bluuebunny/crossref_metadata_2025 huggingface dataset:
Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study
Authors: Jouffroy Romain , Léguillier Teddy , Gilbert Basile , Tourtier Jean Pierre , Bloch-Laine Emmanuel , Ecollan Patrick , Bounes Vincent , Boularan Josiane , Gueye-Ngalgou Papa , Nivet-Antoine Valérie , Beaudeux Jean-Louis , Vivien Benoit
Published: October 2020

Background: Assessment of disease severity in patients with septic shock (SS) is crucial in determining optimal level of care. In both pre- and in-hospital settings, the clinical picture alone is not sufficient for assessing disease severity and outcomes. Because blood lactate level is included in the clinical criteria of SS it should be considered to improve the assessment of its severity. This study aims to investigate the relationship between pre-hospital blood lactate level and 30-day mortality in patients with SS. Methods: From 15 April 2017 to 15 April 2019, patients with SS requiring pre-hospital Mobile Intensive Care Unit intervention (MICU) were prospectively included in the LAPHSUS study, an observational, non-randomized controlled study. Pre-hospital blood lactate levels were measured at the time of first contact between the patients and the MICU. Results: Among the 183 patients with septic shock requiring action by the MICU drawn at random from LAPHSUS study patients, six (3%) were lost to follow-up on the 30th day and thus 177 (97%) were analyzed for blood lactate levels (mean age 70 ± 14 years). Pulmonary, urinary and digestive infections were probably the cause of the SS in respectively 58%, 21% and 11% of the cases. The 30-day overall mortality was 32%. Mean pre-hospital lactatemia was significantly different between patients who died and those who survived (respectively 7.1 ± 4.0 mmol/L vs. 5.9 ± 3.5 mmol/L, p < 10−3). Using Cox regression analysis adjusted for potential confounders we showed that a pre-hospital blood lactate level ≥ 4 mmol/L significantly predicted 30-day mortality in patients with SS (adjusted hazard ratio = 2.37, 95%CI (1.01–5.57), p = 0.04). Conclusion: In this study, we showed that pre-hospital lactatemia predicts 30-day mortality in patients with septic shock handled by the MICU. Further studies will be needed to evaluate if pre-hospital lactatemia alone or combined with clinical scores could affect the triage decision-making process for those patients.
Percutaneous Endoscopic Gastrostomy and Nutritional Interventions by the Pediatric Nutritional Support Team Improve the Nutritional Status of Neurologically Impaired Children
Authors: Suh Chae-ri , Kim Wonkyung , Eun Baik-Lin , Shim Jung Ok
Published: October 2020

Aim: To evaluate the long-term effects of nutritional improvement following percutaneous endoscopic gastrostomy (PEG) tube feeding stratified by previous feeding method and to assess the impact of underlying muscle tone on the outcomes of the nutritional intervention. Methods: Neurologically impaired children who underwent PEG tube insertion and nutritional intervention provided by a pediatric nutritional support team were enrolled. We measured anthropometric variables, laboratory parameters, and nutritional intake at baseline, 6 months after PEG insertion, and the last visit. We evaluated the percent ideal body weight (PIBW), body mass index (BMI)-for-age z-score, and percentiles and calculated the ratios of calorie intake compared to required requirement (CIR) and protein intake compared to recommended requirement (PIR). Results: The PIBW and BMI-for-age z-score improved during the first 6 months (p = 0.003 and p = 0.005, respectively). The CIR (p = 0.015) and PIR (p = 0.004) increased during the study period. The baseline BMI and PIBW of the previous nasogastric tube feeding group were better than those of the oral feeding group (p = 0.02 and p = 0.03, respectively). The BMI-for-age z-score, PIBW, CIR, and PIR improved in the hypertonic group (p = 0.03, 0.02, 0.03, and 0.01, respectively). Conclusion: PEG tube feeding and active nutritional intervention improved the nutritional status of neurologically impaired children immediately after PEG insertion. The nutritional requirements might vary by the muscle tonicity.
Is There a Link between Bisphenol A (BPA), a Key Endocrine Disruptor, and the Risk for SARS-CoV-2 Infection and Severe COVID-19?
Authors: Zahra Aeman , Sisu Cristina , Silva Elisabete , De Aguiar Greca Sophie-Christine , Randeva Harpal S. , Chatha Kamaljit , Kyrou Ioannis , Karteris Emmanouil
Published: October 2020

Infection by the severe acute respiratory syndrome (SARS) coronavirus-2 (SARS-CoV-2) is the causative agent of a new disease (COVID-19). The risk of severe COVID-19 is increased by certain underlying comorbidities, including asthma, cancer, cardiovascular disease, hypertension, diabetes, and obesity. Notably, exposure to hormonally active chemicals called endocrine-disrupting chemicals (EDCs) can promote such cardio-metabolic diseases, endocrine-related cancers, and immune system dysregulation and thus, may also be linked to higher risk of severe COVID-19. Bisphenol A (BPA) is among the most common EDCs and exerts its effects via receptors which are widely distributed in human tissues, including nuclear oestrogen receptors (ERα and ERβ), membrane-bound oestrogen receptor (G protein-coupled receptor 30; GPR30), and human nuclear receptor oestrogen-related receptor gamma. As such, this paper focuses on the potential role of BPA in promoting comorbidities associated with severe COVID-19, as well as on potential BPA-induced effects on key SARS-CoV-2 infection mediators, such as angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2). Interestingly, GPR30 appears to exhibit greater co-localisation with TMPRSS2 in key tissues like lung and prostate, suggesting that BPA exposure may impact on the local expression of these SARS-CoV-2 infection mediators. Overall, the potential role of BPA on the risk and severity of COVID-19 merits further investigation.
Insights into the Procoagulant Profile of Patients with Systemic Lupus Erythematosus without Antiphospholipid Antibodies
Authors: Monzón Manzano Elena , Fernández-Bello Ihosvany , Justo Sanz Raúl , Robles Marhuenda Ángel , López-Longo Francisco Javier , Acuña Paula , Álvarez Román María Teresa , Jiménez Yuste Víctor , Butta Nora V.
Published: October 2020

