bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic Review and Meta-Analyses: Motor Skill Interventions to Improve Fine Motor Development in Children Aged Birth to 6 Years
Authors: Strooband Karel F. B. , Rosnay Marc de , Okely Anthony D. , Veldman Sanne L. C.
Published: January 2020

Objective:

The objective of this study was to systematically review the evidence of motor skill intervention programs on typically developing children's fine motor development aged birth to 6 years.

Methods:

Six electronic databases were searched with no date restrictions. Inclusion criteria were any school-, community-, or home-based intervention targeting the development of fine motor skills of children aged birth to 6 years; randomized controlled trials using quasiexperimental, experimental, or single group prepost designs with a minimum sample size of 15 participants per group; and statistical analyses of fine motor skill development at both preintervention and postintervention or addressing the intervention effects on fine motor skill development. Data were extracted on design, participants, intervention components, methodological quality, and efficacy.

Results:

Twenty-five of the total 31 studies reported positive intervention effects on fine motor skills. The meta-analyses included 19 studies and revealed moderate effect sizes of motor skill programs on fine motor, visual motor, and manual dexterity outcomes. There were substantial differences between intervention settings, facilitators, length, and content with most studies implemented in school settings and facilitated by teachers.

Conclusion:

Fine motor skill development in the early years is an extensive upcoming field of interest for many international researchers. This review study presents evidence on the positive effects of intervention programs that aim to enhance fine motor skills for young children. The findings are promising but need to be interpreted with caution because of the high risk of bias in many of the studies.
Wandering Among Preschool Children with and Without Autism Spectrum Disorder
Authors: Wiggins Lisa D. , DiGuiseppi Carolyn , Schieve Laura , Moody Eric , Soke Gnakub , Giarelli Ellen , Levy Susan
Published: January 2020

Objectives:

(1) Report the occurrence of wandering, or leaving a supervised space, among children with confirmed autism spectrum disorder (ASD), other developmental delay (DD) with a previous but unconfirmed ASD diagnosis (DDprevASD), DD without a previous ASD diagnosis, and a population comparison group (POP) at an age when wandering is no longer expected and (2) explore whether ASD status is associated with wandering independent of behavioral, developmental, and maternal factors.

Method:

Parents and children aged 4 to 5 years enrolled in the Study to Explore Early Development Phase-1+2. All children were screened for ASD symptoms upon enrollment. Those with ASD symptoms and/or a previous ASD diagnosis received the Mullen Scales of Early Learning (MSEL) to determine their developmental level and 2 ASD diagnostic tests to determine their ASD status. All other children were evaluated with the MSEL alone. Mothers completed the Child Behavior Checklist/1½-5, which includes an item on whether the child wanders away (categorized as at least sometimes true vs not true) and items assessing behavior problems.

Results:

Children with ASD (N = 1195) were significantly more likely to wander than children classified as DDprevASD (N = 230), DD (N = 1199), or POP (N = 1272) (60.4%, 41.3%, 22.3%, and 12.4%, respectively, p < 0.01). ASD status, very low developmental level, and affective, anxiety, attention, and oppositional problems were each independently associated with wandering behavior.

Conclusion:

Wandering is significantly more common among children with ASD and those with behavioral and developmental problems compared with other children. These findings can be used to increase the awareness of wandering among children with atypical development.
Postoperative Infections in Dermatologic Surgery: The Role of Wound Cultures
Authors: Ken Kimberly M. , Johnson Mariah M. , Leitenberger Justin J. , Neal Donald E. , Etzkorn Jeremy R. , Govas Panayiota , Carroll Bryan T. , Badawi Ahmed H. , Mudigonda Tejaswi , Council M. Laurin , Avila Christina , Carr David R. , Sasaki Jodie , Blalock Travis W. , Golda Nicholas J.
Published: January 2020

BACKGROUND

Dermatologic surgery is associated with low postoperative infection rates, averaging from approximately 1% to 4.25%. Often, postoperative infections are treated empirically based on clinical diagnosis of infection, given it can take 48 to 72 hours for a wound culture to identify a pathogen.

OBJECTIVE

We aimed to evaluate the efficacy of empiric antibiotics in dermatologic surgery postoperative infections and if wound cultures change postoperative antibiotic therapy.

METHODS

A 7-center, retrospective analysis of postoperative infections, with culture data, in dermatologic surgery patients was performed.

RESULTS

Of 91 cases of clinically diagnosed postoperative infection, 82.4% (n = 75) were successfully treated with empiric oral antibiotics (95% confidence interval [0.73–0.89], p < .0001). In 16 (17.6%) cases, initial empiric antibiotics were unsuccessful, and wound culture results altered antibiotic therapy in 9 cases (9.9%) with 6 (6.6%) of these cases requiring additional coverage for methicillin-resistant Staphylococcus aureus (MRSA).

CONCLUSION

Empiric antibiotic treatment is usually appropriate for patients with postoperative surgical-site infections with wound cultures altering antibiotic management in a minority of cases. When empiric antibiotics fail, lack of MRSA coverage is usually the cause; therefore, providers should be aware of local MRSA prevalence and susceptibilities.
Botulinum Toxin Injections for Leg Contouring in East Asians
Authors: Cheng Judy , Chung Hye Jin , Friedland Matthew , Hsu Sarah Hahn
Published: January 2020

BACKGROUND

A common aesthetic concern among East Asian women is enlarged calves. Although surgical resection has been a traditional treatment option, botulinum toxin injections into the gastrocnemius muscle are an emerging, noninvasive alternative.

