bluuebunny/crossref_metadata_2025 huggingface dataset:
Idiopathic Spinal Epidural Fat Accumulation Is Associated With Hyperlipidemia
Authors: Ishihara Shinichi , Fujita Nobuyuki , Yagi Mitsuru , Tsuji Takashi , Michikawa Takehiro , Nishiwaki Yuji , Fukui Yasuyuki , Horiuchi Keisuke , Ishii Ken , Nakamura Masaya , Matsumoto Morio , Watanabe Kota
Published: August 2017

Study Design.

Single-center retrospective analysis of consecutively collected data.

Objective.

To determine the clinical characteristics of idiopathic spinal epidural lipomatosis (SEL).

Summary of Background Data.

SEL is associated with the overt accumulation of nonencapsulated adipose tissue in the epidural space, leading to spinal cord or nerve root compression. The etiology of this condition is currently not completely understood.

Methods.

Data of 166 male patients who underwent primary surgery for lumbar spinal canal stenosis (LSS) from May 2013 to February 2016 were retrospectively reviewed. Participants were divided into three groups based on the degree of epidural lipomatous lesion. Patient data of age at surgery, body mass index, prevalence of common noncommunicable diseases, blood tests, arteriosclerotic index, and preoperative clinical scores (assessed using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire) were evaluated. Multivariate analysis was performed to assess the potential associated factors for idiopathic SEL.

Results.

Patients with LSS with severe SEL had a significantly higher body mass index and elevated serum levels of total cholesterol and triglyceride compared with those without SEL. Analysis of preoperative clinical scores revealed that patients with SEL experienced pain more frequently and showed less walking ability than did those without SEL. Multivariate analysis revealed that hyperlipidemia was significantly associated with idiopathic SEL (odds ratio = 3.74, 95% confidence interval = 1.31–10.64).

Conclusion.

Our data suggest that aberrant lipid metabolism is related to the pathogenesis of idiopathic SEL and that patients with LSS with idiopathic SEL have more severe pain than do those without SEL.

Level of Evidence: 3
Effects of High-Flow Nasal Cannula on the Work of Breathing in Patients Recovering From Acute Respiratory Failure*
Authors: Delorme Mathieu , Bouchard Pierre-Alexandre , Simon Mathieu , Simard Serge , Lellouche François
Published: August 2017

Objectives:

High-flow nasal cannula is increasingly used in the management of respiratory failure. However, little is known about its impact on respiratory effort, which could explain part of the benefits in terms of comfort and efficiency. This study was designed to assess the effects of high-flow nasal cannula on indexes of respiratory effort (i.e., esophageal pressure variations, esophageal pressure-time product/min, and work of breathing/min) in adults.

Design:

A randomized controlled crossover study was conducted in 12 patients with moderate respiratory distress (i.e., after partial recovery from an acute episode, allowing physiologic measurements).

Setting:

Institut Universitaire de Cardiologie et de Pneumologie de Québec, QC, Canada.

Subjects:

Twelve adult patients with respiratory distress symptoms were enrolled in this study.

Interventions:

Four experimental conditions were evaluated: baseline with conventional oxygen therapy and high-flow nasal cannula at 20, 40, and 60 L/min. The primary outcomes were the indexes of respiratory effort (i.e., esophageal pressure variations, esophageal pressure-time product/min, and work of breathing/min). Secondary outcomes included tidal volume, respiratory rate, minute volume, dynamic lung compliance, inspiratory resistance, and blood gases.

Measurements and Main Results:

Esophageal pressure variations decreased from 9.8 (5.8–14.6) cm H2O at baseline to 4.9 (2.1–9.1) cm H2O at 60 L/min (p = 0.035). Esophageal pressure-time product/min decreased from 165 (126–179) to 72 (54–137) cm H2O • s/min, respectively (p = 0.033). Work of breathing/min decreased from 4.3 (3.5–6.3) to 2.1 (1.5–5.0) J/min, respectively (p = 0.031). Respiratory pattern variables and capillary blood gases were not significantly modified between experimental conditions. Dynamic lung compliance increased from 38 (24–64) mL/cm H2O at baseline to 59 (43–175) mL/cm H2O at 60 L/min (p = 0.007), and inspiratory resistance decreased from 9.6 (5.5–13.4) to 5.0 (1.0–9.1) cm H2O/L/s, respectively (p = 0.07).

Conclusions:

High-flow nasal cannula, when set at 60 L/min, significantly reduces the indexes of respiratory effort in adult patients recovering from acute respiratory failure. This effect is associated with an improvement in respiratory mechanics.
Predicting Fluid Responsiveness in Critically Ill Patients by Using Combined End-Expiratory and End-Inspiratory Occlusions With Echocardiography
Authors: Jozwiak Mathieu , Depret François , Teboul Jean-Louis , Alphonsine Jean-Emmanuel , Lai Christopher , Richard Christian , Monnet Xavier
Published: August 2017

Objectives:

First, we aimed at assessing whether fluid responsiveness is predicted by the effects of an end-expiratory occlusion on the velocity-time integral of the left ventricular outflow tract. Second, we investigated whether adding the effects of an end-inspiratory occlusion and of an end-expiratory occlusion on velocity-time integral can predict fluid responsiveness with similar reliability than end-expiratory occlusion alone but with a higher threshold, which might be more compatible with the precision of echocardiography.

Design:

Diagnostic study.

Setting:

Medical ICU.

Patients:

Thirty mechanically ventilated patients in whom fluid administration was planned.

Interventions:

A 15-second end-expiratory occlusion and end-inspiratory occlusion, separated by 1 minute, followed by a 500-mL saline administration.

