bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative evaluation of retinal and choroidal vascularity and retrobulbar blood flow in patients with myopic anisometropia by CDI and OCTA
Authors: Liu Fang , Niu Lingling , Guo Jie , Jian Weijun , Shang Jianmin , Zhao Jing , Xue Kang , Zhou Xingtao 
Published: May 2022

AimsTo investigate the association between the myopic severity and retinal microvascular density, choroidal vascularity and retrobulbar blood flow in adult anisomyopes.MethodsThis study comprised 90 eyes of 45 myopic anisomyopes who were recruited for Colour Doppler imaging (CDI) and optical coherence tomography angiography (OCTA). The superficial vessel density (SVD), deep vessel density (DVD), choroidal thickness (ChT) and choroidal vascularity, including total choroidal area (TCA), luminal area (LA), stromal area (SA) and Choroidal Vascularity Index (CVI), were measured using OCTA. Moreover, the Pulsatile Index, peak systolic velocity (PSV) and end diastolic velocity (EDV) of posterior ciliary artery (PCA), central retinal artery (CRA) and ophthalmic artery (OA) were quantified by CDI, and all parameters were compared between two eyes and the correlations among parameters were analysed.ResultsThe mean difference of spherical equivalent (SE) and axial lengths (AL) between eyes were −6.00±2.94 D and 2.48±1.31 mm, respectively. The SVD, DVD, ChT, TCA, LA, SA and CVI were significantly lower in more myopic eyes compared with the contralateral eyes. In more myopic eyes, CDI parameters of CRA and PSV and EDV of PCA were also significantly lower. After adjusting for age and sex, the binocular asymmetry in LA and ChT was independent risk factor affecting interocular difference in both AL and SE.ConclusionRetinal microvascular density, choroidal vascularity and retrobulbar blood flow were simultaneously lower in adult myopic anisomyopes with more myopic eyes and disturbed choroid circulation was related to the severity of myopia. Further longitudinal study was helped to identify the effect of choroidal parameters for myopic progression.
Validation of the RCOphth and UKEGS glaucoma risk stratification tool ‘GLAUC-STRAT-fast’
Authors: Konstantakopoulou Evgenia , Kastner Alan , Gazzard Gus , Jayaram Hari 
Published: May 2022

Background/aimsThe aim of this study was to validate the Glaucoma Risk Stratification Tool (GLAUC-STRAT-fast) currently recommended by the Royal College of Ophthalmologists for the risk stratification of patients with glaucoma in the UK National Health Service Hospital Eye Service.MethodsGLAUC-STRAT fast was applied to the LiGHT trial participants by risk-stratifying the worse eye of each patient at baseline and after 3 years of treatment. Metrics of disease severity or treatment intensity used for the validation were: increased number of monitoring visits or treatment escalations; needing a trabeculectomy; a reduction of >2 dB in visual field mean deviation (VF MD) during the monitoring period; identification of rapid VF loss on total (TD) and/or pattern deviation (PD). The proportion of eyes within each baseline stratum for each of the above markers was compared against the other strata, using a χ2test for proportions.ResultsThere was an association between the baseline stratification and the number of treatment escalations needed to maintain the eye-specific target intraocular pressure (p=0.001), the number of visits needed throughout the 3-year follow-up period (p=0.001), the need for trabeculectomy (p<0.001) and absolute loss of MD over the course of the monitoring period (p<0.001). The rate of VF progression was not associated with baseline risk stratification for TD or PD progression (p≥0.007, with Bonferroni correction).ConclusionThe GLAUC-STRAT fast tool is a useful tool for risk stratifying eyes with ocular hypertension or open angle glaucoma. Further research is needed to confirm and validate its applicability to more advanced glaucomas and generalisability to clinical use.Trial registration numberThe LiGHT trial is registered at controlled-trials.com (ISRCTN32038223).
Association between vision impairment and depression: a 9-year, longitudinal, nationwide, population-based cohort study in South Korea
Authors: Seong Hyo Jin , Kim Jiwon , Yook Tae Mi , Lee Deokjong , Chung Eun Jee 
Published: May 2022

