bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychopharmacological Treatment Issues in HIV/AIDS Psychiatry
Authors: Cozza Kelly L. , Wynn Gary H. , Wortmann Glenn W. , Williams Scott G. , Rein Rita
Published: June 2017

Attention to pharmacokinetics and pharmacodynamics and an understanding of intended effects, side effects, toxicities, and drug interactions are imperative when treating persons with HIV/AIDS. This chapter includes an essential review of drug interaction principles and an overview of current antiretroviral treatment (ART) and known side effects, toxicities, and drug interactions, in text and table format. The chapter concludes with a presentation of psychotropic-antiretroviral treatment issues. Most psychotropics are effective in the treatment of persons with HIV, but some, particularly the pan-inducing antiepileptics, are best avoided or at least should be very carefully monitored. Recognizing the potential for drug–drug interactions allows for more careful monitoring and for consideration of alternative treatments or precautions. Being a pharmacologically knowledgeable multidisciplinary team member can reduce morbidity and mortality in patients. An understanding of antiretroviral therapy and psychopharmacological treatment issues prevents morbidity, supports adherence to medications, and improves quality of life for persons with HIV.
Hepatitis C and HIV Co-Infection
Authors: Price Jennifer Cohen , Amin Priyanka , Douaihy Antoine
Published: June 2017

Chronic infection with hepatitis C virus (HCV) is a leading cause of end-stage liver disease and is the most common indication for liver transplantation in the United States. Because of shared risk factors, individuals living with HIV infection are disproportionately affected by HCV. Moreover, co-infection with HIV accelerates the natural history of chronic HCV infection, increasing the risk of cirrhosis, hepatocellular carcinoma, hepatic decompensation, and death. Highly effective medications such as direct-acting antivirals (DAA) to cure HCV are now available and have the potential to profoundly improve the health of HIV-HCV-co-infected individuals. However, addressing the many gaps in the HCV care cascade is necessary to fully achieve the benefits of these drugs. This chapter reviews the natural history of HIV-HCV co-infection, the psychiatric comorbidities associated with HCV infection, the evolution of HCV treatment, and the barriers to care that HIV-HCV-co-infected individuals continue to face.
Endocrine Comorbidities in Persons with HIV
Authors: Soffer Jocelyn , Goforth Harold W.
Published: June 2017

A wide range of endocrine abnormalities commonly accompany and complicate HIV infection, many of which have implications for psychiatrists and other mental health professionals working with this population. Such abnormalities include adrenal insufficiency, hypercortisolism, hyperthyroidism, hypothyroidism, hypogonadism, decreased bone mineral density, and bone disease. Endocrinopathies are great mimickers of psychiatric disorders, manifesting in some cases as disturbances of mood, sleep, appetite, thought process, energy level, or general sense of well-being. Understanding the intricate and complex relationships between immunological, endocrinological, and psychological systems is important to improve recognition and treatment of reversible endocrinopathies, diminish suffering, and enhance quality of life and longevity in persons with HIV and AIDS. This chapter will present an overview of HIV-associated changes in the function of the hypothalamic–pituitary axes, adrenal glands, thyroid gland, gonads, and bone and mineral metabolism, and consider the psychosocial implications of such endocrinopathies.
Overview of HIV-Associated Multimorbidities
Authors: Pereira Luis F. , Bradley Mark , Goforth Harold W. , Alfonso César A. , Lux Joseph Z. , Martínez Esteban , Mullen Michael P.
Published: June 2017

With the advent of effective antiretroviral therapy, persons with access to and engagement in HIV medical care and antiretroviral therapy can live longer and remain healthy with what has become a chronic manageable illness. Despite advances in medical care, without access to HIV medical care and antiretroviral therapy or with access but without viral suppression, persons with HIV still experience opportunistic infections and cancers. This chapter reviews the HIV-associated multimorbidities, including pulmonary manifestations, ophthalmological complications, dermatological manifestations, gastrointestinal and hematological illnesses, as well as HIV-associated malignancies. The proposed mechanisms through which HIV may contribute to premature aging are also discussed.
Health Services and Policy Issues in AIDS Psychiatry
Authors: Walkup James T. , Crystal Stephen
Published: June 2017

Health services research is a practically focused discipline drawing on the social and behavioral sciences and concerned with the organization, financing, and delivery of services. Investigators studying HIV services examine how well healthcare and other systems meet needs, eliminate disparities, integrate services, eliminate barriers, and provide care to socially marginal and stigmatized individuals, such as injection drug users and people who are incarcerated. These issues have been important from the earliest days of the HIV epidemic and have taken on increased significance as efficacious treatments have been developed and, more recently, changes in the financing of care have reduced the number of uninsured. This chapter this focuses primarily on research in the United States with a review of recent work on financing, service fragmentation, and difficulties integrating different sectors of care, as well as problems related to the functioning of medicine in a complex, stratified society. Also addressed are certain general features of the Affordable Care Act that are relevant to HIV care and psychiatry.
Nature
Authors: Troisi Alfonso
Published: June 2017

