bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteochondral Autograft Transplantation to the Metacarpal Head for Avascular Necrosis in a Young Active Patient: Case Report and Technique Overview
Authors: Rosenbaum Yoseph A. , McCarthy Chris M. , Awan Hisham M. 
Published: August 2017

Background:
Aseptic avascular necrosis of the metacarpal head, or Dieterich disease, is a rare and painful condition of unknown etiology. There is no consensus regarding optimal treatment, although multiple surgical options have been described. Many cases are refractory to nonoperative management.

Materials and Methods:
We present a case of a young, active patient with avascular necrosis of the long finger metacarpal head that was treated surgically with osteochondral autograft transplantation. An osteochondral autograft system was used to remove a 10×13 mm core, which contained the entire osteochondral defect. An incision was made and the superior lateral aspect of the trochlea was exposed through a small fascial incision. A size-matched core was harvested from the lateral aspect of the trochlea proximal to the sulcus terminalis in the non–weight-bearing portion of the lateral condyle. The harvested osteochondral donor fragment was then transplanted into the defect in the metacarpal head and noted to be an excellent size match.

Results:
At 2 weeks postoperative, the patient had nearly full range of motion of both the affected hand and the donor knee. Radiographs demonstrated a small intra-articular step-off of <1 mm, which was appreciated in the intraoperative fluoroscopic image and is within the acceptable limits for metacarpophalangeal joint step-off. At one year postoperative he was pain-free with a QuickDASH score of 2.3.

Conclusions:
Avascular necrosis of the metacarpal head in a young patient can be a challenging problem, especially when it is resistant to conservative therapy. Arthroplasty or arthrodesis could be reliable options in older, lower-demand patients, but are not appropriate for a young, high-demand patient.
UK Policy on Doctor Remediation: Trajectories and Challenges
Authors: Price Tristan , Archer Julian 
Published: August 2017

Abstract:
Around the world, policy-makers, academics, and health service professionals have become increasingly aware of the importance of remediation, the process by which poor performance is “remedied,” as part of the changing landscape of medical regulation. It is, therefore, an opportune time to critique the UK experience with remediation policy. This article frames, for the first time, the UK remediation policy as developing from a central policy aim that was articulated in the 1990s: to accelerate the identification of underperformance and, subsequently, remedy any problems identified as soon as possible. In pursuit of this aim, three policy trajectories have emerged: professionalizing and standardizing remediation provision; linking remediation with other forms of regulation, namely relicensure (known in the UK as medical revalidation); and fostering obligations for doctors to report themselves and others for remediation needs. The operationalization of policy along these trajectories, and the challenges that have arisen, has relevance for anyone seeking to understand or indeed improve remediation practices within any health care system. It is argued here that the UK serves as an example of the more general challenges posed by seeking to integrate remediation policy within broader frameworks of medical governance, in particular systems of relicensure, and the need to develop a solid evidence base for remediation practices.
Associations Between Family Member BMI and Obesity Status of Children with Autism Spectrum Disorder
Authors: Dempsey Jack , Dempsey Allison G. , Voigt Robert G. , Monteiro Sonia 
Published: August 2017

ABSTRACT:

Objective:
To determine whether there is an association between parent and sibling obesity status and obesity status in children with autism spectrum disorder (ASD).

Methods:
We examined predictors of obesity in children with ASD with body mass index data for the proband, 1 sibling, and 2 parents using data from the multisite Simons Simplex Collection.

Results:
In a stepwise logistic regression model, proband obesity status was associated with obesity status of the sibling (odds ratio [OR] 2.66; 95% confidence interval [CI], 1.92–3.70), mother (OR 2.10; 95% CI, 1.59–2.77), and father (OR 1.51; 95% CI, 1.15–1.98). Proband obesity was also related to somatic complaints (OR 1.60; 95% CI, 1.006–2.53), mood stabilizers (OR 1.80; 95% CI, 1.19–2.72), internalizing problems (OR 1.60; 95% CI, 1.14–2.30), age (OR 1.01; 95% CI, 1.00–1.01), and some adaptive functioning domains (OR 0.987; 95% CI, 0.977–0.997). Race, ethnicity, income, sex, and maternal education were not significant predictors.

