bluuebunny/crossref_metadata_2025 huggingface dataset:
Anesthesia techniques and the risk of complications as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO).
Authors: Segers Maartje HM , Rosen Paul , van den Biggelaar Frank JHM , Brocato Lucia , Henry Ype P , Nuijts Rudy , Tassignon Marie-José , Young David , Stenevi Ulf , Behndig Anders , Lundström Mats , Dickman Mor M
Published: July 2022

PURPOSE:

To determine the trends in anesthesia techniques for cataract surgery over the past decade and their relationship to surgical complications.

SETTING:

Clinics affiliated with the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO)

DESIGN:

Retrospective cross-sectional register-based study

METHODS:

Variables include patient demographics, visual acuity, ocular comorbidities, surgery characteristics, intraoperative complications, and postoperative complications for the study period from January, 2008, to December, 2018. The anesthesia methods registered in the EUREQUO and included in the study are topical, combined topical and intracameral, sub-Tenon’s, regional, and general anesthesia. Multivariate logistic regression models for each complication were constructed to estimate the adjusted odds ratio (OR) and 95% confidence intervals (CIs).

RESULTS:

Complete data were available of 1,354,036 cataract surgeries. Topical anesthesia increased significantly over time (from 30% to 76%, P<.001). Sub-Tenon’s and regional anesthesia decreased (from 27% and 38% to 16% and 6%, respectively, P<.001), and general and combined topical and intracameral anesthesia remained stable (around 2%). Sub-Tenon’s (OR 0.80 95%CI 0.71-0.91, P<.001), regional (0.74 95%CI 0.71-0.78, P<.001), general (0.53 95%CI 0.50-0.56, P<.001), and intracameral anesthesia (0.76 95%CI 0.64-0.90, P=0.001) carried a significantly decreased risk of posterior capsule rupture (PCR), with and without dropped nucleus, compared with topical anesthesia. The risk of endophthalmitis was significantly lower with regional anesthesia compared with topical anesthesia (OR 0.60 95%CI 0.44-0.82, P=.001).

CONCLUSION:

The use of topical anesthesia for cataract surgery increased over time. Topical anesthesia is associated with an increased risk of PCR with and without dropped nucleus, and endophthalmitis.
Results From the Perceived Value of Certification Tool-12 Survey: Analysis of the Perceived Value of Certification Among Stroke and Neuroscience Nurses
Authors: Walter Suzy Mascaro , McNair Norma D. , Banat Rebecca , Anderson Tracey , Dai Zheng , Wang Kesheng
Published: July 2022

AIM: The purpose of this study was to explore the perceived value of certification among those with a neuroscience or stroke nursing certification. METHODS: The Perceived Value of Certification Tool-12 (PVCT-12) consists of 12 value statements related to the benefits of certification, using a 4-point Likert scale ranging from strongly disagree to strongly agree. Descriptive statistics were used to determine the percentage of agreement among respondents with each of the PVCT-12 items. A generalized linear model approach was then used to estimate the associations between age, sex, race, experience, certification, highest degree earned, primary responsibility, and primary work setting with intrinsic and extrinsic values. An exploratory factor analysis was performed to identify factors on which related variables were found. RESULTS: The 632 certificants were predominantly female (90%) with a mean age of 54 years. Approximately 80% were White, followed by Asian (11%), Hispanic (4%), and Black (3%). Certification included certified neuroscience registered nurse (34%), stroke certified registered nurse (47%), or both (20%). Approximately 57% of the certificants work in critical care/medical-surgical units. Work setting included academic (46%) and community (42%). Responses indicated lower levels of agreement with the value statements regarding certification challenges, professional autonomy, being listened to, and monetary gain. Those in administration had statistically significant higher intrinsic and extrinsic value scores (P = .005) as compared with those in nonadministrative roles. There was no significant difference on perceived intrinsic or extrinsic values for those who work in an academic environment versus those who work in a community environment (P = .25). After factor analysis, the PVCT-12 was found to have 3 factors that accounted for 53.4% of the total variation in the data: recognition of specialization, personal achievement, and professional accomplishment. CONCLUSION: The PVCT-12 incorporated a Likert-type scale to provide levels of agreement for intrinsic and extrinsic values among stroke certified registered nurses and certified neuroscience registered nurses. To complement these findings, further research using open-ended questions is needed to improve our understanding of participant responses regarding complex values such as “autonomy” and the “extent of being listened to.”
A Comparative Survey Study of In-Person Versus Virtual Trauma Peer Review Meetings
Authors: Zebley James A. , Chang Parker , Sarani Babak , Boese Stephanie , Messing Jonathan
Published: July 2022

Background:

The American College of Surgeons Committee on Trauma mandates regular peer review meetings for verified trauma centers. The COVID-19 pandemic forced in-person meetings to transition to an online platform.

Objective:

The objective of this study was to assess the opinions of participants regarding the benefits and negative aspects of the virtual peer review process. We hypothesize that physicians and nurses would prefer a virtual meeting format.

Methods:

An anonymous online survey of members of the American Association for the Surgery of Trauma and the Society of Trauma Nurses was distributed in May and June of 2021. Demographic data and Likert scale-based responses were collected using the Research Electronic Data Capture platform.

