bluuebunny/crossref_metadata_2025 huggingface dataset:
Intralymphatic Immunotherapy With Autologous Semen in a Korean Man With Post-Orgasmic Illness Syndrome
Authors: Kim Tae Beom , Shim Young Sup , Lee Sang Min , Son Eun Suk , Shim Jung Woo , Lee Sang Pyo
Published: March 2018

Post-orgasmic illness syndrome (POIS) is a very rare disease characterized by local allergic symptoms and transient flu-like illness that nearly always occur after masturbation, coitus, or spontaneous ejaculation and last for 2 to 7 days. In a previous case report, 2 patients with POIS received hyposensitization therapy composed of multiple subcutaneous injections of autologous semen that resulted in a gradual decrease of symptoms. However, this procedure requires patients to endure pain and discomfort during frequent subcutaneous injections and preceding masturbations to obtain the autologous semen used for therapy. Recent studies have suggested that intralymphatic immunotherapy is a promising new method of allergen-specific immunotherapy against allergic diseases, showing a faster onset and longer duration of therapeutic effects after only several intralymphatic injections. We report on a case of a Korean man with POIS who received intralymphatic immunotherapy that alleviated POIS-related symptoms and in whom the existence of semen-specific immunoglobulin E was confirmed using immunoglobulin E immunoblotting and enzyme-linked immunosorbent assay.
Elevated DNA methylation across a 48‐kb region spanning the HOXA gene cluster is associated with Alzheimer's disease neuropathology
Authors: Smith Rebecca G. , Hannon Eilis , De Jager Philip L. , Chibnik Lori , Lott Simon J. , Condliffe Daniel , Smith Adam R. , Haroutunian Vahram , Troakes Claire , Al‐Sarraj Safa , Bennett David A. , Powell John , Lovestone Simon , Schalkwyk Leonard , Mill Jonathan , Lunnon Katie
Published: March 2018

Introduction

Alzheimer's disease is a neurodegenerative disorder that is hypothesized to involve epigenetic dysregulation of gene expression in the brain.

Methods

We performed an epigenome‐wide association study to identify differential DNA methylation associated with neuropathology in prefrontal cortex and superior temporal gyrus samples from 147 individuals, replicating our findings in two independent data sets (N = 117 and 740).

Results

We identify elevated DNA methylation associated with neuropathology across a 48‐kb region spanning 208 CpG sites within the HOXA gene cluster. A meta‐analysis of the top‐ranked probe within the HOXA3 gene (cg22962123) highlighted significant hypermethylation across all three cohorts (P = 3.11 × 10−18).

Discussion

We present robust evidence for elevated DNA methylation associated with Alzheimer's disease neuropathology spanning the HOXA gene cluster on chromosome 7. These data add to the growing evidence highlighting a role for epigenetic variation in Alzheimer's disease, implicating the HOX gene family as a target for future investigation.
Multi-objective design of thickness and curvature of a bendable structure considering delamination and strength characteristics
Authors: Lee Hyunseok , Chae Han-Seok , Joo Won-Seok , Lee Jongsoo
Published: March 2018

The present study explores the finite element analysis and design optimization of a multi-layered bendable structure (i.e., a device of smart watch) considering delamination characteristics and materials strength conditions. The materials used for device and rubber in the smart watch are polycarbonate and thermoplastic polyurethane, respectively. Mooney-Rivlin model is employed to accommodate the hyperelastic behavior of rubber under large deformation. An evaluation of the delamination between layers and adhesive of the smart watch is conducted based on the cohesive zone model. The present study suggests the physical definitions of the vertical gap and sliding distance to describe the debonding/delamination properties in case of a bendable structure undergoing a large deformation. In the optimal design for the glass thickness, display thickness and radius of curvature, the bi-objective formal optimization is formulated to minimize both the vertical gap and sliding distance subjected to constraints on materials strength requirements of glass stress and display stress. The optimal design solutions are obtained using 2nd order polynomial based response surface models and a non-dominated sorting genetic algorithm (NSGA-II) in the context of multi-objective approximate optimization. In the optimization result, the sliding distance is improved by 25.64% with the secured stress limits compared to an initial design. The sliding distance value has been more enhanced under the contribution of the shear mode of delamination than the vertical gap under the normal mode. The study accommodates more enhanced design solutions to minimize debonding/delamination properties under strength requirements.

Highlights This work conducts the design optimization of a multi-layered bendable structure (i.e., a smart watch). The delamination and materials strength requirements are considered. The delamination between layers and adhesive is performed based on the cohesive zone model. Vertical gap and sliding distance to represent delamination properties are suggested. The sliding distance is improved by 25.64% with the secured stress limits.
Penoscrotal Decompression—Promising New Treatment Paradigm for Refractory Ischemic Priapism
Authors: Fuchs Joceline S. , Shakir Nabeel , McKibben Maxim J. , Mathur Shawn , Teeple Sloan , Scott Jeremy M. , Morey Allen F.
Published: March 2018

Background

For prolonged ischemic priapism, outcomes after distal shunt are poor, with only 30% success for priapic episodes lasting longer than 48 hours.

