bluuebunny/crossref_metadata_2025 huggingface dataset:
The ABMS MOC Part III Examination: Value, Concerns, and Alternative Formats
Authors: Hawkins Richard E. , Irons Mira Bjelotomich , Welcher Catherine M. , Pouwels Mellie Villahermosa , Holmboe Eric S. , Reisdorff Earl J. , Cohen Joshua M. , Dentzer Susan , Nichols David G. , Lien Cynthia A. , Horn Thomas D. , Noone R. Barrett , Lipner Rebecca S. , Eva Kevin W. , Norcini John J. , Nora Lois Margaret , Gold Jeffrey P.
Published: July 2016

This article describes the presentations and discussions at a conference co-convened by the Council on Medical Education of the American Medical Association (AMA) and by the American Board of Medical Specialties (ABMS). The conference focused on the ABMS Maintenance of Certification (MOC) Part III Examination. This article, reflecting the conference agenda, covers the value of and evidence supporting the examination, as well as concerns about the cost of the examination, and—given the current format—its relevance. In addition, the article outlines alternative formats for the examination that four ABMS member boards are currently developing or implementing. Lastly, the article presents contrasting views on the approach to professional self-regulation. One view operationalizes MOC as a high-stakes, pass–fail process while the other perspective holds MOC as an organized approach to support continuing professional development and improvement. The authors hope to begin a conversation among the AMA, the ABMS, and other professional stakeholders about how knowledge assessment in MOC might align with the MOC program’s educational and quality improvement elements and best meet the future needs of both the public and the physician community.
Peer Support for Clinicians: A Programmatic Approach
Authors: Shapiro Jo , Galowitz Pamela
Published: July 2016

Burnout is plaguing the culture of medicine and is linked to several primary causes including long work hours, increasingly burdensome documentation, and resource constraints. Beyond these, additional emotional stressors for physicians are involvement in an adverse event, especially one that involves a medical error, and malpractice litigation. The authors argue that it is imperative that health care institutions devote resources to programs that support physician well-being and resilience. Doing so after adverse and other emotionally stressful events, such as the death of a colleague or caring for victims of a mass trauma, is crucial as clinicians are often at their most vulnerable during such times. To this end, the Center for Professionalism and Peer Support at Brigham and Women’s Hospital redesigned the peer support program in 2009 to provide one-on-one peer support. The peer support program was one of the first of its kind; over 25 national and international programs have been modeled off of it. This Perspective describes the origin, structure, and basic workings of the peer support program, including important components for the peer support conversation (outreach call, invitation/opening, listening, reflecting, reframing, sense-making, coping, closing, and resources/referrals). The authors argue that creating a peer support program is one way forward, away from a culture of invulnerability, isolation, and shame and toward a culture that truly values a sense of shared organizational responsibility for clinician well-being and patient safety.
Combined Spinal Epidural Technique for Labor Analgesia Does Not Delay Recognition of Epidural Catheter Failures
Authors: Booth Jessica M. , Pan Joshua C. , Ross Vernon H. , Russell Gregory B. , Harris Lynne C. , Pan Peter H.
Published: July 2016

Background

It is unclear whether recognition of epidural catheter failures is delayed with combined spinal epidural technique (CSE) compared to traditional epidural technique (EPID) when used for labor analgesia. The authors hypothesized that recognition of failed catheters is not delayed by CSE.

Methods

Anesthetic, obstetric, and quality assurance records from 2,395 labor neuraxial procedures (1,440 CSE and 955 EPID) performed at Forsyth Medical Center (Winston-Salem, North Carolina) between June 30 and December 31, 2012, were retrospectively analyzed. The primary outcome was catheter survival (failure-free) time during labor analgesia. A proportional hazards model with the counting method was used to assess relationships between the techniques and survival (failure-free) time of catheters, while controlling for subjects’ body mass index and providers’ level of training in the final best-fit multivariable regression model.

Results

Cumulative incidence of epidural catheter failures was 6.6% for CSE and 11.6% for EPID (P = 0.001). In the multivariable regression model, catheters placed with CSE versus epidural were less likely to fail (hazard ratio, 0.58; 95% CI, 0.43 to 0.79; P = 0.0002) for labor analgesia. Among the catheters that failed, there was no overall difference in failure time course between the techniques (hazard ratio, 1.17; 95% CI, 0.89 to 1.54; P = 0.26) even though more failed catheters with CSE (48.4%) than with EPID (30.6%) were recognized within the first 30 min of placement (P = 0.009).

