bluuebunny/crossref_metadata_2025 huggingface dataset:
A Technique for the In Vivo Study of Three-dimensional Cervical Segmental Motion Characteristics After Anterior Screw Fixation for Odontoid Process Fractures
Authors: Zhong Yanlong , Yao Haoqun , Tang Benyu , Song Quanwei , Shaobai Wang , Li Guoan , Wan Zongmiao
Published: November 2020

Study Design.

Kinematics of the cervical spine was investigated using cone beam computed tomography (CBCT) images combined with three dimensions to three dimensions (3D-3D) registration technology in patients after anterior odontoid screw fixation (AOSF) surgery.

Objective.

The aim of this study was to investigate in vivo 3D cervical motion characteristics of patients who had undergone AOSF surgeries.

Summary of Background Data.

AOSF surgery is a classic surgical method for the treatment of odontoid fracture, but there are few studies that investigated its effect on in vivo biomechanics of the cervical spine. Postoperative biomechanical characters of the atlantoaxial joint (C1-C2) and the caudal adjacent segment (C2–C3) have yet to be clarified.

Methods.

The study involved 14 patients subjected to a procedure of AOSF with lag screw. Subjects were matched with 14 healthy controls. All subjects underwent CBCT scanning of the cervical spine under seven functional positions. A 3D-3D registration was performed for each vertebra at each functional position to calculate the segmental motion characteristics. The ranges of motion (ROMs) of the C1-C2, C2–C3, and the overall cervical spine (C1-C7) for each of the functional positions were determined.

Results.

The ROMs of the AOSF group were significantly (P < 0.05) smaller than the control group in flexion-extension positions for the C1-C2 (7.0°vs.11.0°), C2-C3 (3.7°vs.6.7°) and C1-C7 (43.3°vs.54.4°). The twisting ROM of the C1-C2 was 39.3° in the AOSF group and 65.7° in the control (P < 0.05), the bending ROM of the C2-C3 was 2.8° in the AOSF group and 8.9° in the control (P < 0.05). The twisting ROM of C1-C7 segment was 63.2° for the AOSF and 98.1° for the healthy control groups (P < 0.05).

Conclusion.

Although AOSF surgery reduced the flexion-extension ROMs of all investigated spinal segments, additionally, it reduced twisting ROMs of C1-C2 and C1-C7, but only lateral bending ROM of C2-C3, when compared with the control group. The data implied that the AOSF surgery would result in different biomechanics changes in the atlantoaxial segment and caudal adjacent segment. Longer-term follow-up studies of larger patient cohorts are necessary to evaluate the clinical outcomes of patients after the AOSF surgery.

Level of Evidence: 3
Weekly versus triweekly cisplatin-alone adjuvant chemoradiotherapy after radical hysterectomy for stages IB–IIA cervical cancer with risk of recurrence
Authors: Zhu Jiahao , Lou Rui , Ji Shengjun , Wu Gang , Chen Qingqing , Hu Qunchao , Zhao Yutian , Cai Dongyan , Gu Ke
Published: November 2020

Weekly and triweekly cisplatin-alone concomitant chemoradiotherapy regimens after radical surgery were compared in stages IB–IIA cervical cancer with intermediate- or high-risk factors to identify the better therapeutic regimen. We retrospectively analyzed patients with stages IB–IIA cervical cancer who received radical hysterectomy followed by concurrent adjuvant chemoradiotherapy to compare the efficiency between weekly and triweekly regimen groups. We evaluated between-group differences in survival, recurrence, compliance, and adverse effects. A total of 217 patients were included in this study (triweekly group vs. weekly group; 97 vs. 120). The mean follow-up was 47.2 months. The 5-year disease-free survival (DFS) was 84.4% or 76.5% for patients treated with triweekly cisplatin chemotherapy or the weekly regimen, respectively (P = 0.110). The 5-year overall survival (OS) was 82.4 and 78.6% for the same treatment groups, respectively (P = 0.540). The DFS of the patients with pelvic lymph node metastasis were marginally better in triweekly regimen group compared with the weekly group (P = 0.031). Grades 3–4 leukopenia was significantly more common in the triweekly group (P = 0.028). The weekly cisplatin chemotherapy group experienced the same therapeutic effect as the triweekly cisplatin-alone chemotherapy group but with less toxicity. However, triweekly cisplatin regimen reduced the recurrence in patients with pelvic lymph node metastasis.
Adjuvant therapy of operable nonsmall cell lung cancer: an update
Authors: Mitsudomi Tetsuya , Soh Junichi
Published: November 2020

Purpose of review

The current status of postoperative adjuvant therapy for nonsmall cell lung cancer (NSCLC) is reviewed.

Recent findings

Cisplatin-based postoperative chemotherapy is a current standard of care for patients with stage II–III NSCLC who underwent complete resection. However, its benefit is limited. In these 20 years, the introduction of targeted therapies and immune checkpoint inhibitors has dramatically changed the treatment of metastatic lung cancer. The accumulated knowledge is now being applied in the adjuvant setting and many clinical trials are underway. Recently, postoperative osimertinib was shown to greatly prolong disease-free survival of patients with resected, stage II/IIIA NSCLC with EGFR mutation with an unprecedented hazard ratio of 0.17 in ADAURA study. Furthermore, initial results of adjuvant studies of immune checkpoint inhibitors are expected to be reported shortly.

