bluuebunny/crossref_metadata_2025 huggingface dataset:
Heterogeneity of Treatment Effects Among Patients With Type 2 Diabetes and Elevated Body Mass Index in a Study Comparing Group Medical Visits Focused on Weight Management and Medication Intensification
Authors: Kobe Elizabeth A. , Crowley Matthew J. , Jeffreys Amy S. , Yancy William S. , Zervakis Jennifer , Edelman David , Voils Corrine I. , Maciejewski Matthew L. , Coffman Cynthia J.
Published: September 2021

Background:

Illuminating heterogeneity of treatment effect (HTE) within trials is important for identifying target populations for implementation.

Objective:

The aim of this study was to examine HTE in a trial of group medical visits (GMVs) for patients with type 2 diabetes and elevated body mass index.

Research Design and Measures:

Participants (n=263) were randomized to GMV-based medication management plus low carbohydrate diet-focused weight management (WM/GMV; n=127) or GMV-based medication management alone (GMV; n=136) for diabetes control. We used QUalitative INteraction Trees, a tree-based clustering method, to identify subgroups with greater improvement in hemoglobin A1c (HbA1c) and weight from either WM/GMV or GMV. Subgroup predictors included 32 baseline demographic, clinical, and psychosocial factors. Internal validation was conducted to estimate bias in the range of mean outcome differences between arms.

Results:

QUalitative INteraction Trees analyses indicated that for patients who had not previously attempted weight loss, WM/GMV resulted in better glycemic control than GMV (mean difference in HbA1c improvement=1.48%). For patients who had previously attempted weight loss and had lower cholesterol and blood urea nitrogen, GMV was better than WM/GMV (mean difference in HbA1c improvement=1.51%). No treatment-subgroup effects were identified for weight. Internal validation resulted in moderate corrections in mean HbA1c differences between arms; however, differences remained in the clinically significant range.

Conclusion:

This work represents a novel step toward targeting care approaches for patients to maximize benefit based on individual patient characteristics.
Can Nurses Self-Assess Fatigue?
Authors: Cochran Karen R. , Letvak Susan A. , McCoy Thomas P. , Bacon Cynthia , Karper William B.
Published: September 2021

OBJECTIVE

The aims of this study were to describe nurses' self-perceptions of fatigue and to examine nurses' acceptance of specific fatigue countermeasures.

BACKGROUND

The work of nurses places them at a high risk of fatigue. Evidence suggests 75% to 80% of nurses in the United States experience high levels of fatigue.

METHODS

This descriptive, cross-sectional correlational study surveyed 279 nurses.

RESULTS

Results suggest that almost half of nurses (46%) are not able to accurately self-assess fatigue. Nurses expressed acceptance of several workplace fatigue reduction strategies.

CONCLUSIONS

It may be unrealistic to expect nurses to self-assess fatigue levels and make decisions about their ability to safely provide patient care. Reliable methods for assessing fatigue in the workplace are needed. Several strategies exist that may be used to alleviate fatigue, and many were acceptable to nurses. Nurse leaders are well positioned to implement changes that impact the occurrence of nurse fatigue and thereby the quality of patient care.
In Vitro Antibiotic Resistance among Bacteria from the Cornea in the Antibiotic Resistance Monitoring in Ocular MicRoorganisms Surveillance Study
Authors: Thomas Randall K. , Melton Ron , Vollmer Patrick M. , Asbell Penny A.
Published: September 2021

PURPOSE

This study aimed to report on in vitro susceptibility patterns among corneal isolates collected in the Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) study.

METHODS

Each year, from 2009 to 2019, Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae isolates cultured from patients with ocular infections at participating ARMOR sites were submitted to a central laboratory for species confirmation and antibiotic susceptibility testing. In this analysis of corneal isolates, odds ratios for concurrent resistance were based on sample proportions, one-way ANOVA was used to evaluate resistance by patient age, and Cochran-Armitage tests were used to examine changes in antibiotic resistance over time.

RESULTS

A total of 1499 corneal isolates were collected from 61 sites over the 11-year period. Overall, 34.5% (148 of 429) of S. aureus and 41.9% (220 of 525) of CoNS isolates were methicillin resistant and had higher odds ratios for concurrent resistance to azithromycin (17.44 and 5.67), ciprofloxacin (39.63 and 12.81), and tobramycin (19.56 and 19.95), respectively, relative to methicillin-susceptible isolates (P < .001, all); also, a high proportion of methicillin-resistant S. aureus (85.1%) and methicillin-resistant CoNS (81.8%) were multidrug resistant (at least three classes of antibiotics). Resistance among S. pneumoniae isolates was highest for azithromycin (33.1%), whereas P. aeruginosa and H. influenzae isolates demonstrated low resistance overall. Among staphylococci, antibiotic resistance differed by patient age (S. aureus: F = 6.46, P < .001; CoNS: F = 4.82, P < .001), and few small changes in resistance (≤3.60% per year), mostly decreases, were observed over time.

CONCLUSIONS

Although rates of in vitro antibiotic resistance among presumed keratitis isolates obtained in ARMOR seemed stable between 2009 and 2019, resistance among staphylococci and pneumococci remains high (and should be considered when treating keratitis).
Computer Vision Syndrome in the Spanish Population during the COVID-19 Lockdown
Authors: Galindo-Romero Caridad , Ruiz-Porras Alberto , García-Ayuso Diego , Di Pierdomenico Johnny , Sobrado-Calvo Paloma , Valiente-Soriano Francisco J.
Published: September 2021

SIGNIFICANCE

After 6 to 8 weeks of mandatory lockdown due to coronavirus disease 2019 (COVID-19) in Spain, the encouraged change in daily habits resulted in a significant increase in electronic device use. Computer vision syndrome–related symptoms were reported more often in participants who used electronic device for more time and spent less time outdoors.

