bluuebunny/crossref_metadata_2025 huggingface dataset:
Silver(I) metallodrugs of thiosemicarbazones and naproxen: biocompatibility, in vitro anti-proliferative activity and in silico interaction studies with EGFR, VEGFR2 and LOX receptors
Authors: Bharathi Sundaram , Mahendiran Dharmasivam , Kumar Raju Senthil , Choi Hyo Jeong , Gajendiran Mani , Kim Kyobum , Rahiman Aziz Kalilur
Published: January 2020

Four new heteroleptic silver(I) complexes with the general formula [Ag(L1–4)(nap)] (1–4), where L1–4 =  2-(1-(4-substitutedphenyl)ethylidene)hydrazinecarbothioamide and nap = naproxen, have been synthesized and characterized. The geometric parameters determined from density functional theory and UV-Vis studies indicate distorted tetrahedral geometry around silver(I) ion. Fourier transform infrared (FT IR) spectra evidenced asymmetric bidentate coordination mode of carboxyl oxygen atoms of naproxen with silver(I) ion. The complexes are stable for 72 h and biocompatibility was analysed towards normal human dermal fibroblast cells, which showed non-toxic nature up to 100 ng/ml. In vitro anti-proliferative activity of the complexes by MTT assay was tested against three human cancerous cell lines and one non-tumorigenic human breast epithelial cell line (MCF-10a) in which the complex 4 exhibited enhanced activity. The morphological changes observed by acridine orange/ethidium bromide and Hoechst 33258 staining method reveal apoptosis-inducing ability of the complexes. The molecular docking studies suggest hydrogen bonding, hydrophobic and π-pair interactions with the active site of epidermal growth factor receptor, vascular endothelial growth factor receptor 2 and lipoxygenase receptors.
Unraveling virus relationships by structure-based phylogenetic classification
Authors: Ng Weng M , Stelfox Alice J , Bowden Thomas A
Published: January 2020

Delineation of the intricacies of protein function from macromolecular structure constitutes a continual obstacle in the study of cell and pathogen biology. Structure-based phylogenetic analysis has emerged as a powerful tool for addressing this challenge, allowing the detection and quantification of conserved architectural properties between proteins, including those with low or no detectable sequence homology. With a focus on viral protein structure, we highlight how a number of investigations have utilized this powerful method to infer common functionality and ancestry.
Restoring a Burned-Out Workforce
Authors: Sofer Dalia
Published: January 2020

A landmark report highlights clinician burnout and offers recommendations.
New Migraine Medication
Authors: Aschenbrenner Diane S.
Published: January 2020

The Food and Drug Administration has approved lasmiditan (Reyvow), a new treatment for acute migraine.

Patients must avoid driving or other activities requiring full mental alertness, such as operating heavy machinery, for a minimum of eight hours after taking lasmiditan.
New Treatment for Cystic Fibrosis
Authors: Aschenbrenner Diane S.
Published: January 2020

Trikafta, a combination of elexacaftor, ivacaftor, and tezacaftor, is a new drug for the treatment of the most common cystic fibrosis mutation.

Serious adverse effects include elevated liver enzymes and an increased risk of cataracts.
The Effects of Frequent Quizzing on Exam Scores in a Baccalaureate Nursing Course
Authors: Sartain Andrea F. , Wright Vivian H.
Published: January 2020

This study examined the relationship between the use of frequent quizzing and students’ examination scores in a fundamental-level baccalaureate nursing course. Four cohorts of students were utilized: two cohorts (n = 230) received only unit exams and a comprehensive final, whereas the other cohorts (n = 210) were given quizzes in addition to the unit exams and comprehensive final. Exam scores were analyzed to determine if there was improvement in scores once quizzing was implemented. Comparing the quizzing and control cohorts, quizzing was found to improve both unit (p < .001, ηp
2 = .039) and final (p < .001, ηp
2 = .046) exam scores.
Virginia NP scope of practice
Authors: Smith Shelly , Buchanan Holly , Cloutier Rachel
Published: January 2020

During the 2018 state legislative session, Virginia's General Assembly approved legislation supporting a transitional licensing model for NPs with at least 5 years of full-time work equivalence in their certification area. This article outlines Virginia's case as an example for NP advocates who are planning scope-of-practice legislation in other states.
How to care for adults with low back pain in the primary care setting
Authors: Pfieffer Mary Lauren
Published: January 2020

Low back pain (LBP) is one of the most frequent patient complaints in primary care. This article discusses the assessment and treatment of patients with LBP, including nonpharmacologic and pharmacologic approaches.
Self-awareness
Authors: Younas Ahtisham
Published: January 2020

Cultural competence is essential for establishing rapport with patients and for assessing patients' needs. This article discusses how self-awareness can help nurses provide culturally competent care to patients and their families.
Efficacy of Nalbuphine as an Adjuvant to Ropivacaine in Ultrasound-guided Supraclavicular Brachial Block
Authors: Kalika Prakash , Xue Rui , Zheng Junwei , Xiao Yun , Zhen Ming , Ran Ran
Published: January 2020

Background:

A brachial plexus block (BPB) provides anesthesia and analgesia with limited duration. Various opioids have been used as adjuvants of local anesthetics to improve the effects.

Objective:

The objective of this study was to evaluate the safety and effectiveness of nalbuphine used as an adjuvant to local anesthetic during the supraclavicular BPB.

