J reconstr Microsurg
DOI: 10.1055/s-0038-1676602
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Article in Thieme eJournals:
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Σάββατο 22 Δεκεμβρίου 2018
Lateral Crisscross Position for Lymphaticovenular Anastomosis: Comfortable for Both the Patient and the Surgeon
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Obesity and Lower Extremity Reconstruction: Evaluating Body Mass Index as an Independent Risk Factor for Early Complications
J reconstr Microsurg
DOI: 10.1055/s-0038-1676538
Background The prevalence of obesity in the United States continues to grow and is estimated to affect over a quarter of the working-age population. Some studies have identified obesity as a risk factor for flap failure and complications in free flap-based breast reconstruction, but its clinical significance is less clear in nonbreast reconstruction. The role of obesity as a risk factor for failure and complications following lower extremity reconstruction has not been well described, and the limited existing literature demonstrates conflicting results. Methods The American College of Surgeons National Surgical Quality Improvement Program database was reviewed to identify patients undergoing local- or free-flap reconstruction of the lower extremity between 2010 and 2015. Preoperative variables and outcomes were compared between obese (body mass index ≥ 30) and nonobese patients. Chi-square analysis and Fisher's exact test were used for categorical variables and t-tests for continuous variables. Multivariate regression was performed to control for confounders. Results Univariate analysis of medical and surgical outcomes revealed that obese patients undergoing local flaps of the lower extremity required a significantly longer operative time (187.7 ± 123.2 vs. 166.2 ± 111.7 minutes; p = 0.003) and had significantly higher rates of superficial surgical site infection (SSI; 7.2% vs. 4.5%; p = 0.04). On univariate analysis, there were no significant differences in any postoperative outcomes between obese and nonobese patients undergoing microvascular free flaps of the lower extremity.On multivariate regression analysis, obesity was not an independent risk factor for superficial SSI (odds ratio = 1.01, p = 0.98) or increased operative time (β = 16.01, p = 0.14) for local flaps of the lower extremity. Conclusions Evaluation of a large, multicenter, validated and risk-adjusted nationwide cohort demonstrated that obesity is not an independent risk factor for early complications following lower extremity reconstruction, suggesting that these procedures may be performed safely in the obese patient population.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Top‐down and Bottom‐up Control of Stress‐Coping
Abstract
In this 30th anniversary issue review, we focus on glucocorticoid modulation of limbic‐prefrontocortical circuitry during stress‐coping. This action of the stress hormone is mediated by mineralocorticoid receptors (MRs) and glucocorticoid receptors (GRs) that are co‐expressed abundantly in these higher brain regions. Via both receptor types, the glucocorticoids demonstrate, in various contexts, rapid nongenomic and slower genomic actions which coordinate consecutive stages of information processing. MR‐mediated action optimizes stress‐coping, while in complementary fashion, the memory storage of the selected coping strategy is promoted via GR. We highlight the involvement of adipose tissue in the allocation of energy resources to central regulation of stress reactions, point to still poorly‐understood neuronal ensembles in the prefrontal cortex that underlie cognitive flexibility critical for effective coping, and evaluate the role of cortisol as a pleiotropic regulator in vulnerability to, and treatment of, trauma‐related psychiatric disorders.
This article is protected by copyright. All rights reserved.
http://bit.ly/2PX8k1i
Efficacy and safety of switching to ixekizumab in secukinumab nonresponder psoriatic patients: results from a multicenter experience
Abstract
Loss of efficacy of biological therapies in psoriatic patients is a well‐known event. Biological switching is common in clinical practice, especially in TNF‐α and IL‐12/23 inhibitors treatment1,2. Recently, anti‐IL‐17A drugs such as secukinumab have provided a new therapeutic opportunity
This article is protected by copyright. All rights reserved.
http://bit.ly/2EJXtqr
Isotretinoin′s paradoxical effects in immortalized sebocytes
Abstract
in their recently published Research Letter, Burney et al.1 reported that the short‐term exposure of cultured SEB‐1 immortalized sebocytes to isotretinoin (13‐cis retinoic acid), the most powerful sebum‐suppressive drug promoting sebocyte apoptosis in acne patients, paradoxically increased lipogenesis and upregulated the expression of sterol regulatory element‐binding protein 1 (SREBP1)
This article is protected by copyright. All rights reserved.
http://bit.ly/2EIDp7j
Efficacy and safety of switching to ixekizumab in secukinumab nonresponder psoriatic patients: results from a multicenter experience
Abstract
Loss of efficacy of biological therapies in psoriatic patients is a well‐known event. Biological switching is common in clinical practice, especially in TNF‐α and IL‐12/23 inhibitors treatment1,2. Recently, anti‐IL‐17A drugs such as secukinumab have provided a new therapeutic opportunity
This article is protected by copyright. All rights reserved.
http://bit.ly/2EJXtqr
Isotretinoin′s paradoxical effects in immortalized sebocytes
Abstract
in their recently published Research Letter, Burney et al.1 reported that the short‐term exposure of cultured SEB‐1 immortalized sebocytes to isotretinoin (13‐cis retinoic acid), the most powerful sebum‐suppressive drug promoting sebocyte apoptosis in acne patients, paradoxically increased lipogenesis and upregulated the expression of sterol regulatory element‐binding protein 1 (SREBP1)
This article is protected by copyright. All rights reserved.
http://bit.ly/2EIDp7j
Masson’s tumor of the kidney: a case report
Intravascular papillary endothelial hyperplasia (known also as Masson's tumor) is a benign vascular lesion that commonly occurs in the skin and is rarely found in solid organs, especially in the kidney. In wha...
http://bit.ly/2A97PMz
Cardiac arrest associated with pneumorrhachis and pneumocephalus after epidural analgesia: two case reports
Epidural analgesia has become a common procedure to provide excellent pain relief with few complications. Pneumorrhachis and pneumocephalus are rare complications of unintentional dural puncture and injection ...
http://bit.ly/2Sgjgtb
Early presentation of vertebral osteomyelitis following a transrectal ultrasound-guided prostate biopsy with delayed radiological findings
A transrectal ultrasound-guided (TRUS) prostate biopsy is a common diagnostic procedure which carries an expected risk of iatrogenic infections. These range from simple urinary tract infections to rare but serious infections requiring an admission to hospital. Here we present a rare case of vertebral osteomyelitis following a TRUS biopsy, with normal initial MRI and bone scintigraphy scans and delayed radiological findings on repeat MRI of the spine.
http://bit.ly/2EDNwdm
Pleuropulmonary tuberculosis with spinal lesions due to metastatic malignancy differentiated definitively on imaging
A healthy 31-year-old man presenting with back pain was found to have multiple spinal enhancing lesions on MRI. An incidental asymptomatic large pleural effusion was identified on investigations for the back pain and pleural and pulmonary tuberculosis (TB) was subsequently diagnosed. The radiographical features on MRI spine were not typical of spinal TB and a Ga68 DOTATATE Positron Emission Tomography (PET)/CT confirmed metastatic paraganglioma with multiple bone metastases. Although metastatic paraganglioma is rare, this case highlights that even in young patients dual pathology needs to be considered. Most importantly, it is a reminder to physicians managing TB of the clues that help distinguish spinal TB from important alternative causes, including metastatic malignancy.
http://bit.ly/2EJacK5
Chlamydia ascites: a call for sexually transmitted infection testing
A 26-year-old gravida 2, para 2-0-0-2 woman with a recent uncomplicated vaginal delivery 10 weeks prior presented to our hospital with 5 weeks of abdominal swelling and discomfort. Four weeks after delivery, the patient began having right upper quadrant pain and was found to have cholelithiasis. She underwent an elective laparoscopic cholecystectomy 6 weeks prior to admission, but started to develop worsening abdominal swelling 1 week postoperatively. Abdominal distension and shifting dullness were present on examination. CT of the abdomen and pelvis was remarkable for moderate-volume ascites and mild enhancement of the pelvic peritoneum. Paracentesis removed 2.46 L of ascites fluid with 76% lymphocytic predominance. Results for Chlamydia trachomatis were positive in urine, cervical swab and ascitic fluid. Doxycycline was prescribed for a diagnosis of pelvic inflammatory disease exudative ascites. Since discharge, she has completed her antibiotic course and reports resolution of all symptoms without recurrence of ascites.
http://bit.ly/2ECyDbj
Removing the problem: parathyroidectomy for calciphylaxis
Calcific uremic arteriolopathy (CUA), widely known as calciphylaxis, is a rare and lethal disease that usually affects patients with end-stage renal disease. It is characterised by widespread vascular calcification leading to tissue ischaemia and necrosis and formation of characteristic skin lesions with black eschar. Treatment options include sodium thiosulfate, cinacalcet, phosphate binders and in resistant cases, parathyroidectomy. We report a case of recurrent, treatment-resistant CUA successfully treated with parathyroidectomy. Her postoperative course was complicated by hungry bone syndrome and worsening of her wounds before they completely healed. We then discuss the morbidity of CUA, including the controversy around the use of parathyroidectomy and risk of aggressive management of hungry bone syndrome.
http://bit.ly/2EMkycn
PIBIDS syndrome in two Brazilian siblings
Trichothiodystrophy is a rare condition associated with autosomal recessive or X-linked dominant variants in the ERCC2, ERCC3, GTF2H5, MPLKIP, RNF113A or GTF2E2 genes. The genes associated to photosensitive trichothiodystrophy encode subunits of transcription factor IIH, involved in the nucleotide excision repair pathway. The disease is characterised by cysteine-deficient brittle hair along with other neuroectodermal abnormalities. It has a variable clinical expression and some cases might be associated with photosensitivity, resulting in the acronym PIBIDS (photosensitivity, ichthyosis, brittle hair, intellectual impairment, decreased fertility and short stature). We report clinical findings of two siblings diagnosed with trichothiodystrophy associated with marked photosensitivity.
http://bit.ly/2EFE21q
Multiple melanoma in a burns scar
It is well known that up to 2% of chronic burn scar lesions can transform into malignant tumours, however, melanoma formation at these sites is extremely rare. This case report describes a burns case, which progressed to four melanomas in a 78-year-old male patient's little finger, 40 years after the initial incident. The patient underwent 3 mm punch biopsies, then digital amputation of the finger with pathology-proven melanoma. Histopathology investigation demonstrated three melanoma in situ and one invasive melanoma with a Breslow thickness of 1 mm. These findings are rare with few reports of melanoma in burn scars in the literature. This case report highlights the vigilance required from clinicians when performing skin examinations, and the importance of biopsies to newly pigmented lesions.
