bluuebunny/crossref_metadata_2025 huggingface dataset:
FAMILIAL CENTRAL SEROUS CHORIORETINOPATHY
Authors: van Dijk Elon H. C. , Schellevis Rosa L. , Breukink Myrte B. , Mohabati Danial , Dijkman Greet , Keunen Jan E. E. , Yzer Suzanne , den Hollander Anneke I. , Hoyng Carel B. , de Jong Eiko K. , Boon Camiel J. F.
Published: November 2017

Purpose:

To assess ophthalmologic characteristics in patients and unaffected individuals in families with multiple members affected by central serous chorioretinopathy (CSC), both at presentation and long-term follow-up.

Methods:

In 103 subjects from 23 families with at least 2 affected patients with CSC per family, prospective extensive ophthalmologic examination was performed, including best-corrected visual acuity, indirect ophthalmoscopy, digital color fundus photography, optical coherence tomography, fundus autofluorescence, and fluorescein angiography imaging. From these, 24 individuals from 6 families had undergone extensive ophthalmologic examination in either 1994 or 1995 and were followed up in this study.

Results:

Subretinal fluid accumulation on optical coherence tomography and/or “hot spots” of leakage on fluorescein angiography indicative of CSC were detected in 45 of 103 phenotyped subjects (44%). Findings suggestive of CSC, but without the presence of subretinal fluid on optical coherence tomography and/or “hot spots” of leakage on fluorescein angiography, were observed in an additional 27 family members (26%). In 4 of 17 previously nonaffected subjects (24%) from the 24 individuals that were followed up after more than 20 years, we found more severe abnormalities.

Conclusion:

Extensive ophthalmologic phenotyping resulted in the detection of (suggestive) CSC in 52% of family members of patients with CSC. Genetic factors may play an important role in these specific CSC cases. Moreover, during follow-up, progressive disease can occur in a noteworthy number of patients.
FACTORS ASSOCIATED WITH SEROUS RETINAL DETACHMENT IN HIGHLY MYOPIC EYES WITH VERTICAL OVAL-SHAPED DOME
Authors: García-Ben Antonio , Sanchez María J. MORILLO , Gómez Ana GONZALEZ , García-Basterra Ignacio , García Antonio SOLER , García-Campos Jose M.
Published: November 2017

Purpose:

This study investigated factors associated with persistent serous retinal detachment in highly myopic eyes with vertical oval-shaped domes.

Methods:

Twenty-eight highly myopic patients (40 eyes) with smooth macular elevations related to a vertical oval-shaped dome were recruited. Serous retinal detachment was investigated; 11 eyes had persistent submacular fluid (study group) and 29 eyes lacked submacular fluid (control group). All patients underwent complete ophthalmologic examinations, including axial-length measurement and fluorescein angiography. Spectral domain optical coherence tomography scans through the fovea measured choroidal thicknesses, macular bulge height, and vitreoretinal interface factors.

Results:

No studied variables (age, sex, spherical equivalence, axial length, vitreomacular traction, epiretinal membrane, and internal limiting membrane detachment) except higher macular bulge height (P = 0.03) and a reduced macular choroidal thickness (P = 0.02) were associated with the risk of serous retinal detachment. No statistically significant differences in best-corrected visual acuity were observed between the study and control groups. Serous retinal detachment always occurred at the top of the inward incurvation of the macula and was characterized by multiple hyperfluorescent granular patches on fluorescein angiography.

Conclusion:

A higher macular bulge height and a reduced macular choroidal thickness might be important factors in the development of serous retinal detachment in patients with vertical oval-shaped domes.
CORRELATION BETWEEN OUTER RETINAL THICKENING AND RETINAL FUNCTION IMPAIRMENT IN PATIENTS WITH IDIOPATHIC EPIRETINAL MEMBRANES
Authors: Cacciamani Andrea , Cosimi Pamela , Di Nicola Marta , Di Martino Giuseppe , Ripandelli Guido , Scarinci Fabio
Published: November 2017

Purpose:

To examine the relationship between retinal layer thickness, retinal sensitivity, and visual function in patients with idiopathic epiretinal membrane using spectral domain optical coherence tomography automated segmentation algorithm.

Methods:

Twenty-four eyes with epiretinal membrane and 12 control eyes were enrolled. Ophthalmic evaluations included best-corrected visual acuity, mean retinal sensitivity (MRS) of radial 10° and 4° areas tested with microperimetry, and measurements of 4 retinal layer thicknesses by means spectral domain optical coherence tomography. Relations between retinal layer thickness, MRS, and best-corrected visual acuity values were explored.

Results:

Compared with controls, MRS (P < 0.001) and best-corrected visual acuity (P < 0.001) values were reduced. In the epiretinal membrane group, MRS of the central 4° values was associated with thickening of the outer nuclear layer (P < 0.05). Furthermore, a correlation was found between the inner nuclear layer thickening and the MRS of the central 4° limited to the inferior quadrant (P < 0.05). The decreased best-corrected visual acuity values were correlated with the thickening of three of four quadrant of the inner nuclear layer, inferior and temporal quadrants of the outer plexiform layer, and finally outer nuclear layer nasal quadrant.

