bluuebunny/crossref_metadata_2025 huggingface dataset:
Anti-police sentiment and police fear of victimization in the UK
Authors: Smith Richard , Helfers Richard C , Reynolds Paul
Published: June 2021

Victimization of police officers when discharging their duties is not a new phenomenon. In challenging those who seek to undermine legislative provision, there is a clear motive for some sections of society to articulate an anti-police sentiment. Such resistance may be a commonplace among those who see the role of police as agitating and disrupting criminal enterprise. This article explores the concept of anti-police sentiment and fear of victimization among police officers while also exploring the mediating effect of officers’ perception of organizational support. Using survey data from the UK, an assessment is made of the lived experience of law enforcement personnel, in respect of how they perceive the threats to which they are subjected and the influence of perceived organizational support (POS) of their employer. Findings show that increased perception of anti-police sentiment is associated with increased fear of victimization among UK police officers, but that effect is mediated by POS.
Metabolomics analysis identifies a lipidomic profile in treatment-naïve juvenile dermatomyositis patients vs healthy control subjects
Authors: Dvergsten Jeffrey A , Reed Ann M , Landerman Lawrence , Pisetsky David S , Ilkayeva Olga , Huffman Kim M
Published: June 2021

Objectives

To perform an exploratory study to identify a JDM serum metabolic profile that differs from healthy controls (HCs) and responds to immunosuppressive treatment.

Methods

Blood was collected from 9 HCs and 10 patients diagnosed with probable (n = 4) or definite (n = 6) JDM based on the criteria of Bohan and Peter for myositis, with 7 of the 10 providing longitudinal samples following initiation of treatment; these patients comprised the treatment-naïve cohort. Sera underwent mass spectroscopy–based measurements of targeted metabolic intermediates, including 15 amino acids, 45 acylcarnitines (ACs), 15 ceramides and 29 sphingomyelins. Principal components analysis reduced metabolites into smaller sets of factors each comprised of correlated metabolic intermediates. Factor scores and metabolite concentrations were compared with HCs using two-sample t-tests while treatment effects were evaluated using paired t-tests.

Results

Of eight principal components analysis–derived metabolite factors (one AC, two amino acids, three sphingosine and two ceramide), two were significantly associated with JDM: one AC factor containing mostly long-chain ACs (P = 0.049) and one ceramide factor (P < 0.01). For 12 individual ACs, mostly long chain, and three ceramides, concentrations were significantly greater for JDM than HCs. Factors based on these individual metabolites showed decreasing scores with treatment (P = 0.03 and P < 0.01, respectively).

Conclusion

While additional validation is needed, these lipids have potential as JDM serum diagnostic and/or treatment biomarkers. Additionally, the significant association of long-chain ACs and ceramides with JDM offers insights regarding pathogenesis, implicating dysregulation of mitochondrial fatty acid β-oxidation.
During the COVID-19 Pandemic, Opioid Overdose Deaths Revert to Previous Record Levels in Ohio
Authors: Vieson Jamie , Yeh Arthur B. , Lan Qizhen , Sprague Jon E.
Published: June 2021

Objective:

During the COVID-19 pandemic, states have had to confront a drug overdose problem associated with the pandemic. The objective of this study was to identify the impact of the COVID-19 pandemic on the opioid epidemic in the state of Ohio by describing the changes in the quarterly opioid overdose deaths (OOD) over the last 10 years.

Methods:

This longitudinal study included OOD data from death records obtained through the Ohio Department of Health. Temporal trend analysis and visualizations were performed on the OOD death rate per 100,000 quarterly from 2010 to 2020. Age, sex, and ethnicity were also analyzed.

Results:

The OOD rate of 11.15 in Q2 of 2020 was statistically equivalent to the previous peak level of 10.87 in Q1 of 2017. There was a significant increase in the OOD rate from Q1 to Q2 of 2020 and a significant difference between the actual Q2 of 2020 OOD rate and the predicted OOD rate. The poisoning indicator fentanyl was present in 94% of OOD during Q2 of 2020. The total number of OOD remains highest in the White population. There was no significant difference between the actual and predicted OOD rates in the Black population of Q2 of 2020 based on the trend line. However, the OOD rate of 14.29 in Q2 of 2020 was significantly higher than the previous peak level of 8.34 in Q2 of 2017. The Q2 of 2020 OOD rates for 18 to 39 and 40+ age groups were significantly higher from what would be expected from the trend predictions.

Conclusions:

Based on these findings, Ohio has entered a COVID-19 pandemic mediated fourth wave in the opioid epidemic. These findings further suggest that as efforts are made to address the worldwide COVID-19 pandemic, states need to maintain their vigilance toward combating the local opioid epidemic.
Evidence of Designer Benzodiazepine Use in Routine Healthcare Urine Drug Specimens
Authors: Garland Jeneva M. , Hull Jason D. , Bender Chantel L. , Marshall Lucas , Holt Andrew C.
Published: June 2021

Objectives

The illicit drug market continuously evolves, with new substances introduced to mimic prescription or other illicit drugs while evading detection by routine drug testing. The objective was to determine if designer benzodiazepines would be present in urine samples collected from patients in various healthcare settings.

