bluuebunny/crossref_metadata_2025 huggingface dataset:
Potency and Quality of Reconstituted Botulinum Neurotoxin Type A According to Storage Temperatures
Authors: Park Kui Young , Han Hye Sung , Kim Jong Hee , Kim Han Byul , Seo Seong Jun
Published: August 2020

BACKGROUND

In clinical practice, one of the most important issues regarding the use of botulinum neurotoxin A (BoNT-A) is the proper storage conditions and the change in potency and quality over time after reconstitution.

OBJECTIVE

This study aimed to investigate the change in potency and quality of reconstituted prabotulinumtoxin A (PraBoNT-A) over time when stored at different storage temperatures.

MATERIALS AND METHODS

ICR/CD-1 mice and PraBoNT-A were used for the mouse intraperitoneal lethal dose 50% (LD50) test. A thorough quality evaluation of the product was performed.

RESULTS

All of the reconstituted PraBoNT-A stored at different temperatures met the evaluation criteria for the suggested limits of estimated potency and for the quality assessment at every evaluated time point. When the stability of reconstituted PraBoNT-A was evaluated by regression analysis, the shelf life of reconstituted PraBoNT-A was found to be 99.24, 73.80, and 16.34 weeks in the case of PraBoNT-A stored at freezing, refrigeration, or room temperatures, respectively.

CONCLUSION

Based on the results, the authors conclude that the efficacy and quality of the reconstituted PraBoNT-A product are not compromised at least for a certain period of time and that the shelf life of reconstituted PraBoNT-A is longest when stored at the freezing temperature.
Tomography of the Forehead Arteries and Tailored Filler Injection for Forehead Volumizing and Contouring
Authors: Hong Wei-Jin , Liao Zhi-Feng , Zeng Li , Luo Cheng-En , Luo Sheng-Kang
Published: August 2020

BACKGROUND

The forehead is a challenging area for filler injection because of the risk of serious complications. Anatomy-based filler injection techniques help to avoid severe vascular complications.

MATERIALS AND METHODS

Sixty-six cadaver heads were infused with adequate lead oxide contrast through the external carotid arteries, internal carotid arteries, facial artery, and superficial temporal artery. Three-dimensional computed tomography scans were reconstructed using validated algorithms. We measured the length and arc length of “beautiful” foreheads evaluated by 3 skilled surgeons.

RESULTS

The frontal branch of the superficial temporal artery (FBSTA) was classified based on the main trunk as follows: Type I FBSTA (89.72%) took a sudden turn (89.56° ± 11.76°) once passing through the temporal crest, whereas Type II FBSTA (10.28%) barely turned (52.26° ± 6.81°) at the temporal crest. A total of 319 arteries passed through the midline in 48 cadaver heads. There were more superficial arteries (292 of 319) than deep arteries (27 of 319). The difference in the length and arc length of the forehead was 19.66 ± 4.35 mm.

CONCLUSION

This study introduces an effective technique for forehead filler injection that minimizes the risk of filler injection and improves patient satisfaction.
The Current State of Mohs Surgery for the Treatment of Melanoma: A Nationwide Cross-Sectional Survey of Mohs Surgeons
Authors: Siscos Spyros M. , Neill Brett C. , Seger Edward W. , Hooton Tyler A. , Hocker Thomas L. H.
Published: August 2020

BACKGROUND

The increased use of Mohs micrographic surgery (MMS) to treat melanoma has been accompanied by wide variations in practice patterns and a lack of best practice guidelines.

OBJECTIVE

The present study was a nationwide cross-sectional survey of Mohs surgeons to elucidate commonalities and variations in their use of MMS to treat melanoma.

MATERIALS AND METHODS

A cross-sectional analysis was performed using survey responses of Mohs surgeons with membership in the American College of Mohs Surgery.

RESULTS

A total of 210/513 (40.9%) participants used MMS to treat melanoma of any subtype and 123/210 (58.6%) participants within this group treated invasive T1 melanoma (AJCC Eighth Edition) with MMS. A total of 172/210 (81.9%) participants debulked melanoma in situ (MIS). Average margin size of the first Mohs stage for MIS was 4.96 ± 1.74 mm. A total of 149/210 (71.0%) participants used immunohistochemical stains, with 145/149 (97.3%) using melanoma antigen recognized by T-cells 1 (MART-1) in 96.5% of melanoma cases treated with MMS.

CONCLUSION

Over half of surveyed Mohs surgeons treating melanoma with MMS are treating early invasive melanoma with MMS. Most Mohs surgeons treating melanoma with MMS debulk MIS and virtually all use MART-1 when excising invasive melanoma with MMS.
Fractionally Ablative Er:YAG Laser Resurfacing for Thermal Burn Scars: a Split-Scar, Controlled, Prospective Cohort Study
Authors: Sipprell William H. , Bell Derek E. , Ibrahim Sherrif F.
Published: August 2020

BACKGROUND

Thermal burn scars can have catastrophic impact on the quality of life and personal image, and over time can lead to profound physical and psychological debilitation. There are no established treatments to significantly improve burn scars.

OBJECTIVE

To demonstrate the safety, efficacy, and tolerability of fractionally ablative Er:YAG resurfacing of mature burn scars.

