bluuebunny/crossref_metadata_2025_split huggingface dataset:
OCULAR ADVERSE EVENTS ASSOCIATED WITH MEK INHIBITORS
Authors: Méndez-Martínez Silvia , Calvo Pilar , Ruiz-Moreno Oscar , Pardiñas Barón Nieves , Leciñena Bueno Jesús , Gil Ruiz María del Rocío , Pablo Luis 
Published: February 2019

Purpose:
Mitogen-activates protein kinase (MAPK) inhibitors, particularly MEK inhibitors, have shifted the treatment paradigm for metastatic BRAF-mutant cutaneous melanoma; however, oncologists, ophthalmologists, and patients have noticed different toxicities of variable importance. This review aims to provide an update of the ocular adverse events (OAEs), especially retinal toxicity, associated with the use of MEK inhibitors.

Methods:
We conducted a scientific literature search using the PubMed database up to July 2018 with the terms “MEK inhibitors” with a “review” filter and “MEK inhibitors” with a “clinical trials” filter. Phase I–III experimental studies and reviews were selected. Current principles and techniques for diagnosing and managing MEK inhibitor retinopathy and other OAEs are discussed.

Results:
In patients treated with MEK inhibitors, including asymptomatic patients, OAEs occur with an incidence of up to 90%. Mild to severe ophthalmic toxicities are described, including visual disturbances, a 2-line decrease in Snellen visual acuity, dry eye symptoms, ocular adnexal abnormalities, visual field defects, panuveitis, and retinal toxicities, such as different degrees of MEK-associated retinopathy, vascular injury, and retinal vein occlusion.

Conclusion:
MEK inhibitors can lead to different degrees of retinal, uveal, and adnexal OAE, causing visual disturbances or discomfort. One of the most relevant OAE of MEK therapy is MEK inhibitor–associated retinopathy (MEKAR), which is usually mild, self-limited, and may subside after continuous use of the drug for weeks or months, or discontinuation, thereby restoring the normal visual function of the retina, with some exceptions. Ocular adverse events are often associated with other systemic adverse effects that can modify the dosage of treatment, so the communication with the oncologist is fundamental.
ENTEROCOCCUS ENDOPHTHALMITIS
Authors: Dave Vivek Pravin , Pathengay Avinash , Braimah Imoro Zeba , Panchal Bhavik , Sharma Savitri , Pappuru Rajeev Reddy , Mathai Annie , Tyagi Mudit , Narayanan Raja , Jalali Subhadra , Das Taraprasad 
Published: February 2019

Purpose:
To report the clinical presentation and management outcome of patients with endophthalmitis caused by Enterococcus species and to report the susceptibility profile of the isolates.

Methods:
Twenty-nine cases with culture-proven Enterococcus endophthalmitis from January 2005 to May 2018 underwent vitrectomy/vitreous biopsy, intravitreal antibiotic with or without additional procedures. The undiluted vitreous was subjected to microbiologic evaluation. A favorable anatomical outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit. Favorable visual outcome was final visual acuity ≥20/400.

Results:
There were 24 men (82.8%). Mean age at presentation was 32.89 ± 25.25 years (median 24 years). Inciting event was open globe injury in 18 (62%), endogenous in 5 (17.24%), postcataract surgery in 3 (10.34%), postscleral buckling in 2 (6.89%), and postkeratoplasty in 1 (3.44%). Enterococcus casseliflavus was the commonest species isolated (14/29, 48.27%) followed by E. faecalis (9/29, 31%). Susceptibility to vancomycin was seen in 27/29 isolates (93%). Visual acuity was ≤20/400 in all eyes at presentation and ≥20/400 in 10/29 cases (34.48%) at final visit. Anatomical success was seen in 18/29 eyes (62%). Corneal involvement was high at 24/29 eyes (82.75%).

Conclusion:

Enterococcus is not an uncommon organism in the setting of endophthalmitis after open globe injury. Resistance to vancomycin is rare. Multidrug resistance pattern is restricted to E. faecalis. Visual outcome is poor despite early and appropriate therapy due to inherent organism virulence.
SILICONE OIL TAMPONADE EFFECT ON MACULAR LAYER THICKNESS AND VISUAL ACUITY
Authors: Rabina Gilad , Azem Nur , Barequet Dana , Barak Adiel , Loewenstein Anat , Schwartz Shulamit 
Published: February 2019

Purpose:
To evaluate the influence of silicone oil (SO) tamponade on retinal layers thickness and visual acuity in patients who underwent pars plana vitrectomy for rhegmatogenous retinal detachment.

