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Terresa Beckley
We study surgically-induced astigmatism following three kinds of glaucoma surgeries combined with cataract surgery with 6 months of follow-up. The mean surgically-induced astigmatism at 6 months postoperatively was 1.92 +/- 1.87 diopters in phacotrabeculectomy (n = 45), 0.72 +/- 0.40 diopters in advanced non-penetrating phacotrabeculectomy (n = 40) and 0.76 +/- 0.47 diopters in phacotrabeculotomy (n = 49), which appeared to be stabilized by 3 months. Each group revealed a tendency of "with the wound" induced astigmatism. Phacotrabeculectomy could induce greater surgically-induced astigmatism than advanced non-penetrating phacotrabeculectomy and phacotrabeculotomy.
The Author(s) 2021. Context: The effect of advance care planning (ACP) interventions on the trajectory of end-of-life treatment preference congruence between patients and surrogate decision-makers is unstudied. Objective: To identify unobserved distinctive patterns of congruence trajectories and examine how the typology of outcome development differed between ACP and controls. Methods: Multisite, assessor-blinded, intent-to-treat, randomized clinical trial enrolled participants between October 2013 to March 2017 from 5 hospital-based HIV clinics. Persons living with HIV(PLWH)/surrogate dyads were randomized to 2 weekly 60-minute sessions: ACP (1) ACP facilitated conversation, (2) advance directive completion; or Control (1) Developmental/relationship history, (2) Nutrition/Exercise. Growth Mixed Modeling was used for 18-month post-intervention analysis. Findings: 223 dyads (N = 449 participants) were enrolled. PLWH were 56% male, aged 22 to 77 years, and 86% African American. Surrogates were 56% female, aged 18 to 82 years, and 84% African American. Two latent classes (High vs. Low) of congruence growth trajectory were identified. ACP influenced the trajectory of outcome growth (congruence in all 5 AIDS related situations) by latent class. ACP dyads had a significantly higher probability of being in the High Congruence latent class compared to controls (52%, 75/144 dyads versus 27%, 17/62 dyads, p = 0.001). The probabilities of perfect congruence diminished at 3-months post-intervention but was then sustained. ACP had a significant effect (β = 1.92, p = 0.006, OR = 7.10, 95%C.I.: 1.729, 26.897) on the odds of being in the High Congruence class. Conclusion: ACP had a significant effect on the trajectory of congruence growth over time. ACP dyads had 7 times the odds of congruence, compared to controls. Three-months post-intervention is optimal for booster sessions.
Type 2 diabetes mellitus (T2DM) is an important risk factor for the progression of metabolic liver disease to advanced fibrosis. Here, we provide an estimate of the prevalence of steatosis and fibrosis in U.S. adults with T2DM on the basis of transient elastography (TE) and identify factors associated with these conditions.
Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disorder worldwide (1), is associated with a substantial economic and clinical burden (2), and is the most rapidly growing indication for liver transplant, ranking second in the United States (3). NAFLD is tightly connected with obesity, ectopic fat deposition and insulin resistance (4); thus, its prevalence is particularly high in individuals at high metabolic risk, such as patients with type 2 diabetes mellitus (T2DM) (5), who are also at higher risk of progression toward nonalcoholic steatohepatitis, advanced fibrosis, and cirrhosis.
The best predictor of future clinical outcomes related to NAFLD is the degree of fibrosis, and the gold standard for its measurement is liver biopsy (6). Nonetheless, given the prevalence of this condition, noninvasive and readily available tools to identify patients with advanced fibrosis were developed (7). These can be classified as blood-based biomarkers and imaging techniques. Although the former are easier to implement in routine clinical practice, there is low concordance between different tests (8), and their performance has been questioned, especially in patients with T2DM (9), with some authors advocating the direct use of transient elastography (TE) to screen for both steatosis and fibrosis in all patients with T2DM (10). However, this strategy has not yet been tested in unselected patients with T2DM in the United States, and available studies on the prevalence of advanced fibrosis and occult cirrhosis in this population mostly come from tertiary care centers (11).
Distributions of liver steatosis and fibrosis in specific subgroups are shown in Supplementary Tables 2 and 3, respectively. No significant differences were found for sex and Hispanic ethnicity, whereas obese patients had a higher prevalence of both steatosis and advanced fibrosis.
