bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19: should we consider it as a septic shock? (The treatment of COVID-19 patients in the ICU)
Authors: Roger Claire
Published: January 2021

Purpose of review

The severe acute respiratory syndrome coronavirus 2 associated coronavirus disease 2019 (COVID-19) illness combines a syndrome of viral replication and a host dysregulated inflammatory response. Despite sharing a similar etiology, COVID-19 patients present different patterns from asymptomatic to severely hypoxemic patients. In some patients, patterns of multiorgan failure have been observed similarly to patients with bacterial sepsis. This review aimed to analyze the currently available data on the treatment of COVID-19, specifically the most studied antiviral agents and therapies targeting the immune system including those that have been investigated in sepsis.

Recent findings

In the last months, several trials have been conducted worldwide to try to identify optimal antiviral treatments against COVID-19. Antiviral agents such as lopinavir/ritonavir, remdesivir, hydroxychloroquine have been investigated as well as specific and non-specific immunomodulators in order to determine their potential efficacy against SARS-Cov2.

To date, the vast majority of the studied antiviral and immunomodulatory agents have failed to improve outcomes of patients with COVID-19 except for dexamethasone. Many other trials are currently underway with new antiviral agents and various immunomodulatory agents with potential clinical benefit for COVID-19 patients. Despite these emerging data, robust controlled clinical trials assessing patient-centered outcomes remain imperative.
Roadmap for Conducting Neuroscience Research in the COVID-19 Era and Beyond: Recommendations From the SNACC Research Committee
Authors: Vlisides Phillip E. , Vogt Keith M. , Pal Dinesh , Schnell Eric , Armstead William M. , Brambrink Ansgar M. , Kuo Philip , Nelson Priscilla , Vacas Susana , Goettel Nicolai , Aglio Linda S. , Farag Ehab , Gorji Reza , García Paul S. , Koerner Ines P.
Published: January 2021

The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of neuroscience research. At the 2020 Society of Neuroscience in Anesthesiology and Critical Care (SNACC) Annual Meeting, the SNACC Research Committee met virtually to discuss research challenges encountered during the COVID-19 pandemic along with possible strategies for facilitating research activities. These challenges and recommendations are included in this Consensus Statement. The objectives are to: (1) provide an overview of the disruptions and challenges to neuroscience research caused by the COVID-19 pandemic, and; (2) put forth a set of consensus recommendations for strengthening research sustainability during and beyond the current pandemic. Specific recommendations are highlighted for adapting laboratory and human subject study activities to optimize safety. Complementary research activities are also outlined for both laboratory and clinical researchers if specific investigations are impossible because of regulatory or societal changes. The role of virtual platforms is discussed with respect to fostering new collaborations, scheduling research meetings, and holding conferences such that scientific collaboration and exchange of ideas can continue. Our hope is for these recommendations to serve as a valuable resource for investigators in the neurosciences and other research disciplines for current and future research disruptions.
Ankle Fractures: Minimally Invasive Surgery
Authors: Yañez Arauz Juan M.
Published: January 2021

Many patients with ankle fractures present different comorbidities, like diabetes, peripheral vascular disease, tobacco use, fractures blisters, etc., and have a high risk of wound healing complications. The potential for wound dehiscence and infection with open reduction and internal fixation is higher in these patients. The minimally invasive technique allows for proper stabilization with a minimal approach and less soft tissue trauma. These percutaneous methods, allow to reduce the damage of the soft tissues, protect vascularization and, consequently, improve the outcomes with faster rehabilitation and faster return to the patient’s activity. According to the anatomic joint reduction and stable fracture fixation criteria, the author developed a minimally invasive technique for the most frequent type of ankle fracture, with good and excellent outcomes in long-term follow-up. The author mentions that this technique involves higher exposition to fluoroscopy.

Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Combined Conventional and Transulnar Percutaneous Pinning of the Displaced Distal Radius Fracture
Authors: Atyyia Ahmed N. , Diab Ramy A.
Published: January 2021

Background:

This study aimed to study if combined conventional and transulnar percutaneous pinning of the displaced distal radius fracture could maintain the reduction of this unstable fracture.

Materials and Methods:

In all, 64 patients with unstable distal radius fractures were treated by this technique. The mean follow-up period was 18 months (range: 16 to 34 mo). Clinical and radiologic analyses were provided.

Results:

Radiographic union was achieved at an average of 6.4 weeks (range: 5 to 9 wk). Radiologically: according to Sarmiento et al’s modification of Lindstrom criteria, restoration of anatomy was excellent in 40 patients (62.5%), good in 16 patients (25%), and fair in 8 patients (12.5%). At 6-month follow-up, the average radial height was 7.9 mm (range: 5 to 11 mm), volar tilt was 7.8 degrees (range: 4 to 16 degrees), and radial inclination was 20 degrees (range: 17 to 28 degrees). Functionally, according to the Sarmiento et al’s modification of the demerit point system of Gartland and Werley, the outcome was excellent in 36 patients, good in 22 patients, and fair in 6 patients. The most common complication was pin tract infection (4 patients), followed by loss of reduction in 2 patients and complex regional pain syndrome in 2 patients.

