bluuebunny/crossref_metadata_2025 huggingface dataset:
Vascular echo imaging
Authors: Sprynger Muriel , Simova Iana , Carerj Scipione
Published: December 2016

Arterial diseases are heavily intertwined with atherosclerosis and coronary artery disease and the presence of both symptomatic and asymptomatic peripheral artery diseases is known to affect the rate of cardiovascular events and deaths. Screening for abdominal aortic aneurysm (AAA) in selected populations is also a major issue for the cardiologist. Additionally, intima-media thickness and ankle-brachial index (ABI) measurements, screening for carotid or femoral plaques, and new techniques looking at the rigidity and elasticity of arteries may further help with risk stratification, especially in intermediary risk populations. Cardiologists may also encounter other conditions such as subclavian artery disease, arterial dissection, arterial entrapment, and arteritis (e.g. giant cell or Takayasu’s arteritis). Even if they don’t undertake imaging themselves, they should know about these diseases and when to refer patients. Although cardiac and vascular ultrasounds are complementary, they require a completely different skill set and formal training. The ultimate goal of this chapter is to define the basic principles that any cardiologist should know, and also provide guidance to cardiologists more interested in vascular diseases. For the benefit of the patient there is a need for collaboration between the different disciplines involved in vascular diseases according to local medical availability and skill.
Quality assurance in echocardiography
Authors: Fox Kevin F. , Skinner Henry J.
Published: December 2016

Quality assurance in echocardiography is the systematic process of ensuring that information sent out by echo laboratories is timely, appropriate, and accurate. QA may be both an internal and an external process. QA relates to all aspects of a service, so not only should reports be timely, accurate, and useful, but the patient’s experience should be a safe and positive one. All aspects of a service need to be continuously monitored and optimized if quality is to be maintained and furthermore improved. Particular focus is needed on reporting and measurement with continuous checking for reporting errors and assessment of measurement variability. A systematic quality assurance programme needs to be an essential part of any echo laboratory. Life-determining clinical decisions may depend on it.
Pain evaluation
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

Pain is a subjective phenomenon. It is different for each individual who experiences it and, for any individual, will depend on a multiplicity of factors, including its cause, context, and meaning. The sensation of pain is influenced by innumerable factors, not only at the time of the stimulus, but also during the individual’s prior experience. Appropriate tools can report aspects of pain experience; this chapter provides detail of appropriate pain scales to use, describing characteristics of each. It also explains objective and behavioural measures of pain.
Adjuvants
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

An adjuvant is not analgesic but is capable of relieving pain in certain specific pain situations. Selection of an appropriate adjuvant is a key element of a rational and evidence-based approach to management of pain in children. It depends on the diagnosis of the type of pain, considered in this chapter in relation to the selection of a suitable adjuvant, based on recognizing the nature of the pain to be treated. Adjuvants for specific types of pain, including neuropathic pain, bone pain, muscle spasm, and cerebral irritation, and pain syndromes are discussed in detail, with information provided on symptoms and management.
Dyspnoea
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

Dyspnoea is defined as the sense that breathing has become unpleasant. It is therefore, by definition, a subjective phenomenon. It also means that many different factors can contribute to dyspnoea. The principles that underlie the management of dyspnoea are the same as those underlying the management of any other symptom, namely, holistic, rational, and balancing burden and benefit. This chapter considers the pathophysiology of dyspnoea, alongside possible interventions and management. There is also a section on decision-making, focusing on the nature of engagement with the family in a subjective condition.
Psychological symptoms
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

Disorders of the psyche (particularly depression and anxiety) are relatively common amongst children with life-limiting conditions. Most of the tools available for evaluating or assessing them in palliative medicine were developed for adults, as were strategies for treating them. The ideal practice is to collaborate with local child and adolescent mental health services in the management of all such children. This chapter covers management of psychological conditions, including depression, anxiety, insomnia, and terminal delirium. For each symptom, causes or general points are detailed, with recommendations on pharmacological approaches covered in detail.
Malignant diseases
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

With respect to palliative medicine, malignant diseases can be considered in three broad groups: haemopoietic malignancies, central nervous system tumours, and other solid tumours. The likelihood of needing referral for specialist palliative medicine is influenced by prognosis, as well as by incidence, and therefore change as outcomes improve. This chapter includes an easy-to-assimilate list of the commonest symptoms experienced by children with cancer, broken down by incidence. A detailed examination of the interface between oncology and palliative care is provided, with discussion of the primary fears experienced by patients and families, the transition from a curative to a palliative phase, and the role of chemotherapy in palliative cases.
Bereavement
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

Death generates different levels of grief in people, most often linked to our relationship with the individual and our social cultural upbringing. As paediatric palliative care professionals dealing with the family, we are looked towards by other health-care professionals and society to help deal with the bereavement and its associated grief. It is important to recognize that it is not our sole responsibility. This chapter approaches grief through the models of bereavement theory, in order to provide a deeper understanding of this stage. It examines bereavement issues experienced by the chronically ill child, as well as those experienced by siblings, parents, and the community around the dying child. Attention is also given to managing bereavement, with advice provided on how the multidisciplinary team can help parents during the grieving process.
We are dialogue
Authors: Stanghellini Giovanni
Published: December 2016

