bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure: Findings From the Extracorporeal Life Support Organization Database
Authors: Lorusso Roberto , Gelsomino Sandro , Parise Orlando , Di Mauro Michele , Barili Fabio , Geskes Gijs , Vizzardi Enrico , Rycus Peter T. , Muellenbach Raf , Mueller Thomas , Pesenti Antonio , Combes Alain , Peek Giles , Frenckner Bjorn , Di Nardo Matteo , Swol Justyna , Maessen Jos , Thiagarajan Ravi R.
Published: May 2017

Objectives:

To assess in-hospital neurologic (CNS) complications in adult patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure.

Design:

Retrospective analysis of the Extracorporeal Life Support Organization’s data registry.

Setting:

Data reported to Extracorporeal Life Support Organization from 350 international extracorporeal membrane oxygenation centers during 1992–2015.

Patients:

Adults (≥ 18 yr old) supported with veno-venous extracorporeal membrane oxygenation for respiratory failure.

Interventions:

None.

Measurements and Main Results:

We included 4,988 adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. Neurologic injury was defined as brain death, seizures, stroke, and intracranial hemorrhage occurring during extracorporeal membrane oxygenation support. We used multivariable logistic regression to explore patient and extracorporeal membrane oxygenation factors associated with neurologic injury. Median age of the study cohort was 46 (interquartile range, 32–58). Four hundred twenty-six neurologic complications were reported in 356 patients (7.1%), and included 181 intracranial hemorrhage (42.5%), 100 brain deaths (23.5%), 85 stroke (19.9%), and 60 seizure events (14.1%). In-hospital mortality was significantly higher for those with CNS complications (75.8% vs 37.8%;p< 0.001) and varied by type of CNS injury; mortality was 79.6% in patients with intracranial hemorrhage, 68.2% in patients with stroke, and 50% in patients with seizures. Pre-extracorporeal membrane oxygenation cardiac arrest, continuous veno-venous hemofiltration, and hyperbilirubinemia during extracorporeal membrane oxygenation were associated with increased odds of neurologic injury.

Conclusions:

Approximately 7% of adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure had neurologic injury. Intracranial hemorrhage was the most frequent type, and survival for patients with neurologic injury was poor. Future investigations should evaluate anticoagulation management as well as brain/extracorporeal membrane oxygenation interaction to reduce these life-threatening events.
Ultrasound Evaluation as a Complementary Test in Hidradenitis Suppurativa: Proposal of a Standarized Report
Authors: Martorell Antonio , Wortsman Ximena , Alfageme Fernando , Roustan Gaston , Arias-Santiago Salvador , Catalano Orlando , Scotto di Santolo Maria , Zarchi Kian , Bouer Marcio , Gaitini Diana , Gonzalez Claudia , Bard Robert , García-Martínez F. Javier , Mandava Anitha
Published: May 2017

BACKGROUND

Staging and monitoring of patients with hidradenitis suppurativa (HS) have been traditionally based on clinical findings. However, the physical examination may show important limitations because of its poor sensitivity for differentiating between different lesion subtypes, and its low sensitivity to define the disease's activity.

OBJECTIVE

To develop a consensus ultrasound (US) report that could summarize the relevant anatomical characteristics and staging of patients considering the experience of radiologists and dermatologists working on imaging of HS.

METHODS

A questionnaire on different aspects related to US examination in HS was performed. A working group, called DERMUS, composed of doctors from 9 countries who have been working in dermatologic US applied in patients with HS on a regular basis were included to evaluate the different items provided.

RESULTS

A consensus US report to evaluate HS patients was established.

CONCLUSION

The authors present the first attempt to define a HS standardized sonographic report. This model would be the first effort to include this imaging technique as the first elective medical test for staging and monitoring patients, which can support therapeutic decisions by providing earlier, objective, deeper, anatomical, and comparative evaluations in this difficult to treat disease.
Filler Nodules: Inflammatory or Infectious? A Review of Biofilms and Their Implications on Clinical Practice
Authors: Ibrahim Omer , Overman Joseph , Arndt Kenneth A. , Dover Jeffrey S.
Published: May 2017

BACKGROUND

The numbers of minimally invasive cosmetic procedures performed in the United States have steadily increased each year. Concurrently, the rates of filler complications have also increased. Delayed filler reactions and granulomas have recently been attributed to biofilm infections.

OBJECTIVE

The biology and pathogenesis of biofilms, and their diagnosis, treatment, and prevention will be discussed.

METHODS

The relevant and recent literature on delayed filler reactions and biofilms was reviewed.

RESULTS

Increasing evidence implicates biofilm infections in the pathogenesis of delayed filler reactions. Therapeutic and preventative measures can be taken to minimize the occurrence of these potentially devastating consequences of dermal fillers.

CONCLUSION

Awareness of biofilm infections is key in the assessment of filler reactions in order to ensure timely and accurate diagnosis and treatment.
Pelvic organ prolapse: does hormone therapy use matter?
Authors: Wasenda Erika J. , Kamisan Atan Ixora , Subramaniam Nishamini , Dietz Hans Peter
Published: May 2017

Objective:

To determine the effect of hormone therapy (HT) use on pelvic organ support.

Methods:

A retrospective observational study involving postmenopausal women with pelvic floor dysfunction attending a tertiary urogynecology center between January 2012 and March 2015. All underwent a clinical examination including International Continence Society Pelvic Organ Prolapse Quantification and 4D translabial ultrasound imaging. Information on current or former use of systemic HT and current local estrogen use was collected. Main outcome measure was pelvic organ support.

