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Category: Trauma; Ankle Introduction/Purpose: Hawkins III talus neck fractures are associated with elevated rates of complications, notably avascular necrosis, which range between 40% to 70%. The Hawkins sign, characterized by subchondral lucency of the talar dome observed on post-injury ankle x-rays at 6-8 weeks post-injury, has traditionally served as a predictive factor for avascular necrosis development within a year. Nevertheless, we propose that the presence of the Hawkins sign exhibits considerable inter-observer variability and may not predict clinically relevant avascular necrosis development as reliably as previously assumed. Methods: A retrospective study was conducted on patients who experienced Hawkins III fractures between 2018 and 2022 at a Level 1 trauma center. Electronic medical records were thoroughly reviewed to ascertain the occurrence of avascular necrosis. An assessment of six-week postoperative ankle x-rays was conducted by a fellowship-trained foot and ankle orthopaedic surgeon to ascertain the presence or absence of the Hawkins sign. Subsequently, five orthopaedic surgeons independently assessed the x-rays to determine the presence of the Hawkins sign. Statistical analysis was then employed to assess the inter-rater reliability of the Hawkins sign and its association with the future development of avascular necrosis over a one-year follow-up period. Results: Seventeen patients with Hawkins III talus neck fractures were identified. Fleiss' kappa was run to determine if there was agreement between five orthopaedic trauma surgeons’ judgement on whether 17 individuals with Hawkins III talar neck fractures had a Hawkins sign present or not on 6-week postoperative x-rays. There was poor agreement between the surgeons’ judgements, κ = .040 (95% CI, -.035 to .115), but was not statistically significant, p = .294. There was complete agreement between surgeons on only 5/17 (29.4%) cases. Of the 6 patients that went on to develop avascular necrosis at 1 year, only 1 had a Hawkins sign (determined by fellowship-trained foot and ankle surgeon) present on their 6-week postoperative x-ray (Table 1). Conclusion: The reliability of the Hawkins sign among orthopaedic surgeons is notably low due to significant inter-observer variability. This variability introduces subjectivity to the interpretation of the Hawkins sign, rendering it an unreliable objective measure. Furthermore, its inability to correlate with the presence of avascular necrosis at the one-year mark raises doubts about its validity as a predictive marker for talar neck fracture outcomes.

Category: Trauma; Ankle Introduction/Purpose: Talus neck fractures typically result from hyperdorsiflexion in high-impact accidents like motor vehicle crashes and falls from significant heights. Complications arising from these fractures include avascular necrosis of the talus, sensory deficits, infection, and nonunion. Studies report varying rates of avascular necrosis for Hawkins II and III fractures, ranging from 20-35% and 40-70%, respectively. The Hawkins sign is a widely used diagnostic tool in clinical practice, employed around 6-8 weeks post-surgery to assess vascularity and predict the likelihood of complications. Our study aims to evaluate the reliability of the Hawkins sign and analyze rates of reoperation and avascular necrosis in patients with talus neck fractures. Methods: A retrospective study was conducted on patients who sustained Hawkins II or III fractures between 2018 and 2022 at a Level 1 trauma center. The study involved a comprehensive review of electronic medical records to ascertain injury presentation, surgical interventions, and outcomes/complications. Six-week postoperative ankle x-rays were examined by a fellowship-trained foot and ankle orthopaedic surgeon to determine the presence or absence of the Hawkins sign; cases lacking x-rays around the 6-week mark were excluded from the analysis. Patients with less than 1 year of follow-up were also excluded from the analysis of avascular necrosis. Statistical analysis was then employed to delineate differences between Hawkins II and III talar neck fractures concerning reoperation, complications (such as avascular necrosis, nonunion, and infection), and to investigate whether the Hawkins sign was associated with the subsequent development of avascular necrosis. Results: Thirty-eight patients presenting with either a Hawkins II (21/38) or Hawkins III (17/38) talar neck fracture were included in the study. Hawkins III fractures exhibited significantly higher rates of avascular necrosis, infection, and reoperation compared to Hawkins II fractures, while nonunion rates did not show significant differences (Table 1a). Notably, the presence of the Hawkins sign did not demonstrate correlation with the development of avascular necrosis at the one-year post-surgery mark (Table 1b). Conclusion: Hawkins III fractures exhibit poorer outcomes compared to Hawkins II fractures, particularly in terms of avascular necrosis, infection, and the necessity for reoperation. The incidence of avascular necrosis in Hawkins III talar neck fractures aligns closely with current literature, whereas our reported rates for avascular necrosis in Hawkins II fractures were notably lower. Of note, the presence of a Hawkins sign at the six-week post-surgery mark did not show any association with the development of avascular necrosis. This raises important questions regarding the utility of the Hawkins sign in predicting outcomes for these fracture patterns.

