bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the efficacy of part-time versus full-time brace wear in subjects with adolescent idiopathic scoliosis (AIS): a review of literature
Authors: Karimi Mohammad Taghi , Rabczuk Timon , Kavyani Mahsa , Macgarry Anthony
Published: November 2018

Background:

Scoliosis is a musculoskeletal disorder that can be managed by wearing an orthosis full or part time. It is not well understood whether the effectiveness of part-time orthotic management of spinal curve progression is as efficacious as full-time wear. The aim of this review was to determine the efficiency of part-time bracing (with a focus on night-time braces), compared to full-time bracing. Moreover, the study aimed to determine which part-time brace demonstrated the most efficacy.

Method:

A literature review was conducted via a Medline search in PubMed, ISI Web of knowledge, Scopus, Ebsco, Embasco, and Google Scholar. Key words (part time, night braces) were used in combination with adolescent idiopathic scoliosis. The quality of the selected papers was evaluated based on the Downs and Black tool.

Results:

Fifty papers were found. Following application of inclusion and exclusion criteria based on titles and abstracts, 19 papers were selected for final analysis. These papers were divided into three categories: (1) evaluation of the efficacy of night braces on progression of scoliotic curve (seven papers); (2) Comparison of efficacy between night and full-time bracing (10 studies); and (3) three-dimensional modeling and finite element analysis of part-time bracing.

Conclusions:

The Providence brace appears to provide an effective treatment approach to influence curve progression in scoliotic patients. However, it should be emphasized that its maximal effect is for lumbar, lumbosacral, and thoracic curves with a low apex. It is recommended to use the Charleston Bending brace only for patients with a single scoliotic curve. The efficacy of full-time bracing for double curves, thoracolumbar curves, and curves more than 35 degrees indicates that more than just a night brace is necessary. However, it seems that there is no difference between the effects of part-time and full-time bracing for curves of smaller magnitude (less than 35 degrees).
Outcome of ligamentotaxis and percutaneous screws for navicular fractures
Authors: Diab Hossam S.
Published: November 2018

Background:

The tarsal navicular bone plays a pivotal role in hindfoot motion and gait and is considered as a keystone of the foot’s medial longitudinal arch. Despite being relatively uncommon, navicular fractures are difficult to treat and may end up with devastating complications. The purpose of this study was to evaluate the effectiveness of fracture reduction with ligamentotaxis and maintenance of the reduction through percutaneous screw fixation.

Methods:

Twelve patients with comminuted navicular fractures were surgically treated and enrolled in this prospective study. Patients were evaluated through Foot and Ankle Outcome score (FAOS) and Ankle-Hindfoot scale. A composite questionnaire, including the EuroQol-5D (EQ-5D) and Visual Analog Scale (VAS) for pain and satisfaction with the surgical result was executed.

Results:

All patients returned to their preinjury activity level at their final follow-up. Eleven patients presented excellent FAOS score of ≥90. The mean FAOS score for all patients included in the study was 92.91 (SD; 3.26, range 86 to 98), and the mean Ankle-Hindfoot scale was 92.67 (SD 2.84). The mean health-related quality of life (EQ-5D) index score was 9.50, with an overall satisfaction scale of 9.83 (SD 0.39).

Conclusions:

Adequate reduction of navicular fractures can be achieved with axial traction through temporary Steinmann pins in the calcaneus and medial cuneiform. Minimally invasive percutaneous screws can maintain reduction, with excellent functional outcome
The role of complement in antineutrophil cytoplasmic antibody-associated vasculitis
Authors: Wester Trejo Maria A.C. , Trouw Leendert A. , Bajema Ingeborg M.
Published: November 2018

Purpose of review

To provide a comprehensive overview of the current insight into the role of complement activation in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). In addition, the therapeutic options targeting the complement system in AAV are discussed.

Recent findings

It has become increasingly clear that complement, and more specifically signalling through the C5a receptor, contributes to the immunopathology of AAV. This has led to the design of clinical trials with a C5a receptor blocker. The first results show a reduction in tissue damage and a favourable safety profile, as other parts of the complement defence system are left intact.

Although AAV was initially regarded as a pauci-immune disease, it is now well established that, in addition to autoantibodies, complement plays an essential role in the disease process. Animal models delivered the first insight, but the effective therapeutic interventions using complement inhibitors provided the proof that indeed complement activation contributes to disease activity and tissue damage in human AAV.
Cost-Utility Analysis of Operative Versus Nonoperative Treatment of Thoracic Adolescent Idiopathic Scoliosis
Authors: Jain Amit , Marks Michelle C. , Kelly Michael P. , Lenke Lawrence G. , Errico Thomas J. , Lonner Baron S. , Newton Peter O. , Sponseller Paul D.
Published: November 2018

Study Design.

Cost-utility analysis

Objective.

To compare the cost utility of operativeversusnonoperative treatment of adolescent idiopathic scoliosis (AIS) and identity factors that influence cost-utility estimates.

Summary of Background Data.

AIS affects 1% to 3% of children aged 10 to 16 years. When the major coronal curve reaches 50°, operative treatment may be considered. The cost utility of operative treatment of AIS is unknown.

Methods.

A decision-analysis model comparing operativeversusnonoperative treatment was developed for a hypothetical 15-year-old skeletally mature girl with a 55° right thoracic (Lenke 1) curve. The AIS literature was reviewed to estimate the probability, health utility, and quality-adjusted life years (QALYs) for each event. For the conservative model, we assumed that operative treatment did not result directly in any QALYs gained, and the health utility in AIS patients was the same as the age-matched US population mean. Costs were inflation-adjusted at 3.22% per year to 2015 US dollars. Costs and benefits were discounted at 3%. Probabilistic sensitivity analysis was performed using mixed first-order and second-order Monte Carlo simulations. Incremental cost utility ratio (ICUR) and incremental net monetary benefit were calculated. One-way sensitivity analyses were performed by varying cost, probability, and QALY estimates.