METHODS

Sixteen subjects were enrolled and received 3 treatments of fractionally ablative Er:YAG resurfacing at monthly intervals. Twelve completed the study. Scars were scored with the Vancouver Scar Scale (VSS) by the patient and physician before and after treatment. Blinded photographic analysis (Visual Analog Scale [VAS]) and blinded histologic analysis of tissue before and after treatment was also performed.

RESULTS

Significant Improvement in VSS scores were seen in all 12 patients, reported by patients and the evaluating physician alike. Photographic analysis demonstrated subjective improvement in all 12 patients. Histologically, there was significant improvement in collagen architecture and the number of vessels per high-power field. The treatments were tolerated well by patients, and 1 superficial skin infection occurred.

CONCLUSION

Fractionally ablative Er:YAG laser resurfacing is a safe and effective modality in the treatment of thermal burn scars with subjective and objective improvement as seen from the patient and physician.
Periocular Mohs Reconstruction by Lateral Canthotomy With Inferior Cantholysis: A Retrospective Study
Authors: Mori Westley S. , Behshad Ramona , Shahwan Kathryn T. , Fiessinger Lori A. , Farah Ronda S. , Maher Ian A.
Published: August 2020

BACKGROUND

Most eyelid defects after Mohs micrographic surgery are referred to oculoplastic surgery or plastic surgery for reconstruction, but growing evidence suggests the safety of such repairs performed by dermatologic surgeons is equivalent if not better. Lateral canthotomy with inferior cantholysis may be used by the dermatologic surgeon to reconstruct larger lower eyelid defects.

OBJECTIVE

To demonstrate lateral canthotomy with inferior cantholysis performed by the dermatologic surgeon can result in safe, functionally and cosmetically acceptable surgical outcomes.

MATERIALS AND METHODS

An institutional review board-approved retrospective study of repairs performed by a single dermatologic surgeon between January 2013 and August 2019. Patient demographics, operative and follow-up notes were reviewed. Two cosmetic dermatologists assessed aesthetic results based on final follow-up photographs using a visual analogue scale.

RESULTS

Eight cases were included in the analysis. Seventy-five percent of patients were men, with a mean age of 74.1 years old. All tumors were basal cell carcinoma; the mean defect size was 2.4 cm2. No serious complications or postoperative interventions occurred. The median cosmetic score was 85.6 ± 11.5.

CONCLUSION

Dermatologic surgeons can safely perform repairs of lower eyelid defects with lateral canthotomy with inferior cantholysis, achieving satisfactory functional and cosmetic outcomes.
Effects of vascular compression on the rostral ventrolateral medulla for blood pressure variability in stroke patients
Authors: Nezu Tomohisa , Hosomi Naohisa , Kuzume Daisuke , Naito Hiroyuki , Aoki Shiro , Morimoto Yuko , Kinboshi Masato , Shiga Yuji , Kinoshita Naoto , Ueno Hiroki , Maruyama Hirofumi
Published: August 2020

Backgrounds:

Vascular compression of the rostral ventrolateral medulla (RVLM) has been associated with hypertension or blood pressure (BP) variability. For acute ischemic stroke patients, increased BP variability may cause poor functional outcomes. We tested the hypothesis that RVLM compression was associated with increased BP variability or stroke outcome in acute ischemic stroke patients.

Methods:

Acute ischemic stroke patients (n = 622) with 24-h ambulatory BP monitoring during the subacute phase of stroke (median 9 days from onset) were retrospectively studied. Variability in BP was evaluated with the SD and coefficient of variation of SBP and DBP. The morning surge was also evaluated. The presence of RVLM compression was evaluated using time-of-flight three-dimensional MRI. A poor outcome was defined as a modified Rankin Scale score of 3–6 at 3 months.

Results:

Patients with RVLM compression (n = 213) had significantly higher 24-h SBP mean, 24-h SBP SD, 24-h SBP coefficient of variation, 24-h DBP mean, 24-h DBP SD, and 24-h DBP coefficient of variation values and a higher prevalence of morning surge than those without (n = 409). Multiple regression analysis revealed that RVLM compression was associated with increased SBP variability, DBP variability, and morning surge. Despite the significant association between RVLM compression and BP variability, RVLM compression was not associated with poor stroke outcome.

Conclusion:

Although RVLM compression was closely associated with BP variability in the subacute ischemic stroke phase, an effect of RVLM compression on stroke outcome was not observed.
The Elabela in hypertension, cardiovascular disease, renal disease, and preeclampsia: an update
Authors: Xu Chuanming
Published: August 2020

