bluuebunny/crossref_metadata_2025 huggingface dataset:
CONTRAST-TO-NOISE RATIO IS A USEFUL PREDICTOR OF EARLY DISPLACEMENT OF LARGE SUBMACULAR HEMORRHAGE BY INTRAVITREAL SF6 GAS INJECTION
Authors: Ura Sawako , Miyata Manabu , Ooto Sotaro , Yasuhara Satoshi , Tamura Hiroshi , Ueda-Arakawa Naoko , Muraoka Yuki , Miyake Masahiro , Takahashi Ayako , Wakazono Tomotaka , Uji Akihito , Yamashiro Kenji , Tsujikawa Akitaka
Published: December 2021

Purpose:

To investigate predictors of early displacement of submacular hemorrhage (SMH) by simple intravitreal SF6 gas injection.

Methods:

This retrospective study included 16 eyes of 16 consecutive patients (age: 74.5 ± 7.7 years; 15 men) with large SMH treated with simple intravitreal SF6 gas before inception of subretinal tissue plasminogen activator injection at our institution. The SMH displacement was graded at 1-week posttreatment as 0, 1, or 2. Central retinal thickness, central choroidal thickness, SMH height, SMH area, disease duration, use of anticoagulant or antiplatelet drugs, and contrast-to-noise ratio (CNR) of SMH on optical coherence tomography images were recorded. Correlations between displacement grading and baseline parameter were analyzed.

Results:

Univariable correlation analysis revealed association of the 1-week displacement grading with the CNR (P = 0.004; r = −0.68) and SMH height (P = 0.03; r = −0.55). The CNR was most strongly associated with 1-week displacement on multivariable correlation analysis (P = 0.01; β = −0.60).

Conclusion:

Findings of the present study showed that the CNR of SMH was a useful predictor of early displacement of large SMH after simple intravitreal SF6 gas injection. When vitrectomy with subretinal injection of tissue plasminogen activator is difficult in patients with large SMH, with low CNR on optical coherence tomography, simple intravitreal SF6 gas injection may be a treatment option.
SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY BIOMARKERS OF RETINAL HYPERPERMEABILITY AND CHOROIDAL INFLAMMATION AS PREDICTORS OF SHORT-TERM FUNCTIONAL AND ANATOMICAL OUTCOMES IN EYES WITH DIABETIC MACULAR EDEMA TREATED WITH INTRAVITREAL BEVACIZUMAB
Authors: Mazloumi Mehdi , Entezari Morteza , Samadikhadem Sanam , Ramezani Alireza , Nikkhah Homayoun , Arevalo J. Fernando
Published: December 2021

Purpose:

To assess spectral domain optical coherence tomography biomarkers of short-term outcomes in eyes with diabetic macular edema treated with intravitreal bevacizumab.

Methods:

In a prospective interventional case series, 66 eyes with diabetic macular edema underwent 3 monthly intravitreal bevacizumab injections. Best-corrected visual acuity measurement and spectral domain optical coherence tomography were performed at baseline and at 3 months. Multivariate regression analysis was performed to investigate the baseline spectral domain optical coherence tomography parameters as predictors of functional and anatomical outcomes.

Results:

Patients with diabetic nephropathy had greater subfoveal choroidal thickness (300.8 ± 35.54 vs. 253.0 ± 50.07µm,P< 0.01) and were more likely to have subretinal fluid (r = 0.26,P= 0.03) at baseline. Multivariate analysis showed that the extent of external limiting membrane disruption (P= 0.03) and the extent of disorganization of retinal inner layers (P= 0.03) at baseline were predictors of best-corrected visual acuity at 3 months, whereas the extent of disorganization of retinal inner layers (P= 0.04) and duration of diabetes mellitus (P= 0.03) were predictors of central subfield thickness at 3 months.

Conclusion:

External limiting membrane disruption and disorganization of retinal inner layers, as the spectral domain optical coherence tomography biomarkers of retinal hyperpermeability, can predict short-term outcomes in diabetic macular edema eyes treated with intravitreal bevacizumab.
EFFICACY OF HALF-DOSE PHOTODYNAMIC THERAPY VERSUS HIGH-DENSITY SUBTHRESHOLD MICROPULSE LASER FOR TREATING PIGMENT EPITHELIAL DETACHMENTS IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY
Authors: Feenstra Helena M. A. , Hahn Leo C. , van Rijssen Thomas J. , Tsonaka Roula , Breukink Myrte B. , Keunen Jan. E. E. , Peters Petrus J. H. , Dijkman Greet , Souied Eric H. , MacLaren Robert E. , Querques Giuseppe , Downes Susan M. , Fauser Sascha , Hoyng Carel B. , van Dijk Elon H. C. , Boon Camiel J. F.
Published: December 2021

Purpose:

Comparing the effect of half-dose photodynamic therapy and high-density subthreshold micropulse laser treatment on retinal pigment epithelial detachments (PEDs) in chronic central serous chorioretinopathy.

Methods:

This study included data from the PLACE trial, a prospective randomized controlled trial comparing half-dose photodynamic therapy and high-density subthreshold micropulse laser treatment in chronic central serous chorioretinopathy. Main outcome measurements were changes in both the foveal PED and the highest PED within the macula at baseline compared with first and final evaluation visit.

Results:

At baseline, a macular PED was detected in 76.9% of patients (123/160), and a PED within 1,500 µm from the foveal center in 37.5% of patients (60/160). In the half-dose photodynamic therapy arm (61 patients), there was a significantly larger decrease in the highest macular PED compared with the high-density subthreshold micropulse laser treatment arm (62 patients) at both first and final evaluation visits (P < 0.001 and P = 0.012, respectively). The decrease of highest foveal PED was significant at first visit (P = 0.025).

