bluuebunny/crossref_metadata_2025_split huggingface dataset:
EFFICACY AND SAFETY OF INTRAVITREAL AFLIBERCEPT USING A TREAT-AND-EXTEND REGIMEN FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Mitchell Paul , Holz Frank G. , Hykin Philip , Midena Edoardo , Souied Eric , Allmeier Helmut , Lambrou George , Schmelter Thomas , Wolf Sebastian ,   on behalf of the ARIES study investigators
Published: March 2021

Background/Purpose:
Treating neovascular age-related macular degeneration with intravitreal aflibercept treat-and-extend (T&E) can reduce treatment burden. ARIES assessed whether intravitreal aflibercept early-start T&E was noninferior to late-start T&E.

Methods:
A randomized, open-label, Phase 3b/4 study that included treatment-naïve patients aged ≥50 years with the best-corrected visual acuity 73–25 Early Treatment Diabetic Retinopathy Study letters and active choroidal neovascularization secondary to AMD. Patients received 2 mg intravitreal aflibercept at Week (W) 0, W4, W8, and W16. At W16, patients were randomized 1:1 to early-start (2W interval adjustments) or late-start T&E (8W intervals until W48 then 2W interval adjustments). Primary endpoint: the best-corrected visual acuity change from randomization to W104.

Results:
Two-hundred seventy-one patients were randomized. The mean (SD) best-corrected visual acuity at baseline was 60.2 (12.1; early-T&E) and 61.3 (10.8; late-T&E) letters. The mean (SD) best-corrected visual acuity change (W16–104) was −2.1 (11.4) versus −0.4 (8.4) letters (early-T&E vs. late-T&E; least-squares mean difference: −2.0; 95% confidence interval: −4.75 to 0.71; P = 0.0162 for noninferior); +4.3 (13.4) versus +7.9 (11.9) letters (W0–104). The mean (SD) number of injections was 12.0 (2.3) versus 13.0 (1.8). From baseline to W104, 93.4% and 96.2% maintained best-corrected visual acuity; the mean (SD) central retinal thickness change was −161.6 (135.6) µm and −158.6 (125.1) µm. The last injection interval (W104) was ≥12W for 47.2% and 51.9% of patients.

Conclusion:
Outcomes were similar between patients with neovascular age-related macular degeneration treated with an intravitreal aflibercept early-T&E or late-T&E regimen after initial dosing, with one injection difference over 2 years.

Trial Registration:

ClinicalTrials.gov Identifier: NCT02581891 https://clinicaltrials.gov/ct2/show/NCT02581891. Supplemental Digital Contents (files 1 http://links.lww.com/IAE/B419).
Anti-inflammatory and Antioxidant Effects of Selenium on Orbital Fibroblasts of Patients With Graves Ophthalmopathy
Authors: Kim Bo-Yeon , Jang Sun-Young , Choi Dug-Hyun , Jung Chan-Hee , Mok Ji-Oh , Kim Chul-Hee 
Published: March 2021

Purpose:
In the present study, the authors investigated the effects of selenium on inflammation, hyaluronan production, and oxidative stress in primary cultured orbital fibroblasts of patients with Graves ophthalmopathy (GO).

Methods:
Orbital adipose/connective tissue specimens were obtained during the course of orbital surgery for patients with GO (n = 7) and other noninflammatory problems (n = 5). After incubation with various concentrations of sodium selenite for 48 hours, supernatants from primary cultures were collected. Hyaluronan and cytokine levels were measured using commercially available enzyme-linked immunosorbent assay kits. To determine the effect of selenium on reactive oxygen species (ROS) production stimulated by H2O2 (100 μM) for 30 minutes, the cells were pretreated with various concentrations of sodium selenite for 60 minutes.

Results:
Interleukin (IL)-6 and tumor necrosis factor-alpha levels were significantly higher in orbital fibroblasts of patients with GO than in orbital fibroblasts of control patients. Hyaluronan production was suppressed by selenium in cultured orbital fibroblasts of patients with GO. Inflammatory cytokines such as IL-1α, IL-8, and tumor necrosis factor-alpha were suppressed by selenium in cultured orbital fibroblasts of patients with GO. IL-1β and IL-6 were not suppressed by selenium in cultured orbital fibroblasts of patients with GO. Selenium pretreatment reduced intracellular ROS generation stimulated by H2O2 in cultured orbital fibroblasts of patients with GO.

