bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Spacer Device for Treatment of Perimegaprosthetic Infections in Bone Tumor Surgeries Around the Knee
Authors: Kliushin Nikolay M. , Stepanjan Artak B. , Subramanyam Koushik N. , Sudnitsyn Anatoliy S. , Mundargi Abhishek V.
Published: August 2020

Background:

Megaprosthesis constitutes the mainstay of limb salvage after bone tumor surgery, and the rate of perimegaprosthetic infection is relatively high. Although the ideal management of perimegaprosthetic infection is 2-stage revision, the ideal antibiotic spacer device is lacking.

Methods:

We designed a novel spacer device unique to this situation. It is a modular device made of titanium with variable size of the components. This customizes the spacer specific to the situation on the basis of the length of medullary canal and the size of the defect. Antibiotic-impregnated bone cement introduced into the medullary canal on both sides and at the site of the defect provides excellent stability and ability to weight-bear. Modularity ensures that components can be easily assembled and removed at the time of revision surgery. As a proof of concept, we used this spacer in 2 patients with perimegaprosthetic infection as a bridge between debridement and definitive reconstruction.

Results:

Both patients were young male individuals with multiple episodes of perimegaprosthetic infection in the past. Debridement resulted in defect of 24 and 28 cm, respectively. Both of them had spacer application along with antibiotic bone cement. Infection could be well controlled, and patients could be made to fully weight-bear with the spacer. Successful revision prostheses could be implanted 12 and 18 months from index surgery with no relapse of infection at 2-year follow-up.

Conclusion:

We recommend this novel spacer device to ensure stability and functionality in 2-stage revision surgeries of infected megaprostheses.
The Flexor Carpi Radialis Brevis: A Description of an Anomalous Wrist Flexor and Surgical Exposure Technique
Authors: Bates Taylor , Nuelle Julia A.V. , Pierrie Sarah N.
Published: August 2020

The flexor carpi radialis brevis is a rare anomalous flexor of the wrist. Surgeons occasionally encounter it intraoperatively during exposure of the volar radius. In 2 patients, this muscle was identified by its longitudinal fibers during the approach to distal radius fractures. This paper describes a surgical technique for adequately exposing a distal radius fracture when the flexor carpi radialis brevis is identified intraoperatively to preserve the innervation and arterial supply of this anomalous wrist flexor.
Combined Anteversion Technique for the Modified Hardinge Approach in Cementless Total Hip Arthroplasty
Authors: Suksathien Yingyong , Tippimanchai Thanut
Published: August 2020

Objective:

To define the combined anteversion (CA) angle in the modified Hardinge approach, which created an impingement-free range of motion (ROM) and prevented dislocation.

Materials and Methods:

The femoral stem was prepared first, the anteversion of the femoral stem was determined and recorded. The target angle for acetabular cup abduction was 40 degrees in all cases. Cup anteversion angle was targeted individually close to but not exceed the native acetabular anteversion angle in each case. The hip joint was tested for impingement-free ROM and stability intraoperatively.

Results:

There were 120 cases with a mean age of 58.7 years (29 to 91, 14.1) and the mean follow-up of 21.8 months (18 to 37). The mean native acetabular anteversion angle was 11.9 degrees (3 to 28 degrees, 5.1). The mean femoral stem anteversion angle was 13.7 degrees (2 to 35 degrees, 7.7) and the mean acetabular cup anteversion angle was 10.2 degrees (−4 to 21 degrees, 3.6). The mean CA angle was 24.2 degrees (9 to 48 degrees, 7.9). The CA angle was within 10 to 40 degrees for 114 of 120 cases (95%). The acetabular cup anteversion angle was within the Lewinnek safe zone for 113 of 120 cases (94.2%). The mean femoral anteversion angle for male and female individuals was 12.16 degrees (2 to 30 degrees, 6.75) and 14.62 degrees (2 to 35 degrees, 8.17) respectively, there was no significant difference (P=0.094). The mean CA angle for male and female individuals was 23.21 degrees (15 to 42 degrees, 6.37) and 24.72 degrees (9 to 48 degrees, 8.6), respectively, which was not significantly different (P=0.310). There was no dislocation.

Conclusions:

The mean CA angle in the modified Hardinge approach was 24.2 degrees and the effective CA angle for impingement-free ROM and preventing dislocation was between 10 and 40 degrees.
The “Pull-through” Technique for Labral Reconstruction of the Hip
Authors: Maldonado David R. , Domb Benjamin G.
Published: August 2020

Hip arthroscopy has proved to be a valid option for the management of femoroacetabular impingement syndrome and labral tears. In this context, labral preservation has been advocated as a superior alternative to complete debridement in terms of clinical outcomes. While labral repair remains the gold standard, particularly in the primary setting, labral reconstruction has been suggested for irreparable tears. However, labral reconstruction is highly technical and demanding. The pull-through technique was described to overcome some of the challenges in arthroscopic labral hip reconstruction surgery. The present review describes details, tips and pearls, and outcomes of using the pull-through technique for labral reconstruction of the hip.
Efficacy and Economics of Arthroscopic Surgical Treatment of Femoroacetabular Impingement Syndrome
Authors: Maldonado David R. , Domb Benjamin G.
Published: August 2020

