Using a suitable measuring method that takes into account the cyclorotation of the eye, it was possible to precisely determine IOL rotation using picture pairs taken in chronological sequence. The IOL design examined in the study is recommended as a toric IOL because of its good rotational stability.

ObjectivesAge‐related hearing loss (ARHL) is a prevalent condition associated with increased risk for depression and cognitive decline. This 12‐week prospective, double‐blind pilot randomized controlled trial (RCT) of hearing aids (HAs) for depressed older adults with ARHL evaluated the feasibility of a novel research design.Methods/DesignN = 13 individuals aged ≥60 years with Major Depressive Disorder or Persistent Depressive Disorder and at least mild hearing loss (pure tone average ≥ 30 dB) were randomized to receive full‐ (active) vs low‐amplification (sham) HAs added to psychiatric treatment as usual. Duration of HA use in hours/day, adverse events frequency, attrition rate, and maintenance of the study blinding were the primary outcome measures.ResultsCompliance with HAs was excellent (>9 hours/day for both groups) and rates of adverse events and drop‐outs did not differ between groups. Preliminary data demonstrated differential improvement for active vs sham HAs on hearing functioning (Hearing Handicap Inventory for the Elderly [nonparametric effect size (np‐ES) = 0.62]), depressive symptoms (Inventory for Depressive Symptomatology [np‐ES = 0.31]), cognition (Repeatable Battery for the Assessment of Neuropsychological Status Immediate Memory [np‐ES = 0.25]), and general functioning (World Health Organization Disability Assessment Schedule [np‐ES = 0.53]). Significantly greater than 50% of both groups correctly guessed their treatment assignment, indicating incomplete concealment of treatment allocation.ConclusionsThis pilot RCT for ARHL and late‐life depression was feasible to execute and showed clinical promise, but improved methods of blinding the experimental treatments are needed. Larger studies should investigate whether hearing remediation may be an effective preventative and/or therapeutic strategy for late‐life depression and cognitive decline.

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Background Hearing loss (HL), late-life depression, and dementia are three prevalent and disabling conditions in older adults, but the inter-relationships between these disorders remain poorly understood. Methods N=8,529 participants ≥60 years who were free of cognitive impairment at baseline were analyzed from National Alzheimer’s Coordinating Center Uniform Data Set. Participants had either No HL, Untreated HL, or Treated HL. Primary outcomes included depression (15-item Geriatric Depression Scale ≥5) and conversion to dementia. A longitudinal logistic model was fit to examine the association between HL and changes in depressive symptoms across time. Two Cox proportional hazards models were used to examine HL and the development of dementia: Model A included only baseline variables and Model B included time-varying depression to evaluate for the direct effect of changes in depression on dementia over time. Results Treated HL (vs. no HL) had increased risk for depression (OR=1.26, 95% CI 1.04-1.54, p=0.02) and conversion to dementia (HR=1.29, 95% CI 1.03-1.62, p=0.03). Baseline depression was a strong independent predictor of conversion to dementia (HR=2.32, 95% CI 1.77-3.05, p<.0001). Development/persistence of depression over time was also associated with dementia (HR=1.89, 95% CI 1.47-2.42, p<.0001), but only accounted for 6% of the direct hearing-dementia relationship (Model A logHR=0.26 [SE 0.12] to Model B logHR=0.24 [SE 0.12]) suggesting no significant mediation effect of depression. Conclusions Both HL and depression are independent risk factors for eventual conversion to dementia. Further understanding the mechanisms linking these later-life disorders may identify targets for early interventions to alter the clinical trajectories of at-risk individuals.

The aetiology of pericardial effusion has been generally assessed by clinical work-up only, which leaves a large cohort of patients with "idiopathic" effusions virtually undiagnosed. In accordance with the ESC guidelines, this contribution intends to change this attitude. After therapeutic or diagnostic pericardiocentesis of 259 patients with large to moderate pericardial effusions, pericardial fluid, epicardial and pericardial biopsies, and blood samples were analysed by PCR for cardiotropic microbial agents. Cytology, histology, immunohistology of tissue and fluids and laboratory tests were performed. Of the 259 patients, 35 % suffered from an autoreactive aetiology, 28 % suffered from a malignant and 14 % from an infectious cause. Investigating all samples by PCR, we identified viral genomes in 51 (19.7 %) patients, parvovirus B19 (B19 V) being identified in 25 and Epstein-Barr virus (EBV) in 19 cases. In patients with a sole infectious aetiology (n = 36), B19 V was detected in 21 and EBV in 10 cases. When differentiating with regard to the material investigated for the presence of cardiotropic viruses, parvovirus B19 was most often detected in the epicardium and EBV was most frequently detected in the pericardial fluid independent from the final diagnostic categorisation. Bacterial cultures including tests for tuberculosis were all negative. Molecular techniques improve sensitivity, specificity and diagnostic accuracy for the underlying aetiology in pericarditis patients with effusion. The identification of specific viral signatures will help to understand pathogenetic mechanisms in pericarditis and allow to tailor an adequate therapy beyond antiphlogistic treatment.

