Miracle-dz/UniFAR-FTUs huggingface dataset:
the prevalence and risk factors of diabetic retinopathy in a population-based sample of middle-aged and older Asian Malays in Singapore . Patients and Methods Study Population

Purpose: To describe the prevalence and risk factors of diabetic retinopathy in Asian Malays. Design: Population-based cross-sectional study. Participants: Persons with diabetes of Malay ethnicity aged 40 to 80 years in Singapore. Methods: Diabetes mellitus was defined as random glucose of 11.1 mmol/l or more, use of diabetic medication, or a physician diagnosis of diabetes. Retinal photographs taken from both eyes were graded for diabetic retinopathy using the modified Airlie House classification system. Main Outcome Measures: Any diabetic retinopathy, retinopathy grades, macular edema, or vision-threatening retinopathy. Results: Of the 3261 persons who participated in this study, 757 (23.1%) had diabetes and gradable retinal photographs. In persons with diabetes, the overall prevalence of any retinopathy was 35.0% (95% confidence interval [CI], 28.2–43.4), the overall prevalence of macular edema was 5.7% (95% CI, 3.2–9.9), and the overall prevalence of vision-threatening retinopathy was 9.0% (95% CI, 5.8–13.8). Compared with men, women had significantly higher proportions with more severe diabetic retinopathy, moderate (12% vs. 4%) and severe (3% vs. 0.2%) nonproliferative retinopathy, proliferative retinopathy (7% vs. 2%), and vision-threatening retinopathy (13% vs. 3%). In multiple logistic regression, independent risk factors for any retinopathy were longer diabetes duration (odds ratio [OR], 1.07; 95% CI, 1.04–1.09, per year increase), higher hemoglobin A1C (OR, 1.21; 95% CI, 1.10–1.33, per % increase), hypertension (OR, 1.85; 95% CI, 1.04–3.30), and higher pulse pressure (OR, 1.34, 95% CI, 1.19–1.51, per 10-mmHg increase); older age (OR, 0.73; 95% CI, 0.57–0.93, per decade increase) and higher total cholesterol levels (OR, 0.75; 95% CI, 0.63–0.89, per 1-mmol/l increase) were protective of any retinopathy. Vision-threatening retinopathy additionally was associated with previous stroke (OR, 3.74; 95% CI, 1.24–11.26), cardiovascular disease (OR, 2.23; 95% CI, 1.08–4.62), and chronic kidney disease (OR, 4.45; 95% CI, 2.18–9.07). Female gender was not an independent risk factor for diabetic retinopathy after adjusting for metabolic and socioeconomic risk factors. Conclusions: One in 10 Malay adults with diabetes in Singapore has vision-threatening diabetic retinopathy. Risk factors for retinopathy in this population are largely similar to white populations elsewhere, suggesting that control of these risk factors may reduce both the prevalence and impact of retinopathy. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2008;115:1869–1875 © 2008 by the American Academy of Ophthalmology.
Abutment mechanical complications of a Morse taper connection implant system: A 1‐ to 9‐year retrospective study

Abstract Background The fracture of a Morse tapered abutment connection in an osseointegrated implant is one of the most serious mechanical complications, and it is extremely hard to deal with this complication in clinical practice. Purpose The aim of this study was to explore the cumulative mechanical complications focus on abutment of a platform switching Morse taper connection implant system after loading, and to perform a retrospective, approximately 1‐ to 9‐year follow‐up study to identify the predisposing factors. Materials and Methods A total of 495 patients with 945 fitted implants were enrolled in this study with a follow‐up from January 2012 to January 2020. The data of mechanical complications of the abutment, including abutment fracture (AF) and abutment screw loosening (ASL), and possible causative factors were extracted and evaluated statistically. Results A total of 25 out of 945 (2.65%) cumulative abutment mechanical complications occurred. AF was the most common complication (n = 13, 1.38%), followed by ASL (n = 12, 1.27%). For AF, gender, type of prosthesis, abutment design, and implant diameter were identified as the causative factors. AF was mostly observed in the single crown of males in molar areas, while ASL was more likely to occur on an angled abutment than on a non‐angled abutment. Moreover, the abutment with the positioning index (/X) had a higher incidence of fracture than the abutment without the positioning index (C/). Conclusions This study shows that the Morse taper connection is a safe abutment connection. AF occurs more frequently within single crowns in molar area of males, especially with the positioning index (/X), while ASL is more likely to occur in an angled abutment.
Small sight—Big might: Economic impact of bird tourism shows opportunities for rural communities and biodiversity conservation

