bluuebunny/crossref_metadata_2025 huggingface dataset:
Delivery of Nusinersen Through an Ommaya Reservoir in Spinal Muscular Atrophy
Authors: Iannaccone Susan T. , Paul Dustin , Castro Diana , Weprin Bradley , Swift Dale
Published: February 2021

Objective:

Spinal muscular atrophy (SMA) is a common rare neuromuscular disease responsible for very high mortality during infancy and high morbidity during childhood and adolescence. It is caused by autosomal recessive mutations in the survival motor neuron gene. In 2016, the Food and Drug Administration approved the first disease modifying therapy for use in all patients of any age. Nusinersen is an antisense oligonucleotide that showed dramatic benefits with achievement of motor milestones in infants and improved gross motor function in children.

Methods:

This was a retrospective chart review of all SMA patients seen at a single site between 2016 and 2020 for treatment with nusinersen.

Results:

We report 8 patients who underwent placement of an Ommaya reservoir and lumbosacral catheter for drug delivery. Complications included infection and revisions due to catheter separation. One patient required fluoroscopy for injections because of location of port site.

Conclusion:

We conclude that placement of an Ommaya port is a viable option for patients who have challenges for access to intrathecal space. Practical innovations have the potential to control administration costs, achieve therapeutic value, and promote patient safety.
Myotonic Muscular Dystrophy Type 2 in CT, USA: A Single-Center Experience With 50 Patients
Authors: Roy Bhaskar , Wu Qian , Whitaker Charles H. , Felice Kevin J.
Published: February 2021

Myotonic dystrophy type 2 (DM2) is an autosomal dominant disorder due to a (CCTG)n repeat expansion in intron 1 of the CNBP gene. In this article, we report the clinicopathologic findings in 50 patients seen at a single site over a 27 year period. DM2 was the fifth most common type of muscular dystrophy seen at our center with a 5-fold lower frequency as compared to DM1. Age of symptom onset ranged from 15 to 72 years, and the mean duration between symptom onset and diagnosis was 7.4 years. Weakness referable to the proximal lower extremities was the presenting symptom in 62% of patients. The degree of generalized weakness varied from severe in 30% to no weakness in 20% of patients. Clinical myotonia was noted in 18% and myotonic discharges on electromyography in 97% of patients. Pain symptoms were uncommon in our cohort. A significant correlation was noted between limb weakness and degree of muscle pathologic changes. There was no correlation between CCTG repeat size and other clinicopathologic findings. Six patients (12%) had cardiac abnormalities including one who developed progressive nonischemic dilated cardiomyopathy ultimately leading to cardiac transplantation. In 21 patients followed for 2 or more years, we noted a mean rate of decline in total Medical Research Council score of about 1% per year.
Nursing Care for Extracorporeal Membrane Oxygenation in the Trauma Patient
Authors: Leffall Britney , Myers Lauren , Holcomb John B. , Drake Stacy A.
Published: February 2021

Trauma patients that survive the immediate threat of death are at risk for potentially life-threatening complications such as acute respiratory distress syndrome and multisystem organ failure. Extracorporeal membrane oxygenation (ECMO) use in trauma patients has largely been controversial for concerns of inducing major hemorrhage with the use of systemic anticoagulation to prevent thrombus development while connected to the ECMO circuit. There is limited data available for specific guidelines for optimal management of the trauma population; however, recent studies suggest comparable outcomes to those of nontrauma patients treated with ECMO. The purpose of this case study was to introduce indications for implementation of ECMO in the trauma patient for pulmonary and hemodynamic compromise, describe the procedure of ECMO insertion, and delineate clinical expectations of the intensive care unit nurse within the multidisciplinary ECMO team. This case study presents a 28-year-old man who sustained a gunshot wound of the chest and was ultimately treated with ECMO for pulmonary compromise due to acute respiratory distress syndrome.
Early Recognition and Management of Sepsis in the Elderly
Authors: Onawola Alice M.
Published: February 2021

Sepsis is a life-threatening and debilitating sickness in the elderly. This case study explores the importance of adequate assessment of patients on their initial presentation to the emergency department, during hospitalization, and before discharge. The clinical evaluation, recognition, and management of sepsis continue to be essential for patient survival to prevent and decrease the mortality rate. Some changes go on in the elderly organ systems and can lead to delay in identifying and treatment implementation. The use of the Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3) to anticipate outcomes in septic patients and the use of the Survival Sepsis Campaign for treatment guidelines promptly to improve outcomes are crucial. This article aims to inform clinicians and nurses of the importance of early recognition of subtle signs and symptoms and the management of sepsis in the elderly.
Awareness of Delirium by ICU Nurses
Authors: Asmar Imad T. , Yaseen Khalid S. , Jaghama Maram K. , Khawaja Yaqin F. , Alwredat Aseel A. , Sadaqa Marah H.
Published: February 2021