Conclusions:
In conclusion, hyaluronan production, inflammatory cytokines, and intracellular ROS generation were suppressed by selenium in cultured orbital fibroblasts of patients with GO. Several inflammatory cytokines may be suppressed by selenium in cultured orbital fibroblasts of patients with GO. This study provide the basis for use of selenium in the treatment of GO.
Management of Pediatric Acute Dacryocystitis
Authors: Prat Daphna , Magoon Katie , Revere Karen E. , Katowitz James A. , Katowitz William R. 
Published: March 2021

Purpose:
To analyze the clinical presentation, course, and management in a large cohort of pediatric acute dacryocystitis subjects and to examine whether hospitalization and urgent surgical intervention are indeed mandatory.

Methods:
A retrospective analysis of all pediatric subjects diagnosed with dacryocystitis at the Children’s Hospital of Philadelphia over a 12-year period (2009–2020).

Results:
One-hundred sixty-nine pediatric acute dacryocystitis patients were included in this study. Management included admission in 117 cases (69%). Sixty-eight patients (40%) were treated medically with no surgical intervention, 75 cases (44%) required urgent surgical intervention, and 26 additional cases (15%) required surgery due to persistent tearing symptoms after medical management. The urgent procedures included most commonly: 1) endonasal examination and microdebridement of intranasal cysts in 26 cases (35%); 2) probing and irrigation without examination and microdebridement, with or without stent intubation, in 30 cases (40%); and 3) dacryocystorhinostomy (13 endonasal and 4 external) in 17 cases (23%).

Conclusions:
Management of pediatric acute dacryocystitis should be tailored individually for each case. Hospital admission and early surgical intervention are not mandatory, as 31% of cases resolved without admission, and 56% without early surgical intervention. Although a specific age cutoff is not plausible, hospital admission for younger patients is more commonly advocated. When surgical intervention is indicated, endonasal examination and microdebridement of any associated intranasal cyst and probing with possible stenting are the initial procedures of choice. Dacryocystorhinostomy is reserved for more complex obstructions. Although pediatric acute dacryocystitis is an infection with serious potential problems, when managed appropriately, complications are rare.
Surgical Technique to Retrieve a Migrated Lester Jones Lacrimal Tube
Authors: Wirth Magdalena A. , Dolman Peter J. 
Published: March 2021

Purpose:
To describe a technique for retrieving an inferomedially migrated Jones lacrimal tube.

Methods:
The distal end of the migrated Jones tube is visualized directly via the nose. The tip of an endoilluminator (23 Gauge Constellation Vision Systems) is bent to form a 45° to 60° angle using a mosquito forceps and inserted into the distal opening of the tube. The endoilluminator is used to push the tube upward toward the original medial canthal opening and limit downward displacement as the caruncular area is surgically explored. The light transilluminating the tube facilitates its visualization and retrieval in the caruncular area. A new tube may be threaded through the same passage, or if the ostium is traumatized, through a new passage.

Results:
This technique is time-efficient and has proven to be safe and successful in subsequent patients.

Conclusions:
The described technique aids in retrieving an inferomedially migrated Jones tube with minimal trauma to the surrounding structures.
Whole-milk consumption decreases the risk of inflammatory bowel disease: a two-sample Mendelian randomization analysis
Authors: Li Jiuling , Zhu Haoxue , Tian Aowen , Guo Ying , Zhao Xiaoxuan , Zhang Miaoran , Chen Lanlan , Wen Jianping , Yang Jianli , Qi Baiyu , Chen Peng 
Published: March 2021

Objective:
The impact of dairy fat on inflammatory bowel disease remained inconclusive. We aimed to compare the effects of whole-milk and skimmed-milk consumption on the risk of inflammatory bowel disease using a Mendelian randomization analysis.

Methods:

We conducted a genome-wide association study of the preference for whole versus skimmed milk using data for 20,200 whole-milk consumers and 67,847 skimmed-milk consumers from the UK Biobank. The lead single nucleotide polymorphisms in the associated loci were identified at the genome-wide significance level, and were further employed as instrumental variables for whole-milk preference. We conducted a two-sample Mendelian randomization analysis with whole-milk preference as the exposure and inflammatory bowel disease as the outcome. The pleiotropic effects and heterogeneity of the instrumental variables were estimated using Mendelian randomization-Egger regression and Cochran
Q
test, respectively. This study was conducted using the UKB resources under the application "53536" . The UK Biobank was approved by the North West Multi-center Research Ethics Committee, the National Information Governance Board for Health and Social Care in England and Wales, and the Community Health Index Advisory Group in Scotland.

