bluuebunny/crossref_metadata_2025 huggingface dataset:
Peripheral Intrastromal Hydration Facilitates Safe, Deep Trephination in Corneas of Irregular Thickness
Authors: Bovone Cristina , Myerscough James , Friehmann Asaf , Elkadim Mohamed , Parmeggiani Francesco , Busin Massimo
Published: July 2019

Purpose:

To evaluate the feasibility of regularizing the peripheral corneal thickness before deep trephination in highly irregular corneas undergoing deep anterior lamellar keratoplasty (DALK) by means of intrastromal hydration with saline.

Methods:

This is an interventional case series including all eyes with irregular peripheral corneal thickness undergoing DALK for any indication between January 1, 2016, and January 1, 2017, at a single tertiary center in Forli, Italy. Before trephination, 1 mL of normal saline was injected intrastromally into each clock hour of peripheral thinning (determined using preoperative pachymetry) using a 30-gauge needle. A deep trephination of 400 to 450 μm was then performed, and DALK was completed as per our previously described technique. Primary outcome measures were perforation during trephination and intraoperative complications, with secondary outcomes of best corrected visual acuity and refraction.

Results:

Peripheral intrastromal hydration was performed in 61 eyes of 61 patients. Intrastromal hydration ensured a safe trephination without perforation into the anterior chamber (AC) in 59 of 61 eyes. In the 2 cases in which perforation occurred, the perforation site was sutured with a full-thickness suture and the surgery was completed successfully. No cases required conversion to penetrating keratoplasty. Intrastromal injection of 1 mL of normal saline resulted in an increase in corneal thickness of 31%. After surgery, double AC was observed in 3 cases (4.9%), with all cases being managed successfully by air injection into the AC.

Conclusions:

Zonal peripheral intrastromal hydration is a feasible technique to enable safe, deep trephination even in corneas of highly irregular thickness.
Antimycotic Efficacy and Safety of a New Cold Corneal Storage Medium by Time–Kill and Toxicity Studies
Authors: Giurgola Laura , Gatto Claudio , Parel Jean-Marie , Miller Darlene , D'Amato Tóthová Jana
Published: July 2019

Purpose:

To evaluate a new corneal cold storage medium including an antimycotic tablet (Kerasave, AL.CHI.MI.A. S.r.l.).

Methods:

Kerasave and tryptone soy broth (control) were inoculated with 103 and 105 colony-forming units (CFU)/mL of 6 Candida isolates (Candida albicans [n = 4], Candida tropicalis [n = 1], and Candida glabrata [n = 1]). Minimum inhibitory concentrations (MICs) were determined using amphotericin B Etest strips. Sterile porcine corneas contaminated with 105 CFU/mL of each isolate were incubated in Kerasave and control at 4°C. Growth rate and Log10 reduction at 4°C at different time intervals were determined for liquid samples and tissue homogenates. Kerasave biocompatibility was assessed according to ISO 10993-5 and ISO 10993-10.

Results:

No C. albicans or C. tropicalis colonies were recovered from Kerasave inoculated with 103 CFU/mL after incubation for 3 days at 4°C. C. glabrata was inhibited but not killed after 3 days at 4°C. Four of the 6 strains contaminated with 105 CFU/mL demonstrated a significant ≥ 3 Log10 reduction in media and tissue homogenates within 5 days as compared to controls (p < 0.01). Amphotericin B MICs ranged from 0.19 to 0.38 μg/mL for C. albicans (n = 3) and C. tropicalis (n = 1). C. glabrata showed reduced susceptibility (0.5 μg/mL) and 1 C. albicans was resistant to amphotericin B (≥ 1 μg/mL). Kerasave was not cytotoxic, irritating, or sensitizing according to the ISO standards.

Conclusions:

Kerasave showed high antifungal efficacy against susceptible fungal strains at 4°C in the presence and absence of corneal tissue. Resistant strains to amphotericin B were not eliminated by Kerasave. Kerasave is not cytotoxic, irritating, or sensitizing.
Treatment of Severe Keratoconus Hydrops With Intracameral Platelet-Rich Plasma Injection
Authors: Alio Jorge L. , Toprak Ibrahim , Rodriguez Alejandra E.
Published: July 2019

Purpose:

To present successful management of severe corneal hydrops by corneal optical coherence tomography (OCT) guidance and intracameral application of eye platelet-rich plasma (E-PRP) in a case with Down syndrome.

Methods:

A 36-year-old woman with Down syndrome presented with acute vision loss, pain, photophobia, and corneal edema in the left eye. Clinical examination revealed keratoconus in the right eye and extreme keratoconus with severe corneal hydrops in the left eye. Anterior segment OCT (MS-39, Costruzione Strumenti Oftalmici, Firenze, Italy) showed intrastromal cystic fluid collection and ruptured and detached Descemet membrane. The OCT-guided management of hydrops is first described in this case report.

Results:

Medical treatment and intracameral sulfur hexafluoride injection failed. A sterile 0.3 mL of E-PRP was injected into the anterior chamber. Clinical and anatomical improvement began from the first postoperative day, and corneal edema totally resolved at 1 week. Postoperatively, no significant side effect was noted except an early transient moderate (28 mm Hg) intraocular pressure peak. Anterior segment-OCT demonstrated dramatic normalization in corneal morphology with total disappearance of fluid in the cystic intracorneal space, closure of the DM rupture, and DM reattachment. The patient was stable during the 6-month follow-up.

