bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of transfusion in adults undergoing elective posterior thoracolumbar spinal fusion: a retrospective case series
Authors: AlSaleh Khalid , Aldawsari Khalifah , Alsultan Omar , Awwad Waleed , Alrehaili Osama
Published: November 2020

Background:

Posterior thoracolumbar spinal fusion surgery can be associated with significant blood loss. The purpose of this study was to investigate suspected risk factors of blood transfusion in posterior thoracolumbar fusion patients and determine if blood transfusion had a negative impact on the outcomes for those patients after surgery.

Methods:

All adults undergoing posterior thoracolumbar spine fusion in our institution from May 2015 to May 2018 were included. Data collected included demographic data as well as body mass index (BMI), preoperative hemoglobin, American Society of Anesthesiologists (ASA) classification, change in hemoglobin, estimated blood loss, incidence of blood transfusion, number of units transfused, number of levels fused, length of stay, and readmission within 30 days. The data were analyzed to correlate these variables with the frequency of blood transfusion and to assess the association of adverse outcomes after blood transfusion.

Results:

This study included 125 patients. Six patients (4.8%) required readmission within the first 30 days after discharge. Length of stay averaged 8.4 days (range 3 to 74). Eighteen patients (14.4%) required blood transfusion perioperatively. When multiple variables were analyzed for any correlations, the number of levels fused, age, and BMI had statistically significant correlations with the need for blood transfusion (P<0.005). None of the other factors showed any statistically significant correlation. Patients who required blood transfusion were more likely to stay in the hospital more than 7 days (P<0.005).

Conclusions:

Patients undergoing posterior thoracolumbar fusion are more likely to require blood transfusion if they are older, have a higher BMI, or have a multilevel fusion. Receiving a blood transfusion is associated with increased complication rates.

Level of Evidence:

Level IV.
Prosthetic joint infection in culture-negative and alpha-defensin-positive patients versus culture-positive and alpha-defensin-negative patients: a retrospective cohort study of the differences in clinical characteristics and outcomes
Authors: Vajapey Sravya P. , Li Daniel , Lynch Daniel , Li Mengnai
Published: November 2020

Background:

Culture-negative (CN) prosthetic joint infection (PJI) poses a challenge for the clinician for both diagnosis and management. We compared the clinical presentation and outcomes between patients with CN alpha-defensin-positive PJI and culture-positive (CP) alpha-defensin-negative PJI.

Methods:

This was a retrospective study of 15 patients who underwent treatment for PJI (four hips and 11 knees) at a tertiary referral center by a single surgeon from 2016 to 2019. Patients were divided into two cohorts based on their culture results: one group had negative cultures but positive alpha-defensin test (n=7) and the other had positive cultures but negative alpha-defensin test (n=8). These two cohorts were compared in terms of clinical presentation, laboratory values, treatment duration, and functional outcome. Statistical analysis was performed on variables of interest.

Results:

Patients in both PJI groups most commonly presented with pain and swelling of the involved joint. There was a greater proportion of CN PJI patients with a history of infection, such as bacteremia or urinary tract infection (UTI) requiring antibiotics, than CP PJI patients (42.9% vs. 0%). There was no statistically significant difference in inflammatory marker elevation for either group. Only 57% of the CN PJI patients underwent surgical debridement versus all CP PJI patients. There were no differences in outcomes at final follow-up between the two groups.

Conclusions:

Prior history of infection requiring antimicrobial therapy is a risk factor for negative cultures. CN PJI is not a negative prognostic indicator and results in outcomes similar to CP PJI.

Level of Evidence:

Level III.
A bloodless technique for correction of equinovarus deformities by Taylor spatial frame: a prospective case series
Authors: Meselhy Mohammed Anter , Adawy Adel H. , Halawa Abdelsamie M.
Published: November 2020

Background:

Rigid ankle and foot deformities as a sequela of relapsed talipes equinovarus or vascular or neurological disorders are a challenge for orthopedic surgeons. This study introduces a bloodless technique to correct the deformities of the ankle in patients with these disorders using the Taylor Spatial Frame (TSF).

Methods:

Eighteen feet in 18 patients with equinovarus deformities were prospectively enrolled in this study. All patients underwent preoperative clinical evaluation that included neurovascular assessment. Deformity components were measured using a goniometer. All patients had gradual correction of the rigid equinovarus ankle and foot by TSF without any soft-tissue or bony procedures. Preoperative and postoperative ankle and foot equinus and varus angles, in association with the American Orthopaedic Foot and Ankle Society (AOFAS) score, were used for assessment of the functional outcome.

Results:

There were 13 male patients (72.2%) and five female patients (27%). The mean age of the patients was 25.89 (range 14 to 43, SD 7.28) years. The right side was affected in 11 patients (61.1%), and left side was affected in seven patients (38.9%). At the final follow-up the average AOFAS ankle hindfoot scores improved from 25.17 (range 12 to 39, SD 9.91) preoperatively to 74.78 (range 48 to 88, SD 15.33) postoperatively, (t=22.13, P<0.001). Fifteen patients (83.3%) were categorized as “good”, and three patients (16.7%) were categorized as “fair”.

Conclusions:

TSF is a safe, effective, and simple method of correcting rigid equinovarus deformities of the ankle without soft-tissue releases or bone osteotomies and is a bloodless technique.

Level of Evidence:

Level IV.
Analysis of National Football League preseason injuries resulting in roster cuts: a retrospective review
Authors: Baker Hayden P. , Volchenko Elan , Rossi David , Dayton Steven R. , Tjong Vehniah K.
Published: November 2020

Background:

The National Football League (NFL) schedule consists of 16 regular season games and four additional preseason games each season. The structure of the NFL preseason allows franchises to evaluate 90 players in four games to determine which 53 should make the final roster. The purpose of this study was to investigate preseason injuries in NFL players and to identify risk factors for being cut from NFL teams after preseason injury.

