Kidney transplant candidates' perspectives on the implementation of a Canadian Willingness to Cross program: A strategy to increase access to kidney transplantation for highly sensitized patients.

BACKGROUND: Kidney transplantation is the optimal treatment for end-stage renal disease. However, highly sensitized patients (HSPs) have reduced access to transplantation, leading to increased morbidity and mortality on the waiting list. The Canadian Willingness to Cross (WTC) program proposes allowing transplantation across preformed donor specific antibodies (DSA) determined to be at a low risk of rejection under the adaptive design framework. This study collected patients' perspectives on the development of this program. METHODS: Forty-one individual interviews were conducted with kidney transplant candidates from three Canadian transplant centers in 2022. The interviews were digitally recorded and transcribed for subsequent analyses. RESULTS: Despite limited familiarity with the adaptive design, participants demonstrated trust in the researchers. They perceived the WTC program as a pathway for HSPs to access transplantation while mitigating transplant-related risks. HSPs saw the WTC program as a source of hope and an opportunity to leave dialysis, despite acknowledging inherent uncertainties. Some non-HSPs expressed concerns about fairness, anticipating increased waiting times and potential compromise in kidney graft longevity due to higher rejection risks. Participants recommended essential strategies for implementing the WTC program, including organizing informational meetings and highlighting the necessity for psychosocial support. CONCLUSION: The WTC program emerges as a promising strategy to enhance HSPs' access to kidney transplantation. While HSPs perceived this program as a source of hope, non-HSPs voiced concerns about distributive justice issues. These results will help develop a WTC program that is ethically sound for transplant candidates.

Pseudoparesis and pseudoparalysis in the setting of massive irreparable rotator cuff tear: demographic, anatomic, and radiographic risk factors.

BACKGROUND: The primary purpose of this study was to identify demographic, anatomic, and radiographic risk factors for active forward elevation (AFE) <90° in the setting of massive, irreparable rotator cuff tear (miRCT). The secondary purpose was to identify characteristics differentiating between patients with pseudoparalysis (AFE <45°) and pseudoparesis (AFE >45° but <90°). METHODS: This was a retrospective case-control study reviewing patients with miRCTs at a single institution between January 12, 2016 and November 26, 2020. Patients were separated into 2 cohorts based on presence or absence of preoperative AFE <90° with maintained passive range of motion. Demographics, RCT pattern, and radiographic parameters were assessed as risk factors for AFE <90°. A secondary analysis was conducted to compare patients with pseudoparalysis and pseudoparesis. RESULTS: There were 79 patients in the AFE <90° cohort and 50 patients in the control cohort. Univariate analysis confirmed significant differences between the AFE <90° and control cohort in age (71.9 ± 11.0 vs. 65.9 ± 9.1 years), arthritis severity (34.2% vs. 16.0% grade 3 Samilson-Prieto), acromiohumeral distance (AHD; 4.8 ± 2.7 vs. 7.6 ± 2.6 mm), fatty infiltration of the supraspinatus (3.3 ± 0.9 vs. 2.8 ± 0.8) and subscapularis (2.0 ± 1.2 vs. 1.5 ± 1.0), and proportion of subscapularis tears (55.7% vs. 34.0%). On multivariate analysis, age (odds ratio [OR] 1.08, P = .014), decreased AHD (OR 0.67, P < .001), severe arthritis (OR 2.84, P = .041), and subscapularis tear (OR 6.29, P = .015) were independent factors predictive of AFE <90°. Secondary analysis revealed tobacco use (OR 3.54, P = .026) and grade 4 fatty infiltration of the supraspinatus (OR 2.22, P = .015) and subscapularis (OR 3.12, P = .042) as significant predictors for pseudoparalysis compared to pseudoparesis. CONCLUSIONS: In patients with miRCT, increased age, decreased AHD, severe arthritis, and subscapularis tear are associated with AFE <90°. Furthermore, patients with AFE <90° tend to have greater supraspinatus and subscapularis fatty infiltration. Lastly, among patients with AFE <90°, tobacco use and grade 4 fatty infiltration of the supraspinatus and subscapularis are associated with pseudoparalysis compared with pseudoparesis.

Regional versus general anesthesia in knee arthroplasty in patients with different classes of BMI: A matched analysis of the NSQIP database.