Results:

Invitations were sent to 1,726 physicians and 2,912 nurses. In total, 137 (8%) physicians and 141 (5%) nurses completed the survey. Both groups felt that either platform was effective in addressing opportunities for improvement in care. Physicians disagreed with the statement that anonymous online voting improved their ability to more accurately address opportunities for improvement. In total, 108 (79%) physicians and 100 (71%) nurses preferred a hybrid meeting. Only 18 (13%) physicians and 23 (16%) nurses wanted virtual meetings, whereas only 29 (21%) physicians and 36 (26%) nurses wanted in-person meetings going forward.

Conclusions:

Virtual and in-person trauma peer review meetings are equally effective in terms of case discussion and identifying opportunities for improvement in care. Given that most people preferred a hybrid meeting, future studies evaluating how best to incorporate and implement this format are needed.
Health Care Providers' Lived Experience Caring for Victims of Youth Violence Separated From Family During Trauma Resuscitation
Authors: Kittle Jolene
Published: July 2022

Background:

Family presence during trauma resuscitation is increasingly emphasized; yet it is inconsistently applied and has not been studied in victims of youth violence from the perspective of the health care provider.

Objective:

The purpose of this study is to explore the lived experience of health care providers involved in the care of children who are separated from their family during trauma resuscitation for injuries sustained from youth violence.

Methods:

A qualitative, transcendental phenomenological study was conducted to examine health care providers' experiences. Data were collected from March 2021 to April 2021 using open-ended, semistructured interviews conducted via Zoom or telephone. Data were transcribed and analyzed following the transcendental phenomenological reduction approach.

Results:

Seven health care providers were interviewed. Ages of the participants ranged from 31 to 60 years (mean: 52.1 years). Years of practice ranged from 9.5 to 36 years (mean: 26 years). The participants' professions included surgeon, registered nurse, violence interventionalist, and social worker. From the data collected, 6 major themes emerged: current landscape, decision making, safety and security, law enforcement presence, characteristics of families of victims of youth violence, and staff reflections.

Conclusions:

This study demonstrates the value of incorporating health care providers' experiences to inform the barriers, facilitators, and nuances of implementing family presence during trauma resuscitation for pediatric victims of violence.
Acute Traumatic Spinal Cord Injury: Implementation of a Multidisciplinary Care Pathway
Authors: Portelli Tremont Jaclyn N. , Cook Nicole , Murray Laura Helen , Udekwu Pascal Osi , Motameni Amirreza T.
Published: July 2022

BACKGROUND:

Management of acute traumatic spinal cord injuries is complex, and patients are at risk for severe complications while inpatient. Performance review revealed opportunities for improvement in the care of patients with acute traumatic spinal cord injury at our institution.

OBJECTIVE:

To compare mortality, failure-to-rescue, and health care utilization of patients with acute traumatic spinal cord injury after implementation of a revised multidisciplinary care pathway.

METHODS:

Using a pre- and post-between-subjects study design, a retrospective cross-sectional analysis of consecutive patients admitted to our Level I trauma center with acute traumatic spinal cord injury was performed. An updated care pathway for all patients who presented with acute traumatic spinal cord injury was implemented in July 2020. This pathway includes a revised order set in the electronic medical record, distribution of a “best practice” guide to inpatient providers, a formal twice-daily respiratory evaluation, and weekly clinical nurse specialist-led patient rounds.

RESULTS:

One hundred and eight patients were included in analysis (prepathway: n = 52, postpathway: n = 56). Total mean hospital length of stay was 15.2 (14.0) and 21.5 (24.8) days for the pre- and postpathway groups. Eleven patients (21%) compared with six patients (11%) died, and failure-to-rescue occurred in six patients (60%) compared with zero patient in the pre- and postpathway groups, respectively. In addition, 10 (20%) postpathway patients were discharged to home compared with one (2%) in the prepathway group.

DISCUSSION:

Following implementation of the updated acute traumatic spinal cord injury pathway, overall inpatient mortality decreased, and fewer patients died after experiencing a complication. Results highlight the need for continued review of care practices and multidisciplinary review in quality improvement initiatives.
A Case for Genetic Testing in Isolated Tympanic Paragangliomas
Authors: Shrivastava Manu K. , Curran John F. , Sheerin Fintan , Mohammadi Bahram Jafar , Halliday Dorothy , MacKeith Samuel A. C.
Published: July 2022

Objective

The aim of this study is to describe two clinical cases, which we believe highlight the need to consider routine genetic testing of all patients with new diagnosis of a tympanic paraganglioma (PGL).

Patients

Two patients seen in the ENT clinic at a tertiary center with a diagnosis of isolated tympanic PGL, without family history.

Intervention

Since 2016, all patients with newly diagnosed isolated tympanic PGL (glomus tympanicum) are offered review by the clinical genetic team and genetic testing of a panel of paraganglioma/phaeochromocytoma predisposition genes. Previously only those with multiple PGL or a family history were tested.

Main Outcome Measures

We describe the results of genetic testing, the clinical course and discuss the ongoing implications for management.

Results

Both cases were identified to have a pathogenic variant in the SDHB gene after initial surgery. The clinical course for both cases was complicated by disease recurrence, as well as metastatic and secretory disease in one case. Knowledge of genetic status has influenced ongoing management, with annual MRI surveillance for other SDH-related tumors.