On multivariable logistic regression analysis, BMI and ALT values were positively associated with steatosis, whereas non-Hispanic Black race was associated with lower odds of having steatosis. No differences were found for age, sex, and diabetes duration (Table 3). Moreover, higher BMI, AST, and GGT values were positively associated with advanced fibrosis, whereas non-Hispanic Black race was associated with a decreased risk.
According to previous studies, T2DM is one of the most important risk factors for advanced fibrosis in patients with NAFLD (22), and patients with T2DM are two to three times more likely to die of liver-related causes compared with the general population (23). In 2016, the European Association for the Study of the Liver, European Association for the Study of Diabetes, and European Association for the Study of Obesity jointly published guidelines that recommend routine screening for NAFLD and advanced fibrosis in patients with T2DM (24). The guidelines suggest using abdominal ultrasound to make a diagnosis of steatosis and serum-based biomarkers (e.g., FIB-4 or NAFLD fibrosis score) to evaluate the risk of advanced fibrosis. Nonetheless, because they are based on metabolic variables, these scores underperform in patients with diabetes compared with the general NAFLD population (9,25), with different scores leading to different estimates in the number of patients with advanced disease (26).
In contrast, our estimate of advanced fibrosis is higher than what was previously reported by Doycheva et al. (29) in 100 U.S. patients with T2DM using magnetic resonance elastography (7.1%). We believe that less stringent inclusion criteria in this study for alcohol consumption and known liver disease may explain, in part, the discrepancy. On the other hand, Bril et al. (9) recently found biopsy-proven advanced fibrosis in 19% of patients with T2DM and steatosis.
Also in line with previous studies, we found a strong positive association between BMI and increased LSM, whereas advanced fibrosis was less common in non-Hispanic Black patients. AST and GGT levels were also predictive of F3-F4, whereas ALT correlated poorly with disease severity, being only associated with increasing steatosis grade. Interestingly, GGT values, which are not considered in most noninvasive scores of fibrosis, also were identified as independent predictors of increased LSM in a French study evaluating the use of TE in T2DM (31).
In contrast with that study, however, our analysis shows that patients with advanced fibrosis and cirrhosis were not older than their counterparts, suggesting the need for a high index of suspicion even in relatively young individuals. Finally, as previously reported (32), we found only a weak correlation between LSM and FIB-4, and concordance was poor when original cutoffs were applied, suggesting that negative predictive value of FIB-4 may not be high in patients with T2DM.
Our study has the strength of a large sample of unselected patients from the general U.S. population and the use of one of the best-performing noninvasive tests for assessing liver steatosis and fibrosis. Moreover, the availability of the XL probe, which was essential given the prevalence of obesity in our population, made it possible to obtain valid LSM measurements in the vast majority of patients (93.5%). Nevertheless, we acknowledge the presence of some limitations. First, regarding the exclusion of other forms of chronic liver disease, we showed that the prevalence of viral hepatitis was low and unlikely affected the results, whereas data on alcohol intake were not available because they have not yet been published by the Centers for Disease Control and Prevention. Therefore, a formal diagnosis of NAFLD could not be obtained. Second, the absence of histologic data prevents us from reporting the exact prevalence of steatosis and advanced fibrosis according to the gold standard technique. Moreover, there is no universal cutoff guideline for CAP score, and its ability to distinguish between different degrees of liver steatosis is suboptimal (19). However, we used various cutoff points from previous studies performed in Western populations (11,19). Finally, TE has several limitations and is less accurate in the context of active liver inflammation, severe obesity, and liver congestion. As a consequence, its accuracy is lower when compared with magnetic resonance techniques for assessing both steatosis and fibrosis (20,33).
In conclusion, patients with T2DM from the general U.S. population have a high prevalence of both steatosis and advanced fibrosis, supporting routine screening for these conditions. Patients with high BMI and AST and GGT levels might be at particularly high risk and can be prioritized for liver assessment.
Holographic displays have the promise to be the ultimate 3D display technology, able to account for all visual cues. Recent advances in photonics and electronics gave rise to high-resolution holographic display prototypes, indicating that they may become widely available in the near future. One major challenge in driving those display systems is computational: computer generated holography (CGH) consists of numerically simulating diffraction, which is very computationally intensive. Our goal in this paper is to give a broad overview of the state-of-the-art in CGH. We make a classification of modern CGH algorithms, we describe different algorithmic CGH acceleration techniques, discuss the latest dedicated hardware solutions and indicate how to evaluate the perceptual quality of CGH. We summarize our findings, discuss remaining challenges and make projections on the future of CGH.
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