Dictionary of immune responses to cytokines at single-cell resolution.

Cytokines mediate cell-cell communication in the immune system and represent important therapeutic targets1-3. A myriad of studies have highlighted their central role in immune function4-13, yet we lack a global view of the cellular responses of each immune cell type to each cytokine. To address this gap, we created the Immune Dictionary, a compendium of single-cell transcriptomic profiles of more than 17 immune cell types in response to each of 86 cytokines (>1,400 cytokine-cell type combinations) in mouse lymph nodes in vivo. A cytokine-centric view of the dictionary revealed that most cytokines induce highly cell-type-specific responses. For example, the inflammatory cytokine interleukin-1ß induces distinct gene programmes in almost every cell type. A cell-type-centric view of the dictionary identified more than 66 cytokine-driven cellular polarization states across immune cell types, including previously uncharacterized states such as an interleukin-18-induced polyfunctional natural killer cell state. Based on this dictionary, we developed companion software, Immune Response Enrichment Analysis, for assessing cytokine activities and immune cell polarization from gene expression data, and applied it to reveal cytokine networks in tumours following immune checkpoint blockade therapy. Our dictionary generates new hypotheses for cytokine functions, illuminates pleiotropic effects of cytokines, expands our knowledge of activation states of each immune cell type, and provides a framework to deduce the roles of specific cytokines and cell-cell communication networks in any immune response.

Presence of co-infection between bovine leukemia virus and bovine herpesvirus 1 in herds vaccinated against bovine respiratory complex.

The aim of this study was molecular identification of bovine leukemia virus and possible co-infection with bovine respiratory disease complex (BRDC) viral agents in Mexican dairy herds. We collected 533 blood samples from cattle vaccinated against the BRDC virus in 9 states across Mexico. Peripheral blood leukocytes were removed and genetic material was extracted to detect bovine leukemia virus (BLV), bovine herpesvirus 1 (BoHV-1), bovine viral diarrhea virus (BVDV), bovine parainfluenza virus 3 (BPIV-3), and bovine respiratory syncytial virus (BRSV) infection using polymerase chain reaction. We identified high BLV infection rates in 270 cattle (50.65%). One hundred and thirty-three cows (24.95%) tested positive for BoHV-1, of which 65 samples were positive for both viruses (BoHV-1 and BLV) and 68 were only positive for BoHV-1. Only 4 samples tested positive for BPIV-3 and no sample was positive for BVDV or BRSV. Relative risk and odds ratio analyses did not identify that the presence of BLV infection favors BoHV-1 co-infection in vaccinated herds.

Le but de cette étude était l'identification moléculaire du virus de la leucémie bovine et une éventuelle co-infection par des agents viraux du complexe des maladies respiratoires bovines (BRDC) dans des troupeaux laitiers mexicains. Nous avons recueilli 533 échantillons de sang de bovins vaccinés contre le virus BRDC dans neuf états du Mexique. Les leucocytes du sang périphérique ont été prélevés et le matériel génétique a été extrait pour détecter le virus de la leucémie bovine (BLV), le virus de l'herpès bovin 1 (BoHV-1), le virus de la diarrhée virale bovine (BVDV), le virus parainfluenza bovin 3 (BPIV-3), et le virus respiratoire syncytial bovin (BRSV) par réaction d'amplification en chaîne par la polymérase. Nous avons identifié des taux élevés d'infection par le BLV chez 270 bovins (50,65 %). Cent trente-trois bovins (24,95 %) ont été testés positifs pour le BoHV-1, desquels 65 échantillons étaient positifs pour les deux virus (BoHV-1 et BLV) et 68 étaient uniquement positifs pour le BoHV-1. Seuls quatre échantillons ont été testés positifs pour le BPIV-3 et aucun échantillon n'a été positif pour le BVDV ou le BRSV. Les analyses du risque relatif et des rapports de cotes n'ont pas identifié que la présence d'une infection par le BLV favorise la co-infection par le BoHV-1 dans les troupeaux vaccinés.(Traduit par les auteurs).

