bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Anatomy of the Chin Evaluated by 3-Dimensional Tomography and Cadaveric Dissection: Implications for Safety and Optimal Injection Techniques in Chinese
Authors: Li Xin-Rui , Hong Wei-Jin , Li Zhen-Hao , Luo Cheng-En , Jiang Xuan-Yu , Luo Sheng-Kang
Published: February 2023

BACKGROUND:

Soft tissue fillers have been widely used for the correction of chin volume loss because of congenital conditions and aging.

OBJECTIVE:

This study aimed to discuss anatomical concerns for chin filler injections, which may help to reduce the incidence of severe intravascular embolization complications and improve patient satisfaction.

METHODS AND MATERIALS:

We scanned 40 cadaveric heads with a contrast agent using a 64-row spiral computed tomography scanner. The scan was visualized by a Philips IntelliSpace workstation and analyzed by Materialise's interactive m image control system software to measure and quantify the arterial data. Twenty of 40 cadavers were dissected to define the layers of tissue.

RESULTS:

In total, 221 arteries passed through the sagittal plane of 40 specimens. The number of superficial arteries (163 of 221) was much greater than the number of deep arteries (58 of 221). The number of arteries gradually decreased with distance from the lower lip vermilion border plane, which formed the lower third of the face.

CONCLUSION:

This study introduces a safe and effective technique for administering chin filler injections that minimizes risks and improves patient satisfaction.
Reconstruction of Macrocheilia on the Lower Lip Through Bilateral Limited Excision and a Stepwise Single-Stage Approach (BLESS)
Authors: Yu Wenxin , Zhu Jiafang , Han Yue , Ma Gang , Lin Xiaoxi
Published: February 2023

BACKGROUND

The surgical management of macrocheilia secondary to port-wine stains is complicated.

OBJECTIVE

This study aimed to propose an innovative method for treating macrocheilia on the lower lip.

METHODS

Patients who underwent the reconstruction of macrocheilia on the lower lip through the innovative approach were examined. Their preoperative and postoperative standard photographs were taken to evaluate the changes in lip length and thickness. The scores on Vancouver scar scale (VSS) and visual analog scale (VAS) were evaluated.

RESULTS

Thirty-two patients who underwent the reconstruction of macrocheilia were examined. A follow-up of 12.2 months (6–36 months) was conducted. The lower lip contour and the mentolabial groove were reconstructed to normal appearance. The lip length was shortened from 5.38 ± 0.49 cm pretreatment to 4.59 ± 0.30 cm posttreatment (p = .016). The exposed vermilion was shortened from 2.05 ± 0.48 cm to 1.26 ± 0.12 cm posttreatment (p < .01). The mean VSS and VAS scores were 2.2 ± 1.5 and 8.4 ± 1.3, respectively.

CONCLUSION

The bilateral limited excision and stepwise single-stage approach were safe and effective for reconstructing prominent macrocheilia on the lower lip. The technique was also easy to command for the beginners.
Varenicline serves as the training stimulus in the drug-discriminated goal-tracking task with rats: initial evaluation of potential neuropharmacological processes
Authors: Thompson Brady M. , Tracy Matthew E. , Huynh Y. Wendy , Dwoskin Linda P. , Barrett Scott T. , Bevins Rick A.
Published: February 2023

Varenicline (Chantix) is an FDA-approved smoking cessation aid that is pharmacologically similar to nicotine, the primary addictive component found within tobacco. In support of this similarity, previous drug discrimination research in rats has reported that the internal or interoceptive stimulus effects of nicotine and varenicline share stimulus elements. Those shared elements appear to be mediated, in part, by overlapping action at alpha4beta2–containing nicotinic acetylcholine receptors (nAChRs). The research supporting this conclusion, however, has only used nicotine, and not varenicline, as the training drug. Accordingly, we used the discriminated goal tracking (DGT) task in which 1 mg/kg varenicline signaled intermittent access to sucrose. On separate intermixed saline days, sucrose was not available. Rats acquired the discrimination as measured by a differential increase in dipper entries (goal tracking) evoked by varenicline. These rats then received a series of tests with several doses of varenicline, nicotine, nornicotine (a metabolite of nicotine and tobacco alkaloid), sazetidine-A (a partial alpha4beta2 agonist), PHA-543613 (an alpha7 agonist), and bupropion (a norepinephrine and dopamine reuptake inhibitor). Control of goal tracking by varenicline was dose-dependent. Nicotine and nornicotine evoked responding comparable to the varenicline training dose indicating full substitution. Sazetidine-A partially substituted for the varenicline stimulus, whereas bupropion and PHA-543613 evoked little to no varenicline-like responding. These findings indicate that varenicline can serve as the training stimulus in the DGT task. Further, stimulus control of varenicline in the DGT task is driven by its partial agonist activity at alpha4beta2–containing nAChRs. The use of this approach could lead to a better understanding of the pharmacological action of varenicline and help guide treatment geared towards tobacco cessation through a more targeted development of novel synthetically designed, subunit-specific pharmacological interventions.
Involvement of the NO/cGMP/KATP pathway in the antinociceptive effect of rosemary (Rosmarinus officinalis) essential oil in mice
Authors: Hajhashemi Valiollah , Salimian Majid , Hajihashemi Omid
Published: February 2023

