bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of forest fires outbreaks by dynamic fuzzy logic controller
Authors: Toledo-Castro Josué , Rodríguez-Pérez Nayra , Caballero-Gil Pino , Santos-González Iván , Hernández-Goya Candelaria , Aguasca-Colomo Ricardo
Published: August 2020

The use of wireless sensor networks (WSNs) and the Internet of things to detect forest fire outbreaks may help to reduce the response time and avoid natural disasters. This work proposes the deployment of WSN to enhance the real-time monitoring of dynamic variables such as polluting gases, temperature or the presence of fire flames by infrared. In addition, the activation of forest fire alerts if environmental status may involve evidence of a recent fire outbreak. A fuzzy-based controller is implemented to manage the uncertainty related to estimating forest fire occurrence and dynamic update of fuzzy sets is developed to distinguish usual and unusual environmental conditions of every monitored forest area. Merkle trees, AES and hash functions are considered to protect the integrity of environmental data.
Multidisciplinary Guidance Regarding the Use of Immunomodulatory Therapies for Acute Coronavirus Disease 2019 in Pediatric Patients
Authors: Dulek Daniel E , Fuhlbrigge Robert C , Tribble Alison C , Connelly James A , Loi Michele M , El Chebib Hassan , Chandrakasan Shanmuganathan , Otto William R , Diorio Caroline , Keim Garrett , Walkovich Kelly , Jaggi Preeti , Girotto Jennifer E , Yarbrough April , Behrens Edward M , Cron Randy Q , Bassiri Hamid
Published: August 2020

Background

Immune-mediated lung injury and systemic hyperinflammation are characteristic of severe and critical coronavirus disease 2019 (COVID-19) in adults. Although the majority of severe acute respiratory syndrome coronavirus 2 infections in pediatric populations result in minimal or mild COVID-19 in the acute phase of infection, a small subset of children develop severe and even critical disease in this phase with concomitant inflammation that may benefit from immunomodulation. Therefore, guidance is needed regarding immunomodulatory therapies in the setting of acute pediatric COVID-19. This document does not provide guidance regarding the recently emergent multisystem inflammatory syndrome in children (MIS-C).

Methods

A multidisciplinary panel of pediatric subspecialty physicians and pharmacists with expertise in infectious diseases, rheumatology, hematology/oncology, and critical care medicine was convened. Guidance statements were developed based on best available evidence and expert opinion.

Results

The panel devised a framework for considering the use of immunomodulatory therapy based on an assessment of clinical disease severity and degree of multiorgan involvement combined with evidence of hyperinflammation. Additionally, the known rationale for consideration of each immunomodulatory approach and the associated risks and benefits was summarized.

Conclusions

Immunomodulatory therapy is not recommended for the majority of pediatric patients, who typically develop mild or moderate COVID-19. For children with severe or critical illness, the use of immunomodulatory agents may be beneficial. The risks and benefits of such therapies are variable and should be evaluated on a case-by-case basis with input from appropriate specialty services. When available, the panel strongly favors immunomodulatory agent use within the context of clinical trials. The framework presented herein offers an approach to decision-making regarding immunomodulatory therapy for severe or critical pediatric COVID-19 and is informed by currently available data, while awaiting results of placebo-controlled randomized clinical trials.
Unknowable Colour Facts
Authors: Cutter Brian
Published: August 2020

It is common for an object to present different colour appearances to different perceivers, even when the perceivers and viewing conditions are normal. For example, a Munsell chip might look unique green to you and yellowish green to me in normal viewing conditions. In such cases, there are three possibilities. Ecumenism: both experiences are veridical. Nihilism: both experiences are non-veridical. Inegalitarianism: one experience is veridical and the other is non-veridical. Perhaps the most important objection to inegalitarianism is the ignorance objection, according to which inegalitarianism should be rejected because it is committed to the existence of unknowable colour facts (for example, facts about which objects are unique green). The goal of this paper is to show that ecumenists are also committed to unknowable colour facts. More specifically, I argue that, with the exception of colour eliminativism, all major philosophical theories of colour are committed to unknowable colour facts.
TGF-β1 modulates temozolomide resistance in glioblastoma via altered microRNA processing and elevated MGMT
Authors: Nie Er , Jin Xin , Miao Faan , Yu Tianfu , Zhi Tongle , Shi Zhumei , Wang Yingyi , Zhang Junxia , Xie Manyi , You Yongping
Published: August 2020

Background

Our previous studies have indicated that miR-198 reduces cellular methylguanine DNA methyltransferase (MGMT) levels to enhance temozolomide sensitivity. Transforming growth factor beta 1 (TGF-β1) switches off miR-198 expression by repressing K-homology splicing regulatory protein (KSRP) expression in epidermal keratinocytes. However, the underlying role of TGF-β1 in temozolomide resistance has remained unknown.

Methods

The distribution of KSRP was detected by western blotting and immunofluorescence. Microarray analysis was used to compare the levels of long noncoding RNAs (lncRNAs) between TGF-β1–treated and untreated cells. RNA immunoprecipitation was performed to verify the relationship between RNAs and KSRP. Flow cytometry and orthotopic and subcutaneous xenograft tumor models were used to determine the function of TGF-β1 in temozolomide resistance.

