bluuebunny/crossref_metadata_2025 huggingface dataset:
Refining the Classification of Field Cancerization
Authors: Kitrell Bo , Crew Ashley , Wysong Ashley , Sutton Adam
Published: February 2023

BACKGROUND

Field cancerization is a commonly encountered but poorly defined entity in dermatology. Lack of a consensus definition makes characterizing and studying this condition difficult.

OBJECTIVE

Propose a framework for defining and managing field cancerization patients.

METHODS

Clinical experience and available data in the literature was used to develop a proposed field cancerization disease classification system and chemoprevention algorithm.

RESULTS

The author group developed a field cancerization classification and treatment algorithm that stratifies patients into 5 different classes based on the extent of their field cancerization. They have started to recruit and study the highest risk cohort (Category 4 or 5) and have recruited 57 patients with 5 or more lifetime keratinocyte carcinomas for a prospective study evaluating chemoprevention strategies and disease burden. In these cohorts, the average number of skin cancers was greater than 12; however, less than 39% of these patients had used any chemoprevention in the prior 6 months.

CONCLUSION

A meaningful and clinically relevant disease stratification framework with chemoprevention guidance has the potential to highly impact the specialty and patients.
Skin Aging Exposome in Skin of Color Populations: Review of the Literature
Authors: Moutraji Rawan , Taylor Susan C.
Published: February 2023

BACKGROUND

As life expectancy increases, the comorbidities related to aging require greater attention. Skin aging exposomes were only recently defined and need additional delineation, particularly in Skin of Color (SOC) populations.

OBJECTIVE

The primary objective is to shed the light and summarize the existing literature on skin aging exposome in SOC populations.

MATERIALS AND METHODS

We performed an extensive search in the PubMed and Google Scholar databases. We included peer-reviewed studies in SOC populations around the world regarding one or more of the skin aging exposome factors, and we grouped and organized the studies under each factor of the skin aging exposome.

RESULTS

Some environmental exposome factors are preventable or modifiable, for example, by applying broad-spectrum sunscreens with visible light protection, improving nutrition, and smoking cessation. Other factors such as air pollution will require more complex solutions. Our search revealed a paucity of references on skin aging exposome factors in SOC populations.

CONCLUSION

We identified the need for more dedicated studies in SOC populations to advance knowledge on skin aging exposome factors. This knowledge will provide a better understanding of approaches to minimize extrinsic skin aging in these populations.
Patient Anxiety Related to Patient-Perceived Delays in Surgical Treatment of Skin Cancer
Authors: Daly Caroline M. , Scott Jeffrey F. , Bibee Kristin P.
Published: February 2023

BACKGROUND

Patients undergoing dermatologic surgery report higher anxiety levels than those undergoing nonsurgical treatments. However, little is known about the association between patient-perceived delays in skin cancer surgery and patient-reported anxiety.

OBJECTIVE

To examine the relationship between patient-perceived delays in surgery and patient-reported anxiety.

METHODS & MATERIALS

Patients undergoing wide local excision or Mohs micrographic surgery were recruited to complete a survey to assess perception of surgical delay and anxiety related to skin cancer surgery using the validated Psychosocial Screen for Cancer–Revised. Demographic and surgical characteristics were collected through chart review. Chi-square and Student t-tests were used to compare demographic and surgical information between patients who did and did not perceive a surgical delay. Differences in anxiety and depression scores for patients who did and did not report a delay were assessed using univariate and multivariate regressions.

RESULTS

Twenty-seven percent (N = 33) of patients perceived a surgical delay. Perception of surgical delay was associated with increased time between biopsy and surgery (p = .0001) and increased self-reported anxiety scores after controlling for various demographic and surgical factors (p = .038).

CONCLUSION

Patient-perceived delays in dermatologic surgery are associated with increased time to surgery and patient-reported anxiety.
Statin Treatment Intensity, Discontinuation, and Long-Term Outcome in Patients With Acute Myocardial Infarction and Impaired Kidney Function
Authors: Khedri Masih , Szummer Karolina , Lundman Pia , Jernberg Tomas , Desta Liyew , Lindahl Bertil , Erlinge David , Jacobson Stefan H. , Spaak Jonas
Published: February 2023

Statin dosage in patients with acute myocardial infarction (AMI) and concomitant kidney dysfunction is a clinical dilemma. We studied discontinuation during the first year after an AMI and long-term outcome in patients receiving high versus low–moderate intensity statin treatment, in relation to kidney function. For the intention-to-treat analysis (ITT-A), we included all patients admitted to Swedish coronary care units for a first AMI between 2005 and 2016 that survived in-hospital, had known creatinine, and initiated statin therapy (N = 112,727). High intensity was initiated in 38.7% and low–moderate in 61.3%. In patients with estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, 25% discontinued treatment the first year; however, the discontinuation rate was similar regardless of the statin intensity. After excluding patients who died, changed therapy, or were nonadherent during the first year, 84,705 remained for the on-treatment analysis (OT-A). Patients were followed for 12.6 (median 5.6) years. In patients with eGFR 30–59 mL/min, high-intensity statin was associated with lower risk for the composite death, reinfarction, or stroke both in ITT-A (hazard ratio [HR] 0.93; 95% confidence interval, 0.87–0.99) and OT-A (HR 0.90; 0.83–0.99); the interaction test for OT-A indicated no heterogeneity for the eGFR < 60 mL/min group (P = 0.46). Similar associations were seen for all-cause mortality. We confirm that high-intensity statin treatment is associated with improved long-term outcome after AMI in patients with reduced kidney function. Most patients with reduced kidney function initiated on high-intensity statins are persistent after 1 year and equally persistent as patients initiated on low–moderate intensity.
Subtherapeutic Exposure of Ganciclovir in Children Despite Appropriate Dosing: A Short Communication
Authors: Marfil Sjanene , Märtson Anne-Grete , Toren-Wielema Marlous , Leer-Buter Coretta , Schölvinck Elisabeth H. , Alffenaar Jan-Willem C. , Touw Daan J. , Sturkenboom Marieke G. G.
Published: February 2023

