bluuebunny/crossref_metadata_2025_split huggingface dataset:
Finer Needles Reduce Pain Associated With Injection of Local Anesthetic Using a Minimal Insertion Injection Technique
Authors: Zelickson Blake R. , Goldberg Leonard H. , Rubenzik Marc K. , Wu Wesley J. 
Published: October 2017

BACKGROUND
The injection of local anesthetic into the skin is often the only memorable event described by the patient after dermatologic procedures.

OBJECTIVE
The authors compared the pain felt during injection of local anesthetic using a minimal needle insertion technique with a 30- or 33-gauge needle.

MATERIALS AND METHODS
Three hundred eighteen patients with tumors on the head and neck were injected with lidocaine using a previously described technique with either a 30- or 33-gauge needle. After injection, patients were surveyed using the visual assessment scale for pain.

RESULTS
Seventy-seven percent of patients felt no pain with injection on the face using a 33-gauge needle compared with 64% with a 30 gauge, whereas 94% of patients felt no pain on the scalp with a 33-gauge needle compared with 54% with a 30 gauge. Visual analog scale scores were also significantly decreased on the face and scalp using the smaller needle. There was no difference in pain between the 2 needles with injection on the neck.

CONCLUSION
This study further validates the use of this technique for the injection of lidocaine and the preference of a 33 gauge over a 30-gauge needle for the initial injection on the face and scalp.
Long-Pulsed Nd:YAG Laser Treatment for Nail Psoriasis
Authors: Kartal Selda Pelin , Canpolat Filiz , Gonul Muzeyyen , Ergin Can , Gencturk Zeynep 
Published: October 2017

BACKGROUND
Psoriasis is a chronic inflammatory skin disease in which lesions display angiogenesis and increased vascularity.

OBJECTIVE
The long-pulsed 1,064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser treats vascular lesions which suggests that it might also be used to treat nail psoriasis.

METHODS
Sixteen patients (10 males and 6 females) with isolated nail psoriasis or nail with only mild cutaneous involvement were enrolled in the study. Nails were treated for 3 sessions with long-pulsed 1,064-nm Nd:YAG laser once monthly. During the course of the treatment, nail bed and matrix Nail Psoriasis Severity Index (NAPSI) scores were recorded.

RESULTS
The mean baseline NAPSI score was 26 ± 7.2. The means of total NAPSI scores after the first, second, and third treatment sessions were as follows: 22 ± 6.6, 13 ± 6, and 5.7 ± 4.3, respectively. The decline in NAPSI score was statistically significant. At the end of the 3 treatment sessions, both nail bed and matrix lesions significantly responded to Nd:YAG laser treatment.

CONCLUSION
The Nd:YAG laser is a promising treatment option for nail psoriasis.
A Novel Treatment of Acne Keloidalis Nuchae by Long-Pulsed Alexandrite Laser
Authors: Tawfik Abeer , Osman Mai Abdelraouf , Rashwan Iman 
Published: October 2017

BACKGROUND
Acne keloidalis nuchae (AKN) is a dermatological condition characterized by follicular-based papules and pustules that later form hypertrophic or keloid-like scars. Laser-assisted hair reduction such as 810-nm diode laser and 1,064-nm Nd:YAG laser have been used for treating AKN with promising results.

OBJECTIVE
To evaluate the therapeutic effect and safety of alexandrite laser in the treatment of different lesions of AKN.

METHODS
Seventeen male patients with AKN received 6 sessions of 755-nm alexandrite laser. Papule and pustule count, keloidal plaque size, pliability, tenderness, and itching were assessed at the fourth session and 4 weeks after the sixth session. Patient satisfaction and Dermatology Life Quality Index (DLQI) questionnaire were performed at the end of treatment. Patients were followed up for 3 months after the final treatment.

RESULTS
There was a significant decrease in the mean papule, pustule count, keloidal plaque size, and pliability at the fourth and sixth laser sessions when compared with baseline. Reduction of the hair density in the treated area is the only complication observed, which was accepted by the patients because of its reversible course. There was a statistically significantly higher percentage of improvement in the early lesions (papulopustular) compared with late (keloidal plaque) lesions. By the end of laser sessions, DLQI scores were significantly reduced. Temporary hair loss was noted in 4 patients in the treated sites. No lesional recurrence was detected in the follow-up period.