Results

Overexpression of TGF-β1 contributed to temozolomide resistance in MGMT promoter hypomethylated glioblastoma cells in vitro and in vivo. TGF-β1 treatment reduced cellular MGMT levels through suppressing the expression of miR-198. However, TGF-β1 upregulation did not affect KSRP expression in glioma cells. We identified and characterized 2 lncRNAs (H19 and HOXD-AS2) that were upregulated by TGF-β1 through Smad signaling. H19 and HOXD-AS2 exhibited competitive binding to KSRP and prevented KSRP from binding to primary miR-198, thus decreasing miR-198 expression. HOXD-AS2 or H19 upregulation strongly promoted temozolomide resistance and MGMT expression. Moreover, KSRP depletion abrogated the effects of TGF-β1 and lncRNAs on miR-198 and MGMT. Finally, we found that patients with low levels of TGF-β1 or lncRNA expression benefited from temozolomide therapy.

Conclusions

Our results reveal an underlying mechanism by which TGF-β1 confers temozolomide resistance. Furthermore, our findings suggest that a novel combination of temozolomide with a TGF-β inhibitor may serve as an effective therapy for glioblastomas.
Omega-3 long-chain polyunsaturated fatty acid and sleep: a systematic review and meta-analysis of randomized controlled trials and longitudinal studies
Authors: Dai Ying , Liu Jianghong
Published: August 2020

Context

Omega-3, a long-chain polyunsaturated fatty acid (LC-PUFA), may help promote healthy sleep outcomes. However, evidence from randomized controlled trials are inconclusive.

Objective

The objective of this systematic review and meta-analysis was to explore the impact of omega-3 LC-PUFA supplementation and related dietary intervention in clinical trials as well as omega-3 LC-PUFA exposure in longitudinal studies on human’s sleep-related outcome.

Data Sources

The PubMed, EMBASE, Cochrane Library, CINAHL, and AMED databases were searched from inception to November 2019. Randomized controlled trials, clinical trials that included a control group, and longitudinal studies that reported the intake of omega-3 LC-PUFA and sleep-related outcomes were included.

Study Selection

A total of 20 studies with 12 clinical trials and 8 longitudinal studies were identified for inclusion.

Data Extraction

Participant characteristics, study location, intervention information, and sleep-related outcome measurements were reported. Included studies were appraised with Cochrane risk-of-bias tools and the Newcastle-Ottawa Scale. Weighted mean differences (WMDs) and 95%CIs were pooled with fixed or random effect models.

Results

Omega-3 LC-PUFA may improve infants' sleep organization and maturity. It reduced the percentage of infants' active sleep (WMD = –8.40%; 95%CI, –14.50 to –2.29), sleep-wake transition (WMD = –1.15%; 95%CI, –2.09 to –0.20), and enhanced the percentage of wakefulness (WMD = 9.06%; 95%CI, 1.53–16.59) but had no effect on quiet sleep. Omega-3 reduced children’s total sleep disturbance score for those with clinical-level sleep problems (WMD = –1.81; 95%CI, –3.38 to –0.23) but had no effect on healthy children’s total sleep duration, sleep latency, or sleep efficiency. No effectiveness was found in adults’ total sleep duration, sleep latency, sleep efficiency, sleep quality, or insomnia severity.

Conclusion

Omega-3 LC-PUFA may improve certain aspects of sleep health throughout childhood. Additional robust studies are warranted to confirm the relationship between omega-3 LC-PUFA and sleep.
Conceptualising the Victim in England and Wales and the United States within a Spectrum of Public and Private Interests
Authors: Manikis Marie
Published: August 2020

The conception of the victim in criminal justice systems has changed across history and legal systems. A framework that considers the private and public along a spectrum and offers nuances between private and public interests illuminates the ways victims have been conceived within mechanisms of participation in various criminal justice systems and the ways they can oscillate and have oscillated within these categories. This article argues that in England and Wales, victims have been conceived as citizens with both private and predominantly public roles and interests, while in the United States, they have been conceptualised as actors that hold predominantly private interests. Nuances within mechanisms of victim participation that challenge the rigidity of the public/private divide within those jurisdictions are accounted for and discussed.
Facing a Feared Situation: Endoscopic Endonasal Approach for Petroclival Lesions With Internal Carotid Artery Encasement: 2-Dimensional Operative Video
Authors: Anania Yury , Venteicher Andrew S , Wang Eric W , Zenonos George A , Snyderman Carl H , Gardner Paul A
Published: August 2020

A 33-yr-old woman presented with diplopia due to partial III and VI cranial nerve palsies, and an magnetic resonance imaging (MRI) showed a left petroclival lesion with cavernous sinus invasion. The ipsilateral internal carotid artery (ICA) was displaced and encased by the tumor. Chondroid tumors such as this are known to be high risk for ICA injury
1
; however, given the patient's young age a radical resection was desirable,
2
depending on the risk of such a strategy. Therefore, a preoperative balloon test occlusion (BTO) was performed to estimate the risk of stroke in case of ICA sacrifice.
3
Clinical and single-photon emission computed tomography testing predicted low risk of stroke, allowing for aggressive resection. A preoperative ICA occlusion was not performed as intraoperative control was believed to be adequate and preservation is always preferable when possible due to rare inaccuracies in BTO and long term risks of occlusion. An endoscopic endonasal and right contralateral transmaxillary approach with intraoperative neurophysiology were performed to remove this lesion.
4,5
During surgery, the ICA proved dehiscent, and was therefore clip sacrificed.
6
An immediate postoperative digital subtraction angiography showed minimally delayed, but adequate, blood flow to the left cerebral hemisphere. Postoperative MRI showed complete removal and no significant infarct. The patient was discharged in stable neurological condition, with only a slightly worsened CN III palsy.