Methods:

This study was a retrospective review of all injuries suffered by NFL athletes during the 2014 through 2019 NFL preseasons. The data were compiled using publicly available injury reports published on multiple websites.

Results:

We identified 110 injuries during the period of study involving players that were later cut from an NFL team during the preseason. The incidence of a preseason injury before being cut from the team was 1.59 per 1000 athletic exposures. The majority of NFL players who were cut after being injured were undrafted free agents (69 players, 63%). Rookies (38 players, 35%) most commonly were cut after being injured. Most athletes cut from NFL teams after preseason injury did not play another year in the NFL (82 players, 75%). The lower extremity was the most frequently injured body area, accounting for 45% (49 players) of all injuries.

Conclusions:

No prior NFL experience and being undrafted in the NFL draft were two common characteristics identified among athletes that sustained preseason injury and were later cut from the roster.

Level of Evidence:

Level III.
Impact of an Extracorporeal Membrane Oxygenation Intensivist-Led Multidisciplinary Team on Venovenous Extracorporeal Membrane Oxygenation Outcomes
Authors: Goh Ken Junyang , Tan Qiao Li , Tay Chee Kiang , Sewa Duu Wen , Lee Ken Cheah Hooi , Phua Ghee Chee
Published: November 2020

Objectives:

Venovenous extracorporeal membrane oxygenation is increasingly being established as a treatment option for severe acute respiratory failure. We sought to evaluate the impact of a dedicated specialist team-based approach on patient outcomes.

Design:

Retrospective cohort study.

Setting:

Single-center medical ICU in an academic tertiary hospital.

Patients:

Adult patients initiated on venovenous extracorporeal membrane oxygenation for severe acute respiratory failure.

Interventions:

Initiation of an extracorporeal membrane oxygenation intensivist-led multidisciplinary team; critical decisions on extracorporeal membrane oxygenation management were jointly made by a dedicated team of extracorporeal membrane oxygenation intensivists, together with the multidisciplinary team.

Measurements and Main Results:

Eighty-one patients (75%) and 27 patients (35%) were initiated on venovenous extracorporeal membrane oxygenation in the preextracorporeal membrane oxygenation intensivist-led multidisciplinary team (before January 2018) and postextracorporeal membrane oxygenation intensivist-led multidisciplinary team period (after January 2018), respectively. Inhospital (14.8% vs 44.4%, p = 0.006) and ICU mortality (11.1% vs 40.7%, p = 0.005) were significantly lower in the postextracorporeal membrane oxygenation intensivist-led multidisciplinary team period. On multivariate analysis correcting for possible confounding factors (ICU severity and extracorporeal membrane oxygenation-specific mortality prediction scores, body mass index, preextracorporeal membrane oxygenation vasopressor support, preextracorporeal membrane oxygenation cardiac arrest, and days on mechanical ventilation before extracorporeal membrane oxygenation initiation), management by an extracorporeal membrane oxygenation intensivist-led multidisciplinary team remained associated with improved hospital survival (odds ratio, 5.06; 95% CI, 1.20–21.28). Patients in the postextracorporeal membrane oxygenation intensivist-led multidisciplinary team period had less nosocomial infections (18.5% vs 46.9%, p = 0.009), a shorter ICU stay (12 days [interquartile range, 6–16 d] vs 15 days [interquartile range, 10–24 d]; p = 0.049), and none suffered an intracranial hemorrhage or nonhemorrhagic stroke.

Conclusions:

An extracorporeal membrane oxygenation intensivist-led multidisciplinary team approach is associated with improved outcomes in patients initiated on venovenous extracorporeal membrane oxygenation for severe acute respiratory failure.
Predictors of Mortality and Effect of Drug Therapies in Mechanically Ventilated Patients With Coronavirus Disease 2019: A Multicenter Cohort Study
Authors: Lambermont Bernard , Ernst Marie , Demaret Pierre , Boccar Sandrine , Gurdebeke Christine , Cedric Van Brussel , Quinonez Manuel , Dubois Christophe J. J. , Lemineur Thierry , Njambou Thierry , Akando Benoit , Wertz Damien , Higny Julien , Delanaye Pierre , Misset Benoit
Published: November 2020

We conducted a multicenter cohort study to determine the effect of drug therapies on survival in mechanically ventilated patients with coronavirus disease 2019. All consecutive adult patients admitted to ICU for coronavirus disease 2019 from March 1, 2020, to April 25, 2020, and under invasive mechanical ventilation for more than 24 hours were included. Out of 2,003 patients hospitalized for coronavirus disease 2019, 361 were admitted to ICU, 257 were ventilated for more than 24 hours, and 247 were included in the study. Simple and multiple time-dependent Cox regression models were used to assess the effects of factors on survival. Methylprednisolone administration during the first week of mechanical ventilation was associated with a decrease in mortality rate from 48% to 34% (p = 0.01). Mortality was significantly associated with older age, higher creatinine, lower lymphocyte count, and mean arterial pressure lower than 70 mm Hg on the day of admission.
Small interfering RNA targeting of keratin 17 reduces inflammation in imiquimod-induced psoriasis-like dermatitis
Authors: Xiao Chun-Ying , Zhu Zhen-Lai , Zhang Chen , Fu Meng , Qiao Hong-Jiang , Wang Gang , Dang Er-Le
Published: November 2020

Background

Psoriasis is a common chronic inflammatory skin disease with 2% to 3% prevalence worldwide and a heavy social-psychological burden for patients and their families. As the exact pathogenesis of psoriasis is still unknown, the current treatment is far from satisfactory. Thus, there is an urgent need to find a more effective therapy for this disease. Keratin 17 (K17), a type I intermediate filament, is overexpressed in the psoriatic epidermis and plays a critical pathogenic role by stimulating T cells in psoriasis. Therefore, we hypothesized that inhibiting K17 may be a potential therapeutic approach for psoriasis. This study aimed to investigate the therapeutic effect of K17-specific small interfering RNA (siRNA) on mice with imiquimod (IMQ)-induced psoriasis-like dermatitis.

