bluuebunny/crossref_metadata_2025 huggingface dataset:
Anhydramnios in the Setting of Renal Malformations
Authors: Moxey-Mims Marva , Raju Tonse N. K.
Published: May 2018

Anhydramnios in the setting of severe malformations of the fetal kidney and urinary tract is associated with a high incidence of stillbirths and life-threatening complications, including severe pulmonary hypoplasia, umbilical cord compression, and perinatal asphyxia. To prevent such adverse outcomes, some centers in the United States and elsewhere are offering amniotic fluid restoration for women diagnosed with anhydramnios in the setting of fetal renal malformations. The procedures include infusions of amniotic fluid substitutes (normal saline), percutaneously or through an amnioport—an implanted system for serial or continuous infusion of normal saline to maintain the desired amniotic fluid volume. The procedures are intended to prevent pulmonary hypoplasia and allow the pregnancy to progress closer to term gestation, enabling postnatal renal management, including long-term dialysis and renal transplantation. However, these procedures have not been recommended as standard of care by the professional societies because there are many knowledge gaps, including few data on short-term and long-term renal outcomes. The available diagnostic methods do not provide reliable prognostic information, and the current maternal and fetal interventions have not been standardized. To address these unresolved issues and to propose a research agenda, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Diabetes and Digestive and Kidney Diseases invited a panel of experts to a workshop in August 2016. This report provides a summary of that meeting.
Niacin and Selenium Attenuate Brain Injury After Cardiac Arrest in Rats by Up-Regulating DJ-1-Akt Signaling
Authors: Kwon Woon Yong , Suh Gil Joon , Kim Kyung Su , Jung Yoon Sun , Kim Sung Hee , Lee A Rum , You Kyoung Min , Park Min Ji
Published: May 2018

Objectives:

To determine neuroprotective effects and mechanism of the combination therapy of niacin and selenium in cardiac arrest rats.

Design:

Prospective laboratory study.

Setting:

University laboratory.

Subjects:

Rat cortex neurons and male Sprague-Dawley rats (n= 68).

Interventions:

In rat cortex neurons underwent 90 minutes of oxygen-glucose deprivation and 22.5 hours of reoxygenation, effects of the combination therapy of niacin (0.9 mM) and selenium (1.5 μM) were investigated. The role of DJ-1 was determined using DJ-1 knockdown cells. In cardiac arrest rats, posttreatment effects of the combination therapy of niacin (360 mg/kg) and selenium (60 μg/kg) were evaluated.

Measurements and Main Results:

In oxygen-glucose deprivation and 22.5 hours of reoxygenation cells, combination therapy synergistically activated the glutathione redox cycle by a niacin-induced increase in glutathione reductase and a selenium-induced increase in glutathione peroxidase activities and reduced hydrogen peroxide level. It increased phosphorylated Akt and intranuclear Nuclear factor erythroid 2–related factor 2 expression and attenuated neuronal injury. However, these benefits were negated by DJ-1 knockdown. In cardiac arrest rats, combination therapy increased DJ-1, phosphorylated Akt, and intranuclear nuclear factor erythroid 2–related factor 2 expression, suppressed caspase 3 cleavage, and attenuated histologic injury in the brain tissues. It also improved the 7-day Neurologic Deficit Scales from 71.5 (66.0–74.0) to 77.0 (74.–80.0) (p= 0.02).

Conclusions:

The combination therapy of clinically relevant doses of niacin and selenium attenuated brain injury and improved neurologic outcome in cardiac arrest rats. Its benefits were associated with reactive oxygen species reduction and subsequent DJ-1-Akt signaling up-regulation.
Adjunct Ketamine Use in the Management of Severe Ethanol Withdrawal
Authors: Pizon Anthony F. , Lynch Michael J. , Benedict Neal J. , Yanta Joseph H. , Frisch Adam , Menke Nathan B. , Swartzentruber Greg S. , King Andrew M. , Abesamis Michael G. , Kane-Gill Sandra L.
Published: May 2018

Objectives:

Ketamine offers a plausible mechanism with favorable kinetics in treatment of severe ethanol withdrawal. The purpose of this study is to determine if a treatment guideline using an adjunctive ketamine infusion improves outcomes in patients suffering from severe ethanol withdrawal.

Design:

Retrospective observational cohort study.

Setting:

Academic tertiary care hospital.

Patients:

Patients admitted to the ICU and diagnosed with delirium tremens by Diagnostic and Statistical Manual of Mental Disorders V criteria.

Interventions:

Pre and post guideline, all patients were treated in a symptom-triggered fashion with benzodiazepines and/or phenobarbital. Postguideline, standard symptom-triggered dosing continued as preguideline, plus, the patient was initiated on an IV ketamine infusion at 0.15–0.3 mg/kg/hr continuously until delirium resolved. Based upon withdrawal severity and degree of agitation, a ketamine bolus (0.3 mg/kg) was provided prior to continuous infusion in some patients.

Measurements and Main Results:

A total of 63 patients were included (29 preguideline; 34 postguideline). Patients treated with ketamine were less likely to be intubated (odds ratio, 0.14; p < 0.01; 95% CI, 0.04–0.49) and had a decreased ICU stay by 2.83 days (95% CI, –5.58 to –0.089; p = 0.043). For ICU days outcome, correlation coefficients were significant for alcohol level and total benzodiazepine dosing. For hospital days outcome, correlation coefficients were significant for patient age, aspartate aminotransferase, and alanine aminotransferase level. Regression revealed the use of ketamine was associated with a nonsignificant decrease in hospital stay by 3.66 days (95% CI, –8.40 to 1.08; p = 0.13).