http://bit.ly/2ECmCmi
Bishop-Koop jejunostomy in an adult following proximal small bowel anastomotic breakdown
This case involves a proximal penetrating small bowel injury and the use of a Bishop-Koop anastomosis in a 33-year-old man. This case highlights the use of alternative methods used to prevent a proximal small bowel stoma in a rural setting. The Bishop-Koop anastomosis was originally designed for neonates in cases of intestinal anomalies such as atresia, volvulus and apple-peel syndrome. A literature search for the use of the Bishop-Koop anastomosis in adults, although scanty, is included in this article. We believe this article will benefit readers and that this method may be considered in breakdown of proximal small bowel injuries, to prevent a high-output stoma.
http://bit.ly/2EIcbOJ
Pars plana vitrectomy in management of giant retinal tear and retinal detachment following iris-fixated anterior chamber phakic intraocular lens implantation
This case report describes a 26-year-old man presenting with a giant retinal tear (GRT) with retinal detachment (RD) following implantation of iris-fixated anterior chamber phakic intraocular lens (AC-PIOL) for high myopia and occurrence of intraoperative aberrations during vitrectomy due to the presence of AC-PIOL in situ. Posterior chamber PIOL have been well reported to be associated with GRT with RD. Very few reports exist of GRT with RD following AC-PIOL. Moreover, the presence of iris-fixated AC-PIOL, in this case, led to the formation of ghost images intraoperatively especially during crucial steps like induction of posterior vitreous detachment which has never been reported.
http://bit.ly/2EJDE2v
IgA nephropathy with diffuse alveolar haemorrhage
Immunoglobulin (Ig)A nephropathy is the most common cause of primary glomerulonephritis worldwide. While IgA nephropathy has been associated with a variety of other diseases, pulmonary complications are extremely rare. A 58-year-old man presented with a 2-week history of fever and exertional dyspnoea. A chest imaging revealed bilateral consolidation predominantly in upper lungs. Laboratory findings showed elevated serum creatinine with proteinuria and haematuria. Flexible bronchoscopy revealed diffuse alveolar haemorrhage, and IgA nephropathy was confirmed on a renal biopsy. He received prednisone with good effect. This case highlights the need to consider IgA nephropathy in the differential diagnosis of pulmonary renal syndrome.
http://bit.ly/2EF3JPp
Unusual presentation of eosinophilic fasciitis (EF) with a raised ALT
Eosinophilic fasciitis (EF) is a syndrome of unknown aetiology characterised by progressive collagenous thickening of the subcutaneous fascia. Limb oedema can precede the skin thickening and induration classically associated with EF. We describe a case of EF in a 31-year-old woman who presented to her general practitioner with lower limb oedema and stiffness. Blood tests in primary care showed a persistently raised alanine transferase (ALT). No hepatic cause for her raised ALT was found despite investigation. The unusual manner of her presentation led to delay in her referral to the autoimmune connective tissue disease (CTD) clinic. This case illustrates the importance of considering autoimmune CTD such as EF in young patients presenting with limb oedema and raised ALT, as early treatment influences prognosis and functional recovery.
http://bit.ly/2EJDyrF
Acute on chronic anaemia with a haemoglobin of 18 g/L (1.8 g/dL) and haematocrit of 7.2%
Anaemia can present with symptoms of fatigue, shortness of breath, weakness, malaise, tachycardia and skin pallor. If left untreated, this can progress to life-threatening complications such as arrhythmias, cardiac hypertrophy and myocardial infarction. In this report, a 43-year-old woman, who was ambulatory with no exertional dysponea, presented with weakness, fatigue, bilateral lower extremity oedema and intermittent right sided chest pain for several months. This patient was subsequently found to have a haemoglobin of 18 g/L (1.8 g/dL) and haematocrit of 7.2%. She was admitted to the hospital and treated with seven units of blood. CT scan showed a 9.6 cm uterine fibroid in addition to a 5.9x5.4 cm mass near the right kidney, which was later diagnosed as metastatic carcinoid tumour. This case deserves attention due to the importance of looking for multiple causes of blood loss and the effects of low haemoglobin levels.
http://bit.ly/2EKkpWv
Promoting TERT Promoter Mutations for Prognostication in Cutaneous Oncology
Publication date: Available online 22 December 2018
Source: Journal of the American Academy of Dermatology
Author(s): Warren R. Heymann
http://bit.ly/2R8RBwZ
A simple and swift radiofrequency based epilation technique for gray and blonde hair
Publication date: Available online 21 December 2018
Source: Journal of the American Academy of Dermatology
Author(s): Sanjeev Gupta, Ravi Shankar Jangra, Somesh Gupta
http://bit.ly/2GB5FLC
Histological subtype of treatment failures after noninvasive therapy for superficial basal-cell carcinoma: an observational study
Publication date: Available online 21 December 2018
Source: Journal of the American Academy of Dermatology
Author(s): Lieke C.J. van Delft, Patty J. Nelemans, Maud H.E. Jansen, Aimee H.M.M. Arits, Marieke H. Roozeboom, Myrurgia A. Hamid, Klara Mosterd, Nicole W.J. Kelleners-Smeets
Abstract
Background
There have been concerns that recurrences after noninvasive therapy for basal-cell carcinoma (BCC) transform into a 'more aggressive' histological subtype.
Objective
To evaluate the proportion of patients with a non-superficial treatment failure after noninvasive therapy for superficial BCC.
Methods
An observational study was performed using data from a single blind, non-inferiority, randomized controlled trial (March 2008-August 2010) with five year follow-up in patients with primary superficial BCC treated with methylaminolevulinate-photodynamic therapy (MAL-PDT), 5-fluorouracil or imiquimod. Data were used from 166 adults with a histologically confirmed treatment failure.
Results
A non-superficial subtype was found in 64 of 166 treatment failures (38.6%). Proportions with a 'more aggressive' subtype than the primary tumor were 51.3% (38/74) for early and 28.3% (26/92) for later treatment failures (p=0.003). The proportion of 'more aggressive' early failures was significantly lower following imiquimod (26.3%) compared to MAL-PDT (54.8%, p=0.086) and 5-fluorouracil (66.7%, p=0.011).
Limitations
There was limited information on the exact time of occurrence of treatment failures.
Conclusion
'More aggressive' treatment failures after noninvasive therapy for superficial BCC occur most often within the first three months post-treatment probably indicating underdiagnosis of 'more aggressive' components in the primary tumor rather than transformation.
http://bit.ly/2RbwGt7
The Diagnostic Accuracy of Dermoscopy for Basal Cell Carcinoma: A Systematic Review and Meta-Analysis
Publication date: Available online 21 December 2018
Source: Journal of the American Academy of Dermatology
Author(s): Ofer Reiter, Ilit Mimouni, Michael Gdalevich, Ashfaq Marghoob, Assi Levi, Emmilia Hodak, Yael Anne Leshem
Abstract
Background
Dermoscopy is a noninvasive technique for the diagnosis of skin lesions. Its accuracy for basal cell carcinoma (BCC) has not been systematically studied.
Objective
To systematically investigate the accuracy of dermoscopy for the diagnosis of basal cell carcinoma with comparison to naked eye examination.
Methods
A systematic review of studies reporting the accuracy of naked eye examination and dermoscopy for the diagnosis of BCC was conducted. A meta-analysis for sensitivity and specificity was performed using a bivariate mixed-effects logistic regression modeling framework.
Results
Seventeen studies were identified. The pooled sensitivity and specificity of dermoscopy for the diagnosis of basal cell carcinoma were 91.2% and 95%, respectively. In studies comparing test performance, adding dermoscopy to naked eye examination improved sensitivity from 66.9% to 85% (p=0.0001), and specificity, from 97.2% to 98.2% (p=0.006). The sensitivity and specificity of dermoscopy were higher for pigmented than non-pigmented BCC. Sensitivity increased when dermoscopy was performed by experts and when the diagnosis was based on in-person dermoscopy as opposed to dermoscopic photographs.
Limitations
Significant heterogeneity among studies with a medium-to-high risk of bias.
Conclusion
Dermoscopy is a sensitive and specific add-on tool for the diagnosis of basal cell carcinoma. It is especially valuable for pigmented BCC.
http://bit.ly/2GJZaX0
Letter Response
Publication date: Available online 21 December 2018
Source: Journal of the American Academy of Dermatology
Author(s): Sally Tan, Elizabeth Buzney, Arash Mostaghimi
http://bit.ly/2RbwGcB
The Uses of Naltrexone in Dermatological Conditions
Publication date: Available online 21 December 2018
Source: Journal of the American Academy of Dermatology
Author(s): Brigette Lee, Dirk Elston
Abstract
Background
Naltrexone in standard and reduced doses is efficacious in many inflammatory and acantholytic disorders.
Objective
We summarized current data of naltrexone relevant to dermatological practice.
Methods
An English language PubMed literature search was performed using the terms naltrexone, low-dose naltrexone, Hailey-Hailey, psoriasis, lichen planopilaris, alopecia, opioid, opioid receptor, treatment, dermatology, monitoring, side effect, skin, pruritus, cutaneous, acantholytic, and Darier.
Results
Opioid receptors are found throughout the skin and affect cell proliferation, migration and adhesion. Mu opioid receptors have been found in all layers of the epidermis while delta receptors are concentrated at cell junctions and can reduce desmoglein expression. Typical doses of naltrexone result in continuous binding to receptors. Low doses result in intermittent blockade with increased ligand and receptor expression, potentiating their effect.
Limitations
Our review was restricted to the English language literature.