PURPOSE

The main purpose of this study was to evaluate computer vision syndrome–related eye symptoms due to the use of electronic devices during COVID-19 lockdown decreed in Spain in 2020.

METHODS

After 6 to 8 weeks of strict lockdown, a total of 730 participants (18 to 73 years old) filled in a customized questionnaire divided into three sections: (1) general demographics, (2) usage habits of electronic devices during this period, and (3) computer vision syndrome–related ocular and visual symptoms associated with their use and with ergonomic practices.

RESULTS

The daily duration of use of electronic devices increased an average of 3.1 ± 2.2 h/d during the lockdown, with computer use increasing the most. The main symptoms reported by the participants were headache (36.7%), dry eye (31.1%), irritation (24.1%), blurred vision (21.2%), and ocular pain (14.9%). There was a significant relationship between computer vision syndrome–related symptoms and age (greater in participants between 18 and 30 years old than in those older than 45 years, P < .001), primary activity (greater in studying from home and remote working, P < .001), and extended periods of electronic device use (greater when used more than 10 h/d, P = .05). Symptoms were also associated with time spent outdoors (greater in participants with <1 h/d, P = .02).

CONCLUSIONS

The lockdown due to COVID-19 showed an increase in the electronic device use. Participants who spent more time with electronic devices and less time outdoors reported more computer vision syndrome–related eye symptoms.
Correlation between Contrast Sensitivity and Modulation Transfer Functions
Authors: Leroux Charles E. , Bouchet Elise , Espinasse Pauline , Fontvieille Christophe , Bardin Fabrice
Published: September 2021

SIGNIFICANCE

Previous studies found no correlation between visual acuity and optical quality in a population of young subjects with good vision. Using sinusoidal gratings, we systematically investigate the correlation between contrast sensitivity and optical quality as a function of spatial frequency.

PURPOSE

This study describes the correlation between the contrast sensitivity function (CSF) and the modulation transfer function (MTF) in a sample of young and informed subjects. Our results are compared with prior studies on the correlation between visual acuity and metrics of image quality. We also compare our results with previous studies that compare the CSF, the MTF, and the neural contrast sensitivity function (NCSF).

METHODS

The CSF of 28 informed subjects is measured in photopic conditions. The polychromatic MTF is computed from the measurements of monochromatic aberrations. The (CSF, MTF) correlation is estimated as the Pearson correlation coefficient, at each spatial frequency. The NCSF of each subject is estimated as the ratio of CSF to MTF.

RESULTS

We obtain high correlation coefficients (0.8) in the range of spatial frequencies of 3 to 6 cycles per degree, which also corresponds to high NCSF. Correlation decreases with increasing spatial frequency in the range of 6 to 18 cycles per degree (down to 0.0 at 18 cycles per degree). In that range, optical and neural contrast sensitivities are both approximately reduced by factor 4.

CONCLUSIONS

In our sample of young subjects with good vision, the CSF with sinusoidal gratings better differentiates eyes of good optical quality at intermediate spatial frequencies (3 to 6 cycles per degree) than at higher spatial frequencies (12 to 18 cycles per degree). At the highest tested spatial frequency of sinusoidal gratings (18 cycles per degree), there is no significant correlation between optical quality and contrast sensitivity.
Ultraviolet and Visible Transmittance of Soft Contact Lenses with and without Ultraviolet Blockers
Authors: Kapfelsberger Andrea , Eckstein Julia , von Ahrentschildt Anke , Bischoff Jürgen , Marx Sebastian , Sickenberger Wolfgang
Published: September 2021

SIGNIFICANCE

Ultraviolet (UV) and visible light transmittance of soft contact lenses (SCLs) was measured. A significant difference in UV transmittance has been found between SCLs with a positive and negative back vertex power (BVP). It can be shown that thicker SCLs absorb more UV radiation.

PURPOSE

This study aimed to determine UV and visible light transmittance of different SCLs with and without UV protection filters.

METHODS

Twenty-one lens brands were investigated in the BVP range of −12.00 to +6.00 D. Three SCLs were measured per BVP 25 times. Three hundred thirty-nine SCLs with UV filter (stenfilcon A, somofilcon A, narafilcon A, senofilcon A, senofilcon C, etafilcon A, nesofilcon A) and 489 SCLs without UV filter (delefilcon A, lotrafilcon A, lotrafilcon B, comfilcon A, balafilcon A, samfilcon A, asmofilcon A, nelfilcon A, omafilcon A, hilafilcon B, ocufilcon D, hioxifilcon A, omafilcon B) have been examined. The measurement setup was created according to ISO 18369-3.

RESULTS

All UV-absorbing labeled test SCLs meet UV protection class 2. senofilcon A, senofilcon C, and narafilcon A meet the higher UV protection class 1 level. A statistically significant difference in UV transmittance (280 to 380 nm) has been found between SCLs with a positive BVP (+1.00 to +6.00 D) and SCLs with a negative BVP (−1.00 to −12.00 D), both without (P = .04) and with UV filters (P = .02).

