Clinical Research Center Research Articles

Patient preferences for use of archived biospecimens in Turkey.

e18904 Background: In the era of precision medicine translational research biospecimen collection and data sharing is increasingly needed. Ethical challenges emerge when researchers want to use archived biospecimens without informed consent. We examined Turkish cancer patients' or their family member's preferences about informed consent and the use of excised and stored (tumor) tissues in medical research. Methods: A questionnaire in Turkish language was conducted including the sociodemographic characteristics of the participants and preferences about informed consent and use of tumour tissues in medical research. The study was carried out in 5 tertiary health care institutions with clinical research centers in Turkey. Adult patients diagnosed with solid tumors or their family members who agreed to participate were surveyed by medical doctors between January 2020 and April 2021. Results: 978 people whose age ranged 18 and 82 (Mean = 51.43, SD = 14.41) participated in the study. %50.3 were male, %49.7 were female. %60,2 were cancer patient, %39,8 were family member. %82.4 stated that informed consent must be obtained before participating into clinical trials. %31.5 think that infomed consent can be given by their family members. %32.1 stated that medical records can be reviewed for scientific purposes without their consent. %54.9 know that tumor tissue samples stored in hospitals. %38.9 think that tissue samples belong to hospital. %65.6 agrees that tissue or blood samples may be used for research purposes. %49.8 gives permission for tumour tissues or blood samples to be used for research purposes without informed consent. %40.7 gives permission for genetic tests or DNA analysis without informed consent. According to %57.2 of the participants if tumor tissue is going to be used for research purposes, written consent must be obtained. %62.1 stated that if they give permission for a research their tissues can be used for every research. %65.5 allows tissue samples could be linked to personal medical records with their name and personal information confidential. Top motivations for allowing biospescimens for medical research are help treat other people (%76.3), help advance science (%68.4). %50 allowed their tissues to be used for research after their death, %39.1 wants their family members to give consent. Only %23.5 of participants stated that he or she had sufficient knowledge about personal data protection law in turkey. Conclusions: This study contributes to the data on the aspects of cancer patients about tissue banking. The majority of patients are willing to allow their tissues to be used for research purposes and to allow their medical records to be associated with tissue samples. However, there are also patients who are unsure. Comprehensive informed consent and optional consent models should be developed to improve the acceptability of tissue banking programs, and patients should be informed about the potential benefits of tissue donation.

Awareness and perceptions of clinical trials in patients with cancer and their families in Turkey.

e18780 Background: Patient preference plays an important role in enrolling in clinical trials. We conducted this study to understand the perceptions knowledge and willingness of cancer patients or their families about clinical trials. Methods: A questionnaire in Turkish language was conducted including the sociodemographic characteristics of the participants and the factors that may affect their decision to participate in clinical trials. The study was carried out in 5 tertiary health care institutions with clinical research centers in Turkey. Adult patients diagnosed with solid tumors or their family members who agreed to participate were surveyed by medical doctors. Participants were interviewed between January 2020 and April 2021. Comparisons between groups were carried out using chi-square test χ2 for the categorical variables. IBM SPSS25 was used in analyses and p<0.05 was accepted as the level of significance. Results: A total of 978 patients whose age ranged 18 and 82 (Mean= 51.43, SD=14.41) participated in the study. %50.3 was male, %40.7 was female. Willingness to participate a clinical trial was positively corelated with participants self reported health condition is excellent or good (p=0.206), well knowledge about clinical trials (p<0.001), high school or higher education level (p<0.001), household income above poverty level (p=0.003), previously received systemic cancer treatment of himself or family member or friend (p=0.03). %73.7 stated they are more willing to participate if their oncology specialist conducting the clinical trial. %84.3 want to get information about the clinical trial from their oncology specialist. %72.5 stated that positive experiences of a previous clinical trial participant will affect their decision making. Top corcerns about clinical trials are possible treatment side effects (%56.7), being treated as a test subject (%29), risk of placebo (%20.1). Top motivations are accessing best doctors (%45.8), accessing newest and best treatment options (%40.7), getting more information about their health condition (%68.9), helping science adventions (%82.6). Conclusions: Even when patients are eligible for a clinical trial physicians may somehow not discuss the clinical trial option. For patients oncology specialists are a highly trusted source of information and can play an important role in raising awareness and encouraging participation. [Table: see text] [Table: see text]