Birdwatching is considered one of the fastest growing nature-based tourism sectors in the world. Tourists who identify as birdwatchers tend to be well-educated and wealthy travellers with a specific interest in the places they visit. Birdwatchers can bring economic resources to remote communities diversifying their economies and contribute to biodiversity conservation in areas of bird habitat with global significance. Alaska plays a critical role in understanding the link between bird conservation and bird tourism as it supports the world’s largest concentration of shorebirds and is a global breeding hotspot for hundreds of migratory species, including many species of conservation concern for their decline across their ranges. Alaska is also a global destination for birders due to the large congregations of birds that occur during the spring, summer and fall seasons. Despite its global importance, relatively little information exists on the significance of bird tourism in Alaska or on opportunities for community development that align with conservation. This study used ebird data to look at trends in Alaska birdwatching and applied existing information from the Alaska Visitor Statistics Program to estimate visitor expenditures and the impact of that spending on Alaska’s regional economies. In 2016, nearly 300,000 birdwatchers visited Alaska and spent $378 million, supporting approximately 4,000 jobs. The study describes bird tourism’s contributions to local jobs and income in remote rural and urban economies and discusses opportunities for developing and expanding the nature-based tourism sector. The study points toward the importance of partnering with rural communities and landowners to advance both economic opportunities and biodiversity conservation actions. The need for new data collection addressing niche market development and economic diversification is also discussed.
Choroidal changes in posterior microphthalmos

Purpose To describe the choroidal variations in posterior microphthalmos (PM). Methods In this observational case series, four eyes of two patients diagnosed as PM based on the characteristic clinical features were included. Multimodal retinal imaging with clinical fundus documentation using ultrawide field fundus camera, optical coherence tomography (OCT) and indocyanine green angiography (ICGA) was done for these cases. Results Multimodal imaging of these cases confirmed the variations in the choroid in PM cases. In both cases, on OCT, the retina and choroid were thick. retinal papillomacular fold (RPMF) was noted in all four eyes. On ICGA, the dye transit time from the arm to choroid and retina were within normal limits. Choroidal vasculature in the far retinal periphery was reduced and was noted as hypocyanescent areas anterior to the equator while the density of choroidal vessels was significantly more posterior to the equator. Vortex veins were not visualised in both cases. Conclusion Choroidal structure and vessels undergo alterations in PM. Further validation of these findings is required in a larger cohort of PM cases.
Real-world evaluation of perampanel effectiveness in Japanese adolescents with epilepsy

Objective Real-world data from adolescents treated with perampanel in a routine clinical setting are lacking in Japan. We evaluated the safety and efficacy of perampanel for adolescent patients (aged 12-17 years) with drug-resistant, refractory epilepsy in real-world settings. Methods This was a large-scale, prospective, observational post-marketing study, with a 104-week observation period. Safety was assessed by monitoring adverse effects (adverse drug reactions). For efficacy assessments, seizure frequency was compared between the four weeks immediately prior to the last observation and the four weeks before the commencement of perampanel. Results In total, 519 patients were enrolled; 505 and 484 patients were included in the safety and efficacy analysis sets, respectively. The mean age was 14.4 years. The mean daily dose of perampanel was 4.4 mg/day. The main reasons for discontinuation at 104 weeks were adverse events (48.4%) and inadequate efficacy (46.8%). The retention rate at 104 weeks was 50.5%. Adverse effect and severe adverse effect incidences were 42.2% and 1.8%, respectively. The most common adverse effects were somnolence (13.5%), irritability (8.5%), dizziness (5.1%), and agitation (4.8%). There were significant differences in the occurrence of adverse effects between the initial titration interval of <2 weeks and 2-4 weeks (odds ratio=0.441, p=0.029) and 4-8 weeks (odds ratio=0.462, p=0.027). The median percent change in seizure frequency at the last observation carried forward was −50.0 for focal aware seizures with motor signs, −73.3 for focal aware seizures without motor signs, −28.6 for focal impaired awareness seizures, −62.6 for focal to bilateral tonic-clonic seizures, and −20.0 for generalized tonic-clonic seizures. Significance In adolescent patients, perampanel was well tolerated and efficacious in reducing seizure frequency. No unexpected safety issues were observed, and slow titration may reduce the incidence of adverse effects.
Investigating current state Security of OpenFlow Networks: Focusing on the control-data plane communications

