bluuebunny/crossref_metadata_2025 huggingface dataset:
Flow Learning Experience: Applying Marketing Theory to Serious Game Design
Authors: Wang Chung-Hsiang , Wu Ko-Chiu , Tsau Saiau-Yue
Published: January 2018

The aim of this study was to design a digital game that imparts the concept of urban heat island effects to aid in environmental education. Within the play-time limits, gamers must be alert to signs of warning from the environment and keep the balance between economic growth and the temperature of the environment, so they can safely manage the development of a virtual city. We investigated gamers’ learning efficiency in terms of a city’s development scale, socioeconomics and the environment, environmental sustainability, increasing areas of green metropolitan space, and heat management of environmental knowledge and gaming experience through a survey of 209 sixth graders. Interestingly, results indicate that heavy gamers are less interested in serious games; they exhibit shorter periods of concentration and lower levels of immersion. If an individual exhibits a high level of fluency in the dimensions of challenge, player skills, control, and clear goals, then she or he is able to acquire knowledge through message involvement when gaming. This allows a serious game to appear less didactic and more fun. This study explored the means by which gamers acquire procedural and descriptive knowledge related to environmental protection through gameflow and immersion.
Troublesome Knowledge: A New Approach to Quality Assurance in Mental Health Nursing Education
Authors: Leidl Donald M.
Published: January 2018

Background

Quality assurance and quality enhancement processes in nursing education are vital to the establishment of a strong program. Existing quality assurance methods in nursing education such as professional self-regulation and external examination rely on provincial and national nursing associations for evaluation, putting minimal responsibility and accountability on internal program examiners. Threshold concepts and troublesome knowledge provide a framework as outlined by Land that utilizes internal examiners from both student and faculty groups and represents an alternative to traditional quality assurance in nursing education.

Purpose

To identify troublesome mental health nursing content in a nursing curriculum by exploring students and faculty perspectives.

Method

A sequential mixed methods design that utilized surveys and focus groups to explore student and faculty perspectives on troublesome mental health nursing content.

Results

The project data were able to be organized into five main content themes that were identified as being troublesome: the spectrum of mental illness, therapeutic relationships and boundaries, praxis, professionalism in nursing, and brain chemistry and its management.

Conclusion

The findings from this project are unique to the program of review but show the potential of this new approach to quality assurance and program enhancement initiatives in nursing education.
Research on dynamic characteristics and fatigue robust optimization of integrated vehicle model
Authors: Li Bobo , Yuan Huiqun , Zhao Tianyu , Wang Guangding
Published: January 2018

This paper investigates the dynamic characteristics and fatigue robust optimization of heavy-duty tractor. First, this paper presents a vehicle model with sub-structure method. Based on the theory of base motion, the structure dynamic characteristics are analyzed. Second, the accuracy of the method is verified by comparing the experimental results with the simulation results. Also, the dynamic response and the transfer function of vehicle are obtained using the above methods. Combined with the experimental data, the methods of random multiple frequency components and multi-axial fatigue life are adopted to analyze the fatigue damage of the heavy-duty tractor under different road conditions. Finally, the Design for Six Sigma is used to optimize the vehicle’s structure. The results show that by using the proposed method, the dynamic characteristics of the vehicle can be analyzed accurately and effectively, robustness of the vehicle can be improved, and mass of the vehicle can be reduced.
Sequential occurrence of Graves’ disease and immune thrombocytopenic purpura as manifestations of immune reconstitution inflammatory syndrome in an HIV-infected patient
Authors: Okazaki Masafumi , Nakamura Miho , Imai Akiko , Asagiri Tadashi , Takeuchi Seisho
Published: January 2018

Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients after initiating antiretroviral therapy usually involves worsening manifestations of overt infectious disease. Here, we describe a sporadic case of a late-diagnosed HIV-positive man who developed Graves’ disease as the first noninfectious IRIS followed by immune thrombocytopenic purpura as the second noninfectious IRIS.
Consumer attitude and purchase intention toward rooftop photovoltaic installation: The roles of personal trait, psychological benefit, and government incentives
Authors: Sun Pi-Chuan , Wang Hsueh-Mei , Huang Hsien-Long , Ho Chien-Wei
Published: January 2018

Rooftop photovoltaic system is a cheap and abundant energy source that addresses the threat of global warming, and its future success relies on government incentives and marketing strategies designed to improve consumers’ benefit perception. The present study aimed to examine the relationship among personal traits (including environmental concern, an ecological lifestyle, and consumer innovativeness), psychological benefits (including a warm glow and a “nature experience”), attitudes toward rooftop photovoltaic, government incentives, and intentions to install rooftop photovoltaic. Empirical data were collected from one nationwide company in Taiwan, and 300 valid questionnaires were collected. The collected data were analyzed using a structural equation model. The results show that an ecological lifestyle, consumer innovativeness, and warm glow affect rooftop photovoltaic installation intention through the attitude toward rooftop photovoltaic. Moreover, government incentives have the strongest influence on this intention. This study integrates personal traits, psychological benefits, attitudes toward rooftop photovoltaic, government incentives, and intentions to install rooftop photovoltaic in a model from the consumer perception theory perspective; it expands the theory regarding planned behavior in the solar photovoltaic research field. This research also provides suggestions for government policymakers and offers a strong theoretical and practical framework for photovoltaic industry marketers.
Exploring the “unity” of the virtues: The case of an allocentric quintet
Authors: Gulliford Liz , Roberts Robert C.
Published: January 2018

