bluuebunny/crossref_metadata_2025 huggingface dataset:
Parameter identification and generality analysis of photovoltaic module dual-diode model based on artificial hummingbird algorithm
Authors: Li Zhen , Hu Jianke , Han Yifeng , Li Hefeng , Wang Jun , Lund Peter D
Published: November 2023

The aim of this study is to propose a photovoltaic (PV) module simulation model with high accuracy under practical working conditions and strong applicability in the engineering field to meet various PV system simulation needs. Unlike previous model-building methods, this study combines the advantages of analytical and metaheuristic algorithms. First, the applicability of various metaheuristic algorithms is comprehensively compared and the seven parameters of the PV cell under standard test conditions are extracted using the double diode model, which verifies that the artificial hummingbird algorithm has higher accuracy than other algorithms. Then, the seven parameters under different conditions are corrected using the analytical method. In terms of the correction method, the ideal factor correction is added on the basis of previous methods to solve the deviation between simulated data and measured data in the non-linear section. Finally, the root mean squared error between the simulated current data and the measured current data of the proposed model under three different temperatures and irradiance is 0.0697, 0.0570 and 0.0289 A, respectively.
Questionnaire Survey for Inflammatory Bowel Disease Patients in Japan; A Web-Based Japan, Crohn’s Disease, Ulcerative Colitis, Patients Survey
Authors: Matsumoto Takayuki , Imai Keita , Goda Yuki , Fujimitsu Yuki , Kajioka Toshifumi , Kihara Hideaki , Funaki Yuji , Imaki Shigeru , Ueno Masato
Published: November 2023

Background/Aims

The prevalence of inflammatory bowel disease (IBD) in Japan has been increasing. We aimed to clarify the symptoms of patients with IBD in Japan using an internet-based questionnaire survey.

Methods

Overall, 805 patients with IBD were asked to complete an internet-based questionnaire addressing their history of disturbances in daily activities, prevalence of fecal urgency, incontinence, and treatment preferences.

Results

Responses were obtained from 447 patients with IBD (mean age: 54 years; 70% were men), comprising 363 patients with ulcerative colitis (UC), and 84 with Crohn’s disease (CD). Notably, 16% of patients with UC and 35% with CD took over 1 year until the diagnosis of IBD, and 5% of patients with CD visited more than 5 medical institutions. Patients with CD were more likely to experience disturbances in their diet, work, travel, and outings than those with UC. Fecal urgency and incontinence were significantly more frequent in patients with CD than in those with UC (72% vs. 44%, and 50% vs. 26%, respectively). In contrast, 26% of the men and 37% of women with IBD had constipation. Acid reflux, sleep disorders, and depressive symptoms were present in approximately 30% of the patients. Oral administration was preferred.

Conclusions

Patients with IBD in Japan experience more severe disturbances in their daily activities, and these are more severe in those with CD than those with UC. In addition to fecal urgency and incontinence, care is required for constipation, acid reflux, sleep disorders, and depressive symptoms.
Giant ascending aortic aneurysm with impending rupture as presentation of cutis laxa 1B: a case report
Authors: Used-Gavín Alejandro , Larrañaga-Moreira José María , Lago-Cascudo Rafael , Mosquera-Rodríguez Víctor X , Barriales-Villa Roberto
Published: November 2023

Background

Thoracic aortic aneurysms are rarely symptomatic but can result in acute aortic syndromes, associated with a high mortality rate. While most cases may be acquired, a genetic basis is evident in approximately 20–25% of the cases, especially among patients under 50 years of age, and those exhibiting syndromic features or family history. Although autosomal dominant inheritance is predominant in familial aortopathies, exceptions exist, such as cutis laxa 1B (CL1B)-related aortic disease, caused by variants in EFEMP2 gene, that follows an autosomal recessive inheritance pattern.

Case summary

We present the case of a 26-year-old male with a giant ascending aorta aneurysm and massive pericardial effusion, which was ultimately diagnosed of CL1B due to the p.Ser137Cys variant in the EFEMP2 gene in homozygosis. The patient underwent successful ascending aorta replacement (Bentall´s procedure). There were not complications or further events after 2 years of follow-up.

Discussion

This case underscores the importance of genetic testing in young patients presenting with aortopathies, syndromic features, or atypical presentations, irrespective of family history.
Allometry then locomotor diversification shaped the evolution of lumbar morphology in early placental mammals
Authors: Kort Anne E , Polly P David
Published: November 2023

After the end-Cretaceous mass extinction, placental mammals rapidly diversified in size and locomotor mode, setting the stage for mammals to move into almost every habitat on Earth. Locomotion in extant mammals includes unique sagittal flexion of the trunk primarily driven by lumbar vertebrae, a ribless region of the spine. Consequently, variation in lumbar morphology is associated with a wide variety of locomotor styles. While the origin of this region in early therian mammals in the Mesozoic has been studied, along the therian stem, the later functional diversification of lumbar morphology in placental mammals, the dominant extant group, has been essentially unstudied. We measured the shape of lumbar vertebrae from early placental mammals to test how body size, locomotor specialization, and phylogeny interacted in the diversification of lumbar function after the end-Cretaceous mass extinction. We used 3D geometric morphometrics to quantify shape and compare variation between these Palaeogene mammals and modern mammals. We found that Palaeogene mammals had high disparity in lumbar morphology and that this variation correlated with size and locomotor style. Surprisingly, several ‘archaic’ placentals, like hyaenodontids, showed highly mobile lumbar morphology. These findings show that lumbar vertebrae formed an important and evolvable functional unit at the beginning of the Cenozoic.
Can Changes in Older Adults’ Technology Use Patterns Be Used to Detect Cognitive Decline?
Authors: Ghaiumy Anaraky Reza , Schuster Amy M , Cotten Shelia R
Published: November 2023

Background and Objectives

The number of older adults diagnosed with dementia is expected to more than double by mid-century. Monitoring older adults’ cognitive functioning is essential for the early detection of dementia, which can increase treatment efficacy and slow the disease progression. Current approaches to detect preclinical dementia are expensive, invasive, and are not accessible to everyone. This study aimed to determine whether technology use patterns could be used as an indicator of cognitive change.