We aimed to identify the key players in the prothrombotic profile of patients with systemic lupus erythematosus (SLE) not mediated by antiphospholipid antibodies, as well as the potential utility of global coagulation tests to characterize hemostasis in these patients. Patients with SLE without antiphospholipid antibodies and without signs of thrombosis were included. The kinetics of clot formation were determined by ROTEM®. Platelet activation markers were determined by flow cytometry. Thrombin generation associated with Neutrophil Extracellular Traps (NETs) and microparticles (MPs) was measured by calibrated automated thrombogram (CAT). The plasma levels of PAI-1 were also determined. ROTEM® showed a procoagulant profile in SLE patients. SLE patients had activated platelets and more leukocyte/platelet aggregates at basal conditions. The plasma PAI-1 and platelet aggregates correlated with several ROTEM® parameters. The thrombin generation associated withthe tissue factor (TF) content of MPs and with NETs was increased. Our results suggest the utility of global tests for studying hemostasis in SLE patients because they detect their procoagulant profile, despite having had neither antiphospholipid antibodies nor any previous thrombotic event. A global appraisal of hemostasis should, if possible, be incorporated into clinical practice to detect the risk of a thrombotic event in patients with SLE and to consequently act to prevent its occurrence.
Pre-Liver Transplant ROTEM™ Clot Lysis Index Is Associated with 30-Day Mortality, But Is Not a Measure for Fibrinolysis
Authors: Hartmann Matthias , Craciun Bogdan , Paul Andreas , Brenner Thorsten , Saner Fuat H.
Published: October 2020

Complex alterations of the coagulation system in end stage liver disease lead to an increased risk of bleeding and mortality. In the present study, we investigated; 1. the association of pre-liver transplant rotational thrombelastometry (ROTEM™) variables with bleeding as well as 30-day-mortality and 2. the underlying pathophysiology. After approval from the local ethics committee, rotational thrombelastometry variables, conventional laboratory coagulation values, MELD score (model of end-stage liver disease), red blood cell loss, blood product use, coagulation factors, underlying disease, and demographic data were retrospectively analysed. Pre-transplant thrombelastometry clot lysis index (CLI) and MELD were the only variables associated with mortality, bleeding and blood product use, respectively. Mortality was 4.2%, when CLI was <85%, and increased to 25.7% when the CLI was >95%. Multivariate analysis including CLI and MELD score identified the CLI as an independent and the best predictor of 30-day-mortality. Interestingly, the inhibition of fibrinolysis did neither affect CLI nor the association of the variable with mortality. Thus, fibrinolysis can be excluded as the reason for low CLI values. In conclusion, low CLI values measured before the beginning of liver transplantation are associated with reduced bleeding and mortality, but do not indicate fibrinolysis.
Transcriptomic Profile of Genes Encoding Proteins Involved in Pathogenesis of Sjögren’s Syndrome Related Xerostomia—Molecular and Clinical Trial
Authors: Błochowiak Katarzyna , Celichowski Piotr , Kempisty Bartosz , Iwanik Katarzyna , Nowicki Michał
Published: October 2020

Sjögren’s syndrome (SS) is characterized by xerostomia. We aimed to investigate and compare gene expressions in the labial salivary glands of SS patients with xerostomia SS (sicca) and without xerostomia SS (non-sicca) and of healthy subjects (HS) by means of microarray analysis, and to find genes involved in xerostomia. The study group comprised 11 SS patients (3 SS (sicca) and 8 SS (non-sicca)) and 9 HS. The relative gene expression changes were validated with RT-qPCR in the larger study group. Among the differently expressed genes belonging to the “secretion” ontology group with a fold change >2 and with a p value < 0.05, the Transmembrane P24 Trafficking Protein 10 (TMED10), Protein Disulfide Isomerase Family A Member 4 (PDIA4), Calnexin (CANX), Amyloid Beta Precursor Protein (APP), and Transmembrane BAX Inhibitor Motif Containing 6 (TMBIM6) gene expressions in both SS (sicca) and SS (non-sicca) groups were lower than in HS. Significant correlations were observed between TMED10, PDIA4, and CANX gene expression in SS (sicca) patients compared to the controls. There were no differences between the SS (sicca) and SS (non-sicca) study groups in the expression of the aforementioned genes. Results indicate their role in the endoplasmic reticulum system, their overlapping function and the loss of the APP neuroprotective function in xerostomia. It has a multifactorial origin and can be triggered by disturbances to the various signaling pathways in saliva secretion.
Effectiveness of Dry Needling for Myofascial Trigger Points Associated with Neck Pain Symptoms: An Updated Systematic Review and Meta-Analysis
Authors: Navarro-Santana Marcos J. , Sanchez-Infante Jorge , Fernández-de-las-Peñas César , Cleland Joshua A. , Martín-Casas Patricia , Plaza-Manzano Gustavo
Published: October 2020

