bluuebunny/crossref_metadata_2025 huggingface dataset:
Longitudinal Changes of Posterior Vortex Veins in Highly Myopic Eyes determined by Retrospective Analyses of Indocyanine Green Angiograms
Authors: Lu Hongshuang , Chen Changyu , Xiong Jianping , Wang Yining , Wang Ziye , Moriyama Muka , Kamoi Koju , Uramoto Kengo , Takahashi Tomonari , Yoshida Takeshi , Ohno-Matsui Kyoko
Published: November 2023

Purpose:

To assess the longitudinal changes of the posterior vortex veins (VVs) in highly myopic (HM) eyes.

Methods:

The medical records of 1730 consecutive HM eyes that had undergone indocyanine green angiography (ICGA) were studied. Eyes that had posterior VVs and had undergone at least two ICGA examinations with a minimum interval of three years were selected from this group.

Results:

Ninety-one eyes of 78 patients met the inclusion criteria. A total of 124 posterior VVs were identified. Over an average interval of 7.8 ± 5.0 years, 41 (33.1%) of the 124 posterior VVs had marked changes consisting mainly of an attenuation of vessels in 36 posterior VVs (87.8%) and alterations in the drainage course in 16 PVVs (39.0%). Fifteen posterior VVs had both types of changes. Most of the attenuations of the vessels occurred for smaller branches, but a complete loss of the entire trunk was seen in 3 eyes. Additionally, 4 eyes had posterior VV changes in association with changes of peripheral VVs.

Conclusions:

Posterior VV in highly myopic eyes can undergo changes with increasing time. The associated factors included the development and progression of myopic maculopathy lesions. In some cases, the blood drainage shifted from posterior VV to peripheral VV by forming anastomotic channels.
Association of tessellation density with progression of axial length and refraction in children: an AI-assisted 4-year study
Authors: Wei Ruoyan , Li Jun , Yang Weiming , Liu Chang , Wang Yunzhe , Wang Lin , Liu Shixue , Yu Yongfu , Huang Chen , Song Kaimin , Ju Lie , He Wanji , Zhong Hua , Pan Yanting , Fu Fayan , Wang Xiaoying , Chen Yuzhong , Ge Zongyuan , He Mingguang , Zhou Xingtao , Li Meiyan
Published: November 2023

Purpose:

To investigate fundus tessellation density (TD) and its association with axial length (AL) elongation and spherical equivalent (SE) progression in children.

Methods:

The school-based prospective cohort study enrolled 1997 individuals aged 7-9 in 11 elementary schools in Mojiang, China. Cycloplegic refraction and biometry were performed at baseline and 4-year visits. The baseline fundus photos were taken, and TD, defined as the percentage of exposed choroidal vessel area in the photos, was quantified using an artificial intelligence-assisted semi-automatic labeling approach. After the exclusion of 330 ineligible participants due to loss to follow-up or ineligible fundus photos, logistic models were employed to assess the association of TD with rapid AL elongation (>0.36mm/year) and SE progression (>1.00D/year).

Results:

The prevalence of tessellation was 477/1667 (28.6%) and mean TD was 0.008±0.019. The mean AL elongation and SE progression in 4 years were 0.90±0.58mm and -1.09±1.25D. Higher TD was associated with longer baseline AL (beta, 0.030; 95% confidence interval [CI]: 0.015,0.046; p<0.001) and more myopic baseline SE (beta, -0.017; 95%CI: -0.032,-0.002; p=0.029). Higher TD was associated with rapid AL elongation (odds ratio [OR], 1.128; 95%CI: 1.055,1.207; p<0.001) and SE progression (OR, 1.123; 95%CI: 1.020,1.237; p=0.018).

Conclusions:

TD is a potential indicator of rapid AL elongation and refractive progression in children. TD measurement could be a routine to monitor AL elongation.
Comparison of the Choroidal Vascularity Index Measurements of Images Acquired with Different Optical Coherence Tomography Scan Scale Types
Authors: Elbay Ahmet , Kırık Furkan , Ertürk Kamile Melis , Ozdemir Hakan
Published: November 2023

Purpose:

To evaluate the differences in choroidal vascularity index (CVI) measurements between images acquired at the 1:1 pixel scale and at the 1:1 µm scale of the Heidelberg OCT device.

Methods:

Forty-five healthy eyes of 45 healthy subjects are included for this study. Fovea-centred scans were obtained with an enhanced-depth imaging mode with a high speed protocol scan. Each scan was exported in three different types: (a) 1:1 pixel scale type (PST) (b) 1:1 µm scale type (MST) and (c) 4x-magnified MST (4xMST; 400%-magnified 1:1 µm images exported via screenshot). A comparison between CVI measurements based on the different scale types of OCT images was conducted using the Bland–Altman analysis and intraclass correlation coefficient (ICC).

Results:

The image with the worst clarity was acquired via the MST, and the CVI was found to be higher in MST images (69.05±3.21) compared to the other groups. The ICC between the CVI values of the 4xMST and PST images was 0.92, between those of the 4xMST and MST images was 0.33 and between those of the PST and MST images was 0.44.

Conclusion:

The OCT scale and export method type significantly influence the image resolution, CVI and choroidal area measurements.
Early-onset of Familial Exudative Vitreoretinopathy: clinical characteristics, management and outcomes
Authors: Nicolas Kitic , Thibaut Chapron , Florence Metge-Galatoire , Ismael Chehaibou , Georges Caputo , Youssef Abdelmassih
Published: November 2023

Purpose:

To describe the clinical characteristics, management and outcomes of toddlers (under the age of 3) diagnosed with Familial exudative vitreoretinopathy (FEVR).