Conclusion:

Half-dose photodynamic therapy is superior to high-density subthreshold micropulse laser treatment with regard to a statistically significant reduction in the height of macular PEDs in active chronic central serous chorioretinopathy. These findings may also have implications for other diseases within the pachychoroid disease spectrum that can present with PEDs.
COMPARISON OF INTERNAL LIMITING MEMBRANE PEELING WITH THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR RHEGMATOGENOUS RETINAL DETACHMENT COEXISTING WITH MACULAR HOLE
Authors: Liu Xujia , Huang Jinqu , Zhou Ruiqin , Jiang Zehua , Chen Haoyu , Chen Weiqi , Ng Tsz Kin , Wu ZHENGGEN , Zhang Guihua
Published: December 2021

Purpose:

To evaluate the anatomical and functional outcomes of internal limiting membrane (ILM) peeling and the inverted ILM flap technique for rhegmatogenous retinal detachment coexisting with macular hole.

Methods:

This retrospective study evaluated the medical records of 79 eyes with concurrent rhegmatogenous retinal detachment and macular hole received vitrectomy and silicone oil tamponade, with ILM peeling on 56 eyes and the inverted ILM flap technique on 23 eyes.

Results:

The Type 1 closure rate was greater in the inverted ILM flap group than the ILM peeling group (82.6% vs. 55.4%, P = 0.038). Lines of improvement were 7.8 ± 5.3 in the ILM peeling group and 8.9 ± 5.6 in the inverted ILM flap group. Postoperative epiretinal membrane and retinal reattachment rates were similar in two surgical groups (16.1% vs. 21.7%, P = 0.535 and 94.6% vs. 95.7%, P = 0.999, respectively). Type 1 closure was significantly correlated with the inverted ILM flap technique (OR = 5.568, P = 0.023). The inverted ILM flap technique showed no significant association with the final logarithm of the minimum angle of resolution best-corrected visual acuity in multivariate model analysis.

Conclusion:

The inverted ILM flap technique was more effective in restoring the macular structure in patients with rhegmatogenous retinal detachment and coexisting macular hole, but the functional outcomes of the two strategies were comparable.
DOUBLE FLUENCE PHOTODYNAMIC THERAPY FOR THE TREATMENT OF CIRCUMSCRIBED CHOROIDAL HEMANGIOMA
Authors: Pellegrini Marco , Staurenghi Giovanni , Mambretti Manuela , Preziosa Chiara
Published: December 2021

Purpose:

To evaluate the efficacy and safety of double-fluence photodynamic therapy for the treatment of circumscribed choroidal hemangioma.

Methods:

Retrospective observational study including patients affected by circumscribed choroidal hemangioma and treated with double-fluence photodynamic therapy. The photodynamic therapy was performed with verteporfin infusion intravenously (dose of 6 mg/m2 body surface area over 10 minutes), followed by the application of two consecutive spots of 50 J/cm2 light at 689 nm for 83 seconds.

Results:

Twenty-three eyes of 23 patients were included. The mean best-corrected visual acuity increased from 20/45 to 20/28, the mean tumor thickness decreased from 2,758 ± 530 µm to 722 ± 314 µm (P < 0.05), and the mean central retinal thickness decreased from 404 ± 209 µm to 188 ± 56 µm (P < 0.05) in 12 months, respectively. A total reabsorption of macular subretinal fluid, cystoid macular edema, and SRF associated with the tumor was obtained within 6 months in all cases, with persistence of tumor-associated intraretinal fluid up to 12 months only in two patients. No cases of side effects or need for retreatment were reported during the follow-up (average time of 25 months).

Conclusion:

Double-fluence photodynamic therapy is a safe and effective treatment for circumscribed choroidal hemangiomas and should be considered as the first line of treatment for these lesions.
ENDOTHELIN-1 AS A RISK FACTOR IN RETINAL VEIN OCCLUSION
Authors: List Wolfgang , Weger Martin , Pinter-Hausberger Silke , Posch Florian , Rabensteiner Jasmin , Pailer Sabine , Wedrich Andreas , Posch-Pertl Laura
Published: December 2021

Purpose:

Retinal vein occlusion (RVO) risk factors largely coincide with cardiovascular risk factors. Endothelin-1 (ET-1), the most potent vasoconstrictor with proinflammatory properties, is a known cardiovascular risk factor. In this study, we explore the role of serum ET-1 as a potential risk factor for RVO.

Methods:

Endothelin-1 serum levels were measured in patients with RVO and control subjects. Samples were measured using the sandwich enzyme-linked immunosorbent assay for the quantitative determination of human big endothelin-1 (Biomedica Group, Austria).

Results:

The study consisted of 147 RVO patients and 150 control subjects. Median serum ET-1 was significantly higher in RVO patients (0.26 pmol/L; range, 0.19–0.37 pmol/L) compared with control subjects (0.10 pmol/L; range, 0.05–0.22 pmol/L) (P < 0.0001) independent of the occlusion site. The difference remained significant after adjusting for arterial hypertension, diabetes mellitus, history of stroke, history of myocardial infarction, history of venous thromboembolism, glomerular filtration rate, and c-reactive protein.

Conclusion:

In conclusion, our results suggest that ET-1 is a potential risk factor for all types of RVO.
LONGITUDINAL ANALYSIS OF DIABETIC CHOROIDOPATHY IN PROLIFERATIVE DIABETIC RETINOPATHY TREATED WITH PANRETINAL PHOTOCOAGULATION USING WIDEFIELD SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY
Authors: Russell Jonathan F. , Zhou Hao , Shi Yingying , Shen Mengxi , Gregori Giovanni , Feuer William J. , Wang Ruikang K. , Rosenfeld Philip J.
Published: December 2021

Purpose:

Widefield swept-source optical coherence tomography (OCT) imaging was used to characterize choroidal thickness and vascularity at baseline in proliferative diabetic retinopathy (PDR) and longitudinally after panretinal photocoagulation (PRP).

