bluuebunny/crossref_metadata_2025 huggingface dataset:
Leishmania donovanirestricts mitochondrial dynamics to enhance miRNP stability and target RNA repression in host macrophages
Authors: Chakrabarty Yogaditya , Bhattacharyya Suvendra N.
Published: May 2017

MicroRNAs (miRNAs), the tiny regulatory RNAs, form complexes with Argonaute (Ago) proteins and inhibit gene expression in metazoan cells. While studying parasite-invaded macrophages, we identify a unique mode of gene regulation in which the parasite Leishmania donovani (Ld) causes mitochondrial depolarization, reduces mitochondrial dynamics, and restricts turnover of cellular microRNA ribonucleoprotein (miRNP) complexes in infected host cells. This leads to increased stability of miRNPs along with elevated levels of Ago2-bound cytokine mRNA in Ld-infected macrophages. Thus the increase of miRNP stability in Ld-infected cells curtails production of proinflammatory cytokines, which are otherwise detrimental for survival of the parasite within the infected macrophages. Loss of mitochondrial membrane potential is accompanied by reduced juxtaposition of endoplasmic reticulum (ER) and mitochondria as well as endosomes. This is likely coupled with enhanced sequestration and stabilization of ER- associated miRNPs observed in infected macrophage cells. Mitofusin 2 (Mfn2), a membrane protein implicated in ER–mitochondria tethering, also shows reduced expression in Ld-infected cells. A mitochondrial role in Ld-induced alteration of miRNA activity and stability is further corroborated by impaired compartmentalization and stabilization of miRNP components in Mfn2-depleted mammalian cells.
Spatial analysis of Cdc42 activity reveals a role for plasma membrane–associated Cdc42 in centrosome regulation
Authors: Herrington Kari A. , Trinh Andrew L. , Dang Carolyn , O’Shaughnessy Ellen , Hahn Klaus M. , Gratton Enrico , Digman Michelle A. , Sütterlin Christine
Published: May 2017

The ability of the small GTPase Cdc42 to regulate diverse cellular processes depends on tight spatial control of its activity. Cdc42 function is best understood at the plasma membrane (PM), where it regulates cytoskeletal organization and cell polarization. Active Cdc42 has also been detected at the Golgi, but its role and regulation at this organelle are only partially understood. Here we analyze the spatial distribution of Cdc42 activity by moni­toring the dynamics of the Cdc42 FLARE biosensor using the phasor approach to FLIM-FRET. Phasor analysis revealed that Cdc42 is active at all Golgi cisternae and that this activity is controlled by Tuba and ARHGAP10, two Golgi-associated Cdc42 regulators. To our surprise, FGD1, another Cdc42 GEF at the Golgi, was not required for Cdc42 regulation at the Golgi, although its depletion decreased Cdc42 activity at the PM. Similarly, changes in Golgi morphology did not affect Cdc42 activity at the Golgi but were associated with a substantial reduction in PM-associated Cdc42 activity. Of interest, cells with reduced Cdc42 activity at the PM displayed altered centrosome morphology, suggesting that centrosome regulation may be mediated by active Cdc42 at the PM. Our study describes a novel quantitative approach to determine Cdc42 activity at specific subcellular locations and reveals new regulatory principles and functions of this small GTPase.
SEC23B is required for pancreatic acinar cell function in adult mice
Authors: Khoriaty Rami , Vogel Nancy , Hoenerhoff Mark J. , Sans M. Dolors , Zhu Guojing , Everett Lesley , Nelson Bradley , Durairaj Haritha , McKnight Brooke , Zhang Bin , Ernst Stephen A. , Ginsburg David , Williams John A.
Published: May 2017

Mice with germline absence of SEC23B die perinatally, exhibiting massive pancreatic degeneration. We generated mice with tamoxifen-inducible, pancreatic acinar cell–specific Sec23b deletion. Inactivation of Sec23b exclusively in the pancreatic acinar cells of adult mice results in decreased overall pancreatic weights from pancreatic cell loss (decreased pancreatic DNA, RNA, and total protein content), as well as degeneration of exocrine cells, decreased zymogen granules, and alterations in the endoplasmic reticulum (ER), ranging from vesicular ER to markedly expanded cisternae with accumulation of moderate-density content or intracisternal granules. Acinar Sec23b deletion results in induction of ER stress and increased apoptosis in the pancreas, potentially explaining the loss of pancreatic cells and decreased pancreatic weight. These findings demonstrate that SEC23B is required for normal function of pancreatic acinar cells in adult mice.
Mechanical loading regulates organization of the actin cytoskeleton and column formation in postnatal growth plate
Authors: Killion Christy H. , Mitchell Elizabeth H. , Duke Corey G. , Serra Rosa
Published: May 2017

Longitudinal growth of bones occurs at the growth plates where chondrocytes align into columns that allow directional growth. Little is known about the mechanisms controlling the ability of chondrocytes to form columns. We hypothesize that mechanical load and the resulting force on chondrocytes are necessary during active growth for proper growth plate development and limb length. To test this hypothesis, we created a mouse model in which a portion of the sciatic nerve from one hind limb was transected at postnatal day 8 to cause paralysis to that limb. At 6 and 12 wk postsurgery, the hind limb had significantly less bone mineral density than contralateral controls, confirming reduced load. At 8 and 14 wk postsurgery, tibiae were significantly shorter than controls. The paralyzed growth plate showed disruptions to column organization, with fewer and shorter columns. Polarized light microscopy indicated alterations in collagen fiber organization in the growth plate. Furthermore, organization of the actin cytoskeleton in growth plate chondrocytes was disrupted. We conclude that mechanical load and force on chondrocytes within the growth plate regulate postnatal development of the long bones.
Religion and Spirituality in OBGYN
Authors: Peragallo Rachel , Thorp John M.
Published: May 2017