Conclusions:

In this case, intraocular E-PRP was a promising, apparently safe, and effective treatment option in management of corneal hydrops, in which conventional approaches failed. This is the first case in the literature to describe OCT appearance of corneal hydrops and intracameral use of E-PRP for the resolution of DM rupture in acute corneal hydrops.
Combined Phototherapeutic Keratectomy, Intracorneal Ring Segment Implantation, and Corneal Collagen Cross-Linking in Keratoconus Management
Authors: Rocha Guillermo , Ibrahim Tarek , Gulliver Eric , Lewis Kylee
Published: July 2019

Purpose:

To evaluate the efficacy, predictability, and safety of combined corneal collagen cross-linking (CXL), intracorneal ring segment (ICRS) implantation, and superficial phototherapeutic keratectomy (PTK) in patients with keratoconus.

Methods:

Fifty-five eyes received ICRS implantation, followed by CXL and PTK combination treatment. Patients were followed up for 6 months. Primary outcomes included Logarithm of the Minimum Angle of Resolution (LogMAR) uncorrected distance VA (UDVA) and corrected distance VA (CDVA), sphere, cylinder, mean spherical equivalent, index of surface variance, index of vertical asymmetry, keratoconus index, central keratoconus index, index of height asymmetry, and index of height decentration. Secondary outcomes were higher-order aberrations (HOAs), including HOA total, coma, spherical, secondary astigmatism, and trefoil.

Results:

At 6 months, there was a statistically significant improvement in UDVA, CDVA, sphere, and cylinder compared with baseline (P < 0.001). UDVA improved in 14% of the eyes to 20/25 and 96% had at least 20/40 or better spectacle corrected vision; 30.9% of the eyes were within ±0.5 diopter (D), 45.5% of the eyes were within ±1.0 D, and 74.5% of the eyes were within ±2.0 D. For CDVA, 1 eye (2%) lost 3 lines (but gained UDVA), 11% lost 1 line, 38% showed no change, and 49% gained between 1 and 8 lines of vision. Eighty-eight United Arab Emiratespercent of the eyes had at least 1 line of UDVA visual improvement, 79% improved by ≥2 lines, and 69% improved by ≥3 lines. HOA total, coma, spherical aberration, and secondary astigmatism showed improvements of −0.87 (P < 0.001), −0.84 (P < 0.001), −0.10 (P = 0.002), and −0.15 (P = 0.035), respectively.

Conclusions:

A combined procedure of ICRS implantation, CXL, and PTK is effective, predictable, and apparently safe for patients diagnosed with moderate keratoconus.
In Vivo and Ex Vivo Comprehensive Evaluation of Corneal Reinnervation in Eyes Neurotized With Contralateral Supratrochlear and Supraorbital Nerves
Authors: Giannaccare Giuseppe , Bolognesi Federico , Biglioli Federico , Marchetti Claudio , Mariani Silvia , Weiss Jayne S. , Allevi Fabiana , Cazzola Federica E. , Ponzin Diego , Lozza Alessandro , Bovone Cristina , Scorcia Vincenzo , Busin Massimo , Campos Emilio C.
Published: July 2019

Purpose:

To use an automated morphometric analysis system of in vivo confocal microscopy (IVCM) images for evaluating reinnervation occurring at the subbasal nerve plexus (SNP) after direct corneal neurotization (DCN) and to further report neurophysiological and histopathological findings.

Methods:

Prospective interventional case series including 3 eyes with neurotrophic keratitis that underwent DCN. Deep anterior lamellar keratoplasty was performed 18 months after DCN in patient 1. The following evaluations were performed before and at 3, 6, and 12 months after DCN: clinical evolution of keratitis; corneal sensitivity; IVCM images of the SNP analyzed with “ACCMetrics;” neurophysiological study of corneal reflex. Protein gene product 9.5 immunofluorescence staining assay and transmission electron microscopy were conducted on the neurotized button excised during deep anterior lamellar keratoplasty.

Results:

Complete healing was obtained in all patients by 3 months postoperatively. Corneal sensitivity was absent preoperatively in all eyes and improved after surgery, reaching an average value of 30 mm 1 year postoperatively. The corneal SNP was not visible at IVCM in any of the cases preoperatively and became visible by 3 months postoperatively, showing IVCM metrics comparable to normal contralateral eyes at 1 year. In all cases, neurophysiological evaluation showed a partial recovery of the electrical activity of the cornea. In patient 1, protein gene product (PGP) 9.5 staining of neurotized cornea showed nerve fascicles at the SNP, whereas transmission electron microscopy showed amyelinic nerve axons and nerve endings.

Conclusions:

The corneal SNP exhibited IVCM metrics comparable to the normal contralateral eye 1 year after DCN. Ex vivo histopathological assessment of neurotized corneas confirmed the presence of nerves with normal ultrastructure.
Did Collagen Cross-Linking Reduce the Requirement for Corneal Transplantation in Keratoconus? The Canadian Experience
Authors: Sklar Jaime C. , Wendel Colten , Zhang Angela , Chan Clara C. , Yeung Sonia N. , Iovieno Alfonso
Published: July 2019

Purpose:

To investigate the relationship between corneal collagen cross-linking (CXL) and the number of corneal transplants required for the treatment of keratoconus (KCN) in 2 major Canadian provinces.

Methods:

This is a retrospective review of all corneal transplantation performed in Ontario and British Columbia over an 18-year period (1998–2016). Data were collected at the Eye Bank of Canada—Ontario/British Columbia Divisions. The primary outcome was to determine the change in proportion and absolute number of corneal transplants required for treatment of KCN since the introduction of CXL in Canada in 2008.