Materials and Methods:

In this prospective, double-blinded, randomized controlled study, 90 American Society of Anesthesiology (ASA) Physical Status I and II patients (aged 20 to 65 y) of either sex undergoing upper limb orthopedic surgeries under ultrasound-guided supraclavicular BPB were randomly allocated into 3 groups: group C (n=30), group NL (n=30), and group NH (n=30) for analyses. Each patient received 18 mL of 100 mg ropivacaine solution combined with 2 mL of normal saline, 2 mL of 10 mg nalbuphine, or 2 mL of 20 mg nalbuphine. The time of onset and block duration of sensory block (SB) and motor block (MB), duration of analgesia, hemodynamic variables, and any adverse effects were assessed.

Results:

Compared with group C, the onset time of both SB and MB were significantly shortened. The SB and MB duration were significantly prolonged in group NL and group NH. There was no significant difference between the duration of analgesia in group NL and NH although the analgesia duration of both groups was longer than group C. But the incidence of side effects in group NH such as vomiting was significantly higher than group NL.

Conclusions:

Nalbuphine is an effective adjuvant to 0.5% ropivacaine in ultrasound-guided supraclavicular BPB. The dosage of 10 mg improves the quality of the anesthesia with less incidence of side effects.
Intrathecal Morphine and Pulmonary Complications after Arthroplasty in Patients with Obstructive Sleep Apnea
Authors: Bai Johnny W. , Singh Mandeep , Short Anthony , Bozak Didem , Chung Frances , Chan Vincent W. S. , Bhatia Anuj , Perlas Anahi
Published: January 2020

Background

Intrathecal morphine is commonly and effectively used for analgesia after joint arthroplasty, but has been associated with delayed respiratory depression. Patients with obstructive sleep apnea may be at higher risk of postoperative pulmonary complications. However, data is limited regarding the safety of intrathecal morphine in this population undergoing arthroplasty.

Methods

This retrospective cohort study aimed to determine the safety of intrathecal morphine in 1,326 patients with documented or suspected obstructive sleep apnea undergoing hip or knee arthroplasty. Chart review was performed to determine clinical characteristics, perioperative events, and postoperative outcomes. All patients received neuraxial anesthesia with low-dose (100 μg) intrathecal morphine (exposure) or without opioids (control). The primary outcome was any postoperative pulmonary complication including: (1) respiratory depression requiring naloxone; (2) pneumonia; (3) acute respiratory event requiring consultation with the critical care response team; (4) respiratory failure requiring intubation/mechanical ventilation; (5) unplanned admission to the intensive care unit for respiratory support; and (6) death from a respiratory cause. The authors hypothesized that intrathecal morphine would be associated with increased postoperative complications.

Results

In 1,326 patients, 1,042 (78.6%) received intrathecal morphine. The mean age of patients was 65 ± 9 yr and body mass index was 34.7 ± 7.0 kg/m2. Of 1,326 patients, 622 (46.9%) had suspected obstructive sleep apnea (Snoring, Tired, Observed, Pressure, Body Mass Index, Age, Neck size, Gender [STOP-Bang] score greater than 3), while 704 of 1,326 (53.1%) had documented polysomnographic diagnosis. Postoperatively, 20 of 1,322 (1.5%) patients experienced pulmonary complications, including 14 of 1,039 (1.3%) in the exposed and 6 of 283 (2.1%) in the control group (P = 0.345). Overall, there were 6 of 1 322 (0.5%) cases of respiratory depression, 18 of 1,322 (1.4%) respiratory events requiring critical care team consultation, and 4 of 1,322 (0.3%) unplanned intensive care unit admissions; these rates were similar between both groups. After adjustment for confounding, intrathecal morphine was not significantly associated with postoperative pulmonary complication (adjusted odds ratio, 0.60 [95% CI, 0.24 to 1.67]; P = 0.308).

Conclusions

Low-dose intrathecal morphine, in conjunction with multimodal analgesia, was not reliably associated with postoperative pulmonary complications in patients with obstructive sleep apnea undergoing joint arthroplasty.

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Dexamethasone Dose and Early Postoperative Recovery after Mastectomy
Authors: Steinthorsdottir Kristin Julia , Awada Hussein Nasser , Abildstrøm Hanne , Kroman Niels , Kehlet Henrik , Kvanner Aasvang Eske
Published: January 2020

Background

Pain and nausea are the most common challenges in postoperative recovery after mastectomy. Preventive measures include multimodal analgesia with preoperative glucocorticoid. The aim of this study was to investigate whether 24 mg of preoperative dexamethasone was superior to 8 mg on early recovery after mastectomy in addition to a simple analgesic protocol.

Methods

In a randomized, double-blind trial, patients 18 yr of age or older having mastectomy were randomized 1:1 to 24 mg or 8 mg dexamethasone, and all received a standardized anesthetic and surgical protocol with preoperative acetaminophen, total intravenous anesthesia, and local anesthetic wound infiltration. The primary endpoint was number of patients transferred to the postanesthesia care unit according to standardized discharge criteria (modified Aldrete score). Secondary endpoints included pain and nausea at extubation, transfer from the operating room and upon arrival at the ward, length of stay, seroma occurrence, and wound infections.

Results

One hundred thirty patients (65 in each group) were included and analyzed for the primary outcome. Twenty-three (35%) in each group met the primary outcome, without significant differences in standardized discharge scores (odds ratio, 1.00 [95% CI, 0.49 to 2.05], P > 0.999). More patients had seroma requiring drainage in the 24 mg versus 8 mg group, 94% versus 81%, respectively (odds ratio, 3.53 [95% CI, 1.07 to 11.6], P = 0.030). Median pain scores were low at all measured time points, numeric rating scale less than or equal to 2 versus less than or equal to 1 in the 24 mg versus 8 mg group, respectively. Six patients in each group (9%) experienced nausea at any time during hospital stay (P > 0.999). Length of stay was median 11 and 9.2 h in the 24 and 8 mg group, respectively (P = 0.217).