Conclusion

These two cases reinforce the importance of offering genetic testing for all cases of isolated tympanic PGL. The discovery of a significant underlying genetic variant may affect management decisions and subsequent follow-up.
Audiometric Outcomes Comparing Endoscopic Versus Microscopic Ossiculoplasty
Authors: Sakai Mark , Killeen Daniel E. , Ma Connie , Newcomer Mark , Hunter Jacob B. , Isaacson Brandon , Kutz Joe Walter
Published: July 2022

Objective

To assess endoscopic and microscopic ossiculoplasty audiometric outcomes.

Study Design

Retrospective review.

Setting

Tertiary academic center.

Patients

Adult patients who underwent ossiculoplasty with either partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP) from 2010 to 2019 with at least 1 year of audiometric follow-up were included.

Interventions

Endoscopic or microscopic ossiculoplasty.

Main Outcome Measures

Postoperative air-bone gap (ABG) after at least 1 year.

Results

A total of 198 patients, 53.5% female, and a median age of 47.5 years, met inclusion criteria. 64.1% of patients were reconstructed with a PORP, and 31.8% were reconstructed using an endoscopic approach. The median audiometric follow-up was 27 months. The median postoperative ABG was 16.9 dB overall, 15.6 dB for PORP reconstruction, and 19.4 dB for TORP reconstruction (PORP versus TORP, p = 0.002). For TORP reconstructions, the median ABG for both endoscopic and microscopic TORP was 19.4 dB (p = 0.92). For PORP reconstructions, the median ABG for endoscopic PORP was 12.3 dB compared with 16.3 dB for microscopic PORP (p = 0.02). Using multivariate linear regression to predict postoperative PORP ABG, and controlling for age, prior ossiculoplasty, middle ear mucosal disease (granulation, fibrosis, polyposis), middle ear atelectasis, myringitis, contralateral middle ear disease, and use of byte prostheses, endoscopic PORP reconstruction was associated with improvement in ABG over the microscopic approach by 4.4 dB (p = 0.04).

Conclusions

For PORP ossiculoplasty procedures, endoscopic ossiculoplasty is associated with improved postoperative ABG compared with microscopic ossiculoplasty.
Association Between Tinnitus and Hypertension: A Cross-Sectional Analysis of the National Health and Nutrition Examination Survey
Authors: Patel Shrey D. , Patel Shiv , Finberg Ariel , Shah Viraj N. , Mittal Rahul , Eshraghi Adrien A.
Published: July 2022

Objective

Evaluating the association between arterial hypertension and tinnitus while controlling for gender, race, diabetes, hearing loss, and depression as potential confounders.

Study Design

The present study employed a cross-sectional design.

Setting

Health interviews were conducted in the respondents’ homes.

Patients

Respondents represent a nationwide sample of the noninstitutionalized civilian population of the United States. A total of 5,735 adults were identified by the NHANES 2015 to 2016 questionnaires.

Interventions

Questionnaires were administered to each participant.

Main Outcome Measures

Participants’ responses regarding tinnitus, hypertension, hearing loss, depression, diabetes, and demographics were used to evaluate potential associations. Multivariate logistic regression analyses were conducted on different age groups with the presence of hypertension as the response variable.

Results

Participants aged 20 to 39 with tinnitus were significantly more likely to be diagnosed with hypertension (OR = 2.49; p = 0.024) after adjusting for potential confounding. No significant association between tinnitus and hypertension was found for older age groups. The diagnosis of diabetes was associated with hypertension in ages 20 to 39 (OR = 7.11; p = 0.001), 40 to 59 (OR = 3.45; p = 0.020), and 60 to 69 (OR = 3.89; p = 0.032).

Conclusions

Tinnitus is associated with hypertension in younger age groups of 20 to 39 years of age but not in age groups greater than 40 years. Diabetes is also associated with hypertension in individuals aged 20 to 69 years. This finding of tinnitus as a risk factor for hypertension in younger populations may inform better clinical practice and lead to earlier detection of hypertension in at-risk patients.
Epidemiological study about the mental state of patients after a pulmonary embolism or deep venous thrombosis event
Authors: Kämpf Sabine , Weißbach Lisa , Zotz Rainer
Published: July 2022

Venous thromboembolism (VTE) occurs frequently and represents a serious threat to patient health. However, its effects on mental health have not been studied sufficiently. The objective of this study was to investigate whether VTE alters the patients’ mental state. We gathered questionnaire data on 100 patients (59 men, 41 women; age ranging from 24 to 85 years) concerning psychological symptoms and body image. Our results show that after a VTE, patients develop psychological symptoms, some of which persist for more than 2 years. Examples of those symptoms include depression, intrusion, and increased scrutiny of the body. Intrusion (flashbacks, nightmares, and other traumatic sensations of reliving the thrombotic event) affected 69% of patients and may lead to social isolation, occasionally including loss of employment. Depression affected more than 50% of patients. Productivity typically decreases, and body functionality and feeling of health changed in 34–76% of patients. However, anxiety, disordered impulse control, and maladjustment were less frequent (40% or less), and patients’ emotional attitude to their bodies (liking their bodies or being angry with their bodies, feelings of shame and attractiveness) tended not to change over time. Nevertheless, we feel it may be advisable to identify patients with relevant psychological changes after VTE by means of a short evidence-based questionnaire and to offer them psychological treatment in order to improve management and quality of life of these patients. The goal is, therefore, to develop diagnostic and therapeutic recommendations.
Clinical phenotype and F7 gene genotype in 40 Tunisian patients with congenital factor VII deficiency
Authors: Ouardani Cherifa , Elmahmoudi Hejer , ELborgi Wejden , Gharbi Maroua , Meriem Achour , Gouider Emna
Published: July 2022