Conclusions:

Mechanistically, adjunctive therapy with ketamine may attenuate the demonstrated neuroexcitatory contribution of N-methyl-d-aspartate receptor stimulation in severe ethanol withdrawal, reduce the need for excessive gamma-aminobutyric acid agonist mediated–sedation, and limit associated morbidity. A ketamine infusion in patients with delirium tremens was associated with reduced gamma-aminobutyric acid agonist requirements, shorter ICU length of stay, lower likelihood of intubation, and a trend toward a shorter hospitalization.
Value of Collaboration With Standardized Patients and Patient Facilitators in Enhancing Reflection During the Process of Building a Simulation
Authors: Stanley Claire , Lindsay Sally , Parker Kathryn , Kawamura Anne , Samad Zubairi Mohammad
Published: May 2018

Introduction:

We previously reported that experienced clinicians find the process of collectively building and participating in simulations provide (1) a unique reflective opportunity; (2) a venue to identify different perspectives through discussion and action in a group; and (3) a safe environment for learning. No studies have assessed the value of collaborating with standardized patients (SPs) and patient facilitators (PFs) in the process. In this work, we describe this collaboration in building a simulation and the key elements that facilitate reflection.

Methods:

Three simulation scenarios surrounding communication were built by teams of clinicians, a PF, and SPs. Six build sessions were audio recorded, transcribed, and thematically analyzed through an iterative process to (1) describe the steps of building a simulation scenario and (2) identify the key elements involved in the collaboration.

Results:

The five main steps to build a simulation scenario were (1) storytelling and reflection; (2) defining objectives and brainstorming ideas; (3) building a stem and creating a template; (4) refining the scenario with feedback from SPs; and (5) mock run-throughs with follow-up discussion. During these steps, the PF shared personal insights, challenging participants to reflect deeper to better understand and consider the patient's perspective. The SPs provided unique outside perspective to the group. In addition, the interaction between the SPs and the PF helped refine character roles.

Discussion:

A collaborative approach incorporating feedback from PFs and SPs to create a simulation scenario is a valuable method to enhance reflective practice for clinicians.
Malignant melanoma clinically mimicking pyogenic granuloma: comparison of clinical evaluation and histopathology
Authors: Moshe Michael , Levi Assi , Ad-El Dean , Ben-Amitai Dan , Mimouni Daniel , Didkovsky Elena , Feinmesser Meora , Lapidoth Moshe
Published: May 2018

Amelanotic melanomas (AMMs) account for a small proportion of all melanomas. They pose a risk of delayed diagnosis and, consequently, poor prognosis. AMMs may atypically present as a pyogenic granuloma-like lesion. This study sought to investigate the prevalence and clinical and histological features of AMM masquerading as pyogenic granuloma. The database of a tertiary medical center was screened for all patients pathologically diagnosed with melanoma in 2005–2016. Those with a suspected primary (i.e. pre-excision) clinical diagnosis of pyogenic granuloma were identified, and their demographic, clinical, histologic, and outcome data were collected from the medical files. Of 2038 patients diagnosed with melanoma, 10 (∼0.5%) had a pyogenic granuloma-like AMM. The mean±SD age at lesion presentation was 56±18.9 years and the mean time from lesion appearance to diagnosis was 91.5±117.1 months. Nine tumors were located on the skin surface, and one on the oral mucosa. The mean lesion size was 19.6±14.1 mm2 and the mean Breslow’s depth was 6.47±3.1 mm; all tumors presented in the vertical growth phase. Seven (70%) patients had lymph node involvement or metastasis at diagnosis. Two patients died of the disease within 1 year of diagnosis. Given the potential lethality of AMM and the benign nature of pyogenic granuloma, clinician recognition of pyogenic granuloma-like AMMs is crucial. In the presence of a pyogenic granuloma-like lesion, findings of older patient age and large tumor size should raise the index of suspicion and prompt a biopsy study, thereby ensuring early and accurate treatment.
Quality of Life Perception, Cognitive Function, and Psychological Status in a Real-world Population of Glioblastoma Patients Treated With Radiotherapy and Temozolomide
Authors: Lombardi Giuseppe , Bergo Eleonora , Del Bianco Paola , Bellu Luisa , Pambuku Ardi , Caccese Mario , Trentin Leonardo , Zagonel Vittorina
Published: May 2018

Background:

Health-related quality of life (HRQoL), cognitive function, and psychological status represent an important focus during the treatment of glioblastoma patients. Nevertheless, few randomized, prospective clinical trials have analyzed these factors, and very little is known in the real-clinical world. We evaluated these characteristics in glioblastoma patients treated with standard first-line therapy outside clinical trials.

Patients and Methods:

In total, 111 newly, histologically diagnosed glioblastoma patients treated at our oncology center with radiotherapy and temozolomide were prospectively enrolled. No patient was enrolled in an experimental clinical trial. We assessed HRQoL, cognitive function, and psychological status before starting treatment, at the end of radiotherapy, and every 3 months until 9 months after the end of radiotherapy using EORTC QLQ-C30, BN20, MMSE, and HADS questionnaires.

Results:

Global health status, physical, cognitive, and social functioning remained unchanged throughout the study period. A statistically significant change was found in emotional functioning as well as a clinically meaningful amelioration in role functioning between the baseline assessment and 9 months after radiotherapy. Patients older than 65 years reported greater impairment on the bladder control scale than younger patients. When considering tumor location, global health status, communication deficit, and drowsiness, scores were significantly different between the right and left hemispheres. Female patients had a clinically relevant lower score for physical functioning at baseline and 3 months after radiation therapy. Female patients also had a clinically relevant lower depression score at 9 months after radiation therapy.