Conclusion
Naltrexone affects inflammation, cell adhesion, and keratinocyte proliferation and migration. While low-dose naltrexone has demonstrated efficacy in treating Hailey-Hailey disease, further dose-ranging studies are needed. Data suggest naltrexone could be helpful in the treatment of pruritus and a variety of inflammatory and acantholytic skin diseases refractory to other treatments. At higher doses, liver function tests should be monitored on a periodic basis.
http://bit.ly/2GA11gJ
M-CSF and IL-34 expression as indicators for growth in sporadic vestibular schwannoma
Abstract
Macrophage colony stimulating factor and IL-34 are associated with clinical vestibular schwannoma progression. Investigating the biology behind vestibular schwannoma progression helps understanding tumor growth. Inflammation is important in the microenvironment of neoplasms. Macrophages are major players in the intratumoral infiltrate. These tumor-associated macrophages are known to stimulate angiogenesis and cell growth. M-CSF and IL-34 are cytokines that can regulate tumor-infiltrating macrophages. They are expressed by tumors and form potential targets for therapy. The goal of this study was to investigate these cytokines in vestibular schwannomas and to see if their expression is related to angiogenesis, macrophage numbers, cystic degeneration, and volumetric tumor progression. Immunohistochemical expression of M-CSF and IL-34 was analyzed in ten fast-growing vestibular schwannomas and in ten slow-growing vestibular schwannomas. Expression M-CSF and IL-34 were compared between fast- versus slow-growing and cystic versus non-cystic tumors. Data on macrophage numbers and microvessel density, known from earlier research, was also included. All tumors expressed M-CSF and its expression was higher in fast-growing tumors (p = 0.003) and in cystic tumors (p = 0.035). CD163 expression was higher in tumors with strong M-CSF expression (p = 0.003). All tumors expressed IL-34 as well, but no significant differences were found in relation to clinicopathological characteristics. This study demonstrated the expression of M-CSF and IL-34 in vestibular schwannomas. The results suggest that M-CSF is related to macrophage activity and tumor progression, making it a potential target for therapy. If a similar assumption can be made for IL-34 remains unclear.
http://bit.ly/2BAWRzn
Comment on “Skin stripping technique: A diagnostic clue for fiberglass dermatitis”
Publication date: Available online 21 December 2018
Source: Journal of the American Academy of Dermatology
Author(s): Ali Rajabi-Estarabadi, Natalie M. Williams, Antonella Tosti
http://bit.ly/2RbFcYV
REPLY to “Comment on “skin stripping technique: A diagnostic clue for fiberglass dermatitis”
Publication date: Available online 21 December 2018
Source: Journal of the American Academy of Dermatology
Author(s): J. Company-Quiroga, S. Alique-García, Martínez-Morán, S. Córdoba, J. Borbujo
http://bit.ly/2GDf59k
Evaluating results of an interferon gamma release assay in patients with autoimmune disease on hydroxychloroquine
Publication date: Available online 21 December 2018
Source: Journal of the American Academy of Dermatology
Author(s): Rebecca Gaffney, Victoria P. Werth
http://bit.ly/2Reer6d
Visuospatial short-term memory and dorsal visual gray matter volume
Publication date: Available online 21 December 2018
Source: Cortex
Author(s): Dennis Dimond, Rebecca Perry, Giuseppe Iaria, Signe Bray
Abstract
Visual short-term memory (VSTM) is an important cognitive capacity that varies across the healthy adult population and is affected in several neurodevelopmental disorders. It has been suggested that neuroanatomy places limits on this capacity through a map architecture that creates competition for cortical space. This suggestion has been supported by the finding that primary visual (V1) gray matter volume (GMV) is positively associated with VSTM capacity. However, evidence from neurodevelopmental disorders suggests that the dorsal visual stream more broadly is vulnerable and atypical volumes of other map-containing regions may therefore play a role. For example, Turner syndrome is associated with concomitantly reduced volume of the right intraparietal sulcus (IPS) and deficits in VSTM. As posterior IPS regions (IPS0-2) contains topographic maps, together this suggests that posterior IPS volumes may also associate with VSTM. In this study, we assessed VSTM using two tasks, as well as a composite score, and used voxel-based morphometry of T1-weighted magnetic resonance images to assess GMV in V1 and right IPS0-2 in 32 healthy young adults (16 female). For comparison with previous work, we also assessed associations between VSTM and voxel-wise GMV on a whole-brain basis. We found that total brain volume (TBV) significantly correlated with VSTM, and that correlations between VSTM and regional GMV were substantially reduced in strength when controlling for TBV. In our whole-brain analysis, we found that VSTM was associated with GMV of clusters centered around the right putamen and left Rolandic operculum, though only when TBV was not controlled for. Our results suggest that VSTM ability is unlikely to be accounted for by the volume of an individual cortical region, and may instead rely on distributed structural properties.
http://bit.ly/2QP7ZDh
Atypical neural processing of rise time by adults with dyslexia
Publication date: Available online 21 December 2018
Source: Cortex
Author(s): Tilde Van Hirtum, Pol Ghesquière, Jan Wouters
Abstract
In recent studies phonological deficits in dyslexia are related to a deficit in the synchronization of neural oscillations to the dynamics of the speech envelope. The temporal features of both amplitude modulations and rise times characterize the speech envelope. Previous studies uncovered the inefficiency of the dyslexic brain to follow different amplitude modulations in speech. However, it remains to be investigated how the envelope's rise time mediates this neural processing. In this study we examined neural synchronization in students with and without dyslexia using auditory steady-state responses at theta, alpha, beta and low-gamma range oscillations (i.e. 4, 10, 20 and 40 Hz) to stimuli with different envelope rise times. Our results revealed reduced neural synchronization in the alpha, beta and low-gamma frequency ranges in dyslexia. Moreover, atypical neural synchronization was modulated by rise time for alpha and beta oscillations, showing that deficits found at 10 and 20 Hz were only evident when the envelope's rise time was significantly shortened. This impaired tracking of rise time cues may very well lead to the speech and phonological processing difficulties observed in dyslexia.
http://bit.ly/2BykDMB
Dopamine guides competition for cognitive control: Common effects of haloperidol on working memory and response conflict
Publication date: Available online 21 December 2018
Source: Cortex
Author(s): Sean James Fallon, Kinan Muhammed, Daniel S. Drew, Yuen-Siang Ang, Sanjay G. Manohar, Masud Husain
Abstract
Several lines of evidence suggest that dopamine modulates working memory (the ability to faithfully maintain and efficiently manipulate information over time) but its specific role has not been fully defined. Nor is it clear whether any effects of dopamine are specific to memory processes or whether they reflect more general cognitive mechanisms that extend beyond the working memory domain. Here, we examine the effect of haloperidol, principally a dopamine D2 receptor antagonist, on the ability of humans to ignore distracting information or update working memory contents. We compare these effects to performance on an independent measure of cognitive control (response conflict) which has minimal memory requirements. Haloperidol did not selectively affect the ability to ignore or update, but instead reduced the overall quality of recall. In addition, it impaired the ability to overcome response conflict. The deleterious effect of haloperidol on response conflict was selectively associated with the negative effect of the drug on ignoring – but not updating – suggesting that dopamine affects protection of working memory contents and inhibition in response conflict through a common mechanism. These findings provide new insights into the role of dopamine D2 receptors on human cognition. They suggest that D2 receptor effects on protecting the memory contents from distraction might be related to a more general process that supports inhibitory control in contexts that do not require working memory.
http://bit.ly/2QMgVJJ
Increased Inhibition Following Negative Cues: A Possible Role for Enhanced Processing
Publication date: Available online 21 December 2018
Source: Cortex
Author(s): Hadas Okon-Singer, Avishai Henik, Shai Gabay
Abstract
Based on findings showing that attention is captured by aversive stimuli, previous studies have hypothesized that inhibition of return (IOR) is reduced at spatial locations previously occupied by threat cues. Yet evidence for this view is limited: Only a few studies have demonstrated a reduced degree of IOR following threat cues, while most have not found differences in IOR between aversive and neutral cues. In contrast to previous studies that used the spatial cuing paradigm and for the most part employed mild negative stimuli as cues, we examined the influence of highly aversive, colored and complex pictures of real life situations. As opposed to the stimuli used in previous studies, these pictures are thought to result in enhanced processing as well as in specific enhancement for threat pictures in comparison to neutral ones. Based on evidence indicating that enhanced processing of spatial cues results in increased IOR, we hypothesized that the negative picture cues employed in the present study would yield increased IOR. This hypothesis was confirmed in two experiments. We suggest that the enhancement of IOR following highly threatening cues may be related to efficient spatial orienting of attention in response to stimuli that are important from an evolutionary point of view. The results are discussed in the context of neurocognitive mechanisms that may underlie the modulation of IOR by emotional information.
http://bit.ly/2BBz0zF
Simple cell culture media expansion of primary mouse keratinocytes
Publication date: Available online 22 December 2018
Source: Journal of Dermatological Science
Author(s): Sooah Kim, Byung Woo Kim, Vicky P. Prizmic, Eugene Oh, Victoria Yu, Dongwon Kim, Luis A. Garza
http://bit.ly/2EMXnOW
Radiotherapy for parapharyngeal space tumors
Publication date: Available online 21 December 2018
Source: American Journal of Otolaryngology
Author(s): William M. Mendenhall, Primoz Strojan, Jonathan J. Beitler, Johannes A. Langendijk, Carlos Suarez, Anne W. Lee, Alessandra Rinaldo, Juan P. Rodrigo, Robert Smee, Avraham Eisbruch, Louis B. Harrison, June Corry, Alfio Ferlito
Abstract
A wide variety of tumors, both benign and malignant, occur in the parapharyngeal space. Depending on histology and extent, treatment may include surgery and/or radiotherapy (RT). Herein we discuss the role of RT in the management of some of the more commonly encountered neoplasms, including salivary gland tumors, paragangliomas, schwannomas, and soft-tissue sarcomas.
http://bit.ly/2Aex6Fh
Investigating the role of octamer binding transcription Factor-4 (Oct-4) in oral cavity squamous cell carcinoma: A systematic review and meta-analysis
Publication date: Available online 21 December 2018
Source: American Journal of Otolaryngology
Author(s): Vasiliki Gliagias, Michael Wotman, Saori Wendy Herman, Peter Costantino, Dennis Kraus, Tristan Tham
http://bit.ly/2SlQDLf
Free thyroid transfer to anterolateral thigh for prevention of radiation induced hypothyroidism: An initial experience
Publication date: Available online 21 December 2018
Source: American Journal of Otolaryngology
Author(s): Rakesh Katna, Nikhil Kalyani, Akshay Deshpande, Mumbai Oncology Group – Head and Neck
Abstract
Aim
Radiation induced hypothyroidism (RIHT) is one of the commonest late side effects of radiation therapy and is seen in more than half of patients and affects quality of life significantly. We report our initial experience on feasibility of free microvascular transfer of thyroid gland out of radiation field to prevent development of RIHT.
