bluuebunny/crossref_metadata_2025 huggingface dataset:
Isokinetic Resistance Training for Ankle Plantarflexor Spasticity and Muscle Weakness in People With Multiple Sclerosis: A Proof-of-Concept Case Series
Authors: Ventura Lucia , Martinez Gianluca , Aiello Elena , Dvir Zeevi , Deriu Franca , Manca Andrea
Published: October 2022

Objective

To the best of the authors’ knowledge, no data are available about the use of isokinetic resistance training for managing ankle plantarflexor spastic hypertonia in people with multiple sclerosis (MS). The aim of this proof-of-concept study was to explore the feasibility and effects of concentric contractions on spasticity-related resistance to passive motion, strength, and mobility in people with MS and ankle plantarflexor spasticity.

Methods

In this pretest/posttest case series, 5 people with MS (mean age = 53.6 [SD = 8.8] years; median Expanded Disability Status Scale score = 5; Modified Ashworth Scale range = 1–4) received 6 weeks of isokinetic resistance training of the spastic plantarflexors. Before and after the intervention, the following outcomes were assessed: average peak torque during passive robotic mobilization, isometric strength, surface electromyography (sEMG) from the spastic muscles, time to complete the 10-m Walk Test, and the Timed “Up & Go” Test. The standardized effect size was used to test pretest and posttest effects at the individual level. Group-level analyses were also performed.

Results

Following the training, the average peak torque recorded from the plantarflexors during passive motion at a velocity of 150 degrees per second was found to be decreased by at least 1 SD in all participants but 1, with a significant reduction at the group level of 23.8%. Conversely, no changes in sEMG activity were detected. Group-level analyses revealed that the maximal strength of the trained plantarflexors increased significantly (31.4%). Fast walking speed increased and time to complete the Timed “Up & Go” Test decreased in 4 participants, although not significantly at the group level.

Conclusion

Isokinetic resistance training proved safe and feasible in people who had MS and ankle plantarflexor spasticity. The observed reductions in resistance to passive motion from the spastic plantarflexors in the absence of sEMG changes might suggest a mechanical rather than a neural effect of the training.

Impact

Based on these preliminary findings, isokinetic resistance training does not exacerbate hypertonia in people with MS and ankle plantarflexor spasticity and could be safely used to manage muscle weakness in this population.
Constructing biomimetic liver models through biomaterials and vasculature engineering
Authors: Lv Weikang , Zhou Hongzhao , Aazmi Abdellah , Yu Mengfei , Xu Xiaobin , Yang Huayong , Huang Yan Yan Shery , Ma Liang
Published: October 2022

The occurrence of various liver diseases can lead to organ failure of the liver, which is one of the leading causes of mortality worldwide. Liver tissue engineering see the potential for replacing liver transplantation and drug toxicity studies facing donor shortages. The basic elements in liver tissue engineering are cells and biomaterials. Both mature hepatocytes and differentiated stem cells can be used as the main source of cells to construct spheroids and organoids, achieving improved cell function. To mimic the extracellular matrix (ECM) environment, biomaterials need to be biocompatible and bioactive, which also help support cell proliferation and differentiation and allow ECM deposition and vascularized structures formation. In addition, advanced manufacturing approaches are required to construct the extracellular microenvironment, and it has been proved that the structured three-dimensional culture system can help to improve the activity of hepatocytes and the characterization of specific proteins. In summary, we review biomaterials for liver tissue engineering, including natural hydrogels and synthetic polymers, and advanced processing techniques for building vascularized microenvironments, including bioassembly, bioprinting and microfluidic methods. We then summarize the application fields including transplant and regeneration, disease models and drug cytotoxicity analysis. In the end, we put the challenges and prospects of vascularized liver tissue engineering.
Preparation of aripiprazole-poly(methyl vinyl ether-co-maleic anhydride) nanocomposites via supercritical antisolvent process for improved antidepression therapy
Authors: Chen Lin-Fei , Chen Ying , Duan You-Yu , Zhang Man-Man , Xu Pei-Yao , Kankala Ranjith Kumar , Wang Shi-Bin , Chen Ai-Zheng
Published: October 2022

Aripiprazole (ARI), a second-generation atypical antipsychotic drug approved for schizophrenia treatment, shows good efficacy against depression. However, the poorly aqueous solubility of ARI leads to low bioavailability and increased dose-related side effects, seriously limiting its application in pharmaceutics. Herein, we demonstrated the fabrication of ARI and poly (methyl vinyl ether-co-maleic anhydride) (PVMMA) composite nanoparticles (PA NPs) using the supercritical antisolvent (SAS) process for enhancing its water-solubility and curative anti-depressant effects. Initially, the optimal experimental conditions (ARI/PVMMA mass ratio of 1:6, pressure of 10 MPa, and solution flow rate of 0.75 ml min−1) were determined by a 23 factorial experimental design, resulting in the PA NPs with an excellent particle morphology. In vitro cell experiments showed that PA NPs significantly inhibited the inflammatory response caused by the microglia activation induced by lipopolysaccharide (LPS). Similarly, mice behavioral tests demonstrated that PA NPs significantly improved LPS-induced depression-like behavior. Importantly, compared with free ARI, the LPS-induced activation of microglia in the mouse brain and the expression of inflammatory factors in serum were significantly reduced after treatment with PA NPs. Together, the innovative PA NPs designed by SAS process might provide a candidate for developing new ARI-based nano-formulations.
Acceptability of contact management and care of simple cases of COVID-19 at home: a cross-sectional study in Senegal
Authors: Ba Mouhamadou Faly , Ridde Valéry , Diallo Amadou Ibra , Tine Jean Augustin Diégane , Kane Babacar , Gaye Ibrahima , Traoré Zoumana , Bonnet Emmanuel , Faye Adama
Published: October 2022

Background

COVID-19 is a major public health problem. In mid-2020, due to the health system challenges from increased COVID-19 cases, the Ministry of Health and Social Action in Senegal opted for contact management and care of simple cases at home. The objective of the study was to determine the acceptability of contact and simple case management of COVID-19 at home and its associated factors in Senegal.