Conclusions:

This procedure is technically facile, minimizes costs, and provides near-anatomic healing based on radiographic criteria. Our case series demonstrated excellent and good clinical outcomes following this technique.
Bedside Evaluation for Early Sepsis Intervention: Addition of a Sepsis Response Team Leads to Improvement in Sepsis Bundle Compliance
Authors: Suliman Sally , Price John , Cahill Meredith , Young Taylor , Furmanek Stephen , Galvis Juan , Shoff Hugh , Parra Frankie , Stevenson Gina , Cavallazzi Rodrigo
Published: January 2021

Objectives:

Sepsis is associated with high morbidity and mortality and high healthcare costs. We hypothesized that a multifaceted quality improvement project would lead to an improvement in compliance with the sepsis “bundles.”

Design:

Patients presenting to the emergency department that met criteria for sepsis at triage triggered notification of an emergency department physician and the sepsis response team in order to facilitate timely completion of the 3-hour bundles. The primary outcome was compliance with the seven sepsis bundle components. Secondary outcomes included all-cause inhospital mortality, hospital length of stay, and time in the emergency department.

Setting:

The study was conducted at a 404-bed tertiary academic medical center over a 2-year period.

Patients OR SUBJECTS:

The study included patients that presented to the emergency department that met criteria for sepsis.

MEASUREMENTS OR Main Results:

The study included 163 patients. Overall compliance with the sepsis bundle was 79% (95% CI, 72–84%). There was significant improvement in comparison with the hospital’s historical compliance of 37% (p < 0.001). Compliance with the individual bundle components ranged from 80% to 100%. Sixteen patients died (10%) in the hospital. There was no statistically significant difference between the compliant and noncompliant groups regarding the secondary outcomes of length of stay or inhospital mortality.

Conclusions:

This study found that implementation of a sepsis response team can improve compliance with completion of sepsis bundles. This indicates that it is feasible to implement a multidisciplinary quality initiative to improve timely treatment of patients with sepsis at an academic center using a resident-driven sepsis response team.
An 18-Year-Old Survivor With a Body Mass Index of 73.9 kg/m2 on Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019: A Collaborative Multidisciplinary Effort
Authors: Gaglani Bhavita , Westphal Nathaniel David , Bryant Casey , Gaillard John P. , Vishneski Susan R. , Gibbs Kevin W. , Khanna Ashish K.
Published: January 2021

Background:

As the severe acute respiratory syndrome coronavirus 2 demonstrates greater sickness in people with obesity, extracorporeal membrane oxygenation rescue is increasingly being used in this patient population. An appropriate body mass index threshold where the use of extracorporeal membrane oxygenation for this viral syndrome would not be a useful therapy remains unknown and matter of ongoing debate.

Case:

We describe a case of acute respiratory distress syndrome secondary to coronavirus disease 2019 infection in setting of super morbid obesity (body mass index 73.9 kg/m2) with the successful use of extracorporeal membrane oxygenation. To our knowledge, this is the heaviest patient to survive coronavirus disease 2019 with venovenous extracorporeal membrane oxygenation so far.

Conclusions:

While extracorporeal membrane oxygenation in obese patients must be carefully considered in coronavirus disease 2019 acute respiratory distress syndrome, a multidisciplinary care team effort is a requisite for a successful outcome in case like ours.
Relationship Between Skeletal Muscle Area and Density and Clinical Outcome in Adults Receiving Venovenous Extracorporeal Membrane Oxygenation
Authors: Bear Danielle E. , MacGowan Liisa , Elstad Maria , Puthucheary Zudin , Connolly Bronwen , Wright Rebeka , Hart Nicholas , Harridge Stephen , Whelan Kevin , Barrett Nicholas A. , Camporota Luigi
Published: January 2021

OBJECTIVES:

To investigate the prevalence of low skeletal muscle index (area normalized for height) and density, their trajectory of change, and to determine associations with clinical outcome in adults with severe respiratory failure requiring venovenous extracorporeal membrane oxygenation.

DESIGN:

Prospective observational study.

PATIENTS:

Adults receiving venovenous extracorporeal membrane oxygenation for a minimum of 72 hours and a maximum of 6 months between September 2010 and June 2017, who had a CT scan which included the third lumbar vertebra.

INTERVENTION:

None.

MEASUREMENTS AND MAIN RESULTS:

Skeletal muscle index and density was determined using Slice-O-Matic V5.0 (TomoVision, Montreal, QC, Canada). Low skeletal muscle index and density were defined using published criteria. Regression models were used to assess for associations between muscle index and density and clinical outcome. Two-hundred fifteen patients, median (interquartile range) age 46 years (35.0–57.0 yr) were included. Forty-five patients (21.1%) had low skeletal muscle index, and 48 (22.3%) had low skeletal muscle density on commencement of venovenous extracorporeal membrane oxygenation. Low skeletal muscle index was more prevalent in males (28.8% vs 11.6%; χ2 = 9.4; p = 0.002) and was associated with a longer duration of venovenous extracorporeal membrane oxygenation (B = 5.0; 95% CI, 0.2–9.9; p = 0.042). Higher skeletal muscle density was independently associated with ICU survival (odds ratio 1.6 per 10 Hounsfield units; 95% CI, 1.1–2.5; p = 0.025). No relationship was observed between skeletal muscle index nor density and physical function. Adequacy of energy and protein did not influence change in skeletal muscle index or density.

CONCLUSIONS:

Low skeletal muscle index at the commencement of venovenous extracorporeal membrane oxygenation was associated with a longer duration of venovenous extracorporeal membrane oxygenation, whereas preserved skeletal muscle density was associated with improved survival.
Moving beyond the initial colonoscopy: a call for action
Authors: Lim Kia T. , Decruz Glenn M. , Ng Cheng H. , Jain Sneha R. , Chin Yip H. , Chong Choon S. , Devi Kamala
Published: January 2021

Introduction

The evolution of colorectal screening has made headway with continual efforts globally to increase screening rates for colonoscopy-naïve patients. However, little has been done to encourage repeat colonoscopies after the initial scope despite recommendations to repeat colonoscopy every 10 years, with the uptake rates of repeat colonoscopy remaining abysmal at 22%.

