bluuebunny/crossref_metadata_2025 huggingface dataset:
Neoadjuvant Vismodegib and Mohs Micrographic Surgery for Locally Advanced Periocular Basal Cell Carcinoma
Authors: González Abel R. , Etchichury Dardo , Gil Maria E. , del Aguila Roxana
Published: November 2018

Introduction:

Vismodegib has shown a significant response rate in locally advanced periocular basal cell carcinoma. Long-term monotherapy is very difficult to accomplish due to primary or secondary resistance and side effects that limit the length of treatment. The use of Vismodegib as neoadjuvant followed by Mohs micrographic surgery is an option.

Purpose:

To report the use of neoadjuvant Vismodegib as an option for operable locally advanced basal cell carcinoma followed by Mohs surgery.

Patients and Methods:

The authors treated 8 locally advanced periocular basal cell carcinomas. Mean age was 76, and 6 of 8 were women. Mean size was 18 mm (12–30). Three were recurrent after surgery. Maximal clinical response was obtained at 4.8 months. Patients were operated at the mean time of 7.3 months.

Results:

Seven patients (87.5%) had a complete response and 1 (12.5%) progressed. Mohs micrographic surgery allowed to confirm a complete histologic response in 5 of 6 (83.3%) cases, and 1 patient refused surgery. All 7 patients are disease free after a mean follow-up of 12.4 months. All patients experienced adverse events. The most common included dysgeusia (100%) and muscle spasms (100%). Weight loss was present in 75% of the patients with a mean loss of 12.6 pounds and hair loss was seen in 50%. Only 1 (12.5%) patient withdraw from treatment because of intolerable muscle spasms.

Conclusions:

The authors believe there is a clear role for Vismodegib as neoadjuvant in locally advanced periocular basal cell carcinoma, even in operable cases. Specific indications beyond those already approved should be further discussed. Prospective studies to assess the combination of neoadjuvant Vismodegib followed by Mohs micrographic surgery in locally advanced periocular basal cell carcinoma with long-term follow-up are needed.
Sexual Misconduct Policies at Institutes of Higher Education: An Integrative Review
Authors: McNair Katelyn T. , Fantasia Heidi Collins , Harris Allyssa L.
Published: November 2018

Although federal legislation designed to advance sexual misconduct policies at institutes of higher education (IHEs) has been in effect for decades, recent national attention has put more pressure on IHEs to combat sexual violence on their campuses. Thus, the past few years have yielded significant research that examines federal compliance, dissemination, and perception of IHE sexual misconduct policies. This integrative review was conducted to assess sexual misconduct policies in the United States and the potential to prevent and combat sexual violence at IHEs through these policies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using a quality assessment tool to ensure rigor, eight studies were synthesized. Findings indicate that IHE sexual misconduct policies vary widely and that most IHEs lack transparent, legislation-compliant policies. There remains a need for research examining the association between sexual misconduct policy, campus climate, and students' behavior, so as to better inform future sexual misconduct interventions and IHE policies. Forensic nurses may be key stakeholders in policy development that is currently missing from the literature.
Nonverbal Reasoning as a Contributor to Sentence Recognition Outcomes in Adults With Cochlear Implants
Authors: Mattingly Jameson K. , Castellanos Irina , Moberly Aaron C.
Published: November 2018

Hypothesis:

Significant variability in speech recognition persists among postlingually deafened adults with cochlear implants (CIs). We hypothesize that scores of nonverbal reasoning predict sentence recognition in adult CI users.

Background:

Cognitive functions contribute to speech recognition outcomes in adults with hearing loss. These functions may be particularly important for CI users who must interpret highly degraded speech signals through their devices. This study used a visual measure of reasoning (the ability to solve novel problems), the Raven's Progressive Matrices (RPM), to predict sentence recognition in CI users.

Methods:

Participants were 39 postlingually deafened adults with CIs and 43 age-matched normal-hearing (NH) controls. CI users were assessed for recognition of words in sentences in quiet, and NH controls listened to eight-channel vocoded versions to simulate the degraded signal delivered by a CI. A computerized visual task of the RPM, requiring participants to identify the correct missing piece in a 3×3 matrix of geometric designs, was also performed. Particular items from the RPM were examined for their associations with sentence recognition abilities, and a subset of items on the RPM was tested for the ability to predict degraded sentence recognition in the NH controls.

Results:

The overall number of items answered correctly on the 48-item RPM significantly correlated with sentence recognition in CI users (r = 0.35–0.47) and NH controls (r = 0.36–0.57). An abbreviated 12-item version of the RPM was created and performance also correlated with sentence recognition in CI users (r = 0.40–0.48) and NH controls (r = 0.49–0.56).

Conclusions:

Nonverbal reasoning skills correlated with sentence recognition in both CI and NH subjects. Our findings provide further converging evidence that cognitive factors contribute to speech processing by adult CI users and can help explain variability in outcomes. Our abbreviated version of the RPM may serve as a clinically meaningful assessment for predicting sentence recognition outcomes in CI users.
Feasibility Study of a Mechanical Real-Time Feedback System for Optimizing the Sound Transfer in the Reconstructed Middle Ear
Authors: Neudert Marcus , Bornitz Matthias , Mocanu Horia , Lasurashvili Nicoloz , Beleites Thomas , Offergeld Christian , Zahnert Thomas
Published: November 2018

Objective:

To evaluate electromechanical excitation as an alternative excitation mode for middle ear transfer function (METF) measurements as well as real-time feedback in prosthetic ossicular reconstruction.

