bluuebunny/crossref_metadata_2025 huggingface dataset:
Radical Wrist Denervation and Preliminary Results
Authors: Patil Vijay , Arenas-Prat Joan
Published: May 2016

Denervation is a well recognized procedure to treat degenerative or posttraumatic joint conditions, especially in cases where pain is a significant impediment to function even in the presence of stable and supple joint. However, this procedure currently is not as widely used for wrist surgeries as it merits. Denervation procedure obeys all-or-none phenomenon and we believe that even a few residual intact sensory fibers are able to transmit severe pain sensation and therefore every attempt should be made to target all the sensory supply to the wrist joint. In the present article a modified and radical technique using a single dorsal incision is proposed to address the hypothetical pitfalls of leaving undivided sensitive branches. Preliminary results of 21 cases operated on by this method are presented.
Frequency of telomerase reverse transcripter promoter mutations in desmoplastic melanoma subtypes: analyses of 76 cases
Authors: Yang Shi , Leone Dominick , Frydenlund Noah , Hoang Mai , Deng April , Hernandez-Perez Marier , Biswas Asok , Singh Rajendra , Yaar Ron , Mahalingam Meera
Published: May 2016

Estimates of the frequency of telomerase reverse transcripter (TERT) mutations in desmoplastic melanoma (DM) are limited. DM is categorized into subtypes, pure and mixed, differing in prognosis, suggesting genetic heterogeneity. Given this, our aims were to determine the incidence of TERT promoter mutations in DM subtypes and to evaluate its relationship with established histopathologic prognosticators, BRAF and RETp status, and neurofibromin protein expression. Of the archival annotated samples retrieved, 76 cases of DM (48 pure and 28 mixed) fulfilled the criteria for inclusion. PCR amplification of the TERT promoter region was performed on DNA extracted from formalin-fixed paraffin-embedded tissue using primers5′-GCCGATTCGACCTCTCTCC-3′ (forward) and 5′-CAGCGCTGCCTGAAACTC-3′ (reverse). For each case, appropriate C>T mutations were identified on the electropherograms. Univariate analysis using χ
2-test was carried out to identify potential confounders; a nested case–control study of demographic, clinical, histopathological, and genetic determinants was carried out using multiple logistic regression. Significant differences in TERT promoter mutation frequencies were noted in the subtypes (mixed vs. pure; 15/28, 54% vs. 11/48, 23%, respectively, P=0.0066). After adjusting for potential confounding, multivariate analyses indicated a three-fold increase in the odds of the TERT mutation for those with the mixed subtype compared with the pure subtype (P=0.04, adjusted odds ratio =3.32). No other significant associations were noted (sex/junctional component/Breslow depth/ulceration/mitoses/host response/RETp, BRAF status, and neurofibromin protein expression). Our findings, the largest to date investigating TERT promoter mutations in DM, support the hypothesis that the subtypes have distinct genetic drivers and underscore the relevance of telomere integrity in the etiopathogenesis of the mixed variant.
Neodymium-Doped Yttrium Aluminium Garnet Laser Treatment of Pediatric Venous Malformation in the Oral Cavity
Authors: Mungnirandr Akkrapol , Nuntasunti Wasun , Manuskiatti Woraphong
Published: May 2016

BACKGROUND

Treatment of venous malformations in the orofacial region remains a challenge. Laser therapy is an alternative treatment in inoperable cases.

OBJECTIVE

To retrospectively evaluate the effectiveness and complications associated with neodymium-doped yttrium aluminium garnet (Nd:YAG) laser treatment of oral venous malformations.

MATERIALS AND METHODS

A total of 10 children (mean age: 7.3 years; range: 10 months-15 years) with oral venous malformation were treated with Nd:YAG laser during 2005 to 2013. Clinical improvement, including degree of color lightening and size reduction, and treatment complications, including dyspigmentation, textural change, and scarring were evaluated.

RESULTS

Color clearing of 51% to 75% and >75% was seen in 25% and 45% of patients, respectively. Size reduction of 25% to 50%, 51% to 75%, and >75% was observed in 30%, 15%, and 45% of patients, respectively. Mild and moderate scarring was observed in 15% and 5% of cases, respectively.

CONCLUSION

Nd:YAG laser is a promising alternative treatment in pediatric patients with inoperable venous malformations in the oral cavity. Mild to moderate scarring was the most common complication.
Scalp Basal Cell Carcinoma: Review of 2,202 Cases
Authors: Cho Matthew , Lee Jaein , James Craig L. , Marshman Gillian , Huilgol Shyamala C.
Published: May 2016

BACKGROUND

Increases in the incidence of basal cell carcinoma (BCC) in women, younger age groups and in aggressive scalp subtypes in younger women have been reported.

OBJECTIVE

To describe lesion and patient characteristics in scalp BCC.

MATERIALS AND METHODS

Retrospective audit of scalp BCCs from 3 pathology laboratories in Adelaide, South Australia, January 2009–December 2013.

RESULTS

Scalp BCC was 2.6% of all BCC. Of 2,202 patients with scalp BCC, 62% were male and 78% were >60 years. Histologic subtypes included nodular (55%), mixed (30%), and superficial (8%). The concordance between biopsy and excision was 83% for division into nonaggressive and aggressive subtypes. The incomplete excision rate was 16%. Aggressive subtypes were larger and had perineural invasion (PNI) in 8.5% and incomplete excision in 26%.