This article has two interrelated aims. First we explore a novel conceptual analysis of the “unity” of the virtues. Virtues come in clusters differentiated by broad functions within overall character. We identify three such clusters—virtues of intelligent caring, virtues of willpower, and virtues of humility. Virtues within a cluster are “unified” by some commonality, e.g., justice, compassion, and truthfulness all are kinds of intelligent caring. The allocentric virtues, a sub-class of the virtue of intelligent caring, are forms of intelligent caring about people. Virtues of willpower are capacities to manage impulses: desires, emotions, and habits. Virtues of humility are absences of vices of pride. These clusters support and exploit one another in a healthy character. Second, we explore whether empirical psychology can support conceptual analysis such as we propose. Our discussion of the conceptual analysis and empirical studies of the relations between pairs of allocentric virtues illustrates this exploration.
Resistance beyond sovereign politics: Petty sovereigns’ disappearance into the world of fiction in post-Fukushima Japan
Authors: Shindo Reiko
Published: January 2018

What happens to sovereign power when petty sovereigns refuse to exploit discretionary power to suspend the rule of law, the very power that is delegated to them and makes them who they are? How might such a refusal contribute to a better understanding of the relationship between resistance and sovereign power? This article revisits Judith Butler’s notion of petty sovereigns to explore the possibility that petty sovereigns establish a distinctive relationship with law. This article draws on a case involving one nameless petty sovereign and his published writings. He writes novels to expose how law is used by some officials to realize a particular policy goal with regards to nuclear energy. His novels blur the line between fiction and non-fiction: it contains classified information only available to bureaucrats, discusses actual energy policies and related laws, and introduces fictional characters who resemble non-fictional characters. I argue that this example suggests that petty sovereigns are not necessarily tied to the node between governmentality and sovereignty. Shifting between the worlds of fiction and non-fiction, petty sovereigns slip away from sovereign power, which controls the subject-making process, and quietly resist sovereign politics through the contingency of subjectivity.
Look East Policy:  The Case of Zimbabwe–China Political and Economic Relations Since 2000
Authors: Ojakorotu Victor , Kamidza Rumbidzai
Published: January 2018

This article maps the evolution of Zimbabwe’s Look East Policy (LEP) and specifically the bilateral relationship with China through the lens of Zimbabwe’s domestic politics. It argues that political elite in Zimbabwe has a vested interest in a close economic and political relationship with China at the cost of the interests of the people of Zimbabwe. The author establishes that Zimbabwe’s LEP was intended to respond to the economic sanctions imposed on it by Western nations. From the descriptive account of the LEP provided in the article, it appears that the LEP has been successful in doing that by having a broad-based economic and political relationship with China. The author further critiques the impact of Chinese investment in Zimbabwe as detrimental to the interests of the people.

Foreign policy is an instrument that governs and protects the interests of governments, nationals, institutions, organisations and entities within the lenses of bilateral relations between the countries concerned. The Zimbabwe–China relations point to the fact that the latter China is politically and economically committed to engage and develop the former. However, at the heart of commitment and development in Zimbabwe lies questions of interests and the nature of the relationship which is affecting development and commitment to take place. Hence, this article argues that the failure of Zimbabwe to yield satisfying results from the bilateral relations lies mostly on the political and economic weaknesses of the Zimbabwean government and leadership. The fact that the LEP is not formally and publicly developed and disseminated to key stakeholders and the general public and that it remains largely an oral secret public policy statement affects the interests of Zimbabwean economy and interested stakeholders. This also reflects a weak foreign policy directive. As long as Zimbabwe continues to deny to engage with other superpowers and global institutions, the LEP will remain doomed as China will continue to manipulate and exploit the relationship knowingly that Zimbabwe has no other friends and partners for development and cooperation.
Exploring ethnic identity perceptions of Hyun-Jin Ryu’s Korean American fans
Authors: Shin Na Ri , Welty Peachey Jon , Park Doo Jae
Published: January 2018

The purpose of this study was to understand the lived experiences of Korean American fans of the Los Angeles Dodgers’ Korean pitcher Hyun-Jin Ryu. Two research questions were developed to guide the study: (a) How are participants’ ethnic identity perceptions as Korean Americans intertwined with their fanship to Hyun-Jin Ryu? and (b) How are participants’ lived experiences intertwined with their fanship to Ryu? The study focused on the details of how fans perceived their ethnic identity in relation to Ryu’s performance and presence in Major League Baseball. Findings revealed that fans initially became involved due to their ethnic ties to Ryu and remained as fans because they felt connected to the motherland of Korea. Fans individually identified with Ryu through the perceived minority status of being Korean American in the US. Fans experienced vicarious satisfaction as they felt Ryu broke racial, ethnic, and gender stereotypes through his body image and physical performance. Consequently, they developed Korean pride when Ryu performed well. This study extends Tajfel and Turner’s social identity theory and Phinney’s concept of ethnic identity to examine fanship to a specific player rather than a team.
Missingness: The Social Realities of Physical Absence
Authors: Stewart Erin
Published: January 2018

When somebody goes missing, they are missing by virtue of the fact that their whereabouts is unknown. However, being missing is not merely a physical phenomenon—it is socially and politically constituted and has social and political implications. These complexities are explored in this article through the term “missingness,” which refers to the sociality of lost individuals and describes the relational context under which people go missing and are understood to be missing.
Otolaryngology Service Usage in Children With Cleft Palate
Authors: Whittemore Kenneth R. , Dargie Jenna M. , Dornan Briana K. , Boudreau Brian
Published: January 2018

Objectives:

To determine the usage of otolaryngology services by children with cleft palate at a pediatric tertiary care facility.

