bluuebunny/crossref_metadata_2025 huggingface dataset:
In vitroantibiotic activity against intraosteoblasticStaphylococcus aureus: a narrative review of the literature
Authors: Marro Florian C , Abad Lélia , Blocker Ariel J , Laurent Frédéric , Josse Jérôme , Valour Florent
Published: August 2021

Staphylococcus aureus – a major aetiological agent of bone and joint infection (BJI) – is associated with a high risk of relapse and chronicity, in part due to its ability to invade and persist in non-professional phagocytic bone cells such as osteoblasts. This intracellular reservoir protects S. aureus from the action of the immune system and most antibiotics. To date, the choice of antimicrobial strategies for BJI treatment mostly relies on standard susceptibility testing, bone penetration of antibiotics and their ‘antibiofilm’ activity. Despite the role of intracellular persistent S. aureus in the development of chronic infection, the ability of antibiotics to target the S. aureus intraosteoblastic reservoir is not considered in therapeutic choices but might represent a key determinant of treatment outcome. This review provides an overview of the intracellular pharmacokinetics of antistaphylococcal drugs used in the treatment of BJI and of their ability to target intraosteoblastic S. aureus. Thirteen studies focusing on the intraosteoblastic activity of antibiotics against S. aureus were reviewed, all relying on in vitro models of osteoblast infection. Despite varying incubation times, multiplicities of infection, bacterial strains, and the types of infected cell lines, rifamycins and fluoroquinolones remain the two most potent antimicrobial classes for intraosteoblastic S. aureus eradication, consistent with clinical data showing a superiority of this combination therapy in S. aureus orthopaedic device-related infections.
What I Know: The Value of Mentoring and Leadership
Authors: Binder-Macleod Stuart
Published: August 2021

Stuart Binder-Macleod, PT, PhD, FAPTA, the 51st Mary McMillan lecturer, is the Edward L. Ratledge Professor of Physical Therapy and associate vice president for clinical and translation research at the University of Delaware (UD). He served as the chair of UD’s department of physical therapy for 16 years, and his research laboratory had more than 25 years of continuous National Institutes of Health funding, including major funding for projects involving the development and testing of treatment interventions for individuals demonstrating poststroke hemiparesis. A recipient of multiple honors from the American Physical Therapy Association (APTA) and its components, Binder-Macleod also served on the task force that created the American Council of Academic Physical Therapy, and he currently serves on the Board of Trustees of the Foundation for Physical Therapy Research.
Reallocation Effects of the Minimum Wage
Authors: Dustmann Christian , Lindner Attila , Schönberg Uta , Umkehrer Matthias , vom Berge Philipp
Published: August 2021

We investigate the wage, employment, and reallocation effects of the introduction of a nationwide minimum wage in Germany that affected 15% of all employees. Based on identification designs that exploit variation in exposure across individuals and local areas, we find that the minimum wage raised wages but did not lower employment. It also led to the reallocation of low-wage workers from smaller to larger, from lower- to higher-paying, and from less to more productive establishments. This worker upgrading accounts for up to 17% of the wage increase induced by the minimum wage. Moreover, at the regional level, average establishment quality increased in more affected areas in the years following the introduction of the minimum wage.
The Pass-Through of International Commodity Price Shocks to Producers’ Welfare: Evidence from Ethiopian Coffee Farmers
Authors: Kebede Hundanol A
Published: August 2021

International commodity price shocks may have large impacts on producers in developing countries. In this paper, a unique household panel data from Ethiopia is utilized to show that a decrease in international coffee price has strong pass-through to the consumption of households that rely on coffee production as a main source of livelihood. It also results in decreases in on-farm labor supply (particularly male labor supply) and induces reallocation of labor towards non-coffee fields, but has negligible effect on off-farm labor supply. The decline in consumption has significant consequences on child malnutrition: children born in coffee-producing households during low coffee price periods have lower weight-for-age and weight-for-height z-scores than their peers born in non-coffee households.
Exercise training ameliorates early diabetic kidney injury by regulating the H2S/SIRT1/p53 pathway
Authors: Yang Lu , Li Dong‐Xia , Cao Bu‐Qing , Liu Shu‐Juan , Xu Dan‐Hong , Zhu Xiao‐Yan , Liu Yu‐Jian
Published: August 2021

Exercise training exerts protective effects against diabetic nephropathy. This study aimed to investigate whether exercise training could attenuate diabetic renal injury via regulating endogenous hydrogen sulfide (H2S) production. First, C57BL/6 mice were allocated into the control, diabetes, exercise, and diabetes + exercise groups. Diabetes was induced by intraperitoneal injection of streptozotocin (STZ). Treadmill exercise continued for four weeks. Second, mice was allocated into the control, diabetes, H2S and diabetes + H2S groups. H2S donor sodium hydrosulfide (NaHS) was intraperitoneally injected once daily for four weeks. STZ‐induced diabetic mice exhibited glomerular hypertrophy, tissue fibrosis and increased urine albumin levels, urine protein‐ and albumin‐to‐creatinine ratios, which were relieved by exercise training. Diabetic renal injury was associated with apoptotic cell death, as evidenced by the enhanced caspase‐3 activity, the increased TdT‐mediated dUTP nick‐end labeling ‐positive cells and the reduced expression of anti‐apoptotic proteins, all of which were attenuated by exercise training. Exercise training enhanced renal sirtuin 1 (SIRT1) expression in diabetic mice, accompanied by an inhibition of the p53‐#ediated pro‐apoptotic pathway. Furthermore, exercise training restored the STZ‐mediated downregulation of cystathionine‐β‐synthase (CBS) and cystathionine‐γ‐lyase (CSE) and the reduced renal H2S production. NaHS treatment restored SIRT1 expression, inhibited the p53‐mediated pro‐apoptotic pathway and attenuated diabetes‐associated apoptosis and renal injury. In high glucose‐treated MPC5 podocytes, NaHS treatment inhibited the p53‐mediated pro‐apoptotic pathway and podocyte apoptosis in a SIRT1‐dependent manner. Collectively, exercise training upregulated CBS/CSE expression and enhanced the endogenous H2S production in renal tissues, thereby contributing to the modulation of the SIRT1/p53 apoptosis pathway and improvement of diabetic nephropathy.
Does Transvaginal Ultrasound at 13–15 Weeks Improve Anatomic Survey Completion Rates in Obese Gravidas?
Authors: Toscano Marika , Grace Daniel , Pressman Eva K. , Thornburg Loralei L.
Published: August 2021

