Clinical Treatment Recommendations Research Articles

Blood Oxygen Accumulation Distribution Area Index Is Associated With Erectile Dysfunction in Patients With Sleep Apnea-Results From a Cross-sectional Study.

IntroductionObstructive sleep apnea (OSA) has been linked with erectile dysfunction (ED), but the relatively independent polysomnography (PSG) outcomes of apnea and nocturnal hypoxia may not effectively assess the physiological impairment of OSA well.AimTo propose a new calculation method, the blood oxygen accumulation distribution area index (BOADAI), for evaluating the association between OSA and ED.MethodsIn this study, 502 male participants with suspected OSA were enrolled. Clinical questionnaire, physical measurements, and PSG outcomes were obtained by 2 respiratory physicians. ED was assessed by a urologist using the International Index of Erectile Function-5 (IIEF-5). Whole pulse oxygen saturation curves during the sleep time were compressed into a fixed scale image, and the distribution area of oxygen saturation curves was outlined. We then calculated the value of the outlined area and normalized it by total sleep time. The least absolute shrinkage and selection operator logistic regression model was used for selecting the optimal variable associated with ED and model construction. The clinical net benefit of the BOADAI and its related modules was estimated and compared by decision curve analysis.Main Outcome MeasureED and OSA were assessed using the IIEF-5, clinical questionnaire, physical measurements, and PSG outcomes.ResultsThe frequency of ED in patients with OSA was significantly greater than that in the no-OSA group. Meanwhile, the new BOADAI was negatively correlated with the IIEF-5 score (r = −0.2525, P = .0000). Moreover, the least absolute shrinkage and selection operator method retained BOADAI but not the other PSG parameters such as respiratory disorder index and lowest SaO2. Finally, logistic regression analysis revealed that older age, lips with cyanochroia, systemic hypertension, and BOADAI were independently associated with ED, and decision curve analysis indicated the clinical usefulness of the BOADAI module.ConclusionThis study revealed novel evidence that OSA is a risk factor for ED. Meanwhile, the BOADAI could act as a potential clinical characteristic to evaluate ED in patients with OSA and to provide clinical treatment recommendations.Zheng W, Chen X, Huang J, et al. Blood Oxygen Accumulation Distribution Area Index Is Associated With Erectile Dysfunction in Patients With Sleep Apnea—Results From a Cross-sectional Study. Sex Med 2019; 8:36–44.

Implications for Breast Cancer Restaging Based on the 8th Edition AJCC Staging Manual.

We assessed the changes that have resulted from the latest breast cancer staging guidelines and the potential impact on prognosis. Contemporary data suggest that combining anatomic staging and tumor biology yields a predictive synergy for determining breast cancer prognosis. This forms the basis for the American Joint Committee on Cancer's (AJCC) Staging Manual, 8th edition. We assessed the changes that have resulted from the new staging guidelines and the potential impact on prognosis. Women with stages I to III breast cancer from 2010 to 2014 in the National Cancer Data Base were pathologically staged according to the 7th and 8th editions of the AJCC Staging Manual. Patient characteristics and restaging outcomes were summarized. Unadjusted overall survival (OS) was estimated, and differences were assessed. Cox proportional-hazards models were utilized to estimate the adjusted association of stage with OS. After restaging the 493,854 women identified, 6.8% were upstaged and 29.7% were downstaged. The stage changes varied by tumor histology, receptor status, tumor grade, and Oncotype DX scores (all P < 0.0001). Applying the 8th edition criteria yielded an incremental reduction in survival for each increase in stage, which was not consistently seen in the 7th edition. In a subgroup analysis based on hormone receptor (HR) status, those with stages II and III, and HR- disease had a worse OS than those with HR+ disease. Applying the 8th edition staging criteria resulted in a stage change for >35% of patients diagnosed with invasive breast cancer and refined OS estimates. Overall, the transition to the 8th edition is expected to better drive clinical care, treatment recommendations, and future research.

Клинические рекомендации по диагностике и лечению подагры: насколько врачи первичного звена готовы к их обязательному соблюдению?

Клинические рекомендации по диагностике и лечению подагры: насколько врачи первичного звена готовы к их обязательному соблюдению?

Clinical diagnosis and treatment recommendations for immune checkpoint inhibitor-related adverse reactions in the nervous system.