Therapeutic drug monitoring (TDM) results for ganciclovir in 12 different treatment episodes showed large intraindividual and interindividual variabilities in the trough concentration and area under the 24-hour concentration–time curve (AUC24). Despite adequate valganciclovir dosing, subtherapeutic concentrations were found in 30% of the treatment episodes. A decrease in viral load was observed regardless of subtherapeutic exposure. These findings show the need for target concentration evaluation and assessment of the applicability of ganciclovir TDM in children.
Volumetric Absorptive Microsampling to Enhance the Therapeutic Drug Monitoring of Tacrolimus and Mycophenolic Acid: A Systematic Review and Critical Assessment
Authors: Leino Abbie D. , Takyi-Williams John , Pai Manjunath P.
Published: February 2023

Background:

Volumetric absorptive microsampling (VAMS) is an emerging technique that may support multisample collection to enhance therapeutic drug monitoring in solid organ transplantation. This review aimed to assess whether tacrolimus and mycophenolic acid can be reliably assayed using VAMS and to identify knowledge gaps by providing granularity to existing analytical methods and clinical applications.

Methods:

A systematic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, Embase, and Scopus databases were accessed for records from January 2014 to April 2022 to identify scientific reports on the clinical validation of VAMS for monitoring tacrolimus and mycophenolic acid concentrations. Data on the study population, sample sources, analytical methods, and comparison results were compiled.

Results:

Data from 12 studies were collected, including 9 studies pertaining to tacrolimus and 3 studies on the concurrent analysis of tacrolimus and mycophenolic acid. An additional 14 studies that provided information relevant to the secondary objectives (analytical validation and clinical application) were also included. The results of the clinical validation studies generally met the method agreement requirements described by regulatory agencies, but in many cases, it was essential to apply correction factors.

ConclusionsS

Current evidence suggests that the existing analytical methods that use VAMS require additional optimization steps for the analysis of tacrolimus and mycophenolic acid. The recommendations put forth in this review can help guide future studies in achieving the goal of improving the care of transplant recipients by simplifying multisample collection for the dose optimization of these drugs.
Area-Under-Curve–Guided Versus Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-Analysis
Authors: Lim Ashley Shiyuan , Foo Sharlene Hui Wen , Benjamin Seng Jun Jie , Magdeline Ng Tao Tao , Chng Hui Ting , Han Zhe
Published: February 2023

Background:

Conventionally, vancomycin trough levels have been used for therapeutic drug monitoring (TDM). Owing to the increasing evidence of trough levels being poor surrogates of area under the curve (AUC) and the advent of advanced pharmacokinetics software, a paradigm shift has been made toward AUC-guided dosing. This study aims to evaluate the impact of AUC-guided versus trough-guided TDM on vancomycin-associated nephrotoxicity.

Methods:

A systematic review was conducted using PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Google scholar, and Cochrane library databases; articles published from January 01, 2009, to January 01, 2021, were retrieved and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies that evaluated trough-guided or AUC-guided vancomycin TDM and vancomycin-associated nephrotoxicity were included. Random-effects models were used to compare the differences in nephrotoxicity.

Results:

Of the 1191 retrieved studies, 57 were included. Most studies included adults and older adults (n = 47, 82.45%). The pooled prevalence of nephrotoxicity was lower in AUC-guided TDM [6.2%; 95% confidence interval (CI): 2.9%–9.5%] than in trough-guided TDM (17.0%; 95% CI: 14.7%–19.2%). Compared with the trough-guided approach, the AUC-guided approach had a lower risk of nephrotoxicity (odds ratio: 0.53; 95% CI: 0.32–0.89). The risk of nephrotoxicity was unaffected by the AUC derivation method. AUC thresholds correlated with nephrotoxicity only within the first 96 hours of therapy.

Conclusions:

The AUC-guided approach had a lower risk of nephrotoxicity, supporting the updated American Society of Health-System Pharmacists guidelines. Further studies are needed to evaluate the optimal AUC-derivation methods and clinical utility of repeated measurements of the AUC and trough levels of vancomycin.
Impact of COVID-19 on orthopedic surgery residency programs in Algeria: a qualitative study
Authors: Meraghni Nadhir , Derradji Mohamed , Nemmar Rachid , Benkaidali Riad , Boulaioune Soumeya , Kara Zoubir
Published: February 2023

Introduction:

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on the Algerian orthopedic surgery residency programs. Medical education has been negatively impacted. From an educational standpoint, teaching conferences for residents have been suspended. Grand rounds and in-person meetings have also been cancelled to comply with social distancing recommendations.

Objective:

The purpose of this study was to assess the impact of the COVID-19 pandemic on the orthopedic surgery residents’ education, clinical practice, and well-being.

