bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of a Transversus Abdominis Plane Block Including Clonidine Versus Intrathecal Morphine on Nausea and Vomiting After Caesarean Section: A Randomized Controlled Trial
Authors: Dereu D , Savoldelli G.L. , Mercier Y. , Combescure C. , Mathivon S. , Rehberg B.
Published: May 2020

(Eur J Anaesthesiol. 2019;36:575–582)

Pain management within the first 36 hours after cesarean section can have significant impact on postoperative maternal health and satisfaction. Inadequate pain relief may be associated with delayed breastfeeding and increased risk of postoperative complications. In addition, persistent pain at the 2-week postpartum mark is a risk factor for ongoing pain at 3 months postpartum as well as postpartum depression. Anesthesiologists often administer intrathecal morphine (ITM) during spinal anesthesia to manage postcesarean pain, but this approach often results in side effects such as postoperative nausea and vomiting (PONV) and pruritus; these adverse effects can considerably reduce maternal satisfaction. The current investigators conducted this study to determine if a transversus abdominis plane (TAP) block that included both local anesthetic and clonidine was a better pain management treatment compared with ITM in terms of PONV occurrence, other adverse effects, analgesic efficacy, and postoperative recovery quality.
Using interpreters for Deaf patients and patients with limited English proficiency
Authors: Brown Heather L.
Published: May 2020

Communication breakdowns with patients who do not use English as their primary language can hurt the patient-provider relationship and leave patients at risk for health disparities and adverse reactions. An estimated 36 million patients in the United States identify as Deaf and more than 60 million patients prefer to speak a language other than English in primary communication. This article discusses the unique needs of patients who are Deaf or have limited English proficiency, and how to provide qualified interpreters to help improve patient communication and care.
Update
Authors: Craig-Brangan Karen Jean , Day Mary Patricia
Published: May 2020

Continuous review of current research and practice has resulted in updates to the American Heart Association guidelines for CPR and emergency cardiovascular care. This article examines the recommendations and their implementation into current healthcare practice.
Reviewing pain management options for patients in active labor
Authors: Farnham Tammy
Published: May 2020

Pain perception and preferences for pain management are unique to each woman in labor. This article provides an overview of the physiology of labor pain, discusses available nonpharmacologic and pharmacologic approaches to managing pain during active labor, and discusses potential benefits and risks for each option.
The show must go on: an update on clinical experiences and clinical studies on novel pharmaceutical developments for the treatment of atopic dermatitis
Authors: Honstein Tatjana , Werfel Thomas
Published: May 2020

Purpose of review

This review reports on published clinical studies (full publications) with novel therapeutic agents on the treatment of atopic dermatitis with a focus on the last 2 years.

Recent findings

Atopic dermatitis is a T-cell driven complex inflammatory skin disease. The secretion of cytokines involving not only particularly Th2 but also Th17 and Th22 cell subsets provides a broad spectrum of potential therapeutical targets. A couple of studies on atopic dermatitis with new therapeutical antibodies that target not only the Th2 cytokines IL-4, IL-13, IL- 31 but also additional targets, such as TSLP, IL-22 or IL-33, and innovative small molecules binding to the histamine-4 receptor, the phosphodiesterase-4, the aryl hydrocarbon receptor or downstream molecules like Janus kinases have recently been published with promising results on symptoms and signs of atopic dermatitis.

Applications of newly developed drugs in clinical studies or already in daily practice show a substantial progress in the treatment of moderately to severely affected patients with atopic dermatitis not responsive to standard topical treatments with corticosteroids or topical calcineurin inhibitors alone. Moreover, novel treatment approaches generate new knowledge about (anti)inflammatory effects of immune modulations in atopic dermatitis and the heterogeneity of patient subgroups, which may stimulate further innovations in this field.
Opioid Policy Changes During the COVID-19 Pandemic - and Beyond
Authors: Davis Corey S. , Samuels Elizabeth A.
Published: May 2020

The United States is currently in the midst of 2 public health emergencies: COVID-19 and the ongoing opioid crisis. In an attempt to reduce preventable harm to individuals with opioid use disorder (OUD), federal, state, and local governments have temporarily modified law and policy to increase access to OUD treatment and divert some individuals at high risk away from the correctional system. In this Commentary, we briefly describe how people with OUD are at increased risk for COVID-19, discuss existing policy barriers to evidence-based prevention and treatment for individuals with OUD, explain the temporary rollbacks of those barriers, and argue that these changes should be made permanent. We also suggest several additional steps that federal and state governments can urgently take to reduce barriers to care for individuals with OUD, both during the current crisis and beyond.
Gambling During the COVID-19 Crisis – A Cause for Concern
Authors: Håkansson Anders , Fernández-Aranda Fernando , Menchón Jose M. , Potenza Marc N. , Jiménez-Murcia Susana
Published: May 2020

The COVID-19 pandemic has the potential to worsen mental health problems in the general population, including increasing engagement in addictive behaviors. Here, we describe observations suggesting that the current crisis and its sequelae may worsen problem gambling. The current pandemic may impact financial and psychological well-being due to social isolation during spatial distancing, and these stressors in conjunction with substantial changes in gambling markets (land-based, online) during the pandemic may significantly influence gambling behaviors. This situation calls for rapid research initiatives in this area and preventive and regulatory measures by multiple stakeholders.
The effect of neuromuscular electrical stimulation on function outcome measures following muscle fatigue: a systematic review
Authors: Day James , Newman Joseph
Published: May 2020

Background:

The ability to recover after bouts of fatigue caused by high-intensity physical activity is one of the greatest challenges in sports medicine and exercise science. Neuromuscular electrical stimulation has been used with the theory that it decreases blood metabolites more quickly and therefore decreases recovery time. This systematic review analyzed primary research articles that investigated functional outcomes related to the use of neuromuscular electrical stimulation as a recovery modality.