BACKGROUND: Knee arthroplasty for knee arthritis is a commonly performed surgery yielding excellent functional results and good pain relief. It is associated with post-surgical complications according to the type of anesthesia and BMI class. METHODS: The National Surgical Quality Improvement Project database for the years 2005-2012 for patients >18 years of age who underwent knee arthroplasty, condyle and plateau, medial and/or lateral compartment. The surgical site complications, bleeding occurrences necessitating transfusion, unplanned readmissions, and mortality stratified according to anesthesia type and BMI class over a period of 30-days were examined. RESULTS: A total of 78,275 patients were included for analysis; regional anesthesia showed a consistent protective effect from surgical site complications more prominent with increasing obesity class with respective ORs and their corresponding 95% CI for pre-obesity, class I, II, and III obesity being 0.95 [0.89-1.09], 0.75 [0.68-0.83], 0.64 [0.57-0.72], and 0.61 [0.54-0.7]. CONCLUSIONS: Higher BMI values are a protective factor for the risk of bleeding requiring transfusion in patients undergoing total knee arthroplasty. Moreover, regional anesthesia is the preferred choice of anesthesia as well if postoperative complications are considered. A significant decrease in the rate of post-operative blood transfusions was seen in patients with high BMI and regional anesthesia.

Development and Validation of a Railway Safety System for Nordic Trains in Isolated Territories of Northern Quebec Based on IEEE 802.15.4 Protocol.

Connected objects are deployed all over the world. Thus, they are contributing to improving communications. In urban areas, technological challenges are gradually being overcome, and advances in this area are exponential. Unfortunately, isolated territories such as northern Quebec do not beneficiate from this technological progress. Yet, northern Quebec relies on abundant natural resources, with notably its huge hydroelectric dams and iron mines, and therefore, the region's economic life revolves essentially around the exploitation of these resources and is heavily reliant on rail transportation. However, according to Transport Canada, 1246 railroad accidents were reported in 2019 to the Transportation Safety Board (TSB). Thirty-eight people described as trespassers lost their lives, and five railroad employees were fatally injured. In this context, we present the implementation of a security system in an isolated environment for employees intervening on the railroad track to warn them of the imminent arrival of a train. Due to the context of the isolated environment, i.e., without an electrical network, without internet, and without an LTE network, a solution for employees has been developed using a Zigbee telecommunication system and a connected watch. A case study on a train operating in a remote and isolated area in northern Quebec is presented to validate the performance of the proposed system based on an open-source and customizable solution.

State of the Art of Telecommunication Systems in Isolated and Constrained Areas.

Smart objects are deployed globally, contributing to improved communications and the growth of industrial systems' performances. Unfortunately, isolated territories are generally excluded from this progress. Remote areas in Canada are no exception. Thus, about two hundred thousand people are living in isolated regions in Canadian territory. The development of these communities is slowed down not only by an outdated energy supply, but they are also dependent on telecommunication systems not fully deployed in those regions, thus contributing to the amplification of those populations' isolation. Furthermore, the magnetic field in some regions of the planet and very often in isolated areas undergoes partial or total absorption, known as white areas, making the propagation of the signal very delicate. As a part of this article, a state of the art of telecommunication solutions available in an isolated environment is applied with a critical analysis based on several criteria. It shows the ability to use an original approach based on a captive balloon. Despite the proposed solution's feasibility, several challenges need to be addressed before formally adopting it. These challenges include: (i) controlling the height of the balloon; (ii) stabilization of the balloon; and (iii) powering the system. The list of references given at the end of the paper should offer aids for the industry and for researchers working in this field.

Evaluating Cholinergic Receptor Expression in Guinea Pig Primary Auditory and Rostral Belt Cortices After Noise Damage Using [3H]Scopolamine and [18F]Flubatine Autoradiography.

