bluuebunny/crossref_metadata_2025 huggingface dataset:
Monetary Policy when Households have Debt: New Evidence on the Transmission Mechanism
Authors: Cloyne James , Ferreira Clodomiro , Surico Paolo
Published: December 2018

Using household survey data for the U.S. and the U.K., we show that the aggregate response of consumption to interest rate changes is driven by households with a mortgage. Outright home-owners do not adjust expenditure at all while renters change their spending but by less than mortgagors. Income rises for all households as interest rate cuts directly affect firm investment and household consumption, boosting aggregate demand. A crucial difference between the housing tenure groups is the composition of their balance sheets: mortgagors hold sizable illiquid assets but little liquid wealth. Our results reveal that general equilibrium effects on household income coupled with balance-sheet-driven heterogeneity in the marginal propensity to consume play a key role in the transmission of monetary policy.
Understanding natural behavior to improve dairy goat (Capra hircus) management systems
Authors: Zobel Gosia , Neave Heather W , Webster Jim
Published: December 2018

Public interest is stimulating farming industries to improve animal welfare in production systems. Indoor housing of ruminants has received scrutiny because of perceived intensiveness and lack of naturalness. Animal welfare has traditionally focused on health benefits (e.g., bedding management and reducing disease) and reducing negative experiences (e.g., painful husbandry practices). Recent attention to animals having “a life worth living” extends expectations to provide increased care and opportunities for positive experiences and natural behaviors. Although not all natural behaviors necessarily contribute to improved welfare, we present evidence for why many are important, and for how they can be promoted in commercial systems. Worldwide, commercial dairy goats (Capra hircus) are frequently housed in large open barns with space to move and soft bedding for lying; however, this is not sufficient to promote the range of natural behaviors of goats, which in turn suggests that commercial housing could be improved. The basis for this thinking is from the range of behaviors expressed by the Capra genus. Collectively, these species have evolved cognitive and behavioral strategies to cope with harsh and changing environments, as well as variable and limited vegetation. The rocky and often steep terrain that goats inhabit allows for predator avoidance and access to shelter, so it is not surprising that domesticated goats also seek out elevation and hiding spaces; indeed, their hoof structure is designed for the movement and grip in such rugged environments. The browsing techniques and flexibility in diet selection of wild, feral and extensively managed goats, appears to be equally important to housed goats, highlighting the need for more complexity in how and what goats are fed. Goats naturally live in small, dynamic groups, governed by complex social structures in which horns play a strong role. Commercial housing systems should consider the benefits of more natural-sized social groups and revisit the rationale behind horn removal. We suggest that cognitive stimulation is a potential welfare improvement for goats in commercial settings. Goat cognitive abilities, which enabled success in complex and variable social and physical environments, are unchallenged in uniform environments, potentially leading to negative affective states. We make suggestions for housing improvements that could be readily adopted into current systems without compromising production efficiency.
The Previously Unidentified, Divergent Badnavirus Species Cacao red vein-banding virus is Associated with Cacao Swollen Shoot Disease in Nigeria
Authors: Chingandu Nomatter , Dongo Lelia , Gutierrez Osman A. , Brown Judith K.
Published: December 2018

Cacao swollen shoot disease (CSSD) of Theobroma cacao was reported in Nigeria in 1944; however, no badnaviral genome sequences have been found associated with the symptomatic trees. In 2017, leaf samples (n = 18) were collected from cacao trees from Osun and Oyo, Nigeria showing foliar symptoms that included red vein-banding and shoot swelling, and variable secondary mosaic, mottling, and fern-like pattern symptoms. Abutting primers designed around previously determined 500-bp intergenic region sequences were used for polymerase chain reaction (PCR) amplification. Of the 18 samples, 9 yielded an approximately 7,000-bp, apparently genome-size product. The nine genomes were sequenced and found to encode four open reading frames, and to share 86 to 99% nucleotide identity. Pairwise analysis of the Nigerian genomes with 21 previously reported CSSD badnaviruses, at the complete genome and reverse-transcription ribonuclease H (1,230 bp) sequence levels, indicated 71 to 75 and 72 to 76% nucleotide identity, respectively. Phylogenetic analysis of the nine complete genomes indicated that the closest relatives of the divergent Nigerian isolates were previously described West African CSSD badnaviruses. Based on pairwise comparisons and phylogenetic analyses, the Nigerian CSSD isolates constitute a previously unrecognized Badnavirus sp., herein named Cacao red vein-banding virus (CRVBV). Primers designed based on the CRVBV genome sequences amplified a 1,068-bp fragment from 16 of 18 field samples tested by PCR, suggesting the possible existence of additional CRVBV variants.
Walking the Red Carpet: A Multicultural Association of Nursing Students Promotes Diversity in an Urban University’s Prelicensure Programs
Authors: Foley David , Konn Rebecca
Published: December 2018

In order to graduate diverse groups of students who more accurately mirror the US population, schools of nursing must take steps to promote the success of ethnic minorities, men, and those with limited English proficiency. Accordingly, a large urban school of nursing piloted a series of carefully orchestrated “red carpet” events to welcome first-year students in the most inclusive and affirming manner possible. These social gatherings provided valuable opportunities for students to increase their social capital by networking with peers, recent alumni, and established professionals, all of whom shared valuable strategies for success.
The Effect of Transition to Practice Programs on the Self-Assessment of Newly Licensed Registered Nurses’ Confidence in Quality and Safety Competency Attainment
Authors: Letourneau Rayna M. , McCurry Mary K.
Published: December 2018

AIM

The aim of the study was to evaluate effectiveness of transition to practice programs (TPPs) on self-assessment of quality and safety competency development in newly licensed registered nurses (NLRNs).

