bluuebunny/crossref_metadata_2025 huggingface dataset:
Individualizing Thresholds of Cerebral Perfusion Pressure Using Estimated Limits of Autoregulation
Authors: Donnelly Joseph , Czosnyka Marek , Adams Hadie , Robba Chiara , Steiner Luzius A. , Cardim Danilo , Cabella Brenno , Liu Xiuyun , Ercole Ari , Hutchinson Peter John , Menon David Krishna , Aries Marcel J. H. , Smielewski Peter
Published: August 2017

Objectives:

In severe traumatic brain injury, cerebral perfusion pressure management based on cerebrovascular pressure reactivity index has the potential to provide a personalized treatment target to improve patient outcomes. So far, the methods have focused on identifying “one” autoregulation-guided cerebral perfusion pressure target—called “cerebral perfusion pressure optimal”. We investigated whether a cerebral perfusion pressure autoregulation range—which uses a continuous estimation of the “lower” and “upper” cerebral perfusion pressure limits of cerebrovascular pressure autoregulation (assessed with pressure reactivity index)—has prognostic value.

Design:

Single-center retrospective analysis of prospectively collected data.

Setting:

The neurocritical care unit at a tertiary academic medical center.

Patients:

Data from 729 severe traumatic brain injury patients admitted between 1996 and 2016 were used. Treatment was guided by controlling intracranial pressure and cerebral perfusion pressure according to a local protocol.

Interventions:

None.

Methods and Main Results:

Cerebral perfusion pressure-pressure reactivity index curves were fitted automatically using a previously published curve-fitting heuristic from the relationship between pressure reactivity index and cerebral perfusion pressure. The cerebral perfusion pressure values at which this “U-shaped curve” crossed the fixed threshold from intact to impaired pressure reactivity (pressure reactivity index = 0.3) were denoted automatically the “lower” and “upper” cerebral perfusion pressure limits of reactivity, respectively. The percentage of time with cerebral perfusion pressure below (%cerebral perfusion pressure < lower limit of reactivity), above (%cerebral perfusion pressure > upper limit of reactivity), or within these reactivity limits (%cerebral perfusion pressure within limits of reactivity) was calculated for each patient and compared across dichotomized Glasgow Outcome Scores. After adjusting for age, initial Glasgow Coma Scale, and mean intracranial pressure, percentage of time with cerebral perfusion pressure less than lower limit of reactivity was associated with unfavorable outcome (odds ratio %cerebral perfusion pressure < lower limit of reactivity, 1.04; 95% CI, 1.02–1.06; p < 0.001) and mortality (odds ratio, 1.06; 95% CI, 1.04–1.08; p < 0.001).

Conclusions:

Individualized autoregulation-guided cerebral perfusion pressure management may be a plausible alternative to fixed cerebral perfusion pressure threshold management in severe traumatic brain injury patients. Prospective randomized research will help define which autoregulation-guided method is beneficial, safe, and most practical.
Necrotizing Infundibular Crystalline Folliculitis: An Unusual Clinical Presentation and Demonstration of the Presence of Calcium Palmitate
Authors: Beaufrère Aurélie , Garcia Valérie , Frochot Vincent , Molina Thierry , Daudon Michel , Fraitag Sylvie
Published: August 2017

Necrotizing infundibular crystalline folliculitis (NICF) is a rare disorder, which was described for the first time by Lucke et al in 1999. NICF is characterized by multiple folliculocentric papules with a predilection for occurring in seborrheic areas in adults and corresponding dilated follicular ostia containing crystalline material. The precise pathogenesis and nature of this crystalline material are currently unknown. Here, we report an unusual case of NICF presented as an uncommon generalized skin rash in an adolescent. In addition, we present analysis using infrared microscopy for improved characterization of this crystalline material. Similar to previous cases, a biopsy revealed a dilated follicular ostium with the appearance of containing crystalline material associated with parakeratosis. Infrared microscopy analysis produced specific spectral features of calcium palmitate.
Eruptive Keratoacanthoma-Like Discoid Lupus Erythematosus
Authors: Georgesen Corey , Magro Cynthia
Published: August 2017

Hypertrophic discoid lupus erythematosus can resemble keratoacanthoma histomorphologically. We describe a unique case of eruptive keratoacanthomatous scaly papules in a 56-year-old woman with discoid lupus erythematosus. We review the literature and conclude by discussing important histologic features and useful immunostains to consider when attempting to discern the underlying identity and pathogenicity of such lesions.
Elastic Staining in Differentiating Between Follicular Streamers and Follicular Scars in Horizontal Scalp Biopsy Sections
Authors: Tan Timothy , Guitart Joan , Gerami Pedram , Yazdan Pedram
Published: August 2017

Background:

Accurate identification of follicular streamers versus follicular scars on horizontal scalp biopsy sections is important to differentiate between cicatricial and noncicatricial alopecias. However, distinguishing between them can be difficult especially in nonoptimal specimens. The utility of elastic Verhoeff–Van Gieson (EVG) stain in cicatricial alopecias has been described on vertical sections, but its evaluation on horizontal sections has not been performed.

Methods:

Sixty-four cicatricial alopecias (25 lichen planopilaris, 29 central centrifugal cicatricial alopecias, and 10 discoid lupus erythematosus) and 53 noncicatricial alopecias (34 androgenic alopecia, 8 telogen effluvium, and 11 alopecia areata) were identified, and EVG staining was performed on horizontal sections.