Congenital factor VII (FVII) deficiency is an autosomal recessive bleeding disorder characterized by a weak phenotypic and genotypic correlation. This study aimed to determine the genetic alterations of 40 Tunisian patients and to evaluate their relationships with the collected clinical and biological data. Forty FVII-deficient Tunisian patients have been included in this study. First, diagnosis of the FVII deficiency was made on the basis of FVII coagulant activity (FVII:c) levels performed using the prothrombin time assay. Then, clinical and anamnesis data were set up and filed out from the regional registry of bleeding disorders and the medical file of each patient. Finally, genetic alterations were determined by direct sequencing of the coding regions, intron/exons boundaries of the F7 gene. Clinical heterogeneity was noticed, and the direct sequencing allowed the identification of 13 F7 gene mutations of which one was a novel mutation. The clinical manifestations are variably associated with FVII activity FVII:c levels. Lack of relations between severity of clinical manifestations and genotypes was observed; however, a relationship between the nonpathogeneous mutations and clinical phenotypes was noticed. A wide phenotypic inter-individual variability was detected, which suggests the presence of other extra-genetic components influencing the expressivity of the deficiency.
Development and Future Trends of Traditional Kampo Medicine in Japan
Authors: Shibata Risa , Chu Gui-Xiang , Lin Xun , Fu Jin-Rong
Published: July 2022

Traditional Kampo medicine is based on traditional Chinese medicine, which spread to Japan via the Korean Peninsula in the 5th century. The practice of Kampo developed gradually under the influence of local Japanese culture and prospered until the Meiji Restoration. Kampo appeared in schools successively, such as the School of Later Developments, the School of Classic Methods, the School of Textual Research, and the Integrated School. However, the practice of Kampo gradually declined after the Meiji Restoration. Today, through the continuous efforts of knowledgeable Japanese Kampo practitioners, the practice of Kampo has entered a new era as an indispensable aspect of contemporary Japanese medicine.
Edward H. Hume's Contributions to Introducing Chinese Medicine to the West
Authors: Gui Ting
Published: July 2022

Known as the founder of Xiangya School of Medicine and Xiangya Hospital, Edward H. Hume is frequently praised for his pioneering work in bringing Western medicine to China. Some researchers have investigated his efforts in introducing Chinese medicine to the West; less known is the role that he later played as a lecturer on medical history at Johns Hopkins University. This paper presents an exhaustive review of Hume's English writings on Chinese medicine, thus revealing what Hume did to introduce Chinese medicine to Western academia, and how he pioneered research into Chinese medicine from cultural and philosophical perspectives.
Survey of the History and Applications of Saffron
Authors: Asgari Motahareh , Yu Qun , Abdi Meghdad , Du Guang-Li , Shen Yun-Hui
Published: July 2022

Fan Hong Hua (李时珍 saffron) is a natural product that has long been used in food and dye industries and fortreating various disorders. Saffron has a long history of applications in traditional Chinese medicine, following its introduction to China in 1979. According to the theory of traditional Chinese medicine, saffron is sweet, slightly cold in nature and enters heart and liver meridians. Moreover, this spice can invigorate blood circulation, eliminate blood stasis, cool blood and eliminate heat toxins. Saffron has been used to treat asthma, phlegm, insomnia, Alzheimer's disease, depression, fright, shock, hemoptysis, heartburn, and pain. Among the almost 70 bioactive ingredients of saffron, major constituents of this herb include safranal, crocin, and crocetin, which are responsible for the unique taste and color of saffron. These ingredients have been investigated using modern pharmaceutical research methods as potential therapeutics to treat disorders such as Alzheimer's disease, cardiovascular diseases, cancer, digestive system disorders, ocular issues, and COVID-19 infections. However, focus and emphasis on understanding the pharmacological effects of saffron in treating diseases are required. This article briefly reviews the history, cultivation processes, different qualities properties, and traditional and modern applications of this unique herb.
Efficacy of Shugan Hewei Therapy for Chronic Atrophic Gastritis: A Systematic Review and Meta-Analysis
Authors: Niu Jing-Bin , Gai Xiao , Yang De-Cai , Zheng Yi-Xin , Cao Yang , Zhu Chun-Mei , Qian Peng , Yan Hai-Xia , Song Hua-Ling , Liu Guo-Ping
Published: July 2022

Objective:

Shugan Hewei therapy (SHT) acts to soothe the liver and harmonize the stomach. It is a classical traditional Chinese medicine method widely used in China to treat chronic atrophic gastritis (CAG) due to liver qi invading the stomach. However, the clinical effects of SHT remain unclear. We aimed to evaluate the overall clinical effective rate and safety of SHT in treating CAG.

Methods:

We used the Jadad scale and Cochrane Collaboration risk of bias tool to evaluate the methodological quality of studies investigating SHT. Eight medical databases were searched to identify relevant studies. After data extraction and quality evaluation, 27 randomized controlled trials, including 2,441 patients, were considered eligible for analysis. No serious heterogeneity or publication bias was observed across the included studies. We used Revman 5.3 statistical software to evaluate the general clinical effective rate and safety of SHT.