Methods

This was a descriptive and analytical cross-sectional study. We collected data from 11 June to 10 July 2020. We used a marginal quota sampling strategy. A total of 813 individuals took part in the survey. We collected data using a telephone interview.

Results

The care of simple cases of COVID-19 at home was well accepted (78.5%). The use of home contact management was less accepted (51.4%). Knowledge of the modes of transmission of the virus and confidence in institutional information were associated with the acceptability of home care for simple cases. Regularly searching for information on COVID-19 and confidence in the government's control of the epidemic were associated with the acceptability of managing contacts at home.

Conclusions

Authorities should take these factors into account for better communication to improve the acceptability and confidence in home-based care for COVID-19 and future epidemics.
Toxin-Antitoxin System HigBA in Xylella fastidiosa Is Expressed at Low Temperature but Does Not Impact Virulence or Grapevine Recovery in Greenhouse Trials
Authors: Wei Wei , Burbank Lindsey
Published: October 2022

Xylella fastidiosa has multiple chromosomally encoded type II toxin-antitoxin (TA) systems, several of which have unknown functions in the bacterial lifecycle. In many bacterial species, type II TA systems are associated with bacterial stress survival under various detrimental environmental conditions, and with influencing disease-associated phenotypes such as biofilm development and expression of virulence factors. Chromosomal TA systems are often found in genomic regions with evidence of phage insertion, pointing to potential acquisition of these elements by horizontal gene transfer. One of the TA systems found in X. fastidiosa, higBA, is transcriptionally expressed at higher levels at 15°C than at 28°C. However, a higBA deletion mutant (Δ higBA) in X. fastidiosa subsp. fastidiosa Stag's Leap is not deficient in growth or viability under in vitro cold stress and is able to infect and cause disease in grapevines comparable to the wild-type strain. Grapevines infected with X. fastidiosa Δ higBA recover from infection following cold treatment at 4°C at a similar rate to wild-type infected plants, suggesting that this TA system does not contribute significantly to X. fastidiosa survival at a low temperature in planta. Although a definitive function for HigBA in X. fastidiosa has yet to be determined, this study adds to a growing body of work describing the functions and expression dynamics of TA systems in plant pathogenic bacteria.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
The Case for Feedback-in-Practice as a Topic of Educational Scholarship
Authors: Cianciolo Anna T. , Regehr Glenn
Published: October 2022

The importance of clinical performance feedback is well established and the factors relevant to its effectiveness widely recognized, yet feedback continues to play out in problematic ways. For example, learning culture modifications shown to facilitate feedback have not seen widespread adoption, and the learner–educator interactions prescribed by research rarely occur organically. Nevertheless, medical learners achieve clinical competence, suggesting a need to expand educational scholarship on this topic to better account for learner growth. This Scholarly Perspective argues for a more extensive exploration of feedback as an educational activity embedded in clinical practice, where joint clinical work that involves an educator and learner provides a locus for feedback in the midst of performance. In these clinically embedded feedback episodes, learning and performance goals are constrained by the task at hand, and the educator guides the learner in collaboratively identifying problematic elements, naming and reframing the source of challenge, and extrapolating implications for further action. In jointly conducting clinical tasks, educators and learners may frequently engage in feedback interactions that are both aligned with workplace realities and consistent with current theoretical understanding of what feedback is. However, feedback embedded in practice may be challenged by personal, social, and organizational factors that affect learners’ participation in workplace activity. This Scholarly Perspective aims to provide a conceptual framework that helps educators and learners be more intentional about and fully participatory in this important educational activity. By topicalizing this feedback-in-practice and exploring its integration with the more commonly foregrounded feedback-on-practice, future educational scholarship may achieve optimal benefit to learners, educators, and clinical practice.
Advantages of Transmuscular Quadratus Lumborum Block via Subfascial Approach Versus Extrafascial Approach for Postoperative Analgesia After Laparoscopic Cholecystectomy
Authors: He Wen-quan , Li Yu-jie , Li Yong-shuai , Zhang Xu-hao , Cao Jian , Lu Kai-zhi , Cheung Chi Wai , Gu Jian-teng , Xia Zheng-yuan , Yi Bin
Published: October 2022

Objective:

We aimed to compare the analgesic effect and incidence of lower limb weakness of transmuscular quadratus lumborum (TQL) block via subfascial approach with that via extrafascial after laparoscopic cholecystectomy (LC).

Methods:

Eighty patients undergoing LC were randomized to receive ultrasound-guided bilateral TQL block via subfascial (subfascial group) or extrafascial (extrafascial group) using 30 mL of 0.33% ropivacaine unilaterally. Pain scores of port sites while rest and coughing at 1, 6, 12, 24, 36, and 48 hours postoperatively as primary outcome were compared. Modified Lovett Rating Scale, ambulatory dependency, and rescue analgesia requirement was also compared.