Immune checkpoint inhibitors (ICIs) can cause adverse reactions in the nervous system. The incidence rate is 0.1%–12% and 80% of nervous system adverse reactions occur within the first four months of application. ICIs can cause diseases of various parts of the nervous system including central nervous system diseases such as aseptic meningitis, meningeal encephalitis, necrotizing encephalitis, brainstem encephalitis, transverse myelitis, etc., and peripheral neuropathy such as cranial nerve peripheral neuropathy, multifocal nerve root neuropathy, Guillain‐Barré syndrome, spinal nerve root neuropathy, myasthenia gravis, myopathy, etc. For these complications of the nervous system, diagnosis could be difficult. Physicians require a specific collection of nervous system symptoms and signs, combined with supplementary examinations including imaging, cerebrospinal fluid cytology, EEG or electromyography in order to exclude infection or malignant tumor before reaching a final diagnosis. With regard to treatment, ICIs should be discontinued in severe cases, and large doses of glucocorticoid or gamma globulin administered, and supportive treatment may be necessary. If severe adverse reactions of the nervous system occur, the prognosis could be poor.

A modular cluster based collaborative recommender system for cardiac patients.

In the last few years, hospitals have been collecting a large amount of health related digital data for patients. This includes clinical test reports, treatment updates and disease diagnosis. The information extracted from this data is used for clinical decisions and treatment recommendations. Among health recommender systems, collaborative filtering technique has gained a significant success. However, traditional collaborative filtering algorithms are facing challenges such as data sparsity and scalability, which leads to a reduction in system accuracy and efficiency. In a clinical setting, the recommendations should be accurate and timely. In this paper, an improvised collaborative filtering technique is proposed, which is based on clustering and sub-clustering. The proposed methodology is applied on a supervised set of data for four different types of cardiovascular diseases including angina, non-cardiac chest pain, silent ischemia, and myocardial infarction. The patient data is partitioned with respect to their corresponding disease class, which is followed by k-mean clustering, applied separately on each disease partition. A query patient once directed to the correct disease partition requires to get similarity scores from a reduced sub-cluster, thereby improving the efficiency of the system. Each disease partition has a separate process for recommendation, which gives rise to modularization and helps in improving scalability of the system. The experimental results demonstrate that the proposed modular clustering based recommender system reduces the spatial search domain for a query patient and the time required for providing accurate recommendations. The proposed system improves upon the accuracy of recommendations as demonstrated by the precision and recall values. This is significant for health recommendation systems particularly for those related to cardiovascular diseases.

Clinical Diagnosis and Treatment Recommendations for Ocular Toxicities of Target Therapy and Immune Checkpoint Inhibitor Therapy

靶向治疗和免疫治疗给晚期肿瘤患者带来了希望。但是治疗过程中的药物毒副作用也随着药物的普及而逐渐展现出来。其中眼部的毒副反应常被患者和医生忽视。眼部的不良反应包括从眼睑、睫毛、结膜、角膜、葡萄膜、视网膜、视神经和眼眶等，可累及眼部的所有组织。本文就靶向治疗和免疫治疗相关的眼部毒副作用的诊断和治疗给予相应的描述和建议。

Clinical Diagnosis and Treatment Recommendations for Adverse Reaction in the Nervous System Related to Immunocheckpoint Inhibitor

免疫检查点抑制剂（immune checkpoint inhibitors, ICIs）可引起神经系统的不良反应，发生率在0.1%-12%，80%发生在应用前4个月内。可以引起神经系统各部位的病变，包括无菌性脑膜炎，脑膜脑炎，坏死性脑炎，脑干脑炎，横贯性脊髓炎等中枢神经系统病变，也可引起颅神经周围神经病、多灶性神经根神经病、格林巴利综合征、脊神经根神经病、重症肌无力、肌病等周围神经病变。对于神经系统的这些并发症，均需要症状体征，并结合影像学、脑脊液细胞学、脑电图或肌电图等检查，除外感染或恶性肿瘤后获得诊断。治疗中，在严重病例需停用ICIs，并用大剂量糖皮质激素或丙种球蛋白治疗和对症支持治疗。在出现神经系统不良反应后，严重病例预后较差。

Clinical Diagnosis and Treatment Recommendations for Cardiac Adverse Reactions Related to Immune Checkpoint Inhibitor

恶性肿瘤的免疫治疗已经成为肿瘤研究和治疗领域的热点，给晚期肿瘤患者带来了新的希望。免疫检查点分子程序性死亡蛋白-1和细胞毒性T淋巴细胞相关抗原4相关信号通路的激活可以抑制T淋巴细胞活化，从而阻断炎症反应。肿瘤细胞通过激活免疫检查点分子相关的信号通路实现免疫逃逸。而免疫检查点抑制剂能够唤醒T淋巴细胞，增强机体对肿瘤细胞的清除。但是免疫检查点抑制剂的作用并非肿瘤细胞特异，在杀灭肿瘤细胞的同时，会引起包括心血管系统在内的多系统副作用。我们将总结相关的心脏副反应并对如何防治给予建议。

