bluuebunny/crossref_metadata_2025 huggingface dataset:
Late intraocular relapses in retinoblastoma
Authors: Hadjistilianou D. , Borri M. , Defrancesco S. , Munier F. , Galluzzi P. , Bracco S. , Galimberti D. , Menicacci F. , Coriolani G.
Published: September 2016

Purpose

To report very late intraocular relapses in 6 patients treated for bilateral retinoblastoma.

Methods

we rewied the charts of 6 children who presented late intraocular recurrences of retinoblastoma. Three were familial and three sporadic cases. The patients achieved first remission after treatment with neoadjuvant chemotherapy, external radiotherapy and focal therapy. Relapses ocurred after 6–17 years after first remission .

Results

Three out of six patients are currently in second complete remission after receiving futher treatments. Two cases were enucleated and one is still under treatment. Therapeutic approach is reported and discussed for each case.

Conclusions

Retinoblastoma usually recurs within the first few years after treatment completion. Late and very late intraocular relapses are very rare but do ocur. A long‐term and close follow‐up is needed for early detection of late recurrences.
Graft functionality after DSAEK surgeries in Denmark from 2006 to 2009
Authors: Correll M. , Stormly Hansen M. , Hovlykke M. , Hjortdal J. , Olsen Julian H.
Published: September 2016

Purpose

To report graft functionality after the first DSAEK procedures performed in Denmark.

Methods

All primary DSAEK operated eyes in Denmark between 2006 and 2009 were analysed. Patients from three different surgical centers were included, covering all centers performing DSAEK in Denmark during the study period. Events of graft rejection, graft failure and rejection‐related graft failure were recorded, and Kaplan‐Meyer survival curves were used to determine duration of event‐free survival of the grafts.

Results

Data collection is ongoing until august 2016.

Conclusions

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Flash adaptometry in congenital stationary night blindness
Authors: Krastel H. , Zyganow M. , Mai M. , Schlichtenbrede F.
Published: September 2016

Purpose

To demonstrate that flash adaptometry, in x‐linked congenital stationary night blindness with myopia, besides quantification of reduced light sensitivity, renders a proof of deviating temporal resolution.

Methods

The flash adaptometer realizes light stimuli of various intensities by variation of exposure times. Stimuli of low luminance can be created by ultrashort flashes down to 0.002 mcds/m2. Following a 5 min pre‐adaptation (320 cd/m2), slow flicker stimuli are presented in darkness at a repetition rate of 6.7 Hz. The flashes illuminate a Ganzfeld sphere and a Gabor sine wave grating. Thresholds are determined for (i) detection of the Ganzfeld flashes, and (ii) recognition of the directional orientation of the grating.

Results

After 20 min of dark adaptation, the detection threshold for Ganzfeld flashes of young (22–24 year) normal subjects amounts to 0.004 mcds/m2, the recognition threshold for grating orientation to 0.008 mcds/m2. Four more decades of age reduce light and grating sensitivity in normal observers by 0.6–0.9 log units. The CSNB observer (66 year) featured a reduced ganzfeld detection threshold of 1.0 mcds/m2. He experienced, however, the train of flashes of 1.0 and 2.0 mcds/m2 as continuous illumination. At 4 mcds/m2, he was able to recognize temporal contrast i.e. flicker, and spatial contrast i.e. grating orientation.

Conclusions

With flash adaptometry, in x‐linked CSNB, besides reduced light sensitivity, an anomaly of temporal resolution was found. Understanding the mechanism of this particular behavior deserves further consideration.
Chromosomal aberration predict uveal melanoma mutation status
Authors: Kilic E. , Yavuzyigitoglu S. , Drabarek W. , Obulkasim A. , Brands T. , Eussen B. , de Klein A.
Published: September 2016

Purpose

Rationale: In uveal melanoma (UM) non‐random chromosomal aberrations occur and correspond to patients’ prognosis. Mutations in UM specific genes, such as BAP1, SF3B1 and EIF1AX are also used to predict survival. Aim of this study is to identify these mutations corresponding to a specific chromosomal signature in UM.

Methods

For 277 UM patients SNP array data (n = 214) and/or conventional karyotyping (n = 119) of the tumor was available. The mutational status was known in 189 patients. Based on the mutational status, SNP array and conventional karyotyping data was analyzed for recurring copy number variations (CNVs) and structural variants (SVs). Hierarchal clustering of the SNP array data was performed to construct clusters. These clusters were correlated to the mutational status.

Results

BAP1, SF3B1 and EIF1AX‐mutated UMs display specific chromosomal patters with recurring CNVs. Both BAP1‐mutated and SF3B1‐mutated UMs are characterized by specific chromosome anomalies and SF3B1 mutated tumors were characterized by multiple (>3) SVs of the genome. EIF1AX‐mutated UM were characterized by only chromosome 6p gain without additional CNVs. Hierarchal clustering of the SNP array data revealed five clusters of which two clusters predicted BAP1 mutations, one cluster SF3B1 mutations, one cluster EIF1AX mutations or wildtype UM and one cluster predicted SF3B1 mutations, EIF1AX mutations or wildtype.

Conclusion

UMs with either BAP1, SF3B1 or EIF1AX mutations display a mutation‐specific chromosomal pattern. Based on the chromosomal patterns the genetic mutation in UM can be predicted.
Ultrasound evaluation of Ahmed Glaucoma Valve: IOP versus tube patency
Authors: Bono V. , Zeppa L. , Costagliola C. , Zeppa L.
Published: September 2016

Purpose

Refractory glaucoma remains a challenge to be treated with surgical techniques. This study evaluated long‐term results of Ahmed glaucoma valve (AGV) implantation in treating refractory Glaucoma using intraocular pressure (IOP) and B‐scan ultrasound assessment.

