bluuebunny/crossref_metadata_2025 huggingface dataset:
New Metrics Needed in the Evaluation of Hearing Hazard Associated With Industrial Noise Exposure
Authors: Zhang Meibian , Xie Hongwei , Zhou Jiena , Sun Xin , Hu Weijiang , Zou Hua , Zhou Lifang , Li Jingsong , Zhang Ming , Kardous Chucri A. , Morata Thais C. , Murphy William J. , Zhang Jane Hongyuan , Qiu Wei
Published: August 2020

Objectives:

To evaluate (1) the accuracy of the International Organization for Standardization (ISO) standard ISO 1999 [(2013), International Organization for Standardization, Geneva, Switzerland] predictions of noise-induced permanent threshold shift (NIPTS) in workers exposed to various types of high-intensity noise levels, and (2) the role of the kurtosis metric in assessing noise-induced hearing loss (NIHL).

Design:

Audiometric and shift-long noise exposure data were acquired from a population (N = 2,333) of screened workers from 34 industries in China. The entire cohort was exclusively divided into subgroups based on four noise exposure levels (85 ≤ LAeq.8h < 88, 88 ≤ LAeq.8h < 91, 91 ≤ LAeq.8h < 94, and 94 ≤ LAeq.8h ≤ 100 dBA), two exposure durations (D ≤ 10 years and D > 10 years), and four kurtosis categories (Gaussian, low-, medium-, and high-kurtosis). Predicted NIPTS was calculated using the ISO 1999 model for each participant and the actual measured NIPTS was corrected for age and sex also using ISO 1999. The prediction accuracy of the ISO 1999 model was evaluated by comparing the NIPTS predicted by ISO 1999 with the actual NIPTS. The relation between kurtosis and NIPTS was also investigated.

Results:

Overall, using the average NIPTS value across the four audiometric test frequencies (2, 3, 4, and 6 kHz), the ISO 1999 predictions significantly (p < 0.001) underestimated the NIPTS by 7.5 dB on average in participants exposed to Gaussian noise and by 13.6 dB on average in participants exposed to non-Gaussian noise with high kurtosis. The extent of the underestimation of NIPTS by ISO 1999 increased with an increase in noise kurtosis value. For a fixed range of noise exposure level and duration, the actual measured NIPTS increased as the kurtosis of the noise increased. The noise with kurtosis greater than 75 produced the highest NIPTS.

Conclusions:

The applicability of the ISO 1999 prediction model to different types of noise exposures needs to be carefully reexamined. A better understanding of the role of the kurtosis metric in NIHL may lead to its incorporation into a new and more accurate model of hearing loss due to noise exposure.
Systemic sclerosis pathogenesis: contribution of recent advances in genetics
Authors: Orvain Cindy , Assassi Servin , Avouac Jérôme , Allanore Yannick
Published: August 2020

Purpose of review

To review susceptibility genes and how they could integrate in systemic sclerosis (SSc) pathophysiology providing insight and perspectives for innovative therapies.

Recent findings

SSc is a rare disease characterized by vasculopathy, dysregulated immunity and fibrosis. Genome-Wide association studies and ImmunoChip studies performed in recent years revealed associated genetic variants mainly localized in noncoding regions and mostly affecting the immune system of SSc patients. Gene variants were described in innate immunity (IRF5, IRF7 and TLR2), T and B cells activation (CD247, TNFAIP3, STAT4 and BLK) and NF-κB pathway (TNFAIP3 and TNIP1) confirming previous biological data. In addition to impacting immune response, CSK, DDX6, DNASE1L3 and GSDMA/B could also act in the vascular and fibrotic components of SSc.

Although genetic studies highlighted the dysregulated immune response in SSc, future research must focus on a deeper characterization of these variants with determination of their functional effects. Moreover, the role of these genes or others on specific vasculopathy and fibrosis would provide insight. Establishment of polygenic score or integrated genome approaches could identify new targets specific of SSc clinical features. This will allow physicians to propose new therapies to SSc patients.
Immunometabolism in the pathogenesis of systemic lupus erythematosus: an update
Authors: Romo-Tena Jorge , Kaplan Mariana J.
Published: August 2020

Purpose of review

To provide an update on state-of-the-art evidence on the role of immunometabolism reprogramming in the pathogenesis of systemic lupus erythematosus (SLE).

Recent findings

Mitochondrial dysfunction and enhanced oxidative stress, along with specific defects in other metabolic pathways, can promote dysregulation of innate and adaptive immune responses in SLE. These abnormalities appear to be driven by genetic and epigenetic factors, modulated by stochastic events. In addition to extensive descriptions of abnormalities in immunometabolism of lupus lymphocytes, recent studies support the critical role of dysregulation of metabolic pathways in innate immune cells including neutrophils, macrophages and dendritic cells, in SLE pathogenesis. Recent abnormalities described in lipid metabolism have been associated with SLE disease activity and related damage. Promising therapeutic strategies that target these metabolic abnormalities have recently been described in SLE.