Methods:

Patients with treatment-naive PDR were imaged at baseline and at 1 week, 1 month, and 3 months after PRP. Previously validated algorithms were used to calculate the mean choroidal thickness (MCT) and choroidal vascularity index (CVI) in 5 regions of 12 mm × 12 mm scans.

Results:

Fourteen PDR eyes were included. Baseline MCT in PDR eyes did not differ significantly from normal eyes, but CVI measurements in PDR eyes were lower in all regions (P < 0.001–0.008). After PRP, MCT measurements in PDR eyes were significantly lower at 1 month and 3 months in all regions (P < 0.001–0.005) except the fovea (P = 0.074). However, CVI measurements did not change over time in any region after PRP.

Conclusion:

The choroid in PDR eyes has a smaller CVI than that in normal eyes. After PRP, the choroidal thickness decreases outside the fovea, but the CVI remains constant, which suggests that a relative decrease in choroidal vascularity persists. These widefield swept-source OCT results are consistent with choroidal alterations found in histopathological reports of diabetic choroidopathy.
TUBERCULOUS CHORIORETINITIS: A CHALLENGING CASE OF AN OPHTHALMIC MIMIC
Authors: Dedina Liana , Little Matthew , Durkin Shane
Published: December 2021

Purpose:

To report a challenging case of tuberculous chorioretinitis.

Methods:

Case report of a 51-year-old woman from the Middle East, who was referred from an optometrist with a suspicious retinal lesion in her right eye.

Results:

Clinical examination showed multifocal, pale, elevated lesions temporal to the right macula with no vasculitis or hemorrhages. Infective and inflammatory workup showed unremarkable results. B-scan ultrasound confirmed an 8 mm × 3 mm × 10 mm right focal chorioretinal thickening. Computed tomography scanning showed calcified lung hilar nodes supporting a prior granulomatous process, along with an enhancing nodule in the right globe. Magnetic resonance imaging of the brain and obits showed retinal thickening of the temporal surface of the right globe with subtle enhancement without retrobulbar extension or evidence for cerebral vasculitis. Subretinal lesion biopsy showed mononuclear inflammatory cells with granulomatous inflammation, including multinucleated giant cells but no neoplastic features. Interferon-gamma release assay testing for tuberculosis showed negative result, but a high index of suspicion lead to tuberculin skin testing and subsequent treatment for tuberculous chorioretinitis.

Conclusion:

Ocular tuberculosis presents in a variety of ways, making it a challenging diagnosis. Herein, we describe such case of tuberculous chorioretinitis.
Descemet Stripping Only for Fuchs Endothelial Corneal Dystrophy: Will It Become the Gold Standard?
Authors: Colby Kathryn
Published: December 2021

Descemet stripping only (DSO) has become a viable treatment option for certain cases of Fuchs Endothelial Corneal Dystrophy (FECD). This article describes the history of the development of DSO, its current status, and what successful DSO tells us about the pathophysiology of FECD. Remaining questions and future directions are also highlighted.
Astigmatic Vectorial Analysis in Pediatric Keratoconus After Unilateral Cross-Linking Treatment
Authors: Kesim Cem , Öztürkmen Cem , Şahin Afsun
Published: December 2021

Purpose:

The aims of this study were to evaluate the treatment response of pediatric keratoconus (KC) patients to unilateral corneal collagen cross-linking (CXL) in treated eyes, disease progression in untreated eyes, and define the predictive value of astigmatic parameters by astigmatic vectorial analysis.

Methods:

Pediatric patients with KC with CXL-treated progressive eye and untreated fellow eye were included. Patients with other ocular conditions and a history of previous ocular surgery were excluded. Astigmatic changes in anterior and posterior corneal surfaces were evaluated with vectorial analysis. The receiver operating characteristic curves were analyzed to detect the best parameter that discriminates treated and untreated groups.

Results:

Thirty-two eyes of 16 patients with at least 2-year follow-up were analyzed. The maximum keratometry (K) in CXL-treated eyes remained stable (from 53.51 ± 2.86–53.41 ± 2.84 diopter (D), P = 0.84) while the steepest K increased in untreated eyes (from 47.82 ± 1.71–49.59 ± 3.32 D, P = 0.03). The oblique components of corneal astigmatism in CXL-treated eyes were higher than those of fellow eyes (all P < 0.05), which significantly decreased in the anterior 3-mm zone after treatment (P = 0.048). The mean differential astigmatism magnitudes were significantly higher in treated eyes (all P < 0.05). The refractive centroid remained unchanged in treated eyes (P = 0.553) and shifted in the oblique direction in untreated eyes (P = 0.04). The oblique differential astigmatism in the anterior 7-mm zone showed the highest area under the curve value in predicting treatment efficacy (0.813, 95% confidence interval: 0.646–0.981, P < 0.001).

Conclusions:

Astigmatic vectorial analysis is an objective tool for longitudinal assessment of clinical outcomes in KC. Changes in the oblique components of corneal astigmatism might predict progression and treatment efficacy.
Scheimpflug Versus Optical Coherence Tomography to Detect Subclinical Corneal Edema in Fuchs Endothelial Corneal Dystrophy
Authors: Augustin Victor A. , Köppe Max K. , Son Hyeck-Soo , Meis Jan , Yildirim Timur M. , Khoramnia Ramin , Auffarth Gerd U.
Published: December 2021

Purpose:

The purpose of this research was to compare the ability of Scheimpflug and anterior segment optical coherence tomography (OCT) in detecting subclinical corneal edema in patients with Fuchs endothelial corneal dystrophy (FECD) without clinical corneal edema.

