University-based Tertiary Hospital Research Articles

Measuring patient-reported distress from breast magnetic resonance imaging: Development and validation of the MRI-related distress scale (MRI-DS).

Although breast magnetic resonance imaging (MRI) is a valuable screening tool, breast MRI testing burden was associated with cancer worry and quality of life. We aimed to develop and validate the MRI-related distress scale (MRI-DS) to assess comprehensive distress specifically related to breast MRI. We enrolled women aged above 18 years, diagnosed breast cancer, had MRI examination at least one time, and who could speak and read Korean in phase I and enrolled women aged above 18 years, visited outpatient clinic of breast general surgery, had undergone MRI examination at least once, and could speak and read Korean in phase II. We excluded patients who had any physical or psychiatric conditions in both phases. We recruited from a tertiary university-based hospital in South Korea between April and August 2023. All 18 items had acceptable levels of item correlation (≥0.30) in the explanatory factor analysis with a four-factor solution. The fit indices for the four-factor solution model were good. The discriminant validity of the MRI-DS had a moderate correlation with general anxiety or quality of life. In the known-group analysis, those who reported MRI as the most burden breast examination had higher total scores. The validity of the MRI-DS has been confirmed as a scale for measuring the specific distress caused by breast MRI. The MRI-DS is recommended to health professional to communicate with patients with MRI. It can be used to assess the distress associated with MRI screening in breast cancer patients. Physician could use MRI-DS to discuss the reasons for distress caused by breast MRI screening and to address specific sources of discomfort associated with it.

Utility and performance of cell blocks in cerebrospinal fluid cytology: Experience at two teaching hospitals.

Cytology cell blocks (CBs) are not routinely made for cerebrospinal fluid (CSF) specimens. The goal of this study was to identify when CSF CB preparation improves diagnostic performance. Under institutional review board approval, a retrospective review of CSF cytology cases was conducted at a tertiary university-based hospital and an affiliated county hospital. Patient history, CSF volume, final diagnosis, use of stains, and whether the CB was contributory was determined from the cytopathology report. CSF nucleated cell count data was obtained from the medical record. A total of 69 CSF specimens with CBs from January 2006 to March 2023 were identified from 61 patients. The median CSF volume was 8mL (interquartile range, 4-13mL; range, 1-800mL), with immunohistochemical stains performed on 29 (42%) cases. Per cytology report, CB was contributory in 23 cases (33%), not contributory in 34 cases (49%), and not discussed in 12 cases (17%). The median volume was 8mL for cases in which CB was contributory, not contributory, or not discussed. There was no difference in average nucleated cell counts between cases in which CB was contributory versus not contributory (73.9 vs. 40.0, p=.175). CBs for CSF samples were contributory in a subset (33%) of cases. The authors were unable to identify any specific pre-analytic factors, including specimen volume and average nucleated cell counts, for cases in which CB was contributory. Further evaluation is needed to identify if there are scenarios in which CSF CBs should be routinely prepared.

Psychometric validation of the Functional Assessment of Cancer Therapy-Endometrial among endometrial cancer patients.

To evaluate a psychometric validation of the endometrial cancer subscales (EnCS) in the Functional Assessment of Cancer Therapy-Endometrial (FACT-EN) among patients with endometrial cancer. This cross-sectional study was conducted at a tertiary university-based hospital in South Korea between April and October 2022. Participants completed a survey questionnaire that included the FACT-EN. Exploratory and confirmatory factor analyses (EFA, CFA) and the reliability were measured using the intraclass correlation coefficient (ICC) under a two-way mixed model. Pearson's correlations were used to evaluate the validity. We also tested known-group validity. In total, 240 patients with endometrial cancer participated in the survey. In EFA, we found EnCS included four domains. In CFA, four-factor solution model was good: CFI = 0.659; SRMR = 0.066, and RMSEA = 0.073. The mean (SD) of total score of FACT-EN was 122.84 (23.58). The floor and ceiling effects were 0.4% and 0.4%, respectively. Cronbach's α coefficients for the five scales of the EnCS ranged from 0.78 to 0.91. The ICC of EnCS was 0.76. The convergent and discriminant validity of EnCS was acceptable. In the group analysis, older age and lower ECOG performance scores were associated with higher EnCS scores. The stomach and vaginal domains in EnCS were higher in patients who had completed treatment for more than 1 year compared to those who were still undergoing treatment. FACT-EN has demonstrated its validity as an assessment tool with significant implications for capturing various symptoms in patients with endometrial cancer.