Fundamental new insights regarding the role of mitochondrial dysfunction in innate immune dysregulation in SLE pathogenesis have recently emerged. Defects in specific molecular pathways pertinent to immunometabolism in SLE have been described. New insights in translational medicine and promising therapeutic targets have been proposed based on these recent findings.
miR-199a-3p suppresses progression of esophageal squamous cell carcinoma through inhibiting mTOR/p70S6K pathway
Authors: Hou Guiqin , Wang Yang , Zhang Mengying , Hu Yi , Zhao Yu , Jia Ang , Wang Peng , Zhao Wuduo , Zhao Wen , Lu Zhaoming
Published: August 2020

Dysregulation of microRNA contributes to multiple tumorigenic processes. Although downregulation of miR-199a-3p has been shown in many cancers, its effects on esophageal squamous cell carcinoma (ESCC) and the regulatory mechanism are still obscure. Here, we aim to evaluate the biological function and underlying mechanisms of miR-199a-3p in ESCC as well as its value to clinical treatment of ESCC. We first analyzed expression of miR-199a-3p in esophageal cancer by bioinformatic analysis and found that there were different opinions about expression of miR-199a-3p in esophageal cancer, and the following qRT-PCR assay demonstrated which was markedly downregulated in ESCC cells. Next, we increased the expression of miR-199a-3p in ESCC cells using miR-199a-3p mimics and demonstrated that overexpression of miR-199a-3p significantly inhibited cell proliferation, migration and invasion, as well as induced cell cycle retard and promoted apoptosis in ESCC. Furthermore, we explored the functional targets of miR-199a-3p and identified that overexpression of miR-199a-3p inhibited mTOR/p70S6K pathway, but stimulated PI3K/Akt pathway. Finally, we demonstrated that overexpression of miR-199a-3p enhanced proliferation-inhibiting effects of MK2206, an inhibitor of Akt, to ESCC cells, which might be related that MK2206 eliminated the activation of miR-199a-3p to p-Akt. These findings discover that miR-199a-3p might participate in the carcinogenesis process of ESCC, which provides a new insight for treatment of ESCC.
Mortality Rates in a Diverse Cohort of Mechanically Ventilated Patients With Novel Coronavirus in the Urban Midwest
Authors: Twigg Homer L. , Khan Sikandar H. , Perkins Anthony J. , Roberts Scott , Sears Catherine , Rahman Omar , Smith Joseph P. , Kapoor Rajat , Farber Mark O. , Ellender Timothy , Carlos Graham , Gilroy Grant , Buckley John , Bosslet Gabriel , Machado Roberto , Gao Sujuan , Khan Babar A.
Published: August 2020

Objectives:

Differences in mortality rates previously reported in critically ill patients with coronavirus disease 2019 have increased the need for additional data on mortality and risk factors for death. We conducted this study to describe length of stay, mortality, and risk factors associated with in-hospital mortality in mechanically ventilated patients with coronavirus disease 2019.

Design:

Observational study.

Setting:

Two urban, academic referral hospitals in Indianapolis, Indiana.

Patients or Subjects:

Participants were critically ill patients 18 years old and older, admitted with coronavirus disease 2019 between March 1, 2020, and April 27, 2020.

Interventions:

None.

Measurements and Main Results:

Outcomes included in-hospital mortality, duration of mechanical ventilation, and length of stay. A total of 242 patients were included with mean age of 59.6 years (sd, 15.5 yr), 41.7% female and 45% African American. Mortality in the overall cohort was 19.8% and 20.5% in the mechanically ventilated subset. Patients who died were older compared with those that survived (deceased: mean age, 72.8 yr [sd, 10.6 yr] vs patients discharged alive: 54.3 yr [sd, 14.8 yr]; p < 0.001 vs still hospitalized: 59.5 yr [sd, 14.4 yr]; p < 0.001) and had more comorbidities compared with those that survived (deceased: 2 [0.5–3] vs survived: 1 [interquartile range, 0–1]; p = 0.001 vs still hospitalized: 1 [interquartile range, 0–2]; p = 0.015). Older age and end-stage renal disease were associated with increased hazard of in-hospital mortality: age 65–74 years (hazard ratio, 3.1 yr; 95% CI, 1.2–7.9 yr), age 75+ (hazard ratio, 4.1 yr; 95% CI, 1.6–10.5 yr), and end-stage renal disease (hazard ratio, 5.9 yr; 95% CI, 1.3–26.9 yr). The overall median duration of mechanical ventilation was 9.3 days (interquartile range, 5.7–13.7 d), and median ICU length of stay in those that died was 8.7 days (interquartile range, 4.0–14.9 d), compared with 9.2 days (interquartile range, 4.0–14.0 d) in those discharged alive, and 12.7 days (interquartile range, 7.2–20.3 d) in those still remaining hospitalized.

Conclusions:

We found mortality rates in mechanically ventilated patients with coronavirus disease 2019 to be lower than some previously reported with longer lengths of stay.
Tracheostomy for Coronavirus Disease 2019 Patients: Maintaining the Standard of Care
Authors: Bassily-Marcus Adel , Leibner Evan S. , Kohli-Seth Roopa
Published: August 2020

Objectives:

To respond to the new recommendations for delaying tracheostomy for coronavirus disease 2019 patients to day 21 post-intubation to ensure viral clearance.

Design:

Prospective observational cohort from April 1, 2020, to April 30, 2020, with 60 days follow-up.

Setting:

Academic medical center with nine adult ICUs dedicated to caring for coronavirus disease 2019 patients requiring mechanical ventilation.

Patients:

Mechanically ventilated patients with coronavirus disease 2019 pneumonia requiring tracheostomy for prolonged ventilatory support.

Interventions:

Adherence to the standard of care for timing of tracheostomy as deemed necessary by the intensivist without delay and utilizing the existing tracheostomy team in performing the needed procedures within 1 day of the request.

Measurements and Main Results:

One hundred eleven patients with coronavirus disease 2019 received tracheostomy in the month of April 2020. Median time to tracheostomy was 11 days. All procedures were performed percutaneously at bedside under bronchoscopic guidance. Sixty-three percent of patients who received tracheostomy either weaned or discharged alive within 60 days of the procedure. Performing tracheostomy on these patients without delay did not lead to coronavirus disease 2019 viral transmission to the tracheostomy team as evident by lack of symptoms and negative antibody testing.