Background: There is a lack of physician ethnic and gender diversity amongst surgical specialties. This study analyzes the literature that promotes diversity amongst surgical trainees. Specifically, this study sought to answer (i) how the number of publications regarding diversity in orthopaedic surgery compares to other surgical specialties, (ii) how the number of publications amongst all surgical subspecialties trends over time and (iii) which specific topics regarding diversity are discussed in the surgical literature. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to query articles from PubMed, Web of Science, Embase and the Cumulative Index to Nursing and Allied Health Literature. Broad inclusion criteria for both ethnic and gender diversity of any surgical specialty were utilized. Results: Our query resulted 1429 publications, of which 408 duplicates were removed, and 701 were excluded on title and abstract screening, leaving 320 to be included. The highest number of related publications was in orthopaedic surgery (n = 73) followed by general surgery (n = 56). Out of 320 total articles, 260 (81.3 %) were published after 2015, and 56 of 73 (76.7 %) orthopaedic-specific articles were published after 2015. Conclusion: Orthopaedic surgery published the most about ethnic and gender diversity, however, still remains one of the least diverse surgical specialties. With the recent increase in publications on diversity in surgical training, close attention should be paid to ethnic and gender diversity amongst surgical trainees over the coming years. Should diversity remain stagnant, diversification efforts may need to be restructured to achieve a diverse surgeon workforce. Key message: Orthopaedic surgery is the surgical subspecialty that publishes the most about trainee ethnic and gender diversity followed by general surgery. With most of this literature being published over the last eight years, it is imperative to pay close attention to the ethnic and gender landscape of the surgeon workforce over the coming years.

Abstract Introduction Engaging children and young people (CYP) with and without their parents in health research has the potential to improve the development and implementation of health interventions. However, to our knowledge, the scope of engagement activities used with this population and barriers to their engagement is unknown. The objective of this review was to identify and describe CYP engagement with and without their parents in the development and/or implementation of health interventions. Methods This scoping review included any primary research studies reporting on engaging CYP, with or without parents, in the design and/or implementation of health interventions. Healthcare professionals had to be involved over the course of the study and the study had to take place in either community, primary or tertiary care settings. The following databases were searched in May 2017, May 2020 and June 2021: Medline (OVID), CINAHL (EBSCO) and Embase (Elsevier). Two independent reviewers screened titles, abstracts and full‐text articles and used a previously piloted extraction form to extract and summarize information from the included articles. Results Twenty‐eight articles discussing twenty‐four studies were included. CYP engagement throughout the research cycle was limited. There were no observed differences in the reported presence of engagement, types of interventions or outcomes of engagement between studies engaging CYP or CYP and parents. Studies engaging CYP and parents contained limited information on how these relationships affected outcomes of engagement. Engagement was enabled primarily by the maintenance of resources and relationships among stakeholders. Conclusions Although CYP engagement often influenced health intervention and implementation design, they are inconsistently engaged across the research cycle. It is unclear whether parental involvement enhances CYP engagement. Future research should consider reporting guidelines to clarify the level of CYP and/or parent engagement, and enhance CYP engagement by fostering synergistic and sustainable partnerships with key stakeholders. Patient or Public Contribution A parent partner with codesign experience contributed to the creation of the research questions, screened titles, abstracts and full texts, helped with data extraction and provided feedback on the manuscript.

