bluuebunny/crossref_metadata_2025 huggingface dataset:
AI in Radiology: Where are we today in Multiple Sclerosis Imaging?
Authors: Eichinger Paul , Zimmer Claus , Wiestler Benedikt
Published: July 2020

Background MR imaging is an essential component in managing patients with Multiple sclerosis (MS). This holds true for the initial diagnosis as well as for assessing the clinical course of MS. In recent years, a growing number of computer tools were developed to analyze imaging data in MS. This review gives an overview of the most important applications with special emphasis on artificial intelligence (AI).

Methods Relevant studies were identified through a literature search in recognized databases, and through parsing the references in studies found this way. Literature published as of November 2019 was included with a special focus on recent studies from 2018 and 2019.

Results There are a number of studies which focus on optimizing lesion visualization and lesion segmentation. Some of these studies accomplished these tasks with high accuracy, enabling a reproducible quantitative analysis of lesion loads. Some studies took a radiomics approach and aimed at predicting clinical endpoints such as the conversion from a clinically isolated syndrome to definite MS. Moreover, recent studies investigated synthetic imaging, i. e. imaging data that is not measured during an MR scan but generated by a computer algorithm to optimize the contrast between MS lesions and brain parenchyma.

Conclusion Computer-based image analysis and AI are hot topics in imaging MS. Some applications are ready for use in clinical routine. A major challenge for the future is to improve prediction of expected disease courses and thereby helping to find optimal treatment decisions on an individual level. With technical improvements, more questions arise about the integration of new tools into the radiological workflow.

Key Points: 

Citation Format
Welche Schutzmaske schützt vor COVID-19? Was ist evidenzbasiert?
Authors: Schulze-Röbbecke Roland , Reska Marcus , Lemmen Sebastian
Published: July 2020

Die COVID-19-Pandemie hat in der Patientenversorgung wie in der Öffentlichkeit zu Diskussionen geführt, mit welchen Schutzmasken man sich vor einer Ansteckung schützen kann. Ähnliche Diskussionen hatte es schon 2009/10 im Rahmen der damals weltweiten Ausbreitung einer neuen Variante des Influenzavirus A (H1N1) gegeben („Schweinegrippe“). Auffällig sind damals wie heute Unklarheiten und Verwirrungen in Bezug auf die Übertragungswege von Atemwegsinfektionen und über die sich daraus ableitenden Schutzmaßnahmen.
Die deutschsprachige Fassung des Muscle Dysmorphia Inventory:
Evaluation der psychometrischen Kennwerte in männlichen
Stichproben
Authors: Arkenau Rike , Waldorf Manuel , Cordes Martin , Vocks Silja
Published: July 2020

Zur Erfassung zentraler Merkmale der Muskeldysmorphie, die als Subtyp der
Körperdysmorphen Störung klassifiziert wird, steht für den englischsprachigen
Raum das Muscle Dysmorphia Inventory (MDI) zur Verfügung. Gegenstand der
vorliegenden Studie war die psychometrische Überprüfung der deutschsprachigen
Version des MDI. Hierzu bearbeiteten männliche Teilnehmer zweier separater
Stichproben (Stichprobe 1: n=143; Stichprobe 2: n=71; N=214) eine
Fragebogenbatterie inklusive des MDI. Anhand einer konfirmatorischen
Faktorenanalyse konnte die von den Autoren der englischsprachigen
Originalversion postulierte Faktorenstruktur nicht repliziert werden, wobei
annähernd adäquate Fit-Indizes für ein auf Basis der Modifikationsindizes
verändertes Modell vorlagen. Für die MDI-Subskalen ergaben sich akzeptable bis
sehr gute interne Konsistenzen. Die Retest-Reliabilität über ca. 14 Tage war
hoch. Signifikant positive Korrelationen der MDI-Subskalen mit weiteren
Körperbild- und Psychopathologiemaßen sowie der Kraftsportfrequenz pro Woche
legten eine gute konvergente und Kriteriumsvalidität nahe. Zudem differenzierte
das MDI zwischen Subgruppen aus Männern mit einer Muskeldysmorphie sowie Kraft-
und Nicht-Kraftsportlern. Mit Ausnahme der Subskala Nutzung von
Pharmakologischen Mitteln (NP) mit niedrigerer Reliabilität und Validität sowie
der ungenügenden Modellpassung wies die deutschsprachige Übersetzung des MDI
insgesamt adäquate psychometrische Kennwerte auf. Die Anwendung in
klinisch-psychologischer Forschung sowie therapeutischer Praxis scheint daher –
mit Einschränkungen hinsichtlich der Subskala NP – empfehlenswert.
Sozialmedizinische und sozialjuristische Aspekte in der Zusammenhangsbegutachtung asbestbedingter Berufskrankheiten
Authors: Schneider J. , Baur X. , Becker P.
Published: July 2020

