bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rotational stability of toric intraocular lenses with a newly modified capsular tension ring
Authors: Zdral John , Werner Liliana , Mamalis Nick , Bontu Sneha , Kennedy Sean , Henderson Bonnie A. 
Published: November 2020

Purpose:
To determine whether a newly modified capsular tension ring (CTR) is effective at preventing toric intraocular lens (TIOL) rotation and misalignment.

Setting:
John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

Design:
Experimental study.

Methods:
Ten human cadaver eyes were used to test the ease or difficulty of TIOL rotation in the capsular bag under 3 experimental conditions: a TIOL alone, a TIOL with a standard CTR, or a TIOL with a newly modified CTR with indentations in a sinusoidal pattern. Scores for the ease of IOL rotation were compared by using the nonparametric Friedman analysis of variance test. In addition, both anterior and posterior Miyake-Apple views were filmed to observe the rotational stability of TIOLs in the capsular bag under the 3 test conditions.

Results:
In the ten eyes of five patients, the rotational stability improved with a standard CTR, but further improvement was statistically observed (P < .05) with the newly modified CTR under all test conditions. This was true for both IOLs used (AcrySof and TECNIS toric IOLs), with or without ophthalmic viscosurgical device, and for either clockwise or counterclockwise rotations.

Conclusions:
A newly designed CTR prototype represents a new technology for improving the rotational stability of a TIOL in the capsular bag. Under all test conditions, the prototype performed significantly better than a standard CTR. The results support the use of this new CTR design to improve the accuracy and refractive success of TIOLs.
Capsular tension ring explant complication rate comparison using Miyake-Apple video analysis
Authors: Page Timothy P. , Werner Liliana , Ellis Nathan , Heczko Joshua B. 
Published: November 2020

Purpose:
To compare the complication rate and time required to explant standard capsular tension rings (CTRs) vs suture-guided CTRs (SGCTRs).

Setting:
Intermountain Ocular Research Center, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.

Design:
Experimental study.

Methods:
Eight cadaver eyes were prepared using standard Miyake-Apple protocol with digital video recording. A 4 clock-hour zonular dialysis was created, followed by a capsulorhexis, hydrodissection, and CTR (n = 4) or SGCTR (n = 4) implantation. With the CTR hidden from view by the overlying iris, ophthalmic surgical instruments were used to remove the CTRs. Time required to remove the CTR and any complications were recorded. A limit of 180 seconds was imposed to determine inability to remove the CTR.

Results:
In the standard CTR group (n = 4), removal was associated with high rates of complication (100%). Complications included capsular tears (n = 2), dialysis extension (n = 1), and inadvertent intracapsular cataract extraction (n = 1). The SGCTR group had no complications associated with removal (n = 4). Time required to explant a CTR was significantly reduced from 164.5 seconds with standard CTRs to 6.9 seconds with SGCTRs (P = .001).

Conclusions:
Attempts to remove a standard CTR from the capsular bag was met with a high complication rate. The addition of suture to the leading eyelet of the CTR prior to implantation significantly reduced the time and effort required to remove the CTR and was associated with a significant reduction in complication rates.
Preoperative and perioperative music to reduce anxiety during first-time phacoemulsification cataract surgery in the high-volume setting: randomized controlled trial
Authors: Muddana Satish Kumar , Hess Olivia M. , Sundar Sumathy , Venkatesh Rengaraj 
Published: November 2020

Purpose:
To determine whether preoperative and perioperative music exposure reduced patient self-rated anxiety and physiologic indicators of stress during first-time phacoemulsification cataract surgery in the high-volume setting.

Setting:
Aravind Eye Care System, Pondicherry, India.

Design:
Prospective single-masked randomized controlled trial.

Methods:
Patients were provided music before and during first-time phacoemulsification in 1 group and patients underwent surgery without music in another group. Measurements of blood pressure (BP), heart rate, respiration rate, and a Likert scale anxiety rating were collected at preoperative, perioperative, and postoperative timepoints.