Software-Deﬁned Networking (SDN) is the emerging paradigm that breaks vertical integration in networks, separating the network’s control logic from the underlying network devices such as routers and switches. The decoupling of this data plane and control plane, there is need for a new communication channel which is used for the communication between the SDN controller and the network devices. This channel is the so-called control channel and a popular protocol used over this channel is OpenFlow. In this work we focus on the security of SDN while focusing on the control channel and the OpenFlow protocol. In example, we show several impersonation attacks and achieve denial-of-service by misusing the ARP protocol to generate a lot of OpenFlow traffic. We also discuss how we can protect SDN against such attacks in order to improve SDN security. This work has been performed at the IT security company Fox IT.
Costs and Healthcare Resource Utilization Associated with Idarucizumab or Andexanet Alfa Oral Anticoagulant Reversal in Patients Hospitalized with Life-Threatening Bleeds

Purpose: To assess costs and healthcare resource utilization (HCRU) associated with the use of idarucizumab for the reversal of dabigatran and andexanet alfa for the reversal of direct oral Factor Xa inhibitors. Methods: This retrospective study utilizing Premier Healthcare Database (PHD) included patients aged ≥18 years on direct oral anticoagulants (DOACs) who experienced life-threatening bleeds, discharged from the hospital during 5/1/2018–6/30/2019, and received idarucizumab or andexanet alfa. Inverse of treatment probability weighting (IPTW) method was used to balance patient and clinical characteristics between treatment cohorts. Results: Idarucizumab patients were older than andexanet alfa patients (median age 81 vs 77 years; p < 0.001), and less likely to experience intracranial hemorrhage (ICH) (37.1%vs 73.8%; p = 0.001). After IPTW adjustment, idarucizumab patients incurred lower mean total hospital costs ($30,413 ± $33,028 vs $44,477 ± $30,036; p < 0.001),and mean intensive care unit (ICU) cost ($25,114 ± $30,433 vs $43,484 ± $29,335; p < 0.001). Conclusions: Anticoagulant reversal therapy with idarucizumab was associated with significantly lower adjusted mean total hospital and ICU costs compared with andexanet alfa. However, a higher prevalence of ICH bleeds was noted in the andexanet alfa group. Trial Registration: Not applicable.
Clinical profile and demographic distribution of Fuchs’ endothelial dystrophy: An electronic medical record–driven big data analytics from an eye care network in India

Purpose: To describe the demographics and clinical profile of Fuchs' endothelial corneal dystrophy (FECD) in patients presenting to a multi-tiered ophthalmology hospital network in India. Methods: This cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of FECD in at least one eye were included as cases. The data were collected using an electronic medical record system. Results: Overall, 2570 (0.08%) patients were diagnosed with FECD. The majority of the patients were female (65.53%) and were predominantly adults (99.92%). The most common age group at presentation was during the seventh decade of life with 867 patients (33.74%). The overall prevalence was higher in patients from a higher socioeconomic status (0.1%) presenting from the urban geography (0.09%) and in retired individuals (0.4%). About half of the 5,140 eyes had mild or no visual impairment (< 20/70) in 2643 eyes (51.42%) followed by moderate visual impairment (>20/70 to 20/200) in 708 eyes (13.77%). The average logMAR was 0.61 ± 0.81 at presentation. The most documented corneal signs were guttae (76.63%), corneal scar (23%) and stromal edema (21.73%). The most associated ocular comorbidity was cataract (47.32%) followed by glaucoma (5.39%). More than a tenth of the affected eyes required a surgical intervention of endothelial keratoplasty (15.58%). Conclusion: FECD more commonly affects females presenting during the seventh decade of life. Majority of the eyes had mild or no visual impairment and endothelial keratoplasty is warranted in a tenth of the affected eyes.
Development of a prognostic signature based on immune-related genes and the correlation with immune microenvironment in breast cancer