Results:

The results showed that SHT was more effective (RR=1.25; 95% CI [1.20, 1.29]; P<0.01) and safer (MD=0.24, 95% CI [0.08, 0.75]; P<0.01) than control interventions comprising western medicine, Chinese patent medicine, and/or western medicine + Chinese patent medicine. Compared with the control interventions, SHT resulted in greater improvements in the symptom scores for stomach distension and stomachache, serum gastrin level, histopathologic changes, Helicobacter pylori (HP) inhibition rate, and gastric mucosal inflammation.

Conclusion:

SHT was more effective and safer than control interventions for CAG.
Next-generation point-of-care testing in pediatric human immunodeficiency virus infection facilitates diagnosis and monitoring of treatment
Authors: Bengu Nomonde , Mchunu Noxolo , Mokhethi Sijabulile , Fillis Rowena , Cromhout Gabriela , Lobenstein Jeroen van , Graza Yeney , Kapongo Constant , Chinniah Kogielambal , Bhoola Roopesh , Adland Emily , Puertas Mari C. , Ndung’u Thumbi , Martinez-Picado Javier , Archary Moherndran , Goulder Philip J. R
Published: July 2022

Point-of-care (PoC) testing facilitates early infant diagnosis (EID) and treatment initiation, which improves outcome. We present a field evaluation of a new PoC test (Cepheid Xpert® HIV-1 Qual XC RUO) to determine whether this test improves EID and assists the management of children living with human immunodeficiency virus (HIV) infection.

We compared 2 PoC tests with the standard-of-care (SoC) test used to detect HIV infection from dry blood spots in newborn infants at high risk of in utero infection. We also evaluated the ability of the PoC tests to detect HIV total nucleic acid (TNA) in children living with HIV infection who had maintained undetectable plasma viremia following very early combination antiretroviral therapy (cART) initiation.

Qualitative (Qual) detection of HIV using the Xpert® HIV-1 Qual XC RUO (“RUO”) and Xpert® HIV-1 Qual (“Qual”) PoC tests was compared in 224 infants with the SoC DBS Roche COBAS® HIV-1/HIV-2 qualitative test. The same 2 PoC tests were also evaluated in 35 older children who had initiated cART before 21 days of age and maintained undetectable plasma viremia for a mean of 25 months.

No discrepancies were observed in detection of HIV infection via the 2 PoC tests or the SoC test in the 224 neonates studied, but only 95% of the SoC test results were generated compared with 100% of the PoC test results (P = .0009). The cycle threshold values for the research use only (RUO) assay were the lowest of the 3 assays (P < .0001 in each case). In 6 of the 35 early-treated aviremic children, HIV TNA was detected by RUO but not Qual.

The RUO assay outperforms Qual in detecting HIV-1 infection. RUO would therefore potentially improve EID and assist in identifying cART-adherent early-treated children with the lowest HIV TNA levels and the highest HIV cure potential.
Persistent corneal blood staining after microhook trabeculotomy: A case report
Authors: Aoki Ryota , Nakakura Shunsuke
Published: July 2022

Introduction:

Hyphema, that is, massive anterior chamber hemorrhage, is one of the major complications after a recent minimally invasive glaucoma surgery. Hyphema along with high intraocular pressure increases the risk of corneal bloodstaining.

Patient Concerns:

A 71-year-old female was receiving 0.1% fluorometholone drops in both eyes for severe dry eye. She was also receiving antiplatelet agents for platelet aggregation hyperactivity and prednisolone for interstitial pneumonia internally. Her right eye was suffering from increased intraocular pressure.

Diagnosis:

We diagnosed her right eye as steroid-induced glaucoma.

Interventions:

We performed microhook trabeculotomy.

Outcomes:

At postoperative day 10, she had total anterior chamber hemorrhage and high intraocular pressure, and subsequently developed corneal blood staining at postoperative day 15, for which we performed anterior chamber cleaning. After that, we did not perform additional anterior chamber cleaning, and during the 1-year follow-up, a gradual improvement was noted in the entire cornea with reddish-brown opacity, from the periphery to the center. However, almost the entire pupil was still covered with opacity, and her visual acuity was at the light perception at the final visit.

Lessons:

Corneal bloodstaining takes a considerable time to resolve and causes severe vision loss. Special attention should be given to persistent corneal blood staining when hyphema and high intraocular pressure are observed after minimally invasive glaucoma surgeries.
Diagnosis of keratoconus in a young male by electrophysiological test findings: A case report
Authors: Yan Weiming , Chen Yanjin , Chen Xiaohong , Ye Qian , Wang Yutong , Jiang Chuan , Zheng Xiangrong , Wang Yunpeng , Chen Meizhu
Published: July 2022

Rationale:

The purpose of this report was to describe the diagnostic process of a case of keratoconus (KCN) after electrophysiological examination.

Patient concerns:

A 23-year-old male army officer presented with decreased visual acuity (VA) in the left eye for 5 months. Best-corrected VA was 20/20 in the right eye and 20/300 in the left eye. The cornea and lens were clear in both eyes with a normal anterior chamber. No specific abnormalities were found on fundus photography, optical coherence tomography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), or full-field electroretinography (ffERG) of both eyes. Pattern visual-evoked potentials (PVEP) detected a reduced amplitude and delayed peak time of the P100-wave in both eyes, which was more severe in the left eye. The amplitude and peak time of the P2-wave in flash VEP (FVEP) were comparable in both eyes and were within the normal ranges.

