bluuebunny/crossref_metadata_2025 huggingface dataset:
Topographic Anatomy of the Anal Sphincter Complex and Levator Ani Muscle as It Relates to Intersphincteric Resection for Very Low Rectal Disease
Authors: Tsukada Yuichiro , Ito Masaaki , Watanabe Kentaro , Yamaguchi Kumiko , Kojima Motohiro , Hayashi Ryuichi , Akita Keiichi , Saito Norio
Published: April 2016

BACKGROUND:

Intersphincteric resection has become a widely used treatment for patients with rectal cancer. However, the detailed anatomy of the anal canal related to this procedure has remained unclear.

OBJECTIVE:

The purpose of this study was to clarify the detailed anatomy of the anal canal.

DESIGN:

This is a descriptive study.

SETTINGS:

Histologic evaluations of paraffin-embedded tissue specimens were conducted at a tertiary referral hospital.

PATIENTS:

Tissue specimens were obtained from cadavers of 5 adults and from 13 patients who underwent abdominoperineal resection for rectal cancer.

MAIN OUTCOME MEASURES:

Sagittal sections from 9 circumferential portions of the cadaveric anal canal (histologic staining) and 3 circumferential portions from patients were studied (immunohistochemistry for smooth and skeletal muscle fibers).

RESULTS:

Longitudinal fibers between the internal and external anal sphincters consisted primarily of smooth muscle fibers that continued from the longitudinal muscle of the rectum. The levator ani muscle attached directly to the lateral surface of the longitudinal smooth muscle of the rectum. The length of the attachment was longer in the anterolateral portion and shorter in the posterior portion of the anal canal. In the lateral and posterior portions, the levator ani muscle partially overlapped the external anal sphincter; however, there was less overlap in the anterolateral portion. In the posterior portion, thick smooth muscle was present on the surface of the levator ani muscle and it continued to the longitudinal muscle of the rectum.

LIMITATIONS:

We observed only limited portions in some surgical specimens because of obstruction by tumors.

CONCLUSIONS:

The levator ani muscle attaches directly to the longitudinal muscle of the rectum. The spatial relationship between the smooth and skeletal muscles differed in different portions of the anal canal. For intersphincteric resection, dissection must be performed between the longitudinal muscle of the rectum and the levator ani muscle/external anal sphincter, and the appropriate surgical lines must be selected based on the specific structural characteristics of each portion.
Tumor Budding Detection by Immunohistochemical Staining is Not Superior to Hematoxylin and Eosin Staining for Predicting Lymph Node Metastasis in pT1 Colorectal Cancer
Authors: Okamura Takuma , Shimada Yoshifumi , Nogami Hitoshi , Kameyama Hitoshi , Kobayashi Takashi , Kosugi Shin-ichi , Wakai Toshifumi , Ajioka Yoichi
Published: April 2016

BACKGROUND:

Tumor budding is recognized as an important risk factor for lymph node metastasis in pT1 colorectal cancer. Immunohistochemical staining for cytokeratin has the potential to improve the objective diagnosis of tumor budding over detection based on hematoxylin and eosin staining. However, it remains unclear whether tumor budding detected by immunohistochemical staining is a significant predictor of lymph node metastasis in pT1 colorectal cancer.

OBJECTIVE:

The purpose of this study was to clarify the clinical significance of tumor budding detected by immunohistochemical staining in comparison with that detected by hematoxylin and eosin staining.

DESIGN:

This was a retrospective study.

SETTINGS:

The study was conducted at Niigata University Medical & Dental Hospital.

PATIENTS:

We enrolled 265 patients with pT1 colorectal cancer who underwent surgery with lymph node dissection.

MAIN OUTCOME MEASURES:

Tumor budding was evaluated by both hematoxylin and eosin and immunohistochemical staining with the use of CAM5.2 antibody. Receiver operating characteristic curve analyses were conducted to determine the optimal cutoff values for tumor budding detected by hematoxylin and eosin and CAM5.2 staining. Univariate and multivariate analyses were performed to identify the significant factors for predicting lymph node metastasis.

RESULTS:

Receiver operating characteristic curve analyses revealed that the cutoff values for tumor budding detected by hematoxylin and eosin and CAM5.2 staining for predicting lymph node metastases were 5 and 8. On multivariate analysis, histopathological differentiation (OR, 6.21; 95% CI, 1.16–33.33; p = 0.03) and tumor budding detected by hematoxylin and eosin staining (OR, 4.91; 95% CI, 1.64–14.66; p = 0.004) were significant predictors for lymph node metastasis; however, tumor budding detected by CAM5.2 staining was not a significant predictor.

LIMITATIONS:

This study was limited by potential selection bias because surgically resected specimens were collected instead of endoscopically resected specimens.

CONCLUSIONS:

Tumor budding detected by CAM5.2 staining was not superior to hematoxylin and eosin staining for predicting lymph node metastasis in pT1 colorectal cancer.
Systematic Review of Surgical Treatments for Fecal Incontinence
Authors: Forte Mary L. , Andrade Kate E. , Lowry Ann C. , Butler Mary , Bliss Donna Z. , Kane Robert L.
Published: April 2016

BACKGROUND:

No systematic review has examined the collective randomized and nonrandomized evidence for fecal incontinence treatment effectiveness across the range of surgical treatments.

OBJECTIVE:

The purpose of this study was to assess the efficacy, comparative effectiveness, and harms of surgical treatments for fecal incontinence in adults.

