The Effect of Donor- and Recipient-Related Factors on Corneal Graft Survival in Penetrating Keratoplasty

Purpose: To investigate the impact of donor and recipient factors on graft survival in penetrating keratoplasty (PK).

Material and Methods: This retrospective study included 365 eyes that underwent PK using corneas from 231 donors between June 2010 and June 2015. Patients were divided into three groups (group 1: primary endothelial diseases; group 2: iatrogenic endothelial disorders; and group 3: other pathologies with a healthy endothelium) according to PK indications. The primary outcome measure was corneal graft survival at the last visit (clear or opaque). Graft clarity was assessed using Kaplan–Meier survival analysis.

Results: The most frequent PK indication was keratoconus (KC) (20.5%) followed by pseudophakic bullous keratopathy (PBK) (18.9%). Donor age had a negative impact on endothelial cell density (ECD) measured by an eye bank specular microscope (p < 0.001). Median best-corrected visual acuity in logarithm of the minimum angle of resolution units increased from 2.1 to 0.8 at 1 year after PK (p < 0.001). The clear graft rate was 96.7% at year 1, 88.8% at year 2, and 85.5% at year 3. Overall graft survival was 84.9% during a median of 39 months (range: 24–79 months) of follow-up. A higher graft survival rate (67.2%) was observed in KC compared to PBK during 6 years (p < 0.001). Recipients younger than 50 years of age showed a better graft survival rate than those older than 70 years of age (p = 0.037). Donor ECD, time between excision and death, and preservation time had no significant effect on graft survival. Frequent graft rejection episodes (GREs) and additional procedures during surgery had a negative impact on graft survival (p < 0.001 and p = 0.014, respectively). A worse graft survival was observed in group 2 compared to groups 1 and 3 (p = 0.042).

Conclusions: Young recipient age and KC were associated with a better graft survival. Graft endothelial density and preservation time had no impact on graft survival. PBK, low vision at baseline and year 1, frequent GREs, and additional interventions during surgery had a negative impact on graft survivals.     

Differentiated Thyroid Cancer in Children: A UK Multicentre Review and Review of the Literature

Aims

To obtain an overview of the management and outcomes of children aged 18 years or younger diagnosed with differentiated thyroid carcinoma of follicular cell origin across the UK, by collecting and analysing data from the limited number of centres treating these patients. This multicentre data might provide a more realistic perspective than single-institution series.

Prediction modelling using routine clinical parameters to stratify survival in Malignant Pleural Mesothelioma patients undergoing cytoreductive surgery

Introduction

Malignant pleural mesothelioma (MPM) is an uncommon cancer with a poor prognosis and heterogeneous survival. Surgery for MPM is offered in some specialist centers to highly selected patients. A previously described classification and regression tree (CART) model stratified survival in unselected MPM patients using routinely collected clinical data. This study aimed to examine the performance of this CART model on a highly selected surgical population.

Degree of Bystander-Patient Relationship and Prehospital Care for Opioid Overdose

Abstract

Background

Across the spectrum of patient care for opioid overdose, an important, yet frequently overlooked feature is the bystander, or witness to the overdose event. For other acute medical events such as cardiac arrest and stroke, research supports that the presence of a bystander is associated with better outcomes. Despite the similarities, however, this well-established conceptual framework has yet to be applied in the context of overdose patient outcomes. The objective of this study was to assess the association between the nature of the bystander-patient relationship and prehospital care measures in patients being treated for opioid overdose.     

locStra: Fast analysis of regional/global stratification in whole‐genome sequencing studies

locStra is an ‐package for the analysis of regional and global population stratification in whole‐genome sequencing (WGS) studies, where regional stratification refers to the substructure defined by the loci in a particular region on the genome. Population substructure can be assessed based on the genetic covariance matrix, the genomic relationship matrix, and the unweighted/weighted genetic Jaccard similarity matrix. Using a sliding window approach, the regional similarity matrices are compared with the global ones, based on user‐defined window sizes and metrics, for example, the correlation between regional and global eigenvectors. An algorithm for the specification of the window size is provided. As the implementation fully exploits sparse matrix algebra and is written in C++, the analysis is highly efficient. Even on single cores, for realistic study sizes (several thousand subjects, several million rare variants per subject), the runtime for the genome‐wide computation of all regional similarity matrices does typically not exceed one hour, enabling an unprecedented investigation of regional stratification across the entire genome. The package is applied to three WGS studies, illustrating the varying patterns of regional substructure across the genome and its beneficial effects on association testing.     

Exercise training‐induced visceral fat loss in obese women: The role of training intensity and modality

Visceral fat loss in response to four‐cycle ergometer training regimens with explicit differences in exercise intensity and modality was compared. Fifty‐nine obese young women (body fat percentage ≥ 30%) were randomized to a 12‐week intervention consisting of either all‐out sprint interval training (SIT_all‐out, n = 11); supramaximal SIT (SIT₁₂₀, 120% O_2peak, n = 12); high‐intensity interval training (HIIT₉₀, 90% O_2peak, n = 12), moderate‐intensity continuous training (MICT, 60% O_2peak, n = 11), or no training (CON, n = 13). The total work done per training session in SIT₁₂₀, HIIT₉₀, and MICT was confined to 200 kJ, while it was deliberately lower in SIT_all‐out. The abdominal visceral fat area (AVFA) was measured through computed tomography scans. The whole‐body and regional fat mass were assessed through dual‐energy X‐ray absorptiometry. Pre‐, post‐, and 3‐hour post‐exercise serum growth hormone (GH), and epinephrine (EPI) were measured during selected training sessions. Following the intervention, similar reductions in whole‐body and regional fat mass were found in all intervention groups, while the reductions in AVFA resulting from SIT_all‐out, SIT₁₂₀, and HIIT₉₀ (>15 cm²) were greater in comparison with MICT (<3.5 cm², P < .05). The AVFA reductions among the SITs and HIIT groups were similar, and it was concomitant with the similar exercise‐induced releases of serum GH and EPI. CON variables were unchanged. These findings suggest that visceral fat loss induced by interval training at or above 90% O_2peak appeared unresponsive to the change in training intensity. Nonetheless, SIT_all‐out is still the most time‐efficient strategy among the four exercise‐training regimes for controlling visceral obesity.