bluuebunny/crossref_metadata_2025 huggingface dataset:
A password to the future
Authors: Rogoyski Andrew
Published: March 2018

One question security professionals are often asked is: “How can I keep myself safe online?” This question is typically stimulated by the rising tide of news articles disclosing the latest cyber-security breach that has affected some company, some department or some individual – embarrassing, inconveniencing or impoverishing them. People are a little bit scared and perhaps they should be.

A cyber-security measure that we all experience and which remains stubbornly difficult to manage is the password.

Most digital interactions require you to, at some point, have invented, remembered and used a password – people routinely have dozens, sometimes hundreds. There's a wealth of advice on how to improve your passwords and Andrew Rogoyski of CGI UK sifts through what is currently regarded as best practice and argues that, within organisations, good password hygiene starts with senior executive leadership.
A novel key expansion technique using diffusion
Authors: Al-Muhammed Muhammed
Published: March 2018

The security of encryption techniques depends a great deal on the proper manipulation of keys during the encryption process. Improper key handling and use may lead to malicious actors being able to predict the key and consequently endanger the security of the data.
Reception
Authors: Bridges Emma , Paul Joanna
Published: March 2018

With Killing Hercules, Richard Rowland has produced a wide-ranging trans-historical discussion of re-workings of the relationship between the mythical Hercules and Deinaira, from Sophocles’ fifth-century bceTrachiniae to Martin Crimp's 2004 play, Cruel and Tender, and a 2014 staging of Handel's operatic Hercules. Impressive for the breath-taking variety of receptions of the story of Deianira's killing of her husband, the volume devotes as much attention to medieval, post-Reformation, and eighteenth-century versions as to ancient texts (including, as well as Sophoclean tragedy, receptions in Latin – for example, the pseudo-Senecan Hercules Oetaeus and Ovid's Heroides – which lie behind many post-classical re-workings of the story) and contemporary retellings; the study touches on several Italian, French, and German versions as well as those in English. As a scholar who has direct experience of theatre practice, Rowland draws on his involvement in staged versions of both Trachiniae (his own verse translation, which he includes as an appendix) and Cruel and Tender in order to provide fresh insights on both of these texts. The resulting volume, which illustrates the complex and varied reflections on masculinity and sexual identity prompted by the characters of Hercules and Deianira, has at its heart questions relating to the gendered role of violence in retellings of the myth both on a domestic level and in relation to international politics. Hercules has been seen as everything from the epitome of masculine virtue and heroic self-sacrifice to abuser and serial adulterer, ‘sexual deviant and disastrous husband’ (115); in her turn, Deianira – in some versions denied a voice altogether – has been variously portrayed as duplicitous or insane, or as a victim whose killing of her abuser is deserving of sympathy. The chapter on the Middle Ages illustrates well the re-appropriation of the story to serve a range of political, religious, and social agendas – from condemnation of Hercules’ lack of self-control by Augustine to valorization of his sexual violence, as well as the misogynist and misogamist interpretations of Deianira which were marshalled in service of debates on the role of marriage. Elsewhere, Rowland shows how the tale could be used simultaneously on both sides of a single political conflict – during the Civil War period, both regicides and royalists used lines from Seneca's Hercules Furens to insist on the rectitude of their respective stances (153–4). Even those already familiar with the reception of the figure of Hercules will find something new in this rich exploration of the pliability of one mythical story.
Taitaia, a novel lichenicolous fungus in tropical montane forests in Kenya (East Africa)
Authors: SUIJA Ave , KAASALAINEN Ulla , KIRIKA Paul Muigai , RIKKINEN Jouko
Published: March 2018

During lichenological explorations of tropical montane forests in Kenya, a remarkable new lichenicolous fungus was repeatedly found growing on thalli of the epiphytic tripartite cyanolichen Crocodia cf. clathrata. Molecular phylogenetic analyses placed the fungus within Gomphillaceae (Ostropales, Lecanoromycetes), a family mainly of lichen-symbiotic species in the tropics. The anatomical features (unitunicate, non-amyloid asci and simple, septate paraphyses) as well as the hemiangiocarpic ascoma development confirm its taxonomic affinity. DNA sequence data showed the closest relationship was with Gyalidea fritzei, followed by Corticifraga peltigerae. A monotypic genus, Taitaia, is introduced to incorporate a single species, T. aurea. The new fungus is characterized by aggregated ascomata with yellow margins and salmon red discs developing from a single base.
In-vivo optical imaging in head and neck oncology: basic principles, clinical applications and future directions
Authors: Wu Chenzhou , Gleysteen John , Teraphongphom Nutte Tarn , Li Yi , Rosenthal Eben
Published: March 2018

Head and neck cancers become a severe threat to human’s health nowadays and represent the sixth most common cancer worldwide. Surgery remains the first-line choice for head and neck cancer patients. Limited resectable tissue mass and complicated anatomy structures in the head and neck region put the surgeons in a dilemma between the extensive resection and a better quality of life for the patients. Early diagnosis and treatment of the pre-malignancies, as well as real-time in vivo detection of surgical margins during en bloc resection, could be leveraged to minimize the resection of normal tissues. With the understanding of the head and neck oncology, recent advances in optical hardware and reagents have provided unique opportunities for real-time pre-malignancies and cancer imaging in the clinic or operating room. Optical imaging in the head and neck has been reported using autofluorescence imaging, targeted fluorescence imaging, high-resolution microendoscopy, narrow band imaging and the Raman spectroscopy. In this study, we reviewed the basic theories and clinical applications of optical imaging for the diagnosis and treatment in the field of head and neck oncology with the goal of identifying limitations and facilitating future advancements in the field.
Current Ventilator and Oxygen Management during General Anesthesia
Authors: Suzuki Satoshi , Mihara Yuko , Hikasa Yukiko , Okahara Shuji , Ishihara Takuma , Shintani Ayumi , Morimatsu Hiroshi ,   on behalf of the Okayama Research Investigation Organizing Network (ORION) investigators
Published: March 2018

Background

Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia.