This chapter argues that the ground of human existence is dialogue and that from this human existence receives its significance and foundation. To be human means to be in dialogue with alterity. We encounter alterity in two main domains of our life: in ourselves, and in the external world. In the first case alterity is in the involuntary dimension of ourselves, our un-chosen ‘character’, including needs, desires, emotions, and habits. In the external world, alterity is encountered in the challenging otherness of the events and in the meetings with other persons that constellate our life. Dialogue is a kind of ‘experience’: it is not merely a verbal exchange, an exchange of information; rather, dialogue lets something happen. What emerges in dialogue is neither mine nor yours, and hence transcends the interlocutors’ subjective opinions. Dialogue moves in unpredictable directions to experience something that is new for both interlocutors. Something unexpected comes about in dialogue.
The life-world of the I–You relation
Authors: Stanghellini Giovanni
Published: December 2016

This chapter argues that in the beginning is relation. Events, namely significant events, are encountered as I–You meetings, rather than as Its that one observes from without. Only at a later stage, language breaks up the ‘I–You’ relation and creates an ‘I–It’ experience. Language grows out of a more primitive stage of human development in which words are used to indicate phenomena that are relational in nature. Establishing an I–You relation in the context of care may generate a profound transformation of the basic structures of the life-world shared by the therapist and the patient, since the ‘I–You’ relation radically affects the structures of subjectivity of the two partners. A transformation of selfhood (directedness), agency (reciprocity), spatiality (in-betweenness), temporality (presentness), and language (sacredness/bonding) is involved.
A closer look into alterity: eccentricity
Authors: Stanghellini Giovanni
Published: December 2016

This chapter argues that at the heart of alterity lies a double paradox. First, alterity speaks of eccentricity, of the non-coincidence of the Self with itself. Most of the philosophical anthropologies of the last hundred years emphasize that the phenomenon of eccentricity is indigenous to human existence, and characterize Man as an eccentric being. Fundamental to the understanding of human subjectivity is clarifying the ways self-awareness is structured as an experience inextricably entangled with an experience of a basic otherness. To be a human being is to be in juxtaposition with, and sometimes to feel in opposition to, a set of given involuntary dispositions in front of which we need to voluntarily take a position.
Schizophrenia and the disembodiment of desire
Authors: Stanghellini Giovanni
Published: December 2016

The schizophrenic person’s existential trajectory reflects the intolerable mixture of his desperate need for the Other and his hopeless attempts to orientate in human, and especially erotic, relationships. The schizophrenic person may turn away from actual reality into a mystical-romantic, ‘higher’ ideal, which like a dim mist protects him from the encounter with the real Other. Two features seem to best characterize this type of existence. One is his philosophy of life that indulges in cramping reflections concerned with spirituality, that is, rectitude, fidelity, nobility, and purity. The second is disembodiment. Sexual excitement is experienced as a storming, oppressing experience of something going through and travelling across one’s own body. The ‘higher’ ideal image of love seems to downplay this intolerable feeling and transform sexual excitement into a disembodied type of desire. The essential feature of this type of existence is its being disembodied.
Cerebrovascular disease
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter on cerebrovascular disease discusses the evidence-based management of acute stroke, transient ischaemic attacks (TIAs), and secondary stroke prevention (antiplatelet therapy, risk factor modification, atrial fibrillation (AF), carotid and vertebral artery dissection, and symptomatic carotid artery disease). Drug treatment of intracerebral haemorrhage, subarachnoid haemorrhage, and cerebral venous sinus thrombosis are also discussed.
Metabolic disorders
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter discusses the clinical features and management of inborn errors of metabolism (lysosomal storage disorders, peroxisomal disorders, Wilson’s disease, porphyria, and phenylketonuria), vitamin and nutrient deficiency syndromes, and neurological toxicity syndromes.
Uro-neurology
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter discusses the physiology and pharmacological management of neurogenic lower urinary tract dysfunction, non-obstructive urinary retention, and neurological causes of disorders of sexual function.
A
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter includes drugs beginning with the letter [A]
Q
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter includes drugs beginning with the letter [Q]
W
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter includes drugs beginning with the letter [W]
E
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter includes drugs beginning with the letter [E]
M
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter includes drugs beginning with the letter [M]
O
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter includes drugs beginning with the letter [O]
S
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter includes drugs beginning with the letter [S]
Clinical assessment and monitoring of chest radiographs
Authors: Parkhomenko Alexander , Gurjeva Olga S , Yalynska Tetyana
Published: December 2016