Conclusions:

Adherence to standard of care in timing of tracheostomy is safe. Recommending delaying the procedure may lead to harmful consequences from prolonging mechanical ventilation and sedation without apparent benefit.
Testing for Severe Acute Respiratory Syndrome–Coronavirus 2: Challenges in Getting Good Specimens, Choosing the Right Test, and Interpreting the Results
Authors: Tu Yuan-Po , O’Leary Timothy J.
Published: August 2020

Objectives:

We explore ways to reduce errors in laboratory diagnosis of severe acute respiratory syndrome–coronavirus 2 infection by considering preanalytic, analytic, and postanalytic sources. To address preanalytic challenges, we first consider alternative anatomic sites for specimen collection, then discuss self-collection, alternative sampling devices, and transport media. Strengths and limitations of various analytic test systems are considered in the context of postanalytic challenges associated with making test results meaningful, specifically considering the complex relationship between “positive” test results and reproduction and shedding of intact virus. Finally, we provide recommendations regarding healthcare worker surveillance and release of patients with coronavirus disease 2019 from isolation.

Data Sources:

Material was derived from a Webinar available to the public, manufacturer’s websites, U.S. Food and Drug Administration, and Centers for Disease Control and Prevention websites and from both peer-reviewed papers identified by PubMed search and nonpeer-reviewed papers posted on Biorxiv and Medrxiv. Unpublished data came from the Washington State Department of Health.

Study Selection:

We included studies that compared diagnostic performance strategies without introducing bias due to use of an imperfect gold standard. Case series and case reports were included as necessary to illuminate the significance of results.

Data Extraction:

Data were extracted manually.

Data Synthesis:

Sensitivity, specificity, and CIs were computed from article data using a composite reference standard. Nucleic acid-based tests were assumed to perform at 100% specificity.

Conclusions:

Although sputum and bronchoalveolar lavage samples provide the highest diagnostic sensitivity for severe acute respiratory syndrome-coronavirus 2, nasopharyngeal, mid turbinate, and nasal specimens are suitable in most cases and require less use of personal protective equipment. When desired sampling materials are unavailable, alternatives may be substituted with no loss of performance. Both reverse transcriptase polymerase chain reaction tests and rapid nucleic acid-based tests offer good performance in most circumstances. Testing is not required to release most patients from isolation.
Optimizing the Cognitive Space of Nursing Work Through Electronic Medical Records
Authors: Williams Cynthia , Hamadi Hanadi , Cummings Cynthia L.
Published: August 2020

The incorporation of electronic medical records into nursing practice highlights the need to facilitate communication among nurses. The extensive use of information suggests that electronic medical records should be considered in the cognitive workspace to manage information and facilitate communication. The purpose of this study was to construct an integrative model to explain the role of electronic medical records in the cognitive workspace. This work is grounded in the Theory of Swift and Even Flow and Distributive Cognition. The Distributive Cognitive model views the workplace as a cognitive system, such that cognitive processes do not occur in individual clinicians, but as a collaborative effort among nurses. The Theory of Swift and Even Flow was used to explain the flow of information among nurses. We used a qualitative approach to gather data from nurses at local inpatient facilities. Seven focus groups among three facilities were completed (n = 34). A semistructured questionnaire guided the focus group sessions. The results suggest that electronic medical records contribute to the cognitive workspace by serving as a conduit for information to be collected and distributed. These systems may positively influence nursing care when the quality, quantity, and timeliness of information are optimized.
Association between age at arrival, duration of migration, and overweight/obesity in Chinese rural-to-urban migrants: the Yi migrant study
Authors: Wang Ye , Pan Li , Wan Shao-Ping , Yi Huo-Wu-Li , Yang Fang , He Hui-Jing , Li Zheng , Zhang Jia , Yong Zheng-Ping , Shan Guang-Liang
Published: August 2020

Background:

Urbanization in China is rapidly proceeding, but rural-to-urban migration and its association with overweight and obesity is not well studied. This study aimed to explore the age at arrival, duration of migration, and the corresponding association with overweight/obesity in Yi migrants in China.

Methods:

A cross-sectional study was conducted in rural and urban areas in 2015 in Sichuan province, China. Demographic characteristics, lifestyle factors, and anthropometry were collected. General linear regression models were used to assess the effect of duration of migration (1–10, 11–20, 21–30, and >30 years) on body mass index (BMI). Multi-variable logistic regression was used to examine the association between duration of migration and overweight/obesity (BMI ≥ 25 kg/m2).

Results:

A total of 3056 Yi people (1894 Yi farmers and 1162 Yi migrants) aged 20 to 80 years were enrolled. After adjusting for age, sex, and other potential confounders, Yi migrants had 1.71 kg/m2 (95% confidence interval [CI]: 1.36–2.06) higher BMI and a 2.13-fold (95% CI: 1.71–2.65) higher risk of overweight/obesity than Yi farmers. In Yi migrants, stratified by age at arrival, no significant association between duration of migration and overweight/obesity was observed in those who were 0 to 20 years old at arrival. In comparison, in migrants >20 years old at arrival, compared with the reference group (1–10 years), long-term migration (>30 years) was found to be associated with overweight/obesity after adjustment (odds ratio: 1.85, 95% CI: 1.04–3.29).