Method:

In eight human cadaveric temporal bones, the ossicular chain was excited using acoustic and mechanical (floating mass transducer, FMT) stimulation to determine the METF. After disconnecting the ossicular chain and reconstruction with partial or total prosthesis the METFs were measured again. Continuous FMT stimulation was then applied to improve the prosthesis’ position using real-time feedback of the METF.

Results:

Mechanical stimulation of ossicular vibration showed characteristic differences to acoustic excitation resulting from the force characteristics of the FMT. Furthermore, the interspecimen METF variability was greater with electromechanical than acoustic stimulation because of interspecimen variability in the FMT coupling conditions. When the METF with FMT excitation was used as a real-time feedback tool, a measurable improvement in the quality of ossicular reconstruction could be achieved.

Conclusions:

Mechanical excitation is an effective and suitable alternative stimulation method in experimental METF measurements. The system provides real-time feedback for ossicular reconstruction in the experimental setting. Some influencing factors still need to be distinguished for reliable measurements. However, the method does not yet meet the requirements for clinical application as an intraoperative, real-time monitoring tool. However, the system could be an excellent model for high-end cadaveric temporal bone training in ossiculoplasty.
The Insertion Results of a Mid-scala Electrode Assessed by MRI and CBCT Image Fusion
Authors: Sipari Sini , Iso-Mustajärvi Matti , Löppönen Heikki , Dietz Aarno
Published: November 2018

Objectives:

To investigate the results of clinical surgical insertions with a Mid-scala array (HIFocus Mid-Scala Electrode, HFms).

Study Design:

Consecutive retrospective case study.

Settings:

Tertiary referral center.

Patients:

Analyses of imaging data of 26 consecutive patients (31 insertions) implanted with the HFms.

Intervention (s):

The evaluation of insertion trauma evoked by a previously validated image fusion technique. Electrode reconstructions from postoperative cone-beam computed tomography (CBCT) were overlaid onto preoperative magnetic resonance imaging (MRI) scans to create artifact-free images.

Main Outcome Measures:

The electrode position was quantified in relation to the basilar membrane. Trauma scaling adopted from Eshraghi was used for evaluating insertion trauma. The results of the visual assessment of the postoperative CBCT were compared to those obtained with the fusion technique.

Results:

Three insertions had to be excluded due to incompatibility of the imaging data with the fusion software. We found consistent peri- to mid-modiolar placement of the HFms with a mean insertion depth angle of 376°. According to the medical records, a visual examination of the postoperative CBCT indicated that there had been no scala dislocations but when assessed by the image fusion technique, five scala dislocations (17.8%) were found. Additionally, one tip fold-over was detected in the postoperative CBCT even though this was not evident in any intraoperative measurements.

Conclusion:

HFms showed atraumatic surgical insertion results with consistent mid-modiolar placement. Image fusion enhances the accuracy of the insertion trauma assessment. Routine postoperative imaging is recommended for identifying tip fold-over as well as for quality control and documentation.
Epidemiology of atrial fibrillation in patients with cirrhosis and clinical significance: a meta-analysis
Authors: Chokesuwattanaskul Ronpichai , Thongprayoon Charat , Bathini Tarun , O’Corragain Oisin A , Sharma Konika , Preechawat Somchai , Wijarnpreecha Karn , Kröner Paul T. , Ungprasert Patompong , Cheungpasitporn Wisit
Published: November 2018

Objective

The epidemiology of atrial fibrillation (AF) in patients with cirrhosis and its clinical significance remain unclear. This study aimed (i) to investigate the pooled prevalence and/or incidence of AF in patients with cirrhosis and (ii) to assess the mortality risk of AF in patients with cirrhosis.

Patients and methods

A literature search for studies that reported incidence of AF in patients with cirrhosis was carried out using Medline, Embase, and Cochrane Database from inception through July 2018. Pooled incidence with 95% confidence interval (CI) was calculated using a random-effect model. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018102664).

Results

Seven cohort studies including 385 866 patients with cirrhosis were identified. The pooled estimated prevalence of AF in patients with cirrhosis was 5.0% (95% CI: 2.8–8.6%). When studies that solely assessed patients undergoing transplant evaluation or on transplant waiting list were excluded, the pooled estimated prevalence of AF in patients with cirrhosis was 7.4% (95% CI: 3.5–15.2%). There was a significant association between AF and increased mortality risk in cirrhotic patients with a pooled odds ratio of 1.44 (95% CI: 1.36–1.53).

Conclusion

The overall estimated prevalence of AF among patients with cirrhosis is 5.0%. Our study demonstrates a statistically significant increased mortality risk in cirrhotic patients with AF.
Neutropenia in Barth syndrome: characteristics, risks, and management
Authors: Steward Colin G. , Groves Sarah J. , Taylor Carolyn T. , Maisenbacher Melissa K. , Versluys Birgitta , Newbury-Ecob Ruth A. , Ozsahin Hulya , Damin Michaela K. , Bowen Valerie M. , McCurdy Katherine R. , Mackey Michael C. , Bolyard Audrey A. , Dale David C.
Published: November 2018

Purpose of review

Barth syndrome (BTHS) is an X-linked disease characterized by defective remodeling of phospholipid side chains in mitochondrial membranes. Major features include neutropenia, dilated cardiomyopathy, motor delay and proximal myopathy, feeding problems, and constitutional growth delay. We conducted this review of neutropenia in BTHS to aid in the diagnosis of this disease, and to improve understanding of both the consequences of neutropenia and the benefits of treatment with granulocyte colony-stimulating factor (G-CSF).