Referring to “natural behaviors” or “behaviors against nature” is common not only in the media but also in different professional fields dealing with human conduct. However, many assumptions about human nature that are taken for granted in social and human sciences are wrong when evaluated in light of recent discoveries in evolutionary behavioral biology. The aim of this chapter is to set the framework for an evolutionary analysis of the human mind and behavior and to summarize current knowledge on the evolution of Homo sapiens. Basic concepts of evolutionary biology (e.g., adaptation, ultimate versus proximate causation, genetic mismatch) are briefly explained, and their implications for a correct discussion of human nature are illustrated. The take-home message of the chapter is that a full understanding of the human mind and human behavior requires the integration of social and biological sciences, abandoning false dichotomies such as nature versus culture or instinct versus learning. This is a necessary step toward the practical implementation of ethical and legal systems more respectful of individual proclivities.
Pleasure
Authors: Troisi Alfonso
Published: June 2017

Contemporary neurobiological research has greatly improved our understanding of brain mechanisms that regulate hedonic response and the environmental stimuli that trigger physical and mental pleasure. However, to explain what purpose pleasure serves, we need to look at the problem from the perspective of evolutionary biology. Focusing on a specific type of pleasure, sexual pleasure, this chapter introduces several evolutionary studies that show how the variation in pleasurable experiences becomes understandable when hedonic capacity is viewed as an inner navigator that evolved to guide individuals toward the most adaptive behavioral choices. As a case in point, the alternative hypotheses that have been advanced to explain the evolution of female orgasm (the adaptive versus the byproduct hypothesis) are discussed. The findings of recent studies exploring the complexity of human sexual response and the striking sex differences that distinguish male and female responses to sexual stimuli are also presented.
Detachment
Authors: Troisi Alfonso
Published: June 2017

Most of us find social encounters rewarding, especially when we encounter those with whom we are familiar and have built up a relationship. From an evolutionary point of view, this is not surprising; human beings are fundamentally social organisms, and human development and functioning occur within a social context. The origin of individual differences in the capacity to experience social reward is likely to involve a complex interplay of genetic and environmental variables, including genetic variation, early experience and current situational factors. A few individuals seem to lie at the lower extreme of this continuum, experiencing little or no positive feelings during affiliative interactions. This chapter deals with the psychological and behavioral traits that characterize these uncommon individuals and reviews the mechanisms likely to cause their emotional detachment. The chapter then discusses the importance of aversive early experience in promoting an avoidant style of adult attachment and the role of the brain opioid system and genetic polymorphisms in mediating diminished hedonic response to affiliative interactions.
Possessiveness
Authors: Troisi Alfonso
Published: June 2017

The opposite of detachment is possessiveness, which generally reflects a personality profile characterized by anxious attachment. This chapter describes the psychological and behavioral traits that characterize people with anxious attachment and discusses two clinical conditions related to abnormal levels of possessiveness: child abuse and pathological jealousy. The discussion of these two conditions is based on very different databases. Whereas descriptions and explanations of pathological jealousy are based on psychiatric literature, the analysis of child abuse consists of a synopsis of studies of spontaneous cases of maternal abuse of offspring in monkeys, including the successful pharmacological treatment of abusive mothers. Also recounted is the author’s correspondence with John Bowlby regarding interpretation of the observations in monkeys. The chapter closes with a brief discussion of the psychological mechanisms that motivate normal jealousy in intimate relationships and of gender differences in jealousy, along with evolutionary explanations for such differences.
Nonverbal Communication
Authors: Troisi Alfonso
Published: June 2017

Humans use two different means to exchange information: language and nonverbal communication. Often nonverbal signals emphasize and specify what is being said with words. Yet sometimes they collide, and the words are contradicted by what seeps through facial expression, gesture, and posture. This chapter discusses two theoretical frameworks for studying these nonverbal behaviors. The first approach (the emotional model) aims at unveiling the emotional state from facial expression and gesture. The second approach (the behavioral ecology model) analyzes the social meaning of nonverbal behavior, regardless of the emotional state of the sender of nonverbal signals. The two models are not incompatible and can be integrated to study nonverbal behavior. Yet, the behavioral ecology model explains some findings that are not accounted for by the emotional model. The final part of the chapter deals with neuropsychiatric conditions, such as Williams syndrome and prosopagnosia, that alter the encoding and decoding of nonverbal signals. The impact of these conditions on real-life social behavior can be dramatic, which shows the adaptive relevance of nonverbal communication.
Touch
Authors: Troisi Alfonso
Published: June 2017

This chapter briefly reviews recent empirical research on touch, including the role of touch in early development, emotions that can be conveyed by touch, the importance of touch for interpersonal relationships, and how friendly touch affects compliance in different situations. Physiological and biochemical effects of touch are also reviewed, including decreased heart rate, blood pressure and cortisol, and increased oxytocin. The beneficial effects of touch, including massage therapy, for socioemotional and physical well-being are explained in light of the importance of mother–infant contact in all primate species. To develop normally, primate infants and human babies need much physical contact with their mothers; touch deprivation is one of the most pathogenic condition for a young primate. The second part of the chapter analyzes how cultural evolution has elaborated the natural predisposition toward affiliative touch, creating complex rituals and specific taboos. Finally, the chapter briefly discusses “displacement activities” that consist mostly of movements focused on one’s own body, such as self-touching, scratching, and self-grooming.
Authority
Authors: Troisi Alfonso
Published: June 2017