Experience with management of ICA injury is of uttermost importance in endoscopic endonasal surgery,
1,2
and requires adequate training and an experienced 2-surgeon team.
7

The patient provided consent to the submission and publication of the related surgical video.
ADDING TWO NEW CONTACT CIRCUMSTANCES TO ‘MERGED PHANTOM TOOL’ AND A TECHNIQUE TO CONVERT STRUCTURE INFORMATION SEGMENTED BY THE CARIMAS SOFTWARE INTO GEANT4 GEOMETRY
Authors: Thao Nguyen Thi Phuong , Trung Nguyen Thien , Duy Nguyen Khanh , Danh Nguyen Thanh , Anh Pham Tien , Son Nguyen Dong
Published: August 2020

Two new contact circumstances called ‘stand-lie’ and ‘front–rear’ are implemented to the merged phantom tool. To allow more flexibility for users when they calculate the dose for a volume of interest (VOI) with arbitrary geometry, an optional utility to convert segmented structure information from the CARIMAS software into parallel geometry of GEANT4 is provided. The effective dose for a person who has been in contact with a male patient being treated for thyroid cancer with 131I is calculated for four circumstances: opposite, side by side, stand-lie and front–rear. The biggest dose is the ‘opposite’ circumstance and the smallest one is the ‘stand-lie’ circumstance. Using the dose distribution in the patient’s body and applying the right circumstance should be done to optimise the dose calculation for the contact person.
Toward a Complex Network of Risks for Psychosis: Combining Trauma, Cognitive Biases, Depression, and Psychotic-like Experiences on a Large Sample of Young Adults
Authors: Gawęda Łukasz , Pionke Renata , Hartmann Jessica , Nelson Barnaby , Cechnicki Andrzej , Frydecka Dorota
Published: August 2020

Although the linkage between traumatic life events and psychotic-like experiences (PLEs) is well established, the knowledge of potential mechanisms of this relationship is scarce. The aim of the present study was to better understand the structure of connections between traumatic life events and PLEs by considering at the same time the role of cognitive biases and depressive symptoms in the population of young adults (18–35 years of age, M = 26.52, SD = 4.74, n = 6772). Our study was conducted within a framework of network analysis. PLEs were measured with the Prodromal Questionnaire (PQ-16), cognitive biases were measured with nine items from the Davos Assessment of Cognitive Biases Scale-18 (DACOBS-18), depressive symptoms were assessed with the Center for Epidemiologic Studies–Depression Scale (CESD-R) and exposure to traumatic life events was measured with a combination of Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and Traumatic Experience Checklist (TEC). The results present a network of all nodes being interconnected within and between domains, with no isolated factors. Exposures to sexual trauma were the most central node in the network. Pathways were identified from trauma to PLEs via cognitive biases and depressive symptoms. However, the shortest pathway between the most central traumatic life event and PLEs was through other traumatic life events, without cognitive biases or depressive symptoms along the way. Our findings suggest the importance of environmental adversities as well as dysfunctional information processing and depression in the network of psychosis risks.
Investigating the ocular toxicity potential and therapeutic efficiency of in situ gel nanoemulsion formulations of brinzolamide
Authors: Talaei Sima , Mahboobian Mohammad Mehdi , Mohammadi Mojdeh
Published: August 2020

Glaucoma is an ocular disease i.e. more common in older adults with elevated intraocular pressure and a serious threat to vision if it is not controlled. Due to the limitations regarding the conventional form of brinzolamide (Azopt®), two optimum formulations of in situ gel nanoemulsion were developed. To ensure the safety and efficacy of developed formulations for ocular drug delivery, the current study was designed.

MTT assay was carried out on the human retinal pigmentation epithelial cells. To investigate the irritation potential of the chosen formulations, hen’s egg test-chorioallantoic membrane as a borderline test between in vivo and in vitro methods has been done. The modified Draize method was utilized to evaluate eye tolerance against the selected formulations. Intraocular pressure was measured by applying the prepared formulations to the eyes of normotensive albino rabbits in order to assess the therapeutic efficacy.

Based on MTT test, cell viability for NE-2 at 0.1% and NE-1 at 0.1 and 0.5% concentrations was acceptable. The results of the hen’s egg test-chorioallantoic membrane test indicated no sign of vessel injury on the chorioallantoic membrane surface for both formulations. Also, during 24 h, both formulations were well-tolerated by rabbit eyes. The pharmacodynamics effects of formulations had no difference or were even higher than that of suspension in case of adding lower concentration (0.5%) of brinzolamide to the formulations.

With regard to the results of the mentioned methods, our advanced formulations were effective, safe, and well-tolerated, thus can be introduced as an appropriate vehicle for ocular delivery of brinzolamide.
6Queer Theory: Queer Children and Childhoods
Authors: Miller Jennifer L
Published: August 2020

This year’s review of queer theory focuses on recent scholarship about transgender youth. Most of the scholarship reviewed in this chapter defines transgender expansively to include any identifications and/or expressions of gender that trouble dyadic sex-gender ideologies. Additionally, the scholarship reviewed in this chapter evinces a collapse of scholarship and activism by investing in scholarship as activism. Although queer theory is not often heralded for its use in taking a pragmatic approach to social change, the majority of theorists discussed in the chapter do in fact make practical recommendations for justice-oriented social policy and practice changes that would radically improve the lives of transgender youth. Even more, most of the scholars discussed in this chapter are themselves transgender and are committed to creating a world were trans lives can flourish. They resist liberal accommodation models of trans inclusion and instead theorize what meaningful structural change would look like. The chapter is divided into five sections: 1. Introduction: Queer Kids; 2. Queer Gender Now; 3. Queer Youth Now; 4. Transgender Youth In and Out of History; and 5. Conclusion.
Transthoracic Echocardiography in Prone Patients With Acute Respiratory Distress Syndrome: A Feasibility Study
Authors: Gibson Lauren E. , Di Fenza Raffaele , Berra Lorenzo , Bittner Edward A. , Chang Marvin G.
Published: August 2020

