bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and Risk Factors for Cannula-Related Venous Thrombosis After Venovenous Extracorporeal Membrane Oxygenation in Adult Patients With Acute Respiratory Failure
Authors: Fisser Christoph , Reichenbächer Christoph , Müller Thomas , Schneckenpointner Roland , Malfertheiner Maximilian V. , Philipp Alois , Foltan Maik , Lunz Dirk , Zeman Florian , Lubnow Matthias
Published: January 2019

Objectives:

Venovenous extracorporeal membrane oxygenation is indicated in patients with severe refractory acute respiratory failure. Venous thrombosis due to indwelling catheters is a frequent complication. The aim of this study was to analyze the incidence of cannula-related thrombosis and its risk factors after venovenous extracorporeal membrane oxygenation.

Design:

Retrospective observational study.

Setting:

A medical ICU at the University Hospital Regensburg.

Patients:

We analyzed consecutive patients with severe respiratory failure (Pao
2/Fio
2 < 85 mm Hg and/or respiratory acidosis with pH < 7.25) who were successfully treated with venovenous extracorporeal membrane oxygenation in a medical ICU between 2010 and 2017.

Intervention:

None.

Measurements and Main Results:

After extracorporeal membrane oxygenation weaning, duplex sonography or CT was conducted to detect cannula-related thrombosis. Thrombosis was classified as a large thrombosis by vein occlusion of greater than 50%. The incidence of thrombosis was correlated with risk factors such as coagulation variables (mean activated partial thromboplastin time ≤ 50 s, international normalized ratio antithrombin III, fibrinogen, plasma-free hemoglobin, platelets, and decline in D-dimer ≤ 50% the day after decannulation), cannula size, time on venovenous extracorporeal membrane oxygenation, renal failure, and underlying malignant disease. Data cut-off points were identified by receiver operating characteristic analysis. One-hundred seventy-two of 197 patients (87%) were screened. One-hundred six patients (62%) showed thrombosis that was considered large in 48 of 172 (28%). The incidence of thrombosis was higher in patients with a mean aPTT of less than or equal to 50 seconds (odds ratio, 1.02; p = 0.013) and in patients with a decline in D-dimer less than or equal to 50% (odds ratio, 2.76; p = 0.041) the day after decannulation following adjustment for risk factors.

Conclusions:

The incidence of cannula-related venous thrombosis after venovenous extracorporeal membrane oxygenation is high. Reduced systemic anticoagulation may enhance the risk of thrombosis. Sustained elevation of D-dimer after decannulation may indicate thrombosis. Patients should undergo routine duplex sonography after extracorporeal membrane oxygenation to detect thrombosis formation in the cannulated vessel.
Long noncoding RNA X-inactive specific transcript promotes malignant melanoma progression and oxaliplatin resistance
Authors: Pan Bujian , Lin Xiaohua , Zhang Li , Hong Weilong , Zhang Yi
Published: January 2019

Long noncoding RNA X-inactive specific transcript (XIST) was confirmed to participate in the development of many cancers. However, the function of XIST in malignant melanoma (MM) remained largely unknown. In the current study, we found that the XIST expression level was upregulated in MM tissues and cell lines. In addition, the growth rate of MM cells transfected with silencing XIST was significantly decreased compared with that with silencing normal control. XIST knockdown inhibited proliferation and migration in MM cells and increased the oxaliplatin sensitivity of oxaliplatin-resistant MM cells. Bioinformatics analysis showed that XIST acts as a molecular sponge for miR-21 and miR-21 directly targets with 3′-UTR of PI3KR1. Furthermore, XIST knockdown inhibited PI3KRI and AKT expression, and promoted Bcl-2 and Bax expression. In short, the current study showed that XIST was a crucial regulator in progression and oxaliplatin resistance of MM, providing a novel insight into the pathogenesis and underlying therapeutic target for MM.
MRI enables accurate diagnosis and follow-up in uveal melanoma patients after vitrectomy
Authors: Jaarsma-Coes Myriam G. , Goncalves Ferreira Teresa A. , van Haren Guido R. , Marinkovic Marina , Beenakker Jan-Willem M.
Published: January 2019

Uveal melanoma (UM), the most common primary intraocular tumour, is often complicated by exudative retinal detachment (RD). Sometimes, this exudative RD is mistaken for a rhegmatogenous detachment and is subsequently treated with vitrectomy with silicone oil (SiOil) tamponade. As SiOil prevents ultrasound imaging, the diagnosis, treatment planning and/or follow-up of UM underlying the detachment are often severely hindered by the SiOil. We aim to develop and evaluate new MRI methods to image UM patients with a SiOil tamponade and evaluate this in vivo. A dedicated MRI protocol for 3 and 7 T was developed and subsequently evaluated in three patients. The MRI protocol developed was evaluated in three patients. In the first patient, SiOil hindered follow-up and therefore MRI was indicated. No tumour recurrence was found after two follow-up scans. The second and third patient underwent vitrectomy with SiOil for assumed rhegmatogenous RD in another hospital, during which a mass was found. In these cases, MRI was used to determine whether the lesion was UM and perform measurements to plan brachytherapy treatment. In general, the proposed workflow is more complicated on 7 T than on 3 T as the off-resonance effects scale linearly with field strength. For example, the shimming procedure needed modifications at 7 T, whereas at 3 T, the automatic shimming sufficed. However, at 7 T, higher resolution images were obtained compared with 3 T (0.6 vs. 0.8 mm3). A dedicated MRI protocol enables high-resolution imaging of vitrectomized eyes with SiOil tamponade, enabling treatment planning or follow-up in UM patients.
Overall survival after treatment for metastatic uveal melanoma: a systematic review and meta-analysis
Authors: Rantala Elina S. , Hernberg Micaela , Kivelä Tero T.
Published: January 2019