Delirium is a critical issue in the intensive care unit (ICU), and the correct diagnosis and treatment of this disorder by the ICU team are doubtful on many occasions due to a lack of information. This research is intended to test the awareness and control of ICU delirium by the ICU nurses. A nonexperimental, quantitative, descriptive, cross-sectional study was conducted using a previously adopted and translated to Arabic and validated questionnaire. The sample include nurses who work in ICUs of 10 Palestinian hospitals (private and public) located in the West Bank and Jerusalem participated in this study; each gave consent to be part of this study. Approval was received from the Palestinian Ministry of Health and the Ethical Committee at Birzeit University. Version 19 of the Social Sciences Statistical Package (SPSS) software was used to analyze the data. The results showed that ICU nurses hold moderate to low levels of knowledge and lack of adequate clinical experience to handle delirium. Delirium is a common complication in the ICU that increases morbidity and mortality and increases the length of ICU stay, therefore the cost of health care rise and the quality of life is decreased. In clinical practice, there are no assessment guidelines and protocols for patients with delirium.
Combining Effect Estimates Across Cohorts and Sufficient Adjustment Sets for Collaborative Research
Authors: Hamra Ghassan B. , Lesko Catherine R. , Buckley Jessie P. , Jensen Elizabeth T. , Tancredi Daniel , Lau Bryan , Hertz-Picciotto Irva ,   on behalf of program collaborators for Environmental influences on Child Health Outcomes
Published: February 2021

Background:

Collaborative research often combines findings across multiple, independent studies via meta-analysis. Ideally, all study estimates that contribute to the meta-analysis will be equally unbiased. Many meta-analyses require all studies to measure the same covariates. We explored whether differing minimally sufficient sets of confounders identified by a directed acyclic graph (DAG) ensures comparability of individual study estimates. Our analysis applied four statistical estimators to multiple minimally sufficient adjustment sets identified in a single DAG.

Methods:

We compared estimates obtained via linear, log-binomial, and logistic regression and inverse probability weighting, and data were simulated based on a previously published DAG.

Results:

Our results show that linear, log-binomial, and inverse probability weighting estimators generally provide the same estimate of effect for different estimands that are equally sufficient to adjust confounding bias, with modest differences in random error. In contrast, logistic regression often performed poorly, with notable differences in effect estimates obtained from unique minimally sufficient adjustment sets, and larger standard errors than other estimators.

Conclusions:

Our findings do not support the reliance of collaborative research on logistic regression results for meta-analyses. Use of DAGs to identify potentially differing minimally sufficient adjustment sets can allow meta-analyses without requiring the exact same covariates.
Tropical Cyclone Exposures and Risks of Emergency Medicare Hospital Admission for Cardiorespiratory Diseases in 175 Urban United States Counties, 1999–2010
Authors: Yan Meilin , Wilson Ander , Dominici Francesca , Wang Yun , Al-Hamdan Mohammad , Crosson William , Schumacher Andrea , Guikema Seth , Magzamen Sheryl , Peel Jennifer L. , Peng Roger D. , Anderson G. Brooke
Published: February 2021

Background:

Although injuries experienced during hurricanes and other tropical cyclones have been relatively well-characterized through traditional surveillance, less is known about tropical cyclones’ impacts on noninjury morbidity, which can be triggered through pathways that include psychosocial stress or interruption in medical treatment.

Methods:

We investigated daily emergency Medicare hospitalizations (1999–2010) in 180 US counties, drawing on an existing cohort of high-population counties. We classified counties as exposed to tropical cyclones when storm-associated peak sustained winds were ≥21 m/s at the county center; secondary analyses considered other wind thresholds and hazards. We matched storm-exposed days to unexposed days by county and seasonality. We estimated change in tropical cyclone-associated hospitalizations over a storm period from 2 days before to 7 days after the storm’s closest approach, compared to unexposed days, using generalized linear mixed-effect models.

Results:

For 1999–2010, 175 study counties had at least one tropical cyclone exposure. Cardiovascular hospitalizations decreased on the storm day, then increased following the storm, while respiratory hospitalizations were elevated throughout the storm period. Over the 10-day storm period, cardiovascular hospitalizations increased 3% (95% confidence interval = 2%, 5%) and respiratory hospitalizations increased 16% (95% confidence interval = 13%, 20%) compared to matched unexposed periods. Relative risks varied across tropical cyclone exposures, with strongest association for the most restrictive wind-based exposure metric.

Conclusions:

In this study, tropical cyclone exposures were associated with a short-term increase in cardiorespiratory hospitalization risk among the elderly, based on a multi-year/multi-site investigation of US Medicare beneficiaries ≥65 years.
For nasotracheal intubation, which nostril results in less epistaxis: right or left?
Authors: Tan Ying-Lun , Wu Zhu-Hao , Zhao Bao-Jian , Ni Yan-Hong , Dong Ying-Chun
Published: February 2021

BACKGROUND

Nasotracheal intubation is usually required in patients undergoing oromaxillofacial, otolaryngological or plastic surgery to prevent the airway encroaching into the operating field. Epistaxis is the most common complication, but which nostril is associated with a lower incidence and severity of epistaxis is still unclear.

OBJECTIVE

When both nostrils are patent, to determine the preferred nostril for nasotracheal intubation under general anaesthesia.

DESIGN

A systematic review and meta-analysis of randomised controlled trials (RCTs). The primary outcome was the incidence of epistaxis and the secondary outcomes included the incidence of severe epistaxis, the time required to pass the tube through the nasal passage and total intubation time.

DATA SOURCES

PubMed, Embase and the Cochrane Register of Controlled Trials were searched from database inception to 1 March 2020.

ELIGIBILITY CRITERIA

The only studies included were RCTs comparing epistaxis related to nasotracheal intubation via right or left nostril, in adult surgery patients undergoing general anaesthesia.

