bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASSOCIATIONS BETWEEN MACULAR EDEMA AND CIRCULATORY STATUS IN EYES WITH RETINAL VEIN OCCLUSION
Authors: Iida Yuto , Muraoka Yuki , Uji Akihito , Ooto Sotaro , Murakami Tomoaki , Suzuma Kiyoshi , Tsujikawa Akitaka , Arichika Shigeta , Takahashi Ayako , Miwa Yuko , Yoshimura Nagahisa 
Published: December 2016

Purpose:
To investigate associations between parafoveal microcirculatory status and foveal pathomorphology in eyes with macular edema (ME) secondary to retinal vein occlusion (RVO).

Methods:
Ten consecutive patients (10 eyes) with acute retinal vein occlusion were enrolled, 9 eyes of which received intravitreal ranibizumab (IVR) injections. Foveal morphologic changes were examined via optical coherence tomography (OCT), and parafoveal circulatory status was assessed via adaptive optics scanning laser ophthalmoscopy (AO-SLO).

Results:
The mean parafoveal aggregated erythrocyte velocity (AEV) measured by adaptive optics scanning laser ophthalmoscopy in eyes with retinal vein occlusion was 0.99 ± 0.43 mm/second at baseline, which was significantly lower than that of age-matched healthy subjects (1.41 ± 0.28 mm/second, P = 0.042). The longitudinal adaptive optics scanning laser ophthalmoscopy examinations of each patient showed that parafoveal AEV was strongly inversely correlated with optical coherence tomography-measured central foveal thickness (CFT) over the entire observation period. Using parafoveal AEV and central foveal thickness measurements obtained at the first and second examinations, we investigated associations between differences in parafoveal AEV and central foveal thickness, which were significantly and highly correlated (r = −0.84, P = 0.002).

Conclusion:
Using adaptive optics scanning laser ophthalmoscopy in eyes with retinal vein occlusion macular edema, we could quantitatively evaluate the parafoveal AEV. A reduction or an increase in parafoveal AEV may be a clinical marker for the resolution or development/progression of macular edema respectively.
PRIMARY LASER PHOTOCOAGULATION FOR THE TREATMENT OF GIANT RETINAL TEARS
Authors: Ao Jack , Horo Saban , Farmer Lachlan , Chan Weng Onn , Gilhotra Jagjit 
Published: December 2016

Purpose:
Laser photocoagulation has typically been used as an adjunctive treatment to pars planar vitrectomy in achieving retinopexy in the treatment of giant retinal tears. We describe three cases where the giant retinal tear was treated with laser photocoagulation alone.

Methods:
A retrospective case report of three patients with giant retinal tears who underwent primary laser photocoagulation.

Results:
Fundus examination up to 18 months after primary laser photocoagulation of all 3 patients revealed a flat attached retina and no significant complications.

Conclusion:
Laser photocoagulation alone is a viable alternative treatment for giant retinal tears in the absence of significant subretinal fluid.
SUB-TENON TRIAMCINOLONE ACETONIDE INJECTION IN A PREGNANT PATIENT WITH VOGT–KOYANAGI–HARADA DISEASE
Authors: Nakamura Tomoko , Keino Hiroshi , Okada Annabelle A. 
Published: December 2016

Purpose:
To report a case of new-onset Vogt–Koyanagi–Harada disease treated with sub-Tenon injection of triamcinolone acetonide in a 16-week pregnant patient.

Methods:
Review of clinical records.

Results:
A 33-year-old woman in her 16th week of pregnancy presented with bilateral serous retinal detachments associated with anterior chamber inflammation. Enhanced depth imaging optical coherence topography showed marked choroidal thickening. Headache and tinnitus developed 3 days later. The patient was diagnosed with incomplete Vogt–Koyanagi–Harada disease and treated with bilateral sub-Tenon triamcinolone acetonide injections. Within 2 weeks, the serous retinal detachments completely resolved with decreased choroidal thickness in both eyes. No recurrence of inflammation or choroidal thickening was noted over a follow-up of 13 months. The patient delivered a healthy baby at 41 weeks of pregnancy.