Materials and methods:

An online cross-sectional survey was shared with orthopedic surgery residents of 6 teaching hospitals in Algiers (Algeria).

Results:

We received 58 responses (response rate: 24.57%). Fifty-four percent of the residents have been deployed on COVID-19 screening’ duties. Nearly 97% of the trainees reported that the COVID-19 pandemic had negatively impacted their surgical training. Most participants referred inadequate supply in personal protective equipment and indicated that the orthopedic surgery-training program should include a session about personal protective equipment every year. Among all the subjects, 54 (93%) perceived an increase in stress levels during the COVID-19 crisis and 90% were concerned about transmitting infection to their family members.

Conclusions:

The COVID-19 pandemic has had a significant impact on the Algerian orthopedic surgery residency programs. The changes in the orthopedic activities have negatively impacted the residents’ learning, especially surgical training and affected their well-being. Adapted measures must be taken to face this unprecedented challenge and ensure the continuity of training for our residents.
Association between metabolically obese but normal weight and cardiovascular diseases in Korean menopausal women
Authors: Choi Han-Gyo , Kim Hye-Jin
Published: February 2023

Objective

The aim of this study was to present useful data for developing effective health management strategies for cardiovascular disease (CVD) prevention in postmenopausal women by investigating health-related behaviors and the prevalence of CVD for different types of obesity classified according to metabolic health status and body mass index criteria.

Methods

Using the 2016 Korean National Health and Nutrition Examination Survey VII-1 data, 1,190 menopausal women aged 50 years or older were analyzed in this cross-sectional study. The participants were divided into four groups as follows: metabolically healthy and normal weight (MHNW), metabolically obese but normal weight (MONW), metabolically healthy but obese, and metabolically obese and obese. Complex-samples general linear analysis, t tests, and logistic regression analysis were used to compare the differences in health-related behaviors and the risk of CVD among the four groups.

Results

The risk for stroke was 3.61 times higher (95% CI, 1.18-11.03) in the MONW group than in the MHNW group.

Conclusions

We found a strong association between the MONW group of obesity and the risk for CVD, particularly stroke, in postmenopausal women. These findings would serve as valuable evidence for developing and implementing interventions to prevent stroke in postmenopausal women in the MONW group.
Network analysis of eating disorder symptoms in women in perimenopause and early postmenopause
Authors: Finch Jody E. , Xu Ziqian , Girdler Susan , Baker Jessica H.
Published: February 2023

Objective

Eating disorders (EDs) are often stereotyped as disorders of adolescence and young adulthood; however, they can occur at any age. Prevalence of EDs at midlife are approximately 3.5% and specific symptoms at midlife can have prevalences as high as 29.3%. Studies also inconsistently suggest that EDs and related symptoms may be more prevalent in midlife aged women during perimenopause compared with midlife aged women at pre-menopause. To date few studies have examined the structure of and associations between ED symptoms in women specifically during perimenopause and early postmenopause. Thus, the purpose of the current study is to investigate the structure of ED symptoms specifically during perimenopause and early postmenopause.

Methods

Participants included 36 participants (45-61 y old) in a larger clinical trial who completed the Eating Disorder Examination Questionnaire (EDE-Q) at a baseline study visit. Network analysis statistical models were used to examine the structure of and associations between ED symptoms assessed via the EDE-Q.

Results

Shape dissatisfaction and weight dissatisfaction were the top 2 central symptoms in the network.

Conclusions

Results corroborate previous studies and indicate that, similar to young adult samples, dissatisfaction with body image is a core feature of ED pathology across the lifespan.
Symptom monitoring improves physical and emotional outcomes during menopause: a randomized controlled trial
Authors: Andrews Robin A. F. , John Bev , Lancastle Deborah
Published: February 2023

Objectives:
A recent systematic review suggested that symptom monitoring can result in reductions in menopausal symptoms and improvements in health-related behaviors. To date, no studies have experimentally investigated whether symptom monitoring could be a beneficial intervention during the menopause transition.

Methods:
One hundred perimenopausal and postmenopausal women (mean age, 46 y; SD, 8 y) were randomized into either a monitoring-intervention or control group. A mixed between/within design was used, with group membership (ie, monitoring-intervention or control) as the between-subjects component and time (ie, baseline and 2-wk follow-up) as the within-subjects component. Dependent variables included symptom reductions and emotional reactions as measured via the Daily Record Keeping form. Secondary outcomes included help-seeking, communication, medical decision making, health awareness, self-efficacy, and health anxiety.

Results:
A linear mixed-effects model demonstrated that the monitoring-intervention group reported a 42% reduction in physical symptoms at follow-up versus a 12% reduction in the control group: ρ = 0.009, β = 6.3, 95% CI (1.5-11). Negative emotions also significantly reduced in the monitoring-intervention group but did not alter in the control group: ρ < 0.001, β = 3.4, and 95% CI (1.6-5.2). These effects remained significant after controlling for potential moderator variables such as trait neuroticism and coping preferences and potential confounders such as medical and demographic characteristics. Variances in other health outcomes were nonsignificant.

