bluuebunny/crossref_metadata_2025 huggingface dataset:
The Epidemiology of Chronic Critical Illness After Severe Traumatic Injury at Two Level–One Trauma Centers*
Authors: Mira Juan C. , Cuschieri Joseph , Ozrazgat-Baslanti Tezcan , Wang Zhongkai , Ghita Gabriela L. , Loftus Tyler J. , Stortz Julie A. , Raymond Steven L. , Lanz Jennifer D. , Hennessy Laura V. , Brumback Babette , Efron Philip A. , Baker Henry V. , Moore Frederick A. , Maier Ronald V. , Moldawer Lyle L. , Brakenridge Scott C.
Published: August 2017

Objective:

To determine the incidence and risk factors of chronic critical illness after severe blunt trauma.

Design:

Prospective observational cohort study (NCT01810328).

Setting:

Two level–one trauma centers in the United States.

Patients:

One hundred thirty-five adult blunt trauma patients with hemorrhagic shock who survived beyond 48 hours after injury.

Interventions:

None.

Measurements and Main Results:

Chronic critical illness was defined as an ICU stay lasting 14 days or more with evidence of persistent organ dysfunction. Three subjects (2%) died within the first 7 days, 107 (79%) exhibited rapid recovery and 25 (19%) progressed to chronic critical illness. Patients who developed chronic critical illness were older (55 vs 44-year-old; p = 0.01), had more severe shock (base deficit, –9.2 vs –5.5; p = 0.005), greater organ failure severity (Denver multiple organ failure score, 3.5 ± 2.4 vs 0.8 ± 1.1; p < 0.0001) and developed more infectious complications (84% vs 35%; p < 0.0001). Chronic critical illness patients were more likely to be discharged to a long-term care setting (56% vs 34%; p = 0.008) than to a rehabilitation facility/home. At 4 months, chronic critical illness patients had higher mortality (16.0% vs 1.9%; p < 0.05), with survivors scoring lower in general health measures (p < 0.005). Multivariate analysis revealed age greater than or equal to 55 years, systolic hypotension less than or equal to 70 mm Hg, transfusion greater than or equal to 5 units packed red blood cells within 24 hours, and Denver multiple organ failure score at 72 hours as independent predictors of chronic critical illness (area under the receiver operating curve, 0.87; 95% CI, 0.75–0.95).

Conclusions:

Although early mortality is low after severe trauma, chronic critical illness is a common trajectory in survivors and is associated with poor long-term outcomes. Advancing age, shock severity, and persistent organ dysfunction are predictive of chronic critical illness. Early identification may facilitate targeted interventions to change the trajectory of this morbid phenotype.
Oral Agents for the Management of Agitation and Agitated Delirium in Critically Ill Patients
Authors: Yeo Qiu Min , Wiley Tessa L. , Smith Melanie N. , Hammond Drayton A.
Published: August 2017

Agitation is one of the most common issues that critically ill patients experience. Medications used to manage agitation are often administered intravenously or intramuscularly in the acutely agitated, critically ill patient. However, a multimodal approach that utilizes multiple routes of administration may be appropriate. This review summarizes the available literature on oral antipsychotics, clonidine, and valproic acid to manage agitation in critically ill patients while also focusing on their pharmacology and appropriate monitoring. Despite inconclusive findings from different studies, antipsychotics, clonidine, and valproic acid may provide benefit for specific patient populations. As more evidence emerges, these agents may start playing a greater role in the management of agitation, which is not amenable to first-line agents. As health care professionals, it is prudent to be familiar with their dosing regimens, common adverse effects, and the monitoring required to maximize patient benefits and minimize harms.
Opportunistic Pulmonary Infections in the Solid Organ Transplant Recipient
Authors: Goetz Megan E. , Evans Rickey A. , Rendulic TrisAnn
Published: August 2017

Immunosuppression required to prevent allograft rejection in the solid organ transplant recipient increases vulnerability to infections. Given continuous environmental exposure, the lungs are increasingly susceptible to bacterial, viral, and fungal opportunistic infections. Drug therapy options for the treatment of opportunistic pulmonary infections are used infrequently. These medications are often classified as high risk with specific administration instructions, as well as a multitude of toxicities. Therefore, in this article, we will discuss select pulmonary opportunistic infections and their associated drug therapies.
Relationship Between the CYP2C19 Phenotype Using the Voriconazole-to-Voriconazole N-Oxide Plasma Concentration Ratio and Demographic and Clinical Characteristics of Japanese Patients With Different CYP2C19 Genotypes
Authors: Niioka Takenori , Fujishima Naohito , Abumiya Maiko , Yamashita Takaya , Ubukawa Kumi , Nara Miho , Fujishima Masumi , Takahashi Naoto , Miura Masatomo
Published: August 2017

Background:

Although voriconazole (VRCZ) is metabolized to VRCZ N-oxide principally by CYP2C19, VRCZ clearance is affected by multiple factors. In this study, we investigated the relationship between the CYP2C19 phenotype using the VRCZ-to-VRCZ N-oxide plasma concentration ratio (VRCZ/N-oxide) and demographic and clinical characteristics of Japanese patients taking VRCZ.