Conclusion:
Sub-Tenon triamcinolone acetonide injection may be an effective and safe treatment in pregnant women with new-onset Vogt–Koyanagi–Harada disease.
Congenital Cytomegalovirus Infection and Permanent Hearing Loss in Rural North Indian Children
Authors: Dar Lalit , Namdeo Divya , Kumar Pankaj , Thakar Alok , Kant Shashi , Rai Sanjay , Singh Pawan K. , Kabra Madhulika , Fowler Karen B. , Boppana Suresh B. 
Published: December 2016

Background:
Congenital cytomegalovirus infection (cCMV) is a leading nongenetic cause of permanent congenital or early-onset hearing loss (PCEHL). Although cCMV rates are high despite near-universal seroimmunity, the contribution of cCMV to PCEHL in the developing world is unclear.

Methods:
Neonates at a rural North Indian hospital were screened for cCMV by saliva polymerase chain reaction and hearing by distortion-product otoacoustic emission testing. Cytomegalovirus (CMV)-positive infants and those not passing newborn hearing screening (NHS) were evaluated by auditory brainstem response to confirm PCEHL. Infants with cCMV and those with PCEHL were tested for mutations within the GJB2 gene.

Results:
Of the 1720 infants screened, 40 (2.3%) did not pass NHS and 20 (1.2%) were CMV positive. Auditory brainstem evoked response testing confirmed unilateral or bilateral PCEHL in 11 (0.64%) children who either did not pass NHS or CMV positive. PCEHL was 20-fold higher in neonates with cCMV (2/20, 10%) than those without (9/1700, 0.5%; P < 0.01). None of 11 infants with PCEHL had connexin 26 mutations.

Conclusion:
PCEHL incidence is high in India, with cCMV contributing significantly despite near-universal seroimmunity. Our findings also demonstrate the feasibility and the utility of simultaneous newborn screening for both cCMV and hearing loss in a resource-limited setting.
Complementary Feeding
Authors: Fewtrell Mary , Bronsky Jiri , Campoy Cristina , Domellöf Magnus , Embleton Nicholas , Fidler Mis Nataša , Hojsak Iva , Hulst Jessie M. , Indrio Flavia , Lapillonne Alexandre , Molgaard Christian 
Published: December 2016

ABSTRACTThis position paper considers different aspects of complementary feeding (CF), focussing on healthy term infants in Europe. After reviewing current knowledge and practices, we have formulated these recommendations: Timing: Exclusive or full breast‐feeding should be promoted for at least 4 months (17 weeks, beginning of the 5th month of life) and exclusive or predominant breast‐feeding for approximately 6 months (26 weeks, beginning of the 7th month) is a desirable goal. Complementary foods (solids and liquids other than breast milk or infant formula) should not be introduced before 4 months but should not be delayed beyond 6 months. Content: Infants should be offered foods with a variety of flavours and textures including bitter tasting green vegetables. Continued breast‐feeding is recommended alongside CF. Whole cows’ milk should not be used as the main drink before 12 months of age. Allergenic foods may be introduced when CF is commenced any time after 4 months. Infants at high risk of peanut allergy (those with severe eczema, egg allergy, or both) should have peanut introduced between 4 and 11 months, following evaluation by an appropriately trained specialist. Gluten may be introduced between 4 and 12 months, but consumption of large quantities should be avoided during the first weeks after gluten introduction and later during infancy. All infants should receive iron‐rich CF including meat products and/or iron‐fortified foods. No sugar or salt should be added to CF and fruit juices or sugar‐sweetened beverages should be avoided. Vegan diets should only be used under appropriate medical or dietetic supervision and parents should understand the serious consequences of failing to follow advice regarding supplementation of the diet. Method: Parents should be encouraged to respond to their infant's hunger and satiety queues and to avoid feeding to comfort or as a reward.
Substance P in Flush Tears and Schirmer Strips of Healthy Participants
Authors: Markoulli Maria , Gokhale Moneisha , You Jingjing 
Published: December 2016

ABSTRACT

Purpose
To determine the repeatability of the flush tear collection technique and the Schirmer strip for Substance P tear analysis.

Methods
The tears of 10 healthy non–contact-lens wearers were collected via Schirmer strip and microcapillary following instillation of either 20 μL (F-20) or 60 μL (F-60) of saline. Each technique was conducted on two occasions and in a randomized order. Total protein content (TPC) and Substance P concentrations were determined. The overall protein separation profile of each type of tears was examined using one-dimensional gel electrophoresis (1DGE).

