bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship Between Pulmonary Function and Thoracic Morphology in Adolescent Idiopathic Scoliosis
Authors: Deng Zhipeng , Luo Ming , Zhou Quan , Yang Xi , Liu Limin , Song Yueming
Published: October 2020

Study Design.

A retrospective study.

Objective.

The aim of this study was to investigate the relationship between thoracic morphology (TM) and pulmonary function (PF) in patients with adolescent idiopathic scoliosis (AIS) and the feasibility of the “apical vertebra deviation ratio (AVDR)” as a predictor of PF impairment.

Summary of Background.

The PF of AIS is one of the key focuses of clinicians’ attention. Early identification of AIS patients who are at risk of developing impaired PF is important for improving patient management.

Methods.

Preoperative PF and radiographic examination data of 108 patients with thoracic AIS were collected. The following TM data were collected: the costophrenic angle distance (CAD), distance between T1 and mean diaphragm height (T1-diaphragm), T1-T12 height, and AVDR. The correlation coefficient between PF and TM measurements was analyzed, and univariable and multivariable linear regressions were used to determine whether the TM measurements could predict PF.

Results.

The CAD, T1-diaphragm, and T1-T12 height were significantly positively correlated with forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), vital capacity, and total lung capacity (r = 0.54–0.74, P < 0.01). A linear equation between CAD and pulmonary volume could be established: FVC (L) = −3.46 + CAD (cm) × 0.27 (R
2 = 0.54). If T1-T12 height is included, the correlation is further enhanced (R
2 = 0.68). There was a significant negative correlation between the AVDR and predicted values of forced vital capacity (FVC%), FEV1%, predicted values of vital capacity, and predicted values of total lung capacity (r = −0.46 to −0.52, P < 0.01). The AVDR could predict the value of each of these variables. One of the linear equations is as follows: FVC% = 110.70–99.73 × AVDR (R
2 = 0.272).

Conclusion.

The two novel, two-dimensional TM measurements, CAD and AVDR, can be used as moderate to strong predictors of PF outcome in statistical terms. An AVDR >0.2 suggests that the patient may suffer from moderate or severe PF damage.

Level of Evidence: 4
The Politics of Chronic LBP
Authors: Gabel Charles Philip , Mokhtarinia Hamid Reza , Melloh Markus
Published: October 2020

Study Design.

Retrospective review of the literature.

Objective.

To update recent trends in the use of magnetic resonance spectroscopy (MRS) analysis for CLBP.

Summary of Background Data.

The lumbar multifidus (MF) muscle has drawn sustained interest for some time, particularly related to its structure, role in spinal stability, and its association and clinical significance with CLBP. Additionally, the presence of MF-arthrogenic muscle inhibition (AMI) and its relation to induced CLBP, through depleted lumbar stabilization, has gained increased recognition. In contrast, the differential diagnostic use of MRS analysis has suggested specific links between the presence of MF myo-cellular lipid (MCL) infiltration and CLBP patients.

Methods.

Review of the literature related to CLBP with the keywords MCL, MRS analysis, and MF-AMI.

Results.

No articles discussed CLBP using the three key concepts in a single context. The use of MRS analysis has the capacity to distinguish between Extra-MCL (EMCL) and intra-MCL (IMCL) infiltration within the lumbar MF. It is suggested that EMCLs are more likely to be associated with age-related change, while the IMCLs appear more likely to be associated with the presence of CLBP. The increased recognition of MF-AMI as a primary cause of CLBP, and the potential that AMI parallels the presence of IMCLs, facilitates possible use of MRS as a means to quantify the basis of lumbar MF-AMI CLBP, and that proportional IMCL changes in the MF could serve as a ‘proxy’ to indicate the effectiveness of interventions directed at MF activation.

Conclusions.

It may be possible for IMCLs to serve as a ‘proxy’ prognostic marker of lumbar MF-AMI in CLBP patients. Further, if this assertion were correct, then reductions in IMCLs could potentially quantify recovery and the efficacy of rehabilitation management strategies directed at lumbar MF activation.

Level of Evidence: 5
Impact of Fellows-as-Teachers Workshops on Teaching Rounds: An Observational Study in an ICU
Authors: Bergl Paul A. , Franco Rose M. , Patel Jayshil J. , Khan Marium , Fletcher Kathlyn E. , Nanchal Rahul S.
Published: October 2020

Objective:

During training, fellows serve as teachers and role models for junior colleagues. Fellows-as-teachers curricula may support these roles, but little is known about their effectiveness and durability. We sought to measure the long-term effects on ICU rounds after administering fellows-as-teachers workshops.

Design:

Prospective pre-/postintervention observational study of ICU rounds.

Setting:

Tertiary-care medical ICU with both pulmonary critical care and critical care medicine fellowships.

Subjects:

ICU teaching teams.

Interventions:

Fellows attended immersive workshops on promoting clinical reasoning, managing the learning environment, teaching bedside skills, and developing situational awareness on ICU rounds. After the workshops, faculty physicians were encouraged to have fellows routinely lead afternoon rounds.

Measurements and Main Results:

We gathered data from direct observations of ICU rounding activities, residents’ evaluations of rounds from surveys, and faculty physicians’ written comments on fellows’ performance in the ICU from end-of-rotation evaluations. Data were analyzed using descriptive statistics, nonparametric comparative tests, and chi-square tests for categorical data. A total of 61 ICU rounding sessions were observed with 501 discrete provider-patient interactions. Survey responses were collected from a total of 53 residents preintervention and 34 residents postintervention. We reviewed 72 open-ended faculty comments on fellows’ end-of-rotation evaluations, with 22 occurring postintervention. During the postintervention period, fellows were significantly more likely to make clinical decisions, explain their reasoning, provide teaching points, and ask questions on rounds. Additionally, we observed significantly higher quality written feedback on end-of-rotation evaluations by faculty physicians. However, residents generally harbored neutral or negative perceptions about the educational value of fellow-led rounds postintervention.