Methods:

In this retrospective study we included patients diagnosed with FEVR before the age of 3. Presenting characteristics, genetic testing, management and outcomes were collected.

Results:

A total of 54 patients (108 eyes) with a mean age at diagnosis of 10.9±2.6 months were included. Poor visual behavior (33%) and strabismus (26%) were the most common presenting symptoms while screening only represented 11%. About half of included patients had a severe disease (stage 4 and 5). Genetic testing was positive in 40.7% of patients with 24% having a family history of FEVR. LRP5 was the most prevalent mutation (54.5%).

Surgery was performed in 44.4% of eyes and was successful in 69.8% of cases. Failure exclusively occurred in eyes with severe stages. Among eyes evaluated for visual acuity (72 eyes), a majority (76.4%) had a vision of hand motion or better.

Conclusion:

FEVR tended to be worse with earlier age at diagnosis, subsequently affecting the prognosis. Surgical intervention was common and primarily included lens sparing vitrectomy and combined lensectomy and vitrectomy. Surgical success hinged on the stage of the disease.
Novel Methods of Identifying Individual and Neighborhood Risk Factors for Loss to Follow-Up After Ophthalmic Screening
Authors: Heilenbach Noah , Ogunsola Titilola , Elgin Ceyhun , Fry Dustin , Iskander Mina , Abazah Yara , Aboseria Ahmed , Alshamah Rahm , Alshamah Jad , Mooney Stephen J. , Maestre Gladys , Lovasi Gina S. , Patel Vipul , Al-Aswad Lama A.
Published: November 2023

Précis:

Residence in a middle-class neighborhood correlated with lower follow-up compared with residence in more affluent neighborhoods. The most common explanations for not following up were the process of making an appointment and lack of symptoms.

Purpose:

To explore which individual-level and neighborhood-level factors influence follow-up as recommended after positive ophthalmic and primary care screening in a vulnerable population using novel methodologies.

Participants and Methods:

From 2017 to 2018, 957 participants were screened for ophthalmic disease and cardiovascular risk factors as part of the Real-Time Mobile Teleophthalmology study. Individuals who screened positive for either ophthalmic or cardiovascular risk factors were contacted to determine whether or not they followed up with a health care provider. Data from the Social Vulnerability Index, a novel virtual auditing system, and personal demographics were collected for each participant. A multivariate logistic regression was performed to determine which factors significantly differed between participants who followed up and those who did not.

Results:

As a whole, the study population was more socioeconomically vulnerable than the national average (mean summary Social Vulnerability Index score=0.81). Participants whose neighborhoods fell in the middle of the national per capita income distribution had a lower likelihood of follow-up compared with those who resided in the most affluent neighborhoods (relative risk ratio=0.21, P-value<0.01). Participants cited the complicated process of making an eye care appointment and lack of symptoms as the most common reasons for not following up as instructed within 4 months.

Conclusions:

Residence in a middle-class neighborhood, difficulty accessing eye care appointments, and low health literacy may influence follow-up among vulnerable populations.
Barriers to Care Among Glaucoma Patients With a Missed Appointment and Interest in a Navigator Program
Authors: Wasser Lauren M. , Bear Todd M. , Sommers Matthew , Cassidy Julie , Muir Kelly W. , Williams Andrew M.
Published: November 2023

Précis:

Most glaucoma patients with missed appointments report barriers to care and social risk factors. One third expressed interest in engaging with a patient navigator program. Most expressed interest in rescheduling.

Purpose:

The purpose of this study was to identify barriers to care among glaucoma patients with missed appointments and to assess their interest in a patient navigator program.

Material and Methods:

A cross-sectional study involving adult glaucoma patients from an academic eye center who missed their scheduled appointment between April 18 and July 25, 2022. Participants were surveyed about reasons for missed appointments, barriers to care, social risk factors, and interest in consulting with our patient navigator program.

Results:

Of 172 patients with a missed glaucoma appointment, 73% (126/172) were contacted, and 40% (51/126) of those completed the survey. Participant age averaged 67±14 years, half were female (25/51, 49%), and most identified as Black (27/51, 53%) or White (21/51, 40%). Barriers to seeing a doctor including difficulty scheduling appointments (13/51, 26%), transportation (12/51, 24%), and cost or insurance barriers (8/51, 16%). Twenty-eight (55%) respondents reported at least one social risk factor. A positive association was found between having at least one risk factor and expressing interest in consulting our patient navigator (odds ratio=6.7, P=0.009). Overall, a third of respondents expressed interest in engaging with our patient navigator program (17/51, 33%). Two thirds of participants reported awareness of missed appointments (34/51, 67%), of whom 35% (12/34) reported having already rescheduled, 41% (14/34) expressed interest in rescheduling, and 24% (8/34) did not wish to return.

Conclusions:

Glaucoma patients with missed appointments report barriers to care and face social risk factors. Telephone outreach may help to re-engage them with care, and patients expressed interest in a patient navigator program to address social needs.
Association Between Days of the Week and Intraocular Pressure: Japan Ningen Dock Study
Authors: Terauchi Ryo , Wada Takashi , Fukai Kota , Tatemichi Masayuki , Sano Kei , Nishijima Euido , Ogawa Shumpei , Noro Takahiko , Ito Kyoko , Kato Tomohiro , Kato Kiminori , Nakano Tadashi
Published: November 2023

Précis:

The analysis of intraocular pressure (IOP) by day of the week using the mega database showed a periodic weekly pattern with the highest value on Monday.

Purpose:

To evaluate IOP by the day of the week.

