bluuebunny/crossref_metadata_2025 huggingface dataset:
A Retrospective Case Series of High-Frequency Spinal Cord Stimulation (HF10-SCS) in Neurogenic Bladder Incontinence
Authors: Schieferdecker Simon , Neudorfer Clemens , El Majdoub Faycal , Maarouf Mohammad
Published: August 2018

BACKGROUND

Current treatment options for bladder disorders of neurogenic etiology often leave unsatisfactory results. Therefore, new and effective treatments must be investigated. High-frequency spinal cord stimulation (HF-SCS) at 10 kHz has proven to be effective in the treatment of refractory chronic back and leg pain.

OBJECTIVE

To evaluate the efficacy of HF-SCS at 10 kHz in alleviating lower urinary tract dysfunction and bladder incontinence in 5 patients with underlying neurological disease or spinal cord injury, through retrospective study.

METHODS

Urodynamic parameters such as voiding frequency, residual volume, episodes of incontinence, and the patients’ subjective impression impairment of life were assessed and compared pre- and postoperatively. Reduction in pain intensity was assessed as change on the Numeric Rating Scale (NRS).

RESULTS

All 5 patients had significantly positive outcomes. Episodes of leakage per day improved by 83% on average. Quality of life questionnaires and subjective bother scale revealed an improvement of 36% and 57%, respectively. Individual symptoms among the patient group such as residual volume also responded to the treatment as well. Mean pain NRS of 8.6 cm was reduced to 3.9 cm (55%) at 6 mo follow-up.

CONCLUSION

HF-SCS at 10 kHz significantly alleviated symptoms of neurogenic bladder incontinence in patients suffering from neurological disease or spinal cord injury. However, larger and prospective, randomized studies are necessary to make a clear statement regarding the efficacy of this therapy in lower urinary tract dysfunction and bladder incontinence.
Minimally Invasive Single-Position Lateral Interbody Fusion With Robotic Bilateral Percutaneous Pedicle Screw Fixation: 2-Dimensional Operative Video
Authors: Walker Corey T , Godzik Jakub , Xu David S , Theodore Nicholas , Uribe Juan S , Chang Steve W
Published: August 2018

Lateral interbody fusion has distinct advantages over traditional posterior approaches. When adjunctive percutaneous pedicle screw fixation is required, placement from the lateral decubitus position theoretically increases safety and improves operative efficiency by obviating the need for repositioning. However, safe cannulation of the contralateral, down-side pedicles remains technically challenging and often prohibitive. In this video, we present the case of a 59-yr-old man with refractory back pain and bilateral lower extremity radiculopathy that was worse on the left than right side. The patient provided written informed consent before undergoing treatment. We performed minimally invasive single-position lateral interbody fusion with robotic (ExcelsiusGPS, Globus Medical Inc, Audubon, Pennsylvania) bilateral percutaneous pedicle screw fixation for the treatment of asymmetric disc degeneration, dynamic instability, and left paracentral disc herniation with corresponding stenosis at the L3-4 level. A left-sided minimally invasive transpsoas lateral interbody graft was placed with fluoroscopic guidance. Without changing the position of the patient or breaking the sterile field, an intraoperative cone-beam computed tomography image was obtained for navigational screw placement with stereotactic trackers in the iliac spine. Screw trajectories were planned using the robotic navigation software and were placed percutaneously in the bilateral L3 and L4 pedicles using the robotic arm. Concomitant lateral fluoroscopy may be used if desired to ensure the fidelity of the robotic guidance. The patient recovered well postoperatively and was discharged home within 36 h, without complication. Single-position lateral interbody fusion and percutaneous pedicle screw fixation can be accomplished using robotic-assisted navigation and pedicle screw placement. Used with permission from Barrow Neurological Institute.
Spinal Column Shortening for Secondary Tethered Cord Syndrome in Children: 2-Dimensional Operative Video
Authors: Archer Jacob , Jea Andrew
Published: August 2018

Tethered cord syndrome is a constellation of signs and symptoms involving sensory and motor dysfunction of the lower extremities, bladder, and bowel. The pathophysiology may be from a mechanical stretch of the distal spinal cord causing deleterious changes in blood supply and metabolism. The standard of care for tethered cord syndrome has been tethered cord release. However, drawbacks of traditional tethered cord release include neurological injury, cerebrospinal fluid leak, and intradural scarring and retethering of the spinal cord (secondary tethering). As such, spinal column shortening was described to avoid these risks.
1
We applied spinal column shortening to children and transitional adults with secondary tethered cord syndrome.
1
As shown in cadaveric biomechanical studies, the objective of surgery is to shorten by the spinal column by 1.5 to 2.5 cm, to obtain the equivalent relief of traction on the spinal cord and nerve roots as direct circumferential untethering.
2

In this video, we present the case of an 11-yr-old boy with a history of VATERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) and tethered cord syndromes manifest as bladder dysfunction. Our patient had segmentation and formation anomalies of the lumbosacral junction, imperforate anus, and leg length discrepancy. He had already undergone multiple tethered cord releases with no durable improvement in bladder function. After discussion of the advantages and disadvantages of spinal column shortening with the patient and his father, we decided to proceed with this treatment alternative. At 9 mo after surgery, the patient has satisfactory clinical and radiographic outcomes.