Hip arthroscopy has emerged as a highly popular and minimally invasive treatment of femoroacetabular impingement syndrome and labral tears by correcting the femoral and acetabular morphology and addressing the chondrolabral pathology. It has been reported to lead to significant improvements of patient-reported outcomes with minimal complications at short-term, mid-term, and long-term follow-up in addition to having low rates of secondary surgeries. As a result, rates of hip arthroscopy have increased dramatically, both in the United States and worldwide. Albeit these favorable outcomes of hip arthroscopy have been well-established, its cost-effectiveness has not yet been as well defined. However, even in the scenario of limited resources of today’s health care, new data has shown that this procedure is truly cost-effective.
Evaluation of Checkpoint Inhibitors in Cancer Patients With End-stage Renal Disease on Hemodialysis: Case Series and Review of the Literature
Authors: Jain Jayanshu , Stein Jill , Garje Rohan
Published: August 2020

Checkpoint inhibitors (CPIs) have become standard of care for multiple types of malignancies and while end-stage renal disease is not a contraindication, these patients are frequently excluded from clinical trials. As a result, there is limited data regarding the safety and efficacy of CPI use in this patient population. In this case series, we report outcomes and adverse events in 8 patients on hemodialysis treated with CPIs. Treatment was overall well-tolerated with adverse events in 3 of 8 (37.5%) patients, with 1 (12.5%) having a grade 4 adverse event, which is comparable to the rate reported in literature for the overall population receiving CPI. No treatment related deaths were seen. Because of small sample size, efficacy data is limited. Further studies are needed in this patient population to elucidate the true incidence of adverse events and antitumor activity.
Pembrolizumab-related Bilateral Ocular Hypotony, Uveitis, Cataracts, Exudative Retinal, and Choroidal Detachments: An Unusual Success Story
Authors: Golash Vidushi , Almeida Goncalo
Published: August 2020

Here, we report the presentation and management of a rare case of sight-threatening bilateral panuveitis with secondary chronic hypotony, subcapsular cataracts, exudative retinal detachments, and choroidal detachments, following initiation of pembrolizumab immunotherapy for metastatic melanoma. An 82-year-old white woman presented with painful, blurry vision 3 days after initiation of pembrolizumab immunotherapy. She had developed a marked panuveitis causing secondary hypotony. The fundal view was entirely limited by acutely dense cataracts and small, uveitic pupils unresponsive to topical dilation. Urgent cataract surgery with intravitreal dexamethasone implant (Ozurdex) was completed successfully and allowed a fundal examination. This revealed bilateral, symmetrical, inferior exudative retinal detachments, and choroidal detachments secondary to chronic hypotony. After 3 months of observation and cessation of oral steroids, the panuveitis remains quiescent, hypotony persists, and the choroidal and retinal detachments are showing progressive self-resolution. The current best-corrected visual acuity is 6/24 OU. She remains under close monitoring. The immune checkpoint inhibitor, pembrolizumab, has been reported to cause sight-threatening adverse effects. We report a rare case of profound bilateral complications treated successfully with oral and intravitreal steroids. To the authors’ knowledge, this has not previously been reported in the literature. Ophthalmologists and oncologists should be aware of the ocular effects of pembrolizumab and be able to identify various complications early. Here, cataract surgery with a steroid implant has been an effective sight-saving intervention. The promising visual outcome makes this an unusual success story.
Pulmonary deportation of hydatidiform mole: a 12-year, single tertiary center experience in China
Authors: Dai Yu-Xin , Xiang Yang , Feng Feng-Zhi , Ren Tong , Yang Jun-Jun , Zhao Jun , Wan Xi-Run
Published: August 2020

Background

Pulmonary deportation of hydatidiform mole is an exceedingly rare entity. The underlying mechanisms and proper management strategies remain unclear based on sporadic case reports over the past six decades. This study aimed to investigate the clinical features and rational treatment of patients with benign molar pregnancies with pulmonary deportation based on our experience.

Methods

Medical records of 20 cases of hydatidiform mole with pulmonary deportation were retrospectively reviewed at Peking Union Medical College Hospital from November 2006 to May 2019. The detailed information of all patients was recorded and analyzed. Patients were divided into different groups according to their characteristics and Mann-Whitney U test was used to compare the duration to achieve a normal β-human chorionic gonadotrophin (β-hCG) level after the first evacuation among groups.

Results

Initial pulmonary computed tomography scans showed suspected bilateral, left and right chest deportation of hydatidiform mole in 12, four, and four patients, respectively, with the maximum nodular diameter ranging from 0.6 to 1.2 cm. Ten patients achieved lesion resolution while the remaining ten patients achieved decreases in the size of their pulmonary lesions. The median duration to achieve a normal β-hCG level after the first evacuation was 15.5 (13.0, 21.9) weeks. There was no significant difference in the duration to achieve a normal β-hCG level after the first evacuation between two groups based on age (≥40 years vs. < 40 years: 15.8 [12.2, 21.5] weeks vs. 15.5 [12.9, 23.0] weeks, Z = 0.094, P = 0.925), type of antecedent mole (partial mole vs. complete mole: 15.2 [12.5, 27.4] weeks vs. 15.9 [12.9, 21.5] weeks, Z = 0.165, P = 0.869), distribution of pulmonary nodules (bilateral lungs vs. unilateral lung: 15.2 [12.8, 22.5] weeks vs. 15.9 [13.2, 22.2] weeks, Z = 0.386, P = 0.700), maximum size of pulmonary nodules (>0.5 cm vs. ≤0.5 cm: 13.0 [11.3, 17.2] weeks vs. 16.0 [14.5, 23.8] weeks, Z = 1.815, P = 0.070), and number of uterine evacuations (once vs. twice or three times: 15.0 [13.0, 16.3] weeks vs. 16.0 [12.8, 23.9] weeks, Z = 0.832, P = 0.405). The post-molar cohort was followed up for 17 to 139 months, and no gestational trophoblastic neoplasia was observed.

