bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhibition of NADPH oxidase 4 attenuates lymphangiogenesis and tumor metastasis in breast cancer
Authors: Wang Xinzhao , Liu Zhaoyun , Sun Jujie , Song Xiang , Bian Mengxue , Wang Fukai , Yan Feng , Yu Zhiyong
Published: March 2021

Lymphangiogenesis is thought to contribute to promote tumor cells to enter lymphatic vessels and plant at a secondary site. Endothelial cells are the cornerstone of the generation of new lymphatic vessels. NADPH oxidase 4 (Nox4) is the most abundant one of NADPH oxidases in endothelial cells and the most studied one in relevance with cancer. Our purpose is to analyze the relationship between Nox4 and lymphangiogenesis and find out whether the newborn lymphatic vessels lead to cancer metastasis. We first explored the expression of Nox4 in lymphatic endothelial cells of primary invasive breast tumors and human normal mammary glands using GEO databases and found that Nox4 was upregulated in primary invasive breast tumors samples. In addition, its high expression correlated with lymph node metastasis in breast cancer patients. Nox4 could increase the tube formation and lymphatic vessel sprouting in a three‐dimensional setting. In vivo, inhibition of Nox4 in 4T1 tumor‐bearing mice could significantly decrease the tumor lymphangiogenesis and metastasis. Nox4 may increase tumor lymphangiogenesis via ROS/ERK/CCL21 pathway and attract CCR7‐positive breast cancer cells to entry lymphatic vessels and distant organs. In conclusion, our results show that Nox4 is a factor that promotes lymphangiogenesis and is a potential target of antitumor metastasis.
Career Development Considerations for Academic Physician Mentees and Mentors in the Time of COVID-19: Jump in or Just Dip a Toe?
Authors: Gettel Cameron J. , Venkatesh Arjun K.
Published: March 2021

The COVID-19 pandemic has disrupted medical research, pushing mentors and mentees to decide if COVID-19 research would be germane to the early career investigator’s developing research portfolio. With COVID-19 halting hundreds of federal trials involving non–COVID-19 research, mentors and mentees must also consider the broader moral calling of contributing to COVID-19 research. At the time of writing, the National Institutes of Health had responded to the pandemic with significant funding for COVID-19 research. However, because this pandemic is a new phenomenon, few mentors have expertise in the disease and relevant established resources. As a result, many mentors are unable to provide insight on COVID-19 research to early career investigators considering a pivot toward research related to this disease. The authors suggest 4 ways for mentees and mentors to respond to the changes the pandemic has brought to research funding and opportunities: (1) include COVID-19 research in existing portfolios to diversify intellectual opportunities and reduce funding risks; (2) negotiate the mentor–mentee relationship and roles and expectations early in project discussions—considering, as relevant, the disproportionate burden of home responsibilities often borne by early career faculty members who are women and/or from a minority group; (3) address any mentor limitations in content expertise; and (4) if the decision is to pivot to COVID-19 research, select projects with implications generalizable beyond this pandemic to other infectious outbreaks or to the redesign of health care delivery. Mentors and mentees must weigh the relevance of COVID-19 research projects to the postpandemic world and the amount of available funding against the developing interests of early career investigators. Academic medical centers nationwide must enable seasoned and early career researchers to contribute meaningfully to COVID-19 and non–COVID-19 research.
An Investigation on the Guideline Adherence in Opioid Addiction Treatment and the Causes of Nonadherences
Authors: Hoseiny Morasa S.M. Hesam , Haghighi Mohammad , Ataei Sara , Rangchian Maryam
Published: March 2021

Objectives:

This study was aimed to evaluate the level of adherence to the World Health Organization and American Society of Addiction Medicine guidelines regarding opioids addiction medications and to identify the causes of nonadherence, in Hamadan.

Materials and Methods:

The patients’ records were used to obtain data on the patients’ demographics and treatment process. The adherence to the mentioned guidelines was evaluated and reasons for nonadherence were asked from physicians.

Results:

At the time of the study, methadone maintenance treatment (MMT) and buprenorphine maintenance treatment (BMT) were the only common opioid addiction treatments in Hamadan. The number of the cases in BMT and MMT group was 18 and 142, respectively. The rate of the treatment course accomplishment (passing 4 stages) was 4.2% for MMT and 0% for BMT. In the induction phase, the adherence rates regarding initial dosing and regular weekly visits were 66.7 and 27.8% for BMT, beside 27.5, and 60.6% for MMT. Concerning the stabilization stage, the dosage amount, dose modification, and regular visits, respectively, 41.5%, 24.6%, and 27.5% of MMT cases were performed in adherence to the guidelines, whereas adherence of dose selection for BMT was 11.1%. In the MMT elimination stage, 33.3% compliance was observed; no case of BMT had continued the treatment to this stage. No discrepancy was because of the physicians’ disbelief in clinical guidelines; they were either aimed to tailor the treatment with a patient’s condition or resulted from familial, sociocultural, and financial problems.