Conclusions:

Yi migrants were observed to have greater risk of overweight/obesity than Yi farmers. In Yi migrants, the risk of overweight/obesity increased according to the duration of migration, especially in those who were older upon their arrival.
Deep learning-based, computer-aided classifier developed with dermoscopic images shows comparable performance to 164 dermatologists in cutaneous disease diagnosis in the Chinese population
Authors: Wang Shi-Qi , Zhang Xin-Yuan , Liu Jie , Tao Cui , Zhu Chen-Yu , Shu Chang , Xu Tao , Jin Hong-Zhong
Published: August 2020

Background

Diagnoses of Skin diseases are frequently delayed in China due to lack of dermatologists. A deep learning-based diagnosis supporting system can facilitate pre-screening patients to prioritize dermatologists’ efforts. We aimed to evaluate the classification sensitivity and specificity of deep learning models to classify skin tumors and psoriasis for Chinese population with a modest number of dermoscopic images.

Methods

We developed a convolutional neural network (CNN) based on two datasets from a consecutive series of patients who underwent the dermoscopy in the clinic of the Department of Dermatology, Peking Union Medical College Hospital, between 2016 and 2018, prospectively. In order to evaluate the feasibility of the algorithm, we used two datasets. Dataset I consisted of 7192 dermoscopic images for a multi-class model to differentiate three most common skin tumors and other diseases. Dataset II consisted of 3115 dermoscopic images for a two-class model to classify psoriasis from other inflammatory diseases. We compared the performance of CNN with 164 dermatologists in a reader study with 130 dermoscopic images. The experts’ consensus was used as the reference standard except for the cases of basal cell carcinoma (BCC), which were all confirmed by histopathology.

Results

The accuracies of multi-class and two-class models were 81.49% ± 0.88% and 77.02% ± 1.81%, respectively. In the reader study, for the multi-class tasks, the diagnosis sensitivity and specificity of 164 dermatologists were 0.770 and 0.962 for BCC, 0.807 and 0.897 for melanocytic nevus, 0.624 and 0.976 for seborrheic keratosis, 0.939 and 0.875 for the “others” group, respectively; the diagnosis sensitivity and specificity of multi-class CNN were 0.800 and 1.000 for BCC, 0.800 and 0.840 for melanocytic nevus, 0.850 and 0.940 for seborrheic keratosis, 0.750 and 0.940 for the “others” group, respectively. For the two-class tasks, the sensitivity and specificity of dermatologists and CNN for classifying psoriasis were 0.872 and 0.838, 1.000 and 0.605, respectively. Both the dermatologists and CNN achieved at least moderate consistency with the reference standard, and there was no significant difference in Kappa coefficients between them (P > 0.05).

Conclusions

The performance of CNN developed with relatively modest number of dermoscopic images of skin tumors and psoriasis for Chinese population is comparable with 164 dermatologists. These two models could be used for screening in patients suspected with skin tumors and psoriasis respectively in primary care hospital.
Positive Cytosolic 5-Nucleotidase 1A Antibodies in Motor Neuron Disease
Authors: Assadi Rami-James K. , Manousakis Georgios
Published: August 2020

Inclusion body myositis (IBM) is the most common acquired myopathy in adults older than 50 years. Muscle biopsy remains the gold standard for diagnosis. Recently described serum antibodies against cytosolic 5-nucleotidase 1A (cN1A) are considered highly specific for IBM. However, positive cN1A antibodies in diseases other than IBM are recently reported. We review 2 cases in which serum antibodies were positive but ancillary testing revealed motor neuron disease. A 68-year-old man presented with asymmetric quadriceps and handgrip weakness prompting concern for IBM. However, electromyography showed purely chronic neurogenic abnormalities, and muscle biopsy was consistent with post-polio syndrome. A 60-year-old woman reported a history of progressive muscle weakness. Despite positive antibodies, examination and electromyography were indicative of amyotrophic lateral sclerosis. Serum cN1A antibodies are not 100% specific for the diagnosis of IBM. Careful clinical, electrophysiologic, and histopathologic correlation is required in workup of individuals with neuromuscular weakness and positive antibodies.
Wild-type Transthyretin Amyloid Myopathy With an Inclusion Body Myositis Phenotype
Authors: Huser Sara , Loavenbruck Adam , Manousakis Georgios
Published: August 2020

Senile systemic amyloidosis (SSA), or wild-type transthyretin (wtATTR) amyloidosis, is associated most commonly with cardiomyopathy and carpal tunnel syndrome. SSA-associated skeletal myopathy is rare. We describe the case of a patient with SSA who exhibited asymmetric quadriceps and finger flexor weakness, a phenotype usually seen in inclusion body myositis.
Laing Myopathy: Report of 4 New Families With Novel MYH7 Mutations, Double Mutations, and Severe Phenotype
Authors: Alessi Catherine E. , Wu Qian , Whitaker Charles H. , Felice Kevin J.
Published: August 2020

Laing distal myopathy (LDM) is an autosomal dominant disorder caused by mutations in the slow skeletal muscle fiber myosin heavy chain (MYH7) gene on chromosome 14q11.2. The classic LDM phenotype—including early-onset, initial involvement of foot dorsiflexors and great toe extensors, followed by weakness of neck flexors and finger extensors—is well documented. Since the original report by Laing et al in 1995, the spectrum of MYH7-related myopathies has expanded to include congenital myopathies, late-onset myopathies, myosin storage myopathy, and scapuloperoneal myopathies. Most patients with LDM harbor mutations in the midrod domain of the MYH7 gene, but rare cases document disease-associated mutations in the globular head region. In this report, we add to the medical literature by describing the clinicopathological findings in 8 affected family members from 4 new LDM families—including 2 with novel MYH7 mutations (Y162D and A1438P), one with dual mutations (V39M and K1617del), and one family (E1508del) with severe early-onset weakness associated with contractures, respiratory insufficiency, and dilated cardiomyopathy. Our families highlight the ever-expanding clinical spectrum and genetic variation of the skeletal myopathies related to MYH7 gene mutations.
Determining Nursing Education Needs During a Rapidly Changing COVID-19 Environment
Authors: Prior Michele , Delac Kathy , Laux Lori , Melone Debbie
Published: August 2020