Methods

This retrospective study was conducted on patients with refractory glaucoma treated with AGV implant. 60 eyes of 60 patients with a follow up of 36.3 (SD 9.6) months were analyzed. Outcome measures included: IOP, patency of the tube assessed by ultrasound, number of glaucoma medications, and postoperative complications. Success was defined as IOP ≤ 21 mmHg with at least 25% reduction in IOP compared to preoperative values, and tube patency +/− glaucoma medications.

Results

Mean IOP was reduced from 33.1 (SD 11.8) to 16.2 (SD 5.4) mmHg, (p < 0.0001), with a mean reduction of 49.36%. 12 eyes of 60 (20%) showed tube partially non patent with 9 eyes presenting IOP > 21 mmHg. The percentage of success was 76.6% with 17 patients (28.3%) showing postoperative complications, as hyphema and shallowing of the anterior chamber. The mean number of preoperative anti‐glaucoma medications (3; SD 1) was reduced compared to the mean number of postoperative medications (2; SD 1.), (p < 0.0001).

Conclusions

The Ahmed glaucoma valve implant was highly effective in the long term for treating refractory glaucoma. B‐scan ultrasound evaluation showed to be a useful technique for evaluating tube patency/function in eyes with refractory glaucoma.
Accuracy of retinal layers optical coherence tomography automated segmentation before and after epiretinal peeling
Authors: Medeiros Pinto J. , Caiado F. , Marques‐Neves C.
Published: September 2016

Purpose

To access the accuracy of Spectral Domain – Optical Coherence Tomography (SD‐OCT) retinal layers automated segmentation before and after idiopathic epiretinal membrane (ERM) peeling.

Methods

Retrospective observational study that included 37 eyes of 37 patients with ERM. OCT scans before and after peeling were obtained with Spectralis Heidelberg Engineering©. Two independent observers determined the accuracy of the automated retinal layer segmentation in the 3 mm central area. Manual correction of the automated segmentation was made as needed by the two observers and the new measured individual layers central thickness (CT) was compared to the one given by automated segmentation.

Results

Agreement between observers was perfect for the exams that needed manual segmentation correction. The agreement was moderate (κ = 0.51) for outer plexiform layer (OPL) before surgery and good to perfect (κ > 0.62) for the other layers before and after surgery. Preoperatively, 81.8% of the exams needed manual correction. The obtained CT was different (p < 0.05) before and after manual correction for central macular thickness, retinal nerve fibre layer (RNFL), ganglion cell layer, inner nuclear layer (INL), OPL and outer nuclear layer; no difference was noted in the inner plexiform layer and outer retinal layers (between external limiting and Bruch membranes). Postoperatively, 29.7% of the exams needed manual correction. There was a significant difference in the CT obtained with automated segmentation versus manual correction only in RNFL and INL.

Conclusions

OCT automated segmentation is not accurate in the internal retinal layers of patients with ERM before surgery, probably due to the much altered structure of these layers. After the surgery its accuracy is better. We recommend the verification of the automated segmentation in patients with ERM before surgery.
Ophthalmic findings before carotid endarterectomy in the ipsilateral and contralateral eye
Authors: Ala‐Kauhaluoma M. , Vikatmaa P. , Vikatmaa L. , Ijäs P. , Nuotio K. , Koskinen S. , Silvennoinen H. , Lindsberg P. , Soinne L. , Summanen P.
Published: September 2016

Purpose

To assess ophthalmic findings of ipsilateral (IL) and contralateral (CL) eyes of 30 first patients undergoing endarterectomy for carotid artery disease in Helsinki Carotid Endarterectomy Study 2‐ Substudy (HeCES‐BEST) (inclusion criteria ≥70% occlusion, exclusion criteria unable to undergo neuropsychological tests or MRI)

Methods

Best corrected visual acuity (BCVA) with ETDRS chart at 4 meters, anterior and posterior segment biomicroscopy, and 30°/50°/200° fundus photography. Differences in proportions of quantitative variables assessed with Fisher's test.

Results

Of 30 patients (one female) with median age 68 years (range 53–91), eleven had experienced ocular ischemic attack, and one sudden visual loss and pain (40%). Three patients had had surgery of the CI side. All but two IL eyes had full BCVA, one with neovascular glaucoma (NVG) 0.16 and one with unrelated scar 0.63; all CL eyes had full BCVA. No corneal changes related to ischemia were found. Conjunctival and/or episcleral vessels were dilated in nine IL and two CL eyes (p = 0.042), including varicose‐like vessels. Iris transillumination in pupillary border was found in 17 IL and 12 CL eyes (p = NS). Rubeosis iridis occurred in two IL eyes (p = NS). Arteriolosclerotic changes (nickings) were found in all. Retinopathy: microaneyrysms, microinfarctations and hemorrhages were found in nine IL and one CL eye (p = 0.012), midperipheral hemorrhages in four IL eyes and Hollenhorst's plaque in one CL eye. Venous pulsation was undetectable and uninducible in nine IL and five CL eyes (p = NS), and arterial pulsation induceable in 5 IL and two CL eyes (p = NS); no spontaneous arterial pulsation detected. NVG occurred in one IL eye

Conclusions

Vision disturbance and signs of ischemia are not uncommon underlining the role of ophthalmologists in suspicion of carotid artery disease.
Implantable Collamer Lens to treat high myopia: efficiency and safety
Authors: Charpentier S. , Graber M. , Rambaud C. , Monin J. , Berguiga M. , Delbarre M. , Sendon D. , Marechal M. , Timsit A. , Froussart‐Maille F.
Published: September 2016

Purpose

To report the efficiency and safety of Posterior Phakic Lens ICL (Implantable Collamer Lens), implantation for treating high myopia.

