bluuebunny/crossref_metadata_2025 huggingface dataset:
17-year Follow-up after Mandibular Distraction Performed in an Infant with Robin Sequence
Authors: Nakao Takako , Katayama Misato , Fujimori Yasushi , Kawai Shuichi , Nuri Takashi , Ueda Koichi
Published: February 2020

Robin sequence is a congenital anomaly, first described by Pierre Robin as a triad of micrognathia, upper airway obstruction and glossoptosis. The most significant airway management technique is the use of distraction osteogenesis to advance the mandible. On the other hand, late complications such as permanent dentition loss and malformation of the damaged teeth have been reported. Therefore, long-term follow-up after mandibular distraction is important. In our case report, we describe 17 years of follow-up after mandibular distraction performed in a 4-month-old male infant with Robin sequence. The patient was a male with a cleft palate. The tracheotomy and tongue–lip adhesion was performed 1 month after birth, because the percutaneous oxygen saturation decreased to 70% during feeding and crying. However, postoperative X-ray examination revealed that he could not obtain sufficient airway after the operation. For the purpose of closing the tracheotomy early, we performed bilateral mandibular distraction at the age of 4 months. The bilateral corticotomy was performed on the mandibular body and an internal traction device was placed. The mandible was bilaterally lengthened by 17.5 mm, and expansion of the airway was confirmed by X-ray. A cleft palate operation was performed at the age of 17 months. At the age of 3 years, the tracheostomy orifice closed and speech/language training and orthodontics were begun. Dental panoramic radiographs showed favorable mandibular growth. No additional operation has been performed. Finally, his orthodontic treatment was completed without any complications at age 17.
V-Y Hemi-keystone Advancement Flap: A Novel and Simplified Reconstructive Modification
Authors: Petukhova Tatyana A. , Navrazhina Kristina , Minkis Kira
Published: February 2020

Background:

The keystone perforator flap design has been gaining popularity for reconstruction of cutaneous defects due to its robust vascular supply and high rates of flap survival. However, the design requires significant tissue mobilization relative to the defect and is consequently technically demanding, time intensive, and has associated morbidity. We present a novel, simplified modification of the keystone flap that may increase its reconstructive applications.

Methods:

A retrospective chart review was conducted of patients who underwent V-Y hemi-keystone advancement flap reconstruction of cutaneous defects by a single surgeon. Outcomes of interest included wound healing complications.

Results:

Eighty-six consecutive V-Y hemi-keystone advancement flaps were performed with an overall complication rate of 7% (6/86). Reconstruction sites included lower extremities (75/86, 87.2%), upper extremities (9/86, 10.5%), and the trunk (2/86, 2.3%). Mean follow-up time was 26.3 weeks. Four out of 5 surgical site infections occurred on lower extremity wounds. There were no cases of complete or partial flap loss.

Conclusions:

The current series presents a simplification of the traditional keystone flap that decreases surgical complexity and time required for successful reconstruction of cutaneous defects, especially in challenging wounds on the lower extremities. The complication rates were similar, or lower, than previously reported series of keystone flap reconstructions. The consistently favorable outcome of this technique supports the integration of the V-Y hemi-keystone advancement flap into reconstructive surgery.
Toll-like receptor 7-driven lupus autoimmunity induces hypertension and vascular alterations in mice
Authors: Robles-Vera Iñaki , Visitación Néstor De La , Toral Marta , Sánchez Manuel , Gómez-Guzmán Manuel , O’valle Francisco , Jiménez Rosario , Duarte Juan , Romero Miguel
Published: February 2020

Objective:

To investigate whether toll-like receptor 7 (TLR7) activation induces an increase in blood pressure and vascular damage in wild-type mice treated with the TLR7 agonist imiquimod (IMQ).

Methods:

Female BALB/c mice (7–9 week old) were randomly assigned to two experimental groups: an untreated control group and a group treated topically with IMQ (IMQ-treated) for 4 or 8 weeks. A group of IMQ-treated mice that take a combination of the antioxidants tempol and apocynin, and another treated IL-17-neutralizing antibody were also performed.

Results:

TLR7 activation gradually increased blood pressure, associated with elevated plasma levels of anti-dsDNA autoantibodies, splenomegaly, hepatomegaly, and severe expansion of splenic immune cells with an imbalance between proinflammatory T cells and regulatory T cells. TLR7 activation induced a marked vascular remodeling in mesenteric arteries characterized by an increased media--lumen ratio (≈40%), and an impaired endothelium-dependent vasorelaxation in aortas from wild-type mice after 8 weeks of treatment. In addition, an increased ROS production, as a result of the upregulation of NADPH oxidase subunits, and an enhanced vascular inflammation were found in aortas from IMQ-treated mice. These functional and structural vascular alterations induced by IMQ were improved by antioxidant treatment. Anti-IL-17 treatment reduced blood pressure and improved endothelial dysfunction in IMQ-treated mice.

Conclusion:

Our results demonstrate that TLR7 activation induces the development of hypertension and vascular damage in BALB/c mice, and further underscore the increased vascular inflammation and oxidative stress, mediated in part by IL-17, as key factors contributing to cardiovascular complications in this TLR7-driven lupus autoimmunity model.
Impact of ambulatory SBP and overweight on executive function performance in children and adolescents
Authors: Chrysaidou Katerina , Kotsis Vasilios , Chainoglou Athanasia , Tzovaras Filimon , Gidaris Dimos , Chatzipapa Nikoleta , Zafeiriou Dimitrios , Stabouli Stella
Published: February 2020

Background and aim:

Neurocognitive impairment has recently emerged as a hypertensive target organ damage in children and adolescents. In the present study, we aimed to examine the effect of hypertension and overweight on executive function performance in youth.