Expert consensus on the prevention of venous thromboembolism for elderly patients with critical illness in China (2023)

Patients with critical illness are at the high risk of venous thromboembolism (VTE), and the older the patient, the higher the incidence of VTE. Despite its poor prognosis, VTE is preventable. At present, although there are many consensus or guidelines on the prevention of VTE at home and abroad, there is still a lack of consensus or guidelines for the prevention of VTE in elderly patients with critical illness. In order to standardize the prevention of VTE in elderly patients with critical illness in China, Expert consensus on the prevention of venous thromboembolism for elderly patients with critical illness in China (2023) was developed by Critical Care Medicine Division of Chinese Geriatric Society and Zhejiang Provincial Clinical Research Center for Critical Care Medicine. Members of the working group consulted relevant domestic and foreign guidelines, integrated evidence-based medical evidence and clinical experience, formed the draft consensus, submitted it to the expert group for discussion for many times, revised it for many times, and finally sent it to the expert group in the form of electronic questionnaire, and the expert gave a comprehensive score according to the theoretical basis, scientific nature and feasibility of the consensus items. The recommendation strength of each item was determined, and 21 recommendations were finally formed to provide reference for the prevention of VTE in elderly patients with critical illness.

Editorial introductions.

Editorial introductions.

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Introduction: BTK inhibitors (BTKi) monotherapy has introduced the concept of continuous treatment in CLL/SLL until disease progression, leading to several concerns like lack of deep remission, increasing risk of toxic effects and substantial cost. Therefore, time-limited treatment strategies as first line treatment of CLL/SLL were comprehensively explored and BTKi combined with chemoimmunotherapy was one of these options which could induce durable responses in young fit patients. Methods: CLL/SLL patients who were treated with iFCR as initial therapy in the First Affiliated Hospital of Nanjing Medical University were included without any genomic restrictions. Ibrutinib (420 mg daily) was given continuously for 2 years and intravenously rituximab (375 mg/m2 in day 0 of cycle 1; 500 mg/m2 in day 0 of cycle 2–6), fludarabine (25 mg/m2, days 1–3) and cyclophosphamide (250 mg/m2, days 1–3) were administered every 28-day cycle, up to maximal 6 cycles. Patients who achieved complete remission or complete remission with incomplete recovery (CR/CRi) and bone marrow (BM) undetectable MRD (uMRD) 2 years after iFCR initiation were feasible to discontinue ibrutinib maintenance. Results: 34 previously untreated, young fit CLL/SLL patients who received iFCR regimen between January 2019 and March 2021 were included in our cohort. The median age was 55 years (IQR: 48–56). IGHV was unmutated in 21 of 34 (61.8%) patients; complex karyotype was present in 11 of 34 (32.4%) patients; TP53 mutation or del(17p) was detected in 6 of 34 (17.6%) patients. CR/CRi rate and BM uMRD rate was 35.3% (12/34) and 41.2% (14/34) after 3 cycles of iFCR and increased to 55.9% (19/34) 2 months after 6 cycles in both patients who received 3 or 4 and 6 cycles of iFCR. The best CR/CRi and BM uMRD rate were both 73.5% (25/34). With the median follow-up of 33 months (range 7–42 months), the 3-year PFS and OS rate was 80.0% and 95.5% respectively. CR/CRi rate and BM uMRD rate was comparable between patients with IGHV mutated and unmutated status without TP53 aberration, while all patients with TP53 aberration failed to achieve sustainable CR/CRi or BM uMRD. Patients who achieved MRD 10-6 negative post 3 cycles of iFCR sustained remission and discontinued ibrutinib maintenance. The most common hematological adverse events were neutropenia (25/34, 73.5%) and thrombocytopenia (24/34, 70.6%), grade 3–4 neutropenia and thrombocytopenia occurred in 67.6% (23/34) and 35.3% (12/34) patients respectively. The most common non-hematological adverse events were nausea (21/34, 61.8%), fatigue (16/34, 47.1%) and vomiting (15/34, 44.1%). Conclusion: The iFCR regimen could achieve high response rate and uMRD rate as initial treatment for young fit CLL/SLL patient without TP53 aberrations with acceptable tolerability. MRD-guided iFCR courses adjustment in patients who achieved early phase remission could achieved sustainable response and reduced toxicity. Encore Abstract - previously submitted to regional or national meetings (up to <1’000 attendees) The research was funded by: This study was supported by National Natural Science Foundation of China (Grant No. 82170166, No. 82100207, No. 82170186, No. 81970146, No. 81900167), Translational Research Grant of National Clinical Research Center for Hematology (2020ZKZB01), Six Talent Peaks Project in Jiangsu Province 2019 (Grant No. WSN-001) and Youth Talent support Project in Jiangsu Province Hospital (Grant No. YNRCQN035). Keywords: Chronic Lymphocytic Leukemia (CLL), Combination Therapies No conflicts of interests pertinent to the abstract.

