bluuebunny/crossref_metadata_2025 huggingface dataset:
The Influence of Ancestral Lifeways on Individual Economic Outcomes in Sub-Saharan Africa
Authors: Michalopoulos Stelios , Putterman Louis , Weil David N
Published: September 2018

Does a person's historical lineage influence his or her current economic status? Motivated by a large literature in the social sciences stressing the effect of an early transition to agriculture on current economic performance at the country level, we examine the relative contemporary status of individuals as a function of how much their ancestors relied on agriculture during the preindustrial era. We focus on Africa, where—by combining anthropological records of groups with individual-level survey data—we can explore the effect of the historical lifeways of one's forefathers. Within enumeration areas (typically a single village or group of villages in the countryside and a city block in urban areas) as well as occupational groups, we find that individuals from ethnicities that derived a larger share of subsistence from agriculture in the precolonial era are today more educated and wealthy. A tentative exploration of channels suggests that differences in attitudes and beliefs as well as differential treatment by others, including differential political power, may contribute to these divergent outcomes.
Dose-dependent effects of 1O2 in chloroplasts are determined by its timing and localization of production
Authors: Wang Liangsheng , Apel Klaus
Published: September 2018

In plants, 1O2 is primarily generated in chloroplasts and can act as a signal. Its effects are not only dose dependent, but also rely on localization and timing of its production.
Discovery of a cyclotron absorption line in the transient X-ray pulsar XTE J1829−098
Authors: Shtykovsky A E , Lutovinov A A , Tsygankov S S , Molkov S V
Published: September 2018

We report results of a spectral and timing analysis of the X-ray pulsar XTE J1829−098 using data obtained with the NuSTAR observatory during an outburst in 2018 August. A strong absorption feature was detected at the energy of Ecyc ≃ 15 keV in the source spectrum. This feature was interpreted as a cyclotron resonance scattering line corresponding to the magnetic field strength of the neutron star surface B ≃ 1.7 × 1012 G. The pulse phase-resolved spectroscopy shows that the cyclotron line is significantly detected at all phases of the pulse and its energy and other parameters are variable over the pulse period. The timing analysis of the source emission revealed strong pulsations with a period of P = 7.84480(2) s. The pulsed fraction is changed with the energy, including its local increase in the vicinity of the cyclotron line. Using the archival data of the RXTE observatory the presence of the cyclotron line in the spectrum of XTE J1829−098 was independently confirmed and tentative hint for the possible anticorrelation of the line energy with the source flux was revealed.
The Impact of Surgical Wound Dehiscence on Body Image
Authors: de Lima Edson Luiz , de Brito Maria José Azevedo , da Cunha João Batista , Duarte Maria Fernanda Pereira , Corrêa Nely Flávia Machado , de Carvalho Resende Margarida Maria , Ferreira Lydia Masako
Published: September 2018

OBJECTIVE:

To identify changes in body image in patients with surgical wound dehiscence.

DESIGN AND SETTING:

This cross-sectional, descriptive, analytical study was conducted in a university hospital and nursing care center in Brazil.

PATIENTS AND INTERVENTION:

Sixty-one adult surgical patients of both genders from different inpatient wards or receiving outpatient care were selected. Forty-one participants had surgical wound dehiscence, and 20 had achieved complete wound healing (controls).

MAIN OUTCOME MEASURE:

The Body Dysmorphic Disorder Examination (BDDE), Body Investment Scale (BIS), and a questionnaire assessing clinical and sociodemographic characteristics of patients were used for data collection.

MAIN RESULTS:

Surgical wound dehiscence defects were 0.5 to 30 cm in length, located on the arms, legs, and chest. They were significantly associated with being white (P = .048), number of children (P = .024), and presence of comorbid conditions (P = .01). Overall, men reported higher BIS scores (positive feelings about the body) than women (P = .035). Patients with wound dehiscence had higher BDDE scores (negative body image) than controls (P = .013). The BDDE scores were associated with presence of surgical wound dehiscence (P = .013), number of children (P = .009), and wound length (P = .02). There were significant correlations between BIS scores in men with wound dehiscence (P = .042), number of children (P < .001), and BDDE scores (P < .001) and between BDDE scores and number of children (P = .031), wound length (P = .028), and BIS scores (P < .001).

CONCLUSION:

Surgical wound dehiscence had a negative impact on body image.
The Rates of LSS Surgery in Norwegian Public Hospitals
Authors: Grøvle Lars , Fjeld Olaf Randall , Haugen Anne Julsrud , Helgeland Jon , Småstuen Milada Cvancarova , Solberg Tore Kristian , Zwart John-Anker , Grotle Margreth
Published: September 2018

Study Design.

Retrospective administrative database study.

Objective.

To assess temporal and regional trends, and length of hospital stay, in lumbar spinal stenosis (LSS) surgery in Norwegian public hospitals from 1999 to 2013.

Summary of Background Data.

Studies from several countries have reported increasing rates of LSS surgery over the last decades. No such data have been presented from Norway.

Methods.

A database consisting of discharges from all Norwegian public hospitals was established. Inclusion criteria were discharges including a surgical procedure of lumbar spinal decompression and/or fusion in combination with an International Statistical Classification of Diseases and Related Health Problems, 10th Revision diagnosis of Spinal Stenosis (M48.0) or Other Spondylosis with Radiculopathy (M47.2), and a patient age of 18 years or older. Discharges with diagnoses indicating deformity, that is, spondylolisthesis or scoliosis were not included.

Results.