Evolving organisms must balance the need to change at an appropriate rate in response to varying environmental conditions against the need to maintain a functioning phenotype. This trade-off between conservatism and adaptability, between stability and exploration, has an interesting analogue at the social and cultural level. On the one hand, humans are characterized by an extreme dependence on culturally transmitted information, and deference to the group norm is the average individual behavior in human societies. On the other hand, innovation and openness to experience are distinctive features of cultural revolutions. This chapter focuses on the biology of conformity and innovation, discussing a variety of related topics, including personality changes with aging, the neural bases of divergent thinking, the positive effects of conservatism on intragroup cohesion, and the link between creativity and psychosis.
Nepotism
Authors: Troisi Alfonso
Published: June 2017

Nepotism is a social habit that is commonly condemned because it threatens our confidence in meritocracy and offends our sense of fair play. Yet, nepotism has been a common practice in different cultures throughout ancient, modern, and contemporary history. This chapter explores the biological bases of this powerful human inclination to help one’s own and to introduce the reader to those evolutionary theories that account for nepotistic behaviors: kin selection and reciprocal altruism. The chapter briefly reviews the physiological and psychological mechanisms that allow kin recognition and the cultural means that have been developed by human societies to expand the definition of kinship to include nongenetic relatives. The concluding reflection of the chapter is that nepotism was a driving force in human evolution but, in contemporary large-scale societies, its practice can have disrupting effects because it is incompatible with individual rights.
Goodness
Authors: Troisi Alfonso
Published: June 2017

Are we naturally good or bad? This chapter addresses the long-standing question by applying the fresh perspective of evolutionary behavioral biology and introducing the reader to the biological concept of ethical discrimination. From an evolutionary perspective, we are usually good with “us” and usually bad with “them,” whereby us and them are colloquial terms to indicate different degrees of genetic relatedness. With the evolution of complex social structures, genetic relatedness has progressively expanded to include ethnic bonds and common ideological and cultural values. The chapter then reviews the evolution of moral systems, analyzes recent findings from neuroscience on the neural bases of moral behaviors, and illustrates the complex psychological adaptations that have evolved to inform moral choices, including the crucial role of social emotions such as shame, guilt, pride, and empathy. The final section of the chapter faces a problem that many evolutionary scientists have found to be an embarrassment: the cultural evolution of moral and religious systems that have progressively reduced the discriminative limits of goodness, cancelling any distinction between “us” and “them.”
Disease Dynamics of Sclerotinia sclerotiorum on Stevia in North Carolina
Authors: Koehler Alyssa M. , Shew H. David
Published: June 2017

Stevia is a perennial plant being introduced as a new crop to the United States. In 2014-2016, ascospore trapping was conducted to better understand the disease cycle of Sclerotinia sclerotiorum on stevia. In 2016, individual plants were flagged and monitored to quantify symptomatic stems and disease progression.
Recurrent Patellar Instability: Implications of Preoperative Patellar Crepitation on the Status of the Patellofemoral Articular Cartilage
Authors: Luhmann Scott J. , Smith June C. , Schootman Mario , Prasad Nandan
Published: June 2017

Background:

The purpose of the study was to quantify the frequency, severity, and location of patellofemoral (PF) articular cartilage changes recurrent patellar instability treated surgically in patients with preoperative clinical patellar crepitation.

Methods:

A single-surgeon database was queried for all knees with recurrent patellar instability between 3/2000 and 6/2012 (n=214). Only knees which underwent knee arthroscopy during the surgical treatment were included (n=148). PF articular cartilage condition was assessed arthroscopically.

Results:

There were 148 knees in 130 patients (mean age, 16 y), which met inclusion criteria. There were 93 females and 37 males. Diagnoses were dislocations [122 (82.4%)] and subluxations (26). Preoperatively 28 knees (18.9%) had PF crepitation. Statistical analysis demonstrated preoperative PF crepitation was correlated with medial patellar facet lesions (P=0.0022) and were 3.6 times more likely to have medial patellar facet lesions. Crepitation was correlated with the higher outerbridge (OB) patellar grades (P<0.0001) and larger patellar lesion size (P=0.0021). At arthroscopy 89 knees (60.5%) had patellar articular cartilage damage with a mean OB grade of 1.3 (0 to 4) and mean size of 93.2 mm2 (0 to 750). The femoral articular cartilage was identified in 29 knees (19.7%) with a mean OB grade of 0.44 (0 to 4).

Conclusions:

PF articular damage was present in 63% of knees, which were surgically treated for patellar instability. The patella was involved in 61% (mean, 129 mm2) and femoral trochlea in 20% (mean 166 mm2) of knees. Knee with preoperative PF crepitation (20% of cohort) more commonly had medial patellar facet lesions with higher OB grades, and larger patellar lesion size than knees without preoperative crepitation. Because of the high frequency of patellar (83%) and femoral (36%) articular damage documented at the time of surgical reconstruction, visualization of the PF joint is recommended when knees have preoperative PF crepitation.

Level of Evidence:

Level IV.
Transcranial Motor Evoked Potential Alarm Criteria to Predict Foot Drop Injury During Lumbosacral Surgery
Authors: Tamkus Arvydas , Rice Kent S. , Hoffman Gregory
Published: June 2017

Study Design.

A retrospective cohort analysis.

Objective.

This study aims to investigate whether waveform alterations in transcranial motor evoked potentials (TCMEPs) can reliably predict postoperative foot drop.

Summary of Background Data.

Nerve injury leading to foot drop is a potential complication of lumbosacral surgery. Very limited data exist on the use of intraoperative TCMEPs to identify iatrogenic foot drop.

Methods.

