tag:blogger.com,1999:blog-37052112664595058752024-03-12T17:07:54.236-07:00Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.comBlogger62530125tag:blogger.com,1999:blog-3705211266459505875.post-9775952814145157362020-12-22T23:18:00.001-08:002020-12-22T23:18:50.841-08:00Médecine & Droit<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://www.sciencedirect.com/science/article/pii/S1246739120300634?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Le contentieux de la régularité externe des décisions rendues par les juridictions ordinales des médecins</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><p>Publication date: Available online 22 December 2020</p><p><b>Source:</b> Médecine & Droit</p><p>Author(s): Nadia Miloudia</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://www.sciencedirect.com/science/article/pii/S1246739120301056?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Fallait-il sacrifier le secret professionnel sur l'autel de la santé publique ?</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><p>Publication date: Available online 7 December 2020</p><p><b>Source:</b> Médecine & Droit</p><p>Author(s): Bruno Py</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://www.sciencedirect.com/science/article/pii/S1246739120301068?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Non, le COVID ne mérite pas les justes combats de l'époque du Sida pour le respect du secret médical</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><p>Publication date: Available online 5 December 2020</p><p><b>Source:</b> Médecine & Droit</p><p>Author(s): Philippe Biclet</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://www.sciencedirect.com/science/article/pii/S1246739120301251?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">COVID-19: quel rôle pour les comités d'éthique?</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><p>Publication date: Available online 28 November 2020</p><p><b>Source:</b> Médecine & Droit</p><p>Author(s): Henri-Corto Stoeklé, Achille Ivasilevitch, Elisabeth Hulier-Ammar, Dominique Reynaert, Christian Hervé</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://www.sciencedirect.com/science/article/pii/S124673912030124X?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">La Direction des Affaires Juridiques et des Droits des Patients de l'APHP et la première vague de la pandémie Covid-19</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><p>Publication date: Available online 23 November 2020</p><p><b>Source:</b> Médecine & Droit</p><p>Author(s): Jacques Belghiti, Marie Pierre Dilly-Rushenas, Sandra Fournier, Magali Richard Piauger, Soisic Iroz, Daniel Vittecoq, Charline Nicolas, Emmanuel Martinod</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://www.sciencedirect.com/science/article/pii/S1246739120301044?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Corrigendum à « Les grands magasins de la médecine de Milton Friedman » [Med. Droit (Paris). (2020)]. doi:10.1016/j.meddro.2020.07.002</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><p>Publication date: Available online 19 November 2020</p><p><b>Source:</b> Médecine & Droit</p><p>Author(s): Mathieu Ginier-Gillet</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://www.sciencedirect.com/science/article/pii/S1246739120300889?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Erratum à « L'expertise médicale au temps des pandémies : l'exemple des cancers » [Med. Droit 2020 (2020) 92–95]</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><p>Publication date: Available online 18 November 2020</p><p><b>Source:</b> Médecine & Droit</p><p>Author(s): Rémy J. Salmon, Catherine Buffet, Christine Estève</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://www.sciencedirect.com/science/article/pii/S1246739120300919?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Editorial Board</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><p>Publication date: October 2020</p><p><b>Source:</b> Médecine & Droit, Volume 2020, Issue 164</p><p>Author(s):</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://www.sciencedirect.com/science/article/pii/S1246739120300385?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">L'ADN, la reine des preuves imparfaites</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><p>Publication date: October 2020</p><p><b>Source:</b> Médecine & Droit, Volume 2020, Issue 164</p><p>Author(s): Catherine Ménabé</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://www.sciencedirect.com/science/article/pii/S1246739120300361?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Le harcèlement : évolution du droit français et problématiques de l'évaluation des victimes</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><p>Publication date: October 2020</p><p><b>Source:</b> Médecine & Droit, Volume 2020, Issue 164</p><p>Author(s): François Van Maris, Gaëtan Prissette, Cécile Manaouil</p></span><br><br></td></tr></tbody></table><div><div dir="ltr" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-8150177198831268132020-12-22T23:17:00.000-08:002020-12-22T23:18:25.197-08:00Tropical Medicine<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://www.apjtm.org/text.asp?2020/13/12/525/296720" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Current status and future prospects of bacilli-based vector control</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><b>Joleen Savianne Almeida, Ajeet Kumar Mohanty, Savita Kerkar, Sugeerappa Laxmanappa Hoti, Ashwani Kumar</b><br><br>Asian Pacific Journal of Tropical Medicine 2020 13(12):525-534<br><br>Mosquito-borne diseases such as malaria, filariasis, dengue, chikungunya, Japanese encephalitis, yellow fever and Zika contribute significantly to health problems of developing as well as developed nations. Vector control is central to control of vector borne diseases. In the last four-five decades, biological control methods have been inducted in the integrated vector management strategy, advocated nationally as well as globally by the World Health Organization. Currently, biological control of vectors is globally acknowledged as the best available strategy in the wake of growing concerns about vector resistance as well as adverse effects of insecticides on the environment and non-target fauna co-inhabiting the same ecological niches as vectors. In India and elsewhere, efforts are ongoing to screen newer isolates to bring forth new biolarvicidal products of public health importance. In this review, by carrying out extensive literature survey, we discuss advances thus far and the prospects of bacilli-based control of vectors and vector borne diseases.</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://www.apjtm.org/text.asp?2020/13/12/535/296721" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Patterns of hepatitis B virus exposure and associated predictors in Vietnam: A crosssectional study</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><b>Minh C Duong, Phuc V.D. Le, Oanh N.K. Pham, Hien D.T. Pham, Toan B Nguyen, Hai T Phan</b><br><br>Asian Pacific Journal of Tropical Medicine 2020 13(12):535-541<br><br>Objective: To examine the magnitude of isolated anti-HBc and other HBV serological patterns and associated predictors among adults seeking general health check-up at a large health center in Vietnam. Methods: All 564 outpatients seeking general health checkup between January 2016 and December 2016 were asked to undertake HBV surface antigen, surface antibody, IgG and IgM core antibody (anti-HBc total), platelet counts, and liver function testing. An administered questionnaire was used to collect information regarding demography, in-house sources of infection, lifestyle, health condition and treatment, and HBV vaccination. Results: Male gender (P&#61;0.043), age (P&#61;0.000), living in urban areas (P&#61;0.040), HBV vaccination status (P&#61;0.033), and ALT (P&#61;0.040) were associated with isolated anti-HBc. HBV infection was associated with HBV vaccination status (P&#61;0.001), ALT levels (P&#61;0.010), AST levels (P&#61;0.020), and platelet counts (P&#61;0.007). Past/resolved HBV infection was associated with AST levels (P&#61;0.005), ALT levels (P&#61;0.014), and age (P&#61;0.000). Conclusions: Isolated anti-HBc is quite prevalent. Predictors of isolated anti-HBc include male gender, living in rural areas, and HBV non-vaccination. The prevalence of isolated anti-HBc also increases with age. To timely detect occult HBV infection and prevent transmission, anti-HBc testing should be included in the health check-up for high risk individuals and screening program where HBV nucleic acid test is not available. To prevent transmission, clinicians need to pay more attention on those who are at risk of having isolated anti-HBc and closely follow-up patients with isolated anti-HBc and educate them about the prevention of HBV infection.</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://www.apjtm.org/text.asp?2020/13/12/542/296722" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Morphological and molecular characterization of Acanthamoeba isolated from contact lens paraphernalia in Malaysia: Highlighting the pathogenic potential of T4 genotype</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><b>Rosnani Hanim Mohd Hussain, Nur Syahirah Mohamad Isa, Khairul Ameera Kamaruddin, Mohamed Kamel Abdul Ghani, Naveed Ahmed Khan, Ruqaiyyah Siddiqui, Tengku Shahrul Anuar</b><br><br>Asian Pacific Journal of Tropical Medicine 2020 13(12):542-549<br><br>Objective: To determine the morphological and molecular characterization of Acanthamoeba isolates from contact lens paraphernalia in Malaysia and to investigate their pathogenic potential based on the physiological tolerance. Methods: One hundred and eighty contact lens wearers donated their contact lens, lens storage cases and lens solutions between 2018 and 2019. The samples were inoculated onto 1.5&#37; non-nutrient agar plates for 14 d. Polymerase chain reaction (PCR) was performed and the amplified PCR products were sequenced and compared with the published sequences in GenBank. The pathogenic potential of positive isolates was further tested using temperature-tolerance and osmo-tolerance assays. Acanthamoeba species were categorized into three distinct morphological groups established by Pussard and Pons. Results: Acanthamoeba was successfully isolated from 14 (7.8&#37;) culture-positive samples in which 11 belong to morphological group II and 3 belong to morphological group III, respectively. The sequencing of 18S ribosomal RNA gene led to the identification of the T4 genotype in all the isolated strains. In vitro assays revealed that 9 (64.3&#37;) Acanthamoeba isolates were able to grow at 42 &#176;C and 1 M mannitol and were thus considered to be highly pathogenic. Conclusions: To the best of our knowledge, this is the first report identifying the Acanthamoeba genotype and their pathogenic potential among contact lens wearers in Malaysia. The potentially pathogenic T4 genotype isolated in this study is the most predominant genotype responsible for human ocular infection worldwide. Hence, increasing attention should be aimed at the prevention of contamination by Acanthamoeba and the disinfection of contact lens paraphernalia.</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://www.apjtm.org/text.asp?2020/13/12/550/296723" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Multiplex real-time PCR revealed very high prevalence of soil-transmitted helminth infections among aborigines in Peninsular Malaysia</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><b>Nurulhasanah Othman, Noorizan Miswan, Weng-kin Wong, Boon-huat Lim, Rahmah Noordin</b><br><br>Asian Pacific Journal of Tropical Medicine 2020 13(12):550-556<br><br>Objective: To determine the true prevalence of soil-transmitted helminth infections in the Malaysian aborigines using real-time PCR. Methods: A total of 122 aborigines from seven tribes were recruited from settlements and nearby hospitals which served the communities, located in four states in Peninsular Malaysia. The stool samples were examined for the presence of soil-transmitted helminth using real-time PCR and microscopy. The latter included the direct wet mount and formalin-ether concentration technique (FECT). The infection load in FECT-positive samples was determined by the Kato-Katz method. Rotorgene real-time analyzer detected five helminth species using two sets of assays. Results: The real-time PCR detected soil-transmitted helminth in 98.4&#37; samples (n&#61;122), which were 1.56 times higher than by microscopy. Ascaris lumbricoides and Trichuris trichiura were detected in more than 90&#37; of the samples, while hookworm was detected in 46.7&#37; (Necator americanus) and 13.9&#37; (Ancylostoma sp.) of the samples. Comparison with previous reports on the Malaysian aborigines showed that the real-time PCR markedly improved the detection of Ascaris lumbricoides, hookworm and Strongyloides stercoralis. The real-time PCR detected poly-helminths in 92.6&#37; of the samples compared to 28.7&#37; by microscopy. In addition, 27 samples (22.1&#37;) showed amplification of Strongyloides stercoralis DNA. Conclusions: The real-time PCR showed very high prevalence rates of soil-transmitted helminth infections in the aborigines and is the recommended method for epidemiological investigation of soil-transmitted helminth infections in this population.</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://www.apjtm.org/text.asp?2020/13/12/557/296724" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Fermentation of mulberry leaves with Cordyceps militaris enhanced anti-adipogenesis activity in 3T3-L1 cells through down-regulation of PPAR-γ pathway signaling</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><b>Lu Guo, Jum Soon Kang, Young Hoon Park, Beong Il Je, Dae Youn Hwang, Woo Hong Joo, Young Whan Choi</b><br><br>Asian Pacific Journal of Tropical Medicine 2020 13(12):557-565<br><br>Objective: To establish an efficacious and efficient fermentation method of enhancing the anti-adipogenesis effect of mulberry (Morus alba) leaves using Cordyceps militais. Methods: Dried mulberry leaves, dried mulberry leaves with 50&#37; raw silkworm pupa and raw silkworm pupa were fermented with Cordyceps militais for 4 weeks at 25 &#176;C, after which the dried mulberry leaves and fermented product were extracted with 70&#37; ethanol and subjected to high performance liquid chromatography (HPLC). The contents of cordycepin, pelargonidin, chlorogenic acid, iso-quercetin and caffeic acid were determined. We then used the 3T3-L1 cells to investigate whether extracts of fermentation enhanced anti-adipogenesis activity in vitro. Results: HPLC showed that fermentation changed the contents of cordycepin, pelargonidin, chlorogenic acid, iso-quercetin and caffeic acid. Furthermore, fermented dried mulberry leaves with 50&#37; raw silkworm pupa had a better efficacy of anti-adipogenesis than dried mulberry leaves, fermented dried mulberry leaves and fermented silkworm pupa and inhibited triglycerides accumulation and glucose consumption. Additionally, fermented dried mulberry leaves with 50&#37; raw silkworm pupa inhibited PPAR-&#947; signaling. Conclusions: Fermentation with Cordyceps militaris enhanced anti-adipogenesis efficacy of mulberry leaves.</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://www.apjtm.org/text.asp?2020/13/12/566/296725" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">In vitro efficacy of new synthetic benzimidazole-related compounds against Schistosoma mansoni adult worms</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><b>Amira Taman, Samia El-Bardicy, Menerva Tadros, Magda Ayoub, Basem Mansour, Fouad El-Shehabi, Samar N El-Beshbishi</b><br><br>Asian Pacific Journal of Tropical Medicine 2020 13(12):566-572<br><br>Objective: To evaluate the in vitro antischistosomal activity of two new synthetic benzimidazole-related compounds: NBTP-OH and NBTP-F. Methods: Schistosoma adult worms were recovered from mice infected with Schistosoma mansoni cercaria, washed and then incubated in the culture media with different concentrations of compounds NBTP-OH and NBTP-F up to 72 h. Scanning electron microscopy was conducted to report morphological changes. Results: Incubation of adult Schistosoma mansoni with 10 &#956;g/mL of NBTP-OH for 48 h killed 81.25&#37; of worms. The calculated LC50 and LC90 72 h post-incubation were 6.8 &#956;g/mL and 9.8 &#956;g/ mL, respectively. Exposure of worms to 10 &#956;g/mL of NBTP-F killed 89.5&#37; of worms after 48 h, mostly males (83.3&#37;), the LC50 and LC90 after 72 h of incubation were 4.8 &#956;g/mL and 6.9 &#956;g/mL, respectively. Worms incubated for 72 h with these compounds revealed swelling and deformity of oral sucker, disorganization and erosion of the tegument when examined with scanning electron microscopy. Conclusions: NBTP-OH and NBTP-F possess in vitro antischistosomal activities; however, in vivo studies should be conducted to examine their antischistosomal effects.</span><br><br></td></tr></tbody></table><div><div dir="ltr" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-85463737832290891202020-12-22T23:16:00.001-08:002020-12-22T23:17:44.248-08:00Hazardous Materials<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://www.sciencedirect.com/science/article/pii/S030438942032803X?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Possible application of stable isotope compositions for the identification of metal sources in soil</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><p>Publication date: 5 April 2021</p><p><b>Source:</b> Journal of Hazardous Materials, Volume 407</p><p>Author(s): Liuwei Wang, Yuanliang Jin, Dominik J. Weiss, Nina J. Schleicher, Wolfgang Wilcke, Longhua Wu, Qingjun Guo, Jiubin Chen, David O'Connor, Deyi Hou</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://www.sciencedirect.com/science/article/pii/S0304389420328569?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Biochar for simultaneously enhancing the slow-release performance of fertilizers and minimizing the pollution of pesticides</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><p>Publication date: 5 April 2021</p><p><b>Source:</b> Journal of Hazardous Materials, Volume 407</p><p>Author(s): Xiongfang An, Zhansheng Wu, Wen Shi, Huihua Qi, Luohong Zhang, Xiaolin Xu, Bing Yu</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://www.sciencedirect.com/science/article/pii/S030438942032776X?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Nitrogen-doped porous biochar derived from marine algae for efficient solid-phase microextraction of chlorobenzenes from aqueous solution</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><p>Publication date: 5 April 2021</p><p><b>Source:</b> Journal of Hazardous Materials, Volume 407</p><p>Author(s): Rongting Ji, Yarui Wu, Yongrong Bian, Yang Song, Qian Sun, Xin Jiang, Longjiang Zhang, Jiangang Han, Hu Cheng</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://www.sciencedirect.com/science/article/pii/S0304389420328296?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Pre-coagulation with cationic flocculant-composited titanium xerogel coagulant for alleviating subsequent ultrafiltration membrane fouling by algae-related pollutants</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><p>Publication date: 5 April 2021</p><p><b>Source:</b> Journal of Hazardous Materials, Volume 407</p><p>Author(s): Min Xu, Xiaomeng Wang, Bo Zhou, Lixiang Zhou</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://www.sciencedirect.com/science/article/pii/S0304389420328302?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Methane-associated micro-ecological processes crucially improve the self-purification of lindane-polluted paddy soil</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><p>Publication date: 5 April 2021</p><p><b>Source:</b> Journal of Hazardous Materials, Volume 407</p><p>Author(s): Jing Yuan, Jue Shentu, Jiaying Feng, Zhijing Lu, Jianming Xu, Yan He</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://www.sciencedirect.com/science/article/pii/S0304389420328168?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Enhanced adsorptive removal of sulfamethoxazole from water using biochar derived from hydrothermal carbonization of sugarcane bagasse</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><p>Publication date: 5 April 2021</p><p><b>Source:</b> Journal of Hazardous Materials, Volume 407</p><p>Author(s): G. Prasannamedha, P. Senthil Kumar, R. Mehala, T.J. Sharumitha, D. Surendhar</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://www.sciencedirect.com/science/article/pii/S0304389420328260?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Adsorption behaviors of the pristine and aged thermoplastic polyurethane microplastics in Cu(II)-OTC coexisting system</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><p>Publication date: 5 April 2021</p><p><b>Source:</b> Journal of Hazardous Materials, Volume 407</p><p>Author(s): Xiang-Dong Xue, Cheng-Ran Fang, Hai-Feng Zhuang</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://www.sciencedirect.com/science/article/pii/S0304389420328247?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Toxic effects of naturally-aged microplastics on zebrafish juveniles: A more realistic approach to plastic pollution in freshwater ecosystems</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><p>Publication date: 5 April 2021</p><p><b>Source:</b> Journal of Hazardous Materials, Volume 407</p><p>Author(s): Abraão Tiago Batista Guimarães, Ives Charlie-Silva, Guilherme Malafaia</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://www.sciencedirect.com/science/article/pii/S0304389420328442?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Staged assessment for the involving mechanism of humic acid on enhancing water decontamination using H<sub>2</sub>O<sub>2</sub>-Fe(III) process</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><p>Publication date: 5 April 2021</p><p><b>Source:</b> Journal of Hazardous Materials, Volume 407</p><p>Author(s): Bo Yang, Xin Cheng, Yongli Zhang, Wei Li, Jingquan Wang, Zixin Tian, Erdeng Du, Hongguang Guo</p></span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://www.sciencedirect.com/science/article/pii/S0304389420327898?dgcid=rss_sd_all" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Enhanced photocatalytic degradation of glyphosate over 2D CoS/BiOBr heterojunctions under visible light irradiation</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><p>Publication date: 5 April 2021</p><p><b>Source:</b> Journal of Hazardous Materials, Volume 407</p><p>Author(s): Qiang-Yong Tang, Man-Jie Yang, Si-Yuan Yang, Yue-Hua Xu</p></span><br><br></td></tr></tbody></table><div><div dir="ltr" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-78766433709531874132020-12-22T23:16:00.000-08:002020-12-22T23:17:04.826-08:00Otology<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://www.indianjotol.org/text.asp?2020/26/3/115/304284" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Middle ear mucosal compartm</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><b>Mahendra Kumar Taneja</b><br><br>Indian Journal of Otology 2020 26(3):115-121<br><br>Mucosal folds of middle ear are not a significant barrier in spread of infection cholesteatoma spread towards the least resistance and usually follow the folds. The mucosa of the middle ear is continuous with that of the pharynx via Eustachian tube. It covers the ossicles, muscles, nerves and forms the inner layer of tympanic membrane. Mucosal fold are of two types Composite Fold &#8211; these are of ligament with lining mucosa. Duplicate Fold &#8211; Fusion of two expanding sacs in absence of any interposing structure. Epitympanic Diaphragm it is an oblique dividing septum between the posterior superior attic and anteroinferior mesotympanium. It comprises of anterior malleolar ligament, lateral malleolar ligament, posterior malleolar ligament, lateral incudal fold, tensor tympani fold and posterior incudal ligament fold. Tympanic Isthimus is 2.5 mm elongated narrow space in epitympanic diaphragm present naturally and provides ventilation. Key message is tensor tympani fold and anterior Pouch of VonTroltsch is responsible for ventilation of anterior compartment. It is extremely important to understand and restore the functional anatomy, proper gas exchange and mucosal clearance from the middle ear compartment. The obstruction site is at tympanic isthimus. It is crucial to visualise and clearance of disease to restore ventilation. In surgical procedures of ear just removal of tensor tympani fold along with resection of Cog provides good results by providing ventilation of attic, mastoid air cells and a successful tympanoplasty.</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://www.indianjotol.org/text.asp?2020/26/3/122/304274" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Speech recognition in noise in patients with type II diabetes</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><b>Somayeh Falahzadeh, Sima Tajik, Faezeh Azadi, Farnoosh Farjadi</b><br><br>Indian Journal of Otology 2020 26(3):122-126<br><br>Context: The chronic diabetes is associated with damage to the sensory and cognitive regions brain. The central auditory system is susceptible to the damage caused by high glucose level. Aims: Since the healthy auditory system plays an important role in communication, this study examined speech recognition in noise performance of these people so as to better identify the harmful impacts of diabetes on the auditory processing. Settings and Design: This cross-sectional comparative study compares the speech recognition in noise performance of 30 diabetic patients and 30 normal individuals aged 30&#8211;55 years with quick speech in noise (Q-SIN) test. Subjects and Methods: All people had normal hearing and the speech recognition performance in silent, the Persian version of the Q-SIN test was used. Statistical Analysis Used: Results of signal-to-noise ratio loss (SNR loss) and recognition of words at different SNR levels were analyzed with Chi-square test and independent t-test in two groups. Results: There was a significant difference between diabetic patients and normal individuals in mean of SNR loss (P &#60; 0.05). The comparison of word recognition scores in each SNR showed no significant difference in 25, 20 SNRs between the two groups (P &#62; 0.05), but the performance of diabetic patients was weaker in 15, 10, 5, 0 SNR (P &#60; 0.05). Conclusions: In the absence of hearing loss, the diabetic patients have a significant speech perception disorder, especially at lower levels of SNRs, compared to normal people of the same age. Impaired speech comprehension in the presence of a competitive message can result from the damage to central auditory processing as a result of diabetes.</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://www.indianjotol.org/text.asp?2020/26/3/127/304275" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Auditory brainstem response to level-specific CE-CHIRP® threshold estimation in normal-hearing adults</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><b>Ahmad Aidil Arafat Dzulkarnain, Suhaila Ahmad Shuckri, Noraidah Ismail</b><br><br>Indian Journal of Otology 2020 26(3):127-131<br><br>Background: The aim of the present study was to compare the hearing thresholds between pure tone audiometry (PTA) and auditory brainstem response (ABR) from level-specific (LS) CE-Chirp&#174; and click stimuli in normal adult subjects. Materials and Methods: Twenty-four adults with normal audiometric thresholds participated in the study. The ABR was recorded from the study participants at 80 dBnHL until their respective auditory thresholds using both the LS CE-Chirp&#174; and click stimuli. Study Design and Statistical Analysis: A quasi-experimental study design was used. Audiometric thresholds (low frequencies [LFs], mid frequencies [MFs], and high frequencies [HFs]) and the ABR thresholds from both stimuli were compared using the Friedman test with Wilcoxon signed-rank test as the post hoc analysis. Results: No statistically significant difference was identified between the PTA and the ABR to LS CE-Chirp&#174; thresholds at LFs and only small differences (&#60;6 dB) median thresholds differences were identified at the MFs and HF. The amplitudes of wave III and V were larger for ABR to LS CE-Chirp&#174; as compared to the ABR from the click stimulus. Conclusion: This study concluded that the ABR to LS CE-Chirp&#174; has closer thresholds than the audiogram as compared to the ABR from click in normal-hearing adult subjects. At the suprathreshold (80 dBnHL), the ABR amplitudes of wave III, and V were larger in LS CE-Chirp&#174; than the click stimulus.</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://www.indianjotol.org/text.asp?2020/26/3/132/304277" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Vestibular evaluation in patients with congenital profound hearing loss using ice cold water caloric test and rotational chair test</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><b>Arun Dehadaray, Viraj Gaikwad, Maitri Kaushik, Prasun Mishra, Sai Belsare</b><br><br>Indian Journal of Otology 2020 26(3):132-134<br><br>Introduction: With the introduction of newborn hearing screening, hearing problems are often detected at the neonatal stage and in early infancy, and holistic approach including not only auditory but also vestibular function is needed. This study hopes to establish some corelation between cochlear and vestibular system dysfunction in a patient born with congenital profound hearing loss (CPHL). Materials and Methods: In this observational and descriptive study conducted at a tertiary care hospital, we evaluated eighty patients with bilateral CPHL from 2016 to 2018. After taking a detailed history and thorough ear, nose, and throat examination, the patients underwent vestibular function evaluation by ice cold water caloric test (ICCT) and rotational chair test (RCT) in the outpatient department, and the duration of nystagmus was calculated based on which hypoactive or absent vestibular function was found out. Results: In the present study, out of eighty patients with CPHL, vestibular function of 62 (77.50&#37;) was normal, 9 (11.25&#37;) hypoactive, and 9 (11.25&#37;) with absent vestibular function. Conclusion: In the outpatient department where sophisticated equipment and laboratory facilities are not available, ICCT can be used to determine the vestibular function and also RCT can be used. From the present study, it can be concluded that vestibular dysfunction is present in 22.50&#37; of patients with CPHL with the use of ICCT and RCT. There is a strong possibility of genetic origin etiology for vestibular dysfunction. The present study also concludes that consanguinity may be major etiological factor for vestibular dysfunction.</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://www.indianjotol.org/text.asp?2020/26/3/135/304280" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Influence of cardiovascular risk factors on cochlear dysfunction</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><b>Nemanja Radivojevic, Nenad Arsovic, Zoran Dudvarski, Vladimir Nesic, Ljiljana Cvorovic, Snezana Babac, Aleksandra Radivojevic</b><br><br>Indian Journal of Otology 2020 26(3):135-140<br><br>Background: Cochlear dysfunction can arise not only from various factors such as ear diseases but also from systemic disorders of the body. The occurrence of otologic symptoms such as hearing loss, dizziness, and tinnitus can be due to cardiovascular disorders. Therefore, current understandings in the field of the diagnosis and therapy of cardiovascular diseases (CVDs) should include, among others, evidence of otologic disorders. Objective: The aim of this study is to determine the association between risk factors for CVD and cochlear dysfunction. Methods: The cross-sectional study included 128 participants with major CVD risk factors who underwent auditory function examination (pure tone audiometry). Results: There were 52 women (40.6&#37;) and 76 men (59.4&#37;) in total. The mean age of the participants was 58 years (a range of 28&#8211;83 years). The mean age among participants with hearing loss was 60 (&#177;10.88), whereas the mean age among participants that had normal hearing thresholds was 54 (&#177;12.18). Sensorineural hearing loss (SNHL) was measured in 59&#37; of participants, of most frequent mild degree hearing loss. The prevalence of SNHL was higher in participants with arterial hypertension (P &#60; 0.001, OR &#61; 5.881, 95&#37; CI 2.694&#8211;12.837) and the most common among them was moderate degree hearing impairment (38&#37;). There is also a statistically significant association of SNHL with dyslipidemia and elevated body mass index (P &#60; 0.001, [OR]: 4.118, 95&#37; [CI]: 1.873&#8211;9.053 and P&#60; 0.001, [OR]: 1.517, 95&#37; [CI]: 1.237&#8211;1.859 ) with moderate and profound hearing loss. Conclusion: Based on the data obtained, it seems that the presence of major cardiovascular risk factors was a significant predictor for cochlear dysfunction.</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://www.indianjotol.org/text.asp?2020/26/3/141/304281" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Examination of ototoxicity induced by imatinib, being a tyrosine kinase inhibitor: An experimental study</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><b>Emine Elif Altuntas, Kasim Durmus, Adem Bora, Nergiz Hacer Turgut, Hatice Terzi, Ahmet Kutluhan</b><br><br>Indian Journal of Otology 2020 26(3):141-146<br><br>Objectives: Two rats were excluded from the study. Because otitis media developing one rat in Group C (7th dayof the experiment) and bleeding-related death one rat in Group I-50 (14th day of the experiment). While the side effects of imatinib are investigated in the literature, it is remarkable that the case reports suggesting an ototoxic side effect also take place among the publications. The aim of this study was to investigate whether or not imatinib has any ototoxic effect on rats via auditory brainstem response (ABR) responses. Materials and Methods: Rats were divided into three groups as Group C (0.25 mL/kg/day), Group I-30 (30 mg/kg/day), and Group I-50 (50 mg/kg/day). In the ABR record, hearing threshold, latency, amplitude, and interpeak latency values on test days were recorded and assessed. Results: In the assessment made in terms of mean V Wave latency within the group, a difference was determined at all stimulus intensities at 8 kHz in Group I-50 (P &#60; 0.05). In the within-group assessment performed in terms of mean Wave III latency, there were differences in Groups I-30 and I-50 (P &#60; 0.05). In the within-group assessment performed in terms of I&#8211;III interpeak latency mean values, there was a difference at 4 kHz and 70 dB in Group I-30 (P &#60; 0.05). In the within-group assessment in terms of mean III&#8211;V interpeak latency values, the difference between the groups was significant on the 7th day at 6 kHz and 50 dB (P &#61; 0.044) and on the 14th day at 8 kHz and 70 dB (P &#61; 0.036). In the within-group assessment in terms of Wave I amplitude mean values, the change in the amplitude values at 4 kHz (P &#61; 0.003) and 6 kHz (P &#61; 0.018) in Group I-50 was significant. Conclusion: It was observed that imatinib application caused elongation in latency and interpeak latency values and changes in amplitude values. These differences were not enough to state that imatinib is having an ototoxic side effect.</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://www.indianjotol.org/text.asp?2020/26/3/147/304283" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Vestibular epilepsy: Clinical presentation, diagnosis, and management</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><b>Ajay Philip, GR Haripriya, Manju Deena Mammen, Anjali Lepcha, Ann Mary Augustine</b><br><br>Indian Journal of Otology 2020 26(3):147-150<br><br>Background: Vestibular epilepsy as a cause of vertigo is rare. This clinical entity occurs primarily due to epileptic activity in parts of the cortex that represents the vestibular system. It is often distinctive with sudden, brief episodes of vertigo followed by rapid recovery without sequelae. In vestibular epilepsy, vertigo is not simply an aura, but constitutes a part of the seizure, and maybe its only manifestation. Aim: The aim of this study was to describe the clinical profile of patients diagnosed with vestibular epilepsy who presented to the neurotology clinic in our hospital in the past 7 years from January 1, 2014, to May 1, 2020, and to present their clinical features, diagnosis, and management. Materials and Methods: This was a retrospective observational clinical study based on the medical records of all patients diagnosed with vestibular epilepsy who presented during the period January 1, 2014&#8211;May 1, 2020, to our neurotology clinics. Each patient&#39;s history and neurotological examination were documented. All investigations carried out such as audiovestibular tests, electroencephalogram, cardiac tests, and imaging were noted. Results: Ten patients were diagnosed with vestibular epilepsy in our clinic during this time period, with a prevalence of vestibular epilepsy being 0.001&#37;. The main subjective aura in our patients was vestibular disturbance in the form of rotatory type of vertigo which lasted for a few seconds. These symptoms were followed by abnormal movements of limb and loss of consciousness (LOC) in six patients. The patients who experienced a LOC had cardiology workup. Electronystagmogram was abnormal in three patients, while magnetic resonance imaging showed an abnormality in three patients. All patients were started on anticonvulsant drugs and showed a good response to treatment. Conclusion: Vestibular epilepsy is a rare but treatable cause of transient dizziness. The diagnosis of vestibular epilepsy is often missed or delayed and should be considered when brief episodic spontaneous vertigo occurs with LOC and unresponsive to standard vestibular treatment. Treatment with anticonvulsants seems to give relief of symptoms.</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://www.indianjotol.org/text.asp?2020/26/3/151/304285" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Efficacy of medical grade manuka honey in acute otitis externa: A pilot study</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><b>Amit Kumar, Shweta Mittal, Amit Kumar Tyagi, Hano Romesh, Saurabh Varshney, Manu Malhotra</b><br><br>Indian Journal of Otology 2020 26(3):151-154<br><br>Introduction: Manuka honey has been used in chronic diabetic ulcers and traumatic wounds. We have used Manuka honey in cases of otitis externa because of its antibacterial and anti-inflammatory properties. Objectives: The objective was to study the efficacy of topical applications of Manuka honey in the patients of acute otitis externa. Materials and Methods: Patients with acute otitis externa without any prior ear complaint or intervention were selected for the study after informed and written consent. All patients selected for the study were packed with Manuka honey-impregnated umbilical tape and pain scores; canal wall edema was recorded on days 0, 1, 3, and 7. Results: A total of 20 patients were included in our study. Twenty patients followed us on day 1, 15 patients on day 3, and seven patients followed us till day 7. The mean pain score for day 0 was 5.35, and the mean pain score decreased to 2.95 on day 1, and the difference was statistically significant. Conclusion: Manuka honey appears to be an effective therapeutic agent in the management of otitis externa.</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://www.indianjotol.org/text.asp?2020/26/3/155/304287" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Effect of middle ear surgery on taste in patients with chronic otitis media</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><b>Vijin Ravindran, Deviprasad Shetty, K S Gangadhara Somayaji</b><br><br>Indian Journal of Otology 2020 26(3):155-158<br><br>Objective: The objective was to identify the gustatory changes in patients with chronic otitis media due to chorda tympani nerve involvement and to identify the gustatory changes with minimal manipulation, stretching, and cutting of the nerve during surgery and its postoperative recovery. Methodology: A total of 100 patients were selected. Clinical assay, with tests based on &#8220;taste strips&#8221; with different concentrations of salt, sweet, bitter, and sour, was done preoperatively. The taste strips used were sodium chloride for salt, sucrose for sweet, quinine sulfate for bitter, and citric acid for sour. The same was tested postoperatively after 1 week, 1 month, and 6 months. Analysis: Of the total 100 patients, 22 patients had squamosal disease, and the remaining 78 patients had mucosal disease. Fourteen patients were found to have taste changes preoperatively, of whom nine recovered their taste 1 week following surgery. Remaining five patients recovered at 1 month following the surgery. It was also observed that, in all the 25 patients where the nerve was cut, postoperative changes were noted, which recovered completely at the end of 6 months, except in two patients. In patients where the nerve was stretched, patients showed more gustatory alterations when compared with patients where the nerve was minimally manipulated. Conclusion: We conclude from our study that cutting the nerve produced less gustatory alterations, when compared with patients where the nerve was stretched. We also concluded that chronic inflammation of the middle ear itself can cause gustatory alterations, and these changes recovered once the disease was cleared.</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://www.indianjotol.org/text.asp?2020/26/3/159/304288" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Assessment of vestibulotoxicity of neem leaf (Azadirachta indica) in a rat animal model</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><b>Rosdan Salim, Mohd Khairi Md Daud, Maithrea Suresh Narayanan, Aziah Ab Rani</b><br><br>Indian Journal of Otology 2020 26(3):159-162<br><br>Introduction: Otomycosis is a challenging and frustrating entity for both patients and otolaryngologists for it frequently requires long-term treatment and follow-up, yet the recurrence rate remains high. The management is directed toward intense aural toileting with administration of topical antifungals. There has been increased resistance to classical antifungal agents, typically involving the azoles and polyenes. This has led into the research of medicinal plants as an alternative treatment for treating fungal infections. Objective: This study aims to investigate the possible vestibulotoxic effects of neem leaf (Azadirachta indica), a commonly used home remedy on the inner ear in a rat animal model. Methodology: Twenty healthy, mature Wistar albino rats were divided into three groups: Groups A (eight animals), B (eight animals), and C (four animals). They underwent baseline vestibular parameter testing, following which an endoscopic-guided transtympanic instillation of aqueous and alcohol neem extract was performed into the right middle ear of the rats in Groups A and B, while normal saline was instilled into the right middle ear of rats in Group C. Vestibular parameter testing was repeated on the rats in both groups post instillation of transtympanic neem at 4-h, 24-h, 48-h, 72-h, 1-week, 2-week, and 3-week intervals. Results: There was no deterioration in all vestibular parameters recorded post instillation of neem extract within the middle ear. Conclusion: Neem extract is a safe alternative in the treatment of otomycosis in the presence of tympanic membrane perforation as it poses no vestibulotoxic side effects.</span><br><br></td></tr></tbody></table><div><div dir="ltr" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-49840802763853255852020-12-22T23:15:00.000-08:002020-12-22T23:16:04.485-08:00Acta Medica International<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://www.actamedicainternational.com/text.asp?2020/7/2/57/304061" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Romosozumab: A new anabolic arrow in quiver for management of osteoporosis</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><b>Alok Singh, Dhyuti Gupta</b><br><br>Acta Medica International 2020 7(2):57-62<br><br>The multifactorial disease of the elderly, characterized by accelerated bone loss and a high risk of fracture (even with trivial trauma), osteoporosis, is known to primarily affect postmenopausal women. Moreover, the precipitating factors for the same mainly are the hormonal and nutritional deficiency. Clinically, the most common fracture to be encountered is the vertebral compression fracture. Apart from exogenously supplementing calcium and Vitamin D, a diverse group of drugs (bisphosphonates, denosumab, teriparatide, strontium ranelate, raloxifene, and calcitonin) are available to manage the case of osteoporosis. The latest drug to be approved and included in this quiver is a sclerostin-targeting monoclonal antibody, romosozumab. This new drug appears to be promising in managing the postmenopausal patients of osteoporosis. Although the array of adverse effects is not well recognized, a black box warning has been issued for this drug in reference to contraindicated use in patients with comorbid myocardial infarction. The intent of the authors for this review is to discuss the pharmacological profile of romosozumab, with particular emphasis on supportive clinical trials as well as the adverse drug reactions associated with its use.</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://www.actamedicainternational.com/text.asp?2020/7/2/63/304062" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Laboratory findings in COVID-19 patients and biomarkers for early assessment of severity and mortality</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><b>Asbah Shams, Madhu Sinha, Abhijit Das, Natasha Gulati, Rani Sahu, Man Mohan Mehndiratta, Chandra Shekhar</b><br><br>Acta Medica International 2020 7(2):63-68<br><br>The novel coronavirus-19 (severe acute respiratory syndrome coronavirus-2) pandemic has crossed more than 4,006,257 cases with 278,892 deaths worldwide and 67,152 cases and 2206 deaths in India. The disease has a variable clinical course ranging from mild to severe disease. Although most of the patients are asymptomatic, some patients with comorbidities have a high propensity of clinical worsening and mortality and it is this chunk of patients that we need to recuperate. Studies have shown that a number of laboratory parameters, which are easily available and inexpensive, can adequately predict the disease severity at an early stage. In a resource-limited country like India, where costly investigations cannot be routinely carried out in the magnitude as big as that of this pandemic, it is imperative that patients be monitored with these simple and inexpensive parameters that are elucidated in this review. We carried out an electronic search on PubMed and Google Scholar with keywords &#8220;laboratory abnormalities in COVID-19,&#8221; &#8220;coagulopathy in COVID-19,&#8221; &#8220;sepsis in COVID-19,&#8221; &#8220;hematologic abnormalities in COVID-19,&#8221; &#8220;kidney injury in COVID-19,&#8221; &#8220;acute respiratory distress syndrome in COVID-19,&#8221; &#8220;cardiac injury in COVID-19,&#8221; &#8220;liver injury in COVID-19,&#8221; and &#8220;severity indicators in COVID-19&#8221; till present date (May 11, 2020). All studies that appeared in our search results were scrutinized and 40 studies were selected for the study.</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://www.actamedicainternational.com/text.asp?2020/7/2/69/304055" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Dissatisfaction and problems in marital life of spouses of patients with bipolar disorder: A cross-sectional study from a tertiary care hospital</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><b>Bilal Ahmad Bhat, Rouf Ahmad Mir, Arshad Hussain, Iqra Rasheed Shah</b><br><br>Acta Medica International 2020 7(2):69-75<br><br>Introduction: The objective was to understand the marital dissatisfaction/satisfaction and problems in different areas of marital life in spouses of patients with bipolar disorder (BD). Materials and Methods: In this cross sectional descriptive study on BD patients and their spouses, a semi structured questionnaire was used to collect sociodemographic details. Couple satisfaction index (CSI) was used to identify marital satisfaction or dissatisfaction, whereas problem areas questionnaire (PAQ) was used to identify areas in which spouses of BD patients were often dissatisfied or have disagreements about their partner&#39;s behavior. Results: A total of 170 BD patients, along with their spouses, were included in our study. Marital dissatisfaction was present in 104 (61.2&#37;) and there was no significant relation with sociodemographic variables except for the number of children (P &#61; 0.002). Mean scores on CSI and PAQ were 42.75 &#177; 17.32 and 28.91 &#177; 11.28, respectively, with a significant negative correlation between these (r &#61;-0.712; P &#61; 0.0001). Handling family finances; rearing children or parenting, career/job related decisions, demonstrations of affection, handling household tasks, spending recreation leisure time together, moodiness/temper/emotionality, and problems in sex relations were important areas in which partners of BD patients were facing a significant problem. Conclusions: Marital dissatisfaction was very common in spouses of BD patients and they faced a lot of problems in various areas of their lives. As clinicians, we need to evaluate and understand the issues related to the marital life of normal spouses of BD patients to provide emotional and practical support to them, individually as well as couples.</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://www.actamedicainternational.com/text.asp?2020/7/2/76/304054" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Awareness and attitude about heart transplantation among undergraduate nursing students: An institution-based survey in India</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><b>Suresh K Sharma, Hemlata Sadhanu, Manisha Naithani, Anshuman Darbari, Jyoti Bharadwaj, Maneesh Sharma</b><br><br>Acta Medica International 2020 7(2):76-80<br><br>Introduction: Heart transplantation is the currently available and established lifesaving therapy for the end stage heart failure. Considering the paucity of data about nurses&#39; awareness and attitude about heart transplantation, this survey was undertaken. The aim of this study was to assess the awareness and attitude regarding heart transplantation among undergraduate nursing students. A questionnaire based cross sectional survey was conducted among undergraduate nursing students studying in an institute of national importance in India. Materials and Methods: A prevalidated questionnaire was administered among 147 randomly selected participants who were willing to participate in the study. Results: All the students (100&#37;) were aware about organ donation, but majority (77.5&#37;) informed that their source of information on this topic is by Internet/media. Around 18.4&#37; of participants had already pledged permission for organ donation after death and 70.8&#37; were willing to donate the organ after death. Conclusion: Results showed the gap existence and need of addressing this among undergraduate nursing students regarding organ donation and heart transplantation.