bluuebunny/crossref_metadata_2025 huggingface dataset:
Probe-Based Multiplex Real-Time PCR as a Diagnostic Tool to Distinguish Distinct Fungal Symbionts Associated With Euwallacea kuroshio and Euwallacea whitfordiodendrus in California
Authors: Carrillo Joseph D. , Mayorquin Joey S. , Stajich Jason E. , Eskalen Akif
Published: July 2019

California has been invaded by two distinct Euwallacea spp. that vector unique plant pathogenic symbiotic fungi on multiple hosts and cause Fusarium dieback. The objective of this study was to develop multiplex real-time quantitative PCR assays using hydrolysis probes targeting the β-tubulin gene to detect, distinguish, and quantify fungi associated with the polyphagous shot hole borer (PSHB; Euwallacea whitfordiodendrus, Fusarium euwallaceae, Graphium euwallaceae, and Paracremonium pembeum) as well as the Kuroshio shot hole borer (KSHB; Euwallacea kuroshio, Fusarium kuroshium, and Graphium kuroshium) from various sample types. Absolute quantification reaction efficiencies ranged from 88.2 to 104.3%, with a coefficient of determination >0.992 and a limit of detection of 100 copies µl−1 for all targets across both assays. Qualitative detection using the real-time assays on artificially inoculated avocado shoot extracts showed more sensitivity compared with conventional fungal isolation from wood. All symbiotic fungi, except P. pembeum, from PSHB and KSHB female heads were detectable and quantified. Field samples from symptomatic Platanus racemosa, Populus spp., and Salix spp. across 17 of 26 city parks were positively identified as PSHB and KSHB through detection of their symbiotic fungi, and both were found occurring together on five trees from three different park locations. The molecular assays presented here can be utilized to accurately identify fungi associated with these invasive pests in California.
External fixator-augmented flexible intramedullary nailing of an unstable pediatric femoral shaft fracture model: a biomechanical study
Authors: Wilton Peter J. , Burke Corey A. , Inceoglu Serkan , Nelson Scott C. , Morrison Martin J.
Published: July 2019

The objective of this study was to test the compressive strength and torsional stiffness provided by the addition of a two-pin external fixator to an unstable pediatric femoral shaft fracture model after being instrumented with flexible intramedullary nailing (FIMN), and to compare this to bridge plating and FIMN alone. A length-unstable oblique diaphyseal fracture was created in 15 pediatric sized small femur models. Fracture stabilization was achieved by three constructs: standard retrograde FIMN with two 3.5-mm titanium (Ti) nails (Group 1), FIMN augmented with a two-pin external fixator (Group 2), and a 4.5-mm bridge plate (Group 3). Groups I and II were tested in 10 cycles of axial rotation to 10° in both directions at 0.1 Hz under 36 kg of compression. Torsional stiffness was calculated. Compressive strength was calculated by applying an axial load of 5 mm/min until failure was encountered. Failure was defined as the force required to achieve 10° varus at the fracture site or shortening of 2 cm. Group II demonstrated a greater compressive strength compared to Group I (1067.32 N vs 453.49 N, P < 0.001). No significant difference in torsional stiffness was found between Groups I and II (0.45 vs 0.38 Nm/deg, P = 0.18). Group III showed superior compressive strength and rotational stiffness compared to Groups I and II. In an unstable pediatric femoral shaft fracture model, augmenting FIMN with a two-pin external fixator increased the compressive strength by 147%, but did not increase torsional stiffness. Bridge plating with a 4.5-mm plate provided superior compressive strength and torsional stiffness.
Discrepancy between ultrasonographic and radiographic findings in patients treated for developmental dysplasia of the hip; hip maturation on ultrasonography may not be consistent with radiographic hip maturation
Authors: Atalar Hakan , Gunay Cuneyd , Turanli Sacit , Koktener Asli
Published: July 2019

Currently, hip sonography is used for early diagnosis and for monitoring developmental dysplasia of the hip (DDH) treatment in many countries. An early pioneer of ultrasonography for early diagnosis of DDH was Graf. Based on the Graf approach, hip ultrasonography is more sensitive and specific than radiography for the diagnosis of DDH, because of its capability to show cartilaginous structures of the hip joint. The aim of this study was to compare radiographic and ultrasonographic findings in patients treated for DDH. This study included 88 infants (98hips) treated for DDH. Radiography was simultaneously used for treatment and follow-up evaluation in addition to ultrasonography after six months of age. A retrospective evaluation was made of the ultrasonographs and radiographs of these infants. Of the total 98 hips, 28 were normal both ultrasonographically and radiographically, and a pathologic hip was demonstrated in 32 hips both sonographically and radiographically. Hip ultrasonography showed abnormal development in 32 hips, while radiography showed abnormal development in 70 hips. In 38 hips, the findings were normal according to ultrasonography but pathological according to radiography. There were no hips that were normal radiographically but pathological sonographically. When radiography is accepted as the standard imaging method in our study patients, the sensitivity and specificity of hip ultrasonography were determined as 45.7% [95% confidence interval (CI): 41.5–45.7] and 100% (95% CI: 89.4–100), respectively. These findings suggest that hip maturation apparent on ultrasonography may not be consistent with radiographic hip development in infants treated for DDH.
Improving Health-related Quality of Life for Patients With Nonambulatory Cerebral Palsy: Who Stands to Gain From Scoliosis Surgery?
Authors: Miller Daniel J. , Flynn John (Jack) M. , Pasha Saba , Yaszay Burt , Parent Stefan , Asghar Jahangir , Abel Mark F. , Pahys Joshua M. , Samdani Amer , Hwang Steven W. , Narayanan Unni G. , Sponseller Paul D. , Cahill Patrick J.
Published: July 2019

Introduction:

It is unclear what factors influence health-related quality of life (HRQOL) in neuromuscular scoliosis. The aim of this study was to evaluate which factors are associated with an improvement in an HRQOL after spinal fusion surgery for nonambulatory patients with cerebral palsy (CP).