Rosemary essential oil (REO) has been used for several medical purposes. Previous studies have shown the antinociceptive effect of the oil. This study aimed to investigate the role of some well-known receptors in the antinociceptive effect of REO. Male Swiss mice (25–30 g) were used. To assess the antinociceptive activity, the formalin test was used. At first, the antinociceptive effect of three doses of rosemary oil (150, 300 and 450 µL/kg) was tested, and then a dose of 300 µL/kg was selected for the mechanistic study. Animals were pretreated with several antagonists and enzyme inhibitors to evaluate the role of adrenergic, cholinergic, serotoninergic, dopaminergic and opioid receptors as well as the NO/cGMP/KATP pathway in the antinociceptive effect of rosemary essential oil. Yohimbine (5 mg/kg), prazocin (2 mg/kg), propranolol (2 mg/kg), atropine (2.5 mg/kg) naloxone (5 mg/kg), cyproheptadine (2 mg/kg), ondansetron (2 mg/kg) and haloperidol (1 mg/kg) could not reverse the antinociceptive effect. Sulpiride (20 mg/kg) only showed preventive activity in the early phase of formalin test while methylene blue (5 mg/kg), L-NAME (20 mg/kg) and glibenclamide (10 mg/kg) significantly attenuated the antinociceptive effect of REO in both phases. Tadalafil (2 mg/kg) potentiated the antinociceptive effect of REO in the late phase of formalin test and arginine (100 mg/kg) had no effect on both phases. Therefore the NO/cGMP/KATP pathway might have an important role in the antinociceptive effect of REO.
Development of a Dose-Adjusted Polygenic Risk Model for Anthracycline-Induced Cardiotoxicity
Authors: Siemens Angela , Rassekh Shahrad Rod , Ross Colin J. D. , Carleton Bruce C.
Published: February 2023

Background:

Anthracyclines, which are effective chemotherapeutic agents, cause cardiac dysfunction in up to 57% of patients. The cumulative anthracycline dose is a crucial predictor of cardiotoxicity; however, the cumulative dose alone cannot explain all cardiotoxic events. Strongly associated genetic variants in SLC28A3, UGT1A6, and RARG contribute to anthracycline-induced cardiotoxicity in pediatric patients and may help identify those most susceptible. This study aimed to examine how these pharmacogenetic effects are modulated by cumulative anthracycline doses in the development of cardiotoxicity.

Methods:

A total of 595 anthracycline-treated children were genotyped and cardiotoxicity cases were identified. A dose-stratified analysis was performed to compare the contributions of SLC28A3 rs7853758, UGT1A6 rs17863783, and RARG rs2229774 variants to the development of cardiotoxicity in low-dose (<150 mg/m2 cumulative dose) and high-dose (>250 mg/m2 cumulative dose) patient groups. Logistic regression was used to model the relationships between the cumulative anthracycline dose, genetic variants, and cardiotoxicity in the full cohort.

Results:

At < 150 mg/m2 cumulative anthracycline dose, the SLC28A3 protective variant did not reach statistical significance [odds ratio (OR) 0.46 (95% confidence interval (CI) 0.10–1.45), P = 0.23], but it was statistically significant at doses >250 mg/m2 [OR 0.43 (95% CI 0.22–0.78), P = 0.0093]. Conversely, the UGT1A6 and RARG risk variants were either statistically significant or approaching significance at doses <150 mg/m2 [OR 7.18 (95% CI 1.78–28.4), P = 0.0045 for UGT1A6 and OR 2.76 (95% CI 0.89–7.63), P = 0.057 for RARG], but not at doses >250 mg/m2 [OR 2.91 (95% CI 0.80–11.0), P = 0.10; OR 1.56 (95% CI 0.89–2.75), P = 0.12].

Conclusions:

These findings suggest that the SLC28A3 variant imparts more significant protection for patients receiving higher anthracycline doses, whereas the UGT1A6 and RARG risk variants significantly increased the risk of cardiotoxicity at low anthracycline doses.
Associations between bone mass, hormone levels, and body composition in postmenopausal women
Authors: Fighera Tayane M. , Santos Betânia R. , Motta Letícia , Casanova Gislaine , Spritzer Poli Mara
Published: February 2023

Objectives

The aim of this study was to explore body composition parameters and hormone levels as risk factors for low bone mass (osteopenia/osteoporosis) in postmenopausal women.

Methods

We analyzed biorepository samples from 139 postmenopausal women with no clinical evidence of cardiovascular disease. Inclusion criteria were menopause occurring after 40 years of age and no use of hormone therapy in the past 3 months. Bone mineral density and body composition were assessed by dual-energy x-ray absorptiometry. Sex hormone–binding globulin (SHBG) and follicle-stimulating hormone (FSH) levels were measured in all participants. Serum estradiol was measured by gas chromatography/tandem mass spectrometry in a subset of 57 participants. Free estrogen index was calculated by dividing estradiol by SHBG × 100.

Results

Body mass index (25.0 [22.5-26.5] vs 27.7 [26.6-31.9] kg/m2, P < 0.001), estradiol (3.0 [2.7-4.5] vs 6.0 [2.7-15.0] pg/mL, P = 0.006), waist circumference (84 ± 9 vs 93 ± 12 cm, P < 0.001), appendicular lean mass (ALM) (15.739 ± 2.129 vs 17.184 ± 2.104 kg, P = 0.001), and fat mass index (9.36 [7.29-11.43] vs 11.38 [9.95-15.33] kg/m2, P < 0.001) were lower in women with low bone mass by dual-energy x-ray absorptiometry. Univariate analysis showed that free estrogen index, time since menopause, SHBG, and fat mass were significant predictors of low bone mass, and ALM was a significant predictor against low bone mass. Appendicular lean mass persisted as an independent predictor against low bone mass in multivariate models with fat mass and SHBG. In turn, fat mass was no longer significant in this multivariate model after inclusion of SHBG. No association of FSH with low bone mass was observed.