Conclusions

In this cohort, CSE has a significantly lower risk of overall epidural catheter failures than EPID and does not delay recognition of epidural catheter failures. Choice of CSE versus EPID should be based on overall risk of failure, efficacy, and side effects.
Cognitive Spare Capacity as an Index of Listening Effort
Authors: Rudner Mary
Published: July 2016

Everyday listening may be experienced as effortful, especially by individuals with hearing loss. This may be due to internal factors, such as cognitive load, and external factors, such as noise. Even when speech is audible, internal and external factors may combine to reduce cognitive spare capacity, or the ability to engage in cognitive processing of spoken information. A better understanding of cognitive spare capacity and how it can be optimally allocated may guide new approaches to rehabilitation and ultimately improve outcomes. This article presents results of three tests of cognitive spare capacity:

1. Sentence-final Word Identification and Recall (SWIR) test

2. Cognitive Spare Capacity Test (CSCT)

3. Auditory Inference Span Test (AIST)

Results show that noise reduces cognitive spare capacity even when speech intelligibility is retained. In addition, SWIR results show that hearing aid signal processing can increase cognitive spare capacity, and CSCT and AIST results show that increasing load reduces cognitive spare capacity. Correlational evidence suggests that while the effect of noise on cognitive spare capacity is related to working memory capacity, the effect of load is related to executive function. Future studies should continue to investigate how hearing aid signal processing can mitigate the effect of load on cognitive spare capacity, and whether such effects can be enhanced by developing executive skills through training. The mechanisms modulating cognitive spare capacity should be investigated by studying their neural correlates, and tests of cognitive spare capacity should be developed for clinical use in conjunction with developing new approaches to rehabilitation.
Sensory–Cognitive Interactions in Older Adults
Authors: Humes Larry E. , Young Levi A.
Published: July 2016

The objective of this study was regarding sensory and cognitive interactions in older adults published since 2009, the approximate date of the most recent reviews on this topic. After an electronic database search of articles published in English since 2009 on measures of hearing and cognition or vision and cognition in older adults, a total of 437 articles were identified. Screening by title and abstract for appropriateness of topic and for articles presenting original research in peer-reviewed journals reduced the final number of articles reviewed to 34. These articles were qualitatively evaluated and synthesized with the existing knowledge base. Additional evidence has been obtained since 2009 associating declines in vision, hearing, or both with declines in cognition among older adults. The observed sensory–cognitive associations are generally stronger when more than one sensory domain is measured and when the sensory measures involve more than simple threshold sensitivity. Evidence continues to accumulate supporting a link between decline in sensory function and cognitive decline in older adults.
Listening and Learning: Cognitive Contributions to the Rehabilitation of Older Adults With and Without Audiometrically Defined Hearing Loss
Authors: Tremblay Kelly L. , Backer Kristina C.
Published: July 2016

Here, we describe some of the ways in which aging negatively affects the way sensory input is transduced and processed within the aging brain and how cognitive work is involved when listening to a less-than-perfect signal. We also describe how audiologic rehabilitation, including hearing aid amplification and listening training, is used to reduce the amount of cognitive resources required for effective auditory communication and conclude with an example of how listening effort is being studied in research laboratories for the purpose(s) of informing clinical practice.
A Model of Auditory-Cognitive Processing and Relevance to Clinical Applicability
Authors: Edwards Brent
Published: July 2016

Hearing loss and cognitive function interact in both a bottom-up and top-down relationship. Listening effort is tied to these interactions, and models have been developed to explain their relationship. The Ease of Language Understanding model in particular has gained considerable attention in its explanation of the effect of signal distortion on speech understanding. Signal distortion can also affect auditory scene analysis ability, however, resulting in a distorted auditory scene that can affect cognitive function, listening effort, and the allocation of cognitive resources. These effects are explained through an addition to the Ease of Language Understanding model. This model can be generalized to apply to all sounds, not only speech, representing the increased effort required for auditory environmental awareness and other nonspeech auditory tasks. While the authors have measures of speech understanding and cognitive load to quantify these interactions, they are lacking measures of the effect of hearing aid technology on auditory scene analysis ability and how effort and attention varies with the quality of an auditory scene. Additionally, the clinical relevance of hearing aid technology on cognitive function and the application of cognitive measures in hearing aid fittings will be limited until effectiveness is demonstrated in real-world situations.
The Implications of Cognitive Aging for Listening and the Framework for Understanding Effortful Listening (FUEL)
Authors: Phillips Natalie A.
Published: July 2016

This review article considers some of the age-related changes in cognition that are likely to interact with hearing, listening effort, and cognitive energy. The focus of the review is on normative age-related changes in cognition; however, consideration is also given to older adults who experience clinically significant deficits in cognition, such as persons with Alzheimer’s disease or who may be in a preclinical stage of dementia (mild cognitive impairment). The article distinguishes between the assessment of cognitive function for clinical versus research purposes. It reviews the goal of cognitive testing in older adults and discusses the challenges of validly assessing cognition in persons with sensory impairments. The article then discusses the goals of assessing specific cognitive functions (processing speed and attentional processes) for the purpose of understanding their relationships with listening effort. Finally, the article highlights certain concepts that are likely to be relevant to listening effort and cognitive energy, including some issues that have not yet received much attention in this context (e.g., conation, cognitive reserve, and second language speech processing).
Listening Effort in Younger and Older Adults: A Comparison of Auditory-Only and Auditory-Visual Presentations
Authors: Sommers Mitchell S. , Phelps Damian
Published: July 2016