Clinical Diagnosis and Treatment Recommendations for the Pneumonitis Associated with Immune Checkpoint Inhibitor

免疫检查点抑制剂在肿瘤中的使用给晚期肿瘤患者带来了新的希望。然而，由免疫检查点抑制剂激活的免疫系统，其中主要是T细胞免疫，可能攻击人体正常组织器官导致相应的免疫毒性反应产生，在肺部可引起免疫检查点抑制剂相关肺炎。这是一类不同于已知肺部间质性肺炎的疾病，如处理不当，有潜在的致命风险。我们将对免疫检查点抑制剂相关肺炎的诊断和治疗给予建议。

Clinical Diagnosis and Treatment Recommendations for Immune Checkpoint Inhibitor-related Hematological Adverse Events

免疫检查点抑制剂能够重新激活免疫系统，启动肿瘤杀伤，而T细胞过度激活导致各种免疫相关不良反应。血液系统不良反应报道少见，主要表现为单系或多系血细胞减少，包括自身免疫性溶血性贫血、免疫性血小板减少症、中性粒细胞减少症，严重时表现为再生障碍性贫血，甚至可能致命，如噬血细胞淋巴组织细胞增多症。我们将总结免疫检查点抑制剂相关血液不良反应的临床特点，并对诊断和治疗给予建议。

Primary tumor (tumoral) calcification is a rare disease in the practice of a rheumatologist and orthopedist: experience with the use of an interleukin-1 inhibitor in combination with surgical correction

Background. Primary tumoral calcinosis is an orphan disease. There are few data in the literature on the incidence of this disease, as well as clinical recommendations for treatment.&#x0D; Clinical case. This report presents the case of an 11.5-year-old boy with primary tumoral calcinosis and equinus deformity of the foot. The patient had multiple foci of the subcutaneal calcification, cannot walk, experienced fatigue, and had high fever and equinus deformity of the left foot. Immunological and genetic studies were performed, but any specific mutations were not found. After the diagnosis was verified and interleukin-1 inhibitor therapy was prescribed, there was a significant positive trend observed in the patient: a significant improvement in the patients general condition, a decrease in the number of calcinates, and a reduction in inflammation. Calcification of the Achilles tendon and gastrocnemius muscle was the cause of the deformity of the left foot.&#x0D; Discussion. Significant improvement was achieved during treatment: the boy started walking, fatigue was decreased, no new calcificates were formed, and inflammation was under the control. Using an inhibitor of interleukin-1 as a permanent therapy of primary tumoral calcification allowed performsurgical treatment without complications from an operation site, as well as a relapse of deformity.&#x0D; Conclusion. The clinical case presented here demonstrated the application of an interdisciplinary approach to the treatment of an extremely rare disease.

Clinical treatment and practice recommendations for disordered eating in Asian Americans.

Clinical treatment and practice recommendations for disordered eating in Asian Americans.

Nordic clinical guidelines for orthotic treatment of osteoarthritis of the knee: A systematic review using the AGREE II instrument.

High-quality clinical practice guidelines are necessary for effective use of resources both at an individual patient- and national-level. Nordic clinical practice guidelines recommendations for orthotic treatment of knee osteoarthritis vary and little is known about their quality. The aim of the study was to critically evaluate the quality of clinical practice guidelines in orthotic management of knee osteoarthritis in the Nordic countries. Systematic review. Four national clinical practice guidelines for treatment of knee osteoarthritis were assessed for methodological rigour and transparency by four independent assessors using the AGREE II instrument. Summary domain scores and inter-rater agreement (Kendall's W) were calculated. Domain scores indicate that many guidelines have not sufficiently addressed stakeholder involvement (average score: 55%), applicability (20%) and editorial independence (33%) in the development process. Inter-rater agreement for assessors indicated 'good' agreement for clinical practice guidelines from Finland, Norway and Sweden (W = 0.653, p < 0.001; W = 0.512, p = 0.003 and W = 0.532, p = 0.002, respectively) and 'strong' agreement for the clinical practice guideline from Denmark (W = 0.800, p < 0.001). Quality of clinical practice guidelines for orthotic treatment of knee osteoarthritis in the Nordic region is variable. Future guideline development should focus on improving methodology by involving relevant stakeholders (e.g. certified prosthetist/orthotists (CPOs)), specifying conflicts of interest and providing guidance for implementation. The current review suggests that, for the Nordic region, there are areas of improvement which can be addressed, which ensure clinical practice guidelines are developed under stringent conditions and based on sound methods. These improvements would ensure knee osteoarthritis patients are receiving orthotic interventions based on appropriate guidance from published guidelines.