Results:
One hundred sixty-five patients (aged 53–65 years) were provided music using a portable MP3 player before and during first-time phacoemulsification, and 165 patients underwent surgery without music. Systolic and diastolic BPs were statistically significantly lower in the music intervention group at the postoperative timepoint, with similar physiologic measures between groups during the perioperative timepoints. In the preoperative period, before music exposure, 62 patients (38%) in the music group reported being very or extremely anxious. After 10 minutes of music exposure, only 7 patients (4%) reported this anxiety level. In the perioperative period, 80 patients (48%) in the intervention group reported feeling not at all or a little anxious, compared with 50 patients (30%) of the control group. In the postoperative period, 139 (84%) music group patients felt not at all or a little anxious postoperatively compared with 92 patients (56%) in the control group.

Conclusions:
Marked reductions in self-reported anxiety preoperatively, intraoperatively, and postoperatively when exposed to music and a statistically significant decrease in postoperative BP showed that music can be an inexpensive and effective solution to improve the patient experience of cataract surgery in the high-volume setting.
Comparison of pulsed and continuous accelerated corneal crosslinking for keratoconus: 1-year results at a single center
Authors: Kang Min-Ji , Hwang Jehyung , Chung So-Hyang 
Published: November 2020

Purpose:
To compare the clinical outcomes between pulsed and continuous accelerated crosslinking (CXL) for keratoconus.

Setting:
Hospital.

Design:
Retrospective comparison study.

Methods:
Korean patients who were treated for keratoconus between September 2015 and January 2018 at Seoul St. Mary’s Hospital were included. Eyes were subjected to pulsed accelerated crosslinking (30 mW/cm2 for 8 minutes, 1 second on/1 second off) or continuous accelerated crosslinking (30 mW/cm2 for 4 minutes; delivering 7.2 J/cm2). Outcomes were evaluated after 1 year.

Results:
At 1 year, the 2 groups did not exhibit changes in their corrected and uncorrected distance visual acuity values. The pulsed group (25 eyes in 25 patients) exhibited significantly improved values for sphere (P = .009) and spherical equivalent (P = .033), although no statistically significant difference was observed in the continuous group (20 eyes in 20 patients). All keratometry (k)values (SimKf, SimKs, SimKmean, and Kmax) improved in both groups (all P < .05), although the pulsed group had significantly greater changes in the SimKmean value (P = .036) and the Kmax value (P = .03). Both groups had significantly decreased central and thinnest corneal thicknesses (all P < .001), although the pulsed group had a substantially lower thinnest corneal thickness (P = .017). Corneal densitometry measured using the Pentacam device increased in both groups (all P < .001), with a higher densitometry value in the pulsed group (P = .013). Furthermore, the depth of the demarcation line was deeper in the pulsed group (P = .015).

Conclusions:
Pulsed accelerated crosslinking might provide better postcrosslinking effects than continuous accelerated crosslinking.
Bilateral implantation of a supplementary intraocular pinhole
Authors: Trindade Bruno Lovaglio Cançado , Trindade Fernando Cançado , Trindade Claudio Lovaglio Cançado 
Published: November 2020

Purpose:
To evaluate the safety and efficacy of bilateral implantation of a supplementary small-aperture device to treat irregular corneal astigmatism.

Setting:
Private practice.

Design:
Retrospective consecutive case series.

Methods:
Patients with bilateral irregular corneal astigmatism secondary to multiple causes and consented for implantation of the XtraFocus intraocular pinhole (IOPH) were enrolled. The mean follow-up was 27 months (range 5 to 66 months). Patients were assessed in their scheduled follow-up visits and monocular and binocular uncorrected and corrected distance and near visual acuities were recorded. Assessment of darkening vision complaints was also performed after implantation in the first eye and repeated after second-eye surgery.

Results:
Thirty-two eyes of 16 patients were analyzed. The mean monocular and binocular uncorrected distance visual acuities improved from logMAR 1.091 ± 0.208 and 1.078 ± 0.259 preoperatively to 0.342 ± 0.091 (P < .001) and 0.342 ± 0.147 (P = .001) 1 year postoperatively. Three patients were excluded because of darkening vision complaints after surgery in the first eye. No major complications were noted after implantation of the IOPH.