Noise-induced hearing loss leads to anatomic and physiologic changes in primary auditory cortex (A1) and the adjacent dorsal rostral belt (RB). Since acetylcholine is known to modulate plasticity in other cortical areas, changes in A1 and RB following noise damage may be due to changes in cholinergic receptor expression. We used [3H]scopolamine and [18F]flubatine binding to measure muscarinic acetylcholine receptor (mAChR) and nicotinic acetylcholine receptor (nAChR) expression, respectively, in guinea pig A1 and RB 3 weeks following unilateral, left ear noise exposure, and a temporary threshold shift in hearing. [3H]Scopolamine binding decreased in right A1 and RB (contralateral to noise) compared to sham controls across all cortical layers. [18F]Flubatine binding showed a nonsignificant upward trend in right A1 following noise but only significantly increased in right RB and 2 layers of left RB (ipsilateral to noise). This selective response may ultimately influence cortical plasticity and function. The mechanism(s) by which cholinergic receptors are altered following noise exposure remain unknown. However, these data demonstrate noise exposure may differentially influence mAChRs that typically populate interneurons in A1 and RB more than nAChRs that are traditionally located on thalamocortical projections and provide motivation for cholinergic imaging in clinical patient populations of temporary or permanent hearing loss.

Human Auditory and Adjacent Nonauditory Cerebral Cortices Are Hypermetabolic in Tinnitus as Measured by Functional Near-Infrared Spectroscopy (fNIRS).

Tinnitus is the phantom perception of sound in the absence of an acoustic stimulus. To date, the purported neural correlates of tinnitus from animal models have not been adequately characterized with translational technology in the human brain. The aim of the present study was to measure changes in oxy-hemoglobin concentration from regions of interest (ROI; auditory cortex) and non-ROI (adjacent nonauditory cortices) during auditory stimulation and silence in participants with subjective tinnitus appreciated equally in both ears and in nontinnitus controls using functional near-infrared spectroscopy (fNIRS). Control and tinnitus participants with normal/near-normal hearing were tested during a passive auditory task. Hemodynamic activity was monitored over ROI and non-ROI under episodic periods of auditory stimulation with 750 or 8000 Hz tones, broadband noise, and silence. During periods of silence, tinnitus participants maintained increased hemodynamic responses in ROI, while a significant deactivation was seen in controls. Interestingly, non-ROI activity was also increased in the tinnitus group as compared to controls during silence. The present results demonstrate that both auditory and select nonauditory cortices have elevated hemodynamic activity in participants with tinnitus in the absence of an external auditory stimulus, a finding that may reflect basic science neural correlates of tinnitus that ultimately contribute to phantom sound perception.

A novel RLBP1 gene mutation associated to a flecked retina syndrome.

PURPOSE: To present an unusual fleck retina condition associated to a novel RLBP1 gene mutation.Methods/Results: A 25-year old male presented flecks on fundoscopic examination. Clinical presentation, multimodal imaging and ERG were compatible with the diagnosis of benign familial fleck retina. Genetic analysis detected an RLBP1 gene, a gene commonly associated with more severe retinal disease. CONCLUSION: Flecked retina syndromes and other genetic retinal diseases have a complex genotype-phenotype relation and need further research for their pathophysiology to be fully understood.

V-Y Quadricepsplasty for Knee Stiffness Post Total Knee Arthroplasty: A Case Report and Literature Review.

Introduction: Knee stiffness post-total knee arthroplasty (TKA) represents a common and challenging complication. Standard treatment protocols primarily include physical therapy, manipulation under anesthesia (MUA), fibrotic tissue release, lysis of adhesions (LOA), and in refractory cases, revision arthroplasty. However, these interventions often show minimal improvement in refractory cases. This report introduces V-Y quadricepsplasty as an innovative approach for addressing knee stiffness post-TKA, particularly in cases unresponsive to MUA and LOA, without any evidence of prosthetic component malposition or failure. Case Report: We present a case involving a middle-aged woman experiencing persistent knee stiffness post-TKA, unresponsive to both MUA and LOA. Diagnostic evaluations confirmed no malposition or failure of the prosthetic component. The patient underwent a successful V-Y quadricepsplasty, which resulted in significant improvement in her condition. Conclusion: This case underscores the efficacy of V-Y quadricepsplasty in managing knee stiffness post-TKA, especially in cases where traditional treatments such as MUA and LOA are ineffective and there is no evidence of prosthetic component failure or malposition. This approach potentially offers a new avenue for treatment in similar clinical scenarios.

Retromode imaging in retinal diseases: A systematic review of the literature.