Our aim was to evaluate the effect of dry needling alone as compared to sham needling, no intervention, or other physical interventions applied over trigger points (TrPs) related with neck pain symptoms. Randomized controlled trials including one group receiving dry needling for TrPs associated with neck pain were identified in electronic databases. Outcomes included pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion. The Cochrane risk of bias tool and the Physiotherapy Evidence Database (PEDro) score were used to assessed risk of bias (RoB) and methodological quality of the trials. The quality of evidence was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Between-groups mean differences (MD) and standardized mean differences (SMD) were calculated (3) Twenty-eight trials were finally included. Dry needling reduced pain immediately after (MD −1.53, 95% CI −2.29 to −0.76) and at short-term (MD −2.31, 95% CI −3.64 to −0.99) when compared with sham/placebo/waiting list/other form of dry needling and, also, at short-term (MD −0.51, 95% CI −0.95 to −0.06) compared with manual therapy. No differences in comparison with other physical therapy interventions were observed. An effect on pain-related disability at the short-term was found when comparing dry needing with sham/placebo/waiting list/other form of dry needling (SMD −0.87, 95% CI −1.60 to −0.14) but not with manual therapy or other interventions. Dry needling was effective for improving pressure pain thresholds immediately after the intervention (MD 55.48 kPa, 95% CI 27.03 to 83.93). No effect on cervical range of motion of dry needling against either comparative group was found. No between-treatment effect was observed in any outcome at mid-term. Low to moderate evidence suggests that dry needling can be effective for improving pain intensity and pain-related disability in individuals with neck pain symptoms associated with TrPs at the short-term. No significant effects on pressure pain sensitivity or cervical range of motion were observed.
Wedge-Shaped Implants for Minimally Invasive Treatment of Narrow Ridges: A Multicenter Prospective Cohort Study
Authors: Vercellotti Tomaso , Troiano Giuseppe , Oreglia Francesco , Lombardi Teresa , Gregorig Gianluca , Morella Emanuele , Rapani Antonio , Stacchi Claudio
Published: October 2020

The present study aims to investigate clinical and patient-centered outcomes after the implant-supported rehabilitation of narrow ridges using a novel wedge-shaped implant. Forty-four patients were treated with the insertion of 59 tissue-level wedge implants (1.8 mm bucco-lingual width) in horizontally atrophic ridges (mean bone width 3.8 ± 0.4 mm). The main outcome measures were: implant stability quotient (ISQ), marginal bone loss (MBL) and patient morbidity. Fifty-eight implants were functioning satisfactorily after one year of loading (98.3% survival rate). ISQ values measured in the mesio-distal direction resulted significantly higher than those in the bucco-lingual direction at all time points (p < 0.001). Both mesio-distal and bucco-lingual ISQ values at 6-month follow-up resulted significantly higher than at 4-month follow-up (p < 0.001 for both). Mean MBL was 0.38 ± 0.48 mm at prosthesis delivery (6 months after implant insertion) and 0.60 ± 0.52 mm after one year of functional loading. The majority of patients reported slight discomfort related to the surgical procedure. Postoperative pain score was classified as mild pain on the day of surgery and the first postoperative day and no pain over the following five days. Within the limitations of the present study, the device investigated showed low morbidity and positive short-term clinical results in narrow ridges treatment.
Interval Cancer Rate and Diagnostic Performance of Fecal Immunochemical Test According to Family History of Colorectal Cancer
Authors: Jung Yoon Suk , Lee Jinhee , Lee Hye Ah , Moon Chang Mo
Published: October 2020

Background: The potential role of the fecal immunochemical test (FIT) in individuals with a family history of colorectal cancer (CRC) remains unclear. We assessed interval cancer rate (ICR) after the FIT and FIT diagnostic performance according to family history of CRC. Methods: Using the Korean National Cancer Screening Program Database, we collected data on subjects who underwent the FIT between 2009 and 2011. The interval cancer rate (ICR) was defined as the number of subjects diagnosed with CRC within 1 year after the FIT per 1000 subjects with negative FIT results. Results: Of 5,643,438 subjects, 224,178 (3.97%) had a family history of CRC. FIT positivity rate (6.4% vs. 5.9%; adjusted relative risk (aRR) 1.11; 95% confidence interval (CI) 1.09–1.13) and ICR (1.4 vs. 1.1; aRR 1.43 (95% CI 1.27–1.60)) were higher in these subjects than in those with no such history. These results were the same regardless of whether subjects had undergone colonoscopy within the last 5 years before the FIT. However, the diagnostic performance of the FIT for CRC, as measured using the area under the operating characteristic curve, was similar between subjects without a family history and those with one (85.5% and 84.6%, respectively; p = 0.259). Conclusion: the FIT was 1.4 times more likely to miss CRC in subjects with a family history than in those without (aRR 1.43 for ICR), although its diagnostic performance was similar between the two groups. Our results suggest that for individuals with a family history of CRC, colonoscopy should be preferred over FIT for both screening and surveillance.
Deep Learning-Based Classification of Inherited Retinal Diseases Using Fundus Autofluorescence
Authors: Miere Alexandra , Le Meur Thomas , Bitton Karen , Pallone Carlotta , Semoun Oudy , Capuano Vittorio , Colantuono Donato , Taibouni Kawther , Chenoune Yasmina , Astroz Polina , Berlemont Sylvain , Petit Eric , Souied Eric
Published: October 2020