Consensus on targeted drug therapy for spondyloarthritis

Spondyloarthritis (SpA) is a group of chronic inflammatory conditions that predominantly involve the spine and/or peripheral joints. The clinical manifestations of SpA are diverse and disabling, with SpA adversely affecting the quality of life of patients. Many new medications that target cytokines or pathways specific for the pathogenesis of SpA have been developed and these are becoming increasingly important in the treatment of SpA. However, establishing how to identify the target patient population and standardizing the usage of these drugs are critical issues in the clinical application of these "targeted therapies".Under the leadership of National Clinical Research Center for Dermatologic and Immunologic Diseases (Peking Union Medical College Hospital), the"Consensus on targeted drug therapy for spondyloarthritis" has been developed collaborating with the Rheumatology and Immunology Physicians Committee, Chinese Medical Doctors Association, Rheumatology and Immunology Professional Committee, Chinese Association of Rehabilitation Medicine, Chinese Research Hospital Association Rheumatology and Immunology Professional Committee. This consensus was developed with evidence-based methodology and followed the international standard for consensus development.

Expert consensus on the diagnosis and treatment of Alport syndrome (version 2023)

The "Expert Recommendations on the Diagnosis and Treatment of Alport Syndrome" published in 2018 have greatly promoted the standardized management of Alport syndrome in China. In recent years, the rapid advances in researches related to this disorder have provided new insights into the clinical practice of Alport syndrome. To this end, based on the latest research progress at home and abroad, the Alport Syndrome Collaborative Group, the National Clinical Research Center of Kidney Diseases of Jinling Hospital and the Rare Diseases Branch of Beijing Medical Association have jointly organized the experts in relevant fields to revise the 2018 version of the recommendations. The updated version adds new contents related to genetic testing and variant interpretation, and refines the strategies for diagnosis, treatment and follow-up management, thereby providing guidance for the clinical diagnosis and treatment of Alport syndrome.