Conclusions

The authors found no evidence of 24 mg versus 8 mg of dexamethasone affecting the primary outcome regarding immediate recovery after mastectomy. The authors observed a short length of stay and low pain scores despite a simple analgesic protocol.

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Supraspinal Opioid Circuits Differentially Modulate Spinal Neuronal Responses in Neuropathic Rats
Authors: Dickenson Anthony H. , Navratilova Edita , Patel Ryan , Porreca Frank , Bannister Kirsty
Published: January 2020

Background

The anterior cingulate cortex and central nucleus of the amygdala connect widely with brainstem nuclei involved in descending modulation, including the rostral ventromedial medulla. Endogenous opioids in these circuits participate in pain modulation. The hypothesis was that a differential opioidergic role for the brain nuclei listed in regulation of spinal neuronal responses because separable effects on pain behaviors in awake animals were previously observed.

Methods

This study utilized in vivo electrophysiology to determine the effects of morphine microinjection into the anterior cingulate cortex, right or left central nucleus of the amygdala, or the rostral ventromedial medulla on spinal wide dynamic range neuronal responses in isoflurane-anesthetized, male Sprague–Dawley rats. Ongoing activity in the ventrobasal thalamus was also measured. In total, 33 spinal nerve ligated and 26 control age- and weight-matched control rats were used.

Results

Brainstem morphine reduced neuronal firing to 60-g von Frey stimulation in control rats (to 65 ± 12% of control response (means ± 95% CI), P < 0.001) with a greater inhibition in neuropathic rats (to 53 ± 17% of control response, P < 0.001). Contrasting anterior cingulate cortex morphine had only marginal modulatory effects on spinal neuronal responses with limited variance in effect between control and neuropathic rats. The inhibitory effects of morphine in the central nucleus of the amygdala were dependent on pain state and laterality; only right-side morphine reduced neuronal firing to 60-g stimulation in neuropathic rats (to 65 ± 14% of control response, P = 0.001). In addition, in neuropathic rats elevated ongoing neuronal activity in the ventral posterolateral thalamus was not inhibited by anterior cingulate cortex morphine, in contrast to evoked responses.

Conclusions

Cumulatively the data support opioid modulation of evoked responses predominately through a lateralized output from the right amygdala, as well as from the brainstem that is enhanced in injured conditions. Minimal modulation of dorsal horn responses was observed after anterior cingulate cortex opioid administration regardless of injury state.

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Relationships Between Coping Behaviors and Social Loneliness in Adults With Self-reported Hearing Problems
Authors: Warringa Leontine T.L. , Henke Celina E. , Pronk Marieke , Kramer Sophia E. , Stam Mariska
Published: January 2020

Objectives:

To determine the association between various coping behaviors and social loneliness (self-reported deficits in social integration and embeddedness) in adults with self-reported hearing problems. It is hypothesized that adults who frequently use adequate coping behaviors experience less feelings of social loneliness than persons who use these behaviors less often.

Design:

Cross-sectional data of 686 participants with hearing-impairment (24–75 years of age) of the online Netherlands Longitudinal Study on Hearing were analyzed. Six coping behaviors were measured using six subscales of the Communication Profile for the Hearing Impaired (maladaptive behavior, verbal strategies, nonverbal strategies, self-acceptance, acceptance of loss, and stress and withdrawal). The De Jong-Gierveld loneliness scale was used to measure social loneliness. Multiple logistic multinomial regression analyses were applied to determine associations between each of the coping behaviors and (1) moderate social loneliness (reference category: no loneliness) and (2) severe social loneliness (reference category: no loneliness). Potential subgroup effects and confounders were examined.

Results:

Almost two-thirds of the sample reported feeling moderately or severely socially lonely. Significantly less feelings of social loneliness were experienced by participants who reported relatively high levels of self-acceptance or acceptance of loss, relatively infrequent use of maladaptive behavior, or relatively low levels of stress and withdrawal. Particularly those participants whose hearing loss dated back to ≤5 years, better coping with verbal strategies was associated with a lower likelihood of either moderate or severe social loneliness. More frequent use of nonverbal strategies was only associated with a lower likelihood of severe social loneliness for participants with paid work.

Conclusions:

To the best of our knowledge, this study is the first in which the relationship between a wide range of hearing coping behaviors and social loneliness was studied. The results show that more frequent use of adequate coping behaviors is significantly associated with less feelings of social loneliness. The findings underline the importance of recognizing and tackling inadequate coping behaviors so that social loneliness can be prevented or combated.
Spontaneous Incidence of Vertebral Body Infection Following Osteoporotic Vertebral Fracture
Authors: Uto Takaaki , Tokuumi Yuji , Komine Nobuhiko , Yonezawa Noritaka , Demura Satoru , Tsuchiya Hiroyuki
Published: January 2020

Study Design.

Retrospective case series.

Objective.

The aim of this study was to examine the spontaneous incidence rate and features of pyogenic vertebral osteomyelitis in osteoporotic vertebral fracture (OVF).

Summary of Background Data.

Pyogenic vertebral osteomyelitis is a rare complication of OVF. We experienced some cases of vertebral body infection after OVF.

Methods.

In this retrospective, single-center study, clinical data were collected by chart review. We examined the number of cases of pyogenic vertebral osteomyelitis following OVF between April 2014 and August 2018. Further, we examined the mechanism of injury, age, sex, duration from the diagnosis of OVF to the diagnosis of vertebral body infection, C-reactive protein level at the time of diagnosis of OVF, medical history, primary infection site, and serious events.