Results:

The genome-wide association study identified five lead nucleotide polymorphisms associated with whole-milk preference. Mendelian randomization indicated that whole-milk preference significantly decreased the risk of inflammatory bowel disease (
β
=-1.735,
P
=0.048). Of the two subtypes, whole-milk preference was associated with a lower risk of Crohn disease (
β
=-2.549,
P
=0.032), but had no significant effect on the risk of ulcerative colitis (
β
=-1.002,
P
=0.44).

Conclusion:
Consumption of whole-milk fat may protect against Crohn disease, compared with skimmed milk. This conclusion was based on causal inference in a cohort study, and further validation in randomized controlled trials is warranted.
Impact of the COVID-19 pandemic on cardiac arrest systems of care
Authors: Kovach Christopher P. , Perman Sarah M. 
Published: March 2021

Purpose of review
The emergence of severe acute respiratory syndrome coronavirus 2 virus, which causes coronavirus disease 2019 (COVID-19), led to the declaration of a global pandemic by the World Health Organization on March 11, 2020. As of February 6, 2021, over 105 million persons have been infected in 223 countries and there have been 2,290,488 deaths. As a result, emergency medical services and hospital systems have undergone unprecedented healthcare delivery reconfigurations. Here, we review the effects of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) epidemiology and systems of care.

Recent findings
Areas severely affected by the pandemic have reported increased incidence of OHCA, lower rates of successful resuscitation, and increased mortality. COVID-19 has significantly impacted patient outcomes through increased disease severity, decreased access to care, and the reshaping of emergency medical response and hospital-based healthcare systems and policies. The pandemic has negatively influenced attitudes toward resuscitation and challenged providers with novel ethical dilemmas provoked by the scarcity of healthcare resources.

Summary
The COVID-19 pandemic has had direct, indirect, psychosocial, and ethical impacts on the cardiac arrest chain of survival.
Neurogenic fever due to injury of the hypothalamus in a stroke patient
Authors: Jang Sung Ho , Seo You Sung 
Published: March 2021

Abstract

Rationale:
Neurogenic fever is a non-infectious source of fever in a patient with brain injury, especially hypothalamic injury. We report on a stroke patient with neurogenic fever due to injury of hypothalamus, demonstrated by using diffusion tensor imaging (DTI).

Patient concerns:
A 28-year-old male patient was admitted to the rehabilitation department of university hospital at 30 months after onset. Brain MRI showed leukomalactic lesions in hypothalamus, bilateral medial temporal lobe, and bilateral basal ganglia. He showed intermittent high body temperature (maximum:39.5°C, range:38.5–39.2°C), but did not show any infection signs upon physical examination or after assessing his white blood cell count and inflammatory enzyme levels such as erythrocyte sedimentation rate and C-reactive protein. In addition, 8 age-matched normal (control) subjects (4 male, mean age: 26.6 years, range: 21–29years) were enrolled in the study.

Diagnosis:
Intraventricular hemorrhage and intracerebral hemorrhage in the left basal ganglia.

Interventions:
He underwent extraventricular drainage and ventriculoperitoneal shunting for hydrocephalus.

Outcomes:
DTI was performed at 30 months after onset, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained for hypothalamus. The FA and ADC values of patient were lower and higher, respectively, by more than two standard deviations from control values. Injury of hypothalamus was demonstrated in a stroke patient with neurogenic fever.

Lessions:
Our results suggest that evaluation of hypothalamus using DTI would be helpful in patients show unexplained fever following brain injury.
The psychometric measures to assess aggressive dimension following traumatic brain injury
Authors: Corallo Francesco , Anselmo Anna , Palmeri Rosanna , Di Cara Marcella , Formica Caterina , De Salvo Simona , Todaro Antonino , Rifici Carmela , Marino Silvia , Bramanti Placido , Lo Buono Viviana 
Published: March 2021

Abstract

Background:
higher level of aggression and antisocial behavior are frequent following head trauma, due to specific brain alterations. Many tests are used to assess this aspect. A descriptive review was conducted on the main tests used to detect the appearance of aggressive dimensions following traumatic brain injury.

Review summary:
we searched on PubMed and Web of Science databases and screening references of included studies and review articles for additional citations. From initial 723 publications, only 7 met our search criteria. Findings showed that various psychometric tools are used to assess aggressiveness and its subdomains, following head trauma.

Conclusions:
further investigation are necessary to clarify whether these tools ensure a reliable diagnosis in order to make an early intervention and reduce violent behavior and its development.
Basic life support training programme in schools by school nurses
Authors: Martínez-Isasi Santiago , García-Suárez Mario , De La Peña Rodríguez Medea Aglaya , Gómez-Salgado Juan , Fernández Nélida , Méndez-Martínez Carlos , Leon-Castelao Esther , Clemente-Vivancos Alvaro , Fernández-García Daniel 
Published: March 2021

Abstract

Background:
Cardiopulmonary resuscitation (CPR) training in schools, despite being legislated in Spain, is not established as such within the subjects that children are taught in schools.