Diagnosis:

Corneal topography was performed, and KCN was diagnosed by the presence of an asymmetrical bowtie pattern in both eyes, which was worse in the left eye.

Interventions:

Transepithelial corneal collagen cross-linking was performed.

Outcomes:

The BCVA of both eyes remained stable after treatment at follow-up.

Lessons:

KCN should be suspected in cases of unimproved VA and significant irregular stigmatism, while no obvious lesions exist in other parts of the eyes. The evidence of lesion location by electrophysiological examinations could sometimes be of favor in diagnosing KCN.
The association between amniotic fluid-derived inflammatory mediators and the risk of retinopathy of prematurity
Authors: Jang Ji Hye , Kim Jae-Gon , Lee Yu Hyun , Bae Jin Gon , Park Jae Hyun
Published: July 2022

Prenatal and perinatal infections and inflammation appear to associated with the development of retinopathy of prematurity (ROP). In this study, we evaluated whether inflammatory mediators in amniotic fluid (AF) retrieved during cesarean delivery influence the development of ROP in very low birth weight (VLBW) infants.

This retrospective study included 16 and 32 VLBW infants who did and did not develop any stage of ROP, respectively. Each infant with ROP was matched with 2 infants without ROP based on days of ventilation care, gestational age, and birth weight. AF was obtained during cesarean delivery, and the levels of intra-amniotic inflammatory mediators such as interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, matrix metalloproteinase (MMP)-2, MMP-8, MMP-9, and tumor necrosis factor (TNF)-α were measured using a Human Magnetic Luminex assay (R&D Systems, Minneapolis, MN). The differences in the levels of inflammatory mediators according to the presence or absence of ROP were compared.

In patients who developed ROP, the level of MMP-2 in the AF was significantly increased (P = .011), whereas the levels of IL-10 and TNF-α were significantly decreased (P = .028 and .046, respectively) compared with those in infants who did not develop ROP. The levels of the other mediators were not significantly different between the 2 groups. Multivariate regression analysis showed that MMP-2 was a risk factor for the development of ROP (odds ratio, 2.445; 95% confidence interval, 1.170-5.106; P = .017).

The concentration of MMP-2 in AF is an independent factor in the development of ROP. Further studies are needed to determine whether the levels of inflammatory mediators in AF affect the ROP severity.
Intraocular lens power calculation after radical keratotomy and photorefractive keratectomy: A case report
Authors: Xiong Tianxu , Mu Jiancheng , Chen Hao , Fan Wei
Published: July 2022

Rationale:

To report a rare case of calculating the IOL power in a cataract patient who underwent both radial keratotomy (RK) and photorefractive keratectomy (PRK).

Patient concerns:

A 48-year-old woman underwent bilateral RK at age 22 and bilateral PRK at age 46. She developed bilateral corneal haze and corneal endothelial inflammation and received steroids therapy for long time after PRK. Then she was referred to our hospital due to decreased vision in the both eyes.

Diagnoses:

The patient was diagnosed with binocular complicated cataract, corneal haze, high myopia and post corneal refractive surgery (RK and PRK).

Interventions:

The patient underwent bilateral phacoemulsification. The IOL power was calculated using SRK/T formula for RK and Haigis-L formula for PRK, respectively. We finally selected the Haigis-L formula and the intraocular lens (SN60WF) was implanted within the capsular bag.

Outcomes:

After the surgery, both eyes showed myopia drift, and the right eye continuously fluctuated in refractive results. However, by nearly 1 year later, refractive results in both eyes had stabilized, and no other complications had occurred.

Lessons:

IOL power in patients who undergo both RK and PRK can be reliably calculated using the Shammas-PL, Average of multiple formulas, or Barret True-K No History formulas. Haigis-L formula is not suitable. Such patients require at least three months after surgery to attain refractive stability in both eyes.
Surgical strategy for metastatic spinal tumor patients with surgically challenging situation
Authors: Shin Hong Kyung , Kim Myeongjong , Lee Subum , Lee Jung Jae , Park Danbi , Jeon Sang Ryong , Roh Sung Woo , Park Jin Hoon
Published: July 2022

The incidence of spinal metastasis is increasing as cancer patients live longer owing to the improvement of cancer treatments. However, traditional surgery (TS) which fixates at least 2 levels above and 2 levels below the affected vertebrae is sometimes difficult to perform as it is burdensome to the patients. In this article, we introduce our experience and strategy in treating spinal metastasis, focusing particularly on challenging cases.

We retrospectively reviewed the data of 110 patients who underwent spinal surgery for metastatic spinal tumors from April 2018 to March 2020. Among them, 5 patients who received anterior approach surgery were excluded. The remaining 105 patients were enrolled. In addition to TS, we also performed cervical pedicle screw, cervicothoracic junction fixation, thoracolumbar short fixation, and decompression surgery, depending on the characteristics of the tumor. The overall survival was analyzed, and the local tumor control rate was evaluated using magnetic resonance imaging. Perioperative clinical characteristics including Spine Oncology Study Group Outcomes Questionnaire, visual analog scale, Eastern Cooperative Oncology Group performance score, and Karnofsky Performance Score were also investigated.