RESULTS

Ten RCTs with 1658 patients were included. Compared with the left nostril, intubation via the right nostril was associated with a significantly lower incidence of epistaxis: risk ratio (RR) and 95% confidence intervals (CI) were 0.78 (0.62 to 0.99), P = 0.04: a lower incidence of severe epistaxis (five studies, n=923), RR 0.40 (0.22 to 0.75), P = 0.004: and a shorter intubation time (three studies, n=345), mean difference −7.28 (−14.40 to −0.16) seconds, P = 0.05. In two studies (n=310), no significant difference between the right and left nostril was observed in the time to pass the tube through the nasal passages, mean difference −0.59 (−1.95 to 0.77) s, P = 0.40.

CONCLUSION

On the basis of the current available evidence, when both nostrils are patent, the right nostril is more appropriate for nasotracheal intubation, with a lower incidence and severity of epistaxis and faster intubation time.

TRIAL REGISTRATION

The study protocol has been registered in PROSPERO (CRD42020169949).
Recovery of lower oesophageal barrier function: a pilot study comparing a mixture of atropine and neostigmine and sugammadex
Authors: Suganuma Emiri , Ishikawa Teruhiko , Kitamura Yuji , Hayashida Taiichiro , Matsumura Tomoaki , Fujie Mai , Nozaki-Taguchi Natsuko , Sato Yasunori , Isono Shiroh
Published: February 2021

BACKGROUND

The lower oesophageal sphincter (LOS) barrier serves to prevent regurgitation of gastric contents. Although general anaesthesia depresses its function, its recovery process during emergence from anaesthesia has not been systematically examined.

OBJECTIVE

To explore whether recovery of lower oesophageal barrier function differed between patients receiving a mixture of 1 mg atropine and 2 mg neostigmine and those receiving 2 mg kg−1 sugammadex during emergence from anaesthesia.

DESIGN

An unblinded randomised controlled pilot study.

SETTING

A single university hospital from January 2016 to December 2018.

PATIENTS

A total of 20 non-obese adult females undergoing minor surgery.

INTERVENTION

The patients were randomly assigned to a group either receiving atropine and neostigmine or sugammadex for reversal of rocuronium.

MAIN OUTCOME MEASURES

Through use of the high-resolution manometry technique, the lower oesophageal barrier pressure (PBAR: primary variable) defined as a pressure difference between pressures at the LOS and the stomach was measured at five distinguishable time points during emergence from total intravenous anaesthesia. A mixed effects model for repeated measures was used to test the hypothesis.

RESULTS

In all patients baseline PBAR values were positive even under muscle paralysis and general anaesthesia before administration of reversal agents, and did not differ between the groups (P = 0.299). During recovery from muscle paralysis and general anaesthesia, PBAR (mean ± SD) significantly increased (P = 0.004) from 17.0 ± 2.9 to 21.0 ± 5.0 mmHg in the atropine and neostigmine group (n = 8) and from 19.1 ± 9.0 to 24.5 ± 12.7 mmHg in the sugammadex group (n = 11). PBAR significantly increased immediately after return of consciousness in both groups, whereas return of muscle tone, lightening of anaesthesia and tracheal extubation did not change it.

CONCLUSION

Recovery of the lower oesophageal barrier function does not differ between patients receiving either atropine and neostigmine or sugammadex and is completed after recovery of consciousness from general anaesthesia.

TRIAL REGISTRATION

UMIN Clinical Trials Registry: UMIN000020500: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000023594&type=summary&language=E
Body position and the effectiveness of mask ventilation in anaesthetised paralysed obese patients
Authors: Chang Jee-Eun , Seol Taikyung , Hwang Jin-Young
Published: February 2021

BACKGROUND

Airway management is more challenging in the obese. Compared with the supine position, the sitting position can decrease the collapsibility of the upper airway and improve respiratory mechanics.

OBJECTIVE

The aim of this study was to evaluate the 25° semisitting position on the effectiveness of mask ventilation in anaesthetised paralysed obese patients.

DESIGN

A randomised, cross-over study.

SETTING

Medical centre managed by a university tertiary hospital.

PATIENTS

Thirty-eight obese adults scheduled for general anaesthesia.

METHODS

After anaesthesia and paralysis, two-handed mask ventilation was performed in the supine and 25° semi-sitting positions with a cross-over, in a randomised order. During mask ventilation, mechanical ventilation was delivered with a pressure-controlled mode with a peak inspiratory pressure of 15 cmH2O, a respiratory rate of 15 bpm, and no positive end-expiratory pressure. Ventilatory outcomes were based upon lean body weight.

MAIN OUTCOMES

Exhaled tidal volume (ml kg−1), respiratory minute volume (ml kg−1 min−1), and the occurrence of inadequate ventilation, defined as an exhaled tidal volume less than 4 ml kg−1, or absence of end-tidal CO2 recording.

RESULTS

Exhaled tidal volume (mean ± SD) in the 25° semi-sitting position was higher than in the supine position, 9.3 ± 2.7 vs. 7.6 ± 2.4 ml kg−1; P less than 0.001. Respiratory minute volume was improved in the 25° semisitting position compared with that in the supine position, 139.6 ± 40.7 vs. 113.4 ± 35.7 ml kg−1 min−1; P less than 0.001.

CONCLUSION

The 25° semisitting position improved mask ventilation compared with the supine position in anaesthetised paralysed obese patients.