Methods:

SportsDiscus, US National Library of Medicine (PubMed), and Current Nursing and Allied Health Literature (CINAHL) were used to search “neuromuscular electrical stimulation” OR “nmes” OR “electric* stimulation” OR “electrostimulation” AND “recovery” OR “muscle recovery” AND “athlete*.” Articles had to contain results from functional tests following fatigue and needed to compare these results between a neuromuscular electrical stimulation group and a passive recovery or control group.

Results:

One-hundred sixty-two subjects participated in the 11 studies evaluated in the review. Functional outcome measures were obtained in various methods throughout the study. There were inconsistent findings between the studies, with a tendency for the intervention to be ineffective.

Conclusions:

Inconsistencies between the studies likely attributed to the unclear findings of the review. Several protocols were used throughout the various studies causing multiple variables that could not be isolated. Electrode placement, stimulation frequency and intensity, and functional testing protocols were the major difference between studies that led to the inconsistent findings. Although neuromuscular electrical stimulation is often used as a recovery modality, research findings are mixed regarding its effectiveness as an intervention for recovery.

Level of Evidence:

Level I.
Osteoporosis epidemiology using international cohorts
Authors: Zhang Jean , Dennison Elaine , Prieto-Alhambra Daniel
Published: May 2020

Purpose of review

The field of osteoporosis research has been active for the past 20 years and has allowed significant advancement in the management of osteoporosis. This review will give an overview of the latest data from international cohorts that relate to current and recent osteoporosis research.

Recent findings

The clinical diagnosis of osteoporosis relies heavily on bone mineral density (BMD) measured at femoral neck or spine and although BMD has excellent predictive value for future fractures, fracture risk assessment has evolved over the years, resulting in the birth of fracture prediction tools. Fracture risk factors not currently featured in these tools are being considered for inclusion, including imminent risk fracture following a sentinel fracture, number of falls, and previous vertebral fractures. Data from groups with comorbidities such as chronic obstructive pulmonary disease are helping us understand how to best manage patients with multiple comorbidities. Finally, the prevalence of vertebral fracture in the older general population and other selected populations has been explored, alongside the global burden of osteoporosis and its consequences.

Our understanding of osteoporosis continues to expand, but knowledge gaps remain.
Defining a new three-dimensional method for determining femoral torsional pathology in children
Authors: Brooks Jaysson T. , Bomar James D. , Jeffords Megan E. , Farnsworth Christine L. , Pennock Andrew T. , Upasani Vidyadhar V.
Published: May 2020

The purpose of this study was to compare 2D femoral torsional values to measurements made from 3D reconstructions, in pediatric patients with torsional pathology. Seventeen patients were included in this study. Femoral torsion was measured in 2D and 3D and compared using interclass correlation and Bland–Altman plots. The 2D and 3D measurements had excellent correlation (r > 0.79, P < 0.001). However, we found a fixed bias of −5.1 ± 11.3°, with 3D being consistently lower than 2D. This bias persisted when looking at only subjects with normal neck shaft angles. A proportional bias of 1.2 ± 7.8° was found when comparing 2D and 3D MRI measurements indicating that as the magnitude of the torsion changed, the difference between the two measurement techniques also changed. Given the proven accuracy of 3D reconstructions in the measurement of femoral torsion, clinicians should consider this method in pediatric patients with torsional pathology. Although 2D and 3D computed tomography (CT)/MRI torsional measurements correlate well, the presence of fixed and proportional biases indicates that the two methods cannot be used interchangeably. We submit that 3D reconstructed CT/MRI imaging, aligned along the mechanical axis, should be considered to assess femoral torsion in pediatric patients. Level of evidence: III Diagnostic Study.
Direct vertebral rotation significantly decreases the pullout strength of the pedicle screw: a biomechanical study in adult cadavers
Authors: Sariyilmaz Kerim , Ozkunt Okan , Can Gemalmaz Halil , Cingoz Tunca , Pehlivanoglu Tuna , Aksoy Tamer , Kaya Ozcan , Baydogan Murat , Dikici Fatih
Published: May 2020