Results:

In follicular streamers, EVG highlighted an intact elastic network composed of delicate and thin elastic fibers circumferentially surrounding the angiofibrotic streamer without elastic network attenuation, loss, clumping, thickening, or recoil. In follicular scars, EVG demonstrated central attenuation and loss of the elastic network with peripheral clumping and recoil of elastic fibers.

Conclusions:

In cases where distinguishing between follicular streamers and scars is difficult, EVG may be a helpful adjunctive tool in this regard and aid in allowing better discrimination between cicatricial and noncicatricial alopecias.
Resilience in Adolescents with Cancer: Association of Coping with Positive and Negative Affect
Authors: Murphy Lexa K. , Bettis Alexandra H. , Gruhn Meredith A. , Gerhardt Cynthia A. , Vannatta Kathryn , Compas Bruce E.
Published: August 2017

Objective:

To examine the prospective association between adolescents' coping with cancer-related stress and observed positive and negative affect during a mother-adolescent interaction task involving discussion of cancer-related stressors.

Methods:

Adolescents (age 10–15 years) self-reported about their coping and affect approximately 2 months after cancer diagnosis. Approximately 3 months later, adolescents and mothers were video recorded having a discussion about cancer, and adolescents were coded for expression of positive affect (positive mood) and negative affect (sadness and anxiety).

Results:

Adolescents' use of secondary control coping (i.e., acceptance, cognitive reappraisal, and distraction) in response to cancer-related stress predicted higher levels of observed positive affect, but not negative affect, over time.

Conclusion:

Findings provide support for the importance of coping in the regulation of positive emotions. The potential role of coping in preventive interventions to enhance resilience in adolescents facing cancer-related stress is highlighted.
Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial
Authors: Fiks Alexander G. , Mayne Stephanie L. , Michel Jeremy J. , Miller Jeffrey , Abraham Manju , Suh Andrew , Jawad Abbas F. , Guevara James P. , Grundmeier Robert W. , Blum Nathan J. , Power Thomas J.
Published: August 2017

Objective:

To evaluate a distance-learning, quality improvement intervention to improve pediatric primary care provider use of attention-deficit/hyperactivity disorder (ADHD) rating scales.

Methods:

Primary care practices were cluster randomized to a 3-part distance-learning, quality improvement intervention (web-based education, collaborative consultation with ADHD experts, and performance feedback reports/calls), qualifying for Maintenance of Certification (MOC) Part IV credit, or wait-list control. We compared changes relative to a baseline period in rating scale use by study arm using logistic regression clustered by practice (primary analysis) and examined effect modification by level of clinician participation. An electronic health record–linked system for gathering ADHD rating scales from parents and teachers was implemented before the intervention period at all sites. Rating scale use was ascertained by manual chart review.

Results:

One hundred five clinicians at 19 sites participated. Differences between arms were not significant. From the baseline to intervention period and after implementation of the electronic system, clinicians in both study arms were significantly more likely to administer and receive parent and teacher rating scales. Among intervention clinicians, those who participated in at least 1 feedback call or qualified for MOC credit were more likely to give parents rating scales with differences of 14.2 (95% confidence interval [CI], 0.6–27.7) and 18.8 (95% CI, 1.9–35.7) percentage points, respectively.

Conclusion:

A 3-part clinician-focused distance-learning, quality improvement intervention did not improve rating scale use. Complementary strategies that support workflows and more fully engage clinicians may be needed to bolster care. Electronic systems that gather rating scales may help achieve this goal. Index terms: ADHD, primary care, quality improvement, clinical decision support.
Physician Awareness of Developmental Screening and Referral in the State of Kuwait
Authors: Hix-Small Hollie , Alkherainej Khaled
Published: August 2017

Objective:

In the State of Kuwait, family physicians and pediatricians are responsible for identifying and referring children at risk of disability. The aims of this study were to better understand physician (1) use of developmental screening instruments, (2) referral practices for children at risk of developmental disability, (3) interpretation of screening results, and (4) anticipatory guidance topics prioritized over child screening.

Methods:

A nonprobability volunteer, self-selection sample of family physicians, general practitioners, and pediatricians (n = 398) completed a 60-item paper questionnaire. Items assessed included: (1) practitioner familiarity with, belief in, and use of screening instruments; (2) familiarity with early childhood intervention services; (3) perceived barriers to screening implementation; and (4) anticipatory topics prioritized over screening. Logistic regression was used to test a priori hypotheses.

Results:

In general, family doctors and pediatricians practicing in public hospitals and primary health care centers in the State of Kuwait do not use or know how to use a developmental screening instrument, while over half prioritized immunization counseling over child screening. Screening confidence and training on using screening instruments increased the likelihood of tool use. Staff shortages, time constraints, and a perceived lack of Arabic screening instruments were barriers to tool use.

Conclusion:

Raising health care providers' awareness of standardized developmental screening instruments and establishment of an early identification system in the State of Kuwait are needed. Standardization and adaptation of technically sound Arabic-language screening tools for use in the State of Kuwait and physician training programs on screening are recommended.
Congenital Hypotonia in Toddlerhood
Authors: Steiner Naomi , Torres Alcy , Reddy Arathi , Augustyn Marilyn
Published: August 2017

CASE: David is a 22-month-old boy who is new to your practice. He recently moved from a rural area in the Midwest. His father is in the United States Air Force, and his mother works as a full-time homemaker. Their household includes 5 older siblings. The family moves every year because of the father's Air Force placement.