The overall survival (OS) of patients with metastatic uveal melanoma is short, the evidence for effectiveness of treatments is limited, and no consensus on the choice of treatment exists. We aimed to advance interpretation of OS as an outcome by pooling peer-reviewed data. The design is a systematic review and meta-analysis. We searched PubMed from 1 January 1980, to 29 March 2017, for articles reporting patient-level survival in Kaplan–Meier or numerical form. We digitized survival graphs, pooled individual survival times, calculated median OS by treatment modality, and compared each modality by the log-rank test and Cox regression using conventional chemotherapy (CHT) as a reference. Individual-level data were obtained from 78 articles with 2494 patients. The median OS across all treatment modalities was 1.07 years (range: 0.59–2.50 years). Pooled OS reported after isolated hepatic perfusion [median OS: 1.34 years; hazard ratio (HR): 0.92, 95% confidence interval (CI): 0.87–0.97, P = 0.0040], immunoembolization (median OS: 1.63; HR: 0.97, 95% CI: 0.95–1.00, P = 0.0080), and surgery (median OS: 1.43; HR: 0.94, 95% CI: 0.92–0.96, P < 0.0001) was longer, and after checkpoint inhibitor shorter (median OS: 0.59; HR: 1.13, 95% CI: 1.06–1.20, P < 0.0001) than after CHT (median OS: 0.91 years), but subject to identifiable confounding factors. OS following other modalities did not differ from CHT. Reported OS was unassociated with the decade of publication, but depended on the percentage of first-line treated patients. Our results suggest no clinically significant difference in OS by treatment modality or decade. Most of the difference in reported OS likely is attributable to surveillance, selection, and publication bias rather than treatment-related prolongation. Our pooled data provide benchmarks for future trials.
Decreased expression of nemo-like kinase in melanoma is correlated with increased vascularity and metastasis
Authors: Yang Yvying , Zhe Hong , Massoumi Ramin , Ke Hengning
Published: January 2019

Melanoma is a highly metastatic cancer, and its incidence has increased over the past several decades. Angiogenesis is associated with melanoma metastasis and a poor prognosis. Many genetic and epigenetic factors affecting tumour vascularization and metastasis have been investigated, despite the heterogeneity of cancer cells and the complicated mechanisms involved in melanoma. Nemo-like kinase (NLK) is a serine/threonine kinase regulating the transcription factor by negatively regulating Wnt and downstream vascular endothelial growth factor receptor 2 (VEGFR2) signalling. This study aimed to investigate whether NLK expression in melanoma correlates with VEGFR2-related angiogenesis and melanoma metastasis. Immunohistochemistry analysis using 175 biopsied tissues of melanoma patients showed that NLK is expressed in 73.7% of melanoma tissues, whereas 26.3% of the samples showed absent expression of NLK. In metastatic melanoma, the expression of NLK was significantly lower than that in primary melanoma (P = 0.002). Furthermore, tissues with a lower expression of NLK showed a higher microvessel density as detected by VEGFR2 expression compared with tissues showing higher NLK expression. These data suggest that reduced expression of NLK in melanoma correlates with VEGFR2-related microvessel formation and melanoma metastasis. This study showed that NLK may serve as a novel prognosis marker and revealed new mechanisms in melanoma metastasis.
Metformin Use and Kidney Cancer Survival Outcomes
Authors: Nayan Madhur , Punjani Nahid , Juurlink David N. , Finelli Antonio , Austin Peter C. , Kulkarni Girish S. , Uleryk Elizabeth , Hamilton Robert J.
Published: January 2019

Objectives:

Metformin has been associated with improved survival outcomes in various malignancies. However, studies in kidney cancer are conflicting. We performed a systematic review and meta-analysis to evaluate the association between metformin and kidney cancer survival.

Materials and Methods:

We searched Medline and EMBASE databases from inception to June 2017 to identify studies evaluating the association between metformin use and kidney cancer survival outcomes. We evaluated risk of bias with the Newcastle-Ottawa scale. We pooled hazard ratios (HRs) for recurrence-free, progression-free, cancer-specific, and overall survival using random effects models, and explored heterogeneity with metaregression. We evaluated publication bias through Begg’s and Egger’s tests, and the trim and fill procedure.

Results:

We identified 9 studies meeting inclusion criteria, collectively involving 7426 patients. Five studies were at low risk of bias. The direction of association for metformin use was toward benefit for recurrence-free survival (HR, 0.99; 95% confidence interval [CI], 0.36-2.74), progression-free survival (pooled HR, 0.84; 95% CI, 0.66-1.07), cancer-specific (pooled HR, 0.72; 95% CI, 0.48-1.09), and overall survival (pooled HR, 0.73; 95% CI, 0.50-1.09), though none reached statistical significance. Metaregression found no study-level characteristic to be associated with the effect size, and there was no strong evidence of publication bias for any outcome.

Conclusions:

There is no evidence of a statistically significant association between metformin use and any survival outcome in kidney cancer. We discuss the potential for bias in chemoprevention studies and provide recommendations to reduce bias in future studies evaluating metformin in kidney cancer.
Treatment of Uncomplicated Acute Diverticulitis Without Antibiotics: A Systematic Review and Meta-analysis
Authors: Au Stephanie , Aly Emad H.
Published: January 2019

BACKGROUND:

Despite low-quality and conflicting evidence, the Association of Coloproctology of Great Britain and Ireland recommends the routine use of antibiotics in the treatment of uncomplicated acute diverticulitis. Recent studies have shown that treatment without antibiotics did not prolong recovery. Some new guidelines currently recommend selective use of antibiotics.

