bluuebunny/crossref_metadata_2025 huggingface dataset:
Stress experienced by dental students performing clinical training in different dental disciplines: a cross-sectional study
Authors: Alamoush Rasha A , Al-sawaeir Sereen , Baker Dima Abu , Aljamani Sanaa A , Alomoush Salah A , AL-Omiri Mahmoud K
Published: February 2024

Objectives: To assess the stress level, the impact of stress factors, and discrepancies between fourth- and fifth-year undergraduate clinical students at the University of Jordan.

Methods: A cross-sectional study was conducted in the academic year 2022/2023. The study group included fourth- and fifth-year dental students at the University of Jordan (n = 382) who were asked to voluntarily fill in an online dental environment stress (DES) questionnaire. Analysis was conducted using Mann-Whitney U test, independent t-test, χ2 test, and Spearman ρ rank correlations. Statistical significance was inferred when P < .05.

Results: Fourth-year students reported higher levels of nervousness before treating patients for the first time. Fifth-year students faced more difficulty, higher stress, and/or fear regarding the amount of assigned work, provided treatment, completed requirements, failing the course, time to finish assignments, patient comprehensive care, and financial expenses of the course. Comparison between groups revealed that the fifth-year students scored higher levels of stress on the total DES score and all partial DES scores. Furthermore, the total DES questionnaire scores were significantly correlated with grade point average (GPA) among the total study sample and the prosthodontics clinical course marks among the fourth-year students’ group.

Conclusions: The stress level among students in clinical courses was influenced by their academic performance, gender, year level, and the type and time needed for the provided treatment. Completing course requirements was among the most commonly faced stressors. Future research endeavors might be considered to study each clinical factor, its impact on students’ stress level, and how to manage and positively improve these factors.
Integration of pharmacodynamics and metabolomics to reveal rhubarb anthraquinone protection against nonalcoholic fatty liver disease rat model
Authors: Zhang Fang , Wu Rui , Liu Yanfang , Dai Shu , Gong Xiaohong , Li Yunxia
Published: February 2024

Objectives

The objective of the present study was to investigate the effect of Rhubarb anthraquinone (RA) on a high-fat diet (HFD)-induced nonalcoholic fatty liver disease (NAFLD) rat model, and explore potential biomarker and metabolic pathways by using the metabolomics method.

Materials and methods

We established HFD rats as the NAFLD model. Forty Sprague–Dawley rats were randomly divided into a control group, model group, RA low-dose group, RA medium-dose group, and RA high-dose group, and evaluated the protective effect of RA on NAFLD by detecting biochemical indicators of serum and pathological changes of liver tissue. Investigating potential biomarkers and metabolic pathways connected with RA’s protective effects against NAFLD by UHPLC–Q-TOF-MS untargeted metabolomics.

Results

The results showed that RA significantly reversed the increase of TG, TC, ALT, AST, and ALP (P < .05), the decrease of HDL-C (P < .05), and alleviated pathological conditions in NAFLD rats. Based on potential biomarker analysis, RA affected metabolic pathways such as fatty acids biosynthesis, bile acids biosynthesis, and pentose phosphate pathway, delaying the progression of NAFLD.

Conclusion

RA improved blood lipid levels, liver function, and pathological conditions of NAFLD rats. Meanwhile, affected the metabolic pathways and regulated the synthesis of fatty acids and bile acids in NAFLD rats.
‘Bit’ off more than he could chew: asymptomatic foreign body in the appendix
Authors: Waarala Zachary M S , Santucci Christopher , Sandberg Jay H
Published: February 2024

This report details the case of a 69-year-old male who had presented to the emergency department at the suggestion of his dentist after ingesting a diamond-tipped drill bit during a routine dental procedure. Through the use of radiograph, computed tomography, and colonoscopy, the drill bit was determined to be lodged in the distal vermiform appendix. Throughout his clinical course, the patient remained asymptomatic but was monitored closely for signs of complications of a retained foreign body in the appendix. Gastroenterology and general surgery were consulted on the case but ultimately non-surgical approaches prevailed and the drill bit passed in the stool. This patient’s case highlights the success of noninvasive measures for appendiceal foreign body removal.
Interacting galaxies in the IllustrisTNG simulations – VII: the connection between the most luminous active galactic nuclei and galaxy interactions
Authors: Byrne-Mamahit Shoshannah , Patton David R , Ellison Sara L , Bickley Robert , Ferreira Leonardo , Hani Maan , Quai Salvatore , Wilkinson Scott
Published: February 2024

We investigate the connection between the most luminous active galactic nuclei (AGN), galaxy pairs, and post-mergers in the IllustrisTNG simulation. We select galaxy pairs and post-mergers with a mass ratio between 1:10 < μ < 1:1 and a redshift between 0 < z < 1. We compare the incidence of luminous AGN in pairs with matched non-pair controls, finding that AGN with luminosity Lbol > 1044 erg s−1 occur in ∼26 per cent of paired galaxies with a companion within 20 kpc, compared with ∼14 per cent in controls (a fractional excess of ∼2). The enhancement of AGN in galaxy pairs is luminosity dependent, with the highest excess (a factor of ∼6 ± 2 at the closest separations) for AGN with Lbol > 1045 erg s−1. Additionally, pairs exhibit a modest yet statistically significant excess of luminous AGN up to ∼150 kpc in separation. For pairs which merge between 0 < z < 1, AGN fractions are elevated between 1.5 Gyr before and after coalescence, with the highest excess closest to coalescence. Our results indicate that pre-coalescence interactions drive excesses of luminous AGN, but that luminous AGN in galaxy pairs are not ubiquitous. Finally, we investigate what fraction of AGN can be associated with an interaction (either having a companion within 100 kpc or a merger within the last 500 Myr). For AGN with Lbol > 1045 erg s−1, ∼55 per cent are interacting, compared with a 30 per cent interaction fraction in AGN with 1044 < Lbol < 1044.5 erg s−1. Our results support a picture in which interactions play a dominant role in (but are not the sole cause of) triggering the most luminous AGN.
Time resolved spectroscopy of a GRS 1915 + 105 flare during its unusual low state using AstroSat
Authors: Boked Sajad , Maqbool Bari , V Jithesh , Misra Ranjeev , Bhat Naseer I , Bhulla Yashpal
Published: February 2024