Abstract: Women’s reproductive health care involves matters of conscience, religion and spirituality on a daily basis. Most patients are are religious and most major religions have positions about reproductive health decisions. Research regarding the effects of religion and spirituality on patients and their decisions is mixed. Measures of religious practice (e.g. church attendance) are most closely tied to sexual practices, contraceptive and pregnancy termination decisions. For most women, the relationship between reproductive health and their religion or spirituality is complicated. There is a great need for research testing interventions including spiritual and religious components for women making difficult reproductive health decisions. Health care providers who hope to provide women’s health care that includes religious and spiritual dimensions should listen to their patients, ask questions, educate themselves about different religious beliefs and practices, offer fertility awareness-based methods of family planning, and reflect on how their own spiritual and or religious beliefs impact their practice.
Growth-Related Major Recanalization of Coiled Aneurysms: Incidence and Risk Factors
Authors: Cho Young Dae , Jeon Jin Pyeong , Yoo Dong Hyun , Cho Won-Sang , Kang Hyun-Seung , Kim Jeong Eun , Han Moon Hee
Published: May 2017

BACKGROUND

Though endovascular techniques and procedural devices continue to advance, recurrence of embolized aneurysms is still problematic. Enlarging size during follow-up is the presumed basis of recanalization in some lesions, but such growth has not been adequately investigated.

OBJECTIVE

To generate estimates of growth in coiled aneurysms with major recanalization, focusing on incidence and risk factors involved.

METHODS

A cohort of 134 patients harboring 139 aneurysms were retrospectively reviewed, each subjected to re-embolization for major recanalization after initial coil embolization. Cumulative medical records and radiological data were assessed. The aneurysms were grouped by nature of recanalization, either related or unrelated to growth. Growth was defined as >50% increase in aneurysm volume (including coil mass) at the time of re-embolization, compared initial status. Aneurysm volumes were determined by volume of coil mass within full confines of the aneurysm. Univariate and multivariate analyses were performed to identify risk factors predisposing to growth.

RESULTS

Major recanalization was growth related in 74 coiled aneurysms (53.2%) and unrelated to growth (by coil compaction) in 65 (46.8%). Multiple logistic regression analysis indicated that growth of coiled aneurysm was linked to aneurysms initially ruptured at presentation (P = .002) and aneurysm size <7 mm (P < .001). Cumulative growth rates were as follows: 14 (18.9%), 6 mo; 18 (24.3%), 12 mo; 13 (17.6%), 24 mo; 10 (13.5%), 36 mo; and 19 (25.7%), >36 mo.

CONCLUSION

Our data suggest that aneurysms presenting with hemorrhage and small-sized aneurysms (<7 mm) are predisposed major recanalization by growth after coil embolization, as opposed to coil compaction.
Implementation and Evaluation of a Smartphone Application for the Perioperative Care of Neurosurgery Patients at an Academic Medical Center: Implications for Patient Satisfaction, Surgery Cancelations, and Readmissions
Authors: Felbaum Daniel R , Stewart Jeffrey J , Anaizi Amjad N , Sandhu Faheem A , Nair Mani N , Voyadzis Jean-Marc
Published: May 2017

BACKGROUND

Smartphone applications (apps) in the health care arena are being increasingly developed with the aim of benefiting both patients and their physicians. The delivery of adequate instructions both before and after a procedure or surgery is of paramount importance in ensuring the best possible outcome for patients.

OBJECTIVE

To demonstrate that app-based instructions with built-in reminders may improve patient understanding and compliance and contribute to reducing the number of surgery cancellations and postoperative complications and readmissions.

METHODS

We prospectively accrued 56 patients undergoing routine neurosurgery procedures who subsequently downloaded the app. The median age was 54 (range 27-79). Patients were followed for successful registration and use of the app, compliance with reading instructions before and after surgery, and sending pain scores and/or wound images. The number of surgeries cancelled, postoperative complications, 30-d readmissions, and phone calls for surgery-related questions were examined.

RESULTS

Fifty-four of the 56 patients successfully registered, downloaded, and used the app and read and complied with instructions both before and after surgery. There were no cancelled surgeries. There was 1 postoperative complication. There were no readmissions. Eight of the 54 patients (14.8%) called the office on a single occasion for a surgery related question.

CONCLUSION

We demonstrate the utility of a smartphone application in the perioperative neurosurgical care setting with regard to patient compliance and satisfaction as well as surgery cancellations and readmissions. Further study of a larger number of patients with a control group is warranted.
Allergic contact dermatitis in preservatives: current standing and future options
Authors: Deza Gustavo , Giménez-Arnau Ana M.
Published: May 2017

Purpose of review

Preservatives are well known skin sensitizers and represent one of the main causes of contact allergy. The purpose of this article is to review the current state of contact sensitization induced by preservatives and point future alternatives for products’ preservation.

Recent findings

Isothiazolinones currently are the most common preservatives responsible of contact allergy in Europe and in the United States, and although some regulatory interventions have been taken place, the current contact allergy outbreak is not yet under control. Despite the ban of methyldibromo glutaronitrile from cosmetics in Europe, sensitized patients are still diagnosed, suggesting other nonregulated sources of exposure. Sensitization rates to formaldehyde and formaldehyde-releasers are lower in Europe in comparison with the United States due to stricter regulations regarding their use. Prevalence of contact allergy to parabens has remained stable over the last decades, whereas iodopropynyl butylcarbamate is an emerging allergen with an increasing prevalence. Future alternatives for products’ preservation look for a broad antimicrobial spectrum, but with a better safety profile (in terms of sensitization) than the currently available compounds.