Methods:

A total of 157 patients with nonambulatory CP (Gross Motor Function Classification System IV and V) with a minimum of 2-year follow-up after PSF were identified from a prospective multicenter registry. Radiographs and quality of life were evaluated preoperatively and 2 years postoperatively. Quality of life was evaluated using the validated Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire. Patients who had an increase of 10 points or greater from baseline CPCHILD scores were considered to have meaningful improvement at 2 years postoperatively. 10 points was chosen as a threshold for meaningful improvement based on differences between Gross Motor Function Classification System IV and V patients reported during the development of the CPCHILD. Perioperative demographic, clinical, and radiographic variables were analyzed to determine predicators for meaningful improvement by univariate and multivariate regression analysis.

Results:

A total of 36.3% (57/157) of the patients reported meaningful improvement in CPCHILD scores at 2 years postoperatively. Preoperative radiographic parameters, postoperative radiographic parameters, and deformity correction did not differ significantly between groups. Patients who experienced meaningful improvement from surgery had significantly lower preoperative total CHPILD scores (43.8 vs. 55.2, P<0.001). On backwards conditional binary logistic regression, only the preoperative comfort, emotions, and behavior domain of the CPCHILD was predictive of meaningful improvement after surgery (P≤0.001).

Conclusion:

Analysis of 157 CP patients revealed a meaningful improvement in an HRQOL in 36.3% of the patients. These patients tended to have lower preoperative HRQOL, suggesting more “room for improvement” from surgery. A lower score within the comfort, emotions, and behavior domain of the CPCHILD was predictive of meaningful improvement after surgery. Radiographic parameters of deformity or curve correction were not associated with meaningful improvement after surgery.

Level of Evidence:

Level II—retrospective review of prospectively collected data.
Avoiding Complications Associated With Anemia Following Total Joint Arthroplasty
Authors: Hushmendy Shazaan F. , Cushner Fred D.
Published: July 2019

As the number of total knee arthroplasty surgeries exponentially rise over the next decade, there will be a parallel rise in the complications observed. Patients who undergo total knee arthroplasties will be at an increased risk for postoperative anemia and allogenic blood transfusions (ABTs). The range of complications associated with perioperative anemia and ABTs include increased length of stay (LOS) in the hospital, increased surgical site infections/periprosthetic joint infections, and mortality. There are many perioperative blood conservation strategies that can be utilized to help optimize a patient, prevent excessive bleeding, and reduce the need for possible ABTs. Although there is extensive research on this topic, there is a lack of consensus on the best strategy to help prevent perioperative anemia and the complications associated with it. Surgeons should be able to recognize perioperative anemia and utilize the information in this section to prevent its unnecessary complications.
The West Point View: An Intra-Articular 50-Yard Line View With Dynamic Arthroscopic Load Shift
Authors: Fredericks Donald R. , Giuliani Jeffrey , Brelin Alaina , Goodlett Ronald , Posner Matthew , Dickens Jonathan F.
Published: July 2019

Traumatic anterior shoulder instability may present as a transient instability event (subluxation) or complete glenohumeral disassociation (dislocation). History and physical examination can determine the degree and direction of instability, and associated laxity. Silliman and Hawkins described a load shift test to determine the direction and degree the humeral head translation relative to glenoid in the anterior and posterior directions. The purpose of this article is to describe an intraoperative arthroscopic technique for direct visualization of the load and shift test from an intra-articular 50-yard line view. This technique allows for a direct and intraoperative instability examination and dynamic assessment of the anterior, posterior, and inferior glenohumeral joint laxity before, during, and after stabilization. The arthroscopic West Point Load Shift technique when viewing from a 50-yard line intra-articular view is useful to identify isolated anterior, posterior, or combined anterior-posterior instability and guide anchor placement in arthroscopic stabilization surgery. Utilizing the arthroscopic West Point Load Shift technique from the 50-yard line view before, during, and after arthroscopic anchor placement may help achieve greater restoration of glenohumeral capsuloligamentous balance because of the neutral view afforded.
Technique for Guiding Distal Locking Screws into Intramedullary Nails
Authors: Stevens Jarrad M. , Shiels Sarah , Chesser Timothy
Published: July 2019

Placing distal locking screws into an intramedullary nail can be a difficult step for the young surgeon to master. We propose a step-by-step approach to drilling the distal locking screw holes.
Effect of Prone Positioning on Intraocular Pressure in Patients With Acute Respiratory Distress Syndrome
Authors: Saran Sai , Gurjar Mohan , Kanaujia Vikas , Ghosh Pralay S. , Gupta Anshi , Mishra Prabhaker , Azim Afzal , Poddar Banani , Baronia Arvind , Singh Ritu
Published: July 2019

Objectives:

To evaluate the effect of prolonged duration of prone position (with head laterally rotated) on intraocular pressure in acute respiratory distress syndrome patients.

Design:

Prospective observational study.

Setting:

University hospital ICU.

Patients:

Twenty-five acute respiratory distress syndrome patients, age 60 years (51–67 yr), Sequential Organ Failure Assessment score 10 (10–12), Pao
2/Fio
2 ratio of 90 (65–120), and all in septic shock.

Interventions:

None.

