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PurposeTo compare rates of retinal nerve fiber layer change over time in healthy, eyes with nonprogressing glaucoma and eyes with progressing glaucoma using single wide-field (SWF) and optic nerve head (ONH) cube scan optical coherence tomography (OCT) images.MethodsForty-five eyes of 25 healthy individuals and 263 eyes of 161 glaucoma patients from the Diagnostic Innovations in Glaucoma Study were included. All eyes underwent 24-2 visual field testing and OCT (Spectralis SD-OCT) ONH and macular imaging. SWF images (up to 43° × 28°) were created by stitching together ONH cube scans centered on the optic disc and macular cube scans centered on the fovea. Visual field progression was defined as guided progression analysis likely progression and/or a significant (P < 0.01) mean deviation slope of less than -1.0 dB/year. Mixed effects models were used to compare rates of change. Highly myopic eyes were included.ResultsThirty glaucomatous eyes were classified as progressing. In eyes with glaucoma, mean global rate of change was -1.22 µm/year (P < 0.001) using SWF images and -0.83 µm/year (P = 0.003) using ONH cube scans. Rate of change was significantly greater in eyes with progressing glaucoma compared with eyes with nonprogressing glaucoma (-1.51 µm/year vs. -1.24 µm/year; P = 0.002) using SWF images and was similar using ONH cube scans (P = 0.27).ConclusionsIn this cohort that includes eyes with and without high axial myopia, the mean rate of retinal nerve fiber layer thinning measured using SWF images was faster in eyes with progressing glaucoma than in eyes with nonprogressing glaucoma. Wide-field OCT images including the ONH and macula can be effective for monitoring glaucomatous progression in patients with and without high myopia.

PurposeTo develop and evaluate a deep learning (DL) model to assess fundus photograph quality, and quantitatively measure its impact on automated POAG detection in independent study populations.MethodsImage quality ground truth was determined by manual review of 2815 fundus photographs of healthy and POAG eyes from the Diagnostic Innovations in Glaucoma Study and African Descent and Glaucoma Evaluation Study (DIGS/ADAGES), as well as 11,350 from the Ocular Hypertension Treatment Study (OHTS). Human experts assessed a photograph as high quality if of sufficient quality to determine POAG status and poor quality if not. A DL quality model was trained on photographs from DIGS/ADAGES and tested on OHTS. The effect of DL quality assessment on DL POAG detection was measured using area under the receiver operating characteristic (AUROC).ResultsThe DL quality model yielded an AUROC of 0.97 for differentiating between high- and low-quality photographs; qualitative human review affirmed high model performance. Diagnostic accuracy of the DL POAG model was significantly greater (P < 0.001) in good (AUROC, 0.87; 95% CI, 0.80-0.92) compared with poor quality photographs (AUROC, 0.77; 95% CI, 0.67-0.88).ConclusionsThe DL quality model was able to accurately assess fundus photograph quality. Using automated quality assessment to filter out low-quality photographs increased the accuracy of a DL POAG detection model.Translational relevanceIncorporating DL quality assessment into automated review of fundus photographs can help to decrease the burden of manual review and improve accuracy for automated DL POAG detection.

A longitudinal ophthalmic dataset was used to investigate multi-modal machine learning (ML) models incorporating patient demographics and history, clinical measurements, optical coherence tomography (OCT), and visual field (VF) testing in predicting glaucoma surgical interventions. The cohort included 369 patients who underwent glaucoma surgery and 592 patients who did not undergo surgery. The data types used for prediction included patient demographics, history of systemic conditions, medication history, ophthalmic measurements, 24-2 VF results, and thickness measurements from OCT imaging. The ML models were trained to predict surgical interventions and evaluated on independent data collected at a separate study site. The models were evaluated based on their ability to predict surgeries at varying lengths of time prior to surgical intervention. The highest performing predictions achieved an AUC of 0.93, 0.92, and 0.93 in predicting surgical intervention at 1 year, 2 years, and 3 years, respectively. The models were also able to achieve high sensitivity (0.89, 0.77, 0.86 at 1, 2, and 3 years, respectively) and specificity (0.85, 0.90, and 0.91 at 1, 2, and 3 years, respectively) at an 0.80 level of precision. The multi-modal models trained on a combination of data types predicted surgical interventions with high accuracy up to three years prior to surgery and could provide an important tool to predict the need for glaucoma intervention.