Retromode scanning laser ophthalmoscopy imaging captures a pseudo-3-dimensional image of the ocular fundus. Retromode scanning laser ophthalmoscopy imaging was introduced first in 2008 using the Nidek F-10 scanning laser ophthalmoscope (F-10; Nidek Co., Gamagori, Japan). At that time, no major role was described for this imaging modality. The interest in retromode scanning laser ophthalmoscopy imaging is reemerging with the recent advent of the Mirante that combines scanning laser ophthalmoscopy and optical coherence tomography (Nidek Co., Gamagori, Japan) that can capture retromode images of the fundus. We summarize the findings and clinical implications of retromode imaging using the Nidek F-10 and the Mirante in retinal diseases with the aim of helping researchers direct their future studies.

Dual medial and anterior approach for excision of extraosseous synovial hip osteochondroma: a case report.

BACKGROUND: Osteochondromas are the most common benign bone tumors occurring near the end of long bones. In this case report, we demonstrate the successful treatment of a proximal femoral osteochondroma in a pediatric patient excised through a dual medial and anterior approach with no hip dislocation. CASE PRESENTATION: We present the case of a white Arab 14-year-old boy with chronic hip pain and inability to ambulate. He failed conservative treatment and was referred to us after X-rays revealed two osseous masses. He was diagnosed with an intra-articular hip osteochondroma confirmed on magnetic resonance imaging and computed tomography scan. He was treated surgically with excision using two incisions: Smith-Petersen approach and Ferguson approach. CONCLUSION: This case presents the successful resection of a symptomatic pediatric proximal femoral osteochondroma, using dual medial and anterior approaches without the need for hip dislocation. This was optimal for both the safety and accessibility of this unusual condition.

Understanding the Role of the Otolaryngology Hospitalist: Tracheostomies and Tracheostomy Care.

INTRODUCTION: The concept of a hospitalist has been well established. This model has been associated with reduced length of stay contributing to reduction in healthcare costs. Minimal literature is available assessing the effects of an otolaryngology (ENT) hospitalist at a tertiary medical center. The aim of this study is to assess the role of an ENT hospitalist on (1) performing tracheostomies and (2) providing care as part of the tracheostomy care team (TCT). METHODS: Retrospective chart review of all tracheostomies performed by the ENT service over 2 years (July 2015-June 2017), and prospective data collection of all tracheostomy care consults over 1 year (July 2016-June 2017). In year 1 (from July 2015 to June 2016), no ENT hospitalist was employed, and in year 2 (from July 2016 to June 2017), an ENT hospitalist was employed. RESULTS: Compared to other Ear, Nose, and Throat (ENT) surgeons, the ENT hospitalist performed tracheostomies with shorter patient wait times, and performed a greater proportion of percutaneous tracheostomies at the bedside versus open tracheostomies in the operating room. The tracheostomy care team (TCT) received 91 consults over the course of 1 year with an average of 1.1 billable procedures generated per consult. CONCLUSION: In this study, an ENT hospitalist was decreased patient wait time to tracheostomy and increased bedside percutaneous tracheostomies, which has positive implications for resource utilization and healthcare cost. The average wait time to receive a tracheostomy was reduced when calculated across the entire department due to the availability of the ENT hospitalist to see and perform tracheostomies. The TCT generated many billable bedside procedures in addition to encouraged decannulation of patients. This study highlights the fact that the ENT hospitalist contributes to providing expedient tracheostomies and provides valuable consulting services as part of a TCT at a high-volume tertiary care facility.

The role of adipose-derived mesenchymal stem cells in knee osteoarthritis: a meta-analysis of randomized controlled trials.