Recent findings

In 88 patients with BTHS, neutropenia, that is, at least one count below 1.5 × 109/l, was detected in 74 (84%) and 44% had severe chronic neutropenia, with multiple counts below 0.5 × 109/l. The pattern of neutropenia varied between intermittent and unpredictable, chronic and severe, or cyclical with mathematically regular oscillations. Monocytosis, that is, monocytes more than 1.0 × 109/l, was observed at least once in 64 of 85 (75%) patients. G-CSF was administered to 39 of 88 patients (44%). Weekly average G-CSF doses ranged from 0.12 to 10.92 μg/kg/day (mean 1.16 μg/kg/day, median 1.16 μg/kg/day). Antibiotic prophylaxis was additionally employed in 21 of 26 neutropenic patients. Pretreatment bone marrow evaluations predominantly showed reduced myeloid maturation which normalized on G-CSF therapy in seven of 13 examined. Consistent clinical improvement, with reduced signs and symptoms of infections, was observed in response to prophylactic G-CSF ± prophylactic antibiotics. However, despite G-CSF and antibiotics, one adult patient died with multiple infections related to indwelling medical devices and gastrostomy site infection after 15.5 years on G-CSF and a pediatric patient required gastrostomy removal for recurrent abdominal wall cellulitis.

BTHS should be considered in any men with neutropenia accompanied by any of the characteristic features of this syndrome. Prophylaxis with G-CSF ± antibiotics prevents serious bacterial infections in the more severe neutropenic patients although infections remain a threat even in patients who are very compliant with therapy, especially in those with indwelling devices.
The Impact of the Doctorate of Nursing Practice Nurse in a Hospital Setting
Authors: Tussing Todd E. , Brinkman Bevra , Francis Deborah , Hixon Brenda , Labardee Ruth , Chipps Esther
Published: November 2018

This article describes the initiatives of doctorate of nursing practice (DNP)–prepared nurses in a large healthcare system supporting the DNP competencies as outlined by the American Association of Colleges of Nursing. The goal of this group was to demonstrate the impact of DNP education on the roles for nurse administrators, advanced practice nurses, and educators in a large health system. Exemplars profile nurse administrators, clinical nurse specialists, and a nurse educator.
Associations Among Nurse Fatigue, Individual Nurse Factors, and Aspects of the Nursing Practice Environment
Authors: Knupp Amy M. , Patterson Emily S. , Ford Jodi L. , Zurmehly Joyce , Patrick Thelma
Published: November 2018

OBJECTIVE

This study examined the relationships among nurse fatigue, individual nurse factors, and the practice environment in the inpatient setting.

BACKGROUND

Nurse fatigue affects the quality of care provision on inpatient units. Scant literature exists regarding how aspects of the practice environment relate to nurse fatigue.

METHODS

A cross-sectional, correlational design was used in this survey study of 175 neonatal intensive care unit nurses from multiple hospitals. Data were collected using the Checklist Individual Strength questionnaire and the Practice Environment Scale of the Nursing Work Index. Hierarchical regression analysis was performed to examine the relationships.

RESULTS

Higher fatigue was significantly associated with more hours worked, fewer hours of sleep, a physical or mental contributor to fatigue, and a recent distressing patient event. Lower fatigue was significantly associated with better nurse manager ability, leadership, and support.

CONCLUSIONS

Nurse fatigue may be diminished with organizational and individual strategies. Developing tactics for nurse managers to better support staff members after a recent distressing patient event is indicated.
Keep It Moving and Remember to P.A.C. (Pharmacology, Ambulation, and Compression) for Venous Thromboembolism Prevention
Authors: Wilson Kathleen , Devito Dawnmarie , Zavotsky Kathleen Evanovich , Rusay Mitch , Allen Megan , Huang Stephanie
Published: November 2018

The purpose of this article is to describe in detail how an academic hospital system took on the challenge of deep vein thrombosis (DVT) prevention. A VTE Prevention Task Force was formed in response to an increased incidence of hospital acquired DVTs. The interdisciplinary team reviewed the literature and examined the current state of organizational venous thromboembolism (VTE) prevention to identify gaps in process, determine opportunity and approaches for practice and process improvements, and develop standardized VTE prevention protocols. The article discusses the process taken in developing a highly motivated interdisciplinary team, the implementation of a care bundle, and the highly effective educational and surveillance tools used that helped improve patient outcomes by driving down the VTE rate.
Does Information Become Actual Knowledge in Surgical Spine Patients? A Qualitative Study
Authors: Bidstrup Christina Alstrup , Morthorst Karen Rud , Laursen Malene , Jørgensen Lene Bastrup , Høybye Mette Terp
Published: November 2018

BACKGROUND:

It is seldom questioned, if information delivered (to a patient) actually produces knowledge. There is a lack of understanding of how patients in general, surgical patients in particular, perceive, process, and translate clinical information in their everyday lives. The objective of this study was to elucidate how patients undergoing spinal fusion surgery manage and assimilate information provided by clinicians and how they adapt and embrace this information pre- and postsurgery.

METHODS:

The study employed qualitative methods of ethnographic observation and semistructured interview with a total of 14 individuals, that is, spinal fusion patients (n = 6) and clinicians (n = 8) over a 4-month period in 2014.