DATA SOURCES:

Ovid MEDLINE, EMBASE, Physiotherapy Evidence Database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, and the Cochrane Central Register of Controlled Trials, as well as hand searches of systematic reviews, were used as data sources.

STUDY SELECTION:

Two investigators screened abstracts for eligibility (surgical treatment of fecal incontinence in adults, published 1980–2015, randomized controlled trial or observational study with comparator; case series were included for adverse effects). Full-text articles were reviewed for patient-reported outcomes. We extracted data, assessed study risk of bias, and evaluated strength of evidence for each treatment–outcome combination.

INTERVENTIONS:

Surgical treatments for fecal incontinence were included interventions.

MAIN OUTCOME MEASURES:

Fecal incontinence episodes/severity, quality of life, urgency, and pain were measured.

RESULTS:

Twenty-two studies met inclusion criteria (13 randomized trials and 9 observational trials); 53 case series were included for harms. Most patients were middle-aged women with mixed FI etiologies. Intervention and outcome heterogeneity precluded meta-analysis. Evidence was insufficient for all of the surgical comparisons. Few studies examined the same comparisons; no studies were high quality. Functional improvements varied; some authors excluded those patients with complications or lost to follow-up from analyses. Complications ranged from minor to major (infection, bowel obstruction, perforation, and fistula) and were most frequent after the artificial bowel sphincter (22%–100%). Major surgical complications often required reoperation; few required permanent colostomy.

LIMITATIONS:

Most evidence is intermediate term, with small patient samples and substantial methodologic limitations.

CONCLUSIONS:

Evidence was insufficient to support clinical or policy decisions for any surgical treatments for fecal incontinence in adults. More invasive surgical procedures had substantial complications. The lack of compliance with study reporting standards is a modifiable impediment in the field. Future studies should focus on longer-term outcomes and attempt to identify subgroups of adults who might benefit from specific procedures.
Comparative Impact of Hypoglycemic Agents on Severity and Extent of Myocardial Ischemia in Patients With Type 2 Diabetes Mellitus Undergoing Myocardial Perfusion Scintigraphy
Authors: Biondi-Zoccai Giuseppe , Pinto Annamaria , Versaci Francesco , Procaccini Enrica , Neri Giandomenico , Sesti Giorgio , Uccioli Luigi , Vetere Maurizio , Peruzzi Mariangela , Nudi Francesco
Published: April 2016

Background:

Hypoglycemic agents differ in mechanism, efficacy, and profile. However, there is uncertainty on their impact on myocardial perfusion. We thus aimed to investigate whether individuals with type 2 diabetes mellitus treated with different drug classes exhibit different perfusion patterns at myocardial perfusion scintigraphy (MPS).

Methods and Results:

We queried our administrative database for patients with diabetes mellitus without prior or recent myocardial infarction. The primary objective was to compare the severity and extent of ischemia at MPS, distinguishing patients according to management strategy. A total of 7592 patients were included [2336 (31%) on diet, 3611 (48%) on metformin, 749 (10%) on sulfonylureas, 449 (6%) on metformin plus sulfonylureas, 447 (6%) on metformin plus insulin]. Unadjusted analyses and analyses adjusting for baseline features suggested that sulfonylureas alone or in combination were associated with more severe ischemia than nonsulfonylurea regimens (P < 0.05), whereas combination regimens including metformin were associated with more extensive myocardial ischemia than the other regimens (P < 0.05 for both). However, no significant difference disfavoring either metformin or sulfonylurea regimens persisted after multivariable adjustment for baseline, stress, and angiographic characteristics (all P > 0.05).

Conclusion:

Several significant differences in baseline, stress, and scintigraphic features appear evident in patients with diabetes mellitus receiving different hypoglycemic agents or regimens.
Menopause status is associated with circadian- and sleep-related alterations
Authors: Gómez-Santos Cecilia , Saura Cristina Bandín , Lucas J.A. Ros , Castell Pedro , Madrid Juan A. , Garaulet Marta
Published: April 2016

Objective:

The aim of the study was to investigate whether postmenopausal women show differences in circadian-related variables and sleep characteristics compared with premenopausal women, and to analyze potential associations between these circadian-related variables and abdominal fat distribution or metabolic syndrome (MetS) components.

Methods:

A total of 177 women were studied (127 premenopausal, 50 postmenopausal). Sixty percent of the total population was overweight/obese, with no significant differences between premenopausal (60%) and postmenopausal women (62%) (P = 0.865). Wrist temperature (WT) and rest-activity cycles were measured during 8 consecutive days, and sleep and food diaries collected. MetS characteristics and daily patterns of saliva cortisol were analyzed. Sleep characteristics were assessed with domiciliary polysomnography.

Results:

Postmenopausal women showed a less robust rhythm in WT with lower amplitude (°C) (0.8 ± 0.4 vs 0.9 ± 0.5) (P < 0.05) and lower mean temperature values at the midpoint of sleep than premenopausal women. Postmenopausal women were also more morning-type than premenopausal women, showing a phase advance of approximately 1 hour in WT and rest-activity rhythms, and more morning-type habits (earlier sleep onset/offset and breakfast intake) (P < 0.05). Postmenopausal women showed higher levels of activity in the morning and lower in the evening compared with premenopausal women (P < 0.05). Daily variability in cortisol was significantly reduced in postmenopausal women compared with premenopausal women (P < 0.05). Postmenopausal women had increased frequency of sleep-related breathing abnormalities (P < 0.0001). In the women studied, abdominal fat and MetS were associated with an increase in circadian alterations (high fragmentation and low amplitude of the rhythm) (P < 0.05).

