bluuebunny/crossref_metadata_2025 huggingface dataset:
Child Psychological Functioning During the COVID-19 Lockdown: An Ecological, Family-Centered Approach
Authors: Dubois-Comtois Karine , Suffren Sabrina , St-Laurent Diane , Milot Tristan , Lemelin Jean-Pascal
Published: March 2021

Objective:

To evaluate how sociodemographic characteristics and various aspects of parent well-being, family functioning, parent-child relationship, and child characteristics are related to psychological functioning in children aged 9 to 12 years during the COVID-19 lockdown.

Method:

Participants included 144 children aged 9 to 12 years and their parents who lived in the province of Quebec, Canada, during the COVID-19 mandatory lockdown. Parents and children were administered a phone-based survey in which various child, parent, parent-child, and family characteristics were assessed.

Results:

Results showed that higher internalizing problems in children were related to greater depressive symptoms in parents, lower attachment security to parents, and greater aversion to aloneness in children. Results on externalizing behavior problems showed that more problems were associated with more family dysfunction and chaos and lower attachment security to parents. Finally, results on children's anxiety toward COVID-19 showed that more anxiety was associated with greater parental anxiety toward COVID-19 and more child aversion to aloneness.

Conclusion:

Our findings showed that even during an unusual and stressful context such as a pandemic, proximal variables such as the attachment relationship that have been known to be closely associated with adaptation are significantly related to child psychological functioning. Such observations are important because they highlight factors that may accentuate child vulnerability in times of a pandemic and shed light on potential intervention targets.
Validation of Hypertensive Disorders During Pregnancy: ICD-10 Codes in a High-burden Southeastern United States Hospital
Authors: Labgold Katie , Stanhope Kaitlyn K. , Joseph Naima T. , Platner Marissa , Jamieson Denise J. , Boulet Sheree L.
Published: March 2021

Background:

Identification of hypertensive disorders in pregnancy research often uses hospital International Classification of Diseases v. 10 (ICD-10) codes meant for billing purposes, which may introduce misclassification error relative to medical records. We estimated the validity of ICD-10 codes for hypertensive disorders during pregnancy overall and by subdiagnosis, compared with medical record diagnosis, in a Southeastern United States high disease burden hospital.

Methods:

We linked medical record data with hospital discharge records for deliveries between 1 July 2016, and 30 June 2018, in an Atlanta, Georgia, public hospital. For any hypertensive disorder (with and without unspecified codes) and each subdiagnosis (hemolysis, elevated liver enzymes, and low platelet count [HELLP] syndrome, eclampsia, preeclampsia with and without severe features, chronic hypertension, superimposed preeclampsia, and gestational hypertension), we calculated positive predictive value (PPV), negative predictive value (NPV) sensitivity, and specificity for ICD-10 codes compared with medical record diagnoses (gold standard).

Results:

Thirty-seven percent of 3,654 eligible pregnancies had a clinical diagnosis of any hypertensive disorder during pregnancy. Overall, ICD-10 codes identified medical record diagnoses well (PPV, NPV, specificity >90%; sensitivity >80%). PPV, NPV, and specificity were high for all subindicators (>80%). Sensitivity estimates were high for superimposed preeclampsia, chronic hypertension, and gestational hypertension (>80%); moderate for eclampsia (66.7%; 95% confidence interval [CI] = 22.3%, 95.7%), HELLP (75.0%; 95% CI = 50.9%, 91.3%), and preeclampsia with severe features (58.3%; 95% CI = 52.6%, 63.8%); and low for preeclampsia without severe features (3.2%; 95% CI, 1.4%, 6.2%).

Conclusions:

We provide bias parameters for future US-based studies of hypertensive outcomes during pregnancy in high-burden populations using hospital ICD-10 codes.
Effects of pupillary reflex dilation-guided opioid administration on remifentanil and morphine consumption during laparoscopic surgery
Authors: Guerci Philippe , Jay Guillaume , Arnout Chloé , Herbain Delphine , Baka Noureddine , Poirel Olivier , Novy Emmanuel , Bouaziz Hervé , Vial Florence
Published: March 2021

BACKGROUND

Analysis of pupillary reflex dilation (PRD) assesses the balance of nociception--antinociception. Laparoscopic surgery induces haemodynamic variations that are misleading. During laparoscopy, PRD guidance helps differentiate haemodynamic changes because of excess nociception from secondary changes related to the reflex release of endocrine factors.

OBJECTIVE

The present study evaluated the effect of PRD-guided antinociception on the administration of intra-operative remifentanil and immediate postoperative morphine consumption in patients undergoing elective laparoscopic surgery.

DESIGN

The study was a single-blind, randomised controlled trial.

SETTING

The study took place at two sites at the University Hospital of Nancy from March 2014 to November 2017.

PATIENTS

A total of 100 patients who underwent scheduled laparoscopic surgery were included.

INTERVENTIONS

Patients were randomly given remifentanil guided by PRD (PRD-guided) or standard anaesthesia care (control).

MAIN OUTCOME MEASURES

The primary outcome was intra-operative remifentanil consumption. Secondary outcomes included morphine consumption in the immediate postoperative period and the number of intra-operative haemodynamic events.