One goal of the present study was to establish whether providing younger and older adults with visual speech information (both seeing and hearing a talker compared with listening alone) would reduce listening effort for understanding speech in noise. In addition, we used an individual differences approach to assess whether changes in listening effort were related to changes in visual enhancement—the improvement in speech understanding in going from an auditory-only (A-only) to an auditory-visual condition (AV) condition. To compare word recognition in A-only and AV modalities, younger and older adults identified words in both A-only and AV conditions in the presence of six-talker babble. Listening effort was assessed using a modified version of a serial recall task. Participants heard (A-only) or saw and heard (AV) a talker producing individual words without background noise. List presentation was stopped randomly and participants were then asked to repeat the last three words that were presented. Listening effort was assessed using recall performance in the two- and three-back positions. Younger, but not older, adults exhibited reduced listening effort as indexed by greater recall in the two- and three-back positions for the AV compared with the A-only presentations. For younger, but not older adults, changes in performance from the A-only to the AV condition were moderately correlated with visual enhancement. Results are discussed within a limited-resource model of both A-only and AV speech perception.
Shelf acetabuloplasty in Perthes disease: comparison with nonoperative treatment
Authors: Parmentier Charles , Madoki Alexandre , Mercier Pierrick , Docquier Pierre-Louis
Published: July 2016

Background:

The purpose of this study was to compare radiographic results between operatively and nonoperatively treated hips in patients with Perthes disease.

Methods:

Eighty children (88 hips) treated for Perthes disease were retrospectively reviewed with focus on the radiographic result at a mean follow-up of 6.3 yr (range 2.0 to 12.9 yr). Forty-seven hips had shelf acetabuloplasty, and 41 hips were treated nonoperatively. The radiographs were evaluated at the time of diagnosis, at 4 wk and 3 yr postoperatively (for the shelf group) and finally at latest follow-up for both groups.

Results:

In the nonoperatively treated group, the prognosis was initially better than in the shelf group: younger age at the time of diagnosis (4.7 vs. 6.1 yr), more Herring type A and fewer Herring type C, fewer “head at risk” signs. Stulberg’s classification at the latest follow-up showed Stulberg 1, 2 or 3 in 85% and Stulberg 4 in 15% in the nonoperative group compared with 89% and 11%, respectively, in the shelf group. Acetabular depth ratio and the migration index were better in the shelf group.

Conclusions:

Despite initial worse prognostic factors, final radiographic result seemed to be better in the shelf group. The shelf procedure showed radiographic improvement in the hip in Perthes disease.
Single-stage medial open reduction and Pemberton acetabuloplasty in developmental dysplasia of the hip
Authors: Baki Mehmet Emre , Baki Celal , Aydin Hafiz , Ari Bünyamin , Özcan Murat
Published: July 2016

In this study, we aimed to evaluate the long-term clinical and radiological results of single-stage open reduction through a medial approach and Pemberton acetabuloplasty in developmental dysplasia of the hip. We treated 32 hips (22 patients) with developmental dysplasia by a single-stage open reduction through Ferguson’s medial approach and Pemberton acetabuloplasty. The procedure was performed bilaterally in 10 patients. The mean age of the patients at the time of the operation was 19.8 months (16–24 months). The mean follow-up period was 10.9 years (7–19 years). Group I avascular necrosis according to the Kalamchi and MacEwen classification was observed in two hips and group II in one hip. Radiologically, 90.6% of the hips were classified as Severin class I and 9.4% of the hips were classified as Severin class II. At the latest follow-up, 30 hips were assessed clinically as excellent and two hips as good. No patient required subsequent surgery. We conclude that single-stage medial open reduction and Pemberton acetabuloplasty represent an effective method for developmental dysplasia of the hip in children older than 15 months of age.
Complex Monteggia fracture in a 5 year old
Authors: Clark Tyler R. , Merriott Daniel S. , Gonzales Joseph A.
Published: July 2016

Monteggia fractures comprise a small subset of fractures in the pediatric population that are normally reduced nonoperatively. Complex Monteggia fractures can be more difficult to identify and require operative intervention. We describe a case of a Bado type I Monteggia fracture with a posteriorly dislocated radial head and neck fracture that has not been described before in the literature. The patient required advanced imaging because of ossification delays and led to an operative intervention to reduce the radial head and neck. This case exemplifies how irreducible Monteggia fractures may necessitate advanced imaging to determine blocks to a successful reduction.
Early application of the Ponseti casting technique for clubfoot correction in sick infants at the neonatal intensive care unit
Authors: Lebel Ehud , Weinberg Eliraz , Berenstein-Weyel Tamar M. , Bromiker Ruben
Published: July 2016