RESULTS:

The results highlight that in the course of treatment, patients embrace or reject information on the basis of their previous experience, expectations, and confidence in their own ability. Overall, patients adjusting to everyday life after spinal fusion surgery used 4 strategies of information processing about their individual life situation. Patients do not use just one of these strategies but may use a number of strategies depending on the situation. Such production of knowledge is pivotal to the behavior of patients through their treatment trajectory.

CONCLUSIONS:

This study points to the challenges of supporting patients to assimilate information and affect health-related behaviors, recognizing that knowledge and behavior change are emergent processes in patients and not a linear outcome of information.
Bone Marrow Aspirate Concentrate for Orthopaedic Use
Authors: Chahla Jorge , Alland Jeremy A. , Verma Nikhil N.
Published: November 2018

Biological-based therapies are rapidly expanding for different musculoskeletal conditions because of their potential benefits including their minimal invasiveness, capacity for unprecedented healing, and potential for rapid recovery. In this regard, although several approaches have been reported in the literature, most of the body of the literature is increasingly based on platelet-rich plasma, bone marrow aspirate concentrate, and cell-based therapy studies. Although further basic science and clinical research is needed to elucidate the long-term outcome of these therapies in the treatment of several injuries, there is compelling evidence for their use for certain indications. The purpose of this article was to review the main aspects of bone marrow aspirate concentrate, which is one of the few forms of stem cell delivery approved by the Food and Drug Administration, and, furthermore, to critically assess the current evidence-based recommendations and identify potential avenues for development.
Repeatability of Anterior Curvature Metrics in Healthy and Keratoconic Eyes with a Portable Handheld Topographer
Authors: Fernández-Velázquez Fernando José
Published: November 2018

SIGNIFICANCE

This is a prospective observational investigation that studies the repeatability of several outcomes obtained with the Keratron Scout in healthy and keratoconic corneas. In addition, we have been able to determine the “noise” values of the instrument, which can be very useful when evaluating possible progression in keratoconus (KCN).

PURPOSE

The purpose of this study was to evaluate the repeatability of several anterior curvature metrics provided by a portable and handheld Placido disk–based topographer in healthy and keratoconic eyes.

METHODS

One eye from 50 keratoconic patients and 50 eyes from healthy patients were included in this prospective observational study. Two consecutive sessions (with three scans per session) were performed, and the following parameters were analyzed with a Keratron Scout topographer: flat keratometry, steep keratometry, flat corneal axis, corneal astigmatism, and flat and steep asphericities. In addition, in the KCN cohort, indices derived from the Cone Location and Magnitude Index were also recorded. Intrasession (first session, all three measurements) and intersession (one measurement from each session, selected randomly) statistics were calculated. The following variables were calculated: within-subject standard deviation, coefficient of repeatability (R), coefficient of variation, and intraclass correlation coefficient (ICC).

RESULTS

In healthy eyes, the intrasession and intersession ICCs were high (0.947 to 0.999), and for both flat keratometry and steep keratometry, the within-subject standard deviation was 0.08 and R was 0.24 diopters. Repeatability was slightly lower in the KCN group, but the ICC was greater than 0.95, whereas the R for flat keratometry was 0.41 diopters.

CONCLUSIONS

The Keratron Scout provides repeatable measures for the studied metrics in healthy and keratoconic eyes.
Accuracy of a Smartphone-based Autorefractor Compared with Criterion-standard Refraction
Authors: Jeganathan V. Swetha E. , Valikodath Nita , Niziol Leslie M. , Hansen Sean , Apostolou Hannah , Woodward Maria A.
Published: November 2018

SIGNIFICANCE

Uncorrected refractive error is a prevalent problem throughout the world especially among the low-income population who have limited access to professional eye care and cannot afford eyeglasses.

PURPOSE

The purpose of this study was to evaluate the accuracy and usability of a low-cost, portable, smartphone-based autorefractor (Netra, EyeNetra Inc., Somerville, MA) in adults.

METHODS

A cross-sectional study was conducted to compare the portable refractor with subjective (manifest and cycloplegic) refraction for sequential adult participants with best-corrected visual acuity of 20/40 or greater. For each method of refraction, the spherical equivalent was calculated. Differences between methods were tested with linear mixed regression models. A validated usability questionnaire was administered regarding ease of use (100-point scale, higher scores better) for the portable autorefractor.

RESULTS

Eighty-seven subjects (152 eyes) were studied (age range, 20 to 90 years; mean ± standard deviation, 51.9 ± 18.3 years). Mean spherical equivalent by the portable device was −2.76 D (range, −14.75 to 3.63 D) compared with −2.49 D (range, −15.25 to 4.25 D) by manifest refraction. The mean relative difference in spherical equivalent between methods was −0.27 D (P = .001, significantly different than 0 D). The mean absolute difference between methods was 0.69 D (P < .001, significantly different than 0.5-D absolute difference). Similar results were found when comparing spherical equivalent between Netra and cycloplegic refraction methods. Subjects reported average ease of use for the Netra of 75.4 ± 19.8.

CONCLUSIONS

The portable autorefractor had small but clinically significant differences from subjective refraction. The device's scores on the usability scale indicate good overall patient acceptance. The device may be valuable for use where there is limited access to a trained refractionist.
Comparison of the Ultraviolet Light Filtering across Different Intraocular Lenses
Authors: García-Domene Mari Carmen , Pérez-Vives Caridad , Peris-Martínez Cristina , Artigas José María
Published: November 2018

SIGNIFICANCE

We have analyzed the ultraviolet transmittance of some commercial intraocular lenses (IOLs). The results show differences of wavelength cutoff among them.

