bluuebunny/crossref_metadata_2025 huggingface dataset:
Agent-Based Simulation of Heterogeneous Crowd Flows in Critical Infrastructures During Emergencies
Authors: Battista Umberto , De Vito Pietro , Ottonello Davide , Hugon Deborah
Published: July 2022

Scope of this work was the development of a model able to simulate the flows and behaviours of heterogeneous crowds in a large transport hub, both in normal conditions and during an emergency, like a terrorist attack. These places are indeed also so-called “soft targets”, public spaces which are preferred targets of terrorists because they provide them with the opportunity to maximize casualties and publicity. Different modelling approaches were investigated and finally agent-based modelling and the BDI (belief-desire-intention) architecture were selected. Several scenarios were also identified to simulate the crowd behaviour. Flowcharts were developed to model users’ actions and interactions; while statecharts to model emergency conditions and behavioural changes. Simulations were then used to identify weak points in the infrastructure and to analyse the evacuation times for each user category investigated. Finally, various solutions were proposed and simulated, to improve crowd flows and reduce evacuation times.
Internet of Things, Interdisciplinary Pedagogical Assessment and the Promotion of Learning
Authors: Magalhães Andreia Maria Beça , Andrade António , Matias Alves José
Published: July 2022

There are multiple challenges currently facing the school. Its ability to motivate and involve students with the adoption of technology, in an active and participatory way in teaching and learning, deserves special mention. The Internet of Things (IoT) presents itself as a tool well received by students, motivating them for learning, and teachers recognize advantages in using this resource in the classroom. It is intended to show that it is also a device with the potential to respond to what is defined in normative documents where the guiding principles for the learning evaluation are established in order to promote the improvement of learning. A content analysis was carried out of the identified decree-laws and the focus group interviews, with the teachers who participated in the exploration of essential learning in the third cycle of basic education.
Inclusive Leadership Amid Civic Unrest Exploring Solutions to Police Brutality and Inequity
Authors: Cubbage Jayne , Boodhoo Dakota F. , Cotton Priscilla Aquila , Fletcher Autumn Jemika
Published: July 2022

During the fall 2020 academic year, students in a graduate research course had just experienced a volatile summer with racial unrest, civic discord in the midst of a global health pandemic, which required a transition to online learning. As part of the course, and given the ongoing number of killings of unarmed Black men and women by police, the course would take a heightened approach to discussing the events of the summer of 2020, and to working towards a solution of societal ills such as police brutality, inequity and low levels of civic engagement among young people. This work, a qualitative case study using theoretical lens of inclusive leadership (Fournier, 2020) sought ways to empower scholars in a graduate research course at a Mid-Atlantic HBCU by exploring the themes of community-oriented policing, qualified immunity, civic engagement, and equity. The study found that ideas such as the use of social media, holding online forums to meet with police and starting civic groups in one’s own neighborhood can serve as a starting point.
Knowledge Graph Entity Alignment Using Relation Structural Similarity
Authors: Peng Yanhui , Zhang Jing , Zhou Cangqi , Meng Shunmei
Published: July 2022

Embedding-based entity alignment, which represents knowledge graphs as low-dimensional embeddings and finds entities in different knowledge graphs that semantically represent the same real-world entity by measuring the similarities between entity embeddings, has achieved promising results. However, existing methods are still challenged by the error accumulation of embeddings along multi-step paths and the semantic information loss. This paper proposes a novel embedding-based entity alignment method that iteratively aligns both entities and relations with high similarities as training data. Newly-aligned entities and relations are used to calibrate the corresponding embeddings in the uniﬁed embedding space, which reduces the error accumulation. To reduce the negative impact of semantic information loss, the authors propose to use relation structural similarity instead of embedding similarity to align relations. Experimental results on five widely used real-world datasets show that the proposed method significantly outperforms several state-of-the-art methods for entity alignment.
RIP2 Contributes to Expanded CD4+ T Cell IFN-γ Production during Efferocytosis of Streptococcus pneumoniae–Infected Apoptotic Cells
Authors: Niño-Castaño Victoria Eugenia , Penteado Letícia de Aquino , Silva-Pereira Ludmilla , Bazzano Júlia Miranda Ribeiro , Orlando Allan Botinhon , Salina Ana Carolina Guerta , Dejani Naiara Naiana , Bonato Vânia L D , Serezani C Henrique , Medeiros Alexandra Ivo
Published: July 2022

Apoptotic cell clearance by professional and nonprofessional phagocytes in the process of efferocytosis is critical to preserve tissue homeostasis. Uptake of apoptotic cells by dendritic cells generates regulatory T cells and induces immunologic tolerance against self-antigens. In contrast, ingestion of infected apoptotic cells promotes activation of TLR4/MyD88-dependent bone marrow–derived dendritic cells (BMDCs) and triggers Th17 cell differentiation. In this study, we evaluated the impact of Streptococcus pneumoniae–infected apoptotic cell efferocytosis by BMDCs derived from C57BL/6 mice on differentiation and expansion of CD4+ T cell subsets, as well as the role of TLR2/4 and receptor-interacting protein 2 (RIP2) receptors in recognizing intracellular pathogens during efferocytosis. We demonstrated that BMDC-mediated efferocytosis of S. pneumoniae–infected apoptotic cells induced Th1 cell differentiation and expansion. Although TLR2/4 and RIP2 deficiency in BMDCs did not affect Th1 cell differentiation during efferocytosis, the absence of RIP2 decreased IFN-γ production by CD4 T cells during the expansion phase. These findings suggest that RIP2-mediated IL-1β production during efferocytosis of S. pneumoniae–infected apoptotic cells partially supports a Th1-mediated IFN-γ production microenvironment.
Determinants of contraceptive use in Abidjan (Côte d'Ivoire)
Authors: Coulibaly Madikiny , Kouamé Jérôme , Kadjo Florence , Koumi-Mélèdje Marie-Dorothée , Hounsa Annita , Sackou-Kouakou Julie , Aké Odile
Published: July 2022

