bluuebunny/crossref_metadata_2025 huggingface dataset:
DIAGNOSIS OF VORTEX VARIX USING OPTICAL COHERENCE TOMOGRAPHY AND SCLERAL INDENTATION
Authors: Spiess Karina , Elgohary Mostafa A.
Published: February 2020

Purpose:

We report a case of a vortex vein varix diagnosed with optical coherence tomography under globe compression.

Methods:

To illustrate the dynamical behavior of a vortex vein varix, optical coherence tomography was performed with and without gentle globe indentation with a cotton swab.

Results:

A 51-year-old woman was referred by her optician for an incidental finding of a nonpigmented choroidal mass in the right eye. The patient was asymptomatic with a best-corrected visual acuity of 20/16 in both eyes. On fundoscopy, a prominent smooth pink lesion at the level of the superonasal equatorial retina could be observed in the right eye. Peripheral optical coherence tomography over the area revealed dilated choroidal vessels with an overlying healthy retina. Optical coherence tomography scan was repeated applying gentle globe indentation under which the lesion completely collapsed.

Conclusion:

This case illustrates that the diagnosis of a vortex vein varix can be made in clinics using noninvasive tools such as optical coherence tomography. The anatomical localization of the lesion and the pressure-evoked fluctuation of size and shape are important clues which lead to the diagnosis.
Angle alpha orientation and magnitude distribution in a cataract surgery population
Authors: Mahr Michael A. , Simpson Michael J. , Erie Jay C.
Published: February 2020

Purpose:

To report normative angle alpha orientation and magnitude distribution in a cataract surgery patient population.

Setting:

U.S. academic medical center.

Design:

Retrospective review.

Methods:

A total of 11 871 wavefront aberrometer/corneal topographer angle alpha measurements were performed over 40 months, yielding 8773 bilateral measurements (73.9%) with zero bad wavefront datapoints. The analysis was limited to the first right-eye scan for 3382 unique patients. The angle alpha magnitudes (millimeters) and orientations (degrees) were analyzed for these unique right eyes.

Results:

For the 3,382 unique patients, the mean angle alpha magnitude was 0.44 ± 0.15 mm (median, 0.44 mm; 25th and 75th percentiles 0.34 mm, 0.53 mm). Angle alpha orientation was predominantly horizontal (P < .01), with a mean of 186 ± 32 degrees. The expected point of intraocular lens (IOL) centration (EPIC) based on the geometric center of the corneal limbus was temporal to the visual axis in 3212 eyes (95%), nasal in 92 eyes (2.7%), inferior in 56 eyes (1.7%), and superior in 22 eyes (0.6%). The mean angle alpha magnitude was 0.3 mm or less in 607 eyes (18%) and 0.5 mm or greater in 1089 eyes (32%).

Conclusions:

Angle alpha is a predominantly horizontal phenomenon with a mean EPIC of 0.44 mm temporal to the visual axis. This information may assist in determining eligibility for patients in multifocal IOL implantation.
Refractive outcomes comparing small-incision lenticule extraction and femtosecond laser–assisted laser in situ keratomileusis for high myopia
Authors: Han Tian , Shang Jianmin , Zhou Xueyi , Xu Ye , Ang Marcus , Zhou Xingtao
Published: February 2020

Purpose:

To compare the long-term refractive effects of small-incision lenticule extraction (SMILE) and femtosecond laser–assisted laser in situ keratomileusis (FS-LASIK) on the correction of high myopia and astigmatism.

Setting:

The Eye and ENT Hospital of Fudan University, Shanghai, China.

Design:

Retrospective case series.

Methods:

Patients had SMILE or FS-LASIK for high myopia. Subgroup analyses of high myopia (–6.00 to –8.75 diopters [D]) and extremely high myopia (≥–9.00 D) were performed. The main outcome measure was refractive predictability, compared between SMILE and FS-LASIK groups. Secondary outcomes included efficacy, safety, and residual astigmatism.

Results:

This study included 121 patients (121 eyes: 75 in the SMILE group and 46 in the FS-LASIK group). No differences were found in terms of refractive predictability between SMILE and FS-LASIK in eyes with high myopia: 56% vs 58.7% achieved ± 0.50 D of attempted correction (P = .771) and 81.3% vs 76.1% achieved ± 1.00 D of attempted correction (P = .489). Efficacy indices of the SMILE and FS-LASIK groups were 1.02 ± 0.24 and 1.03 ± 0.24 (P = .742), respectively; safety indices were 1.23 ± 0.22 and 1.20 ± 0.24 (P = .324), respectively. Logarithm of the minimum angle of resolution uncorrected distance visual acuity and spherical equivalent in the high myopia subgroup were better than in the extremely high myopia subgroup after both SMILE and FS-LASIK (P < .01).

Conclusions:

SMILE and FS-LASIK were both effective in correcting high myopia and myopic astigmatism. However, both techniques may require further nomogram adjustments when treating eyes with extremely high myopia.
Accelerated corneal crosslinking in children with keratoconus: 5-year results and comparison of 2 protocols
Authors: Ağca Alper , Tülü Beril , Yaşa Dilek , Kepez Yıldız Burçin , Sucu Mehmet E. , Genç Selim , Fazıl Korhan , Yıldırım Yusuf
Published: February 2020

Purpose:

To evaluate long-term clinical results of 2 different accelerated corneal crosslinking (CXL) protocols in pediatric patients with keratoconus.

Setting:

Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey.

Design:

Retrospective case-control study.