Aim

To present a novel, glans-sparing approach of corporal decompression through a penoscrotal approach for cases of refractory ischemic priapism (RIP) after failed distal shunt procedures.

Methods

We describe the technique and present our initial experience with penoscrotal decompression (PSD) for treatment of RIP after failed distal shunt. We compared outcomes of patients with RIP undergoing surgical management using PSD or malleable penile prosthesis (MPP) placement after failed distal penile shunt procedures (2008–2017).

Outcomes

Our initial experience showed favorable outcomes with PSD compared with early MPP placement in patients with RIP whose distal shunt failed.

Results

Of 14 patients with RIP undergoing surgical management after failed distal penile shunt procedures, all patients presented after a prolonged duration of priapism (median = 61 hours) after which the priapism was refractory to multiple prior treatments (median = 3, range = 1–75) including at least 1 distal shunt. MPP was inserted in 8 patients (57.1%), whereas the most recent 6 patients (42.9%) underwent PSD. All patients with PSD (6 of 6, 100%) were successfully treated with corporal decompression without additional intervention and noted immediate relief of pain postoperatively. In contrast, 37.5% of patients (3 of 8) undergoing MPP after failed distal shunt procedures required a total of 8 revision surgeries during a median follow-up of 41.5 months. The most common indications for revision surgery after MPP placement included distal (4 of 8, 50%) and impending lateral (2 of 8, 25%) extrusion.

Clinical Implications

PSD is a simple, effective technique in the management of RIP after failed distal shunt procedures with fewer complications than MPP placement.

Strengths and Limitations

Although PSD is effective in the management of RIP after failed distal shunt procedures, long-term assessment of erectile function and ease of future penile prosthetic implantation is needed.

Conclusion

Corporal decompression resolves RIP through a glans-sparing approach and avoids the high complication rate of prosthetic insertion after failed distal shunt procedures.
Functional Outcomes of an Interdisciplinary Outpatient Rehabilitation Program for Patients with Malignant Brain Tumors
Authors: Shahpar Samman , Wong Alex W.K. , Keeshin Susan , Eickmeyer Sarah M. , Semik Patrick , Kocherginsky Masha , McCarty Stacy
Published: March 2018

Background

Malignant brain tumors cause significant impairments in function because of the nature of the disease. Nevertheless, patients with malignant brain tumors can make functional gains equivalent to those with stroke and traumatic brain injury in the inpatient rehabilitation setting. However, the efficacy of outpatient rehabilitation in this population has received little study.

Objective

To determine if an interdisciplinary outpatient rehabilitation program will improve functional outcomes in patients with malignant brain tumors.

Design

Nonrandomized prospective longitudinal study.

Setting

Six affiliated outpatient sites of one institution.

Patients

Forty‐nine adults with malignant brain tumors were enrolled.

Methods

Patients received interdisciplinary therapy services, with duration determined by the therapist evaluations. The therapists scored the Day Rehabilitation Outcome Scale (DayROS) and Disability Rating Scale (DRS) on admission and discharge. The caregivers filled out the DRS at discharge, 1 month, and 3 months after discharge.

Main Outcome Measurements

The primary study outcome measure was the DayROS, which is a functional measure similar to the Functional Independence Measure. DRS was another functional outcome measure assessing basic self‐care, dependence on others, and psychosocial adaptability.

Results

Forty‐six of 49 enrolled patients (94%) completed the day rehabilitation program. The average length of stay was 76.9 days. There was a significant improvement in total DayROS (P < .001), mobility (P < .001), Activities of Daily Living (P < .001), and communication (P < .001) DayROS subscores from admission to discharge. There were no significant changes over time in the DRS scores. Women had higher DayROS gains (P = .003) and better therapist DRS scores from admission to discharge than men (P = .010).

Conclusions

Patients with malignant brain tumors can make functional gains in an interdisciplinary outpatient rehabilitation program. This level of care should be considered in this patient population.

Level of Evidence

II
Rhythmic Neck Muscle Spasms and Upper Limb Muscle Myoclonic Jerks as an Unusual Initial Presentation of Posttraumatic Cervicothoracic Syringomyelia: A Case Report
Authors: Lin Hsin‐Chin , Tsai Yu‐Lin , Tsai Wen‐Chung
Published: March 2018

Posttraumatic syringomyelia with an initial presentation of involuntary movement is rare. We describe a 25‐year‐old patient who sustained complete traumatic spinal cord injury at the thoracic level and presented with rhythmic neck muscle spasms and upper limb muscle myoclonic jerks 1 month after trauma. Magnetic resonance imaging revealed syrinx formation between C3 and T1. Lumbar‐peritoneal shunt and decompression were performed. The symptoms completely disappeared after surgery. This report highlights that rhythmic neck muscle spasms and upper limb muscle myoclonic jerks can be the initial and only manifestations of syringomyelia.

Level of Evidence

V
Amantadine‐Induced Corneal Edema in a Pediatric Neuro‐Oncology Patient: A Case Report
Authors: Beran Maria , Okyere Britta , Vova Joshua
Published: March 2018

Amantadine is commonly prescribed as a neurostimulant in patients with brain injuries. This is a case of a 14‐year‐old male with a history of brain tumor that developed corneal edema after initiation of amantadine, a rare but documented side effect of this medication. After discontinuation of amantadine, the corneal edema resolved within two months, but endothelial cells density remained low.

