bluuebunny/crossref_metadata_2025 huggingface dataset:
Spatially resolved star formation and fuelling in galaxy interactions
Authors: Moreno Jorge , Torrey Paul , Ellison Sara L , Patton David R , Bottrell Connor , Bluck Asa F L , Hani Maan H , Hayward Christopher C , Bullock James S , Hopkins Philip F , Hernquist Lars
Published: September 2020

We investigate the spatial structure and evolution of star formation and the interstellar medium (ISM) in interacting galaxies. We use an extensive suite of parsec-scale galaxy-merger simulations (stellar mass ratio = 2.5:1), which employs the ‘Feedback In Realistic Environments-2’ model (fire-2). This framework resolves star formation, feedback processes, and the multiphase structure of the ISM. We focus on the galaxy-pair stages of interaction. We find that close encounters substantially augment cool (H i) and cold-dense (H2) gas budgets, elevating the formation of new stars as a result. This enhancement is centrally concentrated for the secondary galaxy, and more radially extended for the primary. This behaviour is weakly dependent on orbital geometry. We also find that galaxies with elevated global star formation rate (SFR) experience intense nuclear SFR enhancement, driven by high levels of either star formation efficiency (SFE) or available cold-dense gas fuel. Galaxies with suppressed global SFR also contain a nuclear cold-dense gas reservoir, but low SFE levels diminish SFR in the central region. Concretely, in the majority of cases, SFR enhancement in the central kiloparsec is fuel-driven (55 per cent for the secondary, 71 per cent for the primary) – while central SFR suppression is efficiency-driven (91 per cent for the secondary, 97 per cent for the primary). Our numerical predictions underscore the need of substantially larger, and/or merger-dedicated, spatially resolved galaxy surveys – capable of examining vast and diverse samples of interacting systems – coupled with multiwavelength campaigns aimed to capture their internal ISM structure.
A ‘head/tail’ plasmon model with a Hubble law velocity profile
Authors: Raga A C , Rodríguez-González A , Hernández-Martínez L , Cantó J , Castellanos-Ramírez A
Published: September 2020

We present a model of a hypersonic, collimated, ‘single pulse’ outflow, produced by an event with an ejection velocity that first grows, reaches a peak, and then decreases again to zero velocity in a finite time (simultaneously, the ejection density can have an arbitrary time-variability). We obtain a flow with a leading ‘head’ and a trailing ‘tail’ that for times greater than the width of the pulse develops a linear, ‘Hubble law’ velocity versus position. We present an analytical model for a simple pulse with a parabolic ejection velocity versus time and time-independent mass-loss rate, and compare it to an axisymmetric gasdynamic simulation with parameters appropriate for fast knots in planetary nebulae. This ‘head/tail plasmon’ flow might be applicable to other high-velocity clumps with ‘Hubble law’ tails.
Asymmetrical effects of deafness-associated mitochondrial DNA 7516delA mutation on the processing of RNAs in the H-strand and L-strand polycistronic transcripts
Authors: Xiao Yun , Wang Meng , He Qiufen , Xu Lei , Zhang Qinghai , Meng Feilong , Jia Zidong , Zhang Fengguo , Wang Haibo , Guan Min-Xin
Published: September 2020

In this report, we investigated the molecular mechanism underlying a deafness-associated m.7516delA mutation affecting the 5′ end processing sites of mitochondrial tRNAAsp and tRNASer(UCN). An in vitro processing experiment demonstrated that m.7516delA mutation caused the aberrant 5′ end processing of tRNASer(UCN) and tRNAAsp precursors, catalyzed by RNase P. Using cytoplasmic hybrids (cybrids) derived from one hearing-impaired Chinese family bearing the m.7516delA mutation and control, we demonstrated the asymmetrical effects of m.7516delA mutation on the processing of tRNAs in the heavy (H)-strand and light (L)-strand polycistronic transcripts. Specially, the m.7516delA mutation caused the decreased levels of tRNASer(UCN) and downstream five tRNAs, including tRNATyr from the L-strand transcripts and tRNAAsp from the H-strand transcripts. Strikingly, mutant cybrids exhibited the lower level of COX2 mRNA and accumulation of longer and uncleaved precursors of COX2 from the H-strand transcripts. Aberrant RNA metabolisms yielded variable reductions in the mitochondrial proteins, especially marked reductions in the levels of ND4, ND5, CO1, CO2 and CO3. The impairment of mitochondrial translation caused the proteostasis stress and respiratory deficiency, diminished ATP production and membrane potential, increased production of reactive oxygen species and promoted apoptosis. Our findings provide new insights into the pathophysiology of deafness arising from mitochondrial tRNA processing defects.
CUBAP: an interactive web portal for analyzing codon usage biases across populations
Authors: Hodgman Matthew W , Miller Justin B , Meurs Taylor E , Kauwe John S K
Published: September 2020