Although considerable success has been shown for antihypertensive medications, the resistant hypertension and hypertension-related organ damages are still the important clinical issues and pose as high health and economic pressure. Therefore, novel therapeutic techniques and antihypertensive drugs are needed to advance more effective therapy of hypertension and hypertension-related disease to ameliorate mortality and healthcare costs worldwide. In this review, we highlight the latest progress in supporting the therapeutic potential of Elabela (ELA), a recently discovered early endogenous ligand for G-protein-coupled receptor apelin peptide jejunum, apelin receptor. Systemic administration of ELA exerts vasodilatory, antihypertensive, cardioprotective, and renoprotective effects, whereas central application of ELA increases blood pressure and causes cardiovascular remodeling primarily secondary to the hypertension. In addition, ELA drives extravillous trophoblast differentiation and prevents the pathogenesis of preeclampsia (a gestational hypertensive syndrome) by promoting placental angiogenesis. These findings strongly suggest peripheral ELA's therapeutic potential in preventing and treating hypertension and hypertension-related diseases including cardiovascular disease, kidney disease, and preeclampsia. Since therapeutic use of ELA is mainly limited by its short half-life and parenteral administration, it may be a clinical application candidate for the therapy of hypertension and its complications when fused with a large inert chemicals (e.g. polyethylene glycol, termed polyethylene glycol-ELA-21) or other proteins (e.g. the Fc fragment of IgG and albumin, termed Fc-ELA-21 or albumin-ELA-21), and new delivery methods are encouraged to develop to improve the efficacy of ELA fragments on apelin peptide jejunum or alternative unknown receptors.
Association between circulating vascular-related microRNAs and an increase in blood pressure: a 5-year longitudinal population-based study
Authors: Suzuki Koji , Yamada Hiroya , Fujii Ryosuke , Munetsuna Eiji , Ando Yoshitaka , Ohashi Koji , Ishikawa Hiroaki , Yamazaki Mirai , Maeda Keisuke , Hashimoto Shuji , Hamajima Nobuyuki
Published: August 2020

Objective:

MicroRNAs (miRNAs) are small noncoding RNAs that regulate gene expression and play essential roles in the pathogenesis of cardiovascular disease. Previous cross-sectional studies showed that the levels of several circulating miRNA are associated with hypertension, but there are no prospective longitudinal studies using a general population. The aim of this study is to evaluate the impact of circulating vascular-related miRNA (miR-126, miR-221, and miR-222) on changes in blood pressure and new-onset hypertension in a Japanese population.

Methods:

We conducted a 5-year longitudinal study using 192 health examination participants (87 men and 105 women). Serum miRNAs were measured using quantitative reverse transcription-PCR. Information regarding lifestyle and health condition was obtained using a self-administered questionnaire. Logistic regression analyses were performed to calculate odds ratios and 95% confidence intervals for new-onset hypertension in the 5-year period between the low and high group of serum miRNAs.

Results:

Serum levels of miR-126, miR-221, and miR-222 were significantly and negatively associated with changes in SBP and the rate of change of SBP. Serum miR-126, miR-221, and miR-222 levels were significantly lower in new-onset hypertensive patients compared with normotensive individuals. The confounding factors adjusted odds ratios of each 1 increment in serum miR-126, miR-221, and miR-222 levels were 0.82 (95% confidence interval: 0.69–0.98), 0.79 (0.68–0.91), and 0.61 (0.46–0.81) for new-onset hypertension, respectively.

Conclusion:

Low serum levels of miR-126, miR-221, and miR-222 were associated with increased blood pressure and new-onset of hypertension. These circulating miRNAs are potential candidate biomarkers for the prediction of hypertension.
Fundamentals of artificial intelligence for ophthalmologists
Authors: Ahmad Baseer U. , Kim Judy E. , Rahimy Ehsan
Published: August 2020

Purpose of review

As artificial intelligence continues to develop new applications in ophthalmic image recognition, we provide here an introduction for ophthalmologists and a primer on the mechanisms of deep learning systems.

Recent findings

Deep learning has lent itself to the automated interpretation of various retinal imaging modalities, including fundus photography and optical coherence tomography. Convolutional neural networks (CNN) represent the primary class of deep neural networks applied to these image analyses. These have been configured to aid in the detection of diabetes retinopathy, AMD, retinal detachment, glaucoma, and ROP, among other ocular disorders. Predictive models for retinal disease prognosis and treatment are also being validated.

Deep learning systems have begun to demonstrate a reliable level of diagnostic accuracy equal or better to human graders for narrow image recognition tasks. However, challenges regarding the use of deep learning systems in ophthalmology remain. These include trust of unsupervised learning systems and the limited ability to recognize broad ranges of disorders.
Ebola, COVID-19, and emerging infectious disease: lessons learned and future preparedness
Authors: Bavinger J. Clay , Shantha Jessica G. , Yeh Steven
Published: August 2020

Purpose of review

To highlight the lessons learned from the Ebola outbreak that may inform our approach to the COVID-19 pandemic, particularly related to the widespread disruption of healthcare, ophthalmic disease manifestations, and vision health systems strengthening for future outbreaks.

Recent findings

Coronavirus disease 2019 (COVID-19), first detected in China in December 2019, has become a worldwide health emergency, with significant disruption of all aspects of society, including travel, business, and medical care. Although this pandemic has had unprecedented effects on healthcare delivery in the United States, experiences from recent Ebola virus disease (EVD) outbreaks in Africa provide insight and inform our approach to COVID-19 and outbreak preparedness. Like COVID-19, the rapid emergence of Ebola required new clinical and surgical approaches to understand its associated spectrum of ophthalmic complications and the potential for Ebola viral persistence within the eye and in tear film. Recent reports of ophthalmic findings associated with COVID-19 include conjunctivitis, retinopathy, and molecular evidence of virus within the tear film in a minority of cases. Yet, more rigorous approaches to understand ophthalmic disease and transmission risk associated with COVID-19 are needed. Gaps also remain in our understanding of eye disease associated with other high priority emerging infectious diseases including Nipah, Lassa fever, Marburg virus, and others.