Given the high rates of sensitization reported over the last years, timely regulatory actions are urgently required for some preservatives that currently represent a concern for public health.
Rehabilitation and Psychosocial Determinants of Cochlear Implant Outcomes in Older Adults
Authors: Tang Liyang , Thompson Carol B. , Clark James H. , Ceh Kristin M. , Yeagle Jennifer D. , Francis Howard W.
Published: May 2017

Objective:

The cochlear implant (CI) has been shown to be associated with better hearing, cognitive abilities, and functional independence. There is variability however in how much benefit each recipient derives from his or her CI. This study’s primary objective is to determine the effects of individual and environmental characteristics on CI outcomes.

Design:

Seventy-six adults who developed postlingual severe to profound hearing loss and received their first unilateral CI at 65 years and older were eligible for the study. Fifty-five patients were asked to participate and the 33 (60%) with complete data were classified as “group 1.” The remaining patients were placed in “group 2.” Primary outcomes included changes in quality of life and open-set speech perception scores. Independent variables included age, health status, trait emotional intelligence (EI), comfort with technology, and living arrangements. Survey outcomes and audiological measurements were collected prospectively at 12 months after surgery, whereas preoperative data were collected retrospectively. Comparisons between groups 1 and 2 were made. Wilcoxon signed rank test, Spearman correlations, Mann–Whitney tests, Chi-square tests, and linear regressions were performed only on group 1 data.

Results:

Having a CI was associated with improved quality of life and speech perception. Familiarity with electronic tablets was associated with increased 12-month postoperative AzBio gains when adjusted for preoperative AzBio scores (adjusted p = 0.019), but only marginally significant when a family-wise error correction was applied (p = 0.057). Furthermore, patients who lived with other people scored at least 20 points higher on the AzBio sentences than those who lived alone (adjusted p = 0.046). Finally, consultation with an auditory rehabilitation therapist was associated with higher self-reported quality of life (p = 0.035).

Conclusion:

This study suggests that in a cohort of older patients cochlear implantation is associated with a meaningful increase in both quality of life and speech perception. Furthermore, it suggests the potential importance of adjunct support and services, including the tailoring of CI rehabilitation sessions depending on the patient’s familiarity with technology and living situation. Investment in rehabilitation and other services is associated with improvements in quality of life and may mitigate clinical, individual and social risk factors for poor communication outcome.
Children With Single-Sided Deafness Use Their Cochlear Implant
Authors: Polonenko Melissa Jane , Papsin Blake Croll , Gordon Karen Ann
Published: May 2017

Objectives:

To assess acceptance of a cochlear implant (CI) by children with single-sided deafness (SSD) as measured by duration of CI use across daily listening environments.

Design:

Datalogs for 7 children aged 1.1 to 14.5 years (mean ± SD: 5.9 ± 5.9 years old), who had SSD and were implanted in their deaf ear, were anonymized and extracted from their CI processors. Data for all available follow-up clinical appointments were included, ranging from two to six visits. Measures calculated from each datalog included frequency and duration of time the coil disconnected from the internal device, average daily CI use, and both duration (hr/day) and percentage of CI use (% daily use) in different intensity ranges and environment types. Linear mixed effects regression analyses were used to evaluate the relationships between CI experience, daily CI use, frequency of coil-offs, and duration of coil-off time. Nonlinear regression analyses were used to evaluate CI use with age in different acoustic environments.

Results:

Children with SSD used their CI on average 7.4 hr/day. Older children used their CI for longer periods of the day than younger children. Longitudinal data indicated consistent CI use from the date of CI activation. Frequency of coil-offs reduced with CI experience, but did not significantly contribute to hours of coil-off time. Children used their CI longest in environments that were moderately loud (50 to 70 dB A) and classified as containing speech-in-noise. Preschoolers tended to spend less time in quiet but more time in music than infants/toddlers and adolescents.

Conclusions:

Children with SSD consistently use their CI upon activation in a variety of environments commonly experienced by children. CI use in children with SSD resembles reported bilateral hearing aid use in children but is longer than reported hearing aid use in children with less severe unilateral hearing loss, suggesting that (1) the normal-hearing ear did not detract from consistent CI use; and (2) a greater asymmetry between ears presents a significant impairment that may facilitate device use to access bilateral sound.
Responsiveness and Minimal Important Changes of the Scoliosis Research Society-22 Patient Questionnaire in Subjects With Mild Adolescent and Moderate Adult Idiopathic Scoliosis Undergoing Multidisciplinary Rehabilitation
Authors: Monticone Marco , Ambrosini Emilia , Rocca Barbara , Foti Calogero , Ferrante Simona
Published: May 2017

Study Design.

Single-center, prospective study.

Objective.

Evaluating the responsiveness and minimal important changes (MICs) for the Scoliosis Research Society-22 Patient Questionnaire (SRS-22) in adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AS).

Summary of Background Data.

Despite the SRS-22 properties have been investigated in various different languages, there is still a lack of information concerning responsiveness and MIC, limiting the use of SRS-22 for clinical and research purposes.

Methods.