Adherence to lung protective mechanical ventilation in patients admitted to a surgical intensive care unit and the associated increased mortality

BackgroundThe adherence rate to the lung protective ventilation (LPV) strategy, which is generally accepted as a standard practice in mechanically ventilated patients, reported in the literature is approximately 40%. This study aimed to determine the adherence rate to the LPV strategy, factors associated with this adherence, and related clinical outcomes in mechanically ventilated patients admitted to the surgical intensive care unit (SICU). MethodsThis prospective observational study was conducted in the SICU of a tertiary university-based hospital between April 2018 and February 2019. Three hundred and six adult patients admitted to the SICU who required mechanical ventilation support for more than 12 h were included. Ventilator parameters at the initiation of mechanical ventilation support in the SICU were recorded. The LPV strategy was defined as ventilation with a tidal volume of equal or less than 8 ml/kg of predicted body weight plus positive end-expiratory pressure of at least 5 cm H2O. Demographic and clinical data were recorded and analyzed. ResultsThere were 306 patients included in this study. The adherence rate to the LPV strategy was 36.9%. Height was the only factor associated with adherence to the LPV strategy (odds ratio for each cm, 1.10; 95% confidence interval (CI), 1.06–1.15). Cox regression analysis showed that the LPV strategy was associated with increased 90-day mortality (hazard ratio, 1.73; 95% CI, 1.02–2.94). ConclusionThe adherence rate to the LPV strategy among patients admitted to the SICU was modest. Further studies are warranted to explore whether the application of the LPV strategy is simply a marker of disease severity or a causative factor for increased mortality.

Factors associated with the initial intracranial hemorrhage occurrence in patients with cerebral venous thrombosis

ObjectivesStudies focusing on intracranial hemorrhage (ICH) in patients with cerebral venous thrombosis (CVT) are limited; thus, we aimed to identify factors associated with the occurrence of ICH in Thai patients with CVT. MethodsThis retrospective cohort study recruited patients with CVT admitted to a tertiary university-based hospital between 2002 and 2022. The baseline characteristics, clinical presentations, radiographic findings, and etiologies were compared between the ICH and non-ICH groups. The factors with p < 0.2 in the univariate analysis were further analyzed using multivariable logistic regression analysis to identify independent factors associated with ICH in patients with CVT. ResultsOf 228 screenings, 202 patients were eligible. The incidence rate of ICH was 36.63%. The ICH group showed a higher prevalence of focal neurological deficits (63.51% vs. 26.56%, p < 0.001), seizures (68.92% vs. 21.88%, p < 0.001), dependency status at admission (60.81% vs. 39.84%, p = 0.004), superior sagittal sinus thrombosis (71.62% vs. 39.07%, p < 0.001), superficial cortical vein thrombosis (36.49% vs. 10.16%, p < 0.001), and hormonal use (17.57% vs. 7.03%, p = 0.021) than the non-ICH group. In contrast, the ICH group showed a lower prevalence of isolated increased intracranial pressure (10.81% vs. 21.88%, p = 0.048) than the non-ICH group. Seizures (adjusted odds ratio [aOR], 4.537; 95% confidence interval [CI], 2.085–9.874; p < 0.001), focal neurological deficits (aOR, 2.431; 95% CI, 1.057–5.593; p = 0.037), and superior sagittal sinus thrombosis (aOR, 1.922; 95% CI, 1.913–4.045; p = 0.045) were independently associated with ICH in the multivariable logistic regression analysis. ConclusionsSeizures, focal neurological deficits, and superior sagittal sinus thrombosis are associated with ICH in patients with CVT.

P-649 Circadian serum progesterone variations on the day of frozen embryo transfer in artificially prepared cycles