The pullout strength of the pedicle screws after direct vertebral rotation (DVR) maneuver is not known. This biomechanical study was performed to quantitatively analyze the pullout strength of a pedicle screw after DVR maneuver using human cadaveric vertebrae. Thoracic vertebral bodies from three cadavers were harvested and stripped of soft tissues. Thirty pedicles of 15 vertebrae were separated into two groups after bone mineral density measurements. Polyaxial 5.5 mm pedicle screws with appropriate length were inserted with a freehand technique for each pedicle. One Kirschner wire was inserted to the anterior part of each vertebral corpus the half depth of each corpus was embedded into PVC pipes using polyester paste. In the DVR group, each screw was pulled horizontally with 2 kg (~20 N) load over a screwdriver rigidly attached to the screw, and a DVR maneuver was simulated. The control group did not load with a DVR maneuver. Samples were placed on a universal testing machine and pullout loads were measured. The Mann–Whitney U test was utilized, and the P value <0.05 was considered as statistically significant. In the DVR group, the mean pullout strength was 183.35 N (SD ± 100.12), and in the control group, the mean pullout strength was 279.95 N (SD ± 76.26). Intergroup comparisons revealed that DVR maneuver significantly decreases the pullout strength (P = 0.012). The results of this study confirm that the pullout strength of pedicle screw significantly decreases by approximately 35% when DVR maneuver is applied.
Impact of presence of ossific nucleus on results of closed reduction in treatment of developmental dysplasia of the hip (302 hips)
Authors: Yilar Sinan , Köse Mehmet , Tuncer Kutsi , Karsan Orhan , Topal Murat , Ezirmik Naci
Published: May 2020

Closed reduction is an effective treatment method for developmental dysplasia of the hip (DDH). Still, there are certain controversial issues regarding the timing of the treatment. In this study, we investigated the results of closed reduction and Outcomes of 302 hips of 218 patients treated with closed reduction have been analyzed retrospectively. One hundred fifty-two hips that had ossific nucleus [ossific nucleus (+)] during reduction have been compared with 150 hips that had no ossific nucleus [ossific nucleus (−)] during reduction. Also, the patients have been divided into two groups, the patients treated with closed reduction before the sixth month and the patients treated with closed reduction after the sixth month. Groups have been compared between themselves in terms of avascular necrosis (AVN) and redislocation. Seventy-seven of the 112 hips treated with closed reduction in the first six months were ossific nucleus (−), and AVN has been noted in 5 (6%) patients. However, although no AVN has been seen in any of the 35 ossific nucleus (+) hips, no statistically significant difference has been found between two groups. Seventy-three of the 190 hips treated with closed reduction after the sixth month were ossific nucleus (−), and AVN has been seen in 13 (17%) of these hips. AVN has been seen in 9 (7%) of the 117 ossific nucleus (+) hips. The AVN ratio was found significantly lower in the ossific nucleus (+) hips (P < 0.034). Although the presence of ossific nucleus does not provide extra protection against AVN in before the sixth month, the presence of ossific nucleus is protective against AVN after the sixth month.
A 3D Parameter Can Guide Concave Rod Contour for the Correction of Hypokyphosis in Adolescent Idiopathic Scoliosis
Authors: Kluck Dylan , Newton Peter O. , Sullivan Thomas Barrett , Yaszay Burt , Jeffords Megan , Bastrom Tracey P. , Bartley Carrie E.
Published: May 2020

Study Design.

Retrospective.

Objective.

To evaluate the effect of preoperative rod shape on 3D spinal deformity correction.

Summary of Background Data.

Differential rod contouring is a surgeon-dependent process based on an estimate of 3D deformity correction sought and the flexibility of the spine. An objective measure to this otherwise subjective scoliosis correction technique is lacking.

Methods.

A series of adolescent idiopathic scoliosis (AIS) patients with right, thoracic major curves, preoperative rod contour tracings, and EOS imaging was evaluated. All patients underwent posterior spinal fusion with 5.5 mm steel rods contoured prior to insertion. 3D reconstructions were generated pre- and postoperatively using sterEOS software (EOS Imaging) and imported into MATLAB (Mathworks) for analysis. A new measurement of the maximum perpendicular distance from the preinsertion concave rod contour to the preoperative 3D sagittal spinal reconstruction was defined as rod to 3D spine distance (RSD). Linear regressions were used to identify relationships between pre and postoperative parameters, including RSD and 3D thoracic kyphosis.

Results.

Ninety-nine patients were included. Average preoperative concave rod angle decreased from (48 ± 10°) preoperatively to 26 ± 6° postoperatively (P < 0.001) for an average flattening of ∼20°. Average convex rod angle increased from 30 ± 6° to 34 ± 5° (P < 0.001). Average preoperative thoracic curve magnitude and apical vertebral rotation were 57 ± 8° and 16 ± 5° and decreased to 11 ± 6° and 5 ± 6° (P < 0.001). Average 2D and 3D thoracic kyphosis increased from 19 ± 14° and 2 ± 12° to 27 ± 6° and 22 ± 5° (P < 0.001). Preoperative RSD strongly correlated with 3D thoracic kyphosis change (P < 0.001, r = 0.796, R
2 = 0.633).

Conclusion.

On average, the concave rod flattened ∼20° after connection to the spine. Similarly, kyphosis increased ∼20° following rod insertion. A strong correlation was identified between RSD and 3D thoracic kyphosis restoration. This novel 3D parameter can guide the degree of concave rod bend necessary to achieve a desired increase in thoracic kyphosis in AIS.

Level of Evidence: 2
Correlates of Google Search Rankings for Spine Surgeons
Authors: Chiu Ryan G. , Parola Rown , Nallani Ankita , Glastris Georgia , Siddiqui Neha , Bheri Abdullah , Shah Miloni , Behbahani Mandana , Mehta Ankit I.
Published: May 2020

Study Design.

Prospective observational study.

Objective.

The objective of this study is to identify correlates of search ranking among academic pedigree, online ratings, and social media following.

Summary of Background Data.

Patients increasingly rely on online search in selecting healthcare providers. When choosing a spine surgeon, patients typically value surgical skill and experience as well as demeanor/bedside manner. It is unclear whether current search engine ranking algorithms reflect these preferences.