Results.

Operative treatment was favored in 98.5% of simulations, with a median ICUR of $20,600/QALY (95% confidence interval, $20,500–$21,900) below the societal willingness-to-pay threshold (WTPT) of $50,000/QALY. The median incremental net monetary benefit associated with operative treatment was $15,100 (95% confidence interval, $14,800–$15,700). Operative treatment produced net monetary benefit across various WTPTs. Factors that most affected the ICUR were net costs associated with uncomplicated operative treatment, undergoing surgery during adulthood, and development of pulmonary complications.

Conclusion.

Cost-utility analysis suggests that operative treatment of AIS is favored over nonoperative treatment and falls below the $50,000/QALY WTPT for patients with Lenke 1 curves.

Level of Evidence:2
30- and 90-Day Unplanned Readmission Rates, Causes, and Risk Factors After Cervical Fusion
Authors: Zaki Omar , Jain Nikhil , Yu Elizabeth M. , Khan Safdar N.
Published: November 2018

Study Design.

Retrospective cohort study

Objective.

To study 30- and 90-day readmission rates, causes, and risk factors after anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF).

Summary of Background Data.

Existing data on readmission after cervical fusion is majorly derived from national databases. Given their inherent limitations in accuracy, follow-up available, and missing data, we intend to add to literature from our institutional analysis.

Methods.

Patients who underwent ACDF and PCF for degenerative cervical pathology in 2013 and 2014 were identified for the study. Comprehensive chart review was performed to record demographics and clinical patient profile. Hospital readmission within 30 and 90 days was identified, and the causes and management were recorded. Binary logistic regression analysis was done to study risk factors for readmission. ACDF and PCF were studied separately.

Results.

Our analysis included a total of 549 patients, stratified as 389 ACDFs and 160 PCFs. The 30- and 90-day unplanned readmission rate was 5.1% and 7.7% after ACDF. These rates were 11.2% and 16.9% after PCF. The most common cause of readmission was systemic infection and sepsis after ACDF and PCF (31.4% and 25.8% of readmitted, respectively), followed by pulmonary complications after ACDF (14.3% of readmitted) and wound complications after PCF (19.4% of readmitted). Predictors of readmission after ACDF included heart failure, history of malignancy, history of deep vein thrombosis/pulmonary embolism, and any intraoperative complication. In the PCF cohort, history of ischemic heart disease, increasing number of fusion levels and longer length of stay were independently predictive.

Conclusion.

The rates, causes, and risk factors of readmission after ACDF and PCF have been identified. There is variation in published data regarding the incidence and risk factors for readmission after cervical fusion; however, majority of readmissions occur due to medical complications and systemic infection.

Level of Evidence: 3
Cervical and Cervicothoracic Sagittal Alignment According to Roussouly Thoracolumbar Subtypes
Authors: Theologis Alekos A. , Iyer Sravisht , Lenke Lawrence G. , Sides Brenda A. , Kim Han Jo , Kelly Michael P.
Published: November 2018

Study Design.

Cross-sectional cohort.

Objective.

To determine normative radiographic sagittal cervical alignment in asymptomatic volunteers based on Roussouly thoracolumbar sagittal alignment subtypes.

Summary of Background Data.

Comprehension of differences in cervicothoracic alignment with respect to variations in thoracolumbar alignment is limited.

Methods.

Asymptomatic adults were recruited and the following parameters measured: PI, PT, SS, LL, orbital tilt, orbital slope, occipital slope and incidence, occiput-C2 lordosis, C2–7 lordosis, occiput-C7 lordosis, CBVA, T1 slope, cervicothoracic alignment, T2–5 kyphosis, and C2–C7 sagittal vertebral alignment (SVA). Each was classified into one of Roussouly's four thoracolumbar subtypes and cervical alignment parameters were compared between groups.

Results.

Eighty-seven individuals [male-23; female-64; average age 49 ± 16 yr (22–77 yr)] were included for analysis. The four groups were not different by age, sex, and body mass index (BMI). Lumbopelvic parameters (PI, SS, PT, LL) were different between Roussouly types. Average values for all patients included: CBVA (−1 ± 9°), occiput-C2 lordosis (28 ± 9°), occiput-C7 lordosis (39 ± 14°), C2–7 lordosis (11 ± 14°), C2-7 SVA (21 ± 9 mm), T1 slope (25 ± 9°), C6-T4 angle (5 ± 8°), T2-5 angle (16 ± 7°), thoracic kyphosis (47 ± 13°). No sagittal radiographic alignment measurements of the cervical spine and cervicothoracic junction were different between groups, except for the global cervical lordosis (occiput-C7 Cobb), which was found to be lowest for Roussouly type 2 (35 ± 14°) and highest for type 4 (48 ± 14°) (P = 0.01). Mean C2–C7 sagittal Cobb, T2–T5 sagittal Cobb, and T1 slope were not different between groups.

Conclusions.

In asymptomatic volunteers, normative sagittal alignment parameters of the cervical spine, cervicothoracic junction, and thoracic spine based on variations in thoracolumbar sagittal alignment, as proposed by Roussouly, are established. These data may guide surgical correction of cervicothoracic deformities to ensure appropriate restoration of normal cervicothoracic parameters to maintain good horizontal gaze and overall sagittal plane alignment.

