bluuebunny/crossref_metadata_2025 huggingface dataset:
TRPC1 intensifies house dust mite–induced airway remodeling by facilitating epithelial‐to‐mesenchymal transition and STAT3/NF‐κB signaling
Authors: Pu Qinqin , Zhao Yuanyu , Sun Yuyang , Huang Ting , Lin Ping , Zhou Chuanmin , Qin Shugang , Singh Brij B. , Wu Min
Published: August 2018

Airway remodeling with progressive epithelial alterations in the respiratory tract is a severe consequence of asthma. Although dysfunctional signaling transduction is attributed to airway inflammation, the exact mechanism of airway remodeling remains largely unknown. TRPC1, a member of the transient receptor potential canonical Ca2+ channel family, possesses versatile functions but its role in airway remodeling remains undefined. Here, we show that ablation of TRPC1 in mice alleviates airway remodeling following house dust mite (HDM) challenge with decreases in mucus production, cytokine secretion, and collagen deposition. HDM challenge induces Ca2+ influx via the TRPC1 channel, resulting in increased levels of signal transducer and activator of transcription 3 (STAT3) and proinflammatory cytokines. In contrast, STAT3 expression was significantly decreased in TRPC1−/− mouse lungs compared with wild‐type controls after HDM challenge. Mechanistically, STAT3 promotes epithelial‐to‐mesenchymal transition and increases mucin 5AC expression. Collectively, these findings identify TRPC1 as a modulator of HDM‐induced airway remodeling via STAT3‐mediated increase in mucus production, which provide new insight in our understanding of the molecular basis of airway remodeling, and identify novel therapeutic targets for intervention of severe chronic asthma.—Pu, Q., Zhao, Y., Sun, Y., Huang, T., Lin, P., Zhou, C., Qin, S., Singh, B. B., Wu, M TRPC1 intensifies house dust mite–induced airway remodeling by facilitating epithelial‐to‐mesenchymal transition and STAT3/NF‐κB signaling. FASEB J. 33, 1074–1085 (2019). www.fasebj.org
Unique Issues of DNP Students
Authors: Volkert Delene , Johnston Heidi
Published: August 2018

AIM

The purpose of this study was to explore, analyze, and describe nursing doctoral students' perceptions of factors that impacted them during their doctoral program.

BACKGROUND

There are two major pathways for nurses to earn a doctoral degree, the most recent of which is the doctor of nursing practice (DNP) degree. Enrollment in and graduates from nursing DNP programs have increased dramatically over the last decade.

METHOD

Answers to an open-ended question in a national descriptive survey study of nursing doctoral students across the United States were analyzed. Colaizzi’s procedural methods were used as a guideline.

RESULTS

The content analysis identified issues unique to DNP students, which related to lack of clarity for the DNP degree and student concerns within academic settings.

CONCLUSION

Recommendations include having DNP faculty on DNP project committees and for standardization of guidelines for the DNP project to ensure rigor and consistency.
Nursing students at risk for clinical placement failure
Authors: Clarke Sean
Published: August 2018

A guide for managers and staff
Therapeutic approaches for suicidal adolescents
Authors: Rajamohan Santhiny , Sharkey Patricia L. , Heavey Elizabeth
Published: August 2018

Suicide is one of the most preventable causes of death among children and adolescents. Because nurses are often the first to interact with someone who is suicidal, all healthcare settings should have protocols for suicide screening and prevention. This article addresses the issue of suicide among adolescents and focuses on risk assessment, therapeutic interventions, and recommendations for successful outcomes.
Promises and Pitfalls of Diversity Statements: Proceed With Caution
Authors: Carnes Molly , Fine Eve , Sheridan Jennifer
Published: August 2018

As part of their efforts to increase the diversity of their workforce and student body, medical schools, academic medical centers, and individual departments are increasingly crafting public statements about their value for and commitment to diversity. For these statements to effectively enhance diversity, however, care must be taken, as research shows that some diversity-related messages can backfire. To avoid the pitfalls and realize the promise of diversity statements, this article presents recommendations based on experimental studies that investigate the impact of diversity messages. These studies suggest that diversity statements be aspirational, emphasize autonomy, and express a value for difference. Aspirational statements avoid creating the impression that equity has been achieved, thus preventing the “illusion of fairness” and the “paradox of meritocracy,” wherein espousing egalitarian values and the existence of a meritocracy can increase biased outcomes and workplace disparities. Statements that emphasize autonomy avoid the backlash that can occur when organizational members feel coerced into adopting prodiversity actions. Statements that emphasize the value of human differences convey a multicultural message that has shown positive outcomes compared with “colorblind” statements that acknowledge our common humanity. Although there are no studies specific to academic medicine, current research on a variety of organizations, including some studies from the health care industry, suggests that relying on these recommendations to craft a diversity statement may help contribute to academic medical centers’ larger efforts to promote diversity and inclusion and may help them avoid some deleterious effects.
Loperamide Abuse and Dependence: Clinical Features and Treatment Considerations
Authors: Okusanya Ayodeji , Li Xiaofan
Published: August 2018

Opioid use disorder and its associated mortality have become national epidemic problems. Different measures and regulations have been implemented to curb this trend, including stricter opioid prescribing practice. With the decreased access to prescription opioids, individuals with opioid use disorder have explored alternatives including loperamide, a peripheral opioid mu-receptor agonist. There are reports of increased loperamide misuse, dependence, and mortality rate in the past few years from poison control centers, medical examiners’ offices, and clinical settings. Here, we report a case of loperamide use disorder, which led to the death of the patient. Associated clinical features and treatment of loperamide use disorder, including management of intoxication and withdrawal, and long-term maintenance therapy are discussed along with potential prescribing and sale regulations to manage this newly emerging substance use disorder.
The clinico-serological spectrum of overlap myositis
Authors: Fredi Micaela , Cavazzana Ilaria , Franceschini Franco
Published: August 2018

Purpose of review

To provide the most recent evidence on the overlap myositis.