CONCLUSION
Using 755-nm alexandrite laser for treatment of AKN is a safe and effective procedure with low recurrence rates. Alexandrite laser can significantly improve the quality of life of those patients suffering from this disfiguring chronic disorder.
Improving Sun-Protective Behaviors and Self-Skin Examinations Among African Americans: A Randomized Controlled Trial
Authors: Tsai Sheena , Frank Scott H. , Bordeaux Jeremy S. 
Published: October 2017

BACKGROUND
Few studies describing sun-protective behaviors, knowledge, and self-efficacy in African Americans exist. Although educational programs targeting Caucasians and Hispanics have been successful in increasing melanoma awareness and knowledge, no such investigation has been applied to African Americans.

OBJECTIVE
To evaluate the effectiveness of a brochure or video educational intervention on the sun-protective behaviors, knowledge, and self-efficacy regarding melanoma in African Americans.

MATERIALS AND METHODS
A randomized controlled trial of a presurvey and postsurvey, in an academic outpatient dermatology clinic. Participants were self-identified African Americans, at least 18 years old, fluent, and literate in English. Patients randomized to the brochure-intervention group (n = 72) received a melanoma brochure from the National Cancer Institute. Patients randomized to the video-intervention group (n = 71) received the brochure and watched an online melanoma tutorial.

RESULTS
Sun-protective behaviors, knowledge, and self-efficacy regarding melanoma all improved equally from pre-to posteducation, in both the brochure- and video-intervention groups.

CONCLUSION
Melanoma educational interventions similar to those previously demonstrated to be successful in Caucasian and Hispanic populations are also effective among African Americans.
Tracheocutaneous Fistula Closure with Turnover Flap and Polydioxanone Plate
Authors: Bryant Justin R. , Boonipat Thanapoom , Chaiyasate Kongkrit 
Published: October 2017

Summary:
An alternative surgical treatment is proposed for closure of tracheocutaneous fistulas. The authors present a new technique for reconstruction of persistent tracheocutaneous fistula resultant from temporary tracheostomy. The single-stage closure under local anesthesia involves a fistulous tract turnover flap with a perforated 0.15 mm polydioxanone plate between the flap and the subcutaneous closure. This article presents 3 cases of persistent tracheocutaneous fistula treated by this method. At follow-up examination after follow-up, no recurrent fistula formation had occurred, and no respiratory deformity was present.
INTRAOCULAR LENS POSITION IN COMBINED PHACOEMULSIFICATION AND VITREORETINAL SURGERY
Authors: Ozates Serdar , Kiziltoprak Hasan , Koc Mustafa , Uzel Mehmet Murat , Teke Mehmet Yasin 
Published: October 2017

Purpose:
To assess the decentration and angle of tilt of the intraocular lens (IOL) according to the intravitreal tamponade types used in combined phacoemulsification and vitreoretinal surgery.

Methods:
This prospective and randomized clinical study involved 73 eyes of 69 patients who underwent combined vitreoretinal surgery. Eyes with intravitreal tamponades formed the study group and eyes without intravitreal tamponades formed the control group. The study group was further divided into silicone oil and gas tamponade subgroups. Cross-sectional IOL images were captured using a Pentacam HR (Oculus, Germany) and tilt and decentration were calculated with Adobe Photoshop software (Adobe, San Jose, CA).

Results:
The mean angle of tilt and decentration at the vertical meridian were significantly higher in both tamponade groups than in the control group (P < 0.05 for all). No significant difference was observed among the groups regarding IOL position parameters at the horizontal meridian (P > 0.05). When comparing the silicone oil and gas tamponade subgroups, no significant differences were noted on the position of IOL at both meridians (P > 0.05 for all).

Conclusion:
Intravitreal tamponades have an important effect on the position of IOL in combined vitreoretinal surgery. Silicone oil and gas tamponades may induce postoperative tilt and decentration of one-piece acrylic IOLs.
CHOROIDAL STRUCTURAL CHANGES AND VASCULARITY INDEX IN STARGARDT DISEASE ON SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY
Authors: Ratra Dhanashree , Tan Roy , Jaishankar Durgasri , Khandelwal Neha , Gupta Arushi , Chhablani Jay , Agrawal Rupesh 
Published: October 2017

Purpose:
To evaluate structural changes in the choroid of patients with Stargardt disease using swept source optical coherence tomography scans.