Conclusions

Appendicular lean mass was a significant independent predictor against low bone mass in postmenopausal women. Further prospective studies are needed to investigate whether lean mass, fat mass, and FSH have a direct effect on bone mass in postmenopausal women, adding to the consequences of hypoestrogenism in this group.
Menopausal symptoms in breast cancer patients receiving adjuvant endocrine therapy and their relationships with health-promoting behaviors and social support
Authors: Wei Tingting , Li Xia , Qiang Wanmin , Zhang Yan , Ren Hailing , Zhang Qiupeng , Jin Xue
Published: February 2023

Objective

To investigate the prevalence and severity of menopausal symptoms in patients with breast cancer undergoing adjuvant endocrine therapy and explore the relationships of these symptoms with health-promoting behaviors and social support.

Methods

This cross-sectional study investigated 226 participants from December 2020 to December 2021 in China. Data were collected using the sociodemographic information questionnaire, Menopause Rating Scale, the Health-Promoting Lifestyle Profile II, and Perceived Social Support Survey. Multivariate step regression was used to analyze the potential factors of menopausal symptoms.

Results

In our sample of 226 patients, 92.9% reported at least one menopausal symptom with a mean score of 13 points (interquartile range, 9-18 points). The highest prevalence of most symptoms included hot flashes/night sweats, fatigue, joint and muscular discomfort, irritability, and sleep problems. In the regression models, health responsibility (β = −0.15, P = 0.03), spiritual growth (β = −0.28, P < 0.01), friend support (β = −0.43, P < 0.01), and other support (β = −0.31, P = 0.01) were negatively associated with menopausal symptoms.

Conclusions

The prevalence and severity of menopausal symptoms are high in breast cancer patients undergoing adjuvant endocrine therapy. Higher health-promoting behaviors and social support are associated with fewer menopausal symptoms. The findings highlight the clinical implications in terms of developing appropriate strategies for managing menopausal symptoms.
Associations between the impact of menopausal symptoms and fall-related self-efficacy
Authors: Espírito Santo João , Hita-Contreras Fidel , Marques de Loureiro Nuno Eduardo , Brandão Loureiro Vânia , Aibar-Almazán Agustín , Carcelén-Fraile María del Carmen , Ortiz-Quesada Raúl
Published: February 2023

Objective

To analyze the association between the severity of menopausal symptoms and two important fall risk factors, namely balance confidence and fear of falling, among Portuguese and Spanish postmenopausal women 65 years or older.

Methods

A cross-sectional, observational study was conducted on 363 women (66.21 ± 9.00 y) from several Portuguese and Spanish locations. The Menopause Rating Scale was used to evaluate the severity of menopausal symptoms, while the Falls Efficacy Scale-International and Activities-specific Balance Confidence Scale-16 items were used to assess balance confidence and fear of falling, respectively. Anxiety and depression (evaluated by the Hospital Anxiety and Depression Scale), age, time since the onset of menopause, body mass index, history of falls, osteoporosis, smoking habit, physical activity level, and nocturia were considered as potential confounders. Independent associations were analyzed after adjusting for potential confounding variables. Student's t test, bivariate correlations, and multivariate linear regression analysis were performed.

Results

A total of 363 women (66.21 ± 9.00 y) participated in the study, 192 from Portugal and 171 from Spain. Linear regression analysis indicates that more severe menopausal symptoms at a somatovegetative level (beta coefficient [β] = −0.25; 95% confidence interval [95% CI], −2.09 to −0.81; P = <0.001), a higher body mass index (β = −0.16; 95% CI, −1.22 to −0.22; P = 0.005), and osteoporosis (β = 0.14; 95% CI, 1.36 to 10.08; P = 0.010) were associated with lower balance confidence values. On the other hand, a higher score in the Menopause Rating Scale somatovegetative domain (β = 0.22; 95% CI, 0.27–0.79; P = <0.001), depression (β = 0.36; 95% CI, 0.59-1.08; P = <0.001), and years after the menopause onset (β = 0.15; 95% CI, 0.04-0.22; P = 0.006) were linked to increased fear of falling.

Conclusions

The findings of our study show that, after taking into account possible confounders, increased severity of menopausal symptoms at a somatic level was associated with heightened fear of falling and diminished balance confidence.
Cardiovascular utility of single cell RNA-Seq
Authors: Safabakhsh Sina , Ma Wei Feng , Miller Clint L. , Laksman Zachary
Published: February 2023

Purpose of review

Cardiovascular diseases remain the leading causes of morbidity and mortality globally. Single-cell RNA sequencing has the potential to improve diagnostics, risk stratification, and provide novel therapeutic targets that have the potential to improve patient outcomes.

Recent findings

Here, we provide an overview of the basic processes underlying single-cell RNA sequencing, including library preparation, data processing, and downstream analyses. We briefly discuss how the technique has been adapted to related medical disciplines, including hematology and oncology, with short term translational impact. We discuss potential applications of this technology within cardiology as well as recent innovative research within the field. We also discuss future directions to translate this technology to other high impact clinical areas.

The use of single-cell RNA sequencing technology has made significant advancements in the field of cardiology, with ongoing growth in terms of applications and uptake. Most of the current research has focused on structural or atherosclerotic heart disease. Future areas that stand to benefit from this technology include cardiac electrophysiology and cardio-oncology.
Exercise Self-efficacy Improvements During Cardiac Rehabilitation
Authors: Candelaria Dion , Kirkness Ann , Bruntsch Christine , Gullick Janice , Randall Sue , Ladak Laila Akbar , Gallagher Robyn
Published: February 2023

Purpose:

The objective of this study was to determine exercise self-efficacy improvements during cardiac rehabilitation (CR) and identify predictors of exercise self-efficacy change in CR participants.