Recent findings

Several new evidences on the overlap myositides have recently emerged. Regarding the classical myositis associated antibodies, several contributions focused on a better definition of the clinical associations and the disease course associated with these autoantibodies. Moreover, in the last years, new autoantibodies in idiopathic inflammatory myositis or other connective tissue diseases have been identified [namely anti-RuvBL1/2, poly-U-binding factor 60 kDa protein (PUF-60) and cytosolic 5′-nucleotidase 1A (NT5C1A)], and an increasing number of publications allow now to consider them as new myositis-associated antibodies with probably their own peculiar clinical profile.

Overlap myositis is probably the largest subgroup within the idiopathic inflammatory myositis, with a prevalence that can reach 50% of all adult patients. The serological spectrum of overlap myositis has recently been enriched by the discovery of new autoantibodies. The spread of multiparametric methods has facilitated the identification of the autoantibody marker of overlap myositis and the better definition of the clinical profiles associated with them.
What’s New in Pediatric Orthopaedic Quality, Safety, and Value? A Systematic Review With Results of the 2016 POSNA Quality, Safety, and Value Initiative (QSVI) Challenge
Authors: Miller Daniel J. , Cahill Patrick J. , Janicki Joseph A. , Stephenson Lindsay P. , Choi Paul D.
Published: August 2018

Background:

Enhancing the safety, quality, and value of care provided is a point of emphasis for modern health care systems. We performed a review of recent literature to highlight those efforts relevant to pediatric musculoskeletal care.

Methods:

We searched the PubMed database for all papers related to quality improvement, patient safety, and/or value in pediatric orthopaedics published from October 1, 2012 to October 31, 2017, yielding 193 papers.

Results:

A total of 36 papers were selected for review based upon new findings. Papers were selected based on significant contributions in the following categories: casting safety, antibiotic stewardship/infection prevention, perioperative care pathways, blood conservation, venous thromboembolic disease prevention, and imaging safety/appropriateness.

Conclusions:

There have been numerous advances in safety, quality, and value in pediatric orthopaedic care. Quality improvement efforts emphasizing provider education and safety monitoring can lead to a decrease in cast-related complications. Perioperative care pathways and bundles are associated with a decrease risk of surgical site infection and decreased length of stay in pediatric spinal deformity surgery. Increased scrutiny has been placed on the value of routine follow-up radiographs in pediatric fracture and spinal deformity care.

Level of Evidence:

Level 4—literature review.
Improvement in Back and Leg Pain and Disability Following Adult Spinal Deformity Surgery
Authors: Verma Ravi , Lafage Renaud , Scheer Justin , Smith Justin , Passias Peter , Hostin Richard , Ames Christopher , Mundis Gregory , Burton Douglas , Kim Han Jo , Bess Shay , Klineberg Eric , Schwab Frank , Lafage Virginie
Published: August 2018

Study Design.

A retrospective review of a prospective, multicenter adult spinal deformity (ASD) database.

Objective.

Our objective was to quantify the change in disability reported for patients with radiculopathy as compared with patients with back pain only following ASD realignment surgery.

Summary of Background Data.

Studies utilizing patient-reported outcomes (PROs) have shown that ASD patients suffer from significant pain and disability. Although surgical correction has been effective at improving back and leg pain, no studies have investigated the impact of radiculopathy on pain and disability in ASD patients.

Methods.

Inclusion criteria were age ≥ 18 years and presence of spinal deformity as defined by coronal Cobb angle ≥ 20°, sagittal vertical axis (SVA) ≥ 5 cm, pelvic tilt (PT) angle ≥ 25°, or thoracic kyphosis (TK) angle ≥ 60°. Demographics and PRO were collected. Patients with radiculopathy were propensity matched with patients with back pain. Preoperative, postoperative, and 2-year follow-up radiographic parameters and PRO were analyzed.

Results.

Three hundred twenty-four patients met inclusion criteria, and following propensity matching, 90 patients were placed into the radiculopathy and back pain groups. These groups showed no difference in demographic or radiographic parameters. The groups were similar in PRO, with a difference in leg pain as per design. At baseline, leg pain patients had higher disability [Oswestry Disability Index (ODI) and Scoliosis Research Society (SRS)]. Surgical strategies between the two groups showed no differences. Postoperative radiographic parameters showed no difference. Despite a significantly greater decrease in numerical rating scale (NRS) Leg for the leg pain group, postoperatively, these patients remained more disabled than the nonleg group in terms of NRS (back and leg), ODI, and most of the SRS domains.

Conclusion.

ASD patients with radiculopathy exhibit increased pain and disability when compared with patients without leg pain. This increased pain and disability persists after surgical correction in these patients.