Since its discovery in 1992, GRS 1915 + 105 has been among the brightest sources in the X-ray sky. However, in early 2018, it dimmed significantly and has stayed in this faint state ever since. We report on AstroSat and NuSTAR observation of GRS 1915 + 105 in its unusual low/hard state during 2019 May. We performed time-resolved spectroscopy of the X-ray flares observed in this state and found that the spectra can be fitted well using highly ionized absorption models. We further show that the spectra can also be fitted using a highly relativistic reflection dominated model, where for the lamp post geometry, the X-ray emitting source is always very close to the central black hole. For both interpretations, the flare can be attributed to a change in the intrinsic flux, rather than dramatic variation in the absorption or geometry. These reflection dominated spectra are very similar to the reflection dominated spectra reported for active galactic nuclei in their low flux states.
Lineage-determining transcription factor-driven promoters regulate cell type-specific macrophage gene expression
Authors: Nagy Gergely , Bojcsuk Dóra , Tzerpos Petros , Cseh Tímea , Nagy László
Published: February 2024

Mammalian promoters consist of multifarious elements, which make them unique and support the selection of the proper transcript variants required under diverse conditions in distinct cell types. However, their direct DNA-transcription factor (TF) interactions are mostly unidentified. Murine bone marrow-derived macrophages (BMDMs) are a widely used model for studying gene expression regulation. Thus, this model serves as a rich source of various next-generation sequencing data sets, including a large number of TF cistromes. By processing and integrating the available cistromic, epigenomic and transcriptomic data from BMDMs, we characterized the macrophage-specific direct DNA-TF interactions, with a particular emphasis on those specific for promoters. Whilst active promoters are enriched for certain types of typically methylatable elements, more than half of them contain non-methylatable and prototypically promoter-distal elements. In addition, circa 14% of promoters—including that of Csf1r—are composed exclusively of ‘distal’ elements that provide cell type-specific gene regulation by specialized TFs. Similar to CG-rich promoters, these also contain methylatable CG sites that are demethylated in a significant portion and show high polymerase activity. We conclude that this unusual class of promoters regulates cell type-specific gene expression in macrophages, and such a mechanism might exist in other cell types too.
RNAvigate: efficient exploration of RNA chemical probing datasets
Authors: Irving Patrick S , Weeks Kevin M
Published: February 2024

Chemical probing technologies enable high-throughput examination of diverse structural features of RNA, including local nucleotide flexibility, RNA secondary structure, protein and ligand binding, through-space interaction networks, and multistate structural ensembles. Deep understanding of RNA structure–function relationships typically requires evaluating a system under structure- and function-altering conditions, linking these data with additional information, and visualizing multilayered relationships. Current platforms lack the broad accessibility, flexibility and efficiency needed to iterate on integrative analyses of these diverse, complex data. Here, we share the RNA visualization and graphical analysis toolset RNAvigate, a straightforward and flexible Python library that automatically parses 21 standard file formats (primary sequence annotations, per- and internucleotide data, and secondary and tertiary structures) and outputs 18 plot types. RNAvigate enables efficient exploration of nuanced relationships between multiple layers of RNA structure information and across multiple experimental conditions. Compatibility with Jupyter notebooks enables nonburdensome, reproducible, transparent and organized sharing of multistep analyses and data visualization strategies. RNAvigate simplifies and accelerates discovery and characterization of RNA-centric functions in biology.
A Seminested PCR Method for the Diagnosis of Invasive Fungal Infections in Combat Injured
Authors: Ellis Graham C , Shaikh Faraz , Carson M Leigh , Sercy Erica , Stewart Laveta , Andrews Jared M , Campbell Wesley R , Mende Katrin , Yabes Joseph M , Tribble David R , Bialek Ralf , Wickes Brian L , Ganesan Anuradha
Published: February 2024

Background

Among combat injured, invasive fungal infections (IFIs) result in significant morbidity. Cultures and histopathology are the primary diagnostic methods for IFIs, but they have limitations. We previously evaluated a panfungal polymerase chain reaction assay, which was 83% sensitive and 99% specific for angioinvasive IFIs. Here, we evaluated 3 less resource-intensive seminested assays targeting clinically relevant fungi in the order Mucorales and genera Aspergillus and Fusarium.

