Total corneal aberration analysis is increasingly used as part of intraocular lens selection, ectasia screening, and refractive surgery planning. Scheimpflug-based tomography and anterior segment optical coherence tomography (AS-OCT) are commonly used imaging techniques to identify the anterior and posterior corneal surfaces; however, many devices combine these methods with Placido-disc topography or reconstruction algorithms. Although these devices provide anterior, posterior, and total corneal wavefront aberrations, multiple studies have shown that Zernike coefficients obtained with different systems are not consistently interchangeable, particularly for posterior-surface-derived and higher-order terms such as trefoil and total higher-order aberration root-mean-square values. This narrative review summarizes the optical principles of Scheimpflug imaging and AS-OCT, synthesizes the available comparative literature, and analyzes the mechanisms that may contribute to inter-device discordance, including differences in light sources and light-tissue interactions, posterior-surface reconstruction and refractive-index assumptions, edge-detection and Zernike-fitting algorithms, sampling geometry and acquisition time, and reference-axis selection. We discuss the clinical implications of these discrepancies and propose a research agenda, including model-eye validation and ray-tracing simulation studies, to help distinguish the effects of hardware optics from those of proprietary reconstruction algorithms.
Background: Intracardiac thrombus is a clinically important complication of acute myocardial infarction (AMI), particularly in patients with ventricular aneurysm. We examined the contemporaneous associations of anterior ventricular involvement and D-dimer with echocardiographically documented intracardiac thrombus with incomplete chamber-specific localization among hospitalized AMI patients with ventricular aneurysm. Methods: This retrospective analysis included 1684 patients with documented ventricular aneurysm from a final cohort of 17,950 hospitalized AMI patients treated between January 2018 and October 2025. The first D-dimer measurement obtained at our hospital after AMI confirmation was used for D-dimer analyses. Ventricular aneurysm and intracardiac thrombus status were determined from the available echocardiographic documentation during the index hospitalization. Aneurysm locations were coded as linked patient-level, non-mutually exclusive indicators. Logistic regression evaluated anterior involvement; missing model covariates were multiply imputed and regression estimates were pooled using Rubin’s rules. Collinearity diagnostics and sensitivity analyses restricted to patients with apical aneurysm, including a complete-case analysis, were performed. Model-performance measures were interpreted as exploratory apparent performance in the development dataset. Results: Intracardiac thrombus was documented in 211 of 1684 patients (12.5%). Anterior involvement was more frequent among patients with thrombus than among those without thrombus (57.3% vs. 45.0%; p < 0.001) and remained associated with thrombus in the primary anatomical and clinical model (OR, 1.63; 95% CI, 1.20–2.21; p = 0.002). D-dimer was available in 1633 patients. On the log2-transformed scale, each doubling of D-dimer was associated with higher odds of echocardiographically documented intracardiac thrombus (adjusted OR, 1.24; 95% CI, 1.14–1.34; p < 0.001). As a complementary descriptive analysis, the observed thrombus proportion increased from 3.63% in Q1 to 22.30% in Q4; compared with Q1, the adjusted ORs were 3.71, 5.22, and 9.50 in Q2, Q3, and Q4, respectively. The combined model had a mean apparent AUC of 0.716, compared with 0.713 for the model containing D-dimer without anterior involvement; the mean absolute increment was approximately 0.003. Conclusions: Among hospitalized patients with AMI and ventricular aneurysm, higher D-dimer levels and anterior ventricular involvement were associated with echocardiographically documented intracardiac thrombus. Chamber-specific localization was incomplete, and these contemporaneous associations do not establish causality or prospective prediction. Anterior involvement provided minimal incremental discrimination beyond D-dimer.