Methods

Previously, a qualitative systematic review evaluated the barriers and facilitators patients faced in their decisions to undergo colonoscopy, analyzing articles from Medline, Embase, CINAHL, PsycINFO and Web of Science. Key findings from articles which highlighted factors influencing patients’ decisions to return for repeat colonoscopies were summarized.

Results

Three articles were identified in the search. Facilitators for repeat colonoscopy included patients’ assurance garnered from fostered trust in the patient–provider relationship, their intrinsic motivations from fear of cancer and an innate appreciation for the significance of obtaining repeated colonoscopies. Procedural factors such as the option for procedural visualization, its comprehensiveness and the utilization of anesthesia were also crucial motivators. Barriers that patients highlighted comprised of cumbersome bowel preparation and potential complications.

Discussion

Recently, minimal research has been conducted on the sentiments of healthcare providers and patients regarding repeat colonoscopy. The lack of emphasis from healthcare institutions on encouraging patients to repeat colonoscopy after 10 years prevents effective colorectal cancer screening. To proficiently alleviate the burden of colorectal cancer, patient counseling has to shift beyond explaining colonoscopy risks and complications to promoting regular follow-up scopes. This article thus calls for more studies to focus on evaluating the uptake of repeat colonoscopies.
Role of various imbalances centered on alveolar epithelial cell/fibroblast apoptosis imbalance in the pathogenesis of idiopathic pulmonary fibrosis
Authors: Wang Qing , Xie Zhao-Liang , Wu Qi , Jin Zhi-Xian , Yang Chao , Feng Jing
Published: January 2021

There have been recent extensive studies and rapid advancement on the pathogenesis underlying idiopathic pulmonary fibrosis (IPF), and intricate pathogenesis of IPF has been suggested. The purpose of this study was to clarify the logical relationship between these mechanisms. An extensive search was undertaken of the PubMed using the following keywords: “etiology,” “pathogenesis,” “alveolar epithelial cell (AEC),” “fibroblast,” “lymphocyte,” “macrophage,” “epigenomics,” “histone,” acetylation,” “methylation,” “endoplasmic reticulum stress,” “mitochondrial dysfunction,” “telomerase,” “proteases,” “plasminogen,” “epithelial-mesenchymal transition,” “oxidative stress,” “inflammation,” “apoptosis,” and “idiopathic pulmonary fibrosis.” This search covered relevant research articles published up to April 30, 2020. Original articles, reviews, and other articles were searched and reviewed for content; 240 highly relevant studies were obtained after screening. IPF is likely the result of complex interactions between environmental, genetic, and epigenetic factors: environmental exposures affect epigenetic marks; epigenetic processes translate environmental exposures into the regulation of chromatin; epigenetic processes shape gene expression profiles; in turn, an individual's genetic background determines epigenetic marks; finally, these genetic and epigenetic factors act in concert to dysregulate gene expression in IPF lung tissue. The pathogenesis of IPF involves various imbalances including endoplasmic reticulum, telomere length homeostasis, mitochondrial dysfunction, oxidant/antioxidant imbalance, Th1/Th2 imbalance, M1–M2 polarization of macrophages, protease/antiprotease imbalance, and plasminogen activation/inhibition imbalance. These affect each other, promote each other, and ultimately promote AEC/fibroblast apoptosis imbalance directly or indirectly. Excessive AEC apoptosis and impaired apoptosis of fibroblasts contribute to fibrosis. IPF is likely the result of complex interactions between environmental, genetic, and epigenetic factors. The pathogenesis of IPF involves various imbalances centered on AEC/fibroblast apoptosis imbalance.
Magnetic resonance imaging of cerebrospinal fluid spread in the epidural space and postdural puncture headache in obstetrics
Authors: Ahmed Iftikhar , Majeed Amer , Fernando Roshan , Hyare Harpreet , Columb Malachy , Setty Thunga
Published: January 2021

BACKGROUND

Currently, performing an epidural blood patch (EBP) for postdural puncture headache (PDPH) remains a subjective clinical decision. An evidence-based protocol may be of value in identifying women at high risk of developing a severe PDPH.

OBJECTIVE

To investigate a potential correlation between the extent of CSF spread in the epidural space, as noted on Magnetic Resonance Imaging (MRI), and the likelihood of development of severe PDPH in obstetric patients.

DESIGN

A prospective double-blind quasi-observational study.

SETTING

Eight tertiary obstetric units, from NHS hospitals.

PATIENTS

Parturients with accidental dural puncture (ADP) underwent T1 and T2-weighted MRI scans of the brain and lumbar spine within 48 h after delivery. All women were followed up, daily, for 1 week.

MAIN OUTCOME MEASURES

For each woman, a PDPH severity score was calculated using a four-point Verbal Reporting Scale (none = 0, mild = 1, moderate = 2, severe = 3), with additional points awarded for visual, auditory and emetic symptoms. MRIs were reported by a neuroradiologist, blind to the patient details, using a predefined MRI score.