Methods

Formalin-fixed paraffin-embedded tissue specimens from a multicenter trauma IFI cohort (2009-2014) were used. Cases were US military personnel injured in Afghanistan with histopathologic IFI evidence. Controls were patients with similar injury patterns and no laboratory IFI evidence (negative culture and histopathology). Seminested assays specific to Mucorales (V4/V5 regions of 18S rDNA), Aspergillus (mitochondrial tRNA), and Fusarium (internal transcribed spacer [ITS]/28A regions of DNA) were compared with a panfungal assay amplifying the internal transcribed spacer 2 region of rDNA and to histopathology.

Results

Specimens from 92 injury sites (62 subjects) were compared with control specimens from 117 injuries (101 subjects). We observed substantial agreement between the seminested and panfungal assays overall, especially for the order Mucorales. Moderate agreement was observed at the genus level for Aspergillus and Fusarium. When compared with histopathology, sensitivity and specificity of seminested assays were 67.4% and 96.6%, respectively (sensitivity increased to 91.7% when restricted to sites with angioinvasion).

Conclusions

Prior studies of seminested molecular diagnostics have focused on culture-negative samples from immunocompromised patients. Our findings underscore the utility of the seminested approach in diagnosing soft-tissue IFIs using formalin-fixed paraffin-embedded tissue samples, especially with angioinvasion.
Irrigation strengthens climate resilience: Long-term evidence from Mali using satellites and surveys
Authors: BenYishay Ariel , Sayers Rachel , Singh Kunwar , Goodman Seth , Walker Madeleine , Traore Souleymane , Rauschenbach Mascha , Noltze Martin
Published: February 2024

Agriculture in the Sahel and much of sub-Saharan Africa remains to a large extent rainfed. At the same time, climate change is already causing less predictable rainfall patterns in the region, even as rising temperatures increase the amount of water needed for agricultural production. We assess to what extent irrigation can strengthen the climate resilience of farming communities. Our study sample consists of nearly 1,000 distinct locations in Mali in which small-scale, river-based irrigation was introduced over the past two decades, as weather conditions worsened and political upheaval erupted. Using the staggered roll-out of the irrigation and repeated observations over 20 years allows us to compare the pre- and postirrigation outcomes of locations while adjusting for confounding factors. We geospatially link data on irrigation interventions with agricultural conditions measured using satellite imagery and surveys, as well as child nutrition and health outcomes and conflict event data. Using a two-way fixed effects model to quasi-experimentally estimate counterfactual outcomes, we find that the introduction of irrigation led to substantial increases in agricultural production on supported fields, with these gains persisting even a decade later. Children in nearby communities are less likely to be stunted or wasted due to the irrigation, and conflict risks decrease in the closest communities. Some of these gains are offset by worsening conditions farther away from the newly installed irrigation. These findings suggest that, even with political conflicts in semi-arid areas already increasing, sustainable irrigation may offer a valuable tool to improve communities' long-term well-being and social cohesion.
Disease activity–guided dose optimization including discontinuation of TNF inhibitors in rheumatoid arthritis is effective for up to 10 years: an observational follow-up of the DRESS study
Authors: van der Togt Céleste J T , den Broeder Nathan , Boonstra Marleen S , van der Maas Aatke , den Broeder Alfons A , van Herwaarden Noortje
Published: February 2024

Objective

The objective of this study was to investigate the safety and effectiveness of disease activity–guided dose optimization of TNF inhibitors in RA over 10 years.

Methods

The study involved an observational long-term extension of a randomized study of participants who completed the 3-year extension of the DRESS-study. After the randomized phase (months 0–18), disease activity–guided dose optimization was allowed for all. The main outcomes were mean time-weighted DAS28-CRP; biologic and targeted synthetic DMARD (b/tsDMARD) use per year, as proportion of daily defined dose; proportion of patients reaching discontinuation; durability and effectiveness of subsequent dose reduction attempts; and radiographic progression between years 3 and 10 using the Sharp–van der Heijde score.

Results

A total of 170 patients were included, of whom 127 completed the 10-year follow-up. The mean disease activity remained low (DAS28-CRP 2.13, 95% CI 2.10–2.16), while the b/tsDMARD dose reduced from 97% at baseline (95% CI 96–99%, n = 170) to 56% at year 10 (95% CI 49–63%, n = 127). Of 161 participants with an optimization attempt, 119 (74%) reached discontinuation with a median duration of 7 months (interquartile range 3–33 months), and 25 participants never had to restart their b/tsDMARD (21%, 95% CI 14–29%). The mean dose reduction after dose optimization was 48% (n = 159) for the first optimization attempt, and 33% for a subsequent attempt (n = 86). Of the 86 participants, 41 (48%) had radiographic progression exceeding the smallest detectable change (5.7 units), and progression was associated with disease activity, not b/tsDMARD use.

Conclusion

Long-term disease activity–guided dose optimization of TNF inhibitors in RA, including discontinuation and multiple tapering attempts, remains safe and effective.
Correlation between surgical booking by a PA and surgical procedure performed
Authors: Gandhi Deep A. , Colón-Sanchez Kaity , Ellsworth Pamela
Published: February 2024

Objective:

This study evaluated the concordance between clinical evaluation and diagnosis by a physician associate/assistant (PA) and the preoperative and intraoperative evaluations by a pediatric urologic surgeon.

Methods:

A retrospective chart review was performed for patients independently evaluated and scheduled for surgery by a single PA between 2017 and 2020. Concordance was measured by comparing the PA's office note with the surgeon's preoperative note and operative report.