Methods:

In this single-center, consecutive case series, 47 eyes of 29 patients with FECD were analyzed. The main outcome measures were anterior/posterior keratometry and central/thinnest corneal thickness. The criteria for subclinical corneal edema were loss of regular isopachs, displacement of the thinnest point of the cornea, and presence of posterior surface depression. Tomographic analyses were performed using Scheimpflug imaging (Pentacam HR) and OCT (anterior segment swept-source optical coherence tomography).

Results:

The measurement of the continuous variables revealed a significant difference between the 2 devices. The anterior curvature was steeper and the posterior curvature was flatter when measured with OCT (P < 0.001). The OCT showed a lower central corneal thickness and thinnest corneal thickness (P < 0.001). The agreement between both devices to detect subclinical corneal edema was high. The interdevice reliability for loss of parallel isopachs as measured by Cohen kappa coefficient was 0.84; for the displacement of the thinnest point of the cornea, it was 0.6, and for the focal posterior corneal surface depression, it was 0.62. Subclinical corneal edema was detected in 72.3% of the patients with both devices. In only 2 cases (4.3%), subclinical corneal edema was detected by one of the devices.

Conclusions:

Scheimpflug and OCT imaging were both able to detect tomographic patterns of subclinical corneal edema. Therefore, both devices can help decision-making, favoring early endothelial keratoplasty in symptomatic patients with FECD without clinical corneal edema.
The Impact of the COVID-19 Pandemic on Corneal Transplantation in Brazil
Authors: Moriyama Aline Silveira , Erbs Pessoa João Luís , Silva Bessa Taciana Ribeiro , Pereira Nicolas Cesário , Mehta Jodhbir Singh , Hofling-Lima Ana Luisa , dos Santos Forseto Adriana
Published: December 2021

Purpose:

The purpose of this study was to evaluate the impact of the coronavirus disease 2019 pandemic on corneal transplantation (CT) in Brazil.

Methods:

Data from patients who underwent CT at the Hospital Oftalmológico de Sorocaba (HOS), Brazil, were analyzed. National and state numbers of keratoplasties, patients added to the CT waiting list, and total patients on the waiting list were also obtained. Baseline prepandemic (from January 1, 2019, to March 31, 2020) data were compared with 2 time frames of the coronavirus disease 2019 pandemic: elective CT suspension period (between April 1, 2020, and September 31, 2020) and after elective CT resumption (between October 1, 2020, and April 30, 2021).

Results:

Despite elective CT resumption after the moratorium, the monthly CT rates did not return to baseline at HOS (−14.7%, P = 0.007), São Paulo state (−19.1%, P = 0.001), or Brazil (−30.1%, P < 0.001). The waiting list increased significantly regionally (P < 0.001) and nationally (P < 0.001). Among optical keratoplasties performed at HOS after resuming elective CTs, the proportion of endothelial keratoplasties declined from 38.2% to 30.0% (P < 0.001), whereas penetrating keratoplasties increased from 33.2% to 39.5% (P < 0.001) when comparing with prepandemic data.

Conclusions:

Keratoplasty numbers dropped significantly locally, regionally, and nationally. Hence, the CT waiting lists had a progressive increase, with significant long-term implications. An estimated increment on monthly CT rates of approximately 34% in São Paulo state, and 91% in Brazil, is required for the CT waiting list to get back to prepandemic numbers over the next 2 years.
Bilateral Corneal Ectasia 3 Years After Small Incision Lenticule Extraction in a Borderline Case
Authors: Hernández-Chavarría César , Benedetti S Mónica , García de Oteyza Gonzalo , García-Albisua Ana Mercedes , Hernández-Quintela Everardo
Published: December 2021

Purpose:

The purpose of this study was to report a case of bilateral ectasia 3 years after small incision lenticule extraction (SMILE) in a patient with normal preoperative topography of the right eye and abnormal topography of the left eye.

Methods:

This study was a case report.

Results:

A 22-year-old man developed bilateral corneal ectasia after SMILE. The preoperative corneal topography of the right eye was unremarkable, with a minimum corneal thickness of 511 μm in the right eye, and the abnormal corneal topography of the left eye revealed a risk factor for developing ectasia, with a minimum corneal thickness of 514 μm in the left eye. The refractive error was −4.50 to 3.50 × 10 degrees in his right eye and −4.25 to 3.50 × 0 degrees in his left eye with a best-corrected visual acuity of 20/20. An uncomplicated SMILE was performed; after his last follow-up visit at 1 month, the patient was lost to follow-up for 3 years. After that time, he presented with visual loss with left predominance. Bilateral ectasia was diagnosed through corneal topography, and crosslinking was performed in both eyes.

Conclusions:

There are a very few reports of corneal ectasia after SMILE with normal preoperative topography.
U-Net Convolutional Neural Network for Segmenting the Corneal Endothelium in a Mouse Model of Fuchs Endothelial Corneal Dystrophy
Authors: Okumura Naoki , Yamada Shohei , Nishikawa Takeru , Narimoto Kaito , Okamura Kengo , Izumi Ayaka , Hiwa Satoru , Hiroyasu Tomoyuki , Koizumi Noriko
Published: December 2021

Purpose:

The purpose of this study was to assess the U-Net–based convolutional neural network performance for segmenting corneal endothelium and guttae of Fuchs endothelial corneal dystrophy.

