bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term efficacy and safety results after iris-fixated foldable phakic intraocular lens for myopia and astigmatism: 6-year follow-up
Authors: Monteiro Tiago , Correia Fernando Faria , Franqueira Nuno , Mendes José Carlos , Pinto Christophe , Vaz Fernando
Published: September 2020

Purpose:

To evaluate the long-term efficacy and safety of iris-fixated foldable phakic intraocular lenses (pIOLs) for the management of myopia and astigmatism after 6-year follow-up.

Setting:

Ophthalmology Department, Hospital Braga, Portugal.

Design:

Retrospective cohort study.

Methods:

Patients included underwent iris-fixated foldable Artiflex pIOL implantation between January 2010 and December 2013. Follow-up evaluations were performed 6 months postoperatively and every 12 months until 72 months. Preoperative and follow-up data on uncorrected and corrected distance visual acuity (CDVA), manifest refraction, endothelial cell density (ECD), and anterior chamber depth (ACD) were analyzed.

Results:

A total of 177 eyes of 98 patients with a mean age of 32.33 ± 7.13 years were analyzed. There was a statistically significant improvement in CDVA from 0.09 ± 0.02 logMAR preoperatively to 0.04 ± 0.02 logMAR (P < .0001) at 6 years postoperatively. The spherical equivalent demonstrated a statistically significant improvement from −9.50 ± 2.93 diopters (D) to −0.41 ± 0.45 D at 6 years. At 72 months, the efficacy and safety indexes were 0.94 and 1.15, respectively. A mean loss of 31.77 cells/mm2 (1.19%) was observed each year until the sixth year. The overall mean ECD loss after correction for the physiological loss was 3.02% after 6 years. No correlations were observed between the mean ECD loss and the preoperative ACD.

Conclusions:

The Artiflex pIOL was a safe, effective, and a stable option to correct myopia. A mean ECD loss of 3.02% was observed over 6 years. No pIOL was explanted due to corneal decompensation.
Incidence of rhegmatogenous retinal detachment in myopic phakic eyes
Authors: Ullrich Marlies , Zwickl Hannah , Findl Oliver
Published: September 2020

Rhegmatogenous retinal detachment (RRD) is a potentially blinding disease, more common in the myopic population. This systematic review aimed to collect the existing literature on the incidence of RRD in myopic phakic eyes. MEDLINE, Embase, and the Cochrane Library were searched to identify eligible studies published until February 2020. In total 2715 publications were identified, of which only 3 were considered eligible and 2 as eligible with major limitations. Because of substantial differences between the included studies, a pooled analysis was not conducted. Summarizing the results and considering several limitations, an annual RRD incidence per 100 000 of 15 to 34 for mild myopia, 15 to 73 for moderate myopia, 102 to 128 for high myopia, and 287 in very highly myopic eyes was shown. Large well-designed studies are needed, including precise information on the refractive status or axial eye length, lens status, traumatic injuries, and intraocular surgeries during follow-up.
Pinhole pupilloplasty after previous radial keratotomy
Authors: Narang Priya , Agarwal Amar , Kumar Dhivya Ashok , Sivagnanam Soundari , Agarwal Ashvin
Published: September 2020

The multiple radial stromal deep corneal incisions placed in radial keratotomy (RK) lead to higher-order aberrations and pose a surgical challenge to performing any further corrective procedure on the cornea because of fear of inducing an incisional dehiscence. A method to perform pinhole pupilloplasty (PPP) in the setting of previous RK is presented. Application of pinhole optics by performing PPP leads to significant improvement in image quality and helps to optimize visual potential in post-RK cases.
Short-term bilateral keratoconus progression after deep anterior lamellar keratoplasty in one eye and intracorneal ring segments and corneal crosslinking in the other due to eye rubbing
Authors: Abad Juan Carlos , Ocampo-Patiño Andrea , Vanegas-Ramírez Claudia
Published: September 2020

A 15-year-old boy had deep anterior lamellar keratoplasty in the right eye and intracorneal ring segments/corneal crosslinking in the left eye for the treatment of progressive keratoconus due to eye rubbing. He achieved a good surgical results, and 6 months later, the uncorrected distance visual acuity (UDVA) was 0.30 logarithm of the minimum angle of resolution (logMAR) in each eye, the refraction in the right eye was plano −2.75 × 135 = 0.30 logMAR and in the left eye was −0.75 −2.50 × 45 = 0.18 logMAR. Twelve months postoperatively, there was recurrence of intense eye rubbing. UDVA dropped, and bilateral corneal steepening was noted. Bilateral corneal crosslinking was performed along with an allergist consultation for eye rubbing control. Ten years later, his UDVA was 1.3 logMAR and 0.40 logMAR and corrected distance visual acuity was 0.10 logMAR and 0.18 logMAR in the right and left eyes, respectively.
Neural effects of placebo analgesia in fibromyalgia patients and healthy individuals
Authors: Frangos Eleni , Čeko Marta , Wang Binquan , Richards Emily A. , Gracely John L. , Colloca Luana , Schweinhardt Petra , Bushnell M. Catherine
Published: September 2020

