bluuebunny/crossref_metadata_2025 huggingface dataset:
Patients With Symptomatic Sequelae of Slipped Capital Femoral Epiphysis Have Advanced Cartilage Wear at the Time of Surgical Intervention
Authors: Lieberman Elizabeth G. , Pascual-Garrido Cecilia , Abu-Amer Wahid , Nepple Jeffrey J. , Shoenecker Perry L. , Clohisy John C.
Published: March 2021

Background:

Slipped capital femoral epiphysis (SCFE) is a common hip problem in children. The resulting deformity can cause impingement similar to cam-type idiopathic femoroacetabular impingement (FAI). Although there are similarities between FAI and SCFE, deformity patterns, severity, and time of onset of symptoms varies, which may impact management. The purpose of this study was to describe patterns of articular cartilage damage in patients undergoing surgical hip dislocation for sequelae of SCFE in comparison to patients undergoing arthroscopic surgery for primary FAI.

Methods:

Patients were identified who underwent surgical treatment for hip pain due to primary FAI (cam type) or sequelae of SCFE. Clinical data and radiographic measurements were recorded. Cartilage was assessed intraoperatively. Severity was classified using the modified Beck classification, while location was classified into 6 sectors. Statistical analysis was performed to test for differences in demographic and radiographic characteristics between the SCFE and FAI patients. χ2 or Fisher exact tests were used to evaluate trends in patterns of acetabular and femoral cartilage wear between SCFE and FAI groups.

Results:

The SCFE group had 28 hips compared with 304 in the FAI group. SCFE patients were younger (19 vs. 32, P<0.001), had higher body mass index (30±5.9 vs. 24±4.8, P<0.001), and were more often male (61% vs. 27%, P<0.001). Deformity severity based on α-angle was higher in the SCFE group [AP 74 vs. 55 (P=0.001) and Dunn 72 vs. 58 (P<0.001)]. There were no significant differences with regards to lateral center edge angle, anterior center edge angle, or Tonnis angle. In both groups the most common locations for cartilage lesions in both groups were the anterior peripheral and superolateral peripheral regions with fewer but more widely distributed femoral head lesions. The SCFE group had higher rates of femoral head and superolateral central cartilage lesions compared with the FAI group. There was no statistical difference between high-grade femoral or acetabular cartilage lesions between groups.

Conclusions:

Patients with SCFE were younger at the time of surgery and presented with more severe deformity based on radiographic α-angle compared to patients with FAI. Our results suggest higher prevalence of femoral head lesions and more diffuse cartilage injury in patients with SCFE. This study can be used to support early surgical intervention in patients with symptomatic sequelae of SCFE due to risk of premature joint damage.

Level of Evidence:

Level III—prognostic study.
Which Functional Outcomes Can be Measured in Low Back Pain Trials and Therapies?
Authors: Niederer Daniel , Engel Tilman , Pfeifer Ann-Christin , Arampatzis Adamantios , Beck Heidrun , Wippert Pia-Maria , Schiltenwolf Marcus , Mayer Frank
Published: March 2021

Study Design.

Prospective 2-year factor-, cluster-, and reliability-multicenter analysis.

Objective.

To provide evidence on the uniqueness and usefulness of a set of potential relevant functional outcomes.

Summary of Background Data.

A very high number of functional outcomes that can be utilized as variables in low back pain (LBP) trials exists.

Methods.

Participants (n = 1049) with and without current LBP were included. At 7 visits (baseline, 4 wk, 3 mo, 6 mo, 9 mo, 1 yr, and 2 yr), 42 different functional outcomes were assessed. Two exploratory factor analyses (for baseline-values and for changes scores to 3 mo post-baseline) were calculated (maximum likelihood extraction, varimax factor rotation). The strongest factor-loading outcomes were selected for the following hierarchical cluster analyses (average linkage, Euclidean distance measure). For each cluster, time point, and outcome, reliability analyses were subsequently calculated using intraclass correlation coefficients, standard error of measurements and coefficients of variation.

Results.

The factor analysis for the cross-sectional values revealed 9 factors with a cumulative variance explanation of 61.7% and 13 unique ones. The change-score factor analysis revealed nine factors with a total variance explanation of 61.8%, seven outcomes were unique. Ten outcomes were important for both cross-sectional and change-score analyses, 11 were most valuable for cross-sectional and four for the change scores. Patients with pain grades 1 to 3 show comparable patterns (cluster 2). Grade 0 (cluster 1) and grade 4 (cluster 3) are unique and cannot be cumulated with other grades. Most biomechanical outcomes were highly reliable and display low measurement errors.

Conclusion.

We found 25 potentially meaningful functional outcomes in the context of objective functional measurements (such as trunk range of motion, dynamic and static balance, strength, and muscle fatigue resistance) and body characteristics. The present framework may help to select appropriate functional outcomes and rate effects beyond the known core set of outcomes.

Level of Evidence: 1
Resident Involvement in Posterior Lumbar Interbody Fusion is Associated With Increased Readmissions and Operative Time, But No Increased Short-term Risks
Authors: Lan Roy H. , Grits Daniel , Samuel Linsen T. , Sultan Assem A.
Published: March 2021

Study Design:

A retrospective cohort study.

Objective:

The aim was to compare rates of adverse events and additional posterior lumbar interbody fusion (PLIF) cases assisted by residents versus cases performed solely by an orthopedic attending.

Summary of Background Data:

PLIF is a widely accepted surgical technique for the management of a variety of spinal conditions requiring spinal stabilization and fusion. However, no published studies have assessed the effects of resident involvement on intraoperative and postoperative outcomes in PLIF.