Methods.

A Google.com search for the top 25 spine surgeon websites by search ranking was conducted for each of the largest 25 American cities. Resulting websites were then perused for academic pedigree, experience, and practice characteristics. Surgeons’ research output and impact were then quantified via number of publications and H-index. Online ratings and followers in various social media outlets were also noted. These variables were assessed as possible correlates of search ranking via linear regression and multivariate analyses of variance.

Results.

A total of 625 surgeons were included. Three categorical variables were identified as significant correlates of higher mean Google search ranking—orthopedics (vs. neurosurgery) as a surgical specialty (P = 0.023), board certification (P = 0.024), and graduation from a top 40 residency program (P = 0.046). Although the majority of the identified surgeons received an allopathic medical education, there was no significant difference in the mean rank of surgeons who had an MD versus DO medical degree (P = 0.530). Additionally, none of the continuous variables collected, including years in practice (P = 0.947), publications (P = 0.527), H-index (P = 0.278), social media following such as on Facebook (P = 0.105), or online ratings such as on Healthgrades (P = 0.080), were significant correlates of Google search ranking.

Conclusions.

Google search rankings do not always align with patient preferences, currently promoting orthopedic over neurosurgical specialists, graduation from top residency programs, and board certification, while largely ignoring academic pedigree, research, social media presence, and online ratings.

Level of Evidence: 3
Relationship Between Muscle Mass of the Lower Limbs and Falls Caused by Spinal Misalignment in Women Aged 70 Years
Authors: Ito Hiroshi , Toyone Tomoaki , Nagai Takashi , Ishikawa Koji , Kuroda Takuma , Inagaki Katsunori
Published: May 2020

Study Design:

This retrospective study was conducted from 2015 to 2016 at the osteoporosis outpatient clinic of Showa University School of Medicine.

Objective:

This study aimed to investigate the association between lower-limb muscle mass and spinal misalignment-related falls in elderly women.

Summary of Background Data:

Poor spinal alignment affects gait and balance, reducing the quality of life. Negative correlations between age-associated skeletal muscle loss and spinal sagittal alignment have been reported.

Materials and Methods:

This study included 127 women with osteoporosis aged more than 70 years. The correlation between lower-limb skeletal muscle index (SMI) and sagittal vertical axis (SVA) was calculated using radiographic measurements. Spinopelvic parameters, including SVA, sacral slope, pelvic tilt (PT), pelvic incidence, and lumbar lordosis, were measured. Lower-limb SMI was measured using whole-body dual-energy x-ray absorptiometry and calculated as SMI=nonfat mass/height2. The balance function was evaluated using the single-leg stance test. Data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests; significance level was set at P<0.05. Bivariate and multivariate logistic regression analyses were used to determine correlations.

Results:

Participants were classified into the balance and mismatch groups on the basis of a threshold SVA value of 50 mm. The groups did not differ significantly in age, height, weight, pelvic incidence, or sacral slope. Lumbar lordosis significantly decreased and PT and lower-limb SMI significantly increased in the mismatch group compared with the balance group. Lower-limb SMI was significantly correlated with increased SVA in bivariate and multivariate regression analyses. Patients with PT ≥20 degrees and SVA ≥50 mm had significantly increased lower-limb SMI.

Conclusions:

Increased SVA is associated with increased lower-limb SMI, which negatively affects standing balance. An increased lower-limb SMI may represent a novel compensatory mechanism for poor spinal alignment in elderly women with osteoporosis.

Level of Evidence:

Level III.
How Does Smoking Influence Patient-reported Outcomes in Patients After Lumbar Fusion?
Authors: Goyal Dhruv K.C. , Divi Srikanth N. , Bowles Daniel R. , Nicholson Kristen J. , Mujica Victor E. , Kaye I. David , Kurd Mark F. , Woods Barrett I. , Radcliff Kris E. , Rihn Jeffery A. , Anderson D. Greg , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D.
Published: May 2020

Study Design:

A retrospective cohort study.

Objective:

The goal of this study was to determine the effect of smoking on patient-reported outcome measurements (PROMs) after lumbar fusion surgery.

Summary of Background Data:

Although smoking is known to decrease fusion rates after lumbar fusion, there is less evidence regarding the influence of smoking on PROMs after surgery.

Methods:

Patients undergoing between 1 and 3 levels of lumbar fusion were divided into 3 groups on the basis of preoperative smoking status: never smokers (NS); current smokers (CS); and former smokers (FS). PROMs collected for analysis include the Physical Component Score (PCS-12), Mental Component Score (MCS-12), Oswestry Disability Index (ODI), and Visual Analogue Scale back (VAS back) and leg (VAS leg) pain scores. Preoperative and postoperative PROMs were compared between groups. A multiple linear regression analysis was performed to determine whether preoperative smoking status was a predictor of change in PROM scores.

Results:

A total of 220 (60.1%) NS, 52 (14.2%) CS, and 94 (25.7%) FS patients were included. Patients in most groups improved within each of the PROMs analyzed (P<0.05). VAS leg pain (P=0.001) was found to significantly differ between groups, with NS and FS having less disability than CS (3.6 vs. 2.0, P=0.010; and 3.6 vs. 2.4, P=0.022; respectively). Being a CS significantly predicted less improvement in ODI (P=0.035), VAS back (P=0.034), and VAS leg (P<0.001) compared with NS. In addition, NS had a significantly lower 30-day readmission rate than CS or FS (3.2% vs. 5.8% and 10.6%, respectively, P=0.029).