Conclusions:

Postmenopausal women exhibit loss of circadian robustness and an increase in sleep abnormalities compared with premenopausal women.
Unusual Vascular Supply to Extensor Digitorum Brevis
Authors: De Silva Dinuksha , Hsieh Frank , Gillies Rowan
Published: April 2016

Lower limb reconstruction after a traumatic event has always been a challenge for plastic surgeons. The reliability of vessel integrity postinjury often drives us away from a local reconstructive option. With the advancement of computed tomography angiogram, it can not only demonstrate the continuation of major vessels but also helps to map the vascular supply at a perforator level. We hereby report an incidentally identified anatomical variant with dual dominant blood supply to the extensor digitorum brevis muscle from an extra branch of anterior tibial artery originated at midtibial level. This variant was picked up preoperatively by computed tomography angiogram and confirmed intraoperatively to be one of the dominant supply. We took advantage of this unusual anatomy by basing our reconstruction on this branch and hence spared the need to terminalize distal dorsalis pedis artery.
30-year International Pediatric Craniofacial Surgery Partnership: Evolution from the “Third World” Forward
Authors: Swanson Jordan W. , Skirpan Jan , Stanek Beata , Kowalczyk Maciej , Bartlett Scott P.
Published: April 2016

Background:

Craniofacial diseases constitute an important component of the surgical disease burden in low- and middle-income countries. The consideration to introduce craniofacial surgery into such settings poses different questions, risks, and challenges compared with cleft or other forms of plastic surgery. We report the evolution, innovations, and challenges of a 30-year international craniofacial surgery partnership.

Methods:

We retrospectively report a partnership between surgeons at the Uniwersytecki Szpital Dzieciecy in Krakow, Poland, and a North American craniofacial surgeon. We studied patient conditions, treatment patterns, and associated complications, as well as program advancements and limitations as perceived by surgeons, patient families, and hospital administrators.

Results:

Since partnership inception in 1986, the complexity of cases performed increased gradually, with the first intracranial case performed in 1995. In the most recent 10-year period (2006–2015), 85 patients have been evaluated, with most common diagnoses of Apert syndrome, Crouzon syndrome, and single-suture craniosynostosis. In the same period, 55 major surgical procedures have been undertaken, with LeFort III midface distraction, posterior vault distraction, and frontoorbital advancement performed most frequently. Key innovations have been the employment of craniofacial distraction osteogenesis, the use of Internet communication and digital photography, and increased understanding of how craniofacial morphology may improve in the absence of surgical intervention. Ongoing challenges include prohibitive training pathways for pediatric plastic surgeons, difficulty in coordinating care with surgeons in other institutions, and limited medical and material resources.

Conclusion:

Safe craniofacial surgery can be introduced and sustained in a resource-limited setting through an international partnership.
Decompression–Avulsion of the Auriculotemporal Nerve for Treatment of Migraines and Chronic Headaches
Authors: Sanniec Kyle , Borsting Emily , Amirlak Bardia
Published: April 2016

Surgical decompression of peripheral branches of the trigeminal and occipital nerves has been shown to alleviate migraine symptoms. Site II surgery involves decompression of the zygomaticotemporal branch of the trigeminal nerve by the technique developed by Guyuron. Failure of site II surgery may occur secondary to an inability to recognize a second temporal trigger: site V, the auriculotemporal nerve. A direct approach for site V has been used with no clear description in the literature. Herein, we describe a safe and efficient method for auriculotemporal nerve decompression during the Guyuron endoscopic approach. Close attention to all temporal sites is necessary to avoid potential failure of migraine decompression surgery.
VITRECTOMY TO REMOVE POSTERIORLY RETAINED IRIS EXPANSION RING
Authors: Olson Jeffrey L. , Mackin Anna G. , Erlanger Michael S.
Published: April 2016

Purpose:

To describe management of posteriorly retained iris expansion ring—a newly reported complication of phacoemulsification surgery in a patient with intact posterior capsule.

Methods:

Case report.

Patients:

A 64-year-old monocular patient with history of regressed proliferative diabetic retinopathy after pars plana vitrectomy, long-standing glaucoma, and cataract, undergoing phacoemulsification for cataract removal, complicated by posterior migration of the Malyugin ring through area of zonular dehiscence despite intact posterior capsule, which resulted in significant visual disturbance.

Results:

The intravitreal Malyugin ring was successfully removed by performing a standard 3-port 25-gauge vitrectomy and retrieving the mobilized ring into the barrel of the original injector device.

Conclusion:

A posteriorly retained iris expansion ring can be effectively extracted from the vitreous cavity with the original injector device, which allows for maximal control of the ring and minimal associated surgical trauma.
DOUBLE PSEUDOHYPOPYON FROM EMULSIFIED HEAVY SILICONE OIL
Authors: Ghasemi Falavarjani Khalil , Modarres Mehdi
Published: April 2016

Purpose:

To report a patient with double pseudohypopyon from emulsification of heavy silicone oil.

Methods:

A 65-year-old woman with rhegmatogenous retinal detachment and a large inferior break underwent pars plana vitrectomy and heavy silicone oil (Oxane HD; Bausch and Lomb, Toulouse, France) tamponade. Eighteen months later, she returned for follow-up examination.

Results:

Slit-lamp examination revealed accumulation of emulsified silicone oil in both the inferior and superior portions of the anterior chamber leading to a “double pseudohypopyon” appearance.