RESULTS

Data from 95 patients were analysed. Intraoperative remifentanil consumption was lower in the PRD-guided group than in the control group: median [IQR], 0.09 [0.07 to 0.11] vs. 0.14 [0.12 to 0.16] μg kg−1 min−1, with a mean difference (95% confidence Interval, CI) of 0.048 (0.035 to 0.060) μg kg−1 min−1; P < 0.0001. Morphine consumption was 0.13 [0.1 to 0.5] vs. 0.15 [0.11 to 0.4] mg kg−1 (P 
= 0.52) in the PRD-guided and control groups, respectively. The number of hypertensive and tachycardia events was greater in the PRD-guided group than in the control group: Hypertensive events 60.4% vs. 32.6%, relative risk 1.85 (95% CI, 1.24 to 2.84), P = 0.004; tachycardia events 31.6% vs. 4.3%, relative risk 2.09 (95% CI, 1.45 to 2.84), P < 0.001.

CONCLUSIONS

When PRD is used to differentiate between haemodynamic events arising from noxious stimuli and those events because of other nonsurgical stimuli, then intra-operative remifentanil administration is reduced intra-operatively during laparoscopic surgery but there was no change in postoperative morphine consumption.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02116868.
Evaluation of glomerular filtration rate using iohexol plasma clearance in critically ill patients with augmented renal creatinine clearance
Authors: Collet Magalie , Hijazi Dany , Sevrain Pauline , Barthélémy Romain , Labeyrie Marc-Antoine , Prié Dominique , Tabibzadeh Nahid , Mebazaa Alexandre , Chousterman Benjamin G.
Published: March 2021

BACKGROUND

Augmented renal creatinine clearance (ARC) (≥130 ml min−1 1.73 m−2) is frequent in intensive care unit (ICU) patients and may impact patient outcome.

OBJECTIVES

To compare glomerular filtration rate (GFR) measured with iohexol plasma clearance and creatinine clearance in critically ill patients with augmented renal clearance.

DESIGN

Single-centre, retrospective study.

SETTING

French University Hospital ICU from November 2016 to May 2019.

PATIENTS

Adult patients with augmented renal clearance who had a measurement of iohexol plasma clearance.

MAIN OUTCOME MEASURE

Agreement between 6 h creatinine clearance (6 h CrCl) and iohexol plasma clearance (GFRio).

RESULTS

Twenty-nine patients were included. The median 6 h creatinine clearance was 195 [interquartile range (IQR) 162 to 251] ml min−1 1.73 m−2 and iohexol clearance was 133 [117 to 153] ml min−1 1.73 m−2. Sixteen patients (55%) had hyperfiltration (clearance >130 ml min−1 1.73 m−2) measured with iohexol clearance. Mean bias between iohexol and creatinine clearance was −80 [limits of agreement (LoA) −216 to 56 ml min−1 1.73 m−2]. For Cockcroft and Gault Modification of Diet in Renal Disease equation (MDRD), Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) formulae, mean biases were, respectively −27 (LoA −99 to 45), −14 (LoA −86 to 59) and 15 (LoA −33 to 64) ml min−1 1.73 m−2.

CONCLUSION

In the present study, we found that in patients with augmented renal creatinine clearance, half of the patients do not have hyperfiltration using iohexol clearance measurements. We observed an important bias between 6 h CrCl and GFRio with large LoA. In critically patients with ARC, 6 h CrCl does not reliably estimate GFR and 6 h CrCl nearly systematically overestimates renal function. Comparison of creatinine-based GFR estimations and GFRio show acceptable bias but wide LoA.
Contemporary perspectives on the genetics and clinical use of lipoprotein(a) in preventive cardiology
Authors: Page Michael M. , Watts Gerald F.
Published: March 2021

Purpose of review

The pathogenicity of lipoprotein(a) [Lp(a)] as a risk factor for atherosclerotic cardiovascular disease (ASCVD) is well evidenced and recognized by international consensus-based guidelines. However, the measurement of Lp(a) is not routine clinical practice. Therapeutic agents targeting Lp(a) are now progressing through randomised clinical trials, and it is timely for clinicians to familiarize themselves with this complex and enigmatic lipoprotein particle.

Recent findings

Recent developments in the understanding of genetic influences on the structure, plasma concentration and atherogenicity of Lp(a) have contextualized its clinical relevance. Mendelian randomization studies have enabled estimation of the contribution of Lp(a) to ASCVD risk. Genotyping individual patients with respect to Lp(a)-raising single nucleotide polymorphisms predicts ASCVD, but has not yet been shown to add value beyond the measurement of Lp(a) plasma concentrations, which should be done by Lp(a) isoform-independent assays capable of reporting in molar concentrations. Contemporary gene-silencing technology underpins small interfering RNA and antisense oligonucleotides, which are emerging as the leading Lp(a)-lowering therapeutic agents. The degree of Lp(a)-lowering required to achieve meaningful reductions in ASCVD risk has been estimated by Mendelian randomization, providing conceptual support.

Measurement of Lp(a) in the clinical setting contributes to the assessment of ASCVD risk, and will become more important with the advent of specific Lp(a)-lowering therapies. Knowledge of an individual patient's genetic predisposition to increased Lp(a) appears to impart little or not additional clinical value beyond Lp(a) particle concentration.
Racial and ethnic disparities in heart failure: current state and future directions
Authors: Lewsey Sabra C. , Breathett Khadijah
Published: March 2021

Purpose of review

This review discusses the current state of racial and ethnic inequities in heart failure burden, outcomes, and management. This review also frames considerations for bridging disparities to optimize quality heart failure care across diverse communities.

Recent findings

Treatment options for heart failure have diversified and overall heart failure survival has improved with the advent of effective pharmacologic and nonpharmacologic therapies. With increased recognition, some racial/ethnic disparity gaps have narrowed whereas others in heart failure outcomes, utilization of therapies, and advanced therapy access persist or worsen.

