bluuebunny/crossref_metadata_2025 huggingface dataset:
Contact heat evoked potentials in knowledge workers and unskilled labors
Authors: Sun Bo , Li Yan-Ran , Wang Hong-Fen , Cui Fang , Ling Li , Yang Fei , Chen Zhao-Hui , Huang Xu-Sheng
Published: February 2020

Background:

Whether occupation has an impact on contact heat evoked potential (CHEP) results has not been investigated. In this study, we investigated the difference of CHEP parameters between knowledge workers and unskilled labors.

Methods:

A total of 137 healthy participants were recruited between November 20, 2014 and December 31, 2016. All participants underwent neurologic examination, laboratory examination, and nerve conduction studies. CHEP was performed on four body sites: the upper border of the distal third of the volar forearm, the upper border of the distal third of the lateral leg, the spinous process of seventh cervical vertebrae (C7), and the spinous process of 12th thoracic vertebrae (T12). Independent t test and nonparametric test were performed using SPSS software to compare the difference of the CHEP parameters between knowledge workers and unskilled labors.

Results:

The “N2 latency/height” (Z = −2.290, P = 0.022) and “P2 latency/height” (Z = −2.020, P = 0.043) on the volar forearm of unskilled labors significantly increased than those of knowledge workers. The “N2 latency/height” (F = 6.348, P = 0.016) and “P2 latency/height” (F = 5.920, P = 0.018) in the distal leg of unskilled labors significantly prolonged than those of knowledge workers. The N2-P2 amplitude (F = 5.797, P = 0.020) in the distal leg of unskilled labors significantly decreased than those of knowledge workers.

Conclusions:

Our study found that significantly prolonged N2 latency and P2 latency and significantly decreased N2-P2 amplitude in the distal leg and the volar forearm in unskilled labors as to knowledge workers.
Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study
Authors: Ren Li-Li , Wang Ye-Ming , Wu Zhi-Qiang , Xiang Zi-Chun , Guo Li , Xu Teng , Jiang Yong-Zhong , Xiong Yan , Li Yong-Jun , Li Xing-Wang , Li Hui , Fan Guo-Hui , Gu Xiao-Ying , Xiao Yan , Gao Hong , Xu Jiu-Yang , Yang Fan , Wang Xin-Ming , Wu Chao , Chen Lan , Liu Yi-Wei , Liu Bo , Yang Jian , Wang Xiao-Rui , Dong Jie , Li Li , Huang Chao-Lin , Zhao Jian-Ping , Hu Yi , Cheng Zhen-Shun , Liu Lin-Lin , Qian Zhao-Hui , Qin Chuan , Jin Qi , Cao Bin , Wang Jian-Wei
Published: February 2020

Background

Human infections with zoonotic coronaviruses (CoVs), including severe acute respiratory syndrome (SARS)-CoV and Middle East respiratory syndrome (MERS)-CoV, have raised great public health concern globally. Here, we report a novel bat-origin CoV causing severe and fatal pneumonia in humans.

Methods

We collected clinical data and bronchoalveolar lavage (BAL) specimens from five patients with severe pneumonia from Wuhan Jinyintan Hospital, Hubei province, China. Nucleic acids of the BAL were extracted and subjected to next-generation sequencing. Virus isolation was carried out, and maximum-likelihood phylogenetic trees were constructed.

Results

Five patients hospitalized from December 18 to December 29, 2019 presented with fever, cough, and dyspnea accompanied by complications of acute respiratory distress syndrome. Chest radiography revealed diffuse opacities and consolidation. One of these patients died. Sequence results revealed the presence of a previously unknown β-CoV strain in all five patients, with 99.8% to 99.9% nucleotide identities among the isolates. These isolates showed 79.0% nucleotide identity with the sequence of SARS-CoV (GenBank NC_004718) and 51.8% identity with the sequence of MERS-CoV (GenBank NC_019843). The virus is phylogenetically closest to a bat SARS-like CoV (SL-ZC45, GenBank MG772933) with 87.6% to 87.7% nucleotide identity, but is in a separate clade. Moreover, these viruses have a single intact open reading frame gene 8, as a further indicator of bat-origin CoVs. However, the amino acid sequence of the tentative receptor-binding domain resembles that of SARS-CoV, indicating that these viruses might use the same receptor.

Conclusion

A novel bat-borne CoV was identified that is associated with severe and fatal respiratory disease in humans.
Physical Activity, Sleep, Body Mass Index, and Associated Risk of Behavioral and Emotional Problems in Childhood
Authors: Slykerman Rebecca F. , Budd Christopher , Thompson John M. D. , Bekker Marthinus , Buckley Jude , Wall Clare , Murphy Rinki , Mitchell Edwin A. , Waldie Karen E.
Published: February 2020

Objective:

Cross-sectional data indicate that physical activity, longer sleep duration, and normal body weight are associated with better mental health in childhood. It is less clear whether these factors protect against future emotional and behavioral problems. We investigated whether physical activity, sleep duration, and body mass index (BMI) at the age of 7 years are associated with emotional and behavioral problems at the age of 11 years.

Methods:

Children born to European mothers enrolled in the prospective longitudinal Auckland Birthweight Collaborative Study (N = 871) were assessed at birth and ages 7 and 11 years. Physical activity and sleep duration were measured using accelerometer. BMI was calculated from height and weight measurement. Outcome variables assessed at the age of 11 years were parent and child self-report Strengths and Difficulties Questionnaire and parent and teacher Conners' Rating Scale scores.