Methods

Eight-week-old female BALB/c mice were administered a 5% IMQ cream on both ears to produce psoriatic dermatitis. On day 3, K17 siRNA was mixed with an emulsion matrix and applied topically to the left ears of the mice after IMQ application every day for 7 days. The right ears of the mice were treated in parallel with negative control (NC) siRNA. Inflammation was evaluated by gross ear thickness, histopathology, the infiltration of inflammatory cells (CD3+ T cells and neutrophils) using immunofluorescence, and the expression of cytokine production using real-time quantitative polymerase chain reaction. The obtained data were statistically evaluated by unpaired t-tests and a one-way analysis of variance.

Results

The severity of IMQ-induced dermatitis on K17 siRNA-treated mice ears was significantly lower than that on NC siRNA-treated mice ears, as evidenced by the alleviated ear inflammation phenotype, including decreased ear thickness, infiltration of inflammatory cells (CD3+ T cells and neutrophils), and inflammatory cytokine/chemokine expression levels (interleukin 17 [IL-17], IL-22, IL-23, C-X-C motif chemokine ligand 1, and C-C motif chemokine ligand 20) (P < 0.05 vs. the Blank or NC siRNA groups). Compared to the NC siRNA treatment, the K17 siRNA treatment resulted in increased K1 and K10 expression, which are characteristic of keratinocyte differentiation (vs. NC siRNA, K17 siRNA1 group: K1, t = 4.782, P = 0.0050; K10, t = 3.365, P = 0.0120; K17 siRNA2 group: K1, t = 4.104, P = 0.0093; K10, t = 4.168, P = 0.0042; siRNA Mix group: K1, t = 3.065, P = 0.0221; K10, t = 10.83, P < 0.0001), and decreased K16 expression, which is characteristic of keratinocyte proliferation (vs. NC siRNA, K17 siRNA1 group: t = 4.156, P = 0.0043; K17 siRNA2 group: t = 2.834, P = 0.0253; siRNA Mix group: t = 2.734, P = 0.0250).

Conclusions

Inhibition of K17 expression by its specific siRNA significantly alleviated inflammation in mice with IMQ-induced psoriasis-like dermatitis. Thus, gene therapy targeting K17 may be a potential treatment approach for psoriasis.
Sleep-related symptoms in multiple system atrophy: determinants and impact on disease severity
Authors: Lin Jun-Yu , Zhang Ling-Yu , Cao Bei , Wei Qian-Qian , Ou Ru-Wei , Hou Yan-Bing , Liu Kun-Cheng , Xu Xin-Ran , Jiang Zheng , Gu Xiao-Jing , Liu Jiao , Shang Hui-Fang
Published: November 2020

Background:

Sleep disorders are common but under-researched symptoms in patients with multiple system atrophy (MSA). We investigated the frequency and factors associated with sleep-related symptoms in patients with MSA and the impact of sleep disturbances on disease severity.

Methods:

This cross-sectional study involved 165 patients with MSA. Three sleep-related symptoms, namely Parkinson's disease (PD)-related sleep problems (PD-SP), excessive daytime sleepiness (EDS), and rapid eye movement sleep behavior disorder (RBD), were evaluated using the PD Sleep Scale-2 (PDSS-2), Epworth Sleepiness Scale (ESS), and RBD Screening Questionnaire (RBDSQ), respectively. Disease severity was evaluated using the Unified MSA Rating Scale (UMSARS).

Results:

The frequency of PD-SP (PDSS-2 score of ≥18), EDS (ESS score of ≥10), and RBD (RBDSQ score of ≥5) in patients with MSA was 18.8%, 27.3%, and 49.7%, respectively. The frequency of coexistence of all three sleep-related symptoms was 7.3%. Compared with the cerebellar subtype of MSA (MSA-C), the parkinsonism subtype of MSA (MSA-P) was associated with a higher frequency of PD-SP and EDS, but not of RBD. Binary logistic regression revealed that the MSA-P subtype, a higher total UMSARS score, and anxiety were associated with PD-SP; that male sex, a higher total UMSARS score, the MSA-P subtype, and fatigue were associated with EDS; and that male sex, a higher total UMSARS score, and autonomic onset were associated with RBD in patients with MSA. Stepwise linear regression showed that the number of sleep-related symptoms (PD-SP, EDS, and RBD), disease duration, depression, fatigue, and total Montreal Cognitive Assessment score were predictors of disease severity in patients with MSA.