Study of the Genetic Expression of Antiretroviral Restriction Factors and Acute Phase Proteins in Cattle Infected with Bovine Leukemia Virus.

The goal of this study was to analyze the genetic expression of antiretroviral restriction factors (ARF) and acute phase proteins (APP), as well as their correlation with proviral and viral loads in cattle with aleukemic (AL) and persistent lymphocytosis (PL). Complete blood samples were collected from a herd of dairy cows, and we extracted genetic material from peripheral blood leukocytes. Absolute quantification of the expression of ARF (APOBEC-Z1, Z2, and Z3; HEXIM-1, HEXIM-2, and BST2) and APP (haptoglobin (HP), and serum amyloid A (SAA)) was performed by qPCR. Statistical significance was observed in the expression of APOBEC-Z3 in BLV-infected animals. We only found positive correlations with a strong expression of the ARF genes in the AL group. The participation of APOBEC (Z1 and Z3), HEXIM-1, and HEXIM-2 was more frequently identified in BLV-infected animals. HEXIM-2 showed active gene expression in the AL group. Although the expression of ARF in early stages of infection (AL) maintains an important participation, in late stages (PL) it seems to have little relevance.

Visual performance and impact of residual refractive errors with trifocal intraocular lenses of different aspheric design.

BACKGROUND: To assess the visual quality and the tolerance to low refractive errors of two trifocal intraocular lenses (IOL) with different amounts of spherical aberration (SA). METHODS: The study included patients having bilateral implantation of the AcrySof® IQ PanOptixTM (aberration-correcting) or the RayOneTM (aberration-free) Trifocal IOL. Three months after the surgery patients underwent: monocular/binocular and uncorrected/corrected distance visual acuity (VA) and binocular defocus curves. Binocular contrast sensitivity (CSF) and subjective halo perception were assessed with the best distance correction (CDVA), with a positive defocus of + 0.50D and with a negative defocus of -0.50D. Patient's satisfaction was evaluated with the Catquest9-SF questionnaire. RESULTS: This study included 54 eyes (28 with PanOptix and 26 with RayOne) of 27 patients. Both groups achieved corrected/uncorrected and monocular/binocular distance VA values better than 0.0 logMAR (1.0 decimal) with no statistically significant differences between them (p > 0.05 for all cases). Defocus curves showed a VA of 0.1 logMAR or better between -2.5 and + 1.0D with no differences between groups (p > 0.05 at all distances). Overall CSF values remained stable under the induced residual refractions for both groups. The halo effect remained stable for the PanOptix group but increased with myopization in the RayOne group (p = 0.02). The questionnaire showed high rates of patient's satisfaction with no differences between groups. CONCLUSION: Both lenses showed overall good visual outcomes and offered high rates of patient's satisfaction. Moreover, in normal patients with trifocal IOLs, the combination of residual refractive errors and certain amounts of SA may increase some visual disturbances.

Sequential Semiology of Seizures and Brain Perfusion Patterns in Patients with Drug-Resistant Focal Epilepsies: A Perspective from Neural Networks.

Ictal semiology and brain single-photon emission computed tomography have been performed in approaching the epileptogenic zone in drug-resistant focal epilepsies. The authors aim to describe the brain structures involved in the ictal and interictal epileptogenic network from sequential semiology and brain perfusion quantitative patterns analysis. A sequential representation of seizures was performed (n = 15). A two-level analysis (individual and global) was carried out for the analysis of brain perfusion quantification and estimating network structures from the perfusion indexes. Most of the subjects started with focal seizures without impaired consciousness, followed by staring, automatisms, language impairments and evolution to a bilateral tonic-clonic seizure (temporal lobe and posterior quadrant epilepsy). Frontal lobe epilepsy seizures continued with upper limb clonus and evolution to bilateral tonic-clonic. The perfusion index of the epileptogenic zone ranged between 0.439-1.362 (mesial and lateral structures), 0.826-1.266 in dorsolateral frontal structures and 0.678-1.507 in the occipital gyrus. The interictal epileptogenic network proposed involved the brainstem and other subcortical structures. For the ictal state, it included the rectus gyrus, putamen and cuneus. The proposed methodology provides information about the brain structures in the neural networks in patients with drug-resistant focal epilepsies.