The overall survival rate was 57.9% at 1 year, and the local tumor control rate was 81.1% after surgery. There was a statistically significant difference according to the type of the tumor in the survival analysis: the overall survival rates were 72.7% for favorable tumors and 48.6% for unfavorable tumors at 12 months after surgery (P = .04). Spine Oncology Study Group Outcomes Questionnaire, visual analog scale, Eastern Cooperative Oncology Group performance score, and Karnofsky Performance Score was improved after surgery. All surgical methods, including TS, cervical pedicle screw, cervicothoracic junction fixation, thoracolumbar short fixation, and decompression surgery, showed good clinical and radiological outcomes.

Optimized surgical methods show similarly good clinical outcomes in managing spinal metastasis as TS.
Usefulness of monocyte distribution width and presepsin for early assessment of disease severity in COVID-19 patients
Authors: Kim Sei Won , Lee Heayon , Lee Sang Haak , Jo Sung Jin , Lee Jehoon , Lim Jihyang
Published: July 2022

Early predictors of severe coronavirus disease 2019 (COVID-19) would identify patients requiring intensive care. Recently, the monocyte distribution width (MDW) and presepsin level have been used for the early diagnosis of sepsis. Here, we assessed the utility of MDW and presepsin for the early assessment of COVID-19 severity.

Eighty-seven inpatients with confirmed COVID-19 were enrolled and divided into 3 groups by the type of respiratory support: (1) mechanical ventilation or high-flow nasal cannula oxygen therapy (MVHF-OT), (2) conventional oxygen therapy, and (3) no oxygen therapy. We measured the complete blood count; MDW; erythrocyte sedimentation rate; and the levels of presepsin, C-reactive protein, procalcitonin, lactate dehydrogenase, ferritin, Krebs von den Lungen-6 (KL-6), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralizing antibody.

Thirteen (14.9%) patients on MVHF-OT exhibited a significantly higher mortality and a longer hospital stay than did the others. The MDW and presepsin levels were significantly elevated on admission, and correlated with COVID-19 severity (both P < .001). Notably, only the MDW correlated significantly with symptoms in the no oxygen therapy group (P < .012). In the first week after admission, the MDW fell and no longer differed among the groups. The KL-6 level did not differ by disease severity at any time. Neutralizing antibodies were detected in 74 patients (91.4%) and the level of neutralization correlated significantly with COVID-19 severity (P < .001).

The MDW and presepsin are useful indicators for early assessment of disease severity in COVID-19 patients.
Potential value of PRKDC as a therapeutic target and prognostic biomarker in pan-cancer
Authors: Yang Xiawei , Yang Feng , Lan Liugen , Wen Ning , Li Haibin , Sun Xuyong
Published: July 2022

Background:

While protein kinase, DNA-activated, catalytic subunit (PRKDC) plays an important role in double-strand break repair to retain genomic stability, there is still no pan-cancer analysis based on large clinical information on the relationship between PRKDC and different tumors. For the first time, this research used numerous databases to perform a pan-cancer review for PRKDC to explore the possible mechanism of PRKDC in the etiology and outcomes in various tumors.

Methods:

PRKDC’s expression profile and prognostic significance in pan-cancer were investigated based on various databases and online platforms, including TIMER2, GEPIA2, cBioPortal, CPTAC, and SangerBox. We applied the TIMER to identified the interlink of PRKDC and the immune infiltration in assorted tumors, and the SangerBox online platform was adopted to find out the relevance between PRKDC and immune checkpoint genes, tumor mutation burden, and microsatellite instability in tumors. GeneMANIA tool was employed to create a protein–protein interaction analysis, gene set enrichment analysis was conducted to performed gene enrichment analysis.

Results:

Overall, tumor tissue presented a higher degree of PRKDC expression than adjacent normal tissue. Meanwhile, patients with high PRKDC expression have a worse prognosis. PRKDC mutations were present in almost all The Cancer Genome Atlas tumors and might lead to a better survival prognosis. The PRKDC expression level was shown a positive correlation with tumor-infiltrating immune cells. PRKDC high expression cohorts were enriched in “cell cycle” “oocyte meiosis” and “RNA-degradation” signaling pathways.

Conclusions:

This study revealed the potential value of PRKDC in tumor immunology and as a therapeutic target and prognostic biomarker in pan-cancer.
Comparison of radiation exposure to physicians between anteroposterior and lateral real-time fluoroscopy when performing lumbar transforaminal epidural steroid injections: A randomized controlled trial
Authors: Yoo Seung Hee , Kim Won-Joong , Jue Mi Jin , Lee Min Jin
Published: July 2022

Background:

Lumbar transforaminal epidural steroid injections are used widely to alleviate low back radicular pain, but it requires real-time fluoroscopy, which can increase the risk of radiation exposure. Anteroposterior or lateral real-time fluoroscopy can be used during lumbar transforaminal epidural steroid injections, but there have been no comparative studies on the exposure of physicians to radiation from anteroposterior or lateral real-time fluoroscopy. The aim of this study was to compare the cumulative radiation exposure to each body part of the physician according to the method of real-time fluoroscopy when performing lumbar transforaminal epidural steroid injections.

Methods:

A single physician performed lumbar transforaminal epidural steroid injections, and 2 groups of patients were formed based on the method used: group A (anteroposterior real-time fluoroscopy) and group L (lateral real-time fluoroscopy). Dosimeters were placed outside the chest, inside the chest, outside the thyroid collar, inside the thyroid collar, outside the groin, inside the groin, outside the lead gloves, and left rim of the glasses.