Methods:

The study population included 116 consecutive children and adolescents referred to our outpatient hypertension clinic who underwent ambulatory blood pressure monitoring (ABPM) and assessment of executive function by Behavior Rating Inventory of Executive Function (BRIEF).

Results:

Children and adolescents with hypertension presented higher T scores in shift sub-scale of Behavior Regulation Index (BRI) compared with normotensives. Participants with hypertension in the ABPM also presented higher T scores in subscales of metacognition (metacognition index). Night-time SBP correlated with BRI (r = 0.21, P < 0.05) and metacognition index (r = 0.19, P < 0.05) composite scales. BMI z score also correlated with BRI (r = 0.28, P < 0.005) and metacognition index (r = 0.22, P < 0.05) scales. The associations of night-time SBP with monitor and plan/organize subscales of metacognition index remained significant after adjustment for BMI z score and socioeconomical status. However, the associations of BMI z score with monitor scale was found to be mediated by night-time SBP. In ROC curve analysis, only night-time SBP could predict impaired performance in monitor and plan/organize scales (AUC 0.68 and 0.70, respectively).

Conclusion:

Night-time SBP may predict a poor performance in domains of executive function in youth. Although overweight/obese status was negatively associated with executive performance, mediation analysis showed that not obesity per se, but BP exerted negative impact on executive performance.
Hypertension: evolving from standardized to individualized care
Authors: Alderman Michael H. , Blumenfeld Jon D.
Published: February 2020

The hypertension paradigm has contributed to a dramatic reduction in CVD mortality. This has been achieved by applying average results of population studies to identify a target population and design a common intervention to achieve a BP goal. Progressive lowering of the BP threshold has expanded the fraction of persons at risk who have access to treatment. Meanwhile, falling risk reduces potential benefit, while treatment-induced adverse events increase – making further expansion of the treatment pool no longer tenable. Still, CVD remains the leading cause of death. Fortunately, new science reveals opportunities to enhance CVD prevention when BP management is based upon individual characteristics. Treatment can be directed at those most likely to benefit, while sparing others the hazards of unnecessary therapy. Treatment can be designed to achieve a variety of physiological objectives that influence cardiovascular outcomes. This new strategy should improve both the efficacy and efficiency of BP-related CVD prevention.
The Third Annual Thomas S. Tenforde Topical Lecture HPS Ask the Experts: The Most Intriguing Questions and Answers
Authors: Roessler Genevieve S. , Baes Fred , Classic Kelly
Published: February 2020

The Health Physics Society (HPS) conceived of the idea of an online “Ask the Experts” (ATE) feature in 1999 when the Society created its website. ATE features are popular now, but at that time it was a novel idea, so there was no assurance it would succeed. Now 20 y later, the HPS considers its ATE feature a success and the most valuable service the Society offers for the public. Nearly 13,000 questions have been submitted to the feature. They come both from members of the public and from health physicists. All have been answered personally by radiation safety experts. While it is important to answer questions personally, it is recognized that the most far-reaching impact of the feature is the written material on the ATE section of the website, which is provided for people searching for answers to their concerns and questions. Posted material includes frequently asked questions, summary papers on topics of interest, and links to other pertinent information. This is in addition to answers to a select group of submitted questions. To enhance the information search, all postings, including answers to questions, have headlines. These serve as keywords that facilitate website searches. The feature, managed by one lead editor, 20 topic editors, and more than 300 experts, draws over one million visitors per year. This statistic suggests that a substantial number of people are finding answers to their questions on the site and, therefore, do not need to submit personal questions. ATE editors have learned much about effective interaction with questioners, especially members of the public. Most important, answers should show compassion, present the bottom line first, be brief, and use plain language. Heavy reliance on peer-reviewed documents adds to the credibility of the information. Questions from the public cover a wide range of subjects; however, by far the most frequent deal with medical exposures, especially computed tomography procedures. Other questions deal with a wide range of concerns including products from Japan, granite countertops, radon, smoke detectors, luggage and whole-body scanners, and radiation exposure from airline travel. Another major concern is exposure to nonionizing radiation sources such as cell phones, radar, ultraviolet radiation, lasers, and power lines. Examples are provided of the most intriguing questions that have come to the ATE feature and the answers provided by the experts.
Yazd Province of Iran ICD Registry for the Years 2014–2016
Authors: Malekpour Maliheh , Dehghani-Tafti Faezeh , Ratki Seid Kazem Razavi , Seifpoor Zeinolabedin , Namiranian Nasim , Shafiee Mohammad , Mali Shahryar , Seyed Hosseini Seyed-Mostafa
Published: February 2020

Objective:

This study aimed to investigate the trends in the care of patients undergoing implantable cardioverter-defibrillator (ICD) implantation in our region and to analyze whether the quality of care is the same as the other centers or not?

Methods:

Adult patients with an indication for ICD implants were enrolled in our registry and followed over a 19–43-month period.