Conclusion:
Familial factors were generally the strongest predictors of obesity rather than medication use, demographics, or psychological characteristics. Results support a family-centered approach to treatment of obesity in children with ASD.
HIGH-RISK INTRAOCULAR RETINOBLASTOMA
Authors: Kaliki Swathi , Shields Carol L. , Eagle Ralph C. , Iram Sadiya , Shields Jerry A. 
Published: August 2017

Purpose:To identify the differences in the clinical and histopathologic features in eyes with advanced intraocular retinoblastoma in a developing country (India) versus a developed country (USA).Methods:Retrospective study.Results:Of 524 patients with retinoblastoma who underwent primary enucleation, 331 were from India, and 193 were from the USA. Asian Indians were older at presentation (35 months vs. 29 months;P= 0.02), had thicker tumors (13.8 mm vs. 12.4 mm;P= 0.0001) compared with Americans. High-risk intraocular retinoblastoma was more common in Asian Indians with a 2-fold greater risk compared with Americans (35% vs. 23%; odds ratio = 1.83;P= 0.003). Statistically significant differences in the histopathologic features (Asian Indians vs. Americans) included massive (≥3 mm) choroidal infiltration (17% vs. 6%;P= 0.0003) and optic nerve infiltration (48% vs. 15%;P= 0.0001). Asian Indians had a 5-fold greater risk of having optic nerve invasion (odds ratio = 5.45;P< 0.0001) and 3-fold greater risk of massive choroidal invasion (odds ratio = 2.80;P< 0.0001) compared with Americans. With appropriate use of adjuvant systemic chemotherapy, the difference in the rates of systemic metastasis (5% vs. 2%,P= 0.67) and related death in both countries (5% vs. 0%,P= 0.14) were not statistically significant.Conclusion:High-risk intraocular retinoblastoma is more common in Asian Indians compared with Americans.
DISEASE ACTIVITY AFTER DEVELOPMENT OF LARGE SUBRETINAL HEMORRHAGE IN POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Baek Jiwon , Kim Jae Hui , Lee Mee Yon , Lee Won Ki 
Published: August 2017

Purpose:
To investigate changes in disease activity after a large subretinal hemorrhage in polypoidal choroidal vasculopathy.

Methods:
Fifty-two polypoidal choroidal vasculopathy eyes with large subretinal hemorrhage (at initial presentation [n = 33, Group 1] or developed during follow-up [n = 19, Group 2]) were enrolled. Thirty polypoidal choroidal vasculopathy eyes without subretinal hemorrhage were enrolled as controls. All subretinal hemorrhages were treated with pneumatic displacement. Other active lesions were treated with intravitreal ranibizumab on an as-needed basis. Injection-free period, 1-year injection numbers, and polyp presence on indocyanine green angiography were analyzed.

Results:
The injection frequency significantly diminished after hemorrhage (1.2 ± 1.8 in Group 1 and 1.1 ± 2.1 in Group 2) compared with control eyes (3.9 ± 3.0) in both groups (both P < 0.001) and the prehemorrhage period (4.7 ± 1.4) in Group 2 (P < 0.001). The median injection-free period after hemorrhage was 12.0 months in both groups. At least one polypoidal lesion disappeared after hemorrhage in 7 of 10 eyes (70%) with comparable indocyanine green angiography.

Conclusion:
The activity of a polypoidal choroidal vasculopathy lesion diminished after a large subretinal hemorrhage, which was associated with rupture of major polyps.
MULTIPLE SEROUS PIGMENT EPITHELIAL DETACHMENTS IN ASSOCIATION WITH MAJOR WEIGHT LOSS: CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Kheir Valeria , Ambresin Aude , Mantel Irmela 
Published: August 2017

Purpose:
To report about two cases with bilateral multiple serous pigment epithelial detachments (sPED) following major acute weight loss.

Methods:
Retrospective chart review of patients who presented with bilateral multiple sPED following acute major weight loss. The files were reviewed for their general and ophthalmic history, medication, ophthalmic status, optical coherence tomography (OCT) and enhanced depth imaging, fluorescein and indocyanine green angiography, arterial pressure, and laboratory workup.

Results:
Two patients, both women, aged 45 and 50 years were identified. The sPED counted 50 and 5, respectively. They were located in the mid-periphery and the macula. Multimodal imaging including optical coherence tomography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography did not reveal an underlying ocular pathology. However, both patients had a thick choroid (455 μm and 542 μm). They both had gone through intentional major weight loss induced by protein-rich Dukan's diet (−20 kg in 3 months) and gastric bypass with protein-enriched diet (−35 kg in less than 1 year), respectively. They were substituted with vitamins (vitamin B, C, D).