Patients and Methods:

Annual health checkup examinees between April 2014 and March 2015 were cross-sectionally evaluated. As a result, 655,818 participants [51.5±10.5 (range: 20–96) years, 40.1% women] from 103 medical centers were included. IOP was measured using a noncontact tonometer. The mean IOPs of each day of the week were compared using multiple comparison test and multiple linear regression analysis. Wednesday was set as the reference. Moreover, weekly IOP variations stratified by sex and age were also evaluated.

Results:

Mean IOPs from Monday to Sunday were 13.19±2.97, 13.06±2.92, 13.05±2.91, 13.05±2.92, 13.12±2.94, 13.10±2.96, and 13.16±2.78 mm Hg. IOP was significantly higher on Monday, Friday, and Saturday than those on Wednesday (P<0.001, <0.001, 0.002). After adjusting for factors affecting IOP, the IOPs on Monday and Saturday were higher than those on Wednesday [β=0.097 (95% CI: 0.074–0.121), P<0.001; β=0.032 (95% CI: 0.005–0.059), P=0.019]. Men had significantly higher IOPs on Monday and Saturday than on Wednesday [β=0.142 (95% CI: 0.110–0.173), P<0.001; β=0.053 (95% CI: 0.017–0.089), P=0.004], whereas women did not have a significant trend. Participants aged below 65 years had higher IOPs on Monday (P<0.001 in under 60 years; P=0.003 in 60–64 years), while those aged 65 years or older did not (P=0.856).

Conclusion:

IOP values may have a periodic weekly pattern. The high IOP on Monday was more pronounced in men aged less than 65 years.
Apoptotic Marker Expression of Resected Lacrimal Gland Adenoid Cystic Carcinoma Tumor Margins After Intra-arterial Chemotherapy and Globe-Sparing Excision
Authors: Shoji Marissa K. , Moeyersoms Acadia H. M. , Wang Qikai , Gonzalez Hernandez Laura , Tang Vincent D. , Khzam Rayan Abou , Dubovy Sander R. , Pelaez Daniel , Tse David T.
Published: November 2023

Purpose:

Lacrimal gland adenoid cystic carcinoma (LGACC) is a rare orbital malignancy with devastating lethality. Neoadjuvant intra-arterial chemotherapy (IACC) has demonstrated cytoreductive effects on LGACC macroscopically, but limited studies have examined cellular and molecular determinants of the cytoreductive effect. This post hoc study assessed apoptotic marker expression on excised tumor specimens after neoadjuvant IACC and globe-sparing resection, emphasizing the examination of tumor margins.

Methods:

This retrospective study identified LGACC specimens resected in a globe-sparing technique after neoadjuvant IACC by reviewing the Florida Lions Ocular Pathology database at Bascom Palmer Eye Institute. Histopathology slides of the specimens were re-examined to confirm the diagnosis and identify the tumor margin. Immunofluorescent staining was performed for apoptotic markers, including P53, cleaved caspase-3, cleaved PARP-1, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL). Positive expression was determined by comparison to the negative control.

Results:

Tumor specimens from 5 patients met inclusion criteria. All 5 cases were positive at the center and the margin for TUNEL, p53, and cleaved caspase-3. One case did not show positive expression of cleaved PARP-1 at the margin but was positive for the other apoptotic markers.

Conclusions:

This post hoc study demonstrated positive staining for multiple apoptotic markers in post-IACC tumor specimens at the tumor center and margin. Apoptotic marker expression along the margins of post-treatment specimens is important, as it may offer surrogate information to speculate on the state of residual cancer cells adjacent to the excision margin inadvertently remaining in the orbit.
Optimizing Ophthalmology Patient Education via ChatBot-Generated Materials: Readability Analysis of AI-Generated Patient Education Materials and The American Society of Ophthalmic Plastic and Reconstructive Surgery Patient Brochures
Authors: Eid Kevin , Eid Alen , Wang Diane , Raiker Rahul S. , Chen Stephen , Nguyen John
Published: November 2023

Purpose:

This study aims to compare the readability of patient education materials (PEM) of the American Society of Ophthalmic Plastic and Reconstructive Surgery to that of PEMs generated by the AI-chat bots ChatGPT and Google Bard.

Methods:

PEMs on 16 common American Society of Ophthalmic Plastic and Reconstructive Surgery topics were generated by 2 AI models, ChatGPT 4.0 and Google Bard, with and without a 6th-grade reading level prompt modifier. The PEMs were analyzed using 7 readability metrics: Flesch Reading Ease Score, Gunning Fog Index, Flesch-Kincaid Grade Level, Coleman–Liau Index, Simple Measure of Gobbledygook Index Score, Automated Readability Index, and Linsear Write Readability Score. Each AI-generated PEM was compared with the equivalent American Society of Ophthalmic Plastic and Reconstructive Surgery PEM.

Results:

Across all readability indices, PEM generated by ChatGPT 4.0 consistently had the highest readability scores, indicating that the material generated by this AI chatbot may be most difficult to read in its unprompted form (Flesch Reading Ease Score: 36.5; Simple Measure of Gobbledygook: 14.7). Google’s Bard was able to generate content that was easier to read than both the American Society of Ophthalmic Plastic and Reconstructive Surgery and ChatGPT 4.0 (Flesch Reading Ease Score: 52.3; Simple Measure of Gobbledygook: 12.7). When prompted to produce PEM at a 6th-grade reading level, both ChatGPT 4.0 and Bard were able to significantly improve in their readability scores, with prompted ChatGPT 4.0 being able to consistently generate content that was easier to read (Flesch Reading Ease Score: 67.9, Simple Measure of Gobbledygook: 10.2).