Conclusions:

Fellows’ contributions to patient care and teaching on ICU rounds increased for several months after our fellows-as-teachers workshops. Despite limitations and contamination in our design, our data suggest that similarly designed curricula may promote fellow engagement, possibly at the expense of residents’ education.
‘Reinventing the wheel’ to advance the development of pain therapeutics
Authors: Kandasamy Ram , Morgan Michael M.
Published: October 2020

Chronic pain affects approximately one-third of the population worldwide. The primary goal of animal research is to understand the neural mechanisms underlying pain so better treatments can be developed. Despite an enormous investment in time and money, almost no novel treatments for pain have been developed. There are many factors that contribute to this lack of translation in drug development. The mismatch between the goals of drug development in animals (inhibition of pain-evoked responses) and treatment in humans (restoration of function) is a major problem. To solve this problem, a number of pain-depressed behavioral tests have been developed to assess changes in normal behavior in laboratory animals. The use of home cage wheel running as a pain assessment tool is especially useful in that it is easy to use, provides an objective measurement of the magnitude and duration of pain, and is a clinically relevant method to screen novel drugs. Pain depresses activity in humans and animals, and effective analgesic treatments restore activity. Unlike traditional pain-evoked tests (e.g., hot plate, tail flick, von Frey test), restoration of home cage wheel running evaluates treatments for both antinociceptive efficacy and the absence of disruptive side effects (e.g., sedation, paralysis, nausea). This article reviews the literature using wheel running to assess pain and makes the case for home cage wheel running as an effective and clinically relevant method to screen novel analgesics for therapeutic potential.
Vaginal elasticity is significantly decreased in vaginal atrophy: a strain elastography study
Authors: Pákozdy Krisztina , Sipos Attila G. , Bombicz Mariann , Lampé Rudolf , Póka Róbert , Takacs Peter , Kozma Bence
Published: October 2020

Objectives:

Strain elastography is a novel method to assess the elasticity of tissues. We aimed to evaluate the value of vaginal strain elastography in women with vulvovaginal atrophy (VVA).

Methods:

Women with or without VVA were enrolled in this prospective study. Participants underwent vaginal cytology and vaginal wall elastography. Vaginal Health Index (VHI) was calculated. Based on Vaginal Maturation Value (VMV), participants were divided into atrophic and nonatrophic groups. Elastography parameters of the vaginal walls were measured in nine regions of interest (ROI). Elastography Index (EI) was defined by the average color score of nine ROIs. Groups were compared with unpaired t test or Mann-Whitney U test. Pearson correlation was used to determine the strength of association between EI and selected parameters. Multiple regression was used to evaluate the association between EI and age, VMV, and vaginal atrophy.

Results:

Ten women were diagnosed with VVA, and twenty had no cytological signs of vaginal atrophy (age-range 38-79 y). VHI score was significantly lower in the atrophic group (mean ± SD, 9.4 ± 2.011 vs 16.6 ± 4.22, P < 0.0001). In the atrophic group, EI was significantly lower than in nonatrophic group (mean ± SD, 20 ± 21 vs 47 ± 4, P < 0.01). We found a strong negative correlation between EI and vaginal atrophy (r =  −0.706, P < 0.0001; 95% CI: 0.8501 to −0.4639). In the multiple regression model, only atrophy remained statistically significant for the prediction of EI (P = 0.004).

Conclusions:

Vaginal elasticity is significantly decreased in women with vaginal atrophy, measured by EI. Our results suggest that strain elastography might be useful in the diagnosis of vaginal atrophy.
Menopause symptoms delineated by HIV clinical characteristics in African American women with HIV
Authors: Garbose Rebecca A. , Wu John , Christianson Mindy S. , Robinson Takeyra , Gaines Tyler , Shen Wen
Published: October 2020

Objective:

To obtain data on prevalence and severity of climacteric symptoms in women with HIV (WWH) during the menopausal transition and early menopause and to evaluate for any differences in symptoms by CD4 count and viral load.

Methods:

We conducted an in-person survey of female patients attending the Johns Hopkins HIV clinic, ages 40 to 50 years with at least one menstrual period within 6 months before the survey. Interviews utilized the Greene Climacteric scale, a validated menopause questionnaire. We also queried patients, (1) if they were informing their primary care physician of menopause symptoms and (2) if their menopause symptoms were being treated. The study used nonparametric Mann-Whitney rank sum tests with significance defined as P < 0.05 to perform symptom severity comparisons of distributions and Fischer exact tests for comparisons of categorical variables such as comparing prevalence of anxiety and depression in the population.

Results:

Twenty-three women aged 40 to 50 years were interviewed with a median age of 47 years [25 percentile = 46, 75 percentile = 49]. All were African American with median length of HIV diagnosis of 12 years [25 percentile = 7, 75 percentile = 20.5]. Most of the patients, 87% (n = 20), reported experiencing at least one menopause symptom with intense frequency and extreme detrimental effects on quality of life. All women interviewed, 100% (n = 23), reported hot flashes, ranging from infrequent to persistent. Sleeping difficulty was reported by 78% (n = 18) of women. Most women, 78% (n = 18), reported feeling tired or lacking energy with moderate frequency. The majority of the women, 87% (n = 20), said they reported menopause symptoms to their primary care provider. Of these, only 20% received treatment for menopause symptoms.

