this cross-sectional study, 49 NTG subjects, 45 hypertension glaucoma (HTG) subjects, and 50 control subjects were enrolled. We compared the differences in DCRs using corneal visualization Scheimpflug technology among the NTG, HTG, and control groups. We also analyzed the correlations between DCRs and known risk factors for glaucoma (eg, central corneal thickness [CCT], intraocular pressure [IOP], etc).

Results:

The maximum inverse concave radius (NTG: 0.18 [0.17, 0.20] mm−1; control: 0.17 [0.16, 0.18] mm−1; P = 0.033), deformation amplitude ratio of 2 mm (DAR 2 mm, NTG: 4.87 [4.33, 5.39]; control: 4.37 [4.07, 4.88]; P < 0.001), and DAR 1 mm (NTG: 1.62 [1.58, 1.65]; control: 1.58 [1.54, 1.61]; P < 0.001) were significantly higher in NTG than in the controls. The integrated radius (IR, NTG: 8.40 ± 1.07 mm−1; HTG: 7.64 ± 1.31 mm−1; P = 0.026) and DAR 2 mm (NTG: 4.87 [4.33, 5.39]; HTG: 4.44 [4.12, 5.02]; P < 0.007) were significantly higher, whereas the stiffness parameter at the first applanation (SP-A1, NTG: 91.23 [77.45, 107.45]; HTG: 102.36 [85.77, 125.12]; P = 0.007) was lower in NTG than in HTG. There were no significant differences in the DCRs between HTG and control groups (P > 0.05). In the univariate and multivariate analyses, some of the DCRs, such as IR, were negatively correlated with CCT and IOP, whereas SP-A1 was positively correlated with CCT and IOP.

Conclusions:

The cornea was more deformable in NTG than in HTG or controls. There were no significant differences in corneal deformability between HTG and controls. The cornea was more deformable with the thinner cornea and lower IOP.
Comparison of mini-percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy for treatment of impacted proximal ureteral stones greater than 15 mm
Authors: Lu Guo-Liang , Wang Xiao-Jin , Huang Bao-Xing , Zhao Yang , Tu Wei-Chao , Jin Xing-Wei , Shao Yuan , Wang Da-Wei
Published: April 2021

Background:

The optimal treatment for large impacted proximal ureteral stones remains controversial. The aim of this study was to evaluate the efficacy, safety, and potential complications of mini-percutaneous nephrolithotomy (MPCNL) and retroperitoneal laparoscopic ureterolithotomy (RPLU) in the treatment of impacted proximal ureteral stones with size greater than 15 mm.

Methods:

A total of 268 patients with impacted proximal ureteral stones greater than 15 mm who received MPCNL or RPLU procedures were enrolled consecutively between January 2014 and January 2019. Data on surgical outcomes and complications were collected and analyzed.

Results:

Demographic and ureteral stone characteristics found between these two groups were not significantly different. The surgical success rate (139/142, 97.9% vs. 121/126, 96.0%, P = 0.595) and stone-free rate after 1 month (139/142, 97.9% vs. 119/126, 94.4%, P = 0.245) of RPLU group were marginally higher than that of the MPCNL group, but there was no significant difference. There was no significant difference in the drop of hemoglobin between the two groups (0.8 ± 0.6 vs. 0.4 ± 0. 2 g/dL, P = 0.621). The mean operative time (68.2 ± 12.5 vs. 87.2 ± 16.8 min, P = 0.041), post-operative analgesics usage (2/121, 1.7% vs. 13/139, 9.4%, P = 0.017), length of hospital stay after surgery (2.2 ± 0.6 vs. 4.8 ± 0.9 days, P < 0.001), double J stent time (3.2 ± 0.5 vs. 3.9 ± 0.8 days, P = 0.027), time of catheterization (1.1 ± 0.3 vs. 3.5 ± 0.5 days, P < 0.001), and time of drainage tube (2.3 ± 0.3 vs. 4.6 ± 0.6 days, P < 0.001) of MPCNL group were significantly shorter than that of the RPLU group. The complication rate was similar between the two groups (20/121, 16.5% vs. 31/139, 22.3%, P = 0.242).

Conclusions:

MPCNL and RPLU have similar surgical success and stone clearance in treating impacted proximal ureteral stones greater than 15 mm, while patients undergoing MPCNL had a lower post-operative pain rate and a faster recovery.
Efficacy and safety of human chorionic gonadotropin combined with human menopausal gonadotropin and a gonadotropin-releasing hormone pump for male adolescents with congenital hypogonadotropic hypogonadism
Authors: Liu Ying , Ren Xiao-Ya , Peng Ya-Guang , Chen Shao-Ke , Cheng Xin-Ran , Qin Miao , Wang Xiao-Ling , Song Yan-Ning , Fan Li-Jun , Gong Chun-Xiu
Published: April 2021

Background:

Compared to adult studies, studies which involve the treatment of pediatric congenital hypogonadotropic hypogonadism (CHH) are limited and no universal treatment regimen is available. The aim of this study was to evaluate the feasibility of human chorionic gonadotropin (hCG)/human menopausal gonadotropin (hMG) therapy for treating male adolescents with CHH.