In Côte d’Ivoire, contraceptive prevalence is low (21%). The search for determinants of contraceptive use could make it possible to redirect existing strategies. The objective is to identify the determinants of the use of contraception among women in Abidjan. A cross-sectional survey was conducted from May to June 2018 in the Dallas neighborhood of Adjamé municipal (Abidjan). Women of reproductive age (15 to 49 years old) were selected there. Sociodemographic, gyneco-obstetrical characteristics, educational level, attitudes and practices of women on contraception were collected. Univariate and multivariate analyzes were performed. A total of 301 women aged 29.34±8.98 years were selected. The proportion of women using modern contraception was 27.24%. In univariate analysis, the factors associated with use were: level of education (p=0.005), unwanted pregnancies (p=0.017), abortions (p0.001), consultation of the gynecologist (p=0.003) or a family planning service (p=0.001). Hearing about contraception (p=0.043), knowing (p0.001) and talking about it with their partner (p=0.027) was significantly associated with its use. In the multivariate analyses, the women who consulted a gynecologist and those who knew the contraceptive methods used them respectively 2 times more (OR= 2.16 [1.14-4.15], p=0.019) and 22 times more (OR= 22.38 [8.42-78.56], p0.001). Women with primary school education used them significantly less (OR=0.15 [0.05-0.41], p0.001). Awareness, the gynecologist’s consultation, and the level of education were the main determinants of contraceptive use. Also, it is necessary to adapt awareness messages to the characteristics of women.
Knowledge and practices of female students at University of Kara regarding sexually transmitted infections in Togo, 2021
Authors: Gnatou Gatibe Y.S. , Gbeasor-Komlanvi Fifonsi A. , Sadio Arnold J. , Konu Yao R. , Tchankoni Martin K. , Zida-Compaore Wendpouiré I.C. , Agbonon Amegnona , Ekouevi Didier K.
Published: July 2022

A good knowledge of sexually transmitted infections (STI) in female students is an important element in the prevention of STI transmission. The objective of this study is to describe the level of knowledge and practices on STI among female students at the University of Kara. A cross-sectional study was conducted at the University of Kara from July to September 2021. Data were collected using a standard, digitalised, selfadministered questionnaire. Logistic regression analysis was used to describe factors associated with the level of knowledge of STIs. A total of 1,055 female students with a median age of 21 years (interquartile range: 20-24) participated in the study. More than one-third (33.7%) of the students had good knowledge of STI. Having already been tested for HIV (aOR=3.25; 95% CI 2.36-4.52), having already had sex (aOR=1.56; 95% CI 1.10-2.24) and the level of education (AOR=3.46; 95% CI 2.10-5.85) were significantly associated with good STIs knowledge. Among the 723 female students (68.5%) who already had sex, 32.5% reported inconsistent use of condoms during sexual intercourse and 18.9% reported having multiple sexual partners. The results of this study highlight the importance of intensifying STIs prevention efforts (awareness, screening, and vaccination) among female students at the University of Kara.
Spectrum of Cardiovascular Autonomic Dysfunction and 24-hour Blood Pressure Variability in Idiopathic Parkinson's Disease
Authors: Sebastian Ivy , Kate Mahesh P. , Khatter Himani , Singh Bharat , Pandian Jeyaraj D.
Published: July 2022

Background:

Uncertainty prevails regarding the patterns of autonomic dysfunction in patients with idiopathic Parkinson's disease (IPD). This study was undertaken with the aim of assessing the complete spectrum of cardiovascular autonomic function tests (CAFTs) and blood pressure variability patterns in IPD patients while comparing the same with age-matched controls.

Methods:

Patients with IPD presenting to the Christian Medical College and Hospital from December 2016 to November 2018 along with age-matched controls were prospectively evaluated using CAFTs. The IPD patients also underwent ambulatory blood pressure (BP) monitoring (ABPM), and the diurnal systolic BP differences were used to classify into dippers (10-20%), non-dippers (0–10%), reverse dippers (<0%), and extreme dippers (>20%).

Results:

Autonomic dysfunction (AD) was prevalent in 41 (68.3%) IPD patients even in early disease (median (inter-quartile range) symptom duration 2 (1–4) years, mean Hoehn and Yahr (H&Y) stage 2 (1.5–2.8). Both sympathetic and parasympathetic parameters were impaired among IPD patients when compared to healthy controls. (E: I ratio 1.17 ± 0.12 vs 1.26 ± 0.14 (P < 0.001), Valsalva ratio (VR) 1.33 ± 0.27 vs 1.55 ± 0.25 (P < 0.001), PRT100 9.6 ± 8.0 vs 3.1 ± 1.8 (P < 0.001), tilt-up SBPAvg change 8.8 (4.2–13.8) vs 1.8 (−2.9–6.1) (P < 0.001), tilt-up HRAvg change 4.8 (2.2–8.2) vs 1.9 (−0.7–5.1) (P < 0.001). BP variability was demonstrated in 47 (79.7%) of IPD patients, with reverse dipping pattern in 28 (47.5%) seen more frequently in this cohort.