Level of Evidence: 3
Trochanteric-sparing Proximal Femoral Resection for Arthritic Spastic Hips
Authors: Bauer Jennifer M. , Butler Marjorie P. , Schoenecker Perry L. , Schoenecker Jonathan G.
Published: August 2018

Progressive hip subluxation or dislocation leading to degenerative disease, in neuromuscular disease, is a significant cause of morbidity to the patient and burden to the caretaker. Surgical salvage procedures have unpredictable success. We hypothesized that modifying the Castle-type proximal femoral resection by securing a retained greater trochanter with its musculature to the capsular arthroplasty and femoral shaft would compartmentalize the femur to decrease proximal femoral migration and heterotopic ossification (HO), thereby precluding the need for traction and HO prophylaxis while improving pain and caretaker satisfaction. The purpose of this report is to describe the novel trochanteric-sparing proximal femoral resection (TS-PFR) technique. Seventeen hips in 13 patients were treated by the TS-PFR procedure. Twelve of 13 patients experienced complete pain relief, and all had improved sitting tolerance and perineal care. These results represent an improvement from prior salvage operations, without increase in blood loss, length of stay, proximal femoral migration, or HO. One patient underwent revision for failed soft tissue envelope. A retrospective review of patients treated at 2 institutions identified those who underwent TS-PFR for arthritic spastic hip. Perioperative course, radiologic evaluation for migration and HO, and caretaker satisfaction were compared with prior published surgical techniques. The TS-PFR technique is a safe alternative to previously described spastic hip salvage procedures and may improve upon them by creating a compartment for the proximal femur that precludes the need for traction and decreases HO. The technique improves patients’ pain, sitting tolerance, perineal hygiene, and caretaker satisfaction.
Does Patella Resurfacing Affect Postoperative Blood Loss in Patients Undergoing Total Knee Replacement?
Authors: Girdler Steven J. , Glezos Christopher D.
Published: August 2018

Patella resurfacing in total knee arthroplasty remains a surgeon-specific decision. Possible benefits of resurfacing include decreased knee pain and rate of reoperation, while complications can occur. No study has assessed postoperative blood loss and transfusion rate as a function of patella resurfacing. Certain patient groups such as elderly patients, Jehovah’s Witnesses, and coagulopathy patients may especially benefit from decreased blood loss during orthopedic surgeries. A retrospective chart review of patients with total knee arthroplasty performed by a single surgeon was conducted. In total, 124 patients were identified that met inclusion criteria with 34 patients in the patella-resurfaced group and 90 patients in the unresurfaced group. Hematocrit level was recorded preoperatively and compared with the hematocrit levels on postoperative days 1 through 3. The primary outcome of average percent drop in hematocrit and SD on postoperative day 1, 2, and 3 was calculated for resurfaced and nonresurfaced groups and data were analyzed for secondary outcomes stratified by sex. After analysis no statistically significant difference in postoperative blood loss between resurfaced and nonresurfaced groups was found.
An Electronic Handover System to Improve Information Transfer for Surgical Patients
Authors: Sun Yao-Kuang , Shih Wei-Chu , Cheng Kuang-Hua
Published: August 2018

Proper clinical transfers of patient care (known as handovers) are important to patient safety. The aim of this study was to investigate the efficacy and satisfaction of an electronic system for clinical transfers of patients with complex surgical procedures. The design was a single-center observational study auditing the handover process. The electronic handover system combined with an electronic health record system was developed to help verbal handover. The system has a checklist to guide the structured handover process and provided information from the health record system. With the system, the elapsed time for surgical handover decreased from 10.5 to 5.4 minutes. The questionnaire analysis showed that clinician satisfaction with surgical handover increased from 69.4% to 79.3%, and the perception of communication completeness increased from 67.2% to 81.6%. The electronic handover system improved communication for the transfer of care for surgical patients.
Cancer Stem Cell Vaccination With PD-L1 and CTLA-4 Blockades Enhances the Eradication of Melanoma Stem Cells in a Mouse Tumor Model
Authors: Zheng Fang , Dang Jianzhong , Zhang Hongyu , Xu Fangzhou , Ba Diandian , Zhang Bingyu , Cheng Fanjun , Chang Alfred E. , Wicha Max S. , Li Qiao
Published: August 2018

Immune checkpoint inhibitors and monoclonal antibodies reinvigorate cancer immunotherapy. However, these immunotherapies only benefit a subset of patients. We previously reported that ALDHhigh tumor cells were highly enriched for cancer stem cells (CSCs), and ALDHhigh CSC lysate-pulsed dendritic cell (CSC-DC) vaccine was shown to induce CSC-specific cytotoxic T lymphocytes. In this study, we investigated the CSC targeting effect of the CSC-DC vaccine combined with a dual blockade of programmed death-ligand 1 and cytotoxic T-lymphocyte-associated protein (CTLA-4) in B16-F10 murine melanoma tumor model. Our data showed that animals treated with the dual blockade of programmed death-ligand 1 and CTLA-4 and CSC-DC vaccine conferred significantly more tumor regression than the CSC-DC vaccine alone. Importantly, the triple combination treatment dramatically eliminated ALDHhigh CSCs in vivo. We observed that CSC-DC vaccine in combination with anti-PD-L1 and anti-CTLA-4 administration resulted in ∼1.7-fold fewer PD-1+CD8+ T cells and ∼2.5-fold fewer CTLA-4+CD8+ T cells than the populations observed following the CSC-DC vaccination alone. Moreover, significant antitumor effects and dramatically eliminated ALDHhigh CSCs following the triple combination treatment were accompanied by significantly enhanced T-cell expansion, suppressed transforming growth factor β secretion, enhanced IFN-γ secretion, and significantly enhanced host specific CD8+ T-cell response against CSCs. Collectively, these data showed that administration of a-PD-L1 and a-CTLA-4 combined with CSC-DC vaccine may represent an effective immunotherapeutic strategy for cancer patients in clinical.
Prognostic factors for first-line therapy and overall survival of metastatic uveal melanoma: The Princess Margaret Cancer Centre experience
Authors: Nicholas Mathew N. , Khoja Leila , Atenafu Eshetu G. , Hogg David , Quirt Ian , Butler Marcus , Joshua Anthony M.
Published: August 2018

