bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determination of Organically Bound Tritium (OBT) Concentration in Fish by Thermal Oxidation and Liquid Scintillation Counting Method
Authors: Nayak S. Rashmi , D’Souza Renita S. , Purushotham Mohan M. , Seraje Bharath , Blangat Dileep N. , Mana Ravi P. , Naregundi Karunakara 
Published: August 2020

Abstract
Effluents containing tritium (3H) dispersed into the fresh water or marine environment from nuclear facilities can be taken up by biota. Aquatic and marine organisms are among the important pathways through which tritium can enter into the human body, and hence, assessment of the extent of pollution of these ecosystems is very important for radiation dose assessments. Tritium present in environmental matrices can be classified as tissue-free water tritium (TFWT) and organically bound tritium (OBT). Optimization of a method for the determination of OBT in fish, based on thermal oxidation of the sample, is discussed. Samples were subjected to thermal oxidation in a pyrolyser system, and the water produced from the combustion was analyzed by liquid scintillation spectrometry. Results show that a maximum of ~2 g of processed fish sample can be combusted efficiently in the pyrolyser. Using this method, a recovery of 84% was achieved, and minimum detectable activity (MDA) for the method was determined to be 8.5 Bq kg−1 (sample weight = 2 g, counting time = 30,000 s, and detection efficiency = 20%).
Can SUVmax of 68Ga-labeled PSMA Ligand and 18F-choline PET/CT Be Used to Predict the Radiation Dose in Prostate Cancer Patients?
Authors: Khansa Zeinab , Neaimeh Nemer , Korek Mahmoud , Haidar Mohamad 
Published: August 2020

Abstract
Gallium-68 (68Ga)-PSMA and 18F-Choline are two radionuclides that have already shown high potential for the detection of prostate cancer. The comparison between these two radionuclides has several advantages in radiation protection. The aim of this prospective study was to identify which of these two radionuclides can help in predicting the equivalent dose using the maximum standard uptake value (SUVmax) of normal organs, the kidneys. Two groups of 40 patients (total n = 80) who underwent PET/CT using 68Ga or 18F for diagnosis of prostate cancer between April 2018 and December 2018 at the American University of Beirut Medical Center were included. First, the dose rates were measured after 1 h of radionuclide uptake at 1 m distance with background of 0.015 μSv h−1. Then, SUVmax for kidneys were determined from images obtained with PET/CT 1 h after injection of both radionuclides. The ratios of the equivalent doses to the SUVmax for kidneys were compared for both 68Ga-PSMA and 18F-Choline. There is a positive moderate relationship between the SUVmax for kidneys and the 68Ga dose rate after 1 h of injection at 1 m distance from the abdomen (p-value = 0.023 < 0.05). This relationship is statistically significant. However, there is a very low negative relationship between the SUVmax kidney and 18F dose rate after 1 h of injection at 1 m distance from the abdomen (p-value = 0.93 > 0.05). This relationship is not statistically significant. This leads to the suggestion that we can predict the equivalent dose due to 68Ga by indicating the SUVmax from the PET/CT images.
COMPARISON OF SCLERAL FIXATION OF INTRAOCULAR LENS
Authors: Jang Kyu Hwan , Kong Mingui , Moon Byung Gil , Son Gisung 
Published: August 2020

Purpose:
To compare the clinical outcomes of sutured scleral and sutureless intrascleral fixations of the intraocular lens.

Methods:
Medical records of patients who underwent sutureless intrascleral fixation (sutureless group) and the conventional sutured scleral fixation (sutured group) were retrospectively reviewed. Patient demographics and the clinical outcomes of the two techniques were compared before and 1, 3, and 6 months after surgery.

Results:
Seventy patients were followed up for 6 months after the surgery: 25 patients in the sutureless group (25 eyes) and 45 in the sutured group (45 eyes). Surgery time was shorter in the sutureless group than that in the sutured group (73.00 ± 15.68 vs. 107.39 ± 25.30 minutes, P < 0.001). The visual acuity gradually improved throughout the postoperative period in both groups, and a faster visual acuity recovery was observed in the sutureless group. The cylindrical error at 6 months after the surgery was significantly lower in the sutureless group than that in the sutured group (−1.33 ± 0.55 vs. −2.29 ± 1.19 diopter, P < 0.001).