TRIAL REGISTRY NUMBER

ClinicalTrials.gov (NCT03996161).
Use of Flap Salvage for Lower Extremity Chronic Wounds Occurs Most Often in Competitive Hospital Markets
Authors: Fan Kenneth L. , Singh Tanvee , Bekeny Jenna C. , Zolper Elizabeth G. , Dekker Paige K. , Attinger Christopher E. , Evans Karen K. , DeLia Derek
Published: February 2021

Background:

Wounds in the comorbid population require limb salvage to prevent amputation. Extensive health economics literature demonstrates that hospital activities are influenced by level of market concentration. The impact of competition and market concentration on limb salvage remains to be determined.

Methods:

Admissions for chronic lower extremity wounds in nonrural hospitals were identified in the 2010–2011 National Inpatient Survey using ICD-9-CM diagnosis codes. The study cohort consisted of admitted patients receiving amputations, salvage without flap techniques (eg, skin grafts), or salvage with flap techniques. The all-service Herfindahl–Hirschman Index (HHI), which is a commonly used tool for market and antitrust analyses, was used to measure hospital competition. Multinomial regression analysis accounting for the complex survey design of the NIS was used to determine the relationship between the HHI and hospital adoption of limb salvage controlling for patient, hospital, and market factors.

Results:

The study cohort represents 124,836 admissions nationally: 89,880 amputations, 26,715 salvage without flap techniques, and 8241 salvage flap techniques. Diabetics accounted for 64.1% of all study admissions. Hospitals in highly competitive markets performed more flaps for chronic lower extremity wounds than noncompetitive markets. Controlling for other factors, hospitals in highly competitive markets, relative to those in highly concentrated markets, were 2.48 percentage points more likely to perform limb salvage with flaps (P < 0.01). Other factors were less predictive.

Conclusion:

Increased hospital competition is the strongest systems-level predictor of receipt of lower extremity flaps among patients with chronic wounds. Improving access to reconstructive limb services must consider the competitive structure of hospital markets.
Preoperative Long-term Therapeutic Subcutaneous Heparin Administration into Abdomen: Possible Cause for Nonobstructive Microvascular Flap Failure
Authors: Rhobaye Saif , Malahias Marco N. , Youssif Sherif , Alsharkawy Kareem , Kalkat Maninder , Khalil Haitham H.
Published: February 2021

The anterioabdominal wall is the most common site for low molecular weight heparin administration for anticoagulation, either for prophylactic or for therapeutic indications. Occasionally, this could be associated with damage of the abdominal pannus microvasculature, which could possibly jeopardize the reliability of free abdominal flaps as deep inferior epigastric perforator and muscle sparing transverse rectus abdominis muscle, especially with therapeutic anticoagulation therapy. These flaps are reliant on a highly intricate complex vascular anatomy and perforasomes for their adequate perfusion and survival. The authors report a case of nonobstructive microvascular failure of a free muscle sparing transverse rectus abdominis muscle utilized for soft tissue coverage following resection of a chest wall breast cancer recurrence on a background of portacath-induced deep venous thrombosis of the axillary and subclavian vein whilst on chemotherapy. History of long-term therapeutic low molecular weight heparin administration in the abdomen resulted in microangiopathic densities evident on computerized tomography scan with subsequent flap failure due to possible jeopardization of the flap microvasculature and perfusion. Following exclusion of common local and systemic factors that can cause vascular compromise, a debridement and salvage re-reconstruction procedure utilizing a contralateral free latissimus dorsi flap was performed. Reconstructive surgeons should be cautious when planning to utilize free abdominal-based flaps on the background of long-term therapeutic low molecular weight heparin administration in the abdomen and may possibly explore other alternative options of using non-abdominal free flaps from the reconstructive armamentarium within this unique context.
EARLY DESCRIPTIONS OF VITREOUS SURGERY
Authors: Grzybowski Andrzej , Kanclerz Piotr
Published: February 2021

Background:

Vitreoretinal surgical techniques have evolved during the last decades because of the development and evolution of pars plana vitrectomy. The introduction of modern vitrectomy is credited to Robert Machemer (1933–2009). The aim of this review is to characterize the early developments of vitreous removal.

Methods:

We used the PubMed web platform to search the terms: complications of cataract surgery, vitrectomy, vitreous body, vitreous humor, vitreous humour, vitreous tap, and vitreous transplantation. Other publications were also considered as a potential source of information when referenced in relevant articles.

Results:

The first description of vitreous removal for treatment of eye disorders dates the 17th century; it was conducted by a Dutch surgeon Anton Nuck (1650–1692) in a case of hydrophthalmia. In English literature, the first description of vitrectomy is attributed to the American surgeon John Collins Warren (1778–1856). This method was implemented in the spontaneous dislocation of the crystalline lens. As the fibrillar structure of the vitreous once destroyed could not be regenerated, the researchers aimed to restore the chemical composition of the vitreous. For several decades, vitreous transplantation was performed for the treatment of vitreous hemorrhages and retinal detachment.