Methods:

Twenty-eight images of corneal endothelial cells and guttae of Col8a2
L450W/L450W knock-in mice were obtained by specular microscopy. We used 20 images as training data to develop the U-Net for analyzing guttae and cell borders. The proposed network was validated using independent test data of 8 images. Cell density, hexagonality, and coefficient of variation were calculated from the predicted cell borders and compared with ground truth.

Results:

U-Net allowed the prediction of cell borders and guttae, and overlays of those segmentations on specular microscopy images highly corresponded to ground truth. The average number of guttae per field was 6.25 ± 8.07 for ground truth and 6.25 ± 7.87 when predicted by the network (Pearson correlation coefficient 0.989, P = 3.25 × 10−6). The guttae areas were 1.60% ± 1.79% by manual determination and 1.90% ± 2.02% determined by the network (Pearson correlation coefficient 0.970, P = 6.72 × 10−5). Cell density, hexagonality, and coefficient of variation analyzed by the proposed network for cell borders showed very strong correlations with ground truth (Pearson correlation coefficient 0.989, P = 3.23 × 10−6, Pearson correlation coefficient 0.978, P = 2.66 × 10−5, and Pearson correlation coefficient 0.936, P = 6.20 × 10−4, respectively).

Conclusions:

We demonstrated proof of concept for application of U-Net for objective analysis of corneal endothelial cells and guttae in Fuchs endothelial corneal dystrophy, based on limited ground truth data.
The Role of Macrophage-Derived Exosomes in Liver Diseases
Authors: Lu Wang , Bai Li , Chen Yu
Published: December 2021

Exosomes (exos) widely distributed in a variety of biological fluids, including blood, urine, saliva, sputum, breast milk, cerebrospinal fluid, and ascites, contain specific bioactive contents which are involved in physiological and pathological processes, such as signal molecular transfer, substance metabolism, gene regulation, and immune regulation. Macrophages are important innate immune cells which usually act as the first line of defense against infection, and can switch between different functional phenotypes in response to the changes around the microenvironment. Evidence suggests that macrophage-derived exos exert a crucial effect on infection, inflammation, regeneration, tumors, fibrosis, and other lesions in multiple human diseases. However, the role and mechanism of macrophage-derived exos in liver diseases remain to be explored. This review summarizes the current researches on the role and possible mechanism of macrophage-derived exos in liver diseases, with the purpose of providing new potential targets and directions for diagnostic biomarker and clinical treatment of liver diseases.
Structural and functional alterations in corneal nerves after single-step transPRK
Authors: Liu Chang , Yu Aomiao , Zhang Chen , Li Fei , Huang Yue , Zhao Shaozhen
Published: December 2021

Purpose:

To evaluate the relationship between structural and functional changes of corneal subbasal nerves after single-step transepithelial photorefractive keratectomy (TransPRK).

Setting:

Tianjin Medical University Eye Hospital.

Design:

Prospective observational study.

Methods:

51 eligible candidates who underwent TransPRK for moderate myopia were included. The regeneration of corneal subbasal nerves were evaluated by in vivo confocal microscopy (IVCM) prior to surgery and at 1 week and 1 month, 3 months, 6 months, and 12 months postoperatively. The corneal sensitivity was measured by Cochet-Bonnet esthesiometer. The number of complete and incomplete blinks were recorded by LipiView interferometer. A correlation analysis was performed between these variables.

Results:

51 eyes of 51 patients were enrolled in this study. IVCM revealed that the density and length of corneal nerve decreased immediately and did not return to preoperative levels by 12 months post-TransPRK (P < .01). The mean corneal sensitivity was slightly lower compared with preoperative levels at 1 week postoperatively (P = .001) and then increased to baseline preoperative level within 1 month postoperatively. Mean total blink frequency and the partial blink rates had no statistically significant change postoperatively (P = .087). There was no direct correlation between postoperative recovery of corneal sensitivity, changes in blink frequency, and regeneration of subbasal corneal nerve.

Conclusions:

The significant and prolonged decrease in corneal subbasal nerve morphology was accompanied by only a slight and transient reduction in corneal sensitivity to mechanical stimuli within 1 month after TransPRK. The results demonstrated that the structural changes of subbasal nerves were not parallel to their functional changes after TransPRK.
Mobilizing Ventilated Neurosurgery Patients: An Integrative Literature Review
Authors: Lall Adrianna , Behan Deborah
Published: December 2021

BACKGROUND: Lack of mobilization in ventilated neurosurgery patients is problematic due to significant consequences. Although early mobility addresses these complications, few studies have been conducted in this population, resulting in infrequent mobilization efforts. Nurses prioritize and implement patient care interventions, including mobilization, with multidisciplinary teams. This integrative literature review examines what is known regarding nursing perceptions on mobilization and their role within a multidisciplinary team for mobilization in ventilated neurosurgery patients. METHODS: A comprehensive literature search was conducted using online databases to identify research articles on early mobility studies in ventilated critically ill and neurosurgical patients from 2010 to 2020. RESULTS: Twenty studies were identified and indicated a paucity of research specific to mobilizing ventilated neurosurgery patients. Nurses understand the purpose and benefits of early mobility in critically ill and mechanically ventilated patients. Mixed perceptions exist regarding the responsibility for prioritizing and initiating mobilization. Main barriers include patient safety concerns, untimeliness due to limited resources, unit culture, lack of nursing knowledge, and need for improved teamwork. Associations between teamwork-based interventions and decreased length of stay, increased rates of mobility, and faster time to early mobilization exist. Nurse-led interventions showed additional benefits including positive perceptions such as empowerment, confidence, increased knowledge, and a progressive shift in unit culture. CONCLUSION: This review demonstrates a continued need for understanding nursing perceptions and role in teamwork to mobilize ventilated neurosurgery patients. Future research should focus on testing nurse-led mobility interventions so higher rates of mobilization and provision of holistic patient care can be achieved.
Oral health in primary care: Integration of enhanced oral health education in a nurse practitioner residency program
Authors: Phillips Lori A. , Coan Lorinda L. , Wijesuriya Uditha A.
Published: December 2021