Racial and ethnic minorities have the highest incidence, prevalence, and hospitalization rates from heart failure. In spite of improved therapies and overall survival, the mortality disparity gap in African American patients has widened over time. Racial/ethnic inequities in access to cardiovascular care, utilization of efficacious guideline-directed heart failure therapies, and allocation of advanced therapies may contribute to disparate outcomes. Strategic and earnest interventions considering social and structural determinants of health are critically needed to bridge racial/ethnic disparities, increase dissemination, and implementation of preventive and therapeutic measures, and collectively improve the health and longevity of patients with heart failure.
Droplet Digital PCR Quantification of Mantle Cell Lymphoma Follow‐up Samples From Four Prospective Trials of the European MCL Network
Authors: Drandi Daniela , Alcantara Marion , Benmaad Ichrafe , Söhlbrandt Arian , Lhermitte Ludovic , Zaccaria GianMaria , Ferrante Martina , Genuardi Elisa , Mantoan Barbara , Villarese Patrick , Cheminant Morgane , Starza Irene della , Ciabatti Elena , Bomben Riccardo , Jimenez Cristina , Callanan Mary , Abdo Chrystelle , Eckert Cornelia , Ribrag Vincent , Cortelazzo Sergio , Dreyling Martin , Hermine Olivier , Delfau‐Larue Marie‐Hélène , Pott Christiane , Ladetto Marco , Ferrero Simone , Macintyre Elizabeth
Published: March 2021

Supplemental Digital Content is available in the text
Predictors of Driving Status in Service Members and Veterans at 1 Year Posttraumatic Brain Injury: A VA TBI Model Systems Study
Authors: Bernstein John P. K. , Sevigny Mitch , Novack Thomas A. , Dreer Laura E. , Chung Joyce , Lamberty Greg J. , Finn Jacob A.
Published: March 2021

Objective:

To identify predictors of driving status in service members and veterans 1 year following a traumatic brain injury (TBI).

Setting:

The 5 Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs).

Participants:

A total of 471 service members and veterans (128 with mild/complicated mild TBI and 343 with moderate/severe TBI) who received TBI-focused inpatient rehabilitation at one of the VA PRCs and who participated in a 1-year postinjury follow-up assessment.

Design:

Secondary analysis from the Department of Veterans Affairs Polytrauma Rehabilitation Centers Traumatic Brain Injury Model Systems (VA PRC TBIMS) national database.

Main Measures:

Primary outcome was a single item that assessed driving status at 1 year postinjury. Predictor variables included demographics; sensory impairment, substance use, and employment status at time of injury; PTSD symptoms reported at study enrollment; and functional impairment rated at rehabilitation discharge.

Results:

In unadjusted bivariate analyses, among those with a mild/complicated mild TBI, older age and greater functional impairment were associated with lower likelihood of driving. Among those with a moderate/severe TBI, discharge to a nonprivate residence, greater functional impairment, and higher PTSD symptoms were linked to lower likelihood of driving. Adjusted multivariate analyses indicated that functional impairment was uniquely associated with driving status in both TBI severity groups. After controlling for other predictors, self-reported PTSD symptoms, particularly dysphoria symptoms, were associated with lower likelihood of driving in both severity groups.

Conclusion:

Given the significance of clinician-rated functional impairment and self-reported PTSD symptoms to the prediction of driving status 1 year post-TBI among service members and veterans, rehabilitation efforts to improve functioning and reduce negative affect may have a positive impact on driving and community integration.
Association between body mass index and clinical outcomes in out-of-hospital cardiac arrest survivors treated with targeted temperature management
Authors: Chen Chung-Ting , Lin Meng-Chen , Lee Yi-Jing , Li Li-Hua , Chen Ying-Ju , Chuanyi Hou Peter , How Chorng-Kuang
Published: March 2021

Background:

To determine the impact of body mass index (BMI) on clinical outcomes in out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM).

Methods:

We conducted a retrospective cohort study of 261 adult OHCA survivors who received complete TTM between January 2011 and December 2018 using data from the Research Patient Database Registry of Partners HealthCare system in Boston. Patients were categorized as underweight (BMI < 18.5 kg/m2), normal weight (BMI = 18.5–24.9 kg/m2), overweight (BMI = 25–29.9 kg/m2), and obese (BMI ≥ 30 kg/m2), according to the World Health Organization classification.

Results:

The average BMI was 28.9 ± 7.1 kg/m2. Patients with a higher BMI had higher rates of hypertension and diabetes mellitus, and were more likely to be witnessed on collapse. Patients with lower BMI levels had higher sequential organ failure assessment (SOFA) scores, blood urea nitrogen values, and mild thrombocytopenia rates (platelet count <150 K/μL) after the TTM treatment. The survival to discharge and favorable neurological outcome at discharge were reported in 117 (44.8%) and 76 (29.1%) patients, respectively. The survival at discharge, favorable neurologic outcomes at discharge, length of hospital admission, and the occurrence of acute kidney injury did not significantly differ between the BMI subgroups. In logistic regression model, BMI was not an independent predictor for survival at discharge (adjusted odds ratio 0.945, 95% CI 0.883–1.012, p = 0.108) nor for the favorable neurologic outcome at discharge (adjusted odds ratio 1.022, 95% CI 0.955–1.093, p = 0.528).

Conclusion:

In OHCA patients treated with TTM, there was no significant difference across BMI subgroups for survival or favorable neurologic outcome at discharge.
The biological function and diagnostic value of miR-762 in nasopharyngeal carcinoma
Authors: Bao Li-Hao , Ji Ke , Li Dong , Liu Shao-Sheng , Song Zhen-Yu , Xia Gui-Hua
Published: March 2021

Background:

Low diagnostic efficiency and high metastasis and recurrence of nasopharyngeal carcinoma (NPC) result in bad survival. A novel diagnostic biomarker is of great importance for the improvement of NPC management. This study aimed to state the biological function and diagnostic values of miR-762 in NPC to provide a novel insight into the detection and therapy of NPC.

