bluuebunny/crossref_metadata_2025 huggingface dataset:
A novel nephrometry scoring system for predicting peri-operative outcomes of retroperitoneal laparoscopic partial nephrectomy
Authors: Yang Bin , Ma Lu-Lin , Qiu Min , Xia Hai-Zhui , He Wei , Meng Tian-Yu , Lu Min , Lu Jian
Published: February 2020

Background:

Although the impact of tumor complexity on peri-operative outcomes has been well established using several nephrometry scoring systems, the impact of adherent perirenal fat remains poorly defined. This study aimed to develop a novel nephrometry scoring system for predicting the peri-operative outcomes of laparoscopic partial nephrectomy (LPN) by integrating and optimizing the RENAL score (RNS) and Mayo adhesive probability (MAP) score.

Methods:

We retrospectively evaluated 159 patients treated with retroperitoneal LPN. The patients’ demographic parameters, RNSs, and MAP scores were evaluated as potential predictors of perioperative outcomes, including operation time, estimated blood loss (EBL), and margin, ischemia, and complication (MIC) achievement rate. The independent predictors were used to develop a novel nephrometry scoring system. The predictive value and inter-observer agreement for the novel nephrometry scoring system were evaluated.

Results:

Tumor radius (R score), nearness to the renal sinus or collecting system (N score), and posterior perinephric fat thickness were independent predictors of peri-operative outcomes and were used to develop the RNP score. The univariate analysis revealed that the RNP score was significantly associated with operation time, EBL, and MIC achievement rate (P < 0.050). The RNP score was an independent predictor of operation time (P < 0.001), EBL (P = 0.018), and MIC achievement rate (P = 0.023) in the multivariate analysis. The RNP score was not inferior to RNS in the area under the curve for predicting peri-operative outcomes and performed better in inter-observer agreement (76.7% vs. 57.8%) and kappa value (0.804 vs. 0.726).

Conclusion:

The RNP score, combining the advantages of the RNS and MAP score, demonstrated a good predictive value for the peri-operative outcomes of retroperitoneal LPN and better inter-observer agreement.
Hyaluronic Acid Soft Tissue Filler for the Treatment of The Hypoplastic Chin: An Observational Study
Authors: Beer Kenneth , Stonehouse Anthony , Dunn Monica
Published: February 2020

BACKGROUND

The hypoplastic chin is associated with facial unattractiveness.

OBJECTIVE

To evaluate safety and efficacy of JUVÉDERM Voluma XC Injectable Gel (hyaluronic acid filler, HAF) for treatment of hypoplastic chin.

METHODS

This was a one-year, open-label, single-center study.

RESULTS

Thirty subjects received HAF injections of which 24 subjects (80%) completed the study. Mean facial angle significantly improved at all time points compared with baseline, improving by 1.83° (95% confidence interval, 0.91, 2.75; p < .001) at 12 months. Subject satisfaction with lower face and jawline increased significantly for all FACE-Q questions and time points compared with baseline (p < .05). Subject satisfaction with overall facial appearance, and percentage of subjects “not bothered” by area under chin increased significantly for most FACE-Q questions and time points compared with baseline (p < .05).

CONCLUSION

In this completed one-year study, HAF injection for hypoplastic chin was safe and accompanied by significant improvement in facial angle, measures of subject satisfaction, and GAIS.
Effect of Different Methods of Trypsinization on Cell Viability and Clinical Outcome in Vitiligo Patients Undergoing Noncultured Epidermal Cellular Suspension
Authors: Rasheed Hoda M. , Esmat Samia M. , Hegazy Rehab A. , Gawdat Heba I. , Bassiouny Dalia M. , Doss Sally S. , Parsad Davinder , Elkhouly Nesrin S.
Published: February 2020

BACKGROUND

Noncultured Epidermal Cell Suspension (NCECS) is a surgical modality used in treating stable vitiligo. Trypsinization of the epidermis may be done either at 4°C overnight (cold) or at 37°C for 30 to 50 minutes (warm). Recently, trypsinization was done at room temperature (25°C) in an in vitro trial.

OBJECTIVE

To compare different trypsinization techniques in NCECS regarding cell viability and clinical outcome.

METHODS

This comparative multicenter study was conducted on 20 patients with stable nonsegmental vitiligo. In each patient, 3, nonacral vitiligo lesions were randomly assigned for treatment by NCECS prepared by warm, room temperature, and cold trypsinization techniques, respectively. A perilesional biopsy was taken from each of the 3 treated lesions as an objective measure of disease stability. After transplantation, all patients received narrow-band ultraviolet B twice weekly for 6 months. Cell viability was assessed in each technique, as well as clinical outcome in all treated lesions.

RESULTS

Warm and room temperature trypsinization techniques were comparable with each other. Both were significantly better than the cold technique regarding viability and repigmentation.

CONCLUSION

Room temperature trypsinization can be used as a convenient substitute to warm trypsinization. Cold trypsinization is not recommended because of its poor results and poor patient satisfaction.
Advantages of A Hairline Incision for the Excision of Forehead Lipomas
Authors: Choi Sooyie , Nam Kyoungae , Roh Mi Ryung , Chung Kee Yang , Oh Byung Ho
Published: February 2020

BACKGROUND

Direct incision (DI) for forehead lipoma removal has a considerable risk of damaging the vertical vessels and leaving a visible scar.

OBJECTIVE

To evaluate the usefulness of the hairline incision (HI) in minimizing scars and neurovascular damage.