Measurements and Main Results:

Pulse contour analysis–derived cardiac index and velocity-time integral were measured during the last 5 seconds of 15-second end-inspiratory occlusion and end-expiratory occlusion and after fluid administration. End-expiratory occlusion increased velocity-time integral more in responders than in nonresponders to fluid administration (11% ± 5% vs 3% ± 1%, respectively; p < 0.0001), and end-inspiratory occlusion decreased velocity-time integral more in responders than in nonresponders (12% ± 5% vs 5% ± 2%, respectively; p = 0.0002). When adding the absolute values of changes in velocity-time integral observed during both occlusions, velocity-time integral changed by 23% ± 9% in responders and by 8% ± 3% in nonresponders. Fluid responsiveness was predicted by the end-expiratory occlusion–induced change in velocity-time integral with an area under the receiver operating characteristic curve of 0.938 (0.785–0.989) and a threshold value of 5%. Fluid responsiveness was predicted by the sum of absolute values of changes in velocity-time integral during both occlusions with a similar reliability (area under the receiver operating characteristic curve = 0.973 [0.838–1.000]) but with a threshold of 13%. Both sensitivity and specificity were 93% (68–100%).

Conclusions:

If consecutive end-inspiratory occlusion and end-expiratory occlusion change velocity-time integral is greater than or equal to 13% in total, fluid responsiveness is accurately predicted. This threshold is more compatible with the precision of echocardiography than that obtained by end-expiratory occlusion alone.
Concurrent radiotherapy for patients with metastatic melanoma and receiving anti-programmed-death 1 therapy: a safe and effective combination
Authors: Aboudaram Amélie , Modesto Anouchka , Chaltiel Léonor , Gomez-Roca Carlos , Boulinguez Serge , Sibaud Vincent , Delord Jean-Pierre , Chira Ciprian , Delannes Martine , Moyal Elizabeth , Meyer Nicolas
Published: August 2017

A combination of immune-checkpoint inhibitors and radiation therapy (RT) represents a promising therapeutic strategy in part mediated by the abscopal effect, but clinical experience related to this combination remains scarce. Clinical data and patterns of treatment were retrospectively collected from all consecutive patients with metastatic melanoma and receiving programmed-death 1 (PD-1) immune-checkpoint inhibitors. Survival data, best overall response, and acute and delayed toxicities (graded according to Common Terminology Criteria for Adverse Events, v 4.3) were compared between patients receiving concurrent RT (IR) or no irradiation (NIR). Fifty-nine patients received anti-PD-1 immunotherapy [pembrolizumab (n=28) or nivolumab (n=31)] between August 2014 and December 2015 at our institution. Among these, 29% (n=17) received palliative RT for a total of 21 sites, with a mean dose of 30 Gy delivered in 10 fractions. Acute and late toxicity profiles were similar in the two groups. After a 10-month median follow-up, the objective response rate (complete or partial response) was significantly higher in the IR group versus the NIR group (64.7 vs. 33.3%, P=0.02) and one complete responder after RT was compatible with an abscopal effect. The 6-month disease-free survival and overall survival rates for the NIR group versus the IR group were 49.7 versus 64.7% (P=0.32) and 58.8 versus 76.4% (P=0.42), respectively. We report here that the combination of RT and anti-PD-1 immunotherapy is well tolerated and leads to a significant higher tumor response rate within and outside the irradiated field, which is emphasized by the first reported case of an abscopal effect in solid tumors.
Perineurial Vascular Hamartoma
Authors: Ronen Shira , Klaassen Rodrigo , Suster Saul
Published: August 2017

Perineural vascular proliferations are extremely rare, and only a few cases have been reported in the literature, usually under the designation of “intraneural hemangioma.” We report a case of a 28-year-old man with a nodule in the right palm of his hand that developed over an 8- to- 12-month period. Microscopic examination revealed a vascular proliferation growing within connective tissue and entrapping small nerve bundles. The features of the lesion are consistent with an unusual hamartomatous growth of small vessels and nerves rather than a hemangioma arising within a nerve. Clinical and histological details, and a discussion of the relevant literature on this unusual lesion, are provided.
Social Responsiveness Scale Assessment of the Preterm Behavioral Phenotype in 10-Year-Olds Born Extremely Preterm
Authors: Korzeniewski Steven J. , Joseph Robert M. , Kim So Hyun , Allred Elizabeth N. , O'Shea T. Michael , Leviton Alan , Kuban Karl C. K. ,   for the ELGAN Study Investigators
Published: August 2017

Objective:

To evaluate the correlates of a clinically significant high score on the Social Responsiveness Scale (SRS) in 10-year-old children who were born extremely preterm and who did not meet criteria for autism spectrum disorder (ASD).

Methods:

After excluding 61 participants diagnosed with ASD, we grouped children by IQ < or ≥85 and then compared the prevalence of neurocognitive and other deficits between those who had SRS total and component scores ≥65 and their peers who had lower scores.

Results:

Among children who had IQ ≥ 85, the prevalence of SRS total scores ≥65 was 16% (n = 103/628), and among children who had IQ < 85, it was 27% (n = 40/148), higher than the 4% prevalence expected based on normative population data. Among children who had IQ ≥ 85, those who had high SRS scores more often than their peers had deficits in attention and executive function, and language and communication, and they were more often rated by their parents and teachers as having behavioral (e.g., attention-deficit hyperactivity disorder [ADHD]) and emotional (e.g., anxiety and depression) problems.