Design:

Retrospective case series.

Setting:

Specialty clinic at a pediatric tertiary care hospital.

Patients:

Children born between January 1, 1999, and December 31, 2002, with the diagnosis of cleft palate or cleft lip and palate. A total of 41 female and 48 male patients were included.

Main Outcome Measures:

Total number of otolaryngology clinic visits and total number of otolaryngologic surgeries (tympanostomy tube placements and other otologic or upper airway procedures).

Results:

In the first 5 years of life, these children utilized an average of 8.2 otolaryngology clinic visits (SD = 5.0; range: 1-22) and underwent 3.3 tympanostomy tube surgeries (SD = 2.0; range: 0-10). Seventy-three had their first tube placed at the time of palate repair, and 4 at the time of lip repair. Fifty-one (57.3%) required other otologic or upper airway procedures, including tonsillectomy and/or adenoidectomy (27 children), removal of tympanostomy tubes (24 children), tympanomastoidectomy (3 children), and tympanoplasty (14 children). Of the children who underwent other procedures, they underwent a mean of 1.67 (SD = 0.84; range: 1-4) surgeries.

Conclusions:

Children with cleft palate are at increased risk for eustachian tube dysfunction, frequently utilize otolaryngology care, and typically receive multiple sets of tympanostomy tubes. This study found that children with cleft palate receive on average of approximately 3 sets of tympanostomy tubes, and the majority required another otologic or upper airway surgery.
Teacher License Revocation and Surrender in North Carolina due to Sexual Misconduct
Authors: Walter Jennifer S.
Published: January 2018

The sexual misconduct of school employees has become a more common issue in the United States, and there has been very little empirical research conducted to provide context or understanding of the prevalence of this problem. Therefore, the purpose of this study was to investigate the reasons for license revocation and surrender in North Carolina with special attention to licenses lost due to sexual misconduct. Analysis indicated that 688 (91%) licenses were revoked and 67 licenses (9%) were voluntarily surrendered. The reasons listed for revocation or surrender were primarily sexual infractions with students ( n = 458; 61%). Employment information was located for 302 of the 458 school employees (66%) who lost their licenses due to sexual infractions. Of the 302 school employees found, 69 were coaches (23%) and 36 were music teachers (12%). Conclusions and implications for music teacher educators are discussed.
Hydrochloric Acid Infusion for the Treatment of Metabolic Alkalosis in Surgical Intensive Care Unit Patients
Authors: Guffey Jason D. , Haas Curtis E. , Crowley Amber , Connor Kathryn A. , Kaufman David C.
Published: January 2018

Background: Older reports of use of hydrochloric acid (HCl) infusions for treatment of metabolic alkalosis document variable dosing strategies and risk. Objectives: This study sought to characterize use of HCl infusions in surgical intensive care unit patients for the treatment of metabolic alkalosis. Methods: This retrospective review included patients who received a HCl infusion for >8 hours. The primary end point was to evaluate the utility of common acid-base equations for predicting HCl dose requirements. Secondary end points evaluated adverse effects, efficacy, duration of therapy, and total HCl dose needed to correct metabolic alkalosis. Data on demographics, potential causes of metabolic alkalosis, fluid volume, and duration of diuretics as well as laboratory data were collected. Results: A total of 30 patients were included, and the average HCl infusion rate was 10.5 ± 3.7 mEq/h for an average of 29 ± 14.6 hours. Metabolic alkalosis was primarily diuretic-induced (n = 26). Efficacy was characterized by reduction in the median total serum CO2 from 34 to 27 mM/L ( P < 0.001). The change in chloride ion deficit and change in apparent strong ion difference (SIDa) were not correlated with total HCl administered. There were no documented serious adverse effects related to HCl infusions. Conclusion: HCl was effective for treating metabolic alkalosis, and no serious adverse events were seen. In this clinical setting, the baseline chloride ion deficit and SIDa were not useful for prediction of total HCl dose requirement, and serial monitoring of response is recommended.
All-Cause, Stroke/Systemic Embolism–, and Major Bleeding-Related Health-Care Costs Among Elderly Patients With Nonvalvular Atrial Fibrillation Treated With Oral Anticoagulants
Authors: Deitelzweig Steve , Luo Xuemei , Gupta Kiran , Trocio Jeffrey , Mardekian Jack , Curtice Tammy , Hlavacek Patrick , Lingohr-Smith Melissa , Menges Brandy , Lin Jay
Published: January 2018

In this study, all-cause, stroke/systemic embolism (SE)-related, and major bleeding (MB)-related health-care costs among elderly patients with nonvalvular atrial fibrillation (NVAF) initiating treatment with different oral anticoagulants (OACs) were compared. Patients ≥65 years of age initiating OACs, including apixaban, rivaroxaban, dabigatran, and warfarin, were identified from the Humana Research Database between January 1, 2013, and September 30, 2015. Propensity score matching was used to separately match the different OAC cohorts with the apixaban cohort. All-cause health-care costs and stroke/SE-related and MB-related medical costs per patient per month (PPPM) were compared using generalized linear or 2-part regression models. Compared to apixaban, rivaroxaban was associated with significantly higher all-cause health-care costs (US$2234 vs US$1846 PPPM, P < .001) and MB-related medical costs (US$106 vs US$47 PPPM, P < .001), dabigatran was associated with significantly higher all-cause health-care costs (US$1980 vs US$1801 PPPM, P = .007), and warfarin was associated with significantly higher all-cause health-care costs (US$2386 vs US$1929 PPPM, P < .001), stroke/SE-related medical costs (US$42 vs US$18 PPPM, P < .001), and MB-related medical costs (US$132 vs US$51 PPPM, P < .001). Among elderly patients with NVAF, other OACs were associated with higher all-cause health-care costs than apixaban.
Fragmented Governance and Spatial Equity in Metropolitan Areas: The Role of Intergovernmental Cooperation and Revenue-Sharing
Authors: Kübler Daniel , Rochat Philippe E.
Published: January 2018