Abstract Study question What is the intra-day variation of serum progesterone related to vaginal progesterone administration on the day of frozen embryo transfer (FET) in an artificial cycle? Summary answer We observed a statistically significant intra-day variation of serum progesterone (P) levels on the day of FET in artificially prepared cycles (AC). What is known already The use of FET cycles has increased enormously. In an attempt to further optimize pregnancy outcomes after FET, recent studies have focused on the importance of correct serum luteal P levels in both natural and AC-FET cycles. Despite the different cut-off values proposed to define low serum P, it is generally accepted that lower serum P values(&amp;lt;8.8 ng/ml) around the day of FET are associated with lower live birth rates and higher miscarriage rates. However, a single luteal serum P measurement can be misleading given the diurnal variation and the impact of patient characteristics such as age, BMI, parity, ethnicity. Study design, size, duration A prospective cohort study was conducted at a tertiary university-based hospital encompassing twenty-two patients undergoing a single blastocyst transfer in an AC from August to December 2022. Sample size calculation was performed using a paired t-test resulting in twenty-two patients required to detect a difference of 15% between the first and the last daily progesterone value with a false-positive rate of 5%(two-sided),a power of 80%,assuming a standard deviation of change in the outcome of 0.250. Participants/materials, setting, methods Patients with a normal BMI,aged between 18 and 40 years old, were included. Endometrial preparation was achieved by administering estradiol valerate(6 mg/day) until an adequate endometrial thickness was reached. Consecutively, micronized vaginal progesterone(MVP, 800 mg/die) was started five days prior to blastocyst transfer. P levels were evaluated on the day of FET at 08:00h, 12:00h, 16:00h, and 20:00h. The first and last blood samples were collected just before the intake of MVP,at 8:00h and 20:00h. Main results and the role of chance Mean age of the study population was 33.95 ± 3.98 years and BMI 23.10 ± 1.95 kg/m2. Basal FSH was 7.84 ± 2.31 IU/L and estradiol concentration at 8:00h on the day of FET was 206.04 ± 93.32 ng/L. Mean P values at 08:00h, 12:00h, 16:00h and 20:00h were 11.72 ± 4.99 µg/L, 13.59 ± 6.33 µg/L, 10.23 ± 3.81 µg/L and 9.28 ± 3.09 µg/L,respectively. Statistically significant differences in P values were observed between measurements performed at 08:00h and 20:00h (p = 0,007), 8:00h and 12:00h(p &amp;lt; 0,001), 12:00h and 16:00h (p &amp;lt; 0,001), and 16:00h and 20:00h (p = 0,004). The proportion of patients encountering low P values, defined as P &amp;lt; 8.8 ng/ml, was 27,3% at 8:00h, 13,6% at 12:00h, 40,9% at 16:00h, and 36,4% at 20:00h. Moreover, the difference in patients with normal P values (&amp;gt; 8.8 ng/ml) was statistically significant between samples performed at 8:00h and 12:00h and 12:00h and 16:00h (p = 0.009 and p = 0.01 respectively). No difference was observed in normal P values between 16:00h and 20:00h(p = 0.3) and 8:00h and 20:00h(p = 0,07). Additionally, no association was found either between age and BMI and the first progesterone evaluation of the day, neither between these parameters and the difference in P levels between 8:00h and 20:00h. Limitations, reasons for caution The strict inclusion criteria applied in this study could potentially imply a bias when extrapolating the results to a wider infertile population undergoing AC-FET cycles. A confirmation of the findings in larger prospective studies including a more heterogeneous patient population is recommended. Wider implications of the findings The results of this study highlight the importance of a standardized procedure for the timing of progesterone measurements, partly taken into account the last MVP intake. This is especially important when clinical actions, such as additional P supplementation, are considered when low or high P values are encountered. Trial registration number not applicable

Utility and performance of cell blocks in urine cytology: Experience at three teaching hospitals.

The use of cell block (CB) preparation is underused in urine cytology (UC) and varies among hospitals. In addition to confirming a diagnosis, CBs can be useful in cases of metastatic disease, diagnoses requiring immunohistochemical (IHC) staining, and for ancillary studies. The role of this study is to examine the performance of CBs for UC at three affiliated teaching hospitals. A retrospective review of UC cases with a CB was conducted at a county hospital, Veterans Affairs hospital, and tertiary university-based hospital. For each specimen, patient demographics, specimen type, volume, original diagnosis, and IHC stains were recorded. Each case was reviewed for diagnosis based on ThinPrep alone, diagnosis based on ThinPrep and CB, utility of CB for diagnosis, and CB cellularity. A total of 250 UC specimens with CB from 186 patients was identified. Bladder washes were the most common (72.1%). IHC stains were performed on 17.2% of cases. On blinded review, CB preparation was deemed useful in 61.2% of cases, with the highest rate for suspicious for high-grade urothelial carcinoma (SHGUC) cases (87.0%). The diagnosis based on ThinPrep review changed with incorporation of CB in 13.2% of cases, with the highest rate for SHGUC cases (43.5%). The results demonstrate that use of CB in UC confirms the final diagnosis in more than one-half of cases and changes the diagnosis in a subset of cases. Use of CB was most helpful in the SHGUC category. Further evaluation of the types of cases in which CB are prepared is warranted.