Results.

The spontaneous incidence rate of complications was 0.7% (4/554). In all cases (two males and two females), fall history was present and vertebral body infection was not suspected to be present at the point of injury. The average age was 81.8 (range, 75–89, SD, 5.7) years. The average duration from the diagnosis of OVF to the diagnosis of vertebral body infection was 55.0 (range, 16–132, SD, 52.4) days. The average C-reactive protein level at the time of diagnosis of OVF was 11.5 (range, 0.5–29.7, SD, 12.7) mg/L. Medical history included rheumatoid arthritis (n = 1), diabetes mellitus (n = 1), malignant tumor (stage IV) (n = 1), and brain infarction (n = 2). The primary sources of infection were pneumonia (n = 3), and urinary tract infection (n = 1), and all patients experienced bacillemia at/after the diagnosis of fracture. All patients died due to septic shock.

Conclusion.

The spontaneous incidence rate of vertebral body infection among OVF patients was 0.7%; however, the occurrence of this complication led to serious events. Clinicians should pay attention to the possibility of bacillemia in elderly or immunocompromised OVF patients.

Level of Evidence: 4
MagnetOs, Vitoss, and Novabone in a Multi-endpoint Study of Posterolateral Fusion
Authors: van Dijk Lukas A. , Barrère-de Groot Florence , Rosenberg Antoine J.W.P. , Pelletier Matthew , Christou Chris , de Bruijn Joost D. , Walsh William R.
Published: January 2020

Study Design:

This study was a multi-endpoint analysis of bone graft substitutes implanted as a standalone graft in a clinically relevantOvinemodel of instrumented posterolateral spinal fusion (PLF).

Objective:

The objective of this study was to obtain high-quality evidence on the efficacy of commercial bone graft substitutes compared with autograft in instrumented PLF using a state-of-the-art model with a complete range of assessment techniques.

Summary of Background Data:

Preclinical and clinical data on the quality of spinal fusions obtained with bone graft substitutes are often limited. Calcium phosphates with submicron topography have shown promising results in PLF, as these are able to induce bone formation in tissues distant from the host bone, which facilitates bony union.

Methods:

Nine female, skeletally mature sheep (4–5 y) underwent posterior pedicle screw/rods instrumented PLF at L2–L3 and L4–L5 using the following bone graft materials as a standalone graft per spinal segment: (1) biphasic calcium phosphate with submicron topography (BCP<µm), (2) 45S5 Bioglass (BG), and (3) collagen-β-tricalcium phosphate with a 45S5 Bioglass adjunct (TCP/BG). Autograft bone (AB) was used as a positive control treatment. Twelve weeks after implantation, the spinal segments were evaluated by fusion assessment (manual palpation, x-ray, micro-computed tomography, and histology), fusion mass volume quantification (micro-computed tomography), range of motion (ROM) testing, histologic evaluation, and histomorphometry.

Results:

Fusion assessment revealed equivalence between AB and BCP<µmby all fusion assessment methods, whereas BG and TCP/BG led to significantly inferior results. Fusion mass volume was highest for BCP<µm, followed by AB, BG, and TCP/BG. ROM testing determined equivalence for spinal levels treated with AB and BCP<µm, while BG and TCP/BG exhibited higher ROM. Histologic evaluation revealed substantial bone formation in the intertransverse regions for AB and BCP<µm, whereas BG and TCP/BG grafts contained fibrous tissue and minimal bone formation. Histologic observations were supported by the histomorphometry data.

Conclusions:

This study reveals clear differences in efficacy between commercially available bone graft substitutes, emphasizing the importance of clinically relevant animal models with multiendpoint analyses for the evaluation of bone graft materials. The results corroborate the efficacy of calcium phosphate with submicron topography, as this was the only material that showed equivalent performance to autograft in achieving spinal fusion.
HIV, aging, and adherence: an update and future directions
Authors: Mann Sarah Czarna , Castillo-Mancilla Jose R.
Published: January 2020

Purpose of review

To highlight recent data on antiretroviral adherence in older people living with HIV (PLWH), describe the most relevant pharmacokinetic antiretroviral studies, and identify critical research gaps in this population.

Recent findings

Overall, studies have found that older PLWH are more likely to be adherent to antiretroviral therapy (ART). Although multiple methods to measure adherence are available (self-report, pharmacy refills, electronic device monitors, drug concentrations), there is currently no ‘gold standard’ adherence measure or sufficient evidence to suggest a preferred method in older patients. Recently, studies evaluating antiretroviral concentrations in hair and dried blood spots in older patients identified no major differences when compared with younger individuals. Similarly, although pharmacokinetic studies in older PLWH are scarce, most data reveal no significant pharmacokinetic differences in the aging population. Furthermore, no specific guidelines or treatment recommendations regarding ART dose modification or long-term toxicity in aging PLWH are available, mostly because of the exclusion of this population in clinical trials.

How aging influences adherence and pharmacokinetics remains poorly understood. As the population of older PLWH increases, research focusing on adherence, toxicity, drug--drug interactions, and the influence of comorbidities is needed.
Norepinephrine for the prevention of spinal-induced hypotension during caesarean delivery under combined spinal–epidural anaesthesia
Authors: Wei Changna , Qian Jin , Zhang Yinfa , Chang Xiangyan , Hu Huijing , Xiao Fei
Published: January 2020

BACKGROUND

During caesarean delivery under spinal anaesthesia hypotension may be managed by norepinephrine in preference to phenylephrine due a perception of less bradycardia and fewer reductions in cardiac output.

