bluuebunny/crossref_metadata_2025 huggingface dataset:
Lateral Temporal Subcutaneous Brow Lift: Clinical Experience and Systematic Review of the Literature
Authors: Savetsky Ira L. , Matarasso Alan
Published: April 2020

Background:

Numerous techniques have been described to correct brow aesthetics in facial rejuvenation. We report the senior author’s (A.M.) current approach for eyebrow elevation utilizing a lateral subcutaneous brow lift and, when indicated, a medial subgaleal brow lift. Furthermore, a systematic review of the literature was performed comparing the different surgical approaches and techniques.

Methods:

A systematic review of the literature was performed using the MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials databases. Studies were included if the content was original, provided outcome data, and complications.

Results:

The senior author (A.M.) has performed over 500 lateral temporal subcutaneous brow lifts for lateral brow ptosis. The vast majority was highly satisfied with the outcome and there were minimal complications. This represents the largest series of patients utilizing this technique. Twenty-six articles were reviewed and 5 met our screening criteria and were analyzed critically for inclusion and further objective review. All of the studies were retrospective in nature and report high patient satisfaction with an acceptable risk profile.

Conclusions:

In this study, we described the largest series of patients undergoing lateral subcutaneous brow lifts (n > 500), as well as a systematic review of the current literature. The current literature described an overall high degree of patient satisfaction with low complication rates, similar to the senior author’s (A.M.) experience. This technique has emerged as a reliable technique for lateral brow elevation with a very low and acceptable risk profile.
Resolution of Thumb Pain following Adoption of Mathieu Needle Holder: An Ergonomic Analysis
Authors: Schuth Olga , Powers Jeremy , Merritt Wyndell , Blanchet Nadia
Published: April 2020

Background:

As surveys reveal the prevalence of musculoskeletal pain among surgeons, it is important to have an appreciation and understanding of surgical ergonomics to protect against long-term injuries and mitigate the symptoms of existing conditions. Surgeons diagnosed with thumb carpometacarpal (CMC) joint osteoarthritis, a progressive and debilitating condition, can be especially vulnerable to the pain caused by the repetitive manual tasks of operating.

Methods:

In this article, the authors describe a case of occupational thumb CMC arthritis in a right-hand dominant plastic surgeon and provide an ergonomic analysis of the different needle holders.

Results:

Following diagnosis, the simple switch from the traditional Hegar needle holder to the Mathieu needle driver with its palm grip and rotating ratchet lock mechanism stalled the progression of the disease, allowing the surgeon to continue operating pain free.

Conclusions:

This is the first report of utilization of an alternative needle holder leading to the resolution of thumb pain. In sharing this case, the authors hope to bring awareness to the importance of hand ergonomics in the operating room and offer a practical tip to surgeons with CMC arthritis.
Do Microsurgical Outcomes Differ Based on Which Specialty Does the Operation? A NSQIP Analysis
Authors: Zhang Jacques X. , Wan Melissa , Ding Yichuan , Jin Yiwen , Nagarajan Mahesh , Courtemanche Douglas J. , Bedford Julie , Arneja Jugpal S.
Published: April 2020

Background:

Because plastic surgeons do not “own” a specific anatomic region, other surgical specialties have increasingly assumed procedures historically performed by plastic surgery. Decreased case volume is postulated to be associated with higher complication rates. Herein, we investigate whether volume and surgical specialty have an impact on microsurgical complications, specifically surgical site infection (SSI) and reoperation rates.

Methods:

The 2005–2015 National Surgical Quality Improvement Program participant use file was queried by Current Procedural Terminology code for breast and head/neck microsurgeries. Multivariate logistic regression was performed to compare the outcomes between surgical specialties. A cumulative frequency variable was introduced to investigate the effect of case volume on complication rates.

Results:

We captured 6,617 microsurgical cases. Multivariate logistic regression revealed that although the rate of SSI was lower in plastic surgery compared with otolaryngology for head and neck reconstructions (13.3% versus 10.5%) and compared with general surgery for breast reconstructions (5.4% versus 4.7%), there was no significant difference between specialties (P = 0.13; P = 0.96). Increased case volume is negatively correlated with complications.

Conclusions:

Plastic surgery is at risk given case cannibalization by other specialties. We conclude that surgical specialty does not affect the rates of SSI and reoperation. We demonstrate a correlation between lower volumes and increased complications, implying that, once a specialty has amassed critical case experience, complication rates may decrease, and outcomes can be equivalent or superior. Case breadth and volumes should be maintained to preserve skills, optimize outcomes, and maintain the specialty as it currently exists.
Excessive Aesthetic Lower Limb Elongation Management
Authors: Barinov Aleksander S. , Vorobyev Aleksander A. , Shtatov Viktor V. , Barinova Ekaterina A. , Nikolenko Vladimir N. , Barinov Alexey N. , Sinelnikov Mikhail Y.
Published: April 2020