Conclusions

No surgeries other than uterine evacuation and no chemotherapy regimens are recommended for such patients if they achieve satisfactory decreases in the level of hCG and gradual decrease or disappearance of pulmonary deportation nodules. Patients should be informed about the necessity of long-term follow-up. More collaborative international studies on this exceedingly rare condition may guide decisions regarding optimal management strategies.
Surgical left atrial appendage occlusion in patients with atrial fibrillation undergoing mechanical heart valve replacement
Authors: Zheng Ye , Rao Chen-Fei , Chen Si-Peng , He Li , Hou Jian-Feng , Zheng Zhe
Published: August 2020

Background

Surgical left atrial appendage occlusion (SLAAO) may be associated with a lower risk of thromboembolism in patients with atrial fibrillation undergoing cardiac surgery. However, evidence regarding the effectiveness of SLAAO in patients undergoing mechanical heart valve replacement (MHVR) is lacking. Therefore, we aimed to evaluate the association between SLAAO and the cardiovascular outcomes in patients with atrial fibrillation undergoing MHVR.

Methods

We retrospectively analyzed data for 497 patients with atrial fibrillation; 27.6% of the patients underwent SLAAO, and the remainder of the patients did not (No-SLAAO group). The primary outcome was a composite of ischemic stroke, systemic embolism, and all-cause mortality. Cumulative event-free survival rates were estimated using Kaplan-Meier curves, and we performed multivariate Cox analyses to evaluate the association between SLAAO and outcomes. We used one-to-one propensity score matching to balance patients’ baseline characteristics, and analyzed 120 matching pairs.

Results

Five patients died within 30 days postoperatively, and there were no significant differences between the two groups regarding in-hospital complications (allP > 0.05). After a median follow-up of 14 months, 14 primary events occurred. Kaplan-Meier curves showed no difference in the cumulative incidence of freedom from the primary outcome (log-rankP = 0.830), hemorrhagic events (log-rankP = 0.870), and the secondary outcome (log-rankP = 0.730), between the two groups. Multivariable Cox proportional hazards regression analysis showed no association between SLAAO and any outcome (allP > 0.05). After propensity score matching, cardiopulmonary bypass time and aortic cross-clamp time, and the postoperative length of stay were significantly longer in the SLAAO group (allP < 0.05); results were similar to the unadjusted analyses.

Conclusions

Concomitant SLAAO and MHVR was associated with longer length of stay, and cardiopulmonary bypass time and aortic cross-clamp time, but was not associated with additional protective effects against thromboembolic events and mortality during the 14-month follow-up.
Molecular Alterations in Vaginal Melanomas: Report of 4 Cases and Literature Review
Authors: Moran Jakob M. T. , Fujimoto Masakazu , Iwahashi Yoshifumi , Cornejo Kristine M. , Hoang Mai P.
Published: August 2020

Melanomas of the female gynecological tract comprise approximately 18% of mucosal melanomas, a rare subtype of melanoma. Within the female genital tract, 70% of primary melanomas of the gynecological tract are from the vulva with the remainder occurring in the vagina and rarely, in the cervix. We investigate molecular alterations by next-generation sequencing-based molecular tests targeting 99 cancer genes and translocation/fusion assays in 4 and 3 vaginal melanomas, respectively. The ages of the 4 patients range from 65 to 90 years. Postmenopausal bleeding was the most common presenting symptom. Tumor size ranged from 0.5 to 6.6 cm. KIT L576P mutation was documented in case 1, whereas TP53 mutation was seen in cases 2 and 3 (L130F and Y163C). Case 2 also harbored NF2 E204Q and ATRX D1719H mutations. A number of gene copy alterations were noted in case 4, which included GNA11 loss, MYC gain, RET loss, SMO loss, SUFU loss, and TSC2 loss. No gene fusion was detected in any of the 3 tested cases. In conclusion, in addition to KIT, TP53, and ATRX mutations, which have been previously reported, our cases harbor NF2 mutation and multiple gene copy alterations that have not previously been documented in vaginal melanomas. These findings highlight the potential role of targeted therapy in this rare melanoma subtype.
Preliminary Impact of an Adapted Emotion Regulation Intervention for Adolescents with Overweight and Obesity Attempting to Lose Weight
Authors: Hadley Wendy , Houck Christopher , Barker David , Wickham Brittany , Bogner Jaclyn , Jelalian Elissa
Published: August 2020

Objective:

This study examines the acceptability, feasibility, and preliminary impact of a program (HealthTRAC) combining 2 efficacious interventions (one targeting emotion regulation [TRAC] and the other a standardized behavioral weight management intervention [SBWC]) to improve weight management outcomes among a sample of adolescents with overweight and obesity.

Method:

Adolescents with overweight or obesity (N = 38), ages 13 to 17 years, were enrolled and randomized into either the SBWC or HealthTRAC. Data were collected at baseline (before intervention), at the end of the 16-week intervention (postintervention), and 4 months after completing the intervention (4 months). Assessments included adolescent self-reports of intervention acceptability and reported emotion regulation (ER) abilities and caregiver report of adolescent ER skills. Body mass index (BMI) was used to examine the impact on adolescent weight outcomes. Analyses of covariance controlling for baseline values were used to evaluate study outcomes.

