bluuebunny/crossref_metadata_2025_split huggingface dataset:
Success Rate of Augmented Trabeculectomy in Primary Congenital Glaucoma
Authors: Jabeen Sidra , Noorani Sorath , Memon Mariya Nazish , Zaheer Naima 
Published: December 2021

Purpose:
To evaluate the outcome of trabeculectomy augmented with mitomycin C in primary congenital glaucoma and to document the complications of the procedure in young children.

Methods:
This was a prospective study of children younger than 2 years with primary congenital glaucoma who were treated with primary trabeculectomy with mitomycin C. After surgery, patients were observed for a minimum of 1 year. Trabeculectomy success was defined as an intraocular pressure (IOP) of 21 mm Hg or less without (absolute success) or with (qualified success) topical antiglaucoma medications. Surgical success was assessed at 1, 6, and 12 months after the procedure.

Results:

Seventy-four eyes of 42 children were included in the current study. The mean age was 11.7 ± 8.5 months. Of the 42 children, 57.2% were male and 42.8% were female. The mean IOP after surgery was significantly lower than the preoperative IOP (
P
< .0001). Absolute success was observed in 98.6%, 50%, and 27% of eyes at 1, 6, and 12 months, respectively. Qualified success was achieved in 1.4%, 36.5%, and 48.6% of eyes at 1, 6, and 12 months, respectively. Overall success of the procedure was 100% at 1 month but reduced to 86.5% at 6 months and 75.7% at 12 months. In 24.3% of eyes, IOP was not controlled even with adjunctive topical glaucoma medications and was considered a failure. Postoperative complications were shallow anterior chamber (10.8%), collapsed anterior chamber (1.3%), and choroidal detachment (12.0%). Complications were managed conservatively, and 6 eyes needed surgical intervention.

Conclusions:
Augmented trabeculectomy is a useful primary procedure in children with primary congenital glaucoma. Topical glaucoma medications supplement the success of the procedure.

[
J Pediatr Ophthalmol Strabismus
. 2022;59(3):180–186.]
Aire Controls Heterogeneity of Medullary Thymic Epithelial Cells for the Expression of Self-Antigens
Authors: Nishijima Hitoshi , Matsumoto Minoru , Morimoto Junko , Hosomichi Kazuyoshi , Akiyama Nobuko , Akiyama Taishin , Oya Takeshi , Tsuneyama Koichi , Yoshida Hideyuki , Matsumoto Mitsuru 
Published: December 2021

Abstract
The deficiency of Aire, a transcriptional regulator whose defect results in the development of autoimmunity, is associated with reduced expression of tissue-restricted self-Ags (TRAs) in medullary thymic epithelial cells (mTECs). Although the mechanisms underlying Aire-dependent expression of TRAs need to be explored, the physical identification of the target(s) of Aire has been hampered by the low and promiscuous expression of TRAs. We have tackled this issue by engineering mice with augmented Aire expression. Integration of the transcriptomic data from Aire-augmented and Aire-deficient mTECs revealed that a large proportion of so-called Aire-dependent genes, including those of TRAs, may not be direct transcriptional targets downstream of Aire. Rather, Aire induces TRA expression indirectly through controlling the heterogeneity of mTECs, as revealed by single-cell analyses. In contrast, Ccl25 emerged as a canonical target of Aire, and we verified this both in vitro and in vivo. Our approach has illuminated the Aire’s primary targets while distinguishing them from the secondary targets.
Is the arterial echo-Doppler a useful tool in the detection of subclinical arteriosclerosis?
Authors: Rios Jorge 
Published: December 2021

INTRODUCTION:
Arteriosclerosis has its history since ancient times, rare at that time due to the high mortality from infectious diseases. It arises with changes in dietary habits and the aging of the population. The disease is characterized by being an inflammatory chronic process, generalized and progressive, with multiple risk factors that converge at the onset of itself. However, it is important to bear in mind that 20%–30% of patients lack risk factors and debut with cardiovascular and cerebrovascular accidents.

OBJECTIVES:
To determine in asymptomatic patients without previous atherothrombotic events, with risk factors and without them, the presence of atheroma in the carotid and iliofemoral sectors, with the use of Echo Doppler Color.

MATERIALS AND METHODS:
Patients were included between January and December 2019, without previous atherothrombotic events, with and without risk factors. All were studied with Echo Doppler color with transverse and longitudinal sections in the carotid and iliofemoral sectors.