Skin Manifestations Among Patients Admitted with COVID-19: A Cross-Sectional Study at a University-Based Tertiary Hospital in Jordan.

COVID-19 pandemic hit the entire world with severe health and economic consequences. Although the infection primarily affected the respiratory system, it was soon recognized that COVID-19 has a multi-systemic component with various manifestations including cutaneous involvement. The main objective of this study is to assess the incidence and patterns of cutaneous manifestations among moderate-to-severe COVID-19 patients who required hospitalization and whether there was a prognostic indication for cutaneous involvement and the outcome in terms of recovery or death. This is a cross-sectional observational study that included inpatients who were diagnosed with a moderate or severe COVID-19 infection. The demographic and clinical data of patients were assessed including age, sex, smoking, and comorbidities. All patients were examined clinically for the presence of skin manifestations. Patients were followed for the outcome of COVID-19 infection. A total of 821 patients (356 females and 465 males) aged 4-95 years were included. More than half of patients (54.6%) aged >60 years. A total of 678 patients (82.6%) had at least one comorbid condition, mostly hypertension and diabetes mellitus. Sixty-two patients (7.55%) developed rashes; 5.24% cutaneous and 2.31% oral. The rashes were then grouped into five major types: group A, Exanthema: morbilliform, papulovesicular, varicella-like. Group B, Vascular: Chilblain-like lesions, purpuric/petechial, livedoid lesions. Group C, Reactive erythemas: Urticaria, Erythema multiforme. Group D, other skin rashes including flare-up of pre-existing disease, and O for oral involvement. Most patients (70%) developed rash after admission. The most frequent skin rashes were reactive erythema (23.3%), followed by vascular (20.9%), exanthema (16.3%), and other rashes with flare-ups of pre-existing diseases (39.5%). Smoking and loss of taste were associated with the appearance of various skin rashes. However, no prognostic implications were found between cutaneous manifestations and outcome. COVID-19 infection may present with various skin manifestations including worsening of pre-existing skin diseases.

A Survey of the Perceptions, Knowledge, Attitudes and Practice of Evidence-Based Medicine among Rehabilitation Medicine Trainees and Consultants in a University-Based Tertiary Hospital

Objectives. The study aimed to determine the perceptions, attitudes, knowledge and practice of Evidence-Based Medicine (EBM) among Rehabilitation Medicine trainees and faculty. It aimed to compare trainees and faculty in terms of perceptions, attitudes, knowledge and practice. The study also intended to identify the barriers in the practice of EBM.&#x0D; Methods. The study utilized a cross-sectional design. The study included residents or trainees and consultants at the Department of Rehabilitation Medicine-Philippine General Hospital. A questionnaire exploring the perceptions, knowledge, attitudes and practice of EBM and the barriers in its practice was developed based on review of previous studies. Focus group discussions were conducted with the residents and consultants separately to probe the responses in the questionnaire.&#x0D; Results. Thirty-four trainees and consultants participated in the study. Trainees considered themselves having received more training in literature search (p=0.005) and critical appraisal (p=0.01) than consultants. Majority had fairly accurate conceptions of EBM. Thirty-eight percent of participants considered themselves competent in developing a clinical question and in doing a literature search. About 18% considered themselves competent in appraising literature. There were no significant differences between trainees and consultants in terms of their perceived knowledge and skills in EBM techniques. Consultants and trainees expressed positive attitudes towards EBM. In a week, some 50% search the literature at least twice and appraised an article. Eighty percent of Rehabilitation Medicine physicians (physiatrists) spent at least 2 hours per week reading related literature. In terms of practice of EBM, the trainees rated themselves higher in searching and appraising literature than the consultants but the differences were not significant. More than 90% indicated interest in further training in EBM. Majority cited lack of time, lack of understanding of statistics and inadequate information sources as barriers to EBM.&#x0D; Conclusion. Physiatrists have fairly accurate perceptions; positive attitudes; some knowledge / skills; and a high level of interest in EBM. There were no significant differences between consultants and trainees except in the aspect of training in literature search and appraisal. The lack of personal time, lack of understanding of statistical analyses and inadequate information sources were the most common perceived barriers in the practice of EBM in Physiatry.