Results:

The pain score of the subxiphoid and of the right subcostal port site for up to the postoperative 36 hours (2 [1 to 2]) and 24 hours (2 [2 to 3]) in the subfascial group was significantly lower than that in extrafascial group (2 [2 to 2] and 3 [2.25 to 4]). Up to postoperative 24 hours, the rescue analgesia requirement in subfascial group was significantly lower than that in extrafascial group, namely less fentanyl consumption and parecoxib (1.3 [±5.5] μg vs. 5.6 [±10.6] μg; 17.5% vs. 37.5%). The ratio of patients with LRS score of 6 at postoperative 1 hour (65.0%), and with dependent ambulation at postoperative 1 and 6 hours in subfascial group (15.0% and 0.0%) was significantly lower than that in extrafascial group (10.0%, 80.0%, and 17.5%).

Conclusion:

TQL block via subfascial had the advantages of better analgesic effect and less lower limbs weakness after LC over that via extrafascial.
Preparing for the Worst-Case Scenario in a Pandemic: Intensivists Simulate Prioritization and Triage of Scarce ICU Resources*
Authors: Knochel Kathrin , Adaktylos-Surber Katharina , Schmolke Eva-Maria , Meier Lukas J. , Kuehlmeyer Katja , Ulm Kurt , Buyx Alena , Schneider Gerhard , Heim Markus
Published: October 2022

OBJECTIVES:

Simulation and evaluation of a prioritization protocol at a German university hospital using a convergent parallel mixed methods design.

DESIGN:

Prospective single-center cohort study with a quantitative analysis of ICU patients and qualitative content analysis of two focus groups with intensivists.

SETTING:

Five ICUs of internal medicine and anesthesiology at a German university hospital.

PATIENTS:

Adult critically ill ICU patients (n = 53).

INTERVENTIONS:

After training the attending senior ICU physicians (n = 13) in rationing, an impending ICU congestion was simulated. All ICU patients were rated according to their likelihood to survive their acute illness (good-moderate-unfavorable). From each ICU, the two patients with the most unfavorable prognosis (n = 10) were evaluated by five prioritization teams for triage.

MEASUREMENTS AND MAIN RESULTS:

Patients nominated for prioritization visit (n = 10) had higher Sequential Organ Failure Assessment scores and already a longer stay at the hospital and on the ICU compared with the other patients. The order within this worst prognosis group was not congruent between the five teams. However, an in-hospital mortality of 80% confirmed the reasonable match with the lowest predicted probability of survival. Qualitative data highlighted the tremendous burden of triage and the need for a team-based consensus-oriented decision-making approach to ensure best possible care and to support professionals. Transparent communication within the teams, the hospital, and to the public was seen as essential for prioritization implementation.

CONCLUSIONS:

To mitigate potential bias and to reduce the emotional burden of triage, a consensus-oriented, interdisciplinary, and collaborative approach should be implemented. Prognostic comparative assessment by intensivists is feasible. The combination of long-term ICU stay and consistently high Sequential Organ Failure Assessment scores resulted in a greater risk for triage in patients. It remains challenging to reliably differentiate between patients with very low chances to survive and requires further conceptual and empirical research.
Electrical impedance spectroscopy significantly enhances correct biopsy choice for pigmented skin lesions beyond clinical evaluation and dermoscopy
Authors: Zakria Danny , Brownstone Nicholas , Han Joseph , Owji Shayan , Dirr McKenzie , Rigel Darrell
Published: October 2022

The purpose of this study was to investigate whether EIS technology can further improve correct biopsy choices beyond clinical and dermoscopic evaluation for melanoma (MM), severe dysplastic nevi (SDN) and benign PSLs. Images of 49 MMs, SDNs and benign PSLs were randomly selected from a prior study and were provided in a reader-type survey study to dermatologists to evaluate for biopsy. A total of 33,957 biopsy decisions were analyzed. Respondents significantly improved on the correct biopsy choice with the addition of dermoscopy versus clinical image alone for melanoma and severely dysplastic nevi. Respondents also showed a statistically significant improvement in correct biopsy choice beyond their dermoscopic evaluation when integrating the EIS score versus dermoscopy with clinical images for MM, SDN and benign lesions. Respondents also made fewer incorrect biopsy choices with the addition of the EIS score versus dermoscopy and clinical image for MM and benign lesions. Sub-analyses of biopsy choices were also conducted based on experience and practice type. The findings from this study demonstrate that the integration of EIS technology into PSL biopsy decisions has the potential to significantly improve the accuracy of lesion selection for biopsy beyond clinical and dermoscopic evaluation alone.
Periurethral abscess etiology, risk factors, treatment options, and outcomes: A systematic review
Authors: Tariq Arsalan , Stewart Adam G. , Desai Devang J. , Britton Sumudu , Dunglison Nigel , Esler Rachel , Roberts Matthew J.
Published: October 2022

Objectives

This study aimed to describe patterns of presentation, etiology, risk factors, management, and treatment outcomes of periurethral abscesses using a systematic review framework.

Materials and methods

After prospective registration on the PROSPERO database (CRD42020193063), a systematic review of Web of Science, Embase, PubMed, and Cochrane scientific databases was performed. Articles published between 1900 and 2021 were considered. Extracted data included symptoms, etiology, medical history, investigations, treatment, and outcomes. Collated data were analyzed using univariate methods.