Level of Evidence: 3
Does the Severity of the Curve in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients Affect the Distance and Position of the Aorta From Vertebra?
Authors: Chiu Chee Kidd , Lee Keong Joo , Chung Weng Hong , Chandren Josephine Rebecca , Chan Chris Yin Wei , Kwan Mun Keong
Published: November 2018

Study Design.

Retrospective study of a prospectively-collected data.

Objective.

To determine whether the severity of the curve magnitude in Lenke 1 and 2 Adolescent Idiopathic Scoliosis (AIS) patients affects the distance and position of the aorta from the vertebra.

Summary of Background Data.

There were studies that looked into the position of the aorta in scoliotic patients but none of them documented the change in distance of the aorta to the vertebra in relation to the magnitude of the scoliosis.

Methods.

Patients with Lenke 1 and 2 AIS who underwent posterior spinal fusion using pedicle screw construct and had a preoperative computed tomography (CT) scan performed were recruited. The radiological parameters measured on preoperative CT scan were: Aortic-Vertebral Distance (AVD), Entry-Aortic Distance (EAD), Aortic-Vertebral angle (AVA), Pedicle Aorta angle/Aortic Alpha angle (α angle), and Aortic Beta angle (β angle).

Results.

Thirty-nine patients were recruited. Significant moderate to strong positive correlation was found between AVD and Cobb angle from T8 to T12 vertebrae (r = 0.360 to 0.666). The EAD was generally small in the thoracic region (T4–T10) with mean EAD of less than 30 mm. Among all apical vertebrae, the mean AVD was 5.9 ± 2.2 mm with significant moderate-strong positive correlation to Cobb angle (r = 0.580). The mean α angle was 37.7 ± 8.7° with significant weak positive correlation with Cobb angle (r = 0.325).

Conclusion.

The larger the scoliotic curve, the aorta was located further away from the apical vertebral wall. The aorta has less risk of injury from the left lateral pedicle screw breach in larger scoliotic curve at the apical region. The distance from the pedicle screw entry point to the wall of the aorta was generally small (less than 30 mm) in the thoracic region (T4–T10).

Level of Evidence: 4
Effect of Modified Japanese Orthopedic Association Severity Classifications on Satisfaction With Outcomes 12 Months After Elective Surgery for Cervical Spine Myelopathy
Authors: Asher Anthony L. , Devin Clinton J. , Weisenthal Benjamin M. , Pennings Jacquelyn , Khan Inamullah , Archer Kristin R. , Sivaganesan Ahilan , Chotai Silky , Bydon Mohamad , Nian Hui , Harrell Frank E. , McGirt Matthew J. , Mummaneni Praveen , Bisson Erica F. , Shaffrey Christopher , Foley Kevin T.
Published: November 2018

Study Design.

This study retrospectively analyzes prospectively collected data.

Objective.

Here, we aim to determine the influence of preoperative and 12-month modified Japanese Orthopedic Association (mJOA) on satisfaction and understand the change in mJOA severity classification after surgical management of degenerative cervical myelopathy (DCM).

Summary of Background Data.

DCM is a progressive degenerative spine disease resulting from cervical cord compression. The natural progression of DCM is variable; some patients experience periods of stability, while others rapidly deteriorate following disease onset. The mJOA is commonly used to grade and categorize myelopathy symptoms, but its association with postoperative satisfaction has not been previously explored.

Methods.

The quality and outcomes database (QOD) was queried for patients undergoing elective surgery for DCM. Patients were divided into mild (≥14), moderate (9 to 13), or severe (<9) categories on the mJOA scores. A McNemar–Bowker test was used to assess whether a significant proportion of patients changed mJOA category between preoperative and 12 months postoperative. A multivariable proportional odds ordinal logistic regression model was fitted with 12-month satisfaction as the outcome of interest.

Results.

We identified 1963 patients who underwent elective surgery for DCM and completed 12-months follow-ups. Comparing mJOA severity level preoperatively and at 12 months revealed that 55% remained in the same category, 37% improved, and 7% moved to a worse category. After adjusting for baseline and surgery-specific variables, the 12-month mJOA category had the highest impact on patient satisfaction (P < 0.001).

Conclusion.

Patient satisfaction is an indispensable tool for measuring quality of care after spine surgery. In this sample, 12-month mJOA category, regardless of preop mJOA, was significantly correlated with satisfaction. Given these findings, it is important to advise patients of the probability that surgery will change their mJOA severity classification and the changes required to achieve postoperative satisfaction.

Level of Evidence: 3
The Association Between Preoperative MRI Findings and Surgical Revision Within Three Years After Surgery for Lumbar Disc Herniation
Authors: Ziegler Dorthe Schoeler , Carreon Leah , Andersen Mikkel Oesterheden , Jensen Rikke Krüger
Published: November 2018

Study Design.

This cohort study was an analysis of prospectively collected data in the DaneSpine Database.

Objective.

The objective was to determine whether preoperative magnetic resonance imaging (MRI) findings were associated with the frequency of surgical revision due to recurrent lumbar disc herniation (LDH) within 3 years after first-time, single-level, simple lumbar discectomy.

Summary of Background Data.

Because of a risk of poorer outcome in patients receiving revision surgery compared with first-time discectomy, there is a need to identify patients with LDH in risk of surgical revision prior to the primary discectomy. The association between preoperative MRI findings and revision surgery in patients with LDH has not been thoroughly studied.

Methods.

Following an interobserver reliability study preoperative MRIs were evaluated. Potential predictive variables for surgical revision were evaluated using univariate and multivariate logistic regression analysis. Also, a sum-score of the number of MRI findings at the involved level was assessed.

Results.