Measurements and Main Results:

Intraocular pressure (in mm Hg) measured by hand-held applanation tonometer, at different time points. Before prone (in both eyes): at 30–45° head-end elevation position (THE pre-prone), in supine position just before turning prone (Tsupine pre-prone); during prone (in nondependent eye): at 10 minutes (T10 prone), 30 minutes (T30 prone), and at just before end of prone session (Tend-prone). After end of prone session (both eyes): at 5 minutes (T5 supine post-prone), 10 minutes (T10 HE post-prone), 15 minutes (T15 HE post-prone), and 30 minutes (T30 HE post-prone). Median duration of prone position was 14 hours (12–18 hr). Median intraocular pressure increased significantly (p ≤ 0.001) in both eyes. In dependent eye, from 15 (12–19) at THE pre-prone to 24, 21, 19, and 16 at T5 supine post-prone, T10 HE post-prone, T15 HE post-prone, and T30 HE post-prone respectively, whereas in nondependent eye from 14 (12–18.5) at THE pre-prone to 23, 25, 32, 25, 22, 20, and 17 at T10 prone, T30 prone, Tend-prone, T5 supine post-prone, T10 HE post-prone, T15 HE post-prone, and T30 HE post-prone respectively. Bland-Altman plot analysis showed significant linear relationship (r = 0.789; p ≤ 0.001) with good agreement between rise in mean intraocular pressure of the both eyes (dependent eye and nondependent eye) with their paired differences after the end of different duration of prone session (T5 supine post-prone).

Conclusions:

There is significant increase in intraocular pressure due to prone positioning among acute respiratory distress syndrome patients. Intraocular pressure increases as early as 10 minutes after proning, with increasing trend during prone position, which persisted even at 30 minutes after the end of post prone session although with decreasing trend.
Patient Outcomes and Cost-Effectiveness of a Sepsis Care Quality Improvement Program in a Health System*
Authors: Afshar Majid , Arain Erum , Ye Chen , Gilbert Emily , Xie Meng , Lee Josh , Churpek Matthew M. , Durazo-Arvizu Ramon , Markossian Talar , Joyce Cara
Published: July 2019

Objectives:

Assess patient outcomes in patients with suspected infection and the cost-effectiveness of implementing a quality improvement program.

Design, Setting, and Participants:

We conducted an observational single-center study of 13,877 adults with suspected infection between March 1, 2014, and July 31, 2017. The 18-month period before and after the effective date for mandated reporting of the sepsis bundle was examined. The Sequential Organ Failure Assessment score and culture and antibiotic orders were used to identify patients meeting Sepsis-3 criteria from the electronic health record.

Interventions:

The following interventions were performed as follows: 1) multidisciplinary sepsis committee with sepsis coordinator and data abstractor; 2) education campaign; 3) electronic health record tools; and 4) a Modified Early Warning System.

Main Outcomes and Measures:

Primary health outcomes were in-hospital death and length of stay. The incremental cost-effectiveness ratio was calculated and the empirical 95% CI for the incremental cost-effectiveness ratio was estimated from 5,000 bootstrap samples.

Results:

In multivariable analysis, the odds ratio for in-hospital death in the post- versus pre-implementation periods was 0.70 (95% CI, 0.57–0.86) in those with suspected infection, and the hazard ratio for time to discharge was 1.25 (95% CI, 1.20–1.29). Similarly, a decrease in the odds for in-hospital death and an increase in the speed to discharge was observed for the subset that met Sepsis-3 criteria. The program was cost saving in patients with suspected infection (–$272,645.7; 95% CI, –$757,970.3 to –$79,667.7). Cost savings were also observed in the Sepsis-3 group.

Conclusions and Relevance:

Our health system’s program designed to adhere to the sepsis bundle metrics led to decreased mortality and length of stay in a cost-effective manner in a much larger catchment than just the cohort meeting the Centers for Medicare and Medicaid Services measures. Our single-center model of interventions may serve as a practice-based benchmark for hospitalized patients with suspected infection.
T-cell receptor and chimeric antigen receptor in solid cancers: current landscape, preclinical data and insight into future developments
Authors: Azizi Alexander A. , Pillai Manon , Thistlethwaite Fiona C.
Published: July 2019

Purpose of review

The remarkable and durable clinical responses seen in certain solid tumours using checkpoint inhibitors and in haematological malignancies using chimeric antigen receptor (CAR) T therapy have led to great interest in the possibility of using engineered T-cell receptor (TCR) and CAR T therapies to treat solid tumours.

Recent findings

In this article, we focus on the published clinical data for engineered TCR and CAR T therapy in solid tumours and recent preclinical work to explore how these therapies may develop and improve. We discuss recent approaches in target selection, encouraging epitope spreading and replicative capacity, CAR activation, T-cell trafficking, survival in the immunosuppressive microenvironment, universal T-cell therapies, manufacturing processes and managing toxicity.

In haematological malignancies, CAR T treatments have shown remarkable clinical responses. Engineered TCR and CAR therapies demonstrate responses in numerous preclinical models of solid tumours and have shown objective clinical responses in select solid tumour types. It is anticipated that the integration of efficacious changes to the T-cell products from disparate preclinical experiments will increase the ability of T-cell therapies to overcome the challenges of treating solid tumours and note that healthcare facilities will need to adapt to deliver these treatments.
Patterns of Postdiagnosis Depression Among Late-Stage Cancer Patients
Authors: Huo Jinhai , Bian Jiang , Xie Zhigang , Hong Young-Rock , Wilkie Diana J. , Pereira Deidre B.
Published: July 2019

Objectives:

The incidence of depression after a late-stage cancer diagnosis is poorly understood and has not been the subject of intense investigation. We used population-based data to examine trends in postdiagnosis depression incidence among racial/ethnic and sexual groups.