Results:

Physical activity, sleep duration, and BMI at the age of 7 years were not significantly associated with emotional and behavioral problems at the age of 11 years. In cross-sectional analysis at the age of 11 years, there was no significant association between physical activity or sleep duration and emotional and behavioral problems. Children with a BMI in the overweight or obese range were significantly more likely to have teacher-rated behavior problems and parent-rated emotional or behavioral problems after adjustment for potential confounders.

Conclusion:

Although physical activity and sleep have physical health benefits, they may not be protective against future emotional and behavioral problems in childhood in the general population. BMI in the obese or overweight range was significantly associated with current emotional and behavioral problems at the age of 11 years.
Sequential Treatment of Superficial Basal Cell Carcinomas With Topical Methyl Aminolevulinate Photodynamic Therapy and Imiquimod 5% Cream: A Retrospective Study of Clinical and Cosmetic Outcomes
Authors: Logan Ian T. , Kulakov Elizabeth L. , Perrett Conal M.
Published: February 2020

BACKGROUND

Topical photodynamic therapy (PDT) and imiquimod 5% (IMQ) cream are established treatments for superficial basal cell carcinoma (sBCC). Both have high initial response rates and recurrence rates of up to 37%. Recent studies demonstrate that PDT and imiquimod may act on sBCCs via synergistic immunomodulatory pathways.

OBJECTIVE

To describe the sequential use of MAL-PDT and imiquimod 5% cream in the treatment of sBCCs and report treatment tolerability, cosmetic outcomes, and efficacy.

MATERIALS AND METHODS

This is a retrospective case series of patients presenting over a 2-year period with primary sBCC who underwent 2 cycles of topical MAL-PDT, followed by 6 weeks of imiquimod 5% cream. Outcome measures were resolution of the index lesion at 3 months, side effects, cosmetic outcome, and long-term recurrence (LTR).

RESULTS

A total of 17 consecutive patients (n = 17) with a combined 21 sBCCs (n = 21) were included. The median length of follow-up was 72 months (range 24–95 months). Long-term recurrence occurred in 2/21 lesions (10%).

CONCLUSION

Sequential use of PDT and imiquimod was well tolerated with good cosmetic outcomes. The 10% LTR rate is at the lower end of the range reported for single modality treatment; however, larger samples are required to evaluate efficacy differences.
Validation of Questionnaire-based Case Definitions for Chronic Obstructive Pulmonary Disease
Authors: Feinstein Lydia , Wilkerson Jesse , Salo Paivi M. , MacNell Nathaniel , Bridge Matthew F. , Fessler Michael B. , Thorne Peter S. , Mendy Angelico , Cohn Richard D. , Curry Matthew D. , Zeldin Darryl C.
Published: February 2020

Background:

Various questionnaire-based definitions of chronic obstructive pulmonary disease (COPD) have been applied using the US representative National Health and Nutrition Examination Survey (NHANES), but few have been validated against objective lung function data. We validated two prior definitions that incorporated self-reported physician diagnosis, respiratory symptoms, and/or smoking. We also validated a new definition that we developed empirically using gradient boosting, an ensemble machine learning method.

Methods:

Data came from 7,996 individuals 40–79 years who participated in NHANES 2007–2012 and underwent spirometry. We considered participants “true” COPD cases if their ratio of postbronchodilator forced expiratory volume in 1 second to forced vital capacity was below 0.7 or the lower limit of normal. We stratified all analyses by smoking history. We developed a gradient boosting model for smokers only; predictors assessed (25 total) included sociodemographics, inhalant exposures, clinical variables, and respiratory symptoms.

Results:

The spirometry-based COPD prevalence was 26% for smokers and 8% for never smokers. Among smokers, using questionnaire-based definitions resulted in a COPD prevalence ranging from 11% to 16%, sensitivity ranging from 18% to 35%, and specificity ranging from 88% to 92%. The new definition classified participants based on age, bronchodilator use, body mass index (BMI), smoking pack-years, and occupational organic dust exposure, and resulted in the highest sensitivity (35%) and specificity (92%) among smokers. Among never smokers, the COPD prevalence ranged from 4% to 5%, and we attained good specificity (96%) at the expense of sensitivity (9-10%).

Conclusion:

Our results can be used to parametrize misclassification assumptions for quantitative bias analysis when pulmonary function data are unavailable.
Therapeutic Drug Monitoring of HIV Antiretroviral Drugs in Pregnancy: A Narrative Review
Authors: O'Kelly Brendan , Murtagh Ross , Lambert John S.
Published: February 2020