Methods

A multicenter, cross-sectional study was conducted to describe current ventilator management, particularly oxygen management, during general anesthesia in Japan. All adult patients (16 yr old or older) who received general anesthesia over 5 consecutive days in 2015 at 43 participating hospitals were identified. Ventilator settings and vital signs were collected 1 h after the induction of general anesthesia. We determined the prevalence of potentially preventable hyperoxemia (oxygen saturation measured by pulse oximetry of more than 98%, despite fractional inspired oxygen tension of more than 0.21) and the risk factors for potentially substantial oxygen exposure (fractional inspired oxygen tension of more than 0.5, despite oxygen saturation measured by pulse oximetry of more than 92%).

Results

A total of 1,786 patients were found eligible, and 1,498 completed the study. Fractional inspired oxygen tension was between 0.31 and 0.6 in 1,385 patients (92%), whereas it was less than or equal to 0.3 in very few patients (1%). Most patients (83%) were exposed to potentially preventable hyperoxemia, and 32% had potentially substantial oxygen exposure. In multivariable analysis, old age, emergency surgery, and one-lung ventilation were independently associated with increased potentially substantial oxygen exposure, whereas use of volume control ventilation and high positive end-expiratory pressure levels were associated with decreased potentially substantial oxygen exposure. One-lung ventilation was particularly a strong risk factor for potentially substantial oxygen exposure (adjusted odds ratio, 13.35; 95% CI, 7.24 to 24.60).

Conclusions

Potentially preventable hyperoxemia and substantial oxygen exposure are common during general anesthesia, especially during one-lung ventilation. Future research should explore the safety and feasibility of a more conservative approach for intraoperative oxygen therapy.
Averting Opioid-induced Respiratory Depression without Affecting Analgesia
Authors: Dahan Albert , van der Schrier Rutger , Smith Terry , Aarts Leon , van Velzen Monique , Niesters Marieke
Published: March 2018

The ventilatory control system is highly vulnerable to exogenous administered opioid analgesics. Particularly respiratory depression is a potentially lethal complication that may occur when opioids are overdosed or consumed in combination with other depressants such as sleep medication or alcohol. Fatalities occur in acute and chronic pain patients on opioid therapy and individuals that abuse prescription or illicit opioids for their hedonistic pleasure. One important strategy to mitigate opioid-induced respiratory depression is cotreatment with nonopioid respiratory stimulants. Effective stimulants prevent respiratory depression without affecting the analgesic opioid response. Several pharmaceutical classes of nonopioid respiratory stimulants are currently under investigation. The majority acts at sites within the brainstem respiratory network including drugs that act at α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (ampakines), 5-hydroxytryptamine receptor agonists, phospodiesterase-4 inhibitors, D1-dopamine receptor agonists, the endogenous peptide glycyl-glutamine, and thyrotropin-releasing hormone. Others act peripherally at potassium channels expressed on oxygen-sensing cells of the carotid bodies, such as doxapram and GAL021 (Galleon Pharmaceuticals Corp., USA). In this review we critically appraise the efficacy of these agents. We conclude that none of the experimental drugs are adequate for therapeutic use in opioid-induced respiratory depression and all need further study of efficacy and toxicity. All discussed drugs, however, do highlight potential mechanisms of action and possible templates for further study and development.
Speech Recognition Abilities in Normal-Hearing Children 4 to 12 Years of Age in Stationary and Interrupted Noise
Authors: Koopmans Wiepke J. A. , Goverts S. Theo , Smits Cas
Published: March 2018

Objectives:

The main purpose of this study was to examine developmental effects for speech recognition in noise abilities for normal-hearing children in several listening conditions, relevant for daily life. Our aim was to study the auditory component in these listening abilities by using a test that was designed to minimize the dependency on nonauditory factors, the digits-in-noise (DIN) test. Secondary aims were to examine the feasibility of the DIN test for children, and to establish age-dependent normative data for diotic and dichotic listening conditions in both stationary and interrupted noise.

Design:

In experiment 1, a newly designed pediatric DIN (pDIN) test was compared with the standard DIN test. Major differences with the DIN test are that the pDIN test uses 79% correct instead of 50% correct as a target point, single digits (except 0) instead of triplets, and animations in the test procedure. In this experiment, 43 normal-hearing subjects between 4 and 12 years of age and 10 adult subjects participated. The authors measured the monaural speech reception threshold for both DIN test and pDIN test using headphones. Experiment 2 used the standard DIN test to measure speech reception thresholds in noise in 112 normal-hearing children between 4 and 12 years of age and 33 adults. The DIN test was applied using headphones in stationary and interrupted noise, and in diotic and dichotic conditions, to study also binaural unmasking and the benefit of listening in the gaps.

