bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of Inflammopathic, Adaptive, and Coagulopathic Sepsis Endotypes in Coronavirus Disease 2019
Authors: Sweeney Timothy E. , Liesenfeld Oliver , Wacker James , He Yudong D. , Rawling David , Remmel Melissa , Coyle Sabrina , Midic Uros , Kotsaki Antigone , Kanavou Aggeliki , Leventogiannis Konstantinos , Kontogeorgou Ioanna , Giamarellos-Bourboulis Evangelos J.
Published: November 2020

Objectives:

Complex critical syndromes like sepsis and coronavirus disease 2019 may be composed of underling “endotypes,” which may respond differently to treatment. The aim of this study was to test whether a previously defined bacterial sepsis endotypes classifier recapitulates the same clinical and immunological endotypes in coronavirus disease 2019.

Design:

Prospective single-center observational cohort study.

Setting:

Patients were enrolled in Athens, Greece, and blood was shipped to Inflammatix (Burlingame, CA) for analysis.

Patients:

Adult patients within 24 hours of hospital admission with coronavirus disease 2019 confirmed by polymerase chain reaction and chest radiography.

Interventions:

None.

Measurements and Main results:

We studied 97 patients with coronavirus disease 2019, of which 50 went on to severe respiratory failure (SRF) and 16 died. We applied a previously defined 33-messenger RNA classifier to assign endotype (Inflammopathic, Adaptive, or Coagulopathic) to each patient. We tested endotype status against other clinical parameters including laboratory values, severity scores, and outcomes. Patients were assigned as Inflammopathic (29%), Adaptive (44%), or Coagulopathic (27%), similar to our prior study in bacterial sepsis. Adaptive patients had lower rates of SRF and no deaths. Coagulopathic and Inflammopathic endotypes had 42% and 18% mortality rates, respectively. The Coagulopathic group showed highest d-dimers, and the Inflammopathic group showed highest C-reactive protein and interleukin-6 levels.

Conclusions:

Our predefined 33-messenger RNA endotypes classifier recapitulated immune phenotypes in viral sepsis (coronavirus disease 2019) despite its prior training and validation only in bacterial sepsis. Further work should focus on continued validation of the endotypes and their interaction with immunomodulatory therapy.
Adrenocortical carcinoma: current treatment options
Authors: De Filpo Giuseppina , Mannelli Massimo , Canu Letizia
Published: November 2020

Purpose of review

In this article, we focus on the current and future treatment options for adrenocortical carcinoma (ACC).

Recent findings

Radical surgery remains the only curative treatment for ACC. Recent reports showed a longer overall survival (OS) in patients with high risk of recurrence treated with adjuvant mitotane; the time in target range (14–20 mg/l) is related to low risk of relapse both in adjuvant and in palliative setting. In patients who experience disease progression after etoposide, doxorubicin, cisplatin with mitotane (EDP-M), gemcitabine and metronomic capecitabine, or the less used streptozotocin, represent a second-line chemotherapy option. Temozolomide can be employed as a third-line chemotherapy. To date, unsatisfactory results have been obtained on the efficacy of targeted therapies. Clinical trials are ongoing to evaluate the efficacy of tyrosine kinase and immune checkpoint inhibitors.

ACC is a rare disease with a poor prognosis. The main therapy is represented by radical surgery conducted by an expert surgeon. Adjuvant mitotane has to be started in patients with high risk of recurrence. In patients with inoperable disease, the scheme EDP-M is the most employed. Few data are available on second-line and third-line chemotherapy in patients with disease progression after EDP-M. Currently, the role of targeted therapies is under evaluation.
Immune checkpoint inhibitors in driver mutation-positive nonsmall cell lung cancer: is there a role?
Authors: Lee Jiyun , Ahn Myung-Ju
Published: November 2020

Purpose of review

Despite advances in immunotherapy for nonsmall cell lung cancer patients, the clinical efficacy of drugs for patients with oncogenic driver mutations remains limited. This article aimed to comprehensively review the currently available data on the efficacy and safety of immune checkpoint blockade (ICB) for patients with driver mutation-positive lung cancer.

Recent findings

Despite the positive interaction between activation of oncogenic pathways and upregulated PD-L1 expression demonstrated in preclinical studies, the efficacy of single-agent ICB in patients with oncogenic mutation has largely been discouraging, except for those with KRAS mutations. The combination therapies using ICB with tyrosine kinase inhibitors (TKIs) for EGFR/ALK alteration raised a concern for the high incidence of treatment-related adverse events, notably hepatotoxicity and interstitial lung disease. A novel combination with bevacizumab demonstrated promising efficacy with tolerable safety profiles.

Other than patients with the KRAS mutation who demonstrate relatively favorable response to ICB, a single-agent ICB therapy should be considered for those who retain good performance status but have no other therapeutic options available. Further studies on the combination of ICB and TKI are needed to identify the most viable pair regarding safety. Additional studies using novel combination partners, such as anti-VEGF inhibitors, are also warranted.
Inter- and intra-observer variability for the assessment of coronary artery tree description and lesion EvaluaTion (CatLet©) angiographic scoring system in patients with acute myocardial infarction
Authors: Liu Jin-Mei , He Yang , Teng Ruo-Ling , Qian Xiao-Dong , Dai Yun-Lang , Xu Jian-Ping , Zhao Xin , Jiang Ting-Bo , He Yong-Ming
Published: November 2020

Background:

Previously, we developed a novel
C
oronary
A
rtery
T
ree description and
L
esion
E
valua
T
ion (CatLet©) angiographic scoring system, which was capable of accounting for the variability in the coronary anatomy and assisting in the risk-stratification of patients with acute myocardial infarction (AMI). Our preliminary study revealed that the CatLet score better predicted clinical outcomes for AMI patients than the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score. However, the reproducibility of the CatLet score in both inter- and intra-observer remains to be evaluated.