At the beginning and end of multidisciplinary rehabilitation programs, 149 subjects with mild AIS (Cobb angle <25°) and 140 subjects with moderate AS (Cobb angle <35°) completed the SRS-22. Upon completing the programs, subjects also performed the global perceived effect (GPE) scales test, which was divided to produce a dichotomous outcome (improved vs. stable). Responsiveness was calculated for all SRS-22 domains but satisfaction with management by distribution (effect size; standardized response mean) and anchor-based methods (receiver operating characteristic [ROC] curves; correlations between change scores of the SRS-22 and GPE). ROC curves were also used to compute the MICs.

Results.

The effect size ranged from 1.23 to 1.50 in AIS and from 1.02 to 1.37 in AS. The standardized response mean ranged from 0.95 to 1.27 in AIS and from 0.66 to 0.90 in AS. The ROC analyses revealed the following MIC values (area under the curve; sensitivity; specificity): function, 0.70 (0.739;66;70) for AIS and 0.60 (0.842;84;76) for AS; pain, 0.70 (0.731;71;70) for AIS and 0.40 (0.817;81;70) for AS; mental health, 0.50 (0.708;83;58) for AIS and 0.55 (0.750;69;78) for AS; self-perceived image, 0.40 (0.609;79;42) for AIS and 0.60 (0.751;61;82) for AS. Correlations between change scores of the SRS-22 domains and GPE were low to moderate, ranging from −0.347 to −0.667.

Conclusion.

The SRS-22 was sensitive in detecting clinical changes in subjects with adolescent and adult scoliosis. We recommend taking the MICs provided into account when assessing patients’ improvement or planning studies in these clinical contexts.

Level of Evidence: 3
Contralateral Spondylolysis and Fracture of the Lumbar Pedicle in a Young Athlete
Authors: Kessous Eran , Borsinger Tracy , Rahman Ayesha , d‘Hemecourt Pierre A.
Published: May 2017

Study Design.

Clinical case report of unilateral pedicular stress fracture with a contralateral spondylolysis in a male high-school athlete presenting with low back pain.

Objective.

To report this uncommon cause of low back pain in an adolescent athlete, and review the relevant literature.

Summary of Background Data.

The incidence of spondylolysis in the Caucasian population was found to be about 3% to 6%. This number is probably higher in the athletic adolescent age group, with reports ranging from 8% to 15%. Spondylolysis may be associated with pedicle fracture, usually on the contralateral side. This is an uncommon phenomenon that is not well described in the adolescent age group.

Methods.

A 16-year-old male athlete presents with low back pain and limitation in sports as well as in daily activities. Clinical evaluation was suspicious for, and radiographic evaluation revealed left-sided L5 spondylolysis as well as contralateral L5 pedicle fracture. Conservative management included Boston Overlapping brace, external electrical stimulation, modification of activities, and a comprehensive physical therapy program.

Results.

Radiological evaluation revealed persistent left L5 pars defect and advanced healing of the contralateral pedicle fracture. The patient achieved complete pain relief and returned to varsity level sporting activity.

Conclusion.

Complete radiographic and clinical healing of the pedicle defect was observed, with return competitive varsity-level football without symptoms.

Level of Evidence: 5
National Trends and In-Hospital Outcomes of Patients With Solid Organ Transplant Undergoing Spinal Fusion
Authors: Yoshihara Hiroyuki , Yoneoka Daisuke , Paulino Carl , Agarwal Sanjeev , Reyna Jose R. , Hasegawa Kazuhiro
Published: May 2017

Study Design.

A retrospective analysis of population-based national hospital discharge data collected for the Nationwide Inpatient Sample.

Objective.

To examine the demographics and in-hospital outcomes of patients with solid organ transplant (SOT) undergoing spinal fusion on a national level.

Summary of Background Data.

Solid organ transplantation has become more common in recent years and some of these patients undergo spinal fusion surgery. There is, however, little information regarding the trends and outcomes in such patients.

Methods.

Clinical data were derived from the US Nationwide Inpatient Sample between 2000 and 2009. Patients with or without SOT who underwent spinal fusion were identified. Data regarding, patient- and healthcare system−related characteristics, comorbidities, in-hospital complications, and mortality were retrieved and analyzed. In-hospital outcomes were compared between patients with or without SOT and analyzed with the use of multivariate logistic regression.

Results.

A total of 5984 patients with SOT underwent spinal fusion in the United States during the last decade. From 2000 to 2009, population growth-adjusted incidence of patients with SOT who underwent spinal fusion has increased more than two fold (0.102 in 2000 to 0.236 in 2009, per 100,000, P < 0.001). Comparison between patients with or without SOT showed that patients with SOT had significantly higher overall in-hospital complication rate (22.4% vs. 9.5%) and in-hospital mortality rate (1.3% vs. 0.3%). Graft versus host disease occurred in 0.7% of patients with SOT undergoing spinal fusion. Patients with SOT had a significant higher risk of urinary and renal complications and overall in-hospital complications.

Conclusion.

During the last decade, the incidence of patients with SOT undergoing spinal fusion has increased in the United States. In-hospital outcomes of patients with SOT undergoing spinal fusion were inferior to those of patients without SOT.

Level of Evidence: 3
The Impact of the Sepsis-3 Septic Shock Definition on Previously Defined Septic Shock Patients*
Authors: Sterling Sarah A. , Puskarich Michael A. , Glass Andrew F. , Guirgis Faheem , Jones Alan E.
Published: May 2017

Objective:

The Third International Consensus Definitions Task Force (Sepsis-3) recently recommended changes to the definitions of sepsis. The impact of these changes remains unclear. Our objective was to determine the outcomes of patients meeting Sepsis-3 septic shock criteria versus patients meeting the “old” (1991) criteria of septic shock only.