Background: Adipose-derived mesenchymal stem cells (ADMSCs) have recently been studied for the treatment of knee osteoarthritis. The goal is pain reduction and improvement of joint function leading to superior health-related quality of life. Objectives: The aim of this study was to provide a comprehensive meta-analysis assessing the evidence on the use of ADMSCs in knee osteoarthritis. Design: This is a Meta-analysis of randomised controlled trials. Data Sources and Methods: PubMed/MEDLINE, Embase, and Cochrane Databases were searched for randomized controlled trials using ADMSCs to treat patients with knee osteoarthritis. Only trials comparing ADMSCs to placebo or conservative treatment were included. The outcomes studied were improvement in functional, pain, and quality of life scores along with radiographic findings. Results: A total of four trials were included, representing 138 patients with knee osteoarthritis. WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores favored ADMSCs with a statistically and clinically significant difference over controls at 6- and 12-month follow-ups (p value < 0.0001). Pain, functional, and quality of life scores also favored ADMSCs at 12-month follow-up (p value < 0.0001). Conclusion: ADMSCs are effective in treating knee osteoarthritis symptoms as observed by functional and pain improvements. Furthermore, ADMSCs injection showed improvement of cartilage integrity, which indicates the potential for regenerating the knee cartilage. Future trials with larger number of patients and longer follow-up periods would help to elaborate further the therapeutic potential of ADMSCs. Plain Language Summary: Adipose-derived mesenchymal stem cells use in knee osteoarthritis Knee osteoarthritis is an extremely common disease that causes damage of the lining of the knee joint.This will lead to pain and limited range of motion of the knee hence limited functionality.Multiple treatments are used currently for knee osteoarthritis which all aim at slowing down the progression and limiting the need for knee replacement surgery.Adipose-derived mesenchymal stem cells (ADMSCs) are stem cells harvested from the fat around the belly. These stem cells have the potential to be converted into cells of a certain origin (cartilage, muscle, fat).Many studies are being performed to see whether these cells can transform to cartilage and repair the damaged knee joint.In this study, we tried to find how the results of different studies comparing the usual treatments for knee osteoarthritis with that of ADMSCs compared.We were mostly interested in the pain, functional, stiffness, and quality of life scores.We also reviewed the MRI findings to find out whether the lining of the knee joint improved.Four studies were included with 138 patients having knee osteoarthritis.WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score which is a self-administered questionnaire evaluating hip and knee osteoarthritis, showed better results in patients receiving ADMSC injections compared with other usual treatments at 12-month follow-up.Pain, functional, stiffness, and quality of life scores also showed better results in ADMSCs at 12-month follow-up.MRI images also showed better cartilage lining in the patients treated with ADMSCs.We concluded that ADMSCs are both effective and safe to be used in treating knee osteoarthritis symptoms. However, studies with longer follow-up periods are needed to better assess the regenerative potential of ADMSCs.

A Meta-analysis Comparing External Fixation against Open Reduction and Internal Fixation for the Management of Tibial Plateau Fractures.

Aim: This article aims to compare the outcomes between open reduction and internal fixation (ORIF) and external fixation (ExFix) in tibial plateau fractures. Background: Open reduction and internal fixation and external fixation are common methods for managing tibial plateau fractures without a consensus of choice. Materials and methods: PubMed, Cochrane Library, Ovid, CINAHL®, Scopus, and Embase were searched. Clinical studies in humans comparing ExFix and ORIF for tibial plateau fractures were included. Case reports, pathological, and biomechanical studies were excluded. Two investigators reviewed the studies independently, and any discrepancies were resolved. The quality and heterogeneity of each study were assessed in addition to calculating the odds ratio (OR) of the surgical outcomes and complications at a 95% confidence interval, with p <0.05 as statistical significance. Results: Of the 14 included studies, one was a randomised trial, one was a prospective study, and 12 were retrospective studies. The 865 fractures identified across the studies constituted 458 (52.9%) in the ExFix group and 407 (47.1%) in the ORIF group. Most studies indicated a better outcome for ORIF as compared to ExFix. Open reduction and internal fixation had a lower incidence of superficial infection and postoperative osteoarthritis, while ExFix revealed a lower proportion with heterotopic ossification (HTO). Conclusion: ExFix has a higher rate of superficial infections and osteoarthritis, whereas ORIF has a higher incidence of HTO. Larger studies are needed to compare outcomes and investigate the findings of this study further. Clinical significance: This up-to-date meta-analysis on tibial plateau management will help surgeons make evidence-based decisions regarding the use of ORIF versus ExFix. How to cite this article: Naja AS, Bouji N, Eddine MN, et al. A Meta-analysis Comparing External Fixation against Open Reduction and Internal Fixation for the Management of Tibial Plateau Fractures. Strategies Trauma Limb Reconstr 2022;17(2):105-116.

Distance to Dislocation and Recurrent Shoulder Dislocation After Arthroscopic Bankart Repair: Rethinking the Glenoid Track Concept.