Level of Evidence

V
Frailty in a Post‐Acute Care Population: A Scoping Review
Authors: Roberts Pamela S. , Goud Manoj , Aronow Harriet Udin , Riggs Richard V.
Published: March 2018

Frailty is a complex and growing phenomenon facing health care providers throughout the continuum of care. Frailty is not well understood in post‐acute care (PAC) settings. The purpose of this scoping review was to summarize current evidence of frailty impact on outcomes and frailty mitigation initiatives in PAC. Three major publication databases were searched from January 2000 to June 2017 that identified 18 articles specifically addressing frailty in PAC. Three themes were identified: scales used to measure frailty, factors that led to an adverse outcome or diagnosis of frailty, and interventions to address frailty in PAC. Scales used to measure frailty were dominated by physical factors and scarce on nutrition and social support. Functional decline, grip strength, gait speed, polypharmacy, and nutrition were identified in the studies as factors that identify frailty and are associated with poor outcomes. All these frailty characteristics compromise patients’ ability to benefit from rehabilitation, which further establishes the importance of PAC providers to identify, prevent, and treat frailty. Intervention studies had mixed outcomes, suggesting a need for further development in this area. The findings of this scoping review highlight the need for a comprehensive multidimensional assessment of frailty risks in PAC.

Level of Evidence

IV
Head trauma and olfactory function
Authors: Howell Jessica , Costanzo Richard M. , Reiter Evan R.
Published: March 2018

Olfactory impairment is a well‐established sequela of head injury. The presence and degree of olfactory dysfunction is dependent on severity of head trauma, duration of posttraumatic amnesia, injuries obtained, and as more recently established, age. Deficits in smell can be conductive or neurosensory, contingent on location of injury. The former may be amenable to medical or surgical treatment, whereas the majority of patients with neurosensory deficits will not recover. Many patients will not seek treatment for such deficits until days, weeks, or even months after the traumatic event due to focus on more pressing injuries. Evaluation should start with a comprehensive history and physical exam. Determination of the site of injury can be aided by CT and MRI scanning. Verification of the presence of olfactory deficit, and assessment of its severity requires objective olfactory testing, which can be accomplished with a number of methods. The prognosis of posttraumatic olfactory dysfunction is unfortunate, with approximately only one third improving. Emphasis must be placed on identification of reversible causes, such as nasal bone fractures, septal deviation, or mucosal edema/hematoma. Olfactory loss is often discounted as an annoyance, rather than a major health concern by both patients and many healthcare providers. Patients with olfactory impairment have diminished quality of life, decreased satisfaction with life, and increased risk for personal injury. Paramount to the management of these patients is counseling with regard to adoption of compensatory strategies to avoid safety risks and maximize quality of life. Practicing otolaryngologists should have a thorough understanding of the mechanisms of traumatic olfactory dysfunction in order to effectively diagnose, manage, and counsel affected patients.
Advances in facial landmark detection
Authors: Feng Zhen-Hua , Kittler Josef
Published: March 2018

In recent years, facial landmark detection – also known as face alignment or facial landmark localisation – has become a very active area, due to its importance to a variety of image and video-based face analysis systems, such as face recognition, emotion analysis, human-computer interaction and 3D face reconstruction. This article looks at the challenges and latest technology advances in facial landmarks.
Why the security industry should stop relying on FUD
Authors: Curry Sam
Published: March 2018

The narrative around information security has always been much more negative than the rest of the technology sector. Discussions around cyber tend to focus on threats and consequences, rather than the optimistic emphasis on progress and opportunity found in areas such as the cloud or mobile technology.

Discussions around cyber tend to focus on threats and consequences, rather than the optimistic emphasis on progress and opportunity found in areas such as the cloud or mobile technology.

The security industry often gets carried away with the level of doom and gloom and all too often, we see the conversation veering into fear, uncertainty and doubt. The industry has a duty to use its knowledge and experience to guide organisations into making choices that will improve their confidentiality, integrity and availability when a security incident occurs, says Sam Curry of Cybereason.
INTERMEDIALITY AND EKPHRASIS IN LATIN EPIC POETRY
Authors: Faber Riemer A.
Published: March 2018

The concept of intermediality arose in the theoretical discourse about the relations between different systems or products of meaning, such as the relations between music and art, or image and text. The word gained currency in the 1980s in German- and French-language studies of theatre performance, and in scholarship on opera, film, and music, in order to capture the notion of the interconnections between different art forms. For reasons of utility, the concept has been divided into three kinds: intermediality may refer to the combination of media (as in opera, in which music, dance, and song are conjoined into one aesthetic experience); the transformation or transposition of media (as in a film version of a book); and intermedial references or connections, whereby attention is drawn to another system of meaning, as in the references in literature to a work of art. The term has entered the field of classics especially via the study of the relations between the narrative and inscriptional modes in literary epigram.
Art and Archaeology
Authors: Spivey Nigel
Published: March 2018