David was born full-term in Virginia, with no reported pregnancy complications and no alcohol, tobacco, or drug exposure. He was delivered vaginally, with Apgar scores of 7 and 9, respectively and no respiratory issues. In the newborn nursery, his nurse noted that he was floppy, with generalized low muscle tone. Laboratory work performed included normal thyroid studies and a chromosomal microarray.

Because of persistent hypotonia, he was seen by a pediatric neurologist at 9 months of age. A magnetic resonance imaging was performed and was normal, with no structural deficits noted. He was referred to Early Intervention at 6 months, when he was not yet rolling over. He received physical therapy for a few months before the family moved again for his father's next placement.

David presents in your office as a sweet nondysmorphic toddler who maintains steady eye contact and smiles responsively. His height, head circumference, and weight are at the 50th percentile. His physical examination is notable for generalized hypotonia, with intact upper and lower deep tendon reflexes. He spontaneously says about 20 words. He turns his head when his name is called and can follow a simple command, such as “clap, clap.” He reaches his whole hand toward desired objects and will look at his parents if they are out of reach. He can grasp a block, bang, and transfer objects. He demonstrates an immature pincer grasp. He can roll over and sit independently and is just beginning to pull to a stand. His parents report he has recently restarted Early Intervention, where he is receiving physical, speech, and occupational therapy. His audiology examination is normal.

His parents' primary concern today is regarding feeding. David is a picky eater. He has difficulty with new foods and textures. The parents noticed a regression in his tolerance for new foods around the recent move. He eats baby puffs, stage 2 to 3 baby foods, and fruit and vegetable pouches. He does not like soft, sticky foods. He is also reported to have other sensory sensitivities. He does not tolerate loud noises and is bothered by tags in his clothing. You wonder, what further work-up would be helpful for David? How can his feeding issues be addressed?
Postmenopausal choriocarcinoma: a rare case report and review of the literature
Authors: Guo Na , Yin Rutie , Li Qingli , Song Liang , Wang Danqing
Published: August 2017

Objective:

Choriocarcinoma is rare in postmenopausal women, and an early diagnosis contributes to a potential cure.

Methods:

We report a rare case of a postmenopausal woman with choriocarcinoma. The 61-year-old patient presented with irregular vaginal bleeding, 11 years after menopause and 30 years after the birth of the last child.

Results:

Radiological investigation found a 3-cm mass on the lower left part of the vaginal wall, and also bilateral lung nodules. Gynecological examination found 3-4 cm blue and purple nodules in the lower left part of the vaginal wall. Her serum CA125 and serum β-hCG levels were 10.2 and 9273.9 mIU/mL, respectively. The early diagnosis was a choriocarcinoma, and combination chemotherapy (etoposide, kengshengmycin, methotrexate, leucovorin, vincristine, and cyclophosphamide [EMACO]) was administered. After the sixth chemotherapy session, her serum β-hCG level was <2 mIU/mL, and two additional consolidation chemotherapy sessions were performed. She achieved serological remission, but 4 months after completion of the chemotherapy, a rise in serum β-hCG level was observed. Therefore, she was subjected to a second treatment with EMACO and fluorouracil (5-Fu) local injection chemotherapy. After nine chemotherapy sessions and three local 5-Fu injections, she showed a normal β-hCG level, with negative radiological results, and negative pigmentation in the lower left part of the vaginal wall. After a 4-year follow-up period, no local recurrence or distant metastases was found.

Conclusions:

This patient has shown a mild response to chemotherapy when compared with patients in reproductive age, and the combination of standard chemotherapy with local injection chemotherapy may be helpful for treating similar clinical cases.
Effects of multicomponent training on lean and bone mass in postmenopausal and older women: a systematic review
Authors: Marín-Cascales Elena , Alcaraz Pedro E. , Ramos-Campo Domingo J. , Rubio-Arias Jacobo A.
Published: August 2017

Objective:

The purpose of this systematic review was to update and examine to what extent multicomponent training interventions could improve lean and bone mass at different anatomical regions of the body in postmenopausal and older women.

Methods:

A computerized literature search was performed in the following online databases: PubMed MEDLINE, Cochrane, and Web of Knowledge. The search was performed to include articles up until February 2017. The methodological quality of selected studies was evaluated using the Cochrane risk of bias tool.

Results:

Fifteen studies met the inclusion criteria. Studies examining the effects of combined training methods in postmenopausal and older women showed contrasting results, possibly due to the wide range of the participants’ age, the evaluation of different regions, and the varying characteristics of the training methods between studies. Overall, it appears that exercise modes that combine resistance, weight-bearing training, and impact-aerobic activities can increase or prevent muscle and skeletal mass loss during the ageing process in women.

Conclusions:

Further studies are needed to identify the optimal multicomponent training protocols, specifically the training loads that will improve lean and bone mass at different anatomical locations, in postmenopausal and older women.
EN FACE VERSUS 12-LINE RADIAL OPTICAL COHERENCE TOMOGRAPHY SCAN PATTERNS FOR DETECTION OF MACULAR FLUID IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Adam Murtaza K. , Shahlaee Abtin , Samara Wasim A. , Maguire Joseph I. , Ho Allen C. , Hsu Jason
Published: August 2017

Purpose:

To compare fluid detection of autosegmented en face to 12-line radial spectral domain optical coherence tomography scan patterns in neovascular age-related macular degeneration.

