Citations

Purpose: The aim of this study was to describe the indications and outcomes of flap amputation after laser in situ keratomileusis (LASIK) at a referral-based institution. Methods: In this retrospective consecutive case series, medical records of patients who underwent LASIK flap amputation at Mayo Clinic, Rochester, MN, between January 1, 1998, and January 31, 2023, were reviewed. Results: Fifteen eyes (15 patients) underwent flap amputation during the study period. The median age was 45 years (range, 25–71 years), and 8 patients (53%) were men. The median uncorrected visual acuity before flap amputation was 20/200 (range 20/40-hand motions). Indications for flap amputation included epithelial ingrowth (n = 6, 40%), infectious keratitis (n = 6, 40%), diffuse lamellar keratitis (n = 1, 7%), vegetative foreign body (n = 1, 7%), and astigmatism from fixed flap striae (n = 1, 7%). The median duration of follow-up was 8 months (range 1–234 months). Subsequent corneal interventions included chelation of calcific band keratopathy (n = 1, 7%), lamellar keratoplasty (n = 1, 7%), penetrating keratoplasty (n = 2, 18%), keratoprosthesis (n = 1, 7%), and rigid contact lens wear (n = 4, 27%). The final median best visual acuity was 20/25 (range 20/20–20/200). Compared with noninfectious indications for flap amputation, eyes with infectious indications had worse baseline median uncorrected visual acuity (hand motions vs. 20/63, P < 0.001), were more likely to undergo major corneal surgical intervention (50% vs. 11%), and had worse final median best visual acuity (20/50 vs. 20/20, P = 0.018). Conclusions: LASIK flap amputation is sometimes necessary to control threatening corneal diseases. Excellent visual outcomes were achieved in most cases, albeit with additional intervention or rigid contact lens wear.

Excess extravascular lung water (EVLW) is a common consequence for patients with congestive heart failure, inflammatory conditions, or acute respiratory distress syndrome. Computed tomography (CT) is widely used to assess EVLW, but with a higher radiation dose and logistical complexity. Lung ultrasound (LUS) using B-line artifacts demonstrates a reasonable correlation with EVLW, but user experience with the acquisition technique, equipment-dependent factors and the subjective analysis of the B-line artifacts results in significant inter-observer variability. We propose a technique to automatically detect lung ultrasound B-lines over heart cycles. The method first extracts B-mode image features from videos in a region of interest (ROI). A ResNet50-UNet network is then applied to segment regions of B-lines. This technique was performed on 8 videos (i.e., 4 patients versus 4 controls with the duration of each video 2–3 s, resolution 1024 × 758 pixels, and frame rate 28 fps). The training accuracy and lossvalue of proposed models were 96.5% and 0.05, respectively. The paired t-test statical analysis shows that there is significant difference (p-value = 0.0035) of total number of B-line between normal and lungs with edema. The proposed method improves the accuracy for counting the B-lines and reduces the labor work and intra-observer variability from different users.

Many lung diseases are associated with dramatic changes in mechanical properties of the lung. Chest radiographs and computed tomography (CT) are the most common clinical methods for evaluating lung disease, but they are expensive, use radiation, and do not measure lung stiffness. Shear wave elastography (SWE) uses ultrasound radiation force (URF) to generate wave propagation in the tissue. However, URF should not be applied to the lung, because there are air and blood in the alveoli. Relatively high-intensity ultrasound can cause alveolar hemorrhage and lung injury. We have developed a noninvasive, and clinically feasible technology, lung ultrasound surface wave elastography (LUSWE), that is capable of measuring lung elastic properties with speed and accuracy. LUSWE uses a handheld shaker to generate a local small harmonic vibration on the chest surface. The resulting wave propagates through the intercostal muscle and propagates on the lung. The surface wave speed is noninvasively measured using an ultrasound technique. LUSWE is safe because diagnostic ultrasound is only used to detect the wave propagation along the lung duo to mechanical wave generation on the chest. LUSWE may be used to assess multiple lung disorders such as lung fibrosis or lung edema.

The evaluation of diffuse lung disease invariably involves chest computerized tomography (CT). The detailed information obtained is often equivalent to that from lung biopsies. It, however, involves exposure to ionising radiation which limits its repeated application in monitoring and follow up. Ultrasound techniques offer potentially safer/cheaper alternatives and lung ultrasound surface wave elastography (LUSWE) is a novel, noninvasive, and clinically feasible technique to quantify lung stiffness, an important biomechanical property that changes in diffuse fibrotic and infiltrative lung diseases. We have developed a sensitive, accurate and reproducible technique to measure changes in lung surface stiffness by using surface wave transmission speed and demonstrated its value in detecting and staging the degree of fibrosis in diffuse interstitial lung diseases, specifically idiopathic pulmonary fibrosis and progressive systemic sclerosis associated lung disease, as well as changes in heart failure. The technique consists of ultrasound detection of the propagation speed of a wave generated by the vibrations from an indenting shaker in multiple intercostal spaces to provide a representative assessment of both lungs. It offers the prospect of simple, radiation-free, repetitive assessment of changes in acute and chronic diffuse lung diseases with the potential for easy and rapid bedside use, all important considerations in clinical practice.