Methods

Samples for which providers ordered testing for prescription benzodiazepines during the study period were diluted, subjected to enzymatic hydrolysis, and analyzed using liquid chromatography- tandem mass spectrometry. In addition to prescription benzodiazepines, samples were also analyzed for presence of any of the following designer benzodiazepines: etizolam, diclazepam, delorazepam, lormetazepam, flubromazepam, flubromazolam, and phenazepam.

Results

Of 38,073 samples tested, 40 samples contained a designer benzodiazepine and/or a metabolite. Of the 40 samples, 19 (47.5%) also tested positive for a prescription benzodiazepine. Twenty-one samples (52.5%) did not test positive for a prescription benzodiazepine, which would result in undetected benzodiazepine use had only traditional definitive testing methods been employed. Thirty-three (82.5%) samples contained an opioid, including 22 (55%) positive for buprenorphine and/or methadone.

Conclusions

The potential harms from the use of designer benzodiazepines are widely unknown due to the lack of traditional pharmacokinetic studies and good manufacturing processes. Our analysis shows that when a designer benzodiazepine was present, over 80% of samples also contained an opioid or a prescription benzodiazepine, which may increase the risk of a drug interaction or adverse drug event. Providers may benefit from knowledge of their patients’ designer benzodiazepine use when formulating risk mitigation strategies as part of a treatment plan.
Acute Hindfoot Nailing for Ankle Fractures: A Systematic Review of Indications and Outcomes
Authors: Cinats David J. , Kooner Sahil , Johal Herman
Published: June 2021

Objectives:

To assess the complication rate of hindfoot nailing of acute fractures involving the tibiotalar joint, and mortality, patient-reported outcome measures, and return to preinjury activities.

Data Sources:

MEDLINE; EMBASE.

Study Selection:

A systematic literature search for articles in English was completed using MEDLINE and EMBASE databases on April 23, 2020. Original research articles that assessed patients with acute intra-articular fractures of the ankle joint (malleolar ankle fractures and/or pilon fractures) that were treated with a locked hindfoot intramedullary nail, inserted retrograde through the plantar surface of the foot, were selected for inclusion. Case reports (≤4 patients), studies with nonlocked implants, and non-English studies were excluded.

Data Extraction and Synthesis:

A validated data extraction form was used, which included study demographics (authors, journal, date of publication, and study design), patient characteristics, implant type, and reported outcomes. Risk of bias for each included study was evaluated using the Institute of Health Economics Quality Appraisal Checklist for case series and the Risk of Bias in randomized trials tool, where appropriate. The best evidence was summarized and weighted mean values were provided when appropriate.

Results:

Ten case series and one randomized controlled trial were included. The overall quality of studies was poor with considerable bias. The majority of studies included elderly patients (weighted mean age 75.5 years) with diabetes (42% of patients). Overall complication rate was 16% with an 8% major complication rate (deep infection, malunion, nonunion, implant failure) and an overall infection rate of 6.2%. Pooled mortality rate was 27% with fracture union rates from 88% to 100%. Mean proportion of patients able to return to preinjury level of activity was 85%.

Conclusions:

Hindfoot nailing of acute ankle and pilon fractures in elderly patients and patients with diabetes is associated with complication rates comparable with other methods of fixation. Issues with elimination of subtalar joint motion and implant complications secondary to poor implant fixation persist. The literature to date has composed of primarily Level IV studies with considerable bias. Further research is necessary to clarify the role of hindfoot nailing of acute ankle and pilon fractures.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Importance of guidelines and networking for the management of rare gynecological cancers
Authors: Lainé Alexandra , Hanvic Brunhilde , Ray-Coquard Isabelle
Published: June 2021

Purpose of review

Guidelines are essential to support appropriate medical management. The objective of our paper is to highlight the need for such recommendations, to reinforce strategies in place and to promote the creation of multidisciplinary networks to provide the most appropriate care to patients and to improve it.

Recent findings

Gynecological rare cancers are not that rare since they represent around 50% of all gynecological cancers. Surgery remains the cornerstone of management for all subtypes. Apart from malignant ovarian germ-cell tumors for which conventional chemotherapy was proven to be efficient, response to standard systemic treatment for other gynecological cancers are disappointing. Better understanding of these pathologies is needed and requires more adapted management.

Rare cancers are substantially heterogeneous but raise the need of integrating new cases in dedicated networks to enhance and homogenize medical practices. Centralized diagnosis, improved medical practice based on regularly updated international guidelines, and inclusion in innovative clinical trials linked to preclinical studies are essential to contribute to the promotion of improvement in patient care.
Assessment of Educational Needs and Design of a Preceptor Development Program for Health Professional Education Programs in Qatar
Authors: Mukhalalati Banan , Awaisu Ahmed , Elshami Sara , Paravattil Bridget , Zolezzi Monica , Abu-Hijleh Marwan , Moslih-Almoslih Ayad , Carr Alison , Bawadi Hiba , Romanowski Michael , Almahasneh Randa , Bacha Rasha
Published: June 2021

Introduction:

Experiential learning is the backbone of many health care professional education programs; however, the quality of learning is profoundly dependent on the skills and experiences of clinical preceptors. This study was conducted at Qatar University Health Cluster (Colleges of Pharmacy, Medicine, and Health Sciences) with the primary objective of identifying the educational needs of preceptors to design and review an educational professional development program.