Results:

A total of 31,943 grafts were included. Overall, the mean age of participants was 39.3 ± 2.2 years, with our cohort being composed of 28% of women and 72% of men. The results showed a significant decrease in the proportion of total transplants required for KCN between 1998 and 2016 [1998–2008 (pre-CXL), range: 14.77%–12.63%; 2009–2016 (post-CXL), range: 12.98%–5.50%, P < 0.001]. However, there was no change in the absolute number of grafts performed for KCN over this time (pre-CXL: 179 ± 26 grafts; post-CXL: 198 ± 27 grafts; P = 0.5), whereas the total number of grafts (pre-CXL: 1318 ± 183 grafts; post-CXL: 2181 ± 404; P < 0.001) and endothelial keratoplasties (pre-CXL: 59 ± 108; post-CXL: 966 ± 431 grafts; P < 0.001) increased significantly. In addition, there were no changes in penetrating keratoplasty/deep anterior lamellar keratoplasty (DALK) performed for indications other than KCN (pre-CXL: 1080 ± 157; post-CXL: 1017 ± 92; P > 0.5).

Conclusions:

Although there has been a significant decrease in the proportion of corneal graft rates for KCN since the introduction of CXL as a factor of all transplants performed for all indications, this result is most likely because of an increase in endothelial keratoplasties rather than decreased transplants performed for definitive treatment.
Efficacy and Safety of Trabeculectomy Versus Nonpenetrating Surgeries in Open-angle Glaucoma: A Meta-analysis
Authors: Gabai Andrea , Cimarosti Rossella , Battistella Claudio , Isola Miriam , Lanzetta Paolo
Published: July 2019

Purpose:

The purpose of this study was to conduct a meta-analysis on the efficacy and safety of trabeculectomy (TE) and nonpenetrating glaucoma surgery (NPGS) techniques in patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma, and normal-tension glaucoma.

Methods:

All studies were identified by searching electronic sources (PubMed, Medline, Scopus, and Embase) until February 5, 2018. Primary outcome was mean intraocular pressure (IOP) reduction at 6, 12, and 24 months. Complications, number of antiglaucomatous medications, and visual outcomes were also evaluated.

Results:

Twenty-one studies were included. Ten studies compared TE with deep sclerectomy (DS), 5 with viscocanalostomy (VC), 1 study with both DS and VC, and 5 with canaloplasty (CP). TE was superior to DS, VC, and CP in reducing IOP at 6 and 12 months, and to DS at 24 months. When comparing TE to VC and to CP at 24 months, there was no significant difference in IOP reduction. Hypotony, choroidals, anterior chamber shallowing or flattening, and cataract formation or progression were more associated with TE than with NPGSs. TE was more effective in reducing antiglaucomatous medications than VC and CP.

Conclusions:

TE is more effective in reducing IOP. TE presents a higher risk of complications as compared with NPGS, except for hyphema.
Association of Gabapentin or Pregabalin Use and Incidence of Acute Angle-closure Glaucoma
Authors: Browne Mitchell J. , Zakrzewski Helena , Carleton Bruce , Etminan Mahyar , Mikelberg Frederick S.
Published: July 2019

Precis:

Gabapentin and its derivatives have numerous indications and are commonly prescribed medications. In this article, we provide evidence of a link between gabapentinoid use and incidence of acute angle-closure glaucoma.

Purpose:

Gabapentinoids, such as gabapentin and pregabalin, are commonly prescribed classes of drugs in North America. We sought to determine the association of gabapentin or pregabalin use and the incidence of acute angle-closure glaucoma.

Materials and Methods:

This was a nested case-control study. All adult patients who developed acute angle-closure glaucoma between January 1, 2006 and December 31, 2016, and enrolled in the PharMetrics Plus database were eligible for inclusion. A conditional logistic regression model was constructed to assess the association between gabapentin or pregabalin use and the incidence of acute angle-closure glaucoma.

Results:

Incidence of acute angle-closure glaucoma was found to be statistically significantly associated with the use of gabapentin in the year before diagnosis [relative risk (RR), 1.42; 95% confidence interval (CI), 1.00-2.00]. This association was not observed to be statistically significant with the current use of gabapentin (RR, 1.28; 95% CI, 0.77-2.12). Incidence of acute angle-closure glaucoma (AAG) was not found to be statistically significantly associated with either use of pregabalin in the year before diagnosis or current use (RR, 1.00; 95% CI, 0.51-1.93 and RR, 1.50; 95% CI, 0.66-3.38, respectively).

Conclusions:

To the best of our knowledge this is the first study to investigate the association between gabapentin or pregabalin use and the incidence of AAG. Gabapentin use in the year before diagnosis was found to be associated with the incidence of AAG.
Safety and Efficacy of Ceftazidime–Avibactam in the Treatment of Children ≥3 Months to <18 Years With Complicated Urinary Tract Infection: Results from a Phase 2 Randomized, Controlled Trial
Authors: Bradley John S. , Roilides Emmanuel , Broadhurst Helen , Cheng Karen , Huang Li-Min , MasCasullo Veronica , Newell Paul , Stone Gregory G. , Tawadrous Margaret , Wajsbrot Dalia , Yates Katrina , Gardner Annie
Published: July 2019

Background:

Ceftazidime–avibactam is effective and well tolerated in adults with complicated urinary tract infection (cUTI), but has not been evaluated in children with cUTI.

Methods:

This single-blind, multicenter, active-controlled, phase 2 study (NCT02497781) randomized children ≥3 months to <18 years with cUTI (3:1) to receive intravenous (IV) ceftazidime–avibactam or cefepime for ≥72 hours, with subsequent optional oral switch. Total treatment duration was 7–14 days. Primary objective was assessment of safety. Secondary objectives included descriptive efficacy and pharmacokinetics. A blinded observer determined adverse event (AE) causality and clinical outcomes up to the late follow-up visit (20–36 days after the last dose of IV/oral therapy).