Objectives:

Patients with acute respiratory distress syndrome are at risk for developing cardiac dysfunction which is independently associated with worse outcomes. Transthoracic echocardiography is an ideal imaging modality for goal-directed assessment and optimization of cardiac function and volume status. Prone positioning, while demonstrated to improve oxygenation, offload the right ventricle, and reduce short-term mortality in acute respiratory distress syndrome, has previously precluded transthoracic echocardiography on these patients. The purpose of this study was to assess the ability to perform focused transthoracic echocardiography examinations on acute respiratory distress syndrome patients in the prone position.

Design:

We performed a cross-sectional study of critically ill patients hospitalized for acute respiratory distress syndrome due to coronavirus disease 2019.

Setting:

This study was conducted in medical and surgical intensive units in a tertiary hospital.

Patients:

We examined 27 mechanically ventilated and prone patients with acute respiratory distress syndrome due to coronavirus disease 2019. Participants were examined at the time of enrollment in an ongoing clinical trial (NCT04306393), and no patients were excluded from echocardiographic analysis.

Interventions:

None.

Measurements and Main Results:

We were able to perform transthoracic echocardiography and obtain satisfactory images for quantitative assessment of right ventricular function in 24 out of 27 (88.9%) and left ventricular function in 26 out of 27 (96.3%) of patients in the prone position, including many who were obese and on high levels of positive end-expiratory pressure (≥ 15 cm H2O).

Conclusions:

Transthoracic echocardiography can be performed at the prone patient’s bedside by critical care intensivists. These findings encourage the use of focused transthoracic echocardiography for goal-directed cardiac assessment in acute respiratory distress syndrome patients undergoing prone positioning.
Targeting molecular subtypes in solid cancers: successes and failures
Authors: Assi Rita , Kotecki Nuria , Awada Ahmad
Published: August 2020

Purpose of review

We herein review some of the major patterns of resistance and lessons learned from the use of earlier targeted therapies in two genotype-driven solid tumors.

Recent findings

Targeted agents have rapidly expanded in the field of oncology over the past 2 decades. The breakthroughs achieved by these agents have been, however, hindered by the inevitable development of drug resistance. Intrinsic or acquired mechanisms of resistance eventually lead to treatment tolerance and tumoral plasticity with phenotypic switch and evasion of the original targeted pathway. Failures in such therapies also result from poor selectivity of the target, drug delivery, and unaffordable costs.

Based on above findings, collaborative efforts are advancing at the molecular level to design better drugs or combinatorial strategies and to develop more sensitive assays to monitor responses and the emergence of resistance.
Chimeric antigen receptor T-cell lymphoma immunotherapy: the next questions
Authors: Salaroli Adriano , Spilleboudt Chloé , Bron Dominique , Lewalle Philippe
Published: August 2020

Purpose of review

Chimeric antigen receptor (CAR) T-cell therapy is an innovative form of adoptive cellular immunotherapy targeting CD19 in its most advanced form. Up to 30% of infused patients achieve long-term survival, meaning that 70% of patients still fail to respond or relapse after therapy. This review will address the unresolved issues relating to responders’ characterization, relapse prediction, and prevention, CAR T-cell construct optimization, rational combination with other therapies and treatment toxicity, focusing on the management of relapsed/refractory lymphoma patients.

Recent findings

Many new antigenic targets are currently investigated and raise the hope of broader successes. However, literature data report that treatment failure is not only related to CAR T construct and infusion but is also due to hostile tumor microenvironment and poor interaction with the host effector cells. Further research should not only target CAR T structure, toxicity and associated therapies, but also tumor-related and host-related microenvironment interactions that lead to treatment failure in relapsed/refractory lymphoma patients.

Poor persistence of CAR T and loss of CD19 antigen are well established mechanisms of relapse in Acute Lymphoblastic Leukemia (ALL). A fourth generation of CAR T construct is currently investigated to overcome this issue. In non-Hodgkin lymphoma, mechanisms of treatment failure remain poorly understood but tumor and host microenvironment are undoubtedly involved and should be further investigated. A deeper understanding of CAR T-cell therapy failure in individuals will help personalize CAR T-cell therapy in the future.
Hemophagocytic lymphohistiocytosis in advanced melanoma treated with dabrafenib and trametinib combination: two cases
Authors: Samaran Quentin , Belakebi Dorian , Theret Sarah , Becquart Ondine , Girard Céline , Du Thanh Aurélie , Guillot Bernard , Lesage Candice , Dereure Olivier
Published: August 2020