Conclusions:

Overall, enhancement of patients and their families’ awareness about medication process appears necessary.
Cannabis Use and Cognitive Impairment Among Male Adolescents: A Case-control Study
Authors: Bassiony Medhat , Ammar Haidy K. , Khalil Yomna
Published: March 2021

Cannabis use by adolescents is a public health problem because it can cause cognitive impairment and educational deterioration. The objective of this study was to assess the prevalence and correlates of cognitive impairment among male adolescents with cannabis use in comparison with a control group. This is a case-control study that included 1682 adolescents who just finished their secondary school. A drug screen was made for all participants. Cognitive assessment using Montreal Cognitive Assessment (MoCA) scale was carried out for adolescents with positive urine screen for cannabis and a control group of adolescents with negative urine screen for drugs. The prevalence of cannabis use among adolescents was 2.14%. About one third of the cases started to use cannabis before the age of 15 years. Fifty-six percent used cannabis frequently (>4 times/wk). Adolescents with cannabis use were more likely to have cognitive impairment based on MoCA than controls (78% vs. 44%, P=0.004). Cases were more likely to have impairment in naming, abstraction, orientation, and total MoCA score than controls. Adolescents who started cannabis use early (below 15 y) had impairment in visuospatial/executive, attention, language, abstraction, delayed recall, and total MoCA score compared with those who started late (above 15 y). In addition, adolescents who use cannabis frequently had impairment in all cognitive domains except naming compared with those who used it occasionally. To conclude, the current study found that adolescents with cannabis use were more likely to have cognitive impairment than controls and this impairment was associated with age of onset and frequency of cannabis use.
Role of Janus Kinase inhibitors in rheumatoid arthritis treatment
Authors: Reddy Virginia , Cohen Stanley
Published: March 2021

Purpose of review

To review recently published articles on use of Janus Kinase inhibitors (Jaki) in the clinic for rheumatoid arthritis (RA).

Recent findings

Several Jaki have been approved for RA patients failing csDMARDS. Over the last 2 years, EULAR and ACR have published updated recommendations for the pharmacologic management of RA providing guidance on the utilization of Jaki after csDMARD failure. Clinical trials have been published addressing the efficacy of Jaki monotherapy as patients often choose monotherapy because of a desire to avoid multiple therapies and aggravating adverse events with csDMARDs. Previous clinical trials have compared the efficacy and safety of Jaki to adalimumab, and a trial comparing abatacept to upadacitinib has recently been published. An increased risk of venous thromboembolism (VTE) has been suggested with Jaki and additional information has recently become available with conflicting results.

Jaki are now standard therapy for RA patients failing csDMARDs and are being utilized frequently as an alternative to biologics in patients without risk factors for VTE. Jaki monotherapy has been demonstrated to be effective, although combination therapy has been demonstrated to be superior in clinical and radiographic outcomes. Preliminary data suggests that cycling through Jaki in patients with incomplete response to initial Jaki treatment may be an appropriate strategy.
Cannabis Abuse and Perioperative Complications Following Inpatient Spine Surgery in the United States
Authors: Chiu Ryan G. , Patel Saavan , Siddiqui Neha , Nunna Ravi S. , Mehta Ankit I.
Published: March 2021

Mini

Due to its complicated legal status, the effects of cannabis on elective spine surgery patients have not been well studied. In this nationwide analysis, we find that cannabis abuse is associated with higher perioperative thromboembolism and neurologic complications, respiratory complications, sepsis, length of stay, hospital charges, and rates of unfavorable discharge disposition.

Study Design.

Retrospective cohort analysis of a nationwide administrative database.

Objective.

The aim of this study was to analyze the association between cannabis abuse and serious adverse events following elective spine surgery.

Summary of Background Data.

Cannabis is the most popular illicit drug in the United States, and its use has been increasing in light of state efforts to decriminalize and legalize its use for both medical and recreational purposes. Its legal status has long precluded extensive research into its adverse effects, and to date, little research has been done on the sequelae of cannabis on surgical patients, particularly in spine surgery.

Methods.

The 2012–2015 Nationwide Inpatient Sample was queried for all patients undergoing common elective spine surgery procedures. These patients were then grouped by the presence of concurrent diagnosis of cannabis use disorder and compared with respect to various peri- and postoperative complications, all-cause mortality, discharge disposition, length of stay, and hospitalization costs. Propensity score matching was utilized to control for potential baseline confounders.

Results.

A total of 423,978 patients met inclusion/exclusion criteria, 2393 (0.56%) of whom had cannabis use disorder. After controlling for baseline characteristics and comorbid tobacco use, these patients similar inpatient mortality, but higher rates of perioperative thromboembolism (odds ratio [OR] 2.2; 95% confidence interval [CI] 1.2–4.0; P = 0.005), respiratory complications (OR 2.0; 95% CI 1.4–2.9; P < 0.001), neurologic complications such as stroke and anoxic brain injury (OR 2.9; 95% CI 1.2–7.5; P = 0.007), septicemia/sepsis (OR 1.5; 95% CI 1.0 to 2.5; P = 0.031), and nonroutine discharge (P < 0.001), as well as increased lengths of stay (7.1 vs. 5.2 days, P < 0.001) and hospitalization charges ($137,631.30 vs. $116,112.60, P < 0.001).

Conclusion.

Cannabis abuse appears to be associated with increased perioperative morbidity among spine surgery patients. Physicians should ensure that a thorough preoperative drug use history is taken, and that affected patients be adequately informed of associated risks.

Level of Evidence: 3
Effect of Minimally Invasive Selective Laminectomy for Cervical Spondylotic Myelopathy on Degenerative Spondylolisthesis
Authors: Kurihara Kota , Iba Kousuke , Teramoto Atsushi , Emori Makoto , Hirota Ryosuke , Oshigiri Tsutomu , Ogon Izaya , Iesato Noriyuki , Terashima Yoshinori , Takashima Hiroyuki , Yoshimoto Mitsunori , Takebayashi Tsuneo , Yamashita Toshihiko
Published: March 2021

Study Design:

Retrospective analysis of prospectively collected observational data.