Results
Collection rates were significantly faster for the F-60 compared to F-20 (17.3 ± 6.9 μL/min and 11.9 ± 5.3 μL/min, respectively, P < .001), with an average Schirmer strip length of 1.5 ± 2.1 mm/min. The coefficient of repeatability between days and eyes was greatest for the Schirmer strip, with eyes and days being significantly different (P = .03 and P = .03, respectively) for Schirmer strip Substance P. TPC was 3.8 ± 2.6 mg/mL, 3.3 ± 1.8 mg/mL, and 3.6 ± 3.0 mg/mL for F-20, F-60, and Schirmer strip techniques, respectively, with no significant difference between techniques (P = .85). Substance P concentration was 13.1 ± 14.8 ng/mL, 9.1 ± 6.1 ng/mL, and 14.9 ± 10.6 ng/mL for F-20, F-60, and Schirmer strip tears, respectively, with no significant difference between techniques (P = .57). 1DGE profile showed similar electrophoresis patterns among F-20, F-60, and basal tears.

Conclusions
The F-60 method allows faster collection than F-20, but the latter results in better repeatability than both the F-60 and Schirmer sampling techniques. All three techniques return the same concentrations of TPC and Substance P. This indicates that tear collection using the F-20 may be more appropriate when conducting comparative analysis, whereas the F-60 may be more appropriate when more volume is required.
Scotoma Visibility and Reading Rate with Bilateral Central Scotomas
Authors: Pratt Joshua D. , Stevenson Scott B. , Bedell Harold E. 
Published: December 2016

ABSTRACT

Purpose
In this experiment, we tested whether perceptually delineating the scotoma location and border with a gaze contingent polygon overlay improves reading speed and reading eye movements in patients with bilateral central scotomas.

Methods
Eight patients with age-related macular degeneration and bilateral central scotomas read aloud MNRead style sentences with their preferred eye. Eye movement signals from an EyeLink II eyetracker were used to create a gaze contingent display in which a polygon overlay delineating the area of the patient’s scotoma was superimposed on the text during 18 of the 42 trials. Blocks of six trials with the superimposed polygon were alternated with blocks of six trials without the polygon. Reading speed and reading eye movements were assessed before and after the subjects practiced reading with the polygon overlay.

Results
All of the subjects but one showed an increase in reading speed. A paired-samples t-test for the group as a whole revealed a statistically significant increase in reading speed of 0.075 ± 0.060 (SD) log wpm after reading with the superimposed polygon. Individual subjects demonstrated significant changes in reading eye movements, with the greatest number of subjects demonstrating a shift in the average vertical fixation locus. Across subjects, there was no significant difference between the initial and final reading eye movements in terms of saccades per second, average fixation duration, average amplitude of saccades, or proportion of non-horizontal saccades.

Conclusions
The improvement in reading speed (0.075 log wpm or 19%) over the short experimental session for the majority of subjects indicates that making the scotoma location more visible is potentially beneficial for improving reading speed in patients with bilateral central scotomas. Additional research to examine the efficacy of more extended training with this paradigm is warranted.
Ultrasound-Guided Bilateral Thoracic Paravertebral Blocks as an Adjunct to General Anesthesia in Patients Undergoing Reduction Mammaplasty: A Historical Cohort Study
Authors: Salviz Emine A. , Sivrikoz Nukhet , Ozonur Anil , Orhan-Sungur Mukadder , Savran-Karadeniz Meltem , Altun Demet , Hocaoglu Emre , Celet-Ozden Burcu , Tugrul Kamil M. 
Published: December 2016

Background:
This study investigates whether ultrasound-guided thoracic paravertebral blocks would improve postoperative analgesia in patients undergoing bilateral reduction mammaplasty.

Methods:
After obtaining ethics committee approval, data of 70 patients who underwent bilateral reduction mammaplasty were reviewed. Sixty-four patients’ data were evaluable; 30 were in the general anesthesia group and 34 were in the thoracic paravertebral block group. Data such as time to first pain, intraoperative fentanyl requirement, postoperative numeric rating scale scores, number of patients who required tramadol in the postoperative care unit, and rescue analgesic consumption through the first 2 postoperative days were analyzed.