Access to oral health care is challenging, especially for vulnerable populations and those in rural and underserved areas. The purpose of this brief report is to discuss the implementation strategies of enhanced content in oral health educational materials and share results of acquisition of knowledge and confidence in oral health content by residents in a nurse practitioner residency program. The method included the use of 3 surveys of 34 questions administered at different time points measuring confidence levels and sustainability. Results showed the average level of confidence obtained in Posttest1 and in Posttest 2 after 6 months is greater than the pretest. The paired-sample t-test provides significant evidence of improving mean responses for Questions 10, 11, 16, and 32 in Posttest 1 (p-values: .04 each) and Questions 10, 17, 25, and 31 in Posttest2 (p-values: .04 each) compared with the pretest. In conclusion, the addition of enhanced oral health educational materials in our program resulted in improved knowledge and confidence in the residents to incorporate oral health care in their practices.
Cultivating diversity in the advanced practice registered nurse workforce: An exemplar from an advanced practice registered nurse fellowship program
Authors: Raghu Natalie , McNamara Mary , Bettencourt Emily , Yingling Charles
Published: December 2021

Diversity in the nursing workforce is an important driver of patient satisfaction, adherence to care, and quality outcomes. Systemic barriers exist that prevent individuals from underrepresented minority groups entering and advancing in the nursing workforce. To advance the health of the community we serve and with grant support from the Health Resources and Services Administration, we developed a postgraduate advanced practice registered nurse (APRN) fellowship in community health. This program is a partnership between a federally qualified health center and a college of nursing. We developed a deliberate plan to recruit and admit diverse applicants who would continue to practice in our community at the conclusion of their fellowship year. Using targeted recruitment outreach, we identified new-graduate APRNs who were representative of the community we serve. Using holistic review methodology, we interviewed applicants with explicit efforts to mitigate the effects of bias towards race, ethnicity, gender, and academic affiliation. We embraced a quality-improvement ethos that enabled evolution and growth with each iteration of the program. Understanding that intention does not translate to outcomes, we undertook ongoing critique of our methods and engaged diverse resources to improve our processes. Over two admission cycles, our fellowship in community health for new graduate APRNs has demonstrated improvements in strategies to diversify the community health workforce. We will describe our process of nonjudgmental self-critique and a quality-improvement framework that can serve as a strategy to promote diversity, equity, and inclusion in the community health workforce.
Evaluation of the Utility of Liquid-based Cytology, Cell-blocks, and Flow Cytometric Immunophenotyping on Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Samples in the Diagnosis of Sarcoidosis
Authors: Mohapatra Dibyanshu S. , Gupta Parikshaa , Gupta Nalini , Dhooria Sahajal , Singh Sehgal I. , Sharma Shelly , Bal Amanjit , Rohilla Manish
Published: December 2021

Background:

There is little information on the value of different processing methods for samples obtained during endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) in suspected sarcoidosis. We evaluated the role of conventional smears, liquid-based cytology (LBC), cell-blocks and flow cytometric immunophenotyping in the diagnosis of sarcoidosis using EBUS-TBNA samples.

Methods:

This was a prospective study of consecutive EBUS-TBNA samples from clinically suspected cases of sarcoidosis. In addition to conventional smears, we prepared LBC smears, cell-blocks, and performed flow cytometric evaluation of the CD4:CD8 ratio. The final diagnosis of sarcoidosis was made based on the relevant clinical details and laboratory investigations including the results of transbronchial and endobronchial biopsies (TBLB and endobronchial biopsy).

Results:

We included 60 subjects [mean age: 45.2 y; 29 (48.3%) men]. The sensitivity of conventional smears, LBC, and cell-blocks for diagnosing sarcoidosis was found to be 75.5%, 37.8%, 35%, respectively, when used alone. However, on combining conventional and LBC smears, the sensitivity increased to 84.4% and on combining all three techniques, the sensitivity was 86.7%. The CD4:CD8 ratio on flow cytometric immunophenotyping of EBUS-TBNA samples ranged from 0 to 11.5 with a mean of 3.17±2.78 in confirmed cases of sarcoidosis and 70% of these cases had CD4:CD8 ratio of more than 2.

Conclusion:

Cell-blocks and liquid-based preparations add to the yield of conventional preparation of EBUS-TBNA samples in the diagnosis of sarcoidosis. A combination of conventional and LBC works well in detecting almost 85% of the cases of sarcoidosis. Higher CD4:CD8 ratio favors a diagnosis of sarcoidosis.
Chest imaging in patients with acute respiratory failure because of coronavirus disease 2019
Authors: Di Meglio Letizia , Carriero Serena , Biondetti Pierpaolo , Wood Bradford J. , Carrafiello Gianpaolo
Published: December 2021

Purpose of review

This review aims to explore the different imaging modalities, such as chest radiography (CXR), computed tomography (CT), ultrasound, PET/CT scan, and MRI to describe the main features for the evaluation of the chest in COVID-19 patients with ARDS.

Recent findings

This article includes a systematic literature search, evidencing the different chest imaging modalities used in patients with ARDS from COVID-19. Literature evidences different possible approaches going from the conventional CXR and CT to the LUS, MRI, and PET/CT.