Informed consent was obtained from the parents of the patient.
Trichobezoar requiring surgical intervention
Authors: Maini Atul , John Jainty
Published: August 2018

A trichobezoar is a collection of hair that forms a mass in the gastrointestinal tract and can cause obstructive symptoms when it fails to pass through the intestine. This article reviews the epidemiology, pathogenesis, clinical manifestations, diagnosis, and surgical management of trichobezoar. Managing the psychiatric aspect of this condition is key to preventing recurrence and the need for another surgery.
Telemedicine and diabetic retinopathy
Authors: DeTore Joanne , Rizzolo Denise
Published: August 2018

Diabetic retinopathy is prevalent among American adults with diabetes. Tight control of glycemic levels, BP, and lipids can help reduce patients' risk of developing diabetic retinopathy, which can lead to severe visual loss and blindness if not treated. Teleophthalmology done in primary care offices can increase the number of patients who are screened, saving patients' vision through early detection and treatment of diabetic retinopathy.
Holistic Nursing Education: Teaching in a Holistic Way
Authors: Kalb Kathleen A. , O’Conner-Von Susan
Published: August 2018

Faculty perspectives about holistic nursing education (HNE) were investigated in this descriptive study. All nurse faculty teaching in a religious-affiliated university were invited to complete a researcher-developed survey; surveys were analyzed to identify themes related to respondents’ definitions of HNE. Themes included teaching holistic nursing, seeing with holistic eyes, and using holistic pedagogy. Respondents’ definitions of HNE were found to be consistent with professional standards and competencies. Respondents were nearly unanimous in describing the importance of educating students to see persons holistically, engage in reflection and self-care, and be knowledgeable about holistic nursing and complementary health approaches.
Are critical care nurses more likely to leave after a merger?
Authors: Harrison Georgia D. , Zavotsky Kathleen E.
Published: August 2018

The relationship between perceptions of a healthy work environment and intent to transfer
Residual Cochlear Function in Adults and Children Receiving Cochlear Implants: Correlations With Speech Perception Outcomes
Authors: Fontenot Tatyana Elizabeth , Giardina Christopher Kenneth , Dillon Megan T. , Rooth Meredith A. , Teagle Holly F. , Park Lisa R. , Brown Kevin David , Adunka Oliver F. , Buchman Craig A. , Pillsbury Harold C. , Fitzpatrick Douglas C.
Published: August 2018

Objectives:

Variability in speech perception outcomes with cochlear implants remains largely unexplained. Recently, electrocochleography, or measurements of cochlear potentials in response to sound, has been used to assess residual cochlear function at the time of implantation. Our objective was to characterize the potentials recorded preimplantation in subjects of all ages, and evaluate the relationship between the responses, including a subjective estimate of neural activity, and speech perception outcomes.

Design:

Electrocochleography was recorded in a prospective cohort of 284 candidates for cochlear implant at University of North Carolina (10 months to 88 years of ages). Measurement of residual cochlear function called the “total response” (TR), which is the sum of magnitudes of spectral components in response to tones of different stimulus frequencies, was obtained for each subject. The TR was then related to results on age-appropriate monosyllabic word score tests presented in quiet. In addition to the TR, the electrocochleography results were also assessed for neural activity in the forms of the compound action potential and auditory nerve neurophonic.

Results:

The TR magnitude ranged from a barely detectable response of about 0.02 µV to more than 100 µV. In adults (18 to 79 years old), the TR accounted for 46% of variability in speech perception outcome by linear regression (r
2 = 0.46; p < 0.001). In children between 6 and 17 years old, the variability accounted for was 36% (p < 0.001). In younger children, the TR accounted for less of the variability, 15% (p = 0.012). Subjects over 80 years old tended to perform worse for a given TR than younger adults at the 6-month testing interval. The subjectively assessed neural activity did not increase the information compared with the TR alone, which is primarily composed of the cochlear microphonic produced by hair cells.

Conclusions:

The status of the auditory periphery, particularly of hair cells rather than neural activity, accounts for a large fraction of variability in speech perception outcomes in adults and older children. In younger children, the relationship is weaker, and the elderly differ from other adults. This simple measurement can be applied with high throughput so that peripheral status can be assessed to help manage patient expectations, create individually-tailored treatment plans, and identify subjects performing below expectations based on residual cochlear function.
Assessment of Open Syndesmosis Reduction Techniques in an Unbroken Fibula Model: Visualization Versus Palpation
Authors: Pang Eric Quan , Coughlan Monica , Bonaretti Serena , Finlay Andrea , Bellino Michael , Bishop Julius A. , Gardner Michael J.
Published: August 2018

Objectives:

This cadaveric study sought to evaluate the accuracy of syndesmotic reduction using direct visualization via an anterolateral approach compared with palpation of the syndesmosis through a laterally based incision.

Methods:

Ten cadaveric specimens were obtained and underwent baseline computed tomography (CT) scans. Subsequently, a complete syndesmotic injury was simulated by transecting the anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, transverse ligament, interosseous membrane, and deltoid ligament. Three orthopaedic trauma surgeons were then asked to reduce each syndesmosis using direct visualization via an anterolateral approach. Specimens were then stabilized and underwent postreduction CT scans. Fixation was then removed, the anterolateral exposure was closed, and the surgeons were then asked to reduce the syndesmosis using palpation only via a direct lateral approach. Specimens were again instrumented and underwent postreduction CT scans. Two-tailed paired t tests were used to compare reductions with baseline scans with significance set at P < 0.05.