Evaluation of Therapeutic Effect of Resectoscopic Surgery on 90 Cases of Cesarean Scar Pregnancy

Cesarean scar pregnancy (CSP) is a rare but life-threatening clinical condition. In the absence of a unanimous agreement on the ideal treatment course, investigating less invasive techniques with minimal blood loss and iatrogenic damage to the female reproductive system holds interest. This study aims to evaluate the safety and efficacy of resectoscopic surgery in CSP. This single-arm interventional study was conducted on 90 patients with CSP at a tertiary university-based hospital from April 21, 2019 to January 2021. The primary endpoint was the comparison of 48-h postoperative β-hCG levels to preoperative values. The average gestational age at diagnosis time was 7.27 ± 2.06 weeks and the baseline myometrial thickness mean was 1.46 ± 0.56 mm. In nearly half of the cases, the baseline β-hCG was lower than 10,000 IU/ml. About 48 h after the study intervention, the β-hCG mean level decreased significantly (p-value = 0.009), 34,965.97 ± 104,670.23 to 6264.12 ± 8622.93 IU/ml. For all patients except two, at least a 30% decline in baseline β-hCG was reached and was more than 50% in most cases (n = 85). Although the Hb mean level decreased significantly (p-value < 0.001) after study intervention, 12.87 ± 1.63 to 11.27 ± 1.88 g/dL, this decline was not of clinical significance and was lower than 50% in all study patients, and was less than 10% in half of the cases. Despite the significant blood loss in patients undergoing surgery, the lack of short-term complications and rapid decline of serum β-hCG concentration presents resectoscopy as an alternative approach to other therapeutic interventions for CSP. Further research is warranted to confirm these results.

Does the Use of a Uterine Manipulator or Intracorporeal Colpotomy Confer an Inferior Prognosis in Minimally Invasive Surgery–Treated Early-stage Cervical Cancer?

To identify whether the use of a uterine manipulator (UM) or intracorporeal colpotomy conferred inferior short-term survival among patients treated for early-stage cervical cancer. Retrospective cohort study. Tertiary university-based hospital. 1169 patients with stage IB1 to IB2 cervical cancer. All patients underwent minimally invasive radical hysterectomy and pelvic lymphadenectomy. A total of 1169 patients diagnosed with preoperative stage IB1 to IB2 cervical cancer were primarily treated with surgery from 2018 to 2019. The eligible patients had a median age of 48 years (range, 23-76 years), and the median follow-up time was 34 months (range, 3.57-50.87 months). The 2-year overall survival rate of the patients with pathologic stage IB1 and IB2 was 99.8% and 98.8%, respectively, according to the 2018 International Federation of Gynecology and Obstetrics staging system. Univariable analysis revealed that the UM group had a 7.6-times higher risk of death than that of the manipulator-free group (p=.006), but multivariable analysis clarified that only tumor size (p=.016; hazard ratio, 2.285; 95% confidence interval, 1.166-4.479) and parametrial involvement (p=.003; hazard ratio, 3.556; 95% confidence interval, 1.549-8.166) were independent risk factors for overall survival. There was no statistically significant difference in survival between patients who underwent intracorporeal and protective colpotomy. Short-term survival outcomes in women undergoing minimally invasive radical hysterectomy for treatment of early-stage cervical cancer did not differ when a UM was avoided or when a protective colpotomy was performed.

Laparoscopic-Assisted Transanal Total Mesorectal Excision for a Patient with Bowel Endometriosis

<h3>Study Objective</h3> To explore a less-invasive surgical route for patient with bowel endometriosis to undergo segmental colorectal resection. <h3>Design</h3> A case report. <h3>Setting</h3> A university-based tertiary hospital. <h3>Patients or Participants</h3> A 34-year-old female was readmitted two years post-conservative surgery for endometriosis due to consistent digestive dysfunction symptoms. A 3-cm nodule within the muscle layer of lower rectal wall was identified by pelvic MRI. <h3>Interventions</h3> A laparoscopic-assisted transanal total mesorectal excion (TaTME) was performed (a 4-minute video clip included). <h3>Measurements and Main Results</h3> The patient was placed in a Trendelenburg position. For the laparoscopic step, the rectovaginal space was dissected. Lateral, posterior and anterior experitoneal rectal and left sigmoid dissection was performed adequately. Pay attention to protect the ureter and hypogastric nerve. An articulated endoscopic cutter was used to transect the distal rectal segment. For the trans-anal step, the rectal lumen was irrigated, the distal end of rectum was grasped out through anus. A safe margin down to the endometriotic lesion was chosen, 3-0 suture was placed followed by reloaded staplers to close the distal rectal lumen. TME was performed utilizing a "bottom up" approach. An avil was placed inside of proximal sigmoid. Rectosigmoid anastomosis completed successfully by using a circular stapler. No protective ileostomy was adopted. The surgery was uncomplicated with minimal blood loss. Significant improvement of bowel symptoms was reported within the first month postoperatively. During 3-year follow-up period no recurrence of endometriosis or digestive dysfunction symptoms was observed. <h3>Conclusion</h3> As a novel technique, laparoscopic-assisted TaTME shows advantage over laparoscopic surgery, such as better visualization of the distal resection margin while avoiding a bigger abdominal scar. Young women with colorectal endometriosis can benefit for more radical but less invasive surgical outcome. An experienced multidisciplinary team making comprehensive evaluation and discussion before surgery will ensure this technically highly demanding operation feasible and safe.