During the 15-year period, 19,543 discharges were identified. The annual rate of decompressions increased from 10.7 to 36.2 and fusions increased from 2.5 to 4.4 per 100,000 people of the general Norwegian population. The proportion of fusion surgery decreased from 19.3% to 10.9%. Among individuals older than 65 years, the annual rate of surgery per 10,000, including both decompressions and fusions, more than quadrupled from 40.2 to 170.3. The regional variation was modest, differing with a factor of 1.4 between the region with the highest and the lowest surgical rates. The mean length of hospital stay decreased from 11.0 (standard deviation 8.0) days in 1999 to 5.0 (4.6) days in 2013, but patients who received fusion surgery stayed on average 3.6 days longer than those who received decompression only.

Conclusion.

The rate of LSS surgery more than tripled in Norway from 1999 to 2013. The mean length of hospital stay was reduced from 11 to 5 days.

Level of Evidence: N/A
Time Taken to Return to Work Does Not Influence Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Liow Ming Han Lincoln , Goh Graham Seow-Hng , Yeo William , Ling Zhixing Marcus , Yue Wai-Mun , Guo Chang Ming , Tan Seang Beng
Published: September 2018

Study Design.

Retrospective cohort study using prospectively collected registry data.

Objective.

To determine factors which influence return-to-work (RTW) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and to determine if early RTW affects functional outcomes.

Summary of Background Data.

MIS-TLIF has been associated with accelerated return to work. RTW in non-WC working-age adults after MIS-TLIF is not well understood.

Methods.

Prospectively collected registry data of 907 patients who underwent MIS-TLIF at a single institution from 2004 to 2013 were reviewed. One hundred ten working adults who underwent single-level MIS-TLIF with complete preoperative and 5-year postoperative follow-up data were included. Patients were assigned into Early RTW (≤60 d, n = 40) and Late RTW (>60 d, n = 70). All patients were assessed pre- and postoperatively at 2 and 5 years. Length of operation, length of stay, and comorbidities were also recorded.

Results.

The Early RTW group had significantly lower Oswestry Disability Index (ODI), North American Spine Society score for neurogenic symptoms (NASS NS), numerical pain rating scale (NPRS) back and leg pain scores than the Late RTW group (<0.01) There were no significant differences in age, body mass index (BMI) and prevalence of medical comorbidities (P > 0.05). In addition, there were no differences in terms of duration of surgery or length of hospitalization. There were no significant differences in ODI, NASS NS, Short-form 36 physical and mental component scores (SF-36 PCS/MCS), NPRS, satisfaction/expectation fulfilment between the Early and Late RTW groups at 2-year and 5-year follow-up. Both groups reported similar proportions that RTW without limitations and return-to-function (RTF) at 2-years and 5-years.

Conclusion.

Patients who RTW late have significantly poorer preoperative SF-36 physical component scores and higher ODI, NASS NS, NPRS back/leg pain scores. Surgeons should be cognizant that working adults with poorer preoperative function will tend to return to work later, but should reassure them that they will likely achieve similar clinical outcomes, satisfaction and expectation fulfilment when compared with patients who returned to work early.

Level of Evidence: 3
Predictive Factors of Postoperative Dysphagia in Single-Level Anterior Cervical Discectomy and Fusion
Authors: Vaishnav Avani S. , Saville Philip , McAnany Steven , Patel Dil , Haws Brittany , Khechen Benjamin , Singh Kern , Gang Catherine Himo , Qureshi Sheeraz A.
Published: September 2018

Study Design.

Retrospective review of prospectively collected data.

Objective.

To investigate if zero profile devices offer an advantage over traditional plate/cage constructs for dysphagia rates in single level anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.

Dysphagia rates following ACDF have been reported to be as high as 83%, most cases are self-limiting, but chronic dysphagia can continue in up to 35% of patients. Zero profile devices were developed to limit dysphagia, and other plate specific complications, however the literature is currently divided regarding their efficacy.

Methods.

Dysphagia was assessed by swallowing quality of life (SWAL-QOL) scores preoperatively, at 6 weeks and 12 weeks. Patient reported outcome measures (PROMs) including visual analog scale (VAS) and Neck Disability Index (NDI) were collected preoperatively, at 6 weeks and at 6 months. Univariate and multivariate regression analysis was conducted with SWAL-QOL score as the dependent variable.

Results.

Sixty-four patients were included, 41 received a zero profile device, and 23 received plate-graft construct. Both groups were similar regarding patient demographics, except operative time, with the zero-profile group having a shorter procedure time than the cage-plate group (44.88 ± 6.54 vs. 54.43 ± 14.71 min, P = 0.001). At all timepoints dysphagia rates were similar between the groups. Regression analysis confirmed preoperative SWAL-QOL and operative time were the only significant variables. PROMs were also similar between groups at all time points, except VAS neck at 6 months, which was lower in the plate-graft group (1.05 ± 1.48 vs. 3.43 ± 3.21, P = 0.007).

Conclusion.

Operative time and preoperative SWAL-QOL scores are predictive of dysphagia in single level ACDF. Zero profile devices had a significantly shorter operative time, and may provide a benefit in dysphagia rates in this regard.

Level of Evidence: 3
Replication Study for the Association of GWAS-associated Loci With Adolescent Idiopathic Scoliosis Susceptibility and Curve Progression in a Chinese Population
Authors: Man Gene Chi-Wai , Tang Nelson Leung-Sang , Chan Ting Fung , Lam Tsz Ping , Li Jing Woei , Ng Bobby Kin-Wah , Zhu Zezhang , Qiu Yong , Cheng Jack Chun-Yiu
Published: September 2018

Study Design.

A genetic association (replication) study.

Objective.

The aim of this study was to replicate and further evaluate the association among seven genome-wide association studies (GWAS)-identified single nucleotide polymorphisms (SNPs) in Chinese girls with adolescent idiopathic scoliosis (AIS) with disease onset, curve types, and progression.