Conclusion:

CS exhibited worse postoperative VAS leg pain and a lower recovery ratio than never smokers. In addition, being in the CS group was a significant predictor of decreased improvement in ODI, VAS back, and VAS leg scores.

Level of Evidence:

Level III.
ICU and Ventilator Mortality Among Critically Ill Adults With Coronavirus Disease 2019*
Authors: Auld Sara C. , Caridi-Scheible Mark , Blum James M. , Robichaux Chad , Kraft Colleen , Jacob Jesse T. , Jabaley Craig S. , Carpenter David , Kaplow Roberta , Hernandez-Romieu Alfonso C. , Adelman Max W. , Martin Greg S. , Coopersmith Craig M. , Murphy David J.
Published: May 2020

Objectives:

To determine mortality rates among adults with critical illness from coronavirus disease 2019.

Design:

Observational cohort study of patients admitted from March 6, 2020, to April 17, 2020.

Setting:

Six coronavirus disease 2019 designated ICUs at three hospitals within an academic health center network in Atlanta, Georgia, United States.

Patients:

Adults greater than or equal to 18 years old with confirmed severe acute respiratory syndrome-CoV-2 disease who were admitted to an ICU during the study period.

Interventions:

None.

Measurements and Main Results:

Among 217 critically ill patients, mortality for those who required mechanical ventilation was 35.7% (59/165), with 4.8% of patients (8/165) still on the ventilator at the time of this report. Overall mortality to date in this critically ill cohort is 30.9% (67/217) and 60.4% (131/217) patients have survived to hospital discharge. Mortality was significantly associated with older age, lower body mass index, chronic renal disease, higher Sequential Organ Failure Assessment score, lower Pao
2/Fio
2 ratio, higher d-dimer, higher C-reactive protein, and receipt of mechanical ventilation, vasopressors, renal replacement therapy, or vasodilator therapy.

Conclusions:

Despite multiple reports of mortality rates exceeding 50% among critically ill adults with coronavirus disease 2019, particularly among those requiring mechanical ventilation, our early experience indicates that many patients survive their critical illness.
Novel therapeutic options for alveolar soft part sarcoma: antiangiogenic therapy, immunotherapy and beyond
Authors: Brahmi Mehdi , Vanacker Hélène , Dufresne Armelle
Published: May 2020

Purpose of review

Alveolar soft part sarcoma (ASPS) represent 0.5% of sarcomas, defining a rarest among rare malignancies. It affects young adults, displaying slow-growing mass of the thigh, head and neck, and trunk. Although quite indolent, a majority of cases displays an advanced disease with lung bone or central nervous system metastasis. Complete surgery is the cornerstone of localized ASPS, and advanced diseases poorly respond to chemotherapy. Here discuss recent progress in molecular characterization of ASPS and future prospects of therapeutic approaches.

Recent findings

ASPS is characterized by a specific oncogenic translocation ASPSCR1-TFE3 that induce hepatocyte growth factor receptor (MET) overexpression, angiogenesis, and immunosuppression in the tumor microenvironment. These specific biological features have encouraged the successful exploration of MET inhibitors, antiangiogenic drugs, and immunotherapy. We reviewed the main tracks of ASPS biology and recent insights from targeted therapies is ASPS mainly driven tyrosine kinase inhibitors (especially antiangiogenics), immune-checkpoint inhibitors, and their combinations.

Overall, antiangiogenics and anti Programmed cell death 1/Programmed cell death ligand 1 therapies showed a significant activity in ASPS that warrants additional investigation through randomized trials to validate those results and through ancillary biological studies to better understand resistance mechanisms and biomarkers of response.
Progress in cancer mortality, incidence, and survival: a global overview
Authors: Santucci Claudia , Carioli Greta , Bertuccio Paola , Malvezzi Matteo , Pastorino Ugo , Boffetta Paolo , Negri Eva , Bosetti Cristina , La Vecchia Carlo
Published: May 2020

Cancer mortality has declined over the last three decades in most high-income countries reflecting improvements in cancer prevention, diagnosis, and management. However, there are persisting and substantial differences in mortality, incidence, and survival worldwide. In order to provide an up-to-date overview of trends in mortality, incidence, and survival, we retrieved data from high-quality, population-based cancer registries for all cancers and 10 selected cancer sites in six high-income countries and the European Union. We computed age-standardized (world standard population) mortality and incidence rates, and applied joinpoint regression models. Mortality from all cancers and most common cancer sites has declined over the last 25 years, except for the pancreas and lung (in women). The patterns for incidence are less consistent between countries, except for a steady decrease in stomach cancer in both sexes and lung cancer in men. Survival for all cancers and the selected cancer sites increased in all countries, even if there is still a substantial variability. Although overall cancer death rates continue to decline, incidence rates have been levelling off among men and have been moderately increasing among women. These trends reflect changes in cancer risk factors, screening test use, diagnostic practices, and treatment advances. Many cancers can be prevented or treated effectively if they are diagnosed early. Population-based cancer incidence and mortality data can be used to focus efforts to decrease the cancer burden and regularly monitor progress towards cancer control goals.
Suberoylanilide hydroxamic acid overcomes erlotinib-acquired resistance via phosphatase and tensin homolog deleted on chromosome 10-mediated apoptosis in non-small cell lung cancer
Authors: Wu Peng-Fei , Gao Wei-Wei , Sun Cui-Lan , Ma Tai , Hao Ji-Qing
Published: May 2020

Background:

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), such as erlotinib and gefitinib, are widely used to treat non-small cell lung cancer (NSCLC). However, acquired resistance is unavoidable, impairing the anti-tumor effects of EGFR-TKIs. It is reported that histone deacetylase (HDAC) inhibitors could enhance the anti-tumor effects of other antineoplastic agents and radiotherapy. However, whether the HDAC inhibitor suberoylanilide hydroxamic acid (SAHA) can overcome erlotinib-acquired resistance is not fully clear.