Background: Long-term survival in sarcoidosis patients can be predicted by several clinical and laboratory parameters. Hypercalcemia serves as a predominant, negative prognostic factor. In the current study, we aimed to identify other patient characteristics influencing outcomes over a 10-year period. Methods: This was a retrospective analysis of hospitalized sarcoidosis patients in a large, tertiary medical center. Results: During a 10-year period between 2014 and 2024, data from 89 sarcoidosis patients was collected using MDClone data-mining software. Overall, 13 patients suffered from hypercalcemia (median, corrected for blood albumin: 10.3 mg/dL [9.9–10.5] vs. 9.5 [9.2–9.8], p < 0.001). Patients with hypercalcemia had higher rates of renal failure (30.8% vs. 3.9%, p = 0.008), lower platelet counts (median 153 K/mcl [113–170] vs. 230 [190.7–263.5], p < 0.001), lower hemoglobin concentrations (median 10.2 g/dL [10.0–11.3] vs. 12.5 [10.8–13.6], p < 0.01), higher urea blood levels (median 88 mg/dL [46–130] vs. 38.5 [30–47.2], p < 0.001), higher creatinine levels (median 1.48 mg/dL [1.31–1.6] vs. 0.9 [0.76–1.05], p < 0.001), and lower albumin (mean 3.07 g/dL ± 0.47 vs. 3.57 ± 0.56, p = 0.003). Hypercalcemia was associated with lower, post-discharge survival rates (median 4.8 years [2.6–7.3] vs. 7.9 [3.3–12.1], p = 0.045) and higher rates of 3-year, post-discharge mortality (30.8% vs. 7.9%, p = 0.036). Thrombocytopenia was present in six patients (6.7%); four (66.7%) died within three years, compared with six of 83 patients without thrombocytopenia (7.2%; p = 0.001). In univariate analysis, hypercalcemia and thrombocytopenia were both associated with a higher risk of mortality within 3 years (HR = 4.11, 95% CI 1.16–14.57, p = 0.029 and HR = 13.92, 95% CI 3.88–49.93, p < 0.001, respectively). However, in a multivariate analysis, only patient age and thrombocytopenia continued to be associated with a statistically significant higher risk of death (HR = 7.04, 95% CI 1.46–33.99, p = 0.015). Five of the six patients with thrombocytopenia (83.3%) were subsequently diagnosed with hematologic malignancy, months to years after thrombocytopenia was identified. Conclusions: Thrombocytopenia was associated with higher three-year mortality and may represent a clinical warning sign for occult or subsequently diagnosed hematologic malignancy in patients with sarcoidosis.
Background/Objectives: Intensive care unit-acquired weakness is a common neuromuscular complication among critically ill patients, but associations of readily available composite biomarkers with this condition remain insufficiently characterized. This study aimed to investigate the clinical characteristics, risk factors, and composite biomarkers associated with intensive care unit-acquired weakness. Methods: This single-center retrospective cohort study included 135 critically ill patients admitted to intensive care units between December 2020 and December 2023. Patients were classified into an intensive care unit-acquired weakness group (n = 57) and a group without intensive care unit-acquired weakness (n = 78) according to Medical Research Council sum score criteria. Clinical characteristics, laboratory parameters, composite biomarkers, and hospitalization outcomes were compared. Multivariable logistic regression and receiver operating characteristic curve analyses were performed. Results: Older age, sepsis, hemodialysis, mechanical ventilation, and glucocorticoid use remained associated with intensive care unit-acquired weakness after adjustment for the other covariates in the model. Affected patients had lower albumin and hemoglobin levels and longer intensive care unit and hospital stays. The neutrophil-to-albumin ratio, inflammatory burden index, creatinine-to-albumin ratio, and serum urea-to-creatinine ratio were higher in affected patients. Receiver operating characteristic analysis showed modest discrimination, with areas under the curve ranging from 0.602 to 0.665. Conclusions: Intensive care unit-acquired weakness was associated with clinical and treatment-related factors, hypoalbuminemia, prolonged hospitalization, and elevated composite biomarkers. The composite biomarkers showed only modest discrimination, and their incremental values beyond clinical assessment and clinical utility remain unestablished. Residual confounding by illness severity and nutritional exposure cannot be excluded.
Background/Objectives: Inflammation is implicated in pterygium, but whether routine blood-count indices are associated with pterygium independently of age is unclear. We evaluated the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in systemically healthy patients with pterygium and systemically healthy controls undergoing strabismus surgery. Methods: This retrospective case-control study compared preoperative NLR and PLR in 100 patients undergoing pterygium surgery (2010–2019) and 86 systemically healthy adult controls undergoing strabismus surgery. Analyses included Holm-corrected Mann–Whitney tests, age- and sex-adjusted logistic regression, receiver operating characteristic (ROC) analysis, and age-restricted and age-matched sensitivity analyses. Results: Patients with pterygium were older (48.3 vs. 29.4 years) and had higher NLR (1.98 vs. 1.66) and PLR (128.1 vs. 114.3) (Holm-adjusted p = 0.006 and 0.005, respectively). After adjustment for age and sex, NLR remained associated with pterygium (odds ratio [OR] 3.18 per unit; 95% confidence interval [CI], 1.54–6.57; p = 0.002), whereas PLR did not (p = 0.106). In 39 age- and sex-matched pairs, differences were directionally similar but not statistically significant. Areas under the ROC curve (AUCs) were 0.632 for NLR and 0.637 for PLR. Neither index differed by pterygium grade or recurrence. Conclusions: NLR, but not PLR, was independently associated with pterygium after adjustment for age and sex, although this association was not confirmed in the small matched subsample. Neither index demonstrated sufficient diagnostic performance to serve as a biomarker. Prospective age-matched studies are needed.