Conclusion:

We found a meaningful correlation between MRS impairment of the central 4° and outer nuclear layer thickness and showed which intraretinal layers mainly contributes to visual acuity loss.
MACULAR ATROPHY FINDINGS BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY COMPARED WITH FUNDUS AUTOFLUORESCENCE IN TREATED EXUDATIVE AGE-RELATED MACULAR DEGENERATION
Authors: Takasago Yukari , Shiragami Chieko , Kobayashi Mamoru , Osaka Rie , Ono Aoi , Yamashita Ayana , Tsujikawa Akitaka , Hirooka Kazuyuki
Published: November 2017

Purpose:

To compare the areas of choriocapillaris (CC) nonperfusion and macular atrophy (MA) in treated exudative age-related macular degeneration.

Methods:

This was a prospective, observational, cross-sectional study. Forty-four eyes exhibiting MA (42 patients with age-related macular degeneration), with a dry macula, underwent fundus autofluorescence and optical coherence tomography angiography. The area of MA detected by fundus autofluorescence and CC nonperfusion detected by optical coherence tomography angiography was measured using image analysis software. The rates of concordance between the MA and CC nonperfusion areas were calculated. We qualitatively and quantitatively compared the areas of MA and CC nonperfusion in age-related macular degeneration eyes.

Results:

The mean areas of MA and CC nonperfusion were 5.95 ± 4.50 mm2 and 10.66 ± 7.05 mm2, respectively (paired t-test, P < 0.001). In 39 eyes (88.6%), the CC nonperfusion area was larger than the MA area, and the mean CC nonperfusion area was significantly larger than the mean MA area. Fundus autofluorescence matching optical coherence tomography angiography showed that the CC nonperfusion area was almost included in the MA area. The mean concordance rate for the MA area inside the CC nonperfusion area was 87.7 ± 13.9%.

Conclusion:

The MA and CC nonperfusion areas markedly overlapped. The area of CC nonperfusion correlated with the MA area. Choroidal ischemia might be involved in the pathogenesis of MA in treated age-related macular degeneration.
DISLODGEMENT OF FLUOCINOLONE ACETONIDE INTRAVITREAL IMPLANT INTO THE INFUSION CANNULA DURING VITRECTOMY FOR RETINAL DETACHMENT
Authors: Andreatta Walter , Elaraoud Ibrahim , Mitra Arijit
Published: November 2017

Background/Purpose:

To report a case of dislodgement of an Iluvien (fluocinolone acetonide) intravitreal implant into the infusion cannula during pars plana vitrectomy for retinal detachment.

Methods:

The patient's surgery was video recorded, and the medical notes were reviewed retrospectively.

Results:

A patient developed a macula off retinal detachment over 1 year after intravitreal injection of Iluvien for diabetic maculopathy. The patient underwent pars plana vitrectomy, removal of implant, and successful retinal reattachment. Although we planned to remove the implant through a sclerostomy, we were not able to localize it after performing peripheral indented vitrectomy. As the intraocular pressure was fluctuating, we suspected that the implant might have dislodged into the infusion cannula. However, despite increasing the intraocular pressure to 60 mmHg and performing repeated fluid–air exchange, we could not eject the implant back into the vitreous cavity. Therefore, after completing the surgery safely, we flushed the infusion cannula with balanced salt solution and we found the implant.

Conclusion:

Increasing the intraocular pressure and performing fluid–air exchange were not sufficient to eject the implant probably because of the strong surface adherence between the infusion cannula and the implant's coating material. We, therefore, recommend removing and flushing the infusion cannula if the implant cannot be localized in the eye. In addition, clinicians should be aware that a fluctuating intraocular pressure might be the first sign of a partially blocked infusion cannula by the implant.
ACUTE FROSTED RETINAL PERIPHLEBITIS IN A PATIENT WITH MEDITERRANEAN FEVER
Authors: Köse Özlem , Willermain François , Caspers Laure , Postelmans Laurence , El Ouardighi Hind , Guillaume Marie-Paule , Makhoul Dorine
Published: November 2017

Purpose:

To present a case of frosted branch periphlebitis in a young Armenian patient with familial Mediterranean fever.

Methods:

Case report.

Results:

A 37-year-old man presented with a unilateral decreased visual acuity and floaters for 4 days on the left eye (LE). Visual acuity was 20/20 in the right eye (RE) and 20/28 in the LE. Anterior segment and fundus examinations of the RE were normal. Slit-lamp examination of LE revealed a mild nongranulomatous anterior uveitis and vitritis. Intraocular pressure was 19 mmHg in the RE and 12 mmHg in the LE. Fundoscopy of the LE showed typical appearance of frosted branch periphlebitis with perivascular sheathing of the retinal veins and scattered retinal hemorrhages. Fluorescein angiography of the RE was normal. The LE showed optic disk and segmented vascular staining without macular leakage. Optical coherence tomography of the RE was normal; LE demonstrated a localized macular thickening and few intraretinal cysts. The detailed ophthalmologic history was negative. The general history and workup were significant for familial Mediterranean fever and a positive lupus anticoagulant. One week later, the fundus findings worsened with a severe decrease of visual acuity of the LE to 20/200. A single intravitreal (IVT) injection of bevacizumab was performed. Three weeks after injection, fundus findings progressively improved with a decrease of the macular thickening and an improvement of the visual acuity to 20/25. Clinical improvement continued up to the last visit (19 weeks after the injection) with a visual acuity that reached back 20/20 with no signs of active inflammation.