Conclusions:

Sleep-related disorders were associated with both MSA subtypes and the severity of disease in patients with MSA, indicating that sleep disorders may reflect the distribution and degree of dopaminergic/non-dopaminergic neuron degeneration in MSA.
Biochemical Pathways and Modeling
Authors: DEANGELIS ANTHONY , DEANGELIS LISA , CATHERINO WILLIAM , ROLLENE NANETTE L.
Published: November 2020

The precise etiology of the biochemical changes and the resulting constellation of symptoms seen in polycystic ovary syndrome (PCOS) has remained a mystery. Despite advances in our knowledge, the pathogenesis and alterations in the biochemical pathways underlying this disease are still not fully understood. PCOS is a multifactorial syndrome where a combination of genetics, lifestyle, and hormone abnormalities all play an intertwining role. This article will provide an in-depth look at the multitude of biochemical pathways that are dysregulated in PCOS and their relation to alterations in female physiology.
WIDEFIELD FLUORESCEIN ANGIOGRAPHY IN THE DIAGNOSIS OF SUSAC SYNDROME
Authors: Turczyńska Monika J. , Krajewski Przemysław , Brydak-Godowska Joanna E.
Published: November 2020

Purpose:

To present the clinical manifestations and results of key diagnostic investigations in patients with Susac syndrome, with special emphasis on the principal role of fluorescein angiography (FA) of the peripheral retina.

Methods:

A retrospective analysis of medical records (collected 2000–2019) of 20 patients (15 women and five men), aged 20 to 51 years (mean age: 31.6 years) with complete or incomplete Susac syndrome diagnosed by an ophthalmic examination and widefield fluorescein angiography (WF-FA) by Spectralis and Optos Tx200.

Results:

Fluorescein angiography abnormalities included vascular changes in the posterior pole in 64.7% and in the peripheral retina in 82.4%. Widefield FA abnormalities in the peripheral retina alone were seen in 35.3% and in the posterior pole, but without peripheral vascular involvement, in 17.6%. Secondary leakage from veins was noted in 58.8%.

Conclusion:

Widefield FA of the peripheral retina has a key role in cases of suspected Susac syndrome as it confirms the diagnosis and assesses disease activity. In addition to the characteristic findings, late-phase FA revealed leakage from veins which is not a typical sign. Patients experiencing migraine headaches may benefit from increasing awareness of neurologists and otologists who more promptly referred patients with suspected Susac syndrome for ophthalmologic evaluation and WF-FA of the peripheral retina.
Comparative Study of Two Infrared Meibographers in Evaporative Dry Eye Versus Nondry Eye Patients
Authors: Garduño Fernando , Salinas Anna , Contreras Katia , Rios Yadira , García Naomi , Quintanilla Patricio , Mendoza Cesar , Garza Leon Manuel
Published: November 2020

Objective:

To compare the measurement of the meibomian gland (MG) dropout between two infrared meibographers in patients with and without dry eye.

Methods:

The right eyelids of each patient were imaged using the Antares and Cobra meibography devices. All images were analyzed using Phoenix software to calculate the percentage of the MG dropout. Lipid layer thickness, eyelid margin characteristics, ocular surface staining, MG secretion, number of expressible glands, and noninvasive tear breakup time were also evaluated. A comparison between nondry eye and evaporative dry eye was performed.

Results:

Eighty participants (mean age, 36.93 years and 51.3% women) were included, of which 67.5% had nondry eye. A significant difference was observed in the dropout percentage of the superior eyelid between the Antares and Cobra devices (P=0.007) for all participants and when only the nondry eye patients were examined. In patients with dry eye, no significant differences were found in the dropout measurements of both eyelids.

Conclusions:

Statistically significant differences in the MG dropout percentage in the upper eyelid of nondry eye patients were obtained from both meibographers. The measurements were similar in patients with dry eye, suggesting that the two instruments can be interchanged.
Repeatability and reproducibility of manifest refraction
Authors: Taneri Suphi , Arba-Mosquera Samuel , Rost Anika , Kießler Saskia , Dick H. Burkhard
Published: November 2020

Purpose:

To evaluate the intraexaminer repeatability and the interobserver reproducibility of manifest refraction.

Setting:

Tertiary referral center.

Design:

Retrospective study.

Methods:

Patients attending at least 2 preoperative refractions before undergoing subsequent refractive surgery were included. All manifest refractions were performed by 1 of 4 experienced optometrists using an automated phoropter according to a standard protocol. The first manifest refraction was performed after obtaining automated refraction and measuring the spectacles of the patient. The second refraction was typically refined from the first also considering wavefront refraction and tomography/topography.

Results:

The latest 2 manifest refractions of 1000 eyes obtained at 2 separate visits showed a mean pairwise absolute difference of 0.16 ± 0.19 diopter (D) (range 0 to 1.38 D) in spherical equivalent (SE). This SD was better than 0.25 D (the minimum measurement increment of refraction itself). The 95% limit of agreement (LoA) was within 0.50 D for sphere, cylinder, and SE. The SD of the astigmatism axis was approximately 10 degrees, and the 95% LoA was within 22 degrees (the difference in axis decreasing significantly with the measured cylinder magnitude). The SD for corrected distance visual acuity (CDVA) was half a Snellen line and the 95% LoA was within 1.5 lines (with increasing deviation with worse vision). There were no clinically meaningful differences in reproducibility (2 optometrists) compared with repeatability (same optometrist) in sphere, axis, and CDVA.

Conclusions:

Reproducibility was 0.16 D irrespective whether refractions were performed by 1 or 2 different optometrists. Obtaining multiple refractions preoperatively might increase the predictability of surgery and decrease the enhancement rate.
Fifteen years of IOL exchange: indications, outcomes, and complications
Authors: Goemaere Jordy , Trigaux Céline , Denissen Laurens , Dragnea Diana , Hua Minh-Tri , Tassignon Marie-José , Dhubhghaill Sorcha Ní
Published: November 2020

Purpose:

To report the indications, frequency, and outcomes regarding intraocular lens (IOL) exchange in 2 university hospital tertiary referral settings over a period of 15 years.