BACKGROUND

TPPs are innovative strategies to promote quality and safety competencies. Hospital-based TPPs support and facilitate transition to practice.

METHOD

A pretest-posttest design was used to determine if NLRNs’ self-assessment of quality and safety knowledge, skills, and attitudes changed significantly over time and by TPP type as measured by the Nursing Quality and Safety Self-Inventory.

RESULTS

Sixty-four NLRNs from three TPPs participated. A statistically significant increase in confidence in knowledge and skills was found with no significant changes in confidence attitudes. No significant changes were found based on TPP type or prelicensure program.

CONCLUSION

The Nursing Quality and Safety Self-Inventory was a valid and reliable instrument for measuring changes in quality and safety knowledge, skills, and attitudes in NLRNs. TPPs are effective strategies to advance confidence in quality and safety competencies.
Toward Gender-inclusive, Nonjudgmental Alcohol Interventions for Pregnant People: Challenging Assumptions in Research and Treatment
Authors: Lowik A.J. , Knight Rod
Published: December 2018

Epidemiological and clinical evidence clearly indicates that binge and/or heavy alcohol use while pregnant can be dangerous for the fetus. As such, there is a large body of research evaluating interventions to address harms associated with alcohol use during pregnancy. Unfortunately, based on our assessment of the scientific literature in this area, including a reading of three high-impact systematic reviews, there are several key areas where the language being used is hindering efforts to address alcohol harms during pregnancy in nonjudgmental and gender-inclusive ways. In this commentary, we describe four areas where intervention research in this area can benefit from a thoughtful refinement of the use of gender-inclusive and nonjudgmental language. We also describe how, in failing to do so, interventions to address alcohol use during pregnancy will continue to be evaluated and designed without a sufficient understanding of how gender and reproduction are diverse, including among people who are experiencing wanted and/or planned pregnancies, unwanted and/or unplanned pregnancies, and among those who are surrogates.
Nitric Oxide Donor Prevents Neonatal Isoflurane-induced Impairments in Synaptic Plasticity and Memory
Authors: Schaefer Michele L. , Wang Meina , Perez Patric J. , Coca Peralta Wescley , Xu Jing , Johns Roger A.
Published: December 2018

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

In humans, multiple early exposures to procedures requiring anesthesia constitute a significant risk factor for development of learning disabilities and disorders of attention. In animal studies, newborns exposed to anesthetics develop long-term deficits in cognition. Previously, our laboratory showed that postsynaptic density (PSD)-95, discs large homolog, and zona occludens-1 (PDZ) domains may serve as a molecular target for inhaled anesthetics. This study investigated a role for PDZ interactions in spine development, plasticity, and memory as a potential mechanism for early anesthetic exposure-produced cognitive impairment.

Methods

Postnatal day 7 mice were exposed to 1.5% isoflurane for 4 h or injected with 8 mg/kg active PSD-95 PDZ2WT peptide. Apoptosis, hippocampal dendritic spine changes, synapse density, long-term potentiation, and cognition functions were evaluated (n = 4 to 18).

Results

Exposure of postnatal day 7 mice to isoflurane or PSD-95 PDZ2WT peptide causes a reduction in long thin spines (median, interquartile range [IQR]: wild type control [0.54, 0.52 to 0.86] vs. wild type isoflurane [0.31, 0.16 to 0.38], P = 0.034 and PDZ2MUT [0.86, 0.67 to 1.0] vs. PDZ2WT [0.55, 0.53 to 0.59], P = 0.028), impairment in long-term potentiation (median, IQR: wild type control [123, 119 to 147] and wild type isoflurane [101, 96 to 118], P = 0.049 and PDZ2MUT [125, 119 to 131] and PDZ2WT [104, 97 to 107], P = 0.029), and deficits in acute object recognition (median, IQR: wild type control [79, 72 to 88] vs. wild type isoflurane [63, 55 to 72], P = 0.044 and PDZ2MUT [81, 69 to 84] vs. PDZ2WT [67, 57 to 77], P = 0.039) at postnatal day 21 without inducing detectable differences in apoptosis or changes in synaptic density. Impairments in recognition memory and long-term potentiation were preventable by introduction of a NO donor.

Conclusions

Early disruption of PDZ domain–mediated protein–protein interactions alters spine morphology, synaptic function, and memory. These results support a role for PDZ interactions in early anesthetic exposure–produced cognitive impairment. Prevention of recognition memory and long-term potentiation deficits with a NO donor supports a role for the N-methyl-d-aspartate receptor/PSD-95/neuronal NO synthase pathway in mediating these aspects of isoflurane-induced cognitive impairment.
Anesthesiologist Specialization and Use of General Anesthesia for Cesarean Delivery
Authors: Cobb Benjamin T. , Lane-Fall Meghan B. , Month Richard C. , Onuoha Onyi C. , Srinivas Sindhu K. , Neuman Mark D.
Published: December 2018

Editor’s Perspective

What We Already Know about This Topic

What This Manuscript Tells Us That Is New

Background

Guidelines for obstetric anesthesia recommend neuraxial anesthesia (i.e., spinal or epidural block) for cesarean delivery in most patients. Little is known about the association of anesthesiologist specialization in obstetric anesthesia with a patient’s likelihood of receiving general anesthesia. The authors conducted a retrospective cohort study to compare utilization of general anesthesia for cesarean delivery among patients treated by generalist versus obstetric-specialized anesthesiologists.