With the evolution of surgical techniques and increased availability of cosmetic orthopedic surgery, new complications manifest. Uncontrolled lower limb elongation without limitations can be achieved by disinformation and undergoing surgery in different countries. Patients receive excessive surgical intervention due to misinforming surgeons and clinics of their previous medical history. We present a previously undocumented case of excessive lower limb elongation in an adult male patient and a treatment method for this novel pathology. Lack of personal constraint and severe aesthetic discomfort led the patient to undergo 3 elongation procedures in 3 clinics in different countries. Correction of excessive elongation is a delicate procedure, which must account for previous medical history, the patient’s psychological status, and strict adherence to anatomical standards. In this case, we managed to correct the complications from hyper-elongation by restoring the normal anatomical proportions of the lower limbs. The patient consented to publication of these findings and has undergone psychiatric evaluation in a specialized clinic after corrective surgery. It is important to properly educate patients of surgical risks and to evaluate all aspects of patient psychosomatic well-being before surgical intervention. Advances in aesthetic medicine underline the development of new iatrogenic pathologies. Excessive lower limb elongation can lead to significant musculoskeletal deformation, requiring precise surgical correction with account to normal anatomical proportions.
Distal Deep Vein Thrombosis Causing Pulmonary Embolism after Outpatient Plastic Surgery: A Case Report
Authors: Swanson Eric
Published: April 2020

A distal deep vein thrombosis is generally believed to be clinically unimportant because of a low incidence of pulmonary emboli. To the author’s knowledge, a symptomatic pulmonary embolism has not been reported in association with an isolated calf deep vein thrombosis in a plastic surgery outpatient. This case report provides the clinical details of a pulmonary embolism occurring after routine ultrasound detection of a distal deep vein thrombosis. Proximal deep venous thromboses originate in the calf and are dangerous because they frequently embolize. Ultrasound surveillance provides early detection of subclinical distal deep vein thromboses. Anticoagulation is initiated, suppressing propagation of the thrombosis to the deep veins of the thigh, and reducing the risk of a catastrophic pulmonary embolism.
Compromise of Personal Protective Clothing from Liquid Exposure
Authors: Schwahn Scott O. , Foster Nathaniel D.
Published: April 2020

Introduction

Following critiques of multiple personal contamination events from entries into the Oak Ridge National Laboratory’s Spallation Neutron Source Transfer Bay, it was considered that the most likely causes for contamination were personal protective clothing doffing errors or moisture (sweat) allowing contamination to wick through the protective clothing. Radiological protection staff looked more closely, however, at the specific area of the clothing where contamination was highest; under enhanced lighting and photochromic manipulation, there appeared to have been some type of moisture in the area. Recognizing the possibility that moisture may have allowed for migration of contamination through the clothing, further experiments were undertaken to determine under which conditions this transport might have occurred.

Objective

The objective for this work was to identify the susceptibility of different types of personal protective clothing to various liquids encountered in the workplace.

Method

Several tests were performed to determine if perspiration had enabled migration of contamination and to identify what other liquids might have affected contamination transport. Two layers of personal protective clothing were subjected to static conditions and dynamic conditions to include active rubbing of the materials while wet. Food dye added to each of the liquids tested enabled visual indications of liquid breakthrough. Additional tests were conducted to see if solid contamination could be transported through the materials along with the liquids.

Results

All but one type of non-rubberized personal protective clothing in use at Oak Ridge National Laboratory were permanently compromised to some extent by the solvents used for decontamination.

Conclusion

It was determined that most common cleaning agents immediately and permanently destroyed the hydrophobic nature of several of the tested protective clothing materials, potentially allowing for radioactive contamination to penetrate through the material to the worker. Work around wet surfaces or performing wet decontamination will only be performed in protective clothing known to prevent transport of the wetting agent.
Controlling a Digital Cursor With a Sterile Gyroscopic Mouse in Digitally Assisted Vitreoretinal Surgery
Authors: Bausili Montserrat M. , Gilhotra Jagjit S. , Durkin Shane R. , Chan Weng Onn
Published: April 2020

Purpose:

To describe our experience using the gyroscopic mouse in digitally assisted vitreoretinal surgery.

Methods:

We used a commercially available gyroscopic mouse to control the on-screen cursor of the NGENUITY System for digitally assisted vitreoretinal surgery. The gyroscopic mouse is sealed in a clear sterile plastic bag to allow for intraoperative use. This allowed both the surgeon and assistant to be fully scrubbed while retaining full control of the NGENUITY system's functions. The mouse also allowed the mentor to provide detailed instructions through the on-screen cursor by highlighting important landmarks.

Conclusion:

Using a sterile gyroscopic mouse improved the teaching utility and surgical workflow of digitally assisted vitreoretinal surgery.
Bilateral XEN Stent Implantation: A Long-term Prospective Study of the Difference in Outcomes Between First-operated and Fellow Eyes
Authors: Gillmann Kevin , Bravetti Giorgio E. , Rao Harsha L. , Mermoud André , Mansouri Kaweh
Published: April 2020

Background/Aims:

Both eyes of a same person are not completely independent entities. The purpose of this study was to assess the difference in outcome between the first-operated eye and the fellow-operated eye following bilateral XEN surgery, and to identify potential success predictors for the fellow eye.

Methods:

This single-site, prospective, nonrandomized interventional study investigated bilateral nonsimultaneous XEN gel stent implantation over 24 months. Its main outcome measure was surgical success, defined as unmedicated intraocular pressure (IOP) ≤15 mm Hg associated with a relative reduction ≥20%.