Conclusion:

This case highlights the possibility of decomposition of the Oxane HD silicone oil with time creating an inverted pseudohypopyon from emulsification of light silicone oil in addition to a pseudohypopyon from heavy oil emulsification.
Evaluation of the Cornea and Anterior Chamber Morphologic Changes After Penetrating Keratoplasty in Patients With Keratoconus
Authors: Ort Abdulkadir , Gunes Alime , Kandemir Baran , Calısır Kenan , Kalaycı Mustafa , Genc Oguzhan , Ozerturk Yusuf
Published: April 2016

Objectives:

To evaluate changes of the cornea and anterior chamber after penetrating keratoplasty in eyes with keratoconus.

Methods:

Medical records of 68 eyes of 68 patients with keratoconus who experienced penetrating keratoplasty at the Eye Clinic of Dr. Lütfi Kirdar Kartal Research and Training Hospital between 2010 and 2012 were studied. Records were retrospectively evaluated with regard to anterior chamber depth, iridocorneal angle, central corneal thickness, thinnest corneal thickness, maximum keratometric value, and mean keratometric value. Patients who developed complications and required additional surgery were excluded.

Results:

A total of 68 eyes of 68 patients were included in this study. There were 40 (58.8%) male and 28 (41.2%) female patients. The mean age was 24.5±8.19 years (range: 11–42 years). The graft diameter was 7.5 mm and the recipient bed diameter was 7.0 mm in all patients. The preoperative anterior chamber depth decreased from 3.92±0.47 mm to 3.01±0.55 mm (23% decrease). No significant postoperative change was observed in the mean iridocorneal angle values. Keratometric values decreased by 30% and corneal thickness increased by 50% (P<0.001 for both).

Conclusion:

Anterior chamber depth decreased significantly, but no change was observed in iridocorneal angle after penetrating keratoplasty in patients with keratoconus. Also, a decrease in the keratometric values and an increase in corneal thickness were observed. Understanding, estimating, and managing changes in the anterior chamber after penetrating keratoplasty, which induces significant changes in anterior chamber morphology, might increase the success of surgery.
Glaucoma Surgery Outcome in Rwanda
Authors: De Smedt Stefan K. , Fonteyne Yannick S. , Muragijimana Felicienne , Palmer Katie , Murdoch Ian
Published: April 2016

Purpose:

To assess long-term intraocular pressure (IOP) outcome after adult trabeculectomy surgery in Central Africa.

Patients and Methods:

All adult glaucoma patients who underwent trabeculectomy surgery in the Kabgayi Eye Unit, Rwanda between August 2003 and March 2008 were invited for a follow-up visit. Surgical and clinical data were collected from medical records. At the study visit, best-corrected visual acuity was measured and Goldmann applanation tonometry and biomicroscopy were done. Good IOP outcome was defined as both an IOP<21 mm Hg and achieving ≥30% reduction from the preoperative IOP. Considering first operated eyes, univariate and multivariate logistic regression was used to investigate risk factors for failure.

Results:

Of 163 individuals operated 3 had died, 118 (74%) participated. Preoperatively, the mean IOP was 31 mm Hg (SD=11; range, 12 to 60). At the time of the follow-up study visit the mean postoperative IOP was 13 mm Hg (SD=5; range, 4 to 35). Good IOP outcome was achieved in 132 eyes (84%). Univariate analysis suggested a protective effect against failure of use of antimetabolites [odds ratio (OR)=0.39; 95% confidence interval (CI), 0.14-1.11; P=0.07] and a decrease in success with length of follow-up (OR=3.57; 95% CI, 1.09-12.50; P=0.03). The latter remained borderline significant with multivariate analysis. Seven eyes went from previously better vision (at least hand movements) down to perception of light or no perception of light after trabeculectomy. Particularly a flat anterior chamber in the first postoperative week (OR=0.07; 95% CI, 0.01-0.49; P<0.001) and late hypotony (OR=0.04; 95% CI, 0.002-0.99; P=0.004) were significant risk factors for severe visual loss.

Conclusions:

Trabeculectomy with antimetabolites is one of the best available options for glaucoma management in Africa. However, the IOP control reduced at a follow-up duration beyond 2 years, highlighting the importance of regular long-term follow-up.
A Randomized Controlled Trial to Determine the Effect of Inhaled Corticosteroid on Intraocular Pressure in Open-Angle Glaucoma and Ocular Hypertension: The ICOUGH Study
Authors: Moss Edward B. , Buys Yvonne M. , Low Stephanie A. , Yuen Darana , Jin Ya-ping , Chapman Kenneth R. , Trope Graham E.
Published: April 2016

Purpose:

The purpose of this study was to determine the risk of a steroid pressure response from inhaled corticosteroids.

Patients and Methods:

This randomized, double-masked, placebo-controlled trial included 22 adults with well-controlled open-angle glaucoma or ocular hypertension. Consenting participants were randomized to a 6-week course of twice-daily fluticasone propionate 250-μg metered-dose inhaler or saline placebo metered-dose inhaler. Biweekly clinic visits included masked Goldmann applanation tonometry and assessment to identify adverse effects. Primary outcome was mean intraocular pressure (IOP) at week 6. Secondary outcomes included IOP elevation of >20% at 2 consecutive visits, adherence, side effects, and logMAR visual acuity.