CONCLUSION

Basal cell carcinoma on the scalp was less common. Men and the elderly had the majority of cases, with no predilection for women, including aggressive histologic subtypes in younger women. Aggressive subtypes were associated with increased size, incomplete excision, and PNI. A preliminary biopsy assisted division into aggressive and nonaggressive histologic subtypes. Incomplete excision rates were higher and increased in aggressive histologic subtypes and PNI. Mohs surgery or wider margins are suggested in these cases.
Avoiding Breast Animation Deformity with Pectoralis-Sparing Subcutaneous Direct-to-Implant Breast Reconstruction
Authors: Kobraei Edward M. , Cauley Ryan , Gadd Michele , Austen William G. , Liao Eric C.
Published: May 2016

There is renewed interest in sparing the pectoralis major muscle in implant breast reconstruction, placing the implant in the subcutaneous position. This advance is made reliable by improvements in mastectomy skin flap quality, evolution of technique, and increased awareness of breast animation deformity. This retrospective review presents 13 patients (23 breasts) reconstructed immediately with placing the definitive implant in the subcutaneous space without disruption of the underlying chest muscles. None of the 13 patients had breast animation deformity postoperatively. One patient experienced an early hematoma, and 3 patients had small seromas that resolved uneventfully. One morbidly obese patient undergoing chemotherapy using a nearby chest port experienced infection requiring implant removal. This study describes an early experience, demonstrates feasibility, and discusses patient selection considerations that are important because we continue to evolve breast reconstruction approaches.
Retroseptal Transconjunctival Approach for Blowout Fracture of the Orbital Floor: An Ideal Choice in East-Asian Patients
Authors: Uemura Tetsuji , Chuman Takahiro , Fujii Tatsuya , Morikawa Aya , Kikuchi Mamoru , Watanabe Hidetaka
Published: May 2016

Objective:

To ask experts in the field to evaluate a surgeon’s experience with a retroseptal transconjunctival approach for the repair of the orbital floor damaged by blowout fracture that the surgeon encountered in 12 East-Asian patients.

Methods:

Patients were identified from a database, and a retrospective case note review was conducted. A total of 12 conjunctival procedures were conducted for the repair of blowout fracture with no other complicating fractures. All operative procedures were done by transconjunctival approach alone without lateral canthotomy or any other additional approach.

Results:

The repair of the orbital floor was successful in all the cases. Three patients had bone grafting to the orbital floor after reduction. The mean of overall surgical time was 48.8 minutes (range, 22–85 minutes) for orbit exposure by transconjunctival approach plus reduction and bone grafting when applicable. There were 6 urgent surgeries associated with missing or entrapment of the inferior rectus muscle, and its repair took an average of 32.0 minutes (range, 22–41 minutes). Postoperative diplopia recovered at an average of 12.4 weeks (range, 0–60 weeks); in urgent cases, it took an average of 5.3 weeks (range, 0–14 weeks) before recovery.

Conclusions:

A retroseptal transconjunctival approach in repairing the orbital floor is a simple, easily manageable, and effective procedure, leaving no conspicuous facial scars. It has proved to be an optimal choice in blowout fracture cases, especially when there was urgency to decompress the ischemic inferior rectus muscle in as short a surgery time as possible.
ACUTE ZONAL OCCULT OUTER RETINOPATHY AFFECTING THE PERIPHERAL RETINA WITH CENTRIPETAL PROGRESSION
Authors: Tan Anna C. S. , Sherman Jerome , Yannuzzi Lawrence A.
Published: May 2016

Purpose:

To describe a variant of acute zonal occult outer retinopathy (AZOOR) that has concentric involvement of the peripheral retina with centripetal progression toward the posterior pole.

Methods:

Three patients with AZOOR were reported to show peripheral concentric zonal involvement with centripetal progression of their disease from the periphery to the posterior fundus.

Results:

All three cases involved elderly hyperopic women with a history of autoimmune disease. All six eyes showed bilateral central peripapillary AZOOR lesions that progressed in a centrifugal manner to the periphery. Five of the six eyes showed the presence of concentric peripheral zonal abnormalities that progressed in a centripetal manner to the posterior pole. In one case, the peripheral and central zonal abnormalities became confluent, leaving only a small island of normal retina temporal to the fovea.

Conclusion:

A variant of AZOOR may involve the peripheral retina, causing concentric zonal atrophy with centripetal progression, with central peripapillary zonal abnormalities that have centrifugal progression. This may eventually lead to widespread atrophic degeneration with severe visual field loss. Wide-field imaging of the peripheral retina and monitoring of the visual fields are important to document this rare atypical presentation of AZOOR and any subsequent disease progression.
SPONTANEOUS CLOSURE OF A FULL-THICKNESS MACULAR HOLE SECONDARY TO IRVINE-GASS SYNDROME
Authors: Llop Stephanie M. , Gonzalez Eduardo , Emanuelli Andres
Published: May 2016

Purpose:

To report a case of spontaneous closure of a full-thickness macular hole after a posterior subtenon injection of triamcinolone in a patient with Irvine-Gass syndrome.

Methods:

Case report and literature review.

Results:

A 70-year-old man presented to the retina clinic with visual disturbance in his right eye after an uneventful cataract surgery. Patient was found to have macular edema associated with a full-thickness macular hole, treated with a posterior subtenon injection of triamcinolone with subsequent spontaneous closure of the hole and excellent visual acuity.

Conclusion:

This case demonstrates possible resolution of a condition which traditionally requires surgical intervention, with a nonsurgical approach.
Compliance and Subjective Patient Responses to Eyelid Hygiene
Authors: Alghamdi Yousef A. , Camp Andrew , Feuer William , Karp Carol L. , Wellik Sarah , Galor Anat
Published: May 2016

Objectives:

Lid hygiene is a commonly prescribed first-line therapy in patients with lid margin disease, yet compliance with therapy is not well characterized. The goals of this study were to assess patient compliance with lid hygiene and evaluate which factors predict a favorable symptomatic response to treatment.