Conclusions:
Findings demonstrated that symptom monitoring reduced symptoms and negative emotions within a perimenopausal and postmenopausal sample, and these outcomes endured after controlling for key moderators and covariates. However, symptom monitoring was not related to improvements in health-related behavioral outcomes, which contrasts with previous findings. These findings show that symptom monitoring may be useful within healthcare settings by providing perimenopausal and postmenopausal women with a simple and accessible means of symptom alleviation while they await treatment or medical consultation.
The Women's Health Initiative randomized trials of menopausal hormone therapy and breast cancer: findings in context
Authors: Chlebowski Rowan T. , Aragaki Aaron K.
Published: February 2023

Importance and Objective

The menopausal hormone therapy (MHT) association with breast cancer has been controversial for more than 40 years. Most recently, findings from cohort studies have been discordant compared with those from the Women's Health Initiative (WHI) randomized trials. In cohort studies, both estrogen therapy and estrogen plus progestin were associated with higher breast cancer incidence. In contrast, in the WHI randomized trials, findings for estrogen plus progestin are concordant with cohort study reports, whereas estrogen therapy significantly reduced breast cancer incidence. In addition, concerns have been raised regarding the WHI findings from both trials. In this report, we briefly summarize findings for MHT on breast cancer from cohort studies and the WHI randomized trials. The report focus is addressing, point-by-point, concerns raised regarding the WHI findings.

Methods

For cohort studies, we relied on the latest findings from (1) the meta-analysis of the Collaborative Group on Hormonal Factors in Breast Cancer and (2) the Million Women's Study. To identify commentaries and editorials, “Menopause” and “Climacteric” were searched from 2002 to present; PubMed and Google Scholar were searched for commentaries, editorials, and breast cancer, MHT, estrogen, conjugated equine estrogen, estradiol, “hormone replacement therapy,” and “HRT.”

Discussion and Conclusions

Thirty commentaries challenging WHI findings were identified. All were reviewed, and issues needing response were identified. Findings from the meta-analysis from the Collaborative Group on Hormonal Factors in Breast Cancer and the Million Women Study were summarized and compared with finding in the two WHI randomized trials evaluating estrogen therapy and estrogen plus progestin. Based on the randomized clinical trials, estrogen therapy, for women with prior hysterectomy, decreases breast cancer incidence and mortality. In contrast, estrogen plus progestin increases breast cancer incidence, which persists through two decades. Women considering estrogen plus progestin use for vasomotor symptoms should understand the breast cancer risk.
Multilevel analysis of factors predicting pregnancy loss experiences among pregnant women in Ghana: a further analysis of nationally representative data
Authors: Klu Desmond
Published: February 2023

Background:

Pregnancy loss experiences due to stillbirths, miscarriages, and abortion among women have a negative effect on maternal health, leading to maternal mortality and strain on the health system. This study, therefore, seeks to examine the individual, proximate, and household factors associated with pregnancy loss experiences among ever pregnant women in Ghana.

Methods:

Data for this study were obtained from the 2014 Ghana Demographic and Health Survey (GDHS) conducted between early September and mid-December 2014. The weighted sample comprised 2321 ever pregnant women aged 15–49 years. Data were analyzed with SPSS version 25 using both descriptive and multilevel logistic regression modelling.

Results:

The study found that 48% of ever pregnant women have experienced pregnancy loss in Ghana. The multilevel regression analysis shows that ever pregnant women aged 25–34 years and 35–49 years had a higher likelihood of losing pregnancy. Pregnant women with secondary/higher education were less likely to lose their pregnancy. pregnant women who reside in urban areas has lower odds of pregnancy loss. Ever pregnant women who were currently married and those who were formerly married were more likely to experience pregnancy loss than never married women. Ever pregnant women who had access to an improved source of drinking water had a higher probability of losing their pregnancy. Interestingly, ever pregnant women who attended antenatal care services 1–3 times and 4 or more times were more likely to experience pregnancy loss.

Conclusion:

Individual, household, and proximate factors, such as pregnant women’s age, educational level, place of residence, religion, marital status, occupational type, household source of drinking water, and a number of antenatal visits, are strong significant predictors of pregnancy loss experiences among pregnant women in Ghana. These factors should be considered in strengthening existing programs and developing new interventions to decrease pregnancy loss and ensure safe motherhood.
Health football beats them all: subgroup analysis of the 3F (Fit&Fun with Football) study on white coat hypertension, sustained hypertension, dippers, nondippers, and on pharmacologically un(treated) arterial hypertension
Authors: Schrader Bastian , Conradi Charis , Lüders Stephan , Vaske Bernhardt , Koziolek Martin , Gehlenborg Eugen , Haller Hermann , Elsässer Albrecht , Schrader Joachim
Published: February 2023

Background:

The 3F study (Fit&Fun with Football) demonstrated a significant reduction in blood pressure, antihypertensive medication, body weight, stress and depression through health football. Health football could be a popular tool to unleash the full preventive potential of physical activity. This work analyses the effect of health football on hypertensive subgroups dipper, nondipper, white coat hypertension (WCH), sustained hypertension, (un)treated hypertensive patients (UH, TH).

Methods:

A prospective interventional study with 1-year follow-up. Football group (FG): n = 103, ‘health’-football training (1×/week, 90 min) led by licensed football coaches. Physical inactive, hypertensive patients older than 45 years were compared with a control group (CG) (n = 105). Subgroups were divided by ambulatory blood pressure monitoring (ABPM), casual blood pressure (CBP), medication schedule and compared by blood pressure (BP), laboratory results and weight.