Placebo analgesia is hypothesized to involve top-down engagement of prefrontal regions that access endogenous pain inhibiting opioid pathways. Fibromyalgia (FM) patients have neuroanatomical and neurochemical alterations in pathways relevant to placebo analgesia. Thus, it remains unclear whether placebo analgesic mechanisms would differ in FM patients compared to healthy controls (HCs). Here, using placebo-analgesia-inducing paradigms that included verbal suggestions and conditioning manipulations, we examined whether behavioral and neural placebo analgesic responses differed between 32 FM patients and 46 age- and sex-matched HCs. Participants underwent a manipulation scan, where noxious high and low heat were paired with the control and placebo cream, respectively, and a placebo experimental scan with equal noxious heat temperatures. Before the experimental scan, each participant received saline or naloxone, an opioid receptor antagonist. Across all participants, the placebo condition decreased pain intensity and unpleasantness ratings, decreased activity within the right insula and bilateral secondary somatosensory cortex, and modulated the neurologic pain signature. There were no differences between HCs and FM patients in pain intensity ratings or neural responses during the placebo condition. Despite the perceptual and neural effects of the placebo manipulation, prefrontal circuitry was not activated during the expectation period and the placebo analgesia was unaltered by naloxone, suggesting placebo effects were driven more by conditioning than expectation. Together, these findings suggest that placebo analgesia can occur in both HCs and chronic pain FM patients, without the involvement of opioidergic prefrontal modulatory networks.
Not as “blurred” as expected? Acuity and spatial summation in the pain system
Authors: Adamczyk Wacław M. , Szikszay Tibor M. , Kung Tiffany , Carvalho Gabriela F. , Luedtke Kerstin
Published: September 2020

Spatial acuity measured by 2-point discrimination (2PD) threshold and spatial summation of pain (SSp) are useful paradigms to probe the pain system in humans. Whether the results of these paradigms are influenced by different stimulus modalities and intensities is unclear. The aim of this study was to test 2PD controlling the stimulus modality and the intensity and to investigate the effect of modality on SSp. Thirty-seven healthy volunteers were tested for 2PDs with 2 stimulus modalities (electrocutaneous and mechanical) and intensity (noxious and innocuous). For each condition, participants received stimuli to either 1 or 2 points on their lower back with different distances (2-14 cm, steps of 2 cm). It was found that 2PDs were significantly smaller for noxious stimuli for both modalities. By contrast, between-modality comparison reproduced previous reports of impaired acuity for noxious stimulation. Higher pain intensities were reported when a larger area was stimulated (SSp), independent of the modality. Furthermore, reported pain intensities were higher when the distance between 2 stimulated areas was increased from 2 to 6 cm (P < 0.001), 8 cm (P < 0.01), and 14 cm (P < 0.01). 2PDs determined by mechanical and electrocutaneous stimuli were significantly correlated within both stimulus intensities, ie, innocuous (r = 0.34, P < 0.05) and noxious (r = 0.35, P < 0.05). The current results show 3 novel findings: (1) the precision of the pain system might be higher than in the innocuous (tactile) system when mechanical and electrocutaneous modalities are used, (2) the pattern of distance-based and area-based SSp seems to be comparable irrespective of the modality applied (mechanical and electrocutaneous), and (3) both modalities are moderately correlated.
Identifying biopsychosocial factors that impact decompressive laminectomy outcomes in veterans with lumbar spinal stenosis: a prospective cohort study
Authors: Weiner Debra K. , Holloway Kathryn , Levin Emily , Keyserling Harold , Epstein Franklin , Monaco Edward , Sembrano Jonathan , Brega Kerry , Nortman Samuel , Krein Sarah L. , Gentili Amilcare , Katz Jeffrey N. , Morrow Lisa A. , Muluk Visala , Pugh Mary Jo , Perera Subashan
Published: September 2020

One in 3 patients with lumbar spinal stenosis undergoing decompressive laminectomy (DL) to alleviate neurogenic claudication do not experience substantial improvement. This prospective cohort study conducted in 193 Veterans aimed to identify key spinal and extraspinal factors that may contribute to a favorable DL outcome. Biopsychosocial factors evaluated pre-DL and 1 year post-DL were hip osteoarthritis, imaging-rated severity of spinal stenosis, scoliosis/kyphosis, leg length discrepancy, comorbidity, fibromyalgia, depression, anxiety, pain coping, social support, pain self-efficacy, sleep, opioid and nonopioid pain medications, smoking, and other substance use. The Brigham Spinal Stenosis (BSS) questionnaire was the main outcome. Brigham Spinal Stenosis scales (symptom severity, physical function [PF], and satisfaction [SAT]) were dichotomized as SAT < 2.42, symptom severity improvement ≥ 0.46, and PF improvement ≥ 0.42, and analyzed using logistic regression. Sixty-two percent improved in 2 of 3 BSS scales (ie, success). Baseline characteristics associated with an increased odds of success were—worse BSS PF (odds ratio [OR] 1.24 [1.08-1.42]), greater self-efficacy for PF (OR 1.30 [1.08-1.58]), lower self-efficacy for pain management (OR 0.80 [0.68-0.94]), less apparent leg length discrepancy (OR 0.71 [0.56-0.91]), greater self-reported alcohol problems (OR 1.53 [1.07-2.18]), greater treatment credibility (OR 1.31 [1.07-1.59]), and moderate or severe magnetic resonance imaging-identified central canal stenosis (OR 3.52 [1.06-11.6]) moderate, OR 5.76 [1.83-18.1] severe). Using opioids was associated with lower odds of significant functional improvement (OR 0.46 [0.23-0.93]). All P < 0.05. Key modifiable factors associated with DL success—self-efficacy, apparent leg length inequality, and opioids—require further investigation and evaluation of the impact of their treatment on DL outcomes.
Visiting in disguise: Analysis of inpatient companions in the time of COVID-19
Authors: Hung Shih-Hsin , Kuo Shu-Chen , Fen Jun-Jeng , Tseng Kuan-Jui , Sun Ying-Chou , Ming Jin-Lain
Published: September 2020

Background:

As outbreak of COVID-19 infection, on April 3, 2020, it is stipulated that the number of inpatient companions is limited to one in Taiwan. All companions are required to register their real personal data with 14 days of travel history, occupation, contact history, and cluster history. We would like to evaluate the impact of the new regulations to the accompanying and visiting culture in Taiwan, via analyzing the appearance and characteristics of inpatient companions in this period.