Perspective of patients on the use of telemedicine in cardiovascular care

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This study is part of Limburg Clinical Research Center, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. Background Many cardiovascular patients are only seen by a physician once or twice a year unless urgent symptoms occur. However, secondary prevention, including self-management, is important in cardiovascular diseases. The use of digital technologies to follow patients remotely, i.e. telemedicine, is increasing. This creates opportunities to provide a more continuous way of follow-up. It is recommended to involve patients in the development of such tools in order to optimise their implementation in clinical practice. Purpose This survey-based study investigated patients’ perspectives on telemedicine and the defined features/services they consider important for using telemedicine in their (daily) care. Methods At two Belgian hospitals, both cardiology patients with various types of prior telemedicine follow-up and patients who never had a telemonitoring follow-up were included. A new self-developed survey was implemented in Qualtrics and took 5-10 minutes to complete. Patients with previous telemedicine follow-up were contacted by phone. If they agreed to participate, the survey was sent by email and filled in online. On the other hand, patients in the control group were included at the cardiology ward and filled in the survey independently on a tablet. The study was approved by the local Ethical Committees. Results In total, 231 patients (191 telemedicine and 40 controls) of the 786 contacted patients were included. Most patients owned a smartphone (84.8%) and only 2.2% of the patients did not own any digital device. As shown in Figure 1, patients with previous use of telemedicine are more interested in such new technologies than control patients (p=0.020). Of the defined services, personalized medicine in various formats attracted most interest in both groups (i.e. personalized health tips based on the medical history, 89.6%; personalized feedback on entered health parameters, 86.1%; and (personalized) information about their medical condition, 85.3%). Recommendation by a doctor is a motivating factor to use telemedicine (84.8%), while a decrease of in-person visits and replacing these with telemedicine follow-up is rather a barrier (24.7%). Two-thirds of the patients in this Belgian cohort (67.1%) would be willing to pay for telemedicine tools, with more patients in the experienced telemedicine group (69.6%) compared to the control group (55.0%; p=0.073). The patients willing to pay, would pay a mean monthly sum between €12.2 and €21.8 or a yearly global sum between €51.5 and €59.5 for telemedicine that supplements their regular insurance. Conclusion Cardiovascular patients have a positive attitude towards telemedicine, especially when it allows for more personalized care and lifestyle advice. Previous use of telemedicine led to a higher willingness to pay. Addressing patient concerns, highlighting the complementary value of telemedicine services, and maintaining equal access for all patients are important for effective implementation.

Rigorous and long-term cardiac monitoring strategy in cryptogenic stroke or TIA patients in a tertiary care centre results in a two-fold increase in AF detection

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Special Research Fund (Bijzonder Onderzoeksfonds, BOF) Hasselt University. This study is part of Limburg Clinical Research Center, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. Background Atrial fibrillation (AF) is a major cause of ischaemic stroke. Oral anticoagulation is recommended in stroke survivors with AF to prevent recurrence. Prolonged ECG monitoring using insertable cardiac monitors (ICMs) has been shown to increase the detection rate of AF compared to standard 24-hour ECG monitoring in cryptogenic stroke patients. However, prolonged ambulatory ECG monitoring is underutilized, likely contributing to an underdiagnosis of AF and missed anticoagulation treatment opportunities for secondary stroke prevention. Purpose This study aims to evaluate how our evolving cardiac monitoring strategy affected AF detection rates one year after cryptogenic ischaemic stroke or transient ischaemic attack (TIA) in a tertiary care centre. Methods We retrospectively identified all consecutive cryptogenic stroke or TIA patients admitted to our centre between 1/01/2017 – 1/01/2022. Patients with a pacemaker or implantable cardioverter-defibrillator were excluded from the analysis. Data were collected from the electronic medical record. Available cardiac monitoring modalities included 24-hour Holter monitoring, 7-day Holter monitoring, and insertable cardiac monitors (ICM). After October 2020 (i.e., period 2), the latter became part of our routine diagnostic workup for AF detection in case extended (7-day) Holter monitoring was negative. Results All 691 cryptogenic stroke or TIA patients admitted to our hospital during the inclusion period were considered. These were elderly patients (69.7 ± 13.2 years) with a CHA2DS2-VASc score of 3 [2 - 5]. Figure 1 shows evolving trends in the use of the different cardiac monitoring tools before and after October 2020. In particular, the use of 7-day Holter monitoring and long-term continuous monitoring with ICM increased after implementing our new diagnostic protocol compared to 24-hour Holter monitoring (p&amp;lt;.001). ICMs were inserted 95 [66 – 145] days after index stroke or TIA. The new diagnostic protocol detected more AF one year after the index stroke or TIA (3.7% vs. 10.1%, p&amp;lt;.001, Figure 2). In 95.6% of patients with AF detected within one year, oral anticoagulation was initiated. Future research should determine whether adopting a strategy of routine ICM following cryptogenic stroke and, thus, more appropriate anticoagulant therapy may improve clinical outcome in these patients. Conclusions The increased use of prolonged cardiac monitoring in cryptogenic stroke or TIA patients resulted in a two-fold increase in AF detection one year after stroke. Therefore, our results underscore the need to implement guideline-recommended prolonged rhythm monitoring using ICMs in addition to short-term ECG monitoring to ensure adequate secondary stroke prevention.