OBJECTIVE:

The purpose of this study was to compare the safety, effectiveness, and outcomes in treating uncomplicated acute diverticulitis without antibiotics with treatment with antibiotics.

DATA SOURCES:

PubMed, Embase, Clinicaltrials.gov, and the Cochrane Library were searched with the key words antibiotics and diverticulitis.

STUDY SELECTION:

All studies published in English on treating uncomplicated acute diverticulitis without antibiotics and containing >20 individuals were included.

INTERVENTION:

Treatment without antibiotics versus treatment with antibiotics were compared.

MAIN OUTCOME MEASURES:

The primary outcome was the percentage of patients requiring additional treatment or intervention to settle during the initial episode. The secondary outcomes were duration of hospital stay, rate of readmission or deferred admission, need for surgical or radiological intervention, recurrence, and complication.

RESULTS:

Search yielded 1164 studies. Nine studies were eligible and included in the meta-analysis, composed of 2505 patients, including 1663 treated without antibiotics and 842 treated with an antibiotic. The no-antibiotics group had a significantly shorter hospital stay (mean difference = –0.68; p = 0.04). There was no significant difference in the percentage of patients requiring additional treatment or intervention to settle during the initial episode (5.3% vs 3.6%; risk ratio = 1.48; p = 0.28), rate of readmission or deferred admission (risk ratio = 1.17; p = 0.26), need for surgical or radiological intervention (risk ratio = 0.61; p = 0.34), recurrence (risk ratio = 0.83; p = 0.21), and complications (risk ratio = 0.70–1.18; p = 0.67–0.91).

LIMITATIONS:

Only a limited number of studies were available, and they were of variable qualities.

CONCLUSIONS:

Treatment of uncomplicated acute diverticulitis without antibiotics is associated with a significantly shorter hospital stay. There is no significant difference in the percentage of patients requiring additional treatment or intervention to settle in the initial episode, rate of readmission or deferred admission, need for surgical or radiological intervention, recurrence, or complications.
Combined Therapeutic Strategies for Keloid Treatment
Authors: Lee Young In , Kim Jihee , Yang Chae Eun , Hong Jong Won , Lee Won Jai , Lee Ju Hee
Published: January 2019

BACKGROUND

Recent advances in keloid management favor the administration of combination therapy over monotherapy.

OBJECTIVE

The authors evaluated the safety and efficacy of combination therapy to treat keloids using fractional lasers, cryotherapy, and intralesional corticosteroids.

MATERIALS AND METHODS

The authors performed a retrospective study involving 35 Korean patients. Each patient underwent treatment using the 1,550 nm nonablative fractional erbium-glass laser, followed by the 10,600 nm ablative fractional carbon dioxide laser. Laser treatment was immediately followed by the administration of superficial cryotherapy and intralesional triamcinolone injection. Therapeutic efficacy was assessed using the Vancouver Scar Scale (VSS) score and the 7-point patient self-assessment score.

RESULTS

The mean total and subcategory VSS scores showed statistically significant improvements. The height and pliability scores showed the most significant and quickest responses to the combination therapy. The patients reported remarkable improvement in itching, pain, and limitations of motion after a single combination therapy session. Twenty patients were followed up for 1 year after the discontinuation of the combination treatment, and the recurrence was observed only in one patient. No significant adverse effects were observed throughout the follow-up period.

CONCLUSION

Combination keloid therapy using fractional lasers, superficial cryotherapy, and intralesional triamcinolone injection is safe and more effective than individual monotherapies.
Contemporary Mohs Micrographic Surgery Histologic Preparation Methods, Laboratory-Assistive Personnel Training, and Practice Setting—A Survey Study
Authors: Ishii Lisa , Arshanapalli Ashish , Surprenant David , Reserva Jeave , Moy Lauren , Martin Brendan , Krol Cindy , Cesario Linda , Alam Murad , Tung Rebecca
Published: January 2019

BACKGROUND

The Mohs histotechnologist (MH) performs tissue preparation, sectioning, and staining, which are critical tasks in ensuring a successful Mohs micrographic surgery (MMS).

OBJECTIVE

To assess current norms in MH training, practice setting, and utilization of specific histologic techniques.

MATERIALS AND METHODS

A 16-question survey was created and distributed using Survey Monkey to all members of the American Society for Mohs Histotechnology.

RESULTS

Response rate was 30%. Most MHs received on-the-job training from other MHs or the Mohs surgeon. Mohs histotechnologists largely performed tasks related to tissue processing while Mohs surgeons generally illustrated the Mohs layer map. Automated routine staining was used in most laboratory tests, and laboratory tests used similar staining techniques. Most respondents worked in private offices verses academic centers. Total staining time was significantly longer at academic medical centers versus private offices (7 vs 5 minutes, p = .01).

CONCLUSION

These findings provide an updated profile of current laboratory training and tissue preparation techniques at MMS practices across the country. Understanding the roles of the MH in laboratory functioning may help laboratories adopt best practices.
Patient-Centered Outcomes for Skin Cancer Management: Utilization of a Patient Delphi Process to Identify Important Treatment Themes
Authors: Cartee Todd V. , Alam Murad , Armbrecht Eric S. , Behera Anit , Lawrence Naomi , Bordeaux Jeremy S. , Baum Christian L. , Rossi Anthony , Maher Ian A.
Published: January 2019

BACKGROUND

Patient-reported outcomes are critical to research directed at maximizing patient benefit. The outcomes patients consider most relevant in the treatment of skin cancer have not been directly investigated.