OBJECTIVE

To perform a literature review on botulinum toxin injections for leg contouring.

MATERIALS AND METHODS

A literature review was conducted using PubMed, Web of Science, Embase, and Cochrane's CENTRAL database to identify articles relating to combinations of the terms botulinum toxin, gastrocnemius, calves, and leg contouring.

RESULTS

Based on the limited publications to date, the authors prepared a review on how to treat an enlarged calf with botulinum toxin including injection techniques, anticipated efficacy, outcome monitoring, and potential side effects.

CONCLUSION

Botulinum toxin injections for calf reduction are an emerging, noninvasive treatment option. Studies to date suggest that it is an efficacious method with few immediate side effects. Future areas for investigation include defining the criteria for calf hypertrophy, minimum effective dosage of botulinum toxin, and the potential long-term effects of injections.
Perception of Beauty in the Visually Blind: A Pilot Observational Study
Authors: Dayan Steven H. , Cristel Robert T. , Gandhi Nimit D. , Fabi Sabrina G. , Placik Otto J. , Montes Jose R. , Kalbag Arjun
Published: January 2020

BACKGROUND

Blind individuals have demonstrated the ability to detect danger and facial expressions without conscious awareness of visual stimuli. These embodied sensations are believed to be the result of primitive neural networks refined by evolutionary adaptations. We postulate that similar embodied sensations may have evolved to allow blind individuals to perceive beauty.

OBJECTIVE

To determine whether the visually blind can detect physical beauty.

PATIENTS AND METHODS

This observational study consisted of 8 blind and 10 nonblind test subjects and 6 models that were categorized into predetermined beauty categories. Test subjects were individually asked to rate 6 models on a 1 to 10 numerical beauty scale. This process was repeated in both groups while blindfolded (masked). All groups' mean model beauty scores underwent multivariate and univariate analysis.

RESULTS

All groups rated preselected (greater than 8) more beautiful models, higher except for the masked, nonblind group. Intraclass correlation was good in the blind raters with a score of 0.751, whereas poor in the nonblind masked raters with a score of 0.458.

CONCLUSION

This is the first pilot study demonstrating with supporting evidence that blind individuals can detect beauty and supports that beauty may rely on primal forms of messaging that are subconsciously appreciated.
High-quality chest compressions are possible during intra-hospital transport, but depend on provider position
Authors: Jansen Gerrit , Kipker Kristin , Latka Eugen , Borgstedt Rainer , Rehberg Sebastian
Published: January 2020

BACKGROUND

Treatment of reversible causes of cardiac arrest often requires intrahospital transportation during ongoing resuscitation. But high-quality chest compression with minimal interruption is the most essential prerequisite for an optimal outcome after cardiac resuscitation.

OBJECTIVE

We aimed to evaluate chest compression quality according to the provider position during intrahospital transportation.

DESIGN

Manikin observational study.

SETTING

German Tertiary Care Hospital.

PARTICIPANTS

A total of 20 paramedics (eight female, 12 male); average professional experience 4.8 ± 3.1 years since their initial enrolment for training.

INTERVENTION(S)

Participants performed chest compressions during simulated intrahospital transportation in four groups: provider kneeling beside manikin on the floor (control group), walking next to the bed (group 1), kneeling on the bed beside the manikin (group 2), kneeling astride the manikin on the bed (group 3).

MAIN OUTCOME MEASURES

Quality metrics as European Resuscitation Council Guidelines 2015. Subsequently, the participants were asked to assess their own subjective feelings of safety, comfort and strain, and to recommend one position.

RESULTS

The quality of chest compression in the control group and groups 2 and 3 did not differ significantly. Group 1 performed significantly worse in terms of the correct hand placement on the chest (P = 0.044 vs. control group) and compression depth (P = 0.004 vs. control group, P = 0.035 vs. group 2, P = 0.006 vs. group 3). Transport speed was faster in groups 2 and 3 vs. group 1 (P < 0.05 vs. group 1, P < 0.05 vs. group 2). The majority of participants rated position 1 as unsafe (90%), unpleasant (100%) and exhausting (100%). They predominantly favoured position 3 (70%).

CONCLUSION

Performing guideline-compliant chest compressions during intra-hospital transportation is feasible with an appropriate provider position. Our results suggest, kneeling beside or astride the patient on the bed enables high-quality chest compressions, faster transport and is perceived by the providers as more pleasant. ‘Walking next to the bed’ while performing chest compressions should be avoided.
Postoperative residual neuromuscular blockade after reversal based on a qualitative peripheral nerve stimulator response
Authors: Lee Yea-Ji , Oh Ah-Young , Koo Bon-Woo , Han Ji-Won , Park Jae-Hee , Hong Jung-Pyo , Seo Kwang-Suk
Published: January 2020

BACKGROUND

Incomplete recovery of neuromuscular blockade is a common postoperative adverse event in the postanaesthesia care unit.

OBJECTIVE

We examined and compared the incidence of residual neuromuscular blockade when the recommended dose of neostigmine or sugammadex was administered according to a qualitative nerve stimulator response.

DESIGN

A randomised controlled trial.