Results:

Of 149 enrolled eyes, 74 eyes of 37 patients who underwent bilateral (standalone or combined) XEN implantation, within a mean of 50.5±74.3 days of each other, were analyzed. Postoperatively, mean medicated IOP decreased from 19.0±6.6 (first-operated) and 18.2±5.2 mm Hg (fellow) at baseline (P=0.209) to 13.7±4.0 (−27.9%; P<0.001; first-operated) and 14.1±3.6 mm Hg (−22.5%; P<0.001; fellow) after 2 years (P=0.673). Rates of complete success were comparable between first-operated and fellow eyes (P=0.65). At 2 years, among patients whose first-operated eyes were considered a failure, 92.0% of fellow eyes failed (P=0.001). The odd ratio of a fellow eye experiencing complete success were 16.1 (95% confidence interval: 2.5-101.9, P=0.003) if the first operated eye experienced complete success.

Conclusions:

The present study demonstrated a strong association between first-operated eyes and fellow eyes following XEN gel stent implantation, in terms of surgical outcomes and IOP reduction. In effect, surgical success in the first-operated eye increases the odds of success in the fellow eye by 16-folds.
Pachymeter Use and Disinfection Practice in the United Kingdom: A National Survey
Authors: Jasani Kirti M. , Barua Ankur , Putri Christine , Mercieca Karl , Sattar Nayeem , Sanghrajka Anmol , Bhan-Bhargava Archana
Published: April 2020

Objective:

Pachymetry plays a crucial role in the diagnosis and management of glaucoma and corneal diseases. There have been several outbreaks of epidemic ocular infections in ophthalmology clinics worldwide with reports of viral, parasitic, and prion disease. Contact pachymetry is a possible vehicle of transmission due to its risk of contamination. We aim to identify the types of pachymetry used and methods employed for cleaning and disinfection in eye units throughout the United Kingdom.

Methods:

A telephone survey was carried out, and a senior nurse or sister questioned based on the proforma created. A follow-up email was sent to units that did not respond with the questionnaire attached.

Results:

Of 109 responses, 10 eye units were unaware of the device name and 4 were unaware of the cleaning method used. Overall, 69/105 (66%) were cleaned with some form of alcohol wipe between patients, 12/105 (11%) used presept solution to soak the pachymetry head mainly 5 to 10 minutes, with 2 units soaking for 20 to 30 minutes. Milton solution was used by 4 units (4%) (10 s to 10 min). Three used a hydrogen peroxide solution for 10 minutes (3%). Three (3%) used an alcohol solution. Fifteen (14%) units used some chlorine-based solution (actichlor/chloraprep) for 5 to 10 minutes. Two (2%) units combined an alcohol-based wipe with solution to soak afterward.

Conclusions:

There is a large variation in methods and duration of tip disinfection with only a few units following the Royal College of Ophthalmologists (RCOphth) guidelines on pachymeter disinfection. The majority of eye units use alcohol/chlorine-based wipes for cleaning the pachymetry heads which is against the current recommended guidelines. The average immersion time when solutions were used was 5 to 10 minutes.
Propionibacterium acnes Endophthalmitis Following Baerveldt Glaucoma Device Implantation
Authors: Ely Amanda L. , Neely Kimberly
Published: April 2020

Purpose:

The purpose of this study was to report a case of Propionibacterium acnes endophthalmitis in a patient with a Baerveldt glaucoma implant.

Patients and Methods:

An 8-year-old boy presented with left eye pain, extreme photophobia, and acute anterior uveitis >6 months after Baerveldt glaucoma implantation. A diagnosis of P. acnes endophthalmitis was made after a positive culture of the explanted Baerveldt device.

Results:

Initially, the patient was treated with intravitreal vancomycin and ceftazidime which led to mild early clinical improvement followed by deterioration of findings with recurrence of fibrin at the Baerveldt tube ostium within the anterior chamber. Repeat intravitreal injections were given to include antifungal coverage, along with intracameral moxifloxacin and subconjunctival vancomycin around the Baerveldt reservoir. Symptoms and findings again recurred, ultimately leading to the decision for complete removal of the glaucoma implant along with irrigation of the scleral bed with moxifloxacin. P. acnes was cultured from the extracted implant. The endophthalmitis resolved completely after implant removal.

Conclusions:

Despite the introduction of antibiotics into the intravitreal, intracameral, and subconjunctival space surrounding the Baerveldt implant, infection persisted until complete explantation of the device. Early explantation should be considered in glaucoma drainage device endophthamitis secondary to P. acnes.
Review of Hygiene and Disinfection Recommendations for Outpatient Glaucoma Care: A COVID Era Update
Authors: Shabto Julie M. , De Moraes Carlos Gustavo , Cioffi George A. , Liebmann Jeffrey M.
Published: April 2020

This review focuses on best practices and recommendations for hygiene and disinfection to limit exposure and transmission of infection in outpatient glaucoma clinics during the current COVID-19 pandemic.
Respiratory Syncytial Virus-related Death in Children With Down Syndrome
Authors: Löwensteyn Yvette N. , Phijffer Emily W. E. M. , Simons Juliette V. L. , Scheltema Nienke M. , Mazur Natalie I. , Nair Harish , Bont Louis J. ,   on behalf of the RSV GOLD Study Group
Published: April 2020

Background:

Respiratory syncytial virus (RSV) is a major cause of mortality in children younger than 5 years worldwide. Systematic reviews have shown that Down syndrome (DS) is an independent risk factor for severe RSV infection. We aimed to describe demographic and clinical characteristics of children with DS who died with RSV infection.

Methods:

We performed a retrospective case series in which data were shared by individual researchers, research networks and physicians worldwide as part of the RSV Global Online Database study. We included children with DS who died when younger than 5 years of age with laboratory-confirmed RSV infection.