Methods:

The expression of miR-762 in NPC and healthy samples was detected by quantitative real-time polymerase chain reaction and its diagnostic value was evaluated by the receiver operating characteristic (ROC) analysis. The functional roles of miR-762 in the proliferation, migration, and invasion of NPC cells were assessed by CCK8 and Transwell assay.

Results:

The significant upregulation of miR-762 was observed in NPC serum compared with healthy controls, which was associated with the TNM stage and lymph node metastasis of NPC patients. The ROC curve showed that miR-762 could be a diagnostic biomarker for NPC with high accuracy and specificity. Additionally, miR-762 served as a tumor promoter, which could promote cell proliferation, migration, and invasion of NPC.

Conclusion:

The upregulation of miR-762 in NPC is associated with the disease progression and diagnosis of NPC. miR-762 might be involved in the tumor progression of NPC, which provides a potential therapeutic target for the treatment and management of NPC.
Are Cal/OSHA Regulations Protecting Farmworkers in California From Heat-Related Illness?
Authors: Langer Chelsea Eastman , Mitchell Diane C. , Armitage Tracey L. , Moyce Sally C. , Tancredi Daniel J. , Castro Javier , Vega-Arroyo Alondra J. , Bennett Deborah H. , Schenker Marc B.
Published: March 2021

Objective:

Determine compliance with and effectiveness of California regulations in reducing farmworkers’ heat-related illness (HRI) risk and identify main factors contributing to HRI.

Methods:

In a cross-sectional study of Latino farmworkers, core body temperature (CBT), work rate, and environmental temperature (WBGT) were monitored over a work shift by individual ingestible thermistors, accelerometers, and weather stations, respectively. Multiple logistic modeling was used to identify risk factors for elevated CBT.

Results:

Although farms complied with Cal/OSHA regulations, worker training of HRI prevention and hydration replacement rates were insufficient. In modeling (AOR [95% CI]) male sex (3.74 [1.22 – 11.54]), WBGT (1.22 [1.08 – 1.38]), work rate (1.004 [1.002 – 1.006]), and increased BMI (1.11 [1.10 – 1.29]) were all independently associated with elevated CBT.

Conclusion:

Risk of HRI was exacerbated by work rate and environmental temperature despite farms following Cal/OSHA regulations.
Relationship Between Galvanic Vestibular-evoked Myogenic Potentials and the Prognosis of Unilateral Severe to Profound Idiopathic Sudden Sensorineural Hearing Loss With Vertigo
Authors: Chang Chih-Ming , Lo Wu-Chia , Young Yi-Ho , Liao Li-Jen , Cheng Po-Wen
Published: March 2021

Objective:

Idiopathic sudden sensorineural hearing loss (ISSNHL) may not only impair cochlear function but also damage vestibular structures, including the saccule, utricle, semicircular canals, and vestibular afferents. Poor recovery often occurs in patient with serious ISSNHL and accompanying vertigo. To define the severity of the disease and to predict prognosis, galvanic vestibular-evoked myogenic potentials (VEMPs) are added to the inner ear test battery.

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Thirty patients with unilateral severe to profound ISSNHL and accompanying vertigo were enrolled in this retrospective study.

Intervention:

Diagnostic.

Main Outcome Measures:

All subjects underwent pure tone audiometry, cervical and ocular VEMPs, and caloric tests before the initiation of treatment. The treatment outcome, rates of abnormal responses in the tests, and the characteristic parameters of VEMPs such as latencies and amplitudes, were analyzed.

Results:

In affected ears, the rates of abnormal acoustic cVEMPs, vibratory oVEMPs, galvanic cVEMPs, and galvanic oVEMPs were 60, 47, 37, and 20%, respectively. The improvement in the hearing of the affected ear was specified as good recovery or poor recovery. The normal galvanic VEMP group had a significant higher rate of good recovery than abnormal galvanic VEMP group (87% versus 27%; p = 0.003).

Conclusions:

Patients with unilateral severe to profound ISSNHL and accompanying vertigo who have normal galvanic VEMPs have a higher likelihood of hearing recovery than those who have abnormal galvanic VEMPs.
Simultaneous Nonmastoidectomy Infrapromontorial Tumor Removal and Cochlear Implantation in Vestibular Schwannoma Patient
Authors: Misron Khairunnisak , Mfuko Godlove , Hur Young Kyun , Moon In Seok
Published: March 2021

Introduction:

Restoration of hearing in patients with vestibular schwannoma (VS) and poor hearing poses a great challenge. Simultaneous cochlear implantation during surgery for VS removal offers favorable hearing outcome if the cochlear nerve remains intact. Recent refinement of surgical techniques using the endoscope has made it possible to simultaneously restore the hearing and remove the tumor.

Case description:

A 62-year-old male had left severe sensorineural hearing loss and a 4 mm intracanalicular VS. We performed simultaneous nonmastoidectomy infrapromontorial VS removal and cochlear implantation in this patient to achieve minimal invasiveness and to provide maximal hearing restoration. The tumor was removed via this corridor while maintaining the integrity of cochlear as well as facial nerves with full insertion of a medium length cochlear implant electrode. After surgery, the patient showed good hearing rehabilitation.