Conclusions:

These findings suggest that WWH undergoing the menopausal transition experience intense symptoms severely impacting quality of life. Although the majority of women reported experiencing menopause symptoms to medical providers, most remained untreated. An opportunity exists to educate providers caring for WWH on menopause medicine.
INTRAOCULAR LENS IMBRICATION FOR RECURRENT PUPILLARY CAPTURE AFTER SUTURELESS INTRASCLERAL FIXATION
Authors: Patel Saagar N. , Stem Maxwell S. , Todorich Bozho
Published: October 2020

Purpose:

To demonstrate a novel surgical technique (intraocular lens imbrication) for persistent postoperative pupillary capture after sutureless scleral intraocular lens fixation.

Methods:

Case report and supplemental digital content demonstrating salient steps of a novel surgical technique.

Results:

The patient did not suffer any further episodes of pupillary capture after intraocular lens imbrication with aforementioned surgical technique five months after the procedure. Postoperative best-corrected visual acuities were 20/40 in both eyes.

Conclusion:

Intraocular lens imbrication is an effective method to address persistent postoperative pupillary capture after sutureless scleral intraocular lens fixation.
Association of Collagen Gene (COL4A3) rs55703767 Variant With Response to Riboflavin/Ultraviolet A-Induced Collagen Cross-Linking in Female Patients With Keratoconus
Authors: Abdelghany Ahmed A. , Toraih Eman A. , Abdelaziz Eman Z. , El-Sherbeeny Nagla A. , Fawzy Manal S.
Published: October 2020

Purpose:

To investigate for the first time the association of collagenCOL4A3(rs55703767),COL5A1(rs7044529), andCOL4A4(rs2229813) variants with response to corneal collagen cross-linking (CXL) with riboflavin and ultraviolet A in patients with keratoconus (KC).

Methods:

A total of 147 eligible patients with KC were genotyped for the specified collagen variants using real-time TaqMan-based polymerase chain reaction. Adjusted odds ratio (OR) with 95% confidence interval (CI) was applied to assess the strength of the association with response to CXL for a decrease in maximum keratometry and/or an increase in corneal thickness.

Results:

Eighty-two patients (55.8%) had post-CXL successful outcomes. The overall analysis revealed that minor allele frequencies ofCOL4A3,COL5A1, andCOL4A4variants were 0.22, 0.22, and 0.38, respectively. The G/T genotype of theCOL4A3variant was more prevalent in the successful group (43%) compared with the failure group (23%) (P< 0.001).COL4A3(rs55703767) was associated with a good response under heterozygote (OR: 2.19, 95% CI, 1.04–4.59,P< 0.001) and overdominant (OR: 2.59, 95% CI, 1.25–5.38,P= 0.008) models. By contrast,COL5A1andCOL4A4variants were not associated with the effective response after CXL treatment. Interestingly, stratification analysis by sex revealed that CXL was more successful in female patients with KC under heterozygote (OR: 4.71, 95% CI, 1.74–12.75), dominant (OR: 3.16, 95% CI, 1.29–7.78), and overdominant (OR: 5.18, 95% CI, 1.92–13.95) models forCOL4A3(rs55703767) variant.

Conclusions:

TheCOL4A3(rs55703767) variant, among other study variants, could be implicated in CXL riboflavin/ultraviolet A treatment response in patients with KC in the study population. Large-scale replication and follow-up studies in different ethnic groups are warranted.
Phenotypic Characterization of Corneal Epithelium in Long-Term Follow-Up of Patients Post-Autologous Cultivated Oral Mucosal Epithelial Transplantation
Authors: Prabhasawat Pinnita , Chirapapaisan Chareenun , Jiravarnsirikul Anuwat , Ekpo Pattama , Uiprasertkul Mongkol , Thamphithak Ranida , Matamnan Sutthicha , Boonwong Chawikan
Published: October 2020

Purpose:

To analyze the phenotype of the corneal epithelium in patients with long-term follow-up who underwent autologous cultivated oral mucosal epithelial transplantation (COMET) using in vivo confocal microscopy (IVCM) and impression cytology with immunofluorescence staining (ICIF).

Methods:

Thirteen eyes from patients with severe limbal stem cell deficiency, who underwent COMET at least 48 months before, were recruited in this noncomparative cohort study. After eye examination, IVCM and ICIF were performed. Clinical manifestations of the cornea were evaluated and compared with epithelial findings detected by IVCM and ICIF [cytokeratin (CK) 3, CK7, and CK12]. Two corneal buttons derived from patients receiving the corneal transplantation post-COMET were sent for immunohistochemistry (CK3, CK6, CK7, CK12, paired box gene 6, p63, zonula occludens-1, and integrin β -1).

Results:

The mean age of patients was 51.2 ± 20.6 years, and the mean follow-up time since COMET was 78.7 ± 16.3 months. Six of 13 eyes showed clinically successful COMET. In these eyes, IVCM demonstrated predominant cornea-like epithelium and ICIF reported positivity for CK3 and CK12, confirming the presence of oral mucosal and corneal epithelium. Meanwhile, 7 eyes showed total conjunctivalization, corresponding with substantial conjunctival epithelium detected by IVCM and positivity for conjunctival (CK7) and oral mucosal epithelial (CK3) markers detected by ICIF. The immunohistochemistry of corneal buttons stained positive for oral mucosal, corneal epithelial, and stem cell markers (CK3, CK12, and p63).