Methods

This retrospective observational monocentric study included 23 eyes of 12 patients who underwent consecutive V4 model ICL implantations between January the 1st 2015 and december 31th 2015. The lenses power were between 7.25 and 18.75 (D) Main outcomes mesures were uncorrected and corrected distance visual acuities, refraction for the evaluation of efficiency, endothelial cell count, intraocular pressure and pupillary diameter. Anatomical results were reported by anterior chamber OCT, biometrics and ICL vault.

Results

At 3 months post operatively, uncorrected distance visual acuity improved from 0.05 to 0.9 ± 0.1 (Monoyer scale) (p < 0.001). The mean spherical equivalent decreased from – 9.4 ± 3.4 (D) to −0.6 ± 1.9 (D) after surgery. The mean post operative vault was 660 ± 280 μm. There was no significant difference in endothelial count (p = 0.06), intraocular pressure (p = 0.22), pupillary diameter (p = 0.10) and anterior chamber angle depth (p < 0.001) pre and post operatevely. Furthermore, 100% of patients were satisfied and would recommended ICL implantation, despite of 40% of them reported halos and night vision problems.

Conclusions

This study indicates that ICL implantation provides refraction safety and efficiency to treat high myopia ineligible for lasik. Patients have to be throughly selected and well informed of possible complications before surgery.
Management of unilateral retinoblastoma with buphthalmia
Authors: Angi M. , Lumbroso Le Rouic L. , Levy C. , Desjardins L. , Cassoux N.
Published: September 2016

Purpose

Locally advanced unilateral retinoblastoma (RB) not amenable to conservative treatments is treated with enucleation. Surgery is challenging in presence of buphthalmia, exophthalmia or severe periocular inflammation, carrying a risk for globe rupture with tumour dissemination. The aim of this study was to report the long‐term results of neoadjuvant chemotherapy (CT) in this setting.

Methods

Retrospective case series of unilateral group E RB patients without extraocular disease receiving pre‐enucleation CT (etoposide‐carboplatin) in a single centre between 1999 and 2011. Clinical, radiological and histopathological data were collected. Outcome measures were: surgical complications, pathological risk factors (PRF) for metastatic dissemination, systemic side effects, metastatic dissemination, survival.

Results

21 patients, median age 9 months (range 1.5–48) were included: 16 with clinical buphthalmia, 2 with orbital inflammation and 3 with uncontrollable ocular hypertension. MRI confirmed the clinical findings and ruled out extraocular disease in all cases. Enucleation was performed after 1 course of neoadjuvant CT in 16/21 (77%), the remaining 5 patients needing two. No surgical complications occurred. Pathological examination showed complete resection in all cases. PRF for were present in 7/21 (33%) eyes. Irrespectively, all children completed a 4‐cycle CT regimen, as CT could mask PRF. Two children required hospitalisation for complicated aplasia, no other systemic side effects were reported. With a median follow‐up time of 8 years (range 4–12), no metastatic dissemination occurred. Survival is 100%.

Conclusions

Locally advanced unilateral RB with buphthalmia can be successfully treated with neoadjuvant CT prior to enucleation to make the surgery safer.
Clinical and instrumental diagnostics in patients with orbital metastasis
Authors: Saakyan S.
Published: September 2016

Purpose

To analyze the data of clinical and instrumental features of patients with metastatic lesions of the orbit.

Methods

26 patients (21 women and 5 men) with orbital metastasis aged from 42 to 84 years (mean – 57.3 ± 11.2) were examined and treated in our department in the period from 2009 to 2014. All patients underwent a complete clinical and instrumental examination including CT (MRI) and ultrasound. Metastatic orbital lesions were confirmed morphologically (23 patients) and cytologically (3 patients).

Results

A unilateral lesion of the orbit was found in 21 patients, bilateral – in 5 patients. 19 patients had a history of cancer before orbital symptoms appeared, in 3 patients – orbital symptoms preceded the identification of the primary tumor, in one patient – simultaneously with the primary focus (uveal melanoma with extraocular growth and metastasis to the contralateral orbit). According to CT and US data in 23 patients there were detected diffuse tissue with extraocular muscles involvement. The lesions mostly localized in the central and lower parts of the orbit (17 patients), rare – in the upper and outer (9 patients). Destructive changes in the orbital walls (by CT) revealed only in 4 patients. According to histogenesis the epithelial metastatic tumors were prevailed: breast cancer – in 13, gastric cancer – 3, kidney cancer – 2, thyroid cancer – 2, cancer of the uterus – 1; bowel leiomyosarcoma – in 1, uveal melanoma – in 1 patient. In 3 patients (11.5%) with morphologically confirmed metastatic cancer of the orbit the nature of the primary lesion was not identified.