Methods:

Patients who were younger than 18 years were included in the study. Group 1 received 4 minutes of illumination at 30 mW/cm2, and Group 2 received 5 minutes of illumination at 18 mW/cm2. Uncorrected and corrected distance visual acuities, manifest refraction, corneal topographic parameters, and corneal higher-order aberrations (HOAs) were evaluated at baseline and during 1-, 3-, and 5-year follow-up visits.

Results:

A total of 143 eyes from 86 patients were included in the study. There were 30 eyes in Group 1 and 113 eyes in Group 2. The mean follow-up time was 4.15 ± 0.99 years. Mean keratometry (K) and/or maximum K progressed ≥1.00 diopter (D) in 7 eyes (23.3%) in Group 1 and 19 eyes (16.8%) in Group 2 (P = .411). Mean K and/or maximum K decreased ≥2.00 D in 2 eyes (6.7%) in Group 1 and 24 eyes (21.2%) in Group 2 (P = .06). In Group 1, there were no statistically significant differences in topographic parameters during follow-up. In Group 2, there was a statistically significant reduction in total HOA and coma during the 5-year visit when compared with the preoperative visit (P = .005 and P = .045, respectively).

Conclusions:

Accelerated CXL is beneficial in terms of halting the progression of keratoconus in pediatric patients throughout 5 years of follow-up examinations. An increased irradiance with a reduced application time reduces the topographic effects of CXL.
Comparison of visual and refractive outcomes of 2 trifocal intraocular lenses
Authors: Ribeiro Filomena J. , Ferreira Tiago B.
Published: February 2020

Purpose:

To compare clinical outcomes after cataract surgery and bilateral implantation of 2 diffractive trifocal toric intraocular lenses (IOLs).

Setting:

Hospital da Luz, Lisbon, Portugal.

Design:

Double-arm, randomized, prospective case series.

Methods:

A total of 60 patients were randomly allocated to receive bilateral implantation of either the FineVision Pod FT toric IOL (PhysIOL) or the AcrySof IQ PanOptix toric IOL (Alcon). Visual and refractive outcomes, contrast sensitivity, IOL misalignment, and quality of vision outcomes (QoV questionnaire) were evaluated at 3 months postoperatively. Surgically induced astigmatic changes were evaluated by vector analysis.

Results:

Each group (FineVision toric and AcrySof IQ PanOptix toric) comprised 30 patients (60 eyes). No significant differences between groups were found regarding uncorrected and corrected distance and near visual outcomes (P ≥ .333). Mean postoperative distance-corrected intermediate visual acuity at 60 cm was 0.04 ± 0.09 logarithm of the minimum angle of resolution (logMAR) and 0.09 ± 0.11 logMAR in the PanOptix and Pod FT group, respectively (P = .032). Mean IOL axis misalignment was 1.59 degrees ± 2.15 degrees (PanOptix group) and 1.89 degrees ± 3.31 degrees (Pod FT group) (P = .821). Mean magnitude of error of astigmatic correction was −0.09 diopters (D) and −0.11 D in the PanOptix group and Pod FT group, respectively (P = .333). Contrast sensitivity, QoV scores for the presence of photic phenomena, and the level of spectacle independence were similar in both groups (P > .05).

Conclusions:

Both trifocal toric IOLs allowed complete patient visual restoration, and good spectacle independence and good visual quality outcomes. The PanOptix IOL provided superior intermediate visual acuity for distances around 60 cm.
Clinical outcomes of immediate transepithelial photorefractive keratectomy after suction loss during small-incision lenticule extraction
Authors: Chung Byunghoon , Kang David Sung Yong , Kim Joon Hyun , Arba-Mosquera Samuel , Jean Seung Ki , Jun Ikhyun , Kim Eung Kweon , Seo Kyoung Yul , Kim Kang Yoon , Kim Tae-im
Published: February 2020

Purpose:

To investigate the surgical outcomes of immediate transepithelial photorefractive keratectomy (PRK) after suction loss during small-incision lenticule extraction (SMILE) and compare the outcomes with those of uneventful SMILE.

Setting:

Eyereum Eye Clinic, Seoul, South Korea.

Design:

Retrospective case series.

Methods:

This study included 24 eyes of 12 patients who had uneventful SMILE in one eye and immediate transepithelial PRK after the development of suction loss during the lenticule cut in the contralateral eye. Visual acuity assessments, manifest refraction, and measurements of corneal wavefront aberrations were performed preoperatively and 6 months postoperatively.

Results:

At 6 months, the mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and spherical equivalent were −0.04 ± 0.05, −0.09 ± 0.05, and −0.02 ± 0.24 diopter (D), respectively, in the transepithelial PRK group and −0.10 ± 0.07, −0.06 ± 0.07, and −0.04 ± 0.17 D, respectively (P = .036, P = .109, and P = .671, respectively), in the uneventful SMILE group. The 6-month Snellen UDVA was better than 20/20 for 11 (92%) and 12 (100%) of eyes in the transepithelial PRK and uneventful SMILE groups, respectively. All 24 eyes showed unchanged or improved CDVA and a significant increase in the total corneal higher-order aberrations postoperatively. Corneal spherical aberrations exhibited a significant postoperative increase only in the transepithelial PRK group.