Conclusion:

This case demonstrates a possible association between unilateral frosted branch periphlebitis and familial Mediterranean fever.
LONG-TERM MULTIMODAL IMAGING OF OCULAR FINDINGS ASSOCIATED WITH THIAMINE-RESPONSIVE MEGALOBLASTIC ANEMIA
Authors: Tsui Edmund , Tauber Jenna , Barbazetto Irene , Gelman Susan K.
Published: November 2017

Purpose:

To report on 5-year multimodal imaging of ocular findings in a patient with thiamine-responsive megaloblastic anemia.

Methods:

Observational case report.

Results:

A 20-year-old-man with a history of thiamine-responsive megaloblastic anemia demonstrated a symmetric bull's eye maculopathy. Spectral domain optical coherence tomography revealed disruption of the parafoveal ellipsoid zone, fundus autofluorescence demonstrated foveal hypoautofluorescence, and full-field electroretinogram testing revealed a decreased photopic and scotopic response consistent with cone–rod dystrophy. His best-corrected visual acuity remained stable over 5 years at 20/50 in the right eye and 20/40 in the left eye, and visual field testing remained stable over time.

Conclusion:

Ocular manifestations in thiamine-responsive megaloblastic anemia are uncommon and variable. In this case, multimodal imaging and electroretinogram findings are consistent with cone–rod degeneration. The patient is taking daily thiamine supplementation, and visual acuity, funduscopic examination, spectral domain optical coherence tomography, and autofluorescence remained stable over a 5-year period.
Demarcation Line in the Human Cornea After Surface Ablation Observed by Optical Coherence Tomography and Confocal Microscopy
Authors: Li Meiyan , Zhao Yu , Xiao Qirui , Yao Peijun , Piao Mingzi , Sun Ling , Zhou Xingtao
Published: November 2017

Purpose:

To investigate the long-term changes in anterior corneal structure after surface ablation.

Methods:

In this retrospective study, patients who received surface ablation including laser-assisted subepithelial keratomileusis (LASEK) and epipolis laser in situ keratomileusis at the Department of Ophthalmology of Fudan University Eye and Ear, Nose and Throat (EENT) Hospital (Shanghai, People's Republic of China) were telephoned. Patients were asked to follow-up at the refractive center. Changes in the anterior cornea (from the epithelium to the anterior stroma) were examined by optical coherence tomography (OCT) and in vivo confocal microscopy.

Results:

Thirty-four eyes of 18 patients (10 years or more after operation), 16 eyes of 8 patients (4 years after operation), 12 eyes of 6 patients (1 year after operation), 8 eyes of 4 patients (6 months after operation), and 12 eyes of 6 patients (1 month after operation) were included. Under OCT, a smooth, continuous, and highly reflective demarcation line between the epithelial layer and the stroma was noted in all eyes that received surgeries more than 1 year previously. For eyes at 6 months after operation, the complete formation of this demarcation line was detected in 12.5% (1/8) of eyes and a partial formation of this demarcation line was observed in 87.5% (7/8) of eyes. A partial formation of this demarcation line was observed in 100% (12/12) of eyes in patients at 1 month after surgery.

Conclusions:

A demarcation line in the human cornea can be detected after corneal surface ablation. It was completely formed around postoperative 6 to 12 months. The functions and components of this structure merit investigation.
Developmental Assessment With Young Children
Authors: Cunha Ana C. B. , Berkovits Michelle D. , Albuquerque Karolina A.
Published: November 2017

Developmental assessment scales are important tools for determining developmental delays and planning preventive interventions. One broad assessment scale used to evaluate child development is the Battelle Developmental Inventories (BDIs). The BDI-2 has a standardized version in English with good psychometric properties and a translated version in Spanish; however, despite widespread clinical use, there has been limited early childhood development research focused on this assessment tool in the past 10 years. The purpose of this systematic review was to evaluate the literature about the BDIs and their screening test and analyze their use for child assessment. Seven databases were used to retrieve articles in English, Portuguese, and Spanish. Overall, 34 articles were evaluated for general features, salient findings, and key methodological issues, such as target population, objectives, research design, and main results. Authors' considerations about the psychometric properties and utility of the BDIs were also examined. Results indicated that 41.17% of studies with the BDIs were from the United States, and the most common target population was children with autism spectrum disorders. Generally, the articles highlighted the broad applications of this measure and robust psychometric properties cited in the BDIs examiner's manual as reasons for their use. This review suggests that it is important to conduct independent analyses of the psychometric properties of the BDIs as well as validation studies to ensure appropriate applications of the BDI, including for use with non-American populations.
The Effect of a Social–Emotional Intervention on the Development of Preterm Infants in Institutions
Authors: Chernego Daria I. , McCall Robert B. , Wanless Shannon B. , Groark Christina J. , Vasilyeva Marina J. , Palmov Oleg I. , Nikiforova Natalia V. , Muhamedrahimov Rifkat J.
Published: November 2017