Age-related Hearing Loss and Dementia

Dementia is a devastating disease and global health challenge that is highly prevalent worldwide. A growing body of research has shown an independent association between age-related hearing loss (ARHL) and dementia, identifying ARHL as a compelling potential target in preventive strategies for dementia. However, a causal linkage between ARHL and dementia needs to be investigated before making definitive clinical guidelines and treatment recommendations regarding ARHL as a modifiable risk factor. In this review, we discuss the association between ARHL and dementia, the importance of addressing this finding, as well as common mechanisms (eg, microvascular disease) and causal mechanisms (eg, depletion of cognitive reserve and social isolation) that may explain the nature of this relationship. Future directions for research are also highlighted, including randomized controlled trials, developing high-resolution microvascular imaging, and further refining audiometric testing.

Concordance between practitioner questionnaire responses and observed clinical treatment recommendations for treatment of dentin hypersensitivity: findings from the National Dental Practice-Based Research Network

BackgroundFew published reports have presented concordance between treatment choices selected by dentists in hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice. The aim of the current cross-sectional study, conducted within the Management of Dental Hypersensitivity (MDH) study, was to assess the potential value of practitioners’ questionnaire responses regarding their typical treatment provided for management of dentin hypersensitivity (DH), by evaluating agreement between these responses and subsequently-observed recommendations recorded during actual clinical examinations.MethodsA total of 171 practitioners enrolled in the National Dental Practice-Based Research Network completed both a questionnaire and a clinical study regarding methods they use to treat dental hypersensitivity. The questionnaire solicited first-, second- and third-choice products when prescribing or recommending management of dentin hypersensitivity. Agreement was calculated for first-choice products/recommendations and for inclusion in the top three choices, as identified by the practitioners, from 11 listed treatment options. Overall percent agreement and Cohen’s kappa statistic were calculated, with associated 95% confidence intervals (CI). Associations between practitioner characteristics and agreement were also evaluated.ResultsFor individual treatment modalities, percentage agreement ranged from 63 to 99%, depending on the specific item. Percentage agreement between typical treatment and actual treatment for each practitioner’s top three treatment modalities, as a combined grouping, ranged from 61 to 100%. When these same agreement pairings were quantified to account for agreement above that expected by chance, kappa values were poor to low.ConclusionsConcordance between hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice showed moderate to high levels of percentage agreement, but Cohen’s kappa values suggested relatively low levels of agreement beyond that expected by chance. This analysis adds to the larger work of the network which has now observed a wide range of agreement between hypothetical and actual care, depending upon the specific diagnosis or treatment under consideration.Questionnaire data for DH might serve as a useful adjunct to clinical data regarding treatment recommendations, but agreement was not sufficiently high to justify use of questionnaires alone to characterize patterns of treatment for this particular condition.

A Review of Hip-Spine Syndrome

This review is aimed at summarizing our current understanding of hip-spine syndrome. In particular, the review discusses the clinical assessment and diagnosis of commonly implicated conditions to help a practitioner realize an efficient and organized approach to the evaluation and management of pain in the setting of hip-spine syndrome. While initially described as the concurrent presence of hip osteoarthritis and lumbar spinal stenosis, the catalog of diagnoses associated with hip-spine syndrome has expanded and includes femoroacetabular impingement, acetabular dysplasia, hip osteoarthritis, sacroiliac joint-mediated pain, facet arthropathy, and lumbar spinal stenosis. There is a limited body of evidence describing clinical findings and treatment recommendations when these diagnoses present concurrently. From the available literature, it seems that patients may be successfully managed with a multimodal approach, although absolute resolution of symptoms is not always plausible. In the context of hip-spine syndrome, identification of a primary pain generator or etiology, when present, is important to guide successful management. Lingering symptoms may persist and can suggest the presence of a more co-dependent relationship between the hip and the spine (so-called complex hip-spine syndrome). Further research is needed to clarify the influences that underlie hip-spine syndrome, particularly in these more complex cases, and in turn better define diagnostic and treatment algorithms.