Visual and refractive outcomes of monofocal toric intraocular lens implantation in amblyopic eyes.

PURPOSE: To evaluate the visual and refractive outcomes of monofocal toric intraocular lens (IOL) implantation after cataract surgery in amblyopic eyes. METHODS: Our center's database was used to identify patients who had undergone bilateral cataract surgery between 2016 and 2020 with the implantation of a toric IOL in their amblyopic eye. Exclusion criteria were the presence of strabismus, ocular pathologies other than cataract or intra-surgical complications. The outcomes analysed were uncorrected distance visual acuity (UDVA), subjective refraction and corrected distance visual acuity (CDVA) one month after surgery. RESULTS: Ninety patients were included, with a mean age of 68.96 ± 7.81years. CDVA was lower for the amblyopic eye, both before and after surgery. There was a mean improvement in CDVA of 0.23 ± 0.21 LogMAR for the dominant eye and of 0.39 ± 0.33 for the amblyopic eye, p < 0.001 in both cases. Postoperative subjective refractive cylinder was higher in the amblyopic eye (-0.24 ± 0.39 D versus -0.10 ± 0.25 D, p < 0.01), as well as mean cylinder prediction error (-0.30 ± 0.47 D versus 0.02 ± 0.42 D, p < 0.01), compared to the dominant eye. There was a statistically significant correlation between preoperative and postoperative CDVA in amblyopic eyes (Spearmans Rho = 260, p = 0.013). Mean postoperative UCVA was 0.15 ± 0.25 for amblyopic and 0.03 ± 0.12 for dominant eyes. Only one patient required distance spectacle correction due to residual astigmatism. CONCLUSIONS: Cataract surgery with toric IOL implantation in amblyopic eyes leads to an improvement in visual acuity and to spectacle independence in almost all cases, even in the presence of a higher cylinder prediction error.

Effect of residual astigmatism and defocus in eyes with trifocal intraocular lenses.

PURPOSE: To assess the effect on visual function of different residual astigmatic situations combined with 0.50 diopters (D) negative defocus at different distances in patients with trifocal intraocular lenses (IOLs). SETTING: Clínica Rementería, Madrid, Spain. DESIGN: Prospective case series. METHODS: The study included patients implanted with AcrySof IQ PanOptix IOL. Visual acuity (VA) was measured at far distance (0.00 D of vergence) and at -1.5 D, -2.5 D, and -3.0 D of vergence. Residual astigmatism was induced by adding 0.50 D and 1.00 D cylindrical lenses placed at 90 degrees (against the rule [ATR]), 45 degrees (oblique), and 180 degrees (with the rule). All measurements were made with distance correction (emmetropia as the reference situation) and with a simulated residual myopia of 0.50 D. RESULTS: The study included 61 eyes of 61 patients. Residual astigmatism of 0.50 D and 1.0 D was induced in 28 and 33 eyes, respectively. For both groups, distance and intermediate VAs were better for the reference situation (P < .001 for all cases). With 1.0 D of cylinder (without and with induced defocus), the proportion of patients who lost ≥2 lines was higher for the ATR astigmatism. For near vision, differences were smaller for all simulated situations. CONCLUSIONS: Residual astigmatism of up to 0.50 D, regardless of its orientation, seems to be tolerated at all distances. For astigmatisms of 1.0 D, distance and intermediate VAs decreased significantly, and ATR orientations showed worse results in a higher proportion of patients. The combination of astigmatism with residual myopia significantly decreased distance VA, whereas this negative shift affected near VA less.

Corrigendum: Segmentation of Older Adults in the Acceptance of Social Networking Sites Using Machine Learning.

[This corrects the article DOI: 10.3389/fpsyg.2021.705715.].

Segmentation of Older Adults in the Acceptance of Social Networking Sites Using Machine Learning.