As lung cancer is inherently prone to metastasize even though it looks in its earlier stage, it is essential to develop a newer generation of adjuvant therapies to improve patient outcomes. To this end, international and multidisciplinary collaboration is key to establish a new standard of care. It is anticipated that the treatment algorithm of early-stage lung cancer will be completely revised in 5 years using a more individualized approach.
The effect of immediate postoperative Boussignac CPAP on adverse pulmonary events after thoracic surgery
Authors: Puente-Maestú Luis , López Eloísa , Sayas Javier , Alday Enrique , Planas Antonio , Parise Diego J. , Martínez-Borja Marcos , Garutti Ignacio
Published: November 2020

BACKGROUND

The effectiveness of prophylactic continuous positive pressure ventilation (CPAP) after thoracic surgery is not clearly established.

OBJECTIVE

The aim of this study was to assess the effectiveness of CPAP immediately after lung resection either by thoracotomy or thoracoscopy in preventing atelectasis and pneumonia.

DESIGN

A multicentre, randomised, controlled, open-label trial.

SETTINGS

Four large University hospitals at Madrid (Spain) from March 2014 to December 2016.

PATIENTS

Immunocompetent patients scheduled for lung resection, without previous diagnosis of sleep-apnoea syndrome or severe bullous emphysema. Four hundred and sixty-four patients were assessed, 426 were randomised and 422 were finally analysed.

INTERVENTION

Six hours of continuous CPAP through a Boussignac system versus standard care.

MAIN OUTCOME MEASURES

Primary outcome: incidence of the composite endpoint ‘atelectasis + pneumonia’. Secondary outcome: incidence of the composite endpoint ‘persistent air leak + pneumothorax’.

RESULTS

The primary outcome occurred in 35 patients (17%) of the CPAP group and in 58 (27%) of the control group [adjusted relative risk (ARR) 0.53, 95% CI 0.30 to 0.93]. The secondary outcome occurred in 33 patients (16%) of the CPAP group and in 29 (14%) of the control group [ARR 0.92, 95% CI 0.51 to 1.65].

CONCLUSION

Prophylactic CPAP decreased the incidence of the composite endpoint ‘postoperative atelectasis + pneumonia’ without increasing the incidence of the endpoint ‘postoperative persistent air leaks + pneumothorax’.
Recruitment and Retention for the Evaluation of a Healthy Food Initiative in Economically Disadvantaged, Majority African American Communities
Authors: Sharpe Patricia A. , Stucker Jessica , Wilcox Sara , Liese Angela D. , Bell Bethany A.
Published: November 2020

Effective recruitment and retention supports equitable participation in research. The aim of this article is to describe recruitment and retention methods among residents of highly disadvantaged, predominantly African American communities in the southeastern United States during the evaluation of a healthy food access initiative. We proposed that active and passive recruitment methods, intensive retention strategies, community outreach and involvement, over-enrollment to anticipate attrition, and applied principles of community participation would achieve the study's recruitment and retention goals. The enrollment goal of 560 was met at 94% (n = 527), and the retention goal of 400 was achieved (n = 408).
Rural and Racial/Ethnic Differences in Children Receiving Early Intervention Services
Authors: Barnard-Brak Lucy , Morales-Alemán Mercedes M. , Tomeny Kimberly , McWilliam R. A.
Published: November 2020

A review of the literature shows that racial and ethnic minority children (eg, African American, Asian, and Hispanic) received diagnoses for developmental concerns later in life compared with their age-matched white counterparts. Research has also documented disparities in access to and receipt of health care services among children with developmental concerns as compared with children with other disabilities.

Objectives:

We examined health care providers' (HCPs') responses to parents' developmental concerns about their children. We looked at the association with race, ethnicity, gender, rurality, and time to diagnosis.

Methods:

All data were secondary and derived from the Centers for Disease Control and Prevention's Survey of Pathways to Diagnosis and Services. Participants consisted of 1321 parents of children who had received early intervention services as reported by respondents' data collected in 2011.

Results:

From a nationally representative sample of families receiving early intervention services, 76% were white, 10% were African American, 3% were Asian, 5% were Native American, and 9% were Hispanic. Families who were Hispanic were more likely to have received only a delaying response from HCPs. The average time to a developmental delay diagnosis was 5 months longer for families who received a delaying HCP response.

Conclusions:

Families who were Hispanic or who were from rural areas were most likely to receive a delayed HCP response; for parents who received a delayed HCP response, a developmental delay diagnosis took 5 months longer than for families from the other groups listed.
Influence of social determinants on fertility: a critical review
Authors: Tabernero Rico Pedro M. , Garcia Velasco Juan A.
Published: November 2020

Purpose of review

Intrinsic factors, such as age, weight and lifestyle habits, together with extrinsic factors, such as socioeconomic level, must be considered when it comes to reproductive healthcare. Over the last few years, studies that attempt to respond to the participation and interaction of these factors in subfertility have been published; however, some questions remain unanswered.

Recent findings

Although there are little modifiable factors for women, it is possible to influence other factors, such as behavioural or cultural factors in order to minimize fertility problems; however, they are often highly influenced by each other.

Advanced age, obesity, sedentary lifestyle, alcohol, tobacco and other compounds, have a clearly negative effect and may extend time-to-pregnancy, although the responsible mechanisms and the magnitude of the detriment that they produce in the reproductive health are yet to be studied. Economic context and new environmental factors are a current challenge for reproductive health too.
Effects of high protein, low-glycemic index diet on lean body mass, strength, and physical performance in late postmenopausal women: a randomized controlled trial
Authors: Silva Thaís R. , Lago Suzana C. , Yavorivski Andressa , Ferreira Laís L. , Fighera Tayane M. , Spritzer Poli Mara
Published: November 2020

Objective:

To investigate whether increasing protein consumption to twice the recommended daily allowance (RDA) by The Institute of Medicine affects lean body mass (LBM), muscle strength, and physical performance in late postmenopausal women.