Synonymous codon usage significantly impacts translational and transcriptional efficiency, gene expression, the secondary structure of both mRNA and proteins, and has been implicated in various diseases. However, population-specific differences in codon usage biases remain largely unexplored. Here, we present a web server, https://cubap.byu.edu, to facilitate analyses of codon usage biases across populations (CUBAP). Using the 1000 Genomes Project, we calculated and visually depict population-specific differences in codon frequencies, codon aversion, identical codon pairing, co-tRNA codon pairing, ramp sequences, and nucleotide composition in 17,634 genes. We found that codon pairing significantly differs between populations in 35.8% of genes, allowing us to successfully predict the place of origin for African and East Asian individuals with 98.8% and 100% accuracy, respectively. We also used CUBAP to identify a significant bias toward decreased CTG pairing in the immunity related GTPase M (IRGM) gene in East Asian and African populations, which may contribute to the decreased association of rs10065172 with Crohn's disease in those populations. CUBAP facilitates in-depth gene-specific and codon-specific visualization that will aid in analyzing candidate genes identified in genome-wide association studies, identifying functional implications of synonymous variants, predicting population-specific impacts of synonymous variants and categorizing genetic biases unique to certain populations.
International Survey Reveals Opportunities to Improve Tuberculous Meningitis Management and the Need for Standardized Guidelines
Authors: Tucker Elizabeth W , Marais Suzaan , Seddon James A , van Crevel Reinout , Ganiem Ahmad Rizal , Ruslami Rovina , Zhang Wenhong , Sun Feng , Zhou Xian , Solomons Regan S , Cresswell Fiona V , Wilmshurst Jo , Rohlwink Ursula
Published: September 2020

Background

Tuberculous meningitis (TBM) is a medical emergency, yet there are no standardized treatment guidelines for the medical or neurosurgical management of these patients and little data on neurocritical care. We conducted an international survey to understand current medical and neurosurgical TBM management and resource availability to provide baseline data needed for future multicenter trials addressing unanswered clinical research questions and the establishment of standardized guidelines.

Methods

An online survey of 77 questions covering medical and neurosurgical TBM management aimed at clinicians/nurses treating TBM was distributed as an anonymous link through email invitation, international organizations’ membership distribution, and direct links on organizational webpages or social media. The survey remained open for 5 months. Data were summarized with frequencies and percentages.

Results

The survey had 222 responses from 43 countries representing 6 continents. Most respondents were from tertiary care facilities, with broad access to medical and neurosurgical resources. There was significant heterogeneity in general supportive care, and TBM-specific management demonstrated considerable divergence from current standard-of-care practices. The lack of standardized guidelines was identified as a major challenge in TBM management. General and neurocritical care were largely absent. Resources for bedside supportive care and noninvasive monitoring were broadly accessible.

Conclusions

These findings suggest that current TBM management could be improved by the establishment of internationally accepted treatment guidelines based on available evidence, and that numerous centers have resources available to participate in future multicenter trials, even for basic interventions, that may further improve patient outcomes globally.
Management of severe hyperinflammation in the COVID-19 era: the role of the rheumatologist
Authors: Papadopoulou Charalampia , Al Obaidi Muthana , Moraitis Elena , Compeyrot-Lacassagne Sandrine  , Eleftheriou Despina , Brogan Paul
Published: September 2020

Objectives

The objectives of this study were (i) to describe the clinical presentation, treatment and outcome of paediatric inflammatory multisystem syndrome temporally related to Sars-CoV-2 (PIMS-TS) in children; (ii) to propose a framework to guide multidisciplinary team (MDT) management; and (iii) to highlight the role of the paediatric rheumatologist in this context.

Methods

This study involved a retrospective case notes review of patients referred to a single specialist paediatric centre with suspected PIMS-TS, with a focus on clinical presentation, laboratory parameters, treatment, and outcome in the context of an MDT framework.

Results

Nineteen children of median age 9.1 years fulfilled the definition of PIMS-TS and were managed within an MDT framework: 5/19 were female; 14/19 were of Black, Asian or minority ethnicity; 9/19 also fulfilled diagnostic criteria for complete or incomplete Kawasaki disease (KD). Severe systemic inflammation, shock, and abdominal pain were ubiquitous. Treatment was stratified within an MDT framework and included CSs in all; i.v. immunoglobulin in all; anakinra in 4/19; infliximab in 1/19; and antiviral (aciclovir) in 4/19.

Conclusions

We observed significant diagnostic equipoise using a current definition of PIMS-TS, overlapping with KD. Outside of clinical trials, an MDT approach is vital. The role of the paediatric rheumatologist is to consider differential diagnoses of hyperinflammation in the young, to advise on empiric immunomodulatory therapy, to set realistic therapeutic targets, to gauge therapeutic success, to oversee timely step-down of immunomodulation, and to contribute to the longer-term MDT follow-up of any late inflammatory sequelae.
Competing modes of responsibility in research organisations—Insights from an international comparison
Authors: Hennen Leonhard , Hahn Julia , Ladikas Miltos
Published: September 2020

Based on findings from research in the incorporation of responsible research and innovation in research organisations in twelve European and non-European countries, the article discusses how old (i.e. internal) and new (i.e. external) modes of responsibility coexist and compete with each other in actual research practice. Although the analysis shows ubiquitous perceived need for re-arranging the relations between science and society in order to legitimise scientific research in organisations, it also finds that the incumbent structures and cultures of internal thinking are still dominant in most organisations, which leads to considerable resistance to change. In particular, for public engagement and reflexive anticipatory ethics, strategies of conceptual and procedural demarcation are evident. Organisations adapt public engagement or reflexive ethics as extraordinary or experimental activities thus allowing for the continuation of the status quo in the perspective of the ‘republic of science’, keeping ‘internal’ affairs unaffected by societal intervention.
In vitro assessment of the cytotoxic, genotoxic and oxidative stress effects of the synthetic cannabinoid JWH-018 in human SH-SY5Y neuronal cells
Authors: Sezer Yigit , Jannuzzi Ayse Tarbin , Huestis Marilyn A , Alpertunga Buket
Published: September 2020