Conclusions:

Immediate transepithelial PRK after early suction loss during SMILE might be safe and effective, with refractive outcomes that are comparable with those after uneventful SMILE.
Scleral fixation of a single-piece foldable acrylic IOL through a 1.80 mm corneal incision
Authors: Veritti Daniele , Grego Lisa , Samassa Francesco , Sarao Valentina , Lanzetta Paolo
Published: February 2020

A new scleral fixation technique of a single-piece acrylic foldable intraocular lens (IOL) (enVista MX60, Bausch & Lomb, Inc.) through a 1.80 mm corneal incision, using the IOL eyelets as anchoring point, is described. It was a retrospective review of 26 cases. The preoperative mean corrected distance visual acuity was 0.51 ± 0.21 logarithm of the minimum angle of resolution (logMAR). It improved significantly to 0.25 ± 0.27 logMAR (P < .01), 0.18 ± 0.16 logMAR (P < .01), and 0.17 ± 0.16 logMAR (P < .01) (at 1 month, 3 months, and 6 months postoperatively, respectively, repeated measures analysis of variance, P < .0001). No astigmatism increase of more than 0.75 diopters was recorded at any time point. In all 26 patients, the IOL was well centered and stable for the entire monitoring period. No complications were observed during follow-up. Scleral fixation of the foldable IOL through a 1.80 mm corneal incision provided excellent IOL stability during the 6-month follow-up of this study and might be an effective and safe surgical technique.
Mobile Electrocardiogram Monitoring and Health-Related Quality of Life in Patients With Atrial Fibrillation
Authors: Caceres Billy A. , Hickey Kathleen T. , Bakken Suzanne B. , Biviano Angelo B. , Garan Hasan , Goldenthal Isaac L. , Koleck Theresa A. , Masterson-Creber Ruth , Turchioe Meghan Reading , Jia Haomiao
Published: February 2020

Background

Atrial fibrillation (AF) is associated with high recurrence rates and poor health-related quality of life (HRQOL) but few effective interventions to improve HRQOL exist.

Objective

The aim of this study was to examine the impact of the “iPhone Helping Evaluate Atrial Fibrillation Rhythm through Technology” (iHEART) intervention on HRQOL in patients with AF.

Methods

We randomized English- and Spanish-speaking adult patients with AF to receive either the iHEART intervention or usual care for 6 months. The iHEART intervention used smartphone-based electrocardiogram monitoring and motivational text messages. Three instruments were used to measure HRQOL: the Atrial Fibrillation Effect on Quality of Life (AFEQT), the 36-item Short-Form Health survey, and the EuroQol-5D. We used linear mixed models to compare the effect of the iHEART intervention on HRQOL, quality-adjusted life-years, and AF symptom severity.

Results

A total of 238 participants were randomized to the iHEART intervention (n = 115) or usual care (n = 123). Of the participants, 77% were men and 76% were white. More than half (55%) had an AF recurrence. Both arms had improved scores from baseline to follow-up for AFEQT and AF symptom severity scores. The global AFEQT score improved 18.5 and 11.2 points in the intervention and control arms, respectively (P < .05). There were no statistically significant differences in HRQOL, quality-adjusted life-years, or AF symptom severity between groups.

Conclusions

We found clinically meaningful improvements in AF-specific HRQOL and AF symptom severity for both groups. Additional research with longer follow-up should examine the influence of smartphone-based interventions for AF management on HRQOL and address the unique needs of patients diagnosed with different subtypes of AF.
Characteristics of Effective Continuing Medical Education for Physician Assistants and Nurse Practitioners in Hospital Medicine
Authors: Breunig Michael J. , Herber Andrew J. , Jenkins Sarah M. , Newman James S. , Beckman Thomas J. , Wittich Christopher M. , Ratelle John T.
Published: February 2020

Purpose

The purpose of this study was to describe participant characteristics and effective teaching methods at a national continuing medical education (CME) conference on hospital medicine for physician assistants (PAs) and nurse practitioners (NPs).

Methods

In this cross-sectional study, participants provided demographic information and teaching effectiveness scores for each presentation. Associations between teaching effectiveness score and presentation characteristics were determined.

Results

In total, 163 of 253 participants (64.4%) completed evaluations of 28 presentations. Many of the participants were younger than 50 years (69.0%), had practiced for fewer than 5 years (41.5%), and worked in nonacademic settings (76.7%). Teaching effectiveness scores were significantly associated with the use of clinical cases (perfect scores for 68.8% of presentations with clinical cases vs. 59.8% without; P = .04).

Conclusion

Many PAs and NPs at an HM CME conference were early-career clinicians working in nonacademic settings. Presenters at CME conferences in hospital medicine should consider using clinical cases to improve their teaching effectiveness among PA and NP learners.
Evaluating the Clinical Implications of an Innovative Anatomy Lab Suturing Curriculum for Physician Assistant Students
Authors: Fankhanel Courtney , Talwalkar Jaideep S. , Rienzo Rita
Published: February 2020

Purpose

The purpose of this study was to evaluate the outcomes of a new suturing curriculum incorporated throughout the anatomy lab for Yale Physician Associate (YPA) students.

Methods

This controlled before-and-after study evaluated the class of 2017 (n = 39) as the control group and the class of 2018 (n = 37) as the intervention group. Suturing competency data were collected on all students from their clinical preceptor evaluations. Students completed surveys to measure perceived confidence in suturing skills.

Results

Preceptor evaluations showed a 14.98% increase in suturing competence between the control and intervention groups (P < .05). Student surveys showed no significant difference in self-perceived confidence in suturing skills between the 2 cohorts.

Conclusions

After initiation of an innovative anatomy lab suturing curriculum, YPA students demonstrated improvement in preceptor-perceived suturing competency during clinical rotations.
Update on nutritional assessment and therapy in critical care
Authors: Reintam Blaser Annika , Rice Todd W. , Deane Adam M.
Published: February 2020

Purpose of review

To summarize recent data regarding nutritional assessment and interventions in the ICU.