Results:

One thousand four hundred forty-three women were seen during the study period. On univariate analysis, current HT was significantly associated with sonographically determined descent of the rectal ampulla (β [95% confidence interval] 3.4 mm [0.4-6.5], P = 0.03) and Gh + Pb (−0.45 mm [−0.8 to −0.1], P = 0.005). Past HT use, duration of HT use, or current vaginal estrogen use was not associated with pelvic organ support. On multivariate analysis controlling for age, parity, body mass index, history of forceps delivery, and avulsion, the association between current HT on the one hand and Gh + Pb as well as increased descent of the rectal ampulla on ultrasound, remained significant (P = 0.008 and P = 0.012, respectively).

Conclusion:

HT may have a minor negative effect on pelvic organ support; however, the effect is likely too small to be clinically relevant.
SCOTOMA CHARACTERISTICS IN MACULAR TELANGIECTASIA TYPE 2
Authors: Vujosevic Stela , Heeren Tjebo F. C. , Florea Daniela , Leung Irene , Pauleikhoff Daniel , Sallo Ferenc , Bird Alan , Peto Tunde ,   on behalf of the MacTel Study Group
Published: May 2017

Purpose:

To characterize scotomas in macular telangiectasia Type 2 (MacTel).

Methods:

Five of the 27 centers performed microperimetry as part of the MacTel Natural History Observation Study. Data were analyzed in the Moorfields Eye Hospital Reading Centre. The number of stimuli under a threshold of 12, 10, 8, and <0 dB were counted (thresholding) and compared with one another.

Results:

A total of 565 examinations were gradable, received from 632 eyes of 322 participants (age 61.1 ± 9.1 years, 62% females). The authors found absolute scotomas in 243 eyes (43%), 98% of these affected the temporal quadrant, and 99.5% were unifocal. Growth of absolute scotomas was limited to an extent of approximately 40 deg2. Although transition from functionally unimpaired retina to absolute scotomas is generally steeply sloped, the larger a scotoma, the steeper it is.

Conclusion:

Scotoma features were consistent throughout a large MacTel cohort. The temporal quadrant was confirmed as predominantly affected, which might result from vascular or metabolic asymmetry. Functional loss did not exceed an area of 5° × 8° however advanced the disorder. Different MacTel phenotypes seem likely and point toward different types of progression; identifying these would improve planning for clinical trials and might lead to better understanding patient outcome.
RETINOCHOROIDAL ANASTOMOSIS ASSOCIATED WITH ENHANCED S-CONE SYNDROME
Authors: Zerbib Jennyfer , Blanco Garavito Rocio , Gerber Sylvie , Oubraham Hassiba , Sikorav Anne , Audo Isabelle , Kaplan Josseline , Rozet Jean-Michel , Souied Eric H.
Published: May 2017

Purpose:

To describe the phenotype and genotype of a 10-year-old boy affected with enhanced S-cone syndrome associated with neovascularization.

Methods:

Fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral domain optical coherence tomography, full-field electroretinogram and NR2E3 molecular testing were performed.

Results:

Best-corrected visual acuity was measured as 20/32, right eye and 20/20, left eye. Fluorescein and indocyanine green angiographies showed unilateral macular retinochoroidal anastomosis on his right eye, and spectral domain optical coherence tomography showed typical signs of subretinal exudation and foveolar pseudoschisis consistent with the diagnosis of enhanced S-cone syndrome. Genetic analysis revealed biparental transmission of mutations in the enhanced S-cone syndrome-causing gene, NR2E3, namely, c.194_202del (p.Asn65_Cys67del), and c.932 G>A (p.Arg311Gln), supporting an autosomal recessive inheritance. The patient received three intravitreal injections of anti-VEGF agents.

Conclusion:

Evidence of retinochoroidal anastomosis in an individual affected with enhanced S-cone syndrome supports the view that neovascularization can occur early in the course of the disease, and raises the question to know whether it might be responsible for previously described enhanced S-cone syndrome-associated hemorrhage-induced fibrosis.
An Assessment of the Clinical Acceptability of Direct Acoustic Cochlear Implantation for Adults With Advanced Otosclerosis in the United Kingdom
Authors: Kitterick Pádraig Thomas , Reddy-Kolanu Guna , Baguley David , Lavy Jeremey , Monksfield Peter , Banga Rupan , Ray Jaydip , Snik Ad , O’Donoghue Gerard M.
Published: May 2017

Hypothesis:

Assess the clinical acceptability of direct acoustic cochlear implantation for patients with advanced otosclerosis and the support for conducting a controlled trial of its effectiveness in the United Kingdom.

Background:

Emerging evidence supports the efficacy of direct acoustic cochlear implantation in patients with advanced otosclerosis whose needs cannot be managed using the combination of stapes surgery and hearing aids. A controlled trial would provide evidence for its effectiveness and cost-effectiveness to healthcare commissioners.

Methods:

An online survey of clinical professionals was constructed to characterize current standard of care for patients with advanced otosclerosis and to assess whether clinicians would be willing to refer patients into a trial to evaluate direct acoustic cochlear implantation. A consensus process was conducted to define inclusion criteria for the future trial.

Results:

No survey respondent considered direct acoustic cochlear implantation to be inappropriate with a majority indicating that they would refer patients into a future trial. The consensus was that there is a lack of available treatment options for those patients with bone conduction thresholds worse than 55 dB HL and who did not meet current criteria for cochlear implantation.