Methods:

This retrospective study utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry from 2007 to 2012 to identify patients who underwent PLIF procedures. A propensity score matching model was utilized to reduce patient cohort variances. The perioperative data and outcomes in the matched population were analyzed using paired t test and the McNemar test in order to assess, based on resident presence, the rates of postoperative adverse events, readmission, reoperation within 30 days, and operative time.

Results:

In total, 1633 patients undergoing PLIF were included in the study, with 24.62% involving resident participation. The propensity score matching algorithm yielded 396 well-matched resident and nonresident pairs. Patients undergoing PLIF involving a resident were associated with a higher rate of readmission (1.77% vs. 0.00%; P=0.008), and longer operative time (245.7 vs. 197.7 min; P<0.001). However, these procedures were not associated with any significant difference in minor or severe adverse events.

Conclusions:

Resident involvement in PLIF was associated with an increased rate of readmissions, and operative time; however, was not associated with an increase in minor or severe adverse events. Further investigation is needed to characterize the role of resident involvement based on level of training experience, as well as methods to improve the learning curve to independence while reducing postoperative hospital length of stay.

Level of Evidence:

Level III—retrospective comparative study.
Enhanced anticancer activity by the combination of vinpocetine and sorafenib via PI3K/AKT/GSK-3β signaling axis in hepatocellular carcinoma cells
Authors: Zhang Zuo-yan , Dong Shu-min , Liu Ye-han , Zhang Man-man , Zhang Jian-kang , Zhu Hua-jian , Shao Jia-an , Liu Hua-qing , Li Yang-ling , Zhang Chong , Zeng Ling-hui
Published: March 2021

Vinpocetine is widely used to treat cerebrovascular diseases. However, the effect of vinpocetine to treat hepatocellular carcinoma (HCC) has not been investigated. In this study, we revealed that vinpocetine was associated with antiproliferative activity in HCC cells, but induced cytoprotective autophagy, which restricted its antitumor activity. Autophagy inhibitors improved the antiproliferative activity of vinpocetine in HCC cells. Sorafenib is effective to treat advanced HCC, but the effect of autophagy induced by sorafenib is indistinct. We demonstrated vinpocetine plus sorafenib suppressed the cytoprotective autophagy activated by vinpocetine in HCC cells and significantly induced apoptosis and suppressed cell proliferation in HCC cells. In addition, vinpocetine plus sorafenib activates glycogen synthase kinase 3β (GSK-3β) and subsequently inhibits cytoprotective autophagy induced by vinpocetine in HCC cells. Meanwhile, overexpression of GSK-3β was efficient to increase the apoptosis induced by vinpocetine plus sorafenib in HCC cells. Our study revealed that vinpocetine plus sorafenib could suppress the cytoprotective autophagy induced by vinpocetine and subsequently show synergistically anti-HCC activity via activating GSK-3β and the combination of vinpocetine and sorafenib might reverse sorafenib resistance via the PI3K/protein kinase B/GSK-3β signaling axis. Thus, vinpocetine may be a potential candidate for sorafenib sensitization and HCC treatment, and our results may help to elucidate more effective therapeutic options for HCC patients with sorafenib resistance.
Overexpression of circ_CELSR1 facilitates paclitaxel resistance of ovarian cancer by regulating miR-149-5p/SIK2 axis
Authors: Wei Shunying , Qi Lianhui , Wang Liehong
Published: March 2021

Circular RNAs (circRNAs) have emerged as vital regulators in the chemoresistance of diverse human tumors, including ovarian cancer. In the present study, we attempted to explore the function of circ_CELSR1 in paclitaxel resistance of ovarian cancer. Quantitative real-time PCR (qRT-PCR) was conducted for the expression of circ_CELSR1, miR-149-5p and salt inducible kinase 2 (SIK2). Cell Counting Kit-8 (CCK-8) assay was performed to evaluate the half-maximal inhibitory concentration (IC50) of paclitaxel and cell viability. Colony formation assay was adopted for cell colony formation. Flow cytometry analysis was conducted to analyze cell cycle process and apoptosis. Western blot assay was utilized to determine the protein levels. RNA immunoprecipitation (RIP) and dual-luciferase reporter assays were conducted to verify the association between miR-149-5p and circ_CELSR1 or SIK2. Murine xenograft model assay was carried out to determine the effect of circ_CELSR1 in paclitaxel resistance in vivo. Circ_CELSR1 was upregulated in paclitaxel-resistant ovarian cancer tissues and cells. Circ_CELSR1 knockdown enhanced paclitaxel sensitivity and cell apoptosis and repressed cell viability, colony formation and cell cycle process in paclitaxel-resistant ovarian cancer cells. For mechanism analysis, circ_CELSR1 could positively modulate SIK2 expression via sponging miR-149-5p. MiR-149-5p inhibition effectively restored the impacts of circ_CELSR1 knockdown on paclitaxel resistance and cell progression in paclitaxel-resistant ovarian cancer cells. MiR-149-5p overexpression suppressed paclitaxel resistance and cell progression in paclitaxel-resistant ovarian cancer cells by interacting with SIK2. In addition, circ_CELSR1 silencing impeded paclitaxel resistance of ovarian cancer in vivo. Circ_CELSR1 improved the resistance of ovarian cancer to paclitaxel by regulating miR-149-5p/SIK2 axis.
Sevoflurane inhibits the migration, invasion and induces apoptosis by regulating the expression of WNT1 via miR-637 in colorectal cancer
Authors: Hu Nianchun , Duan Ji-An , Yu Yuqin , Li Dapeng , Chen Jingli , Yan Hong
Published: March 2021