Background/AimsVision impairment (VI) increases the risk of various comorbidities, including depression. However, the relationship between depression and VI is unclear, and existing findings are inconsistent. We therefore investigated the risk of depression in adults before and after their registration as visually impaired.MethodsIn this longitudinal, nationwide, retrospective cohort study, 131 434 patients (aged ≥18 years) with newly registered VI during 2005–2013 were evaluated using the Korean National Health Insurance Service database. Using 1:1 propensity score matching, randomly selected patients (control group) were compared with patients with VI (patient group) according to age, sex, residential area and household income. Each patient was tracked from 3 years before and 5 years after registration. The risk of depression before and after VI registration was evaluated using a conditional logistic regression model.ResultsThe risk of depression gradually increased from 3 years before registration (OR, 1.186; 95% CI 1.089 to 1.290), then peaked at the time of registration (OR, 1.925; 95% CI 1.788 to 2.073), and then gradually decreased until 5 years after registration (OR, 1.128; 95% CI 1.046 to 1.216). Male patients, those with severe VI and those aged 18–29 years had a higher risk of depression.ConclusionsPatients with VI had an increased risk of depression from 3 years before to 5 years after registration. Significant risk factors included severity, male sex and younger age. Thus, public mental health services are necessary to provide appropriate support and interventions to people before and after registration as visually impaired.
Cardiovascular morbidity and all-cause mortality in patients with retinal vein occlusion: a Danish nationwide cohort study
Authors: Frederiksen Katrine Hartmund , Stokholm Lonny , Frederiksen Peter Hartmund , Jørgensen Christina Mørup , Möller Sören , Kawasaki Ryo , Peto Tunde , Grauslund Jakob 
Published: May 2022

Background/aimsAssociations between retinal vein occlusion (RVO) and subsequent cardiovascular disease (CVD) or mortality have not been evaluated in a recent cohort, after novel therapeutic options have increased referrals for treatment of the condition. We aimed to evaluate overall and subtype-stratified risk of CVD and all-cause mortality following RVO and assess any alterations after the introduction of angiostatic therapy in Denmark in 2011.MethodsThis nationwide, registry-based cohort study from 1998 to 2018 evaluated 4 194 781 individuals. Hazard ratios (HRs) were reported for RVO as an overall measure and subclassified as branch and central RVO.ResultsPatients with RVO (n=15 665) were median 71.8 years old at the time of exposure and 50.7% were women. RVO associated with incident CVD (adjusted HR 1.13, 95% CI 1.09 to 1.17) but not mortality (adjusted HR 1.00, 95% CI 0.97 to 1.03). Almost similar risks of CVD were found for patients with branch and central RVO (adjusted HRs 1.14, 95% CI 1.03 to 1.25, and 1.12, 95% CI 1.00 to 1.25, respectively), but only patients with central RVO exhibited increased mortality (adjusted HR 1.12, 95% CI 1.04 to 1.21). Risk of CVD, especially non-ischaemic, was higher for patients diagnosed after 2011 (adjusted HRs 1.24, 95% CI 1.15 to 1.33 vs 1.06, 95% CI 1.01 to 1.12).ConclusionIn a cohort of the Danish population aged 40 years or more, patients with RVO had a 13% increased risk of incident CVD compared with unexposed individuals. Risk of CVD was increased after 2011, when intravitreal angiostatic treatment was introduced and referral practices altered.
Dapagliflozin protects neural and vascular dysfunction of the retina in diabetes
Authors: Luo Qianyi , Leley Sameer P , Bello Erika , Dhami Hurshdeep , Mathew Deepa , Bhatwadekar Ashay Dilip 
Published: May 2022