Results:

Most children could reliably do both pDIN test and DIN test, and measurement errors for the pDIN test were comparable between children and adults. There was no significant difference between the score for the pDIN test and that of the DIN test. Speech recognition scores increase with age for all conditions tested, and performance is adult-like by 10 to 12 years of age in stationary noise but not interrupted noise. The youngest, 4-year-old children have speech reception thresholds 3 to 7 dB less favorable than adults, depending on test conditions. The authors found significant age effects on binaural unmasking and fluctuating masker benefit, even after correction for the lower baseline speech reception threshold of adults in stationary noise.

Conclusions:

Speech recognition in noise abilities develop well into adolescence, and young children need a more favorable signal-to-noise ratio than adults for all listening conditions. Speech recognition abilities in children in stationary and interrupted noise can accurately and reliably be tested using the DIN test. A pediatric version of the test was shown to be unnecessary. Normative data were established for the DIN test in stationary and fluctuating maskers, and in diotic and dichotic conditions. The DIN test can thus be used to test speech recognition abilities for normal-hearing children from the age of 4 years and older.
Neglected Tibial Pilon Fractures: Can Arthrodesis Be Avoided?
Authors: Ahmed Abdel-Salam A. , Singer Mohammed S. , El Bigawi Hossam A.
Published: March 2018

Objectives:

To evaluate the outcomes of neglected pilon fractures treated by the Ilizarov fixator and to determine whether this technique was successful in avoiding an ankle arthrodesis.

Design:

Retrospective case series.

Setting:

Level I university trauma center.

Patients:

Between January 2003 and March 2015, 18 patients (mean age of 42.17 years) with an untreated pilon fracture with late presentation (>1 month) were evaluated. Six patients were women and 12 were men. The mean duration from trauma to management was 11.17 weeks (range: 7–15). All fractures were OTA/AO 43 type C. Four cases were open fractures.

Intervention:

Closed fracture reduction, correction of deformity, and restoration of alignment by the Ilizarov fixator.

Main Outcome Measurements:

The radiographs were evaluated for tibial alignment, quality of reduction, and development of arthrosis. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale was used for functional assessment.

Results:

The follow-up period ranged from 18 to 168 months (mean; 38.00). The quality of reduction was excellent in 2 cases, satisfactory in 13 cases, and poor in 3 cases. The external fixator period averaged 29.06 weeks (range: 6.1–7.5 months). All fractures healed without deep infection. Ankle dorsiflexion and plantar flexion averaged 8.67 and 25.67 degrees, respectively, in 15 cases. Arthrodesis was performed for the remaining 3 cases. The mean AOFAS Ankle-Hindfoot score was 82.67. One case had mild anterior translation, and another 1 had a procurvatum of 5 degrees. Arthrosis developed in 6 ankles.

Conclusions:

A satisfactory outcome was achieved after management by the Ilizarov fixator while avoiding arthrodesis in most cases of this series of neglected pilon fractures.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
INSTRUMENTAL DIFFERENCE IN ASSESSING CHOROIDAL HYPERPERMEABILITY AND PHOTODYNAMIC THERAPY IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY
Authors: Lee Seung Min , Kwon Han Jo , Park Sung Who , Lee Ji Eun , Byon Ik Soo
Published: March 2018

Purpose:

To investigate the difference in choroidal hyperpermeability (CH) assessed using digital fundus camera (DFC) and scanning laser ophthalmoscope (SLO) and its effect on photodynamic therapy (PDT) outcomes in chronic central serous chorioretinopathy.

Methods:

Midphase indocyanine green angiography (ICGA) images were acquired using both DFC and SLO in 38 consecutive eyes with chronic central serous chorioretinopathy in this retrospective study. Scanning laser ophthalmoscope-ICGA was taken immediately after DFC-ICGA. Photodynamic therapy was applied to the area of CH associated with subretinal fluid (CH-SRF). The main outcome measures included the areas of CH in the macula and CH-SRF, resolution of SRF, and change in the best-corrected visual acuity.

Results:

Areas of CH (5.187 ± 2.625 mm2 vs. 3.170 ± 1.661 mm2, P < 0.001) and CH-SRF (2.315 ± 1.111 mm2 vs. 1.465 ± 0.709 mm2, P < 0.001) were greater in DFC than in SLO. Sixteen eyes underwent DFC ICGA-guided PDT (DFC-PDT group) and 22 underwent SLO ICGA-guided PDT (SLO-PDT group). Subretinal fluid resolution at 12 months was 100.0% and 90.9% in the DFC-PDT and SLO-PDT groups, respectively, without statistical differences. The improvement of best-corrected visual acuity was earlier in the SLO-PDT group than in the DFC-PDT group (3 months, P = 0.002 vs. 6 months, P = 0.003), but the final best-corrected visual acuity showed no difference.