COVID-19 created an environment that required rapid implementation of procedures and processes to minimize transmission. This led to an urgent response from the Department of Professional Practice and Education to implement education to a large number of personnel. This article describes strategies and methods employed to meet the training demands at a time when resources and supplies were limited. This study aims at developing and implementing education on infection prevention and management of patients with suspected or known COVID-19 for the nursing staff providing care. Following guidelines from the hospital's COVID-19 oversight committee, the Department of Professional Practice and Education rapidly initiated education on several key topics. This was accomplished by teamwork within the department to quickly identify priorities and suspend noncritical programs. Multiple training methods were deployed while a smaller group of educators developed additional training. Sixty to seventy percent of 1015 staff were trained within 6 days. Soon after, several additional educational topics were identified and training was concluded over a 3-week period. Training can be provided on an urgent basis with the use of multiple educational methods, suspension of noncritical programs, and teamwork. A smaller committee within the department allows for concentrated efforts in the design of additional training.
Providing Quality Care to the Intellectually Disadvantaged Patient Population During the COVID-19 Pandemic
Authors: McGonigal Michelle
Published: August 2020

The coronavirus pandemic has impacted global health care delivery within a short period of time and has spotlighted the needs of vulnerable patient populations. The recommended initiatives to prevent the viral spread have included strategies such as social distancing, hand hygiene, and wearing protective personal equipment. These activities are community-wide focused, however, may be difficult to achieve for those individuals with intellectual disabilities, thus making this population susceptible to viral spread of infection. This article discusses the experience at a large urban teaching hospital in regard to the care of intellectually disadvantaged patients with COVID-19 infection.
Quantitative Bias Analysis for a Misclassified Confounder
Authors: Nab Linda , Groenwold Rolf H. H. , van Smeden Maarten , Keogh Ruth H.
Published: August 2020

Observational data are increasingly used with the aim of estimating causal effects of treatments, through careful control for confounding. Marginal structural models estimated using inverse probability weighting (MSMs-IPW), like other methods to control for confounding, assume that confounding variables are measured without error. The average treatment effect in an MSM-IPW may however be biased when a confounding variable is error prone. Using the potential outcome framework, we derive expressions for the bias due to confounder misclassification in analyses that aim to estimate the average treatment effect using an marginal structural model estimated using inverse probability weighting (MSM-IPW). We compare this bias with the bias due to confounder misclassification in analyses based on a conditional regression model. Focus is on a point-treatment study with a continuous outcome. Compared with bias in the average treatment effect in a conditional model, the bias in an MSM-IPW can be different in magnitude but is equal in sign. Also, we use a simulation study to investigate the finite sample performance of MSM-IPW and conditional models when a confounding variable is misclassified. Simulation results indicate that confidence intervals of the treatment effect obtained from MSM-IPW are generally wider, and coverage of the true treatment effect is higher compared with a conditional model, ranging from overcoverage if there is no confounder misclassification to undercoverage when there is confounder misclassification. Further, we illustrate in a study of blood pressure-lowering therapy, how the bias expressions can be used to inform a quantitative bias analysis to study the impact of confounder misclassification, supported by an online tool.
Persistent Postconcussion Symptoms: An Expert Consensus-Based Definition Using the Delphi Method
Authors: Lagacé-Legendre Corinne , Boucher Valérie , Robert Sébastien , Tardif Pier-Alexandre , Ouellet Marie-Christine , de Guise Elaine , Boulard Geneviève , Frémont Pierre , Émond Marcel , Moore Lynne , Le Sage Natalie
Published: August 2020

Objective:

To provide an expert consensus definition of persistent postconcussion symptoms following a mild traumatic brain injury (mTBI).

Participants:

Canadian healthcare professionals caring for patients with mTBI.

Design:

Online Delphi process.

Main Measures:

A first Delphi round documented important dimensions or criteria to consider when defining persistent symptoms. Expert opinions were then resubmitted in 4 subsequent Delphi rounds and their relevance was rated using a 9-point Likert scale. An item with a median rating of 7 or more and a sufficient level of agreement were considered consensual.

Results:

After 5 rounds, consensus was reached on a set of criteria that can be summarized as follows: presence of any symptom that cannot be attributed to a preexisting condition and that appeared within hours of an mTBI, that is still present every day 3 months after the trauma, and that has an impact on at least one sphere of a person's life.

Conclusion:

This Delphi consensus proposes a set of criteria that support a more uniform definition of persistent symptoms in mild TBI among clinicians and researchers. This definition may help clinicians better identify persistent postconcussion symptoms and improve patient management.
CHOROIDAL VASCULARITY INDEX IN YOUNG CHOROIDEREMIA PATIENTS
Authors: Murro Vittoria , Mucciolo Dario Pasquale , Giorgio Dario , Passerini Ilaria , Cipollini Francesca , Virgili Gianni , Giansanti Fabrizio , Sodi Andrea
Published: August 2020

Purpose:

To evaluate choroidal features in young patients affected by choroideremia (CHM).

Methods:

Young CHM patients and control subjects were recruited at the Eye Clinic in Florence. High-resolution choroidal imaging was obtained using swept-source optical coherence tomography with long optical coherence tomography scans (12 × 9 mm optical coherence tomography scans). We considered the subfoveal choroidal area within 9 mm of the optic disk in the horizontal plane and the subfoveal choroidal area within a 3-mm diameter centered over the fovea. The subfoveal choroidal thickness, total choroidal area, luminal area, stromal area, and choroidal vascularity index were assessed using the “ImageJ” software in both groups.