Methods:

Patients with coronary heart disease at four metropolitan CR sites completed the Exercise Self-efficacy Scale at entry and completion. A general linear model identified independent predictors of change in exercise self-efficacy.

Results:

The mean age of patients (n = 194) was 65.9 ± 10.5 yr, and 81% were males. The majority (80%) were married or partnered, 76% were White, and 24% were from an ethnic minority background. Patients received CR in-person (n = 91, 47%) or remote-delivered (n = 103, 54%). Exercise self-efficacy mean scores improved significantly from 25.2 ± 5.8 at CR entry to 26.2 ± 6.3 points at completion (P= .025). The majority of patients (59%) improved their self-efficacy scores, 34% worsened, and 7% had no change. Predictors of reduced exercise self-efficacy change were being from an ethnic minority (B =−2.96), not having a spouse/partner (B =−2.42), attending in-person CR (B =1.75), and having higher exercise self-efficacy at entry (B =−0.37) (adjustedR2= 0.247).

Conclusions:

Confidence for self-directed exercise improves in most, but not all, patients during CR. Those at risk for poor improvement (ethnic minorities, single patients) may need extra or tailored support, and screening for exercise self-efficacy at CR entry and completion is recommended. Differences identified from CR delivery mode need exploration using robust methods to account for complex factors.
Association of Perceived Health Competence With Cardiac Rehabilitation Initiation
Authors: Hu Jiun-Ruey , Huang Shi , Bosworth Hayden B. , Freedland Kenneth E. , Mayberry Lindsay S. , Kripalani Sunil , Wallston Kenneth A. , Roumie Christianne L. , Bachmann Justin M.
Published: February 2023

Purpose:

Cardiac rehabilitation (CR), a program of supervised exercise and cardiovascular risk management, is widely underutilized. Psychological factors such as perceived health competence, or belief in one's ability to achieve health-related goals, may play a role in CR initiation. The aim of this study was to evaluate the association of perceived health competence with CR initiation among patients hospitalized for acute coronary syndrome (ACS) after adjusting for demographic, clinical, and psychosocial characteristics.

Methods:

The Vanderbilt Inpatient Cohort Study (VICS) characterized the effect of psychosocial characteristics on post-discharge outcomes in ACS inpatients hospitalized from 2011 to 2015. The primary outcome for this analysis was participation in an outpatient CR program. The primary predictor was the two-item Perceived Health Competence Scale (PHCS-2), which yields a score from 2 to 10 (higher scores indicate greater perceived health competence). Multiple logistic regression was used to evaluate the relationship between the PHCS-2 and CR initiation.

Results:

A total of 1809 VICS participants (median age: 61 yr, 39% female) with ACS were studied, of whom 294 (16%) initiated CR. The PHCS-2 was associated with a higher odds of CR initiation (OR = 1.15/point increase: 95% CI, 1.06-1.26, P = .001) after adjusting for covariates. Participants with comorbid heart failure had a lower odds of CR initiation (OR = 0.31: 95% CI, 0.16-0.60, P < .001) as did current smokers (OR = 0.64: 95% CI, 0.43-0.96, P = .030).

Conclusion:

Perceived health competence is associated with outpatient CR initiation in patients hospitalized with ACS. Interventions designed to support perceived health competence may be useful for improving CR participation.
Pursuing innovation in academic medical centers
Authors: Meer Elana , Ezzeddine Iman , Chao Jessica , Nembhard Ingrid M.
Published: February 2023

Background

Academic medical centers (AMCs) are well recognized for their innovations that enhance frontline care, but there is little study of their innovation management processes, which is key for advancing theory regarding the effectiveness of innovation efforts to improve care.

Purpose

We aimed to identify organizational models used for frontline innovation by AMCs in the United States, core activities within models, and factors that influence innovation success.

Methods

We conducted a qualitative study of 12 AMCs using data from semistructured interviews with centers’ innovation leaders. Inclusion required satisfying two of three criteria in 2021 (only met by 35 AMCs nationally): listed in the professional association of innovation leaders (Council of 33), Becker’s review of most innovative hospitals, and/or top 20 U.S. News and World Report best hospitals honor roll. We analyzed the interview data using the constant comparative method.

Results

Innovative AMCs pursue innovation through innovation centers (using a centralized or multicenter model) or within clinical departments (department-level model). All three models emphasize seven activities, although performed differently: sourcing ideas, developing ideas, implementing innovations, fundraising, managing partnerships, measuring success, and managing mindset. Several factors influenced success: role performance, operational challenges, technology, public policy, customer clarity, stakeholder buy-in, diversity of input, and focus. The centralized model struggled less with standardization and coordination issues.

Conclusion

AMCs have options for structuring their innovation efforts. However, there are consistent activities for successful innovation management and factors that they must manage.