OBJECTIVE

To develop a ranked list of outcomes deemed most important by patients with skin cancer through a proctored Delphi process.

METHODS

Twenty-one patients with a history of skin cancer volunteered to participate in the patient summit. The patient members participated in a guided discussion to generate a long list of potentially relevant outcomes. The list was then condensed and ranked through 2 rounds of a proctored Delphi process.

RESULTS

Patients were diverse in their skin cancer histories and complexities, ages, and states of residence. Twelve themes were rated as highly important by 70% or more of participants. Most of these themes related to patient education and the collaborative nature of the physician–patient relationship. Fear of recurrence and cosmetic outcome were also highly rated. Limitations include a preponderance of older patients and patients from the midwest and northeast.

CONCLUSION

Patients with skin cancer overwhelmingly prioritize a shared decision-making process, in which they are actively engaged and value detailed education regarding their disease. This should inform future research directed at skin cancer treatment and current physician–patient interactions.
A Randomized, Vehicle-Controlled Phase 3 Study of Aminolevulinic Acid Photodynamic Therapy for the Treatment of Actinic Keratoses on the Upper Extremities
Authors: Brian Jiang Shang I. , Kempers Steven , Rich Phoebe , Marcus Stuart , Houlihan Anna , Piacquadio Daniel , Pariser David
Published: January 2019

BACKGROUND

Blue-light aminolevulinic acid photodynamic therapy (ALA-PDT) after broad-area application and 3-hour incubation is efficacious for actinic keratosis (AK) lesion clearance on upper extremities, with use of occlusive dressing significantly increasing efficacy.

OBJECTIVE

To prove the safety and efficacy of ALA-PDT versus vehicle (VEH-PDT) in the spot treatment of multiple AKs on upper extremities.

METHODS

Aminolevulinic acid or VEH was spot applied only to lesions on one upper extremity 3 hours before blue-light exposure. Treated extremity was covered with occlusive dressing during incubation. Identical treatment was repeated at Week 8 if AK lesions were present in the treated area.

RESULTS

Thirty-one percent (42/135) of subjects treated with ALA-PDT had complete clearance at Week 12, compared with 13% (17/134) of the subjects treated with VEH-PDT (p = .0001). The mean AK lesion clearance rate for ALA-treated subjects at Weeks 8 and 12 was 53% and 69%, respectively, compared with 26% and 30% for the VEH-treated group (p < .0001, linear mixed model). Safety profile observed in this study is consistent with previous studies/reports in the literature, and the therapy was well tolerated overall.

CONCLUSION

Aminolevulinic acid-PDT spot treatment using a 3-hour occluded incubation was superior to VEH-PDT for AK lesion clearance of the upper extremity.
Topical Aluminum Chloride and Monsel's Solution Block Toluidine Blue Staining in Mohs Frozen Sections: Mechanism and Solution
Authors: Chen Curtis L. , Wilson Steven , Afzalneia Reza , Chen Chih-Shan Jason
Published: January 2019

BACKGROUND

A diminished-staining artifact is observed in some Mohs frozen sections that are stained in toluidine blue (T-blue). Such an artifact, not yet described in the literature, may interfere with a Mohs surgeon's accurate reading. The authors hypothesize that topical hemostatic agents, aluminum chloride, and Monsel's solution are the causative factors.

OBJECTIVE

To evaluate the aforementioned topical hemostatic agents as a potential cause of the nonstaining artifact, to propose the mechanism associated with this phenomenon, and to develop a method to prevent or rectify the problem.

MATERIALS AND METHODS

Leftover Mohs frozen sections and specimens were treated with aluminum chloride or Monsel's solution and processed with routine Mohs histology.

RESULTS

Nonstaining artifact is reproduced in aluminum chloride or Monsel's solution–treated ex vivo skin specimens. The authors found that ethylenediaminetetraacetic acid (EDTA), a chelating agent, can reverse the staining blockage. Such a finding suggests that aluminum or ferric cations bind to tissue and subsequently inhibit T-blue from interacting with the tissue. Direct binding of ferric cations to the tissue section is demonstrated with Prussian blue iron staining.

CONCLUSION

By rinsing Mohs frozen sections in an EDTA solution before T-blue staining, the authors could prevent hemostatic agent–induced nonstaining. Applying an EDTA wash and restaining the slides can correct the same artifact.
A Review and Update of Treatment Options Using the Acne Scar Classification System
Authors: Boen Monica , Jacob Carolyn
Published: January 2019

BACKGROUND

An unfortunate consequence of acne vulgaris is residual scarring that can negatively affect a patient's quality of life.

OBJECTIVE

Jacob and colleagues have previously described an acne scar classification system based on acne scar pathology that divided atrophic acne scars into icepick, rolling, and boxcar scars, and this review will evaluate new and developing treatment options for acne scarring.

METHODS

A Medline search was performed on the various treatments for acne scars, and particular attention was placed on articles that used the acne scar classification system of icepick, rolling, and boxcar scars.

RESULTS

Therapies for acne scarring included surgical modalities, such as subcision, and punch excision and elevation, injectable fillers, chemical peels, dermabrasion, microneedling, and energy-based devices. In the past decade, there has been a trend toward using cosmetic fillers and energy-based devices to improve acne scarring.