Bei Berufskrankheiten handelt es sich um bestimmte durch Rechtsverordnung bezeichnete Krankheiten. Während die Krankheitsbilder medizinisch in Leitlinien beschrieben sind, beruht deren Anerkennung auf justiziablen Verwaltungsverfahren. Die Kausalitätsprüfungen sind an sozialjuristische Vorgaben gebunden. Es werden die für die Begutachtung grundlegenden sozialjuristischen Begriffe genannt und die Kausalitätsgrundsätze bei asbestbedingten Berufskrankheiten aufgeführt sowie beispielhaft rechtskräftige Sozialgerichtsurteile zitiert. Hieraus resultieren teilweise von der medizinischen Ansicht nicht selten abweichende Beurteilungen. Ziel ist die korrekte Anwendung sozialmedizinischer Kenntnisse, um eine adäquate Begutachtung im Berufskrankheitenfall vorzunehmen, die die rechtlichen Vorgaben umsetzt.
Next-Generation Sequencing in a Cohort of Asian Indian Patients with the Duchenne Muscular Dystrophy Phenotype: Diagnostic Yield and Mutation Spectrum
Authors: Nerakh Gayatri , Ranganath Prajnya , Murugan Sakthivel
Published: July 2020

Multiplex ligation-dependent probe amplification (MLPA) detects exonic deletions and duplications in the DMD gene in around 65 to 70% of patients with the Duchenne muscular dystrophy (DMD) phenotype. This study looks at the diagnostic yield of next-generation sequencing (NGS) and the mutation spectrum in an Asian Indian cohort of MLPA-negative cases with the DMD phenotype. NGS-based sequencing of DMD gene was done in 28 MLPA-negative cases (25 male probands with the DMD phenotype and 3 obligate carrier mothers of deceased affected male patients) and disease-causing variants were identified in 19 (67.9%) of these cases. Further molecular testing in four of the remaining nine cases revealed gene variants associated with limb girdle muscular dystrophies. Thus, NGS-based multigene panel testing for muscular dystrophy-associated genes or clinical exome sequencing rather than targeted DMD gene sequencing appears to be a more cost-effective testing modality with better diagnostic yield, for MLPA-negative patients with the DMD phenotype.
Use of 4-Dimensional Cone Beam Computed Tomography Scan to Estimate the Planning Target Volume Margin in Lung Tumors
Authors: Reddy B. Namratha Sai , Shivananjappa Rashmi , S.N Geeta , Tiwari Richa
Published: July 2020

Introduction This study aimed to estimate the planning target volume (PTV) margin in lung tumors using 4D computed tomography (CT) scan and evaluate other factors that have an effect on tumor motion.

Materials and Methods We recruited 43 biopsy-proven, newly diagnosed carcinoma lung patients who were treated with definitive intent from January 2017 to June 2018. The radiation dose was delivered using a 3D conformal radiation therapy (CRT)/intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) plan to a dose of 6000 to 6600 cGy in 30 or more fractions to the whole primary. All patients underwent 4D CT scan on the Elekta machine where all the 10 phases of respiration in free breathing were recorded. These phases are fused with CT simulation images, on which gross tumor volume (GTV) and clinical target volume (CTV) are contoured in all phases of respiration. Following this, an internal target volume (ITV) was created by measuring tumor motion all the directions from the center of tumor and PTV was concluded.

Results The mean ITV for tumor in all six directions, that is, in superior, inferior, anterior, posterior, medial and lateral directions was 0.9, 0.9, 0.8, 0.9, 0.8, and 0.9 cm, respectively. For coverage of tumor for 90% of patients, the margins required in superior, inferior, anterior, posterior, medial, and lateral directions were 1.3, 1.5, 1.5, 1.4, 1.5, and 1.3 cm, respectively. Other factors such as size of the tumor and location of the tumor did not significantly contribute to PTV changes in our study.

Conclusion Mean ITV for tumor in all six directions summed up to be 0.8 cm, but there was significant movement in inferior direction for upper lobe tumors (0.9 cm) (p = 0.008), in medial direction for middle lobe tumors (0.8 cm) (p = 0.05), and in medial direction for lower lobe tumors (0.75 cm) (p = 0.005).
The Clinicopathological Features and Staging at Presentation of Gastric Cancer: A Single-Center Retrospective Study
Authors: Chong Syn Yi , Ang Soo Fan
Published: July 2020

Introduction Gastric cancer (GC) is the third leading cause of cancer death, with most patients diagnosed at a later stage, with distant metastasis at the time of presentation, contributing to poor prognosis. GC has been associated with nonspecific clinical presentations, which cause a time delay for patients to seek for medical advice. This study aims to identify the clinicopathological features of GC patients and correlate time delay of the diagnosis to the staging of the disease.

Materials and Methods This is a single-center retrospective study of GC patients diagnosed from January 2012 to December 2018. All relevant data of GC patient diagnosed during this time period were extracted from the patients’ case notes.

Results A total of 69 GC patients were included in this study, with male preponderance and mean age of 62 years old. The top three symptoms presented are dyspepsia or ingestion (47.8%), weight loss (43.5%), and nausea or vomiting (33.3%). The mean time delay was 3.7 months. Patients presented with weight loss have a significantly longer average time delay of 4.88 months. Most tumor lesion was found at the distal stomach (43.5%), while 74.5% tested negative for Helicobacter pylori. Most patients were diagnosed at Stage IV (52.6%) and Stage III (36.8%) of the disease, with poorly differentiated (67.7%) histological features which have poor prognosis.