Summary of Background Data.

AIS is the most common pediatric spinal deformity with a strong genetic predisposition. Recent GWAS identified 10 new disease predisposition loci for AIS.

Methods.

Three hundred nineteen female AIS patients with Cobb angle ≥ 10oand 201 healthy controls were studied for the association with disease onset. Seven GWAS-identified SNPs (rs11190870 inLBX1, rs12946942 inSOX9/KCNJ2, rs13398147 inPAX3/EPH4, rs241215 inAJAP1, rs3904778 inBNC2, rs6570507 inGPR126, and rs678741 inLBX1-AS1) were analyzed. In subgroup analysis, AIS patients were subdivided by curve types and disease progression to examine for genotype association.

Results.

We replicated the association with disease onset in four common SNPs rs11190870, rs3904778, rs6570507, and rs678741. In addition, rs1190870 and rs678741 remained significantly associated in the right thoracic curves only subgroup. However, no significant difference was observed with both clinical curve progression or Cobb angle.

Conclusion.

This study replicated the associations of four GWAS-associated SNPs with occurrence of AIS in our Chinese population. However, none of these SNPs was associated with curve severity and progression. The results suggest that curve progression may be determined by environmental (nongenetic) factor, but further study with a larger sample size is required to address this issue.

Level of Evidence:4
30-day Mortality Following Surgery for Spinal Epidural Abscess
Authors: Du Jerry Y. , Schell Adam J. , Kim Chang-yeon , Trivedi Nikunj N. , Ahn Uri M. , Ahn Nicholas U.
Published: September 2018

Study Design.

Retrospective case-control study.

Objective.

To determine incidence and timing of mortality following surgery for spinal epidural abscess (SEA), identify risk factors for mortality, and identify complications associated with mortality.

Summary of Background Data.

SEA is a serious condition with potentially devastating sequelae. There is a paucity of literature characterizing mortality following surgery for SEA.

Methods.

The National Surgical Quality Improvement Program (NSQIP) database was used. Patients with a diagnosis of SEA were included. A Cox proportional hazards model identified independent risk factors for 30-day mortality. A predictive model for mortality was created. Multivariate models identified postoperative complications associated with mortality.

Results.

There were 1094 patients included, with 40 cases of mortality (3.7%), the majority of which occurred within 2 weeks postoperatively (70%). Independent risk factors for 30-day mortality were age>60 years (hazard ratio [HR]: 2.147, P = 0.027), diabetes (HR: 2.242, P = 0.015), respiratory comorbidities (HR: 2.416, P = 0.037), renal comorbidities (HR: 2.556, P = 0.022), disseminated cancer (HR: 5.219, P = 0.001), and preoperative thrombocytopenia (HR: 3.276, P = 0.001). A predictive algorithm predicts a 0.3% mortality for zero risk factors up to 37.5% for 4 or more risk factors. A ROC area under curve (AUC) was 0.761, signifying a fair predictor (95% CI: 0.683–0.839, P < 0.001). Cardiac arrest (adjusted odds ratio [aOR]: 72.240, 95% confidence interval [CI]: 27.8–187.721, P < 0.001), septic shock (aOR: 15.382, 95% CI: 7.604–31.115, P < 0.001), and pneumonia (aOR: 2.84, 95% CI: 1.109–7.275, P = 0.03) were independently associated with mortality.

Conclusion.

The 30-day mortality rate following surgery for SEA was 3.7%. Of the mortalities that occurred within 30 days of surgery, the majority occurred within 2 weeks. Independent risk factors for mortality included older age, diabetes, hypertension, respiratory comorbidities, renal comorbidities, metastatic cancer, and thrombocytopenia. Risk for mortality ranged from 0.3% to 37.5% based on number of risk factors. Septic shock, cardiac arrest, and pneumonia were associated with mortality.

Level of Evidence: 3
Does Surgery Reduce the Risk of Complications Among Patients with Multiple Rib Fractures? A Meta-analysis
Authors: Liang Yu-Shiuan , Yu Kai-Ching , Wong Chung-Shun , Kao Yuan , Tiong Tung-Yu , Tam Ka-Wai
Published: September 2018

Background

Multiple rib fractures are common in trauma patients, who are prone to trauma-associated complications. Surgical or nonsurgical interventions for the aforementioned conditions remain controversial.

Questions/purposes

The purpose of our study was to perform a meta-analysis to evaluate the clinical prognosis of surgical fixation of multiple rib fractures in terms of (1) hospital-related endpoints (including duration of mechanical ventilation, ICU length of stay [LOS] and hospital LOS), (2) complications, (3) pulmonary function, and (4) pain scores.

Methods

We screened PubMed, Embase, and Cochrane databases for randomized and prospective studies published before January 2018. Individual effect sizes were standardized; the pooled effect size was calculated using a random-effects model. Primary outcomes were duration of mechanical ventilation, intensive care unit length of stay (ICU LOS), and hospital LOS. Moreover, complications, pulmonary function, and pain were assessed.