PATIENTS AND METHODS

Retrospective analysis was done for 30 patients with forehead lipomas who underwent excision between 2011 and 2019 at the Severance Hospital of the Yonsei University Health System, Seoul, Korea. Fourteen patients underwent DI, and 16 underwent HI. Comparison of the cosmetic outcomes, complications, and patient's subjective satisfaction was performed.

RESULTS

In the HI group, superior cosmetic outcomes, including patients' subjective satisfaction and photographic assessment findings, were observed. In the DI group, there were 2 cases of skin necrosis with scarring change and 3 cases of recurrence. Periorbital edema was the most common complication in the HI group, which spontaneously resolved within 1 week.

CONCLUSION

Hairline incision using a loupe should be considered as a first-line treatment in the removal of forehead lipomas, because it enables complete removal of lipoma with few complications and minimal scarring. Validation of our treatment algorithm requires further exploration.
Heart fat and carotid artery atherosclerosis progression in recently menopausal women: impact of menopausal hormone therapy: The KEEPS trial
Authors: El Khoudary Samar R. , Venugopal Vidya , Manson JoAnn E. , Brooks Maria M. , Santoro Nanette , Black Dennis M. , Harman Mitchell , Naftolin Frederick , Hodis Howard N. , Brinton Eliot A. , Miller Virginia M. , Taylor Hugh S. , Budoff Matthew J.
Published: February 2020

Objective:

Heart fat deposition has been linked to atherosclerosis, and both accelerate after menopause. Hormone therapy (HT) may differentially slow heart fat deposition and progression of atherosclerosis, depending on the specific HT agent or its route of administration. Our objective was to evaluate the effects of different HT agents, oral and transdermal, on associations between heart fat accumulation and atherosclerosis progression, measured by carotid intima-media thickness (CIMT), in recently menopausal women from the Kronos Early Estrogen Prevention Study (KEEPS) trial.

Methods:

KEEPS was a randomized, placebo-controlled trial of the effects of 0.45 mg/d oral conjugated equine estrogens (o-CEE) or 50 mcg/d transdermal 17β-estradiol (t-E2), compared with placebo, on 48 months progression of CIMT. Epicardial adipose tissue (EAT) and paracardial adipose tissue (PAT) volumes were quantified by computed tomography.

Results:

In all, 467 women (mean age [SD] 52.7 [2.5]; 78.2% White; 30% on o-CEE, 30.8% t-E2, 39.2% placebo) with heart fat volumes and CIMT at baseline and 48 months were included. EAT and PAT changes were not associated with CIMT progression; however, the assigned treatment significantly modified the association between PAT (but not EAT) change and CIMT progression. In the o-CEE group, adjusted CIMT progression was 12.66 μm (95% confidence interval [CI] 1.80, 23.52) lower than in t-E2 group (P = 0.02), and 10.09 μm (95% CI 0.79, 19.39) lower than in placebo group (P = 0.03), as per 1-SD increase in PAT.

Conclusion:

Compared with t-E2, o-CEE appears to slow down the adverse effect of increasing PAT on progression of atherosclerosis. Whether this beneficial association is specific to CEE or to the oral route of CEE administration is unclear and should be assessed further.
An Alternative Periorbital Treatment Option Using Calcium Hydroxyapatite for Hyperpigmentation Associated with the Tear Trough Deformity
Authors: Corduff Niamh
Published: February 2020

Background:

The nasojugal groove or tear trough (TT) area deformity produces visible, pigmented, difficult-to-treat hollows. Hyaluronic acid (HA) filler–based correction yields variable results and complications. We developed an alternative, minimally invasive treatment for this area.

Methods:

Patients with significant, visible TT area pigmentation, and/or those requiring corrections for TT filler removal, were given lignocaine-diluted calcium hydroxyapatite (CaHA) fillers. CaHA boluses were placed deep on the bone, under the origin of the orbicularis retaining ligament, and under the sub–orbicularis oculi fat. Diluted CaHA was used as a subcutaneous biostimulatory wash. Efficacy and complications were assessed using the Global Aesthetic Improvement Scale and a modified Tear Trough Rating Scale, at 4 and 18 months.

Results:

Twelve patients, between 25 and 52 years of age, were treated and showed immediate improvements in hyperpigmentation due to light reflection and some visibility of the filler through skin. Lower eyelid swelling and redness occurred a few days postinjection but resolved spontaneously. Over 4 to 6 months, hyperpigmentation and skin tone, thickness, and color improved noticeably. Global Aesthetic Improvement Scale and modified Tear Trough Rating Scale scores indicated that all patients experienced satisfactory improvements. Three prior HA patients required a second CaHA treatment at 4–6 months for a satisfactory correction, one of whom required a third CaHA “wash” at 10 months. Some mild redness was observed for up to 12 weeks in a few patients; however, no differences in the degree of redness were observed between those treated for dark circles or post-HA correction. One patient experienced a persistent, dull erythema for 8 months; another had overt erythema and swelling following a chest infection which resolved with antibiotics and hydrocortisone cream. No nodules developed in any patient.

Conclusions:

We developed an alternative TT deformity treatment that leverages CaHA unique rheology and neocollagenesis-stimulating ability, which lifted and supported the prolapsing orbicularis retaining ligament, improved skin quality, and rejuvenated the periocular area without direct injections into the TT.
No-drain Technique in Abdominal Closure for Breast Reconstruction: Lower Complication Rate, Shorter Hospitalization Stay
Authors: Chan Stephanie L. S. , Rutherford Claire , Kong Tze Yean
Published: February 2020

Background:

Progressive tension suture (PTS) technique in cosmetic abdominoplasty is safe in terms of seroma rates. This was extrapolated to deep inferior epigastric perforator (DIEP) flap donor site closure. No study to our knowledge has analyzed the PTS technique alone without drains in transverse rectus abdominis musculocutaneous (TRAM) flap donor sites. We aim to show that no-drain closure has similar complication rates and this may be applied to TRAM flaps safely even though they have higher drain output.