RESULTS:
In this period, 426 patients were studied, 303 women with an age range of 37–84 with an average of 59.86 years old, 123 men with an age range of 40–92 with an average of 62.42 years old. The number of women with risk factors was 129 (42.62%), of which 41 (32.13%) had subclinical arteriosclerosis affectations and of the 174 women without risk factors, no subclinical arteriosclerosis was found. In men, the factors of present risk were in 55 (45.23%) patients, all of whom had arteriosclerosis subclinical and 25 (20.40%) patients had arteriosclerosis without risk factors. The presence of subclinical arteriosclerosis was 65.63% in men. The prevalence of cardiovascular risk factors according to sex were: Arterial hypertension (M 48%, H 41%), diabetes (M 9%, H 11%), dyslipidemia (M 43%, H 48.5%), and smoking (M 21%, H 25%). The region more affected was the carotid in both men and women, with a slight predominance of single-site impact versus multiple sites.

CONCLUSION:
According to the results obtained, we can say that risk factors can predict events, but the use of Doppler ultrasound to detect atheromas increases the possibility of finding subclinical arteriosclerosis, which allows patients to be reclassified and thus intensify preventive measures.
Correlation between cotinine urinary levels & cardiovascular autonomic function tests among smokeless tobacco chewers
Authors: Nikam Kiran S. , Wingkar Kanchan C. , Joshi Rajesh K. , Kallur Rajashekar K. 
Published: December 2021

Background & objectives:
Cardiovascular disease (CVD), the leading cause of death worldwide is responsible for over 17 million deaths globally, of which 10 per cent deaths have been expected due to consumption of tobacco. The association between CVD and chewing of tobacco is limited and remains arguable. The aim of this study was to find out the correlation between urinary cotinine level and cardiovascular autonomic function tests of tobacco chewers.

Methods:
In the present study, 600 participants, 300 smokeless tobacco chewers (STC) and 300 non-tobacco chewers (NTC), between 18 and 65 yr were selected. Various parameters such as anthropometric, systolic blood pressure (SBP), diastolic blood pressure (DBP), autonomic function tests and urinary cotinine levels were measured.

Results:
Significant difference (P<0.001) was noted in STC and NTC for anthropometric parameters, SBP, DBP and urinary cotinine levels. Sympathetic and parasympathetic autonomic function test showed significant difference on comparison in STC and NTC groups, except in Valsalva ratio. Correlations with urinary cotinine levels were significant for sympathetic autonomic functions, SBP fall (r=0.138, P=0.016), DBP rise (r=−0.141, P≤0.014); parasympathetic autonomic function, heart rate (HR) response to standing (r=−0.208, P≤0.003), deep breathing (r=−0.473, P≤0.001) and Valsalva ratio (r=−0.396, P≤0.0001).

Interpretation & conclusions:
Correlation between urinary cotinine levels and autonomic function tests elucidates the linkage involving autonomic nervous system damage which can be considered as an important associated relationship for early diagnosis of CVD health risk factors among smokeless tobacco (ST) users.
Predictors of chemotherapy resistance & relapse in gestational trophoblastic neoplasia
Authors: Singhal Seema , Kumar Lalit , Kumar Sunesh , Khurana Sachin , Bhatla Neerja 
Published: December 2021

Background & objectives:
Gestational trophoblastic neoplasia (GTN) is a chemosensitive malignancy with an excellent cure rate. The primary objective of the present study was to determine the predictors of chemoresistance and disease relapse, and the secondary objective was to appraise the WHO/FIGO risk scoring and course of disease in women with GTN.

Methods:
In this retrospective study, case records of women treated for GTN from January 2011 to June 2019 were reviewed. For the purpose of comparison, sub-stratification of FIGO/WHO low risk group (≤6) into low (0-4) and intermediate (5-6) risk was done. Similarly, WHO high risk (≥7) group was sub-stratified into high (7-12) and ultra-high risk (≥13) groups.

Results:
Case records of 116 patients were included: 51.7 per cent (60/116) were of low risk disease and 48.2 per cent (56/116) were of high risk disease. Chemoresistance developed in 28.4 per cent (33/116) and relapse in 10.3 per cent (12/116) cases. Risk of chemoresistance was higher in low risk (0-6) while risk of relapse was more in high risk (≥7) group. On sub-stratification, chemoresistance was more with intermediate [0-4: 28.5% (10/35), 5-6: 44% (11/25), 7-12: 22.5% (9/40), ≥13: 18.7% (3/16)] and relapse with ultra-high risk score [0-4: 5.7% (2/35), 5-6: 4% (1/25), 7-12:10% (4/40), ≥13: 31.2% (5/16)]. Age, myometrial invasion, serum beta-human chorionic gonadotropin and tumour size were not related to chemoresistance or relapse.