CONCLUSION

There were few high-quality evidence-based studies evaluating the management of acne scarring. Many disparate acne severity scores were used in these studies, and the acne scar type was frequently undefined, making comparison between them difficult. Nonetheless, research into interventions for acne scarring has increased substantially in the past decade and has given patients more therapeutic strategies.
Facial Nerve Injury and Repair: A Practical Review for Cutaneous Surgery
Authors: Condie Daniel , Tolkachjov Stanislav N.
Published: January 2019

BACKGROUND

The facial nerve and its branches are at risk of injury during dermatologic surgery. Few publications in the dermatologic literature discuss facial nerve injury and management.

OBJECTIVE

To review facial nerve injury and management, including static and dynamic repair techniques, and to review outcomes in facial nerve reconstruction.

METHODS

Two detailed literature reviews were performed using PubMed. First, articles reporting facial nerve injury and/or management in the dermatologic literature were identified. In addition, articles pertaining to outcomes in facial nerve reconstruction with a minimum of 20 patients were included.

RESULTS

Fifty-three articles reporting outcomes in facial nerve reconstruction were identified and consist of retrospective reviews and case series. Most patients achieve improvement in facial symmetry and movement with nerve repair.

CONCLUSION

Timing of facial nerve repair is an important consideration in management of facial nerve injury, with earlier repairs achieving better outcomes. Facial nerve repair does not result in normal facial movement, and improvements may require a year or more to be realized. Many options exist for facial nerve reconstruction, and patients with long-standing facial nerve injuries may still benefit from treatment.
Subcutaneous Injection of Tranexamic Acid to Reduce Bleeding During Dermatologic Surgery: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial
Authors: Zilinsky Isaac , Barazani Tami Brutman , Visentin Denis , Ahuja Kiran , Martinowitz Uriel , Haik Josef
Published: January 2019

BACKGROUND

Topical application, oral, and IV injection of tranexamic acid (TXA) have been used to reduce surgical bleeding.

OBJECTIVE

To evaluate the safety and efficacy of TXA injected subcutaneously to reduce bleeding during dermatologic surgery.

METHODS

In this double-blinded, placebo-controlled, randomized prospective study, 131 patients were randomized to subcutaneous injection of lidocaine 2% diluted 1:1 with either saline (placebo) or TXA 100 mg/1 mL before surgery. Before the second stage or closure, size measurements of bloodstain impregnation on Telfa and surgical wound size were recorded and analyzed using mixed-effects linear regression. Subjective evaluation of hemostasis was performed using 4-point scale grading and analyzed using Fischer's exact test.

RESULTS

One hundred twenty-seven patients completed the study. The bloodstain to surgical wound size ratio was smaller in the TXA group (1.77) compared with the placebo group (2.49) (p < .001). An improved effect of TXA on bleeding was observed in the subgroup of patients receiving anticoagulants (mean difference; 95% confidence interval; −0.83; −1.20 to −0.46 p < .001). The subjective hemostasis assessment was significantly better in the TXA group overall (p = .043) and anticoagulant subgroup (p = .001) compared with the placebo group.

CONCLUSION

Subcutaneous injection of TXA was safe, reduced bleeding during dermatologic surgery, and particularly effective for patients receiving anticoagulation treatment.
A Clinical Review of Common Medications Used in Emergency Dermatological Situations
Authors: Mo Joshua H. , Chapman Lance W. , Cohen Joel L.
Published: January 2019

BACKGROUND

Medical emergencies can occur in any environment, including dermatologic and procedural surgical settings. There are many options available to dermatologic surgeons, which they should consider having easily accessible in the office in case an emergency arises.

OBJECTIVE

To summarize the current understanding about major medications that should be on-hand during dermatological surgeries. To review their mechanism of action, examine their general use, and dermatological use during surgical emergencies.

METHODS AND MATERIALS

A comprehensive review using PubMed was performed, searching for studies using these various medications in relation to cutaneous surgeries.

RESULTS

Distinct items such as hyaluronidase, nitroglycerin paste, aspirin, injectable epinephrine, and defibrillators are potential options to address various emergencies and should be readily accessible to dermatologic surgeons.

CONCLUSION

Dermatologic surgeons' knowledge of key medications and options to have in the office allow for a proper response in the event an emergency arises.
ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY CAN IMPROVE DIABETIC RETINOPATHY SCORE WITHOUT CHANGE IN RETINAL PERFUSION
Authors: Bonnin Sophie , Dupas Bénédicte , Lavia Carlo , Erginay Ali , Dhundass Myriam , Couturier Aude , Gaudric Alain , Tadayoni Ramin
Published: January 2019

Purpose:

To compare the changes in retinal perfusion on ultra–wide-field fluorescein angiography with the changes in diabetic retinopathy lesions observed on ultra–wide-field fundus color photographs after 3 monthly anti–vascular endothelial growth factor injections.

Methods:

Retrospective interventional cohort study analyzing the files of 14 patients with DR (18 eyes). UWF color photos and FA were analyzed at baseline (M0) and 1 month after the third anti-VEGF injection (M3). The main outcomes included the count of the number of red dots (microaneurysms, hemorrhages) and assessment of DR severity score (DRSS); the analysis of non-perfusion areas and disappearance or reappearance of arterioles or venules in the non-perfusion areas on FA.

Results:

Eighteen eyes of 14 diabetic patients, with mean age of 63 ± 5 years, were included. The DRSS score improved by at least one stage in 11/18 (61%) eyes. The mean number of red dots significantly decreased at M3 (n = 80 ± 85) compared with M0 (n = 139 ± 130) (P < 0.0001). No reperfusion of arterioles or venules was observed in or around nonperfusion areas.