Methods:
This is a retrospective case series of consecutive patients who underwent pars plana vitrectomy for rhegmatogenous retinal detachment with SO tamponade. Visual acuity and central macular thickness were measured with SO and at least a month after SO removal (SOR). Patients with insufficient or poor-quality images or macular pathologies such as macular edema or epiretinal membranes were excluded.

Results:
Forty-one patients with an average age of 56.1 ± 15.2 years were included, and 54% presented with fovea ON. Average tamponade duration was 151 ± 54 days. Central macular thickness of the operated eye increased from 249 ± 50 µm before to 279 ± 48 µm after SOR (P < 0.001), compared with 281 ± 21 µm of the fellow eye (P < 0.001). A mean change of 26 µm was found in the internal layers (P < 0.001). Visual acuity improved from 0.85 ± 0.97 logarithm of the minimal angle of resolution (logMAR; Snellen 20/140) with SO tamponade to 0.34 ± 0.28 logMAR (Snellen 20/43) after SOR (P < 0.001). For patients with fovea ON and without significant cataract, visual acuity was 0.19 ± 0.16 logMAR (Snellen 20/30) at presentation, 0.59 ± 0.41 logMAR (Snellen 20/80) with SO (P = 0.005), and 0.18 ± 0.15 logMAR (Snellen 20/30) after SOR (P = 0.003).

Conclusion:
Silicone oil tamponade causes a transient decrease in central macular thickness, mainly in the inner layers. After SOR, central macular thickness resembles to the fellow eyes. The mechanism for this effect is unclear, but apparently has no influence on final visual acuity.
EVALUATION OF TUMOR NECROSIS FACTOR INHIBITOR THERAPY IN SUSAC SYNDROME
Authors: Buelens Tom , Ossewaarde-van Norel Jeannette , de Boer Joke H. , Nubourgh Isabelle , Glibert Gérald , Kamgang Semeu Prochore , Fils Jean-François , Caspers Laure , Postelmans Laurence , Willermain François 
Published: February 2019

Purpose:
To evaluate the effect of tumor necrosis factor (TNF) inhibitor therapy on ocular relapses in patients with Susac syndrome.

Methods:
Multicenter retrospective cohort study of patients diagnosed with Susac syndrome according to classical clinical criteria. We evaluated the disease activity before and after introduction of anti-TNF therapy and its value as a steroid-sparing agent.

Results:
Five patients were included. All were initially treated with a combination of corticosteroids and classical immunosuppressive drugs. Infliximab was started in three patients, and adalimumab was started in two patients. Patients had on average 5 ocular relapses during a mean follow-up time of 2.59 years before introducing a TNF inhibitor, corresponding with on average 1.93 relapses per year. After the introduction of an anti-TNF agent, this number was reduced by factor 5.51 to an average of 0.35 relapses per year for a mean follow-up of 2.86 years (P = 0.10). Before anti-TNF introduction ocular relapses occurred at a mean daily dose of 34 mg of prednisone, whereas with anti-TNF treatment, corticosteroid administration could be completely stopped in four patients with one patient still needing 5 mg daily (P = 0.10). Infliximab and adalimumab generally were well tolerated, and no serious adverse events were reported.

Conclusion:
Although not statistically significant, our results suggest that anti-TNF therapy can be a valuable option for the treatment of ocular Susac syndrome and may especially be considered in those patients unresponsive to more conventional immunosuppressive treatment.
Caregiver Contribution to Self-care in Patients With Heart Failure
Authors: Durante Angela , Paturzo Marco , Mottola Antonella , Alvaro Rosaria , Vaughan Dickson Victoria , Vellone Ercole 
Published: February 2019

Background
Caregiver contribution to heart failure (HF) self-care maintenance and management is important in HF care. Literature remains unclear regarding which practices caregivers perform to contribute to self-care for patients with HF, especially in Southern Europe.

Objective: The objective of this study was to describe caregiver contributions to HF self-care maintenance (ie, treatment adherence and symptom monitoring) and management (ie, managing HF symptoms when they occur).

Methods
Forty HF caregivers were enrolled from 3 outpatient clinics in Italy for a qualitative descriptive study. Data were collected with a semistructured interview and analyzed using content analysis.