If asked to cite a single image as symbolic of Athenian democracy, many Classicists would probably suggest the Tyrannicides group. It seems the obvious choice. Yet while no one would deny the ideological value given to the statue(s) raised in commemoration of the event, there are some well-known historical reasons for being sceptical about any democratic ideals harboured by Harmodius and Aristogeiton when they assassinated Hipparchus in 514 bc. In that sense, the Tyrannicides group is inappropriate. So what alternatives come to mind? Here is one possibility, which was once visible, like the Tyrannicides, in the Athenian agora: a fourth-century bc marble relief showing several figures engaged in making footwear (Agora inv. I 7396). The piece carries an inscription, worth quoting:

Dionysios the son of [Sim?]on, the cobbler, and the children dedicated this to Heros Kallistephanos. Having seen a divine vision in his sleep, Dionysios adorns the hero and the children of Kallistephanos; do you give in return for these things wealth and happy health.
Tackling rarity and sample bias with large-scale biodiversity monitoring: a case study examining the status, distribution and ecology of the lichen Cladonia rei in Alberta, Canada
Authors: HAUGHLAND Diane L. , HILLMAN Ashley , AZERIA Ermias T.
Published: March 2018

Species conservation depends on accurate data, but for many lichens existing collections are geographically biased and contain many taxonomic errors. It is unclear whether ‘non-expert’, systematic monitoring schemes can address these sources of error, particularly for taxonomically challenging lichens (e.g. species requiring chemistry for accurate identification). In this case study we use the Alberta Biodiversity Monitoring Institute (ABMI), a large-scale, systematic, multi-taxon monitoring programme, to better understand the ecology and distribution of a putative rare species, Cladonia rei. Collections of C. rei from Alberta dating from 1947 suggested the species was broadly distributed but rare, with seven accessioned specimens. We used comparative morphology, thin-layer chromatography and habitat modelling to compare historical records against more recent material from ABMI surveys. Contrary to the historical collections, ABMI samples suggest C. rei is almost entirely limited to the dry mixed grassland, northern fescue grassland and aspen parkland natural regions, and that within these ecosystems it is relatively common. The typical ecotype exhibited included a persistent primary thallus, podetia with a persistent basal cortex, and secondary squamules; typically they lacked cups, well-developed apothecia and fumarprotocetraric acid, and ramifications were sparse. Cladonia rei was consistently found in pastures and undisturbed grasslands that hosted relatively rich communities of epigeic lichens, thus it does not appear to act as a pioneer in Alberta or to commonly occupy the anthropogenic niches documented elsewhere. In summary, large-scale, systematic, non-targeted monitoring employing novices redressed issues of sample bias through almost 300 C. rei collections, simultaneously improving the ecological understanding of a putative rare species.
An analysis of the effect of aspect and vegetation type on fine fuel moisture content in eucalypt forest
Authors: Slijepcevic Alen , Anderson Wendy R. , Matthews Stuart , Anderson David H.
Published: March 2018

The magnitude of site effect on dead fine fuel moisture content (FMC) in eucalypt forests was investigated for different fuel strata: bark, near-surface, top and profile litter. In addition, the variation across two fire seasons in litter FMC and fraction of fuel available for burning was analysed. Over different fuel strata, the aspect effect ranged from an average moisture content of ~3% in the dry forest to 11% in the moist forest, but the effect in the moist forest could also be attributed to increased vegetation cover. For the top litter (first 1 cm of litter), moisture content averaged ~4% higher than bark, and 3% lower than profile (whole) litter, differences being higher on the wetter sites. Site effects were greatest for profile and least for bark. The percentage of days that the top litter moisture content fell into categories associated with severe fire behaviour and prescribed burning availability was calculated for each site in the different forest types to facilitate discussion of fire management planning.
The cost-effectiveness of follow-up strategies after cancer treatment: a systematic literature review
Authors: Barbieri M , Richardson G , Paisley S
Published: March 2018

Introduction

The cost of treatment and follow-up of cancer patients in the UK is substantial. In a budget-constrained system such as the NHS, it is necessary to consider the cost-effectiveness of the range of management strategies at different points on cancer patients’ care pathways to ensure that they provide adequate value for money.

Sources of data

We conducted a systematic literature review to explore the cost-effectiveness of follow-up strategies of patients previously treated for cancer with the aim of informing UK policy. All papers that were considered to be economic evaluations in the subject areas described above were extracted.

Areas of agreement

The existing literature suggests that intensive follow-up of patients with colorectal disease is likely to be cost-effective, but the opposite holds for breast cancer.

Areas of controversy

Interventions and strategies for follow-up in cancer patients were variable across type of cancer and setting. Drawing general conclusions about the cost-effectiveness of these interventions/strategies is difficult.

Growing points

The search identified 2036 references but applying inclusion/exclusion criteria a total of 44 articles were included in the analysis. Breast cancer was the most common (n = 11) cancer type followed by colorectal (n = 10) cancer. In general, there were relatively few studies of cost-effectiveness of follow-up that could influence UK guidance. Where there was evidence, in the most part, NICE guidance broadly reflected this evidence.