This study analyzes the most important predictors of acceptance of social network sites in a sample of Chilean elder people (over 60). We employ a novelty procedure to explore this phenomenon. This procedure performs apriori segmentation based on gender and generation. It then applies the deep learning technique to identify the predictors (performance expectancy, effort expectancy, altruism, telepresence, social identity, facilitating conditions, hedonic motivation, perceived physical condition, social norms, habit, and trust) by segments. The predictor variables were taken from the literature on the use of social network sites, and an empirical study was carried out by quota sampling with a sample size of 395 older people. The results show different predictors of social network sites considering all the samples, baby boomer (born between 1947 and 1966) males and females, silent (born between 1927 and 1946) males and females. The high heterogeneity among older people is confirmed; this means that dealing with older adults as a uniform set of users of social network sites is a mistake. This study demonstrates that the four segments behave differently, and many diverse variables influence the acceptance of social network sites.

Social isolation of adolescent male rats increases anxiety and K+ -induced dopamine release in the nucleus accumbens: Role of CRF-R1.

Early life adversity can disrupt development leading to emotional and cognitive disorders. This study investigated the effects of social isolation after weaning on anxiety, body weight and locomotion, and on extracellular dopamine (DA) and glutamate (GLU) in the nucleus accumbens (NAc) and their modulation by corticotropin releasing factor receptor 1. On the day of weaning, male rats were housed singly or in groups for 10 consecutive days. Anxiety-like behaviors were assessed by an elevated plus maze (EPM) and an open field test (OF). Neurotransmitter levels were measured by in vivo microdialysis. Single-housed rats spent less time, and entered more, into the closed arms of an EPM than group-housed rats. They also spent less time in the center of an OF, weighed more and showed greater locomotion. In the NAc, no differences in CRF, or in basal extracellular DA or GLU between groups, were observed. A depolarizing stimulus increased DA release in both groups but to higher levels in isolated rats, whereas GLU increased only in single-housed rats. Blocking CRF-R1 receptors with CP-154,526 decreased DA release in single-housed but not in group-housed rats. The corticotropin releasing factor receptor type 1 receptor antagonist also decreased GLU in group-housed animals. These results show that isolating adolescent rats increases anxiety, body weight and ambulation, as well as the sensitivity of dopaminergic neurons to a depolarizing stimulus. This study provides further evidence of the detrimental effects of social isolation during early development and indicates that dysregulation of the CRF system in the NAc may contribute to the pathologies observed.

Impact of Trifocal and Trifocal Toric Intraocular Lenses on Spectral-domain OCT Retinal Measurements.

PRECIS: Monofocal, trifocal, and trifocal toric intraocular lenses (IOLs) induce similar changes on overall retinal optical coherence tomography (OCT) measurements. PURPOSE: The purpose of this study was to assess whether trifocal and trifocal toric IOLs affect the measurement of retinal parameters using spectral-domain OCT. METHODS: This cross-over study included patients undergoing implantation of a trifocal IOL: AcrySof IQ PanOptix, a trifocal toric IOL: AcrySof IQ PanOptix Toric, and a monofocal IOL: AcrySof IQ. The monofocal group was considered as the control group. The refractive target was emmetropia in all cases. Mean average macular thickness, macular volume, and retinal nerve fiber layer (RNFL) thickness were measured with the Cirrus HD-OCT. All measurements were performed before and 3 months after the surgery. RESULTS: The study analyzed 150 eyes of 150 patients (50 for each IOL group). Macular thickness and macular volume showed statistically significant differences before and after the surgery for the 3 groups (P<0.05 in all cases). RNFL thickness was found to be similar before and after the surgery in all groups (P>0.05 in all cases). Mean difference values (before and after the surgery) in the monocular, trifocal, and trifocal toric group for macular thickness, macular volume, and RNFL thickness were 4.9±7.8, 7.9±10.0, and 7.7±13.7 µm, respectively; 0.1±0.2, 0.2±0.4, and 0.2±0.3 mm3, respectively; and 0.8±5.5, 1.3±6.0, and 0.8±6.7 µm, respectively. Mean differences were found to be similar for the 3 groups. CONCLUSION: The trifocal and the trifocal toric IOLs under study did not induce an additional impact on spectral-domain OCT retinal measurements compared with monofocal IOLs.