Research Design and Methods

Using 6 waves (2015–2020) from the National Health and Aging Trends Study, we examined within-person and between-person effects of stopping 4 types of technology use on 4 cognitive outcomes.

Results

Our analyses showed that stopping the use of the Internet, computers, and tablets, and sending texts and e-mails were related to cognitive decline.

Discussion and Implications

These results suggest that monitoring technology use patterns may be an innovative approach that is economical and efficient to identify individuals at risk of cognitive decline.
A qualitative interview study among clinicians managing trauma patients: identifying barriers and potential solutions to improving a trauma registry in a lower-to-middle-income country
Authors: Mohammed Zeinab , Saleh Yaseen , AbdelSalam Eman Mohammed , El-Bana Emad , El-Morsy El-Morsy Ahmed , Senosy Shaimaa , Hirshon Jon Mark
Published: November 2023

Background

The ability to adapt clinical management of trauma in many lower- and middle- income countries (LMICs) has been historically constrained by nonexistent or inadequate data registries. These registries suffer from a variety of issues including administrative, logistical, educational, feasibility, and financial barriers.

Objective

The present study aimed to survey physicians at a representative hospital with documented trauma record deficiencies regarding their experiences with the current registry system, barriers that affect the current system, and recommendations for improvement.

Methods

This study was a qualitative analysis of the experiences and opinions of trauma physicians in the Emergency Department of Beni-Suef University Hospital. Eight participants underwent a semi-structured interview covering the aforementioned topics. The interviews were then coded to identify prominent themes, from which quotes that epitomized these themes were selected.

Results

The participants identified issues with the current data registry system that corroborates prior quantitative data at the location, particularly stressing the lack of critical information affecting patient care and safety including mechanisms of injury, patient identification information, and time courses. Clinical duties and staffing were identified as primary barriers as the large patient volume seen in under-resourced hospitals precludes the ability of the physician to adequately complete documentation. Simplicity and practical workflow modification in conjunction with increased data utilization in the form of research output were stressed as desirable features that could facilitate the improvement of the current system.

Conclusion

Data registries enable hospitals and public health systems to engage in primary and secondary interventions, thereby reducing clinical volume loads and increasing clinical efficacy. After engaging in constructive discussion with physicians on the trauma care team at Beni-Suef University Hospital, the goal of workflow modification within existing resources was established as the primary guiding principle for subsequent interventional stages in improving the current trauma registry.
Development of VRE meningitis due to haematogenous spread while on high-dose daptomycin therapy
Authors: Sanikommu Srivani , Lusardi Katherine , Burdine Lyle , Dare Ryan K
Published: November 2023

Introduction

Vancomycin-resistant Enterococcus faecium (VRE) meningitis accounts for only 0.3%–4.0% of bacterial meningitis cases and typically occurs following neurosurgical intervention. We describe a rare case of a patient without neurological devices in situ or a recent neurological procedure who developed VRE meningitis via haematogenous spread. Optimal treatment for VRE meningitis is unknown.

Case presentation

A 67-year-old male with end-stage liver failure underwent liver transplantation complicated by VRE bacteraemia and subsequently developed VRE meningitis while on high-dose daptomycin therapy (12 mg/kg/day). Due to clinical and microbiological failure with daptomycin, he was switched to linezolid and symptoms resolved rapidly. He completed 2 weeks of linezolid, fully recovered, and continued to do well without complications at the 5 month follow-up.

Conclusions

This case highlights the severity of VRE infections in solid organ transplant recipients and raises concerns about daptomycin penetration into the CNS. Linezolid could be considered the preferred treatment for VRE CNS infections rather than high-dose daptomycin.
Outcomes of pharmacy facility inspections: implications on pharmaceutical services
Authors: Singu Bonifasius Siyuka , Mutsambiwa Priscilla , Mvula Ester
Published: November 2023

Objectives

Good Pharmacy Practice (GPP) ensures access to quality medicines, a well-trained and adequate workforce of health professionals, and affordable healthcare. The Namibia Medicines Regulatory Council ensures the sale of medicines and the premises in which such sales are carried out comply with the Medicines and Related Substances Control Act of 2003. The purpose of this study was to report facility inspection outcomes.

Methods

This was a retrospective review of inspection records archived over a period of 5 years (2017–2021) by the Namibia Medicines Regulatory Council. Compliance by facilities to 13 indicators as stipulated in the Namibia Medicines Regulatory Council inspections checklist adopted from international GPP guidelines was the main measure of outcomes. Results were summarized using descriptive statistics such as median, range, and percentages in R. The Mann–Whitney U test was used to compare medians.