Results:

We included 53 children with DS and RSV-related mortality from 20 countries in 5 continents. Five (9.4%) children were from low-income or lower-middle-income countries. Median age at time of death was 6.0 months [interquartile range (IQR): 3.00–12.0]. Thirteen (24.5%) children were born term and had no other risk factors for severe RSV disease. In total, 36 (67.9%) children had congenital heart disease, 8 (15.1%) had chronic lung disease and 1 (1.9%) had congenital immunodeficiency. Duration of hospitalization was significantly longer for children with DS compared with children without DS [median length of stay, 13 days (IQR: 6.8–21.0) vs. 8 days (IQR: 3.0–18.5), P=0.005].

Conclusions:

One-fourth of children with DS and RSV-confirmed death did not have risk factors for severe RSV disease, indicating that DS is an important risk factor for RSV-related mortality. Age distribution at time of death demonstrates that maternal vaccination would not be sufficient to protect children with DS against RSV-related mortality.
Cost-effectiveness of Oral Regimens for Adolescents With Chronic Hepatitis C Virus Infection
Authors: Zhou Hua , Lu Yanming , Wu Bin , Che Datian
Published: April 2020

Background:

Novel oral regimes have been approved for treating hepatitis C virus (HCV) infection in adolescents due to their superior effectiveness and safety. However, its economic outcome is still unclear in this population. The current analysis investigates the cost-effectiveness of novel oral regimens compared with that of pegylated interferon α with ribavirin (PR) therapies in adolescents in the context of the United States and China.

Methods:

A Markov model was developed to measure the economic and health outcomes of ledipasvir/sofosbuvir (LS) for genotypes 1 and 4, sofosbuvir/ribavirin (SR) for genotype 2, and ledipasvir/sofosbuvir/ribavirin (LSR) for genotype 3 HCV infection compared with the outcomes of PR treatment. Clinical costs and utility inputs were gathered from published sources. Lifetime discounted quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) were measured. The uncertainty was facilitated by 1-way and probabilistic sensitivity analyses.

Results:

In the United States, the ICERs of LS strategy were $14,699 and $14,946/QALY for genotypes 1 and 4 HCV infection, respectively; the ICER of SR strategy for genotype 2 was $42,472/QALY; and the ICER of LSR for genotype 3 was $49,409/QALY in comparison with the PR strategy. In Chinese adolescents, LS for genotypes 1 and 4, SR for genotype 2, and LSR for genotype 3 were the dominant alternatives to the PR strategy. The results were robust to sensitivity analyses.

Conclusions:

Novel oral regimes for adolescents with HCV infection are likely to be cost-effective in the context of the United States and China.
Epithelial-Myoepithelial Carcinoma of the Lacrimal Gland: Case Report of Youngest Patient
Authors: Anjum Shahzan , Modaboyina Sujeeth , Sen Seema , Sharma Mehar Chand , Meel Rachna
Published: April 2020

The authors report a case of extremely uncommon malignancy of lacrimal gland epithelial-myoepithelial carcinoma. This carcinoma is more commonly encountered in salivary glands and comprises 1% of all salivary gland tumors. Its occurrence in the orbit is very rare with only 6 cases reported in the literature, most of which arose in a pleomorphic adenoma. Epithelial-myoepithelial carcinoma is primarily a tumor of older adults, with a peak incidence in the sixth and seventh decades of life. The present case is the youngest patient reported to date and had no history of preexisting neoplasm in the lacrimal gland. Histological diagnosis of epithelial-myoepithelial carcinoma is challenging because of the similarity with other lacrimal gland epithelial tumors like malignant adenoid cystic carcinoma and benign pleomorphic adenomas.
Corneal Neurotization for Postherpetic Neurotrophic Keratopathy: Initial Experience and Clinical Outcomes
Authors: Kim Jane S. , Rafailov Leon , Leyngold Ilya M.
Published: April 2020

Purpose:

To assess early outcomes of corneal neurotization for postherpetic neurotrophic keratopathy (NK).

Methods:

Retrospective analysis of patients who underwent corneal neurotization for postherpetic NK by a single experienced oculoplastic surgeon was performed. Collected data included stage and etiology of NK as well as comorbidities, prior treatment history, neurotization technique, donor nerve site, preoperative and postoperative examination findings (i.e., ocular surface quality, corneal clarity, corneal sensation by Cochet-Bonnet esthesiometry, and visual acuity [VA]), and follow-up duration. Differences between preoperative and postoperative values were analyzed by Wilcoxon signed-rank test.

Results:

Of 23 adult patients who underwent corneal neurotization, 3 (13%) had history of herpes simplex keratitis and/or endotheliitis, and 4 (17%) had history of herpes zoster ophthalmicus. One patient with herpes zoster ophthalmicus was excluded due to inadequate follow-up duration. Of the 6 patients included in the study, 3 (50%) had Mackie stage 1 disease, 1 (17%) had stage 2, and 2 (33%) had stage 3 with impending perforation, but all had markedly diminished corneal sensation, with a median denervation time of 11.8 months (interquartile range [IQR] 9.4–29.2 months). Following neurotization, median corneal sensation improved significantly from 1.6 cm (interquartile range 0.0–1.9 cm) to 3.6 cm (IQR 3.0–5.6 cm, p = 0.028), with 1 patient achieving full sensation by postoperative month 5. All patients with a persistent epithelial defect preoperatively showed complete corneal healing by their last follow-up visit. VA also improved postoperatively in all patients (p = 0.028). Median follow-up duration was 11.3 months (interquartile range 9.6–17.9 months).