Results
Caregivers were 53.6 years old on average and mostly female (63.5%). Caregiver contributions to self-care maintenance included practices related to (1) monitoring medication adherence, (2) educating patients about HF symptom monitoring, (3) motivating patients to perform physical activity, and (4) reinforcing dietary restrictions. However, some of these practices were incorrect (eg, weighing the patient only once a week). Caregiver contributions to self-care management included practices related to (1) symptom recognition and (2) treatment implementation. Caregivers were able to recognize symptoms of HF exacerbation (eg, breathlessness) but lacked confidence regarding treatment implementation (eg, administering an extra diuretic).

Conclusions
Although caregivers described contributing to patients' HF self-care maintenance and management, some of their practices were incorrect. Because the caregiver contributions to HF self-care can improve patient outcomes, clinicians should routinely assess caregiver HF self-care practices and provide education and reinforcement regarding evidence-based practices.
Radial Endobronchial Ultrasound-guided Transbronchial Cryobiopsy
Authors: Abdelghani Ramsy , Thakore Sanket , Kaphle Upendra , Lasky Joseph A. , Kheir Fayez 
Published: February 2019

Background:
Transbronchial lung cryobiopsy (TBLC) is a novel technique that has proved its diagnostic value in various diffuse parenchymal lung diseases (DPLD). However, there is substantial variability among interventional pulmonologists in procedural technique, diagnostic yield, and complication rate. Radial endobronchial ultrasound (R-EBUS) is useful for identification of ground-glass opacity lesions and can help identify target lung parenchyma. We aim to evaluate R-EBUS in TBLC histopathologic diagnosis for patients with DPLD.

Methods:
This was a prospective observational study of patients with clinical and radiologic features suggestive of DPLD who underwent TBLC. The R-EBUS probe was initially advanced to the desired lobe under fluoroscopic guidance until reaching 1 cm from the pleura. R-EBUS images were identified looking for either blizzard or mixed blizzard signs. TBLC samples were sent to pathology and microbiology laboratories for diagnostic analysis. Procedural complications were recorded.

Results:
In total, 40 patients (16 women/24 men) with a mean age of 63 years were included. The mean area of the samples was 36.2 mm2 (9 to 189 mm2) with mean number of samples per procedure of 3.45 (1 to 6). Definitive diagnosis was obtained in 37 patients (92.5%). The most frequent histopathologic patterns were: usual interstitial pneumonia (37.5%), nonspecific interstitial pneumonia (17.5%), and pulmonary infection (7.5%). There were 2 pneumothoraces (5%) and 5 cases of moderate bleeding (12.5%).

Conclusion:
The use of R-EBUS to locate and select target lung biopsy site before TBLC might increase diagnostic yield. Randomized studies comparing TBLC histopathologic diagnosis with and without R-EBUS are needed to ascertain its clinical value.
Factors Related to Overtreatment in the See-and-Treat Approach: A Retrospective Multicentric Observational Study
Authors: Ciavattini Andrea , Morini Stefano , Delli Carpini Giovanni , Del Fabro Anna , Serri Matteo , Verdecchia Valeria , Cigolot Federica , Cadel Manuela , Clemente Nicolò , Sopracordevole Francesco 
Published: February 2019

Objective
The aim of the study was to evaluate the association between colposcopic features, age, menopausal status, and overtreatment in women subjected to “see-and-treat” approach, to identify subgroups of patients in which this approach could be more appropriate.

Materials and Methods
Retrospective multicentric cohort study conducted on women older than 25 years, with a high-grade squamous cytological report and a visible squamocolumnar junction, in which colposcopy and the excisional procedure were performed at the same time without a previous cervical biopsy (see and treat). Overtreatment was defined as histopathological finding of cervical intraepithelial lesion grade 1 or normal tissue.

Results
Among the 254 included patients, the overall overtreatment rate was 12.6%, whereas in women with a grade 2 colposcopy, it was 3.2% and, in women with grade 1 colposcopy, it was 22.0%. Among the considered factors (age, menopause, and grade 1 colposcopy), only a positive association with overtreatment and grade 1 colposcopy emerged (odds ratio = 8.70, 95% CI = 2.95–25.62, p < .001).

Conclusions
See and treat may be appropriate in women older than 25 years with a visible squamocolumnar junction and a high-grade squamous cervical cytology. Patients need to be informed about the higher risk of overtreatment in case of a grade 1 colposcopic impression, which however may still be considered acceptable. Patient's age and menopausal status should not influence the decision to propose a see-and-treat approach.
Is Hard Failure Still a Common Indication for Revision Surgery in Adult Cochlear Implant Recipients?
Authors: Stevens Shawn M. , Dougherty Hayden , Wenstrup Lisa , Hammer Theresa , Cole Tyler , Redmann Andrew , Pensak Myles L. , Samy Ravi N. 
Published: February 2019

Outcome Objectives:

Study Design:
Retrospective chart review.