Key findings

General compliance by community pharmacies (operated by pharmacists) was statistically higher (P = .0043) than dispensaries at clinics (mostly operated by nurses) with median (range) values of 84% (30.8–100) and 38% (0.0–100), respectively. There was an improvement in compliance over the 5 years for both pharmacies and clinics.

Conclusions

The Ministry of Health & Social Services should implement policies that will ensure appropriately trained pharmaceutical cadres are stationed at all levels of the healthcare system to improve the delivery of pharmaceutical services. In addition, more inspectors need to be recruited for more frequent inspections.
Pneumatosis cystoids intestinalis in a patient with small bowel obstruction: a case report
Authors: Beyene Andinet , Bayissa Badhaasaa , Atalele Mezgebu , Umer Hamza , Alemu Addisu , Semahegn Agumasie
Published: November 2023

Pneumatosis cystoides intestinalis is a rare and usually benign condition in which multiple thin-walled cysts develop in the submucosa or subserosa of the gastrointestinal tract. While usually asymptomatic, severe cases can result in pneumoperitoneum, which can be managed surgically or medically depending on circumstances. A 35-year-old male patient presented with signs and symptoms of intestinal obstruction. Then the patient was diagnosed with pneumatosis cystoides intestinalis. The patient underwent surgery, and antibiotic treatment, and was discharged improved with no incident. Pneumatosis cystoides intestinalis is a surgical condition that resembles other life-threatening top surgical emergencies and affects clinicians’ decisions on diagnosis and treatment plans substantially, mainly in low-income countries. So, surgeons have to consider such kind of conditions and avoid the costs and morbidities associated with unnecessary bowel resection or surgery.
Quality of life after risk-reducing salpingo-oophorectomy in women with a pathogenic BRCA variant
Authors: Zilski Nicole , Speiser Dorothee , Bartley Julia , Roehle Robert , Blohmer Jens-Uwe , Keilholz Ulrich , Goerling Ute
Published: November 2023

Background

Risk-reducing salpingo-oophorectomy (RRSO) is recommended to women with a pathogenic BRCA variant, but as a main side effect, RRSO could lead to an early onset of menopause.

Aim

To evaluate the impact of RRSO and preoperative menopausal status on menopausal symptoms, sexual functioning, and quality of life (QOL).

Methods

The study was conducted between November 2019 and April 2020. Women were included who tested positive for a pathogenic BRCA1/2 variant between 2015 and 2018. Depression levels, QOL, and global health status were measured and compared with those of women who opted against RRSO. Furthermore, women who underwent RRSO treatment were asked to report menopausal complaints that they experienced at 1 month postsurgery and any current complaints.

Outcomes

RRSO had no significant impact on QOL, but women who were premenopausal at the time of surgery reported more sexual complaints than postmenopausal women.

Results

In total, 134 carriers of a BRCA mutation were included: 90 (67%) underwent RRSO and 44 (33%) did not. At the time of the survey, neither the control nor experimental group experienced significant changes in QOL (b = –0.18, P = .59). Women who underwent RRSO reported a significantly lower global health status (b = –0.66, P = .05). Women who were premenopausal at the time of surgery were bothered more by sexual symptoms (b = 0.91, P = .19) but experienced fewer vasomotor complaints (b = –1.09, P = .13) than women who were postmenopausal at the time of RRSO.

Clinical Implications

The decrease of sexual functioning after RRSO should be an integral part of preoperative counseling because it is important for BRCA carriers, especially for premenopausal women.

Strengths and Limitations

Some strengths of the present study were the long follow-up, a high response rate, and the existence of a control group, whereas defining menopausal status by last menstrual bleeding and self-report of data (eg, breast cancer history) increased the risk of errors.

Conclusion

Our study indicated that women who underwent RRSO experienced no difference in QOL when compared with women without RRSO and that patients with premenopausal status seemed to be at higher risk to experience sexual complaints after surgery.
Observed Warming Trends at U.S. Army Basic Combat Training Installations and Implications for Future Recruit Training
Authors: Patton Erik M , Doyle Martin W
Published: November 2023

Introduction

Army recruits conducting BCT are among the most susceptible population of military personnel to experience exertional heat illness, a concern expected to become increasingly urgent due to steadily rising temperatures. In this study, we provide an empirical analysis of wet bulb globe temperature (WBGT) index trends at U.S. Army BCT installations and quantify the magnitude of these trends. Assuming these warming trends continue, the anticipated effects of increasing temperature trends are discussed in relation to potential impacts on recruit heat illness incidence and training disruption.

Materials and Methods

We obtained weather data beginning in the early 1960s, including WBGT index measurements derived by the U.S. Air Force 14th Weather Squadron. We apply these datasets to two classifications for high WBGT index days, including one classification accounting for heat illness susceptibility based on prior day heat exposure, to determine when recruits are most at risk of heat illness. The daily likelihood of extreme WBGT index values is described at each installation using a 30-year climatological average. Trends in the WBGT index are evaluated quantitatively during the warm season (May 1–September 30) and full year and compared between decades and by individual BCT classes.