We retrospectively reviewed neuromonitoring data from 130 consecutive spine surgeries with instrumentation involving L4-S1. TCMEP waveform analysis included amplitude (A), area under the curve (AUC), latency (L), and duration (D). Patient outcomes were correlated with neuromonitoring results. Intraoperative alert criteria were established on the basis of observed intraoperative changes.

Results.

Three patients developed severe foot drop with a muscle weakness functional grade ranging from 0/5 to 3/5. Two patients developed a mild foot drop with functional grade 4/5. Twenty-three patients had preoperative weakness in an L5 distribution. One-hundred two patients who had neither preoperative nor postoperative neurological complications served as a control group. Amplitude significantly decreased in patients with a severe postoperative deficit (P = 0.005) as did AUC and duration (P < 0.05). Intraoperative alert criteria defined as a >65% decrease in AUC resulted in a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%, 91.4%, 12%, and 100%, respectively. When defining an alert criteria as a >50% decrease in amplitude, sensitivity, specificity, PPV, and NPV were 100%, 87.9%, 8.8%, and 100%, respectively.

Conclusion.

Reduction of TCMEP waveform associated with postoperative severe foot drop can be detected during lumbar surgery. Other waveform parameters such as AUC may predict foot drop better than the amplitude. Additional examinations in larger samples of foot drops are needed to validate these alert threshold findings.

Level of Evidence: 4
Three-Dimensional Topography of the Supratrochlear Nerve With Reference to the Lacrimal Caruncle, and Its Danger Zone in Asians
Authors: Gil Young-Chun , Lee Shin-Hyo , Shin Kang-Jae , Song Wu-Chul , Koh Ki-Seok , Shin Hyun Jin
Published: June 2017

BACKGROUND

The supratrochlear nerve (STN) is relatively superficial and therefore vulnerable to iatrogenic injury.

OBJECTIVE

To elucidate the course of STN with reference to the lacrimal caruncle, with the aim of preventing nerve injury during surgery in the forehead region.

MATERIALS AND METHODS

Thirty-four hemifaces from 18 Korean cadavers were dissected. The vertical line through the apex of lacrimal caruncle and the horizontal line through the supraorbital margin were used as horizontal and vertical reference lines, respectively. The course of STN in the frontal view and the point at which it pierced the overlaying musculature were examined.

RESULTS

After exiting the corrugator muscle cushion, the STN enters the subcutaneous plane by piercing the frontalis muscle. These piercing points occurred at mean horizontal and vertical distances relative to the medial branch of the STN of 9.2 and 9.6 mm, respectively; the corresponding distances for the lateral branch of the STN were 1.1 and 15.3 mm, respectively.

CONCLUSION

When performing surgery in the medial forehead region, the surgeon must ensure that the dissection plane of forehead tissue is more superficial: superiorly within 1.5 cm from the supraorbital margin and medially within 1.0 cm from the vertical line through the apex of lacrimal caruncle.
Drug-induced metabolic acidosis
Authors: Holt Christopher T. , Hitchings Andrew W.
Published: June 2017

Drug causes of metabolic acidosis are numerous and their mechanisms are diverse. Broadly, they can cause metabolic acidosis with either a normal anion gap (e.g. drug-induced renal tubular acidosis) or an elevated anion gap (e.g. drug-induced lactic acidosis or pyroglutamic acidosis). This review describes the drugs that can cause or contribute to metabolic acidosis during therapeutic use, the mechanisms by which this occurs, and how they may be identified in practice.
TIME COURSE OF CHANGES IN METAMORPHOPSIA FOLLOWING INTRAVITREAL RANIBIZUMAB INJECTION FOR BRANCH RETINAL VEIN OCCLUSION
Authors: Sugiura Yoshimi , Okamoto Fumiki , Morikawa Shohei , Okamoto Yoshifumi , Hiraoka Takahiro , Oshika Tetsuro
Published: June 2017

Purpose:

To evaluate the effects of intravitreal ranibizumab injection (IVR) on metamorphopsia in patients with branch retinal vein occlusion (BRVO) and to assess the relationship between retinal microstructure and metamorphopsia.

Methods:

Subjects were 39 eyes of 39 patients with branch retinal vein occlusion. The severity of metamorphopsia was quantified using the M-CHARTS before and 1, 2, 3, 4, 5, and 6 months after treatment. Based on optical coherence tomography (OCT) images, we assessed central retinal thickness (CRT) and status of the external limiting membrane (ELM) and ellipsoid zone (EZ). The association between retinal microstructure and metamorphopsia was analyzed in 24 eyes with treatment-naïve branch retinal vein occlusion.

Results:

Intravitreal ranibizumab injection treatment significantly improved best-corrected visual acuity (BCVA) and central retinal thickness (P < 0.0001, P < 0.0001, respectively), but metamorphopsia did not improve by treatment. Posttreatment metamorphopsia scores showed a significant correlation with duration of symptoms (P < 0.05) and pretreatment metamorphopsia scores (P < 0.01). Posttreatment metamorphopsia score was significantly worse in patients with disruption of external limiting membrane (P < 0.05).