Areas timely to develop research

In terms of future research around the timing, frequency and composition of follow-ups, this is dependent on the type of cancer being considered. Nevertheless, across most cancers, the possibility of remote follow-up (or testing) by health professionals other than hospital consultants in other settings appears to warrant further work.
The benefits of health information exchange: an updated systematic review
Authors: Menachemi Nir , Rahurkar Saurabh , Harle Christopher A , Vest Joshua R
Published: March 2018

Objective

Widespread health information exchange (HIE) is a national objective motivated by the promise of improved care and a reduction in costs. Previous reviews have found little rigorous evidence that HIE positively affects these anticipated benefits. However, early studies of HIE were methodologically limited. The purpose of the current study is to review the recent literature on the impact of HIE.

Methods

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct our systematic review. PubMed and Scopus databases were used to identify empirical articles that evaluated HIE in the context of a health care outcome.

Results

Our search strategy identified 24 articles that included 63 individual analyses. The majority of the studies were from the United States representing 9 states; and about 40% of the included analyses occurred in a handful of HIEs from the state of New York. Seven of the 24 studies used designs suitable for causal inference and all reported some beneficial effect from HIE; none reported adverse effects.

Conclusions

The current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs.
External Ventricular Drain and Hemorrhage in Aneurysmal Subarachnoid Hemorrhage Patients on Dual Antiplatelet Therapy: A Retrospective Cohort Study
Authors: Hudson Joseph S , Prout Benjamin S , Nagahama Yasunori , Nakagawa Daichi , Guerrero Waldo R , Zanaty Mario , Chalouhi Nohra , Jabbour Pascal , Dandapat Sudeepta , Allan Lauren , Ortega-Gutierrez Santiago , Samaniego Edgar A , Hasan David
Published: March 2018

BACKGROUND

Stenting and flow diversion for aneurysmal sub arachnoid hemorrhage (aSAH) require the use of dual antiplatelet therapy (DAPT).

OBJECTIVE

To investigate whether DAPT is associated with hemorrhagic complication following placement of external ventricular drains (EVD) in patients with aSAH.

METHODS

Rates of radiographically identified hemorrhage associated with EVD placement were compared between patients who received DAPT for stenting or flow diversion, and patients who underwent microsurgical clipping or coiling and did not receive DAPT by way of a backward stepwise multivariate analysis.

RESULTS

Four hundred forty-three patients were admitted for aSAH management. Two hundred ninety-eight patients required placement of an EVD. One hundred twenty patients (40%) were treated with stent-assisted coiling or flow diversion and required DAPT, while 178 patients (60%) were treated with coiling without stents or microsurgical clipping and did not receive DAPT. Forty-two (14%) cases of new hemorrhage along the EVD catheter were identified radiographically. Thirty-two of these hemorrhages occurred in patients on DAPT, while 10 occurred in patients without DAPT. After multivariate analysis, DAPT was significantly associated with radiographic hemorrhage [odds ratio: 4.92, 95% confidence interval: 2.45-9.91, P = .0001]. We did not observe an increased proportion of symptomatic hemorrhage in patients receiving DAPT (10 of 32 [31%]) vs those without (5 of 10 [50%]; P = .4508).

CONCLUSION

Patients with aSAH who receive stent-assisted coiling or flow diversion are at higher risk for radiographic hemorrhage associated with EVD placement. The timing between EVD placement and DAPT initiation does not appear to be of clinical significance. Stenting and flow diversion remain viable options for aSAH patients.
Response Changes During Insertion of a Cochlear Implant Using Extracochlear Electrocochleography
Authors: Giardina Christopher K. , Khan Tatyana E. , Pulver Stephen H. , Adunka Oliver F. , Buchman Craig A. , Brown Kevin D. , Pillsbury Harold C. , Fitzpatrick Douglas C.
Published: March 2018

Objectives:

Electrocochleography is increasingly being utilized as an intraoperative monitor of cochlear function during cochlear implantation (CI). Intracochlear recordings from the advancing electrode can be obtained through the device by on-board capabilities. However, such recordings may not be ideal as a monitor because the recording electrode moves in relation to the neural and hair cell generators producing the responses. The purposes of this study were to compare two extracochlear recording locations in terms of signal strength and feasibility as intraoperative monitoring sites and to characterize changes in cochlear physiology during CI insertion.

Design:

In 83 human subjects, responses to 90 dB nHL tone bursts were recorded both at the round window (RW) and then at an extracochlear position—either adjacent to the stapes or on the promontory just superior to the RW. Recording from the fixed, extracochlear position continued during insertion of the CI in 63 cases.

Results:

Before CI insertion, responses to low-frequency tones at the RW were roughly 6 dB larger than when recording at either extracochlear site, but the two extracochlear sites did not differ from one another. During CI insertion, response losses from the promontory or adjacent to the stapes stayed within 5 dB in ≈61% (38/63) of cases, presumably indicating atraumatic insertions. Among responses which dropped more than 5 dB at any time during CI insertion, 12 subjects showed no response recovery, while in 13, the drop was followed by partial or complete response recovery by the end of CI insertion. In cases with recovery, the drop in response occurred relatively early (<15 mm insertion) compared to those where there was no recovery. Changes in response phase during the insertion occurred in some cases; these may indicate a change in the distributions of generators contributing to the response.