Hemophagocytic lymphohistiocytosis (HLH) has been only rarely reported in patients with BRAF-mutated advanced melanoma treated with targeted therapies and never with first-line dabrafenib/trametinib combination thus far. Two patients treated with first-line dabrafenib and trametinib combination therapy for metastatic melanoma presented with sudden occurrence of fever, cytopenia, rhabdomyolysis, hepatic cytolysis, hypertriglyceridemia and very high ferritin levels after few weeks of treatment, associated with concomitant epstein-barr virus (EBV) reactivation in one patient. In both cases, drug-induced HLH was primarily considered owing to a high H-score and the absence of other etiology. Patients rapidly improved after treatment discontinuation associated with oral steroids in one patient and did not relapse after subsequent treatment resumption with a concurrent anti-BRAF/anti-MEK combination. In metastatic melanoma HLH may occur either spontaneously in the absence of any treatment as a paraneoplastic condition, related to an intercurrent infection or drug-induced mainly with various immunotherapy or with dabrafenib and trametinib following immunotherapy. However, such observations are scarce and these are the first cases of HLH occurring during first-line treatment with dabrafenib and trametinib in advanced melanoma to our knowledge. Pathomechanisms remain to be elucidated since triggering factors may encompass the treatment itself but also other significant actors including viral reactivation along with the underlying disease. The liability of treatment should be considered in cases of HLH occurring in patients with advanced melanoma successfully treated with a combined targeted therapy. A rechallenge with a concurrent anti-BRAF/anti-MEK can be proposed in this setting.
A false traumatic aneurysm of the superficial temporal artery: case report and literature review
Authors: Xie Fei , Jianqiang Hao , Ting Wang , Richard Seidu A.
Published: August 2020

Introduction:

Pseudoaneurysms or false aneurysms originating from superficial temporal artery (STA) are rare and often seen as facial swellings. These forms of aneurysms often involve the intimal and media layers of the arterial wall. So far only single cases have been reported at various locations across the world since 1644. We report another unique case of traumatic STA pseudoaneurysms.

Case Presentation:

We present a 51-year-old man with a 1-year history of a pulsatile mass on the left forehead. He suffered a blunt trauma at the temporal region of the left forehead a year prior. Computed tomography angiography confirmed left STA pseudoaneurysms. The lesion was total resected via surgery. We reconstructed parent artery after resecting the pseudoaneurysm. The patient recovered well with an overall good cosmetic look.

Conclusions:

It is very necessary to report the occurrences of STA pseudoaneurysms because the swelling could be mistaken for other lesions leading to inappropriate treatment especially in facilities with no modern radiologic modalities.
Vaginal laser treatment of genitourinary syndrome of menopause: does the evidence support the FDA safety communication?
Authors: Guo Julia Z. , Souders Colby , McClelland Lynn , Anger Jennifer T. , Scott Victoria C.S. , Eilber Karyn S. , Ackerman A. Lenore
Published: August 2020

Importance:

Genitourinary syndrome of menopause (GSM) is a chronic, progressive condition frequently manifesting as vaginal dryness and pain with intercourse. Survey data indicate this is a highly prevalent, likely underreported, condition that profoundly affects quality of life for millions of women. Vaginal lasers demonstrate promise as an effective, nonhormone therapeutic alternative for GSM; however, the risks associated with them may have been overstated.

Objective:

Despite reports of improved sexual and vaginal comfort without serious safety concerns, the Food and Drug Administration (FDA) issued a 2018 safety communication warning against it. We conducted a systematic literature review and surveyed both the FDA Manufacturer and User Facility Device Experience (MAUDE) and Bloomberg Law Databases to evaluate risks associated with laser treatment for GSM.

Evidence Review:

A systematic literature review identified articles published before September 2019. The MAUDE database was searched by name from 2009 to 2019 for safety claims for 24 vaginal laser devices. The Bloomberg Law database was searched for product liability claims against any vaginal laser device manufacturer before July 2019.

Findings:

Literature review revealed 3 publications detailing 29 presumptive laser-associated complications, only 5 of which (17.2%) reported worsening symptoms after treatment. The MAUDE database contained 120 complaints; only 30 (25%) detailed potential adverse patient events, most frequently pain (n = 12) and burning (n = 10). The Bloomberg law database contained no claims asserting harm from device use.

Conclusions and Relevance:

Lacking strong evidence indicating significant patient risk for vaginal laser treatment of GSM, the FDA safety communication appears unsubstantiated and implies gender bias. Identified complications suggest most reported “adverse events” represent lack of treatment effect. The well-documented benefits and low risk of adverse event suggest laser therapy for GSM is reasonable with appropriate pretreatment counseling. Additional randomized, well-controlled clinical trials are needed to further elucidate both the safety and efficacy of this nonhormone therapy.
Feasibility of Continuous Infusions of Acyclovir
Authors: O’Leary Christine K. , Jones Cheryl , Bryant Penelope A. , Abo Yara-Natalie , Osowicki Joshua , Gwee Amanda
Published: August 2020

Current guidelines for severe herpes simplex virus infection recommend 21 days of intravenous therapy. The thrice-daily administration of intravenous acyclovir makes it challenging to deliver as outpatient therapy. We describe 2 cases with confirmed or presumed neonatal herpes simplex virus encephalitis treated with acyclovir administered as a continuous-infusion at home and review the pharmacologic and clinical evidence for continuous infusions of acyclovir.
Adjustable 6-0 polypropylene flanged technique for scleral fixation, part 1: primary fixation IOLs in aphakia, capsular stabilizing devices, and aniridia implants
Authors: Assia Ehud I. , Wong John X.H.
Published: August 2020

Purpose:

To describe the technique and outcomes of modified adjustable flange intrascleral fixation using 6-0 polypropylene sutures in primary scleral fixation in a variety of intraocular lenses (IOLs) and capsular stabilizing devices.

Setting:

Center for Applied Eye Research, Meir Medical Center, Israel.

Design:

Case series.