Methods:

A total of 30 consecutive AMI patients, admitted in September of 2015, were independently assessed by two experienced interventional cardiologists to evaluate the inter-observer reproducibility of the CatLet score. Another set of 49 consecutive AMI patients, admitted between September and October in 2014, were assessed by one of the two interventional cardiologists on two occasions 3 months apart to evaluate the intra-observer reproducibility of the CatLet score. The weighted kappa was used to express the degree of agreement.

Results:

The weighted kappa values (95% confidence interval) for the intra- and inter-observer reproducibility of the CatLet Score were 0.82 (0.59–1.00, Z = 7.23, P < 0.001) and 0.86 (0.54–1.00, Z = 5.20, P < 0.001), respectively, according to the tertile analysis (≤14, 15–22, >22). Regarding the adverse characteristics pertinent to lesions and dominance parameters, the kappa values for the inter-observer variability were 0.80 (0.56–1.00, Z = 6.47, P < 0.001) for total number of lesions, 0.57 (0.28–0.85, Z = 3.03, P < 0.001) for bifurcation, 0.69 (0.43–0.96, Z = 5.06, P < 0.001) for heavy calcification, 1.00 (0.72–1.00, Z = 6.93, P < 0.001) for tortuosity, 0.54 (0.26–0.82, Z = 3.78, P < 0.001) for thrombus, 0.69 (0.48–0.91, Z = 6.29, P < 0.001) for right coronary artery dominance, 0.69 (0.41–0.96, Z = 4.91, P < 0.001) for left anterior descending artery length, and 0.22 (0.06–0.51, Z = 1.56, P = 0.06) for diagonal size. Equivalent values for the intra-observer variability were moderate to almost perfect (range 0.54–1.00).

Conclusions:

The reproducibility of the CatLet angiographic scoring system for evaluation of the coronary angiograms ranged from substantial to excellent. The high reproducibility of the CatLet angiographic scoring system will boost its clinical application to patients with AMI.
Life-threatening polymyositis with spontaneous hematoma induced by nivolumab in a patient with previously resected melanoma
Authors: Liu Wing K. , Naban Nabeel , Kaul Arvind , Patel Nirav , Fusi Alberto
Published: November 2020

Single-agent anti-PD1 antibodies are usually very well tolerated, but serious toxicity can still occur. Despite the PD-1 pathway seems to be relevant in the pathogenesis of immune-related myositis, anti-PD1-related myositis is generally a rare side effect of the treatment and usually not serious. However, its frequency is likely to increase as the use of immune checkpoint blockades. We present here a case of life-threatening polymyositis with associated spontaneous muscular hematoma in a patient treated with single-agent nivolumab in the adjuvant setting. Spontaneous hematoma is an extremely rare complication with unclear etiology of idiopathic myositis. Very few cases have been reported in the literature and their outcome has been often fatal. To our knowledge, this is the first case of autoimmune myositis and spontaneous heamatoma associated with the administration of single-agent checkpoint blockade. Anti-PD1 antibodies have changed the treatment landscape for a number of cancer entities in the past few years. When given as single agent they are usually very well tolerated, but serious rare toxicity can still occur. We present here a case of polymyositis with associated spontaneous muscular hematoma in a patient treated with single agent nivolumab.
Development of a Patient-Reported Outcome Questionnaire to Evaluate Primary Mitochondrial Myopathy Symptoms: The Primary Mitochondrial Myopathy Symptom Assessment
Authors: Gwaltney Chad , Stokes Jonathan , Aiudi Anthony , Mazar Iyar , Ollis Sarah , Love Emily , Espensen Ashlee , Shields Alan L.
Published: November 2020

Objectives:

Primary mitochondrial myopathy (PMM) is a genetic condition characterized by life-limiting symptoms such as muscle weakness, fatigue, and pain. Because these symptoms are best reported by individuals with PMM, the objective of this qualitative research study was to develop a PMM-specific patient-reported outcome (PRO) questionnaire.

Method:

Individuals with PMM were interviewed, identifying the most salient symptoms of PMM and assessing the resulting questionnaire's relevance and comprehensibility.

Results:

Developed based on patient interviews, the 10-item Primary Mitochondrial Myopathy Symptom Assessment assesses patients' symptom experiences at their worst in the last 24 hours. Individuals with PMM confirmed the concepts of the questionnaire as relevant and comprehensive to their symptom experiences and responded to the items consistently with developers' intentions.

Conclusions:

The Primary Mitochondrial Myopathy Symptom Assessment is a content-valid PRO questionnaire with qualitative and quantitative support as a valuable tool to evaluate and monitor the day-to-day experience of PMM symptoms from the patient perspective.
Sleep and Breathing After Nusinersen Therapy in a Child With Spinal Muscular Atrophy
Authors: Kouri Ioanna , Demirel Nadir , Haile Dawit T. , Selcen Duygu , Kotagal Suresh
Published: November 2020

Background:

Spinal muscular atrophy (SMA) type 3 is an autosomal recessive neurological disorder associated with a deletion/mutation in the survival motor neuron gene, with gradually progressive degeneration of the motor neurons of the spinal cord and brainstem, which causes muscle weakness responsible for impairment of swallowing, breathing, and mobility.

Report of case:

We report an 11-year-old girl with SMA type 3 with moderate to severe obstructive sleep apnea (OSA) syndrome refractory to adenotonsillectomy and noninvasive ventilatory support. She was started on nusinersen, which is a novel disease modifying therapy for SMA. This new treatment led to improvement of the OSA in a short period, likely from better respiratory muscle function.