Practice Implications

AMCs can select among innovation models to fit their circumstances but likely need to perform seven activities well for success.
Baseline 18F-FDG Metabolic Tumor Volume Predicts Response to Rituximab Induction in Post-transplant Lymphoproliferative Disorders: A Multi-institutional Retrospective Study
Authors: Morland David , Kanagaratnam Lukshe , Hubelé Fabrice , Toussaint Elise , Choquet Sylvain , Kas Aurélie , Caquot Pierre-Ambroise , Haioun Corinne , Itti Emmanuel , Leprêtre Stéphane , Decazes Pierre , Bijou Fontanet , Schwartz Paul , Jacquet Caroline , Chauchet Adrien , Matuszak Julien , Kamar Nassim , Payoux Pierre ,   K-VIROGREF Study Group, Durot Eric
Published: February 2023

Post-transplant lymphoproliferative disorder (PTLD) is a rare complication of immunosuppression. Sequential treatment is commonly proposed, combining induction with rituximab (R-induction) followed by either continuation of treatment or addition of chemotherapy depending on response. Response to R-induction, often assessed by CT scan, is a major predictor of overall survival (OS). The aim of the study was to analyze predictive factors of R-induction response, including total metabolic tumor volume (TMTV), and investigate the role of 18F-FDG PET/CT in response assessment. This retrospective multicenter study is based on patients with PTLD included in the K-VIROGREF cohort. Only patients treated by R-induction with a baseline 18F-FDG PET/CT were included. Response to R-induction was assessed by 18F-FDG PET/CT. The optimal threshold of TMTV for rituximab response was determined using receiver operating characteristic curves. Univariate and multivariate analyses were conducted to identify predictive factors of response. A total of 67 patients were included. Survival characteristics were similar to those previously reported: the complete response rate to R-induction was 30%, the 3-year OS estimate was 66%, and the treatment-related mortality was 4%. The optimal threshold for TMTV to predict R-induction response was 135 cm3. The response rate to R-induction was 38% in the 21 patients with TMTV ≥ 135 cm3 and 72% in the 46 patients with TMTV < 135 cm3. TMTV was a significant predictor of response, both at univariate and multivariate analyses (odd ratios = 3.71, P = 0.022). Baseline TMTV is predictive of response to R-induction. Early assessment of patient response is feasible with 18F-FDG PET/CT.
Effects of Perceived Discrimination on Behavioral Health Outcomes in People Aging With Traumatic Brain Injury
Authors: Venkatesan Umesh M. , Rabinowitz Amanda R. , Bernier Rachel A. , Soto Jose A. , Hillary Frank G.
Published: February 2023

Objective:

To evaluate major and everyday experiences of discrimination (MED and EED, respectively) in relation to behavioral health outcomes in people with traumatic brain injury (PwTBI).

Setting:

Outpatient research laboratory.

Participants:

Adults, 50 years or older, with a chronic (1+ year) history of moderate or severe TBI (N = 118).

Design:

Cross-sectional observational study.

Main Measures:

MED and EED (primary measures of interest) and behavioral health outcomes: global cognition, psychological symptoms, neurobehavioral symptoms, societal participation, and health-related quality of life (HRQoL). In participants with available geodata (N = 28), neighborhood socioeconomic deprivation (ND) was examined as a potential contributor to MED, EED, and measured outcomes.

Results:

EED and MED were significantly associated with psychological symptoms, neurobehavioral symptoms, and HRQoL after correction for multiple comparisons. Counter to expectations, EED were related to higher societal participation. MED and EED were unrelated to cognition. When MED and EED were entered together in hierarchical regressions, only EED made significant contributions beyond demographic and injury-related covariates to each outcome. Sensitivity analyses revealed that most of these relationships were not solely accounted for by disability-related discrimination. ND showed negligible associations with discrimination but moderate effect sizes for cognition and participation. Race was not significantly related to discrimination and was not a significant predictor in regression models but was strongly associated with ND.

Conclusion:

The current data provide preliminary support for perceived discrimination as an important factor in neurobehavioral and psychosocial health, but not cognitive performance, after TBI. These relationships appear to be driven by daily experiences of discriminatory treatment versus single major instances of injustice. Measured outcomes may also reflect socioeconomic challenges and structural discrimination faced by diverse PwTBI, although more work in this area is urgently needed. Multiple sources of marginalization and disenfranchisement and their functional effects should be considered in TBI rehabilitation and outcome monitoring.
Cognitive Performance, Depression, and Anxiety 1 Year After Traumatic Brain Injury
Authors: Keatley Eva S. , Bombardier Charles H. , Watson Eric , Kumar Raj G. , Novack Thomas , Monden Kimberley R. , Dams-O'Connor Kristen
Published: February 2023

Objectives:

To evaluate associations between depression, anxiety, and cognitive impairment among individuals with complicated mild to severe traumatic brain injury (TBI) 1 year after injury.

Setting:

Multiple inpatient rehabilitation units across the United States.

Participants:

A total of 498 adults 16 years and older who completed inpatient rehabilitation for complicated mild to severe TBI.

Design:

Secondary analysis of a prospective, multicenter, cross-sectional observational cohort study.

Main Measures:

Assessments of depression (Traumatic Brain Injury Quality of Life [TBI-QOL] Depression) and anxiety (TBI-QOL Anxiety) as well as a telephone-based brief screening measure of cognitive functioning (Brief Test of Adult Cognition by Telephone [BTACT]).

Results:

We found an inverse relationship between self-reported depression symptoms and the BTACT Composite score (β = −0.18, P < .01) and anxiety symptoms and the BTACT Composite score (β = −0.20, P < .01). There was no evidence this relationship varied by injury severity. Exploratory analyses showed depression and anxiety were negatively correlated with both BTACT Executive Function factor score and BTACT Memory factor score.

Conclusions:

Both depression and anxiety have a small but significant negative association with cognitive performance in the context of complicated mild to severe TBI. These findings highlight the importance of considering depression and anxiety when interpreting TBI-related neuropsychological impairments, even among more severe TBI.
Clinician Perspectives on Providing Concussion Assessment and Management via Telehealth: A Mixed-Methods Study
Authors: van Ierssel Jacqueline , O'Neil Jennifer , King Judy , Zemek Roger , Sveistrup Heidi
Published: February 2023

Objective:

To examine clinician perspectives regarding the use of telehealth for concussion assessment and management.