Results

Trends in the WBGT index have increased at all four BCT installations. Between January 1960 and October 2022, the mean WBGT index value increased most quickly at Ft Jackson, SC (0.272°C decade−1, CI: 0.255–0.289) and least at Ft Moore, GA (0.190°C decade−1, CI: 0.170–0.210). Ft Moore experiences the greatest heat burden, with the daily likelihood of experiencing a “black flag” event (≥90°F WBGT index) peaking at nearly 50% in late July, while Ft Leonard Wood, MO, experiences the least heat burden. This heat burden is spread unevenly across installations and dependent on BCT class start date. Recruits beginning in mid-June will experience approximately 200 hours of hazardous heat during BCT at Ft Moore, GA; 100 hours at Ft Jackson, SC; 80 hours at Ft Sill, OK; and 61 hours at Ft Leonard Wood, MO.

Conclusions

Temperatures measured on the WBGT index have steadily increased at US Army basic training installations since at least 1960. In the future, adaptation to the BCT program will be required to maintain rigorous standards without incurring unacceptable risk of recruit heat illness. The analysis provided by this study can help inform medical, training, and policy implementations needed to ensure continued BCT in a warming world.
Rearfoot Strike Run Retraining for Achilles Tendon Pain: A Two-patient Case Series
Authors: Gunterstockman Brittney Mazzone , Carmel Jennifer , Bechard Laura , Yoder Adam , Farrokhi Shawn
Published: November 2023

Introduction

Running-related injuries are prevalent in the military and are often related to physical fitness test training. Non-rearfoot striking while running is known to increase the risk of Achilles tendon injuries because of the high eccentric energy absorption by the elastic components of the planarflexor muscle-tendon complex. However, there is limited evidence to suggest benefits of converting runners with Achilles tendon pain to use a rearfoot strike.

Methods

This is a case series of two active-duty Service members with chronic, running-related Achilles tendon pain that utilized a natural non-rearfoot strike pattern. Both patients were trained to utilize a rearfoot strike while running through the use of real-time visual feedback from wearable sensors.

Results

The trained rearfoot strike pattern was retained for over one month after the intervention, and both patients reported improvements in pain and self-reported function.

Conclusions

This case series demonstrated the clinical utility of converting two non-rearfoot strike runners to a rearfoot strike pattern to decrease eccentric demands on the plantarflexors and reduce Achilles tendon pain while running.
The Perfect Med Bag is One that Doesn’t Fall Off a Cliff: A Combat Mass Casualty Case
Authors: Lenn David , Le Daniel T , Scheiber Christopher J , Smeltz Alan M
Published: November 2023

Military trauma provides a unique pattern of injuries due to the high velocity, high kinetic energy ammunition utilized, and the high prevalence of blast injury. To further complicate this, military trauma often occurs in austere environments with limited logistical support. Therefore, military medical providers are forced to learn nonstandard techniques and when necessary, practice a level of improvisation not commonly seen in other medical fields. The case presented in this manuscript is a prime example of these challenges. At the onset of fighting both the medic’s rucksack, carrying with it the primary source of medical gear and the precious supply of cold-stored blood products are lost. The scenario was further complicated by rough mountainous terrain and a prolonged evacuation time. The medical provider was forced to utilize nonstandard devices such as an improvised junctional tourniquet which used a rock to focus the devices pressure. They also adapted their basic understanding of surgical procedures to conduct a vascular cutdown procedure for wound exposure and effectively pack an otherwise non-compressible wound to a major artery. Despite a significant loss of equipment, the medic and their team were able to successfully care for a number of patients in this mass casualty scenario.
12CO and 13CO observation of the low-metallicity dwarf galaxy DDO 154
Authors: Komugi Shinya , Inaba Miku , Shindou Tetsuo
Published: November 2023

The conversion factor from carbon monoxide (CO) intensity to molecular gas mass is a source of large uncertainty in understanding gas and its relation to star formation in galaxies. In particular, the conversion factor in low-metallicity environments have remained elusive, as currently only two galaxies have been detected in any CO isotopes in environments with 12 + log (O$/$H) < 8.0. Here we report 12CO (J = 1–0) and 13CO (J = 1–0) observations towards a star-forming region in DDO 154, a low-metallicity dwarf irregular galaxy at 12 + log (O$/$H) = 7.67. This is a re-observation of a previous non-detection at higher angular and velocity resolution. No significant emission was detected. By estimating the molecular gas mass from associated star formation, we find that DDO 154 has a conversion factor of more than 103 times the Milky Way. Alternatively, if we estimate molecular mass using dust continuum emission, the conversion factor is at least 2 orders of magnitude larger than the Milky Way. These estimates signify a large amount of CO-dark molecular gas in this galaxy.
Surface demineralized freeze-dried bone allograft followed by reimplantation in a failed mandibular dental implant
Authors: Zhang Jing , Wang Jie , You Jiayi , Qin Xuan , Chen Huimin , Hu Xiantong , Zhao Yantao , Xia Yang
Published: November 2023

The removal of a failed implant with high torque causes significant damage to the surrounding tissue, compromising bone regeneration and subsequent osseointegration in the defect area. Here, we report a case of carrier screw fracture followed by immediate implant removal, bone grafting and delayed reimplantation. A dental implant with a fractured central carrier screw was removed using the bur-forceps technique. The resulting three-wall bone defect was filled with granular surface demineralized freeze-dried bone allograft (SD-FDBA). Cone-beam computerized tomography was performed at 1 week, 6 months and 15 months postoperatively and standardized for quantitative evaluation. The alveolar bone width and height at 15 months post-surgery were about 91% of the original values, with a slightly lower bone density, calculated using the gray value ratio. The graft site was reopened and was found to be completely healed with dense and vascularized bone along with some residual bone graft. Reimplantation followed by restoration was performed 8 months later. The quality of regenerated bone following SD-FDBA grafting was adequate for osseointegration and long-term implant success. The excellent osteogenic properties of SD-FDBA are attributed to its human origin, cortical bone-like structure, partly demineralized surfaces and bone morphogenetic protein-2-containing nature. Further investigation with more cases and longer follow-up was required to confirm the final clinical effect.
Latent Inhibition in Schizophrenia and Schizotypy
Authors: Myles Liam , Garrison Jane , Cheke Lucy
Published: November 2023