Methods:

An erlotinib-resistant PC-9/ER cell line was established through cell maintenance in a series of erlotinib-containing cultures. NSCLC cells were co-cultured with SAHA, erlotinib, or their combination, and then the viability of cells was measured by the 3-(4,5-Dimethyl thiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay and apoptosis was determined by flow cytometry and western blotting. Finally, the expression of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) was assessed by western blotting.

Results:

The half-maximal inhibitory concentration of parental PC-9 cells was significantly lower than the established erlotinib-acquired resistant PC-9/ER cell line. PC-9/ER cells demonstrated reduced expression of PTEN compared with PC-9 and H1975 cells, and the combination of SAHA and erlotinib significantly inhibited cell growth and increased apoptosis in both PC-9/ER and H1975 cells. Furthermore, treating PC-9/ER cells with SAHA or SAHA combined with erlotinib significantly upregulated the expression of PTEN mRNA and protein compared with erlotinib treatment alone.

Conclusions:

PTEN deletion is closely related to acquired resistance to EGFR-TKIs, and treatment with the combination of SAHA and erlotinib showed a greater inhibitory effect on NSCLC cells than single-drug therapy. SAHA enhances the suppressive effects of erlotinib in lung cancer cells, increasing cellular apoptosis and PTEN expression. SAHA can be a potential adjuvant to erlotinib treatment, and thus, can improve the efficacy of NSCLC therapy.
Mis-estimation of coronary lesions and rectification by SYNTAX score feedback for coronary revascularization appropriateness
Authors: Lin Shen , Zhang Heng , Chen Si-Peng , Rao Chen-Fei , Wu Fan , Zhou Fa-Jun , Wang Yun , Yan Hong-Bing , Dou Ke-Fei , Wu Yong-Jian , Tang Yi-Da , Xie Li-Hua , Guan Chang-Dong , Xu Bo , Zheng Zhe
Published: May 2020

Background:

Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization. Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a comprehensive system to evaluate the complexity of the overall lesions. We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease (CAD).

Methods:

In this single-center, historical control study, patients with stable CAD with coronary lesion stenosis ≥50% were consecutively recruited. During the control period, SYNTAX scores were calculated by treating cardiologists. During the intervention period, SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making. The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.

Results:

A total of 3245 patients were enrolled and assigned to the control group (08/2016–03/2017,n = 1525) or the intervention group (03/2017–09/2017,n = 1720). For SYNTAX score tertiles, 17.9% patients were overestimated and 4.3% were underestimated by cardiologists in the control group. After adjustment, inappropriate revascularization significantly decreased in the intervention group compared with the control group (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.73–0.95;P = 0.007). Both inappropriate percutaneous coronary intervention (adjusted OR: 0.82; 95% CI: 0.74–0.92;P < 0.001) and percutaneous coronary intervention utilization (adjusted OR: 0.88; 95% CI: 0.79–0.98;P = 0.016) decreased significantly in the intervention group. There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.

Conclusions:

Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.

Clinical trial registration:

Nos. NCT03068858 and NCT02880605; https://www.clinicaltrials.gov.
The Role of Radiation Therapy and Botulinum Toxin Injections in the Management of Sialorrhea in Patients With Amyotrophic Lateral Sclerosis: A Systematic Review
Authors: Shehee Lindsey , O'Rourke Ashli , Garand Kendrea L.
Published: May 2020

Objectives:

Half of patients with amyotrophic lateral sclerosis experience sialorrhea due to facial weakness. Although anticholinergic medications are first-line therapy, they often lead to unacceptable side effects. Radiation therapy and botulinum toxin may be considered when medical management fails. In this systematic review, we investigated the effectiveness of these interventions.

Methods:

Eligible studies were retrieved from PubMed and Scopus databases up to March 2017 along with hand-searching of references from primary articles.

Results:

Fourteen studies (N = 138) examined the benefits of botulinum toxin. Studies varied in salivary glands treated, dosages used, and the use of botulinum toxin subtype A or B. A majority of studies showed benefit after treatment. Although most studies reported only mild adverse effects, 2 case studies revealed severe complications including recurrent TMJ dislocations and rapid deterioration in bulbar function. Ten studies (N = 171) examined the benefits of radiation. Most studies reported improvement with only mild adverse events reported.

Conclusions:

Both radiation and botulinum toxin are effective treatments for sialorrhea in patients with amyotrophic lateral sclerosis and should be considered when medical management fails. Radiation may offer longer duration of symptom improvement with fewer complications.
Efficacy of Electrical Stimulation on Nerve Fiber Growth in Small Fiber Neuropathy
Authors: Burakgazi Ahmet Z.
Published: May 2020

Objectives:

To define whether electrical nerve stimulation (ENS) therapy would promote intraepidermal nerve growth and nerve regeneration in patients with small fiber neuropathy (SFN).