Results:
Time to first pain was 311 minutes (range, 0 to 1605 minutes) and 20 minutes (range, 0 to 120 minutes) in the thoracic paravertebral block and general anesthesia groups, respectively (p < 0.001). Fentanyl requirement was 52.94 ± 11.94 µg and 115 ± 29.79 µg in the thoracic paravertebral block and general anesthesia groups, respectively (p < 0.001). Numeric rating scale scores were lower in the thoracic paravertebral block group through the first 2 postoperative hours (p < 0.001), and only two of 34 patients required tramadol in the postoperative care unit (p < 0.001). On postoperative day 1, both metamizole sodium (p < 0.001) and paracetamol (p = 0.018), and on day 2, only metamizole sodium (p < 0.001) consumption was lower in the thoracic paravertebral block group.

Conclusion:
Adding ultrasound-guided thoracic paravertebral blocks to general anesthesia postponed time to first pain and reduced analgesic consumption in patients undergoing bilateral reduction mammaplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Evidence-Based Medicine: A Graded Approach to Lower Lid Blepharoplasty
Authors: Hashem Ahmed M. , Couto Rafael A. , Waltzman Joshua T. , Drake Richard L. , Zins James E. 
Published: December 2016

Learning Objectives:
After studying this article, the participant should be able to: 1. Define the anatomy of the lower eyelid tarsoligamentous framework and the related periorbital retaining ligaments, and cite their surgical relevance. 2. Perform a systematic functional and aesthetic evaluation of the lower eyelid focusing on the lid-cheek junction, and clinical tests that predict the need for lateral canthal tightening. 3. Enumerate the different approaches to lower eyelid rejuvenation and discuss their merits/limitations. 4. Describe surgical strategies to blend the lid-cheek junction and tighten the lateral canthal retinaculum.

Summary:
Modern lower lid blepharoplasty requires a thorough understanding of periorbital anatomy, age-related changes of the lid-cheek junction, and the variables controlling lower lid tone and position. The surgical strategies are best used in a graded fashion. The patient with isolated lower lid bags may be treated by transconjunctival fat resection alone. Additional mild skin laxity can be improved with skin pinch or skin-only undermining. Skin resurfacing using chemical peeling or laser can further address fine lines. In these patients with an abnormality of the lid-cheek junction, release of the medial orbicularis oculi muscle and variable amounts of the orbicularis retaining ligament is essential. This is combined with orbital fat resection or repositioning through a transconjunctival or transcutaneous skin-muscle flap. The transcutaneous approach most often necessitates lateral canthal tightening to optimize lid margin control. Generally, the degree of laxity dictates whether a canthopexy or a canthoplasty is most appropriate. Lateral canthal procedures can be applied to patients displaying clinical signs predictive of lid malposition and to those presenting with varying degrees of established lid descent.
Evidence-Based Medicine: Evaluation and Treatment of Zygoma Fractures
Authors: Birgfeld Craig B. , Mundinger Gerhard S. , Gruss Joseph S. 
Published: December 2016

Learning Objectives:
After studying this article, the participant should be able to: 1. Diagnose zygomaticomaxillary complex fractures from physical examination and radiographic findings. 2. Plan the necessary surgical approaches for operative treatment of zygomaticomaxillary complex fractures depending on severity. 3. Understand the three-dimensional anatomy of the orbit and zygomaticomaxillary complex and the importance of the zygomaticosphenoid suture along the lateral orbital sidewall. 4. Be aware of pitfalls and associated fractures that can complicate anatomical reduction of zygomaticomaxillary complex fractures.

Summary:
Fractures of the zygoma are some of the most commonly treated facial fractures, yet reconstruction of the three-dimensional structure of the zygomaticomaxillary complex can be challenging, and malunions are common. This article presents an evidence-based, systemic approach to the assessment and treatment of zygoma fractures from the simple to the complex. Anatomy, approaches, techniques, and pitfalls are described in an effort to improve the treatment of these common facial fractures.
Evidence-Based Medicine: Reduction Mammaplasty
Authors: Greco Richard , Noone Barrett 
Published: December 2016

Learning Objectives:
After reading this article, the participant should be able to: 1. Understand the multiple reduction mammaplasty techniques available for patients and describe the advantages and disadvantages associated with each. 2. Describe the indications for the treatment of macromastia in patients younger than 18 years. 3. Identify the preoperative indications for breast imaging before surgery. 4. Describe the benefits of breast infiltration with local anesthesia with epinephrine before surgery. 5. Understand the use of deep venous thrombosis prophylaxis in breast reduction surgery. 6. Describe when the use of drains is indicated after breast reduction surgery.