Conclusions

Breast cancer is most common in development of metastatic tumors. Medical history data, clinical and instrumental findings are informative to suggest malignancy in orbit, requiring the need for morphological verification of the diagnosis for adequate therapy.
Electrospun polymer nanofibers as substrate/carrier for engineering of human corneal epithelium
Authors: Momtazi L. , Shahdadfar A. , Zell Thime H. , Noer A. , Nilsen O. , Eidet J.R.
Published: September 2016

Purpose

Electrospun polymer nanofibers present a structure similar to extracellular matrix (ECM) and support the surrounding cells. The type of polymer used, as well as the polymer blending‐ratio, affects wettability. This in turn influences cell growth by altering the types of proteins adsorbed from the solution. Human corneal epithelial cells were grown on electrospun biodegradable and non‐biodegradable polymer membranes to evaluate the membranes’ potential within ocular surface tissue engineering.

Methods

The electrospun polymer membranes consisted of cellulose acetate, poly (lactic‐co‐glycolic acid) (PLGA), polycaprolactone (PCL), and blends of PCL and polyethylene glycol (PEG). Expression of CDH1 (E‐cadherin), ITGA6, ITGB4 (Integrin α6β4) and MKI67 (Ki67) genes were measured in all conditions after 14 days of culture using qRT‐PCR.

Results

Cells seeded on all types of membranes expressed MKI67, which is associated with cell cycle activity and correlates with cell growth. MKI67 expression was high in cells grown on 3:2 blends of PCL and PEG (2.88) and PCL (2.75). This amount was 1.75, 1.00 and 1.59 for cells grown on cellulose acetate, 1:1 blend of PCL and PEG and PLGA respectively. The amount of ITGA6, ITGB4 expression was 1.72 in cells grown on PCL membranes, 1.10 for 3:2 blend of PCL and PEG, 1.05 for cellulose acetate, 1.53 for PLGA and 1.01 for 1:1 blend of PCL and PEG. Only cells grown on membranes containing blends of PCL: PEG showed CDH1 expression, which is critical for cell‐cell contact.

Conclusions

All polymer membranes enabled cellular adhesion and proliferation. PCL:PEG and PCL membranes appear to promote the highest proliferative activity and strongest cell‐membrane/cell‐cell adhesion. Thus, these might be the most promising substrates for epithelial ocular surface tissue engineering.
The preventive effects of the rhodiola rosea on ischemia‐reperfusion injury in the RAT retina
Authors: Kükner A.Ş. , Erdurmus M. , Terzi E.H. , Fırat T. , Kın Tekçe B. , Çetinkaya A. , Soydan A. , Kükner A.
Published: September 2016

Purpose

The aim of the present study is to evaluate the preventive effects of Rhodiola Rosea, a naturally occurring antioxidant and neuroprotective, on ischemia‐reperfusion (IR) induced damage in rat retina.

Methods

Forty‐eight Sprague‐Dawley rats were randomly divided into 3 groups. Control group (n = 16) just received anterior chamber cannulation. IR group (n = 16) was exposed IR injury created by increased intraocular pressure. The third group (IR+T) (n = 16) received daily intraperitoneal Rhodiola Rosea extract in addition to IR injury. Rats in each group were sacrificed at 24th hour (n = 8) and 7th day (n = 8). Retinal catalase, malondialdehyde and glutathione peroxidase were measured. Retinal sections were stained with hematoxylin‐eosin. Terminal deoxynucleotidyl transferase dUTP nick‐end labeling (TUNEL), TNF‐α and NF‐κB immune staining were also performed.

Results

There was no significant difference among the groups in terms of catalase and glutathione peroxidase (p > 0.05). MDA levels were significantly higher in the IR group on 24th hours and 7th day compared to control group. There was no ganglion cell count difference between control and IR+T group at 24th hour and day 7 (p > 0.05). There were statistically significant difference between control and IR group at 24th hour and at day 7 in terms of ganglion cell counts (p = 0.001 for both). When IR and IR+T are compared, TUNEL positive cells at 24th hour were significantly higher in IR group in the ganglion cell layer and inner nuclear layer (p = 0.001 for both). NF‐κB positive cells in the ganglion cell layer and inner nuclear layer were significantly lower in IR+T group compared to IR group at 24th hour (p = 0.001 for both).

Conclusions

Rhodiola Rosea extract was shown to have partially preventive effects on retinal ischemia reperfusion injury in rats in terms of biochemical and histopathological outcomes.
Personalised therapies for mitochondrial optic neuropathies – myth or reality?
Authors: Yu‐Wai‐Man P.
Published: September 2016

Mitochondrial optic neuropathies affect an estimated 1 in 10,000 individuals in the population and as a group, it represents an important cause of chronic visual morbidity among children and young adults. The pathological hallmark is the preferential loss of retinal ganglion cells (RGCs) within the inner retina, which results in progressive optic nerve degeneration and the onset of visual symptoms. The past decade has seen tremendous progress in our understanding of the molecular genetic basis and pathophysiology of this group of disorders, providing at the same time invaluable insight into the shared disease pathways that precipitate RGC loss. The two classical paradigms are Leber hereditary optic neuropathy (LHON), which is a primary mitochondrial DNA (mtDNA) disorder, and autosomal dominant optic atrophy (DOA) secondary to pathogenic mutations within the nuclear gene OPA1 that encodes for a mitochondrial inner membrane protein. The stark reality is that the majority of patients with mitochondrial optic neuropathies are eventually registered legally blind and management remains largely supportive. The translational gap for this group of disorders still remains to be bridged, but the development of effective disease‐modifying treatments is now within tantalising reach helped by major advances in drug discovery and targeted genetic manipulation.
Living with sub‐optimal glycaemic control: the experiences of Type 2 diabetes diagnosis and education
Authors: Crowe Marie , Whitehead Lisa , Bugge Carol , Carlyle Dave , Carter Janet , Maskill Virginia
Published: September 2016

Aim

The aim of this study was to explore the experiences of diagnosis and education for people living with Type 2 diabetes who have sub‐optimal glycaemic control.