Metastatic uveal melanoma (MUM) has a poor prognosis, with no established standard of care. Delineation of prognostic factors in MUM patients may enable stratified treatment algorithms of stage-specific survival. Overall, 132 MUM patients who presented to a single tertiary institution in Toronto, Canada, over 12 years were identified and data (demographics, clinical status, radiographic images, and laboratory values) were extracted. Associations with systemic first-line treatment outcome 12 weeks after first-line treatment, time to progression (TTP), and overall survival (OS) were explored by univariate and multivariable analysis. Age, presence of liver metastases, and time from primary presentation to metastatic presentation were significant variables affecting first-line treatment outcomes. Age, Eastern Cooperative Oncology Group (ECOG) score, presence of liver metastases, liver metastasis size, neutrophil lymphocyte ratio, absolute neutrophil count, lactate dehydrogenase (LDH), alkaline phosphatase, time from primary presentation to metastatic presentation, and patients receiving surgery as the first-line treatment were significant variables affecting TTP. Age, ECOG score, presence of liver metastases, liver metastasis size, neutrophil lymphocyte ratio, absolute neutrophil count, LDH, and alkaline phosphatase were significant variables affecting OS. Patients who underwent surgery, chemotherapy, immunotherapy, liver-directed therapy, or targeted therapy had better OS compared with patients not receiving treatment with surgery, associated with a significantly better OS compared with all other therapies. Multivariable analysis showed increased age, absence of liver metastases, and absence of bone metastases to be associated with positive treatment outcomes. ECOG score of at least 1, increased LDH, and decreased time from primary to metastatic presentation would predict decreased TTP. Increased LDH, older age, and ECOG score of at least 1 were associated with decreased OS. These results identified prognostic markers and models thereof of treatment benefit and survival. Further validation in larger cohorts is required.
The Effects of Bed Bathing on Vital Signs and Oxygen Saturation in Children Who Are Connected to Mechanical Ventilation
Authors: Kzl Hamiyet , Şendir Merdiye
Published: August 2018

Aim

This study is a quasi-experimental research that was conducted to evaluate the effects of bathing on vital signs and oxygen saturation in intubated children who are connected to mechanical ventilation.

Methods

The study sample consisted of children who are treated in the pediatric intensive care unit, University of Istanbul Cerrahpasa Faculty of Medicine Hospital. A total of 60 children who met the criteria of the sample group were included in the study. The children were given bed bathing with plain warm water of 32°C to 38°C on 3 different days. The vital signs and oxygen saturation values of the children were measured before bathing, just after bathing, and 30 minutes after bathing them.

Results

Most of the children (65%) were on mechanical ventilation because of respiratory system diseases; 91.7% of them were connected to mechanical ventilation with endotracheal tube. The first bed bathing of children was given mean of 1.54 ± 3.57 days after their hospitalization, and bathing durations were mean of 18.3 minutes. The vital signs (pulse, blood pressure, body temperature) were compared before and after bed bathing, and it was observed that the values before bathing, just after bathing, and 30 minutes after bathing had advanced level of difference (P < .001). The lowest values of all signs except body temperature were obtained 30 minutes after bed bathing. When oxygen saturation measurement values before bathing (94.5%) and after bathing were compared, it was found that the highest values (97.3%) were obtained 30 minutes after bed bathing.

Conclusion

The bed bathing positively affected the vital signs and oxygen saturation values in intubated children connected to the mechanical ventilation. Yet, there is still a need for more research to test the effects of bed bathing on respiratory and circulatory function.
Patient Presentations in Outpatient Settings
Authors: Zogg Cheryl K. , Haring R. Sterling , Xu Likang , Canner Joseph K. , Ottesen Taylor D. , Salim Ali , Haider Adil H. , Schneider Eric B.
Published: August 2018

Background:

While deaths, hospitalizations, and emergency department visits for head trauma are well understood, little is known about presentations in outpatient settings. Our objective was to examine the epidemiology and extent of healthcare-seeking adult (18–64 years) head trauma patients presenting in outpatient settings compared with patients receiving nonhospitalized emergency department care.

Methods:

We used 2004–2013 MarketScan Medicaid/commercial claims to identify head trauma patients managed in outpatient settings (primary care provider, urgent care) and the emergency department. We examined differences in demographic and injury-specific factors, Centers for Disease Control and Prevention–defined head trauma diagnoses, and extent of and reasons for postindex visit ambulatory care use within 30/90/180 days by index visit location, as well as annual and monthly variations in head trauma trends. We used outpatient incidence rates to estimate the US nationwide outpatient burden.