Conclusions:

Timely detection of AD may be helpful not only in recognizing IPD in its pre-motor stages but also in optimizing management for this population of patients. BP variability and abnormal dipping patterns on ABPM can be a potential marker of dysautonomia.
Radiation-Induced Hemorrhagic Vasculopathy and Seventh and Eighth Nerve Complex Neuropathy
Authors: Khaladkar Sanjay M. , Chanabasanavar Vijetha , Dilip Darshana , Thakker Vaishnavi
Published: July 2022

Radiation-induced (RI) changes such as radiation-induced cavernous malformations (RICMs) and radiation-induced cranial neuropathy (RICN) manifest as late delayed complications and can be seen on post-treatment imaging. Cavernous malformations (CMs) are vascular malformations that are made up of dilated, thin-walled capillary spaces without intervening brain parenchyma. Cranial nerve damage due to radiation exposure is a rare consequence of radiation therapy (RT). We present a case of intracerebral CMs/hemorrhagic vasculopathy and left seventh and eighth nerve complex cranial neuropathy 14 years following RT to the brain for tectal glioma.
Vasectomy reversal in China during the recent decade: insights from a multicenter retrospective investigation
Authors: Ren Li-Juan , Xue Rui-Zhi , Wu Zi-Qiang , Zhi Er-Lei , Li Wei , Huang Liang , Xiang Xu-Yu , Li Dao-Yuan , Lin Xue-Ming
Published: July 2022

To date, there is little information about the demography of vasectomy reversal (VR) patients or the factors currently influencing VR effectiveness in China, especially after the universal two-child policy was released in 2015. In this research, demographic data and perioperative medical records of VR patients were extracted from seven major hospitals in different provinces or municipalities of China. Meanwhile, a telephone survey of the patients was conducted to collect follow-up information. Eventually, 448 VR cases from the past 13 years were included. The results were analyzed by stratified comparison to investigate factors that can influence postoperative vas deferens patency and pregnancy rate. Appropriately statistical methods were used, and all of the protocols were approved by the Ethics Committees of the institutes in this research. The results showed that the annual operation volume of VR quadrupled after the two-child policy was implemented. Nonmicrosurgery and a long duration of vasectomy were significantly associated with a lower patency rate. A follow-up survey showed that the general postoperative pregnancy rate was 27.2%. For female partners over the age of 35 years, the postoperative pregnancy rate showed a more severe decline, but only 35.5% of them had been given a fertility examination before their husbands’ VR surgery. Our work revealed that more patients in China have been demanding VR in recent years. High-quality microsurgery and a short duration of vasectomy are crucial for restoring patency by VR. Clinical andrologists should perform a preoperative fertility evaluation of the patients’ female partners.
ROC-Analysis Derived Immunohistochemical P53 Cut-Off Scores as an Adjunct to Routine Histopathology for Better Diagnostic Compartmentalisation of Cervical Lesions
Authors: Shukla Ayushi , Sachan Rekha , Maurya Malti , Patel Munna Lal , Sankhwar Pushplata
Published: July 2022

Objective

The aim of this study was to evaluate the predictive value of Immunohistochemical p53 cut-off scores as an adjunct to routine histopathology for better diagnosis of cervical lesions.

Materials and Methods

Prospective study carried out for 1 year. After ethical approval and informed consent, a total of 100 cervical tissue samples were analyzed; chronic cervicitis (CC)-15, cervical intraepithelial neoplasia (CIN)-40, and squamous cell carcinoma cervix (SCC)-45 (FIGO 2018 clinical staging). After routine processing of tissue specimen, hematoxylin and eosin (HE) staining was done. Grading of cervical precancerous lesions (CIN) was done as per World Health Organisation criteria as CIN 1,2 or 3. Broder’s grading was assigned for every SCC sample.

Results

Mean p53 scores of CC, CIN, and SCC cases were 0.0, 1.70, and 4.38, respectively, CIN 1, 2, and 3 were 1.07, 1.63, and 2.22, respectively. SCC was differentiated from CIN3 with p53 ≥4.5 as predictor for SCC, sensitivity and specificity were 57.8% and 88.9%, respectively. Overall diagnostic accuracy of the proposed scoring system for differentiating CC, CIN, and SCC was 61%, while the accuracy of previous methods of interpreting p53 immunoreactivity as immunoscore >2 or arbitrary cut-off of >10% cells with nuclear positivity was only 48%.

Conclusion

ROC-derived immunoscore cut-offs can provide the much-needed objectivity and optimal decision thresholds to immunohistochemistry interpretation.
The Relationship Between Nurses’ Ethical Reasoning with the Quality of Nursing Care
Authors: Safavi Firouzeh , Yousefi Zhila , Bavani Solmaz Mansour , Khodadadi Esmail
Published: July 2022

Context

A high quality of nursing care is an important priority of nursing profession and directly associated with increased patient satisfaction. Evidence shows that ethical professional issues are challenging with significant influences on the quality of nursing care.

Aims

The aim of this study was to determine how quality of patient care relates to the nurses’ ethical reasoning as viewed by patients in medical wards.

Settings and Design

This study used a descriptive correlational design.

Subjects and Methods

Data collection tools included a Nursing Dilemma Test and Quality Patient Care Scale. In total, 180 hospitalized patients and 180 nurses who worked in medical wards of Hospitals in 2017 were enrolled. Sample selection was done by the census method.

Statistical Analysis Used

Data were analyzed by the SPSS software version 22.

Results

The means score for nurses’ quality care was 91.71 ± 14.81. Furthermore, the mean score for ethical reasoning among nurses was at an average level of 45.07 ± 6.12. There was no significant relationship between the quality of care and nurse’s ethical reasoning (P > 0.05).