IntroductionDapagliflozin, a sodium-glucose transporter inhibitor, effectively reduces blood glucose and is indicated for individuals with kidney diseases and cardiovascular disorders. In this study, we further expand the therapeutic benefit of dapagliflozin in the neural and vascular retina, with the potential to effectively manage diabetic retinopathy (DR), the most common complication of diabetes.Research design and methodsDb/db mice, an animal model of type 2 diabetes, were treated with dapagliflozin orally, and the electroretinogram (ERG) response and acellular capillary numbers were assessed. Messenger RNA levels of inflammatory cytokines were studied using real-time quantitative (q)PCR. We assessed endothelial cell migration in a scratch wound assay and retinal glucose uptake using human retinal endothelial cells.ResultsThe dapagliflozin treatment improved the ERG b-wave amplitude and decreased acellular capillary numbers. The scratch wound assay demonstrated a reduction in wound closure after dapagliflozin treatment. Retinal glucose uptake reduced after dapagliflozin treatment compared with the respective controls.ConclusionsOur studies suggest that dapagliflozin treatment effectively corrects neural and vascular dysfunction of the retina in diabetes. This effect is mediated by a decrease in inflammation and improved glycemic control. In addition, dapagliflozin exhibits decreased wound healing and glucose uptake, which could benefit the retina. Thus, dapagliflozin could be helpful in the management of DR, with multimodal therapeutic effects.
COVID-19 and liver cancer: lost patients and larger tumours
Authors: Geh Daniel , Watson Robyn , Sen Gourab , French Jeremy J , Hammond John , Turner Paul , Hoare Tim , Anderson Kirsty , McNeil Michael , McPherson Stuart , Masson Steven , Dyson Jessica , Donnelly Mhairi , MacDougal Louise , Patel Preya , Hudson Mark , Anstee Quentin M , White Steven , Robinson Stuart , Pandanaboyana Sanjay , Walker Lucy , McCain Misti , Bury Yvonne , Raman Shreya , Burt Alastair , Parkinson Daniel , Haugk Beate , Darne Antony , Wadd Nick , Asghar Syed , Mariappan Lavanya , Margetts Jane , Stenberg Benjamin , Scott John , Littler Peter , Manas Derek M , Reeves Helen L 
Published: May 2022

BackgroundNorthern England has been experiencing a persistent rise in the number of primary liver cancers, largely driven by an increasing incidence of hepatocellular carcinoma (HCC) secondary to alcohol-related liver disease and non-alcoholic fatty liver disease. Here we review the effect of the COVID-19 pandemic on primary liver cancer services and patients in our region.ObjectiveTo assess the impact of the COVID-19 pandemic on patients with newly diagnosed liver cancer in our region.DesignWe prospectively audited our service for the first year of the pandemic (March 2020–February 2021), comparing mode of presentation, disease stage, treatments and outcomes to a retrospective observational consecutive cohort immediately prepandemic (March 2019–February 2020).ResultsWe observed a marked decrease in HCC referrals compared with previous years, falling from 190 confirmed new cases to 120 (37%). Symptomatic became the the most common mode of presentation, with fewer tumours detected by surveillance or incidentally (% surveillance/incidental/symptomatic; 34/42/24 prepandemic vs 27/33/40 in the pandemic, p=0.013). HCC tumour size was larger in the pandemic year (60±4.6 mm vs 48±2.6 mm, p=0.017), with a higher incidence of spontaneous tumour haemorrhage. The number of new cases of intrahepatic cholangiocarcinoma (ICC) fell only slightly, with symptomatic presentation typical. Patients received treatment appropriate for their cancer stage, with waiting times shorter for patients with HCC and unchanged for patients with ICC. Survival was associated with stage both before and during the pandemic. 9% acquired COVID-19 infection.ConclusionThe pandemic-associated reduction in referred patients in our region was attributed to the disruption of routine healthcare. For those referred, treatments and survival were appropriate for their stage at presentation. Non-referred or missing patients are expected to present with more advanced disease, with poorer outcomes. While protective measures are necessary during the pandemic, we recommend routine healthcare services continue, with patients encouraged to engage.
Prevalence, severity, duration and resolution of cholestasis after acute liver failure
Authors: Warming Scott , Michel Claire , Serpa Neto Ary , Kishore Kartik , Marhoon Nada , Holmes Natasha , Bellomo Rinaldo , Testro Adam , Sinclair Marie , Gow Paul , Warrillow Stephen 
Published: May 2022