Background. In recent years, deep learning has been increasingly applied to a vast array of ophthalmological diseases. Inherited retinal diseases (IRD) are rare genetic conditions with a distinctive phenotype on fundus autofluorescence imaging (FAF). Our purpose was to automatically classify different IRDs by means of FAF images using a deep learning algorithm. Methods. In this study, FAF images of patients with retinitis pigmentosa (RP), Best disease (BD), Stargardt disease (STGD), as well as a healthy comparable group were used to train a multilayer deep convolutional neural network (CNN) to differentiate FAF images between each type of IRD and normal FAF. The CNN was trained and validated with 389 FAF images. Established augmentation techniques were used. An Adam optimizer was used for training. For subsequent testing, the built classifiers were then tested with 94 untrained FAF images. Results. For the inherited retinal disease classifiers, global accuracy was 0.95. The precision-recall area under the curve (PRC-AUC) averaged 0.988 for BD, 0.999 for RP, 0.996 for STGD, and 0.989 for healthy controls. Conclusions. This study describes the use of a deep learning-based algorithm to automatically detect and classify inherited retinal disease in FAF. Hereby, the created classifiers showed excellent results. With further developments, this model may be a diagnostic tool and may give relevant information for future therapeutic approaches.
Self-Reported Practices in Opioid Management of Chronic Noncancer Pain: An Updated Survey of Canadian Family Physicians
Authors: Furlan Andrea D. , Diaz Santana , Carol Angela , MacDougall Peter , Allen Michael
Published: October 2020

Chronic pain affects one in five Canadians, and opioids continue to be prescribed to 12.3% of the Canadian population. A survey of family physicians was conducted in 2010 as a baseline prior to the release of the Canadian Opioid Guideline. We repeated the same survey with minor modifications to reflect the updated 2017 opioid prescribing guideline. The online survey was distributed in all provinces and territories in both English and French. There were 265 responses from May 2018 to October 2019, 55% of respondents were male, 16% had advanced training in pain management, 51% had more than 20 years in practice, 54% wrote five or fewer prescriptions of opioids per month, and 58% were confident in their skills in prescribing opioids. Of the 11 knowledge questions, only two were correctly selected by more than 80% of the respondents. Twenty-nine physicians (11%) do not prescribe opioids, and the main factor affecting their decisions were concerns about long-term adverse effects and lack of evidence for effectiveness of opioids in chronic noncancer pain. Of the 12 guideline-concordant practices, only two were performed regularly by 90% or more of the respondents: explain potential harms of long-term opioid therapy and beginning dose of less than 50 mg of morphine equivalent daily. This survey represents a small proportion of family physicians in Canada and its generalizability is limited. However, we identified a number of opioid-related and guideline-specific gaps, as well as barriers and enablers to prescribing opioids and adhering to the guideline.
Estimating Minimal Clinically Important Differences for Knee Range of Motion after Stroke
Authors: Guzik Agnieszka , Drużbicki Mariusz , Wolan-Nieroda Andżelina , Turolla Andrea , Kiper Pawel
Published: October 2020

The importance of knee sagittal kinematic parameters, as a predictor of walking performance in post-stroke gait has been emphasised by numerous researchers. However, no studies so far were designed to determine the minimal clinically important differences (MCID), i.e., the smallest difference in the relevant score for the kinematic gait parameters, which are perceived as beneficial for patients with stroke. Studies focusing on clinically important difference are useful because they can identify the clinical relevance of changes in the scores. The purpose of the study was to estimate the MCID for knee range of motion (ROM) in the sagittal plane for the affected and unaffected side at a chronic stage post-stroke. Fifty individuals were identified in a database of a rehabilitation clinic. We estimated MCID values using: an anchor-based method, distribution-based method, linear regression analysis and specification of the receiver operating characteristic (ROC) curve. In the anchor-based study, the mean change in knee flexion/extension ROM for the affected/unaffected side in the MCID group amounted to 8.48°/6.81° (the first MCID estimate). In the distribution-based study, the standard error of measurement for the no-change group was 1.86°/5.63° (the second MCID estimate). Method 3 analyses showed 7.71°/4.66° change in the ROM corresponding to 1.85-point change in the Barthel Index. The best cut-off point, determined with ROC curve, was the value corresponding to 3.9°/3.8° of change in the knee sagittal ROM for the affected/unaffected side (the fourth MCID estimate). We have determined that, in chronic stroke, MCID estimates of knee sagittal ROM for the affected side amount to 8.48° and for the unaffected side to 6.81°. These findings will assist clinicians and researchers in interpreting the significance of changes observed in kinematic sagittal plane parameters of the knee. The data are part of the following clinical trial: Australian New Zealand Clinical Trials Registry: ACTRN12617000436370
Restaging Transurethral Resection of Bladder Tumours after BCG Immunotherapy Induction in Patients with T1 Non-Muscle-Invasive Bladder Cancer Might not Be Associated with Oncologic Benefit
Authors: Krajewski Wojciech , Moschini Marco , Nowak Łukasz , Poletajew Sławomir , Tukiendorf Andrzej , Afferi Luca , Teoh Jeremy , Muilwijk Tim , Joniau Steven , Tafuri Alessandro , Antonelli Alessandro , Gozzo Alessandra , Mari Andrea , Di Trapani Ettore , Hendricksen Kees , Alvarez-Maestro Mario , Serrano Andrea Rodriguez , Simone Giuseppe , Zamboni Stefania , Simeone Claudio , Marconi Maria Cristina , Mastroianni Riccardo , Ploussard Guillaume , Rajwa Paweł , Laukhtina Ekaterina , Zdrojowy-Wełna Aleksandra , Kołodziej Anna , Paradysz Andrzej , Tully Karl , Krajewska Joanna , Piszczek Radosław , Xylinas Evanguelos , Zdrojowy Romuald
Published: October 2020