Conclusions:

Corneal neurotization can successfully reinnervate corneas previously devitalized by herpetic disease and halt the progressive nature of postherpetic NK. If utilized appropriately and early in the disease process, neurotization may reduce morbidity and maximize visual potential in postherpetic NK.
Orbital and Eyelid Inflammation With “Muciphages” and Extravasated Mucin From an Ethmoido-orbital Mucocele
Authors: Dempsey Katharine S. , Tooley Andrea A. , Patel Payal J. , Charles Norman C. , Belinsky Irina
Published: April 2020

A 22-year-old woman presented with an acute compressive optic neuropathy due to a ruptured ethmoido-orbital mucocele. She underwent urgent orbital decompression and drainage of the mucocele via an endoscopic approach. Postoperatively, her course was complicated by an orbital compartment syndrome supervened, exhibiting severe eyelid edema caused by infiltration with mucin and mucin-containing macrophages (“muciphages”). Biopsy of the eyelid showed infiltration with “muciphages,” macrophages laden with extravasated mucinous material. This is the first report that documents the clinical and histopathologic course of orbital inflammation following mucocele extravasation into the orbit and eyelids.
Bundling Probiotics With Antimicrobial Stewardship Programs for the Prevention of Clostridiodes difficile Infections in Acute Care Hospitals
Authors: Kullar Ravina , Johnson Stuart , McFarland Lynne V. , Goff Debra A. , Goldstein Ellie J.C.
Published: April 2020

Objective

Several recommendations based on probiotics with a Clostridiodes difficile infection (CDI) prevention bundle were developed.

Methods

Using a modified Delphi process an expert panel of infectious disease specialists developed and voted on consensus statements regarding CDI.

Results

The panel voted on the following: (1) CDI prevention bundles with antimicrobial stewardship programs (ASPs) are more effective than single interventions in preventing CDI (11/11 panelists); (2) to implement a CDI prevention program that includes probiotics, an institution must have an ASP consistent with established guidelines (11/11); (3) it is important to measure adherence to all components of a CDI prevention bundle, with process and outcomes measures established (11/11): (4) sustainability of a successful probiotic intervention for CDI prevention can be enhanced by incorporating a probiotic order set in the electronic medical record (11/11); (5) champions should be identified and accountable for CDI prevention bundle implementation (11/11); (6) hospital administration support is necessary for a successful and sustained CDI prevention program (10/11); and (7) the probiotic product selected for a CDI prevention program should be a defined strain(s), with a specific formulation, timing, dose, duration, and potency at the time of consumption, with evidence-based efficacy for CDI prevention (11/11).

Conclusions

The panel members agreed with the statements developed and concluded that a bundle with specific probiotics with evidence-based efficacy should be appropriately incorporated into ASPs for the prevention of CDI. Care should be taken when planning the method of probiotic implementation and measures for monitoring adherence to protocol should be included.
Localized sympathectomy reduces peripheral nerve regeneration and pain behaviors in 2 rat neuropathic pain models
Authors: Xie Wenrui , Strong Judith A. , Zhang Jun-Ming
Published: April 2020

Previous studies have shown that the peripheral nerve regeneration process is linked to pain in several neuropathic pain models. Other studies show that sympathetic blockade may relieve pain in some pain models and clinical conditions. This study examined reduction in peripheral nerve regeneration as one possible mechanism for relief of neuropathic pain by sympathetic blockade. A “microsympathectomy,” consisting of cutting the gray rami containing sympathetic postganglionic axons where they enter the L4 and L5 spinal nerves, reduced mechanical hypersensitivity in 2 different rat neuropathic pain models. In the spinal nerve ligation model, in which some functional regeneration and reinnervation of the ligated spinal nerve can be observed, microsympathectomy reduced functional and anatomical measures of regeneration as well as expression of growth-associated protein 43 (GAP43), a regeneration-related protein. In the spared nerve injury model, in which functional reinnervation is not possible and the futile regeneration process results in formation of a neuroma, microsympathectomy reduced neuroma formation and GAP43 expression. In both models, microsympathectomy reduced macrophage density in the sensory ganglia and peripheral nerve. This corroborates previous work showing that sympathetic nerves may locally affect immune function. The results further highlight the challenge of improving pain in neuropathic conditions without inhibiting peripheral nerve regeneration that might otherwise be possible and desired.
Sensitization of knee-innervating sensory neurons by tumor necrosis factor-α-activated fibroblast-like synoviocytes: an in vitro, coculture model of inflammatory pain
Authors: Chakrabarti Sampurna , Hore Zoe , Pattison Luke A. , Lalnunhlimi Sylvine , Bhebhe Charity N. , Callejo Gerard , Bulmer David C. , Taams Leonie S. , Denk Franziska , Smith Ewan St. John
Published: April 2020