Recent findings

Current methods to assess nutritional risk do not allow identification of ICU patients who may benefit from specific nutritional intervention. Early full energy delivery does not appear to improve outcomes at the population level. Specific nutrient composition of formula has been shown to improve glycemic outcomes in patients with hyperglycemia but patient-centered outcomes are unaffected.

Based on recent studies, full energy feeding early during critical illness has no measurable beneficial effect, and may even be harmful, when applied to entire populations. The mechanisms underlying this are unknown and remain proposed theories. Tools to assess nutritional risk in the ICU that identify patients who will benefit from a specific nutritional intervention are lacking. The optimal composition of feeds, and indications for specific interventions for enteral feeding intolerance remain uncertain.
Minimally invasive surgery for intracerebral hemorrhage
Authors: Vitt Jeffrey R. , Sun Chung-Huan , Le Roux Peter D. , Hemphill J. Claude
Published: February 2020

Purpose of review

Spontaneous intracerebral hemorrhage (ICH) is common, associated with a high degree of mortality and long-term functional impairment, and remains without effective proven treatments. Surgical hematoma evacuation can reduce mass effect and decrease cytotoxic effects from blood product breakdown. However, results from large clinical trials that have examined the role of open craniotomy have not demonstrated a significant outcome benefit over medical management. We review the data on minimally invasive surgery (MIS) that is emerging as a treatment modality for spontaneous ICH.

Recent findings

The use of MIS for supratentorial ICH has increased significantly in recent years and appears to be associated with decreased mortality and improved functional outcome compared with medical management. The role of MIS for posterior fossa ICH is ill-defined. Currently available MIS devices allow for stereotactic aspiration and thrombolysis, endoport-mediated evacuation, and endoscopic aspiration. Clinical series demonstrate that MIS can facilitate significant hematoma volume reduction and may be associated with less morbidity than conventional open surgical approaches.

MIS is an appealing treatment modality for supratentorial ICH and with careful patient selection and technologic advances has the potential to improve neurologic outcomes and reduce mortality. Early and extensive hematoma evacuation are important therapeutic targets and current studies are underway that have the potential to change the management for ICH patients.
Evaluation and management of intraabdominal hypertension
Authors: Allen Rebecca , Sarani Babak
Published: February 2020

Purpose of review

The purpose of this review is to provide an overview of the pathophysiology of intraabdominal hypertension/compartment syndrome and to review the recent advances in the areas of evaluation and management of this disorder.

Recent findings

The incidence of intraabdominal hypertension (IAH) in intensive care units is as high as 45%, an incidence much higher than initially suspected. Despite decompressive laparotomy as a treatment, mortality in patients who developed abdominal compartment syndrome (ACS) requiring this procedure is as high as 50%. Some patients may be treated by fewer invasive methods, such as paracentesis, thereby avoiding the morbidity of laparotomy. Protective lung ventilation is key to managing the pulmonary sequalae of ACS. Point-of-care ultrasound can be used as an adjunctive decision-making tool.

IAH is common in critically ill patients and portends a high mortality rate. Prevention and early recognition are key in minimizing adverse events.
Extracranial complications after traumatic brain injury: targeting the brain and the body
Authors: Robba Chiara , Bonatti Giulia , Pelosi Paolo , Citerio Giuseppe
Published: February 2020

Purpose of review

The aim of this review is to provide an update on the pathophysiology and treatment of severe traumatic brain injury (TBI)-related complications on extracranial organs.

Recent findings

Extracranial complications are common and influence the outcome from TBI. Significant improvements in outcome in a sizeable proportion of patients could potentially be accomplished by improving the ability to prevent or reverse nonneurological complications such as pneumonia, cardiac and kidney failure. Prompt recognition and treatment of systemic complications is therefore fundamental to care of this patient cohort. However, the role of extracranial pathology often has been underestimated in outcome assessment since most clinicians focus mainly on intracranial lesions and injury rather than consider the systemic effects of TBI.

Robust evidence about pathophysiology and treatment of extracranial complications in TBI are lacking. Further studies are warranted to precisely understand and manage the multisystem response of the body after TBI.
Impact of Tilt-Down Positioning Compared With Left Lateral Positioning on Ease of Colonoscope Insertion During Colonoscopy
Authors: Early Dayna , Larue Sara , Weinstock Leonard , Kushnir Vladimir , Gyawali Prakash , Sullivan Shelby , Thyssen Erik , Hollander Thomas , Elsner Jeffrey , Vyhmeister Ross , Bhat Trisha , Gaddam Srinivas
Published: February 2020

Goals:

The aim of this study was to evaluate the efficacy of tilt-down (TD) versus left lateral (LL) positioning in speed and ease of colonoscope insertion in women with risk factors for difficult colonoscopy.

Background:

Risk factors for difficult colonoscopy in women include pelvic surgery, diverticulosis, and thin body habitus.

Study:

Female patients with body mass index (BMI) under 25, diverticulosis and history of pelvic surgery were randomized to TD or LL positioning. Five colonoscopists performed all studies at a single center. Time to splenic flexure and cecum, type and amount of medication administered, Boston Bowel Prep Score (BBPS), adverse events, and findings were recorded. The Mann-Whitney U test was used to evaluate the primary endpoint.