PURPOSE

The purpose of this study was to measure and compare the ultraviolet light transmittance of different IOLs made out of acrylic hydrophobic, hydrophilic, and hydrophilic with hydrophobic surface materials from different manufacturers.

METHODS

The spectral transmission curves of eight monofocal IOLs with the same dioptric power of +20.0 diopters were measured using a PerkinElmer Lambda 35 ultraviolet/visible spectrometer. Two IOLs of each type were tested three times. The ultraviolet cutoff wavelength at 10% transmission and the mean values were calculated.

RESULTS

All lenses prevented transmission of ultraviolet C (200 to 280 nm) and B radiation (280 to 315 nm). However, not all IOLs provided the same filtering properties in ultraviolet A (315 to 380 nm). Within the ultraviolet A range, the ultraviolet radiation cutoff wavelength of 10% ranges from approximately 360 to 400 nm. HOYA iSert 250 provided a cutoff wavelength of 398.4 nm; AcrySof SA60AT, 396.2 nm; AcrySof SA60WF, 395.7 nm; CT Asphina 404, 378.34 nm; Tecnis ZCB00, 377.70 nm; CT Lucia 601P, 379 nm; C-Flex 570C, 377 nm; and enVista MX60, 360 nm.

CONCLUSIONS

Intraocular lenses of different materials and manufacturers have different ultraviolet transmission characteristics. AcrySof (SA60AT and SA60WF) and HOYA iSert 250 provided the highest ultraviolet radiation transmission; the cutoff wavelength of 10% is close to 400 nm. In contrast, enVista IOL showed the lowest ultraviolet radiation cutoff.
Visual Performance of Daily-disposable Multifocal Soft Contact Lenses: A Randomized, Double-blind Clinical Trial
Authors: Sha Jennifer , Tilia Daniel , Kho Danny , Amrizal Hamdy , Diec Jennie , Yeotikar Nisha , Jong Monica , Thomas Varghese , Bakaraju Ravi C.
Published: November 2018

SIGNIFICANCE

The present study highlights the differences between modern daily-disposable multifocal soft contact lenses to assist eye care practitioners in fitting presbyopic contact lens wearers.

PURPOSE

The purpose of this study was to compare visual performance of three daily-disposable multifocal contact lenses.

METHODS

Presbyopes (n = 72) wore 1-Day Acuvue Moist Multifocal, BioTrue ONEday for Presbyopia, and Dailies AquaComfort Plus Multifocal for 1 week in a prospective, randomized, double-blind, crossover clinical trial. After 1 week, high- and low-contrast visual acuities (HCVA, LCVA) were measured between 6 m and 40 cm and stereopsis at 40 cm. Subjective performance was assessed with 1- to 10-point rating scales for clarity, ghosting, driving vision, vision stability, ease of focusing, overall vision satisfaction, and ocular comfort. Willingness to purchase was reported with categorical responses. Linear mixed models and χ2 tests were used for analysis, and level of significance was set at 5%.

RESULTS

BioTrue provided better HCVA and LCVA at distance than did Acuvue Moist (P ≤ .03). Subjectively, Acuvue Moist was rated lowest for distance clarity, distance ghosting, and driving vision (P ≤ .05). Acuvue Moist provided better HCVA at 70 to 40 cm and LCVA at 1 m to 40 cm than did BioTrue (P ≤ .01) and better LCVA at 1 m to 50 cm than did AquaComfort Plus (P ≤ .02). AquaComfort Plus also provided better HCVA and LCVA at 50 and 40 cm than did BioTrue (P ≤ .03). Acuvue Moist provided better stereopsis than did BioTrue (P = .02). Subjectively, BioTrue was rated lowest for near clarity (P ≤ .007) and lower than Acuvue Moist for intermediate clarity and near ghosting (P ≤ .04). No other differences were found between lenses (P > .05).

CONCLUSIONS

BioTrue had better distance performance compared with near, whereas Acuvue Moist performed conversely. AquaComfort Plus performed reasonably overall.
Morphologic Overlap Between Inflammatory Myofibroblastic Tumor and IgG4-related Disease
Authors: Taylor Martin S. , Chougule Abhijit , MacLeay Allsion R. , Kurzawa Pawel , Chebib Ivan , Le Long , Deshpande Vikram
Published: November 2018

