bluuebunny/crossref_metadata_2025 huggingface dataset:
Ocular Adnexal Adenomatoid Sebaceous Gland Hyperplasia: A Clinical and Immunopathologic Analysis in Relation to the Muir-Torre Syndrome
Authors: Jakobiec Frederick A. , Cortes Barrantes Paula , Milman Tatyana , Lee Nahyoung Grace , Fay Aaron
Published: October 2019

The purpose of this study is to codify the microscopic diagnostic criteria for ocular adnexal brow and caruncular sebaceous gland hyperplasias (pseudoadenomatoid) that distinguish it from an adenoma. Clinical records and photographs were critically reviewed and microscopic slides were stained with hematoxylin and eosin and immunochemically stained for adipophilin, androgen receptor, p16, p53, a spectrum of cytokeratins, Ki-67 and mismatch repair nuclear protein expression for MLH1, MSH2, PMS2, and MSH6. The patients and their close relatives had no history of cancer. Cytokeratin 7 and especially cytokeratin 17 highlighted the presence of ducts in the hyperplastic lesion, which are not present in adenomas. p16 and p53 were negative and Ki-67 immunostaining demonstrated similar low proliferation indices for normal and hyperplastic glands. The mismatch repair nuclear protein expressions were preserved in both lesions. Histopathologic misdiagnosis of adenomatoid sebaceous gland hyperplasia as an adenoma can lead to the impression of an association with the Muir-Torre syndrome. Cytokeratins 7 and 17 immunostaining can be helpful in highlighting compressed ducts that in exuberant sebaceous gland hyperplasias may lead to a diagnosis of an adenoma (in which ducts are absent). Negative immunostaining for p16 rules out a possible etiologic role of human papillomavirus in hyperplasias and the negative p53 staining indicates the lesions are not truly neoplastic. The preservation of mismatch repair nuclear protein expression rules out the likelihood of the Muir-Torre syndrome. The current cases convincingly establish that sebaceous hyperplasia is not associated with the Muir-Torre syndrome by both clinical findings and immunohistochemical testing.

Two yellow lesions, from the brow and caruncle, were examined microscopically and immunohistochemically to establish the diagnosis of sebaceous gland hyperplasia and to rule out the Muir-Torre syndrome.
Lacrimal Drainage Anomalies in CHARGE Syndrome: Case Report and Review of Literature
Authors: Vasanthapuram Varshitha Hemanth , Ali Mohammad Javed
Published: October 2019

The common ocular manifestations of CHARGE syndrome include colobomatous defects in the eye, strabismus, nystagmus, and micropthalmia. Lacrimal drainage anomalies have been rarely reported and to the best of the authors' knowledge, only 5 such cases have been reported earlier. The present case describes CHARGE syndrome associated with bilateral complex congenital nasolacrimal duct obstruction with multiple prior attacks of acute dacryocystitis and left lower punctal agenesis, successfully managed with a right-sided dacryocystorhinostomy and awaiting a left dacryocystorhinostomy.

Lacrimal drainage anomalies in CHARGE syndrome include complex CNLDO, punctal agenesis, and acute dacryocystitis.
Pain as a predictor of frailty over time among older Mexican Americans
Authors: Sodhi Jaspreet K. , Karmarkar Amol , Raji Mukaila , Markides Kyriakos S. , Ottenbacher Kenneth J. , Al Snih Soham
Published: October 2019

The objective of this study was to examine pain as a predictor of frailty over 18 years of follow-up among older Mexican Americans who were nonfrail at baseline. Data were from a prospective cohort study of 1545 community-dwelling Mexican Americans aged ≥67 years from the Hispanic Established Populations for the Epidemiological Study of the Elderly (1995/1996-2012/2013). Frailty was defined as meeting 2 or more of the following: unintentional weight loss of >10 pounds, weakness, self-reported exhaustion, and slowness. The independent predictor was self-reported pain. Covariates included age, sex, marital status, education, comorbid conditions, body mass index, Mini-Mental State Examination, depressive symptoms, and limitation in activities of daily livings. General equation estimation was performed to estimate the odds ratio of frailty as a function of pain. A total of 538 participants (34.8%) reported pain at baseline. The prevalence of frailty among those with pain ranged from 24.4% in wave 3 to 41% in wave 8. The odds ratio of becoming frail over time as a function of pain was 1.71; 95% confidence interval: 1.41 to 2.09 after controlling for all covariates. Older age, hip fracture, high depressive symptoms, and activities of daily living disability were also associated with higher odds of becoming frail over time. Female participants and those with higher levels of education and high Mini-Mental State Examination scores were less at risk. In conclusion, pain was a significantly predictor of frailty. Early assessment and better management of pain may prevent early onset of frailty in older Mexican Americans.
Remifentanil for abdominal surgery is associated with unexpectedly unfavorable outcomes
Authors: Niedermayer Sebastian , Heyn Jens , Guenther Felix , Küchenhoff Helmut , Luchting Benjamin
Published: October 2019