Methods:

Male adolescent CHH patients were treated with hCG/hMG (n = 20) or a gonadotropin-releasing hormone (GnRH) pump (n = 21). The treatment was divided into a study phase (0–3 months) and a follow-up phase (3–12 months). The testicular volume (TV), penile length (PL), penis diameter (PD), and sex hormone levels were compared between the two groups. The TV and other indicators between the groups were analyzed using a t-test (equal variance) or a rank sum test (unequal variance).

Results:

Before treatment, there was no statistical difference between the two groups in terms of the biochemistry, hormones, and other demographic indicators. After 3 months of treatment, the TV of the hCG/hMG and GnRH groups increased to 5.1 ± 2.3 mL and 4.1 ± 1.8 mL, respectively; however, the difference was not statistically significant (P > 0.05, t = 1.394). The PL reached 6.9 ± 1.8 cm and 5.1 ± 1.6 cm (P < 0.05, t = 3.083), the PD reached 2.4 ± 0.5 cm and 2.0 ± 0.6 cm (P < 0.05, t = 2.224), respectively, in the two groups. At the end of 6 months of treatment, biomarkers were in normal range in the two groups. Compared with the GnRH group, the testosterone (T) level and growth of PL and PD were significantly greater in the hCG/hMG group (all P < 0.05). While the TV of both groups increased, the difference was not statistically significant (P > 0.05, t = 0.314). After 9 to 12 months of treatment, the T level was higher in the hCG/hMG group. Other parameters did not exhibit a statistical difference.

Conclusions:

The hCG/hMG regimen is feasible and effective for treating male adolescents with CHH. The initial 3 months of treatment may be a window to optimally observe the strongest effects of therapy. Furthermore, results from the extended time-period showed positive outcomes at the 1-year mark; however, the long-term effectiveness, strengths, and weaknesses of the hCG/hMG regimen require further research.

Trial Registration:

ClinicalTrials.gov, NCT02880280; https://clinicaltrials.gov/ct2/show/NCT02880280.
Effect of diabetes mellitus on long-term outcomes of surgical revascularization in patients with ischemic heart failure: a propensity score-matching study
Authors: Liu Meng , Zhang Hua-Jun , Song Han , Cheng Nan , Wu Yuan-Bin , Wang Rong
Published: April 2021

Background:

Diabetes mellitus (DM) is an important risk factor in the long-term outcomes of surgical revascularization. However, few studies have focused on patients with ischemic heart failure (IHF) and DM, and the results are controversial. This study aimed to evaluate the effect of DM on the long-term outcomes of IHF patients undergoing coronary artery bypass grafting (CABG).

Methods:

In this propensity-matched study, data of IHF patients who underwent CABG in our hospital from January 2007 to December 2017 were analyzed. With a mean 73-month follow-up time, the patients were divided into two groups according to whether they had DM. The primary endpoint was all-cause death, and the secondary endpoint was a composite of all-cause death, stroke, recurrent myocardial infarction, and revascularization.

Results:

There was no significant difference in all-cause mortality between the two groups (5.8% vs. 4.1%, P = 0.216). The incidence of main adverse cardiovascular and cerebrovascular events (MACCE) in the secondary endpoint was significantly higher in the DM group than that in the non-DM group (10.4% vs. 8.1%, P = 0.023).

Conclusions:

DM can negatively affect the long-term outcomes of IHF patients undergoing CABG by significantly increasing the overall incidence of MACCE, though the long-term survival does not show a significant difference between the DM and non-DM patients.
Possible effects of chemokine-like factor-like MARVEL transmembrane domain-containing family on antiphospholipid syndrome
Authors: Ge Ying-Ying , Duan Hong-Ji , Deng Xiao-Li
Published: April 2021