This chapter reviews the main problems in obtaining portable X-rays in intensive cardiac care unit patients and describes specific features of radiographs taken in the supine anteroposterior position. It also includes a brief review of a systematic, multistep approach of evaluating the quality of radiographic images and describing the chest wall, pulmonary vasculature, the heart and its chambers, the great vessels, and the position of tubes, lines, and devices. This chapter covers the most common conditions for which chest radiographs are useful and provides intensive cardiac care unit physicians, cardiologists, cardiology fellows, and medical students with basic information on water retention, air collection, and lung-related problems. It also focuses on the monitoring of line and device placements (e.g. central venous catheters, tube malposition) and procedure-related abnormalities, which may be apparent on chest X-rays and are helpful for timely diagnoses.
Renal support therapy
Authors: Ronco Claudio , Ricci Zaccaria
Published: December 2016

Renal dysfunction is known to be frequently a component of multiple organ failure, a complex syndrome affecting the most severely ill critical patients. Bidirectional interaction between the kidneys and other organs has always been suspected; evidence suggests that severe kidney injury is an important protagonist in acute illness, even when managed by dialysis. In fact, if it seems that increasing the dose of renal replacement therapy does not reduce mortality, it could be inferred that acute kidney injury influences mortality through means that are not reversed by conventional renal support, either because the putative culprit toxins are not removed by renal replacement therapy or because renal replacement therapy is started too late to prevent these effects. It is known that the kidneys exert effects on other organs, such as the lung, liver, heart, and brain, in a process called ‘crosstalk’. This effect means that the kidney is not only a victim, but also a culprit regarding the malfunction of other organs. This chapter will detail some traditional aspects of different renal replacement therapy modalities and prescription schedules, but it will also describe the most recent evidence on the management and support of the kidney during failure of other organs.
Stroke
Authors: Leys Didier , Cordonnier Charlotte , Caso Valeria
Published: December 2016

Stroke is a major public health issue. Many are treatable in the acute stage, provided patients are admitted soon enough. The overall incidence of stroke in Western countries is approximately 2400 per year per million inhabitants, and 80% are due to cerebral ischaemia. The prevalence is approximately 12 000 per million inhabitants. Stroke is associated with increased long-term mortality, handicap, cognitive and behavioural impairments, recurrence, and an increased risk of other types of vascular events. It is of major interest to take the heterogeneity of stroke into account, because of differences in the acute management, secondary prevention, and outcomes, according to the subtype and cause of stroke. In all types of stroke, early epileptic seizures, delirium, increased intracranial pressure, and non-specific complications are frequent. In ischaemic strokes, specific complications, such as malignant infarcts, spontaneous haemorrhagic transformation, early recurrence, and a new ischaemic event in another vascular territory, are frequent. In haemorrhagic strokes, the major complication is the subsequent increased volume of bleeding. There is strong evidence that stroke patients should be treated in dedicated stroke units; each time 24 patients are treated in a stroke unit, instead of a conventional ward, one death and one dependence are prevented. This effect does not depend on age, severity, and the stroke subtype. For this reason, stroke unit care is the cornerstone of the treatment of stroke, aiming at the detection and management of life-threatening emergencies, stabilization of most physiological parameters, and prevention of early complications. In ischaemic strokes, besides this general management, specific therapies include intravenous recombinant tissue plasminogen activator, given as soon as possible and before 4.5 hours, otherwise aspirin 300 mg, immediately or after 24 hours in case of thrombolysis, and, in a few patients, decompressive surgery. In intracerebral haemorrhages, blood pressure lowering and haemostatic therapy, when needed, are the two targets, but surgery does not seem effective to reduce death and disability.
Infection, sepsis, and multiorgan dysfunction syndrome
Authors: Favory Raphaël , Vincent Jean-Louis
Published: December 2016

Sepsis is the main cause of multiple organ failure and remains a concern because of the associated high morbidity and mortality. In recent years, important advances have been made in the understanding of the pathophysiology of sepsis. Sepsis and septic shock are the end result of complex interactions between infecting organisms and various elements of the host response. A key feature of the common sequence of organ failure is dysfunction of the cardiovascular system, including microcirculatory elements. Outcome improvement in sepsis is based on recognizing the process early and instituting effective therapies. The time window for intervention is relatively short, and treatment must promptly control the source of infection, restore haemodynamic homoeostasis, and support failing organ systems.
Obscured active galactic nuclei triggered in compact star-forming galaxies
Authors: Chang Yu-Yen , Le Floc'h Emeric , Juneau Stéphanie , da Cunha Elisabete , Salvato Mara , Civano Francesca , Marchesi Stefano , Gabor J. M. , Ilbert Olivier , Laigle Clotilde , McCracken H. J. , Hsieh Bau-Ching , Capak Peter
Published: December 2016