Conclusions:

In long-term follow-up of COMET, epithelium of successful patients demonstrated cornea-like phenotype, whereas failed cases revealed mainly conjunctival phenotype. However, there were evidences that oral mucosal epithelial cells remained across the cornea in both successful and failed COMET as detected by IVCM and ICIF.
Cross-Linking Assisted Infection Reduction (CLAIR): A Randomized Clinical Trial Evaluating the Effect of Adjuvant Cross-Linking on Bacterial Keratitis
Authors: Prajna N. Venkatesh , Radhakrishnan Naveen , Lalitha Prajna , Rajaraman Revathi , Narayana Shivananda , Austin Ariana F. , Liu Zijun , Keenan Jeremy D. , Porco Travis C. , Lietman Thomas M. , Rose-Nussbaumer Jennifer
Published: October 2020

Purpose:

To determine whether there is a benefit to adjuvant corneal cross-linking (CXL) for bacterial keratitis.

Methods:

This is an outcome-masked, randomized controlled clinical trial. Consecutive patients presenting with a smear-positive bacterial ulcer at Aravind Eye Hospitals at Madurai, Pondicherry, and Coimbatore in India were enrolled. Study eyes were randomized to topical moxifloxacin 0.5% or topical moxifloxacin 0.5% plus CXL. The primary outcome of the trial was microbiological cure at 24 hours on repeat culture. Secondary outcomes included best spectacle corrected visual acuity at 3 weeks and 3 months, percentage of study participants with epithelial healing at 3 weeks and 3 months, infiltrate and/or scar size at 3 weeks and 3 months, 3-day smear and culture, and adverse events.

Results:

Those randomized to CXL had 0.60 decreased odds of culture positivity at 24 hours (95% confidence interval [CI]: 0.10–3.50; P = 0.65), 0.9 logarithm of the minimum angle of resolution lines worse visual acuity (95% CI: −2.8 to 4.6; P = 0.63), and 0.41-mm larger scar size (95% CI: −0.48 to 1.30; P = 0.38) at 3 months. We note fewer corneal perforations or need for therapeutic penetrating keratoplasty in the CXL group.

Conclusions:

We were unable to confirm a benefit to adjuvant CXL in the primary treatment of moderate bacterial keratitis. However, CXL may reduce culture positivity and complication rates; therefore, a larger trial to fully evaluate this is warranted.

Trial Registration:

NCT02570321.
In Vivo Confocal Microscopy Findings in Bowman Layer Transplantation
Authors: García de Oteyza Gonzalo , Vazquez-Romo Kristian Alfonso , Hernández-Quintela Everardo , de Wit Carter Guillermo , García-Albisua Ana Mercedes
Published: October 2020

Purpose:

To report the in vivo confocal microscopy (IVCM) findings of a case who underwent femtosecond laser-assisted Bowman layer transplantation (BLT).

Methods:

This is a case report.

Results:

In a 25-year-old man with previous diagnosis of keratoconus in whom a BLT was performed using the femtosecond laser-assisted technique, IVCM (Confoscan 4; Fortune Technologies, Vigonza, Italy) was performed 3 months after surgery, obtaining a sequence of 4 digitalized images of the total thickness of the cornea, from the epithelium to the endothelium, and then backward. The images were analyzed with the Navis v. 3.5.0. system (NIDEK, Multi-Instrument Diagnostic System, Japan). In the anterior stroma, before arriving to the graft interphase, activated keratocytes could be observed with higher reflectivity. In this first image of the anterior interphase, a homogenous hyporreflective image could be observed. In the interior of the graft, no keratocytes were found and some hyperreflective particles were present. In addition to the anterior, the posterior interphase presented bright particles.

Conclusions:

This is the first report that documents a BLT using IVCM.
Unilateral Ptosis, Proptosis, and Orbital Myositis After Shingles Vaccination
Authors: Chon Brian H. , Hwang Catherine J. , Perry Julian D.
Published: October 2020

Vaccinations for shingles are recommended for most adults over 60 years of age and are typically well tolerated. The present case describes acute onset of unilateral ptosis, proptosis, and orbital myositis developing within days after administration of shingles vaccination. The episode resolved to baseline after 1 week of treatment with steroids. To the authors' knowledge, this is first reported case of orbital inflammation following shingles vaccination. Given the temporal relationship and rapid response to treatment, this may represent an autoimmune reaction to the shingles vaccine.
The Presentation and Surgical Treatment of Peribulbar Dermolipomas
Authors: Vahdani Kaveh , Rose Geoffrey E.
Published: October 2020

Purpose:

To evaluate the presentation, treatment, and outcome for patients with peribulbar dermolipomas and describe a reliable technique for excision of large lesions.

Patients and methods:

Retrospective chart review for patients seen at Moorfields Eye Hospital between 1976 and 2019. Patient demographics, clinical features, imaging (CT or MRI, where available), histopathology, and surgical outcomes were reviewed.