Results:

Of the 242 patients scheduled for surgery, 11 underwent an operative report procedure change and 11 others underwent a preoperative note procedure change. Concordance increased from 89.09% in 2017 to 92.31% in 2020; this was not statistically significant (P = .230). Urologic conditions evaluated demonstrated an increase in the variety and complexity of conditions.

Conclusions:

A supervisory/collaborative model involving a well-trained PA yields excellent outcomes in terms of concordance with surgical scheduling and procedure performed.
Managing heartburn and reflux in primary care
Authors: Provenza Delaney , Gillette Christopher , Peacock Brian , Rejeski Jared
Published: February 2024

This article describes an algorithmic approach to caring for patients presenting with heartburn and reflux, including empiric treatment with acid-suppression therapy and a data-driven approach to diagnostic testing. This article also reviews the efficacy and safety profile of the widely available and commonly used proton pump inhibitors. Refining our approach to diagnostic testing can reduce time to diagnosis, better control patients' symptoms, and limit complications of longstanding disease.
Peer feedback
Authors: Gallant Alexandra , Erdman Laura , McBeth Lauren , Ngov Li-Kheng , Misky Gregory
Published: February 2024

The increasing use of physician associates/assistants (PAs) and NPs on clinical teams creates an opportunity for colleagues to provide feedback that can drive growth and improvement in PA and NP clinical skills. Through a needs assessment, month-long pilot, and buy-in from our academic hospital medicine group, we initiated a peer feedback platform that sought to highlight individual faculty strengths, facilitate thoughtful and constructive feedback, and create effective collaboration among colleagues. Three months after implementation, results indicated that the platform provided important information on clinical skills and identified areas for growth and opportunities for additional training. Peer feedback can also improve working relationships among PAs, NPs, and physicians by highlighting the clinical skill sets and value of all team members.
Uterine Sacculation With Entrapped Placenta After Delivery
Authors: Solotke Michael T. , Boyles Glenn , Rood Kara , Hinchcliff Emily , Horowitz Jeanne M. , Yee Lynn M.
Published: February 2024

BACKGROUND:

Uterine sacculation refers to a temporary pouch or sac within the uterus that may contain the placenta or fetal parts and that may be diagnosed antepartum or after delivery. There is very limited published information about this rare condition and its management.

CASES:

We report two cases of uterine sacculation with entrapped placenta diagnosed immediately postpartum, managed with two different approaches. In one case, the patient underwent immediate laparotomy and placental extraction. In the second case, the patient was managed conservatively but ultimately developed signs of infection and underwent laparotomy.

CONCLUSION:

Uterine sacculation with entrapped placenta is a rare condition that is a potential etiology of retained placenta. Obstetric clinicians should be aware of this diagnosis and the management strategies available.
Barriers and Facilitators to Collecting Surgical Outcome Data in Low- and Middle-Income Countries: An International Survey
Authors: Diehl Thomas , Jaraczewski Taylor J. , Ahmed Kaleem Sohail , Khan Muhammad Rizwan , Harrison Ewen M. , Abebe Belay Mellese , Latif Asad , Mughal Nabiha , Khan Sadaf , McQueen K. A. Kelly , Tefera Girma , Zafar Syed Nabeel
Published: February 2024

Background:

Perioperative data are essential to improve the safety of surgical care. However, surgical outcome research (SOR) from low- and middle-income countries (LMICs) is disproportionately sparse. We aimed to assess practices, barriers, facilitators, and perceptions influencing the collection and use of surgical outcome data (SOD) in LMICs.

Methods:

An internet-based survey was developed and disseminated to stakeholders involved in the care of surgical patients in LMICs. The Performance of Routine Information Systems Management framework was used to explore the frequency and relative importance of organizational, technical, and behavioral barriers. Associations were determined using χ
2 and ANOVA analyses.

Results:

Final analysis included 229 surgeons, anesthesia providers, nurses, and administrators from 36 separate LMICs. A total of 58.1% of individuals reported that their institution had experience with collection of SOD and 73% of these reported a positive impact on patient care. Mentorship and research training was available in <50% of respondent’s institutions; however, those who had these were more likely to publish SOD (P = 0.02). Sixteen barriers met the threshold for significance of which the top 3 were the burden of clinical responsibility, research costs, and accuracy of medical documentation. The most frequently proposed solutions were the availability of an electronic data collection platform (95.3%), dedicated research personnel (93.2%), and access to research training (93.2%).

Conclusions:

There are several barriers and facilitators to collection of SOD that are common across LMICs. Most of these can be addressed through targeted interventions and are highlighted in this study. We provide a path towards advancing SOR in LMICs.
Physical Therapy Utilization After Single-level Posterior Lumbar Fusion
Authors: Gouzoulis Michael J. , Moran Jay , Jeong Seongho , Galivanche Anoop R. , Kammien Alexander J. , Jabbouri Sahir S. , Grauer Jonathan N.
Published: February 2024

Study Design.

Retrospective cohort study.

Objective.

Characterize physical therapy (PT) utilization following single-level posterior lumbar fusion (PLF).

Summary of Background Data.

PLF is a common procedure that is increasing in frequency. After such surgeries, PT may be considered to facilitate mobilization and return to activities. However, the usage of such therapy has not been well-characterized in the literature.

Materials and Methods.

Patients undergoing single-level PLF were identified from the 2010 to 2021 PearlDiver administrative database. These patients were stratified based on usage of therapy, homeversusoutpatient therapy, and timing of therapy within the year after surgery. To determine predictors of therapy, patient characteristics were determined and multivariable regressions were performed.