In a study population of 451 operated patients, those who had surgical revision were significantly younger and were significantly less likely to have vertebral endplate signal changes Type 2 (OR 0.36 (95% CI 0.15–0.88)) or more than five MRI findings (OR 0.45 (95% CI 0.21–0.95)) at the involved level than the patients not undergoing surgical revision. Surgical revision was not significantly associated with any other MRI findings.

Conclusions.

In general, preoperative MRI findings have a limited explanatory value in predicting surgical revision within 3 years after first-time, single-level, simple lumbar discectomy. Both the single variable VESC Type 2 and a sum-score > 5 MRI findings at the operated level were found to be negatively associated with patients undergoing surgical revision.

Level of evidence: 3
Comparison of Single-Level Versus Multilevel Vertebral Column Resection Surgery for Pediatric Patients With Severe Spinal Deformities
Authors: Hwang Chang Ju , Lenke Lawrence G. , Sides Brenda A. , Blanke Kathy M. , Kelly Michael P.
Published: November 2018

Study Design.

Retrospective cohort of pediatric patients (younger than 21 years) with severe spinal deformities who underwent vertebral column resection (VCR) surgery.

Objective.

To compare patients who underwent single- versus multilevel VCR surgery in terms of radiographic correction and perioperative complications.

Summary of Background Data.

There are few studies comparing single- to multilevel VCR surgery regarding the efficacy and safety of the procedures.

Methods.

Eighty-two pediatric patients who underwent a VCR for severe spinal deformity between 2002 and 2012 by one surgeon were included. A single-level VCR was performed in 45 patients with an average of 4.7-year follow-up, and multilevel VCR in 37 patients with an average of 4.6-year follow-up.

Results.

Coronal Cobb corrections were not different between groups (single level: 63%, multilevel: 58%, P = 0.146). Correction loss at final follow-up did not differ (3.1° vs. 0.3°, P = 0.132). Patients in the single-level group had shorter operation times (9.2 vs. 10.5 hours, P = 0.046), whereas estimated blood loss did not differ between the two groups (1061 vs. 1200 mL, P = 0.181). The rate of spinal cord monitoring events was 20% (8/40) and 30% (9/30), respectively. No patient in the single-level group had a postoperative neurologic deficit, whereas three patients in the multilevel group experienced a temporary deficit postoperatively (0/45 vs. 3/37, P = 0.088).

Conclusion.

There was no difference in radiographic correction between the single- and multilevel VCR groups. The multilevel VCR patients had longer operative times, and although the differences were not statistically significant due to low sample size, the multilevel VCR group also had an increased rate of postoperative neurologic deficits. We would recommend single-level VCRs unless there is an absolute indication for multilevel resection as in necessary decompression for spinal cord impingement.

Level of Evidence: 4
Efficiency of Power Versus Hand Screwdriver for Cortical Lag Screw Insertion
Authors: Runner Robert P. , Boissonneault Adam R. , Bellamy J. Taylor , Moore Thomas J.
Published: November 2018

Introduction:

Limited studies exist on which modality, power or manual instruments, is superior for cortical screw placement. More efficient screw insertion could decrease operative time and reduce overall cost. The purpose of this study is to compare the speed and accuracy of lag screw placement in sawbone models using power and manual screwdrivers.

Materials and Methods:

A total of 48 orthopedic faculty, orthopedic residents, and medical students participated. Eight stations were tested, each with a different anatomic location (femur/tibia/radius), trajectory (anterior-posterior, lateral-medial, oblique), and screw length (18 to 95 mm). Each station had 1 correct passage and 4 false passages to assess for accuracy. The time required to place the screw in the correct passage using both power and hand screwdrivers was recorded along with the total attempts.

Results:

There was no significant difference in speed or accuracy of screw placement using power or manual screwdrivers. However, more accurate screw placement was significantly associated with faster insertion time. Level of training and attendance of a basic fracture course were significantly associated with faster insertion times and more accurate insertion when using the power screwdriver on certain stations, but there was no difference using the manual screwdriver.

Conclusions:

The difference in time between the actual techniques of using power or manual tools is marginal as accuracy is the most important factor for screw insertion efficiency. We propose that surgeons utilize the modality they are more accurate with to prevent misdirected screws and increase efficiency in the operating room.
Circumferential Pharyngoesophageal Reconstruction and Total Larynx Preservation with Extra-anatomical Free Flaps
Authors: Lasso Jose M. , Castellano Michele , Pinilla Carmen , González-Pozega Carlota , Pérez-Cano Rosa
Published: November 2018

Reconstruction of total circumferential pharyngeal defects following caustic or stenosant lesions of the pharynx present major challenges with respect to minimizing surgical morbidity and restoring functional deficits. With recent advances in microvascular free tissue transfer, the options for pharyngeal reconstruction have multiplied in order to maximize swallowing and voice. There is long experience in the reconstruction of the pharynx and the cervical esophagus in oncological patients after total pharyngolaryngectomy, but there are not many publications concerning circumferential pharyngeal reconstruction preserving the larynx. Here, we discuss 2 new techniques for total circumferential pharyngeal reconstruction respecting swallowing and voice by means of extra-anatomical bypasses (visceral or fasciocutaneous), upholding the larynx in its original placement.
The Effect of Liposuction Cannula Diameter on Fat Retention—Based on a Rheological Simulation
Authors: Tong Yuanren , Liu Penghao , Wang Yuneng , Geng Chang , Han Xuefeng , Ma Jiguang , Li Facheng , Cai Lei
Published: November 2018

Background:

Autologous fat is considered as an ideal material for soft-tissue augmentation in plastic and reconstructive surgery. The primary drawback of autologous fat grafting is the high absorption rate, thus fat retention is considered as an essential indicator. There are several researches about the factors that can influence fat retention, including centrifugation and cannula size. However, rheological models of cannula during liposuction are limited. This research focuses on the effects of cannulas with diameters of 2 mm and 2.5 mm on fat retention, which is based on a rheological simulation of inlet pressure and maximum velocity. Experiments on mice were also conducted to confirm the result from the simulation.

