Age and number of lesions predict chalazion recurrence.

PURPOSE: Periocular lesions in pediatric patients usually require general anesthesia for surgical intervention. The US Food and Drug Administration (FDA) warns against multiple exposures to anesthesia in children younger than 3 years due to the increased risk of learning disabilities in this population. This study aimed to evaluate risk factors associated with chalazion recurrence after surgery. METHODS: A retrospective chart review over a five-year period identified 649 patients at our institution undergoing surgical intervention for chalazion. The primary outcomes examined were as follows: (1) return to the operating room for additional surgical intervention and (2) recurrence of chalazion during convalescence from surgery and follow-up. RESULTS: Fewer than one-third of patients suffered a recurrence after surgery. Multivariate logistic regression found younger age (p = 0.01), female sex (p = 0.01), and a greater number of chalazia drained (p < 0.001) were significantly correlated with recurrence of chalazia after surgery. CONCLUSIONS: Patients presenting at a younger age and with a greater number of chalazion were statistically more likely to have a recurrence of chalazion after surgery. Given recurrence is more likely in younger children, reconciling this with the risk-benefit ratio with regard to FDA guidelines on anesthesia in children under three years is a critical consideration for ophthalmologists.

A comprehensive analysis of lung cancer highlighting epidemiological factors and psychiatric comorbidities from the All of Us Research Program.

Lung cancer is the leading cause of cancer-related mortality in the United States. Investigating epidemiological and clinical parameters can contribute to an improved understanding of disease development and management. In this cross-sectional, case-control study, we used the All of Us database to compare healthcare access, family history, smoking-related behaviors, and psychiatric comorbidities in light smoking controls, matched smoking controls, and primary and secondary lung cancer patients. We found a decreased odds of primary lung cancer patients versus matched smoking controls reporting inability to afford follow-up or specialist care. Additionally, we found a significantly increased odds of secondary lung cancer patients having comorbid anxiety and insomnia when compared to matched smoking controls. Our study provides a profile of the psychiatric disease burden in lung cancer patients and reports key epidemiological factors in patients with primary and secondary lung cancer. By using two controls, we were able to separate smoking behavior from lung cancer and identify factors that were mediated by heavy smoking alone or by both smoking and lung cancer.

HLA mismatch is important for 20-year graft survival in kidney transplant patients.

BACKGROUND: Human leukocyte antigens (HLA) matching is gradually being omitted from clinical practice in evaluation for renal allograft transplant. While such practices may yield shorter wait times and adequate short-term outcomes, graft longevity in HLA mismatched patients remains unclear. This study aims to demonstrate that HLA matching may still play an important role in long-term graft survival. METHODS: We identified patients undergoing an index kidney transplant in the United Network for Organ Sharing (UNOS) data from 1990 to 1999, with one-year graft survival. The primary outcome of the analysis was graft survival beyond 10 years. We explored the long-lasting impact of HLA mismatches by landmarking the analysis at established time points. RESULTS: We identified 76,530 patients receiving renal transplants in the time frame, 23,914 from living donors and 52,616 from deceased donors. On multivariate analysis, more HLA mismatches were associated with worse graft survival beyond 10 years for both living and deceased donor allografts. HLA mismatch continued to remain an essential factor in the long term. CONCLUSIONS: A greater number of HLA mismatches was associated with progressively worse long-term graft survival for patients. Our analysis reinforces the importance of HLA matching in the preoperative evaluation of renal allografts.

New Practical Aspects of Sweet Syndrome.

Sweet syndrome (SS), or acute febrile neutrophilic dermatosis, is an inflammatory, non-infectious skin reaction characterized clinically by tender, erythematous papules/plaques/pustules/nodules commonly appearing on the upper limbs, trunk, and head and neck; histologically, SS is characterized by dense neutrophilic infiltrate in the dermis. SS is accompanied by fever; an elevation of inflammatory markers (e.g., erythrocyte sedimentation rate, C reactive protein) in serum may also be observed. Although most cases of SS are idiopathic, SS also occurs in the setting of malignancy or following administration of an associated drug. SS has also been reported in association with pregnancy and a burgeoning list of infectious (most commonly upper respiratory tract infections) and inflammatory diseases; likewise, the litany of possible iatrogenic triggers has also grown. Over the past several years, a wider spectrum of SS presentation has been realized, with several reports highlighting novel clinical and histological variants. Corticosteroids continue to be efficacious first-line therapy for the majority of patients with SS, although novel steroid-sparing agents have been recently added to the therapeutic armamentarium against refractory SS. New mechanisms of SS induction have also been recognized, although the precise etiology of SS still remains elusive. Here, we catalogue the various clinical and histological presentations of SS, summarize recently reported disease associations and iatrogenic triggers, and review treatment options. We also attempt to frame the findings of this review in the context of established and emerging paradigms of SS pathogenesis.

Validation of a nonwearable device in healthy adults with normal and short sleep durations.

STUDY OBJECTIVES: To determine the accuracy of early and newer versions of a nonwearable sleep tracking device relative to polysomnography and actigraphy, under conditions of normal and restricted sleep duration. METHODS: Participants were 35 healthy adults (mean age = 18.97; standard deviation = 0.95 years; 77.14% female; 42.86% White). In a controlled sleep laboratory environment, we randomly assigned participants to go to bed at 10:30 pm (normal sleep) or 1:30 am (restricted sleep), setting lights-on at 7:00 am. Sleep was measured using polysomnography, wristband actigraphy (the Philips Respironics Actiwatch Spectrum Plus), self-report, and an early or newer version of a nonwearable device that uses a sensor strip to measure movement, heart rate, and breathing (the Apple, Inc. Beddit). We tested accuracy against polysomnography for total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset. RESULTS: The early version of the nonwearable device (Beddit 3.0) displayed poor reliability (intraclass correlation coefficient [ICC] < 0.30). However, the newer nonwearable device (Beddit 3.5) yielded excellent reliability with polysomnography for total sleep time (ICC = 0.998) and sleep efficiency (ICC = 0.98) across normal and restricted sleep conditions. Agreement was also excellent for the notoriously difficult metrics of sleep onset latency (ICC = 0.92) and wake after sleep onset (ICC = 0.92). This nonwearable device significantly outperformed clinical-grade actigraphy (ICC between 0.44 and 0.96) and self-reported sleep measures (ICC < 0.75). CONCLUSIONS: A nonwearable device showed better agreement than actigraphy with polysomnography outcome measures. Future work is needed to test the validity of this device in clinical populations. CITATION: Hsiou DA, Gao C, Matlock RC, Scullin MK. Validation of a nonwearable device in healthy adults with normal and short sleep durations. J Clin Sleep Med. 2022;18(3):751-757.