bluuebunny/crossref_metadata_2025 huggingface dataset:
Midwifery
Authors: Worth Valerie
Published: August 2017

Midwifery was a subject of both popular and scientific interest and often of regular scrutiny through the early modern period. While many births continued to be conducted by a local midwife, and family and religious rituals often remained constant, in other respects there were significant changes. However, their extent and the speed at which they affected different countries, even different regions, were extremely varied. The advent of print culture led to a sharp increase, from the 16th century onward, in the number of midwifery manuals available; those in the vernacular rather than Latin particularly found a wider, lay readership, especially when they contained descriptions and illustrations of “monstrous” births. Although most manuals were authored by male surgeons and physicians, in the 17th and 18th centuries some female midwives also kept detailed case notes and published textbooks. This contribution from women coincided in part with the rise of the male midwife, a phenomenon that challenged traditional midwifery, especially in England and France, and led to hotly contested debates over the use by male surgeons of the newly invented forceps, rather than relying on the skills of the expert female midwife. The period thus saw the emergence in some places of a medicalization of normal as well as complicated childbirth, and a potential diminution in the authority of the female midwife. Nonetheless, midwives, like surgeons and physicians, continued to be key members of the community, and midwifery was one of the limited number of remunerated, professional roles open to women. The regulation of midwifery varied by country and state/town, and was often a matter for both ecclesiastical and medical authorities: the former became critical after the Reformations because of the midwife’s potential role in baptizing the newborn. Although ecclesiastical licensing and medical regulations were undoubtedly sometimes more honored in the breach than in the observance, in some cities some formal training was provided for midwives. While the stereotypes of ignorant midwives and the associations of midwifery with witchcraft persisted in the popular imagination, by the 18th century Louis XV of France charged one midwife, Madame du Coudray (c. 1712–1794), with touring the provinces to teach midwifery skills in order to halt the decline in the population. In the cultural imagination, as well as in practice, the midwife remained a powerful if contested figure.
Niche Construction
Authors: Laland Kevin
Published: August 2017

Niche construction is the process whereby organisms, through their activities and choices, modify their own and each other’s niches. Examples of niche construction include the building of nests, burrows, and mounds and alternation of physical and chemical conditions by animals, and the creation of shade, influencing of wind speed, and alternation of nutrient cycling by plants. Here the “niche” is construed as the set of natural selection pressures to which the population is exposed (discussed in Ecology). By transforming natural selection pressures, niche construction generates feedback in evolution, on a scale hitherto underestimated and in a manner that alters the evolutionary dynamic. Niche construction also plays a critical role in ecology, in which it supports ecosystem engineering and eco-evolutionary feedbacks and, in part, regulates the flow of energy and nutrients through ecosystems. Niche construction theory is the body of formal (e.g., population genetic, population ecology) mathematical theory that explores niche construction’s evolutionary and ecological ramifications. Many organisms construct developmental environments for their offspring or modify environmental states for other descendants, a process known as “ecological inheritance.” In recent years, this ecological inheritance has been widely recognized as a core component of extra-genetic inheritance, and it is central to attempts within evolutionary biology to broaden the concept of heredity beyond transmission genetics. The development of many organisms—and the recurrence of traits across generations—has been found to depend critically on the construction of developmental environments by ancestors. Historically, the study of niche construction has been contentious because theoretical and empirical findings from niche construction theory appear to challenge some orthodox accounts of evolution. Many researchers studying niche construction embrace an alternative perspective in which niche construction is regarded as a fundamental evolutionary process in its own right, as well as a major source of adaptation. This perspective is aligned intellectually with other progressive movements within evolutionary biology that are calling for an extended evolutionary synthesis. In addition to ecology and evolution, niche construction theory has had an impact on a variety of disciplines, including archaeology, biological anthropology, conservation biology, developmental biology, earth sciences, and philosophy of biology.
Preference for the Workplace, Investment in Human Capital, and Gender*
Authors: Wiswall Matthew , Zafar Basit
Published: August 2017

We use a hypothetical choice methodology to estimate preferences for workplace attributes from a sample of high-ability undergraduates attending a highly selective university. We estimate that women on average have a higher willingness to pay (WTP) for jobs with greater work flexibility and job stability, and men have a higher WTP for jobs with higher earnings growth. These job preferences relate to college major choices and to actual job choices reported in a follow-up survey four years after graduation. The gender differences in preferences explain at least a quarter of the early career gender wage gap.
Transitioning Florida NPs to opioid prescribing
Authors: Craig-Rodriguez Alicia , Gordon Glenna , Kaplan Louise , Grubbs Laurie
Published: August 2017

Prior to statutory changes in prescriptive authority for controlled substances, this study examined the knowledge gaps and prescribing limitations of Florida advanced registered nurse practitioners regarding opioids. Study results revealed statistically significant knowledge gaps in the areas of federal and state guidelines; opioid classes and proper doses; risk assessment skills; monitoring of treatment; and confidence in dealing with challenges of opioid prescribing.
Are Anesthesia and Surgery during Infancy Associated with Decreased White Matter Integrity and Volume during Childhood?
Authors: Block Robert I. , Magnotta Vincent A. , Bayman Emine O. , Choi James Y. , Thomas Joss J. , Kimble Karolie K.
Published: August 2017

Background

Anesthetics have neurotoxic effects in neonatal animals. Relevant human evidence is limited. We sought such evidence in a structural neuroimaging study.