Discussion and Conclusion No evidence of specific symptom or combination of symptoms predicts higher risk of GC. Regardless of the number of symptoms presented or the time delay, most GC patients were diagnosed at later stage of the disease. The study shows the importance of GC screening in Malaysia to ensure early detection, even before a symptom presented.
Atomic-resolution analytical scanning transmission electron microscopy of topological insulators with a layered tetradymite structure
Authors: Reifsnyder Hickey Danielle , Mkhoyan K. Andre
Published: July 2020

The recent discovery of topological insulators has uncovered exciting new quantum materials with potential applications in the emergent fields of topological spintronics and topological quantum computation. At the heart of uncovering the new physical properties of these materials is the characterization of their atomic structures, composition, defects, and interfaces. The technique of atomic-resolution analytical scanning transmission electron microscopy has already provided many insights and holds great promise for future discoveries. This perspective discusses advances that have been achieved in the atomic-scale characterization of topological insulators with a layered tetradymite structure, and it proposes future directions to link atomic-scale features to exciting new physical phenomena.
Simulation of coarsening of inter-lath cementite in a Q&T steel during tempering
Authors: Ju Yulin , Davis Claire , Strangwood Martin
Published: July 2020

A mathematical model, using the finite difference approach, was established to consider tempering in a low carbon low alloy quenched and tempered steel based on experimental observations, treating the coarsening of a larger particle and dissolution of a smaller particle as a continuous and simultaneous process for coupled inter-lath cementite systems. The diffusion of Mn was simplified as a 1D diffusion and occurred between the interface elements and their adjacent elements in the model. The mathematical model predicted the shortest dissolution times for smaller particles in coupled inter-lath cementite systems, which agreed well with experimental observations on tempering from 2 to 4 h. However, the larger particle coarsening was under predicted due to the simplification of considering two particle arrangements.
Effect of alkyl chain length on interfacial structure of imidazolium-based tetrafluoroborate ionic liquids on Au(100) electrodes
Authors: Dong Yubin
Published: July 2020

The molecular dynamics simulations are employed to investigate the electric double layer structure of three different ionic liquids on single crystalline Au(100) electrodes. We used the same anion BF4
-, and three different cations, 1-Cn(n = 2,4,6)-3-methylimidazolium, respectively. We earn to find out how the alkyl chain length of the cation affects their interfacial structure. All ionic liquids have a significant layered structure within the distance 16 Å from the electrode surface, and the results are similar to those of the other research groups. The imidazole ring of cations tends to be distributed parallel to the surface of the neutral electrode due, as the chain length increases, this trend becomes more apparent, due to the increasing of steric hindrance of cations. The same trend has been found in the system of charged Au electrodes.
Controlling opto-electronic characteristics of ternary II–VI alloyed quantum dots: alcohol processing assay
Authors: Kheirandish E , Marnocha J C , Kouklin N
Published: July 2020

For their ultra-wide color gamut, high efficiency, robustness, and solution processability, Cd-based alloy semiconductor quantum dots (AQDs) continue to proliferate by driving innovations in the fields of optoelectronics, photovoltaics, multiplex bio-imaging, and cancer research. Herein, non-toxic, low-cost isopropyl alcohol vapor-based oxidative treatment protocol is developed and applied to tune the light emission spectrum of crystalline core–shell CdSe1−xSx/ZnS quantum dots. As evidenced by the results of structural investigations, these AQDs when exposed to vapors produced ultrasonically from 10:1 isopropyl alcohol-to-water mix undergo an isotropic, diameter non-specific size reduction at the rate of ∼1.3 Å min−1. Nonlinear time-dependent spectral shifts, revealed experimentally, are consistent with the results of the effective-mass approximation treatment. The emission yields are seen to undergo an initial drop, yet to plateau as the etch time increases. The study opens a door to a soft, top-down monotonic tailoring of the light emission characteristics and opto-electronic response of stoichiometrically- and hierarchically-complex core–shell constructs in technologically-viable group II–VI nano-semiconductors as well as AQD-based catalytic conversion of organic compounds.
Thinking Beyond the “Core” Antibiotic Stewardship Interventions: Shifting the Onus for Appropriate Antibiotic Use from Stewardship Teams to Prescribing Clinicians
Authors: Jenkins Timothy C , Tamma Pranita D
Published: July 2020

United States guidance for hospital antibiotic stewardship has emphasized prospective audit and feedback and prior authorization of select antibiotics as core interventions. These remain the most common interventions implemented by stewardship programs. Although these approaches have been shown to reduce unnecessary antibiotic use, they incorrectly put the onus for appropriate antibiotic use on the stewardship team rather than the prescribing clinician. We propose that a primary focus of stewardship programs should be implementation of broader interventions that engage frontline clinicians and equip them with tools to integrate antibiotic stewardship into their own daily practice, thus reducing the need for day-to-day stewardship team oversite. We discuss a framework of broader interventions and policies that will facilitate this paradigm shift.
Grandparent–Adult Grandchild Relationships: Development of a Typology Using Latent Class Analysis
Authors: Barrett Anne E , Gunderson Justine
Published: July 2020

Background and Objectives

Grandparent–adult grandchild relationships may not be captured in existing grandparenting typologies, which focus on early stages of these relationships. Our study develops a typology for later stages, estimates the prevalence of grandparents in each category, and examines associations between category membership and grandparent and grandchild characteristics.

Research Design and Methods

Using a sample of 289 grandparents from the latest wave of the Longitudinal Study of Generations (2005), we employed latent class analysis to examine underlying categories of grandparent–adult grandchild relationships, based on four dimensions—frequency of contact, relationship quality, grandparents’ receipt of support, and geographic distance.