Conclusions:

The results revealed that factors other than ethical reasoning of nurses are related to quality of care. Furthermore, nurses showed an average ability in ethical reasoning. So to improve this situation, healthcare system administrators can offer professional training programs to increase ethical sensitivity and reasoning among the nurses who face daily ethical issues.
Intrathecal Methotrexate-Induced Aseptic Meningitis in a Patient with Acute Lymphoblastic Leukemia
Authors: Tang Wesley , Tan Jennie
Published: July 2022

The central nervous system is often a site of spread for patients with acute lymphoblastic leukemia (ALL). ALL is often treated with ongoing intrathecal chemotherapy with the most common regimens including methotrexate and/or cytarabine. Uncommonly, intrathecal methotrexate has been associated with stroke-like symptoms. To the author’s knowledge, we present the first reported case of a patient who developed symptoms more akin to bacterial meningitis than stroke-like symptoms as a consequence of intrathecal methotrexate chemotherapy.
Comparative analyses of paclitaxel/carboplatin with cisplatin/5-fluorouracil-based chemoradiation in locally advanced inoperable upper and middle third esophageal cancer
Authors: Kumar Divyesh , Dey Treshita , Khosla Divya , Gedela Sandeep , Oinam Arun S. , Kapoor Rakesh
Published: July 2022

Introduction:

Chemoradiation therapy (CRT) remains the treatment of choice for inoperable locally advanced esophageal cancer (LAEC). Several CRT regimens are existent in esophageal cancer, but definitive conclusions are lacking. We performed a pilot study to compare treatment outcome, survival, and toxicities in inoperable upper and middle third esophageal cancer patients undergoing CRT using either paclitaxel/carboplatin or cisplatin/5FU based regimen.

Methods:

Patients were randomised in two arms (arm A and arm B). In Arm A, taxane-based (Paclitaxel+carboplatin) and in arm B non-taxane-based (cisplatin+5FU) doublet chemotherapy drugs were given concurrently with external beam radiation therapy (EBRT). EBRT in two phases up to a total dose of 54 Gy/27#@2Gy/# was given. Response was subsequently assessed using Response evaluation criteria in solid tumors (RECIST v1.1) and toxicities utilizing Common Terminology Criteria for Adverse Events (CTCAE v 4.0).

Result:

The overall response rate (ORR) in the taxane-based group was higher than the non-taxane-based group, but was not significantly different (p=0.851). Regarding hematological toxicities, anaemia and reduced cell counts were more in the taxane group compared to the non-taxane group while non-hematological toxicities were comparable. Similarly, better survival with late toxicities were seen with taxane-based arm when compared to non-taxane-based arm, though it was not statistically significant.

Conclusion:

Our pilot analysis highlights the fact that paclitaxel/carboplatin CRT shows better response, survival, and comparable toxicities when compared to cisplatin/5FU, though statistically nonsignificant. Further randomised prospective trials with large sample size are warranted.
Prediction of chronic kidney disease in abdominal cancers radiation therapy using the functional assays of normal tissue complication probability models
Authors: Haghbin Ameneh , Mostaar Ahmad , Paydar Reza , Bakhshandeh Mohsen , Nikoofar Alireza , Houshyari Mohammad , Cheraghi Susan
Published: July 2022

Aim:

The purpose of this study is to predict chronic kidney disease (CKD) in the radiotherapy of abdominal cancers by evaluating clinical and functional assays of normal tissue complication probability (NTCP) models.

Materials and Methods:

Radiation renal damage was analyzed in 50 patients with abdominal cancers 12 months after radiotherapy through a clinical estimated glomerular filtration rate (eGFR). According to the common terminology criteria for the scoring system of adverse events, Grade 2 CKD (eGFR ≤30–59 ml/min/1.73 m2) was considered as the radiation therapy endpoint. Modeling and parameter estimation of NTCP models were performed for the Lyman-equivalent uniform dose (EUD), the logit-EUD critical volume (CV), the relative seriality, and the mean dose model.

Results:

The confidence interval of the fitted parameters was 95%. The parameter value of D50 was obtained 22–38 Gy, and the n and s parameters were equivalent to 0.006 –3 and 1, respectively. According to the Akaike's information criterion, the mean dose model predicts radiation-induced CKD more accurately than the other models.

Conclusion:

Although the renal medulla consists of many nephrons arranged in parallel, each nephron has a seriality architecture as renal functional subunits. Therefore, based on this principle and modeling results in this study, the whole kidney organs may have a serial–parallel combination or a secret architecture.
Diagnostic utility of CK19 and galectin-3 in differentiating papillary thyroid carcinoma from nonneoplastic lesions of thyroid
Authors: Prasad Priyanka Arvind , Raju Kalyani
Published: July 2022

Background:

Thyroid neoplasm is one of the most common endocrine neoplasms. The diagnosis and the distinction between malignant and benign neoplasms can be difficult, but it has clinical, therapeutic, and prognostic significance. Hence, it is necessary to make precise diagnosis by using biomarkers.

Materials and Methods:

This is a laboratory observational study considering histologically diagnosed cases of papillary thyroid carcinoma (PTC) and nonneoplastic thyroid lesions. Immunohistochemistry (IHC) staining was done on tissue sections of all cases for CK19 and galectin-3 using appropriate positive and negative controls. The expression of immunomarkers was evaluated by a semi-quantitative method as negative, weak positive, moderate positive, and strong positive. The data were entered in Microsoft Excel sheet and were analyzed using SPSS 22 version software.