Breast cancer (BC) is an inflammatory tumor caused by a variety of pathological factors, and is still the most common malignant tumor in women. Immune-related genes (IRGs) play a prominent role in the oncogenesis and progression of BC, and are of tumor-specific expression patterns that would benefit the prognosis evaluation. However, there were no systematic studies concerning the possibilities of IRGs in BC prognosis. In this study, the Cancer Genome Atlas (TCGA) database was used to integrate the expression profiles of IRG with the overall survival (OS) rate of 1039 breast cancer patients. The Cox regression analysis was used to predict the survival-related IRGs in BC. Then, we successfully screened a total of 6 IRGs, including PSME2, ULBP2, IGHE, SCG2, SDC1, and SSTR1, and accordingly constructed a prognosis prediction model of BC. Based on the IRG-related model, the BC patients were divided into high- and low-risk groups, and the association between the prognostic model and tumor immune microenvironment (TME) was further explored. The prognostic model reflected the infiltration of various immune cells. Moreover, the low-risk group was found to be with higher immunophenoscore and distinct mutation signatures compared with the high-risk group. The histological validation showed that SDC1, as well as M2 macrophage biomarker CD206, were both of higher abundance in BC samples of high-risk patients, compared with those of low-risk patients. Our results identify the clinically significant IRGs and demonstrate the importance of the IRG-based immune prognostic model in BC monitoring, prognosis prediction, and therapy.
City puzzles: Does urban land scape affect genetic population structure in Aedes aegypti?

Cities usually offer a suitable environment for the dengue vector Aedes aegypti, providing oviposition sites, accessibility to human hosts and nectar meals. However, large urban centres are highly heterogeneous environments, forming a patched landscape that could affect Ae. aegypti population dynamics and dispersal. Here, we performed a genome-wide analysis using Rad-seq data from 99 Ae. aegypti specimens collected in three areas within Buenos Aires city with varying levels of urbanization/land use: highly urbanized Area 1, intermediate Area 2 and poorly urbanized Area 3. We found an inverse association between urbanization levels and spatial genetic structure. Populations from highly urbanized Area 1 did not present genetic structure whereas two and three clusters were detected in Areas 2 and 3, respectively. In the case of Area 3, initial analyses showed separation in clusters was mostly due to elevated consanguinity within sites although three clusters were still detected after closely related individuals were discarded. Mosquitoes around each site displayed a high degree of isolation, evidencing a close dependence between the vector and human dwellings. Interestingly, specimens from distant boroughs (within the limits of the city) and the city’s outskirts formed a single cluster with inner city sites (Area 1), highlighting the role of passive transport in shaping population structure. Genetic distances were poorly correlated with geographic distances in Buenos Aires, suggesting a stronger influence of passive than active dispersal on population structure. Only Area 2 displayed a significant isolation-by-distance pattern (p = 0.046), with males dispersing more than females (p = 0.004 and p = 0.016, respectively). Kinship analyses allowed us to detect full-siblings located 1.5 km apart in Area 1, which could be due to an extreme event of active female dispersal. Effective population size was higher in Area 2 confirming that cemeteries represent highly favourable environments for Ae. aegypti and need to be specifically targeted. Our results suggest that control programs should take into account urban landscape heterogeneity in order to improve vector control.
Hyperthermic Intraperitoneal Chemotherapy with Mitomycin C versus Oxaliplatin after Cytoreductive Surgery for the Treatment of Peritoneal Metastases of Colorectal Cancer Origin.