Methods:

Retrospective observational case series. Sixty-seven patients (94 eyes) with neovascular age-related macular degeneration underwent autosegmented en face optical coherence tomography (with associated 304-line raster scan) and 12-line radial scan patterns. Sensitivity and specificity of fluid detection for en face scan and 12-line radial scans were determined by combining radial and 304-line raster scans as a gold standard.

Results:

Two hundred and fifty-eight en face and 12-line radial spectral domain optical coherence tomography scans were interpreted. Seventy-five scans (58.1%) had fluid, whereas 54 scans (41.9%) did not. En face scan pattern fluid detection sensitivity and specificity was 89.3% and 61.1%, respectively. Twelve-line radial scan pattern fluid detection sensitivity and specificity was 97.3% and 100%, respectively. The difference in fluid detection between scan patterns was statistically significant (P = 0.01). Decreased central macular thickness was associated with false-positive (P = 0.035) and false-negative (P = 0.01) fluid detection on en face scans.

Conclusion:

En face optical coherence tomography alone is not as sensitive or specific as the 12-line radial scan pattern in detecting fluid in neovascular age-related macular degeneration. En face scans should be corroborated with other optical coherence tomography protocols to guide clinical decision making.
INCREASED PHOTORECEPTOR OUTER SEGMENT VOLUME FOLLOWING SYSTEMIC TREATMENT OF BIRDSHOT CHORIORETINOPATHY
Authors: Docherty Gavin , Martens Rosanna , Forooghian Farzin
Published: August 2017

Purpose:

Retinal degeneration in birdshot chorioretinopathy can be quantified using spectral domain optical coherence tomography by measuring the photoreceptor outer segment (PROS) volume. The purpose of this study was to determine if the PROS volume in BSCR responds to systemic immunomodulatory therapy (IMT).

Methods:

Retrospective chart review with analysis of PROS volume derived from spectral domain optical coherence tomography.

Results:

We identified a total of three patients who met our inclusion criteria. At baseline, all patients had abnormal PROS and/or ellipsoid layer findings on spectral domain optical coherence tomography. After systemic immunomodulatory therapy, these abnormalities improved, and PROS volume increased, in all patients (P < 0.05).

Conclusion:

PROS volume can increase after systemic treatment of birdshot chorioretinopathy. This SD-OCT parameter may serve as a useful marker of retinal degeneration in BSCR, and may be a useful outcome measure in monitoring treatment response in birdshot chorioretinopathy.
A Novel Surgical Technique for Ahmed Valves in Refractory Glaucoma With Silicone Oil Endotamponade
Authors: Davo-Cabrera Juan Maria , Lanzagorta-Aresti Aitor , Alcocer Yuste Pablo
Published: August 2017

Purpose:

The purpose of the study is to describe a novel technique to implant Ahmed valves in patients with refractory glaucoma because of silicone oil (SO) endotamponade

Patients:

Three patients with glaucoma without SO removal were used as an example for this technique.

Methods:

Technique report.

Results and Conclusions:

We introduce a standard technique modification for Ahmed valves in patients with SO. This modification consists on locating the Ahmed valve more tangential to the limbus curvature instead of the usual perpendicular position and inserting the tube in the posterior chamber. The tube can be longer and run parallel to pupil. This technique allows use superotemporal quadrant (fewer complications), avoid corneal touch and decrease SO loss through the tube to subconjunctival space.
Speed of Improvement in Symptoms of Depression With Desvenlafaxine 50 mg and 100 mg Compared With Placebo in Patients With Major Depressive Disorder
Authors: Katzman Martin A. , Nierenberg Andrew A. , Wajsbrot Dalia B. , Meier Ellen , Prieto Rita , Pappadopulos Elizabeth , Mackell Joan , Boucher Matthieu
Published: August 2017

Purpose/Background

This post hoc analysis examined the time point at which clinically significant improvement in major depressive disorder (MDD) symptoms occurs with desvenlafaxine versus placebo.

Methods

Data were pooled from 9 short-term, double-blind, placebo-controlled studies in adults with MDD randomly assigned to desvenlafaxine 50 mg/d, 100 mg/d, or placebo. A mixed-effects model for repeated-measures analysis of change from baseline score was used to determine the time point at which desvenlafaxine treatment groups separated from placebo on the 17-item Hamilton Rating Scale for Depression and psychosocial outcomes. The association between early improvement and week 8 outcomes was examined using logistic regression analyses. Time to remission for patients with early improvement versus without early improvement was assessed using Kaplan-Meier techniques. Comparisons between groups were performed with log-rank tests.

Results

In the intent-to-treat population (N = 4279 patients: desvenlafaxine 50 mg/d, n = 1714; desvenlafaxine 100 mg/d, n = 870; placebo, n = 1695), a statistically significant improvement on the 17-item Hamilton Rating Scale for Depression was observed with desvenlafaxine 50 mg/d at week 1 (P = 0.0129) and with desvenlafaxine 100 mg/d at week 2 (P = 0.0002) versus placebo. Early improvement was a significant predictor of later remission. Treatment assignment, baseline depression scale scores, and race were significantly associated with probability of early improvement. On several measures of depressive symptoms and function, desvenlafaxine 50 mg/d and 100 mg/d separated from placebo as early as week 1 and no later than week 4 in patients with MDD.