Real-world evaluation of visual results and patient satisfaction for extended range of focus intraocular lenses compared to trifocal lenses.

PURPOSE: To report visual outcomes and patient-perceived satisfaction after trifocal or extended depth-of-focus (EDOF) intraocular lens (IOL) implantation in a real-world scenario. METHODS: Three months after bilateral cataract surgery, corrected and uncorrected visual acuity for far, intermediate and near distances and binocular defocus curves and contrast sensitivity were measured. The patients also completed the Catquest SF-9 questionnaire and reported on dysphotopsia and spectacle use. RESULTS: There were 23 patients in the Symfony, 32 patients in the Finevision and 36 patients in the Panoptix group. The percentage of eyes receiving a toric IOL was 41.2%. There were no differences in uncorrected binocular visual acuities, save for near vision, which was lower in the Symfony group. Binocular defocus curves for the trifocal IOLS were almost identical, while vision achieved with the Symfony IOL was significantly lower starting at - 1.5 D defocus. Contrast sensitivity, as well as the perception of halos and glare and the difficulty for night-driving was similar for all groups, except for contrast sensitivity at 6 cycles per degree, which was lower in the Symfony group compared to both Finevision and Panoptix. For near vision, only 47.6% of the Symfony patients reported being completely spectacle-free, compared to 93.3% and 94.4% for the Finevision and Panoptix groups. CONCLUSIONS: Clinically relevant differences were only detected for near vision, with lower values for EDOF IOLs. In order to achieve patient satisfaction, it is imperative to explain the results expected with each IOL; for EDOF IOLs, patients should be advised that they may require near-spectacle correction.

Automated refraction after trifocal and trifocal toric intraocular lens implantation.

BACKGROUND: To analyze the correlation between automated refraction and manifest refraction after implantation of a trifocal intraocular lens or its toric version. METHODS: This cross-sectional study involved 105 eyes of 105 patients. Subjects were divided in two groups: 62 with trifocal (AcrySof PanOptix) and 43 with trifocal toric (AcrySof PanOptix Toric) intraocular lenses. Automated refraction was employed as starting point for obtaining the manifest refraction. Automated refraction and manifest refraction measurements were analyzed and compared using the vector analysis 3 months after the surgery. RESULTS: In both groups, the higher differences between automated refraction and manifest refraction measurements were found for the cylinder and the spherical equivalent (M). Cylinder values for PanOptix were: -0.60 ± 0.36 D with automated refraction and -0.17 ± 38 D with manifest refraction (p < 0.001); for PanOptix Toric, the values were: -0.49 ± 0.31 D with automated refraction and -0.05 ± 0.21 D with manifest refraction (p < 0.001). M values for PanOptix were: -0.23 ± 0.31 D with automated refraction and -0.03 ± 0.16 D with manifest refraction (p < 0.001); for PanOptix Toric, the values were: -0.13 ± 0.40 D with automated refraction and 0.01 ± 0.12 D with manifest refraction (p < 0.001). For the PanOptix group, intraclass correlation coefficients were: 0.51 (sphere), 0.64 (cylinder), 0.42 (M), 0.62 (J0), and 0.37 (J45). For the PanOptix Toric group, the intraclass correlation coefficients were: 0.39 (sphere), 0.61 (cylinder), 0.39 (M), 0.53 (J0), and 0.09 (J45). CONCLUSION: The results of this study suggest that patients implanted with the trifocal and the trifocal toric intraocular lens under study showed similar automated refraction results between them, with a slight trend to more negative amounts of cylinder and M. Nevertheless, clinicians should carefully confirm all parameters of the refraction with manifest refraction.

Tolerance to Residual Refractive Errors After Trifocal and Trifocal Toric Intraocular Lens Implantation.