CONCLUSIONS

With the ISO-conforming, diopter-independent measurement setup, the UV-absorbing test contact lenses that meet the current international standards, regardless of their BVP, were identified. Lenses with increased center thickness absorb more UV radiation. Further studies may use a modified measurement setup with a larger aperture than 10 mm. It would also be worthwhile to examine the UV absorption of the contact lens over the complete corneal area and limbal area because UV radiation may damage inner ocular tissues like the crystalline lens as well as limbal stem cells.
Case Report: Postpartum Purtscher-like Retinopathy
Authors: Fairbanks Jennifer L. , Lloyd Rachael E. , Dempsey Sean P.
Published: September 2021

SIGNIFICANCE

This case highlights various clinical features and resolution of Purtscher-like retinopathy after childbirth.

PURPOSE

This study aimed to present a case report of postpartum Purtscher-like retinopathy and subsequent resolution after oral and intravitreal treatment.

CASE REPORT

A 30-year-old woman presented with subjective visual disturbance and transient scotoma in her right eye 7 days after giving birth. Vision measured 20/20 in her right eye and 20/20 in her left eye. Clinical examination revealed optic disc edema, retinal ischemia, and retinal hemorrhage in the right eye with a grossly normal appearance of the left eye. A diagnosis of Purtscher-like retinopathy was made. Neuroimaging and bloodwork were noncontributory to the diagnosis. Approximately 1 month after treatment with rapidly tapered oral methylprednisolone and a single intravitreal bevacizumab (Avastin; Genentech, San Francisco, CA) injection, the retinopathy had resolved with subjective visual improvement.

CONCLUSIONS

Purtscher-like retinopathy can occur after childbirth, usually within 1 to 2 days postpartum and occasionally associated with preeclampsia. Clinical course and visual improvement vary, but novel treatments may aid in visual recovery.
Case Report: Ipilimumab-induced Multisystem Autoimmune-like Toxicities Suggestive of Vogt-Koyanagi-Harada–like Syndrome
Authors: Monferrer-Adsuara Clara , Hernández-Bel Laura , Hernández-Garfella María Luisa , Remolí-Sargues Lidia , Ortiz-Salvador Miguel , Castro-Navarro Verónica , Cervera-Taulet Enrique
Published: September 2021

SIGNIFICANCE

The emergence of new cancer therapies has dramatically improved outcomes in metastatic melanoma. Immune checkpoint inhibitors have been the most effective treatment. Although, as a direct consequence of the immune dysregulation induced by them, adverse effects termed immune-related adverse events are observed in more than 60% of the patients.

PURPOSE

We describe the clinical presentation of Vogt-Koyanagi-Harada–like syndrome in a patient with concomitant systemic melanoma treatment with ipilimumab, a cytotoxic T lymphocyte–associated antigen 4 blocker.

METHODS

This study aimed to report a case of ipilimumab-induced vitritis, papillitis, and skin and auditory signs suggestive of Vogt-Koyanagi-Harada–like syndrome.

CASE REPORT

A 64-year-old woman with metastatic melanoma presented with bilateral blurred vision and hearing loss upon completion of three cycles of treatment with ipilimumab. Ophthalmologic examination revealed a bilateral granulomatous uveitis with intense vitritis and papillitis. The result of optical coherence tomography was normal, and fluorescein angiography confirmed the bilateral papillary edema. Ipilimumab was withdrawn, and treatment with oral and systemic steroids led to a rapid improvement in the ophthalmologic and auditory manifestations. Three months after initial presentation, the patient developed vitiligo and poliosis.

CONCLUSIONS

Vogt-Koyanagi-Harada–like syndrome can develop in the process of immunological deregulation by ipilimumab in the treatment of metastatic melanoma and can correlate temporally with the efficacy of the drug in tumor regression. These observations may help elucidate the underlying mechanism of Vogt-Koyanagi-Harada syndrome as well as the relation between tumor-associated tolerance and autoimmunity.
The Equivalency of the Binocular Indirect Ophthalmoscope Simulator to Peer Practice: A Pilot Study
Authors: Douglass Amanda , Cham Kwang Meng , Jaworski Alexandra , Maillet Alissa , Cochrane Anthea , Armitage James A.
Published: September 2021

SIGNIFICANCE

Optometric educators are constantly looking for learning and teaching approaches to improve clinical skills training. In addition, the COVID-19 pandemic has made educators scrutinize the time allocated to face-to-face teaching and practice. Simulation learning is an option, but its use must first be evaluated against traditional learning methods.

PURPOSE

The purpose of this study was to compare the training of binocular indirect ophthalmoscopy skills achieved by students and optometrists through deliberate practice on the Eyesi Indirect Ophthalmoscope simulator with deliberate practice using a peer.

METHODS

Students and optometrists were randomly allocated to practice on either the simulator or a peer. Binocular indirect ophthalmoscopy performance was assessed using a peer and the simulator as the patients at different time points. Knowledge and confidence were examined before and following all practice sessions using a quiz and survey.

RESULTS

Significant improvements in binocular indirect ophthalmoscopy performance using either a peer or the simulator as the patient for assessment were seen after 8 hours of student practice (P < .001) and after a half-hour practice time for optometrists (P < .001). There was no significant difference in performance overall between those practicing on a simulator and those practicing on a peer (P > .05). Confidence in ability to perform the technique was lower for students who had practiced on the simulator.