Conclusions:

The improvement in OSA supports the role of nusinersen in sleep-related upper respiratory muscle function in SMA type 3.
Incidence of postoperative sore throat after using a new technique of insertion of a second generation Laryngeal Mask Airway
Authors: Li Xiaoxiao , Wang Xiuli , Zhao Ye , Jiang Zhenfei , Lv Xueli , Nie Xinrui , Li Tong , Wang Xinghe , Dai Lingyun , Liu Su
Published: November 2020

BACKGROUND

Sore throat is a common complication after Laryngeal Mask Airway Supreme (SLMA) insertion.

OBJECTIVE

The aim of this study was to determine whether a new SLMA insertion technique (not removing the pilot tube blocker before insertion) lowers the incidence of sore throat in the postanaesthesia care unit (PACU).

DESIGN

A prospective, single-centre, parallel randomised controlled trial.

SETTING

Operating room and PACU at a hospital in China from June to September 2019.

PATIENTS

Four hundred and eight patients aged 18 to 65 years with American Society of Anaesthesiologists physical status class I or II who were scheduled for elective surgery requiring anaesthesia and SLMA insertion.

INTERVENTIONS

Leaving the blocker at the end of the pilot tube in situ (this blocker keeps the valve open and the balloon remains partially inflated but will deflate with pressure) or removing the blocker and actively deflating the cuff before SLMA insertion.

MAIN OUTCOME MEASURES

The primary outcome was the incidence of postoperative sore throat in the PACU. The secondary outcomes included sore throat severity (Prince Henry Hospital Pain Score), first-attempt success rate, ease of insertion, time to successful SLMA insertion, oropharyngeal leak pressure, grade of view on fibreoptic bronchoscopy (indicating the accuracy of SLMA positioning) and adverse events.

RESULTS

The incidence of sore throat was 33/204 (16.2%) in the nonremoval group, and 65/204 (31.9%) in the removal group (P < 0.001). The first-attempt success rate was 174/204 (85.3%) in the nonremoval group and 150/204 (73.76%) in the removal group (P = 0.003; relative risk 1.160, 95% CI 1.049 to 1.282). The Kaplan--Meier curves showed that the insertion time in the nonremoval group was shorter (log-rank P = 0.01).

CONCLUSION

The new insertion technique, leaving the blocker attached to the end of the pilot balloon, resulted in a reduced incidence and severity of postoperative sore throat in the PACU, and an improved first-attempt success rate and the accuracy of SLMA positioning.

TRIAL REGISTRATION

Chinese Clinical Trial Registry identifier: ChiCTR1900023022
The analgesic effectiveness of ilioinguinal-iliohypogastric block for caesarean delivery
Authors: Singh Narinder P. , Makkar Jeetinder K. , Bhatia Nidhi , Singh Preet Mohinder
Published: November 2020

BACKGROUND

An effective analgesia strategy following caesarean delivery should be designed to improve fetomaternal outcomes. Much recent research has focused on the efficacy of ilioinguinal-iliohypogastric (II-IH) block for providing such analgesia.

DESIGN

A systematic review and meta-analysis of randomised controlled trials.

OBJECTIVES

To investigate the effectiveness of II-IH block in patients undergoing caesarean delivery. The primary outcome was the cumulative parenteral morphine equivalents at 24 h. Pain scores at 4 to 6 and 24 h postsurgery, time to first rescue analgesia and adverse effects were the secondary outcomes analysed.

DATA SOURCES

Two reviewers searched independently PubMed, Embase, Google Scholar and the Cochrane central registers of a controlled trial from their inception until June 2020.

METHODOLOGY

Prospective randomised control trials comparing II-IH block with either systemic analgesia alone or a placebo block (non-active controls) were eligible for inclusion. Only trials that reported their methods comprehensibly and transparently were included. Cochrane methodology was used to assess the risk of bias. Data are presented as mean difference with 95% confidence interval (CI).

RESULTS

Thirteen trials comprising a total of 858 patients were included. Opioid (intravenous morphine equivalents) consumption was reduced by 15.57 mg (95% CI −19.87 to −11.28; P < 0.00001; I
2 = 95%) during the first 24 h in patients receiving II-IH block when compared with placebo or no block. Patients receiving general anaesthesia showed a greater reduction in morphine requirement at 24 h than those receiving neuraxial anaesthesia. Adequate ‘information size’ for the above outcome was confirmed with trial sequential analysis to rule out the possibility of a false-positive result. II-IH also significantly reduced pain scores at rest more so at 4 to 6 h than at 24 h.

CONCLUSIONS

Our study suggests that the use of II-IH blocks is associated with a lower 24 h requirement for intravenous morphine equivalents in patients undergoing caesarean delivery. However, given the methodological limitations, data should be interpreted with caution until more studies are available.
Home-Initiated-Programme-to-Prepare-for-Operation: evaluating the effect of an animation video on peri-operative anxiety in children
Authors: Nair Tanuja , Choo Candy S.C. , Abdullah Nur S. , Lee Sumin , Teo Lois L.E. , Chen Yong , Nah Shireen A. , Chiang Li-Wei
Published: November 2020

BACKGROUND

Hospital admissions and surgical operations commonly trigger anxiety in young children. Despite employing numerous support measures in our hospital, such as a pre-operative play room, the encouragement of parental companionship during induction of anaesthesia and distraction therapy, allaying the anxiety of our young surgical patients remains a challenge.

OBJECTIVES

To evaluate the effectiveness of a Home-Initiated-Programme-to-Prepare-for-Operation (HIPPO) on emotional manifestation and anxiety in children undergoing surgery.