Design:

Secondary analysis of two clinical trials of early septic shock resuscitation.

Setting:

Large academic emergency departments in the United States.

Patients:

Patients with suspected infection, more than or equal to two systemic inflammatory response syndrome criteria, and systolic blood pressure less than 90 mm Hg after fluid resuscitation.

Interventions:

Patients were further categorized as Sepsis-3 septic shock if they demonstrated hypotension, received vasopressors, and exhibited a lactate greater than 2 mmol/L. We compared in-hospital mortality in patients who met the old definition only with those who met the Sepsis-3 criteria.

Measurements and Main Results:

Four hundred seventy patients were included in the present analysis. Two hundred (42.5%) met Sepsis-3 criteria, whereas 270 (57.4%) met only the old definition. Patients meeting Sepsis-3 criteria demonstrated higher severity of illness by Sequential Organ Failure Assessment score (9 vs 5; p < 0.001) and mortality (29% vs 14%; p < 0.001). Subgroup analysis of 127 patients meeting only the old definition demonstrated significant mortality benefit following implementation of a quantitative resuscitation protocol (35% vs 10%; p = 0.006).

Conclusion:

In this analysis, 57% of patients meeting old definition for septic shock did not meet Sepsis-3 criteria. Although Sepsis-3 criteria identified a group of patients with increased organ failure and higher mortality, those patients who met the old criteria and not Sepsis-3 criteria still demonstrated significant organ failure and 14% mortality rate.
USE OF FEMORAL ARTERY ULTRASOUND DURING INTRAARTERIAL CHEMOTHERAPY FOR CHILDREN UNDER 10 KG WITH RETINOBLASTOMA
Authors: Kim Ryan S. , Dannenbaum Mark J. , Lin Michael W. , Bretana Maria E. , Brown Deborah L. , Schefler Amy C.
Published: May 2017

Purpose:

To demonstrate the safety and efficacy of intraarterial chemotherapy (IAC) in small infants (<10 kg) with retinoblastoma.

Methods:

Retrospective, consecutive, observational case series of patients treated with IAC. Femoral arterial access was obtained using a micropuncture kit and ultrasound guidance, which enabled direct visualization. Melphalan (1.5–5.0 mg), topotecan (0.3–2.0 mg), and/or carboplatin (30–40 mg) were used. Patients underwent adjuvant therapies including laser, cryotherapy, and intravitreal melphalan if persistent disease or recurrence was observed.

Results:

Fifty-nine injections were administered to 11 eyes of 6 patients. All eyes but one were classified as International Classification Groups C or D. Median patient weight at first IAC cycle was 9.2 kg (mean, 8.9 kg). Median diameter of the femoral artery at the catheterization site was 3.74 mm, measured by two independent observers. Median follow-up was 21.4 months (range 13.1–34.5 months). All eyes were salvaged.

Conclusion:

This study confirmed the safety and efficacy of IAC in infants under 10 kg. Ultrasound guidance enabled successful catheterization of femoral arteries as small as 2.7 mm in diameter. Patients in this study appeared to require fewer injections and lower total doses of chemotherapy compared with previously reported series of comparably advanced disease in larger infants.
CLINICAL FEATURES OF TREATED AND UNTREATED TYPE 1 IDIOPATHIC MACULAR TELANGIECTASIA WITHOUT THE OCCURRENCE OF SECONDARY CHOROIDAL NEOVASCULARIZATION FOLLOWED FOR 2 YEARS IN JAPANESE PATIENTS
Authors: Osaka Rie , Shiragami Chieko , Ono Aoi , Kobayashi Mamoru , Takasago Yukari , Yamashita Ayana , Tsujikawa Akitaka
Published: May 2017

Purpose:

To evaluate the clinical features of Type 1 idiopathic macular telangiectasia (IMT) followed up for 2 years.

Methods:

Forty-nine patients with unilateral Type 1 IMT were examined. Thirty-one IMT eyes were treated with direct laser photocoagulation and/or intravitreal bevacizumab; the remaining 18 eyes, with good vision or slight macular edema, were untreated. Changes in best-corrected visual acuity and central retinal thickness between baseline and 24 months after the initial visit were examined.

Results:

Of 49 eyes, nine were treated with direct laser photocoagulation, 12 with laser photocoagulation and intravitreal bevacizumab, 10 with intravitreal bevacizumab monotherapy, whereas 18 did not receive any treatment. The mean logarithm of the minimum angle of resolution best-corrected visual acuity was 0.20 ± 0.19 (median, 20/29) and 0.13 ± 0.22 (median, 20/25) at baseline and 24 months, respectively (P = 0.023). The mean central retinal thickness was 375.0 ± 94.5 μm and 315.3 ± 78.5 μm at baseline and 24 months, respectively (P < 0.001). Retinal vein occlusion and retinal macroaneurysm occurred in six eyes and one eye, respectively, during follow-up.

Conclusion:

Treatment with laser photocoagulation and/or intravitreal bevacizumab may be effective for Type 1 IMT, 36.7% of IMT eyes required no treatment over a 2-year follow-up, and other retinal vascular events were not uncommon.
ROLE OF EARLY VITRECTOMY IN THE TREATMENT OF FUNGAL ENDOPHTHALMITIS
Authors: Behera Umesh Chandra , Budhwani Monica , Das Taraprasad , Basu Soumyava , Padhi Tapas Ranjan , Barik Manas Ranjan , Sharma Savitri
Published: May 2017

Purpose:

To study whether immediate pars plana vitrectomy at the time of sampling vitreous for culture alter the visual and structural outcomes in fungal endophthalmitis.