The treatment of congenital clubfoot has been changing rapidly since the mid-1990s with the worldwide use of the Ponseti method for serial casting and limited operative interventions. This method was first applied for isolated clubfeet and later on for other types of clubfoot (teratologic, residual, and neurogenic). Premature babies sustaining clubfoot commonly suffer from additional congenital and acquired medical problems. These may postpone clubfoot management until urgent issues are resolved. The current study describes early initiation of treatment of clubfoot in premature babies at the neonatal intensive care unit (NICU) and their outcomes. The study group included all babies diagnosed with clubfoot and managed in the NICU (for any etiology) between 2006 and 2012. Management was based on the Ponseti protocol for serial casting. We also report on neonates who died in the NICU before or during treatment. We specifically describe adverse events of early casting and situations necessitating removal of casts or termination of treatment. We diagnosed and treated 20 neonates with clubfoot (four females and 16 males, 10 bilateral cases). Gestational age ranged from 27 weeks to term. Eight were identified with clubfoot by prenatal sonographic survey and 10 were diagnosed with a defined syndrome. Seven had respiratory support, including one with a chest drain (50%). Length of stay in the NICU ranged from 3 to 90 days. Four neonates died while in the NICU (all syndromatic). In the remaining 16 cases, treatment began as early as medically possible. The first cast was applied within the first week of life in 14 cases. A total of 75 casts were applied during the study period. Three casts (4%) were removed because of leg edema or a need for venous access. Casts were routinely replaced every 4–7 days. Achilles tenotomies were performed in the NICU for babies achieving satisfactory correction. At last follow-up, 10 children were independent walkers and six were nonambulatory; all showed successful correction of clubfeet. The results of this study show that in most cases, clubfoot treatment is feasible and effective within the first week of life. Instances necessitating immediate cast removal are highlighted. Although while facing acute life-threatening medical problems, the treatment of clubfoot may not be considered a priority, most neonates will grow up into independent individuals; thus, every effort should be made to initiate the best clubfoot management with minimal delay.
Treatment of the Dislocated Hip in Infants With Spasticity
Authors: Refakis Christian A. , Baldwin Keith D. , Spiegel David A. , Sankar Wudbhav N.
Published: July 2016

Background:

Although many studies have separately investigated the treatment of developmental dysplasia of the hip and spastic hip disease, little data exist regarding the treatment of infants with dislocated hips and underlying spasticity. The purpose of this study was to review our results after the surgical treatment of these infants.

Methods:

We retrospectively reviewed all children below 3 years of age who underwent hip reconstruction for dislocated hips in the setting of cerebral palsy or other spastic/high-tone neuromuscular disease. Medical records were reviewed for clinical data including treatment course, complications, and need for further surgery. Preoperative and postoperative radiographs were used to determine International Hip Dysplasia Institute (IHDI) grade of dislocation, acetabular index, migration percentage, and presence of avascular necrosis according to the Salter criteria.

Results:

Eleven patients with 15 hips met our inclusion criteria with a mean age of 20±8 (range, 6 to 34) months. Preoperatively, 12 of 15 hips (80%) were IHDI grade 4 and 3 of 15 (20%) were IHDI grade 3. Mean acetabular index was 29±8 (range, 19 to 46) degrees. Patients underwent open reduction (15 hips), adductor tenotomy (14 hips), femoral osteotomy (10 hips), and pelvic osteotomy (12 hips). At a mean follow-up of 40±16 (range, 13 to 71) months, 13 of 15 hips were IHDI grade 1 (86.7%), 1 was IHDI grade 2 (6.7%), and 1 hip was IHDI grade 3 (6.7%). The mean postoperative migration index was 7%±24% (range, −30% to 46%); the mean acetabular index was 22±8 (range, 9 to 38) degrees. No patients developed radiographically significant osteonecrosis. Complications included 2 femur fractures (13.3%) and 1 symptomatic implant that required early removal. One patient underwent further reconstructive hip surgery.

Conclusions:

In this series of infants with hip dislocations and underlying spasticity, open reduction±pelvic osteotomy and/or femoral osteotomy has a nearly 90% success rate in achieving and maintaining adequate hip reduction at intermediate-term follow-up. In the unique population of infants with dislocated hips and underlying spasticity, comprehensive hip reconstruction is largely successful with an acceptable rate of complications.

Level of Evidence:

Level IV—retrospective.
Association Between Cartilage Intermediate Layer Protein and Degeneration of Intervertebral Disc
Authors: Wang Wenyu , Hao Jingcan , Zheng Shuyu , Xiao Xiao , Wen Yan , He Awen , Guo Xiong , Zhang Feng
Published: July 2016

Study Design.

Meta-analysis to collect all eligible studies for investigating whether cartilage intermediate layer protein (CILP) gene rs2073711 polymorphism is associated with susceptibility to intervertebral disc degeneration (IVD).

Objective.

To investigate the association between CILP gene rs2073711 and IVD.

Summary of Background Data.

CILP is one of the limited genes that is being suggested to be associated with IVD. However, previous association study results of CILP and IVD are conflicted.

Methods.

The PubMed, ISI Web of Science, Science Direct Online, and China National Knowledge Infrastructure database were searched for relevant articles till November 1, 2015. The odds ratio (OR) and related 95% confidence interval (CI) were drawn out and merged to assess the strength of association by STATA version 12.0.

Results.

A total of 1551 IVD cases and 1793 controls from the 5 studies were used in this study, comprising four Asian populations and two European populations. Meta-analysis found that the CILP 2073711 polymorphism was significantly associated with IVD risk. The estimated OR of risk allele T of rs2073711 was 1.36. (95% CI = 1.18–1.55, P < 0.001). No significant heterogeneity and publication bias were observed in this study.

Conclusion.

Our results confirm the positive association between CILP and IVD, providing novel clues for clarifying the role of CILP in the development of IVD.

Level of Evidence: 2
Antibody drug conjugates: the future of chemotherapy?
Authors: Borcoman Edith , Le Tourneau Christophe
Published: July 2016

Purpose of review

The current review describes the rationale and current clinical development of antibody drug conjugates (ADCs), along with their perspectives for the future.