Conclusion:

Social Responsiveness Scale–defined social impairment was much more common in our cohort of 10-year-old children born extremely preterm than was expected based on general population norms. High SRS scores were characteristic of children who had intellectual, neurocognitive, language, and communication limitations, as well as deficits in behavior and emotion regulation.
Suppression of Oxidative Stress and Apoptosis in Electrically Stimulated Neonatal Rat Cardiomyocytes by Resveratrol and Underlying Mechanisms
Authors: Ge Liqi , Li Chengzong , Wang Zhirong , Zhang Yao , Chen Lei
Published: August 2017

Purpose:

We explored the effects of resveratrol on oxidative stress in cardiomyocytes subjected to rapid electrical stimulation (RES) and also investigated the underlying mechanisms.

Methods:

Cultured ventricular myocytes of neonatal rat were subjected to RES at 4.0 Hz, with or without resveratrol, an NADPH oxidase inhibitor apocyanin (APO) or a Ca2+/calmodulin-dependent protein kinase II (CaMKII) inhibitor autocamtide-2-inhibitory peptide (AIP). Cell counts, to optimize resveratrol concentration, and angiotensin II content were evaluated. Reactive oxygen species (ROS), intracellular Ca2+ in cardiomyocytes, and cardiomyocyte apoptosis were also assessed. Levels of methionine sulfoxide reductase A (MsrA), Nox, oxidative CaMKII (OX-CaMKII), and cleaved caspase-3 in cardiomyocytes were examined.

Results:

Resveratrol treatment, as compared with APO and AIP, significantly decreased ROS levels, improved Ca2+ amplitudes, and intracellular Ca2+ transient decay rates, and inhibited cardiomyocyte apoptosis. Resveratrol also increased MsrA protein levels. In cardiomyocytes subjected to RES, after pretreatment with resveratrol or APO, protein levels of Nox4, Nox2, OX-CaMKII, and cleaved caspase-3 were decreased. In comparison, with AIP pretreatment, only Nox2, OX-CaMKII, and cleaved caspase-3 were decreased. However, in the presence of dimethyl sulfoxide, a competitive inhibitor of MsrA function, a decrease in cleaved caspase-3 did not occur.

Conclusions:

Resveratrol decreased ROS, partially through the inhibition of NADPH oxidase activity and upregulation of MsrA expression.
Comparison of Efficacy and Complications of Cyclophotocoagulation and Second Glaucoma Drainage Device After Initial Glaucoma Drainage Device Failure
Authors: Wang Margaret Y. , Patel Kishan , Blieden Lauren S. , Chuang Alice Z. , Baker Laura A. , Bell Nicholas P. , Feldman Robert M.
Published: August 2017

Purpose:

Compare intraocular pressure (IOP) control and complication rates of a second glaucoma drainage device (GDD) to diode transscleral cyclophotocoagulation (TSCPC) following failure of an initial GDD.

Patients and Methods:

Eyes with 1 GDD that required a second GDD or TSCPC for glaucoma control were included. Exclusion criteria were a cyclodestructive procedure before initial GDD, no light perception vision, or follow-up <1 year. Failure was defined as ≥1 of (1) reoperation for lowering IOP; (2) explantation of second GDD; (3) persistent hypotony; (4) use of oral carbonic anhydrase inhibitor for lowering IOP in the study eye; or (5) loss of light perception. Reoperation for lowering IOP included additional GDD implantation or additional cyclodestruction, except if additional cyclodestruction was within 6 months of the initial session.

Results:

A total of 75 eyes (35 in second GDD; 40 in TSCPC) were included (mean follow-up, 25.5 mo). Both procedures lowered IOP [−11.4 mm Hg (±13.6) for second GDD and −7.8 mm Hg (±11.8) for TSCPC groups] and decreased the number of IOP-lowering medications at the last visit. The second GDD group had significantly greater mean survival time [45.0 mo (±4.2)] than the TSCPC group [26.5 mo (±2.8)] but significantly more postoperative complications (60% of eyes) and non–IOP-related procedures (40% of eyes) than the TSCPC group (20% for postoperative complications and 18% for non–IOP-related procedures).

Conclusions:

Although both second procedures are efficacious in lowering IOP and number of IOP-lowering medications, TSCPC failed earlier, whereas a second GDD had significantly more complications.
Reproducibility of Optical Coherence Tomography Angiography Macular and Optic Nerve Head Vascular Density in Glaucoma and Healthy Eyes
Authors: Manalastas Patricia I.C. , Zangwill Linda M. , Saunders Luke J. , Mansouri Kaweh , Belghith Akram , Suh Min Hee , Yarmohammadi Adeleh , Penteado Rafaella C. , Akagi Tadamichi , Shoji Takuhei , Weinreb Robert N.
Published: August 2017

Purpose:

Optical coherence tomography angiography (OCT-A) is a noninvasive technology that allows visualization of retinal blood vessels. It is important to determine reproducibility of measurements as low precision can impair its diagnostic capabilities. The purpose of this study is to determine intravisit and intervisit reproducibility of optic nerve head (ONH) and macular vessel density measurements with OCT-A.

Patients and Methods:

Fifteen healthy volunteers and 14 glaucoma patients completed 2 OCT-A (AngioVue; Optovue Inc.) scanning sessions on each of 2 separate days to assess intravisit and intervisit reproducibility. A series of ONH and macula scans were acquired at each session. Vessel density (%), the proportion of vessel area over the total measurement area was calculated. Reproducibility was summarized using coefficients of variation (CV) and intraclass correlation coefficients calculated from variance component models.

Results:

In healthy eyes, the CV of intravisit and intervisit global vessel density measures ranged from 1.8% to 3.2% in ONH scans and 2.5% to 9.0% in macular scans. In glaucoma eyes, the CV of intravisit and intervisit global vessel density measures ranged from 2.3% to 4.1% in ONH scans and 3.2% to 7.9% in macular scans. CVs were lower for global than sectorial measures. Global OCT-A ONH intraclass correlation measurements for the retinal nerve fiber layer in healthy eyes were lower (range: 0.65 to 0.85) than in glaucoma eyes (range: 0.89 to 0.94). Scan size did not make large differences in measurement CVs.