Results:

One hundred and ninety-six eyes of 187 patients (117 females; 63%) were identified as having dermolipoma, the patients presenting at an average age of 21.5 years and—where recorded in 163 patients—had first symptoms at an average age of 12.9 years. Although 8/187 (4%) patients were asymptomatic, the commonest symptom was increasing size of a longstanding peribulbar lump (136 patients; 73%); other symptoms included ocular irritation (24%), episodic localized conjunctival injection (12%), and mucoid discharge (12%). One-third of dermolipomas had visible hairs (some with localized giant papillary conjunctivitis), lateral canthal widening was present in 44 patients, aberrant lacrimal gland ductules opening onto skin in 8, and a complex lateral canthal anomaly—with both an external dermoid and an internal dermolipoma—was present in 9 patients. Complete management details were available for 120 patients (those treated after 1990) and 40 (33%) electing for observation, 71 (59%) had excision for long-term irritation and discharge and 9 (8%) for cosmesis: together with the integral subdermal fat lobule, in all cases the abnormal, nonwetting squamous epithelium was delineated and excised under microscopic control, and the conjunctival defect closed directly (59/80 eyes) or with a “V-to-Y” closure (21 eyes; 26%). The presenting symptoms were cured in all except 1 patient, who required excision of residual abnormal epithelium causing persistent symptoms. Two patients developed symblepharon to the lateral canthus after direct conjunctival closure, this having no functional effect, and 2 other patients had slight restriction of extreme horizontal gaze.

Conclusion:

Dermolipomas may require surgery when they become more prominent with age, or start causing ocular irritation and discharge. Complications are few with meticulous removal of the nonwetting squamous epithelium and direct conjunctival closure, or when using a “V-to-Y” conjunctivoplasty for larger defects.
Incidence of corneal transplantation after challenging cataract surgery in patients with and without corneal guttata
Authors: Viberg Andreas , Byström Berit
Published: October 2020

Purpose:

To study the risk for corneal transplantation after phacoemulsification with dense cataract or posterior capsule rupture (PCR) and the impact of corneal guttata.

Setting:

Forty-nine Swedish cataract surgical units and 8 Swedish cornea transplantation units.

Design:

Registry-based cohort study.

Methods:

Patient data from the Swedish National Cataract Registry (2010 to 2012) were linked with data from the Swedish Cornea Transplant Registry (2010 to 2017). The outcome measures were risk for future corneal transplantation, visual acuity, and self-assessed visual function after phacoemulsification. Logistic and Poisson regression analyses with adjustment for confounder effects were used to investigate the association of the outcome measures with dense cataract, indicated by trypan blue capsular staining (TB) and PCR, separately and together.

Results:

Altogether, data from 276 362 cataract patients were linked with data from 2091 patients with endothelial failure who underwent corneal transplantation.The risk for future corneal transplantation increased more than 3-fold with the presence of dense cataract or PCR, and a trend toward an ever-higher risk with the combination of TB and PCR together, but without any significant synergy of corneal guttata. Dense cataract, but not PCR, was significantly associated with an increased probability of inferior visual acuity after phacoemulsification. The impact on satisfaction was not statistically significant for any of the factors.

Conclusions:

Challenging cataract surgery increases the risk for future corneal transplantation equally in patients both with and without corneal guttata, despite a more vulnerable endothelium in the guttata group. This supports a strategy where PCR is limited and handled optimally and that cataract surgery is performed before the cataract turns critically dense.
Triple procedure for coexistent aphakia, squint, and iris defect: single-stage strabismus correction, glued IOL, and single-pass 4-throw pupilloplasty
Authors: Agarwal Rinky , Yadav Neha , Tiwari Kabita , Bafna Rahul Kumar
Published: October 2020

Posttraumatic aphakia is a serious deterrent to visual rehabilitation that usually follows sensory exotropia, thereby mandating urgent surgical intervention. In addition, abnormal iris configuration and iris defects postocular trauma can lead to amblyopia and glare and require surgical correction. However, in individuals where such multiple posttraumatic extraocular and intraocular abnormalities coexist, confusion remains about whether to perform sequential or concomitant surgeries. In these situations, an unusual triple technique consisting of strabismus correction, glued scleral fixation of intraocular lens, and single-pass 4-throw pupilloplasty is a useful cost-effective method of single-stage visual and cosmetic rehabilitation. However, it requires collaboration of experienced surgeons form multiple ophthalmic subspecialties.
Comparison of central topographic maps from a swept-source OCT biometer and a Placido disk–dual Scheimpflug tomographer
Authors: Wang Li , Canedo Ana Laura C. , Wang Yvonne , Xie Kate C , Koch Douglas D.
Published: October 2020

Purpose:

To compare central topography (CT) from IOLMaster 700 with predicate topographic (PT) maps from a Placido disk–dual Scheimpflug tomographer in detection of irregularities that would influence the decision-making for implanting premium intraocular lenses (IOLs) (toric, multifocal, or extended depth-of-focus).

Setting:

Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.

Design:

Prospective comparative case series.

Methods:

Eyes with various corneal conditions were randomly selected: regular/irregular corneas, previous corneal refractive surgery, and keratoconus or pellucid marginal degeneration. Three observers compared the CT and PT maps and answered a questionnaire for each eye. The questionnaire focused on (1) overall shape similarity between CT and PT and (2) decision-making for premium IOL implantation based on CT and PT. Answers to the questionnaire and agreement in answers among observers were evaluated.

Results:

The study included 105 eyes. Comparing CT and PT, similar shape was observed in 68.6% to 89.5% of cases, and comparable map symmetries were reported in 60.0% to 83.8%; the same decision regarding premium IOL implantation was made in 75.2% to 97.1% of cases. There were significant interobserver agreements among 3 observers for all questions, with Fleiss κ values ranging from 0.141 to 0.450 (all P < .05). Peripheral corneal steeping or flattening was the primary finding that was visible on PT but not on CT.

