bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19: a primer for the rheumatologist: management of patients and care settings
Authors: Calabrese Cassandra , Lehman Bethany 
Published: July 2020

Purpose of review
There are currently many unanswered questions surrounding the management of patients with immune-mediated inflammatory diseases during the COVID-19 pandemic and several ‘rapid’ guidelines have been released, although are subject to be updated and changed in the near future. The purpose of this review is to discuss the approach to management of patients with immune-mediated diseases during the COVID-19 pandemic.

Recent findings
At present, there is little evidence to suggest an increased risk of COVID-19 infection or its complications in patients with immune-mediated diseases or associated with conventional or biologic disease modifying antirheumatic drugs; however, glucocorticoid use does appear to have negative associations.

Summary
Currently, conventional and biologic disease modifying antirheumatic drugs can be continued in the absence of SARS-CoV-2 exposure. In the case of exposure, with the exception of hydroxyhcloroquine and sulfasalazine, immunosuppression should be held for 2 weeks. Our recommendations and the guidelines we discuss here are based on C-level recommendations but help provide a framework for how to counsel our patients during this pandemic.
Engineering antibody-based molecules for HIV treatment and cure
Authors: Tuyishime Marina , Ferrari Guido 
Published: July 2020

Purpose of review
Immunotherapy strategies alternative to current antiretroviral therapies will need to address viral diversity while increasing the immune system's ability to efficiently target the latent virus reservoir. Antibody-based molecules can be designed based on broadly neutralizing and non-neutralizing antibodies that target free virions and infected cells. These multispecific molecules, either by IgG-like or non-IgG-like in structure, aim to target several independent HIV-1 epitopes and/or engage effector cells to eliminate the replicating virus and infected cells. This detailed review is intended to stimulate discussion on future requirements for novel immunotherapeutic molecules.

Recent findings
Bispecific and trispecific antibodies are engineered as a single molecules to target two or more independent epitopes on the HIV-1 envelope (Env). These antibody-based molecules have increased avidity for Env, leading to improved neutralization potency and breadth compared with single parental antibodies. Furthermore, bispecific and trispecific antibodies that engage cellular receptors with one arm of the molecule help concentrate inhibitory molecules to the sites of potential infection and facilitate engagement of immune effector cells and Env-expressing target cells for their elimination.

Summary
Recently engineered antibody-based molecules of different sizes and structures show promise in vitro or in vivo and are encouraging candidates for HIV treatment.
Inhalational Exposure Causes Radioactive Material Uptake for Multiple Workers
Authors: Paciello Lara R. , Owoc Julian J. 
Published: July 2020

Abstract
Seven individuals were occupationally exposed to airborne radioactive material, which caused an intake of multiple isotopes and an uptake of 60Co. Committed effective dose equivalents were calculated using ICRP Publication 30 methodology in accordance with US Regulation 10 CFR 20. Doses were in the range of 0.1–2.63 mSv for all individuals. Continued monitoring via whole body counting continues to detect internal contamination of 60Co from this event at 321 d post intake.
Neuroaxonal Degeneration in Patients With Multiple Sclerosis: An Optical Coherence Tomography and in Vivo Corneal Confocal Microscopy Study
Authors: Testa Valeria , De Santis Nicole , Scotto Riccardo , Pastorino Carlo E. , Cellerino Maria , Olivari Sara , Morlacchi Alessia Jenny , Inglese Matilde , Uccelli Antonio , Traverso Carlo E. , Iester Michele 
Published: July 2020

Purpose:
To investigate the effect of multiple sclerosis (MS) on corneal and retinal nerve fiber by quantifying corneal subbasal nerve fibers and retinal ganglion cells.

Methods:
A total of 46 eyes of 23 patients with MS and 42 eyes of 21 healthy subjects were included in the study. All patients and healthy subjects underwent a comprehensive ocular examination. In vivo confocal microscopy with Heidelberg Retina Tomograph in association with Rostock Cornea Module (Heidelberg Engineering, Heidelberg, Germany) and a swept-source optical coherence tomography (Topcon Corporation) were performed in all patients and healthy subjects. The number of subbasal nerve fibers and the nerve fiber density were calculated. Student t test was used to compare eyes with MS with control eyes. The normal distribution was first confirmed with the Shapiro-Wilk test.