Results:

A total of 52 cases were considered for the study, of which 26 cases each were PTC and nonneoplastic lesions of thyroid. Among the 26 PTC cases, 6 were classical variant of PTC (CVPTC) and 20 were follicular variant of papillary thyroid carcinoma (FVPTC). Among 26 nonneoplastic cases, 13 each were nodular hyperplasia cases and lymphocytic thyroiditis. There was a statistically significant (P < 0.01) association of CK19 and galectin-3 expression between CVPTC and FVPTC. There was no statistically significant association (P = 0.271) of CK19 expression between PTC and nonneoplastic cases. There was a statistically significant association (P = 0.003) of galectin-3 expression between PTC and nonneoplastic cases.

Conclusion:

Galectin-3 expression can be used to differentiate PTC from nonneoplastic lesions of thyroid in ambiguous cases. Galectin-3 and CK19 expression can be used to classify PTC into CVPTC and FVPTC.
Melanotic neuroectodermal tumor of infancy (MNTI) – A rare entity
Authors: Goel Divya , Qayoom Sumaira , Goel Madhu Mati , Rawa Jiledar
Published: July 2022

Melanotic neuroectodermal tumor of infancy is a rare pigmented pediatric tumor seen at craniofacial sites with the most common site being maxilla. This tumor arises from neural crest origin with a polyphenotypic expression of epithelial, neuroblastic, and melanotic markers. It is a locally aggressive tumor with rapid, expansile, and destructive growth. The tumor has fairly high chances of recurrence and malignant transformation, if not diagnosed and treated with time. There is no standard protocol for management owing to its rarity. Hereby, we present one such case of a 2-month-old male child with rapidly enlarging upper jaw swelling. The patient was treated with wide local excision, followed by two cycles of chemotherapy. The patient is in follow-up and doing well with no evidence of any local recurrence or metastasis till date.
Carcinoma male breast with tracheal and endobronchial metastasis, masquerading as nonsmall-cell lung cancer, presenting with superior vena cava obstruction - A rare case report
Authors: Srivastava Astha , Pandey Rambha , Anjali V.R , Nambirajan Aruna , Angamuthu Meivel , Mohan Anant
Published: July 2022

Cancer male breast is not very common. It comprises <1% of all breast cancers. Primary sites of metastasis are bone, brain, lung, and liver. Endobronchial and tracheal metastasis is very rare. To the best of our information, this is the first case of male breast carcinoma with upfront tracheal and endobronchial metastasis which presented as Superior vena cava obstruction (SVCO), initially evaluated on the lines of metastatic nonsmall-cell lung cancer. A 60-year-old gentleman presented with shortness of breath and features of SVCO. On primary evaluation, he was thought to be a case of nonsmall-cell lung cancer. Later on, it was confirmed to be carcinoma male breast with endobronchial and tracheal metastasis, which was reconfirmed with biopsy. The case we came across had symptoms associated with endobronchial metastases from primary extrapulmonary tumor and which was later found out to be breast. Treatment options are very different from lung primary and thus, we should be aware of the unusual disease presentation.
Assessment of angiogenesis using endoglin in salivary gland tumors – An immunohistochemical study
Authors: Gaonkar Pratyusha Prakash , Patankar Sangeeta R. , Sridharan Gokul
Published: July 2022

Background:

Endoglin, a co-receptor of transforming growth factor (TGF)-β1 and TGF-β2, is indispensable for endothelial cell proliferation and modulation of tumor promotion activities of TGF-β1. The assessment of neovascularization using endoglin expression has been considered a potential predictor of prognosis in various solid malignancies.

Aims and Objectives:

To analyze the expression of endoglin by immunohistochemistry in both benign and malignant salivary gland tumors.

Materials and Methods:

Fifteen cases of benign salivary gland tumors and seventeen cases of malignant salivary gland tumors were included in the study, and immunohistochemistry was performed using anti-CD105 antibody using standard protocol.

Results and Conclusion:

The study demonstrated that there is increased endoglin expression in malignant tumors as compared to their benign counterparts which is suggestive of increased angiogenic activity in tumor areas and could be responsible for the aggressive behavior of the malignancies. The highest density of endoglin-positive blood vessels was observed in the inflammatory tumor stromal areas. Furthermore, a significant increase in endoglin expression was evident as the grade of malignant salivary gland tumor increased. The results of the study indicate that the increased expression of endoglin in high-grade malignancies contributes to their aggressive nature.
Intracranial hemorrhages associated with meningiomas
Authors: Siedlecki Zygmunt , Nowak Karol , Grzyb Sebastian , Śniegocki Maciej
Published: July 2022

Intracranial hemorrhage associated with meningioma is rare. Relatively, few such cases are described in the source literature, and it is estimated that intracranial meningiomas presenting with hemorrhage account for about one percent of all meningiomas. Hemorrhage can occur in both meningioma tissue and on the tumor surface. It can lead to intracerebral, subdural and subarachnoid hematoma. This can in turn cause high intracranial pressure with rapid neurological deterioration. Urgent neurosurgical intervention is often necessary. In our department, three patients with meningioma-related hemorrhage were treated surgically from 2006 to 2020. One patient was operated on as an emergency, due to the patient's poor neurological condition, while the two others underwent surgery following supplementary diagnosis several days following their admission. The outcomes of the three patients were good. The three meningiomas associated with hemorrhage described in the present manuscript constitute 2.2% of all 136 meningiomas treated surgically from 2006 to 2020 at our department. All three hemorrhages described in this study were associated with WHO I convexity meningiomas. Similar data can be found in some sources also describing meningioma WHO I-related hemorrhages; nevertheless, other literature references indicate a higher risk of bleeding into meningiomas of a higher degree of malignancy. The hemorrhage mechanism remains unclear; however, the proposed mechanism is rupture of defective intratumoral blood vessels and stretching of the superficial veins including bridge veins by the growing tumor, leading to their rupture. Our observations regarding the incidence of meningioma hemorrhage and tumor location are consistent with the source literature data.
Distribution Pattern of Total Corneal Thickness in Keratoconus Versus Normal Eyes Using An Optical Coherence Tomography
Authors: Hashemi Hassan , Heidari Zahra , Mohammadpour Mehrdad , Momeni-Moghaddam Hamed , Khabazkhoob Mehdi
Published: July 2022