Results:

In total, 95 children received ≥1 dose of IV study drug (ceftazidime–avibactam, n = 67; cefepime, n = 28). The predominant baseline Gram-negative uropathogen was Escherichia coli (92.2%). AEs occurred in 53.7% and 53.6% patients in the ceftazidime–avibactam and cefepime groups, respectively. Serious AEs occurred in 11.9% (ceftazidime–avibactam) and 7.1% (cefepime) patients. One serious AE (ceftazidime–avibactam group) was considered drug related. In the microbiologic intent-to-treat analysis set, favorable clinical response rates >95% were observed for both groups at end-of-IV and remained 88.9% (ceftazidime–avibactam) and 82.6% (cefepime) at test-of-cure. Favorable per-patient microbiologic response at test-of-cure was 79.6% (ceftazidime–avibactam) and 60.9% (cefepime).

Conclusions:

Ceftazidime–avibactam was well tolerated in children with cUTI, with a safety profile consistent with that of adults with cUTI and of ceftazidime alone, and appeared effective in children with cUTI due to Gram-negative pathogens.
Asymptomatic Pharyngeal Carriage of Kingella kingae Among Young Children in Vancouver, British Columbia, Canada
Authors: Masud Shazia , Greenman Janet , Mulpuri Kishore , Hasan Mohammad R. , Goldfarb David M. , Tilley Peter , Gadkar Vijay J. , Al-Rawahi Ghada N.
Published: July 2019

Background:

Kingella kingae has emerged as a significant cause of osteoarticular infections in young children. Pharyngeal colonization is considered a prerequisite for invasive K. kingae infection. We conducted a prospective study to estimate the prevalence of pharyngeal carriage of K. kingae among healthy young children in Vancouver.

Methods:

From March 2016 to May 2017, children between 6 and 48 months of age visiting British Columbia Children’s Hospital outpatient clinics for noninfectious causes were included in the study. Another set of participants was enrolled from a day-care center located at British Columbia Children’s Hospital. A single-throat swab was collected after obtaining consent from parent/guardian. The samples were stored at −70°C and tested using an in-house developed real-time polymerase chain reaction assay. Epidemiologic characteristics and risk factors for K. kingae colonization were collected via a study questionnaire.

Results:

A total of 179 children were enrolled in the study, but only 174 samples were eligible for testing. Of the 174 samples, 5 had indeterminate results and the remaining 169 samples were negative by K. kingae polymerase chain reaction. The median age of participants was 23 months. About 36% of children were attending day care and had another sibling <5 years of age. Previous history of cold symptoms and antibiotic use was reported in 42% and 12%, respectively.

Conclusions:

The results of our study showed no prevalence of asymptomatic pharyngeal carriage of K. kingae in young children in Vancouver. Additional multicenter studies may help to understand the differences in pharyngeal carriage rate among healthy children.
A Randomized, Double-blind, Active-controlled Phase III Trial of a Cell Culture-derived Quadrivalent Inactivated Influenza Vaccine in Healthy South Korean Children and Adolescents 6 Months to 18 Years of Age
Authors: Eun Byung Wook , Lee Taek Jin , Lee Jina , Kim Ki Hwan , Kim Dong Ho , Jo Dae Sun , Shin Sun Hee , Kim Hun , Kim Kyung-Ho , Kim Yun-Kyung
Published: July 2019

Background:

Cell culture-derived influenza vaccines have several important advantages over egg-based influenza vaccines. The quadrivalent influenza vaccine may offer broader protection against seasonal influenza than trivalent influenza vaccine by containing 1 more B strain. The purpose of this study was to evaluate the immunogenicity and safety of NBP607-QIV, a novel cell culture-derived inactivated quadrivalent influenza vaccine (cIIV4), in children and adolescents.

Methods:

This phase III, randomized, double-blind, multicenter trial in children/adolescents (6 mo to 18 yr) was conducted in South Korea during 2014–2015 season. Subjects were randomized 4:1 to receive either NBP607-QIV or control inactivated trivalent influenza vaccine. Hemagglutination inhibition antibody titers were assessed in prevaccination and 28 days postvaccination sera. Safety data were collected for up to 6 months postvaccination.

Results:

A total of 454 participants completed the study. Three-hundred sixty-six subjects received cIIV4 and 88 subjects received inactivated trivalent influenza vaccine. Overall, NBP607-QIV met the immunogenicity criteria of Committee for Medicinal Products for Human Use for each of the 4 strains. Between the NBP607-QIV and control groups, immunogenicity endpoints were comparable. Participants younger than 3 years of age had lower immunologic responses to 2 influenza B strains in both NBP607-QIV and control group. No deaths, vaccine-related serious adverse events (AEs) or withdrawals because of AEs were reported. The solicited AEs reported were generally of mild intensity.

Conclusions:

NBP607-QIV, a novel cIIV4, showed good immunogenicity to all 4 influenza strains and had tolerable safety profiles in children and adolescents. Moreover, NBP607-QIV was more immunogenic against influenza B compared with the control, an egg-based subunit vaccine.
Drug-Induced Fulminant Hepatitis in a Child Treated for Latent Multidrug-Resistant Tuberculosis With Dual Therapy Combining Pyrazinamide and Levofloxacin
Authors: Huguet Annabelle , Ader Florence , Ohlmann Camille , Collardeau-Frachon Sophie , Gillet Yves
Published: July 2019

We report the case of a 10-year-old child treated for latent tuberculosis infection (LTBI) with pyrazinamide (PZA) and levofloxacin after contact with a smear-positive multidrug-resistant tuberculosis adult. Over the course of the treatment, the patient developed a drug-induced fulminant hepatitis attributed to the combination of PZA and levofloxacin. This case highlights the hepatotoxicity of the association of second-line anti-TB treatment in children.
Linaclotide treatment reduces endometriosis-associated vaginal hyperalgesia and mechanical allodynia through viscerovisceral cross-talk
Authors: Ge Pei , Ren Jingmei , Harrington Andrea M. , Grundy Luke , Castro Joel , Brierley Stuart M. , Hannig Gerhard
Published: July 2019