Methods:

Using intelligent technology, we designed a novel system in managing the inpatient companions (InPatients Companions Management System [IPCMS]), and the IPCMS was used to collect data about characteristics of inpatients and companions between April 27 and May 3, 2020. The database is built using MySQL software. Microsoft Excel 2016 and SPSS version 20.0 statistical software were used for data analysis, including the basic data of the companions, differential analysis of companions’ gender, person-days and cumulative time, differential analysis of accompaniment-patient relationship, and frequency of accompaniment and cumulative hours.

Results:

During study period, daily inpatient admissions ranged from 2242 to 2514, the number of companions per day ranged from 2048 to 2293, and the number of companions for one inpatient is 1 to 9 per day, with an average of 1.20 to 1.26. The companions were mostly family members, and most of them were the inpatients’ children (32.9%), and spouse (26.13%). More females than males were noted in all categories of companionship with statistical significance.

Conclusion:

The data obtained in this study could be an important basis for the transformation and reform of the companions culture in Taiwan’s hospitals and will also provide a glimpse into the attitudes and culture of companions who have long been ignorant and neglected. The experience gained in our IPCMS could also serve as a reference for other hospitals in Taiwan and worldwide.
Role-play of real patients improves the clinical performance of medical students
Authors: Huang Ling-Ju , Huang Hui-Chun , Chuang Chiao-Lin , Chang Shu-Luen , Tsai Hung-Cheng , Lu Dai-Yin , Yang Ying-Ying , Chang Ching-Chih , Hsu Hui-Chi , Lee Fa-Yauh
Published: September 2020

Background:

This study aimed to evaluate whether the role-play (RP) of real patients by medical students as part of interactive clinical reasoning training can improve medical students’ clinical performance.

Methods:

A total of 26 medical students volunteered to portray real patients within this program and were treated as the RP group while the other 72 students as the non-RP group. In the interactive morning meeting, the medical students practiced how to approach the RP student as if they were encountering a real patient. All students were evaluated by mini-clinical evaluation exercises (mini-CEX) before and after this training program.

Results:

We found that all students had an increased total mini-CEX score after 4-week training, especially for interviewing skills. Notably, after training, the RP students had significantly elevated total mini-CEX scores (51.23 ± 1.06 vs 53.12 ± 1.11, p = 0.028), and for counselling (7.15 ± 0.14 vs 7.54 ± 0.18, p = 0.015) and overall clinical competence (7.27 ± 0.15 vs 7.65 ± 0.16, p = 0.030). In contrast, the non-RP students had lower scores compared with the RP group, as revealed by both the pre- and post-training tests. Moreover, their mini-CEX scores were not improved after training.

Conclusion:

Medical students who were motivated to RP real patients had better performance scores than those who did not. In addition, RP can enhance their counselling skills and clinical competences.
Multimorbidity in Patients With Acute Coronary Syndrome Is Associated With Greater Mortality, Higher Readmission Rates, and Increased Length of Stay
Authors: Breen Katherine , Finnegan Lorna , Vuckovic Karen , Fink Anne , Rosamond Wayne , DeVon Holli A.
Published: September 2020

Objective

The aims of this systematic review were to determine the magnitude and impact of multimorbidity (≥2 chronic conditions) on mortality, length of stay, and rates of coronary intervention in patients with acute coronary syndrome (ACS) and to compare the prevalence of cardiovascular versus noncardiovascular multimorbidities.

Methods

MEDLINE, PubMed, MedlinePlus, EMBASE, OVID, and CINAHL databases were searched for studies published between 2009 and 2019. Eight original studies enrolling patients with ACS and assessing cardiovascular and noncardiovascular comorbid conditions met the inclusion criteria. Study quality was evaluated using the Crowe Critical Appraisal Tool.

Results

The most frequently examined cardiovascular multimorbidities included hypertension, diabetes, heart failure, atrial fibrillation, stroke/transient ischemic attack, coronary heart disease, and peripheral vascular disease; the most frequently examined noncardiovascular multimorbidities included cancer, anemia, chronic obstructive pulmonary disease, renal disease, liver disease, and depression. The prevalence of multimorbidity in the population with ACS is high (25%–95%). Patients with multimorbidities receive fewer evidence-based treatments, including coronary intervention and high-dose statins. Patients with multimorbidities experience higher in-hospital mortality (5%–13.9% vs 2.6%–6.1%), greater average length of stay (5–9 vs 3–4 days), and lower rates of revascularization (9%–14% vs 39%–42%) than nonmultimorbid patients. Women, despite being the minority in all sample populations, exhibited greater levels of multimorbidity than men.

Conclusions

Multimorbid patients with ACS are at a greater risk for worse outcomes than their nonmultimorbid counterparts. Lack of consistent measurement makes interpretation of the impact of multimorbidity challenging and emphasizes the need for more research on multimorbidity's effects on postdischarge healthcare utilization.
An Integrative Review of the Symptom Perception Process in Heart Failure
Authors: Lee Kyoung Suk , Oh Seieun
Published: September 2020

Background

Accurate symptom perception is a fundamentally essential component of self-care for patients with heart failure (HF) so they can make appropriate decisions about their symptoms.