Background: JWH-018 was the first synthetic cannabinoid introduced as a legal high and the first of the new generation of novel psychoactive substances that flooded worldwide drug markets. JWH-018 was marketed as “spice,” “herbal incense,” or “herbal blend,” as a popular and legal (at the time) alternative to cannabis (marijuana). JWH-018 is a potent synthetic cannabinoid with considerable toxicity associated with its use. JWH-018 has qualitatively similar but quantitatively greater pharmacological effects than cannabis, leading to intoxications and even deaths. The mechanisms of action of the drug’s toxicity require research, and thus, the aim of the present study was to investigate the toxicological profile of JWH-018 in human SH-SY5Y neuronal cells. Methods: SH-SY5Y neuronal cells were exposed to increasing concentrations from 5 to 150 μM JWH-018 over 24 h. Cytotoxicity, DNA damage, the apoptotic/necrotic rate, and oxidative stress were assessed following SH-SY5Y exposure. Results: JWH-018 did not produce a significant decrease in SH-SY5Y cell viability, did not alter apoptotic/necrotic rate, and did not cause genotoxicity in SH-SY5Y cells with 24-h exposure. Glutathione reductase and catalase activities were significantly reduced; however, there was no significant change in glutathione peroxidase activity. Also, JWH-018 treatment significantly decreased glutathione concentrations, significantly increased protein carbonylation, and significantly increased malondialdehyde (MDA) concentrations. For significance, all P < 0.05. Discussion/Conclusion: JWH-018 produced oxidative stress in SH-SY5Y cells that could be an underlying mechanism of JWH-018 neurotoxicity. Additional in vivo animal and human-based studies are needed to confirm our findings.
Overlaying COVID-19 mitigation plans on malaria control infrastructures
Authors: Rahi Manju , Baharia Rajendra Kumar , Das Payal , Chhibber-Goel Jyoti , Sharma Amit
Published: September 2020

To counter the coronavirus disease 2019 (COVID-19) pandemic, each country must design sustainable control plans given the inherent disparities in wealth and healthcare systems. Most malaria-endemic countries run well-entrenched malaria control programs via their established frameworks for diagnosis, case management, treatment and overall surveillance. We propose that the malaria control infrastructures can be partially co-opted for launching sustainable COVID-19 mitigation plans.
9Theory on Theory
Authors: Ng Julia
Published: September 2020

This chapter assesses three areas of theoretical work: metatheory, via Jason Demers’s The American Politics of French Theory: Derrida, Deleuze, Guattari, and Foucault in Translation and Galin Tihanov’s The Birth and Death of Literary Theory: Regimes of Relevance in Russia and Beyond; three studies that theorize on the history of theory, John E. Drabinski’s Glissant and the Middle Passage: Philosophy, Beginning, Abyss, John Frow’s On Interpretive Conflict, and Anne Anlin Cheng’s Ornamentalism; and five texts indicative of a surge of interest in the linguisticity of ‘death’, David Wills’s Killing Times: The Temporal Technology of the Death Penalty, Michael Rothberg’s The Implicated Subject: Beyond Victims and Perpetrators, David Simpson’s States of Terror: History, Theory, Literature, and Marc Crépon’s Murderous Consent: On the Accommodation of Violent Death and The Vocation of Writing: Literature, Philosophy, and the Test of Violence.
Subgroups of Pediatric Patients With Functional Abdominal Pain
Authors: Stone Amanda L. , Han Gloria T. , Bruehl Stephen , Garber Judy , Smith Craig A. , Anderson Julia , Palermo Tonya M. , Walker Lynn S.
Published: September 2020

Objectives:

Prior work in a cohort of youth with functional abdominal pain (FAP) identified patient subgroups (High Pain Dysfunctional, High Pain Adaptive, Low Pain Adaptive) that predicted differences in the course of FAP from childhood into young adulthood. We aimed to replicate these subgroups in a new sample of adolescents with FAP using the original classification algorithm and to extend subgroup characteristics to include parental characteristics and health service use.

Methods:

Adolescents (n=278; ages 11 to 17 y, 66% females) presenting to a gastroenterology clinic for abdominal pain, and their parents (92% mothers) completed self-report measures; adolescents also completed a 7-day pain diary.

Results:

The replicated patient subgroups exhibited distress and impairment similar to subgroups in the original sample. Moreover, in novel findings, the High Pain Dysfunctional subgroup differed from other subgroups by the predominance of mother-daughter dyads jointly characterized by high levels of anxiety, depressive symptoms, pain behavior, and pain catastrophizing. The High Pain Dysfunctional subgroup used more health care services than Low Pain Adaptive but did not differ from High Pain Adaptive.