Methods:

We identified 123,066 patients diagnosed with late-stage breast, prostate, lung, or colorectal cancer from 2001 to 2013 in the Surveillance Epidemiology and End Results Medicare-linked database. The primary outcome was the incidence of postdiagnosis depression after a late-stage cancer diagnosis. Trend analysis was performed using the Cochran-Armitage test. Stratified incidence rates were calculated for the racial/ethnic and sexual groups.

Results:

The incidence of depression after cancer diagnosis increased from 15.3% in 2001 to 24.1% in 2013, P
trend<0.0001. About 50% of depression was reported in the first 3 months of stage IV cancer diagnosis. A total of 19,775 (20.0%) non-Hispanic whites, 1937 (15.9%) non-Hispanic blacks, and 657 (12.7%) Hispanics were diagnosed with depression during a mean follow-up of 2.7 months (interquartile range: 0.9 to 10.2 mo). The incidence of depression is significantly higher among females than males, 22.7% versus 16.3%, P<0.0001. In the multivariable logistic regression, non-Hispanic whites and females were still independent predictors of higher risk of postdiagnosis depression.

Conclusions:

There are significant differences in the incidence of postdiagnosis depression among racial/ethnic and sexual groups in the United States. The consideration of racial/ethnic in depression prevention and diagnosis among cancer patients should be discussed as a matter of importance to ensure that there is no diagnosis bias among non-Hispanic blacks and Hispanics.
Sleep quality and fatigue in women with premature ovarian insufficiency receiving hormone therapy: a comparative study
Authors: Benetti-Pinto Cristina Laguna , Menezes Camila , Yela Daniela Angerame , Cardoso Tania Moc
Published: July 2019

Objective:

To compare sleep quality and fatigue between women with premature ovarian insufficiency (POI) receiving hormone therapy (HT) and women of the same age with preserved ovarian function.

Methods:

This was a cross-sectional study of 61 women with POI receiving HT (POI group) and 61 women with preserved ovarian function (control group) who were matched by age (±2 years). The Pittsburgh Sleep Quality Index (PSQI) and Chalder Fatigue Scale were used to assess sleep quality and fatigue. Apart from correlation analysis, the Mann-Whitney, chi-square, or Fisher test was used to compare the groups.

Results:

Women from the POI and control groups were 35.03 ± 7.68 and 34.49 ± 7.55 years of age, respectively (P = 0.63). In the PSQI evaluation, the scores were 7.69 ± 4.18 and 8.03 ± 4.53, respectively (P = 0.79), showing no difference between the POI and control groups. However, the POI group had higher and therefore worse scores for the sleep latency component (1.74 ± 0.66 and 1.18 ± 0.87, respectively; P < 0.001) and use of medication to sleep (1.28 ± 0.88 and 0. 85 ± 0.8; P = 0.008). The POI group had a higher fatigue index than that of the control group (5.25 ± 2.78 and 3.49 ± 1.78, respectively; P < 0.001), with sleep quality being classified as poor in 69% and fatigue present in 59% of patients.

Conclusions:

Women with POI receiving HT have poor sleep quality. They take longer to fall asleep and have a higher fatigue index.
Bundles for Maternal Safety: Promises and Challenges of Bundle Implementation: The Case of Obstetric Hemorrhage
Authors: ATALLAH FOUAD , GOFFMAN DENA
Published: July 2019

Obstetric hemorrhage remains a leading cause of severe maternal morbidity and mortality in the United States. The National Partnership for Maternal Safety Consensus Bundle on Obstetric Hemorrhage presented a framework to help focus standardization and improvements efforts for obstetric hemorrhage. The critical elements of readiness, recognition and prevention, response, and reporting/systems learning, are described and salient points within each are highlighted. New York state implementation efforts, tools that may help translate the bundle into practice, and remaining challenges, are described.
ENHANCED S-CONE SYNDROME: VISUAL FUNCTION, CROSS-SECTIONAL IMAGING, AND CELLULAR STRUCTURE WITH ADAPTIVE OPTICS OPHTHALMOSCOPY
Authors: Ammar Michael J. , Scavelli Kurt T. , Uyhazi Katherine E. , Bedoukian Emma C. , Serrano Leona W. , Edelstein Ilaina D. , Vergilio Grace , Cooper Robert F. , Morgan Jessica I. W. , Kumar Priyanka , Aleman Tomas S.
Published: July 2019

Purpose:

To describe in detail the phenotype of a patient with enhanced S-cone syndrome.

Methods:

We describe a 13-year-old boy who presented with blurred vision, vitreous cells, cystoid macular edema refractory to steroid treatment, and a negative uveitic workup. The patient underwent a complete ophthalmic examination, full-field electroretinograms (ffERG), automatic static perimetry and multimodal imaging with spectral domain optical coherence tomography, and adaptive optics scanning laser ophthalmoscopy (AOSLO).

Results:

Spectral domain optical coherence tomography demonstrated cystoid macular edema and a hyperthick, delaminated midperipheral retina. Fluorescein angiography did not demonstrate macular leakage. Rod-mediated ffERGs were undetectable, and there was a supernormal response to short-wavelength stimuli compared with photopically matched longer wavelengths of light consistent with enhanced S-cone syndrome. Gene screening was positive for compound heterozygous mutations NR2E3: a known (c.119-2 A>C) and a novel (c.119-1G>A) mutation. By perimetry, sensitivities were normal or above normal for short-wavelength stimuli; there was no detectable rod-mediated vision. AOSLO demonstrated higher than normal cone densities in the perifoveal retina and evidence for smaller outer segment cone diameters.