DESIGN, SETTING AND PATIENTS

One hundred and thirty children were randomly assigned to either control or intervention group between February 2018 and April 2019 in a tertiary paediatric hospital in Singapore.

INTERVENTION

In addition to our standard pre-operative workflow, the intervention group received an additional home preparation kit consisting of an animated video on preoperative preparation and age-specific preoperative preparation activity sheets.

MAIN OUTCOME MEASURES

The primary outcome was the Children's Emotional Manifestation Scale score to evaluate behaviour and emotion in the children before and during induction of anaesthesia. Secondary outcomes evaluated anxiety levels in parents and children, the child's behaviour and degree of co-operation using the State-Trait Anxiety Inventory scores, State-Trait Anxiety Inventory Children scores, the Induction Compliance Checklist scores, the Visual Analogue Scale scores for anxiety and the feedback questionnaire.

RESULTS

The difference between the Children's Emotional Manifestation Scale score in control and intervention groups was not statistically significant. A promising difference was however observed in one of the secondary outcomes where the state-State-Trait Anxiety Inventory Children scores of 7 to 10-year olds in the intervention group almost reached significance; P = 0.067.

CONCLUSION

Despite being a child-friendly, easily accessible and affordable tool for patient education, HIPPO did not reduce anxiety experienced by children in the pre-operative waiting area or during induction of anaesthesia.

TRIAL REGISTRATION

ClinicalTrials.gov, identifier: NCT04271553.
Prediction of fluid responsiveness using lung recruitment manoeuvre in paediatric patients receiving lung-protective ventilation
Authors: Kim Eun-Hee , Lee Ji-Hyun , Jang Young-Eun , Ji Sang-Hwan , Kim Hee-Soo , Cho Sung-Ae , Kim Jin-Tae
Published: November 2020

BACKGROUND

Pressure-based dynamic variables are poor predictors of fluid responsiveness in children, and their predictability is expected to reduce further during lung-protective ventilation with a low tidal volume.

OBJECTIVE

We hypothesised that lung recruitment manoeuvre (LRM)-induced changes in dynamic variables improve their ability to predict fluid responsiveness in children.

DESIGN

Prospective observational study.

SETTING

Tertiary care children's hospital, single-centre study performed from June 2017 to May 2019.

PATIENTS

We included patients less than 7 years of age undergoing cardiac surgery. Neonates and patients with pulmonary hypertension, significant dysrhythmia, ventricular ejection fraction of less than 30% or pulmonary disease were excluded.

INTERVENTION

All patients were provided with lung-protective volume-controlled ventilation (tidal volume 6 ml kg−1, positive end-expiratory pressure 6 cmH2O). A LRM was applied with a continuous inspiratory pressure of 25 cmH2O for 20 s.

MAIN OUTCOME MEASURE

The ability of dynamic variables to predict fluid responsiveness was evaluated by the area under the receiver operating characteristic curve [area under the curve (AUC)]. Fluid responsiveness was defined as an increase in the cardiac index by more than 15% with crystalloid administration (10 ml kg−1).

RESULTS

Thirty patients were included in the final analysis, of whom 19 were responders. The baseline pleth variability index (PVI) (AUC 0.794, 95% confidence interval 0.608 to 0.919, P < 0.001) and LRM-induced PVI (AUC 0.711, 95% confidence interval 0.517 to 0.861, P = 0.026) could predict fluid responsiveness. The respiratory variation of pulse oximetry photoplethysmographic waveform and pulse pressure variation did not predict fluid responsiveness regardless of the LRM.

CONCLUSION

The PVI is effective in predicting fluid responsiveness in paediatric patients with lung-protective ventilation regardless of a LRM. However, the LRM did not improve the ability of the other dynamic variables to predict fluid responsiveness in these patients.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov identifier: NCT03184961.
Association of small dense LDL-cholesterol with disease severity, hypertension status and clinical outcome in patients with coronary artery disease
Authors: Zhang Hui-Wen , Jin Jing-Lu , Cao Ye-Xuan , Liu Hui-Hui , Zhang Yan , Guo Yuan-Lin , Wu Na-Qiong , Zhu Cheng-Gang , Gao Ying , Xu Rui-Xia , Hua Qi , Li Yan-Fang , Cui Chuan-Jue , Dong Qian , Sun Jing , Li Jian-Jun
Published: November 2020

Objective:

Previous studies have demonstrated that small dense LDL-cholesterol (sdLDL-C) is related to the pathogenesis of coronary artery disease (CAD). However, its prognostic role in hypertensive patients with CAD has been undetermined. The aim of the study was to investigate the association between sdLDL-C with disease severity, hypertensive status and clinical outcome in patients with CAD.

Methods:

A total of 4594 patients with angiography-proven CAD were consecutively enrolled and categorized into subgroups according to blood pressure status. Serum sdLDL-C levels were measured by direct quantitative measurement using automated chemistry analyzers. The severity of coronary artery lesions were determined by Gensini score, Syntax score and the number of lesion vessels. The associations of sdLDL-C with disease severity, hypertensive status and cardiovascular events (CVEs) were evaluated.

Results:

Patients with hypertension had higher sdLDL-C levels than ones without (P = 0.010). In hypertensive patients, sdLDL-C was positively associated with the severity of CAD (P < 0.05). In addition, hypertensive patients with poorly controlled hypertension had higher sdLDL-C levels than those with well controlled (P < 0.05). Moreover, 149 CVEs occurred in patients with poorly controlled hypertension and Cox regression analysis indicated that elevated sdLDL-C levels were independently associated with CVEs in hypertensive patients with poorly controlled hypertension (adjusted hazard ratio: 1.673, 95% confidence interval: 1.105–2.535, P = 0.015).