Implications/Conclusions

These findings suggest that clinicians may be able to use depression rating scale scores early in treatment as a guide to inform treatment optimization.
Self-care in People With Motor Neuron Disease: An Integrative Review
Authors: Bassola Barbara , Lusignani Maura
Published: August 2017

Introduction: Self-care is a crucial aspect in the management of chronic diseases. People with motor neuron disease (MND) live with a chronic degenerative condition in rapid evolution, which leads them to high dependencies. During their illness, they must apply several behaviors including adherence to ventilation and nutritional therapy. Objective: The purpose of this review is to systematically explore the concept of self-care for people with MND. Method: An integrative review of the literature has been conducted. The electronic databases CINAHL, PubMed, and SCOPUS were searched. Results: Fifteen articles met the inclusion criteria and were reviewed; 7 of them discuss decision-making process and adherence to ventilation and nutritional therapy. Five of them discuss strategies used by people with MND to optimize living with this illness. Four of them discuss care and monitoring behaviors performed and recommended to people with MND. No studies focused on self-care in people with MND was identified in the literature. Conclusions: The concept of self-care in people with MND is related to inventiveness, to adaptability, and to dependence. Further studies seem to be needed to understand the concept of self-care in this population.
Cost Comparison of Socket-Suspended and Bone-Anchored Transfemoral Prostheses
Authors: Frossard Laurent , Berg Debra , Merlo Gregory , Quincey Tanya , Burkett Brendan
Published: August 2017

Introduction

This observational study compared historical costs for provision of socket prostheses with simulated costs for bone-anchored prostheses (BAPs).

Materials and Methods

The costs of transfemoral socket prostheses and BAP were extracted from the Queensland Artificial Limb Service's regulatory documentation according to K-levels and estimated for low-cost, budget, and high-cost limb options. Total costs including labor and parts after 6-year funding cycles were cross-compared for each socket and BAP fitting option.

Results

Labor and attachment costs were reduced by 18% and 79%, respectively, for all BAP options compared with any socket fitting. BAP was more economical by $18,200, $7,000, and $1,600 when fitted with low-cost, budget, and high-cost options, respectively, compared with sockets for K4. The low-cost limb was the only economical option compared with all sockets above K2. Other BAP options were uneconomical compared with socket fitting below K4.

Discussion

Suppliers of conventional prosthetic components can strongly impact the overall costs. Interestingly, manufacturers of BAP could play a decisive role given the cost of specific parts (e.g., connectors, protective devices).

Conclusions

The proposed approach for cost assessments could assist funding organizations worldwide working toward the development of fair and equitable financial assistance programs for individuals choosing BAP.
Evaluation of the Immediate Effect of Bracing on Gait Symmetry, Lower-Limb Kinematics, and Trunk and Pelvic Motion during Level Walking in Adolescents with Idiopathic Scoliosis
Authors: Karimi Mohammad Taghi , Kavyani Borojeni Mahsa
Published: August 2017

Background

Previous research using gait pathology in patients with adolescent idiopathic indicates gait asymmetry based on ground reaction force components, lower-limb joints, pelvic, and trunk excursion during level walking. However, evidence evaluating the effect of trunk bracing on these parameters and on symmetry of gait pattern is scarce. The aims of this study are to evaluate the range of motion of lower-limb joints as well as pelvic and trunk segments and to assess the symmetry of gait pattern in adolescents with idiopathic scoliosis when compared with normal subjects. The effect of trunk bracing on the aforementioned parameters is also investigated.

Method

Ten scoliotic patients (eight girls and two boys) aged between 10 and 16 years and ten normal subjects with comparable age, height, and weight were recruited for this study.

A three-dimensional gait analysis system and Visual3D software were used to evaluate joint range of motion of scoliotic patients in two conditions: with and without brace, as well as from the normal subjects without brace. The symmetry of gait was assessed by use of the asymmetry index.

Results

The results of this study showed that scoliosis led to a decrease in frontal hip, knee, pelvic, and trunk motion. Moreover, it was shown that patients with scoliosis walk with more restricted knee, pelvic, and trunk motions in the sagittal plane. There was no significant difference between the asymmetry index value between walking with and without orthosis. In our study, it was shown that the only discrepancy in the gait pattern between scoliotic patients and healthy subjects is an asymmetrical pelvic movement in the frontal plane.

Conclusion

The results of this study demonstrate that trunk bracing influences the pelvic range of motion and improved symmetry of range of motions of the pelvis. However, bracing did not influence the kinematic parameters of hip, knee, and ankle joints significantly.
Management of Chronic Hepatitis B in Pregnancy
Authors: Li Jie , Chang Matthew S. , Tran Tram T. , Nguyen Mindie H.
Published: August 2017