We present a structural study of 182 obscured active galactic nuclei (AGNs) at z ≤ 1.5, selected in the Cosmic Evolution Survey field from their extreme infrared to X-ray luminosity ratio and their negligible emission at optical wavelengths. We fit optical to far-infrared spectral energy distributions and analyse deep Hubble Space Telescope imaging to derive the physical and morphological properties of their host galaxies. We find that such galaxies are more compact than normal star-forming sources at similar redshift and stellar mass, and we show that it is not an observational bias related to the emission of the AGN. Based on the distribution of their UVJ colours, we also argue that this increased compactness is not due to the additional contribution of a passive bulge. We thus postulate that a vast majority of obscured AGNs reside in galaxies undergoing dynamical compaction, similar to processes recently invoked to explain the formation of compact star-forming sources at high redshift.
HPV-associated oropharyngeal squamous cell carcinoma
Authors: Smith Timothy J. , Mendez Anthony , Donald Carrlene , Nagel Thomas Harold
Published: December 2016

Human papillomavirus (HPV) can infect the tonsillar tissues of the oropharynx and is associated with oropharyngeal squamous cell carcinoma. This article provides an overview to guide primary care providers in screening patients for oropharyngeal cancer and making appropriate referrals. The article also reviews available HPV vaccines and immunization adherence rates.
The Pad Project
Authors: Raines Michele , Garner Shelby L. , Spies Lori A. , Riley Cheryl , Prater Lyn S.
Published: December 2016

The Pad Project is a women's health program used to educate women on their monthly menstrual cycles. Through this ministry, women who do not have access to menstrual hygiene products are given sustainable hygienic kits to promote menstrual health. This unique health education program also integrates stories from the gospel to illustrate Christ's love and caring commitment toward women and women's health.
Entering Into Suffering
Authors: Gaudino Rebecca , Braband Barbara , Rogers Anissa
Published: December 2016

Learning how to respond to suffering is a significant challenge for healthcare providers. This interdisciplinary paper relays a Pedagogy of Suffering Model, based on research following a suffering interview project with undergraduate nursing students. The model is compared to the Gospel account of an encounter between Jesus and a Syrophoenician woman (Mark 7:24-30), supporting biblical and theological soundness of the model's transformative tasks for learning how to respond to suffering. The model can guide development of learning experiences that deepen understanding of compassionate interventions for those who suffer.
Accelerated RN-to-BSN Service-Learning Program Serves the Vulnerable
Authors: Barnes Margaret
Published: December 2016

The definition, implementation, and benefits support the value of service-learning for nursing education. However, accelerated RN-to-BSN programs may have difficulty requiring service-learning experiences. This article offers a biblical rationale for service with vulnerable populations and an example of how service-learning is implemented into the curriculum of an accelerated, nontraditional, online/onsite RN-BSN completion program at a Christian university.
Understanding Spiritual Care
Authors: Christman Sharon K. , Mueller Julia R.
Published: December 2016

Spiritual care has been associated with positive patient outcomes. Although nurses want to provide spiritual care, many have difficulty conceptualizing spiritual care outside of religion and religious activities. The Faith-Hope-Love Model of Spiritual Wellness, a theoretical model of spirituality and spiritual well-being, grounded in Christian theology and biblical text, can help nurses provide spiritual support to patients and families from multiple faith traditions or those without a faith background. Spirituality concepts are discussed, and description of how spirituality is related to finding meaning and purpose in life along with a summary of the spiritual needs identified from healthcare literature and the Bible, are provided.
W1, a Novel Oral Antiplatelet Agent With Less Resistance Than Clopidogrel
Authors: Ge Pengxin , Du Li , Han Chunguang , Li Hui , Feng Yanguo , Han Jie , Wang Zhen , Xiong Liangzhong , Yuan Meiru , Liu Yongxue
Published: December 2016

Clopidogrel (CLO) is a clinical antiplatelet agent, about which there are major concerns because its antiplatelet efficiency decreases with insufficient metabolic activation, leading to “clopidogrel resistance.” We aimed to determine the antiplatelet effects of W1, a novel molecule composed of 2-O-clopidogrel and aspirin (1:1 ratio), on platelet aggregation ex vivo and thrombus formation in vivo, and its susceptibility to CLO resistance in combination with other therapies in rats. Platelets were prepared, and an arteriovenous shunt thrombosis model was established using Wistar rats to measure platelet aggregation and thrombus formation, respectively. W1 markedly inhibited adenosine 5′-diphosphate (ADP)-induced platelet aggregation and thrombus formation dose dependently (0.3, 1, and 3 mg/kg). W1 (3 mg/kg) acted rapidly at 0.5 hours and lasted for 72 hours. W1 prolonged bleeding and clotting times in mice, confirming its antithrombotic properties. Compared with CLO 10 mg/kg, the positive control, W1 3 mg/kg exerted equivalent effects on the above specifications. In addition, cyclic adenosine monophosphate levels, measured in rat platelets, increased rapidly after prostaglandin E1 (alprostadil) stimulation of the vehicle control (0.5% methyl cellulose suspension) and W1 (3 mg/kg)-treated groups. ADP (50 μm) reduced the control levels more remarkably than W1 did (P < 0.05 in 3 minutes or P < 0.001 at 5 minutes), suggesting that W1 suppressed ADP-induced cyclic adenosine monophosphate reduction. This was associated with a significant platelet reactivity inhibition measured using the vasodilator-stimulated phosphoprotein assay. CLO or W1 coadministration with or without omeprazole and amlodipine to rats to investigate the pharmacodynamic interactions revealed that W1 exhibited more stable and potent antithrombotic effects than CLO did. In conclusion, both W1 and CLO showed antiplatelet and antithrombotic effects, while the former exhibited less CLO resistance in combination with omeprazole or amlodipine, 2 drugs that inhibit CLO metabolism. Therefore, this study implies that W1 may be a promising oral antiplatelet agent for reducing CLO resistance after percutaneous coronary intervention.
LC-MS/MS Analysis of Erythrocyte Thiopurine Nucleotides and Their Association With Genetic Variants in Patients With Neuromyelitis Optica Spectrum Disorders Taking Azathioprine
Authors: Mei Shenghui , Li Xindi , Gong Xiaoqing , Li Xingang , Yang Li , Zhou Heng , Liu Yonghong , Zhou Anna , Zhu Leting , Zhang Xinghu , Zhao Zhigang
Published: December 2016