(Abstracted from J Matern Fetal Neonatal Med 2021;34:803–809)

The fetal anatomic survey is less likely to be completed or is completed at a later gestational age in pregnant women who are obese. This reduces the likelihood of detecting fetal anomalies at an earlier stage of pregnancy.
Legal Challenges in Reproductive Genetics
Authors: Suter Sonia M.
Published: August 2021

(Abstracted from Fertil Steril 2021;115:282–289)

New technologies, such as next-generation sequencing, allow for increasing amounts of information to be used in assisted reproductive technologies. Although this can enhance reproductive decision making, it can also present challenges.
Chimeric Contribution of Human Extended Pluripotent Stem Cells to Monkey Embryos Ex Vivo
Authors: Tan Tao , Wu Jun , Si Chenyang , Dai Shaoxing , Zhang Youyue , Sun Nianqin , Zhang E. , Shao Honglian , Si Wei , Yang Pengpeng , Wang Hong , Chen Zhenzhen , Zhu Ran , Kang Yu , Hernandez-Benitez Reyna , Martinez Martinez Llanos , Nuñez Delicado Estrella , Berggren W. Travis , Schwarz May , Ai Zongyong , Li Tianqing , Rodriguez Esteban Concepcion , Ji Weizhi , Niu Yuyu , Belmonte Juan Carlos Izpisua
Published: August 2021

(Abstracted from Cell 2021;184:2020–2032)

Pluripotent stem cells (PSCs) have demonstrated the ability to be used in interspecies organogenesis through blastocyst complementation, opening the door for production of large quantities of in vivo generated human tissue for regenerative medicine applications. A critical step in this process is the ability of human PSCs (hPSCs) to contribute to chimera formation; however, some studies have shown that hPSCs have little chimeric competency in species evolutionarily distant to humans (eg, mice and pigs).
Use of Telehealth by Surgical Specialties During the COVID-19 Pandemic
Authors: Chao Grace F. , Li Kathleen Y. , Zhu Ziwei , McCullough Jeff , Thompson Mike , Claflin Jake , Fliegner Maximilian , Steppe Emma , Ryan Andrew , Ellimoottil Chad
Published: August 2021

(Abstracted from JAMA Surg 2021;e210979. doi:10.1001/jamasurg.2021.0979)

Given the US health care system mandates to minimize patient and clinician exposure to COVID-19, telehealth use across all specialties increased dramatically in the COVID-19 pandemic. Telehealth for preoperative and postoperative surgical follow-up patient visits had started to occur at low levels before the pandemic.
“When Is Health Care Actually Going to Be Care?” The Lived Experience of Family Planning Care Among Young Black Women
Authors: Logan Rachel G. , Daley Ellen M. , Vamos Cheryl A. , Louis-Jacques Adetola , Marhefka Stephanie L.
Published: August 2021

(Abstracted from Qual Health Res 2021;31:1169–1182)

Family planning care (FPC) visits are intended to provide education and opportunities for women to obtain family planning services, including hormonal medications. Structural barriers, sociocultural barriers, and mistreatment by the health care system may perpetuate the numerous health inequities surrounding reproductive health and pregnancy among young Black women.
Neurolytic Splanchnic Nerve Block and Pain Relief, Survival, and Quality of Life in Unresectable Pancreatic Cancer: A Randomized Controlled Trial
Authors: Dong Daosong , Zhao Mingfang , Zhang Jingmei , Huang Ming , Wang Yanwei , Qi Liang , Wan Cheng-fu , Yu Xue , Song Tao
Published: August 2021

Background

Neurolytic splanchnic nerve block is used to manage pancreatic cancer pain. However, its impact on survival and quality of life remains controversial. The authors’ primary hypothesis was that pain relief would be better with a nerve block. Secondarily, they hypothesized that analgesic use, survival, and quality of life might be affected.

Methods

This randomized, double-blind, parallel-armed trial was conducted in five Chinese centers. Eligible patients suffering from moderate to severe pain conditions were randomly assigned to receive splanchnic nerve block with either absolute alcohol (neurolysis) or normal saline (control). The primary outcome was pain relief measured on a visual analogue scale. Opioid consumption, survival, quality of life, and adverse effects were also documented. Analgesics were managed using a protocol common to all centers. Patients were followed up for 8 months or until death.