Methods:

A single-center, single-surgeon retrospective study was performed over 4 years. Patients undergoing breast reconstruction with an abdominal flap were included. Data collected included patient's demographics, type of flap, usage of drains or PTS technique, drain output, date of fitness for discharge, date of discharge, and seroma rates. The outcomes studied were drain volumes, seroma rates, and duration of hospital stay.

Results:

Fifty patients were recruited. The first 25 patients (13 DIEP and 12 TRAM) underwent conventional closure. The subsequent 25 patients (17 DIEP and 8 TRAM) underwent PTS technique. TRAM flaps had higher drain volume (785.6 mL) compared to DIEP flaps (366.2 mL) (P = 0.047). No patients developed a seroma. Patients who underwent the PTS technique had lower abdominal-specific complications (P = 0.021). Patients without drains were discharged faster at 5.4 versus 8.2 days (P ≤ 0.001).

Conclusions:

Patients who underwent the PTS technique had lower complication rates, faster time to fitness for discharge and shorter hospitalization stay. The PTS technique may be applied to TRAM flaps safely.
Boomerang-shaped Lateral-to-back Flap Utilizing Multiple Thoracodorsal Artery Perforators around the Lateral Border of Latissimus Dorsi Muscle for Reconstruction of Large Circular Defect
Authors: Kagaya Yu , Arikawa Masaki , Sekiyama Takuya , Akazawa Satoshi
Published: February 2020

We herein report the successful reconstruction of an extensive circular skin defect of the elbow region using a boomerang-shaped lateral-to-back muscle-sparing latissimus dorsi myocutanous flap utilizing multiple thoracodorsal artery perforators around the lateral border of the latissimus dorsi. The patient was a 74-year-old woman who presented with pleomorphic sarcoma in the left elbow region. The tumor was extensively resected and the skin defect was 13.5 × 12 cm. The boomerang-shaped lateral-to-back muscle-sparing-latissimus dorsi myocutanous flap was transferred as a free flap with the pedicle vessels anastomosed to the brachial artery and vein. The 2 wings of the boomerang were bent in a U shape to completely cover the skin defect. The donor site was closed primarily. This flap can be a versatile option for reconstructing extensive skin defects in various areas with little donor-site morbidity.
Establishing a Clinically Applicable Methodology for Skin Color Matching in Vascularized Composite Allotransplantation
Authors: Hoffman Alexandra F. , Park Jenn J. , Berman Zoe P. , Alfonso Allyson R. , Diep Gustave K. , Mills Emily , Wolfe Erin M. , Felsenheld Julia H. , Ramly Elie P. , Rodriguez Eduardo D.
Published: February 2020

Skin color matching in vascularized composite allotransplantation (VCA) is an important determinant of aesthetic outcomes. The process of color matching is infrequently described in the literature. The Pantone SkinTone Guide (PSTG) is a handheld tool comprised of realistic skin tone swatches with a corresponding virtual swatch system. A color match acceptability threshold (AT) is defined as the point beyond which >50% of observers deem a given skin tone pairing as unacceptable. In this study, color match acceptability thresholds were developed using the PSTG to help standardize donor-recipient color matching. Four representative colors were chosen across the skin tone spectrum. These standard colors were used to develop a survey asking participants to determine the acceptability of color pairings. Using survey results, ATs were determined for changes in lightness, undertone, and lightness and undertone combined for each of the standard colors. Inter- and intra-rater reliability were determined using Fleiss’s Kappa. Participants were more critical of skin tone pairings on the darker versus the lighter end of the spectrum, as evidenced by higher thresholds observed for lighter sample pairs. Additionally, observers were more critical of differences in skin lightness compared with differences in undertone. Intra-rater reliability was fair to substantial, and inter-rater reliability was fair to moderate. The PSTG can be used as a clinical tool to improve the aesthetic outcomes of skin-containing vascularized composite allotransplantation procedures by optimizing donor-recipient skin color matching. This can allow clinicians to complement visual judgment with quantitative reference.
The Adolescent and Genital Dissatisfaction
Authors: MICHALA LINA
Published: February 2020

Genital dissatisfaction in healthy young women is on the rise. Pubic hair removal reveals genital tissue previously hidden, while social trends promote the absence of any protruding genital tissue as the feminine ideal. Information with regard to the natural diversity of external genitalia anatomy, and lifestyle changes to improve physical symptoms related to labial tissue may suffice to reassure a distressed adolescent. Female genital cosmetic surgery is rarely supported, before attaining genital maturity. However, genital dissatisfaction may lead to significant embarrassment and anxiety, requiring formal psychological counselling. Sexual education needs to counterbalance perceived normal anatomy, portrayed in pornography or female genital cosmetic surgery advertisements.
An untargeted metabolomics study of blood pressure: findings from the Bogalusa Heart Study
Authors: He William J. , Li Changwei , Mi Xuenan , Shi Mengyao , Gu Xiaoying , Bazzano Lydia A. , Razavi Alexander C. , Nierenberg Jovia L. , Dorans Kirsten , He Hua , Kelly Tanika N.
Published: February 2020

Objective:

To identify novel and confirm previously reported metabolites associated with SBP, DBP, and hypertension in a biracial sample of Bogalusa Heart Study (BHS) participants.