Conclusion:

This study suggests that AI tools, when guided by appropriate prompts, can generate accessible and comprehensible PEMs in the field of ophthalmic plastic and reconstructive surgeries, balancing readability with the complexity of the necessary information.
Oral Sedation Anesthesia Protocol for In-Office Oculoplastic Surgery
Authors: Conger Jordan R. , Manipud Nickolas , Elhalouti Ichrak , Lo Christopher , Wang Yao , Burnstine Michael A. , Dresner Steven C. , Samimi David B.
Published: November 2023

Purpose:

To present an oral anesthesia protocol for in-office oculoplastic surgery and to compare safety outcomes and patient and physician experiences to ambulatory surgery center (ASC)-based surgery with intravenous sedation or general anesthesia.

Methods:

A prospective study was performed on consecutive patients undergoing surgery at an oculofacial plastic surgery practice. Surgery was performed in an in-office setting using our standardized oral sedation protocol or at an ASC with intravenous sedation or general anesthesia. Preoperative and postoperative surveys were conducted by patients and physicians to compare surgical experience, safety, and efficacy of our oral sedation protocol for in-office surgery in the ASC setting.

Results:

Two hundred and fifty-three patients (167 in-office and 86 at ASC) underwent surgery between March and November 2022. There was no significant difference in how patients or physicians rated their experience between the 2 locations. A significantly higher proportion of ASC patients would have rather had surgery in-office (34.9% vs. 19.2%; p = 0.006). A significantly higher number of physicians in the office setting would have rather performed surgery at the ASC than the reverse (12.7% vs. 2.3%, respectfully; p = 0.007). There were no safety complications reported in either setting.

Conclusions:

Within our patient cohort, the presented oral sedation protocol provided safe and effective anesthesia for in-office oculoplastic surgery that is comparable to an ASC.
Transient Postinflammatory Hyperpigmentation Following Eyelid Surgery
Authors: Gutovitz Joel M. , Ben-Simon Guy , Egozi Ella , Bar Ariel , Landau Prat Daphna
Published: November 2023

Purpose:

The authors’ aim was to describe a rare mild complication of eyelid surgery presenting as transient hyperpigmentation along the suture lines.

Methods:

A retrospective case series of 6 patients experiencing transient hyperpigmentation following eyelid surgery. Each patient underwent either blepharoplasty alone or blepharoplasty with ptosis repair utilizing Müller muscle conjunctival resection. Data including surgery type, hyperpigmentation laterality and location, time to diagnosis, follow-up time, and outcome were assessed.

Results:

All 6 patients with hyperpigmentation were females. All patients underwent blepharoplasty, including 1 upper eyelid blepharoplasty and 4 with both upper and lower eyelid blepharoplasty. One patient underwent bilateral upper blepharoplasty with concurrent posterior approach ptosis surgery repair of the left upper eyelid. Hyperpigmentation was bilateral in all 5 blepharoplasty cases and unilateral in the ptosis repair case. Hyperpigmentation included the medial portion of the operated upper eyelid in all cases. Time to diagnosis ranged from 1 to 4 weeks postoperatively, and follow-up time ranged from 3 to 5 months. Management was conservative in all cases. Five patients experienced complete resolution, and 1 patient experienced near-complete resolution on a 3-month follow-up.

Conclusions:

Transient hyperpigmentation is a rare posteyelid surgery complication, generally with an excellent outcome not requiring additional intervention.
Clinical management of a nonoptimal vault and unexpected postoperative refraction in a patient implanted with a phakic intraocular lens
Authors: Sánchez-Trancón Angel , Baptista António Manuel , Sierra Oscar Torrado , Serra Pedro Miguel
Published: November 2023

Introduction:

This case reports the management of a bilateral toric implantable collamer lens (ICL) surgery with low vaulting and unilateral reduction in visual acuity (VA) associated with a combined effect of surgically induced astigmatism (SIA) and toric-ICL rotation. This case expands the common management of toric-ICL rotation, by adding surgically induced corneal changes.

Patient and Clinical Findings:

The patient presented with moderate myopia and high astigmatism and was implanted with a toric-ICL, resulting in bilateral low vault <150 μm and unilateral VA reduction (20/40) because of postoperative oblique astigmatism, observed at the 4-week follow-up.

Diagnosis, Intervention and Outcomes:

The low ICL vaulting was associated with a high crystalline lens rise and underestimation of the sulcus-to-sulcus distance. The VA reduction resulted from a combined effect of ∼1.0 diopter SIA and 8-degree ICL rotation. The authors associate the high SIA to abnormal corneal biomechanics indexes and the toric-ICL rotation to a lack of stability resultant from a small ICL size. The left eye toric-ICL has exchanged with one with larger size and the power recalculated using vectorial analysis. The toric-ICL exchange increased the vault 75 μm and improved VA.

Conclusions:

Detailed anterior chamber morphometry and corneal biomechanics may assist in improving the refractive outcome in toric-ICL surgery.
Photodynamic Therapy for Treatment of Actinic Keratosis in a Patient With Graft Versus Host Disease
Authors: Sobotka Michelle Hook , Stover Kim Carlson
Published: November 2023

Photodynamic therapy, consisting of aminolevulinic acid and blue light in combination, is a treatment option for diffuse actinic keratosis in patients with cutaneous manifestations of graft-versus-host disease resulting from an allogenic stem cell transplantation for lymphoma. Different treatment options, such as imiquimod and 5-fluorouracil, are effective treatment options in the general population, but risk flaring graft-versus-host disease in patients with this condition. We present a case where photodynamic therapy was successfully used in the treatment of actinic keratosis for a patient with chronic graft-versus-host disease without flaring the cutaneous manifestations of graft-versus-host disease.
Measuring Sexual and Gender-Based Violence at the University of Cape Coast
Authors: Compton Sarah D. , Odoi Amanda , Dickson Kwamena , Darteh Eugene K. M. , Munro-Kramer Michelle L.
Published: November 2023

Aims

Sexual and gender-based violence (SGBV) is a global public health crisis, impacting university youth around the world. The purpose of this study was twofold: (a) determine the best methodology for conducting a campus climate survey at the University of Cape Coast (UCC) in Ghana and (b) gather data on SGBV knowledge, attitudes, and behaviors from a representative sample of students.