Results

The surgical group had a reduced duration of mechanical ventilation (weighted mean difference [WMD], -4.95 days; 95% confidence interval [CI], -7.97 to -1.94; p = 0.001), ICU LOS (WMD, -4.81 days; 95% CI, -6.22 to -3.39; p < 0.001), and hospital LOS (WMD, -8.26 days; 95% CI, -11.73 to -4.79; p < 0.001) compared with the nonsurgical group. Complications likewise were less common in the surgical group, including pneumonia (odds ratio [OR], 0.41; 95% CI, 0.27–0.64; p < 0.001), mortality (OR, 0.24; 95% CI, 0.07–0.87; p = 0.030), chest wall deformity (OR, 0.02; 95% CI. 0.00–0.12; p < 0.001), dyspnea (OR, 0.23; 95% CI, 0.09–0.54; p < 0.001), chest wall tightness (OR, 0.11; 95% CI, 0.05–0.22; p < 0.001) and incidence of tracheostomy (OR, 0.34; 95% CI, 0.20–0.57; p < 0.001). There were no differences between the surgical and nonsurgical groups in terms of pulmonary function, such as forced vital capacity (WMD, 6.81%; 95% CI: -8.86 to 22.48; p = 0.390) and pain scores (WMD, -11.41; 95% CI: -42.09 to 19.26; p = 0.470).

Conclusions

This meta-analysis lends stronger support to surgical fixation, rather than conservative treatment, for multiple rib fractures. Nevertheless, additional trials should be conducted to investigate surgical indications, timing, and followup for quality of life.

Level of Evidence

Level I, therapeutic study.
Classic animal models of Parkinson’s disease: a historical perspective
Authors: Hamadjida Adjia , Frouni Imane , Kwan Cynthia , Huot Philippe
Published: September 2018

The quest to better understand the pathophysiology of Parkinson’s disease (PD) and to find new therapies to provide greater relief to affected patients continues. The use of animal models of PD has been invaluable in the process. Here, we review, through a historical lens, some of the contribution of the 6-hydroxydopamine-lesioned rat and of the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned nonhuman primate, in refining our understanding of PD and its treatment-related complications. We examine the mechanisms underlying the toxicity of 6-hydroxydopamine and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine, and then explore some of the advances at the molecular, pharmacological, electrophysiological and surgical levels made while experimenting on these animal models. We also discuss behavioural testing that can be performed with these animal models and highlight some of their limitations.
Olfaction in female Wistar rats is influenced by dopaminergic periglomerular neurons after nigral and bulbar lesions
Authors: Rodrigues Lais S. , Noseda Ana C.D. , Targa Adriano D.S. , Aurich Mariana F. , Lima Marcelo M.S.
Published: September 2018

Hyposmia is found in Parkinsonian patients decades before the onset of motor disorders. The same occurs with sleep disorders, especially infuencing rapid eye movement (REM) sleep, which affect a large percentage of people who have Parkinson’s disease. These two disturbances presumably are closely related to a dopaminergic dysfunction. Therefore, we propose that selective lesions, induced by rotenone, of the periglomerular neurons within the olfactory bulb or of the nigrostriatal pathway could result in hyposmia. In addition, we hypothesized that REM sleep deprivation (REMSD) could have potential to generate a synergistic olfactory impairment in both lesion paradigms. The results indicated that rotenone-induced nigrostriatal lesions in female Wistar rats were associated with odor preference changes, similar to hedonic tone impairment, but without a supposed potentiation triggered by REMSD. The nigrostriatal injury negatively affected olfaction performance, which was counteracted, functionally, by REMSD. However, injury to periglomerular neurons was less influenced by REMSD, as olfactory performance was restored after rebound sleep. We conclude that female rats present a pattern of olfactory discrimination/preference that is dependent on the activities of the nigrostriatal and the main olfactory pathways.
Radiation Protection Around High-intensity Laser Interactions with Solid Targets
Authors: Liang Taiee Ted , Bauer Johannes M. , Liu James C. , Rokni Sayed H.
Published: September 2018

Interaction of a high-intensity optical laser with a solid target can generate an ionizing radiation hazard in the form of high-energy “hot” electrons and bremsstrahlung, resulting from hot electrons interacting with the target itself and the surrounding target chamber. Previous studies have characterized the bremsstrahlung dose yields generated by such interactions for lasers in the range of 1017 to 1022 W cm−2 using particle-in-cell code EPOCH and Monte Carlo code FLUKA. In this paper, electron measurements based on a depth-dose approach are presented for two laser intensities, which indicate a Maxwellian distribution is more suitable for estimating the hot electrons’ energy distribution. Also, transmission factors for the resulting bremsstrahlung for common shielding materials are calculated with FLUKA, and shielding tenth-value-layer thicknesses are also derived. In combination with the bremsstrahlung dose yield, the tenth-value layers provide radiation protection programs the means to evaluate radiation hazards and design shielding for high-intensity laser facilities.
Navigating Speed Bumps on the Innovation Highway in Hemophilia Therapeutics
Authors: DiMichele Donna M.
Published: September 2018

The unprecedented emergence of novel therapeutics for both hemophilia A and B during the last half decade has been accompanied by the promise of even more extraordinary progress in ameliorative and curative strategies for both disorders. Paradoxically, the speed of innovation has created new dilemmas for persons with hemophilia and their physicians with respect to optimizing individual choices from the expanding menu of standard and novel therapies and approaches to symptom or risk reduction, and ultimately, to normalizing the hemophilia phenotype. Among the most disruptive new approaches, challenges remain in the form of the adverse reactions that have been observed with nonfactor therapies, as well as in the uncertain long‐term safety profile of potentially curative gene therapy. Together, these challenges have generated uncertainty as to how to adopt novel therapies and treatment strategies across a diverse patient population, creating speed bumps on the hemophilia innovation highway. It is from this perspective that this article discusses the current state of gene therapy and bleeding prophylaxis for hemophilia A and B, as well as prevention and treatment of the factor VIII inhibitor phenotype in hemophilia A. It further posits that these speed bumps may provide important clues to the mechanistic understanding of both symptom manifestation and resilience within the hemophilia phenotype, as well as opportunities to reconsider and reconfigure the current paradigms for symptom prediction and individualized therapeutic decision making.
Using Decision Tree Methodology to Predict Employment After Moderate to Severe Traumatic Brain Injury
Authors: Stromberg Katharine A. , Agyemang Amma A. , Graham Kristin M. , Walker William C. , Sima Adam P. , Marwitz Jennifer H. , Harrison-Felix Cynthia , Hoffman Jeanne M. , Brown Allen W. , Kreutzer Jeffrey S. , Merchant Randall
Published: September 2018

Objective:

To build decision tree prediction models for long-term employment outcomes of individuals after moderate to severe closed traumatic brain injury (TBI) and assess model accuracy in an independent sample.