RESULTS

Twenty-two parturients were recruited; 86% (n=19) developed PDPH and 10 of these (53%) required an EBP. The median (range) time for the onset of PDPH was 24 (4 to 126) hours. The median (range) cumulative PDPH severity score was 10 (0 to 21), whereas, the median (range) MRI score was 2.5 (0 to 12). Spearman (r
s) analysis identified a significant positive correlation (r
s = 0.46; P = 0.024) between cumulative PDPH severity and MRI scores. Of all the radiological features identified in an MRI (lumbar dural shift, caudal brain displacement, epidural or intrathecal blood), the presence of intrathecal blood was most strongly correlated with PDPH severity (P = 0.043).

CONCLUSION

Following an ADP, the extent of CSF spread in the epidural space correlates with the severity of subsequent PDPH.

CLINICAL TRIAL NUMBER AND REGISTRY URL

ISRCTN14959004, https://www.isrctn.com/.
Alternative Sampling Devices to Collect Dried Blood Microsamples: State-of-the-Art
Authors: Delahaye Lisa , Veenhof Herman , Koch Birgit C. P. , Alffenaar Jan-Willem C. , Linden Rafael , Stove Christophe
Published: January 2021

Dried blood spots (DBS) have been used in newborn screening programs for several years. More recently, there has been growing interest in using DBS as a home sampling tool for the quantitative determination of analytes. However, this presents challenges, mainly because of the well-known hematocrit effect and other DBS-specific parameters, including spotted volume and punch site, which could add to the method uncertainty. Therefore, new microsampling devices that quantitatively collect capillary dried blood are continuously being developed. In this review, we provided an overview of devices that are commercially available or under development that allow the quantitative (volumetric) collection of dried blood (-based) microsamples and are meant to be used for home or remote sampling. Considering the field of therapeutic drug monitoring (TDM), we examined different aspects that are important for a device to be implemented in clinical practice, including ease of patient use, technical performance, and ease of integration in the workflow of a clinical laboratory. Costs related to microsampling devices are briefly discussed, because this additionally plays an important role in the decision-making process. Although the added value of home sampling for TDM and the willingness of patients to perform home sampling have been demonstrated in some studies, real clinical implementation is progressing at a slower pace. More extensive evaluation of these newly developed devices, not only analytically but also clinically, is needed to demonstrate their real-life applicability, which is a prerequisite for their use in the field of TDM.
Role of whole exome sequencing for unidentified genetic syndromes
Authors: Aggarwal Shagun
Published: January 2021

Purpose of review

The current review seeks to provide a comprehensive update on the revolutionary technology of whole exome sequencing (WES) which has been used to interrogate abnormal foetal phenotypes since the last few years, and is changing the paradigms of prenatal diagnosis, facilitating accurate genetic diagnosis and optimal management of pregnancies affected with foetal abnormalities, as well enabling delineation of novel Mendelian disorders.

Recent findings

WES has contributed to identification of more than 1000 Mendelian genes and made rapid strides into clinical diagnostics in recent years. Diagnostic yield of WES in postnatal cohorts has ranged from 25 to 50%, and this test is now a first tier investigation for various clinical presentations. Various abnormal perinatal phenotypes have also been investigated using WES since 2014, with diagnostic yields ranging from 8.5 to 80%. Studies in foetal phenotypes have been challenging and guidelines in this cohort are still evolving.

WES has proven to be a disrupting technology, enabling genetic diagnosis for pregnancies complicated by previously unexplained foetal abnormalities, and revealing a significant contribution of single gene disorders in these, thereby changing clinical diagnostic paradigms. The application of this technology in perinatal cohorts is also providing interesting insights into single gene defects presenting as previously unknown genetic syndromes, hence contributing to expansion of Mendelian genetics to encompass various foetal phenotypes.
Surgeon Preferences for Endothelial Keratoplasty in Canada
Authors: Kisilevsky Eli , Srikumaran Divya , Chew Hall F.
Published: January 2021

Purpose:

To quantify practice patterns and assess attitudes and barriers to performing Descemet membrane endothelial keratoplasty (DMEK) in Canada.

Methods:

An anonymous online survey was distributed to all corneal surgeons included in the Canadian Ophthalmological Society's database.

Results:

Of 70 listed surgeons, 41 responses were collected (58.6% response rate). Most respondents were practicing in university hospitals (43.9%) or private practice (43.9%) and were involved in residency teaching (77.5%). Most respondents performed DMEK surgery (78%), and most surgeons prepared their own DMEK grafts (62%). Surgeons who were in practice for more than 25 years were less likely to perform DMEK (75% vs. 13%, P = 0.009) and performed fewer corneal transplantation in the previous year (mean 28 vs. 44, P = 0.022). Those who were not performing DMEK reported access to preprepared tissue (77.8%), access to wet laboratory courses (50%), and assistance or mentorship (50%) as common facilitators to start performing DMEK surgery.

Conclusions:

DMEK is the preferred surgery for endothelial disease among Canadian corneal surgeons. Eye banks play a key role in increased adoption by ensuring an adequate supply of tissue and prestripping tissue for surgeons new to DMEK to be confident in performing it. Ensuring adequate supply of donor tissue and supplementary surgeon training can ensure that DMEK surgery is widely available in Canada.
Techniques, Outcomes, and Complications of Preloaded, Trifolded Descemet Membrane Endothelial Keratoplasty Using the DMEK EndoGlide
Authors: Ighani Mehrnaz , Dzhaber Daliya , Jain Shivani , De Rojas Joaquin O. , Eghrari Allen O.
Published: January 2021

Purpose:

To describe 2 insertion techniques, outcomes, and complications of preloaded, trifolded Descemet membrane endothelial keratoplasty (DMEK) cases using the DMEK EndoGlide inserter.