Pain is a principal contributor to the global burden of arthritis with peripheral sensitization being a major cause of arthritis-related pain. Within the knee joint, distal endings of dorsal root ganglion neurons (knee neurons) interact with fibroblast-like synoviocytes (FLS) and the inflammatory mediators they secrete, which are thought to promote peripheral sensitization. Correspondingly, RNA sequencing has demonstrated detectable levels of proinflammatory genes in FLS derived from arthritis patients. This study confirms that stimulation with tumor necrosis factor (TNF-α) results in expression of proinflammatory genes in mouse and human FLS (derived from osteoarthritis and rheumatoid arthritis patients), as well as increased secretion of cytokines from mouse TNF-α-stimulated FLS (TNF-FLS). Electrophysiological recordings from retrograde labelled knee neurons cocultured with TNF-FLS, or supernatant derived from TNF-FLS, revealed a depolarized resting membrane potential, increased spontaneous action potential firing, and enhanced TRPV1 function, all consistent with a role for FLS in mediating the sensitization of pain-sensing nerves in arthritis. Therefore, data from this study demonstrate the ability of FLS activated by TNF-α to promote neuronal sensitization, results that highlight the importance of both nonneuronal and neuronal cells to the development of pain in arthritis.
Hospital visiting policies in the time of coronavirus disease 2019: A nationwide website survey in Taiwan
Authors: Liu Ya-An , Hsu Ya-Chuan , Lin Ming-Hwai , Chang Hsiao-Ting , Chen Tzeng-Ji , Chou Li-Fang , Hwang Shinn-Jang
Published: April 2020

Background:

Coronavirus disease 2019 (COVID-19), a novel infectious coronavirus disease, has become a worldwide pandemic. Infection control precautions for hospital visitors are needed to avoid cluster outbreaks, so this study investigated the visiting policies of all the hospitals in Taiwan in the time of COVID-19.

Methods:

From March 15, 2020, to March 18, 2020, we searched the official websites of all 472 National Health Insurance–contracted hospitals to determine their visiting policies. For those hospitals that had posted new visiting policies and still allowed visits to ordinary wards, we recorded the relevant details shown on their websites, including the number of visitors allowed at one time, the number of visiting slots per day, the total visiting hours per day, and the rules provided to visitors before visiting.

Results:

During the study period, 276 (58.5%) hospitals had posted new visiting policies on their websites, with higher proportions of academic medical centers (92.0%, 23/25) and metropolitan hospitals (91.5%, 75/82) than local community hospitals (48.8%, 178/365) doing so. Visits to ordinary wards were forbidden in 83 hospitals among those. Among the 193 hospitals that had new visiting policies and still allowed visits to ordinary wards, 73.1% (n = 141) restricted visitors to two at a time and 54.9% (n = 106) restricted visits to two visiting slots per day. Furthermore, history taking regarding travel, occupation, contacts, and cluster information was mentioned by 82.4% (n = 159) of these 193 hospitals, body temperature monitoring by 78.2% (n = 151), hand hygiene by 63.2% (n = 122), and identity checks by 51.8% (n = 100).

Conclusion:

In the time of COVID-19 covered by this study, about three-fifths of the hospitals in Taiwan had posted their visiting policies for ordinary wards on their websites. Furthermore, the thoroughness with which such visiting policies have been enforced also requires investigation.
Robotic pancreaticoduodenectomy in the era of minimally invasive surgery
Authors: Shyr Yi-Ming , Wang Shin-E. , Chen Shih-Chin , Shyr Bor-Uei
Published: April 2020

Minimally invasive surgery has become a worldwide trend to reduce the wound and mitigate pain. However, the role of robotic pancreaticoduodenectomy (RPD) has not been well established in the era of minimally invasive surgery. It would be nearly impossible to apply minimally invasive surgery in the tedious and complicated Whipple operation without an experienced and dedicated pancreas team. The pancreatic team led by Shyr YM and Wang SE at Taipei Veterans General Hospital have already been highly accredited with a Copper Award of Symbol of National Quality (SNQ award), entitled with “Minimally Invasive Robotic Pancreatic Surgery—Small Wound for Major Pancreatic Surgery” in Taiwan in 2019. RPD was claimed to be associated with less blood loss, less delayed gastric emptying, shorter length of postoperative stay, and lower wound infection rate, but longer operative time, as compared with the traditional open pancreaticoduodenectomy (OPD). More than 99% of the patients undergoing minimally invasive RPD are satisfied with the surgical outcomes and would like to recommend RPD to those with periampullary lesions. RPD could be recommended not only to surgeons but also to patients in terms of surgical outcomes and patient satisfaction. Moreover, our study showed a survival benefit for pancreatic head adenocarcinoma in RPD group, with 1-year, 3-year, and 5-year survival of 82.9%, 45.3%, and 26.8%, respectively, as compared with 63.8%, 26.2%, and 17.4% in OPD.
Precaution and prevention of coronavirus disease 2019 infection in the eye
Authors: Chen Meng-Jou , Chang Kao-Jung , Hsu Chih-Chien , Lin Pei-Yu , Jui-Ling Liu Catherine
Published: April 2020

Although current studies suggested that conjunctivitis is not a common presentation of coronavirus disease 2019 (COVID-19), several studies have reported the presence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in ocular secretions. Coronavirus had not yet been successfully cultured from tears or conjunctival swabs in humans, neither SARS-CoV-2 nor SARS-CoV. However, live feline coronavirus has been isolated from conjunctival swabs. In addition, infection of COVID-19 through unprotected eye exposure had been suspected in several articles. Reports of ophthalmologists and otolaryngologists died of COVID-19 also raised concern on ocular transmission. As a result, we strongly suggest that personal protective equipment (PPE) should cover the mouth, nose, and eyes of ophthalmologists, especially when conjunctivitis caused by SARS-CoV-2 is clinically indistinguishable from other viral follicular conjunctivitis.
Implementation and Outcomes of a Clozapine-Associated Myocarditis Screening Program in a Region of South Australia—Lessons Learned
Authors: Nachmani Major Nir , Dawson, BPharm(hons) Jessica L. , Clark Scott R.
Published: April 2020

Purpose

Clozapine-associated myocarditis (CAM) is a serious complication, mostly occurring in the first month of treatment. Public mental health in South Australia introduced a screening protocol in 2011 using baseline and weekly C-reactive protein and troponin. The aim of this study was to assess protocol adherence and management of cases with positive screening results.

