bluuebunny/crossref_metadata_2025_split huggingface dataset:
Iridodialysis Repair With Intrascleral Fixation of Flattened Flanged Polypropylene Suture
Authors: Ucar Fikret 
Published: February 2022

Purpose:
To present the flattened flanged polypropylene suture technique developed to obtain round and stable pupils in patients with iridodialysis.

Methods:
After performing a fornix-based conjunctival peritomy, a flange was created at the tip of a 6.0 polypropylene suture by cautery. In the quadrant of iridodialysis, an ultrathin 30-gauge needle was inserted into the sclera at a distance of 2 mm from the limbus and advanced 1.5 mm intrasclerally, parallel to the limbus. The needle was directed radially into the eye and easily passed through the edge of the peripheral iris. The polypropylene suture was pushed into the lumen of the needle with the help of forceps. After the needle was externalized, the tip of the suture was flanged by cautery, and the flange was immediately flattened using a needle holder.

Results:
Six eyes of six patients with iridodialysis were enrolled in this study. Postoperatively, the irises remained well positioned and the pupils became round in all eyes. None of the patients developed suture erosion, suture loosening or rupture, hyphema, hypotony, chronic iridocyclitis, and angle closure.

Conclusion:
The present technique provides a minimally invasive surgery and robust iris fixation without the need to create a scleral flap, groove, or pocket.
PARACENTRAL ACUTE MIDDLE MACULOPATHY AND OCULAR ISCHEMIC SYNDROME AFTER INTRANASAL STEROID INJECTION: A CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Weinstein Jessica E. , Greven Margaret A. 
Published: February 2022

Purpose:
To describe a case of paracentral acute middle maculopathy and ocular ischemic syndrome after intranasal steroid injection.

Methods:
Case report.

Results:
Following an intranasal steroid injection, the patient experienced an episode of amaurosis fugax in her right eye lasting several minutes. Afterward, her visual acuity returned to baseline, but she noted a persistent central scotoma. Optical coherence tomography demonstrated paracentral acute middle maculopathy and fluorescein angiography showed staining and leakage to peripheral vessels concerning for diffuse ischemia.

Conclusion:
Steroid injections to the face and nasopharynx may result in ischemic and vaso-occlusive events in the retina. Ophthalmologists and other physicians performing these procedures need to be aware of this potential adverse outcome.
Glasses-Assisted 3D Display System–Guided Descemet Membrane Endothelial Keratoplasty Tissue Preparation
Authors: Borroni Davide , Rocha-de-Lossada Carlos , Bonci Paola , Rechichi Miguel , Rodríguez-Calvo-de-Mora Marina , Rachwani-Anil Rahul , Sánchez González Jose’ Maria , Urbinati Facundo , Lorente María García , Vigo Luca , Carones Francesco 
Published: February 2022

Purpose:
The aim of this study was to evaluate the feasibility of Descemet membrane endothelial keratoplasty (DMEK) tissue preparation using a glasses-assisted 3-dimensional (3D) display system and to compare it with a conventional surgical microscope.

Methods:
Healthy pairs of human corneas suitable for penetrating keratoplasty surgery were selected for this study. The tissues were randomly divided into 2 groups. Each pair of corneas had 1 cornea (group 1) prepared with NGENUITY (Alcon) with a 5-second staining time with vision blue, and the fellow cornea (group 2) was prepared using a OPMI Lumera 700 surgical microscope (Carl Zeiss Meditec, Jena, Germany) with a 30-second staining time. DMEK graft preparation time, speed of stripping, graft width, and endothelial cell loss were evaluated.

Results:
Twenty-eight pairs of corneas were included in this study. The graft preparation time was significantly higher in the 3D group than in the conventional group (498 ± 147 vs. 418 ± 85 seconds, P value = 0.031). The mean speed of stripping was 0.59 ± 0.081 mm/s in group 1 and 0.089 ± 0.005 mm/s in group 2 (P value = 0.024). The mean endothelial cell density in group 1 and group 2 before tissue preparation was 2162 ± 115.21 and 2153 ± 122.45, respectively (P value > 0.1). After tissue preparation, the endothelial cell density reduced to 1911 ± 150.72 in group 1 and 1998 ± 90.72 in group 2 (P value = P value > 0.05). The graft width was 5.05 ± 0.71 mm in group 1 and 4.92 ± 0.23 mm in group 2 (P value > 0.05).