CONCLUSIONS

The simulator has similar efficacy to peer practice for teaching binocular indirect ophthalmoscopy to students and maintenance of this clinical skill for optometrists. Simulation does not replace the need for peer practice but may be a useful adjunct reducing the face-to-face hours required. These findings present a need for further research regarding diverse applications of the Eyesi Indirect Ophthalmoscope simulator in the curriculum for training optometry students and as a continuing professional development offering for optometrists, given the short exposure duration required to observe a significant improvement in skill.
Case Report: Treatment of Myasthenic Ptosis with Topical Ocular Oxymetazoline
Authors: Cooper Jeffrey , Yang Danica
Published: September 2021

SIGNIFICANCE

Ptosis is often the hallmark finding in ocular and general myasthenia gravis. Reduction of ptosis has been achieved with oral and topical ocular medications. However, these medications can result in systemic and ocular adverse effects. A novel eye drop seems to be effective in reducing ptosis while minimizing adverse effects.

PURPOSE

This case report aimed to demonstrate the efficacy of topical oxymetazoline hydrochloride 0.1%, an α-adrenergic agonist, in temporary elimination of ptosis associated with myasthenia gravis.

CASE REPORT

A 68-year-old woman with a history of myasthenia gravis and long-standing ptosis in the right eye presented to improve the asymmetrical appearance of her eyelids. One drop of oxymetazoline hydrochloride 0.1% was instilled in the right eye of the patient. Within 2 hours, the ptosis was eliminated, the margin-reflex distance 1 increased by 2.0 mm, and the superior visual field measured by a superior 36-point screening test increased by 15 points. The effect lasted for at least 7 hours. Of note, there was a decrease in elevation of the contralateral nonptotic eyelid that did not receive a drop of oxymetazoline, which might occur only in myasthenia gravis. Further evaluation is warranted.

CONCLUSIONS

Oxymetazoline 0.1% is effective in reducing and potentially eliminating ptosis related to ocular myasthenia gravis for up to 7 hours.
Correction of Ocular Aberrations with Prismatic Rigid Gas-permeable Contact Lenses in Keratoconic Eyes
Authors: Carballo-Alvarez Jesus , Caballero-Magro Elena , Cortes-Escudero Irene , Carpena-Torres Carlos
Published: September 2021

SIGNIFICANCE

A base-down prism was incorporated on the anterior surface of rigid gas-permeable (RGP) contact lenses to explore potential effects on the residual ocular aberrations after contact lens fitting in keratoconic eyes.

PURPOSE

This study aimed to evaluate the correction of ocular aberrations with corneal prismatic RGP contact lenses in keratoconic eyes and their impact on visual function.

METHODS

A cross-sectional and randomized study was performed. Seventeen eyes of 17 keratoconus patients (34.6 ± 11.1 years) were evaluated. Two designs (standard and prismatic) of a corneal RGP contact lens (KAKC; Conoptica, Barcelona, Spain) were fitted to the same eye of each patient in a random order: a standard RGP contact lens as control and a prismatic RGP contact lens with a base-down prism of 1.6 prism diopters. Ocular aberrations were measured for a pupil diameter of 3 mm with and without both contact lenses, whereas high-contrast distance visual acuity, low-contrast distance visual acuity, and contrast sensitivity were measured under photopic and mesopic conditions.

RESULTS

Both contact lenses improved oblique primary astigmatism, defocus, vertical coma, coma-like, and root-mean-square higher-order aberrations compared with the unaided eyes (P < .05). Furthermore, the prismatic RGP contact lenses offered lower values of vertical coma and root-mean-square higher-order aberrations than the standard RGP contact lenses (P < .05). Both designs (standard and prismatic) produced a positive vertical coma of lower magnitude than the negative vertical coma of the unaided eyes. On the other hand, the improvement achieved in all visual function variables was the same for both contact lens designs (P ≥ .05).

CONCLUSIONS

The prismatic RGP contact lenses corrected higher levels of higher-order aberrations compared with the standard RGP contact lenses. However, both contact lens designs with the same refractive power were equally efficient at improving visual function.
Case Series: Ocular Trauma Secondary to Masks during the COVID-19 Pandemic
Authors: Zhou Peng , Jiang Xiaodan , Li Xue-min
Published: September 2021

SIGNIFICANCE

Previously, people had only recognized the discomfort of masks, and no one had ever realized the risk of ocular trauma associated with masks. We classify the causes of injuries into two categories and emphasize the importance of using masks properly.

PURPOSE

This study aimed to characterize and classify ocular injuries caused by masks.

CASE REPORTS

With the increase in the number of masks used during the coronavirus disease 2019 pandemic, we have seen a rise in mask-related ocular injuries. This is a single-center retrospective case series of patients presenting to the Peking University Third Hospital Ophthalmology Department emergency department with ocular injuries secondary to masks from February to August 2020. Nine patients (six males, three females) were reviewed. All patients had a unilateral injury (four right eyes, five left eyes). The most frequently injured site was the cornea, which was seen in five patients. Some patients were injured in more than one area. Seven patients were injured by metal nose wires or other rigid, sharp parts of masks. The other two patients were injured by elastic mask straps.