Conclusion:

After anti–vascular endothelial growth factor injections, the improvement in the DRSS score based on color fundus photographs can occur without retinal reperfusion on ultra–wide-field fluorescein angiography.
EN FACE OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF INNER RETINAL DIMPLES AFTER INTERNAL LIMITING MEMBRANE PEELING FOR FULL-THICKNESS MACULAR HOLES
Authors: Navajas Eduardo V. , Schuck Nathan , Govetto Andrea , Akil Handan , Docherty Gavin , Heisler Morgan , Sarunic Marinko V. , Sarraf David
Published: January 2019

Purpose:

To quantitatively and qualitatively evaluate the microvascular and structural abnormalities associated with inner retinal dimpling after internal limiting membrane peeling for full-thickness macular holes using sequential en face optical coherence tomography (OCT) and OCT angiography.

Methods:

Thirteen eyes of 13 patients with idiopathic full-thickness macular holes were enrolled in the study. Patients were treated with pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade. Subjects were evaluated preoperatively and at postoperative Months 1, 3, and 6. At each visit, patients underwent a comprehensive ophthalmologic examination, en face OCT and OCT angiography. The morphology and number and proportionate area of inner retinal dimples were analyzed. Vessel density of the superficial vascular complex at all visits was also measured.

Results:

Inner retinal dimples were identified 1 month after surgery in all cases. The number and proportionate area of inner retinal dimples significantly increased over the follow-up period (P = 0.05). Preoperative vessel density of the superficial vascular complex was 17.9 ± 1.9 and did not change significantly over the follow-up period (P = 0.15).

Conclusion:

Inner retinal dimples are identified with en face OCT as early as the first month after internal limiting membrane peeling for idiopathic full-thickness macular holes and progressively increase in number and proportionate area in the subsequent 3 to 6 months after surgery. This may be the result of progressive deturgescence of the nerve fiber layer in the postoperative period.
STEM CELL THERAPIES, GENE-BASED THERAPIES, OPTOGENETICS, AND RETINAL PROSTHETICS:
Authors: Wood Edward H. , Tang Peter H. , De la Huerta Irina , Korot Edward , Muscat Stephanie , Palanker Daniel A. , Williams George A.
Published: January 2019

Purpose:

To review and discuss current innovations and future implications of promising biotechnology and biomedical offerings in the field of retina. We focus on therapies that have already emerged as clinical offerings or are poised to do so.

Methods:

Literature review and commentary focusing on stem cell therapies, gene-based therapies, optogenetic therapies, and retinal prosthetic devices.

Results:

The technologies discussed herein are some of the more recent promising biotechnology and biomedical developments within the field of retina. Retinal prosthetic devices and gene-based therapies both have an FDA-approved product for ophthalmology, and many other offerings (including optogenetics) are in the pipeline. Stem cell therapies offer personalized medicine through novel regenerative mechanisms but entail complex ethical and reimbursement challenges.

Conclusion:

Stem cell therapies, gene-based therapies, optogenetics, and retinal prosthetic devices represent a new era of biotechnological and biomedical progress. These bring new ethical, regulatory, care delivery, and reimbursement challenges. By addressing these issues proactively, we may accelerate delivery of care to patients in a safe, efficient, and value-based manner.
AQUEOUS HUMOR CYTOKINES AND THERAPEUTIC CUSTOMIZATION IN NONRESPONDING MACULAR EDEMA SECONDARY TO RETINAL VEIN OCCLUSION
Authors: Modi Aditya , Sharma Karen , Sudhakar Neha Peraka , Yadav Naresh Kumar
Published: January 2019

Aim:

To report an alternative cytokine-based customized therapeutic approach of macular edema secondary to retinal vein occlusion.

Methods:

A 64-year-old male patient presented with left eye macular edema secondary to central retinal vein occlusion, status after three consecutive anti–vascular endothelial growth factor injections. He was subsequently subjected to aqueous humor cytokine analysis. Vascular endothelial growth factor, interleukin-6 (IL-6), and interleukin-8 (IL-8) concentrations were determined using multiplex bead assay (BD Cytometric Bead Array). Based on the results, intravitreal steroid was administered. Follow-up examination included monitoring corrected distance visual acuity using Snellen's chart, central subfoveal thickness measurement on spectral domain optical coherence tomography (Spectralis, HRA2; Heidelberg engineering, Heidelberg, Germany) and cytokine quantification at the end of one and three months.

Results:

Baseline corrected distance visual acuity was counting fingers at 1 m, which subsequently improved to 6/12 Snellen equivalent 1 month after customized intravitreal therapy. Central subfoveal thickness demonstrated significant reduction from 529 to 253 µm; baseline vascular endothelial growth factor, IL-6, and IL-8 concentration were ascertained to be 29.94, 1.31, and 82.12 pg/mL (picograms/millilitre). One month after intravitreal steroid injection, the IL-8 levels normalized to 13.28 pg/mL. Functional and anatomical improvements were sustained till the last follow-up at 3 months.

Conclusion:

Customized intravitreal treatment provides an objective, alternative, and effective therapeutic approach for macular edema secondary to retinal vein occlusion.
DYNAMIC ECHOGRAPHY OF VARIX OF THE VORTEX VEIN AMPULLA
Authors: de Carlo Talisa E. , Mieler William
Published: January 2019

Purpose:

To describe four cases of varix of the vortex vein ampulla imaged with dynamic echography.

Methods:

Observational case series of four patients with varix of the vortex vein ampulla diagnosed with ocular examination maneuvers such as digital pressure or Valsalva. Dynamic echography was used to confirm the diagnosis.