Methods

This descriptive study included three phases: (a) develop a campus climate survey unique to UCC, (b) develop a sampling methodology, and (c) deploy the first ever campus climate survey at UCC.

Results

A 71-item survey was developed and then administered via a student portal to 2,000 students. Of those students, 1,381 (69.1%) responded. Although most students (63.2%) know the university has a sexual harassment policy, fewer have seen it (25.9%) or read it (22.3%). Students held generally positive views of how the university would respond to reports of sexual harassment, although 50.2% of participants believed the reporter would be labeled a troublemaker. More participants reported seeking and giving verbal than nonverbal consent, and more men than women reported both seeking and giving verbal consent. More men than women reported they “always” sought verbal consent (61.2% vs. 47.7%, p = 0.001). Most students (n = 316, 56.5%) sought verbal consent all of the time, and an additional 99 (17.7%) sought it most of the time.

Conclusions

Accurate data about students' knowledge, attitudes, and experiences with SGBV policy, prevention, and response are needed globally to better inform locally appropriate practices.

Potential Impact of Campus Intimate Partner Violence and Sexual Assault on Forensic Nursing

Forensic nursing is currently localized in high-income countries. University students' knowledge, attitudes, and experiences with SGBV can support the expansion of forensic nursing research and practice to low- and middle-income countries.
Bladder pain syndrome AKA interstitial cystitis – a condition with severe unmet medical need: an exploration of brimapitide as a potential treatment opportunity
Authors: Taubert Erich , van der Aa Frank , Heesakkers John
Published: November 2023

Purpose of review

The purpose of this article is to present recent findings of KU002 (brimapitide) as a novel treatment option for interstitial cystitis/bladder pain syndrome (IC/BPS).

Recent findings

IC/BPS is a complex and poorly understood heterogeneous syndrome, with many burdensome symptoms that severely affect patients’ quality of life. Treatment options beyond conservative and nonpharmacologic approaches remain limited, and there is an unmet medical need for effective medical treatments. While there are multiple ongoing clinical trials in this area, only a few explore new treatment options. This article summarizes current ongoing development and reports the findings of one such trial.

In a phase 1/2a exploratory trial, intravesical instillation of brimapitide confirmed local action while eliciting in minimal systemic exposure, resulting in a promising and favorable safety profile. Efficacy exploration suggests that brimapitide reduces pain, improves signs and symptoms of IC/BPS and improves the general wellbeing of the study participants.
Secondary central retinal artery occlusion due to rhino-orbital-cerebral mucormycosis in a diabetic patient: a case report
Authors: Sumual Vera , Lukandy Andry , Sutanto Reynardi Larope
Published: November 2023

Introduction and importance:

Acute sinusitis can cause intraorbital complications. Although subperiosteal abscesses generally do not cause severe vision loss, rare cases of decreased vision due to central artery or vein occlusion have been reported since 2003. Central retinal artery occlusion (CRAO) is an eye emergency that can cause sudden loss of vision. This condition is commonly found in elderly individuals with other metabolic diseases. The authors report a case of a type 2 diabetes mellitus (T2DM) patient with CRAO due to suspected rhino-orbital-cerebral mucormycosis (ROCM).

Case presentation:

A 47-year-old man came with sudden blurred vision since the last week. Examination of the left eye revealed no light perception and vision, orthophoric eyeball position with restricted movement in all directions. Hypaesthesia was observed on the left side of the face. In the anterior segment, oedema of the eyelids, ptosis, conjunctival injection, ciliary injection and chemosis, clear cornea, deep anterior chamber with VH4, brown iris, crypts, no neovascularization of the iris, pupil round, mid-dilated with a diameter of 5 mm, no light reflex, relative afferent papillary defect, and NO2NC2 lens were observed. In the posterior segment, non-uniform fundal reflexes were found, as well as retinal oedema, round papillae, hyperaemic fovea reflex (cherry-red spot), and a cup-to-disc ratio that could not be evaluated. The patient was diagnosed with CRAO, orbital cellulitis, and uncontrolled T2DM. The patient was administered topical and oral antibiotics; however, there was no improvement in the left eye. ROCM was suspected.

Clinical discussion:

CRAO is most often caused by embolization or thrombosis associated with atherosclerosis at the lamina cribrosa level. CRAO accompanied by ROCM infection is very rare; to establish the diagnosis, it is necessary to carry out further examinations so that administered therapy can definitely improve the patient’s clinical condition. Due to resource limitation, biopsy and MRI were not performed. Surgical debridement was planned when the patient was stable, but the patient missed follow-up appointments.