Thoroughly understanding the ophthalmic findings and transmission risk associated with COVID-19 is paramount during this pandemic, providing additional measures of safety while resuming ophthalmic care for all patients. Vision health systems preparedness measures developed during recent EVD outbreaks and the current pandemic provide models for ophthalmic clinical practice, research, and education, as we continue to address COVID-19 and future emerging infectious disease threats.
Eye banking in the coronavirus disease 2019 era
Authors: Ballouz Dena , Mian Shahzad I.
Published: August 2020

Purpose of review

Coronavirus disease 2019, caused by novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly infectious; however, the different routes of transmission are not well understood. Transmission through tissue transplantation is possible and must be considered. This review will evaluate the current literature regarding routes of transmission, the likelihood of transmission through ocular tissue transplantation, and the guidelines in place to mitigate this risk.

Recent findings

Although respiratory droplets have been the primary route of SARS-CoV-2 transmission, there is evidence that transmission through blood donation and organ or tissue transplantation is possible. This includes corneal transplantation, as SARS-CoV-2 has been detected in conjunctival swabs of infected patients, and the ocular surface may play an important role in viral entry. Several tissue transplantation organizations have guidelines in place regarding the screening of donors and tissue procurement procedures, including clinical and/or PCR screening of donors. The Eye Bank Association of America (EBAA) is currently not recommending asymptomatic PCR screening. However, their antiseptic protocols may play an important role in viral inactivation.

Based on the current literature and guidelines, the risk of SARS-CoV-2 transmission through corneal transplantation is likely low. However, tissue screening guidelines need to be re-evaluated regularly as knowledge regarding the SARS-CoV-2 virus evolves.
Ophthalmology conferences in the coronavirus disease 2019 era
Authors: Gupta Mrinali P. , Sridhar Jayanth , Wykoff Charles C. , Yonekawa Yoshihiro
Published: August 2020

Purpose of review

To discuss key considerations involved in adapting an in-person ophthalmology conference to a virtual medium.

Recent findings

In 2020, several ophthalmological societies have held or are planning to hold virtual conferences in lieu of their previously scheduled in-person ophthalmology conference because of the coronavirus disease 2019 pandemic. The strategic meeting components attempted to be retained in these transitions include educational information disseminating, academic discussion with colleagues, sponsorships, and networking. Live-streamed components of a virtual conference may be entirely real time or may include a combination of both prerecorded and live-streamed components. A virtual meeting may offer either a single live-streamed program or several concurrent live-streamed programs from which attendees can choose. The availability of on-demand content, mechanisms for audience participation, avenues for industry interaction and contribution, registration costs, and continuing medical education credit availability vary between virtual meeting formats.

Transition of an in-person ophthalmology conference to a virtual format with retention of the inherent value associated with the meeting is possible and the experiences of societies executing this adaptation can be helpful for others entering this space. There are numerous considerations regarding meeting format and logistics to contemplate in light of each meeting's specific audience and objectives.
Artificial intelligence for diabetic retinopathy screening, prediction and management
Authors: Gunasekeran Dinesh V. , Ting Daniel S.W. , Tan Gavin S.W. , Wong Tien Y.
Published: August 2020

Purpose of review

Diabetic retinopathy is the most common specific complication of diabetes mellitus. Traditional care for patients with diabetes and diabetic retinopathy is fragmented, uncoordinated and delivered in a piecemeal nature, often in the most expensive and high-resource tertiary settings. Transformative new models incorporating digital technology are needed to address these gaps in clinical care.

Recent findings

Artificial intelligence and telehealth may improve access, financial sustainability and coverage of diabetic retinopathy screening programs. They enable risk stratifying patients based on individual risk of vision-threatening diabetic retinopathy including diabetic macular edema (DME), and predicting which patients with DME best respond to antivascular endothelial growth factor therapy.

Progress in artificial intelligence and tele-ophthalmology for diabetic retinopathy screening, including artificial intelligence applications in ‘real-world settings’ and cost-effectiveness studies are summarized. Furthermore, the initial research on the use of artificial intelligence models for diabetic retinopathy risk stratification and management of DME are outlined along with potential future directions. Finally, the need for artificial intelligence adoption within ophthalmology in response to coronavirus disease 2019 is discussed. Digital health solutions such as artificial intelligence and telehealth can facilitate the integration of community, primary and specialist eye care services, optimize the flow of patients within healthcare networks, and improve the efficiency of diabetic retinopathy management.
Interpretation of artificial intelligence studies for the ophthalmologist
Authors: Tan Tien-En , Xu Xinxing , Wang Zhaoran , Liu Yong , Ting Daniel S.W.
Published: August 2020

Purpose of review

The use of artificial intelligence (AI) in ophthalmology has increased dramatically. However, interpretation of these studies can be a daunting prospect for the ophthalmologist without a background in computer or data science. This review aims to share some practical considerations for interpretation of AI studies in ophthalmology.

Recent findings

It can be easy to get lost in the technical details of studies involving AI. Nevertheless, it is important for clinicians to remember that the fundamental questions in interpreting these studies remain unchanged – What does this study show, and how does this affect my patients? Being guided by familiar principles like study purpose, impact, validity, and generalizability, these studies become more accessible to the ophthalmologist. Although it may not be necessary for nondomain experts to understand the exact AI technical details, we explain some broad concepts in relation to AI technical architecture and dataset management.