Results

Ninety-six patients (48 for each group) were included in the analysis. Pain relief with neurolysis was greater for the first 3 months (largest at the first month; mean difference, 0.7 [95% CI, 0.3 to 1.0]; adjusted P < 0.001) compared with placebo injection. Opioid consumption with neurolysis was lower for the first 5 months (largest at the first month; mean difference, 95.8 [95% CI, 67.4 to 124.1]; adjusted P < 0.001) compared with placebo injection. There was a significant difference in survival (hazard ratio, 1.56 [95% CI, 1.03 to 2.35]; P = 0.036) between groups. A significant reduction in survival in neurolysis was found for stage IV patients (hazard ratio, 1.94 [95% CI, 1.29 to 2.93]; P = 0.001), but not for stage III patients (hazard ratio, 1.08 [95% CI, 0.59 to 1.97]; P = 0.809). No differences in quality of life were observed.

Conclusions

Neurolytic splanchnic nerve block appears to be an effective option for controlling pain and reducing opioid requirements in patients with unresectable pancreatic cancer.

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Preoperative Biliary Drainage Does Not Independently Reduce Survival After Pancreaticoduodenectomy Among Patients With Pancreatic Ductal Adenocarcinoma
Authors: Johansen Karin , Khodakaram Kaveh , Lundgren Linda , Hasselgren Kristina , Gasslander Thomas , Sandström Per , Bratlie Svein Olav , Björnsson Bergthor
Published: August 2021

Objective:

This study aimed to explore a possible relationship between preoperative biliary drainage (PBD) and overall survival in a national cohort of Swedish patients who underwent pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC).

Background:

PBD has been shown to increase postoperative complications after PD, but its use is steadily increasing. There are a few small studies that have indicated that PBD might in itself negatively affect overall survival after PD.

Methods:

Patients from the Swedish National Registry for tumors in the pancreatic and periampullary region diagnosed from 2010 to 2019 who underwent PD for PDAC were included. Kaplan-Meier curves, log-rank tests and Cox proportional hazards analyses were performed to investigate survival.

Results:

Out of 15,818 patients in the registry, 3113 had undergone PD, of whom 1471 had a histopathological diagnosis of PDAC. Patients who had undergone PBD had significantly worse survival, but the effect of PBD disappeared in the multivariable analysis when elevated bilirubin at any time was included.

Conclusions:

PBD does not independently influence survival after PD for PDAC, but this study implies that even a nominally increased preoperative bilirubin level might impair long-term survival.
Defining Potential Therapeutic Targets in Coronavirus Disease 2019: A Cross-Sectional Analysis of a Single-Center Cohort
Authors: Arulkumaran Nishkantha , Snow Timothy Arthur Chandos , Kulkarni Adarsh , Brealey David , Rickman Hannah , Rees-Spear Chloe , Spyer Moira J. , Heaney Judith , Garr Edmund , Williams Bryan , Cherepanov Peter , Kassiotis George , Lunn Michael , Houlihan Catherine , McCoy Laura E. , Nastouli Eleni , Singer Mervyn
Published: August 2021

OBJECTIVES:

Multiple mechanisms have been proposed to explain disease severity in coronavirus disease 2019. Therapeutic approaches need to be underpinned by sound biological rationale. We evaluated whether serum levels of a range of proposed coronavirus disease 2019 therapeutic targets discriminated between patients with mild or severe disease.

DESIGN:

A search of ClinicalTrials.gov identified coronavirus disease 2019 immunological drug targets. We subsequently conducted a retrospective observational cohort study investigating the association of serum biomarkers within the first 5 days of hospital admission relating to putative therapeutic biomarkers with illness severity and outcome.

SETTING:

University College London, a tertiary academic medical center in the United Kingdom.

PATIENTS:

Patients admitted to hospital with a diagnosis of coronavirus disease 2019.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Eighty-six patients were recruited, 44 (51%) with mild disease and 42 (49%) with severe disease. We measured levels of 10 cytokines/signaling proteins related to the most common therapeutic targets (granulocyte-macrophage colony-stimulating factor, interferon-α2a, interferon-β, interferon-γ, interleukin-1β, interleukin-1 receptor antagonist, interleukin-6, interleukin-7, interleukin-8, tumor necrosis factor-α), immunoglobulin G antibodies directed against either coronavirus disease 2019 spike protein or nucleocapsid protein, and neutralization titers of antibodies. Four-hundred seventy-seven randomized trials, including 168 different therapies against 83 different pathways, were identified. Six of the 10 markers (interleukin-6, interleukin-7, interleukin-8, interferon-α2a, interferon-β, interleukin-1 receptor antagonist) discriminated between patients with mild and severe disease, although most were similar or only modestly raised above that seen in healthy volunteers. A similar proportion of patients with mild or severe disease had detectable spike protein or nucleocapsid protein immunoglobulin G antibodies with equivalent levels between groups. Neutralization titers were higher among patients with severe disease.

CONCLUSIONS:

Some therapeutic and prognostic biomarkers may be useful in identifying coronavirus disease 2019 patients who may benefit from specific immunomodulatory therapies, particularly interleukin-6. However, biomarker absolute values often did not discriminate between patients with mild and severe disease or death, implying that these immunomodulatory treatments may be of limited benefit.
Transthyretin Cardiac Amyloidosis and Novel Therapies to Treat This Not-so-rare Cause of Cardiomyopathy
Authors: Capustin Matthew , Frishman William H.
Published: August 2021