Insufficient perioperative pain treatment is known as a highly predictive risk factor for the development of chronic postoperative pain. Remifentanil is an ultrashort-acting opioid that provides quick and efficient analgesia but is associated with the induction of opioid-induced hyperalgesia. Despite these well-known characteristics, this substance is being increasingly used in anesthesia and in a variety of medical fields, such as intensive-care medicine and obstetrics. The aim of our study was to reveal whether remifentanil influences postoperative pain, the requirement for postoperative analgesics, and requirement of antiemetics (as indirect indicator of postoperative nausea and vomiting), as well as the effects on time to extubation and length of stay in the postanesthesia care unit in daily clinical routine. From an electronic medical records database of 55,693 anesthesias, we analyzed data from all patients receiving intraabdominal surgery (visceral, gynecological, and urological) under general anesthesia or combined general-epidural anesthesia by propensity score matching. The administration of remifentanil was associated with higher postoperative pain scores despite a higher requirement of postoperative analgesics. Additional epidural analgesia was not able to avoid this finding. The intraoperative use of remifentanil is associated with a deterioration of pain levels and postoperative analgesic requirement, wherefore the potential benefit of this substance seems to be outweighed by its potential disadvantages. Especially in operative procedures in which high postoperative pain scores are expected, the unreflective use should be critically questioned.
Prioritizing HIV Services for Transgender Women and Men Who Have Sex With Men in Manila, Philippines: An Opportunity for HIV Provider Interventions
Authors: Restar Arjee Javellana , Chan Randolph C. H. , Adia Alexander , Quilantang Ma Irene , Nazareno Jennifer , Hernandez Laufred , Cu-Uvin Susan , Operario Don
Published: October 2019

Transgender women (TW) and men who have sex with men (MSM) are highly affected by the rising HIV epidemic in the Philippines. HIV providers are essential to curbing the epidemic. Between July and August 2017, we conducted one-on-one qualitative interviews with 15 HIV providers in Manila, Philippines. Overall, providers reported tension between willingness to provide care versus actual competencies. Most discussed treating every patient equally regardless of gender or sexual identities. However, many expressed hesitancies in providing HIV services due to (a) not knowing the health needs of TW and MSM, (b) having little to no training in HIV, and (c) difficulty being sensitive to patient gender and sexuality. Although providers were unsure about how to prioritize HIV services for TW and MSM, some expressed interest in learning and engaging these populations in their practices. Our findings suggest the importance of provider-focused interventions to prioritize TW and MSM health needs.
A Review on Surface Electromyography-Controlled Hand Robotic Devices Used for Rehabilitation and Assistance in Activities of Daily Living
Authors: Hameed Husamuldeen K. , Hassan Wan Zuha Wan , Shafie Suhaidi , Ahmad Siti Anom , Jaafar Haslina
Published: October 2019

Introduction

Spinal cord injuries, traumas, natural aging, and strokes are the main causes of arm impairment or even a chronic disability for an increasing part of the population. Therefore, robotic devices can be essential tools to help individuals afflicted with hand deficit with the activities of daily living in addition to the possibility of restoring hand functions by rehabilitation. Because the surface electromyography (sEMG) control paradigm has recently emerged as an interesting intention control method in devices applied to rehabilitation, the concentration in this study has been devoted to sEMG-controlled hand robotic devices, including gloves and exoskeletons that are used for rehabilitation and for assistance in daily activities.

Materials and Methods

A brief description is given to the previous reviews and studies that have surveyed the robotic devices used for rehabilitation; a comparison is conducted among these studies with respect to the targeted part of the body and the device's control method. Important issues about controlling by sEMG signal are accentuated, and a review of sEMG-controlled hand robotic devices is presented with an abbreviated description for each endeavor. Some criteria related to sEMG control are specifically emphasized, for instance, the muscles used for control, the number of sEMG channels, and the type of sEMG sensor used.

Discussion

It is noted that most of the sEMG-based controls for the devices included in this study have used the nonpattern recognition scheme due to the weak sEMG signals and abnormal pattern of muscle activation for stroke patients. In addition to sEMG-based control, additional control paradigms have been used in many of the listed robotic devices to increase the efficacy of the system; this cooperation is required because of the difficulty in dealing with the sEMG signals of stroke patients. Most of the listed studies have conducted the experiments on a healthy subject to evaluate the efficacy of the systems, whereas the studies that have recruited stroke patients for system assessment were predominately using additional control schemes.

Conclusions

This article highlights the important issues about the sEMG control method and accentuates the weaknesses associated with this type of control to assist researchers in overcoming problems that impede sEMG-controlled robotic devices to be feasible and practical tools for people afflicted with hand impairment.
Group A Streptococcal Vulvitis in Adult Women: Clinical Features and Association With Psoriasis
Authors: Liegeon Anne-Laure , Berville Sophie , Wendling-Héraud Jeanne , Moyal-Barracco Micheline
Published: October 2019

Objectives

Group A streptococcus (GAS) vulvitis is rare, mainly reported in association with vaginitis. We examined the clinical features of GAS vulvitis in adults, the presence of other infected sites, and its association with dermatological conditions.

Materials and Methods

We retrospectively analyzed the medical files and photographs of adult patients with bacteriologically confirmed GAS vulvitis seen at 3 private clinics. Coexisting infected sites, associated dermatological conditions, and bacteriological results for the husbands of 3 patients were examined.

Results

Nineteen patients (mean age = 52.2 [range = 23–83] years) with vulvar GAS infections were identified. The vulvar symptoms consisted of pain (11 cases), pruritus (9), burning (4), and discharge (10). The predominant physical feature was bilateral erythema, mainly located on the labia minora and the inner aspect of the labia majora. This erythema was associated with oozing (3), edema (6), or fissures (6). Seventeen patients had an associated vaginal infection, which was asymptomatic in 7 cases; anal infections were present in 9 cases. The following 10 patients had associated dermatological conditions: psoriasis (6), lichen sclerosus (2), Paget disease (1), or vitiligo (1). Two (one each from the throat and penis) of the 3 bacteriological specimens taken from the 3 husbands were GAS positive.