Usability and accuracy of polygraphy devices as a screening tool for obstructive sleep apnea in an atrial fibrillation population

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This study is part of Limburg Clinical Research Center, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. Background Obstructive sleep apnea (OSA) is an important modifiable risk factor in patients with atrial fibrillation (AF). Unfortunately, it is underdiagnosed in daily clinical practice, although up to 62% of AF patients may have OSA. Early detection of OSA is essential for rhythm control in AF patients. Currently, the gold standard for diagnosing OSA is polysomnography (PSG), but besides being an expensive method, it also requires a supervised hospitalization of one night. There is a lack of accurate and easy-to-use tools to test for OSA that can be implemented in daily ambulatory care. Purpose This study examined the accuracy and user-friendliness of several (cardiorespiratory) polygraphy devices (PG) as a simple screening tool for OSA in an outpatient AF population. Methods This prospective cohort study determines the accuracy of 4 PGs [ApneaLink Air (ALA), SOMNOtouch RESP (STR), SpiderSAS (SpS), and Noxturnal T3 (Nox-T3)] in AF patients who underwent a PSG evaluation at two Belgian sleep clinics. All the patients were instructed and asked to use a PG for one night at home. The Apnea-Hypopnea Index (AHI) was used to identify if moderate to severe OSA was present, i.e. AHI ≥15. Moreover, specific AHI cut-off values for each PG were derived based on the receiver operating characteristics (ROC) curves (best Youden's J Index and an accuracy of more than 0.7 compared to PSG). In addition, patients completed a Comfort Questionnaire (CQ) in order to assess the PG’s user-friendliness. Results In total, 130 AF patients undergoing a PSG were included (100 who tested the three devices ALA, STR, SpS and 30 patients who only tested Nox-T3). Only the successful measurements (i.e. ≥4 hours of data on automated analysis; n=250, 75.8%) were examined. The success rate for the ALA, STR, SpS, and NOX-T3 devices was 72.0%, 73.0%, 79.0% and 86.7%, respectively. The optimal AHI cut-off value for each PG in screening for clinically relevant OSA (i.e. AHI ≥15 on PSG) was 7.0, 10.0, 19.5, and 11.1 for the ALA, STR, SpS, and Nox-T3, respectively. The Nox-T3 PG had the highest sensitivity (92.9%), specificity (75.0%) and accuracy (0.85) in comparison to the other three PGs (Table 1). In addition, the scores of three important questions of the CQ were higher for the patients with Nox-T3 compared to the other PGs (Table 2). Conclusion Our results demonstrate the usability of PGs as early OSA screening tools in AF patients. The Nox-T3 with an optimized AHI cut-off value of 11.1 seems to be the best option for ambulatory OSA screening, based both on accuracy and user-friendliness.

Long-term outcomes following exclusive use of endovascular aortic repair for ruptured infrarenal abdominal aortic aneurysms.

