Background

Parotitis presents in many forms, and the symptoms vary from modest to debilitating. It may
present a diagnostic challenge because of its extensive etiologies: bacterial, pure viral,
autoimmune or a combination of these. Before the development of the mumps vaccine, parotitis
caused by the mumps virus was extremely common, particularly in school-aged children.
However, in recent years, the influenza (type A most commonly) virus has emerged as another
viral etiology associated with parotitis. Given this emerging clinical knowledge, healthcare
workers should start considering influenza as a cause of parotitis, especially during flu seasons.
We present a case of a pediatric patient with a recent positive influenza test who returned to the
Emergency Room with swollen bilateral parotid glands. The patient was diagnosed with parotitis
clinically and it was associated with the influenza virus.

Case presentation

A three-year-old boy with prior medical history of hypoparathyroidism presented to the ER with
swollen bilateral facial edema a day after presenting shortness of breath, runny nose, fever and
cough consistent with influenza. Patient vaccination status was up-to-date, except for the annual
influenza one. Physical examination revealed a well developed and nourished child with nasal
secretions and bilateral facial swelling. He had clear lungs, normal breath sounds and no
respiratory distress. Pertinent labs revealed leukocytosis (12.65), increased CRP (1.8) and
increased amylase levels (241), suggesting inflammation of the parotid glands. Patient underwent
CT of facial bones with IV contrast, which revealed bilateral parotid glands swelling. Given his
upper respiratory symptoms, the patient was diagnosed with bilateral parotitis secondary to
influenza virus infection. He was treated with supportive care, acetaminophen and catch-up
influenza vaccine.

Discussion

It can be challenging to determine whether the temporal association between influenza and rare
complications indicates that the virus is causally associated with the syndrome. However,
physicians should consider the possibility of influenza infection when a patient presents with
parotitis, especially if a temporal relation exists. Patients may benefit because widespread
epidemics of influenza occur in the United States each year and such a public health response
would generally be unnecessary if a case of parotitis were found to be due to influenza rather
than mumps, the most common cause of parotitis.

Is there a link between parotitis and influenza? Physicians should consider influenza virus as an etiology for patients​

Background
The prevalence of diabetes and hypertension is disproportionately elevated in the Arab American population. Dearborn, the largest Arab American population in the United States, suffers specifically from these health inequities. The prevalence of diabetes in Dearborn is estimated to be greater than 18%, in a study conducted 20 years ago, with limited data suggesting more up-to-date figures. Hypertension, likewise, is also disproportionately elevated with over one-third of the population afflicted. These levels have called for urgent intervention by local and state health agencies, with reported glycemic goals being achieved in less than one-third of the population. These chronic, systemic diseases have many micro and macrovascular health complications; many of which manifest in the eye with resulting in irreversible vision loss. Hypertensive and diabetic retinopathy are among the most common ophthalmologic diseases and commonly result in painful vision loss, which alters the patient’s independence and self-confidence. These complications are financially burdensome with these patients having much needing consistent injections and intraocular surgery. By decreasing the health disparities found in this population, we can grant patients a better future in which we help save their vision.

These health disparities can be attributed to many things: language barriers, decreased access to medication, and decreased health literacy among other causes. One way to combat such inequity is with the Dearborn Sees project. This is a project in collaboration with the Dearborn Health Department (DHD), as well as pending cooperation with the American Association of Ophthalmologists (AAO). The goal was to design a website that is coded and written in Arabic from the ground up, with the most common ophthalmologic diseases explained in simple Arabic text and video that the common Arab American could understand. The website will also feature the ability to search for your nearest ophthalmologist and use artificial intelligence to triage symptoms from a questionnaire to suggest the degree of urgency of disease. 

Methods
Coding and building a website in Arabic with a database of Dearborn-based ophthalmologists and using artificial intelligence to triage potential ophthalmologic emergencies.

Results
This website is still being built, with the confirmed cooperation of the DHD, and pending cooperation of the AAO. 