</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://www.actamedicainternational.com/text.asp?2020/7/2/81/304053" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Selfitis, narcissism, and emotional intelligence: Eliciting the interrelation among medical students in Kolkata, West Bengal</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><b>Soumalya Ray, Tanmay Kanti Panja, Dipta Kanti Mukhopadhyay</b><br><br>Acta Medica International 2020 7(2):81-85<br><br>Introduction: Selfitis, the obsessive behavior to take and share one&#39;s own photographs, is a popular activity among young adults. It is growing with the availability of cheap data and free social network services. Scientific literature considers it as an effort to emphasize self-importance in the context of inadequate social support. The aim was to assess the burden of selfitis among medical students and to identify factors associated with it. This cross-sectional study was conducted among 166 students of a medical college in Kolkata, from December 2019 to March 2020. Materials and Methods: The level of selfitis was assessed using the Selfitis Behavior Scale (SBS). Narcissism was evaluated using Narcissistic Personality Inventory-16 and emotional intelligence (EI) was assessed using the mind tool EI questionnaire. Quantitative data were expressed as mean (&#177;standard deviation) or median (&#177;interquartile range) and qualitative data were expressed in frequency and percentage. Binary logistic regression was done with the level of selfitis as a dependent variable and narcissistic trait, EI, and other sociodemographic, individual characteristics as the independent variable. Results: Around one-third (35.5&#37;) of the respondents had borderline selfitis according to SBS. None of the respondents had acute or chronic selfitis. Perceived presence of recreational activity (adjusted odds ratio [AOR] - 15.71), availability of pocket money (AOR - 69.42), family support (AOR - 6.30), and narcissistic trait (AOR - 3.94) were positively associated with borderline selfitis. Conclusions: Around one-third had borderline selfitis. Narcissism and lack of perceived family support were found to be associated with it.</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://www.actamedicainternational.com/text.asp?2020/7/2/86/304052" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Impact of COVID 19 lockdown on the study of medical students: A cross sectional survey</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><b>Jolly Agarwal, Sonam Maheshwari, Anurag Agrawal, MK Pant, Yatika Chaudhary, Manisha Naithani</b><br><br>Acta Medica International 2020 7(2):86-89<br><br>Introduction: During the pandemic of COVID 19, the traditional teaching of MBBS students has been shifted to online teaching. We conduct an online survey to know and record the impact of COVID 19 lockdown on the study of medical students of GDMC, Dehradun. The present study aimed to investigate the MBBS student&#39;s perception of online teaching. The results of this study may provide further inputs which might be of help to the students and faculty for further informed decisions. Materials and Methods: A cross sectional online survey during July 1&#8211;7, 2020 was applied to 334 medical students to evaluate the perception of online teaching among medical students. A questionnaire was prepared in Google form and divided into two sections. The first part covered demographics information of the respondent and the second part assessed with behavior and attitude toward online teaching. Results: The mean assessment, behavior, and attitude scores have significantly differed across age groups and previous experience. The medical students who had no exposure to online teaching their assessment score is higher than who had little exposure also found to be significant. The participants were agreed with the teaching way of the course (59.3&#37;) and with the content of the course (56.9&#37;). Majority of participants (58.4&#37;) also agree that there are barriers in online learning. Most of the students agree (62.3&#37;) and strongly agree (61&#37;) that the course allowed them to take responsibility for their learning. Conclusions: We can conclude that the online learning program is a good alternative to classroom teaching in this era of the COVID 19 pandemic. This study can provide the basic architecture for making further strategy of course content.</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://www.actamedicainternational.com/text.asp?2020/7/2/90/304051" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Prevalence of temporomandibular disorders in individuals seeking treatment at dental hospital: A cross-sectional study</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><b>Varsha Kanjani, Neel Gupta, Akash Bhatt, Mehak Tariq, Ajaz Ahmed, Kanchan Malawat</b><br><br>Acta Medica International 2020 7(2):90-92<br><br>Introduction: Temporomandibular disorders (TMDs) being the most prevalent orofacial condition, is one of the major reason for patients to seek conservative intervention at dental hospital. The multifactorial etiology of TMDs along with the wide spectrum of associated signs and symptoms, mainly orofacial pain, restricted mouth opening, and deviation, has made the condition difficult to diagnose. The aim of the present study is to determine the signs and symptoms associated with temporomandibular disorders according to Research Diagnostic criteria for Temporomandibular disorders (RDC/TMD). Materials and Methods: The present cross-sectional study was conducted at dental hospital, Rajasthan among 1450 individuals. The 209 individuals, above 18 years of age who met the inclusion criteria were enrolled in the study. Along with signs and symptoms of TMDs (VAS score for orofacial pain, clicking sound, crepitus, reduced mouth opening (less than 40 mm), joint deviation and tenderness, etc.) the structured questionnaire according to RDC/ TMD were also assessed. The data was analyzed using Statistical Package for the Social Sciences version 21 software. Results: In the present study population, the prevalence of TMDs was 14.41&#37; only. Most of the patients were in 2nd decade (33.01&#37;) with female predilection (69.85&#37;). The VAS score for patients complaining of orofacial pain (58.85&#37;) was 6.32&#177;1.12 with reduced mouth opening in 42.58&#37;. According to RDC/TMD, the most common finding observed was TM joint deviation (63.15 &#37;), followed by clicking sound (56.93&#37;), crepitus (46.41&#37;), MPDS (12.91&#37;), internal derangements (10.52&#37;) and osteoarthritis (6.22&#37;). Conclusion: The prevalence of TMDs was more prevalent in younger generation, especially with female predilection. The most common signs and symptoms seen in the present study were orofacial pain, followed by reduced mouth opening, TMJ deviation and clicking sound.</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://www.actamedicainternational.com/text.asp?2020/7/2/93/304050" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Cord blood lactate levels as marker for perinatal hypoxia and predictor for hypoxic ischemic encephalopathy</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><b>Ashish Kumar Simalti, Vandana Negi, Anil Kumar, Suman Kumar Pramanik</b><br><br>Acta Medica International 2020 7(2):93-96<br><br>Introduction: This study was conducted to find if cord blood lactate correlates well with Apgar score and umbilical cord blood pH and subsequent development of hypoxic ischemic encephalopathy (HIE). Materials and Methods: It was a cross sectional, observational study which was conducted at a tertiary care referral center of North India from June 2018 to June 2019. Monitoring of cord blood lactate levels along with Apgar and cord blood pH was done for correlation of cord blood lactate with Apgar, cord blood pH, and subsequently development of HIE. Results: During the study period, 115 term neonates got enrolled based on inclusion criteria. Out of these, 83 babies had some degree of HIE based on Sarnat staging. Among these 83 neonates with encephalopathy, 36 had Stage III HIE while, 28 and 19 babies had Stage II and Stage I encephalopathy, respectively. Lactate levels correlated negatively with Apgar score and umbilical cord blood pH and higher levels of lactate correlated well with lower Apgar and cord blood pH. The mean lactate level was significantly higher in cases with HIE (5.18 mmol/L) as compared to cases without HIE (2.91 mmol/L). Conclusion: Our study shows that cord blood lactate can be used as a predictor for perinatal hypoxia. With the availability of cheaper handheld lactate monitors, lactate monitoring may become more practical option and need to be explored.</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://www.actamedicainternational.com/text.asp?2020/7/2/97/304049" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Treatment outcome of percutaneous nephrolithotomy: The initial experience from a tertiary care Center</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><b>Ifrah Ahmad, Irshad Ahmad, Arif Hamid, Erum Khateeb</b><br><br>Acta Medica International 2020 7(2):97-101<br><br>Introduction: The purpose of the study was to assess the operative characteristics and treatment outcome of percutaneous nephrolithotomy (PCNL) for the treatment of renal calculi at our hospital. Materials and Methods: Patients with significant size symptomatic renal calculi not manageable by conservative management and those with calculi resistant to extracorporeal shock wave lithotripsy (ESWL) were included in the study. Patients excluded from the study were those with significant coagulopathy, active upper urinary tract infection, and renal calculi in ectopic kidneys. Results: Our study group had a mean age of 42.46 &#177; 11.29 years. Nearly 60&#37; of stones in our study were of size 21&#8211;30 mm in the longest diameter with mean stone diameter of 24.56 &#177; 7.809 mm. Mean hemoglobin drop following the procedure was 1.35 &#177; 0.843 g/dl. Mean operative time was 93.56 &#177; 9.90 min. We had an overall success rate of 83.5&#37; in our study. Fourteen failure cases were managed by ESWL (ten cases), second look PCNL (three cases), and by open surgery (one case). Conclusion: Although we find a higher frequency of minor complications such as transient mild hematuria (37.6&#37;), mild puncture site pain (55.3&#37;), or low-grade fever (24.7&#37;), no major or long-term side effects were observed in our series.</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://www.actamedicainternational.com/text.asp?2020/7/2/102/304048" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Infectious granulomatous dermatitis: Clinicohistopathological study with some unusual clinical presentation</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><b>Praneeta Jaswant Singh, Ambrish Kumar</b><br><br>Acta Medica International 2020 7(2):102-107<br><br>Introduction: Granulomatous dermatitis has a varied differential diagnosis ranging from infectious etiology to immune mediated diseases. In tropical countries like India, infectious etiology forms an important cause of granulomatous dermatitis with tuberculosis (TB) and leprosy being the major contributing factors. The present study was carried out with the aim to determine the frequency of various etiological agents causing infectious granulomatous dermatitis in our hospital setup and to see clinicohistopathological correlation in these cases. Materials and Methods: This is a hospital based retrospective study conducted in the department of pathology over a period of 1 year. All the skin biopsy cases diagnosed as infectious granulomatous dermatitis were retrieved from the histopathology record section for analysis and were categorized based on the causative etiological agents. Special stains were applied wherever necessary in addition to routine hematoxylin and eosin stain. Results: A total of 40 cases of infectious granulomatous dermatitis were included in the present study. Most common diagnosis was leprosy (57.5&#37;), followed by TB (30.0&#37;), actinomycosis (5.0&#37;), dermatophytosis (2.5&#37;), histoplasmosis (2.5&#37;), and cysticercosis (2.5&#37;). Gender wise distribution showed male predominance with 57.5&#37; of cases and age wise distribution showed a peak in the age group of 41&#8211;60 years (32.5&#37;). Clinicohistopathological correlation was found in 87.50&#37; of the cases. The unusual clinical presentations were seen in cases of cysticercosis, actinomycosis, and histoplasmosis. Conclusion: Histopathological examination of the skin biopsies is an important diagnostic tool providing definitive diagnosis as well as clinicohistopathological correlation in cases of infectious granulomatous dermatitis.</span><br><br></td></tr></tbody></table><div><div dir="ltr" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-61582328221164153152020-12-22T23:14:00.000-08:002020-12-22T23:15:10.681-08:00Anaesthesiology<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Treating_patients_across_European_Union_borders_.98271.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Treating patients across European Union borders: An international survey in light of the coronavirus disease-19 pandemic</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Treating_patients_across_European_Union_borders_.98271.aspx"></a>BACKGROUND In light of the coronavirus disease-2019 (COVID-19) pandemic, how resources are managed and the critically ill are allocated must be reviewed. Although ethical recommendations have been published, strategies for dealing with overcapacity of critical care resources have so far not been addressed. OBJECTIVES Assess expert opinion for allocation preferences regarding the growing imbalance between supply and demand for medical resources. DESIGN A 10-item questionnaire was developed and sent to the most prominent members of the European Society of Anaesthesiology and Intensive Care (ESAIC). SETTING Survey via a web-based platform. PATIENTS Respondents were members of the National Anaesthesiologists Societies Committee and Council Members of the ESAIC; 74 of 80 (92.5%), responded to the survey. MEASUREMENTS AND MAIN RESULTS Responses were analysed thematically. The majority of respondents (83.8%), indicated that resources for COVID-19 were available at the time of the survey. Of the representatives of the ESAIC governing bodies, 58.9% favoured an allocation of excess critical care capacity: 69% wished to make them available to supraregional patients, whereas 30.9% preferred to keep the resources available for the local population. Regarding the type of distribution of resources, 35.3% preferred to make critical care available, 32.4% favoured the allocation of medical equipment and 32.4% wished to support both options. The majority (59.5%) supported the implementation of a central European institution to manage such resource allocation. CONCLUSION Experts in critical care support the allocation of resources from centres with overcapacity. The results indicate the need for centrally administered allocation mechanisms that are not based on ethically disputable triage systems. It seems, therefore, that there is wide acceptance and solidarity among the European anaesthesiological community that local medical and human pressure should be relieved during a pandemic by implementing national and international re-allocation strategies among healthcare providers and healthcare systems. Correspondence to Elisabeth H. Adam, MD, MHBA, Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany Tel: +49 69 6301 5868; fax: +49 69 6301 7695; e-mail: <a href="mailto:elisabeth.adam@kgu.de">elisabeth.adam@kgu.de</a> Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (<a href="http://www.ejanaesthesiology.com">www.ejanaesthesiology.com</a>). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. <a href="http://creativecommons.org/licenses/by-nc-nd/4.0">http://creativecommons.org/licenses/by-nc-nd/4.0</a> © 2020 European Society of Anaesthesiology</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Chronic_stress_indicated_by_hair_cortisol.98272.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Chronic stress indicated by hair cortisol concentration in anaesthesiologists and its relationship to work experience and emotional intelligence: A cross-sectional biomarker and survey study</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Chronic_stress_indicated_by_hair_cortisol.98272.aspx"></a>BACKGROUND Anaesthesia is a stressful medical specialty. The reaction to stress is constituted by behavioural, psychological and physiological components. Chronic physiological stress can have negative consequences for health. OBJECTIVES First, we hypothesised that chronic physiological stress is higher for both beginning and late-career consultant anaesthesiologists. Second, we hypothesised that individuals high in emotional intelligence endure lower physiological stress. DESIGN Cross-sectional biomarker and survey study. SETTING Participants were recruited during the May 2019 annual meeting of the Dutch Anaesthesia Society. PARTICIPANTS Of the 1348 colleagues who attended the meeting, 184 (70 male/114 female) participated in the study. Of the study participants, 123 (67%) were consultant anaesthesiologists (52 male/71 female) and 61 (33%) were resident anaesthesiologists (18 male/43 female). Exclusion criteria were endocrine disorders and not having enough hair. Also, experience of a recent major life event led to exclusion from analysis of our hypotheses. MAIN OUTCOME MEASURES Chronic physiological stress was measured by hair cortisol concentration. Emotional intelligence was assessed using a validated Dutch version of the Trait Emotional Intelligence Questionnaire. As secondary measures, psychological sources of stress were assessed using validated Dutch versions of the home-work interference (SWING) and the effort-reward imbalance questionnaires. RESULTS In support of Hypothesis 1, hair cortisol concentration was highest among early and late-career consultant anaesthesiologists (quadratic effect: b = 45.5, SE = 16.1, t = 2.8, P = 0.006, R2 = 0.14). This nonlinear pattern was not mirrored by self-reported sources of psychological stress. Our results did not support Hypothesis 2; we found no evidence for a relationship between emotional intelligence and physiological stress. CONCLUSION In the early and later phases of an anaesthesiologist's career, physiological chronic stress is higher than in the middle of the career. However, this physiological response could not be explained from known sources of psychological stress. We discuss these findings against the background of key differences between physiological and psychological stress. Correspondence to Raymond A.B. van der Wal, Radboud University Nijmegen Medical Center, Department of Anaesthesiology, Pain and Palliative Medicine, Internal postal code 717, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands Tel: +31 24 361 4406; e-mail: <a href="mailto:Raymond.vanderwal@radboudumc.nl">Raymond.vanderwal@radboudumc.nl</a> Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (<a href="http://www.ejanaesthesiology.com">www.ejanaesthesiology.com</a>). © 2020 European Society of Anaesthesiology</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Hand_or_foot_train_of_four_tests_and_surgical_site.98273.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Hand or foot train-of-four tests and surgical site muscle relaxation assessed with multiple motor evoked potentials: A prospective observational study</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Hand_or_foot_train_of_four_tests_and_surgical_site.98273.aspx"></a>BACKGROUND Intra-operative muscle relaxation is often required in orthopaedic surgery and the hand train-of-four (TOF) test is usually used for its quantification. However, even though full muscle relaxation is claimed by anaesthesiologists based on a TOF count of zero, surgeons observe residual muscle activity. OBJECTIVE The aim of the study was to assess if hand or foot TOF adequately represents intra-operative muscle relaxation compared with multiple motor evoked potentials. DESIGN Prospective observational study. SETTING A single-centre study performed between February 2016 and December 2018 at the Balgrist University Hospital, Zurich, Switzerland. PATIENTS Twenty patients scheduled for elective lumbar spinal fusion were prospectively enrolled in this study after giving written informed consent. INTERVENTIONS To assess neuromuscular blockade (NMB) with the intermediate duration nondepolarising neuromuscular blocking agent rocuronium, hand TOF (adductor pollicis) and foot TOF (flexor hallucis brevis) monitoring, and muscle motor evoked potentials (MMEPs) from the upper and lower extremities were assessed prior to surgery under general anaesthesia. Following baseline measurements, muscle relaxation was performed with rocuronium until the spinal surgeon observed sufficient relaxation for surgical intervention. At this timepoint, NMB was assessed by TOF and MMEP. MAIN OUTCOME MEASURES The primary outcome was to determine the different effect of rocuronium on muscle relaxation comparing hand and foot TOF with the paraspinal musculature assessed by MMEP. RESULTS Hand TOF was more resistant to NMB and had a shorter recovery time than foot TOF. When comparing MMEPs, muscle relaxation occurred first in the hip abductors, and the paraspinal and deltoid muscles. The most resistant muscle to NMB was the abductor digiti minimi. Direct comparison showed that repetitive MMEPs simultaneously recorded from various muscles at the upper and lower extremities and from paraspinal muscles reflect muscle relaxation similar to TOF testing. CONCLUSION Hand TOF is superior to foot TOF in assessing muscle relaxation during spinal surgery. Hand TOF adequately represents the degree of muscle relaxation not only for the paraspinal muscles but also for all orthopaedic surgical sites where NMB is crucial for good surgical conditions. TRIAL REGISTRATION clinicalTrials.gov (NCT03318718). Correspondence to Michael Betz, MD, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland Tel: +41 44 386 1600; fax: +41 44 386 1269; e-mail: <a href="mailto:Michael.betz@balgrist.ch">Michael.betz@balgrist.ch</a> This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. <a href="http://creativecommons.org/licenses/by-nc-nd/4.0">http://creativecommons.org/licenses/by-nc-nd/4.0</a> © 2020 European Society of Anaesthesiology</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Effect_of_dexmedetomidine_on_Nociception_Level.98274.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Effect of dexmedetomidine on Nociception Level Index-guided remifentanil antinociception: A randomised controlled trial</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Effect_of_dexmedetomidine_on_Nociception_Level.98274.aspx"></a>BACKGROUND The effect of dexmedetomidine on Nociception Level Index (Medasense, Israel) antinociception to reduce intra-operative opioid requirements has not been previously investigated. OBJECTIVE We aimed to determine if low-dose dexmedetomidine would reduce remifentanil requirements during Nociception Level Index-guided antinociception without increasing complications associated with dexmedetomidine. DESIGN Double-blind randomised controlled trial. SETTING Two university teaching hospitals in Brussels, Belgium. PATIENTS American Society of Anesthesiologists 1 and 2 patients (n = 58) undergoing maxillofacial or cervicofacial surgery under propofol--remifentanil target-controlled infusion anaesthesia. INTERVENTIONS A 30 min infusion of dexmedetomidine, or equal volume of 0.9% NaCl, was infused at 1.2 μg kg−1 h−1 immediately preceding induction and then decreased to 0.6 μg kg−1 h−1 until 30 min before ending surgery. Nociception Level Index and frontal electroencephalogram guided the remifentanil and propofol infusions, respectively. MAIN OUTCOMES The primary outcome was the remifentanil requirement. Other outcomes included the propofol requirement, cardiovascular status and postoperative outcome. RESULTS Mean ± SD remifentanil (3.96 ± 1.95 vs. 4.42 ± 2.04 ng ml−1; P = 0.0024) and propofol (2.78 ± 1.36 vs. 3.06 ± 1.29 μg ml−1; P = 0.0046) TCI effect site concentrations were lower in the dexmedetomidine group at 30 min postincision and remained lower throughout surgery. When remifentanil (0.133 ± 0.085 vs. 0.198 ± 0.086 μg kg−1 min−1; P = 0.0074) and propofol (5.7 ± 2.72 vs. 7.4 ± 2.80 mg kg−1 h−1; P = 0.0228) requirements are represented as infusion rates, this effect became statistically significant at 2 h postincision. CONCLUSION In ASA 1 and 2 patients receiving Nociception Level Index-guided antinociception, dexmedetomidine decreases intra-operative remifentanil requirements. Combined frontal electroencephalogram and Nociception Level Index monitoring can measure dexmedetomidine's hypnotic and opioid-sparing effects during remifentanil-propofol target-controlled infusion anaesthesia. TRIAL REGISTRATIONS Clinicaltrials.gov: NCT03912740, EudraCT: 2018-004512-22. Correspondence to Sean Coeckelenbergh, Department of Anaesthesiology, Erasme University Hospital, Université Libre de Bruxelles, Rue Lennik 808, 1070 Brussels, Belgium Tel: +32 25 55 39 19; e-mail: <a href="mailto:sean.coeckelenbergh@ulb.be">sean.coeckelenbergh@ulb.be</a> Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (<a href="http://www.ejanaesthesiology.com">www.ejanaesthesiology.com</a>). © 2020 European Society of Anaesthesiology</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Pectoral_nerve_blocks_for_breast_surgery__A.98275.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Pectoral nerve blocks for breast surgery: A meta-analysis</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Pectoral_nerve_blocks_for_breast_surgery__A.98275.aspx"></a>BACKGROUND Pectoral nerve blocks (PECS block) might be an interesting new regional anaesthetic technique in patients undergoing breast surgery. OBJECTIVE The aim of this meta-analysis was to investigate postoperative pain outcomes and adverse events of a PECS block compared with no treatment, sham treatment or other regional anaesthetic techniques in women undergoing breast surgery. DESIGN We performed a systematic review of randomised controlled trials (RCT) with meta-analysis and risk of bias assessment. DATA SOURCES The databases MEDLINE, CENTRAL (until December 2019) and <a href="http://clinicaltrials.gov">clinicaltrials.gov</a> were systematically searched. ELIGIBILITY CRITERIA All RCTs investigating the efficacy and adverse events of PECS compared with sham treatment, no treatment or other regional anaesthetic techniques in women undergoing breast surgery with general anaesthesia were included. RESULTS A total of 24 RCTs (1565 patients) were included. PECS (compared with no treatment) block might reduce pain at rest [mean difference −1.14, 95% confidence interval (CI), −2.1 to −0.18, moderate quality evidence] but we are uncertain regarding the effect on pain during movement at 24 h after surgery (mean difference −1.79, 95% CI, −3.5 to −0.08, very low-quality evidence). We are also uncertain about the effect of PECS block on pain at rest at 24 h compared with sham block (mean difference −0.83, 95% CI, −1.80 to 0.14) or compared with paravertebral block (PVB) (mean difference −0.18, 95% CI, −1.0 to 0.65), both with very low-quality evidence. PECS block may have no effect on pain on movement at 24 h after surgery compared with PVB block (mean difference −0.56, 95% CI, −1.53 to 0.41, low-quality evidence). Block-related complications were generally poorly reported. CONCLUSION There is moderate quality evidence that PECS block compared with no treatment reduces postoperative pain intensity at rest. The observed results were less pronounced if patients received a sham block. Furthermore, PECS blocks might be equally effective as PVBs. Due to mostly low-quality or very low-quality evidence level, further research is warranted. PROTOCOL REGISTRATION CRD42019126733. Correspondence to Priv.-Doz. Dr. med. Alexander Schnabel, Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer Campus 1A, 48149 Muenster, Germany. Tel: +49 251 47255; e-mail: <a href="mailto:alexander.schnabel@ukmuenster.de">alexander.schnabel@ukmuenster.de</a> Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (<a href="http://www.ejanaesthesiology.com">www.ejanaesthesiology.com</a>). © 2020 European Society of Anaesthesiology</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Efficacy_of_intra_operative_administration_of_iron.98276.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Efficacy of intra-operative administration of iron isomaltoside for preventing postoperative anaemia after total knee arthroplasty: A randomised controlled trial</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Efficacy_of_intra_operative_administration_of_iron.98276.aspx"></a>BACKGROUND Postoperative anaemia is common after total knee arthroplasty (TKA). Emerging evidence shows the beneficial effects of peri-operative iron supplementation in patients at risk of postoperative anaemia. OBJECTIVE To evaluate the efficacy of intra-operative administration of iron isomaltoside for the prevention of postoperative anaemia in patients undergoing TKA. DESIGN Randomised, controlled, double-blind, parallel-group study. SETTING A tertiary care teaching hospital; between 29 March 2018 and 16 April 2019. PATIENTS Eighty-nine patients scheduled for unilateral TKA were included. INTERVENTION Iron isomaltoside or placebo were administered intravenously over 30 min during surgical wound closure. MAIN OUTCOME MEASURES The primary outcome measure was the incidence of anaemia at 30 days after TKA: anaemia was defined as haemoglobin less than 12 g dl−1 for female and less than 13 g dl−1 for male. RESULTS In total, 89 patients were included in the final analysis (44 in the treatment group; 45 in the control group). The administered dose of iron isomaltoside in the treatment group was 1136 ± 225 mg. The incidence of anaemia at 30 days after TKA was significantly lower in the treatment group (34.1%, 15/44) than that in the control group (62.2%, 28/45): relative risk 0.55 (95% confidence interval, 0.34 to 0.88), P = 0.008. Haemoglobin concentration, serum ferritin concentrations, and transferrin saturation were also significantly higher in the treatment group at 30 days after TKA. CONCLUSION The intra-operative administration of iron isomaltoside effectively prevents postoperative anaemia in patients undergoing TKA, and thus it can be included in patient blood management protocols for reducing postoperative anaemia in these population. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03470649. Correspondence to Jin-Tae Kim, Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul 03080, South Korea Tel: +82 2 2072 3295; e-mail: <a href="mailto:jintae73@gmail.com">jintae73@gmail.com</a> Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (<a href="http://www.ejanaesthesiology.com">www.ejanaesthesiology.com</a>). © 2020 European Society of Anaesthesiology</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/The_efficacy_of_high_flow_nasal_oxygenation_for.98277.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">The efficacy of high flow nasal oxygenation for maintaining maternal oxygenation during rapid sequence induction in pregnancy: A prospective randomised clinical trial</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/The_efficacy_of_high_flow_nasal_oxygenation_for.98277.aspx"></a>BACKGROUND High-flow nasal oxygenation (HFNO) for pre-oxygenation in rapid sequence induction (RSI) has only been assessed in volunteer parturients without intubation. OBJECTIVES To evaluate the efficacy of HFNO in comparison with the conventional facemask for oxygenation during RSI for caesarean section under general anaesthesia. SETTING Operating room in a tertiary hospital. DESIGN Prospective randomised, controlled study. PARTICIPANTS Thirty-four healthy parturients undergoing general anaesthesia for caesarean section. INTERVENTIONS Parturients were randomly assigned to HFNO or standard facemask (SFM) group. MAIN OUTCOME MEASURES The primary outcome measure was the PaO2 immediately after intubation. Secondary outcomes included lowest saturation throughout the intubation procedure, end-tidal oxygen concentration (EtO2) on commencing ventilation, blood gas analysis (pH, PaCO2), fetal outcomes and intubation-related adverse events. RESULTS PaO2 in the HFNO group was significantly higher than that in SFM group (441.41 ± 46.73 mmHg versus 328.71 ± 72.80 mmHg, P < 0.0001). The EtO2 concentration in the HFNO group was higher than that in the SFM group (86.71 ± 4.12% versus 76.94 ± 7.74%, P < 0.0001). Compared to baseline, PaCO2 immediately after intubation also increased significantly in both groups (HFNO group: 30.87 ± 2.50 mmHg versus 38.28 ± 3.18 mmHg; SFM group: 29.82 ± 2.57 mmHg versus 38.05 ± 5.76 mmHg, P < 0.0001), but there was no difference in PaCO2 between the two groups. There was no difference in lowest saturation, intubation times, duration of apnoea, pH value or fetal outcomes. CONCLUSIONS Compared with SFM, HFNO provided a higher PaO2 and EtO2 immediately after intubation in parturients. HFNO is safe as a method of oxygenation during RSI in parturients undergoing general anaesthesia for caesarean section. TRIAL REGISTRATION Clinical trial ChiCTR1900023121. Correspondence to Zhiqiang Liu, Department of Anaesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, 2699 Gaoke West Road, Shanghai 201204, P.R. China Tel: +021 20261023; e-mail: <a href="mailto:drliuzhiqiang@163.com">drliuzhiqiang@163.com</a> © 2020 European Society of Anaesthesiology</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Effects_on_BMI_and_regional_prevalence_of.98278.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Effects on BMI and regional prevalence of malignant hyperthermia pathogenic ryanodine receptor type 1 sequence variants in Switzerland: A retrospective cohort analysis</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Effects_on_BMI_and_regional_prevalence_of.98278.aspx"></a>BACKGROUND Ryanodine receptor type 1 (RYR1) sequence variants are pathogenic for malignant hyperthermia. Variant carriers have a subtle increase in resting myoplasmic calcium concentration compared with nonaffected individuals, but whether this has metabolic effects in daily life is unknown. OBJECTIVES We analysed the potential effect of malignant hyperthermia-pathogenic RYR1 sequence variants on BMI as a single factor. Due to the heterogeneity of genetic variants predisposing to malignant hyperthermia, and to incomplete information about their regional distribution, we describe the prevalence of RYR1 variants in our population. DESIGN A retrospective cohort study. SETTING A single University hospital. PATIENTS Patients from malignant hyperthermia families with pathogenic RYR1 sequence variants were selected if BMI was available. OUTCOME MEASURES BMI values were compared amongst malignant hyperthermia susceptible (MHS) and malignant hyperthermia-negative individuals using hierarchical multivariable analyses adjusted for age and sex and considering family clustering. Variant prevalence was calculated. RESULTS The study included 281 individuals from 42 unrelated malignant hyperthermia families, 109 of whom were MHS and carriers of the familial RYR1 sequence variants. Median [IQR] BMI in MHS individuals with pathogenic RYR1 variants was 22.5 kg m−2 [21.3 to 25.6 kg m−2]. In malignant hyperthermia-negative individuals without variants, median BMI was 23.4 kg m−2 [21.0 to 26.3 kg m−2]. Using multivariable regression adjusted for age and sex, the mean difference was −0.73 (95% CI −1.51 to 0.05). No carrier of a pathogenic RYR1 sequence variant was found to have BMI more than 30 kg m−2. Only 10 RYR1 variants from the list of the European MH Group were found in our cohort, the most common being p.Val2168Met (39% of families), p.Arg2336His (24%) and p.Arg614Cys (12%). CONCLUSION The observed tendency towards lower BMI values in carriers of malignant hyperthermia-pathogenic RYR1 sequence variants points to a possible protective effect on obesity. This study confirms regional differences of the prevalence of malignant hyperthermia-pathogenic RYR1 sequence variants, with just three variants covering 75% of Swiss MHS families. TRIAL REGISTRATION This manuscript is based on a retrospective analysis. Correspondence to Oliver Bandschapp, MD, Department of Anesthesia, Interdisciplinary Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland Tel: +41 61 265 72 54; e-mail: <a href="mailto:oliver.bandschapp@usb.ch">oliver.bandschapp@usb.ch</a> © 2020 European Society of Anaesthesiology</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Effect_of_positive_end_expiratory_pressure_during.98279.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Effect of positive end-expiratory pressure during anaesthesia induction on nonhypoxic apnoea time in infants: A randomised controlled trial</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Effect_of_positive_end_expiratory_pressure_during.98279.aspx"></a>BACKGROUND Hypoxaemia occurs frequently in infants during anaesthetic induction. OBJECTIVE We evaluated the effect of positive end-expiratory pressure during anaesthesia induction on nonhypoxic apnoea time in infants. DESIGN Randomised controlled trial. SETTING Tertiary care children's hospital, single centre, from November 2018 to October 2019. PATIENTS We included patients under 1 year of age receiving general anaesthesia. INTERVENTION We assigned infants to a 7 cmH2O or 0 cmH2O positive end-expiratory pressure group. Anaesthesia was induced with 0.02 mg kg−1 atropine, 5 mg kg−1 thiopental sodium and 3 to 5% sevoflurane, and neuromuscular blockade with 0.6 mg kg−1 rocuronium. Thereafter, 100% oxygen was provided via face mask with volume-controlled ventilation of 6 ml kg−1 tidal volume, and either 7 cmH2O or no positive end-expiratory pressure. After 3 min of ventilation, the infants' trachea was intubated but disconnected from the breathing circuit, and ventilation resumed when pulse oximetry reached 95%. MAIN OUTCOME MEASURE The primary outcome was nonhypoxic apnoea time defined as the time from cessation of ventilation to a pulse oximeter reading of 95%, whereas the secondary outcome was the incidence of significant atelectasis (consolidation score ≥2) assessed by lung ultrasound. RESULTS Sixty patients were included in the final analysis. Apnoea time in the 7 cmH2O positive end-expiratory pressure group (105.2 s) increased compared with that in the control group (92.1 s) (P = 0.011, mean difference 13.0 s, 95% CI, 3.1 to 22.9 s). Significant atelectasis was observed in all patients without positive end-expiratory pressure and 66.7% of those with 7 cmH2O positive end-expiratory pressure (P = 0.019, 95% CI, 1.7 to 563.1, odds ratio 31.2). CONCLUSION Positive end-expiratory pressure during anaesthesia induction with face mask ventilation increased nonhypoxic apnoea time in infants. CLINICAL TRIAL REGISTRATION <a href="http://www.clinicaltrials.gov">www.clinicaltrials.gov</a>, NCT03540940. Correspondence to Hee-Soo Kim, MD, PhD, Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea Tel: + 82 2 2072 3659; fax: +82 2 747 8412; e-mail: <a href="mailto:dami0605@snu.ac.kr">dami0605@snu.ac.kr</a> © 2020 European Society of Anaesthesiology</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Supraglottic_jet_oxygenation_and_ventilation.98280.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Supraglottic jet oxygenation and ventilation reduces desaturation during bronchoscopy under moderate to deep sedation with propofol and remifentanil: A randomised controlled clinical trial</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/ejanaesthesiology/Fulltext/9000/Supraglottic_jet_oxygenation_and_ventilation.98280.aspx"></a>BACKGROUND Hypoxaemia is frequently seen during flexible bronchoscopies that are done with a nasal approach under the traditional sedation with propofol. This study investigated the potential benefits of supraglottic jet oxygenation and ventilation (SJOV) using the Wei nasal jet tube (WNJ) in reducing hypoxaemia in patients undergoing bronchoscopy under moderate to deep intravenous sedation using a propofol, lidocaine and remifentanil cocktail. OBJECTIVES Our primary objective was to evaluate the efficacy and complications of SJOV via the WNJ during flexible bronchoscopy under moderate to heavy sedation with propofol and remifentanil. DESIGN A randomised controlled clinical trial. SETTING The 180th Hospital of People's Liberation Army, Quanzhou, China, from 1 June to 1 November 2019. PATIENTS A total of 280 patients aged ≥18 years with American Society of Anesthesiologists' physical status 1 to 3 undergoing flexible bronchoscopy were studied. INTERVENTIONS Patients were assigned randomly into one of two groups, a nasal cannula oxygenation (NCO) group (n = 140) using a nasal cannula to deliver oxygen (4 l min−1) or the SJOV group (n = 140) using a WNJ connected to a manual jet ventilator to provide SJOV at a driving pressure of 103 kPa, respiratory rate 20 min−1, FIO2 1.0 and inspiratory:expiratory (I:E) ratio 1:2. MAIN OUTCOME MEASURES The primary outcome was an incidence of desaturation (defined as SpO2 < 90%) during the procedure. Other adverse events related to the sedation or SJOV were also recorded. RESULTS Compared with the NCO group, the incidence of desaturation in the SJOV group was lower (NCO 37.0% vs. SJOV 13.1%) (P < 0.001). Patients in the SJOV group had a higher incidence of a dry mouth at 1 min (13.1% vs. 1.5%, P < 0.001) than at 30 min (1.5% vs. 0%, P = 0.159) or at 24 h (0% vs. 0%). There was no significant difference between the groups in respect of sore throat, subcutaneous emphysema or nasal bleeding. CONCLUSIONS SJOV via a WNJ during flexible bronchoscopy under moderate to deep sedation with propofol and remifentanil significantly reduces the incidence of desaturation when compared with regular oxygen supplementation via a nasal cannula. Patients in the SJOV group had an increased incidence of transient dry mouth. TRIAL REGISTRATION Registered at <a href="http://www.chictr.org.cn">www.chictr.org.cn</a> (ChiCTR1900023514). Correspondence to Ping Xie, Department of Anesthesiology, 180th Hospital of PLA, Quanzhou 362000, China. E-mail: <a href="mailto:21621853@qq.com">21621853@qq.com</a> This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. <a href="http://creativecommons.org/licenses/by-nc-nd/4.0">http://creativecommons.org/licenses/by-nc-nd/4.0</a> © 2020 European Society of Anaesthesiology</span><br><br></td></tr></tbody></table><div><div dir="ltr" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-68163078266758179762020-12-22T23:13:00.000-08:002020-12-22T23:14:35.201-08:00Medical Ultrasound<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="http://www.jmuonline.org/text.asp?2020/28/4/205/284504" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Potential application of low intensity pulsed ultrasound in obstetrics</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><b>Yucheng Liu</b><br><br>Journal of Medical Ultrasound 2020 28(4):205-206<br><br></span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="http://www.jmuonline.org/text.asp?2020/28/4/207/304319" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">The role of the lung ultrasound in Coronavirus Disease 2019: A systematic review</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><b>Kiran Pillai, Savini Hewage, Amer Harky</b><br><br>Journal of Medical Ultrasound 2020 28(4):207-212<br><br>The coronavirus disease 2019 (COVID-19) pandemic has now infected six million people and is responsible for nearly four hundred thousand deaths. We review the potential role of the lung ultrasound to evaluate its benefits and potential roles to compare it to the current gold standard of computed tomography. A literature search was carried out utilizing electronic search engines and databases with COVID-19. Keywords related to the lung ultrasound (LUS) were used to refine this search &#8211; only the relevant articles found are cited. This review showed that there exists a strong correlation between the CT and LUS scan in COVID-19. Prominent features include the vertical B-lines, thicker pleural lines, and subpleural consolidation. Potential roles include reducing transmission between health-care workers and monitoring the progress of the disease. However, the current research is scarce compared to well-established imaging modalities, and as such, there is a necessity for more research to confirm the findings of this review.</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="http://www.jmuonline.org/text.asp?2020/28/4/213/304317" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Screening COVID-19 patients using safe practice score system in non-COVID radiology departments</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><b>Kapoor Atul, Kapur Aprajita, Mahajan Goldaa</b><br><br>Journal of Medical Ultrasound 2020 28(4):213-218<br><br>Background: A prospective study was designed to evaluate the role of safe practice score system (SPSS) for targeted screening of patients in the non-COVID radiology department with the objective to (a) determine the incidence of COVID-19 in patients visiting non-COVID facilities, (b) to determine the sensitivity and specificity with predictive value of SPSS system to identify high-risk COVID patients undergoing ultrasound and echocardiographic examinations, (c) determination of relative risk (RR) estimation for health-care staff and other visiting patients and attendants, and (d) overall impact of the use of SPSS in the prevention of spread of the disease in the society. Methods: The study comprised a cohort of 688 patients who initially presented as non-COVID patients for ultrasound and echocardiography tests to a non-COVID health-care facility. Patients were divided into low-, moderate-, and high-risk COVID-19 probability groups based on SPSS screening scores of 0&#8211;3, 4&#8211;6, and more than 6, respectively. All high-risk patients with SPSS of more than 6 were advised real-time polymerase chain reaction (RT-PCR) or plain high-resolution computed tomography chest for the presence of COVID-19 before the diagnostic test could be done and all results were analyzed statistically. Results: Four hundred and forty-four low-risk patients had a median score of 3, and all underwent their radiological examinations. One hundred and forty patients were in the moderate-risk group and had a median score of 5. Thirty-six patients had a score of 6, out of which 12 patients were upgraded to score 6. One hundred and four patients were in the high-risk category group. Out of these, 20 patients were screened as RT-PCR negative and got their ultrasound examinations. The sensitivity and specificity of SPSS in categorizing patients into low and high risk were 100&#37; and 95&#37;, respectively, with false positive and negative of 4&#37; and 0&#37; with a positive and negative predictive value of 77&#37; and 100&#37;, respectively. The use of SPSS reduced the RR ratio for health-care workers and other staff from 7.9 to 2.6 (P &#61; 0.001). The overall incidence of COVID-19 disease in patients visiting non-COVID hospitals was 12&#37; during this time period. Screening and detection by the use of SPSS had a positive epidemiological impact and saved 33,000 people from getting infected when calculated by the susceptible-exposed-infectious-recovered (SEIR) pandemic model in this period of 90 days. Conclusion: SPSS categorized patients in low-, moderate-, and high-risk pretest COVID-19 probability categories accurately with good sensitivity and specificity and was useful in preventing the spread of disease with reduced RR to 2.6 for medical staff and other hospital patients and also helped to contain spread in the society.</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="http://www.jmuonline.org/text.asp?2020/28/4/219/283172" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Compatibility and validation of a recent developed artificial blood through the vascular phantom using doppler ultrasound color- and motion-mode techniques</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><b>Marwan Alshiplil, Mohannad Adel Sayah, Ammar A Oglat</b><br><br>Journal of Medical Ultrasound 2020 28(4):219-224<br><br>Background: Doppler technique is a technology that can raise the predictive, diagnostic, and monitoring abilities in blood flow and suitable for researchers. The application depends on Doppler shift (shift frequencies), wherein the movement of red blood cells away from the probe is determined by the decrease or increase in the ultrasound (US) frequency. Methods: In this experiment, the clinical US (Hitachi Avious [HI] model) system was used as a primary instrument for data acquisition and test the compatibility, efficacy, and validation of artificial blood (blood-mimicking fluid [BMF]) by color- and motion-mode. This BMF was prepared for use in the Doppler flow phantom. Results: The motion of BMF through the vessel-mimicking material (VMM) was parallel and the flow was laminar and in the straight form (regular flow of BMF inside the VMM). Moreover, the scale of color velocity in the normal range at that flow rate was in the normal range. Conclusion: The new BMF that is being valid and effective in utilizing for US in vitro research applications. In addition, the clinical US ([HI] model) system can be used as a suitable instrument for data acquisition and test the compatibility, efficacy, and validation at in vitro applications (BMF, flow phantom components).</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="http://www.jmuonline.org/text.asp?2020/28/4/225/293250" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Ultrasound-guided-fine-needle aspiration drainage and percutaneous ethanol injection for benign neck cysts</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><b>Li-Jen Liao, Chi-Te Wang, Tsung-Wei Huang, Po-Wen Cheng, Wu-Chia Lo</b><br><br>Journal of Medical Ultrasound 2020 28(4):225-229<br><br>Background: Ultrasound-guided-fine-needle aspiration drainage (US-FNAD) and US-percutaneous ethanol injection (US-PEI) have been widely used in the management of benign neck cysts. However, the long-term results of US-FNAD and US-PEI are not well elucidated. Methods: We retrospectively collated patients under neck US examinations from March 2007 to December 2017 and investigated the recurrence after US-FNAD and US-PEI. Univariate and multivariate Cox regression analyses were used to assess significant risk factors for recurrence after US-FNAD. Results: A total of 1075 patients were recruited, and their age was 50 &#177; 15 (mean &#177; standard deviation) years. A total of 862 patients had thyroid cysts, 118 patients had thyroglossal duct cysts (TGDC), twenty patients had branchial cleft cysts, 64 patients had parotid sialocysts, and 11 patients had plunging ranulas. Majority of the patients (97&#37;, 1037/1075) reported significant symptom improvement immediately. However, 38&#37; of the patients had recurrence with a median 3-year follow-up period. In a multivariate Cox regression analysis with adjustment for age and gender, plunging ranula (hazard ratio [HR]: 2.44, 95&#37; confidence interval [CI]: 1.19&#8211;4.99) and lateral dimension size &#8805; 0.8 cm (HR: 1.32, 95&#37; CI: 1.04&#8211;1.67) after US-FNAD were independent risk factors for recurrence. There were 15 male and 19 female patients who received US-PEI therapy after repeated US-FNAD, of whom 23 patients had thyroid cysts, 6 had plunging ranulas, 4 had TGDC, and one had a branchial cleft cyst. The overall success rate was 94&#37; (32/34), with a median follow-up period of 1.6 years. Two recurrent symptomatic patients had plunging ranulas. Some patients stated mild pain (21&#37;, 7/34) and swelling sensation (26&#37;, 9/34) after the injection. No major complications, such as vocal fold paresis or airway compression, were found. Conclusion: US-FNAD is an effective tool in the management of benign neck cysts with a 38&#37; recurrence rate. Plunging ranulas have the highest rate of recurrence after FNAD. US-PEI is effective for most recurrent neck cysts after repeated US-FNAD.</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="http://www.jmuonline.org/text.asp?2020/28/4/230/286008" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Influence of breast density on patient's compliance during ultrasound examination: Conventional handheld breast ultrasound compared to automated breast ultrasound</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><b>Sara De Giorgis, Nicole Brunetti, Jeries Zawaideh, Federica Rossi, Massimo Calabrese, Alberto Stefano Tagliafico</b><br><br>Journal of Medical Ultrasound 2020 28(4):230-234<br><br>Background: Our aim was to study the influence of breast density on patient&#39;s compliance during conventional handheld breast ultrasound (US) or automated breast US (ABUS), which could be used as adjunct screening modalities. Methods: Between January 2019 and June 2019, 221 patients (mean age: 53; age range: 24&#8211;89 years) underwent both US and ABUS. All participants had independently interpreted US and ABUS regarding patient compliance. The diagnostic experience with US or ABUS was described with a modified testing morbidity index (TMI). The scale ranged from 0 (worst possible experience) to 5 (acceptable experience). Standard statistics was used to compare the data of US and data of ABUS. Breast density was recorded with the Breast Imaging Reporting and Data System (BI-RADS) score. Results: The mean TMI score was 4.6 &#177; 0.5 for US and 4.3 &#177; 0.8 for ABUS. The overall difference between patients&#39; experience on US and ABUS was statistically significant with P &#60; 0.0001. The difference between patients&#39; experience on US and ABUS in women with BI-RADS C and D for breast density was statistically significant with P &#60; 0.02 in favor of US (4.7 &#177; 0.4) versus 4.5 &#177; 0.6 for ABUS. Patients&#39; experience with breast density B was better for US (4.7 &#177; 0.4) versus 4.3 &#177; 0.6 for ABUS with P &#60; 0.01. Pain or discomfort occurred during testing, especially in patients &#62;40 years. Conclusion: Patient age (&#62;40 years) is a significant predictor of decreased compliance to ABUS. Compliance of ABUS resulted lower that of US independently for breast density.