Inflammatory myofibroblastic tumor (IMT), a locally aggressive neoplasm capable of metastasis, may show an immunoglobulin (Ig)G4-rich lymphoplasmacytic infiltrate. Prior reports suggest that storiform-fibrosis and obliterative phlebitis aid in the distinction of IMT from IgG4-related diseases. Herein, we highlight the morphologic overlap between the 2 diseases, and emphasize the importance of a multiplex fusion assay in the distinction of IgG4-related disease (IgG4-RD) from IMT. We identified 7 IMTs with morphologic and immunohistochemical features of IgG4-RD; 3 patients were originally diagnosed with IgG4-RD. Demographic, clinical and morphologic data was recorded. We also reevaluated 56 patients with IgG4-RD. We performed immunohistochemistry for IgG4, IgG, ALK, and ROS1. In situ hybridization for IgG4 and IgG was performed in selected cases. A multiplex next-generation sequencing–based RNA assay for gene fusions was performed to detect all known IMT-related gene fusions. All 7 IMTs showed a dense lymphoplasmacytic infiltrate and storiform-type fibrosis, with obliterative phlebitis noted in 3 cases. The neoplastic stromal cells constituted <5% of overall cellularity and stromal atypia was either absent or focal and mild. Elevated numbers of IgG4 positive cells and increased IgG4 to IgG ratio was identified in all cases. Four cases showed ALK related abnormalities: 3 fusions and one alternative transcription initiation; while 2 patients showed ROS1 and NTRK3 fusions. One tumor was negative for known IMT-related gene fusions. All 56 IgG4-RD cases were negative for ALK and ROS1 on immunohistochemistry; 6 cases were negative on the fusion assay. Highly inflamed IMTs are indistinguishable from IgG4-RD both histologically and on immunohistochemistry for IgG4. We advocate scrutinizing patients with presumptive single organ IgG4-RD for IMT and the diagnostic algorithm should include ALK and ROS1 immunohistochemistry and, in selected cases, a next-generation sequencing–based fusion assay that covers known IMT-associated gene fusions.
SMARCA4-deficient Thoracic Sarcomas
Authors: Perret Raul , Chalabreysse Lara , Watson Sarah , Serre Isabelle , Garcia Stephane , Forest Fabien , Yvorel Violaine , Pissaloux Daniel , Thomas de Montpreville Vincent , Masliah-planchon Julien , Lantuejoul Sylvie , Brevet Marie , Blay Jean-Yves , Coindre Jean-Michel , Tirode Franck , Le Loarer Francois
Published: November 2018

SMARCA4-deficient thoracic sarcoma (SMARCA4-DTS) is a recently described entity with an aggressive clinical course and specific genetic alterations of the BAF chromatin remodeling complex. In the present study, we reviewed the clinical and pathologic features of 30 cases of SMARCA4-DTS, discussed its main differential diagnoses and the challenging diagnostic scenarios that the average pathologist may face. In addition, we tested the specificity of the “SMARCA4-DTS immunohistochemical signature” (co-loss of SMARCA4 and SMARCA2 with overexpression of SOX2) in a large cohort of intrathoracic malignancies. Patients ranged from 28 to 90 years of age (median: 48 y), with a marked male predominance (male:female=9:1) and they were usually smokers. Tumors were generally large compressive masses located in the mediastinum (n=13), pleura (n=5), lung (n=2) or in 2 or more of these topographies (n=10). Treatment strategies were varied, including 1 case treated with EZH2 inhibitors. Median overall survival was 6 months. Histologically, tumors were poorly differentiated frequently showing rhabdoid features. A subset of cases showed a focal myxoid stroma (7%, n=2/30) and rare cases displayed a previously unreported pattern simulating desmoplastic small round cell tumors (7%, n=2/30). Making a diagnosis was challenging when dealing with biopsy material from massively necrotic tumors and in this setting the expression of SOX2, CD34, and SALL4 proved useful. All tested cases displayed concomitant loss of SMARCA4 and SMARCA2 and most tumors expressed epithelial markers (Pan-keratin or EMA) (n=29/30), SOX2 (n=26/27), and CD34 (n=17/27). SMARCB1 expression was retained in all cases (23/23). SALL4 and Claudin-4 were expressed in a subset of cases (n=7/21 and 2/19, respectively). TTF-1 and P63 were focally expressed in 1 case each. P40 and NUT were not expressed (0/23 and 0/20, respectively) The SMARCA4-DTS immunohistochemical signature was both sensitive and specific, with only a subset of small cell carcinoma of the ovary hypercalcemic type showing overlapping phenotypes. Our study confirms and expands the specific features of SMARCA4-DTS, emphasizing the fact that they can be straightforwardly identified by pathologists.
Optimizing antiretroviral regimens in chronic kidney disease
Authors: Hamzah Lisa , Jones Rachael , Post Frank A.
Published: November 2018

Purpose of review

To identify recent data that inform the management of individuals with HIV and chronic kidney disease.

Recent findings

Several nonnucleoside reverse transcriptase, protease, and integrase strand transfer inhibitors inhibit tubular creatinine secretion resulting in stable reductions in creatinine clearance of 5–20 ml/min in the absence of other manifestations of kidney injury. Progressive renal tubular dysfunction is observed with tenofovir disoproxil fumarate in clinical trials, and more rapid decline in estimated glomerular filtration rate in cohort studies of tenofovir disoproxil fumarate and atazanavir, with stabilization, improvement or recovery of kidney function upon discontinuation. Results from clinical trials of tenofovir alafenamide (TAF) in individuals with chronic kidney disease suggest that TAF is well tolerated in those with mild to moderate renal impairment (creatinine clearance >30 ml/min) but results in very high tenofovir exposures in those on haemodialysis.

Standard antiretroviral regimens remain appropriate for individuals with normal and/or stable, mildly impaired kidney function. In those with chronic kidney disease or progressive decline in estimated glomerular filtration rate, antiretrovirals with nephrotoxic potential should be avoided or discontinued. Although TAF provides a tenofovir formulation for individuals with impaired kidney function, TAF is best avoided in those with severe or end-stage kidney disease.
Assessing inflammation and its role in comorbidities among persons living with HIV
Authors: Peterson Tess E. , Baker Jason V.
Published: November 2018

Purpose of review

This article describes the use of biomarkers in expanding our understanding of chronic non-AIDS comorbidities among persons living with HIV (PLWH) receiving antiretroviral therapy (ART).