To date, therapeutic drug monitoring (TDM) has played an important role in the management of pregnant HIV patients on highly active antiretroviral therapy. Historically, in pregnant women living with HIV, the third agent in triple therapy has been either non-nucleoside reverse transcriptase inhibitors or protease inhibitors (PIs). PIs have been the preferred agents because of their robustness from the perspective of viral resistance and the dominant drug class for the management of HIV during pregnancy for the previous decade. As with many drugs used during pregnancy, pharmacokinetic changes decrease exposure to these agents as the pregnancy progresses. This can lead to viral escape at the time of pregnancy and ultimately increase the risk of mother-to-child transmission (MTCT) of HIV. TDM has been well-established for this class of highly active antiretroviral therapy, and appropriate dose adjustment studies have been performed. At present, there is a shift from the traditional treatment paradigm in pregnancy to a new drug class, integrase strand transfer inhibitors (INSTIs). Although INSTIs are affected by pharmacokinetic changes during pregnancy, they do not harbor the same issues with viral escape as seen with PIs at birth and in general eliminate the need for boosting with additional agents like ritonavir (r) and cobicistat (c) [bar elvitegravir (EVG)] that can lead to interactions with treatment of other common infections in HIV, including tuberculosis. Furthermore, INSTIs are the most successful medication for rapidly reducing the viral load (VL) in HIV patients, a useful factor where VL may be unknown, or in late presenters. These merits make INSTIs the best choice in pregnancy, although their use has been hindered in recent years by a report of neural tube defects from a large African study with dolutegravir (DTG). New data from Botswana and Brazil indicate that this risk is less significant than previously reported, necessitating further data to shed light on this critical issue. Current international guidelines including DHHS, EACS, WHO, and BHIVA (for patients with VLs >100,000 copies/mL or late presenters) now recommend INSTIs as first-line agents. The role of TDM in INSTIs shifts to cases of insufficient viral suppression with standard adherence measures, cases of drug–drug interactions, or cases where EVG/c is continued throughout pregnancy, and thus remains an important aspect of HIV care in pregnancy.
Induction of labor with an unfavorable cervix
Authors: Solone Michelle , Shaw Kate A.
Published: February 2020

Purpose of review

Recent evidence supports elective induction of labor after 39 weeks; however, labor induction in patients with an unfavorable cervix, a Bishop score less than 6, may take several days. In this review, we focus on the efficacy and safety of methods of labor induction for the unfavorable cervix.

Recent findings

Recent evidence on the use of mechanical cervical preparation with transcervical balloons suggests balloons are the most effective option for decreasing time to delivery in the nulliparous patient. Single and double balloons are equally effective, with a volume of more 30 ml being more effective. The addition of misoprostol or oxytocin concurrently with a balloon further expedites time to delivery.

Mechanical dilation should be considered when available and technically possible for labor induction in patients with an unfavorable cervix. Misoprostol is an effective adjunct to trans-cervical balloons, further decreasing time to delivery as compared with balloon alone. When misoprostol is contraindicated, oxytocin is a safe, effective, alternative adjunct to trans-cervical balloons. More research is needed to evaluate safe outpatient options, induction methods in the setting of prior cesarean with an unfavorable cervix, and to directly compare misoprostol with oxytocin as adjuncts to transcervical balloons.
Augmented Reality Technology for the Positioning of the Auricle in the Treatment of Microtia
Authors: Nuri Takashi , Mitsuno Daisuke , Otsuki Yuki , Ueda Koichi
Published: February 2020

Background:

The positioning of the auricle is a key factor in successful ear reconstruction. However, the position of the ear is usually determined by transferring the auricle image of the nonaffected side to the affected side using a transparent film. Augmented reality (AR) is becoming useful in the surgical field allowing computer-generated images to be superimposed on patients. In this report, we would like to introduce an application of AR technology in ear reconstruction.

Methods:

AR technology was used to determine the position of the reconstructed ear of a 10-year-old male with right microtia. Preoperative 3-dimensional photographs of the nonaffected side were taken using VECTRAH1. Then, the image was horizontally inverted and superimposed on the three-dimensional image of the affected side with reference to the anatomical landmarks of the patient’s face. These images were projected onto the patient in the operation room using Microsoft’s HoloLens. The design and positioning of the auricle was done with reference to the AR image. To confirm the accuracy of the AR technique, we compared it to the original transparent film technique. After the insertion of the cartilage framework into the skin pocket, the position and shape of the reconstructed ear was confirmed using the AR technology.

Results:

The positioning of the reconstructed ear was successfully performed. The deviation between the 2 designated positions using the AR and the transparent film was within 2 mm.

Conclusion:

The AR technology is a promising option in the surgical treatment of microtia.
Effects of third-generation β-blockers, atenolol or amlodipine on blood pressure variability and target organ damage in spontaneously hypertensive rats
Authors: Del Mauro Julieta S. , Prince Paula D. , Allo Miguel A. , Santander Plantamura Yanina , Morettón Marcela A. , González Germán E. , Bertera Facundo M. , Carranza Andrea , Gorzalczany Susana B. , Chiappetta Diego A. , Morales Celina , Gelpi Ricardo J. , Taira Carlos A. , Polizio Ariel H. , Donato Martín , Höcht Christian
Published: February 2020

Background:

β-blockers are no longer considered as first-line antihypertensive drugs due to their lower cardioprotection.

Method:

Considering the differences in the pharmacological properties of β-blockers, the present work compared the effects of third-generation β-blockers – carvedilol and nebivolol – with a first-line agent – amlodipine – on hemodynamic parameters, including short-term blood pressure variability (BPV), and their ability to prevent target organ damage in spontaneously hypertensive rats (SHR). SHR rats were orally treated with carvedilol, nebivolol, atenolol, amlodipine or vehicle for 8 weeks. Wistar Kyoto rats treated with vehicle were used as normotensive group. Echocardiographic evaluation, BP, and short-term BPV measurements were performed. Left ventricle and thoracic aorta were removed for histological evaluations and to assess the expression of transforming growth factor β (TGF-β), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).