Conclusion:

In chronic central serous chorioretinopathy, larger areas of CH and CH-SRF were observed with DFC than with SLO, which caused the ophthalmologists performing ICGA-guided PDT to determine a larger laser spot. This seemed to affect the time of visual recovery, but not the final outcome.
A Drug to Prevent Pediatric Myopia—What Would it Take?
Authors: Novack Gary D.
Published: March 2018

Because of the epidemic of myopia with both its short-term and long-term effects, we desperately need ways to slow myopic progression. In this study which was part of a myopia prevention symposium, the author answers the following question: Assuming that researchers did come up with a pharmacological treatment to slow myopic progression—what would it take to obtain regulatory approval from the United States Food and Drug Administration (FDA)? Previous publicly available information (a 2003 FDA advisory committee on this topic, International Conference on Harmonisation guidances on drug development, and published articles) as well as the author's experience is used. Development pathways including preclinical safety, chemistry, manufacturing and controls, and early- and late-stage clinical studies are presented. In particular, challenges for the conduct of multi-year controlled double-masked studies are presented. As any treatment would have to be chronic, prophylactic, and pediatric, there are a host of concerns as to efficacy, safety, and benefit/risk (therapeutic index). Although more challenging than some short-term indications in ophthalmology, nonetheless the pharmaceutical community is investing in seemingly equally challenging conditions such as retinal degeneration. The author looks forward to working with colleagues in academia and industry to evaluate and develop novel therapies to slow the development of myopia.
Changes in Optical Density of Postlens Fluid Reservoir During 2 Hours of Scleral Lens Wear
Authors: Schornack Muriel M. , Nau Cherie B.
Published: March 2018

Objectives:

Debris accumulation in the postlens fluid reservoir during scleral lens wear is clinically observed. We evaluated a method to quantify increases in turbidity of the postlens fluid reservoir by assessing changes in optical density of the fluid over time and compared these changes during 2 hr of scleral lens wear using three different lens designs.

Methods:

Thirty-five patients (age, mean [SD], 29 [7] years) with no history of eye disease were enrolled in the study. Participants were fit with a 15.0-, 18.0-, and 18.2-mm scleral lens on one randomly selected eye during the enrollment examination. During each of three subsequent visits, one of three lenses selected during enrollment was placed on the eye. Scheimpflug images were acquired within 5 min of lens placement and at 20-min intervals for the ensuing 2 hr. Fluid reservoir optical density was assessed using Pentacam (Oculus Inc) analysis software.

Results:

Increases in fluid reservoir optical density were significant between each time interval with all lenses until 100 min. No significant increases in fluid reservoir optical density were noted with the 15.0- and 18.0-mm lenses between 100 and 120 min; fluid reservoir optical density increased with the 18.2-mm lens between 100 and 120 min. Optical density increased by 105% (15.0-mm lens) and 117% (18.0- and 18.2-mm lenses) at 2 hr.

Conclusions:

Optical density of the postlens fluid reservoir can be quantified during scleral lens wear. During 2 hr of wear, fluid reservoir optical density doubled with all lens designs evaluated.
A Comparative Study of Central Corneal Epithelial, Stromal, and Total Thickness in Males With and Without Primary Open-Angle Glaucoma
Authors: Batawi Hatim , Lollett Ivonne Valentina , Maliakal Cima , Wellik Sarah R. , Anderson Michael G. , Feuer William , Karp Carol L. , Galor Anat
Published: March 2018

Purpose:

To compare the central corneal epithelial thickness (CET), stromal thickness (CST), and total thickness (CCT) in males with and without primary open-angle glaucoma and to determine the factors associated with corneal thickness.

Methods:

A case–control study was conducted to evaluate 116 male patients at the Miami Veterans Affair Medical Center. Subjects with available anterior segment optical coherence tomography images (Cirrus HD-OCT, Carl Zeiss Meditec Inc, Dublin, CA) were retrospectively classified into 2 groups by glaucoma status. CET, CST, and CCT measurements between the groups were compared. Associations between thickness and other variables of interest were also evaluated.

Results:

The 2 groups were similar with respect to race and ethnicity. Mean age of patients in the glaucoma group (70.3 ± 8.9) was higher than in the nonglaucoma group (66.0 ± 11.7), P < 0.03. Individuals who self-identified as black had lower CST (447.8 ± 29.0 μm) and CCT (503.0 ± 30.5 μm) compared with whites (CST: 470.0 ± 31.7 μm; CCT: 525.1 ± 32.4 μm), P = 0.0001 and P = 0.0002, respectively. In a similar manner, individuals with glaucoma had lower CST (453.4 ± 32.5 μm) and CCT (507.3 ± 33.8 μm) than that of those without glaucoma (CST: 465.2 ± 31.2 μm; CCT: 521.5 ± 31.5 μm), P = 0.05 and P = 0.02, respectively. CET, CST, and CCT were negatively correlated with the number of antiglaucoma medications (r = −0.2, r = −0.22, and r = −0.25, respectively), P = 0.05 for all.

Conclusions:

Individuals with glaucoma have lower CST and CCT measurements compared with individuals without glaucoma. An increased number of glaucoma medications were associated with lower thickness measurements.
Quantitative sensory testing after macroreplantation: evidence for a specific somatosensory profile
Authors: Blume Kathrin R. , Racz Juliane , Franz Marcel , Dietrich Caroline , Puta Christian , Friedel Reinhard , Hofmann Gunther O. , Miltner Wolfgang H.R. , Weiss Thomas
Published: March 2018