Conclusions:

Reproducibility of OCT-A ONH and macula vessel density measurements is good. Moreover, glaucoma patients have sparser vessel density with poorer reproducibility than healthy subjects.
Prevalence and Associated Factors of Segmentation Errors in the Peripapillary Retinal Nerve Fiber Layer and Macular Ganglion Cell Complex in Spectral-domain Optical Coherence Tomography Images
Authors: Miki Atsuya , Kumoi Miho , Usui Shinichi , Endo Takao , Kawashima Rumi , Morimoto Takeshi , Matsushita Kenji , Fujikado Takashi , Nishida Kohji
Published: August 2017

Purpose:

To determine the prevalence of errors in segmentation of the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) boundary in spectral-domain optical coherence tomography (SDOCT) images, and to identify factors associated with the errors.

Materials and Methods:

Peripapillary RNFL circle scans and macular 3-dimensional scans of consecutive cases imaged with SDOCT (RS-3000 Advance; Nidek, Gamagori, Japan) were retrospectively reviewed by a glaucoma specialist. Images with signal strength index (SSI)<6 were excluded. Threshold for segmentation failure was determined as 15 degrees in the RNFL scans and 1/24 of the scanned area in the GCC scans. Relationships between segmentation failure and clinical factors were statistically evaluated with univariable and multivariable analyses.

Results:

This retrospective cross-sectional study included 207 eyes of 117 subjects (mean age, 58.5±16.5 y). Segmentation failure was found in 20.7% of the peripapillary RNFL scans, 16.6% of the 9 mm GCC scans, and 6.9% of the 6 mm GCC scans in SDOCT images. In multivariable logistic regression analyses, low SSI, large disc area, and disease type significantly correlated with RNFL segmentation failure, whereas SSI was the only baseline factor that was significantly associated with GCC segmentation failure.

Conclusions:

Although segmentation failure was common in both RNFL and GCC scans, it was less frequently observed in GCC scans. SSI, disc area, and disease type were significantly associated with segmentation failure. Predictive performance of baseline factors for failure was poor, underlining the importance of reviewing raw OCT images before using OCT parameters.
Clinical Manifestations of Cryptosporidiosis and Identification of a New Cryptosporidium Subtype in Patients From Sonora, Mexico
Authors: Urrea-Quezada Alejandro , González-Díaz Mariana , Villegas-Gómez Isaac , Durazo María , Hernández Jesús , Xiao Lihua , Valenzuela Olivia
Published: August 2017

The aim of this study was to identify the clinical manifestations of cryptosporidiosis and the distribution of Cryptosporidium spp. and subtypes in children in Sonora, Mexico. Two subtypes of C. parvum, including IIaA15G2R1 and IIcA5G3a, and 6 subtypes of Cryptosporidium hominis, including IaA14R3, IaA15R3, IbA12G3, IdA23, IeA11G3T3, and a new subtype IaA14R11, were identified. Cryptosporidium as an etiologic agent for acute gastroenteritis is discussed.
Combined In Silico and In Vitro Approach Predicts Low Wall Shear Stress Regions in a Hemofilter that Correlate with Thrombus Formation In Vivo
Authors: Buck Amanda K. W. , Groszek Joseph J. , Colvin Daniel C. , Keller Sara B. , Kensinger Clark , Forbes Rachel , Karp Seth , Williams Phillip , Roy Shuvo , Fissell William H.
Published: August 2017

A major challenge in developing blood-contacting medical devices is mitigating thrombogenicity of an intravascular device. Thrombi may interfere with device function or embolize from the device to occlude distant vascular beds with catastrophic consequences. Chemical interactions between plasma proteins and bioengineered surface occur at the nanometer scale; however, continuum models of blood predict local shear stresses that lead to platelet activation or aggregation and thrombosis. Here, an iterative approach to blood flow path design incorporating in silico, in vitro, and in vivo experiments predicted the occurrence and location of thrombi in an implantable hemofilter. Low wall shear stress (WSS) regions identified by computational fluid dynamics (CFD) predicted clot formation in vivo. Revised designs based on CFD demonstrated superior performance, illustrating the importance of a multipronged approach for a successful design process.
Utility of trabecular bone score in the evaluation of osteoporosis
Authors: Martineau Patrick , Silva Barbara C. , Leslie William D.
Published: August 2017

Purpose of review

Trabecular bone score (TBS) is a lumbar spine dual-energy absorptiometry texture index which provides information on skeletal quality partially independent of bone mineral density (BMD). A body of work has emerged demonstrating the relationship between TBS and fracture risk, with lower TBS values associated with increased risk for osteoporotic fracture in postmenopausal women and older men. TBS is derived from standard DXA images; however, the information provided by TBS is complementary to that provided by BMD. In this article, we review the current state of TBS and its evolving role in the assessment and management of osteoporosis, with particular emphasis on the literature of the previous year.

Recent findings

TBS-adjusted The Fracture Risk Assessment tool (FRAX) probabilities enhance fracture risk prediction compared with conventional FRAX predictions. TBS has been found to better categorize fracture risk and assists in FRAX-based treatment decisions, particularly for patients close to an intervention threshold. However, change in lumbar spine TBS while undergoing antiresorptive treatment is not a useful indicator of antifracture effect.