Methods:

We employed untargeted, ultra-high performance liquid chromatography tandem mass spectroscopy metabolomics profiling among 1249 BHS participants (427 African-Americans and 822 whites) with BP and covariable data collected during the 2013 to 2016 visit cycle. A total of 1202 metabolites were tested for associations with continuous and binary BP phenotypes using multiple linear and logistic regression models, respectively, in overall and race-stratified analyses.

Results:

A total of 24 novel metabolites robustly associated with BP, achieving Bonferroni-corrected P less than 4.16 × 10−5 in the overall analysis and consistent effect sizes across race groups. The identified metabolites included three amino acid and nucleotide metabolites from histidine, pyrimidine, or tryptophan metabolism sub-pathways, seven cofactor and vitamin or xenobiotic metabolites from the ascorbate and aldarate metabolism, bacterial/fungal, chemical, and food component sub-pathways, 10 lipid metabolites from the eicosanoid, phosphatidylcholine, phosphatidylethanolamine, and sphingolipid metabolism sub-pathways, and four still unnamed metabolites. Six previously described metabolites were robustly confirmed by our study (Bonferroni-corrected P < 4.95 × 10−4 and consistent effect directions across studies). Furthermore, previously reported metabolites for SBP, DBP, and hypertension demonstrated 5.92-fold, 4.77-fold, and 4.54-fold enrichment for nominally significant signals in the BHS (P = 3.08 × 10−10, 5.93 × 10−8, and 2.30 × 10−8, respectively).

Conclusion:

In aggregate, our study provides new information about potential molecular mechanisms underlying BP regulation. We also demonstrate reproducibility of findings across studies despite differences in study populations and metabolite profiling methods.
Determination of the Kinetic Parameters for 123I Uptake by the Thyroid, Thyroid Weights, and Thyroid Volumes in Present-day Healthy Japanese Volunteers
Authors: Kudo Takashi , Inano Akihiro , Midorikawa Sanae , Kubo Hitoshi , Hayashi Kino , Nakashima Sawako , Fukushima Chizu , Maeda Kazuya , Oriuchi Noboru , Irie Shin , Yamashita Shunichi , Kusuhara Hiroyuki
Published: February 2020

The purpose of this study was to evaluate the kinetic parameters that determine the uptake rate of radioiodide in the thyroid over 24 h after administration and to estimate thyroid volumes/masses of present-day Japanese. Methods: We determined the thyroid uptake rate of 123I in healthy male Japanese after oral administration (4.5–8.0 MBq) without iodine restriction. Masses of thyroid glands were collected in 2012–2016 during autopsies of 7,651 male and 3,331 female subjects. Volumes of thyroid glands were estimated by ultrasonography and magnetic resonance imaging in 52 male subjects. Results: The thyroid uptake rate of 123I for 24 h was 16.1 ± 5.4%. Kinetic model analysis was conducted to obtain the clearances (L h−1) for thyroid uptake and urinary excretion of 123I (0.499 ± 0.258 and 2.10 ± 0.39 L h−1, respectively). The masses of thyroid glands were on average 19.8 g (95% confidence interval of 18.3−19.5 g) and 15.5 g (95% confidence interval of 14.7−16.2 g) in male and female subjects aged 19–52 y, respectively. Volumes of thyroid glands estimated by ultrasonography and magnetic resonance imaging were 17.5 ± 5.2 and 14.2 ± 5.3 mL, respectively. In healthy Japanese, there has been no significant change for at least 50 y in the thyroid uptake of radioiodide over 24 h or in its kinetic parameters. These Japanese-specific kinetic parameters will allow quantitative estimation of the radiation exposure from the Fukushima accident and its variance during the individual’s evacuation from or stay in Fukushima.
Atrial Fibrillation in Hypertrophic Cardiomyopathy: Evidence-based Review About Mechanism, Complications and Management
Authors: Arunachalam Karuppiah , Maan Abhishek , Chu Antony
Published: February 2020

Hypertrophic cardiomyopathy (HCM) is 1 of the most frequent genetic cardiovascular diseases affecting 1 out of every 500 individuals in general population. Atrial Fibrillation incidences were 3.8% per 100 patients per year and overall prevalence among HCM patients are 27.09%. Higher risk of death noted in HCM patients with atrial fibrillation. Stroke and other thrombo embolic risks are increased in such patients. Medical management using mainly betablockers or amiodarone produced variable results and high rate of recurrence. Catheter ablation reduced symptom burden and complications despite moderate recurrence. Patients with multiple repeated procedures found to have better success rate and outcomes. The complications are not high leading to increased feasibility of the procedure. More research using latest techniques in catheter ablation need to be studied.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY CAN CATEGORIZE DIFFERENT SUBGROUPS OF CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION
Authors: Arrigo Alessandro , Romano Francesco , Aragona Emanuela , Di Nunzio Carlo , Battista Marco , Bandello Francesco , Battaglia Parodi Maurizio
Published: February 2020

Purpose:

Choroidal neovascularization (CNV) is a common complication of patients affected by age-related macular degeneration, showing a highly variable visual outcome. The main aim of the study was, at baseline, to perform a quantitative optical coherence tomography angiography assessment of CNV secondary to age-related macular degeneration and to assess posttreatment outcomes.

Methods:

Seventy-eight naïve age-related macular degeneration-related CNV patients (39 men, mean age 78 ± 8 years) were recruited and underwent complete ophthalmologic evaluation and multimodal imaging. Several OCT and optical coherence tomography angiography parameters were collected, including vessel tortuosity and vessel dispersion (VDisp), measured for each segmented CNV. All patients underwent anti–vascular endothelial growth factor PRN treatment. Vessel tortuosity and VDisp values of CNVs were tested at baseline to establish a cutoff able to distinguish clinically different patient subgroups.