Chronic hepatitis B virus (HBV) infection due to mother-to-child transmission during the perinatal period remains an important global health problem. Despite standard passive-active immunoprophylaxis with hepatitis B immunoglobulin and hepatitis B vaccine in neonates, up to 8.5% of newborns still acquire HBV infection. Thus, management of chronic HBV during pregnancy and strategies to prevent mother-to-child transmission are important steps in eradicating or reducing the global burden of chronic HBV infection. To date, the management of HBV infection in pregnancy still needs careful attention because of some controversial aspects, including the influence of pregnancy on the course of HBV replication, safety of antiviral prophylaxis with nucleus(t)ide analogs, postpartum flares of hepatitis after delivery, and the safety of breastfeeding. In this review, we highlight these important issues of preventive strategies in the perinatal period.
Unexpected Effect of Propranolol and Prednisolone on Infantile Facial Rhabdomyosarcoma
Authors: Shilpakar Rojina , Lemperle Gottfried , Mentzel Thomas , Shakya Jaswan , Bhandari Santosh Bikram
Published: August 2017

A 14-month-old Nepalese infant had developed a rapidly growing facial tumor originating from a dark spot on her upper eyelid. A cavernous hemangioma was suspected and treated with high doses of propranolol and prednisolone. Remission was dramatic. Histology confirmed alveolar rhabdomyosarcoma. Chemotherapy was planned but not carried out due to complicated logistics. The girl died at the age of 3. We present this case for discussion as to whether propranolol and prednisolone might be effective in rapidly growing rhabdomyosarcomas.
Voriconazole Antifungal Prophylaxis in Children With Malignancies: A Nationwide Study
Authors: Pana Zoi Dorothea , Kourti Maria , Vikelouda Katerina , Vlahou Antonia , Katzilakis Nikolaos , Papageorgiou Maria , Doganis Dimitrios , Petrikkos Loizos , Paisiou Anna , Koliouskas Dimitrios , Kattamis Antonios , Stiakaki Eftichia , Chatzistilianou Maria , Vasilatou-Kosmidis Helen , Polychronopoulou Sophia , Grafakos Stelios , Roilides Emmanuel
Published: August 2017

Background:

Antifungal prophylaxis (AFP) is recommended in at-risk hematology-oncology patients. We evaluated the safety of AFP with voriconazole (VRC) in pediatric hematology/oncology patients.

Materials and Methods:

A retrospective study of VRC AFP in children with malignancies hospitalized in all 7 Greek pediatric hematology/oncology centers during 2008 to 2012 was conducted. Patients’ demographics, outcome, and adverse event (AE) data were recorded.

Results:

Four hundred twenty-nine VRC AFP courses in 249 patients (median age 6 y, 55% boys) were studied. The most common underlying diseases were acute lymphoblastic leukemia (51%), non Hodgkin lymphoma (8.6%), and acute myeloid leukemia (7.7%). The median number of VRC courses per patient was 1.7, whereas the median VRC dose was 7 mg/kg (range, 5 to 7 mg/kg) every 12 hours. During the last 2 weeks before AFP, 51% of the patients had received corticosteroids, 43% suffered from severe neutropenia, and 17.3% from mucositis. The median duration of VRC AFP was 17 days (range, 1 to 31 d). A single breakthrough fungemia due to Candida glabrata was recorded. Only 1 patient died due to the underlying disease. The most common AEs reported in 70/429 (16.3%) courses with ≥1 AE were elevated liver enzymes (50%), hypokalemia (24.3%), and ophthalmological disorders (14.3%). The median time of AE onset was 5 days (range, 1 to 21 d). Among 70 AEs reported, 38.5%, 48.4%, and 12.8% were of grade I, II, and III, respectively.

Conclusions:

VRC prophylaxis in pediatric hematology/oncology patients appears to be well tolerated.
Successful Extracorporeal Life Support in a Pediatric Hematopoietic Stem Cell Transplant Recipient With Periengraftment Respiratory Failure
Authors: Potratz Jenny , Ahlmann Martina , Rössig Claudia , Omran Heymut , Masjosthusmann Katja
Published: August 2017

The use of extracorporeal life support (ECLS) as ultimate salvage therapy for hematopoietic stem cell transplant recipients remains controversial among oncologists and critical care specialists. Prognosis is poor, particularly after allogeneic transplantation, and literature to guide clinical decision-making is scarce. Our report describes successful ECLS in a pediatric patient undergoing allogeneic hematopoietic stem cell transplantation, who developed acute respiratory failure during severe neutropenia, followed by immediate neutrophil engraftment. This unique case highlights periengraftment respiratory failure as a possible patient subgroup that could benefit from ECLS; and illustrates that the distinct etiologies of respiratory failure and the patients’ immune status deserve closer consideration in future studies evaluating ECLS in this high-risk population.
Intrathecal Infusion of Haploidentical Nondonor Lymphocytes for Central Nervous System Leukemic Relapse After Haploidentical Hematopoietic Stem Cell Transplantation
Authors: Mayumi Azusa , Sawada Akihisa , Ioi Aya , Higuchi Kohei , Shimizu Mariko , Sato Maho , Yasui Masahiro , Inoue Masami
Published: August 2017