Results

Sixty articles met the inclusion criteria reporting on 270 patients (211 male, 59 female) with periurethral abscess. The most common clinical features were pain (41.5%), pyuria (41.5%), dysuria (38.5%), urinary frequency (32.3%), fever (25%), and a palpable mass (23%). Predisposing risk factors included the presence of a sexually transmitted infection or urinary tract infection (55.0%), urethral strictures (39.6%), and recent urethral instrumentation (18.7%). Management approaches included open incision and drainage (64.3%), conservative management with antibiotics (29.8%), and minimally invasive techniques (needle aspiration, endoscopic drainage). Time trend analysis of etiology revealed a decreased incidence of infection (sexually transmitted infection/urinary tract infection, human immunodeficiency virus) and higher incidence of diabetes mellitus and periurethral bulking injections in recent years.

Conclusions

Periurethral abscesses may display a wide range of clinical features. Presentation, risk factors and underlying etiology vary with sex. The optimal management technique is guided by abscess size. Open incision and drainage combined with antibiotics continues to be the mainstay of management. However, minimally invasive techniques are gaining favor. To the authors' knowledge, this is the first systematic appraisal and management algorithm for periurethral abscess.
Extension of the RADTriage Colorimetric Dosimeter to Low-Dose Gamma-Ray Exposure Using Scanning Densitometry
Authors: Rand Lindsay , Mille Matthew M. , Jorgensen Timothy J. , Smith David , Benevides Luis
Published: October 2022

There is a need for an instantly indicating, easy-to-read, and inexpensive ionizing radiation dosimeter for first responders and members of the general public. One commercially available option is the RADTriage50TM colorimetric dosimeter. However, existing literature has not adequately addressed the accuracy of RADTriage50 dosimeters at low doses of ionizing radiation (<50 mSv) or the need for methods to quantitatively read the RADTriage50 dosimeters after they are exposed. In this paper, we use digital scanning methods to read the RADTriage50 dosimeters. The performance of the dosimeters was evaluated by irradiation with a gamma irradiator traceable to national standards. Experiments covered a range of deep dose equivalents (50 mSv to 2,000 mSv) within the manufacturer’s specified range (50 mSv to 4,000 mSv) and also below 50 mSv to determine if the digital scanning densitometry method allowed for a quantitative readout with a greater dynamic range. We also conducted tests using different gamma energies, 137Cs (662 keV) and 60Co (1.17 and 1.33 MeV), and different dose rates to evaluate the dependency of the RADTriage50 dosimeters on these parameters. Modeling of our measurements suggests that the dose-response of the RADTriage50 dosimeter is linear at low doses with strong non-linearity beginning at ~750 mSv and the dosimeter response appearing to plateau at ~2,000 mSv, although additional measurements at doses beyond 2,000 mSv are needed to confirm this finding. We also found that the RadTriage50 dosimeter response varied with gamma energy, but not with dose rate.
CNS Involvement at Initial Diagnosis and Risk of Relapse After Allogeneic HCT for Acute Lymphoblastic Leukemia in First Complete Remission
Authors: Kharfan-Dabaja Mohamed A. , Labopin Myriam , Bazarbachi Ali , Salmenniemi Urpu , Mielke Stephan , Chevallier Patrice , Thérèse Rubio Marie , Balsat Marie , Pioltelli Pietro , Menard Anne-Lise , Socié Gerard , Huynh Anne , Schaap Nicolaas , Bermúdez Rodríguez Arancha , Cornelissen Jan J. , Yakoub-Agha Ibrahim , Aljurf Mahmoud , Giebel Sebastian , Brissot Eolia , Peric Zina , Nagler Arnon , Mohty Mohamad
Published: October 2022

Outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) for adult acute lymphoblastic leukemia (ALL) have improved over time. Studies have shown that total body irradiation (TBI) is the preferable type of myeloablative conditioning (MAC). However, outcomes based on central nervous system (CNS) involvement, namely CNS-positive versus CNS-negative, have not been compared. Here, we evaluated outcomes of 547 patients (CNS-positive = 96, CNS-negative = 451) who were allografted in the first complete remission (CR1) between 2009 and 2019. Primary endpoint was leukemia-free survival (LFS). Median follow-up was not different between the CNS-positive and CNS-negative groups (79 versus 67.2 months, P = 0.58). The CNS-positive group were younger (median age 31.3 versus 39.7 years, P = 0.004) and were allografted more recently (median year 2012 versus 2010, P = 0.003). In both groups, MAC was the preferred approach (82.3% versus 85.6%, P = 0.41). On multivariate analysis, the CNS-positive group had higher incidence of relapse (RI) (hazard ratio [HR] = 1.58 [95% confidence interval (CI) = 1.06-2.35], P = 0.025), but no adverse effect on LFS (HR = 1.38 [95% CI = 0.99-1.92], P = 0.057) or overall survival (OS) (HR = 1.28 [95% CI = 0.89-1.85], P = 0.18). A subgroup multivariate analysis limited to CNS-positive patients showed that a TBI-based MAC regimen resulted in better LFS (HR = 0.43 [95% CI = 0.22-0.83], P = 0.01) and OS (HR = 0.44 [95% CI = 0.21-0.92], P = 0.03) and lower RI (HR = 0.35 [95% CI = 0.15-0.79], P = 0.01). Another subgroup analysis in CNS-negative patients showed that MAC-TBI preparative regimens also showed a lower RI without a benefit in LFS or OS. While a MAC-TBI allo-HCT regimen may not be suitable to all, particularly for older patients with comorbidities, this approach should be considered for patients who are deemed fit and able to tolerate.
Combined Phacovitrectomy with Metallic Intraocular Foreign Body Removal through Corneal Incision Using A Novel “Magnetic Conduction” Technique
Authors: Wang Yiwen , Chen Baihua , Liu Shaohua , Gong Yujia , Zhang Liwei
Published: October 2022

Purpose:

To describe a “magnetic conduction” technique for the removal of metallic intraocular foreign bodies (IOFBs) in the posterior segment combined with cataract extraction and pars plana vitrectomy and to report its outcomes.