Long-term outcomes following exclusive use of endovascular aortic repair for ruptured infrarenal abdominal aortic aneurysms.

Association between inflammation, body mass index, and long-term outcomes in patients after percutaneous coronary intervention: A large cohort study.

Association between inflammation, body mass index, and long-term outcomes in patients after percutaneous coronary intervention: A large cohort study.

Gut dysbiosis-derived β-glucuronidase promotes the development of endometriosis

To explore the role of gut dysbiosis-derived β-glucuronidase (GUSB) in the development of endometriosis (EMs). 16S rRNA sequencing of stool samples from women with (n = 35) or without (n = 30) endometriosis and from a mouse model was conducted to assess gut microbiome changes and identify molecular factors influencing the development of endometriosis. Experiments invivo in an endometriosis C57BL6 mouse model and invitro verified the level of GUSB and its role in the development of EMs. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University; Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases. Women of reproductive age with a histological diagnosis of endometriosis were enrolled in the endometriosis group (n = 35) and infertile or healthy age-matched women who had undergone a gynecological or radiological examination in the control group (n = 30). Fecal and blood samples were taken the day before surgery. Paraffin-embedded sections from 50 bowel endometriotic lesions, 50 uterosacral lesions, 50 samples without lesions, and 50 normal endometria were collected. None. Changes in the gut microbiome of patients with EMs and mice and the effect of β-glucuronidase on the proliferation and invasion of endometrial stromal cells and the development of endometriotic lesions were assessed. No difference in α and β diversity was found between patients with EMs and controls. Immunohistochemistry analysis showed higher β-glucuronidase expression in bowel lesions and uterosacral ligament lesions than in the normal endometrium (p<0.01). β-Glucuronidase promoted the proliferation and migration of endometrial stromal cells during cell counting kit-8, Transwell, and wound-healing assays. Macrophage levels, especially M2, were higher in bowel lesions and uterosacral ligament lesions than in controls, and β-glucuronidase promoted the M0 to M2 transition. Medium conditioned by β-glucuronidase-treated macrophages promoted endometrial stromal cell proliferation and migration. β-Glucuronidase increased the number and volume of endometriotic lesions and number of macrophages present in lesions in the mouse EMs model. This β-Glucuronidase promoted EMs development directly or indirectly by causing macrophage dysfunction. The characterization of the pathogenic role of β-glucuronidase in EMs has potential therapeutic implications.

Persistent olfactory dysfunction associated with poor sleep quality and anxiety in patients with long COVID.

Poor sleep quality have been widely reported in patients with long COVID. Determining the characteristics, type, severity, and relationship of long COVID with other neurological symptoms is essential for the prognosis and management of poor sleep quality. This cross-sectional study was conducted at a public university in the eastern Amazon region of Brazil between November 2020 and October 2022. The study involved 288 patients with long COVID with self-report neurological symptoms. One hundred thirty-one patients were evaluated by using standardised protocols: Pittsburgh sleep quality index (PSQI), Beck Anxiety Inventory, Chemosensory Clinical Research Center (CCRC), and Montreal Cognitive Assessment (MoCA). This study aimed to describe the sociodemographic and clinical characteristics of patients with long COVID with poor sleep quality and their relationship with other neurological symptoms (anxiety, cognitive impairment, and olfactory disorder). Patients with poor sleep quality were mainly women (76.3%), 44.04 ± 12.73 years old, with >12 years of education (93.1%), and had monthly incomes of up to US $240.00 (54.2%). Anxiety and olfactory disorder were more common in patients with poor sleep quality. Multivariate analysis shows that the prevalence of poor sleep quality was higher in patients with anxiety, and olfactory disorder is associated with poor sleep quality. In this cohort of patients with long COVID, the prevalence of poor sleep quality was highest in the group tested by PSQI and were associated with other neurological symptoms, such as anxiety and olfactory dysfunction. A previous study indicates a significant association between poor sleep quality and psychological disorders over time. Recent studies involving neuroimaging found functional and structural changes in Long COVID patients with persistent olfactory disfunction. Poor sleep quality are integral part of complex changes related to Long COVID and should be part of patient's clinical management.