Setting:

TBI Model Systems Centers.

Participants:

TBI Model Systems National Database participants injured between January 1997 and January 2017 with moderate to severe closed TBI. Sample sizes were 7867 (year 1 postinjury), 6783 (year 2 postinjury), and 4927 (year 5 postinjury).

Design:

Cross-sectional analyses using flexible classification tree methodology and validation using an independent subset of TBI Model Systems National Database participants.

Main Measures:

Competitive employment at 1, 2, and 5 years postinjury.

Results:

In the final employment prediction models, posttraumatic amnesia duration was the most important predictor of employment in each outcome year. Additional variables consistently contributing were age, preinjury education, productivity, and occupational category. Generally, individuals spending fewer days in posttraumatic amnesia, who were competitively employed preinjury, and more highly educated had better outcomes. Predictability in test data sets ranged from a C-statistic of 0.72 (year 5; confidence interval: 0.68-0.76) to 0.77 (year 1; confidence interval: 0.74-0.80).

Conclusion:

An easy-to-use decision tree tool was created to provide prognostic information on long-term competitive employment outcomes in individuals with moderate to severe closed TBI. Length of posttraumatic amnesia, a clinical marker of injury severity, and preinjury education and employment status were the most important predictors.
OPHTHALMIC VASCULAR EVENTS AFTER INTRA‐ARTERIAL CHEMOTHERAPY FOR RETINOBLASTOMA
Authors: Ancona-Lezama David , Dalvin Lauren A. , Lucio-Alvarez J. Antonio , Jabbour Pascal , Shields Carol L.
Published: September 2018

Purpose:

To determine whether treatment order affects ophthalmic vascular event rates after intra‐arterial chemotherapy (IAC) for retinoblastoma.

Methods:

Patients who received IAC as primary or secondary treatment for retinoblastoma from January 2009 to January 2018 were included. All eyes were imaged with fundus photography and fluorescein angiography. Patient characteristics and vascular event rates were compared using t-test and Fisher's exact test.

Results:

There were 196 patients treated with 682 infusions of IAC, divided into primary (no previous therapy, 98 eyes of 98 patients, 328 infusions) and secondary (after other therapy, 105 eyes of 98 patients, 354 infusions) treatment. Overall, ophthalmic vascular events were found after 5% of infusions (17% eyes). A comparison of ophthalmic vascular events (primary vs. secondary IAC), with mean three infusions per eye (median 3, range 1–7), revealed no difference in overall percentage of eyes affected (18% vs. 15%, P = 0.57). Adverse vascular events per eye included retinal vasculature attenuation (1% vs. 0%, P = 0.99), peripheral retinal pruning (1% vs. 0%, P = 0.99), branch retinal artery occlusion (0% vs. 1%, P = 0.99), central retinal artery occlusion (0% vs. 1%, P = 0.99), macular ischemia (0% vs. 2%, P = 0.51), vitreous hemorrhage (2% vs. 3%, P = 0.92), subretinal hemorrhage (1% vs. 0%, P = 0.99), retinal pigment epithelium atrophy (6% vs. 3% P = 0.43), choroidal atrophy (4% vs. 2%, P = 0.92), optic disk pallor (1% vs. 0%, P = 0.99), and ophthalmic artery occlusion (9% vs. 6%, P = 0.35).

Conclusion:

Ophthalmic vascular events after IAC for retinoblastoma affect only 5% of eyes per infusion (17% of treated eyes). Vascular event risk per eye is similar when using IAC as primary or secondary treatment.
CLINICAL CHARACTERIZATION OF STARGARDT DISEASE PATIENTS WITH THE p.N1868I ABCA4 MUTATION
Authors: Collison Frederick T. , Lee Winston , Fishman Gerald A. , Park Jason C. , Zernant Jana , McAnany J. Jason , Allikmets Rando
Published: September 2018

Purpose:

To investigate the Stargardt disease phenotype associated with an unusually common and “extremely hypomorphic” ABCA4 variant, p.N1868I.

Methods:

The charts of 27 patients with p.N1868I on one allele and a severe/deleterious mutation on the other allele were reviewed. Subjective age of onset, best-corrected visual acuity, and stage of disease were recorded for all 27 patients, 18 of whom had multiple visits. When available, fundus photography, spectral domain optical coherence tomography, fundus autofluorescence, full-field electroretinograms, Goldmann visual fields, and fluorescein angiography were included. Five families with multiple affected members were analyzed.

Results:

The median age at symptom onset was 41.5 years, and 3 p.N1868I patients had not developed visual symptoms as of the most recent eye examination. Median best-corrected visual acuity in the better-seeing eye at baseline was 20/25−2, and the median duration from symptom onset to legal blindness was 25 years. The five families described in this study demonstrated clinically significant intrafamilial variability, and affected family members who did not share the p.N1868I variant had relatively more severe phenotypes.