Conclusions:
Bilateral implantation of the XtraFocus IOPH is a safe technique in a selected group of patients. There was improvement in visual acuity sustained over the analyzed period. Postoperative darkening vision complaints vary between individuals and can limit the application of this approach in certain patients.
Prospective comparison of apex-centered vs standard pupil-centered femtosecond laser–assisted capsulotomy in cataract surgery
Authors: Mursch-Edlmayr Anna Sophie , Pomberger Leon Julian , Hermann Philipp , Wagner Helga , Beka Sophie , Waser Klemens , Wendelstein Jascha , Podkowinski Dominika , Laubichler Peter , Siska René , Bolz Matthias 
Published: November 2020

Purpose:
To compare the lens tilt after apex-centered capsulotomy with standard pupil-centered capsulotomy.

Setting:
Clinical practice.

Design:
Prospective, randomized, investigator-masked trial.

Methods:
This prospective, randomized, investigator masked study included 40 patients with age-related cataract scheduled for femtosecond laser-assisted cataract surgery (FLACS) in both eyes. The main outcome was the tilt of the intraocular lens (IOL), measured with the IOLMaster 700.

Results:
The study enrolled 80 eyes of 40 patients. The mean distance from the center of the apex-centered capsulotomy to the pupil-centered capsulotomy was 175.8 ± 97.2 μm. The amount of IOL tilt was not significantly reduced with the new technique (P > .05). Tilt orientation was more stable in eyes treated with apex-centered capsulotomy.

Conclusions:
Centration of the capsulotomy on the lens apex in FLACS does not influence the amount of IOL tilt but the orientation stability. The clinical importance of this finding has to be further elucidated.
Five-year long-term outcomes of intrastromal corneal ring segment implantation using the manual technique for keratoconus management
Authors: Costa Jorge Vasco , Monteiro Tiago , Franqueira Nuno , Faria-Correia Fernando , Alfonso Jose , Vaz Fernando 
Published: November 2020

Purpose:
To evaluate the long-term effectiveness, safety, and stability of Ferrara-type intrastromal corneal ring segments (ICRS) by manual surgery implantation in patients with keratoconus.

Setting:
Ophthalmology Department, Hospital de Braga, Braga, Portugal.

Design:
Retrospective cohort study.

Methods:
This study included 124 eyes that had ICRS implantation using the manual technique with a follow-up of 5 years. Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), subjective refraction, keratometry, aberrometry, and pachymetry maps were evaluated preoperatively and at 6 months, 1 year, and 5 years postoperatively. A secondary analysis of all variables was performed comparing 2 subgroups of patients: a group younger than 30 years and a group of 30 years or older.

Results:
At 5 years, both mean UDVA and CDVA improved significantly (P < .0001) from a preoperative value of 0.91 ± 0.36 to 0.46 ± 0.32 logMAR and 0.40 ± 0.27 to 0.22 ± 0.20 logMAR, respectively. Spherical equivalent, refractive cylinder, and all topography values significantly decreased postoperatively (P < .0001). No regression was observed in any visual or topographic parameter during the entire follow-up. Regarding the subgroup analysis, both younger and older patients demonstrated similar and stable results from the preoperative to the 5-year visit, except for minimum pachymetry value change over time.

Conclusions:
Ferrara-type ICRS implantation significantly improved visual acuity, refractive error, and topographic values; the improvement was stable throughout a 5-year follow-up period. This study confirms that ICRS implantation surgery for keratoconus is a stable procedure in a long-term follow-up, regardless of the preoperative patient's age.
Tinnitus Is Associated With Extended High-frequency Hearing Loss and Hidden High-frequency Damage in Young Patients
Authors: Song Zijun , Wu Yongzhen , Tang Dongmei , Lu Xiaoling , Qiao Liang , Wang Jing , Li Huawei 
Published: November 2020

Objectives:
To analyze the results of extended high-frequency (EHF) and high-frequency hearing tests in young patients with tinnitus who show normal response in conventional pure-tone audiometry (PTA), and to explore the correlation between tinnitus and hearing loss (HL).

Study Design:
A case–control study.

Setting:
A Tertiary Eye Ear Nose & Throat Hospital of China.

Participants:
Patients with tinnitus, aged 18 to 35 years old, and with normal conventional PTA (125 Hz–8 kHz) were enrolled in the tinnitus group. Volunteers without tinnitus of the same age were enrolled in the control group.