Methods:

Surgical results of 66 consecutive patients with culture-positive fungal endophthalmitis attending a tertiary eye care hospital in eastern India were analyzed. Based on the timing of vitrectomy, they were divided into 2 groups: Group 1—immediate vitrectomy (n = 31) and Group 2—diagnostic vitrectomy alone (n = 35) as the first-line intervention. The demographics, clinical features, and visual and structural outcomes were compared between the groups.

Results:

The proportion of postoperative (54.83 vs. 51.42%), traumatic (29.03 vs. 34.28%), and endogenous (16.12 vs. 14.28%) endophthalmitis and clinical signs such as pain (54.83 vs. 60%), lid edema (48.38 vs. 48.57%), conjunctival congestion (87.09 vs. 94.28%), and corneal involvement (87.09 vs. 80%) in Groups 1 and 2, respectively, were comparable. Logarithm of the minimum angle of resolution vision improvement in Group 1 was significant (P = 0.0278) though there was no statistically significant difference in posttreatment vision between the groups (P = 0.322). Phthisis was seen in 25.8% in Group 1 and 25.7% in Group 2 (P = 0.993). Aspergillus species was the most common fungal pathogen isolated. Early vitrectomy plus intravitreal antifungals in a subset of clinically suspected fungal endophthalmitis resulted in statistically significant visual improvement over diagnostic vitrectomy plus intravitreal antifungals (P = 0.013).

Conclusion:

A strong clinical suspicion that translates into early vitrectomy plus intravitreal antifungal antibiotics leads to favorable visual and structural outcomes. A long wait till microbiological confirmation to institute antifungal therapy may result in poorer outcome.
Quantitative Analysis of Depth, Distribution, and Density of Cysts in Acanthamoeba Keratitis Using Confocal Microscopy
Authors: Huang Ping , Tepelus Tudor , Vickers Laura A. , Baghdasaryan Elmira , Huang Jianyan , Irvine John A. , Hsu Hugo Y. , Sadda Srinivas , Lee Olivia L.
Published: May 2017

Purpose:

To quantify the density, distribution, and depth of invasion of cysts in the corneas of eyes with acanthamoeba keratitis (AK) by in vivo confocal microscopy (IVCM) with a novel scanning pattern.

Methods:

The medical records of patients with AK evaluated at the Doheny Eye Center UCLA between September 2014 and July 2016 were reviewed retrospectively. Patients with clinically diagnosed AK underwent IVCM at various time points during their clinical course. Five corneal locations were scanned at each time point: the central area and 4 standard points on the peripheral cornea corresponding to temporal, nasal, inferior, and superior locations. The IVCM scans were manually graded to quantify the maximum depth of invasion and density of cysts.

Results:

Twenty-one eyes of 18 patients with visible cysts on IVCM were included. Mean cyst density at presentation was 214.1 ± 120.2/mm2 (range: 64–484 cells/mm2), and the average cyst depth was 164.3 ± 81.2 μm (range: 17–290 μm). In 17 eyes, the average cyst depth was 139.4 ± 68.6 μm (range: 17–245 μm), mean cyst density was 177.9 ± 99.6/mm2, and an average of 1.4 ± 1.3 quadrants was infiltrated at presentation, and reached clinical resolution with medical treatment without surgical intervention. Four eyes that ultimately underwent therapeutic penetrating keratoplasty had cysts in all 4 quadrants and deeper cyst infiltration; the average cyst depth in these corneas was 270.5 ± 17.5 μm (range: 252–290).

Conclusions:

Eyes with AK requiring therapeutic keratoplasty were more likely to have a deeper and more diffuse penetration of cysts in the cornea compared with those resolving with medical treatment.
Effects of Diquafosol Ophthalmic Solution on Quality of Life in Dry Eye Assessed Using the Dry Eye–Related Quality-of-Life Score Questionnaire: Effectiveness in Patients While Reading and Using Visual Display Terminals
Authors: Utsunomiya Tsugiaki , Kawahara Atsushi , Hanada Kazuomi , Yoshida Akitoshi
Published: May 2017

Purpose:

Diquafosol ophthalmic solution improves objective findings in the ocular surface and subjective symptoms in patients with dry eye. The Dry Eye-Related Quality-of-Life Score (DEQS) questionnaire was developed to assess dry eye symptoms and their effects on quality of life. However, because little research using the DEQS has been reported, we evaluated the effects of diquafosol ophthalmic solution on ocular surface findings and quality of life using the DEQS in patients with dry eye.

Methods:

Sixty-three patients with dry eye were assigned to the control group (artificial tears) or diquafosol group. Both groups instilled 1 drop of the solution in both eyes 6 times daily and were evaluated after 2 weeks; the diquafosol group also was instructed to be examined at 1 and 3 months. We evaluated the subjective symptoms using the DEQS, fluorescein staining score, tear film breakup time (BUT), Schirmer testing, and lower tear meniscus height with anterior-segment optical coherence tomography.

Results:

In the diquafosol group, the fluorescein staining score, BUT, tear meniscus height, and DEQS scores improved significantly compared with before treatment in contrast to the control group. Furthermore, in the diquafosol group, the staining score and BUT improved significantly compared with the control group. Analysis of each DEQS item indicated that diquafosol ophthalmic solution relieved foreign body sensation and problems when reading and using visual display terminals compared with the control group.