Background:

Azathioprine is a first-line drug in treating neuromyelitis optica spectrum disorders (NMOSD). To exhibit its bioactivity, azathioprine needs to be converted to thiopurine nucleotides (TPNs) including 6-thioguanine nucleotides (6-TGNs) and 6-methylmercaptopurine nucleotides (6-MMPNs) that are affected by genetic polymorphisms. This study aims to develop an LC-MS/MS method for the analysis of erythrocyte concentrations of TPNs and to evaluate their associations with variants of various genes (MTHFR, TPMT, HLA, SLC29A1, SLC28A2, SLC28A3, ABCB1, and ABCC4) in patients with NMOSD.

Methods:

Erythrocyte 6-TGNs and 6-MMPNs were converted to their free bases 6-thioguanine and 6-methylmercaptopurine derivative by 1-hour acid hydrolysis at 95°C. An LC-MS/MS method was developed, validated, and used to study 32 patients with NMOSD to determine these free bases. Genetic variants were identified by MassARRAY (Sequenom) and multiple SNaPshot techniques. The associations between genetic variants and the concentrations of TPNs or the 6-MMPNs:6-TGNs ratio were evaluated by PLINK software using linear regression.

Results:

Methanol and water were used for separation with a total run time of 6.5 minutes. The lowest limit of quantification was 0.1 μmol/L with an injection volume of 10 μL. rs10868138 (SLC28A3) was associated with a higher erythrocyte concentration of 6-TGNs (P = 0.031), whereas rs12378361 (SLC28A3) was associated with a lower erythrocyte concentration of 6-TGNs (P = 0.0067). rs507964 (SLC29A1) was significantly associated with a lower erythrocyte concentration of 6-MMPNs (P = 0.024) and a lower 6-MMPNs:6-TGNs ratio (P = 0.029).

Conclusions:

An LC-MS/MS method for the analysis of erythrocyte TPNs was developed, validated, and used to study 32 patients with NMOSD. SLC29A1 and SLC28A3 were associated with the erythrocyte concentrations of TPNs and 6-MMPNs:6-TGNs ratio. Further studies are needed to confirm these results.
A Systematic Literature Review Approach to Estimate the Therapeutic Index of Selected Immunosuppressant Drugs After Renal Transplantation
Authors: Ericson Jessica E. , Zimmerman Kanecia O. , Gonzalez Daniel , Melloni Chiara , Guptill Jeffrey T. , Hill Kevin D. , Wu Huali , Cohen-Wolkowiez Michael
Published: December 2016

Background:

Drugs that exhibit close margins between therapeutic and toxic blood concentrations are considered to have a narrow therapeutic index (NTI). The Food and Drug Administration has proposed that NTI drugs should have more stringent bioequivalence standards for approval of generic formulations. However, many immunosuppressant drugs do not have a well-defined therapeutic index (TI).

Methods:

We sought to determine whether safety, efficacy, and pharmacokinetic data obtained from the medical literature through a comprehensive literature search could be used to estimate the TI of cyclosporine, tacrolimus, and sirolimus. In this analysis, we considered TI ≤2 as a criterion to define a drug as having an NTI.

Results:

Published literature indicates that cyclosporine has a TI of 2–3, which falls just short of our criteria to be classified as having an NTI. We found sirolimus and tacrolimus to have a therapeutic range of 5–12 ng/mL and of 5–20 ng/mL, respectively, but were unable to calculate the TI.

Conclusions:

Although the current literature does not provide a clear indication that these drugs have an NTI, the routine use of therapeutic drug monitoring in clinical practice suggests that more stringent testing of their pharmacokinetic and pharmacodynamic properties should be performed before the approval of generic formulations.
Vertically Set Sombrero-shaped Abdominal Flap for Asian Breast Reconstruction after Skin-sparing Mastectomy
Authors: Uda Hirokazu , Yoshimura Kotaro , Asahi Rintaro , Sarukawa Syunji , Sunaga Ataru , Kamochi Hideaki , Sugawara Yasushi
Published: December 2016

Background:

Immediate autologous breast reconstruction after skin-sparing mastectomy is an esthetically superior method, and a free abdominal flap is often used. However, in Asian patients, little redundant abdominal skin and thin subcutaneous tissue are common, necessitating the development of a more suitable flap design and setting. We devised a narrow flap, the sombrero-shaped flap (S-flap), set vertically, to reduce postoperative abdominal morbidity without sacrificing cosmetic results.