Purpose:

To evaluate the total corneal thickness distribution pattern using a high-resolution spectral-domain optical coherence tomography (HR SD-OCT) for distinguishing normal eyes from keratoconus (KCN).

Methods:

One hundred and forty-four patients were enrolled in three groups (55 normal, 45 mild KCN, and 44 moderate-to-severe KCN eyes) in this prospective diagnostic test study. Total corneal thickness was measured in 8 semi-meridians using HR SD-OCT (Heidelberg Engineering, Heidelberg, Germany) in 5 and 7 mm zones. The central corneal thickness (CCT), corneal focal thinning (minimum thickness [Min], min minus median and maximum [Min-Med, Min-Max]), and asymmetry indices (inferior minus superior [I-S] and supranasal minus infratemporal [SN-IT]) were calculated. One-way analysis of variance and the area under the receiver operating characteristic curve (AUC) were used for the analysis.

Results:

Thinner CCT, lower Min thickness, more negative Min-Max, Min-Med, and greater I-S and SN-IT were found in KCN eyes compared to the control group (P< 0.001). The inferior and IT semi-meridians were the thinnest locations in KCN cases in the 5 mm central zone (P< 0.001). CCT followed by Min-Med had the highest discriminative ability for differentiating mild KCN (AUC, sensitivity and specificity: 0.822, 87.0%, 60.37% and 0.805, 82.93%, 66.0%, respectively) and moderate-to-severe KCN (0.902, 87.82%, 73.08% and 0.892, 85.37%, and 78.85%, respectively) from normal corneas.

Conclusion:

The inferior and IT sectors of the cornea with the largest thickness changes in the 5 mm zone are the most common thinning sites in keratoconic corneas, and CCT and Min-Med are the most sensitive indices for the diagnosis of KCN.
Descemet's Stripping Automated Endothelial Keratoplasty Using Donor Tissue from An 83-Day-Old Infant
Authors: Ziakas Nikolaos , Chranioti Angeliki , Tzamalis Argyrios , Giannoulis Dimitrios , Kapantais Dimitrios , Tsatsos Michael , Tsaousis Konstantinos T.
Published: July 2022

Purpose:

To report a case of Descemet stripping automated endothelial keratoplasty (DSAEK) combined with phacoemulsification in an adult recipient using endothelial graft from an 83-day-old infant donor.

Methods:

A corneoscleral button was obtained from an infant donor and a DSAEK graft was prepared using a microkeratome. In comparison to the standard technique of DSAEK graft preparation some modifications were made in order to avoid inadvertent perforation, as the donor cornea had a very spherical shape, probably due to the very young age of the donor. The DSAEK graft was transplanted to the left eye of a 68-year-old woman suffering from Fuchs' endothelial dystrophy. Her preoperative best-corrected visual acuity (BCVA) in that eye was 20/100 and central corneal thickness 831 μm.

Results:

An uneventful DSAEK combined with phacoemulsification was performed. The main complication noted was detachment of the peripheral part and contraction of the corneal graft, observed two months after the procedure. The implanted tissue remained centrally attached with a BCVA of 20/40, 3 years postoperatively.

Conclusion:

This case report highlights the difficulties emerging from preparation and implantation using an endothelial graft tissue from the youngest ever reported donor.
Effect of Prophylactic Aqueous Suppression on Ahmed Glaucoma Valve Surgery Success
Authors: Saha Rini , Dharia Riddhi Shah , Trope Graham E. , Buys Yvonne M.
Published: July 2022

Purpose:

To evaluate the effect of prophylactic aqueous suppressants immediately post-Ahmed glaucoma valve (AGV) surgery on the rate of hypertensive phase and success.

Methods:

Retrospective case–control study of 80 eyes with refractory glaucoma undergoing AGV surgery. Forty eyes in the intervention group (preoperative aqueous suppressants continued postoperatively) and 40 in the control group (all glaucoma drops stopped after surgery and reintroduced as required) were included in this study. Patients were followed for 1 year. Data collected included intraocular pressure (IOP), number of glaucoma medications, and number of eyes requiring further IOP lowering surgery. The frequency of hypertensive phase and 1-year success was compared between the groups.

Results:

Hypertensive phase occurred in 22.5% of the intervention group compared to 42.5% of the control group; however, this difference was not statistically significant (P = 0.06). Success at 1 year (IOP ≤21 mmHg but ≥5 mmHg and 20% reduction from baseline without additional surgery) was similar in each group: 77.5% in the intervention group and 62.5% in the control group (P = 0.22). However, at 1 year, significantly more eyes in the intervention group had an IOP ≤17 mmHg (95% vs. 80%,P= 0.04). The mean time interval to a second IOP lowering procedure was significantly shorter in the control group (P < 0.005).