Conclusion:

Evidence for supernumerary cones (at least twice the normal complement) by AOSLO and spectral domain optical coherence tomography was associated with supernormal S-cone sensitivities and electroretinogram responses confirming previous in vivo findings in postmortem human specimens. Smaller than normal cones in enhanced S-cone syndrome may represent “hybrid” photoreceptors analogous to the rd7/rd7 murine model of the disease.
Spatial Analysis of Corneal Densitometry, Thickness Profile, and Volume Distribution After Uneventful Descemet Membrane Endothelial Keratoplasty
Authors: Lazaridis Apostolos , Giallouros Elefterios , Sekundo Walter , Schroeder Frank Michael , Sklavos Sokratis , Droutsas Konstantinos
Published: July 2019

Purpose:

To present normative corneal densitometry (CD), thickness (CT), and volume (CV) after uneventful Descemet membrane endothelial keratoplasty (DMEK).

Methods:

Medical records of 212 consecutive surgeries were reviewed. One hundred cases without intraoperative and postoperative complications were included (group 1). Scheimpflug CD of the optically relevant 0- to 2-mm zone and 2- to 6-mm annulus, CT at the 2-, 4-, and 6-mm rings, and CV at the 3-, 5-, and 7-mm zones were evaluated preoperatively and at 3, 6, 12, and 24 months postoperatively. The 24-month results were compared with an age-matched group of uncomplicated pseudophakic eyes (group 2; n = 20) and a group of healthy, young subjects (group 3; n = 30).

Results:

Total CD at 0 to 2 mm was 33.9 ± 10.7 grayscale units preoperatively and decreased to 20.3 ± 4.7 at 24 months (P < 0.001), being significantly higher compared with both control groups (P ≤ 0.026). Total CD at 2 to 6 mm was 27.9 ± 8.1 preoperatively and decreased to 20.2 ± 4.6 at 24 months (P < 0.001), showing no statistically significant difference compared with group 2 (P = 0.061). At 24 months, group 1 showed a similar central CT, CT at the 2-mm and 4-mm rings compared with group 2 (P ≥ 0.440); however, CT at 6 mm increased significantly (P = 0.008). CV at 3, 5, and 7 m decreased significantly at 24 months (P < 0.001), showing no significant differences compared with both control groups (P ≥ 0.122).

Conclusions:

Twenty four months after uneventful DMEK, CT within the central 4-mm zone and CV at the 3-, 5-, and 7-mm zones were similar to uncomplicated pseudophakic eyes. The total CD at the 0- to 2-mm zone and midperipheral CT at the 6-mm ring were higher compared with the pseudophakic controls.
Clinical Outcomes of a New Asymmetric Intracorneal Ring Segment for the Treatment of Keratoconus
Authors: Vega-Estrada Alfredo , Chorro Elisabet , Sewelam Ashraf , Alio Jorge L.
Published: July 2019

Purpose:

To report visual, refractive, and corneal aberrations after implantation of a new asymmetric intracorneal ring segment (ICRS).

Methods:

This was a prospective, multicenter clinical study including 30 eyes of 26 patients with keratoconus. All cases were implanted with an ICRS, named the VISUMRING (VR), which had an arc length of 353 degrees and 2 asymmetric sections that can be customized in base width, length, and thickness. Ophthalmic evaluation included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, topography, and anterior corneal aberrations using the Sirius System (CSO, Firenze, Italy). Mean follow-up period was 14.7 ± 7.9 months.

Results:

Significant improvement of both UDVA and CDVA was observed after 1 year. UDVA improved from 0.08 ± 0.22 to 0.22 ± 0.16 and CDVA from 0.24 ± 0.29 to 0.43 ± 0.18 (P = 0.01). A significant reduction of more than 7 D in the spherical equivalent from −12.38 ± 3.77 D to −5.00 ± 3.26 D (P < 0.05) was noted 1 year after the procedure. In terms of higher-order aberrations, a slight reduction that was not statistically significant in the higher-order and coma-like aberrations was noted at 1 year from 4.32 and 3.82, to 4.12 and 3.55, respectively. Regarding complications, 5 of the 30 cases needed to have the VR explanted throughout the follow-up period due to severe corneal melting.

Conclusions:

VR ICRS improves vision and refraction and induces major corneal flattening in patients with keratoconus. Further design enhancement is needed to increase the reduction of the asymmetric corneal aberrations and reduce the extrusion rate.
Role of Pattern Electroretinogram in Ocular Hypertension and Early Glaucoma
Authors: Turkey Eman , Elsanabary Zeinab S.E. , Elshazly Laila Hassan M. , Osman Moataz H.
Published: July 2019

Purpose:

To test whether pattern electroretinogram (PERG) can early detect retinal ganglion cells dysfunction in ocular hypertension.

Design:

Cross-sectional observational study.

Participants:

The study included 3 groups: control, primary open-angle glaucoma (POAG) and ocular hypertension (OHT) groups with 30 eyes in each group.

Materials and Methods:

Visual fields were examined using automated perimetry with central 24-2 program. Optical coherent tomography (OCT) was done to assess the neuroretinal rim area, vertical cup/disc ratio, and average superior and inferior retinal nerve fiber layer thickness. PERG was recorded using skin electrodes. Amplitude and latency of P50 and N95 were documented.

Results:

PERG data: the mean P50 and N95 latency were significantly higher in the POAG group and the OHT group compared with the control group (P<0.001, <0.001, respectively). Also, the mean P50 and N95 amplitude were significantly lower in the POAG group and the OHT group compared with the control group (P<0.001,<0.001, respectively). In the POAG group, there was a significant negative correlation between PSD on one hand and P50 amplitude (r=−0.620, P=0.001) and N95 amplitude (r=−0.61, P<0.001) on the other hand. Also, the mean deviation was positively correlated with P50 amplitude (r=0.51, P=0.007) and N95 amplitudes (r=0.50, P=0.002). However, there was no significant correlation between PERG parameters and OCT parameters. In the OHT group, PERG parameters did not correlate with visual field and OCT parameters.