Methods:

Parallel-group randomized trial with 26 apparently healthy women aged ≥ 65 years. Participants were randomly assigned to low-glycemic index diets with protein consumption at current RDA (0.8 g/kg body weight) or twice the RDA (2RDA, 1.6 g/kg body weight). Protein intake was assessed by 24-hours urinary nitrogen excretion. Change in LBM was measured by dual-energy X-ray absorptiometry at 3 and 6 months. Secondary outcomes were appendicular lean mass, handgrip strength by dynamometry, and physical performance by gait speed.

Results:

Mean age was 70.8 ± 3.6 years, and mean BMI was 26.1 ± 3.5 kg/m2 in the overall sample. The RDA and 2RDA groups did not differ regarding baseline dietary intake. Changes from baseline in LBM (0.07 kg; 95% CI, −0.39; 0.52 kg; P = 0.100) and appendicular lean mass (0.07 kg; 95% CI, −0.34; 0.47 kg; P = 0.100) did not differ between the groups. Total body fat (−1.41 kg; 95% CI, −2.62; 0.20 kg; P = 0.019) and trunk fat mass (−0.90 kg; 95% CI, −1.55; −0.24 kg; P = 0.005) decreased similarly in both groups at the end of intervention. Adjusting for baseline BMI did not alter these findings. Handgrip strength and 4-m gait speed increased after the intervention, with no significant difference between the groups.

Conclusions:

Protein intake exceeding the RDA did not increase LBM, strength, and physical performance in a sample of late postmenopausal woman consuming a low-glycemic index diet for 6 months.
Exercise SBP response and incident depressive symptoms: The Maastricht Study
Authors: Zhou Tan Lai , Kroon Abraham A. , Henry Ronald M.A. , Koster Annemarie , Dagnelie Pieter C. , Bosma Hans , van Greevenbroek Marleen M.J. , van der Kallen Carla J.H. , Schalkwijk Casper G. , Wesselius Anke , Reesink Koen D. , Köhler Sebastian , Schram Miranda T. , Stehouwer Coen D.A. , van Sloten Thomas T.
Published: November 2020

Objective

: An exaggerated exercise SBP, which is potentially modifiable, may be associated with incident depressive symptoms via an increased pulsatile pressure load on the brain. However, the association between exaggerated exercise SBP and incident depressive symptoms is unknown. Therefore, we examined whether exaggerated exercise SBP is associated with a higher risk of depressive symptoms over time.

Methods

: We used longitudinal data from the population-based Maastricht Study, with only individuals free of depressive symptoms at baseline included (n = 2121; 51.3% men; age 59.5 ± 8.5 years). Exercise SBP was measured at baseline with a submaximal exercise cycle test. We calculated a composite score of exercise SBP based on four standardized exercise SBP measures: SBP at moderate workload, SBP at peak exercise, SBP change per minute during exercise and SBP 4 min after exercise. Clinically relevant depressive symptoms were determined annually at follow-up and defined as a Patient Health Questionnaire score of at least 10.

Results

: After a mean follow-up of 3.9 years, 175 participants (8.3%) had incident clinically relevant depressive symptoms. A 1 SD higher exercise SBP composite score was associated with a higher incidence of clinically relevant depressive symptoms [hazard ratio: 1.27 (95% confidence interval: 1.04–1.54)]. Results were adjusted for age, sex, education level, glucose metabolism status, lifestyle, cardiovascular risk factors, resting SBP and cardiorespiratory fitness.

Conclusion

: A higher exercise SBP response is associated with a higher incidence of clinically relevant depressive symptoms.
Associations of household solid fuel for heating and cooking with hypertension in Chinese adults
Authors: Liu Zhiguang , Hystad Perry , Zhang Yuqing , Rangarajan Sumathy , Yin Lu , Wang Yang , Hu Bo , Lu Fanghong , Zhou Yihong , Li Yindong , Bangdiwala Shrikant I. , Yusuf Salim , Li Wei , Tse Lap Ah
Published: November 2020

Objective:

The association between indoor air pollution resulting from household solid fuel use for heating and cooking with hypertension or blood pressure (BP) remains less clear. This study aims to rectify these knowledge gaps in a large Chinese population.

Methods:

During 2005–2009, 44 007 individuals aged 35–70 years with complete information on household solid fuel use for cooking and heating were recruited from 279 urban and rural communities of 12 centers. Solid fuel referred to charcoal, coal, wood, agriculture crop, animal dung or shrub. Annual concentration of ambient atmospheric particulate matter that have a diameter of less than 2.5 μm for all communities was collected. Generalized linear mixed models using community as the random effect were performed to estimate the association with hypertension prevalence or BP after considering ambient atmospheric particulate matter that have a diameter of less than 2.5 μm and a comprehensive set of potential confounding factors at the individual and household level.

Results:

A total of 47.6 and 61.2% of participants used household solid fuel for heating and cooking, respectively. Solid fuel use for heating was not associated with an increase in hypertension prevalence (adjusted odds ratio = 1.08, 95% confident interval: 0.98, 1.20) or elevated SBP (0.62 mmHg, 95% confident interval: −0.24, 1.48). No association was found between solid fuel for cooking and hypertension or BP, and no additional risk was observed among participants who had both exposures to solid fuel for heating and cooking compared with those used for heating only.