Results:

Mean best-corrected visual acuity was 0.49 ± 0.57 (20/62) at baseline, improving to 0.31 ± 0.29 (20/41) at the 1-year follow-up (P < 0.01), with a mean number of 6.4 ± 1.9 injections. Our cohort included the following CNV types: occult (45 eyes; 58%), classic (14 eyes; 18%), and mixed (19 eyes; 24%). Observing optical coherence tomography angiography parameters, classic, mixed, and occult CNV revealed significantly different values of VDisp, with classic forms showing the highest values and the occult CNVs showing the lowest (P < 0.01); mixed forms displayed intermediate VDisp values. The ROC analysis revealed that a CNV vessel tortuosity cut-off of 8.40, calculated at baseline, enabled two patient subgroups differing significantly in visual outcomes after anti–vascular endothelial growth factor treatment to be distinguished.

Conclusion:

A baseline quantitative optical coherence tomography angiography-based parameter could provide information regarding both clinical and functional outcomes after anti–vascular endothelial growth factor treatment in age-related macular degeneration-related CNV.
ULTRA-WIDEFIELD OPTICAL COHERENCE TOMOGRAPHY FOR RETINAL DETACHMENT WITH PROLIFERATIVE VITREORETINOPATHY
Authors: Takahashi Hiroyuki , Uramoto Kengo , Ohno-Matsui Kyoko
Published: February 2020

Purpose:

To evaluate the efficacy of using preoperative and postoperative ultra-widefield optical coherence tomography) images in the treatment of proliferative vitreoretinopathy.

Methods:

The preoperative and postoperative images of a 62-year-old man with proliferative vitreoretinopathy accompanied by a rhegmatogenous retinal detachment were analyzed.

Patient:

At the initial examination, the vision was 20/400. It was difficult to obtain clear images of the fundus by color fundus photography because of synechia iridis posterior and mild vitreal opacities. Three-dimensional ultra-widefield optical coherence tomography images showed that the posterior hyaloid membrane was adherent to the retinal surface at a region superior to the macula. A space was present between the hyaloid membrane and retina in the images. During surgery, the hyaloid membrane was pierced over this space without injuring the retina, and the membrane was successfully removed. After surgery, the retina was reattached and a remnant of the proliferative tissue was detected in the ultra-widefield optical coherence tomography images. Four months after the surgery, the vision improved to 20/40.

Conclusion:

Ultra-widefield optical coherence tomography can be used to examine the spatial relationship between a proliferative membrane and the retina in eyes with proliferative vitreoretinopathy even when the preoperative fundus images obtained by conventional methods are not clear.
Long-term Progression of Ocular Surface Disease in Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis
Authors: Yoshikawa Yamato , Ueta Mayumi , Fukuoka Hideki , Inatomi Tsutomu , Yokota Isao , Teramukai Satoshi , Yokoi Norihiko , Kinoshita Shigeru , Tajiri Kensuke , Ikeda Tsunehiko , Sotozono Chie
Published: February 2020

Purpose:

To investigate the details of the long-term progression of ocular surface cicatrization in eyes with ocular sequelae caused by Stevens–Johnson syndrome (SJS)/toxic epidermal necrosis (TEN).

Methods:

In 105 eyes of 66 patients with SJS/TEN, the severity of ocular sequelae was retrospectively evaluated using an ocular surface grading score (OSGS) at 2 time points separated by a greater than 5-year interval. The OSGS included 7 ocular surface components (conjunctivalization, neovascularization, opacification, keratinization, symblepharon, and upper/lower conjunctival-sac shortening) evaluated into grades 0 to 3 (maximum total OSGS: 21), with the worsening of each component and total OSGS evaluated at the greater than 5-year interval. Moreover, we evaluated whether upper-tarsus and lid-margin scarring are factors that affect ocular surface cicatrization progression.

Results:

In 35 (33.3%) of 105 eyes, the total OSGS worsened during the follow-up period. Partial conjunctivalization (score 1–2) progressed more frequently to total conjunctivalization (score 3) than to no conjunctivalization (score 0) (OR [95% CI]; 5.6 [1.6–20.3]). Partial keratinization (score 1–2) also had a high risk of progression into total keratinization (41.0 [6.3–266.5]). In all cases, keratinization progressed only in the eyes with total conjunctivalization (conjunctivalization score 3). Severity of upper-tarsus scarring or lid-margin scarring affected the worsening of the total OSGS.

Conclusions:

In 66 patients with chronic-phase SJS/TEN, ocular surface cicatrization progressed in 33.3% of the 105 eyes during the long-term follow-up period of over 5 years. More than 50% of the partial conjunctivalization eyes progressed toward total conjunctivalization. The partial keratinization eyes had a high possibility of progressing to total keratinization; that is, the so-called “end-stage” status.
Diffuse lamellar keratitis associated with tabletop autoclave biofilms: case series and review
Authors: Sorenson Andrew L. , Holland Simon , Tran Kathy , Evans David J. , Lin Meng C. , Mamalis Nick , Chang David F.
Published: February 2020

Purpose:

To report a diffuse lamellar keratitis (DLK) cluster attributed to autoclave reservoir biofilm and to review the risk and prevention of DLK and toxic anterior segment syndrome (TASS) caused by such biofilms.

Setting:

Refractive Surgery Center, University of California, Berkeley.

Design:

Observational case–control study and review of literature.