Methods:

This was a cross-sectional study of patients seen in the Miami Veterans Affairs eye clinic between August and December 2014. An evaluation was performed to assess dry eye symptoms and lid margin signs. All patients were then instructed to perform warm compresses and lid scrubs. A follow-up phone survey assessed compliance and subjective therapeutic response 6 weeks later.

Results:

Two hundred seven of 211 (98%) patients (94% male, 60% white) completed the survey. Of the 207 patients, 188 (91%) completed the follow-up survey. Compliance with therapy was reported in 104 patients (55%); 66 reported complete improvement, 30 partial improvement, and 8 no improvement in symptoms. Patients who self-reported dry eye symptoms at first visit (n=86, 74%) were more likely to be compliant with lid hygiene than those who did not report symptoms (n=18, 25%) (P<0.0005). The only factor associated with poorer response to lid hygiene was longer time of self-reported dry eye symptoms. None of the other signs studied, including the presence of skin rosacea and lid margin telangiectasia, were associated with a differential response to lid hygiene.

Conclusions:

Patients with dry eye symptoms were moderately compliant with lid hygiene, and patients who performed the routine noted improvement in symptoms.
Patient-Reported Wearing Experience From Hydrogel Daily Disposable Wearers Older Than 40 Years From the TEMPO Registry
Authors: Hickson-Curran Sheila B. , Chalmers Robin L. , Keay Lisa , Gleason William
Published: May 2016

Objectives:

To describe the patient-reported wearing experience over time among wearers of hydrogel daily disposable (HydDD) contact lenses (CLs) in the TruEye and Moist Performance Overview (TEMPO) Registry (NCT01467557).

Methods:

Registered wearers older than 40 years who were recently fit with 1-DAY ACUVUE MOIST HydDDs completed self-administered questionnaires four times during a year-long Registry. Overall opinion of CLs, replacement schedules, Contact Lens Dry Eye Questionnaire (CLDEQ-8), and compliance were queried. Data were analyzed with analysis of variance and signed rank tests.

Results:

A total of 86 subjects (24% men, age 50.2±7.1 years) completed the Registry. Approximately 76% were new to daily disposable lenses, and 8% were neophytes. Overall opinion of CLs improved significantly after refitting with HydDDs (baseline 57% excellent/very good vs. 69%–79% at follow-ups, P<0.05 all vs. baseline). Changing to HydDDs maintained average and comfortable wear time (P>0.05), and it did significantly improve CLDEQ-8 scores at all follow-ups (baseline, 11.2±7.3 vs. 2 weeks, 7.8±5.8, P<0.0001; 4 months, 8.6±6.5, P=0.0006; 12 months, 9.3±6.5, P=0.01). Self-assessment of compliance was excellent/very good for 80% at baseline, and improved to 92% to 98% at follow-ups (P<0.0001). More than 90% never slept in their HydDDs, although compliance to daily replacement diminished from 2-week to 4-month surveys (93% vs. 84%, P=0.007).

Conclusions:

After refitting with HydDDs, older wearers reported significantly higher overall opinions of their lenses, better CLDEQ-8 symptom scores, and most were compliant with proper daily disposable lens use. Diminishing daily replacement rates from 2 weeks to 4 months indicate a need to reinforce that recommendation. Wearers of HydDD CLs older than 40 years experienced many benefits from refitting with these daily disposable lenses.
A Possible Association Between Dry Eye Symptoms and Body Fat: A Prospective, Cross-Sectional Preliminary Study
Authors: Ho Kam Chun , Jalbert Isabelle , Watt Kathleen , Golebiowski Blanka
Published: May 2016

Objectives:

To examine the relationship between dry eye symptoms and adiposity in a population study.

Methods:

A prospective cross-sectional single-visit preliminary study was designed to sample ocular symptoms and indices of adiposity in the general adult population. Patients recruited from the UNSW optometry clinic, the university campus and surrounding community, and overseas were invited to complete a survey composed of the short form Dry Eye Questionnaire (SFDEQ) (Dry Eye Questionnaire-5 or Contact Lens Dry Eye Questionnaire-8) and the Ocular Comfort Index (OCI) via hardcopy or online. Participants self-measured their weight, height, waist circumference (WC), and body fat % (optional). Associations between measures of adiposity (Body mass index [BMI], WC, and body fat %) and ocular symptoms scores (SFDEQ and OCI) were determined using Spearman correlation coefficients. Group differences were compared using independent t test.

Results:

Three hundred and five participants including 52 contact lens wearers completed the study and 78 of them measured body fat %. There was a moderate correlation between body fat % and dry eye symptoms (SFDEQ r=0.34, P=0.003; OCI r=0.32, P=0.004). The interaction between body fat % and gender, wear of contact lenses, and older age were shown to be significant predictors of less ocular comfort in multivariate analysis (F(3,74)=12.13, P<0.001).

Conclusions:

An association between adiposity measured by body fat % and symptoms of dry eye was demonstrated in the general adult population. Confirmation of these findings in a large study is required.
Evaluation of Corneal Biomechanics After Excimer Laser Corneal Refractive Surgery in High Myopic Patients Using Dynamic Scheimpflug Technology
Authors: Hashemi Hassan , Asgari Soheila , Mortazavi Mahdi , Ghaffari Reza
Published: May 2016

Objective:

To compare the effect of femtosecond-assisted thin flap laser-assisted in situ keratomileusis (FS-LASIK) and photorefractive keratectomy with mitomycin-C (PRK-MMC) in highly myopic patients (>7.0 D [D]) on corneal biomechanical parameters.

Methods:

In this prospective comparative interventional case series, 60 patients (30 patients in each group) with a manifest refractive spherical equivalent (MRSE) greater than 7.0 D were enrolled. Corvis ST parameters were measured before and at 3 and 6 months postoperatively.