Methods

Two groups of children underwent structural magnetic resonance imaging: patients who, during infancy, had one of four operations commonly performed in otherwise healthy children and comparable, nonexposed control subjects. Total and regional brain tissue composition and volume, as well as regional indicators of white matter integrity (fractional anisotropy and mean diffusivity), were analyzed.

Results

Analyses included 17 patients, without potential confounding central nervous system problems or risk factors, who had general anesthesia and surgery during infancy and 17 control subjects (age ranges, 12.3 to 15.2 yr and 12.6 to 15.1 yr, respectively). Whole brain white matter volume, as a percentage of total intracranial volume, was lower for the exposed than the nonexposed group, 37.3 ± 0.4% and 38.9 ± 0.4% (least squares mean ± SE), respectively, a difference of 1.5 percentage points (95% CI, 0.3 to 2.8; P = 0.016). Corresponding decreases were statistically significant for parietal and occipital lobes, infratentorium, and brainstem separately. White matter integrity was lower for the exposed than the nonexposed group in superior cerebellar peduncle, cerebral peduncle, external capsule, cingulum (cingulate gyrus), and fornix (cres) and/or stria terminalis. The groups did not differ in total intracranial, gray matter, and cerebrospinal fluid volumes.

Conclusions

Children who had anesthesia and surgery during infancy showed broadly distributed, decreased white matter integrity and volume. Although the findings may be related to anesthesia and surgery during infancy, other explanations are possible.
Clinical Updates in Women’s Health Care Summary: Mood and Anxiety Disorders
Authors: Osborne Lauren M. , Payne Jennifer L.
Published: August 2017

The management of psychiatric disorders in women is complicated by reproductive life cycle events. Psychiatric disorders can be initiated or exacerbated during times of hormonal change (such as menarche, the premenstrual period, the postpartum period, and perimenopause), and during the childbearing years, treatment is complicated by pregnancy and breastfeeding. These issues make determining the appropriate psychiatric medications to use in the treatment of mood and anxiety disorders in women complex. This monograph addresses practical approaches in the provision of thorough and individualized care for women with mood or anxiety disorders.
Spinal Cord Injury—What Are the Controversies?
Authors: Ahuja Christopher S. , Schroeder Gregory D. , Vaccaro Alexander R. , Fehlings Michael G.
Published: August 2017

Traumatic spinal cord injuries have a tremendous impact on individuals, families, and society as a whole. Substantial heterogeneity in the patient population, their presentation and underlying pathophysiology has sparked debates along the care spectrum from initial assessment to definitive treatment. This article reviews spinal cord injury (SCI) management followed by a discussion of the salient controversies in the field. Current care practices modeled on the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint section guidelines are highlighted including key recommendations regarding immobilization, avoidance of hypotension, early International Standards for Neurological Classification of SCI examination and intensive care unit treatment. From a diagnostic perspective, the evolving roles of CT, MRI, and leading-edge microstructural MRI techniques are discussed with descriptions of the relevant clinical literature for each. Controversies in management relevant to clinicians including the timing of surgical decompression, methylprednisolone administration, blood pressure augmentation, intraoperative electrophysiological monitoring, and the role of surgery in central cord syndrome and pediatric SCI are also covered in detail. Finally, the article concludes with a reflection on clinical trial design tailored to the heterogeneous population of individuals with SCI.
Controversies in the Management of Geriatric Odontoid Fractures
Authors: Wagner Scott C. , Schroeder Gregory D. , Kepler Christopher K. , Schupper Alexander J. , Kandziora Frank , Vialle Emiliano N. , Oner Cumhur , Fehlings Michael G. , Vaccaro Alexander R.
Published: August 2017

Fractures of the odontoid process of C2 have become increasingly prevalent in the aging population and are typically associated with a high incidence of morbidity. Dens fractures comprise the majority of all cervical fractures in patients older than 80 years and remain the most common cervical fracture pattern in all geriatric patients. Type II odontoid fractures have been associated with limited healing potential, and both nonoperative and operative management are associated with high mortality rates. Historically, there has been some debate in the literature with regards to optimal management strategies to maximize outcomes in geriatric patients. Recent, high-quality evidence has indicated that surgical treatment of type II odontoid fractures in elderly patients is associated with improvements in both short- and long-term mortality. Additionally, surgical intervention has been shown to improve functional outcomes when compared with nonsurgical treatment. Factors to consider before surgery for geriatric type II odontoid fractures include associated comorbidities and the safety of general anesthesia administration. With appropriate measures of patient selection, surgery can provide an efficacious option for geriatric patients with type II odontoid fractures. We recommend surgical intervention via a posterior C1–C2 arthrodesis for geriatric type II odontoid fractures, provided that the surgery itself does not represent an unreasonable risk for mortality.
Functional Outcomes of Syndesmotic Injuries Based on Objective Reduction Accuracy at a Minimum 1-Year Follow-Up
Authors: Cherney Steven M. , Cosgrove Christopher T. , Spraggs-Hughes Amanda G. , McAndrew Christopher M. , Ricci William M. , Gardner Michael J.
Published: August 2017

Objective:

To evaluate whether objective syndesmosis reduction predicts functional outcomes and pain scores in patients with operatively treated syndesmotic injuries at a minimum 1-year follow-up.