Objective

The purpose of this integrative review was to describe the pathways of the symptom perception process and its contributing factors in patients with HF.

Methods

A comprehensive literature search was conducted using PubMed, EMBASE, and PsycINFO databases to identify studies describing the symptom perception process (symptom detection, comprehension, and response) in adult patients with HF.

Results

Two pathways of the symptom perception process were identified from 42 articles: ideal and undesirable pathways. Patients in the ideal symptom perception pathway had a comprehensive understanding of HF and a firm belief in the importance of self-care, were vigilant, and possessed good decision-making skills. They also were able to successfully use their experiences for future care. However, patients in the undesirable symptom perception pathway had a limited understanding of HF with poor symptom monitoring skills and inaccurate judgments about symptoms. Diverse factors contributing to the symptom perception process were identified (eg, levels of understandings of HF and social support).

Conclusion

Our review indicated that symptom perception was likely to diversify the pathway of HF management. A variety of contributing factors to the symptom perception process were found to be intertwined. The findings of our review can inform the development of best patient education practice, although further research needs to be conducted to understand why and how patients can follow the most appropriate path from their past experiences.
Elder Abuse Detection and Intervention: Challenges for Professionals and Strategies for Engagement From a Canadian Specialist Service
Authors: Fraga Dominguez Silvia , Valiquette Jennifer , Storey Jennifer E. , Glorney Emily
Published: September 2020

Elder abuse (EA) is of increasing relevance in the context of an aging society, and this has implications for detection and intervention for several types of healthcare providers, including forensic nurses. Knowledge related to EA is important as victims are likely to interact with providers, because of either existing health problems or the consequences of abuse. This article provides a brief overview of EA, followed by an outline of current detection and intervention efforts used by healthcare providers in community and hospital settings. In addition, knowledge about help-seeking and barriers to disclosure are discussed to inform healthcare provider interactions with older adults where EA is suspected or disclosed. To illustrate challenges faced by healthcare providers in this area, two cases of EA involving case management by a forensic nurse in a specialist service in Canada are presented.
The Rise of Dementia With Lewy Bodies: Nursing Interventions and Implications
Authors: Davis-Fantauzzi Ashley
Published: September 2020

BACKGROUND: Age and dementia with Lewy bodies (DLB) are highly associated. As the elderly population in the United States increases, so will the incidence of DLB. Nurses increasingly can expect to care for this population. This article will examine and explain the current literature describing the state of DLB as well as best practices for nursing care of physical, psychosocial, and educational needs of DLB patients, families, and caregivers. METHODS: CINAHL Complete and Google Scholar were used to search for relevant literature within the last 6 years. The following keywords were used alone or in combination: “Lewy,” “Lewy body,” “dementia,” “aging,” “caregiver,” “support,” and “nursing.” RESULTS: Eighty articles were reviewed and 26 were chosen, along with 1 government website, for this review article. Dementia with Lewy bodies is defined, and the presentation is described. Behavioral and psychological, motor, autonomic, and cognitive symptoms most common and those considered to be hallmarks are explained. Diagnosis and both pharmacologic and nonpharmacologic treatments, along with nursing implications and interventions, are provided. CONCLUSION: Early recognition of signs and symptoms of DLB helps to provide timely diagnosis and appropriate treatment. The importance of knowledge acquisition for nurses to better care for DLB patients and their families is addressed throughout the article.
Musculoskeletal Disorders and Prescription Opioid Use Among U.S. Construction Workers
Authors: Dong Xiuwen Sue , Brooks Raina D. , Brown Samantha
Published: September 2020

Background:

Musculoskeletal disorders (MSDs) and opioid use are a combined burden for construction safety and health. This study examines both issues among construction workers using a large population-based survey.

Methods:

The prevalence of MSDs in construction was estimated using multi-year data from the Medical Expenditure Panel Survey. Prescription opioid use among workers with MSDs was compared to those without MSDs.

Results:

About 34% of construction workers had at least one MSD symptom. Compared to those without MSDs, prescription opioid use tripled (aOR = 3.28, 95% CI: 2.44 to 4.41) among construction workers with MSDs.

Conclusions:

MSDs are prevalent among construction workers, and prescription opioid use significantly increased among workers with MSDs. It is critical to adopt ergonomic solutions in construction to reduce MSDs, and support workers in injury recovery with effective pain management.
SARS-CoV-2 Antibody Seroprevalence in Industry Workers in Split-Dalmatia and Šibenik-Knin County, Croatia
Authors: Jerković Ivan , Ljubić Toni , Bašić Željana , Kružić Ivana , Kunac Nenad , Bezić Joško , Vuko Arijana , Markotić Alemka , Anđelinović Šimun
Published: September 2020

Objectives:

To examine seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in industry workers population sample.

Methods:

From 23 to April 28, 2020, we conducted serological testing for antibodies (Immunoglobulin G (IgG) and Immunoglobulin M (IgM)) on 1494 factory employees living in the Split-Dalmatia and Šibenik-Knin County (Croatia).