This study examined the effect of a social–emotional intervention implemented in one St. Petersburg (Russian Federation) institution (called a Baby Home, BH) on the general behavioral development of preterm children (gestational ages of 30–36 weeks) during their first 2 years of life. The intervention consisted of training caregivers and implementing structural changes to create a more family-like environment. The study included preterm (N = 56) and full-term (N = 93) children from one BH that implemented the intervention and from another BH with no intervention. Children were assessed at 3, 6, 9, 12, 18, and 24 months of age with the Battelle Development Inventory (LINC Associates, 1988). The results showed that the intervention positively influenced the general behavioral development of BH preterm children throughout their first 2 years of life compared with preterm children from the no intervention BH. Also, results indicated that the intervention effect was developmentally similar for preterm and for full-term children, but preterm children consistently scored lower than full-term children during their first 2 years living in the BH. In general, our research emphasizes the crucial role of warm, sensitive, and responsive interactions with a constant and emotionally available caregiver for healthy child development for both term and preterm children.
Families as Partners
Authors: Frantz Rebecca , Hansen Sarah Grace , Squires Jane , Machalicek Wendy
Published: November 2017

Child development occurs within the context of the child's family, neighborhood, and community environment. Early childhood providers support positive outcomes, not only for the children with whom they directly work with but also for their families. Families of children with developmental delays often experience unique challenges. A family resiliency framework addresses how families confronting these challenges can experience positive outcomes. Family resiliency is strengthened by protective factors, which augment outcomes for the child and the family. A family resiliency framework is described and protective factors known to strengthen family resiliency are discussed. Strategies for enhancing family protective factors through early intervention and related services are presented.
Association between pain and sexual health in older people: results from the English Longitudinal Study of Ageing
Authors: Wade Katie , Wu Frederick C.W. , O'Neill Terence W. , Lee David M.
Published: November 2017

There is little information on the impact of pain on sexual health in later life. The aim of this analysis was to determine the association between self-reported pain and sexual health in older men and women. Data were collected for the nationally representative English Longitudinal Study of Ageing. Community-dwelling adults aged 50 years and older completed the Sexual Relationships and Activities Questionnaire in Wave 6 (2012/2013). Participants were asked (waves 1-6 [2002-2013]) whether they were “often troubled with pain” and, how severe was their pain; mild, moderate, or severe. The association between pain and sexual health was assessed using logistic regression. Analyses were stratified by sex, with adjustments made for age followed by adjustments for health and lifestyle factors, depressive symptoms, and socioeconomic status. Of the 3916 participants who reported having sexual activity in the past year, 28% of women and 23% of men reported experiencing moderate or severe pain often at Wave 6. After adjusting for age, compared with men experiencing no pain, men with moderate or severe pain reported less frequent intercourse and masturbation, more erectile difficulties, and more concerns about their sexual health. After age adjustment, there were no associations between pain severity and sexual health among women. Of the 1872 participants with a cumulative pain score, there were significant associations between reporting pain and concerns about sexual health in both men and women. Pain was associated with impairment in sexual health in men and women; however, the effect was more marked in men.
Is There a Potential of Misuse for Quetiapine?
Authors: Chiappini Stefania , Schifano Fabrizio
Published: November 2017

Purpose/Background

A recent years' increase in both prescribing and availability of second-generation antipsychotics (SGAs) has been observed. According to the literature, typically made up by case studies/series, quetiapine seems to be the most commonly misused SGA, with both intranasal and intravenous intake modalities having been described. Another SGA that has been anecdotally reported to be misused is olanzapine. For these molecules, both a previous history of drug misuse and being an inmate have been described as factors associated with misuse. Hence, while providing here an updated literature review of the topic, we aimed at assessing all cases of quetiapine misuse/abuse/dependence/withdrawal as reported to the European Medicines Agency's EudraVigilance (EV) database; this was carried out in comparison with the reference drug olanzapine.

Methods

All spontaneous, European Medicines Agency database reports relating to both quetiapine (2005–2016) and olanzapine (2004–2016) misuse/abuse/dependence/withdrawal issues were retrieved, and a descriptive analysis was performed.

Results

From the EV database, 18,112 (8.64% of 209,571) and 4178 (7.58% of 55,100) adverse drug reaction reports of misuse/abuse/dependence/withdrawal were associated with quetiapine and olanzapine, respectively. The resulting proportional reporting ratio values suggested that the misuse/abuse–, dependence-, and withdrawal-related adverse drug reactions were more frequently reported for quetiapine (1.07, 1.01, and 5.25, respectively) in comparison with olanzapine.

Conclusions

Despite data collection limitations, present EV data may suggest that, at least in comparison with olanzapine, quetiapine misuse may be a cause for concern.
Splitting of the Nails
Authors: Malakouti Mona , Rundle Chandler , Jacob Sharon E.
Published: November 2017

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of splitting of the nails.
Do Psychosocial Factors Have Any Impact on Outcomes After Left Ventricular Assist Device Implantation?
Authors: Lundgren Scott , Lowes Brian D. , Zolty Ronald , Burdorf Adam , Raichlin Eugenia , Um John Y. , Poon Cecilia
Published: November 2017