Results:

There was no statistically significant difference between reduction via direct visualization or palpation via lateral approach when compared with baseline scans. Although measurements did not reach significance, there was a tendency toward external rotation, and anteromedial translation with direct visualization, and a trend toward fibular external rotation and posterolateral translation with palpation.

Conclusions:

There is no difference in reduction quality using direct visualization or palpation to assess the syndesmosis. Surgeons may therefore choose either technique when reducing syndesmotic injures based on personal preference and other injury factors.
Current management of patients with chronic myelomonocytic leukemia
Authors: Mora Elvira , Sanz Guillermo F.
Published: August 2018

Purpose of review

The present review focuses on the current management of patients with chronic myelomonocytic leukemia (CMML) and the most recent developments in the field.

Recent findings

CMML is a heterogeneous malignant myeloid disorder sharing features of myelodysplastic syndromes (MDS) and myeloproliferative neoplasms and characterized by peripheral blood monocytosis and increased risk of progression to acute leukemia. Its natural course is highly variable and use of CMML-specific prognostic scoring systems is strongly recommended for tailoring treatment. Multiple recent studies have showed that somatic mutations, which are almost always present have a relevant and independent impact on survival but lack a clear role in predicting the response to currently available drugs.

The incorporation of somatic mutations to prognostic scoring systems has improved the prediction of patients’ outcomes. Current treatment for CMML remains unsatisfactory. Allogeneic hematopoietic cell transplantation is the only curative option but is applicable to a minority of patients. Usually higher-risk patients displaying MDS-like characteristics are treated with hypomethylating agents (HMAs), whereas those with myeloproliferative features generally receive hydroxyurea or HMAs but none of these drugs substantially modify the natural history of CMML. Newer therapies are clearly needed.
Routine retrieval of pelvic sentinel lymph nodes for melanoma rarely adds prognostic information or alters management
Authors: Swords Douglas S. , Andtbacka Robert H.I. , Bowles Tawnya L. , Hyngstrom John R.
Published: August 2018

Pelvic sentinel lymph nodes (SLNs) are commonly identified during inguinal SLN biopsy for melanoma, but retrieval is not uniform among surgeons/centers. Few studies have assessed rates of micrometastases in pelvic versus superficial inguinal SLNs. Previous studies suggested that presence of pelvic SLNs was predicted by aggressive pathologic features and that their presence portended a worse prognosis. The objectives of this study were to examine presurgical predictors of pelvic SLNs among patients undergoing inguinal SLN biopsy, assess rates of micrometastases in superficial inguinal versus pelvic SLNs, and determine whether presence of pelvic SLNs was associated with long-term outcomes. Multivariable regression was used to assess presurgical factors associated with presence of pelvic SLNs. Rates of micrometastases in superficial inguinal versus pelvic SLNs in patients who had a pelvic SLN were compared with McNemar’s test. Groin recurrence, disease-free survival (DFS), and disease-specific survival were analyzed by Kaplan–Meier method. A multivariable Cox model for DFS was performed. Pelvic SLNs were retrieved in 100/537 (18.6%) superficial inguinal SLN biopsies and no preoperative factors predicted their presence. In patients with a pelvic SLN, micrometastases were present in 3.0% of pelvic versus 34.0% of superficial inguinal SLN biopsies (P<0.001). There were no differences in groin recurrence, DFS, and disease-specific survival for patients with/without pelvic SLNs in univariate analyses (all P>0.2) or in the multivariable Cox model for DFS (hazard ratio: 1.1, 95% confidence interval: 0.6–2.1). In conclusion, pelvic SLNs harbor micrometastases less frequently than superficial inguinal SLNs do, suggesting that omission of pelvic SLN biopsy may be reasonable.
Anti-programmed cell death-1 therapy-associated bullous disorders: a systematic review of the literature
Authors: Zhao Cathy Yunjia , Hwang Shelley Ji Eun , Consuegra Germana , Chou Shaun , Fernandez-Peñas Pablo
Published: August 2018

Bullous disorders are rare adverse events associated with anti-programmed cell death-1 (anti-PD1) therapy. This paper presents two new cases of bullous disorders under anti-PD1 therapy and systematically reviewed the literature to foster a better understanding of the presentation and pathogenesis of bullous disorders under anti-PD1. A systematic review of the literature was completed using MEDLINE, Embase, PubMed and LILACS databases. We identified 29 cases of bullous disorders under anti-PD1 therapy, including our two new cases. This includes 18 cases of bullous pemphigoid (BP), five cases of toxic epidermal necrolysis (TEN)/Stevens–Johnson syndrome (SJS) spectrum, one case of erythema multiforme (EM), four cases of bullous lichenoid reactions and one case of vesiculobullous eczema. In BP, blistering occurred by a median of 23 weeks after anti-PD1 therapy initiation and is often preceded by a prodrome, which lasts for a median of 9.5 weeks. Limbs and trunk were the most frequently involved body sites. Most cases (76%) achieved remission. In TEN/SJS/EM, blistering was usually preceded by a prodrome of interface dermatitis that lasted for a median of 1.5 weeks. Most cases (80%) died from either TEN/SJS or disease progression. Bullous disorders under anti-PD1 may be classified clinically as BP, SJS/TEN/EM, bullous lichenoid reactions and vesiculobullous eczema and histologically by intraepidermal splitting and subepidermal splitting. BP is usually preceded by a pruritic eruption and has a relatively good prognosis. SJS/TEN is usually preceded by a maculopapular eruption and has a very poor prognosis.
Optogenetic and chemogenetic approaches to manipulate attention, impulsivity and behavioural flexibility in rodents
Authors: Carr Madison R. , de Vries Taco J. , Pattij Tommy
Published: August 2018