Conclusion:
Sutureless intrascleral fixation is an effective and reliable surgical technique that provides more favorable visual and refractive outcomes than the conventional sutured scleral fixation method.
DEEP PHENOTYPING AND FURTHER INSIGHTS INTO ITM2B-RELATED RETINAL DYSTROPHY
Authors: Nassisi Marco , Wohlschlegel Juliette , Liu Bingqian , Letellier Camille , Michiels Christelle , Aubois Anne , Mohand-Said Saddek , Habas Christophe , Sahel José-Alain , Zeitz Christina , Audo Isabelle 
Published: August 2020

Purpose:
To reappraise the presentation and the course of ITM2B-related retinal dystrophy and give further insights into ITM2B expression in the retina.

Methods:
The clinical data of nine subjects with ITM2B-related retinal dystrophy were retrospectively reviewed. The genetic mutation was assessed for its influence on splicing in cultured fibroblasts. The cellular expression of ITM2B within the inner retina was investigated in wild-type mice through mRNA in situ hybridization.

Results:
All patients complained of decreased vision and mild photophobia around their twenties–thirties. The peculiar feature was the hyperreflective material on optical coherence tomography within the inner retina and the central outer nuclear layer with thinning of the retinal nerve fiber layer. Although retinal imaging revealed very mild or no changes over the years, the visual acuity slowly decreased with about one Early Treatment Diabetic Retinopathy Study letter per year. Finally, full-field electroretinography showed a mildly progressive inner retinal and cone dysfunction. ITM2B mRNA is expressed in all cellular types of the inner retina. Disease mechanism most likely involves mutant protein misfolding and/or modified protein interaction rather than misplicing.

Conclusion:

ITM2B-related retinal dystrophy is a peculiar, rare, slowly progressive retinal degeneration. Functional examinations (full-field electroretinography and visual acuity) seem more accurate in monitoring the progression in these patients because imaging tends to be stable over the years.
CHARACTERISTICS OF PERIPAPILLARY INTRACHOROIDAL CAVITATION IN HIGHLY MYOPIC EYES
Authors: Liu Ran , Li Zhixi , Xiao Ou , Zhang Jian , Guo Xinxing , Loong Lee Jonathan Tak , Wang Decai , Lee Peiying , Jong Monica , Sankaridurg Padmaja , He Mingguang 
Published: August 2020

Purpose:
To characterize peripapillary intrachoroidal cavitation (PICC) in highly myopic participants and its associated risk factors.

Methods:
This observational, cross-sectional study recruited 890 Chinese participants with bilateral high myopia, defined as ≤−6.00 diopters spherical power. Fundus photography and spectral-domain optical coherence tomography were used to determine the presence of PICC, defined as a yellow–orange lesion adjacent to the disc border with a corresponding intrachoroidal hyporeflective space.

Results:
Among 890 participants, 884 right eyes were included for analysis. The rate of PICC was 3.6% (32 eyes). Peripapillary intrachoroidal cavitation was observed in two eyes without myopic retinal lesions, nine eyes with tessellated fundus only, 16 eyes with diffuse chorioretinal atrophy, and five eyes with patchy chorioretinal atrophy. The most commonly affected area was inferior disc border (87.5%), followed by multiple (9.4%) and superior (3.1%) disc borders. The multiple linear logistic regression model showed that older age, more myopic spherical equivalent, and longer axial length were associated with the presence of PICC.

Conclusion:
Peripapillary intrachoroidal cavitation was present in 3.6% of highly myopic eyes. It was more common in eyes with a higher myopic maculopathy category. Older age, more myopic spherical equivalent, and longer axial length were risk factors for the presence of PICC.
Safety of KPI-121 Ophthalmic Suspension 0.25% in Patients With Dry Eye Disease: A Pooled Analysis of 4 Multicenter, Randomized, Vehicle-Controlled Studies
Authors: Korenfeld Michael , Nichols Kelly K. , Goldberg Damien , Evans David , Sall Ken , Foulks Gary , Coultas Susan , Brazzell Kim 
Published: August 2020

Purpose:
The safety of KPI-121 0.25%, an ophthalmic nanoparticle suspension of loteprednol etabonate, was evaluated in subjects with dry eye disease (DED) in one phase 2 and three phase 3 randomized trials of similar design.

Methods:
Adults with DED received KPI-121 0.25% or vehicle drops 4 times daily (QID) for ≥2 weeks; 1430 subjects received KPI-121 0.25% and 1438 subjects received vehicle drops. Main safety assessments were adverse events (AEs) and intraocular pressure (IOP). As a common side effect associated with the use of ocular corticosteroids is elevated IOP, subjects with a history of or current diagnosis of glaucoma were excluded.