Psychosocial factors have been show to impact survival and outcomes in a number of different diseases, including heart failure and patients receiving heart transplantation. With the increasing utilization of these devices, it is important to identify risk factors that could impact post-left ventricular assist device (LVAD) outcomes. This study was a single center, retrospective analysis of 238 patients who underwent implantation of a LVAD between July 27, 2004, and July 21, 2016, at The University of Nebraska Medical Center. Data collected include length of stay, number of readmission, alive status at 30 days, 180 days, and 1 year, as well as multiple psychosocial factors including history of drug abuse, history of alcohol abuse, history of noncompliance, history of anxiety, and history of depression, among others. Outcomes were calculated using univariate and multivariate analyses with SAS Version 9.4. None of the psychosocial factors assessed in this study showed statistical significance in predicting 30 day or 6 month mortality, but patients who smoked at the time of admission for LVAD implantation had higher mortality at 1 year (odds ratio 4.6, 95% confidence interval, 1.226–15.898, p = 0.011.) Patients with a diagnosis of depression had higher numbers of readmissions compared with those without depression (p = 0.048) with the number of readmissions further increased in patients with a diagnosis of both depression and anxiety (p = 0.0074). Psychosocial determinants do not appear to have a significant effect on mortality, but can result in increased risk of readmission if not adequately addressed before implantation and continually monitored postimplantation.
Smoking Habits are Strongly Associated With Colorectal Polyps in a Population-based Case-control Study
Authors: Fliss-Isakov Naomi , Zelber-Sagi Shira , Webb Muriel , Halpern Zamir , Kariv Revital
Published: November 2017

Goals:

The goal of this study is to test the association between lifetime smoking habits and colorectal polyps of different classifications.

Background:

Smoking is an established risk factor for several cancers, including colorectal cancer. However, the association between lifetime smoking habits including intensity, duration, and cessation, and premalignant colorectal polyps is yet to be established.

Study:

A case-control study among 828 consecutive subjects aged 40 to 70 years, undergoing screening or diagnostic colonoscopy. Exclusion criteria were: medically treated diabetes, colectomy, and belonging to colorectal cancer high risk group. Polyps were stratified according to histology (serrated or adenomatous polyp) and location. All participants underwent anthropometric measurements and a structured medical and lifestyle interview.

Results:

Current-smoking was more strongly associated with increased odds for distal rather than proximal polyps [odds ratio (OR), 4.00; 95% confidence interval (CI), 2.40-6.68 and OR, 2.52; 95% CI, 1.46-4.36, respectively], with serrated-polyps rather than adenomas (OR, 6.36; 95% CI, 2.77-14.57 and OR, 3.01; 1.90-4.74, respectively). All levels of smoking intensity (daily cigarettes) were associated with colorectal polyps. A dose-response association was seen between smoking duration and colorectal polyps. Smoking duration of ≥20 years was strongly associated with distal polyps (OR, 4.01; 95% CI, 1.62-9.84), independently of potential confounders, smoking intensity and years since smoking cessation. All associations were stronger for distal serrated polyps.

Conclusions:

Smoking duration is associated with colorectal plyps, independently of other potential confounders, smoking intensity, and cessation. The association is stronger with distal rather than proximal polyps, and with serrated polyps rather than adenomas.
Development of Image-enhanced Endoscopy of the Gastrointestinal Tract
Authors: Ho Shiaw-Hooi , Uedo Noriya , Aso Akira , Shimizu Shuji , Saito Yutaka , Yao Kenshi , Goh Khean-Lee
Published: November 2017

Endoscopy imaging of the gastrointestinal (GI) tract has evolved tremendously over the last few decades. Key milestones in the development of endoscopy imaging include the use of various dyes for chromoendoscopy, the application of optical magnification in endoscopy, the introduction of high-definition image capturing and display technology and the application of altered illuminating light to achieve vascular and surface enhancement. Aims of this review paper are to summarize the development and evolution of modern endoscopy imaging and in particular, imaged-enhanced endoscopy (IEE), to promote appropriate usage, and to guide future development of good endoscopy practice. A search of PubMed database was performed to identify articles related to IEE of the GI tract. Where appropriate, landmark trials and high-quality meta-analyses and systematic reviews were used in the discussion. In this review, the developments and evolutions in endoscopy imaging and in particular, IEE, were summarized into discernible eras and the literature evidence with regard to the strengths and weaknesses in term of their detection and characterization capability in each of these eras were discussed. It is in the authors’ opinion that IEE is capable of fairly good detection and accurate characterization of various GI lesions but such benefits may not be readily reaped by those who are new in the field of luminal endoscopy. Exposure and training in making confident diagnoses using these endoscopy imaging technologies are required in tandem with these new developments in order to fully embrace and adopt the benefits.
Discrepancy Between Cerebral Structure and Cognitive Functioning
Authors: Nahm Michael , Rousseau David , Greyson Bruce
Published: November 2017

Neuroscientists typically assume that human mental functions are generated by the brain and that its structural elements, including the different cell layers and tissues that form the neocortex, play specific roles in this complex process. Different functional units are thought to complement one another to create an integrated self-awareness or episodic memory. Still, findings that pertain to brain dysplasia and brain lesions indicate that in some individuals there is a considerable discrepancy between the cerebral structures and cognitive functioning. This seems to question the seemingly well-defined role of these brain structures. This article provides a review of such remarkable cases. It contains overviews of noteworthy aspects of hydrocephalus, hemihydranencephaly, hemispherectomy, and certain abilities of “savants.” We add considerations on memory processing, comment on the assumed role of neural plasticity in these contexts, and highlight the importance of taking such anomalies into account when formulating encompassing models of brain functioning.
Composition and Associated Factors of Radiological Examination in Major Trauma Patients
Authors: Shanshou Liu , Wei Zhao , Xianqi Wang , Jiangang Xie , Chaojuan Zhu , Qianmei Wang , Wen Yin , Junjie Li
Published: November 2017