Material and methods
A prospective pilot study was undertaken during August 2017 to May 2018. Six Patients with stage III/IV patients of oral cavity cancers who required wide excision/composite resections with microvascular free flap (ALT) reconstruction and adjuvant radiation therapy were enrolled. A written informed consent was obtained from all patients prior to the procedure.
Results
The mean age of cohort was 51 years with tongue most common site of primary cancer. The free transfer of thyroid gland to anterolateral thigh was done using microvascular technique. The mean additional time for procedure was 51 min. All patients had successful transfer with no associated immediate complications. Patients were followed up with Tc99 scan, USG Doppler and biochemical assay at routine intervals in peri and postoperative period to assess the anatomical and physiological function of the transferred gland. At median follow up of 8 months, 5 patients were euthyroid and remaining one had biochemical hypothyroidism. All patients had functional thyroid gland in anetrolateral thigh. Five patient were alive, one patient died due to disease.
Conclusion
This is a small and early feasibility study for free thyroid gland transfer and validates the previously published data. The selected group of patients who have high chances of developing RIHT may benefit from this strategy. Further validation of the technique may be explored in a larger cohort.
http://bit.ly/2Aex2W3
Water mobility spectral imaging of the spinal cord: parametrization of model-free Laplace MRI
Publication date: Available online 22 December 2018
Source: Magnetic Resonance Imaging
Author(s): Dan Benjamini, Peter J. Basser
Abstract
Diffusion magnetic resonance imaging (dMRI) of biological systems most often results in non-monoexponential signal, due to their complexity and heterogeneity. One approach to interpreting dMRI data without imposing tissue microstructural models is to fit the signal to a multiexponential function, which is sometimes referred to as an inverse Laplace transformation, and to display the coefficients as a distribution of the diffusivities, or water mobility spectra. Until recently, this method has not been used in a voxelwise manner, mainly because of heavy data requirements. With recent advancements in processing and experimental design, voxelwise Laplace MRI approaches are becoming feasible and attractive. The rich spectral information, combined with a three-dimensional image, presents a challenge because it tremendously increases the dimensionality of the data and requires a robust method for interpretation and analysis. In this work, we suggest parameterizing the empirically measured water mobility spectra using a bimodal lognormal function. This approach allows for a compact representation of the spectrum, and it also resolves overlapping spectral peaks, which allows for a robust extraction of their signal fraction. We apply the method on a fixed spinal cord sample and use it to generate robust intensity images of slow- and fast-diffusion components. Using the parametric variables, we create novel image contrasts, among them the information entropy of the water mobility spectrum, which pack unique features of the individual diffusion regimes in the investigated system.
http://bit.ly/2LxqwxY
Blood eosinophils may predict radiographic sinus opacification in patients with chronic rhinitis
Background
The association between chronic rhinosinusitis (CRS) and chronic rhinitis remains unclear. The aim of this study was to estimate the predictive factors for sinus opacification in chronic rhinitis patients without obvious CRS.
Methods
We retrospectively studied a total of 332 adult patients with chronic rhinitis who visited our clinic from January 2015 to December 2017. All of the patients underwent endoscopic examination, allergy test, and osteomeatal‐unit computed tomography. The subjects were assigned to the normal sinus (NS) group (Lund‐Mackay score [LMS] <5) and sinus opacification (SO) group (LMS ≥5).
Results
A total of 288 patients were eligible for this study. Of them, 183 (63.5%) were classified in the NS group and 105 (36.5%) in the SO group. Total immunoglobulin E (IgE) level and peripheral blood eosinophil count were significantly higher in the SO than NS group (p = 0.031 and p < 0.0001, respectively). Using Pearson correlation coefficients, we determined that eosinophil count had a positive correlation with the LMS (r = 0.282). In logistic analysis, the interquartile range increase (0.19 × 109/L) of the eosinophil count was significantly associated with SO (odds ratio [OR] 1.76; 95% confidence interval [CI], 1.30 to 2.39). After adjusting for age, gender, smoking, drinking, and underlying disease, the interquartile range increase of the eosinophil count increased the odds of SO to 1.69‐fold; this increase was statistically significant (p = 0.007; 95% CI, 1.17 to 2.43).
Conclusion
Peripheral blood eosinophil count is an independent predictor of CRS in patients with chronic rhinitis.
http://bit.ly/2EHRKl7
Analysis of anterior and posterior maneuvers to enhance intraconal exposure
Background
The medial and inferior recti encompass the ideal surgical corridor to approach the intraconal space endonasally. Here, we describe 3 different maneuvers to achieve greater access to orbital contents through an expanded endonasal approach (EEA).
Methods
Four human cadaver heads were dissected bilaterally (n = 8). EEA to the medial intraconal orbit was executed. The following 3 maneuvers were performed: (1) anterior: extraocular muscles control (EOM); (2) posterior: annulus of Zinn (AZ) release; and (3) anterior/posterior combined. Measurements of the inferior and medial rectus corridor at the level of anterior ethmoidal artery (AEA) and posterior ethmoidal artery (PEA) and extent of optic nerve and medial rectus visualization was performed before and after each maneuver.
Results
Medial rectus length (MRL) and optic nerve length (ONL) achieved were 1.72 ± 0.28 cm and 0.85 ± 0.2 cm, respectively. Mean caudal‐rostral distances between the rectus muscles at the level of the AEA and PEA were 3.45 ± 0.7 mm and 1.30 ± 0.3 mm, respectively. After EOM control, mean caudal‐rostral distances at the same level were as follows: AEA 4.90 ± 1.15 mm (p = 0.009) and PEA 1.70 ± 0.20 mm (p = 0.016). With AZ release, MRL was 2.20 ± 0.7 cm (p = 0.002) and ONL was 1.30 ± 0.2 cm (p = 0.003), with mean rostral‐caudal distance at the level of AEA at 4.03 ± 0.8 mm (p = 0.16) and PEA at 1.71 ± 0.36 mm (p = 0.039). Mean caudal‐rostral distances achieved with AZ release and EOM control were as follows: AEA 5.6 ± 1.2 mm (p = 0.001) and PEA 2.15 ± 0.4 mm (p = 0.001).
Conclusion
Progressive access to the orbital contents is afforded with the 3 delineated maneuvers. The magnitude of access is optimized with the combined maneuver. The actual anterior/posterior location of the target will determine which maneuvers are required.
http://bit.ly/2EFghqg
Tonsillectomy using the BiZact: A pilot study in 186 children and adults
Abstract
1.The BiZact tonsillectomy device, produced by Medtronic (Minneapolis, MN, USA), was approved for market use in Australia by the Therapeutics Good Administration (TGA) in 2016 and is a new device for tonsillectomy
2.Results from this pilot study of 186 patients demonstrate a post‐operative hemorrhage rate of 4.3% similar to rates described by other studies.
3.BiZact tonsillectomy allows for a shortened operative time in the hands of both experienced and training surgeons with a median time of 5.1 minutes (range 1.5 – 26.5 minutes).
4.BiZact tonsillectomy is associated with reduced intraoperative blood loss with less than 1mL of blood loss observed in 71 (38.2%) cases and between 1‐10mL loss observed in 81 (43.5%) cases in this report.
5.This study demonstrates safety and feasibility of this device as a pilot study towards undertaking a prospective randomized trial comparing it to other tonsillectomy techniques.
This article is protected by copyright. All rights reserved.
http://bit.ly/2rZkf5z
Pathogen reservoir hypothesis investigated by analyses of the adenotonsillar and middle ear microbiota
Publication date: Available online 21 December 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): James Johnston, Michael Hoggard, Kristi Biswas, Carmen Astudillo‐García, Fiona J. Radcliff, Murali Mahadevan, Richard G. Douglas
Abstract
Introduction
Adenotonsillar and middle ear diseases result in some of the most frequently performed operations in the pediatric population worldwide. The pathogen reservoir hypothesis (PRH) suggests that the adenoids act as a reservoir of bacteria which play a potential pathogenic role in otitis media. Evidence supporting this hypothesis is limited. This study sought to comprehensively determine and compare associations between the adenotonsillar and middle ear bacterial microbiota within individual patients via next-generation sequencing and microbial network analyses.
Methods
Bacterial 16S rRNA gene-targeted amplicon sequencing was used to determine the bacterial composition of ten pediatric patients undergoing adenotonsillectomy and ventilation tube insertion for otitis media with effusion. At the time of surgery, swabs were taken from the adenoid surface, tonsil crypts and middle ear clefts (through the myringotomy incision).
Results
The most abundant sequences within the bacterial community at genus level across all anatomical sites were Fusobacterium, Haemophilus, Neisseria, and Porphyromonas. There was an observable difference in the relative abundance of bacterial communities, with a higher proportion of Haemophilus and Moraxella in the adenoid when compared with the middle ear. Furthermore, only one module (consisting of 4 bacterial OTUs) from one patient was identified through microbial network analyses to be significantly associated between middle ear and adenoid. In addition, microbial network analysis revealed that the adenoid and tonsil microbiota share greater similarity than do the adenoid and middle ear.