Conclusion:

The current data, for the first time, showed that serum sdLDL-C levels were correlated with hypertension control, disease severity and worse outcomes in hypertensive patients with CAD, suggesting that paying more attention on sdLDL-C in these patients were warranted.
Relationship between casual serum triglyceride levels and the development of hypertension in Japanese
Authors: Tomita Yusuke , Sakata Satoko , Arima Hisatomi , Yamato Ikumi , Ibaraki Ai , Ohtsubo Toshio , Matsumura Kiyoshi , Fukuhara Masayo , Goto Kenichi , Kitazono Takanari
Published: November 2020

Objective:

The purpose of the present study was to investigate the effects of serum triglyceride levels on the risk of new-onset hypertension in Japanese.

Methods:

Five thousand nine hundred and thirty-three Japanese workers without hypertension at baseline, who participated in medical check-ups from 2006 to 2018, were followed retrospectively. The participants were divided into quartiles of casual serum triglyceride levels and were followed from the first to last visit of the study period. The outcome was development of hypertension. Risk estimates were computed using Cox's proportional hazards model.

Results:

During the follow-up period (average: 6.7 years), 946 individuals developed hypertension. The crude incidence rates of hypertension (per 1000 person-years) increased with rising serum triglyceride levels: 10.1 for quartile 1 (<0.76 mmol/l), 19.6 for quartile 2 (0.76–1.17 mmol/l), 26.0 for quartile 3 (1.18–1.84 mmol/l), and 36.5 for quartile 4 (>1.84 mmol/l) (P < 0.0001 for trend). These associations remained significant even after adjustment for other risk factors: the multivariable-adjusted hazard ratio was 1.29 (1.01–1.66) for the second quartile, 1.27 (0.99–1.63) for the third quartile, and 1.39 (1.09–1.77) for the highest quartile compared with the lowest. There were comparable effects of serum triglyceride levels for incidence of hypertension between subgroups defined by sex, obesity, and diabetes (all P > 0.1 for interaction), whereas stronger associations were observed for participants under 40 years of age than for those aged 40 or above (P = 0.002 for interaction).

Conclusion:

Serum triglyceride levels were significantly associated with development of hypertension in a Japanese worksite population.
The diagnostic accuracy of adjusted unconventional indices for adrenal vein sampling in the diagnosis of primary aldosteronism subtypes
Authors: Parasiliti-Caprino Mirko , Bioletto Fabio , Ceccato Filippo , Lopez Chiara , Bollati Martina , Voltan Giacomo , Rossato Denis , Giraudo Giuseppe , Scaroni Carla , Ghigo Ezio , Maccario Mauro
Published: November 2020

Objective:

Simple unconventional indices did not demonstrate a satisfactory accuracy for diagnosing unilateral primary aldosteronism when adrenal vein sampling is not bilaterally selective. This study aimed to evaluate the reliability of clinical/imaging-corrected unconventional indices for adrenal vein sampling in predicting unilateral primary aldosteronism.

Methods:

Data of all consecutive patients with primary aldosteronism subtyped with adrenal vein sampling, referred to two Italian centers, were analyzed retrospectively. All patients with proved unilateral aldosterone hypersecretion underwent adrenalectomy.

Results:

Unilateral disease was diagnosed in 58 cases (54.2%) and idiopathic hyperaldosteronism in 49 individuals (45.8%). The monoadrenal index (aldosterone-to-cortisol ratio in the adrenal vein) showed high accuracy in predicting ipsilateral disease and moderate accuracy in predicting contralateral aldosterone hypersecretion. The monolateral index (aldosterone-to-cortisol ratio in the adrenal vein vs. peripheral blood) revealed moderate accuracy in predicting ipsilateral disease and high accuracy in predicting contralateral aldosterone hypersecretion. Lesion side- and hypokalemia-corrected ROC curves for these unconventional indices revealed a significant improvement in the reliability of predicting ipsilateral/contralateral disease, reaching high accuracy in all models. For an immediate clinical application of our results, the adjusted cut-offs were calculated, according to the Youden's criterion and to a pre-established specificity of 95%, for all possible combinations of lesion side at imaging and presence/absence of hypokalemia.

Conclusion:

This study demonstrated the high diagnostic accuracy of clinical-/imaging-corrected unconventional indices for adrenal vein sampling in the diagnosis of primary aldosteronism subtypes and suggests the use of these adjusted indices to select patients for adrenalectomy when adrenal vein sampling is not bilaterally selective.
Visit-to-visit variability in blood pressure among cannabis users participating in the Third National Health and Nutrition Examination Survey
Authors: Alshaarawy Omayma , Vanderziel Alyssa
Published: November 2020

Objective:

Blood pressure variability (BPV) has emerged as an important predictor of cardiovascular morbidity and mortality. Plausible biological mechanisms link cannabis use and blood pressure (BP) regulation. Here, we assess the relationship between cannabis use and BPV, measured by the SD and coefficient of variation across three separate study visits.

Methods:

Data for individuals (17–59 years, n = 758) participating in the United States Third National Health and Nutrition Examination Survey substudy were used. Associations between cannabis use and mean BP, SBP and DBP variability were estimated. Participants were classified according to recency or lifetime frequency of cannabis use. Generalized linear regressions were used to model BPV as the outcome and cannabis use status as the exposure, adjusting for potential confounding variables.