Results:

A total of 1.19 million index outpatient visits were included (emergency department: 348,659). Nationwide, they represented a weighted annual burden of 1.16 million index outpatient cases. These encompassed 46% of all known healthcare-seeking head trauma in 2013 (outpatient/emergency department/inpatient/fatalities) and increased in magnitude (+31%) from 2004 to 2013. One fourth (27%) of office/clinic visits led to diagnosis with concussion on index presentation (urgent care: 32%). Distributions of demographic factors varied with index visit location while injury-specific factors were largely comparable. Subsequent visits reflected high demand for follow-up treatment, increased concussive diagnoses, and sequelae-associated care.

Conclusions:

Adult outpatient presentations of head trauma remain poorly understood. The results of this study demonstrate the extensive magnitude of their occurrence and close association with need for follow-up care.
Shared and Study-specific Dietary Patterns and Head and Neck Cancer Risk in an International Consortium
Authors: De Vito R. , Lee Yuan Chin Amy , Parpinel M. , Serraino D. , Olshan Andrew Fergus , Zevallos Jose Pedro , Levi F. , Zhang Zhuo Feng , Morgenstern H. , Garavello W. , Kelsey K. , McClean M. , Schantz S. , Yu Guo Pei , Boffetta P. , Chuang Shu Chun , Hashibe M. , La Vecchia C. , Parmigiani G. , Edefonti V.
Published: August 2018

Background:

A few papers have considered reproducibility of a posteriori dietary patterns across populations, as well as pattern associations with head and neck cancer risk when multiple populations are available.

Methods:

We used individual-level pooled data from seven case–control studies (3844 cases; 6824 controls) participating in the International Head and Neck Cancer Epidemiology consortium. We simultaneously derived shared and study-specific a posteriori patterns with a novel approach called multi-study factor analysis applied to 23 nutrients. We derived odds ratios (ORs) and 95% confidence intervals (CIs) for cancers of the oral cavity and pharynx combined, and larynx, from logistic regression models.

Results:

We identified three shared patterns that were reproducible across studies (75% variance explained): the Antioxidant vitamins and fiber (OR = 0.57, 95% CI = 0.41, 0.78, highest versus lowest score quintile) and the Fats (OR = 0.80, 95% CI = 0.67, 0.95) patterns were inversely associated with oral and pharyngeal cancer risk. The Animal products and cereals (OR = 1.5, 95% CI = 1.1, 2.1) and the Fats (OR = 1.8, 95% CI = 1.4, 2.3) patterns were positively associated with laryngeal cancer risk, whereas a linear inverse trend in laryngeal cancer risk was evident for the Antioxidant vitamins and fiber pattern. We also identified four additional study-specific patterns, one for each of the four US studies examined. We named them all as Dairy products and breakfast cereals, and two were associated with oral and pharyngeal cancer risk.

Conclusion:

Multi-study factor analysis provides insight into pattern reproducibility and supports previous evidence on cross-country reproducibility of dietary patterns and on their association with head and neck cancer risk. See video abstract at, http://links.lww.com/EDE/B430.
ATYPICAL CONGENITAL HYPERTROPHY OF THE RETINAL PIGMENT EPITHELIUM COMPLICATED BY PRESUMED RETINAL PIGMENT EPITHELIAL ADENOMA AND EXUDATIVE MACULOPATHY
Authors: Mehta Nitish , Gal-Or Orly , Barbazetto Irene , Modi Yasha , Shields Carol L. , Freund K. Bailey
Published: August 2018

Purpose:

To report a retinal pigment epithelium (RPE) tumor with exudative maculopathy, originating from an atypical RPE lesion presumed to represent congenital hypertrophy of the RPE or RPE hyperplasia.

Methods:

Multimodal imaging including fundus autofluorescence, optical coherence tomography, fluorescein angiography, and optical coherence tomography angiography.

Results:

A 76-year-old West African man noted visual acuity reduction to count fingers in the right eye and 20/400 in the left eye. Features of chronic glaucoma were noted. In addition, there was a fairly well-circumscribed darkly pigmented RPE lesion in the paramacular region in the right eye, measuring 4 mm in diameter and flat and consistent with atypical congenital hypertrophy of the RPE or RPE hyperplasia. On the posterior margin of this mass was an RPE tumor, presumed to represent RPE adenoma, producing exudative maculopathy and cystoid macular edema. Multimodal imaging was used to distinguish the RPE tumor from macular neovascularization. A similar atypical congenital hypertrophy of the RPE without retinopathy measuring 3.5mm in diameter was noted in the temporal macular region in the left eye. After six monthly doses of intravitreal bevacizumab (1.25 mg/0.05 mL) in the right eye, the maculopathy resolved and the RPE mass showed partial involution with visual acuity return to baseline 20/200.

Conclusion:

Congenital hypertrophy of the RPE and RPE hyperplasia can produce RPE adenoma with related exudative maculopathy. In this case, the maculopathy responded to bevacizumab.
SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN A CASE OF WHIPLASH MACULOPATHY WITH INCOMPLETE RESOLUTION
Authors: Cappello Ezio , Della Guardia Chiara , Cecchin Elisa , Morselli Simonetta
Published: August 2018

Purpose:

To report spectral domain optical coherence tomography (OCT) findings of a patient who experienced bilateral visual loss after a motorcycle accident.

Methods:

A 51-year-old man presented to the emergency department complaining of bilateral visual loss after a motorcycle falling down. A complete ophthalmologic examination and OCT testing were made on the same day of the accident. Follow-up was made at 2 days, 2 weeks, 5 months, and 12 months adding central visual field assessment using Humphrey automated perimetry.