Methods:

Laboratory studies were performed to test the feasibility of passing 6-0 polypropylene sutures through hydrophobic and hydrophilic IOLs. The durability of the IOL, suture, and created flange was tested. IOL implantation was performed first on porcine eyes with assessment of IOL position. Surgery was then performed using this adjustable flange technique using a variety of IOLs, including hydrophilic, hydrophobic, and poly(methyl methacrylate) aniridic IOLs and the capsular anchor (AssiAnchor) to stabilize the capsular lens in eyes with compromised zonular fibers.

Results:

Surgery was performed on 9 eyes. Both hydrophobic and hydrophilic IOLs together with the 6-0 polypropylene suture were sufficiently durable in laboratory tests. Intrascleral fixation of 3 hydrophobic IOLs and 1 hydrophilic IOL was successfully achieved in 4 aphakic eyes. Stable and secure capsular bag fixation using the AssiAnchor was achieved in 4 eyes. Fixation of an aniridia IOL was also performed with success in 1 eye. All cases had stable and securely fixated IOLs and good postoperative recovery at 3 months follow-up. There was improvement in uncorrected distance visual acuity postoperatively in all cases.

Conclusions:

The modified adjustable flange technique for scleral fixation using polypropylene 6-0 was effective, relatively quick, and technically simpler and safer than alternative methods in the management of aphakia and zonular instability.
Serial opacification of a hydrophilic–hydrophobic acrylic intraocular lens: analysis of potential risk factors
Authors: Scherer Nicolas C.D. , Müller Karolina , Prahs Philipp M. , Radeck Viola , Helbig Horst , Märker David A.
Published: August 2020

Purpose:

To identify potential risk factors related to the opacification of a hydrophilic–hydrophobic acrylic intraocular lens (IOL) model.

Setting:

University Hospital Regensburg, Department of Ophthalmology, Regensburg, Germany.

Design:

Cross-sectional study.

Methods:

All patients with a Lentis LS-502-1 IOL implanted at the Department of Ophthalmology were identified. Existing medical records and information from the treating ophthalmologists were reviewed to determine the IOL status (clear or opacified). Potential risk factors were analyzed using binary logistic regression models.

Results:

A total of 223 IOLs of 199 patients were included. Sixty-seven (30.0%) opacified (calcified) IOLs were identified and compared with a control group of 156 IOLs. Statistical analyses revealed age at IOL implantation (odds ratio [OR] = 1.05,P= .012) to be associated with an increased risk of calcification. Posterior capsulotomy (OR = 0.45,P= .011) was found to have a protective influence. No other ophthalmic or systemic condition showed a significant association. Mean corrected distance visual acuity diminished significantly under opacification from 0.21 ± 0.25 logarithm of the correct minimum angle of resolution (logMAR) to 0.42 ± 0.32 logMAR (P< .001). IOL exchange in 55 of 67 cases at 45.8 ± 20.5 months after initial implantation yielded significant visual recovery (P= .001).

Conclusions:

Age at implantation might be a risk factor of IOL calcification, whereas posterior capsulotomy might be a protective factor. Calcification of the LS-502-1 IOL might be caused by the interaction of 3 main factors: IOL material traits, manufacturing-associated contamination, and patients’ individual factors altering intraocular ion concentrations.
Cataract incision-related corneal erosion: recurrent corneal erosion because of clear corneal cataract surgery
Authors: Kim Madeleine Eun-Ji , Kim Dooho Brian
Published: August 2020

Three patients developed recurrent corneal erosions (RCEs) over their cataract surgery corneal incisions. These cataract incision-related corneal erosions (CIRCEs) resulted in pain after cataract surgery. None had any physical findings for corneal erosion; thus, a new technique called the corneal sweep test was developed to identify the erosion. To the authors' knowledge, this is the first time this association between the clear corneal cataract incision and RCEs has been reported. Considering the high number of cataract surgeries performed around the world, it is important for ophthalmologists to recognize CIRCEs as a potential cause of ocular discomfort after clear corneal cataract surgery.
Repeatability and comparability of keratometry measurements obtained with swept-source optical coherence and combined dual Scheimpflug–Placido disk–based tomography
Authors: Lu Amy Q. , Poulsen Anne , Cui David , Seeger Catherine , Lehman Erik , Scott Ingrid U. , Pantanelli Seth M.
Published: August 2020

Purpose:

To assess the repeatability of keratometric measurements obtained using a reflectance and swept-source optical coherence tomography (SS-OCT) based biometer and to compare these values with those obtained with a dual Scheimpflug–Placido (S-P) disk–based tomographer/topographer.

Setting:

Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania, USA.

Design:

Prospective consecutive case series.

Methods:

Patients undergoing cataract evaluation were prospectively enrolled. Surgery-naive eyes without corneal pathology were measured 3 times with the reflectance/SS-OCT biometer and once with the dual S-P disk tomographer/topographer. Intradevice repeatability for anterior (K), posterior (PK), and total corneal keratometry (TK) readings were evaluated using within-eye SDs, test–retest repeatability (TRT), coefficients of variance, and intraclass correlation coefficients (ICCs). Bland-Altman analysis was used to assess agreement between devices.

Results:

Eighty-two eyes from 48 patients met inclusion criteria. The TRT for the anterior, posterior, and total corneal powers were 0.33, 0.08, and 0.36 diopter (D), respectively. TRT for the anterior, posterior, and total keratometric astigmatism were 0.58, 0.14, and 0.64 D, respectively. Anterior keratometric indices had higher ICCs than posterior indices. Bland-Altman analysis revealed that the SS-OCT consistently reported flatter posterior corneal curvatures than the S-P.