OBJECTIVE: The objective of this study was to assess the impact of 0.50 diopter (D) positive or negative defocus on visual function in patients implanted with trifocal and trifocal toric intraocular lenses (IOLs). METHODS: The study included patients implanted with the AcrySof IQ PanOptix IOL or the PanOptix Toric. Visual acuity (VA) at high (100%), medium (50%) and low (10%) contrast, contrast sensitivity function (CSF), and halo perception were assessed three months after surgery. Explorations were performed with corrected distance visual acuity (CDVA), with a positive defocus of +0.50D (myopization) and with a negative defocus of -0.50D (hyperopization). RESULTS: The study included 60 eyes of 60 patients (30 eyes with PanOptix and 30 eyes with PanOptix Toric). For both groups, VA was better for all contrast settings at the CDVA situation (P<0.05 in all cases). For low spatial frequencies, no differences in CSF were found among the three refractive situations in either group. For higher frequencies, the results showed an overall trend for better CSF results for the CDVA situation. The halo effect was lower for the CDVA situation if compared to myopization and hyperopization in both the PanOptix and the PanOptix Toric groups (P<0.05 for all cases). CONCLUSIONS: There is an impact on visual quality and halo perception in patients implanted with trifocal or trifocal toric IOLs even for low residual refractive errors.

Visual and Refractive Outcomes of Cataract Surgeries Performed in One Year in a Private Practice Setting: Review of 2714 Procedures.

METHODS: Our center's database was used to identify all isolated cataract procedures performed during 2017. The electronic records were reviewed to collect the preoperative information, presence of intra- or postsurgical complications, and visual and refractive outcomes one month after surgery. RESULTS: In 2017, 2714 eyes of 1543 patients underwent cataract surgery in our center. Mean patient age was 70.42 years. 775 eyes (28.55%) had prior ophthalmic pathologies, and 113 eyes (4.16%) had undergone previous surgical procedures. Surgical complications developed in 35 eyes (1.29%), including 9 posterior capsule tears (0.33%) and 3 cases of dropped lens fragments (0.11%). A toric or multifocal intraocular lens was implanted in 45.6% of eyes. As regards postoperative complications, 59 eyes (2.17%) required a return to the operating theater, including 29 eyes (1.07%) requiring reinterventions due to an unexpected refractive result. There were no cases of endophthalmitis. Mean LogMAR-corrected distance visual acuity (CDVA) improved from 0.25 (SD 0.34) preoperatively to 0.04 (SD 0.17) postoperatively; 86.5% of eyes achieved a CDVA ≤0.0, with 97.5% achieving ≤0.3. In 86.4% of eyes, the difference between target and residual spherical equivalent difference was of 0.50 D or lower; 88% of eyes had a spherical equivalent ±0.50 D. CONCLUSIONS: The visual and refractive outcomes of cataract surgery in a private practice setting were excellent, well over the benchmarks set by the ESCRS. The safety profile was also within expected standards. This study provides information for ophthalmologists in private practice on expected outcomes.

Check-in Kiosks in the Outpatient Clinical Setting: Fad or the Future?

OBJECTIVES: Check-in kiosks are increasingly used in health care. This project aims to assess the effects of kiosk use upon check-in duration, point of service (POS) financial returns, and patient satisfaction. METHODS: Six kiosks were implemented in a large academic orthopedic clinic, and check-in duration for 8.5 months following implementation and POS returns for 10.5 months before and after implementation were analyzed. Consumer Assessment of Healthcare Providers and Systems Clinician and Group survey and self-devised surveys recorded patient satisfaction. RESULTS: Cumulatively, 28,636 kiosk-based patient encounters were analyzed. Compared with historical norms, check-in duration decreased 2 minutes, 47 seconds (P < 0.001). Daily gross and individual POS returns increased $532.13 and $1.89, respectively (P < 0.001). Satisfaction surveys were completed by 719 of 1376 consecutive patients (52% response rate), revealing 12% improvement (P < 0.001), but Consumer Assessment of Healthcare Providers and Systems Clinician and Group survey responses demonstrated no change (P = 0.146, 0.928, and 0.336). CONCLUSIONS: Kiosks offer to reduce check-in duration and increase POS revenue without negatively affecting patient satisfaction.

The rising use of total hip arthroplasty for femoral neck fractures in the United States.