Conclusion:

Simultaneous infrapromontorial VS removal and nonmastoidectomy cochlear implantation serves as an option for hearing restoration with minimal invasiveness in small VS removal.
Minimally Invasive Off-Pump Technique for Temporary Left Ventricular Support
Authors: Lima Brian , Hufton Austen D. , Hussain Syed T.
Published: March 2021

Use of short-term mechanical circulatory support (MCS) for cardiogenic shock has rapidly increased. Most common initial MCS strategies entail institution of peripheral extracorporeal membrane oxygenation (ECMO) or temporary ventricular assist devices. For patients with anatomically small peripheral arteries or insufficient circulatory support, sternotomy and central cannulation techniques may be necessary. These invasive approaches are associated with increased risk of bleeding and other significant complications. We describe a minimally invasive, off-pump technique to provide adequate hemodynamic support and left ventricular unloading, allowing early postoperative ambulation, and ability to easily provide additional right ventricular/ECMO support if needed.
Thrombohaemorhhagic balance in coronavirus disease 2019 and its management: a perspective
Authors: Ghosh Kanjaksha , Ghosh Malay
Published: March 2021

Coronavirus disease 2019 infection produce a prothrombotic state. This is initiated through multiple pathways and is finally aggravated by cross talks with cytokine storm and neutrophil, platelet, complement activation. All these combine towards the second week of illness to produce thrombosis in the lung capillaries surrounding the alveolus producing characteristic pulmonary dysfunction (PaO2/FiO2 > 300, normal or minimally increased lung compliance and very high d-dimer levels) and a high rate of peripheral venous thrombosis. International and many national guidelines have approached this state in different ways but all emphasized the need for management and prevention of widespread thrombosis. It is felt more aggressive and graded thrombosis prevention and management should be initiated early in the treatment. d-Dimer, neutrophil count, SaO2, fibrinogen levels should be used to control the hypercoagulability. Drugs like statins which have anti-inflammatory action as well as ability to reduce fibrinogen and other clotting factors should be used in the beginning along with antiplatelet drugs and progressively complement activation and neutrophil extracellular traps inhibitors, oral mucopolysaccharides, full-scale anticoagulation along with judicial use of fibrinolysis supporting drugs should be added. In the present review, we have evaluated the various studies and argued the rationality that the anticoagulation in this condition should be initiated early during the infection and should be increased in a graded manner depending on clinical and laboratory progression of the condition until a strong specific antiviral drug for coronavirus disease 2019 infection is available.
Soluble thrombomodulin and cardiovascular disease risk factors in Japanese children
Authors: Kikuchi Toshihiro , Lin Lisheng , Horigome Hitoshi
Published: March 2021

This study aimed to establish standard reference values for soluble thrombomodulin in healthy prepubertal school-aged children and elucidate the relationship between soluble thrombomodulin levels and obesity, metabolic syndrome-associated indices, and other markers of vascular endothelial damage. The participants in this study were healthy Japanese children aged 9–10 years (315 boys and 267 girls). Blood tests for soluble thrombomodulin, leptin, fibrinogen, and general biochemical markers were performed, and the mean and 10th, 50th, and 90th percentiles for each marker were determined. Participants were divided into two groups based on their waist circumference (≥75 vs. <75 cm), and each parameter was compared between the two groups. Analyses were performed to compare subgroups with different numbers of risk factors for cardiovascular disease (CVD). We found that as CVD risk factors accumulated, the levels of total cholesterol, alanine aminotransferase, uric acid, soluble thrombomodulin, fibrinogen, and leptin were significantly elevated, whereas the level of high-density lipoprotein cholesterol significantly decreased. We determined reference values for soluble thrombomodulin in prepubertal children, and our results suggest that soluble thrombomodulin levels contribute to the latent progress of arteriosclerosis from childhood.
Ready-to-use therapeutic foods for the treatment of malnourished children and infants
Authors: Nel Etienne , Lombard Martani
Published: March 2021

Purpose of review

Ready-to-use therapeutic foods (RUTF) allow effective community-based management of severe acute malnutrition (SAM). Current interest focuses on their optimal composition and use.

Recent findings

Studies of alternative RUTF have yielded differing results. Partial soybean, sorghum flour, and whey protein replacement RUTF were inferior to standard RUTF. In contrast, soy-based RUTF was as effective as milk-based RUTF and an alternative RUTF with added oats lead to superior recovery in comparison to standard RUTF.

Reducing the dose of RUTF in the later phases of SAM recovery resulted in small reductions in the growth of uncertain clinical significance.

Although iron and vitamin A status improve during treatment with standard RUTF, a significant proportion of children remained deficient. Alternative soya, maize, and sorghum-based formulas with no milk protein may improve recovery of iron status compared to standard RUTF.

Finally, in children with SAM, plasma essential fatty acids and conversion to long-chain polyunsaturated fatty acids are reduced. Despite the improvement, these parameters remain lower than in normal children after 3 months.

New RUTF formulations may provide a cost-effective alternative to standard RUTF. Future research should focus on addressing micronutrient deficiency, lipid metabolism, and long-term recovery.
Vitamin D requirements in infancy: an updated systematic review
Authors: Mimouni Francis B. , Mendlovic Joseph
Published: March 2021

Purpose of review

Systematic review looking for new evidence for recommendations for vitamin D supplementation in healthy infants based upon the most recent (4 years) available literature.

Recent findings

Randomized controlled trials published since 1 January 2017 that related to vitamin D doses in infancy were reviewed. They do not provide any additional evidence that larger, more generous amounts of daily vitamin D beyond the customary recommended 400 international units (IU) daily dose, affect any significant outcome. Larger amounts may lead to serum 25-hydroxyvitamin D [25(OH)D] concentrations that have been reported to be potentially associated with adverse effects, and a daily dose of 1200 IU may even harm in terms of increasing the risks of allergic sensitization.