Results.

A total of 213,240 patients undergoing single-level PLF were identified, of which therapy was done in the year after surgery for 63,231 (29.0%, of which home therapy accounted for 16.5% of therapy visits). Of those who utilized PT, the average number of visits was 10.6±10.6. Home therapy peaked within the first month after surgery and outpatient therapy peaked at month two. Factors associated with any PT following PLF in decreasing odds ratio (OR) were having commercial insurance (OR: 1.68), being from the Northeast (OR: 1.41), age (OR: 1.13 for 70+ of age) female sex (OR: 1.09), and ECI (OR: 1.04 per point) (P<0.001 for all). Of those who received therapy, factors associated with home PT utilization were being from the Northeast (OR: 2.55), age (OR: 1.91 for 70+ of age), Medicaid insurance (OR: 1.48), female sex (OR: 1.39), and interbody fusion (OR:1.07) (P<0.001 for all).

Conclusions.

After single-level PLF, the minority of patients received home or outpatient PT. Of those who did, there was significant variation in the number of visits, with nonmedical factors such as insurance plan and geographic region being strongly associated suggesting room for more consistent practice patterns.

Level of Evidence:

Level 3.
Avelumab in the Treatment of Advanced Merkel Cell Carcinoma: A Systematic Review
Authors: Sharma Ajay N. , Shah Karishma S. , Sharma Aditi A. , Yu Siegrid S.
Published: February 2024

BACKGROUND

Avelumab, a programmed death ligand-1 inhibitor, has shown success in providing durable responses for difficult-to-treat Merkel cell carcinomas (MCCs).

OBJECTIVE

Evaluate the efficacy and safety of avelumab in the treatment of advanced MCC.

METHODS

Studies reporting the use of avelumab as a monotherapy or in combination with other agents in the treatment of stage III or IV (advanced) MCC were included. The primary outcomes were overall response rate, overall survival (OS), and treatment-related adverse events.

RESULTS

A total of 48 studies were included, involving 1,565 patients with advanced MCC. Most patients were male (1,051, 67.3%) with stage IV MCC (517, 97.0%). The overall response rate was 46.1% (partial response—25.4% and complete response—20.7%) after a mean follow-up period of 9.5 months. Kaplan–Meier survival curves for the pooled stage III and IV group demonstrated OS rates of 58% at 1 year, 47% at 2 years, and 28% at 5 years after completion of treatment with avelumab (median OS: 23.1 months). The most common treatment-related adverse events consisted of constitutional (44%), gastrointestinal (19%), and dermatologic (12%) symptoms.

CONCLUSION

Avelumab monotherapy and combination therapy have shown success in the overall response rate and survival for patients with advanced MCC.
Dexamethasone Mesotherapy: An Alternative for Keloid Treatment in Hispanic Skin
Authors: Carvajal Jenny , Carvajal Melissa
Published: February 2024

The incidence of keloids in individuals with skin of color is as high as 16%. Intralesional steroid injection is recommended as a first-line treatment, even though the outcomes are often suboptimal. Histologically, the keloid epidermal layer is thicker than in normal skin, and the vascular density is higher in the marginal area at subepidermal level due to the elevated expression of vascular endothelial growth factor. Dexamethasone significantly suppresses this proangiogenic cytokine compared with Triamcinolone. We report the case of a 32-year-old phototype VI man with a 6-month-history of a keloid on the dorsum of his right hand that caused functional and cosmetic morbidity. We performed an intralesional injection of dexamethasone using a mesotherapy technique, that led to significant shrinking and complete recovery of range of motion after two sessions, with no regrowth at the 1-year follow-up. Mesotherapy is a safe and easy technique used in cosmetic medicine, which allows for a slower diffusion of dexamethasone and prolongs its pharmacological action, reducing the risk of local side effects. This technique has the potential to be standardized, but its main drawback is the need for proper sedation. Randomized clinical trials are required to further evaluate the clinical efficacy of dexamethasone mesotherapy.
Use of In Vivo Corneal Confocal Microscopy to Guide Excimer Laser With Adjunctive Mitomycin C for Treatment of Recalcitrant Acanthamoeba Keratitis
Authors: Kaiser Klemens Paul , Wissiak Elfriede , Daas Loay , Walochnik Julia , Ardjomand Navid
Published: February 2024

Purpose:

The aim of this study was to describe 3 cases of recalcitrant Acanthamoeba keratitis (AK) that were successfully treated using in vivo corneal confocal microscopy (IVCM) to guide excimer laser ablation depth with adjunctive mitomycin C 0.02%.

Methods:

Three patients diagnosed with AK did not respond to several weeks of intensive topical therapy with antiamoebic agents. The patient underwent phototherapeutic keratectomy with topical mitomycin C 0.02% application. The maximum stromal depth of cysts measured by IVCM was 80 μm, 100 μm, and 240 μm, and the stromal ablation depths were 80 μm, 100 μm, and 100 μm, respectively.

Results:

In all 3 eyes, AK resolved after a single excimer laser application, and topical treatment was gradually discontinued within 6 weeks afterward. In 1 eye, penetrating corneal transplantation was performed 6 weeks after phototherapeutic keratectomy because of ongoing severe corneal pain. IVCM and histology of the corneal transplant did not reveal any Acanthamoeba cysts within the excised corneal button. No recurrence was observed during the follow-up period of 19 to 34 months.