Methods

The authors studied patients undergoing cesarean delivery for live singleton pregnancies from 2013 through 2017 at one academic medical center. Data were extracted from the electronic medical record. The authors estimated the association of anesthesiologist specialization in obstetric anesthesia with the odds of receiving general anesthesia for cesarean delivery.

Results

Of the cesarean deliveries in our sample, 2,649 of 4,052 (65.4%) were performed by obstetric-specialized anesthesiologists, and 1,403 of 4,052 (34.6%) by generalists. Use of general anesthesia differed for patients treated by specialists and generalists (7.3% vs. 12.1%; P < 0.001). After adjustment, the odds of receiving general anesthesia were lower among patients treated by obstetric-specialized anesthesiologists among all patients (adjusted odds ratio, 0.71; 95% CI, 0.55 to 0.92; P = 0.011), and in a subgroup analysis restricted to urgent or emergent cesarean deliveries (adjusted odds ratio, 0.75; 95% CI, 0.56 to 0.99; P = 0.049). There was no association between provider specialization and the odds of receiving general anesthesia in a subgroup analysis restricted to evening or weekend deliveries (adjusted odds ratio, 0.76; 95% CI, 0.56 to 1.03; P = 0.085).

Conclusions

Treatment by an obstetric anesthesiologist was associated with lower odds of receiving general anesthesia for cesarean delivery; however, this finding did not persist in a subgroup analysis restricted to evening and weekend deliveries.
The vitamin D and calcium controversy: an update
Authors: Lewis Joshua R. , Sim Marc , Daly Robin M.
Published: December 2018

Purpose of review

Calcium and vitamin D supplementation is widely recommended for prevention of falls and fracture, particularly in the elderly where calcium intakes and vitamin D levels are often inadequate. A number of meta-analyses have questioned the benefits of untargeted or ‘holistic’ supplementation for falls and fracture, and raised the possibility of adverse cardiovascular effects. This review provides an update on these controversies.

Recent findings

Recent advances have largely centred around new trials of vitamin D and meta-analyses of published trials and observational studies. These articles have identified holistic vitamin D supplementation with or without calcium is unlikely to be an effective primary prevention strategy for falls or fracture. There has also been high-quality evidence that vitamin D, daily or as a bolus, does not reduce the risk of cardiovascular events.

The benefits of vitamin D and calcium supplements for holistic fall and fracture prevention remain uncertain. Recent evidence supports the concept that high-dose vitamin D has adverse musculoskeletal effects. Future studies should focus on moderate daily doses. Finally, there remain inconsistent findings for adverse cardiovascular effects of calcium supplements with or without vitamin D. This uncertainty should be taken into account when evaluating the risk/benefits of supplementation.
Gout and cardiovascular disease: crystallized confusion
Authors: Abeles Aryeh M. , Pillinger Michael H.
Published: December 2018

Purpose of review

Gout is associated with the risk of cardiovascular morbidity and mortality, but the biological relationship between the two remains uncertain. The demonstration of reduction of cardiovascular risk with appropriate gout treatment would argue for a causal role for gout in cardiovascular disease. We reviewed recent studies that address the relationship between gout and cardiovascular disease.

Recent findings

Studies are conflicting; some show that lowering serum uric acid levels leads to better cardiovascular outcomes, whereas others show no such benefit. Inconsistencies in study design may contribute to these variations in outcome. Additionally, different gout treatment strategies may affect cardiovascular outcomes differently.

Despite an abundance of data generated in the last 5 years, it remains unclear whether treating gout with urate-lowering therapy provides a cardiovascular benefit. Additionally, further studies are needed to clarify whether different urate-lowering drugs confer different cardiovascular risks or benefits. Nonurate-lowering agents used for gout or commonly used in gout patients, such as colchicine and statins, may also improve cardiovascular outcomes in this population.
Neurological Outcomes After Surgical or Conservative Management of Spontaneous Spinal Epidural Abscesses
Authors: Wang Timothy Y. , Harward Stephen C. , Tsvankin Vadim , Bell Hannah , Charalambous Lefko , Adil Syed M. , Englot Dario J. , Goodwin C. Rory , Karikari Isaac O. , Isaacs Robert E. , Krucoff Max O.
Published: December 2018

Study Design:

This is a meta-analysis.

Objective:

Perform a systematic review and quantitative meta-analysis of neurological outcomes from all available spinal epidural abscess (SEA) literature published between 1980 and 2016.

Summary of Background Data:

Current literature on SEAs lacks large-scale data characterizing prognostic factors and surgical indications.