Colorectal cancer (CRC) is a common malignancy. Sevoflurane has been reported to involve in the progression in several cancers. However, the molecular mechanism of sevoflurane in CRC progression remains unclear. Quantitative real-time PCR and western blot was used to detect the expression of miR-637 and WNT1. Cell migration, invasion and apoptosis were detected by transwell assay, flow cytometry or western blot, respectively. The interaction between WNT1 and miR-637 was confirmed by luciferase reporter assay, RNA immunoprecipitation assay and pull-down assay. We found sevoflurane could inhibit cell migration and invasion but induced apoptosis in CRC. Besides, the miR-637 level was decreased in CRC tissues and cells but could be rescued by sevoflurane. MiR-637 overexpression enhanced the anticancer functions of sevoflurane in CRC cells, while miR-637 inhibition showed opposite effects. WNT1 was confirmed to be a target of miR-637 and was inhibited by sevoflurane or miR-637. Importantly, knockdown of WNT1 reversed the carcinogenic effects mediated by miR-637 inhibitor in CRC cells treated with sevoflurane. Collectively, sevoflurane inhibited cell migration, invasion and induced apoptosis by regulating the miR-637/WNT1 axis in colorectal cancer, indicating a novel insight into the effective clinical implication for the anesthetic in CRC treatment.
Pembrolizumab Utilization and Clinical Outcomes Among Patients With Advanced Melanoma in the US Community Oncology Setting: An Updated Analysis
Authors: Cowey Charles Lance , Scherrer Emilie , Boyd Marley , Aguilar Kathleen M. , Beeks April , Krepler Clemens
Published: March 2021

Favorable outcomes have been observed with pembrolizumab among patients with advanced melanoma in clinical trials; however, limited evidence exists on the long-term efficacy in the real-world setting. This was an updated, retrospective observational study of adult patients with advanced (unresectable or metastatic) melanoma who initiated pembrolizumab (in any line of therapy) between January 1, 2014, and December 31, 2016, in The US Oncology Network and were followed through December 31, 2019 [median follow-up: 18.2 mo (range: 0.1–63.1 mo)]. Study data were sourced from electronic health records. Patient demographic, clinical, and treatment characteristics were assessed descriptively. Kaplan-Meier methods were used to evaluate overall survival (OS), time to treatment discontinuation, time to next treatment, physician-assessed time to tumor progression, and physician-assessed progression-free survival (rwPFS). Independent risk factors for OS and rwPFS were identified with multivariable Cox regression models. Of the 303 study-eligible patients, 119, 131, and 53 received pembrolizumab in the first-line, second-line, and third-line or beyond setting, respectively. Median OS across the study population was 29.3 months [95% confidence interval (CI): 20.3–49.7] and was the longest among those who received first-line pembrolizumab [42.8 mo (95% CI: 24.8–not reached)]. Median rwPFS across the study population was 5.1 months (95% CI: 4.0–7.6) and 8.1 months (95% CI: 4.6–14.4) among those who received first-line pembrolizumab. In the multivariable analyses for OS, increased age, worsening performance status, elevated lactate dehydrogenase, brain metastases, and pembrolizumab use in later lines were significantly associated a worse prognosis.
Characterization of the Activity of Croton tiglium Oil in Hetter's Very Heavy Phenol–Croton Oil Chemical Peels
Authors: Justo Aline S. , Lemes Bruna M. , Nunes Bruna , Antunes Kevin A. , Capote Anna Claudia M. O. , Lipinski Leandro C. , Campagnoli Eduardo B. , Emiliano Janaina , Meurer Eduardo C. , Ezemma Ogechi , Miot Helio A. , Beltrame Flávio L. , Wambier Carlos G.
Published: March 2021

BACKGROUND

Croton oil (CO) is used by dermatologists and plastic surgeons in deep chemical peels. It is mixed with phenol, water, and a soap in Baker–Gordon's or Hetter's formulas. There is controversy as to whether CO or phenol is the active agent in the dermal effect of deep chemical peels.

OBJECTIVE

To better clarify the role of CO in deep peels, by identification of active compounds in commercially available CO in the United States and biological effects in vivo.

MATERIALS AND METHODS

Liquid chromatography–tandem mass spectrometry on CO and a domestic pig model experiment using 3 different formulas: G1: 5% Septisol (SEP), G2: 1.6% croton oil in 35% phenol with 5% SEP, and G3: 35% phenol with 5% SEP.

RESULTS

Liquid chromatography–tandem mass spectrometry indicated the presence of phorbol esters. G1 was null overall. Extent of the coagulative necrosis: G2 > G3. Vascular ectasia: G2 > G3. Inflammation pattern: intense neutrophilic inflammatory band in G2 versus mild, sparse, perivascular mononuclear cell infiltrate in G3. Neocollagenesis: pronounced in G2, negligible in G3.

CONCLUSION

Coagulative necrosis of the epidermis, superficial fibroblasts, and vasculature can be attributed to the action of phenol. Phorbol esters on CO could be responsible for the dense deep acute inflammation and the distinctive neocollagenesis.
QUANTIFICATION OF VESSELS OF HALLER'S LAYER BASED ON EN-FACE OPTICAL COHERENCE TOMOGRAPHY IMAGES
Authors: Shiihara Hideki , Sonoda Shozo , Terasaki Hiroto , Kakiuchi Naoko , Shinohara Yuki , Tomita Masatoshi , Sakamoto Taiji
Published: March 2021

Purpose:

To quantify the vessels of Haller's layer of normal subjects in en-face optical coherence tomographic images.