Background

The Salience Hypothesis posits that aberrations in the assignment of salience culminate in hallucinations and unusual beliefs, the “positive symptoms” of schizophrenia. Evidence for this comes from studies on latent inhibition (LI), referring to the phenomenon that prior exposure to a stimulus impedes learning about the relationship between that stimulus and an outcome.

Design

This article reviewed all published studies examining the relationship between LI and both schizophrenia and schizotypy.

Results

Contemporary literature suggests that LI is attenuated in both people with schizophrenia and those loading highly on measures of schizotypy, the multidimensional derivative of schizophrenia. This suggests that these individuals assign greater salience to stimuli than healthy controls and people scoring low on measures of schizotypy, respectively. However, several confounds limit these conclusions. Studies on people with schizophrenia are limited by the confounding effects of psychotropic medications, idiosyncratic parsing of samples, variation in dependent variables, and lack of statistical power. Moreover, LI paradigms are limited by the confounding effects of learned irrelevance, conditioned inhibition, negative priming, and novel pop-out effects.

Conclusions

This review concludes with the recommendation that researchers develop novel paradigms that overcome these limitations to evaluate the predictions of the Salience Hypothesis.
Combined Hip Procedure Versus Open Reduction and Internal Fixation for Displaced Acetabular Fractures in Patients Older than 75 years: A Matched Cohort Study
Authors: Kahhaleh Edward , Belzile Etienne L. , Reed-Métayer Thomas , Dartus Julien , Plante Dominic , Lesieur Martin , Lamontagne Jean , Bédard Luc , Pelet Stéphane
Published: November 2023

Objective:

To compare surgical outcomes between combined hip procedure (CHP: open reduction and internal fixation [ORIF] with total hip replacement) and ORIF alone for the treatment of displaced acetabular fractures in a geriatric population.

Design:

Retrospective case–control study.

Setting:

Academic Level 1 trauma center.

Patients:

Consecutive patients from 2012 till 2020 with acetabular fractures fitting inclusion criteria were enrolled.

Intervention:

Combined hip procedure or ORIF alone for displaced acetabular fractures.

Main Outcome Measurement:

Revision surgery at the latest follow-up, defined as the need for implant revision in the CHP group and conversion to total hip replacement in the ORIF group.

Results:

The need for revision surgery was lower in the CHP group (12.5%) compared with the ORIF alone group (25%). The median time for conversion to total hip replacement in the ORIF alone group was 2.6 years. Ten-year survivorship was significantly higher in the CHP group (85.7% vs. 45.8%, P < 0.01). Patients in the CHP group presented with higher American Society of Anesthesiologists and Charlson index scores and had more marginal impaction and concomitant femoral head fractures.

Conclusions:

In patients older than 75 years presenting with a displaced acetabular fracture with marginal impaction or femoral head fracture, survivorship of CHP is higher than ORIF alone. A combined hip procedure should be considered in such patients.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Duodenal graft perforation after 9 years from simultaneous pancreas-kidney transplantation
Authors: Militerno Giuseppe , Cimmino Claudio , Rosano Nicola , Rosato Andrea , Camocardi Andrea , Benassai Gianluca , Fittipaldi Ciro
Published: November 2023

Transplantation is a natural replacement therapy for kidney and pancreatic failures. Transplant complications should be treated in hub centers; however, it is also true that some acute complications must be treated by emergency surgeons. Simultaneous pancreas-kidney transplantation (SPK) is a standardized surgical procedure; however, it is associated with complications, some of which can lead to graft loss. We report the case of a 41-year-old woman with duodenal graft perforation nine years after undergoing SPK. The patient was referred with an acute abdomen secondary to small-bowel obstruction. The finding of an adhesive band near the cecal valve during surgery led us to understand the cause of this complication. This case report demonstrates the need for rapid treatment of the most dangerous complications in transplant patients. The intestinal obstruction and duodenal graft perforation were treated in the emergency surgery department.
The long-term recovery of vision in pseudophakic macula-off rhegmatogenous retinal detachments.
Authors: Moussa George , Jalil Assad , Lippera Myrta , Ivanova Tsveta , Cristescu Irina , Ally Naseer , Jasani Kirti , Patton Niall , Dhawahir-Scala Felipe , Ferrara Mariantonia
Published: November 2023

Purpose:

To assess the long-term visual recovery in uncomplicated macula-off pseudophakic rhegmatogenous retinal detachment (PRRD) treated with pars plana vitrectomy (PPV) and gas tamponade in the absence of other visual co-morbidities.

Methods:

Single-centre retrospective longitudinal study on eyes with macula-off PRRD successfully treated with PPV between 2011 and 2020 and with at least two follow-ups (FU), first gas-free FU (first-FU) and a final FU, were included. Patients with subsequent ocular surgery or comorbidities affecting BCVA were excluded. The duration between operation date and final-FU was calculated (total days FU [TD]) and split into TD-quintiles: 1:≤57, 2: >57 and ≤77, 3:>77 and ≤152, 4:>152 and ≤508 and 5:>508 days. Multivariable regression was performed with logMAR gain between first and final-FU as the dependent variable.