Endometriosis, an estrogen-dependent chronic inflammatory disease, is the most common cause of chronic pelvic pain. Here, we investigated the effects of linaclotide, a Food and Drug Administration–approved treatment for IBS-C, in a rat model of endometriosis. Eight weeks after endometrium transplantation into the intestinal mesentery, rats developed endometrial lesions as well as vaginal hyperalgesia to distension and decreased mechanical hind paw withdrawal thresholds. Daily oral administration of linaclotide, a peripherally restricted guanylate cyclase-C (GC-C) agonist peptide acting locally within the gastrointestinal tract, increased pain thresholds to vaginal distension and mechanical hind paw withdrawal thresholds relative to vehicle treatment. Furthermore, using a cross-over design, administering linaclotide to rats previously administered vehicle resulted in increased hind paw withdrawal thresholds, whereas replacing linaclotide with vehicle treatment decreased hind paw withdrawal thresholds. Retrograde tracing of sensory afferent nerves from the ileum, colon, and vagina revealed that central terminals of these afferents lie in close apposition to one another within the dorsal horn of the spinal cord. We also identified dichotomizing dual-labelled ileal/colon innervating afferents as well as colon/vaginal dual-labelled neurons and a rare population of triple traced ileal/colon/vaginal neurons within thoracolumbar DRG. These observations provide potential sources of cross-organ interaction at the level of the DRG and spinal cord. GC-C expression is absent in the vagina and endometrial cysts suggesting that the actions of linaclotide are shared through nerve pathways between these organs. In summary, linaclotide may offer a novel therapeutic option not only for treatment of chronic endometriosis-associated pain, but also for concurrent treatment of comorbid chronic pelvic pain syndromes.
Preoperative breast volume evaluation of one-stage immediate breast reconstruction using three-dimensional surface imaging and a printed mold
Authors: Chen Keng , Feng Chin-Jung , Ma Hsu , Hsiao Fu-Yin , Tseng Ling-Ming , Tsai Yi-Fang , Lin Yen-Shu , Huang Li-Ying , Yu Wen-Chan , Perng Cherng-Kang
Published: July 2019

Background:

Accurate assessment of breast volume is an essential component of preoperative planning in one-stage immediate breast reconstruction (IBR) for achieving breast symmetry and a satisfactory cosmetic outcome. In this study, we compared breast volume estimation using three-dimensional (3D) surface imaging with magnetic resonance imaging (MRI) to determine the accuracy of breast volume measurements. Further, a 3D printing mold for facilitating autologous breast reconstruction intraoperatively is described.

Methods:

Patients scheduled to therapeutic or prophylactic mastectomy with one-stage IBR, either by autologous tissue transfer or direct implant, from 2016 to 2019, were enrolled in this study. 3D surface image and MRI were performed to evaluate breast volume and shape. The results were validated by the water displacement volume of the mastectomy specimen. Finally, a 3D printing mold was designed for breast reconstruction with autologous tissue.

Results:

Nineteen women who were scheduled to have 20 mastectomies (18 unilateral and one bilateral) were included. There was a strong linear association between breast volume measured using the two different methods and water displacement of mastectomy specimens when a Pearson correlation was used (3D surface image: r = 0.925, p < 0.001; MRI: r = 0.915, p < 0.001). Bland-Altman plots demonstrated no proportional bias between the assessment methods. The coefficient of variation was 52.7% for 3D surface imaging and 59.9% for MRI. The volume of six breasts was evaluated by both measurements and the intraclass correlation coefficient was 0.689 for 3D surface image (p = 0.043) and 0.743 for MRI (p = 0.028).

Conclusion:

Using 3D surface image to evaluate breast shape and volume is a quick, effective, and convenient method. The accuracy, reproducibility, and reliability of 3D surface imaging were comparable with MRI in our study. In addition, 3D-printed molds can achieve better symmetry and aesthetic outcomes in immediate autologous breast reconstructions.
CD4+ T Cell Count, Sleep, Depression, and Anxiety in People Living With HIV: A Growth Curve Mixture Modeling
Authors: Shi Yirong , Yang Chongming , Xu Liumei , He Yun , Wang Hui , Cao Jing , Wen Min , Chen Weimei , Wu Baohong , Chen Suqing , Chen Huiwen
Published: July 2019

We investigated changes in CD4+ T cell counts related to sleep quality, depression, anxiety, and sociodemographic variables in heterogeneous groups of people living with HIV in a 6-month prospective study. Our longitudinal study involved 247 ambulatory patients living with HIV and using antiretroviral therapy. Sleep quality, anxiety, depression, and CD4+ T cell counts were assessed three times at 3-month intervals. Growth curve mixture modeling was conducted to explore changes over time. A two-class mixture model with logarithmic change pattern fit the data best. For the majority of the sample (89.1%), anxiety, depression, and sleep quality did not change when CD4+ T cells increased. For a small proportion of the sample (11.9%), sleep quality, anxiety, and depression deteriorated when CD4+ T cells decreased. Marital status and alcohol use affected the classification significantly. Health care professionals should provide relevant services to people living with HIV with decreasing CD4+ T cell counts.
Perspective of neo-adjuvant/conversion and adjuvant therapy for pancreatic neuroendocrine tumors
Authors: Chen Luohai , Chen Jie
Published: July 2019