Results:
Instillation site pain was the most common AE, reported by 5.2% of subjects in the KPI-121 0.25% group and 4.4% of subjects in the vehicle group; other AEs were reported by ≤0.8% of subjects in the KPI-121 group. IOP elevations, a side effect associated with the use of ophthalmic corticosteroids, were observed with low incidence: 0.6% and 0.2% of subjects in the KPI-121 and vehicle groups, respectively. An IOP elevation was defined as an increase from baseline of >5 mm Hg that resulted in an IOP of ≥21 mm Hg in either eye during use of the study product.

Conclusions:
KPI-121 ophthalmic suspension 0.25% seemed to be safe and well tolerated when dosed QID for 2 to 4 weeks in those DED subjects included in the 4 trials.
Varied Presentations of Posterior Keratoconus: A Clinical Case Series
Authors: Ganesan Niruban , Narayana Shivananda , Kasturi Nirupama , Kaliaperumal Subashini , Srinivasan Renuka , Vallinayagam Muthukrishnan 
Published: August 2020

Purpose:
To describe the varied presentations of posterior keratoconus.

Methods:
This is a 3-year institute-based retrospective study report from June 2015 to June 2018 that describes 13 eyes of 12 patients with varied presentations of posterior keratoconus, evaluating tomographic changes using Scheimpflug corneal tomography and anterior segment optical coherence tomography. Slit-lamp examination revealed circumscribed nebular corneal opacity with posterior corneal depression.

Results:
Eleven patients had unilateral and one had a bilateral presentation. Five patients presented in the first and second decade with a nebular opacity and circumscribed excavation of the posterior cornea. One patient was a 12-year-old girl who presented with systemic manifestations. Seven others were middle-aged adults with superior, central, or peripheral excavation. Two patients had microcornea.

Conclusions:
This is the largest case series on posterior keratoconus, depicting its varied features. Diagnosis of this uncommon condition requires a high index of suspicion, meticulous slit-lamp examination, and systemic evaluation to rule out other associated anomalies. We report a patient of unilateral posterior keratoconus with systemic associations, second such case in the literature.
Nivolumab-Induced Ulcerative Keratitis—A Case Report
Authors: Losonczy Gergely , Gijs Marlies , Nuijts Rudy M.M.A. 
Published: August 2020

Purpose:
To describe a case of nivolumab-induced ulcerative keratitis rapidly recovering on topical steroid treatment and to determine changes in cytokine levels in the tear fluid caused by nivolumab.

Methods:
We report a 34-year-old man receiving nivolumab for metastasized melanoma with severe dry eye symptoms and a persistent corneal epithelial defect. Levels of cytokine and matrix metalloproteinase in tear fluid were measured by multiplex immunoassays.

Results:
The corneal epithelial defect failed to recover for antiviral and lubrication therapy but resolved within 48 hours after topical steroid therapy was initiated. No recurrence of corneal ulceration was observed with intermittent topical steroid therapy during the remaining period of nivolumab treatment. No Sjögren disease-related autoantibodies were detected in the patient's serum. The levels of inflammatory cytokines and matrix metalloproteinases in the tear fluid were markedly elevated after nivolumab treatment.

Conclusions:
Our observations suggest that nivolumab treatment induces a local autoimmune ocular surface disorder resulting in corneal ulceration that promptly resolves using steroid eye drops. The integrity of the corneal epithelial layer can be sustained using intermittent topical steroid therapy in patients receiving nivolumab.
Dupilumab-Associated Ocular Surface Disease: Clinical Characteristics, Treatment, and Follow-Up
Authors: Bohner Austin , Topham Christina , Strunck Jennifer , Haynes Dylan , Brazil Molly , Clements John , Simpson Eric , Chamberlain Winston 
Published: August 2020

Purpose:
A consecutive case series of patients with dupilumab-associated ocular surface disease (DAOSD) that describes common ocular symptoms and signs, proposes a symptom disease severity grading system, and describes treatment strategies of DAOSD patients was evaluated.

Methods:
A retrospective chart review of patients with concomitant dupilumab-treated atopic dermatitis and DAOSD with ophthalmic evaluation between January 2014 and May 2019 was conducted.