Conclusions:

In routine neurooncology practice, HRQoL, cognitive function, and psychological status did not worsen during first-line treatment in glioblastoma patients receiving standard radiotherapy and temozolomide treatment. However, some patient subgroups, such as elderly and female patients, may have different experiences with treatment, and further investigation is required.
Primary Subcutaneous Synovial Sarcoma: First Reported Subcutaneous Case Showing TLE1 Immunoreactivity
Authors: Alegría-Landa Victoria , Nájera Laura , Massa Dolores Suárez , Roustan Gastón , Río María del , Kutzner Heinz , Requena Luis
Published: May 2018

Synovial sarcoma (SS) accounts for 5%–10% of all soft tissue sarcomas. It is a well-defined soft tissue neoplasm with biphasic and monophasic histologic subtypes and unknown histogenesis. It usually occurs in the extremities, especially the thigh-knee region of young adults. Recurrences are frequent and distant metastasis developed in approximately half of the patients. SSs are characterized by a recurrent nonrandom chromosomal translocation, t(X; 18) (p11; q11), which is considered the primary genetic event in more than 90% of cases. Only 4 cases of cutaneous and subcutaneous SSs have been published in the literature so far. We report a case of primary subcutaneous SS in the forearm of a young woman and discuss the histopathologic differential diagnosis with other similar neoplasms. This is the first reported case of primary cutaneous SS showing immunoreactivity for TLE1 in the nuclei of neoplastic cells, supporting the use of this marker for diagnosis of this rare cutaneous neoplasm.
Mass Spectrometry for Research and Application in Therapeutic Drug Monitoring or Clinical and Forensic Toxicology
Authors: Maurer Hans H.
Published: May 2018

This article reviews current applications of various hyphenated low- and high-resolution mass spectrometry techniques in the field of therapeutic drug monitoring and clinical/forensic toxicology in both research and practice. They cover gas chromatography, liquid chromatography, matrix-assisted laser desorption ionization, or paper spray ionization coupled to quadrupole, ion trap, time-of-flight, or Orbitrap mass analyzers.
Large-Scale Variability of Inpatient Tacrolimus Therapeutic Drug Monitoring at an Academic Transplant Center: A Retrospective Study
Authors: Strohbehn Garth W. , Pan Warren W. , Petrilli Christopher M. , Heidemann Lauren , Larson Sophia , Aaronson Keith D. , Johnson Matt , Ellies Tammy , Heung Michael
Published: May 2018

Background:

Inpatient tacrolimus therapeutic drug monitoring (TDM) lacks standardized guidelines. In this study, the authors analyzed variability in the preanalytical phase of the inpatient tacrolimus TDM process at their institution.

Methods:

Patients receiving tacrolimus (twice-daily formulation) and tacrolimus laboratory analysis were included in the study. Times of tacrolimus administration and laboratory study collection were extracted, and time distribution plots for each step in the inpatient TDM process were generated.

Results:

Trough levels were drawn appropriately in 25.9% of the cases. Timing between doses was consistent, with 91.9% of the following dose administrations occurring 12 ± 2 hours after the previous dose. Only 38.1% of the drug administrations occurred within 1 hour of laboratory study collection. Tacrolimus-related patient safety events were reported at a rate of 1.9 events per month while incorrect timing of TDM sample collection occurred approximately 200 times per month. Root cause analysis identified a TDM process marked by a lack of communication and coordination of drug administration and TDM sample collection. Extrapolating findings nationwide, we estimate $22 million in laboratory costs wasted annually.

Conclusions:

Based on this large single-center study, the authors concluded that the inpatient TDM process is prone to timing errors, thus is financially wasteful, and at its worst harmful to patients due to clinical decisions being made on the basis of unreliable data. Further work is needed on systems solutions to better align the laboratory study collection and drug administration processes.
CRISPR GENOME SURGERY IN THE RETINA IN LIGHT OF OFF-TARGETING
Authors: Cho Galaxy Y. , Schaefer Kellie A. , Bassuk Alexander G. , Tsang Stephen H. , Mahajan Vinit B.
Published: May 2018

Purpose:

Recent concerns regarding the clinical utilization of clustered regularly interspaced short palindromic repeats (CRISPR) involve uncertainties about the potential detrimental effects that many arise due to unintended genetic changes, as in off-target mutagenesis, during CRISPR genome surgery. This review gives an overview of off-targeting detection methods and CRISPR's place in the clinical setting, specifically in the field of ophthalmology.

Results:

As CRISPR utilization in the laboratory setting has increased, knowledge regarding CRISPR mechanisms including its off-target effects has also increased. Although a perfect method for achieving 100% specificity is yet to be determined, the past few years have seen many developments in off-targeting detection and in increasing efficacy of CRISPR tools.

Conclusion:

The CRISPR system has high potential to be an invaluable therapeutic tool as it has the ability to modify and repair pathogenic retinal lesions. Although it is not yet a perfect system, with further efforts to improve its specificity and efficacy along with careful screening of off-target mutations, CRISPR-mediated genome surgery potential can become maximized and applied to patients.
REDUCED CHORIOCAPILLARIS FLOW IN EYES WITH TYPE 3 NEOVASCULARIZATION AND AGE-RELATED MACULAR DEGENERATION
Authors: Borrelli Enrico , Souied Eric H. , Freund K. Bailey , Querques Giuseppe , Miere Alexandra , Gal-Or Orly , Sacconi Riccardo , Sadda SriniVas R. , Sarraf David
Published: May 2018

Purpose:

To study choriocapillaris (CC) flow in eyes with Type 3 neovascularization (NV) and age-related macular degeneration, using optical coherence tomography angiography analysis.