Interpretation & conclusions:
WHO risk score and presence of metastatic disease predict the probability of developing chemotherapy resistance and disease relapse. Risk of chemotherapy resistance was higher in women with intermediate-risk score (5-6), and risk of relapse was more in those with ultra-high risk score (≥13).
Effect of slow breathing on autonomic tone & baroreflex sensitivity in yoga practitioners
Authors: Anasuya Boligarla , Deepak Kishore Kumar , Jaryal Ashok Kumar , Narang Rajiv 
Published: December 2021

Background & objectives:
Slow breathing increases parasympathetic activity and baroreflex sensitivity (BRS) in healthy individuals, also similarly observed in yoga practitioners. Pranayama which is an important component of yoga when practiced at a slow pace was at a respiratory frequency of around 0.1 Hz (6 breaths/min). Therefore, it was hypothesized that yoga practitioners might have adapted to slow breathing. This study was aimed to decipher the role of yoga on cardiovascular variability during slow breathing (0.1 Hz) in yoga practitioners.

Methods:
A cross-sectional study was undertaken in naïve-to-yoga individuals (n=40) and yoga practitioners (n=40) with an average age of 31.08 ± 7.31 and 29.93 ± 7.57 yr, respectively. The analysis of heart rate variability, blood pressure variability (BPV) and BRS during spontaneous and slow breathing was compared between the two groups.

Results:
During slow breathing, the heart rate (P<0.01) was lower, respiratory rate interval (P<0.05) and pNN50 per cent (P=0.01) were higher, mean systolic BP (SBP) (P<0.05) and SDSD (Standard deviation of successive beat to beat systolic blood pressure differences) (P<0.01) of SBP variability were lower with sequence BRS (P<0.001) and α low frequency (P<0.01) and α high frequency (P<0.001) of spectral BRS were higher in yoga practitioners.

Interpretation & conclusions:
The present study indicated higher parasympathetic activity and BRS with lower SBP variability at rest and during slow breathing in yoga practitioners compared to naive group. Findings indicate that the short-term practice of slow breathing complements the augmented parasympathetic activity and BRS in the yoga group.
Cystic fibrosis transmembrane conductance regulator-related male infertility
Authors: Gaikwad Avinash , Khan Shagufta , Kadam Seema , Shah Rupin , Kulkarni Vijay , Kumaraswamy Rangaswamy , Kadam Kaushiki , Dighe Vikas , Gajbhiye Rahul 
Published: December 2021

Background & objectives:
Due to limited information available on the frequency and spectrum of cystic fibrosis (CF) transmembrane conductance regulator (CFTR) gene mutations in congenital bilateral absence of vas deferens (CBAVD) in Indian population, it is difficult to provide accurate genetic counselling to couples. The present study was undertaken to investigate the spectrum and frequency of CFTR gene mutations in Indian men with CBAVD and to determine the female CF carrier status.

Methods:
Direct DNA sequencing of the CFTR gene was carried out in eighty CBAVD men, their female partners and fifty controls from the general population. Pathological significance of the identified novel CFTR gene variants was carried out using in silico tools. Appropriate genetic counselling was provided to the couples prior to intracytoplasmic sperm injection (ICSI).

Results:
A significant association was observed for CFTR gene variants in Indian CBAVD men versus controls (odds ratio: 12.1; 95% confidence interval: 4.8-30.4; P<0.0001). A total of 20 CFTR gene variants were identified in 53 CBAVD men. Eight novel missense CFTR gene variants (L214V, A238P, E379V, L578I, F587L, L926W, R1325K and R1453Q); two novel splice-site gene variants (c.1-30C>G and IVS1+2T>G) and ten previously reported mutations (R75Q, c.1210-12[5], F508del, A309G, R334W, I444T, R668C, R709X, A1285V and Q1352H) were detected in CBAVD men. The novel and reported CFTR gene mutations were L926W (2.5%, P=0.26), R1453Q (2.5%, P=0.26), F508del (8.75%, P=0.03) and c.1210-12[5] (42.5%, P=0.002). A total of 13 (16.2%) female partners were found to be a CF carrier. Nine couples had a risk of transmitting mutant CFTR allele to the offspring.