Transthyretin cardiac amyloidosis (ATTR-CA) is typically a late-onset disease caused by the deposit of transthyretin amyloid fibrils throughout the heart. When this occurs, various cardiac sequelae can develop, including hypotension, conduction abnormalities, and valvular lesions. The cardiomyopathy caused by ATTR-CA (ATTR-CM) has proven difficult to treat. Until recently, symptomatic management was the only therapeutic option, and many therapies used to treat congestive heart failure were ineffective or even detrimental to patients with ATTR-CM. In addition, treatment was limited to heart and liver transplantation. As a result, prognosis was poor. Recently, a few drug therapies have come to light as potential treatment modalities for ATTR-CM, most notably tafamidis, sold under the brand names Vyndaqel and Vyndamax. After the phase III Transthyretin Amyloidosis Cardiomyopathy trial displayed the drug’s efficacy, it was given breakthrough therapy designation and was approved by the Food and Drug Administration on May 6, 2019, for the treatment of ATTR-CA. This novel therapy, as well as various other therapies in the pipeline, such as inotersen and patisiran, provide hope where, until recently, there was little. Unfortunately, the exorbitant cost of these new therapies may present a barrier to long-term treatment for some patients. However, by further improving diagnostic algorithms and incorporating these new treatments into our existing therapeutic modalities, patients with ATTR-CA should be able to live far longer than previously expected. Finally, further research combining these novel treatment modalities must be done, as they may prove to be additive or even synergistic in their treatment of ATTR amyloidosis.
Analysis of 30 anaesthesia-related deaths in Germany between 2006 and 2015
Authors: Koppenberg Joachim , Stoevesandt Dietrich , Watzke Stefan , Schwappach David , Bucher Michael
Published: August 2021

BACKGROUND

Anaesthesiology is one of the safest fields in medicine today in relation to mortality. Deaths directly because of anaesthesia have fortunately now become rare exceptions. Nevertheless, important findings can still be drawn from the rare deaths that still occur.

OBJECTIVE

The aim of this study was to identify and analyse the causes of deaths related to anaesthesia alone over a 10-year period.

DESIGN

Retrospective structured analysis of a database of medical liability claims.

SETTING

Hospitals at all levels of care in Germany.

PATIENTS

The database of a large insurance broker included data for 81 413 completed liability claims over the 10-year period from 2006 to 2015. Among 1914 cases associated with anaesthetic procedures, 56 deaths were identified. Of these, 30 clearly involved anaesthesia (Edwards category 1) and were included in the evaluation.

INTERVENTIONS

None (retrospective database analysis).

MAIN OUTCOME MEASURES

Causes of anaesthesia-related death identified from medical records, court records, expert opinions and autopsy reports.

RESULTS

The 30 deaths were analysed in detail at the case and document level. They included high proportions of ‘potentially avoidable’ deaths, at 86.6%, and what are termed ‘never events’, at 66.7%. Problems with the airway were the cause in 40% and problems with correct monitoring in 20%. In addition, communication problems were identified as a ‘human factor’ in 50% of the cases.

CONCLUSION

The majority of the anaesthesia-related deaths investigated could very probably have been avoided with simple anaesthesiological measures if routine guidelines had been followed and current standards observed. Actions to be taken are inferred from these results, and recommendations are made. In future, greater care must be taken to ensure that the level of safety already achieved in anaesthesiology can be maintained despite demographic developments and increasing economic pressures.
Inclination Angle in Greenstick Fracture of Mandibular Subcondyle Treated with Intermaxillary Fixation in an Elderly Patient
Authors: Hwang Kun , Ma Sung Hwan
Published: August 2021

This study presents the outcomes of a conservative approach to greenstick condylar fracture treatment in an elderly patient. Serial changes of the inclination angle were measured in a greenstick fracture of the mandibular subcondyle treated with intermaxillary fixation (IMF). A 64-year-old woman presented to an outpatient clinic complaining of pain on her chin. While waiting for an elevator, she lost consciousness and hit her face on the floor. She had a limited mouth-opening of 13 mm. Panoramic radiography and computed tomography confirmed a greenstick (incomplete) fracture of the left condyle, in which the lateral side of the bone was fractured and the medial side was bent. The medial inclination was approximately 40.4 degrees. On the second post-trauma day, IMF was performed using arch-bars and a prefabricated occlusal stop. Serial Towne’s views were taken. The inclination of the fractured condyle was measured and compared with the contralateral side. The difference in inclination angles (DI) between the fractured and contralateral sides was plotted over time. In SPSS version 19.0, an exponential regression model was constructed. In this patient, a greenstick (incomplete) fracture of the condyle (40.4 degree inclination) was treated with IMF and a pre-fabricated occlusal stop. On day 42 post-IMF, the inclination angle had decreased to 15.6 degrees, only 5.4 degrees greater than the contralateral side. The DI was fitted to exponential regression model (y = 25.111e−0.028x, P = 0.004). This case shows that even in an elderly patient, a greenstick fracture of the mandibular condyle can be treated by vertical lengthening using an occlusal stop and IMF.
Study of Frontal and Temporal Hairline Patterns in Japanese Subjects
Authors: Kashiyama Kazuya , Haraguchi Rina , Ban Fuko , Yoshida Daisaku , Fukuda Maimi , Date Naoto , Koga Koko , Koga Kazufumi , Tanaka Katsumi
Published: August 2021

Background:

The shape of the hairline is very important in a person’s identity and in determining the impression they make. Reports on the morphology of a normal hairline are still scarce. Differences in the shape of male and female hairlines in Japanese subjects are discussed in this study.

Methods:

A questionnaire about hairline type, the presence or absence of a widow’s peak, and measurement of the width and height of the forehead was given to 456 healthy subjects, and their responses were recorded.

Results:

Percentages of frontal hairline types were found to be linear (women 36.1%, men 45.9%), triangular (7.2%, 0.82%), round (38.5%, 10.7%), and M- shaped (18.2%, 42.6%). Temporal hairline types: inverted triangle (20.3%, 65.6%), inverted round (27.8%, 17.2%), straight (24.8%, 10.6%), and convex (27.2%, 6.6%). The incidence of a widow’s peak was 29.6% in women and 32.8% in men. The mean length of the mid-frontal line was 6.2 cm in women and 6.65 cm in men.