Recent findings

Trastuzumab emtansine was the first ADC approved by the U.S. Food and Drug Administration for the treatment of human epidermal growth factor receptor 2 positive metastatic breast cancer in the second-line setting, with a high efficacy and a favorable safety profile. ADC represents an exciting new class of cancer therapeutics that combines a targeted approach for delivering cytotoxic agents. About 30 new ADCs are currently under investigation in oncology.

ADCs are empowered antibodies designed to exploit the targeting ability of monoclonal antibodies (mAbs) by linking them to cytotoxic agents, giving them higher tumor selectivity, and potentially an increased therapeutic window, as compared with cytotoxic agents alone. The key components of ADCs include a mAb, a stable linker and a cytotoxic agent. In linking mAbs with cytotoxic agents, the aim is to optimize the properties of both components, bringing their complementary features together. Trastuzumab emtansine has been the first ADC to be marketed in human epidermal growth factor receptor 2 positive metastatic breast cancer. Current clinical development of ADCs includes a variety of targets, as well as combinations with other therapeutic agents, such as chemotherapy, radiotherapy, targeted therapies, and immune checkpoint inhibitors.
Bedtime Electronic Media Use and Sleep in Children with Autism Spectrum Disorder
Authors: Mazurek Micah O. , Engelhardt Christopher R. , Hilgard Joseph , Sohl Kristin
Published: July 2016

Objectives:

The purpose of this study was to better understand the use of screen-based media at bedtime among children with autism spectrum disorder (ASD). The study specifically examined whether the presence of media devices in the child's bedroom, the use of media as part of the bedtime routine, and exposure to media with violent content just before bedtime were associated with sleep difficulties.

Methods:

Parents of 101 children with ASD completed questionnaires assessing their children's sleep habits, bedroom media access (including television, video game devices, and computers), and patterns of nighttime media use (including timing of media exposure and violent media content).

Results:

Children with ASD who used media as part of the bedtime routine showed significantly greater sleep onset latency than those who did not (39.8 vs 16.0 minutes). Similarly, children who were exposed to media with violent content within the 30-minute period before bedtime experienced significantly greater sleep onset delays and shorter overall sleep duration. In contrast, the mere presence of bedroom media was not associated with either sleep onset latency or sleep duration.

Conclusion:

Overall, these findings indicate that incorporating television and video games into the bedtime routine is associated with sleep onset difficulties among children with ASD. Exposure to violent media before bed is also associated with poor sleep. Families of children with ASD should be encouraged to regulate and monitor the timing and content of television and video game use, whether or not such devices are physically present in the child's bedroom.
The Effect of Bilingual Exposure on Executive Function Skills in Preterm and Full-Term Preschoolers
Authors: Loe Irene M. , Feldman Heidi M.
Published: July 2016

Objective:

To evaluate the effects of bilingual exposure on executive function (EF) skills, measured by parent-rating and performance-based instruments, in preterm and full-term preschoolers.

Method:

Children age 3 to 5 years (mean 4.4) born preterm (PT; n = 82) and full term (FT; n = 79) had monolingual (PT-M, n = 51; FT-M, n = 53) or bilingual (PT-B, n = 31; FT-B, n = 26) language exposure. Groups were similar in age, gender and race, but PT children had lower socioeconomic status (SES) than FT children. Parents completed a language questionnaire and diary and a standardized parent rating of EF skills. Children completed EF tasks that tap response inhibition, working memory, and cognitive flexibility. ANCOVA and logistic regression examined effects on EF of birth group (PT/FT), language status (M/B), and birth group by language status interaction, controlling for age and SES.

Results:

Compared to children born FT, children born PT had significantly higher parent-rated EF scores and poorer performance on all but one EF task, both indicating more EF problems. No main effects of language status and no birth group by language status interactions were significant.

Conclusion:

PT status was clearly associated with poorer EF skills, similar to many other studies. In this sample, bilingual exposure conferred neither an advantage nor disadvantage in the FT and PT group. This information may prove useful in counseling families of both PT and FT children about the impact of bilingual exposure on their children's cognitive skills.
Ablative Fractional Laser–Assisted Topical Fluorouracil for the Treatment of Superficial Basal Cell Carcinoma and Squamous Cell Carcinoma In Situ: A Follow-Up Study
Authors: Hsu Sarah H. , Gan Stephanie D. , Nguyen Bichchau T. , Konnikov Nellie , Liang Christine A.
Published: July 2016

BACKGROUND

The authors previously reported the safety and short-term efficacy of ablative fractional laser (AFXL)–assisted delivery of topical fluorouracil in the treatment of superficial basal cell carcinoma (sBCC) and squamous cell carcinoma in situ (SCCis).

OBJECTIVE

This follow-up study was conducted to assess whether tumor clearance was sustained in this cohort of patients at >9 months post-treatment.

METHODS

Thirty primary sBCC or SCCis <2 cm on the trunk or extremities were treated with AFXL and a single application of topical 5-fluorouracil 5% under occlusion for 7 days. Among the 26 patients who achieved tumor clearance at 4 to 8 weeks post-treatment, 20 patients presented for this follow-up study and underwent shave biopsy to confirm histologic clearance. Mean follow-up time was 15 months.