Results:
A statistically significant (P < 0.05) decrease was found for nerve fiber number, ganglion cell–inner plexiform layer, and retinal nerve fiber layer in patients with MS compared with those of healthy subjects. Moreover, an inverse correlation was found between retinal nerve fiber layer (r = −0.32), nerve fiber number (r = −0.47), and ganglion cell–inner plexiform layer (r = −0.51) and Expanded Disability Status Scale. A direct correlation between Expanded Disability Status Scale and optic neuritis frequency was found (r = 0.322).

Conclusions:
In vivo confocal microscopy showed a difference in corneal morphological parameters and retinal damage; moreover, these changes seemed to be related to the degree of neurological disability. Both retinal ganglion and trigeminal cell atrophy measurements could become affordable and accessible biomarkers for clinical trials in progressive disease.
Topography-Guided Photorefractive Keratectomy for Postkeratoplasty Astigmatism: Long-Term Outcomes
Authors: Bizrah Mukhtar , Lin David T. C. , Babili Abdulaa , Wirth Magdalena Anna , Arba-Mosquera Samuel , Holland Simon P. 
Published: July 2020

Purpose:
To evaluate the long-term efficacy and safety of topography-guided photorefractive keratectomy (TG-PRK) for postkeratoplasty refractive error correction.

Methods:
A retrospective interventional case series of 54 eyes of 50 patients who underwent previous corneal transplants. Unaided distance visual acuity (UDVA) and best corrected visual acuity (CDVA), manifest refraction, mean central keratometric value, mean keratometric astigmatism, and postoperative complications were reviewed.

Results:
Final follow-up was at mean 31 (±17) months. Sixteen point seven percent of eyes underwent more than 1 surface ablation. Mean UDVA improved from 0.96 ± 0.06 logarithm of the minimum angle of resolution (LogMAR) preoperatively to 0.46 ± 0.05 LogMAR of resolution at the final follow-up (Bonferroni, P < 0.0001). Mean UDVA improved by 4.4 Snellen lines. Improvement in CDVA was not significant, although a significant improvement was noted when eyes with preoperative CDVA <20/40 were analyzed separately (t test, P = 0.005). Mean astigmatism improved from −4.4 ± 0.26 D preoperatively to −2.4 ± 0.26 D at the final follow-up (Bonferroni, P < 0.0001), whereas mean SEQ improved from −2.5 ± 0.39 D preoperatively to −1.1 ± 0.25 D (Bonferroni, P = 0.02). In total, 9% at the preoperative visit and 55% at the final visit had less than 2 D of astigmatism, respectively. Keratometric astigmatism decreased from 5.24 ± 0.36 D preoperatively to 2.98 ± 0.34 D at the final follow-up (t test, P < 0.0001). No eyes developed clinically significant haze, 14.8% developed regression, and 13% had a reduction of 2 or more CDVA lines.

Conclusions:
Postkeratoplasty topography–guided photorefractive keratectomy has good long-term efficacy and safety, resulting in significant UDVA, refractive, and keratometric improvement. Regression can occur after the first year of treatment, emphasizing the importance of long-term follow-up.
Management of Stromal Herpes Simplex Virus Keratitis With Epithelial Ulceration Using Optical Coherence Tomography–Generated Corneal Thickness Maps
Authors: Lu Louise , Palioura Sotiria 
Published: July 2020

Purpose:
To report 2 cases of herpes simplex virus (HSV) stromal keratitis with epithelial ulceration that were managed using optical coherence tomography–generated pachymetric and corneal epithelial thickness maps.

Methods:
Two patients with a history of HSV keratitis with nonhealing epithelial defects were referred to the Athens Vision Eye Institute. Anterior segment optical coherence tomography–generated pachymetric and corneal epithelial thickness maps showed subclinical stromal edema and irregular epithelium, thus indicating diagnoses of HSV stromal keratitis with epithelial ulceration. The patients were administered topical preservative-free dexamethasone and oral antiviral therapy. Steroid tapering was guided by pachymetric and corneal epithelial thickness maps at each follow-up visit.

Results:
Both patients experienced initial healing of the epithelium and resolution of stromal inflammation. One patient had a recurrence of HSV stromal keratitis with epithelial defect 3 months after initial improvement, with pachymetric and corneal epithelial thickness maps indicating subclinical stromal edema. He was reintroduced to topical steroid therapy, and the stromal edema and epithelial defect subsequently resolved. Both patients have had no recurrences in the past year.