Lumbar spine TBS is a recently developed image-based software technique for skeletal assessment, complementary to conventional BMD, which has been shown to be clinically useful as a fracture risk prediction tool.
Short article: Alcohol and substance use, race, and insurance status predict nontreatment for hepatitis C virus in the era of direct acting antivirals: a retrospective study in a large urban tertiary center
Authors: Sims Omar T. , Guo Yuqi , Shoreibah Mohamed G. , Venkata Krishna , Fitzmorris Paul , Kommineni Vishnu , Romano John , Massoud Omar I.
Published: August 2017

Objective

Direct acting antivirals (DAAs) have overcome many long-standing medical barriers to hepatitis C virus (HCV) treatment (i.e. host characteristics and medical contraindications) and treatment outcome disparities that were associated with interferon regimens. The public health and clinical benefit of current and forthcoming DAA discoveries will be limited if efforts are not made to examine racial, psychological, and socioeconomic factors associated with being treated with DAAs. This study examined racial, psychological, and socioeconomic factors that facilitate and inhibit patients receiving DAAs for HCV.

Patients and methods

This was a single-center retrospective cohort study at a large urban tertiary center of patients (n=747) who were referred for evaluation and treatment of HCV.

Results

Sixty-eight percent of patients were non-Hispanic White, 31% were African American, and 1% were of other ethnicities. The majority of patients received treatment, but 29% (218/747) did not. Patients who were older [odds ratio (OR)=1.02, 95% confidence interval (CI): 1.01–1.04] and insured (OR=2.73, 95% CI: 1.12–6.97) were more likely to receive HCV treatment. Patients who were African American (OR=0.46, 95% CI: 0.46–1.06), used drugs (OR=0.09, 95% CI: 0.04–0.17), smoked (OR=0.55, 95% CI: 0.37–0.81), and used alcohol (OR=0.11, 95% CI: 0.06–0.20) were less likely to receive HCV treatment.

Conclusion

Though DAAs have eliminated many historically, long-standing medical barriers to HCV treatment, several racial, psychological and socioeconomic barriers, and disparities remain. Consequently, patients who are African American, uninsured, and actively use drugs and alcohol will suffer from increased HCV-related morbidity and mortality in the coming years if deliberate public health and clinical efforts are not made to facilitate access to DAAs.
A Web Application to Facilitate Syphilis Reactor Grid Evaluations
Authors: Avoundjian Tigran , Khosropour Christine M. , Golden Matthew R. , Barbee Lindley A. , Dombrowski Julia C.
Published: August 2017

Background

Many health departments use a “reactor grid” to determine which laboratory-reported syphilis serologic test results require investigation. We developed a Web-based tool, the Syphilis Reactor Grid Evaluator (SRGE), to facilitate health department reactor grid evaluations and test the tool using data from Seattle & King County, Washington.

Methods

We developed SRGE using the R Shiny Web application framework. When populated with a data set including titer results and final disposition codes, SRGE displays the percent of verified early syphilis cases by serologic titer result and patient age in each cell of the grid. The results can be optionally stratified by sex, test type, and previous rapid plasma reagin titer. The impact of closing laboratory results without investigation in cells selected by the user is dynamically computed. The SRGE calculates the percent of all laboratory reports closed (“efficiency gained”), the proportion of all early syphilis cases closed without investigation (“case finding loss”), and the ratio of percent of cases identified for investigation to percent of all laboratory reports investigated (“efficiency ratio”). After defining algorithms, users can compare them side-by-side, combine subgroup-specific algorithms, and export results. We used SRGE to compare the current Public Health–Seattle & King County (PHSKC) reactor grid to 5 alternate algorithms.

Results

Of 13,504 rapid plasma reagin results reported to PHSKC from January 1, 2006, to December 31, 2015, 1565 were linked to verified early syphilis cases. Updating PHSKC's current reactor grid could result in an efficiency gain of 4.8% to 25.2% (653–3403 laboratory reports) and case finding loss of 1% to 8.4% (10–99 fewer cases investigated).

Conclusions

The Syphilis Reactor Grid Evaluator can be used to rapidly evaluate alternative approaches to optimizing the reactor grid. Changing the reactor grid in King County to close more laboratory results without investigation could improve efficiency with minimal impact on syphilis case finding.
Corneal Hysteresis Is Reduced in Obstructive Sleep Apnea Syndrome
Authors: Nadarajah Suchitra , Samsudin Amir , Ramli Norlina , Tan Chong Tin , Mimiwati Zahari
Published: August 2017

SIGNIFICANCE

To our knowledge, this is the first time a study looking at the association between corneal hysteresis (CH) and obstructive sleep apnea syndrome (OSAS) severity has been reported. We provide evidence that CH is lower in OSAS and speculate on the possible causes.

PURPOSE

The present study aims to look at the association between CH and severity of OSAS, and whether CH could be another link between OSAS and the development of glaucoma.

METHODS

This was a cross-sectional, observational study at the University Malaya Medical Centre, Kuala Lumpur. Patients undergoing polysomnography for assessment of OSAS were recruited. We measured central corneal thickness (CCT) using optical biometry, and CH using ocular response analysis. Intraocular pressure (IOP) and Humphrey visual field (HVF) indices were also measured. The Apnea Hypopnea Index (AHI) divided patients into normal, mild, moderate, and severe OSAS categories. The normal and mild categories (47.9%) were then collectively called group 1, and the moderate and severe categories (52.1%) were called group 2. T tests, Pearson correlation tests, and general linear model analysis were performed, with P <.05 considered statistically significant.

RESULTS

One eye each from 117 patients (75 men, 42 women) was included. Patients in group 2 had lower CH (9.8 ± 1.4 vs. 10.3 ± 1.1 mm Hg, P = .029), with unchanged estimated marginal means after correcting for age, sex, CCT, and IOP (P = .026). There were no statistically significant differences in IOP, CCT, or HVF indices between the two groups (all P > .05). CH correlated negatively with AHI (r = −0.229, P = .013) and positively with lowest oxygen saturation (r = 0.213, P = .022).