Conclusions:

In patients with branch retinal vein occlusion, intravitreal ranibizumab injection treatment significantly improved best-corrected visual acuity and central retinal thickness, but not metamorphopsia. The severity of posttreatment metamorphopsia was significantly associated with duration of symptoms, degree of pretreatment metamorphopsia, and posttreatment integrity of external limiting membrane.
MULTIPLE EVANESCENT WHITE DOT SYNDROME WITH SUBRETINAL DEPOSITS
Authors: Gal-Or Orly , Sorenson John A. , Gattoussi Sarra , Dolz-Marco Rosa , Freund K. Bailey
Published: June 2017

Purpose:

To describe the multimodal imaging findings of transient subretinal deposits occurring in multiple evanescent white dot syndrome (MEWDS).

Methods:

The multimodal imaging characteristics of transient subretinal deposits occurring in MEWDS were investigated with ultra-widefield color and fundus autofluorescence, cross-sectional and en-face optical coherence tomography (OCT), en face OCT-angiography, and quantitative autofluorescence.

Results:

A 28-year-old woman presented with photopsia and temporal visual field loss in her right eye. Her best-corrected visual acuity was 20/20 in her right eye and 20/25 in her left eye. Funduscopic examination showed characteristic peripapillary hyperautofluorescent white dots of MEWDS corresponding to ellipsoid zone disruption on OCT. These lesions became confluent throughout the posterior fundus over the next 4 weeks. As the patient's symptoms were resolving, a second type of transient hyperautofluorescent lesion was noted which corresponded to hyperreflective subretinal deposits on cross-sectional and en face structural OCT. These subretinal deposits were most evident at 10-week follow-up and had nearly resolved at 14-week follow-up. Quantitative autofluorescence showed that, unlike the acute MEWDS lesions, the hyperautoflurescence of the subretinal deposits persisted after photobleaching. At multiple time points over 14 weeks of follow-up, OCT angiography showed no evidence of retinal or choroidal flow abnormalities.

Conclusion:

Transient subretinal deposits may develop during MEWDS in areas of previous diffuse outer retinal disruption. As these deposits remain hyperautoflurescent on quantitative autofluorescence after photobleaching, they may represent accumulations of debris originating from damaged photoreceptor outer segments.
Further Analysis of the Predictability of Corneal Endothelial Cell Density Estimates When Polymegethism Is Present
Authors: Doughty Michael J.
Published: June 2017

Purpose:

To assess variability in endothelial cell density (ECD) estimates when polymegethism (variance in cell areas) is present.

Methods:

Using noncontact specular microscope images of the corneal endothelium, 4 sets of 20 cases were selected, which included 200 cells and had coefficient of variation values of less than 30% (group 1), 31%–40% (group 2), 41%–50% (group 3), and over 50% (group 4). A stepwise analysis was undertaken, 20 cells at a time, of the ECD estimates when using different numbers of cells for the calculations.

Results:

The net differences in ECD estimates when comparing sets of 20 cells with 200 cells were 5.0% ± 3.9%, 8.1% ± 7.3%, 11.3% ± 9.4%, and 14.5% ± 12.4% for groups 1 to 4, respectively. For measures on 100 cells per image, the predicted variances in ECD values were 5.6%, 8.8%, 11.1%, and 13.7% for the 4 groups.

Conclusions:

Higher values of corneal endothelial polymegethism result in predictable increases in the variability (uncertainty) in ECD estimates, thus reducing the “accuracy” of ECD values. There is no obvious utility in assessing more than 100 cells in such endothelia.
Superficial Automated Keratopigmentation for Iris and Pupil Simulation Using Micronized Mineral Pigments and a New Puncturing Device: Experimental Study
Authors: Rodriguez Alejandra E. , Amesty Maria A. , El Bahrawy Mohammed , Rey Severino , Alio del Barrio Jorge , Alio Jorge L.
Published: June 2017

Purpose:

To study the outcomes and tolerance of micronized mineral pigments for corneal tattooing, using a superficial automated keratopigmentation (SAK) technique in an experimental animal model and a new puncture device to inject the pigments into the corneal stroma.

Methods:

Forty eyes of 40 New Zealand rabbits were included in this study. The animals were divided into groups A and B. Both groups underwent SAK using a new automated keratopigmentation device. Micronized mineral pigments were injected through the epithelium into the corneal stroma to replicate the iris color in 25 eyes (group A), and black color was used to replicate the pupil in 15 eyes (group B). Slit-lamp examination was performed to evaluate the outcome. Histopathological examination was also performed to ascertain the presence of pigment dispersion, inflammation, and/or neovascularization.

Results:

All 40 eyes showed good cosmetic appearance after keratopigmentation. No intraoperative complications were detected. At the first week, mild or moderated conjunctival injection was observed in 13 eyes and transitory corneal epithelial defects were also detected in 27 eyes. Examination was unremarkable 2, 4, and 6 months after surgery. No neovascularization was detected in any case in the histopathology study.

Conclusions:

SAK using a new automated puncture device and micronized mineral pigments achieved good cosmetic outcomes for iris and pupil simulation. This method could be a valid alternative to treat serious cosmetic eye problems that affect the superficial cornea or functional problems, such as photophobia or diplopia secondary to iris defects or trauma.
Regression of Inflamed Pterygia by Frequent High-Dose Intralesional Ziv-Aflibercept
Authors: Mansour Ahmad M.
Published: June 2017

Purpose:

Intralesional single low-dose vascular endothelial growth factor antagonists have traditionally failed in causing regression of pterygia. The current pilot study investigates the role of high-dose repeated intralesional ziv-aflibercept in causing regression of inflamed or recurring pterygia.