Background

The increasing prevalence of Type 2 diabetes is a global concern. Many people have difficulty maintaining optimal glycaemic control with up to 50% having HbA1c levels higher than recommended. A range of factors that have been suggested as possibly contributing to this, however, little is known about how their experience of diagnosis, education and support to attempt to understand the context of their self‐management practices.

Design

A qualitative thematic analysis of interviews conducted with people with sub‐optimal glycaemic control prior to their participation in an intervention study.

Method

Thirty participants taking part in a psychosocial/educational intervention for people with sub‐optimal glycaemic control were interviewed in 2012 before the intervention commenced. These interviews explored each participant's experience of the diagnosis and associated education. The interviews were transcribed and a thematic analysis was conducted.

Findings

Almost all the participants had been shocked at receiving the diagnosis and felt it had been a moral indictment on their lifestyle. Many had been given the impression that they had a mild form of diabetes and most had been given very little information on self‐management that they had found useful.

Conclusion

The findings suggest that for the participants there was a considerable gap between the rhetoric of person‐centred services and the reality of the experiences of diagnosis and education for the self‐management of Type 2 diabetes.
Responding to families with complex needs: a national survey of child and family health nurses
Authors: Rossiter Chris , Schmied Virginia , Kemp Lynn , Fowler Cathrine , Kruske Sue , Homer Caroline S.E.
Published: September 2016

Aims

The aim of this study was to explore the extent to which Australian child and family health nurses work with families with complex needs and how their practice responds to the needs of these families.

Background

Many families with young children face challenges to their parenting capacity, potentially placing their children at risk of poorer developmental outcomes. Nurses increasingly work with families with mental health problems, trauma histories and/or substance dependence. Universal child health services must respond effectively to these challenges, to address health inequalities and to promote the best outcomes for all children and families.

Design

The descriptive study used cross‐sectional data from the first national survey of child and family health nurses in Australia, conducted during 2011.

Methods

Survey data reported how often, where and how child and family health nurses worked with families with complex needs and their confidence in nursing tasks.

Findings

Many, but not all, of the 679 respondents saw families with complex needs in their regular weekly caseload. Child and family health nurses with diverse and complex caseloads reported using varied approaches to support their clients. They often undertook additional professional development and leadership roles compared with nurses who reported less complex caseloads. Most respondents reported high levels of professional confidence.

Conclusion

For health services providing universal support and early intervention for families at risk, the findings underscore the importance of appropriate education, training and support for child and family health professionals. The findings can inform the organization and delivery of services for families in Australia and internationally.
Exploring beyond the oral mucosa in patients affected with autoimmune blistering diseases: the importance of endoscopic procedures
Authors: España A. , Fernandez S.
Published: September 2016

Autoimmune blistering diseases (AIBD) comprise several entities characterized by the presence of autoantibodies targeted against structural proteins either in desmosomes or in the dermoepidermal junction of polystratified squamous epithelium. Patients develop blisters, erosions in cutaneous surfaces or mucosas. Diagnosis is based on the characteristic mucocutaneous lesions, the typical findings on histological studies and direct immunofluorescence assays, and the presence of specific autoantibodies against the epidermal antigens. It may not be possible for dermatologists to appropriately explore the nose and throat (NT). Thus, a clinical exploration by endoscopic procedures of NT may be a useful tool during the conventional dermatological exam. The aims of this review are to draw attention to the most frequent NT manifestations in AIBD patients, and underline the utility of endoscopic procedures to achieve a more successful and rationale management of patients. Additionally, we will provide brief information related to the anatomical structures and type of epithelium in NT areas which may explain the extent and type of NT involvement in AIBD. Endoscopic exploration in AIBD patients is important for several reasons. Firstly, it will allow the real NT mucosal involvement in each patient to be determined, thus making a differential diagnosis during the endoscopic exam possible, based on the localization of mucosal lesions. Secondary mucosal morbidity can also be ruled out. Secondly, the clinical response to treatment may be established, especially in NT mucosa, as these are anatomical areas subjected to important local traumas, and physiological functions such as breathing, swallowing, speech production and phonation may be damaged. Therefore, a multidisciplinary management in AIBD is mandatory by both dermatologists and otorhinolaryngologists, adding the clinical exploration by endoscopic procedures of NT to the conventional dermatological exam in all AIBD patients, irrespective of whether they exhibit associated symptoms.
Early transjugular intrahepatic portosystemic shunt in US patients hospitalized with acute esophageal variceal bleeding
Authors: Njei Basile , McCarty Thomas R , Laine Loren
Published: September 2016

Background and Aim

Early transjugular intrahepatic portosystemic shunt (TIPS) used as preventive therapy prior to recurrent bleeding has been recommended in patients presenting with acute esophageal variceal bleeding (EVB) who are at high risk of further bleeding and death. We investigated the impact of early TIPS on outcomes of US patients hospitalized with EVB from 2000 to 2010.