The expansion of AI into healthcare and ophthalmology is here to stay. AI systems have made the transition from bench to bedside, and are already being applied to patient care. In this context, ‘AI education’ is crucial for ophthalmologists to be confident in interpretation and translation of new developments in this field to their own clinical practice.
Predicting Adherence With the Glaucoma Treatment Compliance Assessment Tool
Authors: Sanchez Facundo G. , Mansberger Steven L. , Newman-Casey Paula A.
Published: August 2020

Précis:

Univariate and multivariable models using the Glaucoma Treatment Compliance Assessment Tool (GTCAT) statements identified multiple, patient-specific factors associated with adherence that could be used to inform personalized interventions to optimize glaucoma adherence.

Purpose:

The purpose of this study was to determine the health behavior factors related to glaucoma adherence in patients with self-reported poor adherence.

Methods:

A research coordinator used the Chang Adherence Measure and the Morisky Medication Adherence Scale to identify subjects with poor self-reported glaucoma medication adherence and enrolled them in a 3-month study to electronically monitor medication adherence. At enrollment, the coordinator administered the GTCAT. We calculated the percentage of prescribed doses taken over a 3-month period using an electronic dose monitor (AdhereTech). We used Rasch analysis, and univariate and multivariable regression to determine the GTCAT statements that predicted electronically monitored adherence.

Results:

The mean adherence was 73.8% (SD=21.04%, range: 13% to 100%). Rasch analysis showed that the GTCAT had a good overall fit and no differential bias (Anderson likelihood ratio test >0.05). Multiple GTCAT statements were associated with adherence, which represented increased knowledge, increased cues-to-action, decreased barriers, less depression, and increased self-efficacy (P<0.09 for each). The full GTCAT or a subset of statements had a high association with adherence (R
2 range: 0.44 to 0.51, P<0.005 for all). The GTCAT identified >50% of patients who wanted more education about glaucoma; >68% who did not use reminders; and >40% who reported having difficulty using the eye drops.

Conclusions:

The GTCAT identified multiple factors associated with adherence. Clinicians and researchers could use this tool to identify specific barriers to adherence and develop potential interventions to improve adherence.
Bordetella holmesii Bacteremia and Cellulitis in an Immunocompetent Patient
Authors: Peterson Joshua Allen , Fisher Mark A. , Lacy Mark D.
Published: August 2020

Bordetella holmesii is a pathogenic gram-negative rod, first identified in 1995. Most human infections have been reported in immunocompromised patients with a respiratory syndrome or bacteremia. Here, we report B. holmesii cellulitis and bacteremia in a healthy, immunocompetent young adult.
Assessing the validity of health administrative data compared to population health survey data for the measurement of low back pain
Authors: Wong Jessica J. , Côté Pierre , Tricco Andrea C. , Watson Tristan , Rosella Laura C.
Published: August 2020

Low back pain (LBP) is a high-burden condition that lacks routine surveillance data. Health administrative data may be used for surveillance, but their validity for measuring LBP in the general population has not been established. We aimed to (1) determine the validity of health administrative data to measure LBP compared to self-reported LBP in a population-based sample of Ontario adults; and (2) describe the differences in characteristics of LBP cases based on data sources. Adult respondents (≥18 years) of the Canadian Community Health Survey (CCHS) from 2003 to 2012 were included (N = 150,695). Canadian Community Health Survey data were individually linked to health administrative data, including Ontario Health Insurance Plan and hospitalization data. The reference standard was defined as self-reported back problem diagnosed by a health professional in the CCHS. Measurement of LBP from billing records was defined as ≥1 physician billing or procedural code for LBP during the year preceding CCHS interview date. We measured concurrent validity by comparing prevalence, agreement (kappa), and accuracy (sensitivity, specificity, and positive and negative predictive values [PV]) of administrative data to measure LBP. Prevalence of LBP was higher using self-reported (21.2%) than administrative data (10.2%), and agreement was low (kappa = 0.21). Administrative data had sensitivity 23.9% (95% CI 23.1-24.6), specificity 93.4% (95% CI 93.2-93.7), positive PV 50.4% (95% CI 49.1-51.7), and negative PV 82.0% (95% CI 81.7-82.3). Characteristics of LBP cases based on data sources differed in sex, health/behaviour characteristics, and allied health care utilization. Using health administrative data significantly underestimates the prevalence of LBP. This can lead to misclassification bias that is likely nondifferential in epidemiological studies.
New therapeutic strategies in lung vasculitis
Authors: Nasser Mouhamad , Cottin Vincent
Published: August 2020

Purpose of review

To summarize the latest publications and provide a practical overview of treatment strategies for lung vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs).

Recent findings

In patients with severe ANCA-associated vasculitis, plasma exchange, as adjunctive therapy to standard treatment, is not associated with improved survival or reduced risk of end-stage kidney disease. A regimen with reduced dose of glucocorticoids is equally effective to induce remission as a standard regimen. In patients without organ or life-threatening disease, mycophenolate mofetil can be used in combination with oral glucocorticoid therapy to induce remission, however, with a higher risk of relapse than when using rituximab or cyclophosphamide. For maintenance of remission, a tailored regimen of rituximab infusion was equivalent to a fixed regimen, with fewer perfusions. Belimumab, a human IgG1

JOURNAL/copme/04.03/00063198-202009000-00018/inline-graphic1/v/2024-02-07T194110Z/r/image-tiff

monoclonal antibody against B-lymphocyte stimulator, did not decrease the relapse rate when added to azathioprine and glucocorticoids. Avacopan, a complement C5a receptor inhibitor, was effective in replacing high-dose glucocorticoids in achieving complete remission of vasculitis.