A comprehensive functional recovery is one of the criteria for successful replantation of an amputated limb. Functionality of a replanted limb is strongly dependent on its regained sensibility. In previous studies concerning the sensibility of replanted limbs, only a few somatosensory submodalities were examined in small samples. The purpose of this study is to provide a full pattern of somatosensory symptoms after replantation. Quantitative sensory testing was performed according to a standardized protocol in a sample of 15 patients who underwent replantation of their upper limb proximal to the radiocarpal joint (macroreplantation). Results indicate that most of these patients showed a specific somatosensory profile characterized by thermal and mechanical hypoesthesia and hyperalgesia in response to pressure pain, whereas no single case of hyperalgesia to heat pain occurred. This distinct profile of impaired somatosensation shares some features of the somatosensory profile of neuropathic pain syndromes. Patients' limbs that were replanted many years before the present quantitative sensory testing showed more sensory deficits than patients with more recent replantations. This knowledge might be helpful in the development of more specific and more successful rehabilitation programs with replanted patients and improves the behavioral function of the replanted limb.
Piloting a Multifaceted Interprofessional Education Program to Improve Physical Therapy and Nursing Students' Communication and Teamwork Skills
Authors: Turkelson Carman , Keiser Megan , Yorke Amy M. , Smith Leslie
Published: March 2018

While effective interpersonal communication and teamwork skills among health care professionals are critical to patient safety, health care students have limited opportunities to learn or practice these skills. Therefore, the purpose of this pilot program was to explore the effect of a multifaceted interprofessional education program on the behaviors and perceptions of students from 3 health care professions.

Between January and April 2016, students from graduate physical therapy (n = 57), undergraduate nursing (n = 39), and graduate nursing acute care nurse practitioner (n = 6) programs participated in didactic and standardized patient simulation sessions designed to develop teamwork and communication skills. A prospective pre-/postdesign was used to examine program effectiveness using 3 scales: the Readiness for Interprofessional Learning Scale (pre-/post-simulation), the Interdisciplinary Education Perception Scale (pre/post-simulation), and the National League of Nursing Student Satisfaction and Self-Confidence in Learning Scale (postsimulation).

Statistical analysis of the pre- and postscore Readiness for Interprofessional Learning Scale and Interdisciplinary Education Perception Scale measures was performed using the Wilcoxon signed rank test. Statistically significant changes were noted pre- to posttest in the Readiness for Interprofessional Learning Scale teamwork/collaboration (P < .001) and professional identity subscales (P ≤ .001). No statistically significant changes were noted in the 4 Interdisciplinary Education Perception Scale subscales pre- and posttest. The National League of Nursing Student Satisfaction and Self-Confidence in Learning Scale results indicated that students had a high level of satisfaction and self-confidence with the knowledge and skills presented.

Preliminary findings suggest that using a multifaceted approach that includes standardized patient simulations allowed physical therapy and nursing students to gain valuable experiential knowledge and practice the teamwork behaviors required for safe, high-quality clinical practice.
Unique Device Identifier Database Integration for Clinical Engineers
Authors: Jacobson Daniel R.
Published: March 2018

Over the last several years, the US Food and Drug Administration has established the Unique Device Identification system. The US Food and Drug Administration has published several previous articles explaining the background for developing the system and helping hospitals adopt Unique Device Identification into their daily use. In this article, we provide background on the database where device identification information is stored and accessed, the Global Unique Device Identification Database (GUDID). We also explain several methods for accessing those data through the public portal, AccessGUDID, and describe efforts to integrate GUDID data into existing infrastructure using the GUDID application programming interfaces.
Improving the Quality Management System of the Biomedical Engineering Department at Niagara Health as per Best Practices Recommended by Canadian Medical and Biological Engineering Society
Authors: Kanamala Nikhil , Teeluckdharry Kritananda
Published: March 2018

The Biomedical Engineering Department at Niagara Health has gone through a peer review conducted by the Canadian Medical and Biological Engineering Society (CMBES) in September 2015. The peer review is a voluntary assessment where the quality of services provided by the Biomedical Engineering Department at Niagara Health is compared with the most current Clinical Engineering Standards of Practice. Before this review, a quality management system was implemented by the department. Upon review of the existing system in place, CMBES came up with 29 recommendations to improve on, for the next peer review scheduled for fall 2018. This article describes the strategies deployed to consolidate and improve the existing system by incorporating the recommendations of CMBES. The current system was amended, and new processes were developed to better serve the purpose, vision, values, and success factors of Niagara Health, as well as the 4 focus areas laid out in the 10-year strategic plan of the organization.
Subsequent Fracture Prevention in Patients 50 Years and Older With Fragility Fractures: A Quality Improvement Initiative
Authors: Mackey Patricia A. , Rosenthal Laura D. , Mi Lanyu , Whitaker Michael D.
Published: March 2018

Because of osteoporosis, patients older than 50 years with fragility fractures are at risk of further fractures. We developed a quality improvement initiative based on an evidence-based Fracture Liaison Service (FLS) model of care to help prevent subsequent fractures. Previous to the implemented FLS model, less than 13% of patients with fragility fractures were assessed for osteoporosis at our institution. We created a registry tool to identify patients with fractures who were older than 50 years. Our interventions focused on identifying, contacting, and educating patients; and coordinating screening tests and an outpatient follow-up visit with an endocrinologist. Identification of patients older than 50 years with fragility fractures increased from 0% to 74.5%, with implementation of the fracture registry. Of those identified, 33.9% were screened and had a follow-up visit. The fragility fracture population older than 50 years is at risk of subsequent fractures and should be identified, contacted, educated, screened, and assessed for osteoporosis to prevent subsequent fractures.
The Effects of Severe Myopia on the Properties of Sampling Units in Peripheral Retina
Authors: Nagra Manbir , Gilmartin Bernard , Logan Nicola S. , Anderson Stephen J.
Published: March 2018

SIGNIFICANCE

Poor peripheral visual acuity in myopia may reflect, in part, photoreceptor misalignment with the exit pupil of the eye. We speculate that if such misalignment causes sufficient visual deprivation and/or disrupts retinal feedback processes, it may influence eye growth itself.