Materials and Methods:

PubMed was queried for studies reporting neurological outcomes from patients undergoing conservative or surgical management for spontaneous SEA. Inclusion criteria included outcomes data measured ≥6 months after presentation, ≥10 human subjects, and diagnosis by magnetic resonance imaging or Computed tomography-myelogram. Where available, demographic data, abscess location, comorbidities, pretreatment neurological deficits, treatment methods, bacterial speciation, and complications were extracted from each study. Potential outcome predictors represented by continuous variables were compared using student t test and categorical variables were compared using the Pearson χ2 test. Variables identified as potentially associated with outcome (P≤0.05) were subjected to meta-analysis using Cochran-Mantel-Haenszel testing to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

Results:

In total, 808 patients were analyzed from 20 studies that met inclusion criteria. 456 (56.3%) patients were treated with surgery and antibiotics, and 353 (43.7%) patients were managed with antibiotics alone. Neither surgical intervention (OR=1.01, 95% CI=0.40–2.59), lumbosacral location (OR=1.51, 95% CI=0.23–9.79), nor neurological deficit on presentation (OR=0.88, 95% CI=0.40–1.92) were significantly associated with good (stable or improved) or bad (worsened) neurological outcome, whereas delayed surgery was significantly associated with bad outcome (OR=0.01, 95% CI=0.02–0.62) and cervicothoracic location approached significance for predicting bad outcome (OR=0.41, 95% CI=0.15–1.09).

Conclusions:

Current literature does not definitively support or oppose surgical intervention in all SEA cases. Therefore, until better evidence exists, the decision to operate must be made on an individual case-by-case basis with the goals of preventing neurological decline, obtaining source control after failed conservative treatment, or restoring spinal stability.
Angiotensin II (Giapreza): A Distinct Mechanism for the Treatment of Vasodilatory Shock
Authors: Khalique Saira C. , Ferguson Nadia
Published: December 2018

Septic shock, a form of vasodilatory shock associated with high morbidity and mortality, requires early and effective therapy to improve patient outcomes. Current management of septic shock includes the use of intravenous fluids, catecholamines, and vasopressin for hemodynamic support to ensure adequate perfusion. Despite these interventions, hospital mortality rates are still greater than 40%. Practitioners are continuously faced with cases of refractory shock that are associated with poor clinical outcomes. In December of 2017, the Food and Drug Administration approved the first synthetic human angiotensin II, a potent vasoconstrictor, to increase blood pressure in adults with septic or other distributive shock. This approval was based (ATHOS) on the results from the Angiotensin II for the Treatment of High Output Shock study. In this randomized, double-blind, placebo-controlled trial, patients in the angiotensin II group achieved higher rates of target mean arterial pressure and had lower catecholamine requirements in the first 3 hours of therapy compared with patients in the placebo group. There was no significant difference in the 28-day mortality. Safety issues including the risk of thromboembolic events, infection, and delirium have made clinicians cautious in adopting angiotensin II into practice. Ongoing studies are needed to more clearly define the role of this agent and its utility in the management of shock.
Absence of Relationship Between Crohn's Disease Activity Index or C-Reactive Protein and Infliximab Exposure Calls for Objective Crohn's Disease Activity Measures for the Evaluation of Treatment Effects at Treatment Failure
Authors: Edlund Helena , Grisic Ana-Marija , Steenholdt Casper , Ainsworth Mark A. , Brynskov Jørn , Huisinga Wilhelm , Kloft Charlotte
Published: December 2018

Background:

Circulating infliximab (IFX) concentrations correlate with clinical outcomes, forming the basis of the IFX concentration monitoring in patients with Crohn's disease. This study aims to investigate and refine the exposure–response relationship by linking the disease activity markers “Crohn's disease activity index” (CDAI) and C-reactive protein (CRP) to IFX exposure. In addition, we aim to explore the correlations between different disease markers and exposure metrics.

Methods:

Data from 47 Crohn's disease patients of a randomized controlled trial were analyzed post hoc. All patients had secondary treatment failure at inclusion and had received intensified IFX of 5 mg/kg every 4 weeks for up to 20 weeks. Graphical analyses were performed to explore exposure–response relationships. Metrics of exposure included area under the concentration–time curve (AUC) and trough concentrations (Cmin). Disease activity was measured by CDAI and CRP values, their change from baseline/last visit, and response/remission outcomes at week 12.

Results:

Although trends toward lower Cmin and lower AUC in nonresponders were observed, neither CDAI nor CRP showed consistent trends of lower disease activity with higher IFX exposure across the 30 evaluated relationships. As can be expected, Cmin and AUC were strongly correlated with each other. Contrarily, the disease activity markers were only weakly correlated with each other.

Conclusions:

No significant relationship between disease activity, as evaluated by CDAI or CRP, and IFX exposure was identified. AUC did not add benefit compared with Cmin. These findings support the continued use of Cmin and call for stringent objective disease activity (bio-)markers (eg, endoscopy) to form the basis of personalized IFX therapy for Crohn's disease patients with IFX treatment failure.
Persistent vasomotor symptoms and breast cancer in the Women's Health Initiative
Authors: Chlebowski Rowan T. , Mortimer Joanne E. , Crandall Carolyn J. , Pan Kathy , Manson JoAnn E. , Nelson Rebecca , Johnson Karen C. , Vitolin Mara Z. , Lane Dorothy , Wactawski-Wende Jean , Kwan Karen , Stefanick Marcia L.
Published: December 2018

Objective:

Vasomotor symptoms (VMS) including hot flashes and night sweats are common during the menopausal transition and may persist. Although VMS pathophysiology is complex, estrogen's efficiency as VMS therapy suggests hormonal environment change may influence this process. As studies of VMS and breast cancer are inconsistent, we examined associations between persistent VMS and breast cancer incidence and mortality.