Results:

In 209 eyes, we report association with increase of logMAR gain between first and final-FU, with reducing clock-hours of PRRD (p=0.041) and relative to the TD-quintile 1. Mean (standard deviation) LogMAR gain between first and final follow-up was 0.02 (0.07) in the first quintile, increasing to 0.14 (0.13) (p<0.001) by fifth quintile on multivariable regression. For patients not achieving 0.30 logMAR at first-FU, this was attained at final-FU with a sensitivity of 51.9% and specificity of 95.5% at a cut off ≤0.58 logMAR at first-FU (AUC 0.756 [95%CI 0.664 to 0.848], p<0.001)

Conclusions:

We report a significant time-dependent visual improvement after uncomplicated PPV with gas tamponade for macula-off PRRD without visual confounders, and provide important quantitative data for counselling patients with macula-off repair.
Tangential Retinal Displacement Increases After Macular Pucker Surgery: An Apparent Nonsense
Authors: Rossi Tommaso , Querzoli Giorgio , Cosimi Pamela , Ripandelli Guido , Steel David H. , Romano Mario R.
Published: November 2023

Purpose:

To measure the tangential retinal displacement and vision before and after macular pucker surgery and study if Pars Plana Vitrectomy (PPV) with EpiRetinal Membrane (ERM) peeling allows the reconstitution of previous anatomy or else it results in a different configuration.

Methods:

Retrospective series of patients undergoing PPV for ERM, with greater than 6-month follow-up before and after surgery, complete with best-corrected visual acuity (BCVA), Optical Coherence Tomography (OCT), M-charts, and InfraRed (IR) retinography. Tangential retinal displacement between Earliest visit (TE), time of surgery (T0) and latest available visit (TL) of the examined retina, concentric circles at 0.5, 1.5 and 4.5mm radii and the central horizontal and vertical meridian were measured. Tangential displacement was calculated as the optical flow of consecutive IR photos.

Results:

The study comprised 32 patients: 15 males and 17 females. Average pre- and post-operative follow-up were 23.4±27.9 months and 19.2±11.8 months. BCVA reduced before surgery (0.69 ± 0.16 Snellen to 0.46 ± 0.17; p<0.001) and increased after (0.866 ± 0.16 Snellen; p<0.001). Horizontal and vertical metamorphopsia increased between before surgery but only horizontal metamorphopsia significantly reduced after. Average tangential displacement before surgery was 35.6±29.9 µmversus56.6±41.3 µm after (p=0.023). Pre- and post-operative displacement within the fovea was less than over the entire area (p<0.001).

Conclusion:

Retinal tangential displacement between diagnosis and surgery (TE-T0) is less than the displacement occurring after surgery (T0-TL). Post-operative displacement does not represent the restoration of the anatomy existing before the disease ensued, but rather the resulting equilibrium of newly deployed forces.
Bilateral eye patching may improve clinical outcomes for acute primary rhegmatogenous retinal detachment
Authors: Tang Peter H. , Curran Christian D. , Salman Ali R. , Sodhi Guneet S. , Vagaggini Tommaso , Haq Zeeshan , Mittra Robert A. , Dev Sundeep , Emerson Geoffrey G. , Parke 3rd D. Wilkin , Quiram Polly A. , Belin Peter J. , Sastry Ananth , Ryan Edwin H.
Published: November 2023

Purpose:

Evaluate preoperative bilateral eye patching (BEP) on subretinal fluid (SRF) and vision in acute primary rhegmatogenous retinal detachments (RRD).

Methods:

Retrospective non-randomized interventional study of 335 RRD patients undergoing BEP until surgery (BEP cohort) and separated by % full-time compliance: high (≥ 90%), medium (> 90% but ≥ 50%), and low (< 50%). Those declining BEP were included (control). All underwent surgery and followed for ≥ 3 months. Imaging was obtained immediately prior to surgery (iPTS). Best-corrected visual acuity (BCVA) was measured at longest follow-up and iPTS. SRF and foveal status iPTS were analyzed.

Results:

240 and 95 patients were in BEP and control cohorts, respectively. 30 patients presented iPTS for analysis. High (64%) and medium (35%) compliance showed significantly greater (P < 0.01) SRF reduction compared to low (4%) and control (3%). Mac-off RRD showed significantly greater (P < 0.01) foveal reattachment with high (29%) and medium (8%) compliance compared to low (2%) and control (1%). Mac-on RRD demonstrated no significant differences (P ≥ 0.51) in final BCVA among high (0 logMAR [median], 20/20 Snellen), medium (0.10 logMAR, 20/25 Snellen), low (0.10 logMAR), and control cohorts (0.10 logMAR). Mac-off RRD demonstrated significantly better final BCVA with high compliance (0.30 logMAR, 20/40 Snellen) compared to low (0.40 logMAR, 20/50 Snellen; P = 0.04) and control (0.60 logMAR, 20/80 Snellen; P = 0.02).