Methods:

We retrospectively analyzed the data of 42 eyes of 42 patients with posterior metallic IOFBs between April 2020 and February 2022. In all patients, cataract extraction was combined with pars plana vitrectomy. With an external magnet, the IOFBs were captured by a magnetized vitrectomy cutter, delivered to the anterior chamber, and then extracted through a corneal phacoemulsification incision.

Results:

All patients were men, with a mean age of 45.6 ± 10.7 years. The mean size of the IOFBs was 3.5 ± 1.7 mm (range, 1.5–8.9 mm) in their longest dimension. A final best-corrected visual acuity of 20/200 or better was noted in 24 of 42 patients (57.1%). Postoperatively, recurrent retinal detachment was seen in three eyes. There were no other intraoperative or postoperative complications.

Conclusion:

The “magnetic conduction” technique combined with phacovitrectomy is a safe and feasible approach to removing IOFBs in the posterior segment.
NONPERFORATING INTRASCLERAL STABBING FOR SUTURELESS 23G SCLEROTOMY CLOSURE
Authors: Yalcinbayir Ozgur , Ucan Gunduz Gamze , Nizam Sema , Yildiz Meral
Published: October 2022

Purpose:

The need for suturing leaking sclerotomies have not been eliminated completely in transconjunctival sutureless vitrectomy (TSV). This study aims to describe a novel technique for 23-gauge (G) sclerotomy closure in TSV surgery and discuss its effectiveness.

Materials and Methods:

Two hundred and thirty cases of 180 patients who underwent 23G TSV with various diagnoses were included to the study. Cases with connective tissue diseases, thin sclera, and significant conjunctival and scleral scarring were excluded. Nonperforating intrascleral stabbing (NIS) was performed to leaking 23G sclerotomies (n = 650) and 27G chandeliers (n = 84). Demographics, rate of sclerotomy closure with NIS procedure, the need for suturing, and complications of the procedure were recorded.

Results:

The overall success of NIS was found to be 91.0% in sclerotomies. Although 9.1% of sclerotomies required sutures, 592 of the 650 sclerotomies could be closed with NIS procedure (P < 0.001). Nonperforating intrascleral stabbing procedure helped close 98.8% of leaking 27G chandeliers. An average of 1.28 ± 0.52 NIS attempts were needed for successful sclerotomy closure. Closure of sclerotomies with the NIS technique were somewhat related to the location of the sclerotomy, history of TSV and NIS, duration of TSV, and type of endotamponade. Hypotonia and choroidal detachment were seen in one case. No additional interventions were needed to normalize intraocular pressure in any case. Subconjunctival hemorrhage happened to be the leading complication of the procedure.

Conclusion:

NIS procedure seems as a practical, reproducible, cost-effective, and uncomplicated approach, which significantly reduces the need to suture 23G sclerotomies. Further studies are required.
Stand-Alone Xen Gel Microstent Implantation Compared With Kahook Dual Blade Goniotomy
Authors: Duong Ryan T. , Pittner Andrew C. , Roa Tina M. , Dirghangi Arjun J. , Netland Peter A.
Published: October 2022

Précis:

Both Xen gel Microstent implantation and Kahook Dual Blade (KDB) goniotomy are safe and effective as stand-alone procedures, but the Xen Gel Microstent was associated with more postoperative interventions and achieved higher success at a lower intraocular pressure threshold.

Purpose:

To evaluate outcomes of stand-alone Xen Gel Microstent implantation compared with stand-alone KDB goniotomy for moderate to severe glaucoma.

Methods:

A retrospective, single-center, case-series analysis comparing outcomes of Xen Gel Microstent implantation and KDB goniotomy stand-alone cases in 75 eyes. Primary outcomes included intraocular pressure (IOP) reduction, glaucoma medication reduction, surgical success, and complications. Surgical success was defined using IOP<21 mm Hg and IOP<18 mm Hg thresholds, with or without glaucoma medications, and without further glaucoma surgery. Subjects were followed for at least 24 months after surgery.

Results:

Mean baseline IOP was comparable between the Xen Gel Microstent and KDB goniotomy groups (23.7±8.4 and 25.9±7.9 mm Hg, respectively, P=0.32). At 24 months after surgery, the mean IOP after Xen Gel Microstent was 14.7±3.2 mm Hg (32.7% reduction from baseline, P=0.018) and KDB goniotomy was 16.7±3.2 mm Hg (40.4% reduction from baseline, P=0.049). Although the mean IOP was significantly lower during the first month after Xen Gel Microstent implantation, no difference in mean IOP was observed between the 2 treatment groups at 24 months after surgery (P=0.416). At 24 months after surgery, the percent reduction of IOP from baseline was not significantly different between the 2 groups. The mean reduction of glaucoma medications from baseline at 24 months was 1.69 drops after Xen Gel Microstent implantation (P=.008) and 1.67 drops after KDB goniotomy (P=0.038). Postoperative complications were nonvision-threatening and were not significantly different between the 2 groups (P=0.550). Interventions not included with complications were needling performed in 21 (37%) of eyes in the Xen Gel Microstent group and Nd:YAG goniopuncture in 1 (5.6%) eye after KDB goniotomy. With an IOP threshold <21 mm Hg, surgical success was not significantly different between the 2 groups (P=0.06). At a lower IOP threshold (<18 mm Hg), surgical success was higher after Xen Gel Microstent implantation compared with KDB goniotomy (P=0.001).