Methods:

The analytic sample included 25,499 postmenopausal women aged 50 to 79 in the Women's Health Initiative (WHI) without current/former menopausal hormone therapy use with information on VMS status (never vs persistent). Breast cancers were verified by medical record review. Cause of death attribution was enhanced by serial National Death Index queries. Associations between VMS status and breast cancer incidence and mortality was determined using time dependent Cox regression analyses adjusted for breast cancer risk factors.

Results:

Through 17.9 years (median) follow-up, 1,399 incident breast cancers were seen. Women with persistent VMS (VMS median duration 10+ years) (n = 9,715), compared to women with never VMS (n = 15,784), had a higher breast cancer incidence (hazard ratio [HR] 1.13 95% confidence interval [CI] 1.02-1.27). While breast cancer-specific mortality was higher in women with persistent VMS (HR 1.33 95% CI 0.88-2.02), the difference was not statistically significant. Persistent VMS status had no influence on breast cancer overall survival (HR 1.02 95% CI 0.81-1.29).

Conclusion:

Women with persistent VMS are more likely to be diagnosed with breast cancer than women who never experienced VMS, but not more likely to die from breast cancer.
Genitourinary syndrome of menopause symptom severity and impact outcome measures: are they reliable and correlated?
Authors: Mercier Joanie , Morin Mélanie , Reichetzer Barbara , Lemieux Marie-Claude , Khalifé Samir , Dumoulin Chantale
Published: December 2018

Objective:

The Most Bothersome Symptom Approach (MBSA) assesses symptom severity of genitourinary syndrome of menopause (GSM), and identifies the symptom with the greatest burden. The Atrophy Symptoms Questionnaire (ASQ) assesses the impact of GSM symptoms on the activities of daily living. The psychometric properties of these outcomes remain to be completely assessed. This study aimed to assess the test-retest reliability of the MBSA and the ASQ and their convergent validity.

Method:

One evaluator administered the outcomes twice 2 weeks apart to postmenopausal women with GSM and urinary incontinence. MBSA reliability was assessed with the graphical analysis of paired differences, Kappa coefficients and intraclass correlation coefficient (ICC), and the ASQ reliability, with paired t test and ICC. The convergent validity of both outcomes was investigated through their association with the Pearson correlation coefficient.

Results:

Thirty-one women participated in the study. For the MBSA, the severity of the most bothersome symptom obtained a good reliability with 80% observed agreement between sessions, a substantial kappa (0.67 ± 0.12) and excellent ICC (0.88 [95% confidence interval 0.75-0.94]). For the ASQ, no significant difference was found between sessions (P = 0.146) and ICC indicated excellent reliability (0.85 [95% confidence interval 0.69-0.93]). There was a large, positive correlation between the severity of the most bothersome symptom selected by the participants in the MBSA and the ASQ total score for the two measurement sessions (T1: r = 0.587, P = 0.001 and T2: r = 0.601, P < 0.001).

Conclusions:

The MBSA and the ASQ are reliable outcome measures in postmenopausal women with GSM and urinary incontinence. Our findings support good convergent validity of those two outcomes as they showed a significant positive correlation between the severity of GSM symptoms and their impact on activities of daily living.
CHOROIDAL NEOVASCULAR AREA AND VESSEL DENSITY COMPARISON BETWEEN TWO SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY DEVICES
Authors: Ohayon Avi , Sacconi Riccardo , Semoun Oudy , Corbelli Eleonora , Souied Eric H. , Querques Giuseppe
Published: December 2018

Purpose:

To compare choroidal neovascularization (CNV) area and vessel density (VD) measurements between two different swept-source optical coherence tomography angiography (SS-OCTA) devices.

Methods:

En face optical coherence tomography angiography (OCTA) images of patients affected by neovascular age-related macular degeneration were collected prospectively from two devices: Zeiss PLEX Elite 9000 (Carl Zeiss Meditec, Dublin, CA) and Topcon DRI OCT Triton SS-OCTA (Topcon, Tokyo, Japan). Choroidal neovascularization area and VD of images were measured and analyzed with ImageJ software by two readers to evaluate the agreement between two devices, with respect to different image size (3 × 3 and 6 × 6 mm) and different image segmentation (automatic vs. manual), and a Topcon equivalent Zeiss segmentation as control (i.e., the equivalent anatomical slab given by Topcon device on the Zeiss device).

Results:

A total of 30 eyes (30 patients) were analyzed. There was an excellent agreement between the two readers in CNV area measurements intraclass correlation coefficient >0.9 in all analyses. We found excellent agreement in CNV area measurements (manual and automatic segmentations) when comparing 3 × 3-mm or 6 × 6-mm images both for each single device and between the two devices (overall intraclass correlation coefficient > 0.9). Vessel density measurements between manual to automatic segmentation within the same device and same image size had a high intraclass correlation coefficient value, but there was a poor agreement in VD between different image sizes (3 × 3 mm vs. 6 × 6 mm) in the same device and also comparing the two devices (3 × 3 Topcon vs. 3 × 3 Zeiss; 6 × 6 Topcon vs. 6 × 6 Zeiss). There was a poor agreement between the Topcon equivalent Zeiss segmentation and all other segmentations.