Methods:

This study adopted a mixed-methods approach and was conducted in three stages: (1) assessment of preceptor educational needs, (2) designing of the Practice Educators' Academy program, and (3) revision and refinement of the designed program. The needs' assessment was conducted at all the three colleges through a validated survey and focus groups comprising of preceptors, students, and clinical faculty members. The sample included 209 survey respondents and 11 focus group sessions.

Results:

The results yielded five key themes and a variety of individual preferences, which were used to design a five-module face-to-face two-day interactive workshop. For the revision of the designed program, the syllabus was shared purposively with selected scholars and experts in the area of health professions education, and their feedback was collected and critically examined. Furthermore, the refinement of the program was performed on the basis of this feedback, resulting in the revised and representative program being ready for piloting.

Discussion:

A preceptor development program on experiential teaching and learning skills was successfully designed and revised with the needs of the clinical preceptors at its core. Preceptors' skills development can advance health care outcomes by preparing competent health professional graduates.
Impact of regional differences in stroke symptom awareness and low-income status on seeking emergency medical service in China
Authors: Yuan Jing , Shan Guang-Liang , Li Sheng-De , Gao Chun-Peng , Cui Li-Ying , Peng Bin
Published: June 2021

Background:

Unawareness of stroke symptoms and low income are two barriers that affect the seeking of emergency medical service (EMS). This study aimed to assess the effect of unawareness and low income on seeking EMS and to investigate the regional distribution of the unawareness and low-income status and their associations with failing to call EMS in China.

Methods:

A total of 187,723 samples from the China National Stroke Screening Survey was interviewed cross-sectionally. Four status of awareness and annual income were identified: unaware and low-income, unaware-only, low-income-only, and aware and regular income. The outcomes were whether they intended to call EMS or not. The regional distribution of each status and their associations with not calling EMS were presented.

Results:

The status of unaware and low-income, unaware-only, and low-income-only accounted for 6.3% (11,806/187,673), 11.9% (22,241/187,673), and 21.5% (40,289/187,673) of the total sample, respectively. Not calling EMS was significantly associated with the status of unaware and low-income (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 3.07–3.35), unaware-only (OR: 2.38, 95% CI: 2.31–2.46), and low-income-only (OR: 1.67, 95% CI: 1.63–1.71), compared with the aware and regular income status. The Midwest regions had higher percentages of people in the unaware and low-income status; the East, South, and Central had higher percentages of unaware-only status; the North and Northeast regions had a higher percentage of low-income-only status, compared with other regions.

Conclusion:

The existence of the regional difference in unawareness and low income justifies the specific stroke education strategies for the targeted regions and population.
Association between socioeconomic status and chronic obstructive pulmonary disease in Jiangsu province, China: a population-based study
Authors: Zhang Dan-Dan , Liu Jian-Nan , Ye Qing , Chen Zi , Wu Ling , Peng Xue-Qing , Lu Gan , Zhou Jin-Yi , Tao Ran , Ding Zhen , Xu Fei , Zhou Linfu
Published: June 2021

Background:

Chronic obstructive pulmonary disease (COPD) is a common public health problem worldwide. Recent studies have reported that socioeconomic status (SES) is related to the incidence of COPD. This study aimed to investigate the association between SES and COPD among adults in Jiangsu province, China, and to determine the possible direct and indirect effects of SES on the morbidity of COPD.

Methods:

A cross-sectional study was conducted among adults aged 40 years and above between May and December of 2015 in Jiangsu province, China. Participants were selected using a multistage sampling approach. COPD, the outcome variable, was diagnosed by physicians based on spirometry, respiratory symptoms, and risk factors. Education, occupation, and monthly family average income (FAI) were used to separately indicate SES as the explanatory variable. Mixed-effects logistic regression models were introduced to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for examining the SES-COPD relationship. A pathway analysis was conducted to further explore the pulmonary function impairment of patients with different SES.

Results:

The mean age of the 2421 participants was 56.63 ± 9.62 years. The prevalence of COPD was 11.8% (95% CI: 10.5%–13.1%) among the overall sample population. After adjustment for age, gender, residence, outdoor and indoor air pollution, body weight status, cigarette smoking, and potential study area-level clustering effects, educational attainment was negatively associated with COPD prevalence in men; white collars were at lower risk (OR: 0.60, 95% CI: 0.43–0.83) of experiencing COPD than blue collars; compared with those within the lower FAI subgroup, participants in the upper (OR: 0.68, 95% CI: 0.49–0.97) tertiles were less likely to experience COPD. Such negative associations between all these three SES indicators and COPD were significant among men only. Education, FAI, and occupation had direct or indirect effects on pulmonary function including post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC), FEV1, FVC, and FEV1 percentage of predicted. Education, FAI, and occupation had indirect effects on pulmonary function indices of all participants mainly through smoking status, indoor air pollution, and outdoor air pollution. We also found that occupation could affect post-bronchodilator FEV1/FVC through body mass index.