Abstract The search for new superhard materials is of great interest for extreme industrial applications. However, the theoretical prediction of hardness is still a challenge for the scientific community, given the difficulty of modeling plastic behavior of solids. Different hardness models have been proposed over the years. Still, they are either too complicated to use, inaccurate when extrapolating to a wide variety of solids or require coding knowledge. In this investigation, we built a successful machine learning model that implements Gradient Boosting Regressor (GBR) to predict hardness and uses the mechanical properties of a solid (bulk modulus, shear modulus, Young’s modulus, and Poisson’s ratio) as input variables. The model was trained with an experimental Vickers hardness database of 143 materials, assuring various kinds of compounds. The input properties were calculated from the theoretical elastic tensor. The Materials Project’s database was explored to search for new superhard materials, and our results are in good agreement with the experimental data available. Other alternative models to compute hardness from mechanical properties are also discussed in this work. Our results are available in a free-access easy to use online application to be further used in future studies of new materials at www.hardnesscalculator.com .

Nova Scotia's Supportive Care Program (SCP) is an individualized funding program that provides funds for people living with dementia (PLWD) or acquired brain injuries to purchase basic home care services such as personal care, respite, cleaning and cooking. The SCP has the potential to address the Quintuple Aim of enhancing care experience, improving population health, reducing costs, improving provider experience and improving health equity, yet qualitative evidence is lacking. The aim of this study is to use participatory program evaluation methods to evaluate the SCP and consider how effective it is in addressing the Quintuple Aim. The study objectives and corresponding methods are to (1) Co-develop a SCP logic model to guide the evaluation through consultations with a diverse group of stakeholders including PLWD, caregivers, care providers, researchers, government representatives, and nongovernment organizations, with attention to gender; (2) Evaluate the SCP based on the outcomes and outputs identified in the logic model using focus groups with PLWD, caregivers and home care providers, and interviews with PLWD and their caregivers; and (3) Mobilize knowledge about the ways the SCP addresses the Quintuple Aim through integrated knowledge translation activities with public, policy and research audiences. By focusing on clinically and socially vulnerable populations of PLWD and caregivers, the proposed evaluation of the SCP offers a valuable case in assessing the effectiveness of individually-funded home care in addressing the Quintuple Aim including health equity within the context of dementia care.

Glioblastomas (GBMs) are a form of malignant gliomas characterized by a dismal prognosis. Standard treatment for glioblastoma patients is combined maximal surgical removal of the tumor with postoperative radiotherapy and concomitant chemotherapy with Temozolomide (TMZ). Among the histological characteristics that contribute to GBM progression are the rapid proliferation and neo-angiogenetic processes. The Na+/K+-ATPase is a transporter that promotes the migration of cancer cells, and its aberrant expression and activity have been associated with several cancers, including GBM. Using cardiac glycosides, we examined the effects of direct inhibition of the Na+/K+-ATPase in glioblastoma cells in vitro. We found that cardiac glycoside Digoxin is an effective anticancer agent on several glioma cell lines via Na+/K+-ATPase inhibition. Drug cytotoxicity assays showed that Digoxin as monotherapy significantly increased cell death and increased the efficacy of Temozolomide (TMZ) in the glioma cell lines T98G, U-97 MG, and primary GBM cells BNC-6. Additionally, Digoxin exhibited important anti-migratory effects on the highly aggressive and chemotherapy-resistant T98G glioma cell-line, demonstrating a potential therapeutic role for cardiac glycosides.

Electroactive polymers (EAPs) are an advanced family of polymers that change their shape through electric stimulation and have been a point of interest since their inception. This unique functionality has helped EAPs to contribute to versatile fields, such as electrical, biomedical, and robotics, to name a few. Ionic EAPs have a significant advantage over electronic EAPs. For example, Ionic EAPs require a lower voltage to activate than electronic EAPs. On the other hand, electronic EAPs could generate a relatively larger actuation force. Therefore, efforts have been focused on improving both kinds to achieve superior properties. In this review, the synthesis routes of different EAP-based actuators and their properties are discussed. Moreover, their mechanical interactions have been investigated from a tribological perspective as all these EAPs undergo surface interactions. Such interactions could reduce their useful life and need significant research attention for enhancing their life. Recent advancements and numerous applications of EAPs in various sectors are also discussed in this review.