Conclusion
The prevalence of diabetes and hypertension is disproportionally elevated in the Dearborn community. The implementation of technology that allows for easier comprehension for non-native speakers allows for far-reaching implications for many ethnically diverse communities throughout the United States.

The Dearborn Sees Project: Using Technology to Decrease Language Barriers and Improve Access to Care

Background
Described in 1770, Bouveret’s syndrome is rare and characterized by gastric outlet obstruction caused by gallstone-driven fistulization between the gallbladder and the stomach or duodenum, accounting for 1-3% of gallstone ileus. Women with a mean age of 71 years are the primary demographic. 91% undergo surgical intervention for obstruction relief. Mortality ranges from 12-27%, with morbidity reaching 50%. We present a case of Bouveret’s syndrome with gallstone migration to the jejunum resulting in gallstone ileus, with the benefit of multiple imaging modalities. 

Case Presentation
A 54-year-old female presented with 4-day history of right upper quadrant abdominal pain. Ultrasound (US) elicited sonographic Murphy’s sign and showed gallbladder wall thickening and a gallstone. Subsequent computed tomography (CT) with contrast demonstrated cholecystitis, pneumobilia, and a cholecytoduodenal fistula. A large radiolucent gallstone was impacted in the duodenum resulting in gastric outlet obstruction. 

On hospital day 2, she developed vomiting with abdominal distension and a nasogastric tube provided relief. Abdominal radiographs showed new small bowel dilation concerning for small bowel obstruction (SBO). Magnetic resonance imaging (MRI) the following day redemonstrated cholecystitis and cholecystoduodenal fistula. Importantly, it also showed a new proximal SBO, with transition point in the jejunum, which was secondary to interval migration of the gallstone from duodenum to jejunum. 

Exploratory laparotomy was performed on hospital day 5 and a 5 cm cholelith was removed from the jejunum, relieving the obstruction. The patient tolerated the procedure well. She was discharged the following day and was stable at follow up. 

Discussion
This case illustrates the uncommon diagnosis of Bouveret’s syndrome with subsequent gallstone migration into the jejunum resulting in gallstone ileus with the benefit of US, CT, XR, and MRI imaging modalities. There is an average of 7 days from symptom onset to surgery, with 9 days for this patient. As mortality and morbidity rates are high, early diagnosis of Bouveret’s syndrome is crucial, which can be challenging due to its non-specific presentation of abdominal pain and vomiting, and because gallstones are frequently radiolucent making them difficult to detect on CT. The classic Rigler’s triad (ectopic gallstone, pneumobilia, and SBO) associated with gallstone ileus is not always visualized on imaging. CT is the most accurate imaging test for diagnosis of Bouveret’s syndrome and is therefore the imaging test of choice, although US and MRI can be very helpful adjunct to aid in detecting radiolucent gallstones, as in this case.

Multiple Imaging Modalities of Bouveret's Syndrome with Further Gallstone Migration

Background
Performing ptosis surgery in an office-based setting is less costly to the health system relative to an operating room. However, 90% of US ptosis surgeries are performed in the less economical operating room. This study aims to understand the financial and practical factors involved in surgical location decision-making, and the modifiable incentives to influence migration from operating room to procedure room.

Design
Economic analysis 

Methods
Oculoplastic surgeons were surveyed to determine the most important attributes when deciding to perform a surgery in an operating room (OR) or office procedure room (PR). Responses were collated and common themes extracted. Consensus themes were operationalized into major domains: reimbursement, comorbidities, sedation requirements, and logistics. Reimbursement consisted of five levels starting at $550, with each level increasing by 50%, until total reimbursement tripled at $1650. Comorbidities, sedation requirements, and logistics each had two levels, with one being preferable.

A discrete choice analysis was used to evaluate the relative importance each factor had on decision-making by surveying oculoplastic surgeons. Participants were randomly assigned 14 out of 40 hypothetical ptosis procedure scenarios, asking physicians to choose between completing a procedure in the PR or OR. For all scenarios, OR reimbursement was $550. Key physician characteristics were collected: urban vs rural location, surgery center ownership, age, years of experience, and number of ptosis surgeries performed. Analysis was conducted using an econometric model that assumes physicians decide whether to use the PR by evaluating a random utility function.