Results:

The ICD implantation rate was 100/million per year. The mean age of patients treated with ICD was 62.36 (±12.93) years old and the majority of patients were men (77.6%). Most patients had ischemic heart failure (65.2%). Nearly half of the patients had NYHA class III (53.8%) and the mean of ejection fraction was 26.7 (±9.8%). ICDs were frequently implanted for primary prevention (71.9%). Single chamber ICDs (ICD-VR) were chosen in 25.2%, dual-chamber ICDs in 37.1% (ICD-DR) and biventricular ICDs (CRT-D) in 37.6%, respectively. Complications related to ICD implantation occurred in about 7.49% of all procedures. During follow-up period death occurred in 14.8% of our patients. Also, 13.3% of patients received ICD shock which was appropriate in 71% of patients.

Conclusions:

In comparison between our registry and NCDR registry, baseline patient characteristics and ICD type were almost the same, but the complication rate was higher. There is still a need to perform a large multicenter registry in our community to improve our knowledge in this Era.
ACUTE FOVEALITIS
Authors: Ledesma-Gil Gerardo , Spaide Richard F.
Published: February 2020

Purpose:

To describe the clinical, optical coherence tomography (OCT), and OCT angiography findings of a patient with a foveal disturbance from the acute phase to the resolution of the visual disturbances.

Method:

The patient had a comprehensive ophthalmic examination to include OCT and OCT angiography.

Results:

A 36-year-old man presented with decreased vision and distortion in the right eye. The right eye showed yellow-white punctate opacities in the central fovea. OCT showed numerous, well-defined, globular, aggregated, hyperreflective lesions that corresponded to the visible opacities along with a focal discontinuity of the outer retinal layers. Over 3 weeks, the patient's findings resolved, and the VA improved to 20/20. No abnormalities of the choriocapillaris flow were detected using OCT angiography. The lesion resolved without pigmentary change.

Conclusion:

The configuration of the hyperreflective deposits, the lack of pigmentary change, and the absence of OCT angiographic findings of flow problems in the choriocapillaris argue against a primary retinal pigment epithelial or choriocapillaris abnormality as the fundamental cause of the disease. The name acute fovealitis is suggested.
Laser in Situ Keratomileusis and Surface Ablation in Breastfeeding Patients
Authors: Alonso-Santander Nuria , Ortega-Usobiaga Julio , Beltrán-Sanz Jaime , Druchkiv Vasyl , Llovet-Osuna Fernando , Baviera-Sabater Julio
Published: February 2020

Purpose:

Our objectives were to determine the anatomical and functional (visual and refractive) outcomes of corneal refractive surgery during breastfeeding and to compare the results with those of women who stopped breastfeeding at least 3 months before the procedure. We also evaluated predictability, safety, and efficacy indexes; number of retreatments; and adverse effects reported in babies.

Methods:

We performed a multicenter, retrospective, interventional case series review of patients who were breastfeeding and who underwent laser in situ keratomileusis or surface ablation (photorefractive keratectomy) from September 11, 2002 to December 12, 2017 (group 1, n = 142 eyes in the case group). Patients were compared with women who stopped breastfeeding at least 3 months before the procedure from September 11, 2002 to December 12, 2017 (group 2, n = 95 eyes in the control group). A total of 168 women (237 eyes) were included. Patients were incorporated consecutively. Functional (visual and refractive) and anatomical outcomes are described.

Results:

No significant intraoperative or postoperative complications were recorded. There were no significant differences between the groups in visual acuity, postoperative spherical equivalent, efficacy index, predictability, safety index, or retreatments. No infants experienced adverse effects.

Conclusions:

In our experience, laser in situ keratomileusis and photorefractive keratectomy can be performed effectively and safely in breastfeeding women.
Comparative corneal endothelial cell toxicity of differing intracameral moxifloxacin doses after phacoemulsification
Authors: Chang David F. , Prajna N. Venkatesh , Szczotka-Flynn Loretta B. , Benetz Beth Ann , Lass Jonathan H. , O'Brien Robert C. , Menegay Harry J. , Gardner Susanne , Shekar Madhu , Rajendrababu Sharmila , Rhee Douglas J.
Published: February 2020

Purpose:

To determine whether intracameral moxifloxacin 500 μg is noninferior to 250 μg for central endothelial cell loss (ECL) after phacoemulsification.

Setting:

Aravind Eye Care System.

Design:

Prospective masked randomized study.

Methods:

Eyes with bilateral nuclear cataracts, central endothelial cell density (ECD) of more than 2000 cells/mm2, and ECD not differing between eyes by more than 200 cells/mm2 underwent phacoemulsification at least 14 days apart. Intraoperatively, the first eye was randomized to receive either a 500 or 250 μg dose of moxifloxacin intracamerally and received the other dose for the second-eye surgery. Postoperative course was monitored at 1 day, 1 week, 1 month, and 3 months. Preoperative and 30-day and 90-day postoperative central ECD was determined by a reading center for a masked analysis of ECL at 3 months postoperatively.

Results:

Fifty eyes of 25 patients (aged 48 to 69 years) underwent uneventful surgery and had normal postoperative courses. The point estimate (PE) and 95% CI for the mean difference in % ECL between the 500 μg and 250 μg doses at 3 months postoperatively was 0.8% (−5.8%, 7.4%). Upon identifying and removing 2 outliers, noninferiority was proven with a mean difference of the PE, −2.2% (CI, −6.5%, 2.1%).

Conclusions:

Clinical and corneal endothelial cell were comparable in this study population for the 250 μg and 500 μg doses of intracameral moxifloxacin. Both doses were well tolerated clinically, supporting the use of the higher dose for improved antimicrobial coverage for the prevention of postoperative endophthalmitis.
Visual performance comparison of 2 extended depth-of-focus intraocular lenses
Authors: Schojai Merita , Schultz Tim , Jerke Corinna , Böcker Jörg , Dick H. Burkhard
Published: February 2020

Purpose:

To compare the visual acuity and satisfaction outcomes of 2 different concepts of extended depth-of-focus intraocular lenses (EDOF IOLs).