Conclusion:

The current large Chinese study revealed a statistically insignificant increase in the association between solid fuel use for heating and hypertension prevalence or BP. As this cross-sectional study has its inherent limitation on causality, findings from this study would have to be confirmed by prospective cohort studies.
Dapagliflozin decreases ambulatory central blood pressure and pulse wave velocity in patients with type 2 diabetes: a randomized, double-blind, placebo-controlled clinical trial
Authors: Papadopoulou Eirini , Loutradis Charalampos , Tzatzagou Glykeria , Kotsa Kalliopi , Zografou Ioanna , Minopoulou Ioanna , Theodorakopoulou Marietta P. , Tsapas Apostolos , Karagiannis Asterios , Sarafidis Pantelis
Published: November 2020

Objectives:

Sodium-glucose co-transporter 2 (SGLT-2) inhibitors reduce the incidence of heart failure and death in patients with type-2 diabetes mellitus. Arterial stiffness is a prominent risk factor for heart failure and overall mortality. The aim of this study was to evaluate the effects of dapagliflozin on ambulatory brachial and central blood pressure (BP) levels and arterial stiffness parameters in patients with type-2 diabetes mellitus.

Methods:

This is a double-blind, randomized, placebo-controlled clinical trial including 85 adult patients with type-2 diabetes mellitus on monotherapy or combination therapy with two of: metformin, sulphonylurea, DPP-4 inhibitor, or insulin. Patients were randomized in a 1 : 1 ratio to oral dapagliflozin 10 mg per day or placebo for 12 weeks. Study participants underwent 24-h ambulatory BP monitoring with the Mobil-O-Graph NG monitor at baseline and study-end.

Results:

Baseline demographic, clinical and laboratory parameters were similar in the two groups. During follow-up, 24-h brachial SBP/DBP (129.0 ± 12.6/77.3 ± 7.3 vs. 123.2 ± 12.4/75.1 ± 6.4 mmHg; P < 0.001/P = 0.008) and central SBP/DBP (117.4 ± 10.5/78.9 ± 7.3 vs. 113.3 ± 8.8/77.3 ± 6.5 mmHg; P = 0.002/P = 0.047) significantly decreased in dapagliflozin but not in the placebo group. Corresponding reductions of 24-h brachial SBP (−5.8 ± 9.5 vs. −0.1 ± 8.7, P = 0.005) and central SBP (−4.1 ± 8.0 vs. −0.7 ± 7.8; P = 0.046) were greater with dapagliflozin than placebo. Twenty-four-hour heart-rate adjusted augmentation index significantly decreased with dapagliflozin and insignificantly with placebo. Importantly, there was a significant difference in change of estimated 24-h PWV (−0.16 ± 0.32 vs. 0.02 ± 0.27; P = 0.007) favoring dapagliflozin. In generalized linear mixed models including 24-h brachial SBP as a random covariate, the adjusted marginal means of delta 24-h central SBP and delta 24-h PWV were not significantly different between-groups.

Conclusion:

Treatment with dapagliflozin significantly reduces ambulatory brachial and central BP levels and PWV in patients with type-2 diabetes mellitus. Improvement in these parameters may substantially contribute to the cardiovascular benefits of SGLT-2 inhibitors.
Estimated pulse wave velocity is associated with residual-specific mortality: findings from the National Health and Nutrition Examination Survey
Authors: Heffernan Kevin S. , Jae Sae Young , Loprinzi Paul D.
Published: November 2020

Introduction:

Estimated pulse wave velocity (ePWV) is emerging as a predictor of cardiovascular and all-cause mortality. Approximately one-third of all deaths are not related to the top nine causes of mortality as defined by the CDC. We examined the association of ePWV with residual-specific mortality in a large sample of US adults.

Methods:

Data from the 1999–2006 National Health and Nutrition Examination Survey (NHANES) were used (n = 13 909 adults between the ages of 18–85 years), with follow-up through 2011 (mean follow-up, 104 months). ePWV was calculated from a regression equation using age and mean blood pressure.

Results:

After adjusting for age, pulse pressure, race/ethnicity, blood lipids, glucose, C-reactive protein, eGFR, smoking, self-reported physical activity, history of hypertension and diabetes, for every 1 m/s increase in ePWV, there was a 17% increased risk of residual-specific mortality (hazard ratio = 1.17, 95% CI = 1.02–1.36; P = 0.03). If using a previously recommended clinical cut-point of 10 m/s, those with an elevated ePWV had an increased risk of 57% (hazard ratio = 1.57; 95% CI = 0.98–2.50; P = 0.06).

Conclusion:

ePWV is associated with residual-specific mortality in a nationally representative sample of adults.
Trends in hypertension prevalence, awareness, treatment and control rates among Chinese adults, 1991–2015
Authors: Ma Shujing , Yang Liu , Zhao Min , Magnussen Costan G. , Xi Bo
Published: November 2020

Objective:

The upward trends in the prevalence and control of hypertension in Chinese adults have been described, but recent trends based on the most recent guidelines are unavailable. We examined recent trends in the prevalence, awareness, treatment and control of hypertension among Chinese adults from 1991 to 2015 based on the 2018 Chinese Guideline.

Methods:

A total of 72 452 adults aged 20–79 years from the China Health and Nutrition Survey conducted between 1991 and 2015 were included in the study. Hypertension status and control rate were defined according to the 2018 Chinese Guideline. Age-standardized estimates were calculated based on the age distribution of the WHO standard population.