Objective:

This study aimed to evaluate the slippage, sagittal alignment, and range of motion (ROM) after selective laminectomy (SL) in patients who had cervical spondylotic myelopathy (CSM) with degenerative spondylolisthesis (DS).

Summary of Background Data:

Clinical outcomes have been reported for both decompression and fusion surgeries for DS of the lumbar spine. However, only a few reports have examined cervical spine spondylolisthesis.

Materials and Methods:

This study included 178 patients who underwent SL for CSM. Those with ossification of the posterior longitudinal ligament were excluded. Slippage >2 mm was defined as spondylolisthesis, and spondylolisthesis progression was defined as an additional displacement >2 mm on a neutral radiograph. The slippage, translational motion, C2–C7 angle, local kyphosis, and ROM were examined before and ≥2 years after surgery. Radiologic parameters were evaluated according to the slip direction and the number of laminae removed.

Results:

DS was observed in 29 patients (16.3%); 24 patients, comprising 9 and 15 in the anterolisthesis and retrolisthesis groups, respectively, were successfully followed up for more than 2 years. Preoperative and postoperative radiologic changes in slippage, translational motion, C2–C7 angle, local kyphosis, and ROM were not remarkable in either group regardless of the number of laminae removed. Revision surgery for the progression of DS and alignment deterioration was not required in any patient of either group.

Conclusions:

SL does not affect DS, sagittal alignment, or ROM irrespective of the slip direction and the number of laminae removed, even after >2 years after surgery. Given the preservation of the posterior elements, SL may be an effective treatment for CSM with DS.

Level of Evidence:

Level IV.
Laminoplasty Achieves Improved Outcomes Despite Leading to a More Positive Sagittal Balance
Authors: Niu Shuo , Anastasio Albert T. , Rhee John M.
Published: March 2021

Study Design:

A retrospective study of prospective data.

Objective:

Determine the correlation between cervical sagittal alignment, either preoperative or postoperative, and the outcomes of laminoplasty.

Summary of Background Data:

Cervical laminoplasty is a common surgical treatment for myelopathy. However, the effect of preoperative or postoperative cervical sagittal alignment on outcomes, such as neurological improvement and patient-reported outcomes, remains unclear.

Methods:

A total of 144 consecutive patients (2007–2017) with laminoplasty for myelopathy and a minimum of 1-year postoperative follow-up were reviewed. The severity of myelopathy was assessed by modified Japanese Orthopedic Association (mJOA) scores. Total pain was measured by the visual analog scale. Patient-reported outcome included neck disability index (NDI) and 12-item short-form survey (SF-12). Radiographic measures of cervical sagittal alignment on x-ray images consisted of C2–C7 angle, T1 slope, C2–C7 sagittal vertical axis (SVA), and C2–C7 forward pitch (FP). Patients were also divided into 2 groups based on the postoperative C2–C7 SVA (≥40 or <40 mm) for outcome comparison.

Results:

Laminoplasty yielded improvement in functionality as evidenced by significantly increased mJOA scores, decreased total pain scores, and improved NDI scores at final follow-up. There was a change in sagittal balance postoperatively with significantly increased C2–C7 SVA and FP (7–8 mm increase). However, there was no correlation between preoperative sagittal alignment and outcomes. There was also no correlation between postoperative sagittal alignment and most outcomes, except for a significantly negative correlation between FP and short form-physical component summary (Spearman r=−0.328, P=0.011). When those with postoperative C2–C7 SVA ≥40 mm (n=60) were compared with those with <40 mm (n=84), there was no significant difference in outcomes.

Conclusions:

Cervical laminoplasty yields significant neurological and functional improvement despite a more positive sagittal balance postoperatively, with increased C2–C7 SVA and FP. However, other than a lower short form-physical component summary score, neither preoperative nor postoperative sagittal alignment measures correlated with spine-specific outcomes.

Level of Evidence:

Level II—a retrospective cohort study.
Thoracic Kyphosis and Lumbar Lordosis Distribution After Idiopathic Scoliosis Correction Using Posterior Hybrid Versus Screw Instrumentation
Authors: Charles Yann P. , Marchand Pierre-Luc , Tuzin Nicolas , Steib Jean-Paul
Published: March 2021

Study Design:

This was a retrospective observational study.

Objective:

The aim of this study was to evaluate kyphosis and lordosis distribution, inflexion points, and the relationship with proximal junctional kyphosis (PJK) comparing hybrid instrumentation (in situ contouring, derotation) versus screw instrumentation (thoracic cantilever reduction, lumbar in situ contouring, and derotation).

Summary of Background Data:

The combination of reduction techniques aims at restoring the levels of lumbar apex and thoracolumbar inflexion point according to Roussouly alignment types. This approach could minimize the PJK risk after adolescent idiopathic scoliosis (AIS) surgery.

Materials and Methods:

The study assessed coronal curve correction, thoracolumbar and spinopelvic sagittal parameters in 86 skeletally mature adolescents and young adults 2.2 years after AIS correction, comparing a hybrid group (HG, n=34) to a screw group (SG, n=52). Segmental kyphosis and lordosis distribution, number of vertebrae included in curves, thoracic and lumbar apex, thoracolumbar inflexion point and Roussouly types were modeled using KEOPS software.

Results:

Global coronal and sagittal correction were similar in both groups. In the SG, lumbar lordosis (LL) decreased from 61.1 to 53.9 degrees (P<0.0001) and matched with pelvic incidence (r=0.69), whereas LL did not change in the HG. Postoperatively, the thoracolumbar inflexion point migrated cranially, resulting in a longer LL in both groups. Postoperative thoracolumbar inflexion point (P<0.0001) and the lumbar apex (P=0.0274) were more caudal in the SG compared with the HG. The PJK rate was 14.7% in the HG and 7.7% in the SG. In patients with PJK, lumbar apex and thoracolumbar inflexion point shifted cranially and were too high according to the Roussouly type.