This article focuses on policies seeking to address social inequalities in metropolitan areas, where the allocation of resources to places with needs often clashes with the politics of redistribution in fragmented local government systems. Scholarship on metropolitan governance has yet to overcome the opposition between proponents of consolidation and defenders of polycentrism. The crucial open question is whether and how intergovernmental cooperation and revenue-sharing can redress spatial equity in institutionally fragmented metropolitan areas. This article addresses this question by exploring the determinants of social expenditures in the 630 municipalities of seven major metropolitan areas in Switzerland, where revenue-sharing systems are common. The analysis shows that intergovernmental grants make a significant but limited contribution to reducing the mismatch between needs and resources in fragmented and decentralized metropolitan areas, depending on the redistributive efforts made by higher state levels.
Effectiveness of a bipolar vessel sealant device for ovariohysterectomy in cats with pyometra
Authors: Boursier Jean-François , Bassanino Jean , Leperlier Dimitri
Published: January 2018

Objectives

The objective was to describe the use of a bipolar vessel sealant device for complete ovariohysterectomy in cats (ie, removal of both the ovarian pedicle and the uterine body and vessels) and to report on the feasibility of ovariohysterectomy in cats with pyometra.

Methods

Cats with confirmed pyometra and whose owners agreed to the surgical procedure were prospectively included in the study. Ovaries were visualised and the vessel sealant device was used to coagulate and cut the suspensory ligament, the ovarian pedicle and the broad ligament up to the level of the uterine body. Once the uterine body was measured, it was grasped, coagulated and transected just proximal to the cervix using the vessel sealant device when its diameter was <0.9 cm. Immediate postoperative and short-term follow-up were evaluated by clinical examination.

Results

Thirteen cases were initially included between November 2015 and February 2017. Three cases were subsequently excluded because of a uterine body diameter >0.9 cm. Of the 10 cats finally included, all were intact females, with a median age of 2.7 years (range 0.9–9 years). Median weight was 3.7 kg (range 2.6–6.7 kg). The median surgery time was 10.9 mins (range 9.8–15.2 mins). Median uterus diameter was 0.51 cm (range 0.45–0.64 cm) and median skin incision was 4.1 cm (range 3.6–5.1 cm). No complications during the procedures occurred in any patient. All cases were discharged from the hospital 1 day after surgery, without any abnormality. No complications were noted during the postoperative period.

Conclusions and relevance

The findings suggest that the bipolar vessel sealant device used in this study is safe in performing ovariohysterectomy for pyometra in cats, when the uterine body is <0.9 cm in diameter, without short-term complications.
The Pharmacokinetics and Effects of Diltiazem in Rabbits
Authors: Oruç S. , Orhan D. , Orhan M. , Irkeç M. , Başçi N. , Barun S. , Bozkurt A.
Published: January 2018

Purpose

To investigate the effect of diltiazem on wound healing after the creation of conjunctival flaps in rabbit eyes. Also, to investigate the pharmacokinetics of diltiazem in rabbits after subconjunctival and topical administration.

Methods

For the histopathological study, a limbal-based flap was prepared and diltiazem was injected subconjunctivally for five days after the surgery. The rabbits were euthanised 20 days after surgery. The effectiveness of diltiazem on wound healing was evaluated by histopathological examination and measurement of the thickness of subconjunctival fibrous tissue. For the pharmacokinetic study, diltiazem was applied topically or injected subconjunctivally. Aqueous paracenteses were performed 0.5, 1, 2, 4 hours thereafter.

Results

The histopathological study found no difference in thickness of the subconjunctival fibrous tissue in control and diltiazem-treated eyes. No significant toxicity was observed in eyes treated with diltiazem. The peak aqueous concentration was 3.8 ± 0.4 μg/ml after topical application and 15.3 ± 1.1 μg/ml after subconjunctival injection. The peak aqueous concentration was achieved 1/2 hours after administration in both cases.

Conclusions

Diltiazem did not appear to affect wound healing at the dose tested. Topical and subconjunctival diltiazem successfully penetrated the aqueous humor of rabbit eyes.
Experimental Retinopathy of Prematurity: Angiostatic Inhibition by Nimodipine, Ginkgo-Biloba, and Dipyridamole, and Response to Different Growth Factors
Authors: Juárez C.P. , Muiño J.C. , Guglielmone H. , Sambuelli R. , Echenique J.R. , Hernández M. , Luna J.D.
Published: January 2018

Purpose

To investigate whether commonly used vasodilating drugs ameliorate angiogenesis in experimental retinopathy of prematurity (ROP), and to study the response of these drugs to different growth factors.