Results:

From 1991 to 2015, the crude/age-standardized hypertension prevalence (14.0/15.3 to 34.1/25.6%), awareness (29.4/24.2 to 43.8/27.2%), treatment (19.2/15.1 to 39.2/23.6%) and control rates (3.5/3.6 to 13.8/8.4%) increased (all P for trend <0.001). The prevalence of hypertension increased at a greater rate in rural regions compared with that in urban regions, whereas the control rate was higher in urban regions than that in rural regions. Compared with middle-aged and older adults aged 40–79 years, young adults aged 20–39 years had a larger increase in the prevalence of hypertension, but the awareness, treatment and control rates in the young adults did not increase.

Conclusion:

The prevalence of hypertension has increased markedly over the past two decades among Chinese adults, and the awareness, treatment and control rates have increased slightly or moderately and they have remained very low. These data underscore the need for effective measures to prevent hypertension and to increase the control of hypertension in Chinese adults.
Circulating senescent angiogenic T cells are linked with endothelial dysfunction and systemic inflammation in hypertension
Authors: Zhang Gaoxing , Liu Yuanya , Qiu Yumin , Zhang Jianning , Sun Jiapan , Zhou Zhe , Wang Zhichao , Zeng Peishan , Tao Jun , He Jiang
Published: November 2020

Objective:

Angiogenic T cells (Tang cells), a recently discovered T-cell subset, have been reported involved in the repair of endothelial injury. The purpose of this study was to explore the correlation of immunologic senescence and pro-inflammatory capacity of Tang cells with endothelial dysfunction in hypertensive patients.

Methods:

Immunological characteristics of Tang cells (CD3+CD31+CXCR4+) from hypertensive patients with or without endothelial dysfunction were elucidated by surface immunophenotyping and intracellular cytokine staining. Endothelial function was measured by flow-mediated dilation (FMD).

Results:

The frequency of CD28null subset in CD4+ Tang cells was notably elevated in hypertensive patients with endothelial dysfunction, which was negatively associated with FMD. The high frequency of CD28nullCD4+ Tang cells was an independent risk factor of endothelial dysfunction with good diagnostic performance in ROC curve analysis. Immunophenotyping revealed that this specific subset of Tang cells exhibited senescent profile and has low hTERT expression. CD28nullCD4+ Tang cells produced high levels of inflammatory cytokines, IL-6, IFN-γ and TNF-α, and significantly correlated with the systemic inflammation in hypertensive patients with endothelial dysfunction.

Conclusion:

Collectively, our findings demonstrate for the first time that CD28null subset in CD4+ Tang cells with senescent and pro-inflammatory phenotype is dependently correlated with impaired FMD and systemic inflammation, which might contribute to the immunopathologic mechanism of endothelial dysfunction. Identification of a pathogenic CD4+ Tang-cell subset lacking CD28 may offer opportunities for the evaluation and management of endothelial dysfunction in hypertension.
A New Treatment Experience in Pseudomonas Keratitis: Topical Meropenem and Cefepime
Authors: Bozkurt Erdinç , Muhafiz Ersin , Kepenek Hasan Sami , Bozlak Çigdem Eda Balkan , Koç Saltan Seher , Bingol Seyit Ali
Published: November 2020

Purpose:

To compare the efficacy of topical meropenem and cefepime treatments with respect to moxifloxacin as new treatment options in an experimental Pseudomonas keratitis model.

Methods:

Twenty-four rabbits in which keratitis are induced using Pseudomonas aeruginosa were divided into four groups according to treatment options. A solution of 50 mg/mL meropenem was prepared and topically applied to the first group, 50 mg/mL cefepime solution to the second group, topical 0.5% moxifloxacin drop to the third group, and topical isotonic (0.9% saline) solution to the fourth (control) group. The eyes were examined before and after treatment to score the clinical severity. After the subjects were sacrificed, their corneas were excised. To determine the efficacy of treatments, clinical score, bacterial load, and histopathological and immunohistochemical findings were evaluated.

Results:

When the three treatment groups were compared, there was a significant difference in the colony-forming unit (CFU) value, polymorph-nuclear leukocyte (PMNL) infiltration, and matrix metalloproteinase (MMP)-9 immunoreactivity (P=0.022, P=0.038, and P=0.037, respectively). The CFU values, PMNL infiltration scores and MMP-9 immunoreactivity were significantly lower in the meropenem and moxifloxacin groups compared with the cefepime group (P<0.05 for all). There was no significant difference between the meropenem and moxifloxacin groups in respect of the CFU values, PMNL infiltration, and MMP-9 immunoreactivity (P=0.842, P=0.784, and P=0.699, respectively).

Conclusion:

The results of our study indicate that topical meropenem is at least as effective as topical moxifloxacin in the treatment of Pseudomonas keratitis. The meropenem and moxifloxacin are safer and suitable in the limited corneal invasion than cefepime. Thus, topical meropenem may be an alternative drug in the treatment of this condition. Clinical studies are needed to be conducted to assess this possibility more accurately.
Adverse Skin Reactions to Personal Protective Equipment Among Health-Care Workers During COVID-19 Pandemic: A Multicenter Cross-sectional Study in Indonesia
Authors: Christopher Paulus Mario , Roren Regina Stefani , Tania Clarissa , Jayadi Nana Novia , Cucunawangsih Cucunawangsih
Published: November 2020

Objective:

Health-care workers (HCWs) in Indonesia have been participating in the war against the coronavirus disease-2019 since March 2020. Ever since HCWs were exposed to the regular use of personal protective equipment (PPE) with varying levels and maintain hand hygiene more as recommended by the World Health Organization. Adverse skin reactions to PPE in Indonesia has yet to be acknowledged. This study aimed to study the prevalence and characteristics-, possible risk factors-, and suggest possible solutions towards adverse skin reactions to PPE among HCWs in a multi-center setting of Indonesia.