Results:

Carvedilol, nebivolol or amlodipine induced a greater reduction of carotid BP, short-term BPV and echocardiography parameters than atenolol in SHR rats. Carvedilol, nebivolol and amlodipine were more effective than atenolol in the prevention of cardiac hypertrophy, and cardiac and aortic collagen deposit. Carvedilol and nebivolol, but not atenolol, reduced the expressions of fibrotic and inflammatory biomarkers – TGF-β, TNF-α and IL-6 – in SHR rats to a similar extent to that of amlodipine.

Conclusion:

Chronic treatment with carvedilol or nebivolol attenuates carotid BP and short-term BPV, and reduces target organ damage in SHR to a greater extent than atenolol. Our findings suggest that the lower cardiovascular protection of nonvasodilating β-blockers, as atenolol, in hypertension must not be translated to third-generation β-blockers.
Impact of antihypertensive treatment on resiliency to clinical pain
Authors: Davydov Dmitry M.
Published: February 2020

Objectives:

Although progress has been made in the regulation of hypertension over the past decades, the USA and some other countries have faced a significant rise in incidence of chronic pain management cases during the same period. Studies of the relationship between pain and blood pressure (BP) regulations propose that these two processes may be interconnected. Studies of effects of antihypertensive treatment on pain in general and its chronification have never been reviewed.

Methods:

A narrative review of respective studies with analysis of credibility of the findings was conducted.

Results:

Some studies have suggested that aggressive reduction of high BP may contribute to a return in pain symptoms and may require more aggressive, long-term pain management. Other studies propose that long-term antihypertensive medication could also increase the risk for new cases of chronic pain. Pain initiates a central neuroplastic resetting of the baroreceptor activation accounting for sustained increase of BP with an adaptive ‘pain-killing’ or maladaptive ‘pain-complication’ effect associated with pain chronification, and these mechanisms may be moderated by antihypertensive medications. However, different antihypertensive drugs and nondrug treatments may diversely affect pain mechanisms at different stages of treatments.

Conclusion:

Uncontrollable reduction of high BP in some patients with hypertension could increase the risk for chronic pain incidence and its severity. Practical recommendations in BP control should be reconsidered to take into account patients’ chronic pain. Further research is needed of moderation effects of different antihypertensive manipulations on pain to improve pain management in these patients.
Association of arterial stiffness with left atrial structure and phasic function: a community-based cohort study
Authors: Yoshida Yuriko , Nakanishi Koki , Daimon Masao , Ishiwata Jumpei , Sawada Naoko , Hirokawa Megumi , Kaneko Hidehiro , Nakao Tomoko , Mizuno Yoshiko , Morita Hiroyuki , Di Tullio Marco R. , Homma Shunichi , Komuro Issei
Published: February 2020

Objectives:

Increased arterial stiffness is currently recognized as an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. This study aimed to investigate the association of arterial stiffness with left atrial (LA) volume and phasic function in a community-based cohort.

Methods:

We included 1156 participants without overt cardiovascular disease who underwent extensive cardiovascular examination. Arterial stiffness was evaluated by cardio-ankle vascular index (CAVI). Speckle-tracking echocardiography was employed to evaluate LA phasic function including reservoir, conduit, and pump strain as well as left ventricular global longitudinal strain (LVGLS).

Results:

CAVI was negatively correlated with reservoir and conduit strain (r = −0.37 and −0.45, both P < 0.001), whereas weakly, but positively correlated with LA volume index and pump strain (r = 0.12 and 0.09, both P < 0.01). In multivariable analysis, CAVI was significantly associated with reservoir and conduit strain independent of traditional cardiovascular risk factors and LV morphology and function including LVGLS (standardized β = −0.22 and −0.27, respectively, both P < 0.001), whereas there was no independent association with LA volume index and pump strain. In the categorical analysis, the abnormal CAVI (≥9.0) carried the significant risk of impaired reservoir and conduit strain (adjusted odds ratio = 2.61 and 3.73 vs. normal CAVI, both P < 0.01) in a fully adjusted model including laboratory and echocardiographic parameters.

Conclusion:

Arterial stiffness was independently associated with LA phasic function, even in the absence of overt cardiovascular disease, which may explain the higher incidence of atrial fibrillation in individuals with increased arterial stiffness.
LONGITUDINAL STUDY OF RPE65-ASSOCIATED INHERITED RETINAL DEGENERATIONS
Authors: Pierrache Laurence H. M. , Ghafaryasl Babak , Khan Muhammad I. , Yzer Susanne , van Genderen Maria M. , Schuil José , Boonstra F. Nienke , Pott Jan W. R. , de Faber Jan Tjeerd H. N. , Tjon-Fo-Sang Martha J. H. , Vermeer Koenraad A. , Cremers Frans P. M. , Klaver Caroline C. W. , van den Born L. Ingeborgh
Published: February 2020

Purpose:

To study the disease course of RPE65
-associated inherited retinal degenerations (IRDs) as a function of the genotype, define a critical age for blindness, and identify potential modifiers.

Methods:

Forty-five patients with IRD from 33 families with biallelic RPE65 mutations, 28 stemming from a genetic isolate. We collected retrospective data from medical charts. Coexisting variants in 108 IRD-associated genes were identified with Molecular Inversion Probe analysis.