Results:

Eighty-four percent (n = 32) of participants completed the immediate postintervention and 4-month follow-up assessments. Adolescents in both conditions reported high treatment satisfaction. Adolescents randomized to HealthTRAC demonstrated greater reductions in BMI relative to SBWC and reported greater use of emotion regulation skills. Finally, caregivers of adolescents randomized to HealthTRAC also reported greater improvements in emotion regulation abilities among their adolescents at the 4-month follow-up.

Conclusion:

Findings suggest that the HealthTRAC intervention was acceptable, feasible to deliver, and demonstrated a positive impact on BMI and emotion regulation abilities. These data suggest that ER is related to health decision-making and is relevant to most overweight/obese adolescents seeking to lose weight.
Maternal Consistency in Recalling Prenatal Experiences at 6 Months and 8 Years Postnatal
Authors: Ramos Amanda M. , Marceau Kristine , Neiderhiser Jenae M. , De Araujo-Greecher Marielena , Natsuaki Misaki N. , Leve Leslie D.
Published: August 2020

Objective:

Mothers are known to be reliable reporters of smoking during pregnancy, type of delivery, and birth weight when compared with medical records. Few studies have considered whether the timing of retrospective collection affects the mother's retrospective self-report. We examined the consistency of maternal retrospective recall of prenatal experiences, behaviors, and basic birth outcomes between 6 months and 8 years postpartum.

Method:

We examined 117 mothers (62% White, 44% living in a committed relationship, median high school education) from the Early Growth and Development Study (EGDS). EGDS is a longitudinal adoption study that includes birth mothers of children born between 2003 and 2009 who were involved in a domestic adoption. Using the modified life history calendar and a pregnancy screener, mothers reported on their prenatal health behaviors, prenatal substance use, and labor and delivery at 6 months and 8 years postpartum. Cohen κ was calculated to examine consistency, and χ2 tests were used to test differences by parity and maternal education.

Results:

Mothers' recall was very good for recall of the type of delivery and good for smoking during pregnancy, medicine used for labor induction, and specific medical problems (i.e., pre-eclampsia, sexually transmitted infections, and kidney infections). Recall consistency was poor for illicit drug use, specific prenatal tests performed (i.e., amniocentesis and emergency room visits), and using drugs other than an epidural during delivery.

Conclusion:

This study provides support for using retrospective collection of maternal self-report on some prenatal experiences up to 8 years postpartum and offers a potential way to more accurately collect self-reported prenatal experiences.
Non-hormonal mediators of uterine fibroid growth
Authors: Cetin Esra , Al-Hendy Ayman , Ciebiera Michał
Published: August 2020

Purpose of review

Uterine fibroids are the most common benign neoplasms of the female reproductive tract and one of the major public health concerns. Although most women with uterine fibroids are asymptomatic, over 30% of them will present with varying symptoms. This review focuses on the role of non-hormonal mediators and pathways in uterine fibroid biology. Furthermore, it provides data regarding the most recent findings in the field of compounds, which use those non-hormonal pathways in the medical therapy of uterine fibroids.

Recent findings

Complex signaling pathway alterations are crucial for uterine fibroid development. The topic of the pathophysiology of uterine fibroids focuses mostly on steroids and other hormones. However, other very important pathways exist, and some of them are independent of hormones. Some of the most important pathways, which are non-hormonal, but in some cases still hormone-depended, include growth factors, cytokines and inflammation, Smad proteins, wingless type/β-catenin and others.

Much more is known about hormonal than about non-hormonal signaling in uterine fibroids. Growth factors, early life exposure and inflammation are key factors in uterine fibroid biology. Numerous agents depend on those pathways and may find their place in the current and future therapy of uterine fibroids.
Surgical treatment of mitral regurgitation
Authors: Lawrie Gerald M.
Published: August 2020

Purpose of review

Mitral repair is the best treatment for degenerative mitral regurgitation. Many patients are referred too late for optimal outcomes. The US repair vs. replacement rate is only 60–80%, at a time when the inferiority of replacement has been established. Therefore, widely used traditional techniques of repair are being reappraised.

Recent findings

Identification of risk factors predictive of poor early and late outcome have improved timing for surgical referral. Composite risk scores have been developed. Novel echocardiographic, cardiac MRI, and molecular level risk factors could improve timing. Analysis of factors contributing to low repair rates is also of critical importance. The role of institutional and surgeon volumes have been identified. More detailed data on the importance of dynamic function of the mitral valve have led to improved repair techniques such as intraoperative simulation of end diastole and early systole, use of expanded polytetrafluoroethylene neochords instead of leaflet resection, and dynamic instead of rigid annuloplasty.

Our perception of mitral regurgitation has changed from a seemingly simple condition to one of considerable complexity at multiple levels. National guidelines should be studied and followed.
Revascularization strategies for left main coronary artery disease: current perspectives
Authors: Elbatarny Malak , Cheema Asim N. , Mazine Amine , Verma Subodh , Yanagawa Bobby
Published: August 2020

Purpose of review

Left main coronary artery disease (LMCAD) represents a high-risk subset of coronary artery disease with significant morbidity and mortality if not treated in a timely manner. In this review, we survey the contemporary evidence on the management of LMCAD, highlight advances, and provide in-depth review of data comparing surgical and percutaneous approaches.