Conclusion:

Although the achievements of vitreoretinal surgery preceding Machemer's inventions are uncommonly reported, they have contributed to the concept and understanding of the treatment modalities.
Neurotrophic Keratopathy: Ophthalmology's Diabetic Foot Problem
Authors: Margolis Todd P.
Published: February 2021

This article summarizes key elements of the 2020 Harold A. Stein Lecture presented at the Eye and Contact Lens Special Symposium “Healing the Ocular Surface: What's New for Neurotrophic Keratitis.” The major point that I made in this talk is that we need to think about neurotrophic keratopathy as ophthalmology's diabetic foot problem; as a chronic condition that is, often best managed by prevention. Neurotrophic keratopathy is not primarily an inflammatory condition, as suggested by the term ‟neurotrophic keratitis.” The epitheliopathy in this condition is a consequence of the dysregulated epithelial cell migration, differentiation, and homeostasis that occurs with denervation of the ocular surface. Although this epitheliopathy may be complicated by poor lid closure, or rarely, aqueous tear deficiency, most of these eyes are not dry and do not require exogenous lubrication for comfort, prophylaxis, or healing. The use of topical agents in these eyes inevitably leads to unrecognized iatrogenic injury, with poor outcomes because of inherently poor wound healing and delays in seeking medical care. Tarsorrhaphy is a time-honored method of protecting the neurotrophic cornea, shielding the eye from iatrogenic injury. Alternative methods for protecting the ‟at risk” surface of the neurotrophic cornea include patient education, minimizing topical agents, and the use of protective eyewear.
Rituximab as an Adjuvant Rescue Treatment for Ocular Cicatricial Pemphigoid
Authors: Bevans Stephanie L. , Parker John , Ivey Jordan M. , Pavlidakey Peter , Sami Naveed
Published: February 2021

Purpose:

Ocular cicatricial pemphigoid (OCP) can lead to devastating ocular complications without prompt treatment. A number of immunomodulatory agents have been attempted with varying success. The objective of this study was to evaluate the use of rituximab as an adjuvant to immunomodulatory treatments (IMTs) in refractory OCP.

Methods:

The clinical records of 14 patients with treatment refractory OCP treated with rituximab as monotherapy or in combination with IMTs were retrospectively reviewed, with a focus on demographics, treatments prerituximab and postrituximab, total number of rituximab infusions, response to treatment, and ocular outcomes including staging and best-corrected visual acuity.

Results:

Thirteen patients (92.9%) achieved a complete response with rituximab over a mean period of 4.3 months. The average sustained complete response time in those without relapse was 29.7 months. Five patients relapsed over a mean period of 15 months, 2 of whom were able to regain control over a mean of 2.5 months with additional rituximab treatments. At the final evaluation, rituximab-based therapy improved ocular outcomes in OCP by stabilizing Foster staging and preventing the deterioration of best-corrected visual acuity in 72% of eyes. In total, 90% of eyes with Foster stages 3 or less did not progress. All patients were able to decrease IMT dosage and/or transition to less potent adjuvant treatments.

Conclusions:

The consideration of rituximab earlier in treatment of OCP as a rescue and/or maintenance therapy could result in an earlier arrest of disease progression, resulting in preservation of patients' vision, and enable tapering of adjuvant IMT.
Recovery of Contrast Sensitivity After Descemet Membrane Endothelial Keratoplasty
Authors: Gundlach Enken , Pilger Daniel , Brockmann Tobias , Dietrich-Ntoukas Tina , Joussen Antonia M. , Torun Necip , Maier Anna-Karina B.
Published: February 2021

Purpose:

To study the change in contrast sensitivities in eyes with Fuchs endothelial dystrophy and bullous keratopathy after Descemet membrane endothelial keratoplasty (DMEK).

Methods:

In this prospective study, 50 pseudophakic eyes of 50 patients who received DMEK surgery at the Charité—Universitätsmedizin Berlin were included. Visual acuity; contrast sensitivity using OPTEC 6500 at spatial frequencies of 1.5, 3, 6, 12, and 18 cycles/degree in photopic and mesopic light with and without glare; central corneal thickness (CCT); and anterior and posterior corneal aberrations were measured preoperatively and at 3 and 12 months postoperatively.

Results:

Best-corrected visual acuity (preoperative 0.67 ± 0.46 and after 12 months 0.19 ± 0.16 LogMAR, P < 0.001) and photopic and mesopic contrast sensitivities with and without glare improved significantly, whereas CCT decreased significantly (preoperative 677 ± 114 μm, after 12 months 527 ± 29 μm, P < 0.001). Preoperative CCT correlates significantly with preoperative photopic contrast sensitivity (correlation coefficient −0.462, P = 0.002), and postoperative total anterior aberrations correlates with postoperative photopic contrast sensitivity (correlation coefficient −0.361, P = 0.006).

Conclusions:

Photopic and mesopic contrast sensitivities, especially with glare, are impaired in patients with Fuchs endothelial dystrophy and bullous keratopathy. The extent of the corneal thickening seems to mainly influence the contrast sensitivity preoperatively. DMEK surgery improves the contrast sensitivity significantly. However, higher postoperative anterior corneal aberrations limit the postoperative contrast sensitivities.
Safety of 3 Tesla Magnetic Resonance Imaging on iStent Implants: An Ex-Vivo Study
Authors: Ayalon Anfisa , Fanadka Feda , Belkin Avner , Burgansky Zvia , Moisseiev Elad
Published: February 2021

Précis:

Our study shows that iStent implant does not cause significant image artifacts, heating, or displacement during magnetic resonance imaging (MRI) scan. This device can be safely used in patients undergoing MRI scans using 3 Tesla (3T) machines.