Conclusion:

There was an excellent agreement in CNV area measurements for both swept-source optical coherence tomography angiography devices in automatic and manual segmentations. However, the Topcon equivalent Zeiss segmentation was not comparable with any of the preset segmentations of Topcon and Zeiss devices. There was a poor agreement in CNV VD between different image size and different devices. For these reasons, it seems that, for accurate longitudinal analysis of VD, it is better to use the same device for each individual, even if both devices can be used interchangeably for CNV area measurements using automatic or manual segmentations.
Contralateral Eye Comparison Between 2 Cap Thicknesses in Small Incision Lenticule Extraction: 110 Versus 130 μm
Authors: Wu Fang , Yin Houfa , Yang Yabo
Published: December 2018

Purpose:

To evaluate the posterior corneal elevation (PCE) and biomechanical changes after small incision lenticule extraction (SMILE) at depths of 110 μm and 130 μm.

Methods:

One hundred sixteen eyes from 58 consecutive patients who underwent SMILE were included in this prospective study. Each patient underwent SMILE in one eye to a depth of 110 μm and in the other eye to a depth of 130 μm. A Scheimpflug camera and Hartmann-Shack WASCA aberrometer were used to assess the PCE and wavefront aberrations, respectively, before SMILE and at 1 and 3 months after surgery. The PCE was analyzed along 3 optical zones (apex and 2 and 4 mm diameters) as a function of the meridian. Dynamic Scheimpflug imaging was used to evaluate the biomechanics preoperatively and at 1 day, 1 month, and 3 months postoperatively.

Results:

No significant difference was found in either vision correction or corneal biomechanics between the 2 groups. In both groups, the PCE became significantly flattened at the apex and at 2 mm annulus 1 month postoperatively, especially for the 110-μm cap group. Three months postoperatively, the 110-μm cap group was still flattened significantly, whereas the displacement at the apex in the 130-μm cap group had disappeared. There was no significant difference in wavefront aberrations between the groups after surgery, except in the vertical coma (P < 0.001).

Conclusions:

The differences in corneal biomechanics between the 110-μm cap group and 130-μm cap group were small; however, the superficial lenticule might cause displacement of the PCE to be more persistent in one eye than in the other.
Reports of Post-keratoplasty Infections for Eye Bank-prepared and Non–Eye Bank-prepared Corneas: 12 Years of Data From a Single Eye Bank
Authors: Mathes Kristin J. , Tran Khoa D. , Mayko Zachary M. , Stoeger Christopher G. , Straiko Michael D. , Terry Mark A.
Published: December 2018

Purpose:

To examine postoperative reports of infection rates for eye bank-prepared and non–eye bank-prepared corneas from January 1, 2006 to December 31, 2017, from a single eye bank.

Method:

A retrospective review of reported fungal and bacterial infections with corneal transplant surgeries using corneas distributed by our eye bank was conducted. The reported number of infections for corneas that underwent eye bank preparation (pre-cut and pre-stripped corneas) and for those distributed without eye bank preparation was quantified. The potential association between infection rates in tissue prepared by the eye bank and those in corneas that had no additional eye bank processing was also examined.

Results:

Four of 17,035 corneas distributed during the study period were associated with fungal infections (1 eye bank-prepared and 3 non–eye bank-prepared corneas) and were attributed to the tissue after investigation by eye bank medical directors. There was no ascending trend of infections reported with eye bank-prepared corneas in the first 3 years (2 of 1054 corneas, 0.19%) compared with that in the last 3 years of the study period (6 of 3500 corneas, 0.17%; P = 0.901) when the eye bank distributed 3 times more prepared corneas than non–eye bank-prepared corneas. A significant increase in the numbers of reported infections for non–eye bank-prepared corneas was observed between these 3-year intervals (0.1% in the first 3 years to 1.58% in the last 3 years; P = 0.001).

Conclusions:

Reports of infections remained low despite increased use of eye bank-prepared tissue. These results suggest that factors other than eye bank tissue preparation should be considered when investigating potential sources of pathogen contamination in donor corneas.
Relationship Between Ocular Surface Epithelial Damage, Tear Abnormalities, and Blink in Patients With Dry Eye
Authors: Kato Hiroaki , Yokoi Norihiko , Watanabe Akihide , Komuro Aoi , Sonomura Yukiko , Sotozono Chie , Kinoshita Shigeru
Published: December 2018

Purpose:

Considering that tears play the role of a lubricant, it is speculated that in the pathophysiology of dry eye, increased friction during blinking results in corneal and conjunctival damage, which may subsequently affect the blink. The purpose of this study was to investigate the relationship between ocular surface epithelial damage, tear abnormalities, and blinks in patients with dry eye.

Methods:

This study involved 45 eyes of 45 female patients with dry eye (mean age: 57.6 years). In all eyes, tear meniscus radius (mm), spread grade of the tear film lipid layer (SG: 1-5: 1 being the best), fluorescein breakup time (FBUT, seconds), corneal and bulbar conjunctival epithelial damage (CED: 15 points maximum and CONJUNCTIVAL EPITHELIAL DAMAGE (CjED): 6 points maximum, respectively), and Schirmer I test (ST1, mm) were evaluated. Blink rate (BR, blinks per minute), palpebral aperture height (mm), upper-eyelid opening-phase amplitude/upper-eyelid closing-phase amplitude (mm), upper-eyelid opening-phase duration/upper-eyelid closing-phase duration (ms), and upper-eyelid opening-phase maximum velocity/upper-eyelid closing-phase maximum velocity (mm/s) were measured using a custom-made high-speed blink analyzer. Finally, the factors that determine CED and CjED were investigated by multiple regression analysis, in which the parameters were chosen using the stepwise procedure.