Conclusion
The results of this study suggest that the adenoid microenvironment does not correlate to the middle ear microenvironment. A future study at the species level, and over time, is required to further investigate whether the differing relationship between the microbiota of the adenoid and middle ear rejects the pathogen reservoir hypothesis.
http://bit.ly/2rOsfGn
Transcriptomic and lipidomic profiling of eicosanoid / docosanoid signalling in affected and non‐affected skin of human atopic dermatitis patients
Abstract
Lipoxygenases (LOX) and cycloxygenase (COX) are the main enzymes for PUFA‐metabolism to highly bio‐active prostaglandins, leukotrienes, thromboxanes, lipoxines, resolvins and protectins. LOX and COX pathways are important for the regulation of pro‐inflammatory or pro‐resolving metabolite synthesis and metabolism for various inflammatory diseases such as atopic dermatitis (AD). In this study we determined PUFAs and PUFA‐metabolites in serum as well as affected and non‐affected skin samples from AD‐patients and the dermal expression of various enzymes, binding proteins and receptors involved in these LOX and COX pathways. Decreased EPA and DHA levels in serum and reduced EPA level in affected and non‐affected skin were found; in addition n3/n6‐PUFA ratios were lower in affected and non‐affected skin and serum. Mono‐hydroxylated PUFA‐metabolites of AA, EPA, DHA and the sum of AA, EPA and DHA metabolites were increased in affected and non‐affected skin. COX1 and ALOX12B expression, COX and 12/15‐LOX metabolites as well as various lipids, which are known to induce itch (12‐HETE, LTB4, TXB2, PGE2 and PGF2) and the ratio of pro‐inflammatory vs pro‐resolving lipid mediators in non‐affected and affected skin as well as in the serum of AD patients were increased, while n3/n6‐PUFAs and metabolite ratios were lower in non‐affected and affected AD‐skin. Expression of COX1 and COX‐metabolites were even higher in non‐affected AD‐skin. To conclude, 12/15‐LOX and COX pathways were mainly upregulated, while n3/n6‐PUFA and metabolite ratios were lower in AD‐patients skin. All these parameters are a hallmark of a pro‐inflammatory and non‐resolving environment in affected and partly in non‐affected skin of AD‐patients.
This article is protected by copyright. All rights reserved.
http://bit.ly/2Ab8vB4
Predictors of cisplatin-induced ototoxicity and survival in chemoradiation treated head and neck cancer patients
Publication date: February 2019
Source: Oral Oncology, Volume 89
Author(s): Wendy A. Teft, Eric Winquist, Anthony C. Nichols, Sara Kuruvilla, Suzanne Richter, Christina Parker, Peggy Francis, Maureen Trinnear, Jelena Lukovic, Nedal Bukhari, Yun-Hee Choi, Stephen Welch, David A. Palma, John Yoo, Richard B. Kim
Abstract
Objectives
Cisplatin-induced ototoxicity is a common permanent consequence of curative chemoradiation for locally advanced head and neck squamous cell carcinoma (HNSCC). Predictors of ototoxicity in HNSCC were examined.
Materials and methods
In this prospective, observational cohort study, 206 adult HNSCC patients underwent audiometric testing at baseline, during and after treatment with cisplatin-based chemoradiation. Ototoxicity was defined as ≥grade 2 audiometric change from baseline (CTCAE v4.02). Relationships between clinical and pharmacogenetic (TPMT, COMT, ACYP2, CTR1, OCT2, MATE1, ABCC2, ABCC3, and ABCG2) covariates and ototoxicity, progression-free (PFS) and overall survival (OS) were assessed by Cox regression.
Results
Weekly cisplatin resulted in lower ototoxicity risk while PFS and OS were similar compared to high dose cisplatin (P = 0.00035; HR = 0.18; 95% CI, 0.07–0.46). COMT (rs9332377) carriers had higher ototoxicity risk (P = 0.00556; HR = 1.72; 95% CI, 1.17–2.52) while MATE1 (rs2289669) A/A carriers were protected from ototoxicity (P = 0.01062; HR = 0.46; 95% CI, 0.26–0.84). Absence of the protective MATE1 allele among those who carry the risk allele in COMT predicted increased ototoxicity risk, (P = 0.00414; HR = 3.22; 95% CI, 1.45–7.17 and P = 0.00022; HR = 4.89; 95% CI, 2.11–11.36). Survival outcomes did not differ between carriers of protective or risk alleles.
Conclusions
Weekly cisplatin dosing, COMT and MATE1 are predictors of ototoxicity without affecting treatment efficacy. COMT and MATE1 genotyping and weekly dosing may be a potential strategy for mitigating cisplatin-induced ototoxicity in HNSCC.
http://bit.ly/2PWMTNZ
Five-year outcomes of sparing level IB in node-positive, human papillomavirus–associated oropharyngeal carcinoma: A safety and efficacy analysis
Publication date: February 2019
Source: Oral Oncology, Volume 89
Author(s): R.B. Ross, A. Juloori, V. Varra, M.C. Ward, S. Campbell, N.M. Woody, E. Murray, P. Xia, J.F. Greskovich, S.A. Koyfman, N.P. Joshi
Abstract
Introduction
The conformality of modern intensity modulated radiation therapy (IMRT) allows avoidance of the submandibular glands (SMG) in select patients, potentially improving late xerostomia. This study explores the safety and efficacy of this approach in select oropharyngeal carcinoma (OPC) patients.
Methods
Patients with T1-2N+ human papillomavirus (HPV)-associated OPC treated with definitive IMRT at one institution from 2009 to 2014 were identified. Patients were divided into 3 groups: bilateral level IB targeted (A, n = 16), a single level IB targeted (B, n = 61), and bilateral IB spared (C, n = 9). Outcomes were reviewed to identify the rate of level IB regional recurrence. Odds ratios were calculated for xerostomia between groups.
Results
Level Ib was targeted in 93 instances (54.1%) and avoided in 79 instances (45.9%). Mean SMG doses were significantly lower when level IB was spared compared to when targeted (37.5 Gy vs 67.5 Gy; P < 0.0001). Median doses to oral cavity decreased with increasing level Ib sparing (40.7 Gy [A] vs 35.4 Gy [B] vs 30.7 [C]; P = 0.002). The rate of late grade ≥2 xerostomia was significantly lower in patients with bilateral 1b sparing (53% in A vs 0% in C; P = 0.007). Sparing 1b unilaterally resulted in a non-significant decrease in late grade ≥2 xerostomia (P = 0.181). No regional failures were identified in levels IB (median follow up = 59.3 months).
Conclusion
Sparing level IB is safe in T1-2N+ HPV+ OPC. Avoiding level Ib translates into significantly lower SMG and oral cavity doses. Larger studies are needed to validate these findings and the impact of this technique.
http://bit.ly/2V4bgx5
Basophil activation testing in occupational respiratory allergy to low molecular weight compounds
Purpose of review There is an unmet need for better immunological tests in cases of suspected occupational asthma to many workplace chemicals; here we consider the basophil activation test (BAT), a potential alternative to the detection of specific IgE antibodies. Recent findings BAT is fairly widely used in general allergy services; and there is increasing experience of its use in the diagnosis of occupational allergy to low molecular weight agents and chemicals including wood dusts, persulphates, antibiotics and latex. Summary There is potential for BAT to become a useful tool in the clinical consideration of occupational asthma and of its mechanisms, and even to take a place in a Bayesian-based diagnostic algorithm. Further development will only occur if specialist centres with appropriate facilities, and preferably in collaboration, contemplate its use. Correspondence to Johanna Feary, Department of Occupational Lung Disease, Royal Brompton Hospital, London SW3 6LR. Tel: +44 20 7594 7968; e-mail: j.feary@imperial.ac.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
http://bit.ly/2T2XAR9
http://bit.ly/2T2XAR9
Rates of Abnormal Aldosterone/ Renin ratio in African‐origin compared to European‐origin patients; a retrospective study
Abstract
Introduction
The aldosterone/ renin ratio is the initial screening test for primary hyperaldosteronism (PHA), but little data exists regarding ethnic variations in this.
Methods
Following clinical observation of a high prevalence of abnormal ARR in patients of African origin, we retrospectively reviewed all ARR measurements in a single centre over 10 years. Rates of hypokalaemia, intraventricular septal thickness (IVS, by echocardiography) and adrenal imaging were recorded when available.
Results
ARR was available in 1473 patients, and abnormal in 374 (25.4%). Abnormal ARR was observed in 305/ 1349 (22.6%) of European‐origin and 69/ 124 (55.6%) of African‐origin patients (p<0.001). Among those with abnormal ARR, hypokalaemia (<3.5 mmol/l) was documented on at least one occasion in 171/ 305 (56.1%) European‐origin and 43/ 69 (62.3%) African‐origin patients (p=0.35). Median (range) IVS was 1.57 (0.78 ‐ 2.80) cm in African‐origin and 1.20 (0.69 ‐ 2.18) cm in European‐origin patients (p<0.002); IVS did not correlate with aldosterone or ARR however. Adrenal adenoma was identified in 41/170 (24.1%) of European‐origin and 4/29 (13.7%) African‐origin patients (p=0.15), while hyperplasia was identified in 35/170 (20.5%) of European and 8/29 (27.5%) African patients (p=0.39).
Conclusion
In summary, ARR was abnormal in 55.6% of African‐origin patients screened at an Irish hospital. Rates of hypokalaemia were similar between European‐origin and African‐origin patients. These findings have implications for the use of current screening guidelines for ARR in African‐origin patients and also for the mechanistic role of aldosterone in hypertensive complications in African‐origin patients.
This article is protected by copyright. All rights reserved.
http://bit.ly/2rOp8OH
Thigh and abdominal adipose tissue depot associations with testosterone levels in postmenopausal females
Summary
Objective
Research findings on the relationship between serum androgens and adipose tissue in older females are inconsistent. We aimed to clarify the relationship using state‐of‐the art techniques to evaluate associations between body fat distribution and plasma testosterone (T) levels in older postmenopausal women.
Design
Observational, cross‐sectional study of healthy, community dwelling postmenopausal women.
Patients and Measurements
Postmenopausal women, (60‐80 years old) were included in this study. Overall body composition was evaluated by dual‐energy x‐ray absorptiometry. Abdominal and thigh fat depots were measured by magnetic resonance imaging. Circulating T concentrations by liquid chromatography‐tandem mass spectrometry.
Results
Thirty‐five women (66.6 ± 0.8 years) participated in this study. T levels were positively associated with clinical proxy measure of adiposity including weight (ρ=0.39), BMI (ρ=0.43) and waist circumference (ρ=0.39) (all p<0.05). Fat mass and percent body fat were correlated with T levels (ρ=0.42 and 0.38 respectively, both p<0.05). T correlated with overall and superficial abdominal fat (ρ=0.34 and 0.37 respectively, both p<0.05) but not with visceral adipose tissue. T increased with greater thigh fat (ρ=0.49, p<0.05) in both superficial and deep depots (ρ=0.50 and 0.35 respectively, both p<0.05).
Conclusion
Our results suggest that postmenopausal women with higher circulating T levels have both higher regional and overall body adiposity. These findings underscore the sexual dimorphism in the relationship between serum androgen levels and adiposity.