Results
68 oculoplastic surgeons completed the survey, yielding 882 observations. Age and years of experience were highly correlated (.97) and only years of experience was used in the analysis.

Increasing PR reimbursement increased probability of choosing PR, with diminishing effect as reimbursement rose above $1100. Risk factors demonstrated expected directional effects: serious comorbidities, sedation requirements, and logistical issues each reduced probability of PR use for a given reimbursement. Rural offices dramatically increased probability of choosing PR. Number of surgeries performed slightly increased probability of PR choice for every 100 prior surgeries. Ownership and years of experience were not significant.

Conclusion
The model revealed reimbursement is the most important factor, especially at $1100 or more, followed by practice location, sedation, number of surgeries, logistical issues and comorbidities. The results suggest if all risk factors are low, doubling reimbursement increases the likelihood of using the PR by 35%. If all risk factors are high, the likelihood increases by 17%. This study shed light on the factors surgeons use to evaluate ptosis surgery location choice. The insight gained through this analysis will hopefully inform policy decisions and lead to a more efficient and thoughtful use of resources.

The Impacts of Reimbursement Rates on Ptosis Procedure Location Choice: A Discrete Choice Analysis

Background
Guillotine amputations involve amputating an extremity with the wound left open, and are indicated in the setting of contamination. With lower extremity amputation, surgical options include below-knee amputation (BKA), through-knee amputation or knee disarticulation (KD), and above-knee amputation (AKA). BKAs preserve the knee joint and have been shown to have fewer complications and improved rehabilitation compared to KDs and AKAs. When BKAs are not feasible for a traumatic injury, an AKA is often chosen, due to difficulty or lack of understanding of KD surgery. While few RCTs have compared KDs to AKAs, they may be a viable alternative to AKAs.
Case Presentation
A 28-year-old male presented to the ED after being hit by a truck while on a motorcycle. Physical exam revealed severe injuries to the left lower extremity (LLE), including open tibia and fibula fractures, degloving of the associated soft tissue, obliteration of the anterior compartment of muscles, and a cool foot with no identifiable pulse. Radiographs revealed open, comminuted fractures of the left tibia and fibula. CTA of the LLE revealed abrupt cut-off of contrast at the level of the distal trifurcation of the popliteal artery, proximally in the tibia. 
The patient was urgently taken to the OR, where a guillotine amputation was performed through the knee joint (KD), due to the proximal nature of the fractures and level of vessel tear. KD was chosen over AKA in order to preserve the thigh musculature and therefore maximal function in this young, healthy patient. Three days later, he underwent irrigation and debridement of the LLE with wound closure. The patient was discharged home five days after wound closure, or eight days after admission. Three months out of surgery, the patient has done well with physical therapy and prosthetic usage; he will continue to be followed closely for rehabilitation and recovery. 
Discussion
Factors to be considered in the level of amputation include soft tissue viability for bone coverage, blood vessel viability, and wound contamination. When BKA is not possible, KD can offer an alternative to AKA. KDs present concerns of poor wound healing and stump breakdown, as well as increased risk of revision surgery. However, compared to ambulating on a normal leg, patients undergoing AKAs require 70% more energy expenditure. As compared to AKA, KD preserves the adductor muscles, leading to improved stability and reduced metabolic expenditure with ambulation. Therefore, KDs may result in improved rehabilitation and increased long-term functionality.


A Case of Traumatic Guillotine Knee Disarticulation

Background: Mammary Paget’s Disease (MPD) of the nipple-areolar complex (NAC) is a rare disorder of the breast associated with an underlying carcinoma affecting 1-4% of breast cancer patients. The etiology of MPD is thought to arise from a malignant conversion of pluripotent keratinocyte stem cells or cells of apocrine gland ducts; that is supported by structural similarity between Paget and Toker cells – epithelial cells found in the NAC of 10% of women. MPD presents as eczematous patches of scaly tissue surrounding the NAC associated with tingling and pruritis. 