Results:

In all three subgroups (WCH vs. sustained hypertension, TH vs. UH, D vs. ND), health football reduced BP and weight significantly compared with the CG, and compared with the admission. An even greater effect in CBP was found in people with WCH than in sustained hypertension (FG: WCH: 141–127 mmHg, sustained Hypertension (SH): 142–132 mmHg; CG: WCH: 141–143 mmHg, SH: 140–141 mmHg). In contrast, the significant reduction in CBP and ABPM was comparable in treated and untreated patients, although antihypertensive drugs were reduced significantly more frequently in FG than in CG. BP reduction in nondippers and dippers was also comparable. In the nondipper group, nocturnal BP was significantly reduced in the FB (122.0–111.5 mmHg), but not in the CG or the dippers.

Conclusion:

All evaluated football subgroups achieved a significant BP reduction (compared with CG). This applied to dipper, nondipper, (un)treated hypertension, WCH and SH. All mentioned subgroups displayed a clear benefit. The even greater reduction in BP in WCH demonstrates the importance of physical activity before the additional prescription of antihypertensive medications, underscoring the recommendations of the ESC and ISH in WCH.
Temporal Variation in Indoor Radon Concentrations Using Environmental Public Health Tracking Data
Authors: Manono Fotso Kamgang Sidoine Lafleur , Monti Michele M. , Salame-Alfie Adela
Published: February 2023

Indoor radon is the second leading cause of lung cancer in the United States (US) after smoking and the number one for lung cancer in non-smokers. Understanding how indoor radon varies during the year reveals the best time to test to avoid underestimating exposure. This study looks at the temporal variation in 13 years of radon concentrations in buildings located in 46 US states and the District of Columbia (DC). In the dataset, radon concentration varies from 3.7 Bq m−3 (Becquerels per cubic meter) to 52,958.1 Bq m−3, with an overall mean of 181.4 Bq m−3. About 35.4% of tests have a radon concentration level equal to or greater than the US Environmental Protection Agency (US EPA) action level 4.0 pCi L−1 (148 Bq m−3).
3
Temporal variation in radon concentrations was assessed using the overall monthly mean radon concentration. The highest concentrations were found in January (203.8 Bq m−3) and the lowest in July (129.5 Bq m−3). Higher monthly mean indoor radon concentrations were found in January, February, and October, and lower in July, August, and June. This result is consistent with findings from other studies and suggests continuing to encourage radon testing throughout the year with an emphasis on testing during the colder months.
Pregnancy, Fetal, and Neonatal Outcomes Among Women With Traumatic Brain Injury
Authors: Adams Rachel Sayko , Akobirshoev Ilhom , Brenner Lisa A. , Katon Jodie G. , Mitra Monika
Published: February 2023

Objective:

There have been no systematic studies of pregnancy outcomes among women with traumatic brain injury (TBI), potentially limiting informed clinical care for women with such injuries. The purpose of this exploratory study was to evaluate pregnancy and fetal/neonatal outcomes among women with a TBI diagnosis recorded during their delivery hospitalization compared with women without TBI.

Setting:

In this cross-sectional study, we identified women with delivery hospitalizations using 2004-2014 data from the Nationwide Inpatient Sample of the Health Care and Cost Utilization Project.

Participants:

We identified deliveries to women with a TBI diagnosis on hospital discharge records, which included all diagnoses recorded during the delivery, and compared them with deliveries of women without a TBI diagnosis.

Main Measures:

Pregnancy outcomes included gestational diabetes; preeclampsia/eclampsia; placental abruption; cesarean delivery; and others. Fetal/neonatal outcomes included preterm birth; stillbirth; and small or large gestational age.

Design:

We modeled risk for each outcome among deliveries to women with TBI compared with women without TBI, using multivariate Poisson regression. Models included sociodemographic and hospital characteristics; secondary models added clinical characteristics (eg, psychiatric disorders) that may be influenced by TBI.

Results:

We identified 3 597 deliveries to women with a TBI diagnosis and 9 106 312 deliveries to women without TBI. Women with TBI were at an increased risk for placental abruption (relative risk [RR] = 2.73; 95% CI, 2.26-3.30) and associated sequelae (ie, antepartum hemorrhage, cesarean delivery). Women with TBI were at an increased risk for stillbirth (RR = 2.55; 95% CI, 1.97-3.29) and having a baby large for gestational age (RR = 1.30; 95% CI, 1.09-1.56). Findings persisted after controlling for clinical characteristics.

Conclusions:

Risk for adverse pregnancy outcomes, including placental abruption and stillbirth, were increased among women with TBI. Future research is needed to examine the association between TBI and pregnancy outcomes using longitudinal and prospective data and to investigate potential mechanisms that may heighten risk for adverse outcomes.
US Military Healthcare Professionals' Practice, Knowledge, and Misconceptions About Concussion
Authors: Baxi Sangita , Cabreros Irineo , Meredith Lisa S. , Holliday Stephanie Brooks , Martinez Jose , Piquado Tepring
Published: February 2023

Objective:

To determine the US military healthcare professionals' knowledge and training preferences to improve diagnosis and management of concussion sustained in nondeployed settings.

Participants:

US military healthcare professionals (physicians, physician assistants, and nurse practitioners) completed online surveys to investigate practices, knowledge, and attitudes about concussion diagnosis and treatment, as well as preferences on future training. There were 744 responses from active duty US military healthcare providers, all of whom had cared for at least one patient with mild traumatic brain injury (mTBI) in the previous 24 months.