Methods:

To assess this new flap design and setting, the recipient- and donor-site complications of consecutive patients treated by S-flap (n = 40) and conventional flap (C-flap) (n = 22) were retrospectively investigated. Postoperative abdominal pain, stiffness, and patient activity were also assessed in each group with our original grading scale.

Results:

Compared with the C-flap group, the S-flap group had a significantly lower skin paddle vertical height (mean, 14.0 and 10.2 cm, respectively; P < 0.001), lower abdominal stiffness (P = 0.023), and higher rate of double-pedicled flap use (27.3% and 52.5%, respectively; P < 0.048). The rates of donor and recipient site complications, postoperative abdominal pain, and activity did not significantly differ between the groups.

Conclusions:

For immediate breast reconstruction after skin-sparing mastectomy in Asian patients, our newly designed S-flap and vertical flap setting achieved cosmetically good, consistent results with low abdominal morbidity, even though the abdominal flap was thin and narrow. The viability of the S-flap, including medial fan-shaped adipose flap, was reliable, even though the flap often required elevation with double pedicles.
Congenital Symmastia: A 3-Step Approach
Authors: Sadaka Mohamed Saad , Allam Atef A.
Published: December 2016

Congenital symmastia is a medial confluence of the breasts. It is a rare anomaly with few reports in the literature and no standard treatment. In this article, we present a case of congenital symmastia treated by 3 steps: liposuction, fixation of the skin to the chest wall in the area of the intermammary sulcus, and postoperative intermammary compression. A successful result was achieved with normal cleavage between the breasts. So, this is considered the ideal treatment for this condition.
REPRODUCIBILITY OF VESSEL DENSITY MEASUREMENT WITH OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN EYES WITH AND WITHOUT RETINOPATHY
Authors: You Qisheng , Freeman William R. , Weinreb Robert N. , Zangwill Linda , Manalastas Patricia I. C. , Saunders Luke J. , Nudleman Eric
Published: December 2016

Purpose:

To determine the intravisit and intervisit reproducibility of optical coherence tomography angiography measurements of macular vessel density in eyes with and without retinal diseases.

Methods:

Fifteen healthy volunteers and 22 patients with retinal diseases underwent repeated optical coherence tomography angiography (Angiovue Imaging System, Optovue Inc) scans after pupil dilation on 2 separate visit days. For each visit day, the eyes were scanned twice. Vessel density defined as the proportion of vessel area with flowing blood over the total measurement area was calculated using Angiovue software. Intravisit and intervisit reproducibility were summarized as coefficient of variations and intraclass correlation coefficients were calculated from variance component models.

Results:

The coefficient of variations representing the intravisit reproducibility of the superficial macular vessel density measurements for different quadrants on 3 mm × 3-mm scans varied from 2.1% to 4.9% and 3.4% to 6.8% for healthy and diseased eyes, respectively, and for the intervisit it was 2.9% to 5.1% and 4.0% to 6.8%, respectively. The coefficient of variations were lower in healthy eyes than in diseased eyes, lower for intravisit than for intervisit, lower on 3 mm × 3-mm scans than on 6 mm × 6-mm scans, and lower for paracentral subfields than for central subfield.

Conclusion:

The evidence presented here demonstrates good reproducibility of optical coherence tomography angiography for measurement of superficial macula vessel density in both healthy eyes and eyes with diabetic retinopathy without diabetic macular edema.
NOVEL FINDINGS ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH TUBERCULAR SERPIGINOUS-LIKE CHOROIDITIS
Authors: Mandadi Spoorti Krishna Reddy , Agarwal Aniruddha , Aggarwal Kanika , Moharana Bruttendu , Singh Ramandeep , Sharma Aman , Bansal Reema , Dogra Mangat R. , Gupta Vishali ,   for OCTA Study Group
Published: December 2016

Purpose:

To analyze and describe the imaging characteristics of tubercular serpiginous-like choroiditis using optical coherence tomography angiography (OCTA) and to compare these findings with multimodal imaging.

Methods:

In this prospective cross-sectional study, multimodal imaging was performed in subjects with tubercular serpiginous-like choroiditis using OCTA (Optovue RTVue XR Avanti), enhanced-depth imaging OCT (Heidelberg Spectralis), fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. Distinct morphologic features of the retinochoroidal vasculature at the sites of choroiditis lesions were analyzed on OCTA imaging. Multimodal imaging analysis was performed to study the changes observed on OCTA.