Conclusion:

The present study confirms that a controlled trial to evaluate the effectiveness of direct acoustic cochlear implantation would have the support of clinicians in the United Kingdom. A feasibility study would be required to determine whether patients who meet the inclusion criteria could be recruited in a timely manner and in sufficient numbers to conduct a formal evaluation of effectiveness.
Central Nervous System Disease, Education, and Race Impact Radiation Refusal in Pediatric Cancer Patients
Authors: Patel Chirayu G. , Stavas Mark , Perkins Stephanie , Shinohara Eric T.
Published: May 2017

To investigate the determinants of radiation therapy refusal in pediatric cancer, we used the Surveillance, Epidemiology, and End Results registry to identify 24,421 patients who met the eligibility criteria, diagnosed between 1974 and 2012. Patients had any stage of cancer, were aged 0 to 19, and received radiation therapy or refused radiation therapy when it was recommended. One hundred twenty-eight patients (0.52%) refused radiation therapy when it was recommended. Thirty-two percent of patients who refused radiation therapy ultimately died from their cancer, at a median of 7 months after diagnosis (95% confidence interval, 3-11 mo), as compared with 29.0% of patients who did not refuse radiation therapy died from their cancer, at a median of 17 months after diagnosis (95% confidence interval, 17-18 mo). On multivariable analysis, central nervous system (CNS) site, education, and race were associated with radiation refusal. The odds ratio for radiation refusal for patients with CNS disease was 1.62 (P=0.009) as compared with patients without CNS disease. For patients living in a county with ≥10% residents having less than ninth grade education, the odds ratio for radiation refusal was 1.71 (P=0.008) as compared with patients living in a county with <10% residents having less than ninth grade education. Asian, Pacific Islander, Alaska Native, and American Indian races had an odds ratio of 2.12 (P=0.002) for radiation refusal as compared with black or white race. Although the radiation refusal rate in the pediatric cancer population is low, we show that CNS site, education level, and race are associated with a significant difference in radiation refusal.
Allogeneic Hematopoietic Cell Transplantation for Dyskeratosis Congenita: A Report of 3 Cases
Authors: Tamura Shinichi , Imamura Toshihiko , Urata Takayo , Kobayashi Miki , Gen Mari , Tomii Toshihiro , Do Junko , Osone Shinya , Ishida Hiroyuki , Hosoi Hajime , Kuroda Hiroshi
Published: May 2017

Although bone marrow failure in patients with dyskeratosis congenita (DKC) can be successfully treated with allogeneic hematopoietic cell transplantation (allo-HCT) using a reduced intensity conditioning (RIC) regimen, the outcome of nonhematological disorders in patients with DKC treated with allo-HCT using RIC has not been fully elucidated. Here, we describe the clinical course of nonhematological disorders after allo-HCT with RIC in 3 consecutive patients with DKC. Allo-HCT with RIC was feasible in all cases; however, patient 1 developed lethal pulmonary disease and patient 2 experienced progression of hepatic fibrosis. Careful follow-up of patient-specific complications is required after allo-HCT in patients with DKC.
Attention Deficit Hyperactivity Disorder in Children With Sickle Cell Disease Referred for an Evaluation
Authors: Acquazzino Melissa A. , Miller Meghan , Myrvik Matthew , Newby Robert , Scott John Paul
Published: May 2017

Neuropsychological deficits, including difficulties with attention, are well described in children with sickle cell disease (SCD). Very little is known about attention deficit hyperactivity disorder (ADHD) in children with SCD. The objective of this study was to determine the proportion of ADHD in children with SCD referred for neuropsychological evaluation. This prospective, cross-sectional study included patients (age, 4 to 18 y) with SCD and completion of a neuropsychological evaluation between December 2013 and March 2016. Patients were referred for neuropsychological evaluation because of concern regarding school performance, development, and/or behavior. The diagnosis of ADHD was made by a neuropsychologist on the basis of the diagnostic criteria in the Diagnostic Statistical Manual—Fourth or Fifth Editions. ADHD medication usage rate was obtained by medical record review. Of the 89 patients with SCD referred for neuropsychological evaluation, 25% (95% confidence interval, 16%-35%) met diagnostic criteria for ADHD. Only 21% of the patients with SCD and ADHD were prescribed an ADHD medication. Our study supports routine ADHD screening in children with SCD who have poor school performance or behavioral concerns. Despite the benefits of pharmacologic treatment, the majority of patients with SCD and ADHD did not receive a medication for management of their ADHD.
Clinical Features and Prognosis According to Immunophenotypic Subtypes Including the Early T-Cell Precursor Subtype of T-Lymphoblastic Lymphoma in the Japanese Pediatric Leukemia/Lymphoma Study Group ALB-NHL03 Study
Authors: Fukano Reiji , Sunami Shosuke , Sekimizu Masahiro , Takimoto Tetsuya , Mori Tetsuya , Mitsui Tetsuo , Mori Takeshi , Saito Akiko Moriya , Watanabe Tomoyuki , Ohshima Koichi , Fujimoto Junichiro , Nakazawa Atsuko , Kiyokawa Nobutaka , Kobayashi Ryoji , Horibe Keizo , Tsurusawa Masahito
Published: May 2017