Conclusions:

Regarding the hairline morphology of the frontal view, two types (linear and M-shaped) accounted for 88.5% of men. In women, linear accounted for 36.1%, being relatively high, but lower than the frequency in men. Round accounted for 38.5%, being the highest. Regarding the temporal hairline, a hairless region (inverted triangle and inverted round) was noted in 82.8% of men. In women, a hairless region was present in 48.1% and was absent (straight and convex) in 51.9%. A temporal hairline with a hairless region was noted in the majority of men, whereas it was absent in slightly more cases in women.
Within-visit SBP variability from childhood to adulthood and markers of cardiovascular end-organ damage in mid-life
Authors: Meng Yaxing , Magnussen Costan G. , Wu Feitong , Buscot Marie-Jeanne , Juonala Markus , Pahkala Katja , Hutri-Kähönen Nina , Kähönen Mika , Laitinen Tomi , Viikari Jorma S.A. , Raitakari Olli T. , Sharman James E.
Published: August 2021

Background:

Within-visit SBP variability is associated with age and SBP, but its long-term clinical significance is unknown. We examined the association between child, adult, and life-time within-visit SBP variability with markers of end-organ damage using data from a 31-year longitudinal study.

Methods:

Within-visit SBP variability was calculated as the standard deviation of three sitting SBP readings among up to 3010 participants aged 6–18 years (childhood) who were re-measured up to seven times to mid-adulthood. Markers of cardiovascular end-organ damage in adulthood were carotid intima--media thickness, brachial flow-mediated dilatation, carotid distensibility, pulse wave velocity, left ventricular mass index, carotid plaque, and coronary artery calcification.

Results:

The mean (standard deviation) cumulative within-visit SBP variability was 2.7 (1.5) mmHg in childhood, 3.9 (1.9) mmHg in adulthood and 3.7 (1.5) mmHg across the observed life-time. Childhood within-visit SBP variability was not correlated with its subsequent values measured from 3 to 31 years later. With adjustment for age, sex, cumulative SBP, BMI and serum lipids, neither child, adult, or life-time cumulative within-visit SBP variability associated with markers of cardiovascular end-organ damage. However, higher child, adult, and life-time cumulative SBP significantly associated with higher carotid intima--media thickness, higher pulse wave velocity, lower brachial flow-mediated dilatation, lower carotid distensibility in adulthood.

Conclusion:

Within-visit SBP variability from childhood to adulthood does not provide additional predictive utility over SBP over the same period of the life course.
ANALYSIS OF TRANSFER LEARNING FOR SELECT RETINAL DISEASE CLASSIFICATION
Authors: Gelman Rony , Fernandez-Granda Carlos
Published: August 2021

Purpose:

To analyze the effect of transfer learning for classification of diabetic retinopathy (DR) by fundus photography and select retinal diseases by spectral domain optical coherence tomography (SD-OCT).

Methods:

Five widely used open-source deep neural networks and four customized simpler and smaller networks, termed the CBR family, were trained and evaluated on two tasks: 1) classification of DR using fundus photography and 2) classification of drusen, choroidal neovascularization, and diabetic macular edema using SD-OCT. For DR classification, the quadratic weighted Kappa coefficient was used to measure the level of agreement between each network and ground truth–labeled test cases. For SD-OCT–based classification, accuracy was calculated for each network. Kappa and accuracy were compared between iterations with and without use of transfer learning for each network to assess for its effect.

Results:

For DR classification, Kappa increased with transfer learning for all networks (range of increase 0.152–0.556). For SD-OCT–based classification, accuracy increased for four of five open-source deep neural networks (range of increase 1.8%–3.5%), slightly decreased for the remaining deep neural network (−0.6%), decreased slightly for three of four CBR networks (range of decrease 0.9%–1.8%), and decreased by 9.6% for the remaining CBR network.

Conclusion:

Transfer learning improved performance, as measured by Kappa, for DR classification for all networks, although the effect ranged from small to substantial. Transfer learning had minimal effect on accuracy for SD-OCT–based classification for eight of the nine networks analyzed. These results imply that transfer learning may substantially increase performance for DR classification but may have minimal effect for SD-OCT–based classification.
Laser-integrated real-time OCT in anterior segment procedures
Authors: Neuhann Raphael , Neuhann Tobias , Hörster Robert , Cursiefen Claus , Guell José , Siebelmann Sebastian
Published: August 2021

Intraoperative optical coherence tomography (OCT) was so far only available as a microscope-integrated or handheld device. Recently, this technology has been integrated into a femtosecond (FS) laser. This pilot study analyzed the potential of intraoperative imaging using OCT during FS-assisted procedures of the anterior eye segment. Therefore, intraoperatively acquired videos using FS-integrated intraoperative OCT (laser-integrated [LI] OCT) in 14 patients (Victus, Bausch & Lomb) were analyzed in different surgical procedures. The results showed that all surgical steps could be successfully visualized by LI-OCT. LI-OCT added important information regarding the depth and location of the incisions and dissection planes. Moreover, dynamic processes could be observed in real-time. LI-OCT represents a new imaging technology that makes it possible to visualize intraoperative steps during FS-assisted surgery. In the future, automatic image analysis based on artificial intelligence could be helpful to detect complications at an early stage and to automatically stop the laser process in relevant constellations.
Repeatability and agreement of wavefront aberrations of a new hybrid topographer and aberrometer in healthy eyes
Authors: Shetty Rohit , Trivedi Divya , Ranade Reshma , Arun Spriha , Khamar Pooja , Kundu Gairik
Published: August 2021

Purpose:

To assess repeatability and agreement of the Pentacam AXL Wave with that of the iTrace aberrometer.