Objective:
to evaluate the acquisition of CPR skills by 11-year-old children after a brief theoretical-practical teaching programme taught by nurses at school.

Methods:
62 students were assessed in a quasi-experimental study on 2 cohorts (51.4% of the sample in control group [CG]). In total, 2 sessions were given, a theoretical one, and a practical training for skill development in children, in which the CG performed the CPR in 2-minute cycles and the intervention group in 1-minute cycles. The anthropometric variables recorded were weight and height, and the variables compression quality and ventilation quality were recorded using the Laerdal ResusciAnne manikin with Personal Computer/Wireless SkillReport.

Results:
The assessment showed better results, in terms of BLS sequence performance and use of automated external defibrillator, in the CG and after training, except for the evaluation of the 10-second breathing assessment technique. The quality of chest compressions was better in the CG after training, as was the quality of the ventilations. There were no major differences in CPR quality after training and 4 months after the 1-minute and 2-minute training cycles.

Conclusions:
11-year-old children do not perform quality chest compressions or ventilations but, considering their age, they are able to perform a BLS sequence correctly.
Castleman disease and paraneoplastic pemphigus in a pregnant woman
Authors: Cui Beibei , Lin Hui 
Published: March 2021

Abstract

Rationale:
Orogenital ulcers can be observed in various conditions, such as Behcet disease, infection and also paraneoplastic pemphigus (PNP). Castleman disease (CD), which is a rare cause of paraneoplastic pemphigus represents a heterogenous lymphoproliferative disorder of unknown etiology. Paraneoplastic pemphigus associated with CD in pregnancy is rare and has not been reported yet.

Patient concerns:
We report a rare case of CD in a 26-year-old pregnant woman with orogenital ulcers. The patient suffered from mucosal erosions and uveitis at 23 weeks of gestation. A retroperitoneal mass (9.7×7.3×11.8 cm) was identified by CT scan.

Diagnoses:
According to histological and immunohistological findings, a diagnosis of unicentric CD, hyaline vascular type, and PNP was formulated.

Intervention:
High dose methylpredisonlone was given for the therapy. Pancreatic uncinatectomy, portal vein and superior mesenteric vein repair, pancreaticojejunostomy, and caesarean section were performed on the patient to remove the tumor and the fetus.

Outcomes:
The fetus did not survive after surgery. The patient did not achieve remission and she died from epidermolysis and sepsis several months later.

Lessons:
PNP associated with CD is a rare lymphoproliferative disorder and needs to be differentiated from other orogenital diseases by histological features.

Ethics and dissemination:
Written informed consent was obtained from the patient for publication of this case report and accompanying images. Ethical approval of this study was granted by the Ethics Committee of West China Hospital of Sichuan University. (Ethics Reference No: 2021143).
Marinacci anastomosis (reverse Martin-Gruber anastomosis)
Authors: Chang Yu-Tai , Chen Chun-Lung , Lai Chien-Hung 
Published: March 2021

Abstract

Rationale:
The incidence of Martin-Gruber anastomosis ranges from 5% to 34%, which is characterized by crossing over from the median to the ulnar nerve and innervating the first dorsal interosseous, thenar or hypothenar muscles. However, the reverse Martin-Gruber anastomosis, or Marinacci anastomosis, is far less discussed and appears in recent literature.

Patient concerns:
A 56-year-old man presented to the clinic of a university hospital because of left neck soreness with numbness radiating to the left lateral shoulder. The neck discomfort was aggravated while the neck rotated or tilted to the right.

Diagnosis:
Higher compound muscle action potential over the abductor pollicis brevis on elbow stimulation than on the wrist was found during upper limb nerve conduction velocity study. Ulnar to median anastomosis was identified.

Intervention:
We performed cervical spine X-ray and electrophysiological examinations and monitored the patient.

Outcomes:
We identified that this patient had left C5 and C6 subacute radiculopathy with active denervation and left subclinical ulnar sensory neuropathy, and verified the existence of ulnar-to-median anastomosis.