Conclusions

In most adult women, GAS vulvitis is associated with a vaginal infection that may be asymptomatic. A bilateral, oozing, and edematous or fissured erythema involving the vulvar or anovulvar area is suggestive of GAS vulvitis. The association with psoriasis and the benefits of screening household members and sexual partners deserves further attention.
Severe Japanese encephalitis with multiple intracranial hemorrhages
Authors: Feng Qiaochan , Chen Qi , Bi Xizhuang , Yu Shaoxia , Wang Jiahui , Sun Xuwen , Ren Chao , Liu Hong , Guan Lina
Published: October 2019

Rationale:

Intracranial hemorrhage occurs infrequently in Japanese encephalitis (JE), and even less frequently with hemorrhage occurring twice. In this report, we describe the clinical features and outcomes of a patient with confirmed JE combined with hemorrhage twice.

Patient concerns:

The patient, a 71-year-old Asian woman, was admitted to the hospital with symptoms of hemiplegia following fever and diarrhea. Soon her condition worsened and a decreased level of consciousness, respiratory failure, and paralysis of extremities occurred.

The brain diffusion-weighted imaging sequence showed suspicious abnormal signals in bilateral thalami. Japanese encephalitis virus immunoglobulin M antibody was detected in her serum and cerebrospinal fluid samples, so the patient was diagnosed with JE. During treatment, her condition became aggravated and the brain computed tomography (CT) scan showed multiple lobar hemorrhages. One month later, the multiple lobar hemorrhages occurred again, as observed by a brain CT scan.

Diagnosis:

JE with multiple intracranial hemorrhages.

Interventions:

The patient was treated comprehensively, including surgery, lowering her intracranial pressure and ventilator-assisted breathing.

Outcomes:

One month later, the patient underwent another surgical procedure for intracranial hemorrhage and suffered a serious neurological disorder.

Lessons:

Severe intracranial hemorrhage may occur in elderly patients with JE, especially in those with poor vascular condition. Therefore, when treating such patients, great caution, as well as early detection and prevention, should be taken in case of the occurrence of severe intracranial hemorrhage.
Rehabilitation of neuromyelitis optica
Authors: Kim Won Bin , Lee So Young , Kim Bo Ryun , Kim Youn Ji
Published: October 2019

Rationale:

Neuromyelitis optica (NMO), also known as Devic syndrome, is a central nervous system demyelinating disease consisting of optic neuritis and myelitis. Several studies have reported the effects of rehabilitation programs and specific exercises on outcomes in individuals with multiple sclerosis, but few have considered individuals with NMO. We present 2 cases of paraplegia due to NMO with rehabilitation outcome.

Patient concerns:

The first case corresponds to a 65-year-old woman with NMO presented with C4 incomplete American Spinal Injury Association (ASIA) scale D, and the second case is a 41-year-old woman with NMO presented with C1 incomplete ASIA-C.

Diagnoses:

Two cases were confirmed by positive anti-aquaporin-4 antibody and presence of T2-weighted hyperintense lesion in spinal cord on magnetic resonance imaging.

Intervention:

The first patient planned for focusing on left hand fine motor training through occupational therapy by strengthening and stretching muscle using E-link (Biometrics Ltd, Newport, UK) during 4 weeks, and the second patient received strengthening lower extremity and gait training using a lower-body positive pressure treadmill (AlterG, Anti-Gravity Treadmill, Fremont, CA) during 4 weeks.

Outcomes:

After a 4-week rehabilitation, the first patient's manual muscle testing was improved to grade 2/5 to 3+/5 in left upper limb specifically. Also, Spinal Cord Independence Measure (SCIM) was improved 79 to 88. Functional gains were made in bathing, upper-extremity dressing, and using chopsticks independently. Also, the second patient's manual muscle testing improved to grades 1 to 2/5 to 3 to 4/5 generally, and ASIA scale improved C5 incomplete ASIA-D. SCIM was improved to by allowing walking independently and increasing lower-extremity dressing and toileting ability.

Lessons:

An intensive, multidisciplinary rehabilitation program may lead to neurological and functional gains in patients with NMO.
Complete obliteration of a spontaneous pediatric vertebral arteriovenous fistula with patency of the parent vertebral artery
Authors: Zhang Chang-wei , Wang Ting , Richard Seidu A. , Xie Xiao-dong
Published: October 2019

Rationale:

Vertebral arteriovenous fistulas (VAVFs) are depicted with anomalous connections between the vertebral artery, or its branches, and the adjacent venous system. Most VAVFs occur as a result of direct trauma during accidents, whereas others have iatrogenic origin.

Patient Concerns:

We report a case of 11-year-old male who presented with right limb weakness and walking instability.

Diagnosis:

Magnetic resonance angiography as well as digital subtraction angiogram (DSA) of the neck demonstrated a right VAVF. The cervical medulla was compressed by a dilated vein in vertebral canal. The blood supply of the fistula was from the right vertebral artery, whereas drainage was via epidural and paraspinal venous plexus.