Methods:

A total of 65 Japanese patients taking VRCZ for prophylaxis or treatment of fungal infection were enrolled in this study. Stepwise selection multiple linear regression analysis was performed to investigate the effect of factors on the VRCZ/N-oxide ratio.

Results:

In patients not undergoing concurrent treatment with a drug influencing CYP2C19 activity (n = 54), the VRCZ/N-oxide ratio with definite thresholds for CYP2C19 genotypes, CYP2C19*1/*1, *1/*2 + *1/*3 + *2/*17, and *2/*2 + *2/*3, was specifically identified in patients taking VRCZ (<0.48, ≥0.48 < and <0.82 and ≥0.82). However, the VRCZ/N-oxide ratio could not be predicted based solely on the CYP2C19 genotype (R
2 = 0.053). The route of VRCZ administration, C-reactive protein concentration determined on the same day as VRCZ plasma concentration measurement, CYP2C19 extensive metabolizer, and patient age were independent factors influencing the VRCZ/N-oxide ratio (R
2 = 0.489, standardized regression coefficient = 0.385, 0.380, −0.231, and 0.231; P = 0.001, 0.001, 0.032, and 0.036, respectively).

Conclusions:

It is possible to comprehensively evaluate CYP2C19 activity using the actual measured value of the VRCZ/N-oxide ratio in patients taking VRCZ. The predictive performance of the VRCZ/N-oxide ratio was improved by including the route of administration, C-reactive protein level, and patient age in addition to the CYP2C19 genotype as predictive factors.
MACULAR TELANGIECTASIA TYPE 2
Authors: Okada Mali , Egan Catherine A. , Heeren Tjebo F. C. , Tufail Adnan , Fruttiger Marcus , Maloca Peter M.
Published: August 2017

Purpose:

To investigate retinal microcystoid spaces in macular telangiectasia type 2 with spectral domain optical coherence tomography.

Methods:

Retrospective review of 135 patients enrolled in the MacTel Natural History Observation and Registry Study at Moorfields Eye Hospital, United Kingdom. One hundred seventy-two eyes from 86 patients who had a comparable scan protocol of at least 30 μm interval were included for analysis. Retinal microcystoid spaces were identified and segmented and metrics analyzed.

Results:

From 172 eyes of 86 patients, microcystoid spaces were found in 11 eyes (6.4%) from 8 patients (9.3%). The mean number of microcystoid spaces per eye was 12.9 ± 18.2. Most were located in the inner nuclear layer. The inferonasal quadrant of the macula was the least commonly affected region. Microcystoid spaces were distributed entirely within the assumed macular telangiectasia area on blue light reflectance in all but 2 eyes (4 of 142 microcysts). The median diameter of the microcystoid spaces was 31 μm (range 15 μm–80 μm).

Conclusion:

Microcystoid spaces as a phenotype of macular telangiectasia should be considered in the differentials for microcystic edema. Understanding the pathogenesis of these lesions may provide further insight into the role of Müller cell dysfunction in this disorder.
BENEFIT OF INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY FOR VITREOMACULAR SURGERY IN HIGHLY MYOPIC EYES
Authors: Bruyère Elsa , Philippakis Elise , Dupas Bénédicte , Nguyen-Kim Pauline , Tadayoni Ramin , Couturier Aude
Published: August 2017

Purpose:

To report the feasibility and information provided by intraoperative optical coherence tomography (iOCT) during vitreomacular surgery in highly myopic eyes.

Methods:

Retrospective observational case series on consecutive highly myopic eyes that underwent vitreomacular surgery with iOCT for epiretinal membrane (ERM), macular hole, and myopic foveoschisis. The main outcome was the qualitative and quantitative assessment of retinal changes: detection of persistent epiretinal structures, new openings, central macular thickness, and macular hole diameters after each step of the surgical procedure. Quantitative measurements (in pixels) were manually obtained on iOCT video screen captures.

Results:

Twenty-two eyes were included: six ERMs, 10 macular holes, and 6 with myopic foveoschisis. An unsuspected postpeeling macular opening was detected by iOCT in 2/22 eyes. Intraoperative optical coherence tomography also allowed for detecting the presence of residual fragments of the vitreous cortex in 6/12 eyes after surgically induced posterior vitreous detachment. Intraoperative optical coherence tomography detected residual fragments of the internal limiting membrane in 5/21 eyes after internal limiting membrane peeling, and residual fragments of ERM in 3/15 eyes with ERM. Quantitative analysis did not find any significant change in central macular thickness and macular hole diameters before and after ERM and internal limiting membrane peeling.