Setting:

University Eye Hospital Bochum, Germany.

Design:

Prospective randomized comparative clinical trial.

Methods:

Patients undergoing cataract surgery with the implantation of 2 different concept EDOF IOLs. In the first group (IC-8 Group), a monofocal 1-piece Tecnis Z B00 IOL (Johnson & Johnson Vision Care, Inc.) was implanted in the dominant eye, and an IC-8 IOL (AcuFocus) was implanted in the nondominant eye. In the second group (Symfony Group), a Tecnis Symfony IOL (Johnson & Johnson Vision Care, Inc.) was implanted in both eyes. The target refraction of the dominant eye was emmetropia and slight myopia (mini-monovision, −0.75 diopters) in the nondominant eye. Visual and refractive outcomes and patient satisfaction rates were evaluated 3 months postoperatively.

Results:

This study comprised 76 eyes of 38 patients. No intraoperative or postoperative complications occurred in either group. Target refraction was reached in both groups without statistically significant differences. The uncorrected distance visual acuity (UDVA, photopic and mesopic light conditions) was excellent in both groups with statistically significantly better results in the IC-8 goup (logarithm of the minimum angle of resolution; IC-8 Group (0.1 ± 0.07 logarithm of the minimum angle of resolution [logMAR]; Symfony Group 0.07 ± 0.1 logMAR, P value .02 [photopic]; IC-8 group 0.12 ± 0.09 logMAR, Symfony group 0.22 ± 0.1 logMAR, P value < .01 [mesopic]). Binocular uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA) were also good in both groups without statistically significant differences (UIVA: IC-8 Group, 0.01 ± 0.07 logMAR, Symfony Group 0.01 ± 0.08 logMAR, P value .35; UNVA: IC-8 Group 0.14 ± 0.11, Symfony Group 0.09 ± 0.08, P value .14). Subjective satisfaction was high in both groups.

Conclusions:

Both EDOF IOLs provided a very good UDVA with superior results in the IC-8 Group, and a good UIVA and UNVA under photopic light conditions. Subjective patient satisfaction was higher in the IC-8 Group.
Refractive outcomes of 8 biometric formulas in combined phacovitrectomy with internal limiting membrane peeling for epiretinal membrane
Authors: Vounotrypidis Efstathios , Shajari Mehdi , Muth Daniel R. , Hirnschall Nino , Findl Oliver , Priglinger Siegfried , Mayer Wolfgang J.
Published: February 2020

Purpose:

To investigate the accuracy of 8 different biometric formulas in combined phacovitrectomy and the effect of constant optimization on refractive outcome.

Setting:

Ludwig-Maximilians-University, Munich, Germany.

Design:

Retrospective observational case series.

Methods:

In this single-center study, patients with cataract and epiretinal membrane who underwent combined phacovitrectomy with internal limiting membrane peeling (Group B) and axial length–matched patients who underwent phacoemulsification (Group A) were included. In Group C, optimized constants from Group A were applied in patients of Group B. One eye of each patient was included. Main outcome measures after constant optimization for each biometric formula were refractive prediction error (PE), mean absolute error (MAE), and percentages of eyes with a PE within ±0.25 diopters (D), ±0.5 D, and ±1.0 D.

Results:

The study comprised 128 patients. For all formulas in Group A and Group B, refractive PE was 0.000 (P = .964 and P = .967, respectively). For formulas Barrett, Haigis, Hill, Hoffer Q, Holladay 1, Holladay 2, Kane, and SRK-T, refractive PE was −0.147, −0.204, −0.180, −0.212, −0.180, −0.178, −0.153, and −0.159, respectively, in Group C (P = .569); MAE was 0.346, 0.375, 0.382, 0.379, 0.355, 0.377, 0.318, and 0.364, respectively, in Group A (P = .286); 0.402, 0.422, 0.417, 0.427, 0.417, 0.402, 0.370, and 0.401, respectively, in Group B (P = .364); and 0.401, 0.424, 0.419, 0.444, 0.424, 0.404, 0.391, and 0.422, respectively, in Group C (P = .767). Effect of constant optimization in phacovitrectomy was statistically significant for all formulas (P < .001 for each formula).

Conclusions:

No statistically significant difference was observed between the biometric formulas with regard to PE and MAE. However, in terms of phacovitrectomy, constant optimization should be considered for individual intraocular lens power calculations attributable to myopic shift.
Visual outcome and optical quality after implantation of zonal refractive multifocal and extended-range-of-vision IOLs: a prospective comparison
Authors: Song Xiaohui , Liu Xin , Wang Wei , Zhu Yanan , Qin Zhenwei , Lyu Danni , Shentu Xingchao , Xv Wen , Chen Peiqing , Ke Yao
Published: February 2020

Purpose:

To compare the visual outcomes and optical quality of 2 presbyopia-correcting intraocular lenses (IOLs) with those of a monofocal IOL.

Settings:

Eye Center, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China.

Design:

Prospective cohort study.