Methods:

One hundred and seventy-two normal eyes were studied. En-face images of the top 25% slab of Haller's layer was analyzed. The vessel area, vessel length, and mean vessel diameter were calculated. The vessel running pattern was quantified for the degree of symmetry and designated as the “symmetry index.” The coefficient of correlation between each choroidal parameter and the age, sex, axial length, and central choroidal thickness was determined.

Results:

The vessel area was 23.4 ± 3.6 mm2, vessel length was 164.6 ± 24.1 mm, mean vessel diameter was 0.143 ± 0.019 mm, and the symmetry index was 58.6 ± 6.1%. Multiple regression analysis showed that the vessel area was significantly correlated with the age (R = −0.421, P < 0.001) and central choroidal thickness (R = 0.315, P < 0.001). The vessel length was significantly correlated with the age (R = −0.391, P = 0.024) and central choroidal thickness (R = −0.410, P < 0.001). The mean vessel diameter was significantly correlated with the age (R = −0.107, P = 0.024) and central choroidal thickness (R = 0.775, P < 0.001). The correlation between the symmetry index and any clinical findings was not significant.

Conclusion:

Quantification of en-face images of Haller's layer provide new biomarkers of the choroid.
NATURAL HISTORY AND PREDICTORS OF VISION LOSS IN EYES WITH DIABETIC MACULAR EDEMA AND GOOD INITIAL VISUAL ACUITY
Authors: Lent-Schochet Daniella , Lo Therlinder , Luu Kieu-Yen , Tran Steven , Wilson Machelle D. , Moshiri Ala , Park Susanna S. , Yiu Glenn
Published: March 2021

Purpose:

To identify clinical and anatomic factor–associated vision loss in eyes with treatment-naïve diabetic macular edema and good initial visual acuity.

Methods:

Retrospective cohort study after long-term history of eyes with untreated center-involving diabetic macular edema and baseline visual acuity ≥ 20/25 seen at the University of California, Davis Eye Center between March 2007 and March 2018. We collected characteristics including diabetes type, hemoglobin A1c, presence of visual symptoms, visual acuity, and diabetic retinopathy severity; and spectral-domain optical coherence tomography biomarkers including central subfield thickness, intraretinal cyst size, intraretinal hyperreflective foci, disorganization of retinal inner layers, and outer layer disruptions to determine factors associated with vision loss as defined by DRCR Protocol V as threshold for initiating aflibercept therapy.

Results:

Fifty-six eyes (48 patients) with untreated diabetic macular edema and mean baseline visual acuity of logMAR 0.05 ± 0.05 (Snellen 20/22) were followed for an average of 5.1 ± 3.3 years, with a median time to vision loss of 465 days (15 months). Older age (hazard ratio [HR] 1.04/year, P = 0.0195) and eyes with severe NPDR (HR 3.0, P = 0.0353) or proliferative diabetic retinopathy (HR 7.7, P = 0.0008) had a higher risk of a vision loss event. None of the spectral-domain optical coherence tomography biomarkers were associated with vision loss except central subfield thickness (HR 0.98, P = 0.0470) and cyst diameter (HR 1.0, P = 0.0094).

Conclusion:

In eyes with diabetic macular edema and good initial vision, those with older age and worse diabetic retinopathy severity should be monitored closely for prompt treatment initiation when vision loss occurs.
ENDOGENOUS ENDOPHTHALMITIS IN THE SETTING OF COVID-19 INFECTION
Authors: Bilgic Alper , Sudhalkar Aditya , Gonzalez-Cortes Jesus H. , March de Ribot Francesc , Yogi Rohit , Kodjikian Laurent , Mathis Thibaud
Published: March 2021

Purpose:

To describe endogenous endophthalmitis in the setting of COVID-19 pneumonia.

Methods:

Patients recovering from COVID-19 pneumonia who presented to our department with any or all of the following complaints: pain, watering, redness, and decreased vision were identified. All relevant data were collected for analysis.

Results:

Three patients with endogenous endophthalmitis were identified. All patients had been treated for COVID-19 pneumonia and therefore had received remdesivir and systemic steroids; 2 of the 3 patients received tocilizumab. All patients received vitreous biopsy, vitrectomy, and intraocular antibiotic injection. Patient 1 demonstrated Klebsiella pneumoniae in blood culture, K. pneumoniae and Escherichia coli in urine culture, and K. pneumoniae in vitreous fluid, whereas Patients 2 and 3 demonstrated Stenotrophomonas maltophilia and methicillin-resistant Staphylococcus aureus in the blood and nasopharyngeal culture, respectively. Correspondingly, the same organism was cultured from vitreous in Patients 2 and 3. The visual acuity at the last follow-up in Patients 1 to 3 was 20/100, 20/80, and 20/40, respectively. The probable source of infection was identified in each as renal calculi, dental caries, and the pharynx, respectively. Real-time polymerase chain reaction demonstrated the presence of Severe Acute Respiratory Syndrome Coronavirus 2 in the vitreous fluid of Patient 1.

Conclusion:

We report good outcomes of early intervention for endogenous endophthalmitis in the setting of COVID-19 infection. We also document the presence of SARS-CoV-2 in vitreous.
PRESUMED INTRARETINAL TUBERCULOSIS: CASE REPORT WITH MULTIMODAL IMAGING INCLUDING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Alsberge Joseph B. , Safi Mustafa , Peng Michelle Y. , Jumper J. Michael
Published: March 2021

Purpose:

To report a case of presumed intraretinal tuberculosis evaluated with optical coherence tomography angiography.