Discussion:

Findings replicate and extend the original FAP classification and suggest that the subgroups have unique patient and parent features that may reflect distinct illness mechanisms requiring different treatments.
Power Analysis for Null Hypothesis Significance Testing
Authors: Nicholson Kristen J. , Reyes Ariana A. , Sherman Matthew , Divi Srikanth N. , Vaccaro Alex R.
Published: September 2020

Before conducting a scientific study, a power analysis is performed to determine the sample size required to test an effect within allowable probabilities of Type I error (α) or Type II error (β). The power of a study is related to Type II error by 1−β. Most scientific studies set α=0.05 and power=0.80 as minimums. More conservative study designs will decrease α or increase power, which will require a larger sample size. The third and final parameter required for a power analysis is the effect size (ES). ES is a measure of the strength of the observation in the outcome of interest (ie, the dependent variable). ES must be estimated from pilot studies or published values. A small ES will require a larger sample size than a large ES. It is possible to detect statistically significant findings even for very small ES, if the sample size is sufficiently large. Therefore, it is also essential to evaluate whether ES is sufficiently large to be clinically meaningful.
Digitalization and Physician Learning
Authors: Vallo Hult Helena , Hansson Anders , Gellerstedt Martin
Published: September 2020

Introduction:

The emerging context of online platforms and digitally engaged patients demands new competencies of health care professionals. Although information and communication technologies (ICTs) can strengthen continuous professional development (CPD) and learning at work, more research is needed on ICT for experiential and collegial learning.

Methods:

The study builds on prior qualitative research to identify issues and comprises a quantitative assessment of ICT usage for learning in health care. A survey was administered to Swedish physicians participating in a CPD program as part of specialist medical training. Conclusions focused specifically on learning dimensions are drawn from correlation analyses complemented with multiple regression.

Results:

The findings show that physicians' actual use of ICT is related to perceived performance, social influence, and organizational context. Social norm was the most important variable for measured general usage, whereas performance expectancy (perceived usefulness of ICT) was important for ICT usage for learning. The degree of individual digitalization affects performance and, in turn, actual use.

Discussion:

The study highlights the need to incorporate ICT effectively into CPD and clinical work. Besides formal training and support for specific systems, there is a need to understand the usefulness of digitalization integrated into practice. Moving beyond instrumentalist views of technology, the model in this study includes contextualized dimensions of ICT and learning in health care. Findings confirm that medical communities are influencers of use, which suggests that an emphasis on collegial expectations for digital collaboration will enhance practitioner adaptation.
Genetic factors related to the widespread dissemination of ST11 extensively drug-resistant carbapenemase-producing Klebsiella pneumoniae strains within hospital
Authors: Li Dai-Xi , Zhai Yao , Zhang Zhao , Guo Ya-Tao , Wang Zhan-Wei , He Zi-Long , Hu Song-Nian , Chen Yu-Sheng , Kang Yu , Gao Zhan-Cheng
Published: September 2020

Background

Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) poses distinct clinical challenges due to extensively drug resistant (XDR) phenotype, and sequence type (ST) 11 is the most dominant bla
KPC-2-bearing CP-Kp clone in China. The purpose of this current retrospective study was to explore the genetic factors associated with the success of XDR CP-Kp ST11 strains circulated in the intensive care unit (ICU) of a Chinese tertiary hospital.

Methods

Six ST11 XDR CP-Kp strains were identified between May and December 2014 and validated by minimum inhibitory concentration examination, polymerase chain reaction, and pyrosequencing. The six ST11 XDR CP-Kp, as well as three multi-drug resistant (MDR) and four susceptible strains, were sequenced using single-molecule real-time method. Comprehensively structural and functional analysis based on comparative genomics was performed to identify genomic characteristics of the XDR ST11 CP-Kp strains.

Results

We found that ST11 XDR bla
KPC-2-bearing CP-Kp strains isolated from inpatients spread in the ICU of the hospital. Functionally, genes associated with information storage and processing of the ST11 XDR CP-Kp strains were more abundant than those of MDR and susceptible strains, especially genes correlative with mobile genetic elements (MGEs) such as transposons and prophages. Structurally, eleven large-scale genetic regions taken for the unique genome in these ST11 XDR CP-Kp strains were identified as MGEs including transposons, integrons, prophages, genomic islands, and integrative and conjugative elements. Three of them were located on plasmids and eight on chromosomes; five of them were with antimicrobial resistance genes and eight with adaptation associated genes. Notably, a new bla
KPC-2-bearing ΔΔTn1721-bla
KPC-2 transposon, probably transposed and truncated from ΔTn1721-bla
KPC-2 by IS903D and ISKpn8, was identified in all six ST11 XDR CP-Kp strains.

Conclusion

Our findings suggested that together with clonal spread, MGEs identified uniquely in the ST11 XDR CP-Kp strains might contribute to their formidable adaptability, which facilitated their widespread dissemination in hospital.
Mechanisms of resistance to immune checkpoint inhibitors and strategies to reverse drug resistance in lung cancer
Authors: Qian Fang-Fei , Han Bao-Hui
Published: September 2020

In recent years, the research of immune checkpoint inhibitors has made a great breakthrough in lung cancer treatment. Currently, a variety of immune checkpoint inhibitors have been applied into clinical practice, including antibodies targeting the programmed cell death-1, programmed cell death-ligand 1, and cytotoxic T-lymphocyte antigen 4, and so on. However, not all patients can benefit from the treatment. Abnormal antigen presentation, functional gene mutation, tumor microenvironment, and other factors can lead to primary or secondary resistance. In this paper, we reviewed the molecular mechanism of immune checkpoint inhibitor resistance and various combination strategies to overcome resistance, in order to expand the beneficial population and enable precision medicine.
The Coronavirus Disease 2019 pandemic: how does it spread and how do we stop it?
Authors: Li Xin , Sridhar Siddharth , Chan Jasper Fuk-Woo
Published: September 2020

Purpose of review

The Coronavirus Disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global health threat associated with major socioeconomic disruptions. Understanding on the transmission characteristics of SARS-CoV-2 is crucial for optimizing preventive strategies.