Background and Purpose: The European Association of Urology guidelines recommend restaging transurethral resection of bladder tumours (reTURB) 2–6 weeks after primary TURB. However, in clinical practice some patients undergo a second TURB procedure after Bacillus Calmette-Guérin immunotherapy (BCG)induction. To date, there are no studies comparing post-BCG reTURB with the classic pre-BCG approach. The aim of this study was to assess whether the performance of reTURB after BCG induction in T1HG bladder cancer is related to potential oncological benefits. Materials and Methods: Data from 645 patients with primary T1HG bladder cancer treated between 2001 and 2019 in 12 tertiary care centres were retrospectively reviewed. The study included patients who underwent reTURB before BCG induction (Pre-BCG group: 397 patients; 61.6%) and those who had reTURB performed after BCG induction (Post-BCG group: 248 patients, 38.4%). The decision to perform reTURB before or after BCG induction was according to the surgeon’s discretion, as well as a consideration of local proceedings and protocols. Due to variation in patients’ characteristics, both propensity-score-matched analysis (PSM) and inverse-probability weighting (IPW) were implemented. Results: The five-year recurrence-free survival (RFS) was 64.7% and 69.1% for the Pre- and Post-BCG groups, respectively, and progression-free survival (PFS) was 82.7% and 83.3% for the Pre- and Post-BCG groups, respectively (both: p > 0.05). Similarly, neither RFS nor PFS differed significantly for a five-year period or in the whole time of observation after the PSM and IPW matching methods were used. Conclusions: Our results suggest that there might be no difference in recurrence-free survival and progression-free survival rates, regardless of whether patients have reTURB performed before or after BCG induction.
Targeting Endothelial Cell Metabolism by Inhibition of Pyruvate Dehydrogenase Kinase and Glutaminase-1
Authors: Schoonjans Céline A. , Mathieu Barbara , Joudiou Nicolas , Zampieri Luca X. , Brusa Davide , Sonveaux Pierre , Feron Olivier , Gallez Bernard
Published: October 2020

Targeting endothelial cell (EC) metabolism should impair angiogenesis, regardless of how many angiogenic signals are present. The dependency of proliferating ECs on glucose and glutamine for energy and biomass production opens new opportunities for anti-angiogenic therapy in cancer. The aim of the present study was to investigate the role of pyruvate dehydrogenase kinase (PDK) inhibition with dichloroacetate (DCA), alone or in combination with the glutaminase-1 (GLS-1) inhibitor, Bis-2-(5-phenylacetamido-1,3,4-thiadiazol-2-yl) ethyl sulfide (BPTES), on Human umbilical vein endothelial cells (HUVECs) metabolism, proliferation, apoptosis, migration, and vessel formation. We demonstrated that both drugs normalize HUVECs metabolism by decreasing glycolysis for DCA and by reducing glutamate production for BPTES. DCA and BPTES reduced HUVECs proliferation and migration but have no impact on tube formation. While DCA increased HUVECs respiration, BPTES decreased it. Using both drugs in combination further reduced HUVECs proliferation while normalizing respiration and apoptosis induction. Overall, we demonstrated that DCA, a metabolic drug under study to target cancer cells metabolism, also affects tumor angiogenesis. Combining DCA and BPTES may reduce adverse effect of each drug alone and favor tumor angiogenesis normalization.
Pancreatitis Associated with Viral Hepatitis: Systematic Review
Authors: Panic Nikola , Mihajlovic Sladjana , Vujasinovic Miroslav , Bulajic Milutin , Löhr Johannes-Matthias
Published: October 2020

Background: We conducted a systematic review in order to summarize the available data on pancreatitis associated with viral hepatitis. Methods: A comprehensive literature search of Medline, Scopus and ISI Web of Science databases was conducted and papers eligible for the inclusion identified. Results: In total, 46 studies reporting data on 73 patients were included in the analysis. Most of the cases were diagnosed in Asia (57.53%), followed by North America (23.29%), and Europe (13.70%). Most of the patients were affected by hepatitis A virus (HAV) (42.47%), followed by hepatitis E virus (HEV) (28.77%), hepatitis B virus (HBV) (8.22%), and hepatitis C virus (HCV) (1.37%), while 17.81% at the time of diagnosis were classified as affected by “hepatitis virus”. Pancreatitis was severe in 32.88% of cases. The respiratory system was affected in 2.74% of patients, 6.85% experienced renal failure, while 5.48% experienced a multiorgan dysfunction syndrome (MODS). Four patients (5.48%) needed pancreatic surgery. Despite the treatment, 21.92% of patients died. We identified fulminant hepatitis (p < 0.0001), MODS (p < 0.0001) and severe pancreatitis (p < 0.0001) to be significantly more present in patients who died in comparison to cured ones. Conclusion: Increased awareness of pancreatic involvement in viral hepatitis is needed because it can have a substantial impact on therapeutic approaches and outcomes.
Winter Exercise and Speleotherapy for Allergy and Asthma: A Randomized Controlled Clinical Trial
Authors: Freidl Johanna , Huber Daniela , Braunschmid Herbert , Romodow Carina , Pichler Christina , Weisböck-Erdheim Renate , Mayr Michaela , Hartl Arnulf
Published: October 2020