Results:

A total of 10 patients in each arm completed the study. There were no statistically significant differences in IOP between groups at baseline (14.3±3.0 and 15.6±3.6 mm Hg in steroid and placebo groups, respectively, P=0.39) or at week 6 (14.7±2.4 and 14.8±3.8 mm Hg in steroid and placebo groups, respectively, P=0.92). Adherence was >80% for all participants. There were no statistically significant differences between groups in any secondary measures. One patient in the steroid group met the secondary end point of >20% elevation in IOP (IOP increased from baseline of 9 to 11 mm Hg at weeks 2 and 4).

Conclusions:

We found no clinically significant increase in mean IOP in patients with well-controlled open-angle glaucoma and ocular hypertension after 6 weeks of twice-daily inhaled fluticasone propionate compared with inhaled placebo. No participants exceeded their individualized target IOP. There were no differences in secondary outcomes.
User-centered Design of the eyeGuide: A Tailored Glaucoma Behavior Change Program
Authors: Killeen Olivia J. , MacKenzie Chamisa , Heisler Michele , Resnicow Ken , Lee Paul P. , Newman-Casey Paula Anne
Published: April 2016

Purpose:

We employed user-centered design to refine a prototype of the eyeGuide, a novel, tailored behavior change program intended to improve medication adherence among glaucoma patients.

Patients:

Glaucoma patients age 40 years and above prescribed ≥1 glaucoma medication were included.

Methods:

The eyeGuide consists of tailored educational content and tailored testimonials in which patients share how they were able to overcome barriers to improve their medication adherence. A hybrid of semistructured diagnostic and pretesting interviews were used to refine the content of the eyeGuide. Purposeful sampling was used to recruit a study population representative of the glaucoma patient population. Interviews were conducted until thematic saturation was reached. Interviews were audiorecorded and transcribed verbatim. Three researchers analyzed the transcripts, generated a codebook, and identified key themes using NVivo 10.0 to further refine the eyeGuide.

Results:

Twenty-one glaucoma patients were interviewed; mean age 72±12.4 years, 5 (24%) African Americans, 9 (43%) with poor self-reported adherence, 10 (47.6%) age 75 years and above, 10 (47.6%) with poor vision, and 9 (42.9%) women. Qualitative analysis identified 5 important themes for improving glaucoma self-management: social support, patient-provider relationship, medication routine, patients’ beliefs about disease and treatment, and eye drop instillation. All participants expressed satisfaction with in-person delivery of the eyeGuide and preferred this to a Web-based module. Participant feedback resulted in revised content.

Conclusions:

User-centered design generated improvements in the eyeGuide that would not have been possible without patient input. Participants expressed satisfaction with the tailored content.
Endoscopic Medial Rectus Sling: A Window Into the Intraconal Orbital Apex
Authors: Shafi Fariha , Zaidi Syed , Mehta Purnima , Ahluwalia Harpreet Singh , Ahmed Shahzada K.
Published: April 2016

Purpose:

Surgical approaches to the medial orbit especially within the cone of orbital muscles necessitate great precision and care to avoid damage to surrounding structures—most importantly the optic nerve. The authors present a novel technique in which access to the medial orbital contents was achieved through an entirely endoscopic approach.

Methods:

A 72-year-old Caucasian female presented with loss of vision in the right eye and reduced extraocular movements. Baseline blood tests were within normal limits. Inflammatory markers were slightly elevated. CT scan revealed bilateral medial orbital apex masses. Biopsy of the right orbital apex lesion was performed through an exclusively endoscopic approach in which the medial rectus muscle was retracted infero-medially.

Results:

This exclusively endonasal approach to the medial intraconal space provided excellent access to the orbital apex, thus allowing successful biopsy of the medial orbital apex lesion. A video of the surgical technique demonstrates its use in this patient (see Video, Supplemental Digital Content 1, available at http://links.lww.com/IOP/A123).

Conclusions:

Similar reports of endonasal medialization of the medial rectus for accessing intraconal orbital lesions have been previously described in the rhinological literature. The authors describe a modification that allows for a safe and less invasive approach to the medial intraconal space and intraorbital optic nerve. There is minimal trauma to the surrounding tissues and no further damage to the optic nerve along with no associated adverse clinical sequelae. In addition, this negates the need for an adjuvant external or transconjunctival approach.
Clinical Features and Treatment Outcomes of Orbital Inflammatory Disease in Singapore: A 10-Year Clinicopathologic Review
Authors: Young Stephanie M. , Chan Anita S. Y. , Jajeh Issam Al , Shen Sunny , Seah Lay-Leng , Choo Chai-Teck , Lang Stephanie S. , Looi Audrey L. G.
Published: April 2016

Purpose:

1) To assess the clinical profile and treatment outcomes of orbital inflammatory disease in the local population, and 2) classify patients using current histopathological criteria.

Methods:

Ten-year retrospective clinicopathologic review of patients diagnosed with orbital inflammatory disease who underwent tissue biopsy from January 2001 to December 2011 at a tertiary referral centre in Singapore. Data collection included patient demographics, clinical presentation, investigations, systemic disease, histopathology review, clinical classification, medical and surgical management, response to treatment and recurrence rates.

Results:

The study comprised 70 patients. Thirty-seven (52.9%) had nonspecific inflammation distributed as follows: lacrimal (n = 23), diffuse (n = 5), anterior (n = 5), myositic (n = 4). Thirty-three (47.1%) had specific inflammation of the following subtypes: idiopathic sclerosing inflammation (n = 9), granulomatous disorders (n = 8), transitional lesions (n = 5), vasculitis (n = 4), and others (n = 7). A total of 76.8% of patients received oral prednisolone, with a median duration of three months. Response to treatment was good in 71.9% of patients. Recurrence occurred in 22 (32.8%) patients at a mean interval of 20 months after completion of treatment, and was higher in myositic and vasculitic subtypes. There was no significant correlation between duration of treatment and recurrence.