Conclusion:

Fungal aetiology should be considered especially in T2DM patient with CRAO that do not improve with antibiotics.
Changes in Pelvic Floor Symptoms After Procedural Interventions for Uterine Leiomyomas, A Systematic Review
Authors: Gupta Ankita , Balk Ethan M. , Lenger Stacy M. , Yang Linda C. , Misal Meenal , Balgobin Sunil , Chang Olivia H. , Sharma Vidya , Stuparich Mallory , Behbehani Sadikah , Nihira Mikio , Alas Alexandriah , Jampa Alekhya , Sheyn David , Meriwether Kate , Antosh Danielle D.
Published: November 2023

(Abstracted from Obstet Gynecol 2023;142:319–329)

Uterine leiomyomas are the most prevalent benign uterine tumors with a cumulative incidence of 70% to 80% by age 50 years. Up to 70% of women with leiomyomas are asymptomatic and require no treatment, but among symptomatic women, heavy or prolonged menstrual bleeding, bulk-related symptoms, dysmenorrhea, sexual dysfunction, and adverse pregnancy outcomes are common.
Immunodetection of NUT Protein: Implementation, Indications, and Results in a Tertiary Reference Center
Authors: Noorwali Hussain , Casiraghi Odile , Classe Marion , Adam Julien , Ngo Carine , Ghigna Maria-Rosa , Kanaan Christina , Khneisser Pierre , Bani Mohamed-Amine , Cotteret Sophie , Scoazec Jean-Yves
Published: November 2023

The immunodetection of NUT protein is a reliable tool to identify NUT carcinoma, a rare and still underdiagnosed tumor entity. The technique was implemented in 2017 in our department, a tertiary reference center with a large recruitment in all tumor types, including head and neck and thoracic tumors. We evaluated its use over a 6-year period (2017–2022) to (a) describe the indications for the technique, (b) determine the number of NUT carcinomas detected and confirmed by Fluorescence in situ hybridization, and (c) describe briefly the characteristics of these tumors. Over the study period, 382 NUT immunodetections were performed; the annual number of requests varied from 45 to 83. All 21 pathologists of the department made at least one request (range: 1 to 94; annual mean: 18.2). 54.7% of immunodetections were performed for internal cases, 37% for cases submitted for consultation, and 8.3% for cases submitted for confirmation of a suspected diagnosis. The main indications were poorly differentiated tumors of the head and neck region (39%) and the thorax (19.6%), and difficult-to-classify soft tissue tumors (11.8%). Twelve cases of NUT carcinoma were detected by immunohistochemistry and confirmed by Fluorescence in situ hybridization. Seven were from the head and neck region (4.7% of the tumors tested), 4 from lung or mediastinum (5.3%), 1 from an unknown primary at the time of diagnosis. In conclusion, the implementation of NUT immunodetection in the daily workflow of a pathology department improves the detection of NUT carcinoma. This becomes essential with the emergence of potential targeted therapies.
Unexpected Symmetrical Uptake of 18F-FDG of Distal Peripheral Bones in a Patient With Diffuse Large B-Cell Lymphoma
Authors: Güneren Cansu , Şahin Kübra , Sönmezoğlu Kerim
Published: November 2023

A 74-year-old woman was referred for 18F-FDG PET/CT scanning to investigate an underlining etiology due to recently developed unexplained bone pains and lack of walking capacity. On the initial PET/CT scan, we have noted a highly symmetrical and apparent intramedullary FDG uptake of the distal parts of appendicular skeleton system including the bilateral elbows, wrists, and foot ankles in addition to a lymphadenomegaly in the right groin. The excisional biopsy from the lymph node of right groin revealed a diagnosis of diffuse large B-cell lymphoma.
Elevated 68Ga-FAPI-04 Activity Due to Staphylococcus aureus Intracranial Infection
Authors: Zhang Zeyu , Hou Wenli , Pan Guixia , Zuo Changjing , Cheng Chao
Published: November 2023

A 37-year-old man was admitted to our hospital after experiencing syncope. An MRI of his head revealed multiple foci of abnormal signal, which could potentially be metastases. The patient then underwent a 68Ga-FAPI-04 PET/MRI examination, which revealed multiple FAPI-avid foci in the brain. Upon analyzing the cerebrospinal fluid, it was found that the patient had a Staphylococcus aureus infection. The results suggest that 68Ga-FAPI-04 PET has the potential to be a valuable tool in the visualization of intracranial infectious lesions.
The Maxillomandibularis Muscle
Authors: Rusu Mugurel Constantin , Stoenescu Mihai Dragomir , Săndulescu Mihai
Published: November 2023

Fibers of the lateral pterygoid muscle (LPM) occasionally originate on the posterior surface of the maxilla. Anatomic exploration of an adult patient’s cone beam computed tomography files revealed a previously unreported unilateral anatomic variant of the LPM. The variant consisted of a distinctive muscular slip that originated on the tuberosity of the maxilla and coursed postero-laterally through the notch of the mandible to insert on an accessory pterygoid fovea on the outer condylar pole. This maxillomandibular muscle was lateral to the inferior head of the LPM. Therefore, it could contribute to the antero-inferior displacement and medial rotation of the mandibular condyle during the movements of the temporomandibular joint. The maxillomandibular muscle should be added to the extensive spectrum of anatomical variations of the LPM; however, prevalence studies should assess whether its maxillary attachment is the rule or the exception.
Soft tissue Reconstruction Using Pedicled Trapezius Musculocutaneous Flap for Cranial Bone Flap Infection in the Occipital Region
Authors: Kanayama Koji , Takayanagi Shunsaku , Miyamoto Shimpei , Saito Nobuhito , Okazaki Mutsumi
Published: November 2023

When managing cranial bone flap infections, infected bone flaps are typically removed and subsequently replaced with artificial bones 6 to 12 months after the inflammation subsides. However, defects in the occipital region pose challenges due to concerns regarding brain protection when patients lie in the supine position. Herein, the authors report the case of a 73-year-old woman with an occipital bone flap infection, which was successfully managed by reconstruction with a trapezius musculocutaneous flap immediately after removing the infected bone flap. One year and 2 months postoperatively, the wound had fully healed, and the patient remained symptom-free without any complications, such as sunken flap syndrome. Soft tissue reconstruction using pedicled trapezius musculocutaneous flap is a viable strategy for managing occipital bone flap infections. This flap ensures stable blood flow and requires minimal vascular manipulation, thereby reducing operation time as the patient does not need to change position.
‘I Did No Harm’
Authors: Desouky Elsayed , Ibrahim Mohamed. , Sharma Harbinder. , Jallad Samer
Published: November 2023

Objective:

To assess the performance of our urology team against GMC guidelines for using chaperone during intimate clinical examination.