Recent findings

LMCAD represents a heterogeneous condition and management should be guided by key clinical and anatomic factors. In recent years, there has been a wealth of published prospective data including results of the EXCEL and NOBLE trials. Coronary artery bypass graft (CABG), remains the gold standard for optimal long-term outcomes and the greatest benefit seen in patients with higher anatomic complexity and longer life expectancy. Percutaneous coronary intervention (PCI) offers a less-invasive approach with rapid recovery. PCI is optimal in situations when surgery cannot be offered in a timely manner due to hemodynamic instability, for high-risk surgical patients, or those with limited life expectancy, if LMCAD is anatomically simple. As a result of continued technological and procedural improvements in both PCI and CABG, cardiovascular specialists possess a growing armamentarium of approaches to treat LMCAD. Thus, center specialization and use of a heart team approach are increasingly vital, though barriers remain.

Emerging evidence continues to support CABG as the gold standard for achieving optimal long-term outcomes in patients with LMCAD. PCI offers a more expeditious approach with rapid recovery and is a safe and effective alternative in appropriately selected candidates.
Influence of Sodium Hyaluronate Concentration in Tear Meniscus Height: 10-min Dynamic Profile After Single Instillation
Authors: Rocha-de-Lossada Carlos , Sánchez-González José-María , Zamorano-Martín Francisco , Rachwani-Anil Rahul , Torras-Sanvicens Josep , Peraza-Nieves Jorge
Published: August 2020

Purpose:

To assess the height, area, and density of tear meniscus throughout 10 min after instillation of sodium hyaluronate (SH) of equal molecular weight at two different concentrations.

Methods:

Thirty-four eyes from 17 patients were enrolled in this longitudinal, nonrandomized, interventional and contralateral eye study. Tear meniscus height (TMH), corneal meniscus junction (CMJ), lower-lid meniscus junction (LLMJ), and tear meniscus area (TMA) images were obtained with the anterior segment module of the deep range imaging ocular coherence tomography ([DRI-OCT] Triton Swept-Source). Tear meniscus density (TMD) was calculated using the image processing and analysis software by Java (ImageJ program). Sodium hyaluronate artificial tears at 0.1% and 0.2% concentrations were instilled into all right and left eyes, respectively.

Results:

Patients' mean age was 61.05±11.43 years. Tear meniscus height, CMJ, LLMJ, and TMA measured at 1-, 5-, 7- and 10-min postinstillation of 0.1% SH proved significant differences among them (P<0.05). Sodium hyaluronate 0.2% instillation obtained similar findings, although no significant differences were found between 1- and 3-min postinstillation measurements (P>0.05). Fewer differences were found in TMD 0.2% SH group due to a lower baseline densitometry compared to the 0.1% group.

Conclusion:

0.2% sodium hyaluronate achieved better TMH and TMA in 1 and 3 min after instillation than 0.1% concentration. However, there were no statistically significant differences between 0.1% and 0.2% sodium hyaluronate throughout a ten-minute longitudinal profile measurement using DRI-OCT.
Precision Pulse Capsulotomy During Combined Penetrating Keratoplasty With Cataract Surgery and Intraocular Lens in Small Nondilating Pupil
Authors: Singh Bhupesh , Sharma Sourabh , Bharti Neha , Bharti Sudhank
Published: August 2020

Objective:

To demonstrate precision pulse capsulotomy (PPC) in an open-sky procedure and to evaluate its use during triple procedure keratoplasty in small nondilating pupils.

Methods:

This single-center retrospective case series study included 10 eyes (from 10 patients) with corneal opacity and poorly dilated pupils who were scheduled to undergo triple procedure keratoplasty. The main outcome measures were capsulotomy performance of the PPC device and intraoperative complications. Secondary outcome measures included postoperative best-corrected visual acuity, intraocular pressure, and other postoperative complications.

Results:

Complete free-floating capsulotomy was achieved in all 10 eyes. There were no cases of anterior capsule tears or tags. There were no postoperative complications that occurred in association with the PPC device.

Conclusions:

The PPC device facilitates creation of a smooth, round, and appropriately sized anterior capsulotomy in open-sky surgeries, particularly in presence of small nondilating pupils.
Axial Length Elongation in Japanese Youth With Myopia
Authors: Itoi Motohiro , Itoi Motozumi
Published: August 2020

Objectives:

To investigate the correlation between the annual axial length (AL) elongation and associated factors in Japanese youth with myopia.

Methods:

This retrospective study enrolled patients aged 7 to 21 years with myopia. Axial length was measured using ocular biometry. Refractive errors and curvature radius (CR) were measured using an open-field Binocular Auto Ref/Keratometer without cycloplegia. Subjects were divided into five groups using 3-year age intervals, and the relationship between annual AL elongation and age, spherical equivalent (SE), corneal CR, and sex was evaluated.

Results:

Four hundred and eighty-two patients (184 male and 298 female subjects) with a mean age of 15.55±4.09 years were included. The annual AL elongation was largest in the youngest group (0.47±0.19) and decreased with age to 0.03±0.04 in the oldest group. The annual change in AL was associated with age and SE (P<0.01) but not with sex or CR (P>0.05). Axial length elongation stratified by age was significantly correlated with SE in the 15 to 18-year-old (R
2=0.20, P<0.01) and 19 to 21-year-old (R
2=0.37, P=0.01) groups, whereas there was no significant correlation in the 7 to 9-year-old group (R
2=0.04, P=0.14), the 10 to 12-year-old group (R
2=0.05, P=0.07), and the 13 to 15-year-old group (R
2=0.01, P=0.14).