Conclusions:
Pachymetric and corneal epithelial thickness maps provide an objective assessment of stromal inflammation and the following 2 clinical advantages in the management of HSV stromal keratitis with epithelial ulceration: (1) they help differentiate it from HSV epithelial keratitis with geographic ulceration and neurotrophic keratopathy and (2) offer objective measurements to guide management with topical corticosteroids until resolution of stromal edema. Thus, treatment can be initiated in a timely manner, and the blinding complications of HSV stromal keratitis can be avoided.
Predictors of Vision-Related Quality of Life After Endothelial Keratoplasty in the Descemet Endothelial Thickness Comparison Trials
Authors: Pickel Julia , Chamberlain Winston D. , Lin Charles C. , Austin Ariana , Clover Jameson , Lietman Thomas M. , Rose-Nussbaumer Jennifer 
Published: July 2020

Purpose:
To determine which baseline characteristics are associated with vision-related quality of life (QOL) after endothelial keratoplasty.

Methods:
A patient- and outcome-masked randomized clinical trial. Consecutive patients presenting with isolated endothelial disease requiring endothelial keratoplasty at Oregon Health Sciences University and Stanford University. Study eyes randomized to one of the 2 types of endothelial keratoplasty were given the national eye institute vision function questionnaire 25 at baseline and 12 months. In this prespecified secondary outcome, we assessed the role of recipient and donor characteristics as predictors of the 12-month national eye institute vision function questionnaire 25 change score.

Results:
The mean vision function questionnaire (VFQ) score was 74 (SD 14) at baseline and increased to 82 (SD 12) at 3 months and 87 (SD 10) at 12 months. We were unable to find a difference in vision-related QOL in study participants who underwent Descemet membrane endothelial keratoplasty compared with ultrathin Descemet stripping endothelial keratoplasty [coef −0.98, 95% confidence interval (CI) −9.27 to 7.31; P = 0.82]. In multivariable analysis, patients who underwent endothelial keratoplasty in 2 eyes had approximately 8 points higher VFQ at 12 months after the second eye than those who had only one eye enrolled (95% CI 0.10–15.72; P = 0.047). Posterior densitometry produced an approximately 1-point increase each in the VFQ change score for each 1 grayscale unit increase at baseline (95% CI 0.26–1.81; P = 0.009). Although the sample size was small, a diagnosis of pseudophakic bullous keratopathy had approximately 19-points more improvement on average compared with Fuchs (95% CI 7.68–30.00; P = 0.001).

Conclusions:
Bilateral endothelial keratoplasty resulted in higher vision-related QOL compared with unilateral. Baseline densitometry, objective measure of corneal haze that predicts vision-related QOL, may play a role in monitoring disease progression.
Recipient Factors Associated With Graft Detachment of a Subsequent Eye in Sequential Descemet Membrane Endothelial Keratoplasty
Authors: Kim Kyeong Hwan , Tijunelis Marius A. , Zhou Yunshu , Musch David C. , Hood Christopher T. , Tannen Bradford L. , Mian Shahzad I. 
Published: July 2020

Purpose:
To evaluate the recipient factors associated with graft detachment in the subsequent eye of patients who underwent sequential Descemet membrane endothelial keratoplasty (DMEK).

Methods:
A retrospective, consecutive case series with 158 eyes of 79 patients who underwent DMEK surgeries in both eyes between October 2013 and April 2019 for treatment of Fuchs endothelial dystrophy. The main outcome measure was the presence of graft detachment (any amount of detachment) at postoperative 1 week in the subsequent eye. Preoperative, intraoperative, and postoperative factors were evaluated for association with graft detachment.

Results:
Of 79 patients (158 eyes) with a mean follow-up of 11.7 ± 8.4 months, 18 patients (36 eyes) developed graft detachment in both eyes 1 week postoperatively. The risk of detachment in the subsequent eye was increased when the first eye had any amount of detachment [odds ratio = 2.8; 95% confidence interval (CI) = 1.1–7.3; P = 0.037]. When the first eye had a clinically significant detachment (>30% detached), the risk of detachment occurring in the subsequent eye was greater (odds ratio = 15.7; 95% CI = 1.8–134.5; P = 0.012). This risk of graft detachment in the subsequent eye increased 33% for every 5% increase in the detachment percentage in the first eye (odds ratio = 1.3; 95% CI = 1.1–1.6; P = 0.008).