2454-PUB: Hypoglycemic Symptoms in the Absence of Diabetes: Pilot Evidence of Clinical Hypoglycemia in Young Healthy Women

Background: Hypoglycemic symptoms in the absence of diabetes remains a common complaint in endocrinology practices, but remains understudied and lacks clinical definition and evidence-based recommendations for diagnosis or treatment. Our goal was to pilot test the concordance of hypoglycemic symptoms with low glucose values in young healthy individuals. Methods: We recruited 8 individuals who reported regularly experiencing symptoms consistent with hypoglycemia to wear a blinded Dexcom continuous glucose monitor and report symptoms for seven days. We excluded individuals with diabetes or other known causes of hypoglycemia. Results: All participants experienced glucose values &amp;lt;70mg/dL and half (4/8) experienced glucose &amp;lt;50mg/dL for at least 15 minutes or 3 consecutive readings. Lower glucose values were significantly associated with higher odds of experiencing hypoglycemic symptoms (OR=1.15 (1.06-1.24) for every 5mg/dL, p&amp;lt;0.001) from mixed effects models for repeated measures (Figure). All participants also reported reduced quality of life and engaging in potentially obesogenic behaviors in order to avoid symptoms. Conclusions: Individuals with hypoglycemic symptoms in the absence of diabetes experience clinical hypoglycemia, indicating the need to understand the etiology, behavioral responses, and other health risks that might be associated with this condition. Disclosure M. Mongraw-Chaffin: None. D. McClain: None. D.P. Beavers: None. Funding National Center for Advancing Translational Sciences (UL1TR001420)

Hair loss: A review of the role of food bioactive compounds

Background: The impact that hair loss has on an individual's psychological wellness, and subsequent quality of life, is widespread and long lasting. The current standard treatments for hair loss include surgery and medications, ranging from over-the-counter treatments to corticosteroid injections and immunosuppressants. Unfortunately, these current treatments are either expensive, invasive, or have extremely negative side effects. Recently, the role of vitamins, minerals, and functional foods with their associated bioactive compounds, have gained increasing recognition as a potential means to address this issue. Some of these compounds have been shown to decrease the risk of specific forms of hair loss, particularly alopecia, a form of balding that results due from an autoimmune disorder. These include experimental studies using black raspberry extract and egg yolks as well as epidemiological studies using Mediterranean diets and various micronutrients. Other compounds have been shown to promote hair growth on a more general scale, including in vivo studies using rice bran extract and mouse models using red ginseng oil and annurca apple polyphenols. This review identifies key hair growth promoting vitamins, minerals, and functional foods, as well as summarizes the relevant mechanisms of action of these compounds that have been elucidated. Knowledge regarding the effects of these nutriceuticals on reducing hair loss is rapidly expanding. However, it is imperative that further research be done in order to delineate mechanisms of actions for all compounds related to managing and treating hair loss and subsequently integrate these dietary modifications into clinical treatment recommendations for hair loss.Keywords: Hair loss, alopecia, berry extract, mediterranean diet, rice bran, ginseng, annurca apple, thuja orientalis, marine supplement, honey, egg yolk, functional foods, bioactive compounds

Impact of Magnetic Resonance Imaging on Prostate Cancer Staging and European Association of Urology Risk Classification

To investigate the impact of magnetic resonance imaging (MRI) information on clinical staging, risk stratification, and treatment recommendations for prostate cancer (PCa) according to the European Association of Urology (EAU) guidelines. We performed a single-center analysis of 180 men with PCa, undergoing clinical staging by digital rectal examination (DRE) as well as MRI before their robot-assisted radical prostatectomy. Patients were stratified according to the EAU guidelines into 4 well-defined risk categories, based on their clinical T-stage assessed by either DRE or MRI. Descriptive statistics of categorical variables are shown as frequencies and proportions. Differences between both scenarios (DRE- vs MRI-staged) were analyzed using a paired-samples sign test. Use of MRI information instead of DRE information leads to significant upstaging of clinical T-stage (33%) and EAU risk grouping (31%). When comparing these results with the pathologic T-stage, MRI showed a higher sensitivity than DRE to detect nonorgan-confined PCa (59% vs 41%; P <.01). In contrast, the specificity of MRI was lower than DRE (69% vs 95%; P <.01). Incorporation of MRI-based instead of DRE-based staging in the treatment decision process would alter the surgical treatment strategy in 49/180 patients (27%). The incorporation of MRI information substantially affects the treatment choice in PCa patients as compared to using the current available EAU guidelines based on DRE information. More specifically, treatment intensification would be recommended in 1 out of 4 patients.

Hearing Loss and Depression in the Hispanic/Latino Population

Hearing Loss and Depression in the Hispanic/Latino Population