Setting:

Narayana Nethralaya, Bangalore, India.

Design:

Prospective, cross-sectional study.

Methods:

All eyes of patients underwent 3 sets of measurements at a single visit, using Pentacam AXL Wave and iTrace. Lower-order aberrations (LOAs), higher-order aberrations (HOAs), and coma and spherical aberrations (SAs) were analyzed. Repeatability was assessed using within-subject (Sw) SD, test–retest variability (TRT), Sw coefficient of variation (CoV), and intraclass correlation coefficient (ICC). The Bland-Altman analysis was used to assess 95% limits of agreement (LoA) and the correlation coefficient (r) to determine strength of relationship between measurements.

Results:

100 eyes of 100 patients underwent measurements. Pentacam AXL Wave had repeatability with an ICC for total ocular aberrations ranging from 0.84 for HOAs to 0.92 for LOAs and for corneal from 0.76 for HOAs to 0.86 for LOAs. The Sw, TRT, and CoV of all aberrations were significantly lower (better) than those of iTrace (P < .001). The mean differences between 2 devices were insignificant for the comparison of all parameters, except for spherical aberration (0.011 [0.002571 to 0.02008]; P = .01). Both devices showed excellent correlations for ocular aberrations (total HOAs [P = .12, LoA = −0.52 to 0.025; r = 0.89]; LOAs [P = .14, LoA = −2.71 to 2.61; r = 0.96]; coma [P = .27, LoA = −0.11 to 0.12; r = 0.89]; and SA [P = .01, LoA = −0.09 to 0.07; r = 0.97]).

Conclusions:

The repeatability estimates for wavefront aberrations using Pentacam AXL Wave were significantly better than those using iTrace. Both devices showed excellent correlations for total ocular aberrations.
International Survey of Operative Practices for Otologists and Neurotologists During the COVID-19 Crisis
Authors: Ridge Sarah E. , Chari Divya A. , Kozin Elliott D. , Remenschneider Aaron K. , Adunka Oliver F. , Aristegui Miguel , Chang Wai Tsz , Cheng Yen-Fu , Chung Jong Woo , Cohen Michael S. , Crowson Matthew G. , Golub Justin S. , Handzel Ophir , Isaacson Brandon , Iyer Arunachalam , Kakehata Seiji , Marchioni Daniele , Nogueira João Flávio , Patel Nirmal , Quesnel Alicia M. , Rivas Alejandro , Saeed Shakeel R. , Salzman Richard , Santos Felipe , Saxby Alexander J. , Tarabichi Muaaz , Verhaert Nicolas , Vincent Robert , Wanna George , Wolpert Stephan , Lee Daniel J.
Published: August 2021

Objective:

To investigate the influence of the COVID-19 pandemic on operative practices of otology and neurotology providers internationally.

Study Design:

Cross-sectional survey.

Methods:

A 78-question survey was distributed to otologists and neurotologists between May 12, 2020 and June 8, 2020 to assess the impact of the pandemic on surgical practices. Sections within the survey delineated time periods: prior to the crisis, onset of the crisis, during the crisis, postcrisis transition.

Results:

Of 396 survey respondents, 284 participants from 38 countries met inclusion criteria.

Respondents were 16.9% female and 82.4% male, with a most common age range of 40 to 49 years (36.3%). 69.8% of participants had been in practice for over 10 years and most respondents worked in an academic medical center (79.2%). The average operative weekly caseload was 5.3 (SD 3.9) per surgeon prior to the crisis, 0.7 (SD 1.2) during the COVID-19 crisis, and 3.5 (SD 3.3) for those who had begun a postcrisis transition at the time of survey administration (p < 0.001). 71.5% of providers did not perform an elective otologic or neurotologic operative procedure during the initial crisis period. 49.8% reported modifying their surgical technique due to the COVID-19 pandemic. Use of powered air-purifying respirators and filtering facepiece 2 or 3 (FFP2/FFP3) respirators were in minimal supply for 66.9% and 62.3% of respondents, respectively.

Conclusion:

The COVID-19 pandemic impacted the otology and neurotology community globally, resulting in significant changes in operative volume and case selection. Modification of surgical technique and shortages of personal protective equipment were frequently reported.
Cost-effectiveness of thrombotic thrombocytopenic purpura diagnosis: a retrospective analysis in the University Hospital Center of Lyon (France)
Authors: Jousselme Emilie , Sobas Frédéric , Guerre Pascale , Simon Marie , Nougier Christophe
Published: August 2021

The aim of the present study was to perform an economic evaluation of two alternative assays of ADAMTS13 activity (A Disintegrin And Metalloprotease with ThromboSpondin type 1 repeats, member 13) for diagnosing thrombotic thrombocytopenic purpura (TTP) in the Hospital of Lyon (France). The study approach was more economic than clinical. We retrospectively calculated the prescription costs of ADAMST13 activity from January to December 2019 for patients depending on the assay: manual ELISA (Technozym) or automated assay (AcuStar Werfen, Instrumentation Laboratory). Then, we compared the cost of therapeutic plasma exchange (TPE) consumption awaiting ADAMTS13 activity assay results. From an economic point of view, the automated assay was more cost-effective. From a clinical one, we supposed that the faster results given by AcuStar could improve patient care by reducing the number of TPEs. Automated assay could improve patient care without increasing costs in our institution.
Clinical study of invasive pulmonary aspergillosis following influenza A H1N1
Authors: Liu Yi , Xie Zuo-Zhou , Wang Xiang , Zhu Zheng-Hua , Yang Chen
Published: August 2021

This study to analyze the clinical characteristics of patients with invasive pulmonary aspergillosis (IPA) following influenza A (H1N1) infection.