Results:

A total of 150 women were enrolled (81 TD, 69 LL). The mean age was 60.1 (SD 10.5) and the mean BMI was 23.9 (SD 3.5). In total 98 (65.3%) women had prior pelvic surgery, 94 (62.7%) had BMI <25 and 60 (40.0%) had diverticulosis. There was no statistically significant difference in time to the splenic flexure overall but insertion to the splenic flexure was significantly faster in the TD position as compared with the LL position in patients with diverticulosis (124 s for TD, 160 s for LL, P=0.022). In a linear regression analysis, lower BMI, diverticulosis and lower BBPS were significantly associated with a longer insertion time to the splenic flexure. There were no adverse events.

Conclusion:

TD positioning represents a straightforward maneuver to facilitate advancement through the sigmoid colon and may be beneficial in women with diverticular disease.
N − 3 fatty acids during chemotherapy: toward a higher level of evidence for clinical application
Authors: Klassen Pamela , Cervantes Mayra , Mazurak Vera C.
Published: February 2020

Purpose of review

Recommendations for intakes of n − 3 fatty acids (FAs) in patients who are receiving chemotherapy for cancer are based on weak evidence. This review highlights themes within the emergent literature to suggest improvements in the design of studies that provide n − 3 FA supplements concurrent with cytotoxic agents.

Recent findings

Following earlier research in animal models and human pilot studies, recent human studies have evaluated the effect of providing n − 3 FAs during delivery of single agent and multiagent chemotherapy regimens for breast and gastro-intestinal cancers. Regimens were based on platinum compounds, fluoropyrimidines or both, and a variety of additional agents. Tumor location and stage, supplement dose and duration, and endpoints were dissimilar across studies. Overall, the recent research continues to support the safety and tolerability of n − 3 FA supplementation with chemotherapy and provides additional evidence, albeit weak, for enhanced tumor response, maintenance of weight and muscle, and reduction in inflammation and toxicities in the host across multiple cancer sites and chemotherapy regimens.

The barriers to implementation in practice remain small study sizes, variations in supplement dosage and methodology, and differences in primary endpoints. Randomized, blinded trials with a justifiable sample size, adequate doses, monitored compliance and measures of clinically important endpoints are required to move these findings to a higher level of evidence for implementation into clinical practice.
One-year outcome of low dose laser cyclophotocoagulation for capsular tension ring-induced malignant glaucoma
Authors: Lin Haishuang , Zhou Guangming , Zhang Shaodan , Huang Fang , Liang Yuanbo
Published: February 2020

Rationale:

Malignant glaucoma is a refractory glaucoma which often relentlessly worsened despite conventional therapy. Ultrasonographic biomicroscopy always cannot show the ciliary-block of malignant glaucoma. We report a case of capsular tension ring induced ciliary-block and successfully treated by low dose laser cyclophotocoagulation, with 1-year follow-up.

Patient concerns:

A 75-year-old woman was referred for glaucoma with a history of cataract and lens zonular laxity, and surgery with combined phacoemulsification and capsular tension ring implantation. She subsequently underwent trabeculectomy for uncontrolled intraocular pressure on maximal medical therapy. One day later, the patient presented as shallow anterior chamber of Shaffer grade 1 and an elevated intraocular pressure of 51.0 mmHg in the right eye.

Diagnosis:

Ciliary block caused by capsular tension ring and malignant glaucoma was observed.

Interventions:

Low dose laser cyclophotocoagulation was performed under retrobulbar anesthesia.

Outcomes:

One day later, the patient's intraocular pressure decreased to 14.3 mmHg on topical atropine 1% and 2 classes of intraocular pressure lowering medications. The patient discontinued topical atropine and intraocular pressure lowering medications 4 months postoperatively and her condition had remained stable for 1 year without any medications. The patient had a satisfactory recovery benefited from the low dose laser cyclophotocoagulation.

Lessons:

Low dose laser cyclophotocoagulation in this challenging case of capsular tension ring-induced malignant glaucoma provided an effective and fast recovery of anterior chamber depth over a 1-year period.
Phase 2 randomized placebo controlled double blind study to assess the efficacy and safety of tecfidera in patients with amyotrophic lateral sclerosis (TEALS Study)
Authors: Vucic Steve , Ryder Julie , Mekhael Linda , RD Henderson , Mathers Susan , Needham Merilee , DW Schultz , MC Kiernan
Published: February 2020

Background:

Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disorder of the human motor system. Neuroinflammation appears to be an important modulator of disease progression in ALS. Specifically, reduction of regulatory T cell (Treg) levels, along with an increase in pro-inflammatory effector T cells, macrophage activation and upregulation of co-stimulatory pathways have all been associated with a rapid disease course in ALS. Autologous infusion of expanded Tregs into sporadic ALS patients, resulted in greater suppressive function, slowing of disease progression and stabilization of respiratory function. Tecfidera (dimethyl fumarate) increases the ratio of anti-inflammatory (Treg) to proinflammatory T-cells in patients with relapsing remitting multiple sclerosis and rebalances the regulatory: inflammatory axis towards a neuroprotective phenotype. Consequently, the aim of this study was to assess the efficacy, safety, and tolerability of Tecfidera in sporadic ALS.

Methods:

The study is an investigator led Phase 2 multi-center, randomized, placebo controlled, double blind clinical trial assessing the efficacy and safety of Tecfidera in patients with sporadic ALS. The study duration is 40 weeks, with a 36-week study period and end of study visit occurring at 40 weeks or at early termination/withdrawal from study. The TEALS study has been registered with the Australian and New Zealand Clinical Trials registry (ANZCTR) under the trials registration number ACTRN12618000534280 and has been approved by the Human Research Ethics Committee and Research Governance Office at the lead site (Westmead Hospital) with the ethics number HREC/17/WMEAD/353. The participating sites have obtained site specific ethics and governance approvals from the local institution.