Methods:

Case report.

Results:

A 61-year-old woman recently immigrated from China presented with round yellow-white retinal lesions in the left eye. The lesions were evaluated with multimodal imaging, including optical coherence tomography angiography. Subsequent serologic testing revealed a positive QuantiFERON-TB Gold test, whereas workup for other entities was negative. The patient was diagnosed with presumed intraretinal tuberculosis. She was started on systemic antitubercular therapy and the lesions regressed. The regression was documented with optical coherence tomography angiography.

Conclusion:

Case reports of primary intraretinal tuberculosis are uncommon. To the best of our knowledge, this is the first case to demonstrate optical coherence tomography angiography findings of presumed intraretinal tuberculosis.
SUBRETINAL AIR USED AS A BALL VALVE TO STABILIZE A RETINAL BLEB
Authors: Garg Sunir J. , Gekeler Florian
Published: March 2021

Purpose:

To describe a technique of using subretinal air to create and stabilize a neurosensory detachment performed during placement of a subretinal implant.

Methods:

A case report of an experiment in a live porcine model.

Results:

Creation of a neurosensory detachment may be facilitated by instillation of subretinal air. We use a small-gauge cannula to infuse approximately 0.1 mL of subretinal air to create a neurosensory detachment. We then expand the bleb using an additional 0.1 cc to 0.2 cc of subretinal air followed by balanced salt solution and stabilize it further with installation of viscoelastic. The small-gauge retinotomy should be created on the anterior and superior aspect of the bleb so that the air can tamponade the retinotomy both during surgery and postoperatively.

Conclusion:

This technique may be useful for some newer procedures, such as subretinal implants and perhaps administration of subretinal gene therapy or cell therapy, that require access to the subretinal space.
Evaluation of Retinal Nerve Fiber Layer, Ganglion Cell-Inner Plexiform Layer, and Optic Nerve Head in Glaucoma Suspects With Varying Myopia
Authors: Miller Gregg D. , Abu-Qamar Omar , Salim Sarwat
Published: March 2021

Précis:

Myopic glaucoma suspects, particularly with high myopia, experience thinning of nontemporal parameters of retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL), without change in optic nerve head (ONH) parameters.

Purpose:

The aim was to assess the effect of myopia on RNFL, GCIPL, and ONH parameters in glaucoma suspects.

Materials and Methods:

Seventy-six eyes of glaucoma suspects studied with Cirrus high definition optical coherence tomography were divided into low (n=27), moderate (n=25), and high myopia (n=24) groups. Optical coherence tomography parameters were correlated with spherical equivalent (SE) and evaluated with areas under the receiver operating characteristic curve for quantifying diagnostic ability to differentiate high myopia from nonhigh myopia.

Results:

In high myopia, SE was positively correlated with thinning of average, minimum, and nontemporal GCIPL and thinning of average and nontemporal RNFL (P<0.05 for all), but not for inferior RNFL (P=0.28). In moderate myopia, SE was correlated with thinning of inferonasal and minimum GCIPL as well as superior and inferior RNFL (P<0.05 for all). SE was not correlated with ONH parameters in moderate or high myopia (P>0.05). The largest areas under the receiver operating characteristic curve for RNFL and GCIPL parameters were for superior (0.82) and superonasal (0.80) regions, respectively, with comparable diagnostic ability (P=0.74).

Conclusion:

High myopia, in particular, is associated with thinning of average RNFL, average and minimum GCIPL, and nontemporal parameters of both RNFL and GCIPL, warranting consideration of refractive status in glaucoma suspects.
Seven-year observation of posterior corneal elevation after small-incision lenticule extraction in patients with moderate and high myopia
Authors: Chen Zhuoyi , Zhao Yu , Zhou Xueyi , Xia Fei , Zhao Jing , Zhou Xingtao
Published: March 2021

Purpose:

To investigate the long-term changes in posterior corneal elevation in moderate and high myopia after small-incision lenticule extraction (SMILE).

Setting:

Eye & ENT Hospital, Fudan University, Shanghai, China.

Design:

Prospective case series.

Methods:

33 eyes of 20 patients (30.1 ± 9.5 years, 7 men and 13 women, spherical equivalent [SE] range −4.00 to −8.75 D, mean SE −6.25 ± 1.29 D) who underwent SMILE were included. Changes in the posterior corneal elevation at central points (PCE), the thinnest point (PTE), the maximal point (PME), and an additional 20 points within the 4 mm area of the best-fit sphere were evaluated with a Pentacam (Oculus Optikgeräte GmbH) during a 7-year follow-up period. Mixed linear models were used to evaluate changes with P values less than 0.05. Correlations of elevation changes and residual bed thickness (RBT) were also evaluated.

Results:

No ectasia was observed among the 33 eyes studied. The safety index was 1.08, and the efficacy index was 1.03. The mean change in PCE at 1 year, 3 years, 5 years, and 7 years was −1.42 ± 0.95 μm, −2.67 ± 0.98 μm, −2.44 ± 1.06 μm, and −1.91 ± 0.92 μm, respectively. Statistically significant differences were found at 3 years, 5 years, and 7 years (P = .007, .023, and .040, respectively). PTE reduced significantly at each time point compared with baseline. The mean change was −2.82 ± 1.19 μm, −3.55 ± 1.22 μm, −3.47 ± 1.32 μm, and −2.39 ± 1.15 μm, respectively (P = .019, .004, .010, and .039, respectively). PME changed in 2.45 ± 1.02 μm at 7 years compared with baseline (P = .017). The changes in PCE and PME negatively correlated with the RBT.