IntroductionDonor brain death (BD) is an unavoidable component of vascularized composite allograft (VCA) transplantation and a key contributor to ischemia-reperfusion injury (IRI). Complement is activated and deposited within solid organ grafts as a consequence of BD and has been shown to exacerbate IRI, although the role of BD and complement in VCA and the role it plays in IRI and VCA rejection has not been studied.MethodsBD was induced in Balb/c donors, and the VCA perfused prior to graft procurement with UW solution supplemented with or without CR2-Crry, a C3 convertase complement inhibitor that binds at sites of complement activation, such as that induced on the endothelium by induction of BD. Following perfusion, donor VCAs were cold stored for 6 hours before transplantation into C57BL/6 recipients. Donor VCAs from living donors (LD) were also procured and stored. Analyses included CR2-Crry graft binding, complement activation, toxicity, injury/inflammation, graft gene expression and survival.ResultsCompared to LD VCAs, BD donor VCAs had exacerbated IRI and rejected earlier. Following pretransplant in-situ perfusion of the donor graft, CR2-Crry bound within the graft and was retained post-transplantation. CR2-Crry treatment significantly reduced complement deposition, inflammation and IRI as compared to vehicle-treated BD donors. Treatment of BD donor VCAs with CR2-Crry led to an injury profile not dissimilar to that seen in recipients of LD VCAs.ConclusionPre-coating a VCA with CR2-Crry in a clinically relevant treatment paradigm provides localized, and therefore minimally immunosuppressive, protection from the complement-mediated effects of BD induced exacerbated IRI.

Background and Purpose: Over the last decade, the field of implementation science (IS) has yielded an array of theoretical approaches to clarify and understand how factors influence the application and scaling-up of evidence-based practice in health care. These developments have led to questions about whether IS theories and frameworks might be of value to population health researchers and decision makers. The purpose of this research was to conduct a critical interpretive synthesis to explore, if, and how, key IS theories and frameworks might inform population health interventions aimed at reducing the burden of illness across populations. Methods: An initial list of theories and frameworks was developed based on previous published research and narrowed to focus on theories considered as formative for the field of IS. A standardized data extraction form was used to gather key features of the theories and critically appraise their relevance to population health interventions. Results: Ten theories were included in the review and six deemed most applicable to population health based on their consideration of broader contextual and system-level factors. The remaining four were determined to have less relevant components for population health due to their limited consideration of macro-level factors, often focusing on micro (individual) and meso (organizational) level factors. Conclusions: Theories and frameworks are important to guide the implementation and sustainability of population health interventions. The articulation of meso level factors common in IS theories may be of value to interventions targeted at the population level. However, some of the reviewed theories were limited in their consideration of broader contextual factors at the macro level (community, policy or societal). This critical interpretive synthesis also found that some theories lacked provision of practical guidance to address interventions targeting structural factors such as key social determinants of health (e.g., housing, income).

Translational cancer research relies on the availability of human patient tissue demonstrating the specific disease process under investigation. Biobanks of human tissue have historically been and remain to date the primary access point for cancer research samples. Biorepositories routinely supply researchers with varying sample types for use in biomedical studies; most commonly formalin-fixed and paraffin-embedded (FFPE) tissue, or fresh snap-frozen tissue. In conjunction with preserved tissue samples, viable tumor cell lines derived from patient tissue have emerged to be a new gold standard in cancer research particularly in drug discovery and functional prognostic assays. Tissue banks providing these samples are being termed “next-generation” and are adapting to directly assist researchers by performing high throughput technical studies such as routine histology and immunostaining of donor tissue. These high quality, next-generation biorepositories are a relatively scarce resource in the broader research community in the United States and have traditionally been associated with large centralized and very well established university medical centers. This article describes the next-generation resources now available at the Edwards Comprehensive Cancer Center with its association with the Marshall University Joan C. Edwards School of Medicine in Huntington, West Virginia. This manuscript details the procedures, protocols, and success rates of the Tissue Procurement Program (TPP) to generate a growing cohort of viable primary human tumor cell lines representing varying malignancies to be used in conjunction with matched formalin-fixed and paraffin-embedded (FFPE) and snap-frozen tissue samples for comprehensive translational research.