We retrospectively analyzed 10 cases with IPA following H1N1 infection. The clinical manifestations, laboratory examination results, chest computed tomography, and treatments were analyzed.

Clinical manifestations: all 10 cases had typical flu-like symptoms at the onset of the disease, among which 7 patients developed dyspnea in the late stage, and 8 patients had hemoptysis. Laboratory examination: the absolute and percentage of peripheral blood lymphocytes in all 10 patients were declined, among which 5 cases were with decreased CD3+ CD4+ T cells/lymphocytes; 9 cases with increased bronchoalveolar lavage fluid galactomannan; 6 cases with increased serum galactomannan; 1 case with bronchoalveolar lavage fluid cultured aspergillus fumigatus; and 2 cases with aspergillus by second-generation sequencing. Chest computed tomography: all patients showed multiple diffused ground-glass opacities at the beginning, along with linear or reticular interstitial changes. Two cases had multiple subarachnoid nodules with halo signs, 3 cases had consolidation in multiple segments of both lungs, 2 cases had cavities, and 4 cases were with pleural effusion. Treatment: 10 patients were treated with antiviral and anti-Aspergillus drugs after admission. Four patients received respiratory support. All 10 cases were cured and discharged.

Early diagnosis of IPA in influenza A (H1N1) patients is the key to successful treatment.
Expression and clinical significance of AURKB gene in lung adenocarcinoma
Authors: Gao Xiaoyan , Jiang Aigui , Shen Yahui , Lu Huiyu , Chen Rong
Published: August 2021

This study aimed to investigate the expression and clinical significance of aurora B kinase (AURKB) gene in lung adenocarcinoma (LUAD) by collecting relevant data in Oncomine database.

Firstly, mRNA expression level of AURKB in LUAD was systematically analyzed using the ONCOMINE and the cancer genome atlas databases. Then, the association between AURKB expression and clinical parameters was investigated by UALCAN. The Kaplan–Meier Plotter was used to assess the prognostic significance of AURKB.

Pooled analysis showed that AURKB was frequently up-regulated expression in LUAD. In addition, immunohistochemistry showed that AURKB was highly expressed in lung adenocarcinoma tissues, while it was weakly expressed in normal tissues. Subsequently, AURKB expression was identified to be negatively associated with Overall survival (P < 1e−16), post-progression survival (P = .017), first progression (P = 9.8e−09).

This study confirms that increased expression of AURKB in LUAD is associated with poor prognosis, suggesting that AURKB might be used as a promising prognostic biomarker and novel therapeutic target for LUAD.
Long-term cardiac remodeling associated with heart failure following left-ventricular valve replacement surgery
Authors: Chen Mengyuan , Yao Xin , Wang Daowen , Li Chenze , Ma Fei , Li Rui , Wang Hong , Wei Sheng , Zhou Qiang
Published: August 2021

To investigate long-term cardiac remodeling and prognosis of patients post-left-ventricular valve replacement, and explored related risk factors of heart failure and management strategies.

Retrospective cohort of patients with left-ventricular valve replacement between 2005 and 2007. Major adverse cardiac events were recorded, including death, hospitalization, stroke, and New York Heart Association (NYHA) functional classifications. Cardiac remodeling was assessed by comparing pre-operative, post-operative, and follow-up echocardiographic images.

LA enlargement and TR after left-ventricular valve replacement surgery were time-dependent events, which represented cardiac remodeling and were closely related to post-operative long-term consequences of heart failure. It is important to be cognizant of and to explore long-term preventive and treatment strategies for adverse cardiac events in patients following left-ventricular valve replacement.
Effectiveness of bisphosphonates on bone mineral density in osteopenic postmenopausal women
Authors: Dong Su-li , Jiao Yongqiang , Yang Hai-liang
Published: August 2021

Background:

Various bisphosphonate agents have been proven to be effective in preventing bone loss and fracture in osteopenic postmenopausal women. This study was designed to compare the effectiveness of various BPs on preventing the loss of bone mineral density (BMD) for postmenopausal women with osteopenia.

Methods:

PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were screened up to identify randomized controlled trails comparing effectiveness of BPs or placebo on the BMD of postmenopausal women with osteopenia. Network meta-analysis and standard pair-wise meta-analyses were performed. The main outcomes include the percentage changes of 6-, 12-, 24-, and 36-month BMD at lumbar, total hip and femoral neck, and frequencies of new fractures and severe adverse events.

Results:

Fourteen randomized controlled trials were eligible, involving 11,540 participants. No significant difference was presented among the available interventions for the 6-month BMD at 3 different sites, but the magnitudes of differences among the treatment regimens became gradually increased along with the extending of follow-up periods. Daily aledronate of more than 5 mg provided the maximal percentage increase on BMD of femoral neck and lumbar spine, while zoledronate provided maximal change on BMD of total hip, at different follow-up periods. This network meta-analysis also demonstrated similar frequencies of new clinical fractures and severe adverse events among different interventions.

Conclusions:

A ranking spectrum depicting the effectiveness on BMD percentage change following interventions with different bisphosphonate regimens was provided. Generally, regimens with zoledronate and aledronate were found to be the most effective interventions in the 3 sites at different end points.
Screening cardiovascular risk factors of diabetes patients in the primary diabetes clinics
Authors: An Lingwang , Wang Yanlei , Cao Chenxiang , Chen Tao , Zhang Yonghong , Chen Linhui , Ren Shuhong , Tang Manni , Ma Fenglian , Li Xianglan , Yuan Shuang , Zhao Wenhui , Lee Yaujiunn , Xiao Jianzhong
Published: August 2021

To evaluate the atherosclerotic cardiovascular diseases (ASCVD) risk factors in type 2 diabetes patients from the primary diabetes clinics for further comprehensive intervention in China.