Background: Mitomycin C and oxaliplatin are considered the main chemotherapeutic agents used in the context of hyperthermic intraperitoneal chemotherapy (HIPEC) after the performance of cytoreductive surgery for peritoneal metastases of colorectal cancer origin. However, there is lack of a generally accepted consensus regarding the optimal choice between them as upfront chemo-therapetic agent. Our paper aims to summarize in a comprehensive manner the available evidence, while individualised schemes with targeted therapies are under development. Methods: We conducted a comprehensive, narrative review of the literature including all previous studies until 03/2022, which reported perioperative and/ or oncological outcomes after the use of mitomycin C and/ or oxaliplatin as main hyperthermic chemotherapy agents after cytoreductive surgery for colorectal peritoneal metastatic disease. Results: Data from a total of 23 single-agent and 13 comparative studies were included in our review. Despite the demonstrated safety profile of both chemotherapeutics, the heterogeneity of the included studies, their retrospective nature and the absence of relevant randomized trials prohibits the drawing of safe conclusions regarding the superiority of one of the two agents. However, it seems that perioperative morbidity is less with oxaliplatin-based HIPEC, while mitomycin C appears as a more cost-effective option. Conclusions: Selection of the optimal intraperitoneal chemotherapy agent for peritoneal metastases of colorectal cancer origin after the completion of cytoreductive surgery is still a matter of debate, with significant institutional variation. Further randomized clinical trials between the two commonest HIPEC agents are required, assessing the differences in perioperative outcomes, oncological outcomes, healthcare-associated costs and patientsÃ¢? quality of life.
‘Sometimes I can't look in the mirror’: Recognising the importance of the sociocultural context in patient experiences of sexuality, relationships and body image after ovarian cancer

Abstract Objective Ovarian cancer (OC) can significantly change the way women feel about their body. However, personal accounts regarding these changes are lacking in the literature. Therefore, the aim of this study was to gain an understanding of the ways in which OC can affect relationships, sexuality, womanhood and body image. Methods Ninety‐eight Australian women aged 18 and over diagnosed with OC completed an online survey that invited narrative responses to open‐ended questions about relationships, sexuality, body image and womanhood following OC treatment. Responses were analysed thematically while applying a sociocultural lens. Results Three themes and two subthemes were identified: Failure and Loss of Femininity and Womanhood, Internalising Public Perception of Body and Illness and Altered Relationships which comprised two subthemes, Loss of the Sexual Self and Relationship Burden. These themes suggest women view themselves and their relationships in comparison with sociocultural understandings of body normalcy. Women often questioned their self‐worth, their relationships and place within society due to changes in fertility, sexuality and bodily functioning. Conclusion These results highlight a need for health care professionals to open dialogue with women about sexuality and ensure information and support is given to reduce stigma and positively influence self‐perception and increase body acceptance.
Aripiprazole for the treatment of schizophrenia: Recommendations of a panel of Spanish experts on its use in clinical practice

Abstract Objectives Aripiprazole is an antipsychotic with a partial agonism of dopamine D2 and D3 receptors. This differential mechanism implies a rigorous appraisal of the appropriate therapeutic strategies in certain situations. To answer currently unsolved clinical questions about the use of oral and long-acting injectable (LAI) aripiprazole, we present here an expert consensus from 12 Spanish psychiatrists and a pharmacologist with extensive experience in the use of this antipsychotic. Methods Through one face-to-face session and online collaboration, we reached consensus and established practical recommendations based on scientific evidence and clinical experience. We classified the available scientific literature according to SIGN system and attributed a level of evidence to each reviewed article. Results The recommendations were divided according to (i) chronological dimension (based on previous treatments, including patients naïve or not to antipsychotic treatment and maintenance regimen), and (ii) dimension related to therapeutic options, comprising switches to aripiprazole and the most used combinations with this antipsychotic. Conclusions We recommend considering aripiprazole as first treatment option in the early stages of schizophrenia and in patients with affective symptoms and contemplating a switch to aripiprazole LAI in all candidate patients. Importantly, switches from other antipsychotics should consider previous antipsychotic history and exposure to aripiprazole. KEYPOINTS Aripiprazole can be considered as first treatment option in early stages of schizophrenia and in patients with significant affective symptoms. Aripiprazole LAI shows better adherence than oral aripiprazole and could be considered in all candidate patients. Before switching to aripiprazole, detailed information about previous antipsychotic history should be gathered. Switch to aripiprazole should be managed differently for aripiprazole naïve and non-naïve patients. Rigorous and controlled studies on antipsychotics in real clinical practice should be carried out.