Interventions:

We introduced the TransForm Occlusion Balloon Catheter into right vertebral artery, identified the VAVF, and occluded it with the balloon.

Outcomes:

We successfully obliterated the VAVF with patency of parent vertebral artery with a balloon. The symptoms of the patient were relieved after the procedure. Two years’ follow-up revealed no recurrence of the fistula. The patient is currently well.

Lessons:

Patency of the parent artery following obliteration a VAVF is still a challenge. Obliteration of the VAVF with a balloon while the parent vertebral artery is still patent is very possible.
Which is the best probiotic treatment strategy to prevent the necrotizing enterocolitis in premature infants
Authors: Bi Le-wee , Yan Bei-lei , Yang Qian-yu , Li Miao-miao , Cui Hua-lei
Published: October 2019

Background:

Previous studies have neglected to report the specific action of different probiotic genera in preterm infants. To evaluate the efficacy and safety of specific probiotic genera, we performed a network meta-analysis (NMA) to identify the best prevention strategy for necrotizing enterocolitis in preterm infants.

Methods:

MEDLINE, PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials had been searched for randomized control trials reporting the probiotics strategy for premature infants.

Results:

We identified 34 eligible studies of 9161 participants. The intervention in the observation group was to add probiotics for feeding: Lactobacilli in 6 studies; Bifidobacterium in 8 studies; Bacillus in 1 study; Saccharomyces in 4 studies and probiotic mixture in 15 studies. This NMA showed a significant advantage of probiotic mixture and Bifidobacterium to prevent the incidence of necrotizing enterocolitis in preterm infants. A probiotic mixture showed effectiveness in reducing mortality in preterm infants.

Conclusion:

The recent literature has reported a total of 5 probiotic strategies, including Bacillus, Bifidobacterium, Lactobacillus, Saccharomyces, and probiotic mixture. Our thorough review and NMA provided a piece of available evidence to choose optimal probiotics prophylactic strategy for premature infants. The results indicated that probiotic mixture and Bifidobacterium showed a stronger advantage to use in preterm infants; the other probiotic genera failed to show an obvious effect to reduce the incidence of NEC, sepsis and all-cause death. More trials need to be performed to determine the optimal probiotic treatment strategy to prevent preterm related complications.
Does relatively low iodine intake contribute to thyroid cancer? An ecological comparison of epidemiology
Authors: Zhang Yong-Li , Li Peng , Liu Zhi-Ya , Yi Jing-Ping , Chen Yan , Zhang Min , Lin Qi
Published: October 2019

Research on the relationship between iodine intake and thyroid cancer (TC) risk is limited, and the findings are inconclusive. The objective of this study was to provide emerging evidence for the association between iodine intake and TC risk in a Chinese population.

An ecological study of epidemiology is used to compare the iodine intake among populations with different TC incidence in Zhoushan, China. Incidence rates of TC were investigated and compared among four counties of the Zhoushan Islands from 2014 to 2018. Iodized salt consumption rate and the level of urinary iodine concentration (UIC) were analyzed for pupils and pregnant women from four counties.

During 2014 to 2018, a total of 2495 new cases of TC were diagnosed in Zhoushan Islands. The mean crude incidence rate of TC was 51.29 per 100,000 inhabitants, and the standardized (world population) incidence rate (SIR) was 31.34 per 100,000 population. Incidence rates (SIR and crude incidence rates) were significantly higher in women than in men (χ2 test, P < .05). Both male and female, the incidence of TC in Daishan County is higher than the other three counties of Zhoushan. Iodized salt consumption rate and median UIC in pupils and pregnant women in Daishan County was significantly lower than the other three counties (χ2 test and Kruskal–Wallis test, all P < .05). The population with high TC incidence has a lower iodized salt consumption and a lower level of UIC compare with the relative low TC incidence populations.

The low consumption of iodized salt with mild iodine deficiency may contribute to explain the exceptionally high incidence of TC in Daishan County. Further subtle designed studies are needed to provide additional insights into the epidemiology and etiology of TC and help identify the safe limit of iodine intake for prevention.
Catastrophic thoracolumbar spinal massive hematoma triggered by intraspinal anesthesia puncture
Authors: Yin Ruofeng , Zhu Yuhang , Su Zhenbo , Chang Pengyu , Zhu Qingsan , Gu Rui , Xing Hongjian , Zhao Baolin , An Yuan , Yang Fuwei , Zhang Bo-Yin
Published: October 2019

Rationale:

Intraspinal anesthesia, the most common anesthesia type of orthopedic operation, is regarded as safe and simple. Despite of the rare incidence, puncture related complication of intraspinal anesthesia is catastrophic for spinal cord. Here we present an intradural hematoma case triggered by improper anesthesia puncture. The principal reason of this tragedy was rooted in the neglect of spine deformities diagnosis before anesthesia. To the best of our knowledge, there is no specific case report focusing on the intradural hematoma triggered by improper anesthesia puncture.

Patient concerns:

Hereby a case of thoracolumbar spinal massive hematoma triggered by intraspinal anesthesia puncture was reported. The presenting complaint of the patient was little neurologic function improvement after surgery at 6-month follow-up.

Diagnoses:

Emergency MRI demonstrated that massive spindle-like intradural T2-weighted image hypointense signal masses from T12 to S2 badly compressed the dural sac ventrally, and his conus medullaris was at L3/4 intervertebral level with absence of L5 vertebral lamina. Hereby, the diagnoses were congenital spinal bifida, tethered cord syndrome, spine intradural hematoma, and paraplegia.