Purpose:

The iStent is a medical grade titanium implant commonly implanted in the anterior chamber angle of glaucomatous eyes in order to reduce intraocular pressure and medication burden. As many people now have these devices implanted in their eyes, the issue of their compatibility with MRI in terms of safety and interference with interpretation of these studies commonly arises. The purpose of this study is to evaluate the safety of 3T MRI scans in eyes that have undergone iStent implantation and to assess the interference of the implant to the scan interpretation.

Materials and Methods:

An ex vivo model of sheep eye with an iStent and proximately placed heat detector probe was used to study changes in the temperature during MRI 3T scan. The study included 2 fresh eyes with preserved extraocular muscles and orbital fat tissue placed in the orbital cavity of a human skull. Each eye with orbital content was scanned with a 3T MRI machine.

Results:

No displacement of the implant was observed during MRI scanning. The heat detector showed mild temperature elevation during the first minutes of the scan from 14.6 to 16.5°C. The iStent was best visualized in T2 turbo spin echo sequences and showed no significant artifacts.

Conclusion:

iStent implants did not move during the MRI scan, showed minimal interaction with the magnetic field in terms of heating and image distortion. These interactions were not strong enough to present a substantial risk to patients with this implant undergoing an MRI scan.
Surgical Outcomes of Ahmed Glaucoma Valve Implantation Without Plate Sutures: A 10-Year Retrospective Study
Authors: Kapelushnik Noa , Singer Reut , Barkana Yaniv , Rosenfeld Alik , Tucker Yisrael , Jaber Wasim , Gaton Dan , Leshno Ari , Skaat Alon
Published: February 2021

Précis:

Ahmed glaucoma valve (AGV) implantation without plate fixation resulted in high rates of complications related to plate or tube movement.

Purpose:

Scleral suturing of the plate of AGV is associated with technical difficulty and potential complications. This study summarizes the surgical outcomes of 10 years of experience with AGV implantation without suture plate fixation.

Methods:

The medical records of all glaucoma patients who underwent AGV implantation surgery without plate fixation between 2009 and 2019 at the Sheba Medical Center (Tel Hashomer, Israel) were retrospectively reviewed. Clinical data on intraoperative and postoperative complications, best-corrected visual acuity, intraocular pressure, and number of intraocular pressure-lowering medications were retrieved.

Results:

Included were 95 eyes of 95 patients (53 men, 42 women; mean age, 54.9±17.5 y). The mean follow-up was 687±673 days. In total, 37 patients (37/95, 38.%) had AGV-related complications, of whom 28 (29.5%) required additional intervention. Women had a significantly higher rate of complications than men (21/42, 50% vs. 16/53, 30.2%, respectively, P=0.049). The 2 most common complications were AGV migration in 13 eyes (13.7%) and tube exposure/AGV extrusion in 9 eyes (9.5%). AGV was removed in 10 cases.

Conclusions:

In this cohort, omitting suture AGV plate fixation resulted in high rates of complications related to plate or tube movement, the need for further intervention, and AGV removal. Therefore, we cannot recommend this surgical technique.
Comparison of the iCare, Tono-Pen, non-contact airpuff, and Goldmann applanation tonometers in eyes with corneal edema after penetrating keratoplasty
Authors: Yeh Shih-Jung , Chen Ko-Hua , Kuang Tung-Mei , Liu Catherine Jui-Ling , Chen Mei-Ju
Published: February 2021

Background:

To compare the utility of the iCare, Tono-Pen, and non-contact airpuff (NCT) tonometers with the Goldmann applanation tonometer (GAT) for measuring intraocular pressure (IOP) in patients with corneal edema after penetrating keratoplasty (PKP) and to assess the effects of central corneal thickness (CCT) and corneal curvature (CC) on IOP measurements.

Methods:

Thirty-two eyes of 27 patients with corneal edema after PKP due to corneal abnormalities and 43 control eyes of 30 patients with normal corneas were recruited. Before IOP measurements, all patients underwent a baseline examination, including auto-refraction, keratometry, slit lamp biomicroscopy, and CCT measurement. IOP was measured using the devices in the same order: first the NCT, followed by the iCare, Tono-Pen, and GAT. The differences between the iCare, Tono-Pen, NCT, and GAT were calculated with repeated-measures analysis of variance. The Bland-Altman method was used to assess the agreement between the iCare, Tono-Pen, and NCT versus the GAT. The influences of CCT and CC on IOP measurement were evaluated by correlation analysis using Pearson’s correlation coefficient.

Results:

Mean IOP measurements were significantly higher with the NCT and Tono-Pen than with the GAT in the PKP and control groups. When compared with GAT, iCare showed significantly higher IOP readings in the control group, but the IOP readings did not differ between the iCare and GAT in the PKP group. Poor agreement was noted between the NCT and GAT in both groups. The Tono-Pen showed clinically acceptable agreement with GAT in control eyes and poor agreement in PKP eyes. The agreement between the iCare and GAT appeared to be clinically acceptable in both groups. Correlation analysis of the results from control eyes showed that the IOP measurements with the GAT and NCT were weakly related to CCT and moderately correlated with CC. The iCare IOP readings were weakly correlated with CCT and CC.