Design:

Prospective Cohort.

Setting:

Urban Level I Trauma Center.

Patients:

Sixty-nine patients with operatively treated syndesmotic injuries were initially identified and consented for inclusion in the study. Nine patients were excluded perioperatively. Twelve patients were lost to follow-up. Forty-eight patients with operatively treated unilateral syndesmotic injuries were available and participated at the final follow-up.

Intervention:

Trans-syndesmotic stabilization with either 1 or 2 quadricortical position screws. Postoperatively, bilateral ankle computed tomography scans were obtained to objectively assess syndesmosis reduction accuracy.

Main Outcome Measurements:

Olerud–Molander Ankle Score, Short Musculoskeletal Function Assessment Dysfunction Index and Bother Index, and Numeric Pain Rating Scales at a minimum 1-year postoperative follow-up.

Results:

At 1-year follow-up, there was no significant difference in functional outcomes between reduced and malreduced groups at the 1.5-, 2-, and 3-mm thresholds for linear measurements. Similarly, there was no functional difference between the reduced and malreduced groups for rotational malreductions at a 10 or 15 degrees threshold. Patients with state-sponsored insurance (Medicaid) had significantly worse functional scores and pain scores when compared with the groups with private insurance, Medicare, or no insurance.

Conclusions:

At 1-year follow-up, functional outcomes were not related to objective measures of syndesmosis reduction.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Quengel Casting for the Management of Pediatric Knee Flexion Contractures: A 26-Year Single Institution Experience
Authors: Wiley Marcel R. , Riccio Anthony I. , Felton Kevin , Rodgers Jennifer A. , Wimberly Robert L. , Johnston Charles E.
Published: August 2017

Background:

Quengel casting was introduced in 1922 for nonsurgical treatment of knee flexion contractures (KFC) associated with hemophilic arthropathy. It consists of an extension-desubluxation hinge fixed to a cast allowing for gradual correction of a flexion deformity while preventing posterior tibial subluxation. The purpose of this study is to report 1 center’s experience with this technique for the treatment of pediatric KFC.

Methods:

A retrospective review was conducted over a 26-year period. All patients with KFC treated with Quengel casting were included. Demographic data, associated medical conditions, adjunctive soft tissue releases, complications, and the need for late surgical intervention were recorded. Tibiofemoral angle measurements in maximal extension were recorded at initiation and termination of casting, 1-year follow-up, and final follow-up. Success was defined as no symptomatic recurrence of KFC or need for subsequent surgery.

Results:

Eighteen patients (26 knees) were treated for KFC with Quengel casting. Average age at initiation of casting was 8.1 years with average follow-up of 59.9 months. Fifteen knees (58%) underwent soft tissue releases before casting. An average of 1.5 casts per knee were applied over an average of 23.9 days. Average KFC before casting was 50.6 degrees (range, 15 to 100 degrees) which improved to 5.96 degrees (0 to 40 degrees) at cast removal (P<0.00001). Sixteen patients (22 knees) had 1-year follow-up or failed casting before 1 year. Of these, 11 knees (50%) had a successful outcome. Residual KFC of those treated successfully was 6.8 degrees (range, 0 to 30 degrees) at 1 year and 8.2 degrees (range, 0 to 30 degrees) at final follow-up, averaging 71.4 months (P=0.81). Of the 11 knees deemed failures, all had recurrence of deformity within an average of 1 year from cast removal. Surgical release before Quengel casting did not improve the chances for success (P=0.09).

Conclusions:

Quengel casting can improve pediatric KFC an average of 44.2 degrees with minimal complications. Although 50% of treated patients will demonstrate significant recurrence or need later surgery, the majority of those treated successfully have durable results at intermediate term follow-up.

Level of Evidence:

Level IV—therapeutic study.
Orthopedic Application of Polycarbonate Urethanes: A Review
Authors: Elsner Jonathan J. , McKeon Brian P.
Published: August 2017

Soft materials that aim to reproduce the tribological function of the natural joint are gaining popularity as an alternative concept to conventional hard bearing materials in the hip and knee. Polyurethane (PU) elastomers, in particularly polycarbonate urethane, are among the highest performing medical-grade polymers. They have mechanical and biological properties that make them suitable for use in orthopedic implants, as they demonstrate a unique combination of toughness, durability, flexibility, biocompatibility, and biostability. As presented in this paper, newly developed implants based on polycarbonate urethane perform more similarly to the natural joint in their mechanical response to load, and in their ability to utilize a thinner structure similar to that of cartilage, without jeopardizing the integrity or stability of the implant. Several wear studies of implants based on PU demonstrate a very low damage level to the implants’ articulating surfaces following repeated loading, and provide good assurance that this material can generate a low and stable wear rate in the long term. Animal studies further provide understanding of the biological response to PU implants in the hip and knee. Short-term clinical results are now becoming available from several commercial products. These generally show good functioning of these implants in the body and no material-related complications.
Shape-memory Polymers for Orthopaedic Soft-Tissue Repair
Authors: Smith Kathryn E. , Garcia Mateo , Dupont Kenneth M. , Higgs Geoffrey B. , Gall Ken , Safranski David L.
Published: August 2017

Shape-memory polymers (SMPs) and their medical devices offer improved performance for soft-tissue fixation because of their ability to expand in vivo. Here, we describe the basics of the SMP cycle and the fundamental biomechanics of SMP soft-tissue fixation devices, in particular their effect on graft relaxation after device insertion. A surgical technique for posterior lateral corner reconstruction of the knee is presented that uses several SMP devices to simplify the procedure.
Severe Burnout Is Common Among Critical Care Physician Assistants: Retracted
Authors: Bhatt Muneer , Lizano Danny , Carlese Anthony , Kvetan Vladimir , Gershengorn Hayley Beth
Published: August 2017

Objectives:

To determine the prevalence of and risk factors for burnout among critical care medicine physician assistants.