Conclusions:

PERG can detect the dysfunctional, but still live retinal ganglion cells earlier than OCT in OHT cases, allowing the early start of treatment that can restore the ganglion cell function before irreversible damage occurs.
High-dose Corticosteroids for Adult Bell's Palsy: Systematic Review and Meta-analysis
Authors: Fujiwara Takashi , Namekawa Motoki , Kuriyama Akira , Tamaki Hisanobu
Published: July 2019

Objectives:

To compare the efficacy and safety of high-dose corticosteroids (initial prednisolone [PSL] of 100 mg or more daily) and standard-dose corticosteroids (initial PSL of 50–60 mg) in patients with Bell's palsy.

Study Design:

A systematic review and meta-analysis.

Data Sources:

Medline, Embase, Cochrane Central Register of Controlled Trials, Ichushi-Web, Web of Science, and CINAHL, combined with data from ClinicalTrials.gov.

Study Selection:

Published and unpublished cohort studies comparing high- and standard-dose corticosteroids in adult patients with Bell's palsy were included.

Data Extraction:

Study characteristics (study design, patient's number), patient characteristics (sex, age, disease severity, prescription of antivirals), and outcomes (nonrecovery, any adverse effects).

Data Synthesis:

From the 1,974 identified articles, 8 studies were met eligible criteria. Of the included studies, the initial dose in high-dose corticosteroids regimens varied from 120 mg to 200 mg PSL daily. Compared with standard-dose corticosteroids, high-dose corticosteroids were associated with a significantly decreased nonrecovery at 6 months after disease onset (odds ratio 0.42, 95% confidence interval 0.22–0.80; very low quality) in patients with Bell's palsy. No severe adverse effects were observed in patients receiving high- or standard-dose corticosteroids.

Conclusion:

High-dose corticosteroids reduce nonrecovery in patients with Bell's palsy. The dose of high-dose corticosteroids was varied and further prospective study is needed to identify an adequate dose of corticosteroids in these patients.
Serum Levels of Chemerin, Apelin, and Adiponectin in Relation to Clinical Symptoms, Quality of Life, and Psychological Factors in Irritable Bowel Syndrome
Authors: Baram Mohammad A. , Abbasnezhad Amir , Ghanadi Koroush , Anbari Khatereh , Choghakhori Razieh , Ahmadvand Hassan
Published: July 2019

Background:

Adipokines have endocrine roles in metabolism and immunity. Dysregulation of adipokine levels is associated with several diseases with chronic inflammation. We aimed to assess the serum concentrations of chemerin, apelin, and adiponectin in irritable bowel syndrome (IBS). Furthermore, we evaluated the possible association of these adipokines with clinical symptoms, quality of life (QoL), and psychological factors.

Materials and Methods:

In this case-control study, 114 male and female IBS patients were recruited from outpatient clinics. Along with the IBS patients, 114 sex and age-matched healthy volunteers were recruited. Patients filled in the questionnaires of the IBS severity scoring system (IBSSS), gastrointestinal (GI) and somatic symptoms, IBS specific QoL (IBS-QoL), and psychological disorders, and went to the lab for blood sampling.

Results:

Serum levels of both adiponectin and apelin were significantly (P=0.04, 0.03, respectively) lower, whereas chemerin was significantly (P=0.01) higher in IBS patients. Chemerin was higher in IBS-D compared with both IBS-C and IBS-A, while apelin and adiponectin were not different between subtypes. After adjustments for confounders only, chemerin had a positive association with IB severity scoring system and GI symptoms. Furthermore, chemerin had positive associations, whereas apelin and adiponectin had inverse associations with somatic symptoms and psychological factors. There were no significant associations between adipokines including chemerin, apelin, and adiponectin, and IBS-QoL.

Conclusions:

Chemerin had significant associations with both the severity of clinical symptoms and psychological factors in IBS; thus, it could be considered as a potential therapeutic target in these patients; however, further studies are needed.
Obesity Does Not Impact Outcomes or Rates of Gastroesophageal Reflux After Peroral Endoscopic Myotomy in Achalasia
Authors: Sanaka Madhusudhan R. , Parikh Malav P. , Subramanium Subanandhini , Thota Prashanthi N. , Gupta Niyati M. , Lopez Rocio , Gabbard Scott , Murthy Sudish , Raja Siva
Published: July 2019

Background:

Outcomes of laparoscopic Heller myotomy in obese patients with achalasia are suboptimal along with the increased risk of gastroesophageal reflux disease (GERD). The impact of obesity on treatment success and GERD after peroral endoscopic myotomy (POEM) are not well known. Hence, our study aims were to compare the clinical outcomes and rates of GERD after POEM in nonobese versus obese patients with achalasia.

Methods:

Chart review of all achalasia patients who underwent POEM at our institution between April 2014 and June 2018. Patients with timed barium esophagram (TBE) and high-resolution esophageal manometry (HREM) before POEM along with post-POEM TBE, HREM, and esophageal pH study were included. Patients were categorized into 2 groups, nonobese (body mass index <30 kg/m2) and obese (body mass index ≥30 kg/m2). Patient demographics, TBE, HREM, pH study findings, and Eckardt scores were compared between the 2 groups.

Results:

A total of 89 patients (46 nonobese; 43 obese) met the study criteria. There were no significant differences in age, gender, achalasia subtype, operative time, length of stay and complication rates between the 2 groups. Treatment success (Eckardt score ≤3) was similar in both groups (97.7% nonobese vs. 92.7% obese, P=0.35). Abnormal DeMeester scores on pH study (>14.72) were similar in nonobese and obese patients (58.7% vs. 46.5%, P=0.25). Symptomatic GERD was also similar in both groups (17.8% in nonobese vs. 20% in obese, P=0.79).