Recent findings

We review current evidence that biomarkers of chronic immune activation and inflammation associate with a broad spectrum of end-organ diseases in PLWH. We discuss how ART may impact inflammation associated with HIV infection and the degree to which inflammation persists despite effective suppression of viral replication in plasma. We then discuss the limitations of the current literature, which lacks evidence of causality and disproportionately involves a few protein biomarkers that are unable to disentangle complex and overlapping biological pathways.

Premature end-organ disease among PLWH has been repeatedly associated with higher levels of blood biomarkers reflecting inflammation and immune activation, which, despite viral suppression and CD4+ T-cell increases after ART treatment, remain elevated relative to uninfected persons. There remain important unanswered questions with implications for the development of anti-inflammatory treatment strategies aimed at mitigating excess risk for end-organ comorbidities among PLWH.
Introduction to the Craniofacial Collaboration UK: A Developmental Screening Protocol at the United Kingdom's Four Highly Specialized Craniofacial Centers
Authors: Care Helen , Horton Jo , Kearney Anna , Kennedy-Williams Patrick , Knapp Maria , Rooney Natasha , Thomas Siân , Evans Martin , James Greg , Johnson David , Parks Chris , Wall Steven , Dalton Louise
Published: November 2018

The clinical psychologists at the 4 highly specialized craniofacial centers in the United Kingdom have developed a systematic, developmental screening protocol, called the Craniofacial Collaboration UK (CC-UK). Previous systematic reviews of the literature into the developmental sequelae of single-suture craniosynostosis have identified a number of methodological flaws which the CC-UK seeks to avoid. This study presents an introduction to the rationale for its development, as well as the methodology of the CC-UK.
Soft Palate Dysfunction in Children With Microtia
Authors: van Hövell tot Westerflier Claire , Bracamontes Ignacio Colin , Tahiri Youssef , Breugem Corstiaan , Reinisch John
Published: November 2018

Background:

Speech issues in microtia patients have been historically attributed to poor hearing. However, the authors have noted that almost all patients with microtia have palatal dysfunction. The aim of this study is to determine the prevalence of soft palate dysfunction (SPD) and velopharyngeal insufficiency (VPI) in microtia patients.

Methods:

A prospective cohort study was performed on consecutive microtia patients from March to June 2017. Clinical characteristics were collected. Palate movement was rated by oral examination and degree of nasal escape by the mirror-fogging test. Correlations between clinical characteristics of microtia and SPD were determined.

Results:

Ninety-seven (40 unilateral, 27 bilateral, and 30 control) children met inclusion criteria. Among all 67 patients with microtia, 96% (64 patients) showed SPD. Twenty-four unilaterals (60%) and 23 bilaterals (85%) had observable VPI by mirror examination. Of these patients, nasality was noticeable to the examiners in 14 unilaterals (58%) and 21 bilaterals (91%). Sixteen of the 27 bilaterals (59%) showed almost no movement of the soft palate. There was a significant correlation between SPD and mirror-fogging. A less developed middle ear as determined by computed tomography scan was associated with palatal dysfunction (P = 0.007). The severity of mandibular shift (P = 0.048) and presence of a syndrome (P = 0.045) were associated with grade of VPI. The severity of the ear deformity (P = 0.007) and presence of a syndrome (P = 0.034) were also correlated with the presence of SPD.

Conclusions:

This is the first study that documents the presence of VPI due to soft palate dysfunction in patients with isolated and nonisolated microtia.
The Diffuse and Severe Traumatic Subarachnoid Hemorrhage Being Hard to Distinguish to Aneurysmal Subarachnoid Hemorrhage
Authors: Arai Nobuhiko , Mine Yutaka , Kagami Hiroshi , Inaba Makoto
Published: November 2018

Background:

In primary intracerebral hemorrhage, several studies showed that contrast extravasation (CEV) is reported to be an indicator of delayed hematoma expansion, emergent hematoma removal and poor prognosis. On the contrary in head trauma, few researches validated the effectiveness of CEV because of other influences such as subarachnoid hemorrhage (SAH), contusion or brain swelling. The authors experienced a patient showing diffuse SAH caused by traumatic mechanism with acute subdural hematoma (ASDH). In the angiography, a notable rare image of CEV was found and emergency operation mainly to cease the bleeding points was performed.

Patient Presentation:

A 70-year-old man was found being comatose and brought to emergency room. Computed tomography (CT) revealed diffuse SAH with left ASDH. Computed tomography angiography (CTA) also did not clarify any abnormal vessel structure except for slightly dilatation at the part of internal carotid artery, suggesting tiny ruptured aneurysm. The authors performed a cerebral angiography and resulted in no aneurysm or arteriovenous shunt detection but revealed the extravasation from middle cerebral artery and middle meningeal artery. Follow-up CT revealed increased left ASDH though 5 hours have already elapsed. The authors performed surgical intervention to halt the bleeding.