Conclusions:

Both stand-alone Xen Gel Microstent implantation and KDB goniotomy can effectively and safely reduce IOP for moderate to severe glaucoma. The Xen Gel Microstent was associated with a higher need for postoperative interventions and achieved greater success at a lower IOP threshold.
Real-World Outcomes of Glaucoma Filtration Surgery Using Electronic Health Records: An Informatics Study
Authors: Sun Michelle T. , Singh Kuldev , Wang Sophia Y.
Published: October 2022

Précis:

Utilizing an automated pipeline for data extraction from electronic health records provides real-world information on the success of various glaucoma procedures, with tube shunt implantation associated with increased failure rates compared with trabeculectomy.

Background:

We aimed to evaluate the long-term survival of glaucoma surgeries using an automated pipeline for extraction of outcomes from electronic health records.

Methods:

A retrospective observational study from a single academic center. Patients undergoing trabeculectomy, Ex-PRESS shunt, Baerveldt, and Ahmed tube shunt insertion from 2009 to 2018 were identified from electronic health record procedure codes. Patient characteristics were identified from structured and unstructured fields using a previously validated natural language processing pipeline.

Results:

Five hundred twelve patients underwent 711 glaucoma surgeries: 287 trabeculectomies, 47 Ex-PRESS shunts, 274 Baerveldt and 103 Ahmed tube implantations. The Median follow-up was 359 days. The mean baseline IOP was 24.4 mm Hg (SD 10.9), and 73.1% were on ≥3 medications. Compared with trabeculectomy, tube shunt surgery had a higher risk of failure (Baerveldt: Hazard Ratio (HR) 1.44, 95% CI 1.02 to 2.02; Ahmed: HR 2.01, 95% CI 1.28 to 3.17). Previous glaucoma surgery was associated with increased failure (≥2 previous surgeries: HR 2.74, 95% CI 1.62 to 4.64), as were fewer baseline medications (<3 medications: HR 2.96, 95% CI 2.12 to 4.13) and male sex (HR 1.40, 95% CI 1.03 to 1.90). At 1 year, tube shunt patients had a 2.53 mm Hg (P=0.002) higher IOP compared with trabeculectomy patients.

Conclusions:

Baerveldt and Ahmed tube shunt implantation was associated with increased failure compared with trabeculectomy. Fewer baseline medications, previous glaucoma surgeries, and male sex were also risk factors for failure. These results demonstrate the utility of applying an informatics pipeline to electronic health records to investigate key clinical questions using real-world evidence.
Healthcare Access and Utilization Among Glaucoma Patients in a Nationwide Cohort
Authors: Delavar Arash , Saseendrakumar Bharanidharan Radha , Weinreb Robert N. , Baxter Sally L.
Published: October 2022

Précis:

Despite having lower socioeconomic status on several measures, glaucoma patients do not report more barriers to healthcare access and utilization than non-glaucoma patients.

Purpose:

To characterize measures of socioeconomic status and barriers to healthcare access and utilization between patients with and without a diagnosis of glaucoma.

Methods:

Patients aged 65 years and over who enrolled in the NIH All of Us Research Program, a nationwide longitudinal cohort, were extracted. We analyzed demographic information and several measures of socioeconomic status and healthcare access and utilization. Survey responses were compared by glaucoma status (any type) with Pearson χ2 tests, univariable logistic regression, and multivariable logistic regression adjusting for age, gender, race/ethnicity, and insurance status.

Results:

Of the 49,487 patients who answered at least 1 question on the All of Us Healthcare Access and Utilization Survey, 4441 (9.0%) had a diagnosis of glaucoma. Majority of the cohort was female (28,162, 56.9%) and nonHispanic White (42,008, 84.9%). Glaucoma patients were observed to have lower rates of education (P=0.004), employment (P<0.001), and home ownership (P<0.001) on χ2tests. On multivariable logistic regression models, those with glaucoma were significantly more likely to speak to an eye doctor (Odds ratio: 2.46; 95% confidence interval: 2.16 to 2.81) and significantly less likely to have trouble affording eyeglasses (OR: 0.85 95% CI: 0.72 to 0.99) in the prior year than those without a diagnosis of glaucoma. No significant association was found for other measures of healthcare access and utilization by glaucoma status.

Conclusion:

Although glaucoma patients aged 65 years and over fared worse on several measures of socioeconomic status, no significant difference was found in measures of healthcare access and utilization.
Two Year Randomized Prospective Comparison of Ahmed Valve Versus Baerveldt Implant in Vitrectomized Eyes
Authors: Kandarakis Stylianos A. , Petrou Petros , Katsimpris Andreas , Papakonstantinou Evangelia , Timpilis Marios , Chronopoulou Konstantina , Lehman Amanda , Ifantides Cristos , Georgalas Ilias
Published: October 2022

Précis:

Ahmed Valve and Baerveldt shunt are efficacious options in vitrectomized eyes. Baerveldt implant achieves a lower mean intraocular pressure (IOP) at 2 years, with fewer medications and a higher percentage of medication-free patients.

Purpose:

To investigate and compare the efficacy and complications between Ahmed FP7 Glaucoma Valve (AGV) and Baerveldt 101–350 Glaucoma Implant (BGI) in vitrectomized eyes.