Significant advances have been made in the treatment strategy to both induce remission and maintain remission in patients with ANCA-associated vasculitis. The choice should take into consideration efficacy, cost-effectiveness, safety profile, ease of use, and possibility of individual tailoring of treatment.
An update on sarcoidosis-associated pulmonary hypertension
Authors: Bandyopadhyay Debabrata , Humbert Marc
Published: August 2020

Purpose of review

Pulmonary hypertension in sarcoidosis is a well known entity. Sarcoidosis-associated pulmonary hypertension (SAPH) incurs substantial morbidity and mortality. This review examines recent literatures published on epidemiology, prognosis and therapeutic management in SAPH.

Recent findings

Several registries have been published between 2017 and 2020. The consensus conclusion – SAPH is a harbinger for poor prognosis. Several factors were noted for predicting adverse outcome in SAPH like reduced 6-min walk distance and diffusing capacity for carbon monoxide. Given its adverse outcome, experts have now focused on methods for early screening of SAPH in sarcoid patients. The exploration of pulmonary vasodilator drugs in SAPH is ongoing. In recent times, trials have been published utilizing Macitentan and parenteral prostacyclin in severe SAPH. Although these trials show encouraging results, the evidence from these studies are limited to approve these agents as preferred drugs for treating SAPH. A large multicentric trial of drugs used for pulmonary arterial hypertension with meaningful, yet feasible, event driven endpoint is still lacking. Lately, interventional treatment by pulmonary artery balloon pulmonary angioplasty and stenting has gained traction for treating pulmonary artery stenosis and chronic thromboembolic pulmonary hypertension. However, the conclusion is still based on small cohorts or case series.

Several registries have highlighted SAPH portends an unfavorable consequence. On the contrary, no published guideline exists to treat SAPH. The precise role of immunosuppressive agents is unclear. The limited evidence favoring use of pulmonary vasodilators arise from small retrospective case series and/or single-center nonrandomized observational studies. Further multicenter randomized research is warranted to better define patient population to treat and how best to treat them.
Alternative routes of levothyroxine administration for hypothyroidism
Authors: Ritter Megan J. , Gupta Suruchi , Hennessey James V.
Published: August 2020

Purpose of review

The aim of the article is to present the basics of oral levothyroxine (LT4) absorption, reasons why patients may have persistently elevated serum thyroid stimulation hormone (TSH) levels, and alternative strategies for LT4 dosing.

Recent findings

Although oral LT4 tablets are most commonly used for thyroid hormone replacement in patients with hypothyroidism, case studies report that liquid oral LT4, intravenous, intramuscular, and rectal administration of LT4 can successfully treat refractory hypothyroidism.

Hypothyroidism is one of the most common endocrine disorders encountered by primary care physicians and endocrinologists. LT4 is one of the most widely prescribed medications in the world and it is the standard of care treatment for hypothyroidism. Generally, hypothyroid patients will be treated with LT4 tablets to be taken orally, and monitoring will occur with routine serum thyroid tests, including TSH concentrations. However, many patients fail to maintain serum TSH levels in the target range while managed on oral LT4 tablets. A subset of these patients would be considered to have poorly controlled hypothyroidism, sometimes termed refractory hypothyroidism. For these patients, optimization of ingestion routines and alternative formulations and routes of administration of LT4 can be considered, including oral liquid, intravenous, intramuscular, and even rectal formulations.
Intracranial Hypertension and Papilledema in a Large Cohort of Pediatric Patients With Alagille Syndrome
Authors: Rock Nathalie M. , Demaret Tanguy , Stéphenne Xavier , Scheers Isabelle , Smets Francoise , McLin Valérie A. , Boschi Antonella , Sokal Etienne M.
Published: August 2020

Aims and Background:

Ophthalmic abnormalities are amongst the 5 major criteria required for a diagnosis of Alagille syndrome (ALGS), of which embryotoxon, pseudopapilledema, and hypopigmented retinopathy are the most common. Papilledema with or without intracranial hypertension (ICHT) is rarely described. We report 9 pediatric cases of ALGS with bilateral papilledema, 5 of which were diagnosed with ICHT.

Methods:

The ophthalmic data from 85 patients with clinically and/or genetically (n = 37) proven ALGS were reviewed. The study inclusion criteria were a positive diagnosis of ALGS and availability of ophthalmic follow-up data. Ophthalmic data from 40 patients after liver transplantation (LT) for other indications were also analyzed.

Results:

Nine (13.0%) of the 69 patients meeting the inclusion criteria had papilledema. The neurological and neuroimaging results in all 9 patients were normal. These 9 patients were categorized into 4 groups: a nontransplant group (n = 1), a group with pretransplant papilledema persistent after LT (n = 2), a group with papilledema occurring after LT with spontaneous resolution (n = 1), and a group with papilledema and signs of ICHT after LT (n = 5). The patients with ICHT were treated with steroids alone (n = 1) or with acetazolamide (n = 4). A ventriculoperitoneal shunt was placed in 2 of the 5 cases because of progressive visual loss. Pseudopapilledema was present in 10 additional patients (14.5%, 10/69). One (2.5%) of the 40 patients without ALGS developed papilledema after LT.