Results:

Most patients were diagnosed within the first years of life. Daytime visual function ranged from near-normal to blindness in the first four decades and met WHO criteria for blindness for visual acuity and visual field in the fifth decade. p.(Thr368His) was the most common variant (54%). Intrafamilial variability and interfamilial variability in disease severity and progression were observed. Molecular Inversion Probe analysis confirmed all RPE65 variants and identified one additional variant in LRAT and one in EYS in two separate patients.

Conclusion:

All patients with RPE65-associated IRDs developed symptoms within the first year of life. Visual function in childhood and adolescence varied but deteriorated inevitably toward blindness after age 40. In this study, genotype was not predictive of clinical course. The variance in severity of disease could not be explained by double hits in other IRD genes.
CURRENT CONCEPTS AND MODALITIES FOR MONITORING THE FELLOW EYE IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Wong Tien Yin , Lanzetta Paolo , Bandello Francesco , Eldem Bora , Navarro Rafael , Lövestam-Adrian Monica , Loewenstein Anat
Published: February 2020

Purpose:

The presence of neovascular age-related macular degeneration (nAMD) in one eye is a major risk factor for the development of disease in the fellow eye. Several methods exist to help physicians monitor the fellow eye, with new technologies becoming increasingly available.

Methods:

We provide an overview of modalities for nAMD monitoring, including advances in home-based options, and review their utility for fellow-eye monitoring, based on a review of the literature and a consensus of retinal experts.

Results:

Studies demonstrate the importance of early detection of nAMD in the fellow eye so that interventions can be made before significant vision loss occurs. A series of techniques exist for the early detection of nAMD including chart-based methods and imaging devices. The increased availability of home-based methods has presented an opportunity for patients to monitor their vision at home.

Conclusion:

Frequent monitoring of the fellow eye in patients with unilateral nAMD is of critical importance to prevent vision loss and maintain quality of life. Patients should be examined every 3 to 4 months from the time of choroidal neovascularization diagnosis and encouraged to monitor their vision at home using home-based technologies where available, to provide the best opportunity for early detection.
MULTIMODAL IMAGING IN HELLP-RELATED CHORIORETINOPATHY
Authors: Van Rysselberge Camille , Balikova Irina , Judice Lia , Makhoul Dorine , Postelmans Laurence
Published: February 2020

Purpose:

To illustrate with multimodal imaging a case of HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) complicated by bilateral multifocal serous retinal detachments, subretinal exudation, and papilledema.

Methods:

Case report. Fundus photography, spectral domain optical coherence tomography (SD-OCT), fluorescein angiography, and indocyanine green angiography were performed at presentation and the day after. We also present the SD-OCT follow-up at 8 days, 1 year, and 4 years.

Results:

A 25-year-old 5-month-pregnant Guinean woman complained about decreased visual acuity in the right eye. Eye fundus and multimodal imaging were abnormal in both eyes. Spectral domain optical coherence tomography showed the presence of multifocal serous retinal detachments, subretinal deposits, and intraretinal cysts. Indocyanin green angiography revealed an irregular choroidal perfusion and localized choroidal ischemia. Spectral domain optical coherence tomography also provided assessment of retinal changes during the long-term follow-up, showing tissue damage in the outer retina.

Conclusion:

Serous retinal detachments during pregnancy can be the leading sign of HELLP syndrome—a potentially life-threatening condition. Spectral domain optical coherence tomography is a noninvasive and useful tool for its diagnosis and follow-up. ICG is important to confirm the choroidal ischemia and choroidal vascular abnormalities, underlying conditions leading to main sign of HELLP syndrome in the eye.
AUTOFLUORESCENT TIMELINE OF SPOTS AND DOTS IN MULTIPLE EVANESCENT WHITE DOT SYNDROME
Authors: Scharf Jackson M. , Hilely Assaf , Freund K. Bailey , Sarraf David
Published: February 2020

Purpose:

To describe the recovery timeline of spots and dots in multiple evanescent white dot syndrome.

Methods:

Sequential multimodal retinal imaging including fundus autofluorescence and cross-sectional and en face optical coherence tomography was performed to track the development and resolution of spots and dots in a case of multiple evanescent white dot syndrome.

Results:

En face optical coherence tomography showed that the spots are the result of ellipsoid zone loss and are hyperautofluorescent due to unmasking of the underlying retinal pigment epithelium autofluorescence. Conversely, the dots are hyperreflective with cross-sectional and en face optical coherence tomography and hyperautofluorescent, which we propose may be due to accumulation of degenerated photoreceptor material including fluorophores with autofluorescent capability such as precursors of A2E. The earlier resolution of the hyperautofluorescent spots allowed for later detection of the hyperautofluorescent dots.

Conclusion:

This case report illustrates the different recovery timelines of spots and dots in multiple evanescent white dot syndrome. Although both lesion types are hyperautofluorescent, the mechanism of autofluorescence is distinctive and may be explained by their contrasting pathoanatomy.
Surgical Treatment of Massive Teratoma of the Orbit
Authors: Bojino Alessandro , Zavattero Emanuele , Gambella Alessandro , Gerbino Giovanni
Published: February 2020

Orbital location of teratoma is extremely rare. The differential diagnosis can be difficult and they may be mistaken for other tumors as they may have both cystic and solid areas. The authors report a case of a 7-day-old neonate with a massive congenital orbital teratoma in which it was decided to apply a surgical technique that involves the aspiration of the cystic fluid, the subsequent infusion of fibrin glue, and the radical excision. The definitive histological examination reported a diagnosis of trifillic cystic teratoma. At fourth year of follow up the patient is free from disease.
Clinical and Morphologic Outcomes of Minimally Invasive Direct Corneal Neurotization
Authors: Wisely C. Ellis , Rafailov Leon , Cypen Sanja , Proia Alan D. , Boehlke Christopher S. , Leyngold Ilya M.
Published: February 2020

Purpose:

To describe clinical outcomes of a minimally invasive technique for direct corneal neurotization to treat neurotrophic keratopathy.