CT is the technique with higher sensitivity and definition for studying chest in COVID-19 patients. LUS or bedside CXR are critical in patients requiring close and repeated monitoring. Moreover, LUS and CXR reduce the radiation burden and the risk of infection compared with CT. PET/CT and MRI, especially in ARDS patients, are not usually used for diagnostic or follow-up purposes.
Outcomes of Fecal Microbiota Transplantation for C. difficile Infection in Inflammatory Bowel Disease
Authors: Tariq Raseen , Syed Tausif , Yadav Devvrat , Prokop Larry J. , Singh Siddharth , Loftus Edward V. , Pardi Darrell S. , Khanna Sahil
Published: December 2021

Background:

Fecal microbiota transplantation (FMT) is a safe and effective therapy for recurrent Clostridioides difficile infection (CDI). Data on FMT for CDI in patients with underlying inflammatory bowel disease (IBD) are emerging but conflicting. We performed a systematic review and meta-analysis to describe the efficacy and safety of FMT for CDI in IBD and its impact on IBD outcomes.

Methods:

A systematic search of multiple databases including Embase, Scopus, and Web of Science was performed. Our primary analysis focused on pooled rate of CDI resolution after single and multiple FMTs in IBD patients. Additional analyses included rates of IBD-associated outcomes (flare, surgery, symptom improvement) after FMT. The random-effects model was used to calculate pooled rates.

Results:

Among 457 adult patients, 363 had CDI resolution after first FMT with a pooled cure rate of 78% [95% confidence interval (CI): 73%-83%; I
2=39%]. Overall pooled rate cure rate with single and multiple FMTs was 88% (95% CI: 81%-94%; I
2=73%). The pooled rate of an IBD flare after FMT was 26.8% (95% CI: 22.5%-31.6%; I
2=9%) and of colectomy was 7.3% (95% CI: 4.7%-10.5%; I
2=56%). Among 141 pediatric patients, 106 had CDI resolution after first FMT with pooled cure rate of 78% (95% CI: 58%-93%; I
2=59%). Overall pooled cure rate with single and multiple FMTs was 77% (95% CI: 50%-96%; I
2=63%). The pooled rate of an IBD flare after FMT was 10.8% (95% CI: 5.7%-18.5% I
2=43%), and of colectomy was 10.3% (95% CI: 2.1%-30.2% I
2=23%).

Conclusions:

FMT appears to be a highly effective therapy for preventing recurrent CDI in patients with IBD. Patients who fail a single FMT may benefit from multiple FMTs.
Polypharmacy in Patients With Inflammatory Bowel Disease
Authors: Mesonero Francisco , Fernández Cristina , Sánchez-Rodríguez Eugenia , García-García Paredes Ana , Senosiain Carla , Albillos Agustín , López-Sanromán Antonio
Published: December 2021

Background:

Polypharmacy can complicate the course and management of chronic diseases, and has been little explored in patients with inflammatory bowel disease (IBD) to date.

Aim:

The aim of this study was to determine the prevalence of polypharmacy in a series of IBD patients, describing associated factors and its correlation with poor disease outcomes.

Materials and Methods:

Retrospective study of a single-center series. Polypharmacy was defined as the simultaneous use of 5 or more drugs. Disease outcomes, IBD treatment nonadherence and undertreatment were evaluated at 1 year.

Results:

A total of 407 patients were included [56% males, median age: 48 y (interquartile range, 18 to 92 y)], of whom 60.2% had Crohn’s disease; Chronic comorbidity and multiple comorbidities were present in 54% and 27% of patients, respectively. Median number of prescriptions per patient was 3 (range: 0 to 15). Polypharmacy was identified in 18.4% of cases, inappropriate medication in 10.5% and use of high-risk drugs in 6.1% (mainly opioids). In multivariate analysis, polypharmacy was associated with chronic comorbidity [odds ratio (OR)=10.1, 95% confidence interval (CI): 2.14-47.56; P˂0.003], multiple comorbidities (OR=3.53, 95% CI: 1.46-8.51; P=0.005) and age above 62 years (OR=3.54, 95% CI: 1.67-7.51; P=0.001). No association with poor disease outcomes was found at 12 months. However, polypharmacy was the only factor associated with IBD treatment nonadherence (OR=2.24, 95% CI: 1.13-4.54, P=0.02).

Conclusions:

Polypharmacy occurs in around 1 in 5 patients with IBD, mainly in older adults and those with comorbidity. This situation could interfere with adherence to IBD treatment and therapeutic success.
Maximizing diabetes education efforts in vulnerable populations – newer delivery concepts
Authors: Torres Hugo A. , Schmidt Vanessa A.
Published: December 2021

Purpose of review

Patients from ethnic/minority backgrounds or low socioeconomic status face numerous barriers to achieving ideal diabetes care goals. The purpose of this review is to describe the burden of diabetes in vulnerable populations; discuss the etiologic factors leading to health disparities in diabetes; and present challenges and solutions to improving diabetes care through novel diabetes self-management education and support interventions.

Recent findings

Recent interventions to alleviate health disparities utilize a combination of community health workers, peer leaders and technology-based approaches to provide diabetes self-management education and support and overcome barriers to diabetes control such as low literacy, difficulty with transportation, and cultural beliefs. These interventions achieve clinically meaningful improvements in blood glucose control as measured by haemoglobin A1C and are effective in addressing psychosocial outcomes such as diabetes distress. Research is underway to address food insecurity through food delivery and use behavioural economics principles to provide financial incentives to diabetes control.

Combining human interaction through peer or community health worker led diabetes educational efforts and support with technology-based interventions shows promise in improving diabetes outcomes for vulnerable populations.
Growth and development in type 1 diabetes
Authors: Koren Dorit
Published: December 2021

Purpose of review

The purpose of this review is to summarize the current literature on the subject of linear growth in children and adolescents with or at risk for type 1 diabetes mellitus (T1DM).