There are still many unanswered questions left, in particular, whether or not more ‘generous’ amounts of vitamin D in infancy may improve long-term health outcomes such as prevention of adult osteoporosis, allergies, or cancer.
Chronic kidney disease in adrenal disorders
Authors: Salman Liann Abu , Cohen Debbie L.
Published: March 2021

Purpose of review

This review will focus on hypertension due to underlying adrenal disorders in chronic kidney disease (CKD). Diagnosis of adrenal hypertension and particularly primary aldosteronism (PA) in CKD is frequently not pursued. We outline limitations that advanced kidney disease poses on the diagnostic work up of these disorders and provide a framework for approaching CKD patients suspected of having an adrenal disorder. Recognition of these disorders is important as they are often underdiagnosed which leads to poorer outcomes.

Recent findings

Adrenal disease associated with hypertension in CKD is most commonly due to PA whereas pheochromocytoma and Cushing's disease are important but less common. Diagnosis of these diseases is important as their identification leads to better blood pressure control and can possibly mitigate the risk of progression of CKD. Work up and treatment of PA has been shown to be safe and is associated with less antihypertensive medication requirement for the associated hypertension and slower progression of CKD.

This chapter summarizes the importance of recognizing adrenal hypertension in CKD and reinforces the need for physicians to pursue these diagnoses in CKD patients as this is safe and improves both BP control and delays progression of CKD.
Thromboembolic disease in hypercortisolism
Authors: Capatina Cristina , Fleseriu Maria
Published: March 2021

Purpose of review

Endogenous Cushing's syndrome (CS) is associated with increased patient morbidity (hypertension, diabetes mellitus, dyslipidemia, visceral obesity, osteoporosis, cognitive alterations, and impaired quality of life). Both arterial and venous thromboembolic events (TE) due to alterations in the hemostatic system and prothrombotic state are widely reported in patients with CS, more so postoperatively. Increased mortality, if not appropriately treated, is largely due to cardiovascular events and infections.

Recent findings

Patients with CS have markedly increased risk of thromboembolic episodes compared to the general population. The prothrombotic state is mediated by increased levels of procoagulant factors, but also by an impaired fibrinolytic capacity. All contribute to TE, atherosclerosis, and subsequent cardiovascular morbidity and mortality. Some abnormalities progressively improve after CS remission, but do not fully normalize for at least 1 year or more.

Due to the additional thrombotic risk of surgery or any invasive procedure, anticoagulation prophylaxis should be at least considered in patients with CS and balanced with individual bleeding risk. However, a clear protocol of thromboprophylaxis is lacking and increased awareness regarding risks per se is needed. Large prospective trials will clarify, which patients with CS are at the highest risk and the optimal prevention protocol to minimize risks and maximize efficacy.
Safety and protection in endoscopic services during phase II of COVID-19 pandemic: a national survey
Authors: Vassallo Roberto , Venezia Ludovica , Zullo Angelo , Stasi Elisa , Milazzo Giuseppe , Soncini Marco , Triossi Omero , Neri Bortoluzzi Francesco , Montalto Paolo , Usai Satta Paolo , Monica Fabio
Published: March 2021

Background

The coronavirus disease 2019 (COVID-19) pandemic requires appropriate measures for containing infection spreading. Endoscopic procedures are considered at increased risk of infection transmission. We evaluated organizational aspects and personal behaviours in Italian Endoscopic Units during phase II of the pandemic.

Methods

A questionnaire on organizational aspects and use of personal protective equipment (PPE) were e-mailed to gastroenterologists working in Endoscopic Units. Data were analysed accordingly to the National Health Institute and Gastroenterology Societies recommendations.

Results

Data of 117 centres were collected, and different shortcomings emerged. Specific protocols for containing infection and training programs for operators were lacking in 20 and 30% of centres, respectively, and telephone triage 24–72 h before the endoscopy was not implemented in 25% of hospitals. In 30% of centres, the slot time for endoscopies and between examinations was not prolonged. PPE, masks, shirts and gloves were universally adopted, although with some differences. In 20% of centres, a FFPE-FFP3 mask was not adopted during endoscopic examinations. Postendoscopy patient tracking/contact was completed in only one-third of centres.

Conclusions

Our survey provides information on organizational and medical behaviours during COVID-19 phase II in Italy, which could be useful for adopting appropriate measures for containing COVID-19 spread during phase II.
The dietary practices and beliefs of people living with older-onset inflammatory bowel disease
Authors: Crooks Benjamin , Misra Ravi , Arebi Naila , Kok Klaartje , Brookes Matthew J. , McLaughlin John , Limdi Jimmy K.
Published: March 2021

Background and Objectives

The role of diet in inflammatory bowel disease (IBD) remains incompletely understood. Studies have previously examined dietary practices in IBD, but none have specifically focused on older-onset disease. IBD may put vulnerable groups at risk of nutritional deficiency and associated complications, potentially heightened by comorbidities, frailty and polypharmacy. Our objective was to describe dietary practices and beliefs in older-onset IBD.

Methods

A questionnaire exploring dietary practices and beliefs was prospectively administered to 137 people with older-onset IBD attending gastroenterology clinics.