Results:

Dynamic echography can quickly and noninvasively show the varix of the vortex vein ampulla disappear with external pressure, or engorge with a Valsalva maneuver or altered gaze directions.

Conclusion:

Dynamic echography is very helpful in the establishment of the diagnosis of varix of the vortex vein ampulla and differentiating this benign condition from other retinal or choroidal abnormalities.
BISPHOSPHONATE-INDUCED BILATERAL ANTERIOR UVEITIS AND CHOROIDAL EFFUSIONS WITH SECONDARY ANGLE CLOSURE
Authors: Thng Zheng Xian , Li Zhenghao Kelvin , Gan Nicola Yi'an
Published: January 2019

Purpose:

To report a case of bisphosphonate-induced bilateral anterior uveitis and choroidal effusions with secondary angle closure in a 64-year-old female patient.

Methods:

Observational case report.

Results:

A 64-year-old woman with history of scleroderma and antiphospholipid syndrome, presented with bilateral painless blurring of vision after commencement of alendronate. Clinical examination revealed bilateral anterior uveitis and choroidal effusions with resultant secondary angle closure in the left eye. Ultrasound biomicroscopy showed bilateral anteriorly rotated ciliary bodies. There was also a −2D myopic shift in the left eye. On drug cessation, complete resolution was seen within 2 weeks.

Conclusion:

In the absence of other plausible etiologies and with recent commencement of a new drug, we postulate that the anterior uveitis and choroidal effusions are likely due to alendronate. This is further supported by complete resolution of the inflammation and effusions once alendronate was withheld.
TRAUMATIC RETINAL DETACHMENT CAUSED BY NERF GUN SHOT IN A PEDIATRIC PATIENT
Authors: Mandviwala Murtaza M. , Sassani Patrick P.
Published: January 2019

Purpose:

To present a case of retinal detachment caused by a Nerf-gun shot in a pediatric patient.

Methods:

Single case report.

Results:

A 16-year-old white man presented with a nasal visual field deficit and floaters in his left eye for 1 month after being shot with a foam-ball Nerf gun by a friend. Fundus examination revealed a midperipheral retinal dialysis extending from 1 to 4:30 clock hours with a macula-on retinal detachment and superficial proliferative vitreoretinopathy. He underwent successful 25-gauge pars plana vitrectomy with membrane peel, retinectomy, injection of perfluoron, endolaser, and use of 1,000 centistoke silicone oil for tamponade.

Conclusion:

This is the first reported case of traumatic retinal detachment secondary to a Nerf-gun shot.
ACUTE MYOCARDITIS WITH CARDIOGENIC SHOCK AND MULTIPLE ORGAN FAILURE, FOLLOWED BY BILATERAL PANUVEITIS MASQUERADING AS ENDOGENOUS ENDOPHTHALMITIS, DUE TO TOXOPLASMA GONDII IN AN IMMUNOCOMPETENT PATIENT
Authors: Filipowicz Artur , Coca Mircea N. , Blair Barbra M. , Chang Peter Y.
Published: January 2019

Purpose:

To report a case of systemic and ocular toxoplasmosis in an immunocompetent patient, who developed myocarditis with resulting cardiogenic shock and multiple organ failure, followed by bilateral panuveitis masquerading as endogenous endophthalmitis.

Methods:

Single case report with images.

Results:

A 59-year-old man with a history of monoclonal gammopathy of undetermined significance and associated scleromyxedema but otherwise immunocompetent was admitted to the intensive care unit for cardiogenic shock and multiple organ failure due to presumed viral myocarditis. After hospital discharge, ophthalmic examination revealed what seemed to be endogenous fungal endophthalmitis in both eyes. The ocular inflammation failed to improve on local and systemic antifungal therapies. After repeated testing and vitrectomy, the causative organism responsible for his intraocular inflammation remained elusive. The patient was then found to have significantly elevated serum titers of anti–Toxoplasma gondii IgG and IgM, followed by an appearance of a focal retinochoroidal lesion more typical of ocular toxoplasmosis. Systemic anti-Toxoplasma therapy led to resolution of intraocular inflammation, and the patient had since fully recovered from the myocarditis and its multiple comorbidities. Of note, myocardial biopsy and polymerase chain reaction testing of aqueous and vitreous fluids were all negative for Toxoplasma.

Conclusion:

Even in an immunocompetent patient, Toxoplasma can result in myocarditis with significant morbidities and even death, and its ocular manifestation may be quite different from the classic focal retinochoroiditis. In addition, polymerase chain reaction analysis of ocular fluids can be unreliable in an immunocompetent host, and thus treatment decision should be guided by clinical history and examination findings.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY STUDY OF CHOROIDAL NEOVASCULARIZATION ASSOCIATED WITH EARLY-ONSET DRUSEN
Authors: Terao Ryo , Matsuda Aya , Ogawa Asako , Shimizu Kimiko , Azuma Keiko , Inoue Tatsuya , Obata Ryo
Published: January 2019

Purpose:

To report three middle-aged cases with choroidal neovascularization (CNV) associated with early-onset drusen documented with optical coherence tomography angiography (OCTA).

Methods:

Three patients with bilateral early-onset drusen were referred to our hospital. Fundus examination, fluorescein angiography, indocyanine green angiography, OCTA, and other multimodal imaging were performed.