Setting:

A Pan-Canadian survey.

Participants:

Twenty-five purposively sampled multidisciplinary clinician-researchers with concussion expertise (female, n = 21; physician, n = 11; and other health professional, n = 14).

Design:

Sequential mixed-method design: (1) electronic survey and (2) semistructured interviews with focus groups via videoconference. Qualitative descriptive design.

Main Outcome Measures:

Survey: A 59-item questionnaire regarding the suitability of telehealth to perform recommended best practice components of concussion assessment and management. Focus groups: 10 open-ended questions explored survey results in more detail.

Results:

Clinicians strongly agreed that telehealth could be utilized to obtain a clinical history (96%), assess mental status (88%), and convey a diagnosis (83%) on initial assessment; to take a focused clinical history (80%); to monitor functional status (80%) on follow-up; and to manage symptoms using education on rest (92%), planning and pacing (92%), and sleep recommendations (91%); and to refer to a specialist (80%). Conversely, many clinicians believed telehealth was unsuitable to perform a complete neurologic examination (48%), cervical spine (38%) or vestibular assessment (61%), or to provide vestibular therapy (21%) or vision therapy (13%). Key benefits included convenience, provision of care, and patient-centered approach. General and concussion-specific challenges included technology, quality of care, patient and clinician characteristics, and logistics. Strategies to overcome identified challenges are presented.

Conclusions:

From the perspective of experienced clinicians, telehealth is suited to manage symptomatic concussion patients presenting without red flags or following an initial in-person assessment, but may have limitations in ruling out serious pathology or providing return-to-sport clearance without an in-person physical examination.
Trajectories of Executive Functions After Early Childhood Traumatic Brain Injury: Teacher Ratings in the Initial 81 Months Postinjury
Authors: Rempe Gary , Petranovich Christine , Narad Megan E. , Yeates Keith Owen , Taylor H. Gerry , Stancin Terry , Wade Shari
Published: February 2023

Objective:

To explore teacher-rated trajectories of executive functioning (EF) after early childhood traumatic brain injury (TBI) and to identify injury-related, academic, and family factors associated with growth trajectories using latent class growth analysis.

Participants:

A total of 121 children who sustained a TBI or orthopedic injury (OI) between the ages of 3 and 7 years were recruited from 3 tertiary care children's hospitals and a general hospital in Ohio, including 57 with moderate or severe TBI and 64 with OI.

Design:

Assessments were completed at baseline (0-3 months postinjury) and an average of 6, 12, 18, and 81 months postinjury. Changes in teacher-rated EF were modeled across time and heterogeneity in recovery and moderating factors was examined.

Measures:

Study variables included participant demographics, teacher-rated EF (Behavior Rating Inventory of Executive Function), family functioning (McMaster Family Assessment Device), and parenting style (Parenting Practices Questionnaire).

Results:

Analysis of teacher-rated EF yielded 2 trajectories: Normative (64.71%) and At-Risk (35.29%). Traumatic brain injury was a weak predictor of membership in the At-Risk trajectory (P = .05). Membership in the At-Risk trajectory (compared with Normative category) was associated with a higher incidence of Individualized Education Programs, higher baseline EF concerns, increased endorsement of authoritarian parenting, lower socioeconomic status, and non-White race.

Conclusion:

Teacher-rated EF after pediatric TBI differs from OI. Increased EF concerns over time were associated with increased baseline EF and characteristics of the home and school environment. These findings extend previous research on recovery of EF to educational settings and outline potentially modifiable risk factors that can maximize success in the school settings for children who experience early-childhood traumatic injury.
Using a Capsular Tension Ring (CTR) Inserter for CTR Explantation in Cases of Posteriorly Dislocated Intraocular Lens–CTR–Capsule Complex
Authors: Henderson Matthew N. , Masia Hayden A. , Prenner Jonathan L. , Fine Howard F.
Published: February 2023

Purpose:

Explantation of a dislocated capsular tension ring (CTR) from the vitreous cavity can be challenging, typically requiring a bimanual hand-shake technique or cutting the CTR into segments. We present three cases of dislocated intraocular lens (IOL)–CTR–capsule complexes in which CTRs were explanted efficiently and safely by using a CTR inserter (CTR-I) through a clear corneal incision.

Methods:

Retrospective case series.

Results:

Capsular tension rings were successfully explanted by freeing the eyelet of the CTR from the capsule, engaging it with the CTR-I hook and retracting the CTR into the device’s shaft while maintaining the entire IOL–CTR–capsule complex in a safe position behind the iris plane. No complications of the procedure were observed in all three cases. All patients had subsequent uneventful IOL exchange through sutureless scleral fixation during the same surgery.

Conclusion:

The CTR inserter provides a simple and efficient approach to CTR removal from IOL–CTR–capsule complexes dislocated into the vitreous cavity. Greater awareness of this technique among providers is needed.
INCREASING EVIDENCE FOR THE SAFETY OF FOVEA-INVOLVING HALF-DOSE PHOTODYNAMIC THERAPY FOR CHRONIC CENTRAL SEROUS CHORIORETINOPATHY
Authors: Feenstra Helena M. A. , Diederen Roselie M. H. , Lamme Martine J. C. M. , Tsonaka Roula , Fauser Sascha , Yzer Suzanne , van Rijssen Thomas , Gkika Theodora , Downes Susan M. , Schlingemann Reinier O. , Hoyng Carel B. , van Dijk Elon H. C. , Boon Camiel J. F.
Published: February 2023

Purpose:

A retrospective study was performed with data from the prospective randomized controlled trials, PLACE and SPECTRA, assessing the risk of foveal atrophy and the likelihood of structural and functional improvement on optical coherence tomography, after foveal half-dose photodynamic therapy in chronic central serous chorioretinopathy.