Studies manipulating neural activity acutely with optogenetic or chemogenetic intervention in behaving rodents have increased considerably in recent years. More often, these circuit-level neural manipulations are tested within an existing framework of behavioural testing that strives to model complex executive functions or symptomologies relevant to multidimensional psychiatric disorders in humans, such as attentional control deficits, impulsivity or behavioural (in)flexibility. This methods perspective argues in favour of carefully implementing these acute circuit-based approaches to better understand and model cognitive symptomologies or their similar isomorphic animal behaviours, which often arise and persist in overlapping brain circuitries. First, we offer some practical considerations for combining long-term, behavioural paradigms with optogenetic or chemogenetic interventions. Next, we examine how cell-type or projection-specific manipulations to the ascending neuromodulatory systems, local brain region or descending cortical glutamatergic projections influence aspects of cognitive control. For this, we primarily focus on the influence exerted on attentional and motor impulsivity performance in the (3-choice or) 5-choice serial reaction time task, and impulsive, risky or inflexible choice biases during alternative preference, reward discounting or reversal learning tasks.
Gut–brain axis in the executive function of austism spectrum disorder
Authors: Roman Pablo , Rueda-Ruzafa Lola , Cardona Diana , Cortes-Rodríguez Alda
Published: August 2018

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired communication and social interactions, and repetitive behavioural patterns. These patterns are believed to be dysfunctional symptoms in executive processing, which impact other cognitive functions such as attention or cognitive flexibility. In recent years, several studies have shown that certain intestinal bacteria may play a role in shaping cognitive networks encompassing emotional and social domains. A microbiota–gut–brain axis is known to exist, establishing several mechanisms by which microbiota may modulate brain development, function and behaviour, including immune, endocrine and neural pathways. As the aetiology of ASD is largely unknown, some studies have shown that intestinal bacteria may be involved in its pathogenesis. The aim of this review was to focus on the role of the gut–brain axis in ASD and, specifically, on its role in executive functions. First, we summarize the relationship between the gastrointestinal and cognitive symptoms of ASD patients. In addition, we highlight the evidence that supports and emphasizes the involvement of gut microbiota, and the putative underlying mechanisms in this population. Finally, we present evidence from preclinical and clinical studies on the modulation of microbiota and their effects on cognitive symptoms, specifically in relation to executive function. In conclusion, manipulation of microbiota could be a positive intervention to improve ASD symptoms. However, more research evaluating the role of microbiota in the cognitive symptoms ASD is needed.
Benefits of Methylphenidate for Long-Term Attention Problems After Traumatic Brain Injury in Childhood: A Randomized, Double-Masked, Placebo-Controlled, Dose-Titration, Crossover Trial
Authors: Kurowski Brad G. , Epstein Jeffery N. , Pruitt David W. , Horn Paul S. , Altaye Mekibib , Wade Shari L.
Published: August 2018

Objective:

To characterize the benefits and optimal dose of long-acting methylphenidate for management of long-term attention problems after childhood traumatic brain injury (TBI).

Design:

Phase 2, randomized, double-masked, placebo-controlled, dose-titration, crossover clinical trial.

Setting:

Outpatient, clinical research.

Participants:

Twenty-six children aged 6 to 17 years who were at least 6 months post-TBI and met criteria for attention-deficit hyperactivity disorder (ADHD) at the time of enrollment.

Outcome Measures:

Vanderbilt Rating Scale of attention problems, Pittsburgh Side Effects Rating Scale, and vital signs.

Results:

Among the 26 participants randomized, 20 completed the trial. The mean ages at injury and enrollment were 6.3 and 11.5 years, respectively. Eight participants had a severe TBI. On an optimal dose of medication, greater reductions were found on the Vanderbilt Parent Rating Scale for the medicated condition than for placebo (P = .022, effect size = 0.59). The mean optimal dose of methylphenidate was 40.5 mg (1.00 mg/kg/day). Preinjury ADHD diagnosis status was not associated with a differential medication response. Methylphenidate was associated with weight loss (∼1 kg), increased systolic blood pressure (∼3- to 6-point increase), and mild reported changes in appetite.

Conclusion:

Findings support use of long-acting methylphenidate for management of long-term attention problems after pediatric TBI. Larger trials are warranted of stimulant medications, including comparative effectiveness and combination medication and nonmedication interventions.
PATIENTS WITH EPIRETINAL MEMBRANES DISPLAY RETROGRADE MACULOPATHY AFTER SURGICAL PEELING OF THE INTERNAL LIMITING MEMBRANE
Authors: Dysli Muriel , Ebneter Andreas , Menke Marcel N. , Zinkernagel Martin , Wolf Sebastian , Grabe Hilary , Abegg Mathias
Published: August 2018

Purpose:

Intraretinal cystoid spaces are commonly found after surgical peeling of epiretinal membranes. In this study, we explored whether these cysts were associated with ganglion cell loss and thus might be a manifestation of retrograde maculopathy. The latter is a nonvascular edema with a characteristic morphology that is often found in the inner nuclear layer (INL) of patients with optic neuropathy.