Design:

Online survey.

Settings:

U.S. ICUs.

Subjects:

Critical care medicine physician assistant members of the Society of Critical Care Medicine coupled with personal contacts.

Interventions:

None.

Measurements and Main Results:

We used SurveyMonkey to query critical care medicine physician assistants on demographics and the full 22-question Maslach Burnout Inventory, a validated tool comprised of three subscales—emotional exhaustion, depersonalization, and achievement. Multivariate regression was performed to identify factors independently associated with severe burnout on at least one subscale and higher burnout scores on each subscale and the total inventory. From 431 critical care medicine physician assistants invited, 135 (31.3%) responded to the survey. Severe burnout was seen on at least one subscale in 55.6%—10% showed evidence of severe burnout on the “exhaustion” subscale, 44% on the “depersonalization” subscale, and 26% on the “achievement” subscale. After multivariable adjustment, caring for fewer patients per shift (odds ratio [95% CI]: 0.17 [0.05–0.57] for 1–5 vs 6–10 patients; p = 0.004) and rarely providing futile care (0.26 [0.07–0.95] vs providing futile care often; p = 0.041) were independently associated with having less severe burnout on at least one subscale. Those caring for 1–5 patients per shift and those providing futile care rarely also had a lower depersonalization scores; job satisfaction was independently associated with having less exhaustion, less depersonalization, a greater sense of personal achievement, and a lower overall burnout score.

Conclusions:

Severe burnout is common in critical care medicine physician assistants. Higher patient-to-critical care medicine physician assistant ratios and provision of futile care are risk factors for severe burnout.
A Review of Digital, Social, and Mobile Technologies in Health Professional Education
Authors: Curran Vernon , Matthews Lauren , Fleet Lisa , Simmons Karla , Gustafson Diana L. , Wetsch Lyle
Published: August 2017

Introduction:

Digital, social, and mobile technologies (DSMTs) can support a wide range of self-directed learning activities, providing learners with diverse resources, information, and ways to network that support their learning needs. DSMTs are increasingly used to facilitate learning across the continuum of health professional education (HPE). Given the diverse characteristics of DSMTs and the formal, informal, and nonformal nature of health professional learning, a review of the literature on DSMTs and HPE could inform more effective adoption and usage by regulatory organizations, educators, and learners.

Methods:

A scoping review of the literature was performed to explore the effectiveness and implications of adopting and using DSMTs across the educational continuum in HPE. A data extraction tool was used to review and analyze 125 peer-reviewed articles. Common themes were identified by thematic analysis.

Results:

Most articles (56.0%) related to undergraduate education; 31.2% to continuing professional development, and 52.8% to graduate/postgraduate education. The main DSMTs described include mobile phones, apps, tablets, Facebook, Twitter, and YouTube. Approximately half of the articles (49.6%) reported evaluative outcomes at a satisfaction/reaction level; 45.6% were commentaries, reporting no evaluative outcomes. Most studies reporting evaluative outcomes suggest that learners across all levels are typically satisfied with the use of DSMTs in their learning. Thematic analysis revealed three main themes: use of DSMTs across the HPE continuum; key benefits and barriers; and best practices.

Discussion:

Despite the positive commentary on the potential benefits and opportunities for enhancing teaching and learning in HPE with DSMTs, there is limited evidence at this time that demonstrates effectiveness of DSMTs at higher evaluative outcome levels. Further exploration of the learning benefits and effectiveness of DSMTs for teaching and learning in HPE is warranted.
Choice of Fluids for Resuscitation of the Critically Ill
Authors: Gross Whitney , Samarin Michael , Kimmons Lauren A.
Published: August 2017

Fluid administration is one of the most universal interventions in the intensive care unit; however, there remains a lack of optimal fluid choice in clinical practice. With increasing evidence suggesting that the choice and dose of fluid may influence patient outcomes, it is important to have an understanding of the differences between the various fluid products and these potential effects in order for nurses to navigate the critically ill patient. This article reviews properties, adverse effects, and monitoring of commonly used colloid and crystalloid fluids, providing information that may aid in fluid selection in the intensive care unit.
The Evolving Role of Tumor Treating Fields in Managing Glioblastoma
Authors: Burri Stuart H. , Gondi Vinai , Brown Paul D. , Mehta Minesh P.
Published: August 2017