Materials and Methods:

In this single-center randomized clinical trial, 43 vitrectomized eyes (39 patients) underwent glaucoma drainage device implantation. Eyes were randomized to receive either an AGV (FP7) or a BGI (101–350) and were followed for 2 years. Surgical success was defined as an IOP measurement≤18 mm Hg and≥5 mm Hg with or without glaucoma medication at 2 or more sequential visits after 3 months. The primary outcome was the comparison of the success rate at 2 years, while mean IOP, mean number of medications, and number of complications were considered secondary outcomes.

Results:

Kaplan-Meier estimates of the 2-year success rates in IOP control after GDD implantation were similar between the 2 groups; AGV group 81.8% (95% CI: 67.2%–99.6%) and BGI group 85.7% (95% CI: 72.0%–100.0%), (log-rank test P value = 0.74). Patients in the BGI group had a statistically significant lower mean IOP compared with the AGV group in all follow-up visits at 2, 6, 12, and 24 months (11.62 vs. 17.45 mm Hg at the latter P value <0.001). The BGI group required a significantly lower number of medications for IOP control at the 2-year visit compared with the AGV group (0.76±0.99 vs. 1.5±1.06 P value = 0.02) but had a higher number of complications (62% vs. 41%, respectively).

Conclusions:

GDDs provide a viable solution for IOP control in vitrectomized eyes. Based on our prospective comparison, both Ahmed FP7 Glaucoma Valve and Baerveldt 101–350 Glaucoma Implant are efficacious options.
Association of Health Literacy and Health Care Utilization Among Glaucoma Patients
Authors: Cheng Brian T. , Tanna Angelo P.
Published: October 2022

Précis:

Among 7846 adults with self-reported glaucoma, low health literacy (LHL) was associated with fewer outpatient ophthalmological follow-up visits, utilization of a greater number of ocular hypotensive medication classes, and higher costs for glaucoma medications.

Purpose:

Previous studies found LHL is associated with increased difficulty with treatment adherence among adults with glaucoma, which can lead to poor outcomes. This study examined patterns of glaucoma health care utilization associated with LHL.

Methods:

We analyzed 7846 adults with self-reported glaucoma enrolled in the 1996–2017 Medical Expenditure Panel Survey. Adult glaucoma patients with LHL (defined by National Assessment of Adult Literacy score <226) were the compared with those with high health literacy. Multivariable regression models were constructed to examine the association of LHL with number of outpatient glaucoma visits, prescription medications, polypharmacy (≥2 ocular hypotensive classes prescribed), and associated costs.

Results:

Self-reported glaucoma diagnosis was associated with higher rates of LHL [23.9% vs. 9.7%, odds ratio (95% CI): 2.43 (2.25–2.62), P<0.0001]. Among those with glaucoma, LHL was associated with fewer glaucoma outpatient visits [risk ratio: 0.94 (0.89–0.99), P=0.02] and the use of a greater number of ocular hypotensive medications [1.06 (1.01–1.12), P=0.03]. Moreover, those with LHL had higher health care spending on prescription medications [mean: $556.40 vs. $471.87, β (95% CI): $57.05 ($30.22–$83.87)]. Adult glaucoma patients with LHL were also more likely to have polypharmacy [odds ratio (95% CI): 1.26 (1.01–1.59)].

Conclusion:

LHL was more prevalent in patients with glaucoma, compared with those without. Glaucoma patients with LHL were prescribed more medications and had higher medication costs, however, they had fewer outpatient glaucoma visits. Improved glaucoma patient education to address LHL is needed, in addition to studies to understand the impact of these findings on treatment outcomes.
Comparing Surgical and Clinical Success Rates of Ahmed FP7, and Baerveldt 250 and Baerveldt 350 Glaucoma Drainage Devices
Authors: Kilgore Khin P. , Grosinger Alexander J. , Liu Liang Yen , Jamali Sepideh , Arora Nitika , White Launia J. , Khanna Cheryl L.
Published: October 2022

Précis:

Surgical and clinical success rates were similar among Ahmed FP7, and Baerveldt 250 and 350 glaucoma drainage devices at three years.

Purpose:

To compare rates of surgical and clinical success in patients with Ahmed FP7 (FP7), Baerveldt 250 (B250), or Baerveldt 350 (B350) glaucoma drainage devices (GDDs).

Design:

A retrospective cohort study.

Methods:

A total of 157 eyes of 129 adult patients with FP7, B250, B350 GDDs, and 190 eyes of 99 medically controlled glaucoma patients were enrolled at a tertiary care institution from August 2017 through July 2019. They were followed through April 2020. The main outcome measures included surgical and clinical failure. Surgical failure was defined as intraocular pressure (IOP) outside 5–21 mm Hg, IOP reduced <20% below baseline, additional glaucoma surgery, GDD removal, or no light perception. Eyes that did not meet their goal IOP ranges or required secondary glaucoma interventions were deemed clinical failures.

Results:

A total of 43 (12.4%) FP7, 36 (10.4%) B250, 78 (22.5%) B350, and 190 (54.8%) medically treated control eyes were enrolled. By the postoperative year 3 visit, 10 (23.2%) FP7, 11 (30.6%) B250, and 32 (41.0%) B350 eyes had met a surgical failure criterion (P=0.127). There were no significant differences in the numbers of eyes meeting their IOP target ranges (P=0.510), and rates of secondary glaucoma surgeries (P=0.270). Overall clinical success was attained among 83.3% FP7, 81.8% B250, and 68.0% B350 eyes (P=0.447).