Conclusions:

Education, occupation, and FAI had an adverse relationship with COPD prevalence in Jiangsu province, China. SES has both direct and indirect associations with pulmonary function impairment. SES is of great significance for COPD morbidity. It is important that population-based COPD prevention strategies should be tailored for people with different SES.
HIV and Sexually Transmitted Infection Epidemic Potential of Networks of Men Who Have Sex With Men in Two Cities
Authors: Anderson Emeli J. , Weiss Kevin M. , Morris Martina M. , Sanchez Travis H. , Prasad Pragati , Jenness Samuel M.
Published: June 2021

Background:

The speed with which a pathogen circulates in a sexual network is a function of network connectivity. Cross-sectional connectivity is a function of network features like momentary degree and assortative mixing. Temporal connectivity is driven by partner acquisition rates. The forward-reachable path (FRP) has been proposed as a summary measure of these two aspects of transmission potential. We use empirical data from San Francisco and Atlanta to estimate the generative parameters of the FRP and compare results to the HIV/sexually transmitted infection epidemics in each city.

Methods:

We used temporal exponential random graph models to estimate the generative parameters for each city’s dynamic sexual network from survey data. We then simulated stochastic dynamic networks from the fitted models and calculated the FRP for each realization, overall, and stratified by partnership type and demographics.

Results:

The overall mean and median paths were higher in San Francisco than in Atlanta. The overall paths for each city were greater than the sum of the paths in each individual partnership network. In the casual partnership network, the mean path was highest in the youngest age group and lowest in the oldest age group, despite the fact that the youngest group had the lowest mean momentary degree and past-year partner counts.

Conclusions:

The FRP by age group revealed the additional utility of the measure beyond the temporal and cross-sectional network connectivity measures. Other nonnetwork factors are still necessary to infer total epidemic potential for any specific pathogen.
Estimating the Impact of Sustained Social Participation on Depressive Symptoms in Older Adults
Authors: Shiba Koichiro , Torres Jacqueline M. , Daoud Adel , Inoue Kosuke , Kanamori Satoru , Tsuji Taishi , Kamada Masamitsu , Kondo Katsunori , Kawachi Ichiro
Published: June 2021

Background:

Social participation has been suggested as a means to prevent depressive symptoms. However, it remains unclear whether a one-time boost suffices or whether participation needs to be sustained over time for long-term prevention. We estimated the impacts of alternative hypothetical interventions in social participation on subsequent depressive symptoms among older adults.

Methods:

Data were from a nationwide prospective cohort study of Japanese older adults ≥65 years of age (n = 32,748). We analyzed social participation (1) as a baseline exposure from 2010 (approximating a one-time boost intervention) and (2) as a time-varying exposure from 2010 and 2013 (approximating a sustained intervention). We defined binary depressive symptoms in 2016 using the Geriatric Depression Scale. We used the doubly robust targeted maximum likelihood estimation to address time-dependent confounding.

Results:

The magnitude of the association between sustained participation and the lower prevalence of depressive symptoms was larger than the association observed for baseline participation only (e.g., prevalence ratio [PR] for participation in any activity = 0.83 [95% confidence interval = 0.79, 0.88] vs. 0.90 [0.87, 0.94]). For activities with a lower proportion of consistent participation over time (e.g., senior clubs), there was little evidence of an association between baseline participation and subsequent depressive symptoms, while an association for sustained participation was evident (e.g., PR for senior clubs = 0.96 [0.90, 1.02] vs. 0.88 [0.79, 0.97]). Participation at baseline but withholding participation in 2013 was not associated with subsequent depressive symptoms.

Conclusions:

Sustained social participation may be more strongly associated with fewer depressive symptoms among older adults.
Effects of Spironolactone on Hypoxia-Inducible Factor-1α in the Patients Receiving Coronary Artery Bypass Grafting
Authors: Lou Yu-Mei , Zheng Zhe-Lan , Xie Lin-Yuan , Lian Jiang-Fang , Shen Wen-Jun , Zhou Jian-Qing , Shao Guo-Feng , Hu De-Xing
Published: June 2021

We explored the protective effect of spironolactone on cardiac function in the patients undergoing coronary artery bypass grafting (CABG) by determining serum hypoxia-inducible factor-1α (HIF-1α) before and after CABG. We used the propensity score matching method retrospectively to select 174 patients undergoing CABG in our hospital from March 2018 to December 2019. Of the 174 patients, 87 patients taking spironolactone for more than 3 months before CABG were used as a test group and other 87 patients who were not taking spironolactone as a control group. In all patients, serum HIF-1α and troponin I levels were determined before as well as 24 hours and 7 days after CABG, serum N-terminal probrain natriuretic peptide (NT-proBNP) level was determined before as well as 12, 24, and 36 hours after CABG, and electrocardiographic monitoring was performed within 36 hours after CABG. The results indicated that there were no significant differences in the HIF-1α level between the test group and the control group before and 7 days after CABG, but the HIF-1α level was significantly lower in the test group than that in the control group 24 hours after CABG (P < 0.01). The 2 groups were not significantly different in the troponin I level at any time point. There was no significant difference in the serum NT-proBNP level between the test group and the control group before CABG, but NT-proBNP (BNP) levels were all significantly lower in the test group than those in the control group at postoperative 12, 24, and 36 hour time points (all P <0.05). The incidence of postoperative atrial fibrillation was also significantly lower in the test group than that in the control group (P = 0.035). Spironolactone protects cardiac function probably by improving myocardial hypoxia and inhibiting myocardial remodeling.
Preadmission Statin Therapy and Clinical Outcome in Hospitalized Patients With COVID-19: An Italian Multicenter Observational Study
Authors: Russo Vincenzo , Silverio Angelo , Scudiero Fernando , Attena Emilio , D'Andrea Antonello , Nunziata Luigi , Parodi Guido , Celentani Dario , Varbella Ferdinando , Albani Stefano , Musumeci Giuseppe , Di Micco Pierpaolo , Di Maio Marco
Published: June 2021