Results:

The primary endpoint is slowing of disease progression as reflected by the differences in the ALS Functional Rating Score-Revised (ALSFRS-R) score at Week 36. The secondary endpoints will include effects in survival, lower motor neuron function, respiratory function, quality of life and safety.

Conclusion:

This Phase 2 multi-center, randomized, placebo controlled, double blind clinical trial will provide evidence of efficacy and safety of Tecfidera in sporadic ALS.
Clinical effects and safety of electroacupuncture for the treatment of allergic rhinitis
Authors: Fu Li , Zhong Juan , Fu Qinwei , Yang Yepeng , Zhang Mengni , Zhang Qinxiu
Published: February 2020

Background:

As the therapy of acupuncture continues to expand, electroacupuncture is increasing used in allergic rhinitis prevention and therapy, and many studies have published that it is effective in the treatment of allergic rhinitis. However, it is unclear if electroacupuncture provides an evidence-based clinical benefit in the allergic rhinitis population.

Methods/design:

We will conduct a systematic review of electroacupuncture and health-related outcomes in allergic rhinitis patients according to the Preferred Reporting Items for Systematic Reviews. The primary objective is to assess the impact of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on clinical outcomes relevant to allergic rhinitis patients, such as effective rate, life-quality evaluation, and adverse events. The Cochrane Risk Assessment Tool will be used to assess the quality of eligible studies according to the Cochrane handbook.

Results:

We will perform a meta-analysis using standard techniques for the outcomes.

Conclusion:

The results of this systematic review may highlight the gaps in our knowledge of the relevance of electroacupuncture after treatment or after follow-ups.

PROSPERO registration number: PROSPERO CRD42018104080. (https://www.crd.york.ac.uk/PROSPERO/#recordDetails)
Behçet's disease with invasive pulmonary aspergillosis and Aspergillus auriculatus infection
Authors: Sun Fenfen , Cao Hui , Wang Fan , Cao Guoqiang
Published: February 2020

Rationale:

Behçet's disease (BD) is an inflammatory disease that leads to multisystemic immune dysfunction and that involves pulmonary system alterations.

Patient concerns:

A 26-year-old woman presented with dull right chest pain for 30 days and intermittent cough with expectoration for 5 days. She had a history of recurrent oral ulcer and constitutional rash 2 months prior.

Diagnoses:

The patient was diagnosed with BD complicated by IPA and Aspergillus auriculatus infection.

Interventions:

The patient was administered itraconazole oral solution (200 mg b.i.d) to treat the fungal infection. After a diagnosis of BD was made, she received 40 mg of methylprednisolone sodium succinate daily for 1 week.

Then, she also received 24 mg of methylprednisolone sodium succinate daily, which was decreased by 2 mg per half month, until the rash had resolved. The patient continued to receive 200 mg Q. D itraconazole orally for 3 months. Thereafter, itraconazole was stopped, while daily oral administration of 10 mg of methylprednisolone sodium succinate was continued.

Outcomes:

The rash was observed to resolve, and CT revealed that the lesions in both the right and left lung were reduced. During a telephone follow-up performed after 6 months, the patient stated that no symptoms had recurred during the follow-up period.

Lessons:

This case illustrates that for patients with BD, ignoring extrapulmonary symptoms often leads to a delayed diagnosis. Physicians should perform a thorough medical history and physical examination of these patients, as the information obtained in this manner may provide important clues for disease diagnosis and treatment.
Direct acting antivirals treatment for hepatitis C virus infection does not increase the incidence of de novo hepatocellular carcinoma occurrence
Authors: Buonomo Antonio Riccardo , Scotto Riccardo , Coppola Carmine , Pinchera Biagio , Viceconte Giulio , Rapillo Costanza Maria , Staiano Laura , Saturnino Mariarosaria , Scarano Ferdinando , Portunato Federica , Pisaturo Mariantonietta , De Pascalis Stefania , Martini Salvatore , Tosone Grazia , Nappa Salvatore , Coppola Nicola , Gentile Ivan
Published: February 2020

The effectiveness of direct-acting antivirals (DAAs) against hepatitis C virus (HCV) infection is ascertained. However, some authors raised the issue of an increased incidence of de novo hepatocellular carcinoma (HCC) in patients treated with DAAs. Aim of the study was to evaluate the rate of HCC occurrence in a real-life cohort of patients who received anti-HCV treatment with DAAs.

A prospective multicentre study was conducted. All adult patients with HCV infection who received treatment between March 2015 and December 2017 in 4 hospital of Campania region (South Italy) with at least 6 months of follow-up were enrolled.

A total of 323 patients were included in the study. Most patients had HCV genotype 1b (61.8%). The overall SVR12 rate was 95.5%. Median time of observation was 10 months. The incidence rate of HCC was 0.2 per 100 person-months (crude incidence rate 3.4%, 95 confidence interval: 1.5%–5.3%). The median time for HCC occurrence was 11 months. HCC occurrence rate was significantly higher among patients who did not achieve SVR12 compared with patients who did (28.6% vs 2.8%, P < 0.05). No patient with F0-F3 fibrosis developed HCC. Among patients with cirrhosis, at the multivariate time-to-event analysis, no covariates were independently associated with the risk of HCC occurrence.