Antiphospholipid syndrome (APS) is a systemic autoimmune disease defined by thrombotic or obstetrical events and persistent antiphospholipid antibodies (aPLs). Chemokine-like factor-like MARVEL transmembrane domain-containing family (CMTM) is widely expressed in the immune system and may closely related to APS. This review aimed to systematically summarize the possible effects of CMTM on APS. Publications were collected from PubMed and Web of Science databases up to August 2020. CKLF, CKLFSF, CMTM, antiphospholipid syndrome, immune cells, and immune molecules were used as search criteria. Immune cells, including neutrophil, dendritic cells (DCs), T-cells, B-cells, and inflammatory cytokines, play an important role in the development of APS. Chemokine-like factor 1 (CKLF1) has a chemotactic effect on many cells and can affect the expression of inflammatory cytokines and adhesion molecules through the nuclear factor-kB (NF-kB) pathway or mitogen-activated protein kinase (MARK) pathway. CKLF1 can participate in the maturation of DCs, T lymphocyte activation, and the activation of neutrophils through the MAPK pathway. CMTM1 may act on Annexin A2 by regulating Ca2+ signaling. CMTM2 and CMTM6 are up-regulated in neutrophils of APS patients. Some CMTM family members influence the activation and accumulation of platelets. CMTM3 and CMTM7 are binding partners of B-cell linker protein (BLNK), thereby linking B cell receptor (BCR) and activating BLNK-mediated signal transduction in B cells. Moreover, CMTM3 and CMTM7 can act on DCs and B-1a cell development, respectively. CMTM may have potential effects on the development of APS by acting on immune cells and immune molecules. Thus, CMTM may act as a novel prognostic factor or immunomodulatory treatment option of APS.
Implication of epigenetic factors in the pathogenesis of type 1 diabetes
Authors: Zhang Jing , Chen Long-Min , Zou Yuan , Zhang Shu , Xiong Fei , Wang Cong-Yi
Published: April 2021

Type 1 diabetes (T1D) is an autoimmune disease that resulted from the severe destruction of the insulin-producing β cells in the pancreases of individuals with a genetic predisposition. Genome-wide studies have identified HLA and other risk genes associated with T1D susceptibility in humans. However, evidence obtained from the incomplete concordance of diabetes incidence among monozygotic twins suggests that environmental factors also play critical roles in T1D pathogenesis. Epigenetics is a rapidly growing field that serves as a bridge to link T1D risk genes and environmental exposures, thereby modulating the expression of critical genes relevant to T1D development beyond the changes of DNA sequences. Indeed, there is compelling evidence that epigenetic changes induced by environmental insults are implicated in T1D pathogenesis. Herein, we sought to summarize the recent progress in terms of epigenetic mechanisms in T1D initiation and progression, and discuss their potential as biomarkers and therapeutic targets in the T1D setting.
Clinical features and risk factors associated with severe COVID-19 patients in China
Authors: Jiang Ning , Liu Yan-Nan , Bao Jing , Li Ran , Ni Wen-Tao , Tan Xing-Yu , Xu Yu , Peng Li-Ping , Wang Xiao-Rong , Zeng Yi-Ming , Liu Dai-Shun , Xue Qing , Li Jia-Shu , Hu Ke , Zheng Ya-Li , Gao Zhan-Cheng
Published: April 2021

Background:

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the world. In this study, we aimed to identify the risk factors for severe COVID-19 to improve treatment guidelines.

Methods:

A multicenter, cross-sectional study was conducted on 313 patients hospitalized with COVID-19. Patients were classified into two groups based on disease severity (nonsevere and severe) according to initial clinical presentation. Laboratory test results and epidemiological and clinical characteristics were analyzed using descriptive statistics. Univariate and multivariate logistic regression models were used to detect potential risk factors associated with severe COVID-19.

Results:

A total of 289 patients (197 nonsevere and 92 severe cases) with a median age of 45.0 (33.0, 61.0) years were included in this study, and 53.3% (154/289) were male. Fever (192/286, 67.1%) and cough (170/289, 58.8%) were commonly observed, followed by sore throat (49/289, 17.0%). Multivariate logistic regression analysis suggested that patients who were aged ≥ 65 years (OR: 2.725, 95% confidence interval [CI]: 1.317–5.636; P = 0.007), were male (OR: 1.878, 95% CI: 1.002–3.520, P = 0.049), had comorbid diabetes (OR: 3.314, 95% CI: 1.126–9.758, P = 0.030), cough (OR: 3.427, 95% CI: 1.752–6.706, P < 0.001), and/or diarrhea (OR: 2.629, 95% CI: 1.109–6.231, P = 0.028) on admission had a higher risk of severe disease. Moreover, stratification analysis indicated that male patients with diabetes were more likely to have severe COVID-19 (71.4% vs. 28.6%, χ

2
 = 8.183, P = 0.004).

Conclusions:

The clinical characteristics of those with severe and nonsevere COVID-19 were significantly different. The elderly, male patients with COVID-19, diabetes, and presenting with cough and/or diarrhea on admission may require close monitoring to prevent deterioration.
Earlier and lower dose administration of sugammadex
Authors: Duranteau Olivier , Fernandez Wendy , Tuna Turgay , Engelman Edgard , Van Obbergh Luc , Tabolcea Ionut
Published: April 2021

BACKGROUND

Sugammadex allows for rapid reversal of muscle relaxation after the use of rocuronium or vecuronium. The lowest recommended dose is 2 mg kg−1 intravenously when there are two twitches during the train-of-four stimulation.