CONCLUSIONS

Masks can cause two types of ocular injuries that may require surgical intervention. One kind is metal nose wires or other rigid, sharp parts of masks causing lacerations or abrasions. The other is recoiling elastic mask straps snapping into the eyes and causing contusions. Our report emphasizes the importance of using masks properly.
Relationship Between Injury Pattern and Domestic Violence in a Romanian Population
Authors: Isailă Oana-Maria , Hostiuc Sorin , Curcă George-Cristian
Published: September 2021

Physical violence is a cause of morbidity and mortality worldwide. An often-underreported subtype of physical violence is domestic violence (DV). The main aim of this study was to identify DV-specific patterns of traumatic injuries in comparison to other types of interpersonal violence (OV) in a Romanian population from a medical-legal standpoint. We performed a retrospective study drawing on 500 medical-legal certificates (medical-legal document attesting the traumatic injuries) of victims of interpersonal violence issued by the National Institute of Legal Medicine Bucharest during the 2017–2020 period. A total of 500 victims comprised the sample, including 188 DV victims and 312 victims of OVs. A majority of the DV victims were women (153 victims; 81%), whereas a majority of the OV victims were men (231 victims, 74%). Overall, DV victims were older compared with OV victims (40.9 ± 15.4 vs 37.3 ± 14.8 years, respectively). We found a pattern of frequent upper limb injuries specific to DV, whereas head injuries were specific to OV.
Fatal Excipients
Authors: Hossein-Zadeh Zarrin , Shuman Mark J. , Rapkiewicz Amy
Published: September 2021

Crushed oral tablets, when injected intravenously, may induce a foreign body granulomatous reaction in and around pulmonary arterioles, because of the presence of filler materials (excipients). This typically presents as shortness of breath in the context of pulmonary hypertension with arteriolar dilation and centrilobular nodules on imaging modalities. The constellation of findings may be overlooked or misdiagnosed by clinicians and pathologists, ultimately affecting patient care and postmortem assessment. We describe 5 patients with excipient lung disease that had antemortem chronic medical conditions that required a peripherally inserted catheter or port. All 5 patients had intravascular and perivascular deposition of polarizable foreign material within the pulmonary arteries. Foreign body granulomatosis as a result of intravenous drug use was not clinically suspected in any patient, and 2 of the 5 patients were misdiagnosed with mycobacterium infections. Pulmonary congestion, dyspnea, and symptoms of heart failure were noted in 3 patients and 2 had a history of upper arm deep vein thrombosis. We conclude that excipient lung disease may be underdiagnosed cause of dyspnea, pulmonary hypertension, and death in patients with a known history of intravenous drug use.
Hypoplasia of Extrahepatic Biliary Tree and Intrahepatic Cholangiolopathy in Cystic Fibrosis Imperfectly Mimic Biliary Atresia in 4 Infants With Cystic Fibrosis and Kasai Portoenterostomy
Authors: Bove Kevin E. , Bernieh Anas , Picarsic Jennifer , Cox Joseph P. , Yang Edmund , Mantor Philip C. , Thaker Ameet , Lazar Lauren , Sathe Meghana , Megison Stephen
Published: September 2021

Four male infants with cystic fibrosis and prolonged neonatal jaundice underwent Kasai procedure to relieve biliary obstruction due to apparent biliary atresia. The excised remnants had viscid mucus accumulation in hypoplastic gallbladders and distended peribiliary glands. Main hepatic ducts were narrow and/or malformed. Microscopic differences between the gallbladder and extrahepatic bile ducts in cystic fibrosis and sporadic biliary atresia were unequivocal, despite some histologic overlap; no erosive or fibro-obliterative lesions typical of biliary atresia were seen. Common in liver, biopsies were small duct cholangiopathy with intense focal cholangiolitis and massive accumulation of ceroid pigment within damaged cholangiocytes, and in portal macrophages, portal fibrosis, and unequivocal features of large duct obstruction were inconspicuous compared with biliary atresia. Plugs of bile in small ducts tended to be pale and strongly periodic acid–Schiff-reactive in cystic fibrosis. Distinguishing the liver lesion from that of biliary atresia is challenging but possible. Liver biopsies from 2 additional infants with cystic fibrosis and prolonged jaundice that spontaneously resolved showed a similar small duct cholangiopathy. Small gallbladders and extrahepatic ducts challenge surgical judgment as findings in liver biopsies challenge the pathologist. The decision to perform a Kasai procedure is reasonable when mimicry of biliary atresia is grossly complete. We hypothesize that a disorder of bile volume/flow during development and/or early infancy linked to the CFTR mutation alone or in combination with the stresses of neonatal intensive care causes destructive cholangiolitis and intrahepatic reduction of bile flow with secondary hypoplasia of extrahepatic biliary structures.
Trends in HIV prevalence by self-report among MSM diagnosed and reported with gonorrhea in six United States jurisdictions from 2010 to 2019
Authors: Stenger Mark Richard , Pathela Preeti , Schumacher Christina , Burghardt Nicole , Amiya Rachel , Madera Robbie , Nguyen Trang Q. , Torrone Elizabeth
Published: September 2021

Background:

HIV co-infection among persons diagnosed with gonorrhea is not well characterized. Trends in HIV prevalence among persons diagnosed with gonorrhea may have significant implications for HIV prevention interventions, especially for MSM. MSM are increasingly and disproportionately represented among incident gonorrhea cases reported in a multistate sentinel surveillance network. Using data from this network, we estimated HIV prevalence among MSM by self-report and explored trends in co-infection by key demographics.

Design:

Observational study using enhanced surveillance data.

Methods:

Six geographically diverse jurisdictions in the STD Surveillance Network (SSuN) 2010–2019 randomly sampled laboratory-confirmed gonorrhea cases. Enhanced investigations on sampled cases included patient interviews eliciting demographic, behavioral and HIV testing history. These data were weighted to adjust for study design and nonresponse to estimate trends in HIV prevalence.