SETTING

A tertiary care hospital in South Korea from September 2017 to November 2017.

PATIENTS

Eighty patients aged between 18 and 69 years were included in this study. All were patients scheduled to undergo elective laparoscopic cholecystectomy and who had an American Society of Anaesthesiologists physical status of one or two were eligible.

INTERVENTIONS

Patients were allocated randomly to receive neostigmine or sugammadex at the end of surgery. The doses of the reversal agents were based on the response to peripheral nerve stimulation, which was discontinued after administration of the reversal agent.

MAIN OUTCOME MEASURES

The primary outcome was the incidence of postoperative residual neuromuscular blockade. The secondary outcomes were the incidences of symptoms or signs of residual neuromuscular blockade such as hypoxaemia, inability to maintain head-lift for 5 s and diplopia.

RESULTS

The incidence of residual neuromuscular blockade on arrival in the recovery room was 44.4% in the neostigmine group and 0% in the sugammadex group (P < 0.0001, relative risk = 1.80, 95% confidence interval 1.36 to 2.41). The incidences of adverse events in the recovery room were low and comparable between the groups.

CONCLUSION

The incidence of residual neuromuscular blockade on arrival in the recovery room was significantly higher in the neostigmine group than that in the sugammadex group. However, the incidence of adverse events was similar in the neostigmine and sugammadex groups.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03292965.
Management of Sural Nerve Neuromas with Targeted Muscle Reinnervation
Authors: Fracol Megan E. , Dumanian Gregory A. , Janes Lindsay E. , Bai Jennifer , Ko Jason H.
Published: January 2020

Neuromas are a debilitating peripheral nerve problem due to aberrant axon sprouting and inflammation after nerve injury. The surgical management of neuromas has for a long time been up for debate, largely due to lack of consistent, reliable outcomes with any one technique. We have found success utilizing targeted muscle reinnervation, a technique originally described in amputees that re-routes the proximal ends of cut sensory nerve stumps into the distal ends of motor nerves to nearby muscles. In doing so, the sensory nerve ending can regenerate along the length of the motor nerve, giving it a place to go and something to do. In this report, we describe our technique specifically for targeted muscle reinnervation of sural nerve neuromas that is applicable to both amputees and to patients with intact limbs. Sural nerve neuromas can occur after sural nerve harvest for reconstructive procedures and particularly after lateral malleolar incisions for orthopedic access to the calcaneus. By re-routing the sural nerve into a motor nerve of the lateral gastrocnemius muscle, we are able to manage a variety of sural nerve neuromas presenting anywhere along the course of the sural nerve and in a variety of clinical settings.
Gender Bias in the Integrated Plastic Surgery Residency: A Snapshot of Current Trends
Authors: Karamanos Efstathios , Julian Bao-Quynh , Wampler Mallory , Sippel Michael , Shah Amita , Wang Howard
Published: January 2020

Introduction:

According to the American Society of Plastic Surgeons, the male to female ratio of plastic surgeons is approximately 5:1. As more surgical specialties are recruiting female residents, there has been an increase in the amount of females. We set out to examine the current trends in residency recruitment and whether a quantifiable gender bias exists.

Methods:

A review of all the integrated plastic surgery programs within the United States was conducted. Data were collected regarding department or division status, the gender of the chairman and the program directors, the number of residents per year and gender of residents per year. The ratio of male to female residents was calculated.

Results:

A total of 62 residency programs were identified. The vast majority had a male program director with only 8 female program directors identified. The mean ratio of female/male (F/M) residents overall was 1/1.2. Female program directors selected residents in the same ratio as their male counterparts [F/M ratio: 1/1.26 versus 1/1.18, p:0.813]. A linear logistic regression failed to identify the geographic location, department status, gender of the department chairman or the number of residents selected per year as predictors of higher F/M ratio.

Conclusions:

There are still fewer female program directors and residents in plastic surgery overall. However, neither was more likely to select a resident of their own gender. This analysis does not rule out the possible self-selection factor.
Remote Ischemic Preconditioning in Microsurgical Head and Neck Reconstruction: A Randomized Controlled Trial
Authors: Krag Andreas E. , Hvas Anne-Mette , Hvas Christine L. , Kiil Birgitte J.
Published: January 2020

Background:

The free flap failure rate is 5% in head and neck microsurgical reconstruction, and ischemia–reperfusion injury is an important mechanism behind this failure rate. Remote ischemic preconditioning (RIPC) is a recent intervention targeting ischemia–reperfusion injury. The aim of the present study was to investigate if RIPC improved clinical outcomes in microsurgical reconstruction.

Methods:

Head and neck cancer patients undergoing tumor resection and microsurgical reconstruction were included in a randomized controlled trial. Patients were randomized (1:1) to RIPC or sham intervention administered intraoperatively just before transfer of the free flap. RIPC was administered by four 5-minute periods of upper extremity occlusion and reperfusion. Clinical data were prospectively collected in the perioperative period and at follow-up on postoperative days 30 and 90. Intention-to-treat analysis was performed.

Results:

Sixty patients were randomized to RIPC (n = 30) or sham intervention (n = 30). All patients received allocated intervention. No patients were lost to follow up. At 30-day follow-up, flap failure occurred in 7% of RIPC patients (n = 2) and 3% of sham patients (n = 1) with the relative risk and 95% confidence interval 2.0 [0.2;20.9], P = 1.0. The rate of pedicle thrombosis was 10% (n = 3) in both groups with relative risk 1.0 [0.2;4.6], P = 1.0. The flap failure rate did not change at 90-day follow-up.