Treatment with DAAs did not increase the risk of HCC occurrence. Patients who achieved SVR12 had a lower rate of HCC occurrence. Further studies are needed to estimate the incidence and the risk for HCC in the long-term follow-up among patients undergoing treatment with DAAs.
Disparities in National Institute of Health trauma research funding
Authors: Dowd Brianna , McKenney Mark , Boneva Dessy , Elkbuli Adel
Published: February 2020

To evaluate disparities in the National Institute of Health (NIH) trauma research funding.

Traumatic injury has increased in both prevalence and cost over the last decade. In the event of a traumatic injury, patients in the United States (US) rely on the trauma system to provide high-quality care. The current trauma research funding is not commensurate with the extent of the burden of trauma on the US population.

In this qualitative study, the National Institutes of Health's Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC) data were reviewed. The burden of traumatic injury on the US and the NIH trauma research funding was examined and compared with other diseases.

In 2018, the NIH funded an estimated $639 million to traumatic injury research projects, <2% of the NIH budget. Comparatively, the NIH funded an estimated $6.3 billion towards cancer research in 2018. Cancer research receives extensively more funding than trauma research despite that trauma accounts for 24.1% of all years of potential life lost (YPLL) before age 75 compared with 21.3% for cancer.

In the event of traumatic injury, trauma systems in the US should be able to provide high-quality care to patients yet cannot do so without adequate research funding. The federal funding contributed towards trauma research deserves a re-evaluation.
Maximal muscle strength and body composition are associated with bone mineral density in chinese adult males
Authors: Chen Fei , Su Qi , Tu Yulan , Zhang Jun , Chen Xinji , Zhao Tingxiao , Huang Yazeng , Xu Guokang
Published: February 2020

The relationship between maximal muscle strength (MMS) and bone mineral density (BMD) in males remains unclear. Therefore, the aim of this cross-sectional study was to investigate the association of MMS, using 3 fundamental compound exercises, and body composition with BMD in Chinese male adults. One hundred forty-seven Chinese male adults aged 20 to 47 years were recruited. Total and regional BMD and body composition were measured using dual-energy X-ray absorptiometry. Measurements of MMS included bench press, deadlift, and squat 1-repetition maximum (1RM). Bench press, deadlift, squat 1RM, fat mass (FM), and lean mass (LM) had a significant positive association with BMD. Intriguingly, squat 1RM was found to have a stronger association than bench press or deadlift 1RM, whereas bench press 1RM was found as the strongest determinant of BMD at the forearm sites. Furthermore, LM was found to be stronger related with BMD than FM. Our findings identify LM, FM and MMS are positively associated with BMD and squat may serve as a simple, most efficient strategy to optimize peak total body BMD, while bench press fit best for forearm BMD. Our results validate the benefits of MMS training in males and underscores site-specific effects on BMD levels. These findings emphasize the need for prospective studies to investigate the maximum therapeutic potential and sex specific modifiers of MMS training.
Dyskeratotic cells in persistent pruritic skin lesions as a prognostic factor in adult-onset Still disease
Authors: Maeda-Aoyama Natsuki , Hamada-Ode Kazu , Taniguchi Yoshinori , Nishikawa Hirofumi , Arii Kaoru , Nakajima Kimiko , Fujimoto Shimpei , Terada Yoshio
Published: February 2020

Adult-onset Still disease (AOSD), a systemic inflammatory disorder, is characterized by high fever, evanescent rash, arthritis, and hyperferritinaemia. AOSD is also reported to be associated with other skin lesions, including persistent pruritic papules and plaques. This study aimed to assess the significance of dyskeratotic skin lesions in Japanese AOSD patients.

We retrospectively assessed the histology of persistent pruritic skin lesions and evanescent rashes and the relationship between dyskeratotic cells, serum markers, and outcomes in 20 Japanese AOSD patients, comparing AOSD histology with that of dermatomyositis (DM), drug eruptions, and graft-versus-host disease (GVHD).

As the results, Persistent pruritic lesions were characterized by scattered single keratinocytes with an apoptotic appearance confined to the upper layer of the epidermis and horny layer without inflammatory infiltrate. In contrast to AOSD, the histology of DM, drug eruption, and GVHD demonstrated dyskeratotic cells in all layers of the epidermis with inflammatory infiltrate. AOSD with evanescent rash showed no dyskeratotic cells. The dyskeratotic cells in pruritic AOSD lesions stained positive for ssDNA and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling, indicating apoptosis. Serum IL-18 was significantly higher in AOSD patients with dyskeratotic cells than those without, and generally required higher doses of glucocorticoids, immunosuppressants, and biologic agents. Two of ten AOSD patients with dyskeratotic cells died from hemophagocytic lymphohistiocytosis.

In conclusion, Persistent pruritic AOSD skin lesions are characterized by dyskeratotic cells with apoptotic features, involving the upper layers of the epidermis. There may be a link to elevated IL-18. This dyskeratosis may be a negative prognostic indicator.
Comparison of severity index and plasma paraquat concentration for predicting survival after paraquat poisoning
Authors: Cao Zong Xun , Zhao Yong , Gao Jie , Feng Shun Yi , Wu Cheng Pu , Zhai Yan Zhao , Zhang Meng , Nie Shen , Li Yong
Published: February 2020

Background:

Severity index and plasma paraquat (PQ) concentration can predict the prognosis of patients with PQ poisoning. However, the better parameter is yet to be systematically investigated and determined. Thus, we conduct this systematic review and meta-analysis to investigate the prognostic value of severity index and plasma PQ concentration in patients with PQ poisoning.