Conclusions:

True ICHT may be underdiagnosed in patients with ALGS. Our findings underscore the need for close ophthalmic follow-up before and after LT in these patients.
Childhood Neglect and Psychological Distress Among Pregnant Women
Authors: Zhang Xuan , Li Jia-Huan , Wang Juan , Li Jie , Long Zhou-ting , Cao Feng-lin
Published: August 2020

This study aimed to investigate the association between childhood neglect and psychological distress in pregnant women and to assess whether perceived social support and coping styles mediated this association. Pregnant women (N = 276) recruited from the prenatal clinic of a comprehensive hospital in China participated in this study. Participants reported their experiences of childhood neglect and abuse, depression, anxiety, perceived social support, and coping styles. Childhood neglect was positively associated with psychological distress. Perceived social support mediated the relationship between childhood neglect and psychological distress. Perceived social support and positive coping acted as chain mediators between childhood neglect and psychological distress. Childhood neglect is a risk factor for psychological distress during pregnancy independent of childhood abuse; perceived social support and positive coping can influence this relationship.
Common Symptom Presentations in Individuals With Probable Comorbid Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder
Authors: Pinciotti Caitlin M. , Orcutt Holly K.
Published: August 2020

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are heterogeneous disorders that share common underlying factors, etiology, and symptoms. A small body of literature suggests common OCD symptom presentations may exist for this comorbid group, yet common comorbid PTSD symptom presentations remain unknown. The current study examined common symptom presentations in individuals with probable comorbid OCD + PTSD compared with those with a sole presentation of probable OCD or PTSD, controlling for overlapping symptoms, using a sample of 133 undergraduates. Individuals who exceeded cutoffs for probable OCD + PTSD endorse more severe OCD symptoms overall but report similar levels of PTSD symptoms compared with the respective diagnostic groups. Logistic regressions found that symptom domains present similarly overall in a comorbid presentation compared with the respective diagnostic groups, yet some OCD symptom domains were significantly more severe in the comorbid group compared with individuals with probable PTSD. Explanations for the unique contributions of symptoms are discussed, and clinical recommendations for addressing these domains are provided.
Witnessing Acute Stress Reaction in Team Members
Authors: Svetlitzky Vlad , Farchi Moshe , Yehuda Ariel Ben , Adler Amy B.
Published: August 2020

Individuals who witness team members exhibiting symptoms of an acute stress reaction (ASR) in the middle of a high-stress operational event may be negatively affected; ASR-related training may moderate this impact. In the present study, 560 Israeli soldiers were surveyed about ASR exposure, posttraumatic stress disorder (PTSD) symptoms, public stigma, and whether they had received ASR-related training. This training, calledYaHaLOM, is a Hebrew acronym that outlines steps for managing ASR in team members. Controlling for combat exposure, greater exposure to ASR symptoms was associated with more overall PTSD symptoms, PTSD cluster symptoms, and public stigma.YaHaLOMtraining buffered these relationships for PTSD, intrusion and avoidance symptoms, and public stigma. The findings suggest that such training may help teams in high-risk occupations better manage ASR exposure.
Chick Eyes Can Recover from Lens Compensation without Visual Cues
Authors: Zhu Xiaoying , McFadden Sally A.
Published: August 2020

SIGNIFICANCE

This study shows that nonvisual mechanism(s) can guide chick eyes to recover from myopia or hyperopia bidirectionally to regain their age-matched length. Because eye growth control is phylogenetically conserved across many species, it is possible that, in general, emmetropization mechanisms are not exclusively based on a local visual feedback system.

PURPOSE

Across species, growing eyes compensate for imposed defocus by modifying their growth, showing the visual controls on eye growth and emmetropization. When the spectacle lens is removed, the eyes rapidly recover back to a normal size similar to that in the untreated eyes. We asked whether this recovery process was dependent on visual feedback or whether it might be guided by intrinsic nonvisual mechanisms.

METHODS

Chicks wore either a +7 (n = 16) or −7 D (n = 16) lens over one eye for 4 to 7 days; the fellow eye was left untreated. After lens removal, half were recovered in darkness and half in white light. Refractive error and ocular dimensions were measured before and after lens treatment and after recovery with a Hartinger refractometer and A-scan biometer, respectively.

RESULTS

Whereas chick eyes completely recovered from prior lens treatment under normal light after 2 days, they also partially recovered from prior hyperopia (by 60%) and myopia (by 69%) after being kept in darkness for 3 days: a +7 and −7 D lens induced a difference between the eyes of +7.08 and −4.69 D, respectively. After recovery in darkness, the eyes recovered by 3.18 and 2.88 D, respectively.

CONCLUSIONS

In the absence of visual cues, anisometropic eyes can modify and reverse their growth to regain a similar length to their fellow untreated eye. Because eye growth control is phylogenetically conserved across many species, it is possible that nonvisual mechanisms may contribute more generally to emmetropization and that recovery from anisometropic refractive errors may not be wholly visually controlled.
Findings from Optometrists' Practices in Advising about Lifestyle Study
Authors: Sahli Michelle W. , Ochs-Balcom Heather M. , Moeller Suzen M. , Brady William E. , Tolford Timothy W. , Millen Amy E.
Published: August 2020

SIGNIFICANCE

Lifestyle influences eye health and other chronic diseases. All health care providers, not just primary care physicians, should have the necessary information and training to advise and refer patients on lifestyle to take advantage of opportunities to provide such advice.