Administration of ineffective anticancer therapy is associated with unnecessary toxicity and development of resistant clones. Cancer stem-like cells (CSLCs) resist chemotherapy, thereby causing relapse of the disease. Thus, development of a test that identifies the most effective chemotherapy management offers great promise for individualized anticancer treatments. We have developed an ex vivo chemotherapy sensitivity assay (ChemoID), which measures the sensitivity of CSLCs as well as the bulk of tumor cells to a variety of chemotherapy agents. Two patients, a 21-year old male (patient 1) and a 5-month female (patient 2), affected by anaplastic WHO grade-III ependymoma were screened using the ChemoID assay. Patient 1 was found sensitive to the combination of irinotecan and bevacizumab, which resulted in a prolonged disease progression free period of 18 months. Following recurrence, the combination of various chemotherapy drugs was tested again with the ChemoID assay. We found that benzyl isothiocyanate (BITC) greatly increased the chemosensitivity of the ependymoma cells to the combination of irinotecan and bevacizumab. After patient 1 was treated for two months with irinotecan, bevacizumab and supplements of cruciferous vegetable extracts containing BITC, we observed over 50% tumoral regression in comparison with pre-ChemoID scan as evidenced by MRI. Patient 2 was found resistant to all treatments tested and following 6 cycles of vincristine, carboplatin, cyclophosphamide, etoposide, and cisplatin in various combinations, the tumor of this patient rapidly progressed and proton beam therapy was recommended. As expected animal studies conducted with patient derived xenografts treated with ChemoID screened drugs recapitulated the clinical observation. This assay demonstrates that patients with the same histological stage and grade of cancer may vary considerably in their clinical response, suggesting that ChemoID testing which measures the sensitivity of CSLCs as well as the bulk of tumor cells to a variety of chemotherapy agents could lead to more effective and personalized anticancer treatments in the future.

Purpose: To assess early visual outcomes and military task performance after small-incision lenticule extraction (SMILE) among U.S. military service members., Setting: Warfighter Refractive Eye Surgery Program and Research Center and Night Vision and Electronic Sensors Directorate, Fort Belvoir, Virginia., Design: Single-center, prospective, observational study., Methods: The study was composed of active duty service members (n = 37) electing to undergo SMILE for myopia or myopic astigmatism. Testing performed preoperatively and at 1 month and 3 months postoperatively included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, wavefront aberrometry, low-contrast visual acuity (LCVA), contrast sensitivity, and vision-related questionnaire. 14 participants underwent rifle marksmanship with spectacle correction before and without correction at 6 to 8 weeks postoperatively., Results: At 3 months postoperatively, the efficacy index was 0.96 and the safety index was 1.03. UDVA was ≥20/20 in 69 (96%) of eyes. LCVA change from baseline was significant under night vision condition. Eye problems contributed to 10% work and 20% activity impairments, both of which decreased to 0% (P = .001). The overall satisfaction rating for SMILE was high at 90.9 (95% CI, 85.3 to 96.5), and 95% of participants would be willing to undergo the procedure again. The median scores between preoperative and 6 to 8 weeks postoperative firing performance were comparable (34 vs 35, with and without correction, respectively; P = .247)., Conclusions: After the early recovery period, SMILE seems to preserve quality of vision, which appears to facilitate the accomplishment of tasks related to their work as military service members as well as performing activities outside of work., (Copyright © 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

The Biber Figure Learning Test (BFLT), a visuospatial serial figure learning test, was evaluated for biological correlates and psychometric properties, and normative data were generated. Nondemented individuals ( n = 332, 73 ± 7, 41% female) from the Vanderbilt Memory & Aging Project completed a comprehensive neuropsychological protocol. Adjusted regression models related BFLT indices to structural brain magnetic resonance imaging and cerebrospinal fluid (CSF) markers of brain health. Regression-based normative data were generated. Lower BFLT performances (Total Learning, Delayed Recall, Recognition) related to smaller medial temporal lobe volumes and higher CSF tau concentrations but not CSF amyloid. BFLT indices were most strongly correlated with other measures of verbal and nonverbal memory and visuospatial skills. The BFLT provides a comprehensive assessment of all aspects of visuospatial learning and memory and is sensitive to biomarkers of unhealthy brain aging. Enhanced normative data enriches the clinical utility of this visual serial figure learning test for use with older adults.