This article is protected by copyright. All rights reserved.
http://bit.ly/2LtJwxD
Systemic comorbidities associated with rosacea: a multicentric retrospective observational study
Abstract
Background
Once considered a disorder limited to the skin, rosacea is now known to be associated with systemic disorders. The aim of this study was to determine what systemic comorbidities accompany rosacea and to determine the relationship between the type, severity, and duration of rosacea, and the presence of and type of systemic comorbidities.
Methods
This retrospective multicenter study was conducted by the Turkish Society of Dermatology Acne Study Group. Thirteen dermatology clinics throughout Turkey participated in the study. A structured physician‐administered questionnaire was used to collect patient demographics, clinical findings, and lifestyle data. The principal rosacea subtype, physician global assessment of severity, and duration of rosacea were recorded. Physicians recorded each participant's medical history, including current and past comorbidities, duration of any such comorbidity, and the use of medications to treat any comorbidities.
Results
The study included 1,195 rosacea patients and 621 controls without rosacea aged 18–85 years. As compared to the controls, more of the rosacea patients had respiratory tract, gastrointestinal system, and metabolic and hepatobiliary system disorders in a rosacea's severity‐ and duration‐dependent manner.
Conclusion
Clinicians must be aware of the potential for systemic comorbidities in rosacea patients, which becomes more likely as disease duration and severity increase.
http://bit.ly/2AbdKkx
Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption
Objectives
To compare long‐term oncologic outcomes and adjuvant therapies for patients treated with transoral robotic surgery (TORS), nonrobotic surgery, or transoral laser microsurgery (TLM).
Study Design
A retrospective analysis of the National Cancer Database (2010–2014).
Methods
Patients with clinical tumor (T)1 and T2 oropharyngeal squamous cell carcinomas (OPSCC) were classified into those receiving TORS versus nonrobotic surgery versus TLM. Univariate and multivariate survival analyses were conducted with chi‐square tests; Kaplan‐Meier log‐rank test; and Cox multivariate, logistic regression, and multinomial regression modeling.
Results
We identified 2,224 OPSCC TORS patients; 6,697 nonrobotic surgery patients; and 333 TLM patients. The majority of patients were white males with a mean age of approximately 59 years. No significant difference was noted between the cohorts in tumor stage; however, TORS patients were more likely to have nodal (N)1 to N3 disease than nonrobotic surgery and TLM patients, respectively (69.8% vs. 62.0% vs. 59.7%, P < 0.001).
TORS was associated with a lower likelihood of positive margins when compared to nonrobotic surgery, although not TLM (nonrobotic surgery: hazard ratio [HR] 1.51, P < 0.001, TLM: HR 1.13, P = 0.582). TORS was associated with lower likelihood of postsurgical chemoradiotherapy (TLM: HR 2.07, P < 0.001, nonrobotic surgery: 1.65, P < 0.001) but not adjuvant radiotherapy alone (TLM: HR 1.06, P = 0.569, nonrobotic surgery: 0.96, P = 0.655). On multivariate Cox analysis of overall survival, the use of TORS was not associated with increased survival (TLM: HR 1.31, P = 0.233, nonrobotic surgery: HR 1.12, P < 0.303).
Conclusion
The advantages of TORS for early‐stage OPSCC may be a lower likelihood of postsurgical positive margins and subsequent need for adjuvant chemoradiotherapy.
Level of Evidence
NA. Laryngoscope, 2018
http://bit.ly/2PSPCId
Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: A systematic review and meta‐analysis
Abstract
Background
This systematic review and meta‐analysis aims to evaluate the effectiveness of palatine tonsillectomy in patients with cervical metastasis from squamous cell carcinoma of unknown primary (SCCUP) origin.
Methods
A systematic review including studies that encompassed palatine tonsillectomy in the SSCUP diagnostic evaluation was conducted. A single arm meta‐analysis was then made to obtain the overall identification rate of tonsillectomy.
Results
Fourteen studies were included, comprising 673 patients who underwent 416 palatine tonsillectomies, 338 preformed during examination under anesthesia (EUA) and 78 managed with transoral robotic surgery (TORS). A total of 140 occult tonsillar malignancies were identified; of these, 124 (89%) were ipsilateral, 2 (1%) contralateral, and 14 (10%) synchronous bilateral. Meta‐analysis of 11 studies showed an overall detection rate of tonsillectomy of 0.34 (99% confidence interval 0.23‐0.46).
Conclusion
Palatine tonsillectomy is a valuable diagnostic tool in the management of patients with head and neck SCCUP. Bilaterality of tonsillectomy should be taken into consideration.
http://bit.ly/2UZYsbb
Construct validity of a low‐cost medium‐fidelity endoscopic sinus surgery simulation model
Objective
Assess construct validity of a low‐cost medium‐fidelity silicone injection molded model task trainer for endoscopic sinus surgery (ESS) training.
Methods
Fellowship‐trained rhinologists, otolaryngology attendings, and otolaryngology residents at various levels of training performed sinus endoscopy and seven procedures on the model. Construct validity was evaluated by comparing novice to various levels of experienced performance using a validated checklist.
Results
Thirty‐two subjects participated in this study. Otolaryngology attendings and postgraduate year (PGY) 3 to 5 otolaryngology residents significantly outperformed PGY 1 to 2 otolaryngology residents on most tasks in the task‐specific checklist.
Conclusions
This study demonstrated the construct validity of the low‐cost medium‐fidelity ESS model.
Level of Evidence
NA. Laryngoscope, 2018
http://bit.ly/2PY3FMO
Evaluation of spin in the abstracts of otolaryngology randomized controlled trials
Objective
Spin, the misrepresentation and distortion of research findings, has been shown to affect clinical decision making. Spin has been found in randomized controlled trials (RCTs) published in various fields of medicine, but no study has tested for the presence of spin in otolaryngology RCTs. The purpose of this study is to evaluate the abstracts of RCTs found in the otolaryngology literature for spin.
Methods
In this cross‐sectional analysis, we analyzed the abstracts of RCTs for spin using a pilot‐tested form. Double data extraction was performed by two blinded authors, and discrepancies were resolved using mutual discussion.
Results
Out of the 534 PubMed citations retrieved by our search string, 162 parallel‐group RCTs with clearly defined primary and secondary endpoints were identified. Further analysis identified 47 trials with nonsignificant primary outcomes, which were then evaluated for spin. Spin was identified in 33 of the 47 (70%) abstracts. Spin was found in the results sections of 25 (53%) of the included abstracts and was found in the conclusion section of 27 (57%) of the abstracts. Spin was not present in the titles of any of the included studies.
Conclusion
Spin was common in our sample of otolaryngology RCTs. Spin may potentially create false impressions about the true validity of a drug or intervention. Further research needs to test for potential clinical implications of spin in the otolaryngology literature.
Level of Evidence
NA. Laryngoscope, 2018
http://bit.ly/2V2CrIu
Endoscope‐assisted resection of intravestibular Schwannoma: A video case report
Intravestibular schwannomas are a rare cause of unilateral sensorineural hearing loss. Management of these tumors involves translabyrinthine resection, for which complete visualization around the angles of the vestibule may be limited under an operating microscope. We present the first reported case of an endoscope‐assisted resection of an intravestibular schwannoma, along with the operative video recording. Using additional information gained from endoscopic examination of the tumor and its resection site, we also propose a mechanism by which this patient's intravestibular schwannoma caused hearing loss. Use of the endoscope in resection of intravestibular schwannomas may have advantages over the traditional operating microscope in improving visualization of the narrow and angled vestibule, confirming the integrity of surrounding structures, and ensuring complete tumor removal. Laryngoscope, 2018
http://bit.ly/2V004l4
Polysomnography outcomes in children with small tonsils undergoing drug‐induced sleep endoscopy–directed surgery
Objectives/Hypothesis
The optimal surgical treatment to improve sleep apnea in children with small tonsils is not known. Drug‐induced sleep endoscopy (DISE) may be useful in selecting effective surgical procedures for this patient population. This study compared polysomnography (PSG) measures before and after DISE‐directed surgery in children with small tonsils. We hypothesize that DISE‐directed surgery improves PSG measures in children with small tonsils. We also aimed to identify the most common surgery performed in this population.
Study Design
Retrospective chart review.
Methods
A retrospective review was performed of subjects who underwent DISE at a single pediatric tertiary care center over a 6‐year period. Inclusion criteria were 1+ tonsils and PSG performed before and after DISE‐directed surgery. Exclusion criteria were previous tonsillectomy and tonsils score 2+ or greater. Pre‐ and postoperative PSG parameters were compared using paired t tests.
Results
Average age was 7 ± 4 years old at the time of surgery. The most common DISE‐directed intervention was supraglottoplasty (n = 23). DISE‐directed surgery significantly improved mean apnea‐hypopnea index (AHI) from 14.4 to 8.0 (P = .02). Although improvements were seen in mean obstructive AHI (12.5 to 5.5), O2 nadir (87.0 to 88.3), and ODI (10.6 to 5.8), these measures did not reach statistical significance.
Conclusions
DISE‐directed surgery significantly improves AHI in children with small tonsils. The most common intervention performed on these children was supraglottoplasty. Interestingly, adenotonsillectomy was rarely performed in this cohort. Additionally, supraglottic collapse, prompting supraglottoplasty, is difficult to accurately assess in an awake child, supporting use of a DISE‐directed approach in this patient population.
Level of Evidence
4 Laryngoscope, 2018
http://bit.ly/2PW4rdk
In‐office procedures for the treatment of benign vocal fold lesions in the awake patient: A contemporary review
Objectives
To review available information regarding in‐office procedures for benign vocal fold lesions (BVFL).
Methods
PubMed term search on office/awake laryngeal procedures for any of the following specific lesions: Reinke's edema (RE), polyps, nodules, varices, vocal process granuloma, and vocal fold (VF) scar.