Results:

At presentation, best-corrected visual acuity was 20/200 in both eyes, anterior segment was normal, and fundus examination showed a bilateral macular edema confirmed by OCT. After 2 days, visual acuity recovered to 20/25. Optical coherence tomography findings showed foveal detachment, hyperreflective clump below external limiting membrane, and hyperreflectivity of Henle layer nasally to the fovea. After 15 days, visual acuity was 20/20, but vision was altered by a paracentral scotoma and some irregularities of OCT findings persisted. At 1 year of follow-up, best-corrected visual acuity was 20/20, and paracentral scotoma was very tiny in the right eye, whereas larger and deeper in the left eye. Optical coherence tomography was normal in the right eye, whereas some fragmentations of interdigitation zone were still evident in the left eye.

Conclusion:

We report a case of bilateral whiplash maculopathy from vitreoretinal traction subsequent to road traffic accident. After 1 year of follow-up, visual acuity was restored but paracentral scotoma persisted. Optical coherence tomography appearance of the left eye was still abnormal.
Visual and Refractive Outcomes After Sub-Bowman Keratomileusis and Transepithelial Photorefractive Keratectomy for Myopia
Authors: Zhang Riping , Sun Lixia , Li Jinyu , Law Antony , Jhanji Vishal , Zhang Mingzhi
Published: August 2018

Purpose:

To compare the visual and refractive outcomes of transepithelial photorefractive keratectomy (Trans-PRK) and sub-Bowman femtosecond-assisted laser in situ keratomileusis (SBK).

Setting:

University hospital.

Design:

Retrospective, comparative study.

Methods:

Two hundred forty patients with myopia and myopic astigmatism underwent SBK (n=157) or Trans-PRK (n=83). The main outcome measures included manifest spherical equivalent refraction (MRSE), logarithm of the minimum angle of resolution uncorrected visual acuity (UCVA), and best-corrected visual acuity (BCVA), which were evaluated at 1 and 3 months postoperatively.

Results:

The preoperative mean MRSE was −4.00±1.2 diopters (D) and −4.05±1.36 D (P=0.76) in Trans-PRK and SBK groups, respectively. There was a significant improvement in UCVA after Trans-PRK (1.29–0.00 at 1 month and −0.05 at 3 months; P<0.001 for both) and SBK (1.25 to −0.04 at 1 month and −0.05 at 3 months; P<0.001 for both). Both UCVA and BCVA were better after SBK compared with Trans-PRK at 1 month (−0.07 vs. −0.03; P<0.001) but not at 3 months (−0.08 vs. −0.07; P=0.223). The patients in Trans-PRK group were significantly more hyperopic compared with those in the SBK group at 1 month (0.11 vs. 0.04; P=0.034) and 3 months (0.11 vs. 0.04; P=0.011) postoperatively. Subgroup analysis showed that patients with myopia >3 diopters were more hyperopic at 1 month postoperatively as compared to patients with myopia of ≤3 diopters.

Conclusions:

Both Trans-PRK and SBK are effective procedures to correct mild to moderate myopia and myopic astigmatism. Patients undergoing SBK experience quick visual recovery. Both procedures had no difference in visual outcomes 3 months postoperatively.
Infrared Video Meibography of Lower Lid Meibomian Glands Shows Easily Distorted Glands: Implications for Longitudinal Assessment of Atrophy or Growth Using Lower Lid Meibography
Authors: Maskin Steven L. , Testa Whitney R.
Published: August 2018

Purpose:

To evaluate measurement reliability of the meibomian gland (MG) tissue area during infrared video meibography (IR-VM) of the lower lid.

Methods:

This is a retrospective analysis, using ImageJ, of IR-VM of 17 lids of 11 consecutive patients (age 56.6 ± 15.9 years; 9 females and 2 males) focusing on the presence of a statistically significant variation of the MG tissue area and the MG tissue area relative to the total measurement field (TMF) secondary to inadvertent lid distortion and/or an altered vertical gaze direction during a single-image acquisition video sequence.

Results:

For lids with distortions, 10 of 10 lids with distortion showed a statistically significant difference (P < 0.0001–0.0136) in the mean individual gland area (MIGA, % change: 16.2%–114.1%) and/or the ratio of MIGA to TMF (% change: 19.8%–108.5%) during its video sequence. For the altered vertical gaze direction, 7 of 9 lids individually showed a statistically significantly increased MIGA/TMF with the globe in primary gaze compared with upgaze (P = 0.001–0.0156), whereas collectively as a group, all 9 lids showed a significant increase in MIGA/TMF (P < 0.0001, % change: 1.1%–38.9%). Two lids from the same patient were evaluated for both types of distortion.

Conclusions:

IR-VM of lower lids revealed statistically significant unreliability of measuring the MG tissue area from inadvertent lid distortion or an altered vertical globe gaze direction during meibography. These data suggest that, lacking context seen when using the video, still-shot nonvideo infrared meibography images of the lower lid, and related data, may be specious and should be used with caution in drawing conclusions of the change in the MG area over time, to avoid misguided clinical decision making.
Incidence and Risk Factors of Dry Eye in a Spanish Adult Population: 11-Year Follow-Up From the Salnés Eye Study
Authors: Millán Alejandro , Viso Eloy , Gude Francisco , Parafita-Fernández Alberto , Moraña Noelia , Rodríguez-Ares María Teresa
Published: August 2018

Purpose:

To estimate the incidence of dry eye (DE) and to evaluate risk factors in an adult cohort in Spain.