Results:

Compared with nonuse, active cannabis use was associated with higher SD (mmHg) of mean BP [β = 0.97; 95% confidence interval (CI) = 0.22, 1.73], SBP (β = 0.95; 95% CI = 0.04, 1.85) and DBP (β = 1.18; 95% CI = 0.28, 2.08). Similar conclusions were obtained when the coefficient of variation was modelled as the outcome. A robust association was not observed for lifetime use frequency. The association between active cannabis use and SBP variability was stronger in the tobacco smoking subgroup, whereas the association between active cannabis use and DBP variability was stronger in the tobacco nonsmoking subgroup.

Conclusion:

Active cannabis use is associated with BPV. Future research is needed to understand the effects of cannabis use on BP regulation.
Evaluating sources of bias in observational studies of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use during COVID-19: beyond confounding
Authors: Cohen Jordana B. , D’Agostino McGowan Lucy , Jensen Elizabeth T. , Rigdon Joseph , South Andrew M.
Published: November 2020

Concerns over ACE inhibitor or ARB use to treat hypertension during COVID-19 remain unresolved. Although studies using more robust methodologies provided some clarity, sources of bias persist and it remains critical to quickly address this question. In this review, we discuss pernicious sources of bias using a causal model framework, including time-varying confounder, collider, information, and time-dependent bias, in the context of recently published studies. We discuss causal inference methodologies that can address these issues, including causal diagrams, time-to-event analyses, sensitivity analyses, and marginal structural modeling. We discuss effect modification and we propose a role for causal mediation analysis to estimate indirect effects via mediating factors, especially components of the renin--angiotensin system. Thorough knowledge of these sources of bias and the appropriate methodologies to address them is crucial when evaluating observational studies to inform patient management decisions regarding whether ACE inhibitors or ARBs are associated with greater risk from COVID-19.
Radiofrequency ablation for adenoma in patients with primary aldosteronism and hypertension: ADERADHTA, a pilot study
Authors: Bouhanick Béatrice , Delchier Marie C. , Lagarde Séverine , Boulestreau Romain , Conil Claude , Gosse Philippe , Rousseau Hervé , Lepage Benoit , Olivier Pascale , Papadopoulos Panteleimon , Trillaud Hervé , Cremer Antoine
Published: November 2020

Objective:

To evaluate the efficacy and the feasibility of radiofrequency ablation to treat aldosterone-producing adenomas.

Methods:

In an open prospective bicentric pilot study, patients with hypertension on ambulatory blood pressure measurement, a primary aldosteronism, an adenoma measuring less than 4 cm, and confirmation of lateralization by adrenal venous sampling were recruited. The primary endpoint, based on ABPM performed at 6 months after the radiofrequency ablation, was a daytime SBP/DBP less than 135/85 mmHg without any antihypertensive drugs or a reduction of at least 20 mmHg for SBP or 10 mmHg for DBP.

Results:

Thirty patients have been included (mean age = 51 ± 11 years; 50% women). Mean baseline daytime SBP and DBP were 144 ± 19 / 95 ± 15 mmHg and 80% received at least two antihypertensive drugs. At 6 months: 47% (95% CI 28–66) of patients reached the primary endpoint, mean daytime SBP and DBP were 131 ± 14 (101–154)/87 ± 10 (71–107) mmHg; 43% of them did not take any antihypertensive drug and 70% of them did not take potassium supplements. Few complications were recorded: four cases of back pain at day 1 postablation; three limited pneumothoraxes, which resolved spontaneously; one lesion of a polar renal artery.

Conclusion:

Radiofrequency ablation for hypertensive patients with aldosterone-producing adenomas seems to be an emerging promising alternative to surgery. Its efficacy and its feasibility have to be confirmed in a larger sample of patients.
Surgical Management of the Ocular Surface in Neurotrophic Keratopathy: Amniotic Membrane, Conjunctival Grafts, Lid Surgery, and Neurotization
Authors: Trinh Tanya , Mimouni Michael , Santaella Gisella , Cohen Eyal , Chan Clara C.
Published: November 2020

Purpose:

To review the surgical modalities available to treat Mackie stage 2 and stage 3 neurotrophic keratopathy.

Methods:

Literature review and technique descriptions.

Results:

The following procedures are described in detail with accompanying videos: temporary, permanent, and botox-assisted tarsorrhaphy; amniotic membrane transplant; keratoplasty with amniotic membrane and tarsorrhaphy augmentation; Gunderson and conjunctival pedicle flaps; buccal graft transplantation; and neurotization.

Conclusion:

A variety of surgical options exist to manage neurotrophic keratopathy when medical treatments alone fail to resolve epitheliopathy. Ongoing protection and optimization of the ocular surface health remains crucial to prevent recurrent epithelial breakdown.
Flanged fixation: Yamane technique and its application
Authors: Yamane Shin , Ito Arisa
Published: November 2020

Purpose of review

To review variations of flanged intraocular lens fixation (Yamane technique) and their outcomes.

Recent findings

Sutureless intrascleral IOL fixation has become popular, and many techniques have been reported. Among them, the Yamane technique has been widely used in recent years, and there are many variations. However, there are no reports that systematically compare them.