Interpretation & conclusions:
The heterogeneous spectrum of CFTR gene in Indian population suggests the necessity of screening CBAVD men and female partners for accurate genetic counselling prior to undergoing ICSI.
Antimicrobial susceptibility pattern of Burkholderia cepacia complex & Stenotrophomonas maltophilia from North India
Authors: Sethi Shveta , Sharma Megha , Kumar Sunil , Singhal Lipika , Gautam Vikas , Ray Pallab 
Published: December 2021

Background & objectives:
With increased isolation of Burkholderia cepacia complex (Bcc) and Stenotrophomonas maltophilia from clinical specimens, knowledge of their antimicrobial susceptibility trend will aid in better patient management. This study provides a comprehensive picture of this trend over a decade.

Methods:
A retrospective analysis of laboratory records over 10 years for antimicrobial susceptibility pattern of Bcc and S. maltophilia was carried out. The susceptibility pattern to commonly used antimicrobials was determined using disk diffusion and compared at the beginning, mid and end of the study period.

Results:
Five hundred and thirty Bcc and 665 S. maltophilia isolated over the past 10 yr were included in the study. Over the years, susceptibility of Bcc for co-trimoxazole varied as 80, 70 and 89 per cent at the beginning, middle and end of the study, respectively. Susceptibility to tetracycline was 43 per cent at the beginning of the study and that to minocycline was 100 per cent mid-study and 74 per cent at the end. Susceptibility to ceftazidime varied as 83, 60 and 65 per cent, respectively, and to meropenem, increased during the first half of the study and decreased in the second half, as 60, 70 and 43 per cent, respectively. Bcc susceptibility to levofloxacin decreased from 84 (in 2014) to 76 per cent (in 2016). S. maltophilia susceptibility to co-trimoxazole varied as 90, 82 and 87 per cent, respectively, whereas that to levofloxacin was 80, 100 and 94 per cent, respectively, during the start, mid and end of the study. Susceptibility to minocycline decreased from 100 per cent mid-study to 96 per cent at the end. Susceptibility of S. maltophilia to ceftazidime increased from 24 (in 2012) to 37 per cent (in 2016). All variations among the three phases of the study were significant for all antimicrobials tested for both the organisms.

Interpretation & conclusions:
While Bcc showed increased resistance to ceftazidime, meropenem and minocycline, S. maltophilia maintained >80 per cent susceptibility to minocycline, levofloxacin and co-trimoxazole throughout the decade. By 2016, Bcc was most susceptible to co-trimoxazole, whereas S. maltophilia was most susceptible to minocycline and levofloxacin.
Prospective Study of Functional and Radiological Outcome of Proximal Fibular Osteotomy for Medial Compartment Osteoarthritis in Elderly
Authors: Kakumanu Ravi Kiran , Kunadharaju Ravi Teja , Ganesh Chinni 
Published: December 2021

Background:
Osteoarthritis (OA) is the most common form of arthritis in Indian population. Proximal fibular osteotomy (PFO) is an alternative treatment to high tibial osteotomy and unicondylar arthroplasty or total knee arthroplasty. It is a surgical procedure for medial compartment knee osteoarthritis (KOA). The PFO helps in the correction of a varus deformity in KOA, which shift the loading force from the medial compartment more laterally. It, therefore, helps in decreasing the pain and satisfactory functional recovery.

Objective:
The objective of the study is to evaluate the clinical and radiological outcomes in medial compartment OA knee treated with minimally invasive PFO as a new and alternative modality of treatment.

Materials and Methods:
A total of 30 patients were selected (18 men and 12 women, age range between 50 and 72 years) from May 2019 to May 2020 who had undergone PFO for medial compartment OA knee were followed in a prospective manner. Preoperative and postoperative weight-bearing whole lower extremity scanogram was obtained to analyze the alignment of lower limb (femorotibial angle) and ratio of joint space (medial/lateral joint space). Functional outcome was assessed with American Knee Society Score (KSS), and knee pain was assessed with visual analog scale (VAS).

Results:
In our study, we had 30 patients who were managed by PFO and were followed up for a minimum period of 1 year. Following the surgery, all patients reported dramatic relief in pain with the VAS dropping significantly from 6.39 in the preoperative period to 2.1 postoperatively (P < 0.005). Weight-bearing lower extremities radiographs showed significant increase in medial knee joint space in 20% of patients. We also noted an increase in the medial joint space from 1.1 ± 0.29 mm preoperatively to 4.21 ± 0.7 min postoperatively. The femorotibial angle improved by around 7°, while the hip knee ankle angle improved by around 6°.