</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="http://www.jmuonline.org/text.asp?2020/28/4/235/284501" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Ultrasonographic features associated with diffuse hepatosteatosis among diabetic obese and normal body mass index patients</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><b>Mahjabeen Liaqat, Mehreen Fatima, Sajid Shaheen Malik, Syed Amir Gillani, Iqra Manzoor</b><br><br>Journal of Medical Ultrasound 2020 28(4):235-238<br><br>Background: The purpose of the study is to evaluate and compare the changes associated with hepatosteatosis in diabetic obese versus diabetic normal-weight patients through ultrasonography. It is estimated that with the prevalence of about 30&#37;&#8211;75&#37; of obese individuals accordingto the body mass index (BMI) criteria are at increase risk of developing simple fatty live. Besides obesity, diabetes mellitus is also considered to be one of the important causes of hepatosteatosis. Methods: This prospective study was conducted in February 2015&#8211;December 2015 on a group of 181 diabetic patients, including 65 males and 116 females with an age range of 40&#8211;80 years. The patients were divided into two diabetic groups: those having a BMI &#8805;30 kg/m2 were included in the obese group (n &#61; 116) and those with a BMI of 18.5&#8211;25 kg/m2 were included in the normal BMI group (n &#61; 65). Ultrasound machine Esaote MyLab 50 equipped with a 3.5&#8211;5 MHz curvilinear multifrequency transducer was used to scan the liver. Independent samples t-test was performed to compare the liver span in the two groups. Chi-square tests were applied to compare the frequencies of fatty changes, border, and surface characteristics. Results: The presence of fatty changes among obese groups was statistically significant in the diabetic obese group compared to the normal-weight individuals with P &#60; 0.0001. Similarly, hepatic spans were found to be significantly greater in the diabetic obese group than the diabetic normal BMI group on independent samples t-test with P &#60; 0.0001. Females were seen to develop hepatosteatosis more frequently compared to males in all diabetic individuals with P &#61; 0.02. Conclusion: It is concluded that diabetic obese patients are more prone to develop hepatosteatosis as compared to normal BMI diabetic individuals.</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="http://www.jmuonline.org/text.asp?2020/28/4/239/286009" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Fetal epicardial fat thickness: Can it serve as a sonographic screening marker for gestational diabetes mellitus?</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><b>Sonay Aydin, Erdem Fatihoglu</b><br><br>Journal of Medical Ultrasound 2020 28(4):239-244<br><br>Background: Gestational diabetes mellitus (GDM) is defined as the new onset of impairment in carbohydrate tolerance during pregnancy. The aim of the current study was to define fetal epicardial fat thickness (fEFT) changes that developed before 24 weeks of gestation, to evaluate the diagnostic effectiveness of fEFT in predicting GDM diagnosis, and to correlate fEFT values with hemoglobin A1C (HbA1C) values. Methods: The study included a total of 60 GDM patients and 60 control subjects. A record consisted of fEFT measurements, maternal body mass index, maternal subcutaneous fat thickness, and fetal subcutaneous fat thickness during sonographic screening performed at 18&#8211;22 gestational weeks. Fetal abdominal circumference (AC) values, estimated fetal weight (EFW), and fetal gender were also recorded. Results: The median fEFT measurement of the whole study population was 0.9 &#177; 0.21 mm; 1.05 &#177; 0.21 mm in the GDM patients, and 0.8 &#177; 0.15 mm in the control group. The median fEFT values of the GDM patients were significantly higher than those of the control group (P &#60; 0.01). According to the correlation analysis results, a strong positive correlation was determined between the fEFT and HbA1C values (r &#61; 0.71, P &#60; 0.01), gestational week of the fetus (r &#61; 0.76, P &#61; P &#60; 0.01), AC (r &#61; 0.81, P &#60; 0.01), and EFW (r &#61; 0.71, P &#60; 0.01). According to the receiver operating characteristic analysis results, a fEFT value of &#62; 0.95 can predict GDM diagnosis with sensitivity of 65&#37; and specificity of 88&#37; (odds ratio &#61; 13). Conclusion: fEFT values are increased in GDM cases, and the increase can be detected earlier than 24 weeks of gestation. fEFT values are positively correlated with HbA1C values and can serve as an early predictor for GDM diagnosis.</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="http://www.jmuonline.org/text.asp?2020/28/4/245/300421" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Physiotherapeutic treatment for levator ani avulsion after delivery: A transperineal three-dimensional ultrasound assessment</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><b>Juliana Sayuri Kubotani, Edward Araujo J&#250;nior, Andrea Silveira de Queiroz Campo, Jurandir Piassi Passos, Caroline Ferreira do Nascimento Neri, Miriam Raquel Diniz Zanetti</b><br><br>Journal of Medical Ultrasound 2020 28(4):245-248<br><br>Background: Levator ani avulsion is defined as the interruption of the insertion of this muscle on the pubic bone. It is currently recognized as an important triggering factor for genital prolapse. Although surgical interventions are available, there are no conservative strategies for this muscular injury. Description: A 40-year-old female presented with urinary incontinence and levator ani avulsion, which was confirmed on transperineal three-dimensional ultrasound (3DUS). Upon referral for physiotherapy, she presented with incorrect and weak contractions of the pelvic floor. Her treatment comprised 13 sessions of intravaginal electrotherapy followed by pelvic floor muscle (PFM) exercises in different positions. At the end of the sessions, another transperineal 3DUS was performed, and it revealed rapprochement of the levator ani muscle. The avulsed levator ani muscle can be reinserted using physiotherapeutic interventions, especially a combination of electrotherapy and PFM exercises. Conclusion: Transperineal 3DUS is an important approach for the follow-up of conservative treatment until full recovery.</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="http://www.jmuonline.org/text.asp?2020/28/4/249/304318" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Peripheral polyneuropathy associated with COVID-19 in two patients: A musculoskeletal ultrasound case report</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><b>Steven B Soliman, Chad L Klochko, Manmeet K Dhillon, Naomi R Vandermissen, Marnix T van Holsbeeck</b><br><br>Journal of Medical Ultrasound 2020 28(4):249-252<br><br>As coronavirus disease 2019 (COVID-19) spreads, we are encountering multiple different symptoms and related complications. Although the vast majority of literature is focused on its pulmonary manifestations, recent reports have mentioned neurologic manifestations but typically those related to the central nervous system and diagnosed utilizing magnetic resonance imaging. We present two cases of COVID-19&#8211;associated peripheral polyneuropathy diagnosed utilizing musculoskeletal ultrasound (US), which to our knowledge is the first such case report. US is an instrumental portable modality that can be used for COVID-19 patients in isolation. As this virus continues to spread, understanding and recognizing these COVID-19 related complications and their sonographic findings are crucial.</span><br><br></td></tr></tbody></table><div><div dir="ltr" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-71900258843480089142020-12-22T23:11:00.001-08:002020-12-22T23:11:47.272-08:00Eye & Contact Lens<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Marching_Ahead_Online_and_Leaving_the_Print_Behind.1.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Marching Ahead Online and Leaving the Print Behind</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Marching_Ahead_Online_and_Leaving_the_Print_Behind.1.aspx"></a>No abstract available</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Associations_Between_Systemic_Omega_3_Fatty_Acid.2.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Associations Between Systemic Omega-3 Fatty Acid Levels With Moderate-to-Severe Dry Eye Disease Signs and Symptoms at Baseline in the Dry Eye Assessment and Management Study</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Associations_Between_Systemic_Omega_3_Fatty_Acid.2.aspx"><img src="https://images.journals.lww.com/claojournal/SmallThumb.00140068-202101000-00002.T1.jpeg" border="0" align="left" alt="image"></a>Purpose: Omega-3 (n-3) fatty acid supplementation is used to treat systemic inflammatory diseases, but the role of n-3 in the pathophysiology and therapy of dry eye disease (DED) is not definitive. We evaluated the relationship of systemic n-3 levels with signs and symptoms at baseline in the Dry Eye Assessment and Management (DREAM) Study. Methods: Blood samples from participants at baseline were analyzed for n-3 and n-6, measured as relative percentage by weight among all fatty acids in erythrocytes. Symptoms were evaluated using the Ocular Surface Disease Index. Signs including conjunctival staining, corneal staining, tear breakup time (TBUT), and Schirmer's test with anesthesia were also evaluated. Results: There was no correlation between the systemic n-3 levels and DED symptoms. When the associations with signs of DED were assessed, lower DHA levels were associated with higher conjunctival staining, with mean scores of 3.31, 2.96, and 2.82 for low, medium, and high levels of DHA, respectively (linear trend P=0.007). None of the other signs were associated with DHA or the other measures of n-3. Conclusion: Previous studies have found varying results on the role of n-3 supplementation with the signs and symptoms of DED. Among patients with DED enrolled in the DREAM Study, lower systemic n-3 levels were not associated with worse symptoms and most signs of DED.</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Development_of_a_Questionnaire_for_Detecting.3.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Development of a Questionnaire for Detecting Changes in Dry Eye Disease–Related Symptoms</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Development_of_a_Questionnaire_for_Detecting.3.aspx"><img src="https://images.journals.lww.com/claojournal/SmallThumb.00140068-202101000-00003.F1.jpeg" border="0" align="left" alt="image"></a>Objectives: Determining the changes in symptomatology suffered by dry eye disease (DED) patients after an intervention is difficult because there is only one validated questionnaire specifically designed to measure these changes and it is somewhat complex. This work uses a simplified questionnaire to evaluate the changes in DED-related symptoms. Methods: A new questionnaire based on a global rating of change scale was designed. The Change in Dry Eye Symptoms Questionnaire (CDES-Q) consists of 2 questions: CDES-Q1 asks for the change in symptoms ("better," "same," or "worse") relative to a determined previous time and CDES-Q2 quantifies this change (range: 0 to +100). To evaluate the CDES-Q, a prospective observational study was performed. At baseline (V1; day-0), DED-related symptoms were evaluated using the ocular surface disease index (OSDI). In the post-treatment visit (V2; day-90), OSDI, Symptoms Assessment Questionnaire in Dry Eye (SANDE) II, and CDES-Q were used. Also, clinical evaluations were performed in each visit. Results: Thirty-six patients were included. At V2, OSDI, SANDE II, and CDES-Q showed a significant reduction in symptoms (−7.17±12.73, P=0.0021; −11.29±20.95, P=0.0035; −25.28±42.28, P=0.0011, respectively). Patients who answered "better" in CDES-Q1 showed a significantly lower SANDE II than those who answered "same" or "worse," while SANDE II did not discriminate between these groups. Conclusions: CDES-Q can be a useful tool for the evaluation of changes in DED-related symptoms. It is simple and better discriminates patients without changes from those who suffered a worsening than SANDE II.</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Simplified_Classification_of_Tear_Film_Break_Up.4.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Simplified Classification of Tear Film Break-Up Patterns and Their Clinicopathological Correlations in Patients With Dry Eye Disease</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Simplified_Classification_of_Tear_Film_Break_Up.4.aspx"><img src="https://images.journals.lww.com/claojournal/SmallThumb.00140068-202101000-00004.F1.jpeg" border="0" align="left" alt="image"></a>Purpose: To analyze the pathophysiological differences between patients with dry eye disease (DED) having different tear film break-up patterns (TBUPs). Methods: This investigative analysis involved 91 eyes of 91 patients with DED who were divided into two groups: those with "dot" break-up pattern (group I) and those with "random" break-up pattern (group II). Clinical severity was evaluated using the Ocular Surface Disease Index (OSDI), Oxford stain score system (OSS) score, and tear film break-up time (TF-BUT). Eighteen patients in group I and 17 patients in group II were selected for sampling of tears and the conjunctiva, and the concentrations of inflammatory cytokines and mucin in the tears and conjunctival tissue were measured. Results: Thirty-seven patients were classified as group I and 54 patients as group II. Patients in group I had a statistically lower TF-BUT and a higher OSS score than those in group II, whereas the OSDI was not statistically different between the groups. The concentrations of interleukin (IL)-6 and IL-8 were statistically higher in group I than those in group II. Impression cytology showed that the expression of IL-1β and IL-8 was higher in group I, whereas that of other genes was not statistically different. Conclusions: We were able to clearly classify patients with DED with different TBUPs into two groups, and each group had different clinical and pathophysiological characteristics. In patients with the dot break-up pattern, the disease was strongly associated with ocular surface inflammation, as opposed to that in patients without this pattern.</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://journals.lww.com/claojournal/Fulltext/2021/01000/The_Early_Effects_of_Alcohol_Consumption_on.5.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">The Early Effects of Alcohol Consumption on Functional Visual Acuity, Tear Functions, and the Ocular Surface</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/claojournal/Fulltext/2021/01000/The_Early_Effects_of_Alcohol_Consumption_on.5.aspx"><img src="https://images.journals.lww.com/claojournal/SmallThumb.00140068-202101000-00005.F1.jpeg" border="0" align="left" alt="image"></a>Purpose: We investigated the early effects of alcohol intake on tear functions and ocular surface health in this prospective controlled study. Methods: Forty-four eyes of 22 subjects (17 males, 5 females; mean age: 35.3 years) who drank 200 mL of 25% Japanese vodka and 44 eyes of age- and sex-matched 22 control subjects who drank water were investigated. Subjects were requested to refrain from alcohol consumption from the previous day and food ingestion 6 hr before the study. Each subject consumed exactly the same order prepared dinner and same quantity of alcohol over the same time frame. Subjects underwent breath alcohol level, tear evaporation and blink rate, tear lipid layer interferometry, tear film break-up time (BUT), fluorescein and Rose Bengal stainings, Schirmer test, and visual analog scale (VAS) evaluation of dry eye symptoms before, as well as 2 and 12 hr after alcohol intake. Results: The mean breath alcohol level was significantly higher in the alcohol group compared to the water group at 2 and 12 hr (P<0.001). The mean tear evaporation increased significantly from 2.5×10−7 to 8.8×10−7 gr/cm2/sec 12 hr after alcohol intake (P<0.001). The mean BUT shortened significantly from 15.0±5.0 to 5.0±2.5 sec 12 hr after alcohol intake. Lipid layer interferometry showed signs of tear film thinning 12 hr after alcohol intake in all subjects of the alcohol intake group, which was not observed in the water group. The mean blink rates increased significantly from 10.6±1.5 blinks/min to 13.5±0.9 blinks/min and 15.1±1.2 blinks/min at 2 and 12 hr, respectively, in the alcohol group (P<0.001). The Schirmer test values decreased significantly 12 hr after alcohol intake (P<0.001). The mean VAS score for dryness increased from baseline significantly in the alcohol group at 12 hr (P<0.001). No significant time-wise changes in tear functions were observed in the water group. Conclusion: The tear film and ocular surface epithelia showed early and distinctive quantitative and qualitative changes associated with visual disturbances after alcohol intake.</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Association_Between_Dry_Eye_and_Polycystic_Ovary.6.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Association Between Dry Eye and Polycystic Ovary Syndrome: Subclinical Inflammation May Be Part of the Process</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Association_Between_Dry_Eye_and_Polycystic_Ovary.6.aspx"><img src="https://images.journals.lww.com/claojournal/SmallThumb.00140068-202101000-00006.F1.jpeg" border="0" align="left" alt="image"></a>Purpose: To evaluate the changes in tear function in patients with polycystic ovary syndrome (PCOS) and establish whether there is a correlation between hormonal levels, novel hematologic biomarkers, and dry eye parameters. Material and Method: Forty-seven patients with PCOS and 43 age-matched patients with unexplained infertility were included in the control group. Follicle-stimulating hormone, luteinizing hormone, estradiol, thyroid-stimulating hormone, prolactin, dehydroepiandrosterone sulfate (DHEA-S), 17-OH progesterone, fasting and postprandial glucose, fasting insulin, and cholesterol metabolites were evaluated in both groups. In addition, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio were obtained from a complete blood count. The Ocular Surface Disease Index (OSDI) questionnaire was administered, and all patients underwent tear break-up time (BUT) and Schirmer I tests. Bivariate correlations were investigated using Spearman correlation coefficient analysis. Results: The mean age of the PCOS group and the control group was 27.66±3.96 years and 29.28±6.83 years, respectively. Schirmer I test scores and BUT values were significantly lower and OSDI results were significantly higher in the PCOS group (P=0.003, P<0.001, and P=0.004). An inverse correlation was found between DHEA-S and BUT values in the PCOS group (r=−0.296, P=0.043). Similarly, a negative correlation was also present between NLR and BUT values in the PCOS group (r=−0.322, P=0.027). Conclusions: Dry eye can be well established by sensitive tests in patients with PCOS. The severity of dry eye may be correlated with the level of inflammation and hyperandrogenism.</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Ocular_Surface_Changes_in_Hashimoto_s_Thyroiditis.7.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Ocular Surface Changes in Hashimoto's Thyroiditis Without Thyroid Ophthalmopathy</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Ocular_Surface_Changes_in_Hashimoto_s_Thyroiditis.7.aspx"><img src="https://images.journals.lww.com/claojournal/SmallThumb.00140068-202101000-00007.F1.jpeg" border="0" align="left" alt="image"></a>Objective: We sought to evaluate ocular surface changes in patients with Hashimoto's thyroiditis without thyroid ophthalmopathy and elucidate the relationship between dry eye syndrome and meibomian gland dysfunction (MGD) in cases of Hashimoto's thyroiditis. Methods: This prospective study included 105 patients with Hashimoto's thyroiditis and 105 age- and sex-matched controls. The 12-item Ocular Surface Disease Index (OSDI) questionnaire was administered to all patients. Both eyes affected by Hashimoto's thyroiditis and normal eyes were evaluated and compared with regard to the following parameters: Hertel exophthalmometry, palpebral fissure height, tear-film breakup time (TBUT), Schirmer 1 test, area and density scores for corneal fluorescein staining, eyelid abnormality, meibomian gland expression, meibography scores, and areas of meibomian gland loss. Results: The eyes affected by Hashimoto's thyroiditis demonstrated significantly lower TBUTs (P<0.001), Schirmer 1 test scores (P<0.001), and meibomian gland expression (P<0.05) and significantly higher OSDI scores (P<0.001), corneal fluorescein staining results (P<0.05), eyelid abnormality scores (P<0.05), meibography scores (P<0.05), and areas of meibomian gland loss (P<0.05). Ocular Surface Disease Index scores were significantly positively correlated with eyelid abnormality scores (P=0.025), meibography scores (P<0.05), and areas of meibomian gland loss (P<0.05) and negatively correlated with meibomian gland expression (P<0.05). The duration of Hashimoto's thyroiditis was significantly positively correlated with MGD (P<0.05). Conclusion: Dry eye syndrome and ocular discomfort symptoms are significantly more common among patients with Hashimoto's thyroiditis, even in the absence of thyroid ophthalmopathy. Dry eye syndrome in patients with Hashimoto's thyroiditis is believed to result from MGD and is correlated with the duration of the thyroid disease.</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://journals.lww.com/claojournal/Fulltext/2021/01000/A_Retrospective_Study_of_Treatment_Outcomes_and.8.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">A Retrospective Study of Treatment Outcomes and Prognostic Factors of Intense Pulsed Light Therapy Combined With Meibomian Gland Expression in Patients With Meibomian Gland Dysfunction</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/claojournal/Fulltext/2021/01000/A_Retrospective_Study_of_Treatment_Outcomes_and.8.aspx"><img src="https://images.journals.lww.com/claojournal/SmallThumb.00140068-202101000-00008.F1.jpeg" border="0" align="left" alt="image"></a>Objectives: To evaluate clinical changes after intense pulsed light and meibomian gland expression (IPL/MGX) treatment in meibomian gland dysfunction (MGD) patients, and to identify ideal candidates, and the therapeutic window, for IPL/MGX. Methods: This retrospective study reviewed the medical records of 44 MGD patients (44 eyes). The IPL/MGX treatment was applied on the eyelids three times at intervals of 4 weeks. Age, sex, relevant ocular history, Standard Patient Evaluation of Eye Dryness (SPEED), Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), corneal fluorescein staining score (CFSS), meiboscore, meibomian gland loss score (MGLS), meibomian glands yielding secretion score (MGYSS), meibomian glands yielding clear secretion (MGYCS), and meibomian glands yielding liquid secretion (MGYLS) were analyzed. Results: Standard Patient Evaluation of Eye Dryness, OSDI, TBUT, CFSS, MGYSS, MGYLS, and MGYCS were significantly improved after three IPL/MGX treatments, but the meiboscore and MGLS remained unchanged. In patients who had better treatment outcomes (improvement in MGYSS >7), younger age (36.0, 22.5 vs. 53.0, 25.0 years; P=0.012), a longer TBUT (8.0, 4.5 vs. 6.0, 3.0 sec; P=0.010), better meiboscore (1.0, 0.5 vs. 2.0, 1.0; P=0.012), and less gland loss (19.8%, 20.3% vs. 41.1%, 30.2%; P=0.008) before IPL/MGX were noted. Sex, relevant ocular history, SPEED, OSDI, MGYSS, MGYLS, and MGYCS before IPL/MGX showed no significant differences between patients with an improvement in MGYSS >7 versus those with an improvement of ≤7. Meibomian glands yielding secretion score changes in patients who had a meiboscore of 0 to 1 and MGYSS of 0 before IPL/MGX (12.0, 10.0) were significantly higher than those who had a meiboscore of 2 to 3 and MGYSS of 0 (6.5, 9.3; P=0.031), or a meiboscore of 0 to 1 and MGYSS >0 (5.0, 11.5; P=0.041). Conclusions: Improved dry eye symptoms, TBUT, corneal staining, and meibomian gland secretion were observed in MGD patients after IPL/MGX. Patients in the early stages of MGD maybe benefited most from IPL/MGX treatment.</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://journals.lww.com/claojournal/Fulltext/2021/01000/The_Efficacy_of_Intense_Pulsed_Light_Combined_With.9.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">The Efficacy of Intense Pulsed Light Combined With Meibomian Gland Expression for the Treatment of Dry Eye Disease Due to Meibomian Gland Dysfunction: A Multicenter, Randomized Controlled Trial</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/claojournal/Fulltext/2021/01000/The_Efficacy_of_Intense_Pulsed_Light_Combined_With.9.aspx"><img src="https://images.journals.lww.com/claojournal/SmallThumb.00140068-202101000-00009.F1.jpeg" border="0" align="left" alt="image"></a>Objectives: To compare the efficacy of intense pulsed light (IPL) combined with Meibomian gland expression (MGX), and instant warm compresses combined with MGX, for treatment of dry eye disease (DED) due to meibomian gland dysfunction (MGD). Methods: In a prospective, multicenter, interventional study, 120 subjects with DED due to MGD were randomized 1:1 to an IPL arm or a control arm. Each subject was treated 3 times at 3-week intervals. The primary outcome measure was the tear break up time (TBUT). Tear break up time and a few additional outcome measures were evaluated at the baseline and at 3 weeks after the last treatment. Results: All outcome measures improved in both arms, but in general, the improvement was significantly larger in the IPL arm. Tear break up time increased by 2.3±1.9 and 0.5±1.4 sec, in the IPL and control arms respectively (P<0.001). SPEED was reduced by 38% and 22% in the IPL and control arms, respectively (P<0.01). Meibomian Gland Yielding Secretion Score was improved by 197% in the IPL arm and 96% in the control arm. Corneal fluorescein staining also decreased by 51% and 24% in the IPL and control arms respectively, but the differences between the two arms were not statistically significant (P=0.61). A composite score of lid margin abnormalities improved in both arms, but more in the IPL arm (P<0.05). Conclusions: Intense pulsed light combined with MGX therapy was significantly more effective than instant warm compresses followed with MGX. This suggests that the IPL component has a genuine contribution to the improvement of signs and symptoms of DED.</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Efficacy_of_Azithromycin_Eyedrops_for_Individuals.10.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Efficacy of Azithromycin Eyedrops for Individuals With Meibomian Gland Dysfunction–Associated Posterior Blepharitis</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/claojournal/Fulltext/2021/01000/Efficacy_of_Azithromycin_Eyedrops_for_Individuals.10.aspx"><img src="https://images.journals.lww.com/claojournal/SmallThumb.00140068-202101000-00010.T1.jpeg" border="0" align="left" alt="image"></a>Purpose: To examine the safety and efficacy of azithromycin eyedrops in Japanese individuals with meibomian gland dysfunction (MGD)-associated posterior blepharitis. Methods: Individuals with MGD-associated posterior blepharitis who visited the Itoh Clinic, Saitama, Japan, were randomly assigned to receive azithromycin (1%) eyedrops (AZM group, 16 eyes of 16 patients) or preservative-free artificial tears (control group, 20 eyes of 20 patients) for 2 weeks. All subjects also applied a warming eyelid compress twice per day. Subjective symptoms (Standardized Patient Evaluation of Eye Dryness [SPEED] score), lipid layer thickness (LLT) and interferometric pattern of the tear film, plugging and vascularity of the lid margin, noninvasive break-up time of the tear film (NIBUT) and fluorescein-based break-up time of the tear film (TBUT), corneal–conjunctival fluorescein staining score, tear meniscus height, meibum grade, meiboscore, tear osmolarity, and Schirmer test value were determined before and after treatment. Side effects of treatment were also recorded. Results: In the AZM group, SPEED score, LLT, interferometric pattern, plugging and vascularity of the lid margin, NIBUT, TBUT, meibum grade, and tear osmolarity were significantly improved after treatment compared with baseline. The SPEED score, interferometric pattern, plugging, vascularity, meibum grade, and tear osmolarity were also significantly improved after treatment in the AZM group compared with the control group. Common side effects in the AZM group were transient eye irritation and blurred vision. Conclusion: Azithromycin eyedrops improved eyelid inflammation, the quality and quantity of the lipid layer of the tear film, and tear film stability. Such eyedrops thus seem to be a safe and effective treatment for MGD-associated posterior blepharitis.</span><br><br></td></tr></tbody></table><div><div dir="ltr" class="gmail_signature" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-69108737604113339732020-12-22T23:10:00.000-08:002020-12-22T23:11:14.461-08:00Spine<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/_The_Night_View_of_Bund_in_Shanghai,_China_.1.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">"The Night View of Bund in Shanghai, China"</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/_The_Night_View_of_Bund_in_Shanghai,_China_.1.aspx"><img src="https://images.journals.lww.com/spinejournal/SmallThumb.00007632-202101150-00001.figure1.jpeg" border="0" align="left" alt="image"></a>No abstract available</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/It_is_Time_to_Change_Our_Mindset_and_Perform_More.2.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">It is Time to Change Our Mindset and Perform More High-quality Research in Low Back Pain</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/It_is_Time_to_Change_Our_Mindset_and_Perform_More.2.aspx"></a>No abstract available</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/The_Impact_of_Anterior_Spondylolisthesis_and.3.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">The Impact of Anterior Spondylolisthesis and Kyphotic Alignment on Dynamic Changes in Spinal Cord Compression and Neurological Status in Cervical Spondylotic Myelopathy: A Radiological Analysis Involving Kinematic CT Myelography and Multimodal Spinal Cord Evoked Potentials</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/The_Impact_of_Anterior_Spondylolisthesis_and.3.aspx"><img src="https://images.journals.lww.com/spinejournal/SmallThumb.00007632-202101150-00003.F1.jpeg" border="0" align="left" alt="image"></a>Study Design. A retrospective study of prospectively collected data. Objective. This study aimed to examine how radiological parameters affect dynamic changes in the cross-sectional area of the spinal cord (CSA) in cervical spondylotic myelopathy (CSM) patients and how they correlate with the severity of myelopathy, by evaluating multi-modal spinal cord evoked potentials (SCEPs). Summary of Background Data. Appropriate assessments of dynamic factors should reveal hidden spinal cord compression and provide useful information for choosing surgical procedures. Methods. Seventy-nine CSM patients were enrolled. They were examined with kinematic CT myelography (CTM), and the spinal levels responsible for their CSM were determined via SCEP examinations. The C2–7 angle, C2–7 range of motion, and percentage of slip were measured on the midsagittal view during flexion and extension, and the CSA was measured on the axial view in each neck position using kinematic CTM. The patients who exhibited the smallest CSA values during extension and flexion were classified into Groups E and F, respectively. Results. Fifty-two (65.8%) and 27 (34.2%) cases were included in Groups E and F, respectively. The preoperative JOA score did not differ significantly between the groups; however, the preoperative lower-limb JOA score of Group F was significantly lower than that of Group E (2.24 ± 0.82 vs. 2.83 ± 1.09, P = 0.016). In the multiple logistic regression analysis, a small C2–7 angle during extension (β = 5°, odds ratio: 0.69, 95% confidence interval [CI]: 0.54–0.90) and the slip percentage during flexion (β = 5%, odds ratio: 1.42, 95% CI: 1.09–1.85) were identified as significant predictors of belonging to Group F. Conclusion. Exhibiting more severe spinal cord compression during neck flexion was associated with a small C2–7 angle and anterior spondylolisthesis. The neurological status of the patients in Group F was characterized by severe lower limb dysfunction because of a disturbed blood supply to the anterior column. Level of Evidence: 4</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Cervical_Extensor_Muscles_Play_the_Role_on.4.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Cervical Extensor Muscles Play the Role on Malalignment of Cervical Spine: A Case Control Study With Surface Electromyography Assessment</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Cervical_Extensor_Muscles_Play_the_Role_on.4.aspx"><img src="https://images.journals.lww.com/spinejournal/SmallThumb.00007632-202101150-00004.F1.jpeg" border="0" align="left" alt="image"></a>Study Design. A case control study. Objective. The aim of this study was to identify the potential impact of cervical spine malalignment on muscle parameters. Summary of Background Data. Muscular factors are associated with cervical alignment. Nevertheless, only muscle dimensions or imaging changes have been evaluated, function of cervical muscles has scarcely been investigated. Methods. Thirty-four patients diagnosed as cervical spine degeneration associated with cervical malalignment and 32 control subjects were included in this case control study. Visual analogue scale (VAS) and the neck disability index (NDI) were used. The sagittal alignment parameters and cervical range of motion (ROM) were measured on cervical spine lateral radiographs, included C2-C7 lordosis, C2-C7 sagittal vertical axis (C2-C7 SVA), cervical gravity-sagittal vertical axis (CG-SVA), T1-Slope, and spinal canal angle (SCA). Surface electromyography (SEMG)-based flexion-relaxation ratio (FRR) was measured. Results. The result showed VAS score of the neck significantly lower in controls (P<0.05), C2-C7 lordosis, C2-C7 SVA, CG-SVA, T1-Slope and ROM showed significantly different (P<0.001) between malalignment group and control group, FRR of splenius capitis (FRRSpl) and upper trapezius (FRRUTr) of the malalignment group were lower than in the control group, which correlated well with NDI (rSpl = −0.181 rUTr = −0.275), FRRSpl correlated well with VAS (rSpl = −0.177). FRRSpl correlated strongly with C2-C7 SVA (r = 0.30), CG-SVA (r = 0.32), T1-Slope (r = 0.17), ROM (r = 0.19), FRRUTr correlated with C2-C7 lordosis (r = −0.23), CG-SVA (r = 0.19), T1-Slope (r = 0.28), ROM (r = 0.23). Conclusion. Cervical malalignment patients had more tensional posterior cervical muscle and poor muscle functions. CG-SVA showed advantages in evaluating cervical malalignment. Level of Evidence: 3</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Preoperative_Opioid_Weaning_Before_Major_Spinal.5.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Preoperative Opioid Weaning Before Major Spinal Fusion: Simulated Data, Real-World Insights</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Preoperative_Opioid_Weaning_Before_Major_Spinal.5.aspx"><img src="https://images.journals.lww.com/spinejournal/SmallThumb.00007632-202101150-00005.T1.jpeg" border="0" align="left" alt="image"></a>Study Design. Retrospective cohort. Objective. To identify gaps in opioid prescription immediately prior to spinal fusion and to study the effect of such simulated "opioid weaning/elimination" on risk of long-term postoperative opioid use. Summary of Background Data. Numerous studies have described preoperative opioid duration and dose thresholds associated with sustained postoperative opioid use. However, the benefit and duration of preoperative opioid weaning before spinal fusion has not been elaborated. Methods. Humana commercial insurance data (2007-Q1 2017) was used to study primary cervical and lumbar/thoracolumbar fusions. More than 5000 total morphine equivalents in the year before spinal fusion were classified as chronic preoperative opioid use. Based on time between last opioid prescription (<14-days' supply) and spinal fusion, chronic opioid users were divided as; no gap, >2-months gap (2G) and >3-months gap (3G). Primary outcome measure was long-term postoperative opioid use (>5000 total morphine equivalents between 3 and 12-mo postoperatively). The effect of "opioid gap" on risk of long-term postoperative opioid use was studied using multiple-variable logistic regression analyses. Results. 17,643 patients were included, of whom 3590 (20.3%) had chronic preoperative opioid use. Of these patients, 41 (1.1%) were in the 3G group and 106 (3.0%) were in the 2G group. In the 2G group, 53.8% patients ceased to have long-term postoperative use as compared with 27.8% in NG group. This association was significant on logistic regression analysis (OR 0.30, 95% CI: 0.20–0.46, P < 0.001). Conclusions. Chronic opioid users whose last opioid prescription was >2-months prior to spinal fusion and less than 14-days' supply had significantly lower risk of long-term postoperative opioid use. We have simulated "opioid weaning" in chronic opioid users undergoing major spinal fusion and our analysis provides an initial reference point for current clinical practice and future clinical studies. Level of Evidence: 3</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Relationship_Between_Pulmonary_Function_and.6.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Relationship Between Pulmonary Function and Thoracic Morphology in Adolescent Idiopathic Scoliosis: A New Index, the "Apical Vertebra Deviation Ratio", as a Predictive Factor for Pulmonary Function Impairment</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Relationship_Between_Pulmonary_Function_and.6.aspx"><img src="https://images.journals.lww.com/spinejournal/SmallThumb.00007632-202101150-00006.F1.jpeg" border="0" align="left" alt="image"></a>Study Design. A retrospective study. Objective. The aim of this study was to investigate the relationship between thoracic morphology (TM) and pulmonary function (PF) in patients with adolescent idiopathic scoliosis (AIS) and the feasibility of the "apical vertebra deviation ratio (AVDR)" as a predictor of PF impairment. Summary of Background. The PF of AIS is one of the key focuses of clinicians' attention. Early identification of AIS patients who are at risk of developing impaired PF is important for improving patient management. Methods. Preoperative PF and radiographic examination data of 108 patients with thoracic AIS were collected. The following TM data were collected: the costophrenic angle distance (CAD), distance between T1 and mean diaphragm height (T1-diaphragm), T1-T12 height, and AVDR. The correlation coefficient between PF and TM measurements was analyzed, and univariable and multivariable linear regressions were used to determine whether the TM measurements could predict PF. Results. The CAD, T1-diaphragm, and T1-T12 height were significantly positively correlated with forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), vital capacity, and total lung capacity (r = 0.54–0.74, P < 0.01). A linear equation between CAD and pulmonary volume could be established: FVC (L) = −3.46 + CAD (cm) × 0.27 (R2 = 0.54). If T1-T12 height is included, the correlation is further enhanced (R2 = 0.68). There was a significant negative correlation between the AVDR and predicted values of forced vital capacity (FVC%), FEV1%, predicted values of vital capacity, and predicted values of total lung capacity (r = −0.46 to −0.52, P < 0.01). The AVDR could predict the value of each of these variables. One of the linear equations is as follows: FVC% = 110.70–99.73 × AVDR (R2 = 0.272). Conclusion. The two novel, two-dimensional TM measurements, CAD and AVDR, can be used as moderate to strong predictors of PF outcome in statistical terms. An AVDR >0.2 suggests that the patient may suffer from moderate or severe PF damage. Level of Evidence: 4</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Predictive_Probability_of_the_Global_Alignment_and.7.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Predictive Probability of the Global Alignment and Proportion Score for the Development of Mechanical Failure Following Adult Spinal Deformity Surgery in Asian Patients</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Predictive_Probability_of_the_Global_Alignment_and.7.aspx"><img src="https://images.journals.lww.com/spinejournal/SmallThumb.00007632-202101150-00007.F1.jpeg" border="0" align="left" alt="image"></a>Study Design. This is a multicenter retrospective review of 257 surgically treated consecutive ASD patients who had a minimum of five fused segments, completed a 2-year follow-up (53 ± 19 yrs, females: 236 [92%]). Objective. This study aimed to validate the predictive probability of the GAP score in an Asian ASD patient cohort. Summary of Background Data. The GAP score is a recently established risk stratification model for MF following ASD surgery. However, the predictive ability of the GAP score is not well studied. This study aimed to validate the predictive probability of the GAP score in an Asian ASD patient cohort. Methods. Comparisons of the immediate postoperative GAP scores between MF the and MF-free groups were performed. We evaluated the discriminative ability of the GAP score based on the area under the receiver operating characteristic curve (AUROC). The Cuzick test was performed to determine whether there is a trend between the GAP score and the incidence of MF or revision surgery. Univariate logistic regression analyses were performed to explore the associations between the GAP score and the incidence of MF or revision surgery. Results. No difference was observed in the GAP score between the MF and MF-free groups (MF vs. MF-free; GAP: 5.9 ± 3.3 vs. 5.2 ± 2.7, P = 0.07). The Cuzick analysis showed no trend between the GAP score and the risk for MF or revision surgery. Likewise, the MF rate was not correlated with the GAP score, as shown by the ROC curve (AUC of 0.56 [95% CI 0.48–0.63], P = 0.124). Univariate logistic regression confirmed no associations between the GAP score and the incidence of MF or revision surgery (MF; moderately disproportioned [MD]: OR: 0.6 [95% CI: 0.3–1.2], P = 0.17, severely disproportioned [SD]: OR: 1.2 [95% CI: 0.6–2.3], P = 0.69, revision surgery; MD: OR: 0.8 [95% CI: 0.2–2.8], P = 0.71, SD: OR: 1.2 [95% CI: 0.9–8.7], P = 0.08). Conclusion. In this multicenter study, in an Asian ASD patient cohort, the GAP score was not associated with the incidence of MF or revision surgery. Additional studies on the predictive ability of the GAP score in different patient cohorts are warranted. Level of Evidence: 3</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Accuracy_of_EOS_Imaging_Technology_in_Comparison.8.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Accuracy of EOS Imaging Technology in Comparison to Computed Tomography in the Assessment of Vertebral Rotational Orientation in Instrumented Spines in Adolescent Idiopathic Scoliosis</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Accuracy_of_EOS_Imaging_Technology_in_Comparison.8.aspx"><img src="https://images.journals.lww.com/spinejournal/SmallThumb.00007632-202101150-00008.F1.jpeg" border="0" align="left" alt="image"></a>Study Design. Retrospective radiographic reliability study. Objective. The aim of this study was to assess the validity of EOS 3D imaging technology in the determination of vertebral rotations in the spine of patients with previous instrumentation. Summary of Background Data. There is a lack of evidence on the accuracy of vertebral rotational measurement using EOS 3D morphological analysis in the instrumented spine. Methods. A retrospective review of 31 patients with adolescent idiopathic scoliosis (AIS) who underwent instrumented fusion and postoperative computed tomography (CT) scans of the spine was performed. Vertebral rotations of the apex vertebra, the uppermost (UIV) and lowermost (LIV) instrumented vertebra, the noninstrumented vertebra one level cranial to the UIV (UIV + 1) and one level caudal to LIV (LIV + 1) were determined using EOS 3D reconstruction. The vertebral rotation was also measured using reformatted CT axial images. Relative vertebral rotational difference (VRD) were calculated for UIV to apex, UIV + 1 to apex, LIV to apex, LIV + 1 to apex, UIV to LIV and UIV + 1 to LIV + 1. Paired t tests were used to compare the VRD measured using the two different imagining modalities. For values where P > 0.05, the Bland-Altman plot was used to assess the agreement between the measures. Interclass correlation (ICC) was used to determine interobserver and intraobserver reliabilities of EOS and CT measurements. Results. EOS analysis of relative VRD was found to be significantly different from that of CT for UIV to apex (P = 0.006) and UIV + 1 to apex (P = 0.003). No significant differences were found for LIV to apex (P = 0.06), LIV + 1 to apex (P = 0.06), UIV to LIV (P = 0.59) and UIV + 1 to LIV + 1 (P = 0.64). However, Bland-Altman plots showed that agreement was poor, and variance was beyond acceptable. ICC showed good interobserver and good to very good intraobserver reliability for EOS. Conclusion. EOS 3D morphological analysis of VRD in the instrumented levels of the spine demonstrated significant difference and unacceptable variance in comparison to CT measurement. Level of Evidence: 4</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Presurgical_Short_Term_Halo_Pelvic_Traction_for.9.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Presurgical Short-Term Halo-Pelvic Traction for Severe Rigid Scoliosis (Cobb Angle >120°): A 2-Year Follow-up Review of 62 Patients</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Presurgical_Short_Term_Halo_Pelvic_Traction_for.9.aspx"><img src="https://images.journals.lww.com/spinejournal/SmallThumb.00007632-202101150-00009.F1.jpeg" border="0" align="left" alt="image"></a>Study Design. A 2-year follow-up review of 62 patients with severe rigid scoliosis (>120°). Objective. To evaluate the effectiveness and safety of halo-pelvic traction (HPT) for treating severe rigid scoliosis (>120°). Summary of Background Data. Severe rigid scoliosis (>120°) is still a challenge for spine surgeons. A combination of presurgical HPT traction, osteotomy, and internal fixation could be a safe and effective solution for these cases. Methods. We reviewed the records of all the patients with severe rigid scoliosis (>120°) treated with presurgical HPT from 2013 through 2017. Radiographic measurements were performed. The period of traction, estimated blood loss, operation time, complications, and bed rest period were recorded. Results. A total of 62 patients who had 2-year radiological follow-up were included in the study. In 30 patients, vertebral column resection (VCR) was performed aiming to achieve a better correction rate. In patients who received a VCR, the average preoperative Cobb angle was 133.6°, and the average correction rate at 2 years after surgery was 65.4%. Compared with the average height before treatment, at 2 years after surgery the average height was 12.5 cm greater. In patients who did NOT received VCR, the average preoperative Cobb angle was 131.5°, and the average correction rate at 2 years after surgery was 64.1%. Compared with the average height before treatment, at 2 years after surgery the average height was 14.0 cm greater. Common complications during HPT included infected pelvic pins, brachial plexus palsy, and weakness of the lower extremities. No patients experienced permanent neurological deficits or death. Conclusion. For severe rigid scoliosis with a Cobb angle greater than 120°, a combination of short-term presurgical HPT and posterior surgery is an effective and safe solution. After 4 to 6 weeks of presurgical HPT the Cobb angle can be decreased by approximately 50%, providing a favorable condition for spine corrective surgery. Level of Evidence: 3</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Three_Dimensional_Analysis_of_Preoperative_and.10.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Three-Dimensional Analysis of Preoperative and Postoperative Rib Cage Parameters by Simultaneous Biplanar Radiographic Scanning Technique in Adolescent Idiopathic Scoliosis: Minimum 2-Year Follow-Up</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/spinejournal/Fulltext/2021/01150/Three_Dimensional_Analysis_of_Preoperative_and.10.aspx"><img src="https://images.journals.lww.com/spinejournal/SmallThumb.00007632-202101150-00010.F1.jpeg" border="0" align="left" alt="image"></a>Study Design. Prospective study. Objective. This study aimed to investigate the changes in rib cage deformity in adolescent idiopathic scoliosis (AIS) by comparing the preoperative and postoperative three-dimensional (3D) reconstruction images using simultaneous biplanar radiographic scanning technique (EOS) (EOS Imaging, Paris, France). Summary of Background Data. EOS data are limited for the analyses of preoperative and postoperative rib cage deformity. Methods. A total of 67 Lenke type 1 or 2 AIS patients who underwent surgery (59 females and 8 males) were enrolled in this study. The mean patient age was 14.4 years (range: 11–17 yr). In all patients, posterior corrective fusion was performed with a rod rotation maneuver based on segmental pedicle fixation. Spinal parameters (scoliosis and kyphosis) and rib cage parameters (max thickness, thoracic index (TI), rib hump (RH), surface spinal penetration index (sSPI), end thoracic hump ratio, vertebra-sternum angle, rib vertebral angle difference at the apex, and vertebral lateral decentering), were measured. 3D images were assessed preoperatively and postoperatively at 2-year follow-up. Results. Both main thoracic (MT) and proximal thoracic scoliosis were significantly corrected (51° to 15°, 30° to 17°, P < 0.0001). The rotation of MT apical vertebrae was also significantly corrected (12° to 5°, P < 0.0001). Thoracic kyphosis (T4-T12) significantly increased (13° to 18°, P < 0.0001). Besides, max thickness, TI, and RH demonstrated significant differences between preoperative and postoperative images (P < 0.01). T8–10 sSPI and end thoracic hump ratio decreased significantly postoperatively (P < 0.05). Although surgery significantly decreased vertebra-sternum angle (P < 0.0001), no significant difference was observed between the preoperative and postoperative rib vertebral angle difference (P = 0.32). Following the surgery, vertebral lateral decentering and rib cage volume were significantly increased (P < 0.0001). Conclusions. 3D reconstruction of the rib cage using biplanar standing stereoradiography is useful to evaluate preoperative and postoperative rib cage deformity in patients with AIS. Level of Evidence: 2</span><br><br></td></tr></tbody></table><div><div dir="ltr" class="gmail_signature" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-21016114415056380762020-12-22T23:09:00.000-08:002020-12-22T23:10:00.552-08:00Anesthesia & Analgesia<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Clinical_Outcomes_of_Pregnant_and_Postpartum.1.