Statin therapy has been recently suggested as possible adjuvant treatment to improve the clinical outcome in patients with coronavirus disease 2019 (COVID-19). The aim of this study was to describe the prevalence of preadmission statin therapy in hospitalized patients with COVID-19 and to investigate its potential association with acute distress respiratory syndrome (ARDS) at admission and in-hospital mortality. We retrospectively recruited 467 patients with laboratory-confirmed COVID-19 admitted to the emergency department of 10 Italian hospitals. The study population was divided in 2 groups according to the ARDS diagnosis at admission and in-hospital mortality. A multivariable regression analysis was performed to assess the risk of ARDS at admission and death during hospitalization among patients with COVID-19. A competing risk analysis in patients taking or not statins before admission was also performed. ARDS at admission was reported in 122 cases (26.1%). There was no statistically significant difference for clinical characteristics between patients presenting with and without ARDS. One hundred seven patients (18.5%) died during the hospitalization; they showed increased age (69.6 ± 13.1 vs. 66.1 ± 14.9; P = 0.001), coronary artery disease (23.4% vs. 12.8%; P = 0.012), and chronic kidney disease (20.6% vs. 11.1%; P = 0.018) prevalence; moreover, they presented more frequently ARDS at admission (48.6% vs. 19.4%; P < 0.001). At multivariable regression model, statin therapy was not associated neither with ARDS at admission nor with in-hospital mortality. Preadmission statin therapy does not seem to show a protective effect in severe forms of COVID-19 complicated by ARDS at presentation and rapidly evolving toward death.
Potential Biomarkers in Atrial Fibrillation: Insight Into Their Clinical Significance
Authors: Charafeddine Khalil , Zakka Patrick , Bou Dargham Bassel , Abdulhai Farah , Zakka Katerina , Zouein Fouad A. , Refaat Marwan
Published: June 2021

In risk-stratifying patients with atrial fibrillation (AF), physicians rely heavily on clinical parameters that provide risk scores and determine treatment strategies. There has been increasing research on potential biomarkers in the blood that could more accurately determine both risk of complications in AF and risk of incidence of AF. This review highlights the clinical significance of 5 novel biomarkers that have been shown to be linked to AF. These biomarkers are carbohydrate antigen 125, galectin-3, growth differentiation factor-15, a member of the interleukin 1 receptor family, IL1RL1 (ST2), and N-terminal pro B-type natriuretic peptide.
Comparative Results of Treatment and Complications: Pedea in Open Ductus Arteriosus in Premature Infants
Authors: Kemelbekov Kanatzhan , Musaev Yuldash , Bektenova Gulmira , Datkayeva Gulmira , Tuktibayeva Saule , Bekenov Nurlan , Khatamov Furkhat , Ilyassova Gulnara , Gatauova Madina , Zhumabekov Zharylkap , Kuandykov Yerlan , Tazhiyeva Aigul , Abdrakhmanova Zinat , Omarova Balnur , Tasbulatov Nurgeldi
Published: June 2021

The open ductus arteriosus (ODA) is the vessel through which the pathological communication between the aorta and the pulmonary artery persists after birth. Clinical manifestations depend on the size of the duct and the stage of hemodynamic disorders. The course of the defect varies from asymptomatic to extremely severe. With large duct sizes, the latter manifests itself from the first week of life with signs of heart failure. The current research is devoted to the choice of the optimal method of medical and surgical treatment in premature newborns with an unaffected ductus arteriosus. Drug therapy for pulmonary hypertension is recommended only for those patients who have irreversible pulmonary hypertension. Surgical closure of the ODA is recommended for overloads of the left heart or signs of pulmonary hypertension in the presence of blood discharge from left to right and after previously suffered endocarditis. The article analyzes current information about the treatment of premature infants with ODA.
Pulmonary Embolism in Pregnancy: Ultrasound-Assisted Catheter-Directed Thrombolytic Therapy for the Treatment of a Pulmonary Embolus—A Case Report
Authors: Baracy Michael G. , Olotu Olumide , Marchese Phillip , Gosselin Marc , Vengalil Shyla
Published: June 2021