The incidence rate of pancreatic neuroendocrine tumors (panNET) is increasing continuously. Curative resection was the primary treatment choice for panNET. However, till now, there were few studies concerning neo-adjuvant/conversion and adjuvant therapy for panNET. In this article, we reviewed the currently widely used medical treatments for advanced panNET. It seemed that peptide receptor radionuclide therapy (PRRT), chemotherapy (temozolomide-based or streptozocin-based) and sunitinib might be more effective to induce tumor shrinkage in panNET and therefore, these treatments could be tried in panNET when neo-adjuvant/conversion therapy was considered. As for adjuvant therapy, it was of great importance to identify patients with high risks of recurrence after curative surgery and previous studies found that high ki-67 index, large tumor size, lymphatic metastasis and perineural/vascular invasion, and so on, were correlated with early recurrence of panNET. Since PRRT and chemotherapy were more cytotoxic, these two kinds of therapies might be worth trying as adjuvant therapies in patients with high risks of recurrence after curative resection of panNET. Admittedly, no studies discussed in this review directly investigated neo-adjuvant/conversion and adjuvant therapy for panNET. Therefore, more prospective studies were still warranted.
The Pillow Project, Infant Choking, and Basic Life Support Training for Prospective Parents
Authors: Barry Maebh , Dixon Mark , Armstrong Claire , Keane Frank
Published: July 2019

Dissemination of pediatric basic life support skills, while recommended, is not done routinely for pregnant women and their partners within the maternity services. This study evaluates an e-learning program coupled with the use of a novel infant pillow mannequin to determine whether a low-cost intervention with potential for widespread application could enable training in the event of an infant choking and the provision of basic life support. A prospective cohort study with an uncontrolled pre- and posttest design was used following institutional ethical approval. A 4-week cycle of antenatal education classes in a regional Maternity Hospital in Ireland and a purposive sample of pregnant women and their partners attending the antenatal education classes were used. The following measures were assessed: (1) confidence in knowing what to do in the event of an infant choking; (2) confidence in performing infant cardiopulmonary resuscitation (CPR); (3) ability to perform the requisite skills; and (4) the perceived acceptability of the infant pillow mannequin as a means of practice. Twenty-four individuals completed a pre- and postprogram questionnaire. The e-learning program along with practice on the pillow mannequin significantly affected confidence (P < .001) in the actions to take in the event of an infant choking and in performing infant CPR. Forty-four participants used the pillow mannequin for practice and volunteered to have their skills assessed. More than 90% demonstrated correct positioning of the infant in the event of choking, correctly identified the correct ratio of chest compressions to breaths, and conducted chest compressions to the required depth. Three distinct categories of comment were identified: usefulness of the program; simplicity of the program/pillow mannequin; and accessibility for practice at home. A self-instructional e-learning program coupled with an infant pillow mannequin enables parents to learn the procedure in the event of an infant choking and to demonstrate basic life support. This low-cost intervention has the potential for widespread application within developed and developing countries.
When Disaster Strikes in Rural America—Call the Midwife!
Authors: Mielke Ruth , Prepas Roberta
Published: July 2019

Midwives can play a critical role in emergency preparedness and response. Rural areas have unique disaster preparedness needs but receive less attention than urban centers. Childbearing women and infants are particularly affected during disasters. Midwives are well positioned to coordinate disaster preparedness training and response to optimize the health of women and infants in rural areas.
Emergency Preparedness in Obstetrics
Authors: Maher Melissa J.
Published: July 2019

Large-scale natural or environmental disasters, infectious disease outbreaks, and terrorist attacks are becoming increasingly common in developed countries. In response to these local, national, and international tragedies, many healthcare systems have developed hospital preparedness programs to manage catastrophic disasters while maintaining essential patient care. However, emergency preparedness initiatives that specifically address the unique needs of pregnant women are lacking. The purpose of this article is to identify challenges that impact perinatal patients during disasters and provide strategies and recommendations for emergency preparedness. Specific emphasis is placed on perinatal emergency preparedness including obstetric triage, surge capacity, sheltering in place, trauma in pregnancy, mental health, and management of special pathogens. Guidance to hospitals on the immediate evaluation, stabilization, acute management, and transfer of pregnant patients and neonates following these events is provided.
Hurricane Harvey
Authors: Ybarra Nan
Published: July 2019

One hospital's experiences during the Hurricane Harvey disaster are reviewed and detailed using the strategic technique of strengths, weaknesses, opportunities, and threats analysis. Three leadership behaviors, adaptability, empowerment, and social justice, are discussed relative to organizational resiliency. This hospital's journey during Hurricane Harvey is analyzed using these leadership behaviors in a detailed strengths, weaknesses, opportunities, and threats analysis format. Key lessons learned from this exercise are presented and are applicable to other disaster situations facing hospital performance.
Maternal Factors Associated With the Healthcare Utilization of Technology-Dependent Infants Following NICU Discharge
Authors: Toly Valerie Boebel , Sattar Abdus , Zauszniewski Jaclene A.
Published: July 2019