Results:

Preoperatively, mean MRSE was −8.65±1.51 D in FS-LASIK and −8.04±1.70 D in PRK-MMC groups (P=0.149), and corneal thickness was 570.67±36.79 μm and 507.12±32.55 μm, respectively (P<0.001). At 6 months, both groups showed significantly higher applanation (A) 2 time and A2-velocity (P<0.05 in both), whereas intraocular pressure (IOP), corrected IOP, A1 time, A1-velocity, and radius at highest concavity were significantly reduced (P<0.05 in all). In the FS-LASIK group, there was a significant increase in deformation amplitude (DA) (P=0.001), and significant decreases in A2-length (P=0.004). Peak distance increased in the PRK-MMC group (P=0.029). At 6 months, after controlling for fellow eye correlations and preoperative corneal thickness between the two groups, decreases in IOP, A1-time, A2-length and radius, and the increase in DA was greater in FS-LASIK.

Conclusion:

This study demonstrated significant changes in Corvis ST ocular biomechanical metrics after both PRK-MMC and FS-LASIK in high myopic patients, indicating the significant effect of excimer laser refractive surgery on corneal biomechanical properties. However, changes that occur with FS-LASIK are more significant than with PRK-MMC. Further randomized studies are needed to better characterize the pattern of biomechanical changes associated with each type of surgery.
Short-Term Effects of Overnight Orthokeratology on Corneal Sub-basal Nerve Plexus Morphology and Corneal Sensitivity
Authors: Nombela-Palomo María , Felipe-Marquez Gema , Hernandez-Verdejo Jose Luis , Nieto-Bona Amelia
Published: May 2016

Objective:

To assess the effects of a short period of orthokeratology (OK) on corneal sub-basal nerve plexus (SBNP) morphology and corneal sensitivity.

Methods:

Measurements were made in 56 right eyes of 56 subjects with low-to-moderate myopia who wore 2 OK lens designs (Group CRT: HDS 100 Paragon CRT, n=35; Group SF: Seefree; n=21) for a period of 1 month and in 15 right eyes of noncontact lens wearers as controls. The variables determined in each participant were corneal sensitivity using a Cochet-Bonnet esthesiometer and 12 SBNP variables determined on laser scanning confocal microscopy images using 3 different software packages. Correlation between SBNP architecture and corneal sensitivity was also examined.

Results:

Few changes were observed over the 1-month period in the variables examined in the OK treatment and control groups. However, significant reductions were detected over time in the number of nerves in the central cornea in the groups CRT (P=0.029) and SF (P=0.043) and in central corneal sensitivity in CRT (P=0.047) along with significant increases in central and midperipheral corneal Langerhans cell counts in SF (P=0.001 and 0.048, respectively).

Conclusions:

This study provides useful data to better understand the anatomical changes induced by OK in corneal SBNP. The different response observed to the 2 OK lens designs requires further investigation.
Diquafosol Ophthalmic Solution Increases Pre- and Postlens Tear Film During Contact Lens Wear in Rabbit Eyes
Authors: Nagahara Yukiko , Koh Shizuka , Oshita Yoshihiro , Nagano Takashi , Mano Hidetoshi , Nishida Kohji , Watanabe Hitoshi
Published: May 2016

Objectives:

To investigate the behavior of prelens tear film (PLTF) and postlens tear film (PoLTF) after the instillation of diquafosol using an experimental rabbit model of eyes with contact lens.

Methods:

Cross-sectional, anterior segment optical coherence tomographic images of the inferior midperipheral cornea were obtained at baseline and at 5, 15, 30, 60, 90, and 120 min after the instillation of 3% diquafosol ophthalmic solution in 10 Japanese white rabbits wearing contact lenses. From the obtained images, the areas of the PLTF and PoLTF were calculated. Both artificial tear solution and 0.1% sodium hyaluronate ophthalmic solution were used for comparison.

Results:

Significant fluid accumulation in both the PLTF and PoLTF was observed after diquafosol instillation, whereas no fluid accumulation was visible after the instillation of artificial tear or sodium hyaluronate. The increase in PLTF area after diquafosol instillation was significantly higher (P<0.01) at 15 and 30 min than that after the instillation of artificial tear or sodium hyaluronate. The increase in PoLTF area up to 60 min after the instillation of diquafosol was significantly higher (P<0.01) than that after the instillation of either of the other two drugs.

Conclusions:

Instillation of 3% diquafosol ophthalmic solution increases PLTF and PoLTF in rabbit eyes with contact lenses. Diquafosol has potential as a treatment option for contact lens–related dry eye.
Safety and Efficacy of an Artificial Tear Containing 0.3% Hyaluronic Acid in the Management of Moderate-to-Severe Dry Eye Disease
Authors: López-de la Rosa Alberto , Pinto-Fraga José , Blázquez Arauzo Francisco , Urbano Rodríguez Rubén , González-García María J.
Published: May 2016

Purpose:

To evaluate the safety and efficacy of a new 0.3% hyaluronic acid artificial tear compared with 0.9% saline solution (0.9% NaCl) in moderate-to-severe dry eye patients after 1 month's use.

Methods:

A total of 16 patients with moderate-to-severe dry eye were included in this crossover study. After a 1-week washout period, patients used the experimental (Visaid 0.3%) or control solution (0.9% NaCl), selected randomly, applying three to eight drops daily for a month. After another washout period, patients used the other solution in the same way. Percentage of change (ΔY) was calculated and analyzed for (1) safety variables: visual acuity, intraocular pressure, and ophthalmoscopy evaluation; (2) efficacy variable: Ocular Surface Disease Index (OSDI) questionnaire; and (3) secondary variables: biomicroscopy findings, fluorescein corneal staining, lissamine green conjunctival staining, tear breakup time (TBUT), contrast sensitivity, Schirmer test, and subject satisfaction.