Conclusions:

Compared with the PT, CT provided similar overall shape and comparable symmetries in most cases. The same decision was made whether to recommend a premium IOL based on CT and PT in 75% to 97% of cases.
Endoscopic and histologic evaluation of the gastrointestinal tract in patients with sarcoidosis
Authors: Wu Hao , Shen Bo
Published: October 2020

Background

The involvement of gastrointestinal tract is rare in sarcoidosis. Endoscopic and histologic evaluation likely provides diagnostic clue in sarcoidosis patients. The aims were to assess the frequency of abnormal endoscopy and histology in patients with sarcoidosis undergoing endoscopic evaluation and to characterize the endoscopic and histologic features in sarcoidosis of the gastrointestinal tract.

Methods

This was a retrospective study that included 230 patients with a confirmed diagnosis of sarcoidosis in a tertiary care center. The endoscopic and pathology reports were assessed, and serum angiotensin converting enzyme analysis was performed.

Results

Of 230 patients, 63 upper endoscopies and 142 colonoscopies were performed. The most common indication for upper endoscopy was abdominal pain (36.8%) while colonoscopy was most frequently performed for colorectal cancer screening (58.2%). There were 25 upper gastrointestinal biopsies performed (biopsy rate 39.7%) with a diagnostic yield of 92.0% abnormal biopsies, of which the main findings were esophageal tissue eosinophilia, gastritis and duodenal villous blunting. There were 99 lower gastrointestinal biopsies (biopsy rate 64.1%) with a diagnostic yield of 68.7% abnormal biopsies for adenocarcinoma, adenoma, inflammation, low-grade dysplasia, or polyp. Only one gastric biopsy revealed evidence of non-necrotizing granulomas. Of note, patients undergoing esophagogastroduodenoscopy or colonoscopy were more likely to have underlying gastrointestinal comorbidities (62.5%, P < 0.001).

Conclusion

Patients with sarcoidosis undergoing endoscopic evaluation have high histologic abnormalities with a low probability of characteristic histologic (i.e. granulomas, Schaumann and asteroid bodies) findings.
Evaluation of the efficacy and safety of direct oral anticoagulants in the treatment of portal vein thrombosis
Authors: Ilcewicz Haley N. , Martello Jay L. , Piechowski Kara
Published: October 2020

Objective

The purpose of this study was to evaluate the efficacy and safety of direct oral anticoagulants vs. warfarin for portal vein thrombosis treatment.

Methods

This was a single-center, retrospective study. Adult patients initiated on a direct oral anticoagulant or warfarin for treatment of a new portal vein thrombosis were included. The primary failure outcome was the absolute difference in recurrent thromboembolic events 90 days following initiation of a direct oral anticoagulant vs. warfarin. The primary safety outcome was the absolute difference in bleeding events 90 days following initiation of a direct oral anticoagulant vs. warfarin. Descriptive statistics, Fisher’s exact, and Student’s t-tests were utilized as appropriate.

Results

Thirty-three patients were included. Thirteen (39.4%) patients received direct oral anticoagulants, and 20 (60.6%) received warfarin. None of the patients receiving direct oral anticoagulants experienced a primary failure event compared to four receiving warfarin (P < 0.001). None of the patients receiving direct oral anticoagulants experienced a primary safety event vs. one receiving warfarin (P < 0.001).

Conclusion

Direct oral anticoagulants appear to be effective and safe in the treatment of portal vein thrombosis and in preventing recurrent thromboembolic events. Future studies with larger sample sizes are warranted to confirm direct oral anticoagulants’ efficacy in portal vein thrombosis.
The potential value of miRNA-223 as a diagnostic biomarker for Egyptian colorectal patients
Authors: Bader El Din Noha G. , Farouk Sally , Abdel-Salam Lubna O. , Khairy Ahmed
Published: October 2020

Objectives

Colorectal cancer (CRC) is the third lethal malignancy worldwide. Dysregulation of microRNAs (miRNAs) mediates several growth factors signaling pathways and induces abnormal genes expression, which leads to colorectal carcinogenesis. We aimed to comprehensively assess the expression of miRNA-200c, miRNA-203a, miRNA-223 in Egyptian CRC tissue and their corresponding serum samples and to explore if they have any potential prognostic or diagnostic value for CRC patients.

Methods

A total of 195 subjects (120 CRC patients and 75 healthy controls) participated in exploration and validation sets. The relative expression of miRNA-200c, miRNA-203a, and miRNA-223 was measured in both CRC tissue and serum samples, and the expressed miRNAs were compared in different CRC grades and types and the prognostic value was evaluated.

Results

The expression levels of miRNA-200c and miRNA-203a were reduced in CRC tissue samples than adjacent noncancerous tissues. miRNA-223 level was significantly upregulated in both CRC tissue and serum samples with a positive association between them (r = 0.85, P = 0.001). The miRNA-223 can effectively discriminate CRC patients from controls and can significantly differentiate between colon and rectal cancer patients. The association between serum miRNA-223 expression and CRC development was validated in the second set and the ROC curve showed highly significant prognostic value with 90.1% sensitivity, 87% specificity, and area under the curve of 0.914 (95% confidence interval: 0.830–0.978, P = 0.0001). These results showed the association between miRNA-223 upregulation and the CRC carcinogenesis.

Conclusion

Circulating miRNA-223 can be a potential noninvasive prognostic biomarker for Egyptian CRC patients.
Variceal bleeding has increased mortality compared to nonvariceal bleeding only in males
Authors: Erasmus Hans-Peter , Bektas Rukiye , Orland Katharina , Trifonova Svetlozara , Gu Wen-Yi , Uschner Frank Erhard , Brol Maximilian J. , Chang Johannes , Praktiknjo Michael , Strassburg Christian P. , Trebicka Jonel , Jansen Christian
Published: October 2020

Background

Gastrointestinal bleedings (GIBs) are frequent in cirrhotic patients and lead to high morbidity and mortality. Lately, there have been conflicting reports on the role of and bleeding type [variceal bleeding and nonvariceal bleeding (NVB)]. This study investigated the predictors of mortality in patients with variceal bleeding and NVB with relationship to sex differences.