There are variations of the Yamane technique, such as those used to create a scleral tunnel or to dock needles and haptics. Although few reports have directly compared each technique, small scleral wounds appear to be beneficial for long-term stability of the IOL. A method of fixing a capsule tension segment or iris using a flange has also been reported, demonstrating the diverse range of uses of the flange.
Prevalence of Capsular Serotype, Pilus Island Distribution, and Antibiotic Resistance in Pediatric and Adult Invasive Group B Streptococcus Isolates: Data From a Nationwide Prospective Surveillance Study in Germany
Authors: Lohrmann Florens , Berg Angela , Wicker Esther , Imm Anita , Krause Gérard , Zürn Katharina , Berner Reinhard , Hufnagel Markus , Lander Fabian
Published: November 2020

For neonates, group B Streptococcus is life threatening. Current prevention strategies remain insufficient, especially for cases of late-onset sepsis, where intrapartum antibiotic prophylaxis has demonstrated no benefit. One promising approach is the vaccination of pregnant women, which offers protective immunity via transplacental transmission of neutralizing antibodies. Our nationwide, prospective surveillance study aimed to characterize the prevalence of pilus antigen, capsular polysaccharide serotypes, and antibiotic resistance from invasive GBS infections in neonates and compare these results with those from children and adults in Germany. Our study includes 173 neonatal isolates of a total of 450 reported cases during the study period (incidence: 0.34/1000 live births), in addition to 2 pediatric and 803 adult isolates. The comparison between neonatal and adult isolates reveals age-dependent differences in capsular serotype and pilus type distribution and differences in antibiotic resistance patterns.
Electrocochleography Observations in a Series of Cochlear Implant Electrode Tip Fold-Overs
Authors: Trecca Eleonora M. C. , Adunka Oliver F. , Mattingly Jameson K. , Hiss Meghan M. , Cassano Michele , Malhotra Prashant S. , Riggs William J.
Published: November 2020

Objective:

Tip fold-over is a rare but serious complication of cochlear implant (CI) surgery. The purpose of this study was to present intraoperative electrocochleography (ECochG) observations in a series of CI electrode tip fold-overs.

Patients:

Five pediatric subjects undergoing CI surgery through a round window (RW) approach with a perimodiolar electrode array, who were diagnosed with either auditory neuropathy spectrum disorder or enlarged vestibular aqueduct.

Interventions:

Intraoperative RW ECochG during CI surgery: tone burst stimuli were presented from 95 to 110 dB SPL.

Main Outcome Measure(s):

Magnitude and phase characteristics of ECochG responses obtained intraoperatively before and immediately after electrode insertion were examined for patients with and without tip fold-over.

Results:

Three subjects presented with tip fold-over and two formed the control group. Among fold-over cases, one participant exhibited an inversion in the starting phase of the cochlear microphonic response and a decrease in spectral magnitude from pre- to postinsertion. Both subjects who did not exhibit a change in phase had an increase in the ECochG-total response (ECochG-TR) magnitude. No case in the control group exhibited a change in starting phase. In regard to the ECochG-TR, all controls showed a decrease in the magnitude.

Conclusions:

Despite the small number of patients, heterogeneous ECochG response patterns were observed within the fold-over group. Though these results are not conclusive, they can serve as a framework to begin to understand ECochG's utility in detecting intraoperative tip fold-over.
Assessment of myocardial function by two-dimensional speckle tracking echocardiography in patients with Kawasaki disease: a mid-term follow-up study
Authors: Wang Haiyong , Tong Minghui , Mu Jingjing , Wu Tingting , Ruan Litao
Published: November 2020

Background

Myocardial impairment proved by histological studies persists in late convalescent phase Kawasaki disease patients. Whether Kawasaki disease-induced myocardial lesions can be detected in an earlier time is not well explored. In this study, we aimed to evaluate left ventricular (LV) myocardial function by two dimensional speckle tracking echocardiography (2DSTE) in late convalescent phase Kawasaki disease patients.

Methods

A total of 68 Kawasaki disease patients during mid-term phase including 47 with no coronary artery aneurysm (NCAA) and 21 with coronary artery aneurysm (CAA), and 60 controls with age matched were consecutively enrolled.

Results

No significant differences on conventional echocardiographic LV systolic function indices were found among group comparison. Compared with controls, Kawasaki disease patients had lower global longitudinal stain (GLS) and global circumferential stain (GCS). In subgroup analysis, both those with CAA and without CAA had lower GLS, lower GCS, higher amino-terminal propeptide of type III procollagen (PIIINP) and higher carboxyterminal propeptide of procollagen type I (PIPC) than in controls. GLS had significantly negative correlations with PIIINP (r = −0.69, P = 0.002) and PIPC (r = −0.82, P = 0.000).

Conclusion

Subclinical myocardial dysfunction in mid-term follow-up Kawasaki disease patients existed regardless of coronary artery status despite normal measurements of LV systolic function by routine echocardiography, and myocardial fibrosis may play a contributed role in this subclinical myocardial function impairment. 2DSTE is a valuable imaging modality for detecting regional and global myocardial dysfunction in Kawasaki disease patients in an early time.
Spontaneous coronary artery dissection and Takotsubo syndrome: comparison of baseline clinical and angiographic characteristics and in-hospital outcomes
Authors: Salamanca Jorge , García-Guimaraes Marcos , Camacho-Freire Santiago Jesús , Ojeda Soledad , Veiga Gabriela , Jiménez-Valero Santiago , Hernández-Antolín Rosana , Trillo Ramiro , Velázquez Maite , Cortes Carlos , Gutiérrez-Barrios Alejandro , Franco-Pelaez Juan Antonio , Lezcano-Pertejo Cristina , Diez-Delhoyo Felipe , Gamarra Alvaro , Aguilar Rio , Díez-Villanueva Pablo , Bastante Teresa , Alfonso Fernando
Published: November 2020

Background

Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) constitute two relatively common nonatherosclerotic causes of acute coronary syndrome particularly frequent in women.

Methods

This study sought to compare the baseline clinical and angiographic characteristics and in-hospital outcomes of patients from two large prospective registries on SCAD and TTS (the prospective nation-wide Spanish SCAD Registry and a prospective single-center TTS registry).