Results:

We detected antibodies in 1.27% of participants (95% confidence interval [CI] 0.77–1.98%). In Split facility 13/1316 (0.99%, 95% CI 0.53–1.68%) of participants were tested positive, of which 13/1079 (1.20%, 95% CI 0.64–2.05%) of those living outside the facility and 0/237 (0%, 95% CI 0–1.26%) of those living inside the facility. In Knin facility, 6/178 (3.37%, 95% CI 1.25–7.19%) participants were tested positive for antibodies.

Conclusions:

The study showed relatively small SARS-CoV-2 antibody seroprevalence in the DIV Group population sample.
Toe Rings: Suitable Option for Retention of Toe Prosthesis
Authors: Raghuvanshi Snehkiran , Tripathi Shuchi , Anwar Mohd
Published: September 2020

Introduction

The most common problem in fabrication of toe prosthesis is inadequate retention, which can be overcome by using implants or adhesive. In the present case, a modified technique for retention of toe prosthesis with the help of toe rings has been described.

Case Description and Method

The prosthesis was retained using toe rings in hallux and baby toe, which were joined together by a silver wire passing through the prosthesis. It helped a lot for retaining the prosthesis during movement, along with functional and cosmetic advantages.

Result

Retention with the help of toe rings was found to be adequate, user friendly, aesthetically pleasing, and economical.

Conclusions

This article proposes a modification in the designing of a toe prosthesis that can be worn easily with adequate retention. To increase the stability of retentive rings, a silver wire was incorporated into the body of prosthesis.

Clinical Relevance

Toe rings can be successfully used for toe prosthesis, which help in ease of handling, improved aesthetics, and increased retention of the prosthesis without using adhesive material or any additional surgical procedure.
Application of Artificial Intelligence in Gastrointestinal Endoscopy
Authors: Wu Jia , Chen Jiamin , Cai Jianting
Published: September 2020

Artificial intelligence (AI), also known as computer-aided diagnosis, is a technology that enables machines to process information and functions at or above human level and has great potential in gastrointestinal endoscopy applications. At present, the research on medical image recognition usually adopts the deep-learning algorithm based on the convolutional neural network. AI has been used in gastrointestinal endoscopy including esophagogastroduodenoscopy, capsule endoscopy, colonoscopy, etc. AI can help endoscopic physicians improve the diagnosis rate of various lesions, reduce the rate of missed diagnosis, improve the quality of endoscopy, assess the severity of the disease, and improve the efficiency of endoscopy. The diversity, susceptibility, and imaging specificity of gastrointestinal endoscopic images are all difficulties and challenges on the road to intelligence. We need more large-scale, high-quality, multicenter prospective studies to explore the clinical applicability of AI, and ethical issues need to be taken into account.
Repeated Negative Urine Trypsinogen-2 Dipstick Test Rules Out Diagnosis of Post-ERCP Pancreatitis
Authors: Rainio Mia , Lindström Outi , Udd Marianne , Puolakkainen Pauli , Stenman Ulf-Håkan , Kylänpää Leena
Published: September 2020

Background:

A dipstick test for urine trypsinogen-2 has been used in the diagnosis of acute pancreatitis, but there are only a few studies exploring the effectiveness of this test for early diagnose of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).

Goals:

The authors explore if the rapid point-of-care urine trypsinogen-2 dipstick test can replace assay of amylase in diagnosing PEP.

Study:

For this prospective study, from Helsinki University Hospital 400 ERCP patients were enrolled in whom the authors analyzed plasma amylase or pancreas-specific amylase, bilirubin, and urine trypsinogen-2, and urine trypsinogen-2 with dipstick before, 4 and 24 hours after ERCP.

Results:

PEP developed in 15 (3.8%) patients. Urine trypsinogen-2 concentrations were significantly higher in PEP than in non-PEP patients 24 hours after ERCP (P=0.001, Mann-Whitney U test) but not 4 hours after ERCP (P=0.094). When combined with abdominal pain symptoms at 4 hours the dipstick test had a sensitivity of 60%, a specificity of 99%, a positive predictive value of 64%, and a negative predictive value 98%. At 24 hours, sensitivity was 100%, specificity 98%, positive predictive value 71%, and negative predictive value 100%.

Conclusions:

A positive dipstick seems to identify PEP cases and a negative test excludes PEP with high accuracy.
Can nicotinamide riboside protect against cognitive impairment?
Authors: Braidy Nady , Liu Yue
Published: September 2020

Purpose of review

The present review aims to address the clinical benefits of using nicotinamide riboside, a precursor to the essential pyridine nucleotide, nicotinamide adenine dinucleotide (NAD+) as a therapeutic agent to attenuate age-related cognitive decline.

Recent findings

Oral supplementation with nicotinamide riboside can inhibit the accumulation of pathological hallmarks of Alzheimer's disease and improve learning and memory in various murine models for dementia. Nicotinamide riboside can also reduce DNA damage, neuroinflammation, apoptosis, and improved hippocampal synaptic plasticity in diabetic mice, and another Alzheimer's disease mouse model. The cognitive benefits of nicotinamide riboside in Alzheimer's disease models may be modulated in part by upregulation of proliferator-activated-γ coactivator 1α-mediated β-secretase 1(BACE-1) ubiquitination and degradation, preventing Aβ production in the brain. Nicotinamide riboside also maintained blood–brain barrier integrity and maintained the gut microbiota in a mouse model for cerebral small vessel disease and alcohol-induced depression, respectively. Oral nicotinamide riboside has been shown to be bioavailable and well tolerated in humans with limited adverse effects compared to other NAD+ precursors.