Conclusions:
The presence of graft detachment after DMEK increases the risk of graft detachment in subsequent DMEK in the contralateral eye. Modification in perioperative care and surgical technique in the contralateral eye, such as a larger gas bubble, use of SF6 20%, and combining cataract surgery, may be needed when graft detachment occurs after DMEK in the first eye.
Cyanoacrylate Tissue Adhesive for the Treatment of Corneal Thinning and Perforations: A Multicenter Study
Authors: Anchouche Sonia , Harissi-Dagher Mona , Segal Laura , Racine Louis , Darvish-Zargar Mahshad , Robert Marie-Claude 
Published: July 2020

Purpose:
To examine the outcomes of cyanoacrylate tissue adhesive (CTA) application for impending or frank corneal perforations and assess for predictors of treatment response.

Methods:
A multicenter cohort study was conducted to assess the clinical outcomes of adult patients who underwent CTA gluing for impending or frank corneal perforations between 2013 and 2018. The primary outcome was the proportion of successful CTA applications, defined as tectonic stability of the globe without subsequent keratoplasty (KP). Secondary outcomes included visual acuity and success of subsequent surgical interventions, if performed.

Results:
Fifty-three eyes of 52 patients were included in this study [56% women; mean age at presentation 70 ± 13 years; median length of follow-up of 387 days (interquartile range: 191–704)]. Medical comorbidities were present in 62% of patients. The most common etiologies for perforations included infections (43%) and Sjogren disease (9%). Of the CTA-treated eyes, 22% had a complete resolution of the corneal lesion. Fifty-four percent of patients underwent KP. Longer duration of CTA treatment was associated with CTA success (P = 0.04). For patients requiring KP, 71% were successful and 29% failed. There is no significant difference in the median time delay between patients with successful and failed KPs (P = 0.4).

Conclusions:
CTA may be considered a stand-alone treatment for corneal perforations. It yielded a success rate of 22%. Failed CTA treatment occurred quickly, largely because of the severity of presentation. In cases requiring KP, the delay between glue application and surgery did not influence the PK success.
Longitudinal Corneal Endothelial Cell Changes in Patients Undergoing Hematopoietic Stem Cell Transplantation
Authors: Pellegrini Marco , Giannaccare Giuseppe , Bernabei Federico , Moscardelli Fabiana , Sessa Mariarosaria , Arpinati Mario , Bonifazi Francesca , Versura Piera 
Published: July 2020

Purpose:
To evaluate longitudinally corneal endothelial cell changes in patients undergoing hematopoietic stem cell transplantation (HSCT) and to further investigate possible correlations with hematological and ocular characteristics.

Methods:
Prospective observational study conducted at a single center. All patients underwent a comprehensive ophthalmological examination, before and after HSCT, including slitlamp examination, Schirmer test, tear breakup time, ocular surface staining, specular microscopy of corneal endothelium, and Ocular Surface Disease Index questionnaire.

Results:
Twenty-five patients undergoing HSCT and 25 age- and sex-matched controls were included. At baseline, hematological patients showed significantly lower values of endothelial cell density (ECD) compared with those of controls (2514.5 ± 390.2 vs. 2723.7 ± 298.0 cells/mm2, P = 0.038). After HSCT, ocular surface disease index score significantly increased (P = 0.020) and tear breakup time significantly decreased (P = 0.036). Conversely, no significant changes were found in Schirmer test and corneal fluorescein staining (always P > 0.05). Eight patients (32%) developed ocular graft-versus-host disease (GVHD). ECD values significantly decreased after HSCT (from 2514.5 ± 390.2 to 2409.5 ± 330.9 cells/mm2, P = 0.009). The decrease in ECD values after HSCT was more pronounced in patients with ocular GVHD compared with those without (231.1 ± 188.8 vs. 45.6 ± 156.5, P = 0.016). No significant correlations between the changes in ECD and hematological and ocular characteristics were found (always P > 0.05).

Conclusions:
Hematological patients showed a lower endothelial cell count already before HSCT, compared with controls. After HSCT, the endothelial cell count further significantly decreased, particularly in patients who developed ocular GVHD.
Impact of On-Site Hospital Medicine Curriculum on Preceptor Perception of Rotation
Authors: Sharma Poonam , Brooks Megan , Roomiany Pahresah , Verma Lalit , Criscione-Schreiber Lisa 
Published: July 2020

Purpose
To assess the feasibility of an on-site, case-based curriculum delivered by preceptors and to assess preceptors' perceptions of the impact of the curriculum on rotation performance and ability to teach.