Pediatric Open Globe Injury in a University-Based Tertiary Hospital in the Anatolian Region

Objective: Evaluation of the epidemiological and clinical features of pediatric open globe injury. &#x0D; Methods: Medical records of 51 patients under the age of 18 who presented to the emergency department with open globe injury (OGI) between 2009 and 2021 were evaluated retrospectively. Patient demographics, Birmingham Eye Trauma Terminology (BETT) category, pediatric ocular trauma score (POTS), visual acuity (VA), site of injury, and seasonal distribution were evaluated. &#x0D; Results: Of all patients included, 40 (78.4%) were male, 11 (21.6%) were female, and the mean age was 9.6±5.2 years. Zone I injury was detected in 31 (60.8%) patients. The most common cause of injury was sharp objects such as metal or wood splinters. Of all injuries, 29 (56.9%) occurred outdoors. Ocular trauma occurred more frequently in boys, especially in the summer months. Initial VA was less than 0,1 in 21 (41.2%) of the patients, between 0.1-0.5 in 9 (17.6%) and 0.6 and above in 5 (9.8%) patients. At the final visit, VA was less than 0.1 in 9 (17.6%) patients, 0.1-0.5 in 10 (19.6%) patients, and 0.6 and above in 18 (35.3%) patients. Final VA was related to the Zone and was lower as the Zone increased (p:0.011). VA and POTS scores were positively correlated at the final visit (p=0.001). &#x0D; Conclusion: It is substantial for emergency physicians to have a comprehensive understanding of pediatric globe injuries so that children with suspected ocular trauma should be evaluated by an ophthalmologist to prevent medicolegal problems.

Type 2 Deiodinase Thr92Ala Polymorphism Is Not Associated with Cognitive Impairment in Older Adults: A Cross-Sectional Study.

Background: Type 2 Deiodinase (DIO2) converts thyroxine (T4) into the active hormone triiodothyronine (T3). Thr92Ala DIO2 polymorphism has been associated with reduced conversion of T4 into T3 and central nervous system hypothyroidism. However, how Thr92Ala DIO2 polymorphism affects cognitive function is still unclear. Objective: To assess the association between Thr92Ala DIO2 polymorphism and cognitive performance in older adults. Design: Cross-sectional study. Setting: University-based tertiary hospital in Brazil. Patients: > 65-year-old with no limiting clinical disease. Interventions: All participants answered a standard questionnaire before undergoing thyroid function laboratory evaluation and genotyping of the Thr92Ala DIO2 polymorphism. Main Outcomes: Cognitive impairment measured by the Word List Memory task from the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Battery (CERAD-NB) and the Brief Cognitive Screening Battery (BCSB). Results: A hundred individuals were included. Clinical and laboratory characteristics were similar among DIO2 genotypes (all p > 0.05). No differences were found in the Word List Memory, recall, or recognition tests of the CERAD-NB assuming a recessive model for the Ala/Ala vs. Thr/Ala-Thr/Thr genotypes. Results of Clock Drawing Test, Animal Fluency Test, Mini-Mental State Exam, and Figure Memory Test of the BCSB were similar between groups. Conclusions: These findings suggest that Thr92Ala DIO2 polymorphism is not associated with relevant cognitive impairment in older adults.

Outcomes of a Single-Segment Intrastromal Corneal Ring in Early Keratoconus and Early Pellucid Marginal Degeneration.