Setting:

Ophthalmology departments of the University Hospital Antwerp and the University Hospital Leuven, Belgium.

Design:

Retrospective cross-sectional study.

Methods:

In this retrospective study, included were patients who underwent an IOL exchange between 2002 and 2017. Patient demographics, surgical indication, comorbidities, visual outcomes, and complications were reported. Patients who underwent IOL repositioning or add-on IOL implantation or extraction, and patients who were left aphakic, were excluded.

Results:

Included in the study were 492 eyes. The mean age was 66.0 ± 13.3 years (range 19–91 years). The mean time between primary surgery and IOL exchange was 54.61 ± 67.07 months (range 0–343 months). Primary indication for explantation was IOL opacification, and the most common ophthalmic comorbidity was a previous history of vitreoretinal surgery. Preoperatively, the mean uncorrected visual acuity (UCVA) and corrected distance visual acuity (CDVA) were 0.47 ± 0.27 (range 0–1) and 0.61 ± 0.32 (range 0–1.2), respectively. Postoperative UCVA and CDVA was 0.7 ± 0.3 (range 0–1.2) and 0.8 ± 0.28 (range 0.05–1.6), respectively. The increase in both CDVA and UCVA was statistically significant (P < .001, paired t test). The most common complication perioperatively was vitreous prolapse, which occurred in 61 eyes (16%).

Conclusions:

IOL exchange is a challenging yet valuable treatment option for a wide spectrum of problematic IOL outcomes. The most common indication remains IOL opacification, although IOL dislocation and patient dissatisfaction are increasing as indications.
Agreement between 2 swept-source OCT biometers and a Scheimpflug partial coherence interferometer
Authors: Tañá-Rivero Pedro , Aguilar-Córcoles Salvador , Tello-Elordi Cristina , Pastor-Pascual Francisco , Montés-Micó Robert
Published: November 2020

Purpose:

To evaluate the agreement between different parameters obtained with 2 swept-source optical coherence tomography (SS-OCT)-based biometers and 1 Scheimpflug camera with partial coherence interferometry (PCI).

Setting:

Single center, Oftalvist, Alicante, Spain.

Design:

Prospective case series.

Methods:

Biometry was performed in 49 eyes using 3 optical biometers: ANTERION SS-OCT, IOLMaster 700 SS-OCT, and Pentacam AXL PCI. Keratometry (K), J0 and J45 vectors, anterior chamber depth (ACD), central corneal thickness (CCT), white-to-white (WTW), lens thickness (LT), and axial length (AL) were measured with each device. Bland-Altman analysis was applied.

Results:

This study comprises 49 eyes of 49 patients. There were no statistically significant differences for K1, K2, J0 and J45 between the 3 devices (P > .9). In contrast, there was a statistically significant difference in the ACD, CCT, WTW, LT, and AL between the biometers (P < .001). Specifically, there was a statistically significant difference between ACD, CCT, and WTW values for all-pairwise comparisons. IOLMaster showed the shortest ACD value and ANTERION showed the largest ACD. IOLMaster showed the highest CCT and Pentacam showed the lowest CCT. IOLMaster showed the largest WTW and Pentacam showed the shortest WTW. The LT measured with IOLMaster was thicker than that measured with ANTERION. There was a statistically significant difference in the AL between IOLMaster and Pentacam, with a shorter AL measured with IOLMaster (P < .001), but no differences were found between ANTERION and IOLMaster (P = .599) and between ANTERION and Pentacam (P = .054).

Conclusions:

Mean differences and the limits of agreement obtained in all-pairwise comparisons of the different parameters should be judged clinically to consider the interchangeability of these devices.
Anterior capsule coverage and rotational stability of an acrylic toric intraocular lens
Authors: Sasaki Koh , Eguchi Shuichiro , Miyata Akira , Nishimura Tomohisa , Miyata Kazunori , Hasegawa Yumi , Oshika Tetsuro
Published: November 2020

Purpose:

To investigate factors related to the rotational stability of an acrylic toric intraocular lens (IOL).

Setting:

Four ophthalmic surgical sites in Japan.

Design:

Prospective case series.

Methods:

The study included 120 eyes of 120 patients undergoing phacoemulsification and implantation of a toric IOL (AcrySof IQ, Alcon Laboratories, Inc.). At 1 hour postoperatively, the area of continuous curvilinear capsulorhexis (CCC) was measured, and the state of anterior capsule coverage on the IOL optic (total on or partial on) was recorded. The toric IOL axis orientation was assessed at the end of surgery and at 1 hour, 1 week, 1 month, and 6 months postoperatively. Multiple regression analysis was performed to explore any clinical factors relevant to IOL rotation from the end of surgery to 6 months postoperatively. The explanatory variables included age, anterior chamber depth preoperatively, axial length, type of corneal astigmatism (with-the-rule, against-the-rule, or oblique astigmatism), area of CCC, state of anterior capsule overlap on IOL optic (total coverage vs partial coverage), and surgical sites (surgeons).

Results:

The multiple regression analysis in 110 eyes of 110 patients indicated that anterior capsule overlap on the IOL optic was the only variable associated with IOL rotation at 6 months postoperatively (P = .0482). The mean absolute rotation at 6 months was 1.96 ± 1.81 degrees in the total on group and 3.79 ± 3.12 degrees in the partial on group (P = .0004).

Conclusions:

Rotational stability of a single-piece, acrylic toric IOL was better in eyes with total anterior capsule coverage than that in those with partial anterior capsule coverage on the IOL optic.
Outcomes of bioptics with small-incision lenticule extraction as a sequential treatment after implantable collamer lens for management of extreme myopia
Authors: Brar Sheetal , Batra Akanksha , Shah Mamta Lakhana , Ganesh Sri
Published: November 2020

Purpose:

To study the safety and efficacy of bioptics using implantable collamer lens (ICL) followed by small-incision lenticule extraction (SMILE) for management of extreme myopia.