Conclusions:

RIPC is safe and feasible but does not affect clinical outcomes in head and neck cancer patients undergoing microsurgical reconstruction.
Massive Localized Abdominal Lymphedema Treatment Challenges
Authors: Al-Tarrah Khaled , Ashour Tarek , Rao Rajashankar , Rayatt Sukhbir , Thomas Sunil S.
Published: January 2020

Massive localized lymphedema of the abdomen is a rare condition resulting from a neglected lower abdominal pannus associated with significant disability and morbidity. Compared to other surgical procedures, postbariatric surgery is usually considered a financial drain. In the United Kingdom, this requires National Health Service approval and delays may lead to sequelae that adversely impact on patients’ quality of life with increased morbidity. We present a wheelchair-bound patient whose body mass index increased from 53 to 82, while awaiting funding approval increasing her anesthetic and surgical risks. A multidisciplinary approach is mandatory for preoperative, intraoperative, and postoperative care for these patients including anesthetic input and high dependency unit care. Managing this patient was a significant anesthetic and surgical challenge with 47-kg resected tissue. The planning and perioperative measures to minimize morbidity are discussed.
Bridging Acellular Dermal Matrix in Abdominal Wall Repair following Radical Resection of Recurrent Endometrioma
Authors: Hackenberger Paige N. , Poteet Stephen J. , Janis Jeffrey E.
Published: January 2020

The patient is a 31-year-old woman with a history of prior resection of a presumed keloid scar around her Pfannenstiel incision found to be endometrial tissue on final pathology. She presented 5 years later with recurrence of pain and a mass associated with menses despite maximal medical therapy for endometriosis. Computed tomography of her abdomen and pelvis demonstrated an infiltrative soft tissue mass measuring 8.8 cm × 4.0 cm. Surgical oncology conducted an en bloc resection of the mass and obstetrics and gynecology performed a concomitant total abdominal hysterectomy and bilateral salpingo-oophorectomy. Plastic and reconstructive surgery completed the repair of the final 23 cm × 10 cm full-thickness abdominal wall defect with bridging biologic mesh, complex layered closure, and incisional negative-pressure wound therapy. Final pathology confirmed a diagnosis of endometriosis. Patient’s hospital course was uncomplicated, and follow-up at 6 months does not demonstrate clinical or radiographic evidence of bulge or hernia recurrence. Abdominal wall endometrioma is a well-documented occurrence in prior cesarean scars; plastic surgeons can contribute to a multidisciplinary approach in reconstruction when resection compromises abdominal wall integrity, necessitating expertise in complex repairs.
Analysis of Trends in the Selection and Production of U.S. Academic Plastic Surgery Faculty
Authors: Daneshgaran Giulia , Cooper Michael N. , Ni Pauline , Zhou Sarah , Weichman Katie E. , Wong Alex K.
Published: January 2020

Purpose:

In academic plastic surgery, there is a paucity of data examining the relationship between program rank, faculty training history, and production of academic program graduates. The purpose of this study is to determine objective faculty characteristics that are associated with a high program reputation.

Methods:

Accreditation Council for Graduate Medical Education-accredited integrated Plastic and Reconstructive Surgery (PRS) programs were ranked using Doximity and divided into Top-quartile programs and Other programs. Accredited medical schools were ranked using U.S. News and World Report. Individual faculty profiles were reviewed on program websites for information on prior training.

Results:

Seventy-nine programs with 712 faculty were identified and objectively analyzed. Compared to Other PRS programs, Top-quartile programs had a higher proportion of faculty that trained at Top-quartile residency programs (P < 0.0001) and Top-quartile medical schools (P < 0.0001). Top-quartile programs also had the highest proportion of faculty that trained at the same institution for fellowship (P = 0.0001), residency (P = 0.03), medical school (P = 0.4), or any prior training (medical school, residency, or fellowship) (P = 0.002). Top-quartile programs were associated with the largest total faculty size (P < 0.0001) and the largest number of graduates entering the field of academic plastic surgery (P < 0.0001).

Conclusions:

Program reputation is associated with PRS faculty selection and production. Top-ranked programs are more likely to have faculty that previously trained at the same institution or at top-ranked programs. Top-ranked programs are more likely to graduate residents that will become academic plastic surgeons.
Trends in Academic “Ghost Publications” in Plastic Surgery Residency Applications: A 3-Year Study
Authors: Rodriguez-Unda Nelson A. , Webster Nicholas D. , Verheyden Charles N.
Published: January 2020

Background:

Plastic surgery is an attractive specialty to medical students. Residency training programs have the luxury of selecting their trainees from the “cream of the crop” from United States medical schools. Because of the steep competition for PGY-1 integrated program positions, the temptation exists for applicants to falsify parts of their applications, particularly those parts that are difficult to verify.

Methods:

A retrospective analysis of the Integrated Plastic Surgery applications from the years (2010–2013) was done. Two reviewers manually and independently handsearched each of the articles in the databases (Medline, Scopus, Clinical trials, Google scholar) additionally, a specialized medical librarian corroborated. A ghost article was defined as the inability to find the listed applicant in the authorship list of the claimed article/abstract/chapter or the inability to find the submitted article. Misrepresentation was defined as a change in authorship order. Data were summarized and analyzed, generalized estimating equations model was used. SAS software, v9.4.