Results:

Eight patients (16 eyes; mean age, 19.3 ± 5.2 years) and seven control subjects (14 eyes; mean age, 19.0 ± 5.0 years) were included in this study. Best-corrected visual acuity was 20/20 in both eyes of seven CHM patients and in all control subjects and 20/25 in both eyes in one CHM patient. Mean subfoveal choroidal thickness did not differ between CHM patients and control subjects. Luminal area9mm, stromal area9mm, and total choroidal area9mm were reduced in patients compared with the control group. Luminal area3mm, stromal area3mm, and total choroidal area3mm did not differ between patients and control subjects. Choroidal vascularity index9mm and choroidal vascularity index3mm were not different between patients and control subjects.

Conclusion:

There are no differences in the choroidal vascularity index between young CHM patients and control subjects; this result suggests a simultaneous, proportional impairment of both the stromal and vascular components of the choroid in the early stages of the disease.
ASSOCIATION BETWEEN CHOROIDAL CHARACTERISTICS AND SYSTEMIC SEVERITY IN AMYLOIDOSIS
Authors: Mano Fukutaro , Dispenzieri Angela , Kusaka Shunji , Pavesio Carlos , Khalid Hagar , Keane Pearse A. , Pulido Jose S.
Published: August 2020

Purpose:

This study aimed to describe the choroidal features of ocular amyloidosis using multimodal imaging, to correlate these findings with systemic involvement, and to propose a choroidal grading system.

Methods:

Eleven patients with systemic amyloidosis were reviewed retrospectively. Each case was assigned a grade according to the severity of choroidal findings as determined by both enhanced depth imaging optical coherence tomography and indocyanine green angiography. The severity of systemic amyloidosis was then correlated with the choroidal involvement.

Results:

On indocyanine green angiography, all patients exhibited hyperfluorescent spots in the late stage and were classified according to preexisting criteria. On enhanced depth imaging optical coherence tomography, hyperreflective foci were seen in the choriocapillaris and Sattler's layer in Grade 1, partial loss of Sattler's layer was additionally seen in Grade 2, and a dense hyperreflective Haller's layer was seen in Grade 3. Choroidal grading scores were significantly correlated with the systemic severity score (P = 0.0014, Pearson's correlation coefficient; ρ = 0.83).

Conclusion:

With ocular amyloidosis, evaluation of choroidal characteristics using multimodal imaging may serve as a biomarker for systemic involvement.
Morphological Changes of Meibomian Glands in Men With Benign Prostate Hyperplasia
Authors: Shimizu Shota , Arita Reiko , Kawashima Motoko , Inoue Sachiko , Itoh Kouzo , Tsubota Kazuo
Published: August 2020

Purpose:

Meibomian glands are subject to regulation by sex hormones. We have now investigated the possible relation between benign prostate hyperplasia (BPH) and meibomian gland dysfunction (MGD).

Methods:

Men diagnosed with BPH and receiving treatment with tamsulosin and age-matched male control subjects who attended Itoh Clinic, Saitama, Japan, were enrolled. An ocular symptom score, lid margin abnormality score, and superficial punctate keratopathy score as well as the meiboscore (0–6), meibum grade, breakup time of the tear film, and Schirmer test values were evaluated. Male pattern baldness was also graded according to the Hamilton-Norwood scale.

Results:

Forty-four eyes of 44 men with BPH (mean age ± SD, 76.1 ± 2.2 years) and 46 eyes of 46 control subjects (mean age ± SD, 75.3 ± 6.2 years) were enrolled. The meiboscore in the BPH group (4.5 ± 1.4) was significantly higher than that in the control group (1.8 ± 1.5, P < 0.0001). Breakup time of the tear film was significantly shorter (3.6 ± 1.7 vs. 5.6 ± 2.5 seconds, P < 0.0001), and Schirmer test value was significantly smaller (9.8 ± 4.8 vs. 13.3 ± 8.0 mm, P = 0.048) in the BPH group than that in the control group. Other ocular parameters did not differ significantly between the 2 groups. The proportion of men with androgenic alopecia was also higher in the BPH group than that in the control group.

Conclusions:

BPH was associated with meibomian gland loss and instability of the tear film as well as with the presence of androgenic alopecia.
Pooled Efficacy and Safety Profile of Netarsudil Ophthalmic Solution 0.02% in Patients With Open-angle Glaucoma or Ocular Hypertension
Authors: Singh Inder P. , Fechtner Robert D. , Myers Jonathan S. , Kim Terry , Usner Dale W. , McKee Hayley , Sheng Huan , Lewis Richard A. , Heah Theresa , Kopczynski Casey C.
Published: August 2020

Precis:

In pooled phase III analyses, once-daily netarsudil 0.02% resulted in intraocular pressure (IOP) reduction that was noninferior to twice-daily timolol 0.5%, with minimal treatment-related serious or systemic adverse events (AEs). Ocular AEs were generally tolerable.

Purpose:

The purpose of this study was to assess the efficacy and safety of the Rho kinase inhibitor netarsudil in patients with open-angle glaucoma or ocular hypertension.

Patients and Methods:

Pooled analysis of data from the ROCKET-1 to 4 phase III studies of once-daily (PM) netarsudil or twice-daily timolol in patients with open-angle glaucoma or ocular hypertension. The primary efficacy measure was mean IOP at 8:00 am, 10:00 am, and 4:00 pm at week 2, week 6, and month 3 in patients with baseline IOP <25 mm Hg.