Methods:

The Salnés Eye Study (SES) was a cross-sectional population-based study of 654 subjects conducted from 2005 to 2006. After 11 years, 264 individuals (65.8% response rate) participated in SES 2. The incidence cohort consisted of 209 subjects not diagnosed with DE in SES 1 [mean age (SD) 67.6 years (±10.1), range: 51–92, women 69.4%]. DE was defined as the simultaneous presence of symptoms and at least 1 sign. A Schirmer test score ≤5 mm, tear film breakup time ≤10 seconds, rose bengal staining ≥3, and fluorescein staining ≥1 were considered indicative of signs. Poisson regression models were performed to evaluate risk factors.

Results:

The 11-year incidence of DE was 25.4% (95% confidence interval, 19.5–31.3) and that of symptoms was 31.6% (confidence interval, 25.4–37.8). DE incidence was significantly associated with age (P < 0.05). After adjusting for age, secondary or university studies were protective factors for DE; taking anxiolytics or antidepressants and angiotensin-converting enzyme inhibitors increased the risk of symptoms; a history of hypertension, chronic obstructive pulmonary disease, or autoimmune diseases increased the risk of signs.

Conclusions:

The annual incidence of DE, symptoms, and signs, was found to be 2.3 per 100 person-years. The incidence of symptoms was higher than that reported in similar studies. This study suggests that some factors may increase the risk of symptoms, whereas other factors may increase the risk of signs.
Comparison of Intraocular Pressure Changes During the Water Drinking Test Between Different Fluid Volumes in Patients With Primary Open-angle Glaucoma
Authors: Susanna Carolina N. , Susanna Remo , Hatanaka Marcelo , Susanna Bianca N. , Susanna Fernanda N. , De Moraes Carlos G.
Published: August 2018

Purpose:

The main objective of this study was to compare the intraocular pressure (IOP) response during the water drinking test (WDT) performed with 800 mL, 1000 mL, and 10 mL/kg of body weight and to test its relationship with body mass index (BMI).

Methods:

In this prospective, observer-masked, observational study, patients treated with primary open-angle glaucoma were evaluated. In group I, 29 consecutive patients with body weight ≤60 kg underwent an 800 mL fluid challenge followed by a second WDT session with 10 mL/kg of body weight no longer than 4 months apart. Group II included 30 consecutive patients with body weight >60 kg who underwent a 1000 mL fluid challenge followed by an 800 mL test no longer than 4 months apart. IOP was measured before (baseline) and after water ingestion every 15 minutes for 45 minutes.

Results:

In group I, there was no significant difference in baseline or peak IOP between 800 mL and 10 mL/kg of body weight tests (P=0.12 and 0.56, respectively). However, 10 mL/kg tended to lead to consistently lower IOP values and a biased response in eyes with higher IOP. In group II, there was also no significant difference in baseline or peak IOP between 800 and 1000 mL tests (P=0.26 and 0.72, respectively). No biased response was observed in this group. There was no significant association between IOP peak and BMI with 800 mL (P=0.18), 10 mL/kg (P=0.29), or 1000 mL (P=0.34).

Conclusions:

There was overall good agreement between WDT results with different fluid volumes. The response to the volume loads tested in this study was not influenced by the BMI.
Positive 2-Tiered Lyme Disease Serology is Uncommon in Asymptomatic Children Living in Endemic Areas of the United States
Authors: Garro Aris , Bennett Jonathan , Balamuth Fran , Levas Michael N. , Neville Desiree , Branda John C. , Maulden Alexandra B. , Lantos Paul M. , Nigrovic Lise E.
Published: August 2018

Knowing the frequency of positive Lyme disease serology in children without signs of infection facilitates test interpretation. Of 315 asymptomatic children from Lyme disease endemic regions, 32 had positive or equivocal C6 enzyme-linked immunoassays, but only 5 had positive IgG or IgM supplemental immunoblots (1.6%; 95% confidence interval: 0.7%–3.7%).
Frequency of Community-acquired Methicillin-resistant Staphylococcus aureus in Pediatric Population in a General Hospital in São Paulo, Brazil, Over 5 Years
Authors: Penteado Fernando Domingues , Tubero Thais Zenero , Hein Noely , Gilio Alfredo Elias
Published: August 2018

We retrospectively evaluated the frequency of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children at a general hospital in São Paulo, Brazil, from 2011 to 2015. Of 64 patients with confirmed S. aureus infection, 11 (17.2%) had CA-MRSA. CA-MRSA infections in Brazil, and in particular those with a severe presentation, should not be overlooked.
Decreased Prevalence of Rheumatic Heart Disease Confirmed Among HIV-positive Youth
Authors: Hovis Ian W. , Namuyonga Judith , Kisitu Grace P. , Ndagire Emma , Okello Emmy , Longenecker Chris T. , Sanyahumbi Amy , Sable Craig A. , Penny Daniel J. , Lwabi Peter , Kekitiinwa Adeodata R. , Beaton Andrea
Published: August 2018

Background:

There is geographical overlap between areas endemic for rheumatic heart disease (RHD) and those endemic for HIV. A recent pilot study demonstrated that children living with HIV might be at less risk for RHD development; however, the sample size was too small to make definitive conclusions. Our objective was to determine the prevalence of RHD among HIV-positive children in Uganda.