Methods:

The study included patients who had cataract surgery and were implanted with a Tecnis Symfony Extended Range of Vision (EROV) IOL (ZXR00), a zonal refractive multifocal IOL (Lentis Comfort LS-313 MF15), or a monofocal IOL (Lentis L-313). Postoperative examinations took place at 1 week, 1 month, and 3 months and included visual acuity at far, intermediate, and near distances, defocus curves, contrast sensitivity, wavefront aberrations, and modulation transfer function (MTF). Patients completed the Visual Function Index questionnaire (VF-14), the Quality of Vision questionnaire (QoV), and a visual quality self-evaluation.

Results:

One hundred thirteen patients were enrolled. The EROV and multifocal IOLs achieved a significantly better range of intermediate vergences (P < .05), better distance-corrected intermediate visual acuity (P ≤ .001), higher VF-14 (P < .05) and visual quality self-evaluation scores (P < .05) than the monofocal IOL, but there were no significant differences between the 2 presbyopia-correcting IOLs. The EROV provided lower total wavefront aberrations and better MTF than the multifocal and the monofocal IOLs (P < .05) but demonstrated a worse QoV score (P < .05), especially for severity of halo (P < .01) and starburst (P < .05) symptoms.

Conclusions:

Both the Tecnis Symfony ZXR00 and the Lentis Comfort LS-313 MF15 offered excellent visual restoration and stable distance and intermediate visual acuity, good subjective visual function, and good contrast sensitivity. The EROV IOL provided better objective optical quality and more prominent dysphotopsia symptoms than the multifocal IOL.
Outcome of toric intraocular lenses implanted in eyes with previous corneal refractive surgery
Authors: Cao Danmin , Wang Li , Koch Douglas D.
Published: February 2020

Purpose:

To evaluate the outcome of toric intraocular lens (IOL) implantation in eyes with previous laser in situ keratomileusis/photorefractive keratectomy (LASIK/PRK).

Setting:

Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.

Design:

Retrospective case series.

Methods:

Consecutive cases that had previous myopic or hyperopic LASIK/PRK and had undergone cataract surgery with toric IOL implantation were retrospectively reviewed. Included were eyes that had (1) preoperative ocular biometry measurements with the Lenstar, (2) no intraoperative or postoperative complications, and (3) available postoperative manifest refraction at ≥3 weeks with corrected distance visual acuity of 20/30 or better. Vector analysis was used to assess the preoperative corneal and postoperative refractive astigmatism.

Results:

In 56 eyes with previous myopic LASIK/PRK and 19 eyes with previous hyperopic LASIK/PRK, respectively, the mean magnitudes of corneal astigmatism were 1.34 ± 0.62 diopters (D) and 1.66 ± 0.80 D, 5% and 0% of eyes had anterior corneal astigmatism ≤0.50 D, and the centroid values were 0.31 D at 19 degrees ± 1.45 D and 0.74 D at 92 degrees ± 1.72 D preoperatively. Postoperatively, the mean magnitudes of refractive astigmatism were 0.36 ± 0.31 D and 0.34 ± 0.34 D, 80% and 84% of eyes had refractive astigmatism of ≤0.50 D, and the centroid values were 0.12 D at 152 degrees ± 0.46 D and 0.05 D at 172 degrees ± 0.48 D (all P < .05).

Conclusions:

Toric IOLs were effective to correct preexisting corneal astigmatism in eyes with previous excimer laser corneal refractive surgery.
Mid-term and long-term clinical assessments of a new 1-piece hydrophobic acrylic IOL with hydroxyethyl methacrylate
Authors: Oshika Tetsuro , Fujita Yoshifumi , Inamura Mikio , Miyata Kazunori
Published: February 2020

Purpose:

To investigate the clinical outcomes after implantation of a new hydrophobic acrylic intraocular lens (IOL) with hydroxyethyl methacrylate (HEMA) at 1 year and 9 years postoperatively.

Setting:

Three surgical sites in Japan.

Design:

Prospective case series and retrospective review.

Methods:

In 110 eyes of 110 patients who underwent phacoemulsification and implantation of a new hydrophobic acrylic IOL (Clareon CNA0T0), clinical data were collected preoperatively and at 1 day, 1 week, 1 month, 6 months, and 12 months postoperatively. Of these eyes, 20 eyes of 20 patients were examined at 9 years postoperatively, and corrected distance visual acuity (CDVA) and clarity of the IOL were evaluated.

Results:

All 110 patients (110 eyes) completed every follow-up examination up to 12 months postoperatively. At 12 months, a CDVA of 20/30 and 20/20 was obtained in 110 (100%) and 101 (91.8%) of 110 eyes, respectively. The contrast sensitivity function was better than or similar to the age-matched normal controls, and there was no case of posterior capsule opacification requiring a laser treatment. Glistenings and surface light scattering were not seen in any of these cases. At 9 years postoperatively, a CDVA of 20/40, 20/30, and 20/20 was attained in 20 (100%), 19 (95%), and 14 (70%) of 20 eyes, respectively. One eye (5%) was treated with laser capsulotomy for posterior capsule opacification. There was no case of glistenings and surface light scattering.