(1) Background: The prevalence of allergic respiratory diseases is still rising and efforts towards holistic treatments should be made. Although speleotherapy is widely applied in Europe to treat chronic airway diseases, the existing scientific evidence is rather low. Recreational winter exercise has been shown to improve allergic airway inflammation, but little is known about the combined effects of speleotherapy and recreational winter exercise. (2) Methods: In this clinical study we investigated the effects of winter exercise and speleotherapy on adults with allergic rhinitis and/or asthma. The speleotherapy group (n = 23) participated in a ten-day combined winter exercise and speleotherapy program and the exercise group (n = 18) joined a full-day winter sports program. The effects on allergic airway inflammation, quality of life, spirometry and cardiorespiratory fitness were assessed. (3) Results: No significant effects were found for fractional exhaled nitric oxide or nasal nitric oxide. Quality of life (p < 0.001 time effect) and allergic symptoms (p < 0.001 time effect) were improved in the speleotherapy and in the exercise group. (4) Conclusions: Winter exercise alone and winter exercise in combination with speleotherapy improve quality of life and allergic symptoms in adults with allergic rhinitis and/or asthma. Further studies are required to investigate the specific effects of speleotherapy. To our knowledge, this is the first investigation examining speleotherapy in combination with winter exercise. Recreational outdoor winter exercise and speleotherapy may be recommended for highly functioning patients with good disease control.
Diagnostic Power of Galectin-3 in Rheumatic Diseases
Authors: Gruszewska Ewa , Cylwik Bogdan , Gińdzieńska-Sieśkiewicz Ewa , Kowal-Bielecka Otylia , Mroczko Barbara , Chrostek Lech
Published: October 2020

Background: The purpose of our study was to assess the diagnostic power of galectin-3 and compare its between rheumatic diseases and with routinely used tests such as CRP and ESR. Methods: Eighty-two patients with rheumatoid arthritis (RA), 49 patients with systemic sclerosis (SSc), and 18 patients with systemic lupus erythematosus (SLE) were enrolled in this study. The control group comprised 30 healthy controls. Serum galectin-3 concentration was measured using immunochemical method. Results: The galectin-3 concentration were significantly elevated in the RA, SSc, and SLE in comparison to the controls (p = 0.000, p = 0.000, p < 0.001; respectively). However, there were no significant differences in the serum galectin-3 levels between rheumatic diseases (H = 0.395, p = 0.821). In RA and SSc patients, galectin-3 positively correlated with erythrocyte sedimentation rate (R = 0.332, p = 0.004; R = 0.384, p = 0.009; respectively). ROC analysis revealed that galectin-3 had an excellent diagnostic power in RA (AUC = 0.911) and SSc (AUC = 0.903) and very good for SLE (AUC = 0.859). Conclusion: We concluded that diagnostic power of serum galectin-3 is as great as CRP and ESR in rheumatic diseases and it can be a very good laboratory marker in RA and SSc patients and a useful tool in the diagnosis of SLE.
Scope of Artificial Intelligence in Screening and Diagnosis of Colorectal Cancer
Authors: Goyal Hemant , Mann Rupinder , Gandhi Zainab , Perisetti Abhilash , Ali Aman , Aman Ali Khizar , Sharma Neil , Saligram Shreyas , Tharian Benjamin , Inamdar Sumant
Published: October 2020

Globally, colorectal cancer is the third most diagnosed malignancy. It causes significant mortality and morbidity, which can be reduced by early diagnosis with an effective screening test. Integrating artificial intelligence (AI) and computer-aided detection (CAD) with screening methods has shown promising colorectal cancer screening results. AI could provide a “second look” for endoscopists to decrease the rate of missed polyps during a colonoscopy. It can also improve detection and characterization of polyps by integration with colonoscopy and various advanced endoscopic modalities such as magnifying narrow-band imaging, endocytoscopy, confocal endomicroscopy, laser-induced fluorescence spectroscopy, and magnifying chromoendoscopy. This descriptive review discusses various AI and CAD applications in colorectal cancer screening, polyp detection, and characterization.
Changes in Gene Expression Associated with Collagen Regeneration and Remodeling of Extracellular Matrix after Percutaneous Electrolysis on Collagenase-Induced Achilles Tendinopathy in an Experimental Animal Model: A Pilot Study
Authors: Sánchez-Sánchez José Luis , Calderón-Díez Laura , Herrero-Turrión Javier , Méndez-Sánchez Roberto , Arias-Buría José L. , Fernández-de-las-Peñas César
Published: October 2020

Percutaneous electrolysis is an emerging intervention proposed for the management of tendinopathies. Tendon pathology is characterized by a significant cell response to injury and gene expression. No study investigating changes in expression of those genes associated with collagen regeneration and remodeling of extracellular matrix has been conducted. The aim of this pilot study was to investigate gene expression changes after the application of percutaneous electrolysis on experimentally induced Achilles tendinopathy with collagenase injection in an animal model. Fifteen Sprague Dawley male rats were randomly divided into three different groups (no treatment vs. percutaneous electrolysis vs. needling). Achilles tendinopathy was experimentally induced with a single bolus of collagenase injection. Interventions consisted of 3 sessions (one per week) of percutaneous electrolysis or just needling. The rats were euthanized, and molecular expression of genes involved in tendon repair and remodeling, e.g., Cox2, Mmp2, Mmp9, Col1a1, Col3a1, Vegf and Scx, was examined at 28 days after injury. Histological tissue changes were determined with hematoxylin–eosin and safranin O analyses. The images of hematoxylin–eosin and Safranin O tissue images revealed that collagenase injection induced histological changes compatible with a tendinopathy. No further histological changes were observed after the application of percutaneous electrolysis or needling. A significant increase in molecular expression of Cox2, Mmp9 and Vegf genes was observed in Achilles tendons treated with percutaneous electrolysis to a greater extent than after just needling. The expression of Mmp2, Col1a1, Col3a1, or Scx genes also increased, but did not reach statistical significance. This animal study demonstrated that percutaneous electrolysis applied on an experimentally induced Achilles tendinopathy model could increase the expression of some genes associated with collagen regeneration and remodeling of extracellular matrix. The observed gene overexpression was higher with percutaneous electrolysis than with just needling.
Normative Database for All Retinal Layer Thicknesses Using SD-OCT Posterior Pole Algorithm and the Effects of Age, Gender and Axial Lenght
Authors: Palazon-Cabanes Ana , Palazon-Cabanes Begoña , Rubio-Velazquez Elena , Lopez-Bernal Maria Dolores , Garcia-Medina Jose Javier , Villegas-Perez Maria Paz
Published: October 2020