Recent findings

SARS-CoV-2 can be transmitted efficiently between persons through respiratory droplets and direct and indirect contact. The significance of airborne droplet nuclei in SARS-CoV-2 transmission in the community setting is less clear. SARS-CoV-2 RNA and live viral particles may also be detected in other bodily fluids. Outbreaks have been reported in families, nursing homes, markets, restaurants, churches, shipping vessels, gyms, and healthcare facilities. Nonpharmaceutical preventive measures at both the community and individual levels are essential for reducing the transmission of SARS-CoV-2.

Because well tolerated and effective vaccines for SARS-CoV-2 are unlikely to be widely available in the near future, there is an urgent need for finding other measures to reduce the spread of the COVID-19 pandemic. With better understanding of its transmission characteristics, practical nonpharmaceutical preventive measures remain essential to reduce SARS-CoV-2 transmission and its associated health and socioeconomic burdens.
HIV care during the coronavirus disease-2019 pandemic in Shenzhen, China
Authors: Wang Hui
Published: September 2020

Purpose of review

Due to the stringent measures including quarantine of infected individuals and social distancing, the COVID-19 pandemic has posted great challenges for HIV-1 care in China. In this mini-review, I will discuss the situation in Shenzhen city as a window of China to reflect our strategies in fighting the concurrent HIV/AIDS and COVID-19 pandemics.

Recent findings

Prevention of nosocomial infection, minimizing the follow-up visits to the hospital, maintaining the delivery of PreP/PEP services and testing for SARS-Cov-2 and HIV when someone have fever or respiratory symptoms were the four major approaches to maintain uninterrupted HIV care in Shenzhen. None of 15 000 PLWH seeking HIV care at Shenzhen were diagnosed with COVID-19 during this pandemic.

This article share the experience unprecedented from Shenzhen. We have to adapt our care and service to continue to engage PLWH to avoid poor outcomes. More research is needed to know the long-term implications of pandemic for the health of PLWH.
Advances in contraception research and development
Authors: Cahill Erica P. , Kaur Simranvir
Published: September 2020

Purpose of review

In the past few years, there have been great advances in contraceptive technology and development. Here we review advances in contraception over the past two years including new medications, and technologies.

Recent findings

Contraception must be discussed within the context of individual goals and context. New contraceptive options approved by the FDA in the past two years include a year-long vaginal ring, a progestin-only pill that is as effective as combined oral contraceptive pills, a new hormonal patch and a vaginal gel that may also help prevent sexually transmitted infections.

There are still areas of contraceptive research that are very much unknown including biomarkers of contraceptive efficacy or side effects, how individuals or groups metabolize contraception, initiation around reproductive life events or the discontinuation of other methods.

There have been many new contraceptives developed over the past few years to address challenges of existing contraception and create new methods; yet, there remain many unanswered questions in contraceptive research. Contraceptive technology has far-reaching consequences, and independent of technology itself, represents a great opportunity for truly personalized medicine.
NONARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY AFTER INTRAVITREAL AFLIBERCEPT FOR AGE-RELATED MACULAR DEGENERATION
Authors: Paxton Andrew B. , Christakis Panos G. , Micieli Jonathan A.
Published: September 2020

Purpose:

To report a case of nonarteritic anterior ischemic optic neuropathy (NAION) after intravitreal injection in a patient with a history of fellow-eye NAION.

Methods:

Observational case report.

Results:

An 82-year-old woman with a history of fellow eye NAION developed an inferior visual field defect 1 day after an intravitreal aflibercept injection for neovascular age-related macular degeneration. She was found to have optic disk edema and an inferior altitudinal defect, consistent with NAION. The mechanism may have involved compromised perfusion to the optic nerve head related to elevated intraocular pressure or vasoconstriction because of antivascular endothelial growth factor activity.

Conclusion:

Nonarteritic anterior ischemic optic neuropathy is a rare complication of intravitreal injection and may be related to postinjection elevation in intraocular pressure. Monitoring of intraocular pressure postinjection with low-threshold for preinjection aqueous suppression or postinjection anterior chamber paracentesis for persistently elevated intraocular pressure is recommended in patients with a history of NAION.
MULTIMODAL IMAGING OF RECURRENT CYSTOID MACULAR EDEMA ASSOCIATED WITH POEMS SYNDROME RESPONSIVE TO INTRAVITREAL DEXAMETHASONE IMPLANT
Authors: Pole Cameron , Hosseini Hamid , Prasad Pradeep
Published: September 2020

Purpose:

To describe the multimodal imaging findings of cystoid macular edema (CME) in POEMS syndrome and to demonstrate the effectiveness of the dexamethasone intravitreal implant in this condition.

Methods:

A case report of a patient with POEMS syndrome. Multimodal imaging, including optical coherence tomography and ultra-wide field fluorescein angiography, was used to evaluate the CME and its response to treatment.

Results:

A 66-year-old man with a history of POEMS syndrome in clinical remission after chemotherapy presented with blurry vision in the left eye. Vitreomacular traction and CME were noted on optical coherence tomography. After pars plana vitrectomy, the patient had persistent CME in the left eye and developed new CME in the right eye, which worsened over the next year. Visual acuities at this time were 20 of 60 in both eyes. The CME was unresponsive to topical ketorolac and prednisolone acetate and intravitreal bevacizumab but partially response to intravitreal and sub-Tenon's triamcinolone acetate injections. Intravitreal dexamethasone implant was given bilaterally with full resolution and visual acuities improvement to 20 of 40 in the right eye and 20 of 30 in the left eye. However, CME recurred after 3 months. Ultra-wide field fluorescein angiography demonstrated bilateral CME and diffuse peripheral vascular leakage. Serum vascular endothelial growth factor levels were normal.