Purpose: To assess the visual outcomes of small-incision lenticule extraction (SMILE) after the first year of treatments at a military refractive surgery center and compare with photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) outcomes during the same period., Setting: Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, VA., Design: Retrospective study., Methods: Records of service members who underwent SMILE, PRK, or LASIK for myopia from March 2017 to February 2018 were reviewed. Preoperative and up to 6-month postoperative data were collected. Visual outcomes were compared between treatments., Results: Of 563 treated eyes, 173 (30.7%) underwent SMILE, 304 (54.0%) PRK, and 86 (15.3%) LASIK. In comparing SMILE with PRK 1 month postoperatively, SMILE (145 eyes [87.9%]) attained uncorrected distance visual acuity (UDVA) ≥20/20 more vs PRK (214 eyes [73.8%]; P < .01). Similarly, SMILE (152 eyes [94.4%]) achieved more eyes with manifest spherical equivalent (MSE) within ±0.50 diopters (D) from intended target vs PRK (250 eyes [85.9%]; P = .01). None lost ≥1 line of corrected distance visual acuity in SMILE vs PRK (16 eyes [5.5%]; P < .01). Thereafter, there were no other significant differences except SMILE had 117 eyes (95.1%) vs PRK with 224 eyes (99.6%) achieving UDVA ≥20/20 at 3 months postoperatively (P = .01). In assessing SMILE vs LASIK, all parameters were comparable; however, 77 SMILE eyes (96.3%) had MSE within ±0.50 D from target vs 31 LASIK eyes (83.8%) at 6 months postoperatively (P = .02)., Conclusions: The first year after SMILE treatments in a U.S. military center demonstrated early postoperative outcomes superior to PRK. SMILE seemed more predictable compared with LASIK.

Background: This study evaluated the VIsion PERformance (VIPER) simulator's ability to assess the functional visual performance in warfighters conducting civilian and military tasks., Methods: Thirty service members, aged 25-35 years old with a best corrected distance visual acuity (VA) better than or equal to 20/20 or logarithm of the minimum angle of resolution (logMAR) 0.00, were randomized to locate and identify road signs and mock improvised explosive devices (IEDs) under either daytime conditions or with infrared imagery, with (cc) and without (sc) wearing their habitual correction. Participants also underwent binocular uncorrected (UDVA) and corrected (CDVA) visual assessment, refraction, contrast sensitivity testing and wavefront aberrometry., Results: The mean age was 28.47 years. The manifest spherical equivalent was - 3.16 ± 1.75 diopters (D), the UDVA in both eyes (OU) was logMAR 0.83 ± 0.47, and the CDVA OU was - 0.11 ± 0.06. For VIPER, the mean difference in the detection distance (DD) for road signs ccDD vs. scDD was 76.7 ± 52.8 m (P < 0.001). The average difference in identification distance (ID) ccID vs. scID was 13.9 ± 6.3 m (P < 0.001). The mean accuracies were 83.5 and 27.9% for cc and sc, respectively (P < 0.001). The regression analysis indicated that a 1.6 m change in the distance accounts for a 1% change in the accuracy (P = 0.002). Without correction, a 4.1 m change accounts for a 1% change in the accuracy (P < 0.001). The average IED ccDD was 29.9 ± 8.2 m, and that for scDD was 13.2 ± 13.6 m (P < 0.001). The average IED ccID was 32.2 ± 6.2 m and that for the scID was 7.4 ± 10.3 m (P < 0.001). The mean IED identification accuracy was 46.7 and 11.4% for cc and sc, respectively (P < 0.001)., Conclusions: The preliminary results reflect VIPER's ability to assess functional visual performance when detecting and identifying signs and IEDs. Furthermore, VIPER is able to detect performance changes with and without correction.