Methods

We identified all patients commenced on clozapine in our area between 2012 and 2015. Those with abnormal C-reactive protein and/or troponin in the first 4 weeks of treatment were identified (potential cases). For those, we collected clinical characteristics and test results and reviewed their management.

Findings

Protocol compliance increased to 80%. We identified 24 potential CAM cases, 8 at high risk based on established definition (7.6% of new commencements) and 9 formally diagnosed from 143 commenced on clozapine. Potential cases not meeting CAM definition were significantly more likely commenced on clozapine for the first time and have preexisting respiratory disease. Likely CAM cases were younger, and more often prescribed additional antipsychotics, specifically quetiapine. Seven (78%) of 9 patients diagnosed with CAM met published CAM definition. In 14 undiagnosed potential cases, 10 (71%) did not have timely testing to exclude CAM.

Conclusions

Maintaining a high index of suspicion, clinical monitoring and timely testing is important to supplement CAM screening protocols. More research is needed to identify those that can be safely rechallenged or even continue clozapine treatment with monitoring.
Homeopathic Remedies in Psychiatric Disorders
Authors: Rotella Francesco , Cassioli Emanuele , Falone Andrea , Ricca Valdo , Mannucci Edoardo
Published: April 2020

Purpose/Background

Homeopathy is a complementary and alternative medicine. Conclusive evidence on the plausibility, efficacy, and safety of these treatments is not currently available. Nonetheless, homeopathic remedies (HRs) are widespread throughout the world and especially in mental disorders. The aim is to assess the efficacy of HRs in the treatment of mental disorders.

Methods/Procedures

We performed a Medline/Embase search for studies written in English and published from any date to October 23, 2018. All randomized controlled trials enrolling patients with any psychiatric disorder and comparing HR with placebo, no treatment, or other psychotropic drugs were included.

Findings/Results

A total of 212 studies were screened, 9 met all selection criteria and reported data on major depressive disorder (MDD) (n = 4), generalized anxiety disorder (n = 1), attention-deficit/hyperactivity disorder (n = 2), and premenstrual syndrome/dysphoric disorder (n = 2). Eight of 9 randomized controlled trials showed high risk of bias. Homeopathy showed greater efficacy in MDD compared with fluoxetine, and in premenstrual syndrome/dysphoric disorder compared with placebo, whereas no difference emerged between homeopathy and placebo in MDD and attention deficit/hyperactivity disorder.

Implications/Conclusions

Available data on homeopathy in psychiatric disorders are insufficient to support their use in clinical practice.
Reporting Patterns of Sialorrhea Comparing Users of Clozapine to Users of Other Antipsychotics
Authors: Man Wai Hong , Wilting Ingeborg , Souverein Patrick , Meyboom Ronald , Egberts Toine , Heerdink Eibert R.
Published: April 2020

Background

Sialorrhea is a non–life-threatening, but potentially invalidating adverse drug reaction (ADR) in patients using clozapine. In light of the very serious ADRs (agranulocytosis and myocarditis), sialorrhea is at risk to be overlooked by health care professionals. In this study, the sialorrhea reporting patterns of clozapine compared with other antipsychotics were assessed by evaluating differences in relative reporting frequency and reporter type.

Methods

A case/noncase disproportionality analysis using data from VigiBase (1968–2016) was performed. Reports of antipsychotics with “salivary hypersecretion” as ADR were considered as cases, and those with ADRs other than salivary hypersecretion were defined as noncases. Relative reporting frequencies were expressed as reporting odds ratios (RORs), and multivariate logistic regression was performed with the drug-ADR pair as unit of analysis to estimate RORs with 95% confidence intervals (CIs).

Results

A total of 1,169,254 drug-ADR pairs from 425,304 unique Individual Case Safety Reports were identified. Sialorrhea was relatively more frequently reported in clozapine (n = 2732 [1.1%]) compared with other antipsychotics (n = 2911 [0.31%]; ROR, 3.60; 95% CI, 3.41–3.79) and was reported relatively more often by consumers (ROR, 19.8; 95% CI, 15.1–25.9) compared with health care professionals (ROR, 2.44; 95% CI, 2.27–2.63).

Conclusions

Sialorrhea was reported almost 4 times more often with clozapine use than with other antipsychotic use and was reported 8 times more often by patients than by health care professionals. This provides a signal of disproportion in sialorrhea occurrence among clozapine compared with other antipsychotics and in light of the disproportionality between reporter and an underreporting by health care professionals, underlining the importance to incorporate sialorrhea into the shared decision process when commencing clozapine therapy.
Pregabalin as a Treatment for Anxiety in Patients With Dementia With Lewy Bodies
Authors: Segers Kurt , Baxevani Ermioni , Benoit Florence , Meyts Jean-Marie , Surquin Murielle
Published: April 2020

Background

Anxiety is a common and invalidating symptom of dementia with Lewy bodies (DLB).