Conclusion:

Cystoid macular edema may develop in POEMS syndrome in the absence of systemic findings, elevated serum vascular endothelial growth factor, or optic nerve edema. Previously unreported peripheral vascular leakage was demonstrated on ultra-wide field fluorescein angiography. Dexamethasone implant was the most effective of used therapies to treat CME.
Neuro-ophthalmic manifestations of coronavirus disease 19
Authors: Tisdale Alanna K. , Chwalisz Bart K.
Published: September 2020

Purpose of review

To provide a summary of the neuro-ophthalmic manifestations of coronavirus disease 19 (COVID-19), documented in the literature thus far.

Recent findings

A small but growing literature documents cases of new onset neuro-ophthalmic disease, in the setting of COVID-19 infection. Patients with COVID-19 have experienced acute onset vision loss, optic neuritis, cranial neuropathies, and Miller Fisher syndrome. In addition, COVID-19 increases the risk of cerebrovascular diseases that can impact the visual system.

The literature on COVID-19 continues to evolve. Although COVID-19 primarily impacts the respiratory system, there are several reports of new onset neuro-ophthalmic conditions in COVID-infected patients. When patients present with new onset neuro-ophthalmic issues, COVID-19 should be kept on the differential. Testing for COVID-19 should be considered, especially when fever or respiratory symptoms are also present. When screening general patients for COVID-19-associated symptoms, frontline physicians can consider including questions about diplopia, eye pain, pain with extraocular movements, decreased vision, gait issues, and other neurologic symptoms. The presence of these symptoms may increase the overall probability of viral infection, especially when fever or respiratory symptoms are present. More research is needed to establish a causal relationship between COVID-19 and neuro-ophthalmic disease, and better understand pathogenesis.
Retinal manifestations of the neurocutaneous disorders
Authors: Engelhard Stephanie B. , Kiss Szilard , Gupta Mrinali P.
Published: September 2020

Purpose of review

The neurocutaneous disorders are a genetically and phenotypically diverse group of congenital syndromes characterized by cutaneous, ocular, and central nervous system manifestations. This review provides an overview of the clinical features and retinal findings in selected neurocutaneous disorders.

Recent findings

Advances in genetics and diagnostic retinal and neuroimaging allow for the recognition of retinal features of common neurocutaneous syndromes and for improved characterization of rarer entities based on previously underdiagnosed or unrecognized retinal findings.

Better characterization of the neurocutaneous disorders allows for earlier recognition and the potential for expeditious vision-saving and life-saving treatment.
Neuro-ophthalmic manifestations of Susac syndrome
Authors: Redler Yael , Chwalisz Bart K.
Published: September 2020

Purpose of review

This review discusses general features and organ-specific presentations of Susac syndrome as well as diagnosis and treatment.

Recent findings

Latest literature regarding demographics, new diagnostic modalities such as optical coherence tomography and treatment options for Susac syndrome are discussed in detail in this review, summarizing the most recent updated information.

Susac syndrome is a rare, underdiagnosed, and often misdiagnosed disease that can lead to severe complications such as deafness, vision loss, dementia, and death. It involves the central nervous system and may mimic other neurological and neuro-ophthalmological diseases.
Effect of Nylon Wick Technique on Early Intraocular Pressure Control in Nonvalved Aqueous Shunt Surgery
Authors: Swaminathan Swarup S. , Quist Michael S. , Dawson Lindsay E. , Rothman Adam L. , Herndon Leon W.
Published: September 2020

Precis:

The use of nylon wicks with fenestrations in nonvalved aqueous shunt surgery significantly reduces intraocular pressure (IOP) and glaucoma medication usage in the immediate postoperative period compared with the use of fenestrations alone.

Purpose:

To compare early postoperative IOP and medication usage in patients undergoing implantation of a nonvalved aqueous shunt device with fenestrations only or fenestrations with nylon wicks.

Methods:

A retrospective review of all nonvalved aqueous shunt insertions completed by one surgeon (L.W.H.) was completed using current procedure terminology. Patients undergoing Baerveldt or ClearPath 350 mm2 aqueous shunt insertion with fenestrations only (n=37) or fenestrations with 2 nylon wicks were identified (n=92). All devices were ligated with 7-0 Vicryl (polyglactin) suture, and either 4 fenestrations or 2 fenestrations and two 9-0 nylon wicks were placed anterior to the ligature. Data regarding visual acuity (VA), IOP, number of glaucoma medications, and complications were collected from the preoperative visit just before surgery, postoperative day 1, week 3 (POW3), week 5, and month 2 (POM2). The main outcome measures were VA, IOP, number of glaucoma medications, and complications at all postoperative time points.

Results:

There was no difference in logMAR VA between the 2 groups at any time point. At POW3, IOP was significantly lower in the wick group (14.6±7.7 vs. 18.1±8.7 mm Hg, P=0.03). Number of glaucoma medications used was significantly reduced in the wick group at POW3 (0.5±0.9 vs. 1.0±1.2, P=0.02) and POM2 (0.7±1.0 vs. 1.4±1.3, P=0.02). There was no significant increase in the overall rate of complications in the wick group, but there was a higher rate of transient hyphema (28% vs. 8%, P=0.02).