Methods

We used a rat and mouse model of oxygen-induced ischemic retinopathy. Animals were treated with nimodipine, gingko-biloba and dipyridamole intraperitoneally starting the day before exposure to room air (day 1). Controls were injected with vehicle solution only. Eyes were processed histopathologically with serial sections and neovascularization was measured by counting the nuclei within the retinal internal limiting membrane, by a masked observer. Retinal and vitreous tissues were assayed by ELISA for VEGF, PDGF and TGFβ2.

Results

Nimodipine significantly inhibited the growth of new vessels in rats. The number of nuclei was 310 ± 69 in the control group (n:14) and 121 ± 53 in the treated ones (n:14), (p<0.0005). Similar results were found with ginkgo-biloba extracts: 344 ± 53 (n:15) in controls, and 136 ± 29 (n:11) in treated ones (p<0.0005), and with dipyridamole: 303 ± 69 (n:13) in controls, and 131 ± 48.5 in treated rats (p<0.0005). Results were similar in mice. 186 ± 45 (n:7) nuclei counted in controls against 90 ± 25 (n:6) for dipyridamole treated (p<0.0005); and 81 ± 21 for ginkgo-biloba treated animals (p<0.0005). A gradual, very significant increase in VEGF values in response to relative hypoxia (room air) contrasted with the significant inhibition noted both with ginkgo-biloba extracts and dipyridamole. TGFβ2 and PDGF both showed a gradual increase in relative hypoxia at days 2 and 4 of room air (p<0.0005). Treated animals showed marked inhibition of the three growth factors.

Conclusions

All three drugs markedly inhibited angiogenesis in experimental ROP. Growth factors were elevated in hypoxic conditions. Treated animals showed significant decreases of PDGF, VEGF, and TGFβ2 in retinal and vitreous tissues.
Visual Acuity and Macular Sensitivity in Myopic Eyes before and after Laser in Situ Keratomileusis
Authors: Varano M. , Scassa C. , Ducoli P. , Terrana M. , Calabrò F. , Parisi V.
Published: January 2018

Purpose

To evaluate the changes in visual acuity (VA) and in macular sensitivity in myopic eyes subjected to laser in situ keratomileusis (LASIK) refractive surgery.

Methods

In 38 myopic eyes, VA by Snellen's table and macular sensitivity by scanning laser ophthalmoscope (SLO) microperimetry were assessed before and after 24 weeks after LASIK surgery. The myopic eyes were divided into three age-matched groups: Group A = from −5 diopters (D) to −7 D and normal SLO-macular sensitivity (15 eyes); Group B = from −8 D to −16 D and normal SLO-macular sensitivity (9 eyes); and Group C = from −8 D to −16 D and abnormal SLO-macular sensitivity.

Results

In Group A and B eyes, at the first week after LASIK surgery, we observed a significant (analysis of variance, p<0.01) reduction in VA and SLO-macular sensitivity with respect to baseline values, while after 12 and 24 weeks no differences (p>0.01) were found when compared to baseline. In Group C patients, at 1 and 4 weeks after surgical treatment, we observed a significant (p<0.01) reduction in VA and SLO-macular sensitivity with respect to baseline values. At 12 and 24 weeks the values of VA were reduced, but not significantly (p>0.01), while values of SLO-macular sensitivity were still significantly (p<0.01) reduced.

Conclusions

LASIK could induce a reduction in VA and SLO-macular sensitivity in all myopic eyes during the 4 weeks following the surgery. This reduction is still present after 24 weeks only in eyes with the highest preoperative degree of myopia combined with the greatest reduction in macular sensitivity.
Risk Factors of Massive Suprachoroidal Hemorrhage during Extracapsular Cataract Extraction Surgery
Authors: Obuchowska I. , Mariak Z.
Published: January 2018

Purpose

To estimate retrospectively the incidence, predisposing factors, and possible mechanisms precipitating massive suprachoroidal hemorrhage (MSCH) development during cataract extraction surgery.

Methods

The study was conducted on 6639 consecutive cataract extractions performed between 1994 and 2002. All of the procedures were carried out using traditional nucleus expression methods. The study cases comprised 19 patients who developed intraoperative MSCH. The remaining 6620 patients served as the control group. Baseline systemic and ocular characteristics, as well as intraoperative factors, were analyzed. Categorical variables were analyzed using the chi-square test and the Fisher exact test.

Results

The incidence of MSCH during cataract surgery was 0.28%. Highly significant risk factors included high myopia, glaucoma, and diabetes (p<0.01). Atherosclerotic vascular diseases and/or hypertension were less significantly related to the condition (p<0.05). There was no significant relationship between MSCH formation and age, sex, side of the cataract, history of ocular trauma, or inflammation. The incidence of MSCH did not differ between patients operated on with extracapsular or intracapsular cataract extraction.

Conclusions

Attention to multiple preoperative and intraoperative ocular and systemic variables may allow the identification of, and prophylaxis for, patients at greater risk for MSCH.
Conventional Perimetry, Short-Wavelength Automated Perimetry, Frequency-Doubling Technology, and Visual Evoked Potentials in the Assessment of Patients with Multiple Sclerosis
Authors: Corallo G. , Cicinelli S. , Papadia M. , Bandini F. , Uccelli A. , Calabria G.
Published: January 2018

Purpose

To evaluate the diagnostic power of conventional, achromatic, automated perimetry (CAP), short-wavelength automated perimetry (SWAP), frequency-doubling technology (FDT) perimetry, and visual evoked potentials (VEP) in a group of patients with multiple sclerosis (MS) with or without a history of optic neuritis.