Conclusions:

Hybrid and screw instrumentation led to similar global AIS correction, but the use of cantilever reduction in the SG allowed setting the thoracolumbar inflexion point and the lumbar apex lower than in the HG. Cranial migration of these points was identified as PJK risk factor.

Level of Evidence:

Level III.
Genome-wide DNA methylation patterns in monocytes derived from patients with primary Sjogren syndrome
Authors: Luo Xuan , Peng Yu , Chen Ying-Ying , Wang An-Qi , Deng Chui-Wen , Peng Lin-Yi , Wu Qing-Jun , Zhao Yan , Fei Yun-Yun , Zhang Wen
Published: March 2021

Background:

Epigenetics, especially DNA methylation, plays an important role in the pathogenesis of primary Sjogren syndrome (pSS). Our study aimed to reveal the role of DNA methylation in peripheral monocytes of pSS patients.

Methods:

A total of 11 pSS patients and five age-matched healthy controls (HCs) were included in this study. Monocytes were isolated from peripheral blood mononuclear cells using magnetic microbeads. DNA methylation profiles were generated using Human Methylation 850K BeadChips.

Results:

In monocytes from pSS patients, we identified 2819 differentially methylated positions (DMPs), comprising 1977 hypomethylated- and 842 hypermethylated-DMPs, corresponding to 1313 unique genes when compared with HCs. IFI44L, MX1, PAARP9, and IFITM1, which influence the interferon (IFN) signaling pathway, were among the genes hypomethylated in pSS. Functional analysis of genes with a minimum of two DMPs showed involvement in antigen binding, transcriptional regulation, cell adhesion, IFN-γ pathway, type I IFN pathway, antigen presentation, Epstein-Barr virus infection, human T-lymphotropic virus type 1 virus infection, and metabolic disease-related pathways. In addition, patients with higher serum IgG levels exhibited enrichment in Notch signaling and metabolic-related pathways. Upon comparing monocytes with salivary gland epithelial cells, an important overlap was observed in the cell cycle, cell senescence, and interleukin-17 signaling pathways. The differentially methylated genes were more enriched in the ribosome- and AMP-activated protein kinase signaling pathway in anti-Ro/SSA and anti-La/SSB autoantibodies double-positive patients.

Conclusion:

Genome-wide DNA methylation profiling revealed significant differences in DNA methylation in monocytes isolated from patients with pSS.
Solitary CD8-Positive Primary Cutaneous Peripheral T-Cell Lymphoma: A Question of Classification
Authors: Rolim Inês , BakShi Arti , West Elizabeth , Azurdia Richard , Kempf Werner , Robson Alistair
Published: March 2021

Acral CD8(+) lymphoma is a provisional entity in the latest edition of the WHO Lymphoma Classification and is associated with a highly specific dot-like pattern of immunohistochemical expression of CD68. We report a case of an ulcerated solitary cutaneous lesion arising on the forehead of an adult man, which had a CD8(+) cytotoxic phenotype and areas of dot-like CD68 positivity, but with a number of features that significantly detracted from the classically described acral CD8(+) lymphoma. The nosological status of the lesion is discussed with respect to a preferred diagnosis of peripheral T-cell lymphoma, not otherwise specified.
Social Networks and HIV Care Outcomes in Rural Kenya and Uganda
Authors: Chen Yiqun T. , Brown Lillian , Chamie Gabriel , Kwarisiima Dalsone , Ayieko James , Kabami Jane , Charlebois Edwin , Clark Tamara , Kamya Moses , Havlir Diane V. , Petersen Maya L. , Balzer Laura B.
Published: March 2021

Background:

Social isolation among HIV-positive persons might be an important barrier to care. Using data from the SEARCH Study in rural Kenya and Uganda, we constructed 32 community-wide, sociocentric networks and evaluated whether less socially connected HIV-positive persons were less likely to know their status, have initiated treatment, and be virally suppressed.

Methods:

Between 2013 and 2014, 168,720 adult residents in the SEARCH Study were census-enumerated, offered HIV testing, and asked to name social contacts. Social networks were constructed by matching named contacts to other residents. We characterized the resulting networks and estimated risk ratios (aRR) associated with poor HIV care outcomes, adjusting for sociodemographic factors and clustering by community with generalized estimating equations.

Results:

The sociocentric networks contained 170,028 residents (nodes) and 362,965 social connections (edges). Among 11,239 HIV-positive persons who named ≥1 contact, 30.9% were previously undiagnosed, 43.7% had not initiated treatment, and 49.4% had viral nonsuppression. Lower social connectedness, measured by the number of persons naming an HIV-positive individual as a contact (in-degree), was associated with poorer outcomes in Uganda, but not Kenya. Specifically, HIV-positive persons in the lowest connectedness tercile were less likely to be previously diagnosed (Uganda-West aRR: 0.89 [95% confidence interval (CI): 0.83, 0.96]; Uganda-East aRR: 0.85 [95% CI: 0.76, 0.96]); on treatment (Uganda-West aRR: 0.88 [95% CI: 0.80, 0.98]; Uganda-East aRR: 0.81 [0.72, 0.92]), and suppressed (Uganda-West aRR: 0.84 [95% CI: 0.73, 0.96]; Uganda-East aRR: 0.74 [95% CI: 0.58, 0.94]) than those in the highest connectedness tercile.