Methods:
A retrospective comparison cohort study was conducted on 39 patients with Stargardt disease, and on 25 age and gender matched-healthy controls. Subfoveal choroidal thickness (SFCT) was computed from the swept source optical coherence tomography machine, and the scans were binarized into luminal area and stromal areas, which were then used to derive choroidal vascularity index (CVI). Choroidal vascularity index and SFCT were analyzed independently using linear mixed effects model.

Results:
There was no significant difference in SFCT between the 2 groups (347.20 ± 13.61 μm in Stargardt disease vs. 333.09 ± 18.96 μm in the control group, P = 0.548). There was a significant decrease in the CVI among eyes with Stargardt disease as compared with the normal eyes (62.51 ± 0.25% vs. 65.45 ± 0.29%, P < 0.001). There was a negative association between visual acuity and CVI (correlation coefficient = −0.75, P < 0.001) and a positive association between visual acuity and SFCT (correlation coefficient = 0.21, P = 0.035).

Conclusion:
Choroidal vascularity index appears to be a more robust tool compared with SFCT for choroidal changes in Stargardt disease. Choroidal vascularity index can possibly be used as a surrogate marker for disease monitoring. A decrease in CVI was associated with a decrease in visual function in eyes with Stargardt disease.
TREFOIL FACTOR FAMILY 1 EXPRESSION CORRELATES WITH CLINICAL OUTCOME IN PATIENTS WITH RETINOBLASTOMA
Authors: Busch Maike , Metz Klaus , Beier Manfred , Biewald Eva , Dünker Nicole 
Published: October 2017

Purpose:
Correlation of trefoil factor family 1 (TFF1) expression in retinoblastoma tumors with different clinical parameters to evaluate a potential involvement of TFF1 in tumor development and progression.

Methods:
A representative cohort of 59 enucleated eyes from individual patients with retinoblastoma was analyzed for its TFF1 expression profile by immuno staining and real-time PCR. Trefoil factor family 1 expression was correlated with demographics, laterality, tumor-node-metastasis stage, International Classification of Retinoblastoma, tumor differentiation level, and treatment.

Results:
According to our analysis, increased TFF1 expression significantly correlates with unilateral tumors diagnosed in older children and with poorly differentiated tumors and higher tumor-node-metastasis stages.

Conclusion:
This retrospective study reveals that unilateral tumors at a higher clinical tumor-node-metastasis stage and poorly differentiated tumor cells express significantly higher levels of TFF1 than those of differentiated tumors at lower tumor-node-metastasis stages. Besides, TFF1 expression correlates with the age of the patients at the time of tumor diagnosis. Our data indicate that TFF1 expression levels are potentially useful additional markers in the classification of tumor staging and prognosis of patients with retinoblastoma.
INTRAOCULAR DEXAMETHASONE IMPLANT POSITION IN SITU AND OCULAR HYPERTENSION
Authors: Sudhalkar Aditya , Kodjikian Laurent , Chhablani Jay , Bhojwani Deepak , Vasavada Abhay 
Published: October 2017

Purpose:
To determine the association between the dexamethasone implant position in the vitreous cavity and ocular hypertension (OHT).

Methods:
Retrospective review of patients with at least one intravitreal dexamethasone implant injection between 2012 and 2016. Patients who had a minimum follow-up for 6 months and documented evidence of the implant position were included in the study. Steroid responders, glaucoma patients, vitrectomized eyes, and eyes with liquefied vitreous were excluded. Relevant data were collected from patient charts. Three positions (P1, P2, and P3) were identified: P1 (in contact with the pars plana/ciliary body region), P2 (anterior to vortex veins), and P3 (posterior to vortex veins). Ocular hypertension was defined as absolute intraocular pressure > 25 mmHg and/or intraocular pressure rise > 10 mmHg. The relationship between implant position and intraocular pressure rise after factoring in other characteristics was the outcome measure. Appropriate statistical analysis was performed.

Results:
A total of 377 patients (432 eyes; 257 males; 677 injections) were eligible for analysis. The median age was 57.24 (±6.32) years. Eighty-eight eyes had OHT. Of these, 54 eyes had the implant in P1. P1 was associated with high intraocular pressure response (>15 mmHg; P = 0.004) and early (<15 days) onset OHT (r = 0.84, P < 0.001).