Results

Thirty-two percent believed diet was the initiating factor for their IBD. This was significantly more likely in people with Crohn’s disease than ulcerative colitis (P = 0.05) and in those who felt limited in their dietary choices due to cost (P = 0.008). Forty-three percent believed diet could trigger IBD relapse and 68% avoided dietary components to avoid relapse. Most frequently avoided were spicy and fatty foods, carbonated drinks, red meat, alcohol and raw fruit and vegetables. Twenty-two percent of participants had tried a whole food exclusion diet, most frequently gluten- or lactose-free. Almost a third avoided eating out (29%) or eating the same meal as their family (32%) to prevent relapse. Respondents rarely relied upon healthcare professionals or patient support organisations for their dietary information.

Conclusion

Individuals with older-onset IBD report dietary practices with a high degree of consistency. Dietary avoidance may impact upon both nutritional and psychosocial wellbeing in this more vulnerable group and, as such, early dietetic assessment could help improve outcomes.
Efficacy of puncturing different portal vein branch during transjugular intrahepatic portosystemic shunt with 8 mm covered stent: a propensity-score analysis
Authors: Zhou Yongjie , Ma Jingqin , Ju Shuai , Zhang Zihan , Zhang Wen , Yang Minjie , Zhou Xin , Yan Zhiping , Luo Jianjun
Published: March 2021

Background

Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) remains an unsolved problem; therefore, this study aimed to compare the efficacy of shunting different portal vein branch during TIPS with 8 mm covered stent for preventing gastroesophageal variceal rebleeding in cirrhotic patients.

Methods

Between November 2015 and December 2018, the medical records of consecutive cirrhotic patients who received TIPS with an 8 mm covered stent for preventing gastroesophageal variceal rebleeding were analyzed retrospectively. Shunting the left and right branches of the portal vein was performed in 58 (group A) and 104 patients (group B), respectively. Afterwards, 54 patients in each group were produced by the PSM method. The incidence of overt hepatic encephalopathy (OHE), shunt patency, variceal rebleeding and survival were compared between two groups by using Kaplan–Meier analysis and log-rank test.

Results

The median follow-up time was 37 months (range 0.3–50 months). The 6-,12- and 24-months cumulative OHE free rates in groups A and B were 92.5, 86.2, 83.6% and 74.1, 70.2, 67.6%, respectively (P = 0.042; hazard ratio = 0.469; 95% CI, 0.223–0.988). Two (3.7%) and eight (14.8%) patients experienced severe OHE in groups A and B, respectively (P = 0.042). There were no significant differences between the two groups in terms of shunt patency, variceal rebleeding and survival.

Conclusion

Shunting the left portal vein branch during TIPS with an 8 mm covered stent for preventing gastroesophageal variceal rebleeding in cirrhotic patients might decrease the occurrence of OHE significantly. The prospective trial is needed to further provide evidence of this results in future.
Prediction of tumor response and patient outcome after radioembolization of hepatocellular carcinoma using 90Y-PET-computed tomography dosimetry
Authors: d’Abadie Philippe , Walrand Stephan , Hesse Michel , Annet Laurence , Borbath Ivan , Van den Eynde Marc , Lhommel Renaud , Jamar François
Published: March 2021

Aim

90Y-radioembolization using glass or resin microspheres is increasingly used for the treatment of hepatocellular carcinoma (HCC). The aim of this retrospective study is to determine the prognostic relevance of dosimetric parameters defined with 90Y-PET-CT obtained immediately after radioembolization.

Methods

Forty-five HCC patients, mostly with multiple lesions, were treated by radioembolization between 2011 and 2017. After treatment, all underwent a 90Y PET-CT with time of flight reconstruction (90Y-TOF-PET-CT). Tumor absorbed dose and cumulative tumor dose-volume histogram were calculated using a dose point Kernel convolution algorithm. The radiological tumor response was assessed using modified (m)-RECIST criteria. Progression-free-survival (PFS) and overall survival (OS) were analyzed using the Kaplan–Meier method and Cox regression analysis.

Results

Twenty-six patients were treated with glass microspheres (73 lesions) and nineteen with resin microspheres (60 lesions). Thresholds of 118 and 61 Gy for glass and resin microspheres respectively correlate well with radiological response with a positive predictive value (PPV) of 98 and 80% and discriminate patient outcome with regard to PFS (P = 0.03 and 0.005) and OS (P = 0.003 and 0.007). Using dose volume histogram, a minimal absorbed dose of 40 Gy in 66% of the tumor volume (defined as D66) was highly predictive of radiological response (PPV = 94%), PFS (P < 0.001) and OS (P = 0. 008), for either device.

Conclusion

Dosimetric parameters obtained using 90Y-PET-CT are predictive of tumor response, PFS and OS. In clinical practice, a systematic dosimetric evaluation using 90Y PET should be implemented to help predicting patient outcomes.
FDG-PET/CT: novel method for viability assessment of livers perfused ex vivo
Authors: Orita Erika , Becker Dustin , Mueller Matteo , Hefti Max , Schuler Martin J. , Bautista Borrego Lucia , Dutkowski Philipp , Zeimpekis Konstantinos , Treyer Valerie , Kaufmann Philipp A. , Eshmuminov Dilmurodjon , Clavien Pierre-Alain , Huellner Martin W.
Published: March 2021

Purpose

Ex vivo liver machine perfusion is a promising option to rescue marginal liver grafts mitigating the donated organ shortage. Recently, a novel liver perfusion machine that can keep injured liver grafts alive for 1 week ex vivo was developed and reported in Nature Biotechnology. However, liver viability assessment ex vivo is an unsolved issue and the value of 18F-fluorodeoxyglucose (FDG)-PET/CT for such purpose was explored.