Results:

Eighteen eyes (18 subjects, 16 males) were included in the study. The en face OCTA images demonstrated discrete areas of flow void beneath the retinal pigment epithelium–Bruch membrane layer suggestive of choriocapillaris hypoperfusion that corresponded well with indocyanine green angiography, especially in the chronic phase. Additional information such as areas of preserved choriocapillaris, vascular tufts, and tangled vessels were observed using OCTA among lesions in advanced stages of healing. Compared with indocyanine green angiography, the areas of choriocapillaris atrophy appeared better defined on OCTA and correlated well with enhanced-depth imaging OCT.

Conclusion:

The OCTA images provide high-resolution structural information of the retinochoroidal vasculature in tubercular serpiginous-like choroiditis. Morphologic information obtained from OCTA images correlates well with and supplements other imaging techniques such as indocyanine green angiography and enhanced-depth imaging OCT.
CASE OF METASTATIC UROTHELIAL CARCINOMA OF THE RETINA AND VITREOUS
Authors: Whalen Katherine E. , Eagle Ralph C. , Vrabec Tamara R.
Published: December 2016

Purpose:

To report a rare case of vitreo-retinal metastasis from urothelial carcinoma of the bladder.

Methods:

Case report.

Results:

A 55-year-old man with a history of bladder cancer developed atypical vitritis and a white fundus mass. Intravenous fluorescein angiography demonstrated connection between the retinal and tumor vasculature consistent with a retinal malignancy. Cytologic analysis of the vitreous sample revealed large, atypical cells with pleomorphic nuclei, mucin vacuoles, and rare mitotic figures. The cells were immunoreactive for cytokeratin markers AE1/AE3, CK7, and CK20 and the urothelial carcinoma marker GATA3. Review of the patient's initial bladder tumor revealed an anaplastic epithelial neoplasm with dyscohesive cells that appeared histologically identical to those in the vitreous biopsy. Despite external beam radiation therapy, the patient's vision declined and the eye became painful and was ultimately enucleated.

Conclusion:

Retinal metastasis from systemic adenocarcinoma is an extremely rare occurrence with poor prognosis for vision.
RETINAL FINDINGS IN A CASE OF PRESUMED CUTIS MARMORATA TELANGIECTATICA CONGENITA
Authors: Taleb Eman A. , Nagpal Manish P. , Mehrotra Navneet S. , Bhatt Kalyani
Published: December 2016

Purposes:

To correlate the clinical picture and fundus fluorescein angiography findings in case of presumed cutis marmorata telangiectatica congenita.

Methods:

A 41-year-old woman with presumed cutis marmorata telangiectatica congenita who is a known case of hypothyroidism for the last 6 years and has bilateral peripheral retinal vascular abnormalities, peripheral retinal nonperfusion on fluorescein angiography and bilateral optic disk drusen.

Result:

A patient presented with blurring of vision in both eyes for last 6 months. On examination, livedo reticularis skin lesions in both upper and lower extremities were noted. Best-corrected visual acuity in the right eye was 6/18 and left eye was 6/36. Slit-lamp examination revealed posterior subcapsular cataract in the right eye. Fundus examination showed bilateral optic disk drusen, tortuous blood vessels, and peripheral fan-shaped sclerosed neovascularization. Fundus fluorescein angiography showed peripheral retinal nonperfusion. She underwent peripheral laser photocoagulation of the left eye and cataract surgery in the right eye. After 2 years of follow-up, her best-corrected visual acuity was 6/9 in both eyes. Her fundus examination and fundus fluorescein angiography findings were stable in both eyes.

Conclusion:

Presumed cutis marmorata telangiectatica congenita is a rare cutaneous vascular disorder that can manifest with nonprogressive retinal vascular abnormality and optic disk drusen.
The Gracillimus Orbitis Muscle
Authors: Jordan David R. , Stoica Bazil
Published: December 2016

The gracillimus orbitis muscle is an anomalous, accessory, or supernumerary extraocular muscle that, although is rarely seen clinically in the human orbit, has been identified in 5% to 14% of dissected cadaver orbits. It arises from the medial surface of the levator near its origin and runs forward between the levator and superior oblique muscles resembling one of the other extraocular muscles. More anteriorly, it becomes thinner, less well defined, and mostly fibrous. Its major insertion is into the fascia surrounding the trochlea, while other fibers may travel to the supratrochlear artery, intermuscular septum, the levator or medial rectus muscle, and the fascia surrounding the superior ophthalmic vein. The function of this anomalous muscle remains unknown in most cases. Knowledge of its presence is important as the oculoplastic/orbital surgeon may encounter it during an eyelid or orbital procedure.
Lacrimal Drainage System Involvement in Linear Scleroderma
Authors: Singh Swati , Ali Mohammad Javed , Mishra Dilip Kumar , Naik Milind N.
Published: December 2016

Linear scleroderma is a localized variety of scleroderma characterized by fibrotic areas of the dermis involving head region without systemic features. Ocular involvement has been sparsely reported in the form of episcleritis, dry eye, and uveitis. We describe a 42-year-old man with linear scleroderma, en coup de sabre type with associated nasolacrimal duct obstruction and prolonged dacryocystitis.
Prazosin in Children and Adolescents With Posttraumatic Stress Disorder Who Have Nightmares
Authors: Akinsanya Adefolake , Marwaha Raman , Tampi Rajesh R.
Published: December 2016

Background

The aim of this systematic review was to identify published articles that evaluated the use of prazosin for treating nightmares in children and adolescents who have posttraumatic stress disorder (PTSD).