Case Presentation: Here we describe a 74-year-old patient with local recurrence of breast cancer >20 years following treatment. She initially presented with a right breast stage IA (cT1cN0M0) invasive ductal carcinoma involving right upper inner quadrant in year 2000. She was treated with partial mastectomy (PM) and sentinel lymph node biopsy (SLNB) followed by adjuvant whole breast radiation therapy and 2.5 years of adjuvant tamoxifen. She remained disease free until year 2022 when she presented with waxing and waning four-month history of skin irritation involving the right nipple. Exam demonstrated a small, 1 centimeter (cm), crusty erythematous rash. Initial trial of antibiotics did not improve symptoms. She underwent a punch biopsy which demonstrated MPD. Breast MRI showed a right NAC enhancement with a 0.5 cm mass at 12:00 o’clock position. Biopsy of the central mass demonstrated a grade 2 invasive ductal carcinoma, ER/PR+ without HER2 amplification. She underwent right mastectomy with SLNB with final pathology demonstrating stage IA disease (pT1apN0[sn]). 

Discussion: This case highlights a unique clinical sign for breast cancer recurrence despite a long period of remission. Several factors are associated with a high risk of late recurrence including ER+ tumors, diagnosis before the age of 40, treatment involving breast conserving surgery, 4 or more positive lymph nodes, and a T2 or higher tumor stage. It is challenging to know if the new breast cancer is recurrent or new primary, although management is similar. For patients with underlying malignancy, the rate of SLNB was 17% warranting nodal evaluation. MPD local recurrence has been shown to be common in patients who previously underwent nipple sparing mastectomy. Small, single institution, series found that patients with underlying MPD had worse survival compared to those without MPD. Unfortunately, no high quality, prospective, data exist to guide management for patients with MPD versus non-MPD recurrence; general approach includes SLNB followed by mastectomy; an alternative approach to mastectomy in women who recur a decade or two after initial PM and adjuvant radiation who are averse to mastectomy would be to repeat PM followed by partial breast radiotherapy. This case emphasizes the importance of early cancer surveillance to prevent delays in intervention.


Mammary Paget’s disease of the nipple as a sign of local recurrence two decades after properly treated breast cancer

Purpose: To test the hypothesis that rod photoreceptor mitochondria function in vivo progressively declines over time.

Methods: 2, 12, and 24 mo dark- and light-adapted C57BL/6J (B6J) mice were examined by OCT. We measured i) an index of mitochondrial configuration within photoreceptors measured from the profile shape aspect ratio (MCP/AR) of the hyperreflective band posterior to the external limiting membrane (ELM)], ii) a proxy for energy-dependent pH-triggered water removal, the thickness of the ELM-retinal pigment epithelium (ELM-RPE), and its correlate iii) the hyporeflective band (HB) signal intensity at the photoreceptor tips. Visual performance was assessed by optokinetic tracking.

Results: In 2 mo and 24 mo mice, MCP/AR in both inferior and superior retina were smaller in light than in dark; no dark-light differences were noted in 12 mo mice. Dark-adapted inferior and superior, and light-adapted superior, ELM-RPE thickness increased with age. The dark-light difference in ELM-RPE thickness remained constant across all ages. All ages showed a decreased HB signal intensity magnitude in dark relative to light. In 12 mo mice, the dark-light difference in HB magnitude was greater than in younger and older mice. Anatomically, outer nuclear layer thickness decreased with age. Visual performance indices were reduced at 24 mo compared to 2 mo mice.

Conclusions: Whilst the working hypothesis was not supported herein, the results raise the possibility of a mid-life adaptation in rod mitochondrial function during healthy aging in B6J mice, a plasticity that occurred prior to declines in visual performance. 


Do Multiple OCT Biomarkers Indicate Age-related Decline in Rod Mitochondrial Function in C57BL/6J Mice? 

Background
The under-reporting of subject demographics and race disparities in ophthalmic clinical trials have been documented in the past. The Final Rule for Clinical Trials Registration and Results Information Submission conditionally requires race and ethnicity disclosure for studies whose primary completion date is on or after January 18, 2017. We examined the change in the enrollment and demographic disclosure rate among US-based ophthalmic clinical trials after the implementation of the Final Rule.