OBJECTIVE

To study the efficacy and risks of a lower dose of sugammadex administered earlier.

DESIGN

Monocentric randomised controlled double-blind study.

SETTING

Academic hospital.

PATIENTS

Eighty patients were enrolled and randomised in 8 groups of 10 patients, 56 were finally evaluated.

INTERVENTIONS

Patients were distributed in two clusters constituting four groups each. In the first cluster, injections were administered after the return of one twitch with the train-of-four (TOF1). In the second cluster, injections were delivered after the return of two twitches with the TOF (TOF2). We created four groups in each cluster for different dosages: placebo, 0.5, 1 or 2 mg kg−1.

MAIN OUTCOME MEASURES

Time between the injection of sugammadex and full recovery (TOF ratio > 0.9) that is expressed in minutes.

RESULTS

Fifty-six successive patients were assessed between February and August 2018. The difference to TOF greater than 0.9 was not statistically significant between groups with the same dose administered at different times (F value = 0.001, P value = 0.975). There was a significant difference between groups with a different dosage administered at the same time (F ratio = 28.34; P value <0.0001). Concerning the time to TOF greater than 0.9 from the time point of TOF1, the timing of the dosages were statistically significant using log rank test (P < 0.0001). No patient presented a reparalysis.

CONCLUSION

No difference between injecting sugammadex at TOF1 or TOF2 was found regarding time to full recovery. Difference regarding sugammadex quantity was found and compatible with other studies.

TRIAL REGISTRATION

clinicaltrials.gov: ‘BRIDION_ERASME’, EudraCT: 2017-005074-19.
Mobile Health Approaches to Breastfeeding
Authors: LEWKOWITZ ADAM K. , CAHILL ALISON G.
Published: April 2021

Breastfeeding is available to nearly all women and has well-established short-term and long-term health benefits for mothers and infants. However, rates of breastfeeding initiation and continuation vary significantly according to sociodemographic factors, particularly in the United States. Mobile health (mHealth) interventions such as web-based/online education or smartphone applications have showed promise in increasing breastfeeding initiation and supporting breastfeeding continuation, and the importance of such mHealth-based breastfeeding support has increased significantly during the ongoing COVID-19 pandemic. This expert commentary reviews prior studies on mHealth in breastfeeding and highlights areas for future research on this topic.
A Randomized Phase 2 Trial Comparing Omidenepag Isopropyl 0.002% Once and Twice Daily in Subjects With Primary Open-angle Glaucoma or Ocular Hypertension (SPECTRUM-6)
Authors: Olander Kenneth W. , Sato Michelle A. , Abrams Marc A. , Jerkins Gary W. , Lu Fenghe , Dinh Phillip , Odani-Kawabata Noriko , Chabi Almira , Shams Naveed K.
Published: April 2021

Précis:

No significant difference was found between the intraocular pressure (IOP) lowering of omidenepag isopropyl 0.002% once daily (QD) and twice daily (BID). However, adverse events (AEs) were higher in the BID arm; thus, QD dosing is the preferred dosing frequency for further investigation.

Purpose:

This phase 2, randomized, double-masked, parallel-arm, multicenter study (NCT03858894) was conducted in the United States to examine whether the efficacy and safety of omidenepag isopropyl 0.002% BID dosing was superior to QD dosing in subjects with primary open-angle glaucoma or ocular hypertension.

Methods:

Randomized subjects (1:1) received omidenepag isopropyl 0.002% QD (n=50) or BID (n=48) for 6 weeks (after a ≤4-week washout period). IOP was measured at 8:00 am, 12:00 pm, and 4:00 pm at baseline and weeks 2 and 6. The primary efficacy endpoint was IOP at each timepoint at weeks 2 and 6. AEs were evaluated.

Results:

Baseline mean diurnal IOP (±SD) post washout was 25.4±2.9 mm Hg (BID) and 24.6±1.9 mm Hg (QD). At weeks 2 and 6, clinically significant IOP reductions from baseline were observed for omidenepag isopropyl BID and QD treatments. Least-squares mean (±SE) IOP differences (BID versus QD) were not statistically significant (week 2: 0.44±0.68 to 1.08±0.65 mm Hg; week 6: 0.36±0.63 to 0.68±0.68 mm Hg) at any timepoint (all P > 0.05). AEs were 3-fold greater in the BID arm (41.7%; QD: 14.0%); the most frequently reported AE was conjunctival/ocular hyperemia (BID: 22.9%; QD: 2.0%). Five subjects discontinued omidenepag isopropyl prematurely, 4 of 5 owing to AEs (BID: 4; QD: 0).