OBJECTIVE

As the optimum prophylactic dose of norepinephrine is unclear, we aimed to investigate its dose–response for preventing postspinal hypotension in caesarean delivery.

DESIGN

A randomised, double-blinded, dose-finding study.

SETTING

Jiaxing University affiliated Women and Children Hospital, Jiaxing, China.

PATIENTS

Ninety-nine patients undergoing elective caesarean delivery from 1 February to 5 August: excluding patients with ASA III or above, preeclampsia or hypertension, pre-existing or gestational diabetes, BMI more than 35 kg m−2, height less than 150 cm or with more than 175 cm, or with contraindications to local anaesthesia.

INTERVENTIONS

Patients received 0, 0.04, 0.05, 0.06 or 0.07 μg kg−1 min−1 preventive norepinephrine infusions immediately after intrathecal injection of 10 mg bupivacaine with 5 μg sufentanil.

MAIN OUTCOME MEASURES

The norepinephrine (Median effective dose) or (95% effective dose) ED50 and ED95, which were estimated using Probit analysis to compare haemodynamic changes associated with the different doses.

RESULTS

The incidence of hypotension was 70, 47.4, 40, 20 and 15% in the 0, 0.04, 0.05, 0.06 and 0.07 μg kg−1 min−1 groups, respectively. The ED50, ED80 and ED95 values were 0.029 (95% CI 0.008 to 0.042 μg kg−1 min−1), 0.068 (95% CI 0.055 to 0.099 μg kg−1 min−1) and 0.105 μg kg−1 min−1 (95% CI 0.082 to 0.172 μg kg−1 min−1), respectively. Apgar scores or umbilical arterial pH were similar among groups.

CONCLUSION

The ED50, ED80 and ED95 were 0.029, 0.068 and 0.105 μg kg−1 min−1 respectively. A 0.07 μg kg−1 min−1 norepinephrine infusion may be optimum for preventing postspinal hypotension after intrathecal injection of 10 mg bupivacaine combined with 5 μg sufentanil.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (identifier: ChiCTR-TRC-1800014614).
Management of Unreconstructable Saphenous Nerve Injury with Targeted Muscle Reinnervation
Authors: Janes Lindsay E. , Fracol Megan E. , Ko Jason H. , Dumanian Gregory A.
Published: January 2020

Neuroma pain significantly impacts patient quality of life and is associated with unemployment, chronic opioid dependence, and depression. Targeted muscle reinnervation (TMR), a surgical technique that coapts proximal stumps of cut nerves to distal motor nerves of adjacent muscles, has demonstrated efficacy in the treatment and prevention of neuroma pain. The objective of this study was to describe the surgical technique for TMR of the saphenous nerve, while providing a retrospective review. Between January 2015 and December 2018, 18 patients underwent TMR of the saphenous nerve: 1 nonamputee patient with chronic pain after ankle surgery and 17 amputee patients (10 for relief of chronic postamputation neuroma pain and phantom pain and 7 at the time of amputation for prevention of these symptoms). Six patients were lost to follow up; 2 patients had recurrent pain; and 10 patients had reduced or no pain after TMR surgery. TMR is a successful technique for the management of traumatic neuroma pain in both the amputee and nonamputee populations, and in this study, we describe the technique for saphenous nerve TMR.
The Use of Virtual Surgical Planning for Reduction Cranioplasty
Authors: Saleh Eli , Govshievich Alexander , Justino Julian , Weil Alexander G. , Borsuk Daniel E.
Published: January 2020

Hydrocephalic macrocephaly may occur as a result of untreated hydrocephalus. Reduction cranioplasty is the treatment of choice for these patients when the weight of their head interferes with normal development and negatively impacts quality of life. However, this procedure has several associated risks, including prolonged anesthesia, significant blood loss, and death. Virtual surgical planning (VSP) has been shown to be a useful adjunct for orthognathic and craniofacial surgery. The following report details the application and advantages of this technology in the setting of a reduction cranioplasty. We report the case of a 2-year-old girl with severe hydrocephalic macrocephaly who underwent a reduction cranioplasty guided by VSP with computer-aided design and manufacturing (CAD/CAM). Prefabricated cutting guides and a concave assembly bowl were used for precise fixation of bony segments. Our patient underwent a successful reduction cranioplasty using VSP and CAD/CAM. This technology allowed precise remodeling of the cranial vault with minimal bony gaps in the final construct. Head circumference and intracranial volume were reduced from 70 cm and 4,575 cm3 to 62 cm and 2,645 cm3, respectively. VSP with CAD/CAM can serve as a useful adjunct in complex cases of cranioplasty allowing for an increase in the precision, the efficacy, and the esthetic result.
Clinical Evaluation of an Off-the-Shelf Allogeneic Adipose Matrix for Soft Tissue Reconstruction
Authors: Kokai Lauren E. , Sivak Wesley N. , Schilling Benjamin K. , Karunamurthy Arivarasan , Egro Francesco M. , Schusterman M. Asher , Minteer Danielle M. , Simon Patsy , D’Amico Richard A. , Rubin J. Peter
Published: January 2020

Background:

Biomaterials derived from human adipose extracellular matrix have shown promise in vitro and in animal studies as an off-the-shelf adipogenic matrix for sustained volume replacement. Herein, we report the results of a randomized prospective study conducted with allograft adipose matrix (AAM) grafted into the pannus of presurgical abdominoplasty patients 3 or 6 months before scheduled surgery. This is the first report of a longitudinal histologic analysis of AAM in clinical use.