Conclusions:
DMEK tissue preparation with 3D display system NGENUITY is feasible with a slightly increased preparation time. The improved visualization allows a reduced staining time that could be beneficial for eye banks because it may reduce the toxic effect of staining colorants.
Severe Recurrent Bacterial Pneumonia Among Children Living With HIV
Authors: Boettiger David C. , An Vu Thien , Lumbiganon Pagakrong , Wittawatmongkol Orasri , Huu Truong Khanh , Chau Do Viet , Van Nguyen Lam , Sun Ly Penh , Kinikar Aarti , Ounchanum Pradthana , Puthanakit Thanyawee , Kurniati Nia , Kumarasamy Nagalingeswaran , Kumara Wati Dewi , Chokephaibulkit Kulkanya , Jamal Mohamed Thahira A. , Sudjaritruk Tavitiya , Nik Yusoff Nik Khairulddin , Siew Fong Moy , Nallusamy Revathy A. , Kariminia Azar ,   on behalf of the TREAT Asia Pediatric HIV Observational Database
Published: February 2022

Background:
Bacterial pneumonia imparts a major morbidity and mortality burden on children living with HIV, yet effective prevention and treatment options are underutilized. We explored clinical factors associated with severe recurrent bacterial pneumonia among children living with HIV.

Methods:
Children enrolled in the TREAT Asia Pediatric HIV Observational Database were included if they started antiretroviral therapy (ART) on or after January 1st, 2008. Factors associated with severe recurrent bacterial pneumonia were assessed using competing-risk regression.

Results:
A total of 3,944 children were included in the analysis; 136 cases of severe recurrent bacterial pneumonia were reported at a rate of 6.5 [95% confidence interval (CI): 5.5–7.7] events per 1,000 patient-years. Clinical factors associated with severe recurrent bacterial pneumonia were younger age [adjusted subdistribution hazard ratio (aHR): 4.4 for <5 years versus ≥10 years, 95% CI: 2.2–8.4, P < 0.001], lower weight-for-age z-score (aHR: 1.5 for <−3.0 versus >−2.0, 95% CI: 1.1–2.3, P = 0.024), pre-ART diagnosis of severe recurrent bacterial pneumonia (aHR: 4.0 versus no pre-ART diagnosis, 95% CI: 2.7−5.8, P < 0.001), past diagnosis of symptomatic lymphoid interstitial pneumonitis or chronic HIV-associated lung disease, including bronchiectasis (aHR: 4.8 versus no past diagnosis, 95% CI: 2.8−8.4, P < 0.001), low CD4% (aHR: 3.5 for <10% versus ≥25%, 95% CI: 1.9−6.4, P < 0.001) and detectable HIV viral load (aHR: 2.6 versus undetectable, 95% CI: 1.2−5.9, P = 0.018).

Conclusions:
Children <10-years-old and those with low weight-for-age, a history of respiratory illness, low CD4% or poorly controlled HIV are likely to gain the greatest benefit from targeted prevention and treatment programs to reduce the burden of bacterial pneumonia in children living with HIV.
Pediatric Emergency Department Testing for Gonorrhea and Chlamydia in Children
Authors: Kazmir Sundes , Pierce Mary Clyde , Simonton Kirsten , Rodean Jonathan , Neuman Mark I. , Simon Norma-Jean E. , Alpern Elizabeth R. 
Published: February 2022

Objective
This study aimed to describe trends in the utilization of nucleic acid amplification (NAAT) testing for gonorrhea and chlamydia in US pediatric emergency departments. Nucleic acid amplification has been recommended over genital culture by the American Academy of Pediatrics and Centers for Disease Control and Prevention for children evaluated for sexual abuse.

Methods
We conducted a multicenter study of children aged 12 months to 11 years tested for gonorrhea and chlamydia between 2004 and 2018 at 22 hospitals in the Pediatric Health Information System. We included patients diagnosed with maltreatment concerns and/or genitourinary (GU) symptoms. The primary outcome was prevalence of testing with NAAT, culture, or both. We analyzed groups based on patient sex, as well as diagnoses of maltreatment versus GU symptoms.

Results
A total of 36,312 visits were analyzed. Visits were 73.4% girls and 26.6% boys. During the study period, there was an increase in use of NAAT-only testing for girls (49.3% to 94.3%; P < 0.001) and boys (54.5% to 96.1%; P < 0.001). There was a decrease in use of culture alone for girls (40% to 1.6%; P < 0.001) and boys (38.7% to 0.8%; P < 0.001). Use of both tests in the same encounter was higher among children diagnosed with maltreatment than GU symptoms, regardless of sex (P < 0.001).