In the United States, pulmonary embolism (PE) accounts for approximately 10% of all pregnancy related deaths. The standard treatment for a patient with high-risk PE is systemic thrombolysis. Systemic thrombolysis in pregnancy is associated with the risk of maternal hemorrhage and fetal complications, including spontaneous abortion, preterm delivery, and fetal bleeding. Currently, there is limited evidence for a standardized approach for the treatment and management of intermediate- and high-risk PEs in pregnancy. A 36-year-old gravida 3 para 2002 woman at 31+1 weeks of gestation with a history of deep vein thrombosis in her prior pregnancy presented with shortness of breath. A computed tomography angiogram revealed a large pulmonary embolus with a saddle component that extended into the bilateral upper and lower lobes and into the secondary and tertiary pulmonary branches. A subsequent bedside echocardiogram demonstrated a dilated right ventricle with severely reduced right ventricular systolic function. The patient was successfully treated with bilateral ultrasound-assisted catheter-directed thrombolysis. She subsequently delivered a healthy male infant at term. Reported cases of ultrasound-assisted catheter-directed thrombolysis in pregnant patients is limited. Our case demonstrates that localized thrombolysis is a viable treatment option for life-threatening PE in pregnancy. Catheter-directed thrombolysis can be efficacious in treating intermediate- and high-risk PEs in pregnancy while simultaneously reducing the risk of bleeding complications.
Reproductive potential and fertility preservation in transgender and nonbinary individuals
Authors: Schwartz Amanda R. , Moravek Molly B.
Published: June 2021

Purpose of review

To synthesize recent literature to better understand parenting desires and challenges of transgender individuals as well as the impact of gender-affirming care on reproductive potential.

Recent findings

Survey studies of transgender and nonbinary individuals demonstrate significant parenting interest, yet uptake in fertility preservation services remains low with potential for decisional regret. Masculinizing hormones have demonstrated variable effects on folliculogenesis and follicle distribution in the human ovary. In the mouse model, testosterone administration has demonstrated an increase in atretic late antral follicles without a reduction in primordial or total antral follicle counts and a preserved ability to respond to gonadotropin stimulation. Case series of transgender individuals undergoing oocyte or embryo cryopreservation are promising with outcomes similar to cisgender controls. Feminizing hormones have shown detrimental effects on sperm parameters at time of cryopreservation and spermatogenesis in orchiectomy samples with uncertainty regarding the reversibility of these changes.

Current evidence demonstrates variable effects of gender-affirming hormones on ovarian and testicular function with potential for detrimental impact on an individual's reproductive potential. As many individuals initiate gender-affirming care prior to or during their reproductive years it is imperative that they receive thorough fertility preservation counseling and improved access to reproductive care services.
Cardiac rehabilitation for coronary artery disease: latest updates
Authors: Epstein Elizabeth , Maisel Sofie , Maysent Kathryn , Taub Pam R.
Published: June 2021

Purpose of review

To summarize recent innovations in cardiac rehabilitation and provide a view towards the future of cardiac rehabilitation as it adjusts to the pressures of a global pandemic.

Recent findings

Although cardiac rehabilitation has been shown to result in a mortality benefit, research continues to enumerate the benefits of cardiac rehabilitation to patient function and quality of life in a growing range of cardiovascular diseases. In addition, new methodologies and new models of cardiac rehabilitation have emerged with the goal of increasing patient referral and participation.

Cardiac rehabilitation continues to evolve and adapt to serve a growing and diversifying number of patients with cardiovascular disease with the goal of both decreasing mortality and improving patient function.
Characteristics of people with severe hypertension in France and determinants of medication persistence after 6 years
Authors: Tuppin Philippe , Denis Pierre , Gastaldi Christelle , Olié Valérie , Blacher Jacques
Published: June 2021

Background:

Low medication persistence is reported in patients with severe hypertension but few data are available according to drug classes.

Method:

Adults without cardiovascular disease who started treatment, in a semester between 2010 and 2012, with two concurrent dispensings of at least three classes were identified in the French national health data system. High persistence after 12 semesters of follow-up was defined by a 6-monthly mean of number of drug classes equal to or greater than 80%.

Results:

Five hundred and seventy-six thousand and forty-eight adults alive at 6 years were included (three classes: 79%, four classes: 18%, five or more classes: 4%) with a mean age of 65.3 years, constituting 42% of men. High persistence was observed for 72% of people and multivariate analysis of baseline factors found a negative association for: female sex, extreme ages, living in an overseas department, at least one comorbidity, absence or frequent general practitioner consultations and a cardiologist consultation. The adjusted odds ratio was low for dispensing of ACEIs (0.87; 95% CI: 0.8–0.95), other RAS antagonists (0.91; 95% CI: 0.83–0.99) and a high number of classes (4: 0.17; 95% CI: 0.15–0.19, five and more: 0.06; 95% CI: 0.05–0.08). An inverse association was observed for diuretics (1.45; 95% CI: 1.33–1.59), calcium channel blockers (1.63; 95% CI: 1.50–1.79), beta-blockers (1.92; 95% CI: 1.76–2.1) and other antihypertensive classes (1.6; 95% CI: 1.5–1.8). No significant association was observed for ARBs (1.0; 95% CI: 0.9–1.1).