Materials and methods

A total of 271 patients with suspected upper GIB who underwent endoscopy were included. Patients were followed up at 1 week, 6 months and 1 year after admission. Univariate and multivariate logistic or Cox regression analyses investigated correlations of predictive factors and clinical outcomes. Propensity score matching was performed to control for severity of disease and compare groups for sex and bleeding type.

Results

A total of 42 patients were excluded (cirrhosis or bleeding not confirmed). The remaining patients were classified by bleeding type into patients with variceal bleeding (n = 115) or NVB (n = 156). Males (n = 155) had higher mortality in variceal bleeding than in NVB, while in females (n = 116) mortality was similar in the two bleeding types. This was confirmed after matching in males (n = 116) and females (n = 82). Further independent predictors of mortality in males were model for end-stage liver disease (MELD) at baseline, blood urea nitrogen, alanine aminotransferase, while in females age, leukocytes, MELD, history of ascites and hepatic encephalopathy.

Conclusion

This study shows that variceal bleeding has higher mortality in males compared to NVB, while in females the type of GIB does not impact the outcome. This highlights that sex-specific clinical management should be based on bleeding type after endoscopy.
The association of plasma high-density lipoprotein cholesterol levels and cirrhosis development in obese patients with chronic hepatitis B: a cohort study
Authors: Wang Xian , Chen Hui-Zhen , Liu Wan-Ting , Liu Min , Zhou Dong-Qi , Chen Qiu , Peng Bo
Published: October 2020

Objective

Metabolic disorder is a common risk factor for cirrhosis in Asia, and it will increase the risk of cirrhosis in patients with Chronic hepatitis B (CHB). However, studies on the efficacy of plasma lipid markers which predict the happening and development of cirrhosis in obese CHB patients are limited.

Methods

In total, 3327 patients who were followed for more than 4 years’ follow-up in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine joined the program. Finally, 287 obese CHB patients were included in this study according to the results of metabolic tests. The data of baseline and follow-up were collected, and the association between them was analyzed.

Results

Based on the follow-up results, enrolled patients were divided into a group of cirrhosis (n = 146) and a group of noncirrhosis (n = 141). Plasma glucose and high-density lipoprotein cholesterol (HDL-C) levels in the noncirrhosis group (5.2 and 1.2 mmol/L, respectively) were significantly higher than that in the cirrhosis group (5.0 and 1.0 mmol/L, respectively), while the amount of total bile acid (TBA) in the cirrhosis group was lower than that in the cirrhosis group. Levels of HDL-C and total cholesterol were associated with liver function. Plasma HDL-C was an independent indicator of cirrhosis in patients with CHB. Patients with HDL-C levels less than 1.03 mmol/L had a 2.21-fold higher incidence rate of cirrhosis, and patients over 40 years old or the levels of HDL-C less than 1.03 mmol/L were more likely to generate cirrhosis.

Conclusions

Plasma HDL-C was an appropriate marker in predicting cirrhosis for patients with CHB.
Building Capacity in Health Professionals to Conduct Quality Improvement
Authors: Plummer Carolyn , Ruco Arlinda , Smith Kerry-Ann , Chandler Jillian , Ash Peter , McMillan Sarah , Di Prospero Lisa , Morassaei Sara , Nichol Kathryn
Published: October 2020

Background:

The Toronto Academic Health Sciences Network Health Professions Innovation Fellowship Program began in 2014 as a pilot initiative among 4 academic teaching hospitals in Toronto, Ontario. The purpose of the Program was to cultivate applied leadership, interprofessional collaboration, and quality improvement capacity among health professionals.

Purpose:

This article reports on the evaluation findings from the initial year as well as an update on current program status and sustainability.

Methods:

A formative evaluation was conducted focused on the impact on clinical practice, participant skill development, participant experience, and cross-organizational partnerships. Data were collected through a focus group, interviews, and pre- and postsurveys.

Results:

Data from the initial pilot showed increases in leadership practices, project management, and quality improvement knowledge, with changes in leadership practices being significant. Positive changes in clinical practice at both the individual and unit/team levels and capacity for building relationships were also reported. Since the pilot, more than 160 participants from 15 health professions and 9 organizations have participated. Several graduates have taken on leadership roles since their participation in the Program.

Conclusions:

Health care organizations wishing to advance academic practice may benefit from implementing a similar collaborative program to reap benefits beyond organizational silos.
Childhood Trauma in Schizophrenia Spectrum Disorders
Authors: Álvarez María-José , Masramom Helga , Foguet-Boreu Quintí , Tasa-Vinyals Elisabet , García-Eslava Jairo Santiago , Roura-Poch Pere , Escoté-Llobet Santiago , Gonzalez Anabel
Published: October 2020

Current evidence suggests a high prevalence of childhood trauma (CT) among adult patients diagnosed with schizophrenia spectrum disorders. Exposure to CT might lead to clinical differences eventually observed in these patients. We present a cross-sectional study with 54 patients with schizophrenia spectrum disorder (schizophrenia and schizoaffective disorder). We obtained sociodemographic data, as well as data on CT, dissociation, suicide history, and intensity of positive and negative psychotic symptoms. More than 75% of the patients reported a history of CT. We observed a link between CT and suicidal behavior. Patients showed high rates of dissociation. Dissociative experiences were related to CT, both in terms of intensity of trauma and number of traumas experienced. All CT forms except emotional neglect showed direct correlations with dissociative experiences. We found no correlation between intensity of CT and intensity of positive psychotic symptoms, yet we observed a moderate inverse correlation with negative psychotic symptoms.
Hyper-Activation of Endogenous GLP-1 System to Gram-negative Sepsis Is Associated With Early Innate Immune Response and Modulated by Diabetes
Authors: Bloch Olga , Perl Sivan H. , Lazarovitch Tsilia , Zelnik-Yovel Dana , Love Itamar , Mendel-Cohen Lior , Goltsman Galina , Flor Hadar , Rapoport Micha J.
Published: October 2020