Background data:

intimate physical examination is an integral part of our urological practice. There is a paucity of literature regarding the use of chaperones among urologists. Given the importance of this topic for both patient safety and providing support for the urologist, we decided to assess our performance as per the GMC guidelines for good medical practice.

Methods:

We completed an audit loop to evaluate the performance of 12 members in our urology team as regards compliance with GMC guidance for the documentation of chaperone use in urology clinic. Based on our scoring system, we objectively assessed both overall team performance as well as individual scores for documenting chaperone use.

Results:

There was a significant improvement in the overall documentation rate in both clinical notes (+9.85%) and clinic letters (+36.65%). Raising awareness among team members managed to increase the individual performance scores as well.

Conclusion:

This is the first report using a scoring system for objective assessment of a pertinent topic such as the use of chaperone and its documentation. This managed to achieve a significant improvement in our practice.
A new minimally invasive, nonexcisional, surgical browlift technique with minimal scarring: a protocol for a prospective observational study
Authors: de Jongh Frank W. , Kooiman Laurens B.R. , Sanches Elijah E. , Pouwels Sjaak , Ingels Koen J.A.O. , Wehrens Kim M.E. , Tan Liang T.
Published: November 2023

Background:

The aim of this study is to prospectively evaluate the new minimal invasive (MINE) browlift technique with possibly superior results and minimal visible scarring.

Study design:

A prospective observational study will be performed on all available data from patients who will undergo a browlift procedure in the HMC from 1 June 2021 till 31 May 2024. Our goal is to include at least 50 patients. Inclusion criteria are: patients with medical (i.e. brow ptosis and facial paralysis) or cosmetic indication, patients with sufficient understanding of the Dutch or English language and willingness to participate in extra study specific follow-up moments and filling in of questionnaires. Exclusion criteria are: less than 18 years of age and patients with previous brow or eyelid surgery. Patients will be photographed preoperatively and postoperatively using the VECTRA camera.

Outcome measurements:

Scarring after procedure; functionality of eyebrow movement; amount of correction in brow ptosis, measured in VECTRA; longevity of procedure in months; aesthetic result as assessed by questionnaires and adverse effects of procedure will be measured.

Ethics and dissemination:

The database management software ʻCastorʼ will be used to store and collect the data from the questionnaire. The Medical Research Ethics Committee found this study not eligible to be submitted to the Dutch Medical Research Involving Human Subjects Acts (WMO). Written consent will be obtained from all patients.
Predictors of suicidality among Polish university students during COVID-19 pandemic
Authors: Cichoń Ewelina , Gawrych Magdalena , Kiejna Andrzej , Gondek Tomasz M. , Andrzejewska Beata , Adamowski Tomasz , Kozak Karol , Mortier Philippe , Alonso Jordi
Published: November 2023

Purpose of review

The main purpose of the study was to assess university students’ mental health and identify factors associated with the risk of suicidal thoughts, plans, and attempts during coronavirus disease 2019 (COVID-19) pandemic and distance learning.

Recent findings

The study was conducted in spring 2021 and comprised 10 760 Polish students. The survey employed modified versions of the C-SSRS, CIDI, WHO-5, GAD-7, the PTSD checklist for DSM-5 and CAGE-AID Questionnaire and included questions about panic attacks, COVID-19-related information and sociodemographic characteristics. The correlates of suicidality were examined using a series of logistic regression analyses. Almost 40% students experienced any suicidal thoughts and/or behaviours in the previous month: passive ideations only (15.8%), active ideations only (7.1%), plans without attempts (15%), and attempts (1.4%). Following variables were related to the increased risk for suicide attempts: severe anxiety [odds ratio (OR) = 11.39; 95% confidence interval (CI): 1.44–90.26], panic attacks (OR = 3.21; 95% CI: 1.75–5.91), and COVID-19 hospitalisation (OR = 11.04; 95% CI: 1.17–104.59). Major depression was associated with passive and active ideations, suicide plans, but not with attempts (OR = 1.37; 95% CI: 0.45–4.13).

University students present a high level of adverse mental health and increased risk of STBs during COVID-19 pandemic. A suicide prevention program tailored to this population is needed during and after the pandemic.
Exploring the Utility of a Functional Magnetic Resonance Imaging (fMRI) Cannabis Cue-Reactivity Paradigm in Treatment Seeking Adults with Cannabis Use Disorder
Authors: Sahlem Gregory L. , Dowdle Logan T. , Baker Nathaniel L. , Sherman Brian J. , Gray Kevin M. , McRae-Clark Aimee L. , Froeliger Brett , Squeglia Lindsay M.
Published: November 2023

Introduction

Functional magnetic resonance imaging (fMRI) studies examining cue-reactivity in cannabis use disorder (CUD) to date have either involved non-treatment seeking participants or been small. We addressed this gap by administering an fMRI cue-reactivity task to CUD participants entering two separate clinical trials.