Results:

A total of 200 lumbar transforaminal epidural steroid injections were analyzed, and the radiation exposure was measured by cumulative dose equivalents in mSv. The dose equivalents were lower at every level in group A compared with group L except for outside the groin.

Conclusions:

The cumulative radiation exposure at all the measurement sites was lower for anteroposterior real-time fluoroscopy compared with lateral real-time fluoroscopy when performing lumbar transforaminal epidural steroid injections, except for outside the groin.
A retrospective cohort study on the optimal interval between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy
Authors: Liu Huan , Pan Wenjun , Yan Guoqiang , Li Zhongmin
Published: July 2022

Endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) are the most important procedures for patients with choledocholithiasis and gallstones. Many studies recommend early LC after ERCP; however, there is still no consensus on the optimal interval between the two. The purpose of this study was to investigate the appropriate timing of LC after ERCP in patients with choledocholithiasis and cholecystolithiasis.

We retrospectively reviewed all ERCPs in our institution from November 2014 to August 2021. All eligible 261 patients were divided into ERCP-LC1 (≤3 days), ERCP-LC2 (3–7 days), and ERCP-LC3 (>7 days). We also reviewed 90 patients with elective LC as the LC group. Procedures, treatment outcomes, and postoperative adverse events were evaluated.

In a total of 1642 ERCPs, 261 eligible patients were divided into ERCP-LC1 (n = 102), ERCP-LC2 (n = 113), and ERCP-LC3 (n = 46). The ERCP-LC groups had no difference in operation time, postoperative adverse events, and open conversion rate with the LC group, but the total hospital stay and hospital stay after LC were longer than the LC group. There were no differences between the ERCP-LC groups in operation time, hospital stay after LC, open conversion rate, postoperative adverse events, and efficacy. However, LC within 7 days and even 3 days after ERCP had significant advantages in improvement in total length of stay and medical expenses. Furthermore, we also found an increased risk of gallbladder gangrene and perforation in LC >7 days after ERCP.

LC within 7 days and even 3 days after ERCP is a safe, effective, and economical method for patients with choledocholithiasis and gallstones.
Biportal endoscopic spine surgery for cervical disk herniation: A technical notes and preliminary report
Authors: Jung Seok Bong , Kim Nackhwan
Published: July 2022

Biportal endoscopic spine surgery (BESS) for cervical disk herniation (CDH) has been rarely reported. The aim of the article is to describe a novel BESS as a posterior approach for CDH and report the preliminary outcomes and complications. This single-centered retrospective chart review included 109 consecutive patients who underwent BESS for symptomatic single-level CDH. Working and viewing portals were created in each unilateral paravertebral area at the target disk level. Endoscopic exploration allowed for effective and minimally invasive decompression via safe access to the medial foramen with minimal laminectomy and facetectomy. Clinical outcomes, including the visual analog scale, neck disability index, Macnab criteria, and the motor function of the involved arm, were evaluated at 4, 8, 12, and 24 postoperative weeks. Visual analog scale and neck disability index improved significantly at 24 weeks postoperatively (P < .01). According to the Macnab criteria, “excellent,” “good,” and “fair” results were obtained for 55.9%, 30.3%, and 13.8% of patients, respectively. The post 24-week distribution of the involved upper extremity strength grade was significantly improved compared to the initial value (P = .02). One patient had a motor weakness with a decreased grade over 4 weeks from excessive irrigation. The posterior approach of BESS was efficient and feasible for the treatment of CDH.
Nomogram to predict risk and prognosis of synchronous lung metastasis in renal cell carcinoma: A large cohort analysis
Authors: Lu Zhaoxiang , Yang Cheng , He Wei , Zhou Jun , Xiang Rong
Published: July 2022

We aimed to construct and validate nomogram models that predict the incidence of lung metastasis (LM) in patients with renal cell carcinoma (RCC) and evaluate overall survival (OS) and cancer-specific survival (CSS) among RCC patients with LM.

The Surveillance, Epidemiology, and End Results database was analyzed for RCC patients diagnosed between 2010 and 2015. The X-tile program was used to determine the best cutoff values for age at initial diagnosis and tumor size. Logistic regression analysis was performed to explore independent risk factors for LM, and COX regression analysis was used to identify prognostic indicators for OS and CSS in lung metastatic RCC patients. Subsequently, 3 nomograms were established, and receiver operating characteristic (ROC) curves and decision curve analysis (DCA) were utilized to validate their accuracy.

We randomly assigned 10,929 patients with RCC to 2 groups with 1:1 allocation. Multivariate logistic analyses revealed that pathology, tumor (T) stage, nodes (N) stage, race, grade, surgery, metastatic sites, and tumor size were independent risk factors for LM. Multivariate Cox analyses showed that pathology, T stage, N stage, age, surgery, metastatic sites, and residence were independent prognostic factors for OS and CSS in patients with LM. Then, nomograms were developed based on the multivariate logistic and Cox regression analyses results. The ROC and DCA curves confirmed that these nomograms achieved satisfactory discriminative power.

Three effective nomograms were constructed and validated that can be used to assist clinicians in predicting the incidence of LM and evaluating the prognosis of lung metastatic RCC.