Conclusions:

IVCM-guided phototherapeutic keratectomy with mitomycin C 0.02% seems to be a safe and successful approach for the treatment of AK, especially in cases of resistance to topical treatment. Corneal IVCM should be performed before laser application to measure cyst depth, determine ablation depth, and assess postoperative treatment success.
The Incidence of Strabismus After Upper and Lower Blepharoplasty in the United States
Authors: Oke Isdin , Elze Tobias , Miller Joan W. , Lorch Alice C. , Hunter David G. , Freitag Suzanne K. , Dagi Linda R. ,   on behalf of the IRIS® Registry Analytic Center Consortium
Published: February 2024

Purpose:

To compare the incidence of strabismus after upper and lower blepharoplasty in the United States.

Methods:

Retrospective cohort study of adults (age ≥18 years) in the IRIS Registry (Intelligent Research in Sight) who underwent blepharoplasty between January 1, 2013 and December 31, 2020. The primary outcome was the Kaplan–Meier estimated cumulative incidence of strabismus diagnosis and surgery within 3 years of blepharoplasty. Multivariable Cox regression was used to determine the association of blepharoplasty type with strabismus diagnosis and surgery, adjusting for patient age, sex, and geographic region.

Results:

Blepharoplasty was performed in 368,623 patients (median [interquartile range] age, 69 [63–75] years, and 69% female). Compared with those undergoing upper eyelid blepharoplasty, patients treated with lower eyelid blepharoplasty were slightly younger (median age, 66 vs. 69 years; p < 0.001) and more likely to be female (71% vs. 69%; p < 0.001). There was a greater 3-year incidence of strabismus diagnosis (2.0% vs. 1.5%; p < 0.001) and a greater 3-year incidence of strabismus surgery (0.15% vs. 0.06%; p = 0.003) for individuals undergoing lower vs. upper blepharoplasty. After adjusting for age, sex, and geographic region, lower blepharoplasty was associated with a higher 3-year risk of strabismus diagnosis (HR, 1.49; 95% CI, 1.23–1.81; p < 0.001) and surgery (HR, 2.53; 95% CI, 1.27–5.03; p = 0.008).

Conclusions:

This registry-based analysis found that individuals undergoing lower eyelid blepharoplasty were at higher risk of strabismus compared with those undergoing upper eyelid blepharoplasty. Using large databases to understand the incidence of complications of frequently performed procedures may improve ophthalmologists’ ability to provide data-driven counseling on surgical risks prior to intervention.
Blepharotomy Versus Levator Recession With Adjustable Sutures for Correction of Upper Eyelid Retraction in Thyroid Eye Disease
Authors: Ueland Hans Olav , Halsøy Kathrine , Rødahl Eyvind
Published: February 2024

Purpose:

To compare outcome, complications and surgical time of blepharotomy versus levator recession with adjustable sutures (LRWAS) for correction of upper eyelid retraction in thyroid eye disease.

Methods:

In the period 2019–2023, we performed a prospective randomized comparative study between blepharotomy and LRWAS. We examined patients, recorded time consumption, and obtained photographs preoperatively, 1 day, 1 week, 3 months, and 6 months after surgery. Outcome was categorized according to Mourits and Sasim`s classification from 1999 (perfect–acceptable–unacceptable).

Results:

A total of 30 patients (25 women) with a median (range) age of 51.5 (34–74) years at surgery were included. A significant different (p < 0.01) median operation time was found between blepharotomy (41.5 (17–105) minutes) and LRWAS (68 (35–101) minutes). Median time from operation to last examination was 6 (6–18) months. Fifteen patients (24 eyelids) were operated with blepharotomy and 15 patients (25 eyelids) with LRWAS. Preoperative median margin reflex distance 1 was 6.5 (5–8) mm, and at final visit, median margin reflex distance 1 was 3.5 (3–4) mm after blepharotomy and 3.5 (2–5.5) mm after LRWAS. Reoperation was performed in 11 eyelids, 10 due to overcorrection and 1 because of a residual retraction. Significantly more eyelids needed reoperation after LRWAS (n = 9) compared with blepharotomy (n = 2). At final examination, a perfect or acceptable result was found in 14 (93%) patients after both procedures. Significantly shorter total duration of all visits was observed after treatment with blepharotomy (50 (35–70) minutes) compared with LRWAS (65 (40–115) minutes). Wound dehiscence occurred in 1 patient after blepharotomy, and 1 postoperative infection was observed after LRWAS.

Conclusion:

We demonstrate equally high success rates after blepharotomy and LRWAS for correcting upper eyelid retraction in thyroid eye disease, but blepharotomy is less time-consuming and implies fewer reoperations.
Lens capsule pathological characteristics in cases of intraocular lens dislocation with atopic dermatitis
Authors: Komatsu Koji , Masuda Yoichiro , Iwauchi Ai , Kubota Hoshiho , Iida Masanobu , Ichihara Kosuke , Iwamoto Masami , Kawai Kenji , Yamamoto Naoki , Shimoda Masayuki , Nakano Tadashi
Published: February 2024

Purpose:

To explore lens capsule pathological characteristics in intraocular lens (IOL) dislocation after cataract surgery in patients with atopic dermatitis (AD).

Setting:

University hospital department of ophthalmology.

Design:

Case series with clinicopathological correlations.