BACKGROUND: We examined the trends in the treatment of femoral neck fractures with arthroplasty in the United States from 2004-2013. METHODS: We used the National Inpatient Sample database in conjunction with codes from the International Classification of Diseases, Ninth Revision, to identify patients receiving hemiarthroplasty (HA) or total hip arthroplasty (THA) for the treatment of closed femoral neck fracture from 2004-2013. We evaluated the trend of these 2 treatments along with demographics, comorbidities, length of stay and same admission mortality. RESULTS: Our study identified 1,059,414 patients who underwent arthroplasty for the treatment of femoral neck fracture. We found a 42% increase in the use of THA during the study period from 8.4% in 2004 to 12.9% in 2013. While the large majority of patients received HA (87.1%), there was an overall decline in the use of HA (89,132 in 2004 to 85,635 in 2013) and increase in the use of THA (8,177 in 2004 to 11,375 in 2013). Patients receiving THA were younger (mean age 74.7 THA vs. 80.4 HA, p < 0.001) with fewer comorbidities, higher likelihood of discharge to home (24% THA vs. 10% HA, p < 0.001) and lower inpatient mortality rates (1.5 % THA vs. 2.4 % HA, p < 0.001) in comparison to HA. CONCLUSION: There has been a significant increase in the use of THA over the last decade. Patients receiving THA were younger and healthier with fewer comorbidities, less likely to sustain a same admission mortality and more likely to discharge to home in comparison to HA patients.

Visual quality and patient satisfaction with a trifocal intraocular lens and its new toric version.

PURPOSE: To assess and compare the visual quality and subjective outcomes of a trifocal spherical intraocular lens (IOL) and its new toric version. SETTING: Clínica Rementería, Madrid, Spain. DESIGN: Prospective case series. METHODS: Patients had bilateral implantation of the AcrySof IQ PanOptix spherical or toric IOL. Three months postoperatively, monocular and the binocular uncorrected and corrected distance, intermediate, and near visual acuities; binocular defocus curves; and binocular contrast sensitivity function (CSF) were assessed. Patient satisfaction was evaluated with the Catquest 9SF questionnaire. RESULTS: The study comprised 250 eyes (166 with spherical IOL; 84 with toric IOL) of 125 patients. Both groups had good monocular visual acuity at all distances with no statistically significant differences between groups. The mean monocular uncorrected acuity in the spherical group was 0.06 logarithm of the minimum angle of resolution (logMAR) ± 0.07 (SD), 0.20 ± 0.10 logMAR, and 0.05 ± 0.07 logMAR for far, intermediate, and near, respectively, and in the toric group, 0.07 ± 0.10 logMAR, 0.23 ± 0.20 logMAR, and 0.07 ± 0.12 logMAR, respectively. Defocus curves showed a visual acuity of 0.1 logMAR or better between -2.5 diopters (D) and +0.5 D with no differences between groups. The CSF values were within normal ranges with both IOLs. The questionnaire showed high rates of patient satisfaction with no differences between groups. CONCLUSIONS: The visual outcomes with the 2 IOLs were similar. With optimum implantation and alignment, the trifocal toric IOL seems to provide visual quality and patient satisfaction that is equivalent to that with the nontoric version with the same platform.

Adoption of Intramedullary Nail Fixation for Proximal Humerus Fractures: Assessment of Surgical Efficiency and Complications.

Fixation of proximal humerus fractures (PHFs) with intramedullary (IM) nails potentially is a newer, less invasive technique. The purpose of this study was to report on the early adoption results of IM nail use for PHF. Retrospective chart reviews were performed on the first 60 patients treated with IM nails for acute PHFs by two shoulder surgeons. The first 15 patients treated by each surgeon were compared with the subsequent 15 patients. Surgical and fluoroscopic times, fracture type, union, and varus collapse were compared. The average operating time decreased (p = .002). Fluoroscopy time, radiographic alignment, union rate, complications, and reoperations were not influenced. Three- and four-part fractures had a higher complication rate than two-part fractures (53% vs. 20%). When considering implementing use of IM nails for treatment of PHFs, initial cases can have outcomes and complications similar to those performed with greater experience. IM nailing appears a good treatment option for two-part PHFs. (Journal of Surgical Orthopaedic Advances 28(2):121-126, 2019).