Interventions:

Urgent surgical interventions including laminectomy, spinal canal exploration hematoma removal, and pedicle fixation were performed. The patient received both medication (mannitol, mecobalamin, and steroids) and rehabilitation (neuromuscular electric stimulation, hyperbaric oxygen).

Outcomes:

Postoperation, he had regained only hip and knee flexion at II grade strength. His neurologic function was unchanged until 3 weeks postoperation. Six-month follow-up showed just little neurologic function improvement, and the American Spinal Injury Association grade was C.

Lessons:

By presenting an intradural hematoma case triggered by improper anesthesia puncture, we shared the treatment experience and discussed the potential mechanism of neurologic compromise. The principal reason for this tragedy is preanesthesia examination deficiency. Necessary radiology examinations must be performed to prevent misdiagnosis for spinal malformation.
A case report of an expensive yet necessary thoracentesis
Authors: Cocciardi Steven , Borah Amit , Terrigno Rocco , Abouzgheib Wissam , Boujaoude Ziad
Published: October 2019

Rationale:

Endobronchial ultrasound has revolutionized the field of bronchoscopy and has become one of the most important tools for the diagnosis of intrathoracic lymphadenopathy and para-bronchial structures. The reach of this technique has not been limited to these structures and pleural lesions have been at times accessible. To our knowledge, pleural fluid collections have not been accessed with endobronchial ultrasound (EBUS).

Patient concerns:

52-year-old women with dyspnea, fever and a new loculated pleural effusion that was suspected to be the source of the fever but was not accessible through traditional thoracentesis.

Diagnosis:

Malignant pleural effusion.

Interventions:

Sampling and drainage of the loculated pleural fluid collection using EBUS scope introduced via the esophagus.

Outcomes:

Infection excluded. Resolution of fever and improved dyspnea after drainage of effusion.

Lessons:

The convex curvilinear ultrasound bronchoscope allows unprecedented access to thoracic structures. The reach is not limited to mediastinal lymph nodes and parenchymal masses adjacent to the airways, and pleural space and pleural fluid are at times accessible, particularly when one considers the esophageal approach.
Veterans Affairs Low-vision Intervention Trial II: One-year Follow-up
Authors: Stelmack Joan A. , Tang Charlene , Wei Yongliang , Rose Kenneth , Ballinger Rex , Whitman Olga , Chronister Connie , Sayers Scott , Massof Robert W.
Published: October 2019

SIGNIFICANCE

One-year follow-up is recommended for patients with macular diseases to assess functional changes associated with disease progression and to modify low-vision (LV) treatment plans, if indicated.

PURPOSE

The purpose of this study was to observe 255 patients with macular diseases who received LV rehabilitation (rehabilitation with a therapist) or basic LV services (LV devices dispensed without therapy) during Veterans Affairs Low-vision Intervention Trial II after the trial ended at 4 months until 1-year follow-up.

METHODS

The primary outcome measure was visual ability measured with the 48-item Veterans Affairs Low-vision Visual Functioning Questionnaire. Mean visual ability scores for the treatment groups were compared from baseline to 4 months, 4 months to 1 year, and baseline to 1 year. Changes from baseline to 1 year were compared between the two groups. Predictors of changes in visual ability from 4 months to 1 year were assessed using linear regression.

RESULTS

Both groups experienced significant improvement in all measures of visual ability from baseline to 1 year but lost visual reading ability during the observation period (LV rehabilitation group, −0.64 [1.2] logit; 95% confidence interval [CI], −0.84 to −0.44 logit; basic LV group, −0.63 [1.4] logit; 95% CI, −0.88 to −0.38 logit), and overall visual ability was lost in the LV rehabilitation group (−0.20 [0.8] logit; 95% CI, −0.34 to −0.06 logit). Loss of visual reading ability in both groups from 4 months to 1 year was predicted by reading ability scores at 4 months, loss of near visual acuity from 4 months to 1 year, and lower EuroQol-5D utility index scores; loss of overall visual ability in the LV rehabilitation group during the same time period was predicted by lower overall ability scores at 4 months.

CONCLUSIONS

Visual ability significantly improved in all groups from baseline to 1 year. However, the loss of visual reading ability experienced by both groups from 4 months to 1 year reduced the benefit of the services provided.
Topical Review: Retinally Induced Aniseikonia
Authors: Rutstein Robert P. , Currie Debra C.
Published: October 2019

SIGNIFICANCE

We review retinally induced aniseikonia, an underrecognized condition resulting from common retinal conditions that has a significant effect on quality of life. Optometrists can influence the timing of surgical intervention to mitigate the damage from delaying surgical intervention in patients whose other findings do not meet a surgeon's treatment threshold.