Methods:

A cross-sectional survey was conducted online among HCWs in the Siloam Hospitals Group of Banten province. HCWs of Banten Province were surveyed from June 1 to August 31, 2020. The data was obtained using avalidated online survey questionnaire including (1) demographic characteristics; (2) occupational-related characteristics; (3) adverse skin reactions.

Results:

A response rate of 40.2% was obtained and 200 valid respondents were yielded. The mean age of respondents was (26.94 ± 7.23) years old. Adverse skin reactions (66.5%) were reported primarily in female (73.7%) working as doctors (82.7%) of a non-referral center for coronavirus disease-2019 (60.2%) wearing level 2 and 3 PPE (43.6% and 37.6%, respectively). The cheeks and chin was the most common site involved (69.9%) with dryness/tightness (63.9%) and acne (77.4%) as the highest symptoms and signs reported. Sex, age group classification, level of PPE worn, hand hygiene frequency, and duration of PPE worn daily were factors considerably associated with adverse skin reactions to PPE (P < 0.05).

Conclusions:

Adverse skin reactions to PPE are common among HCWs in Indonesia. Comprehensive strengthening of the skin condition and awareness on adverse skin reactions should be advocated.
Efficacy and Safety of Prednisolone Monotherapy Versus Prednisolone Plus Methotrexate in Erythema Nodosum Leprosum (Type 2 Lepra Reaction)
Authors: Hasan Zahidul , Mowla Mohammad Rafiqul , Angkur Debashish Mondol , Khan Md. Ismail
Published: November 2020

Objective:

This study was performed to compare the efficacy and safety of methotrexate (MTX) plus prednisolone versus prednisolone monotherapy in patients with erythema nodosum leprosum (ENL).

Methods:

This comparative clinical study was performed in the Chittagong Medical College Hospital, Bangladesh from June 2018 to December 2019. Nineteen patients were selected according to inclusion criteria and randomly allocated to either the MTX plus prednisolone group (Group A, n = 10) or the prednisolone monotherapy group (Group B, n = 9). All patients were followed up until the end of the 6-month duration of therapy to observe the clinical outcomes and adverse effects.

Results:

All patients in both groups showed significant improvement (P = 0.005 and P = 0.008 in Group A and B, respectively). However, prednisolone-related adverse events were more frequent in Group B.

Conclusion:

The present study has demonstrated that a combination of prednisolone and MTX is a safer and more effective treatment than steroid monotherapy in ENL patients including the healing of nodules. However, this combination therapy did not appear to have a significant steroid-sparing effect, possibly because of the small sample size and short study period. Therefore, a well-designed multicenter randomized controlled trial is recommended for validation of MTX with prednisolone for the management of ENL.
Discharge and Readmissions After Ventricular Assist Device Placement in the US Pediatric Hospitals: A Collaboration in ACTION
Authors: Bearl David W. , Feingold Brian , Lorts Angela , Rosenthal David , Zafar Farhan , Conway Jennifer , Elias Barbara , Tunuguntla Hari , Thurm Cary , Amdani Shahnawaz , Jaworski Nancy , Godown Justin
Published: November 2020

Discharging children on ventricular assist device (VAD) support offers advantages for quality of life. We sought to describe discharge and readmission frequency in children on VAD support. All VAD-implanted patients aged 10–21 years at Advanced Cardiac Therapies Improving Outcomes Network (ACTION) centers were identified from the Pediatric Health Information System database (2009–2018). Discharge frequency on VAD was calculated. Patients discharged on VAD were compared with those not discharged. Freedom from readmission was assessed using the Kaplan–Meier method. A total of 298 VAD-implanted patients from 25 centers were identified, of which 163 (54.7%) were discharged. Discharges increased over time (36.9% [2009–2012] vs. 59.7% [2013–2018], p = 0.001). Of 144 discharged patients with follow-up, 96 (66.7%) were readmitted for reasons other than transplantation. Heart failure was the most common reason for readmission (27.7%), followed by infection (25.8%) and hematologic concerns (16.8%). In-hospital mortality on readmission was uncommon (1.8%) and the median length of stay was 6 days (interquartile range 2–19 days). Discharge of children on VAD support has increased over time, although variability exists across centers. Readmissions are common with diverse indications; however, the risk of mortality is low. Further interventions, including collaboration in ACTION, are critical to increasing discharges and optimizing outpatient management.
Derangement of the coagulation process using subclinical markers and viscoelastic measurements in critically ill patients with coronavirus disease 2019 pneumonia and non-coronavirus disease 2019 pneumonia
Authors: Pavoni Vittorio , Gianesello Lara , Pazzi Maddalena , Horton Andrew , Suardi Lorenzo R.
Published: November 2020