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Clinical Outcomes of Pregnant and Postpartum Extracorporeal Membrane Oxygenation Patients</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Clinical_Outcomes_of_Pregnant_and_Postpartum.1.aspx"><img src="https://images.journals.lww.com/anesthesia-analgesia/SmallThumb.00000539-990000000-00001.F1.jpeg" border="0" align="left" alt="image"></a>BACKGROUND: The use of extracorporeal membrane oxygenation (ECMO) as a rescue therapy for cardiopulmonary failure is expanding in critical care medicine. In this case series, we describe the clinical outcomes of 21 consecutive pregnant or postpartum patients that required venovenous (VV) or venoarterial (VA) ECMO. Our objective was to characterize maternal and fetal survival in peripartum ECMO and better understand ECMO-related complications that occur in this unique patient population. METHODS: Between January 2009 and June 2019, all pregnant and postpartum patients treated with ECMO for respiratory or circulatory failure at a single quaternary referral center were identified. For all patients, indications for ECMO, maternal and neonatal outcomes, details of ECMO support, and anticoagulation and bleeding complications were collected. RESULTS: Twenty-one obstetric patients were treated with ECMO over 10 years. Thirteen patients were treated with VV ECMO and 8 patients were treated with VA ECMO. Six patients were pregnant at the time of cannulation and 3 patients delivered while on ECMO; all 6 maternal and infant dyads survived to hospital discharge. The median gestational age at cannulation was 28 weeks (interquartile range [IQR], 24–31). In the postpartum cohort, ECMO initiation ranged from immediately after delivery up to 46 days postpartum. Fifteen women survived (72%). Major bleeding complications requiring surgical intervention were observed in 7 patients (33.3%). Two patients on VV ECMO required bilateral orthotopic lung transplantation and 1 patient on VA ECMO required orthotopic heart transplantation to wean from ECMO. CONCLUSIONS: Survival for mother and neonate are excellent with peripartum ECMO in a high-volume ECMO center. Neonatal and maternal survival was 100% when ECMO was used in the late second or early third trimester. Based on these results, ECMO remains an important treatment option for peripartum patients with cardiopulmonary failure.</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Efficiency_Metrics_at_an_Academic_Freestanding.2.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Efficiency Metrics at an Academic Freestanding Ambulatory Surgery Center: Analysis of the Impact on Scheduled End-Times</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Efficiency_Metrics_at_an_Academic_Freestanding.2.aspx"><img src="https://images.journals.lww.com/anesthesia-analgesia/SmallThumb.00000539-990000000-00002.F1.jpeg" border="0" align="left" alt="image"></a>BACKGROUND: Understanding the impact of key metrics on operating room (OR) efficiency is important to optimize utilization and reduce costs, particularly in freestanding ambulatory surgery centers. The aim of this study was to assess the association between commonly used efficiency metrics and scheduled end-time accuracy. METHODS: Data from patients who underwent surgery from May 2018 to June 2019 at an academic freestanding ambulatory surgery center was extracted from the medical record. Unique operating room days (ORDs) were analyzed to determine (1) duration of first case delays, (2) turnover times (TOT), and (3) scheduled case duration accuracies. Spearman's correlation coefficients and mixed-effects multivariable linear regression were used to assess the association of each metric with scheduled end-time accuracy. RESULTS: There were 1378 cases performed over 300 unique ORDs. There were 86 (28.7%) ORDs with a first case delay, mean (standard deviation [SD]) 11.2 minutes (15.1 minutes), range of 2–101 minutes; the overall mean (SD) TOT was 28.1 minutes (19.9 minutes), range of 6–83 minutes; there were 640 (46.4%) TOT >20 minutes; the overall mean (SD) case duration accuracy was −6.6 minutes (30.3 minutes), range of −114 to 176; and there were 389 (28.2%) case duration accuracies ≥30 minutes. The mean (SD) scheduled end-time accuracy was 6.9 minutes (68.3 minutes), range of −173 to 229 minutes; 48 (15.9%) ORDs ended ≥1 hour before scheduled end-time and 56 (18.6%) ORDs ended ≥1 hour after scheduled end-time. The total case duration accuracy was strongly correlated with the scheduled end-time accuracy (r = 0.87, 95% confidence interval [CI], 0.84-0.89, P < .0001), while the total first case delay minutes (r = 0.12, 95% CI, 0.01-0.21, P = .04) and total turnover time (r = −0.16, 95% CI, 0.21-0.05, P = .005) were less relevant. Case duration accuracy had the highest association with the dependent variable (0.95 minutes changed in the difference between actual and schedule end time per minute increase in case duration accuracy, 95% CI, 0.90-0.99, P < .0001), compared to turnover time (estimate = 0.87, 95% CI, 0.75-0.99, P < .0001) and first case delay time (estimate = 0.83, 95% CI, 0.56-1.11, P < .0001). CONCLUSIONS: Standard efficiency metrics are similarly associated with scheduled end-time accuracy, and addressing problems in each is requisite to having an efficient ambulatory surgery center. Pursuing methods to narrow the gap between scheduled and actual case duration may result in a more productive enterprise.</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Postoperative_Morbidity_and_Mortality_in_Diabetic.3.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Postoperative Morbidity and Mortality in Diabetic Patients After Fast-Track Hip and Knee Arthroplasty: A Prospective Follow-up Cohort of 36,762 Procedures</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Postoperative_Morbidity_and_Mortality_in_Diabetic.3.aspx"><img src="https://images.journals.lww.com/anesthesia-analgesia/SmallThumb.00000539-990000000-00003.F1.jpeg" border="0" align="left" alt="image"></a>BACKGROUND: Diabetes increases the risk of adverse outcomes in surgical procedures, including total hip and knee arthroplasty (THA/TKA), and the prevalence of diabetic patients undergoing these procedures is high, ranging from approximately 8% to 20%. However, there is still a need to clarify the role of diabetes and antihyperglycemic treatment in a fast-track THA/TKA setting, which otherwise may decrease morbidity. Consequently, we investigated the association between diabetes and antihyperglycemic treatment on length of stay (LOS) and complications following fast-track THA/TKA within a multicenter fast-track collaboration. METHODS: We used an observational study design on data from a prospective multicenter fast-track collaboration on unselected elective primary THA/TKA from 2010 to 2017. Complete follow-up (>99%) was achieved through The Danish National Patient Registry, antihyperglycemic treatment established through the Danish National Database of Reimbursed Prescriptions and types of complications leading to LOS >4 days, 90-day readmission or mortality obtained by scrutinizing health records and discharge summaries. Patients were categorized as nondiabetic and if diabetic into insulin-, orally, and dietary-treated diabetic patients. RESULTS: A total of 36,762 procedures were included, of which 837 (2.3%) had insulin-treated diabetes, 2615 (7.1%) orally treated diabetes, and 566 (1.5%) dietary-treated diabetes. Overall median LOS was 2 (interquartile range [IQR]: 1–3) days, and mean LOS was 2.4 (standard deviation [SD], 2.5) days. The proportion of patients with LOS >4 days was 6.0% for nondiabetic patients, 14.7% for insulin-treated, 9.4% for orally treated, and 9.5% for dietary-treated diabetic patients. Pharmacologically treated diabetes (versus nondiabetes) was independently associated with increased odds of LOS >4 days (insulin-treated: odds ratio [OR], 2.2 [99.6% confidence interval {CI}, 1.3–3.7], P < .001; orally treated: OR, 1.5 [99.6% CI, 1.0-2.1]; P = .002). Insulin-treated diabetes was independently associated with increased odds of "diabetes-related" morbidity (OR, 2.3 [99.6% CI, 1.2-4.2]; P < .001). Diabetic patients had increased renal complications regardless of antihyperglycemic treatment, but only insulin-treated patients suffered significantly more cardiac complications than nondiabetic patients. There was no increase in periprosthetic joint infections or mortality associated with diabetes. CONCLUSIONS: Patients with pharmacologically treated diabetes undergoing fast-track THA/TKA were at increased odds of LOS >4 days. Although complication rates were low, patients with insulin-treated diabetes were at increased odds of postoperative complications compared to nondiabetic patients and to their orally treated counterparts. Further investigation into the pathogenesis of postoperative complications differentiated by antihyperglycemic treatment is needed.</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Intermittent_Hypoxia_and_Effects_on_Early.4.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Intermittent Hypoxia and Effects on Early Learning/Memory: Exploring the Hippocampal Cellular Effects of Pediatric Obstructive Sleep Apnea</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Intermittent_Hypoxia_and_Effects_on_Early.4.aspx"><img src="https://images.journals.lww.com/anesthesia-analgesia/SmallThumb.00000539-990000000-00004.F1.jpeg" border="0" align="left" alt="image"></a>This review provides an update on the neurocognitive phenotype of pediatric obstructive sleep apnea (OSA). Pediatric OSA is associated with neurocognitive deficits involving memory, learning, and executive functioning. Adenotonsillectomy (AT) is presently accepted as the first-line surgical treatment for pediatric OSA, but the executive function deficits do not resolve postsurgery, and the timeline for recovery remains unknown. This finding suggests that pediatric OSA potentially causes irreversible damage to multiple areas of the brain. The focus of this review is the hippocampus, 1 of the 2 major sites of postnatal neurogenesis, where new neurons are formed and integrated into existing circuitry and the mammalian center of learning/memory functions. Here, we review the clinical phenotype of pediatric OSA, and then discuss existing studies of OSA on different cell types in the hippocampus during critical periods of development. This will set the stage for future study using preclinical models to understand the pathogenesis of persistent neurocognitive dysfunction in pediatric OSA.</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Development_and_Evaluation_of_a_Risk_Adjusted.6.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Development and Evaluation of a Risk-Adjusted Measure of Intraoperative Hypotension in Patients Having Nonemergent, Noncardiac Surgery</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Development_and_Evaluation_of_a_Risk_Adjusted.6.aspx"><img src="https://images.journals.lww.com/anesthesia-analgesia/SmallThumb.00000539-990000000-00006.inline-graphic1.jpeg" border="0" align="left" alt="image"></a>BACKGROUND: Intraoperative hypotension is common and associated with organ injury and death, although randomized data showing a causal relationship remain sparse. A risk-adjusted measure of intraoperative hypotension may therefore contribute to quality improvement efforts. METHODS: The measure we developed defines hypotension as a mean arterial pressure <65 mm Hg sustained for at least 15 cumulative minutes. Comparisons are based on whether clinicians have more or fewer cases of hypotension than expected over 12 months, given their patient mix. The measure was developed and evaluated with data from 225,389 surgeries in 5 hospitals. We assessed discrimination and calibration of the risk adjustment model, then calculated the distribution of clinician-level measure scores, and finally estimated the signal-to-noise reliability and predictive validity of the measure. RESULTS: The risk adjustment model showed acceptable calibration and discrimination (area under the curve was 0.72 and 0.73 in different validation samples). Clinician-level, risk-adjusted scores varied widely, and 36% of clinicians had significantly more cases of intraoperative hypotension than predicted. Clinician-level score distributions differed across hospitals, indicating substantial hospital-level variation. The mean signal-to-noise reliability estimate was 0.87 among all clinicians and 0.94 among clinicians with >30 cases during the 12-month measurement period. Kidney injury and in-hospital mortality were most common in patients whose anesthesia providers had worse scores. However, a sensitivity analysis in 1 hospital showed that score distributions differed markedly between anesthesiology fellows and attending anesthesiologists or certified registered nurse anesthetists; score distributions also varied as a function of the fraction of cases that were inpatients. CONCLUSIONS: Intraoperative hypotension was common and was associated with acute kidney injury and in-hospital mortality. There were substantial variations in clinician-level scores, and the measure score distribution suggests that there may be opportunity to reduce hypotension which may improve patient safety and outcomes. However, sensitivity analyses suggest that some portion of the variation results from limitations of risk adjustment. Future versions of the measure should risk adjust for important patient and procedural factors including comorbidities and surgical complexity, although this will require more consistent structured data capture in anesthesia information management systems. Including structured data on additional risk factors may improve hypotension risk prediction which is integral to the measure's validity.</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Do_Elderly_Patients_With_Diastolic_Dysfunction.7.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Do Elderly Patients With Diastolic Dysfunction Require Higher Doses of Norepinephrine During General Anesthesia for Noncardiac Surgeries? A Prospective Observational Study</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Do_Elderly_Patients_With_Diastolic_Dysfunction.7.aspx"><img src="https://images.journals.lww.com/anesthesia-analgesia/SmallThumb.00000539-990000000-00007.F1.jpeg" border="0" align="left" alt="image"></a>BACKGROUND: Diastolic dysfunction is a risk factor for postoperative major cardiovascular events. During anesthesia, patients with diastolic dysfunction might experience impaired hemodynamic function and worsening of diastolic function, which in turn, might be associated with a higher incidence of postoperative complications. We aimed to investigate whether patients with diastolic dysfunction require higher doses of norepinephrine during general anesthesia. Furthermore, we aimed to examine the association between the grade of diastolic dysfunction and the E/e' ratio during anesthesia. A high E/e' ratio corresponds to elevated filling pressures and is an important measure of impaired diastolic function. METHODS: We conducted a prospective observational cohort study at a German university hospital from February 2017 to September 2018. Patients aged ≥60 years and undergoing general anesthesia (ie, propofol and sevoflurane) for elective noncardiac surgery were enrolled. Exclusion: mitral valve disease, atrial fibrillation, and implanted mechanical device. The primary outcome parameter was the administered dose of norepinephrine within 30 minutes after anesthesia induction (μg·kg−1 30 min−1). The secondary outcome parameter was the change of Doppler echocardiographic E/e' from ECHO1 (baseline) to ECHO2 (anesthesia). Linear models and linear mixed models were used for statistical evaluation. RESULTS: A total of 247 patients were enrolled, and 200 patients (75 female) were included in the final analysis. Diastolic dysfunction at baseline was not associated with a higher dose of norepinephrine during anesthesia (P = .6953). The grade of diastolic dysfunction at baseline was associated with a decrease of the E/e' ratio during anesthesia (P < .001). CONCLUSIONS: We did not find evidence for an association between diastolic dysfunction and impaired hemodynamic function, as expressed by high vasopressor support during anesthesia. Additionally, our findings suggest that diastolic function, as expressed by the E/e' ratio, does not worsen during anesthesia.</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Fiber_Needle_Swept_Source_Optical_Coherence.8.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Fiber-Needle Swept-Source Optical Coherence Tomography for the Real-Time Visualization of the Transversus Abdominis Plane Block Procedure in a Swine Model</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Fiber_Needle_Swept_Source_Optical_Coherence.8.aspx"><img src="https://images.journals.lww.com/anesthesia-analgesia/SmallThumb.00000539-990000000-00008.F1.jpeg" border="0" align="left" alt="image"></a>BACKGROUND: Fascia blocks (eg, the transversus abdominis plane [TAP] block) target the intermuscular fascia layers. Ultrasound techniques have allowed peripheral blocks to be performed with accuracy and safety, however, with limitations. Optical coherence tomography (OCT) is based on low-coherence interferometry. In this study, we examined the ability of OCT to identify the TAP. METHODS: A swept-source OCT probe was placed in a 17-gauge needle to obtain imaging. The needle was inserted within 2 different angle ranges (0°–30° and 30°–60°) on a slice of pork belly to assess imaging characteristics. A series of real-time OCT imaging of the muscle, fascia, and interfascial space was obtained. The tissue location of the needle tip was identified using near-infrared (NIR) imaging. In vivo OCT imaging was further done on 3 female 6-month-old native Chinese Landrance Duroc pigs. Real-time images of tissue layers were obtained with needle insertion. Ultrasound imaging of the OCT needle probe was also performed at the same time for needle trajectory guidance. After imaging, the OCT probe was removed, and 5 mL of normal saline was injected via the needle to confirm correct fascia plane identification. RESULTS: In and ex vivo studies showed clear visual distinction of muscle, fascia, and interfascial layer with OCT, with limitations. Independent validation of OCT criteria for the muscle/fascia differentiation by 20 OCT readers for the in vivo data demonstrated the sensitivity = 0.91, specificity = 0.90, and accuracy = 0.89. Although the angle of needle entry affected the depth of OCT penetration in the muscle, the attenuation coefficient values of the fascia and muscle tissue were statistically different (P < .001) and with high area under the receiver operating characteristics (ROC) curve (AUC) (AUC = 0.93 in 0°–30° and AUC = 1 in 30°–60°) for fascia identification. CONCLUSIONS: This study introduced a novel needle imaging probe method to identify the transversus abdominis fascia plane in real-time. Quantitative calculation of the attenuation coefficients can further aid objective identification by providing direct confirmation of the tip position, increasing the first-pass success rate, and decreasing the need for needle repositioning. Combining OCT and ultrasound may improve the accuracy of anesthetics placement.</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Incidence,_Mortality,_and_Characteristics_of_18.9.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Incidence, Mortality, and Characteristics of 18 Pediatric Perioperative Cardiac Arrests: An Observational Trial From 22,650 Pediatric Anesthesias in a German Tertiary Care Hospital</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Incidence,_Mortality,_and_Characteristics_of_18.9.aspx"><img src="https://images.journals.lww.com/anesthesia-analgesia/SmallThumb.00000539-990000000-00009.T1.jpeg" border="0" align="left" alt="image"></a>BACKGROUND: Recently, a very low incidence of 3 per 10,000 and a mortality of 30% were reported for pediatric perioperative cardiac arrest (POCA). However, high-risk patients, namely children already anesthetized on the intensive care unit (ICU), were excluded. This study investigates the incidence and mortality of POCA in children in whom anesthesia was induced in the ICU or in the operating room using real-world data. In addition, different classifications of POCA were compared with respect to outcome relevance. METHODS: This is a retrospective observational study conducted at a German level 1 perinatal center and tertiary care hospital between 2008 and 2018. Children ≤15 years who underwent an anesthetic procedure and suffered from POCA (defined as any condition requiring chest compressions and/or defibrillation) from the beginning of care provided by an anesthesiologist to 60 minutes after anesthesia or sedation were included. Primary end points were incidence and mortality of POCA in children with anesthesia induced in the ICU versus in the operating room. Secondary end points included incidences and outcomes with respect to the pathophysiological cause (respiratory versus circulatory associated). RESULTS: There were 18 POCA during 22,650 anesthetic procedures (incidence 7.9 per 10,000; 95% confidence interval [CI], 4.7-12.5). Thirty-day mortality was 3.5 per 10,000 (95% CI, 1.5-6.9). Incidence and mortality were higher in children in whom anesthesia was induced in the ICU versus in the operating room (incidence: 131.6; 95% CI, 57 to 257.6 versus 4.5; 95% CI, 2.2-8.3; P < .001; and mortality: 82.2; 95% CI, 26.7-190.8 versus 1.4; 95% CI, 0.3-3.9; P < .001). Mortality in circulatory-induced POCA (n = 8; 44%) was 100%, in respiratory-induced POCA (n = 9; 50%) 0% (P < .001). CONCLUSIONS: Children with anesthesia induction in the ICU represent a high-risk population for POCA and POCA-associated mortality. POCA classification should be based on the individual cause (respiratory versus circulatory) rather than on the perioperative phase or the responsible specialty.</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/A_Bayesian_Comparison_of_Frailty_Instruments_in.10.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">A Bayesian Comparison of Frailty Instruments in Noncardiac Surgery: A Cohort Study</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/A_Bayesian_Comparison_of_Frailty_Instruments_in.10.aspx"><img src="https://images.journals.lww.com/anesthesia-analgesia/SmallThumb.00000539-990000000-00010.display-formula1.jpeg" border="0" align="left" alt="image"></a>BACKGROUND: Frailty—a multidimensional syndrome related to age- and disease-related deficits—is a key risk factor for older surgical patients. However, it is unknown which frailty instrument most accurately predicts postoperative outcomes. Our objectives were to quantify the probability of association and relative predictive performance of 2 frailty instruments (ie, the risk analysis index-administrative [RAI-A] and 5-item modified frailty index [mFI-5]) with postoperative outcomes in National Surgical Quality Improvement Program (NSQIP) data. METHODS: Retrospective cohort study using Bayesian analysis of NSQIP hospitals. Adults having inpatient small or large bowel surgery 2010–2015 (derivation cohort) or intermediate to high risk mixed noncardiac surgery in 2016 (validation cohort) had preoperative frailty assigned using 2 unique approaches (RAI-A and mFI-5). Probabilities of association were calculated based on posterior distributions and relative predictive performance using posterior predictive distributions and Bayes factors for 30-day mortality (primary outcome) and serious complications (secondary outcome). RESULTS: Of 50,630 participants, 7630 (14.0%) died and 19,545 (38.6%) had a serious complication. Without adjustment, the RAI-A and mFI-5 had >99% probability being associated with mortality with a ≥2.0 odds ratio (ie, large effect size). After adjustment for NSQIP risk calculator variables, only the RAI-A had ≥95% probability of a nonzero association with mortality. Similar results arose when predicting postoperative complications. The RAI-A provided better predictive accuracy for mortality than the mFI-5 (minimum Bayes factor 3.25 × 1014), and only the RAI-A improved predictive accuracy beyond that of the NSQIP risk calculator (minimum Bayes factor = 4.27 × 1013). Results were consistent in leave-one-out cross-validation. CONCLUSIONS: Translation of frailty-related findings from research and quality improvement studies to clinical care and surgical planning will be aided by a consistent approach to measuring frailty with a multidimensional instrument like RAI-A, which appears to be superior to the mFI-5 when predicting outcomes for inpatient noncardiac surgery.</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Assessment_of_Anesthesia_Capacity_in_Public.11.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Assessment of Anesthesia Capacity in Public Surgical Hospitals in Guatemala</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/anesthesia-analgesia/Fulltext/9900/Assessment_of_Anesthesia_Capacity_in_Public.11.aspx"><img src="https://images.journals.lww.com/anesthesia-analgesia/SmallThumb.00000539-990000000-00011.F1.jpeg" border="0" align="left" alt="image"></a>BACKGROUND: International standards for safe anesthetic care have been developed by the World Federation of Societies of Anaesthesiologists (WFSA) and the World Health Organization (WHO). Whether these standards are met is unknown in many nations, including Guatemala, a country with universal health coverage. We aimed to establish an overview of anesthesia care capacity in public surgical hospitals in Guatemala to help guide public sector health care development. METHODS: In partnership with the Guatemalan Ministry of Public Health and Social Assistance (MSPAS), a national survey of all public hospitals providing surgical care was conducted using the WFSA anesthesia facility assessment tool (AFAT) in 2018. Each facility was assessed for infrastructure, service delivery, workforce, medications, equipment, and monitoring practices. Descriptive statistics were calculated and presented. RESULTS: Of the 46 public hospitals in Guatemala in 2018, 36 (78%) were found to provide surgical care, including 20 district, 14 regional, and 2 national referral hospitals. We identified 573 full-time physician surgeons, anesthesiologists, and obstetricians (SAO) in the public sector, with an estimated SAO density of 3.3/100,000 population. There were 300 full-time anesthesia providers working at public hospitals. Physician anesthesiologists made up 47% of these providers, with an estimated physician anesthesiologist density of 0.8/100,000 population. Only 10% of district hospitals reported having an anesthesia provider continuously present intraoperatively during general or neuraxial anesthesia cases. No hospitals reported assessing pain in the immediate postoperative period. While the availability of some medications such as benzodiazepines and local anesthetics was robust (100% availability across all hospitals), not all hospitals had essential medications such as ketamine, epinephrine, or atropine. There were deficiencies in the availability of essential equipment and basic intraoperative monitors, such as end-tidal carbon dioxide detectors (17% availability across all hospitals). Postoperative care and access to resuscitative equipment, such as defibrillators, were also lacking. CONCLUSIONS: This first countrywide, MSPAS-led assessment of anesthesia capacity at public facilities in Guatemala revealed a lack of essential materials and personnel to provide safe anesthesia and surgery. Hospitals surveyed often did not have resources regardless of hospital size or level, which may suggest multiple factors preventing availability and use. Local and national policy initiatives are needed to address these deficiencies.</span><br><br></td></tr></tbody></table><div><div dir="ltr" class="gmail_signature" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-70898962063694749062020-12-22T23:08:00.002-08:002020-12-22T23:09:26.091-08:00Neonatal Care<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Correlates_and_Trajectories_of_Preterm_Infant.99624.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Correlates and Trajectories of Preterm Infant Sucking Patterns and Sucking Organization at Term Age</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Correlates_and_Trajectories_of_Preterm_Infant.99624.aspx"></a>Background: Premature infants may experience increased difficulty with nutrition and growth. Successful oral feeding is an important factor associated with discharge readiness. Despite the importance of feeding as a growth-fostering process, little empiric evidence exists to guide recommendations for early interventions. Purpose: Evaluate whether specific elements of sucking, during preterm initiation of oral feeding, predict sucking organization at corrected term age. Methods: Sucking performance of 88 preterm infants born between 24 and 34 weeks of post–menstrual age was measured at baseline and term (33-35 and 40 ± 1.5 weeks). Participants were divided into 4 groups (quartiles) based on initial measures of performance including number of sucks, number of bursts, sucks per burst, and maximum pressure. Stability in sucking organization was assessed by comparing changes in infant's quartile location from baseline to term. Results: A correlation between quartile location was observed for mean maximum pressure (PMAX): infants with PMAX in the lowest quartile (poorest performance) were significantly more likely to remain in the lowest quartile at term (P < .000); infants in the highest quartile (best performance) at baseline were significantly more likely to be in the highest quartile at term (P < .000). Implication for Practice: Infants with the weakest sucking pressures at 34 weeks of post–menstrual age continue to be at risk for less than optimal feeding skills at 40 weeks of post–menstrual age. Early identification of at-risk infants may allow for effective interventions to potentially decrease long-term feeding problems. Implications for Research: Future research should focus on the development of personalized interventions to address attributes of problematic feeding such as sucking efficiency. Correspondence: Jacqueline M. McGrath, PhD, RN, FNAP, FAAN, UT Health San Antonio, School of Nursing, 7703 Floyd Curl Blvd, Room 2.202e, San Antonio, TX 78229 (<a href="mailto:mcgrathj@uthscsa.edu">mcgrathj@uthscsa.edu</a>). There are no competing financial interests in relation to the work described. Dr McGrath, who is a coeditor for Advances in Neonatal Care and the coauthor and mentor to the primary author, was not involved in the editorial review or decision to publish this article. The entire process from submission, referee assignment, and editorial decisions was handled by other members of the editorial team for the journal. © 2020 by The National Association of Neonatal Nurses</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Human_Milk_Expression,_Storage,_and_Transport_by.99625.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Human Milk Expression, Storage, and Transport by Women Whose Infants Are Inpatients at a Tertiary Neonatal Unit in Melbourne, Australia: An Exploratory Study</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Human_Milk_Expression,_Storage,_and_Transport_by.99625.aspx"></a>Background: Expression and storage of mothers' own milk at home and its transportation to hospital neonatal units are a common practice worldwide when newborns are inpatients. Studies assessing adherence to hospital protocols and guidelines for this are not widely published. Purpose: To explore the advice received and practices followed by mothers when expressing, storing, and transporting their milk from home to the hospital, with a substudy exploring the factors related to temperature maintenance of refrigerated milk at recommended values. Methods: Cross-sectional descriptive study at the neonatal intensive care unit of Mercy Hospital for Women, Melbourne, Australia. Mothers who were discharged home after birth of the infant, but whose infant(s) remained in the neonatal unit for 7 days or more participated. All participants completed a self-administered questionnaire. In the substudy, home refrigerator temperature and surface temperature of milk on arrival to the hospital were recorded. Results: The questionnaire was completed by 100 mothers; 38 participated in the substudy. Median travel time from home to the hospital was 32 minutes (range, 2-135 minutes). Lactation consultants were the largest group providing information, with 44 participants (45%) identifying them as the primary information source. Knowledge about recommended refrigerator storage times for expressed milk was correct in 53 mothers (54%). Coolness of milk was better maintained when transported in an insulated food container than nonuse (surface temperature: mean 9.1°C vs 12.2°C; P = .007). Distance and travel duration were not correlated with temperature. Implications for Practice: More diligent monitoring of conditions under which mothers' own milk is transported to hospital is required, and the use of an insulated food container for refrigerated/frozen milk, even for a short duration, should be strongly recommended. Staff to be trained and better equipped to provide uniform, concise information on expressed human milk management to mothers. Implications for Research: Further research to correlate factors associated with transporting human milk expressed at home and infant health outcome is needed. Correspondence: Ranmali Rodrigo, MD, DCH, MBBS, MRCPCH, Judith Lumley Centre, La Trobe University, Level 3, George Singer, Bldg, Bundoora, VIC 3086, Australia (<a href="mailto:ranmali_waduge@yahoo.com">ranmali_waduge@yahoo.com</a>). Funding was received from the postgraduate student support grant, La Trobe University, in 2013 to purchase equipment. Conflict of Interest: None. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (<a href="http://www.advancesinneonatalcare.org">www.advancesinneonatalcare.org</a>). © 2020 by The National Association of Neonatal Nurses</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/40__Glucose_Gel_for_the_Treatment_of_Asymptomatic.99626.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">40% Glucose Gel for the Treatment of Asymptomatic Neonatal Hypoglycemia</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/40__Glucose_Gel_for_the_Treatment_of_Asymptomatic.99626.aspx"></a>Background: The Mother Infant Care Center at Fort Belvoir Community Hospital (FBCH) recently revised its asymptotic neonatal hypoglycemia (ANH) protocol and adopted 40% glucose gel into its treatment pathway. The previous protocol used infant formula as the primary intervention. Purpose: To evaluate the effectiveness of 40% glucose gel on exclusive human milk diet rates, time on protocol, level II Special Care Nursery (SCN) admission rates, length of stay (LOS), and total hospital costs for newborns with ANH at FBCH. Methods: Infants with ANH were treated with 40% glucose gel (n = 35) and compared with a historical group of infants with ANH (n = 29) who were treated with formula. Results: Exclusive human milk diet rates increased by 33.6%. The mean time on protocol dropped by 1.13 hours. The SCN admission rates dropped by 2.4% in the postimplementation group. The mean LOS was more than 12 hours less in the postimplementation group. The mean total cost per patient was $1190.60 lower after implementation of 40% glucose gel. Implications for Practice: The use of 40% glucose gel is a patient-focused, less-invasive, and cost-effective treatment of ANH. Implications for Research: More studies are needed to better define neonatal hypoglycemia. The use of 40% glucose gel is safe for use in infants with ANH; however, more studies are needed to examine its comprehensive benefits. Correspondence: LCDR Brandi L. Gibson, NC, USN, Duke University School of Nursing, 307 Trent Dr, Durham, NC 27710 (<a href="mailto:Gibson.brandi@rocketmail.com">Gibson.brandi@rocketmail.com</a>). All authors and coauthors of this article have read and approved the manuscript for publication and have all contributed equal substance to this work. No funding was required for this quality improvement project as it was conducted as part of the primary investigator's doctoral studies. Special acknowledgments recognize Mr Andrew Kim at Fort Belvoir Community Hospital for assisting with acquiring the cost data for the project and statistician Dr Julie Thompson at Duke for her assistance with data analysis on the project. Additional acknowledgments go to the neonatal nurse practitioners: Angela Wallace, Debbie Rosado, Christa Brown, Joan Hammond, and Tina Anderson for managing the daily data collection for our postimplementation group and championing this project. The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US government. LCDR Gibson, NC, USN, and LT LeDuff, NC, USN, are military service members. This work was prepared as part of their official duties. Title 17, USC, §105 provides that "Copyright protection under this title is not available for any work of the US government." Title 17, USC, §101 defines a "US government work as a work prepared by a military service member or employees of the US government as part of that person's official duties." Written work prepared by employees of the federal government as part of their official duties is, under the US Copyright Act, a "work of the US government" for which copyright is not available. As such, copyright does not extend to the contributions of employees of the federal government. There are no conflicts of interest or financial disclosures. © 2020 by The National Association of Neonatal Nurses</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/What_Do_Neonatal_Intensive_Care_Unit_Policies_Tell.99627.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">What Do Neonatal Intensive Care Unit Policies Tell Us About Kangaroo Care implementation? A Realist Review</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/What_Do_Neonatal_Intensive_Care_Unit_Policies_Tell.99627.aspx"></a>Background: Kangaroo care (KC) is recommended for infants during their stay in the neonatal intensive care unit (NICU) due to the benefits to infant growth, stabilized vital signs, and parental bonding; however, literature primarily explores the physiologic benefits, barriers, and facilitators to KC practice. Little is known about the context and mechanisms of KC implementation. Purpose: This realist review is to explore what NICU policies tell us about practices to implement KC in the NICU. Methods: Policies were obtained via email, database, and search engines. Criteria were established to review each policy. Data were entered into a database then exported for frequency counts of identified characteristics. Results: Fifty-one policies were reviewed, which revealed inconsistencies in the implementation of KC practices. Inconsistencies include variability in infant postmenstrual ages and weight criteria, infant medical equipment in place during participation, duration and frequency of KC, KC documentation, and ongoing monitoring requirements. Implications for Practice: KC implementation varies widely across NICUs, even with similar infant populations. Exclusion of some infants from receiving KC may decrease the potential beneficial outcomes known to result from KC. Implications for Research: More research to understand KC best practice recommendations and implementation in the NICU is needed. Studies are needed to evaluate the duration and frequency of KC, as well as the benefits to infants and families to optimize KC in the NICU setting. Correspondence: Melissa Fluharty, BSN, RN, 4838 Buttercup Way, Summerville, SC 29485 (<a href="mailto:fluhart@musc.edu">fluhart@musc.edu</a>). The authors declare no conflicts of interest. © 2020 by The National Association of Neonatal Nurses</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/The_Effect_of_2_Humidifier_Temperature_Settings_on.99628.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">The Effect of 2 Humidifier Temperature Settings on Inspired Gas Temperatures and the Physiological Parameters of Preterm Infants Receiving Mechanical Ventilation Therapy</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/The_Effect_of_2_Humidifier_Temperature_Settings_on.99628.aspx"></a>Background: The use of heated and humidified gas during mechanical ventilation is routine care in neonatal intensive care units. Giving gas at inadequate heat and humidity levels can affect neonatal morbidity and mortality. Purpose: To compare the effects of 2 humidifier temperature settings on the temperature and humidity of the inspired gas and the physiologic parameters in preterm newborns receiving mechanical ventilation. Methods: The research was conducted in a single-group quasi-experimental design. Proximal temperature was measured using a humidity heat transmitter. The humidifier temperature was set at 38°C (temperature I) and then at 39°C (temperature II). Results: The mean proximal temperatures were significantly lower than the values set in the humidifier (33.8 ± 1.20°C at temperature I, and 34.06 ± 1.30°C at temperature II, P < .001). However, the difference between the 2 proximal temperatures was not significant (P = .162). The incubator temperature was found to be effective on the proximal gas temperature (P < .05). It was found that only preterm infants in the temperature II group had a higher mean heart rate (P < .05). Implications for Practice: Incubator temperatures may have an effect on inspired gas temperature in preterm infants who are mechanically ventilated and caregivers should be aware of these potentially negative effects. Implications for Research: Future studies should focus on how to measure the temperature and humidity of gas reaching infants in order to prevent heat and humidity losses. Correspondence: Sema Bayraktar, PhD, MSc, RN, Department of Nursing, Faculty of Health Sciences, Bezmialem Vakif University, Silahtaraga caddesi, No:189 34065 Eyupsultan, Istanbul, Turkey (<a href="mailto:sema.byrktrr@gmail.com">sema.byrktrr@gmail.com</a>). The project was funded by the Research Fund of Istanbul University-Cerrahpasa: project no. 24657. The authors have no conflicts of interest to disclose. © 2020 by The National Association of Neonatal Nurses</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Recovering_Together__Mothers__Experiences.99629.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Recovering Together: Mothers' Experiences Providing Skin-to-Skin Care for Their Infants With NAS</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Recovering_Together__Mothers__Experiences.99629.aspx"></a>Background: Over the past 2 decades, the prevalence of neonatal abstinence syndrome (NAS) has increased almost 5-fold. Skin-to-skin care (SSC), a method of parent–infant holding, is a recommended nonpharmacologic intervention for managing NAS symptoms. SSC has the potential to reduce withdrawal symptoms while positively influencing parent–infant attachment. Yet, little is known about the SSC experiences of mothers of infants with NAS. Purpose: The purpose of this study was to explore the SSC experiences of mothers of infants with NAS, including perceived barriers to SSC in the hospital and following discharge home. Methods: A qualitative descriptive design was used to obtain new knowledge regarding the experience of SSC of mothers of infants with NAS. Purposive sampling was used to recruit participants eligible for the study. We conducted semistructured individual interviews with postpartum mothers of infants with NAS. Data were analyzed using thematic analysis. Findings/Results: Thirteen mothers participated in the study. Four themes emerged from the data analysis: "a little nerve racking"; "she needed me, and I needed her"; dealing with the "hard times"; and "a piece of my puzzle is missing." SSC was described as a conduit for healing and bonding; in addition, several barriers to SSC were reported. Implications for Practice and Research: These findings highlight the inherent benefits of SSC for infants with NAS and demonstrate the unique challenges of these mother–infant dyads. Critical changes in hospital practices are needed to create an environment supportive of SSC for this patient population. In addition, research regarding implementation of interventions to increase SSC usage in this population is warranted. Correspondence: Kelly McGlothen-Bell, PhD, RN, IBCLC, School of Nursing, UT Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (<a href="mailto:mcglothen@uthscsa.edu">mcglothen@uthscsa.edu</a>). This work was funded by the Texas Health & Human Services Commission. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Dr McGrath, who is a Co-Editor for Advances in Neonatal Care and the coauthor and mentor to the primary author, was not involved in the editorial review or decision to publish this article. The entire process from submission, referee assignment, and editorial decisions was handled by other members of the editorial team for the journal. © 2020 by The National Association of Neonatal Nurses</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Implementing_a_Hospital_Based_Safe_Sleep_Program.99630.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Implementing a Hospital-Based Safe Sleep Program for Newborns and Infants</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Implementing_a_Hospital_Based_Safe_Sleep_Program.99630.aspx"></a>Background: An unsafe sleep environment remains the leading contributor to unexpected infant death. Purpose: To determine the effectiveness of a quality improvement initiative developed to create a hospital-based safe sleep environment for all newborns and infants. Methods: A multidisciplinary team from the well-baby nursery (WBN) and neonatal intensive care unit (NICU) of a 149-bed academic, quaternary care, regional referral center developed and implemented safe sleep environments within the hospital for all prior to discharge. To monitor compliance, the following were tracked monthly: documentation of parent education, caregiver surveys, and hospital crib check audits. On the inpatient general pediatric units, only hospital crib check audits were tracked. Investigators used Plan-Do-Study-Act (PDSA) cycles to evaluate the impact of the initiative from October 2015 through February 2018. Results: Safe sleep education was documented for all randomly checked records (n = 440). A survey (n = 348) revealed that almost all caregivers (95.4%) reported receiving information on safe infant sleep. Initial compliance with all criteria in WBN (n = 281), NICU (n = 285), and general pediatric inpatient units (n = 121) was 0%, 0%, and 8.3%, respectively. At 29 months, WBN and NICU compliance with all criteria was 90% and 100%, respectively. At 7 months, general pediatric inpatient units' compliance with all criteria was 20%. Implications for Practice: WBN, NICU and general pediatric inpatient unit collaboration with content experts led to unit-specific strategies that improved safe sleep practices. Implications for Research: Future studies on the impact of such an initiative at other hospitals are needed. Correspondence: Patricia A. Patrick, DrPH, Westchester Institute for Human Development, 20 Plaza West, Cedarwood Hall, Valhalla, NY 10595 (<a href="mailto:ppatrick@wihd.org">ppatrick@wihd.org</a>). The authors declare no conflicts of interest. © 2020 by The National Association of Neonatal Nurses</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Availability_of_Donor_Human_Milk_Decreases_the.99631.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Availability of Donor Human Milk Decreases the Incidence of Necrotizing Enterocolitis in VLBW Infants</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Availability_of_Donor_Human_Milk_Decreases_the.99631.aspx"></a>Background: Human milk feeding is associated with decreased risk of necrotizing enterocolitis (NEC). Purpose: To determine whether a quality improvement project in New Jersey neonatal intensive care units (NICUs) to promote human milk (HM) feedings would be associated with a decrease in NEC. Methods: Fourteen New Jersey NICUs engaged in efforts to reduce infection and promote HM feeding in very low birth-weight (VLBW) infants. Donor human milk (DHM) availability and NEC rates were assessed. Results: From 2009 to 2016, NICUs with DHM increased from 0 to 7. VLBW infants discharged on any HM increased from 35% in 2007 before the formation of the New Jersey NICU Collaborative to more than 55% in 2016. Time to first oropharyngeal colostrum decreased from 37 to 30 hours from 2014 to 2016. HM at first feeding increased from 71% in 2013 to 82% in 2016. There was an increase in the percentage of feeds that were HM over the first 7 days of feeding. Analyses of data from 9400 VLBW infants born between 2009 and 2016 showed that the incidence of NEC when DHM was not available was 5.1% (367/7182) whereas the incidence when DHM was available (64/2218) was significantly lower (2.9%; P < .0001). Implications for Practice: These findings show advantages of feeding HM and effectiveness of forming an NICU collaborative for improving care for preterm infants. Implications for Research New research projects should measure the quantity of HM consumed daily during the entire NICU stay and assess the timing and amount of HM consumption in relationship to incidence of NEC and infection in neonates. Correspondence: Morris Cohen, MBBCh, Division of Neonatal Medicine, Children's Hospital of New Jersey, Newark Beth Israel Medical Center, 201 Lyons Ave, C-10, Newark, NJ 07112 (<a href="mailto:morris.cohen@rwjbh.org">morris.cohen@rwjbh.org</a>). The authors have no conflicts of interest relevant to this article to disclose. The Vermont Oxford Network had no role in the concept, design, analysis, or formulation of this research. The discussion and views belong solely to the coauthors and do not represent the opinions of the Vermont Oxford Network. © 2020 by The National Association of Neonatal Nurses</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Reliability_and_Validity_of_the_Arabic_Version_of.99632.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Reliability and Validity of the Arabic Version of the Parental Stressor Scale and Nurse Parental Support Tool: Opening Up Research on Parental Needs in Neonatal Intensive Care Units in Egypt</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Reliability_and_Validity_of_the_Arabic_Version_of.99632.aspx"></a>Background: The admission of a newborn infant to a neonatal intensive care unit (NICU) due to preterm birth or high-risk conditions, such as perinatal injury, sepsis, hypoxia, congenital malformation, or brain injury, is a stressful experience for mothers. There is currently a lack of research on maternal perceived stress and support in Egyptian NICUs and no validated Arabic tool to investigate this further. Purpose: To determine the reliability and validity of the Arabic language versions of the Parental Stressor Scale: NICU (PSS:NICU) and the Nurse Parental Support Tool (NPST). Methods: Egyptian mothers completed the PSS:NICU and the NPST at the time of their infants' discharge from the NICU. Reliability was assessed with Cronbach α and Spearman-Brown coefficient. The multifactorial structure of the PSS:NICU Arabic version was tested. Associations with sociodemographic and clinical variables were explored with bivariate correlations and t tests. Results: Sixty-eight mothers of preterm (PT) infants and 52 mothers of ill full-term (IFT) infants completed the study. Mothers of PT and IFT infants did not differ for sociodemographic variables. High internal consistency (α range between .93 and .96) emerged for both tools. Spearman-Brown coefficients ranged between 0.86 and 0.94. The multidimensional structure of the PSS:NICU was confirmed and 3 core dimensions explained up to 71.48% of the variance. Perceived nursing support did not diminish the effects of stress in mothers of infants admitted to the NICU, regardless of PT or IFT infants' status. A longer NICU stay was associated with greater stress in mothers of PT infants. The presence of comorbidities was significantly associated with stress of mothers of IFT infants. Implications for Research: Future research is needed to develop evidence-based support for mothers whose infants are admitted to a NICU in Egypt. The availability of validated and reliable PSS:NICU and NPST scales in Arabic will facilitate cross-country and cross-cultural research on maternal stress in the NICU. Implications for Practice: Neonatal care nurses in Egypt will be able to increase their understanding of the stressors experienced by mothers of infants admitted to the NICU. This will in turn enable the introduction of neonatal care policies aimed at reducing specific stressors and provide improved maternal support. Correspondence: Dina Rabie, MD, Faculty of Medicine, Ain Shams University, Abbassia Square, Ramses, Cairo, Egypt (<a href="mailto:d_essam_rabie@outlook.com">d_essam_rabie@outlook.com</a>). Drs Dina Rabie and Livio Provenzi are co-first authors. LP contributed to conception and design, analysis and interpretation of data, and drafting of the article. DR contributed to data acquisition and interpretation of data. NM contributed to interpretation of data. RM contributed to conception and design and interpretation of data. All the authors contributed to revising the manuscript and approved final version for submission. The authors declare no conflicts of interest. © 2020 by The National Association of Neonatal Nurses</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Eat,_Sleep,_Console_and_Adjunctive_Buprenorphine.99633.