Conclusion:

In this study, the benefit-risk profile of omidenepag isopropyl 0.002% QD was more favorable than the benefit-risk profile of BID. This difference was driven by a higher incidence of local tolerability issues in the BID arm.
Prediction of 10-2 Visual Field Loss Using Optical Coherence Tomography and 24-2 Visual Field Data
Authors: Sullivan-Mee Michael , Hedayat Mahdi , Charry Nicole , Katiyar Suchitra , Kee Helen , Kimura Bryan , Pensyl Denise
Published: April 2021

Precis:

Using standard glaucoma structural and functional tests, clinicians accurately predicted the presence/absence of 10-2 glaucomatous visual field (VF) loss in 90% of the eyes in this study.

Purpose:

To investigate how well clinicians with variable experience can predict the presence and location of 10-2 VF loss using structural and functional data that are routinely obtained for glaucoma assessment.

Methods:

Within a test set of 416 eyes (210 subjects) who were diagnosed glaucoma suspect or primary open-angle glaucoma (with most eyes having mild disease), 6 clinicians were asked to predict the presence and hemispheric location of 10-2 VF loss using 24-2 VF and spectral-domain optical coherence tomography structural data. Prediction accuracies were calculated for each clinician and compared using the weighted κ-statistic. Receiver operating characteristic analyses were used to evaluate models for predicting 10-2 VF loss.

Results:

Among the 6 clinicians, mean (range) accuracy, false negatives, and false positives for predicting presence/absence of 10-2 VF loss were 90% (87% to 92%), 4.7% (2.4% to 7.0%), and 5.4% (1.7% to 7.5%) respectively. The mean (range) weighted κ-statistic was 0.75 (0.64 to 0.83), suggesting good or very good inter-rater agreement between examiners. Mean accuracy for correctly predicting hemispheric location was 73% (range, 65% to 82%) with the most common error occurring in eyes with both superior and inferior 10-2 VF defects in which one hemisphere was correctly identified but the other missed.

Conclusions:

In this study, the presence/absence of 10-2 glaucomatous VF loss was highly predictable using standard functional and structural clinical metrics. These findings suggest that 10-2 VF testing is not needed to reliably recognize and confirm central VF involvement in most eyes with glaucoma. Whether error related to identifying second hemisphere involvement in 10-2 VF loss is important requires further study.
Migration of the XEN45 Gel Stent into the Anterior Chamber Managed by Trimming the Implant
Authors: Sigona Mark , Murthy Shashidhar
Published: April 2021

We report a case of migration of the XEN45 gel stent into the anterior chamber successfully treated with trimming of the implant. To the best of our knowledge, this management strategy for migration of the implant has not previously been reported.
Intraluminal Stent Optimization for the Baerveldt Glaucoma Implant: An Experimental Study
Authors: DiSclafani Mark , Richards David , Schneider Alex , Whitfield Whitney , Ayoubi Yasmin
Published: April 2021

Precis:

Our laboratory study determined the approximate suture diameter for use in intraluminal stenting of the Baerveldt glaucoma implant (BGI) to prevent postoperative hypotony. Commercial 3-0 monofilament nylon sutures which are commonly used may vary significantly outside of this diameter.

Purpose:

Postoperative hypotony is a complication of surgical treatment of glaucoma using the BGI. One method utilized to prevent early postoperative hypotony is intraluminal stenting of the implant with monofilament sutures. The present study attempted to determine optimal stent diameter in microns for 3-0 monofilament sutures to reduce outflow and thereby reduce the risk of postoperative hypotony using the BGI.

Materials and Methods:

A laboratory bench model of the anterior chamber was utilized to measure the outflow rate of balanced salt solution through the BGI at pressures of 20 and 40 mm Hg while utilizing commercially available 3-0 monofilament nylon stents of various diameters. The BGI tube has an inner diameter of 300 µm. In addition, 3-0 nylon sutures were studied for variability by measuring the diameters at 10 equally spaced points along the length of each sample using a digital micrometer.

Results:

Average experimental flow rates decreased with increasing intraluminal stent diameter and increased with increasing pressure. An intraluminal stent diameter of 250 µm yielded a flow rate of 40 µL/min at a nominal pressure of 20 mm Hg. Diameters of the tested 3-0 monofilament nylon sutures were all within the United States Pharmacopeia diameter range of 200 to 250 µm, but diameters varied significantly depending on the manufacturer.

Conclusions:

In our laboratory model, the optimal stent diameter to reduce aqueous flow to a level approaching the normal aqueous production is at least 250 µm. Secondarily, commercially available 3-0 monofilament nylon suture materials showed variable diameters within the United States Pharmacopeia diameter range.
Endothelial Cell Density After XEN Implant Surgery: Short-term Data From the Italian XEN Glaucoma Treatment Registry (XEN-GTR)
Authors: Oddone Francesco , Roberti Gloria , Posarelli Chiara , Agnifili Luca , Mastropasqua Leonardo , Carnevale Carmela , Micelli Ferrari Tommaso , Pace Vincenzo , Sacchi Matteo , Cremonesi Elena , Uva Maurizio , Menchini Martina , Brescia Lorenza , Figus Michele
Published: April 2021

Precis:

XEN implant was associated with low endothelial cell density (ECD) reduction. In fact, when combined with phacoemulsification, the reduction in ECD was similar to that expected after phacoemulsification alone.