Methods:

Ten healthy patients undergoing elective abdominoplasty were recruited to receive AAM before surgery. Enrolled subjects were randomized into either a 3-month follow-up cohort or a 6-month follow-up cohort. Subjects were monitored for adverse events associated with AAM grafting in addition to undergoing serial biopsy. Following surgical excision of the pannus, representative samples from the AAM surgical sites were stained and evaluated with hematoxylin and eosin for tissue morphology, Masson’s trichrome for collagen, and perilipin for adipocytes.

Results:

All subjects tolerated AAM with no severe adverse events reported. At 3 months following implantation, AAM remained visible within the confines of the subjects’ native surrounding adipose tissue with sparse adipocytes apparent within the matrix. By 6 months, AAM had remodeled and was primarily composed of perilipin-positive adipocytes. Histologic analysis confirmed tissue remodeling (hematoxylin and eosin), adipogenesis (perilipin), and angiogenesis (Masson’s trichrome) occurred with the presence of AAM.

Conclusions:

AAM is a safe, allogeneic, off-the-shelf regenerative matrix that is adipogenic and noninflammatory and promotes angiogenesis.
Operative Time as the Predominant Risk Factor for Transfusion Requirements in Nonsyndromic Craniosynostosis Repair
Authors: Chocron Yehuda , Azzi Alain J. , Galli Rafael , Alnaif Nayif , Atkinson Jeffrey , Dudley Roy , Farmer Jean-Pierre , Gilardino Mirko S.
Published: January 2020

Background:

Despite recent advances in surgical, anesthetic, and safety protocols in the management of nonsyndromic craniosynostosis (NSC), significant rates of intraoperative blood loss continue to be reported by multiple centers. The purpose of the current study was to examine our center’s experience with the surgical correction of NSC in an effort to determine independent risk factors of transfusion requirements.

Methods:

A retrospective cohort study of patients with NSC undergoing surgical correction at the Montreal Children’s Hospital was carried out. Baseline characteristics and perioperative complications were compared between patients receiving and not receiving transfusions and between those receiving a transfusion in excess or <25 cc/kg. Logistic regression analysis was carried out to determine independent predictors of transfusion requirements.

Results:

A total of 100 patients met our inclusion criteria with a mean transfusion requirement of 29.6 cc/kg. Eighty-seven patients (87%) required a transfusion, and 45 patients (45%) required a significant (>25 cc/kg) intraoperative transfusion. Regression analysis revealed that increasing length of surgery was the main determinant for intraoperative (P = 0.008; odds ratio, 18.48; 95% CI, 2.14–159.36) and significant (>25 cc/kg) intraoperative (P = 0.004; odds ratio, 1.95; 95% CI, 1.23–3.07) transfusions.

Conclusions:

Our findings suggest increasing operative time as the predominant risk factor for intraoperative transfusion requirements. We encourage craniofacial surgeons to consider techniques to streamline the delivery of their selected procedure, in an effort to reduce operative time while minimizing the need for transfusion.
A Case of Concurrent Extramammary Paget Disease and Basal Cell Carcinoma of the Perianal Region
Authors: Takahashi Natsuko , Okumura Yoshiyuki , Sawaragi Eiichi
Published: January 2020

An 83-year-old Japanese man who had been aware of a tumor near his anus for 2 years underwent tumor resection. Although he was diagnosed with basal cell carcinoma (BCC), extramammary Paget disease (EMPD) was also accidentally found in the same specimen. In the pathological histology of EMPD, there were large round cells with ample cytoplasm spread in the epidermis; these cells were positive for cytokeratin 7 and gross cystic disease fluid protein 15. No signs that are typically associated with EMPD, such as erythema or leukoderma, were observed near the anus. There have been only 4 reports in which BCC and EMPD developed in the same area, and the authors present the fifth case. In the reported case, no clear evidence was found for the corelative development of BCC and EMPD.
Long-term blood pressure behavior and progression to end-stage renal disease in patients with immunoglobulin A nephropathy: a single-center observational study in Italy
Authors: Russo Elisa , Verzola Daniela , Salvidio Gennaro , Bonino Barbara , Picciotto Daniela , Drovandi Stefania , Pozzi Claudio , Ferrario Francesca , Pontremoli Roberto , Garibotto Giacomo , Viazzi Francesca
Published: January 2020

Background:

Antihypertensive treatment by the use of RAAS inhibitors (RAAS-is) is of paramount importance in the management of slowly progressive IgA nephropathy (IgAN). With the aim of better understanding the relationship between BP behavior and progression, we looked at time-averaged SBP and time-averaged proteinuria and renal outcome in a single-center cohort of IgAN patients.

Methods:

Among 248 consecutive patients referred to the Clinic of Nephrology of San Martino Hospital from 1996 to 2018 for native renal biopsy with a diagnosis of IgAN, we retrospectively analyzed 145 with available data at baseline and during follow-up. All patients received Supportive Care, 39% were on RAAS-is alone, 45% plus steroids, and 16% plus steroids and immunosuppressors. Renal replacing treatment (RRT) was the primary endpoint.

Results:

During a mean follow-up of 67 ± 6 months, 23% of study patients (n = 33) progressed to RRT and 6% (n = 9) died. Patients who reached the renal endpoint, had lower baseline eGFR and higher proteinuria and proteinuria indexed at baseline. Moreover, they had higher TA-SBP (139 ± 17 vs. 130 ± 13, P = 0.0016). The incidence of RRT was higher in IgAN patients in the highest time-averaged SBP tertile as compared with the others (32 vs. 23 vs. 9%, χ
2 6.8, P = 0.033). After adjusting for baseline SBP, baseline and time-averaged proteinuria indexed, MEST-C score, and treatment, the association between TA-SBP and RRT persisted.