Conclusions:

HIV-positive persons named as a contact by fewer people may be at higher risk for poor HIV care outcomes, suggesting opportunities for targeted interventions.
Understanding oocyte ageing: can we influence the process as clinicians?
Authors: Homer Hayden Anthony
Published: March 2021

Purpose of review

Oocyte quality is rate-limiting for pregnancy success and declines with age. Here, I review animal-study evidence showing dramatic reversal of oocyte ageing with mitochondrial nutrients and explore clinical evidence related to their usage.

Recent findings

Oocyte ageing is strongly tied to mitochondrial dysfunction and oxidative stress. Quality-defining events occur over a protracted period (2—3 months in humans) when oocyte volume increases over 100-fold. Treating mice during the growth phase with mitochondrial modifiers such as CoQ10 combats oocyte ageing. Exciting new work shows that raising oocyte NAD+ levels also dramatically rejuvenate aged oocytes. However, evidence that any of these agents can reproducibly improve quality in humans is lacking. This is largely because there has been a focus on patients with poor ovarian response during IVF and/or low ovarian follicular pool size, rather than patients with poor oocyte quality. In addition, studies have used short-term treatment during ovarian stimulation after oocyte growth is already complete.

Mitochondrial therapeutics such as NAD+-boosting used during the oocyte's growth phase markedly improve oocyte quality in mice. Evaluating them in humans should focus on patients with poor oocyte quality and utilise per-oocyte (rather than per-cycle) endpoints after adequate treatment that captures the growth phase when quality is defined.
The 100 Most-disruptive Articles in Plastic and Reconstructive Surgery and Sub-specialties (1954–2014)
Authors: Hansdorfer Marek A. , Horen Sydney R. , Alba Brandon E. , Akin Jennifer N. , Dorafshar Amir H. , Becerra Adan Z.
Published: March 2021

Background:

Alternative bibliometrics have recently been the subject of significantly increased interest. The disruption index is a new bibliometric that was recently applied to surgery and urology and identifies papers that shift paradigms and eclipse previous research in a given field.

Methods:

The 100 most-disruptive publications in the 14 most prominent plastic and reconstructive surgery and subspecialty journals were identified.

Results:

We present the 100 most-disruptive studies as well as the 100 most-cited studies for comparison in n=14 of the most popular plastic and reconstructive surgery (and subspecialty) journals between 1954 and 2014. The 100 most-disruptive publications in these journals were more disruptive than 99.8% of all PubMed papers. Plastic and Reconstructive Surgery (PRS) had the most papers in the top 100 (n=64) followed by British Journal of Plastic Surgery (currently Journal of Plastic, Reconstructive & Aesthetic Surgery, n=15), and Journal of Oral and Maxillofacial Surgery (n=7). PRS had 9 of the top 10 papers. However, Clinics in Plastic Surgery had the highest average disruption score for all its published papers (0.0029). The correlation coefficient linking disruption scores and citation counts was 0.01 and 0.11, respectively. The most common decade represented in the top 100 was the 1980's (n=31) and the least common was the 2000's (n=9).

Conclusions:

This is the first application of the disruption index to plastic and reconstructive surgery. The disruption score provides a unique ability to identify research that has shifted paradigms and driven the innovation that defines our specialty.
Choroidal hemorrhage, preplaced sutures, and host-over-donor keratoplasty
Authors: Carpel Emmett F. , Scheurer Ryan A.
Published: March 2021

An old and currently seldom used technique, true preplaced sutures, is described in a case that was high risk for choroidal hemorrhage (CH). A penetrating keratoplasty technique, termed graft-over-host technique, was used allowing the surgeon to expeditiously close the eye in the event of CH. After partial-thickness trephination, true preplaced sutures through the corneal host tissue were passed. After complete trephination, the corneal donor graft was placed under the host and sutured in a controlled fashion. The preplaced sutures had been drawn immediately, giving a broad secure cover, allowing controlled permanent suturing of the graft while selectively removing the preplaced sutures. When CH occurs, the preplaced sutures allow the surgeon to quickly close the eye securely.
Associations between anterior segment parameters and rotational stability of a plate-haptic toric intraocular lens
Authors: Yao Yunqian , Meng Jiaqi , He Wenwen , Zhang Keke , Wei Ling , Cheng Kaiwen , Lu Yi , Zhu Xiangjia
Published: March 2021

Purpose:

To evaluate the associations between anterior segment parameters and the rotational stability of a plate-haptic toric intraocular lens (IOL).

Setting:

Eye and Ear, Nose, Throat Hospital of Fudan University.

Design:

Retrospective case series.

Methods:

Patients who underwent uneventful phacoemulsification and plate-haptic toric IOL (AT TORBI 709M IOL) implantation were included. Preoperative axial length (AL) and anterior segment parameters, including the white-to-white (WTW) distance, anterior chamber depth (ACD), lens thickness (LT), and anterior segment length (ASL; the sum of ACD and LT) were recorded. IOL rotation, residual astigmatism (RAS), and visual acuity were evaluated 1 month postoperatively. The associations between the anterior segment parameters and IOL rotation were evaluated.

Results:

A total of 102 eyes of 102 patients were included. The mean AL was 26.43 ± 2.65 mm (range 21.71–34.60 mm). The mean IOL rotation was 4.59 ± 3.18 degrees, and RAS was 0.62 ± 0.39 D postoperatively. No correlation was detected between AL, ACD, or LT and the rotation of the plate-haptic toric IOL (all P > .05). However, its rotation correlated positively with the WTW distance (r = 0.250, P = .011) and ASL (r = 0.214, P = .030). Backward stepwise multiple linear regression revealed that the WTW distance (β = 2.142, P = .014) and ASL (β = 2.060, P = .037) were independent predictors of plate-haptic toric IOL rotation.