Conclusions:

Long-term posterior corneal elevation was stable in moderate and high myopia after SMILE.
Selective transepithelial ablation with simultaneous accelerated corneal crosslinking for corneal regularization of keratoconus: STARE-X protocol
Authors: Rechichi Miguel , Mazzotta Cosimo , Oliverio Giovanni William , Romano Vito , Borroni Davide , Ferrise Marco , Bagaglia Simone , Jacob Soosan , Meduri Alessandro
Published: March 2021

Purpose:

To evaluate the changes in refractive outcomes and corneal aberrations in central and paracentral keratoconus after selective transepithelial topography-guided photorefractive keratectomy combined with accelerated corneal crosslinking (STARE-X).

Settings:

Centro Polispecialistico Mediterraneo, Siena Crosslinking Center, and University of Messina, Italy.

Design:

Prospective, interventional, multicentric study.

Methods:

Patients were subdivided into 2 groups: Group 1 with cone located within the central 3 mm zone (50 eyes) and Group 2 (50 eyes) with cone located outside the central 3 mm zone. Follow-up was 2 years at least for all eyes. Outcome parameters included uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). Corneal tomography and corneal wavefront aberrations were assessed and compared before and 2 years after the treatment.

Results:

100 eyes of 100 patients underwent STARE-X protocol. At 2 years, UDVA and CDVA improved, and sphere, cylinder, and Kmax reduced after treatment in both groups (P < .001, respectively). Moreover, a statistically significant reduction was observed of total higher-order aberrations root main square (RMS), coma RMS, and spherical aberration RMS in both groups (P < .001, respectively). However, CDVA improved more in Group 1 than in Group 2 (P < .02).

Conclusions:

The STARE-X protocol demonstrated effective results in halting keratoconus progression and improving corneal regularity with a safe and effective profile. STARE-X improved both visual acuity and corneal aberration at 2 years. Longer follow-up studies are warranted to observe further long-term CXL flattening effect on the cone.
The Role for Health Technology Managers on Fall Prevention Teams
Authors: Brown Cedric , Koustenis Alexandra , Morabito Julie
Published: March 2021

Health technology managers (HTMs) play a pivotal role in ensuring that the devices involved in protecting vulnerable patients from suffering falls are functional and safe for use. Patient falls are common events in healthcare settings, with between 700,000 and 1,000,000 patients suffering falls annually in the United States (Agency for Healthcare Research and Quality. Preventing falls in hospitals. Updated July 2018. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html). The experience and expertise of HTMs in handling devices throughout their entire lifecycle provide unique perspective and can help to establish proactive measures to ensure the risks of patient falls are mitigated as much as possible. This article will explore, using several real case examples submitted to Food and Drug Administration's MedSun, the many ways that hospitals can best use their HTMs in enhancing their fall prevention teams and overall patient fall mitigation strategies. Among these effective strategies are preadmission risk assessments and education, fostering a no-blame culture of reporting adverse events and device malfunctions, and regular interdisciplinary fall prevention team meetings where best practices can be discussed and implemented.
Hospital Redesign Based on International Standards
Authors: Hassanien Amr A. , Eldosoky Mohamed A. A. , Soliman Ahmed M.
Published: March 2021

This article reviews the regulations for redesigning a hospital facility to the international levels. It evaluates the different building guidelines such as Guidelines for Design and Construction of Health Care Facilities by the American Institution of Architecture, Facility Guidelines Institute, Joint Commission, American Society of Heating, Refrigerating, and Air-Conditioning Engineering, Health Technical Memorandum, National Fire Protection Associations, Housing and Building National Research Center, and American Society for Healthcare Engineering. These organizations offer guidance and set standards for the construction of healthcare institutions by making them patient friendly and as safe as possible.
Investigation of Sterilizers Causing Wet Loads Through Root Cause Analysis
Authors: Crisafulli Jacob
Published: March 2021

Belimed Incorporated sterilizers are used in the sterile processing department (SPD) to decontaminate operating room instruments and tools used during surgery. There are 3 phases to the sterilization process: conditioning, exposure, and the exhaust phases. During the conditioning phase, air is removed from the chamber using a vacuum system; otherwise, it would inhibit steam contact with the instruments being cleaned. Steam is then released to fill the space in the chamber during the exposure phase, increasing the pressure and temperature inside to a desired level. This sterilizes the items inside over a fixed period based on the predetermined settings. Finally, during the exhaust phase, the drain is opened to release steam, which lowers the pressure inside the vessel and allows the items to dry.
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The quality of sterilization steam is vital for operating room (OR) surgeries to proceed as planned. During the month of July, our New England–based teaching hospital witnessed multiple wet loads, which resulted in the cancellation of several surgeries and delaying pivotal patient care. These wet loads were caused by condensation of equipment after being sterilized as A/C units are placed too close to the sterilizer units. Also contributing to wet loads was the temperature of incoming cold-water lines being out of specification by 4 degrees. Warm water causes inefficient vacuum pumps, which prevents the air in the system from being removed during the conditioning phase. Additional investigation found procedures and policies were occasionally neglected resulting in contaminated trays. A root cause analysis (RCA) was conducted by our Risk Management (RM) department as these issues affected patient care. The root/proximate causes were identified, and an action plan was formulated with the help of Clinical Engineering (CE), Belimed, and the facilities staff to prevent wet load recurrence.
Reducing Cost Variance and Increasing Quality Across Medical Device Maintenance Purchasing
Authors: Behm Jason , Davis-Smith Carol
Published: March 2021