Conclusions
Over a 14-year period, downtrend of culture use with increase in NAAT was observed, suggesting general adherence to evidence-based guidelines. Almost 10% of children diagnosed with maltreatment continued to be tested with culture. This could indicate provider concerns regarding test accuracy, legal admissibility, or lack of test availability.
Multiple Continuous Y-to-V–Plasties for Excision and Reconstruction of Constriction Band Syndrome: Case Series and Description of Surgical Technique
Authors: Chan Andrea H. W. , Zeitlinger Lauren , Little Kevin J. 
Published: February 2022

Background:
Many patients with constriction band syndrome will seek treatment to improve limb function and cosmesis. Although several techniques for excision are reported, cosmetic and functional deficits can persist, including hourglass deformity, lymphedema, and inadequate band excision with resultant neurovascular compromise, which may lead to revision surgery, including amputation. The authors present a novel technique that uses multiple continuous opposing Y-to-V–plasties in a single or staged manner to correct extremity constriction bands.

Methods:
Seven patients with 10 involved extremities were included in this retrospective case series. Patient demographics, associated abnormalities, and operative indications were collected from medical records. The primary outcome measures were primary wound healing and release of the constriction band. Secondary outcomes measures were perioperative complications and the need for revision surgery.

Results:
All patients achieved primary closure with excellent healing in one or two stages. No infections or scar complications occurred, and no revision surgery of the band was required. One patient had mild indentation of scar tissue after their second stage, which improved with scar massage. One patient who had preoperative sciatic compression neuropathy and an insensate foot secondary to band constriction developed chronic calcaneal osteomyelitis requiring a subsequent Syme amputation. Postoperative lymphedema occurred in two patients, which resolved with the use of compression bandages over several weeks.

Conclusion:
Use of multiple continuous opposing Y-to-V–plasties is a safe and effective technique for adequate constriction band excision without residual hourglass deformity and good functional outcomes for patients with partial or circumferential constriction bands.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Comparison of HIV-Infected and Noninfected Patients Undergoing Bariatric Surgery: The ObeVIH Study
Authors: Pourcher V. , Capeau J. , Dudoit Y. , Boccara F. , Soulié C. , Ndoadoumgue A.L. , Charlotte F. , Fellahi S. , Bastard J. P. , Béréziat V. , Lagathu C. , Marcelin A. G. , Peytavin G. , Boutron-Ruault M. C. , Tubbax C. , D'Avout D'Auerstaedt A. , Valantin M. A. , Schneider L. , Costagliola D. , Katlama C. , Assoumou L. , Pourcher G. 
Published: February 2022

Objective:
The aim of this study was to compare clinical characteristics and adipose/liver tissue histology analysis in HIV-infected and HIV-uninfected subjects undergoing bariatric surgery.

Design:
This was a cross-sectional study of HIV-infected subjects undergoing single-port sleeve gastrectomy with prospective enrolment and frequency age (±5 years), sex, and body mass index (BMI, ± 5 kg/m2) matched on HIV-uninfected subjects.

Methods:
This study was conducted at a single clinical site at Pitié-Salpêtrière hospital-Paris-France comprising 19 HIV-uninfected and 21 HIV-infected subjects with plasma VL < 20 copies/mL, all with a BMI > 40 kg/m2 or >35 kg/m2 with comorbidities. Histology of subcutaneous and visceral abdominal adipose tissue (SCAT/VAT) and liver biopsies was collected during single-port sleeve gastrectomy. Outcomes included anthropometric characteristics, comorbidities, cardiovascular parameters, adipose tissue, and liver histology.

Results:
The age of HIV-infected participants was (median, interquartile range IQR) 48 y (42–51), with 76.2% females, a BMI of 41.4 kg/m2 (37.3–44.4), an antiretroviral duration of 16 y (8–21), current integrase strand transfer inhibitor (INSTI)-based regimen in 15 participants and non-INSTI regimen in 6 participants, and a CD4 count of 864/mm3 (560–1066). The age of controls was 43 y (37–51), with 78.9% females and a BMI of 39.2 kg/m2 (36.3–42.6). Anthropometric characteristics, comorbidities, and cardiovascular parameters did not differ according to HIV status and INSTI treatment. The number of macrophage crown-like structures in SCAT was lower in INSTI-treated participants than in HIV-uninfected participants (P = 0.02) and non–INSTI-treated HIV-infected subjects (P = 0.07). Hepatic steatosis and liver disease severity global score were lower in INSTI-treated participants than in non–INSTI-treated HIV-infected participants (P = 0.05 and P = 0.04, respectively).