Setting:

Nethradhama Superspeciality Eye Hospital, Bangalore, India.

Design:

Retrospective case series.

Methods:

Data were analyzed for patients who underwent bioptics using ICL in the first stage and SMILE in the second stage for correction of the residual refractive error. The mean interval between stage 1 and stage 2 correction was 24.2 ± 13.33 days. The mean follow-up after the SMILE procedure was 12.26 ± 1.39 (range 11 to 14) months.

Results:

Fifteen eyes from 9 patients with mean age 26 ± 4.69 years were included. Preoperatively, the mean SE was −22.89 ± 3.04 diopter (D) (−16.50 to −28.00 D), which decreased to −3.40 ± 1.89 D after ICL and further reduced to −0.48 ± 0.24 D after final correction with SMILE, at the end of the mean follow-up. The mean cylinder reduced from −2.88 ± 1.69 D to −1.93 ± 1.07D post-ICL and to −0.38 ± 0.24 D post-SMILE surgery. The mean corrected distance visual acuity (CDVA) significantly improved from 0.38 ± 0.22 to 0.068 ± 0.09 logMAR after SMILE correction (P = .00). The mean uncorrected distance visual acuity (UDVA) at the end of follow-up was 0.15 ± 0.09 logMAR, with all eyes achieving UDVA of 0.3 logMAR or greater. All eyes had gain in CDVA, with 53% eyes gaining 2 or more lines. No wound-, intraocular pressure–, or ICL-related complications were observed during and after the SMILE surgery. No patient required spectacles, contact lenses, or enhancement for further improvement of vision.

Conclusions:

Bioptics with SMILE after ICL implantation might be a valid option for extremely myopic patients, resulting in significant improvements in visual acuity and high patient satisfaction.
A picture is worth a thousand words: linking fibromyalgia pain widespreadness from digital pain drawings with pain catastrophizing and brain cross-network connectivity
Authors: Ellingsen Dan-Mikael , Beissner Florian , Moher Alsady Tawfik , Lazaridou Asimina , Paschali Myrella , Berry Michael , Isaro Laura , Grahl Arvina , Lee Jeungchan , Wasan Ajay D. , Edwards Robert R. , Napadow Vitaly
Published: November 2020

Pain catastrophizing is prominent in chronic pain conditions such as fibromyalgia and has been proposed to contribute to the development of pain widespreadness. However, the brain mechanisms responsible for this association are unknown. We hypothesized that increased resting salience network (SLN) connectivity to nodes of the default mode network (DMN), representing previously reported pain-linked cross-network enmeshment, would be associated with increased pain catastrophizing and widespreadness across body sites. We applied functional magnetic resonance imaging (fMRI) and digital pain drawings (free-hand drawing over a body outline, analyzed using conventional software for multivoxel fMRI analysis) to investigate precisely quantified measures of pain widespreadness and the associations between pain catastrophizing (Pain Catastrophizing Scale), resting brain network connectivity (Dual-regression Independent Component Analysis, 6-minute multiband accelerated fMRI), and pain widespreadness in fibromyalgia patients (N = 79). Fibromyalgia patients reported pain in multiple body areas (most frequently the spinal region, from the lower back to the neck), with moderately high pain widespreadness (mean ± SD: 26.1 ± 24.1% of total body area), and high pain catastrophizing scale scores (27.0 ± 21.9, scale range: 0-52), which were positively correlated (r = 0.26, P = 0.02). A whole-brain regression analysis focused on SLN connectivity indicated that pain widespreadness was also positively associated with SLN connectivity to the posterior cingulate cortex, a key node of the DMN. Moreover, we found that SLN-posterior cingulate cortex connectivity statistically mediated the association between pain catastrophizing and pain widespreadness (P = 0.01). In conclusion, we identified a putative brain mechanism underpinning the association between greater pain catastrophizing and a larger spatial extent of body pain in fibromyalgia, implicating a role for brain SLN-DMN cross-network enmeshment in mediating this association.
Occupational leg edema—use of compression stockings
Authors: Guedes Pedro M. , Saldanha Nuno A. , Matos Pedro M. , Carvalho Francisco S. , Veiga Graça , Norton Pedro
Published: November 2020

To analyze the use of compression stockings to avoid the formation of occupational edema of the lower limbs in jobs with prolonged orthostatism. We carried out a review of the articles published in PubMed, from the 1st of January 2008 to 31st of December 2018 using the term “Occupational Leg Swelling”. Only articles that met the following criteria were selected: prospective, observational and experimental retrospectives articles written in Portuguese or English. The research resulted in 23 articles. After reading the titles and abstracts and applying the inclusion and exclusion criteria, 5 were selected. Prolonged orthostatism is considered a risk factor for the development of chronic venous disease. The use of compression stockings reduces the occupational edema of the lower limbs. Professionals exposed to prolonged orthostatism during their work activity have a higher risk of developing lower limb edema; Despite few studies demonstrated the effectiveness of wearing compression stockings to prevent occupational edema of the lower limbs, they have showed benefit in reducing edema as well as associated symptoms. The use of compression stockings should therefore be recommended to all professionals at increased risk for occupational edema of the lower limbs.
Reducing Time to Surgery for Hip Fragility Fracture Patients: A Resident Quality Improvement Initiative
Authors: Rubenstein William , Barry Jeffrey , Rogers Stephanie , Grace Trevor R. , Tay Bobby , Ward Derek
Published: November 2020