Methods:

In this multicenter, retrospective, observational study, we collected data from 21 patients with unilateral Type 3 NV and age-related macular degeneration, based on clinical examination, structural optical coherence tomography, and fluorescein angiography when available. An additional group of 20 nonneovascular age-related macular degeneration eyes with unilateral Type 1 or Type 2 NV due to age-related macular degeneration was included for comparison. En face optical coherence tomography angiography imaging (3 × 3 mm scans) with quantitative microvascular analysis of the CC was performed. Main outcome measures were: 1) the percent nonperfused choriocapillaris area; and 2) the average CC signal void size.

Results:

We included 21 patients with unilateral Type 3 NV (15 female, 71.5%) and 20 patients with unilateral Type 1 or 2 NV (9 female, 45.0% P = 0.118). Mean ± SD age was 82.1 ± 7.4 years in the unilateral Type 3 patients and 78.3 ± 8.1 in unilateral Type 1/2 NV subjects (P = 0.392). The percent nonperfused choriocapillaris area was 56.3 ± 8.1% in eyes with Type 3 NV and 51.9 ± 4.3% in the fellow eyes (P = 0.016). The average signal void size was also increased in those eyes with Type 3 NV (939.9 ± 680.9 μm2), compared with the fellow eyes (616.3 ± 304.2 μm2, P = 0.039). The number of signal voids was reduced in the Type 3 NV eyes (604.5 ± 282.9 vs. 747.3 ± 195.8, P = 0.046). The subfoveal choroidal thickness was 135.9 ± 54.2 μm in eyes with Type 3 NV and 167.2 ± 65.4 μm in the fellow eyes (P = 0.003). In addition, the fellow eyes of patients with unilateral Type 3 NV displayed more significant CC flow abnormalities versus the fellow eyes with unilateral Type 1/2 NV (percent nonperfused choriocapillaris area = 51.9 ± 4.3% vs. 46.0 ± 2.1%, respectively, P < 0.0001; and average signal void size 616.3 ± 304.2 μm2 versus 351.4 ± 65.5 μm2, respectively, P < 0.0001; and number of signal voids 747.3 ± 195.8 vs. 998.5 ± 147.3, respectively, P < 0.0001).

Conclusion:

Eyes with unilateral Type 3 NV illustrated increased CC nonperfusion versus fellow nonneovascular eyes. These results suggest that choroidal ischemia may play an important role in the development of Type 3 NV.
RAPID PROGRESSION OF FOVEOMACULAR RETINOSCHISIS IN YOUNG MYOPICS
Authors: Sun Zhongcui , Gao Hua , Wang Min , Chang Qing , Xu Gezhi
Published: May 2018

Purpose:

To describe a foveomacular retinoschisis that has not been described.

Methods:

Patients with foveomacular retinoschisis were included. Exclusion criteria included refractive error over −6.00 diopters, presence of posterior staphyloma, positive RS1-gene mutation, family history of retinoschisis, optic disk abnormalities, or glaucoma. Vitrectomy was performed on eyes with functional or structural deterioration.

Results:

Seventeen eyes from 10 patients (15–30 years old, 8 females and 2 males) with foveoschisis were recruited, with bilateral involvement in 7 patients and unilateral in 3 patients. Vitrectomy was performed in 13 eyes (13/17, 76.5%). Seven eyes (6 patients) were operated soon after the first presentation because of poor vision and severe foveoschisis. Six eyes (6 patients) were operated 2 weeks to 13 months later because of deterioration of vision and foveoschisis. Preoperative vision was 20/134 ± 20/165, and postoperative vision was 20/25 ± 20/57, with visual improvement of 6.9 (4–14) lines. The mean postoperative follow-up period was 36.5 (15–69) months. Four eyes (4 patients) were asymptomatic, despite progression of foveoschisis. Three eyes (3 patients) maintained normal macula structures.

Conclusion:

We report a foveomacular retinoschisis characterized by young age of onset, female predominant, no highly myopia, mostly bilateral involvement, and rapid progression of foveoschisis and visual acuity. Vitrectomy is effective in restoring anatomical structure and stabilize vision.
Pediatric Corneal Transplants: Review of Current Practice Patterns
Authors: Zhu Angela Y. , Marquezan Maria Carolina , Kraus Courtney L. , Prescott Christina R.
Published: May 2018

Purpose:

To facilitate development of standardized guidelines for management of pediatric patients undergoing keratoplasty, particularly the youngest cohort, through a comprehensive survey assessing recent trends in practice patterns of corneal specialists and pediatric ophthalmologists.

Methods:

A cross-sectional, observational study of current practices pertaining to pediatric keratoplasty was performed by designing a 20-question survey focused on preoperative indications, surgical techniques, and postoperative management. This survey was sent electronically to corneal specialists and pediatric ophthalmologists. Results were compared with the findings of previous studies regarding pediatric keratoplasty.