Oral nicotinamide riboside may represent a promising stratagem to improve cognitive decline during ‘normal’ ageing, Alzheimer's disease and other diseases. Results from recent clinical trials are needed to enumerate the preclinical benefits in humans.
Vitamin D status and supplementation impacts on skeletal muscle function: comparisons between young athletes and older adults
Authors: Byers Adam W. , Connolly Gavin , Campbell Wayne W.
Published: September 2020

Purpose of review

The present narrative review analyzes emerging research implicating vitamin D status and supplementation with skeletal muscle homeostasis and functions in two distinct segments of the adult population: young athletes and older adults.

Recent findings

Vitamin D deficiency compromises multiple indices of muscle function in young athletes and older adults. A variety of vitamin D3 (cholecalciferol) supplementation regimens may transition young athletes and older adults from deficient or inadequate to adequate vitamin D status. Vitamin D supplementation, used to treat a vitamin D deficiency, but not necessarily an inadequacy, promotes muscle anabolism in older adults. For both young athletes and older adults, vitamin D supplementation, which transitions them from inadequate to adequate vitamin D status, may not beneficially affect measures of muscle strength and power, or physical performance. Also, when vitamin D status is adequate, vitamin D supplementation to further increase serum 25(OH)D concentrations does not seem to confer additional benefits to muscle strength and power and physical performance.

The impacts of vitamin D status and supplementation on skeletal muscle homeostasis and functions seem comparable in young athletes who strive to maximize physical performance and older adults who seek to attenuate muscle mass and physical performance declines.
Dietary fibers reduce obesity-related disorders: mechanisms of action
Authors: Dayib Miski , Larson Jacob , Slavin Joanne
Published: September 2020

Purpose of review

Dietary fibers decrease risk of cardiovascular disease and obesity, but the most important mechanisms for fiber's protective properties are debated. The purpose of the review is to summarize the recent human studies that examine mechanisms how dietary fiber decreases risk of obesity-related disorders.

Recent findings

Dietary fiber has effects throughout the digestive tract that decrease risk of obesity-related diseases. Soluble, viscous fibers slow absorption of and decrease serum cholesterol. Intake of dietary fiber enhances satiety and reduces food intake at future meals. The importance of gut fermentation and changes in the gut microbiota and metabolites are linked to decrease risk for obesity-related disorders. Dietary fibers alter the gut microbiota and produce metabolites such as short-chain fatty acids that may explain fiber's role in obesity prevention and treatment. Dietary fiber encompasses many plant compounds, so conclusions that dietary fiber reduces or treats obesity-related disorders must be considered by the fiber was fed in the study.

Dietary fiber prevents and treats obesity-related disorders. Mechanisms for this protection include decreased absorption of macronutrients and enhanced satiety. Changes in the gut microbiota and short-chain fatty acids are emerging mechanisms to explain why high fiber diets protect against obesity and have a role in obesity treatment.
L-carnitine reduces hospital admissions in patients with hepatic encephalopathy
Authors: Tani Joji , Morishita Asahiro , Sakamoto Teppei , Takuma Kei , Nakahara Mai , Fujita Koji , Oura Kyoko , Tadokoro Tomoko , Mimura Shima , Nomura Takako , Yoneyama Hirohito , Kobara Hideki , Himoto Takashi , Masaki Tsutomu
Published: September 2020

Aim

The aim of this study was to determine whether oral L-carnitine administration reduces the blood ammonia concentration and number of hospital admissions for hepatic encephalopathy in patients with advanced cirrhosis.

Methods

Of 68 patients with hepatic encephalopathy treated with oral L-carnitine supplementation from April 2013 to March 2016, we enrolled 19 patients who had received full standard treatment. We analyzed blood ammonia concentration, number of hospital admissions, and prognosis to determine how effective L-carnitine was in achieving mid-term to long-term suppression of recurrent hepatic encephalopathy.

Results:

Median blood ammonia concentrations at the start, 1 week, 12 weeks, 24 weeks, and 48 weeks were 159, 79, 75, and 82 μg/dL, respectively. Blood ammonia concentrations 12 week, 24 weeks, and 48 weeks after L-carnitine administration were significantly lower than those at the start (P < 0.0001, respectively). During the 3 years prior to oral L-carnitine administration, the enrolled patients were hospitalized a total of 29 times for hepatic encephalopathy. However, during the 3 years following oral L-carnitine administration, they were admitted a total of six times for hepatic encephalopathy (P < 0.001). Median survival time was 40.9 months. Child-Pugh scores before and after oral L-carnitine administration differed significantly, whereas liver reserve function, nutritional status, and muscle index did not change significantly.

Conclusions

Oral L-carnitine administration is effective and free of adverse effects in patients with hyperammonemia and reduces the number of hospital admissions for hepatic encephalopathy.
Endoscopist-directed propofol is more efficient than anesthesiologist-administered propofol in patients at low-intermediate anesthetic risk
Authors: Riesco-López José María , Rizo-Pascual Juana , Díaz-Sánchez A , Manzano-Fernández Rebeca , Martín-Saborido Carlos , Varillas-Delgado David , Rivero-Fernández Miguel , González-Alonso Rosario , Moya-Valverde Eloísa , García-Fernández Pedro , Campos-Cantero Rocío
Published: September 2020

Objective

Endoscopist-directed propofol (EDP) sedation is becoming more popular, with a reported safety and efficacy similar to anesthesiologist-administered propofol (AAP). The aim of this study is to compare the efficiency of EDP and AAP in patients of low-intermediate anesthetic risk.