Methods

To evaluate the efficacy of pregabalin as a treatment for anxiety in DLB, we screened all medical files of our patients with DLB for the use of pregabalin in this context.

Findings

Overall, pregabalin was well tolerated. Ten (62.5%) of 16 patients showed an improvement of anxiety, whereas in 3 of them, anxiety disappeared completely, at respectively 3, 11, and 22 months of follow-up, with total daily doses ranging from 75 to 150 mg. Positive response to pregabalin was associated with a significant reduction in benzodiazepine use.

Conclusions

Pregabalin seems a useful and safe tool for treating anxiety in patients with DLB.
Clozapine-Related Diarrhea and Colitis
Authors: Rask Susanna Maria , Luoto Kaisa E. , Solismaa Anssi , Jokinen Elina , Jussila Airi , Kampman Olli
Published: April 2020

Background

During clozapine treatment, diarrhea is a rare but clinically relevant adverse effect. Cases of microscopic colitis and eosinophilic colitis have been previously reported.

Procedures

We present 4 patients who developed severe diarrhea in early weeks of clozapine therapy.

Findings

Two patients had significant peripheral eosinophilia 1 week after diarrhea symptoms. One of these patients also had Charcot-Leyden crystals in stool afterward, confirming the presence of eosinophils in the gut lumen. One of our patients had a confirmed microscopic colitis and later also neutropenia, which required treatment.

Conclusions

Charcot-Leyden crystals in stool may be associated with concurrent diarrhea and eosinophilia during clozapine treatment, which is a previously unreported finding. Occurrence of blood dyscrasias with diarrhea symptoms during clozapine treatment needs further investigation to understand the possible shared mechanisms.
Teaching Differential Diagnosis: Tool Box Techniques
Authors: Satterly Lynn-Beth
Published: April 2020

Differential diagnosis is one of the most challenging skills for a new clinician to learn. Typically, students are first exposed to the process of differential diagnosis in problem-based learning sessions. In general, techniques and tools to use in performing this important task are not universally or consistently taught, so successful clinicians learn this process largely from observing other more experienced clinicians. This article presents effective techniques and assignments that can be used to teach the process of differential diagnosis, enabling novice clinicians to become more accurate and proficient diagnosticians earlier on. Rubrics for evaluation and the theory behind these techniques are also provided.
Transitioning Into the Role of Mother Following the Birth of a Very Low-Birth-Weight Infant
Authors: Bright Katherine Stuart , Mannion Cynthia , White Deborah , Raffin Bouchal Shelley
Published: April 2020

This qualitative grounded theory pilot study investigated the concerns and coping mechanisms of mothers of very low-birth-weight (VLBW; <1500 g) infants following discharge from the neonatal intensive care unit in Alberta, Canada. In-depth, semistructured, face-to-face, audio-recorded interviews were conducted with women of VLBW infants. Interviews lasting 75 to 90 minutes were transcribed verbatim and coded using grounded theory methodology. Data saturation and theoretical redundancy were achieved in interviews with 6 mothers of VLBW infants. The core variable of “reconstructing normal” emerged from the interview data. Women indicated that mothering a VLBW infant is an unfolding experience that is continuously being revised, creating a new sense of normal. The construct consists of 4 categories; mother-infant relationship, maternal development, maternal caregiving and role-reclaiming strategies, and infant developmental milestones. Findings from this study suggest that women found the transition into motherhood following the birth of a VLBW infant as a multidimensional and dynamic process. Further research is warranted to confirm these results and to further explore mothering issues with VLBW infants.
The State of the Science of Preterm Birth
Authors: Wade Eleanor E. , Byers Jennifer G. , Thagard Andrew S.
Published: April 2020

Preterm birth remains a leading cause of morbidity and mortality during the perinatal and neonatal periods. Now affecting approximately 1 in 10 births in the United States, preterm birth often occurs spontaneously and without a clear etiology. Careful assessment of risk factors, however, identifies vulnerable women allowing targeted interventions such as progestogen therapy and cerclage. This article is intended to highlight preterm birth risk factors and current predictive and preventive strategies for midwives, nurse practitioners, clinical nurse specialists, and perinatal nurses.
Application of a Bundle in the Prevention of Peri-Intraventricular Hemorrhage in Preterm Newborns
Authors: Ferreira Daniela Monteiro , Girão Ana Lívia Araújo , e Silva Ana Valeska Siebra , Chaves Edna Maria Camelo , de Almeida Paulo César , Freire Vanessa Sousa , de Carvalho Rhanna Emanuela Fontenele Lima
Published: April 2020

The purpose of this study was to evaluate the impact of implementing a care bundle for preventing peri-intraventricular hemorrhage (PIVH) in preterm newborns. A longitudinal, quantitative, quasi-experimental study was conducted with preterm newborns from a neonatal unit. The study was divided into 2 stages: the first consisted of a retrospective cohort of newborns (control group) not exposed to the bundle, and the second consisted of 5 practical steps of implementing a care bundle for preventing PIVH in eligible newborns. The results show that a significant reduction in PIVH occurred, from 34.8% before the intervention to 26.3% after application of the bundle. Also, after implementation of the bundle, there was a reduction in the severe forms of PIVH in the newborns who presented with hemorrhage compared with the control group. The study shows how the use of a low-cost and easy operationalization tool can contribute to the health of preterm newborns. It was found that the bundle is directly related to the decrease in the incidence of PIVH. The results may contribute to the improvement in care quality, thus promoting safe care for premature newborns.