Methods:

In this retrospective case series, we identified consecutive patients who underwent surgical epiretinal membrane peeling. We determined the frequency of microcystic macular edema (MME), defined by vertical cystoid spaces in the INL, and we measured the thickness of individual macular layers before and after surgery.

Results:

Epiretinal membrane peeling resulted in an improvement of visual acuity and a reduction of retinal thickness by about 15%. In total, 35% of patients with MME before surgery showed no sign of MME postoperatively, whereas edema persisted after surgery in 65% of patients. Interestingly, 29% of the patients without MME before surgery developed MME after surgery. Overall, we found MME in 35% of patients before peeling and in 42% after peeling. After surgery, the mean ganglion cell layer thickness was reduced compared with healthy control eyes. Ganglion cell layer thickness correlated inversely with thickness of the INL. Compared with patients without MME, individuals with MME had a thinner ganglion cell layer and a thicker INL in the affected eye.

Conclusion:

Our findings indicate that peeling of epiretinal membranes and internal limiting membranes is associated with atrophy of ganglion cells and thickening of the INL. The latter is associated with the presence of MME. Altogether, we assume that surgical treatment of epiretinal membranes induces a variant of a retrograde maculopathy.
PREOPERATIVE VITREORETINAL INTERFACE ABNORMALITIES ON SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AS RISK FACTOR FOR PSEUDOPHAKIC CYSTOID MACULAR EDEMA AFTER PHACOEMULSIFICATION
Authors: Copete Sergio , Martí-Rodrigo Pablo , Muñiz-Vidal Romina , Pastor-Idoate Salvador , Rigo Jaume , Figueroa Marta S. , García-Arumí JOSÉ , Zapata Miguel A.
Published: August 2018

Purpose:

We assessed the role of vitreoretinal interface status in the development of pseudophakic cystoid macular edema (PCME) after cataract surgery.

Methods:

Prospective cohort study in which 112 patients (112 eyes) scheduled for cataract surgery were selected at random to undergo spectral domain optical coherence tomography (OCT) within 1 week preoperatively and at 1 and 3 months postoperatively. Spectral domain OCT macular images included no vitreoretinal contact, focal and diffuse vitreomacular adhesion, focal and diffuse vitreomacular traction, epiretinal membrane, macular hole, and macular edema.

Results:

The incidence of PCME was 11.6% (13 eyes), all of them being diagnosed at 1 month, and 7 eyes resolved at 3 months. The only risk factor for PCME was detection of nonsurgical epiretinal membrane by spectral domain OCT before phacoemulsification, being developed in 5 of 16 eyes (χ2 = 0.08, odds ratio 4.53, 95% confidence interval 1.28–16.13). Other variables such as posterior vitreous detachment, subfoveal choroidal thickness, diabetes, or hypertension were not significantly associated with PCME.

Conclusion:

In this cohort, preoperative detection of epiretinal membrane by spectral domain OCT was a risk factor for PCME after cataract extraction. It is recommended to perform a spectral domain OCT before cataract surgery because the presence of an epiretinal membrane may be passed unnoticed by fundus examination.
Prevalence of Novel Candidate Sjogren Syndrome Autoantibodies in the Dry Eye Assessment and Management (DREAM) Study
Authors: Bunya Vatinee Y. , Ying Gui-Shuang , Maguire Maureen G. , Kuklinski Eric , Lin Meng C. , Peskin Ellen , Asbell Penny A. ,   the DREAM Study Research Group
Published: August 2018

Purpose:

To evaluate the prevalence of novel candidate Sjogren syndrome (SS) autoantibodies [salivary protein-1 (SP-1), parotid secretory protein, carbonic anhydrase 6] in the DRy Eye Assessment and Management (DREAM) cohort, a study evaluating the effectiveness of omega-3 fatty acid supplements for the treatment of dry eye.

Methods:

Participants underwent ocular surface examinations and serological testing for traditional and novel SS autoantibodies. Dry eye assessment and management participants were categorized into the following 3 groups: 1) no history of SS or other autoimmune diseases and negative traditional SS autoantibodies (n = 352); 2) no history of SS but a history of other autoimmune diseases (n = 66); and 3) those who met the 2012 American College of Rheumatology SS classification criteria (n = 52).

Results:

Eleven percent had a history of SS, and 6% of those without a history of SS most likely had undiagnosed SS. The SS group had a higher prevalence of SP-1 autoantibodies than the group without SS or other autoimmune diseases (33% vs. 19%; P = 0.02) but had no difference in carbonic anhydrase 6 (P = 0.31) or parotid secretory protein autoantibodies (P = 0.33). Participants who were positive for the traditional autoantibodies alone or positive for both traditional and novel autoantibodies had the highest scores for corneal (P = 0.002) and conjunctival staining (P < 0.001).

Conclusions:

Data from this multicenter, prospective study demonstrated that one of the novel candidate autoantibodies, SP-1, is associated with underlying SS and that novel autoantibodies may be associated with worse ocular surface disease. Future longitudinal studies are needed to evaluate their utility in screening patients with dry eye for SS.
Outcomes of the Boston Type I Keratoprosthesis as the Primary Penetrating Corneal Procedure
Authors: Driver Todd H. , Aravena Carolina , Duong Huong N.V. , Christenbury Joseph G. , Yu Fei , Basak Samar K. , Aldave Anthony J.
Published: August 2018

Purpose:

To report the outcomes of the Boston type I keratoprosthesis (KPro) as the primary penetrating corneal procedure.