Methods

Thirty eyes of 15 patients (5 male, 10 female, average age 38±7 years) with confirmed diagnosis of MS underwent CAP, SWAP (Humphrey 750–II VFA, program central 30-2, full-threshold strategy), FDT perimetry (program N-30), and pattern VEPs. Sixteen eyes (53.3%) had no history of ocular involvement and a negative ophthalmologic examination. They were matched with a control group of 10 healthy volunteers (4 male, 6 female, average age 31±10 years). The mean deviation (MD) and the pattern standard deviation (PSD) of the two groups were compared (t-test). Fourteen eyes (46.7%) had, on the contrary, a history of optic neuritis. Inside this group, the MD and the PSD of the three techniques were correlated (Spearman's rank test), in order to investigate whether any significant differences might be revealed by these techniques in pointing out the total amount of visual field damage.

Results

When comparing MS patients without signs or symptoms of ocular involvement and a control group, no significant differences were found for CAP MD, CAP PSD, and FDT PSD. Significant differences were found, on the contrary, for SWAP MD (p=0.0014), SWAP PSD (p=0.0001), and FDT MD (p=0.0001). When considering the MD and the PSD of the three techniques in the group of MS patients who had a history of optic neuritis, a significant correlation was found only between CAP MD and SWAP MD (r=0.0057), with a tendency by SWAP to reveal a higher rate of visual field loss. The other correlations were not significant. According to predefined criteria, the group of asymptomatic subjects had abnormal CAP in 1 eye (6.25%), abnormal SWAP in 9 (56.2%), abnormal FDT in 11 (68.7%), and abnormal VEPs in 7 (43.7%). The combined use of all techniques allowed us to identify silent optic nerve impairment in 15 (93.7%) eyes.

Conclusions

Short-wavelength automated perimetry and FDT perimetry are two non-conventional perimetric techniques that were mainly developed for the early detection of glaucomatous damage. The results of this study demonstrate their efficacy also in detecting early visual field deficits in MS patients without clinical signs of optic neuropathy. Frequency doubling perimetry, in particular, proved to be an easy, fast, and sensitive technique in the assessment of patients with MS. Our results also suggest that subclinical visual involvement in MS can be better diagnosed using multiple (neurophysiologic and psychophysical) tests.
A Comparison between Humphrey and Frequency Doubling Perimetry for Chiasmal Visual Field Defects
Authors: Noval S. , Contreras I. , Rebolleda G. , Muñoz-negrete F.J. , Ruiz de zárate B.
Published: January 2018

Purpose

To evaluate and compare the diagnostic ability of frequency doubling technology perimetry (FDT) with standard automated perimetry (SAP) using Humphrey Field Analyser for the detection of visual field defects produced by chiasmal lesions.

Methods

Fifteen patients with documented chiasmal disease and previously diagnosed of bitemporal hemianopia with Humphrey perimetry were prospectively evaluated. All of them underwent a new SAP (SITA 24-2) followed by FDT tests (C-20 threshold). Diagnostic criteria for hemianopia were established according to the total deviation plot and the threshold values of FDT. A patient was diagnosed with hemianopia if one or both criteria were met. Based on these criteria, FDT sensitivity was calculated. Testing time and global indexes for both perimetric strategies were compared.

Results

The sensitivity of FDT was 75.0% (18 out of 24 eyes); the criterion based on threshold values was met more often (70.83%) than the criterion based on the total deviation plot (50.0%). Linear correlation was better for the external column than for the internal column of the visual field. Testing time with FDT was 122.16 seconds shorter than with SAP (p<0.001). The mean value for mean deviation (MD) was −13.62 dB (SD 6.88) for SAP and −8.83 dB (SD 5.94) for FDT (p<0.001).

Conclusions

Compared with standard automatic perimetry, FDT has a low sensitivity for detecting temporal hemianopias and also has more difficulty in defining the vertical limits of the defects. Therefore, it does not appear to be an adequate method for the detection of chiasmal visual field defects.
Intravitreal Triamcinolone Acetonide for Treatment of Central Retinal Vein Occlusion
Authors: Jonas J.B. , Akkoyun I. , Kamppeter B. , Kreissig I. , Degenring R.F.
Published: January 2018

Purpose

To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and intraocular pressure in patients with central retinal vein occlusion.

Methods

This prospective comparative non-randomized clinical interventional study included 32 patients (33 eyes) with central retinal vein occlusion. The study group (12 patients; 13 eyes) received an intravitreal injection of about 20 mg of triamcinolone acetonide. The control group (20 patients) did not receive any treatment. Mean follow-up was 10.1±8.6 months in the study group and 6.0±5.2 months in the control group.

Results

In the study group, mean visual acuity increased significantly (p=0.018) from 0.11±0.11 preoperatively to a best visual acuity during follow-up of 0.18±0.15. An improvement in visual acuity by at least 2 Snellen lines and 3 Snellen lines, respectively was found for 8 (62%) eyes and 5 (38) eyes. Visual acuity measurements determined 1 month (p=0.038) and 3 months (p=0.046) after the injection were significantly higher than the baseline values. Increase in visual acuity was higher in the non-ischemic subgroup than in the ischemic subgroup. In the control group, baseline visual acuity and best visual acuity during the follow-up did not vary significantly (p=0.33). Visual acuity decreased significantly (p=0.007) towards the end of the follow-up. Comparing study group and control group, gain in visual acuity was significantly (p=0.01) higher in the study group. In the study group, intraocular pressure increased significantly (p=0.018) from 14.4±3.9 mmHg to a mean maximal value of 21.6±9.2 mmHg (range, 10–44 mmHg), and re-decreased (p=0.012) towards the end of follow-up to 15.3±5.1 mmHg (range, 10–21 mmHg).