This study examined the relationship of mothers' psychological well-being (depressive symptoms, posttraumatic stress symptoms) and resourcefulness with their technology-dependent infants' healthcare utilization (rehospitalization, emergency department [ED] visits) following discharge from the neonatal intensive care unit (NICU). This descriptive, correlational study was conducted at a large Midwest level 4 NICU in the United States. Mothers (n = 19) with a technology-dependent infant (eg, supplemental oxygen, feeding tubes) to be discharged home from the NICU within 2 to 3 weeks were interviewed face-to-face using standardized instruments. Infant rehospitalization and ED visit data were collected from the electronic medical record (EMR) for the first 3 months following the infant's discharge. Analyses included descriptive statistics and negative binomial regression. A majority of infants (72.2%) required at least 1 hospitalization; 33% required at least one ED visit. Mothers' age and resourcefulness were significant predictors of ED visits while only resourcefulness predicted rehospitalizations. Neither depressive symptoms nor posttraumatic stress symptoms significantly predicted healthcare utilization. Maternal resourcefulness was the only main variable that significantly predicted both ED visits and hospitalizations and one of the few modifiable factors that could assist mothers with successfully coping with the complexity of caring for a technology-dependent infant. Future research should focus on interventions to enhance mothers' resourcefulness prior to their technology-dependent infant's NICU discharge.
Simulation Prepares an Interprofessional Team to Evacuate a 60-Bed Level 4 Neonatal Intensive Care Unit
Authors: Zell Lisa , Blake Carmen , Brittingham Dawn , Brown Ann-Marie , Soghier Lamia
Published: July 2019

In August 2011, a 5.8 magnitude earthquake struck the Baltimore/Washington, District of Columbia, corridor. The event identified a critical requirement to prepare our interprofessional team to evacuate approximately 60 neonatal patients. A needs assessment indicated that 60% of staff members had little or no knowledge of the unit's evacuation plan and 55% of respondents were not aware of their specific role in an emergency evacuation. The neonatal intensive care unit educators in collaboration with the unit's medical team, the leadership team, the hospital emergency management team, and the unit practice and professional council coordinated the design, implementation, and assessment of the simulated evacuation activity. To encourage realism within the simulated activity, prepared manikins were placed in patient rooms and assigned varying levels of acuity. The training session began with a prebrief session that included a description of the evacuation plan, delineation of roles, responsibilities based on scope of practice, use of the evacuation equipment, and unit emergency bags. Participants engaged in a debrief session following each session during which the staff notably expressed an increased confidence with the evacuation plan, roles, and operation of the evacuation equipment. In addition, the debriefing allowed for identification of latent threats, which the planning group used to streamline the evacuation process.
Incidence and Risk of Various Disorders of the External Ear in Patients With Hearing Aids Treated in ENT Practices in Germany
Authors: Seidel David Ulrich , Park Jonas Jae-Hyun , Sesterhenn Andreas M. , Kostev Karel
Published: July 2019

Objective:

The aim of the study was to investigate the relationship between the presence of a hearing aid (HA) and the occurrence of various disorders of the external ear, using data from ear, nose, and throat (ENT) practices in Germany from a nationwide, representative practice database.

Methods:

In the period between 2012 and 2016, the incidences of disorders of the external ear (ICD-10 groups H60 and H61) in patients with HA prescriptions were compared retrospectively with a control group without HA prescriptions (1:1 matching).

Results:

A total of 20,127 patients with HA prescriptions were compared with 20,127 controls. The highest 12-month incidences (HA vs. controls) were determined for “Impacted cerumen” (H61.2) (16.5% vs. 4.2%), “Unspecified otitis externa” (H60.9) (2.6% vs. 1.2%) and "Acute noninfective otitis externa" (H60.5) (2.3% vs. 0.7%). The most significant risk increases for HA wearers were found for “Abscess of external ear" (H60.0, OR 10.03), “Other otitis externa" (H60.8, OR 6.00), and “Impacted cerumen" (H61.2, OR 4.55). A smaller risk increase was found for “Cholesteatoma of external ear" (H60.4, OR 2.26), among others.

Conclusion:

In HA wearers, the risk of developing almost all of the diagnoses reviewed is significantly increased, especially for external auditory canal (EAC) furuncle, chronic otitis externa, and impacted cerumen. This study provides the first epidemiological evidence for HA as a risk factor for the rare EAC cholesteatoma.
Vestibular Schwannoma Tumor Size Is Associated With Acute Vestibular Symptoms After Gamma Knife Therapy
Authors: Lee Daniel Y. , Lerner David K. , Naples James G. , Brant Jason A. , Bigelow Douglas C. , Lee John Y. K. , Alonso-Basanta Michelle , Ruckenstein Michael J.
Published: July 2019

Objective:

To assess how pretreatment vestibular schwannoma (VS) tumor characteristics are associated with vestibular symptoms after gamma knife (GK) surgery.

Study Design:

Retrospective chart review of patients undergoing GK treatment for VS at our institution from 2005 to 2018.

Setting:

Academic tertiary referral center.

Patients:

Patients receiving primary GK surgery for vestibular schwannomas with at least 6 months of follow up. Patients with neurofibromatosis 2 or previous surgery were excluded.

Main Outcome Measures:

The presence of posttreatment vestibular symptoms within 6 months after GK. Clinical records were assessed for pretreatment tumor, patient, and treatment characteristics that impacted posttreatment symptoms.

Results:

All patients received radiation doses between 12 and 13 Gy. Of 115 patients, the average age was 60. Thirty-seven (32%) patients developed vestibular symptoms within 6 months post-GK, and 18 patients were referred for vestibular rehabilitation. Ten of 13 patients undergoing vestibular rehabilitation reported improvement. Overall, 112 patients had tumor measurements. Pretreatment tumors were significantly smaller for patients with acute vestibular symptoms (mean 1.43 cm versus 1.71 cm, p = 0.007). On multivariate analysis, smaller tumor size (p = 0.009, odds ratio [OR] = 0.29, 95% confidence interval [CI] [0.12–0.73]) was significantly associated with vestibular symptoms within 6 months of GK. Patients with tumors less than 1.6 cm were more likely to receive referrals for vestibular rehabilitation within 6 months posttreatment (25% versus 9.4%, p = 0.026, OR = 3.22, 95% CI [1.00, 11.32]).