Results:

Of the 80 ophthalmologists who responded, 51.3% currently perform pediatric keratoplasty; only 20% have performed >50 cases. The majority (73.8%) completed solely corneal fellowships; all perform penetrating keratoplasty, 35.2% also perform endothelial keratoplasty, and 37% also perform lamellar keratoplasty. Peters anomaly was the most common indication for transplantation (34.3%). The majority believe that 1 to 3 months is the optimal age range to perform keratoplasty for both monocular and binocular congenital corneal opacities, although 13% stated that they would never perform keratoplasty in a patient with a monocular opacity. All surgeons report modifying their intraoperative techniques for pediatric patients, but specific practices and postoperative management protocols vary. There is a consensus regarding the importance of amblyopia therapy in these patients.

Conclusions:

Our results were consistent with the published literature regarding the indication and types of surgery performed. Variability among surgical techniques and postoperative management protocols highlights the necessity of creating standardized guidelines to optimize management of pediatric patients undergoing keratoplasty. Collaborative efforts between corneal and pediatric specialists are crucial for defining visual rehabilitation protocols to enhance visual outcomes.
Novel Gonioscopy Score and Predictive Factors for Intraocular Pressure Lowering After Phacoemulsification
Authors: Perez Claudio I. , Chansangpetch Sunee , Feinstein Max , Mora Marta , Nguyen Anwell , Badr Mai , Masis Marisse , Lin Shan C.
Published: May 2018

Purpose:

To evaluate a novel gonioscopy score as a potential predictor for intraocular pressure (IOP) reduction after cataract surgery.

Materials and Methods:

This was a prospective study that included consecutive patients with or without glaucoma, either with open or narrow angles but without peripheral anterior synechiae, who underwent phacoemulsification. Eyes with intraoperative complications and secondary glaucoma were excluded. A preoperative gonioscopy score was created, summing the Shaffer gonioscopy grading in 4 quadrants (range, 0 to 16). To determine variables associated with IOP change at 6 months, univariate and multivariate linear mixed-effects regression analysis was performed adjusting for age, sex, and preoperative IOP.

Results:

In total, 188 eyes from 137 patients were enrolled. The mean age of the patients was 75.0 (±8.5) years and the average preoperative IOP was 15.6 (±3.6) mm Hg with 0.7 (range, 0 to 4) glaucoma medications. The mean IOP reduction after phacoemulsification was 3.0 (±2.6) mm Hg at postoperative month 6. After multivariate analysis, preoperative IOP [β=0.49 (0.41-0.58), P<0.0001], gonioscopy score [β=−0.17 (−0.24 to −0.09), P<0.0001], anterior chamber depth (ACD) [β=−0.88 (−1.64 to −0.14), P=0.02], and IOP/ACD ratio [β=0.45 (0.07 to 0.83) P=0.021] were associated with IOP reduction at 6 months.

Conclusions:

Preoperative predictors for IOP reduction after cataract surgery were preoperative IOP, ACD, gonioscopy score, and IOP/ACD ratio. The IOP/ACD ratio and gonioscopy score can be easy parameters to obtain and may help clinicians to estimate the IOP reduction after phacoemulsification.
Visual Field Tests for Glaucoma Patients With Initial Macular Damage: Comparison Between Frequency-doubling Technology and Standard Automated Perimetry Using 24-2 or 10-2 Visual Fields
Authors: Park Hae-Young Lopilly , Lee Jiyoung , Park Chan Kee
Published: May 2018

Purpose:

The purpose of this study was to compare standard automated perimetry (SAP) and frequency-doubling technology (FDT) perimetry for detecting macular damage in glaucoma.

Materials and Methods:

A total of 112 glaucomatous eyes with localized retinal nerve fiber layer defects on red-free photographs and corresponding macular ganglion cell/inner plexiform layer (mGC/IPL) thinning on the deviation map of macular optical coherence tomography, and 35 healthy eyes were enrolled in the study. All participants underwent SAP 24-2, SAP 10-2, FDT 24-2, and FDT 10-2 visual field (VF) tests. Significantly depressed points, with confidence limits of 5% and 1%, were checked for in the pattern deviation plots of the VF tests. Detection rate of the macular damage, sensitivity, and specificity were compared among various VF tests. Patients were divided into eyes with mGC/IPL thinning within the normative database, depressed <5% or <1%. Comparison of VF parameters between various VF tests were performed according to the degree of mGC/IPL thinning.

Results:

All of the macular damage in glaucoma were detected using FDT 10-2 and 83.3% to 90.0% were detected using FDT 24-2 when the mGC/IPL thickness was <5%. Even when mGC/IPL thickness was within normal range, the detection rate of macular damage were 96% for FDT 10-2 and 80% for FDT 24-2. FDT 10-2 had the best diagnostic ability (areas under the receiver operating characteristics curve, 0.96) followed by FDT 24-2 (areas under the receiver operating characteristics curve, 0.76) for discriminating normal controls from glaucoma patients with macular damage. Comparing 10-2 and 24-2 tests with same strategy showed that FDT 10-2 was more sensitive than FDT 24-2 (P=0.004), with better specificity (P=0.010). Also, SAP 24-2 had similar specificity with SAP 10-2 (P=0.373), which was better than FDT 24-2 (P=0.016). The mean deviation of SAP 10-2 and the pattern standard deviation of SAP 10-2 were significantly related to mGC/IPL thickness.

Conclusions:

We found the detection rate of functional depression related to early macular damage were significant using FDT and parameters of SAP significantly predicted the degree of mGC/IPL thinning in glaucoma patients.
Pattern Scanning Laser (PASCAL) for Peripheral Iridoplasty in Eyes With Plateau Iris Syndrome: A Novel Application
Authors: Midha Neha , Hoskens Kirsten , Mansouri Kaweh
Published: May 2018

Purpose:

The purpose of this study was to evaluate safety and efficacy of pattern scanning laser (PASCAL) for peripheral iridoplasty in eyes with plateau iris syndrome.