Results

Three latent classes emerged: Geographically Distant/Low Contact (45%), Geographically Close/High Contact (42%), and Geographically Close/Low Contact (13%). While geographic distance and frequency of contact were dimensions distinguishing grandparent–adult grandchild relationships, receipt of support and relationship quality were not. Most grandparents reported close relationships but infrequent support.

Discussion and Implications

By identifying categories of grandparent–adult grandchild relationships and factors influencing membership in them, our study may aid in efforts to strengthen those characterized by weak bonds—namely, those with grandparents who are older, frailer, and poorer.
Toward Reference Intervals of ARSA Activity in the Cerebrospinal Fluid: Implication for the Clinical Practice of Metachromatic Leukodystrophy
Authors: Morena Francesco , Argentati Chiara , Acquati Serena , DeWall Stephen , Kelly Fiona , Calbi Valeria , Fumagalli Francesca , Zancan Stefano , Biffi Alessandra , Aiuti Alessandro , Martino Sabata
Published: July 2020

Background

Cerebrospinal fluid (CSF) has emerged as a sensitive matrix for the screening of biomarkers for diagnosis and clinical follow-up of diseases with neurological manifestations, including some lysosomal storage disorders. In this study, we assessed the range of values of arylsulfatase A (ARSA) activity in the CSF of pediatric and adult donors, and in pediatric patients who underwent gene therapy for metachromatic leukodystrophy (MLD).

Methods

A cohort of 56 CSF samples was included in the study: pediatric donors (n = 36), adult donors (n = 9), and MLD patients (n = 11) at different timepoints [pre-gene therapy (GT), post-GT + 1 Year, post-GT + 2 Years, post-GT + 3 Years]. We have used our fluorometric assay for the determination of ARSA activity. The total protein content in the samples was also evaluated.

Results

We discovered that ARSA activity was higher in pediatric donors (geometric mean: 1.039 nmol/mg/h; 95% range: 0.859–1.258 nmol/mg/h) compared to adults (geometric mean: 0.305 nmol/mg/h; 95% range: 0.214–0.435 nmol/mg/h). No ARSA activity was detected in the CSF of MLD patients pre-GT, whereas ARSA activity was stably expressed and almost restored to range of values of pediatric donors in MLD patients post-GT + 3 Years with a geometric mean of 0.822 nmol/mg/h (95% range: 0.580–1.165 nmol/mg/h).

Conclusions

This study establishes range of values of ARSA activity in the CSF for MLD clinical practice. The observed ranges of ARSA activities in CSF exhibited an unpredicted age dependence and, in turn, revealed the need of using pediatric ARSA activity for evaluating the restoration of the enzyme activity during the therapy of MLD.
Hepatitis B seroprevalence in the U.S. military and its impact on potential screening strategies
Authors: Scott Paul T , Cohen Robert L , Brett-Major David M , Hakre Shilpa , Malia Jennifer A , Okulicz Jason F , Beckett Charmagne G , Blaylock Jason M , Forgione Michael A , Harrison Stephen A , Murray Clinton K , Rentas Francisco J , Fahie Roland L , Armstrong Adam W , Hayat Aatif M , Pacha Laura A , Dawson Peter , Blackwell Beth , Eick-Cost Angelia A , Maktabi Hala H , Michael Nelson L , Jagodzinski Linda L , Cersovsky Steven B , Peel Sheila A
Published: July 2020

Introduction

Knowledge of the contemporary epidemiology of hepatitis B virus (HBV) infection among military personnel can inform potential Department of Defense (DoD) screening policy and infection and disease control strategies.

Materials and Methods

HBV infection status at accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period from 2007 to 2010. A cost model was developed from the perspective of the Department of Defense for a program to integrate HBV infection screening of applicants for military service into the existing screening program of screening new accessions for vaccine-preventable infections.

Results

The prevalence of chronic HBV infection at accession was 2.3/1,000 (95% CI: 1.4, 3.2); most cases (16/21, 76%) identified after deployment were present at accession. There were 110 military service-related HBV infections identified. Screening accessions who are identified as HBV susceptible with HBV surface antigen followed by HBV surface antigen neutralization for confirmation offered no cost advantage over not screening and resulted in a net annual increase in cost of $5.78 million. However, screening would exclude as many as 514 HBV cases each year from accession.

Conclusions

Screening for HBV infection at service entry would potentially reduce chronic HBV infection in the force, decrease the threat of transfusion-transmitted HBV infection in the battlefield blood supply, and lead to earlier diagnosis and linkage to care; however, applicant screening is not cost saving. Service-related incident infections indicate a durable threat, the need for improved laboratory-based surveillance tools, and mandate review of immunization policy and practice.
Geometrical interpretation of the pilot wave theory and manifestation of spinor fields
Authors: Trukhanova Mariya Iv. , Shipov Gennady
Published: July 2020

Using the hydrodynamical formalism of quantum mechanics for a Schrödinger spinning particle developed by Takabayashi, Vigier, and followers, which involves vortical flows, we propose a new geometrical interpretation of the pilot wave theory. The spinor wave in this interpretation represents an objectively real field, and the evolution of a material particle controlled by the wave is a manifestation of the geometry of space. We assume this field to have a geometrical nature, basing on the idea that the intrinsic angular momentum, the spin, modifies the geometry of the space, which becomes a manifold, represented as a vector bundle with a base formed by the translational coordinates and time, and the fiber of the bundle, specified at each point by the field of a tetrad $e^a_{\mu}$, forms from bilinear combinations of the spinor wave function. It has been shown that the spin vector rotates following the geodesic of the space with torsion, and the particle moves according to the geometrized guidance equation. This fact explains the self-action of the spinning particle. We show that the curvature and torsion of the spin vector line is determined by the space torsion of the absolute parallelism geometry.
An insight of how multiple skeletal maturity indices can be used for growth assessment: relationship between the simplified olecranon, simplified digital, and distal radius and ulna classifications
Authors: Cheung Prudence Wing Hang , Canavese Federico , Luk Keith Dip Kei , Cheung Jason Pui Yin
Published: July 2020