Conclusions:

Monitoring the electrocochleography during CI insertion from an extracochlear site reveals insertions that are potentially atraumatic, show interaction with cochlear structures followed by response recovery, or show interactions such that response losses persist to the end of recording.
Costs and Complications of Single-Stage Fixation Versus 2-Stage Treatment of Select Bicondylar Tibial Plateau Fractures
Authors: Virkus Walter W. , Caballero Jesse , Kempton Laurence B. , Cavallero Matthew , Rosales Rich , Gaski Greg E.
Published: March 2018

Objectives:

To determine the differences in costs and complications in patients with bicondylar tibial plateau (BTP) fractures treated with 1-stage definitive fixation compared with 2-stage fixation after initial spanning external fixation.

Design:

Retrospective cohort study.

Setting:

Level 1 Trauma Center.

Patients/Participants:

Patients with OTA/AO 41-C (Schatzker 6) BTP fractures treated with open reduction internal fixation.

Intervention:

Definitive treatment with open reduction internal fixation either acutely (1 stage) or delayed after initial spanning external fixation (2 stage).

Main Outcome Measures:

Wound healing complications, implant costs, hospital charges, Patient-Reported Outcomes Measurement Information System (PROMIS), reoperation, nonunion and infection.

Results:

One hundred five patients were identified over a three-year period, of whom 52 met the inclusion criteria. There were 28 patients in the 1-stage group and 24 patients in the 2-stage group. Mean follow-up was 21.8 months, and 87% of patients had at least 12 months of follow-up. The mean number of days to definitive fixation was 1.2 in the 1-stage group and 7.8 in the 2-stage group. There were no differences between groups with respect to wound healing or any other surgery-related complications. Functional outcomes PROMIS were similar between groups. Mean implant cost in the 2-stage group was $10,821 greater than the 1-stage group, mostly because of the costs of external fixation. Median hospital inpatient charges in the 2-stage group exceeded the 1-stage group by more than $68,000 for all BTP fractures and by $61,000 for isolated BTP fractures.

Conclusions:

Early single-stage treatment of BTP fractures is cost-effective and is not associated with a higher complication rate than 2-stage treatment in appropriately selected patients.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Misophonia in Children with Tic Disorders: A Case Series
Authors: Robinson Sally , Hedderly Tammy , Conte Giulia , Malik Osman , Cardona Francesco
Published: March 2018

Objective:

Misophonia is a condition characterized by the dislike or hatred (miso) of specific sounds (phonia) that results in an extreme emotional response. There has been growing interest in misophonia, with emerging evidence from neurodevelopmental populations and ongoing debate regarding the psychiatric classification and the mechanisms underlying this phenomenon. This is the first article to report on misophonic experiences and associated clinical characteristics in young people with tic disorders.

Method:

In this article, we present the cases of 12 children and young people with tic disorders who have attended clinics in the United Kingdom and Italy who report misophonia. Misophonia was classified as a selective aversive response in accordance with the criteria proposed by Schröder.

Results:

These cases support the view that a range of auditory stimuli may lead to negative/aversive emotional responses of varying degrees, with misophonia seeming to contribute to behavioral reactions. Among these, the most frequent was anger outbursts, followed by an increase in tics, trigger avoidance, repetition of the sound, and self-injurious behavior. No single treatment approach was effective, with some patients responding to cognitive behavioral therapies and others to pharmacological support.

Conclusion:

We postulate that misophonia could be an underestimated causative phenomenon for abrupt emotional dysregulation in individuals with tic disorders and should be considered as part of a comprehensive clinical assessment. This article presents findings of relevance to general discussions regarding the classification of misophonia, as well as the potential relationship between sensory abnormalities and the broader phenotype of tic disorders during development.
COMPARISON OF RETINAL PATHOLOGY VISUALIZATION IN MULTISPECTRAL SCANNING LASER IMAGING
Authors: Meshi Amit , Lin Tiezhu , Dans Kunny , Chen Kevin C. , Amador Manuel , Hasenstab Kyle , Muftuoglu Ilkay Kilic , Nudleman Eric , Chao Daniel , Bartsch Dirk-Uwe , Freeman William R.
Published: March 2018

Purpose:

To compare retinal pathology visualization in multispectral scanning laser ophthalmoscope imaging between the Spectralis and Optos devices.

Methods:

This retrospective cross-sectional study included 42 eyes from 30 patients with age-related macular degeneration (19 eyes), diabetic retinopathy (10 eyes), and epiretinal membrane (13 eyes). All patients underwent retinal imaging with a color fundus camera (broad-spectrum white light), the Spectralis HRA-2 system (3-color monochromatic lasers), and the Optos P200 system (2-color monochromatic lasers). The Optos image was cropped to a similar size as the Spectralis image. Seven masked graders marked retinal pathologies in each image within a 5 × 5 grid that included the macula.