Methods:

This was a prospective study conducted on 8 subjects with previously diagnosed SFN. Nerve conduction testing, punch biopsies, and clinical examinations with a calculation of revised total neuropathy score were conducted on subjects before beginning ENS therapy and at 30 and 60 days after the start of ENS therapy.

Results:

Clinical examination findings and intraepidermal nerve fiber density measurements on day 30 and day 60 did not show statistically significant changes in the treated group compared with the untreated group.

Conclusions:

Despite the success of previous animal studies, no meaningful nerve growth and regeneration in SFN was demonstrated with ENS therapy in this study. Studies of larger subject larger populations with longer duration of ENS treatment are warranted to confirm our findings.
Investigating the association between labour epidural analgesia and postpartum depression
Authors: Tan Chin Wen , Sultana Rehena , Kee Michelle Z.L. , Meaney Michael J. , Sng Ban Leong
Published: May 2020

BACKGROUND

Postpartum depression (PPD) affects 10 to 15% of women and is associated with socio-economic burden and maternal morbidity. Recent studies showed that epidural analgesia may be associated with the development of PPD, although this association remains inconclusive.

OBJECTIVE

To investigate the role of perinatal demographic, analgesic and psychological factors that may be related to PPD.

DESIGN

Prospective, longitudinal multiethnic cohort study.

SETTING

Singapore's two major public maternity institutions.

PATIENTS

Pregnant women recruited during antenatal consultation and with follow-up 3 months postdelivery at Singapore hospitals with maternity services.

INTERVENTION

None.

MAIN OUTCOME MEASURES

The primary outcome of PPD was assessed 3 months postdelivery using the Edinburgh Postnatal Depression Scale to investigate an association with the use of labour epidural analgesia. The associations between PPD and anxiety and depression at 26 weeks’ gestation predelivery were also evaluated. Demographic, analgesic, psychological factors and intrapartum data were analysed.

RESULTS

There were 651 women with 152 cases (23.3%) of PPD and 499 controls (76.7%) at 3 months after childbirth. There was no significant difference between women who received labour epidural analgesia (95 of 385, 24.7%) and those who did not receive epidural analgesia (57 of 266, 21.4%) (unadjusted odds ratio 1.20, 95% confidence interval 0.83 to 1.75, P = 0.3361) in the incidence of PPD 3 months postdelivery. Predelivery anxiety and depression were positively associated with PPD 3 months postdelivery.

CONCLUSION

Our study did not demonstrate an association between PPD at 3 months postdelivery and labour epidural analgesia.

TRIAL REGISTRATION

NCT01174875.
Abacavir adverse reactions related with HLA-B*57:01 haplotype in a large cohort of patients infected with HIV
Authors: Quiros-Roldan Eugenia , Gardini Giulia , Properzi Martina , Ferraresi Alice , Carella Graziella , Marchi Alessandro , Malagoli Alberto , Focà Emanuele , Castelli Francesco
Published: May 2020

Objective

Carriage of human leukocyte antigen (HLA)-B*57:01 allele increases the risk of abacavir hypersensitivity reaction. Therefore, since 2008 HIV treatment guidelines recommend HLA-B*57:01 screening before abacavir administration, greatly reducing hypersensitivity reaction rate. However, clinically suspected abacavir-related hypersensitivity reactions are described in allele non-carriers. Major aim of this study was to evaluate the relationship between HLA-B*57:01 pattern and abacavir-related hypersensitivity reaction, focusing on hypersensitivity reaction prevalence in allele non-carriers.

Methods

We included all outpatients aged >18 years old with HIV infection and known HLA-B*57:01 pattern, followed at our Department from January 2000 until December 2017. Patients were divided according to HLA-B*57:01 pattern and first antiretroviral treatment prescribed (containing or not abacavir) as follows: HLA-B*57:01 allele carriers treated with abacavir and HLA-B*57:01 allele non-carriers treated with abacavir. We considered all adverse events reported during first abacavir administration, differentiating between confirmed hypersensitivity reactions and non-hypersensitivity reactions, according to abacavir hypersensitivity reaction definition included in the abacavir EU Summary of Product Characteristics and the US Prescribing Information.

Results

A total of 3144 patients had a known HLA-B*57:01 pattern. About 5.4% of them showed allele polymorphism; Caucasian ethnicity was the most represented. In this cohort, 1801 patients were treated with a first abacavir-containing regimen (98.2% of them was represented by allele non-carriers). 191 out of 1801 patients discontinued abacavir because of toxicity/intolerance; among them 107 described adverse events fulfilled the criteria of confirmed abacavir hypersensitivity reaction (22/32 allele-positive patients and 85/1769 allele-negative patients). After having experienced a confirmed abacavir hypersensitivity reaction, abacavir was re-administered to eight HLA-B*57:01 negative patients. Seven of them re-experienced a syndrome consistent with hypersensitivity reaction, finally leading to drug discontinuation. Overall, no fatal reactions were described.