Methods:

This prospective study from January 2015 to April 2017 consisted of using high dose of ziv-aflibercept between 0.1 mL (2.5 mg) and 0.3 mL (7.5 mg), depending on the pterygium size and the degree of inflammation. The injection was deep after tunneling the 30-gauge needle away from the injection site to avoid reflux. Reinjection was done at the first sign of recurrence of inflammation. The main outcome measure was regression of pterygial vessels by central retraction as documented by slit-lamp photography and anterior optical coherence tomography.

Results:

Four subjects, one with bilateral pterygia, were treated. Regression of new vessels and retraction of the leading edge of pterygial vessels occurred in all treated eyes (5 eyes) with dramatic visual gain in 1 eye from counting fingers to 6/9 (20/30). Numbers of injections were 9 (1 eye; 18 mo), 3 (2 eyes; 12 and 18 mo), and 1 (2 eyes; 2.5 and 7 mo).

Conclusions:

Frequent high-dose intralesional ziv-aflibercept can lead to regression and/or retraction of inflamed pterygia in this pilot study.

Clinical Trial Registration:

https://clinicaltrials.gov, NCT02486484.
Effect of Uterine Fundal Pressure on Maternal Intraocular Pressure in Cesarean Delivery: Comparison of Regional and General Anesthesia
Authors: Kurtay Aysun , Ozayar Esra , Gulec Handan , Yildiz Gokhan , Turkyilmaz Esra , Yildiz Zennure , Horasanli Eyup
Published: June 2017

Purpose:

To evaluate the intraocular pressure (IOP) changes accompanying fundal pressure during a cesarean-section procedure under both regional and general anesthesia.

Methods:

In total, 60 women scheduled for elective cesarean section, none of them diagnosed with ocular problems, were enrolled in the study. Patients underwent cesarean section under either general (group G, n=30) or regional anesthesia (group S, n=30) according to their choice. IOP was measured with a Tono-Pen before (T1) and after (T2) application of anesthesia, during fundal pressure (T3), and after the birth of the baby (T4). Heart rate as well as systolic, diastolic, and mean arterial pressure were recorded during the procedure.

Results:

There was no significant difference in IOP between the groups (P>0.05). In group S, IOP at T3 was significantly higher than at all other timepoints (P<0.001). In group G, IOP at T3 was significantly higher than at T2 and T4. Mean arterial pressure was significantly lower in group S at all timepoints except T1.

Conclusions:

In conclusion, fundal pressure may significantly increase the IOP, but the choice of anesthetic technique may not have any effect on IOP.
Success Rate of Variable Collar Size Frosted Jones Tubes
Authors: Perry C. Blake , Dailey Roger A.
Published: June 2017

Purpose:

To describe success rates and long-term outcomes of conjunctivodacryocystorhinostomy (CDCR) with larger collar (4.5 or 5.0 mm) frosted Jones tubes (FJTs).

Methods:

A retrospective chart review of all patients who received a larger collar (4.5 or 5.0 mm) FJT following CDCR by an author (RAD) was performed between January 1, 2010 and July 1, 2016. Patient demographics, etiology of tearing, follow-up time from placement of larger collar FJT, original tube collar diameter, number and sizes of collar adjustments, tearing status, and complications were recorded. Exclusion criteria included follow up less than 6 months after placement of a larger collar FJT. The study was IRB approved, HIPAA compliant, and adherent to the Declaration of Helsinki.

Results:

Twenty-five patients (29 eyes) met the inclusion criteria. Average follow-up time was 30 months. Twenty-eight out of 29 eyes had complete resolution of tearing after placement of larger collar FJT and no tubes were lost. Fourteen out of 29 eyes required adjustment in collar size after a larger collar was placed. Two out of 13 eyes that had a 5.0 mm collar placed required exchanged due to collar prominence.

Conclusion:

With the use of larger collar FJTs, the long-term success of CDCR in tearing patients remains highly effective. This study demonstrates larger collar FJTs are well tolerated and help reduce the chance of tube loss.
Exophytic Osteochondroma of the Brow
Authors: Jakobiec Frederick A. , Zakka Fouad R. , Lee Nahyoung Grace
Published: June 2017

Most bony and cartilaginous lesions of the orbit and periorbital compartments are benign, grow endophytically, and are composed of dense lamellar bone (eburnated or ivory osteomas). An 87-year-old woman had a well-circumscribed, firm, round, and exophytic lesion of the brow region for at least 15 years. Excisional surgery disclosed an osteocartilaginous lesion with an enveloping pseudocapsule (periosteum/perichondrium) and a narrow stalk connecting it to the frontal bone. The periphery of the lesion displayed lamellar bone which appeared to be replacing a central cartilaginous zone. The adjacent deep preaponeurotic fat displayed nodules of collagen with myxoid change and occasional CD34+ spindle cells suggestive of a spindle cell lipoma. Because of the osteochondroma’s deep location in the preaponeurotic fat, the lesion differs from an osteoma cutis found in the dermis which fails to exhibit a cartilaginous component or a periosteum. Other clinically simulating lesions are described.
Coordinating Care Across Health Care Systems for Veterans With Gynecologic Malignancies
Authors: Zuchowski Jessica L. , Chrystal Joya G. , Hamilton Alison B. , Patton Elizabeth W. , Zephyrin Laurie C. , Yano Elizabeth M. , Cordasco Kristina M.
Published: June 2017

Background:

Veterans concurrently using both Veterans Affairs (VA) and community providers and facilities have increased coordination needs related to bridging their care across health care settings. Women Veterans commonly require a combination of VA and community care if they have women-specific specialty care needs, such as gynecologic malignancies.