RESULTS

Considering those who had persistent tumor at 4 to 8 weeks post-treatment and those who presented for follow-up at >9 months post-treatment, overall treatment success was 79% (95% confidence interval: 67%–96%), with 92% (11/12) for SCCis and 67% (8/12) for sBCC. Neither the tumor location nor size significantly impacted treatment outcome (p = .96 and 0.87, respectively).

CONCLUSION

Ablative fractional laser–assisted topical fluorouracil is a reasonable noninvasive treatment option for primary SCCis and sBCC, especially for lesions located in areas where self-application is not possible, or when clinician-administered therapy is preferred.
Emerging Points of the Supraorbital and Supratrochlear Nerves in the Supraorbital Margin With Reference to the Lacrimal Caruncle: Implications for Regional Nerve Block in Upper Eyelid and Dermatologic Surgery
Authors: Shin Kang-Jae , Shin Hyun Jin , Lee Shin-Hyo , Song Wu-Chul , Koh Ki-Seok , Gil Young-Chun
Published: July 2016

BACKGROUND

Blocking the supraorbital nerve (SON) and supratrochlear nerve (STN) by injecting anesthetic distal to the surgical site has the advantage in upper eyelid surgery that avoids obscuring the surgical landmarks and compromising the levator function.

OBJECTIVE

To identify the emerging points of the SON and STN in the supraorbital margin with reference to the lacrimal caruncle.

METHODS

Forty-nine orbits from 27 embalmed Korean cadavers were dissected. The lacrimal caruncle and facial midline were used as landmarks. The emerging points of the SON and STN in the supraorbital margin were determined.

RESULTS

The emerging points of the SON and STN were, respectively, located at 3.0 mm lateral and 3.3 mm medial to the vertical line through the apex of the lacrimal caruncle along the supraorbital margin. The horizontal distances from the facial midline to the emerging points of the SON and STN were 22.8 and 15.2 mm, respectively.

CONCLUSION

The optimum sites for achieving SON and STN block are, respectively, located approximately 3 mm lateral and 3 mm medial to the vertical line through the apex of lacrimal caruncle along the supraorbital margin. This knowledge will help the surgeon achieve an easy and accurate approach for regional nerve block.
Is Sterile Better Than Aseptic? Comparing the Microbiology of Acellular Dermal Matrices
Authors: Klein Gabriel M. , Nasser Ahmed E. , Phillips Brett T. , Gersch Robert P. , Fourman Mitchell S. , Lilo Sarit E. , Fritz Jason R. , Khan Sami U. , Dagum Alexander B. , Bui Duc T.
Published: July 2016

Introduction:

Postoperative infections are a major complication associated with tissue-expander-based breast reconstruction. The use of acellular dermal matrix (ADM) in this surgery has been identified as a potential reservoir of infection, prompting the development of sterile ADM. Although aseptic and sterile ADMs have been investigated, no study has focused on the occurrence and clinical outcome of bacterial colonization before implantation.

Methods:

Samples of aseptic AlloDerm, sterile Ready-To-Use AlloDerm, and AlloMax were taken before implantation. These samples were incubated in Tryptic soy broth overnight before being streaked on Trypticase soy agar, MacConkey agar, and 5% blood agar plates for culture and incubated for 48 hours. Culture results were cross-referenced with patient outcomes for 1 year postoperatively.

Results:

A total of 92 samples of ADM were collected from 63 patients. There were 15 cases of postoperative surgical site infection (16.3%). Only 1 sample of ADM (AlloMax) showed growth of Escherichia coli, which was likely a result of contamination. That patient did not develop any infectious sequelae. Patient outcomes showed no difference in the incidence of seroma or infection between sterile and aseptic ADMs.

Conclusions:

This study evaluates the microbiology of acellular dermal matrices before use in breast reconstruction. No difference was found in the preoperative bacterial load of either aseptic or sterile ADM. No significant difference was noted in infection or seroma formation. Given these results, we believe aseptic processing used on ADMs is equivalent to sterile processing in our patient cohort in terms of clinical infection and seroma occurrence postoperatively.
Video Capture of Perforator Flap Harvesting Procedure with a Full High-definition Wearable Camera
Authors: Miyamoto Shimpei
Published: July 2016

Recent advances in wearable recording technology have enabled high-quality video recording of several surgical procedures from the surgeon’s perspective. However, the available wearable cameras are not optimal for recording the harvesting of perforator flaps because they are too heavy and cannot be attached to the surgical loupe. The Ecous is a small high-resolution camera that was specially developed for recording loupe magnification surgery. This study investigated the use of the Ecous for recording perforator flap harvesting procedures. The Ecous SC MiCron is a high-resolution camera that can be mounted directly on the surgical loupe. The camera is light (30 g) and measures only 28 × 32 × 60 mm. We recorded 23 perforator flap harvesting procedures with the Ecous connected to a laptop through a USB cable. The elevated flaps included 9 deep inferior epigastric artery perforator flaps, 7 thoracodorsal artery perforator flaps, 4 anterolateral thigh flaps, and 3 superficial inferior epigastric artery flaps. All procedures were recorded with no equipment failure. The Ecous recorded the technical details of the perforator dissection at a high-resolution level. The surgeon did not feel any extra stress or interference when wearing the Ecous. The Ecous is an ideal camera for recording perforator flap harvesting procedures. It fits onto the surgical loupe perfectly without creating additional stress on the surgeon. High-quality video from the surgeon’s perspective makes accurate documentation of the procedures possible, thereby enhancing surgical education and allowing critical self-reflection.
Solely Penile Skin for Neovaginal Construction in Sex Reassignment Surgery
Authors: Sigurjonsson Hannes , Rinder Johan , Lindqvist Ebba K. , Farnebo Filip , Lundgren T. Kalle
Published: July 2016