Methods:

Eyes were evaluated for DLK following laser in situ keratomileusis (LASIK) over a 5-year period. Multiple changes in surgical and operating room protocols were prompted by a cluster of DLK cases. The autoclave reservoir chamber wall was cultured for microbial contamination. The MEDLINE database was used to identify relevant past publications.

Results:

From January 7, 2010, to December 18, 2014, 1115 eyes received LASIK. Between September 2, 2010, and June 11, 2012, 147 eyes of 395 LASIK cases developed DLK (37.2%). Systematic modifications in surgical protocols were unsuccessful in ending the prolonged cluster of DLK cases until the STATIM 2000 autoclave was replaced with a new STATIM autoclave and a reservoir sterilization and surveillance protocol implemented. Over the subsequent 30 months, DLK incidence was reduced to 2.2% (14 DLK cases from 632 total LASIK cases,P< .0001). The retired autoclave reservoir chamber wall cultures grewPseudomonas aeruginosaand theBurkholderia cepaciacomplex.

Conclusions:

Fluid reservoirs of tabletop steam autoclaves can readily develop polymicrobial biofilms harboring microbial pathogens, whose inert molecular byproducts can cause DLK and TASS when introduced to the eye by surgical instruments. Stringent reservoir cleaning and maintenance may significantly reduce this risk by preventing and removing these biofilms.
Axial length measurement and detection rates using a swept-source optical coherence tomography–based biometer in the presence of a dense vitreous hemorrhage
Authors: Wang Qinmei , Huang Yingying , Gao Rongrong , Chen Hao , Song Benhao , Tu Ruixue , Zhao Yune , McAlinden Colm , Huang Jinhai
Published: February 2020

Purpose:

To evaluate axial length (AL) measurements and detection rates using a swept-source optical coherence tomography (SS-OCT) biometer (OA-2000) compared with the IOLMaster, LENSTAR, and ultrasound (US) measurements in eyes with vitreous hemorrhage.

Setting:

Eye Hospital of Wenzhou Medical University, China.

Design:

Comparative evaluation of a diagnostic test or technology.

Methods:

Patients were adults with vitreous hemorrhage in one or both eyes. Lens Opacities Classification System III was used to determine they type and severity of cataract and the Forrester system was used to classify the grade of vitreous hemorrhage. The AL measurement was taken with the OA-2000, IOLMaster (v5.4), and LENSTAR (v2.1), and with US (Axis-II). The Bland-Altman test was used to assess the agreement between devices.

Results:

Forty eyes were scanned with each of the 4 biometers. For Forrester grade III, the detection rate was 100%, 41.7%, and 41.7% with the OA-2000, IOLMaster, and LENSTAR, respectively. For Forrester grades I and II, the detection rate was 46.4%, 3.57%, and 3.57% with the OA-2000, IOLMaster, and LENSTAR, respectively. The detection rate with US was 100% for all grades. The Bland-Altman limits of agreement between the 4 biometers indicated an excellent agreement: OA-2000 vs IOLMaster (95% limits of agreement −0.15 to 0.05 mm), OA-2000 vs LENSTAR (−0.04 to 0.12 mm), and OA-2000 vs US (−0.3 to 0.56 mm).

Conclusions:

In vitreous hemorrhage, the detection rate with the SS-OCT OA-2000 biometer was better than that with the IOLMaster and LENSTAR. In cases in which all biometers were able to acquire an AL measurement an excellent agreement was found.
Photorefractive intrastromal corneal crosslinking for treatment of low myopia: clinical outcomes using the transepithelial approach with supplemental oxygen
Authors: Sachdev Gitansha Shreyas , Ramamurthy Shreyas , Dandapani Ramamurthy
Published: February 2020

Purpose:

To evaluate the safety and efficacy of photorefractive intrastromal corneal crosslinking (PiXL) for the treatment of low myopia using the epithelium-on approach with supplemental oxygen.

Setting:

The Eye Foundation, Coimbatore, India.

Design:

Prospective interventional case series.

Methods:

Myopic nonectatic eyes underwent PiXL using the Mosaic system. Ultraviolet-A (UV-A) irradiation of 365 nm wavelength was delivered in an accelerated (30 mW/cm2) pulsed approach to provide a total fluence of 15 J/cm2. Supplemental oxygen (concentration greater than 95%) was provided to increase the efficacy of the epithelium-on approach during the UV-A irradiation. Efficacy was determined by improvement in mean refractive spherical equivalent (MRSE), uncorrected distance visual acuity (UDVA), and keratometric flattening. Safety was determined by loss of lines of corrected distance visual acuity, endothelial cell loss, and adverse events.

Results:

Fifty eyes of 26 patients with a mean age of 22.73 ± 3.74 years were included. A significant improvement in UDVA from baseline (logarithm of the minimum angle of resolution [logMAR] 0.63 ± 0.25) was noted at the 3-month (logMAR 0.08 ± 0.15) and 6-month (logMAR 0.13 ± 0.18) follow-up visits (P < .001). Significant keratometric flattening from baseline was noted at all follow-up visits (P < .001). No significant endothelial cell loss or adverse effects were noted. A significant correlation was noted between the change in MRSE and preoperative corneal biomechanics (deformation amplitude ratio, P = .029).

Conclusions:

Transepithelial PiXL with supplemental oxygen might be a safe and effective approach for reduction of myopia. The change in MRSE and keratometric flattening was greater in comparison with earlier protocols, including the epithelium-off approach.
Astigmatism prediction in small-incision lenticule extraction
Authors: Gyldenkerne Anders , Hjortdal Jesper , Ivarsen Anders
Published: February 2020

Purpose:

To investigate whether postoperative-induced refractive astigmatism after small-incision lenticule extraction (SMILE) could be predicted by preoperative objective astigmatism measured with autorefraction, keratometry, and Scheimpflug tomography.