PURPOSE

It is known that myopic eyes have a reduced peripheral resolution acuity relative to emmetropic eyes, though it remains unclear how mechanical stretching of the retina in myopia impacts on peripheral visual performance. Our aim was to determine how retinal stretching affects the properties of sampling units in peripheral vision.

METHODS

Three-dimensional magnetic resonance imaging provided a depiction in vivo of ocular shape, allowing the inter-eye ratio of retinal image surface areas and the relative alignment of surfaces to be determined in our observer, who was unique in having severe myopia in the right eye (~21 D) but only modest myopia in the left (~3 D). Visual performance was assessed for the detection and direction discrimination of drifting sinusoids positioned 40° in the temporal retina. Applying the sampling theorem to our measures, we estimated the density and cut-off frequency of the underlying sampling units.

RESULTS

The retinal image surface area of the right eye was 40% larger than that of the left and was rotated 8.9° anticlockwise relative to the left eye’s image surface. In agreement with a linear stretch model of myopia, the sampling density of the right eye was reduced by approximately the same ratio as that predicted from the inter-eye MRI data, namely, 1.18. However, the cut-off frequency (cycles/mm) of the right eye was approximately half that of the left, a reduction that cannot be explained solely by a linear areal expansion of retinal sampling units.

CONCLUSIONS

Poor peripheral acuity in severe myopia may be caused, at least in part, by receptoral misalignment with the exit pupil.
Case Series: Herpes Zoster Ophthalmicus with Acute Orbital Inflammation
Authors: Bak Eunoo , Kim Namju , Khwarg Sang In , Choung Ho-Kyung
Published: March 2018

SIGNIFICANCE

Herpes zoster ophthalmicus (HZO) has variable initial manifestations, and acute orbital inflammation may be the first sign without apparent zoster rash. This case series is significant for presenting diverse clinical features and treatment options of HZO with acute orbital inflammation.

PURPOSE

To report a case series of patients diagnosed as HZO with acute orbital inflammation including two cases with unique presentations.

CASE REPORTS

Medical records of four patients of HZO with acute orbital inflammation were reviewed. Two men and two women with a median age of 57 years (range, 32 to 69 years) were diagnosed as having HZO with acute orbital inflammation. Initial presentations included two cases of zoster rash and two cases of orbital pain preceding vesicles. Clinical orbital findings included proptosis, ptosis, ophthalmoplegia, and decreased visual acuity. Orbital magnetic resonance image showed enlarged extraocular muscle with enhancement and optic nerve sheath enhancement in all four patients, and unilateral dacryoadenitis in one patient. All four patients were administered with systemic steroid, three patients received intravenous acyclovir, and one patient received oral acyclovir. Orbital signs improved in all patients over several months.

CONCLUSIONS

Herpes zoster ophthalmicus may initially present with orbital inflammatory signs, such as acute orbital myositis, perioptic neuritis, or dacryoadenitis, without zoster rash. Physicians should be aware of acute orbital inflammation as a presenting sign of HZO.
Case Report: Acanthamoeba Keratitis Management in a First-trimester Pregnant Patient
Authors: de Borja Domínguez-Serrano Francisco , Caro-Magdaleno Manuel , Perea-Pérez Rafael , Rodríguez-de-la-Rúa Enrique , Montero-Iruzubieta Jesús
Published: March 2018

SIGNIFICANCE

Lacrimal punctal plugs may prevent the teratogenicity of the treatment used in infectious keratitis. Its use should be strongly considered in these cases.

PURPOSE

We present the case of a 7-week pregnant patient with Acanthamoeba keratitis.

CASE REPORT

The patient was a contact lens user with photophobia, redness, and intense pain in the right eye that started 2 weeks earlier. Corrected visual acuity was 20/63 (0.5 logMAR). Biomicroscopy revealed a ciliary injection, perineural infiltrates, and corneal edema. Confocal microscopy and culture confirmed the diagnosis of Acanthamoeba keratitis. Prior to treatment with amebicidal eye drops, plugs were implanted in the lacrimal puncta to reduce the risk of drugs' teratogenicity. Three months after initiating amebicidal treatment, a melting ulcer of immunological etiology developed, which was treated with ReGeneraTing Agent eye drops, carboxymethyl glucose polysulfate (Cacicol; Théa, Clermont-Ferrand, France).