Conclusions:
HIV-infected and HIV-uninfected subjects undergoing bariatric surgery presented a similar profile regarding anthropometric measures, cardiovascular parameters, and comorbidities. However, INSTI-treated participants presented milder SCAT and liver alterations than non–INSTI-treated participants.
Diabetes mellitus self-management education at Jimma University Medical Center: evidence-based implementation project
Authors: Berhanu Hiwot , Feyissa Garumma Tolu , Geleta Daniel , Sudhakar Morankar 
Published: February 2022

ABSTRACT

Background:
Low and middle-income countries are currently enduring the heaviest global burden of diabetes and diabetes-related mortalities. Diabetes self-management education (DSME) improves patient clinical outcomes, health status, and quality of life. Lack of awareness about best practice guidelines and recommendations may be associated with increased risk of diabetes morbidity and mortality.

Objectives:
The objective of this study was to improve knowledge and skill of healthcare providers and patients with diabetes by enhancing evidence-based practice through self-management education to increase compliance with best practice recommendations.

Methods:
JBI's three-phase Practical Application of Clinical Evidence System and Getting Research into Practice audit criteria of diabetes of audit management criteria were used. To understand barriers, 12 audit criteria, patient's medical record handling and educational plan according to set standards were evaluated. To mitigate the barriers, strategies of training and supportive supervision on evidence-based DSME were implemented from 20 April 2018 to 7 June 2018. Sixteen health professionals and 80 patients with diabetes participated in the study conducted in Jimma University Medical Center. Both a baseline and follow-up audit was conducted using the JBI feedback tool.

Result:
The baseline audit results indicate that 3 of the 12 audit criteria recorded zero percent compliance, whereas other compliances were below 40%, representing poor compliance with the current evidence. The post implementation audit reported 100% compliance for criteria on availability of structured education plan, existence of appropriate training for staff, the presence of education regarding nutrition and medications, while for the remaining criteria on competency of staff members for delivering DSME, assessment of prior diabetes knowledge, status of documentation after each session, and the presence of appropriate referrals or booking the compliance rate was improved to 88%. Similarly, criteria on the presence of individualized education plan improved (0–75%), encountering knowledge regarding physical activity (6–75%), self-monitoring of blood glucose (4–60%), and prevention diabetes complications (10–90%).

Conclusion:
There were remarkable changes in both patients and care providers on comparison of pre-intervention and post-intervention, particularly in availability of materials, involvement of staff in self-management education, nutrition, and medication.
Temporal variation may have diverse impacts on range limits
Authors: Holt Robert D. , Barfield Michael , Peniston James H. 
Published: February 2022

Environmental fluctuations are pervasive in nature, but the influence of non-directional temporal variation on range limits has received scant attention. We synthesize insights from the literature and use simple models to make conceptual points about the potentially wide range of ecological and evolutionary effects of temporal variation on range limits. Because organisms respond nonlinearly to environmental conditions, temporal variation can directionally alter long-term growth rates, either to shrink or to expand ranges. We illustrate this diversity of outcomes with a model of competition along a mortality gradient. Temporal variation can permit transitions between alternative states, potentially facilitating range expansion. We show this for variation in dispersal, using simple source–sink population models (with strong Allee effects, or with gene flow hampering local adaptation). Temporal variation enhances extinction risk owing to demographic stochasticity, rare events, and loss of genetic variation, all tending to shrink ranges. However, specific adaptations to exploit variation (including dispersal) may permit larger ranges than in similar but constant environments. Grappling with temporal variation is essential both to understand eco-evolutionary dynamics at range limits and to guide conservation and management strategies.This article is part of the theme issue ‘Species’ ranges in the face of changing environments (Part II)’.
A review on trade-offs at the warm and cold ends of geographical distributions
Authors: Willi Yvonne , Van Buskirk Josh 
Published: February 2022

Species’ range limits are ubiquitous. This suggests that the evolution of the ecological niche is constrained in general and at the edges of distributions in particular. While there may be many ecological and genetic reasons for this phenomenon, here we focus on the potential role of trade-offs. We performed a literature search on evidence for trade-offs associated with geographical or elevational range limits. The majority of trade-offs were reported as relevant at either the cold end of species' distribution (n= 19), the warm or dry end (n= 19) or both together (n= 14). One common type of trade-off involved accelerating growth or development (27%), often at the cost of small size. Another common type involved resistance to or tolerance of climatic extremes that occur at certain periods of the year (64%), often at the cost of small size or reduced growth. Trade-offs overlapped with some of the classic trade-offs reported in life-history evolution or thermal adaptation. The results highlight several general insights about species' niches and ranges, and we outline how future research should better integrate the ecological context and test for the presence of microevolutionary trade-offs.This article is part of the theme issue ‘Species’ ranges in the face of changing environments (Part II)’.
Detailed Clinical and Functional Studies of New MTOR Variants in Smith-Kingsmore Syndrome Reveal Deficits of Circadian and Sleep Homeostasis
Authors: Liu Andrew C. , Shen Yang , Roman Destino , He Hongzhi , Serbinski Carolyn R. , Aschbacher-Smith Lindsey , King Katherine A. , Granadillo Jorge L. , López Isabel , Krueger Darcy A. , Dye Thomas J. , Smith David F. , Hogenesch John B. , Prada Carlos E. 
Published: February 2022