Results:

The average area with detected retinal pathology in all eyes was larger in the Spectralis images compared with Optos images (32.4% larger, P < 0.0001), mainly because of better visualization of epiretinal membrane and retinal hemorrhage. The average detection rate of age-related macular degeneration and diabetic retinopathy pathologies was similar across the three modalities, whereas epiretinal membrane detection rate was significantly higher in the Spectralis images.

Conclusion:

Spectralis tricolor multispectral scanning laser ophthalmoscope imaging had higher rate of pathology detection primarily because of better epiretinal membrane and retinal hemorrhage visualization compared with Optos bicolor multispectral scanning laser ophthalmoscope imaging.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN A CASE OF CHOROIDAL NEOVASCULARIZATION SECONDARY TO TRAUMATIC CHOROIDAL RUPTURE
Authors: Preziosa Chiara , Corvi Federico , Pellegrini Marco , Bochicchio Sara , Rosar Ana P. , Staurenghi Giovanni
Published: March 2018

Background/Purpose:

To document by optical coherence tomography angiography, the onset of a choroidal neovascularization (CNV) secondary to traumatic choroidal rupture and describe its changes after an intravitreal injection of bevacizumab.

Methods:

Case report.

Results:

A 20-year-old woman presented referring vision loss after a blunt ocular trauma in her left eye. The patient underwent a complete ophthalmic examination. Best-corrected visual acuity was 20/200. Fundus examination, fluorescein angiography, indocyanine green angiography, and optical coherence tomography displayed a choroidal rupture with no evidence of CNV. Optical coherence tomography angiography showed the choroidal rupture as a line of choriocapillaris rarefaction because of the mechanical damage. Six months later, best-corrected visual acuity decreased to 20/300; optical coherence tomography angiography displayed the growth of a CNV, characterized by a tangled vascular network. After one intravitreal injection of bevacizumab, optical coherence tomography angiography documented a contraction of the CNV.

Conclusion:

Optical coherence tomography angiography is a useful imaging technique for the diagnosis and follow-up of patients with choroidal ruptures. Anti–vascular endothelial growth factor agents represent an effective therapy for the treatment of CNVs secondary to this affection.
Assessment of Tear Film and Bulbar Redness by Keratograph 5M in Pediatric Patients After Orthokeratology
Authors: Xie Wenjia , Zhang Xia , Xu Yesheng , Yao Yu-Feng
Published: March 2018

Objectives:

To assess the tear meniscus height (TMH), noninvasive tear breakup time (NITBUT), and bulbar redness in pediatric patients after orthokeratology (OK).

Methods:

Pediatric patients who underwent overnight OK between December 2014 and November 2017 were retrospectively investigated. According to the time of wearing, subjects were divided into three groups: 1-week, 1-month, and over 1-year. Age-matched subjects were recruited as a control group. Keratograph 5M was used to assess TMH, NITBUT-first, NITBUT-average, and bulbar redness score.

Results:

A total of 106 subjects aged from 7 to 15 years were included. Compared with control group, NITBUT-first was significantly lower in 1-week group (P=0.036) and NITBUT-average was significantly lower in 1-month group (P=0.019). Compared with over 1-year group, NITBUT-first was significantly lower in 1-week and 1-month groups (P=0.014, P=0.035, respectively), and NITBUT-average was significantly lower in 1-month group (P=0.022). Bulbar redness score was significantly lower in 1-month group than 1-week group (P=0.004). No significant difference in TMH was found between all groups. Significant correlation was found between NITBUT-first and NITBUT-average in all subjects (R=0.812, P<0.001). No other significant correlations were found between variables included TMH, NITBUT, bulbar redness score, or target correction.

Conclusions:

As a noninvasive method, Keratograph 5M was easily to be applied on pediatric patients. The OK lens did not induce significant tear deficiency or bulbar redness, but might affect tear film stability in a short term after wearing.
The Joint Commission vs Joint Commission International
Authors: Wang Binseng , Tabshouri Bassam
Published: March 2018

Accreditation of healthcare organizations is used by government agencies and insurance companies in some countries to determine acceptable quality level and thus ability to receive reimbursements. Even when not required by law, achieving accreditation helps a healthcare organization to attract more patients and earn higher reimbursement rates. Among the healthcare accreditation organizations, The Joint Commission (TJC) and Joint Commission International (JCI) are known for their longevity, wide scope, and prestige, with the former being the dominant player in the United States and the latter highly recognized elsewhere. A previous article examined the differences and similarities of their standards, whereas this article compares their survey practices. Through a worldwide survey of approximately 1% of their accredited hospitals, the questions most frequently asked by their surveyors and their focus topics were uncovered and compared. Despite the inevitable similarities imposed by the common goal of ensuring patient safety and the adoption of the same tracer methodology, some differences were apparent. Joint Commission International surveyors tend to focus more on equipment planning and selection and scheduled maintenance, whereas TJC surveyors tend to focus more on maintenance strategy. Both asked for scheduled maintenance records, but JCI surveyors concentrated more on safety, national laws/regulations, inventory inclusion, staff training/qualifications, and incident reporting. Although some of these differences can be traced to local laws and regulations, most are apparently derived from previous survey lessons learned. Surprisingly, a large portion of the JCI-accredited hospitals are not strictly following JCI standards and have actually adopted some of the more flexible standards allowed by TJC. It is hoped that this comparison can help clinical engineering professionals worldwide to prepare themselves better for future surveys.
Effects of Coupling Parameter in Thalamocortical Model on Seizure Prediction for Temporal Lobe Epilepsy
Authors: Shojaee Milad , Soltanpour Mohammad Reza
Published: March 2018