Conclusions:

Smaller vestibular schwannomas were significantly associated with higher rates of post-GK vestibular symptoms. Pretreatment tumor size may be used to counsel patients on the likelihood of post-GK vestibular symptoms and vestibular rehabilitation.
Density of Macrophages Immunostained With Anti-iba1 Antibody in the Vestibular Endorgans After Cochlear Implantation in the Human
Authors: Okayasu Tadao , O’Malley Jennifer T. , Nadol Joseph B.
Published: July 2019

Hypothesis:

Cochlear implantation may result in an increase in the density of macrophages in vestibular endorgans in the human.

Background:

Vestibular symptoms are a common complication of cochlear implantation. In a previous study, we demonstrated histological evidence of a foreign-body response caused by silicon and platinum in the human cochlea following cochlear implantation. The objective of the current study was to seek evidence of a possible immune response in vestibular endorgans after cochlear implantation.

Methods:

The density of macrophages immunostained with anti-Iba1 antibody in the vestibular endorgans (lateral and posterior semicircular canals, utricle and saccule) in 10 human subjects who had undergone unilateral cochlear implantation was studied by light microscopy. The densities of macrophages in the neuroepithelium, subepithelial stroma, and among dendritic processes in the mid-stromal zone in four vestibular endorgans in the implanted and the opposite unimplanted ears were compared. The distributions of macrophage morphology (amoeboid, transitional and ramified) were also compared.

Results:

The densities of macrophages in implanted ears in four vestibular endorgans were significantly greater than that in opposite unimplanted ears except in the subepithelial zone of the utricle and posterior semicircular canal. In contrast to the neuroepithelium, the subepithelial distribution of amoeboid macrophages in implanted ears was significantly less than in unimplanted ears.

Conclusion:

An increase in the density of macrophages in four vestibular endorgans after implantation was demonstrated. The transition among phenotype of macrophages suggested possible migration of amoeboid macrophages from the subepithelial stroma into the neuroepithelium.
Hearing and Quality of Life Over Time in Vestibular Schwannoma Patients: Observation Compared to Stereotactic Radiosurgery
Authors: Miller Lauren E. , Brant Jason A. , Chen Jinbo , Kaufman Adam C. , Ruckenstein Michael J.
Published: July 2019

Objective:

To examine quality of life changes for patients with vestibular schwannoma (VS) undergoing observation or stereotactic radiosurgery (SRS).

Study Design:

Retrospective review.

Setting:

Academic medical center.

Patients:

Patients with VS who underwent observation or SRS and had at least two audiograms and Penn Acoustic Neuroma Quality of Life (PANQOL) surveys, a quality of life survey for patients with VS.

Interventions:

SRS or observation.

Main Outcome Measures:

Pure-tone average (PTA), speech discrimination score (SDS), PANQOL score; controlling for tumor size, baseline hearing, and other factors.

Results:

One hundred twenty-three patients met inclusion criteria: 89 underwent observation and 34 SRS. There was no significant difference in the rate of decline measured by PTA (PTA worsened at a rate of 0.25 dB/yr more in the observation group compared with the SRS group, p = 0.77) and SDS (SDS worsened at a rate of 2.1%/yr more in the SRS group compared with the observation group, p = 0.82). Kaplan–Meier analysis demonstrated the SRS group had a higher probability to progress to class D hearing over observation (hazard ratio 7.1, p = 0.005). The rate of change of the SRS PANQOL scores was significantly improved in the total (p = 0.005) and hearing (p = 0.04) domain score compared with observation. However, both groups regress to a similar PANQOL total and hearing domain score over time.

Conclusion:

PANQOL scores were higher at baseline in the observation group than in the SRS group. However, over time, PANQOL scores in the observation group decreased while PANQOL scores in the SRS group increased, resulting in PANQOL scores that were equivalent by the end of follow-up.
The Influence of Metabolic Syndrome on the Prognosis of Idiopathic Sudden Sensorineural Hearing Loss
Authors: Zhang Yanni , Jiang Qian , Wu Xuewen , Xie Shaobing , Feng Yong , Sun Hong
Published: July 2019

Objectives:

We aimed to verify the hypothesis that metabolic syndrome (MetS) and its components affect the prognosis of idiopathic sudden sensorineural hearing loss (ISNNHL).

Study Design:

A retrospective cohort study.

Setting:

Tertiary otology referral center.

Patients:

We divided patients who were diagnosed with ISSNHL between January 2015 and January 2018 into a MetS group and a Non-MetS group according to the diagnostic criteria of MetS.

Interventions:

We diagnosed ISSNHL patients by using pure-tone audiometry and treated them with oral steroids, blood flow promoting agents, and hyperbaric oxygen therapy.

Main Outcome Measures:

We used multivariate logistic analysis to identify prognostic factors of ISSNHL.

Results:

The MetS group comprised 94 patients, and the Non-MetS group comprised 162 subjects. Despite the rate of hypertension, diabetes mellitus, hyperlipidemia, and BMI, no significant difference was observed between the two groups (p > 0.05). The rates of complete recovery and partial recovery of the MetS group were significantly lower than those of the Non-MetS group (p < 0.05). According to the multivariate analysis, MetS was significantly correlated with a poor prognosis (OR = 2.912, p = 0.008), and the OR increased with an increase in the number of MetS components. Late onset of treatment, high initial hearing threshold, and presence of diabetes mellitus and hyperlipidemia were associated with a poor prognosis (p < 0.05).

Conclusions:

The presence of MetS may negatively affect the recovery of Chinese patients with ISSNHL, and the prognosis was poorer with an increase in the number of MetS components. Early onset of treatment, low initial hearing threshold and absence of diabetes mellitus, and hyperlipidemia are associated with favorable hearing recovery.