Conclusions:

In Japanese youth with myopia, AL elongation was largest in the youngest group, decreased with age, especially in the group older than 15 years.
Heads-up Descemet Membrane Endothelial Keratoplasty Surgery: Feasibility, Surgical Duration, Complication Rates, and Comparison With a Conventional Microscope
Authors: Panthier Christophe , Courtin Romain , Moran Sarah , Gatinel Damien
Published: August 2020

Purpose:

To assess the feasibility of Descemet membrane endothelial keratoplasty (DMEK) surgery using the glasses-assisted 3-dimensional (3D) display system NGENUITY (Alcon Laboratories, Fort Worth, TX) and to compare with standard DMEK surgery by using a conventional operating microscope.

Methods:

Twelve consecutive cases of DMEK surgery were performed using the glasses-assisted 3D display system NGENUITY (Alcon) and matched with similar cases performed by using the OPMI-Lumera 700 surgical microscope (Carl Zeiss Meditec, Jena, Germany) in this prospective cross-sectional study realized at the Rothschild Foundation, Paris, France. DMEK graft preparation time, graft unfolding time, time to perform the descemetorhexis (DM), and overall surgical time were recorded. Best corrected visual acuity, endothelial cell density of the donor tissue measured by specular microscopy, and the recipient's central corneal thickness were recorded preoperatively and again at 1 and 3 months postoperatively.

Results:

In the 3D group, time to perform the graft preparation, DM, and global surgical time were significantly higher in the 3D group than in the conventional groups (17 minutes 36 seconds ± 3 minutes 13 seconds and 14 minutes 50 seconds ± 1 minutes 28 seconds, P = 0.04; 6 minutes 18 seconds ± 2 minutes 30 seconds vs. 3 minutes 50 seconds ± 2 minutes 8 seconds, P = 0.03; and 31 minutes 30 seconds ± 6 minutes 10 seconds vs. 24 minutes 10 seconds ± 3 minutes 26 seconds, respectively, P = 0.05). The time to unfold the graft was higher, although not significantly so, in the 3D group compared with the conventional group (5 minutes 15 seconds ± 2 minutes 40 seconds vs. 4 minutes 40 seconds ± 2 minutes 25 seconds, P = 0.89). Mean central corneal thickness decreased about 168 ± 82 μm at 3 months after surgery in the 3D group and about 228 ± 123 μm in the conventional group without significant difference (P = 0.60). Best corrected visual acuity in the 3D group was 0.33 ± 0.32 LogMAR at 3 months after surgery with no significant differences found when compared with conventional surgery. The percent endothelial cell loss from preoperative at 3 months was 35% in the 3D group and 26% in the conventional group, respectively, with no significant difference (P > 0.05).

Conclusions:

Performing DMEK surgery using a 3D display system is feasible; however, it is more challenging and the total surgical time is longer. This method would certainly be useful for instructional courses.
Keratoconus in Children: A Literature Review
Authors: Buzzonetti Luca , Bohringer Daniel , Liskova Petra , Lang Stefan , Valente Paola
Published: August 2020

Purpose:

This review discusses the main aspects of pediatric keratoconus (KC) based on the current evidence to propose a guideline for helping early diagnosis and improving efficacy in treatment.

Methods:

This literature review was performed using PubMed, Ovid, and Elsevier databases. For the database search, the primary entered term included “pediatric keratoconus,” connected to descriptors such as “keratoconus,” “screening,” “corneal cross-linking” (CXL), and “keratoplasty.” Peer-reviewed and scholarly resources including original scientific articles and review articles were included.

Results:

The prevalence of KC changes among populations. The greatest incidence has been reported in Middle-Eastern populations, an estimate of incidence of 1/2,000 individuals per year. Scheimpflug imaging, optical coherence tomography, and slit-scan tomography are commonly used to detect early diagnosis. Epithelium-off CXL is the treatment that should be discussed as soon as there is evidence for disease progression. Actually, penetrating keratoplasty represents the more common technique of pediatric keratoplasty; however, deep anterior lamellar keratoplasty probably seems as the best surgical option because of healthy endothelium. Options to increase visual acuity thereafter include contact lens fitting and corneal implants.

Conclusions:

The review of the literature confirms that KC in children is more aggressive than that in adults. In the attempt to preserve a good visual acuity, guidelines for improving early diagnosis and appropriate treatment seem crucial.
Descemet Stripping Only Supplemented With Topical Ripasudil for Fuchs Endothelial Dystrophy 12-Month Outcomes of the Sydney Eye Hospital Study
Authors: Moloney Gregory , Garcerant Congote Daniel , Hirnschall Nino , Arsiwalla Tasneem , Luiza Mylla Boso Ana , Toalster Nicholas , D'Souza Mario , Devasahayam Raj N.
Published: August 2020

Purpose:

To report early safety and efficacy of Descemet stripping only (DSO) supplemented with ripasudil.