PURPOSE

The extent to which optometrists offer lifestyle advice to their patients is largely unknown. The Optometrists' Practices in Advising about Lifestyle (OPAL) study aimed to examine lifestyle advice that optometrists offer, to whom such advice is offered, and reasons for not offering this advice.

METHODS

We developed and administered a mail-in survey to 140 optometrists in Western New York.

RESULTS

Five surveys were returned because of death, retirement, and relocation. Of the 135 remaining eligible participants, 46 of the optometrists contacted responded to our survey; however, only 42 (31%) provided signed consent forms. Of these, more than 93% report offering advice on smoking, dietary supplements, and diet, and >59% reported offering on physical activity and alcohol use. Eighty-three percent offer advice to only those with unhealthy behaviors or certain conditions. Most advice consisted of mentioning the lifestyle factor's influence on eye or overall health. Reasons for not offering advice included lack of knowledge or training or the belief that advice would not change behaviors.

CONCLUSIONS

Optometrists reported offering advice primarily to those with unhealthy lifestyle behaviors or pre-existing health conditions. Future studies should address low response rates, include nonphysician health care providers in addition to optometrists, and also examine patients' perceptions and understanding of the advice offered to better understand whether this advice is received as the provider envisioned.
Evaluation of Intradural Ecchordosis Physaliphora With Three-Dimensional Fluid-Attenuated Inversion Recovery
Authors: Kogue Ryota , Maeda Masayuki , Umino Maki , Kishi Seiya , Tanaka Fumine , Tsuchiya Kazuhiro , Sakuma Hajime
Published: August 2020

Objective

This study evaluated the efficacy of 3-dimensional fluid-attenuated inversion recovery (3D FLAIR) for detecting intradural ecchordosis physaliphora (EP).

Methods

We retrospectively determined the presence or absence of intradural EP on 3D FLAIR for 3888 consecutive patients, classifying the EP as “classical” or “possible” and analyzing the prevalence, size, and presence or absence of an intraosseous stalk. Where available, magnetic resonance cisternography images were compared with the 3D FLAIR images.

Results

Intradural EP was identified in 50 patients (1.3%): 36 (0.9%) classical and 14 (0.4%) possible. The classical EPs were significantly larger than the possible EPs (P < 0.01). Nine EPs (18.0%) showed an osseous stalk. Magnetic resonance cisternography was performed for 19 EPs (16 classical, 3 possible), detecting all 16 classical EPs but none of the possible EPs.

Conclusions

Classical EPs were detected by 3D FLAIR as with magnetic resonance cisternography. The 3D FLAIR findings suggested a new type of possible EP variant previously unreported.
Changes in the behavioural determinants of health during the coronavirus (COVID-19) pandemic: gender, socioeconomic and ethnic inequalities in 5 British cohort studies
Authors: Bann David , Villadsen Aase , Maddock Jane , Hughes Alun , Ploubidis George B. , Silverwood Richard J. , Patalay Praveetha
Published: August 2020

Background

The coronavirus (COVID-19) pandemic and physical distancing measures are expected to have far-reaching consequences on population health, particularly in already disadvantaged groups. These consequences include changes in health impacting behaviours (such as exercise, sleep, diet and alcohol use) which are important drivers of health inequalities. We sought to add to the rapidly developing empirical evidence base investigating the impacts of the pandemic on such behavioural outcomes.

Methods

Using data from five nationally representative British cohort studies (born 2000-2, 1989-90, 1970, 1958, and 1946), we investigated sleep, physical activity (exercise), diet, and alcohol intake (N=14,297). Using measures of each behaviour reported before and during lockdown, we investigated change in each behaviour, and whether such changes differed by age/cohort, gender, ethnicity, and socioeconomic position (SEP; childhood social class, education attainment, and adult reporting of financial difficulties). Binary logistic regression models were used, accounting for study design and incorporating non-response weights, to estimate absolute differences in each outcome before and during lockdown within each cohort. Meta-analysis was used to pool cohort-specific estimates and formally test for heterogeneity across cohorts.

Results

Changes in these outcomes occurred in both directions, i.e. shifts from the middle part of the distribution to both declines and increases in sleep, exercise, and alcohol use. For all outcomes, older cohorts were less likely to report changes in behaviours compared with younger cohorts. In the youngest cohort (born 2001), the following shifts were more evident: increases in exercise, fruit and vegetable intake, sleep duration, and less frequent alcohol consumption. Widening inequalities in sleep during lockdown were more frequent amongst females, socioeconomically disadvantaged groups, and ethnic minorities. For other outcomes, inequalities were largely similar before and during lockdown, yet ethnic minorities were increasingly likely during lockdown to undertake less exercise and consume lower amounts of fruit and vegetables.

Conclusions

Our findings highlight the multiple changes to behavioural outcomes that may have occurred due to COVID-19 lockdown, and the differential impacts across generation, gender, socioeconomic circumstances across life, and ethnicity. Such changes require further monitoring given their possible implications to population health and the widening of health inequalities.