We reviewed the immunophenotypic subtypes of pediatric T-cell lymphoblastic lymphoma in the Japanese Pediatric Leukemia/Lymphoma Study Group ALB-NHL03 study. Of the 104 patients, 40 patients each had sufficient data to evaluate the immunophenotypes and early T-cell precursor (ETP) subtype. Pro-T, pre-T, intermediate T, and mature T cells were observed in 1, 9, 21, and 9 cases, respectively. The 3-year event-free survival (EFS) rates of those with pro-T/pre-T, intermediate T, and mature T cells were 80.0±12.6%, 71.4±9.9%, and 88.9±10.5%, respectively (P=0.546). There were 8 and 32 cases of ETP and non-ETP subtypes, with 3-year EFS rates of 75.0±15.3% and 71.9±8.0%, respectively (P=0.828), indicating that the immunophenotypic subtype was not predictive of EFS in this study.
Long-term Outcome of 4 Patients With Transcobalamin Deficiency Caused by 2 Novel TCN2 Mutations
Authors: Nashabat Marwan , Maegawa Gustavo , Nissen Peter H. , Nexo Ebba , Al-Shamrani Hussain , Al-Owain Mohammed , Alfadhel Majid
Published: May 2017

Cobalamin (vitamin B12 [Cbl]) is an essential cofactor for many biochemical pathways. Transcobalamin (TC) is required to internalize Cbl into the cells through membrane receptor-mediated endocytosis. Cbl is then processed in the cytoplasm and mitochondria by complementation factors leading to its active metabolites; methylcobalamin and 5-deoxyadenosyl-cobalamin. Deficiency of TC results in an elevation in methylmalonic acid and homocysteine. Patients usually present with macrocytic anemia, pancytopenia, failure to thrive, gastrointestinal symptoms, and neurological dysfunction. In this study, we report 4 patients from 2 unrelated families, with confirmed diagnosis of TC deficiency. Patients initially had a typical presentation of TC deficiency: severe diarrhea and vomiting, recurrent infections, stomatitis, macrocytic anemia, and neutropenia. Interestingly one of the patients was diagnosed at 3 months of age and developed ataxic gait related to cerebellar atrophy at the age of 14 months. His elder affected sibling was diagnosed at 5 months of age was completely normal. Two sibs, diagnosed at 2 months of age and immediately after birth, had autism spectrum disorder. Molecular investigations showed 2 novel mutations in TCN2 gene. Patients were treated and stayed stable on weekly injection of Cbl. In conclusion, TC deficiency has a wide heterogeneity in clinical phenotype, genotype, laboratory, and radiologic findings. Early detection of the disease and early initiation of aggressive parenteral treatment is probably associated with better prognosis and disease control.
Invasive Pneumococcal Disease in Patients With Sickle Cell Disease
Authors: Navalkele Pournima , Özgönenel Bülent , McGrath Eric , Lephart Paul , Sarnaik Sharada
Published: May 2017

Background:

Patients with sickle cell disease (SCD) are at risk of fatal sepsis with encapsulated bacteria, such as Streptococcus pneumoniae, because of the inherent autosplenectomy that occurs in SCD. This risk is thwarted with oral penicillin prophylaxis during the first 5 years of life, and with stringent vaccination against S. pneumoniae alongside routine childhood immunization. But compared with the general African American pediatric population, the rate of invasive pneumococcal disease (IPD) in patients with SCD still remains high, resulting in hospitalization and fatality.

Methods:

Patients with SCD who developed IPD from 2004 up to 2013 were identified using microbiology records. Descriptive analysis of presence of risk factors for IPD, type of SCD, pneumococcal vaccination and prophylaxis status, clinical presentation, microbiological data, and the outcome of IPD was performed.

Results:

Eight patients with SCD developed IPD (7 bacteremia and 1 respiratory tract infection). Three of the 8 isolates underwent serotype analysis (15 C in 2 and 15A in 1), none covered with the current vaccination program. One patient had fatal outcome (15A).

Conclusions:

Breakthrough cases of IPD may involve nonvaccine isolates, and seem to occur after 5 years of age when oral penicillin prophylaxis has been terminated.
Effect of Simulation on Learner Stress as Measured by Cortisol
Authors: McGuire Kelley , Lorenz Rebecca
Published: May 2017

Simulated learning has become a mainstay in nursing education. Current literature focuses primarily on the development and implementation of simulation, although little is known about the stress that students experience. This integrative review examines studies evaluating learner stress in simulated settings as measured by cortisol. Findings suggest that cortisol is a valid measure of stress in simulation. Evidence is inconclusive on whether elevated stress during simulation promotes performance.
Identification and Management of Obese Patients in a Pediatric Orthopaedic Clinic
Authors: Davila Natalia , Vess Joy , Johnson Emily E.
Published: May 2017

BACKGROUND:

Childhood obesity is a complex healthcare problem that affects all aspects of a child's health. The American Academy of Pediatrics and the Expert Committee recommends that all children be evaluated for current medical conditions including the risk for obesity by identifying elevated body mass index (BMI), physical activity habits, and diet. Childhood obesity is defined as a BMI of 95th percentile or greater on standardized age-based growth charts. Abdominal and visceral fat mass has a negative effect on bone formation during childhood and adolescence. Effective interventions are aimed at prevention and treatment and include collection and assessment of obesity, eating habits, physical activity, and family history. At a local outpatient pediatric orthopaedic practice, few patients had a diagnosis of childhood obesity and weight management varied by providers.

PURPOSE:

The purpose of this quality improvement project was to improve identification of obese children and increase referrals to a weight management program.