Background:

Gender reassignment surgery due to transsexualism (International Classification of Diseases, Tenth Revision: F64.0) is a procedure becoming increasingly common worldwide as a result of a significant increase in diagnostic incidence. Several methods have been described for this complex surgery, but no internationally agreed upon gold standard exists, in particular with regard to which methods allow for creating a sufficient neovaginal depth.

Methods:

We use a 2-stage technique using solely penile skin for creating a neovaginal cavity and present the long-term outcome in terms of measured neovaginal depth. Eighty patients were included. Patients’ neovaginal depth was measured in a standardized fashion 6 months or more after initial surgery. Results were compared with published data on female anatomy.

Results:

The average neovaginal depth achieved was 10.2 cm. Having had a postoperative complication and noncompliance to neovaginal dilatation were both negatively correlated with neovaginal depth, whereas higher body mass index was not. Most patients received a neovaginal depth sufficient for penetrative intercourse and within the range for biological women.

Conclusions:

Using solely penile skin for the vaginal lining is a satisfactory surgical method to achieve adequate vaginal depth, provided that the postoperative dilatation regimen is followed. This holds true regardless of age or body mass index.
Effects of Swimming Goggles Wearing on Intraocular Pressure, Ocular Perfusion Pressure, and Ocular Pulse Amplitude
Authors: Paula Ana P.B. , Paula Jayter S. , Silva Marcelo J.L. , Rocha Eduardo M. , De Moraes Carlos G. , Rodrigues Maria L.V.
Published: July 2016

Purpose:

To evaluate changes in the ocular pulse amplitude (OPA) and ocular perfusion pressure (OPP), and investigate factors associated with intraocular pressure (IOP) elevation due to periorbital compression during swimming goggles (SG) use.

Methods:

This cross-sectional study evaluated 35 eyes of 35 healthy volunteers during the wearing of a drilled SG. OPP calculation, Goldman applanation tonometry, and OPA measurements (using Pascal dynamic contour tonometer) were performed before, during, and after SG use. Scleral rigidity (calculated with Schiotz tonometry readings), orbital rim area, exophthalmometry, spherical equivalent, axial length, corneal thickness, and the goggles’ rubber elastic force were considered in the multivariable analysis as potentially related to IOP changes.

Results:

SG significantly increased IOP after 2 minutes of use (13.34±2.67 vs. 23.46±7.20 mm Hg, P<0.0001). After removal, IOP decreased significantly (10.20±5.85 mm Hg, P<0.0001). A inverse correlation between IOP and OPP differences was observed with the SG wearing (r=−0.57; P=0.0003). Mean OPA was significantly higher during compared with before SG wear (2.57±1.34 vs. 1.82±0.55 mm Hg for the timepoints 2 and 1, respectively; P=0.0064). Only orbital rim area (P=0.0052) and elastic force (P=0.0019) were significantly associated with IOP elevation.

Conclusions:

SG provoked acute IOP elevation and disturbance in the ocular hemodynamics, which was associated with larger orbital rim area and greater SG elastic force. These findings could have implications for subjects at high risk for glaucoma onset or progression.
Psychological interventions in managing postoperative pain in children: a systematic review
Authors: Davidson Fiona , Snow Stephanie , Hayden Jill A. , Chorney Jill
Published: July 2016

Pediatric surgeries are common and painful for children. Postoperative pain is commonly managed with analgesics; however, pain is often still problematic. Despite evidence for psychological interventions for procedural pain, there is currently no evidence synthesis for psychological interventions in managing postoperative pain in children. The purpose of this review was to assess the efficacy of psychological interventions for postoperative pain in youth. Psychological interventions included Preparation/education, distraction/imagery, and mixed. Four databases (PsycINFO, PubMed, EMBASE, and Certified Index to Nursing and Allied Health Literature) were searched to July 2015 for published articles and dissertations. We screened 1401 citations and included 20 studies of youth aged 2 to 18 years undergoing surgery. Two reviewers independently screened articles, extracted data, and assessed risk of bias. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using RevMan 5.3. Fourteen studies (1096 participants) were included in meta-analyses. Primary outcome was pain intensity (0-10 metric). Results indicated that psychological interventions as a whole were effective in reducing children's self-reported pain in the short term (SMD = −0.47, 95% CI = −0.76 to −0.18). Subgroup analysis indicated that distraction/imagery interventions were effective in reducing self-reported pain in the short term (24 hours, SMD = −0.63, 95% CI = −1.04 to −0.23), whereas preparation/education interventions were not effective (SMD = −0.27, 95% CI = −0.61 to 0.08). Data on the effects of interventions on longer term pain outcomes were limited. Psychological interventions may be effective in reducing short-term postoperative pain intensity in children, as well as longer term pain and other outcomes (eg, adverse events) require further study.
Strategies to Alleviate Anxiety Before the Placement of a Stereotactic Radiosurgery Frame
Authors: Avbovbo Ufuoma E. , Appel Susan J.
Published: July 2016