The care of major trauma patients continues to be a challenge for emergency physicians and trauma surgeons. We found that the total number of radiological examinations for major trauma patients in this study was high and mainly comprised radiography and computed tomography (CT), with CT being more commonly adopted. The number of CT scans was positively correlated with severity of injury and intensive care unit length of stay. Further study is warranted to optimize radiological examinations involving major trauma patients.
Molecular Modifiers of Hormone Receptor Action: Decreased Androgen Receptor Expression in Mismatch Repair Deficient Endometrial Endometrioid Adenocarcinoma
Authors: Gan Qiong , Crumley Suzanne , Broaddus Russell R.
Published: November 2017

Endometrial endometrioid carcinoma is related to estrogen excess and expression of estrogen and progesterone receptors. Epidemiological evidence suggests that exposure to elevated androgens, as in polycystic ovarian syndrome, increases the risk of endometrial cancer. Factors impacting androgen receptor (AR) expression are not well studied. Mismatch repair (MMR) deficiency due to MLH1 gene methylation is one of the most common molecular alterations in endometrial cancer, occurring in 15% to 20% of cases. MLH1 methylation can be associated with decreased expression of other genes, so we examined the effect of MMR status on AR expression. As NF-κB is known to induce AR, this transcription factor was also examined. Three hundred forty-four unselected endometrial carcinomas were evaluated for DNA MMR. Loss of expression of MLH1 with MLH1 methylation was defined as MMR deficient, and positive expression of MMR proteins was defined as MMR intact. A case-control cohort of 96 grade 2 endometrioid carcinomas was studied from this set (47 MMR deficient, 49 MMR intact). Cases were matched for histotype, grade, and age. AR and NF-κB immunohistochemical expression were evaluated by 2 different scoring systems (CAP/ASCO and Allred) used for estrogen receptor. Despite higher levels of NF-κB, MMR deficiency was associated with a significantly lower mean percentage of AR expression. The MMR deficient group had more variable AR expression, with more cases scoring on the lower end of the spectrum. These findings have implications for clinical trials of AR antagonists in gynecologic cancers.
Effect of Stretching Combined With Ultrashort Wave Diathermy on Joint Function and Its Possible Mechanism in a Rabbit Knee Contracture Model
Authors: Zhang Quan Bing , Zhou Yun , Zhong Hua Zhang , Liu Yi
Published: November 2017

Objective

The aim of this study was to investigate the therapeutic effect of stretching combined with ultrashort wave on joint contracture and explore its possible mechanism.

Design

Thirty-two rabbits underwent unilateral immobilization of a knee joint at full extension to cause joint contracture. At 6 wks after immobilization, the rabbits were randomly divided into the following four groups: natural recovery group, stretching treatment group, ultrashort wave treatment group, and combined treatment group. For comparison, eight control group animals of corresponding age were also examined. The effect of stretching and ultrashort wave treatment on joint contracture was assessed by measuring the joint range of motion, evaluating the collagen deposition of joint capsule and assessing the mRNA and protein levels for transforming growth factor β1 in the joint capsule.

Results

The combined treatment group led to the best recovery of joint function. The combined treatment with stretching and ultrashort wave was more effective than stretching or ultrashort wave treatment alone against the synovial thickening of suprapatellar joint capsule, the collagen deposition of anterior joint capsule, and the elevated expression of transforming growth factor β1 in the joint capsule.

Conclusions

Stretching combined with ultrashort wave treatment was effective in improving joint range of motion, reducing the biomechanical, histological, and molecular manifestations of joint capsule fibrosis in a rabbit model of extending joint contracture.
Post-traumatic stress symptom clusters in acute whiplash associated disorder and their prediction of chronic pain-related disability
Authors: Maujean Annick , Gullo Matthew J. , Andersen Tonny Elmose , Ravn Sophie Lykkegaard , Sterling Michele
Published: November 2017

Introduction:

The presence of post-traumatic stress disorder (PTSD) symptoms has been found to be associated with an increased risk of persisting neck pain and disability in motor vehicle crash (MVC) survivors with whiplash injuries. The findings are mixed as to which PTSD symptom(s) best predicts recovery in this population.

Objectives:

The aims were (1) to explore the factor structure of the Post-traumatic Stress Diagnostic Scale (PDS) in a sample of acute whiplash-injured individuals following a MVC and (2) to identify the PTSD-symptom clusters that best predict long-term neck pain-related disability in this population as measured by the Neck Pain Disability Index (NDI).

Methods:

A sample (N = 146) of whiplash-injured individuals completed the NDI and the PDS at baseline (<1 month) and at 6 months follow-up.

Results:

Principal component analyses generated 2 symptom clusters: re-experiencing/avoidance and hyperarousal/numbing. Nine trauma-related PTSD symptoms loaded exclusively on the re-experiencing/avoidance cluster and 7 nonspecific PTSD symptoms loaded exclusively on the hyperarousal/numbing cluster. One PTSD symptom (ie, inability to recall an important aspect of the trauma) had no salient loading on either clusters. Structural equation modelling analysis indicated that there was a significant positive relationship between the hyperarousal/numbing symptom cluster and long-term neck pain-related disability, while no significant relationship was found between the re-experiencing/avoidance symptom cluster and long-term neck pain-related disability.