Results:

The majority of physicians reported they were confident in their ability to evaluate a patient for a new mTBI (82.1%) and order appropriate imaging for mTBI (78.3%). Accuracy of identifying “red flag” symptoms ranged between 28.2% and 92.6%. A Likert scale from 1 (“not at all confident”) to 4 (“very confident”) was used to assess providers' confidence in their ability to perform services for patients with mTBI. With respect to barriers to optimal patient care, nurse practitioners consistently reported highest levels of barriers (90.8%).

Conclusions:

Although US military providers regularly care for patients with concussion, many report experiencing barriers to providing care, low confidence in basic skills, and inadequate training to diagnose and manage these patients. Customized provider education based on branch of service and occupation, and broader dissemination and utilization of decision support tools or practice guidelines, and patient information tool kits could help improve concussion care.
Examining the Relationship Between Sleep Apnea Diagnosis and Suicide Risk in Veterans With Traumatic Brain Injury: A VA TBI Model Systems Study
Authors: Silva Marc A. , Gonzalez Alexandria V. , Tang Xinyu , Carnahan Nicolette D. , Klyce Daniel W. , Liou-Johnson Victoria , Martin Aaron M. , Moberg Jordan M. , Dreer Laura E.
Published: February 2023

Objective:

Obstructive sleep apnea (OSA) is a common sleep disorder in people with traumatic brain injury (TBI). Although sleep disturbances have been associated with an increased risk of suicide compared with the general population, the relationship between OSA and suicide risk after TBI is not well documented. In this study, we hypothesized that OSA diagnosis would predict suicide risk in veterans with TBI.

Setting:

Five Veterans Affairs (VA) Polytrauma Rehabilitation Centers.

Participants:

Participants were drawn from the VA TBI Model Systems study, with follow-up interviews at year 1 (n = 392), year 2 (n = 444), year 5 (n = 498), or year 10 (n = 252) post-TBI (7.8%-14.5% follow-up attrition).

Design:

This was a retrospective analysis from observational data using logistic regression with repeated measurements. Suicide ideation and suicide attempts were examined as outcomes at each follow-up to evaluate the relationship between OSA and suicide risk after adjusting for other risk factors determined a priori via literature review.

Main Measures:

Suicidal ideation (Patient Health Questionnaire-9 item 9), suicide attempt during the past year (self-reported), and OSA diagnosis (self-reported).

Results:

Contrary to study hypotheses, OSA diagnosis had no statistically significant association with suicide ideation or attempt after accounting for known predictors. However, greater depression symptoms, headache severity, and pre-TBI suicidal ideation and attempts predicted suicide risk at follow-up after accounting for other predictors.

Conclusions:

Results of this study did not support a relationship between OSA and suicide risk, possibly due to methodological limitations of OSA measurement. Future research on this topic should include objective measures of OSA severity and OSA treatment including adherence. Although suicide is a low base rate occurrence, the impact is disastrous and further research is needed to mitigate suicide risk.
LONG-TERM ANALYSIS OF INTRASCLERAL FIXATION OF INTRAOCULAR LENS
Authors: Byun Zeeyoon , Kim Dong IK , Kong Mingui
Published: February 2023

Purpose:

To compare the long-term outcomes of sutureless intrascleral fixation of the intraocular lens versus sutured scleral fixation.

Methods:

The authors retrospectively analyzed the medical records of patients who underwent intrascleral fixation of the intraocular lens using two different techniques: trocar–cannula–based sutureless fixation and sutured scleral fixation. Clinical outcomes were compared before and 1-, 3-, 6-, and 12-month follow-ups after the operation.

Results:

A total of 51 patients were followed over a 12-month period after the operation, including 28 eyes in the sutureless group and 23 eyes in the sutured group. Best-corrected visual acuity and spherical equivalent values reached targeted values faster in the sutureless scleral fixation of the intraocular lens. However, no significant difference was observed between the two groups. For intraocular lens capture, there was a statistically significant difference observed in the incidence of postoperative complications, which was demonstrated by one eye in the sutureless group and seven in the sutured group (P= 0.009). To exclude the effect of corneal astigmatism, surgically induced astigmatism was calculated based on the astigmatism value 1 year after surgery. It was found that the sutureless technique significantly reduced the occurrence of astigmatism (2.43 ± 1.42 vs. 1.65 ± 0.94,P= 0.031).

Conclusion:

In a 1-year follow-up period, the trocar–cannula–based sutureless technique was reliable and effective. Sutureless fixation was associated with fewer postoperative complications and lower surgically induced astigmatism values than those with sutured fixation.
COMPLEX HEMODYNAMICS OF INTERVORTEX VEIN ANASTOMOSES IN HIGHLY MYOPIC EYES
Authors: Lu Hongshuang , Xie Shiqi , Xiong Jianping , Chen Changyu , Wang Yining , Moriyama Muka , Kamoi Koju , Uramoto Kengo , Ohno-Matsui Kyoko
Published: February 2023

Purpose:

To analyze the complex pattern of filling of the intervortex vein (IVV) anastomoses through large trunks in highly myopic eyes based on indocyanine green angiographic (ICGA) videos.

Methods:

The medical records of 1,060 consecutive highly myopic eyes that had undergone ICGA were studied. IVV anastomoses were identified in the ICGA images, and the ICGA images and videos were analyzed comprehensively to characterize their hemodynamic features.