Methods
ClinicalTrials.gov was queried for “eye,” “eye diseases,” and “ocular.” US-based trials with a completed status and enrollment greater than or equal to 50 subjects were included (n=872). Trials with a primary completion date on or after 1/18/2017, and results first submitted on or after 4/18/2017 (Final Rule compliance date) were categorized as “post-requirement” (n=314) trials. Trials prior to these dates were categorized as “pre-requirement” (n=558) trials. Primary outcomes included the disclosure rate and enrollment of each race/ethnicity category. The disclosure rate before and after the implementation of the Final Rule was compared with Pearson’s chi-square test. The enrollment before and after the implementation of the Final Rule was compared with the Mann-Whitney U-test.

Results
The race disclosure rate, as defined by the proportion of studies disclosing any race information, significantly increased (p<0.0001) among post-requirement trials (84.39%) compared to pre-requirement trials (26.16%). The ethnicity disclosure rate, as defined by the proportion of studies disclosing any ethnicity information, significantly increased (p<0.0001) among post-requirement trials (55.73%) compared to pre-requirement trials (16.85%). The disclosure rate of all race/ethnicity categories increased significantly among post-requirement trials (p<0.0001) compared to pre-requirement trials. There was no significant change in enrollment of any race/ethnicity category between all pre- and post-requirement trials. White subject enrollment was higher and Hispanic subject enrollment was lower in non-NIH-funded trials versus NIH-funded trials both before (White subjects, p=0.0022; Hispanic/Latino subjects, p=0.0495) and after (White subjects, p=0.0002; Hispanic/Latino subjects, p=0.0168) the implementation of the Final Rule.

Conclusion
While the disclosure rate of race in clinical trials approximately increased by a factor of 3, the enrollment of minorities demonstrated no change after the implementation of the Final Rule. White subject enrollment was higher, and Hispanic subject enrollment was lower in non-NIH-funded trials compared to NIH-funded trials after the implementation of the Final Rule, which has not been previously reported. Stronger legislation that requires the enrollment of minority groups and subsequent demographic information reporting is needed to improve diversity in ophthalmic clinical trials.

Demographic Disclosure Rate and Enrollment Before and After the Final Rule in Ophthalmic Clinical Trials

Introduction: This study identifies retinitis pigmentosa (RP) and Leber congenital amaurosis (LCA) patients at an inherited retinal disease (IRD) clinic that qualify for ongoing or FDA-approved adeno-associated virus (AAV) gene-replacement therapies. The goal is to demonstrate the benefits of genetic testing at the initial evaluation.

Method: A database for RP and LCA patients was curated and clinicaltrials.gov was used to search all ongoing or approved gene-replacement therapies between 1 January 2022 – 1 January 2023. Patients were evaluated for qualification based on the inclusion/exclusion criteria set by each trial.

Results: 199 RP and 31 LCA patients were included in the study. Our team identified six AAV gene-replacement therapy clinical trials and the FDA-approved Luxturna®. One hundred fifty-five patients underwent genetic testing, and 89 patients had a pathogenic variant identified. A total of 15 patients qualified for one of the proposed trials. Three patients had a biallelic RPE65 mutation, and two of them qualified for Luxturna®. All 11 patients with an RPGR mutation qualified for one of the three clinical trials that focused on this gene. Three patients had a c.2991+1655A>G mutation in CEP290 and two of them qualified one of two clinical trials for this gene.

Conclusion: Overall, ~10% of patients who had genetic testing qualified for one of the reviewed therapies. A total of 15 patients qualified for an AAV gene-replacement therapy. This study highlights the importance of promoting genetic testing for IRD patients, the need for earlier disease evaluation, and the value of continual monitoring of disease progression.