Purpose Chronic ankle instability is the main complication of ankle sprains and requires surgery if non-operative treatment fails. The goal of this study was to validate a tool to quantify psychological readiness to return to sport after ankle ligament reconstruction. Methods The form was designed like the anterior cruciate ligament-return to sport after injury scale and “Knee” was replaced by the term “ankle”. The ankle ligament reconstruction-return to sport after injury (ALR-RSI) scale was filled by patients who underwent ankle ligament reconstruction and were active in sports. The scale was then validated according to the international COSMIN methodology. The AOFAS and Karlsson scores were used as reference questionnaires. Results Fifty-seven patients (59 ankles) were included, 27 women. The ALR-RSI scale was strongly correlated with the Karlsson score (r = 0.79 [0.66–0.87]) and the AOFAS score (r = 0.8 [0.66–0.87]). A highly significant difference was found in the ALR-RSI between the subgroup of 50 patients who returned to playing sport and the seven who did not: 68.8 (56.5–86.5) vs 45.0 (31.3–55.8), respectively, p = 0.02. The internal consistency of the scale was high (α = 0.96). Reproducibility of the test–retest was excellent (ρ = 0.92; 95% CI [0.86–0.96]). Conclusion The ALR-RSI is a valid, reproducible scale that identifies patients who are ready to return to the same sport after ankle ligament reconstruction. This scale may help to identify athletes who will find sport resumption difficult. Level of evidence III.

Expression analysis of programmed death-ligand 1 (PD-L1) may be helpful in guiding clinical decisions for immune checkpoint inhibition therapy, but testing by immunohistochemistry may be hampered by heterogeneous staining patterns within tumors and expression changes during metastatic course. PD-L1 expression (clone SP142) was investigated in esophageal adenocarcinomas using tissue microarrays (TMA) from 112 primary resected tumors, preoperative biopsies and full slide sections from a subset of these cases (n = 24), corresponding lymph node (n = 55) and distant metastases (n = 17). PD-L1 expression was scored as 0.1-1, >1, >5, >50% positive membranous staining of tumor cells and any positive staining of tumor-associated inflammatory infiltrates and/or stroma cells. There was a significant correlation with overall PD-L1 expression between the full slide sections and the TMA (p = 0.001), but not with the corresponding biopsies. PD-L1 expression in tumor cells >1% was detected in 8.0% of cases (9/112) and 51.8% of cases (58/112) in tumor-associated inflammatory infiltrates and/or stroma cells of primary tumors. Epithelial expression in metastases was found in 5.6% of cases (4/72) and immune cell expression in 18.1% of cases (13/72), but did not correlate with the expression pattern in the primary tumor. Overall PD-L1 expression in the primary tumor did not influence survival. However, PD-L1 expression was correlated with the number of CD3 tumor-infiltrating lymphocytes in the tumor center, and a combinational score of PD-L1 status/CD3 tumor-infiltrating lymphocytes was correlated with patients' overall survival.

Without landmarks, navigation is based on information about self-velocity, which is transformed to position or orientation by a process called path integration. Simple path integration tasks, such as reaching a previously seen goal by blindfolded locomotion, were often considered to be automatic and not influenced by unrelated cognitive activity. However, we recently showed that reproduction of self-motion without landmark cues exhibits systematic dual-task interference. Since these experiments did not exclude that the dual task only interferes with memory for self-motion, we performed two additional experiments testing generic path integration. We show that locomotor homing and reaching predefined goals by active self-motion are affected systematically by a concurrent mental task. The similarity of the effects we found to those reported for duration estimation led us to the hypothesis that subjective time may be used as a temporal basis of path integration. Alternatively, path integration and duration estimation may be based on similar underlying neuronal mechanisms, for example, coincidence detection in neural oscillators.