Glioblastoma (GBM) is a devastating brain tumor with poor prognosis despite advances in surgery, radiation, and chemotherapy. Survival of patients with glioblastoma remains poor, with only 1 in 4 patients alive at 2 years, and a 5-year survival rate of about 5%. Recurrence is nearly universal and, after recurrence, prognosis is poor with very short progression-free survival and overall survival (OS). Various salvage chemotherapy strategies have been applied with limited success. Tumor Treating Fields (TTFields) are a novel treatment modality approved for treatment of either newly diagnosed or recurrent GBM. TTFields therapy involves a medical device and transducer arrays to provide targeted delivery of low intensity, intermediate frequency, alternating electric fields to produce antimitotic effects selective for rapidly dividing tumor cells with limited toxicity. In the phase 3 EF-14 trial, TTFields plus temozolomide provided significantly longer progression-free survival and OS compared with temozolomide alone in patients with newly diagnosed GBM after initial chemoradiotherapy. The addition of TTFields to standard therapy improved median OS from 15.6 to 20.5 months (P=0.04). In the phase 3 EF-11 trial, for recurrent GBM, TTFields provided comparable efficacy as investigator’s choice systemic therapy, with improved patient-reported quality of life and a lower incidence of serious adverse events. Primary toxicity associated with TTFields is skin irritation generally managed with array relocation and topical treatments including antibiotics and steroids. TTFields therapy has demonstrated proven efficacy in management of GBM, including improvement in OS for patients with newly diagnosed GBM, and is under current investigation in other brain and extracranial tumors.
Transition of care to an adult provider
Authors: Zuckerman Andrea L.
Published: August 2017

Purpose of review

The transition from adolescence to young adulthood can be a difficult and overwhelming time. Many adult care providers are unaware of the issues facing adolescents and young adults. Often the focus is on older patients and their problems. Internists, family practitioners and obstetricians and Gynecologists (OBGYNs) typically care for these patients. Often, young adults view their obstetrician and gynecologist as their primary care physician, so reviewing the issues facing this age group is important.

Recent findings

Lifestyle habits begun in childhood frequently continue throughout life. Adolescence and young adulthood are times when change in these habits may be easier to enforce. Reviewing nutrition, exercise, risky behaviors, preventive health objectives, sexuality and mental health are of utmost importance in the transition of care from a pediatric to an adult provider.

The transition from adolescence to young adulthood can be difficult for patients. Knowledge of these issues is crucial to the adult provider caring for these patients. Although visits frequently are short in duration, using screening tools and checklists filled out by the patient prior to the visit may be beneficial.
Efficacy and safety of bazedoxifene in postmenopausal Latino women with osteoporosis
Authors: Bueno Jose A. Hernández , Arias Lizbeth , Yu Ching-Ray , Williams Robert , Komm Barry S.
Published: August 2017

Objective:

Bazedoxifene (BZA) reduces fractures and bone turnover in postmenopausal women with osteoporosis. This report evaluates safety and efficacy of BZA in Latin American women in the global trial.

Methods:

In the 3-year, phase 3, randomized, double-blind trial, postmenopausal women with osteoporosis (N = 7,492) received BZA 20 or 40 mg/d, raloxifene 60 mg/d, or placebo. Outcomes included vertebral fractures, bone mineral density, bone turnover markers, and safety. This post hoc analysis included 3,036 Latin American women.

Results:

Incidence of vertebral fractures at month 36 with BZA 20 mg, BZA 40 mg, raloxifene, and placebo was 1.87%, 1.90%, 1.43%, and 2.83%, respectively (differences not significant). Adjusted mean percentage increases in bone mineral density were 2.49%, 2.79%, 3.18%, and 1.26% for lumbar spine, and 0.40%, 0.95%, 1.11%, and −0.41% for total hip (P < 0.001 for BZA 20/40 mg vs placebo). Adjusted median percentage reductions in osteocalcin at month 12 were −43.0%, −44.1%, −46.9%, and −27.0%, and C-telopeptide were −50.7%, −53.4%, −57.6%, and −32.1% (P < 0.001 for BZA 20/40 mg vs placebo). Common adverse events included pain and flu syndrome.

Conclusions:

BZA significantly improved bone mineral density and reduced bone turnover, and numerically reduced fractures, compared with placebo in postmenopausal Latin American women with osteoporosis. Results were similar to the global trial.
Acellular Dermal Matrix: Treating Periocular Melanoma in a Patient with Xeroderma Pigmentosa
Authors: Pillay Kamlen , Adams Saleigh , Vandermaesen Laura , Hudson Donald Anthony
Published: August 2017

We report a 7-year-old girl with xeroderma pigmentosum (XP), who presented in our clinic with a large melanoma (35 × 50 × 20 mm, Breslow depth 18 mm) in the zygomatic-malar area. Palliative surgery was performed to maintain her residual vision and to reduce the pain caused by the compression of local structures. Because of the limited access of autologous skin grafts in pediatric patients with XP who are severely affected, we opted to use an acellular dermal matrix. There was 100% graft uptake, and the pain due to compression by the tumor was alleviated. This case demonstrates that acellular dermal matrices can be safely and effectively used in oncological facial reconstruction, especially in patients with progressive conditions such as XP.
SEX STEROIDS AND MACULAR TELANGIECTASIA TYPE 2
Authors: Müller Simone , Allam Jean-Pierre , Bunzek Christopher G. , Clemons Traci E. , Holz Frank G. , Issa Peter CHARBEL
Published: August 2017

Purpose:

To investigate the relationship between macular telangiectasia Type 2 and systemic levels of sex steroids or their antagonization.