Conclusions:

This study has re-emphasized the importance and utility of orbital biopsy and histopathologic typing for optimal management of orbital inflammatory disease. It has also improved the knowledge of the rate and response to treatment of its various subtypes.
Congenital Sebaceous Trichofolliculoma of the Upper Eyelid
Authors: Al-Ghadeer Huda , Edward Deepak P.
Published: April 2016

A 6-year-old male presented with a protruding hair emerging from a temporally located nodule on his left upper eyelid 5mm above the eyelid margin since birth. The lesion was excised and sent to histopathology. The features were consistent with congenital sebaceous trichofolliculoma, a rare hamartomatous skin lesion.
N-acetyl-cysteine attenuates neuropathic pain by suppressing matrix metalloproteinases
Authors: Li Jiajie , Xu Lujie , Deng Xueting , Jiang Chunyi , Pan Cailong , Chen Lu , Han Yuan , Dai Wenling , Hu Liang , Zhang Guangqin , Cheng Zhixiang , Liu Wentao
Published: April 2016

The treatment of neuropathic pain remains a clinical challenge because of its unclear mechanisms and broad clinical morbidity. Matrix metalloproteinase (MMP)-9 and MMP-2 have previously been described as key components in neuropathic pain because of their facilitation of inflammatory cytokine maturation and induction of neural inflammation. Therefore, the inhibition of MMPs may represent a novel therapeutic approach to the treatment of neuropathic pain. In this study, we report that N-acetyl-cysteine (NAC), which is a broadly used respiratory drug, significantly attenuates neuropathic pain through a unique mechanism of MMP inhibition. Both the in vitro (0.1 mM) and in vivo application of NAC significantly suppressed the activity of MMP-9/2. Orally administered NAC (50, 100, and 200 mg/kg) not only postponed the occurrence but also inhibited the maintenance of chronic constrictive injury (CCI)-induced neuropathic pain in rats. The administration of NAC blocked the maturation of interleukin-1β, which is a critical substrate of MMPs, and markedly suppressed the neuronal activation induced by CCI, including inhibiting the phosphorylation of protein kinase Cγ, NMDAR1, and mitogen-activated protein kinases. Finally, NAC significantly inhibited CCI-induced microglia activation but elicited no notable effects on astrocytes. These results demonstrate an effective and safe approach that has been used clinically to alleviate neuropathic pain through the powerful inhibition of the activation of MMPs.
Characterization of a mouse model of headache
Authors: Huang Dongyue , Ren Lynn , Qiu Chang-Shen , Liu Ping , Peterson Jonathan , Yanagawa Yuchio , Cao Yu-Qing
Published: April 2016

Migraine and other primary headache disorders affect a large population and cause debilitating pain. Establishing animal models that display behavioral correlates of long-lasting and ongoing headache, the most common and disabling symptom of migraine, is vital for the elucidation of disease mechanisms and identification of drug targets. We have developed a mouse model of headache, using dural application of capsaicin along with a mixture of inflammatory mediators (IScap) to simulate the induction of a headache episode. This elicited intermittent head-directed wiping and scratching as well as the phosphorylation of c-Jun N-terminal kinase in trigeminal ganglion neurons. Interestingly, dural application of IScap preferentially induced FOS protein expression in the excitatory but not inhibitory cervical/medullary dorsal horn neurons. The duration of IScap-induced behavior and the number of FOS-positive neurons correlated positively in individual mice; both were reduced to the control level by the pretreatment of antimigraine drug sumatriptan. Dural application of CGRP(8-37), the calcitonin gene-related peptide (CGRP) receptor antagonist, also effectively blocked IScap-induced behavior, which suggests that the release of endogenous CGRP in the dura is necessary for IScap-induced nociception. These data suggest that dural IScap-induced nocifensive behavior in mice may be mechanistically related to the ongoing headache in humans. In addition, dural application of IScap increased resting time in female mice. Taken together, we present the first detailed study using dural application of IScap in mice. This headache model can be applied to genetically modified mice to facilitate research on the mechanisms and therapeutic targets for migraine headache.
Acute Treatment of an Atypical Benign Paroxysmal Positional Vertigo Variant Postsevere Traumatic Brain Injury
Authors: Stam Daniel
Published: April 2016

Background and Purpose:

The differential diagnosis and treatment of peripheral vestibular disorders in persons with traumatic brain injury presents a complex set of challenges. In the acute rehabilitation setting, orthopedic and medical restrictions, agitation, and/or the inability of the patient to verbalize current symptoms present barriers to many traditional means of assessment and intervention. The purpose of this article is to present a case report of 2 patients successfully treated in the acute inpatient rehabilitation setting postsevere traumatic brain injury with an atypical variant of horizontal canal benign paroxysmal positional vertigo in which both examination and intervention modifications were required in a novel context when applied to this patient population.

Case Description:

Two patients were consulted to have a vestibular rehabilitation examination performed given interdisciplinary reports of nystagmus and in 1 case significant emesis associated with bed mobility. Both patients presented as Rancho Los Amigos classification 3 to 4, were nonverbal, and presented with multiple comorbidities.

Intervention:

Both patients were treated for apogeotropic horizontal canal benign paroxysmal positional vertigo using a sequence of bedside canalith repositioning maneuvers safely and efficiently accommodating the clinical brain injury presentation.