Conclusion:

Time-averaged low BP values were independently associated to a decreased risk of renal progression in IgAN with no evidence of a J-curve relationship even at SBP levels below 125 mmHg.
DIAGNOSTIC CHARACTERISTICS OF POLYPOIDAL CHOROIDAL VASCULOPATHY BASED ON B-SCAN SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AND ITS INTERRATER AGREEMENT COMPARED WITH INDOCYANINE GREEN ANGIOGRAPHY
Authors: Fujita Ai , Kataoka Keiko , Takeuchi Jun , Nakano Yuyako , Horiguchi Etsuyo , Kaneko Hiroki , Ito Yasuki , Terasaki Hiroko
Published: January 2020

Purpose:

To examine the characteristics of polypoidal choroidal vasculopathy using B-scan optical coherence tomography angiography (OCTA), and determine the diagnostic criteria of polypoidal choroidal vasculopathy based on OCTA.

Methods:

This retrospective case series included patients diagnosed with treatment-naïve polypoidal choroidal vasculopathy who underwent indocyanine green angiography (ICGA) and swept-source OCTA at baseline. We compared the characteristics of the polyps detected using B-scan OCTA and ICGA. Then, the diagnostic concordance of each polypoidal lesion between ICGA and OCTA was evaluated.

Results:

Among 54 eyes of 52 patients, all 54 eyes showed flow signals indicating polyps on both ICGA and B-scan OCTA. All polyps on B-scan OCTA were detected as round/ring-like flow signals inside pigment epithelial detachments, incomplete round/ring-like flow signals overlaid with round/ring-like OCT structures inside pigment epithelial detachments, or flow signals adjacent to a pigment epithelial detachment notch. Using B-scan OCTA, 94.7% of the polypoidal lesions were detected by an independent evaluator with an overall accuracy of 92.6% for counting the polypoidal lesions per eye relative to ICGA and a Kappa value of 0.82.

Conclusion:

Polyp detection on B-scan OCTA demonstrates high accuracy and is comparable to that obtained on ICGA. B-scan OCTA could replace ICGA for the diagnosis of polypoidal choroidal vasculopathy.
VISUAL PROGNOSIS AFTER PNEUMATIC DISPLACEMENT OF SUBMACULAR HEMORRHAGE ACCORDING TO AGE-RELATED MACULAR DEGENERATION SUBTYPES
Authors: Lee Kook , Park Young Gun , Park Young-Hoon
Published: January 2020

Purpose:

This study compared the visual outcome after pneumatic displacement of submacular hemorrhage among patients with different subtypes of age-related macular degeneration (AMD).

Methods:

We retrospectively reviewed the medical records of 67 patients (67 eyes) who underwent treatment for submacular hemorrhage associated with AMD. All the patients underwent pneumatic displacement. Demographic parameters, visual acuity, and anatomical features were analyzed among AMD subtypes: typical AMD, polypoidal choroidal vasculopathy (PCV), and retinal angiomatous proliferation (RAP).

Results:

Among the eyes with submacular hemorrhage, 24, 30, and 13 eyes had typical AMD, PCV, and RAP, respectively. Post-treatment best-corrected visual acuity was best in the PCV group and worst in the RAP group (P < 0.001). The proportion of eyes with improved visual acuity was highest in the PCV subtype and lowest in the RAP subtype (P = 0.044). Logistic regression analysis showed that AMD subtype (P = 0.016) and time to treatment (<7 days) (P = 0.037) are associated with the final visual outcome.

Conclusion:

The final post-treatment visual outcome after the incidence of submacular hemorrhage was best in the PCV group and worst in the RAP group. Age-related macular degeneration subtype is a significant factor associated with the visual prognosis of submacular hemorrhage.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FEATURES OF FOCAL CHOROIDAL EXCAVATION AND THE CHOROIDAL STROMA VARIATIONS WITH OCCURRENCE OF EXCAVATION
Authors: Rajabian Firuzeh , Arrigo Alessandro , Jampol Lee M. , Mercuri Stefano , Introini Ugo , Bandello Francesco , Battaglia Parodi Maurizio
Published: January 2020

Purpose:

To describe retinal and choroidal vascular changes, and choroidal stroma variations occurring in focal choroidal excavation (FCE).

Methods:

Study design was a cross-sectional case series. Consecutive patients affected by FCE and healthy controls were recruited. All patients underwent complete ophthalmologic assessment and multimodal imaging, including structural optical coherence tomography and optical coherence tomography angiography. Choroidal thickness and stromal index were calculated from structural optical coherence tomography images. Moreover, we measured vessel density values of the superficial capillary plexus, deep capillary plexus and choriocapillaris at the level of the macula.

Results:

Twenty-two patients (28 eyes; mean age 57.2 ± 16.4) and 28 control eyes (mean age of 56.5 ± 9.8) were included. Five patients (23%) were asymptomatic, whereas 17 patients (77%) complained of visual symptoms. FCE was associated with choroidal neovascularization in 10 eyes (35%). Choroidal stromal component was lower in FCE patients than controls, whereas choroidal thickness was unremarkable. Stromal index values calculated in the region proximal to the FCE was significantly lower than the values obtained from the external region. Deep capillary plexus vessel density was lower in FCE than controls. Choriocapillaris was altered in the region surrounding the FCE, whereas it was normal in the external region.