Results:

There were no significant differences in the safety parameters for either solution. After using Visaid 0.3%, patients showed significant improvements in OSDI score (ΔY: −9.66%±10.90), tarsal hyperemia (ΔY: −16.67%±27.89), corneal staining extension (ΔY: −34.90%±42.41), TBUT (ΔY: 13.98%±26.19), and subjective satisfaction (ΔY: 38.06%±47.06). When using 0.9% NaCl, Schirmer test results were significantly worse (ΔY: −11.47%±19.27). A significant difference between the 2 solutions was found in TBUT (ΔY: 13.98%±26.19 vs. 10.15%±42.34, respectively; P=0.0214).

Conclusion:

Visaid 0.3% is a safe product with some benefits over 0.9% NaCl in reducing ocular symptoms and improving some ocular signs in patients with moderate-to-severe dry eye.
Predicting Short-term Performance of Multifocal Contact Lenses
Authors: Diec Jennie , Tilia Daniel , Naduvilath Thomas , Bakaraju Ravi C.
Published: May 2016

Objective:

To investigate if initial multifocal contact lens (MFCL) performance predicts short-term dispensing performance.

Methods:

A retrospective analysis of 55 participants (Px) in a masked, crossover, clinical trial, using ACUVUE OASYS for Presbyopia and AIR OPTIX AQUA Multifocal. Subjective questionnaires were administered at the following instances: initial fitting, two take home questionnaires (THQ) completed between days 2 and 4 and at assessment, ≥5 days after fitting. Questionnaires included vision clarity and lack of ghosting at distance, intermediate and near at day/night time points rated on a 1 to 10 (1-step, 10 most favorable) rating scale. Vision stability, vision while driving, overall vision satisfaction, willingness to purchase and comfort, as well as acuity-based measures were also collected.

Results:

There were no statistical differences in comfort and vision at all distances, in vision stability or driving at either time points between THQ and assessment (P>0.05). However, there was a statistical decline in subjective overall vision satisfaction and comfort between fitting and assessment visits (P<0.001). Willingness to purchase remained the same at fitting and assessment in 68% of Px, whereas only 4% of Px converted to a positive willingness to purchase at assessment. The majority of acuity-based measures remained constant between fitting and assessment visits.

Conclusion:

Initial performance at fitting was not able to predict short-term performance of MFCL. Subjective measures peaked at fitting and declined thereafter whereas acuity-based measures remained constant. Utility of subjective rating tools may aid practitioners to gauge success of MFCL.
Transscleral Suture-Fixated Versus Intrascleral Haptic-Fixated Intraocular Lens: A Comparative Study
Authors: Sinha Rajesh , Bansal Mayank , Sharma Namrata , Dada Tanuj , Tandon Radhika , Titiyal Jeewan S.
Published: May 2016

Purpose:

To compare the clinical outcomes between sutured transscleral-fixated and intrascleral haptic-fixated posterior chamber intraocular lens (IOL).

Setting:

Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi.

Design:

A comparative case series.

Methods:

Forty eyes of 40 patients were included; 20 in each group. Patients in group 1 underwent sutured transscleral-fixated IOL and those in group 2 underwent intrascleral haptic-fixated IOL augmented by fibrin glue. Parameters evaluated were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), IOL tilt on ultrasound biomicroscopy (UBM), and pseudophakodonesis on slitlamp and UBM.

Results:

The most common cause of aphakia was complicated cataract surgery (50%). The mean preoperative UCVA in logarithm of minimum angle of resolution (logMAR) was 1.59±0.24 and 1.63±0.26 in group 1 and 2, respectively (P=0.45). There was significant improvement in UCVA in both groups (P=0.001) at 6 months (group 1: 0.33±0.17; group 2: 0.22±0.10); the improvement being greater in group 2 (P<0.05). Mean percentage endothelial cell loss and IOP change were comparable. Mean CMT (μm) was 250.95±23.98 and 225.85±21.13 in group 1 and 2, respectively (P=0.009). Pseudophakodonesis was more in group 1 as assessed on slitlamp (P=0.037) and as assessed on UBM (P=0.046). Macular edema was the most common complication seen more in group 1.

Conclusions:

Intrascleral haptic-fixated IOL provides more stable fixation, better visual outcome, and lesser complication in comparison with sutured transscleral-fixated IOL.
The Use of the Colposcopically Directed Punch Biopsy in Clinical Practice: A Survey of British Society of Colposcopy and Cervical Pathology (BSCCP)-Accredited Colposcopists
Authors: Myriokefalitaki Eva , Redman Charles W.E. , Potdar Neelam , Pearmain Philippa , Moss Esther L.
Published: May 2016

Objectives

The colposcopically directed punch biopsy has been an integral component of colposcopic practice. In light of the changing landscape of the cervical screening programme, a study was conducted to investigate the current practice of British Society of Colposcopy and Cervical Pathology–accredited colposcopists on technique and rationale for performing a punch biopsy.

Materials and Methods

A web-based questionnaire survey was e-mailed to all British Society of Colposcopy and Cervical Pathology–accredited colposcopists. Questions included selection criteria for performing a punch biopsy, number of biopsies, and technique. Results were analyzed by specialty, experience, and workload.

Results

A total of 749 colposcopists responded, 50.2% of the 1,493 total. The respondents were obstetrician and gynecologists (42.9%), gynecologists/oncologists (33.6%), and nurse colposcopists (19.8%). Most colposcopists (78.3%) had more than 5-year colposcopy experience and saw in excess of 11 new cases (73.4%) of abnormal cervical cytology/month. Most colposcopists (56%) aimed to take 2 biopsies to diagnose cervical intraepithelial neoplasia, and very few (16.2%) reported routinely taking random biopsies from normal areas of cervix. Looking at the trends in management in the case scenarios, there was a lower threshold for performing punch biopsy before large loop excision of the transformation zone in younger (age, <25 years) or nulliparous women versus older women (age, >40 years; p < .05). Colposcopists were more likely to take biopsies in women with low-grade cytology/colposcopic findings (71.2%, always or most of the times) as compared with high-grade cytology/colposcopic findings (40.3%, never or rarely).