Methods:

Lens capsules and surrounding tissues excised during surgery from eyes with AD (AD group) and eyes without AD (non-AD group) with IOL dislocation were histologically evaluated. Hematoxylin and eosin staining was used to assess abnormal changes in lens epithelial cells (LECs). Masson trichrome staining distinguished the fibrous metaplasia around the lens capsule into high-density and low-density fibrosis. Capsular splitting (thinning) was identified in both stained preparations.

Results:

The IOL dislocation morphology in the AD group (10 eyes of 10 patients) included 7 cases of capsular bag dislocation (CBD) and 3 cases of dead bag syndrome (DBS), with an average duration to IOL dislocation of 11.5 ± 5.6 years. All patients in the non-AD group (12 eyes of 12 patients) had CBD, averaging 10.2 ± 5.7 years to dislocation. Abnormal LECs, low-density fibrosis, and capsular splitting were observed in 9 (90), 9 (90), and 6 (60) of the patients in the AD group compared with 6 (50), 3 (25), and 2 (18), respectively, in the non-AD group (total n [%]).

Conclusions:

Compared with the non-AD group, the AD group exhibited higher frequencies of morphological changes in LECs, low-density fibrosis around the lens capsule, and capsular splitting characteristics of DBS. These results suggest LEC degeneration and increased lens capsule fragility occurred in patients with AD.
Mesopic pupil indices as potential risk factors for glare disability after intraocular implantable collamer lens implantation: prospective study
Authors: Xiong Jian , Xu Jingjing , Zhou Mengyun , Liu Jie , Wang Qing , Yin Xiaolong , Deng Yan , Luo Xiao , Wang Nanye , Gui Fu , Yu Kang , Liu Jueling , Zhu Zeyu , Cheng Chiwen , Yu Yifeng
Published: February 2024

Purpose:

To explore the influence of preoperative factors, including varying pupil sizes and refractive attributes, on postoperative glare disability in patients undergoing implantable collamer lens (ICL) implantation.

Setting:

Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China.

Design:

Prospective observational study.

Methods:

The preoperative ocular characteristics and 6-month postoperative glare status in eligible patients who underwent EVO-Visian ICL V4c (VICMO) implantation were analyzed. The glare disability criteria encompassed a glare symptom score >6 and glare sensitivity exceeding 1:2.7. Logistic regression analysis was used to explore the relationship between the preoperative ocular parameters and post-ICL glare.

Results:

The study included 95 patients (mean age, 26.04 ± 6.29 years), comprising 30 men (58 eyes) and 65 women (129 eyes). Multivariate analysis revealed a significant correlation between postoperative glare disability and increased spherical power in preoperative mesopic pupils (β = −0.124, P = .039), as well as elevated cylinder power in preoperative mesopic (β = −0.412, P = .009) and photopic pupils (β = −0.430, P = .007). Moreover, a larger preoperative mesopic pupil diameter (β = 0.561, P = .005) demonstrated a significant correlation with glare disability.

Conclusions:

Preoperative mesopic pupil dimensions and associated refractive parameters, such as sphere and cylinder, were correlated with glare disability, including the cylinder aspect in photopic pupils, which can assist clinicians in optimizing preoperative selection for ICL implantation, aiding in the anticipation of potential glare disability risks.
Update on gepants for the treatment of chronic migraine
Authors: Aoh Yu , Hou Tsung-Wei , Yang Cheng-Chia , Chang Ching-Mao , Chen Shih-Pin , Tsai I-Ju , Cheng Chin-Wen , Yang Chun-Pai
Published: February 2024

Chronic migraine (CM) is a profoundly debilitating condition that has detrimental clinical and social outcomes. Over the past two decades, novel small-molecule calcitonin gene-related peptide (CGRP) receptor antagonists, known as gepants, and CGRP monoclonal antibodies (mAbs) have been developed, ushering in a new era of migraine-specific treatment. In this review, we discuss the literature investigating the role of gepants for the treatment of CM. Numerous completed and ongoing clinical studies have conclusively demonstrated the safety, tolerability, and efficacy of several gepants for the acute treatment of migraine. However, preventive trials involving gepants have focused on patients with episodic migraine, with atogepant being the only gepant approved for CM prevention by the US Food and Drug Administration at the time of writing. Although some preliminary positive results have been reported, further research is still required to achieve additional advancements in the future. In summary, the effectiveness of gepants for treating individuals with CM are highly expected. This review highlights the development and current progress of gepants for the treatment of CM, focusing both on their role as acute abortive agents and preventive measures and on their concomitant use with other antimigraine medications, such as CGRP mAbs or triptans.
A Novel Likely Pathogenic Variant in NOTCH1 Associated With Primary Lymphedema
Authors: Holcroft Lorna , Mc Aleer Maeve , Irvine Alan
Published: February 2024