Objectives:

We assessed VA women’s health providers’ and administrators’ perceptions of coordination challenges for Veterans’ gynecologic cancer care, and potential approaches for addressing these challenges.

Research Design and Participants:

We carried out semistructured qualitative interviews with field-based key informants (VA gynecologists, women’s health medical directors, and other staff directly involved in women’s health care coordination) at 15 VA facilities. Transcripts were summarized in a template to capture key points. Themes were identified and iteratively revised (inductively/deductively) via a collaborative decision-making process utilizing matrices to compare content across interviews.

Results:

Key informants (n=23) noted that services for patients with gynecologic cancers are provided through a combination of VA and community care with wide variation in care arrangements by facility. Care coordination challenges included care fragmentation, lack of role clarity and care tracking, and difficulties associated with VA and community provider communication, patient communication, patient records exchange, and authorizations. Care coordination roles suggested for addressing challenges included: care tracker, provider point-of-contact, patient liaison, and records administrator.

Conclusions:

Experiences in coordinating care for women Veterans with gynecologic malignancies receiving concurrent VA and community cancer care reveal challenges inherent in delivering care across health care systems, as well as potential approaches for addressing them.
Using Self-reports or Claims to Assess Disease Prevalence
Authors: St. Clair Patricia , Gaudette Étienne , Zhao Henu , Tysinger Bryan , Seyedin Roxanna , Goldman Dana P.
Published: June 2017

Background:

Two common ways of measuring disease prevalence include: (1) using self-reported disease diagnosis from survey responses; and (2) using disease-specific diagnosis codes found in administrative data. Because they do not suffer from self-report biases, claims are often assumed to be more objective. However, it is not clear that claims always produce better prevalence estimates.

Objective:

Conduct an assessment of discrepancies between self-report and claims-based measures for 2 diseases in the US elderly to investigate definition, selection, and measurement error issues which may help explain divergence between claims and self-report estimates of prevalence.

Data:

Self-reported data from 3 sources are included: the Health and Retirement Study, the Medicare Current Beneficiary Survey, and the National Health and Nutrition Examination Survey. Claims-based disease measurements are provided from Medicare claims linked to Health and Retirement Study and Medicare Current Beneficiary Survey participants, comprehensive claims data from a 20% random sample of Medicare enrollees, and private health insurance claims from Humana Inc.

Methods:

Prevalence of diagnosed disease in the US elderly are computed and compared across sources. Two medical conditions are considered: diabetes and heart attack.

Results:

Comparisons of diagnosed diabetes and heart attack prevalence show similar trends by source, but claims differ from self-reports with regard to levels. Selection into insurance plans, disease definitions, and the reference period used by algorithms are identified as sources contributing to differences.

Conclusions:

Claims and self-reports both have strengths and weaknesses, which researchers need to consider when interpreting estimates of prevalence from these 2 sources.
The Almost-Normal Liver Biopsy
Authors: Czeczok Thomas W. , Van Arnam John S. , Wood Laura D. , Torbenson Michael S. , Mounajjed Taofic
Published: June 2017

Liver biopsies obtained for abnormal liver enzymes or unexplained ascites occasionally appear histologically almost normal. The differential diagnosis for these cases is challenging because literature addressing this topic is lacking. We aimed to establish a differential diagnosis and determine clinical associations and outcomes for almost-normal liver biopsies. Ninety-seven histologically almost-normal liver biopsies were collected from 2 institutions. All cases lacked significant inflammation, fatty change, biliary tract disease, vascular disease, nodular regenerative hyperplasia, iron overload, inherited metabolic or storage disorder, viral hepatitis, or fibrosis. Biopsies for follow-up of known liver diseases were excluded. Transplant biopsies, lesion-directed biopsies, biopsies obtained during bariatric surgery, liver donor biopsies, and biopsies to evaluate methotrexate toxicity were excluded. Clinical (including follow-up) and laboratory data were collected. The frequency of almost-normal liver biopsies was 0.6% and 3.7% at the 2 institutions. The most common biopsy indications were elevated liver biochemistries or clinical findings that suggested portal hypertension. In 70 patients (72%), an associated clinical abnormality was identified; the most common were autoimmune systemic inflammatory conditions (18%), vascular/ischemic events (13%), metabolic syndrome (11%), drug effects (8%), and inflammatory conditions of the gastrointestinal tract (7%). The median follow-up period was 4.3 years (range=0 to 10 y); detailed clinical follow-up was available for 66 patients (68%). Liver biochemistries normalized in 32 patients (48.5%) and remained elevated in 34 (51.5%). Seven patients (7.2%) eventually developed chronic liver disease (autoimmune hepatitis [n=3], primary biliary cirrhosis [n=3], cryptogenic cirrhosis [n=1]). This multicenter study determines the differential diagnosis for almost-normal liver biopsies; this will guide pathologists in subsequent workup efforts in these challenging cases.
The Advantage of Discordance
Authors: Dalton Leslie W. , Gerds Thomas A.
Published: June 2017