Conclusions

Colposcopically directed punch biopsy is routinely used by colposcopists; however, techniques, number of biopsies taken, and rationale for performing a biopsy vary greatly between colposcopists.
See-and-Treat for High-Grade Cytology: Do Young Women Have Different Rates of High-Grade Histology?
Authors: Smith Haller J. , Leath Charles A. , Huh Warner K. , Erickson Britt K.
Published: May 2016

Objective

To compare rates of cervical intraepithelial neoplasia grade 3 or greater (CIN3+) between women aged 21 to 24 and women aged 25 or older undergoing a see-and-treat strategy for high-grade squamous intraepithelial lesion (HSIL) cytology.

Methods

In this retrospective cohort study, women treated with a see-and-treat loop electrosurgical excisional procedure (LEEP) for HSIL cytology at our university-based colposcopy clinic between 2008 and 2013 were identified. Data collected included age, race, parity, smoking status, method of contraception, history of abnormal cytology, HIV status, and LEEP histology. Cohorts were compared using Pearson chi-squared test of association and Fisher exact test.

Results

Three hundred sixty-nine women were included in this analysis. The mean age was 30 (SD, 7.2; range, 21–56). Ninety-seven women (26.3%) were 21 to 24 years old. The rate of CIN3 in all women undergoing a see-and-treat LEEP for HSIL cytology was 65.9% (95% CI, 60.8–70.5). The rate of CIN 2 was 15.2% (95% CI, 11.9–19.2). Three women (1.1%) had invasive carcinoma. There was no difference in risk of CIN3+ in the young women compared with women aged 25 years or older (RR, 1.37; 95% CI, 0.92–2.02). Within this see-and-treat population, there was no correlation between presence of CIN3+ and race, smoking, contraception, or HIV status.

Conclusions

Most women undergoing see-and-treat for HSIL cytology will have CIN3 on final histology. In this large cohort, women aged 21 to 24 did not have lower rates of CIN3 compared with women aged 25 and older, suggesting that see-and-treat is still a valid treatment option for the prevention of invasive disease in young women.
See-and-Treat Loop Electrosurgical Excision Procedure for High-Grade Cervical Cytology: Are We Overtreating?
Authors: Kuroki Lindsay M. , Bergeron Lauren M. , Gao Feng , Thaker Premal H. , Massad Leslie S.
Published: May 2016

Objectives

To report the overtreatment rate for see-and-treat versus 3-step conventional strategy (cervical cytology, colposcopic biopsies, then LEEP) for patients with high-grade squamous intraepithelial lesion (HSIL) cytology. Our second aim was to identify risk factors for overtreatment.

Methods

We included 178 women with HSIL cytology from our university-based colposcopy clinic who underwent LEEP between 2007 and 2014. Overtreatment was defined as cervical intraepithelial neoplasia (CIN) 1 or less on LEEP specimen. Differences between treatment groups were compared using chi-square test, 2-sample t test, or Mann-Whitney rank-sum test as appropriate.

Results

CIN2+ was found in 69 (80%) of women in the see-and-treat group and 69 (75%) of the conventional management group (P = 0.093), with overtreatment in 17 (20%) and 23 (25%, P = 0.403), respectively. Women who underwent see-and-treat (n = 86) were older (mean age, 36 vs 31 years; P = 0.007), and a greater proportion completed childbearing (30% vs 13%, P = 0.024). There were no differences in top hat excision; however, a higher proportion of the see-and-treat group had CIN2+ in endocervical samples (54% vs 27%, P = 0.047). Overtreatment, regardless of management strategy, was associated with age at time of LEEP, where older women were more likely to be overtreated (median age, 37 vs 32 years, respectively; OR, 1.04; 95% CI, 1.01–1.08; P = 0.011).

Conclusions

A see-and-treat strategy minimizes risk of loss to follow-up with a similar overtreatment rate compared with conventional management. With CIN2+ in some three-fourths of women with HSIL, a see-and-treat should be favored especially when adherence to follow-up is questionable.
α1,2‐Fucosyllactose Does Not Improve Intestinal Function or Prevent Escherichia coli F18 Diarrhea in Newborn Pigs
Authors: Cilieborg Malene S. , Sangild Per T. , Jensen Michael L. , Østergaard Mette V. , Christensen Lars , Rasmussen Stine O. , Mørbak Anne L. , Jørgensen Claus B. , Bering Stine B.
Published: May 2016

Objectives:

Infectious diarrhea, a leading cause of morbidity and deaths, is less prevalent in breastfed infants compared with infants fed infant formula. The dominant human milk oligosaccharide (HMO), α‐1,2‐fucosyllactose (2′‐FL), has structural homology to bacterial adhesion sites in the intestine and may in part explain the protective effects of human milk. We hypothesized that 2′‐FL prevents diarrhea via competitive inhibition of pathogen adhesion in a pig model for sensitive newborn infants.

Methods:

Intestinal cell studies were coupled with studies on cesarean‐delivered newborn pigs (n = 24) without (control) or with inoculation of enterotoxigenic Escherichia coli F18 (7.5 × 1010/day for 8 days) fed either no (F18) or 10 g/L 2′‐FL (2FL‐F18).