ObjectivePersistent cholestasis may follow acute liver failure (ALF), but its course remains unknown. We aimed to describe the prevalence, onset, severity, duration and resolution of post-ALF cholestasis.DesignCohort of 127 adult patients with ALF at a liver transplantation centre identified using electronic databases. We obtained laboratory data every 6 hours for the first week, daily until day 30 and weekly, when documented, until day 180.ResultsMedian age was 40.7 (IQR 31.0–52.4) years, median peak alanine aminotransferase level was 5494 (2521–8819) U/L and 87 (68.5%) cases had paracetamol toxicity. Overall, 12.6% underwent transplantation (3.4% for paracetamol vs 32.5% for non-paracetamol; p<0.001). Ninety-day mortality was 20.7% for paracetamol versus 30.0% for non-paracetamol patients. All non-transplanted survivors reached a bilirubin level>50 µmol/L, which peaked 3.5 (1.0–10.1) days after admission at 169.0 (80.0–302.0) µmol/L. At hospital discharge, 18.8% of patients had normal bilirubin levels and, at a median follow-up time from admission to last measurement of 16 (10-30) days, 46.9% had normal levels. Similarly, there was an increase in alkaline phosphatase (ALP) (207.0 (148.0–292.5) U/L) and gamma-glutamyl transferase (GGT) (336.0 (209.5–554.5) U/L) peaking at 4.5 days, with normalised values in 40.3% and 8.3% at hospital discharge.ConclusionPost-ALF cholestasis is ubiquitous. Bilirubin, ALP and GGT peak at 3 to 5 days and, return to baseline in the minority of patients at median follow-up of 16 days. These data inform clinical expectations of the natural course of this condition.
Approaching healthcare delivery through a new lens: a crowdsourcing challenge to identify health-related social innovations to increase universal health coverage in Nigeria
Authors: Ekwunife Obinna Ikechukwu , Onubogu Chinyere Ukamaka , Aribodor Ogechukwu Benedicta , Anigbogu Kingsley Chike , Ogwaluonye Uchenna Chukwunonso , Ekwunife Chinyelu Angela , Okunna Chinyere Stella , Nwaorgu Obioma 
Published: May 2022

BackgroundNigeria, the most populous country in Africa, is faced with several health challenges including neglected tropical diseases, non-communicable diseases and emerging infectious diseases. Unfortunately, the country has a weak health system to tackle these health challenges. Creative solutions for solving these systemic health challenges through social innovations are therefore needed in Nigeria. Hence, Social Innovation in Health Initiative (SIHI) Nigeria conducted a pilot crowdsourcing challenge to identify social innovation solutions in Anambra State, Nigeria.MethodA crowdsourcing approach was used to identify social innovations in healthcare delivery that has been applied in Nigeria for a minimum of 1 year. The six-stage process of the crowdsourcing challenge contest included: (1) selection of challenge focus, (2) organising community steering group, (3) engaging the community to contribute, (4) receiving and evaluating contributions, (5) recognising finalists and (6) sharing solutions. The crowdsourcing challenge was hosted by SIHI Nigeria, based at the Nnamdi Azikiwe University, Awka, Nigeria.ResultSeventeen innovations were received in the crowdsourcing challenge. Five of the innovations were eligible based on criteria developed and were sent to the panel of experts for review. Following the review of the average score and case study research, the panel of experts selected top three innovations, which included a digital health solution, a mobile clinic and a community-based health insurance programme.ConclusionTop three social innovations were identified in the crowdsourcing challenge. These innovations could be refined and scaled up to increase universal health coverage in Nigeria by subjecting them to further research.
Thoracic spinal anaesthesia for abdominal surgery in a humanitarian military field hospital: a prospective observational study
Authors: Aissaoui Younes , Bahi M , El Khader A , El Barni R , Belhadj A 
Published: May 2022

BackgroundProviding safe and effective anaesthesia in the context of humanitarian medicine is always a challenging situation. Spinal anaesthesia, and in particular its thoracic approach, represents a promising technique for such a limited-resource environment. This prospective observational study investigated the feasibility of thoracic spinal anaesthesia (TSA) for abdominal surgery in a field-deployed military hospital.Materials and methodsWe included adults scheduled for elective open cholecystectomy in a field hospital. Patients received TSA at the T9–T10 level. The primary outcomes were the feasibility of surgery under TSA and the haemodynamic/respiratory stability of this anaesthetic technique. The secondary outcomes included patient satisfaction and surgeon comfort regarding the anaesthesia technique and postoperative events (nausea and vomiting, urinary retention, postdural puncture headache).ResultsSurgery was performed successfully in 61 patients under TSA (90% female, 53±13 years old). Intraoperative pain scores were low, with a median Numeric Rating Scale score of 0 (IQR 0–2). Surgeon and patient satisfaction scores were excellent. The haemodynamic and respiratory parameters remained stable throughout the surgery. The incidence of postoperative events was low (nausea/vomiting=8%). None of our patients presented with postdural puncture headache or urinary retention.ConclusionTSA could be an effective anaesthetic technique for abdominal surgery in the context of a field hospital or austere environment.
Non-invasive ventilation for acute hypoxaemic respiratory failure: a propensity-matched cohort study
Authors: Jayasimhan Dilip , Martynoga Robert Adam , Fairweather Sarah M , Chang Catherina L 
Published: May 2022