Results:

Of 653 522 reported cases, 28 979 were sampled and investigated. The proportion of cases reporting living with diagnosed HIV at the time of their gonorrhea diagnosis increased 61% across the study period from 6.6% in 2010 to 10.8% in 2019. The observed increase in HIV prevalence is concurrent with an increase in the proportion of gonorrhea cases attributable to MSM. HIV prevalence among MSM decreased in two jurisdictions and increasing trends were observed among non-Hispanic Black and Hispanic MSM. HIV prevalence decreased among non-Hispanic white MSM, MSM under 20 and those 40 years of age or older.

Conclusion:

Diagnosis with gonorrhea, especially among MSM, should be a sentinel event triggering screening for HIV, referral to high-impact HIV prevention interventions or to HIV primary care.
7 Tesla and Beyond
Authors: Platt Tanja , Ladd Mark E. , Paech Daniel
Published: September 2021

Ultrahigh magnetic fields offer significantly higher signal-to-noise ratio, and several magnetic resonance applications additionally benefit from a higher contrast-to-noise ratio, with static magnetic field strengths of B
0 ≥ 7 T currently being referred to as ultrahigh fields (UHFs). The advantages of UHF can be used to resolve structures more precisely or to visualize physiological/pathophysiological effects that would be difficult or even impossible to detect at lower field strengths. However, with these advantages also come challenges, such as inhomogeneities applying standard radiofrequency excitation techniques, higher energy deposition in the human body, and enhanced B
0 field inhomogeneities. The advantages but also the challenges of UHF as well as promising advanced methodological developments and clinical applications that particularly benefit from UHF are discussed in this review article.
The Clinical Utility of Magnetic Resonance Imaging According to Field Strength, Specifically Addressing the Breadth of Current State-of-the-Art Systems, Which Include 0.55 T, 1.5 T, 3 T, and 7 T
Authors: Runge Val M. , Heverhagen Johannes T.
Published: September 2021

This review provides a balanced perspective regarding the clinical utility of magnetic resonance systems across the range of field strengths for which current state-of-the-art units exist (0.55 T, 1.5 T, 3 T, and 7 T). Guidance regarding this issue is critical to appropriate purchasing, usage, and further dissemination of this important imaging modality, both in the industrial world and in developing nations. The review serves to provide an important update, although to a large extent this information has never previously been openly presented. In that sense, it serves also as a position paper, with statements and recommendations as appropriate.
Analysis of a Deep Learning-Based Superresolution Algorithm Tailored to Partial Fourier Gradient Echo Sequences of the Abdomen at 1.5 T
Authors: Afat Saif , Wessling Daniel , Afat Carmen , Nickel Dominik , Arberet Simon , Herrmann Judith , Othman Ahmed E. , Gassenmaier Sebastian
Published: September 2021

Objectives

The aim of this study was to investigate the feasibility and impact of a novel deep learning superresolution algorithm tailored to partial Fourier allowing retrospectively theoretical acquisition time reduction in 1.5 T T1-weighted gradient echo imaging of the abdomen.

Materials and Methods

Fifty consecutive patients who underwent a 1.5 T contrast-enhanced magnetic resonance imaging examination of the abdomen between April and May 2021 were included in this retrospective study. After acquisition of a conventional T1-weighted volumetric interpolated breath-hold examination using Dixon for water-fat separation (VIBEStd), the acquired data were reprocessed including a superresolution algorithm that was optimized for partial Fourier acquisitions (VIBESR). To accelerate theoretically the acquisition process, a more aggressive partial Fourier setting was applied in VIBESR reconstructions practically corresponding to a shorter acquisition for the data included in the retrospective reconstruction. Precontrast, dynamic contrast-enhanced, and postcontrast data sets were processed. Image analysis was performed by 2 radiologists independently in a blinded random order without access to clinical data regarding the following criteria using a Likert scale ranging from 1 to 4 with 4 being the best: noise levels, sharpness and contrast of vessels, sharpness and contrast of organs and lymph nodes, overall image quality, diagnostic confidence, and lesion conspicuity. Wilcoxon signed rank test for paired data was applied to test for significance.

Results

Mean patient age was 61 ± 14 years. Mean acquisition time for the conventional VIBEStd sequence was 15 ± 1 seconds versus theoretical 13 ± 1 seconds of acquired data used for the VIBESR reconstruction. Noise levels were evaluated to be better in VIBESR with a median of 4 (4–4) versus a median of 3 (3–3) in VIBEStd by both readers (P < 0.001). Sharpness and contrast of vessels as well as organs and lymph nodes were also evaluated to be superior in VIBESR compared with VIBEStd with a median of 4 (4–4) versus a median of 3 (3–3) (P < 0.001). Diagnostic confidence was also rated superior in VIBESR with a median of 4 (4–4) versus a median of 3.5 (3–4) in VIBEStd by reader 1 and with a median of 4 (4–4) for VIBESR and a median of 4 (4–4) for VIBEStd by reader 2 (both P < 0.001).

Conclusions

Image enhancement using deep learning–based superresolution tailored to partial Fourier acquisitions of T1-weighted gradient echo imaging of the abdomen provides improved image quality and diagnostic confidence in combination with more aggressive partial Fourier settings leading to shorter scan time.
Reconstruction of Large Cervicofacial Defects With Expanded Island Superficial Temporal Artery Flaps and an 810-nm Diode Laser Hair Removal Technique
Authors: Li Haizhou , Xu Xiangwen , Gao Yashan , Gu Shuchen , Xin Huang , Ren Jie-Yi , Gu Yi-Hui , Wang Zhichao , Gu Bin , Zan Tao
Published: September 2021

Background

Extensive cervicofacial reconstruction is challenging for plastic surgeons. Because of the location of the adjacent scalp flap nourished by the superficial temporal artery (STA), it can be a candidate for cervicofacial reconstruction.