Results:

Seven eyes with IVV anastomoses through large trunks were analyzed. In the ICGA videos of six eyes, laminar flow was observed in the IVV anastomotic vessels. The laminar flow started in the arterial phase in two eyes, with pulsatile fashion in 1 of them. The flow began in the early arteriovenous transition phase in four eyes. The laminar flow continued for a mean of 12.17 ± 3.06 seconds, and the remaining section was gradually filled slower than the surrounding veins. The anastomotic trunk for the remaining one eye was too narrow to be analyzed. Four eyes had longitudinal ICGA records, and two had significant attenuation and narrowing of the anastomotic vessels.

Conclusion:

The very early filling of part of the IVV anastomoses suggests that arteriovenous anastomoses are involved in the IVV of highly myopic eyes. However, this suggestion needs further study. There may be similar pathogenesis for IVV anastomoses either in thick or thin sclera.
Evaluation of Corneal Parameters and Meibomian Gland Alterations After Corneal Cross-Linking in Patients With Progressive Keratoconus
Authors: Balıkçı Ayşe Tüfekçi , Ulutaş Hafize Gökben
Published: February 2023

Objectives:

The aim of the study was to evaluate the changes in corneal parameters and meibomian gland alterations after corneal cross-linking (CXL) for progressive keratoconus.

Methods:

Thirty nine eyes of 39 keratoconus patients were treated with CXL. Corneal topography, specular microscopy, the Ocular Surface Disease Index© (OSDI), noninvasive tear break-up time (NITBUT), and meibography indices were evaluated preoperatively and at the first, third, and sixth months after CXL.

Results:

The flattest keratometry (K1) (P=0.003), steepest keratometry (K2) (P<0.001), apex, central, and thinnest corneal thicknesses (P<0.001) showed significant differences after cross-linking, whereas the changes in the maximum keratometry (Kmax) were not significant (P=0.140). The endothelial cell density, coefficient of variation, and hexagonality were unchanged. The NITBUT values decreased after cross-linking; however, there was no significant change in OSDI index (P=0.313), meiboscore (P=0.392), and meibomian gland loss degrees (P=0.300). No change was detected in the morphology of the meibomian glands after CXL.

Conclusion:

In eyes with keratoconus, a flattening in keratometry readings and thinning in corneal thickness were observed after CXL. The corneal endothelium is protected by dextran-free riboflavin. Cross-linking procedure causes dry eye by changing the corneal structure without affecting the morphology of the meibomian glands.
Pediatric Phlyctenular Keratoconjunctivitis at a Tertiary Care Center in the United States
Authors: Kaufman Aaron R. , Chhadva Priyanka , Bontu Sneha , Bueno Carmen S. , Jain Sandeep , Tu Elmer Y. , D'Jalilian Ali R. , Sugar Joel , Cortina Maria Soledad
Published: February 2023

Purpose:

The aim of this study was to evaluate characteristics and outcomes of pediatric phlyctenulosis at a tertiary care center in the United States.

Methods:

A retrospective cohort study of phlyctenulosis diagnosis in patients younger than 18 years was conducted. Demographics, presenting features, treatment regimens, and outcomes were analyzed.

Results:

Seventy patients (95 eyes) with phlyctenulosis were identified. Fifty-four patients (77.1%) were Hispanic, which was greater than the center's proportion of pediatric patients identifying as Hispanic (53.8%, P < 0.0001). Common comorbidities included adjacent external/lid disease (82.9%), allergic/atopic disease (18.6%), and viral infections (8.6%). Nine patients had tuberculosis testing which was negative in all cases. Five patients had vitamin A testing which revealed deficiency in 1 patient. Treatment regimens were diverse and included varying combinations of topical and systemic medications. Complications included corneal scarring (27.4%), corneal neovascularization (40.0%), amblyopia (16.8%), corneal perforation (3.2%), and severe limbal stem-cell deficiency (1.1%). 26.3% of affected eyes had final visual acuity worse than 20/40. Differences in rates of corneal complications between Hispanic and non-Hispanic patients were not statistically significant, although severe corneal complications including perforation occurred only in the Hispanic group.

Conclusions:

This study presents a modern cohort of phlyctenulosis at a tertiary center in the United States and includes a larger proportion of Hispanic patients than expected. Phlyctenulosis carries high corneal morbidity and may frequently result in reduced visual acuity. Similar rates of corneal complications were seen in Hispanic versus non-Hispanic patients, but severe corneal complications were seen only in the Hispanic group.
Mini-Conjunctival Limbal Autograft (Mini-CLAU) Using Platelet-Rich Plasma Eye Drops (E-PRP): A Case Series
Authors: Baradaran-Rafii Alireza , Heidari-Keshel Saeed , Behnaz Nazanin , Alemzadeh-Ansari Mohammadhasan , Feizi Sepehr , Hassanpour Kiana , Sadoughi Mohammad-Mehdi , Filutowski Oliver , Ghahari Mohammadreza
Published: February 2023

Purpose:

The purpose of this study was to introduce a new method of limbal stem cell transplantation using autologous platelet-rich plasma (E-PRP) eye drops for unilateral total limbal stem cell deficiency.

Methods:

Patients with total unilateral limbal stem cell deficiency due to chemical burn underwent mini-conjunctival limbal autograft using autologous E-PRP drops. One small limbal block, measuring 2 × 2 mm, was harvested from the patients' contralateral healthy eye and transplanted to the diseased eye. All patients received E-PRP drops until achieving complete corneal epithelialization. Subsequent corneal transplantation was performed in eyes with significant stromal opacification. Corneal buttons obtained during corneal transplantation underwent immunohistochemistry for the evaluation of limbal stem cell markers (ABCG2 and P63). Visual acuity, epithelial healing, corneal clarity, and regression of corneal conjunctivalization/vascularization were evaluated after surgery.