Systemic coagulation abnormalities including clotting activation and inhibition of anticoagulant factors have been observed in patients with pneumonia. In severe coronavirus disease 2019 (COVID-19) the alteration of coagulation parameters was associated with poor prognosis. We evaluated the difference in coagulopathy between critically ill patients with COVID-19 pneumonia (COVID group) and non-COVID-19 pneumonia (non-COVID group), using traditional coagulation markers and rotational thromboelastometry (ROTEM). Standard laboratory and ROTEM parameters were evaluated in 45 patients (20 COVID group patients and 25 non-COVID group patients) at time of admission to the Intensive Care Unit (ICU) (T0) and at 5 (T5) and 10 days (T10) later. In all evaluations times, platelet count was found higher in COVID group rather than in non-COVID group. At T0, COVID group revealed a fibrinogen value greater than non-COVID group. d-Dimer values were high in both groups and they were not statistically different. At T0 COVID group showed a significant reduction of clot formation time in INTEM and in EXTEM and a significant increase of maximum clot firmness in INTEM, EXTEM and FIBTEM respect to non-COVID group. Moreover, COVID group demonstrated a coagulability state with ROTEM profiles higher than non-COVID group at T5 and T10. Coagulation profiles showed that critically ill patients with COVID-19 pneumonia are characterized by a higher coagulable state than others; this greater procoagulative state persists over time.
Fibrin clot susceptibility to lysis is impaired after on-pump coronary artery by-pass grafting with tranexamic acid: clinical implications
Authors: Mazur Piotr , Ząbczyk Michał , Khan Imran , Litwinowicz Radosław , Iwaniec Teresa , Kędziora Anna , Kapelak Bogusław , Natorska Joanna
Published: November 2020

Coronary artery bypass grafting (CABG) done on-pump may cause a significant blood loss. Low fibrinogen is associated with perioperative bleeding. The influence of cardiopulmonary bypass on fibrin clot properties is poorly investigated. We studied 55 patients with isolated coronary artery disease on aspirin undergoing on-pump CABG with tranexamic acid. Fibrinogen levels, fibrinolytic capacity expressed as clot lysis time (CLT), thrombin generation potential and platelet count were assessed before and after the surgery (prior to admission to the intensive care unit). A postoperative drop in haemoglobin (–30% from baseline), haematocrit (–31% from baseline) and platelet count (–42% from baseline) was observed (all, P < 0.0001). Postoperative fibrinogen level was lower by 57%, compared with preoperative value (1.5 [1.3–1.8] vs. 3.5 [2.8–3.9] g/l, P < 0.0001). Postoperative CLT was longer by 48 min, compared with preoperative (182 [170–218] vs. 134 [122–165] min, P < 0.0001). Thrombin generation was impaired postoperatively: both lag time and time to peak thrombin were prolonged by 44 and 45%, respectively, whereas endogenous thrombin potential and peak thrombin generation decreased by 45 and 78%, respectively (all P < 0.0001). Median postoperative drainage at 12 h was 400 [290–570] ml. Predictors of blood loss at 12 h identified in multivariable linear regression model adjusted for sex and preoperative fibrinogen level were: BMI (b 
= –23.4, P 
= 0.048) and postoperative CLT (b 
= –2.4, P 
= 0.042). Despite decreased fibrinogen levels after on-pump CABG with tranexamic acid, fibrin clot susceptibility to lysis is impaired, as reflected by prolonged CLT. Postoperative CLT is associated with mediastinal drainage at 12 h.
Cancer treatment resumption in patients with new-generation drug-eluting stents
Authors: Balanescu Dinu Valentin , Aziz Moez Karim , Donisan Teodora , Palaskas Nicolas , Lopez-Mattei Juan , Hassan Saamir , Kim Peter , Song Juhee , Ntim William , Cilingiroglu Mehmet , Marmagkiolis Konstantinos , Iliescu Cezar
Published: November 2020

Objective

Percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DESs) may provide survival benefits to the cancer population undergoing PCI by expediting cancer treatment due to improved safety profile. We aimed to assess the safety of starting or resuming cancer treatment within 6 months of DES placement. We also compared the impact of different DES types on the overall survival (OS) in cancer patients and to identify a safe threshold for dual antiplatelet therapy (DAPT) discontinuation.

Methods

Cancer patients at our institution undergoing PCI with DES from December 2014 to June 2017 were included. Baseline demographics, DAPT duration, malignancy type, stage, and treatment were retrospectively analyzed. Univariate Cox regression was used to pinpoint baseline characteristics that correlated with OS. Survivorship was determined by Kaplan–Meier analysis, and the log-rank test was used to compare OS among DES types.

Results

Seventy-five patients were included. Of these, 45 had biodegradable polymer DES (Synergy) and 30 patients had durable polymer DES (Resolute Integrity, Xience, Ion, or Promus). Mean duration of follow-up was 1367 ± 334 days. There were two minor bleeding complications. No statistically significant differences in OS were found among different stent brands. Discontinuation of aspirin, early P2Y12 inhibitor discontinuation, and advanced cancer were significantly associated with OS. DAPT discontinuation <6 months after PCI was not associated with stent thrombosis or in-stent restenosis. There were two major adverse cardiac events: one in-stent restenosis while on DAPT for >12 months (attributed to radiation-induced heart disease) and one myocardial infarction and death. Of patients who resumed or started cancer treatment (chemotherapy, radiation therapy, or surgery) after PCI, all but one did so within 6 months of PCI, and most of them as early as 2 weeks.

Conclusion

Patients may resume cancer treatment <6 months after PCI. We suggest that DAPT may be safely interrupted as early as 6 months, but additional longitudinal studies are needed.
Dietary management of cardiovascular risk including type 2 diabetes
Authors: Nestel Paul J. , Sullivan David R. , Mori Trevor A.
Published: November 2020

Purpose of review

Recent changes or confirmations linking patterns of eating and specific dietary interventions in the management of cardiovascular risk factors including associations with prevalent and incident type 2 diabetes.