Conclusions:

POEM is an equally safe and effective treatment option for both nonobese and obese patients with achalasia in the short-term. Interestingly, POEM does not lead to higher rates of GERD in obese compared with nonobese patients.
CHD is Associated With Higher Grades of NAFLD Predicted by Liver Stiffness
Authors: Song Yan , Dang Ying , Wang Ping , Tian Gang , Ruan Litao
Published: July 2019

Background and Aim:

Accumulating clinical and epidemiologic evidence indicates that nonalcoholic fatty liver disease (NAFLD) is not only associated with liver-related morbidity and mortality, but also with a greater risk of coronary heart disease (CHD). However, there is currently no diagnostic parameter for NAFLD that has been determined to reliably indicate the presence of CHD as a co-morbidity. We evaluated the liver stiffness and visceral fat thickness of NAFLD patients ultrasonographically to explore the relationship between liver stiffness, visceral fat thickness, and CHD, aiming to find explore the relationship between the liver stiffness and CHD.

Methods:

We enrolled 120 consecutive patients who had been initially diagnosed with CHD on the basis of their symptoms. All patients underwent coronary angiography or computed tomography angiography, and were classified into a CHD group and a non-CHD group on the basis of the results. All patients underwent liver ultrasonography, shear-wave elastography, and visceral fat thickness measurement.

Results:

NAFLD and visceral fat thickness were significantly positively correlated with CHD and Gensini score (P<0.001). Multivariate regression showed that age, male, cholesterol, liver stiffness, and visceral fat thickness were determinants of CHD. Age, cholesterol, liver stiffness, and visceral fat thickness cut-off points for the prediction of CHD were above 50 years old [area under the curve (AUC): 0.678; sensitivity, 87%; specificity, 42.6%], >3.76 mmol/L (AUC: 0.687; sensitivity, 68.4%; specificity, 64.8%), >6.1 kPa (AUC: 0.798; sensitivity, 50%; specificity, 92.6%), and >7.41 cm (AUC: 0.694; sensitivity, 52.6%; specificity, 87%), respectively. Compared with the use of age, gender, and cholesterol (model 1), the addition of the liver stiffness cut-off to model 1 resulted in a stronger predictive value (P=0.005).

Conclusions:

High-grade NAFLD is more present in symptomatic CHD. The higher degree of liver stiffness in patients with NAFLD, the higher risk of CHD in these NAFLD patients.
Symptomatic posterior fossa and supratentorial subdural hygromas as a rare complication following transarticular screw fixation with posterior wiring for atlantoaxial instability
Authors: Han In-Bo , Choi Un Yong , Shin Dong-Eun , Ropper Alexander E. , Choi Dae-Sung , Ahn Tae-Keun
Published: July 2019

Rationale:

Atlantoaxial transarticular screw fixation has been an effective and appealing method for inducing fusion of the C1-C2 complex. This technique is usually performed with Gallie fusion. In performing Gallie fusion using sublaminar wiring, a major concern is the risk of dural tear associated with passing sublaminar wires through the epidural space. We present the first report on symptomatic symptomatic subdural hygroma (SDH) due to transarticular screw fixation with posterior wiring.

Patients concerns:

A 50-year-old man had sustained dens fracture 20 years ago and presented with severe neck pain following a recent traffic accident. The images showed atlantoaxial instability due to nonunion of the dens fracture and the patient underwent transarticular screw fixation with posterior sublaminar wiring using Gallie technique. When the U-shaped wire was passed under the arch of C1 from inferior to superior, a dural tear and cerebrospinal fluid (CSF) leak occurred. The site of dural tear was repaired by direct application of sutures. The patient was discharged in good condition. Fifteen day after surgery, the patient was readmitted with a history of a progressive headache associated with vomiting and vertigo.

Diagnonsis:

Brain CT and MRI showed bilateral posterior fossa and a right-sided supratentorial SDH.

Interventions:

The patient underwent right occipital burr hole and evacuation of posterior fossa SDH due to deteriorating neurological status.

Outcomes:

The patient's condition gradually improved after the operation and became asymptomatic at 3-year follow-up.

Lessons:

Posterior fossa and supratentorial SDH could occur resulting from any intraoperative dural tear and CSF leakage during posterior cervical spinal surgery. Symptomatic SDH after posterior cervical spinal surgery should be cautiously assessed and treated.

Level of Evidence: 5
Prognostic significance of polyvascular disease in heart failure with preserved left ventricular ejection fraction
Authors: Fujisue Koichiro , Tokitsu Takanori , Yamamoto Eiichiro , Sueta Daisuke , Takae Masafumi , Nishihara Taiki , Oike Fumi , Usuku Hiroki , Ito Miwa , Motozato Kota , Kanazawa Hisanori , Araki Satoshi , Arima Yuichiro , Takashio Seiji , Izumiya Yasuhiro , Suzuki Satoru , Sakamoto Kenji , Kaikita Koichi , Tsujita Kenichi
Published: July 2019

The prognostic significance of systemic atherothrombosis in heart failure (HF) with preserved ejection fraction (HFpEF) remains unclear. This study aimed to investigate the relation between the presence of polyvascular disease (PVD) and cardiovascular outcomes in HFpEF patients.

A total of 510 consecutive HFpEF patients were prospectively observed for up to 1500 days or until occurrence of cardiovascular events. PVD was defined as ≥2 coexistence of coronary artery disease, peripheral arterial disease, and cerebrovascular disease.