Conclusions:

Plate-haptic toric IOLs rotate more in eyes with larger WTW distances and longer ASLs; therefore, toric IOL implantation should be performed with caution in eyes with these characteristics.
Usefulness of Self-Expanding Drainage Cannula in Venovenous Extracorporeal Membrane Oxygenation: Tips, Tricks, and Results of an Early Experience
Authors: Piñón Miguel , Suárez Javier , Acuña Beatriz , Ajhuacho Narda , Sisinni Consuelo , Pereira Jorge , Chico Juan Ignacio , Raposeiras Sergio , Legarra Juan José
Published: March 2021

Inadequate venous drainage decreases the efficiency of extracorporeal membrane oxygenation (ECMO). Pump augmentation may even make it worse due to collapse of the venous system under negative pressures. Furthermore, recirculation is a phenomenon that occurs when oxygenated blood supplied through the infusion cannula is withdrawn directly through the drainage cannula without contributing to the oxygenation of the patient and also compromises the efficacy of the therapy. Large drainage cannulas allow for similar flow rates at lower pump speed. But percutaneous insertion of these larger cannulas could be challenging. When using a self-expandable cannula, the diameter of the cannula for the insertion can be reduced, and once inserted, its intravascular diameter maximized, resulting in a large venous cannula due to in situ expansion after mandrel removal (up to 36F). We present a retrospective series of selfexpanding venous cannula 430 or 530 mm in length in six consecutive patients undergoing venovenous (VV) ECMO. No vascular or cardiac iatrogenic injury was caused during implantation. Target flows were reached, and no clinically significant recirculation was described in any case. The use of selfexpanding drainage cannulas was safe, and efficient drainage was achieved with easy and definitive unique positioning during cannulation.
Veno-Venous Extracorporeal Rewarming Using Dual-Lumen Cannula in Accidental Hypothermia
Authors: Denk Jennifer A. , Michel Eriberto , Clark Aaron J. , Thinh Pham Duc , Mehta Christopher K.
Published: March 2021

Accidental hypothermia with a core temperature below 28°C is associated with an increased risk of hemodynamic instability. It is difficult to predict which patients will survive with a favorable neurologic outcome; therefore, decision-making regarding extracorporeal support is not straightforward. We report a case of rewarming using veno-venous dual-lumen cannula as an alternative to veno-arterial support with full recovery and normal neurologic examination. In centers where extracorporeal membrane oxygenation is available, rewarming using veno-venous dual-lumen extracorporeal support may be a useful strategy to mitigate the risks associated with veno-arterial extracorporeal support.
Outcomes of Durable Mechanical Circulatory Support in Myocarditis: Analysis of the International Society for Heart and Lung Transplantation Registry for Mechanically Assisted Circulatory Support Registry
Authors: Al-Kindi Sadeer G. , Xie Rongbing , Kirklin James K. , Cowger Jennifer , Oliveira Guilherme H. , Krabatsch Thomas , Nakatani Takeshi , Schueler Stephan , Leet Angeline , Golstein Daniel , Elamm Chantal A.
Published: March 2021

Myocarditis can be refractory to medical therapy and require durable mechanical circulatory support (MCS). The characteristics and outcomes of these patients are not known. We identified all patients with clinically-diagnosed or pathology-proven myocarditis who underwent mechanical circulatory support in the International Society for Heart and Lung Transplantation Registry for Mechanically Assisted Circulatory Support registry (2013–2016). The characteristics and outcomes of these patients were compared to those of patients with nonischemic cardiomyopathy (NICM). Out of 14,062 patients in the registry, 180 (1.2%) had myocarditis and 6,602 (46.9%) had NICM. Among patients with myocarditis, duration of heart failure was <1 month in 22%, 1–12 months in 22.6%, and >1 year in 55.4%. Compared with NICM, patients with myocarditis were younger (45 vs. 52 years, P < 0.001) and were more often implanted with Interagency Registry for Mechanically Assisted Circulatory Support profile 1 (30% vs. 15%, P < 0.001). Biventricular mechanical support (biventricular ventricular assist device [BIVAD] or total artificial heart) was implanted more frequently in myocarditis (18% vs. 6.7%, P < 0.001). Overall postimplant survival was not different between myocarditis and NICM (left ventricular assist device: P = 0.27, BIVAD: P = 0.50). The proportion of myocarditis patients that have recovered by 12 months postimplant was significantly higher in myocarditis compared to that of NICM (5% vs. 1.7%, P = 0.0003). Adverse events (bleeding, infection, and neurologic dysfunction) were all lower in the myocarditis than NICM. In conclusion, although myocarditis patients who receive durable MCS are sicker preoperatively with higher needs for biventricular MCS, their overall MCS survival is noninferior to NICM. Patients who received MCS for myocarditis are more likely than NICM to have MCS explanted due to recovery, however, the absolute rates of recovery were low.
The Impact of Malnutrition on the Hospital and Infectious Outcomes of Patients Admitted With Alcoholic Hepatitis
Authors: Lee David U. , Fan Gregory H. , Hastie David J. , Addonizio Elyse A. , Prakasam Vibhav N. , Ahern Ryan R. , Seog Kristen J. , Karagozian Raffi
Published: March 2021

Goals:

We specifically evaluate the effect of malnutrition on the infection risks of patients admitted with alcoholic hepatitis using a national registry of hospitalized patients in the United States.