Main Outcome Measures:
The incidence of EHF-HL and the hearing thresholds at each frequency, as well as the distribution of maximum HL frequency and edge frequency in all participants were compared.

Results:
In total, 28 cases (43 ears) were enrolled in the tinnitus group and 34 cases (68 ears) in the control group. The incidence of EHF-HL, average hearing threshold of each frequency ranging from 4 to 16 kHz, and the maximum hearing threshold were significantly higher in the tinnitus group. The edge frequency in the tinnitus group was lower than that in the control group (10.4 ± 3.1 kHz versus 12.3 ± 2.5 kHz, p = 0.010). The dominant tinnitus pitch in cases whose EHF was impaired was positively correlated with the hearing-level loudness of tinnitus (r = 0.627, p < 0.001).

Conclusion:
Patients with tinnitus and normal hearing in conventional PTA showed signs of EHF-HL and hidden damage in the high-frequencies more easily. EHF hearing tests and the follow-up of HF hearing tests are recommended to facilitate early detection of hearing impairment for timely intervention.
Pharmacotherapy in pediatric obesity: current evidence and landscape
Authors: Singhal Vibha , Sella Aluma Chovel , Malhotra Sonali 
Published: November 2020

Purpose of review
Childhood obesity is escalating globally. Lifestyle and behavioral changes, which are the frequently used interventions in clinical practice, lead to only modest improvements in children with established obesity. Bariatric surgery is currently the most effective obesity treatment but has very limited utilization in pediatric obesity and is preferentially used for children with worsening comorbidities. There exists a massive treatment gap for children suffering with obesity especially after the failure of lifestyle modifications. Pharmacotherapy that is an established management tool in adults is very infrequently used in children. Only two medications, Phentermine and Orlistat are approved by the Food and Drug Administration (FDA) for use in adolescent obesity. Herein, we discuss the current landscape and available literature on the use of antiobesity pharmacotherapy in children.

Recent findings
There are emerging pediatric data about the efficacy of the many weight loss medications that are FDA approved in adults. Moreover, more clinical trials are underway on the rarer, intractable forms of obesity such as monogenic, syndromic, and hypothalamic obesity.

Summary
Weight loss medications in children, like adults, have variable efficacy and similar side effect profiles. Rigorous research and improved education of providers about weight loss medications may address the huge treatment gap in severe pediatric obesity.
Chimerism and tolerance: past, present and future strategies to prolong renal allograft survival
Authors: Tantisattamo Ekamol , Leventhal Joseph R. , Mathew James M. , Gallon Lorenzo 
Published: November 2020

Purpose of review
Immunological factors are a major cause of kidney allograft loss. Calcineurin inhibitors (CNIs) have improved short-term kidney allograft survival; however, they in turn contribute to long-term kidney allograft loss from chronic CNI nephrotoxicity. Tolerance induction in transplantation can avoid the long-term adverse effects of immunosuppressive medications. This review aims to critically discuss recent efforts in inducing transplantation tolerance.

Recent findings
Tolerance induction mediated by chimerism has shown some promise in minimizing or even complete withdrawal of immunosuppressive treatments in kidney allograft recipients. There has been a number of approaches as varied as the number of centres conducting these trials. However, they can be grouped into those mediated by transient microchimerism and those facilitated by more stable macro or full donor chimerism. The success rates in terms of long-term drug-free graft survival has been limited in microchimerism-mediated tolerance induction approaches. Mixed macrochimerism of less than 50% donor may be unstable with mostly the recipient's native immune system overpowering the donor chimeric status.
Tolerance induction leading to chimerism has been limited to living donor kidney transplantation and additional long-term outcomes are required. Furthermore, immune monitoring after tolerance induction has faced a limitation in studying due to a lack of sufficient study participants and appropriate study controls.