Discordance among multiple assessments has been a reason to criticize a biomarker. But, if different assessments are all relevant, the meaning of discordance requires explanation. As an example, for 1085 breast cancers, a low (score 1), intermediate (score 2) or high nuclear grade (NG) (score 3) was assigned in years 2013, 2015, 2016. Year apart readings allowed for memory lapse of prior readings. For each cancer, scores for NG2013, NG2015, NG2016 were added together to yield sum score nuclear grade (SSNG) with range 3 to 9. SSNG was used to find if discrepancy between NG readings carried information for patient outcome. Discrepancies were inherent with SSNG=4, 5, 7 or 8. Time-dependent receiver operator curves were central for evaluating discordance as related to patient outcome. Area under curves for SSNG, and the component NGs, in stage 1, stage 2, and stage 3 cancers were, respectively: SSNG: 70, 68, 75; NG2013: 70, 63, 71; NG2015: 67, 65, 74; and NG2016: 65, 66, 68. The area under curves of SSNG was not significantly lower than any of the components from which it was derived. This is despite discordant readings having been incorporated into SSNG. Among the 3 readings, 50.1% were discordant, yet only 2.1% were low/high discrepancy. Concordance in high-grade assignment (SSNG=9) corresponded to poor prognosis. If morphologic features are midway between 2 predefined levels it is sensible that separate readings will be distributed between adjacent levels. Shown has been how an “in-between” level helps predict survival then discordance discovery offers classification. Discordance discovery can conceivably be embraced for real-world applications.
IL-8 Expression in Granulocytic Epithelial Lesions of Idiopathic Duct-centric Pancreatitis (Type 2 Autoimmune Pancreatitis)
Authors: Ku Yuna , Hong Seung-Mo , Fujikura Kohei , Kim Sung Joo , Akita Masayuki , Abe-Suzuki Shiho , Shiomi Hideyuki , Masuda Atsuhiro , Itoh Tomoo , Azuma Takeshi , Kim Myung-Hwan , Zen Yoh
Published: June 2017

Type 2 autoimmune pancreatitis (type 2 AIP) develops in isolation or sometimes in association with ulcerative colitis. Its diagnosis requires the histologic confirmation of granulocytic epithelial lesions (GELs) with no diagnostic biomarker currently available. This study aimed to elucidate the tissue expression of cytokines and their diagnostic value in this condition. In quantitative polymerase chain reaction for multiple cytokines using tissue-derived mRNA, the expression level of interleukin (IL)-8 was markedly higher in type 2 AIP than in type 1 AIP (P<0.001). In immunostaining, IL-8 expression was detected in the ductal/ductular epithelium (11/13; 85%) and infiltrating neutrophils or lymphocytes (12/12; 100%) in type 2 AIP, but was almost entirely negative in type 1 AIP (n=13; both, P<0.001). Although obstructive pancreatitis adjacent to pancreatic cancers (peritumoral pancreatitis) exhibited IL-8 expression in the epithelium (3/12; 25%) and inflammatory cells (10/12; 83%), expression levels were significantly lower than those in type 2 AIP (P<0.001 and 0.020, respectively). The presence of either GELs or IL-8-positive epithelium discriminated type 2 AIP from type 1 AIP or obstructive pancreatitis with 92% sensitivity and 92% to 100% specificity. Furthermore, CD3/IL-8-coexpressing lymphocytes were almost restricted to type 2 AIP. Interestingly, a similar pattern of IL-8 expression was also observed in colonic biopsies of ulcerative colitis. In conclusion, the overexpression of IL-8 may underlie the development of GELs in type 2 AIP, and IL-8 immunostaining or IL-8/CD3 double staining may become an ancillary method for its diagnosis. The similar expression pattern of IL-8 in ulcerative colitis also suggests a pathogenetic link between the 2 conditions.
Acuity Prediction Using Emergency Medical Services Prenotifications in a Pediatric Emergency Department
Authors: Williamson Kristy , Gochman Robert , Bullaro Francesca , Kaufman Bradley , Krief William
Published: June 2017

Objectives

Emergency medical services (EMS) prenotifications are critical, although they oftentimes inaccurately convey the arriving patient’s true acuity, resulting in inappropriate preparation in the emergency department. The objectives of this study were (1) to determine interrater reliability of acuity prediction based on prenotifications among physicians and (2) to compare predicted versus actual patient acuity based on prenotifications.

Methods

A panel of physicians reviewed recordings of EMS prenotifications and then predicted the patient’s acuity using the Emergency Severity Index (ESI). The scores were analyzed for interrater reliability using the weighted κ statistic. In the prospective phase of the study, physicians predicted an ESI before patient arrival based solely on the EMS prenotification and then calculated an actual ESI upon arrival. Descriptive statistics were calculated, and comparisons between the predicted and actual ESI were performed using Wilcoxon signed rank for matched pairs.

Results

Panelists reviewed a total of 23 recordings, and the interrater reliability was 0.23 overall (SE, 0.026; P < 0.001), indicating only fair agreement. One hundred patients were enrolled in the prospective analysis. There was a statistically significant difference between the predicted and actual ESI made by physicians (P = 0.0001). For 46 patients, the predicted and actual scores matched, but 13 patients were “undertriaged,” and 41 patients were “overtriaged” based on predicted acuity.

Conclusions

Interpretation of acuity using EMS prenotifications among physicians was only fairly reliable, and physicians had difficulty predicting actual acuity based on prenotifications. Improper preparation based on these prenotifications can potentially impact patient care and resource allocation.