Conclusions:

The use of 2 nylon wicks with fenestrations in nonvalved aqueous shunt device implantation can significantly lower IOP and medication burden while awaiting the dissolution of the ligature suture.
Juvenile Open-angle Glaucoma With Waardenburg Syndrome: A Case Report
Authors: AbdelRahman Ahmed M. , Amin Rana H.
Published: September 2020

Waardenburg syndrome (WS) is a genetic disorder resulting in anomalies of derivatives of neural crest cells during development. Patients tend to have variable degrees of pigmentary defects affecting skin, hair, and irides in addition to hearing loss and possible systemic neurological associations. Elevation of the intraocular pressure has been reported in several adult patients with WS. We report the first case of WS to be associated with juvenile open-angle glaucoma in a 20-year-old Egyptian man thus expanding the spectrum of the types of glaucoma that can coexist with the syndrome.
Assessment of Corneal Epithelium Thickness in Glaucomatous Patients Undergoing Medical Treatment
Authors: Halkiadakis Ioannis , Vernikou Anna , Tzimis Vasilis , Markopoulos Ioannis , Popeskou Korina , Konstadinidou Vasiliki
Published: September 2020

Precis:

Patients with glaucoma have reduced and irregular corneal epithelial thickness (CET) even if they do not report symptoms of dry eyes. The reduction of corneal epithelium affects equally the superior and inferior areas of the cornea.

Purpose:

To evaluate CET parameters by means of anterior segment optical coherence tomography in glaucomatous patients undergoing medical treatment and compare them with CET parameters of controls.

Methods:

This was a cross-sectional study of 62 patients with primary open-angle or pseudoexfoliative glaucoma (study group) and 62 age-matched controls. Fourier-domain optical coherence tomography (RTVue) with a corneal adaptor module was used in the present study. Τhe pachymetry scan pattern was used to map the cornea and the software generated corneal thickness parameters were recorded. Simple comparisons between groups were performed and the correlations of CET parameters with parameters associated with medication use (treatment duration, number of medications and number of instillations) were assessed.

Results:

Mean age of the patients was 68±11.9 years in the glaucoma group and 65.5±8.5, years in the control group (P=0.17). Median number of instillations of medication was 2 (range, 1 to 6) for the glaucoma group. Central corneal thickness was 537.6±33.3 in the glaucoma group and 550.8±33.7 in the control group, respectively (P=0.028). The central CET was 48.8.±3.7 μm in the glaucoma group and 53.5±3.7 μm in the control group (P<0.001). Similarly, the average superior (2 to 7 mm) CET and the average inferior (2 to 7 mm) CET were almost equally reduced in the glaucoma group (45±4 vs. 49.6±3.3 μm, P<0.001 and 49±3.9 vs 53.5±3.7, P<0.001, respectively). No CET parameter was correlated with any of the treatment parameters.

Conclusions:

Patients treated for glaucoma have uniformly reduced corneal epithelial thickness.
Association of Nailfold Capillary Abnormalities With Primary Open-angle Glaucoma and Glaucomatous Visual Field Loss
Authors: Goh Hilary , Kersten Hannah M. , Yoon Jinny J. , Gossage Lisa , Danesh-Meyer Helen V.
Published: September 2020

Precis:

Nailfold capillary abnormalities are associated with primary open-angle glaucoma (POAG) and increased severity of global and central glaucomatous visual field (VF) loss.

Purpose:

The purpose of this study was to investigate whether nailfold capillary abnormalities are associated with POAG and the severity of glaucomatous VF loss.

Materials and Methods:

A cross-sectional study of 83 POAG cases and 40 controls was conducted. Nailfold capillaroscopy images were assessed by masked graders for dilated capillaries >50 μm, crossed capillaries, tortuous capillaries, hemorrhages, avascular zones >100 μm, capillary density, and capillary distribution. VF loss in glaucoma cases was quantified using mean deviation and mean central pattern standard deviation (PSD) from the worst-affected eye.

Results:

Logistic regression analyses of cases and controls showed that avascular zones [odds ratio (OR)=1.24; 95% confidence interval (CI): 1.06, 1.47; P=0.005], capillary density (OR=0.63; 95% CI: 0.46, 0.83; P<0.001), and capillary distribution (OR=7.88; 95% 95% CI: 2.53, 28.40; P=0.001) were associated with POAG. Simple linear regression analysis of cases only showed that nailfold hemorrhages were associated with mean deviation (β=−5.10; 95% CI: −9.20, −1.01; P=0.015) and mean central PSD (β=−4.37; 95% CI: −8.18, −0.57; P=0.025), and this remained significant in the multiple linear regressions. After controlling for demographic and clinical factors, avascular zones were associated with both mean deviation (β=−0.76; 95% CI: −1.48, −0.04; P=0.040) and mean central PSD (β=−0.78; 95% CI: −1.45, −0.10; P=0.024), whereas capillary distribution was only associated with mean deviation (β=−4.67; 95% CI: −7.92, −1.43; P=0.017).

Conclusion:

Nailfold capillary abnormalities are associated with POAG as well as increased global and central vision loss.
Management Patterns and Visual Outcomes of Endophthalmitis After Glaucoma Drainage Device Placement: A Case Series
Authors: Robbins Cason B. , Feng Henry L. , Fekrat Sharon
Published: September 2020

Purpose:

To describe clinical presentation, management, and outcomes of eyes with endophthalmitis related to glaucoma drainage device (GDD) placement.