Leukemic relapse in the central nervous system (CNS) after conventional treatment is associated with a poor prognosis. The effectiveness and safety of IV infusion of human leukocyte antigen (HLA)-mismatched lymphocytes for leukemia, and intrathecal (IT) infusion of HLA-mismatched lymphocytes for cerebrospinal fluid (CSF) dissemination of medulloblastoma have been reported. A 13-year-old girl (HLA-A31+) was diagnosed as relapsing from Philadelphia chromosome–positive acute leukemia in the CNS after receiving chemotherapy, tyrosine kinase inhibitors, haploidentical hematopoietic stem cell transplantation (HSCT) from her father (HLA-A31−), and craniospinal irradiation. We performed an IT infusion of haploidentical lymphocytes from her mother. Peripheral blood mononuclear cells obtained from her mother (HLA-A31+) were administered by IT infusion weekly. Examination of CSF 1 week after first IT showed that lymphocyte counts had increased markedly and the breakpoint cluster region/abelson-bearing cells had disappeared. Furthermore, CD3+ T cells in the CSF were negative for HLA-A31, and expressed high HLA-DR. These results indicate the infused non–HSCT-donor lymphocytes did not survive, and that the HSCT donor(father)–derived lymphocytes migrated to the CSF and were activated. The patient showed partial remission for 2 months following this therapy. Serious adverse reactions and graft versus host disease were not observed. To control leukemic CNS dissemination, haploidentical nondonor lymphocytes might contribute to a graft versus leukemia effect.
What Predicts Ongoing Nonsuicidal Self-Injury?
Authors: Kiekens Glenn , Hasking Penelope , Bruffaerts Ronny , Claes Laurence , Baetens Imke , Boyes Mark , Mortier Philippe , Demyttenaere Koen , Whitlock Janis
Published: August 2017

Although nonsuicidal self-injury (NSSI) peaks in adolescence, a significant proportion of young people continue to self-injure into emerging adulthood. Yet, little is known about factors prospectively associated with persistent NSSI. Using data from a 3-year longitudinal study (n = 1466), we compared 51 emerging adults (67.3% female; average age, 20.0 years) who continued to self-injure from adolescence and 50 emerging adults (83.7% female; average age, 20.3 years) who had ceased NSSI, on a broad range of psychosocial factors. More frequent NSSI, use of a greater number of methods, specific NSSI functions, academic and emotional distress, and lack of perceived emotion regulatory capability differentiated emerging adults who continued with NSSI and those who had ceased the behavior. Further, the relationships between social support, life satisfaction, and NSSI were mediated by perceived ability to regulate emotion. Findings from this study point to the role of personal belief in the ability to effectively regulate emotion in the cessation of NSSI. Future research directions and clinical implications are discussed.
The Impact of Negative Life Events on Attempted Suicide in Rural China
Authors: Liu Yanzheng , Zhang Jie
Published: August 2017

This study aims to explore the impact of negative life events (NLEs) on attempted suicide in a Chinese cultural setting. The sample comprised 791 suicide attempters and an equal number of controls matched on age, sex, and location from selected rural counties in China. Conditional logistic regression model was used to examine the association between NLEs and suicide risk. The impact of NLEs on attempted suicide was further examined using regression-based method to explore its mediation effect. The types of NLEs that were most likely to precede a suicide attempt in rural sample included the events in marriage/love, family/home, and friend/relationship. Rural women were more likely to experience more interpersonal conflicts than rural men. Approximately 75.6% of suicide attempters had experienced at least one NLE, and NLEs were strongly associated with attempted suicide. Total effect (0.676), direct effect (0.501), and the total indirect effect (0.301) of NLEs on suicide attempts were significantly mediated by hopelessness and depression. NLEs play a crucial role in predicting suicidal attempt in rural China, and they are mediated by depression and hopelessness.
Scaffolding Interprofessional Education
Authors: Zook Sharon Strang , Hulton Linda J. , Dudding Carol C. , Stewart Anne L. , Graham Amy C.
Published: August 2017

Fragmentation of health care negatively impacts quality; one of the contributing factors may be ineffective collaboration among health care professionals. This article describes the implementation of an interprofessional education curriculum for graduate students enrolled in nursing, psychology, and speech-language pathology programs. Over 3 semesters, students engaged in interprofessional collaboration modules, unfolding case studies, virtual simulation, and shared case planning experiences. The curriculum’s impact on students’ attitudes and values toward interprofessional collaborative practice was measured.
More Than 1 Million Potential Second Victims
Authors: Jones Jackie H. , Treiber Linda A.
Published: August 2017

Any error made in health care can cause the health care provider to become a second victim. There are many initiatives, tools, and instruments designed to support second victims after an error has been made. The role that nursing education can play in preventing nurses from becoming second victims has not been well explored. This article presents a study designed to investigate perceptions of recent BSN graduates about preparation for medication administration, medication error, and their personal experience with error making and second victimhood.
Liquid Crystal Spatial Light Modulators for Simulating Zonal Multifocal Lenses
Authors: Li Yiyu , Bradley Arthur , Xu Renfeng , Kollbaum Pete S.
Published: August 2017

SIGNIFICANCE

To maximize efficiency of the normally lengthy and costly multizone lens design and testing process, it is advantageous to evaluate the potential efficacy of a design as thoroughly as possible prior to lens fabrication and on-eye testing. The current work describes an ex vivo approach of optical design testing.

PURPOSE

The aim of this study was to describe a system capable of examining the optical characteristics of multizone bifocal and multifocal optics by subaperture stitching using liquid crystal technologies.

METHODS

A liquid crystal spatial light modulator (SLM) was incorporated in each of two channels to generate complementary subapertures by amplitude modulation. Additional trial lenses and phase plates were placed in pupil conjugate planes of either channel to integrate the desired bifocal and multifocal optics once the two optical paths were recombined. A high-resolution Shack-Hartmann aberrometer was integrated to measure the optics of the dual-channel system. Power and wavefront error maps as well as point spread functions were measured and computed for each of three multizone multifocal designs.