Conclusions

Intravitreal triamcinolone acetonide temporarily increases visual acuity in central retinal vein occlusion. It is accompanied by an increase in intraocular pressure.
Unilateral Exophthalmos Associated with Ipsilateral Mucosal Turbinate Hypertrophy: Benign Exophthalmos Syndrome (Bes). A Description of a New Clinical Condition
Authors: Bonavolontà G. , Iuliano A. , Bonavolontà P. , Strianese D.
Published: January 2018

Purpose

To report the clinical and radiologic characteristics of a group of patients who experienced unilateral exophthalmos associated with ipsilateral mucosal turbinate hypertrophy. The clinical features of these patients are presented and a hypothesis proposed to explain this condition for which the authors introduce the term benign exophthalmos syndrome (BES).

Methods

Retrospective, noncomparative case series. Participants: Four patients experienced slow progressive unilateral exophthalmos associated with ipsilateral mucosal turbinate hypertrophy, with no evidence of orbital mass or extraocular muscles involvement. Intervention: Main Outcome Measures. Symptomatic outcome and measurement of the degree of relative exophthalmos.

Results

The onset of exophthalmos was associated with clinical and radiologic features that resemble BES. In all patients, radiologic examination demonstrated an ipsilateral mucosal turbinate hypertrophy and not the presence of orbital disease or expanding lesions of paranasal sinus. After daily intranasal spray of steroid, in three of the four cases the globe returned to within 1 mm of exophthalmometry of the contralateral eye.

Conclusions

The relationship between the feature of paranasal sinus disease and the development of ipsilateral exophthalmos has been described in the literature. The four cases described herein appear peculiar for the slow progressive onset of the exophthalmos, without inflammatory and mass effect signs. This condition associated in all cases with ipsilateral hypertrophy of the nasal mucosa provides a guide to a hypothetical mechanism for BES. According to these hypothesis, the therapy should be devoted to the nasal disease more than the orbital.
Primary Open Angle Glaucoma in a Case of Mitochondrial Encephalomyopathy (Kearns-Sayre Syndrome)
Authors: Frezzotti P. , Frezzotti R.
Published: January 2018

Purpose

Kearns-Sayre syndrome is characterized by chronic progressive external ophthalmoplegia, tapetoretinal degeneration and severe generalized myopathy.

Methods

AND RESULTS. We report on a 82-year-old male patient with Kearns-Sayre syndrome with open angle glaucoma.

DISCUSSION

Reports of primary open angle glaucoma with Keams-Sayre syndrome are very rare, but it is difficult to believe that this association is merely coincidental.
Phacoemulsification Surgery and Foldable Intraocular Lens Implantation in a Child with Regressed Retinoblastoma
Authors: Corrêa Z.M.S. , Marcon I.M. , Augsburger J.J.
Published: January 2018

Purpose

The management of retinobla stoma has been shifting toward conservativetreat-ment. Visual preservation has become a concern as tumor regression is achieved. To re -port the surgical approach and outcome of a radiation-induced cataract in an only eye with regressed retinoblastoma.

Methods

Single case report and review of literature.

Results

Small incision sutureless phacoemulsification and implant of an acrylic foldable in-traocular lens was performed. Best-corrected visual acuity 1 year after surgery was 20/20. No tumor recurrence has been noted after 27 months of follow-up.

Conclusions

Phacoemulsification and foldable intraocular lens implant seemed to be an ap-propriate therapeutic option for this case.
Sweet Hyperopia: Refractive Changes in Acute Hyperglycemia
Authors: Tai M.-C. , Lin S.-Y. , Chen J.-T. , Liang C.-M. , Chou P.-I. , Lu D.-W.
Published: January 2018

Purpose

A prospective study was performed to evaluate refractive and ocular biometric changes in acute hyperglycemic status in patients with diabetes mellitus.

Methods

From January to August 2002, 48 eyes of 24 patients with persistent diabetes and a plasma glucose level 17 mmol/L or HbA1c 10.0% on admission were enrolled in this prospective study. Upon admission to Tri-Service General Hospital in Taipei, Taiwan, these patients underwent intensive glycemic control. The basic ophthalmic examinations, including visual acuity, intraocular pressure measurement, slit lamp, and fundus examinations, were conducted. The ocular parameters including refraction, anterior chamber depth, lens thickness, axial length, mean keratometry and thinnest corneal thickness were evaluated by A-mode scan and Orbscan II. Each patient underwent clinical follow-up visits at 1, 2, and 4 weeks after the acute hyperglycemic episode.

Results

Of the 24 patients, 18 were male and 6 were female. The mean age of the patients was 55 years (range: 38 to 69). Comparing the refractive status on admission and at week 4, the authors found that 8 cases (16 eyes, 33%) showed hyperopia during hyperglycemia (+1.9±0.8 D), but in the other 16 cases (32 eyes, 67%), there were no significant changes. In addition, there were also no significant changes in anterior chamber depth, lens thickness, axial length, thinnest corneal thickness, or mean keratometry in the follow-up period.