This cross-sectional study aims to investigate the relationship between the simplified olecranon, simplified digital, and distal radius and ulna (DRU) classifications, and whether they can aid in more comprehensive maturity assessment together. Left hand and wrist and lateral elbow radiographs from pediatric patients were assessed using the three skeletal maturity indices. The association between maturity indices was investigated using Goodman and Kruskal’s gamma, and by mapping of individual grades based on chronological age. Specific maturity grades, at which peak height velocity (PHV) occurs as previously identified, were based upon to explore how the three systems interact. A total of 114 patients (63.2% girls) were studied. Correlations and associations between the three maturity parameters were significant (all at P < 0.001). Mapping revealed uneven spans and coverage of different periods by each index. Olecranon stage 1 coincided with R3 (for girls), R4 (for boys), U3, and SS1. Olecranon stage 5 occurred as early as R7, U6, and SS4. Upon elbow fusion, the simplified digital (SS5–SS8) and DRU (R8–R11 and U7–U9) classifications can be used for assessment until maturity. The inter-relationship of the simplified hand, wrist, and olecranon methods indicates their combined use. DRU grades can be used in growth periods which are less well covered. Prepubertal and growth acceleration phase of pubertal growth spurt can best be assessed by both the simplified olecranon (stages 1–3) and DRU classifications (R1–R5 and U1–U4). All three indices are required during PHV. For post-PHV, DRU (R8–R11 and U7–U9) and simplified digital method (SS5–SS8) complement each other for assessment until skeletal maturity.
Blood pressure management in hypertensive patients with syncope: how to balance hypotensive and cardiovascular risk
Authors: Rivasi Giulia , Brignole Michele , Rafanelli Martina , Bilo Grzegorz , Pengo Martino F. , Ungar Andrea , Parati Gianfranco
Published: July 2020

Managing hypertension in syncope patients requires the accurate balancing of hypotensive and cardiovascular risks. On the basis of the available literature, this study analyses the complex inter-relationship between these clinical problems and presents an algorithm strategy to guide hypertension management in patients affected by syncope episodes. A SBP target of 120 mmHg is recommended in patients with a low syncope risk and a high cardiovascular risk. In patients with a high syncope risk and a low cardiovascular risk, and in older (70+) frail individuals, a less intensive treatment is advisable, targeting SBP of 140 mmHg. SBP values up to 160 mmHg can be tolerated in severe frailty or disability.

Patients with hypertension and syncope may benefit from team-based care by a ‘Blood Pressure Team’ including experts on hypertension and syncope and a geriatrician. The team should carry out a multidimensional assessment to balance syncope and cardiovascular risk and develop therapeutic strategies customized to individuals’ frailty and functional status.
Acanthamoeba Keratitis in Minors With Orthokeratology (OK) Lens Use: A Case Series
Authors: Scanzera Angelica C. , Tu Elmer Y. , Joslin Charlotte E.
Published: July 2020

Objectives:

Myopia progression is a significant public health issue. Methods to halt myopia progression in minors continue to gain momentum. Orthokeratology, with market penetrance estimates approximating 1%, is a corneal reshaping therapy and potential myopia progression treatment. Our objective was to explore whether orthokeratology may increase the frequency of Acanthamoeba keratitis compared with other lens modalities.

Methods:

Individuals less than 18 years diagnosed with Acanthamoeba keratitis (AK) at the University of Illinois at Chicago (UIC) Cornea Service between January 1st, 2003, and December 31st, 2016, were retrospectively reviewed. Subjects were grouped by lens modality (soft, rigid gas permeable [RGP], and orthokeratology), and all cases with orthokeratology lens use were reviewed. The primary outcome was a history of orthokeratology lens use in minors diagnosed with AK.

Results:

Forty-seven contact lens users less than 18 years were diagnosed with AK. The mean age was 15.0 years (range 12–17), 26 (55%) were women, and 4 (8.5%) had bilateral disease. Lens modality included 6 (13%) with orthokeratology, 39 (83%) with soft contact lenses, 0 with nonorthokeratology RGP (0%), and 2 (4%) unknown.