Conclusions:

Preoperative BEP can stabilize or improve SRF in acute primary RRD. Patients with BEP >50% of time experienced greatest benefits.
Characteristics Predictive of Fellow-Eye Geographic Atrophy without Neovascularization in Unilateral Type 3 Macular Neovascularization
Authors: Kim Jae Hui , Kim Jong Woo , Kim Chul Gu
Published: November 2023

Purpose:

To evaluate the predictive characteristics of fellow-eye geographic atrophy (GA) without neovascularization in patients with unilateral type 3 macular neovascularization (MNV).

Methods:

This retrospective study included 84 patients who were diagnosed with unilateral type 3 MNV. Patients who developed fellow-eye neovascularization and those exhibiting GA without neovascularization at the final follow-up were included in the NV and GA groups, respectively. The patient demographics and baseline fellow-eye characteristics were compared between the two groups.

Results:

The mean follow-up period was 40.5±11.5 months after diagnosis. Patients included in the GA group (n = 28) were significantly older (mean 77.4 ± 5.2 years vs. 74.2 ± 5.8 years, P = 0.016), had significantly thinner subfoveal choroidal thickness (SCT; mean 109.4 ± 36.8 µm vs. 173.1 ± 77.6 µm, P < 0.001), and had a significantly higher incidence of baseline GA (39.3% vs. 16.1%, P = 0.019) than those included in the NV group (n = 56). In the multivariate analysis, SCT showed a close negative association with the risk of GA rather than neovascularization (P = 0.004, β = 0.982, 95% confidence interval = 0.970–0.994).

Conclusions:

In patients with unilateral type 3 MNV, older age, the presence of GA, and a thin choroid in the fellow eye were found to be indicative of a higher probability of progression towards fellow-eye GA instead of neovascularization may be potential candidates for future complement inhibitor treatments targeting fellow-eye GA.
TRANSDIFFERENTIATION AND INTRACHOROIDAL MIGRATION OF MELANOTIC RETINAL PIGMENT EPITHELIUM IN PUNCTATE INNER CHOROIDITIS
Authors: Bijon Jacques , Freund K. Bailey
Published: November 2023

Purpose:

The objective of this study was to report the multimodal imaging features of hyperpigmented chorioretinal lesions originating from the retinal pigment epithelium within punched-out lesions of punctate inner choroidopathy.

Methods:

This was a retrospective case report. Multimodal imaging findings including fundus photography, optical coherence tomography, and optical coherence tomography–angiography were analyzed.

Results:

A 49-year-old woman with myopic degeneration developed progressive lesions of punctate inner choroidopathy, requiring immunosuppressive therapy with adalimumab. Within the areas of punched-out chorioretinal atrophic lesions, the occurrence of hyperpigmented lesions was observed, which enlarged and extended into the choroid over a multiyear follow-up.

Conclusion:

This case illustrates the development of pigmented choroidal lesions appearing to originate from the retinal pigment epithelium through transdifferentiation after previous chorioretinal inflammatory lesions. The introduction of adalimumab treatment may have activated the cellular migration of the retinal pigment epithelium. To the best of the authors' knowledge, this is the first report of intrachoroidal retinal pigment epithelium migration in punctate inner choroidopathy.
BELZUTIFAN FOR TREATMENT OF GIANT RETINAL HEMANGIOBLASTOMA WITH EXTRASCLERAL EXTENSION ASSOCIATED WITH VON HIPPEL–LINDAU SYNDROME
Authors: Cotton Caroline C. , Chandrabhatla Anirudha S. , Andrews Patrick H. , Purrow Benjamin W. , Shildkrot Yevgeniy (Eugene)
Published: November 2023

Purpose:

To describe the clinical response and safety profile of the novel HIF-2ɑ inhibitor belzutifan in treating a giant retinal hemangioblastoma with extrascleral extension associated with von Hippel–Lindau syndrome.

Methods:

A 71-year-old woman with Von Hippel–Lindau syndrome presented with a giant retinal hemangioblastoma with extrascleral extension in her only remaining eye. She had no light perception in the right eye and intraocular pressure was 48. She requested enucleation because of chronic pain, but because of concern for significant bleeding given the size of the neoplasm, a trial of belzutifan was initiated.

Results:

Within 3 months of treatment initiation, the patient reported an 80% reduction in pain. Magnetic resonance imaging showed 30% reduction in longest tumor diameter. Dose adjustments were guided by serum hemoglobin levels, allowing the patient to remain on the medication for over a year with continued tumor regression on MRI and avoid enucleation.

Conclusion:

Retinal hemangioblastoma with extrascleral extension is exceedingly rare and its treatment is complex, often requiring enucleation or external beam radiotherapy. This report demonstrates the use of belzutifan to safely and successfully reduce ocular tumor burden of complicated retinal hemangioblastoma with extrascleral extension, ultimately decreasing the need for enucleation.
Recent Fluctuations in Public Searches for Cosmetic Procedures as Shown by Google Trends
Authors: Oh Angela J. , Rootman Daniel B.
Published: November 2023

Purpose:

The goal of this study is to understand the dynamic trends of 20 cosmetic procedures in the United States using Google Trends.

Methods:

This was a descriptive cross-sectional study using Google Trends to measure changes in search volumes for 20 cosmetic procedures from a 5-year period (2018 to 2023) in the United States. Outcome measures included total and weekly changes in relative search volumes and variance levels for the following 20 search terms related to cosmetic surgeries: blepharoplasty, botox, breast augmentation, breast lift, brow lift, buccal fat removal, chemical peel, dermal filler, face lift, hair removal, hair transplant, lip filler, liposuction, masseter botox, microneedling, otoplasty, photofacial, rhinoplasty, tear trough filler, and tummy tuck. Search terms were divided into 3 categories, a) those with a change of public interest over a single week of 25% or less, b) 26%–50%, and c) greater than 50%.