Abstract Background we aim to discuss the origin and the differences of the phenotypic features and the management care of rare form of disorder of sex development due to Mosaic monosomy X and Y chromosome materiel. Methods We report our experience with patients harboring mosaic monosomy X and Y chromosome material diagnosed by blood cells karyotypes and cared for in our department from 2005 to 2022. Results We have included five infants in our study. The current average age was 8 years. In four cases, the diagnosis was still after born and it was at the age of 15 years in one case. Physical examination revealed a variable degree of virilization, ranging from a normal male phallus with unilateral ectopic gonad to ambiguous with a genital tubercle and bilateral not palpable gonads in four cases and normal female external genitalia in patient 5. Karyotype found 45, X/46, XY mosaicism in patient 1 and 2 and 45, X/46, X, der (Y) mosaicism in patient 3, 4 and 5. Three cases were assigned to male gender and two cases were assigned to female. After radiologic and histologic exploration, four patients had been explored by laparoscopy to perform gonadectomy in two cases and Mullerian derivative resection in the other. Urethroplasty was done in two cases of posterior hypospadias. Gender identity was concordant with the sex of assignment at birth in only 3 cases. Conclusion Because of the phenotypic heterogeneity of this sexual disorders and the variability of its management care, then the decision should rely on a multidisciplinary team approach.

Background: Inguinal hernia (IH) is a prevalent condition in children necessitating surgical repair. However, determining the optimal timing (early or delayed) of inguinal herniotomy in neonates and preterm infants remains debatable. While open herniotomy traditionally serves as the standard inguinal hernia repair (IHR) procedure, laparoscopic repair has gained traction in recent decades. Our study aims to scrutinize both the optimal timing and approach to inguinal hernia repair in neonates and preterm infants. Methods: We conducted a literature review on surgical repair of IH in neonates and preterm infants published between 1999 and 2024. Results: Twenty studies met the inclusion criteria for this review. All studies were retrospective, predominantly originating from Europe and the United States. Thirteen out of the 20 studies focused solely on preterm infants. Patient sample sizes ranged from 30 to 8037, totaling 14533 patients. Most studies indicate that delaying inguinal hernia repair in newborns and preterm infants does not increase the risk of incarceration or recurrence. Moreover, postponing repair until after discharge from the NICU correlates with a shorter postoperative hospital stay and notably diminishes the risk of long-term postoperative ventilator dependence, thereby mitigating potential perioperative complications. Hence, this approach seems safe for certain patients whose families can reliably access appropriate surgical care. Conclusion: Significant disparities exist in the timing of inguinal hernia repair for newborns and preterm infants across various pediatric surgery centers. Current evidence suggests delayed inguinal hernia repair may be a viable option for selected patients. Regarding the optimal approach in this population, laparoscopy appears safe and effective.

Background: Fetus in fetu is a rare congenital malformation resulting from abnormal embryogenesis in a monochorionic diamniotic twinning gestation. This study aimed to document our experience with this anomaly in a developing country. Methods: This retrospective analysis covers cases of fetus in fetu diagnosed at our institution between 1999 and 2023. Patients presenting with an intracorporeal mass containing a vertebral column and an appropriate arrangement of organs and limbs around the axis were included in the study. Results: Five female patients with fetus in fetu were identified. The timing of diagnosis varied from incidental antenatal ultrasound discovery to postnatal abdominal mass presentation. The initial diagnosis involved radiological and serological investigations, confirmed by histopathology after surgical excision. The mean age at the time of surgery was 44 days. All patients underwent complete excision of the fetal mass, resulting in excellent postoperative outcomes and no recurrences. Conclusion: Fetus in fetu is a pediatric rarity and must be distinguished from a teratoma mass, which carries a high malignant potential. Histological and genetic studies may contribute to understanding the pathogenesis and etiology of the disease.

Several studies have investigated muscle rigidity using SWE. However, the assessments may not consider the most affected regions within the same muscle tissue nor the intramuscular variability of rigidity between muscles of the same muscle group, e.g., plantar flexors. The data presented in this article aimed to explore the inter–and intramuscular variability of plantar flexors stiffness during prone and standing positions at different muscle lengths in healthy and paretic individuals. Shear wave ultrasound images were acquired for the three plantar flexor muscles (gastrocnemius medialis [GM], gastrocnemius lateralis [GL], and soleus [SOL]) in two positions: prone and standing. The imaging was conducted at various dorsiflexion angles (0°, 10°, and 20°), and measurements were taken at different proximo-distal regions within each muscle. This data set allowed us to highlight the impact of stroke on mechanical properties that varies depending on whether ankle muscles are in an active or passive state during dorsiflexion. Additionally, the modification of the ankle muscle state influences the distribution of stiffness both within and between the plantar flexors.