Aniseikonia due to optical differences between the eyes occurs in 1 to 3.5% of the population and can hinder the quality of binocular vision. The less noted retinally induced aniseikonia is due to mechanical distortion and displacement of the retinal photoreceptors and occurs with disorders such as epiretinal membrane, reattached retinal detachment, macular hole, and macular edema. Despite that it was first reported in 1950 and its incidence continues to rise in the aging population, many eye care practitioners are unaware of this condition, which can persist or even be exacerbated after treatment as a contributing cause of binocular vision symptoms. The purpose of this report is to allow more eye care practitioners to become familiar with retinally induced aniseikonia. The review of the literature includes demographics and epidemiology, etiology, pathogenesis, diagnosis, results of treatment, prognosis, and case examples.
Assessing the Validity of Measurements of Swept-source and Partial Coherence Interferometry Devices in Cataract Patients
Authors: Ghaffari Reza , Mahmoudzadeh Raziyeh , Mohammadi S.Saeed , Salabati Mirataollah , Latifi Golshan , Ghassemi Hamed
Published: October 2019

SIGNIFICANCE

The validity of measurements of OA-2000 (Tomey, Nagoya, Japan), a new swept-source optical coherence tomography–based biometer, was evaluated in comparison with IOLMaster 500 (Carl Zeiss Meditec AG, Jena, Germany) as a reference method for optical biometry in cataract patients.

PURPOSE

This article compares the validity of measurements between OA-2000 and IOLMaster 500.

METHODS

In this cross-sectional study, axial length, lens thickness, anterior chamber depth, and keratometry readings were obtained by the OA-2000 and IOLMaster 500. Two measurements were taken by each method. Patients in which any one of the biometry methods could not be performed owing to severity of the cataract were excluded from the study. Repeatability of measurements was presented by coefficient of variation, and Bland-Altman method was used for evaluating the agreement between the two biometers.

RESULTS

Fifty-eight eyes of 58 cataract patients with mean ± standard deviation age of 61.4 ± 8.3 years were included in this study. Intraclass correlation ranged from 0.898 to 0.901 and showed good to excellent reliability. It was good for keratometry 1 (0.898) and excellent for keratometry 2 (0.992), axial length (0.999), and anterior chamber depth (0.901). Bland-Altman analysis showed good agreement between the swept-source optical coherence tomography and partial coherence interferometry devices for axial length, anterior chamber depth, and mean keratometry, with narrow 95% limits of agreement (−0.09 to 0.1 mm, −0.33 to 0.54 mm, −0.97 to 1.03 D, respectively), and also indicated small mean difference (0.01 for axial length, 0.11 for anterior chamber depth, 0.03 for mean keratometry, respectively) for all comparisons.

CONCLUSIONS

OA-2000 as a new swept-source optical coherence tomography has an excellent repeatability for measurement of biometric data in cataract patients, comparing with the standard partial coherence interferometry biometer (IOLMaster 500).
Paralysis After Lumbar Interlaminar Epidural Steroid Injection in the Absence of Hematoma
Authors: Petrin Ziva , Marino Ralph J. , Oleson Christina V. , Simon Jeremy I. , McCormick Zachary L.
Published: October 2019

Paraplegia after interlaminar epidural steroid injection is a rare event and has typically been described after epidural hematoma or direct spinal cord injury. We present a case of an 87-yr-old man who experienced transient lower limb weakness after a lumbar interlaminar epidural steroid injection due to an alternative cause, congestive myelopathy related to an underlying vascular malformation, namely, a spinal dural arteriovenous fistula. This is a poorly recognized and potentially treatable cause of progressive myelopathy. We present this case and review the literature on paraplegia after epidural steroid injection due to spinal dural arteriovenous fistula. Notably, this case of paralysis occurred in association with the lowest volume of epidural injectate reported in the literature to date (4 ml); importantly, this volume is consistent with the current clinical practice guideline standards for the safe performance of interlaminar epidural steroid injections. Physicians should be aware of this potential complication of epidural steroid injection and remain vigilant for the possibility after a procedure, even when performed according to current practice standards.
The Effect of Bone Marrow Aspirate Concentrate Application on Distracted Bone Biomechanical Properties
Authors: El Hadidi Yasser Nabil , Seif Mohamed , Sleem Heba , Mohsen Karim Abdel , El Kassaby Marwa
Published: October 2019

Background:

This study was conducted to assess effect of bone marrow aspirate concentrate (BMAC) on enhancing biomechanical properties of distraction osteogenesis (DO).

Methods:

Twelve rami of goats had distraction and were divided into test group (DO bone supplemented with BMAC) and control group.

Results:

Assessment of bone-width showed nonsignificant (P = 0.9) increase in test group (mean = 5.3 mm, standard deviation = 1.9 mm) compared to control group (mean = 5.2 mm, standard deviation = 0.8 mm). Assessment of radiographic density showed nonsignificant (P = 0.5) increase in test group (mean = 163.4 Hounsfield Unit, standard deviation = 6.5 Hounsfield Unit) compared to control group (mean = 156.6 Hounsfield Unit, standard deviation = 21.8 Hounsfield Unit). Histomorphometry of mature-bone % showed significant (P = 0.02) increase in test group (mean = 30%, standard deviation = 9.8%) compared to control group (mean = 15.9%, standard deviation = 7.2%). Assessment of biomechanical testing (bone strength) by 3-point bending test showed nonsignificant (P = 0.7) increase in test group (mean = 511.6 Newton, standard deviation = 189.1 Newton) compared to control group (mean = 467.8 Newton, standard deviation = 201.1 Newton).

Conclusion:

The BMAC failed to improve both bone quantity and biomechanical bone strength of distracted bone.
Barriers to the Effective Management of Gynecomastia in Adolescents
Authors: Arora Yingyot , Mittal Rhiya Ridhi , Williams Eva Adanna , Thaller Seth Ray
Published: October 2019

Background:

The aim of this study was to explore the impacts of gynecomastia on adolescents, explore the surgical and psychological success of mastectomy, and evaluate the adequacy of insurance guidelines and coverage.