Our aim was to provide, for the first time, reference thickness values for the SD-OCT posterior pole algorithm (PPA) available for Spectralis OCT device (Heidelberg Engineering, Heidelberg, Germany) and to analyze the correlations with age, gender and axial length. We recruited 300 eyes of 300 healthy Caucasian subjects between 18 and 84 years. By PPA, composed of 64 (8 × 8) cells, we analyzed the thickness of the following macular layers: retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE), inner retina, outer retina and full retina. Mean ± SD, 1st, 5th, 95th percentiles were obtained for each cell at all macular layers. Significant negative correlations were found between age and thickness for most macular layers. The mean thickness of most macular layers was thicker for men than women, except for RNFL, OPL and RPE, with no gender differences. GCL, IPL and INL thicknesses positively correlated with axial length in central cells, and negatively in the cells near the optic disk. The mean RNFL thickness was positively associated with axial length. This is the first normative database for PPA. Age, gender and axial length should be taken into account when interpreting PPA results.
The Long-Term Effect of Adapting the Vertical Position of Implants on Peri-Implant Health: A 5-Year Intra-Subject Comparison in the Edentulous Mandible Including Oral Health-Related Quality of Life
Authors: Doornewaard Ron , De Bruyn Hugo , Matthys Carine , Bronkhorst Ewald , Vandeweghe Stefan , Vervaeke Stijn
Published: October 2020

Despite high success rates of dental implants, surface exposure may occur as a consequence of biologic width establishment associated with surgery. This prospective split-mouth study evaluated the effect of early implant surface exposure caused by initial bone remodeling on long-term peri-implant bone stability and peri-implant health. Additionally, Oral Health-Related Quality of Life (OHRQoL) was assessed by means of the Oral Health Impact Profile-14 (OHIP-14). Twenty-six patients received two non-splinted implants supporting an overdenture in the mandible by means of locators. One implant was installed equicrestally (control) and the second one was installed subcrestally, taking at least 3 mm soft tissue thickness into account (test). During initial bone remodeling (up to 6 months postoperatively), equicrestal placement yielded 0.68 mm additional surface exposure compared to subcrestal placement (p < 0.001). Afterwards, bone level and peri-implant health were comparable in both treatment conditions and stable up to 5 years. The implant overdenture improved OHRQoL (p < 0.01) and remained unchanged thereafter (p = 0.51). In conclusion, adapting the vertical position of the implant concerning the soft tissue thickness prevents early implant surface exposure caused by initial bone remodeling, but in a well-maintained population, this has no impact on long-term prognosis. The treatment of edentulousness with an implant mandibular overdenture improves OHRQoL.
In Vitro Evaluation of Different Irrigation Protocols on Intracanal Smear Layer Removal in Teeth with or without Pre-Endodontic Proximal Wall Restoration
Authors: Kharouf Naji , Pedullà Eugenio , La Rosa Giusy Rita Maria , Bukiet Frédéric , Sauro Salvatore , Haikel Youssef , Mancino Davide
Published: October 2020

To investigate the influence of pre-endodontic coronal wall restoration on smear layer removal during different root canal irrigation strategies, single-root premolars were prepared with a mesio-occlusal cavity. Half were left untreated (G1), while the mesial walls of the remaining half were reconstructed using a resin composite (G2). The specimens were divided into control (ctrl) groups, which used the conventional needle irrigation method, and four experimental subgroups according to irrigation strategy: Sonic activation using the Endoactivator, sonic activation using the EQ-S, mechanical activation using the XP-Endo finisher, and ultrasonic activation using the EndoUltra. Smear layer removal was assessed through SEM and the results were statistically analyzed. At the coronal and middle thirds, no significant difference (p > 0.05) was detected for G1 and G2, except for the control subgroups (G1ctrl vs G2 ctrl) at the middle third. At the apical third, the smear layer removal was significantly greater for G2 than G1. In G1, both at the middle and apical level, EQ-S and EndoUltra showed greater smear layer removal (p < 0.05) compared to the others G1 subgroups. In G2, at the apical level, the EQ-S and EndoUltra were the most effective in smear layer removal. Pre-endodontic coronal wall restoration may improve the smear layer removal during root canal irrigation.
The Impact of Experience, Length of Service, and Workplace Preparedness in Physicians’ Readiness in the Response to Disasters
Authors: Goniewicz Krzysztof , Goniewicz Mariusz , Burkle Frederick M. , Khorram-Manesh Amir
Published: October 2020