Setting:
Single tertiary care center, 2001 to 2016.

Patients:
Adult CI recipients were assessed. Inclusion required ≥1 revision surgeries, operative note(s), and postrevision follow-up of 6 months.

Interventions:
Therapeutic/rehabilitative.

Main Outcomes Measures:
Indications for revision (HF, SF, WC, and MM) were tabulated. The incidence of each was compared between cohorts implanted before/after 2011. Additional outcomes included implant usage, explantation rates, and postrevision speech scores.

Results:
Four hundred thirty-two patients received 512 CIs. Of these, 30 patients required 38 revisions. Median time to revision was 24.5 months. Frequency by indication was HF (n = 14), SF (n = 12), WC (n = 8), and MM (n = 4). The overall revision rate was 7.4%. There was a significant decline in overall revisions for patients implanted before/after 2011 (10.4 versus3.5%; p = 0.009). No patients implanted after 2011 experienced a HF (p = 0.002). Patients with WC/MM had significantly shorter time to revision compared with patients with HF/SF (p = 0.04). The overall median follow-up was 24 months. Twenty-three of 30 patients are still using their revised CI. Patients revised for HF and MM achieved the best outcomes.

Conclusion:
7.4% of adult CI recipients required revision surgery. Explantation/immediate reimplantation was an effective management strategy. While HF was the most common indication overall, no patients implanted after 2011 have suffered this complication. The overall revision rate has significantly declined since 2011.
Comparison of Skull Radiograph and Computed Tomography Measurements of Cochlear Implant Insertion Angles
Authors: Gallant Sara , Friedmann David R. , Hagiwara Mari , Roland J. Thomas , Svirsky Mario A. , Jethanamest Daniel 
Published: February 2019

Background:
Measurement of the angular depth of insertion (aDOI) of cochlear implant electrode arrays has numerous clinical and research applications. Plain-film radiographs are easily obtained intraoperatively and have been described as a means to calculate aDOI. CT imaging with 3D reformatting can also be used for this measurement, but is less conveniently obtained and requires higher radiation doses, a particular concern in pediatrics. The extent to which plain-film and 3D CT image-based measurements are representative of the true position of the electrode within the cochlea is unknown.

Methods:
Cochlear implantation was performed on 10 cadaveric temporal bones. Five bones were implanted with perimodiolar electrodes (Contour Advance TM, Cochlear, Sydney, Australia) and five were implanted with lateral wall electrodes (Slim Straight, Cochlear). The insertion depths of the electrodes were varied. Each bone was imaged with a radiograph and CT. aDOI was measured for each bone in each imaging modality by a neurotologist and a neuroradiologist. To obtain a "gold standard" estimate of aDOI, the implanted temporal bones were embedded in an epoxy resin and methodically sectioned at 100 μm intervals; histologic images were captured at each interval. A 3D stack of the images was compounded, and a MATLAB script used to calculate aDOI of the most apical electrode. Measurements in the three modalities (radiograph, CT, and histology) were then compared.

Results:
The average aDOI across all bones was similar for all modalities: 423° for radiographs, 425° for CT scans, and 427° for histology, indicating that neither imaging modality resulted in large systematic errors. Using the histology-measured angles as a reference, the average error for CT-based measures (regardless of whether the error was in the positive or negative direction) was 12°, and that for radiograph-based measures was 15°. This small difference (12 vs 15° error) was not statistically significant.

Conclusion:
Based on this cadaveric temporal bone model, both radiographs and CTs can provide reasonably accurate aDOI measurements. In this small sample, and as expected, the CT-based estimates were more accurate than the radiograph-based measurements. However, the difference was small and not statistically significant. Thus, the use of plain radiographs to calculate aDOI seems judicious whenever it is desired to prevent unnecessary radiation exposure and expense.
Temporal Modulation Detection in Children and Adults With Cochlear Implants: Initial Results
Authors: Landsberger David Mark , Stupak Natalia , Green Janet , Tona Kaitlyn , Padilla Monica , Martinez Amy S. , Eisenberg Laurie S. , Waltzman Susan 
Published: February 2019

Objectives:
The auditory experience of early deafened pediatric cochlear implant (CI) users is different from that of postlingually deafened adult CI users due to disparities in the developing auditory system. It is therefore expected that the auditory psychophysical capabilities between these two groups would differ. In this study, temporal resolving ability was investigated using a temporal modulation detection task to compare the performance outcomes between these two groups.