Methods:

A pre-post clinical trial with a historical control group for time to heal and cell count parameters. The study received ethics approval and was conducted with oversight of a data safety monitoring board. All enrolled patients had a superior endothelial cell count of >1000 cells/mm2 and were symptomatic from the presence of central guttata degrading vision and/or producing glare. DSO was carried out with a peeling technique and not combined with any other intervention. Ripasudil 0.4% was applied topically from day 1 postoperatively at a dose of 6 times/d until corneal clearance. Cases with relapse of edema were permitted to restart on ripasudil at a reduced dose of 2 drops/d for a further 2 weeks. Stopping rules with progression to a corneal graft were established. Baseline ocular and systemic investigations were carried out and repeated at varying intervals to monitor for local and systemic adverse events.

Results:

Twenty-three eyes of 23 patients met the inclusion criteria and underwent DSO. Twenty-two of 23 eyes achieved corneal clearance at a mean time of 4.1 weeks. In all patients achieving clearance, improvement in vision was recorded. Improvement in mean uncorrected visual acuity was 0.20 Logarithm of the minimum angle of resolution (LogMar), and improvement in mean best spectacle corrected visual acuity was 0.156 LogMar. One patient failed to clear and underwent Descemet membrane endothelial keratoplasty at week 12. Twenty-one of 22 patients achieving corneal clearance expressed satisfaction with the procedure. The commonest systemic side effect of topical ripasudil was gastrointestinal upset (24%), and the commonest local side effect was ocular irritation (43%). No patient experienced a serious adverse event in the course of the trial. Thirty-nine percent of patients experienced a relapse of edema on ceasing ripasudil, with clearance again on recommencing.

Conclusions:

This trial of DSO supplemented with ripasudil included local and systemic safety analysis. We judge that this treatment option is emerging as a reliable intervention for select patients with Fuchs' Endothelial Corneal Dystrophy (FECD) with an acceptable safety profile. The observation of relapse edema is strong evidence of a drug effect. The longevity of these results remains unknown.
Conjunctival Melanoma: Outcomes Based on Age at Presentation in 629 Patients at a Single Ocular Oncology Center
Authors: Dalvin Lauren A. , Yaghy Antonio , Vaidya Sarangdev , Pacheco Richard R. , Perez Alejandro L. , Lally Sara E. , Shields Jerry A. , Shields Carol L.
Published: August 2020

Purpose:

To investigate the clinical features and outcomes for conjunctival melanoma based on patient age.

Methods:

A retrospective review of patients with conjunctival melanoma managed at a single tertiary referral center from April 18, 1974, to September 9, 2019. Clinical features and outcomes were compared by patient age category at presentation (young ≤45 years, middle-aged 46–69 years, and older ≥70 years), with Kaplan–Meier and Cox proportional hazard analysis [hazard ratio (95% confidence interval)].

Results:

There were 629 patients categorized as young in 130 (21%), middle-aged in 278 (44%), and older in 221 (35%). A comparison by age category (young vs. middle-aged vs. older) revealed that older patients had melanoma with greater number of affected quadrants (1.7 vs. 1.8 vs. 2.0, P = 0.001) and clock hours (3.9 vs. 4.2 vs. 5.2, P = 0.001). All patients were treated with surgical excision, with no difference in requirement for additional medical or radiation therapy. By 10-year Kaplan–Meier outcomes, older patients had more frequent visual acuity loss ≥3 lines (11% vs. 28% vs. 64%, P < 0.001) and local tumor recurrence (38% vs. 46% vs. 70%, P < 0.001). Hazard ratio for the oldest age group (age ≥70) revealed a 7.76-fold (3.33–18.09) increased risk for visual acuity loss (P < 0.001), and a 2.08-fold (1.32–3.28) increased risk of local tumor recurrence (P = 0.002). There was no difference by age in risk for enucleation, exenteration, locoregional lymph node involvement, distant systemic metastasis, or death.

Conclusions:

Older patients with conjunctival melanoma present with more extensive disease and have increased risk for visual acuity loss and local tumor recurrence.
Evaluation of Densitometric Analysis for Early Detection of Corneal Blood Staining in Hyphema
Authors: Kiziltoprak Hasan , Atesoglu Halil İbrahim , Tekin Kemal , Yetkin Esat , Koc Mustafa
Published: August 2020

Purpose:

To investigate the possibility of detecting presumed corneal blood staining after traumatic hyphema with corneal densitometry and to evaluate corneal transparency after hyphema resolution.

Methods:

Twenty-eight patients with uniocular nonpenetrating ocular trauma with hyphema were included in the study. Corneal densitometry measurements were performed at the first week and the first month after full resolution of blood in the anterior chamber and discontinuation of medication. The uninjured eyes were accepted as the control group.

Results:

The corneal densitometry values at all zones of the posterior layer in the study eyes were significantly higher at the first week compared with the first month (P < 0.05 for all). Comparison of the corneal densitometry values of the study eyes at the first week with the fellow eyes showed significantly higher values at all zones of the posterior corneal layer (P < 0.05 for all). Comparison of the study eyes at the first month with the fellow eyes was significantly higher at the posterior 0- to 2-, 2- to 6-, and 6- to 10-mm zones (P = 0.030, P = 0.044, and P = 0.035, respectively). Although corneal densitometry values at the posterior 10- to 12-mm and posterior total zones were higher at the first month compared with those of the fellow eyes, these differences were not statistically significant (P = 0.197 and P = 0.085, respectively).