Methods:

This retrospective, consecutive case series analyzed the first 35 cases using the DMEK EndoGlide performed between October 2018 and October 2019 at a single center. Preloaded, trifolded DMEK tissues were delivered through a fluid-injected or pull-through technique. To inject the tissue, a burst of fluid was delivered into the lumen of the injector with a second instrument. Postoperatively, best-spectacle corrected visual acuity (BSCVA), pachymetry, graft survival, and complications were assessed.

Results:

Thirty-five eyes of 29 patients underwent DMEK alone (n = 11), with cataract surgery (n = 21), or with additional surgeries (n = 3). Of these, 19 (54.3%) grafts were injected. Video analysis revealed a median time of 3.5 minutes from graft insertion to opening for gas insertion. Median preoperative BSCVA of 0.398 logMAR improved to 0.097 logMAR (P = 0.02) at 9 months. Median pachymetry decreased from 619 μm to 551 μm (P = 0.03) at 9 months. Median donor endothelial cell count of 2890.5 cells/mm2 reduced to 2123 cells/mm2 (26.6% endothelial cell loss; P = 0.008) 6 months postoperatively. One (2.9%) graft failed due to inverted marking at the eye bank and subsequent reverse implantation.

Conclusions:

Pre-loaded, tri-folded tissues can be implanted with acceptable levels of endothelial cell loss. We describe a no-touch method of injecting pre-loaded, tri-folded tissue and highlight incorrect marking as a potential complication. This may not be identifiable intraoperatively due to lack of scroll formation.
Is laser trabeculoplasty the new star in glaucoma treatment?
Authors: Töteberg-Harms Marc , Meier-Gibbons Frances
Published: January 2021

Purpose of review

For decades, laser trabeculoplasty has been a well-proven therapeutic option in glaucoma management, and more recently, it has only gained in popularity. One reason for such popularity is that selective laser trabeculoplasty (SLT) is a therapy independent of patient adherence, which is typically low among glaucoma patients. Consequently, the number of studies on SLT has multiplied throughout the past years. This review provides an overview of studies on SLT from the last 12 months.

Recent findings

The studies on treatment outcome show a wide range of success rates of SLT reaching between 18 and 88%; however, study designs differ and many studies are not directly comparable. The prospective laser trabeculoplasty for open-angle glaucoma and ocular hypertension (LiGHT) trial has demonstrated good efficacy of SLT – 75% of the eyes achieved their target pressure without drops and 58% after a single SLT.

SLT has proven to be effective in lowering IOP with satisfactory success rates even after single SLT. SLT is repeatable independent of patient's adherence.
Comparative study of phacoemulsification parameters with and without nitinol filament nuclear disassembly
Authors: Wiley William F. , Bafna Shamik , Logothetis Hercules D.
Published: January 2021

Purpose:

The purpose of this study was to evaluate the impact of nitinol microfilament lens disassembly using the miLOOP device on phacoemulsification parameters in routine cataract surgery.

Setting:

Private practice in Cleveland, Ohio.

Design:

Retrospective comparative consecutive case series.

Methods:

A chart review of consecutive cataract surgery cases in a single center operated by a single surgeon was conducted. Eyes were grouped by whether they underwent nitinol filament nuclear disassembly. Phacoemulsification energy, phacoemulsification time, and irrigation/aspiration (I/A) recorded during the operation were compared. Bilateral eyes were included only if the contralateral eye was in the opposite group.

Results:

A total of 212 eyes in 131 patients were eligible for analysis, including 81 subjects with both eyes. Most eyes (93%) had grade 2+ or 3+ nuclear sclerotic cataracts. A total of 102 eyes (48%) underwent nitinol filament nuclear disassembly preceding phacoemulsification. For all eyes, there was a 16% reduction in phacoemulsification energy, with a larger drop in grade 3+ eyes (−22%). Phacoemulsification and I/A times also reduced significantly (−19% and −37%, respectively, P < .02).

Conclusions:

Nitinol microfilament nuclear disassembly reduced total phacoemulsification energy and time during cataract surgery, particularly in severe cataracts.
Intraoperative posterior polar cortical disc defect: sign of intact posterior capsule
Authors: Titiyal Jeewan S. , Nair Sridevi , Kaur Manpreet , Rawat Jyoti , Mazumdar Saima Ahsan
Published: January 2021

Purpose:

To describe the incidence and morphological characteristics of posterior polar cortical disc defect (PPCDD) sign observed during phacoemulsification in posterior polar cataract (PPC).

Setting:

Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Design:

Prospective case series.

Methods:

Sixty-seven eyes of 56 patients with PPC undergoing phacoemulsification were evaluated. Outcome measures were the incidence and characteristics of the intraoperative PPCDD sign, as well as its relation to the intraoperative surgical dynamics and posterior capsule (PC) dehiscence.

Results:

Of the 67 eyes evaluated, the PPCDD sign was seen in 86.5% of eyes (58/67). Among these, 93.1% of eyes (54/58) showed a complete disc defect, whereas 6.9% of eyes (4/58) had a partial disc defect with incomplete margins. In the majority of cases (89.6%; 52/58), the PPCDD sign was seen after epinuclear plate and plaque aspiration. Among the 9 eyes that did not show the PPCDD sign, en bloc separation of the plaque and cortical matter from the PC was observed in 2 eyes, the plaque remained adherent to the PC till the end of cortical fiber aspiration in 3 eyes, and intraoperative PC rupture (PCR) was observed during the plaque separation in 4 eyes. The incidence of PCR in eyes without PPCDD sign was significantly higher (44.4% vs 0%; P < .001).