Results:

All 392 applicants were included, 159 (2010–2011), 120 (2011–2012), and 119 (2012–2013). The number of manually reviewed records was 2,124. “Ghost” authorship was found in 234 articles out of 2,124 (11.02%). The overall rate of “Ghost” authorship in applicants to our program was found to be 34.4%, 135 applicants and misrepresentation in 5 cases (1.28%).

Conclusions:

Ghost publications are present in Plastic Surgery applications, its trend is similar through the years, “protective” factors are: first authorship and published peer reviewed abstract/article.
How do ultrafine particles in urban air affect ambulatory blood pressure?
Authors: Soldevila Núria , Vinyoles Ernest , Tobias Aurelio , Banegas José R. , De La Sierra Alejandro , Gorostidi Manuel , Segura Julián , De La Cruz Juan J. , Muñoz-Pérez Miguel A. , Querol Xavier , Ruilope Luís M.
Published: January 2020

Introduction:

Air in urban areas is usually contaminated with particle matter. High concentrations lead to a rise in the risk of cardiovascular and respiratory diseases. Some studies have reported that ultrafine particles (UFP) play a greater role in cardiovascular diseases than other particle matter, particularly regarding hypertensive crises and DBP, although in the latter such effects were described concerning clinical blood pressure (BP). In this study, we evaluate the relationship between 24-h ambulatory BP monitoring (ABPM) and atmospheric UFP concentrations in Barcelona.

Methods:

An observational study of individual patients’ temporal and geographical characteristics attended in Primary Care Centres and Hypertensive Units during 2009–2014 was performed.

Results:

The participants were 521 hypertensive patients, mean age 56.8 years (SD 14.5), 52.4% were women. Mean BMI was 28.0 kg/m2 and the most prominent cardiovascular risk factors were diabetes (N = 66, 12.7%) and smoking (N = 79, 15.2%). We describe UFP effects at short-term and up to 1 week (from lag 0 to 7). For every 10 000 particle/cm3 UFP increase measured at an urban background site, a corresponding statistically significant increase of 2.7 mmHg [95% confidence interval = (0.5–4.8)] in 24-h DBP with ABPM for the following day was observed (lag 1).

Conclusion:

We have observed that a rise in UFP concentrations during the day prior to ABPM is significantly associated with an increase in 24 h and diurnal DBP. It has been increasingly demonstrated that UFP play a key role in cardiovascular risk factors and, as we have demonstrated, in good BP control.
Outcomes of Gel Stent Implantation for Glaucoma in Patients With Previous Corneal Graft Surgery: A Case Series
Authors: Rahmania Nesrine , Rampat Radhika , Moran Sarah , Gatinel Damien , Grise-Dulac Alice
Published: January 2020

Purpose:

To report a series of 5 cases with successful placement of a minimally invasive glaucoma surgery (MIGS) device for glaucoma refractory to medical management in patients with previous corneal grafts.

Methods:

This is a retrospective analysis of all cases with a Xen45 Gel Stent (Allergan plc, Dublin, Ireland) for ocular hypertension and glaucoma refractory to medical treatment after corneal graft surgery between 2016 and 2019 at the Rothschild Foundation, Paris. We did the imaging studies and studied the intraocular pressure (IOP) and the endothelial cell count preimplantation and postimplantation with a MIGS device.

Results:

Five cases were included in this study, demonstrating a well-tolerated, highly effective, and sustained method for controlling the IOP, which was refractory to previous treatment. An average IOP reduction of 70.5% was noted with a needling rate of 20%, and no adverse events were noted except 1 IOP spike day 7 post-op with no long-term effects.

Conclusions:

Glaucoma after graft surgery is a well-known and devastating complication, and as numbers of graft surgery performed increases, so will the incidence of glaucoma. MIGS devices such as the Xen45 Gel Stent (Allergan plc) should become a part of our accepted armory to treat raised IOP refractory to medical treatment without delay.
Algorithm Variability in Quantification of Epithelial Defect Size in Microbial Keratitis Images
Authors: Kriegel Matthias F. , Huang Jennifer , Ashfaq Hamza A. , Niziol Leslie M. , Preethi Mohana , Tan Huan , Tuohy Megan M. , Patel Tapan P. , Prajna Venkatesh , Woodward Maria A.
Published: January 2020

Purpose:

To investigate the sources of measurement variability when quantifying the morphology of microbial keratitis (MK) from slit-lamp photography (SLP) images using a semiautomated, image-analysis algorithm.

Methods:

Prospectively enrolled patients with MK underwent SLP to obtain images of their epithelial defects (ED). Eyes were stained with fluorescein and imaged multiple times under blue light, at low and high magnifications. A masked research assistant chose the 3 best images and annotated each 3 times to provide seed regions corresponding to ED and healthy cornea. The algorithm returned the ED area for each seeded image. Eyes without EDs and algorithm failures were excluded. Variance components were estimated with a random effects model and intraclass correlation coefficients estimated with intragrader reliability.