Methods:

In a prospective single-center study, 90 patients with macular telangiectasia Type 2 were investigated. Female patients were evaluated for previous surgical (e.g., ovariectomy) and/or pharmacological (e.g., aromatase inhibitors, tamoxifen) therapy resulting in reduced action of sex steroids. In males, free serum testosterone levels were assessed in patients and controls.

Results:

Fourteen of 49 (29%) female patients had a history of pharmacological suppression of sex steroids and/or ovariectomy. These patients were younger at disease onset when compared with those without such medical history (mean ± SD: 47.1 ± 7.8, range: 38–59, versus 60.1 ± 7.6, range: 45–76; P < 0.0001). Male patients showed significantly lower free serum testosterone levels compared with controls at younger age (P < 0.0001 and 0.04 in the first and second age quartiles, respectively), as opposed to nonsignificant differences in older patients. In men ≤ 60 years of age, a biochemical hypogonadism (free serum testosterone < 0.05 ng/mL) was present in 53% (8/15) and 4% (2/49) of patients and controls, respectively (P < 0.0001).

Conclusion:

The results indicate that steroidal sex hormones might be involved in the presumably multifactorial pathophysiology of macular telangiectasia Type 2.
CONTAMINATION OF ANTI-VEGF DRUGS FOR INTRAVITREAL INJECTION
Authors: Schargus Marc , Werner Benjamin P. , Geerling Gerd , Winter Gerhard
Published: August 2017

Purpose:

The particle counts and the nature of particles of three different antivascular endothelial growth factor agents (VEGF) in different containers in a laboratory setting were compared.

Methods:

Original prefilled ranibizumab glass syringes, original vials with aflibercept, and repacked ready-to-use plastic syringes with bevacizumab from a compounding pharmacy and a compounding company (CC) were analyzed. Particle counts and size distributions were quantified by different particle characterization methods (nephelometry, light obscuration, Micro-Flow Imaging, nanotracking analysis, resonant mass measurement). Using high-performance size-exclusion chromatography (HP-SEC), levels of protein drug monomer and soluble aggregates were determined.

Results:

Nearly all samples showed similar product quality. Light obscuration and Micro-Flow Imaging showed a 4-fold to 9-fold higher total particle count in compounding company bevacizumab (other samples up to 42,000 particles/mL). Nanotracking analysis revealed highest values for compounding company bevacizumab (6,375 million particles/mL). All containers showed similar amounts of silicone oil microdroplets. Ranibizumab showed lowest particle count of all tested agents with only one monomer peak in HP-SEC. Repackaged bevacizumab from different suppliers showed varying product quality.

Conclusion:

All three tested agents are available in similar quality regarding particulate purity and silicone oil microdroplet count. Repackaging can have a major impact on the quality.
CASE REPORT OF SEVERE PROLIFERATIVE RETINOPATHY IN A PATIENT WITH CONGENITAL LIPODYSTROPHY
Authors: Rosin Boris , Jaouni Tareq
Published: August 2017

Purpose:

A case report of a patient with severe proliferative retinopathy due to congenital lipodystrophy.

Methods:

We reviewed the medical history, imaging, and surgical procedures of a 25-year-old woman with a history of congenital lipodystrophy, presenting with bilateral combined tractional and exudative retinal detachment, poorly controlled diabetes mellitus, and extreme dislipidemia.

Results:

The patient underwent retinal detachment repair surgery both eyes. On the last follow-up, both retinae were flat, and visual acuity had improved in the right eye to J3 for near and finger counting 3 m for distance.

Conclusion:

Surgery combining pars plana vitrectomy and scleral bucking successfully flattened both retinae and significantly improved visual acuity in one eye in this case of bilateral retinal detachment with combined tractional and exudative components in a patient with congenital lipodystrophy. Surgical control of retinal complications is thus possible, provided there is adequate control of the underlying risk factors.
Recovery From Amiodarone-Induced Cornea Verticillata by Application of Topical Heparin
Authors: Frings Andreas , Schargus Marc
Published: August 2017

Purpose:

To report a case of amiodarone-induced vortex keratopathy–associated anatomical findings and subjective visual perception before and after treatment with topical heparin eye drops.

Methods:

Case report.

Results:

A 76-year-old man complained of halos in his vision in both his eyes due to prominent bilateral cornea verticillata. For treatment of cornea verticillata, we prescribed unpreserved eye drops of a sterile, phosphate-free solution of 0.1% sodium hyaluronate with 1300 IU/mL heparin sodium 3 times daily to the left eye, whereas the other side served as the control. The area of corneal deposits was measured by 2 examiners before and at the 1- and 3-month examination. At last follow-up, cornea verticillata had been reduced from 6 to 2 mm2 in area by approximately 66% from grade-III to grade-II amiodarone keratopathy.

Conclusions:

In patients using amiodarone, clearing of cornea verticillata may be achieved by topical use of unpreserved eye drops of a sterile, phosphate-free solution of 0.1% sodium hyaluronate with 1300 IU/mL heparin sodium.
Development of Cell Analysis Software for Cultivated Corneal Endothelial Cells
Authors: Okumura Naoki , Ishida Naoya , Kakutani Kazuya , Hongo Akane , Hiwa Satoru , Hiroyasu Tomoyuki , Koizumi Noriko
Published: August 2017

Purpose:

To develop analysis software for cultured human corneal endothelial cells (HCECs).