Methods:

In this retrospective review of all KPro procedures performed by 2 surgeons from May 1, 2004, to December 31, 2015, indications and outcomes were compared between KPros performed as the primary keratoplasty procedure (primary KPro) versus after failed keratoplasty (previous keratoplasty).

Results:

A total of 262 KPros were implanted in 231 eyes, including 67 primary KPro procedures. The most common indications for primary KPros were corneal scarring/vascularization (43%), Stevens–Johnson syndrome (22%), and chemical/thermal injury (22%). Although preoperative corrected distance visual acuity (CDVA) was similar in the 2 groups (P = 0.36), a significantly higher proportion of the eyes in the primary KPro group had a CDVA ≥ 20/200 each of the first 4 years after surgery (all P ≤ 0.023). The most common postoperative complications in the primary KPro and previous keratoplasty groups were retroprosthetic membrane (40% vs. 51%, P = 0.15), persistent epithelial defect (37% vs. 24%, P = 0.05), and elevated intraocular pressure, which was the only complication significantly more common in either group (31% vs. 18%, P = 0.03). No difference in KPro retention was observed between the 2 groups (P = 0.63).

Conclusions:

In the setting of preexisting ocular comorbidities in which PK is associated with poor outcomes and KPros have been associated with an increased incidence of postoperative complications, primary KPro is associated with significantly greater % of eyes with CDVA ≥ 20/200 in the first 4 years. However, given a significantly higher incidence of postoperative intraocular pressure elevation in these eyes, longer follow-up is needed to determine whether the difference in CDVA is maintained.
Endophthalmitis After XEN Gel Stent Implantation: 2 Cases
Authors: Olgun Ali , Imamoğlu Serhat , Karapapak Murat , Düzgün Eyüp , Kaçar Hakan
Published: August 2018

Herein, we report 2 cases of endophthalmitis after XEN Gel Stent implantation. A 68-year-old woman and an 80-year-old man had previously undergone uncomplicated XEN Gel Stent implantation for primary open-angle glaucoma 4 and 5 months prior, respectively. Both patients had presented with pain, redness, loss of vision, and sensitivity to light. For both patients, the best-corrected visual acuity was hand motion, eyelids and conjunctiva were hyperemic and edematous, anterior chamber had +3 cells and exhibited hypopyon, and B-scan ultrasonography revealed vitreous condensation. Blebitis was absent; the bleb height was medium, bleb width was 1 to 2 hours, and the bleb was avascular in the first case. In the second case, ∼2 mm of the XEN Gel Stent implant protruded from the conjunctiva; therefore, bleb formation was not observed. On a previous visit, the bleb height was medium, bleb width was 2 to 3 hours, and the bleb was mildly vascular. Both patients had undergone vitrectomy with silicone oil injection, but only the female patient had received intravitreal and topical antibiotics preoperatively. After surgery, both patients received topical antibiotic therapy. After 2 to 3 months, the silicone oil was removed; the final visual acuity remained low for the female patient (hand motion level). Despite immediate treatment, the final visual acuity may remain poor, similar to the outcome of patients with other types of endophthalmitis. It is important to provide the patients scheduled for XEN Gel Stent implantation information on the risk of infection and the other risk factors involved.
Impact of Trimethoprim-sulfamethoxazole Urinary Tract Infection Prophylaxis on Non-UTI Infections
Authors: Desai Sanyukta , Fisher Brian
Published: August 2018

In this secondary analysis of the Randomized Intervention for Children with Vesicoureteral Reflux cohort, we found that daily prophylaxis with trimethoprim-sulfamethoxazole was not associated with an increased or decreased risk of skin and soft tissue infections, pharyngitis or sinopulmonary infections in otherwise healthy children 2–71 months of age.
Acceptability and Cost Comparison of a Telehealth Intervention for Families of Children With Autism
Authors: Little Lauren M. , Wallisch Anna , Pope Ellen , Dunn Winnie
Published: August 2018

Intervention services positively impact outcomes of children with autism spectrum disorder (ASD) and their families. However, families face many burdens when accessing high-quality intervention services such as availability of providers, time, and cost; these burdens are often magnified for underserved families. Therefore, the purpose of this study was to investigate the acceptability (n = 17) and cost-effectiveness (n = 18) of a 12-week telehealth intervention among families of young children with ASD. To understand the acceptability of the intervention, caregivers completed a questionnaire about the process and content of the intervention. We then used descriptive statistics to calculate estimated cost differences between a Clinic-based Model, an In-Home Model, and a Telehealth Model. Results suggest that families found the intervention highly acceptable and effective, and telehealth would result in exponential savings for both families and providers. Telehealth provides a promising method for serving an increased number of families, particularly those in underserved and rural areas.
Effects of manipulating the interstimulus interval on heat-evoked temporal summation of second pain across the age span
Authors: Riley Joseph L. , Cruz-Almeida Yenisel , Staud Roland , Fillingim Roger B.
Published: August 2018