Results:
Twenty-nine patients (mean age 46 years, M/F: 12/17) with 57 ophthalmic exams were identified. The most common ocular symptoms included irritation/pain (n = 28, 97%), redness (n = 24, 83%), pruritus (n = 18, 62%), discharge (n = 18, 62%), and light sensitivity (n = 6, 21%). The most frequent signs included conjunctival injection (n = 18, 62%), superficial punctate keratitis (n = 16, 55%), and papillary reaction (n = 8, 28%). Topical corticosteroids (TCS) (n = 23, 79%), tacrolimus (n = 6, 21%), and artificial tears (n = 7, 24%) were the most commonly used therapies. Of those with follow-up documentation (n = 21), 20 were noted to have partial or complete response with TCS based on symptoms and reduction of signs. Using our proposed symptom-based grading scale, scaled 1 to 5 based on the presence of common symptoms listed above, 66% (n = 19) requiring topical immunomodulating therapy were found in the ‘severe’ group (≥3 symptoms) and 17% (n = 5) were found in the ‘mild’ group (≤2 symptoms).

Conclusions:
This study provides insight into the commonly presenting ocular signs and symptoms associated with DAOSD and highlights the efficacy of TCS and other immunomodulators in improving symptoms associated with DAOSD. Based on our findings, we propose a symptom-based grading system that can guide nonophthalmic physicians regarding ophthalmology consult.
Safety and Efficacy of Corneal Minimized-Volume Ablation With Accelerated Cross-Linking in Improving Visual Function for Keratoconus
Authors: Yang Xiaonan , Liu Quan , Feng Qiting , Lin Haiqin 
Published: August 2020

Purpose:
To evaluate the safety and efficacy of corneal minimized-volume ablation with accelerated cross-linking in improving visual function in keratoconus eyes.

Methods:
Through a pilot study, 25 eyes of 25 consecutive patients with keratoconus grade I–III were recruited that underwent corneal transepithelial photorefractive keratectomy with “minimized volume” ablation profile and accelerated corneal cross-linking in the same session. Corrected and uncorrected distance visual acuities, manifest refraction, corneal curvature and higher-order aberrations, endothelial cells, and the ocular modulation transfer function were assessed preoperatively and postoperatively, with a minimum follow-up of 6 months. A P value < 0.05 was the threshold of statistical significance.

Results:
At 8.2 ± 3.6 months postoperatively, the mean corrected and uncorrected distance visual acuities (LogMAR) were 0.07 ± 0.15 and 0.45 ± 0.39, significantly improving from the baseline of 0.24 ± 0.24 (P
8m-before = 0.005) and 1.12 ± 0.33 (P
8m-before < 0.001), respectively. Spherical equivalent was −2.80 ± 2.72 diopters (D), significantly decreasing from the baseline of −6.61 ± 3.06 D (P
8m-before < 0.001), whereas the attempted corrected spherical equivalent was−2.30 ± 1.22 D. Meanwhile, a significant reduction was found in higher-order aberration, along with the postoperative improvement in ocular modulation transfer function. Corneal surface morphological parameters were found with significant decreases postoperatively (index of surface variance: P
8m-before = 0.003; index of vertical asymmetry: P
8m-before = 0.005; keratoconus index: P
8m-before = 0.004; center keratoconus index: P
8m-before = 0.003; and index of height decentration: P
8m-before < 0.001). Nevertheless, no significant change was found in posterior corneal curvature or endothelial cell density between pre- and post-operative periods.

Conclusions:
Corneal minimized-volume ablation with accelerated cross-linking was an effective and safe option for correction of mild refractive error, leading to significant improvement of visual function in patients with keratoconus.
Dual Molecular Diagnosis of Microsporidia (Encephalitozoon hellem) Keratoconjunctivitis in an Immunocompetent Adult
Authors: Ma Kevin K. , Kinde Benyam , Doan Thuy , Jacobs Deborah S. , Ong Tone Stephan 
Published: August 2020

Purpose:
To report a case of microsporidia (Encephalitozoon hellem) keratoconjunctivitis acquired through avian transmission in an immunocompetent adult, diagnosed by metagenomic deep sequencing (MDS), and confirmed by polymerase chain reaction.

Methods:
A case report.

Results:
An 18-year-old woman was referred with unilateral keratoconjunctivitis unresponsive to topical and systemic therapy after exposure to birdcage debris. Slit-lamp examination of the left eye revealed a follicular papillary reaction of the palpebral conjunctiva and multiple corneal punctate epithelial opacities that stained minimally with fluorescein. In vivo confocal microscopy revealed bright double-walled structures and smaller bright round structures in the superficial epithelial debris and epithelium. Molecular diagnosis with MDS of E. hellem was confirmed by polymerase chain reaction. Clinical resolution and normalization of in vivo confocal microscopy was observed after a 6-week course of topical azithromycin. The patient elected a 3-week course of topical voriconazole 1% for definitive antimicrosporidial treatment, with no evidence of persistent infection 1 month later.