Methods:

All cases of corneal neurotization for neurotrophic keratopathy performed by a single surgeon using minimally invasive direct corneal neurotization were reviewed. The supraorbital donor nerve was directly transferred to the cornea through an upper eyelid crease incision using either a combination of endoscopic and direct visualization or direct visualization alone. Detailed ocular and adnexal examinations as well as Cochet–Bonnet esthesiometry of the affected cornea were performed. Corneal histopathology and in vivo confocal microscopy after minimally invasive direct corneal neurotization were reviewed in one patient who underwent simultaneous penetrating keratoplasty.

Results:

Five consecutive cases in 4 patients were included, with a mean follow up of 15.8 months (range: 11–23 months). Average denervation time was 17.8 months (range: 6–24 months). Baseline corneal conditions were Mackie stage 1 (20%), Mackie stage 2 (40%), and Mackie stage 3 (40%). All patients demonstrated improvements in corneal sensibility and appearance postoperatively. All patients demonstrated stable or improved visual acuity. No patients developed persistent epithelial defects postoperatively, and all achieved return of tactile skin sensation in the donor nerve sensory distribution. In vivo confocal microscopy after minimally invasive direct corneal neurotization and simultaneous penetrating keratoplasty demonstrated regeneration of corneal nerves. Complications included an asymptomatic small bony excrescence lateral to the supraorbital notch in one patient and cataract progression in the patient who underwent penetrating keratoplasty.

Conclusions:

Minimally invasive direct corneal neurotization is a safe and effective treatment of neurotrophic keratopathy.
Müller Muscle Conjunctiva Resection for Revision of Residual Ptosis After External Levator Advancement Surgery
Authors: Ozturk Karabulut Gamze , Fazil Korhan , Karaagac Gunaydin Zehra , Serefoglu Cabuk Kubra , Onmez Funda Ebru , Taskapili Muhittin
Published: February 2020

Purpose:

To evaluate surgical outcomes of Müller muscle conjunctival resection surgery for reoperation of residual ptosis after external levator advancement in patients with aponeurotic ptosis.

Methods:

A total of 23 eyes of 23 patients who had undergone Müller muscle conjunctival resection for residual ptosis between January 2016 and July 2018 were reviewed retrospectively. Margin reflex distance (MRD), interlid crease, and show distance measurements were performed with a ruler in millimeters during the office examination, and the photographs of patients were taken before the procedure and on the 10th day, at the first, third, and sixth months after the procedure. The successful outcome was described as MRD1 between 3 and 5 mm, interlid MRD1 difference ≤1 mm, interlid crease difference ≤2 mm, interlid show difference ≤2 mm, and the presence of symmetrical lid contour.

Results:

The mean increases in MRD1 were statistically significant at the first, third, and sixth months postoperatively when compared with preoperative values both before external levator advancement and before Müller muscle conjunctival resection (p = 0.000). There was statistically significant decrease in interlid MRD1 difference, interlid crease difference, and interlid show difference relative to preoperative values. Interlid crease and show difference within the range of successful outcome criteria were achieved in all patients. However, interlid MRD1 difference exceeded 1 mm in only 1 patient who had overcorrection.

Conclusions:

In patients who have residual ptosis without contour abnormality following external levator advancement, and positive response to phenylephrine testing, Müller muscle conjunctival resection is an effective approach.
Thickness of Retro- and Sub-Orbicularis Oculi Fat in Thyroid Eye Disease: Comparison With Controls and Its Influential Factors
Authors: Valencia Ma. Regina Paula , Miyazaki Hidetaka , Kakizaki Hirohiko , Takahashi Yasuhiro
Published: February 2020

Purpose:

To compare the thickness of the retro- and sub-orbicularis oculi fat (ROOF and SOOF) between patients with thyroid eye disease (TED) and controls via MRI and to determine factors influencing fat thickness.

Methods:

This retrospective, comparative, case-control study included 136 patients (272 sides) with TED and 50 control patients (50 sides). The thickness of the ROOF and SOOF was measured on the quasi-sagittal plane through the optic nerve (the central plane) and 6 mm lateral and medial to the central plane at the level through the superior orbital rim and at the level just below the orbital septum in the lower eyelid, respectively.

Results:

The ROOF and SOOF were thickest on the lateral plane (p < 0.050; Tukey Kramer post hoc test) and were significantly thicker in patients with TED than controls on all planes (p < 0.050; Student t test). Multivariate stepwise analysis showed that age, sex, clinical activity score, Hertel exophthalmometric values, and number of enlarged extraocular muscles are significant predictors of the ROOF and SOOF thickness in patients with TED (p < 0.050).