Results
In‐office ablative and nonablative laser procedures have been described for BVFL, including RE, polyps, varices, and granuloma. Fiber‐based lasers used include potassium titanyl phosphate, pulsed dye laser, and more recently CO2. In‐office intralesional steroid injection (ISI) for BVFL targets the inflammatory process involved with the lesion and may induce regression of polyps, nodules, RE, and granuloma. Botulinum toxin‐induced "voice rest" has been described as adjunctive treatment for refractory VF nodules or vocal process granuloma. Most in‐office techniques for treating BVFL rely on induction of lesion regression rather than complete lesion removal, as in conventional operative microsurgery. When treating VF scarring, in‐office procedures aim to alter the wound‐healing process; ISI targets the inflammatory phase and angiolytic lasers target the proliferative phase.
Conclusion
In‐office procedures for BVFL apply new technology that can potentially lower risk and cost. Although numerous case series have shown the potential of these procedures, data that thoroughly compares outcomes with those of microlaryngoscopic techniques is needed. Laryngoscope, 2018
http://bit.ly/2V42kaU
Oral tongue squamous cell carcinoma survival as stratified by age and sex: A surveillance, epidemiology, and end results analysis
Objectives/Hypothesis
To utilize the Surveillance, Epidemiology, and End Results (SEER) database to elucidate differences in predictors of survival in oral tongue squamous cell carcinoma (OTSCC) as stratified by age and sex.
Study Design
Retrospective, population‐based database analysis.
Methods
The SEER registry was utilized to calculate survival trends for patients with OTSCC between 1973 and 2012. Patient data were then stratified by age (≤40 years vs. >40 years) and sex, then analyzed with respect to race, stage, grade, and treatment modalities. Overall survival (OS) and disease‐specific survival (DSS) were calculated and compared.
Results
There were 16,423 cases of OTSCC identified, with 526 and 706 young female and male patients, respectively. Young female patients had improved OS and DSS as compared to young male patients (75% vs. 67% at 5 years), which is better than older patients (P < .001). Younger patients were more likely to receive surgery (P < .001) and combination surgery and radiation (P < .001) as compared to older patients. On multivariate analysis, tumor stage was uniformly associated with worse OS and DSS (P < .05), with surgery predicting improved OS and DSS in all groups except young females (P < .05). Higher tumor grade predicted worse OS and DSS in older patients, but not younger patients (P < .05).
Conclusions
OTSCC appears to present with relatively heterogeneous characteristics across different age groups and sexes. Despite the rising incidence of OTSCC in young individuals, our study demonstrates that young patients have improved survival rates compared to older patients.
Level of Evidence
NA Laryngoscope, 2018
http://bit.ly/2PYCEch
Nasal obstruction symptom evaluation score outcomes after septorhinoplasty
Objectives/Hypothesis
The time interval at which Nasal Obstruction Symptom Evaluation (NOSE) scores stabilize after functional septorhinoplasty has not been determined. Our goal was to characterize longitudinal trends of patient‐reported outcomes of nasal obstruction using the NOSE survey instrument following functional septorhinoplasty.
Study Design
Prospective longitudinal cohort study.
Methods
Adult patients (≥18 years) with nasal obstruction who underwent functional septorhinoplasty by three different surgeons at a single academic, tertiary referral center were identified. NOSE scores were obtained preoperatively and prospectively during three postoperative intervals defined as early (1–3 months), middle (4–6 months), and late (≥10 months.) Longitudinal analysis included repeated measures analysis of variance and adjustments for multiple comparisons.
Results
A total of 49 patients met inclusion criteria. For the total cohort, mean NOSE scores significantly improved between preoperative and early postoperative evaluations (71.4, standard deviation [SD] ± 17.0 vs. 24.2, SD ± 19.5; P < .001) but did not significantly change between early and middle (20.6, SD ± 19.1; P = .543) or middle and late (23.1, SD ± 24.9; P > .999) time intervals.
Conclusions
Patients with nasal obstruction who undergo functional septorhinoplasty can be expected to have significant improvement in self ‐reported nasal obstruction as early as 1 to 3 months postoperatively with a continued, durable, long‐standing benefit lasting at least 10 months after surgery. Future studies can consider the 3‐month time frame as a proxy for 1 year outcomes to help reduce survey burden.
Level of Evidence
2c Laryngoscope, 2018
http://bit.ly/2V42lvu
Analysis of patients with drug‐induced pemphigoid using the Japanese Adverse Drug Event Report database
Abstract
To clarify the incidence of drug‐induced pemphigoid in Japan, we conducted a database search and analysis using the Japanese Adverse Drug Event Report database (JADER). Among the cases recorded in JADER between April 2004 and November 2017, we targeted "pemphigoid" and analyzed the patients' backgrounds, drug involvement, time of pemphigoid onset, outcomes and year reported. For cases where three or more drugs were reportedly involved, the signal index was calculated using the reporting odds ratio (ROR) method. The total number of reported pemphigoid cases was 769. Males accounted for 58% (446 cases) and patients over the age of 60 years accounted for 82% (630 cases). The most frequently reported causative drug was vildagliptin (288 cases), followed in order by sitagliptin phosphate hydrate (102 cases), teneligliptin hydrobromide hydrate (86 cases), linagliptin (64 cases) and furosemide (46 cases). For the 27 causative drugs, the safety signal was detected by the ROR method. The median time to onset tended to be long for these drugs. For vildagliptin with the largest reported number, the value was 508 days (range, 2–1871). Analysis of outcomes demonstrated recovery or improvement in 66.3% of cases. Analysis of the years in which reports had been published revealed that the number of pemphigoid cases has increased rapidly in recent years. Our survey was able to reveal useful data on the incidence of drug‐induced pemphigoid. We expect that these results will aid the early detection and treatment of this condition.
http://bit.ly/2SZuBxE
Basophil activation testing in occupational respiratory allergy to low molecular weight compounds
Purpose of review There is an unmet need for better immunological tests in cases of suspected occupational asthma to many workplace chemicals; here we consider the basophil activation test (BAT), a potential alternative to the detection of specific IgE antibodies. Recent findings BAT is fairly widely used in general allergy services; and there is increasing experience of its use in the diagnosis of occupational allergy to low molecular weight agents and chemicals including wood dusts, persulphates, antibiotics and latex. Summary There is potential for BAT to become a useful tool in the clinical consideration of occupational asthma and of its mechanisms, and even to take a place in a Bayesian-based diagnostic algorithm. Further development will only occur if specialist centres with appropriate facilities, and preferably in collaboration, contemplate its use. Correspondence to Johanna Feary, Department of Occupational Lung Disease, Royal Brompton Hospital, London SW3 6LR. Tel: +44 20 7594 7968; e-mail: j.feary@imperial.ac.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
http://bit.ly/2T2XAR9
http://bit.ly/2T2XAR9
Microbial keratitis: Significant increase in Gram-positive bacterial infection
Types of organisms and in-vitro susceptibility of bacterial isolates from patients with microbial keratitis: A trend analysis of 8 years p. 49
Sujata Das, Ruchipriya Samantaray, Aparajita Mallick, Srikant K Sahu, Savitri Sharma
DOI:10.4103/ijo.IJO_500_18
Purpose: To report the distribution and trends of types of organisms and antibiotic susceptibility of the bacterial isolates obtained from patients with microbial keratitis. Methods: Microbiology records of culture-positive microbial keratitis that underwent a diagnostic corneal scraping and cultures were reviewed. Fungal, bacterial, and parasitic culture results and antibiotic susceptibility profile of bacteria were analyzed and comparisons were made between two halves of the study period (2007–2010 vs. 2011–2014). Results: A total of 3981 corneal scrapings were processed during the 8-year study period. Pathogen was recovered in culture in 1914 (48.1%) samples. Fungi, bacteria, and parasites constituted 38.7%, 60%, and 1.3% of the total isolates, respectively. The common fungal isolates were Aspergillus spp. (224/868, 25.8%) and Fusarium spp. (200/868, 23.0%), while common Gram-positive bacteria were Streptococcus pneumoniae (217/1125, 19.3%) and Staphylococcus aureus (185/1125, 16.4%), and common Gram-negative bacteria was Pseudomonas spp. (99/219, 45.2%). There was no significant difference in proportion of bacterial (P = 0.225) and fungal (P = 0.421) keratitis between the first half and second half of the study period. There was a significant increase in proportion of Gram-positive isolates (P = 0.015) [353/758 (46.6%) vs. 772/1482 (52.1%)] and decrease in proportion of Gram-negative organisms (P = 0.044) [88/758 (11.6%) vs. 131/1482 (8.8%)] in the recent years. In-vitro antibiotic susceptibility testing showed decrease in susceptibility to moxifloxacin for Pseudomonas spp. (P = 0.016) in recent years. Conclusion: Prevalence of fungal and bacterial keratitis has remained unchanged over the years. This study shows a significant increase in Gram-positive bacterial infection and decrease in Gram-negative bacterial infection of the cornea in the recent years.
http://www.ijo.in/currentissue.asp?sabs=y
Sujata Das, Ruchipriya Samantaray, Aparajita Mallick, Srikant K Sahu, Savitri Sharma
DOI:10.4103/ijo.IJO_500_18
Purpose: To report the distribution and trends of types of organisms and antibiotic susceptibility of the bacterial isolates obtained from patients with microbial keratitis. Methods: Microbiology records of culture-positive microbial keratitis that underwent a diagnostic corneal scraping and cultures were reviewed. Fungal, bacterial, and parasitic culture results and antibiotic susceptibility profile of bacteria were analyzed and comparisons were made between two halves of the study period (2007–2010 vs. 2011–2014). Results: A total of 3981 corneal scrapings were processed during the 8-year study period. Pathogen was recovered in culture in 1914 (48.1%) samples. Fungi, bacteria, and parasites constituted 38.7%, 60%, and 1.3% of the total isolates, respectively. The common fungal isolates were Aspergillus spp. (224/868, 25.8%) and Fusarium spp. (200/868, 23.0%), while common Gram-positive bacteria were Streptococcus pneumoniae (217/1125, 19.3%) and Staphylococcus aureus (185/1125, 16.4%), and common Gram-negative bacteria was Pseudomonas spp. (99/219, 45.2%). There was no significant difference in proportion of bacterial (P = 0.225) and fungal (P = 0.421) keratitis between the first half and second half of the study period. There was a significant increase in proportion of Gram-positive isolates (P = 0.015) [353/758 (46.6%) vs. 772/1482 (52.1%)] and decrease in proportion of Gram-negative organisms (P = 0.044) [88/758 (11.6%) vs. 131/1482 (8.8%)] in the recent years. In-vitro antibiotic susceptibility testing showed decrease in susceptibility to moxifloxacin for Pseudomonas spp. (P = 0.016) in recent years. Conclusion: Prevalence of fungal and bacterial keratitis has remained unchanged over the years. This study shows a significant increase in Gram-positive bacterial infection and decrease in Gram-negative bacterial infection of the cornea in the recent years.