Methods:

Software was designed to recognize cell borders and to provide parameters such as cell density, coefficient of variation, and polygonality of cultured HCECs based on phase contrast images. Cultured HCECs with high or low cell density were incubated with Ca2+-free and Mg2+-free phosphate-buffered saline for 10 minutes to reveal the cell borders and were then analyzed with software (n = 50).

Results:

Phase contrast images showed that cell borders were not distinctly outlined, but these borders became more distinctly outlined after phosphate-buffered saline treatment and were recognized by cell analysis software. The cell density value provided by software was similar to that obtained using manual cell counting by an experienced researcher. Morphometric parameters, such as the coefficient of variation and polygonality, were also produced by software, and these values were significantly correlated with cell density (Pearson correlation coefficients −0.62 and 0.63, respectively).

Conclusions:

The software described here provides morphometric information from phase contrast images, and it enables subjective and noninvasive quality assessment for tissue engineering therapy of the corneal endothelium.
Long-Term Follow-up of Intrastromal Corneal Ring Segments (210-Degree Arc Length) in Central Keratoconus With High Corneal Asphericity
Authors: Lisa C. , Fernández-Vega Cueto L. , Poo-López A. , Madrid-Costa D. , Alfonso José F.
Published: August 2017

Purpose:

To assess the long-term outcomes of implanting intrastromal corneal ring segments (ICRSs) to correct central keratoconus with a high corneal asphericity value.

Methods:

Forty-three eyes with central keratoconus with a corneal asphericity value ≥−1.00 were evaluated before and after implanting an inferior 210-degree arc-length Ferrara-type AFR5 ICRS (AJL Ophthalmic, Spain). Logarithm of the minimum angle of resolution uncorrected (UDVA) and best-corrected (CDVA) distance visual acuity, corneal asphericity, root mean square for coma-like aberrations [computed for the Zernike terms Z (3, 1) and Z (3, −1)], and residual refractive errors analyzed using vector analysis were recorded before and at all follow-up visits. The postoperative follow-up duration was 3 years in all cases.

Results:

Mean UDVA (logarithm of the minimum angle of resolution scale) rose from 1.18 ± 0.59 to a postoperative 0.53 ± 0.39 after ICRS implantation (P < 0.0001). Mean CDVA varied in turn from 0.36 ± 0.18 to 0.17 ± 0.10 (P < 0.0001). CDVA remained unchanged or improved in all eyes after surgery. Both UDVA and CDVA were stable over the postoperative period (P > 0.05). The spherical equivalent declined steeply after ICRS implantation (P < 0.0001). Both spherical equivalent and refractive cylinder were stable over the postoperative period. The corneal asphericity and root mean square values for coma-like aberrations exhibited statistically significant decreases 6 months after ICRS implantation (P < 0.0001) and were also stable over postoperative follow-up (P > 0.05).

Conclusions:

These results suggest that implanting a single, inferior, 210-degree arc-length Ferrara-type ICRS is a safe, effective, and stable procedure for treating patients with central hyperprolate keratoconus.
Corneal Tomographic Changes After UV Cross-Linking for Corneal Ectasia (1-Year Results)
Authors: Baksoellah Zainab , Lavy Itay , Baydoun Lamis , Hooijmaijers Hilde C. M. , van Dijk Korine , Melles Gerrit R. J.
Published: August 2017

Purpose:

To evaluate changes in maximum keratometry (Kmax), corneal higher-order aberrations (HOAs), and densitometry (backscattered light) up to 1 year after UV cross-linking and their possible relation with changes in the visual outcome.

Methods:

Retrospective cohort study on 18 eyes of 16 patients, who underwent UV cross-linking after the Dresden protocol for progressive keratoconus or ectasia after laser-assisted in situ keratomileusis. Corrected distance visual acuity (CDVA), Scheimpflug-based corneal tomography, mean image brightness (corneal densitometry) from the anterior 120 μm of the midcornea, and posterior 60 μm of the central 6 mm of the cornea, and HOAs were evaluated.

Results:

Kmax at 1 month (59.7 ± 6.0D) after UV cross-linking resembled preoperative Kmax (59.3 ± 6.4D,P= 0.368), decreased until 3 months postoperatively (58.3 ± 6.3D,P= 0.002), and stabilized thereafter (P> 0.227). All postoperative corneal densitometry values were higher than preoperative values in all measured depths (P <0.05). One-month anterior and total corneal HOAs (4.28 ± 1.64 μm and 3.87 ± 1.62 μm, respectively) resembled preoperative values (4.10 ± 1.70 μm and 3.67 ± 1.62 μm, respectively;P> 0.221) and then decreased until 12 months postoperatively (3.86 ± 1.84 μm and 3.40 ± 1.80 μm, respectively;P< 0.005). Thinnest point thickness decreased from before (442 ± 25 μm) to 3 months postoperatively (427 ± 25 μm,P< 0.001), with no difference at 12 months postoperatively compared with preoperative values (437 ± 29 μm,P= 0.149). CDVA and endothelial cell density remained unchanged (P> 0.345 andP> 0.257, respectively). No relations were found between CDVA and the evaluated parameters (P> 0.05).