Methods:

American College of Surgeons National Surgical Quality Improvement Program (NSQIP) surgical database from 2010 to 2014 was evaluated for current procedural terminology codes 19300 and 19303, representing mastectomies for gynecomastia and complete mastectomies respectively to compare surgical site complications.

Results:

Of 1132 procedures for mastectomy for gynecomastia 1.5% of patients (n = 17) were associated with postoperative superficial surgical site complications. In the same timeframe, a total of 33,124 procedures for simple, complete mastectomy performed with a postoperative surgical complication rate of 2.2% (n = 721). Results of a Chi-squared goodness of fit χ2 (1, N = 34,997) = 2.10, P > 0.05 suggests no statistically significant difference between incidence of surgical site complications for a mastectomy for gynecomastia versus typical mastectomy.

Discussion:

High surgical success rate, coupled with significant improvements in psychosocial functioning suggests that mastectomy is a highly effective intervention for adolescents with gynecomastia. However, due to vague and inadequate coverage and evaluation criteria surgery is often not performed. This paper offers a framework for developing a quantitative system by which to evaluate surgical candidates by adopting well-established guidelines currently in use for reduction mammoplasties and suggests further analysis into a cost/benefit analysis for coverage of the procedure.
Frontal and cerebellar atrophy supports FTSD-ALS clinical continuum
Authors: Pizzarotti Beatrice , Palesi Fulvia , Vitali Paolo , Castellazzi Gloria , Anzalone Nicoletta , Alvisi Elena , Martinelli Daniele , Bernini Sara , Ramusino Matteo Cotta , Ceroni Mauro , Micieli Giuseppe , Sinforiani Elena , D’Angelo Egidio , Costa Alfredo , Wheeler-Kingshott Claudia AM Gandini
Published: October 2019

Background

Frontotemporal Spectrum Disorder (FTSD) and Amyotrophic Lateral Sclerosis (ALS) are neurodegenerative diseases often considered as a continuum from clinical, epidemiologic and genetic perspectives. We used localized brain volume alterations to evaluate common and specific features of FTSD, FTSD-ALS and ALS patients to further understand this clinical continuum.

Methods

We used voxel-based morphometry on structural MRI images to localize volume alterations in group comparisons: patients (20 FTSD, seven FTSD-ALS, 18 ALS) versus healthy controls (39 CTR), and patient groups between themselves. We used mean whole-brain cortical thickness to assess whether its correlations with local brain volume could propose mechanistic explanations of the heterogeneous clinical presentations. We also assessed whether volume reduction can explain cognitive impairment, measured with frontal assessment battery, verbal fluency and semantic fluency.

Results

Common (mainly frontal) and specific areas with reduced volume were detected between FTSD, FTSD-ALS and ALS patients, confirming suggestions of a clinical continuum, while at the same time defining morphological specificities for each clinical group (e.g. a difference of cerebral and cerebellar involvement between FTSD and ALS). values suggested extensive network disruption in the pathological process, with indications of a correlation between cerebral and cerebellar volumes and in ALS. The analysis of the neuropsychological scores indeed pointed towards an important role for the cerebellum, along with fronto-temporal areas, in explaining impairment of executive and linguistic functions.

Conclusions

We identified common elements that explain the FTSD-ALS clinical continuum, while also identifying specificities of each group, partially explained by different cerebral and cerebellar involvement.
Effect of a simple exercise programme on hospitalisation-associated disability in older patients: a randomised controlled trial
Authors: Ortiz-Alonso Javier , Bustamante-Ara Natalia , Valenzuela Pedro L. , Vidán María T. , Rodríguez-Romo Gabriel , Mayordomo-Cava Jennifer , Javier-González Marianna , Hidalgo-Gamarra Mercedes , Lopéz-Tatis Myriel , Valades-Malagón María Isabel , Santos-Lozano Alejandro , Lucia Alejandro , Serra-Rexach José Antonio
Published: October 2019

Objective

Hospitalisation-associated disability (HAD, defined as the loss of ability to perform one or more basic activities of daily living [ADL] independently at discharge) is a frequent condition among older patients. The present study aimed to assess whether a simple inpatient exercise programme decreases the incidence of HAD in acutely hospitalised very old patients.

Design

In this randomized controlled trial (Activity in GEriatric acute CARe, AGECAR) participants were assigned to a control or intervention (exercise) group, and were assessed at baseline, admission, discharge, and 3 months thereafter.

Setting and participants

268 patients (mean age 88 years, range 75–102) admitted to an acute care for elders (ACE) unit of a Public Hospital were randomized to a control (n=125) or intervention (exercise) group (n=143).

Methods

Both groups received usual care, and patients in the intervention group also performed simple supervised exercises (walking and rising from a chair, for a total daily duration of ∼20 min). We measured incident HAD at discharge and after 3 months (primary outcome); and Short Physical Performance Battery (SPPB), ambulatory capacity, number of falls, re-hospitalisation and death during a 3-month follow-up (secondary outcomes).

Results

Median duration of hospitalisation was 7 days (interquartile range 4 days). Compared with admission, the intervention group had a lower risk of HAD at discharge (odds ratio [OR]: 0.32; 95% confidence interval [CI]: 0.11–0.92) and at 3-months follow-up (OR 0.24; 95% CI: 0.08–0.74) than controls during follow-up. No intervention effect was noted for the other secondary endpoints (all p>0.05), although a trend towards a lower mortality risk was observed in the intervention group (p=0.078).