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Eat, Sleep, Console and Adjunctive Buprenorphine Improved Outcomes in Neonatal Opioid Withdrawal Syndrome</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/advancesinneonatalcare/Fulltext/9000/Eat,_Sleep,_Console_and_Adjunctive_Buprenorphine.99633.aspx"></a>Background: The worsening opioid crisis has increased the number of infants exposed to maternal opioids. Standard treatment of newborns exposed to opioids prenatally often requires prolonged hospitalization and separation of the mother–infant dyad. These practices can potentially increase severity of withdrawal symptoms, interrupt breastfeeding, and disturb mother–infant bonding. Use of the Eat, Sleep, Console (ESC) model may ameliorate symptoms, decrease mother–infant separation, and decrease hospital length of stay. Purpose: To manage opioid exposed infants in a more holistic manner to decrease neonatal intensive care unit (NICU) admissions, reduce the need for pharmacotherapy, and evaluate response and total length of treatment after a unit protocol change from morphine to buprenorphine. Methods: Implemented ESC model, optimized nonpharmacologic bundle, and prescribed buprenorphine therapy instead of morphine as needed for adjunctive therapy. Results: Admissions of opioid-exposed infants from the Mother–Baby Unit (MBU) to the NICU decreased by 22%, and the number of infants who required pharmacotherapy was reduced by 50%. The average length of pharmacotherapy fell from 14 to 6.5 days. Implications for Practice: The successful implementation of the ESC model helped keep the mother–infant dyad together, reduced admissions to the NICU, and lessened the need for pharmacotherapy. The change to buprenorphine further reduced our average length of treatment. Implications for Research: Investigation of monotherapy with buprenorphine needs to be evaluated as a valid treatment option. The buprenorphine dosing and weaning chart will need to be revised and modified if indicated. Correspondence: Sarrah Hein, PharmD, BCPPS, Pharmacy Department, Akron Children's Hospital Mahoning Valley, 6505 Market St, Boardman, OH 44512 (<a href="mailto:shein@akronchildrens.org">shein@akronchildrens.org</a>). Conflict of Interest: None declared for the listed authors. © 2020 by The National Association of Neonatal Nurses</span><br><br></td></tr></tbody></table><div><div dir="ltr" class="gmail_signature" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-58087487749835508982020-12-22T23:08:00.001-08:002020-12-22T23:08:51.640-08:00Transplantation<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://journals.lww.com/transplantjournal/Fulltext/9000/Clinical_Profile_and_Outcome_of_COVID_19_in_250.95441.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Clinical Profile and Outcome of COVID-19 in 250 Kidney Transplant Recipients: a Multicenter Cohort Study From India</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/transplantjournal/Fulltext/9000/Clinical_Profile_and_Outcome_of_COVID_19_in_250.95441.aspx"></a>Background: There is scarcity of data on the consequences coronavirus 19 (COVID-19) infections in kidney transplant recipients (KTR) from emerging countries. Methods: Here, we present a cohort study of 13 transplant centers in India including 250 KTR (226 living and 24 deceased donor) with PCR confirmed COVID-19 positivity from March 23, 2020 until September 15, 2020. We detailed demographics, immunosuppression regimen, clinical profile, treatment and outcomes. Results: Median age of transplant recipients was 43 years and recipients presented at a median of 3.5 years after transplant. Most common comorbidities (94%) included arterial hypertension (84%), diabetes (32%); presenting symptoms at the time of COVID-19 included fever (88%), cough (72%) and sputum production (52%). Clinical severity ranged from asymptomatic (6%), mild (60%), moderate (20%) to severe (14%). Strategies to modify immunosuppressants included discontinuation of antimetabolites without changes in calcineurin inhibitors and steroids (60%). Risk factors for mortality included older age, dyspnoea, severe disease, obesity, allograft dysfunction prior to COVID-19 infection, acute kidney injury (AKI) , higher levels of inflammatory markers including C reactive protein, IL6 level, procalcitonin, chest XR abnormality, and ICU/ventilator requirements. Overall patient mortality was 11.6%(29/250), 14.5%(29/200) in hospitalized patients, 47%(25/53) in ICU patients and 96.7%(29/30) in patients requiring ventilation. KTR with mild COVID-19 symptoms(n=50) were managed as outpatients to optimize the utilization of scarce resources during the COVID-19 pandemic. Conclusions: Mortality rates in COVID-19 positive KTR appears to be higher than those in nonimmunosuppressed patients and high mortality was noted among those requiring intensive care and those on ventilator. Disclosure: The authors of this manuscript have no conflicts of interest to disclose Financial Disclosure: The authors declare no funding was received for this study. Correspondence: Vivek Kute, MD, FCPS, DM Nephrology, FASN, FISOT, FISN, FRCP (London) Professor Nephrology and Transplantation Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences,(IKDRC-ITS) Ahmedabad India, Secretary, Indian society of Organ Transplantation (ISOT). Phone: +919099927543. Email: <a href="mailto:drvivekkute@rediffmail.com">drvivekkute@rediffmail.com</a>. Website: <a href="http://www.ikdrc-its.org">www.ikdrc-its.org</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://journals.lww.com/transplantjournal/Fulltext/9000/Pathways_to_Clinical_Cardiac_Xenotransplantation.95442.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Pathways to Clinical Cardiac Xenotransplantation</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/transplantjournal/Fulltext/9000/Pathways_to_Clinical_Cardiac_Xenotransplantation.95442.aspx"></a>Heart transplantation is the only long-lasting life-saving option for patients with terminal cardiac failure. The number of available human organs is however far below the actual need, resulting in substantial mortality of patients while waiting for a human heart. Mechanical assist devices are used to support cardiac function, but are associated with a high risk of severe complications and poor quality of life for the patients. Consistent success in orthotopic transplantation of genetically modified pig hearts into baboons indicates that cardiac xenotransplantation may become a clinically applicable option for heart failure patients who cannot get a human heart transplant. In this overview, we project potential paths to clinical cardiac xenotransplantation, including the choice of genetically modified source pigs, associated requirements of microbiological, including virological, safety, optimized matching of source pig and recipient, and specific treatments of the donor heart after explantation and of the recipients. Moreover, selection of patients and the regulatory framework will be discussed. Disclosure: The authors declare no conflicts of interest. Funding: Our studies are supported by the Deutsche Forschungsgemeinschaft (TRR127 Biology of xenogeneic cell tissue and organ transplantation – from bench to bedside; to B.R., M.L., J.D., R.S., and E.W.) and by the German Center for Diabetes Research (DZD; to E.W.). P.J.C. received a fellowship of the Center for Advanced Studies (CAS) of LMU Munich. Correspondence: Bruno Reichart, MD, Walter Brendel Center for Experimental Medicine, LMU Munich, Marchioninistr. 27, 81377 Munich, Germany Phone: +49-89-4400-73727 Email: <a href="mailto:bruno.reichart@med.uni-muenchen.de">bruno.reichart@med.uni-muenchen.de</a> Eckhard Wolf, DVM, Gene Center, LMU Munich, Feodor-Lynen-Str. 25, 81377Munich,Germany Phone: +49-89-2180-76800 Email: <a href="mailto:ewolf@genzentrum.lmu.de">ewolf@genzentrum.lmu.de</a> Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://journals.lww.com/transplantjournal/Fulltext/9000/Sex_Based_Disparities_in_Hepatocellular_Carcinoma.95443.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Sex-Based Disparities in Hepatocellular Carcinoma Recurrence After Liver Transplantation</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/transplantjournal/Fulltext/9000/Sex_Based_Disparities_in_Hepatocellular_Carcinoma.95443.aspx"></a>Background: Women with chronic liver disease have lower rates of hepatocellular carcinoma (HCC) as compared to men; it is unknown if there are sex-based differences in HCC recurrence post-liver transplant. Methods: We conducted an analysis of patients who underwent liver transplant for HCC in the United Network for Organ Sharing/Organ Procurement and Transplantation Network from January 1, 2012 through December 31, 2017. Results: A total of 12,711 patients underwent liver transplant for HCC: 2,909 (23%) women and 9,802 (73%) men. Women had significantly lower rates of post-liver transplant HCC recurrence than men (4.0 v. 5.4%, p=0.002). A cox-regression analysis for post-liver transplant HCC recurrence highlighted that even after accounting for etiology of cirrhosis, alpha-fetoprotein (AFP) at liver transplant, tumor diameter, tumor pathology, and vascular invasion, female sex was associated with a 25% lower risk of post-liver transplant HCC recurrence (95CI 0.57–0.99). There were no interactions between female sex and the following variables: age, type of locoregional therapy, AFP, donor sex, body mass index, or nonalcoholic steatohepatitis etiology (p>0.05 for each). Conclusions: This study demonstrates an independent effect of sex on risk for HCC recurrence post-liver transplant. Our data highlight an opportunity to better understand HCC tumor biology by investigating the drivers of this sex-based difference in HCC recurrence. Financial Support: This study was funded by NIA Research Project Grant (R01AG059183; Lai), K23AG048337 (Paul B. Beeson Career Development Award in Aging Research; Lai) and by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (T32 DK060414; Cullaro), all of which played no role in the analysis of the data or the preparation of this manuscript Disclosures: The authors have no conflicts of interest to disclose. Correspondence: Jennifer C. Lai, MD, MBA 513 Parnassus Avenue, UCSF Box 0538 San Francisco, CA 94143 Telephone: 415-476-2777 Fax: 415-476-0659 E-mail: <a href="mailto:Jennifer.Lai@ucsf.edu">Jennifer.Lai@ucsf.edu</a> Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://journals.lww.com/transplantjournal/Fulltext/9000/Fluid_Management_During_Kidney_Transplantation__A.95444.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Fluid Management During Kidney Transplantation: A Consensus Statement of the Committee on Transplant Anesthesia of the American Society of Anesthesiologists</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/transplantjournal/Fulltext/9000/Fluid_Management_During_Kidney_Transplantation__A.95444.aspx"></a>Background: Intraoperative fluid management may affect outcome after kidney transplantation. However, the amount and type of fluid administered, and monitoring techniques vary greatly between institutions and there are limited prospective randomized trials and meta-analyses to guide fluid management in kidney transplant recipients. Methods: Members of the American Society of Anesthesiologists (ASA) committee on transplantation reviewed the current literature on the amount and type of fluids (albumin, starches, 0.9% saline and balanced crystalloid solutions) administered and the different monitors used to assess fluid status, resulting in this consensus statement with recommendations based on the best available evidence. Results: Review of the current literature suggests that starch solutions are associated with increased risk of renal injury in randomized trials and should be avoided in kidney donors and recipients. There is no evidence supporting the routine use of albumin solutions in kidney transplants. Balanced crystalloid solutions such as Lactated Ringer are associated with less acidosis and may lead to less hyperkalemia than 0.9% saline solutions. Central venous pressure is only weakly supported as tool to assess fluid status. Conclusion: These recommendations may be useful to anesthesiologists making fluid management decisions during kidney transplantation and facilitate future research on this topic. Financial Disclosure: Support was provided solely from institutional and/or departmental sources Disclaimer: NONE. Correspondence:Gebhard Wagener, MD Professor of Anesthesiology at CUMC Department of Anesthesiology, Columbia University P&S Box 46 (PH-5)630 West 168th Street New York, NY 10032-3784 Tel: (212) 305-6494 (Office) Fax: (212) 305-2182 Email: <a href="mailto:gw72@cumc.columbia.edu">gw72@cumc.columbia.edu</a> Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://journals.lww.com/transplantjournal/Fulltext/9000/A_Comprehensive_Evaluation_of_Risk_Factors_for.95445.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">A Comprehensive Evaluation of Risk Factors for Pneumocystis Jirovecii Pneumonia in Adult Solid Organ Transplant Recipients: a Systematic Review and Meta-Analysis</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/transplantjournal/Fulltext/9000/A_Comprehensive_Evaluation_of_Risk_Factors_for.95445.aspx"></a>Background: There is no consensus guidance on when to reinitiate Pneumocystis jirovecii pneumonia (PJP) prophylaxis in solid organ transplant (SOT) recipients at increased risk. The 2019 American Society of Transplantation Infectious Diseases Community of Practice (AST IDCOP) guidelines suggested to continue or reinstitute PJP prophylaxis in those receiving intensified immunosuppression for graft rejection, CMV infection, higher dose of corticosteroids, or prolonged neutropenia. Methods: A literature search was conducted evaluating all literature from existence through April 22, 2020 using MEDLINE and EMBASE. (PROSPERO: CRD42019134204) Results: A total of 30 studies with 413 276 SOT recipients were included. The following factors were associated with PJP development: acute rejection (pooled odds ratio (pOR) = 2.35 (1.69, 3.26), study heterogeneity index (I2)= 23.4%), cytomegalovirus (CMV)-related illnesses (pOR = 3.14 (2.30, 4.29), I2=48%), absolute lymphocyte count < 500 cells/mm3 (pOR = 6.29[3.56, 11.13], I2 0%), BK-related diseases (pOR = 2.59[1.22, 5.49], I2 0%), HLA mismatch ≥ 3 (pOR = 1.83 [1.06, 3.17], I2= 0%), rituximab use (pOR =3.03 (1.82, 5.04); I2 =0%) and polyclonal antibodies use for rejection (pOR = 3.92 [1.87, 8.19], I2= 0%). On the other hand, sex, CMV mismatch, interleukin-2 inhibitors, corticosteroids for rejection, and plasmapheresis were not associated with developing PJP. Conclusion: PJP prophylaxis should be considered in SOT recipients with lymphopenia, BK-related infections and rituximab exposure in addition to the previously mentioned risk factors in the AST IDCOP guidelines. Correspondence: Nitipong Permpalung, MD, MPH E-mail: <a href="mailto:npermpa1@jhmi.edu">npermpa1@jhmi.edu</a> Address: 601 N Wolfe Street, Carnegie Building #340, Baltimore, MD 21287; Tel: 443-287-6217; Fax: 410-955-0788 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://journals.lww.com/transplantjournal/Fulltext/9000/Early_Signs_of_Sinoatrial_Reinnervation_in_the.95446.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Early Signs of Sinoatrial Reinnervation in the Transplanted Heart</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/transplantjournal/Fulltext/9000/Early_Signs_of_Sinoatrial_Reinnervation_in_the.95446.aspx"></a>Background: Heart transplantation (HTx) surgically transects all connections to the heart, including the autonomic nerves. We prospectively examined signs, timing and consequences of early sympathetic and parasympathetic sinoatrial reinnervation, as well as explored indirect evidence of afferent cardiopulmonary reinnervation. Methods: Fifty HTx recipients were assessed at 2.5, 6 and 12 months after HTx. For comparison, 50 healthy controls were examined once. Continuous, noninvasive recordings of hemodynamic variables and heart rate variability indices were carried out at supine rest, 0.2 Hz controlled breathing, 60 degrees head-up-tilt, during the Valsalva maneuver and during handgrip isometric exercise. Results: In HTx recipients, supine low-frequency heart rate variability gradually increased; supine high-frequency variability did not change; heart rate variability indices during controlled breathing remained unaltered; heart rate responses during tilt and isometric exercise gradually increased; the tachycardia response during Valsalva maneuver increased while the bradycardia response remained unchanged; and indices of baroreflex sensitivity improved. Responses remained low compared to healthy controls. A negative correlation between indices of preload and heart rate response during head-up tilt emerged at 12 months. Conclusions: Results suggest that sympathetic reinnervation of the sinoatrial node starts within 6 months after HTx and strengthens during the first year. No evidence of early parasympathetic reinnervation was found. Indirect signs of afferent reinnervation of cardiopulmonary low-pressure baroreceptors emerged at 12 months. Better sympathetic sinoatrial control improved heart rate responsiveness to orthostatic challenge and isometric exercise, as well as heart rate buffering of blood pressure fluctuations. Financial Disclosure This study was founded by the Health South–East Hospital Trust, Norway. Data availability The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Clinical trial notation: Autonomic Cardiovascular Control after Heart Transplantation (AccHEART), Clinical Trials ID: NCT01759966. Correspondence Anders Haugom Christensen, Dept. of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, N-0372, Oslo, Norway. Cell phone + 47 99 61 99 06. E-mail: <a href="mailto:a.h.christens1@gmail.com">a.h.christens1@gmail.com</a>. Twitter: @AndersHaugom. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://journals.lww.com/transplantjournal/Fulltext/9000/Pneumocystis_jirovecii__the_Changing_Landscape_for.95447.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Pneumocystis jirovecii: the Changing Landscape for Prophylaxis</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/transplantjournal/Fulltext/9000/Pneumocystis_jirovecii__the_Changing_Landscape_for.95447.aspx"></a>No abstract available</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://journals.lww.com/transplantjournal/Fulltext/9000/Urine_the_Right_Direction__The_Consensus_Statement.95448.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Urine the Right Direction: The Consensus Statement from the Committee on Transplant Anesthesia of the American Society of Anesthesiologists on Fluid Management During Kidney Transplantation</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/transplantjournal/Fulltext/9000/Urine_the_Right_Direction__The_Consensus_Statement.95448.aspx"></a>No abstract available</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://journals.lww.com/transplantjournal/Fulltext/9000/Uterine_Transplantation__Review_of_Livebirths_and.95449.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Uterine Transplantation; Review of Livebirths and Reproductive Implications</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/transplantjournal/Fulltext/9000/Uterine_Transplantation__Review_of_Livebirths_and.95449.aspx"></a>Uterine transplantation (UTx) is a fertility restoring treatment for women with absolute uterine factor infertility. At a time when there is no question of the procedure's feasibility, and as the number of livebirths begins to increase exponentially, various important reproductive, fetal and maternal medicine implications have emerged. Detailed outcomes from 17 livebirths following UTx are now available, which are reviewed herein, along with contextualized extrapolation from pregnancy outcomes in other solid organ transplants. Differences in recipient demographics and reproductive aspirations between UTx and other transplant recipients make extrapolating management strategies and outcomes in other solid organ transplants inappropriate. Whereas preterm delivery remains prominent, small for gestational age or hypertensive disorders do not appear to be as prevalent following UTx when compared to other solid organ transplants. Given the primary objective of undertaking UTx is to achieve a livebirth, publication of reproductive outcomes is essential at this early stage, to reflect upon and optimize the management of future cases. Financial Disclosure: None Disclaimer: The authors report no conflict of interest Correspondence: Mr Benjamin P Jones MBChB BSc (Hons) MRCOG epartment of Surgery and Cancer, Imperial College London, London W12 0NN, United Kingdom. Telephone: 07740358900. E-mail: <a href="mailto:Benjamin.jones@nhs.net">Benjamin.jones@nhs.net</a> Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://journals.lww.com/transplantjournal/Fulltext/9000/Chronic_Histologic_Changes_Are_Present_Regardless.95450.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Chronic Histologic Changes Are Present Regardless of HLA Mismatches: Evidence from HLA Identical Living Donor Kidney Transplants</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/transplantjournal/Fulltext/9000/Chronic_Histologic_Changes_Are_Present_Regardless.95450.aspx"></a>Background: At 5 and 10 years after kidney transplantation, chronic histologic changes such as arteriolar hyalinosis and mesangial expansion are common, however, determining etiology is difficult. We compared surveillance biopsies in living donor kidney transplants (LDKTx) from HLA matched siblings (termed HLA-identical (HLA-ID)) to HLA non-ID to investigate which histologic changes were likely due to alloimmune injury and which were due to non-alloimmune injury. Methods: We performed a retrospective, cohort study comparing HLA-ID sibling LDKTx (n=175) to HLA non-ID LDKTx (n=175; matched for age, sex and year of transplant +/- 2 years) performed at a single institution from 03/1999 to 11/2018. Results: Baseline characteristics and maintenance immunosuppression were similar. Mortality rates were similar, but in the HLA-ID group, 10-year death-censored graft survival was higher (93.8% vs 80.9% HLA non-ID LDKTx, p<0.001), rejection rates were lower (after 1 year 9.6% vs 27.1%; p<0.001) and Banff inflammation scores including glomerulitis and peritubular capillaritis were lower on surveillance biopsies at 1, 5 and 10 years. In contrast, chronic Banff scores (interstitial fibrosis, arteriolar hyalinosis, mesangial expansion, etc.) were similar in prevalence and severity on surveillance biopsies at 1, 5 and 10 years. Conclusions: HLA-ID LDKTx have less inflammation and less transplant glomerulopathy, but most chronic histologic changes were similar to less-well matched LDKTx. We conclude that these types of chronic changes are not associated with HLA mismatches and may be due to non-immunologic causes (hypertension, obesity, etc.) suggesting that new management approaches to prevent these lesions may be needed. Funding Andrew Bentall would like to acknowledge internal funding awards including the 'Transplant Scholar Award' and the 'Career Development Award in Transplantation' although these funds were not directly used in this study. All other authors have no acknowledgements. Disclosure: The authors declare no conflicts of interest. Address correspondence to: Dr. Mark D. Stegall, Department of Surgery and Immunology, Division of Transplant Surgery; von Liebig Transplant Center, Mayo Clinic, Rochester, MN E-mail: <a href="mailto:stegall.mark@mayo.edu">stegall.mark@mayo.edu</a> Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr></tbody></table><div><div dir="ltr" class="gmail_signature" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-65316196899240490372020-12-22T23:07:00.000-08:002020-12-22T23:08:20.961-08:00Thoracic Imaging<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Quantitative_Differentiation_of_Left_Atrial.99371.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Quantitative Differentiation of Left Atrial Performance in Hypertrophic Cardiomyopathy: Comparison Between Nonobstruction and Occult Obstruction With 4-dimensional Volume-strain</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Quantitative_Differentiation_of_Left_Atrial.99371.aspx"></a>Objective: The objective of this study was to describe the different components of left atrial (LA) dysfunction predictors in nonobstructive and occult obstructive hypertrophy cardiomyopathy (HCM) patients especially with preserved left ventricular (LV) ejection fraction, particularly using LA 4-dimensional (D) longitudinal and circumferential strains. Methods: Twenty-eight nonobstructive HCM patients and 30 occult obstructive HCM patients according to LV outflow tract gradient at rest and after exercise were prospectively enrolled. 4D echocardiographic evaluation was performed in 58 HCM patients, both nonobstructive and occult obstructive, and 38 control subjects. LA reservoir, conduit, contractile functions were performed by 4D volume-strain with volumes and longitudinal, circumferential strains. Results: Optimal correlation coefficients obtained between LV 4D mass (index) and LA 4D longitudinal/circumferential strain (r=−0.860 to 0.518, all P<0.001). Both nonobstructive and occult obstructive HCM patients had increased volumes and significantly decreased longitudinal, circumferential strain values with lower reservoir, conduit, contractile functions than the controls (all P<0.001). Occult obstructive HCM patients presented incremented volumes compared with nonobstructive ones (P<0.001 to 0.003). Lower conduit function and higher contractile function indicated with lower reservoir function revealed by circumferential strain in occult obstructive HCM patients than nonobstructive ones (P<0.001 to 0.017). Interclass correlation coefficients of intraobserver and interobserver in the LV and LA 4D value evaluations were >0.75 and >0.85, respectively. Conclusions: LA volumes were significantly increased and LA reservoir, conduit, and contractile functions were significantly impaired in HCM patients. Furthermore, different performances of LA functional analyses in nonobstruction and occult obstruction patients with 4D volume-strain echocardiography may facilitate the recognition of subtle LA dysfunctional differentiation in HCM patients. M.S. is a co-first author and contributed equally as H.R. The research protocol was approved by the regional ethics committee, and all included patients provided written informed consent. H.R.: was involved in compilation of the data collected, drafting, and writing the manuscript. M.S. and P.-y.Z.: were the supervisors responsible for echocardiography and revision of the manuscript. L.-l.W., J.-y.R., and X.-w.M.: assisted in the measurement and monitoring the patients' examination. Supported by Nanjing Medical Science and Technique Development Foundation 2017(8). The authors declare no conflict of interest. Correspondence to: Ping-yang Zhang, MD, PhD, Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Changle Road 68, Nanjing 210006, Jiangsu Province, China (e-mail: <a href="mailto:zhpy28@hotmail.com">zhpy28@hotmail.com</a>). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. <a href="http://creativecommons.org/licenses/by-nc-nd/4.0/">http://creativecommons.org/licenses/by-nc-nd/4.0/</a> Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Cardiac_Magnetic_Resonance_Imaging_in_Coronavirus.99372.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Cardiac Magnetic Resonance Imaging in Coronavirus Disease 2019 (COVID-19): A Systematic Review of Cardiac Magnetic Resonance Imaging Findings in 199 Patients</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Cardiac_Magnetic_Resonance_Imaging_in_Coronavirus.99372.aspx"></a>Objective: Cardiac magnetic resonance imaging (CMR) with its new quantitative mapping techniques has proved to be an essential diagnostic tool for detecting myocardial injury associated with coronavirus disease 2019 (COVID-19) infection. This systematic review sought to assess the important imaging features on CMR in patients diagnosed with COVID-19. Materials and Methods: We performed a systematic literature review within the PubMed, Embase, Google Scholar, and WHO databases for articles describing the CMR findings in COVID-19 patients. Results: A total of 34 studies comprising 199 patients were included in the final qualitative synthesis. Of the CMRs 21% were normal. Myocarditis (40.2%) was the most prevalent diagnosis. T1 (109/150; 73%) and T2 (91/144; 63%) mapping abnormalities, edema on T2/STIR (46/90; 51%), and late gadolinium enhancement (LGE) (85/199; 43%) were the most common imaging findings. Perfusion deficits (18/21; 85%) and extracellular volume mapping abnormalities (21/40; 52%), pericardial effusion (43/175; 24%), and pericardial LGE (22/100; 22%) were also seen. LGE was most commonly seen in the subepicardial location (81%) and in the basal-mid part of the left ventricle in inferior segments. In most of the patients, ventricular functions were normal. Kawasaki-like involvement with myocardial edema without necrosis/LGE (4/6; 67%) was seen in children. Conclusion: CMR is useful in assessing the prevalence, mechanism, and extent of myocardial injury in COVID-19 patients. Myocarditis is the most common imaging diagnosis, with the common imaging findings being mapping abnormalities and myocardial edema on T2, followed by LGE. As cardiovascular involvement is associated with poor prognosis, its detection warrants prompt attention and appropriate treatment. The authors declare no conflicts of interest. Correspondence to: Sanjiv Sharma, MD, Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi 110029, India (e-mail: <a href="mailto:meetisv@yahoo.com">meetisv@yahoo.com</a>). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Smooth_Muscle_Conditions_of_the_Chest__A_Clinical,.99373.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Smooth Muscle Conditions of the Chest: A Clinical, Radiologic, and Pathologic Review</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Smooth_Muscle_Conditions_of_the_Chest__A_Clinical,.99373.aspx"></a>Smooth muscle conditions of the chest have diverse clinical and imaging manifestations and may involve nearly every thoracic structure. Differentiation among these conditions requires the integration of clinical, radiologic, and histopathologic data. Histologic examination in conjunction with immunohistochemistry is essential for differentiation from other spindle cell neoplastic mimics. Familiarity with these entities will ensure the inclusion of smooth muscle conditions in the differential diagnosis of thoracic soft tissue lesions and potentially guide the clinician in appropriate management. We review the clinical, imaging, and histopathologic features of thoracic smooth muscle-related conditions organized by the anatomic structures affected. The authors declare no conflicts of interest. Correspondence to: Justin T. Stowell, MD, Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (e-mail: <a href="mailto:stowell.justin@mayo.edu">stowell.justin@mayo.edu</a>). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Influence_of_Asthma_Onset_on_Airway_Dimensions_on.99374.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Influence of Asthma Onset on Airway Dimensions on Ultra–high-resolution Computed Tomography in Chronic Obstructive Pulmonary Disease</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Influence_of_Asthma_Onset_on_Airway_Dimensions_on.99374.aspx"></a>Purpose: Asthma onset before the age of 40 years is associated with distinct clinical manifestations in chronic obstructive pulmonary disease (COPD) patients, but its morphologic features remain unestablished. This study aimed to explore airway morphology in COPD patients with asthma onset before 40 years of age using ultra–high-resolution computed tomography (U-HRCT), which allows a more accurate quantitation of the lumen and the wall in smaller airways than using conventional CT. Materials and Methods: Clinical data of 500 consecutive patients undergoing full inspiratory U-HRCT (1024×1024 matrix and 0.25 mm slice thickness) were retrospectively analyzed. COPD patients without asthma, COPD patients with asthma onset at age below or 40 years and above, and non-COPD smoker controls (N=137, 29, 34, and 22, respectively) were enrolled. The length, lumen area (LA), wall thickness and area (WA), and wall area percent (WA%) of the segmental (third-generation) to sub-subsegmental (fifth-generation) bronchus and the low attenuation volume percent (LAV%) were measured. Results: LA and WA were smaller in the fourth and fifth generation in COPD patients than in non-COPD controls, regardless of the age of asthma onset. LA was smaller and WA% was larger in the fourth-generation and fifth-generation airways in COPD with asthma onset before 40 years than COPD without asthma, whereas WA did not differ between them. In multivariate analyses, asthma onset before 40 years was associated with smaller LA in COPD patients independent of demographics, use of inhaled corticosteroids and long-acting bronchodilators, airflow limitation, and LAV%. Conclusions: Asthma onset before 40 years of age could be associated with greater lumen narrowing of the airways in COPD. This study was partially supported by the Japan Society for the Promotion of Science (JSPS) [Grants-in-Aid for Scientific Research 19K08624]. N.T., S.S, T.O., and T.H. were supported by a grant from FUJIFILM Co., Ltd. K.T. was supported by Canon Medical Systems Corporation. None of these companies had a role in the design or analysis of the study or in the writing of the manuscript. The authors declare no conflicts of interest. Correspondence to: Naoya Tanabe, MD, Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (e-mail: <a href="mailto:ntana@kuhp.kyoto-u.ac.jp">ntana@kuhp.kyoto-u.ac.jp</a>). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Accessory_and_Incomplete_Lung_Fissures__Clinical.99375.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Accessory and Incomplete Lung Fissures: Clinical and Histopathologic Implications</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Accessory_and_Incomplete_Lung_Fissures__Clinical.99375.aspx"></a>Objective: This article reviews the anatomy, histology, and disease processes of pulmonary fissures, with emphasis on clinical implications of accessory and incomplete fissures. Conclusion: Accessory and incomplete pulmonary fissures are often overlooked during routine imaging but can have profound clinical importance. Knowledge of fissure anatomy could improve diagnostic accuracy and inform prognosis for oncologists, interventional pulmonologists, and thoracic surgeons. P.A.B.: primary manuscript author, retrieval and analysis of literature, design and production of tables, and editing and approval of the manuscript. R.A.G., G.M.L., and C.M.W.: data collection, critical review, and editing and approval of the manuscript. D.I.S.: pathologic data collection and analysis, pathologic slide preparation, literature analysis, and editing and approval of the manuscript. R.E.G.: critical review and editing and approval of the manuscript. M.D.G.: project supervision and editing and approval of the manuscript. M.L.: surgical data collection and analysis, surgical photography and video preparation, and editing and approval of the manuscript. J.T.S.: conception and design, senior manuscript author, study coordination, literature review; data collection and analysis, project oversight, and leadership. C.M.W. receives royalties from Amirsys and Elsevier. C.M.W. is a part of the speaker's bureau for Boehringer Ingelheim. The remaining authors declare no conflicts of interest. Correspondence to: Justin T. Stowell, MD, Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 (e-mail: <a href="mailto:stowell.justin@mayo.edu">stowell.justin@mayo.edu</a>). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Cardiovascular_Risk_Factors_and_Coronary.99377.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Cardiovascular Risk Factors and Coronary Calcification in a Middle-aged Dutch Population: The ImaLife Study</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Cardiovascular_Risk_Factors_and_Coronary.99377.aspx"></a>Purpose: To assess the presence of coronary artery calcium (CAC) and its association with cardiovascular risk factors and Systematic COronary Risk Evaluation (SCORE) risk in a middle-aged Dutch population. Methods: Classic cardiovascular risk factors and CAC were analyzed in 4083 participants aged 45 to 60 years (57.9% women) from the population-based ImaLife study. CAC scores were quantified on noncontrast cardiac CT scans. Age-specific and sex-specific distribution of CAC categories (0, 1 to 99, 100 to 299, ≥300) and percentiles were determined. SCORE risk categories (<1%, ≥1% to 5%, and ≥5%) were compared with CAC distribution. Population attributable fractions (PAFs) of classic risk factors for CAC were estimated. Results: CAC was present in 54.5% male and 26.5% female participants. The percentage of individuals with CAC increased with increasing age. Mean SCORE was 2.0% in men and 0.7% in women. In SCORE <1%, 32.7% of men and 17.1% of women had CAC. In men with SCORE ≥5%, 26.9% had no CAC. Only 0.1% of women had SCORE ≥5%. PAF of classic risk factors for CAC was 18.5% in men and 31.4% in women. PAF was highest for hypertension (in men 8.0%, 95% confidence interval, 4.2%-11.8%; in women 13.1%, 95% confidence interval, 7.9%-18.2%) followed by hypercholesterolemia and obesity. Conclusion: In this middle-aged cohort, more than half of the men and a quarter of the women had CAC. One out of 4 men at high risk (SCORE ≥5%) could be placed into a lower risk category owing to absence of CAC. Thus, adding CAC scoring to SCORE could have considerable effect on cardiovascular risk classification. Elimination of exposure to classic risk factors could reduce limited proportion of CAC in a middle-aged population. The PhD project of Congying Xia is part of the ImaLife project, which is funded by an institutional research grant from Siemens Healthineers and by the Ministry of Economic Affairs and Climate Policy by means of the PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships. M.O. is involved in the company iDNA BV. The authors declare no conflicts of interest. Correspondence to: Rozemarijn Vliegenthart, MD, PhD, Department of Radiology, University Medical Center Groningen, EB44, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands (e-mail: <a href="mailto:r.vliegenthart@umcg.nl">r.vliegenthart@umcg.nl</a>). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. <a href="http://creativecommons.org/licenses/by-nc-nd/4.0/">http://creativecommons.org/licenses/by-nc-nd/4.0/</a> Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Prevalence_of_Abnormal_Coronary_Findings_on.99380.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Prevalence of Abnormal Coronary Findings on Coronary Computed Tomography Angiography Among Young Adults Presenting With Chest Pain</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Prevalence_of_Abnormal_Coronary_Findings_on.99380.aspx"></a>Purpose: We evaluated the prevalence of coronary stenosis on coronary computed tomography angiography (CCTA) in patients aged 18 to 30 years, who presented to the emergency department with chest pain. We also examined the risk factors potentially associated with abnormal coronary findings on CCTA in this age group. Materials and Methods: A total of 884 patients were retrospectively evaluated. Indication for CCTA was guided by our hospital's chest pain protocol based on ACC/AHA guidelines. These were performed using the standard technique and interpreted based on CAD-RADS guidelines. Scans were identified as abnormal if atherosclerotic coronary artery disease (CAD), myocardial bridging (MB), or any anatomic coronary artery anomaly were present. Results: Twenty-two percent of patients had a coronary abnormality on CCTA. The most common abnormality was MB (17.3%), followed by CAD (4.4%) and coronary anomalies (1.5%). A small minority had stenosis (2.8%), most commonly caused by CAD. Most cases with stenosis were minimal to mild (72%) with 0.8% having coronary stenosis ≥50%. Age and male sex were risk factors for both coronary artery stenosis (odds ratio: 1.32 and 4.50, 95% confidence interval: 1.03-1.69, and 1.23-16.46, P=0.028 and 0.023, respectively) and CAD (odds ratio: 1.52 and 3.67, 95% confidence interval: 1.14-2.04, and 1.26-10.66, P=0.005 and 0.017, respectively). Conclusions: Epicardial coronary stenosis is rarely the cause of chest pain among young adult patients presenting to the emergency department. Age and male sex were both risk factors for coronary artery stenosis/disease in this age group. J.R.B.: concept, design, data collection, writing and editing manuscript, submission for publication. M.C.O.: concept, design, data collection. B.Y. and J.C.: writing and editing manuscript, statistical analysis. M.K., J.W., M.K., and A.A.: writing and editing manuscript. M.S., M.H., and A.G.: data collection. N.F.: data collection, writing and editing manuscript. C.W.: writing and editing manuscript, submission for publication. B.L.: concept, design, data collection, writing and editing manuscript. The authors declare no conflicts of interest. Correspondence to: Jeremy R. Burt, MD, Department of Radiology, MUSC, 96 Jonathan Lucas Street, MSC 323, Clinical Science Building, Room 210, Charleston, SC 29425 (e-mail: <a href="mailto:burtje@musc.edu">burtje@musc.edu</a>). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Blastomycosis__The_Great_Pretender.99381.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Blastomycosis: The Great Pretender</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Blastomycosis__The_Great_Pretender.99381.aspx"></a>Blastomycosis is an endemic fungal infection caused by Blastomyces, a soil-dwelling dimorphic fungus found predominantly in North America. In this pictorial essay, we illustrate the varied imaging features of blastomycosis along with a brief description of the epidemiology, clinical aspects, and differential diagnosis, emphasizing clues that can help radiologists arrive at this diagnosis. The authors declare no conflicts of interest. Correspondence to: Jeffrey P. Kanne, MD, Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792-3252 (e-mail: <a href="mailto:jkanne@uwhealth.org">jkanne@uwhealth.org</a>). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Differentiating_Nonischemic_Dilated_Cardiomyopathy.99383.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Differentiating Nonischemic Dilated Cardiomyopathy With Incidental Infarction From Ischemic Cardiomyopathy by Geometric Indices Derived From Cardiovascular Magnetic Resonance</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Differentiating_Nonischemic_Dilated_Cardiomyopathy.99383.aspx"></a>Purpose: The purpose of this study was to differentiate nonischemic dilated cardiomyopathy with incidental myocardial infarction (NICM with incidental MI) from ischemic cardiomyopathy (ICM) by integrating left ventricular (LV) geometric indices and ischemic late gadolinium enhancement (LGE), obtained from cardiac magnetic resonance (CMR) imaging. Materials and Methods: All subjects were studied on a 1.5 Tesla magnetic resonance imaging scanner. All patients had an LV ejection fraction (LVEF) <50% with LV dilation. LV end-diastolic volume (LVEDV), LVEDV index (LVEDVi), LVEF, the number and distribution of ischemic LGE segments, and ratios of volumetric and functional indices to ischemic LGE segments were determined. Logistic regression was used to detect the independent predictor of ICM. Receiver operating characteristic analysis differentiated NICM with incidental MI from ICM. Results: Of a total of 63 patients enrolled, 45 patients had ICM, and 18 patients had NICM with incidental MI. Both groups had similar LVEF. Compared with ICM, NICM with incidental MI had more LV dilation, whereas ICM had more ischemic LGE segments. A higher number of ischamic LGE segments remained an independent predictor of ICM (odds ratio: 18.2, 95% confidence interval: 1.64-201.34, P=0.018). The optimal cut-off value for detecting NICM with incidental MI is the ratio of LVEDVi to the number of ischemic LGE segments over 25 mL/m2/segment (sensitivity 100%, specificity 91%, P<0.0001). Conclusion: Patients with NICM with incidental MI can be reliably distinguished from ICM using the ratio of LVEDVi divided by the number of ischemic LGE segments. This technique may improve diagnosis and help aid management of patients with cardiomyopathy and coexistent coronary artery disease. The authors declare no conflicts of interest. Correspondence to: Shihua Zhao, MD, FESC, Fuwai Hospital, No. 167 Beilishi Road, Beijing 100037, China (e-mail: <a href="mailto:cjrzhaoshihua2009@163.com">cjrzhaoshihua2009@163.com</a>). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Radiologic_Manifestations_of_Pulmonary_Vein.99384.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Radiologic Manifestations of Pulmonary Vein Ablation Complications: A Pictorial Review</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/thoracicimaging/Fulltext/9000/Radiologic_Manifestations_of_Pulmonary_Vein.99384.aspx"></a>In patients with atrial fibrillation refractory to drug therapy and cardioversion, pulmonary vein ablation is an alternative treatment that eradicates arrhythmogenic activity originating in the muscles of the pulmonary veins. While this procedure has a low incidence of significant complications, iatrogenic injuries are possible. Through multimodality pictorial examples utilizing computed tomography, nuclear medicine, fluoroscopy, and chest radiographs, the complications associated with pulmonary vein ablation will be reviewed. Examples of pulmonary vein stenosis, right phrenic nerve injury with associated diaphragmatic paralysis, atrioesophageal fistula, and pericardioesophageal fistula will be illustrated. The authors declare no conflicts of interest. Correspondence to: Daniel T. Myers, MD, Department of Radiology, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 (e-mail: <a href="mailto:danielm@rad.hfh.edu">danielm@rad.hfh.edu</a>). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved</span><br><br></td></tr></tbody></table><div><div dir="ltr" class="gmail_signature" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-45301114169004494792020-12-22T23:06:00.000-08:002020-12-22T23:07:33.152-08:00Shock<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://journals.lww.com/shockjournal/Fulltext/9000/Toll_Like_Receptors,_Associated_Biochemical.97336.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Toll-Like Receptors, Associated Biochemical Signaling Networks, and S100 Ligands</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/shockjournal/Fulltext/9000/Toll_Like_Receptors,_Associated_Biochemical.97336.aspx"></a>Host cells recognize molecules that signal danger using pattern recognition receptors (PRRs). Toll-Like Receptors (TLRs) are the most studied class of PRRs and detect pathogen associated molecular patterns and danger associated molecular patterns. Cellular TLR activation and signal transduction can therefore contain, combat and clear danger by enabling appropriate gene transcription. Here we review the expression, regulation and function of different TLRs, with an emphasis on TLR-4, and how TLR adaptor protein binding directs intracellular signaling resulting in activation or termination of an innate immune response. Finally, we highlight the recent progress of research on the involvement of S100 proteins as ligands for TLR-4 in inflammatory disease. Address reprint requests to John C. Marshall, MD, St. Michael's Hospital, 4th Floor Bond Wing, Room 4-007, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. E-mail: <a href="mailto:john.marshall@unityhealth.to">john.marshall@unityhealth.to</a> Received 25 October, 2020 Revised 12 November, 2020 Accepted 30 November, 2020 Conflicts of Interest: The authors have no conflicts of interest to declare. Grant Funding Source: Canadian Institutes of Health Research (MOP 129493) © 2020 by the Shock Society</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://journals.lww.com/shockjournal/Fulltext/9000/Bone_Marrow_Derived_Mononuclear_Cell.97337.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Bone Marrow-Derived Mononuclear Cell Transplantation can Reduce Systemic Inflammation and Endothelial Glycocalyx Damage in Sepsis</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/shockjournal/Fulltext/9000/Bone_Marrow_Derived_Mononuclear_Cell.97337.aspx"></a>Bone marrow-derived mononuclear cells (BMMNCs) secrete anti-inflammatory mediators that protect against acute inflammation. Current evidence suggests that BMMNC transplantation can reduce acute tissue injury caused by systemic inflammation and lung dysfunction. This study evaluated the role of BMMNCs in reducing systemic inflammatory responses to vascular endothelial injury in sepsis. Bone marrow cells were harvested from the tibias and femurs of twelve-week-old male Wistar rats; BMMNCs were separated by density centrifugation. Additional rats underwent cecal ligation and puncture (CLP) or similar sham surgery. BMMNCs were injected intravenously 30 min after CLP. The Sham and CLP Control groups were administered PBS. The seven-day survival rate improved markedly in the CLP-BMMNC group compared with that in the Control group. BMMNCs markedly suppressed the serum levels of pro-inflammatory mediators such as tumor necrosis factor-alpha, interleukin-6, and histone H3 at 3, 6, and 12 h after CLP. In the CLP-BMMNC group, the serum levels of syndecan-1, the main component of the vascular endothelial glycocalyx layer, were notably lower than those in the Control group 6 h after CLP. Histological analysis revealed improvement of morphological damages in the CLP-BMMNC group. Ultrastructural analysis revealed that the glycocalyx structure was maintained and the continuity of the vascular endothelial glycocalyx layer was preserved in the BMMNC group, compared to the case for the Control group at 6 and 12 h. Therefore, BMMNC transplantation may provide reduced systemic inflammation and endothelial glycocalyx damage, dramatically improving the survival of rats. These findings provide insights into formulating potential therapeutic strategies against sepsis. Address reprint requests to Tsunehiro Matsubara, MD, Osaka University Graduate School of Medicine Department of Traumatology and Acute Critical Care Center, 2-15 Yamadaoka, Suita-city, Osaka 565-0871, Japan. E-mail: <a href="mailto:tsunehiro1231@live.jp">tsunehiro1231@live.jp</a> Received 1 August, 2020 Revised 10 September, 2020 Accepted 9 December, 2020 Conflicts of Interest and Source of Funding: This study received a Grant-in-Aid for Young Scientists from The Ministry of Education, Culture, Sports, Science and Technology, Japan. The authors declare no conflicts of interest. © 2020 by the Shock Society</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://journals.lww.com/shockjournal/Fulltext/9000/Neutrophil_To_Lymphocyte_Ratio_And_Covid_19.97338.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Neutrophil-To-Lymphocyte Ratio And Covid-19</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/shockjournal/Fulltext/9000/Neutrophil_To_Lymphocyte_Ratio_And_Covid_19.97338.aspx"></a>No abstract available</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://journals.lww.com/shockjournal/Fulltext/9000/Pharmacological_and_Genetic_Inhibition_of.97339.