This study examined the effects of interstimulus interval (ISI) on heat-evoked temporal summation of second pain (TSSP) and tested whether greatest maintenance of TSSP would occur at longer ISIs in older adults. Several lines of evidence support that TSSP is associated with central sensitization and is centrally mediated. The participants were 198 community-dwelling adults divided into 3 age cohorts (18-39, 40-59, and 60-78 years of age). Six TSSP trials used a train of 10 contacts with a preheated probe that made repetitive contact with the volar forearm. Participants completed 2 trials at each ISI of 2.5, 3.5, and 4.5 seconds. The intraclass correlations for each pair of trials support the reliability of the current methodology. Temporal summation of second pain scores declined in a time-dependent manner across ISI. In addition, greater maintenance of TSSP at longer ISIs was observed in middle-aged and older age groups compared with the younger cohort. Significant associations were found between TSSP and measures of recent pain. Greater summation at longer ISIs in older adults would suggest slower decay of excitability in spinal neurons and infer increased risk for central sensitization with advancing age.
The NOD2 signaling in peripheral macrophages contributes to neuropathic pain development
Authors: Santa-Cecília Flávia V. , Ferreira David W. , Guimaraes Rafaela M. , Cecilio Nerry T. , Fonseca Miriam M. , Lopes Alexandre H. , Davoli-Ferreira Marcela , Kusuda Ricardo , Souza Guilherme R. , Nachbur Ueli , Alves-Filho José C. , Teixeira Mauro M. , Zamboni Dario S. , Cunha Fernando Q. , Cunha Thiago M.
Published: August 2018

Neuropathic pain is one of the most important types of chronic pain. It is caused by neuronal damage. Clinical and experimental studies suggest a critical role for neuroimmune interactions in the development of neuropathic pain. In this article, we have shown that the cytoplasmic receptor Nod-like receptor-2, NOD2, and its adaptor-signaling molecule RIPK2 participate in the development of neuropathic pain after peripheral nerve injury (spared nerve injury model). The activation of NOD2 signaling in peripheral macrophage mediates the development of neuropathic pain through the production of pronociceptive cytokines (tumor necrosis factor and IL-1β). This study found that peripheral nerve injury promoted a systemic increase in the NOD2 ligand. These results highlight a previously undetermined role for NOD2 signaling in the development of neuropathic pain, suggesting a new potential target for preventing neuropathic pain.
Betulinic acid, derived from the desert lavender Hyptis emoryi, attenuates paclitaxel-, HIV-, and nerve injury–associated peripheral sensory neuropathy via block of N- and T-type calcium channels
Authors: Bellampalli Shreya S. , Ji Yingshi , Moutal Aubin , Cai Song , Wijeratne E.M. Kithsiri , Gandini Maria A. , Yu Jie , Chefdeville Aude , Dorame Angie , Chew Lindsey A. , Madura Cynthia L. , Luo Shizhen , Molnar Gabriella , Khanna May , Streicher John M. , Zamponi Gerald W. , Gunatilaka A.A. Leslie , Khanna Rajesh
Published: August 2018

The Federal Pain Research Strategy recommended development of nonopioid analgesics as a top priority in its strategic plan to address the significant public health crisis and individual burden of chronic pain faced by >100 million Americans. Motivated by this challenge, a natural product extracts library was screened and identified a plant extract that targets activity of voltage-gated calcium channels. This profile is of interest as a potential treatment for neuropathic pain. The active extract derived from the desert lavender plant native to southwestern United States, when subjected to bioassay-guided fractionation, afforded 3 compounds identified as pentacyclic triterpenoids, betulinic acid (BA), oleanolic acid, and ursolic acid. Betulinic acid inhibited depolarization-evoked calcium influx in dorsal root ganglion (DRG) neurons predominantly through targeting low-voltage–gated (Cav3 or T-type) and CaV2.2 (N-type) calcium channels. Voltage-clamp electrophysiology experiments revealed a reduction of Ca2+, but not Na+, currents in sensory neurons after BA exposure. Betulinic acid inhibited spontaneous excitatory postsynaptic currents and depolarization-evoked release of calcitonin gene–related peptide from lumbar spinal cord slices. Notably, BA did not engage human mu, delta, or kappa opioid receptors. Intrathecal administration of BA reversed mechanical allodynia in rat models of chemotherapy-induced peripheral neuropathy and HIV-associated peripheral sensory neuropathy as well as a mouse model of partial sciatic nerve ligation without effects on locomotion. The broad-spectrum biological and medicinal properties reported, including anti-HIV and anticancer activities of BA and its derivatives, position this plant-derived small molecule natural product as a potential nonopioid therapy for management of chronic pain.
Objective Assessment of Postural Control After Lower-Limb Amputation: A Pilot Study
Authors: Overgaard Michael , Gehlert Trine Friis , Pedersen Line Kjeldgaard , Nordbye-Nielsen Kirsten
Published: August 2018

Introduction

Postural control might be impaired after lower-limb amputation (LLA) and contributes to a high incidence of falling in individuals with LLAs with the risk of an injury occurring. There is no agreement on which objective assessment method is most appropriate for quantifying postural control during rehabilitation. Attention should be pointed to which test is most accurate at detecting a change in postural control after a given intervention. The objective of this quantitative prospective cohort pilot study was to compare four balance tests to determine their feasibility in detecting a change in postural control in persons with LLA (transtibial and transfemoral) during rehabilitation and prosthesis fitting.

Methods

Four different balance tests were used as primary outcomes before and after a 4-week rehabilitation program (n = 5). The tests used were Berg Balance Scale (BBS), Timed Up and Go (TUG), and force plate measurements in standing and seated position (FPMstand + seat). Secondary outcome was quality of life assessed by the EuroQol, 5 dimensions, 5 levels (EQ-5D-5L) questionnaire.