BACKGROUND: The "distance to dislocation" (DTD) calculation has been proposed as 1 method to predict the risk of recurrent dislocation after arthroscopic Bankart repair for an "on-track" shoulder. Rates of recurrent dislocation at specific DTD values are unknown. HYPOTHESIS: Among patients with "on-track" shoulder lesions who underwent primary arthroscopic Bankart repair, the rate of recurrent dislocation would increase as DTD values decrease. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We performed a retrospective analysis of 188 patients with "on-track" shoulder lesions who underwent primary arthroscopic anterior labral repair between 2007 and 2019, with a minimum 2-year follow-up. Glenoid bone loss, Hill-Sachs interval, glenoid track, and DTD were determined from preoperative magnetic resonance imaging scans. The rate of recurrent dislocation was determined at 2-mm DTD intervals. Univariate and multivariate regression analyses were used to evaluate the relationship between recurrent dislocation, patient characteristics, and bone loss variables. A multivariate regression model was created to predict the probability of failure at continuous DTD values. A subgroup analysis of failure rate based on collision sports participation was also performed. RESULTS: A total of 29 patients (15.4%) sustained recurrent dislocations. Patient age (P = .046), multiple dislocations (P = .03), glenoid bone loss (P < .001), Hill-Sachs interval length (P < .001), and DTD (P < .001) were all independent predictors of failure. As the DTD decreased, the rate of recurrent dislocation increased. Below a DTD threshold of 10 mm, the recurrent dislocation rate increased exponentially. Up to a threshold of 24 mm, the failure rate for collision athletes remained >12.3%, independent of the DTD. Conversely, the failure rate among noncollision athletes decreased steadily as the DTD increased. CONCLUSION: For "on-track" shoulder lesions, as the DTD approached 0 mm ("off-track" threshold), the risk of recurrent dislocation after arthroscopic Bankart repair increased significantly. Below a DTD threshold of 10 mm, the risk of failure increased exponentially. The risk of recurrent dislocation for collision sports athletes remained elevated at higher DTD values than for noncollision athletes.

Dorsal Approach with Low-Profile Plate in Treatment of Scaphoid Nonunion with Proximal Pole Avascular Necrosis: A Case Report.

CASE: Avascular necrosis (AVN) and nonunion are common complications encountered with scaphoid waist fractures. We present a case of a 23-year-old man presenting with a right scaphoid fracture nonunion associated with AVN of the proximal pole. He was treated with a 1,2 intercompartmental supraretinacular arterial bone graft (Zaidemberg technique) in combination with a dorsal plate yielding excellent functional and radiographic results. CONCLUSION: Scaphoid waist fracture nonunion with AVN of the proximal pole is challenging to treat and combining the Zaidemberg technique along with dorsal plating allows for easy access and excellent healing.

Evaluation of corneal sensitivity in multiple sclerosis patients.

PURPOSE: To measure the corneal sensitivity in patients with multiple sclerosis (MS), to compare it with normal values and to study its correlation with different disease characteristics. METHODS: Corneal sensitivity of 28 MS patients was compared to corneal sensitivity of 28 age- and gender-matched normal controls. Corneal sensitivity was measured using the Cochet-Bonnet esthesiometer and was correlated to the duration, type and severity indexes of the disease. RESULTS: Corneal sensitivity was comparable between both groups (P = 0.79). No statistically significant correlation was found between corneal sensitivity and the duration of MS (P = 0.55) nor the severity indexes of MS (expanded disability status scale [EDSS] P = 0.52, global multiple sclerosis severity score [MSSS] P = 0.64). Following subgroup analysis, only the primary progressive (PPMS) form of MS had a reduced corneal sensitivity with P = 0.023, while remittent-recurrent (RRMS), secondary progressive (SPMS), and clinically isolated (CIS) forms of MS did not have any reduction in the corneal sensitivity. "ROC curve analysis" showed an area under the curve of 0.48. CONCLUSION: In the exception of PPMS subtype, MS patients have similar corneal sensitivity in comparison to controls. Cochet-Bonnet esthesiometer does not seem to be a good diagnostic tool or a disease severity marker for patients with MS.

Corneal Cross-Linking for Keratoconus and Post-LASIK Ectasia and Failure Rate: A 3 Years Follow-Up Study.