Conclusions:

One year after UV cross-linking, the observation of stable CDVA and thinnest point thickness, together with reduced Kmax suggests no ectasia progression within the study period in these cases. Although HOAs showed a trend toward improvement, corneal densitometry remained elevated.
Intraocular Pressure Responses to Maximal Cycling Sprints Against Different Resistances: The Influence of Fitness Level
Authors: Vera Jesús , Jiménez Raimundo , Redondo Beatriz , Cárdenas David , De Moraes Carlos Gustavo , Garcia-Ramos Amador
Published: August 2017

Purpose:

This study investigated the acute effect of maximal cycling sprint against difference resistances on intraocular pressure (IOP) depending on participants’ fitness level.

Methods:

In total, 26 physically active collegiate men performed 5 maximal cycling sprints against different resistances in a randomized order, and IOP was measured immediately before and after each sprint. Participants were divided in 2 subgroups (low fit and high fit) according to their maximum power output relative to body weight to assess the influence of fitness level. Two identical testing sessions were performed to assess the repeatability of IOP values.

Results:

We found that IOP decreases with the lightest resistance (P<0.01), whereas IOP increases with heavier resistances (P<0.01), and it showed a positive linear tendency (r=0.99). Our results suggest that participants’ fitness level seems to influence IOP responses, with a more stable response in the high-fit group. A strong intersession repeatability of IOP values was observed (intraclass correlation coefficient range, 0.82 to 0.98; coefficients of variations range, 1.76% to 6.23%).

Conclusions:

We conclude that (1) IOP is sensitive to cycling resistance in all-out sprints, with a lowering effect on the lightest resistance and an increasing effect with medium and heavy resistances, (2) high fitness level is beneficial to avoid IOP fluctuations during sprints, and (3) these changes are comparable when measured on 2 different days under the same experimental conditions. A progressive involvement in physical activity may be desirable to avoid IOP peaks during highly demanding physical effort. Future studies are needed to clarify the consequences of exercise in glaucoma patients.
Enterovirus Infection and Subsequent Risk of Kawasaki Disease: A Population-based Cohort Study
Authors: Weng Ken-Pen , Cheng-Chung Wei James , Hung Yao-Min , Huang Shih-Hui , Chien Kuang-Jen , Lin Chu-Chuan , Huang Shih-Ming , Lin Cheng-Li , Cheng Ming-Fang
Published: August 2017

Background:

The relationship of enterovirus (EV) infection and Kawasaki disease (KD) is still unclear. The purpose of this study was to conduct a population-based cohort study to determine the relationship between KD and EV infection in Taiwan.

Methods:

A population-based cohort study was conducted to analyze the children file (age < 18 years) of the Taiwan National Health Insurance program between 2000 and 2008. In total, 285,636 children with EV infection and 285,636 children without EV infection were included and followed up. The subsequent KD was the major outcome event.

Results:

The cumulative incidence of KD was significantly higher in the EV-infected cohort than in the non-EV–infected cohort (log-rank test, P < 0.001). The overall incidence of KD was 56% higher in the EV-infected cohort than in the non-EV–infected cohort, with an adjusted hazard ratio of 1.56 (95% confidence interval: 1.44–1.69). Stratified analysis showed higher KD risk associated with previous EV infection in children 3–5 years old, in girls, in children living in less urbanization levels, in children with parental low-income occupation, and in children with allergic diseases.

Conclusions:

There is a higher association between KD and previous EV infection in Taiwanese children, especially in those 3–5 years old, with female sex, with less urbanization level, with low-income parental occupation, and with allergy.
Low Varicella Zoster Virus Seroprevalence Among Young Children in the Democratic Republic of the Congo
Authors: Doshi Reena H. , Alfonso Vivian H. , Mukadi Patrick , Hoff Nicole A. , Gerber Sue , Bwaka Ado , Higgins Stephen G. , Sinai Cyrus , Cowell Brian , Ngoie Mwamba Guillaume , Okitolonda Emile , Muyembe-Tamfum Jean-Jacques , Rimoin Anne W.
Published: August 2017

Background:

Varicella zoster virus (VZV) causes both varicella (chickenpox) and herpes zoster (shingles) and is associated with significant global morbidity. Most epidemiological data on VZV come from high-income countries, and to date there are limited data on the burden of VZV in Africa.

Methods:

We assessed the seroprevalence of VZV antibodies among children in the Democratic Republic of Congo in collaboration with the 2013–2014 Demographic and Health Survey. Dried blood spot samples collected from children 6–59 months of age were run on Dynex™ Technologies Multiplier FLEX® chemiluminescent immunoassay platform to assess serologic response. Multivariate logistic regression was then used to determine risk factors for VZV seropositivity.

Results:

Serologic and survey data were matched for 7,195 children 6–59 months of age, among whom 8% were positive and 2% indeterminate for VZV antibodies in weighted analyses. In multivariate analyses, the odds of seropositivity increased with increasing age, increasing socioeconomic status, mother’s education level, rural residence, and province (South Kivu, North Kivu, Bandundu, Bas Congo had the highest odds of a positive test result compared with Kinshasa).

Conclusion:

Our data suggest that VZV is circulating in DRC, and seropositivity is low among children 6–59 months. Seropositivity increased with age and varied by other sociodemographic factors, such as geographic location. This study provides the first nationally representative estimates of VZV infection among children in the DRC.