Methods:

A simulation was conducted with the physical parameters of the adipose tissue. Human lipoaspirate samples were obtained from patients by liposuction through cannulas of different diameters and were transferred into subcutaneous tissue of nude mice, a part of which were used in viscosity and density measurement. Graft retention was measured and fat quality was assessed through histologic analysis after 6 months.

Results:

Viscosity and density of the fat tissue had significant effects on fat retention. The 2.5 mm diameter cannula had significantly lower inlet pressure and maximum velocity and thus led to higher graft retention, but oil cystic nodules appeared meanwhile.

Conclusions:

Cannulas with larger diameters have lower inlet pressure and maximum velocity during the liposuction process, which further influences the viability of adipocytes and adipose stem cells and thus has larger fat graft retention. This research built a mathematical model with less bias than in vivo experiments and provides a general way for analyzing the outcome of a liposuction precisely, which adds to the data for cannula optimization.
THE OCCURRENCE, CHARACTERISTICS, MANAGEMENT, AND PROGNOSIS OF RETINAL PIGMENT EPITHELIUM TEARS IN PATIENTS WITH POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Zhao Xin-yu , Xia Song , Luo Ming-yue , Wang Er-qian , Chen You-xin
Published: November 2018

Purpose:

To investigate retinal pigment epithelium (RPE) tears in patients with polypoidal choroidal vasculopathy.

Method:

A retrospective review of polypoidal choroidal vasculopathy cases with confirmed RPE tears was conducted. Patients' comprehensive clinical data were collected and analyzed. The treatment strategy was a loading dose of one intravitreal antivascular endothelial growth factor injection, combined with additional injections if exudative activities or visual deterioration were detected.

Results:

Among 397 polypoidal choroidal vasculopathy patients, 33 patients with RPE tears (8.3%) were included. 42.4% of them happened spontaneously. Pigment epithelial detachment (PED) occurred more frequently in RPE tear patients and most of them had serous vascularized or hemorrhagic PED. The height and greatest linear diameter of PED, and the subfoveal choroidal thickness of these cases were significantly larger, whereas the central foveal thickness was significantly smaller. Most of the RPE tears occurred at the edge of the PED. After our treatment strategy, patients' best-corrected visual acuity improved significantly from 2.13 ± 1.24 (median 20/52) to 1.32 ± 1.31 (median 20/166). Large subretinal hemorrhage may increase the risk of the formation of subretinal fibrosis (P < 0.05).

Conclusion:

Retinal pigment epithelium tears in polypoidal choroidal vasculopathy are associated with high subRPE hydrostatic pressure, produced by a large PED or hemorrhage. After our intervention strategy, this condition may not necessarily result in poor prognosis.
ADVERSE EVENTS OF THE ARGUS II RETINAL PROSTHESIS
Authors: Rizzo Stanislao , Barale Pierre-Olivier , Ayello-Scheer Sarah , Devenyi Robert G. , Delyfer Marie-Noëlle , Korobelnik Jean-François , Rachitskaya Aleksandra , Yuan Alex , Jayasundera K. Thiran , Zacks David N. , Handa James T. , Montezuma Sandra R. , Koozekanani Dara , Stanga Paulo E. , da Cruz Lyndon , Walter Peter , Augustin Albert J. , Chizzolini Marzio , Olmos de Koo Lisa C. , Ho Allen C. , Kirchhof Bernd , Hahn Paul , Vajzovic Lejla , Iezzi Raymond , Gaucher David , Arevalo J. Fernando , Gregori Ninel Z. , Grisanti Salvatore , Özmert Emin , Yoon Young Hee , Kokame Gregg T. , Lim Jennifer I. , Szurman Peter , de Juan Eugene , Rezende Flavio A. , Salzmann Joël , Richard Gisbert , Huang Suber S. , Merlini Francesco , Patel Uday , Cruz Cynthia , Greenberg Robert J. , Justus Sally , Cinelli Laura , Humayun Mark S.
Published: November 2018

Purpose:

To analyze and provide an overview of the incidence, management, and prevention of conjunctival erosion in Argus II clinical trial subjects and postapproval patients.

Methods:

This retrospective analysis followed the results of 274 patients treated with the Argus II Retinal Prosthesis System between June 2007 and November 2017, including 30 subjects from the US and European clinical trials, and 244 patients in the postapproval phase. Results were gathered for incidence of a serious adverse event, incidence of conjunctival erosion, occurrence sites, rates of erosion, and erosion timing.

Results:

Overall, 60% of subjects in the clinical trial subjects versus 83% of patients in the postapproval phase did not experience device- or surgery-related serious adverse events. In the postapproval phase, conjunctival erosion had an incidence rate of 6.2% over 5 years and 11 months. In 55% of conjunctival erosion cases, erosion occurred in the inferotemporal quadrant, 25% in the superotemporal quadrant, and 20% in both. Sixty percent of the erosion events occurred in the first 15 months after implantation, and 85% within the first 2.5 years.