Qualifications for Retinitis Pigmentosa and Leber Congenital Amaurosis Patients for Adeno-Associated Viral Gene-Replacement Therapy Clinical Trials

Persistent sciatic artery is a rare congenital malformation, with an incidence under 0.04%. The sciatic artery is a branch of the internal iliac artery, supplying the lower limb in the early embryonic stage. Normally, the sciatic artery involutes, while the superficial femoral artery becomes the major blood supply of the lower extremity. However, the absence of femoral artery development leads to the sciatic artery becoming the dominant blood supply.
Uterine artery embolization is widely used, has minimal morbidity and high technical success rates. However; in the few reported cases of patients undergoing Uterine artery embolization where a persistent sciatic artery wasn’t recognized, there was non-targeted embolization and failure to embolize the uterine artery. 
In the patient’s case, the uterine artery bifurcates off the persistent sciatic artery and is crucial to identify in order to properly conduct the uterine artery embolization. If this vascular variant was not properly identified it is possible that non-targeted embolization could have occurred leading to catastrophic consequences.



Uterine Artery Embolization in a Patient with a Persistent Sciatic Artery

Background

Retinal vascular occlusions (RAVO), such as retinal vein occlusion (RVO) and retinal artery occlusion (RAO), have been shown to be associated with cognitive impairment, including dementia. The purpose of our study is to examine the risk of dementia among patients with retinal vascular occlusion.

Methods

Demographic, clinical, and ophthalmic information was collected for subjects with and without retinal vascular occlusions. 503 subjects with retinal vascular occlusion and 1006 subjects without retinal vascular occlusion (comparison group) seen in an eye clinic were included. Among subjects with retinal vascular occlusions, 432 had retinal vein occlusion (RVO) and 71 had retinal artery occlusion (RAO). Among subjects with retinal vein occlusion, 200 had central RVO (CRVO) and 232 had branch RVO (BRVO). Subjects in the comparison group were age- and sex-matched to those with vascular occlusion. Logistic regression was used to analyze the odds of all-cause dementia, vascular dementia, and Alzheimer’s disease after adjusting for race, ethnicity, diabetes, hypertension, hyperlipidemia, stroke, coronary heart disease, diabetic retinopathy, age-related macular degeneration, and glaucoma.

Results

Subjects with RAVO had increased odds for all-cause dementia (Odds ratio (OR)=2.04, p=0.001) and vascular dementia (OR=2.66, p=0.011). Subjects with RVO had increased odds for all-cause dementia (OR=2.34, p<0.001) and vascular dementia (OR=3.27, p=0.006) relative to the comparison group. Subjects with CRVO (OR=2.34, p=0.013) or BRVO (OR=2.72, p=0.006) had increased odds for all-cause dementia relative to the comparison group. There was no significant association between RAO and the odds for all-cause dementia (OR=1.03, p=0.963).

Conclusion

Central retinal vein occlusions increase the odds of all-cause dementia by over two-fold. Branch retinal vein occlusions increase the odds of all-cause dementia by nearly three-fold. These associations were not seen among patients with retinal arterial occlusions. Retinal vein occlusions also increase the odds of vascular dementia by approximately three-fold.

Risk Factors for Dementia in Patients with Retinal Vein Occlusions


Background:

The two main classes of AMTs commercially available today are “cryopreserved” and “dehydrated.”

Many studies have indicated that the process of cryopreservation is effective at maintaining both the quantity and activity of biological signaling proteins found within the amniotic tissue. One notable drawback of cryopreserved amniotic membranes is that they carry a higher monetary cost due to their stringent production and storage requirements.

Dehydrated amniotic membranes are a cheaper alternative to their cryopreserved counterparts. This is primarily because they have simpler storage requirements, as they can be kept at room temperature. However, studies have also shown that dehydrated amniotic membranes are less effective at maintaining the availability and activity of important biological factors that influence healing and tissue regeneration. Yet, it remains unclear if these findings have any significant real-world implications in a clinical setting. Accordingly, our study seeks to identify and compare the benefits and shortcomings of each type of membrane. 