Conclusions:

Diquafosol ophthalmic solution was effective in patients with dry eye, especially those with foreign body sensation and problems when reading and using visual display terminals.
Utility of PROSE Device in the Management of Complex Oculoplastic Pathology
Authors: Scofield-Kaplan Stacy M. , Dunbar Kristen E. , Campbell Ashley A. , Kazim Michael
Published: May 2017

Purpose:

To describe the use of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) device in the management of complex oculoplastic pathology.

Methods:

The authors retrospectively reviewed the records of individuals over 18 years of age who were referred and successfully fit with the PROSE scleral device between January 1995 and June 2015.

Results:

Nine cases were identified that had complex oculoplastic disease and severe corneal surface disease. All patients with ptosis had improvement in marginal reflex distance-1 following PROSE and 5 of 7 patients with ptosis were spared further surgical intervention. Two underwent surgical repair with successful corneal stabilization with PROSE. Those with eyelid malposition including ectropion, entropion, or trichiasis experienced improvement in their corneal surface and deferred further surgical intervention.

Conclusions:

These cases highlight the use of the PROSE device to elevate the upper eyelid in patients with lagophthalmos and ptosis, stabilize the corneal surface to allow for additional eyelid surgery to be performed safely, and protect the corneal surface in patients with intractable trichiasis and entropion. Prosthetic Replacement of the Ocular Surface Ecosystem should be considered in patients with complex oculoplastic pathology to improve visual function, corneal surface disease, and eyelid position.
The Impact of Community Input in Community Health Needs Assessments
Authors: Bias Thomas K. , Abildso Christiaan G. , Vasile Emily , Coffman Jessica
Published: May 2017

Objective:

To determine the impact of community participation on nonprofit hospital priorities as outlined in a Community Health Needs Assessment.

Design:

Using 3 completed Community Health Needs Assessments, we compare key stakeholder survey responses with community survey responses and determine their contribution to the finalized priorities.

Setting:

Three communities in West Virginia served by nonprofit hospitals (1 metropolitan statistical area, 1 micropolitan statistical area, and 1 rural community).

Participants:

Key stakeholders and the general population of communities served by the hospital.

Main Outcome Measure:

Finalized priorities as outlined in the Community Health Needs Assessment.

Results:

Community participation had an impact on finalized priorities.

Conclusion:

Community participation is key in identifying unique health needs and should be incorporated into the assessment process by nonprofit hospitals, local health departments, and other public health practitioners. As reforms are considered to the Patient Protection and Affordable Care Act, it will be important to emphasize the importance of community input in identifying ways nonprofit hospitals contribute community benefit. CHNAs without adequate public input may not translate into implementation plans that accurately address pressing health concerns.
Making the Most of Our Community Health Assessment by Developing a Framework for Evaluation
Authors: Gutilla Margaret J. , Hewitt Susan J. , Cooper Bruce
Published: May 2017

The Health District of Northern Larimer County is a special district delivering community health programs and services in Northern Colorado. Since 1995, we have conducted a community health assessment (CHA) every 3 years. In 2015, we looked at our CHA process to see whether improvements could be made. We gathered information to understand recommended processes and potential impacts of CHA. We then developed a logic model to describe our CHA process and intended outcomes. The model outlined our CHA activities and impacts and informed our evaluation questions. We identified areas for process improvement, including our ability to analyze health inequities and effectively disseminate CHA data and findings. We recommend that others conducting a CHA evaluate their processes and impacts. Developing a logic model can be a first step toward creating an evaluation. While evaluation requires resources, we believe that the practice of CHA could greatly benefit from additional evaluation efforts.
The Misconception of Case-Control Studies in the Plastic Surgery Literature: A Literature Audit
Authors: Hatchell Alexandra C. , Farrokhyar Forough , Choi Matthew
Published: May 2017

Background:

Case-control study designs are commonly used. However, many published case-control studies are not true case-controls and are in fact mislabeled. The purpose of this study was to identify all case-control studies published in the top three plastic surgery journals over the past 10 years, assess which were truly case-control studies, clarify the actual design of the articles, and address common misconceptions.

Methods:

MEDLINE, Embase, and Web of Science databases were searched for case-control studies in the three highest–impact factor plastic surgery journals (2005 to 2015). Two independent reviewers screened the resulting titles, abstracts, and methods, if applicable, to identify articles labeled as case-control studies. These articles were appraised and classified as true case-control studies or non–case-control studies.

Results:

The authors found 28 articles labeled as case-control studies. However, only six of these articles (21 percent) were truly case-control designs. Of the 22 incorrectly labeled studies, one (5 percent) was a randomized controlled trial, three (14 percent) were nonrandomized trials, two (9 percent) were prospective comparative cohort designs, 14 (64 percent) were retrospective comparative cohort designs, and two (9 percent) were cross-sectional designs. The mislabeling was worse in recent years, despite increases in evidence-based medicine awareness.

Conclusions:

The majority of published case-control studies are not in fact case-control studies. This misunderstanding is worsening with time. Most of these studies are actually comparative cohort designs. However, some studies are truly clinical trials and thus a higher level of evidence than originally proposed.
What’s New in Cleft Palate and Velopharyngeal Dysfunction Management?
Authors: Naran Sanjay , Ford Matthew , Losee Joseph E.
Published: May 2017

Learning Objectives:

After studying this article, the participant should be able to: 1. Have a clear understanding of the evolution of concepts of velopharyngeal dysfunction, especially as it relates to patients with a cleft palate. 2. Explain the subjective and objective evaluation of speech in children with velopharyngeal dysfunction. 3. On the basis of these diagnostic findings, be able to classify types of velopharyngeal dysfunction. 4. Develop a safe, evidence-based, patient-customized treatment plan for velopharyngeal dysfunction founded on objective considerations.