With an increasing number of natural and man-made disasters, the need for preparedness in all levels of management is obvious. Among healthcare professionals responding to these emergencies, physicians are of particular importance due to their significant roles as leaders and frontline workers in minimizing morbidity and mortality of the affected population. This study analyses the preparedness of 549 physicians from all medical centers in Lublin, Poland to formulate their observations, suggestions, and recommendations concerning the improvement of the chain of response in disaster management. The results of this study show that the perceived preparedness of physicians for disaster management and response is not as high as it should be, and the majority of the respondents perceived their disaster preparedness insufficient. Training of physicians in disaster management and principles of disaster medicine is needed, by focusing on the specificity of rescue response to emergencies following disasters, and medical and non-medical aspects of the response with particular emphasis on a management approach covering all hazards.
Retinal Vascular Features in Ocular Blunt Trauma by Optical Coherence Tomography Angiography
Authors: Montorio Daniela , D’Andrea Luca , Cennamo Gilda
Published: October 2020

In this prospective study, we analysed the changes in retinal vessel density (VD) using optical coherence tomography angiography (OCTA) in patients with commotio retinae up to 6 months after blunt ocular trauma. We analysed the VD in the superficial capillary plexus (SCP), deep capillary plexus (DCP), radial peripapillary capillary (RPC) and the foveal avascular zone (FAZ) area at 48 h, and 1, 3 and 6 months after the trauma and compared results with those of healthy fellow eyes. We also evaluated the best-corrected visual acuity (BCVA) and the structural, spectral domain (SD)-OCT parameters: ganglion cell complex (GCC) and retinal nerve fibre layer (RNFL). A total of 18 eyes of 18 patients (8 males, 10 females, mean age 49.61 ± 9.2 years) and 18 healthy control eyes were evaluated. GCC and RNFL thicknesses showed a significant trend towards progressively lower values from 1 month and 3 months after the trauma, respectively, compared to healthy eyes (p < 0.005). The reduction in SD-OCT parameters reached a plateau at 6 months. Similar behaviour was found in the VD of the SCP and RPC that significantly decreased, starting from 1 and 3 months after the trauma, respectively (p < 0.001). At 6 months, the VD values were stable. The DCP presented an initial decrease of VD (p < 0.001), and after 1 month, the values statistically increased until the sixth month, reaching values similar to those of the control group. The FAZ area and BCVA did not show statistically significant changes during the follow-up. OCTA provided a detailed and quantitative analysis of early retinal vascular perfusion alterations after commotio retinae, demonstrating that the impairment of the retinal microvasculature and its progressive changes over time occurred even in the absence of compromised visual acuity.
Immediate Effect of Masticatory Muscle Activity with Transcutaneous Electrical Nerve Stimulation in Muscle Pain of Temporomandibular Disorders Patients
Authors: Abe Susumu , Miyagi Akane , Yoshinaga Kaoru , Matsuka Yoshizo , Matsumoto Fumihiro , Uyama Emi , Suzuki Yoshitaka , Oshima Masamitsu , Okura Kazuo , Tanaka Eiji
Published: October 2020

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive treatment modality for acute and chronic pain. However, little information for muscle activity is available on the immediate effects of TENS in masticatory muscle pain related to temporomandibular disorders (TMDs). The present study aimed to evaluate the immediate effects of TENS treatment on TMD-related muscle pain. Thirty-six patients with TMD-related muscle pain and 39 healthy subjects served as TMD and control groups, respectively. For objective evaluations, maximum mouth opening, and maximum bite force were measured before and after TENS. The pain intensity was assessed according to a 100-mm visual analog scale (VAS). TENS was applied to painful muscles for 20 min with frequencies of 100–200 Hz. The treatment outcome was evaluated using Global Rating of Change (GRC) scales. In the TMD group, VAS values significantly decreased after TENS. Although there was significant increase in the maximum mouth opening after TENS for only TMD group, the maximum bite force of both groups was significantly greater after TENS. According to GRC scales, one patient with TMD-related muscle pain expressed negative feelings after TENS. Conclusively, TENS treatment might quickly relieve pain in masticatory muscles and improve masticatory functions in patients with TMD-related muscle pain.
The Eye as a Non-Invasive Window to the Microcirculation in Liver Cirrhosis: A Prospective Pilot Study
Authors: Gifford Fiona J , Moroni Francesca , Farrah Tariq E , Hetherington Kirstie , MacGillivray Tom J , Hayes Peter C , Dhaun Neeraj , Fallowfield Jonathan A
Published: October 2020

Microcirculatory dysfunction is associated with organ failure, poor response to vasoactive drugs and increased mortality in cirrhosis, but monitoring techniques are not established. We hypothesized that the chorioretinal structures of the eye could be visualized as a non-invasive proxy of the systemic microvasculature in cirrhosis and would correlate with renal dysfunction. Optical Coherence Tomography (OCT) was performed to image the retina in n = 55 cirrhosis patients being assessed for liver transplantation. OCT parameters were compared with established cohorts of age- and sex-matched healthy volunteers (HV) and patients with chronic kidney disease (CKD). Retinal thickness, macular volume and choroidal thickness were significantly reduced relative to HV and comparable to CKD patients (macular volume: HV vs. cirrhosis mean difference 0.44 mm3 (95% CI 0.26–0.61), p ≤ 0.0001). Reduced retinal thickness and macular volume correlated with renal dysfunction in cirrhosis (macular volume vs. MDRD-6 eGFR r = 0.40, p = 0.006). Retinal changes had resolved substantially 6 weeks following transplantation. There was an inverse association between choroidal thickness and circulating markers of endothelial dysfunction (endothelin-1 r = −0.49, p ≤ 0.001; von Willebrand factor r = −0.32, p ≤ 0.05). Retinal OCT may represent a non-invasive window to the microcirculation in cirrhosis and a dynamic measure of renal and endothelial dysfunction. Validation in different cirrhosis populations is now required.