Results:

In vitro studies revealed decreased pathogen adhesion to intestinal epithelial cells with 2′‐FL (5 g/L; P < 0.001). F18 pigs showed more diarrhea than control pigs (P < 0.01). Administration of 2′‐FL to F18 pigs failed to prevent diarrhea, although the relative weight loss tended to be reduced (−19 vs −124 g/kg, P = 0.12), higher villi were observed in the distal small intestine (P < 0.05), and a trend toward increased proportion of mucosa and activities of some brush border enzymes in the proximal small intestine. In situ abundance of α‐1,2‐fucose and E coli was similar between groups, whereas sequencing showed higher abundance of Enterobacteriaceae in F18, Enterococcus in control and Lachnospiraceae in 2FL‐F18 pigs.

Conclusions:

2′‐FL inhibited in vitro adhesion of E coli F18 to epithelial cells, but had limited effects on diarrhea and mucosal health in newborn pigs challenged with E coli F18.
Clearance of Hepatitis C Virus After Fixed‐Dose Combination Ledipasvir/Sofosbuvir in an Adolescent Female With Decompensated Cirrhosis
Authors: Smith Sara K. , Rosenthal Philip
Published: May 2016

Currently the only Food and Drug Administration–approved treatment for children with chronic hepatitis C virus is pegylated interferon with ribavirin, which is associated with significant adverse effects and low sustained virologic response rates. In this report, we discuss the use of ledipasvir/sofosbuvir to treat an adolescent with cirrhosis secondary to chronic hepatitis C virus.
Predictors of Pouchitis After Ileal Pouch‐Anal Anastomosis in Children
Authors: Dharmaraj Rajmohan , Dasgupta Mahua , Simpson Pippa , Noe Joshua
Published: May 2016

Objectives:

Predictive factors for the development of pouchitis after ileal pouch‐anal anastomosis (IPAA) in children have not been well studied. In this retrospective study, the incidence and risk factors that predict pouchitis in children with IPAA will be identified.

Methods:

The records of patients who underwent IPAA surgery at Children's Hospital of Wisconsin between January 2000 and December 2013 were reviewed retrospectively. Patients with clinical, endoscopic, and histological findings consistent with pouchitis were identified. The groups of patients with and without pouchitis or chronic pouchitis were compared to determine which demographic, pathological, or disease characteristics may serve as predictive factors for the development of pouchitis or chronic pouchitis.

Results:

Out of a total of 60 patients who underwent IPAA, preoperative diagnosis was ulcerative colitis (UC) in 43 and familial adenomatous polyposis (FAP) in 17. Pouchitis was identified in 24 (56%) patients with UC and 2 (12%) patients with FAP. Subgroup analysis of patients with UC revealed that chronic pouchitis occurred in 15 (35%) patients. The median follow‐up period from construction of the IPAA was 35 months (range 4.59–104.26 months). The study analysis revealed that a higher Pediatric Ulcerative Colitis Activity Index score at the time of diagnosis was a significant predictive factor for both pouchitis (P = 0.001) and chronic pouchitis (P = 0.02).

Conclusions:

Patients with UC and a higher PUCAI score at the time of diagnosis have a higher risk for developing pouchitis.
Associated Factors for Antegrade Continence Enemas for Refractory Constipation and Fecal Incontinence
Authors: Gomez‐Suarez Roberto A. , Gomez‐Mendez Michelle , Petty John K. , Fortunato John E.
Published: May 2016

Objective:

Determine clinical and manometric parameters associated with success of antegrade continence enemas (ACEs) administered via cecostomy in the treatment of constipation and fecal overflow incontinence.

Methods:

We performed a retrospective review of clinical symptoms and manometry (colonic and anorectal) before cecostomy in 40 pediatric patients (20 males, 20 females). The mean age at time of follow‐up was 9.5 ± 4.4 years with a mean follow‐up time of 12.2 ± 10.9 months. Clinical outcomes were defined as good, if subjects had >3 bowel movements per week, <2 episodes of soiling per week, and absence of pain at the time of follow‐up after cecostomy.

Results:

Before cecostomy, the mean duration of constipation and/or fecal incontinence was 7.7 ± 4.4 years, mean number of BMs was 1.5 ± 0.9 per week, and soiling episodes 4.12 ± 3.5 per week; 24 (60%) patients had abdominal pain. At follow‐up 30 out of 40 patients had a good outcome, and 10 had a poor outcome; with a difference in the number of weekly BM of 5.7 ± 2.2 versus 1.5 ± 0.9, P < 0.001, and soiling episodes (0.4 ± 1.5 vs 4 ± 3.1, P < 0.001). There was no difference in the duration of symptoms between groups. Obesity was more common in the poor‐outcome group, 60% versus 21% (P = 0.01). Abdominal pain was more common in the poor‐outcome group, 100% versus 47% (P = 0.003). Normal colonic manometry was associated with good outcome, whereas absence of high‐amplitude propagating contraction (HAPC) in any part of the colon was associated with poor outcome. No other differences in colonic manometry were observed between the good‐ and poor‐outcome groups with the exception of a trend toward decreased number of sigmoid HAPCs in the poor‐outcome group (P = 0.07). No differences were observed in anorectal manometry measurements between good‐ and poor‐outcome groups with the exception of an observable increased baseline resting pressure in the poor outcome (P = 0.05).

Conclusions:

Obesity and abdominal pain tend to be associated with poor outcomes after cecostomy for refractory constipation. Normal colonic and anorectal manometry were associated with good outcome. Absence of HAPC in any part of the colon, and increased baseline resting pressure of the anal canal were more associated with poor outcome. No other specific differences in either colonic or anorectal manometric parameters were observed in patients with good versus poor outcomes with cecostomy. Large prospective studies potentially combining other diagnostic modalities such as colonic transit studies are needed to determine the optimal tests to predict successful outcomes from cecostomy.
Psychometric Properties of the Chinese Version of the M.D. Anderson Dysphagia Inventory for Head and Neck Cancer Patients
Authors: Zhang Li-Juan , Jiang Nan , Li Zheng , Chen Xi-Wei , Wang Pei-Guo , Wang Xin , Zhao Yue
Published: May 2016

Background:

Dysphagia is a common side effect of anticancer treatments in patients with head and neck cancer (HNC) and can worsen patients’ quality of life. A well-established measure is essential to evaluate dysphagia in HNC patients.