This paper presents an in-depth review of software-defined named data networking (SD-NDN), a transformative approach in network architectures poised to deliver substantial benefits. By addressing the limitations inherent in traditional host-centric network architectures, SD-NDN offers improvements in network performance, scalability, and efficiency. The paper commences with an overview of named data networking (NDN) and software-defined networking (SDN), the two fundamental building blocks of SD-NDN. It then explores the specifics of integrating NDN with SDN, illustrating examples of various SD-NDN models. These models are designed to leverage SDN for NDN routing, caching, and forwarding. The paper concludes by proposing potential strategies for further integration of SDN and NDN and some open research questions. These proposed strategies aim to stimulate further exploration and innovation in the field of SD-NDN.

A longitudinal ophthalmic dataset was used to investigate multi-modal machine learning (ML) models incorporating patient demographics and history, clinical measurements, optical coherence tomography (OCT), and visual field (VF) testing in predicting glaucoma surgical interventions. The cohort included 369 patients who underwent glaucoma surgery and 592 patients who did not undergo surgery. The data types used for prediction included patient demographics, history of systemic conditions, medication history, ophthalmic measurements, 24-2 VF results, and thickness measurements from OCT imaging. The ML models were trained to predict surgical interventions and evaluated on independent data collected at a separate study site. The models were evaluated based on their ability to predict surgeries at varying lengths of time prior to surgical intervention. The highest performing predictions achieved an AUC of 0.93, 0.92, and 0.93 in predicting surgical intervention at 1 year, 2 years, and 3 years, respectively. The models were also able to achieve high sensitivity (0.89, 0.77, 0.86 at 1, 2, and 3 years, respectively) and specificity (0.85, 0.90, and 0.91 at 1, 2, and 3 years, respectively) at an 0.80 level of precision. The multi-modal models trained on a combination of data types predicted surgical interventions with high accuracy up to three years prior to surgery and could provide an important tool to predict the need for glaucoma intervention.

This paper presents an in-depth review of software-defined named data networking (SD-NDN), a transformative approach in network architectures poised to deliver substantial benefits. By addressing the limitations inherent in traditional host-centric network architectures, SD-NDN offers improvements in network performance, scalability, and efficiency. The paper commences with an overview of named data networking (NDN) and software-defined networking (SDN), the two fundamental building blocks of SD-NDN. It then explores the specifics of integrating NDN with SDN, illustrating examples of various SD-NDN models. These models are designed to leverage SDN for NDN routing, caching, and forwarding. The paper concludes by proposing potential strategies for further integration of SDN and NDN and some open research questions. These proposed strategies aim to stimulate further exploration and innovation in the field of SD-NDN. [ABSTRACT FROM AUTHOR]

Purpose To characterise the relationship between a deep-layer microvasculature dropout (MvD) and central visual field (VF) damage in primary open-angle glaucoma (POAG) patients with and without high axial myopia. Design Cross-sectional study. Methods Seventy-one eyes (49 patients) with high axial myopia and POAG and 125 non-highly myopic POAG eyes (97 patients) were enrolled. Presence, area and angular circumference of juxtapapillary MvD were evaluated on optical coherence tomography angiography B-scans and en-face choroidal images. Results Juxtapapillary MvD was detected more often in the highly myopic POAG eyes (43 eyes, 86%) than in the non-highly myopic eyes (73 eyes, 61.9%; p=0.002). In eyes with MvD, MvD area and angular circumference (95% CI) were significantly larger in the highly myopic eyes compared with the non-highly myopic eyes (area: (0.69 (0.40, 0.98) mm² vs 0.31 (0.19, 0.42) mm², p=0.011) and (angular circumference: 84.3 (62.9, 105.8) vs 74.5 (58.3, 90.9) degrees, p<0.001), respectively. 24-2 VF mean deviation (MD) was significantly worse in eyes with MvD compared with eyes without MvD in both groups (p<0.001). After adjusting for 24-2 MD VF, central VF defects were more frequently found in eyes with MvD compared with eyes without MvD (82.7% vs 60.9%, p<0.001). In multivariable analysis, higher intraocular pressure, worse 24-2 VF MD, longer axial length and greater MvD area and angular circumference were associated with worse 10-2 VF MD. Conclusions MvD was more prevalent and larger in POAG eyes with high myopia than in non-highly myopic POAG eyes. In both groups, eyes with MvD showed worse glaucoma severity and more central VF defects. [ABSTRACT FROM AUTHOR]

This article presents a retrospective study conducted in Tunis hospitals to assess the impact of COVID-19 on hospitalized pregnant women. The study population consisted of women aged 28-38 years with diverse educational backgrounds. Most women had no significant medical history, but some had controlled asthma or a prior pregnancy loss. Vaccination rates were high, with the majority receiving prenatal care. Common COVID-19 symptoms were reported in 73% of women, and most cases were mild with no maternal deaths. However, COVID-19 infection was associated with an increased risk of preterm delivery, respiratory distress, and miscarriage. Psychological distress was observed in all women. Delivery outcomes were significantly impacted, with a rise in Caesarean sections and a high preterm birth rate. Neonatal COVID-19 infection occurred in 6% of cases, but most newborns had good Apgar scores. The study emphasizes the importance of continued vaccination efforts and close monitoring throughout pregnancy. [Extracted from the article]