As part of an institutional quality improvement (QI) initiative for the 2018–2019 academic year, orthopedic residents at our tertiary center were incentivized to bring over 75% of hip fracture patients with American Society of Anesthesiologists (ASA) Class 2 or less to surgery in under 24 hours, compared to the baseline rate of 55.9%. The time between admission and surgery for hip fracture patients with ASA class 2 or less was prospectively recorded. At the end of the study period, a retrospective comparison was performed between patients treated before and after the resident QI initiative. The percentage of patients who underwent surgery within 24 hours of admission increased significantly in the Study Cohort compared to the Baseline Cohort (78.6% vs. 55.9%, p = .037). Length of stay was shorter in the Study Cohort compared to the Baseline Cohort (3 days vs. 4 days, p = .01), whereas readmissions (3.6% vs. 4.4%, p = .85) and discharges to skilled nursing facilities (60.7% vs. 57.4%, p = .76) were comparable between both cohorts. A goal-directed, resident-led QI initiative was associated with a significantly increased percentage of hip fragility fracture patients who underwent surgery in less than 24 hours.
Esophageal Fibrosis in Eosinophilic Gastrointestinal Diseases
Authors: Thaker Ameet I. , Melo Diana Montoya , Samandi Layla Z. , Huang Rong , Park Jason Y. , Cheng Edaire
Published: November 2020

Objectives:

Eosinophilic esophagitis (EoE), the most common eosinophilic gastrointestinal disease (EGID), is associated with lamina propria (LP) fibrosis. The relationship of EoE to other EGIDs is still unclear. We frequently observe cases of concurrent esophageal eosinophilia and extra‐esophageal mucosal eosinophilia. The purpose of this study was to compare clinical, endoscopic, and histologic features, as well as the prevalence of esophageal LP fibrosis in children with EGID and concurrent esophageal eosinophilia to children with EoE. We also examine the current practices of pathologists in evaluating fibrosis.

Methods:

We reviewed esophageal biopsies from index cases of EoE (N = 38), EGID with significant esophageal eosinophilia (≥15 eos/hpf) (EGID‐SEE, N = 38), EGID with mild esophageal eosinophilia (1–14 eos/hpf) (EGID‐MEE, N = 12), and EGID with no esophageal eosinophilia (EGID‐NEE, N = 12) for LP presence, adequacy, and fibrosis.

Results:

EoE and EGID‐SEE cases share similar demographics, esophageal endoscopic features, and symptoms. A majority of EGID‐SEE cases (71%) had adequate LP for the evaluation of fibrosis, similar to EoE cases (87%). The prevalence of esophageal fibrosis in EoE (79%) and EGID‐SEE (55%) cases were similar, whereas no fibrosis was detected in the EGID‐MEE and EGID‐NEE cases. The fibrosis was patchy and often detected in the distal esophagus. Fourteen cases were reclassified from their original clinical diagnosis as having fibrosis by the study pathologists.

Conclusions:

Cases of EGID‐SEE have overlapping features with EoE, suggesting that all EGIDs are part of a disease continuum. A consensus for the evaluation of LP fibrosis is needed.
Fruit Myth or Fact
Authors: McGinnis Margaret J. , Gustashaw Kristin A. R. , Painter James E.
Published: November 2020

The purpose of this article is to address the myth that fresh fruit is nutritionally superior to unsweetened frozen and canned fruits. The results show that fresh fruit and unsweetened frozen and unsweetened canned fruits are similar in nutrient content. Canned, frozen, and fresh fruits retain similar levels of nutrients; therefore, all 3 forms can be used to help consumers reach recommended intakes of fruit. Nutrition professionals may help Americans improve fruit and nutrient intake by encouraging all 3 forms of fruit.
Osseous Metaplasia in Low-grade Ovarian Serous Carcinoma With a BRAF Mutation: A Case Report
Authors: Catteau Xavier , Preat Fanny , D’haene Nicky , Noël Jean-Christophe
Published: November 2020

A 44-yr-old woman presented with lower, painless abdominal discomfort and a vacuolated mass measuring 12 cm on the right-hand side of the pelvis. She subsequently underwent a bilateral salpingo-oophorectomy. An osseous lesion was identified in the left ovary, which was hard in consistency and was associated with a multicystic complex lesion. Microscopic examination of the left ovary showed clusters of serous cells with moderate atypia, surrounded by a desmoplastic stroma with large areas of bone matrix. To the best of our knowledge, this is the first reported case of low-grade serous carcinoma with osseous metaplasia and a BRAF mutation.
National Trends in Pediatric Facial Fractures: The Impact of Health Care Policy
Authors: Jenny Hillary E. , Yesantharao Pooja , Redett Richard J. , Yang Robin
Published: November 2020

Background:

Traumatic injuries are significant sources of morbidity and mortality in the pediatric population. Using a national database, this study aims to characterize pediatric facial fracture management and the effect of health care policy changes on populations receiving treatment.

Methods:

A retrospective cohort study was performed using Healthcare Cost and Utilization Project Kids’ Inpatient Database databases from 2000 to 2016. Pediatric patients admitted with a facial fracture diagnosis were included. Clinical outcomes include mortality, reduction of fracture during hospital stay, and open fracture reduction. The impact of the Affordable Care Act on patient demographics and management was assessed.