Methods
Hospital medicine preceptors were surveyed before and after curriculum deployment using a previously developed survey.

Results
Preceptors had positive perceptions of the impact of the curriculum. Rotation performance for health care systems topics had the greatest increase.

Conclusions
Curriculum delivery through on-site, case-based teaching might be well received by preceptors. Despite increased demands on preceptor time, preceptor response to the introduction of a structured curriculum during the second-year internal medicine rotation was positive. Use of preceptor-delivered, preprepared, case-based curricular content might be a tool worth testing in further contexts.
Endoscope infection transmission state-of-the-art: beyond duodenoscopes to a culture of infection prevention
Authors: Hutfless Susan 
Published: July 2020

Purpose of review
The elevator mechanism of the duodenoscope was the focus of endoscopically transmitted infections prior to the COVID-19 pandemic. Since that time, the ‘suspicious suspects’ in the endoscopy unit have grown in number in the eyes of both patients and endoscopists.

Recent findings
This review summarizes the existing guidelines related to infection control in the endoscopy unit and emerging technologies to address gaps, identifies recommendations proposed during the COVID-19 pandemic, and reminds the reader that infection prevention has not changed since the emergence of COVID-19, only the importance of infection prevention has increased in visibility.

Summary
Infection prevention has been and will always be necessary in the gastrointestinal endoscopy unit. Although outbreaks of antibiotic-resistant organisms and infectious diseases like COVID-19 raise the profile of infection control, there have been no major changes to infection control practice recommendations because of the global pandemic. The history of lapses in infection control, persistent contamination of reprocessed endoscopes, and failure of many endoscopy units to identify certain endoscopic procedures as aerosol-generating procedures prior to the pandemic emphasize the need for better knowledge and implementation of infection control practices within endoscopy units.
Prostate-specific membrane antigen targeted PET imaging for prostate cancer recurrence
Authors: Ferdinandus Justin , Fendler Wolfgang Peter , Hadaschik Boris , Herrmann Ken 
Published: July 2020

Purpose of review
Prostate-specific membrane antigen targeted PET imaging (PSMA PET) of biochemically recurrent prostate cancer (BCR) is implemented in routine management in many countries and recommended in European Association of Urology (EAU) and American Society of Clinical Oncology (ASCO) guidelines. Purpose of this review is to summarize recently published evidence of accuracy, management impact, and clinical benefit of PSMA PET in this setting and to state our opinion on the role of PSMA PET in future trials and clinical routine to improve patient outcomes.

Recent findings
The past two years saw an increase of evidence supporting superior detection rates and accuracy of PSMA PET versus standard imaging and other PET radiotracers in the localization of BCR. Systematic reviews, prospective trials and large-scale retrospective studies establish PSMA PET as a new benchmark imaging in this setting and demonstrate considerable impact on therapeutic and diagnostic management. Multiple studies have highlighted pitfalls of PSMA PET imaging warranting attention while interpreting these scans.

Summary
PSMA PET is the new imaging method of choice in BCR. Recent evidence shows unprecedented accuracy and high detection rates along with translation into management changes in a majority of patients. However, improvement of oncologic outcome has not been assessed yet. Implementation of PSMA PET into clinical trials and management of BCR will be crucial to demonstrate outcome improvement.
Volume outcome relationship in penile cancer: a systematic review
Authors: Quhal Fahad , Pradere Benjamin , Mori Keiichiro , Shariat Shahrokh F. 
Published: July 2020

Purpose of review
Penile cancer is a rare disease with significant morbidity. Because of the low volume of cases, it has been suggested that its treatment should be centralized in order to improve outcomes through better management of both the primary tumor and distant disease. We reviewed and summarized the most relevant recent publications regarding centralization of penile cancer management.

Recent findings
Management of penile cancer in academic and supra-regional centers was associated with better survival outcomes. Moreover, reports from population-based studies showed more adherence to guidelines recommendations in academic centers with higher utilization of organ sparing treatments and invasive inguinal lymph node staging.

Summary
The optimal management of penile cancer remains a major therapeutic challenge. Patients with invasive tumors are less adequately managed in lower volume nonspecialized centers. The data convincingly support efforts to centralize penile cancer care and to promote the development of centers of expertise in order to achieve the best possible outcomes for each patient.