This article discusses a rare pregnancy complication called hemolytic uremic syndrome (HUS), which has microangiopathy as a key characteristic. The case study presented involves a 38-year-old pregnant woman at 17 weeks gestation who experienced symptoms such as headache, vomiting, and visual blur. The patient had a history of prior miscarriages, an ectopic pregnancy, and a previous Caesarean section. Physical examination and laboratory findings indicated microangiopathic hemolytic anemia, low platelet count, and elevated creatinine levels, leading to a suspected diagnosis of HUS. The importance of early diagnosis in pregnant women with anemia, thrombocytopenia, and acute renal failure is emphasized due to the potential for severe maternal complications. [Extracted from the article]

Purpose Materials and methods Results Conclusion The concept of interposing double dorsal preputial flaps to cover the urethroplasty was introduced in 2005 to reduce the risk of urethrocutaneous fistula (UCF). Our study aims to compare the postoperative outcomes of urethroplasty for distal hypospadias between two groups: one receiving single preputial flap coverage and another receiving double flap coverage.We conducted a retrospective analysis study of boys with primary distal hypospadias who underwent surgery by the same experienced surgeon, at our department between 2010 and 2021. The study population was divided into two groups: Group A, which underwent urethroplasty coverage with single dorsal preputial flap, and Group B, which underwent coverage with double flap. Postoperative complications were compared between the two groups.We collected 105 cases, comprising 51 in Group A and 54 cases in Group B. The mean age at surgery was 29 months in Group A and 24 months in Group B. Post‐operative follow‐up period ranged from 6 months to 8 years. Functional and cosmetic outcomes were judged excellent in 88.7%. Only 10 boys experienced complications requiring reoperation. UCF occurred in 5 patients from Group A, while no cases were reported in Group B (p = 0.024). Meatal stenosis was identified in three patients in Group A and in two patients in Group B (p = 1). No other complications, such as glans dehiscence or penile torsion, were noted.Double dorsal dartos flap is an effective method for covering the new urethra and can be recommended in the treatment of patients with virgin distal hypospadias. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the association between rates of juxtapapillary choriocapillaris microvasculature dropout (MvD) change and rates of ganglion cell inner plexiform layer (GCIPL) loss in primary open-angle glaucoma (POAG) and glaucoma suspect eyes with and without myopia., Design: Cohort study from clinical trial data., Methods: 238 eyes from 155 POAG and glaucoma suspect patients were stratified into no-myopia (axial length (AL) ≤ 24 mm; n = 78 eyes), mild myopia (24 mm < AL ≤ 26 mm; n = 114 eyes), and high myopia (AL > 26 mm; n = 46 eyes). Eyes with a minimum of 3 visits and 1.5 years of follow-up with both optical coherence tomography angiography (OCT-A) and OCT macula scans were included. Presence, area, and angular circumference of juxtapapillary MvD were evaluated on en face choroidal images and horizontal B-scans obtained from OCT-A imaging., Results: Over the mean follow-up of 4.4 years, the mean MvD area rates of change (95% CI) were largest in high and mild myopia group (0.04 [0.03, 0.05] mm 2 /year in both groups), followed by the no-myopia group (0.03 [0.02, 0.04] mm 2 /year). The mean MvD angular circumference rates of change (95% CI) were highest in mild myopia group (8.7° [6.9°, 10.5°]/year) followed by the high myopia and no-myopia groups (8.1° [5.3°, 10.9°]/year, and 7.4° [5.3°, 9.6°]/year, respectively). While the mean global GCIPL thinning rates between eyes with MvD at baseline compared to eyes without were similar in all myopia groups, the rates of MvD area change were significantly faster in all myopia groups with baseline MvD (all p ≤ 0.004). Significant faster rates of MvD angular circumference change were found in the mild myopia group with baseline MvD (P < .001) only. In multivariable models, the rates of GCIPL thinning over time were significantly associated with rates of MvD angular circumference change and MvD area change (R 2 = 0.33, P < .001 and R 2 = 0.32, P = .006, respectively)., Conclusions: Rates of GCIPL thinning were associated with rates of MvD area and angular circumference change over time in myopic POAG eyes. Utilizing OCT-A to detect MvD may provide an additional tool for monitoring macular structural changes in glaucomatous eyes with myopia., (Copyright © 2024 Elsevier Inc. All rights reserved.)