Conclusions:

Patients with TED had thicker ROOF and SOOF on all planes than controls with various factors influencing the thickness. These results may be helpful in planning rehabilitative blepharoplasty with removal of the ROOF and SOOF for correction of eyelid fullness in TED.
Visual outcome, optical quality, and patient satisfaction with a new monofocal IOL, enhanced for intermediate vision: preliminary results
Authors: Mencucci Rita , Cennamo Michela , Venturi Daniel , Vignapiano Roberto , Favuzza Eleonora
Published: February 2020

Purpose:

To compare visual outcomes, contrast sensitivity, optical quality, spectacle independence, and visual disturbances in patients implanted with 2 models of monofocal intraocular lenses (IOLs).

Setting:

Eye Clinic, Department of NEUROFARBA, University of Florence, Italy.

Design:

Prospective case series

Methods:

Patients without ocular comorbidities and corneal astigmatism less than 0.75 diopters (D) had cataract surgery with bilateral implantation of either of 2 monofocal IOLs, the Tecnis ZCB00 or the Tecnis Eyhance ICB00 (Johnson & Johnson Vision Care, Inc.). Six months postoperatively, monocular and binocular uncorrected and corrected (at 4 m) distance visual acuities, as well as uncorrected (UIVA), distance corrected, and corrected intermediate (at 66 cm) and near (at 40 cm) visual acuities were measured. Photopic contrast sensitivity, binocular defocus curve, objective scatter index (OSI), Strehl ratio, modulation transfer function (MTF) cutoff, halo and glare perception, and spectacle independence were also evaluated.

Results:

A total of 80 eyes of 40 patients were evaluated in this study. Although monocular and binocular uncorrected and corrected distance and near visual acuities were similar between groups, monocular and binocular UIVA were significantly higher in the Eyhance group. There were no statistically significant differences between the 2 groups in terms of photopic contrast sensitivity, OSI, MTF cutoff, Strehl ratio, and glare and halo perception. The ICB00 IOL provided better spectacle independence than the ZCB00 IOL for intermediate distance.

Conclusions:

In patients without ocular comorbidities, the Eyhance ICB00 IOL provided better UIVA and higher intermediate spectacle independence without impairment of far vision and visual quality, compared with the ZCB00 IOL.
Rate of pseudophakic cystoid macular edema using intraoperative and topical nonsteroidal antiinflammatory drugs alone without steroids
Authors: Walter Keith , Kauffman Levi , Hess Justin
Published: February 2020

Purpose:

To determine the rate of postoperative cystoid macular edema (CME) in patients undergoing cataract surgery treated with intraoperative intracameral and postoperative topical nonsteroidal antiinflammatory drugs (NSAIDs) without steroids.

Setting:

Academic outpatient surgery center Wake Forest Baptist Health in Bermuda Run, NC.

Design:

Retrospective cohort study.

Methods:

A retrospective chart review was performed. Patients were identified through a medical record search tool using criteria of the Current Procedural Terminology code (66984), a single surgeon, and a date range from January 1, 2016, through December 31, 2017. Medical records were reviewed to determine intraoperative and postoperative medication regimen, visual outcome, and development of postoperative CME. Patients with a history of uveitis, diabetic macular edema, retinal vein occlusions, epiretinal membranes, vitreomacular traction, or any prior macular edema were excluded. In addition, any patients with less than 6 weeks of postoperative follow-up were excluded.

Results:

Overall, 824 patient records were reviewed, and the analysis included 504 eyes. Of these, 2 eyes developed postoperative CME (rate = 0.40%, 95% CI 0.0005 to 0.0143).

Conclusions:

The rate of CME in patients treated with intraoperative and postoperative NSAIDs without steroids was low and below the historical rates derived from a literature review of CME development with the use of steroids.
Changes in angle kappa and angle alpha before and after cataract surgery
Authors: Wang Rui , Long Tan , Gu Xin , Ma Ting
Published: February 2020

Purpose:

To observe the distributions and changes in angle kappa and angle alpha preoperatively and postoperatively in patients with cataract who were implanted with a multifocal intraocular lens (mIOL).

Setting:

The First Affiliated Hospital of Northwest University, Shaanxi, China.

Design:

Prospective nonrandomized noncomparative case series.

Methods:

Eyes that underwent phacoemulsification were included. The magnitudes and orientations of angle kappa and angle alpha preoperatively and postoperatively were compared, respectively.

Results:

The study comprised 81 eyes of 70 patients. The magnitude of angle kappa significantly decreased after phacoemulsification. No significant differences were observed between preoperative and postoperative angle kappa in orientation, as well as between preoperative and postoperative angle alpha. The correlations between preoperative and postoperative angle kappa and angle alpha were significant. There were displacement vectors for angle kappa (0.15 ± 0.10) and angle alpha (0.12 ± 0.12) after phacoemulsification. Locations of angle kappa of right and left eyes were scattered mostly in the temporal side of corneal light reflection, whereas locations of angle alpha were well organized in the horizontal position on temporal sides of corneal light reflection.

Conclusions:

The distribution of angle alpha was more organized compared with angle kappa. Angle kappa may change after phacoemulsification. During preoperative evaluation for patients with cataract planning for mIOLs implanted angle alpha may be a more reliable and stable factor compared with angle kappa.
European study of the efficacy of a cross-linked gel stent for the treatment of glaucoma
Authors: Fea Antonio M. , Bron Alain M. , Economou Mario A. , Laffi Gianluca , Martini Enrico , Figus Michele , Oddone Francesco
Published: February 2020

Purpose:

To investigate the efficacy and safety of a cross-linked gel stent (XEN45) with or without cataract surgery in the treatment of glaucoma patients.