Methods

Treatment-seeking participants with moderate or severe CUD had behavioral craving measured at baseline via the Marijuana Craving Questionnaire (MCQ-SF). They additionally completed a visual cannabis cue-reactivity paradigm during fMRI following 24-hours of abstinence from cannabis. During fMRI, the Blood Oxygen Level Dependent (BOLD) signal was acquired while participants viewed cannabis-images or matched-neutral-images. BOLD responses were correlated with the MCQ-SF using a General Linear Model.

Results

N=65 participants (32% female; mean age 30.4±9.9SD) averaged 46.3±15.5SD on the MCQ-SF. When contrasting cannabis-images vs. matched-neutral-images, participants showed greater BOLD response in bilateral ventromedial prefrontal, dorsolateral prefrontal, anterior cingulate, and visual cortices, as well as the striatum. Similarly, there was stronger task-based functional-connectivity (tbFC) between the medial prefrontal cortex and both the amygdala and the visual cortex. There were no significant differences in either activation or tbFC between studies or between sexes. Craving negatively correlated with BOLD response in the left ventral striatum (R2=-0.25;p=0.01).

Conclusions

We found that, among two separate treatment-seeking CUD groups, cannabis cue-reactivity was evidenced by greater activation and tbFC in regions related to executive function and reward processing, and craving was negatively associated with cue-reactivity in the ventral striatum. Future directions include examining if pharmacological, neuromodulatory, or psychosocial interventions can alter corticostriatal cue-reactivity.
Combined Right Ventricular Preload and Afterload Challenge Induces Contractile Dysfunction and Ventricular Arrhythmia in an Age-dependent Manner in Isolated Hearts of Dystrophin-deficient Mice
Authors: Behrmann Andrew , Cayton Jessica , Hayden Matt , Lambert Michelle , Nourian Zahra , Nyanyo Keith , Hanft Laurin , Krenz Maike , McDonald Kerry , Domeier Timothy
Published: November 2023

Duchenne muscular dystrophy (DMD) is an X-linked recessive myopathy due to mutations in the dystrophin gene. Diaphragmatic weakness in DMD causes restrictive lung disease and excessive afterload on the right ventricle (RV). Thus, RV dysfunction in DMD develops early in disease progression. Herein, we deliver a 30-minute sustained RV preload and afterload challenge to isolated hearts of wildtype (Wt) and dystrophic (mdx4CV) mice at both young (2-6 month) and middle-age (8-12 month). Young dystrophic hearts exhibited greater pressure development than wildtype under unloaded conditions but following RV preload/afterload challenge exhibited similar contractile function as wildtype. Following RV preload/afterload challenge, young dystrophic hearts had an increased incidence of ventricular arrhythmias compared to wildtype. Hearts of middle-aged wildtype and dystrophic mice had similar contractile function during unloaded conditions, yet, after RV preload/afterload challenge, hearts of middle-aged dystrophic mice had severe RV contractile dysfunction and ventricular arrhythmogenesis, including ventricular tachycardia. Following load challenge, young and middle-aged dystrophic hearts had greater damage, measured via tissue LDH release, than wildtype mice of similar age. Our data indicate complex age-dependent changes in RV function and arrhythmogenesis with load in dystrophin deficiency, highlighting the need to avoid sustained RV load to forestall RV dysfunction and arrhythmia.
Hybrid Adipocyte-Derived Exosome Nano Platform for Potent Chemo-Phototherapy in Targeted Hepatocellular Carcinoma
Authors: Liu Xinying , Zhang Jiaxin , Zheng Shunzhe , Li Meng , Xu Wenqian , Shi Jianbin , Kamei Ken-ichiro , Tian Chutong
Published: November 2023

The high prevalence and severity of hepatocellular carcinoma (HCC) present a significant menace to human health. Despite the significant advancements in nanotechnology-driven antineoplastic agents, there remains a conspicuous gap in the development of targeted chemotherapeutic agents specifically designed for HCC. Consequently, there is an urgent need to explore potent drug delivery systems for effective HCC treatment. Here we have exploited the interplay between HCC and adipocyte to engineer a hybrid adipocyte-derived exosome platform, serving as a versatile vehicle to specifically target HCC and exsert potent antitumor effect. A lipid-like prodrug of docetaxel (DSTG) with a reactive oxygen species (ROS)-cleavable linker, and a lipid-conjugated photosensitizer (PPLA), spontaneously co-assemble into nanoparticles, functioning as the lipid cores of the hybrid exosomes (HEMPs and NEMPs). These nanoparticles are further encapsuled within adipocyte-derived exosome membranes, enhancing their affinity towards HCC cancer cells. As such, cancer cell uptakes of hybrid exosomes are increased up to 5.73-fold compared to lipid core nanoparticles. Ourin vitroandin vivoexperiments have demonstrated that HEMPs not only enhance the bioactivity of the prodrug and extend its circulation in the bloodstream but also effectively inhibit tumor growth by selectively targeting hepatocellular carcinoma tumor cells. Self-facilitated synergistic drug release subsequently promoting antitumor efficacy, inducing significant inhibition of tumor growth with minimal side effects. Our findings herald a promising direction for the development of targeted HCC therapeutics.

Graphical abstract

An adipocyte-derived exosome nanoplatform has been developed for the combined therapy of both chemotherapy and photodynamic therapy. The hybrid adipocyte-derived exosome nanoplatform integrates the advantage of targeted co-delivery and combination therapy, which can stimulate the release of drugs under the tumor microenvironment, effectively enhanced targeted co-delivery in hepatocellular carcinoma cells, prolonged blood circulation time and improve the therapeutic effect of hepatocellular carcinoma tumors model.