Setting:

University eye clinic.

Design:

Retrospective case series.

Methods:

Only eyes without preoperative subjective astigmatism treated with SMILE for myopia were included. Postoperative subjective astigmatism was compared with preoperative objective astigmatism. Examinations were performed before SMILE and 3 months postoperatively and included subjective refraction, keratometry, autorefraction, and Scheimpflug tomographer measurements. Astigmatism was analyzed using double-angle plots and multivariate statistics.

Results:

A total of 358 eyes of 358 patients were included. The mean preoperative sphere was −7.33 diopter (D) ± 1.46 (SD). The postoperative spherical equivalent was −0.30 ± 0.49 D. Postoperatively, 79.6% and 98.9% of patients had a subjective cylinder ≤0.50 D and ≤1.00 D, respectively. Preoperative objective astigmatism measured with keratometry, autorefraction, and Scheimpflug tomography was significantly different (P < .05) from postoperative subjective refraction when all patients were analyzed; for patients with postoperative refractive astigmatism ≥0.50 D, preoperative astigmatism with keratometry and Scheimpflug tomography was not significantly different from postoperative refractive astigmatism. Preoperative objective astigmatism ≥0.50 D increased the risk ratio of postoperative subjective astigmatism ≥0.50 D by 2.2 (P < .001).

Conclusions:

Preoperative objective astigmatism could not be directly interchanged with postoperative subjective astigmatism, but the presence of preoperative astigmatism ≥0.50 D doubled the risk of inducing a postoperative subjective astigmatism ≥0.50 D. Extra care when performing subjective refraction should be taken in the presence of high objective astigmatism.
Level of agreement of intraocular lens power measurements between an image-guided system and partial coherence interferometry
Authors: Labiris Georgios , Panagiotopoulou Eirini-Kanella , Ntonti Panagiota , Gkika Maria , Konstantinidis Aristeidis , Perente Irfan , Dardabounis Doukas , Ioannakis Konstantinos
Published: February 2020

Purpose:

To evaluate the level of agreement of partial coherence interferometry (IOLMaster) and an image-guided system (Verion) in terms of keratometric values and intraocular lens (IOL) power calculation.

Setting:

Department of Ophthalmology, University Hospital of Alexandroupolis, Greece.

Design:

Prospective comparative study.

Methods:

Keratometric (K) values and IOL power calculations were compared for 3 toric IOL models (SN6ATx, TFNTx0, and SV25Tx) using 4 formulas (SRK/T, Holladay 1, Hoffer Q, and Haigis) in patients who had cataract surgery in a consecutive-if-eligible way.

Results:

Ninety-eight eyes from 54 patients were included in the study (mean age: 60.2 ± 9.2 years). Compared with the IOLMaster, the Verion measured significantly steeper K1, K2, and Km values (P < .05), but no significant difference was observed in astigmatism power and vectors J0 and J45 (P > .05). With the SRK/T formula, the SN6ATx IOL showed significant difference in the mean IOL power calculated by the 2 devices, whereas no significant difference was observed in the TFNTx0 IOL and the SV25Tx IOL. However, with the Holladay 1, Hoffer Q, and Haigis formulas, a significant difference was found in the mean IOL power of all 3 toric IOL models. Generally, the Verion calculated a significantly lower mean IOL power for almost all formulas and IOL models. For 35 toric implantations, the mean residual astigmatism power, 6 months postoperatively, was 0.29 ± 0.24 diopter.

Conclusions:

The IOLMaster and the Verion seemed to present differences in IOL calculation and surgical planning that could lead to unexpected residual refractive error. When discrepancy is detected in IOL calculation, using the IOLMaster as the primary biometry and the Verion as a digital marker alone could provide excellent outcomes in terms of astigmatism correction.
Eckardt keratoprosthesis for combined pars plana vitrectomy and therapeutic keratoplasty in a patient with endophthalmitis and suppurative keratitis
Authors: Kim Seong Ho , Kim Na Rae , Chin Hee Seung , Jung Ji Won
Published: February 2020

This is a case report on the use of Eckardt keratoprosthesis for pars plana vitrectomy in a patient with endophthalmitis and suppurative keratitis that developed after cataract surgery. A 79-year-old woman developed acute-onset infectious endophthalmitis and suppurative keratitis after cataract surgery that failed to respond to treatment with antibiotic eyedrops and intravitreal antibiotic injection. Using a temporary keratoprosthesis that enabled sufficient visualization, vitrectomy was performed, followed by therapeutic keratoplasty using a cryopreserved donor cornea. The patient's vision was improved from light perception to counting fingers at 30 cm, 3 months postoperatively. There was no recurrence of infection or other significant complications.
Comparison of clinical outcomes between vector planning and manifest refraction planning in SMILE for myopic astigmatism
Authors: Jun Ikhyun , Kang David Sung Yong , Arba-Mosquera Samuel , Reinstein Dan Z. , Archer Timothy J. , Jean Seung Ki , Kim Eung Kweon , Seo Kyoung Yul , Lee Hyung Keun , Kim Tae-im
Published: February 2020

Purpose:

To compare clinical outcomes of small-incision lenticule extraction (SMILE) between manifest refraction (MR) and vector planning for myopic astigmatism with high ocular residual astigmatism (ORA).

Setting:

Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea.

Design:

Prospective, randomized, comparative case series.