Recent findings

Poor glycemic control in T1DM is associated with growth hormone resistance, and improving glycemic control can improve linear growth. Newer reports suggest that the increasingly popular very low carbohydrate diets, may reduce linear growth velocity.

Linear growth during childhood is a complex process regulated influenced by genetic, hormonal, nutritional and environmental factors. Linear growth may be impaired in children with T1DM, correlating with poor metabolic control; an extreme example is Mauriac syndrome. This decrement in linear growth appears to be driven in part by a reduction in growth hormone responsiveness, leading to low insulin-like growth factor-1 (IGF-1) levels. Improving glycemic control can lead to improved IGF-1 levels and linear growth. Other factors associated with poor linear growth in T1DM include celiac disease and dietary alterations, with early reports suggesting that very low carbohydrate diets, if not carefully managed, may increase risk of attenuated linear growth. This review examines the latest data regarding the associations between T1DM and linear growth in children.
Growth and development in monogenic forms of neonatal diabetes
Authors: Hammoud Batoul , Greeley Siri Atma W.
Published: December 2021

Purpose of review

Neonatal diabetes mellitus (NDM) is a rare disorder in which 80–85% of infants diagnosed under 6 months of age will be found to have an underlying monogenic cause. This review will summarize what is known about growth and neurodevelopmental difficulties among individuals with various forms of NDM.

Recent findings

Patients with NDM often have intrauterine growth restriction and/or low birth weight because of insulin deficiency in utero and the severity and likelihood of ongoing growth concerns after birth depends on the specific cause. A growing list of rare recessive causes of NDM are associated with neurodevelopmental and/or growth problems that can either be related to direct gene effects on brain development, or may be related to a variety of co-morbidities. The most common form of NDM results in spectrum of neurological disability due to expression of mutated KATP channels throughout the brain.

Monogenic causes of neonatal diabetes are characterized by variable degree of restriction of growth in utero because of deficiency of insulin that depends on the specific gene cause. Many forms also include a spectrum of neurodevelopmental disability because of mutation-related effects on brain development. Longer term study is needed to clarify longitudinal effects on growth into adulthood.
Derivation and validation of a 18F-FDG PET/CT scoring model to predict malignant pleural effusion
Authors: Lu Peiou , Sun Yajuan , Liang Bangyu , Yu Lijuan
Published: December 2021

Objective

To develop an 18F-fluorodeoxyglucose PET/computed tomography (CT) scoring model based on metabolic and radiologic findings of the pleura and fluid to identify malignant pleural effusion.

Methods

The PET and CT findings from patients with pleural effusion in the derivation dataset were used to develop a scoring model. Then, the diagnostic accuracy of the predictive score was verified by the validation dataset.

Results

Eight parameters independently predicting malignancy were retained in the scoring model, including pleural nodules or masses (4 points), focal pleural thickening (2 points), absence of pleural loculation (2 points), thickness of mediastinal pleura involvement ≥0.5 cm (2 points), maximum standardized uptake value (SUVmax) of mediastinal pleura involvement ≥2.3 (2 points), thickness of nonmediastinal pleura involvement ≥0.5 cm (1 point), SUVmax of nonmediastinal pleura involvement ≥3.0 (1 point) and fluid SUVmax ≥1.6 (1 point). The operating characteristics of the PET/CT score were 0.958 area under the curve (AUC), 88.6% sensitivity, 91.2% specificity, 10.09 positive likelihood ratio and 0.13 negative likelihood ratio, with 6 points as the threshold. These values in the validation dataset were 0.947, 91.7%, 88.4%, 7.91 and 0.094, respectively. No difference was found in AUCs between the derivation and validation datasets (z = 0.517, P = 0.697). The negative predictive value was 99.4% in the score from 0 to 2, and the positive predictive value was 98.3% for patients with score between 9 and 15.

Conclusions

The PET/CT scoring model is a valuable strategy to help physicians to distinguish malignant–benign pleural effusion and stratify patients who will benefit from invasive procedures.
Reduction of radiation accumulation in salivary glands through oral vitamin C during 68Ga-PSMA-11 total-body dynamic PET/CT imaging
Authors: Yu Haojun , Lv Jing , Hu Pengcheng , Chen Shuguang , Shi Hongcheng
Published: December 2021

Objective

This study explored the utility of oral vitamin C in reducing radiation accumulation in the salivary glands during total-body dynamic PET/computed tomography (CT) imaging with 68Ga labeled Prostate-specific membrane antigen (68Ga-PSMA-11).

Methods

We enrolled 31 patients who underwent total-body dynamic PET/CT imaging with 68Ga-PSMA-11, of which 11 were given oral vitamin C 30 min after starting the dynamic PET acquisition, whereas the others did not. The volume of interest was automatically segmented on the parotid and submandibular salivary glands once the PET acquisition was completed. The standard uptake value (SUV)mean and its slope during 30–60 min of the acquisition were compared between the trial and control groups.

Results

The SUVmean of the left and right parotid and submandibular glands in the trial group were 15.37 ± 3.07, 15.03 ± 2.64, 14.92 ± 4.38 and 15.38 ± 4.18, respectively. The respective values of the control group were 19.37 ± 3.82, 20.08 ± 3.55, 22.61 ± 5.62 and 22.73 ± 5.90. The SUVmean slope during 30–60 min of acquisition for the left and right parotid and submandibular glands in the trial group were 0.63 ± 0.13, 0.64 ± 0.14, 0.56 ± 0.25 and 0.62 ± 0.26, respectively. The respective values of the control group were 0.84 ± 0.21, 0.84 ± 0.17, 1.01 ± 0.34 and 1.02 ± 0.37.

Conclusion

Oral vitamin C could reduce the accumulation of radiation in the salivary glands during 68Ga-PSMA-11 total-body dynamic PET/CT imaging.