Methods:

A total of 57 chronic central serous chorioretinopathy patients received a single half-dose photodynamic therapy with a treatment spot that included the fovea. Optical coherence tomography scans and fundus autofluorescence images were analyzed for structural improvement and possible atrophy development, at baseline and at several visits after treatment. Main outcome measures were integrity of the external limiting membrane and ellipsoid zone on optical coherence tomography and hypoautofluorescence on fundus autofluorescence.

Results:

The subfoveal external limiting membrane was graded as continuous in 21 of 57 of patients (36.8%) at baseline, and the subfoveal ellipsoid zone was graded as continuous in 5 of 57 patients (8.8%) at first visit, which improved to 50 of 51 (98.0%) and 32 out of 51 (62.7%) at the final visit at 2 years, respectively (both P < 0.001). Hypoautofluorescent changes on fundus autofluorescence were present in 25 of 55 patients (45.5%) at baseline and in 23 of 51 patients (45.1%) at the final visit (P = 0.480).

Conclusion:

In patients with chronic central serous chorioretinopathy who received a single, foveal, half-dose photodynamic therapy, a significant improvement in structure and function was seen at the final follow-up. None of the patients developed foveal atrophy.
LEPREL1-RELATED GIANT RETINAL TEAR DETACHMENTS MIMIC THE PHENOTYPE OF OCULAR STICKLER SYNDROME
Authors: Magliyah Moustafa S. , Almarek Faisal , Nowilaty Sawsan R. , Al-Abdi Lama , Alkuraya Fowzan S. , Alowain Mohammed , Schatz Patrik , Alfaadhel Talal , Khan Arif O. , Alsulaiman Sulaiman M.
Published: February 2023

Purpose:

To describe the features of retinal detachments and high myopia in patients with novel pathogenic variants in LEPREL1 and report a possible association with nephropathy.

Methods:

Retrospective study of 10 children with biallelic LEPREL1 pathogenic variants. Data included ophthalmic features, surgical interventions, and genetic and laboratory findings.

Results:

10 patients (8 females) from three families with homozygous (2) or compound heterozygous (1) variants in LEPREL1 were included. At presentation, mean age was 9.9 ± 2.6 years. Mean axial length was 28.9 ± 1.9 mm and mean refraction was −13.9 ± 2.8 diopters. Bilateral posterior subcapsular cataracts were present in eight patients (80%), with lens subluxation in five eyes of three patients (30%). Rhegmatogenous retinal detachments (RRD), associated with giant retinal tears (GRT), developed in seven eyes of five patients (50%) at a mean age of 14.14 ± 5.9 years. Six were successfully reattached with mean Snellen best-corrected visual acuity improving from 20/120 preoperatively to 20/60 at last follow-up. Urinalysis in nine patients revealed microhematuria and/or mild proteinuria in six patients (67%).

Conclusion:

LEPREL1-related high myopia confers a high risk of early-onset GRT-related RRD. The ocular phenotype may be confused with that of ocular Stickler syndrome if genetic testing is not performed. Further investigations into a potential association with renal dysfunction are warranted.
CHARACTERIZATION OF MACULAR NEOVASCULARIZATION IN BIETTI CRYSTALLINE DYSTROPHY USING MULTIMODAL IMAGING MODALITIES
Authors: Li Qian , Zhang Shengjuan , Kang Lihua , Wang Donglin , Jiao Xiaodong , Hejtmancik J. Fielding , Wang Lifei , Peng Xiaoyan
Published: February 2023

Purpose:

To characterize the clinical features of macular neovascularization (MNV) secondary to Bietti crystalline dystrophy.

Methods:

The imaging data of 157 eyes in 79 patients with Bietti crystalline dystrophy were retrospectively reviewed. 12 individuals (19 eyes) were found to have MNVs. Multimodal retinal imaging was used to evaluate the features of MNVs and the primary chorioretinopathy.

Results:

The MNV lesions were shown as typical type 2 MNVs with subretinal hyperreflective material (SHRM), and usually detected along the borders of the retinal pigment epithelium/choriocapillaris dropout. The active MNVs were noted in earlier stages of Bietti crystalline dystrophy, while the activity was observed to be reduced in advanced cases. On spectral domain optical coherence tomography, the outer retinal structures were demonstrated to be partially preserved above the SHRMs compared with the extensive atrophy contiguously. Fibrotic scaring of the MNVs was commonly observed and arteriolarization was usually shown within the scars.

Conclusion:

MNV was demonstrated to be a common complication secondary to Bietti crystalline dystrophy. The lesions were typical type 2 MNV of varied activities possibly associated with the degrees of the primary degeneration. Choriocapillaris hypoperfusion may participate in MNV development.
The Cosine Law to Choose the Correct Forceps Shaft Length for Macular Surgery in Highly Myopic Eyes
Authors: Teixeira Anderson , Salaroli Camila , Fuganti Raphaela M. , casella Antônio Marcelo B.
Published: February 2023

Purpose:

To demonstrate a mathematical analogy between the Pythagorean theorem using the axial a-scan measurement, i.e., the distance between the central cornea and the sclerotomy, and the lengths of the forceps in eyes of patients with all axial lengths.

Methods:

We used the Pythagorean equation (c2 = a2 + b2) to calculate the adequate shaft length of the forceps to use in macular surgery, especially in highly myopic eyes, where c2 represents the axial length (hypotenuse); b2 the sum of the corneal ray and distance between the corneal limbus and the sclerotomy (base side); and a2 the distance between the sclerotomy and the fovea (perpendicular side).