Methods:

Patients with myopic astigmatism and ORA of 0.75 diopters (D) or greater were randomized into the MR or vector planning group and underwent SMILE without applying any nomogram for cylinder correction. Visual acuity, MR, corneal topography, and corneal aberration were measured preoperatively and postoperatively. Outcomes at 6 months postoperatively were compared between the groups.

Results:

The study comprised 114 patients (114 eyes): 58 eyes in MR planning and 56 eyes in vector planning. The mean uncorrected and corrected distance visual acuity, safety and efficacy indices were comparable between the 2 groups. Postoperative refractive cylinder reached statistically significant differences between the groups (−0.22 ± 0.18 D and −0.14 ± 0.16 D in the MR and vector planning groups, respectively, P = .02). Postoperative corneal toricity and ORA reached statistically significant lower in the vector planning group.

Conclusions:

In myopic astigmatism with high ORA, MR and vector planning in SMILE were effective with comparable visual outcomes; vector planning showed statistically significant lower postoperative refractive and corneal astigmatism and ORA. Use of vector planning may improve refractive outcomes in SMILE cases with high ORA. However, the results may have been different had a nomogram adjustment been applied, as is often used for cylinder corrections with SMILE.
Improvement of Physical and Occupational Therapy Referral Process to Reduce Unskilled Consults
Authors: Bednarczyk Matt , Pritchard Kevin , Barquin Will , Beyer Abram , Stankiewicz Christine
Published: February 2020

Purpose:

Baseline data collected for 9 months showed that physical (PT) and occupational therapy (OT) services were consulted 14.5% of the time for unskilled therapy needs. The goal of this performance improvement project was to identify whether acute care physical and occupational therapists can reduce unskilled consults using a multidisciplinary education intervention.

Methods:

Therapists were trained on how to define and use each of 4 categories of unskilled consults. An interdisciplinary focus group was formed to gain feedback from providers with regard to the culture of mobility, the role of PT and OT, skilled versus unskilled consults, and strategies to reduce these unskilled consults. After discussion, the focus group determined that the primary strategy to reduce unskilled consults is to incorporate mobility and activities of daily living (ADL) discussion for each patient into interdisciplinary rounds (IDR).

Results:

Data show that PT and OT services collectively were consulted for unskilled therapy needs 3.05% of the time, compared with baseline data of 14.5%, which is a clinically meaningful decrease.

Conclusion:

Results provide preliminary evidence that an interdisciplinary approach using IDR can assist with reducing unskilled consults. Establishing a focus group can assist the initiatives through education on what defines an unskilled consult, collaboration, and improved communication regarding patient mobility and ADL performance while hospitalized.
The Value Transformation Framework: An Approach to Value-Based Care in Federally Qualified Health Centers
Authors: Modica Cheryl
Published: February 2020

Background:

With the transition toward value-based care, health care organizations have a business imperative to simultaneously focus on improved health outcomes, improved patient and staff experience, and reduced costs (the Quadruple Aim). For federally qualified health centers—which provide care to some of nation's most vulnerable populations—balancing the complex task of systems change in the face of overwhelming volumes of information and best practices is challenging and can be supported through a guiding framework.

Purpose:

This need for synthesis and translation of evidence in an actionable and practical way led to the design of a model for health center systems change. This article describes the development process and defines the resulting conceptual framework.

Methods:

Deployed a four-step process between 2016 and 2018 to develop and test a framework for value transformation in health centers.

Results:

NACHC's Quality Center developed the Value Transformation Framework to guide health center systems change toward high value care. The framework identifies 15 change areas across three Domains: infrastructure, care delivery, and people and summarizes evidence-based action steps within the change areas.

Conclusions:

The framework shows promise in supporting health center efforts to adapt, transform, and balance competing demands as they advance value-based models of care.
Anticoagulation reversal for intracranial hemorrhage in the era of the direct oral anticoagulants
Authors: Strein Micheal , May Scott , Brophy Gretchen M.
Published: February 2020

Purpose of review

This review focuses on recent relevant literature that examines the reversal of direct oral anticoagulants (DOACs) in patients with intracranial hemorrhage (ICH). The aim of this review is to provide an insightful description of available reversal agents and their clinical utility.

Recent findings

Increases in prescribing of DOACs has led to the introduction of drug-specific reversal agents. The clinical trials that evaluated these agents did not include a comparator arm making it difficult to determine if they are clinically superior to nonspecific reversal agents.

Numerous options for reversal of DOAC-associated ICH are currently available. Recent clinical trials have demonstrated drug-specific reversal agents are effective in this setting, but additional research is needed to determine whether these agents should be routinely preferred over nonspecific reversal agents.
Management of Incidental Pancreatic Cystic Lesions
Authors: Kim Marina , Karadsheh Zeid , Levy Alexander , Al-Haddad Mohammad A.
Published: February 2020

Owing to increased detection rates, the diagnosis and management of incidental pancreatic cysts has become a common predicament. Up to 13% of patients undergoing cross-sectional imaging studies for other indications are found to have pancreatic cystic lesions. Although most cystic lesions are benign, the malignant potential of several types of pancreatic cysts makes accurate classification vital to directing therapy. To this end, advances in the last decade led to better characterization of pancreatic cyst morphology and hence enhanced the ability to predict underlying histopathology, and biological behavior. Although accurate classification remains a challenge, the utilization of complementary diagnostic tools is the optimal approach to dictate management. The following review includes a description of pancreatic cysts, a critical review of current and emerging diagnostic techniques and a review of recent guidelines in the management of incidental pancreatic cysts.