AbstractBackgroundBier anemic spots, cyanosis with urticaria‐like eruption (BASCULE) syndrome is a recently described entity with episodic urticarial lesions and white anemic halos on a background of erythrocyanosis, commonly affecting the lower extremities. Possible association with autonomic dysfunction remains poorly understood. Existing publications are limited, but the condition is suggested as highly underrecognized.ObjectiveTo further characterize clinical and epidemiologic data for BASCULE syndrome.MethodsWe performed an IRB‐approved retrospective chart review on patients with BASCULE syndrome evaluated at Mayo Clinic from April 2021 to November 2022.ResultsA total of 17 patients were identified (13 female, 4 male). Median age of onset was 12 years (range 9–17). Lower extremities were involved in all patients (17). Most patients were symptomatic with pruritus (8) or burning pain (8); three were asymptomatic. Triggers were standing (11), hot showers or hot environments (7), or no clear trigger (4). Autonomic dysfunction was present in 10 patients. Treatment responses were observed from propranolol (3) and high‐dose cetirizine (1).ConclusionNovel epidemiologic data from 17 pediatric and young adult patients with BASCULE syndrome further supports an association with autonomic dysfunction and suggests a higher prevalence than previously acknowledged.

The scarcity of liver grafts has prompted developments in living donor liver transplantations (LDLT), with previous literature illustrating similar outcomes in recipients compared to deceased donor transplants. However, significant concerns regarding living donor morbidity and mortality have yet to be examined comprehensively. This study aims to provide estimates of the incidence of various outcomes in living liver donors. In this meta-analysis, Medline and Embase were searched from inception to July 2022 for articles assessing the incidence of outcomes in LDLT donors. Complications in the included studies were classified into respective organ systems. Analysis of incidence was conducted using a generalized linear mixed model with Clopper-Pearson intervals. Eighty-seven articles involving 60,829 living liver donors were included. The overall pooled incidence of complications in LDLT donors was 24.7% (CI: 21.6%–28.1%). The incidence of minor complications was 17.3% (CI: 14.7%–20.3%), while the incidence of major complications was lower at 5.5% (CI: 4.5%–6.7%). The overall incidence of donor mortality was 0.06% (CI: 0.0%–0.1%) in 49,027 individuals. Psychological complications (7.6%, CI: 4.9%–11.5%) were the most common among LDLT donors, followed by wound-related (5.2%, CI: 4.4%–6.2%) and respiratory complications (4.9%, CI: 3.8%–6.3%). Conversely, cardiovascular complications had the lowest incidence among the subgroups at 0.8% (CI: 0.4%–1.3%). This study presents the incidence of post-LDLT outcomes in living liver donors, illustrating significant psychological, wound-related, and respiratory complications. While significant advancements in recent decades have contributed towards decreased morbidity in living donors, our findings call for targeted measures and continued efforts to ensure the safety and quality of life of liver donors post-LDLT.

The number of kidney after liver transplants (KALT) increased after the implementation of the United Network of Organ Sharing (UNOS) safety net policy, but the effects of the policy on KALT outcomes remain unknown. Using the UNOS database, we identified KALT between 60 and 365 days from liver transplant from January 1, 2010, to December 31, 2020. The main outcome was 1- and 3-year patient, liver, and kidney graft survival. Secondary outcomes included 6-month and 1-year acute rejection (AR) of liver and kidney, and 1-year kidney allograft function. Of the 256 KALT, 90 were pre-policy and 166 post-policy. Compared to pre-policy, post-policy 1- and 3-year liver graft survival was higher (54% and 54% vs. 86% and 81%, respectively, p <0.001), while 1- and 3-year kidney graft survival (99% and 75% vs. 92% and 79%, respectively, p =0.19), and 1- and 3-year patient survival (99% and 99% vs. 95% and 89%, respectively, p =0.11) were not significantly different. Subgroup analysis revealed similar trends in patients with and without renal failure at liver transplant. Liver AR at 6 months was lower post-policy (6.3% vs. 18.3%, p =0.006) but was similar (10.5% vs. 13%, p =0.63) at 1 year. Kidney AR was unchanged post-policy at 6 months and 1 year. Creatinine at 1 year did not differ post-policy versus pre-policy (1.4 vs. 1.3 mg/dL, p =0.07) despite a higher proportion of deceased donors, higher Kidney Donor Profile Index, and longer kidney cold ischemia time post-policy ( p <0.05 for all). This 3-year follow-up after the 2017 UNOS policy revision demonstrated that the safety net implementation has resulted in improved liver outcomes for patients who underwent KALT with no increased AR of the liver or the kidney allografts.

Background Innovative restructuring of cardiac rehabilitation (CR) delivery remains critical to reduce barriers and improve access to diverse populations. Destination Cardiac Rehab is a novel virtual world technology‐based CR program delivered through the virtual world platform, Second Life, which previously demonstrated high acceptability as an extension of traditional center‐based CR. This study aims to evaluate efficacy and adherence of the virtual world–based CR program compared with center‐based CR within a community‐informed, implementation science framework. Methods Using a noninferiority, hybrid type 1 effectiveness‐implementation, randomized controlled trial, 150 patients with an eligible cardiovascular event will be recruited from 6 geographically diverse CR centers across the United States. Participants will be randomized 1:1 to either the 12‐week Destination Cardiac Rehab or the center‐based CR control groups. The primary efficacy outcome is a composite cardiovascular health score based on the American Heart Association Life's Essential 8 at 3 and 6 months. Adherence outcomes include CR session attendance and participation in exercise sessions. A diverse patient/caregiver/stakeholder advisory board was assembled to guide recruitment, implementation, and dissemination plans and to contextualize study findings. The institutional review board–approved randomized controlled trial will enroll and randomize patients to the intervention (or control group) in 3 consecutive waves/year over 3 years. The results will be published at data collection and analyses completion. Conclusions The Destination Cardiac Rehab randomized controlled trial tests an innovative and potentially scalable model to enhance CR participation and advance health equity. Our findings will inform the use of effective virtual CR programs to expand equitable access to diverse patient populations. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05897710.