Conclusion

Not all abacavir-related side effects occur as a result of classic HLA-B*57:01-mediated hypersensitivity reaction, as they can develop irrespective of HLA-B*57:01 status. Clinical vigilance must be an essential part of the management of individuals starting abacavir, at any time during treatment. In a ‘real-life’ setting, clinical diagnosis of suspected abacavir hypersensitivity reaction in allele non-carriers remains crucial for further clinical decision making.
Pharmacogenomics of thiopurines: distribution of TPMT and NUDT15 polymorphisms in the Brazilian Amazon
Authors: Ferreira Guilherme Motta Antunes , Ribeiro Elias Anna Beatriz , Nascimento Joabi , Monteiro Wuelton Marcelo , Melo Gisely Cardoso , Baia-da-Silva Djane Clarys , Lacerda Marcus Vinícius Guimarães , Suarez-Kurtz Guilherme
Published: May 2020

Reduced function alleles in the TPMT and NUDT15 genes are risk factors for thiopurine toxicity. This study evaluated the influence of Native ancestry on the distribution of TPMT (rs1142345, rs1800460 and rs1800462) and NUDT15 (rs116855232) polymorphisms and compound metabolic phenotypes in 128 healthy males from the Brazilian Amazon. The average proportion of Native and European ancestry differed greatly and significantly between self-declared Amerindians and non-Amerindians, although extensive admixture in both groups was evident. Native ancestry was not significantly associated with the frequency distribution of the TPMT or NUDT15 polymorphisms investigated. The apparent discrepancy with our previous results for NUDT15 rs116855232 in the Ad Mixed American superpopulation of the 1000 Genomes Project is ascribed to the diversity of the Native populations of the Americas. Based on the inferred TPMT/NUDT15 compound metabolic phenotypes, the Clinical Pharmacogenetics Implementation Consortium recommendations for starting thiopurine therapy with reduced doses or to consider dose reduction applied respectively to 3–5% and to 12–20% of the study cohorts.
NAMS 2019 Pre-Meeting Symposium, September 2019, Chicago Illinois: The Perimenopause
Authors: Stuenkel Cynthia A. , Santoro Nanette F. , Laughlin-Tommaso Shannon K. , Black Amanda , Joffe Hadine , Su H. Irene
Published: May 2020

The North American Menopause Society held the 2019 Pre-Meeting Symposium on September 25, 2019, in Chicago, Illinois, to review the current state of the science related to the physiology of the perimenopause and to address management of the most prevalent and pressing clinical issues. The perimenopause, as defined by the Stages of Reproductive Aging Workshop + 10, encompasses the menopause transition as well as the first year following menopause, the final menstrual period. This phase in the continuum of women's reproductive lives had been one of the least well understood. Fortunately, contributions from a number of prospective, longitudinal, decades-long studies have provided a better understanding of the perimenopause, whereas posing important new questions related to symptom interaction and linkages between symptoms and long-term health. There is now added clarity to distinguish the effects of reproductive hormonal changes from aging. The variation in symptoms, including vasomotor symptoms, among women over time including differences in experiences by ethnicity and race, provides paradigm shifts in clinical perspective. Refinements in understanding the character, timing, and potential predictive markers for menstrual cycles during the transition have emerged. From the perspective of myriad clinical management challenges, significant progress in recommendations for evaluation and therapeutic approaches has been achieved. Finally, recognizing the menopause transition as an opportunity to initiate positive lifestyle changes to enhance future health was emphasized.
Association between waist-hip ratio and coronary artery calcification in postmenopausal women
Authors: Eun Youngmi , Lee Su Nam , Jung Jin , Kim Min Sik , Moon Keon-Woong , Yoo Ki-Dong
Published: May 2020

Objective:

Many studies have reported that body composition might be associated with cardiovascular disease, but the issue has not been fully investigated in postmenopausal women.

Methods:

This retrospective study comprised 582 postmenopausal women without a history of cardiovascular disease who visited the Health Promotion Center between May 2008 and February 2018. All women were screened for body fat composition by bioelectrical impedance analysis and for degree of coronary artery calcification (CAC) by multidetector computed tomography. In addition, multivariate analysis, integrated discrimination improvement, and category-free net reclassification improvement were performed.

Results:

The level of triglycerides, and the waist-hip ratio (WHR) in participants with CAC (coronary artery calcium score [CACS] > 0) were higher than in participants with a CACS of zero points. When the participants were stratified into four groups according to WHR, participants with CAC (CACS > 0) increased significantly as WHR quartile increased. A multivariate analysis showed that older age (odds ratio [OR]: 2.539; 95% confidence interval [CI]: 1.524-4.230; P < 0.001), triglyceride level (OR: 1.005; 95% CI: 1.002-1.008; P = 0.003), WHR (OR: 1.103; 95% CI: 1.018-1.195; P = 0.017), and history of hypertension (OR: 2.701; 95% CI: 1.715-4.253; P < 0.001) were significantly associated with CAC. The Brier score upon adding WHR to a clinical model was lower than that of the clinical model without WHR. Adding WHR to a clinical model better predicted CAC than a clinical model without WHR (C index: 0.761, 95% CI: 0.724-0.795, P < 0.001; net reclassification improvement: 0.195, P = 0.037; integrated discrimination improvement: 1.02%, P = 0.043).

Conclusions:

In asymptomatic postmenopausal women, WHR as measured by bioelectrical impedance analysis was significantly associated with coronary atherosclerosis, supplementing information of usual clinical markers. Hence, WHR might be appropriate as a marker for early atherosclerosis.