Setting:

Five university hospitals.

Design:

Prospective multicenter clinical trial.

Methods:

Patients with glaucoma inadequately controlled by treatment or poor compliance or intolerance to topical therapy were included. Patients were divided into those who had an implant only (Solo Group; phakic and pseudophakic patients) and those who had an implant combined with cataract surgery (Combo Group). Differences in mean intraocular pressure (IOP) and number of medications between the baseline preoperative visit and study end (12 months), and the rate of qualified and complete success, were evaluated.

Results:

The Solo Group comprised 115 glaucoma patients (43 phakic and 72 pseudophakic) and the Combo Group comprised 56 patients. Compared with baseline, mean IOP (23.9 ± 7.6 to 15.5 ± 3.9) and number of medications (3.0 ± 1.1 to 0.5 ± 1.0) decreased significantly at 12-month follow-up (P < .001 for both). A >20% and >30% reduction in IOP from baseline was achieved by 72.3% and 52.6% of patients, respectively. IOP at 1 week postoperatively was a predictor of success, and the needling rate was inversely correlated with early postoperative IOP. The number of preoperative medications and patient age were not significantly associated with failure.

Conclusions:

Insertion of a cross-linked gel stent alone or combined with phacoemulsification might be effective and safe in the treatment of open-angle glaucoma, with a substantial reduction in IOP and number of medications.
Development of low laser energy levels in small-incision lenticule extraction: clinical results, black area, and ultrastructural evaluation
Authors: Lin Limian , Weng Shengbei , Liu Fang , Lin Haiqin , Xu Jiping , Xie Yi , Liu Quan
Published: February 2020

Purpose:

To evaluate the outcomes of 4 low laser energy levels after small-incision lenticule extraction (SMILE) surgery.

Setting:

Zhongshan Ophthalmic Center, Guangzhou, China.

Design:

Prospective randomized clinical trial.

Methods:

This study evaluated consecutive patients who had SMILE to correct myopia or myopia with astigmatism. Eyes were placed into groups based on the laser energy used during surgery (ie, 105 nJ, 110 nJ, 115 nJ, or 120 nJ). All patients had a thorough ophthalmic examination preoperative and at 4 timepoints over 3 months postoperatively. Black areas and surface regularity of the extracted lenticules were observed and evaluated qualitatively and quantitatively.

Results:

The study comprised 124 eyes of 62 patients (40 women, 22 men), with 31 eyes in each laser energy group. The incidence of black areas was 45.16% (14 of 31 eyes), 12.90% (4 of 31 eyes), 16.13% (5 of 31 eyes), and 12.90% (4 of 31 eyes) for 105 nJ, 110 nJ, 115 nJ, and 120 nJ, respectively. The mean time for lenticule creation was the longest in the 105 nJ group (P = .015). The greatest increase in corneal thickness postoperatively occurred with 105 nJ (P < .05). Regression was highest in the 105 nJ group at 3 months (P < .01). However, corneal horizontal coma (C8) was lowest in the 105 nJ group at 1 week (P = .032). The lenticular surface in the 110 nJ group was the smoothest (P = .011). All contrast sensitivity values varied with time and recovered to preoperative levels by 1 week or 1 month. In all eyes, the uncorrected distance visual acuity and corrected distance visual acuity were good, with no statistically significant differences between the 4 energy groups.

Conclusions:

The 105 nJ group, in which the lowest energy was used, had the highest risk for black areas, serious postoperative corneal edema, and a significant healing response.
Corneal aberrations measured with a high-resolution Scheimpflug tomographer: repeatability and reproducibility
Authors: McAlinden Colm , Schwiegerling Jim , Khadka Jyoti , Pesudovs Konrad
Published: February 2020

Purpose:

To evaluate the precision of elevation and wavefront aberration measurements with the Pentacam HR (Oculus Optikgeräte GmbH).

Setting:

Flinders University, Australia.

Design:

Instrument evaluation study.

Methods:

A randomly selected eye of 100 participants was scanned twice with the Pentacam HR by 1 observer on the 3 measurement modes: 25-picture, 50-picture, and cornea fine. A second observer performed 2 scans on the same random eye with the 25-picture mode. Repeatability and reproducibility were assessed using the within-subject SD (Sw) statistic from a 1-way analysis of variance.

Results:

From the 100 scanned eyes, the higher-order aberration root mean square (RMS) repeatability limit

for both elevation and wavefront, and anterior and posterior measurements was 0.03 μm for all 3 measurement modes. Anterior, posterior, and total corneal wavefront Zernike terms were highly precise, with most Zernike terms displaying a repeatability limit of 0.03 μm. The least repeatable measurement was the posterior elevation Zernike term

with the 25-picture scan (repeatability limit 1.50 μm). The cornea fine measurement mode provided the most precise measurements. Reproducibility limits (second observer) were similar to repeatability limits with the 25-picture scan mode.

Conclusions:

The Pentacam HR provided highly precise aberration outputs. The most precise measurements are achievable with the cornea fine measurement mode and wavefront aberrations. One should be cognizant of posterior elevation aberration precision, particularly for lower radial order and higher azimuthal frequency terms. Accounting for tilt and misalignment of aberrations, all RMS and Zernike aberrations were extremely precise (repeatability and reproducibility limit less than 0.000001 μm).