Background: Patients scheduled for stereotactic radiosurgery (SRS) need the placement of a head frame for accurate treatment of brain metastases and other abnormalities in the brain. These patients frequently experience anxiety before frame placement. Although there is evidence that preprocedure education can alleviate anxiety, less is known about education for patients undergoing head frame placement. Objective: The aim of this study was to determine whether a preprocedure educational intervention can reduce/alleviate anxiety for patients undergoing head frame placement for SRS. Methods: This study was a practice improvement project using a nonrandomized controlled design to evaluate patients (N = 28) diagnosed with metastasized brain cancer or other abnormalities in the brain. Patients aged ≥19 and <75 years were recruited, and all participants had been radiographically diagnosed and were dispositioned for SRS. The control group (n = 14) received the standard preprocedure teaching, and the intervention group (n = 14) received both the standard preprocedure teaching and an additional educational intervention. Data collecting tools included the Hospital Anxiety and Depression Scale and a visual analog scale to measure the patient’s anxiety. Results: It was found that, on average, anxiety levels were lower in the intervention group on both the visual analog scale and Hospital Anxiety and Depression Scale. However, the findings did not reach statistical significance, p < .05. Conclusion: On the basis of existing literature, preprocedure education has been shown to decrease patient anxiety. This study aimed to determine whether an additional educational intervention impacted anxiety in patients undergoing SRS for metastatic cancer. Although we found that anxiety levels were decreased in the intervention group, this finding did not reach statistical significance. A larger randomized study is needed to confirm the efficacy of such an intervention in this unique patient population.
An Atypical Case of Mounier-Kuhn Syndrome
Authors: Kuwal Ashok , Dutt Naveen , Chauhan Nishant , Kumar Sunil , Purohit Swetabh , Saini Lokesh K.
Published: July 2016

Mounier-Kuhn syndrome (MKS) is a rare disease of unknown etiology characterized by abnormal pathologic dilatation of tracheabronchial tree. The diagnosis of MKS is normally made on CT scan of chest on the basis of enlarged diameters of trachea and main stem bronchi. We are presenting histologically confirmed case of MKS, where the diameter of right main bronchus is below minimum diameter (mean+3 SD) required for the diagnosis. We suggest that the diagnosis of MKS should not be solely based on fixed criteria such as the diameter of airways, but on the basis of the overall clinical, pathologic, and radiologic profile.
Mediastinal Bronchogenic Cysts
Authors: Han Se Eun , Kwon Woon Jung , Cha Hee Jeong , Lee Young Jik , Lee Taehoon , Seo Kwang Won , Jegal Yangjin , Ahn Jong-Joon , Ra Seung Won
Published: July 2016

We report the findings for 2 patients with a fluid-fluid level seen on endobronchial ultrasound (EBUS) images of bronchogenic cysts. The EBUS images demonstrated a well-circumscribed cyst with a fluid-fluid level showing an anechoic upper part and a relatively hyperechoic lower part. A fluid-fluid level on EBUS imaging of a bronchogenic cyst, which can help confirm the cystic nature of the lesion, has not been previously reported. EBUS-based confirmation of these cysts using fluid-fluid levels may help avoid unnecessary aspiration of the lesions.
Comparison of single-session transarterial chemoembolization combined with microwave ablation or radiofrequency ablation in the treatment of hepatocellular carcinoma: a randomized-controlled study
Authors: Sheta Elshazly , El-Kalla Ferial , El-Gharib Mohamed , Kobtan Abdelrahman , Elhendawy Mohammed , Abd-Elsalam Sherief , Mansour Loai , Amer Ibrahim
Published: July 2016

Background

Globally, hepatocellular carcinoma (HCC) is the third most frequent cause of cancer-related mortality. In recent years, transarterial chemoembolization, radiofrequency ablation, and microwave ablation (MWA) have been accepted as treatment modalities for patients with surgically unresectable HCC.

Aim of this work

This study aimed to compare combination treatment with radiofrequency or MWA, followed by transarterial chemoembolization, and performed in a single session.

Patients and methods

This study was carried out on 50 patients with nonresectable single-lesion HCC, who were divided into three groups: group A included 20 patients treated by transcatheter hepatic arterial chemoembolization, group B included 20 patients treated by radiofrequency thermal ablation combined with transcatheter arterial chemoembolization, and group C included 10 patients treated by MWA combined with transcatheter arterial chemoembolization. The combined treatments were performed in a single session, with the ablation performed first.

Results

The total success rate in this study at 6 months following the procedure was 50% in group A, 70% in group B, and 80% in group C. Major complications were recorded in 22% of patients. The number of complications was the highest in group A.

Conclusion

Combined ablation with chemoembolization is superior in the treatment of nonresectable single masses larger than 4 cm. Transcatheter arterial chemoembolization and ablation can be performed safely and successfully during a single session, which has not been found to decrease the response rates to treatment. Combined treatment with MWA is more effective in terms of tumor response, and results in the same complication rate as with radiofrequency, but less than chemoembolization alone.