Conclusions:

With prophylactic preoperative aqueous suppressants, more eyes achieved an IOP of ≤17 mmHg. The time interval to repeat the glaucoma procedure was significantly shorter in the control group.
Comparing Pentacam Hr Screening Indices in Different Normal Corneal Thicknesses Among Refractive Surgery Candidates
Authors: Ghiasian Leila , Abdolalizadeh Parya , Hadavandkhani Ali , Eshaghi Acieh , Hadi Yasaman , Nadjafi-Semnani Fatemeh
Published: July 2022

Purpose:

To compare Pentacam indices in normal eyes with different corneal thicknesses.

Methods:

It is a retrospective observational study. Ninety-six normal eyes of 96 patients who were referred for refractive surgery in a tertiary university-based hospital from October 2015 to April 2019 were recruited consecutively. Corneal keratometry as well as Pentacam's software Belin-Ambrósio Enhanced Ectasia Display (BAD) parameters including pachymetry progression indices (PPIs), maximum Ambrosio's relational thickness (ART-max), corneal elevations, normalized deviations, BAD total deviation value (BAD-D), and anterior surface indices were measured by Pentacam HR (Type 70900). The included were classified as thin (26 eyes), average (45 eyes), and thick (25 eyes) corneas with the thinnest point thickness of ≤496 μm, 497–595 μm, and ≥596 μm, respectively. The specificities of all parameters were calculated based on routine cut-off values.

Results:

The refraction, keratometry, and elevations were not different (P> 0.05). All PPIs (minimum, average, and maximum) of thick corneas were significantly lower than average and thin corneas (P< 0.001). ART-max increased by thickening of the cornea (P< 0.001). BAD-D score and normalized indices of pachymetric parameters decreased with the increase of thickness (P< 0.001), while specificities of all indices increased with corneal thickening. More than 96% of thick corneas were classified as normal PPI-max (24/25), ART-max (25/25), and BAD-D (25/25), while nearly <54% of thin corneas (14/26 for PPI-max, 9/26 for ART-max, and 12/26 for BAD-D) were normal.

Conclusions:

The pachymetry-related indices and BAD-D were different among normal corneas with various thicknesses. The specificities of PPIs, ART-max, and BAD-D of thin corneas were lower than in thick corneas.
Efficacy and Safety of Aflibercept Therapy for Diabetic Macular Edema
Authors: Santhakumaran Sangeetha , Salimi Ali , Brunetti Vanessa C. , Galic John
Published: July 2022

Purpose:

To assess the real-world efficacy and safety of aflibercept for the treatment of diabetic macular edema (DME).

Methods:

A systematic search was conducted across multiple databases. Articles were included if participants had DME and received aflibercept treatment for a minimum of 52 ± 4 weeks. Primary outcomes included changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT). A risk of bias assessment of studies was completed, pooled estimates were obtained, and a meta-regression was performed. Information on adverse events was collected.

Results:

The search yielded 2112 articles, of which 30 were included. Aflibercept was more effective than laser photocoagulation functionally (12-month BCVA-weighted mean difference [WMD] = 10.77 letters,P< 0.001; 24 months = 8.12 letters,P< 0.001) and anatomically (12-month CMT WMD = –114.12 μm,P< 0.001; 24 months = –90.4 μm,P= 0.004). Compared to bevacizumab, aflibercept was noninferior at improving BCVA at 12 months (WMD = 1.71 letters,P= 0.34) and 24 months (WMD = 1.58 letters,P= 0.083). One study found that aflibercept was more effective than bevacizumab anatomically at 1 and 2 years (P < 0.001 at 12 and 24 months). Compared to ranibizumab, aflibercept rendered a greater improvement in BCVA at 1 year (WMD = 1.76 letters,P= 0.001), but not 2 years (WMD = 1.66 letters,P= 0.072). CMT was not significantly different between both therapies at 12 months (WMD = −14.30 μm,P= 0.282) and 24 months (P = 0.08). One study reported greater functional improvement with aflibercept compared with dexamethasone (P = 0.004), but inferiority in reducing CMT (P < 0.001). Meta-regression analysis demonstrated that dosing schedule was found to impact outcomes at 12 and 24 months, while study design and sample size did not impact outcomes at 12 months. There were minimal safety concerns using aflibercept therapy.

Conclusions:

Aflibercept is a safe and effective therapy option for DME in the clinical setting, performing superiorly to laser photocoagulation. Evidence regarding comparisons with bevacizumab, ranibizumab, and dexamethasone is mixed and limited.
Early Macular Thickness Changes after Trabeculectomy and Combined Phaco-Trabeculectomy
Authors: Nilforushan Naveed , Loni Shima , Abdolalizadeh Parya , Miraftabi Arezoo , Banifatemi Mohammad , Rakhshan Reza , Jafari Samira , Abolfathzadeh Navid
Published: July 2022

Purpose:

To assess postoperative changes in central retinal thickness (RT) following trabeculectomy and combined phaco-trabeculectomy using spectral domain-optical coherence tomography.

Methods:

In a prospective interventional comparative study, 64 consecutive glaucoma patients who underwent trabeculectomy (32 eyes) or phaco-trabeculectomy (32 eyes) were included. A macular thickness map using the Early Treatment Diabetic Retinopathy Study circles of 1 mm, 3 mm, and 6 mm was the standard to evaluate the 9-subfield thickness preoperatively and again at 1 and 3 months after surgery. Four subfields in each of the 3 mm and 6 mm rings were considered parafoveal and perifoveal regions, respectively.