Results:

A total of 42 eyes from 42 MK participants were photographed. After excluding poor quality images, eyes with no EDs, and algorithm failures, 34 patients with 92 images and 274 seeds were analyzed. No significant differences in the average ED area were found between seedings or high- versus low-SLP magnifications (all P > 0.5, paired t tests). Minimal measurement variability was because of image (0.9%), magnification (0.2%), or seed (0.1%). Most variability was attributable to differences in ED sizes between patients (85.2%). 13.7% of variability was unexplained. Multiple iterations of the algorithm on the same image showed good consistency (intraclass correlation coefficient = 0.98, 95% confidence interval, 0.97–0.99).

Conclusions:

Image-analysis algorithms showed good reliability for measuring the ED area from SLP images. Most measurement variability was because of between-patient differences, not imaging settings or application of the algorithm by the user.
Ciliary Body and Iris Metastases With Anterior Chamber Angle Infiltration: A Rare Complication From Invasive Ductal Breast Cancer
Authors: Swampillai Andrew J. , Booth Adam P. , Cohen Victoria M.L.
Published: January 2020

A 54-year-old woman who presented with photopsia was found to have elevated intraocular pressure in both eyes and optic disc cupping in the right eye. Angle infiltration was noted on gonioscopy. She was previously been diagnosed with metastatic breast cancer. This case report describes a rare case of glaucoma as a complication of ciliary body and iris metastases secondary to invasive ductal breast cancer.
Risk factors for dropped nucleus in cataract surgery as reflected by the European Registry of Quality Outcomes for Cataract and Refractive Surgery
Authors: Lundström Mats , Dickman Mor , Henry Ype , Manning Sonia , Rosen Paul , Tassignon Marie-José , Young David , Stenevi Ulf
Published: January 2020

Purpose:

To analyze the incidence, risk factors, and outcomes of cataract surgery complicated by a dropped nucleus.

Setting:

Patients who have received cataract surgery in 18 European countries.

Design:

Retrospective cross-sectional register-based study.

Methods:

Data from the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) were analyzed. The EUREQUO contains preoperative baseline, intraoperative, and follow-up data. Intraoperative data include dropped nucleus as a complication. Baseline data such as demographic data, ocular comorbidities, surgical difficulties, and visual and refractive outcomes were tested for association with a dropped nucleus for the study period from January 1, 2008, to December 31, 2018.

Results:

The number of reported patients with complete data was 1 715 348. Dropped nucleus was reported in 1221 eyes (0.071%) during the study period. White cataract, previous vitrectomy, poor preoperative visual acuity, small pupil, pseudoexfoliation, diabetic retinopathy, and male sex were significantly related to dropped nucleus. Year of surgery showed a significant trend of decreasing occurrence of dropped nucleus over time. Eyes with the complication of a dropped nucleus also had a poorer visual and refractive outcome compared with eyes with existing risk factors but no such complication.

Conclusions:

Many risk factors for dropped nucleus complications were identified. A significant trend of decreasing occurrence of dropped nucleus was found for the study period. The visual and refractive outcome was poorer for eyes with a dropped nucleus.
Visual performance and positional stability of a capsulorhexis-fixated extended depth-of-focus intraocular lens
Authors: Darian-Smith Erica , Versace Patrick
Published: January 2020

Purpose:

To examine the 6-month outcomes of visual performance and positional stability of a capsule-fixated intraocular lens (IOL), FEMTIS Comfort MF15, extended depth-focus (EDOF) version, after cataract surgery performed using femtosecond laser-assisted cataract surgery capsulotomy.

Setting:

Vision Eye Institute, Sydney, Australia.

Design:

Prospective open-label postregistration data collection.

Methods:

Three-month and 6-month outcomes were measured including visual function, stability of IOL position, and quantitative measurement of glare and halo. Subjective patient satisfaction and spectacle independence rates were documented with a subjective questionnaire. A computer simulator was used to quantify the incidence and severity of unwanted visual phenomena allowing comparison with other EDOF and multifocal IOLs.

Results:

Forty-four eyes of 25 patients were included in the study. There were 19 bilateral cases. The median shift in IOL position over 6 months (from surgery to 6 months) was 0.095 ± 0.09 mm. There was a marked improvement in uncorrected and corrected distance visual acuity from the preoperative to the 6-month mark. Patient satisfaction and spectacle independence levels were high. There was no IOL enclevation, negative dysphotopsia, decentration, or capsular phimosis.

Conclusions:

To the authors' knowledge, this is the first study to report outcomes after insertion of the FEMTIS capsulorhexis-fixated EDOF IOL. This IOL offers excellent refractive predictability, functional range of vision, and minimal unwanted visual phenomena. The attachment to the anterior capsulorhexis is shown to be stable over time with no significant shift in the position or capsular phimosis. There was high patient satisfaction with spectacle independence.
Phacoemulsification in eyes with long anterior zonules
Authors: Khurana Mona , Shah Deep Dashrathbhai , George Ronnie Jacob , Vijaya Lingam , Balekudaru Shantha
Published: January 2020

Purpose:

To study the safety of phacoemulsification in eyes with long anterior zonules (LAZs).

Setting:

Institute.

Design:

Retrospective interventional case series.