Conclusions:

The proportion of orthokeratology cases among AK minors (13%) in our case series exceeds the expected proportion of orthokeratology cases expected based on orthokeratology market penetrance (1%). Results from this case series suggest a potential increased risk of AK in orthokeratology users compared with other lens modalities. In the context of the current myopia epidemic and concerns for halting myopia progression in minors, caution should be exercised when selecting appropriate treatment options to minimize the risk of AK.
Ex vivo photoactivated chromophore for keratitis-corneal crosslinking on inverted graft: new approach to manage interface infectious keratitis after deep anterior lamellar keratoplasty
Authors: Mularoni Alessandro , Rania Laura , Imburgia Aurelio , Scorcia Vincenzo , Giannaccare Giuseppe
Published: July 2020

A 44-year-old man affected by keratoconus underwent deep anterior lamellar keratoplasty (DALK). Two weeks postoperatively, slitlamp examination showed grayish-white lesions in the donor–host interface. Corneal scraping and donor broth culture tested negative for both bacteria and fungi. In vivo confocal microscopy showed elongated particles resembling Candida pseudofilaments. Despite antimicrobial therapy, the clinical picture worsened, and surgical approach was chosen: the graft was peeled off and inverted (epithelium facing down), and ex vivo photoactivated chromophore for infectious keratitis-corneal crosslinking (PACK-CXL) was performed; the recipient bed was washed with antibiotics/antifungals and the graft resutured. Microbiological and histological evaluations of biopsy specimen tested positive for Candida albicans. Postoperative slitlamp examination revealed a progressive recovery of graft transparency with disappearance of the infiltrates. To the authors' knowledge, this is the first report of ex vivo PACK-CXL on inverted DALK graft for the treatment of interface infectious keratitis. This technique allowed the resolution of the infection while sparing the use of new donor tissue.
Image quality and diagnostic accuracy of a handheld nonmydriatic fundus camera: Feasibility of a telemedical approach in screening retinal diseases
Authors: Lin Tai-Chi , Chiang Yueh-Hua , Hsu Chih-Lu , Liao Long-Sheng , Chen Yi-Ying , Chen Shih-Jen
Published: July 2020

Background:

A suitable fundus camera for telemedicine screening can expand the scale of eye care service. The purpose of this study was to compare a handheld nonmydriatic digital fundus camera and a conventional mydriatic fundus camera according to the image quality of their photographs and usability of those photographs to accurately diagnose various retinal diseases.

Methods:

A handheld nonmydriatic fundus camera and conventional fundus camera were used to take fundus photographs of outpatients at an ophthalmic clinic before and after pupillary dilation. Image quality and diagnostic agreement of the photos were graded by two masked and experienced retinal specialists.

Results:

A total of 867 photographs of 393 eyes of 200 patients were collected. Approximately 80% of photos taken under nonmydriasis status using the handheld nonmydriatic fundus camera had good (55.7%) or excellent (22.7%) image quality. The overall agreement of diagnoses between the doctors was more than 90%. When the handheld nonmydriatic fundus camera was used after mydriasis, the proportion of images with good (45%) or excellent (49.7%) quality reached 94.7% and diagnostic agreement was 93.4%. Lens opacity was associated with the quality of images obtained using the handheld camera (p = 0.041), and diagnosis disagreement for handheld camera images was associated with preexisting diabetes diagnosis (p = 0.009). Approximately 40% of patients expressed preference for use of the handheld nonmydriatic camera.

Conclusion:

This study demonstrated the effectiveness of the handheld nonmydriatic fundus camera in clinical practice and its feasibility for telemedicine screening of retinal diseases.
Type II toxin/antitoxin system genes expression in persister cells of Klebsiella pneumoniae
Authors: Narimisa Negar , Kalani Behrooz S. , Amraei Fatemeh , Mohammadzadeh Rokhsareh , Mirkalantari Shiva , Razavi Shabnam , Jazi Faramarz M.
Published: July 2020

Objective:

Persistence is a subpopulation of bacteria that can tolerate high doses of antibiotics by undergoing a period of dormancy. This study aimed to investigate the hypothetical role of toxin/antitoxin systems in persister cell formation of Klebsiella pneumoniae ATCC 13883 by evaluating toxins of type II toxin/antitoxin systems expression.

Methods:

To determine the number of surviving cells, bacterial colonies were counted at 1, 3, 5, 7, and 24 h after treated with a lethal dose of kanamycin. The role of toxin/antitoxin systems in persister cell formation was then determined by toxins of type II toxin/antitoxin systems (relE1, relE2, hipA, vapC, and doc) expression levels using real-time PCR.

Results:

Our results showed the viability of persister cells after 5 h. The results of relative real-time PCR showed higher levels of toxin gene expression due to stress conditions, suggesting the possible role of toxin/antitoxin systems in persister cell formation and antibiotic tolerance.

Conclusion:

Considering the importance of persistence and the tolerance to antibiotics, further studies on persister cell formation and related genes such as the toxin/antitoxin system genes might help us to identify the precise mechanisms leading to persister cell formation.
Pain Management Experiences Among Hospitalized Postcraniotomy Brain Tumor Patients
Authors: Foust Winton Rebecca E. , Draucker Claire B. , Von Ah Diane
Published: July 2020

Background

Brain tumors account for the majority of central nervous system tumors, and most are removed by craniotomies. Many postcraniotomy patients experience moderate or severe pain after surgery, but patient perspectives on their experiences with pain management in the hospital have not been well described.

Objective

The aim of this study was to describe how patients who have undergone a craniotomy for brain tumor removal experience pain management while hospitalized.

Methods

Qualitative descriptive methods using semistructured interviews were conducted with patients on a neurological step-down unit in an urban teaching hospital in the Midwest United States. Interviews focused on how patients experienced postcraniotomy pain and how it was managed. Narratives were analyzed with standard content analytic procedures.

Results

Twenty-seven participants (median age, 58.5 years; interquartile range, 26–41 years; range, 21–83 years) were interviewed. The majority were white (n = 25) and female (n = 15) and had an anterior craniotomy (n = 25) with sedation (n = 17). Their pain experiences varied on 2 dimensions: salience of pain during recovery and complexity of pain management. Based on these dimensions, 3 distinct types of pain management experiences were identified: (1) pain-as-nonsalient, routine pain management experience; (2) pain-as-salient, routine pain management experience; and (3) pain-as-salient, complex pain management experience.