Velopharyngeal dysfunction is improper function of the dynamic structures that work to control the velopharyngeal sphincter. Approximately 30 percent of patients having undergone cleft palate repair require secondary surgery for velopharyngeal dysfunction. A multidisciplinary team using multimodal instruments to evaluate velopharyngeal function and speech should manage these patients. Instruments may include perceptual speech analysis, video nasopharyngeal endoscopy, multiview speech videofluoroscopy, nasometry, pressure-flow, and magnetic resonance imaging. Velopharyngeal dysfunction may be amenable to surgical or nonsurgical treatment methods or a combination of each. Nonsurgical management may include speech therapy or prosthetic devices. Surgical interventions could include palatal re-repair with repositioning of levator veli palatini muscles, posterior pharyngeal flap, sphincter pharyngoplasty, or soft palate or posterior wall augmentation. Treatment interventions should be based on objective assessment and rating of the movement of lateral and posterior pharyngeal walls and the palate to optimize speech outcomes. Treatment should be tailored to specific anatomical and physiologic findings and the overall needs of the patient.
Impact of Evolving Radiation Therapy Techniques on Implant-Based Breast Reconstruction
Authors: Muresan Horatiu , Lam Gretl , Cooper Benjamin T. , Perez Carmen A. , Hazen Alexes , Levine Jamie P. , Saadeh Pierre B. , Choi Mihye , Karp Nolan S. , Ceradini Daniel J.
Published: May 2017

Background:

Patients undergoing implant-based reconstruction in the setting of postmastectomy radiation therapy suffer from increased complications and inferior outcomes compared with those not irradiated, but advances in radiation delivery have allowed for more nuanced therapy. The authors investigated whether these advances impact patient outcomes in implant-based breast reconstruction.

Methods:

Retrospective chart review identified all implant-based reconstructions performed at a single institution from November of 2010 to November of 2013. These data were cross-referenced with a registry of patients undergoing breast irradiation. Patient demographics, treatment characteristics, and outcomes were analyzed.

Results:

Three hundred twenty-six patients (533 reconstructions) were not irradiated, whereas 83 patients (125 reconstructions) received radiation therapy; mean follow-up was 24.7 months versus 26.0 months (p = 0.49). Overall complication rates were higher in the irradiated group (35.2 percent versus 14.4 percent; p < 0.01). Increased maximum radiation doses to the skin were associated with complications (maximum dose to skin, p = 0.05; maximum dose to 1 cc of skin, p = 0.01). Different treatment modalities (e.g., three-dimensional conformal, intensity-modulated, field-in-field, and hybrid techniques) did not impact complication rates. Prone versus supine positioning significantly decreased the maximum skin dose (58.5 Gy versus 61.7 Gy; p = 0.05), although this did not translate to significantly decreased complication rates in analysis of prone versus supine positioning.

Conclusions:

As radiation techniques evolve, the maximum dose to skin should be given consideration similar to that for heart and lung dosing, to optimize reconstructive outcomes. Prone positioning significantly decreases the maximum skin dose and trends toward significance in reducing reconstructive complications. With continued study, this may become clinically important. Interdepartmental studies such as this one ensure quality of care.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Comparison of Lymphovenous Shunt Methods in a Rat Model: Supermicrosurgical Lymphaticovenular Anastomosis versus Microsurgical Lymphaticovenous Implantation
Authors: Ishiura Ryohei , Yamamoto Takumi , Saito Takahumi , Mito Daisuke , Iida Takuya
Published: May 2017

Background:

Lymphaticovenular anastomosis and lymphaticovenous implantation are the most popular lymphovenous shunt operations for the treatment of obstructive lymphedema. However, no study has been reported regarding direct comparison between lymphaticovenular anastomosis and lymphaticovenous implantation. This study aimed to compare postoperative patency of lymphaticovenular anastomosis and lymphaticovenous implantation using a rat model.

Methods:

Twelve Wistar rats were used for the study. The rats were randomized into the lymphaticovenular anastomosis group (n= 6) or the lymphaticovenous implantation group (n= 6). In the lymphaticovenular anastomosis group, the largest femoral lymphatic vessel was anastomosed to a similar-size vein in an end-to-end intima-to-intima coaptation manner, and the other lymphatics were ligated. In the lymphaticovenous implantation group, the femoral lymphatic vessel and surrounding tissue were inserted into the short saphenous vein with a telescopic anastomosis technique. Patency was evaluated intraoperatively and 1 week postoperatively with patent blue dye and indocyanine green lymphography.

Results:

The mean diameters of the lymphatic vessels and the veins were 0.242 mm (range, 0.20 to 0.35 mm) and 0.471 mm (range, 0.30 to 0.75 mm), respectively. Intraoperative patency was 100 percent (six of six) in both groups (p= 1.000). Postoperative patency was significantly higher in the lymphaticovenular anastomosis group compared with the lymphaticovenous implantation group [100 percent (six of six) versus 33.3 percent (two of six);p= 0.014]

Conclusion:

Postoperative patency of the lymphaticovenular anastomosis group was higher than that of the lymphaticovenous implantation group, although intraoperative patency rates of the lymphaticovenular anastomosis and lymphaticovenous implantation groups were comparable.