Methods:

All patients with clinically proven LAZs who had undergone phacoemulsification by a single surgeon from January 2014 to December 2018 were included. All cases of LAZs with cataract extraction by procedures other than phacoemulsification or combined with any other ocular surgery were excluded. Sixty-five eyes of 52 patients were analyzed. Phacoemulsification with capsulorhexis that involves sacrificing the LAZs was performed. The primary outcome measures were the incidence of capsulorhexis extension or the need to rescue intraoperatively and the rate of intraoperative complications. Secondary outcomes assessed were the percentage of eyes within ±0.5 diopters (D) and ±1 D of the target refraction.

Results:

Sixty-five eyes (52 patients) were analyzed; the mean age of patients was 67.3 ± 7.4 years. The successful completion of an adequately sized capsulorhexis without extension or rescue was seen in 100% of cases. The incidence of intraoperative complications was 1.5% (posterior capsular rupture in 1 eye). The mean postoperative corrected distance visual acuity was 0.05 ± 0.1 (logarithm of the minimum angle of resolution) at a mean of 26.8 ± 7.6 days. The mean spherical equivalent was −0.15 ± 0.7 D. Eyes within ±0.5 D and ±1.00 D of the target refraction were 77% and 94%, respectively.

Conclusions:

Phacoemulsification in eyes with LAZs can be safely performed through an adequately sized capsulorhexis by sacrificing, ie, cutting or breaking, the anteriorly inserted zonules 360 degrees without significant intraoperative complications.
Intracameral endoilluminator-assisted phacoemulsification surgery in patients with severe corneal opacity
Authors: Yuksel Erdem
Published: January 2020

While phacoemulsification cataract surgery is a routine and safe procedure, clear visualization of the anterior segment is challenging in patients with corneal opacity. Illumination from the operating microscope can cause scattering and light reflection in a patient with corneal opacity. A frequent approach for these cases is cataract surgery with sequential or simultaneous corneal transplantation. This method has serious preoperative, intraoperative, and postoperative drawbacks, such as a long wait for a donor cornea, choroidal hemorrhage, and delayed visual rehabilitation. In this case series, the technique of intracameral endoilluminator-assisted phacoemulsification surgery in patients with severe corneal opacity was shown to provide better visualization and reduced scattering and reflection in patients with corneal opacity.
Lasmiditan inhibits calcitonin gene-related peptide release in the rodent trigeminovascular system
Authors: Labastida-Ramírez Alejandro , Rubio-Beltrán Eloísa , Haanes Kristian A. , Chan Kayi Y. , Garrelds Ingrid M. , Johnson Kirk W. , Danser Alexander H.J. , Villalón Carlos M. , MaassenVanDenBrink Antoinette
Published: January 2020

Migraine headache pathophysiology involves trigeminovascular system activation, calcitonin gene-related peptide (CGRP) release, and dysfunctional nociceptive transmission. Triptans are 5-HT1B/1D/(1F)receptor agonists that prejunctionally inhibit trigeminal CGRP release, but their vasoconstrictor properties limit their use in migraine patients with cardiovascular disease. By contrast, lasmiditan is a novel antimigraine and selective 5-HT1Freceptor agonist devoid of vasoconstrictor properties. On this basis, this study has investigated the modulation of trigeminal CGRP release by lasmiditan. For this purpose, we have comparatively analysed the inhibition of several components of the trigeminovascular system induced by lasmiditan and sumatriptan through: ex vivo KCl-induced CGRP release from isolated dura mater, trigeminal ganglion, and trigeminal nucleus caudalis of mice; and in vivo dural vasodilation in the rat closed-cranial window model induced by endogenous (electrical stimulation and capsaicin) and exogenous CGRP. The ex vivo release of CGRP was similarly inhibited by sumatriptan and lasmiditan in all trigeminovascular system components. In vivo, intravenous (i.v.) lasmiditan or higher doses of sumatriptan significantly attenuated the vasodilatory responses to endogenous CGRP release, but not exogenous CGRP effects. These data suggest that lasmiditan prejunctionally inhibits CGRP release in peripheral and central trigeminal nerve terminals. Because lasmiditan is a lipophilic drug that crosses the blood–brain barrier, additional central sites of action remain to be determined.
Neck pain and headache after whiplash injury: a systematic review and meta-analysis
Authors: Al-Khazali Haidar Muhsen , Ashina Håkan , Iljazi Afrim , Lipton Richard B. , Ashina Messoud , Ashina Sait , Schytz Henrik W.
Published: January 2020

Neck pain and headache are 2 of the most common complications of whiplash injury. Therefore, we performed a systematic literature search on PubMed and Embase for publications reporting on the prevalence of neck pain and headache after whiplash injury. The literature search identified 2709 citations of which 44 contained relevant original data. Of these, 27 studies provided data for the quantitative analysis. For non–population-based studies, the present meta-analysis showed that a pooled relative frequency of neck pain was 84% confidence interval (68%-95%) and a pooled relative frequency of headache was 60% (46%-73%), within 7 days after whiplash injury. At 12 months after injury, 38% (32%-45%) of patients with whiplash still experienced neck pain, while 38% (18%-60%) of whiplash patients reported headache at the same time interval after injury. However, we also found considerable heterogeneity among studies with I2-values ranging from 89% to 98% for the aforementioned meta-analyses. We believe that the considerable heterogeneity among studies underscores the need for clear-cut definitions of whiplash injury and standardized reporting guidelines for postwhiplash sequelae such as neck pain and headache. Future studies should seek to optimize these aspects paving the way for a better understanding of the clinical characteristics and natural course of whiplash-associated sequelae.
c-Jun/p38MAPK/ASIC3 pathways specifically activated by nerve growth factor through TrkA are crucial for mechanical allodynia development
Authors: Chaumette Tanguy , Delay Lauriane , Barbier Julie , Boudieu Ludivine , Aissouni Youssef , Meleine Mathieu , Lashermes Amandine , Legha Wassim , Antraigue Sophie , Carvalho Frederic Antonio , Eschalier Alain , Ardid Denis , Moqrich Aziz , Marchand Fabien
Published: January 2020