Conclusion:
Bilateral multiple serous PEDs may occur in the context of acute major weight loss and protein-rich diet. The precise pathogenesis remains to be elucidated. However, potential candidates include the protein-, mineral- and/or vitamin-related metabolism disturbing the pigment epithelium function. A predisposition for a central serous chorioretinopathy like response might have contributed.
Therapeutic Femtosecond Laser-Assisted Lamellar Keratectomy for Multidrug-Resistant Nocardia Keratitis
Authors: Shah Parth , Zhu Dagny , Culbertson William W. 
Published: August 2017

Purpose:
To describe the novel use of femtosecond laser technology for therapeutic resection of infectious foci in a case of multidrug-resistant Nocardia asteroides keratitis.

Methods:
A 30-year-old man presented with a corneal infiltrate. Cultures were taken, and fortified vancomycin and tobramycin were initiated. After 3 negative cultures and minimal improvement on various broad-spectrum antibiotics, all topical medications were stopped and a final fourth corneal culture grew N. asteroides. Treatment with topical amikacin was initiated, but the infection continued to worsen. With drug sensitivities still pending, the patient's clinical status continued to deteriorate rapidly, despite treatment with amikacin, gatifloxacin, and polymyxin B/trimethoprim. The femtosecond laser was then used to perform targeted lamellar keratectomy.

Results:
Femtosecond laser-assisted lamellar keratectomy successfully removed the infected tissue and allowed for increased penetration of topical antibiotics. Drug sensitivities finally returned, revealing multidrug resistance and sensitivity only to trimethoprim/sulfamethoxazole and tobramycin, some of which the patient had previously tried and failed. The infection fully resolved after readministering polymyxin B/trimethoprim and tobramycin, leaving minimal residual scarring.

Conclusions:
Multidrug-resistant N. asteroides keratitis can be difficult to manage even with appropriate antibiotic therapy based on drug sensitivity testing. Femtosecond laser-assisted resections may facilitate treatment in these cases by safely and precisely debulking infected tissue and enhancing penetration of topical medications.
Donor-Derived Conjunctival-Limbal Melanoma After a Keratolimbal Allograft
Authors: Sepsakos Lorena , Cheung Albert Y. , Nerad Jeffrey A. , Mogilishetty Gautham , Holland Edward J. 
Published: August 2017

Purpose:
To report a single case of donor-derived conjunctival–limbal melanoma that occurred after a keratolimbal allograft (KLAL).

Methods:
Case report and literature review.

Results:
A 56-year-old white woman with a history of bilateral limbal stem cell deficiency developed a donor-related melanoma after a KLAL. Three months after undergoing an uncomplicated KLAL, the patient presented with hemorrhagic nodules within her conjunctiva and transplanted tissue. Excisional biopsy was performed, and the pathology results revealed melanoma cells. Although the donor of the KLAL had a history of metastatic melanoma, the ocular tissue was in compliance with all eye bank requirements for donation. After discovery of the tumor, the patient's systemic immunosuppression was stopped. Within 1 week, the patient demonstrated a dramatic improvement in the size of the lesion. One month after the initial biopsy, the KLAL tissue was excised, and a pathology report revealed that there were no viable tumor cells on the ocular surface. As the limbal stem cell deficiency recurred, the eye underwent placement of a Boston type 1 keratoprosthesis.

Conclusions:
We present a case of conjunctival–limbal melanoma after a KLAL from a donor who had a history of metastatic melanoma. In response to this case, the US eye banking guidelines were amended to include stricter parameters for vascularized ocular tissue transplantation.
Effect of Multipurpose Solution Combined With Autophagy Inhibitors on Adhesion of Acanthamoeba trophozoites to Silicone Hydrogel Contact Lenses
Authors: Lee Seung-Mok , Lee Da-In , Park Sung-Hee , Yu Hak-Sun , Lee Ji-Eun , Lee Jong-Soo 
Published: August 2017

Purpose:
The aim of the study was to evaluate the effect of multipurpose contact lens (CL) solution (MPS) combined with autophagy inhibitors on the adhesion properties of Acanthamoeba castellanii (AC) trophozoites to silicone hydrogel CLs.

Methods:
AC trophozoites were inoculated onto discs trimmed from a silicone hydrogel CL with plasma surface treatment. After 18 hours, the number of adherent AC trophozoites on the CL treated with MPS was counted under phase-contrast microscopy. We analyzed the efficacy of MPS combined with autophagy inhibitors, 3-methyladenine (0.1, 1, and 5 mM) and chloroquine (10, 100 μM, and 1 mM), on Acanthamoeba adhesion by electron microscopy.