Conclusions:

The SS-OCT posterior keratometric measurements contain more noise (lower ICCs), but still have lower within-eye SDs and TRTs than that of anterior measurements. This may be due to the small index of refraction change at the cornea-aqueous interface. Although keratometric indices from the 2 devices are highly correlated, measurements taken using SS-OCT and S-P devices were not interchangeable.
Granulicatella adiacens endophthalmitis after phacoemulsification cataract surgery
Authors: Pilli Suman , Murjaneh Salem
Published: August 2020

Two cases of acute postoperative Granulicatella adiacens endophthalmitis following uneventful phacoemulsification surgery are reported. The cases had intracameral cefuroxime as antibiotic prophylaxis, visual acuity (VA) was perception of light and hand movements, respectively, and there was severe anterior chamber inflammation and dense vitritis with no fundal view. Vitreous biopsy identified G adiacens using genome sequencing. Intraoperative findings included extensive retinal hemorrhages, abscesses, occluded retinal vessels, and retinal necrosis. Because of the ischemic retinal appearance, pan-retinal photocoagulation endolaser was performed. Postoperatively both cases developed rhegmatogenous retinal detachment (RRD) anterior to the laser marks and were successfully treated. VA improved to 6/18 and 6/60, respectively. Hyperreflective dots and Henle fiber layer hemorrhage are reported for the first time, to the authors' knowledge, in association with endophthalmitis. The successful outcome suggested that intraoperative pan-retinal photocoagulation could be considered in such ischemic cases to prevent rubeosis and to reduce the risk for postoperative RRD or limit its extent if it recurs.
Outcomes of IOL power calculation using measurements by a rotating Scheimpflug camera combined with partial coherence interferometry
Authors: Taroni Leonardo , Hoffer Kenneth J. , Barboni Piero , Schiano-Lomoriello Domenico , Savini Giacomo
Published: August 2020

Purpose:

To evaluate the accuracy of the measurements provided by a Scheimpflug camera combined with partial coherence interferometry for intraocular lens (IOL) power calculation.

Setting:

I.R.C.C.S.-G.B. Bietti Foundation, Rome, Italy.

Design:

Prospective case series.

Methods:

Consecutive patients scheduled for cataract surgery were enrolled. Preoperative biometry was performed with a Pentacam AXL. All patients received the same IOL (AcrySof SN60WF). Measurements were entered into the following formulas: Barrett Universal II, Emmetropia Verifying Optical 2.0, Haigis, Hoffer Q, Holladay 1, Holladay 2 with axial length adjustment, Kane, Ladas Super Formula (LSF) 2.0, Næser 2, Pearl-DGS, SRK/T, T2, and VRF. When refraction was measured at 1 month postoperatively, the mean prediction error (PE), the median absolute error (MedAE), and the percentage of eyes with a PE within ±0.25, ±0.50, and ±1.00 diopter (D) were calculated after constant optimization.

Results:

Ninety-one eyes of 91 patients were analyzed. Comparison of the mean PE and MedAE did not reveal any statistically significant difference. However, the Pearl DGS formula achieved the lowest MedAE (0.19 D), followed by the LSF 2.0 (0.22). Twelve of the 13 formulas obtained a PE within ±0.50 D in at least 80% of eyes (range 80%-87%) and 7 of them in at least 85%. Twelve formulas yielded a PE within ±0.25 D in at least 50% of eyes (range 51%-64%).

Conclusions:

All the investigated formulas performed well using the Pentacam AXL measurements. The newest Pearl DGS formula version and LSF 2.0 showed promising results.
Review and recommendations for univariate statistical analysis of spherical equivalent prediction error for IOL power calculations
Authors: Holladay Jack T. , Wilcox Rand R. , Koch Douglas D. , Wang Li
Published: August 2020

Purpose:

To provide a reference for study design comparing intraocular lens (IOL) power calculation formulas, to show that the standard deviation (SD) of the prediction error (PE) is the single most accurate measure of outcomes, and to provide the most recent statistical methods to determine P values for type 1 errors.

Setting:

Baylor College of Medicine, Houston, Texas, and University of Southern California, Los Angeles, California, USA.

Design:

Retrospective consecutive case series.

Methods:

Two datasets comprised of 5200 and 13 301 single eyes were used. The SDs of the PEs for 11 IOL power calculation formulas were calculated for each dataset. The probability density functions of signed and absolute PE were determined.

Results:

None of the probability distributions for any formula in either dataset was normal (Gaussian). All the original signed PE distributions were not normal, but symmetric and leptokurtotic (heavy tailed) and had higher peaks than a normal distribution. The absolute distributions were asymmetric and skewed to the right. The heteroscedastic method was much better at controlling the probability of a type I error than older methods.

Conclusions:

(1) The criteria for patient and data inclusion were outlined; (2) the appropriate sample size was recommended; (3) the requirement that the formulas be optimized to bring the mean error to zero was reinforced; (4) why the SD is the single best parameter to characterize the performance of an IOL power calculation formula was demonstrated; and (5) and using the heteroscedastic statistical method was the preferred method of analysis was shown.
Role of Race in Short-Term Outcomes for 1700 Consecutive Patients Undergoing Brain Tumor Resection
Authors: Haldar Debanjan , Glauser Gregory , Schuster James M. , Winter Eric , Goodrich Stephen , Shultz Kaitlyn , Brem Steven , McClintock Scott D. , Malhotra Neil R.
Published: August 2020

Background:

Access to medical care seems to be impacted by race. However, the effect of race on outcomes, once care has been established, is poorly understood.