Conclusions:

The visualization of intraoperative PPCDD sign during phacoemulsification in PPC is suggestive of an intact PC and associated with a significantly lower rate of intraoperative PCR as compared with eyes without the PPCDD sign.
Detection of Gene Promoter Methylation and Protein Expression of p21 in Psoriasis
Authors: Liu Xin-Mei , Luo Dong , Wang Hui-Qin , Zhang Jing-Zhan , Kang Xiao-Jing , Wu Wei-Dong
Published: January 2021

Object:

The study was aimed to detect the methylation patterns in psoriasis tissues.

Methods:

We collected 15 psoriasis tissues and 19 uninvolved psoriatic samples from psoriasis patients, and 3 normal skin samples from healthy control, and investigated the methylation levels of p21 gene promoter by pyrosequencing analysis. The expression of p21 protein was detected by immunohischemistry in 38 psoriatic tissues and 16 uninvolved samples from psoriasis patients, and 3 normal samples from healthy control. The differences among the three groups were analyzed by Chi-square test.

Results:

We found that there was no significant difference in the frequency of p21 gene promoter methylation among the three groups (P=0.204), howerver the p21 protein expression were different among the three groups (P=0.007).

Conclusion:

This methylation marker maybe not an indicator for the detection and monitoring of psoriasis.
Use of Tissue Plasminogen Activator Alteplase Purge Solution in an Impella 5.5 Heart Pump
Authors: Tunney Robert K. , Tidwell William P. , Kumar Anupam A. , Brinkley Marshall
Published: January 2021

Standardized Impella purge solutions have traditionally consisted of 5–40% dextrose with or without unfractionated heparin as a means of anticoagulation. Such a solution serves to create a pressure barrier preventing entry of blood into the pump’s motor housing with heparin providing adequate purge pathway patency in the event of this occurring. We present a case of tissue plasminogen activator (tPA, Activase) utilization in lieu of the recommended purge solution due to concern for thrombus formation of the purge pathway in a 51-year-old male with cardiogenic shock status-post Impella 5.5 heart pump placement for hemodynamic support while awaiting heart transplantation. The purge solution was successfully administered for 48 hours without complication and a reduction in average purge pressure with increase in purge flow rate was observed.
Carbon Monoxide Diffusing Capacity Predicts Cardiac Readmission in Patients Undergoing Left Ventricular Assist Device Implantation in Japan
Authors: Tsuji Masaki , Amiya Eisuke , Bujo Chie , Hara Toru , Saito Akihito , Minatsuki Shun , Maki Hisataka , Ishida Junichi , Hosoya Yumiko , Hatano Masaru , Imai Hiroko , Nemoto Mariko , Kagami Yukie , Endo Miyoko , Kimura Mitsutoshi , Ando Masahiko , Shimada Shogo , Kinoshita Osamu , Ono Minoru , Komuro Issei
Published: January 2021

Carbon monoxide diffusion capacity (DLCO) is impaired in heart failure patients; however, its clinical impact has not been well investigated in the left ventricular assist device (LVAD) population. We explored the predictive value of preoperative DLCO in the survival and cardiac readmission rates after LVAD implantation. Seventy-six patients who received continuous-flow LVAD as bridge-to-transplant therapy from November 2007 to September 2018 and underwent pulmonary function test before LVAD implantation were included. The primary study endpoints were death and readmission for heart failure or arrhythmia (cardiac readmission). Patients were stratified into two groups according to the percent of predicted DLCO (%DLCO). Pulmonary vascular resistance (PVR) was equivocal between the groups preoperatively, whereas the low DLCO group (%DLCO < 80%) showed significantly high PVR postoperatively. The mortality rate was not different between the groups. The 2 year cardiac readmission rate was 33.5% in the low DLCO group and 8.7% in the high DLCO group (%DLCO ≥ 80%) (P = 0.028). The %DLCO was associated with cardiac readmission in univariate and multivariate analyses (hazard ratio: 4.32; 95% CI: 1.50–15.9; P = 0.005). Low %DLCO was associated with high PVR postoperatively and was a risk factor for cardiac readmission after LVAD implantation.
Extracorporeal Membrane Oxygenation for COVID-19 Respiratory Distress Syndrome: An Italian Society for Cardiac Surgery Report
Authors: Loforte Antonio , Di Mauro Michele , Pellegrini Carlo , Monterosso Christian , Pelenghi Stefano , Degani Antonella , Rinaldi Mauro , Cura Stura Erik , Sales Gabriele , Montrucchio Giorgia , Mangino Domenico , Terrini Alberto , Pacini Davide , Affronti Alessandro , Tarzia Vincenzo , Bottio Tomaso , Pantaleo Antonio , Donatelli Francesco , Miceli Antonio , Santini Francesco , Salsano Antonio , Colli Andrea , Ravenni Giacomo , Montalto Andrea , Musumeci Francesco , Salvador Loris , Gerosa Gino , Parolari Alessandro , Picichè Marco
Published: January 2021