METHODS:

Setting:
A hospital-affiliated pediatric orthopaedic clinic staffed with 3 orthopaedic surgeons and 2 nurse practitioners.
Population:
6- to 18-year-olds with a BMI of greater than 95th percentile (N = 239).
Data Collection:
Electronic medical record chart review for documented obesity and referral to weight management program:
Intervention:
Provider educational in-service reviewing management guidelines and referral process.

RESULTS:

Average percentages of documented obesity diagnosis increased from 11% to 53%. The number of referrals to Heart Healthy weight management program increased by 400%.

CONCLUSION:

An educational-based intervention in a pediatric orthopaedic clinic was effective in increasing the number of patients with a diagnosis of obesity and referred to a weight management program.
Enhanced Recovery After Surgery for Hip and Knee Replacements
Authors: Gwynne-Jones David P. , Martin Ginny , Crane Chris
Published: May 2017

BACKGROUND:

Enhanced recovery after surgery (ERAS) programs or hip and knee replacements have had a significant effect on streamlining patient care with shorter stays, no increase in complications, and improved outcomes including reduced mortality.

PURPOSE:

To compare outcomes following the introduction of an ERAS program for hip and knee replacements developed at our institution with a historical cohort of patients.

METHODS:

ERAS protocols were developed at our institution for patients undergoing hip and knee joint replacements. Key aspects were changes in preadmission, a new education session, improved management of perioperative anemia, standardized anesthetic guidelines, day of surgery mobilization, and improved discharge planning. The results of the first 18 months (528 consecutive patients) were compared with those of a historical cohort of 507 patients from the 18 months prior to their introduction.

RESULTS:

In the ERAS group, the mean age was 68.3 years for patients who underwent hip replacement and 70.4 years for patients who underwent knee replacement. Thirty-two percent of patients were ASA (American Society of Anesthesiologists) Grades III and IV. The average preoperative Oxford score was 11. The average length of stay (ALOS) fell from 5.6 to 4.3 days for patients who underwent hip replacement and from 5.7 to 4.8 days for patients who underwent knee replacement (p < .001). Ninety-six percent of patients were discharged home. The 30-day readmission rate increased from 3.2% to 5.5% (p = .065). Six-month Oxford knee scores were higher in the ERAS group (39.8 vs. 36.3, p = .03). There was no increase in mortality or early revision rate.

CONCLUSIONS:

Substantial reductions in ALOS can be gained with the introduction of ERAS protocols, with high patient satisfaction and no increase in complications in a consecutive unselected group of public hospital patients. This requires a multidisciplinary approach and a strong clinical input.
Developing a Logarithmic Chinese Reading Acuity Chart
Authors: Han Qi-Ming , Cong Lin-Juan , Yu Cong , Liu Lei
Published: May 2017

Purpose

An individual’s reading ability cannot be reliably predicted from his/her letter acuity, contrast sensitivity, and visual field extent. We developed a set of Chinese reading acuity charts (C-READ) to assess the reading ability of Chinese readers, based on the collective wisdom of previously published reading acuity charts, especially the MNRead and the Radner Reading Charts.

Methods

The C-READ consists of three charts. Each consists sixteen 12-character simplified Chinese sentences crafted from first- to third-grade textbooks. One hundred eighteen native Chinese-speaking college students (aged 22.1 ± 2.1 years) with normal or corrected to normal near vision (−0.26 ± 0.05 logMAR) were included in the study to develop the C-READ charts, to test the homogeneity of the three charts, and to validate the C-READ against the text paragraphs from the International Reading Speed Texts (IReST) with corrected and uncorrected near vision.

Results

The reading acuity, critical print size, and maximum reading speed for young normal native Chinese-speaking readers were 0.16 ± 0.05 logMAR, 0.24 ± 0.06 logMAR, and 273.44 ± 34.37 characters per minute (mean ± SD), respectively. The reliability test revealed no significant differences among the three C-READ charts and no significant test order effect in the three reading parameters. Regression analyses showed that the IReST reading speed could be reliably predicted by the C-READ maximum reading speed under the corrected near-vision condition (adjusted R
2 = 0.72) and by C-READ maximum reading speed and critical print size under the uncorrected near-vision condition (adjusted R
2 = 0.69).

Conclusions

The three C-READ charts are very comparable to each other, and there is no significant order effect. Reading test results can accurately predict continuous text reading performance quantified by the IReST reading speed over a wide range of refractive errors. The C-READ is a reliable and valid clinical instrument for quantifying reading performance in simplified Chinese readers.
Influence of Optic Disc Size on Identifying Glaucomatous Optic Neuropathy
Authors: Nixon Gregory J. , Watanabe Ronald K. , Sullivan-Mee Michael , DeWilde Anthony , Young Lisa , Mitchell G. Lynn
Published: May 2017

Purpose

The aim of this study was to use a large group of observers to test prior research findings that suggest optic disc size, clinical evaluation of the neuroretinal rim (ISNT rule), and practitioner characteristics influence the accuracy of differentiating normal from glaucomatous optic nerves.

Methods

Participant observers were optometrists, optometry students, and vision scientists/researchers attending the 2013 American Academy of Optometry Annual Meeting. Each observer viewed and judged six sets of stereoscopic photographs of normal and clinically confirmed glaucomatous optic nerves of different sizes presented in random order. Observers were queried on whether each nerve was glaucomatous or normal, whether the nerve followed the ISNT rule, and whether further evaluation with advanced imaging techniques was indicated.