CONCLUSIONS

CH is lower in moderate/severe OSAS than in normal/mild cases. This may be another link between OSAS and the development of glaucoma; further studies are indicated to determine the significance of this connection.
Centration and Decentration of Contact Lenses during Peripheral Gaze
Authors: El-Nimri Nevin W. , Walline Jeffrey J.
Published: August 2017

SIGNIFICANCE

Varying amounts of peripheral defocus reported in previous studies are likely due to whether peripheral defocus is measured while turning the eyes or the head. Contact lenses (CLs) lag when viewing objects in peripheral gaze, so future studies ought to measure peripheral defocus while turning the head to measure defocus through the peripheral add power.

PURPOSE

Soft multifocal CL peripheral defocus studies report varying results. To determine whether soft multifocal CL lag when turning the eyes could affect the measurement of peripheral defocus, we measured how much CLs move when looking in different gazes.

METHODS

The distance between limbus and CL edge was measured with a slit-lamp reticle magnifier. Centration was measured as the distance between CL edge and limbus at the superior, inferior, nasal, and temporal location of the CL while in primary gaze. Decentration of the CL equals the difference of the distance between the CL edge and limbus while looking centrally and 20 degrees in each direction. All measurements were performed while subjects wore habitual and Proclear Multifocal CL.

RESULTS

The average ± SD age of the 40 subjects was 27.8 ± 8.4 years, 65% were female, and SE refractive error was −4.43 ± 2.05 diopters. The soft multifocal CLs decentered 0.09 ± 0.03 mm temporal (P = .006). The soft multifocal CLs lagged 0.49 ± 0.28 mm while looking down (P < .001), 0.24 ± 0.36 mm while looking up (P = .008), 0.58 ± 0.20 mm while looking nasal (P < .001), and 0.35 ± 0.21 mm while looking temporal (P < .001).

CONCLUSIONS

Soft multifocal CLs center temporally in primary gaze, and they lag significantly while looking in every direction, but 0.50 mm or more when looking down or nasal, which could affect measurement of peripheral defocus when subjects turn their eyes instead of their head.
Multicolor Scanning Laser Imaging in Diabetic Retinopathy
Authors: Ahmad Mohammad S. Z. , Carrim Zia Iqbal
Published: August 2017

SIGNIFICANCE

Diabetic retinopathy is a common cause of blindness in individuals younger than 60 years. Screening for retinopathy is undertaken using conventional color fundus photography and relies on the identification of hemorrhages, vascular abnormalities, exudates, and cotton-wool spots. These can sometimes be difficult to identify.

PURPOSE

Multicolor scanning laser imaging, a new imaging modality, may have a role in improving screening outcomes, as well as facilitating treatment decisions.

METHODS

Observational case series comprising two patients with known diabetes who were referred for further examination after color fundus photography revealed abnormal findings. Multicolor scanning laser imaging was undertaken. Features of retinal disease from each modality were compared.

RESULTS

Multicolor scanning laser imaging provides superior visualization of retinal anatomy and pathology, thereby facilitating risk stratification and treatment decisions.

CONCLUSIONS

Multicolor scanning laser imaging is a novel imaging technique offering the potential for improving the reliability of screening for diabetic retinopathy. Validation studies are warranted.
Preinflammatory Signs in Established Reusable and Disposable Contact Lens Wearers
Authors: Chao Cecilia , Stapleton Fiona , Willcox Mark D. P. , Golebiowski Blanka , Richdale Kathryn
Published: August 2017

SIGNIFICANCE

Established reusable contact lens (CL) wearers show higher tear inflammatory cytokine concentrations and greater conjunctival metaplasia in the region covered by standard soft CLs. The balance of proinflammatory to anti-inflammatory cytokines, but not individual tear cytokine concentrations, was associated with self-reported CL discomfort.

PURPOSE

Daily disposable (DD) lenses are often used to improve CL discomfort, but the effect on ocular inflammatory responses has not been fully investigated. This study aimed to compare the concentrations of tear cytokines and conjunctival cell morphology in healthy habitual DD and reusable soft CL wearers.

METHODS

Thirty-six established daily CL wearers, including 14 DD and 24 reusable wearers, were enrolled. Symptoms and ocular surface integrity were evaluated. The concentration of tear cytokines (interleukin 1β [IL-1β], IL-6, IL-10, IL-12(p70), IL-17A, and tumor necrosis factor α) were determined using Multiplex assays. The ratios of proinflammatory and anti-inflammatory cytokines were calculated. Impression cytology was performed on the conjunctiva, and goblet cell density and epithelial squamous metaplasia were quantified. Differences in variables by CL replacement schedules and the associations between variables were analyzed.

RESULTS

Reusable CL wearers had higher concentrations (in pg/mL) of IL-1β (26 ± 7 vs. 16 ± 11), IL-6 (42 ± 14 vs. 25 ± 20), IL-10 (83 ± 23 vs. 49 ± 36), IL-12(p70) (145 ± 44 vs. 91 ± 68), IL-17A (93 ± 26 vs. 54 ± 44), and tumor necrosis factor α (312 [171 to 468] vs. 189 [6 to 447]) (allP< .01) and greater conjunctival metaplasia in the region covered by CLs (0.7 [0.2 to 1.6] vs. 0.4 [0.04 to 1.2],P= .01) compared with DD wearers. There was a positive association between CL discomfort and ratios of IL-1β to IL-10 and IL-12(p70) to IL-10 (ρ = 0.42 and ρ = 0.33,P< .05).