Conclusion:
Anterior position of dexamethasone implant in situ increases the risk of OHT.
PARACENTRAL ACUTE MIDDLE MACULOPATHY IN SUSAC SYNDROME
Authors: Haider Ali S. , Viswanathan Deepa , Williams David , Davies Peter 
Published: October 2017

Purpose:
To present the first reported case of paracentral acute middle maculopathy in association with Susac syndrome.

Method:
Case report.

Results:
A young female patient presented with unilateral sudden loss of vision of her right eye to count fingers. There were numerous cotton wool spots in a multifocal pattern concentrated around the right macula and optic disk. Clinical examination and spectral domain optical coherence tomography imaging were consistent with paracentral acute middle maculopathy, and fluorescein angiography showed features of retinal arteriole vasculitis. Magnetic resonance imaging demonstrated multiple white matter lesions in a pericallosal distribution. High-dose corticosteroid therapy was commenced, and visual acuity gradually improved to 6/6 corrected. The patient reported hearing impairment and was diagnosed with Susac syndrome for which she has responded extremely well to long-term immunosuppressive therapy.

Conclusion:
Paracentral acute middle maculopathy can occur in association with Susac syndrome. Susac syndrome may present only with multifocal retinal ischemia, and such patients with paracentral acute middle maculopathy should be checked for characteristic magnetic resonance imaging lesions and hearing loss.
TRANSTHYRETIN V30M FAMILIAL AMYLOIDOSIS PRESENTING AS ISOLATED RETINAL ANGIOPATHY
Authors: Chen Judy J. , Kalevar Ananda , Vora Robin A. , Qian Ying , Gorenberg Peter H. , Garcia-Kennedy Richard , Cunningham Emmett T. 
Published: October 2017

Purpose:
To describe a patient with confirmed transthyretin V30M form of familial amyloidosis who presented initially with isolated retinal angiopathy.

Methods:
Retrospective chart review.

Results:
A 66-year-old woman presented with bilateral retinal angiopathy. Extensive workup for an infectious, inflammatory, or hypercoagulable cause was unrevealing. The patient subsequently developed bilateral neovascularization of the optic nerve and iris complicated by recurrent vitreous hemorrhages, which were treated with intravitreal bevacizumab and panretinal photocoagulation. The development of cardiac and gastrointestinal symptoms 5 years after presentation led to tissue biopsies that revealed both Congo red staining and apple-green birefringence in polarized light, confirming the diagnosis of systemic amyloidosis. Sequencing of the transthyretin gene confirmed the patient to be heterozygous for the common amyloidogenic V30M mutation.

Conclusion:
The common transthyretin V30M form of familial amyloidotic polyneuropathy can rarely present with retinal angiopathy. Recurrent vitreous hemorrhages were treated successfully with intravitreal bevacizumab and panretinal photocoagulation.
Episcleral Venous Outflow: A Potential Outcome Marker for iStent Surgery
Authors: Bostan Cristina , Harasymowycz Paul 
Published: October 2017

Purpose:
(1) To propose the use of episcleral venous outflow (EVO) as an outcome marker of iStent surgery, and an EVO grading scale. (2) To determine the association of EVO with: (a) postoperative intraocular pressure (IOP) and medication burden; (b) iStent patency status.

Patients and Methods:
Retrospective cohort study including 151 glaucomatous eyes having undergone iStent-phacoemulsification surgery. Demographic and preoperative data (IOP, number of antiglaucoma medications, glaucoma type and stage, maximal IOP) were collected. Postoperatively, were recorded: IOP, number of antiglaucoma medications, occurrence of stent malpositioning or obstruction, and EVO scores based on the proposed scale (0: no laminar flow; 1+: faint laminar flow; 2+: marked laminar flow). A Kruskal-Wallis test determined the association between EVO, postoperative IOP, and medication burden. A multivariable-adjusted ordinal logistic regression was used for the association with iStent patency status.

Results:
Patients with marked laminar flow (2+) were more likely to have a lower IOP (P=0.022) and fewer medications (P=0.009) at 1-year postoperatively than those with no laminar flow (0). No difference was found in postoperative IOP and number of medications when comparing patients having faint laminar flow (1+) with patients from the other 2 EVO categories (0 and 2+). iStent patency was associated with greater EVO as opposed to its obstruction (odds ratio, 4.73; 95% confidence interval, 1.74-12.9). No malpositioned stents were noted in our cohort.