Conclusions:

This mid-term and long-term study indicated that the new hydrophobic acrylic IOL with HEMA was safe and effective with excellent postoperative vision. Glistenings and surface light scattering did not develop with this IOL in contrast to its predecessor.
Parent physical and mental health contributions to interpersonal fear avoidance processes in pediatric chronic pain
Authors: Birnie Kathryn A. , Heathcote Lauren C. , Bhandari Rashmi P. , Feinstein Amanda , Yoon Isabel A. , Simons Laura E.
Published: February 2020

Theoretical models and evidence increasingly identify chronic pain as a family issue. To date, much of this work has focused on risk conferred by parental chronic pain status despite evidence suggesting parent mental illness and non–pain-related chronic illness may also contribute to poorer chronic pain outcomes in children. This study is the first to test interpersonal fear avoidance processes as possible mechanisms through which parent health (mental and physical) influences pediatric chronic pain functioning. We used structural equation models to test such an integrative model using cross-sectional data from a large clinical registry of 448 dyads of patients aged between 8 and 18 years (M = 14.57 years; SD = 2.38; 327 females) with mixed chronic pain and their parents (403 mothers). As expected, poorer parent global health was indirectly related to greater child pain interference through higher parent pain catastrophizing, and then through greater parent protective behaviors and child pain catastrophizing. The model demonstrated excellent fit to the data (χ2[5] = 5.04, ns; χ2/df = 1.01; comparative fit index = 1.00, root mean square error of approximation = 0.004 [90% confidence interval = 0.000 to 0.066]). Exploratory multiple-group comparison structural equation model revealed moderation of specific model paths based on child age group (8- to 12-year-olds vs 13- to 18-year-olds) and parent pain status (present vs absent). This study integrates family models of pain with the interpersonal fear avoidance model to extend our mechanistic understanding of parental physical and mental health contributors to pediatric chronic pain.
Comparing Rates of Multiple Chronic Conditions at Primary Care and Mental Health Visits to Community Health Centers Versus Private Practice Providers
Authors: Corallo Bradley , Proser Michelle , Nocon Robert
Published: February 2020

This study identifies differences in rates of multiple chronic conditions at primary care and mental health visits to Community Health Centers and private practice providers using 2013 National Ambulatory Medical Care Survey data. Community health center visits had higher rates of 1 or more, 2 or more, and 3 or more chronic conditions for working-age patient visits (ages 18-64). There were no differences in other age groups. After controlling for age and other covariates using logistic regression, community health center visits had 35% higher odds of having any chronic condition and 31% higher odds of having 2 or more chronic conditions.
Leveraged Primary Care
Authors: Smithline Neil
Published: February 2020

To support primary care physicians (PCPs) in managing populations of patients requires a reengineering of PCP practices, and a new, disruptive model of care management, with the seamless integration of the 2. That is our conclusion, having watched 7 Accountable Care Organizations (ACOs) with direct employer contracts provide care to employed populations over a period of 6 years. We have seen dramatic improvement in outcomes when an ACO provides the needed resources, tears down the silos, and interweaves care management with PCP practices. That is leveraged primary care.
Hospitalized Adults With Intellectual and Developmental Disabilities: Confronting Challenges
Authors: McCoy Jeanne O'Neil , Holt Marilyn
Published: February 2020

Background:

The hospitalization of adults with intellectual and developmental disabilities (IDD) presents unique challenges for individuals, their families, and care providers. These challenges include longer lengths of stay, higher rates of readmission, increased risk for complications related to multiple comorbidities, and poorer hospital experiences. Physical therapists and physical therapist assistants as members of interdisciplinary teams are well positioned to enhance the hospital experience and outcome optimization of persons with IDD when they are acutely ill and more vulnerable.

Purpose and Methods:

Following a brief review highlighting the effect of aging for adults with IDD along with common reasons for hospitalization and potential negative sequelae, the primary purpose of this article is to identify and confront challenges to enhance the hospital experience and outcomes of hospitalized adults with IDD. Practical advice is provided regarding examination and evaluation guidelines, early mobilization and safe patient handling, and strategies fostering continuity of care.

Conclusion:

Embracing these challenges ultimately facilitates return to prior or enhanced levels of activity and participation for adults with IDD.
Inspiring the Future of Physician Assistant Ultrasound Education: Lessons Learned From the Inaugural Yes, iScan Event
Authors: Bafuma Patrick , Bludorn Janelle , Baeten Robert , Fuller Fritz , Monti Jonathan , Norman Francisco
Published: February 2020

Purpose

Point-of-care ultrasound (POCUS), despite its rapid integration into undergraduate medical education curriculum, remains underutilized among physician assistant (PA) programs, with a resultant training gap between PAs and their physician collaborators. Herein, we present the Yes, iScan Ultrasound event, piloted at the 2018 American Academy of PAs (AAPA) conference, as a means to generate PA student interest in, and introductory engagement with, the emerging clinical adjunct of POCUS.

Methods

Physician assistant students and instructors were recruited to voluntarily participate. Student participants received pre-event online training access. They then competed in a team-based 8-hour competition covering core POCUS concepts of image acquisition, interpretation, and clinical implementation. Student participants' pre- and post-event self-assessments of their knowledge of how ultrasound could be implemented into clinical practice were analyzed using a 2-tailed t-test.

Results

A total of 62 students participated in the competition, with a post-event response rate of 53%. Surveys demonstrated a statistically significant post-event increase in knowledge of how ultrasound integrates into clinical practice from 3.9 to 6 (7-point Likert scale, P-value < .01, 95% confidence interval −2.51 to −1.76). Seventy-nine percentage of students reported being highly engaged throughout the event, with 95% of students recommending recurring incorporation into future AAPA conferences.