Purpose:

The purpose of this study was to assess the impact of XEN implant, either alone or in combination with phacoemulsification, on ECD.

Methods:

Multicenter, prospective, observational study conducted on consecutive open-angle glaucoma patients, who were enrolled in the Italian XEN Glaucoma Treatment Registry and have complete endothelial cell count data at baseline and at 6 months after implantation. The primary endpoint was the mean percentage change in ECD between baseline and month 6.

Results:

The study included 108 open-angle glaucoma eyes (68 in the XEN-solo and 40 eyes in the XEN+phaco groups) and 60 control eyes (phaco-solo group). As compared with baseline, mean (95% confidence interval, CI) ECD reduction was −5.6% (−7.0% to −4.9%), −11.3% (−13.8% to −10.9%), and −13.0% (14.8% to −11.8%) in the XEN-solo, XEN+phaco, and phaco-solo groups, respectively (P=0.0004, <0.0001, and <0.0001, respectively). As compared with the XEN-solo group, the ECD reduction was significantly greater in the XEN+phaco group (mean difference=5.7%; 95% CI: 4.1%-7.3%, P<0.0001) and in the phaco-solo group (mean difference=7.4%; 95% CI: 5.7%-9.1%, P<0.0001). ECD reduction was similar in XEN+phaco and phaco-solo groups (P=0.9). In absolute terms, ECD reduction was significantly greater in the XEN+phaco (mean difference=169±306, P=0.021) and in the phaco-solo (mean difference=192±302, P=0.0022) groups than in the XEN-solo group.

Conclusions:

The mean ECD reduction 6 months after XEN implantation was low. The ECD reduction in the XEN+phaco group was larger than in the XEN-solo group but was similar to that observed in the phaco-solo group.
Agreement Between 10-2 and 24-2C Visual Field Test Protocols for Detecting Glaucomatous Central Visual Field Defects
Authors: Chakravarti Tutul , Moghadam Mohamad , Proudfoot James A. , Weinreb Robert N. , Bowd Christopher , Zangwill Linda M.
Published: April 2021

Precis:

Moderate to substantial agreement between 10-2 and 24-2C perimetry for detecting central field defects suggests that adding central test points to the 24-2 protocol may improve efficiency of visual field (VF) testing for glaucoma management.

Purpose:

The purpose of this study was to assess agreement between Humphrey Visual Field Analyzer 10-2 and 24-2C test protocols for detecting glaucomatous defects in the central 10 degrees of the visual field (CVFDs).

Materials and Methods:

VFs from 165 eyes of 18 healthy individuals, 12 glaucoma suspects and 62 glaucoma patients who completed 10-2 and 24-2C VF testing protocols within 6 months were included. CVFDs on 10-2 and 24-2C (within the central 22 points) test grids required a cluster of 3 contiguous points with P<5%, 5%, and 1% or <5%, 2%, and 2% within a hemifield on the total deviation (TD) or pattern deviation (PD) plot. Cohen kappa (k) was used to assess agreement between 10-2 and 24-2C test grids in identifying CVFDs. Specificity of each testing strategy was assessed in VFs from healthy eyes.

Results:

CVFDs in suspect and glaucoma eyes were combined and reported as localized to superior, inferior or both hemifields based on TD and PD plots for 10-2 and 24-2C test grids. Moderate to substantial agreement was observed between 10-2 and 24-2C grids for detecting any CVFD from PD (k=0.551) and TD (k=0.651) plots. Specificity was high in healthy eyes ranging from 0.94 to 1.0 for both test protocols.

Conclusion:

Substantial agreement for identifying CVFDs using the 24-2C and 10-2 protocols suggests that combining tests by adding central test points to the 24-2 test grid may supplant the need for 2 perimetry regimens for detecting central and peripheral glaucomatous VF damage.
A Novel Approach to Measuring Binocular Visual Fields in Glaucoma
Authors: Kuzhuppilly Neetha I.R. , Pai Vijaya H. , Daruka Ravi , Jain Vikram , Menon Sudha
Published: April 2021

Precis:

Combined average visual field index (VFI) is a simple, novel tool for binocular visual field which agrees with the existing binocular integrated visual field (IVF) model, as well as patient reported activity limitation in glaucoma.

Purpose:

The aim was to determine the correlation between novel models of binocular visual field with the existing IVF and glaucoma activity limitation (GAL-9).