Results

All participants improved in BBS, TUG, and FPMstand. FPMseat showed varying results. The EQ-5D-5L questionnaire showed a slight improvement in quality of life in accordance with the changes in primary outcome measures.

Conclusions

A change in postural control during rehabilitation and prosthesis fitting in individuals with LLAs may be assessed by BBS, TUG, and FPMstand. A criterion standard for quantifying postural control is lacking. Hence, a combination of tests to measure and detect a change in postural control can be used. Present pilot study finds that BBS, TUG, and FPMstand may be measurements used for assessment of changes in postural control in the rehabilitation of individuals with LLAs.
The Cost of ICU Delirium and Coma in the Intensive Care Unit Patient
Authors: Vasilevskis Eduard E. , Chandrasekhar Rameela , Holtze Colin H. , Graves John , Speroff Theodore , Girard Timothy D. , Patel Mayur B. , Hughes Christopher G. , Cao Aize , Pandharipande Pratik P. , Ely E. Wesley
Published: August 2018

Rationale:

Intensive care unit (ICU) delirium is highly prevalent and a potentially avoidable hospital complication. The current cost of ICU delirium is unknown.

Objectives:

To specify the association between the daily occurrence of delirium in the ICU with costs of ICU care accounting for time-varying illness severity and death.

Research Design:

We performed a prospective cohort study within medical and surgical ICUs in a large academic medical center.

Subjects:

We analyzed critically ill patients (N=479) with respiratory failure and/or shock.

Measures:

Covariates included baseline factors (age, insurance, cognitive impairment, comorbidities, Acute Physiology and Chronic Health Evaluation II Score) and time-varying factors (sequential organ failure assessment score, mechanical ventilation, and severe sepsis). The primary analysis used a novel 3-stage regression method: first, estimation of the cumulative cost of delirium over 30 ICU days and then costs separated into those attributable to increased resource utilization among survivors and those that were avoided on the account of delirium’s association with early mortality in the ICU.

Results:

The patient-level 30-day cumulative cost of ICU delirium attributable to increased resource utilization was $17,838 (95% confidence interval, $11,132–$23,497). A combination of professional, dialysis, and bed costs accounted for the largest percentage of the incremental costs associated with ICU delirium. The 30-day cumulative incremental costs of ICU delirium that were avoided due to delirium-associated early mortality was $4654 (95% confidence interval, $2056–7869).

Conclusions:

Delirium is associated with substantial costs after accounting for time-varying illness severity and could be 20% higher (∼$22,500) if not for its association with early ICU mortality.
Enteric Virome and Bacterial Microbiota in Children With Ulcerative Colitis and Crohn Disease
Authors: Fernandes Melissa A. , Verstraete Sofia G. , Phan Tung G. , Deng Xutao , Stekol Emily , LaMere Brandon , Lynch Susan V. , Heyman Melvin B. , Delwart Eric
Published: August 2018

Objectives:

We examined the fecal virome and bacterial community composition of children with Crohn disease (CD), ulcerative colitis (UC), and healthy controls to test the hypothesis that unique patterns of viral organisms and/or presence of bacterial pathogens may be identified that could contribute to the pathogenesis of pediatric inflammatory bowel disease (IBD).

Methods:

Fecal samples from 24 children (mean 12.2 years) with CD (n = 7) or UC (n = 5) and similar aged controls (n = 12) were processed to determine individual viromes. Viral sequences were identified through translated protein sequence similarity search. Bacterial microbiota were determined by sequencing of the V4 region of the 16S rRNA gene.

Results:

Only a few human viruses were detected, so virome analyses focused on bacterial viruses. The relative abundance of Caudovirales was greater than that of Microviridae phages in both IBD and healthy controls. Caudovirales phages were more abundant in CD (mean 80.8%) than UC (48.8%) (P = 0.05) but not controls. The richness of viral strains in Microviridae but not Caudovirales was higher in controls than CD (P = 0.05) but not UC cases. No other measure of phage abundance, richness, or Shannon diversity showed significant difference between the 2 IBD and control groups. Bacterial microbiota analysis revealed that IBD diagnosis, albumin, hemoglobin, erythrocyte sedimentation rate, and probiotic supplementation correlated to the composition of gut bacterial microbiota.

Conclusions:

Minor patterns in gut virome and bacterial community composition distinguish pediatric IBD patients from healthy controls. Probiotics are associated with bacterial microbiota composition. These exploratory results need confirmation in larger studies.
Major Issues of Care in Thalassemia Major Children Refugees
Authors: Hamouni Eglantine , Armari Corinne , Dupuis Clémentine , Giroux-Lathuile Claudine , Petit Audrey , Plantaz Dominique , Adjaoud Dalila , Rubio Amandine
Published: August 2018

Beta thalassemia major (βTM) is the most common inherited hemoglobinopathy. Management essentially focuses on preventing and treating complications. Conventional treatment is based on a regular blood transfusion program, and chelation therapy. Management essentially focuses on preventing and treating complications. Severe complications of βTM are very rarely seen in children in Europe. In the context of the migrant crisis, pediatricians will be confronted with the challenge of managing severe complicated βTM. We report the case of 2 Syrian 10-year-old twin girls who arrived to France with numerous and severe complications of βTM: hemochromatosis, alloimmunization, hypopituitarism, osteopenia… Their clinical management, which led to successful vital and functional improvement, is reported in this article.