CONCLUSIONS

Higher ocular inflammatory responses, as indicated by higher tear cytokine concentrations and higher conjunctival epithelial metaplasia, were found in reusable CL wearers than in DD CL wearers. The balance of proinflammatory and anti-inflammatory cytokines may be helpful to assess the inflammatory status of the eye.
Craniofacial and Dental Features in Six Children With Cherubism
Authors: Stoor Patricia , Suomalainen Anni , Kemola w , Arte Sirpa
Published: August 2017

Cherubism is an autosomal-dominant benign bone disorder, characterized by fibro-osseous lesions in the mandible and maxilla commonly caused by mutations in the SH3-binding protein 2-gene. The purpose of the authors’ study was to analyze craniofacial and dental features of children diagnosed with cherubism, describe their treatment, and assess their dental age compared with norms for Finnish children. Six children were diagnosed, followed up and treated due to dental and skeletal disorders caused by cherubsim. The patients were followed up for an average of 91.5 months with emphasis on the skeletal changes and development of dentition. The treatment consisted of minor orthodontic treatment, dental extractions, and exposures. One patient underwent cosmetic mandibular surgery. All patients had lesions in the lower jaw and 5 of 6 patients had lesions in the maxilla as well. The patients were characterized by varying swelling of the jaws, premature loss of deciduous teeth in the affected area and widely spaced, displaced, un-erupted, or absent permanent teeth. The dental age was delayed at younger age but near to normal or even a little ahead at older age. Even though cherubism affects the jaws, jaw positions, and malocclusion, no common dentofacial proportions associated with the disease could be confirmed by cephalometric analysis. The surgical interventions did not provoke adverse reactions or local growth of the lesions.
Surgical Tip for Prevention of Lip Injury During Orthognathic and Facial Bone Contouring Surgery
Authors: Lee Tae Sung , Park Sanghoon
Published: August 2017

Iatrogenic lip injury is a rather common complication after facial bone surgery, but is usually treated lightly by the surgeon compared with other more severe functional complications. However, these injuries can have permanent sequelae and can therefore be a reason for patient dissatisfaction, especially after cosmetic surgery. Intraoperative lip injuries during facial bone surgery are usually caused by heat-generating surgical instruments or forced traction on the operative fields. The authors have applied a special technical strategy using a hydrocolloid dressing material to avoid these intraoperative lip injuries. This method does not disturb the operative procedure itself, but efficiently prevents lip injuries and decreases surgical morbidities and postoperative swelling.
Stability of Orbital Floor Fracture Fixation After Endoscope-Assisted Balloon Placement
Authors: Kashimura Tsutomu , Soejima Kazutaka , Kikuchi Yuji , Nakazawa Hiroaki
Published: August 2017

In recent years, endoscope-assisted balloon fixation using transantral and endonasal approaches has gained popularity as a minimally invasive treatment for orbital floor fractures. However, the optimal duration for balloon placement and the efficacy of the method have not been fully evaluated. The authors report their assessment of this method using postoperative and chronological measurements of the maxillary sinus volume.

Fourteen patients with blowout fracture of the orbital floor who underwent reduction using endoscopic transantral and endonasal approaches followed by 6-week fixation with a balloon were evaluated. The volume of the maxillary sinus was measured for comparison using computed tomography at the time of balloon removal and 6 months after the surgery.

The ratio of change in the maxillary sinus volume (maxillary sinus volume 6 months after surgery/maxillary sinus volume at balloon removal) for all subjects was 0.90 to 1.04 (0.96 ± 0.44, mean ± SD). No postoperative reduction in volume was detected, indicating satisfactory fixation. Postoperative computed tomography showed bone regeneration in the orbital floor in all patients in whom the fractured bone fragments were removed. No subjects had remaining enophthalmos greater than 2 mm.

The postoperative change in the maxillary sinus volume was small, confirming the efficacy of 6-week balloon placement. This method was effective even in patients in whom fractured bone fragments were removed. Therefore, it is advisable to remove the fractured bone fragments if there is concern that the fragments will stray into the orbit due to inflation of the balloon.
Lipoadenoma of the Submandibular Gland
Authors: Çelik Mehmet , Doruk Can , Bayram Aysel , Yegen Gülçin , Orhan Kadir Serkan
Published: August 2017

We report a case of an oncocytic lipoadenoma of the submandibular gland, which is a very rare benign tumor of the salivary gland. The patient was a 36-year-old man with a right submandibular mass measuring 29 × 1.3 × 1.2 cm. When the preoperative diagnostic tools were insufficient to rule out malignancy and for definite diagnosis, total removal of the gland was performed. Histopathologically, microscopic examination revealed a well-circumscribed tumor that is surrounded by a thin, fibrous capsule. The majority of the tumor consisted of adipocytes and normal components of salivary gland tissue. Oncocytic cells were observed only focally. Physicians should keep in mind that salivary glands may rarely exhibit this special tumor growth pattern.
Spontaneous Healing of Clodronate-Related Osteonecrosis of the Jaw
Authors: Nastro Siniscalchi Enrico , Allegra Alessandro , De Ponte Francesco Saverio , Oteri Giacomo , Cervino Gabriele , Lauritano Floriana , Musolino Caterina , Cicciù Marco
Published: August 2017

Cases of medication-related osteonecrosis of the jaw (MRONJ) have been more commonly associated with aminobiphosphonate therapy than with alkylbiphosphonate treatment. Here, we report a case of MRONJ in a subject who received an alkylbiphosphonate, clodronate, for the treatment of osteoporosis, and discuss the pathogenic mechanisms of alkylbiphosphonates and the possible reasons for the spontaneous and rapid remission of MRONJ occurring in our patient.
Learning Curve and Associated Morbidity of Minimally Invasive Esophagectomy
Authors: van Workum Frans , Stenstra Marianne H. B. C. , Berkelmans Gijs H. K. , Slaman Annelijn E. , van Berge Henegouwen Mark I. , Gisbertz Suzanne S. , van den Wildenberg Frits J. H. , Polat Fatih , Irino Tomoyuki , Nilsson Magnus , Nieuwenhuijzen Grard A. P. , Luyer Misha D. , Adang Eddy M. , Hannink Gerjon , Rovers Maroeska M. , Rosman Camiel
Published: August 2017

Objective:

To investigate the morbidity that is associated with the learning curve of minimally invasive esophagectomy.