Conclusions

Transitory hyperglycemia produces hyperopia. The alteration in refractive index in the lens may contribute to the hyperopic change, but no change of ocular biometrics in lens or cornea is observed.
Relationship between Short Wavelength Perimetry and Central Corneal Thickness Values in Ocular Hypertensive Subjects
Authors: Dadaci Z. , Bozkurt B. , Irkeç M.T. , Orhan M. , Arslan U.
Published: January 2018

Purpose

To evaluate the results of short wavelength perimetry (SWAP) of ocular hypertensive (OHT) patients and correlate these findings with central corneal thickness (CCT) measurements.

Methods

Thirty-seven OHT patients with a mean age of 50.2±8.2 (SD) years and 30 control subjects with a mean age of 50.3±8.5 (SD) years were included in this study. A questionnaire was applied to patients to evaluate the demographic risk factors that may predict glaucoma development. After a detailed ophthalmologic examination, achromatic and short wavelength perimetries and ultrasonic pachymetry were performed and the results were compared between the two groups with Student t test and Mann-Whitney U test. A p value <0.05 is considered as statistically significant.

Results

Mean CCT was higher in the OHT group (right eye; 558.13±28.39 μm and left eye; 558.94±27.30μm) when compared with the control subjects (524.66±30.53 μm and 525.86±30.46 μm, respectively) (p<0.01). A significant positive correlation was found between CCT measurements and intraocular pressure (r=0.5, p<0.001). Four right eyes (10.8%) and five left eyes (13.5%) of OHT patients had defects in SWAP. OHT patients with SWAP abnormalities had significantly lower CCT measurements in right (527.25±17.34 μm) and left eye (528.80±13.60 μm) when compared with OHT patients without SWAP defects (561.87±27.29 μm and 563.65±25.92 μm, respectively) (p<0.05). Significant correlations were found between CCT and SWAP MD, PSD, and CPSD (p<0.05).

Conclusions

OHT patients with SWAP abnormalities had significantly lower CCT measurements than those without. CCT is considered as a risk factor for the development of glaucomatous damage in OHT patients.
Antiproliferative Effect of 4-Thiouridylate on OCM-1 Uveal Melanoma Cells
Authors: Kemény-Beke Á. , Berényi E. , Facskó A. , Damjanovich J. , Horváth A. , Bodnár A. , Berta A. , Aradi J.
Published: January 2018

Purpose

Brachytherapy is a well-established, effective treatment for uveal melanoma with a failure rate of 15%. The fatal consequence of unsuccessful treatments offers reason for improvement of the method. The authors propose using an apoptosis inducing agent locally, concomitantly with the well-established therapy, to sensitize the tumor cells. The authors propose a new nontoxic moderately active apoptosis inducing agent, 4-thio-uridylate (s4UMP), for this purpose.

Methods

OCM-1 uveal melanoma cells were treated with various concentrations of s4UMP and its effect was monitored by measuring the cell viability (MTT assay). The following apoptosis detecting methods were performed to reveal the mechanism of decreased cell viability: light microscopy, DNA fragmentation assay, determination of caspase 9 activity, and FACS analysis.

Results

The viability of uveal melanoma cells was decreased by 32%, 40%, and 9% after 24, 48, and 72 hours of treatment with 10 μg/mL (30 μM) S4UMP. The effect was not dose dependent; it rather followed a saturation-type inhibition and the cells at lower drug concentration recovered after 72 hours. Characteristic apoptotic cell morphology and DNA fragmentation was detected in treated cells. The caspase-9 was activated upon treatment showing maximal activity at 48 hours suggesting the induction of apoptosis. The annexin binding activity further verified the apoptogenic activity of s4UMP.

Conclusions

Uveal melanoma, more than other solid tumors, is resistant to most of the chemotherapeutic protocols as indicated by the high mortality rate of metastatic disease. The authors showed that s4UMP, a naturally occurring nucleotide, could induce apoptosis in uveal melanoma cells, suggesting a potential supplementary therapeutic application of the compound.
Is There any Relationship between Photodynamic Therapy for Exudative Age-Related Macular Degeneration and Choroidal Neovascularization Recurrence? A Rationale for Combined Treatments
Authors: Piermarocchi S. , Sartore M. , Lo Giudice G. , Monterosso G. , Pilotto E. , Segato T.
Published: January 2018

Purpose

Photodynamic therapy (PDT) is the treatment of choice for subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). Interpretation of PDT mechanism of action is not yet fully understood and causes of CNV recurrences are unclear. The authors have conducted a retrospective analysis of fluorescein and indocyanine green angiographies in patients treated with multiple PDT in order to identify risk factors for recurrence.

Methods

A total of 342 eyes of 342 patients (207 women and 135 men) with ARMD and subfoveal CNV were treated with at least two PDT. Angiographic (fluorescein and indocyanine green) features of recurrences were confronted to pretreatment examinations in all patients. RESULTS. Post-PDT angiographies showed in all eyes a dark circle corresponding to the laser spot even 1 year after treatment. Persistence or progressive regrowth of CNV developed in an area adjacent or corresponding to the original lesion, without any specific relationship with the location of fluorescein and indocyanine green late leakage or with presence of abnormal fluorescence due to pigment abnormalities. At the 3-month angiographic follow-up, 23 patients (6.7%) showed a recurrent CNV resembling shape and dimension of the laser spot used for the PDT treatment.

Conclusions

The authors failed to identify angiographic signs helpful to predict the risk of CNV persistence or recurrence. PDT leaves minor but persistent changes in the choroidal vasculature within the treatment area. In some cases, the recurrent CNV seems to be related to the laser spot of the PDT.