Methods

The Nationwide Inpatient Sample database was queried to identify patients with EVB and decompensated cirrhosis (because early TIPS is recommended only in high‐risk patients). The primary outcome was in‐hospital death, and secondary outcomes included rebleeding and hepatic encephalopathy. Early preventive TIPS was defined by placement within 3 days of hospitalization for acute EVB after one session of endoscopic therapy. Rescue TIPS was defined as TIPS after two interventions for EVB.

Results

The study included 142 539 patients. From 2000 to 2010, the age‐adjusted in‐hospital mortality rate decreased 37.2% from 656 per 100 000 to 412 per 100 000 (P <0.01), while early and rescue TIPS increased (0.22% to 0.70%; P < 0.01 and 1.1% to 6.1%; P < 0.01). On multivariate analysis, as compared with no TIPS, early TIPS was associated with decreased inpatient mortality (risk ratio [RR] = 0.87; 95% confidence interval [CI], 0.84–0.90) and rebleeding (RR = 0.56; 95% CI, 0.45–0.71) without an increase in hepatic encephalopathy (RR = 1.01; 95% CI, 0.93–1.11).

Conclusion

Early preventive TIPS in patients with EVB and decompensated cirrhosis was associated with significant in‐hospital reductions in rebleeding and mortality without a significant increase in encephalopathy in “real‐world” US clinical practice.
Dual treatment with sofosbuvir plus ribavirin is as effective as triple therapy with pegylated interferon plus sofosbuvir plus ribavirin in predominant genotype 3 patients with chronic hepatitis C
Authors: Satsangi Sandeep , Mehta Manu , Duseja Ajay , Taneja Sunil , Dhiman Radha K , Chawla Yogesh
Published: September 2016

Background and Aim

Sofosbuvir (SOF) was the first directly acting antiviral made available for chronic hepatitis C (CHC) in India. We describe our “real life” experience of using SOF with ribavirin (RBV) with or without pegylated interferon (Peg‐IFN) in predominant genotype 3 patients with CHC.

Methods

A total of 158 patients (men 99 [62.6%], mean age 40.3 ± 12.8 years) with CHC treated with dual therapy (SOF + RBV) for 24 weeks or triple therapy (Peg‐IFN + SOF + RBV) for 12 weeks were included prospectively. Patients with co‐infection, decompensated liver disease, and post‐organ transplantation were excluded. Data were analysed for the preference of treatment regimen, end of treatment response (ETR), sustained virological response at 12 weeks, and side effects.

Results

Genotype 3 was the predominant genotype (105 [66.4%]) followed by genotype 1 (40 [25.3%]) and genotype 4 (13[8.2%]). Forty‐eight (30.37%) patients had cirrhosis (LSM ≥ 13 kPa), and 30 (19%) were treatment experienced with Peg‐IFN + RBV. A total of 103 (65.18%) patients received dual therapy, and 55 (34.81%) received triple therapy. Resentment to receive injections, inaccessibility to a facility, fear of injection or its side effects, and financial constraints were the reasons to refuse triple therapy. All patients in triple therapy group and all but two patients (98%) in the dual therapy group attained ETR. All those who achieved ETR achieved sustained virological response at 12 weeks in both groups. But for anemia in three patients (two in triple, one in dual therapy), there were no major side effects.

Conclusions

Most patients with CHC prefer an oral treatment with directly acting antivirals. Both oral and interferon‐based regimens achieve high response rate.
Unsupportive parenting and internalising behaviour problems in children with or without intellectual disability
Authors: Rodas N. V. , Zeedyk S. M. , Baker B. L.
Published: September 2016

Background

Children with intellectual disability (ID) are at heightened risk for developing other psychological disorders, including internalising disorders. Anxiety and depression have been shown to be familial, and parenting is a contributing factor to the development of these disorders. To extend this research, we examined the extent to which mother and father depression and negative, unsupportive parenting related to child internalising behaviour problems, in children with ID or with typical development (TD).

Method

Participants were 156 mother and father dyads and their children, assessed at ages 4 and 5 years. We examined parent (mother and father) and child delay status (ID and TD) in relation to measures of both observed and self‐reported unsupportive, negative parenting. Utilising moderation models, we examined the relationship between parental depression, unsupportive/negative parenting and child internalising behaviour problems.

Results

Unsupportive, negative parenting differed based on parent gender and child delay status. In addition, father depression was a significant moderator of the relationship between unsupportive parenting and child internalising behaviour problems.

Conclusions

Children with ID were found to be at higher risk of experiencing unsupportive, negative parenting than children with TD. Children of depressed fathers were especially vulnerable to developing internalising behaviour problems in an unsupportive parenting context.
Breast cancer and screening in persons with an intellectual disability living in institutions in France
Authors: Trétarre B. , Bourgarel S. , Stoebner‐Delbarre A. , Jacot W. , Bessaoud F. , Satge D.
Published: September 2016

Background

We aimed to describe, among a population of women with intellectual disabilities (ID) living in institutions in France, the characteristics in whom breast cancer (BC) was diagnosed and of those who participated in BC screening.

Methods

Study was performed in 2009 among a random, representative sample of women with ID living in institutions in France. Participants answered a questionnaire either directly by themselves, or with the help of an intermediary.