Hospitals often order parts and repairs from multiple vendors selected by their healthcare technology managers, resulting in differences in quality and multiple prices for the same item or service. Online marketplace solutions that allow health systems to implement evidence-based purchasing can increase quality and produce significant savings.
Flipped learning: A shift in graduate nursing education
Authors: Murphy Nancy , Strong Caron , Jones Gloria
Published: March 2021

The coronavirus (COVID-19) pandemic has caused a shift in education. Nursing education must respond to these changing times by redesigning classroom instruction. Flipped learning (FL) is a proposed method for teaching advanced practice nurses that is student-centered and engaging, both critical areas for contemporary learners. This qualitative study explored the perspectives and experiences of the family nurse practitioner faculty and the family nurse practitioner nursing students who participated in FL. The type and level of FL practices faculty can apply to support students coming to class prepared to engage in active learning activities was also investigated. The study used an insider action research design. There were two arms of the study, faculty and student. Ten faculty-led learning circles with four faculty and three family nurse practitioner student focus groups, each with six students, were held over the course of the study. Thematic findings were developed from both student and faculty data. The results revealed that family nurse practitioner students had a positive attitude toward FL. Many expressed FL provided perceptions of gained confidence, personalized learning, increased engagement, and preparedness for classroom instruction. Overall, faculty preferred FL over traditional teaching approaches. Several active learning activities were used by faculty with clinical case studies being the most preferred by student participants. This study confirms FL is a plausible and promising approach to traditional classroom instruction. However, more robust studies are needed to determine its benefits in advanced practice nursing education.
Approach to pulmonary embolism: A clinical care pathway
Authors: El Hussein Mohamed Toufic , Bayrouti Ali
Published: March 2021

Acute pulmonary embolism (PE) is a potentially fatal condition that is often underdiagnosed due to its ambiguous and generalized symptoms. As such, nurse practitioners (NPs) may struggle to respond in a timely and accurate manner to clients presenting with acute PE. Given the complexities of diagnosing and managing PE, we propose a visual clinical care pathway to support NPs in recognizing and stratifying clients' risks of PE. The article provides guidance regarding PE diagnostic testing and offers a summary of effective, evidence-based treatment options for adult clients, including those with cancer.
Update your “sore throat” differential list: A case report and discussion of oral chlamydia
Authors: Cunningham Jodi L. , Pilati Claudia D. , Cotler Karen F.
Published: March 2021

There has been an exponential increase in sexually transmitted infections (STIs) in the United States, causing the Centers for Disease Control and Prevention to declare an epidemic. Current evidence demonstrates that extragenital STIs of the oropharynx and rectum are often asymptomatic and may not be associated with concurrent positive urogenital infections. As a result, these infections are often missed in primary care. Furthermore, guidelines only recommend extragenital site testing in men who have sex with men, excluding oropharyngeal chlamydia, despite evidence that extragenital STIs are occurring in other high-risk populations as well. A case report is provided to enhance primary health care providers' knowledge of extragenital STIs and promote early recognition and testing to improve patient outcomes.
Diagnostic Yield of Digital Tomosynthesis-assisted Navigational Bronchoscopy for Indeterminate Lung Nodules
Authors: Katsis James , Roller Lance , Aboudara Matthew , Pannu Jasleen , Chen Heidi , Johnson Joyce , Lentz Robert J. , Rickman Otis , Maldonado Fabien
Published: March 2021

Background:

Navigational bronchoscopy is commonly used to sample lung nodules, with a better safety profile but lower diagnostic yield than computerized tomography-guided transthoracic needle biopsy. The addition of digital tomosynthesis to electromagnetic navigation, using intraprocedural images obtained from a C-arm fluoroscope to identify target lesion location and update navigational guidance, may improve diagnostic yield.

Methods:

Consecutive bronchoscopies using tomosynthesis-assisted fluoroscopic electromagnetic navigational bronchoscopy (F-ENB) at a single institution over a 1-year period were included. The primary outcome was diagnostic yield. A bronchoscopy was defined as diagnostic if pathologic examination revealed malignancy or specific histological findings indicative of lesional sampling with confirmatory 6-month follow-up for benign lesions.

Results:

A total of 324 patients with 363 nodules underwent F-ENB between April 25, 2018 and April 29, 2019. The average nodule size was 1.9±1.1 cm, 65% of the nodules were located in the peripheral third of the lung. A bronchus sign was present in 24% of cases. Of the 363 nodules, 299 (82.4%) had lesional findings. At 6-month follow-up, among these 299 nodules, 6 were found to be false negatives and 12 nodules were lost to follow-up. Considering all nodules lost to follow-up as false negatives, the 6-month diagnostic yield was 77.4%. Pneumothorax complicated 8 (2.5%) of cases. There was 1 episode of respiratory failure.

Conclusion:

This retrospective study suggests the diagnostic yield of F-ENB may exceed that of traditional ENB. Future prospective and comparative studies are needed to confirm these promising data.
Validation of the Microlife BP B3 AFIB upper arm blood pressure monitor in adults and adolescents according to the ANSI/AAMI/ISO 81060-2:2019 protocol
Authors: Beime Beate , Bramlage Carsten , Krüger Ralf , Deutsch Cornelia , van Mark Gesine , Bramlage Peter , Botta Beate
Published: March 2021

Objective

Aim of this study was to validate the Microlife BP B3 AFIB/enterprise resource planning (ERP) No: BP3KT1-3 N blood pressure (BP) monitor according to the American National Standards Institute (ANSI)/Association for the Advancement of Medical Instrumentation (AAMI)/International Organization for Standardization (ISO) 81060–2:2019 in adolescents and adults from a general population.