Overall, 124 cardiovascular events were observed during follow-up (median: 1430 days). Kaplan–Meier curve showed HFpEF with PVD (n = 84) experienced more cardiovascular events than did those without PVD patients (44.0% vs 20.4%, log-rank: P < .001). Multivariable Cox proportional hazards analysis with significant factors from univariate analysis showed the presence of PVD (hazard ratio [HR]: 2.875, 95% [CI]: 1.894–4.365, P < .001), previous HF hospitalization (HR: 1.578, 95% CI: 1.031–2.414, P = .036), hemoglobin (HR: 0.889, 95% CI: 0.805–0.983, P = .021), serum sodium (HR: 0.946, 95% CI 0.896–1.000, P = .048), ln-BNP (per 1.0, HR: 1.255, 95% CI: 1.055–1.494, P = .010), and E/e’ (HR: 1.047, 95% CI: 1.020–1.075, P < .001) significantly predicted future cardiovascular events. Multivariable Cox hazard analysis with 4 established factors (age, BNP, diabetes mellitus, and previous HF hospitalization) from the I-PRESERVE (Irbesartan in HFpEF) study showed PVD was independently associated with cardiovascular events in HFpEF patients (HR: 2.562, 95% CI: 1.715–3.827, P < .001).

The presence of PVD is significantly associated with cardiovascular events in HFpEF, suggesting the importance of screening PVD in HFpEF.
Disappearance of the blood supply to a giant uterine myoma due to childbirth
Authors: Li Lu-Jing , Liang Xuan-Kun , Wang Xian-Xiang , Zeng Dan , Xu Zuo-Feng
Published: July 2019

Rationale:

Giant uterine myomas may be life-threatening due to pressure effects on the lungs and other contiguous organs.

Patient concerns:

A 32-year-old pregnant Asian woman was admitted to our hospital early in her pregnancy with a pre-pregnancy history of multiple uterine myomas.

Diagnosis:

She was diagnosed with multiple giant uterine myomas in pregnancy.

Interventions:

No intervention was performed on the woman.

Outcomes:

A reduction in tumor size and disappearance of tumor blood supply were seen on conventional and contrast-enhanced ultrasounds (CEUS) on postpartum day 34. Mass volume gradually decreased and no blood flow signals were seen on CEUS during postpartum follow-up.

Lessons:

Childbirth can block the blood supply of giant uterine myomas and reduce mass size. In such cases, childbirth may be considered therapeutic.
The mediating and moderating roles of self-acceptance and self-reported health in the relationship between self-worth and subjective well-being among elderly Chinese rural empty-nester
Authors: Su Hong , Wang Lina , Li Yang , Yu Hong , Zhang Jiayuan
Published: July 2019

This study aims to test the moderation and mediation effects of self-acceptance and self-reported health on self-worth's impact on subjective well-being among elderly Chinese rural empty-nester elderly, and confirm whether self-report health is a moderating variable between self-worth and subjective well-being.

This cross-sectional study was performed from May 2017 to April 2018; the participants were 365 empty-nest elderly adults from rural areas of Chifeng City in Inner Mongolia.

Data were collected with the General information questionnaire, Self-worth questionnaire for adults, Self-acceptance Questionnaire, and Memorial University of New Found land Scale of Happiness. For the analyses, correlations, regressions, and structural equation models were used. Bootstrapping was performed to confirm the mediation effect. Multiple regression analysis was performed to confirm the moderation effect.

Self-worth showed significant correlations with self-acceptance and subjective well-being (all P < .01). Bootstrapping indicated that the mediating role of self-acceptance was statistically significant. And self-reported health moderated the self-worth and subjective well-being association.

Self-acceptance partially mediated the relationship between self-worth and subjective well-being of the rural empty-nest elderly and self-reported health moderated self-worth and subjective well-being association. Consequently, to improve the subjective well-being of the rural empty-nest elderly, self-acceptance and personal health should be the focus.
Application of abdominal sonography in diagnosis of infants with necrotizing enterocolitis
Authors: Chen Shuai , Hu Yuanjun , Liu Qinghua , Li Xiaoying , Wang Hefeng , Wang Kelai , Zhang Aihua
Published: July 2019

The purpose of this study was to explore the diagnostic significance of abdominal sonography (AUS) in infants with Necrotizing enterocolitis (NEC) admitted to a neonatal intensive care unit to better evaluate the ability of AUS to differentiate necrotizing enterocolitis from other intestinal diseases.

All patients diagnosed with NEC at the Department of General Surgery and Neonatal Surgery, Qilu Children‘s Hospital between 1st, Jun, 2010 and 30th, Dec, 2015. The logistic regression analysis and the area under receiver operating characteristic (ROC) curve (AUCs) were also used to identify the sonographic factors for diagnosing NEC.

For the entire cohort of 91 patients, we divided these patients into suspected NEC (n = 35) group and definite NEC (n = 56) group. After adjusting for competing sonographic factors, we identified that thick bowel wall (more than 2.5 mm) (P = .013, OR: 1.246), intramural gas (pneumatosis intestinalis) (P = .002, OR:1.983), portal venous gas (P = .022, OR:1.655) and reduced peristalsis (P = .011, OR:1.667) were independent diagnostic factors associated with NEC. We built a logistic model to diagnose NEC according to the results of multivariable logistic regression analysis. We found the AUROC for thick bowel wall (more than 2.5 mm), intramural gas (pneumatosis intestinalis), portal venous gas and reduced peristalsis were significantly lower than the AUROC for the logistic model was 0.841 (95% CI: 0.669 to 0.946).

We found that thick bowel wall (more than 2.5 mm), intramural gas (pneumatosis intestinalis), portal venous gas and reduced peristalsis were independent diagnostic factors associated with NEC. The logistic model was significantly superior to the single sonographic parameter for diagnosing NEC.