BackgroundNon-invasive ventilation (NIV), although effective in treating hypercapnic respiratory failure, has not demonstrated the same efficacy in treating acute hypoxaemic respiratory failure. We aimed to examine the effect of NIV use on ventilator-free days in patients with acute hypoxaemic respiratory failure admitted to the intensive care unit (ICU).MethodsWe conducted a retrospective study of patients admitted to the ICU with acute hypoxaemic respiratory failure at Waikato Hospital, New Zealand, from 1 January 2009 to 31 December 2018. Patients treated with NIV as the initial oxygenation strategy were compared with controls treated with early intubation. The two groups were matched using a propensity score based on baseline characteristics. The primary outcome was the number of ventilator-free days at day 28. The secondary outcomes were ICU and hospital length of stay and in-hospital mortality.ResultsOut of 175 eligible patients, 79 each out of the NIV and early intubation groups were matched using a propensity score. Early NIV was associated with significantly higher median ventilator-free days than early intubation (17 days vs 23 days, p=0.013). There was no significant difference in median ICU length of stay (112.5 hours vs 117.7 hours), hospital length of stay (14 days vs 14 days) or in-hospital mortality (31.6% vs 37.9%) between the NIV and the early intubation group.ConclusionCompared with early intubation, NIV use was associated with more ventilator-free days in patients with hypoxaemic respiratory failure. However, this did not translate into a shorter length of stay or reduced mortality based on our single-centre experience.
Functional status recovery trajectories in hospitalised older adults with pneumonia
Authors: Park Chan Mi , Dhawan Ravi , Lie Jessica J , Sison Stephanie M , Kim Wonsock , Lee Eun Sik , Kim Jong Hun , Kim Dae Hyun 
Published: May 2022

Background and objectivesPneumonia is associated with significant mortality and morbidity in older adults. We investigated changes in functional status over 6 months after pneumonia hospitalisation by frailty status.Methods and measurementsThis single-centre prospective cohort study enrolled 201 patients (mean age 79.4, 37.3% women) who were hospitalised with pneumonia. A deficit-accumulation frailty index (range: 0–1; robust <0.15, pre-frail 0.15–0.24, mild-to-moderately frail 0.25–0.44, severely frail ≥0.45) was calculated on admission. Functional status, defined as self-reported ability to perform 21 activities and physical tasks independently, was measured by telephone at 1, 3 and 6 months after discharge. Group-based trajectory model was used to identify functional trajectories. We examined the probability of each trajectory based on frailty levels.ResultsOn admission, 51 (25.4%) were robust, 43 (21.4%) pre-frail, 40 (20.0%) mild-to-moderately frail and 67 (33.3%) severely frail patients. Four trajectories were identified: excellent (14.4%), good (25.4%), poor (28.9%) and very poor (31.3%). The trajectory was more strongly correlated with frailty level on admission than pneumonia severity. The most common trajectory was excellent trajectory (59.9%) in robust patients, good trajectory (74.4%) in pre-frail patients, poor trajectory (85.0%) in mild-to-moderately frail patients and very poor trajectory (89.6%) in severely frail patients. The risk of poor or very poor trajectory from robust to severely frail patients was 11.8%, 25.6%, 92.5% and 100%, respectively.ConclusionsFrailty was a strong determinant of lack of functional recovery over 6 months after pneumonia hospitalisation in older adults. Our results call for hospital-based and post-acute care interventions for frail patients.
Modelling the potential spread of virus during soccer matches
Authors: Knudsen Nikolas Sten , Thomasen Manuel Mounir Demetry , Andersen Thomas Bull 
Published: May 2022

ObjectiveIn the present study, we model the potential spread of virus during soccer matches.MethodsTracking data from 14 elite soccer matches was used. One player in each match was designated as a virus carrier (called ‘infected player’) for the purpose of the study. The exposure score (measured in seconds) was calculated as time spent closer than 1.5 m from the infected player or time spent in an exponentially declining zone, where the infected player was positioned earlier.ResultsThe results revealed that, on average, each player was exposed for 87.8 s per match.ConclusionPotential spread of virus during soccer matches was modelled and it revealed that the exposure to a virus during soccer matches is limited.