Background:

Although learning curves have been described, it is currently unknown how much extra morbidity is associated with the learning curve of technically challenging surgical procedures.

Methods:

Prospectively collected data were retrospectively analyzed of all consecutive patients undergoing minimally invasive Ivor Lewis esophagectomy in 4 European expert centers. The primary outcome parameter was anastomotic leakage. Secondary outcome parameters were operative time and textbook outcome (“optimal outcome”). Learning curves were plotted using weighted moving average and CUSUM analysis was used to determine after how many cases the plateau was reached. Learning associated morbidity was calculated with area under the curve analysis.

Results:

This study included 646 patients. Three of the 4 hospitals reached the plateau of 8% anastomotic leakage. The length of the learning curve was 119 cases. The mean incidence of anastomotic leakage decreased from 18.8% during the learning phase to 4.5% after the plateau had been reached (P < 0.001). Thirty-six extra patients (10.1% of all patients operated on during the learning curve) experienced learning associated anastomotic leakage, that could have been avoided if patients were operated by surgeons who had completed the learning curve. The incidence of textbook outcome increased from 28% to 53% and the mean operative time decreased from 344 minutes to 270 minutes.

Conclusions:

A considerable number of 36 extra patients (10.1%) experienced learning associated anastomotic leakage. More research is urgently needed to investigate how learning associated morbidity can be reduced to increase patient safety during learning curves.
Risk Factors and Mitigation Strategies for Pancreatic Fistula After Distal Pancreatectomy
Authors: Ecker Brett L. , McMillan Matthew T. , Allegrini Valentina , Bassi Claudio , Beane Joal D. , Beckman Ross M. , Behrman Stephen W. , Dickson Euan J. , Callery Mark P. , Christein John D. , Drebin Jeffrey A. , Hollis Robert H. , House Michael G. , Jamieson Nigel B. , Javed Ammar A. , Kent Tara S. , Kluger Michael D. , Kowalsky Stacy J. , Maggino Laura , Malleo Giuseppe , Valero Vicente , Velu Lavanniya K. P. , Watkins Amarra A. , Wolfgang Christopher L. , Zureikat Amer H. , Vollmer Charles M.
Published: August 2017

Objective:

To identify a clinical fistula risk score following distal pancreatectomy.

Background:

Clinically relevant pancreatic fistula (CR-POPF) following distal pancreatectomy (DP) is a dominant contributor to procedural morbidity, yet risk factors attributable to CR-POPF and effective practices to reduce its occurrence remain elusive.

Methods:

This multinational, retrospective study of 2026 DPs involved 52 surgeons at 10 institutions (2001–2016). CR-POPFs were defined by 2016 International Study Group criteria, and risk models generated using stepwise logistic regression analysis were evaluated by c-statistic. Mitigation strategies were assessed by regression modeling while controlling for identified risk factors and treating institution.

Results:

CR-POPF occurred following 306 (15.1%) DPs. Risk factors independently associated with CR-POPF included: age (<60 yrs: OR 1.42, 95% CI 1.05–1.82), obesity (OR 1.54, 95% CI 1.19–2.12), hypoalbuminenia (OR 1.63, 95% CI 1.06–2.51), the absence of epidural anesthesia (OR 1.59, 95% CI 1.17–2.16), neuroendocrine or nonmalignant pathology (OR 1.56, 95% CI 1.18–2.06), concomitant splenectomy (OR 1.99, 95% CI 1.25–3.17), and vascular resection (OR 2.29, 95% CI 1.25–3.17). After adjusting for inherent risk between cases by multivariable regression, the following were not independently associated with CR-POPF: method of transection, suture ligation of the pancreatic duct, staple size, the use of staple line reinforcement, tissue patches, biologic sealants, or prophylactic octreotide. Intraoperative drainage was associated with a greater fistula rate (OR 2.09, 95% CI 1.51–3.78) but reduced fistula severity (P < 0.001).

Conclusions:

From this large analysis of pancreatic fistula following DP, CR-POPF occurrence cannot be reliably predicted. Opportunities for developing a risk score model are limited for performing risk-adjusted analyses of mitigation strategies and surgeon performance.
SUMO, a small, but powerful, regulator of double-strand break repair
Authors: Garvin Alexander J. , Morris Joanna R.
Published: August 2017

The response to a DNA double-stranded break in mammalian cells is a process of sensing and signalling the lesion. It results in halting the cell cycle and local transcription and in the mediation of the DNA repair process itself. The response is launched through a series of post-translational modification signalling events coordinated by phosphorylation and ubiquitination. More recently modifications of proteins bySmallUbiquitin-likeMOdifier (SUMO) isoforms have also been found to be key to coordination of the response (Morriset al.2009Nature462, 886–890 (doi:10.1038/nature08593); Galantyet al.2009Nature462, 935–939 (doi:10.1038/nature08657)). However our understanding of the role of SUMOylation is slight compared with our growing knowledge of how ubiquitin drives signal amplification and key chromatin interactions. In this review we consider our current knowledge of how SUMO isoforms, SUMO conjugation machinery, SUMO proteases and SUMO-interacting proteins contribute to directing altered chromatin states and to repair-protein kinetics at a double-stranded DNA lesion in mammalian cells. We also consider the gaps in our understanding.

This article is part of the themed issue ‘Chromatin modifiers and remodellers in DNA repair and signalling’.