Results

In total, 978 women with ID aged over 18 years were included, and 14 were diagnosed with BC. The incidence observed in this sample of women with ID is similar to that of the general population (standardised incidence ratio, SIR 0.857, 95% confidence interval (CI) 0.42–1.53). Average age at diagnosis was 47.8 years, and the risk of developing BC before the age of 50 was 2.03% (0.4–3.66). This risk was not significantly different from that of the general population (2.4%, 1.0–3.78). Obesity was almost twice as frequent in women who had BC as compared to those without BC (43% vs. 22.5%, P = 0.0196). Among the 310 women aged >50 years and eligible for the national BC screening programme, 238 (77%) had already had at least one mammogram, and 199 had had it within the previous 2 years. Adherence to the screening programme was 64.2% (199/310) in the participating institutions. This rate was slightly higher than the national average of 62% for the same period.

Conclusions

The results of this study show that BC is equally as frequent among women with ID living in institutions as in the general population, and occurs at around the same age. Obesity was significantly more frequent among women in whom BC was diagnosed in our study. Participation in BC screening is slightly higher among women with ID living in institutions than among the general population.
Continence care for people with dementia living at home in Europe: a review of literature with a focus on problems and challenges
Authors: Gove Dianne , Scerri Anthony , Georges Jean , van Houten Paul , Huige Nicole , Hayder‐Beichel Daniela , Leichsenring Kai , Morris Vikky Christina
Published: September 2016

Aims and objectives

To report the findings of a review of literature relating to the continence care of community‐dwelling people with dementia in Europe.

Background

More than two‐thirds of people with dementia live at home, and many experience continence problems. Incontinence is a significant contributor towards institutionalisation. Care and support is often inadequate or inappropriate, and guidelines are lacking. This represents a failure to respect the human rights and dignity of this group.

Design

A structured review of the literature relating to the continence care of community‐dwelling people with dementia in Europe with a focus on problems and challenges.

Methods

Search terms reflecting dementia, continence, care/management and guidelines for community‐dwelling people with dementia were applied to four databases. Hand‐searching was also carried out. A total of 208 articles were searched for content relating to problems and challenges linked to continence care for this group.

Results

Six relevant articles were fully reviewed. The main difficulties and challenges included the following: (1) perceptions, (2) availability/provision of support and care, (3) financial cost, (4) mobility and the environment, (5) relationships and social inclusion and (6) emotional issues.

Conclusion

Dementia and incontinence have profound effects on quality of life. The dearth of good quality data within this area and the findings of the review confirm the need for expert, consensus‐based guidelines and appropriate research to ensure that the rights and dignity of people with dementia are respected.

Relevance to clinical practice

The findings of the review will hopefully raise awareness amongst healthcare professionals in community practice of unmet needs of people with dementia and continence problems, and their caregivers, especially those related to social, financial, emotional and relational issues. The review does not provide solutions or guidance but is helpful in highlighting some of the key areas where special attention is needed.
Validation of the optimal site in the neck region for detecting swallowing sounds
Authors: Pan Q. , Maeda N. , Manda Y. , Kodama N. , Minagi S.
Published: September 2016

Recently, the swallowing sound has been used to detect swallowing events non‐invasively. A previous study, using an accelerometer, showed that the site over the lateral border of the trachea immediately inferior to the cricoid cartilage was the optimal site for detecting swallowing sounds. However, the optimal site for detection of the swallowing sound using a microphone remains undetermined. To validate the optimal site in the neck region for detecting swallowing sounds. Fourteen healthy subjects (mean age, 27·6 ± 2·2 years; seven male and seven female) participated in this study. Twenty condenser microphones were attached to 20 sites on the left neck surface to detect swallowing sounds. Participants were instructed to swallow five different stimuli three times as follows: Resting saliva, 1 and 5 mL of Japanese tea, and 1 and 5 mL of yoghurt. Mean relative peak intensity was used to indicate the magnitude of the swallowing sound. Sound spectrograms were used to illustrate differences in the properties of swallowing sounds. Mean relative peak intensity number was highest in sites at the inferior border of the mandible just above the sternocleidomastoid muscle (site 11) and sites over the lateral border of the trachea immediately inferior to the cricoid cartilage (site 8). Comparison of spectrograms showed a greater density distribution of higher frequency components at site 11 compared with site 8. These results indicate that the inferior border of the mandible just above the sternocleidomastoid muscle is the optimal site for the detection of swallowing sounds.
FACTOR ACCUMULATION, EXTERNALITIES, AND ABSORPTIVE CAPACITY IN REGIONAL GROWTH: EVIDENCE FROM EUROPE
Authors: Jung Juan , López‐Bazo Enrique
Published: September 2016

This paper proposes a model that incorporates capital accumulation and spatial spillovers across economies, while allowing for regional differences in absorptive capacity. This model is estimated using a sample of EU regions, over a period including the enlargement of the single‐market area in the middle of the first decade of the 21st century. Results confirm the relevance of local absorptive capacity that is directly linked with the process of making the most of externalities. Capital deepening reduced the role of capital in explaining the regional productivity gap, but was not enough to help lagging regions to equal the return to human capital investments reached by most advanced regions.
Attachment and perceived stress in patients with ulcerative colitis, a case–control study
Authors: Agostini Alessandro , Spuri Fornarini Giulia , Ercolani Mauro , Campieri Massimo
Published: September 2016

Accessible summary

What is known on the subject?

Ulcerative colitis (UC) is a chronic inflammatory disorder associated with high perceived psychological stress.

The attachment theory provides a psychodynamic perspective to investigate the relationship between close interpersonal relationships and stress in UC.

Researchers have hypothesized that the chronic illness might affect personality trait as the attachment style of patients.