Results:

CED and CjED were found to be described as 2.687 + (1.816 × SG) − (0.937 × FBUT) (R2 = 0.656, P < 0.0001) and 0.684 + (0.801 × SG) − (0.526 × FBUT) − (0.041 × ST1) + (0.010 × upper-eyelid closing-phase maximum velocity) (R2 = 0.714, P < 0.0001), respectively.

Conclusions:

Although CED was significantly related to only tear abnormalities, CjED was significantly related to tear abnormalities and blinking.
Accuracy of Tonopen Versus iCare in Human Cadaveric Eyes With Edematous Corneas Over a Wide Range of Intraocular Pressures
Authors: Ruland Kelly , Olayanju Jessica , Borras Terete , Grewal Dilraj S. , Fleischman David
Published: December 2018

Purpose:

The purpose of this study was to compare the accuracy of 2 portable tonometers, Tonopen and iCare, in extreme corneal edema, while also accounting for the location of pressure measurement over a wide range of intraocular pressure (IOP).

Methods:

Utilizing an experimental laboratory investigation, IOP measurements were obtained with iCare and Tonopen against an internal digital manometer in 2 enucleated human cadaveric eyes with edematous corneas. Pachymetry was used to measure central corneal thickness in each eye. Each eye was then mounted on an upright-positioned mannequin, and a 30-G needle connected to a digital manometer was introduced into the anterior chamber at the limbus. Pressures were maintained at 0, 10, 20, 30, 40, and 50 mmHg using the digital manometer. Three measurements were taken with the tonometers at the central cornea, limbal cornea, and sclera, for a total of 9 measurements per device per eye at each manometric pressure reading.

Results:

Comparing the mean absolute error of Tonopen versus iCare measurements at the central cornea for each manometric pressure reading, both devices underestimated the control at pressures >10 mmHg, with mean error increasing as IOP increased [mean absolute error (MAE) ranged from 1.67 to 13.33 with Tonopen and 3.67 to 21.00 with iCare]. Tonopen more accurately estimated pressure with an average MAE of 5.72 at the central cornea, compared with MAE of 10.83 at the central cornea for iCare (P<0.03). Comparing MAE between the devices at the limbus, there was no significant difference between the 2 (P=0.91), with average MAE for the Tonopen 5.47 and average MAE for the iCare 5.22. There was no significant difference between average MAE for Tonopen measurements at the central cornea versus the limbus (P=0.89), while the iCare was more accurate at the limbus with average MAE of 5.22 than the central cornea with average MAE of 10.83 (P<0.03). When measuring at the sclera, there was no statistically significant difference between average MAE for Tonopen (18.03) versus iCare (10.39) (P=0.24).

Discussion:

Tonopen was more accurate than iCare when measuring at the central cornea, but consistently underestimated the control. MAE for both devices increased linearly with increasing true IOP. With limbus measurements in an edematous cornea, Tonopen and iCare performed similarly. The iCare performed better at the limbus than at the central cornea. Scleral measurements for both Tonopen and iCare were poor. In this experimental model, Tonopen performed superiorly to iCare with central cornea measurements in a grossly edematous cornea. Both devices underestimated true IOP.
The Relationship Between Long-term Use of Intranasal Corticosteroid and Intraocular Pressure
Authors: Mohd Zain Ayesha , Md Noh Umi K. , Hussein Salina , Che Hamzah Jemaima , Mohd Khialdin Safinaz , Md Din Norshamsiah
Published: December 2018

Purpose:

The purpose of this study was to investigate the association between long-term intranasal steroid use and intraocular pressure (IOP) elevation.

Patients and Methods:

In total, 100 eyes from 50 patients on long-term intranasal steroids (>2 y) for allergic rhinitis and 90 eyes from 45 controls were included in this study. Patients on other forms of steroids and risk factors for glaucoma were excluded. IOP was measured and nonmydriatic stereoscopic optic disc photos were taken for each eye. The vertical cup-to-disc ratio and the status of the optic disc were evaluated.

Results:

The mean IOP for intranasal steroids group was significantly higher (15.24±2.31 mm Hg) compared to the control group (13.91±1.86 mm Hg; P=0.000). However, there were no significant differences in the vertical cup-to-disc ratio and the status of glaucomatous optic disc changes between the groups.

Conclusions:

Prolonged use of intranasal steroids cause statistical significant increase in IOP in patients with allergic rhinitis although no significant glaucomatous disc changes were seen. We suggest patients on long-term use of intranasal steroid have a yearly eye examination to be monitored for IOP elevation and those with additional risk factors for glaucoma is closely monitored for glaucoma.
Conjunctival Goblet Cells, the Overlooked Cells in Glaucoma Treatment
Authors: Tiedemann Daniel , Mouhammad Zaynab A. , Utheim Tor P. , Dartt Darlene A. , Heegaard Steffen , Petrovski Goran , Kolko Miriam
Published: December 2018