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Pharmacological and Genetic Inhibition of Translocator Protein 18 kDa Ameliorated Neuroinflammation in Murine Endotoxemia Model</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/shockjournal/Fulltext/9000/Pharmacological_and_Genetic_Inhibition_of.97339.aspx"></a>Sepsis-associated encephalopathy (SAE) is a diffuse brain dysfunction associated with sepsis. The development of an effective strategy for early diagnosis and therapeutic intervention is essential for the prevention of poor prognosis of SAE. Translocator protein 18 kDa (TSPO) is a mitochondrial protein implicated in steroidogenesis and inflammatory responses. Despite accumulating evidence that implicates TSPO in the neuroinflammatory response of the central nervous system, the possible role of TSPO in SAE remains unclear. Aim of this study is to address a role of TSPO in neuroinflammation using mice 24 h after systemic injection of lipopolysaccharide (LPS), which consistently demonstrated microglial activation and behavioral inhibition. Quantitative polymerase chain reaction analysis revealed that hippocampal TSPO expression was induced following the systemic LPS injection, associated with an increase in pro-inflammatory cytokines such as tumor necrosis factor-α and interleukin-1β. Interestingly, pretreatment with the TSPO antagonist, ONO-2952, or germ-line deletion of the TSPO gene exhibited an anti-inflammatory effect with significant suppression of LPS-induced production of those cytokines. These effects demonstrated by the ONO-2952 or TSPO knockout were associated with significant recovery from behavioral inhibition, as shown by improved locomotor activity in the open field analysis. Histological analysis revealed that ONO-2952 pretreatment suppressed the LPS-induced activation of TSPO-expressing microglia in the hippocampus of mice. Collectively, these results suggest that TSPO plays a critical role in the SAE mouse model. Based on this finding, monitoring TSPO activity, as well as the progress of endotoxemia and its sequelae in the animal model, would deepen our understanding of the underlying molecular mechanism of SAE. Address reprint requests to Hidenori Aizawa, MD, PhD, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553 Japan. E-mail: <a href="mailto:haizawa@hiroshima-u.ac.jp">haizawa@hiroshima-u.ac.jp</a> Received 24 September, 2020 Revised 12 October, 2020 Accepted 23 November, 2020 Disclosure: The authors declare that they have no conflicts of interest. Funding: This research was supported by a Grant-in-Aid for Scientific Research on Innovative Areas (JP19H05723) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) to HA; a Grant-in-Aid for 'Integrated Research on Depression, Dementia and Development Disorders (20dm0107093)' carried out under the Strategic Research Program for Brain Sciences by AMED to SY and a Grant-in-Aid for Scientific Research C (18K08888) to KH. © 2020 by the Shock Society</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://journals.lww.com/shockjournal/Fulltext/9000/HIF_1__and_Hypoxia_Responsive_Genes_are.97340.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">HIF-1α and Hypoxia Responsive Genes are Differentially Expressed in Leukocytes from Survivors and Non-Survivors Patients during Clinical Sepsis</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/shockjournal/Fulltext/9000/HIF_1__and_Hypoxia_Responsive_Genes_are.97340.aspx"></a>Hypoxia inducible factor 1 alpha (HIF-1α) is linked to the metabolic and immune alterations in septic patients. Stabilization of HIF-1α by hypoxia or inflammation promotes the expression of several genes related to glycolytic metabolism, angiogenesis, coagulation, cell proliferation and apoptosis. Here we analyzed public available blood transcriptome datasets from septic patients and evaluated by PCR array the expression of HIF-1α and other hypoxia responsive genes in peripheral blood mononuclear cells (PBMC) from patients with sepsis secondary to community acquired infections. Samples were collected at ICU admission (D0, n=29) and after 7 days follow-up (D7, n = 18); healthy volunteers (n = 10) were included as controls. Hypoxia and glycolysis were among the top scored molecular signatures in the transcriptome datasets. PCR array showed that 24 out of 78 analyzed genes were modulated in septic patients compared to healthy volunteers; most of them (23/24) were downregulated at admission. This same pattern was observed in surviving patients, while non-survivors presented more upregulated genes. EGLN1, EGLN2 and HIF1AN, inhibitors of HIF-1α activation were downregulated in patients, regardless of the outcome, while HIF-1α and other target genes, such as PDK1 and HMOX1, expression were higher in non-survivors than in survivors, mainly at D7. Non-survivor patients also presented a higher SOFA score and lower PaO2/FiO2 ratio. Our results indicate a differential modulation of hypoxia pathway in leukocytes between septic patients who survived and those who did not survive with an increased intensity at D7, which is possibly influenced by disease severity and may affect the immune response in sepsis. Address reprint requests to Reinaldo Salomao, MD, PhD, Division of Infectious Diseases, Escola Paulista de Medicina, Hospital São Paulo, Universidade Federal de São Paulo, Rua Pedro de Toledo, 669, 10th Floor, Sao Paulo, SP, 04039-032, Brazil. E-mail: <a href="mailto:rsalomao@unifesp.br">rsalomao@unifesp.br</a> Received 25 September, 2020 Revised 19 October, 2020 Accepted 6 November, 2020 Funding: This work was supported by FAPESP (Grant 2017/21052-0). RS is the recipient of a Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) fellowship. BLF has a scholarship from FAPESP (2016/13855-2). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (<a href="http://www.shockjournal.com">www.shockjournal.com</a>). © 2020 by the Shock Society</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://journals.lww.com/shockjournal/Fulltext/9000/The_Value_of_Extracellular_Cold_Inducible.97341.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">The Value of Extracellular Cold-Inducible RNA-Binding Protein (eCIRP) in Predicting the Severity and Prognosis of Patients after Cardiac Arrest: A Preliminary Observational Study</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/shockjournal/Fulltext/9000/The_Value_of_Extracellular_Cold_Inducible.97341.aspx"></a>Background: Extracellular cold-inducible RNA-binding protein (eCIRP) acting as a novel damage-associated molecular pattern molecule promotes systemic inflammatory responses, including neuroinflammation in cerebral ischemia. We aimed to observe the changes of serum eCIRP and evaluate whether the increased serum eCIRP was associated with the severity and prognosis in patients with restoration of spontaneous circulation (ROSC). Methods: A total of 73 patients after ROSC were divided into non-survivor (n = 48) and survivor (n = 25) groups based on 28-day survival. Healthy volunteers (n = 25) were enrolled as controls. Serum eCIRP, procalcitonin (PCT), the pro-inflammatory mediators tumor necrosis factor (TNF)-α, interleukin-6 (IL)-6 and high mobility group protein (HMGB1), the neurological damage biomarkers neuron-specific enolase (NSE) and soluble protein 100β (S100β) were measured on days 1, 3 and 7 after ROSC. Clinical data and laboratory findings were collected, and the Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation (APACHE II) were calculated concurrently. Cerebral performance category (CPC) scores on day 28 after ROSC were recorded. Results: Serum eCIRP, IL-6, TNF-α, PCT and HMGB1, NSE and S100β were significantly increased within the first week after ROSC. The increased levels of eCIRP was positively correlated with IL-6, TNF-α, lactate, NSE, S100β, CPR time, SOFA score, APACHE II score and HMGB1 after ROSC. Serum eCIRP on days 1, 3 and 7 after ROSC could predict 28-day mortality and neurological prognosis. Serum eCIRP on day 3 after ROSC had a biggest AUC [0.862 (95%CI: 0.741–0.941)] for 28-day mortality and a biggest AUC [0.807 (95%CI: 0.630–0.981)] for neurological prognosis. Conclusions: Systemic inflammatory response with increased serum eCIRP occurred in patients after ROSC. Increased eCIRP level was positively correlated with the aggravation of systemic inflammatory response and the severity after ROSC. Serum eCIRP serves as a potential predictor for 28-day mortality and poor neurological prognosis after ROSC. Address reprint requests to Ping Gong, Emergency Department, First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian 116023, Liaoning Province, China. E-mail: <a href="mailto:gongp828@sina.cn">gongp828@sina.cn</a> Received 10 October, 2020 Revised 27 October, 2020 Accepted 20 November, 2020 LW and R-FL contributed equally to this study and should be considered co-first authors. The authors report no conflicts of interest. Funding: This study was supported by the National Natural Science Foundation of China (81571869). Competing interests: The authors declare that they have no competing interests. © 2020 by the Shock Society</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://journals.lww.com/shockjournal/Fulltext/9000/Endothelial_NOX2_Limits_Systemic_Inflammation_and.97342.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Endothelial NOX2 Limits Systemic Inflammation and Hypotension in Endotoxemia by Controlling Expression of Toll-Like Receptor 4</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/shockjournal/Fulltext/9000/Endothelial_NOX2_Limits_Systemic_Inflammation_and.97342.aspx"></a>Leukocyte Nox2 is recognized to have a fundamental microbicidal function in sepsis but the specific role of Nox2 in endothelial cells (EC) remains poorly elucidated. Here, we tested the hypothesis that endothelial Nox2 participates in the pathogenesis of systemic inflammation and hypotension induced by lipopolysaccharide (LPS). LPS was injected intravenously in mice with Tie2-targeted deficiency or transgenic overexpression of Nox2. Mice with Tie2-targeted Nox2 deficiency had increased circulating levels of tumor necrosis factor alpha (TNF-α), enhanced numbers of neutrophils trapped in lungs and aggravated hypotension after LPS injection, as compared to control LPS-injected animals. In contrast, Tie2-driven Nox2 overexpression attenuated inflammation and prevented the hypotension induced by LPS. Because Tie2-Cre targets both EC and myeloid cells we generated bone marrow chimeric mice with Nox2 deletion restricted to leukocytes or ECs. Mice deficient in Nox2 either in leukocytes or ECs had reduced LPS-induced neutrophil trapping in the lungs and lower plasma TNF-α levels as compared to control LPS-injected mice. However, the pronounced hypotensive response to LPS was present only in mice with EC-specific Nox2 deletion. Experiments in vitro with human vein or aortic endothelial cells (HUVEC and HAEC, respectively) treated with LPS revealed that EC Nox2 controls NF-κB activation and the transcription of toll-like receptor 4 (TLR4), which is the recognition receptor for LPS. In conclusion, these results suggest that endothelial Nox2 limits NF-κB activation and TLR4 expression, which in turn attenuates the severity of hypotension and systemic inflammation induced by LPS. Address reprint requests to Prof. Ajay M. Shah, School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London, 125 Coldharbour Lane SE5 9NU, London, United Kingdom. E-mail: <a href="mailto:ajay.shah@kcl.ac.uk">ajay.shah@kcl.ac.uk</a>. Received 9 September, 2020 Revised 29 September, 2020 Accepted 2 December, 2020 Sources of support: This research was supported by Sao Paulo Research Foundation (FAPESP) under grant agreement no 2012/24677-7 (S.C.T. Fellowship) and 2013/08216-2 (Center for Research of Inflammatory Disease (CRID), 2013/07937-8 (LRL as member of CEPID Redoxoma), the European Society of Cardiology (ESC, Basic Research Fellowship), and the British Heart Foundation (BHF CH/1999001/11735). Disclosure: The authors declare no financial conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (<a href="http://www.shockjournal.com">www.shockjournal.com</a>). © 2020 by the Shock Society</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://journals.lww.com/shockjournal/Fulltext/9000/Red_Blood_Cells_Elicit_Platelet_Dependent.97343.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Red Blood Cells Elicit Platelet-Dependent Neutrophil Recruitment into Lung Airspaces</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/shockjournal/Fulltext/9000/Red_Blood_Cells_Elicit_Platelet_Dependent.97343.aspx"></a>Haemolysis that occurs in intravascular haemolytic disorders, such as sickle cell disease and malaria, is associated with inflammation and platelet activation. Alveolar haemorrhage, for example following primary blast lung injury (PBLI) or acute respiratory distress syndrome (ARDS), results in the escape of erythrocytes (RBCs) into alveolar spaces, where they subsequently lyse and release their intracellular contents. However, the inflammatory effects of RBCs in the airways are not fully understood. We hypothesized that RBCs in the airway induce an inflammatory response, associated with platelet activation. By instilling whole RBCs or lysed RBCs into the airways of mice, we have demonstrated that whole RBCs elicit macrophage accumulation in the lung. However, lysed RBCs induce significant inflammatory cell recruitment, particularly neutrophils and this was associated with a 50% increase in circulating platelet neutrophil complexes (PNCs). Platelet depletion prior to lysed RBC exposure in the lung resulted in reduced neutrophil recruitment, suggesting that the presence of intracellular RBC components in the airways can elicit inflammation that is platelet dependent. To identify specific platelet dependent signalling pathways involved in neutrophil recruitment, anti-P-selectin ligand and anti-PSGL1 blocking antibodies were tested, however neither affected neutrophil recruitment. These findings implicate an involvement for other, as yet unidentified platelet-dependent signalling and adhesion mechanisms. Further understanding of how platelets contribute to lung inflammation induced by the presence of RBCs could offer novel therapeutic approaches to attenuate inflammation that occurs in conditions associated with alveolar haemorrhage. Address reprint requests to Simon C. Pitchford, Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK. E-mail: <a href="mailto:simon.pitchford@kcl.ac.uk">simon.pitchford@kcl.ac.uk</a> Received 23 September, 2020 Revised 13 October, 2020 Accepted 2 December, 2020 Authorship: S.A. designed and performed the research, analyzed the data, and wrote the paper. S.A.S., S.J.C., B.G.O'S., R.T.A., and K.A contributed to assay development and performed in vivo procedures. S.C.P., and C.P.P proposed the project, designed research and wrote the paper. Conflicts of interest. No author has a conflicts of interest to disclose. © 2020 by the Shock Society</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://journals.lww.com/shockjournal/Fulltext/9000/Burn_Injury_Impairs_Neutrophil_Chemotaxis_through.97344.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Burn Injury Impairs Neutrophil Chemotaxis through Increased Ceramide</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/shockjournal/Fulltext/9000/Burn_Injury_Impairs_Neutrophil_Chemotaxis_through.97344.aspx"></a>Infection is a common and often deadly complication after burn injury. A major underlying factor is burn-induced immune dysfunction, particularly with respect to neutrophils as the primary responders to infection. Temporally after murine scald injury, we demonstrate impaired bone marrow neutrophil chemotaxis towards CXCL1 ex vivo. Additionally, we observed a reduced recruitment of neutrophils to the peritoneal after elicitation seven days after injury. We demonstrate that neutrophil ceramide levels increase after burn injury, and this is associated with decreased expression of CXCR2 and blunted chemotaxis. A major signaling event upon CXCR2 activation is Akt phosphorylation and this was reduced when ceramide was elevated. In contrast, PTEN levels were elevated and PTEN-inhibition elevated phospho-Akt levels and mitigated the burn-induced neutrophil chemotaxis defect. Altogether, this study identifies a newly described pathway of ceramide-mediated suppression of neutrophil chemotaxis after burn injury and introduces potential targets to mitigate this defect and reduce infection-related morbidity and mortality after burn. Address reprint requests to Charles C. Caldwell, Department of Surgery, University of Cincinnati College of Medicine, MSB SRU G479, 231 Albert Sabin Way, Cincinnati, OH 45267-0558. E-mail: <a href="mailto:Charles.caldwell@uc.edu">Charles.caldwell@uc.edu</a> Received 17 September, 2020 Revised 7 October, 2020 Accepted 5 November, 2020 Conflict of Interest: None Authorship: NB, VN, CCC: Conception and study design. NB, FS: Data acquisition and analysis, drafting of the article. NB, FS, BK, EG, VN, CCC: Data interpretation, revision of the article, final approval of the version to be submitted. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (<a href="http://www.shockjournal.com">www.shockjournal.com</a>). © 2020 by the Shock Society</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://journals.lww.com/shockjournal/Fulltext/9000/Findings_and_Prognostic_Value_of_Lung.97345.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Findings and Prognostic Value of Lung Ultrasonography in Coronal Virus Disease 2019(COVID-19) Pneumonia</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/shockjournal/Fulltext/9000/Findings_and_Prognostic_Value_of_Lung.97345.aspx"></a>Purpose: We used lung ultrasonography to identify features of COVID-19 pneumonia and to evaluate the prognostic value. Materials and Methods: We performed lung ultrasonography on 48 COVID-19 patients in an ICU (Wuhan, China) using a 12-zone method. The associations between lung ultrasonography score, PaO2/FiO2, APACHE II, SOFA, and PaCO2 with 28-day mortality were analyzed and the receiver operator characteristic curve was plotted. Results: 25.9% areas in all scanning zones presented with B7 lines and 23.5% with B3 lines(B-pattern) on lung ultrasonography; 13% areas with confluent B lines(B-pattern), 24.9% in areas with consolidations, and 9.9% in areas with A lines. Pleural effusion was observed in 2.8% of areas. Lung ultrasonography score was negatively correlated with PaO2/FiO2 (n = 48, r = -0.498, P < 0.05) andpositively correlated with APACHE II (n = 48, r = 0.435, P < 0.05). Lung ultrasonography score was independently associated with 28-day mortality. The areas under ROC curves of lung ultrasonography score was 0.735 (95% CI: 0.586–0.844). The sensitivity, specificity, and cutoff values were 0.833, 0.722, and 22.5, respectively. Conclusions: Lung ultrasonography could be used to assess the severity of COVID-19 pneumonia, and it could also reveal the pathological signs of the disease. The lung ultrasonography score on ICU admission was independently related to the ICU 28-day mortality. Address reprint requests to Zhiyong Peng, and Shuhan Cai, Wuhan University Zhongnan Hospital, China. <a href="mailto:e-mails%3Apengzy5@hotmail.com">e-mails:pengzy5@hotmail.com</a>,<a href="mailto:caishuhan@163.com">caishuhan@163.com</a> Received 12 September, 2020 Revised 1 October, 2020 Accepted 18 November, 2020 Lu Li and Aihua Qin: Authors contributed equally to this study and therefore shared the first authorship. Declaration of Conflicting Interests' statement: The authors have no conflicts of interest to declare relevant to this publication. Funding: This work was supported by the National Natural Science Fund (grants 81772046 and 81971816 to Dr Peng) and the Special Project for Significant New Drug Research and Development in the Major National Science and Technology Projects of China (2020ZX09201007 to Dr Peng). Ethics approval and consent to participate: This study was approved by the institutional ethics board of Zhongnan Hospital of Wuhan University (No. 2020088K). Informed consent was waived as it was a retrospective study. Consent for publication: Not applicable. Availability of data and materials: The datasets analyzed during the current study are available from the corresponding author on reasonable request. Authors' contributions: LL and AQ collected the data and wrote the manuscript. XY did the statistical analysis. SZ, YL, and FZ collected the data. JL, BH, and SC revised the manuscript. ZP designed and finalized the manuscript.{Citation} © 2020 by the Shock Society</span><br><br></td></tr></tbody></table><div><div dir="ltr" class="gmail_signature" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-47867378105833352222020-12-22T23:05:00.001-08:002020-12-22T23:06:53.739-08:00Pediatric Critical Care Medicine<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://journals.lww.com/pccmjournal/Fulltext/9000/Organ_Donation_Authorization_After_Brain_Death.97883.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Organ Donation Authorization After Brain Death Among Patients Admitted to PICUs in the United States, 2009–2018</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/pccmjournal/Fulltext/9000/Organ_Donation_Authorization_After_Brain_Death.97883.aspx"></a>Objectives: To identify trends in and factors associated with pediatric organ donation authorization after brain death. Design: Retrospective cohort study of data from Virtual Pediatric Systems, LLC (Los Angeles, CA). Setting: Data from 123 PICUs reporting to Virtual Pediatric Systems from 2009 to 2018. Patients: Patients less than 19 years old eligible for organ donation after brain death. Measurements and Main Results: Of 2,777 eligible patients, 1,935 (70%) were authorized for organ donation; the authorization rate remained unchanged over time (ptrend = 0.22). In a multivariable logistic regression model, hospitalizations lasting greater than 7 days had lower odds of authorization (adjusted odds ratio, 0.5; p < 0.001 vs ≤ 1 d) and White patients had higher odds than other race/ethnicity groups. Authorization was higher for trauma-related encounters (adjusted odds ratio, 1.5; p < 0.001) and when donation was discussed with an organ procurement organization coordinator (adjusted odds ratio, 1.7; p < 0.001). Of 123 hospitals, 35 (28%) met or exceeded a 75% organ donation authorization target threshold; these hospitals more often had an organ procurement organization coordinator discussing organ donation (85% vs 72% of encounters; p < 0.001), but no difference was observed by PICU bed size. Conclusions: Organ donation authorization after brain death among PICU patients was associated with length of stay, race/ethnicity, and trauma-related encounter, and authorization rates were higher when an organ procurement organization coordinator was involved in the donation discussion. This study identified factors that could inform initiatives to improve the authorization process and increase pediatric organ donation rates. No endorsement or editorial restriction of the interpretation of these data or opinions of the authors has been implied or stated. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (<a href="http://journals.lww.com/pccmjournal">http://journals.lww.com/pccmjournal</a>). Virtual Pediatric Systems (VPS) data were provided by VPS, LLC (Los Angeles, CA). The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: <a href="mailto:alicen.spaulding@childrensmn.org">alicen.spaulding@childrensmn.org</a> ©2020The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://journals.lww.com/pccmjournal/Fulltext/9000/Avoidable_Serum_Potassium_Testing_in_the_Cardiac.97884.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Avoidable Serum Potassium Testing in the Cardiac ICU: Development and Testing of a Machine-Learning Model</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/pccmjournal/Fulltext/9000/Avoidable_Serum_Potassium_Testing_in_the_Cardiac.97884.aspx"></a>Objectives: To create a machine-learning model identifying potentially avoidable blood draws for serum potassium among pediatric patients following cardiac surgery. Design: Retrospective cohort study. Setting: Tertiary-care center. Patients: All patients admitted to the cardiac ICU at Boston Children's Hospital between January 2010 and December 2018 with a length of stay greater than or equal to 4 days and greater than or equal to two recorded serum potassium measurements. Interventions: None. Measurements and Main Results: We collected variables related to potassium homeostasis, including serum chemistry, hourly potassium intake, diuretics, and urine output. Using established machine-learning techniques, including random forest classifiers, and hyperparameter tuning, we created models predicting whether a patient's potassium would be normal or abnormal based on the most recent potassium level, medications administered, urine output, and markers of renal function. We developed multiple models based on different age-categories and temporal proximity of the most recent potassium measurement. We assessed the predictive performance of the models using an independent test set. Of the 7,269 admissions (6,196 patients) included, serum potassium was measured on average of 1 (interquartile range, 0–1) time per day. Approximately 96% of patients received at least one dose of IV diuretic and 83% received a form of potassium supplementation. Our models predicted a normal potassium value with a median positive predictive value of 0.900. A median percentage of 2.1% measurements (mean 2.5%; interquartile range, 1.3–3.7%) was incorrectly predicted as normal when they were abnormal. A median percentage of 0.0% (interquartile range, 0.0–0.4%) critically low or high measurements was incorrectly predicted as normal. A median of 27.2% (interquartile range, 7.8–32.4%) of samples was correctly predicted to be normal and could have been potentially avoided. Conclusions: Machine-learning methods can be used to predict avoidable blood tests accurately for serum potassium in critically ill pediatric patients. A median of 27.2% of samples could have been saved, with decreased costs and risk of infection or anemia. Mr. Patel, Dr. Sperotto, and Mr. Molina contributed equally. Drs. Santillana and Kheir jointly supervised this research. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (<a href="http://journals.lww.com/pccmjournal">http://journals.lww.com/pccmjournal</a>). Supported, in part, by the Gerber Foundation and, in part, by the Joyful Heart Fund. The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: <a href="mailto:msantill@fas.harvard.edu">msantill@fas.harvard.edu</a>; <a href="mailto:john.kheir@childrens.harvard.edu">john.kheir@childrens.harvard.edu</a> ©2020The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://journals.lww.com/pccmjournal/Fulltext/9000/Early_Mobilization_in_a_PICU__A_Qualitative.97885.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Early Mobilization in a PICU: A Qualitative Sustainability Analysis of PICU Up!</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/pccmjournal/Fulltext/9000/Early_Mobilization_in_a_PICU__A_Qualitative.97885.aspx"></a>Objectives: To identify staff-reported factors and perceptions that influenced implementation and sustainability of an early mobilization program (PICU Up!) in the PICU. Design: A qualitative study using semistructured phone interviews to characterize interprofessional staff perspectives of the PICU Up! program. Following data saturation, thematic analysis was performed on interview transcripts. Setting: Tertiary-care PICU in the Johns Hopkins Hospital, Baltimore, MD. Subjects: Interprofessional PICU staff. Interventions: None. Measurements and Main Results: Fifty-two staff members involved in PICU mobilization across multiple disciplines were interviewed. Three constructs emerged that reflected the different stages of PICU Up! program execution: 1) factors influencing the implementation process, 2) staff perceptions of PICU Up!, and 3) improvements in program integration. Themes were developed within these constructs, addressing facilitators for PICU Up! implementation, cultural changes for unitwide integration, positive impressions toward early mobility, barriers to program sustainability, and refinements for more robust staff and family engagement. Conclusions: Three years after implementation, PICU Up! remains well-received by staff, positively influencing role satisfaction and PICU team dynamics. Furthermore, patients and family members are perceived to be enthusiastic about mobility efforts, driving staff support. Through an ongoing focus on stakeholder buy-in, interprofessional engagement, and bundled care to promote mobility, the program has become part of the culture in the Johns Hopkins Hospital PICU. However, several barriers remain that prevent consistent execution of early mobility, including challenges with resource management, sedation decisions, and patient heterogeneity. Characterizing these staff perceptions can facilitate the development of solutions that use institutional strengths to grow and sustain PICU mobility initiatives. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (<a href="http://journals.lww.com/pccmjournal">http://journals.lww.com/pccmjournal</a>). Mr. Patel was funded by the Johns Hopkins University Provost's Undergraduate Research Award. Dr. Kudchadkar was supported by the Johns Hopkins Clinical and Translational Science Awards Award Number 5KL2RR025006 from the National Center for Advancing Translational Sciences of the National Institutes of Health and the Johns Hopkins Bloomberg School of Public Health Sommer Scholars Program. Dr. Eakin's institution received funding from the National Heart Lung and Blood Institute (NHLBI). Dr. Balas's institution received funding from NHLBI 1 R01 HL146781-01, American Association of Critical Care Nurses Research Grant, and she received funding from the Society of Critical Care Medicine and H3C. Dr. Needham's institution received funding from Baxter Pharma and Reck Medical Devices, and he received funding from Haisco USA. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: <a href="mailto:sapna@jhmi.edu">sapna@jhmi.edu</a> ©2020The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://journals.lww.com/pccmjournal/Fulltext/9000/Respiratory_Variation_in_Aortic_Blood_Flow.97886.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Respiratory Variation in Aortic Blood Flow Velocity in Hemodynamically Unstable, Ventilated Neonates: A Pilot Study of Fluid Responsiveness</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/pccmjournal/Fulltext/9000/Respiratory_Variation_in_Aortic_Blood_Flow.97886.aspx"></a>Objectives: To assess whether respiratory variation in aortic blood flow peak velocity can predict preload responsiveness in mechanically ventilated and hemodynamically unstable neonates. Design: Prospective observational diagnostic accuracy study. Setting: Third-level neonatal ICU. Patients: Hemodynamically unstable neonates under mechanical ventilation. Interventions: Fluid challenge with 10 mL/kg of normal saline over 20 minutes. Measurements and Main Results: Respiratory variation in aortic blood flow peak velocity and superior vena cava flow were measured at baseline (T0), immediately upon completion of the fluid infusion (T1), and at 1 hour after fluid administration (T2). Our main outcome was preload responsiveness which was defined as an increase in superior vena cava flow of at least 10% from T0 to T1. Forty-six infants with a median (interquartile range) gestational age of 30.5 weeks (28–36 wk) were included. Twenty-nine infants (63%) were fluid responders, and 17 (37%) were nonresponders Fluid responders had a higher baseline (T0) respiratory variation in aortic blood flow peak velocity than nonresponders (9% [8.2–10.8] vs 5.5% [3.7–6.6]; p < 0.001). Baseline respiratory variation in aortic blood flow peak velocity was correlated with the increase in superior vena cava flow from T0 to T1 (rho = 0.841; p < 0.001). The area under the receiver operating characteristic curve of respiratory variation in aortic blood flow peak velocity to predict preload responsiveness was 0.912 (95% CI, 0.82–1). A respiratory variation in aortic blood flow peak velocity cut-off point of 7.8% provided a 90% sensitivity (95% CI, 71–97), 88% specificity (95% CI, 62–98), 7.6 positive likelihood ratio (95% CI, 2–28), and 0.11 negative likelihood ratio (95% CI, 0.03–0.34) to predict preload responsiveness. Conclusions: Respiratory variation in aortic blood flow velocity may be useful to predict the immediate response to a fluid challenge in hemodynamically unstable neonates under mechanical ventilation. If our results are confirmed, this measurement could be used to guide safe and individualized fluid resuscitation in critically ill neonates. Dr. Oulego-Erroz, guarantor, takes full responsibility of the content of the article, including data and analysis, and he conceived and designed the study, analyzed data, and drafted the article. Dr. Terroba-Seara acquired and analyzed data and critically reviewed the article. Dr. Alonso-Quintela conceived the study, acquired data, and critically reviewed the article. Dr. Rodríguez-Núñez conceived and designed the study and critically reviewed the article. All authors gave their approval for the final version of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (<a href="http://journals.lww.com/pccmjournal">http://journals.lww.com/pccmjournal</a>). The authors have disclosed that they do not have any potential conflicts of interest. Address requests for reprints to: Ignacio Oulego-Erroz, Complejo Asistencial Universitario de León, Altos de Nava s/n 24002, León, Spain. E-mail: <a href="mailto:ignacio.oulego@gmail.com">ignacio.oulego@gmail.com</a>. ©2020The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://journals.lww.com/pccmjournal/Fulltext/9000/Spillover_of_Early_Extubation_Practices_From_the.97887.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Spillover of Early Extubation Practices From the Pediatric Heart Network Collaborative Learning Study</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/pccmjournal/Fulltext/9000/Spillover_of_Early_Extubation_Practices_From_the.97887.aspx"></a>Objectives: The Pediatric Heart Network Collaborative Learning Study used collaborative learning strategies to implement a clinical practice guideline that increased rates of early extubation after infant repair of tetralogy of Fallot and coarctation of the aorta. We assessed early extubation rates for infants undergoing cardiac surgeries not targeted by the clinical practice guideline to determine whether changes in extubation practices spilled over to care of other infants. Design: Observational analyses of site's local Society of Thoracic Surgeons Congenital Heart Surgery Database and Pediatric Cardiac Critical Care Consortium Registry. Setting: Four Pediatric Heart Network Collaborative Learning Study active-site hospitals. Patients: Infants undergoing ventricular septal defect repair, atrioventricular septal defect repair, or superior cavopulmonary anastomosis (lower complexity), and arterial switch operation or isolated aortopulmonary shunt (higher complexity). Interventions: None. Measurements and Main Results: Aggregate outcomes were compared between the 12 month pre-clinical practice guideline and 12 months after study completion (Follow Up). In infants undergoing lower complexity surgeries, early extubation increased during Follow Up compared with Pre-Clinical Practice Guideline (30.2% vs 18.8%, p = 0.006), and hours to initial postoperative extubation decreased. We observed variation in these outcomes by surgery type, with only ventricular septal defect repair associated with a significant increase in early extubation during Follow Up compared with Pre-Clinical Practice Guideline (47% vs 26%, p = 0.006). Variation by study site was also seen, with only one hospital showing an increase in early extubation. In patients undergoing higher complexity surgeries, there was no difference in early extubation or hours to initial extubation between the study eras. Conclusions: We observed spillover of extubation practices promoted by the Collaborative Learning Study clinical practice guideline to lower complexity operations not included in the original study that was sustainable 1 year after study completion, though this effect differed across sites and operation subtypes. No changes in postoperative extubation outcomes following higher complexity surgeries were seen. The significant variation in outcomes by site suggests that center-specific factors may have influenced spillover of clinical practice guideline practices. Supported, in part, by funding from the National Heart, Lung, and Blood Institute, NIH5U10HL109781 and K08HL116639 (principal investigator Gailes). The Pediatric Cardiac Critical Care Consortium Data Coordinating Center receives funding from the University of Michigan Congenital Heart Center, CHAMPS for Mott, and the Michigan Institute for Clinical & Health Research (National Institutes of Health/National Center for Advancing Translational Sciences UL1TR002240), all University of Michigan, Ann Arbor, MI. Dr. Witte's institution received funding from the Pediatric Heart Network/National Heart, Lung, and Blood Institute. Drs. Witte, Mahle, Pasquali, and Gaies received support for article research from the National Institutes of Health (NIH). Dr. Pasquali's institution received funding from the NIH. Dr. Zhang disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: <a href="mailto:madolin.witte@hsc.utah.edu">madolin.witte@hsc.utah.edu</a> ©2020The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://journals.lww.com/pccmjournal/Fulltext/9000/Brain_Death_Evaluation_in_Children_With_Suspected.97888.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Brain Death Evaluation in Children With Suspected or Confirmed Coronavirus Disease 2019</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/pccmjournal/Fulltext/9000/Brain_Death_Evaluation_in_Children_With_Suspected.97888.aspx"></a>Objectives: To discuss the challenges of conducting a death by neurologic criteria or brain death evaluation in the coronavirus disease 2019 era and provide guidance to mitigate viral transmission risk and maintain patient safety during testing. Design: Not applicable. Setting: Not applicable. Patients: Children with suspected or confirmed coronavirus disease 2019 who suffer catastrophic brain injury due to one of numerous neurologic complications or from an unrelated process and require evaluation for death by neurologic criteria. Interventions: Not applicable. Measurements and Main Results: There is a risk to healthcare providers from aerosol generation during the neurologic examination and apnea test for determination of death by neurologic criteria. In this technical note, we provide guidance to mitigate transmission risk and maintain patient safety during each step of the death by neurologic criteria evaluation. Clinicians should put on appropriate personal protective equipment before performing the death by neurologic criteria evaluation. Risk of aerosol generation and viral transmission during the apnea test can be mitigated by using continuous positive airway pressure delivered via the ventilator as a means of apneic oxygenation. Physicians should assess the risk of transporting coronavirus disease 2019 patients to the nuclear medicine suite to perform a radionucleotide cerebral blood flow study, as disconnections to and from the ventilator for transport and inadvertent ventilator disconnections during transport can increase transmission risk. Conclusions: When conducting the neurologic examination and apnea test required for death by neurologic criteria determination in patients with suspected or confirmed coronavirus disease 2019, appropriate modifications are needed to mitigate the risk of viral transmission and ensure patient safety. The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: <a href="mailto:kirschenm@chop.edu">kirschenm@chop.edu</a> ©2020The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://journals.lww.com/pccmjournal/Fulltext/9000/Echocardiographic_Parameters_and_Mortality_in.97889.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Echocardiographic Parameters and Mortality in Pediatric Sepsis: A Systematic Review and Meta-Analysis</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/pccmjournal/Fulltext/9000/Echocardiographic_Parameters_and_Mortality_in.97889.aspx"></a>Objective: We conducted a systematic review and meta-analysis to investigate the prognostic value of echocardiographic parameters in pediatric septic patients. Data Sources: MEDLINE, PubMed, and EMBASE (last update April 5, 2020). Study Selection: Observational studies of pediatric sepsis providing echocardiographic parameters in relation to mortality. Data Extraction: Echocardiography data were categorized as those describing left ventricular systolic or diastolic function, right ventricular function, and strain echocardiography parameters. Data from neonates and children were considered separately. Analysis is reported as standardized mean difference and 95% CI. Data Synthesis: We included data from 14 articles (n = 5 neonates, n = 9 children). The fractional shortening was the most commonly reported variable (11 studies, n = 555 patients) and we did not identify an association with mortality (standardized mean difference 0.22, 95% CI [–0.02 to 0.47]; p = 0.07, I2 = 28%). In addition, we did not find any association with mortality also for left ventricular ejection fraction (nine studies, n = 417; standardized mean difference 0.06, 95% CI [–0.27 to 0.40]; p = 0.72, I2 = 51%), peak velocity of systolic mitral annular motion determined by tissue Doppler imaging wave (four studies, n = 178; standardized mean difference –0.01, 95% CI [–0.34 to 0.33]; p = 0.97, I2 = 0%), and myocardial performance index (five studies, n = 219; standardized mean difference –0.51, 95% CI [–1.10 to 0.08]; p = 0.09, I2 = 63%). However, in regard to left ventricular diastolic function, there was an association with mortality for higher early wave of transmitral flow/peak velocity of early diastolic mitral annular motion determined by tissue Doppler imaging ratio (four studies, n = 189, standardized mean difference –0.45, 95% CI [–0.80 to –0.10]; p = 0.01, I2 = 0%) or lower peak velocity of early diastolic mitral annular motion determined by tissue Doppler imaging wave (three studies, n = 159; standardized mean difference 0.49, 95% CI [0.13–0.85]; p = 0.008, I2 = 0%). We did not find any association with mortality for early wave of transmitral flow/late (atrial) wave of trans-mitral flow ratio (six studies, n = 273; standardized mean difference 0.28, 95% CI [–0.42 to 0.99]; p = 0.43, I2 = 81%) and peak velocity of systolic mitral annular motion determined by tissue Doppler imaging wave measured at the tricuspid annulus (three studies, n = 148; standardized mean difference –0.18, 95% CI [–0.53 to 0.17]; p = 0.32, I2 = 0%). Only a few studies were conducted with strain echocardiography. Conclusions: This meta-analysis of echocardiography parameters in pediatric sepsis failed to find any association between the measures of left ventricular systolic or right ventricular function and mortality. However, mortality was associated with higher early wave of transmitral flow/peak velocity of early diastolic mitral annular motion determined by tissue Doppler imaging or lower peak velocity of early diastolic mitral annular motion determined by tissue Doppler imaging, indicating possible importance of left ventricular diastolic dysfunction. These are preliminary findings because of high clinical heterogeneity in the studies to date. Drs. La Rosa and Grasso contributed equally. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (<a href="http://journals.lww.com/pccmjournal">http://journals.lww.com/pccmjournal</a>). The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: <a href="mailto:filipposanfi@yahoo.it">filipposanfi@yahoo.it</a> ©2020The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://journals.lww.com/pccmjournal/Fulltext/9000/Intracranial_and_Cerebral_Perfusion_Pressure.97890.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Intracranial and Cerebral Perfusion Pressure Thresholds Associated With Inhospital Mortality Across Pediatric Neurocritical Care</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/pccmjournal/Fulltext/9000/Intracranial_and_Cerebral_Perfusion_Pressure.97890.aspx"></a>Objectives: Targets for treatment of raised intracranial pressure or decreased cerebral perfusion pressure in pediatric neurocritical care are not well defined. Current pediatric guidelines, based on traumatic brain injury, suggest an intracranial pressure target of less than 20 mm Hg and cerebral perfusion pressure minimum of 40–50 mm Hg, with possible age dependence of cerebral perfusion pressure . We sought to define intracranial pressure and cerebral perfusion pressure thresholds associated with inhospital mortality across a large single-center pediatric neurocritical care cohort. Design: Retrospective chart review. Setting: PICU, single quaternary-care center. Patients: Individuals receiving intracranial pressure monitoring from January 2012 to December 2016. Interventions: None. Measurements and Main Results: Intracranial pressure and cerebral perfusion pressure measurements from 262 neurocritical care patients (87 traumatic brain injury and 175 nontraumatic brain injury; 63% male; 8.3 ± 5.8 yr; mortality 11.1%). Mean intracranial pressure and cerebral perfusion pressure had area under the receiver operating characteristic curves of 0.75 and 0.64, respectively, for association of inhospital mortality. Cerebral perfusion pressure cut points increased with age (< 2 yr = 47, 2 to < 8 yr = 58 mm Hg, ≥ 8 yr = 73 mm Hg). In the traumatic brain injury subset, mean intracranial pressure and cerebral perfusion pressure had area under the receiver operating characteristic curves of 0.70 and 0.78, respectively, for association of inhospital mortality. Traumatic brain injury cerebral perfusion pressure cut points increased with age (< 2 yr = 45, 2 to < 8 yr = 57, ≥ 8 yr = 68 mm Hg). Mean intracranial pressure greater than 15 mm Hg, male sex, and traumatic brain injury status were independently associated with inhospital mortality (odds ratio, 14.23 [5.55–36.46], 2.77 [1.04–7.39], and 2.57 [1.03–6.38], respectively; all p < 0.05). Mean cerebral perfusion pressure less than 67 mm Hg and traumatic brain injury status were independently associated with inhospital mortality (odds ratio, 5.16 [2.05–12.98] and 3.71 [1.55–8.91], respectively; both p < 0.01). In the nontraumatic brain injury subset, mean intracranial pressure had an area under the receiver operating characteristic curve 0.77 with an intracranial pressure cut point of 15 mm Hg, whereas mean cerebral perfusion pressure was not predictive of inhospital mortality. Conclusions: We identified mean intracranial pressure thresholds, utilizing receiver operating characteristic and regression analyses, associated with inhospital mortality that is below current guidelines-based treatment targets in both traumatic brain injury and nontraumatic brain injury patients, and age-dependent cerebral perfusion pressure thresholds associated with inhospital mortality that were above current guidelines-based targets in traumatic brain injury patients. Further study is warranted to identify data-driven intracranial pressure and cerebral perfusion pressure targets in children undergoing intracranial pressure monitoring, whether for traumatic brain injury or other indications. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (<a href="http://journals.lww.com/pccmjournal">http://journals.lww.com/pccmjournal</a>). Supported, in part, by K23 NS104133 (to Dr. Au), 1K23 HD099331-01A1 (to Dr. Horvat), T32 HD040686 (to Dr. Rakkar), R21 NS115174 (to Dr. Clark), The Children's Trust Fund (to Drs. Horvat and Simon), and the UPMC Children's Hospital of Pittsburgh Scientific Program. Drs. Clark and Au are funded by the National Institute of Neurological Disorders and Stroke. Drs. Horvat and Rakkar are funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The work was performed at the UPMC Children's Hospital of Pittsburgh. For information regarding this article, E-mail: <a href="mailto:auak@upmc.edu">auak@upmc.edu</a> ©2020The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://journals.lww.com/pccmjournal/Fulltext/9000/Influence_of_Cardiopulmonary_Resuscitation.97891.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Influence of Cardiopulmonary Resuscitation Coaching on Interruptions in Chest Compressions During Simulated Pediatric Cardiac Arrest</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/pccmjournal/Fulltext/9000/Influence_of_Cardiopulmonary_Resuscitation.97891.aspx"></a>Objectives: To determine the impact of a cardiopulmonary resuscitation coach on the frequency and duration of pauses during simulated pediatric cardiac arrest. Design: This is a secondary analysis of video data collected from a prospective multicenter trial. Forty simulated pediatric cardiac arrest scenarios (20 noncoach and 20 coach teams), each lasting 18 minutes in duration, were reviewed by three clinical experts to document events surrounding each pause in chest compressions. Setting: Four pediatric academic medical centers from Canada and the United States. Subjects: Two-hundred healthcare providers in five-member interprofessional resuscitation teams that included either a cardiopulmonary resuscitation coach or a noncoach clinical provider. Interventions: Teams were randomized to include either a trained cardiopulmonary resuscitation coach or an additional noncoach clinical provider. Measurements and Main Results: The frequency, duration, and associated factors with each interruption in chest compressions were recorded and compared between the groups with and without a cardiopulmonary resuscitation coach, using t tests, Wilcoxon rank-sum tests, or chi-squared tests, depending on the distribution and types of outcome variables. Mixed-effect linear models were used to explore the effect of cardiopulmonary resuscitation coaching on pause durations, accounting for multiple measures of pause duration within teams. A total of 655 pauses were identified (noncoach n = 304 and coach n = 351). Cardiopulmonary resuscitation-coached teams had decreased total mean pause duration (98.6 vs 120.85 s, p = 0.04), decreased intubation pause duration (median 4.0 vs 15.5 s, p = 0.002), and similar mean frequency of pauses (17.6 vs 15.2, p = 0.33) when compared with noncoach teams. Teams with cardiopulmonary resuscitation coaches are more likely to verbalize the need for pause (86.5% vs 73.7%, p < 0.001) and coordinate change of the compressors, rhythm check, and pulse check (31.7% vs 23.2%, p = 0.05). Teams with cardiopulmonary resuscitation coach have a shorter pause duration than non-coach teams, adjusting for number and types of tasks performed during the pause. Conclusions: When compared with teams without a cardiopulmonary resuscitation coach, the inclusion of a trained cardiopulmonary resuscitation coach leads to improved verbalization before pauses, decreased pause duration, shorter pauses during intubation, and better coordination of key tasks during chest compression pauses. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http:<a href="http://journals.lww.com/pccmjournal">journals.lww.com/pccmjournal</a>). Drs. Kessler and Cheng conceptualized and designed the study. Dr. Kessler, Dr. Grabinski, Dr. Shepard, Ms. Jones, and Dr. Cheng designed the data collection instruments. Dr. Grabinski, Dr. Shepard, and Ms. Jones reviewed videos and coordinated data collection. Drs. Kessler and Lin contributed to the statistical analysis and the interpretation of data. Dr. Kessler takes overall responsibility for the article. All authors contributed to the drafting and meaningful review of the article and approved the final article as submitted. Ms. Nye, Ms. Gaither, Dr. Hunt, Ms. Davidson, and Ms. Chatfield (International Network for Simulation-based Pediatric Innovation, Research, and Education Cardiopulmonary Resuscitation Group byline authors) contributed to the conceptualization and design of the study, coordinated and supervised data collection at one site, and approved the final article as submitted. Findings from this study were presented in poster format at the International Pediatric Simulation Society annual meeting in Toronto on May 20, 2019. Dr. Cheng reports that the parent study for this project was funded through a research grant from the Heart and Stroke Foundation of Alberta, Alberta Health Services, and the University of Calgary. He also reports additional research infrastructure support provided by the Alberta Children's Research Institute, the Alberta Children's Hospital Foundation, and the Department of Pediatrics, Cumming School of Medicine, University of Calgary, to support investigator initiated research conducted in concert with the Kid Simulation Research Program, Alberta Children's Hospital. Dr. Hunt was responsible for the initial description of the cardiopulmonary resuscitation (CPR) coach. She reports funding from International Network for Simulation-Based Innovation, Research, & Education to investigate further the impact of the CPR Coach on compliance with CPR guidelines. She also reports that unrelated to this study she and her research partners do have nonexclusive agreement with Zoll Medical Corporation licensing educational technology on which they hold patents with the potential for revenue. She has also received reimbursement for travel expenses and honoraria for speaking about the CPR Coach role she created. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: <a href="mailto:dk2592@cumc.columbia.edu">dk2592@cumc.columbia.edu</a> ©2020The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://journals.lww.com/pccmjournal/Fulltext/9000/Use_of_Honey_Versus_Standard_Care_for.97892.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Use of Honey Versus Standard Care for Hospital-Acquired Pressure Injury in Critically Ill Children: A Multicenter Randomized Controlled Trial</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/pccmjournal/Fulltext/9000/Use_of_Honey_Versus_Standard_Care_for.97892.aspx"></a>Objectives: To examine if the use of honey (medicated) for dressing is superior to standard care in terms of time to complete wound healing in stages 1–3 of pressure injuries in children admitted to the PICU. Design: Multicenter, open-label, parallel-group, randomized trial. Setting: Tertiary-care PICU from August 2017 to January 2019. Patients: Critically ill children, 2 months to 17 years old, who developed pressure injury (stages 1–3) were included; those on more than two inotropes or with signs of acute wound infection or wounds with greater than 5 cm diameter or known allergy to honey were excluded. Interventions: Children were randomized to receive either medicated honey dressing or standard (routine) wound care for the management of their pressure injury. Measurements and Main Results: The primary outcome was the time to complete wound healing. Manuka or active Leptospermum honey dressing/gel was used in the intervention group. Enrolled children were followed up until death or discharge from the hospital. A total of 99 children were enrolled: 51 in the intervention group and 48 in the standard care group. Baseline characteristics, including the nutritional status, were comparable between the groups. The most common sites of injury were bony prominences at face mask contact points. The median time to complete healing was 7 days (95% CI, 6–7 d) versus 9 days (7–10 d) in the intervention and standard care groups, respectively (p = 0.002; log-rank test). At any random time, children in the intervention group were about 1.9-fold more likely to have their pressure injury completely healed than those in the standard care group (hazard ratio 1.86; 95% CI, 1.21–2.87). There were no allergic reactions or secondary wound infections in the intervention group. Conclusions: The use of medicated honey dressings decreased the time to wound healing in critically ill children with pressure injuries. There were no allergic reactions or secondary bacterial infections in any of these children. ClinicalTrials.gov ID: NCT03391310 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (<a href="http://journals.lww.com/pccmjournal">http://journals.lww.com/pccmjournal</a>). Supported, in part, by HARD Manufacturing-WFPICCS Pediatric Critical Care Research Grant'-10000 USD. Drs. Sankar's, AV's, Rameshkumar's, Mahadevan's, and Kabra's institutions received funding from WFPICCS HARD Manufacturing Pediatric Critical Care Research Grant. Dr. Sankar's institution also received funding from the Department of Science and Technology and the Indian Council of Medical Research. Dr. Lodha disclosed off-label product use of medicated honey dressings for pressure ulcers in critically ill children For information regarding this article, E-mail: <a href="mailto:jhumaji@gmail.com">jhumaji@gmail.com</a> ©2020The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies</span><br><br></td></tr></tbody></table><div><div dir="ltr" class="gmail_signature" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-38572546556180898502020-12-22T23:05:00.000-08:002020-12-22T23:06:13.359-08:00Clinical Nuclear Medicine<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://journals.lww.com/nuclearmed/Fulltext/9000/Solitary_Vulvar_Involvement_of_Ovarian_Non_Hodgkin.96262.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Solitary Vulvar Involvement of Ovarian Non-Hodgkin Lymphoma Mimicking Bartholin's Abscess on 18F-FDG PET/CT</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/nuclearmed/Fulltext/9000/Solitary_Vulvar_Involvement_of_Ovarian_Non_Hodgkin.96262.aspx"></a>A 49-year-old woman was diagnosed with diffuse large B-cell lymphoma of the left ovary. Two months after the hysterectomy and bilateral salpingo-oophorectomy operation, the patient was referred to 18F-FDG PET/CT for staging. A mass lesion measuring 2.8 × 3 cm with intense 18F-FDG uptake was observed at right labium majus, which could be considered as a Bartholin's cyst or abscess. The lesion was excised, and non-Hodgkin lymphoma involvement of vulva was revealed by histopathology. Received for publication October 2, 2020; revision accepted November 15, 2020. Conflicts of interest and sources of funding: none declared. Correspondence to: Nurhan Ergül, MD, Clinic of Nuclear Medicine, Istanbul Training and Research Hospital, Kasap İlyas Mah. Org. Abdurrahman Nafiz Gürman Cd. 34098 Fatih, Istanbul, Turkey. E-mail: <a href="mailto:nurhanergul@yahoo.com">nurhanergul@yahoo.com</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://journals.lww.com/nuclearmed/Fulltext/9000/Prospective_Correlation_of_Prognostic.96263.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Prospective Correlation of Prognostic Immunohistochemical Markers With SUV and ADC Derived From Dedicated Hybrid Breast 18F-FDG PET/MRI in Women With Newly Diagnosed Breast Cancer</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/nuclearmed/Fulltext/9000/Prospective_Correlation_of_Prognostic.96263.aspx"></a>Purpose The aim of this study was to correlate prognostically relevant immunohistochemical parameters of breast cancer with simultaneously acquired SUVs and apparent diffusion coefficient (ADC) values derived from hybrid breast PET/MRI. Patients and Methods Fifty-six women with newly diagnosed, therapy-naive, histologically proven breast cancer (mean age, 54.1 ± 12.0 years) underwent dedicated prone 18F-FDG breast PET/MRI. Diffusion-weighted imaging (b-values: 0, 500, 1000 s/mm2) was performed simultaneously with the PET acquisition. A region of interest encompassing the entire primary tumor on each patient's PET/MRI scan was used to determine the glucose metabolism represented by maximum and mean SUV as well as into corresponding ADC maps to assess tumor cellularity represented by mean and minimum ADC values. Histopathological tumor grading and prognostically relevant immunohistochemical markers, that is, Ki67, progesterone receptor, estrogen receptor, and human epidermal growth factor receptor 2 (HER2), were assessed. Pearson correlation coefficients were calculated to compare SUV and ADC values as well as the immunohistochemically markers and molecular subtype. For the comparison with the tumor grading, a Wilcoxon test was used. Results A significant inverse correlation between SUV and ADC values derived from breast PET/MRI (r = −0.49 for SUVmean vs ADCmean; r = −0.43 for SUVmax vs ADCmin; both P's < 0.001) was found. Tumor grading and Ki67 both showed a positive correlation with SUVmean from breast PET/MRI (r = 0.37 and r = 0.32, P < 0.01). For immunohistochemical markers, HER2 showed an inverse correlation with ADC values from breast PET/MRI (r = −0.35, P < 0.01). Molecular subtypes significantly correlate with SUVmax and SUVmean (r = 0.52 and r = 0.42, both P's < 0.05). In addition, estrogen receptor expression showed an inverse correlation with SUVmax and SUVmean from breast PET/MRI (r = −0.45 and r = −0.42, P < 0.001). Conclusions The present data show a correlation between increased glucose metabolism, cellularity, tumor grading, estrogen and HER2 expression, as well as molecular subtype of breast cancer primaries. Hence, simultaneous 18F-FDG PET and diffusion-weighted imaging from hybrid breast PET/MRI may serve as a predictive tool for identifying high-risk breast cancer patients in initial staging and guide-targeted therapy. Received for publication August 23, 2020; revision accepted November 12, 2020. J.M. and J.K. contributed equally to this study. Conflicts of interest and sources of funding: The authors declare no conflict of interest. The study is funded by Deutsche Forschungsgemeinschaft, a German research foundation (BU3075/2-1). The funding foundation was not involved in the trial design, patient recruitment, data collection, analysis, interpretation or presentation, writing or editing of the reports, or the decision to submit for publication. The corresponding author had full access to all data in the study and had all the responsibility for the decision to submit for publication. Ethical approval: All procedures performed were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments. Informed consent: Informed consent was obtained from all individual participants included in the study. Correspondence to: Julian Kirchner, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany. E-mail: <a href="mailto:Julian.Kirchner@med.uni-duesseldorf.de">Julian.Kirchner@med.uni-duesseldorf.de</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://journals.lww.com/nuclearmed/Fulltext/9000/Intense_Diffuse_Uptake_of_68Ga_FAPI_04_in_the.96264.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Intense Diffuse Uptake of 68Ga-FAPI-04 in the Breasts Found by PET/CT in a Patient With Advanced Nasopharyngeal Carcinoma</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/nuclearmed/Fulltext/9000/Intense_Diffuse_Uptake_of_68Ga_FAPI_04_in_the.96264.aspx"></a>The physiological uptake of 68Ga-FAPI-04 due to the change of the internal environment is little known. We report the case of a 45-year-old woman who was highly suspected to have advanced nasopharyngeal carcinoma. 18F-FDG and 68Ga-FAPI-04 PET/CT was performed for evaluating the disease. Both PET and CT with different tracers detected the primary nasopharyngeal carcinoma and metastases in right neck lymph nodes, liver, and bones. To our surprise, intense diffuse uptake of 68Ga-FAPI-04 was found in both breasts, which might be due to the hormone stimulation because the patient received 68Ga-FAPi-04 PET/CT just at the period of ovulation. Received for publication October 6, 2020; revision accepted November 12, 2020. Conflicts of interest and sources of funding: none declared. Correspondence to: Hu-bing Wu, MD, PET Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangdong 510515, China. E-mail: <a href="mailto:wuhbym@163.com">wuhbym@163.com</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://journals.lww.com/nuclearmed/Fulltext/9000/Fibroblast_Activation_Protein_Inhibitor_PET_CT__A.96265.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Fibroblast Activation Protein Inhibitor PET/CT: A Promising Molecular Imaging Tool</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/nuclearmed/Fulltext/9000/Fibroblast_Activation_Protein_Inhibitor_PET_CT__A.96265.aspx"></a>Purpose Fibroblast activation protein (FAP) is a cell membrane–bound serine peptidase, overexpressed in cancer-associated fibroblasts and activated fibroblasts at wound healing/inflammatory sites. Recently, molecular PET/CT imaging with radiolabeled FAP inhibitor (FAPI) has been evaluated in different diseases. We aimed to assess its potential role based on the available literature. Patients and Methods We conducted a comprehensive review of the available preclinical and clinical data on FAPI PET/CT in an attempt to summarize its current status and potential future role. Based on that, we have discussed the pathophysiology behind FAP-based imaging, followed by a discussion of FAPI radiopharmaceuticals including their synthesis, biodistribution, and dosimetry. Next, we have discussed studies evaluating FAPI PET/CT in different oncological and nononcological pathologies. The potential of FAPI PET/CT in theranostics has also been addressed. Results Based on the early scientific evidence available, including preclinical and clinical studies, FAPI PET/CT seems to be a promising molecular imaging tool, especially in oncology. It can be used for imaging different types of cancers and outperforms 18F-FDG PET/CT in some of these. Its potential as a theranostic tool warrants special attention. Conclusions Fibroblast activation protein inhibitor PET/CT has the potential to emerge as a powerful molecular imaging tool in the future. However, as of yet, the available evidence is limited, warranting further research and trials in this field. Received for publication September 8, 2020; revision accepted November 12, 2020. Conflicts of interest and sources of funding: none declared. Correspondence to: Punit Sharma, MD, FEBNM, FANMB, Department of Nuclear Medicine and PET/CT, Apollo Gleneagles Hospital, 58, Canal Circular Rd, Kolkata 700054, India. E-mail: <a href="mailto:dr_punitsharma@yahoo.com">dr_punitsharma@yahoo.com</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://journals.lww.com/nuclearmed/Fulltext/9000/68Ga_FAPI_PET_CT_Versus_68Ga_DOTATATE_PET_CT_in.96266.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">68Ga-FAPI PET/CT Versus 68Ga-DOTATATE PET/CT in the Evaluation of a Patient With Neuroendocrine Tumor</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/nuclearmed/Fulltext/9000/68Ga_FAPI_PET_CT_Versus_68Ga_DOTATATE_PET_CT_in.96266.aspx"></a>68Ga-FAPI (fibroblast activation protein-specific inhibitor) PET/CT was performed in a 56-year-old man with multiple liver masses, which were confirmed grade 2 well-differentiated neuroendocrine tumors with liver Tru-Cut biopsy. With 68Ga-DOTATE PET/CT, primary tumor in the pancreas, multiple metastases in the liver and metastatic portocaval lymph node were detected. In 68Ga-FAPI PET/CT imaging performed for comparison, it was seen that metastatic lesions in the liver were distinguished much better because of low background activity, and the primary tumor and metastatic lymph node were clearly selected. This case suggested that FAPI-bounded radionuclides may be useful in the evaluation and targeted therapy of neuroendocrine tumors. Received for publication September 25, 2020; revision accepted November 12, 2020. Conflicts of interest and sources of funding: none declared. Correspondence to: Cihan Gündoğan, MD, Department of Nuclear Medicine, Gazi Yaşargil Training and Research Hospital, University of Health Sciences, Üçkuyular mevki, 21070, Kayapınar, Diyarbakır, Turkey. E-mail: <a href="mailto:cihangd@hotmail.com">cihangd@hotmail.com</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://journals.lww.com/nuclearmed/Fulltext/9000/Inferior_Vena_Cava_Tumor_Thrombus_From_Thyroid.96267.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Inferior Vena Cava Tumor Thrombus From Thyroid Cancer Detected by 68Ga-PSMA-617 PET/CT</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/nuclearmed/Fulltext/9000/Inferior_Vena_Cava_Tumor_Thrombus_From_Thyroid.96267.aspx"></a>A 61-year-old woman was diagnosed with progressive metastatic radioactive iodine refractory differentiated thyroid cancer and underwent multitargeted tyrosine kinase inhibitor (TKI) Donafenib therapy. After 12 months of therapy, she developed resistance to TKI. Considering the limited treatment options available, a 68Ga–prostate-specific membrane antigen (PSMA)–617 PET/CT was conducted for potential therapeutic target. 68Ga-PSMA-617 PET/CT showed an intense radiotracer uptake in inferior vena cava, which was subsequently confirmed as tumor thrombus. Thus, this patient is a rare case in which the tumor thrombus from thyroid cancer was discovered in inferior vena cava via 68Ga-PSMA-617 PET/CT. Received for publication October 28, 2020; revision accepted November 13, 2020. Conflicts of interest and sources of funding: This work was supported by the National Natural Science Foundation of China (no. 81771875). None declared to all authors. Correspondence to: Zhi Yang, PhD, Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 52 Fucheng Rd, Haidian District, Beijing100142, China. E-mail: <a href="mailto:pekyz@163.com">pekyz@163.com</a>; and Yansong Lin, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing St, Dongcheng District, Beijing 100730, China. E-mail: <a href="mailto:linyansong1968@163.com">linyansong1968@163.com</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://journals.lww.com/nuclearmed/Fulltext/9000/FDG_PET_CT_of_Benign_Psammomatous_Meningioma.96268.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">FDG PET/CT of Benign Psammomatous Meningioma Effacing the Medulla</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/nuclearmed/Fulltext/9000/FDG_PET_CT_of_Benign_Psammomatous_Meningioma.96268.aspx"></a>A 62-year-old woman had progressively developing throbbing right neck pain for 1 year. The pain radiated to the right suboccipital area, sometimes accompanied by breathlessness. To rule out cancer, patient received FDG PET/CT, which showed an intraspinal cord intense FDG-avid calcified mass at the level of the first cervical spine, mimicking malignancy. MRI showed it effacing the medulla; surgery is probably a challenge. She received laminectomy with tumor removal; pathology showed psammomatous meningioma, World Health Organization grade I. This case suggests that benign spinal cord psammomatous meningioma with calcification may show high FDG uptake, mimicking malignancy. Received for publication September 23, 2020; revision accepted November 5, 2020. Conflicts of interest and sources of funding: none declared. Correspondence to: Yuh-Feng Wang, MD, PhD, Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd, Dalin Township, Chiayi 622, Taiwan, Republic of China. E-mail: <a href="mailto:yuhfeng@gmail.com">yuhfeng@gmail.com</a>. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://journals.lww.com/nuclearmed/Fulltext/9000/Ovarian_Inflammation_Mass_Mimicking_Recurrent.96269.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Ovarian Inflammation Mass Mimicking Recurrent Rectal Cancer 17 Years After Surgery: PET/CT and MRI Findings</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/nuclearmed/Fulltext/9000/Ovarian_Inflammation_Mass_Mimicking_Recurrent.96269.aspx"></a>A 58-year-old woman diagnosed with rectal cancer received surgery and chemotherapy 17 years ago, and since then, she has been tumor-free. However, 1 month ago, she complained of progressive abdominal and pelvic pain. MRI scans revealed a soft-tissue ovarian mass with heterogeneous signals in the right pelvis, showing obvious enhancement after contrast injection. On PET/CT images, the lesion presented with intense FDG accumulation. Above imaging findings raised the possibility of tumor recurrence, and thus exploratory laparotomy was performed. Pathological results confirmed the diagnosis of active inflammation with fibrous tissue hyperplasia. Received for publication October 15, 2020; revision accepted November 1, 2020. Conflicts of interest and sources of funding: This study was supported by the National Natural Science Foundation of China (grants 81471692 and 81901776), project funded by the China Postdoctoral Science Foundation (grant 2019M650245), and Post-Doctor Research Project, West China Hospital, Sichuan University (grant 18HXBH070). None declared to both authors. Correspondence to: Anren Kuang, MD, Department of Nuclear Medicine, Laboratory of Clinical Nuclear Medicine, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China. E-mail: <a href="mailto:kuanganren@263.net">kuanganren@263.net</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://journals.lww.com/nuclearmed/Fulltext/9000/Prognostic_Value_of_Positive_Presurgical_FDG.96270.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Prognostic Value of Positive Presurgical FDG PET/CT in the Evaluation of Tumor-Induced Osteomalacia</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/nuclearmed/Fulltext/9000/Prognostic_Value_of_Positive_Presurgical_FDG.96270.aspx"></a>Objectives Tumor-induced osteomalacia (TIO), a rare paraneoplastic syndrome, is curable by excision or destruction of the causative tumor. However, occasionally, TIO may relapse after surgical intervention. We aimed to investigate the roles of 18F-FDG PET/CT in the prognosis of TIOs. Methods Seventy-six patients who had surgically removed tumors that caused osteomalacia were included in this retrospective investigation. All patients underwent both 18F-FDG and 68Ga-DOTATATE PET/CT prior to surgery. The prognostic value of presurgical FDG PET/CT study was determined with 5-year follow-up. Results In the presurgical evaluation, 68Ga-DOTATATE detected lesions in all 76 patients. However, FDG PET/CT was positive in only 25 among all 76 patients. Following surgical removal of the causative tumor, all 76 patients had symptomatic relief and normalization of the serum phosphate level initially. However, 15 of 76 cases (19.7%) had recurrent hypophosphatemia and became symptomatic again during the follow-up. Among these 15 patients with recurrence, 11 (73.3%) had recurrent lesions at the original location of the resected causative tumors, whereas 4 were in other locations due to malignant nature of the primary tumor. Interestingly, 14 of these 15 patients with recurrent disease had positive presurgical FDG PET/CT findings with an incident ratio of 56.0% (14 of 25). In contrast, only 1 patient with recurrent disease had negative presurgical FDG PET/CT scan with an incident ratio of 1.9% (1 of 51), significantly less than the positive presurgical FDG PET/CT group (P < 0.05). Conclusions A positive presurgical FDG PET/CT suggests increased likelihood for possible recurrence of TIO after surgical resection. In contrast, when a causative tumor detected by 68Ga-DOTATATE PET/CT does not have elevated activity on FDG PET/CT, the chance of recurrence is very small. Received for publication October 26, 2020; revision accepted November 2, 2020. Conflicts of interest and sources of funding: The authors declare that they have no conflict of interest. This report was funded by CAMS Innovation Fund for Medical Sciences (CAMS-2017-I2M-1-001). The requirement for informed consent was waived because this retrospective study used existing patient data and images. Correspondence to: Hongli Jing, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China. E-mail: <a href="mailto:annsmile1976@sina.com">annsmile1976@sina.com</a>; or Fang Li, MD, Department of Nuclear Medicine, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China. E-mail: <a href="mailto:lifang@pumch.cn">lifang@pumch.cn</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://journals.lww.com/nuclearmed/Fulltext/9000/Reduced_Myocardial_Uptake_of_123I_MIBG_in.96271.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Reduced Myocardial Uptake of 123I-MIBG in Congenital Insensitivity to Pain With Anhidrosis</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/nuclearmed/Fulltext/9000/Reduced_Myocardial_Uptake_of_123I_MIBG_in.96271.aspx"></a>A 30-year-old man presented with repeated episodes of painless injuries in his feet and abnormally high body temperature. He was diagnosed with congenital insensitivity to pain with anhidrosis—a rare hereditary peripheral neuropathy characterized by decreased pain, reduced sweating, and autonomic neuropathy. Congenital insensitivity to pain with anhidrosis is also called hereditary sensory and autonomic neuropathy type IV. 123I-MIBG myocardial scintigraphy showed reduced myocardial uptake (heart-to-mediastinum ratio: 1.56 and 1.42 in the early and late phases, respectively; washout ratio, 49%), indicating autonomic dysfunction. This finding may contribute to the diagnosis of congenital insensitivity to pain with anhidrosis and the semiquantitative evaluation of an autonomic dysfunction. Received for publication July 7, 2020; revision accepted October 29, 2020. Conflicts of interest and sources of funding: none declared. Correspondence to: Mihoko Sasahara, MD, Department of Radiology, Tokushima University Graduate School of Biomedical Sciences, 2-50-1 Kuramoto-cho, Tokushima 770-8503, Japan. E-mail: <a href="mailto:k.mihoko.928@gmail.com">k.mihoko.928@gmail.com</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr></tbody></table><div><div dir="ltr" class="gmail_signature" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-45801924747761327232020-12-22T23:04:00.000-08:002020-12-22T23:05:27.432-08:00Investigative Radiology<div dir="ltr"><table style="font-family:arial,sans-serif"><tbody><tr><td><a id="gmail-anchor_0" href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Empiric_Switching_of_Gadolinium_Based_Contrast.98741.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Empiric Switching of Gadolinium-Based Contrast Agents in Patients With History of Previous Immediate Hypersensitivity Reaction to GBCA: A Prospective Single-Center, Single-Arm Efficacy Trial</a><br><span id="gmail-desc_0" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Empiric_Switching_of_Gadolinium_Based_Contrast.98741.aspx"></a>Background Breakthrough hypersensitivity reactions (HRs) to gadolinium-based contrast agent (GBCA) occur in 40% of patients despite corticosteroid premedication. Other strategies to reduce HRs are not well studied. Objective The aim of this study was to prospectively evaluate HR rate to GBCA among patients with history of HR to GBCA, empirically given an alternative GBCA prior to repeat administration. Materials and Methods From September 2019 to September 2020, patients with prior HR to GBCA received 13-hour oral corticosteroid and diphenhydramine premedication prescription with switching of GBCA to gadoterate (previously unavailable at our institution before September 2019). Power analysis (α error, 0.05; β error, 0.80) determined 21 patients were required. Patients were evaluated under a quality assurance waiver from the institutional review board. A radiologist documented the nature of initial HR and inciting GBCA, premedication received, incidence, and severity of breakthrough HR. Results After exclusions, we evaluated 26 patients with mild (92.3% [24/26]) or moderate (7.7% [2/26]) HR to gadobutrol (53.8% [14/26]), gadoxetate (3.8% [1/26]), and gadopentetate (3.8% [1/26]). In 38.5% (10/26), inciting GBCA was unknown but was likely gadobutrol or gadopentetate based on availability. There were 22 females. The mean patient age was 52.1 ± 15.8 years. From 27 gadoterate administrations, 59.3% (16/27) patients received corticosteroid and diphenhydramine premedication, 11.1% (3/27) received only diphenhydramine, and 29.6% (8/27) with no premedication. Hypersensitivity reaction rate after empiric switching to gadoterate was 3.7% (1 mild reaction; 95% confidence interval [CI], 0.09%–18.9%) overall with no difference in patients with (6.3% [1/16]; 95% CI, 0.15%–28.7%) or without (0%; [0/11] upper bound 95% CI, 25.0%) corticosteroid premedication. Conclusions In this prospective single-arm study, empirically switching GBCA to gadoterate in patients with prior HR to GBCA substantially reduced the expected rate of subsequent HRs in patients with and without the use of corticosteroid premedication. Implications for PatientCare Empirically switching GBCAs, with or without the use of corticosteroid premedication, can substantially reduce the rate of hypersensitivity breakthrough reactions. Received for publication September 22, 2020; and accepted for publication, after revision, November 5, 2020. Conflicts of interest and sources of funding: none declared. Correspondence to: Nicola Schieda, MD, FRCPC, Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Room C159, Ottawa, Ontario K1Y 4E9, Canada. E-mail: <a href="mailto:nschieda@toh.ca">nschieda@toh.ca</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_1" href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Steadily_Increasing_Inversion_Time_Improves_Blood.98742.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Steadily Increasing Inversion Time Improves Blood Suppression for Free-Breathing 3D Late Gadolinium Enhancement MRI With Optimized Dark-Blood Contrast</a><br><span id="gmail-desc_1" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Steadily_Increasing_Inversion_Time_Improves_Blood.98742.aspx"></a>Objectives Free-breathing 3-dimensional (3D) late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) techniques with high isotropic resolution and dark-blood contrast may optimize the delineation of myocardial scar patterns. The extended acquisition times required for such scans, however, are paralleled by a declining contrast agent concentration. Consequently, the optimal inversion time (TI) is continuously increasing. We hypothesize that a steadily increasing (dynamic) TI can compensate for this effect and can lead to improved blood nulling to optimize the dark-blood contrast. Materials and Methods Fifty consecutive patients with previous cardiac arrhythmias, scheduled for high-resolution 3D LGE MRI, were prospectively enrolled between October 2017 and February 2020. Free-breathing 3D dark-blood LGE MRI with high isotropic resolution (1.6 × 1.6 × 1.6 mm) was performed using a conventional fixed TI (n = 25) or a dynamic TI (n = 25). The average increase in blood nulling TI per minute was obtained from Look-Locker scans before and after the 3D acquisition in the first fixed TI group. This average increment in TI was used as input to calculate the dynamic increment of the initial blood nulling TI value as set in the second dynamic TI group. Regions of interest were drawn in the left ventricular blood pool to assess mean signal intensity as a measure for blood pool suppression. Overall image quality, observer confidence, and scar demarcation were scored on a 3-point scale. Results Three-dimensional dark-blood LGE data sets were successfully acquired in 46/50 patients (92%). The calculated average TI increase of 2.3 ± 0.5 ms/min obtained in the first fixed TI group was incorporated in the second dynamic TI group and led to a significant decrease of 72% in the mean blood pool signal intensity compared with the fixed TI group (P < 0.001). Overall image quality (P = 0.02), observer confidence (P = 0.02), and scar demarcation (P = 0.01) significantly improved using a dynamic TI. Conclusions A steadily increasing dynamic TI improves blood pool suppression for optimized dark-blood contrast and increases observer confidence in free-breathing 3D dark-blood LGE MRI with high isotropic resolution. Received for publication September 29, 2020; and accepted for publication, after revision, October 25, 2020. Conflicts of interest and sources of funding: R.J.H., S.G., and J.E.W. acknowledge financial support from Stichting de Weijerhorst. R.J.H. was supported by an HS-BAFTA fellowship from the Cardiovascular Research Institute Maastricht (CARIM). J.S. and D.M.H. are employees of Philips Healthcare. J.E.W. receives institutional grants from Agfa Healthcare, Bard Medical, Bayer Healthcare, General Electric, Optimed, Philips Healthcare, and Siemens Healthineers. The other authors have no conflicts of interest to declare. Correspondence to: Robert J. Holtackers, MSc, Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, the Netherlands. E-mail: <a href="mailto:rob.holtackers@mumc.nl">rob.holtackers@mumc.nl</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_2" href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Detection_of_U_87_Tumor_Cells_by.98743.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Detection of U-87 Tumor Cells by RGD-Functionalized/Gd-Containing Giant Unilamellar Vesicles in Magnetization Transfer Contrast Magnetic Resonance Images</a><br><span id="gmail-desc_2" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Detection_of_U_87_Tumor_Cells_by.98743.aspx"></a>Objectives The targeting of tumor cells and their visualization with magnetic resonance imaging (MRI) is an important task in biomedicine. The low sensitivity of this technique is a significant drawback and one that may hamper the detection of the imaging reporters used. To overcome this sensitivity issue, this work explores the synergy between 2 strategies: (1) arginine, glycine, aspartic acid peptide (RGD)-functionalized giant unilamellar vesicles (GUVs) loaded with Gd complexes to accumulate large amounts of MRI contrast agent at the targeting site; and (2) the use of magnetization transfer contrast (MTC), which is a sensitive MRI technique for the detection of Gd complexes in the tumor region. Materials and Methods Giant unilamellar vesicles were prepared using the gentle swelling method, and the cyclic RGD targeting moiety was introduced onto the external membrane. Paramagnetic Gd-containing complexes and the fluorescent probe rhodamine were both part of the vesicle membranes and Gd-complexes were also the payload within the inner aqueous cavity. Giant unilamellar vesicles that were loaded with the imaging reporters, but devoid of the RGD targeting moiety, were used as controls. U-87 MG human glioblastoma cells, which are known to overexpress the targets for RGD moieties, were used. In the in vivo experiments, U-87 MG cells were subcutaneously injected into nu/nu mice, and the generated tumors were imaged using MRI, 15 days after cell administration. Magnetic resonance imaging was carried out at 7 T, and T2W, T1W, and MTC/Z-spectra were acquired. Confocal microscopy images and Inductively Coupled Plasma Mass Spectrometry (ICP-MS) were used for result validation. Results In vitro results show that RGD GUVs specifically bind to U-87 MG cells. Microscopy demonstrates that (1) RGD GUVs were anchored onto the external surface of the tumor cells without any internalization; (2) a low number of GUVs per cell were clustered at specific regions; and (3) there is no evidence for macrophage uptake or cell toxicity. The MRI of cell pellets after incubation with RGD GUVs and untargeted ctrl-GUVs was performed. No difference in T1 signal was detected, whereas a 15% difference in MT contrast is present between the RGD GUV–treated cells and the ctrl-GUV–treated cells. Magnetic resonance imaging scans of tumor-bearing mice were acquired before and after (t = 0, 4 hours and 24 hours) the administration of RGD GUVs and ctrl-GUVs. A roughly 16% MTC difference between the 2 groups was observed after 4 hours. Immunofluorescence analyses and ICP-MS analyses (for Gd-detection) of the explanted tumors confirmed the specific accumulation of RGD GUVs in the tumor region. Conclusions RGD GUVs seem to be interesting carriers that can facilitate the specific accumulation of MRI contrast agents at the tumor region. However, the concentration achieved is still below the threshold needed for T1w-MRI visualization. Conversely, MTC proved to be sufficiently sensitive for the visualization of detectable contrast between pretargeting and posttargeting images. Received for publication June 29, 2020; and accepted for publication, after revision, October 7, 2020. Conflicts of interest and sources of funding: The authors declare no conflicts of interest. Funding was received from the Italian Ministry of Research through FOE contribution to the Euro-BioImaging MultiModal Molecular Imaging Italian Node (<a href="http://www.mmmi.unito.it">www.mmmi.unito.it</a>). Funding was also received from the University of Turin (G.F.). This research was performed in the framework of COST Action AC15209 (EURELAX). Correspondence to: Giuseppe Ferrauto, PhD, Department of Molecular Biotechnology and Health Sciences, Molecular Imaging Center, University of Turin, Via Nizza 52, 10126 Turin, Italy. E-mail: <a href="mailto:giuseppe.ferrauto@unito.it">giuseppe.ferrauto@unito.it</a>. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (<a href="http://www.investigativeradiology.com">www.investigativeradiology.com</a>). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_3" href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Accelerated_Isotropic_Multiparametric_Imaging_by.98744.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Accelerated Isotropic Multiparametric Imaging by High Spatial Resolution 3D-QALAS With Compressed Sensing: A Phantom, Volunteer, and Patient Study</a><br><span id="gmail-desc_3" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Accelerated_Isotropic_Multiparametric_Imaging_by.98744.aspx"></a>Objectives The aims of this study were to develop an accelerated multiparametric magnetic resonance imaging method based on 3D-quantification using an interleaved Look-Locker acquisition sequence with a T2 preparation pulse (3D-QALAS) combined with compressed sensing (CS) and to evaluate the effect of CS on the quantitative mapping, tissue segmentation, and quality of synthetic images. Materials and Methods A magnetic resonance imaging system phantom, containing multiple compartments with standardized T1, T2, and proton density (PD) values; 10 healthy volunteers; and 12 patients with multiple sclerosis were scanned using the 3D-QALAS sequence with and without CS and conventional contrast-weighted imaging. The scan times of 3D-QALAS with and without CS were 5:56 and 11:11, respectively. For healthy volunteers, brain volumetry and myelin estimation were performed based on the measured T1, T2, and PD. For patients with multiple sclerosis, the mean T1, T2, PD, and the amount of myelin in plaques and contralateral normal-appearing white matter (NAWM) were measured. Simple linear regression analysis and Bland-Altman analysis were performed for each metric obtained from the datasets with and without CS. To compare overall image quality and structural delineations on synthetic and conventional contrast-weighted images, case-control randomized reading sessions were performed by 2 neuroradiologists in a blinded manner. Results The linearity of both phantom and volunteer measurements in T1, T2, and PD values obtained with and without CS was very strong (R2 = 0.9901–1.000). The tissue segmentation obtained with and without CS also had high linearity (R2 = 0.987–0.999). The quantitative tissue values of the plaques and NAWM obtained with CS showed high linearity with those without CS (R2 = 0.967–1.000). There were no significant differences in overall image quality between synthetic contrast-weighted images obtained with and without CS (P = 0.17–0.99). Conclusions Multiparametric imaging of the whole brain based on 3D-QALAS can be accelerated using CS while preserving tissue quantitative values, tissue segmentation, and quality of synthetic images. Received for publication August 10, 2020; and accepted for publication, after revision, October 3, 2020. Conflicts of interest and sources of funding: N.T. is an employee of GE Healthcare Japan. This work was supported by Japan Agency for Medical Research and Development under grant number JP19lk1010025h9902; JSPS KAKENHI grant numbers 19K17150, 19K17177, 18H02772, and 18K07692; Health, Labor and Welfare Policy Research Grants for Research on Region Medical; and a grant-in-aid for special research in subsidies for ordinary expenses of private schools from The Promotion and Mutual Aid Corporation for Private Schools of Japan; Brain/MINDS beyond program from Japan Agency for Medical Research and Development grant numbers JP19dm0307024 and JP19dm0307101. Correspondence to: Akifumi Hagiwara, MD, PhD, Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, Japan, 113-8421. E-mail: <a href="mailto:a-hagiwara@juntendo.ac.jp">a-hagiwara@juntendo.ac.jp</a>. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (<a href="http://www.investigativeradiology.com">www.investigativeradiology.com</a>). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_4" href="https://journals.lww.com/investigativeradiology/Fulltext/9000/A_Deep_Learning_Diagnostic_Support_System_for_the.98745.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">A Deep-Learning Diagnostic Support System for the Detection of COVID-19 Using Chest Radiographs: A Multireader Validation Study</a><br><span id="gmail-desc_4" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/investigativeradiology/Fulltext/9000/A_Deep_Learning_Diagnostic_Support_System_for_the.98745.aspx"></a>Objectives The aim of this study was to compare a diagnosis support system to detect COVID-19 pneumonia on chest radiographs (CXRs) against radiologists of various levels of expertise in chest imaging. Materials and Methods Five publicly available databases comprising normal CXR, confirmed COVID-19 pneumonia cases, and other pneumonias were used. After the harmonization of the data, the training set included 7966 normal cases, 5451 with other pneumonia, and 258 CXRs with COVID-19 pneumonia, whereas in the testing data set, each category was represented by 100 cases. Eleven blinded radiologists with various levels of expertise independently read the testing data set. The data were analyzed separately with the newly proposed artificial intelligence–based system and by consultant radiologists and residents, with respect to positive predictive value (PPV), sensitivity, and F-score (harmonic mean for PPV and sensitivity). The χ2 test was used to compare the sensitivity, specificity, accuracy, PPV, and F-scores of the readers and the system. Results The proposed system achieved higher overall diagnostic accuracy (94.3%) than the radiologists (61.4% ± 5.3%). The radiologists reached average sensitivities for normal CXR, other type of pneumonia, and COVID-19 pneumonia of 85.0% ± 12.8%, 60.1% ± 12.2%, and 53.2% ± 11.2%, respectively, which were significantly lower than the results achieved by the algorithm (98.0%, 88.0%, and 97.0%; P < 0.00032). The mean PPVs for all 11 radiologists for the 3 categories were 82.4%, 59.0%, and 59.0% for the healthy, other pneumonia, and COVID-19 pneumonia, respectively, resulting in an F-score of 65.5% ± 12.4%, which was significantly lower than the F-score of the algorithm (94.3% ± 2.0%, P < 0.00001). When other pneumonia and COVID-19 pneumonia cases were pooled, the proposed system reached an accuracy of 95.7% for any pathology and the radiologists, 88.8%. The overall accuracy of consultants did not vary significantly compared with residents (65.0% ± 5.8% vs 67.4% ± 4.2%); however, consultants detected significantly more COVID-19 pneumonia cases (P = 0.008) and less healthy cases (P < 0.00001). Conclusions The system showed robust accuracy for COVID-19 pneumonia detection on CXR and surpassed radiologists at various training levels. Received for publication August 18, 2020; and accepted for publication, after revision, October 26, 2020. M.F., L.E., S.M., and A.C. contributed equally to this study. Conflicts of interest and sources of funding: none declared. Correspondence to: Lukas Ebner, MD, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland. E-mail: <a href="mailto:lukas.ebner@insel.ch">lukas.ebner@insel.ch</a>. This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_5" href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Pre_examinations_Improve_Automated_Metastases.98746.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Pre-examinations Improve Automated Metastases Detection on Cranial MRI</a><br><span id="gmail-desc_5" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Pre_examinations_Improve_Automated_Metastases.98746.aspx"></a>Objective The aim of this study was to assess the diagnostic value of inclusion of prediagnosis magnetic resonance imaging (MRI) and different MRI sequences when training a convolutional neural network (CNN) in detection of metastases from malignant melanoma (MM) on an annotated real-life cranial MRI dataset. Diagnostic performance was challenged by extracerebral-intracranial MM and by inclusion of MRI with varying sequence parameters. Materials and Methods Our local ethics committee approved this retrospective monocenter study. First, a dual-time approach was assessed, for which the CNN was provided sequences of the MRI that initially depicted new MM (diagnosis MRI) as well as of a prediagnosis MRI: inclusion of only contrast-enhanced T1-weighted images (CNNdual_ce) was compared with inclusion of also the native T1-weighted images, T2-weighted images, and FLAIR sequences of both time points (CNNdual_all). Second, results were compared with the corresponding single time approaches, in which the CNN was provided exclusively the respective sequences of the diagnosis MRI. Casewise diagnostic performance parameters were calculated from 5-fold cross-validation. Results In total, 94 cases with 494 MMs were included. Overall, the highest diagnostic performance was achieved by inclusion of only the contrast-enhanced T1-weighted images of the diagnosis and of a prediagnosis MRI (CNNdual_ce, sensitivity = 73%, PPV = 25%, F1-score = 36%). Using exclusively contrast-enhanced T1-weighted images as input resulted in significantly less false-positives (FPs) compared with inclusion of further sequences beyond contrast-enhanced T1-weighted images (FPs = 5/7 for CNNdual_ce/CNNdual_all, P < 1e-5). Comparison of contrast-enhanced dual and mono time approaches revealed that exclusion of prediagnosis MRI significantly increased FPs (FPs = 5/10 for CNNdual_ce/CNNce, P < 1e-9). Approaches with only native sequences were clearly inferior to CNNs that were provided contrast-enhanced sequences. Conclusions Automated MM detection on contrast-enhanced T1-weighted images performed with high sensitivity. Frequent FPs due to artifacts and vessels were significantly reduced by additional inclusion of prediagnosis MRI, but not by inclusion of further sequences beyond contrast-enhanced T1-weighted images. Future studies might investigate different change detection architectures for computer-aided detection. Received for publication September 1, 2020; and accepted for publication, after revision, October 12, 2020. Financial study support was provided by Guerbet. Conflicts of interest and sources of funding: A.R. received personal fees for consulting and talks (within the last 3 years) from Bayer, Guerbet, and Novartis, and financial study support from Bayer and Guerbet. K.D.H. received personal fees for talks from GE and financial study support from Bayer and Guerbet. The other authors declare no conflicts of interest. Correspondence to: Alexander Radbruch, MD, JD, Clinic for Diagnostic and Interventional Neuroradiology, Venusberg Campus 1, 53127 Bonn, Germany. E-mail: <a href="mailto:alexander.radbruch@ukbonn.de">alexander.radbruch@ukbonn.de</a>. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (<a href="http://www.investigativeradiology.com">www.investigativeradiology.com</a>). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_6" href="https://journals.lww.com/investigativeradiology/Fulltext/9000/The_Macrocyclic_Gadolinium_Based_Contrast_Agents.98747.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">The Macrocyclic Gadolinium-Based Contrast Agents Gadobutrol and Gadoteridol Show Similar Elimination Kinetics From the Brain After Repeated Intravenous Injections in Rabbits</a><br><span id="gmail-desc_6" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/investigativeradiology/Fulltext/9000/The_Macrocyclic_Gadolinium_Based_Contrast_Agents.98747.aspx"></a>Objective The gadolinium (Gd) concentrations in the cerebellum and cerebrum of rabbits and the elimination kinetics were compared after repeated injection of the macrocyclic Gd-based contrast agents (GBCAs) gadobutrol and gadoteridol. Materials and Methods Male white New Zealand rabbits (2.4–3.1 kg) in 2 study groups (n = 21 each) received 3 injections of either gadobutrol or gadoteridol at 0.9 mmol Gd/kg within 5 days (total dose, 2.7 mmol Gd/kg). Animals in one control group (n = 9) received 3 injections of saline (1.8 mL/kg). After 2, 6, and 12 weeks, 7 animals from each study group and 3 from the control group were killed and the Gd concentrations in the cerebellum, cerebrum, in blood and in urine were determined by inductively coupled plasma mass spectrometry. The chemical species of excreted Gd in urine were determined by high pressure liquid chromatography. Results No significant (P > 0.05) differences in the Gd concentrations in the brain of rabbits were observed between the 2 macrocyclic GBCAs gadoteridol and gadobutrol at all time points. In the gadobutrol group, the mean Gd concentrations in the cerebellum and cerebrum decreased from 0.26 and 0.21 nmol Gd/g after 2 weeks, to 0.040 and 0.027 nmol Gd/g after 12 weeks, respectively, and in the gadoteridol group, from 0.25 and 0.21, to 0.037 and 0.023 nmol Gd/g, respectively. The plasma levels decreased from 0.11 and 0.13 nmol Gd/mL at 2 weeks for gadobutrol and gadoteridol to below the limit of quantification (<0.005 nmol Gd/mL) at 12 weeks. The urine concentration dropped in a biphasic course from 2 to 6 and from 6 to 12 weeks for both agents. The Gd excreted after 12 weeks was still present in the urine in the chemical form of the intact Gd complex for both agents. Conclusions Contrary to what had been reported in rats, no significant differences in the elimination kinetics from brain tissue in rabbits were observed after intravenous injection of multiple doses of the macrocyclic GBCAs gadobutrol and gadoteridol. Received for publication September 4, 2020; and accepted for publication, after revision, October 26, 2020. Conflicts of interest and sources of funding: all authors are employees of Bayer AG. Correspondence to: Thomas Frenzel, PhD, Bayer AG, Müllerstraße 178, 13353 Berlin, Germany. E-mail: <a href="mailto:thomas.frenzel1@bayer.com">thomas.frenzel1@bayer.com</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_7" href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Application_of_a_Novel_Iterative_Denoising_and.98748.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Application of a Novel Iterative Denoising and Image Enhancement Technique in T1-Weighted Precontrast and Postcontrast Gradient Echo Imaging of the Abdomen: Improvement of Image Quality and Diagnostic Confidence</a><br><span id="gmail-desc_7" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Application_of_a_Novel_Iterative_Denoising_and.98748.aspx"></a>Objectives The aim of this study was to investigate the impact of a novel iterative denoising and image enhancement technique in T1-weighted precontrast and postcontrast volume-interpolated breath-hold examination (VIBE) of the abdomen on image quality, noise levels, and diagnostic confidence without change of acquisition parameters. Materials and Methods Fifty patients were included in this retrospective, monocentric, institutional review board–approved study after clinically indicated magnetic resonance imaging of the abdomen including T1-weighted precontrast and postcontrast imaging. After acquisition of the standard VIBE (VIBES), images were processed with a novel reconstruction algorithm using the same raw data as for VIBES, resulting in a denoised and enhanced dataset (VIBEDE). Two different radiologists evaluated both datasets in a randomized order regarding sharpness of organs as well as vessels, noise levels, artifacts, overall image quality, and diagnostic confidence using a Likert scale ranging from 1 to 4 with 4 being the best. Furthermore, in the presence of focal liver lesions, the largest lesion was measured in the postcontrast dataset, and lesion detectability was analyzed using a Likert scale (1–4). Results Precontrast and postcontrast sharpness of organs and sharpness of vessels were rated significantly superior by both readers in VIBEDE with a median of 4 (interquartile range, 0) compared with VIBES with a median of 3 (1) (all P's < 0.0001). Precontrast and postcontrast noise levels were also rated superior by both readers in VIBEDE with a median of 4 (0) compared with VIBES with a median of 3 (1) for precontrast and a median of 3 (0) (median of 3 [1] for reader 2) for postcontrast imaging (all P's < 0.0001). Overall image quality was also rated higher with a median of 4 (0) in VIBEDE versus 3 (1) in VIBES (P < 0.0001). Twenty-seven imaging studies contained liver lesions. There was no difference regarding the number and localization between the readers and between VIBES and VIBEDE. Lesion detectability was rated by both readers significantly better in VIBEDE with a median of 4 (0) compared with a median of 4 (1) for reader 1 and a median of 3 (1) for reader 2 (P = 0.001 for reader 1; P < 0.001 for reader 2). Consequently, diagnostic confidence was also significantly superior in VIBEDE versus VIBES with a median of 4 (0) for both (P = 0.001). Interreader agreement resulted in a Cohen κ of 0.76 for precontrast analysis as well as of 0.76 for postcontrast analysis. Conclusions Application of a novel iterative denoising and image enhancement technique in T1-weighted VIBE precontrast and postcontrast imaging of the abdomen is feasible, providing superior image quality, noise levels, and diagnostic confidence. Received for publication September 28, 2020; and accepted for publication, after revision, October 18, 2020. Conflicts of interest and sources of funding: none declared. Correspondence to: Ahmed E. Othman, MD, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany. E-mail: <a href="mailto:ahmed.e.othman@googlemail.com">ahmed.e.othman@googlemail.com</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_8" href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Diagnostic_Confidence_and_Feasibility_of_a_Deep.98749.