Conclusions:

Corneal densitometry at all zones of the posterior corneal layer significantly changed after traumatic hyphema. Corneal densitometry analysis could be used in clinically normal cases for possible early corneal blood staining detection.
Effect of Intravenous Dexmedetomidine on Intraocular Pressure in Patients Undergoing Glaucoma Surgery Under Local Anesthesia: A Pilot Study
Authors: Senthil Sirisha , Burugupally Keerthi , Rout Umashankar , Rao Harsha L. , Krishnamurthy Rashmi , Badakere Swathi , Choudhari Nikhil , Garudadri Chandrasekhar
Published: August 2020

Precis:

Preoperative intravenous (IV) dexmedetomidine produced a 33% reduction in intraocular pressure (IOP) within 15 minutes of administration in patients with glaucoma.

Purpose:

To evaluate the effect of preoperative IV dexmedetomidine on IOP in adult patients undergoing glaucoma surgery under local anesthesia.

Methods:

In a prospective interventional case series, 12 patients with uncontrolled IOP (IOP>24 mm Hg in both the eyes) with the systemic status of American Society of Anesthesiologists (ASA) classification I-II, received IV dexmedetomidine 0.6 µg/kg 30 minutes preoperatively. The IOP of the nonsurgical eye (measured with Perkins tonometer), the heart rate (HR), and blood pressure (BP) were recorded 5 minutes prior, 15 minutes and 2 hours after IV dexmedetomidine administration, and were compared using analysis of variance and Tukey honestly significant difference tests.

Results:

There were 4 women and 8 men with a mean age (±SD) of 60.6±10.4 years. The mean number of antiglaucoma medications was 4.3±1.3. The mean pre-dexmedetomidine IOP was 31.5±5.6 mm Hg. At 15 minutes post-dexmedetomidine administration, the mean and percentage drop in IOP were 10.2±3.2 mm Hg (P=0.001) and 33%±11%, respectively. The mean and percentage drop in systolic BP were 18±20 mm Hg (P=0.01) and 12%±14%, and drop in diastolic BP were 6.5±10 mm Hg (P=0.05) and 7%±11%, respectively. The mean and percentage drop in HR were 2±0.6 bpm (P=0.48) and 2%±13%, respectively. None of the subjects experienced any medication-related adverse effects. At 2 hours, the mean and percentage drop in IOP were 5.3±3 mm Hg and 17%±11%, respectively.

Conclusion:

In the small sample of (ASA I-II) patients studied, preoperative dexmedetomidine produced a significant drop in IOP (33%) within 15 minutes of IV administration in patients with glaucoma that was reversing at 2 hours, with a good safety profile.
From hemorrhagic stroke to lipid paradox: a double-hit hypothesis underlying low low-density lipoprotein cholesterol related cardiovascular risk—a narrative review
Authors: Zhou Xin , Yang Qing
Published: August 2020

Despite overwhelming evidence from large randomized clinical trials supporting a clear benefit of low-density lipoprotein cholesterol (LDL-C) lowering therapy on the primary and secondary prevention of atherosclerotic cardiovascular disease, data from epidemiological and clinical observations demonstrated an increased incidence of hemorrhagic stroke in patients with low LDL-C exposure (<70 mg/dL), especially among East Asians. Meanwhile, emerging studies have reported a paradoxical phenomenon in which hypercholesterolemia is associated with better short-term outcomes in acute coronary syndrome patients, the "lipid paradox." The underlying mechanism for these two closely connected clinical observations is not clear. This review aimed to summarize the evolution and clinical implications of these two low LDL-C related concepts, and proposed a "double-hit" hypothesis that may help explain these phenomena. It is worth noting that in the era of increasing use of high-intensity LDL-C lowering and dual antiplatelet strategies in atherosclerotic cardiovascular disease in patients receiving percutaneous coronary intervention, balancing the risk of thrombosis with bleeding complication should be a priority in clinical practice. Our hypothesis may raise clinicians’ awareness to identify potential high risk patients with low LDL-C (<70 mg/dL), especially among East Asians.
Knowledge, Attitudes, and Perceptions of Young Adults About Electronic Nicotine Delivery Systems in the United States
Authors: Tremblay Beth , Turk Melanie T. , Cooper Maria R. , Zoucha Richard
Published: August 2020

Background

The causal link between cigarettes and cardiovascular disease is well known. The long-term effects of e-cigarettes are yet unknown, although early studies show biomarkers indicating inflammation and damage to endothelial cells associated with later development of cardiovascular disease. With the rapid rise in e-cigarette use, especially in young adults, it is imperative that health professionals understand the knowledge, perceptions, and motivations for use among young adults.

Objectives

The purpose of this integrative review is to explore existing literature on young adults' knowledge, attitudes, values, and perceptions about e-cigarettes, as well as the social norms they experience.

Methods

The Whittemore and Knafl model for integrative review guided the methodology. Three databases were searched from January 2010 through December 2018. The study selection process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion and exclusion criteria were applied. Studies were evaluated for quality and strength. Key themes were extracted, coded, and synthesized.

Results

Seventy-one full-text studies were assessed for inclusion criteria; 15 articles were included, coded, and analyzed for quality and thematic content. Current e-cigarette users represented just 3% to 35% of study participants. Three themes arose from a synthesis of the literature: “Is it bad for me?,” “I just like it,” and “Is it cool or not?”

Conclusions

Young adults are not armed with the accurate knowledge to make informed choices about using e-cigarettes. E-cigarette users are understudied and tend to value appearance and physical sensation over health. Social norms related to e-cigarette use are linked to perception of identity and the current technology-focused culture.