Materials and Methods:

This study was a retrospective review of cases that underwent PASCAL laser peripheral iridoplasty. Eyes with plateau iris syndrome confirmed on gonioscopy and ultrasound biomicroscopy were included in the study. Primary and secondary outcome measures were angle widening on gonioscopy and magnitude of intraocular pressure (IOP) reduction, respectively.

Results:

Twelve eyes of 8 patients that completed 1-year follow-up were analyzed. Angle widening was noted in 46% of treated quadrants by at least 1 grade (Shaffer classification) at 1-month follow-up. A statistically significant IOP reduction was noted at 1 year from 20.6±4.8 to 17.8±3.8 mm Hg (P=0.01). At 1 month, 8 of 12 eyes (66.6%) achieved gonioscopic success (widening of the angle by at least 1 grade in 2 of 4 quadrants). At 1 year, 6 of 12 eyes (50%) achieved tonometric success (20% reduction or 3 mm Hg IOP reduction from the baseline without addition of new antiglaucoma medications). No adverse effects associated with PASCAL laser peripheral iridoplasty were observed.

Conclusions:

PASCAL laser iridoplasty can be a safe and effective alternative to argon laser peripheral iridoplasty in the management of eyes with plateau iris syndrome. Our findings need to be further validated on larger sample size and in different ethnicities.
Direct Saliva Real-time Polymerase Chain Reaction Assay Shows Low Birth Prevalence of Congenital Cytomegalovirus Infection in Urban Western India
Authors: Viswanathan Rajlakshmi , Bafna Sanjay , Mergu Ravikanth , Deshpande Gururajrao , Gunjikar Rashmi , Gaikwad Shivshankar , Mullick Jayati
Published: May 2018

Background:

Congenital cytomegalovirus (cCMV) infection is the leading infectious cause of mental retardation, developmental delay and sensorineural deafness. Nonprimary infection plays a major role in transmission of this infection in countries with high maternal seroprevalence. Noninvasive sampling and testing is a useful alternative to traditional methods of laboratory detection of congenital CMV infection. The present study was conducted to understand birth prevalence of cCMV infection using molecular techniques, in an urban setting of a developing country with evidence of high maternal seroprevalence.

Methods:

Universal newborn screening for cCMV was performed for 750 infants born at a tertiary care center in Western India. Real-time polymerase chain reaction was directly carried out on saliva samples. Follow-up laboratory testing of saliva, urine and blood was performed for neonates identified as positive. Sequential clinical follow-up was offered to the affected infants.

Results:

A birth prevalence of 0.4% (95% CI: 0.13–1.2) was observed with 3 of 750 babies confirmed to be positive for cCMV infection. All 3 babies were born to seropositive mothers (anti-CMV immunoglobulin G positive). One of the babies detected was symptomatic with sepsis like features. All of them survived and did not develop any sequelae up to 1 year of age.

Conclusion:

The use of direct real-time polymerase chain reaction of saliva samples can be considered as a feasible option for newborn screening of congenital CMV infection in developing countries. Relatively low birth prevalence of cCMV infection was observed in our study, which needs to be corroborated through further studies.
Neruodevelopmental Outcomes in Preschool Children Living With HIV-1 Subtypes A and D in Uganda
Authors: Ruiseñor-Escudero Horacio , Sikorskii Alla , Familiar-Lopez Itziar , Persaud Deborah , Ziemniak Carrie , Nakasujja Noeline , Opoka Robert , Boivin Michael
Published: May 2018

Background:

HIV is a neuropathogenic virus that may result in detrimental neurodevelopmental (ND) outcomes early in life. This is the first study to evaluate the effect of HIV-1 subtype on neurodevelopment of Ugandan preschool children.

Methods:

Neurodevelopment of 87 HIV-1 infected and 221 HIV exposed uninfected Ugandan children 1.8–4.9 years of age was assessed using 4 scales of the Mullen Scales of Early Learning (MSEL), 2 scales of the Color Object Association Test (COAT), and 1 score of the Early Childhood Vigilance Test. HIV-1 subtype was defined by phylogenetic analyses. General linear models were used to relate test scores to HIV-1 subtype (A versus D) while adjusting for relevant covariates. The scores were benchmarked against HIV exposed uninfected group to facilitate the interpretation.

Results:

Seventy-one percentage of children infected with subtype A versus 60% of children with subtype D were currently on antiretroviral therapy (P = 0.49). Children with HIV-1 subtype A infection were older when compared with subtype D (3.29 vs. 2.76 years, respectively, P = 0.03), but similar regarding sex, socioeconomic status, weight-for-age z-score, CD4+ and CD8+ (% and total), viral load. No statistically significant differences by HIV-1 subtype were observed in the MSEL, COAT and Early Childhood Vigilance Test. Differences ≥ 0.33 of the SD were observed for the MSEL Composite Score, Receptive Language (MSEL) and Total Memory (COAT).