Mechanical allodynia is a cardinal sign of several inflammatory pain disorders where nerve growth factor, a prototypic neurotrophin, plays a crucial role by binding to TrkA receptors. Here, we took the advantage of our generated knock-in mouse model expressing a chimeric TrkA/TrkC receptor that seems to not specifically develop mechanical allodynia after inflammation, to identify the TrkA downstream pathways involved in this phenomenon. We confirmed and extended that disrupting TrkA-specific pathways leads to a specific deficit in mechanical hypersensitivity development after somatic (systemic nerve growth factor administration and paw incision) and, to a lesser extent, visceral injuries. Despite a deficit in thin, mainly peptidergic, fibre innervation in TrkAC mice, thermal hyperalgesia development was not different from WT mice. Inflammatory reaction (oedema, IL-6 content), pain behaviours after intraplantar capsaicin, as well as TRPV1 calcium imaging response of dorsal root ganglion neurons were similar between TrkAC and WT mice. This deficiency in mechanical allodynia development in TrkAC mice is likely due to the alteration of the expression of different TrkA transduction pathways (ie, Akt, p38 MAPK, and c-Jun) especially p38 MAPK, in the dorsal root ganglion cell bodies, ultimately leading to an alteration of at least, ASIC3 channel overexpression, known to participate in nociceptor mechanosensory function.
Brain networks and endogenous pain inhibition are modulated by age and sex in healthy rats
Authors: Da Silva Joyce T. , Tricou Christina , Zhang Youping , Seminowicz David A. , Ro Jin Y.
Published: January 2020

Endogenous pain inhibition is less efficient in chronic pain patients. Diffuse noxious inhibitory control (DNIC), a form of endogenous pain inhibition, is compromised in women and older people, making them more vulnerable to chronic pain. However, the underlying mechanisms remain unclear. Here, we used a capsaicin-induced DNIC test and resting-state functional MRI to investigate the impact of aging and sex on endogenous pain inhibition and associated brain circuitries in healthy rats. We found that DNIC was less efficient in young females compared with young males. Diffuse noxious inhibitory control response was lost in old rats of both sexes, but the brain networks engaged during DNIC differed in a sex-dependent manner. Young males had the most efficient analgesia with the strongest connectivity between anterior cingulate cortex (ACC) and periaqueductal gray (PAG). The reduced efficiency of DNIC in young females seemed to be driven by widespread brain connectivity. Old males showed increased connectivity between PAG, raphe nuclei, pontine reticular nucleus, and hippocampus, which may not be dependent on connections to ACC, whereas old females showed increased connectivity between ACC, PAG, and more limbic regions. These findings suggest that distinct brain circuitries including the limbic system may contribute to higher susceptibility to pain modulatory deficits in the elderly population, and sex may be a risk factor for developing age-related chronic pain.
Six-Month Clinical Outcomes for Bone-Anchored Hearing Implants: Comparison Between Minimally Invasive Ponto Surgery and the Linear Incision Technique With Tissue Preservation
Authors: Caspers Coosje J. I. , Kruyt Ivo J. , Mylanus Emmanuel A. M. , Hol Myrthe K. S.
Published: January 2020

Objectives:

The aim of this study is to investigate and compare the clinical outcomes of minimally invasive ponto surgery (MIPS) to the linear incision technique with soft tissue preservation (LIT-TP) for percutaneous bone-anchored hearing implants (BAHI).

Study Design:

Prospective cohort study with a historical control group.

Setting:

Tertiary referral center.

Patients:

Twenty-five patients were prospectively included in the test group. The control group consisted of 25 patients who previously participated in another clinical trial and already underwent BAHI surgery.

Intervention:

All patients were implanted with a 4.5-mm-wide implant, using MIPS in the test group and the LIT-TP in the control group. Follow-up visits were scheduled 7 days, 21 days (sound processor fitting), 12 weeks and 6 months after surgery.

Main Outcome Measures:

The primary outcome measure was skin sensibility around the abutment 6 months after surgery. Secondary outcomes were subjective numbness, surgery time, wound healing, adverse soft tissue reactions, cosmetic outcomes, implant stability quotient (ISQ), implant survival, and sound processor use.

Results:

Skin sensibility, adverse soft tissue reactions, and sound processor use were comparable between groups. The test group had a shorter surgery time and better cosmetic outcomes. More skin dehiscences and a statistically nonsignificant higher implant loss rate (12% vs 0%, p = 0.079) were observed in the test group.

Conclusion:

MIPS is comparable to the LIT-TP regarding skin sensibility at 6 months and soft tissue tolerability. With MIPS, surgery time is further reduced and better cosmetic outcomes are reported. More research into MIPS, exact drill protocol, used instruments, and associated implant loss is warranted.