Lymphedema is a chronic condition characterized by the accumulation of lymphatic fluid in interstitial and fibro-adipose tissues. Primary lymphedema that arises from intrinsic defects in the lymphatic system is a rare form of lymphedema with a variable age of onset and heterogeneous presentation. Although a number of genetic variants have been identified and matched to corresponding phenotypes, a genetic cause for lymphedema is found in less than 30% of individuals with primary lymphedema. Recently, Michelini et al proposed NOTCH1 as a candidate gene for primary lymphedema, having identified missense variants in NOTCH1 in 7 of 235 patients with primary lymphedema for whom no causative gene had previously been identified. We report the case of a young female who developed bilateral primary lower limb lymphedema and on genetic testing was found to have a previously unreported heterozygous frameshift variant in the NOTCH1 gene predicting loss of function.
Evaluation of transrectal ultrasound-guided tru-cut biopsy as a complementary method for predicting pathological complete response in rectal cancer after neoadjuvant treatment: a phase II prospective and diagnostic trial
Authors: Huang Yaoyi , Xie Yumo , Wang Puning , Chen Yao , Qin Si , Li Fangqian , Wu Yuanhui , Huang Mingzhe , Hou Zehui , Cai Yonghua , He Xiaosheng , Lin Hongcheng , Hu Bang , Qin Qiyuan , Ma Tenghui , Tan Shuyun , Liao Yi , Ke Jia , Zhang Di , Lai Sicong , Jiang ZhiPeng , Wang Huaiming , Xiang Jun , Cai Zerong , Wang Hui , He Xiaowen , Yang Zuli , Ren Donglin , Wu Xiaojian , Hong Yisong , Huang Meijin , Luo Yanxin , Liu Guangjian , Lin Jinxin
Published: February 2024

Importance:

Patients with pathological complete response (pCR) of rectal cancer following neoadjuvant treatment had better oncological outcomes. However, reliable methods for accurately predicting pCR remain limited.

Objective:

To evaluate whether transrectal ultrasound-guided tru-cut biopsy (TRUS-TCB) adds diagnostic value to conventional modalities for predicting pathological complete response in patients with rectal cancer after neoadjuvant treatment.

Design, setting, and participants:

This study evaluated data of patients with rectal cancer who were treated with neoadjuvant treatment and reassessed using TRUS-TCB and conventional modalities before surgery. This study is registered with ClinicalTrials.gov.

Main outcomes and measures:

The primary outcome was accuracy, along with secondary outcomes including sensitivity, specificity, negative predictive value, and positive predictive value in predicting tumour residues. Final surgical pathology was used as reference standard.

Results:

Between June 2021 and June 2022, a total of 74 patients were enroled, with 63 patients ultimately evaluated. Among them, 17 patients (28%) exhibited a complete pathological response. TRUS-TCB demonstrated an accuracy of 0.71 (95% CI, 0.58–0.82) in predicting tumour residues. The combined use of TRUS-TCB and conventional modalities significantly improved diagnostic accuracy compared to conventional modalities alone (0.75 vs. 0.59, P=0.02). Furthermore, TRUS-TCB correctly reclassified 52% of patients erroneously classified as having a complete clinical response by conventional methods. The occurrence of only one mild adverse event was observed.

Conclusions and relevance:

TRUS-TCB proves to be a safe and accessible tool for reevaluation with minimal complications. The incorporation of TRUS-TCB alongside conventional methods leads to enhanced diagnostic performance.
Metagenomic next-generation sequencing, instead of procalcitonin, could guide antibiotic usage in patients with febrile acute necrotizing pancreatitis: a multicenter, prospective cohort study
Authors: Lin Chiayen , Li Jiarong , Liu Baiqi , Hong Xiaoyue , Luo Tao , Ye Jinsong , Yu Yi , Peng Xinran , Gou Shanmiao , Tang Huayong , Yuan Tongli , Luo Jianguan , Yang Ming , Feng Bin , Zhao Zhijian , Ning Caihong , Sun Zefang , Zhu Shuai , Chen Lu , Shen Dingcheng , Huang Gengwen
Published: February 2024

Backgrounds:

The effectiveness of procalcitonin-based algorithms in guiding antibiotic usage for febrile acute necrotizing pancreatitis (ANP) remains controversial. Metagenomic next-generation sequencing (mNGS) has been applied to diagnose infectious diseases. We aimed to evaluate the effectiveness of blood mNGS in guiding antibiotic stewardship for febrile ANP.

Materials and Methods:

The prospective multicenter clinical trial was conducted at seven hospitals in China. Blood samples were collected during fever (T ≥38.5°C) from ANP patients. The effectiveness of blood mNGS, procalcitonin, and blood culture in diagnosing pancreatic infection was evaluated and compared. Additionally, the real-world utilization of antibiotics and the potential mNGS-guided antimicrobial strategy in febrile ANP were also analyzed.

Results:

From May 2023 to October 2023, a total of 78 patients with febrile ANP were enrolled and 30 patients (38.5%) were confirmed infected pancreatic necrosis (IPN). Compared with procalcitonin and blood culture, mNGS showed a significantly higher sensitivity rate (86.7% vs. 56.7% vs. 26.7%,P<0.001). Moreover, mNGS outperformed procalcitonin (89.5% vs. 61.4%,P<0.01) and blood culture (89.5% vs. 69.0%,P<0.01) in terms of negative predictive value. Blood mNGS exhibited the highest accuracy (85.7%) in diagnosing IPN and sterile pancreatic necrosis (SPN), significantly superior to both procalcitonin (65.7%) and blood culture (61.4%). In the multivariate analysis, positive blood mNGS (OR=60.2,P<0.001) and lower fibrinogen level (OR=2.0,P<0.05) were identified as independent predictors associated with IPN, whereas procalcitonin was not associated with IPN, but with increased mortality (OR=11.7,P=0.006). Overall, the rate of correct use of antibiotics in the cohort was only 18.6% (13/70) and would be improved to 81.4% (57/70) if adjusted according to the mNGS results.

Conclusion:

Blood mNGS represents important progress in the early diagnosis of IPN, with particular importance in guiding antibiotic usage for patients with febrile ANP.