Results:

Between 2000 and 2016, 82,414 patients were managed for facial fractures, 8.3 percent of whom were managed after implementation of the Affordable Care Act (n = 6841). Mean age was 15.2 years, and the male-to-female ratio was 2.9:1. Significant racial disparities were identified before the Affordable Care Act: African American and Native American patients had decreased odds of having facial fracture reduction during the initial hospital stay (OR, 0.84 and 0.86, respectively), and identifying as either Hispanic or Native American was associated with higher odds of mortality (OR, 1.4 or 2.4, respectively). Race was not contributory to patient mortality after the Affordable Care Act. Before Affordable Care Act implementation, patients receiving care with no charge (including charity care/charity research) had lower odds of having an open reduction or any reduction; insurance status was not contributory to management after the Affordable Care Act.

Conclusion:

Although the Affordable Care Act may have increased access to care for certain populations, race- and sex-associated differences in mortality rate and fracture management should be further investigated to ensure a national standard of equitable patient care.
Day-of–Free Tissue Transfer Qualitative Cultures Do Not Predict Limb Salvage Outcomes
Authors: Zolper Elizabeth G. , Bekeny Jenna C. , Ormiston Laurel D. , Walters Elliot T. , Fortman Emilie , Kotha Vikas S. , Fan Kenneth L. , Evans Karen K.
Published: November 2020

Background:

Successful free tissue transfer is critical for lower extremity salvage in the chronic wound population. The rates of lower extremity free tissue transfer success lag behind those for other anatomical sites. The aim of this study was to evaluate whether positive qualitative day-of–free tissue transfer cultures or pathogen virulence negatively impacts short- and long-term outcomes of lower extremity free tissue transfer.

Methods:

Between April of 2011 and January of 2018, 105 lower extremity free tissue transfer procedures were performed. Growth level and speciation were identified from qualitative cultures taken during free tissue transfer. The relationship between demographics, comorbidities, culture data, postoperative infection, free tissue transfer survival, and long-term limb salvage was examined using logistic regression.

Results:

The median Charlson Comorbidity Index was 3. Intraoperative free tissue transfer cultures were positive in 39.1 percent. Flap survival was 93.3 percent. Postoperative infection developed in 12.4 percent. The limb salvage rate was 81.0 percent. Positive culture was not significant for flap survival, postoperative infection, or amputation. Cultures positive for Enterococcus species had a significant relationship with flap success (OR, 0.08; p = 0.01) and amputation (OR, 7.32; p = 0.04). Insufficient antimicrobial coverage had a significant relationship with postoperative infection (OR, 6.56; p = 0.01) despite the lack of pathogen concordance. On multivariate analysis, postoperative infection (OR, 12.85; p < 0.01) and Charlson Comorbidity Index were predictive of eventual amputation (OR, 1.44; p = 0.01).

Conclusions:

Positive day-of–free tissue transfer cultures, regardless of pathogen, had limited predictive value for short- and long-term outcomes of free tissue transfer in the authors’ cohort. These findings call for a broader multicenter prospective analysis and consideration of health care–associated infections and their impact on limb salvage outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Evidence-Based Performance Measures for Rhinoplasty: A Multidisciplinary Performance Measure Set
Authors: Manahan Michele A. , Fedok Fred , Davidson Caryn , Ahmad Jamil , Constantinides Minas , Davis Richard , Friedman Oren , Gilman Robert , Ishii Lisa , Keyes Geoffrey , Lin Samuel J. , Marcus Benjamin , Matarasso Alan , Most Sam P. , Quereshy Faisal , Sinno Sammy , Steinbacher Derek , Tollefson Travis , Rohrich Rod J.
Published: November 2020

The American Society of Plastic Surgeons, the American Academy of Otolaryngology–Head and Neck Surgery, and the American Academy of Facial Plastic and Reconstructive Surgery commissioned the multidisciplinary Rhinoplasty Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing both functional and aesthetic rhinoplasty. One outcome measure and three process measures were identified. The outcome looked at patient satisfaction with rhinoplasty procedures. The process measures look at motivations and expectations of the procedure, airway assessment, and nonnarcotic shared decision-making strategies for pain management. All measures in this report were approved by the American Society of Plastic Surgeons Quality and Performance Measures Work Group and Executive Committee, and the American Academy of Otolaryngology–Head and Neck Surgery Foundation, the American Academy of Facial Plastic and Reconstructive Surgery, The Rhinoplasty Society, and the American Association of Oral and Maxillofacial Surgeons. The Work Group recommends the use of these measures for quality initiatives, Continuing Medical Education, Maintenance of Certification, Qualified Clinical Data Registry reporting, and national quality reporting programs.
Grafting a spherical hidradenitis-affected scrotal raw area using a sterile glove: a case report describing the Al Lahham technique
Authors: Al Lahham Salim , Aljassem Ghanem , Al-Basti Habib , Alyazji Zaki T.N. , Sada Ruba
Published: November 2020

Introduction:

Hidradenitis suppurative (HS) is a chronic inflammatory skin condition that can be resistant to medical treatment, in which case the surgical option stands out as the only solution. In this paper, we present a case of severe hidradenitis treated surgically, and we introduce a simple way to secure a graft on a big circumferential area.

Presentation of case:

Our case is a severe form of HS involving both the axillary, the inguinal region and the scrotum that required multistaged surgery; the challenge was in the final stage, that is the grafting of the scrotum. To secure the graft on a big circumferential area we used our own technique that is simple and can be conducted in any hospital setting.

Discussion:

Surgical treatment of HS includes wide debridement and reconstruction with grafts or flaps. Using a piece of sterile glove to secure the graft is useful because of its stretchable properties that can compress the graft and the ability to maintain a moist environment that promotes healing, with making slits it can also help in draining excess fluids.

Conclusion:

We recommend testing this technique when grafting the scrotum or any circumferential area to secure the grafts.