Conclusion:

These results based on a large primary prevention population should encourage the implementation of new pharmacological and nonpharmacological management strategies for people with severe hypertension in France.
Maternal myocardial dysfunction after hemolysis, elevated liver enzymes, and low platelets syndrome: a speckle-tracking study
Authors: Sciatti Edoardo , Mohseni Zenab , Orabona Rossana , Mulder Eva G. , Prefumo Federico , Lorusso Roberto , Frusca Tiziana , Ghossein-Doha Chahinda , Spaanderman Marc E.A.
Published: June 2021

Objectives:

Pregnancy complicated by pre-eclampsia (PE) and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is associated with an increased risk of cardiovascular (CV) diseases later in life. Subclinical cardiac alterations precede eminent CV diseases. Speckle-tracking echocardiography (STE) is an effective method to assess subclinical myocardial dysfunction. We performed a myocardial speckle tracking study to investigate the prevalence of subclinical myocardial dysfunction in former PE patients (with and without HELLP syndrome) compared to normotensive women affected by HELLP syndrome.

Methods:

In this cross-sectional retrospective study, women with a history of normotensive HELLP (n = 32), PE without HELLP (n = 59), and PE with HELLP (n = 101) underwent conventional and STE as part of the clinical CV work-up after their complicated pregnancies from 6 months to 4 years postpartum. We excluded women with comorbidities, including chronic hypertension, hypercholesterolemia, and obesity.

Results:

Women with a history of PE with HELLP syndrome were characterized by a higher prevalence of altered left ventricular circumferential and global longitudinal two-dimensional (2D) strain (74 and 20%, respectively), altered right ventricular longitudinal 2D strain (37%), and left atrial (LA) 2D strain (57%). Moreover, a higher proportion of alterations of biventricular and LA strains was also present in former PE without HELLP as well as in the normotensive HELLP group.

Conclusions:

In the first years after a pregnancy complicated by HELLP syndrome, irrespective of whether there was concomitant PE, a higher rate of abnormal STE myocardial function is observed. Therefore, these women may benefit from CV risk management.
Insulin resistance, metabolic syndrome, and blood pressure progression among Blacks: the Jackson Heart Study
Authors: Kaze Arnaud D. , Musani Solomon K. , Correa Adolfo , Bertoni Alain G. , Golden Sherita H. , Abdalla Marwah , Echouffo-Tcheugui Justin B.
Published: June 2021

Objective:

There is a paucity of data on the relations of insulin resistance with incident blood pressure (BP) changes among Blacks. We investigated the associations of insulin resistance and metabolic syndrome (MetS) with BP progression in a community-based sample of African Americans.

Methods:

We analyzed 1064 participants without hypertension at baseline (2000–2004) who attended at least one follow-up visit in 2005–2008 or 2009–2013. Four insulin resistance indices [fasting insulin, insulin-to-glucose ratio (IGR), homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI)] and MetS (excluding hypertension in the definition) were assessed at baseline. Robust Poisson regression was used to generate risk ratios (RRs) and 95% confidence intervals (CI) for BP progression and incident hypertension.

Results:

Over a median of 7 years, 69.6% progressed to a higher BP category and 62.7% developed hypertension. After multivariable adjustment, participants in the highest quartile of HOMA-IR had higher risks of BP progression [RR 1.25 (95% CI 1.09–1.43), P
trend = 0.004] and hypertension [RR 1.35 (95% CI 1.16–1.58), P
trend < 0.001] compared with those in the lowest quartile. A similar positive association of insulin resistance with BP outcomes was noted with insulin resistance assessed using IGR, fasting insulin, and QUICKI. MetS was associated with increased risks of BP progression [RR 1.15 (95% CI 1.02–1.30), P = 0.02] and incident hypertension [RR 1.23 [95% CI 1.08–1.41], P = 0.002]. These associations were present across baseline BP categories.

Conclusion:

Our findings support the notion that higher insulin resistance levels are associated with greater risks of BP progression and incident hypertension among Blacks.
The Effect of Mindfulness Breathing Meditation on Psychological Well-being
Authors: Ibrahim Kusman , Komariah Maria , Herliani Yusshy Kurnia
Published: June 2021

The study aims to test the effect of mindfulness breathing meditation on psychological well-being among nurses working for COVID-19 patients. A total of 50 nurses (25 each in the intervention and control groups) were included in the study. We found significant differences between the preintervention and postintervention mean scores of both groups, based on the Warwick-Edinburgh Mental Well-being Scale Indonesian version.
NEW INSIGHTS INTO THE ASSOCIATION BETWEEN CHOROIDAL VESSELS AND CHORIOCAPILLARIS IN NORMAL EYES
Authors: Sun Gongpeng , Chen Changzheng , Jiang Jingwen , Yi Zuohuizi , Wang Xiaoling , Miao Qingmei , Xu Amin , He Lu
Published: June 2021

Purpose:

To determine the relationship between large-sized and medium-sized choroidal vessels and choriocapillaris using the three-dimensional choroidal vascularity index (3D CVI) and percentage of flow deficits (FD%).

Methods:

Prospective observational study. The main outcome measures included choroidal volume parameters (3D CVI, mean choroidal thickness, total choroidal volume, choroidal luminal volume, and choroidal stromal volume), choriocapillaris parameters (FD%, average area of FD, and FD count), and age and axial length.

Results:

A total of 63 healthy individuals with an average age of 40.60 ± 12.32 years were included in this study. Univariate analysis showed that FD% (R = 0.295, P = 0.019) and area of FD (R = 0.276, P = 0.028) were significantly positively associated with 3D CVI, and FD count was negatively associated with 3D CVI (R = −0.297, P = 0.018). After adjusting for age and axial length, a significant correlation between FD% and 3D CVI (R = 0.264, P = 0.039) and between area of FD and 3D CVI remained (R = 0.267, P = 0.037). However, no significant correlation was found between FD count and 3D CVI after adjusting for axial length (R = −0.220, P = 0.085).