Conclusion and implications

These findings demonstrate that a simple inpatient exercise programme significantly decreases the risk of HAD in acutely hospitalised, very old patients.

Trial registration

NCT0137489 (https://clinicaltrials.gov/ct2/show/NCT01374893).

Brief summary

A simple inpatient intervention consisting of walking and rising from a chair (∼20 minutes/day) considerably decreases the risk of hospitalisation-associated disability in acutely hospitalised older patients.
Evaluating the boundaries of marine biogeographic regions of the Southwestern Atlantic using halacarid mites (Halacaridae), meiobenthic organisms with a low dispersal potential
Authors: Pepato Almir R. , Vidigal Teofânia H. D. , Klimov Pavel B.
Published: October 2019

Aim

We evaluated traditional biogeographic boundaries of coastal marine regions in SW Atlantic using DNA sequence data from common, rocky-shore inhabiting, marine mites of the generaAgauopsisandRhombognathus, family Halacaridae.

Methods

We investigated geographic population genetic structure using CO1 gene sequences, estimated divergence times using a multigene dataset and absolute time-calibrated molecular clock analyses, and performed environmental niche modeling (ENM) of common marine mite species.

Results

Agauopsis legioniumhas a shallow history (2.01 Ma) with four geographically differentiated groups. Two of them corresponded to the traditional Amazonian and Northeastern ecoregions, but the boundary between the two other groups was inferred at the Abrolhos Plateau, not Cabo Frio.Rhombognathus levigatoidess. lat. was represented by two cryptic species that diverged 7.22 (multilocus data) or 10.01 Ma (CO1-only analyses), with their boundary, again at the Abrolhos Plateau. ENM showed thatA. legioniumhas suitable habitats scattered along the coast, while the twoR. levigatoidescryptic species differ considerably in their niches, especially in parameters related to upwelling. This indicates that genetic isolation associated with the Abrolhos Plateau occurred in both lineages, but for theR. levigatoidesspecies complex, ecological niche specialization was also an important factor.

Main conclusions

Our study suggests that the major biogeographic boundary in the Southwestern Atlantic lies not at Cabo Frio but at the Abrolhos Plateau. There, two biogeographically relevant factors meet: (i) changes in current directions (which limit dispersal) and (ii) abrupt changes in environmental parameters associated with the South Atlantic Central Waters (SACW) upwelling (offering distinct ecological niches). We suggest that our result represents a general biogeographic pattern because a barrier at the Abrolhos Plateau was found previously for the fish genusMacrodon(phylogeographic data), prosobranch mollusks, ascidians, and reef fishes (community-level data).
Sexual dimorphism and the effect of wild introgressions on recombination in Manihot esculenta
Authors: Chan Ariel W. , Williams Amy L. , Jannink Jean-Luc
Published: October 2019

Recombination has essential functions in evolution, meiosis, and breeding. Here, we use the multi-generational pedigree, consisting of 7,165 informative meioses (3,679 female; 3,486 male), and genotyping-by-sequencing (GBS) data from the International Institute of Tropical Agriculture (IITA) to study recombination in cassava (Manihot esculenta). We detected recombination events using SHAPEIT2 and duoHMM, examined the recombination landscape across the 18 chromosomes of cassava and in regions with known introgressed segments from cassava’s wild relative Manihot glaziovii, constructed a genetic map and compared it to an existing map constructed by the International Cassava Genetic Map Consortium (ICGMC), and inspected patterns of recombination placement in male and female meioses to see if there is evidence of sexual dimorphism in crossover distribution and frequency. We found that the placement of crossovers along chromosomes did not vary between the two sexes but that females undergo more meiotic recombination than males. We also observed that introgressions from M. glaziovii decreased recombination in the introgressed region and, in the case of chromosome 4, along the entire length of the chromosome that the introgression is on. We observed a dosage effect on chromosome 1, possibly suggesting the presence of a variant on the M. glaziovii haplotype that leads to lower overall recombination in the introgressed region.
Exact Distribution of Linkage Disequilibrium in the Presence of Mutation, Selection or Minor Allele Frequency Filtering
Authors: Qu Jiayi , Kachman Stephen D , Garrick Dorian , Fernando Rohan L , Cheng Hao
Published: October 2019

Linkage disequilibrium (LD), often expressed in terms of the squared correlation (r2) between allelic values at two loci, is an important concept in many branches of genetics and genomics. Genetic drift and recombination have opposite effects on LD, and thusr2will keep changing until the effects of these two forces are counterbalanced. Several approximations have been used to determine the expected value ofr2at equilibrium in the presence or absence of mutation. In this paper, we propose a probability-based approach to compute the exact distribution of allele frequencies at two loci in a finite population at any generationtconditional on the distribution at generationt− 1. Asr2is a function of this distribution of allele frequencies, this approach can be used to examine the distribution ofr2over generations as it approaches equilibrium. The exact distribution of LD from our method is used to describe, quantify and compare LD at different equilibria, including equilibrium in the absence or presence of mutation, selection, and filtering by minor allele frequency. We also propose a deterministic formula for expected LD in the presence of mutation at equilibrium based on the exact distribution of LD.