To determine the effect of a single-segment intrastromal corneal ring segment (ICRS; Intacs SK) on early keratoconus (KCN) and pellucid marginal degeneration (PMD). It is a prospective interventional study. One hundred twenty-four eyes (99 patients) with KCN and 36 eyes (26 patients) with PMD at early stage (the maximum keratometric reading less than 55 diopters) were included to ICRS implantation using femtosecond laser at a tertiary university-based hospital and a private outpatient center. The uncorrected distance and spectacle-corrected visual acuity (UDVA and SCDVA), manifest spherical and cylindrical refractions, and keratometry indices were measured preoperatively and postoperatively, 1week, 2 and 6months. One week after surgery, significant improvements were observed in UDVA, SCDVA, cylinder and keratometry readings of both KCN and PMD groups (all P < 0.05) with no significant changes afterward. No significant change occurred in the sphere refraction of PMD group (P = 0.10) in contrast to KCN group (P < 0.001). Corneal irregularity of KCN group in central 3 and 5mm zones increased at 1week (both P < 0.001) and then started to decrease up to 6months. However, the corneal irregularity of PMD group had significant reduction only at 1week in 5-mm zone (P = 0.02) and 2months in 3-mm zone (P = 0.01) postoperatively. The final efficacy indexes were 1.44 ± 0.71 and 0.87 ± 0.40 in KCN and PMD groups, respectively. Visual acuity, refractive errors and keratometry values have been improved after one-segment Intacs SK implantation in early KCN and PMD patients.

Comparing Pentacam HR Screening Indices in Different Normal Corneal Thicknesses among Refractive Surgery Candidates.

Purpose:To compare Pentacam indices in normal eyes with different corneal thicknesses.Methods:It is a retrospective observational study. Ninety-six normal eyes of 96 patients who were referred for refractive surgery in a tertiary university-based hospital from October 2015 to April 2019 were recruited consecutively. Corneal keratometry as well as Pentacam's software Belin-Ambrósio Enhanced Ectasia Display (BAD) parameters including pachymetry progression indices (PPIs), maximum Ambrosio's relational thickness (ART-max), corneal elevations, normalized deviations, BAD total deviation value (BAD-D), and anterior surface indices were measured by Pentacam HR (Type 70900). The included were classified as thin (26 eyes), average (45 eyes), and thick (25 eyes) corneas with the thinnest point thickness of ≤496 μm, 497–595 μm, and ≥596 μm, respectively. The specificities of all parameters were calculated based on routine cut-off values.Results:The refraction, keratometry, and elevations were not different (P > 0.05). All PPIs (minimum, average, and maximum) of thick corneas were significantly lower than average and thin corneas (P < 0.001). ART-max increased by thickening of the cornea (P < 0.001). BAD-D score and normalized indices of pachymetric parameters decreased with the increase of thickness (P < 0.001), while specificities of all indices increased with corneal thickening. More than 96% of thick corneas were classified as normal PPI-max (24/25), ART-max (25/25), and BAD-D (25/25), while nearly <54% of thin corneas (14/26 for PPI-max, 9/26 for ART-max, and 12/26 for BAD-D) were normal.Conclusions:The pachymetry-related indices and BAD-D were different among normal corneas with various thicknesses. The specificities of PPIs, ART-max, and BAD-D of thin corneas were lower than in thick corneas.

Importance of pre-operative COVID-19 screening test in elective surgeries.

Background and Objectives:Since the COVID-19 pandemic initiation, more than 28 million elective surgeries were postponed with a cancellation rate of 72.3%. However, studies suggested that the patient treatment should be conducted within 12 weeks of diagnosis because delay in treatment might have had adverse impacts on patients' health status, prognosis, and pathologic stage. Hence, the current study aimed to assess the importance of a pre-operative COVID-19 screening test for the patients were candidates for elective surgery.Materials and Methods:This cross-sectional study was conducted on 141 patients who were candidates for any type of elective surgeries or cesarean section at a tertiary university-based hospital, between June 2020, and September 2020.Results:The mean age of participants was 41.38 ± 11.66 years. Of them, 91.5% were women and 8.5% were men. The COVID-19 polymerase chain reaction (PCR) screening tests were positive in 12 (8.5%) patients. From whose PCR tests were positive, only five people (less than half) had symptoms of COVID-19 such as fever (three patients), a distinctive smell (two patients), and cough (one patient). Suspected exposure to COVID-19 was reported in four of them.Conclusion:In this study, we found that more than half of PCR positive COVID-19 patients were asymptomatic. Therefore, to have a safe hospital environment, and improve patient health outcomes, the COVID-19 screening test should be applied before any interventions.