Conclusions:

The GDD groups were similar in their rates of success, based on both the surgical and clinical success definitions.
Psychosocial Predictors and Mediators Relating to the Preventive Behaviors of Hospital Workers During the COVID-19 Pandemic in Turkey
Authors: Selçuk Fatma Ülkü , Solak Grassie Semiha
Published: October 2022

Objective

The aim is to analyze the relation of psychosocial factors to COVID-19 contraction, vaccination, and preventive health behavior in and outside work.

Methods

The questionnaire data from hospital-workers in Turkey is analyzed using independent-samples t-test, logistic regression, linear regression, and mediation analyses. We developed a questionnaire on mask-hygiene-distance measures and also used previously developed scales including the Big Five Personality Questionnaire, Young Schema Questionnaire Short Form 3, Schwartz's Basic Human Values Scale, Short Dark Triad.

Results

The odds of being infected by COVID-19 increases by self-direction. The odds of being vaccinated increases by age and conformity, and decreases by emotional stability. Education predicts certain preventive behaviors at work negatively and outside work positively. Older age, being a woman, having chronic disease, the self-transcendence and conservation values, agreeableness, and conscientiousness predict more preventive behaviors. The self-enhancement and openness to change values, the Dark Triad, and early maladaptive schemas predict more risky behaviors.

Conclusions

Designing prohealth policies requires further elaboration on the relation of psychosocial factors to preventive behaviors.
Revitalizing the Muddiest Point for Formative Assessment and Student Engagement in a Large Class
Authors: Mackos Amy R. , Casler Kelly , Tornwall Joni , O'Brien Tara
Published: October 2022

Background:

Ascertaining student understanding can be challenging in large-enrollment and hybrid or asynchronous courses.

Problem:

Instructors needed an innovative instructional strategy to encourage student engagement and support learning in a large-enrollment, mixed-format pathophysiology class.

Approach:

A weekly, graded assignment was created by merging the formative assessment commonly referred to as the muddiest point (MP) with an asynchronous discussion board activity within the learning management system. Each week, students were required to submit a question and respond to a peer. Instructors created a remediation lecture based on the most common student questions.

Outcomes:

The majority of students reported they benefitted from the MP discussion boards and remediation lectures.

Conclusions:

The MP discussion board activity is a flexible, instructional strategy to determine areas of confusion, increase student engagement, and facilitate learning in large-enrollment classes offered in multiple formats.
Evaluation of the Patient With Paroxysmal Spells Mimicking Epileptic Seizures
Authors: Feyissa Anteneh M. , Bower James H.
Published: October 2022

Background:

The diagnostic issue of paroxysmal spells, including epileptic seizure (ES) mimics, is one that neurologists frequently encounter. This review provides an up-to-date overview of the most common causes of ES mimics encountered in the outpatient setting.

Review Summary:

Paroxysmal spells are characterized by changes in awareness, attention, perception, or abnormal movements. These can be broadly classified as ES and nonepileptic spells (NES). NES mimics ES but are distinguished by their symptomatology and lack of epileptiform activity on electroencephalography. NES may have psychological or physiological underpinnings. Psychogenic non-ES are the most common mimics of ES. Physiological causes of NES include syncope, cerebrovascular, movement, and sleep-related disorders.

Conclusions:

Distinguishing NES from ES at times may be challenging even to the most experienced clinicians. However, detailed history with an emphasis on the clinical clues, including taking a moment-by-moment history of the event from the patient and observers and physical examination, helps create an appropriate differential diagnosis to guide further diagnostic testing. An accurate diagnosis of NES prevents iatrogenic harm, including unnecessary exposure to antiseizure medications and overuse of health care resources. It also allows for the correct specialist referral and appropriate treatment.
Angiotensin-converting Enzyme-2 (ACE2) Expression in Pediatric Liver Disease
Authors: Stevens James P. , Kolachala Vasantha L. , Joshi Gaurav N. , Nagpal Sini , Gibson Greg , Gupta Nitika A.
Published: October 2022

The membrane protein angiotensin-converting enzyme-2 (ACE2) has gained notoriety as the receptor for severe acute respiratory syndrome coronavirus 2. Prior evidence has shown ACE2 is expressed within the liver but its function has not been fully discerned. Here, we utilized novel methodology to assess ACE2 expression in pediatric immune-mediated liver disease to better understand its presence in liver diseases and its role during infections such as COVID-19. We stained liver tissue with ACE2-specific immunofluorescent antibodies, analyzed via confocal microscopy. Computational deep learning-based segmentation models identified nuclei and cells, allowing the quantification of mean cellular and cytosolic immunofluorescent. Spatial transcriptomics provided high-throughput gene expression analysis in tissue to determine cellular composition for ACE2 expression. ACE2 plasma expression was quantified via enzyme-linked immunosorbent assay. High ACE2 expression was seen at the apical surface of cholangiocytes, with lower expression within hepatocyte cytosol and nonparenchymal cells (P<0.001). Children with liver disease had higher ACE2 hepatic expression than pediatric control tissue (P<0.001). Adult control tissue had higher expression than pediatric control (P<0.001). Plasma ACE2 was not found to be statistically different between samples. Spatial transcriptomics identified cell composition of ACE2-expressing spots containing antibody-secreting cells. Our results show ACE2 expression throughout the liver, with strongest localization to cholangiocyte membranes. Machine learning can be used to rapidly identify hepatic cellular components for histologic analysis. ACE2 expression in the liver may be increased in pediatric liver disease. Future work is needed to better understand the role of ACE2 in chronic disease and acute infections.