Materials and methods

Discarded two human and six porcine liver grafts underwent FDG-PET/CT for viability assessment after 1 week of ex vivo perfusion. PET parameters [standardized uptake value (SUV)max, SUVmean, SUVpeak and total lesion glycolysis] were compared between hepatic lobes and between porcine and human livers. The prevalence of FDG-negative organ parts was recorded. The estimated effective radiation dose for PET/CT was calculated.

Results

All organs were viable with essentially homogeneous FDG uptake. Of note, viability was preserved in contact areas disclosing the absence of pressure necrosis. Four porcine and two human organs had small superficial FDG-negative areas confirmed as biopsy sites. Total lesion glycolysis was significantly higher in the right hepatic lobe (P = 0.012), while there was no significant difference of SUVmax, SUVmean and SUVpeak between hepatic lobes. There was no significant difference in FDG uptake parameters between porcine and human organs. The estimated effective radiation dose was 1.99 ± 1.67 mSv per organ.

Conclusion

This study demonstrates the feasibility of FDG-PET/CT for viability assessment of ex vivo perfused liver grafts after 1 week.
Utility of 18F-FDG-PET/CT in management and prognostication of treatment naïve late-stage soft tissue sarcomas
Authors: Singh Tejesh Pratap , Sharma Anshul , Sharma Akshima , Bakhshi Sameer , Patel Chetan , Pandey Anil Kumar , Dhamija Ekta , Batra Atul , Kumar Rakesh
Published: March 2021

Objective

This study evaluated the utility of 18F-fluorodexoyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in staging, grading, and prognostication of Stage III and IV soft tissue sarcomas (STSs).

Methods

Forty patients (Median age = 32.5 years; 25 men) with histologically proven STSs, prospectively underwent 18F-FDG-PET/CTs at baseline. Three-dimensional region of interests were drawn encompassing the lesions to calculate standardized uptake values (SUVs) and metabolic tumor volumes (MTVs). After segmentation, Haralick statistical texture analysis was performed. Follow-up was available for 35 patients. Survival at 6 months was 71.4% and at 1 year was 57.1%.

Results

American Joint Committee on Cancer Stage III was seen in 23 and Stage IV in 17 patients. None of the baseline quantitative and semi-quantitative parameters could predict response or progression. Only reduction in SUVmax in interim PET/CT correlated with baseline SUVmax (Spearman’s Rho = 0.533; P = 0.019). Textural parameters namely ‘contrast’ in CT (P = 0.039) and ‘difference entropy’ in PET/CT (P = 0.051) could differentiate intermediate from high-grade lesions, with corresponding area under curves being 0.736 (0.533–0.889) and 0.700 (0.518–0.882). M1 disease [Hazard ratio (HR): 3.184 (1.179–8.595); P = 0.022], absence of surgical treatment [HR 0.305 (0.106–0.873), P = 0.027 with surgery], lower MTV/total tumor volume (TTV) [HR: 0.975 (0.953–0.997; P = 0.028] and progressive disease in interim PET/CT [3.483 (0.898–13.515); P = 0.056] were predictors of lower survival in univariate analysis. Only M1 disease was found to be reaching significance in multivariate analysis [HR = 2.683 (0.949–7.580); P = 0.063]. Baseline PET/CT changed management in 12.5% of patients [compared to local-imaging and high-resolution CT chest]; with detection of extra-pulmonary metastases. Though, interim and end of treatment PET/CTs detected more metastatic lesions, management was not impacted.

Conclusion

18F-FDG-PET/CT allows for more accurate M-staging in late-stage STSs, which in turn influences the option of curative surgical resection and thus impacts patient prognosis. Lower baseline MTV/TTV and progression in interim PET/CT are also associated with lower survival. Textural analysis may have a role in noninvasive grading.
Re-188-tricarbonyl tamoxifen as a theranostic radiopharmaceutical for estrogen receptor expressing breast cancers: radiolabeling, characterization and in-vitro cytotoxic assessment
Authors: Chhabra Anupriya , Shukla Jaya , Sharma Uma , Vatsa Rakhee , Bhatia Alka , Upadhyay Deepti , Mittal Bhagwant Rai
Published: March 2021

Purpose

Development of a novel theranostic radiopharmaceutical for estrogen receptor, expressing unresectable primary and metastatic breast cancers.

Methods

Tamoxifen was radiolabeled with Rhenium-188 (Re-188) through tricarbonyl core. Radiolabeled complex was characterized by 1proton nuclear magnetic resonance spectroscopy and Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF). Various quality control tests such as sterility, apyrogenicity, and radiochemical purity (RCP) were performed to assess the suitability of the radiopharmaceutical for intravenous administration. In-vitro cell culture studies were performed for cytotoxic assessment. In addition to this, exposure due to different doses of Re-188-tricarbonyl tamoxifen was also calculated.

Results

Re-188-tricarbonyl and Re-188-tricarbonyl tamoxifen showed more than 99% RCP. Sample was found to be sterile and pyrogens levels were within the permissible limit. Re-188-tricarbonyl tamoxifen was successfully characterized by MALDI-TOF and 1H-NMR spectroscopy. Re-188 (1.480 MBq) and tamoxifen (0.027 or 0.054 µM) individually showed 36 and 70% cell death, respectively. However, radiolabeled complex (Re-188-tricarbonyl tamoxifen) with the same amount of radioactivity (1.480 MBq) increased the cell death to more than 90% with one-fifth to one-tenth molar concentration of tamoxifen (0.0054 μM).

Conclusion

Re-188-tricarbonyl tamoxifen can be synthesized in-house in radiopharmacy lab. Radionuclide therapy with Re-188-tricarbonyl tamoxifen can be given using 10 times less amount of tamoxifen as compared to cold tamoxifen.