Procedures

A literature search was conducted of PubMed, MEDLINE, EMBASE, Cochrane Collaboration, and PsycINFO databases for published articles in any language that evaluated the use of prazosin for treating nightmares in the context of PTSD in children and adolescents using the following key words: PTSD, nightmares, prazosin, children, adolescents, trauma, and sleep.

Results

A total of 9 published articles related to the use of prazosin for treatment of nightmares in PTSD in children and adolescents were identified. Six of the 9 articles that met our inclusion criteria were case reports. All of these 6 case reports showed marked improvement in nightmares when prazosin was used, although at a generally lower dose when compared with its use in adults, with dosing ranging from 1 to 4 mg/d.

Conclusions

Prazosin has shown promising outcomes in treating nightmares associated with PTSD in children and adolescents, although this has not been well studied. Future placebo-controlled trials are needed to assess the efficacy and safety of prazosin in treating PTSD-related nightmares in children and adolescents.
Validity and Reliability Study of the Baxter Animated Retching Faces Nausea Scale
Authors: Şişman Hamide , Eti Aslan Fatma , Özgen Refiye , Alptekin Dudu , Akil Yasemin
Published: December 2016

Aim:

Nausea and vomiting, which are unpleasant clinical problems in the postoperative period, have negative outcomes related to patient satisfaction, morbidity, hospital stay, and medical costs. Nausea and/or vomiting may cause tracheal aspiration when unconscious after anesthesia, rupture of wound site, wound infection, recurrent and severe dehydration, and electrolyte impairments with pediatric surgery patients. It is very important to detect and prevent these clinical problems at an early period. Therefore, it is necessary to objectively assess nausea, which is a subjective perception. The aim of the current study was to discover the validity and reliability of the Baxter Animated Retching Faces (BARF) Nausea Scale among pediatric surgery patients.

Method:

The sample of the study, which was in methodological model, consisted of 82 children aged 7-18 years who were treated at inpatient pediatric surgery clinics. The BARF Nausea Scale is a pictorial nausea scale that rates nausea from neutral (no nausea) to emesis (maximum nausea) with six items and six face expressions that describe each of these items. The scale was developed in the English language and includes assessments based on perceptions; Turkish translation and back-translation procedures were not performed. For the content validity, expert reviews were obtained. While the findings obtained from the study were being evaluated, descriptive statistical methods, the Kolmogorov–Smirnov distribution test, the Mann–Whitney U test, the Kruskal–Wallis test, and Pearson correlation analyses were employed. Cochran's Q test was used to determine the suitability of scale options in theoretically measuring nausea–vomiting.

Findings:

Sixty-one percent of the children aged 7-18 years were male. It was identified that 50% of the children were operated because of gastrointestinal problems, 81.1% of them did not get premedication, 91.5% of them did not use antiemetic medicines, and 41.5% of them started to eat 5-6 hours later after the surgery. It was noted that opinions of all the experts were consistent in terms of content validity and that BARF and the visual analog scale, which was found to be suitable for the Turkish people, could statistically be accepted as equal (Cochran's Q = 9, p = .437).

Result:

In the parallel test in which the visual analog scale and BARF were compared, it was understood that BARF was reliable in assessing nausea and vomiting. In light of these results, it may be suggested that the BARF Nausea Scale was a valid and reliable tool in theoretically measuring nausea–vomiting. It is recommended that the BARF Nausea Scale be used for children over 7 years old to measure nausea after operations.
The Utilization of Hypnosis for Children Recovering From Surgical Procedures
Authors: Edmundson Elizabeth Ellen
Published: December 2016

In the United States, approximately 4 million surgical procedures are performed on children every year. Unfortunately, severe postsurgical pain is common. Patients who still have moderate-to-severe postsurgical pain 1 month after a surgical procedure are at risk for deterioration of their health-related quality of life and the development of chronic postsurgical pain. Despite the magnitude of effects that postsurgical pain can have on a child, it is often inadequately assessed and treated because of the wrong notion that children neither experience or feel pain nor respond to or remember painful experiences to the same degree as adults. PubMed, CINAHL, MEDLINE (R), PsycINFO, and Google Scholar were searched for current research and literature that examine the use of hypnosis to manage pain for children undergoing surgical procedures during their postoperative recovery period. Although the literature supports a paucity of hypnosis research in children undergoing surgical procedures, four studies were found suggesting that hypnosis may be an effective tool to decrease postsurgical pain for children. The current state of the science leaves many opportunities to improve on the postoperative pain management strategies for children recovering from surgical procedures.