Results

Of the 261 observers who participated, 59% were practicing optometrists, 7% were vision scientists, and 34% were residents or students. Of practicing optometrists and vision scientists, half (49%) had more than 15 years of experience, whereas 11% had less than 2 years of experience. Diagnostic accuracy differed based on optic nerve size: average-sized nerves were correctly identified by 90% of subjects, whereas small nerves and large nerves were correctly identified by 42% and 62%, respectively. Notably, only 9% of subjects correctly identified the small glaucomatous nerve, and only 34% correctly identified the large normal nerve. No practitioner characteristics were associated with diagnostic accuracy.

Conclusions

Accurate identification of glaucomatous optic neuropathy was significantly influenced by optic disc size. This was particularly evident for the large normal nerve and the small glaucomatous nerve. The ISNT rule provided value for differentiating normal from glaucomatous nerves, but its subjective interpretation resulted in considerable intergrader variability. These findings agree with other studies utilizing smaller numbers of observers but larger numbers of optic nerve presentations that disc size and the ISNT rule have value for enhancing accuracy of optic nerve assessment.
Impact of Dry Eye Symptoms and Daily Activities in a Modern Office
Authors: van Tilborg Mirjam M. , Murphy Paul J. , Evans Katharine S.
Published: May 2017

Purpose

Modern offices and the use of electronic devices are increasing factors in work-related eye symptoms. However, symptoms of eye fatigue or dry eye sensation can be mixed and confusing. This study surveys the eye symptoms reported during a working day at modern offices to investigate the possible inhibition on daily work activities.

Methods

Two online digital surveys were sent to three different work locations, by direct e-mail. Survey A consisted of 14 questions that investigated eye symptoms experienced during daily activities at work and the impact on daily activities. Survey B consisted of four general questions, the Dutch Ocular Surface Disease Index, the Work Productivity and Activity Index, and the Illness Perception Questionnaire.

Results

A total of 505 participants completed survey A, and 213 completed survey B. The participants reported that a high proportion of their day was spent working on a computer (60%). The majority experienced an air draft (79.1%) and had no adjustable light (81.5%) at their workspace. Dry eye–related symptoms were reported at a significantly higher frequency at work than at home (P < .001). Up to 70% experienced some inhibition of daily activity at work due to eye symptoms, with more than 5% experiencing symptoms most or all of the time. Indoor environment, work environment, and general health were perceived as the main reasons for developing dry eye. Compared with males, females showed a statistically significant higher Ocular Surface Disease Index score (P < .001) and experienced more inhibition and adverse effects on daily life and work productivity.

Conclusions

This investigation shows that dry eye symptoms have a negative impact on daily activities at work. These findings suggest that multidisciplinary understanding of the negative impact of dry eye by a range of specialists will be of help in managing work-related dry eye.
Effects of Affordable Care Act Marketplaces and Medicaid Eligibility Expansion on Access to Cancer Care
Authors: Graves John A. , Swartz Katherine
Published: May 2017

Purpose

The aim of this study was to inform oncologists about how repealing the Affordable Care Act (ACA) may affect their ability to provide cancer therapies for people with cancer enrolled in ACA health plans and why proposals to change Medicaid funding may make it even more difficult for Medicaid beneficiaries to access cancer treatments.

Methods

We examined the regulations and provisions of the ACA related to how health insurance impacts access to diagnostic testing and treatments for people with cancer, including access to clinical trials. Similarly, we examined federal and state rules affecting Medicaid beneficiaries’ access to cancer treatments.

Results

Repealing various provisions of the ACA will restrict who has access to both current and new cancer treatments. Such changes also will impact oncology research that depends on having heterogeneous people in clinical trials.

Conclusions

Significant changes to the ACA will affect oncology treatment choices of everyone with health insurance—not only the 10 million people newly covered by ACA health plans and the 70 million people with Medicaid coverage.
Seven-Tesla MRI of Hippocampal Sclerosis
Authors: Stefanits Harald , Springer Elisabeth , Pataraia Ekaterina , Baumgartner Christoph , Hainfellner Johannes A. , Prayer Daniela , Weisstanner Christian , Czech Thomas , Trattnig Siegfried
Published: May 2017

Introduction

Temporal lobe epilepsy (TLE) is the most frequent form of focal epilepsy in adults. Because approximately half of these patients develop drug resistance, epilepsy surgery designed to remove the epileptogenic zone is an excellent option in selected patients. Histopathological analyses of hippocampal specimens in TLE patients revealed 4 types of Ammon's horn sclerosis, which are correlated with long-term epileptological outcome. The aim of this study was the correlation of noninvasive, high-resolution, morphological magnetic resonance imaging (MRI) at an ultra-high-field (7 T) of the hippocampus in TLE patients with histopathological findings.

Methods

High-resolution, T2-weighted FSE MRI in 14 patients with drug-resistant temporal lobe epilepsy was performed on a 7 T Magnetom using a 32-channel coil. Four independent investigators assessed the delineation and semiquantitative evaluation of volume, signal intensity, internal architecture, and overall grading of the hippocampal subfields CA1-4, as well as the presence of the dentate granule cell layer (DGCL), on MRI scans. Results were compared with semiquantitative evaluation of neuronal loss and astrogliosis in the histological sections of the surgical specimens.

Results

Seven-tesla MR examinations were evaluable in 13 cases. Volume loss and signal intensity, as well as overall grading, showed a strong correlation between MRI and histology in individual CA regions. Furthermore, sensitivity and specificity values up to 100% were found for the detection of pathology in the CA subfields. The prediction of Ammon's horn sclerosis type was correct in up to 12 of 13 cases, whereas the dentate gyrus could not be delineated on MRI.