Conclusions

Students reported high engagement and a significant increase in their knowledge of how POCUS may integrate into clinical practice following their participation. Although these data suggest that such events are successful at generating enthusiasm for this emerging clinical adjunct, further studies on the impact of the event toward increased POCUS integration into PA education are recommended.
Anticoagulation of Impella with a Bivalirudin Purge Solution
Authors: Szymanski Thomas W. , Weeks Phillip A. , Lee Yeunju , Kumar Sachin , Castillo Brian , Kar Biswajit , Gregoric Igor D.
Published: February 2020

The use of percutaneous ventricular assist devices (VADs) in the acute management of cardiogenic shock is becoming increasingly common. The Impella is a percutaneous VAD, which requires a heparin-containing purge solution to prevent thrombosis and maintain proper pump functionality. In this report, we describe two patients with heparin-induced thrombocytopenia (HIT) supported with an Impella using a bivalirudin-containing purge solution. Case 1 involved a 39-year-old man with cardiogenic shock, initially implanted with an intraaortic balloon pump, who developed HIT early in his hospital course. His worsening hemodynamics necessitated the placement of an Impella and later venoarterial extracorporeal membrane oxygenation until he eventually underwent durable left VAD implantation. Case 2 involved a 69-year-old man who had an Impella implanted for worsening cardiogenic shock. HIT was suspected shortly after device insertion, necessitating switching his anticoagulation to bivalirudin. He was successfully bridged directly to heart transplantation. Both patients’ courses resulted in therapeutic anticoagulation without major bleeding or thrombotic events. These cases demonstrate the safe and effective use of bivalirudin-containing purge solutions for patients with confirmed HIT requiring temporary mechanical circulatory support with Impella.
Seasonal and meteorological associations of vitamin K-dependent coagulation factors in 1-month-old infants: assessment of Normotest values
Authors: Iijima Shigeo
Published: February 2020

We aimed to determine the presence of seasonal and meteorological associations of the activity of vitamin K-dependent coagulation factors to explain the seasonal variation in vitamin K deficiency-related bleeding. Seasonal and monthly changes in Normotest values in 1759 healthy 1-month-old infants were retrospectively accessed, and the impact of meteorological parameters on Normotest values was analyzed. Normotest values peaked in winter and were the lowest in summer, with statistically significant differences among the seasonal values (P < 0.001). Comparing monthly variations, the values peaked in January and were the lowest in August (P < 0.001). Only the average daily air temperature significantly correlated with the Normotest values on multiple linear regression (P < 0.001) and with low Normotest values on multiple logistic regression analysis (odds ratio, 1.023; P = 0.002). Seasonal and monthly variations in Normotest values were observed in 1-month-old infants, possibly due to fluctuations in daily air temperature.
Effects of arterial hemorrhage speed on the blood coagulation/fibrinolysis system and hemodynamics in rats
Authors: Furukawa Shota , Sasao Ako , Yonemitsu Kosei , Ohtsu Yuki , Tsutsumi Hiroshi , Taguchi Kazuaki , Otagiri Masaki , Nishitani Yoko
Published: February 2020

The effects of rapid hemorrhage on coagulopathy have been reported. However, the effects of different hemorrhage speeds on the blood coagulation/fibrinolysis system have not been investigated. This study aimed to compare different hemorrhage speeds for clarifying their effects on the coagulation/fibrinolysis system and circulation disorders in rats. Male Sprague–Dawley rats (301–396 g) were randomly assigned to five groups depending on hemorrhage speed and length of procedure: first, rapid (1.4 ml/min, 30-min bleeding); second, rapid-L (1.4 ml/min, 30-min bleeding and observation until 6 h); third, slow (0.1 ml/min, intermittently, 6-h bleeding); fourth, control (30-min observation); and fifth, control-L (6-h observation). Hemorrhage was induced by withdrawing blood until 40% of the estimated blood volume from the femoral artery. We measured vital signs, hematology, general chemistry, blood gas status, coagulation parameters, fibrinolytic markers [tissue-type plasminogen activator and plasminogen activator inhibitor one (PAI-1)], vascular endothelial damage (syndecan-1), and liver PAI-1 mRNA expression. Rapid hemorrhage induced elevation of lactate and syndecan-1 levels and prolonged prothrombin time and activated partial thromboplastin time in the rapid group. In contrast, slow hemorrhage did not induce these changes. Hemorrhage speed had no effect on plasma tissue-type plasminogen activator and hematology. Plasma PAI-1 levels were significantly increased in the rapid-L group, while liver PAI-1 mRNA levels were increased in the slow group. This study shows changes in the circulatory and fibrinolysis systems, depending on the hemorrhage speed. Hemorrhage might promote production of PAI-1, while tissue hypoxia due to rapid hemorrhage might promote release of PAI-1.
Evaluation and management of abdominal sepsis
Authors: Sartelli Massimo
Published: February 2020

Purpose of review

The review focuses on the evaluation and management of abdominal sepsis.

Recent findings

A multitude of surgical approaches towards abdominal sepsis are practized in the world and may be associated with significant morbidity and mortality rates. Despite decades of sepsis research, no specific therapies for sepsis have emerged. Without specific therapies, the management of abdominal sepsis is based on the control of the infection and organ support.

Early clinical diagnosis, adequate source control to stop ongoing contamination, appropriate antibiotic therapy dictated by patient and infection risk factors, and prompt resuscitation are the cornerstones of its management.
Management of severe upper gastrointestinal bleeding in the ICU
Authors: Al Duhailib Zainab , Dionne Joanna C. , Alhazzani Waleed
Published: February 2020

Purpose of review

Upper gastrointestinal bleeding (UGIB) is a common condition that can lead to significant morbidity and mortality. Critical care physicians usually get involved in the care of patients with severe UGIB that is associated with hemodynamic compromise. We aim to provide the readers with evidence-based review of the management of patients with severe UGIB.