Conclusion:

This study demonstrates the consistency of foveal sparing, the variation in age at onset, the intrafamilial variability, and the prognosis with regard to visual acuity in p.N1868I-associated Stargardt disease.
FACEDOWN POSITIONING AFTER VITRECTOMY WILL NOT FACILITATE MACULAR HOLE CLOSURE BASED ON SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY IMAGING IN GAS-FILLED EYES
Authors: Zhang Yong , Chen Xiao , Hong Lin , Yan Ying , Zeng Miao , Huang Zhijian , Liu Ran , Ding Qin
Published: September 2018

Purpose:

To compare clinical outcomes in eyes with macular hole (MH) managed by either facedown (FD) or no-FD (nFD) postoperative positioning protocols.

Methods:

This is a prospective randomized cohort study. Eighty eyes of 80 consecutive patients with MH who had undergone vitrectomy surgery with internal limiting membrane peeling and gas tamponade were included in this study. Forty eyes of 40 patients who were kept in FD position for 3 days after surgery were assigned to the FD group, 40 eyes of 40 patients with nFD positioning were assigned to the nFD group. Macular hole was examined with swept-source optical coherence tomography images at 1 day, 2 days, 3 days, 2 weeks, 1 month, and 3 months after surgery. The MH closure rate and change of best-corrected visual acuity were compared.

Results:

At postoperative Day 1, MH was closed in 24 of 32 eyes (with clear optical coherence tomography images) (75%) in the FD group and 23 of 30 eyes (with clear optical coherence tomography images) (77%) in the nFD group (P = 0.97). At postoperative Day 2, MH closure was confirmed in 32 of 36 eyes (88.9%) in the FD group and in 31 of 33 eyes (94%) in the nFD group (P = 0.84), and the results were unchanged at Day 3. At 2 weeks after surgery, clear optical coherence tomography images were acquired from all eyes in both groups, and MH closure was confirmed in 36 of 40 eyes (90%) in the FD group and in 37 of 40 (92.5%) eyes in the nFD group (P = 0.91). Macular hole closure was not achieved in eyes that were kept open by Day 3 after surgery, and none of the eyes with confirmed MH closure by Day 3 had a reopening of the MH by 3 months. The distribution of macular configuration at 3 months was not significantly different between the two groups (P = 0.96). There was no difference in terms of the improvement in best-corrected visual acuity (Early Treatment Diabetic Retinopathy Study letters gain) between the 2 groups at 1 month (P = 0.22) and 3 months (P = 0.45).

Conclusion:

The nFD protocol neither delayed the MH closure nor decreased the final closure rate after vitrectomy surgery. Therefore, postoperative prone position seems to be unnecessary for all MH repair procedures.
Collagen I Defect Corneal Profiles in Osteogenesis Imperfecta
Authors: Magalhaes Otavio A. , Rohenkohl Helena C. , de Souza Liliane Todeschini , Schuler-Faccini Lavinia , Félix Têmis M.
Published: September 2018

Purpose:

The goal of this study was to evaluate corneal profiles of patients with osteogenesis imperfecta (OI) due to a collagen I gene mutation.

Methods:

This was a cross-sectional comparative study. There were 84 eyes from 42 patients with OI types I, III, and IV who were recruited from the OI Clinic at the Clinical Hospital of Porto Alegre, Brazil. All cases presented either COL1A1 or A2 gene mutations. Controls were matched by sex, age, and refractive error. Corneal Scheimpflug tomography was used to determine curvature and thickness parameters in both groups.

Results:

Quantitative collagen mutations were found only in OI type I. Qualitative mutations were responsible for all mutations observed in type III and IV patients. Each OI type presented significantly lower pachymetric values at the thinnest point compared with controls (443.7–505.1 vs. 541.9–548.5 μm; P < 0.001). In addition, significantly lower pachymetric values were observed in patients with OI compared with controls in all positions between the central and corneal periphery (581.4–657.0 vs. 704.5–720.7 μm at an 8.0-mm-diameter circle; P < 0.001). Differences in anterior and posterior radii of curvatures, respectively, between patients with OI and controls were not statistically significant (7.64–7.80 vs. 7.65–7.69 mm; P > 0.05) except for a lower anterior radii of curvatures in type III (7.33 vs. 7.72 mm; P < 0.01).

Conclusions:

Although patients with OI have homogenously thinner corneas compared with controls, we observed that a collagen I chain mutation was not responsible for corneal curvature alterations in OI.
Perceptions of gendered and ungendered pain relief norms and stereotypes using Q-methodology
Authors: Wratten Samantha , Eccleston Christopher , Keogh Edmund
Published: September 2018

Pain is ubiquitous, but effective pain relief eludes many. Research has shown that some pain behaviours are perceived as gendered, and this may influence the way men and women express and cope with pain, but such enquiries have not extended to specific methods of pain relief. Our aim was to explore perceptions of the most socially acceptable ways for men and women to relieve pain. Across 2 studies, 60 participants (50% men) aged 18 to 78 years completed a Q-sort task, sorting different pain relief strategies by the social acceptability for either women (study 1; N = 30) or men (study 2; N = 30). Analyses revealed 2 stereotypes for each sex. The overarching stereotype for women suggested it is most acceptable for them to use pain relief strategies considered conventional and effective. However, a second stereotype suggested it is most acceptable for women to use strategies that generally conform to feminine gender norms and stereotypes. The overarching male stereotype suggested it is most acceptable for men to use pain relief aligned with stereotypical masculinity; however, a second stereotype also emerged, characterised by conventional and effective responses to pain, much like the overarching stereotype for women. These differing viewpoints seem to depend on whether gender norm conformity or perceived analgesic efficacy is believed to determine social acceptability. These studies provide initial evidence of both a gendered and ungendered lens through which pain relief can be viewed, which may influence how men and women use pain relief.
Utilization and Adherence in Medical Homes
Authors: Kilany Mona , Morrissey Joseph P. , Domino Marisa E. , Thomas Kathleen C. , Silberman Pam
Published: September 2018

Background:

The complex nature of managing care for people with severe mental illness (SMI), including major depression, bipolar disorder, and schizophrenia, is a challenge for primary care practices, especially in rural areas. The team-based emphasis of medical homes may act as an important facilitator to help reduce observed rural-urban differences in care.