Background:

Malnutrition is a common manifestation of alcoholic hepatitis that affects patient outcomes.

Study:

2011 to 2017 National Inpatient Sample was used to isolated patients with alcoholic hepatitis, stratified using malnutrition (protein-calorie malnutrition, sarcopenia, and weight loss/cachexia) and matched using age, gender, and race with 1:1 nearest neighbor matching method. Endpoints included mortality and infectious endpoints.

Results:

After matching, there were 10,520 with malnutrition and 10,520 malnutrition-absent controls. Mortality was higher in the malnutrition cohort [5.02 vs. 2.29%, P<0.001, odds ratio (OR): 2.25, 95% confidence interval (CI): 1.93-2.63], as were sepsis (14.2 vs. 5.46, P<0.001, OR: 2.87, 95% CI: 2.60-3.18), pneumonia (10.9 vs. 4.63%, P<0.001, OR: 2.51, 95% CI: 2.25-2.81), urinary tract infection (14.8 vs. 9.01%, P<0.001, OR: 1.76, 95% CI: 1.61-1.91), cellulitis (3.17 vs. 2.18%, P<0.001, OR: 1.47, 95% CI: 1.24-1.74), cholangitis (0.52 vs. 0.20%, P<0.001, OR: 2.63, 95% CI: 1.59-4.35), and Clostridium difficile infection (1.67 vs. 0.91%, P<0.001, OR: 1.85, 95% CI: 1.44-2.37). In multivariate models, malnutrition was associated with mortality [P<0.001, adjusted odds ratio (aOR): 1.61, 95% CI: 1.37-1.90] and infectious endpoints: sepsis (P<0.001, aOR: 2.42, 95% CI: 2.18-2.69), pneumonia (P<0.001, aOR: 2.19, 95% CI: 1.96-2.46), urinary tract infection (P<0.001, aOR: 1.68, 95% CI: 1.53-1.84), cellulitis (P<0.001, aOR: 1.46, 95% CI: 1.22-1.74), cholangitis (P=0.002, aOR: 2.27, 95% CI: 1.36-3.80), and C. difficile infection (P<0.001, aOR: 1.89, 95% CI: 1.46-2.44).

Conclusion:

This study shows the presence of malnutrition is an independent risk factor of mortality and local/systemic infections in patients admitted with alcoholic hepatitis.
Recent evidence on the effect of urate-lowering treatment on the progression of kidney disease
Authors: Tiku Anushree , Johnson David W. , Badve Sunil V.
Published: March 2021

Purpose of review

Several observational studies have shown that hyperuricemia is associated with chronic kidney disease (CKD) progression and is a potential therapeutic target in people with CKD. This review discusses the results of three recently published placebo-controlled randomized trials evaluating the effect of urate-lowering treatment on the progression of CKD with at least 2 years of follow-up.

Recent findings

The Febuxostat versus Placebo Randomized Controlled Trial Regarding Reduced Renal Function in Patients with Hyperuricemia Complicated by Chronic Kidney Disease Stage 3 trial evaluated the effect of febuxostat in 443 patients with stage 3 CKD (mean estimated glomerular filtration rate [eGFR] 45 mL/min/1.73 m2) and asymptomatic hyperuricemia (mean serum urate 7.8 mg/dL). The Controlled trial of slowing of Kidney Disease progression From the Inhibition of Xanthine oxidase and Preventing Early Renal Loss in Diabetes trials respectively evaluated the effect of allopurinol in 369 adults with stage 3 or 4 CKD (mean eGFR 31.7 mL/min/1.73 m2, mean serum urate 8.2 mg/dL) with high progression risk and 530 patients with type 1 diabetes and diabetic kidney disease (mean eGFR 74.7 mL/min/1.73 m2, mean serum urate 6.1 mg/dL). Despite the large and sustained reductions in serum urate levels in all 3 trials, urate-lowering treatment with febuxostat or allopurinol did not result in clinically meaningful improvement in kidney outcomes.

The results of large and well-designed placebo-controlled trials do not support the use of urate-lowering therapy to slow the progression of CKD.
Towards harmony in defining and reporting glomerular diseases on kidney biopsy
Authors: Haas Mark
Published: March 2021

Purpose of review

To review recent efforts to develop uniformity and precision in defining individual glomerular histologic and ultrastructural lesions and proposals for developing greater uniformity in reporting of glomerular diseases.

Recent findings

Over the past 2 decades, scoring systems for multiple glomerular diseases have emerged, as have several consortia for the study of glomerular diseases. However, one important limitation faced by renal pathologists and nephrologists has been a lack of uniformity and precision in defining the morphologic lesions seen by light and electron microscopy on which the scoring systems are based. In response to this, the Renal Pathology Society organized a working group that over 4 years arrived at consensus definitions for many such lesions. These definitions can be applied within the context of scoring systems for different glomerular diseases, and recently proposed reporting systems based on pathogenic categories and for defining the overall severity of chronic changes.

From extensive discussions a panel of 13 renal pathologists reached consensus in defining 47 individual glomerular lesions seen on light microscopy and 56 glomerular lesions and key normal structures seen by electron microscopy. Validation of the impact of these consensus definitions on interobserver agreement in lesion identification is currently underway.
Updated strategies in the management of acute variceal haemorrhage
Authors: Edelson Jerome , Basso Jessica E. , Rockey Don C.
Published: March 2021

Purpose of review

This article reviews the most recent studies regarding the management of acute esophageal variceal haemorrhage.