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Diagnostic Confidence and Feasibility of a Deep Learning Accelerated HASTE Sequence of the Abdomen in a Single Breath-Hold</a><br><span id="gmail-desc_8" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Diagnostic_Confidence_and_Feasibility_of_a_Deep.98749.aspx"></a>Objective The aim of this study was to evaluate the feasibility of a single breath-hold fast half-Fourier single-shot turbo spin echo (HASTE) sequence using a deep learning reconstruction (HASTEDL) for T2-weighted magnetic resonance imaging of the abdomen as compared with 2 standard T2-weighted imaging sequences (HASTE and BLADE). Materials and Methods Sixty-six patients who underwent 1.5-T liver magnetic resonance imaging were included in this monocentric, retrospective study. The following T2-weighted sequences in axial orientation and using spectral fat suppression were compared: a conventional respiratory-triggered BLADE sequence (time of acquisition [TA] = 4:00 minutes), a conventional multiple breath-hold HASTE sequence (HASTES) (TA = 1:30 minutes), as well as a single breath-hold HASTE with deep learning reconstruction (HASTEDL) (TA = 0:16 minutes). Two radiologists assessed the 3 sequences regarding overall image quality, noise, sharpness, diagnostic confidence, and lesion detectability as well as lesion characterization using a Likert scale ranging from 1 to 4 with 4 being the best. Comparative analyses were conducted to assess the differences between the 3 sequences. Results HASTEDL was successfully acquired in all patients. Overall image quality for HASTEDL was rated as good (median, 3; interquartile range, 3–4) and was significantly superior to HASTEs (P < 0.001) and inferior to BLADE (P = 0.001). Noise, sharpness, and artifacts for HASTEDL reached similar levels to BLADE (P ≤ 0.176) and were significantly superior to HASTEs (P < 0.001). Diagnostic confidence for HASTEDL was rated excellent by both readers and significantly superior to HASTEs (P < 0.001) and inferior to BLADE (P = 0.044). Lesion detectability and lesion characterization for HASTEDL reached similar levels to those of BLADE (P ≤ 0.523) and were significantly superior to HASTEs (P < 0.001). Concerning the number of detected lesions and the measured diameter of the largest lesion, no significant differences were found comparing BLADE, HASTES, and HASTEDL (P ≤ 0.912). Conclusions The single breath-hold HASTEDL is feasible and yields comparable image quality and diagnostic confidence to standard T2-weighted TSE BLADE and may therefore allow for a remarkable time saving in abdominal imaging. Received for publication September 8, 2020; and accepted for publication, after revision, October 12, 2020. Conflicts of interest and sources of funding: none declared. Disclaimer: The concepts and information presented in this article are based on research results that are not commercially available. Correspondence to: Ahmed Othman, MD, Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany. E-mail: ahmed.e.othman@googlemail. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr><tr><td><a id="gmail-anchor_9" href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Computed_Tomography_Angiography_of_the.98753.aspx" class="gmail-item_title" style="color:rgb(34,68,210);font-size:20px;font-weight:bold;text-decoration-line:none">Computed Tomography Angiography of the Aorta—Optimization of Automatic Tube Voltage Selection Settings to Reduce Radiation Dose or Contrast Medium in a Prospective Randomized Trial</a><br><span id="gmail-desc_9" class="gmail-item_desc" style="font-size:12px"><a href="https://journals.lww.com/investigativeradiology/Fulltext/9000/Computed_Tomography_Angiography_of_the.98753.aspx"></a>Objectives The aim of this study was to compare the image quality of low-kV protocols with optimized automatic tube voltage selection (ATVS) settings to reduce either radiation dose or contrast medium (CM) with that of a reference protocol for computed tomography angiography (CTA) of the thoracoabdominal aorta. Materials and Methods In this institutional review board–approved, single-center, prospective randomized controlled trial, 126 patients receiving CTA of the aorta were allocated to one of three computed tomography protocols: (A) reference protocol at 120 kVp and standard weight-adapted CM dose; (B) protocol at 90 kVp, reduced radiation and standard CM dose; and (C) protocol at 90 kVp, standard radiation and reduced CM dose. All three protocols were performed on a third-generation dual-source computed tomography scanner using the semimode of the ATVS system. The image-task-dependent optimization settings of the ATVS (slider level) were adjusted to level 11 (high-contrast task) for protocols A and B and level 3 (low-contrast task) for protocol C. Radiation dose parameters were assessed. The contrast-to-noise ratios (CNRs) of protocols B and C were tested for noninferiority compared with A. Subjective image quality was assessed using a 5-point Likert scale. Results Size-specific dose estimate was 34.3% lower for protocol B compared with A (P < 0.0001). Contrast medium was 20.2% lower for protocol C compared with A (P < 0.0001). Mean CNR in B and C was noninferior to protocol A (CNR of 30.2 ± 7, 33.4 ± 6.7, and 30.5 ± 8.9 for protocols A, B, and C, respectively). There was no significant difference in overall subjective image quality among protocols (4.09 ± 0.21, 4.03 ± 0.19, and 4.08 ± 0.17 for protocols A, B, and C, respectively; P = 0.4). Conclusions The slider settings of an ATVS system can be adjusted to optimize either radiation dose or CM at noninferior image quality in low-kV CTA of the aorta. This optimization could be used to extend future ATVS algorithms to take clinical risk factors like kidney function of individual patients into account. Received for publication August 3, 2020; and accepted for publication, after revision, September 28, 2020. Conflicts of interest and sources of funding: A.K., R.G., B.S. are employees of Siemens Healthcare GmbH. No funding was received. Correspondence to: Hatem Alkadhi, MD, MPH, EBCR, FESER, Institute for Diagnostic and Interventional Radiology, University Hospital of Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland. E-mail: <a href="mailto:hatem.alkadhi@usz.ch">hatem.alkadhi@usz.ch</a>. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</span><br><br></td></tr></tbody></table><div><div dir="ltr" class="gmail_signature" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"></div></div></div></div><div><br></div><div><div>#</div><div>Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,<a href="mailto:alsfakia@gmail.com" target="_blank">alsfakia@gmail.com</a>,<br></div><div>Telephone consultation 11855 int 1193,</div></div></div></div></div></div> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-13741640123429269402020-12-22T22:48:00.007-08:002020-12-22T22:48:38.397-08:00Gemcitabine plus concurrent irreversible electroporation vs gemcitabine alone for locally advanced pancreatic cancer.<table class="arial" cellpadding="0" cellspacing="0" style="width:100%;font-family:'Roboto', Arial, sans-serif"> <tr> <td align="center"> <table id="header_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr height="20"></tr> <tr> <td> <table width="600px" class="inner-table"> <tr> <td> <a href="https://www.inoreader.com" target="_blank"> <img src="https://www.inoreader.com/newsletter/images/email-logo.png" width="117" class="light-mode-logo"/> <img src="https://www.inoreader.com/newsletter/images/email-logo-light.png" width="117" class="dark-mode-logo"/> </a> </td> <td> </td> </tr> </table> </td> </tr> </table> <table id="content_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <span style="font-size:16px;margin:20px 0;padding-bottom:10px;font-weight:500;"> paythelady.612 </span> <span style="font-size:16px;letter-spacing:-0.02rem;margin:20px 0;padding-bottom:10px;"> shared this article with you from <a href="https://www.inoreader.com/article/3a9c6e7bf349f39b?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:underline;">Inoreader</a> </span> </td> </tr> <tr height="20"></tr> </table> </td> </tr> <tr> <td style="text-align:left;"> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <div dir="ltr"> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344547?dopt=Abstract" style="font-size:24px;line-height:28px;text-decoration:none;font-weight:bold;">Gemcitabine plus concurrent irreversible electroporation vs gemcitabine alone for locally advanced pancreatic cancer.</a> </div> </td> </tr> <tr> <td> <div style="margin-top:8px;"> <span style="font-weight: 300;">Μέσω</span> <a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Search&db=PubMed&term=%22World%20J%20Clin%20Cases%22%5Bjour%5D">pubmed: "world j clin cases"...</a> </div> </td> </tr> <tr> <td> <div class="article-content" style="font-size:16px;margin-top:16px;line-height:28px;font-family:'Merriweather', Georgia, serif;" dir="ltr"> <table width="100%"><tbody><tr><td></td><td><a href="https://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Link&LinkName=pubmed_pubmed&from_uid=33344547" target="_blank" rel="noopener" class="underlink bluelink" tabindex="-1">Related Articles</a></td></tr></tbody></table> <p><b>Gemcitabine plus concurrent irreversible electroporation vs gemcitabine alone for locally advanced pancreatic cancer.</b></p> <p>World J Clin Cases. 2020 Nov 26;8(22):5564-5575</p> <p>Authors: Ma YY, Leng Y, Xing YL, Li HM, Chen JB, Niu LZ</p> <p>Abstract<br> BACKGROUND: Locally advanced pancreatic cancer (LAPC) is a common malignant digestive system tumor that ranks as the fourth leading cause of cancer-related death in the world. The prognosis of LAPC is poor even after standard treatment. Irreversible electroporation (IRE) is a novel ablative strategy for LAPC. Several studies have confirmed the safety of IRE. To date, no prospective studies have been performed to investigate the therapeutic efficacy of conventional gemcitabine (GEM) plus concurrent IRE.<br> AIM: To compare the therapeutic efficacy between conventional GEM plus concurrent IRE and GEM alone for LAPC.<br> METHODS: From February 2016 to September 2017, a total of 68 LAPC patients were treated with GEM plus concurrent IRE n = 33) or GEM alone n = 35). Overall survival (OS), progression free survival (PFS), and procedure-related complications were compared between the two groups. Multivariate analyses were performed to identify any prognostic factors.<br> RESULTS: There were no treatment-related deaths. The technical success rate of IRE ablation was 100%. The GEM + IRE group had a significantly longer OS from the time of diagnosis of LAPC (19.8 mo vs 9.3 mo, P < 0.0001) than the GEM alone group. The GEM + IRE group had a significantly longer PFS (8.3 mo vs 4.7 mo, P < 0.0001) than the GEM alone group. Tumor volume less than 37 cm3 and GEM plus concurrent IRE were identified as significant favorable factors for both the OS and PFS.<br> CONCLUSION: Gemcitabine plus concurrent IRE is an effective treatment for patients with LAPC.<br> </p><p>PMID: 33344547 [PubMed]</p> <div style="clear:both;"> </div> </div> </td> </tr> <tr> <td> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344547?dopt=Abstract" target="_blank" style="text-decoration:none;display:block;padding:10px 14px;font-weight:500;background-color:#00a7f6;color:#ffffff;border-radius:3px;border:1px solid #00a7f6; text-align: center;font-size: 16px;">View on the web</a> </td> </tr> <tr height="20"></tr> </table> </td> </tr> </table> <table id="footer_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td style="font-size: 14px;text-align: left;"> <table width="600px" class="inner-table"> <tr> <td> <p style="border-top:1px solid #ddd;padding-top:8px;margin-top:24px"> <a href="https://www.inoreader.com?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:none;">Inoreader</a>. Take back control of your news feed. Follow us on <a href="http://www.twitter.com/Inoreader" style="text-decoration:none;">Twitter</a> and <a href="http://www.facebook.com/Inoreader" style="text-decoration:none;">Facebook</a>. </p> </td> </tr> </table> </td> </tr> </table> </td> </tr> </table> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-6811234963370682852020-12-22T22:48:00.005-08:002020-12-22T22:48:29.654-08:00No significant association between dipeptidyl peptidase-4 inhibitors and adverse outcomes of COVID-19.<table class="arial" cellpadding="0" cellspacing="0" style="width:100%;font-family:'Roboto', Arial, sans-serif"> <tr> <td align="center"> <table id="header_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr height="20"></tr> <tr> <td> <table width="600px" class="inner-table"> <tr> <td> <a href="https://www.inoreader.com" target="_blank"> <img src="https://www.inoreader.com/newsletter/images/email-logo.png" width="117" class="light-mode-logo"/> <img src="https://www.inoreader.com/newsletter/images/email-logo-light.png" width="117" class="dark-mode-logo"/> </a> </td> <td> </td> </tr> </table> </td> </tr> </table> <table id="content_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <span style="font-size:16px;margin:20px 0;padding-bottom:10px;font-weight:500;"> paythelady.612 </span> <span style="font-size:16px;letter-spacing:-0.02rem;margin:20px 0;padding-bottom:10px;"> shared this article with you from <a href="https://www.inoreader.com/article/3a9c6e7bf349f3aa?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:underline;">Inoreader</a> </span> </td> </tr> <tr height="20"></tr> </table> </td> </tr> <tr> <td style="text-align:left;"> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <div dir="ltr"> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344548?dopt=Abstract" style="font-size:24px;line-height:28px;text-decoration:none;font-weight:bold;">No significant association between dipeptidyl peptidase-4 inhibitors and adverse outcomes of COVID-19.</a> </div> </td> </tr> <tr> <td> <div style="margin-top:8px;"> <span style="font-weight: 300;">Μέσω</span> <a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Search&db=PubMed&term=%22World%20J%20Clin%20Cases%22%5Bjour%5D">pubmed: "world j clin cases"...</a> </div> </td> </tr> <tr> <td> <div class="article-content" style="font-size:16px;margin-top:16px;line-height:28px;font-family:'Merriweather', Georgia, serif;" dir="ltr"> <table width="100%"><tbody><tr><td></td><td><a href="https://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Link&LinkName=pubmed_pubmed&from_uid=33344548" target="_blank" rel="noopener" class="underlink bluelink" tabindex="-1">Related Articles</a></td></tr></tbody></table> <p><b>No significant association between dipeptidyl peptidase-4 inhibitors and adverse outcomes of COVID-19.</b></p> <p>World J Clin Cases. 2020 Nov 26;8(22):5576-5588</p> <p>Authors: Zhou JH, Wu B, Wang WX, Lei F, Cheng X, Qin JJ, Cai JJ, Zhang XJ, Zhou F, Liu YM, Li HM, Zhu LH, She ZG, Zhang X, Yang J, Li HL</p> <p>Abstract<br> BACKGROUND: Dipeptidyl peptidase-4 (DPP4) is commonly targeted to achieve glycemic control and has potent anti-inflammatory and immunoregulatory effects. Recent structural analyses indicated a potential tight interaction between DPP4 and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), raising a promising hypothesis that DPP4 inhibitor (DPP4i) drugs might be an optimal strategy for treating coronavirus disease 2019 (COVID-19) among patients with diabetes. However, there has been no direct clinical evidence illuminating the associations between DPP4i use and COVID-19 outcomes.<br> AIM: To illuminate the associations between DPP4i usage and the adverse outcomes of COVID-19.<br> METHODS: We conducted a multicenter, retrospective analysis including 2563 patients with type 2 diabetes who were hospitalized due to COVID-19 at 16 hospitals in Hubei Province, China. After excluding ineligible individuals, 142 patients who received DPP4i drugs and 1115 patients who received non-DPP4i oral anti-diabetic drugs were included in the subsequent analysis. We performed a strict propensity score matching (PSM) analysis where age, sex, comorbidities, number of oral hypoglycemic agents, heart rate, blood pressure, pulse oxygen saturation (SpO2) < 95%, CT diagnosed bilateral lung lesions, laboratory indicators, and proportion of insulin usage were matched. Finally, 111 participants treated with DPP4i drugs were successfully matched to 333 non-DPP4i users. Then, a linear logistic model and mixed-effect Cox model were applied to analyze the associations between in-hospital DPP4i use and adverse outcomes of COVID-19.<br> RESULTS: After rigorous matching and further adjustments for imbalanced variables in the linear logistic model and Cox adjusted model, we found that there was no significant association between in-hospital DPP4i use (DPP4i group) and 28-d all-cause mortality (adjusted hazard ratio = 0.44, 95%CI: 0.09-2.11, P = 0.31). Likewise, the incidences and risks of secondary outcomes, including septic shock, acute respiratory distress syndrome, or acute organ (kidney, liver, and cardiac) injuries, were also comparable between the DPP4i and non-DPP4i groups. The performance of DPP4i agents in achieving glucose control (e.g., the median level of fasting blood glucose and random blood glucose) and inflammatory regulation was approximately equivalent in the DPP4i and non-DPP4i groups. Furthermore, we did not observe substantial side effects such as uncontrolled glycemia or acidosis due to DPP4i application relative to the use of non-DPP4i agents in the study cohort.<br> CONCLUSION: Our findings demonstrated that DPP4i use is not significantly associated with poor outcomes of COVID-19 or other adverse effects of anti-diabetic treatment. The data support the continuation of DPP4i agents for diabetes management in the setting of COVID-19.<br> </p><p>PMID: 33344548 [PubMed]</p> <div style="clear:both;"> </div> </div> </td> </tr> <tr> <td> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344548?dopt=Abstract" target="_blank" style="text-decoration:none;display:block;padding:10px 14px;font-weight:500;background-color:#00a7f6;color:#ffffff;border-radius:3px;border:1px solid #00a7f6; text-align: center;font-size: 16px;">View on the web</a> </td> </tr> <tr height="20"></tr> </table> </td> </tr> </table> <table id="footer_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td style="font-size: 14px;text-align: left;"> <table width="600px" class="inner-table"> <tr> <td> <p style="border-top:1px solid #ddd;padding-top:8px;margin-top:24px"> <a href="https://www.inoreader.com?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:none;">Inoreader</a>. Take back control of your news feed. Follow us on <a href="http://www.twitter.com/Inoreader" style="text-decoration:none;">Twitter</a> and <a href="http://www.facebook.com/Inoreader" style="text-decoration:none;">Facebook</a>. </p> </td> </tr> </table> </td> </tr> </table> </td> </tr> </table> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-41451169339756374062020-12-22T22:48:00.003-08:002020-12-22T22:48:21.984-08:00Interobserver agreement for contrast-enhanced ultrasound of liver imaging reporting and data system: A systematic review and meta-analysis.<table class="arial" cellpadding="0" cellspacing="0" style="width:100%;font-family:'Roboto', Arial, sans-serif"> <tr> <td align="center"> <table id="header_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr height="20"></tr> <tr> <td> <table width="600px" class="inner-table"> <tr> <td> <a href="https://www.inoreader.com" target="_blank"> <img src="https://www.inoreader.com/newsletter/images/email-logo.png" width="117" class="light-mode-logo"/> <img src="https://www.inoreader.com/newsletter/images/email-logo-light.png" width="117" class="dark-mode-logo"/> </a> </td> <td> </td> </tr> </table> </td> </tr> </table> <table id="content_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <span style="font-size:16px;margin:20px 0;padding-bottom:10px;font-weight:500;"> paythelady.612 </span> <span style="font-size:16px;letter-spacing:-0.02rem;margin:20px 0;padding-bottom:10px;"> shared this article with you from <a href="https://www.inoreader.com/article/3a9c6e7bf349f3b2?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:underline;">Inoreader</a> </span> </td> </tr> <tr height="20"></tr> </table> </td> </tr> <tr> <td style="text-align:left;"> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <div dir="ltr"> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344549?dopt=Abstract" style="font-size:24px;line-height:28px;text-decoration:none;font-weight:bold;">Interobserver agreement for contrast-enhanced ultrasound of liver imaging reporting and data system: A systematic review and meta-analysis.</a> </div> </td> </tr> <tr> <td> <div style="margin-top:8px;"> <span style="font-weight: 300;">Μέσω</span> <a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Search&db=PubMed&term=%22World%20J%20Clin%20Cases%22%5Bjour%5D">pubmed: "world j clin cases"...</a> </div> </td> </tr> <tr> <td> <div class="article-content" style="font-size:16px;margin-top:16px;line-height:28px;font-family:'Merriweather', Georgia, serif;" dir="ltr"> <table width="100%"><tbody><tr><td></td><td><a href="https://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Link&LinkName=pubmed_pubmed&from_uid=33344549" target="_blank" rel="noopener" class="underlink bluelink" tabindex="-1">Related Articles</a></td></tr></tbody></table> <p><b>Interobserver agreement for contrast-enhanced ultrasound of liver imaging reporting and data system: A systematic review and meta-analysis.</b></p> <p>World J Clin Cases. 2020 Nov 26;8(22):5589-5602</p> <p>Authors: Li J, Chen M, Wang ZJ, Li SG, Jiang M, Shi L, Cao CL, Sang T, Cui XW, Dietrich CF</p> <p>Abstract<br> BACKGROUND: Hepatocellular carcinoma is the most common primary liver malignancy. From the results of previous studies, Liver Imaging Reporting and Data System (LI-RADS) on contrast-enhanced ultrasound (CEUS) has shown satisfactory diagnostic value. However, a unified conclusion on the interobserver stability of this innovative ultrasound imaging has not been determined. The present meta-analysis examined the interobserver agreement of CEUS LI-RADS to provide some reference for subsequent related research.<br> AIM: To evaluate the interobserver agreement of LI-RADS on CEUS and analyze the sources of heterogeneity between studies.<br> METHODS: Relevant papers on the subject of interobserver agreement on CEUS LI-RADS published before March 1, 2020 in China and other countries were analyzed. The studies were filtered, and the diagnostic criteria were evaluated. The selected references were analyzed using the "meta" and "metafor" packages of R software version 3.6.2.<br> RESULTS: Eight studies were ultimately included in the present analysis. Meta-analysis results revealed that the summary Kappa value of included studies was 0.76 [95% confidence interval, 0.67-0.83], which shows substantial agreement. Higgins I 2 statistics also confirmed the substantial heterogeneity (I 2 = 91.30%, 95% confidence interval, 85.3%-94.9%, P < 0.01). Meta-regression identified the variables, including the method of patient enrollment, method of consistency testing, and patient race, which explained the substantial study heterogeneity.<br> CONCLUSION: CEUS LI-RADS demonstrated overall substantial interobserver agreement, but heterogeneous results between studies were also obvious. Further clinical investigations should consider a modified recommendation about the experimental design.<br> </p><p>PMID: 33344549 [PubMed]</p> <div style="clear:both;"> </div> </div> </td> </tr> <tr> <td> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344549?dopt=Abstract" target="_blank" style="text-decoration:none;display:block;padding:10px 14px;font-weight:500;background-color:#00a7f6;color:#ffffff;border-radius:3px;border:1px solid #00a7f6; text-align: center;font-size: 16px;">View on the web</a> </td> </tr> <tr height="20"></tr> </table> </td> </tr> </table> <table id="footer_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td style="font-size: 14px;text-align: left;"> <table width="600px" class="inner-table"> <tr> <td> <p style="border-top:1px solid #ddd;padding-top:8px;margin-top:24px"> <a href="https://www.inoreader.com?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:none;">Inoreader</a>. Take back control of your news feed. Follow us on <a href="http://www.twitter.com/Inoreader" style="text-decoration:none;">Twitter</a> and <a href="http://www.facebook.com/Inoreader" style="text-decoration:none;">Facebook</a>. </p> </td> </tr> </table> </td> </tr> </table> </td> </tr> </table> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-83439407496616770062020-12-22T22:48:00.001-08:002020-12-22T22:48:07.099-08:00CLAG-M chemotherapy followed by umbilical cord blood stem cell transplantation for primary refractory acute myeloid leukaemia in a child: A case report.<table class="arial" cellpadding="0" cellspacing="0" style="width:100%;font-family:'Roboto', Arial, sans-serif"> <tr> <td align="center"> <table id="header_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr height="20"></tr> <tr> <td> <table width="600px" class="inner-table"> <tr> <td> <a href="https://www.inoreader.com" target="_blank"> <img src="https://www.inoreader.com/newsletter/images/email-logo.png" width="117" class="light-mode-logo"/> <img src="https://www.inoreader.com/newsletter/images/email-logo-light.png" width="117" class="dark-mode-logo"/> </a> </td> <td> </td> </tr> </table> </td> </tr> </table> <table id="content_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <span style="font-size:16px;margin:20px 0;padding-bottom:10px;font-weight:500;"> paythelady.612 </span> <span style="font-size:16px;letter-spacing:-0.02rem;margin:20px 0;padding-bottom:10px;"> shared this article with you from <a href="https://www.inoreader.com/article/3a9c6e7bf349f3ba?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:underline;">Inoreader</a> </span> </td> </tr> <tr height="20"></tr> </table> </td> </tr> <tr> <td style="text-align:left;"> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <div dir="ltr"> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344550?dopt=Abstract" style="font-size:24px;line-height:28px;text-decoration:none;font-weight:bold;">CLAG-M chemotherapy followed by umbilical cord blood stem cell transplantation for primary refractory acute myeloid leukaemia in a child: A case report.</a> </div> </td> </tr> <tr> <td> <div style="margin-top:8px;"> <span style="font-weight: 300;">Μέσω</span> <a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Search&db=PubMed&term=%22World%20J%20Clin%20Cases%22%5Bjour%5D">pubmed: "world j clin cases"...</a> </div> </td> </tr> <tr> <td> <div class="article-content" style="font-size:16px;margin-top:16px;line-height:28px;font-family:'Merriweather', Georgia, serif;" dir="ltr"> <table width="100%"><tbody><tr><td></td><td><a href="https://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Link&LinkName=pubmed_pubmed&from_uid=33344550" target="_blank" rel="noopener" class="underlink bluelink" tabindex="-1">Related Articles</a></td></tr></tbody></table> <p><b>CLAG-M chemotherapy followed by umbilical cord blood stem cell transplantation for primary refractory acute myeloid leukaemia in a child: A case report.</b></p> <p>World J Clin Cases. 2020 Nov 26;8(22):5603-5610</p> <p>Authors: Huang J, Yang XY, Rong LC, Xue Y, Zhu J, Fang YJ</p> <p>Abstract<br> BACKGROUND: The prognosis of paediatric primary refractory/relapsed acute myeloid leukaemia (R/R AML) remains poor. Intensive therapy is typically used as salvage treatment for those with R/R AML. No data are currently available about the use of the CLAG-M protocol as salvage therapy in paediatric patients with R/R AML.<br> CASE SUMMARY: An 8-year-old patient was diagnosed with acute myeloid leukaemia by bone marrow morphology and immunophenotype. The patient showed poor response to two cycles of induction therapy with 60% blast cells in the bone marrow after the second induction cycle. The patient achieved complete remission after being treated with the CLAG-M protocol as salvage therapy before undergoing umbilical cord blood stem cell transplantation. Morphological complete remission with haematological recovery has hitherto been maintained over 4 mo. Abnormal gene mutations detected at diagnosis were undetectable after haematopoietic stem cell transplantation.<br> CONCLUSION: Here we present a paediatric patient with primary refractory acute myeloid leukaemia who was successfully treated with the CLAG-M protocol. Given the positive results of the presented patient, large-scale clinical studies are required to assess the role of the CLAG-M protocol in the salvage treatment of refractory or relapsed AML in childhood.<br> </p><p>PMID: 33344550 [PubMed]</p> <div style="clear:both;"> </div> </div> </td> </tr> <tr> <td> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344550?dopt=Abstract" target="_blank" style="text-decoration:none;display:block;padding:10px 14px;font-weight:500;background-color:#00a7f6;color:#ffffff;border-radius:3px;border:1px solid #00a7f6; text-align: center;font-size: 16px;">View on the web</a> </td> </tr> <tr height="20"></tr> </table> </td> </tr> </table> <table id="footer_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td style="font-size: 14px;text-align: left;"> <table width="600px" class="inner-table"> <tr> <td> <p style="border-top:1px solid #ddd;padding-top:8px;margin-top:24px"> <a href="https://www.inoreader.com?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:none;">Inoreader</a>. Take back control of your news feed. Follow us on <a href="http://www.twitter.com/Inoreader" style="text-decoration:none;">Twitter</a> and <a href="http://www.facebook.com/Inoreader" style="text-decoration:none;">Facebook</a>. </p> </td> </tr> </table> </td> </tr> </table> </td> </tr> </table> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-81734472573641262282020-12-22T22:47:00.009-08:002020-12-22T22:47:52.821-08:00Multiple schwannomas with pseudoglandular element synchronously occurring under the tongue: A case report.<table class="arial" cellpadding="0" cellspacing="0" style="width:100%;font-family:'Roboto', Arial, sans-serif"> <tr> <td align="center"> <table id="header_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr height="20"></tr> <tr> <td> <table width="600px" class="inner-table"> <tr> <td> <a href="https://www.inoreader.com" target="_blank"> <img src="https://www.inoreader.com/newsletter/images/email-logo.png" width="117" class="light-mode-logo"/> <img src="https://www.inoreader.com/newsletter/images/email-logo-light.png" width="117" class="dark-mode-logo"/> </a> </td> <td> </td> </tr> </table> </td> </tr> </table> <table id="content_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <span style="font-size:16px;margin:20px 0;padding-bottom:10px;font-weight:500;"> paythelady.612 </span> <span style="font-size:16px;letter-spacing:-0.02rem;margin:20px 0;padding-bottom:10px;"> shared this article with you from <a href="https://www.inoreader.com/article/3a9c6e7bf349f3bf?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:underline;">Inoreader</a> </span> </td> </tr> <tr height="20"></tr> </table> </td> </tr> <tr> <td style="text-align:left;"> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <div dir="ltr"> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344551?dopt=Abstract" style="font-size:24px;line-height:28px;text-decoration:none;font-weight:bold;">Multiple schwannomas with pseudoglandular element synchronously occurring under the tongue: A case report.</a> </div> </td> </tr> <tr> <td> <div style="margin-top:8px;"> <span style="font-weight: 300;">Μέσω</span> <a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Search&db=PubMed&term=%22World%20J%20Clin%20Cases%22%5Bjour%5D">pubmed: "world j clin cases"...</a> </div> </td> </tr> <tr> <td> <div class="article-content" style="font-size:16px;margin-top:16px;line-height:28px;font-family:'Merriweather', Georgia, serif;" dir="ltr"> <table width="100%"><tbody><tr><td></td><td><a href="https://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Link&LinkName=pubmed_pubmed&from_uid=33344551" target="_blank" rel="noopener" class="underlink bluelink" tabindex="-1">Related Articles</a></td></tr></tbody></table> <p><b>Multiple schwannomas with pseudoglandular element synchronously occurring under the tongue: A case report.</b></p> <p>World J Clin Cases. 2020 Nov 26;8(22):5611-5617</p> <p>Authors: Chen YL, He DQ, Yang HX, Dou Y</p> <p>Abstract<br> BACKGROUND: Schwannoma is a rare benign, encapsulated tumor of the nerve sheath under the tongue, mostly occurring as solitary tumors with classical histological pattern and several common morphological variants. To our knowledge, multiple schwannomas with pseudoglandular element synchronously occurring under the tongue are rare; we report herein the first such case.<br> CASE SUMMARY: A 53-year-old man had first noticed an isolated asymptomatic mass under the tongue, and as the mass grew, the tongue was elevated. Physical examination showed multiple oval neoplasms, and the overlying mucosa was normal. Computed tomography showed three low-density oval neoplasms under the tongue, which were cystic-solid with unclear boundary. The patient has no cutaneous tumors, VIII nerve tumors, or lens opacities and no history of neurofibromatosis 2 or confirmed schwannomatosis in any first-degree relative. Magnetic resonance imaging showed no evidence of vestibular schwannoma. The preoperative diagnosis was mucoepidermoid carcinoma. During hospitalization, all neoplasms were completely excised by surgeons through an intraoral approach under general anesthesia. The diagnosis of the multiple schwannomas with pseudoglandular element was made by histopathology after surgery. At the 15-mo follow-up visit, the patient had no sign of recurrence or development of o ther peripheral nerve tumors.<br> CONCLUSION: Although rare, multiple schwannomas with pseudoglandular element do exist in patients presenting with masses under the tongue. Oral surgeons should be aware of the existence of multiple schwannomas with pseudoglandular element when considering masses under the tongue due to the different prognosis between multiple schwannomas with pseudoglandular element and mucoepidermoid carcinoma.<br> </p><p>PMID: 33344551 [PubMed]</p> <div style="clear:both;"> </div> </div> </td> </tr> <tr> <td> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344551?dopt=Abstract" target="_blank" style="text-decoration:none;display:block;padding:10px 14px;font-weight:500;background-color:#00a7f6;color:#ffffff;border-radius:3px;border:1px solid #00a7f6; text-align: center;font-size: 16px;">View on the web</a> </td> </tr> <tr height="20"></tr> </table> </td> </tr> </table> <table id="footer_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td style="font-size: 14px;text-align: left;"> <table width="600px" class="inner-table"> <tr> <td> <p style="border-top:1px solid #ddd;padding-top:8px;margin-top:24px"> <a href="https://www.inoreader.com?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:none;">Inoreader</a>. Take back control of your news feed. Follow us on <a href="http://www.twitter.com/Inoreader" style="text-decoration:none;">Twitter</a> and <a href="http://www.facebook.com/Inoreader" style="text-decoration:none;">Facebook</a>. </p> </td> </tr> </table> </td> </tr> </table> </td> </tr> </table> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-80762606911910083252020-12-22T22:47:00.007-08:002020-12-22T22:47:42.260-08:00Primary myelofibrosis with concurrent CALR and MPL mutations: A case report.<table class="arial" cellpadding="0" cellspacing="0" style="width:100%;font-family:'Roboto', Arial, sans-serif"> <tr> <td align="center"> <table id="header_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr height="20"></tr> <tr> <td> <table width="600px" class="inner-table"> <tr> <td> <a href="https://www.inoreader.com" target="_blank"> <img src="https://www.inoreader.com/newsletter/images/email-logo.png" width="117" class="light-mode-logo"/> <img src="https://www.inoreader.com/newsletter/images/email-logo-light.png" width="117" class="dark-mode-logo"/> </a> </td> <td> </td> </tr> </table> </td> </tr> </table> <table id="content_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <span style="font-size:16px;margin:20px 0;padding-bottom:10px;font-weight:500;"> paythelady.612 </span> <span style="font-size:16px;letter-spacing:-0.02rem;margin:20px 0;padding-bottom:10px;"> shared this article with you from <a href="https://www.inoreader.com/article/3a9c6e7bf349f3c9?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:underline;">Inoreader</a> </span> </td> </tr> <tr height="20"></tr> </table> </td> </tr> <tr> <td style="text-align:left;"> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <div dir="ltr"> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344552?dopt=Abstract" style="font-size:24px;line-height:28px;text-decoration:none;font-weight:bold;">Primary myelofibrosis with concurrent CALR and MPL mutations: A case report.</a> </div> </td> </tr> <tr> <td> <div style="margin-top:8px;"> <span style="font-weight: 300;">Μέσω</span> <a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Search&db=PubMed&term=%22World%20J%20Clin%20Cases%22%5Bjour%5D">pubmed: "world j clin cases"...</a> </div> </td> </tr> <tr> <td> <div class="article-content" style="font-size:16px;margin-top:16px;line-height:28px;font-family:'Merriweather', Georgia, serif;" dir="ltr"> <table width="100%"><tbody><tr><td></td><td><a href="https://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Link&LinkName=pubmed_pubmed&from_uid=33344552" target="_blank" rel="noopener" class="underlink bluelink" tabindex="-1">Related Articles</a></td></tr></tbody></table> <p><b>Primary myelofibrosis with concurrent CALR and MPL mutations: A case report.</b></p> <p>World J Clin Cases. 2020 Nov 26;8(22):5618-5624</p> <p>Authors: Zhou FP, Wang CC, Du HP, Cao SB, Zhang J</p> <p>Abstract<br> BACKGROUND: Primary myelofibrosis (PMF) is a myeloproliferative neoplasm (MPN) characterized by recurrent mutations in the JAK2, CALR, and MPL genes. The CALR and MPL co-mutation is very rare. To our knowledge, no more than five cases have been reported. Here, we report a case of PMF in which a CALR and MPL co-mutation was detected by next-generation sequencing (NGS) technology, and a literature review was performed.<br> CASE SUMMARY: A 73-year-old woman was admitted to our hospital in 2018 due to abdominal distension. The patient had splenomegaly, lymphadenopathy, leukopenia, anemia, and immature granulocytes in peripheral blood. There were dacrocytes and atypical megakaryocytes in bone marrow, and megakaryocytic proliferation was very active, accompanied by reticulin fibrosis grade 2. By NGS analysis of the bone marrow sample, we detected mutations in CALR, MPL, and PIK3RI, while JAK2 V617F and BCR-ABL were negative. Therefore, the patient was diagnosed with PMF and received oral ruxolitinib. However, the spleen and hematologic responses were poor. We review the literature, analyze previous reports of the mutation sites in our patient and differences between our patient and other reported cases of co-mutated CALR and MPL genes, and discuss the reason why the CALR and MPL co-mutations are rare and possible mechanisms and their impact on the prognosis of patients.<br> CONCLUSION: CALR and MPL mutations can be concurrent in MPN, but they are rare. The use of NGS may help to identify more patients with co-mutated CALR and MPL genes. This will help to further explore the mechanism and its impact on these patients to develop appropriate treatment strategies.<br> </p><p>PMID: 33344552 [PubMed]</p> <div style="clear:both;"> </div> </div> </td> </tr> <tr> <td> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344552?dopt=Abstract" target="_blank" style="text-decoration:none;display:block;padding:10px 14px;font-weight:500;background-color:#00a7f6;color:#ffffff;border-radius:3px;border:1px solid #00a7f6; text-align: center;font-size: 16px;">View on the web</a> </td> </tr> <tr height="20"></tr> </table> </td> </tr> </table> <table id="footer_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td style="font-size: 14px;text-align: left;"> <table width="600px" class="inner-table"> <tr> <td> <p style="border-top:1px solid #ddd;padding-top:8px;margin-top:24px"> <a href="https://www.inoreader.com?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:none;">Inoreader</a>. Take back control of your news feed. Follow us on <a href="http://www.twitter.com/Inoreader" style="text-decoration:none;">Twitter</a> and <a href="http://www.facebook.com/Inoreader" style="text-decoration:none;">Facebook</a>. </p> </td> </tr> </table> </td> </tr> </table> </td> </tr> </table> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-43753232524563311532020-12-22T22:47:00.005-08:002020-12-22T22:47:33.461-08:00Endometrial stromal sarcoma extending to the pulmonary artery: A rare case report.<table class="arial" cellpadding="0" cellspacing="0" style="width:100%;font-family:'Roboto', Arial, sans-serif"> <tr> <td align="center"> <table id="header_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr height="20"></tr> <tr> <td> <table width="600px" class="inner-table"> <tr> <td> <a href="https://www.inoreader.com" target="_blank"> <img src="https://www.inoreader.com/newsletter/images/email-logo.png" width="117" class="light-mode-logo"/> <img src="https://www.inoreader.com/newsletter/images/email-logo-light.png" width="117" class="dark-mode-logo"/> </a> </td> <td> </td> </tr> </table> </td> </tr> </table> <table id="content_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <span style="font-size:16px;margin:20px 0;padding-bottom:10px;font-weight:500;"> paythelady.612 </span> <span style="font-size:16px;letter-spacing:-0.02rem;margin:20px 0;padding-bottom:10px;"> shared this article with you from <a href="https://www.inoreader.com/article/3a9c6e7bf349f3e1?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:underline;">Inoreader</a> </span> </td> </tr> <tr height="20"></tr> </table> </td> </tr> <tr> <td style="text-align:left;"> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <div dir="ltr"> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344553?dopt=Abstract" style="font-size:24px;line-height:28px;text-decoration:none;font-weight:bold;">Endometrial stromal sarcoma extending to the pulmonary artery: A rare case report.</a> </div> </td> </tr> <tr> <td> <div style="margin-top:8px;"> <span style="font-weight: 300;">Μέσω</span> <a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Search&db=PubMed&term=%22World%20J%20Clin%20Cases%22%5Bjour%5D">pubmed: "world j clin cases"...</a> </div> </td> </tr> <tr> <td> <div class="article-content" style="font-size:16px;margin-top:16px;line-height:28px;font-family:'Merriweather', Georgia, serif;" dir="ltr"> <table width="100%"><tbody><tr><td></td><td><a href="https://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Link&LinkName=pubmed_pubmed&from_uid=33344553" target="_blank" rel="noopener" class="underlink bluelink" tabindex="-1">Related Articles</a></td></tr></tbody></table> <p><b>Endometrial stromal sarcoma extending to the pulmonary artery: A rare case report.</b></p> <p>World J Clin Cases. 2020 Nov 26;8(22):5625-5631</p> <p>Authors: Fan JK, Tang GC, Yang H</p> <p>Abstract<br> BACKGROUND: Endometrial stromal sarcoma (ESS) is a rare malignant mesenchymal tumor. Early in the disease, the findings on magnetic resonance imaging are similar to those of leiomyoma. When the lesion involves both vascular and cardiac tissue, it might be misdiagnosed as intravenous leiomyomatosis, which is not common in the clinic.<br> CASE SUMMARY: We present the case of a 34-year-old female patient with tumor embolus, which extended from the right iliac vein and ovarian vein to the inferior vena cava (IVC), and then to the right atrium and right ventricle, and finally protruded into the pulmonary artery. The patient had undergone a hystero-myomectomy 7 years previously. Based on the findings of the imaging examinations, the diagnosis of intravenous leiomyomatosis was considered preoperatively. The patient then underwent complete resection of the endovascular and intracardiac tumor embolus. The postoperative pathology results confirmed metastatic ESS with endovascular and intracardiac involvement. The patient was discharged from hospital in good condition, and there was no sign of recurrence 5 mo after the operation.<br> CONCLUSION: Extending from the iliac vein and ovarian vein to the IVC, this metastatic ESS invaded both vascular and cardiac tissues. For patients with ESS involving vascular and cardiac tissues, pathological examinations are essential for the differential diagnosis, such as intravenous leiomyomatosis. In addition, due to the high recurrence rate of ESS, long-term and close follow-up evaluation is necessary.<br> </p><p>PMID: 33344553 [PubMed]</p> <div style="clear:both;"> </div> </div> </td> </tr> <tr> <td> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344553?dopt=Abstract" target="_blank" style="text-decoration:none;display:block;padding:10px 14px;font-weight:500;background-color:#00a7f6;color:#ffffff;border-radius:3px;border:1px solid #00a7f6; text-align: center;font-size: 16px;">View on the web</a> </td> </tr> <tr height="20"></tr> </table> </td> </tr> </table> <table id="footer_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td style="font-size: 14px;text-align: left;"> <table width="600px" class="inner-table"> <tr> <td> <p style="border-top:1px solid #ddd;padding-top:8px;margin-top:24px"> <a href="https://www.inoreader.com?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:none;">Inoreader</a>. Take back control of your news feed. Follow us on <a href="http://www.twitter.com/Inoreader" style="text-decoration:none;">Twitter</a> and <a href="http://www.facebook.com/Inoreader" style="text-decoration:none;">Facebook</a>. </p> </td> </tr> </table> </td> </tr> </table> </td> </tr> </table> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0tag:blogger.com,1999:blog-3705211266459505875.post-91603800580178643822020-12-22T22:47:00.003-08:002020-12-22T22:47:23.940-08:00Malignant acanthosis nigricans with Leser-Trélat sign and tripe palms: A case report.<table class="arial" cellpadding="0" cellspacing="0" style="width:100%;font-family:'Roboto', Arial, sans-serif"> <tr> <td align="center"> <table id="header_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr height="20"></tr> <tr> <td> <table width="600px" class="inner-table"> <tr> <td> <a href="https://www.inoreader.com" target="_blank"> <img src="https://www.inoreader.com/newsletter/images/email-logo.png" width="117" class="light-mode-logo"/> <img src="https://www.inoreader.com/newsletter/images/email-logo-light.png" width="117" class="dark-mode-logo"/> </a> </td> <td> </td> </tr> </table> </td> </tr> </table> <table id="content_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <span style="font-size:16px;margin:20px 0;padding-bottom:10px;font-weight:500;"> paythelady.612 </span> <span style="font-size:16px;letter-spacing:-0.02rem;margin:20px 0;padding-bottom:10px;"> shared this article with you from <a href="https://www.inoreader.com/article/3a9c6e7bf349f3f5?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:underline;">Inoreader</a> </span> </td> </tr> <tr height="20"></tr> </table> </td> </tr> <tr> <td style="text-align:left;"> <table width="600px" class="inner-table"> <tr height="20"></tr> <tr> <td> <div dir="ltr"> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344554?dopt=Abstract" style="font-size:24px;line-height:28px;text-decoration:none;font-weight:bold;">Malignant acanthosis nigricans with Leser-Trélat sign and tripe palms: A case report.</a> </div> </td> </tr> <tr> <td> <div style="margin-top:8px;"> <span style="font-weight: 300;">Μέσω</span> <a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Search&db=PubMed&term=%22World%20J%20Clin%20Cases%22%5Bjour%5D">pubmed: "world j clin cases"...</a> </div> </td> </tr> <tr> <td> <div class="article-content" style="font-size:16px;margin-top:16px;line-height:28px;font-family:'Merriweather', Georgia, serif;" dir="ltr"> <table width="100%"><tbody><tr><td></td><td><a href="https://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Link&LinkName=pubmed_pubmed&from_uid=33344554" target="_blank" rel="noopener" class="underlink bluelink" tabindex="-1">Related Articles</a></td></tr></tbody></table> <p><b>Malignant acanthosis nigricans with Leser-Trélat sign and tripe palms: A case report.</b></p> <p>World J Clin Cases. 2020 Nov 26;8(22):5632-5638</p> <p>Authors: Wang N, Yu PJ, Liu ZL, Zhu SM, Zhang CW</p> <p>Abstract<br> BACKGROUND: Acanthosis nigricans (AN), Leser-Trélat sign, and tripe palm are all skin diseases. To date, reports of these appearing as a paraneoplastic syndrome in a gastric cancer patient are quite rare.<br> CASE SUMMARY: We report the case of a 61-year-old man with darkened skin color in the face and torso with no obvious inducement after 1 year of treatment for Riehl's melanosis. He had 40 brown maculopapular eruptions on his face and the top of his head with obvious itching. Papillary wart-like hyperkeratosis with dark brown pigmentation was also observed on both sides of the areola. He had papilloma-like lesions on the face, around the orbit, and on the neck. His bilateral palms had small, smooth, papillary projections with millet-like appearance. Histopathological examination of the skin showed that the patient was suffering from AN, tripe palms, and Leser-Trélat sign. Gastroscopy showed the patient's cardia was affected, and pathological biopsy revealed that he had moderate-to-poorly differentiated adenocarcinoma. Computed tomography test results showed that his cardia wall had thickened. Based on these histological and skin characteristics, the patient was diagnosed with gastric cancer with AN, tripe palms, and Leser-Trélat sign.<br> CONCLUSION: Researchers should follow up on patients with malignant AN, Leser-Trélat sign, and tripe palms.<br> </p><p>PMID: 33344554 [PubMed]</p> <div style="clear:both;"> </div> </div> </td> </tr> <tr> <td> <a href="https://www.ncbi.nlm.nih.gov/pubmed/33344554?dopt=Abstract" target="_blank" style="text-decoration:none;display:block;padding:10px 14px;font-weight:500;background-color:#00a7f6;color:#ffffff;border-radius:3px;border:1px solid #00a7f6; text-align: center;font-size: 16px;">View on the web</a> </td> </tr> <tr height="20"></tr> </table> </td> </tr> </table> <table id="footer_table" cellpadding="0" cellspacing="0" style="width:640px;"> <tr> <td style="font-size: 14px;text-align: left;"> <table width="600px" class="inner-table"> <tr> <td> <p style="border-top:1px solid #ddd;padding-top:8px;margin-top:24px"> <a href="https://www.inoreader.com?utm_source=email_sharing&utm_campaign=u1004820411&utm_medium=email" style="text-decoration:none;">Inoreader</a>. Take back control of your news feed. Follow us on <a href="http://www.twitter.com/Inoreader" style="text-decoration:none;">Twitter</a> and <a href="http://www.facebook.com/Inoreader" style="text-decoration:none;">Facebook</a>. </p> </td> </tr> </table> </td> </tr> </table> </td> </tr> </table> Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,http://www.blogger.com/profile/06256783141762724092noreply@blogger.com0