Conclusions:

In contrast to previously reported differences in ND outcomes of school-age children by HIV-1 subtype, ND scores among preschool children were similar for subtypes A and D, with few potential differences on language production and memory outcomes that favored subtype A. Further investigation with larger sample sizes and longitudinal follow-up is needed.
Acute Encephalitis Syndrome in Gorakhpur, Uttar Pradesh, 2016
Authors: Mittal Mahima , Bondre Vijay , Murhekar Manoj , Deval Hirawati , Rose Winsley , Verghese Valsan Philip , Mittal Mahim , Patil Gajanan , Sabarinathan Ramsamy , Vivian Thangaraj Jeromie Wesley , Kanagasabai Kaliaperumal , Prakash John Antony Jude , Gupta Nivedita , Gupte Manish M. , Gupte Mohan D.
Published: May 2018

Background:

Seasonal outbreaks of acute encephalitis syndrome (AES) with high fatality have been occurring in Gorakhpur, Uttar Pradesh, India, for several years. We conducted investigations during the 2016 outbreak to identify the etiology.

Methods:

We included 407 hospitalized AES patients with cerebrospinal fluid pleocytosis (>5 cells/mm3) in our study. These patients were clinically examined; their blood and cerebrospinal fluid samples were collected and investigated for scrub typhus (ST), Japanese encephalitis virus (JEV), dengue virus and spotted fever group of Rickettsia by serology and/or polymerase chain reaction.

Results:

Of the 407 AES patients, 266 (65.4%), 42 (10.3%) and 29 (7.1%) were diagnosed to have ST, JEV and dengue infection, respectively. Four patients were diagnosed to have spotted fever group of Rickettsia infection. A significantly higher proportion of ST patients with AES had hepatomegaly, splenomegaly and facial edema. The common hematologic and biochemical abnormalities among ST-positive patients include thrombocytopenia, raised liver enzymes and bilirubin levels. The case fatality ratio was significantly higher among ST-negative AES patients (36.2% vs. 15.2%; P < 0.05).

Conclusions:

ST accounted for approximately two third of the AES case-patients. Efforts are required to identify the etiology of AES case-patients who are negative for ST, JEV and dengue fever.
Reflections on 50 Years of Neuroscience Nursing: The Growth of Stroke Nursing
Authors: Jackson Nancy , Haxton Elaine , Morrison Kathy , Markey Erin , Andreoli Linda J. , Maloney Theresa , Omelchenko Nataliya , Aroose Amanda , Stevens Lynn B.
Published: May 2018

Over the past 50 years, the Journal of Neuroscience Nursing (JNN) has grown from a neurosurgical focus to the broader neuroscience focus alongside the professional nursing organization that it supports. Stroke care in JNN focused on the surgical treatment and nursing care for cranial treatment of conditions such as cerebral aneurysm, carotid disease, arteriovenous malformation, and artery bypass procedures. As medical science has grown and new medications and treatment modalities have been successfully trialed, JNN has brought to its readership this information about recombinant tissue plasminogen activator, endovascular trials, and new assessment tools such as the National Institute of Health Stroke Scale. JNN is on the forefront of publishing nursing research in the areas of stroke caregiver needs and community education for rapid treatment of stroke and stroke risk reduction. The journal has been timely and informative in keeping neuroscience nurses on the forefront of the changing world of stroke nursing.
Evaluation of Dwell Time for Peripheral Intravenous Catheters Started in the Field for Geriatric Blunt Trauma Patients
Authors: Day Darcy L. , Conde Francisco
Published: May 2018

Replacement time for peripheral intravenous (PIV) catheters started in the field is unclear. The purpose of this study was to compare field-start PIV catheter dwell time of 2 days or less versus field-start PIV catheter dwell time of more than 2 days for the development of indicators of infection for geriatric blunt trauma patients. A retrospective case series was conducted at the state-designated trauma referral center. Activated trauma team patients with blunt injury were included if 65 years or older and if admitted from the field for 7 days or more with a PIV catheter placed prehospital. Presence of fever, abnormal white blood cell (WBC) count, and a positive Quick Sequential Organ Failure Assessment (qSOFA) score as recommended by the Surviving Sepsis Campaign were used to describe potential infection and were analyzed in relation to PIV catheter dwell time with statistical significance set at p < .05. Forty-two patients (28%) had PIV catheter dwell time of 2 days or less, and 108 (72%) had PIV catheter dwell time of more than 2 days. At dwell time of more than 2 days, a statistically significant smaller percentage of patients demonstrated positive qSOFA score (p = .005) and fever (p = .003) and approached statistical significance for abnormal WBC count (p = .05). Dwell time of more than 2 days for field-start PIV catheters did not lead to an increase in fevers, abnormal WBC count, or positive qSOFA scores. These data support consideration of longer dwell time for PIV catheters initiated in the field for geriatric blunt trauma patients. Further studies are needed.
Death in Trauma: The Role of the ACNP in Patient Advocacy and Familial Support in End-of-Life Care Decision-Making
Authors: Barndt Stephanie N.
Published: May 2018

The trauma acute care nurse practitioner (ACNP) participates in the care of critically-ill patients by utilizing his or her advanced clinical skills at the bedside and through communication with the interdisciplinary team, the patient, and the patient's family. Although the incidence of morbidity is decreasing in trauma, death can occur shortly after arrival to hospital, or in the days after initial injury, leading to the need for the unexpected conversation of end-of-life wishes with a patient or the patient's family. It is within the scope of the ACNP to facilitate these conversations, and it is recommended that ACNPs engage patients and their families in these conversations for overall improved patient outcomes. Many techniques exist to aid in this difficult decision-making process and may be useful to the trauma ACNP when having end-of-life discussions.
Perceived Changes in Quality of Life in Trauma Patients: A Focus Group Study
Authors: Kruithof Nena , Traa Marjan Johanna , Karabatzakis Maria , Polinder Suzanne , de Vries Jolanda , de Jongh Mariska Adriana Cornelia
Published: May 2018