Coupling between different regions of the brain plays an important role in many functions of the brain. Dynamical changes occurring in coupling strengths between brain regions can result in synchronous activity within neuronal populations, which in turn render epileptic seizures happen. Knowing this fact can help us to develop new prediction systems with better performance. This seizure prediction study takes coupling strength into account to detect preictal changes several minutes before seizures. Simulation results indicate that preictal changes begin 20 to 25 minutes before upcoming seizures.
Factors Influencing Fixation Stability Area: A Comparison of Two Methods of Recording
Authors: Fragiotta Serena , Carnevale Carmela , Cutini Alessandro , Rigoni Erika , Grenga Pier Luigi , Vingolo Enzo Maria
Published: March 2018

SIGNIFICANCE

The authors analyze factors influencing bivariate contour ellipse area (BCEA) in healthy and pathologic eyes and how such factors may affect isolated (static BCEA) or microperimetric fixation (dynamic BCEA). They conclude that aging increases both dynamic BCEA and examination time, whereas static BCEA offers less variance and the maximum distinction with pathologic eyes.

PURPOSE

The aim of this study was to assess factors influencing BCEA and the recording method that offer less variability and thus maximum distinction between healthy and pathologic eyes.

METHODS

A total of 136 eyes were retrospectively reviewed, 85 eyes without ophthalmic disorders (logMAR acuity ≦0.0) and 51 eyes with late age-related macular degeneration (AMD) were enrolled. All patients underwent two consecutive examinations, a 30-second isolated fixation (static BCEA) and a microperimetric test with continuous fixation recording (dynamic BCEA). All the examinations were carried out using MP1 microperimeter (NAVIS software version 1.7.6; Nidek Technologies, Padova, Italy).

RESULTS

Dynamic BCEA was significantly correlated with age (r = 0.38, P < .001), total (r = 0.32, P = .03), and tracking time (r = 0.33, P = .02) in controls, whereas no significant relationships were found in the AMD group. The greatest difference between static and dynamic BCEA was observed in 70- to 79-year decade in healthy subjects (P < .01). Logistic regression analysis showed that late AMD status was significantly predicted by ±2 SD and ±3 SD static BCEA (both P = .03).

CONCLUSIONS

Dynamic BCEA is influenced by a certain degree of variability in advanced-age healthy subjects. In such cases, the use of ±2 SD and ±3 SD static BCEAs seems to offer a more accurate detection of fixation stability changes in the AMD group with respect to normal subjects.
LogMAR and Stereoacuity in Keratoconus Corrected with Spectacles and Rigid Gas-permeable Contact Lenses
Authors: Nilagiri Vinay Kumar , Metlapally Sangeetha , Kalaiselvan Parthasarathi , Schor Clifton M. , Bharadwaj Shrikant R.
Published: March 2018

SIGNIFICANCE

This study showed an improvement in three-dimensional depth perception of subjects with bilateral and unilateral keratoconus with rigid gas-permeable (RGP) contact lens wear, relative to spectacles. This novel information will aid clinicians to consider RGP contact lenses as a management modality in keratoconic patients complaining of depth-related difficulties with their spectacles.

PURPOSE

The aim of this study was to systematically compare changes in logMAR acuity and stereoacuity from best-corrected spherocylindrical spectacles to RGP contact lenses in bilateral and unilateral keratoconus vis-à-vis age-matched control subjects.

METHODS

Monocular and binocular logMAR acuity and random-dot stereoacuity were determined in subjects with bilateral (n = 30; 18 to 24 years) and unilateral (n = 10; 18 to 24 years) keratoconus and 20 control subjects using standard psychophysical protocols.

RESULTS

Median (25th to 75th interquartile range) monocular (right eye) and binocular logMAR acuity and stereoacuity improved significantly from spectacles to RGP contact lenses in the bilateral keratoconus cohort (P < .001). Only monocular logMAR acuity of affected eye and stereoacuity improved from spectacles to RGP contact lenses in the unilateral keratoconus cohort (P < .001). There was no significant change in the binocular logMAR acuity from spectacles to RGP contact lenses in the unilateral keratoconus cohort. The magnitude of improvement in binocular logMAR acuity and stereoacuity was also greater for the bilateral compared with the unilateral keratoconus cohort. All outcome measures of cases with RGP contact lenses remained poorer than control subjects (P < .001).

CONCLUSIONS

Binocular resolution and stereoacuity improve from spectacles to RGP contact lenses in bilateral keratoconus, whereas only stereoacuity improves from spectacles to RGP contact lenses in unilateral keratoconus. The magnitude of improvement in visual performance is greater for the binocular compared with the unilateral keratoconus cohort.