Background: A random ultrasensitive luteinizing hormone (LH) (LH-ICMA) ≥0.3 mIU/L is highly accurate in confirming a diagnosis of central precocious puberty (CPP). However, a prepubertal value does not exclude the diagnosis. The clinical differences between patients with CPP who have a pubertal versus prepubertal LH-ICMA have not been clearly defined. Furthermore, there is minimal information regarding the utility of this test in boys with CPP. The objective of this study was to analyze differences between patients diagnosed with CPP who had a pubertal versus prepubertal LH-ICMA, including a cohort of boys., Methods: A retrospective chart review of children diagnosed with CPP within the last 10 years who had a baseline LH-ICMA obtained was performed. Variables analyzed included sex, age, ethnicity, bone age, BMI, etiology, Tanner stage (TS), testicular volume, and menarchal status., Results: Of 27 boys and 126 girls who qualified for the study, the LH-ICMA was pubertal in 87% and prepubertal in 13%. Girls with a pubertal LH-ICMA had higher baseline estradiol concentrations (p < 0.001) and more advanced breast development (p = 0.015) compared to girls with a prepubertal LH-ICMA. Of girls with a prepubertal LH-ICMA, 74% had at least TS 3 breast development and 1 was post-menarchal. The LH-ICMA was pubertal in 96% of the boys with CPP in this study., Conclusions: The LH-ICMA can be prepubertal even in girls with advanced development. To our knowledge, ours is the largest cohort of boys in whom the accuracy of a random LH-ICMA has been reported., (© 2021 S. Karger AG, Basel.)

Purpose: To compare contrast sensitivity among participants undergoing wavefront-guided or wavefront-optimized photorefractive keratectomy (PRK) or LASIK for the treatment of myopia or myopic astigmatism 12 months after surgery., Methods: In a prospective, randomized clinical trial, 215 participants with myopia ranging from -0.50 to -7.25 diopters (D) and less than -3.50 D of manifest astigmatism electing to undergo either LASIK or PRK were randomized to receive wavefront-guided or wavefront-optimized treatment. Corrected Super Vision Test (Precision Vision, La Salle, IL) high contrast and small letter contrast sensitivity, uncorrected postoperative contrast sensitivity function, and uncorrected and corrected distance visual acuity were measured preoperatively and at 1, 3, 6, and 12 months postoperatively., Results: There was a significant difference within each of the four groups over time when measuring high contrast visual acuity (P < .001) and small letter contrast sensitivity (P < .001), with the most significant decrease occurring 1 month postoperatively. However, there were no significant differences when comparing the four groups for high contrast sensitivity (P = .22) or small letter contrast sensitivity (P = .06). The area under the logarithm of contrast sensitivity function did not differ significantly over time (P = .09) or between groups (P = .16). A pairwise comparison of preoperative to 12-month CDVA showed a significant improvement in all groups (P < .017). The change in CDVA was also significantly different between groups as determined by one-way analysis of variance (P = .003)., Conclusions: Wavefront-guided and wavefront-optimized PRK and LASIK procedures maintained high contrast, small letter contrast sensitivity, and contrast sensitivity function 12 months postoperatively. Although the recovery period for visual performance was longer for PRK versus LASIK, there was no significant difference in treatment type or treatment profile at 12 months postoperatively. [J Refract Surg. 2018;34(9):590-596.]., (Copyright 2018, SLACK Incorporated.)

Purpose: To assess vision-related quality of life and military readiness and capabilities among active duty U.S. military service members undergoing refractive surgery., Methods: In this prospective, single-center, observational study, active duty U.S. military service members electing to undergo refractive surgery were asked to complete a military performance questionnaire and the National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL-42) preoperatively and at 6 months postoperatively. On the military performance questionnaire, participants rated (1 = very bad to 5 = very good) how they felt their vision affected their military readiness and capabilities after refractive surgery., Results: Among 360 participants at 6 months postoperatively, the overall mean military performance score increased from 3.6 ± 0.8 to 4.8 ± 0.3, a change of 1.2, with 91.7% of the participants indicating an overall improvement in readiness and capability (P < .001). Scores measuring overall individual readiness, contribution to unit's mission, use of night vision goggles, function at night, weapons sighting ability, employment of personal masks, weather extreme environmental conditions, and optical support were significantly higher postoperatively (P < .001). For the NEI RQL-42, scores were significantly higher postoperatively for the subscales clarity of vision, expectations, near vision, far vision, diurnal fluctuations, activity limit, glare, dependence on correction, worry, appearance, and satisfaction with correction (all P < .001), but not for symptoms after refractive surgery (P = .403)., Conclusions: Refractive surgery significantly improves military readiness and capabilities and vision-related quality of life of active duty U.S. military service members with refractive error. [J Refract Surg. 2018;34(9):597-603.]., (Copyright 2018, SLACK Incorporated.)