Purpose:

This study seeks to assess the influence of race on patient outcomes in a brain tumor surgery population.

Importance and Relevance to Healthcare Quality:

This study offers insights to if or how quality is impacted based on patient race, after care has been established. Knowledge of disparities may serve as a valuable first step toward risk factor mitigation.

Methods:

Patients differing in race, but matched on other outcomes affecting characteristics, were assessed for differences in outcomes subsequent to brain tumor resection. Coarsened exact matching was used to match 1700 supratentorial brain tumor procedures performed over a 6-year period at a single, multihospital academic medical center. Patient outcomes assessed included unplanned readmission, mortality, emergency department (ED) visits, and unanticipated return to surgery.

Results:

There was no significant difference in readmissions, mortality, ED visits, return to surgery after index admission, or return to surgery within 30 days between the two races.

Conclusion:

This study suggests that race does not independently influence postsurgical outcomes but may instead serve as a proxy for other closely related demographics.
Reducing Caesarean Section Surgical Site Infection (SSI) by 50%: A Collaborative Approach
Authors: Corbett Gillian A. , O'Shea Evelyn , Nazir Syeda Farah , Hanniffy Rosena , Chawke Geraldine , Rothwell Alison , Gilsenan Fiona , MacIntyre Anne , Meenan Anne Marie , O'Sullivan Niamh , Maher Niamh , Tan Terry , Sheehan Sharon R.
Published: August 2020

Objective:

Caesarean section surgical site infection (SSI) is a surgical wound site infection occurring within 30 days of surgery with a reported incidence of 3–15%. This quality improvement (QI) project aimed to reduce caesarean section SSI by 50% in a tertiary maternity center.

Methods:

Using multidisciplinary team approach, the project was designed with evidence-based interventions. The Royal College of Physicians of Ireland/Royal College of Surgeons in Ireland “Preventing Surgical Site Infections Key Recommendations for Practice” guideline was used as standard perioperative care. A care bundle was designed targeting preoperative personal patient preparation, preoperative prophylactic antibiotics, and strict skin preparation technique, all measured using a patient survey. The rate of SSI was followed for 14 months. The Model for Improvement methodology was used to implement change.

Results:

Surgical site infection rate decreased from 6.7% (n = 684 caesarean sections, n = 46 SSI) to 3.45% (n = 3,206 caesarean sections, n = 110 SSI), p = .0006. Reduction occurred in both elective (4.4%–2.7%) and emergency (9.1%–4.1%) caesarean section groups. There was excellent adherence to all three elements of the care bundle. The 50% reduction in caesarean section SSI was sustained over the 14-month period, significantly reducing maternal morbidity.

Conclusions:

The success of this QI project is attributable to frontline ownership and empowerment of patients and staff.
Prediction of Adverse Outcomes Within 90 Days of Surgery in a Heterogeneous Orthopedic Surgery Population
Authors: Dimentberg Ryan , Caplan Ian F. , Winter Eric , Glauser Gregory , Goodrich Stephen , McClintock Scott D. , Hume Eric L. , Malhotra Neil R.
Published: August 2020

Introduction:

The LACE+ index has been shown to predict readmissions; however, LACE+ has not been validated for extended postoperative outcomes in an orthopedic surgery population. The purpose of this study is to examine whether LACE+ scores predict unplanned readmissions and adverse outcomes following orthopedic surgery. Use of the LACE1 index to proactively identify at-risk patients may enable actions to reduce preventable readmissions.

Methods:

LACE+ scores were retrospectively calculated at the time of discharge for all consecutive orthopedic surgery patients (n = 18,893) at a multicenter health system over 3 years (2016–2018). Coarsened exact matching was used to match patients based on characteristics not assessed in the LACE+ index. Outcome differences between matched patients in different LACE quartiles (i.e. Q4 vs. Q3, Q2, and Q1) were analyzed.

Results:

Higher LACE+ scores significantly predicted readmission and emergency department visits within 90 days of discharge and for 30–90 days after discharge for all studied quartiles. Higher LACE+ scores also significantly predicted reoperations, but only between Q4 and Q3 quartiles.

Conclusions:

The results suggest that the LACE+ risk-prediction tool may accurately predict patients with a high likelihood of adverse outcomes after a broad array of orthopedic procedures.
DUSP1 Blocks autophagy-dependent ferroptosis in pancreatic cancer
Authors: Xie Yangchun , Kuang Feimei , Liu Jiao , Tang Daolin , Kang Rui
Published: August 2020

Ferroptosis is a oxidative damage-dependent form of regulated cell death that has become an emerging target for disease prevention and treatment. Here, we show that dual-specificity phosphatase 1 (DUSP1), a phosphatase playing multiple roles in stress-signaling pathways, is a new repressor of ferroptosis in human pancreatic cancer cells. Several classical ferroptosis activators (eg, erastin and RSL3) induce the expression of DUSP1, but not other members of DUSP, which depends on extracellular signal-regulated protein kinases 1 and 2 (ERK1/2). Moreover, shRNA-mediated DUSP1 knockdown increases the anticancer activity of ferroptosis activators in pancreatic cancer cells through activating lipid peroxidation in vitro and in vivo. Importantly, DUSP1-mediated autophagy is responsible for lipid peroxidation-mediated ferroptotic cell death. Thus, the DUSP1-related ferroptotic pathway may represent a potential target for therapeutic intervention in pancreatic cancer.