Conclusions

Many postcraniotomy patients experience their pain as tolerable and/or pain management as satisfying and effective; others experience pain and pain management as challenging.

Implications for Practice

Clinicians should be attuned to needs of patients with complex pain management experiences and should incorporate good patient/clinician communication.
What Variables Contribute to the Achievement of a Preferred Home Death for Cancer Patients in Receipt of Home-Based Palliative Care in Canada?
Authors: Cai Jiaoli , Zhang Li , Guerriere Denise , Fan Hongli , Coyte Peter C.
Published: July 2020

Background

Home is often deemed to be the preferred place of death for most patients. Knowing the factors related to the actualization of a preferred home death may yield evidence to enhance the organization and delivery of healthcare services.

Objective

The objectives of this study were to measure the congruence between a preferred and actualized home death among cancer patients in receipt of home-based palliative care in Canada and explore predictors of actualizing a preferred home death.

Methods

A longitudinal prospective cohort design was conducted. A total of 290 caregivers were interviewed biweekly over the course of patients’ palliative care trajectory between July 2010 and August 2012. Cross-tabulations and multivariate analyses were used in the analysis.

Results

Home was the most preferred place of death, and 68% of patients who had voiced a preference for home death had their wish fulfilled. Care context variables, such as living with others and the intensity of home-based nursing visits and hours of care provided by personal support workers (PSW), contributed to actualizing a preferred home death. The intensity of emergency department visits was associated with a lower likelihood of achieving a preferred home death.

Conclusions

Higher intensity of home-based nursing visits and hours of PSW care contribute to the actualization of a preferred home death.

Implications for Practice

This study has implications for policy decision-makers and healthcare managers. Improving and expanding the provision of home-based PSW and nursing services in palliative home care programs may help patients to actualize a preferred home death.
Knowing What We Do Not Know: Analysis of an Online Consultation Service to Identify Provider Knowledge Gaps in Sexually Transmitted Disease Care
Authors: Plotzker Rosalyn E. , Hauschild Benjamin C. , Kelley Destiny , Blakley Lauren A. , Park Ina U.
Published: July 2020

The national Sexually Transmitted Diseases (STD) Clinical Consultation Network receives requests regarding complex STD cases. A total of 927 requests from Western states, 2017 to 2019, were analyzed for STD of inquiry and syphilis-specific subtopics. Syphilis requests accounted for most queries, and the number and proportion of syphilis-related requests increased significantly over time.
Evaluating the Image Quality of Monoenergetic Images From Dual-Energy Computed Tomography With Low-Concentration and Low-Flow-Rate Contrast Media for the Arterials Supply to the Nipple-Areola Complex in Breast Cancer Compared With Conventional Computed Tomography Angiography
Authors: Zeng Xiangfei , Wang Xiaoxia , Chen Huifang , Liu Daihong , Shi Jinfang , Zhang Jing , Li Xiaoqin , Zhang Liyin , Yang Yi , Zhang Jiuquan
Published: July 2020

Objective

The objective of this study was to evaluate the image quality of monoenergetic images (MEIs (+)) acquired from dual-energy computed tomography with low-concentration and low-flow-rate contrast media for the arterial supply to the nipple-areola complex (NAC) in breast cancer compared with conventional computed tomography angiography (CTA).

Methods

We enrolled 25 patients (MEI (+)300 group, 300 mg/mL and 2.5 mL/s of contrast media) and 23 patients (CTA370 group, 370 mg/mL and 3.5 mL/s of contrast media) for assessing NAC blood supply angiography. The image quality of the 2 groups was evaluated objectively and subjectively.

Results

The 40 keV MEI (+)300 demonstrated higher attenuation and contrast-to-noise ratio than CTA370 group (P < 0.001). The subjective image quality and visualization of the arteries were comparable between 2 groups.

Conclusions

The 40 keV MEI (+)300 acquired from dual-energy computed tomography can achieve comparable image quality of arterial supply to NAC with low-concentration and low-flow-rate contrast media in breast cancer compared with CTA370.
Guidelines and Recommendations for Patient Management, Surgical Activities, and Safety in the Maxillofacial Unit and Head and Neck Department During COVID-19 Pandemic
Authors: Piombino Pasquale , Sani Lorenzo , Committeri Umberto , Carraturo Emanuele , Foderini Andrea , Romano Antonio , Orabona Giovanni Dell’Aversana , Bonavolontà Paola , Abbate Vincenzo , Califano Luigi
Published: July 2020

The recent pandemic has led to an unprecedented overload of sanitary systems around the world. Despite that a maxillofacial department is not a frontline specialty in the treatment of coronavirus disease 2019 infections, our department has found itself faced with numerous problems in keeping the care system active and efficient while ensuring safety for patients and healthcare professionals. Massive redistribution of health personnel was needed to improve prevention and personal safety measures. The education and training system has been kept active, giving residents a decisive role in managing the state of emergency response. This article outlines new guidelines for infection prevention: from clinical control, treatment processes, clinical management, protection, and disinfection of healthcare professionals.
The Evolution of Transplantation From Saving Lives to Fertility Treatment
Authors: Testa Giuliano , McKenna Greg J. , Bayer Johanna , Wall Anji , Fernandez Hoylan , Martinez Eric , Gupta Amar , Ruiz Richard , Onaca Nicholas , Gunby Robert T. , Gregg Anthony R. , Olausson Michael , Koon E. Colin , Johannesson Liza
Published: July 2020

Objective:

We report the results of the first 20 uterus transplants performed in our institution.