Patients and Methods:

Retrospective chart review of patients diagnosed with GDD-related endophthalmitis at Duke Eye Center from 2009 to 2018.

Results:

Six eyes of 6 patients had endophthalmitis related to a GDD (2 Ahmed, 4 Baerveldt). The mean time from surgery to presentation was 22.7 months. Five of 6 cases (83%) had culture-proven infectious endophthalmitis. Eyes undergoing GDD explantation (n=2) had better visual acuity at 6 months compared with those without hardware removal (20/11,314 vs. 20/358). Visual acuity at 6 months was hand motion (20/8000) or worse in 3 of 6 cases (50%).

Conclusions:

GDD-related endophthalmitis often leads to poor visual outcomes. Hardware removal may lead to improved visual outcomes; a multicenter prospective study assessing the benefit of hardware removal may be warranted.
Changes in Intraocular Pressure and Anterior Chamber Angle After Congenital Cataract Extraction
Authors: Gouda Jylan , Tomairek Reham H. , Elhusseiny Abdelrahman M. , El-Fayoumi Dina , Awadein Ahmed , Gawdat Ghada , Elhilali Hala
Published: September 2020

Precis:

Anterior chamber angle (ACA) narrowing continues to occur for at least 2 years after congenital cataract surgery. Risk factors for intraocular pressure (IOP) elevation after congenital cataract surgery were higher central corneal thickness (CCT) and surgery at <2 months.

Purpose:

The purpose of this study was to study the changes in IOP and in the ACA during the first 2 years after pediatric cataract surgery and to determine risk factors for such changes.

Patients and Methods:

A retrospective observational study was done on infants who underwent pediatric cataract surgery in Cairo University Hospitals and completed a 1-year follow-up. Demographic and clinical characteristics were recorded including age at surgery, sex, corneal diameter, CCT pupil diameter, IOP, gonioscopic findings, presence of persistent hyperplastic primary vitreous, surgical approach, primary intraocular lens implantation, and perioperative subconjunctival steroid injection. Changes in IOP and in the ACA were recorded, and the risk factors for such changes were analyzed.

Results:

Postoperative IOP elevation >18 mm Hg occurred in 23 eyes of 206 eyes (11%), who completed Year 1 and in 9 (13%) of 86 eyes who completed Year 2. Risk factors for IOP elevation were larger preoperative CCT (P=0.01) in Year 1, and younger age at surgery (P=0.01), and aphakia (P=0.05) in Year 2. In multivariate analysis only younger age at surgery was a risk factor for IOP elevation in Year 2. ACA narrowing occurred in 49% and in 21% of the examined eyes in Years 1 and 2, respectively. Aphakia was not a significant risk factor of angle narrowing in Years 1 and 2 (P=0.17 and 0.42, respectively).

Conclusions:

Higher preoperative CCT was a risk factor for early-onset IOP elevation. Surgery at >2 months was associated with lower susceptibility to late-onset IOP elevation.
Tube-Shunt Bleb Pathophysiology, the Cytokine Story
Authors: Freedman Jeffrey
Published: September 2020

Purpose:

To define tube bleb-pathophysiology, outlining factors that may play a major role in the ultimate success or failure of the bleb. Methods that may be used to advance success of these blebs are discussed.

Materials and Methods:

The study describes the importance of tube shunt bleb pathophysiology, including the role of cytokines, relating to bleb failure or success. Methods to influence these outcomes, are outlined.

Results:

Understanding the various parameters involved with the pathophysiology of tube shunt blebs, especially intraocular pressure (IOP), and cytokine content of aqueous. The production of cytokines by tube shunt blebs, and the possible adverse results of this action on a second tube shunt in a different quadrant of the eye.

Conclusions:

Tube shunts are conduits transporting aqueous from within the eye to the subconjunctival space. The ultimate end result is to create a drainage bleb over the tube plate. The formation of the bleb is controlled by multifactorial components, including age of the patient, racial background, presurgical IOP, and thereby aqueous cytokine content, and patient’s individual reaction to the presence of a foreign body beneath the conjunctiva. Prolonged IOP within the bleb results in cytokine production by the bleb lining. Occluding the tube of a failed implant can prevent damage to a new implant in a different eye quadrant.
Living Related Liver Transplantation for Metabolic Liver Diseases in Children
Authors: Sood Vikrant , Squires James E. , Mazariegos George V. , Vockley Jerry , McKiernan Patrick J.
Published: September 2020

Metabolic liver diseases (MLDs) are a heterogeneous group of inherited conditions for which liver transplantation can provide definitive treatment. The limited availability of deceased donor organs means some who could benefit from transplant do not have this option. Living related liver transplant (LrLT) using relatives as donors has emerged as one solution to this problem. This technique is established worldwide, especially in Asian countries, with shorter waiting times and patient and graft survival rates equivalent to deceased donor liver transplantation. However, living donors are underutilized for MLDs in many western countries, possibly due to the fear of limited efficacy using heterozygous donors. We have reviewed the published literature and shown that the use of heterozygous donors for liver transplantation is safe for the majority of MLDs with excellent metabolic correction. The use of LrLT should be encouraged to complement deceased donor liver transplantation (DDLT) for treatment of MLDs.