CONCLUSIONS

Lacrimal occlusion with punctal plugs is one of the available options available in cases of pregnant patients to reduce the risk of teratogenicity.
Fresh Cut Versus Stored Cut Paraffin-embedded Tissue: Effect on Immunohistochemical Staining for Common Breast Cancer Markers
Authors: Forse Catherine L. , Pinnaduwage Dushanthi , Bull Shelley B. , Mulligan Anna Marie , Andrulis Irene L.
Published: March 2018

The proper handling of unstained paraffin slides for immunohistochemistry has been a matter of debate, with several studies demonstrating loss of antigenicity with prolonged storage at room temperature, 4°C and −20°C. The purpose of this study was to determine whether long-term storage of unstained slides at −80°C would impact the staining intensity and expression distribution of markers used to molecularly subtype breast cancer specimens [estrogen receptor (ER), human epidermal growth factor receptor 2 (HER2), cytokeratin 5 (CK5), epidermal growth factor receptor (EGFR), and Ki67]. The staining pattern of previously unstained breast tumor slides (n=39 to 64) stored at −80°C for a minimum of 9.93 years (avg., 12.8 y) was compared with the staining pattern of fresh cut slides from the same tumors. The Allred scoring method was used to score ER (0 to 2, negative; 3 to 8, positive), CK5 (≥4, positive), and EGFR (≥4, positive). ASCO/CAP guidelines were used to assess HER2 (0/1+, 2+, or 3+). Ki67 scores were determined based on the proportion of cells stained of any intensity, with 20% staining used as a cut-off. Agreement was assessed using concordance rates and chance-corrected agreement statistics. The chance-corrected agreements were as follows: 0.94 (38/39) for ER, 0.92 (53/55) for CK5, 0.87 (61/64) for EGFR, 0.86 (37/39) for HER2, and 0.67 (46/54) for Ki67. Long-term storage of cut unstained slides at −80°C does not significantly impact the scoring interpretation of ER, CK5, EGFR, and HER2.
Expanded Paramedian Forehead Flaps for Nasal Defects
Authors: Ni Hai-chun , Wang Jie-cong , Sun Jia-ming , Guo Neng-qiang
Published: March 2018

Background

Reconstruction of nasal tip defects presents a significant challenge for plastic surgeons. The form, function, and aesthetic appeal of all nasal subunits must be addressed. The expanded paramedian forehead flap is a good choice for nasal reconstruction, providing similar texture, structure, and skin color, and high reliability. This article discusses the authors' modification of the expanded paramedian forehead flap in reconstructing defects on or around the nasal tip.

Methods

Twenty-two patients with nasal defects located on or around the nasal tip were treated in our institution. Sixteen patients underwent nasal reconstruction with expanded forehead flaps. The other 6 cases with cartilage defect underwent reconstruction with expanded forehead flaps and autogenous rib cartilage grafts. Functional and cosmetic results were assessed by surgeon, patient, and patient's relatives using a scale from 1 to 10.

Results

The aesthetic appearance of all patients was significantly improved after surgery. Two cases had mild hyperpigmentation. Two patients considered the flaps too thick. Three cases had minor brow elevation at the donor site. There were no obvious scars at the donor sites. There were no serious complications, such as infection, flap necrosis, deviation, or collapse.

Conclusions

The expanded paramedian forehead flap is a safe and effective method for reconstructing defects located on or around the nasal tip. Moreover, this technique can result in good functional and cosmetic outcomes with very few complications.
Rare Report of Unilateral Postauricular Dermoid Cyst
Authors: Byeon Je Yeon , Choi Hwan Jun , Lee Ji Hye
Published: March 2018

Dermoid cysts are benign developmental anomalies that occurred as a result of the sequestration of the skin along the lines of embryonic closure. Those occurring in the cervicofacial region are uncommon, accounting for about 7% of all dermoids and its presence in postauricular region is further exceptionally rare. A healthy 19-year-old Asian boy presented with a unilateral postauricular cyst that had been present since childhood without any symptom. The computed tomography scan revealed an encapsulated tumor with no intracranial extension. Histological examination of a biopsy taken from the lesion revealed a unilocular cyst found in the deep dermis and subcutaneous tissue. Multinuclear giant cells and fragments of hair shaft are infiltrated in the cystic wall. Some keratin materials are seen in the intracystic area. However, the lining cells are not found. These histologic findings were suggested of the dermoid cyst. Patients with postauricular dermoid cysts usually seek medical advice for the cosmetic reasons because of the embarrassing look of the prominent unilateral or bilateral ears. The treatment of postauricular dermoid cyst is complete surgical excision of the cyst wall. Incomplete removal may result in recurrence or infection; thus, complete surgical excision is necessary. The prognosis is excellent without further complication.
Characteristics of the Development of the Maxillae and Vomer in Patients With Bilateral Cleft Lip and Palate
Authors: Jiang Chanyuan , Zheng Yilue , Yin Ningbei , Song Tao
Published: March 2018

The aim of this study was to investigate the anatomical features of the maxillae and vomer in patients with bilateral cleft lip and palate (BCLP). Craniofacial measurements of 24 adult BCLP patients (GB) and 32 normal adult controls (GN) were carried out. We measured the width and length of the maxillae, their relative positions with respect to the coronal plane passing through the basion, and the volume, length, cross-sectional area, and mean width of the vomer. Between-group differences were assessed using independent-sample t tests. Finite element models (FEMs) were used to explore the bite forces acting on the bone by evaluating the distribution of stress and bone displacement. The mean vomer volume and width were significantly larger in the GB group than in the GN group (P = 0.000), whereas the length was significantly shorter (P = 0.000). The anterior maxillary length (A1-P3M⊥CP) was significantly larger in the GB group (P = 0.013), whereas the posterior maxillary length (P3M-P6M⊥CP) and overall maxillary length (A1-P6M⊥CP) at the dental level were significantly reduced (P < 0.01). In the BCLP FEM analysis, the maximum displacement was on the left premaxillary edge (0.2 mm), and high Mises stresses were found in the superior region of the vomer (22.4 Mpa), high tensile stresses in the inferior region (14.3 Mpa), and significant compressive stresses in the superior region (−24.7 Mpa). In summary, for BCLP patients, forward growth of the maxillae and vomer was inhibited during maxillary development, and the vomer was thicker and its volume was increased compared with the vomer in normal subjects.
The Combined Application of Database and Three-Dimensional Image Registration Technology in the Restoration of Total Nose Defect
Authors: Zeng Wei , Chen Gang , Ju Rui , Yin Huaqiang , Tian Weidong , Tang Wei
Published: March 2018