Conclusion:

In healthy individuals, choroidal vessel dilatation as suggested by elevated 3D CVI may lead to decreased choriocapillaris perfusion, which was correlated with an enlarged area of FD in choriocapillaris.
LONG-TERM COURSE AND VISUAL OUTCOMES OF PRECHOROIDAL CLEFT IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION AND POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Kim Jae Hui , Kim Jong Woo , Kim Chul Gu , Lee Dong Won
Published: June 2021

Purpose:

To evaluate the regression of prechoroidal cleft, its influence on visual outcomes, and differences in visual outcomes between neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.

Methods:

This retrospective study included 61 patients exhibiting prechoroidal cleft who were treated with antivascular endothelial growth factors. The patients were divided into two groups according to the following categories: 1) regression of prechoroidal cleft: regression group versus nonregression group and 2) type of neovascularization: neovascular age-related macular degeneration group versus polypoidal choroidal vasculopathy group. Changes in the visual acuity during the follow-up period were also compared between the two groups.

Results:

During the 52.4 ± 17.4-month follow-up period, regression of prechoroidal cleft was noted in 17 patients (27.9%) at a mean of 25.7 ± 18.3 months after the first identification. The degree of the logarithm of the minimum angle of resolution of visual deterioration was greater in the nonregression group (0.59 ± 0.56, n = 17) than that in the regression group (0.25 ± 0.61, n = 44) (P = 0.007) and in the neovascular age-related macular degeneration group (0.56 ± 0.61, n = 51) than that in the polypoidal choroidal vasculopathy group (0.18 ± 0.33, n = 10) (P = 0.034).

Conclusion:

Approximately 27.9% of prechoroidal cleft cases eventually regressed, in conjunction with relatively favorable visual outcomes. Considering the poor visual prognosis in neovascular age-related macular degeneration accompanied by prechoroidal cleft, more caution is required for this condition.
REVISED PREDICTIVE BIOMARKER FOR OCRIPLASMIN THERAPY IN VITREOMACULAR TRACTION DISORDERS
Authors: Al-Nawaiseh Sami , Rickmann Annekatrin , Seuthe Anna-Maria , Al-Rimawi Dalia , Viktor Stanzel Boris , Szurman Peter
Published: June 2021

Purpose:

To determine a statistically optimal limit of adhesion size in vitreomacular traction (VMT) syndrome for ocriplasmin treatment.

Methods:

In this retrospective, consecutive, interventional study, we included 106 patients treated with ocriplasmin injection because of VMT between July 2013 and January 2018. A univariate and multivariate risk analysis was performed with grouped factors and continuous factors. We used a receiver operating characteristic curve to measure the prognostic relevance of each continuous factor for therapy success and determined the statistically optimal cutoff value at which specificity and sensitivity are simultaneously maximized.

Results:

Among the grouped factors, only a phakic lens status showed a highly significant positive influence on the resolution of the VMT. For the continuous factors, only the adhesion diameter before injection was a good predictor of anatomical success. The statistically optimal threshold value for the adhesion size was calculated to be 480 µm. Eyes below this limit had a 6.84-fold better chance of VMT resolution compared with eyes with a larger adhesion diameter.

Conclusion:

The threshold value of the VMT diameter for ocriplasmin therapy could be statistically defined as 480 µm and may thus be a new quantitative biomarker to predict treatment success.
A Novel Virtual Wet Lab–Using a Smartphone Camera Adapter and a Video Conference Platform to Provide Real-Time Surgical Instruction
Authors: Cervantes Lorenzo J. , Tallo Christian A. , Lopes Caithlin A. , Hellier Erik A. , Chu David S.
Published: June 2021

Purpose:

Proctored surgical instruction has traditionally been taught through in-person interactions in either the operating room or an improvised wet lab. Because of the COVID-19 pandemic, live in-person instruction was not feasible owing to social distancing protocols, so a virtual wet lab (VWL) was proposed and implemented. The purpose of this article is to describe our experience with a VWL as a Descemet membrane endothelial keratoplasty (DMEK) skills-transfer course. This is the first time that a VWL environment has been described for the instruction of ophthalmic surgery.

Methods:

Thirteen participant surgeons took part in VWLs designed for DMEK skills transfer in September and October 2020. A smartphone camera adapter and a video conference software platform were the unique media for the VWL. After a didactic session, participants were divided into breakout rooms where their surgical scope view was broadcast live, allowing instructors to virtually proctor their participants in real time. Participants were surveyed to assess their satisfaction with the course.

Results:

All (100%) participants successfully injected and unfolded their DMEK grafts. Ten of the 13 participants completed the survey. Respondents rated the experience highly favorably.

Conclusions:

With the use of readily available technology, VWLs can be successfully implemented in lieu of in-person skills-transfer courses. Further development catering to the needs of the participant might allow VWLs to serve as a viable option of surgical education, currently limited by geographical and social distancing boundaries.