A cross-sectional study was conducted in 5 primary diabetes chain hospitals in Beijing, Lanzhou, Harbin, Chengdu, and Taiyuan in continuous patients with type 2 diabetes from March 2016 to December 2019. The data collected at the first visit were analyzed, and proportions of patients reached the targets (glycosylated hemoglobin [HbA1c] < 7%, blood pressure < 130/80 mm Hg, and low-density lipoprotein cholesterol [LDL-C] < 2.6mmol/l) were calculated. The clinical characteristics and the associated factors with achievement in HbA1c, blood pressure, and LDL-C targets were analyzed.

A total of 20,412 participants, including 11,353 men (55.6%), with an average age of (59.4 ± 10.4) years were enrolled. Nearly 95% diabetes had one or more ASCVD risk factors other than hyperglycemia. The control rates of HbA1c, blood pressure, and LDL-C were 26.5%, 27.8%, and 42.6%, respectively. Only 4.1% patients achieved all 3 targets. Nearly 95% patients had one or more ASCVD risk factors other than hyperglyciemia. Diabetes duration, family history, and overweight/obesity were associated with the number of aggregated ASCVD risk factors. The patients with older age, no overweight/obesity, not smoking, less ASCVD risk factors, and having special diabetes care insurance (Chengdu) were associated with a higher control rates.

To deal with poor control status, global management of ASCVD risk factors, weight loss, and smoking cessation must be emphasized in the primary diabetes care settings. Special diabetes care insurance should be advocated.

Current ClinicalTrial.gov protocol ID NCT03707379. Date of Registration: October 16, 2018. https://clinicaltrials.gov.
Association between chronic pain medications and the severity and mortality of COVID-19
Authors: Serrano Afonso Andrés Ancor , Pérez Hernández Concepción , Ochoa Mazarro Dolores , Román Martínez Manuel , Failde Martínez Inmaculada , Montes Pérez Antonio , López Pais Pablo , Cánovas Martínez Luz , Revuelta Rizo Miren , Padilla del Rey María Luz , Peiró Perió Ana , Aberasturi Fueyo Teresa , Margarit Ferrí César , Rojo Rodríguez Elena , Mendiola de la Osa Agustín , Muñoz Martinez Manuel José , Domínguez Bronchal María Jesús , Herrero Trujillano Manuel , Cid Calzada José , Fabregat-Cid Gustavo , Hernández-Cádiz María José , Mareque Ortega Manuel , Gómez-Caro Álvarez Palencia Leticia , Mayoral Rojals Víctor
Published: August 2021

In patients with coronavirus disease 2019 (COVID-19) infection, common drugs may exacerbate symptoms and negatively impact outcomes. However, the role of chronic medications on COVID-19 effects remains poorly understood. We hypothesized that certain chronic pain medications would influence outcomes in patients with COVID-19.

The main aim is to assess the effect of these medications on the course of the disease in COVID-19 patients. Secondary aims are to compare disease severity and outcomes in patients with COVID-19 receiving chronic treatment with analgesics or other medications versus untreated patients and to determine prevalence of chronic pain medications in specific subgroups of hospitalized patients for COVID-19.

Multicenter case-population study in 15 care centers for patients ≥18 years of age diagnosed and hospitalized with COVID-19. Controls will include patients treated at participating centers for chronic pain during the six-month period prior to March 15th, 2020. Each case will be age- and sex-matched to 10 controls. Patients will be grouped according to disease severity criteria. The primary outcome measures in patients admitted for COVID-19 will be:

Secondary outcome measures include:

Patients and controls will be paired by age, sex, and geographic residence. Odds ratios with 95% confidence intervals will be calculated to determine the association between each drug and clinical status. Univariate and multivariate analyses will be performed.

This is a study protocol. Data is actually being gathered and results are yet not achieved. There is no numerical data presented, so the conclusions cannot be considered solid at this point.

Pain medications are likely to influence severity of COVID-19 and patient survival. Identifying those medications that are most closely associated with severe COVID-19 will provide clinicians with valuable data to guide treatment and reduce mortality rates and the long-term sequelae of the disease.
Relationship between statins and the risk of amyotrophic lateral sclerosis
Authors: Chang Min Cheol , Kwak Sang Gyu , Park Jin-Sung , Park Donghwi
Published: August 2021

Objective:

Previous studies on overlapping surveillance databases have suggested that statin use was associated with the development of amyotrophic lateral sclerosis (ALS)-like syndrome. However, the association between statin use and ALS incidence has not been clearly elucidated. To further explore this issue, we performed a systemic review and meta-analysis of all available clinical studies on the association between statin use and ALS incidence.

Methods:

A comprehensive database search on PubMed, Embase, Cochrane Library, and SCOPUS was conducted. We included studies up to January 31, 2020 that fulfilled our inclusion and exclusion criteria. Statin use between the ALS and control groups was collected for the meta-analysis.

Results:

Three case-control studies and 1 cohort study, that related the risk of ALS to statin use, satisfied the inclusion criteria for the meta-analysis. There was no statistically significant difference in statin use between the ALS and control groups (odds ratio, 0.75 [95% confidence interval, 0.53–1.08]).

Conclusion:

No definite association was found between statin use and the development of ALS. Further large-scale prospective randomized control studies are necessary to draw definite conclusions.