Conclusion:

Reducing occurrence of conjunctival erosion in patients with the Argus II Retinal Prosthesis requires identification and minimization of risk factors before and during implantation. Implementing inverted sutures at the implant tabs, use of graft material at these locations as well as Mersilene rather than nylon sutures, and accurate Tenon's and conjunctiva closure are recommended for consideration in all patients.
Clinical Presentation and Management Outcomes of Coexistent Congenital Glaucoma and Retinopathy of Prematurity
Authors: Senthil Sirisha , Balijepalli Pasyanthi , Garudadri Chandrasekhar , Jalali Subhadra
Published: November 2018

Purpose:

The purpose of this study was to report presentation and outcomes of coexisting congenital glaucoma with retinopathy of prematurity (ROP) in “Indian Twin cities ROP study (ITCROPS).”

Methods:

Children with ROP and congenital glaucoma were identified from ITCROPS (prospective digital database) between 1997 and 2016. The presentation, interventions, and outcomes for glaucoma and ROP were evaluated.

Results:

Out of 15,000 premature-infants database, 3000 children had ROP, of these 87 eyes of 64 premature children had glaucoma. Five eyes (5.7%) of 3 children in the entire ROP cohort had coexisting congenital glaucoma (before any ROP intervention), 3 eyes of 2 children had primary congenital glaucoma and 2 eyes of one child had glaucoma with microspherophakia. The mean age at surgery was 2.7±0.6 months. At presentation, all eyes had corneal edema, mean corneal diameter was 10.3±0.75 mm and IOP was 20.4±1.67 mm Hg. Three eyes had stage-2 ROP and two eyes had stage-3 ROP. Four eyes received intravitreal Bevacizumab. All eyes underwent combined trabeculotomy with trabeculectomy. Post glaucoma surgery, 2 eyes underwent laser for ROP and 1 eye with stage-2 ROP was observed with no treatment. ROP regressed without any sequalae in all 5 eyes. Two eyes with microspherophakia and one eye with lens coloboma underwent lensectomy. One eye postlensectomy needed Ahmed glaucoma valve implant for IOP control. The mean IOP at last follow-up was 13.6±1.67 mm Hg and all eyes needed topical antiglaucoma medications for IOP control.

Conclusions:

Congenital glaucoma coexisting with ROP is a medical emergency. Intravitreal therapy can help tide over the vision-threatening fulminant phase of ROP while awaiting the effect of glaucoma surgery on corneal clarity. The need for medications even after glaucoma surgery suggests severe glaucoma phenotype. Close coordination between subspecialties is needed for best outcomes.
Optical Coherence Tomography Angiography of Optic Disc and Macula Vessel Density in Glaucoma and Healthy Eyes
Authors: Yip Vivien C.H. , Wong Hon Tym , Yong Vernon K.Y. , Lim Boon Ang , Hee Owen K. , Cheng Jun , Fu Huazhu , Lim Chingwei , Tay Elton L.T. , Loo-Valdez Roselyn G. , Teo Hwei Yee , Lim PH Angela , Yip Leonard W.L.
Published: November 2018

Aim:

To study the microvascular density of the macular and optic nerve head in healthy and glaucoma subjects using optical coherence tomography angiography.

Methodology:

We performed a cross-sectional cohort study on healthy subjects and patients with glaucoma. The AngioVue Enhanced Microvascular Imaging System was used to capture the optic nerve head and macula images during one visit. En face segment images of the macular and optic disc were studied in layers. Microvascular density of the optic nerve head and macula were quantified by the number of pixels measured by a novel in-house developed software. Areas under the receiver operating characteristic curves (AUROC) were used to determine the accuracy of differentiating between glaucoma and healthy subjects.

Results:

A total of 24 (32 eyes) glaucoma subjects (57.5±9.5-y old) and 29 (58 eyes) age-matched controls (51.17±13.5-y old) were recruited. Optic disc and macula scans were performed showing a greater mean vessel density (VD) in healthy compared with glaucoma subjects. The control group had higher VD than the glaucoma group at the en face segmented layers of the optic disc (optic nerve head: 0.209±0.05 vs. 0.110±0.048, P<0.001; vitreoretinal interface: 0.086±0.045 vs. 0.052±0.034, P=0.001; radial peripapillary capillary: 0.146±0.040 vs. 0.053±0.036, P<0.001; and choroid: 0.228±0.074 vs. 0.165±0.062, P<0.001). Similarly, the VD at the macula was also greater in controls than glaucoma patients (superficial retina capillary plexus: 0.115±0.016 vs. 0.088±0.027, P<0.001; deep retina capillary plexus: 0.233±0.027 vs. 0.136±0.073, P<0.001; outer retinal capillary plexus: 0.190±0.057 vs. 0.136±0.105, P=0.036; and choriocapillaris: 0.225±0.053 vs. 0.153±0.068, P<0.001. The AUROC was highest for optic disc radial peripapillary capillary (0.96), followed by nerve head (0.92) and optic disc choroid (0.76). At the macula, the AUROC was highest for deep retina (0.86), followed by choroid (0.84), superficial retina (0.81), and outer retina (0.72).

Conclusions:

Microvascular density of the optic disc and macula in glaucoma patients was reduced compared with healthy controls. VD of both optic disc and macula had a high diagnostic ability in differentiating healthy and glaucoma eyes.
Episcleral Venous Fluid Wave in the Living Human Eye Adjacent to Microinvasive Glaucoma Surgery (MIGS) Supports Laboratory Research: Outflow is Limited Circumferentially, Conserved Distally, and Favored Inferonasally
Authors: Fellman Ronald L. , Grover Davinder S.
Published: November 2018

Purpose:

The purpose of this study was to describe downstream patterns of outflow with the episcleral venous fluid wave (EVFW) in the living human eye adjacent to microinvasive glaucoma surgery (MIGS) and determine if the EVFW supports existing ex-vivo laboratory outflow research.