Conclusion:

Deep capillary plexus and choriocapillaris plexus were significantly altered in FCE patients. Moreover, choroidal stroma was significantly reduced in the areas closer to FCE compared to the surrounding choroid in patients, as well as compared to healthy controls, suggesting the hypothesis of weakening of the architectural support, creating a more friable point, which can favor FCE development.
A SIMPLE, INEXPENSIVE, “MODIFIED LASSO” FOR REMOVAL OF SMOOTH, SPHERICAL INTRAOCULAR FOREIGN BODIES
Authors: Rice James C. , Steffen Jonel , Nyaka Tamara , van der Westhuizen Dean
Published: January 2020

Purpose:

To report and demonstrate removal of an intraocular metallic spherical pellet and to describe the construction of a basket instrument.

Methods:

A 9-year-old boy sustained a pellet gun injury and underwent pars plana vitrectomy to remove an intraocular spherical metallic pellet. A suture loop basket constructed with 3-O nylon and 16-gauge intravenous cannula was used to grasp and remove the foreign body.

Results:

The pellet was mobilized from a subretinal position and effectively captured in the basket using the light pipe as a second instrument. The captured pellet was successfully removed without slippage via a scleral tunnel incision. Despite reattachment of the retina under silicone oil, the vision deteriorated to no light perception.

Conclusion:

A simple, readily available basket can be constructed for the effective removal of spherical foreign bodies which are difficult to grasp.
Ahmed Valve Tube Extension in Pediatric Glaucoma
Authors: Sternfeld Amir , Dotan Gad , Bohra Lisa , Roarty John
Published: January 2020

Précis:

Ahmed valve tube extender showed good long-term outcomes for retracted tubes in pediatric glaucoma. The procedure is safe with limited complications.

Purpose:

To analyze the long-term outcomes of Ahmed valve tube extension in pediatric glaucoma patients.

Patients and Methods:

This study analyzed the records of all children who underwent surgery involving extension of a pediatric Ahmed valve tube, treated at a tertiary medical center between 2007 and 2018. Surgical success was defined as intraocular pressure between 6 and 22 mm Hg and reduced by at least 20% from its preoperative value, with or without intraocular pressure lowering medications, without additional surgical procedures and without vision loss.

Results:

Fourteen eyes of 11 children were treated with the Ahmed tube extender during the study period. Mean age of all children was 5.7±4.7 years (range, 3 mo to 16 y). The most common type of glaucoma was congenital glaucoma (n=6, 42.9%). The mean age at the time of initial valve implant was 2.39±3.89 years and the mean duration from initial insertion to the extension was 3.39±2.95 years. The mean follow-up was 72.8±43.3 months (range, 12 to 140 mo), with 85.7% followed for >2 years. The mean survival was 34.1±37.2 months after the extension. Three surgeries (21.4%) were primary failures, 8 patients (57.1%) failed during follow-up (mean, 40.6±44.4 mo after the extension; range, 1 to 125 mo), whereas 3 patients (21.4%) maintained the successful outcome until their last follow-up visit (mean, 37.7±24.1 mo; range, 12 to 70 mo).

Conclusions:

The Ahmed valve extender can often save a retracted or obstructed tube. The procedure has limited complications and long-term efficacy in one third of the patients.
Diagnostic Ability of Optical Coherence Tomography Angiography Macula Vessel Density for the Diagnosis of Glaucoma Using Difference Scan Sizes
Authors: Penteado Rafaella C. , Bowd Christopher , Proudfoot James A. , Moghimi Sasan , Manalastas Patricia I.C. , Ghahari Elham , Hou Huiyuan , Shoji Takuhei , Zangwill Linda M. , Weinreb Robert N.
Published: January 2020

Précis:

There is diagnostic information in the outer region of optical coherence tomography angiography (OCT-A) macula scans not available in the inner region, and this information is especially useful in the early stages of glaucoma.

Purpose:

The aim of this study was to evaluate the diagnostic accuracy of 3×3 and 6×6 mm2 macula OCT-A scans for classifying healthy, mild glaucoma, and moderate to severe glaucoma eyes.

Methods:

Participants enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) with good quality 3×3 and 6×6 mm2 OCT-A images of the macula acquired on the same day were included in this cross-sectional study. The area under the receiver operating characteristic (AUC) curves were calculated to assess the diagnostic accuracy of vessel density (VD) of both scan sizes for differentiating between 3 diagnostic groups.

Results:

Two hundred seventy-nine eyes (89 healthy, 127 with mild glaucoma, and 63 with moderate to severe glaucoma) from 190 subjects were included in this study. The VD of the outer area of the 6×6 mm2 scan size had higher diagnostic accuracy compared with the VD of the inner area of the 3×3 mm2 scan when differentiating between healthy and mild glaucoma (3×3 mm2 AUC=0.71 and 6×6 mm2 AUC=0.79, P=0.032). The VD of the outer area of the 6×6 mm2 scans had only similar diagnostic accuracy compared with the inner area of the 3×3 mm2 scan when differentiating between healthy and moderate to severe glaucoma eyes (AUC=0.90 for 3×3 mm2 and 0.92 for 6×6 mm2, P=0.279). The VD of the inner area of the 6×6 mm2 scan size had similar diagnostic accuracy to the corresponding area of the 3×3 mm2 scan in both diagnostic categories.

Conclusion:

The diagnostic accuracy of VD using the 6×6 mm2 macula OCT-A scan was better than the 3×3 mm2 scan when differentiating between healthy and mild glaucoma eyes, and similar to the 3×3 mm2 scan when differentiating between healthy and moderate to severe glaucoma eyes.