Objective:

The objective of this study was to examine whether enrollment in medical homes improved care in rural versus urban settings for people with SMI.

Research Design:

Secondary data analysis of North Carolina Medicaid claims from 2004–2007, using propensity score weights and generalized estimating equations to assess differences between urban, nonmetropolitan urban and rural areas.

Subjects:

Medicaid-enrolled adults with diagnoses of major depressive disorder, bipolar disorder or schizophrenia. Medicare/Medicaid dual eligibles were excluded.

Measures:

We examined utilization measures of primary care use, specialty mental health use, inpatient hospitalizations, and emergency department use and medication adherence.

Results:

Rural medical home enrollees generally had higher primary care use and medication adherence than rural nonmedical home enrollees. Rural medical home enrollees had fewer primary care visits than urban medical home enrollees, but both groups were similar on the other outcome measures. These findings varied somewhat by SMI diagnosis.

Conclusions:

Findings indicate that enrollment in medical homes among rural Medicaid beneficiaries holds the promise of reducing rural-urban differences in care. Both urban and rural medical homes may benefit from targeted resources to help close the remaining gaps and to improve the success of the medical home model in addressing the health care needs of people with SMI.
“I Want to Survive and Thrive”
Authors: Kolasa Kathryn M. , Bouchenoire Anne R.
Published: September 2018

In this article, we review current diet and physical activity recommendations for long-time survivors of breast cancer. We also hear the voice of a survivor and her response to the diagnosis of a postmenopausal breast cancer, the type of care she received, and her readiness to respond to diet and physical activity recommendations. Suggestions for interprofessional nutrition and physical activity counseling across the continuum of cancer care are given.
Patient-Reported Outcomes in First-Line Antiretroviral Therapy: Results From NEAT001/ANRS143 Trial Comparing Darunavir/Ritonavir in Combination With Tenofovir/Emtricitabine or Raltegravir
Authors: George Elizabeth C. , Bucciardini Raffaella , Richert Laura , Dedes Nikos , Fragola Vincenzo , Nieuwkerk Pythia , Spire Bruno , Volny-Anne Alain , West Brian , Molina Jean-Michel , Horban Andrzej , Fox Julie , Pozniak Anton , Vella Stefano , Termote Monique , Raffi François ,   the NEAT 001/ANRS 143 Study Group
Published: September 2018

Background:

There are few data comparing patient-reported outcomes (PROs) in randomized trials of initial antiretroviral therapy. We present results from a substudy of the NEAT001/ANRS143 trial.

Methods:

The randomized trial compared first-line DRV/r 800/100 mg once daily plus RAL 400 mg twice daily and DRV/r plus TDF/FTC 245/200 mg once daily. Changes in PROs were assessed with 3 questionnaires: EuroQoL 5 domains (EQ-5D), Center for Epidemiologic Studies Depression (CES-D) scale, and HIV Treatment Satisfaction Questionnaire. Major depressive disorder (MDD) was defined as CES-D ≥ 16. General estimating equations were used to model change over 96 weeks in PROs from baseline.

Results:

Of the 805 participants, 797 (99%) contributed to the substudy. Baseline PRO data were similar for the 2 randomized groups. Health status improved over time with a mean increase in EQ-5D visual analogue scale (VAS) of 8.0 by W96 [95% confidence interval (CI): 6.5 to 9.4; P < 0.001], and no statistically significant differences between groups (difference of 0.3 on VAS score (95% CI: −1.7 to 2.3); P = 0.7, global P value ≥0.05 for all domains over follow-up). There was no significant difference between groups on CES-D [difference of −0.1 (95% CI: −1.3 to 1.1); P = 0.9], or MDD during follow-up, adjusted for baseline MDD (odds ratio = 0.98, 95% CI: 0.82 to 1.18; P = 0.9). RAL + DRV/r group had lower level of convenience (P = 0.03) and fitted less well into patients' lifestyle (P = 0.007) than the TDF/FTC + DRV/r regimen, and was associated with lower treatment satisfaction [median score: 53 RAL + DRV/r vs 55 TDF/FTC + DRV/r (P = 0.001)].

Conclusion:

PROs improved after starting antiretroviral therapy, with no statistically significant difference between groups. The lower satisfaction with RAL + DRV/r may be explained by twice-daily administration.
Brief Report: Integration of PrEP Services Into Routine Antenatal and Postnatal Care: Experiences From an Implementation Program in Western Kenya
Authors: Pintye Jillian , Kinuthia John , Roberts D. Allen , Wagner Anjuli D. , Mugwanya Kenneth , Abuna Felix , Lagat Harison , Owiti George , Levin Carol E. , Barnabas Ruanne V. , Baeten Jared M. , John-Stewart Grace
Published: September 2018

Background:

Programmatic approaches for delivering pre-exposure prophylaxis (PrEP) to pregnant and postpartum women in settings with high HIV burden are undefined. The PrEP Implementation for Young Women and Adolescents (PrIYA) Program developed approaches for delivering PrEP in maternal child health (MCH) clinics.

Methods:

Under the PrIYA Program, nurse-led teams worked with MCH staff at 16 public, faith-based, and private facilities in Kisumu, Kenya, to determine optimal clinic flow for PrEP integration into antenatal care (ANC) and postnatal care (PNC). A program-dedicated nurse facilitated integration. HIV-uninfected women were screened for behavioral risk factors; same-day PrEP was provided to interested and medically eligible women. PrEP and MCH services were evaluated using standardized flow mapping and time-and-motion surveys.