Discussion

High-resolution, ultra-high-field MRI is a promising tool for the detection of subtle changes in the hippocampus in patients with temporal lobe epilepsy. Large cohorts will be necessary to confirm the predictive value of 7 T MRI in the preoperative evaluation of TLE patients.
Sphingosine-1-Phosphate Receptor-1 Agonist Sew2871 Causes Severe Cardiac Side Effects and Does Not Improve Microvascular Barrier Breakdown in Sepsis
Authors: Flemming Sven , Burkard Natalie , Meir Michael , Schick Martin Alexander , Germer Christoph-Thomas , Schlegel Nicolas
Published: May 2017

Background:

Endothelial barrier dysfunction is a hallmark in the pathogenesis of sepsis. Sphingosine-1-phosphate (S1P) has been proposed to be critically involved in the maintenance of endothelial barrier function predominately by activating S1P receptor-1 (S1P1). Previous studies have shown that the specific S1P1 agonist SEW2871 improves endothelial barrier function under inflammatory conditions. However, the effectiveness of SEW2871 and potential side effects remained largely unexplored in a clinically relevant model of sepsis. Therefore, this study aimed to evaluate the effects of SEW2871 in the Colon ascendens stent peritonitis (CASP) model.

Methods:

Polymicrobial sepsis was induced in Sprague–Dawley rats using CASP model that enabled the monitoring of macro-hemodynamic parameters. Twelve hours after surgery, animals received either SEW2871 or sodium chloride. Mesenteric endothelial barrier function was evaluated 24 h after sepsis induction by intravital microscopy. Organ pathology was assessed in lungs. S1P levels, blood gas analyses, and blood values were measured at different time points. In parallel the effect of SEW2871 was evaluated in human dermal microvascular endothelial cells.

Result:

In vitro SEW2871 partially stabilized TNF-α-induced endothelial barrier breakdown. However, in vivo SEW2871 caused severe cardiac side effects in septic animals leading to an increased lethality. Sepsis-induced endothelial barrier dysfunction was not attenuated by SEW2871 as revealed by increased FITC-albumin extra-vasation, requirement of intravasal fluid replacement, and pulmonary edema. Interestingly, Sham-operated animals did not present any side effects after SEW2871 treatment.

Conclusion:

Our study demonstrates that the application of SEW2871 causes severe cardiac side effects and cannot attenuate the inflammation-induced endothelial barrier breakdown in a clinically relevant sepsis model, suggesting that the time point of administration and the pro-inflammatory milieu play a pivotal role in the therapeutic benefit of SEW2871.
Defining the gastroesophageal junction in trauma: Epidemiology and management of a challenging injury
Authors: Schellenberg Morgan , Inaba Kenji , Bardes James M. , O'Brien Daniel , Lam Lydia , Benjamin Elizabeth , Grabo Daniel , Demetriades Demetrios
Published: May 2017

BACKGROUND

Injuries to the gastroesophageal (GE) junction are infrequently encountered because of the high mortality of associated injuries. Consequently, there is a paucity of literature on the patient demographics and treatment options. The aim of this study was to examine the epidemiology, surgical management, and outcomes of these rare injuries.

METHODS

Patients presenting to LAC + USC Medical Center (January 2008 to August 2016) with traumatic esophageal or gastric injury (DRG International Classification of Diseases—9th Rev.—Clinical Modification and 10th Rev. codes) were extracted from the trauma registry. Patient charts were reviewed, and all patients who sustained an injury to the GE junction were enrolled. Patient demographics, injury characteristics, procedures, and outcomes were analyzed.

RESULTS

Of the 238 patients who sustained an injury to the esophagus or stomach during the study period, 28 (12%) were found to have a GE junction injury. Mean age was 26 years (range, 14–57 years), 89% male. Mechanism of injury was penetrating in 96% (n = 27), the majority of which were gunshot wounds (n = 22, 81%). Most patients (n = 18, 64%) were taken directly to the operating room. Ten (36%) underwent computed tomography scan before going to the operating room, all demonstrating a GE junction injury. All patients underwent repair via laparotomy. One (4%) also required thoracotomy to facilitate delayed reconstruction. GE junction injuries were typically managed with primary repair (n = 22, 79%). Associated injuries were frequent (n = 26, 93%), and injury severity was high (mean Injury Severity Score, 25 [9–75]). Mortality was 25% (n = 7), and all patients required intensive care unit admission. Most did not require total parenteral nutrition (n = 25, 89%) or a surgically placed feeding tube (n = 26, 93%). Of the 13 patients who presented for clinical follow-up, all but one (n = 12, 92%) were eating independently by the first clinic visit.

CONCLUSION

GE junction injuries are uncommon and occur almost exclusively after penetrating trauma. Patients are severely injured with a high mortality rate and frequently have associated intracavitary injuries. Most can be fixed through the abdomen alone and do not require thoracotomy for repair. Despite the severity of injuries, the majority of survivors are eating independently by the first clinic visit.

LEVEL OF EVIDENCE

Epidemiological, level V.
Factors associated with intimate partner homicide in Illinois, 2005–2010: Findings from the Illinois Violent Death Reporting System
Authors: Yousuf Sana , McLone Suzanne , Mason Maryann , Snow Lisa , Gall Carol , Sheehan Karen
Published: May 2017

BACKGROUND

Critical elements in intimate partner homicides (IPH) often go undocumented. Previous studies have highlighted precipitating causes, but few have examined the place of injury that led to the victim’s death. We sought to describe IPH cases in Illinois and in particular to examine factors surrounding the location of injury that led to the victim’s death.