Purpose To report the response of keratoconus (KC) and post-LASIK ectasia (referred to as "ectasia") to the corneal crosslinking (CXL) and to compare the rate of progression between KC and ectasia at three years. Methods A retrospective cohort study of patients undergoing CXL for either KC or ectasia. Fifty-four eyes (31 patients) with ectasia and 111 eyes (67 patients) with KC were included in the study. Corrected distance visual acuities (CDVA), refraction, keratometry (K), and pachymetry were followed up for three years. Simultaneous photorefractive keratectomy (PRK) and CXL were performed on 20 KC and 20 ectasia eyes. Intrastromal Corneal Ring Segments (ICRS) were performed on 51 KC and six ectasia eyes. Results In KC, CDVA, spherical equivalence, sphere, cylinder, and mean K improved at three years post-CXL (p-value<0.05), but these values improved without reaching a statistical significance in ectasia(p-values <0.05). 12 of 54 eyes with ectasia (22.2%) and 4 of 111 eyes (3.6%) with KC had progression post CXL(p-value:0.0001). Ectasia patients diagnosed with progression were older at presentation (36.1 years) than non-progressive ectasia patients (31 years) (p-value 0.02) and also older than KC patients. Sub-analysis excluding PRK and ICRS cases showed that there was an improvement in mean sphere (from -5.23±4.2D to-4.46±3.89D) (p-value 0.03) cylinder (from 2.54 ± 1.68D to 1.97 ± 1.51D) (p-value 0.03) mean keratometry (from 46.81 ± 3.78D to 46.01 ± 3.25D) (p-value 0.006) in KC patients 3 years post CXL (40 patients). Compared to baseline, all the mean refractive and topographic variables deteriorated at three years post CXL in ectasia (28 patients) (p-value>0.05). Also, 2 of 40 patients with KC (5%) vs. 7 of 28 patients with ectasia (25%) had progression three years post-CXL, and the difference between both groups remained statistically significant(p-value 0.027). Conclusion Eyes with post-LASIK ectasia seem to be less responsive to CXL than KC.

Biologic stromal ring to manage stromal melting after intrastromal corneal ring segment implantation.

We report a new technique to replace a manufactured poly(methyl methacrylate) (PMMA) ring with a biologic stromal ring fashioned from human corneal donor tissue in eyes with stromal melting above the PMMA ring. The biologic stromal ring is prepared using manual or femtosecond laser trephination of a donor cornea to obtain a 360-degree ring that is denuded and adjusted to match the PMMA ring being replaced. The biologic ring is attached to the PMMA ring. The PMMA ring is pushed and retrieved from the other side, which installs the biologic ring in place. Six biologic stromal rings were implanted successfully in 5 eyes of 5 patients with previous stromal melting; no complications were reported up to 6 months postoperatively. The biologic stromal ring stopped and healed the melting, prevented further ring complications, and preserved the therapeutic refractive effect of the previously implanted PMMA ring.

Dual antiplatelet therapy up to the time of non-elective coronary artery bypass grafting with prophylactic platelet transfusion: is it safe?

BACKGROUND: Guidelines suggest that patients discontinue Clopidogrel at least 5 days prior to coronary artery bypass grafting (CABG). Those with acute coronary syndrome (ACS) are at high risk for myocardial infarction (MI) if not treated with dual antiplatelet therapy (DAPT). We sought to assess pre and post-operative outcomes of patients maintained on Clopidogrel and aspirin up to the time of surgery and compare them with those on aspirin alone. METHODS: From the cardiac surgery database, 240 patients were retrospectively registered between January and May 2017. There were 126 patients with ACS who underwent CABG on DAPT (Clopidogrel group [CG]) and 114 patients who underwent elective CABG on aspirin alone (control). The CG received intraoperative prophylactic platelet transfusion (PPT). Demographics, comorbidities, and laboratory data were prospectively entered at the time of surgery and were subsequently retrieved for analysis. Per and postoperative findings were identified and compared between both groups. RESULTS: The cohort consisted of 240 patients (mean age 61 years, 81.3% were male, SD ± 9.58). Patients in the CG were younger (Median 57 vs. 63, P-value 0.001), and with male predominance (86% versus 75%, P-value 0.028). In addition, they had less prevalence for diabetes and renal failure as compared to control (P-values 0.003, and 0.005, respectively). There were no significant differences between both groups in number of vessels grafts, duration of on-pump and aortic clamp. Hematologic laboratory data had also similar baseline values. The CG had similar bleeding rate, redo surgery and in-hospital death (P-values non-significant), however more infection and total hospital stay as compared to control (p-values 0.048 and 0.001). CONCLUSION: Patients who are at increased risk for MI can be maintained on DAPT up to the time of CABG because surgery is safe when patients are offered PPT.