Conclusion:

In the PKP group, the NCT and Tono-Pen significantly overestimated IOP, whereas the iCare IOP readings were similar to those obtained using the GAT. Poor agreement was noted between the NCT and GAT as well as between the Tono-Pen and GAT, but the iCare showed clinically acceptable agreement with GAT. In normal corneas, the GAT, NCT, and iCare were affected by CCT and CC. The iCare tonometer was less affected by corneal edema than were the NCT and the Tono-Pen. The iCare appears to be a useful device for IOP measurement in eyes with corneal edema after PKP.
Impact of screening COVID-19 on orthopedic trauma patients at the emergency department: A consecutive series from a level I trauma center
Authors: Ma Hsuan-Hsiao , Tsai Shang-Wen , Chen Cheng-Fong , Wu Po-Kuei , Chen Chao-Ming , Chiang Chao-Ching , Chen Wei-Ming
Published: February 2021

Background:

Coronavirus disease 2019 (COVID-19) posed a major threat to the clinical practice of orthopedic surgeons, especially in the emergency department. We aim to present: (1) the criteria established by the Surgery Management Committee of Taipei Veterans General Hospital in response to COVID-19 and (2) the impact of COVID-19 screening on orthopedic trauma patients in the emergency department.

Methods:

From April 1 to April 30, 2020, all orthopedic trauma patients in the emergency department were screened for COVID-19 if they fulfilled any of the following: (1) travel from abroad within 14 days, (2) high-risk occupation, (3) contact or cluster history with a COVID-19–positive patient, and (4) any associated symptom, including fever up to 38°C, cough, sore throat, rhinorrhea, loss of taste or smell, muscle soreness, malaise, or shortness of breath. We recorded details on the injury, fever, management, and associated outcomes.

Results:

Of the 163 orthopedic trauma patients presenting to the emergency department, 24 were screened for COVID-19; of these, 22 received surgery. Sixty-two patients received surgery without screening for COVID-19. Fever was the most common reason to screen for COVID-19 (N = 20; 83.3%). No patients were COVID-19 positive. Screened patients had a significantly longer mean interval from presentation to the emergency department to surgery (2.7 ± 2.5 vs. 1.5 ± 0.8 days, p = 0.037). Of the 20 patients screened because of fever, the focus was not identified in 12 (60.0%) patients. The other eight had urinary tract infection (N = 6; 27.2%), septic hip (N = 1; 4.6%), and concomitant pneumonia and urinary tract infection (N = 1; 4.6%). The mean duration of fever and hospital stay was 4.3 ± 4.6 and 8.7 ± 4.9 days, respectively. There were no thromboembolic events, surgical complications, or in-hospital mortality.

Conclusion:

We developed safe and reliable screening criteria for this COVID-19 pandemic. The delay in surgery was reasonable and did not adversely affect in-patient outcomes.
Possible acquired gastrointestinal polyposis in a childhood cancer survivor
Authors: Snyder Cynthia T. , Bird Patricia
Published: February 2021

Childhood cancer survivors (CCSs) are at an increased risk for secondary cancers, including colorectal, thyroid, lung, and breast. Treatment with abdominal radiotherapy and/or alkylating agent chemotherapy has been associated with an increased risk for colorectal adenomas and colorectal cancer (CRC) in CCSs. The phenotype of therapy-associated polyposis (TAP) is not well-understood, given the paucity of cases described in the literature. Further defining the phenotype of TAP is important to increase the primary care provider's awareness of when to begin CRC screening in these patients. We present a case of a patient with possible acquired polyposis that seems to meet the criteria identified in the literature for TAP. The purpose of this case study is to add to the body of knowledge related to TAP, further defining the phenotype. Better understanding of therapy-related risks in CCSs and hereditary predisposition will provide primary care providers and their patients with an improved plan for CRC screening.
Anticoagulant management by low-dose of low molecular weight heparin in patients with nonvalvular atrial fibrillation following hemorrhagic transformation and complicated with venous thrombosis
Authors: Zhang Ling , Kong Yu-Han , Wang Da-Wu , Li Kai-Ting , Yu He-Ping
Published: February 2021

For patients with nonvalvular atrial fibrillation (NVAF) following hemorrhagic infarction (HI)/hemorrhage transformation (HT) and complicated with venous thrombosis, the management of anticoagulation is controversial. Our study intends to explore the safety and effectiveness of using low-dose of low molecular weight heparin (LMWH) to treat NVAF patients with HI (or HT) and complicated with venous thrombosis.

Between January 2018 and January 2019, NVAF related acute ischemic stroke patients with HT/HI, hospitalized in the department of neurology or rehabilitation in our hospital, are enrolled retrospectively. Among them, those who were found to have venous thrombosis and undergo anticoagulation (LMWH) during the treatment were extracted. We investigate the efficacy and safety in those patients who have been treated with anticoagulant of LMWH.

Five cases accepted LMWH within 3 weeks attributed to the appearance of venous thrombosis, and all of them did not display new symptomatic bleeding or recurrent stroke. However, based on the results of a head computed tomography scan, there were 2 cases of slightly increased intracranial hemorrhage, and then we reduced the dose of anticoagulant. In addition, color ultrasound showed that venous thrombosis disappeared or became stable.