Methods

A prospective cost-effectiveness comparison study was conducted. The costs of the endoscopic procedures in the EDP and AAP group were calculated using the full cost methodology after breaking down the endoscopic activity into relative value units to allocate costs in an equitable way. To determine the effectiveness, adverse events related to endoscopic sedation and the number of incomplete procedures were registered for the EDP group and compared with those published by anesthesiologists for AAP.

Results:

A total of 1165 and 18 919 endoscopic procedures were, respectively, included in the EDP and AAP groups. The average costs of EDP vs. AAP for gastroscopy, colonoscopy and endoscopic ultrasound were € 182.81 vs. € 332.93, € 297.07 vs. € 459.76, and € 319.92 vs. € 485.12, respectively. No significant differences were detected regarding the rate of overall adverse events (4.43 vs. 4.46%) or serious adverse events (0 vs. 0.17%); the rate of arterial hypotension was significantly lower in the EDP group: 0.34 vs. 1.78% [odds ratio (OR), 0.19; 95% confidence interval (CI), 0.08–0.46] and the desaturation rate was significantly lower in the AAP group: 3.26 vs. 1.29% (OR, 2.58; 95% CI, 1.85–3.60). No significant differences were found in terms of incomplete examinations (0.17 vs. 0.14%).

Conclusion

In patients with low-intermediate anesthetic risk referred for an endoscopic examination, EDP appears to be more efficient than AAP.
Endoscopic radiofrequency ablation for the treatment of severe gastric antral vascular ectasia in patients with cirrhosis
Authors: Senzolo Marco , Realdon Stefano , Zanetto Alberto , Simoncin Beatrice , Schepis Filippo , Caronna Stefania , Saracco Giorgio Maria , De Angelis Claudio Giovanni , Debernardi Venon Wilma
Published: September 2020

Introduction

Gastric antral vascular ectasia is a significant cause of gastrointestinal bleeding in patients with cirrhosis.

Aim

To assess safety/efficacy and cost/advantages of radiofrequency ablation for the treatment of gastric antral vascular ectasia in patients with cirrhosis.

Materials and methods

Patients with cirrhosis and severe gastric antral vascular ectasia who underwent radiofrequency ablation were enrolled. Clinical data, gastric antral vascular ectasia grade, and gastric antral vascular ectasia-related hospitalizations were collected. Primary outcome was defined as the absence of transfusion over the 6 months after radiofrequency. An economic analysis was performed in the same period.

Results

Forty patients (50% Child B) were enrolled (80% refractory to argon plasma coagulation). Gastric antral vascular ectasia eradication was obtained in all patients and 65% of these patients achieved primary outcome. After radiofrequency, mean number of red blood cells transfusions dropped (from 25 to 0.9, P < 0.0001), with a parallel increase in hemoglobin (from 8 to 10.5 g/dL, P < 0.0001). No major complication occurred and liver function remained stable in all patients. The cost-analysis demonstrated a profound reduction of health care cost (from € 536.084 to € 189.044 in the 6 months before vs. after radiofrequency, respectively). These results were confirmed in the subgroup analysis in patients refractory to argon plasma coagulation.

Conclusions

Radiofrequency ablation is safe and effective for the treatment of gastric antral vascular ectasia in patients with cirrhosis, including those refractory to argon plasma coagulation. Although the cost of single radiofrequency ablation is relatively high, the cost-analysis demonstrated considerable saving.
Transjugular liver biopsy and hepatic venous pressure gradient measurement in patients with and without liver cirrhosis
Authors: Eichholz Julia C. , Kirstein Martha M. , Book Thorsten , Wedemeyer Heiner , Voigtländer Torsten
Published: September 2020

Background

Transjugular liver biopsy (TJLB) and hepatic venous pressure gradient (HVPG) measurement are diagnostic procedures for patients with acute and chronic liver diseases. Technical execution of TJLB and HVPG may be challenging in patients with advanced liver disease.

Objective

We studied consecutive TJLB and HVPG procedures and investigated technical success, complications, quality of biopsies, indications and treatment changes in patients with and without liver cirrhosis.

Methods

In the study period from 2010 to 2018, 575 consecutive TJLB and HVPG procedures were analyzed. Demographic characteristics, procedure-related and follow-up data were extracted from medical records.

Results

In total, 259 (45%) patients were diagnosed with liver cirrhosis whereas 316 (55%) patients had no evidence of advanced chronic liver disease. Technical success of TJLB was significantly higher in patients without liver cirrhosis (287; 92%) compared to patients with liver cirrhosis [184; 76.7% (P = 0.001)]. Technical success of HVPG measurement was not different between both groups (P = 0.553). Liver biopsy specimens were significantly shorter in patients with liver cirrhosis (P = 0.001). Medical therapy was adjusted in 163 (28.4%) patients. In patients with liver cirrhosis, results of TJLB led less frequently to therapy initiation or adjustment compared to patients without liver cirrhosis (P = 0.001). In multivariate analysis, liver cirrhosis (Exp(B) 1.866; P = 0.012), alanine aminotransferase (Exp(B) 0.248; P < 0.001) and INR (Exp(B) 0.583; P = 0.027) were independently associated with treatment change.