Results:
Adhesion of AC trophozoites to the CL treated with MPS (average number of trophozoites adhered to the CL: 61.2 ± 8.1) was significantly lower compared with that of the CL treated without MPS (83.8 ± 10.2) (P = 0.027). In MPS application, the number of adhered AC trophozoites treated with 3-methyladenine [8.2 ± 2.5 for 5 mM (P = 0.008)] or chloroquine [19.4 ± 7.6 for 100 μM (P = 0.038) and 5.3 ± 1.9 for 1 mM (P = 0.001)] was significantly reduced compared with the sample without autophagy inhibitors. However, the number of adherent AC trophozoites was not significantly reduced in less than 5 mM in 3-methyladenine [50.4 ± 5.1 for 0.1 mM (P = 0.084) and 43.1 ± 5.0 for 1 mM (P = 0.079)] and 100 μM in chloroquine [40.6 ± 13.5 for 10 μM (P = 0.075)]. 3-methyladenine induced blebby structures or disrupted the membranes of AC trophozoites. AC trophozoites treated with chloroquine showed undigested organelles in the cytoplasm of Acanthamoeba cells.

Conclusions:
MPS combined with 3-methyladenine or chloroquine reduced the adhesion rate of AC trophozoites rather than MPS containing only polyhexamethylene biguanide. Appropriate concentrations of autophagy inhibitors, 3-methyladenine and chloroquine, added to commercial MPS should be considered to decrease the clinical rate of Acanthamoeba keratitis.
Intraocular Pressure Fluctuations and 24-Hour Continuous Monitoring for Glaucoma Risk in Wind Instrument Players
Authors: de Crom Ronald M.P.C. , Webers Carroll A.B. , van Kooten-Noordzij Marina A.W. , Michiels Agnes C. , Schouten Jan S.A.G. , Berendschot Tos T.J.M. , Beckers Henny J.M. 
Published: August 2017

Purpose:
The purpose of this study is to investigate the influence of playing a wind instrument on intraocular pressure (IOP) and to monitor 24-hour (IOP) fluctuations in wind musicians of symphony and wind orchestras to compare IOP levels during normal daily activities with IOP levels during playing.

Methods:
Professional and amateur musicians of symphony and wind orchestras were invited to participate. A total of 42 participants, 9 with glaucoma, underwent a routine ophthalmologic examination. IOP measurements were taken before and immediately after 20 minutes of playing wind instruments. In addition, 6 participants underwent 24-hour IOP monitoring with the Triggerfish (Sensimed AG, Switzerland) sensing contact lens, during which they kept an activity logbook.

Results:
Eleven professionals and 31 amateur musicians participated in the study. A total of 7 eyes of 6 patients underwent additional 24-hour IOP monitoring. Mean IOP before playing was 13.6±2.6 mm Hg, IOP change after playing was +1.5±2.2 mm Hg with a significant difference between professionals (2.5±1.5 mm Hg) and amateurs (1.1±2.3 mm Hg). There were no significant differences in IOP change between subjects with or without glaucoma. During 24-hour IOP monitoring there were slight increases in IOP while playing an instrument, but also during other activities and overnight. These latter IOP levels were similar or even higher than the IOP rise caused by playing a wind instrument.

Conclusions:
IOP often rises after playing wind instruments, but similar or even higher IOP levels seem to occur during common other daily activities or at night. These peaks may be relevant for glaucomatous field progression and treatment of glaucoma patients.
Valsalva Maneuver-induced Changes in Anterior Lamina Cribrosa Surface DEPTH: A Comparison Between Normal and Glaucomatous Eyes
Authors: Kim Young Kook , Ha Ahnul , Song Yong Ju , Na Kyeong Ik , Lee Won June , Jeoung Jin Wook , Park Ki Ho 
Published: August 2017

Purpose:
The purpose of this study is to investigate the influence of the Valsalva maneuver (VM) on anterior lamina cribrosa surface depth (ALCSD), and to compare normal with treated glaucomatous eyes in terms of this effect.

Methods:
Thirty-two patients (32 eyes) with early-to-moderate glaucoma under treatment and 30 normal healthy participants (30 eyes) were prospectively enrolled. Study subjects performed the VM by blowing through a mouthpiece attached to a handheld manometer; expiratory pressure during the maneuver ranged from 35 to 40 mm Hg. Swept-source optical coherence tomography B-scans were performed during phase 2 of the VM (from 10 to 15 s).