Paediatric clinical trials need paediatric clinical trial budgets.

Clinical trials and the need for new treatments were recently listed among the most important factors for child health. The aim of the present study was to describe some of our experiences with budget preparations in paediatric clinical trials. We selected ten trials sponsored by the pharmaceutical industry at the Pediatric Clinical Research Center at Sahlgrenska University Hospital in Gothenburg, Sweden. We compared the sponsor´s initial budget (budget proposal from the sponsor), with the final budget (negotiated and agreed between sponsor and site) and identified areas where discrepancies may arise. The mean difference in total budget amount between the initial budget and the final budget was +60% (mean 59%, range 31 to 139%). The costs for preparation of the clinical trial, time spent for study activities, and costs for examinations were identified as key budget items for these differences. Our findings indicate that a substantial part of the trial-related costs would not be covered by the sponsor, had the initial budget been accepted. A thorough review and budget negotiation, as well as to have a dedicated team-member for this task, are essential to ensure equitable responsibility for the study-related costs and to avoid discontinuation of trials.

A pilot clinical study of complex rhegmatogenous retinal detachment treatment via foldable capsular buckle scleral buckling

BackgroundTo evaluate the feasibility of and identify problems in treating complex rhegmatogenous retinal detachment using foldable capsular buckle scleral buckling.MethodsThis prospective clinical study enrolled five patients with complex rhegmatogenous retinal detachment treated with foldable capsular buckle scleral buckling at the 988th Hospital of People’s Liberation Army Joint Logistic Force, China. During the 24-week follow-up period, the patients underwent measurements of their best-corrected visual acuity, slit-lamp examination, indirect ophthalmoscopy, and visual field testing. Additionally, B-ultrasound and fundus photography of the patients’ retinal reattachments helped evaluate the treatment’s post-surgery efficacy. We determined the safety of foldable capsular buckle scleral buckling based on infection, eye pain, diplopia, elevated intraocular pressure, and other postoperative severe complications.ResultsAll five patients’ complex rhegmatogenous retinal detachments were successfully treated and evaluated via B-ultrasound and fundus photography after surgery. Visual acuity was enhanced in four patients 24 weeks after surgery, while the remaining patients developed diplopia after surgery. No other complications were observed.ConclusionThis pilot study preliminarily determined that foldable capsular buckle scleral buckling is feasible for efficient and safe treatment of complex rhegmatogenous retinal detachment. These results support this surgery as a potential and novel alternative to current extraocular procedures for treating complex rhegmatogenous retinal detachment.Trial registrationThe prospective observational clinical study protocol was approved by the Institutional Review Board and Ethics Committee and registered at the clinical research center in the 988th Hospital of People’s Liberation Army Joint Logistic Force, China (9,882,019,000).

Olfactory Threshold Test as a Quick Screening Tool for Cognitive Impairment: Analysis of Two Independent Cohorts.

Olfactory dysfunction appears prior to cognitive decline, and thus it has been suggested to be an early predictor of Alzheimer's disease. However, it is currently not known whether and how olfactory threshold test could serve as a quick screening tool for cognitive impairment. To define olfactory threshold test for screening cognitive impairment in two independent cohorts. The participants are comprised of two cohorts in China, 1,139 inpatients with type 2 diabetes mellitus (T2DM, Discovery cohort) and 1,236 community-dwelling elderly (Validation cohort). Olfactory and cognitive functions were evaluated by Connecticut Chemosensory Clinical Research Center test and Mini-Mental State Examination (MMSE), respectively. Regression analyses and receiver operating characteristic (ROC) analyses were carried out to determine the relation and discriminative performance of the olfactory threshold score (OTS) regarding identification of cognition impairment. Regression analysis showed that olfactory deficit (reducing OTS) was correlated with cognitive impairment (reducing MMSE score) in two cohorts. ROC analysis revealed that the OTS could distinguish cognitive impairment from cognitively normal individuals, with mean area under the curve values of 0.71 (0.67, 0.74) and 0.63 (0.60, 0.66), respectively, but it failed to discriminate dementia from mild cognitive impairment. The cut-off point of 3 showed the highest validity for the screening, with the diagnostic accuracy of 73.3% and 69.5%. Reducing OTS is associated with cognitive impairment in T2DM patients and the community-dwelling elderly. Therefore, olfactory threshold test may be used as a readily accessible screening tool for cognitive impairment.