Design:

Retrospective, noncomparative case series.

Patients:

A total of 10 eyes of 10 patients who underwent phaco-Trabectome and 10 eyes of 10 patients who underwent phaco-iStent consecutively at Glaucoma Associates of Texas for cataract and uncontrolled glaucoma who demonstrated an episcleral wave.

Methods:

The EVFW was visualized and recorded during irrigation and aspiration. To describe the hydrodynamic properties of the fluid wave, its degrees, extent, and characteristics were measured with a protractor in Photoshop.

Results:

The incised Trabectome arc produced adjacent episcleral blanching of 134±11 degrees (range, 112 to 150 degrees) with an additional 54 degrees of marginal recruitment (41 degrees inferonasal plus 13 degrees superonasal) adjacent to the ends of the Trabectome incision. The mean episcleral blanch for the iStent was 51±19 degrees (range, 19 to 90 degrees), comprised of 29 degrees inferonasal plus 22 degrees superonasal.

Conclusions:

Downstream episcleral flow in the living human eye adjacent to the iStent is variable and mainly confined to 2 clock hours indicating a lack of significant circumferential flow in glaucomatous eyes. Flow distal to the Trabectome site encompasses the Trabectome incisional arc with an additional 2 clock hours of lateral fluid wave favoring the inferonasal over superonasal quadrant 3 to 1. These in-vivo findings made visible with MIGS, corroborate recent in-vivo and long-standing ex-vivo laboratory research that outflow is largely segmented, favored inferonasally and conserved distally.
Healthcare Resource Utilization and Cost of Invasive Meningococcal Disease in Ontario, Canada
Authors: Rampakakis Emmanouil , Vaillancourt Julie , Mursleen Sara , Sampalis John S.
Published: November 2018

Background:

Invasive meningococcal disease (IMD) is associated with significant morbidity and mortality, thus remaining a concern for healthcare providers and the public. Evidence of the longitudinal burden of IMD and associated costs are scarce. Here we have evaluated the healthcare utilization and cost associated with hospitalized IMD cases in Ontario, Canada.

Methods:

Observational cohort study utilizing the Ontario provincial claims databases, comprising: (1) individuals hospitalized with IMD between January 1995 and June 2012 and (2) age-, gender- and area-matched non-IMD controls (1:20 ratio). IMD cases were identified through diagnostic codes from hospitalization data and medical services claims. Costs are presented in Canadian dollars.

Results:

Nine-hundred twelve IMD cases and 18,221 non-IMD controls were included. Over 5 years of follow-up, 27% of IMD cases (excluding initial hospitalization and 30-day acute phase) versus 15% of non-IMD controls (P < 0.001) were hospitalized. Compared with controls, IMD cases were more likely to receive alternative level of care (6.7% vs. 1.1%; P < 0.001) or visit the intensive care unit (49.2% vs. 2.4%; P < 0.001), and were associated with significantly higher mean hospitalization cost per case ($40,075 vs. $2827; P < 0.001). The hospitalization cost per case remained significantly higher when excluding the initial hospitalization and acute phase ($9867 vs. $3312; P < 0.001). The mean total cost per IMD case, including medications, hospitalization and medical services, was $45,768–$52,631 ($13,520–$23,789 excluding initial hospitalization and acute phase), for an overall cost (all cases during total follow-up) of $41,740,142–$47,999,289.

Conclusions:

In addition to its clinical burden, IMD is associated with significant economic burden to the public health system.
Physicians in Kentucky Perceive Physician Assistants to Be Competent Health Care Providers
Authors: Chatterjee Somu , Westneat Susan , Wyant Andrew , Hunton Ryan
Published: November 2018

Purpose

The use of certified physician assistants (PA) has increased throughout the US health care system. The purpose of this study was to objectively evaluate physicians' perceptions of PAs' mastery of specific skills. It is important to understand stakeholders' perceptions of PAs' capabilities to support future changes in policies for better utilization of PAs in our health care system.

Methods

From 2014 to 2015, randomly chosen “active” physicians listed with the Kentucky Board of Medical Licensure were surveyed about their perceptions of competencies of certified PAs. Six competency domains (medical knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning, and improvement and systems-based practice) were rated using a Likert scale. Each competency-derived skill-based question was ranked by the number of physicians giving the highest scores on the Likert scale (a score of 4 or 5) and by effect size. Cronbach's alpha for the survey was calculated.

Results

An overwhelming majority of the physicians perceived certified PAs to be competent (n ≥ 161, ≥ 60%) for specific skills. The survey had internal consistency with Cronbach's alpha ranging from 0.75 to 0.87 for competency domains. Effect size ranged from 0.44 to 0.98 for scores given by physicians with, versus without, experience with PAs.

Conclusions

For the first time, there is objective evidence of physicians' perceptions of PAs' mastery of specific competency-derived PA skill sets. This study will help guide effective utilization of PAs throughout the health care system and future PA education.
How Do Socket Size Adjustments during Ambulation Affect Residual Limb Fluid Volume? Case Study Results
Authors: Larsen Brian G. , McLean Jake B. , Redd Christian B. , Brzostowski Jacob T. , Allyn Katheryn J. , Sanders Joan E.
Published: November 2018

Introduction

Adjustable prosthetic sockets may be useful in management of limb volume in individuals with amputation. Incrementally increasing socket size during ambulation may increase residual limb fluid volume, deterring daily volume loss without sacrificing gait stability.

Materials and Methods

Participants with transtibial limb loss wore motor-controlled cabled-panel adjustable sockets while residual limb fluid volume was monitored using bioimpedance analysis. Participants walked on a treadmill with a safety harness while socket size was adjusted to establish users' ranges of acceptable sizes and optimal size. Then single controlled size adjustments were made. In longer duration testing outside the laboratory, participants used a portable system controlled by a mobile phone app to incrementally increase or decrease their socket size.