An increased need of extracorporeal membrane oxygenation (ECMO) support is going to become evident as treatment of SARS-CoV-2 respiratory distress syndrome. This is the first report of the Italian Society for Cardiac Surgery (SICCH) on preliminary experience with COVID-19 patients receiving ECMO support. Data from 12 Italian hospitals participating in SICCH were retrospectively analyzed. Between March 1 and September 15, 2020, a veno-venous (VV) ECMO system was installed in 67 patients (94%) and a veno-arterio-venous ECMO in four (6%). Five patients required VA ECMO after initial weaning from VV ECMO. Thirty (42.2%) patients were weaned from ECMO, while 39 (54.9%) died on ECMO, and six (8.5%) died after ECMO removal. Overall hospital survival was 36.6% (n = 26). Main causes of death were multiple organ failure (n = 14, 31.1%) and sepsis (n = 11, 24.4%). On multivariable analysis, predictors of death while on ECMO support were older age (p = 0.048), elevated pre-ECMO C-reactive protein level (p = 0.048), higher positive end-expiratory pressure on ventilator (p = 0.036) and lower lung compliance (p = 0.032). If the conservative treatment is not effective, ECMO support might be considered as life-saving rescue therapy for COVID-19 refractory respiratory failure. However warm caution and thoughtful approaches for timely detection and treatment should be taken for such a delicate patients population.
Combinations of fibrinolytic gene polymorphisms (plasminogen activator inhibitor type 1 4G/5G, factor XIII Val34Leu and angiotensin-converting enzyme I/D) in women with idiopathic infertility
Authors: Velickovic Jelena , Jelicic Mihajlo , Stojkovic Oliver
Published: January 2021

During normal pregnancy depressed fibrinolytic system is caused by changes in many factors, which could be influenced by different gene polymorphisms. The aim of this study was to investigate the combination of fibrinolysis-related gene polymorphisms in women with idiopathic infertility. We genotype polymorphisms 4G/5G in plasminogen activator inhibitor type 1 (PAI-1), Val34Leu in factor XIII (FXIII) and I/D in angiotensin-converting enzyme (ACE) gene. The patients group consisted of 83 females with idiopathic infertility, while the control group included 121 females with at least one born child. The alleles and genotypes distributions showed no significant differences between analyzed groups. Although higher frequency of PAI-1 5G5G genotype in patients did not reach statistical significance, 5G5G genotype of PAI-1 in combination with ValVal genotype of FXIII leads to higher risk for infertility (P < 0.05). In addition, when we added ACE I/D polymorphism in analysis, the 4G in PAI-1 and D allele in ACE, showed protective effect in combination with FXIII polymorphism (P < 0.05). The finding that combined homozygosity of 5G of PAI-1, commonly associated with greater fibrinolytic activity and bleeding tendency, in combination with Val genotype of FXIII impose a risk for female idiopathic infertility. The protective effect of alleles 4G (PAI-1) and D (ACE) suggest that different combinations of polymorphisms influencing fibrinolysis could lead to better established hemostatic balance and reproductive success. Further analyses, with larger number of samples, as well as assessment of additional biochemical parameters of fibrinolysis, should be performed to clarify the role of gene polymorphisms on fibrinolysis and consequently their influence on reproductive success.
A survey to gauge confidence of Indian clinicians on three primary devices for blood pressure measurement
Authors: Kumar Ravinder , Sahani Ashish Kumar , Wander Gurpreet Singh
Published: January 2021

Purpose

As per its commitment at Minamata convention, and in line with other developed economies, the Indian government is set to ban the use of mercury sphygmomanometers by end of the year 2020. However, the Mercury sphygmomanometer is still widely used by clinicians in India. We conducted a survey to gauge the confidence of Indian clinicians on three primary devices of blood pressure (BP) measurement – mercury sphygmomanometer, aneroid sphygmomanometer and automatic digital BP monitor.

Materials and methods

We conducted an anonymous online survey through various clinician forums asking questions related to accuracy, reliability and expectations from BP monitors.

Results

A total of 139 responses were received from clinicians across specialties. The results show that more than 80% of clinicians believe that mercury sphygmomanometers are the most accurate and nearly 50% find it most reliable. For most respondents, accuracy is the most important parameter and convenience of use and portability are secondary considerations. If a mercury-free sphygmomanometer is offered with the same accuracy and reliability, 88% of respondents said they are willing to buy it.

Conclusions

Mercury sphygmomanometer is still perceived favorably over other non-mercury alternatives by most Indian clinicians. Validated oscillometric devices should be promoted to bring about change in the perspectives of clinicians towards adopting non-mercury alternatives of BP measurement in India.
An update on hypersensitivity pneumonitis: what a clinician wants to know
Authors: Huntley Christopher C. , Walters Gareth I.
Published: January 2021

Purpose of review

A recent international collaboration has updated the clinical definition and diagnostic recommendations for hypersensitivity pneumonitis, focusing on fibrotic and non-fibrotic phenotypes. However, how these transfer to clinical practice and their impact upon clinical management and prognosis of hypersensitivity pneumonitis is unclear. This review will focus on recent advances in the understanding of the clinical aspects of hypersensitivity pneumonitis, predominantly its epidemiology, diagnosis, classification and treatment.

Recent findings

Hypersensitivity pneumonitis is a rare disease within the general population, with variable geographical incidence because of environmental, cultural and occupational factors. Confidence in diagnosis relies upon the presence of clinical features with a temporal relationship to an associated exposure, radiological and histopathological features, bronchiolo-alveolar lavage lymphocytosis and precipitating antibodies/specific immunoglobulin G to antigens. Although emerging evidence regarding nintedanib use in progressive fibrotic interstitial lung disease is promising, the majority of therapies (corticosteroids and immunosuppressive agents) used traditionally in hypersensitivity pneumonitis lack a robust evidence base.