Conclusions:
Microsporidial (E. hellem) keratoconjunctivitis can occur through avian transmission in immunocompetent hosts. Topical azithromycin may be effective against this pathogen. MDS has utility in the diagnosis of atypical keratoconjunctivitis.
Containment of a Large SARS-CoV-2 Outbreak Among Healthcare Workers in a Pediatric Intensive Care Unit
Authors: Knoll Rebecca Luise , Klopp Jonas , Bonewitz Gloria , Gröndahl Britta , Hilbert Katja , Kohnen Wolfgang , Weise Kerstin , Plachter Bodo , Hitzler Walter , Kowalzik Frank , Runkel Stefan , Zepp Fred , Winter Julia , Cacicedo Maximiliano Luis , Gehring Stephan 
Published: August 2020

Objective:
Healthcare workers (HCWs) are particularly exposed SARS-CoV-2 because they are critical in preventing viral transmission and treating COVID-19 patients. Within HCWs, personnel of intensive care units (ICUs) are at the forefront of treating patients with a severe course of COVID-19 infection and therefore represent an extremely vulnerable group. Thus, our objective is to contribute to establish means of infection control protecting HCWs in the frontline of the current pandemic.

Design:
An outbreak of SARS-CoV-2 was detected and contained in a pediatric ICU (PICU). The first positive case was identified with a point-of-care diagnostic system on site. Real-time PCR-based testing systems from self-collected nasopharyngeal samples swabs were used to test for viral RNA of SARS-CoV-2 in the follow-up.

Setting:
PICU within a tertiary university hospital in Germany.

Participants:
Healthcare workers of the PICU.

Interventions:
Positive HCWs were sent into quarantine. Containment measures were implemented including wearing of surgical-masks, physical distancing and systematic testing.

Results:
Among 432 HCWs, 91 (25%) were tested. Forty-five percent reported symptoms corresponding to characteristics of COVID-19. Of those, only 19,5% (8 HCWs) were tested positive for SARS-CoV-2. No infection occurred outside the PICU. After the implementation of containment measures, viral transmission was stopped.

Conclusions:
In the present study, a large outbreak within a team of healthcare workers of a PICU, affecting almost one fifth of the entire personnel is documented, along with detailed insights about how the outbreak was contained and how operability of the unit was maintained.
Antibiotic Utilization and Infection Among Infants with Abdominal Wall Defects
Authors: Ravikumar Chandana , Mitchell Ian C. , Cantey Joseph B. 
Published: August 2020

Background:
Neonates with abdominal wall defects are at an increased infection risk because of the defect itself and prolonged neonatal intensive care unit (NICU) stays. Antibiotic prophylaxis until closure of the defect is common. However, infection risk and antibiotic use have not been well quantified in these infants.

Methods:
A retrospective cohort study of infants with abdominal wall defects (gastroschisis and omphalocele) admitted to a single-center NICU from 2007 to 2018. Demographic and clinical information, including microbiologic studies, antibiotic dosing and surgical care, were collected. Antibiotic use was quantified using days of therapy (DOT) per 1000 patient-days. Sepsis was defined as culture of a pathogen from a normally sterile site.

Results:
Seventy-four infants were included; 64 (86%) with gastroschisis and 10 (14%) with omphalocele. Median day of closure was 8 days [interquartile range (IQR) 6–10, range 0–31]. All infants received ≥1 course of antibiotics; median antibiotic DOT/infant was 24.5 (IQR 18–36) for an average of 416.5 DOT per 1000 patient-days. Most antibiotic use was preclosure prophylaxis (44%) and treatment of small intestinal bowel overgrowth (24%). Suspected and proven infection accounted for 26% of all antibiotic use. Skin and soft tissue infection (13/74, 18%) and late-onset sepsis (11/74, 15%) were the most common infections; 2 infants had sepsis while on antibiotic prophylaxis. All infants survived to discharge.

Conclusions:
Most antibiotic use among infants with abdominal wall defects was prophylactic. Infection on prophylaxis was rare, but 35% of infants had infection after prophylaxis. Improved stewardship strategies are needed for these high-risk infants.