Objectives

This article aims to report a combined treatment of an expanded island STA flap and an 810-nm diode laser hair removal technique for extensive cervicofacial defects.

Methods

Between January 2015 and December 2018, 10 patients with lower face and neck scar contraction were reconstructed with a bilateral or unilateral expanded STA island flap and an 810-nm diode laser for hair removal in this retrospective study. Hair removal via the 810-nm laser was started when the injected volume reached the volume of the expander, with a fluence of 35 to 40 J/cm2 and a 1 to 2 Hz repetition rate. Before second-stage surgery, the hair reduction rate was assessed. Twelve months after surgery, the degree of epilation efficacy according to the satisfaction scale and Global Aesthetic Improvement Scale was evaluated.

Results

This study included 2 single-pedicle flaps and 8 double-pedicle flaps. The average size of the implanted expanders was 600 mL. The average injected volume was 1405 mL. Before second surgery, there was a 67.4% hair reduction rate. Twelve months after surgery, the results of Global Aesthetic Improvement Scale were very good (3), good (6), average (1), and poor (0).

Conclusions

The expanded island STA flap and 810-nm diode laser technique may be a novel treatment option for severe face and neck aesthetic reconstruction.
Clinical Comparison of 3 Different Double Eyelid Surgeries
Authors: Yang E. , Hengshu Zhang
Published: September 2021

Objective

Double blepharoplasty or double eyelid surgery is a common plastic surgery in Asians. Our study aimed to evaluate the advantages and disadvantages of the minimally invasive 3-point subcutaneous tunnel double eyelid surgical technique relative to other commonly used approaches.

Method

The study compared 852 single eyelid patients electing 1 of 3 double eyelid surgical options; minimally invasive 3-point subcutaneous tunnel, minimally invasive 3-point embedding, or incision double eyelid surgery. Evaluation criteria included postoperative swelling, hyperemia, pain, scarring, single eyelid recurrence, and patient satisfaction after 2 years.

Results

All surgical methods effectively achieved double eyelids. Directly after the procedure, the minimally invasive 3-point embedding method produced the mildest degree of swelling and congestion, followed by the 3-point subcutaneous tunnel method and then the incision method (F = 523.908, P = 0.000). The incision method also resulted in more serious postoperative pain, whereas the other 2 methods were equivalent (F = 83.117, P = 0.000). Patients in the incision group had the most severe scars compared with the other 2 groups with milder scarring (F = 882.102, P = 0.000). The minimally invasive 3-point embedding method group had the highest single eyelid recurrence rate (5.88%), whereas the recurrence rates for the other 2 methods were less than 1%. Patients satisfaction after 2 years was highest in the minimally invasive 3-point subcutaneous tunneling method, followed by the 3-point embedding method and lastly the incision method (F = 25.931, P = 0.00).

Conclusions

Minimally invasive 3-point subcutaneous tunnel double eyelid surgery has advantages over other techniques, and its clinical application is worth promoting for suitable patients.
Alloplastic Temporomandibular Joint Reconstruction Following Recurrent Ameloblastoma Resection
Authors: Horen Sydney R. , Hansdorfer Marek A. , Seu Michelle , Murphy James , Figueroa Alvaro , Tragos Christina
Published: September 2021

Ameloblastomas are benign tumors that most commonly affecting the mandible. The current standard of treatment for ameloblastomas is resection followed by reconstruction that has historically been accomplished through the use of a microsurgical vascularized flaps taken from the iliac crest or fibula. Alloplastic reconstruction methods have gained popularity over recent years with success reported in the reconstruction of many pathologies, including ankylosis, condylar fracture, neoplasia involving extensive resection, severe inflammatory/degenerative temporomandibular joint (TMJ) disease, and congenital TMJ abnormalities. The authors present a patient who successfully underwent ameloblastoma resection and TMJ reconstruction with a custom TMJ Concepts alloplastic implant. The authors also present a review of the literature on alloplastic TMJ reconstruction following ameloblastoma resection. To our knowledge, this is the second report in the literature on the use of a TMJ Concepts implant after ameloblastoma resection.
Utilizing Age of Menarche to Optimize Pediatric Rhinoplasty
Authors: Khetpal Sumun , Dinis Jacob , Peck Connor , Parsaei Yassmin , Lopez Joseph , Steinbacher Derek M.
Published: September 2021

Background/Purpose:

Pediatric septorhinoplasty has sparked controversial debate amongst craniofacial surgeons, particularly due to its potential growth disturbances of the face and nose. The purpose of this study is (1) to conduct a systematic literature review that explores unique considerations and limitations associated with performing rhinoplasty in the pediatric population; (2) to discuss objective indicators for determining craniofacial skeleton maturation; (3) to perform a case series to further understand whether the age of menarche serves as a good proxy for estimating the time of facial growth maturation, and by extension, whether a post-menarchal patient is a suitable candidate for rhinoplasty.

Methods:

Systematic literature review was performed in order to assess unique considerations and limitations of pediatric rhinoplasty. Retrospective chart review and anthropometric (9 linear, 3 angular, 6 indices) measurements were performed for ten pediatric female patients who underwent open septo-rhinoplasty. Follow-up times ranged from 66 to 103 weeks. Patients were separated into 2 cohorts according to age at the time of menarche. Cohort 1 consisted of patients who had undergone menses for longer than 2 years at the time of rhinoplasty, whereas Cohort 2 comprised of patients who either had menses within 2 years of rhinoplasty or did not have menses at the time of rhinoplasty. Data included demographic factors, procedural variables, revision surgeries, and complications. Measurements were conducted using VECTRA software (Canfield Scientific, Parsippany, NJ). Differences in measurements between the 2 postoperative timepoints were compared.