Artificially prepared vitrified–warmed embryo transfer cycles are associated with an increased risk of pre-eclampsia

Research questionWhat is the association between the development of pre-eclampsia and endometrial preparation prior to vitrified–warmed embryo transfer (frozen embryo transfer, FET)? DesignA retrospective cohort study at a tertiary university-based hospital, including a total of 536 pregnant patients who underwent a FET between 2010 and 2019 and delivered in the same institution; 325 patients underwent natural cycle FET (NC-FET) and 211 artificial cycle FET (AC-FET). ResultsUnadjusted, the incidence of pre-eclampsia was significantly higher in AC-FET cycles than in NC-FET cycles (3.7% versus 11.8%, P < 0.001). Multivariable logistic regression analysis showed that, when adjusting for type of endometrial preparation (artificial cycle versus natural cycle), oocyte recipient cycles and African ethnicity, the risk of developing pre-eclampsia was significantly associated with artificial endometrial preparation or oocyte recipient cycles (AC-FET versus NC-FET: odds ratio 2.9, 95% confidence interval 1.4–6.0, P = 0.005). ConclusionsThe current data show a higher incidence of pre-eclampsia in AC-FET versus NC-FET cycles, adding further strength to the existing data on this topic. Together, these recent findings may result in a change in clinical practice, towards a preference for NC-FET cycles over AC-FET cycles in ovulatory patients. Screening for high-risk patients and the development of strategies to mitigate their risk profile could reduce the risk of pre-eclampsia. Further understanding of the different vasoactive substances excreted by the corpus luteum is vital.

Precise Resection of Rectal Endometriosis with Intra-Operative Trans-Anal Endoscopy

<h3>Study Objective</h3> The challenge of rectal endometriosis surgery is how to achieve the complete resection and preserve the bowel function to the greatest extent. This video demonstrates a laparoscopic surgery assisted by trans-analy hysteroscopy to precisely locate and resect the rectal lesion. <h3>Design</h3> Stepwise demonstration of the surgery. <h3>Setting</h3> In a tertiary university-based hospital. <h3>Patients or Participants</h3> A 34-year-old woman had secondary dysmenorrhea for more than 10 years and anal distension during menstruation for 1 year. Preoperative colonoscopy suggested that there was a 2*3cm hyperemia and edema lesions penetrating mucous membrane in rectal 10cm, which was considered as rectal endometriosis. <h3>Interventions</h3> During laparoscopic surgery, it was not easy to precisely locate the penetrating lesion involving rectum even after shaving the seromuscular lesions. Then we used trans-anal hysteroscopy to perform as colonoscopy to position the penetrating lesion and resect it. There was only a tear of 3cm on the rectum which we anastomosed with a lateral stapler. <h3>Measurements and Main Results</h3> The patient passed gas on Day 2 and restored bowel movement. Her symptom was relieved with satisfying quality of life. <h3>Conclusion</h3> In rectal endometriosis, we can use hysteroscopy as an alternative type of colonoscopy to locate the penetrating lesion accurately, and the precise resection can help retaining the bowel function and preserve the patients' quality of life.

Disease modifying drugs in idiopathic sclerosing orbital inflammatory syndrome

ABSTRACT Purpose Idiopathic sclerosing orbital inflammatory syndrome (ISOIS) is a rare, progressive and hard to control disease. There is a deep gap of evidence regarding application of disease-modifying drugs (DMD) regimen as a potentially effective treatment for orbital inflammatory diseases. We aimed to report the results of using DMDs and discuss the concept of applying this modality of treatment in patients with ISOIS. Methods This was a prospective interventional case series conducted in a tertiary university-based hospital. Biopsy proven patients with active ISOIS were included. Systematic criteria were developed to define and measure disease activity and monitor response to treatment. A DMD regimen including an anti-tumor necrosis factor alpha (anti-TNF alpha) agent plus azathioprine and low-dose corticosteroids were used. Comprehensive ophthalmic, orbital and systemic assessments were performed during each visit. Results Five eligible patients with primary ISOIS were included. Mean age was 34.20 (SD = 13.33, range 19–53) years. Three had unilateral and two had bilateral involvement. Four had diffuse orbital involvement pattern and progressive worsening of visual functions, reduced extraocular motility and proptosis. In one patient the disease was localized to extraocular muscle and lacrimal gland. Disease activity was decreased and stabilized after DMDs regimen in all patients. Mean follow up was 32.80 (SD = 30.80, range: 12–86) months. Conclusion Biologic DMD (b-DMD) including anti-TNF alpha, corticosteroid and azathioprine were effective in decreasing disease activity and could change course of the disease. This study supports the concept of using b-DMD regimen in treatment of ISOIS.