Quality of life (QoL) following a physical trauma is still insufficiently known from a patient perspective. The aim of this study was to qualitatively report perceived changes in QoL after trauma. Focus groups were conducted. Patients admitted to the hospital were eligible for inclusion if they had a lower extremity trauma, severe injuries, or severe traumatic brain injury (TBI). Patients 75 years or older were invited. To analyze the perceived changes in QoL, open coding was used. Patients (n = 20, M = 55 years) reported comparable consequences. In the first month posttrauma, physical limitations, independency, pain, and anxiety predominated. Later, patients experienced problems with acceptance. The patients' feelings of the need to have control over their own situation, their own expectations, and a social network were related to QoL. Compared with the other patient groups, TBI patients reported more psychosocial consequences, and elderly patients reported more difficulties in performing (social) activities. Quality of health care was considered an important aspect in the patients' perceived QoL, and adequate aftercare was missed according to the patients. The impact of a trauma influences QoL in different health domains. Further improving the quality of aftercare may positively influence trauma patients' perceived QoL. These results indicated that TBI patients and elderly patients deserve specific attention regarding QoL.
Neurobiology of Trauma and Mindfulness for Children
Authors: Iacona Jaclyn , Johnson Stephanie
Published: May 2018

Adverse child experiences (ACEs) have a significant impact on developing children, both physically and psychologically, with ongoing consequences that may manifest throughout adulthood. These negative health consequences can be mitigated if a child is given a supportive environment in which to develop healthy coping mechanisms. Those who specialize in caring for children with ACEs must understand the neurobiology of trauma to conceptualize how trauma triggers the brain and body when encountering stressful events. Mindfulness is an evidence-based practice that can be used as a healthy coping mechanism to develop self-regulation and resiliency in children. The purpose of this article is to provide evidenced-based research on the neurobiology of trauma and mindfulness intervention as a recommended modality for use in children. Furthermore, the content in this article was utilized in developing a training module for a suburban, youth organization that provides residential housing, basic necessities, education, and therapy for children with ACEs. The training module is intended to assist staff members in understanding the neurobiology of trauma and mindfulness techniques in their interactions with the children, thereby improving child–staff relationships and encouraging the development of self-regulation and healthy coping mechanisms.
Malposition of a Central Venous Catheter in Trauma: Confirmation of Placement Prevents Complications
Authors: Hobbs Steven D.
Published: May 2018

This case study presents the inadvertent catheterization of a traumatic hemopneumothorax. A 22-year-old man sustained multiple stab wounds, including the left chest with a resultant hemopneumothorax. Upon arrival at a Level 1 trauma center, an ipsilateral subclavian central catheter was placed, blood was freely aspirated, and because of the patient's critical status, immediately utilized for resuscitation prior to line verification by radiography. A short time later, the catheter was felt to be malpositioned, most likely in the left intrathoracic space, and removed. The patient subsequently recovered and was discharged home 3 days later.
Nonsurgical Admissions With Traumatic Injury: Medical Patients Are Trauma Patients Too
Authors: Nelson Laura , Kuzniewski Sally , Grossman Michael , Yelon Jay A. , Szydziak Lisa
Published: May 2018

Nontrauma service (NTS) admissions are an increasing problem as ground-level falls in elderly patients become more common. The admission and evaluation of trauma patients to nontrauma services in trauma centers seeking American College of Surgeons (ACS) verification, must follow the ACS mandates for performance improvement requiring some method of evaluating this population when admitted to services other than trauma, orthopedics, and neurosurgery. The purpose of this study and performance improvement project was to improve our process for the definition and evaluation of trauma patients who were being admitted to nontrauma services. We designed an algorithm to evaluate appropriateness of NTS admission and evaluated outcomes for NTS admissions utilizing that algorithm.

We created a scoring algorithm and evaluated appropriateness of NTS admission over 2 years in a community-teaching ACS Level II trauma center. We reviewed trauma registry data using χ2 and Fisher exact tests to determine differences in outcome for NTS versus trauma service (TS) admissions.

From December 2014 to December 2016, NTS admission rate fell from maximum of 28% to 4% stabilizing between 8% and 10%. Mortality and overall complication rate between NTS and TS were similar (p = .40 and .66, respectively), but length of stay was lower for TS admissions (p < .0001).

A scoring system of algorithm can be used to determine appropriateness of NTS admissions, and validity of the tool can be confirmed using registry-based outcome data for TS versus NTS admissions.
Trauma Simulation in Prehospital Emergency Care
Authors: Abelsson Anna , Lundberg Lars
Published: May 2018

Well-educated ambulance staff is a prerequisite for high-quality prehospital trauma care. The aim of this study was to examine how nurses in the ambulance service experienced participation in trauma simulation. Sixty-one nurses, working in an emergency ambulance service, performed simulated trauma care on four different occasions and afterward rated three statements on a 5-point Likert scale. A descriptive and inferential analysis was conducted. There are statistically significant increases between the pre- and posttests regarding all three statements: “I think simulation of severe trauma with manikins is realistic” (0.23 or 6% increase), “Simulation is a suitable method for learning severe trauma care” (1.3 or 38% increase), and “I am comfortable in the situation learning severe trauma care through simulation” (0.74 or 19% increase). With the experience of realism in simulation, participants become more motivated to learn and prepare for future events. If the participants instead feel uncomfortable during simulation training, they focus on their own feelings instead of learning. In a realistic simulated environment, participants are prepared to understand and manage the emergency care situation in clinical work. Participants learn during simulation when they are outside their comfort zone but without being uncomfortable or experiencing anxiety.