Background:

Culture-positive gram-negative sepsis induces greater magnitude of early innate immunity /inflammatory response compared with culture-negative sepsis. We previously demonstrated increased activation of anti-inflammatory Glucagon Like Peptide-1 (GLP-1) hormone in initial phase of sepsis more pronounced in diabetes patients. However, whether GLP-1 system is hyperactivated during the early innate immune response to gram-negative sepsis and modulated by diabetes remains unknown.

Objectives:

Total and active GLP-1, soluble Dipeptidyl peptidase 4 (sDPP-4) enzyme, and innate immunity markers presepsin (sCD14) and procalcitonin (PCT) in plasma were determined by ELISA on admission and after 2 to 4 days in 37 adult patients with and without type 2 diabetes and gram-negative or culture-negative sepsis of different severity.

Results:

Severe but not non-severe sepsis was associated with markedly increased GLP-1 system response, which correlated with PCT and the organ dysfunction marker lactate. Culture-positive gram-negative bacteria but not culture-negative sepsis induced hyper-activation of GLP-1 system, which correlated with increased innate immune markers sCD14, PCT, and lactate. GLP-1 inhibitory enzyme sDPP-4 was down regulated by sepsis and correlated negatively with sCD14 in gram-negative sepsis. Diabetic patients demonstrated increased GLP-1 response but significantly weaker innate immune response to severe and gram-negative sepsis.

Conclusions:

Early stage of gram-negative sepsis is characterized by endogenous GLP-1 system hyperactivity associated with over activation of innate immune response and organ dysfunction, which are modulated by diabetes. Total GLP-1 may be novel marker for rapid diagnosis of gram-negative sepsis and its severity.
The 1919 eclipse results that verified general relativity and their later detractors: a story re-told
Authors: Gilmore Gerard , Tausch-Pebody Gudrun
Published: October 2020

Einstein became world famous on 7 November 1919, following press publication of a meeting held in London on 6 November 1919 where the results were announced of two British expeditions led by Eddington, Dyson and Davidson to measure how much background starlight is bent as it passes the Sun. Three data sets were obtained: two showed the measured deflection matched the theoretical prediction of Einstein's 1915 Theory of General Relativity, and became the official result; the third was discarded as defective.

At the time, the experimental result was accepted by the expert astronomical community. However, in 1980 a study by philosophers of science Earman and Glymour claimed that the data selection in the 1919 analysis was flawed and that the discarded data set was fully valid and was not consistent with the Einstein prediction, and that, therefore, the overall result did not verify General Relativity. This claim, and the resulting accusation of Eddington's bias, was repeated with exaggeration in later literature and has become ubiquitous.

The 1919 and 1980 analyses of the same data provide two discordant conclusions. We reanalyse the 1919 data, and identify the error that undermines the conclusions of Earman and Glymour.
Tenacibaculum piscium sp. nov., isolated from skin ulcers of sea-farmed fish, and description of Tenacibaculum finnmarkense sp. nov. with subdivision into genomovars finnmarkense and ulcerans
Authors: Olsen Anne Berit , Spilsberg Bjørn , Nilsen Hanne K. , Lagesen Karin , Gulla Snorre , Avendaño-Herrera Ruben , Irgang Rute , Duchaud Eric , Colquhoun Duncan J.
Published: October 2020

Results of previous multilocus sequence and whole-genome-based analyses have suggested that a homogeneous group of isolates belonging to the genus

Tenacibaculum

, represented by strain TNO020T and associated with skin ulcer development in sea-farmed fish, represents an as-yet-undescribed species. Comparative whole-genome analysis performed in the present study clustered five isolates, including TNO020T, in a distinct lineage within the genus

Tenacibaculum

. Phenotypic differences, high intra-cluster average nucleotide identity (ANI) values and low ANI values with other

Tenacibaculum

species support the proposal of a novel species, for which we propose the name Tenacibaculum piscium sp. nov. with strain TNO020T (=CCUG 73833T=NCIMB 15240T) as the type strain. Further, large-scale genome analyses confirmed the existence of two different phylogenetic lineages within ‘

T. finnmarkense

’, a species effectively but not validly published previously. ANI values just above the species delineation threshold of 95–96 % confirmed that both lineages belong to the same species. This result was also supported by DNA–DNA hybridization values. Phenotypically, the two conspecific lineages are distinguishable by differences in growth temperature range and ability to degrade l-proline. For the group of isolates already commonly known as ‘

T. finnmarkense

’, we propose the name

Tenacibaculum finnmarkense

sp. nov., with strain TNO006T (=CCUG 73831T=NCIMB 15238T) as the type strain. We further propose the subdivision of

T. finnmarkense

sp. nov. into two genomovars,

T. finnmarkense

genomovar finnmarkense with strain TNO006T (=CCUG 73831T=NCIMB 15238T) as the type strain and

T. finnmarkense

genomovar ulcerans with strain TNO010T (=CCUG 73832T=NCIMB 15239T) as the type strain.