Objectives:

The aim of this study is to determine the psychometric properties of the Chinese version of the M.D. Anderson Dysphagia Inventory (MDADI-C) for HNC patients.

Methods:

A total of 220 subjects were included in the study. Reliability was examined by internal consistency (Cronbach’s α) and test-retest reliability (intraclass correlation coefficient). Validity was evaluated with Spearman correlations (r).

Results:

The Cronbach’s α and intraclass correlation coefficient of the MDADI-C were .923 and 0.942, respectively. The criterion validity of the MDADI-C was 0.777. The Spearman correlation coefficients of the MDADI-C with the European Organization for Research Into the Treatment of Cancer Quality of Life Questionnaire for Head and Neck Cancer (r = −0.851), Hospital Anxiety and Depression Scale (r = −0.424), radiotherapy dose (r = −0.553), and treatment regimens (r = −0.407) demonstrated good construct validity (all P < .01).

Conclusions:

The MDADI-C demonstrated good psychometric properties and would be a valuable tool for clinicians to screen dysphagia rapidly and evaluate its impact on the quality of life of HNC patients.

Implications for Practice:

The MDADI-C could be used to document and monitor the dysphagia level of HNC patients for clinicians, nurses, and researchers. This validated questionnaire will help nurses and doctors to improve dysphagia management in HNC patients and will allow researchers to compare the study results across different countries.
Postdischarge Care of Pediatric Traumatic Brain Injury in Argentina: A Multicenter Randomized Controlled Trial*
Authors: Carney Nancy A. , Petroni Gustavo J. , Luján Silvia B. , Ballarini Nicolás M. , Faguaga Gabriela A. , du Coudray Hugo E. M. , Huddleston Amy E. , Baggio Gloria M. , Becerra Juan M. , Busso Leonardo O. , Dikmen Sureyya S. , Falcone Roberto , García Mirta E. , González Carrillo Osvaldo R. , Medici Paula L. , Quaglino Marta B. , Randisi Carina A. , Sáenz Silvia S. , Temkin Nancy R. , Vanella Elida E.
Published: May 2016

Objective:

To develop, in partnership with families of children with traumatic brain injury, a postdischarge intervention that is effective, simple, and sustainable.

Design:

Randomized Controlled Trial.

Setting:

Seven Level 1 Pediatric Trauma Centers in Argentina.

Patients:

Persons less than 19 years of age admitted to one of the study hospitals with a diagnosis of severe, moderate, or complicated mild traumatic brain injury and were discharged alive.

Interventions:

Patients were randomly assigned to either the intervention or standard care group. A specially trained Community Resource Coordinator was assigned to each family in the intervention group. We hypothesized that children with severe, moderate, and complicated mild traumatic brain injury who received the intervention would have significantly better functional outcomes at 6 months post discharge than those who received standard care. We further hypothesized that there would be a direct correlation between patient outcome and measures of family function.

Measurements and Main Results:

The primary outcome measure was a composite measured at 6 months post injury. There were 308 patients included in the study (61% men). Forty-four percent sustained a complicated mild traumatic brain injury, 18% moderate, and 38% severe. Sixty-five percent of the patients were 8 years old or younger, and over 70% were transported to the hospital without ambulance assistance. There was no significant difference between groups on the primary outcome measure. There was a statistically significant correlation between the primary outcome measure and the scores on the Family Impact Module of the Pediatric Quality of Life Inventory (ρ = 0.57; p < 0.0001). Children with better outcomes lived with families reporting better function at 6 months post injury.

Conclusions:

Although no significant effect of the intervention was demonstrated, this study represents the first conducted in Latin America that documents the complete course of treatment for pediatric patients with traumatic brain injury spanning hospital transport through hospital care and into the postdischarge setting.
Assessment of Anti–HIV-1 Antibodies in Oral and Nasal Compartments of Volunteers From 3 Different Populations
Authors: Bergin Philip J. , Langat Robert , Omosa-Manyonyi Gloria , Farah Bashir , Ouattara Gina , Park Harriet , Coutinho Helen , Laufer Dagna , Fast Pat , Verlinde Carl , Bizimana Jean , Umviligihozo Gisele , Nyombayire Julien , Ingabire Rosine , Kuldanek Kristin , Cox Josephine , McMorrow Martin , Fidler Sarah , Karita Etienne , Gilmour Jill , Anzala Omu
Published: May 2016

In this study, we assessed the feasibility of collecting standardized nasal and salivary samples at centers in Nairobi (Kenya), Kigali (Rwanda), and London (United Kingdom) using different collection devices and media (synthetic absorptive matrices versus flocked swabs, and Salimetrics oral swabs versus whole oral fluid collection). We detected anti-Gag (p24) and envelope (gp140) antibodies in both nasal fluid and salivary collections from all HIV-infected individuals, and cross-reactive anti-p24 antibodies were detected in 10% of HIV-uninfected individuals enrolled at one site. Collections from the nasal turbinates were comparable with samples collected deeper in the nasopharyngeal tract, and the yield of anti-p24 IgA in the whole oral fluid samples was higher than in samples collected from the parotid gland. We noted a trend toward reduced levels of anti-HIV antibody in the volunteers receiving anti-retroviral therapy. Levels of antibodies were stable over multiple collection visits. Overall, this study shows that nasal and salivary samples can be collected in a standardized manner over repeated visits in both low- and high-resource settings. These methods may be used in support for future HIV vaccine clinical trials.