Summary Background Data:

Uterus transplantation (UTx) aims at giving women affected by absolute uterine-factor infertility the possibility of carrying their own pregnancy. UTx has evolved from experimental to an established surgical procedure.

Methods:

The Dallas Uterus Transplant Study (DUETS) program started in 2016. The uterus was transplanted in orthotopic position with vascular anastomoses to the external iliac vessels and removed when 1 or 2 live births were achieved. Immunosuppression lasted only for the duration of the uterus graft.

Results:

Twenty women, median age 29.7 years, enrolled in the study, with 10 in phase 1 and 10 in phase 2. All but 2 recipients had a congenital absence of the uterus. Eighteen recipients received uteri from living donors and 2 from deceased donors. In phase 1, 50% of recipients had a technically successful uterus transplant, compared to 90% in phase 2. Four recipients with a technical success in phase 1 have delivered 1 or 2 babies, and the fifth recipient with a technical success is >30 weeks pregnant. In phase 2, 2 recipients have delivered healthy babies and 5 are pregnant.

Conclusions:

UTx is a unique type of transplant; whose only true success is a healthy child birth. Based on results presented here, involving refinement of the surgical technique and donor selection process, UTx is now an established solution for absolute uterine-factor infertility.
Urinary cell cycle arrest proteins urinary tissue inhibitor of metalloprotease 2 and insulin-like growth factor binding protein 7 predict acute kidney injury after severe trauma: A prospective observational study
Authors: Hatton Gabrielle E. , Wang Yao Wei , Isbell Kayla D. , Finkel Kevin W. , Kao Lillian S. , Wade Charles E.
Published: July 2020

BACKGROUND

Recognition and clinical diagnosis of acute kidney injury (AKI) after trauma is difficult. The majority of trauma patients do not have a known true baseline creatinine, which makes application of the guidelines set forth by the international guidelines difficult to apply. Use of alternative biomarkers of renal dysfunction in trauma patients may be beneficial. We hypothesized that urinary tissue inhibitor of metalloprotease 2 (TIMP-2) × insulin-like growth factor binding protein 7 (IGFBP-7) would accurately predict AKI development in severely injured trauma patients.

METHODS

A prospective observational study of adult (≥16 years old) trauma intensive care unit (ICU) patients was performed between September 2018 to March 2019. Urine was collected on ICU admission and was measured for TIMP-2 × IGFBP-7. Univariate, multivariable, and receiver operating characteristic curve analyses were performed using the optimal threshold generated by a Youden index.

MAIN RESULTS

Of 88 included patients, 75% were male, with a median injury severity score was 27 (interquartile range [IQR], 17–34), and age of 40 years (IQR, 28–54 years). Early AKI developed in 39 patients (44%), and of those, 7 (8%) required dialysis within 48 hours. Patients without early AKI had a TIMP-2 × IGFBP-7 of 0.17 U (IQR, 0.1–0.3 U), while patients with early AKI had a TIMP-2 × IGFBP-7 of 0.46 U (IQR, 0.17–1.29 U; p < 0.001). On multivariable analyses, TIMP-2 × IGFBP-7 was associated with AKI development (p = 0.02) and need for dialysis (p = 0.03). Using the optimal threshold 0.33 U to predict AKI, the area under the receiver operating characteristic curve was 0.731, with an accuracy of 0.75, sensitivity of 0.72, and specificity of 0.78.

CONCLUSION

Urinary TIMP-2 × IGFBP-7 measured on ICU admission accurately predicted 48-hour AKI and was independently associated with AKI and dialysis requirement after trauma and is a promising screening tool for treatment.

LEVEL OF EVIDENCE

Prognostic, prospective, observational study, level III.
A Trans-Omic Mendelian Randomization Study of Parental Lifespan Uncovers Novel Aging Biology and Drug Candidates for Human Healthspan Extension
Authors: Perrot Nicolas , Pelletier William , Bourgeault Jerome , Couture Christian , Li Zhonglin , Mitchell Patricia , Ghodsian Nooshin , Bosse Yohan , Theriault Sebastien , Mathieu Patrick , Arsenault Benoit J
Published: July 2020

The study of parental lifespan has emerged as an innovative tool to advance aging biology and our understanding of the genetic architecture of human longevity and healthspan. Here, we leveraged summary statistics of a genome-wide association study including over one million parental lifespans to identify genetically regulated genes from the Genotype-Tissue Expression project through a combination of multi-tissue transcriptome-wide association analyses and genetic colocalization. Mendelian randomization (MR) analyses also identified circulating proteins and metabolites causally associated with parental lifespan that may offer new drug repositioning opportunities for healthspan such as drugs targeting apolipoprotein-B-containing lipoproteins. Liver expression of HP, the gene encoding haptoglobin, and plasma haptoglobin levels were causally linked with parental lifespan. Phenome-wide MR analyses were used to map genetically regulated genes, proteins and metabolites with the disease-related phenome in the UK Biobank and FinnGen. Altogether, this study identified novel biological determinants of aging and potential therapeutic targets for human healthspan extension.