With a clear definition of fibrotic and nonfibrotic hypersensitivity pneumonitis phenotypes now established, clinical research trials (predominantly randomized controlled trials) should clarify and resolve the discussion regarding antigen avoidance, corticosteroid therapy, immunosuppressive therapy and antifibrotic therapy in fibrotic and nonfibrotic subtypes of hypersensitivity pneumonitis.
Pancreatic and hepatobiliary manifestations of nonalcoholic fatty pancreatic disease: a referral multi-center experience
Authors: Sbeit Wisam , Greener Tomer , Kadah Anas , Mari Amir , Goldin Eran , Mahamid Mahmud , Khoury Tawfik
Published: January 2021

Background

Nonalcoholic fatty pancreatic disease (NAFPD) is an increasingly recognized disease with accumulating evidence of associated co-morbidities. However, data linked with other pancreatic and hepatobiliary disorders are still being studied.

Aims

To investigate the association of pancreato-hepato-biliary disorders with NAFPD.

Methods

At two Israeli medical centers, a total of 569 patients were analyzed who underwent endoscopic ultrasound for hepatobiliary indications. They were divided into groups depending on the presence or absence of NAFPD.

Results

Seventy-eight patients (13.7%) had NAFPD (NAFPD group) vs. 491 patients (86.3%) without (non-NAFPD group). NAFPD was significantly associated with obesity [odds ratio (OR) 4.98, 95% confidence interval (CI) 3.02–8.24, P < 0.0001], hypertension (OR 2.55, 95% CI 1.57–4.15, P = 0.0002), active smoking (OR 2.02, 95% CI 1.04–3.93, P = 0.03), and hyperlipidemia (OR 2.86, 95% CI 1.58–5.18, P = 0.0005). On multivariate regression analysis: fatty liver (OR 5.49, 95% CI 2.88–10.49, P < 0.0001), main duct intraductal papillary mucinous neoplasm (M-IPMN) (OR 2.69, 95% CI 1.05–6.9, P = 0.04), and gallstones (OR 1.93, 95% CI 1.1–3.38, P = 0.02) were the most endoscopically and ultrasonographically detected diseases that significantly correlated with NAFPD.

Conclusion

NAFPD was associated with several diseases, most importantly the premalignant M-IPMN. Further investigation for these coexisting diseases should be considered.
Very low rate of residual neoplasia after non-curative endoscopic submucosal dissection: a western single-center experience
Authors: Santos-Antunes João , Marques Margarida , Carneiro Fátima , Macedo Guilherme
Published: January 2021

Background

Short and long outcomes of endoscopic submucosal dissection (ESD) are now well described. However, the outcome of non-curative ESDs is scarcely reported.

Objective

To describe our experience with non-curative ESDs, assessing the presence of residual lesion in the endoscopic follow-up or surgery.

Methods

Data of all the patients submitted to ESD between January 2015 and June 2020 in our tertiary Center was prospectively recorded. Among non-curative ESDs, the presence of residual neoplasia after complementary surgical treatment or in the endoscopic follow-up was assessed.

Results

In that period, a total of 388 ESDs were performed in the esophagus (n = 13), stomach (n = 222), colon (n = 20), rectum (n = 132), and duodenum (n = 1). Median follow-up was 30 months (range 4–69 months). ESD was technically successful in 376 lesions (97%). From 325 neoplastic epithelial lesions and 18 neoplastic submucosal tumors, 61 (17.8%) did not fulfill curative criteria entirely. Positive horizontal margins (n = 28), positive vertical margins (n = 10) and submucosal invasion >SM1 (n = 14) were the main causes of non-curative ESD. Among patients with non-curative ESDs, 20 were operated and 33 were already followed-up by endoscopy, and only seven (13%, corresponding to 2% of the total number of successful neoplastic ESDs) had residual neoplasia.

Conclusion

Our real-life experience showed that the vast majority of non-curative ESD did not actually have residual neoplasia in the follow-up.
Sleep disruption in nonalcoholic fatty liver disease: What is the role of lifestyle and diet?
Authors: Akram Siddique T. , Ewy Matthew W. , Said Adnan
Published: January 2021

Background

Patients with nonalcoholic fatty liver disease (NAFLD) have sleep disruption. The aim of this study is to understand how underlying factors such as diet, degree of liver disease and morningness–eveningness tendencies contribute to this sleep disruption.

Methods

Patients with NAFLD were recruited from liver clinics at a University and Veterans Affairs practice. Patients with decompensated cirrhosis were excluded. Patients completed self-reported surveys to evaluate sleep disturbance using the Epworth Sleepiness Scale (ESS) and chronotype (circadian preference) using the morningness–eveningness questionnaire (MEQ). Information on occupation, physical activity and dietary intake were collected at clinic intake. Dietary intake was evaluated via food-frequency questionnaire and analyzed as individual categories or grouped on the basis of dietary composition.

Results

A 54 patients completed the survey; 37% were female. Median ESS was 8 ± 4.2 and 37% of NAFLD patients were found to have sleep disturbance as defined by ESS >10. Sleep disturbance was common in NAFLD regardless of the liver disease stage. Dietary factors, including higher added sugar (P = 0.01), candy intake (P = 0.01), elevated Ferritin level (P = 0.04) and elevated platelet count (P = 0.05), were significantly associated with sleep disturbance. Chronotype, time to sleep, and duration of sleep were not associated with sleep disruption.

Conclusions

Sleep disruption is present in NAFLD regardless of underlying cirrhosis. Interventions aimed at improving dietary and lifestyle practices such as reduced sugar intake may help mitigate the risk for sleep disruption in NAFLD. Further longitudinal studies are needed to further delineate these links.