Results

A total of 318 SCAD and 106 TTS consecutive patients were included. Most patients in both groups (88%) were women. Patients in the TTS group were older [74 (interquartile range, IQR 67–81) vs. 53 years-old (IQR 47–60), P < 0.001] and presented a higher prevalence of cardiovascular risk factors. Precipitating triggers were more frequent in TTS (56% vs. 42%, P = 0.009) but emotional stress was more common in the SCAD group (25% vs. 15%, P = 0.037). TTS patients showed a reduced release of cardiac biomarkers but had more severe left ventricular dysfunction (ejection fraction <50%: 73% vs. 12%, P < 0.001). In-hospital major adverse cardiovascular events occurred more frequently in TTS patients (12% vs. 4.7%, P < 0.001). Notably, TTS patients showed more frequently congestive heart failure (10% vs. 0.6%, P < 0.001), atrial fibrillation (11% vs. 1%, P < 0.001) and had a higher all-cause in-hospital mortality (5.7% vs. 1.3%, P = 0.032).

Conclusion

TTS patients are older and present a higher prevalence of some cardiovascular risk factors than patients with SCAD. TTS is linked to a worse in-hospital prognosis with higher mortality.
2-Stage Collaborative Testing Results in Improved Academic Performance and Student Satisfaction in a PreLicensure Nursing Course
Authors: Riley Elizabeth , McCormack Leslie , Ward Nicole , Renteria Fermin , Steele Taylor
Published: November 2020

Background

The results remain mixed regarding improved student academic performance and satisfaction when 2-stage collaborative testing (CT) is used in nursing education.

Purpose

The purpose of this study was to evaluate student academic performance and perceived satisfaction after a CT experience and to compare academic performance between a CT and non-CT cohort.

Methods

A quantitative design was used to evaluate the effect of CT on academic performance by comparing examination scores and item difficulty values (IDVs) within a CT cohort (n = 111) and between the CT cohort and non-CT retrospective cohort (n = 105). A faculty-created survey was used to measure student-perceived satisfaction in the CT cohort.

Results

Student examination scores increased after the CT experience on a duplicate unit examination. The IDVs on 8 content-specific duplicate final examination items 1 month after the CT experience were significantly increased. There were no significant differences in the IDVs on the 8 content-specific items between a CT and non-CT retrospective cohort.

Conclusions

Collaborative testing is an active learning modality that can be used in nursing programs to aid students in their learning of specific nursing concepts.
Nursing Faculty Perceptions Regarding Students With Physical Disabilities
Authors: Elting Julie Kientz , Avit Elaina , Gordon Rebecca
Published: November 2020

Background

Students with physical disabilities continue to face barriers seeking entry into nursing programs even as the nursing profession advocates vigorously for the rights of these individuals.

Purpose

The purpose of this study was to identify faculty perceptions that create barriers for students with physical disabilities to meet the requirements of a BSN education.

Methods

Nursing faculty (n = 111) completed an online survey about the ability of a student who uses a wheelchair for mobility to meet required outcomes.

Results

Participants believed students could meet the 14 cognitive and affective domain outcomes (88%-100%) for generalist practice. Their agreement that students could meet psychomotor domain outcomes was lower (66%-90%). Younger faculty expressed more positive perceptions.

Conclusions

Using the psychomotor requirements of bedside nursing as the technical standard for nursing education is a barrier for students with physical disabilities. Faculty should expand their perceptions of the essentials of nursing education to create an inclusive environment.
Toward Quantification
Authors: Kiselev Valerij G. , Körzdörfer Gregor , Gall Peter
Published: November 2020

Quantitative magnetic resonance imaging (MRI) is a long-standing challenge. We advocate that the origin of the problem is the simplification applied in commonly used models of the MRI signal relation to the target parameters of biological tissues. Two research fields are briefly reviewed as ways to respond to the challenge of quantitative MRI, both experiencing an exponential growth right now. Microstructure MRI strives to build physiology-based models from cells to signal and, given the signal, back to the cells again. Magnetic resonance fingerprinting aims at efficient simultaneous determination of multiple signal parameters. The synergy of these yet disjoined approaches promises truly quantitative MRI with specific target-oriented diagnostic tools rather than universal imaging methods.
Ultrasonography-Based Radiomics of Screening-Detected Ductal Carcinoma In Situ According to Visibility on Mammography
Authors: Koh Jieun , Lee Eunjung , Han Kyunghwa , Lee Young Han , Kwak Jin Young , Yoon Jung Hyun , Moon Hee Jung
Published: November 2020

Ductal carcinoma in situ (DCIS) has different prognostic factors according to the detection modality. The purpose of this study was to compare parameters from a radiomic analysis of ultrasonography (US) images for DCIS detected on screening mammography (MMG) and US and detected on screening US only. A total of 154 surgically confirmed DCIS visible on US were included. Regions of interest were drawn onto US images of DCIS, and texture analysis was performed. Lesions were classified into those detected by both US and MMG (the US-MMG group) and those detected by US only (the US group). Analysis parameters were compared between the US-MMG group and the US group. Ninety-six lesions were included in the US-MMG group and 58 lesions in the US group. Energy, entropy, maximum, mean absolute deviation, range, SD, and variance were significantly higher in the US-MMG group than the US group. Kurtosis, skewness, and uniformity were significantly lower in the US-MMG group than the US group. Among the 22 gray-level cooccurrence matrix parameters, 18, 21, 22, 20, and 21 parameters were significantly different between the 2 groups in 0, 45, 90, and 135 degrees and the average value. Among the 11 gray-level run-length matrix parameters, 6, 6, 7, 7, and 6 parameters were significantly different in 0, 45, 90, and 135 degrees and the average value. Inverse variance and gray-level nonuniformity were the most different features between the 2 groups. Screening-detected DCIS showed different radiomic features according to the detection modality.