Results:

Preoperative measurements were similar in the two groups, except patients in the combined group which were older (P = 0.002). The mean RT in the combined phaco-trabeculectomy group at month 1 was significantly higher than baseline measurements at central subfield retinal thickness (CSRT) (P = 0.01), temporal (P = 0.001), and inferior (P = 0.04) parafoveal and temporal (P = 0.01), superior (P = 0.02), and nasal (P < 0.001) perifoveal quadrants; however, RT changes in the trabeculectomy-only group were not statistically significant at months 1 and 3 (P > 0.05). The increase in the temporal perifoveal RT of the combined phaco-trabeculectomy group persisted at month 3 (P = 0.01), while the RT in other sectors returned to preoperative values. The two treatment groups did not differ in terms of changes in the CSRT over time (P = 0.37). In addition, no difference was observed between the treatment groups regarding the parafoveal RTs at each time points (0.06 ≤P ≤ 0.29).

Conclusions:

There was no significant difference in the pattern of changes of CSRT and parafoveal RT between trabeculectomy and combined phaco-trabeculectomy treatment groups up to 3 months after surgery. Some detectable increase in RT in the combined phaco-trabeculectomy will reverse to baseline values 3 months after surgery, except in the temporal perifoveal region.
Retinotomy and Retinectomy in the Management of Rhegmatogenous Retinal Detachment Associated with Advanced Proliferative Vitreoretinopathy
Authors: Zand Amin , Birjandi Alireza Helal , Saeedian Behrouz , Alemzadeh Sayyed Amirpooya , Abdi Fatemeh , Sedaghat Ahad , Parvaresh Mohammad Mehdi , Falavarjani Khalil Ghasemi
Published: July 2022

Purpose:

To report the anatomical and functional outcomes of retinotomy and/or retinectomy for the management of rhegmatogenous retinal detachment (RRD) complicated by advanced proliferative vitreoretinopathy (PVR).

Methods:

In this retrospective study, the charts of patients who underwent pars plana vitrectomy with retinotomy and/or retinectomy for the management of RRD complicated by PVR were reviewed. Primary outcome measures were final best-corrected visual acuity (BCVA) and anatomical reattachment rate.

Results:

Sixty-one eyes of 61 patients with a mean age of 48.56 ± 15.92 were studied. The mean follow-up time was 21.38 ± 23.08 months. The mean angle of the retinotomy was 171.31° ± 79.15°. Thirty-two (52.5%) of them needed extensive (≥180°) retinotomy. In addition, simultaneous retinectomy was performed in 36.2% of the cases. The BCVA was 2.18 ± 0.63 and 1.85 ± 0.71 logMAR before the surgery and at the last visit, respectively (P = 0.001). The initial anatomical success was achieved in 45 eyes (73.8%) after retinotomy surgery. Sixteen eyes (26.2%) had recurrent RD and needed reoperation, which was performed 5.60 ± 4.01 months after the initial retinotomy surgery. At the last examination, the retina was attached in all patients.

Conclusion:

Retinotomy with/without retinectomy is an effective procedure in the majority of patients with RRD associated with advanced PVR; however, additional surgeries are needed in a significant number of eyes to achieve final anatomical success.
Association of Use of Statins with Progression of Diabetic Retinopathy at a Tertiary Care Hospital in Southern India
Authors: Priyadarshini Prachi , Chogtu Bharti , Bhandary Sulatha V , Kabirdev  , Magazine Rahul
Published: July 2022

Purpose:

To study the role of statin therapy on diabetic retinopathy (DR) progression.

Methods:

This retrospective study was carried out at a tertiary care hospital in southern India. Data were collected from the medical records of patients admitted from January 2013 to December 2018. Out of 1673 patients of DR enrolled in the study, 171 met the inclusion criteria. Patients' demographic data, drug history, clinical characteristics, and laboratory investigations were recorded as per the pro forma. The patients were divided into statin users and nonusers. The results were analyzed to compare the DR progression between the two groups.

Results:

DR progressed in 67% of nonstatin users and 37% of statin users (P < 0.001). The use of statins decreased the risk of DR progression (P < 0.001). Center-involving macular edema was seen in 8 of 79 statin users (10%) and 16 of 92 statin nonusers (16%) based on optical coherence tomography findings during the follow-up period (P = 0.17).

Conclusion:

In patients with type 2 diabetes, lipid-lowering therapy with statins has the potential to retard DR progression.
Flow cytometry for evaluating platelet immunophenotyping and function in patients with thrombocytopenia
Authors: Shen Chih-Lung , Wu Yi-Feng
Published: July 2022

Platelets play an essential role in primary hemostasis through bleeding and thromboembolism. Thus, the diagnosis or evaluation of impaired hereditary, acquired, and drug-related platelet dysfunction has become imperative. The assessment of the platelet function is too complex for routine platelet function study. The major methods involved in platelet function study include platelet function analyzer testing, thromboelastography, thromboelastometry, light transmission aggregometry, and flow cytometry. The current review article focuses on the methods with flow cytometry for immunophenotyping of platelet and evaluating platelet function for platelet disorders, especially in patients with thrombocytopenia. According to the consensus published by the International Society on Thrombosis and Haemostasis, for inherited and acquired platelet disorders, the two major measures by which flow cytometry determines platelet function are glycoprotein IIb/IIIa/P-selectin (CD62p) expression and percentage of leukocyte–platelet aggregates. Using flow cytometry to determine platelet function has several advantages, including good sensitivity to low platelet counts, small blood volume required, and the nonnecessity of centrifugation. However, flow cytometry has still many limitations and challenges, with standardization for routine laboratory testing also proving difficult. Although flow cytometry is available for multipurpose and sensitive study of platelet functions at the same time, the challenging analysis gradually increases and needs to be addressed before reality.