Methods:

We conducted a prospective, cross-sectional study of HIV-positive children (5–15 years of age) receiving care at the Baylor Uganda HIV Clinic, Kampala, Uganda. A focused echocardiogram and chart review was performed. A sample size of 988 children was needed to provide 80% power to detect a difference in population prevalence between HIV-positive children and the general population, 2.97% [95% confidence interval (CI): 2.70–3.24%], based on previous reports.

Results:

Screening echocardiography of 993 HIV-positive children found 15 individuals (1.5%; 95% CI: 0.88%–2.54%) with RHD. Of these 15, 2 were classified as definite RHD and 13 as borderline RHD. The majority of children had isolated mitral valve disease (93%). Children found to have RHD were older than those without RHD, 12 versus 10 years of age (P = 0.004). When separated based on geographic location, the prevalence of RHD among HIV-positive children from Kampala was 1.28% (95% CI: 0.63%–2.51%) compared with 2.1% (95% CI: 0.89%–4.89%) in those from outside Kampala.

Conclusions:

Children living with HIV have a lower prevalence of RHD than the general pediatric population. Further studies are needed to explore this protective association.
Perceived Social Support in Persons With Heart Failure Living With an Implantable Cardioverter Defibrillator
Authors: Allemann Hanna , Strömberg Anna , Thylén Ingela
Published: August 2018

Background:

The links between chronic illness, psychological well-being, and social support have previously been established. Social isolation and loneliness have shown an increased mortality risk for those with heart failure (HF). Increasingly more people with HF are living with an implantable cardioverter defibrillator (ICD), but only a few small-scale studies have focused on social support in this population.

Objective:

The aim of this study was to explore factors related to perceived social support in a large cohort of individuals with HF living with an ICD.

Methods:

All eligible adult ICD recipients in the Swedish ICD registry were invited to participate in this cross-sectional study. For this analysis, those with HF and complete data on perceived social support were included (N = 1550; age, 67.3 (SD, 9.8) years; 19.5% female).

Results:

Most reported a high level of social support, but 18% did not. In logistic regression, living alone was the greatest predictor of low/medium support. Lower social support for those living alone was associated with poorer perceived health status, having symptoms of depression, and experiencing low perceived control. For those living with someone, lower support was associated with female gender, symptoms of depression and anxiety, and less control. Heart failure status and perceived symptom severity were not related to the outcome.

Conclusion:

One in five participants reported low/medium social support. Our study underlines the complex relationships between perceived social support, psychological well-being and perceived control over the heart condition. Multiple aspects need to be taken into account when developing interventions to provide psychosocial support and optimize outcomes in this patient group.
Reduced Levels of Aligned Fibrillar Structure Are Not Associated With Achilles and Patellar Tendon Symptoms
Authors: Docking Sean I. , Girdwood Michael A. , Cook Jill , Fortington Lauren V. , Rio Ebonie
Published: August 2018

Objective:

To investigate whether the mean cross-sectional area (mCSA) of aligned fibrillar structure (AFS) was associated with the presence and severity of symptoms.

Design:

Prospective cohort study.

Participants:

One hundred seventy-five elite male Australian football players completed monthly Oslo Sports Trauma Research Center overuse injury questionnaires for both the Achilles and patellar tendon over the season to ascertain the presence and severity of symptoms. At the start of the preseason, participants underwent ultrasound tissue characterization (UTC) imaging of the Achilles and patellar tendon.

Main Outcome Measures:

Images were classified as normal or abnormal based on gray-scale ultrasound. Based on UTC quantification, the mCSA of AFS was compared between those with and without current symptoms.

Results:

No difference in the mCSA of AFS was observed between those with or without tendon symptoms (P < 0.05). Similar to previous findings, 80% to 92% of abnormal tendons had similar amounts of mCSA of AFS compared with normal tendon. If reduced mCSA of AFS was present, it was not associated with the presence or severity of symptoms.

Conclusions:

The prevalence, development, or severity of symptoms was not associated with decreased levels of AFS in the Achilles or patellar tendon. This suggests that a lack of structural integrity is not linked to symptoms and questions the rationale behind regenerative medicine. Most tendons are able to compensate for areas of disorganization and maintain tissue homeostasis.
Understanding patient-important outcomes after critical illness: a synthesis of recent qualitative, empirical, and consensus-related studies
Authors: Dinglas Victor D. , Faraone Leeza N. , Needham Dale M.
Published: August 2018

Purpose of review

Patients surviving critical illness frequently experience long-lasting morbidities. Consequently, researchers and clinicians are increasingly focused on evaluating and improving survivors’ outcomes after hospital discharge. This review synthesizes recent research aimed at understanding the postdischarge outcomes that patients consider important (i.e., patient-important outcomes) for the purpose of advancing future clinical research in the field.

Recent findings

Across multiple types of studies, patients, family members, researchers, and clinicians have consistently endorsed physical function, cognition, and mental health as important outcomes to evaluate in future research. Aspects of social health, such as return to work and changes in interpersonal relationships, also were noted in some research publications. Informed by these recent studies, an international Delphi consensus process (including patient and caregiver representatives) recommended the following core set of outcomes for use in all studies evaluating acute respiratory failure survivors after hospital discharge: survival, physical function (including muscle/nerve function and pulmonary function), cognition, mental health, health-related quality of life, and pain. The Delphi panel also reached consensus on recommended measurement instruments for some of these core outcomes.

Recent studies have made major advances in understanding patient-important outcomes to help guide future clinical research aimed at improving ICU survivors’ recovery.