Purpose: To compare visual outcomes following Visx Star S4 Customvue wavefront-guided and Allegretto Wave Eye-Q 400 Hz wavefront-optimized photorefractive keratectomy (PRK)., Setting: Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, Virginia, and Walter Reed National Military Medical Center, Bethesda, Maryland, USA., Design: Prospective randomized clinical trial., Methods: Active-duty United States military soldiers were randomized to have wavefront-guided (Visx Star S4 Customvue) or wavefront-optimized PRK. Participants were followed up to 12 months postoperatively. Primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest spherical equivalent (SE). Secondary outcome measures included refractive astigmatism, higher-order aberrations (HOAs), contrast sensitivity, subjective visual complaints, and patient satisfaction., Results: The study evaluated 108 soldiers (mean age 30.3 years ± 6.3 [SD]; mean manifest SE -3.51 ± 1.63 D). At 12 months postoperatively, achieved UDVA, CDVA, manifest SE, and refractive astigmatism were comparable between wavefront-guided and wavefront-optimized groups (P > .213). Spherical aberration and total HOAs significantly increased from baseline in both groups (P < .006). The change in coma, trefoil, spherical aberration, and total HOAs (P > .254) were comparable between groups. There were fewer losses of photopic low-contrast visual acuity (LCVA) at 5% contrast after wavefront-guided compared to wavefront-optimized treatment (P = .003). There was no significant difference between treatment groups in visual symptoms, overall vision expectation, and satisfaction (P > .075)., Conclusion: Wavefront-guided treatment offered a small advantage in photopic LCVA. Refractive outcomes, HOAs, self-reported visual difficulties, overall vision expectation, and satisfaction were otherwise comparable between wavefront-guided and wavefront-optimized treatments., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 ASCRS and ESCRS. All rights reserved.)

This study evaluated the efficacy of intraarterial papaverine infusion after pediatric cardiac catheterization in reducing the incidence of lost pulse. This study was conducted at a teaching pediatric hospital and was designed as a randomized, prospective, double-blind, placebo-controlled study. Patients were children 5 years old or less undergoing antegrade and retrograde heart catheterization. The intervention used was an intraarterial infusion of placebo or 1.5 mg/kg papaverine after catheterization. Bilateral femoral artery ultrasound study was performed pre- and postcatheterization, including two-dimensional, color, spectral, and pulsatility index analysis. Outcome measures included clinical loss of pulse, ultrasound findings, plus other clinical factors. Fifty-six patients participated in the study (28 per group). Six patients clinically lost the pulse in the catheterized arteries [four in the papaverine and two in the placebo groups (p > 0.64)]. Clinical loss of pulse correlated with diminished pulsatility index (p < 0.035). The use of papaverine did not prevent decreased pulse or pulsatility index (p > 0.79). Increased arterial time was the only clinical factor associated with lost pulse (p < 0.0004). Pulsatility index <3.34 correlated with loss of pulse in the catheterized artery. The results indicated that intraarterial papaverine infusion after femoral artery catheterization does not prevent loss of pulse in the catheterized artery, and decreased pulsatility index correlates with diminished pulse and represents a good noninvasive method of evaluating femoral artery patency and flow.

To evaluate the usefulness of the estrogen receptor test as a prognostic indicator, a retrospective study of 134 patients with primary breast cancer was carried out at the Ottawa Civic Hospital. The estrogen receptor values, measured in a single laboratory, were correlated with the recurrence rate and the survival time after recurrence. Other well-established prognostic data, such as stage of cancer, lymph-node involvement and menopausal state, have been similarly examined to ensure that information obtained from the estrogen receptor test offers more than a duplication of information from these traditional methods. It was found that this test is a useful prognostic tool when used on premenopausal women. The results of the study show that (a) breast cancer patients having positive estrogen receptor values have recurrences less frequently, (b) among estrogen receptor-negative patients there is more than a 50% chance of early recurrence in premenopausal women compared with less than a 20% chance in postmenopausal women, (c) conventional adjuvant chemotherapy in estrogen receptor-negative premenopausal patients does not prevent early recurrence, hence, this group requires more aggressive adjuvant treatment and (d) the method described by Heuson and colleagues for estrogen receptor determination follows the trends of better-established tests.