Results:
The ALCSD was significantly different in the normal eyes only, decreasing by 31.90±14.81 μm (−8.79%; 394.85±53.63 μm at baseline vs. 362.95±44.23 μm during the VM; P<0.001). In the glaucomatous eyes, the ALCSD decreased by only 3.57±4.91 μm (−0.75%; 473.85±64.35 μm at baseline vs. 470.28±68.18 μm during the VM; P=0.092). In multivariate regression analysis, the mean ALCSD change was greater when the central corneal thickness was thinner in glaucomatous eyes (standardized β value=0.21; P=0.02), whereas that was greater in normal eye when baseline IOP was lower (standardized β value=0.37; P<0.001).

Conclusions:
During the VM, the ALCSD was decreased in normal eyes, but was not significantly changed in eyes with treated glaucoma. These results suggest that the physiology of LC displacement in response to IOP and cerebrospinal fluid pressure dynamics might differ between normal and glaucomatous eyes.
Adverse Events Following Vaccination With Bivalent rLP2086 (Trumenba®): An Observational, Longitudinal Study During a College Outbreak and a Systematic Review
Authors: Fiorito Theresa M. , Baird Grayson L. , Alexander-Scott Nicole , Bornschein Suzanne , Kelleher Catherine , Du Nan , Dennehy Penelope H. 
Published: August 2017

Background:
In February 2015, two unlinked culture-confirmed cases of Neisseria meningitidis serogroup B (MenB) disease occurred at a local college in Rhode Island (“college X”) within 3 days. This represented a 489-fold increase in the incidence of MenB disease, and an outbreak was declared. For the first time, bivalent rLP2086 (Trumenba®) was selected as a mandatory intervention response. A mass vaccination clinic was coordinated, which provided a unique opportunity to collect safety data in a real-world population of college-age participants. Though the Advisory Committee on Immunization Practices recommends MenB vaccination for college-age individuals (16–23 year olds), there is limited quantifiable safety data available for this population.

Methods:
The Dillman total design survey method was used. Adverse events of bivalent rLP2086 were solicited and quantified retrospectively 2–4 months following each dose of vaccine. Safety data from six clinical trials were used as comparison tools.

Results:
The most commonly reported adverse event following vaccination was injection site pain. Reported rates of injection site pain, fatigue, myalgia, fever, and chills were similar than those reported in clinical trials. Reported rates of headache were lower than in clinical trials.

Conclusions:
This study is the first to examine adverse events of bivalent rLP2086 in a real-world setting where more than 90% of a college-age population was vaccinated.
Higher Transplacental Pathogen-Specific Antibody Transfer Among Pregnant Women Randomized to Triple Antiretroviral Treatment Versus Short Course Zidovudine
Authors: Bosire Rose , Farquhar Carey , Nduati Ruth , Broliden Kristina , Luchters Stanley , Van de Perre Philippe , De Vincenzi Isabelle , Merkel Michele , Wachuka Veronicah , Mbori-Ngacha Dorothy , John-Stewart Grace , Lohman-Payne Barbara , Reilly Marie 
Published: August 2017

Background:
HIV-1 infection may impair transplacental antibody transfer to infants. The impact of highly active antiretroviral treatment (ART) given during pregnancy on transplacental antibody transport is unknown.

Methods:
HIV-1 infected pregnant women with CD4 counts between 200 – 500 were randomized to short-course zidovudine (ZDV) or triple ART at 32 weeks gestation for prevention of mother-to-child HIV-1 transmission. Levels of maternal antibody against measles, pneumococcus and rotavirus at delivery, and antibody transfer to the baby through cord blood, were compared between trial arms.

Results:
Overall, 141 and 148 women were randomized to triple ART and ZDV, respectively; cord blood was available for a subset (n = 20 in triple ART and n = 22 in ZDV). Maternal antibody levels to all pathogens during pregnancy and at delivery were not significantly different between arms. Within each arm, antibody levels at delivery were lower than at enrolment. For all antibodies, a woman’s levels before delivery were an important predictor of amount transferred to her infant. Women on triple ART transferred higher levels of pathogen-specific antibodies when compared with women on short course ZDV.

Conclusions:
Women on triple ART transferred higher levels of pathogen-specific antibodies compared with women on ZDV alone.