Editorial introductions.

Editorial introductions.

0875 Self-Reported Sleep Indices in Veterans Exposed to Deleted Uranium

Abstract Introduction During Gulf War I, a group of veterans sustained exposure to deplete uranium (DU) through a series of “friendly fire” incidents. This resulted in both inhalational and traumatic injuries, with a subset having retained fragments and ongoing systemic exposure to DU. These veterans have undergone biennial surveillance assessments to monitor for DU-related health effects. While effects of DU on bones and kidneys have been consistently shown, less is understood about the effect of DU on sleep. In rat models, exposure to DU affected sleep architecture by increasing both sleep fragmentation and quantity of REM sleep. We therefore sought to characterize the effect of DU on self-reported sleep complaints among this unique veteran cohort. Methods Of a dynamic cohort of 81 DU-exposed veterans, 37 completed medical history, exposure, and sleep questionnaires and 24-hour urine uranium collections. Responses on the sleep questionnaires -which included subjective assessment of sleep quality and quantity as well as an Epworth Sleepiness Scale (ESS) score – were compared in veterans with elevated (&amp;gt;0.1 mcg U/g creatinine) vs low urine uranium (uU). Results The 37 veterans assessed were all male, mostly white, and had a mean age of 54 ± 2.8 years. 10 were identified as having elevated urine DU levels. The mean ESS score for the group overall was in the pathologic range (13 ± 4) and did not differ significantly between the high and low uU groups. The most frequent complaints in the group overall were of difficulty falling asleep, awakening frequently throughout the night, restless sleep, and frequent tossing and turning. Among all self-reported sleep indices, there were no significant differences among the two groups. Conclusion In this group of DU-exposed veterans, excessive daytime sleepiness and several other sleep complaints were observed. Although there were no differences in the frequency or severity of self-reported sleep indices among this group of DU-exposed veterans, the group was overall pathologically sleepy. More work is needed to further characterize the possible impact of DU exposure on sleep. Support (if any) Funded by the US Department of Veterans Affairs and supported by the University of Maryland General Clinical Research Center.

Differences in Extent of Surgery for Papillary Thyroid Carcinoma Between Rural and Urban Settings

Clinical ThyroidologyVol. 35, No. 5 Thyroid CancerDifferences in Extent of Surgery for Papillary Thyroid Carcinoma Between Rural and Urban SettingsJie LiuJie LiuDepartment of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of ChinaSearch for more papers by this authorPublished Online:12 May 2023https://doi.org/10.1089/ct.2023;35.190-191AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Differences in Extent of Surgery for Papillary Thyroid Carcinoma Between Rural and Urban Settings." Clinical Thyroidology, 35(5), pp. 190–191FiguresReferencesRelatedDetails Volume 35Issue 5May 2023 Information© Copyright 2023, Mary Ann Liebert, Inc.To cite this article:Jie Liu.Differences in Extent of Surgery for Papillary Thyroid Carcinoma Between Rural and Urban Settings.Clinical Thyroidology.May 2023.190-191.http://doi.org/10.1089/ct.2023;35.190-191Published in Volume: 35 Issue 5: May 12, 2023PDF download