What this paper adds to existing knowledge?

UC patients exhibit a more pronounced attachment insecurity that, in turn, resulted as a determinant of psychological stress.

This study suggests that UC could determine a shift towards insecurity in the attachment style that, in turn, promotes psychological stress and increases the risk of psychopathologies.

What are the implications for practice?

The more accurate knowledge of attachment insecurity in patients with chronic disorders such as UC may help the nurses to face with often dysfunctional patients’ styles of manifesting distress, patterns of help seeking and expectations of health professionals.

The knowledge of psychopathological mechanisms in patients with UC could improve the prevention and treatment of psychological disorders in affected patients.

Introduction

Ulcerative colitis (UC) is a chronic disorder characterized by recurrent intestinal symptoms. The attachment theory provides a psychodynamic perspective to investigate the relationship between interpersonal relationships and stress in UC.

Aim

The aim of this study was to compare the attachment dimensions between UC patients and controls and to evaluate the impact of these dimensions on perceived stress in patients.

Method

In all, 101 patients with UC completed the attachment style questionnaire and the perceived stress questionnaire (PSQ). Clinical and psychometric parameters were added as predictor variables in a regression with the PSQ score as dependent variable. One hundred and five healthy subjects took part in the study as controls.

Results

Compared to controls, UC patients exhibited greater scores in relationships as secondary, need for approval and preoccupation with relationships. In UC, disease activity, confidence and preoccupation with relationships resulted predictors of perceived stress.

Discussion

Compared to healthy controls, UC patients exhibited more pronounced attachment insecurity that, in turn, was a significant predictor of the perceived stress.

Implications for practice

The knowledge of attachment insecurity may help the nurses and all health care providers to face with dysfunctional patients’ styles of manifesting distress, help seeking and expectations of health professionals.
Mannose‐binding lectin gene polymorphism in relation to periodontal infection
Authors: Liukkonen A. , He Q. , Gürsoy U. K. , Pussinen P. J. , Gröndahl‐Yli‐Hannuksela K. , Liukkonen J. , Sorsa T. , Suominen A. L. , Huumonen S. , Könönen E.
Published: September 2016

Background and Objective

Mannose‐binding lectin (MBL) plays an important role in innate immunity. MBL deficiency is usually caused by mutations in exon 1 of the MBL structural gene (MBL2). Our aim was to investigate MBL2 polymorphisms and their relation to salivary levels of periodontal inflammatory/tissue destruction markers and two major periodontitis‐associated bacteria.

Material and Methods

Salivary samples from 222 subjects were available for genotyping by pyrosequencing. The subjects between 40 and 60 years of age and having a minimum of 20 teeth were divided into three periodontal groups: 80 had generalized periodontitis, 65 had localized periodontitis and 77 were periodontitis‐free. A comparison between their MBL2 genotypes and salivary detection rates and levels of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis as well as interleukin ‐1β, matrix metalloproteinase ‐8, and tissue inhibitor of matrix metalloproteinase (TIMP)‐1 was performed.

Results

The frequencies of the MBL2 wild‐type (A/A), heterozygote variants (A/O) and homozygote variants (O/O) were 69.4%, 26.6% and 4%, respectively. In A. actinomycetemcomitans‐positive subjects having homozygote or heterozygote MBL2 variants, the salivary concentrations of IL‐1β (p = 0.010) were elevated and those of TIMP‐1 (p = 0.001) were decreased. In addition their matrix metalloproteinase ‐8/TIMP‐1 ratio was higher (p < 0.001) and they had more pocket teeth (p = 0.012) than subjects negative for A. actinomycetemcomitans.

Conclusion

Our findings indicate that the carriage of A. actinomycetemcomitans may facilitate extended periodontal inflammation and destruction in subjects with a variant form of human MBL2.
Occult hepatitis B virus infection: clinical implications in tuberculosis treatment
Authors: Trigo C. , do Brasil P. E. A. A. , Costa M. J. M. , de Castro L.
Published: September 2016

Occult hepatitis B virus infection (OBI) is characterized by the absence of HBsAg and persistence of the virus genome (HBV‐DNA) in liver tissue and/or blood. OBI has been reported in several clinical contexts. However, the clinical significance of OBI in tuberculosis (TB) treatment is unknown. We investigated the OBI prevalence and its impact on the risk of drug‐induced liver injury (DILI) during TB treatment. This was a prospective cohort study with one hundred patients who were treated for TB from 2008 to 2015. Laboratory, clinical and demographic data of TB patients were extracted from medical records. Based on HBV‐DNA testing of serum samples, an OBI prevalence of 12% was established; almost half of these patients had both anti‐HBc and anti‐HBs serological markers. Low CD4+ cell counts have been shown to be a risk factor for OBI among TB patients co‐infected with HIV (P=.036). High DILI incidence was observed in this study. A multivariable Cox proportional hazard model was conducted and identified OBI (HR 2.98, 95% CI 1.30–6.86) as the strongest predictor for DILI when adjusted to CD4+ cell count (HR 0.38, 95% CI 0.17–0.90), ALT before TB treatment (HR 1.37, 95% CI 0.81–2.32) and TB extrapulmonary clinical form (HR 2.91, 95% CI 1.75–7.21). The main aim of this study was to highlight DILI as a clinical outcome during treatment of TB patients with OBI. Therefore, HBV‐DNA testing should be considered routinely in monitoring DILI, and also in other clinical implications associated with OBI, reduce morbidity and mortality.