Outcomes:

Both patients demonstrated complete remission of horizontal nystagmus and remission of associated emesis in the 1 case allowing for increased interdisciplinary rehabilitation participation.

Discussion:

This case report illustrates how application of recent scientific and clinical evidence may be applied within the early acute brain injury population. Vestibular rehabilitation may be an important component to acute neurological rehabilitation posttraumatic brain injury, even when the patient cannot actively verbalize symptoms. In these cases, the clinician must then use a collaborative approach as well as a clinical decision-making model on the basis of an understanding of the neurological underpinning of eye movements and nystagmus.
Development and Psychometric Evaluation of the Caring Scale for Institutionalized Elders
Authors: Hwang Huei-Lih , Tu Chin-Tang , Wang Hsiu-Hung
Published: April 2016

Background:

A scale that measures the efficacy of care from the perspectives of institutionalized older adults is needed to meet the growing need for better caring knowledge and skills among nurses and caretakers working in long-term care facilities. The currently available tools are insufficient for measuring the caring-related interactions of caretakers with institutionalized older adults.

Purpose:

The aim of this study was to develop and explore the psychometric structure of a caring scale for institutionalized older adults.

Methods:

The scale development process took place in two stages. In the first stage, a 34-item Caring Scale for Institutionalized Elders was generated using literature reviews and interviews with institutionalized older adults. Twenty-nine items were retained after item analysis and content validity testing, and then 19 items were retained after an exploratory factor analysis of 300 institution-dwelling older adults. The factor structure and reliability were further tested in 216 older adults using confirmatory factor analysis. The second stage provided evidence of the validity and reliability of the developed scale. This study was conducted between 2011 and 2013 in Taiwan.

Results:

Confirmatory factor analysis indicated that a 12-item scale with a two-factor structure best fits the data (χ2 =106.990, df = 53, p < .001, χ2/df ratio = 2.019, goodness-of-fit index = .926, comparative fit index = .958, Tucker–Lewis index = .948, root mean square error of approximation = .069). This scale had acceptable Cronbach’s α values (range = .827–.907).

Conclusions:

This scale has satisfactory validity and reliability for measuring the efficacy of care that is provided to institutionalized older adults. Further studies are necessary to test the applicability of this scale to other populations.
Endobronchial Ultrasound Bronchoscope Damage
Authors: Patil Monali , Harris Kassem , Krishnan Amita , Alraiyes Abdul H. , Dhillon Samjot S.
Published: April 2016

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration is an effective, safe, and cost-effective diagnostic bronchoscopy technique for the work-up of mediastinal lymphadenopathy. Concern has been raised, however, about the high cost of convex-probe EBUS bronchoscope repairs. The damage is usually due to breakage of the insertion tube (the flexible part that is advanced into the airways), moisture invasion and damages to the working channel, image guide bundle, or umbilical cord. Understanding the root cause of EBUS scope damage is important for its prevention. We describe 2 unusual cases of EBUS scope damage. In the first case, the distal black rubber covering of the EBUS scope insertion tube was damaged due to friction with the edge of an endotracheal tube and in the second case, the EBUS scope insertion tube was angulating laterally instead of vertically during the flexion maneuver, probably due to scope manipulation while wedged tightly in a segmental bronchus.
mHealth to Train Community Health Nurses in Visual Inspection With Acetic Acid for Cervical Cancer Screening in Ghana
Authors: Asgary Ramin , Adongo Philip Baba , Nwameme Adanna , Cole Helen V.S. , Maya Ernest , Liu Mengling , Yeates Karen , Adanu Richard , Ogedegbe Olugbenga
Published: April 2016

Objective

There is a shortage of trained health care personnel for cervical cancer screening in low-/middle-income countries. We evaluated the feasibility and limited efficacy of a smartphone-based training of community health nurses in visual inspection of the cervix under acetic acid (VIA).

Materials and Methods

During April to July 2015 in urban Ghana, we designed and developed a study to determine the feasibility and efficacy of an mHealth-supported training of community health nurses (CHNs, n = 15) to perform VIA and to use smartphone images to obtain expert feedback on their diagnoses within 24 hours and to improve VIA skills retention. The CHNs completed a 2-week on-site introductory training in VIA performance and interpretation, followed by an ongoing 3-month text messaging–supported VIA training by an expert VIA reviewer.

Results

Community health nurses screened 169 women at their respective community health centers while receiving real-time feedback from the reviewer. The total agreement rate between all VIA diagnoses made by all CHNs and the expert reviewer was 95%. The mean (SD) rate of agreement between each CHN and the expert reviewer was 89.6% (12.8%). The agreement rates for positive and negative cases were 61.5% and 98.0%, respectively. Cohen κ statistic was 0.67 (95% CI = 0.45–0.88). Around 7.7% of women tested VIA positive and received cryotherapy or further services.