Methods: 

We completed a retrospective, non-inferiority trial involving 36 patients who formed 2 populations. Group 1 received a cryopreserved membrane while Group 2 received a dehydrated membrane. The duration of therapy was 1 week. We recorded each patient's indications, number of amniotic membrane transplants (AMTs), adjunct medications, tolerability, visual acuity, and ocular pressure pre/post treatment. A positive outcome at the 1-month post-AMT visit was defined as improvement in ≥3 symptoms of eye irritation, resolution of primary indication for AMT, improvement in visual acuity, and improvement in intraocular pressure. If the criteria was not met, the outcome was considered to be negative. This trial was non-randomized nor blinded.


Results:
51 AMTs from 36 patients were included. At both the 1 week and 1 month interval, patients who received a cryopreserved amniotic membrane transplant (CAMT) self-reported a greater number of side-effects when compared to patients who received a dehydrated membrane (DAMT). Those who received a CAMT also had greater vision improvement and a higher self-reported feeling of wellness at both intervals when compared to patients who received a DAMT [P =.03]. Patients who received a DAMT were less likely to require repeated treatments [P = .001]. 

Conclusion:
Cryopreserved membranes are currently more expensive than dehydrated membranes. These cost disparities become amplified given that our data suggests a higher re-treatment rate in the Group 1. Despite these concerns, CAMTs may be viewed as a more effective treatment since patients in this cohort were more likely to have a positive outcome.


Underline digital video library

Is there a link between parotitis and influenza? Physicians should consider influenza virus as an etiology for patients

The Dearborn Sees Project: Using Technology to Decrease Language Barriers and Improve Access to Care

Multiple Imaging Modalities of Bouveret's Syndrome with Further Gallstone Migration

The Impacts of Reimbursement Rates on Ptosis Procedure Location Choice: A Discrete Choice Analysis

A Case of Traumatic Guillotine Knee Disarticulation

Mammary Paget’s disease of the nipple as a sign of local recurrence two decades after properly treated breast cancer

Do Multiple OCT Biomarkers Indicate Age-related Decline in Rod Mitochondrial Function in C57BL/6J Mice?

Demographic Disclosure Rate and Enrollment Before and After the Final Rule in Ophthalmic Clinical Trials

Qualifications for Retinitis Pigmentosa and Leber Congenital Amaurosis Patients for Adeno-Associated Viral Gene-Replacement Therapy Clinical Trials

Uterine Artery Embolization in a Patient with a Persistent Sciatic Artery

Risk Factors for Dementia in Patients with Retinal Vein Occlusions

Comparing patient tolerability of cryopreserved and dehydrated amniotic membrane transplantations for managing corneal disease

Stay up to date with the latest Underline news!

PRESENTATIONS

CONFERENCES

COMPANY

RESOURCES

Underline digital video library

Is there a link between parotitis and influenza? Physicians should consider influenza virus as an etiology for patients​

The Dearborn Sees Project: Using Technology to Decrease Language Barriers and Improve Access to Care

Multiple Imaging Modalities of Bouveret's Syndrome with Further Gallstone Migration

The Impacts of Reimbursement Rates on Ptosis Procedure Location Choice: A Discrete Choice Analysis

A Case of Traumatic Guillotine Knee Disarticulation

Mammary Paget’s disease of the nipple as a sign of local recurrence two decades after properly treated breast cancer

Do Multiple OCT Biomarkers Indicate Age-related Decline in Rod Mitochondrial Function in C57BL/6J Mice?

Demographic Disclosure Rate and Enrollment Before and After the Final Rule in Ophthalmic Clinical Trials

Qualifications for Retinitis Pigmentosa and Leber Congenital Amaurosis Patients for Adeno-Associated Viral Gene-Replacement Therapy Clinical Trials

Uterine Artery Embolization in a Patient with a Persistent Sciatic Artery

Risk Factors for Dementia in Patients with Retinal Vein Occlusions

Comparing patient tolerability of cryopreserved and dehydrated amniotic membrane transplantations for managing corneal disease

Stay up to date with the latest Underline news!

PRESENTATIONS

CONFERENCES

COMPANY

RESOURCES

Is there a link between parotitis and influenza? Physicians should consider influenza virus as an etiology for patients