RESULTS

High transmission modulation was achieved by introducing half-wavelength optical path differences to create two- and five-zone bifocal apertures. Dual-channel stitching revealed classic annular rings in the point spread functions generated from two-zone designs when the outer annular optic was defocused. However, low efficiency of the SLM prevented us from simultaneously measuring the eye + simulator aberrations, and the higher-order diffraction patterns generated by the cellular structure of the liquid crystal arrays limited the visual field to ±0.45 degrees.

CONCLUSIONS

The system successfully simulated bifocal and multifocal simultaneous lenses allowing for future evaluation of both objective and subjective evaluation of complex optical designs. However, low efficiency and diffraction phenomena of the SLM limit the utility of this technology for simulating multizone and multifocal optics.
Effect of Time on Scleral Lens Settling and Change in Corneal Clearance
Authors: Otchere Heinz , Jones Lyndon W. , Sorbara Luigina
Published: August 2017

SIGNIFICANCE

With the increase in the use of scleral contact lenses among practitioners, questions regarding lens settling are gradually gaining attention. This is because current studies support the notion that scleral lenses settle back over time. More research is needed to understand the exact cause and the factors that underpin such phenomenon.

PURPOSE

The present study aims to assess the effect of time on topographic corneal clearance of three scleral contact lenses of varying sagittal depths.

METHODS

Three scleral contact lenses were fitted to 20 subjects with previous diagnosis of keratoconus (n = 18) or pellucid marginal degeneration (n = 2). The fit was based on corneal sagittal height measured with the Visante optical coherence tomographer (OCT) at 15 mm along the horizontal meridian. To select an appropriate lens from the diagnostic lens set, values of 325 μm (lens 1), 375 μm (lens 2), and 425 μm (lens 3) were randomly added in sequence to the corneal sagittal height. Subjects wore each lens for 1 hour. Corneal clearance was measured at 10-minute intervals for 1 hour using a custom ultra-long OCT. To assess change in clearance, central point and two mid-peripheral points (+3 mm and −3 mm) along an 8-mm chord were measured by taking differences at each time point up to 1 hour. Measurements were repeated for the two other lenses.

RESULTS

Mean central corneal clearance loss for all three lenses was 33.83 ± 48.40 μm. This was 26 ± 27 μm (13 ± 14 μm, +3 mm; 34 ± 37 μm, −3 mm), lens 1; 35 ± 59 μm (38 ± 61 μm, +3 mm; 52 ± 69 μm, −3 mm), lens 2; and 41 ± 54 μm (33 ± 26 μm, +3 mm; 52 ± 48 μm, −3 mm), lens 3, respectively. There was no significant difference (P = 0.06) at central and other locations for lens 1 (location and over time). There were significant differences for both lenses 2 and 3 (P < .001, P = .01, respectively) for all three locations and over time.

CONCLUSIONS

There is a likelihood of clearance loss after 1 hour of lens wear. This varies between subjects, initial lens-fit relationship, and over time.
Peripheral Refraction and Aberration Profiles with Multifocal Lenses
Authors: Fedtke Cathleen , Ehrmann Klaus , Thomas Varghese , Bakaraju Ravi C.
Published: August 2017

SIGNIFICANCE

The amount of central or peripheral myopic shift, as induced by different multifocal contact lenses when viewing objects at distance or near, may provide insights on the potential efficacy for slowing eye growth.

PURPOSE

The present study aims to compare peripheral refraction and higher-order aberration profiles of four multifocal contact lenses with a single vision control lens.

METHODS

Thirty-five myopes (age 21.2 ± 2.1 years) completed the trial, of whom 16 wore Air Optix Aqua and Proclear Multifocal Distance and Near (Group 1, spherical equivalent: −2.90 ± 0.95D), whereas 19 wore Air Optix Aqua, Air Optix Multifocal, and PureVision Multifocal (Group 2, spherical equivalent: −2.95 ± 0.78D). Refraction and aberration profiles with lenses were measured using the BHVI-EyeMapper with (−2.00 to −5.00D in 1.00D steps) and without (+1.00D fogging) accommodation. Data were quantified using M
2/4 (2nd and 2nd + 4th order), J
0, J
45, and higher-order aberration coefficients coma C[3, 1] and spherical aberration C[4, 0].

RESULTS

The center-distance lens exhibited a relative peripheral myopic shift in M
2/4 and J
0, positive on-axis C[4, 0], negative on-axis C[3, 1] and on-axis M
4 was less negative for accommodative demands ≤−3.00D (P < .05). Inversely, the center-near lenses showed a relative peripheral hyperopic shift in M
2/4 and J
0, negative on-axis C[4, 0], positive on-axis C[3, 1] and on-axis M
4 was more negative for demands of −2.00 and −3.00D (P < .05). Independent of lens type, relative peripheral M
4 significantly decreased during accommodation. Accounting for C[4, 0], a greater change in relative M profiles and accommodative responses was found for multifocal lenses.

CONCLUSIONS

Based on the hypothesis that myopic retinal defocus counters eye growth, center-near multifocal lenses exhibited the preferred on-axis features, i.e., producing a central myopic shift at near compared to the control. The center-distance lens exhibited preferred off-axis features, producing relative peripheral myopia, which increased further during accommodation.