Methods:

We searched PubMed, Embase, Web of Science, ScienceDirect, and Cochrane Library to identify all relevant papers that were published up to March 2019. All diagnostic studies that compared severity index and plasma PQ concentration to predict mortality in patients with PQ poisoning were enrolled in this meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) for individual trials were pooled using a random-effect model. We also aggregated heterogeneity testing, sensitivity analysis, and publication bias analysis.

Results:

Ultimately, seven studies involving 821 patients were included. The pooled OR with a 95% CI of severity index was 24.12 (95% CI: 9.34–62.34, P < .001), with an area under the curve of 0.88 (95% CI: 0.85–0.90), sensitivity of 0.84 (95% CI: 0.74–0.91), and specificity of 0.81 (95% CI: 0.75–0.87). Meanwhile, the pooled OR with 95% CI of plasma PQ concentration was 34.39 (95% CI: 14.69–80.56, P < .001), with an area under the curve of 0.94 (95% CI: 0.91–0.96), sensitivity of 0.86 (95% CI: 0.75–0.93), and specificity of 0.89 (95% CI: 0.76–0.95). Sensitivity analysis demonstrated the stability of the results of our meta-analysis. No significant publication bias was observed in this meta-analysis.

Conclusion

: Overall, this study indicated that severity index and plasma PQ concentration have relatively high-prognostic value in patients with PQ poisoning, and that the sensitivity and specificity of plasma PQ concentration are superior to those of severity index.
Efficacy and safety of bivalirudin vs heparin in patients with coronary heart disease undergoing percutaneous coronary intervention
Authors: Liu Xiao-Qiang , Luo Xian-Du , Wu Yan-Qing
Published: February 2020

Background:

This meta-analysis is to evaluate the efficacy and safety of bivalirudin in patients with ST-elevation myocardial infarction (STEMI).

Methods:

PubMed, Cochrane Library, Embase, CNKI, CBMdisc, and VIP database were searched. Randomized controlled trial (RCT) was selected and the meta-analysis was conducted by RevMan 5.1. The primary efficacy endpoint was the incidence of major adverse cardiovascular events (MACE) and the primary safety endpoint was the incidence of major bleeding. Secondary efficacy endpoints were myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST), stock, mortality, and thrombocytopenia. The pooled risk ratios (RRs) with the corresponding 95% confidence intervals (CI) were used to assess the efficacy and safety of bivalirudin vs heparin.

Results:

Seven RCTs met the inclusion criteria, and 16,640 patients were included. We found that bivalirudin associated with lower risk of mortality (RR = 1.05; 95% CI = 0.74–1.49; P = .03; I
2 = 2%), major bleeding (RR = 0.64; 95% CI = 0.54–0.75; P < .00001; I
2 = 70%) and thrombocytopenia (RR = 0.39; 95% CI = 0.25–0.61; P < .0001; I
2 = 0) compared with heparin. However, the use of bivalirudin increase the risk of MI(RR = 1.37; 95% CI = 1.10–1.71; P 
= .004; I
2 = 25%) and ST(RR = 1.61; 95% CI = 1.05–2.47; P = .03; I
2 = 70%) and has similar risk of MACE (RR = 1.00; 95% CI = 0.90–1.11; P = .97; I
2 = 16%), TVR (RR = 1.43; 95% CI = 0.92–2.22; P = .11; I
2 = 46%) and stock (RR = 1.43; 95% CI = 0.92–2.22; P = .11; I
2 = 46%) compared with heparin used in STEMI patients.

Conclusion:

Bivalirudin associated with lower risk of mortality, major bleeding and thrombocytopenia compared with heparin. However, the use of bivalirudin increase the risk of MI and ST and has similar risk of MACE, TVR and stock compared with heparin used in STEMI patients.
The association between anterior femoroacetabular impingement and femoral neck fractures
Authors: Yang Pengfei , Fan Huaquan , Wang Xin , Xu Senlin , Yang Liu , Chen Guangxing
Published: February 2020

The impact between acetabulum and femoral neck is another possible mechanism of femoral neck fracture.

Direct trauma of the greater trochanter may not be able to fully explain the mechanism underlying femoral neck fracture. In this study, we sought to investigate whether anterior femoroacetabular impingement are associated with femoral neck fractures.

A total of 36 patients with femoral neck fracture who had undergone total hip arthroplasty or hemiarthroplasty were included in this study. These patients were divided into 2 groups: labrum tear group and normal labrum group. Patients’ age, gender, body mass index, muscle injury, injury pattern, trauma severity, femoral head-neck offset, femoral head-neck ratio, Cam deformity alpha angle, acetabular anteversion, femoral head diameter, acetabular index, cortical index, hip axis length, and neck stem angle were recorded and analyzed. SPSS 18.0 software was used for statistical analyses.

According to intraoperative findings, 22 patients exhibited a labrum tear. Magnetic resonance imaging examination revealed bone contusion on the anterolateral margin of the acetabulum with muscle damage surrounding the hip. Among 14 cases without a labrum tear, no bone contusion and obvious muscle injury were found on the anterolateral margin of the acetabulum. Notably, muscle injury, injury pattern, trauma severity and femoral head-neck offset differed significantly (P < .05) between labrum tear and normal labrum groups.

Previous studies have focused more on direct lateral trauma. In this study, the impact between acetabulum and femoral neck is another possible mechanism besides lateral impact. Specifically, the abnormal anatomy of the hip, such as femoral head-neck offset, may promote the fracturing process.