Summary:
The goal of this Continuing Medical Education module is to summarize key evidence-based data available to plastic surgeons to improve their care of patients with breast hypertrophy. The authors’ goal is to present the current controversies regarding their treatment and provide a discussion of the various options in their care. The article was prepared to accompany practice-based assessment with ongoing surgical education for the Maintenance of Certification Program of the American Board of Plastic Surgery.
Pregnancy and the Plastic Surgery Resident
Authors: Garza Rebecca M. , Weston Jane S. , Furnas Heather J. 
Published: December 2016

Background:
Combining pregnancy with plastic surgery residency has historically been difficult. Two decades ago, 36 percent of plastic surgery program directors surveyed actively discouraged pregnancy among residents, and 33 percent of women plastic surgeons suffered from infertility.
1
Most alarmingly, 26 percent of plastic surgery trainees had had an elective abortion during residency. With increasing numbers of women training in plastic surgery, this historical lack of support for pregnancy deserves further attention.

Methods:
To explore the current accommodations made for the pregnant plastic surgery resident, an electronic survey was sent to 88 plastic surgery program directors in the United States.

Results:
Fifty-four responded, for a response rate of 61.36 percent. On average, a director trained a total of 7.91 women among 17.28 residents trained over 8.19 years. Of the women residents, 1.43 were pregnant during a director’s tenure, with 1.35 of those residents taking maternity leave. An average 1.75 male residents took paternity leave. Approximately one-third of programs had a formal maternity/paternity leave policy (36.54 percent) which, in most cases, was limited to defining allowed weeks of leave, time required to fulfill program requirements, and remuneration during leave.

Conclusions:
This survey of plastic surgery directors is a first step in defining the challenges training programs face in supporting the pregnant resident. Directors provided comments describing their challenges accommodating an absent resident in a small program and complying with the American Board of Plastic Surgery’s required weeks of training per year. A discussion of these challenges is followed by suggested solutions.
Free Functioning Gracilis Muscle Transfer for Elbow Flexion Reconstruction after Traumatic Adult Brachial Pan-Plexus Injury: Where Is the Optimal Distal Tendon Attachment for Elbow Flexion?
Authors: Maldonado Andrés A. , Romero-Brufau Santiago , Kircher, R.N. Michelle F. , Spinner Robert J. , Bishop Allen T. , Shin Alexander Y. 
Published: December 2016

Background:
Reconstruction after pan-plexus root avulsions often includes gracilis free functioning muscle transfer. For elbow flexion reconstruction, the free functioning muscle transfer distal tendon is inserted into the biceps tendon or more distally (i.e., flexor digitorum profundus/flexor pollicis longus tendons) for combined elbow and finger flexion; the theoretical drawback of the latter approach is weaker elbow flexion. The authors compared elbow flexion strength with a biceps tendon versus a flexor digitorum profundus/flexor pollicis longus tendon attachment to determine which insertion point resulted in better elbow flexion.

Methods:
Thirty-nine patients underwent free functioning muscle transfer with either a biceps tendon or a distal attachment. Groups were compared on postoperative elbow flexion strength, preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores, range of motion, and other surgical and demographic characteristics. A biomechanical analysis simulating different tendon attachments determined which reconstruction resulted in optimal elbow flexion mechanics.

Results:
Distal tendon attachment was associated with M3 or M4 elbow flexion and greater range of motion compared with the biceps tendon attachment (p < 0.05). There were no statistically significant improvements in Disabilities of the Arm, Shoulder, and Hand questionnaire scores. Biomechanical analysis demonstrated that all distal tendon attachments studied generated a 15 to 30 percent greater torque compared with the biceps tendon attachment; this was true for attachments either at the flexor digitorum profundus/flexor pollicis longus tendon, or directly at the radius at 10 cm or 15 cm from the elbow axis of rotation.

Conclusions:
The flexor digitorum profundus/flexor pollicis longus tendon attachment of the gracilis free functioning muscle transfer distal tendon was superior in achieving elbow flexion strength. Patients with only elbow flexion reconstruction may also benefit from a flexor digitorum profundus/flexor pollicis longus tendon attachment or from a more distal attachment to the radius.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.