Materials and Methods:

IVFs were calculated from the monocular visual fields of 58 patients with primary glaucoma and the novel binocular visual field models termed binocular summation visual field index (BiSumVFI) and combined average visual field index (CaVFI) were derived from the VFIs of both fields. GAL-9 questionnaire was administered to the patients. The relationship between IVF and the 2 newer models of binocular fields were determined and the correlation of IVF, BiSumVFI, and CaVFI with GAL-9 was estimated.

Results:

A very strong correlation was seen between IVF and BiSumVFI (r=−0.913, P<0.001, confidence interval: −0.958 to −0.821) and also between IVF and CaVFI (r=−0.896, P<0.001, confidence interval: −0.947 to −0.802). Linear regression analysis showed a significant R
2 of 0.902 (P<0.001) to predict IVF from BiSumVFI and R
2 of 0.847 (P<0.001) to predict IVF from CaVFI. IVF, BiSumVFI, and CaVFI correlated moderately and significantly with GAL-9 with correlation coefficients of 0.481, −0.499, and −0.505, respectively.

Conclusion:

The binocular summation VFI and combined average VFI models of binocular visual field are good predictors of IVF in glaucoma. They correlate well with the existing IVF model in estimating patients’ perception of activity limitation in glaucoma.
Trans-conjunctival Erosion of a Novel SIBS Microshunt After Revision Surgery Using Mitomycin C
Authors: Michaels Luke , Holland Lee , Mercieca Karl
Published: April 2021

This article describes the first reported case of trans-conjunctival Preserflo microshunt erosion after revision surgery augmented with mitomycin C. Recommendations to avoid this complication include removal of original microshunt and limiting secondary application of mitomycin C.
Psychological Distress Among Patients With Advanced Cancer
Authors: Huda Nurul , Shaw Malissa Kay , Chang Hsiu-Ju
Published: April 2021

Background

Psychological distress is a common problem that occurs in advanced cancer patients; however, the concept has not been sufficiently specified or clearly described.

Objective

To develop succinct understanding of psychological distress among advanced cancer patients.

Methods

A literature search was conducted using the CINAHL, PubMed, and MEDLINE databases from 1988 to 2018. The analysis used the 8 steps of concept analysis developed by Walker and Avant. The final articles selected focused on definitions, predictors, determinant factors, and measurements of psychological distress in advanced cancer.

Results

Analysis identified that psychological distress in terms of advanced cancer has 5 defining attributes: (1) anxiety, (2) depression, (3) death anxiety, (4) demoralization, and (5) a perceived inability to cope effectively. The primary antecedent is treatment complexity. The consequences are acceptance and living in the present positively, lower performance status, poor quality of life, suicide, and hastened death.

Conclusions

This concept analysis clarifies the meaning of the concept and differentiates the concept of psychological distress from other emotional symptoms that advanced cancer patients commonly experience. It provides clarity in meaning by examining various ways the concept is used in the area of nursing.

Implications for Practice

The identified attributes of psychological distress play vital roles in nursing assessments and should be used as guidance for nurses to provide appropriate nursing care for advanced cancer patients. Interventions should address antecedents and consequences of the concept and consider individuals as persons with unique characteristics.
Breast Cancer Screening Practices and Satisfaction With Healthcare Providers in Chinese Women
Authors: Zhang Xuehui , Li Ping , Zhang Chunmiao , Guo Pingping , Wang Jie , Liu Na , Yang Shu , Yu Lin , Zhang Wei
Published: April 2021

Background

The Chinese government has proposed cancer screening guidelines and launched 2 cancer screening programs to improve screening practices. However, the screening participation rates of Chinese women remain low. Exploring the factors affecting breast cancer screening to promote cancer screening is necessary.

Objective

The aim of this study was to investigate women's satisfaction with healthcare providers and screening practices.

Methods

A cross-sectional survey was conducted from November 2019 to April 2020 in Changchun, Jilin Province, China. The Medical Care Satisfaction Scale and SERVQUAL were used to quantify women's satisfaction with doctors and nurses, respectively.

Results

Women's satisfaction with doctors (68.81 ± 11.08; range, 20–100) and with nurses (87.64 ± 16.17; range, 22–110) was moderate. Compared with women who had not participated in screening within the past 2 years, screened women reported higher satisfaction with doctors (P = .026) and nurses (P = .012). Older age (P = .004) was an independent predictor of women's satisfaction with doctors. Similarly, women's education level (P = .049), chronic disease history (P = .029), and physical examination history (P = .039) were 3 independent predictors of women's satisfaction with nurses.

Conclusions

Future intervention strategies can not only increase the screening rates by providing existing intervention methods but also improve women's satisfaction with healthcare providers to promote screening practices.

Implications for Practice

This article provides a theoretical basis for healthcare providers to increase female screening practices. It also provides references for improving existing intervention methods.
Fatigue and Vigilance-Related Factors in Family Caregivers of Patients With Advanced Cancer
Authors: Yiin Jia-Jean , Chen Ya-Yun , Lee Kwo-Chen
Published: April 2021

Background

Family caregivers (FCs) commonly experience fatigue during caregiving. The factors of fatigue in the FCs of patients with advanced cancer have not yet been investigated in Taiwan.