Objective:

The purpose of this study is to present a virtual planning protocol based on the database and three-dimensional (3D) image registration technology for the restoration of the total nasal defect, and evaluate its feasibility and clinical efficacy.

Methods:

Patients were scanned with a FaceScan to obtain the 3D facial model which was stored in an Extensible Neuroimaging Archive Toolkit (XNAT) database. Personalized search and similarity evaluation were performed in the database to find a normal 3D facial model with the highest similarity to the patient's. Then, the 2 models were imported into the dedicated software for 3D image registration to get the 3D model of the nasal defect part and the preoperative planning 3D facial model of virtual restoration. Subsequently, the dimensionality reduction algorithm was conducted to transform the 3D model of the nasal defect to a 2D flatten one for determining the scope of the forehead flap during surgery. Four weeks after the insetting surgery of forehead flap pedicle, the postoperative 3D facial model was gained. At last, the clinical efficacy was evaluated by comparing the difference between the preoperative planning and postoperative 3D facial model.

Results:

The nasal shapes of the patients were good after the operation, and the results revealed that the maximum error was ranging from 3.12 to 4.07 mm with the mean error from 0.92 to 1.04 mm.

Conclusion:

The database and 3D image registration technology provide a new approach for precisely determining the scope of total nasal defect and the forehead flap, which may be used for reference in the accurate restoration of other facial soft tissue defects.
Reconstruction of Complex Facial Asymmetry: Problems and Refinements
Authors: Gómez Díaz Oswaldo Javir , Martínez Gutiérrez Diana Carolina , Rueda Gallardo Luz Elena
Published: March 2018

This article describes 2 patients with complex facial asymmetry characterized by hemiarhinia, microorbitism, palpebral fissure shortening, ipsilateral canthal dystopia, maxillomandibular hypoplasia, and occlusal plane inclination. These unusual phenotypes are part of the oculoauriculo-vertebral spectrum. Their devastating functional, esthetic, and psychologic effects demand the use of different craniofacial surgery techniques, in order to alleviate the profound impact of these pathologies. Initial skeletal balance through bimaxillary distraction osteogenesis and orbital expansion sets the basis for further reconstruction of the nose and periorbital area with local tissue.
Upper Eyelid Blepharoplasty With Voltaic Arc Dermabrasion
Authors: Scarano Antonio , Lorusso Felice , Brucoli Matteo , Lucchina Alberta Greco , Carinci Francesco , Mortellaro Carmen
Published: March 2018

The aging to the upper eyelid complex includes skin laxity, resulting in rhytids, orbicularis oculi hypertrophy, and pseudohermitian of orbital fat and nowadays a high number of patients seeking cosmetic surgery. Excess and laxity of upper eyelid skin affect more than 90% of women, the impact of these problems on the patient's self-esteem can become important enough to affect quality of life in psychological and sociocultural terms.

The aim of the study was to evaluate the clinical efficacy of blepharoplasty with an electrosurgical technology for treatment of skin laxity of upper eyelid, which produced a lid retraction and an elevation of the upper lid without complications.

This retrospective evaluation was conducted from October 2008 to July 2015, where 80 patients (56 female and 24 male) were treated for excess and laxity of upper eyelid skin with voltaic arc dermabrasion.

The outcome was that all patients displayed some aspects of tissue contraction that stretched the lax skin of the upper eyelids, resulting in cosmetic improvement.

In conclusion this technique was predictable and useful to remove the laxity of upper eyelid skin minimal recurrence rates, and acceptable aesthetics.
Relationship Between Third Mandibular Molar Angulation and Distal Cervical Caries in the Second Molar
Authors: Claudia Andreescu , Barbu Horia Mihail , Adi Lorean , Gultekin Alper , Reiser Vadim , Gultekin Pinar , Mijiritsky Eitan
Published: March 2018

Third lower molar partially erupted is commonly encountered in dental practice. This situation challenges clinicians with the dilemma whether to remove or to monitor it, because this molar can cause pathology of the adjacent second molar. The aim of this retrospective study is to evaluate the relationship between third mandibular molar and distal cervical caries in second molar. This retrospective study analyzed 55 digital orthopantograms of adult patients and a total number of 95 mandibular third molars were assessed for eruption status, angulation, radiographic evidence of caries or restoration in the mandibular third molar, and radiographic evidence of caries or restoration in the distal surface of the mandibular second molar. The distal cervical caries in second molar is associated with fully erupted and partially erupted wisdom molar in horizontal, mesioangular and vertical position and less with presence of caries in third molar. There are caries lesions in distal second molars in mesioangular position when adjacent third molar is caries free.