Results:

There was an overall 5-year increase of public interest in all but 5 search terms: breast augmentation, breast lift, liposuction, photofacial, and tummy tuck. Within a single week, lip filler, masseter botox, buccal fat removal, and tear trough filler exhibited greater than 50% change in public interest, while public interest in microneedling, hair removal, rhinoplasty, tummy tuck, liposuction, breast lift, and augmentation were more stable with less than 26% change.

Conclusions:

While certain procedures may experience rapid accelerations in public interest, not all procedures will consistently increase in popularity. Physicians must recognize the shifting popularity of cosmetic procedures to provide informed cosmetic care to patients.
Teprotumumab and Orbital Decompression for the Management of Proptosis in Patients With Thyroid Eye Disease
Authors: Hubschman Sasha , Sojitra Badal , Ghiam Sean , Sears Connie , Hwangbo Nathan , Goldberg Robert A. , Rootman Daniel B.
Published: November 2023

Purpose:

To compare outcomes of patients with thyroid eye disease treated with teprotumumab or orbital decompression, or both in sequence.

Methods:

Patients with thyroid eye disease and treated with decompression, teprotumumab, or both were included. Four groups were defined: decompression only, teprotumumab only, teprotumumab first with decompression later, and decompression first with teprotumumab later. The primary outcome was change in exophthalmometry. Secondary outcomes included change in extraocular muscle motility, strabismus, diplopia, and side effects.

Results:

One hundred and thirty-nine patients were included. The mean duration for early follow-up was 1.2 months for both decompression and teprotumumab groups. The mean late follow-up was 14.4 and 8.2 months for the decompression and teprotumumab groups respectively. Mean change in exophthalmometry was significantly greater for the decompression group (3.5 mm) compared with teprotumumab (2.0 mm) at late follow-up. Improvement in total extraocular muscle restriction was significantly greater in the teprotumumab group (14.7 degrees) than in the decompression group (2.6 degrees). The teprotumumab group had a significantly higher percentage of patients with diplopia score >1 at baseline and late follow-up (p < 0.01) compared with the decompression group. Additional treatment with teprotumumab or decompression when previously treated with the opposite had similar proptosis reduction effect as that therapy alone.

Conclusions:

Surgical decompression has a greater proptosis reduction effect than teprotumumab, whereas teprotumumab better improves extraocular muscle motility. The addition of teprotumumab or decompression to a previous course of the opposite adds a similar effect to the supplemental treatment alone.
ENABLE-LVAD
Authors: Pfahl Jamie , Thompson Jocelyn S. , Matlock Daniel D. , Allen Larry A. , Dionne-Odom J. Nicholas , Bakitas Marie A. , McIlvennan Colleen K.
Published: November 2023

Background

Despite significant family caregiver (FCG) burnout, there are currently no tested interventions to support the FCG role after left ventricular assist device (LVAD) implantation or formalized training for clinicians to support FCGs.

Objective

We adapted the existing ENABLE (Educate, Nurture, Advise Before Life Ends) intervention to LVAD clinicians and FCGs and assessed clinical implementation and dissemination.

Methods

ENABLE-LVAD is an interactive, self-paced clinician training coupled with FCG-facing guidebooks and resources. Implementation and dissemination were evaluated by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework.

Results

As of May 2023, 187 clinicians registered for the training, and 41 completed all modules (22.0% completion rate). Of those who completed the training and responded to a 6-month survey, one-third (n = 10, 33.3%) used ENABLE-LVAD with FCGs, and 100% of those planned to continue using it. The primary barrier to completing the training was time.

Conclusions

The ENABLE-LVAD clinician training was successfully disseminated and implemented as a useful resource to support LVAD FCGs.
Differences Between Clients and Professionals of Forensic and Nonforensic Flexible Assertive Community Treatment
Authors: Clercx Maartje , van Tuijn Genevieve
Published: November 2023

Rationale

Flexible assertive community treatment (FACT) has been adapted for application with clients with criminal justice involvement (forensic FACT [ForFACT]). Differences have been found between clients of ForFACT services and clients of nonforensic FACT services; however, less is known about differences in behaviors. Furthermore, because of the different guiding frameworks and goals of treatment, and the difference in clients' presenting problems, it is possible professionals also differ in terms of specialist skills they need and in areas of care they deem important.

Method

The current study used an online survey among professionals of ForFACT and non-ForFACT teams to gain insight into mental disorders and clients' presenting behavioral problems and to gain insight into the level of forensic vigilance needed by professionals of both services. We also gathered information pertaining to important areas of care and what both groups of professionals view as key nursing interventions.

Results

ForFACT clients differ from non-ForFACT clients in terms of the clients' presenting psychiatric problems. Furthermore, ForFACT professionals indicated they encounter more clients who show aggressive and (sexually) transgressive behavior. ForFACT professionals were found to score higher on forensic vigilance; however, no differences pertaining to important areas of care and key nursing interventions were found.

Conclusion

These findings further strengthen the notion that ForFACT clients are a different group compared with non-ForFACT clients, and professionals need different skills. Organizations could provide tailored supervision and training to ForFACT professionals.