ABSTRACTHeterozygous de novo or inherited gain-of-function mutations in the MTOR gene cause Smith-Kingsmore Syndrome (SKS). SKS is a rare autosomal dominant condition, and individuals with SKS display macrocephaly/megalencephaly, developmental delay, intellectual disability, and seizures. A few dozen individuals are reported in the literature. Here, we report a cohort of 28 individuals with SKS that represent 9 new MTOR pathogenic variants, including p.R1480_C1483del or Δ(R1480-C1483). We conducted a detailed natural history study on these patients and found prevalent pathophysiological deficits among SKS individuals, in addition to the common neurodevelopmental symptoms. The new symptoms include sleep-wake disturbance, hyperphagia, and hyperactivity, which are indicative of homeostatic imbalance. To better characterize SKS variants, we developed MTOR mutant cellular models and performed biochemical and cellular circadian rhythm assays to study the variants. We showed that these SKS alleles display a range of MTOR activities under nutrient-deficient basal conditions and respond to MTOR inhibitors differently. For example, Δ(R1480-C1483) is more active than the classic SKS variant C1483F and less responsive to MTOR inhibition by rapamycin. Further, we showed that optimal MTOR activity, important for metabolic and protein homeostasis, is required for normal circadian function. These data can help guide treatment strategies. As SKS is caused by gain of function mutations in MTOR, we used rapamycin to treat several patients. While higher doses caused delayed sleep-wake phase disorder, lower doses improved not only sleep but also aggression and repetitive behaviors. Thus, our study expands both the clinical and molecular spectrum of SKS and offers treatment options guided by molecular and sleep/wake data to improve both cognitive and non-cognitive homeostatic functions.
COVID-19 Surveillance in the Biobank at the Colorado Center for Personalized Medicine
Authors: Johnson Randi K. , Marker Katie M. , Mayer David , Shortt Jonathan , Kao David , Barnes Kathleen C. , Lowery Jan T. , Gignoux Christopher R. 
Published: February 2022

ABSTRACTBackgroundCharacterizing the experience and impact of the COVID-19 pandemic among various populations remains challenging due to the limitations inherent in common data sources such as the electronic health record (EHR) or convenience sample surveys.ObjectiveTo describe testing behaviors, symptoms, impact, vaccination status and case ascertainment during the COVID-19 pandemic using integrated data sources.MethodsIn summer 2020 and 2021, we surveyed participants enrolled in the Biobank at the Colorado Center for Personalized Medicine (CCPM, N = 180,599) about their experience with COVID-19. Prevalence of testing, symptoms, and the impacts of COVID-19 on employment, family life, and physical and mental health were calculated overall and by demographic categories. Using the Electronic Health Record (EHR), we compared COVID-19 case ascertainment and characteristics in the EHR versus the survey.ResultsOf the 25,063 survey respondents (13.9%), 42.5% had been tested for COVID-19 and of those, 12.8% tested positive. Nearly half of those tested had symptoms and/or had been exposed to someone who was infected. Young adults (18-29 years) and Hispanics were more likely to have positive tests compared to older adults and persons of other racial/ethnic groups. Mental health (54.6%) and family life (48.8%) were most negatively affected by the pandemic and more so among younger groups and women; negative impacts on employment were more commonly reported among Black respondents. After integration with EHR data up to the time of the survey completion, 4.0% of survey respondents (n=1,006) had discordant COVID-19 case status between the EHR and the survey. Using all longitudinal EHR and survey data, we identified 11,472 COVID-positive cases among Biobank participants (6.4%). In comparison to COVID-19 cases identified through the survey, EHR-identified cases were younger and more likely to be Hispanic.ConclusionsIntegrated data assets such as the Biobank at the CCPM are key resources for population health monitoring in response to public health emergencies, such as the COVID-19 pandemic.