Background: Surveys suggest that a large proportion of people use the internet to search for information on medical symptoms they experience and that around one-third of the people in the United States self-diagnose using online information. However, surveys are known to be biased, and the true rates at which people search for information on their medical symptoms before receiving a formal medical diagnosis are unknown. Objective: This study aimed to estimate the rate at which people search for information on their medical symptoms before receiving a formal medical diagnosis by a health professional. Methods: We collected queries made on a general-purpose internet search engine by people in the United States who self-identified their diagnosis from 1 of 20 medical conditions. We focused on conditions that have evident symptoms and are neither screened systematically nor a part of usual medical care. Thus, they are generally diagnosed after the investigation of specific symptoms. We evaluated how many of these people queried for symptoms associated with their medical condition before their formal diagnosis. In addition, we used a survey questionnaire to assess the familiarity of laypeople with the symptoms associated with these conditions. Results: On average, 15.49% (1792/12,367, SD 8.4%) of people queried about symptoms associated with their medical condition before receiving a medical diagnosis. A longer duration between the first query for a symptom and the corresponding diagnosis was correlated with an increased likelihood of people querying about those symptoms (rho=0.6; P=.005); similarly, unfamiliarity with the association between a condition and its symptom was correlated with an increased likelihood of people querying about those symptoms (rho=−0.47; P=.08). In addition, worrying symptoms were 14% more likely to be queried about. Conclusions: Our results indicate that there is large variability in the percentage of people who query the internet for their symptoms before a formal medical diagnosis is made. This finding has important implications for systems that attempt to screen for medical conditions.

Background: Metacarpal shaft fractures that necessitate surgery are frequently fixated with either intramedullary pins or plates and screws. This study compared outcome measurements of these two techniques. Methods: Patients operated on for closed shaft fractures of metacarpals 2-5 were examined at least 1 year after injury. All fractures were fixated by pinning between years 2013 and 2015 and by locking plates and screws between 2016 and 2017. Evaluation included range of motion measurements for all fingers compared with the contralateral hand; comparison of grip strength; finger alignment and rotation; Disabilities of the Arm, Shoulder and Hand (DASH) score; and radiographic measurements of fracture reduction and healing. Results: Thirty patients with 39 fractured metacarpals treated by pinning were compared with 29 patients with 35 fractured metacarpals treated by locking plate and screws. Both groups had similar characteristics and preoperative fracture patterns on radiograph. Patients in the plate group were found to have significantly improved outcomes in total range of motion of the operated digits (loss of 4° extension, 10° flexion, and 14° total vs 10° extension, 19° flexion, and 29° total), grip strength (93% vs 83% of contralateral hand), rotational deformity (5 digits, 1° vs 15 digits, 6°), and DASH score (10.5 vs 15.6). Radiographic bone healing time (59 vs 50 days) and operative time (58 vs 41 minutes) were both significantly longer in fractures fixated by plates. Conclusions: Fixation with locking plates allows earlier mobilization without need for splinting. Our study supports the use of this method over intramedullary pinning for metacarpal shaft fractures.

Cataract, the leading cause of vision impairment worldwide, arises from abnormal aggregation of crystallin lens proteins. Presently, surgical removal is the only therapeutic approach. Recent findings have triggered renewed interest in development of non-surgical treatment alternatives. However, emerging treatments are yet to achieve full and consistent lens clearance. Here, the first ex vivo assay to screen for drug candidates that reduce human lenticular protein aggregation was developed. This assay allowed the identification of two leading compounds as facilitating the restoration of nearly-complete transparency of phacoemulsified cataractous preparation ex vivo. Mechanistic studies demonstrated that both compounds reduce cataract microparticle size and modify their amyloid-like features. In vivo studies confirmed that the lead compound, rosmarinic acid, delays cataract formation and reduces the severity of lens opacification in model rats. Thus, the ex vivo assay may provide an initial platform for broad screening of potential novel therapeutic agents towards pharmacological treatment of cataract.

Background: The substantial burden of kidney disease fosters interest in new ways of screening for early disease diagnosis, especially by non-invasive imaging. Increasing evidence for an association between retinal microvascular signs and kidney disease prompted us to investigate the relevant current literature on such an association systematically by performing a meta-analysis of our findings. Methods: We scrutinized the current literature by searching PubMed and Embase databases from for clinical studies of the association between retinal microvascular signs and prevalent or incident kidney disease. After excluding cases that did not meet our criteria, we extracted relevant data from 42 published studies (9 prospective, 32 cross-sectional, and 1 retrospective). Results: Our investigation yielded significant associations between retinal vascular changes (including retinopathy and retinal vascular diameter) and kidney dysfunction (including chronic kidney disease (CKD), end-stage renal disease (ESRD), albuminuria, and estimated glomerular filtration rate (eGFR) decline). According to our meta-analysis, retinopathy was associated with ESRD (hazard ratio (HR) 2.12 (95% confidence interval CI; 1.39–3.22)) and with CKD prevalence in the general population (odds ratio (OR) 1.31 (95% CI; 1.14–1.50)), and specifically in type 2 diabetic patients (OR 1.68 (95% CI; 1.68–2.16)). CRAE was associated with prevalent CKD (OR 1.41 (95% CI; 1.09–1.82)). Conclusions: Our findings suggest that the retinal microvasculature can provide essential data about concurrent kidney disease status and predict future risk for kidney disease development and progression.