Recent findings

Recently published guidance for dietary management of cardiovascular risk and type 2 diabetes have mostly common features. Major findings include a trend to replace strict quantitative advice on nutrients with qualitative advice on food consumption with exceptions for diabetes, global advice to increase intake of plant foods, confirmation to substitute mono and polyunsaturated oils for saturated and trans fats, new advisory on supplemental omega-3 intake, less limitation on dairy foods and fermented dairy foods encouraged, reduced emphasis on specific cholesterol-rich foods allowing greater consumption of eggs except for people with diabetes, processed meat consumption limited allowing modest intake of lean red meat, distinguishing between ‘healthy’ and ‘unhealthy’ carbohydrates including sugars, and maintaining advice on healthy bodyweight, reducing salt intake and encouraging water as preferred beverage.

The new guidance for healthier patterns of food consumption supported by evidence is more readily understood by health practitioners and translatable to consumers and patients.
Novel approaches to management of hypertension
Authors: Bosch Agnes , Schmieder Roland E.
Published: November 2020

Purpose of review

Of the roughly 1.4 billion people with hypertension worldwide, only about one in seven has their blood pressure (BP) successfully treated and adequately controlled. This review will focus on new therapeutic approaches of hypertension.

Recent findings

Several recent clinical studies and guidelines have favoured the assessment of target organ damage and cardiovascular risk scores for the diagnosis and treatment approach of hypertension. Paradigm shifts recommended in the guidelines are the initiation of antihypertensive treatment with combination (not mono) therapy and the recommendation of single-pill combinations (SPC), which improve adherence and result in rapid and effective BP control. In clinical trials with optimized design and renal denervation (RDN) technology, the biological proof of concept has been established. Consistent, durable ambulatory and office BP reductions without procedure associated serious adverse events have been documented. The challenges are now to identify patients who respond best to interventional treatment.

Major key points in the treatment strategy for hypertension are: individualization of the therapy according to total cardiovascular risk, combination therapy as initial step, recommendation of SPC and RDN as promising interventional therapy.
Novel conservative management of chronic kidney disease via dialysis-free interventions
Authors: Zarantonello Diana , Rhee Connie M. , Kalantar-Zadeh Kamyar , Brunori Giuliano
Published: November 2020

Purpose of review

In advanced chronic kidney disease (CKD) patients with progressive uremia, dialysis has traditionally been the dominant treatment paradigm. However, there is increasing interest in conservative and preservative management of kidney function as alternative patient-centered treatment approaches in this population.

Recent findings

The primary objectives of conservative nondialytic management include optimization of quality of life and treating symptoms of end-stage renal disease (ESRD). Dietetic-nutritional therapy can be a cornerstone in the conservative management of CKD by reducing glomerular hyperfiltration, uremic toxin generation, metabolic acidosis, and phosphorus burden. Given the high symptom burden of advanced CKD patients, routine symptom assessment using validated tools should be an integral component of their treatment. As dialysis has variable effects in ameliorating symptoms, palliative care may be needed to manage symptoms such as pain, fatigue/lethargy, anorexia, and anxiety/depression. There are also emerging treatments that utilize intestinal (e.g., diarrhea induction, colonic dialysis, oral sorbents, gut microbiota modulation) and dermatologic pathways (e.g., perspiration reduction) to reduce uremic toxin burden.

As dialysis may not confer better survival nor improved patient-centered outcomes in certain patients, conservative management is a viable treatment option in the advanced CKD population.
Novel approaches to sarcopenic obesity and weight management before and after kidney transplantation
Authors: Tantisattamo Ekamol , Kalantar-Zadeh Kamyar , Halleck Fabian , Duettmann Wiebke , Naik Marcel , Budde Klemens
Published: November 2020

Purpose of review

Although a widely recognized and complex pathophysiological condition, sarcopenic obesity remains less appreciated and may elude diagnosis and workup in both kidney transplant waitlisted candidates and kidney transplant recipients. The lack of consensus definition, and practical diagnostic tools for evaluating waitlisted candidates and transplant recipients are barriers to early detect and initiate therapeutic management for sarcopenic obesity. Although sarcopenia leads to poor clinical outcomes, posttransplant obesity yields conflicting results. Exercise and nutritional managements are common therapies for sarcopenic obese patients; however, surgery weight loss or bariatric surgery in both transplant candidates and potential living kidney donors shows promising benefits for kidney transplant access in waitlist obese candidates but may require to be selected for appropriate patients.

Recent findings

Pathogenesis and management for sarcopenia and obesity are interconnected. The benefits of exercise to improve muscle mass and function is clear in waitlist kidney transplant candidates and transplant recipients. However, there are several barriers for those to increase exercise and improve physical activity including patient, provider, and healthcare or environmental factors. The advantages of fat mass reduction to lose weight can promote muscle mass and strength. However, epidemiological data regarding the obesity paradox in dialysis-dependent patients when overnutrition provides survival benefits for this population should be taken into account when performing weight loss especially bariatric surgery.

Barriers in providing optimal care to kidney transplant waitlisted candidates and transplant recipients may partly result from underdiagnosis of sarcopenic obesity; notwithstanding that this entity has increasingly been more recognized. Mechanistic studies to better understand pathogenesis of sarcopenic obesity will help determine pathogenesis and clinical tools for diagnosis of this entity, which can facilitate further studies related to the outcomes and weight management to ultimately improve kidney transplant outcomes.