Objective

This study investigated potential predictors of fatigue in the FCs of patients with advanced cancer.

Methods

A descriptive, cross-sectional study was conducted on 184 FCs. Data were collected using the Checklist Individual Strength and the palm-based psychomotor vigilance test. A linear regression model was the main statistical method for identifying the factors predictive of fatigue in FCs.

Results

Subjective and objective measurements revealed that 95% of the FCs had fatigue and poor vigilance. Those who spent more time each day on caregiving tasks, had no religious beliefs, had a full- or part-time job, and had a greater caregiver burden experienced greater fatigue.

Conclusions

Fatigue and poor vigilance were common in the Taiwanese FCs of patients with advanced cancer. Family caregivers with risk factors for fatigue must be identified and given access to resources for assistance.

Implication for Practice

Healthcare providers must proactively assess FCs for fatigue and vigilance status and provide interventions appropriate for individual needs.
Pediatric Education Discharge Support Strategies for Newly Diagnosed Children With Cancer
Authors: Hockenberry Marilyn , Haugen Maureen , Slaven Abigail , Skeens Micah , Patton Lindsey , Montgomery Kathleen , Trimble Katherine , Coyne Kelly , Hancock Donna , Ahmad Amer , Daut Emily , Glover Leslie , Brown Lauren , St Pierre Sherryann , Shay April , Maloney Jacqueline , Burke Michelle , Hatch Daniel , Arthur Megan
Published: April 2021

Background

Discharge education practices vary among institutions and lack a standardized approach for newly diagnosed pediatric oncology patients and their parents.

Objective

The purpose of this American Nurses Credentialing Center–supported pediatric multisite trial was to determine the feasibility and effectiveness of 2 nurse-led Parent Education Discharge Support Strategies (PEDSS) for families with a child who is newly diagnosed with cancer.

Interventions/Methods

A cluster randomized clinical trial design assigned 16 Magnet-designated sites to a symptom management PEDSS intervention or parent support and coping PEDSS intervention. Outcome measures evaluated at baseline, 1, and 2 months after diagnosis include symptom experiences, parent perceptions of care, unplanned service utilization, and parent evaluation of the PEDSS interventions.

Results

There were 283 newly diagnosed children and their parent participating in this study. Linear mixed models revealed pain differed over time by the intervention; children in the symptom management group had a greater decrease in pain. Greater nausea and appetite disturbances were experienced by older children in both groups. Fatigue and sleep disturbance showed a significant decrease over time in both groups. The symptom management group reported significantly greater satisfaction with the PEDSS intervention.

Conclusions

This study is among the first to examine the effects of 2 different early-discharge planning strategies for families of a newly diagnosed child with cancer. The evidence supports a standardized discharge education strategy that can be successfully implemented across institutions.

Implications for Practice

Nurses play a major role in the educational preparation and discharge of newly diagnosed pediatric cancer patients and their families.
Effects of Rehabilitation Program on Quality of Life, Sleep, Rest-Activity Rhythms, Anxiety, and Depression of Patients With Esophageal Cancer
Authors: Chen Hui-Mei , Lin Yi-Yun , Wu Yu-Chung , Huang Chien-Sheng , Hsu Po-Kuei , Chien Ling-I , Lin Yu-Jung , Huang Hsiu-Li
Published: April 2021

Background

Esophageal cancer patients experience severe symptoms and poor quality of life.

Objective

We examined the effects of a rehabilitation program on quality of life, sleep, rest-activity rhythms, anxiety, and depression of esophageal cancer patients.

Methods

Forty-four patients with esophageal cancer were randomly assigned to an experimental group, which underwent a 12-week brisk walking and diet education program, or a control group, which received standard care. Health-related quality of life, subjective and objective sleep quality, rest-activity rhythms, anxiety, and depression were assessed at baseline and post intervention.

Results

A generalized estimating equation analysis revealed that, after intervention, compared with the control group, the experimental group exhibited significantly improved reflux (P = .022; effect size, 0.32) and marginally improved emotional (P = .069; effect size, 0.27) and social (P = .069; effect size, 0.27) functions; constipation (P = .050; effect size, 0.29), eating difficulty (P = .058; effect size, 0.27), anxiety (P = .050; effect size, 0.29), and total sleep time (P = .068; effect size, 0.39).

Conclusions

The rehabilitation program may improve health-related quality of life and sleep and alleviate anxiety in patients with esophageal cancer.

Implications for Practice

A rehabilitation program comprising exercise and diet education is a feasible and low-cost intervention for improving quality of life of patients with esophageal cancer. Healthcare team members may consider it as a nonpharmacological treatment option for patients.