Glaucoma is the leading cause of irreversible blindness worldwide. Although no definitive cure exists, lowering of the intraocular pressure decreases the rate of progression in the majority of patients with glaucoma. Antiglaucomatous treatment modalities consist predominantly of chronic use of eye drops. It has become increasingly evident that long-term exposure to eye drops has a significant impact on the ocular surface, and thereby on patient compliance and quality of life. Maintenance of the ocular surface is highly dependent on a stable tear film. Conjunctival goblet cells (GCs) of the ocular surface play an important role in providing the innermost mucin layer of the tear film and are essential for maintaining the ocular surface homeostasis. Recent studies have reported severe side effects of antiglaucomatous drops on GCs. In particular, a preservative containing antiglaucomatous drops have been shown to affect the viability and functions of the GCs. Furthermore, GC density has been suggested as a potential predictor of surgical outcome after filtration surgery. The present review provides an overview of the current literature on the impact of antiglaucomatous eye drops on GCs as well as the impact on the ocular surface. Moreover, the existing evidence of a possible association between GC density and glaucoma filtration surgery outcome is summarized. We conclude that prostaglandin analogs spare the conjunctival GCs more compared with other antiglaucomatous drops and that GCs may be a good predictor of surgical outcome after filtration surgery. Overall, given the multiple functions of GCs in the ocular surface homeostasis, dedicated strategies should be adopted to preserve this cell population during the course of glaucoma.
Primary Orbital Leiomyosarcoma in an Adult Male
Authors: Chaugule Sonal S. , Putambekar Anirudha , Gavade Smita , Deshpande Rahul
Published: December 2018

A 71-year-old male presented with a history of noticing gradual painless progressive proptosis along with a pinkish mass seen on the outer aspect of his left eyeball. Orbital CT revealed a fairly defined homogenous lesion, abutting the left eyeball and involving the lateral orbit reaching almost till orbital apex. Histopathology analysis aided with immunohistochemistry after an incision biopsy was consistent with leiomyosarcoma. Positron emission tomography scan ruled out presence of any distant primary or metastatic tumor. He underwent eyelid sparing total orbital exenteration with confirmed tumor free soft-tissue margins. He is doing well at 5 months of follow-up with no sign of local recurrence or distant metastasis. Primary orbital leiomyosarcoma is a rare tumor. It is mainly found in older woman; it is even rarer in males. Complete surgical excision with tumor free margins is the recommended treatment. Histopathology and immunohistochemistry are valuable in diagnosis and management.
Multimodality Management of Complex Periorbital Venolymphatic Malformations
Authors: Ramesh Sathyadeepak , Duckwiler Gary , Goldberg Robert A. , Rootman Daniel B.
Published: December 2018

Purpose:

To review a representative case series and share a stepwise approach to the diagnosis and treatment of periorbital venolymphatic malformations.

Methods:

A case series of 9 patients with representative periorbital venolymphatic malformations. All patients managed at the University of California, Los Angeles Orbital Center for a vascular malformation over the last 5 years were reviewed. Cases representative of the varied pathologic findings and techniques were selected. The clinical, radiologic, and intraoperative findings are presented and a survey of techniques composed.

Results:

Venolymphatic malformations can have protean manifestations. Characteristics vital to the understanding and management of these lesions are the classification and vascular composition of the lesion, internal flow and drainage patterns, anatomic localization and association with distant components. Options for treatment include sclerotherapy, biologic therapy, embolization, surgical excision, or some combination thereof.

Conclusions:

A comprehensive understanding of each patient’s unique lesion is critical to a rational treatment approach. Teamwork and creativity are key to effectively managing these lesions.
Lichenoid Dermatitis Development After Excision of Basal Cell Carcinoma
Authors: Akella Sruti S. , Lee Thomas , Barmettler Anne
Published: December 2018

This is the first reported case of lichenoid dermatitis erupting after surgical excision of basal cell carcinoma on the upper eyelid of an African-American woman. Lichenoid dermatitis is a common dermatologic diagnosis which may coexist with superficial malignancies, although the exact interaction between the 2 entities is not entirely known. The authors propose that successful treatment of basal cell carcinoma induces inflammation in the form of lichenoid dermatitis, which may play an adjunct role in eradication of the malignancy. The appearance of lichenoid dermatitis could theoretically represent a positive response to treatment; future studies are needed to establish this.
A New Safety Scoring System for the Use of Psychotropic Drugs During Lactation
Authors: Uguz Faruk
Published: December 2018

Background:

Psychotropic drugs are frequently used to treat postpartum women with psychiatric diagnoses, especially psychotic disorder, major depression, and bipolar mood episodes. Pharmacotherapy in breastfeeding mothers is a major challenge.

Study Question:

This article presents a new safety scoring system for the use of psychotropic drugs during lactation.

Study Design:

The scoring system is based on the following 6 safety parameters: reported total sample, reported maximum relative infant dose, reported sample size for relative infant dose, infant plasma drug levels, prevalence of reported any adverse effect, and reported serious adverse effects. The total score ranges from 0 to 10. Higher scores represent a higher safety profile.

Results:

According to this scoring system, sertraline and paroxetine, respectively, had the highest scores representing “very good safety profile.” Citalopram, olanzapine, and midazolam were assigned to “good safety profile.” Among drugs evaluated in this article, trifluoperazine, aripiprazole, amisulpride, clozapine, doxepin, zaleplon, and zolpidem are not recommended owing to safety scores ≤3.

Conclusions:

Most psychotropic drugs examined in this article have “moderate” or “low” safety profile.