Conclusion:

The authors experienced a notably rare image of the extravasation from middle cerebral artery and middle meningeal artery in the cerebral angiography. When an obscure arterial abnormality is suspected on CTA for the unknown origin SAH with ASDH, the authors may have an affirmative attitude toward performing conventional cerebral angiography, which is most promising modality to detect the source of bleeding including CEV.
Mandibular Regeneration With Autologous Human Bone Marrow Derived Mesenchymal Stem Cells to Treat Unicystic Ameloblastoma: A Clinical Report
Authors: Son Jeong Wan , Kim Bong Chul , Yoon Jung Hoon , Jun Lee  , Lim Hun Jun
Published: November 2018

Ameloblastoma is a rare, benign tumor found in the jaw. These tumors have a tendency for locally aggressive expansion, and thus require surgical removal. For the previous 3 decades, autologous bone grafting and free flap surgeries have been most commonly used to correct bone defects after surgical removal of the lesion. In this report, the authors describe a case of unicystic ameloblastoma in a 14-year-old girl who was successfully treated with mandibular regeneration, attained by autologous human bone marrow mesenchymal stem cells without any autologous bone graft and free flap transfer. This case shows that autologous human bone marrow mesenchymal stem cells can be used as an alternative method to autologous bone graft and free flap transfer in a large bone defect of the jaw.
Assessment of Bioabsorbable Hydroxyapatite for Cranial Defect in Children
Authors: Sakamoto Yoshiaki , Miwa Tomoru , Yoshida Kazunari , Kishi Kazuo
Published: November 2018

Purpose:

To evaluate the utility and efficacy of bioabsorbable hydroxyapatite and collagen complex (HA/Col) for cranioplasty repair of cranial bone defects in children.

Methods:

Two patients (a 6-year-old male and 11-year-old female) with Treacher Collins syndrome received zygoma and orbital floor reconstruction using a full thickness of parietal bone. The bone grafts were taken from each patient's parietal cranium. The right parietal cranial defect was repaired with autologous bone dust, and the left side was repaired with HA/Col in each patient. Computed tomography scans were taken immediately after and at 12 months following surgery. The osteosynthesis areas and thicknesses were measured using computer-aided engineering.

Results:

Both patients experienced no complications, including infection. In the 6- and 11-year-old patients, the extent of osteosynthesis for HA/Col was 92.2% and 89.4%, respectively; and for the autologous bone dust was 78.5% and 53.2%, respectively. Because of the small sample size, a significant difference could not be calculated; however, the percentage of osteosynthesis for HA/Col was higher than for the autologous bone dust.

Conclusion:

This study showed that HA/Col can be effectively used in cranial defects and can be considered an alternative graft material for cranial reconstruction.
Gingival Neurofibroma With Teardrop-Shaped Defects of the Interdental Alveolar Bone: An Unusual Oral Manifestation of Neurofibromatosis Type 1
Authors: Kubota Seiko , Imai Tomoaki , Iwai Soichi , Nakazawa Mitsuhiro , Uzawa Narikazu
Published: November 2018

Gingival enlargement, although frequently encountered in clinical settings, is rarely associated with systemic diseases or syndromes. Among the diverse pathological conditions of neurofibromatosis type 1 (NF-1), minor manifestations in the orofacial region are occasionally overlooked. Herein, the authors present an unusual case of gingival neurofibroma in a patient with NF-1 associated with characteristic osseous defects in the alveolus in the long-term course of 17 years from the first examination.

A 5-year-old boy with NF-1 was referred for the evaluation of gingival enlargement in the posterior left maxilla. An incisal biopsy led to the diagnosis of neurofibroma. At 22 years of age, the patient was referred again with a complaint of bleeding and pain in the same region refractory to periodontal therapy. The gingiva and tuberosity were swollen, and the second molar was affected by the tumor. Radiography revealed a low level of the interdental septum beneath the tumor with a relatively intact periodontal cortical bone, exhibiting a teardrop-shaped bone defect. The lesion was completely resected with the periosteum.

Gingival neurofibroma in NF-1 may be associated with osseous and dental abnormalities and can be mistaken for periodontitis. Raising awareness of this clinical entity can lead to proper management of the esthetic and functional problems in the oral and maxillofacial region.
Reliability of Ultrasound-Guided One-Point Fixation for Zygomaticomaxillary Complex Fractures
Authors: Sato Akimitsu , Imai Yoshimichi , Muraki Kenji , Tachi Masahiro
Published: November 2018

This study aimed to analyze the precision and postoperative stability of ultrasound guided 1-point fixation on the zygomaticomaxillary buttress for the treatment of zygomaticomaxillary complex (ZMC) fractures. The authors analyzed 24 consecutive patients who underwent ultrasound-guided 1-point fixation for ZMC fractures without separation of the fracture at the frontal process of the zygomatic bone. The authors used titanium plates in the first 6 cases, and biodegradable plates in the remaining 18 cases. The authors obtained computed tomography images preoperatively, and again the first day after surgery (T1) and 6 months after the surgery (T2). The authors calculated vertical change (VC) and horizontal change (HC) of the zygoma on computed tomography. Precision was evaluated with T1 images. Stability was evaluated from T1 to T2, and titanium and biodegradable plates were compared. From T1 images, the mean VC and HC was 0.22° (range, 1.60°–1.08°) and 0.33° (range, 1.86°–1.03°), respectively. From T1 to T2, the mean VC and HC was 0.08° and 0.28°, respectively. Comparing the types of plates, the mean HC in the biodegradable plate group was 0.39°, which was significantly greater than that in the titanium plate group (mean −0.10°). However, as the degree of change was relatively small, this did not pose any clinical problems. Our findings suggest that ultrasound-guided 1-point fixation on the zygomaticomaxillary buttress provides accurate reduction on ZMC fractures without the separation of the frontal process of the zygomatic bone fracture. Sufficient stability was obtained, even with the use of biodegradable plates.