Conclusion:

Given that only the hyperarousal/numbing symptom cluster predicted long-term neck pain-related disability, this finding may have implications in terms of diagnosis, assessment, and management of the psychological impact of whiplash-injured individuals following a MVC.
Prospective, Double-Blind Evaluation of Umbilicoplasty Techniques Using Conventional and Crowdsourcing Methods
Authors: van Veldhuisen Charlotte L. , Kamali Parisa , Wu Winona , Becherer Babette E. , Sinno Hani H. , Ashraf Azra A. , Ibrahim Ahmed M. S. , Tobias Adam , Lee Bernard T. , Lin Samuel J.
Published: November 2017

Background:

Umbilical reconstruction is an important component of deep inferior epigastric perforator (DIEP) flap breast reconstruction. This study evaluated the aesthetics of three different umbilical reconstruction techniques during DIEP flap breast reconstruction.

Methods:

From January to April of 2013, a total of 29 consecutive patients undergoing DIEP flap breast reconstruction were randomized intraoperatively to receive one of three umbilicoplasty types: a diamond, an oval, or an inverted V incision. Independent plastic surgeons and members of the general public, identified using an online “crowdsourcing” platform, evaluated aesthetic outcomes in a blinded fashion. Reviewers were shown postoperative photographs of the umbilicus of all patients and a four-point Likert scale was used to rate the new umbilicus on the size, scar formation, shape, localization, and overall appearance.

Results:

Results for the focus group of independent plastic surgeons and 377 members of the public were retrieved (n = 391). A total of 10 patients (34.5 percent) were randomized into having the diamond incision, 10 (34.5 percent) had the oval incision, and nine (31.0 percent) had the inverted V incision. Patients were well matched in terms of overall characteristics. The general public demonstrated a significant preference for the oval incision in all five parameters. There was no preference identified among surgeons.

Conclusion:

This study provides evidence that a sample of the U.S. general public prefers the aesthetics of the oval umbilicoplasty incision, which contrasted with the lack of preference identified within this focus group of plastic surgeons.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Trends and Predictors of National Institutes of Health Funding to Plastic Surgery Residency Programs
Authors: Silvestre Jason , Abbatematteo Joseph M. , Chang Benjamin , Serletti Joseph M.
Published: November 2017

Background:

Recent studies have demonstrated low levels of National Institutes of Health funding for surgical research. The authors compared the funding in plastic surgery with the funding for other surgical specialties.

Methods:

A query of National Institutes of Health grants awarded to departments of surgical specialties was performed using the National Institutes of Health RePORTER database (2008 to 2016). Trends in funding were compared by specialty and adjusted for the number of active physicians in each specialty. Plastic surgery residency program characteristics were correlated with funding procurement.

Results:

Eight hundred eighty-nine faculty at 94 plastic surgery residency programs were queried. Forty-eight investigators (5.4 percent) at 23 programs (24.4 percent) had National Institutes of Health funding. From 2008 to 2016, a total of $84,142,138 was awarded through 81 grants. Funding supported translational (44.6 percent), clinical (26.4 percent), basic science (27.2 percent), and educational (1.7 percent) research. In 2016, plastic surgery received the least amount of National Institutes of Health funding per active physician ($1,530) relative to orthopedic surgery ($3124), obstetrics and gynecology ($3885), urology ($5943), otolaryngology ($9999), general surgery ($11,649), ophthalmology ($11,933), and neurologic surgery ($20,874). Plastic surgery residency program characteristics associated with National Institutes of Health funding were high ranking and had more than 10 clinical faculty (p < 0.05).

Conclusions:

Plastic surgery receives the least National Institutes of Health funding among the surgical specialties. Departments and divisions of plastic surgery should support investigators applying for research grants to increase future National Institutes of Health funding.
The Role of Checklists and Human Factors for Improved Patient Safety in Plastic Surgery
Authors: Oppikofer Claude , Schwappach David
Published: November 2017

Learning Objectives:

After studying the article, participants should be able to: 1. Describe the role of human factors and nontechnical skills for patient safety and recognize the need for customization of surgical checklists. 2. Apply encouragement to speaking up and understand the importance of patient involvement for patient safety. 3. Recognize the potential for improvement regarding patient safety in their own environment and take a leading role in the patient safety process. 4. Assess their own safety status and develop measures to avoid unnecessary distraction in the operating room.

Over the past 20 years, there has been increased attention to improving all aspects of patient safety and, in particular, the important role of checklists and human factors. This article gives a condensed overview of selected aspects of patient safety and aims to raise the awareness of the reader and encourage further study of referenced literature, with the goal of increased knowledge and use of proven safety methods. The CME questions should help indicate where there is still potential for improvement in patient safety, namely, in the field of nontechnical skills.
Quality of Caregiving is Positively Associated With Neurodevelopment During the First Year of Life Among HIV-Exposed Uninfected Children in Uganda
Authors: Familiar Itziar , Collins Shalean M. , Sikorskii Alla , Ruisenor-Escudero Horacio , Natamba Barnabas , Bangirana Paul , Widen Elizabeth M. , Achidri Daniel , Achola Harriet , Onen Daniel , Boivin Michael , Young Sera L.
Published: November 2017

Objective:

We sought to evaluate whether maternal characteristics and infant developmental milieu were predictive of early cognitive development in HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HU) infants in Uganda.

Design:

Longitudinal pregnancy study.