Results:

Case 1 involved a 47-year-old woman who presented with sudden unilateral anorthopia. She had no previous systemic pathologies. Funduscopic examination and fluorescein angiography revealed bilateral large colloid drusen accompanied by unilateral mild subretinal hemorrhage. Indocyanine green angiography revealed CNV, although it was unclear in fluorescein angiography. Optical coherence tomography angiography also showed interconnecting CNV beneath the retinal pigment epithelium. Case 2 involved a 40-year-old woman with membranoproliferative glomerulonephritis Type 3 who presented with unilateral anorthopia. On fluorescein angiography, cuticular drusen secondary to membranoproliferative glomerulonephritis were seen in both eyes. An interconnecting vascular network was revealed with OCTA and indocyanine green angiography indicating Type 1 CNV in the affected eye. Case 3 involved a 47-year-old man without any medical or family history. Predominant large colloid drusen associated with cuticular drusen were seen in both eyes. Unilateral mild serosanguinous changes were accompanied in the macula, where Type 1 CNV was detected with OCTA.

Conclusion:

All our cases with early-onset drusen showed Type 1 CNV that was detected by indocyanine green angiography or OCTA. Optical coherence tomography angiography has a potential to help noninvasively diagnose CNV in the cases of EOD.
Comparison of Donor Cornea Endothelial Cell Density Determined by Eye Banks and by a Central Reading Center in the Cornea Preservation Time Study
Authors: Benetz Beth Ann , Stoeger Christopher G. , Patel Sanjay V. , O'Brien Robert C. , Szczotka-Flynn Loretta B. , Ayala Allison R. , Maguire Maureen G. , Menegay Harry J. , Bedard Peter , Clover Jameson M. , Gupta Pankaj C. , McCoy Kristen E. , Song Jonathan C. , Lass Jonathan H. ,   on behalf of the Cornea Preservation Time Study Group
Published: January 2019

Purpose:

To evaluate agreement between eye banks (EBs) and a reading center on endothelial cell density (ECD) determinations in the Cornea Preservation Time Study.

Methods:

The Cornea Image Analysis Reading Center (CIARC) performed variable frame image analysis on EB-obtained–preoperative central endothelial images (after lamellar dissection for Descemet stripping automated endothelial keratoplasty by the EBs or before shipping, if surgeon prepared) to determine ECD. The EBs performed their usual method of ECD determination. The CIARC and EBs also provided ECD determinations from screening central endothelial images taken by the EBs during donor evaluation. Two independent masked CIARC readers determined ECD with measurements averaged.

Results:

The mean preoperative ECD was 15 cells/mm2 greater by the EBs than by CIARC (N = 1286, P < 0.001) with 95% limits of agreement of (−644, 675 cells/mm2). The limits of agreement in preoperative ECD were wider in the After-Lamellar-Dissection Group (−687, 683 cells/mm2) than in the Before Shipping Group [(−505, 633 cells/mm2); P = 0.03]. The EBs-determined preoperative ECD was within 10% of the CIARC-determined ECD for 886 (69%) image sets, with 236 (18%) higher by >10% and 164 (13%) lower by >10%. Excellent agreement appeared between the EBs and CIARC when 100–300 cells could be analyzed in contrast to <100 cells (SD = 308 cells/mm2 vs. SD = 603 cells/mm2; P < 0.001).

Conclusions:

The mean ECD by the EBs and CIARC were similar, but there was considerable variability between determinations for individual corneas. Agreement improved between the 2 measurements when more than 100 cells were able to be analyzed.
Feasibility of Intraocular Projection for Treatment of Intractable Corneal Opacity
Authors: Shim Sarah Y. , Gong Songbin , Rosenblatt Mark I. , Palanker Daniel , Al-Qahtani Ahmed , Sun Michael G. , Zhou Qiang , Kanu Levi , Chau Felix , Yu Charles Q.
Published: January 2019

Despite many decades of research and development, corneal opacity remains a leading cause of reversible blindness worldwide. Corneal transplantation and keratoprosthesis can restore corneal clarity, but both have well-known limitations. High-resolution electronic microdisplays may offer an alternative to traditional methods of treating corneal disease using an intraocular implant to project imagery onto the retina, obviating the need for a clear cornea. In this study, we review previous work and recent technologic developments relevant to the development of such an intraocular projection system.
A Systematic Review and Meta-analysis of Methods for Reducing Local Anesthetic Injection Pain Among Patients Undergoing Periocular Surgery
Authors: Gostimir Mišo , Hussain Ahsen
Published: January 2019

Purpose:

Various factors help minimize pain during the injection of local anesthetic. The majority of current evidence involves nonspecific injection sites. The objective of this review was to provide a comprehensive summary of all existing evidence for methods used to reduce injection pain specifically in the context of periocular procedures.

Methods:

A literature search of the MEDLINE, EMBASE, and Scopus databases was conducted to identify all relevant experimental and observational studies from 1946 to 2018. Studies were included of patients undergoing periocular surgery under subcutaneous local anesthesia whereby outcomes were reported following a specific intervention intended to help reduce pain. Risk of bias was assessed using recognized tools. A subgroup meta-analysis was performed to indirectly compare pooled intervention-versus-control differences for various pain reduction interventions.

Results:

Following the review of 2089 search results, 23 articles representing 1135 patients were included. The methods assessed in the studies included choice of anesthetic agent, buffering, warming, dilution, needle type, administration of an inhalational anesthetic, application of topical anesthetics, iontophoresis, skin cooling with ice, tactile distraction with vibration, and decreasing the rate of injection.

Conclusions:

Methods demonstrating best efficacy included solution modification (buffering, dilution, warming), skin cooling with ice, vibration, transconjunctival topical anesthetic before injection, and decreased rate of injection. Further study is warranted for modification of equipment factors, topical anesthetics, and strategies to reduce pain because of anesthetic infiltration.