Lessons:
We demonstrated a pure motor ulnar-to-median anastomosis without sensory correspondence and higher CMAP over the abductor pollicis brevis on elbow stimulation of the ulnar nerve than on the wrist. The prevalence might be underestimated in a Chinese population-based published study.
Refusal of cancer-directed surgery in male breast cancer
Authors: Wang Shipei , Chen Sichao , Huang Yihui , Hu Di , Zeng Wen , Zhou Ling , Zhou Wei , Chen Danyang , Feng Haifeng , Wei Wei , Zhang Chao , Liu Zeming , Wang Min , Guo Liang 
Published: March 2021

Abstract
It has been reported that some male breast cancer patients may refuse the recommended surgery, but the incidence rate in the United States is not clear. The purpose of this study was to identify the incidence, trends, risk factors, and eventual survival outcomes associated with the rejection of such cancer-directed surgery.
We collected data on 5860 patients with male breast cancer (MBC) from the Surveillance, Epidemiology, and End Results database, including 50 patients refusing surgery as recommended. Kaplan–Meier survival analysis and Cox proportional hazard regression were used to identify the effects of refusing surgery on cancer-specific survival (CSS) and overall survival (OS). The association between acceptance or rejection of surgery and mortality were estimated by nested Cox proportional hazards regression models with adjustment for age, race, clinical characteristics, and radiation.
Of the 5860 patients identified, 50 (0.9%) refused surgery. Old age (≥65: hazard ratio [HR]: 3.056, 95% confidence interval [CI]: 1.738–5.374, P < .0001), higher AJCC stage (III: HR: 3.283, 95% CI: 2.134–5.050, P < .0001, IV: HR: 14.237, 95% CI: 8.367–24.226, P < .0001), progesterone receptor status (negative: HR: 1.633, 95% CI: 1.007–2.648, P = .047) were considered risk factors. Compared with the surgery group, the refusal group was associated with a poorer prognosis in both OS and CSS (χ2 = 94.81, P < .001, χ2 = 140.4, P < .001). Moreover, significant differences were also observed in OS and CSS among 1:3 matched groups (P = .0002, P < .001).
Compared with the patients undergoing surgery, the patients who refused the cancer-directed surgery had poor prognosis in the total survival period, particularly in stage II and III. The survival benefit for undergoing surgery remained even after adjustment, which indicates the importance of surgical treatment before an advanced stage for male breast cancer patients.
Analysis of clinical characteristics and prognosis of patients with peripheral T-cell lymphoma
Authors: Liang Xiao , Guo Li , Hu Xin , Li Shan , Wen Shujuan 
Published: March 2021

AbstractBackground:This study aimed to explore the clinical characteristics, therapeutic efficacy and prognostic factors of peripheral T-cell lymphoma (PTCL).Methods:The clinical data of 119 PTCL patients who were admitted to the Xinjiang Medical University Affiliated Tumor Hospital from January 2010 to December 2017 were retrospectively analyzed, including the clinical characteristics, therapeutic efficacy, prognosis-related factors and treatments. Among the patients, 98 patients received antharcyclines-based therapeutic protocols, including Cyclophosphamide, Pirarubicin, Vincristine, Prednisone (CHOP) protocol and Cyclophosphamide, Pirarubicin, Vincristine, Prednisone, Etoposide (CHOPE) protocol, with median follow-up time of 32.5 months (2–166 months). The patients’ clinical characteristics were analyzed, and COX ratio risk regression model was adopted to analyze the prognostic factors related with the survival rate of PTCL patients.Results:The 5-year overall survival (OS) rate was 46.4% and progression-free survival (PFS) rate was 42.7% in the 98 patients, and there were insignificant differences between patients with CHOP protocol and those with CHOPE protocol in the 5-year OS and PFS rates (OS:P = 0.197, PFS:P = 0.663). The univariate analysis results showed that different pathological types, Ann Arbor stage, Eastern Cooperative Oncology Group (ECOG) score ≥ 2, the number of extranodal lymphomas involved, Lactic dehydrogenase (LDH) level, presence/absence of bone marrow involved, international prognostic index (IPI) score, β2microglobulin (β2-MG) level and hemoglobin (Hb) level were poor prognosis factors influencing patients’ OS and PFS rates (Pall < .05). Multivariate analysis demonstrated that different pathological types, Ann Arbor stage, presence/absence of bone marrow involved and Hb level were independent prognostic indicators influencing patients’ OS and PFS rates (Pall < .05).Conclusion:PTCL is poor in therapeutic efficacy and prognosis, and different pathological types, Ann Arbor stage, presence/absence of bone marrow involved and Hb level are related with the prognosis of PTCL patients. Anemia occurring before the treatment is an important predictive indicator influencing the prognosis of PTCL patients and patients who experience anemia will be poor in prognosis.