http://www.ijo.in/currentissue.asp?sabs=y
Giant cell arteritis related arteritic anterior ischemic optic neuropathy
http://www.ijo.in/viewimage.asp?img=IndianJOphthalmol_2019_67_1_142_248176_f1.jpg
A 63-year-old male presented with sudden painless vision loss in his right eye of 2 day duration. He had no perception of light, Relative afferent pupillary defect (RAPD), pale disc edema along with an inferotemporal branch retinal artery occlusion [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. Clinical diagnosis of arteritic anterior ischemic optic neuropathy was made, and systemic examination revealed repeated bouts of fever and right sided scalp tenderness.[1],[2] Right side temporal artery biopsy revealed giant cell arteritis. The patient was treated with intravenous pulse steroids and immunosuppressive therapy.[2],[3] In cases of severe vision loss with pale disc edema, giant cell arteritis should be kept in mind.[4],[5]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
: Clinico-pathological correlation
Mohit Dogra, Ramandeep Singh, Mangat R Dogra
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Correspondence Address:
Dr. Mohit Dogra
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
India
DOI: 10.4103/ijo.IJO_881_18
A 63-year-old male presented with sudden painless vision loss in his right eye of 2 day duration. He had no perception of light, Relative afferent pupillary defect (RAPD), pale disc edema along with an inferotemporal branch retinal artery occlusion [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. Clinical diagnosis of arteritic anterior ischemic optic neuropathy was made, and systemic examination revealed repeated bouts of fever and right sided scalp tenderness.[1],[2] Right side temporal artery biopsy revealed giant cell arteritis. The patient was treated with intravenous pulse steroids and immunosuppressive therapy.[2],[3] In cases of severe vision loss with pale disc edema, giant cell arteritis should be kept in mind.[4],[5]
 | Figure 1: (a) showing pale disc edema (blue arrows) with an inferotemporal branch retinal artery occlusion, (b and c) showing "wedge shaped" equatorial choroidal infarcts on fluorescein angiogram, and (d) right side temporal artery biopsy at 200× magnification showing intimal proliferation with breaks in the internal elastic lamina (yellow arrows) with extravasation of red blood cells in the tunica media (black arrow) with minimal inflammatory cells, suggestive of vasculitis Click here to view |
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References |  |
| 1. | Hayreh SS, Podhasky PA, Zimmerman B. Ocular manifestations of giant cell arteritis. Am J Ophthalmol 1998;125:509-20.  |
| 2. | Wayand CM, Bartley GB. Giant cell arteritis: New concepts inpathogenesis and implications of management. Am J Ophthalmol1997;123:392-5. |
| 3. | Guevara M, Kollipara CS. Recent advances ingiant cell arteritis. CurrRheumatol Rep 2018;20:25. |
| 4. | HayrehSS. Management of ischaemic optic neuropathy. Indian J Ophthalmol 2011;59:123-36. |
| 5. | Attaseth T, Vanikieti K, Poonyathalang A, Preechawat P, Jindahra P, Wattanatranon D. Anterior ischemic optic neuropathydue tobiopsy-provengiant cell arteritisin Thai patients. ClinOphthalmol 2015;9:1071-5. |
Ophthalmology
http://www.ijo.in/currentissue.asp?sabs=y
| Indian Journal of Ophthalmology – On the right path Santosh G Honavar Indian Journal of Ophthalmology 2019 67(1):1-2 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Artificial intelligence (AI) in healthcare and biomedical research: Why a strong computational/AI bioethics framework is required? Jatinder Bali, Rohit Garg, Renu T Bali Indian Journal of Ophthalmology 2019 67(1):3-6 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypopigmented fundus in a young male Nawazish Fatma Shaikh, Vinod Kumar Indian Journal of Ophthalmology 2019 67(1):7-7 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Current concepts in crosslinking thin corneas Rashmi Deshmukh, Farhad Hafezi, George D Kymionis, Sabine Kling, Rupal Shah, Prema Padmanabhan, Mahipal S Sachdev Indian Journal of Ophthalmology 2019 67(1):8-15 Corneal cross-linking (CXL), introduced by Wollensak et al. in 2003, is a minimally invasive procedure to halt the progression of keratoconus. Conventional CXL is recommended in eyes with corneal thickness of at least 400 microns after de-epithelialization to prevent endothelial toxicity. However, most of the keratoconic corneas requiring CXL may not fulfill this preoperative inclusion criterion. Moderate-to-advanced cases are often found to have a pachymetry less than this threshold. There are various modifications to the conventional method to circumvent this issue of CXL thin corneas while avoiding the possible complications. This review is an update on the modifications of conventional CXL for thin corneas. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Management of Duane retraction syndrome: A simplified approach Nripen Gaur, Pradeep Sharma Indian Journal of Ophthalmology 2019 67(1):16-22 Duane retraction (or co-contraction) syndrome is a congenital restrictive strabismus which can occur either as an isolated entity or in conjunction with other congenital anomalies and is now listed as a congenital cranial dysinnervation disorder. It is characterized by co-contraction of horizontal recti on attempted adduction causing globe retraction along with variable amounts of upshoots or downshoots. It may have limited abduction or adduction or both and present as esotropic, exotropic, or orthotropic Duane. The diagnosis of this disease is usually clinical. However, recent research has provided a greater insight into the genetic basis of this disease paving a way for a greater role of genetics in the diagnosis and management. This disease can have a varied presentation and hence the treatment plan should be tailor-made for every patient. The indications for surgery are abnormal head posture, deviations in the primary position, retraction and narrowing of palpebral aperture and up- or downshoots during adduction, and sometimes also to improve abduction. The arrival of newer surgical techniques of periosteal fixation (PF) of lateral rectus (LR), partial vertical rectus transposition, or superior or inferior rectus transposition in addition to LR recession with Y-split has vastly improved the management outcomes, providing not only primary position orthophoria but also increased binocular visual fields as well. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Visual electrodiagnostics and eye movement recording - World Society of Pediatric Ophthalmology and Strabismus (WSPOS) consensus statement Manca Tekavcic Pompe, Alki Liasis, Richard Hertle Indian Journal of Ophthalmology 2019 67(1):23-30 Visual electrodiagnostics and eye movement recording are important additional clinical tools in evaluation, diagnosing and management of ophthalmic and neurological disorders. Due to their objectiveness and non-invasiveness they can play an important role in pediatric ophthalmology. The WSPOS (World Society of Pediatric Ophthalmology and Strabismus) consensus statement gives insight into basic principles and highlights the clinical application of both visual electrodiagnostic tests and eye movement recording. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Commentary: "Current" consensus: Electrodiagnostics in eye Nripen Gaur, Pradeep Sharma Indian Journal of Ophthalmology 2019 67(1):30-31 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Limbal ischemia: Reliability of clinical assessment and implications in the management of ocular burns Ka Wai Kam, Chaitali N Patel, Neda Nikpoor, Marco Yu, Sayan Basu Indian Journal of Ophthalmology 2019 67(1):32-36 Purpose: Limbal ischemia is an important prognostic factor in the management of ocular burns. In this study, we evaluated the reliability of clinically assessing limbal ischemia among ophthalmic professionals. Methods: This study included 111 ophthalmic professionals who were shown 12 diffuse illumination color slit-lamp photographs of eyes with recent chemical injuries. Respondents were asked whether the photos were assessable and if yes, then to indicate the presence, location, and grade of limbal ischemia in each case. The responses were collected using a standard data collection sheet and the inter-observer agreement was calculated. Results: All participants responded to every question. Of the 1,332 responses, images were deemed assessable in 1,222 (91.7%) instances. The overall agreement (Fleiss' kappa) for the presence of limbal ischemia and severity of limbal ischemia was 0.106 and 0.139, respectively (P < 0.012). Among the four groups of observers, practicing cornea specialists displayed significantly (P < 0.003) higher kappa values (0.201–0.203) when compared to residents (0.131–0.185), fellows (0.086–0.127), and optometrists (0.077–0.102). All indicated a poor level of inter-rater consistency. Conclusion: The results indicate that clinical assessment of limbal ischemia is highly subjective and there is lack of reliability even among cornea specialists who regularly manage patients with ocular burns. A non-invasive, standardized, objective, accurate, and reliable modality for ocular surface angiography is desperately needed for proper assessment and prognostication of ocular burns. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Commentary: Assessment of limbal ischemia in ocular burns Naveen Radhakrishnan, N Venkatesh Prajna Indian Journal of Ophthalmology 2019 67(1):37-37 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dopamine levels in human tear fluid Niyati Seshagiri Sharma, Suraj Kumar Acharya, Archana Padmanabhan Nair, Jyoti Matalia, Rohit Shetty, Arkasubhra Ghosh, Swaminathan Sethu Indian Journal of Ophthalmology 2019 67(1):38-41 Purpose: To determine the levels of dopamine in tear fluid and demonstrate the use of tear fluid as a non-invasive source for dopamine measurements in humans. Methods: The study cohort included 30 clinically healthy individuals without any pre-existing ocular or systemic conditions. Matched tear fluid (using Schirmer's strips and capillary tubes) and plasma were collected from the subjects. Dopamine levels were evaluated using direct competitive chemiluminescent enzyme-linked immunosorbent assay (ELISA), dopamine kit (Cloud Clone Corp, TX, USA). Results: Significantly higher dopamine levels were found in the tear fluid compared to plasma in the study subjects. The level of dopamine was 97.2 ± 11.80 pg/ml (mean ± SEM), 279 ± 14.8 pg/ml (mean ± SEM), and 470.4 ± 37.64 pg/ml (mean ± SEM) in the plasma and in the tears collected using Schirmer's strips and capillary tubes, respectively. Conclusion: Dopamine was detectable in all the tear fluid samples tested and was also found to be at a higher concentration than in plasma samples. Tear fluid can be used as a non-invasive sample source to monitor dopamine levels.
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