Results:

In the pooled primary efficacy population (netarsudil, n=494; timolol, n=510), once-daily netarsudil was noninferior to twice-daily timolol at all 9 timepoints through month 3. Mean treated IOP ranged from 16.4 to 18.1 mm Hg among netarsudil-treated patients and 16.8 to 17.6 mm Hg among timolol-treated patients. In the pooled safety population (n=839 in each treatment group), treatment-related serious AEs occurred at similar frequencies in each treatment group (netarsudil, 0.1%; timolol, 0%). The most common ocular AE, conjunctival hyperemia (netarsudil, 54.4%; timolol, 10.4%), was graded as mild in 77.6% (354/456) of affected netarsudil-treated patients.

Conclusions:

Once-daily netarsudil resulted in IOP lowering that was noninferior to twice-daily timolol, with tolerable ocular AEs that were generally mild and self-resolving. As a first-in-class agent in the United States, with a novel mechanism of action, netarsudil may provide a useful therapeutic option for patients who would benefit from IOP lowering.
Comparison of Intraocular Pressure, Usage of Topical Steroids, Need for Intraocular Pressure Lowering Drops, and Incidence of Glaucoma Surgery Up to 2 Years After Penetrating Keratoplasty and Endothelial Keratoplasty
Authors: Vu Priscilla Q. , Aggarwal Sahil , Lu Yvonne , Xie Kate , Wade Matthew , Bhatt Anand
Published: August 2020

Precis:

A retrospective review of 239 eyes comparing intraocular pressure (IOP), steroid needs, IOP-lowering drop needs, and incidence of glaucoma surgery between endothelial keratoplasty and penetrating keratoplasties (PKP) at multiple timepoints postoperatively up to 2 years.

Purpose:

The purpose of this study was to compare postoperative IOP, steroid use, IOP-lowering drop use, and need for glaucoma surgery between PKP, Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSEK).

Materials and Methods:

A retrospective chart review of all PKP, DMEK, and DSEK surgeries was performed between July 1, 2012 and July 1, 2017 at the University of California, Irvine. Patients with a prior history of glaucoma, corneal or glaucoma surgery, concurrent major or emergent surgery, active infection, and eye disease with synechiae were excluded. A total of 239 patients who underwent PKP (N=127), DMEK (N=46), or DSEK (N=66) were included. IOP, steroid use, IOP-lowering drop use, and need for glaucoma surgery were compared at postoperative day 1, postoperative week 1 (POW1), and postoperative month 1 to 24 (POM1-24).

Results:

IOP for PKP was higher than DMEK and DSEK at POW1, POM1, POM6, and POM24 (P<0.05). IOP for PKP was higher than DMEK at POM12 (P=0.028). There was no significant difference in IOP between DMEK and DSEK for all timepoints. PKP required more steroids than DSEK and DMEK at POM3, POM6, POM12, and POM24 (P<0.05). More IOP-lowering drops were required for DSEK than DMEK and PKP at postoperative day 1 and POW1 (P<0.05). More IOP-lowering medications were used for DSEK than DMEK at POM3 and POM12 (P<0.05). About 6% to 7% of patients needed glaucoma surgery by POM24.

Conclusions:

Endothelial keratoplasties had decreased IOP and steroid needs compared with PKPs postoperatively up to 2 years. The rate of glaucoma surgery and IOP-lowering drop needs were similar between the groups.
Sub-flap Mattress Suture With Deep Sclerectomy: A Novel Step
Authors: Abdelrahman Ahmed M. , Habib Mina M.
Published: August 2020

The study was a prospective interventional clinical trial enrolling 29 eyes from 20 patients with uncontrolled open-angle glaucoma to evaluate the effect of adding a novel simple economical step to nonpenetrating deep sclerectomy. We obtained an additional 12.5% reduction in the intraocular pressure compared with the standard surgery.
Intraocular Pressure Measurement in Patients Wearing Filtering Facepiece Masks
Authors: Quaranta Luciano , Micheletti Eleonora , Riva Ivano , Weinreb Robert N.
Published: August 2020

Ophthalmological examination requires a strict contact between caregivers and patients. In the COVID-19 era, this may be a risk factor for virus spread, and the use of facial masks for all in-office ophthalmological procedures has been recommended. In this case-series, we report about some errors in intraocular pressure measurement, that may occur during the slit-lamp examination of patients wearing filtering facepiece masks and N95 respirators. This is mainly due to the greater dimensions of these masks in comparison with the surgical standard ones, and to the presence of a preshaped rigid nose area that may press against the Goldmann tonometer. Special care should be taken when measuring intraocular pressure in these cases.
Pediatric Bartonella henselae Infection
Authors: Alattas Nadia H. , Patel Samir N. , Richardson Susan E. , Akseer Nadia , Morris Shaun K.
Published: August 2020

Background:

Bartonella henselae serology is commonly used to diagnose cat-scratch disease (CSD). Titers above a threshold for positivity suggest either a recent or remote infection. Recent infection can be confirmed by a 4-fold rise in the convalescent titer in some cases. Many atypical presentations attributed to CSD utilize a low threshold for positivity without supportive evidence from convalescent sera or supplemental testing, raising a concern for the overdiagnosis of CSD.

Methods:

We conducted a retrospective chart review of immunocompetent pediatric patients at the Hospital for Sick Children, Toronto, spanning an 11-year period. A total of 154 cases were included with serologic titers ≥1:128. These were divided into 3 groups: group 1 = 1:128, group 2 = 1:256, and group 3 ≥ 1:512. Cases within groups were evaluated with respect to cat contact, clinical presentation, further testing, and final diagnosis.