Conclusion:
PFO is a new alternative method in the management of medial compartment arthritis of the knee, which is minimally invasive, safe, and effective, relieves pain, and improves joint function. It helps in the correction of varus knee.
Efficacy of Lateral Extra-Articular Tenodesis on Anterior Cruciate Ligament Reconstruction with Quadrupled Hamstring Graft
Authors: Singh Lalit Pratap , Sinha Shivam , Kumar Ishan , Verma Ashish Kumar , Saraf Shyam Kumar , Singh Tej Bali , Pandey Shubhrendu Shekhar 
Published: December 2021

Background:
Isolated anterior cruciate ligament (ACL) reconstruction is frequently associated with anterolateral ligament injury (ALL) and results in residual instability at follow-up. It was hypothesized that patients who underwent combined ACL and lateral extra-articular tenodesis (LET) reconstruction would exhibit less residual laxity, better clinical outcomes, and better graft incorporation on follow-up magnetic resonance imaging (MRI) as well.

Patient and Methods:
Sixty-four patients with concomitant ACL and ALL injuries who were operated over a period of 2 years were enrolled between 2016 and 2018. Two groups of patients were evaluated prospectively. Eighteen patients in control Group B underwent anatomical ACL reconstruction alone, and 20 in test Group A underwent ACL reconstruction combined with LET. Exclusions were multiligament injuries, chondral injury, meniscus tear, and ramp lesion. Follow-up by Lysholm and modified Cincinnati knee rating was done and MRI for status of graft at least 1-year postoperative.

Results:
After excluding dropout or inadequate follow-up, Group A (n = 20) with ACL + LET was compared with Group B (n = 18), with isolated ACL reconstruction, at final median follow-up of 18 months. There were no significant differences between groups regarding gender, age, and duration of injury. Regarding functional outcome scores, patients in the LET group presented better results on both the clinical scoring (P < 0.0001). In addition, patients in the LET group had better graft uptake on MRI and no pivoting at physical examination. Regarding graft failures, the isolated ACL reconstruction group had 5 and the LET group had 1 failure.

Conclusion:
The combined ACL and LET reconstruction in patients with ACL injury is an effective and safe solution and leads to good functional outcomes with no increase in complications and aids in early return to preinjury activities with a surviving healthy graft.
Functional Outcome of Proximal Fibular Osteotomy in Medial Compartment Knee Osteoarthritis
Authors: Ranjan Priya , Anand Rajeev , Choudhary Rakesh 
Published: December 2021

Aims:
Medial compartment arthritis is very common in the Asian population because of a preponderance of varus knees. High tibial osteotomy and total knee replacement are technically demanding procedures, while proximal fibular osteotomy (PFO) significantly relieves pain and improves joint function in knee osteoarthritis (OA). This retrospective study was conducted at Patna Medical College and Hospital. The objective of this study was to assess functional outcomes after PFO and its correlation with bone mineral density.

Settings and Design:
The study design was a retrospective study.

Subjects and Methods:
Twenty patients with unicompartmental OA with varus deformity were included in the study. Inclusion criteria included patients with moderate-to-severe symptomatic medial unicompartmental OA of the knee, who had an indication for a surgical procedure, and who were able to give informed consent for the surgery. Exclusion criteria included patients with posttraumatic knee OA or inflammatory joint disease and patients with a history of previous operations or fractures the primary outcome was measured by calculating the ratio of knee joint space. The secondary outcome measure was pain measured by the visual analog scale (VAS).

Statistical Analysis Used:
Statistical analysis was performed by measurement of study variable.

Results:
Immediate postoperative pain relieved was noticed in all twenty patients. While at 1-, 3-, and 6-month follow-up, pain relieved was noticed maximum in osteoporotic group patients (n = 12). At 9-month follow-up, pain relieved was noticed equally in all patients. Radiographs of the weight-bearing lower extremity showed an average increase in the medial knee joint space postoperatively compared with preoperatively. The ratio of the knee joint space (medial/lateral compartment) improved significantly from 0.50 ± 0.30 preoperatively to 0.58 ± 0.28 postoperatively.

Conclusions:
PFO is a simple, safe, fast, and affordable surgery to relieve pain and improve joint function and the medial joint space in knee osteoarthritis, particularly in osteoporotic individuals.