Methods:

Ugandan women (n = 228) were enrolled into the Postnatal Nutrition and Psychosocial Health Outcomes study with a 2:1 HIV-uninfected: infected ratio. Maternal sociodemographic, perceived social support, and depressive symptomatology were assessed. Infant growth and neurocognitive development were assessed at 6 and 12 months of age using Mullen Scales of Early Learning (MSEL). Caldwell Home Observation for Home Environment was used to gauge caregiving quality. Linear mixed-effects models were built to examine the relationships between maternal and infant characteristics with infant MSEL scores by HIV exposure.

Results:

Two MSEL measures were available for 215 mother–child dyads: 140 infants (65%) were HIV-uninfected (HU), 57 (27%) were HIV-exposed uninfected (HEU) with mothers reporting antiretroviral therapy, and 18 (8%) were HEU with mothers not reporting antiretroviral therapy. HEU had lower MSEL Composite (β = −3.94, P = 0.03) and Gross Motor scores (β = −3.41, P = 0.01) than HU. Home Observation for Home Environment total score was positively associated with MSEL Composite (β = 0.81, P = 0.01), Receptive Language (β = 0.59, P = 0.001), and Expressive Language (β = 0.64, P = 0.01) scores.

Conclusions:

HIV exposure is associated with lower infant cognitive development scores. Increasing maternal quality of caregiving may improve early cognitive development.
Brief Report: Tenofovir-Associated Nephrotoxicity Among a US National Historical Cohort of HIV-Infected Veterans: Risk Modification by Concomitant Antiretrovirals
Authors: LaFleur Joanne , Bress Adam P. , Esker Stephen , Knippenberg Kristin , Crook Jacob , Nyman Heather , Bedimo Roger , Tebas Pablo , Rosenblatt Lisa
Published: November 2017

Background:

Tenofovir disoproxil fumarate (TDF) has been associated with renal complications. The third agent in TDF-containing antiretroviral regimens may modify that risk. We compared renal adverse outcomes among treatment-naive HIV-infected patients initiating TDF-containing regimens including efavirenz (EFV) or other agents.

Setting:

This population-based historical cohort study used national Veterans Health Administration (VHA) clinical and administrative data sets to identify treatment-naive HIV-infected veterans initiating antiretroviral therapy with TDF/emtricitabine (FTC) + EFV, rilpivirine (RPV), elvitegravir/cobicistat (EVG/c), or ritonavir (RTV)-boosted protease inhibitors (PIs) from 2003 to 2015.

Methods:

Unadjusted incidence rates (IRs) for each regimen and covariate-adjusted hazard ratios [ using Cox proportional hazards models and inverse probability of treatment weighting] for between-regimen comparisons were calculated for renal outcomes including confirmed proteinuria, defined as 2 consecutive protein-to-creatinine ratios >150 mg/g or albumin-to-creatinine ratios >30 mg/g occurring ≥90 days apart; chronic kidney disease (CKD), defined as 2 consecutive estimated glomerular filtration rate measurements <60 mL·min−1·1.73 m−2 occurring ≥90 days apart; and kidney dialysis.

Results:

Of 33,048 HIV-positive veterans, 4172 received EFV + TDF/FTC, 234 EVG/c/TDF/FTC, 173 RPV/TDF/FTC, and 2651 RTV-boosted PIs + TDF/FTC. Confirmed proteinuria and CKD IRs were numerically lower with EFV + TDF/FTC versus non-EFV + TDF/FTC (dialysis IRs were rare and comparable). After inverse probability of treatment weighting adjustment, EFV + TDF/FTC was associated with lower CKD risk versus non-EFV + TDF/FTC (hazard ratio, 0.62; 95% confidence interval, 0.53 to 0.72), EVG/c/TDF/FTC (0.75; 0.59 to 0.95), RPV/TDF/FTC (0.20; 0.17 to 0.24), and RTV-boosted PIs + TDF/FTC (0.62; 0.53 to 0.72).

Conclusions:

EFV + TDF/FTC was associated with significantly lower risk of CKD versus other TDF-containing regimens in the Veterans Health Administration.
Effect of Low-Volume Split-Dose Purgative on the Quality of Bowel Prep for Colonoscopy on the Hospitalized Patient
Authors: Corliss Judy A.
Published: November 2017

Although colon cancer is preventable, it is still the second leading cause of cancer death in both men and women in the United States (CDC, 2014). Colonoscopy is as yet the gold standard for colon cancer prevention (ASGE, 2015). The success of colonoscopy is dependent upon the quality of the bowel prep. The problem addressed in this study was the impact of hospitalization on bowel prep quality. The participants in this study were 54 consecutive inpatients older than 18 years and 52 consecutive outpatients older than 18 years who were scheduled for colonoscopy in the Endoscopy Lab at Santa Barbara Cottage Hospital. Convenience sampling was used to collect sample data utilizing the Boston Bowel Prep Scale (BBPS). The study group contained 48.1% of the inpatients who had a BBPS of less than seven (out of nine total possible points with a score of nine representing the most optimal prep outcome) compared to 19.2% of the outpatients. Efforts to improve bowel prep palatability, decrease cost, and decrease side effects while improving quality should be continued. Split-dosing is a best practice recommendation. This researcher hypothesized that an intervention in the form of a lower-volume, split-dosage prep would improve the quality of bowel prep in the inpatient population. There was a statistically significant improvement noted with the intervention group in the follow-up study, which indicates potential for improving the quality of bowel prep for screening colonoscopy, thus a possibility for better colon health surveillance.