Recent findings

New randomized control trials and meta-analyses confirmed the role of early transjugular intrahepatic portosystemic shunt (TIPS) in the management of acute variceal haemorrhage in Child-Pugh C (10–13) and B patients with active bleeding. A recent randomized controlled trial focused on the duration of vasoactive therapy showed no difference between 2 and 5 days of octreotide. A randomized trial showed decreased use of blood products for the correction of coagulopathy using a thromboelastography-guided approach (vs. conventional parameters) as well as decreased bleeding rates when compared with standard of care. A meta-analysis found that for rescue of variceal bleeding, self-expanding metallic stents were more efficacious and safer than balloon tamponade. In addition, studies showed that Child-Pugh C patients and those with hepatic vein pressure gradient more than 20 were at the highest risk of treatment failure, while model for end-stage liver disease was highly predictive of in-hospital mortality.

In patients with severe coagulopathy and uncontrolled bleeding, TEG-based transfusion strategies are recommended. Antibiotics should be used for all cirrhotic patients presenting with upper gastrointestinal bleeding, but should be tailored in accordance to local resistance patterns. Early TIPS for high-risk patients has been shown to have a significant survival benefit. Certain aspects of the management of variceal bleeding remain poorly studied such as the role of early TIPS in Child-B patients as well as strategies for rescue therapy in patients who are not TIPS candidates, and require further investigation.
Neuroblastoma With Opsoclonus-Myoclonus-Ataxia Syndrome: Role of Chemotherapy in the Management: Experience From a Tertiary Care Center in a Resource-limited Setting
Authors: Anand Sachit , Agarwala Sandeep , Jain Vishesh , Bakhshi Sameer , Dhua Anjan , Gulati Sheffali , Seth Rachna , Srinivas Maddur , Jana Manisha , Kandasamy Devasenathipathy , Bhatnagar Veereshwar
Published: March 2021

Children with neuroblastoma (NB) and opsoclonus-myoclonus-ataxia syndrome (OMAS) have a favorable oncologic outcome and overall survival. In contrast, despite intensive multidrug immunomodulation, the neurologic outcome is complicated by the relapsing nature of the neurologic symptoms and long-term neurobehavioral sequelae. Being associated with low-risk NB, there exists an ambiguity in the current literature regarding the administration of chemotherapy in these children. We reviewed our archives for children with NB-OMAS over a 22-year (January 1996 to January 2018) period. Eighteen children (10 female) with a median age at diagnosis of 23 months had NB-OMAS and were included. They had stage 1 (9/18; 50%), 2 (1/18; 5.5%), 3 (7/18; 39%), and 4 (1/18; 5.5%) disease according to the International Neuroblastoma Staging System. Multimodality therapy included surgery (16/18; 89%), chemotherapy (11/18; 61%), and immunomodulatory therapy (10/18; 55%). Complete oncologic remission was achieved in all children. Relapse of OMAS and presence of neurologic sequelae were observed in 1 (5.5%) and 5 (28%) cases, respectively. Presence of neurologic sequelae was significantly associated with low-tumor stage (P=0.036) and treatment without chemotherapy (P=0.003). Chemotherapy administration was the only variable significantly predicting a favorable neurologic outcome (95% confidence interval: 0.26-1.40, P=0.01). To conclude, our study including a limited cohort of patients highlights a favorable neurologic outcome associated with chemotherapy administration in children with NB-OMAS. However, further studies with larger sample size need to be conducted before drawing any definite conclusions.
The Predictive Value of the Eighth Edition of the Clinical TNM Staging System for the Likelihood of Eye Salvage for Intraocular Retinoblastoma by Systemic Chemotherapy and Focal Therapy
Authors: Yousef Yacoub A. , Mohammad Mona , Mehyar Mustafa , Sultan Iyad , Al-Hussaini Maysa , Alhourani Joud , Halalsheh Hadeel , Khzouz Jakub , Jaradat Imad , Qaddoumi Ibrahim , Al-Nawaiseh Ibrahim
Published: March 2021

Background:

The American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) cTNM staging is emerging as a universal staging for all cancers, including retinoblastoma.

Methods:

Here we evaluated the predictive value of the eighth edition AJCC/UICC cTNM staging in comparison with the International Intraocular Retinoblastoma Classification for eye globe salvage by primary systemic chemotherapy and focal therapy (CRD) using logistic regression model for the probability of treatment failure.

Results:

The eye salvage rate for 565 treated eyes was 95% (n=139/147) for T1 tumors (98% for T1a and 93% for T1b), 56% (n=230/410) for T2 (81% for T2a and 53% for T2b), and 0% for T3 tumors, and was 98%, 93%, 76%, and 44% for group A, B, C, and D tumors, respectively. As estimated by odds ratios, T2 were 13.6-fold more likely to fail treatment than T1, and T1b, T2a, and T2b were 2.8-, 9.4-, and 35.1-fold more likely to fail treatment than T1a, respectively. Group B, C, and D tumors were 2.8-, 12.7-, and 50.1-fold more likely to fail treatment than group A tumors, respectively. Eye salvage rate was 62% for eyes with focal seeds (3 mm close to the tumor), and 42% for eyes with diffuse seeds (clouds more than 3 mm from tumor edge) (P<0.0001).

Conclusion:

Both, the eighth edition cTNM classification and the International Intraocular Retinoblastoma Classification systems, can effectively predict eye salvage rates for retinoblastoma by CRD. Eyes with higher cT stages are more likely to experience treatment failure. Because the cT2b group is very heterogeneous, our findings suggest further division of this group based on the severity of vitreous/subretinal seeds, this should be revised in the next edition of cTNM system.