Results:

Literature review yielded 17 articles, which had conflicting opinions regarding pediatric rhinoplasty and ultimately, highlighting the need for a more objective tool for guiding the decision to perform rhinoplasty.

Patients in Cohort 1 had minimal deviations in measurements over time, within the exception of an increase in nasal tip projection and a decrease in nasolabial angle and facial width. Patients in Cohort 2 had decreases in facial height, upper facial height, nasal tip angle, and nasofrontal angle. Nasolabial angle decreased for both cohorts. Of the ten patients, 1 in Cohort 2 underwent revision rhinoplasty.

Conclusions:

Our case series suggests that anthropometric measurements remain relatively more stable for patients who have undergone menses for more than 2 years, compared to those who have not. Although this study has limitations, further investigation is warranted in order to determine whether age of menarche may serve as a useful tool for craniofacial surgeons in guiding the decision to perform rhinoplasty.
Major Complications and Associated Risk Factors for Osseous Genioplasty With Bimaxillary Orthognathic Surgery: An American College of Surgeons-National Surgical Quality Improvement Program Analysis
Authors: Jazayeri Hossein E. , Parsaei Yassmin , Peck Connor J. , Henry Andrew , Lopez Joseph , Steinbacher Derek M.
Published: September 2021

Purpose:

Patients with significant dentofacial deformities undergoing aesthetic and functional orthognathic surgery may often require genioplasty to advance the position of the pogonion relative to B point. No study to date has evaluated nationally registered data pertaining to addition of osseous genioplasty to bimaxillary orthognathic surgery and its associated clinical outcomes.

Methods:

Data was extracted from the National Surgical Quality Improvement Program from 2010 to 2018 using current procedural terminology codes pertaining to Le Fort I osteotomy (LF), bilateral sagittal split osteotomy (BSSO), and osseous genioplasty (G) and divided into 2 cohorts: bimaxillary orthognathic surgery with and without osseous genioplasty. Thirty-day postoperative outcomes inherently recorded within National Surgical Quality Improvement Program were identified and recorded. Chi-squared analysis and unpaired 2-tail t tests were performed between the cohorts and their respective outcomes to determine significant relationships with significance set as P < 0.05.

Results:

There were 373 patients double- or triple-jaw patients identified from the years 2010 to 2018. The most common recorded indication for LF/BSSO was maxillary hypoplasia (27.3%) and mandibular hypoplasia (6.8%). The most common indications for LF/BSSO/G were maxillary hypoplasia (16.1%) and maxillary asymmetry (16.1%). In comparison to LF/BBSO only, LF/BSSO/GP was not associated with any differences in the rate of surgical (0.0% versus 0.31%, P = 0.72) or medical complications (0.0% versus 0.63%, P = 0.60), in addition to unplanned readmissions (0.0% versus 1.56% versus P = 0.41) or reoperations (0.0% versus 1.25%, P = 0.46). However, osseous genioplasty addition was associated with increased overall operating time (271.77 versus 231.75 minutes, P = 0.04).

Conclusions:

Osseous genioplasty does not alter short-term, 30-day complication rate when performed with bimaxillary orthognathic surgery. As reoperation rates remained relatively unchanged, it can be inferred that immediate adverse events or patient dissatisfaction were not apparent within 30 days. Although mean operating time is slightly longer, cardiopulmonary resuscitation without medical comorbidity was achieved at the conclusion of the procedure.
Reconstruction of Extensive Periorbital Defects With Pericranial Flap
Authors: Gümüş Nazim , Gümüş Zehra Betül
Published: September 2021

Wide excision of recurrent malignant tumors of periorbital region leaves deep and large composite defects, requiring a reconstruction to restore both the form and function of the eyelids. In this study, a pericranial flap was utilized in the reconstruction of large, complex defects of periorbital region.

This study included 5 patients who underwent wide excision of recurrent large medial canthus and supraorbital rim malignant tumors. All defects involved the medial parts of eyelids including medial canthal ligaments, nasal walls, periosteum, and medial orbital walls. Defects were reconstructed via a pericranial flap, which was facilitated by the natural concavity and the acute angled nature of the medial canthus.

The pericranial flap is not only a versatile alternative to the local or regional flaps in the reconstruction of periorbital defects, but also has the advantages of availability of abundant amount of flap tissue.
Lingual Arteriovenous Malformation With Bleeding Treated With Polidocanol Foam Sclerotherapy Using Intestinal Forceps to Control Blood Flow
Authors: Sasaki Yuki , Sasaki Satoru , Ishikawa Kosuke
Published: September 2021

Arteriovenous malformation (AVM) sometimes causes hemorrhage that can be fatal. We report a case of AVM of the tongue with bleeding that was treated by semi-emergent sclerotherapy with polidocanol. A 33-year-old woman presented with Schobinger stage III AVM of the tongue. Sclerotherapy with 3% polidocanol foam was performed under general anesthesia using curved intestinal forceps to clamp the root of the tongue for control of blood flow. Postoperatively, there was no further bleeding from the lesion. Three subsequent sclerotherapy sessions with polidocanol were performed, and there was a marked reduction in the size of the lesion. The lesion has remained well controlled in the year since the last sclerotherapy session.