Conclusions

Our findings demonstrate the feasibility and efficacy of mHealth-supported VIA training of CHNs and have the potential to improve cervical cancer screening coverage in Ghana.
Percutaneous Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock Is Associated with Improved Short- and Long-Term Survival
Authors: Hryniewicz Katarzyna , Sandoval Yader , Samara Michael , Bennett Mosi , Cabuay Barry , Chavez Ivan J. , Seatter Susan , Eckman Peter , Zimbwa Peter , Dunn Aaron , Sun Benjamin
Published: April 2016

Mortality due to refractory cardiogenic shock (RCS) exceeds 50%. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has become an accepted therapy for RCS. The aim of our study was to evaluate outcomes of patients with RCS treated with percutaneous VA-ECMO (pVA-ECMO). Retrospective review of patients supported with VA-ECMO at our institution in 2012–2013. Clinical characteristics, bleeding, vascular complications, and outcomes including survival were assessed. A total of 37 patients were supported with VA-ECMO for RCS. The majority of VA-ECMO (76%) was placed in the catheterization laboratory. Nearly half (49%) of the patients presented with acute myocardial infarction. Seven patients (19%) underwent insertion of pVA-ECMO in the setting of cardiopulmonary resuscitation with mechanical chest compression device. Median duration of support was 5 days. Index hospitalization, 30-day, and 1-year survival were 65%, 65%, and 57%, respectively. Survival rate for discharged patients was 87.5% with a median follow-up of 450 days. Refractory cardiogenic shock supported with pVA-ECMO is associated with an improved survival in patients with a traditionally poor prognosis.
The relationship between liver histology and noninvasive markers in primary biliary cirrhosis
Authors: Olmez Sehmus , Sayar Suleyman , Avcioglu Ufuk , Tenlik İlyas , Ozaslan Ersan , Koseoglu Hasan T. , Altiparmak Emin
Published: April 2016

Background

Primary biliary cirrhosis (PBC) is a disease that affects liver with various severity and progression rates. It is important to diagnose advanced stage of the disease to lower liver-related morbidity and mortality. Since liver biopsy is an invasive method, liver biopsy tends to be replaced by noninvasive methods. In this study, we aim to show the role of aminotransferase to platelet ratio index (APRI) and fibrosis index on the basis of the four factors (FIB-4) scores, laboratory values, and their effectiveness in predicting advanced disease.

Materials and methods

PBC patients diagnosed pathologically at Numune Education and Research Hospital were included in the study between the years 1995 and 2013. Patients were grouped according to their fibrosis level: group 1 (early stage) included 18 patients with F1 and F2 fibrosis and group 2 (advanced stage) included 22 patients with F3 and F4 fibrosis. APRI and FIB-4 scores, routine laboratory values, and their proportions were compared. The effectiveness of parameters showing advanced stage was further compared.

Results

There were statistically significant differences in APRI, FIB-4 scores, and aspartate aminotransferase (AST) levels between the groups with early and advanced stages of disease. Receiver operating curve analysis was used to determine APRI, FIB-4 and AST levels. The most effective parameters for diagnosing an advanced stage were APRI, AST levels, and FIB-4 scores, respectively.

Conclusion

In conclusion, APRI and FIB-4 scores can be calculated simply and easily by routine laboratory tests at low cost and also these scores may be a predictor of advanced stage of the disease in PBC. These tests may be reproducible and may be used to monitor disease progression.
Hospital preparedness and response in CBRN emergencies: TIER assessment tool
Authors: Olivieri Carlo , Ingrassia Pier L. , Della Corte Francesco , Carenzo Luca , Sapori Jean-Marc , Gabilly Laurent , Segond Fredrique , Grieger Fiene , Arnod-Prin Philippe , Larrucea Xabier , Violi Chrisitan , Lopez Cédric , Djalali Ahmadreza
Published: April 2016

Introduction

Chemical, biological, radiological, and nuclear (CBRN) emergencies need particular hospital preparedness and resources availability. Also, specific skills and capabilities are required for efficient response to these types of events. The aim of this study was to develop an assessment tool to evaluate hospital preparedness and response performance with respect to CBRN emergencies.

Methods

An evaluation tool was developed using the Delphi technique. A panel of experts from 10 countries, both European and non-European, with more than 5 years of experience in research or practice in CBRN emergency management was involved in this study. The study was run online, and the experts were asked to evaluate a list of items on hospital preparedness and response in CBRN emergencies. A threshold of 85% agreement level was defined as the consensus of experts in this study.

Results

The first-round questionnaire was answered by 13 experts. Consensus on the preparedness section was reached for all 29 items during the first round and one item was also added by the experts. Consensus on the response performance indicators were reached in 51 out of the 59 items, during the first round, and eight items were modified and then approved in the second round by the experts.

Conclusion

Hospitals need a specific level of preparedness to enable an effective response to CBRN emergencies. The assessment tool, developed through experts’ consensus in this study, provides a standardized method for the evaluation of hospital preparedness and response performance with respect to CBRN emergencies. The feasibility and reliability of this assessment tool could be evaluated before and during simulated exercises in a standardized manner.
MiR-221 Exacerbate Cell Proliferation and Invasion by Targeting TIMP3 in Papillary Thyroid Carcinoma
Authors: Diao Yingbin , Fu Hongyu , Wang Qian
Published: April 2016

MiR-221 is frequently upregulated in papillary thyroid cancer (PTC) tissues and cell lines, and this study was designed to validate the association of miR-221 with PTC proliferation, apoptosis, and migration. We observed that miR-221 suppressed TIMP3 expression by binding to 3′ untranslated region of TIMP3 mRNA, and TIMP3 expression was increased with the presence of miR-221 inhibitors; TIMP3 siRNA could reverse the effects of miR-221 inhibitors on PTC cells. The results indicated that miR-221 exacerbated PTC by downregulating the expression of TIMP3. The effects of miR-221 and TIMP3 in vivo were also confirmed by human PTC-bearing mice models which suggest consistent results with those in vitro studies. In summary, miR-221 could aggravate cell proliferation and invasion of PTC by targeting TIMP3.