Results:

Clinics developed 2 approaches for integrating PrEP delivery within ANC/PNC: (1) co-delivery: ANC/PNC and PrEP services delivered by same MCH nurse or (2) sequential services: PrEP services after ANC/PNC by a PrEP-specialized nurse. Three clinics selected co-delivery and 13 sequential services, based on patient volume and space availability. Overall, 86 ANC/PNC visits were observed. Clients who initiated PrEP took a median of 18 minutes (interquartile range 15–26) for PrEP-related activities (risk assessment, PrEP counseling, creatinine testing, dispensation, and documentation) in addition to other routine ANC/PNC activities. For clients who declined PrEP, an additional 13 minutes (interquartile range 7–15) was spent on PrEP-related risk assessment and counseling.

Conclusions:

PrEP delivery within MCH used co-delivery or sequential approaches. The moderate additional time burden for PrEP initiation in MCH would likely decline with community awareness and innovations such as group/peer counseling or expedited dispensing.
Effect of Hormonal Contraception on Pharmacokinetics of Vaginal Tenofovir in Healthy Women: Increased Tenofovir Diphosphate in Injectable Depot Medroxyprogesterone Acetate Users
Authors: Thurman Andrea R. , Schwartz Jill L. , Brache Vivian , Chen Beatrice A. , Chandra Neelima , Kashuba Angela D.M. , Weiner Debra H. , Mauck Christine , Doncel Gustavo F.
Published: September 2018

Objective:

Endogenous and exogenous contraceptive hormones may affect mucosal pharmacokinetics (PKs) of topical antiretrovirals such as tenofovir. We present PK data from healthy women using tenofovir vaginal gel, at baseline (follicular and luteal phases) and after oral contraceptive pill (OCP) or depot medroxyprogesterone acetate (DMPA) use.

Methods:

CONRAD A10-114 was a prospective, interventional, open-label, parallel study. We enrolled 74 women and 60 completed the study (32 and 28 who selected OCPs or DMPA, respectively). Participants used 2 doses of tenofovir gel separated by 2 hours, without intercourse, and were examined 3 or 11 hours after the last dose. We assessed pharmacokinetics in plasma, cervicovaginal (CV) aspirate, and vaginal tissue.

Results:

In general, there were no significant differences in mucosal tenofovir and tenofovir diphosphate concentrations (P > 0.23) in the follicular and luteal phases, except for lower mean tenofovir tissue concentrations (P < 0.01) in the follicular phase. Tenofovir concentrations significantly decreased in CV aspirate (P < 0.01) after contraceptive use, but overall remained very high (>106 ng/mL). Mean tissue tenofovir diphosphate increased to 6229 fmol/mg after DMPA use compared with 3693 and 1460 fmol/mg in the follicular and luteal phases, respectively (P < 0.01). The molecular conversion of tenofovir into tenofovir diphosphate was more effective in DMPA users (molecular ratio of 2.02 versus 0.65 luteal phase, P < 0.01).

Conclusions:

Both menstrual cycle phase and exogenous hormones affect topical tenofovir mucosal and systemic PKs. However, high levels of tenofovir and tenofovir diphosphate were observed in the CV mucosa in the presence or absence of OCPs and DMPA, with tissue levels exceeding benchmarks of predicted mucosal anti-HIV efficacy (tenofovir >1.00 ng/mL in CV aspirate and tenofovir diphosphate >1000 fmol/mg).
Natural History of Cervical Intraepithelial Neoplasia-2 in HIV-Positive Women of Reproductive Age
Authors: Colie Christine , Michel Katherine G. , Massad Leslie S. , Wang Cuiwei , D'Souza Gypsyamber , Rahangdale Lisa , Flowers Lisa , Milam Joel , Palefsky Joel M. , Minkoff Howard , Strickler Howard D. , Kassaye Seble G.
Published: September 2018

Objective:

To evaluate the natural history of treated and untreated cervical intraepithelial neoplasia-2 (CIN2) among HIV-positive women.

Methods:

Participants were women enrolled in the Women's Interagency HIV Study between 1994 and 2013. One hundred four HIV-positive women diagnosed with CIN2 before age 46 were selected, contributing 2076 visits over a median of 10 years (interquartile range 5–16). The outcome of interest was biopsy-confirmed CIN2 progression, defined as CIN3 or invasive cervical cancer. CIN2 treatment was abstracted from medical records.

Results:

Most women were African American (53%), current smokers (53%), and had a median age of 33 years at CIN2 diagnosis. Among the 104 HIV-positive women, 62 (59.6%) did not receive CIN2 treatment. Twelve HIV-positive women (11.5%) showed CIN2 progression to CIN3; none were diagnosed with cervical cancer. There was no difference in the median time to progression between CIN2-treated and CIN2-untreated HIV-positive women (2.9 vs. 2.7 years, P = 0.41). CIN2 treatment was not associated with CIN2 progression in multivariate analysis (adjusted hazard ratio 1.82; 95% confidence interval: 0.54 to 7.11), adjusting for combination antiretroviral therapy and CD4+ T-cell count. In HIV-positive women, each increase of 100 CD4+ T cells was associated with a 33% decrease in CIN2 progression (adjusted hazard ratio 0.67; 95% confidence interval: 0.47 to 0.88), adjusting for CIN2 treatment and combination antiretroviral therapy.

Conclusions:

CIN2 progression is uncommon in this population, regardless of CIN2 treatment. Additional studies are needed to identify factors to differentiate women at highest risk of CIN2 progression.