Recent findings

Proton pump inhibitors are the main pharmacologic intervention for UGIB, along with adequate resuscitation and timely endoscopic intervention. Endoscopic therapy should be performed as soon as haemodynamics stabilization is achieved, which requires team collaboration. Several radiologic interventions are now commonly used as a second-line intervention after endoscopy.

The management of severe UGIB requires multidisciplinary collaboration, prompt recognition and resuscitation, carful use of blood products, early correction of coagulopathy, and early endoscopic or radiologic interventions.
Update on extracorporeal liver support
Authors: Katarey Dev , Jalan Rajiv
Published: February 2020

Purpose of review

Extracorporeal liver support (ELS) is a large unmet need in day-to-day hepatology practice. In an era of ever-improving outcomes with liver transplantation for very sick patients with either acute liver failure (ALF) or acute-on-chronic liver failure, the outcomes for similar patients who are ineligible for transplantation remains poor. Providing a bridge to recovery from these catastrophic conditions is the aim of ELS, and we aim to review the evidence to date of different ELS devices as well as look to the future of ELS device development.

Recent findings

Studies on different ELS devices shave been relatively consistent in their inability to demonstrate a survival benefit; however, recent published evidence has suggested ways in which the three key pillars to ELS – the disease (patient selection), device (ELS system), and dose (intensity) – may be modified to attain a more positive outcome. New devices are grasping these concepts and demonstrating encouraging preclinical results.

ELS devices to studied to date have not been able to significantly improve transplant-free survival. Newer ELS devices are currently in clinical trials and their results are awaited.
Long-Term Efficacy and Safety of Fecal Microbiota Transplantation for Treatment of Recurrent Clostridioides difficile Infection
Authors: Perler Bryce K. , Chen Brendan , Phelps Emmalee , Allegretti Jessica R. , Fischer Monika , Ganapini Vincent , Krajiceck Edward , Kumar Vinod , Marcus Jenna , Nativ Lotem , Kelly Colleen R.
Published: February 2020

Goals:

We investigated the long-term efficacy and safety of fecal microbiota transplant (FMT) for the treatment of recurrent Clostridioides difficile infection (rCDI).

Background:

FMT has emerged as a promising therapy for patients with rCDI unresponsive to standard medical therapy, though long-term efficacy and safety data are scarce.

Materials and Methods:

A multicenter retrospective study was performed on patients treated with FMT for rCDI with ≥6 months of clinical follow-up post-FMT. Patients were contacted to document sustained efficacy, potential adverse events, and antibiotic exposure. The electronic medical record was reviewed to confirm patient-reported outcomes and obtain additional data. The primary outcome was sustained cure, as defined by the absence of Clostridioides difficile infection (CDI) at any timepoint after FMT.

Results:

Of 528 patients treated, 207 were successfully contacted. The mean follow-up post-FMT was 34 (range: 6 to 84) months. One hundred fifty-seven patients (75.8%) reported sustained cure at the time of follow-up. One hundred patients (48%) reported the use of antibiotics for non-CDI indications post-FMT, of whom 11 (11%) had experienced CDI post-FMT. Fifty-two of the original 528 patients (9.8%) treated with FMT had died at the time of follow-up contact; none were felt attributable to the procedure. New medical conditions or diagnoses post-FMT were reported in 105 patients (50.5%). Fifteen reported improvement post-FMT in previously diagnosed medical conditions.

Conclusions:

In this largest and longest study to date on efficacy and safety after FMT for treatment of rCDI, we found that the majority of patients experienced long-term cure. Although a number of new conditions developed post-FMT, there was no clustering of diseases associated with dysbiosis.
The effect of an intensive patients’ education program on anxiety, depression and patient global assessment in diabetic foot ulcer patients with Wagner grade 1/2
Authors: Chen Huifen , Cai Cong , Xie Jun
Published: February 2020

This study aimed to synthetically evaluate the impact of intensive patients’ education program (IEP) on anxiety, depression and patient global assessment (PGA) in diabetic foot ulcer (DFU) patients.

One hundred eighty DFU patients with Wagner grade 1 and Wagner grade 2 were consecutively recruited in this randomized, controlled study and randomly assigned to IEP group (N = 90) or control group (N = 90) as 1:1 ratio. In the IEP group, patients received the IEP and usual care, and patients in the control group received usual care only. IEP included educating patients and their family members, supervising patients’ harmful habits and diets, psychological care for the patients and establishing a patient-physician-nurse WeChat group. Hospital Anxiety and Depression Scale-anxiety/depression (HADS-A/D) and Zung Self-Rating Anxiety/depression Scale (SAS/SDS) were applied to assess anxiety/depression at M0-M3. PGA score was also assessed at M0-M3.

For anxiety assessment, IEP group presented decreased HADS-A/SAS scores at M2/M3 and increased HADS-A/SAS score changes (M3-M0) compared to control group. For depression assessment, IEP group displayed reduced HADS-D/SDS scores at M2/M3 and raised SDS score change (M3-M0) compared to control group. Moreover, IEP group exhibited reduced PGA score at M1/M2/M3 and elevated PGA score change (M3-M0) compared to control group. Further subgroup analyses disclosed that IEP reduced HADS-A/SAS/HADS-D/PGA scores at M3 and elevated these score changes (M3-M0) in patients with Wagener grade 2 but not Wagener grade 1.

IEP ameliorates anxiety, depression and PGA in DFU patients with Wagner grade 2 but not Wagner grade 1.