Methods

BP measurements on the upper arm were performed in 85 subjects (age range 12–88 years), using the Microlife BP B3 AFIB and a standard mercury reference sphygmomanometer.

Results

A total of 255 valid BP comparisons were performed for the present validation analysis. The mean ± SD difference between the test and the reference device was 0.70 ± 7.05 mmHg for SBP (pass criterion ≤5 mmHg) and −0.85 ± 4.70 mmHg for DBP (pass criterion ≤5 mmHg) with the SD below the required value of ≤8 mmHg. The mean ± SD of the intraindividual differences between the test and the reference device was 0.70 ± 5.87 mmHg for SBP (pass criterion for the SD ≤6.90 mmHg) and −0.85 ± 4.19 mmHg for DBP (pass criterion for the SD ≤6.88 mmHg).

Conclusion

The Microlife BP B3 AFIB/ERP No: BP3KT1-3 N has passed the criteria of the ANSI/AAMI/ISO 81060–2:2019 protocol and can be recommended for home BP measurements in adolescents and adults.
Eating and Psychiatric Disorders Are Independent Risk Factors for Rumination Syndrome
Authors: Cai Jennifer X. , Wong Danny , Lee Darren J.H. , Chan Walter W.
Published: March 2021

Goal:

The goal of this study was to evaluate whether a history of eating disorders (EDs) or psychiatric disorders (PDs) are risk factors for rumination syndrome (RS).

Background:

RS is a disorder of gut-brain interaction characterized by an effortless postprandial retrograde flow of ingested contents. Disorder of gut-brain interactions have been associated with psychiatric and behavioral comorbidities. No prior comparative study has assessed the relationship between RS and ED or PD.

Methods:

This was a case-control study of adults with RS at a tertiary center in January 2013 to January 2018. Two age-matched/gender-matched controls per RS case were identified. The Fisher exact test (categorical)/Student t test (continuous) and forward stepwise logistic regression were performed for univariate and multivariable analyses, respectively.

Results:

Seventy-two patients (24 cases/48 controls) were included. Baseline demographics and characteristics were similar between cases and controls. Among RS patients, 9 (37.5%) had a history of ED, including 3 (12.5%) anorexia nervosa and 4 (16.7%) bulimia nervosa; and 20 (83.3%) had a PD, including 9 (37.5%) anxiety and 7 (29.2%) depression. Prevalence of ED (37.5% vs. 4.2%, P=0.0002) and PD (83.3% vs. 50.0%, P=0.0062) were higher among RS patients than controls. Specifically, the risks of anorexia nervosa (16.7% vs. 0%, P=0.005) and bulimia nervosa (21.1% vs. 0%, P=0.001) were both increased in RS patients. On multivariable analysis, ED (adjusted odds ratio=16.4, P=0.0033) and PD (adjusted odds ratio=4.47, P=0.029) remained independent predictors for RS.

Conclusions:

A history of ED and PD were independent risk factors for RS. Abnormal eating behaviors and psychiatric comorbidities may contribute to the pathogenesis of RS. Evaluation of RS should include a detailed history for ED and PD.
Impact of COVID-19 on Individuals With Irritable Bowel Syndrome and Comorbid Anxiety and/or Depression
Authors: Kamp Kendra J. , Levy Rona L. , Munson Sean A. , Heitkemper Margaret M.
Published: March 2021

Goals:

The goal of this study was to describe the influence of the COVID-19 pandemic on ability to engage in activities and the influence on psychological distress and gastrointestinal symptoms among individuals with irritable bowel syndrome (IBS) and comorbid anxiety and/or depression.

Background:

Individuals with IBS and comorbid anxiety and/or depression report increased symptoms and decreased quality of life compared with individuals with IBS alone. The current COVID-19 pandemic has the potential to further influence symptoms among individuals with IBS and comorbid anxiety and/or depression.

Study:

Individuals who met the Rome-IV IBS criteria and reported mild to severe anxiety and/or depression were included. Participants completed an online survey with questions about anxiety, depression, impact of COVID on activities and symptoms, and demographics.

Results:

Fifty-five individuals participated in the study. The COVID-19 pandemic most commonly influenced their ability to spend time with friends and family, shop for certain types of food, and access health care. Participants also reported increased stress (92%), anxiety (81%), and depressive symptoms (67%). Finally, around half the sample reported increases in abdominal pain (48%), diarrhea (45%), or constipation (44%).

Conclusions:

The COVID-19 pandemic is related to self-reported increases in psychological distress and gastrointestinal symptoms among individuals with IBS and comorbid anxiety and/or depression. Additional research is needed to intervene on these symptoms.
Hepatitis B Reactivation
Authors: Wang Yun , Han Steven-Huy B.
Published: March 2021

Hepatitis B virus reactivation (HBVr) can occur spontaneously, but more often occurs when a patient is in an immunocompromised state or on immunosuppressive therapy. HBVr can lead to clinical hepatitis, acute liver failure, and even death. HBVr is preventable with screening of at-risk patients and initiation of prophylactic antiviral therapy for appropriate candidates. Screening for hepatitis B virus is recommended for all patients who plan to initiate immunosuppressive therapy. An individual’s serological profile, underlying disease, and planned type of immunosuppression contribute to their risk of HBVr. This review serves to summarize the major society guidelines regarding screening, management of, and monitoring for HBVr in individuals on anticancer therapy and immunosuppressive therapy.