Conclusions:
The use of EVO as an outcome marker of iStent surgery is physiologically plausible. The proposed EVO grading scale is simple, comprises few categories, and is easily applicable in an in-office setting. The results of this study suggest this scale could be useful in the assessment of iStent functionality and encourage its further investigation in prospective studies.
Glaucoma Diagnostic Capabilities of Foveal Avascular Zone Parameters Using Optical Coherence Tomography Angiography According to Visual Field Defect Location
Authors: Kwon Junki , Choi Jaewan , Shin Joong Won , Lee Jiyun , Kook Michael S. 
Published: October 2017

Purpose:
To assess the diagnostic ability of foveal avascular zone (FAZ) parameters to discriminate glaucomatous eyes with visual field defects (VFDs) in different locations (central vs. peripheral) from normal eyes.

Patients and Methods:
Totally, 125 participants were separated into 3 groups: normal (n=45), glaucoma with peripheral VFD (PVFD, n=45), and glaucoma with central VFD (CVFD, n=35). The FAZ area, perimeter, and circularity and parafoveal vessel density were calculated from optical coherence tomography angiography images. The diagnostic ability of the FAZ parameters and other structural parameters was determined according to glaucomatous VFD location. Associations between the FAZ parameters and central visual function were evaluated.

Results:
A larger FAZ area and longer FAZ perimeter were observed in the CVFD group than in the PVFD and normal groups. The FAZ area, perimeter, and circularity were better in differentiating glaucomatous eyes with CVFDs from normal eyes [areas under the receiver operating characteristic curves (AUC), 0.78 to 0.88] than in differentiating PVFDs from normal eyes (AUC, 0.51 to 0.64). The FAZ perimeter had a similar AUC value to the circumpapillary retinal nerve fiber layer and macular ganglion cell-inner plexiform layer thickness for differentiating eyes with CVFDs from normal eyes (all P>0.05, the DeLong test). The FAZ area was significantly correlated with central visual function (β=−112.7, P=0.035, multivariate linear regression).

Conclusions:
The FAZ perimeter had good diagnostic capability in differentiating glaucomatous eyes with CVFDs from normal eyes, and may be a potential diagnostic biomarker for detecting glaucomatous patients with CVFDs.
Comparison of Del Nido Cardioplegia with Blood Cardioplegia in Adult Combined Surgery
Authors: Hamad Raphael , Nguyen Anthony , Laliberté Éric , Bouchard Denis , Lamarche Yoan , El-Hamamsy Ismail , Demers Philippe 
Published: October 2017

Objective del Nido solution (DNS) is a single-dose cardioplegia designed for pediatric use proposed to offer superior myocardial protection in adults. However, few data support this claim. We hypothesized that DNS and modified blood cardioplegia solution (BS) provide equivalent safety in combined adult valve surgery. Methods Between November 2014 and December 2015, 25 patients underwent primary aortic valve replacement and concomitant coronary artery bypass grafting (CABG) with DNS. Outcomes were compared with 25 patients who underwent the same surgery with BS between September 2013 and August 2015. Results All preoperative characteristics, comorbidities, and number of CABG performed were similar between groups. One hospital death occurred in the BS group. Postoperative creatine kinase, MB isotype (16.7 ± 5.3 μg/L vs. 22.1 ± 8.9 μg/L, P = 0.011) and troponin T levels (260 ± 105.3 ng/L vs. 370.5 ±218.4 ng/L, P =0.028) were significantly lower in the DNS group. There was no difference in inotropic or vasoactive agent use ( P = 0.512). Cardiopulmonary bypass times (65.5 ± 12.5 min vs. 76.6 ± 19.1 min, P = 0.019) and cross-clamp times (55.6 ± 11.2 min vs. 64.3 ± 18.9 min, P = 0.05) were lower in the DNS group but total operating room times ( P = 0.198) were similar. Peak postoperative creatinine levels were similar in both groups ( P = 0.063). There was no difference in postoperative outcomes including acute renal failure ( P > 0.999), atrial fibrillation ( P = 0.773), acute respiratory failure ( P > 0.999), nor stroke or transient ischemic attack ( P > 0.999). Intensive care unit stay ( P = 0.213) and hospital stay ( P = 0.1) did not differ between groups. Conclusions The DNS can be used as an alternative to BS in adult concomitant aortic valve replacement + CABG surgery. This supports our hypothesis that in this specific setting, DNS provides comparable myocardial protection as BS, with possibly shorter cardiopulmonary bypass and cross-clamp times.