Results

For the two participants tested, comfortable socket sizes spanned as low as a 1.6% range of socket volume to as high as a 6.1% range. Limb fluid volume changed in proportion to socket size when adjustments were near users' optimal socket size setting.

Conclusions

Adjustable sockets are a viable means to manipulate limb fluid volume during ambulation. Incremental changes in socket size, approximately 0.33% socket volume, were sufficient to induce detectable changes in socket fit.
Review of evidence for bosentan therapy for treatment of Eisenmenger syndrome
Authors: Hartwig Benjamin J. , Schultze Benjamin
Published: November 2018

Background and purpose:

Eisenmenger syndrome (ES) is a rare condition caused by a right-to-left cyanotic shunt. To date, only heart–lung transplant has been shown to be curative. Bosentan is the only medication studied with a double-blind placebo-controlled randomized trial for management of this condition. The intent of this article is to explore the literature surrounding bosentan in ES and assess its efficacy.

Methods:

A literature review was conducted with no limitation on date. Titles were scanned for applicability, and abstracts of those articles found to be pertinent were reviewed. Those articles considered relevant based on the abstract were read in entirety.

Conclusions:

Eisenmenger syndrome remains incurable except through heart–lung transplant. Although no specific medical treatment or algorithm exists, three pharmacological classes show promise in disease management: endothelin receptor antagonists, phosphodiesterase inhibitors, and prostacyclins. Combined therapy with these agents may improve cardiopulmonary function. Bosentan has not been proven as a monotherapy for ES and is not appropriate in all patients as side effects are commonly reported.

Implications for practice:

Further study is required to assess efficacy of combination therapy and utilization as a bridge to transplant or surgical correction of the underlying defect.
Long-term Outcomes of Ossiculoplasty With and Without an Intact Malleus
Authors: Page Joshua Cody , Cox Matthew D. , King DeAnne , Allsopp Tristan , Dornhoffer John L.
Published: November 2018

Objective:

To compare long-term hearing outcomes following ossiculoplasty with cartilage tympanoplasty with (M+) and without (M−) the malleus present.

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

One twenty-six patients (18–88 yr of age) undergoing ossiculoplasty with tympanoplasty or tympanomastoidectomy using cartilage tympanic membrane grafts from 1998 to 2012 with at least 5 years of documented postoperative follow-up.

Main Outcome Measures:

Short-term hearing results (pure-tone average air-bone gap [PTA-ABG] measured between 60 d and 1 yr after surgery), long-term hearing results (PTA-ABG measured ≥5 yr after surgery), Ossiculoplasty Outcome Parameter Staging (OOPS) index, and complications.

Results:

There were 46 patients in the M+group and 80 in the M−group. Preoperative PTA-ABG was 23.8 dB for M+and 34.5 dB for M−(p = 0.00001). Short-term postoperative PTA-ABG was 19.3 dB for M+and 18.5 dB for M−(p = 0.727). Long-term postoperative PTA-ABG was 18.2 dB for M+and 19.6 dB for M−(p = 0.500). The OOPS index was 4.11 and 6.41 for M+and M_, respectively, (p = 0.00001). Thirteen patients (10.3%) experienced complications.

Conclusion:

Our data suggest that the malleus is not statistically significant with regard to its impact on final audiometric outcome following ossiculoplasty. This has implications in our clinic, particularly in our use of the OOPS index as a prognostic tool, and will likely lead to its revision. These data may further support the coupling theory of acoustic gain and weaken the catenary lever theory.
Treatment of chronic obstructive pulmonary disease in patients with different fractional exhaled nitric oxide levels
Authors: Wu Yao-Kuang , Su Wen-Lin , Huang Chun-Yao , Yang Mei-Chen , Chen Sin-Yi , Lan Chou-Chin
Published: November 2018

Some patients with chronic obstructive pulmonary disease (COPD) have eosinophilic inflammation which may be evaluated via the measurement of fractional exhaled nitric oxide (FeNO) like asthma. The aim of this prospective study was to assess whether FeNO levels can be used to identify patients with COPD with eosinophilic inflammation who may respond to inhaled corticosteroid (ICS) therapy.

This study included patients (N = 112) with COPD (age >18 years) who were divided into 4 groups depending upon whether they had high (≥25 parts per billion [ppb]) or low (<25 ppb) pretreatment (baseline) FeNO and if they were treated with either ICS plus long-acting β-agonist (ICS + LABA) or a long-acting muscarinic antagonist (LAMA). The 4 groups were: high FeNO/ICS + LABA, high FeNO/LAMA, low FeNO/ICS + LABA, and low FeNO/LAMA. Outcomes assessed included FeNO, COPD assessment test (CAT), and pulmonary function.

The high FeNO/ICS + LABA group had the greatest reduction from baseline in FeNO levels (−25.80 ppb ± 27.14) compared with the high FeNO/LAMA, low FeNO/ICS + LABA, and low FeNO/LAMA groups (range, −4.45 to 1.31 ppb; P < .001). The high FeNO/ICS + LABA group also showed the greatest improvement in CAT (−7.20), which was statistically larger than the low FeNO/ICS + LABA and low FeNO/LAMA groups (−1.72 and −2.03, respectively). No difference in pulmonary function following treatment was observed across the 4 groups.

This study found that patients with high FeNO showed the greatest reduction in FeNO and improvement in CAT with ICS + LABA therapy, supporting the use of FeNO to identify patients who would benefit from ICS use.