Results:

Ten patients with acid (n = 7) or alkali (n = 3) burn were included. The mean follow-up period was 21.7 ± 5.8 months (range, 12–32 months). Corneas were completely reepithelialized within 14.9 ± 3.5 days (range, 11–21 days). Corneal conjunctivalization/vascularization dramatically regressed 1 to 2 months after surgery in all cases, and corneal clarity considerably improved in 7 patients. In the 3 eyes with significant stromal opacification, subsequent optical penetrating keratoplasty was performed. The ocular surface was stable throughout the follow-up period in all eyes. BSCVA improved to 0.60 ± 0.0.32 and 0.46 ± 0.0.25 logMAR in eyes with and without corneal transplantation, respectively, at the final follow-up visit. ABCG2 and P63 markers were detected on corneal buttons after keratoplasty.

Conclusions:

Based on our clinical and laboratory findings, mini-conjunctival limbal autograft using E-PRP can be considered as a promising alternative to ocular surface reconstruction.
Cross-Linking Improves the Quality of Life of People With Keratoconus: A Cross-Sectional and Longitudinal Study From the Save Sight Keratoconus Registry
Authors: Kandel Himal , Chen Jern Yee , Sahebjada Srujana , Chong Elaine W. , Wiffen Steven , Watson Stephanie L.
Published: February 2023

Purpose:

The purpose of this study was to comprehensively evaluate the patient-reported quality-of-life (QoL) outcomes after corneal cross-linking for keratoconus.

Methods:

This Save Sight Keratoconus Registry study used cross-sectional and longitudinal designs. For the cross-sectional study, 532 patients with keratoconus (mean age 30.9 ± 11.9 years; 31.6% female) completed the Keratoconus Outcomes Research Questionnaire (KORQ) and 343 patients with keratoconus (mean age 28.3 ± 10.7 years; 32.7% female) completed the Impact of Vision Impairment (IVI) questionnaires. Similarly, for the longitudinal study, 39 patients (mean age 24.2 ± 8.4 years; 23.1% female) completed the KORQ and 16 patients (mean age 27.9 ± 17.1 years; 50.0% female) completed the IVI questionnaire before and after 6 months of cross-linking. The QoL data were analyzed using the Andrich Rating Scale Model of Rasch analysis.

Results:

For both cross-sectional and longitudinal studies, the KORQ and IVI scales demonstrated satisfactory psychometric properties [ordered and well-spaced categories, variance explained by the measure 52%–73%, person separation index 2.4–3.9, and fit statistics <1.3 (most cases)]. The patients who had not undergone corneal cross-linking had worse mean activity limitation than those with cross-linking (P = 0.008). However, the differences in symptoms and emotional scores between the groups were not statistically significant (both P > 0.05). The longitudinal study showed that cross-linking was associated with improved activity limitation, symptoms, and emotional scores.

Conclusions:

The KORQ and IVI are psychometrically robust tools to evaluate the QoL outcomes of corneal cross-linking. Cross-linking is associated with improved activity limitation, symptoms, and emotional status.
Incidence, Clinical Profile, and Management of Keratitis Caused by Uncommon Species of Pseudomonas at a Tertiary Eye Care Center
Authors: Thamizhselvi Sinouvassane , Pooja Andhare , Prajna Lalitha , Rameshkumar Gunasekaran , Prajna Numperumalsamy Venkatesh , Karpagam Rajarathinam
Published: February 2023

Purpose:

The purpose of this study was to study the incidence, demographic features, clinical course, profiling, and management of uncommon species of Pseudomonas keratitis (other than Pseudomonas aeruginosa) at a tertiary eye care center.

Methods:

Thirty cases of culture-proven uncommon species of Pseudomonas keratitis between January 2017 and December 2021 were retrospectively studied. The incidence, demographic and clinical profile, predisposing factors, microbial results, treatment, and visual outcomes were analyzed. We evaluated the risk factors for poor treatment outcomes.

Results:

Among bacterial keratitis cases, uncommon species of Pseudomonas keratitis occurred at a rate of 2.2%. The mean age at presentation was 51.37 years, and the most common predisposing factor was corneal trauma (36.7%). The mean best corrected visual acuity (BCVA) [in log of minimum angle of resolution (logMAR)] at presentation was 1.99, and the mean ulcer size was 5.75 mm. On culture, 56.7% of the cases were identified as Pseudomonas putida, 26.7% as Pseudomonas stutzeri, 10% as Pseudomonas mendocina, and 3.3% each of Pseudomonas oryzihabitans and Pseudomonas alcaligenes. We recorded good treatment responses in 66.7% of cases with the medical therapy of a combination of broad-spectrum antibiotics, whereas 33.3% of cases required surgical intervention. The risk factors for poor clinical outcome were older age, ocular trauma, previous ocular surgeries, poor BCVA at presentation, large ulcer size, delayed treatment, hypopyon, and early complications such as perforation, limbal involvement, and total ulcer.

Conclusions:

Uncommon species of pseudomonas keratitis was more closely related to predisposing factors such as corneal trauma and other factors such as previous ocular surgeries, older age, large ulcers, longer duration of treatment, early surgical intervention in complicated cases, and poor visual outcome.