Results:

We reproduced the cosine law to estimate the distance between the sclerotomy and the fovea. The distance between the sclerotomy and the foveal area is shorter than the axial length and can become smaller based on the distance from the sclerotomy to the corneal limbus.

Conclusion:

This simple mathematical formula is useful when performing surgery in highly myopic eyes, in which there can be difficulties reaching the macular area.
GIANT RETINAL TEAR DETACHMENT
Authors: Ramamurthy Srishti , Raval Vishal , Ali Hasnat , Tyagi Mudit , Narayanan Raja , Reddy Rajeev , Das Anthony Vipin
Published: February 2023

Purpose:

To study etiology, clinical presentation, anatomical, and functional outcomes of patients with giant retinal tear detachment at a tertiary eye institute.

Methods:

Retrospective, consecutive case series of 396 patients (396 eyes) who underwent surgery were reviewed. Factors affecting the final anatomical and functional success were determined.

Results:

Mean age was 37 years (range; 1–79 years), and 86% (n = 339) of the subjects were men. Trauma (21%) and high myopia (11%) were predisposing risk factors. Two hundred and seventy-seven eyes (70%) had giant retinal tear configuration of >180° and <270°, associated with partial retinal detachment in 282 (71%) eyes and macular detachment in 262 (66%) eyes. Primary surgery included pars plana vitrectomy (n = 240, 61%), pars plana vitrectomy with encirclage band (n = 152, 38%), or scleral buckle (n = 4, 1%). The mean follow-up duration was 15 months (median, 8.4 months; range, 3–83 months). Anatomical success after initial surgery was 64% (255 eyes), which improved to 78% (308 eyes) after undergoing a second vitreoretinal procedure for recurrent retinal detachment (53 eyes). Median visual acuity improved from 20/1,500 preoperatively to 20/400 at final follow-up (P= 0.01), and 15% of eyes achieved postoperative visual acuity of 20/60 or better. Factors associated with poor anatomical success included age <16 years (P = 0.005) and presenting visual acuity 20/400 or less (P = 0.001).

Conclusion:

Trauma and myopia constituted the major risk factors for giant retinal tear detachment in our series. Surgery for giant retinal tear detachment managed with pars plana vitrectomy with or without encirclage band and silicone oil tamponade had good anatomical and favorable visual outcomes at last follow-up.
HEALING MECHANISMS AFTER MACULAR HOLE REPAIR SUGGESTS PROCESS OF FOVEATION
Authors: Spaide Richard F.
Published: February 2023

Purpose:

To evaluate the long-term healing of the fovea following macular hole surgery in light of the processes known to occur during the maturation of the fovea during childhood, in which there is migration of the inner retinal layers away from and the photoreceptors toward the center of the macula.

Methods:

Consecutive patients with longer than 1 year of follow-up were evaluated with spectral-domain optical coherence tomography. The interinner nuclear layer distance, which was the separation across the fovea of the midpoints of the inner nuclear layers, and the ONL (outer nuclear layer) to RPE (retinal pigment epithelium) thicknesses were measured.

Results:

There were 22 eyes of 21 patients, 16 of whom were female; the mean age was 65.6 years. Initially, after the surgery, there was closure of the hole with continuity of the inner and middle layers of the retina across the previous macular hole. Over time, there was a migration of the inner retinal layers away from and movement of the ONL toward the center of the macula. The mean interinner nuclear layer distance increased from 352 µm to 549 µm (P = 0.001), and the ONL-RPE thickness increased from 77 µm to 146 µm (P < 0.001). The mean logMAR acuity improved 6.5 lines.

Conclusion:

Healing of a macular hole after surgery seems to recapitulate the development of the macula in childhood. The process of foveation may have evolutionary benefit of optimizing macular function after injury despite the absence of effective replication of the highly specialized, postmitotic photoreceptors.
PREDISPOSING CHARACTERISTICS OF OPTICAL COHERENCE TOMOGRAPHY FOR PATIENTS WITH PERSISTENT SUBRETINAL FLUID AFTER SUCCESSFUL REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Zhao Tongtao , Gu Peng , Sun Cheng , Zhang Minfang , Duan Ping
Published: February 2023

Purpose:

To investigate the predisposing clinical parameters and characteristics of fundus imaging of patients with persistent subretinal fluid (PSF) after successful repair of rhegmatogenous retinal detachment.

Methods:

A retrospective study recruiting 57 patients was conducted. All patients underwent pars plana vitrectomy with silicone oil tamponade. Patients were divided into two groups: patients presenting PSF by the time of silicone oil removal as PSF group and patients presenting no PSF by the time of silicone oil removal as control group. All patients were followed up for 3 months or longer after primary surgery. Ophthalmic examinations, including fundus photography and optical coherence tomography, were performed.

Results:

There were significant differences between the two groups in average age, durations of preoperative symptoms, and type of retinal breaks (P < 0.05). These clinical parameters showed statistical correlations with PSF (P < 0.05). The proportions of patients presenting distinctive boundaries of the detached retina on fundus photograph and patients showing a hyperreflective line underlying the detached retina on optical coherence tomography in the PSF group were both significantly higher than the control group (P < 0.05). The macular detachment heights on optical coherence tomography in the PSF group were significantly lower than the control group (P < 0.05). These imaging characteristics also showed strong correlations with PSF (P < 0.05).

Conclusion:

This study suggests that patients with PSF have younger age, longer symptom duration, and higher incidence of retinal holes. The distinctive detachment boundary on fundus photograph, lower macular detachment height, and hyperreflective line underlying the detached retina on optical coherence tomography may be the predisposing characteristics of PSF.