Summary
Tolerance induction is one of several strategies used to prolong kidney allograft survival, but it has not been routinely utilized in clinical practice. However, future applications from the trials to clinical practice remain limited to living donor kidney transplantation. Once further data regarding tolerance inductions exist and practicality becomes widely accepted, tolerance induction may shift the paradigm in the field of kidney transplantation to achieve the best possible outcome of ‘One Organ for Life’.
Socioeconomic Differences in Sympathovagal Balance: The Healthy Life in an Urban Setting Study
Authors: van Nieuwenhuizen Benjamin P. , Collard Didier , Tan Hanno L. , Blom Marieke T. , van den Born Bert-Jan H. , Kunst Anton E. , van Valkengoed Irene G.M. 
Published: November 2020

ABSTRACT

Objective
Alterations in sympathovagal balance are associated with cardiovascular disease. If sympathovagal balance differs across socioeconomic groups, it may reflect a mechanism through which disparities in cardiovascular disease occur. We therefore assessed the association between education and occupation with measures of sympathovagal balance in a large multiethnic sample.

Methods
We included cross-sectional data of 10,202 South Asian Surinamese, African Surinamese, Ghanaian, Turkish, Moroccan, and Dutch-origin participants from the Healthy Life in an Urban Setting study. Sympathovagal balance was measured by baroreflex sensitivity (BRS) and the standard deviation of the interbeat interval, calculated from changes in blood pressure and interbeat intervals, from 5-minute recordings. We calculated geometric means and estimated the relative index of inequality, using age- and ethnicity-adjusted linear regression, to quantify the association between education and occupation and sympathovagal balance. In addition, we assessed whether the association was consistent across ethnic groups.

Results
The geometric means of BRS ranged from 8.16 ms/mm Hg (confidence interval [CI] = 7.91–8.43 ms/mm Hg) in low-educated to 14.00 ms/mm Hg (CI = 13.53–14.48 ms/mm Hg) in highly educated women, and from 8.32 ms/mm Hg (CI, 7.97–8.69 ms/mm Hg) in low-educated to 12.25 ms/mm Hg (CI = 11.86–12.66 ms/mm Hg) in highly educated men. High education and occupation were statistically significantly associated with higher BRS and standard deviation of the interbeat interval. Compared with the participants of Dutch origin, a pattern of weaker associations was found in the Surinamese and Ghanaian ethnic groups, but not the Turkish and Moroccan groups.

Conclusions
There is a clear socioeconomic gradient in measures of sympathovagal balance, indicating that sympathovagal balance may play a role in socioeconomic disparities in cardiovascular morbidity and mortality.
COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV
Authors: Bogart Laura M. , Ojikutu Bisola O. , Tyagi Keshav , Klein David J. , Mutchler Matt G. , Dong Lu , Lawrence Sean J. , Thomas Damone R. , Kellman Sarah 
Published: November 2020

Background:
Medical mistrust, a result of systemic racism, is prevalent among Black Americans and may play a role in COVID-19 inequities. In a convenience sample of HIV-positive Black Americans, we examined associations of COVID-19-related medical mistrust with COVID-19 vaccine and COVID-19 treatment hesitancy and negative impacts of COVID-19 on antiretroviral therapy (ART) adherence.

Methods:
Participants were 101 HIV-positive Black Americans (age: M = 50.3 years; SD = 11.5; 86% cisgender men; 77% sexual minority) enrolled in a randomized controlled trial of a community-based ART adherence intervention in Los Angeles County, CA. From May to July 2020, participants completed telephone interviews on negative COVID-19 impacts, general COVID-19 mistrust (eg, about the government withholding information), COVID-19 vaccine and treatment hesitancy, and trust in COVID-19 information sources. Adherence was monitored electronically with the Medication Event Monitoring System.

Results:
Nearly all participants (97%) endorsed at least one general COVID-19 mistrust belief, and more than half endorsed at least one COVID-19 vaccine or treatment hesitancy belief. Social service and health care providers were the most trusted sources. Greater COVID-19 mistrust was related to greater vaccine and treatment hesitancy [b (SE) = 0.85 (0.14), P < 0.0001 and b (SE) = 0.88 (0.14), P < 0.0001, respectively]. Participants experiencing more negative COVID-19 impacts showed lower ART adherence, assessed among a subset of 49 participants [b (SE) = −5.19 (2.08), P = 0.02].

Discussion:
To prevent widening health inequities, health care providers should engage with communities to tailor strategies to overcome mistrust and deliver evidence-based information, to encourage COVID-19 vaccine and treatment uptake.