Conclusion

Technical success and therapeutic decisions of TJLB are directly linked to presence or absence of liver cirrhosis.
Optical effect of spraying l-menthol on gastric intestinal metaplasia visualized by linked color imaging
Authors: Ono Shoko , Shimoda Yoshihiko , Tanaka Ikko , Kinowaki Sayoko , Inoue Masaki , Ono Masayoshi , Yamamoto Keiko , Shimizu Yuichi , Sakamoto Naoya
Published: September 2020

Objective

Linked color imaging (LCI) enables noninvasive detection of gastric intestinal metaplasia (GIM) as a lavender color sign (LCS), and there has been a recent report that l-menthol enhanced GIM with LCI. We measured color values of GIM and surrounding mucosa with white light imaging (WLI), LCI and LCI after spraying l-menthol (Mint-LCI) and investigated the effect of l-menthol on gastric mucosa.

Methods

Endoscopic images of the antrum with WLI, LCI and Mint-LCI from 18 patients were prepared. Each of six regions of interest (three points of GIM and three points of surrounding mucosa) was selected for each modality, and CIE1976 (L*a*b*) color space was used to measure the color values. The primary endpoint was color differences (ΔE) between GIM and surrounding mucosa in each modality.

Results

For surrounding mucosa, the mean a* value with Mint-LCI was significantly higher than the mean values with WLI and LCI (P < 0.01). The mean b* value of GIM with LCI was significantly lower than that of surrounding mucosa, and spraying l-menthol decreased the b* values of GIM with a change to a deeper lavender color (LCI: 10.0 ± 5.8, Mint-LCI: 3.7 ± 6.1, P < 0.01). However, there was no significant difference in mean ΔE values between LCI and Mint LCI (LCI: 21.1 ± 6.6, Mint-LCI: 22.7 ± 5.4, NS). After spraying l-menthol, the microstructure of GIM changed to translucent and microvessels were obscured.

Conclusions

As shown by LCI, spraying l-menthol optically enhances the color of GIM in the antrum.
Is there any role of renin-angiotensin system inhibitors in modulating inflammatory bowel disease outcome?
Authors: Mantaka Aikaterini , Tsoukali Emmanouela , Fragkaki Maria , Karmiris Konstantinos , Viazis Nikos , Mantzaris Gerassimos J. , Koutroubakis Ioannis E.
Published: September 2020

Background

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have been associated with improved outcomes in inflammatory bowel disease. We aimed to investigate any possible effect of antihypertensive medications on inflammatory bowel disease course.

Methods

One hundred and fifty inflammatory bowel disease patients with hypertension were compared using a 1:1 ratio with age- and gender-matched control patients with inflammatory bowel disease. The class of antihypertensive medication, traditional risk factors for atherosclerosis, inflammatory bowel disease characteristics, and history (surgery, hospitalizations, and treatment) were retrospectively analyzed.

Results

Of 150 (44.7% Crohn’s disease) patients with hypertension, 46.7% were on angiotensin receptor blockers, 30.6% on angiotensin-converting enzyme inhibitors, 40% on β-blockers, and 40.7% on calcium channel blockers. Univariate analysis revealed significantly higher rates of traditional risk factors for atherosclerosis among antihypertensive users. When analyzing by class of antihypertensive medication, angiotensin receptor blockers were significantly associated with milder course as indicated by less frequent immunomodulator (P = 0.039) and steroid use (P = 0.041). Rates of lifetime steroids were statistically significantly lower among angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (odds ratio = 1.191, 95% confidence interval, 1.005–1.411). After adjustment with confounding factors, only angiotensin receptor blockers were associated with milder inflammatory bowel disease course (P = 0.037) and lower rates of immunomodulator use (P = 0.038).

Conclusions

Our study suggests a possible protective effect of angiotensin receptor blockers on overall inflammatory bowel disease course by targeting the renin-angiotensin system. Their effect on inflammatory bowel disease needs to be studied in larger cohorts.
Ambulatory seton placement followed by fistulotomy: efficacy and safety for perianal fistula treatment
Authors: Gamelas Verónica , Simões Guilherme , Santos Sara , Loureiro Rafaela , Seves Isabel , Costa Simões João , Bettencourt Maria João
Published: September 2020

Purpose

To evaluate the efficacy and safety of ambulatory seton placement followed by superficial fistulotomy as treatment of perianal fistula.

Methods

Retrospective observational analysis of patients with cryptogenic perianal fistula aged 18–90 years, followed in a central hospital proctology consultation between 2006 and 2017. Data were obtained through clinical record’s analysis. Fistula was characterized, using Parks Classification. A probe was passed through the fistula tract, followed by a seton, which remained in situ until superficial fistulotomy was possible.

Results

Ninety-six patients were included (66.67% males, mean age 56 ± 15 years old). Nineteen patients (19.89%) had previous history of perianal fistula and 14 (14.58%) previous anorectal surgery. Seventy-four patients (78.72%) were submitted to fistulotomy, three (3.19%) had seton fistulotomy and one had no seton progression. Intention-to-treat and per-protocol efficacy analyses were 80.2 and 98.7%, respectively. Among the 74 patients who completed the procedure, type of fistula and time with seton were distributed as followed: 47 (63.51%) intersphincteric fistula (15 ± 31 weeks), 26 (35.14%) transsphincteric fistula (32 ± 47 weeks), one (1.35%) suprasphincteric fistula (11 weeks). Previous fistula was associated with a longer time with seton (P = 0.018). Incontinence was reported in two (2.7%) patients, who had previous perianal fistula or anorectal surgery. Two patients (2.7%) had recurrence after fistulotomy.

Conclusion

Placement of seton followed by superficial fistulotomy in an ambulatory setting is a safe and effective method for simple low perianal fistula treatment. Incontinence rate may be higher in patients with previous perianal fistula or anorectal surgery.