Design:
The minimum detectable modulation depth of amplitude modulated broadband noise at 100 Hz was measured for 11 early deafened children with a CI and 16 postlingually deafened adult CI users.

Results:
Amplitude modulation detection thresholds were significantly lower (i.e., better) for the pediatric CI users than for the adult CI users. Within each group, modulation detection thresholds were not significantly associated with chronologic age, age at implantation, or years of CI experience.

Conclusions:
Early implanted children whose auditory systems develop in response to electric stimulation demonstrate better temporal resolving abilities than postlingually deafened adult CI users. This finding provides evidence to suggest that early implanted children might benefit from sound coding strategies emphasizing temporal information.
Beyond Technology: The Interaction of Perceptual Accuracy and Experiential Factors in Pediatric Music Engagement
Authors: Gfeller Kate , Driscoll Virginia , Schwalje Adam 
Published: February 2019

Background:
Music engagement (the active making of music, e.g., music lessons and ensembles) is a common part of educational and community experiences. Music making typically involves listening to and production of rapidly changing combinations of pitch, timbre, and rhythm, which can be challenging for cochlear implant (CI) recipients, given that pitch and timbre are poorly conveyed through the CI. Pediatric CI users have variable patterns of music engagement, but some have achieved, sustained participation despite the degraded CI signal. What factors contribute to their persistence in these demanding listening situations? Our study examined a cohort of pediatric CI recipients from our center to better understand those perceptual and experiential factors most influential in relation to music engagement.

Method:
Regressions and correlations were run for measures of pitch and speech perception, hearing history, familial involvement in music, personal importance of music, and extent of music engagement (years in music lessons; general involvement in music).

Results:
Pitch ranking accuracy was a significant predictor of sustained participation in music lessons (p = 0.0019), and sustained involvement in music (p = 0.0038), as well as performance on CNC words (p = −0.0060) and phonemes (p = −0.0174). Extent of familial involvement in music at the time of testing was significantly predictive of the user's musical engagement (p = 0.0007). Personal importance of music was not predicted by or significantly correlated with, any of the variables investigated.

Conclusion:
Better pitch perception was associated with sustained involvement in music lessons as well as better speech perception. However, familial involvement in music was of greater impact for sustained music engagement. Judicious choice of musical instrument also influenced persistence. The positive impact of familial involvement indicates that perceptual limitations associated with CI processing do not present insurmountable barriers to music engagement. Because music engagement provides normalizing social involvement and challenging auditory practice, the impact of parental involvement has implications for counseling parents of CI users.
Individual Hearing Preservation Cochlear Implantation Using the Concept of Partial Insertion
Authors: Lenarz Thomas , Timm Max Eike , Salcher Rolf , Büchner Andreas 
Published: February 2019

Objective:
Aim of this study was to evaluate the method of partial insertion of flexible lateral wall electrodes in patients with residual hearing and potential electric–acoustic stimulation (EAS) users.

Patients and Intervention:
N = 6 patients with a high-frequency hearing loss were treated with a partial insertion using atraumatic lateral wall electrodes. In three cases, a electrode of 24 mm length was inserted with the aim to achieve a 16 mm insertion depth and in three cases a electrode of 28 mm length to achieve a 20 mm insertion depth.

Main Outcome Measure:
Differences between the pre- and postoperative unaided air-conducted pure tone thresholds in low frequencies (125 Hz–1.5 kHz) were analyzed. Freiburg monosyllables (FBM) at 65 dB and Hochmair–Desoyer sentence test in noise (10 dB SNR) were performed. The pre- and postoperative cochlea images were analyzed.

Results:
Residual hearing could be preserved in all patients (n = 6) and is stable up to 6 months follow-up. All patients could use EAS with an average speech understanding score of 65% in monosyllables (FBM) and 76% in sentences in noise. All patients benefit significantly compared to the preoperative best aided situation.

Conclusion:
First results of patients treated with partially inserted atraumatic lateral wall electrodes show good hearing preservation rates and very good speech perception results in EAS. Partial insertion appears to be a method for an individualized cochlea implantation. In case of postoperative hearing loss the electrode can be further inserted, so the patients can benefit from deeper insertion using electric stimulation only equivalent to larger electrodes.