Patients with NVAF following HI/HT have a higher risk of thromboembolism. Early acceptance of low-dose LMWH as an anticoagulant is relatively safe and may gain benefit. However, in the process of anticoagulant therapy, we should follow-up head computed tomography/magnetic resonance imaging frequently, as well as D-dimer values, limb vascular ultrasound. Besides, the changes of symptoms and signs should be focused to judge the symptomatic bleeding or recurrent stroke. Furthermore, it is better to adjust anticoagulant drug dosage according to specific conditions.
Novel signaling pathways regulate SARS-CoV and SARS-CoV-2 infectious disease
Authors: Cheng Li-Chin , Kao Tzu-Jen , Phan Nam Nhut , Chiao Chung-Chieh , Yen Meng-Chi , Chen Chien-Fu , Hung Jui-Hsiang , Jiang Jia-Zhen , Sun Zhengda , Wang Chih-Yang , Hsu Hui-Ping
Published: February 2021

Severe acute respiratory syndrome coronavirus (SARS-CoV)-2 induces severe infection, and it is responsible for a worldwide disease outbreak starting in late 2019. Currently, there are no effective medications against coronavirus. In the present study, we utilized a holistic bioinformatics approach to study gene signatures of SARS-CoV- and SARS-CoV-2-infected Calu-3 lung adenocarcinoma cells. Through the Gene Ontology platform, we determined that several cytokine genes were up-regulated after SARS-CoV-2 infection, including TNF, IL6, CSF2, IFNL1, IL-17C, CXCL10, and CXCL11. Differentially regulated pathways were detected by the Kyoto Encyclopedia of Genes and Genomes, gene ontology, and Hallmark platform, including chemokines, cytokines, cytokine receptors, cytokine metabolism, inflammation, immune responses, and cellular responses to the virus. A Venn diagram was utilized to illustrate common overlapping genes from SARS-CoV- and SARS-CoV-2-infected datasets. An Ingenuity pathway analysis discovered an enrichment of tumor necrosis factor- (TNF-) and interleukin (IL)-17-related signaling in a gene set enrichment analysis. Downstream networks were predicted by the Database for Annotation, Visualization, and Integrated Discovery platform also revealed that TNF and TNF receptor 2 signaling elicited leukocyte recruitment, activation, and survival of host cells after coronavirus infection. Our discovery provides essential evidence for transcript regulation and downstream signaling of SARS-CoV and SARS-CoV-2 infection.
Partial trisomy 16q and partial monosomy 7p of a fetus derivated from paternal balanced translocation
Authors: Xie Hui-Hui , Liu Tong , Zhang Jing-Bo , Zhai Jing-Fang , Liu Ying
Published: February 2021

Introduction:

Subchromosomal deletions and duplications could currently be detected by noninvasive preliminary screening (NIPS). However, NIPS is a screening test that requires further diagnosis. Here we report a fetus with an autosomal abnormality revealed by NIPS and conventional karyotype combined with copy number variations sequencing (CNV-seq) confirmed the fetus with an unbalanced translocation.

Patient concern:

This was the fourth pregnancy of a 30-year-old woman who underwent 2 spontaneous abortions and gave birth to a child with a normal phenotype. The woman and her husband were healthy and nonconsanguineous. NIPS indicated a repeat of about 19-Mb fragment at the region of 16q22.1-q22.4 at 17-week gestation.

Diagnoses:

The combination of traditional karyotype and CNV-seq could better locate the abnormal chromosomal region and further identify the source of fetal chromosomal abnormalities. Simultaneously, we evaluated the fetal morphology by ultrasound examination. The karyotype of the fetus was 46,XX,der(7)t(7;16)(p22;q23) and CNV-seq results showed an approximately 20.96-Mb duplication in 16q22.1-q24.3 (69200001-90160000) and an approximately 3.86-Mb deletion in 7p22.3-p22.2 (40001-3900000). Prenatal ultrasound revealed the fetal micrognathia. The paternal karyotype was 46,XY, t (7;16) (p22;q23), while the maternal was normal. The fetus inherited an abnormal chromosome 7 from its father.

Interventions:

No treatment for the fetus.

Outcomes:

Pregnancy was terminated.

Conclusions:

To our knowledge, the occurrence of de novo partial trisomy 16q (16q22.1-qter) and partial monosomy 7p (7p22.2-pter) has not previously been reported up to now. Here, we present the perinatal findings of such a case and a review of the literatures. CNV-seq combined with karyotype is a useful tool for chromosomal abnormalities indicated by NIPS.
The role of estrogen receptor-beta gene +1730G/A polymorphisms in recurrent pregnancy loss
Authors: Mu Fangxiang , Shi Minge , Huang Li , Wang Dafen , Shen Aiqun
Published: February 2021

Objective:

To identify the role of estrogen receptor-beta (ER-β) gene +1730G/A (rs4986938) polymorphisms in recurrent pregnancy loss (RPL).

Methods:

All relevant case-control studies will be systematically searched in multiple databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Internet (CNKI), Wanfang and Cqvip. Both pooled odds rations (ORs) and 95% confidence intervals (CIs) will be used to assess the association between ER-β gene +1730G/A polymorphisms and RPL risk. The publication bias will be evaluated using Egger test.

Results:

ER-β gene +1730G/A variation may be associated with a higher risk of RPL in Caucasian population.

Conclusions:

The findings of this meta-analysis will provide high-quality evidence for the association between ER-β gene +1730G/A polymorphisms and RPL, facilitating clinical practice and further scientific studies.

OSF registration number:

10.17605/OSF.IO/EW9FB.