METHODS

We analyzed data collected in the Illinois Violent Death Reporting System to assess victim demographics, perpetrator characteristics, the victim/perpetrator relationship, and circumstances surrounding the location of injury that led to the victim’s death.

RESULTS

From 2005 to 2010, 275 cases were identified as IPH. Women comprised 60.4% of victims and men 39.6%. Among perpetrators, 78.5% were identified as male and 21.5% as female. Of the 31 corollary victims, 54.8% were less than 18 years and 58.1% were injured in front of a family member. Females were 1.6 times more likely to have the injury that led to their death occur at their residence, as compared to males (OR 1.6, 95% CI 1.1–2.9). Cases in which the perpetrator had documented history of abuse were 2.4 times more likely to have the fatal injury occur at the victim’s residence compared to those that did not have previous history (OR 2.4, 95% CI 1.2–4.8). IPH cases in which the perpetrator was the current partner of the victim were twice as likely to have the injury leading to the victim’s death occur at the victim’s residence compared to those perpetrators who were not a current partner (OR 2.1, 95% CI 1.2–3.5).

CONCLUSIONS

Considering the increased risk of IPH occurring at the place of residence for women at the hands of current intimate partners and by perpetrators with a previous history of abuse, prevention efforts may wish to prioritize in-home and relocation intervention strategies.

LEVEL OF EVIDENCE

Epidemiologic, level IV.
Development of the emergency preservation and resuscitation for cardiac arrest from trauma clinical trial
Authors: Tisherman Samuel A. , Alam Hasan B. , Rhee Peter M. , Scalea Thomas M. , Drabek Tomas , Forsythe Raquel M. , Kochanek Patrick M.
Published: May 2017

BACKGROUND

Patients who suffer a cardiac arrest from trauma rarely survive, even with aggressive resuscitation attempts, including an emergency department thoracotomy. Emergency Preservation and Resuscitation (EPR) was developed to utilize hypothermia to buy time to obtain hemostasis before irreversible organ damage occurs. Large animal studies have demonstrated that cooling to tympanic membrane temperature 10°C during exsanguination cardiac arrest can allow up to 2 hours of circulatory arrest and repair of simulated injuries with normal neurologic recovery.

STUDY DESIGN

The Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma trial has been developed to test the feasibility and safety of initiating EPR. Select surgeons will be trained in the EPR technique. If a trained surgeon is available, the subject will undergo EPR. If not, the subject will be followed as a control subject. For this feasibility study, 10 EPR and 10 control subjects will be enrolled.

STUDY PARTICIPANTS

Study participants will be those with penetrating trauma who remain pulseless despite an emergency department thoracotomy.

INTERVENTIONS

Emergency Preservation and Resuscitation will be initiated via an intra-aortic flush of a large volume of ice-cold saline solution. Following surgical hemostasis, delayed resuscitation will be accomplished with cardiopulmonary bypass.

OUTCOME MEASURES

The primary outcome will be survival to hospital discharge without significant neurologic deficits. Secondary outcomes include long-term survival and functional outcome.

IMPLICATIONS

Once data from these 20 subjects are reviewed, revisions to the inclusion criteria and/or the EPR technique may then be tested in a second set of EPR and control subjects.
Trends in the epidemiology of major burn injury among hospitalized patients: A population-based analysis
Authors: Mason Stephanie A. , Nathens Avery B. , Byrne James P. , Gonzalez Alejandro , Fowler Rob , Karanicolas Paul J. , Moineddin Rahim , Jeschke Marc G.
Published: May 2017

BACKGROUND

Burn-related mortality has decreased significantly over the past several decades. Although often attributed in part to regionalization of burn care, this has not been evaluated at the population level.

METHODS

We conducted a retrospective, population-based cohort study of all patients with 20% or higher total body surface area burn injury in Ontario, Canada. Adult (≥16 years) patients injured between 2003 and 2013 were included. Deaths in the emergency department were excluded. Logistic generalized estimating equations were used to estimate risk-adjusted 30-day mortality. Mortality trends were compared at burn and nonburn centers.

RESULTS

Seven hundred seventy-two patients were identified at 84 centers (2 burn, 82 nonburn). Patients were 74% (n = 570) male, of median age 46 (interquartile range [IQR], 35–60) years and median total body surface area 35% (IQR, 25–45). Mortality at 30 days was 19% (n = 149). The proportion of patients treated at a burn center increased from 57% to 71% between 2003 and 2013 (p = 0.07). Average risk-adjusted 30-day mortality rates decreased over time; there were significantly reduced odds of death in 2010 to 2013 compared with 2003 to 2006 (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.25–0.61). Burn centers exhibited significantly reduced mortality from 2003–2006 to 2010–2013 (OR, 0.36; 95% CI, 0.34–0.38) compared with nonburn centers (OR, 0.41; 95% CI, 0.13–1.24).

CONCLUSION

Mortality rates have decreased over time; significant improvements have occurred at burn centers, whereas mortality rates at nonburn centers vary widely. A high proportion of patients continue to receive care outside of burn centers. These data suggest that there are further opportunities to regionalize burn care and in so doing, potentially lower burn-related mortality.

LEVEL OF EVIDENCE

Epidemiological study, level III; Therapy, level IV.