Results:

One-third of patients with a titer of 1:128 had an alternative diagnosis. Most cases with a titer of 1:128 or 1:256 did not have convalescent serologic testing performed. Within these 2 groups, only 1 case had a 4-fold rise in the convalescent titer. A trend of decreasing number of cases with alternative diagnoses (P = 0.03) and increasing number of cases presenting with regional lymphadenopathy (P = 0.07) was associated with higher titers in group 3 compared with group 1.

Conclusion:

Concerns about the serologic diagnosis of CSD include the use of low titers for positivity, incomplete diagnostic evaluation, and the lack of convalescent serologic testing. We propose a clinical guide to assist in managing suspected cases of CSD.
Multisystem Inflammatory Syndrome Associated With Coronavirus Disease in Children
Authors: de Farias Emmerson C. F. , Pedro Piva Jefferson , de Mello Mary L. F. M. F. , do Nascimento Luciana M. P. P. , Costa Carina C. , Machado Mayara M. M. , Rodrigues Thatiane da S. , Carvalho Railana D. F. P. , Alves Marília C. B. , Aires Larisse F. Q. , Cotta Marilia L. M. , Pedreira Ana R. G. , Saraty Salma B. , Lima Miriam C. , Justino Maria C. A.
Published: August 2020

We described the characteristics of 11 children with pediatric multisystem inflammatory syndrome-temporally associated with SARS-CoV-2. The main clinical indications for hospital admission were vasogenic toxic shock (n = 2), Kawasaki disease (n = 4), and Kawasaki disease shock syndrome (n = 5). The echocardiography findings were abnormal in 63% of cases. All patients had 2 or more organ dysfunctions, and the mortality rate was 18%.
Chocolate Cysts Associated With Porous Polyethylene Orbital Implants
Authors: Suller Armida L. , Parikh Rupin N. , Zhao Jiawei , Mahoney Nicholas R. , Campbell Ashley A. , Siadati Sepideh , Eberhart Charles G. , Fu Roxana
Published: August 2020

Late-onset orbital hemorrhage is a rare complication of alloplastic implant use in orbital wall reconstruction following trauma. The authors report 3 patients with chocolate cysts presenting 3 to 9 years after orbital fracture repair with porous polyethylene implants. All patients were managed by implant removal and evacuation of cyst contents. Complete excision of the cyst was performed in 1 patient, while partial excision of the capsule was performed in 2 patients. Improvement of symptoms associated with the mass effects of the cyst was noted after surgical intervention. The authors also report the first case of orbital volume expansion from a chocolate cyst associated with a nonbarriered porous polyethylene implant. Delayed hemorrhage with capsule formation, although extremely rare, is a possible complication following orbital fracture repair with porous polyethylene implants.
Rituximab Monotherapy for Compressive Optic Neuropathy With Giant Ocular Adnexal Mucosa–Associated Lymphoid Tissue lymphoma
Authors: Fujita Yasushi , Mimura Masashi , Satou Youhei , Akioka Toshikazu , Oku Hidehiro , Ikeda Tsunehiko
Published: August 2020

A rare case of compressive optic neuropathy due to giant mucosa-associated lymphoid tissue lymphoma in the orbit was presented. A 87-year-old woman was aware of a slow progressive left ocular proptosis for 10 years and presented after becoming aware of a sudden progression of the proptosis accompanying visual disturbance over the previous 2 months. Orbital imaging and a biopsy of the tumor revealed a mucosa-associated lymphoid tissue lymphoma occupying her left orbit compressing and stretching the left optic nerve. Considering her age and the additional adverse effects of external beam radiation therapy to her damaged optic nerve, rituximab monotherapy was utilized. The intervention resulted in almost complete regression without any serious adverse effect, with left eye best–corrected visual acuity improving from 12/200 to 16/20. Rituximab monotherapy can be one of the first-choice treatment options for mucosa-associated lymphoid tissue lymphoma, especially in cases with the critical damage in the optic nerve.
Gender-Based Differences in the Relationships Among Social Support, Positive Psychological Capital, and Sleep Quality in Patients Implanted With Pacemakers
Authors: Lv Gaorong , Zhao Xiaojing , Xu Xiaofang , Hou Fangyan , Li Ping
Published: August 2020

Background

Sleep disorders are common and seriously affect the prognosis of patients implanted with pacemakers.

Aims

In this study, it was investigated whether social support directly impacts sleep quality and whether positive psychological capital mediates and gender moderates the relationship between social support and sleep quality among this group.

Methods

A total of 178 patients implanted with pacemakers were recruited to participate in the study from 2 tertiary hospitals in Shandong, China. Patients were assessed using the Perceived Social Support Scale, Positive PsyCap Questionnaire, and Pittsburgh Sleep Quality Index (PSQI). Multiple linear regression and the PROCESS macro were used to test the mediating and moderated mediating effects.

Results

Patients' mean PSQI score was (8.48 ± 4.50), and 71.30% of the patients had sleep problems (PSQI > 5). Social support scores were negatively correlated with PSQI scores (r = −0.19, P = .010) and positively correlated with positive psychological capital scores (r = 0.45, P < .001). In addition, positive psychological capital scores were negatively related to PSQI scores (r = −0.39, P < .001). The confidence interval (CI) from the bootstrap output indicated that positive psychological capital played a mediating role between social support and sleep quality (95% CI, −0.098 to −0.033), and gender moderated the association between social support and sleep via positive psychological capital (95% CI, −0.087 to −0.006).

Conclusion

The sleep problems of this population cannot be ignored. Gender-based differences should be considered when guiding such patients toward using internal and external resources to cope with sleep problems.