Conclusion:

In highly myopic eyes, iOCT could help assess undetected macular openings and otherwise posterior vitreous status and epiretinal structure peeling.
ACUTE PSEUDOPHAKIC CYSTOID MACULAR EDEMA IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Chetrit Mardoche , Bonnin Sophie , Mané Valérie , Erginay Ali , Tadayoni Ramin , Gaudric Alain , Couturier Aude
Published: August 2017

Purpose:

To study macular capillary changes and vessel density in acute pseudophakic cystoid macular edema (PCME) before and after treatment using optical coherence tomography angiography.

Methods:

Retrospective observational case–control study of seven consecutive patients (eight eyes) with PCME and eight age-matched control eyes imaged with optical coherence tomography angiography (RTVue XR Avanti; Optovue, Inc, Fremont, CA) using Projection Removal Artifacts software. Vessel density was calculated.

Results:

The mean time to diagnosis of PCME was 2.3 ± 0.9 months after surgery. At initial examination, the superficial capillary plexus pattern was near-normal in all PCME eyes, although it was attenuated in the deep capillary plexus. The mean vessel density of the superficial capillary plexus in PCME eyes was slightly but significantly lower than in control eyes (47.8 ± 3.8% vs. 52.9 ± 4.0%, P = 0.01), the difference being greater in the deep capillary plexus (44.1 ± 7.4% vs. 54.2 ± 3.2%, P = 0.007). After resolution of the edema, the deep capillary plexus completely recovered its normal pattern and the vessel density in both plexuses was no longer different from that observed in control eyes.

Conclusion:

Macular vessel density after resolution of an acute PCME did not differ from that of normal control eyes in both the superficial capillary plexus and deep capillary plexus, unlike macular edema in retinal vaso-occlusive diseases.
A CASE OF NEUROFIBROMATOSIS TYPE 2 WITH UNUSUAL CLINICAL FEATURES
Authors: Zarei Mohamma , Hamzeloui Parisa , Rooipoor Ramak , Fard Masoud Aghsaei
Published: August 2017

Purpose:

To report a case of a neurofibromatosis Type 2 with unusual clinical features.

Methods:

Observational clinical case report.

Results:

A 22-year-old woman was referred with bilateral blurred vision and macular “scars.” Ocular examination revealed bilateral posterior subcapsular and cortical cataract, optic disk swelling, hyperpigmented macular lesions, epiretinal membrane, and macular temporal dragging. Spectral-domain optical coherence tomographic imaging showed bilateral epiretinal membranes, peripapillary nerve fiber layer thickening, and vitreoretinal tractional bands. In the right eye, focal choroidal excavation was noted at the site of the macular lesion. In fluorescein angiography, mild vascular leakage, capillary nonperfusion, and ground glass hyperfluorescence was seen in temporal periphery of the right eye. Brain imaging showed intracranial calcification and vestibular schwannoma, which was removed by a neurosurgeon. A clinical diagnosis of neurofibromatosis Type 2 was made.

Conclusion:

A case of neurofibromatosis Type 2 with some possibly novel or rare findings, namely, focal choroidal excavation, ash leaf spots, and intracranial calcifications was presented.
Agreement of Corneal Diameter Measurements Obtained by a Swept-source Biometer and a Scheimpflug-based Topographer
Authors: Salouti Ramin , Nowroozzadeh Mohammad Hossein , Tajbakhsh Zahra , Bagheri Mansoureh , Ghoreyshi Maryam , Azizzadeh Monir , Razeghinejad Mohammad Reza
Published: August 2017

Purpose:

To assess the agreement between a swept-source optical biometry device (IOLMaster 700) and a Scheimpflug-based topography device (Pentacam HR) in measuring the corneal diameter.

Methods:

A total of 100 eyes from 100 cataract surgery candidates were enrolled. The white-to-white (WTW) distance measurements provided by both devices were recorded and analyzed. A paired t test was performed to compare the mean values of the WTW distance between the IOLMaster 700 and Pentacam HR. The Bland–Altman analysis was used to evaluate the agreement between the measurements of both devices.

Results:

Mean age (±SD) of the participants was 65.9 ± 3.3 years, and 58 (58%) were men. The mean WTW distances measured by the IOLMaster 700 and Pentacam HR were 11.72 ± 0.45 mm and 11.41 ± 0.42 mm, respectively (P < 0.001). The overall 95% limits of agreement were −0.17 and 0.78 mm. The 95% limits of agreement between the measurements of the 2 devices were −0.30 and 0.84 versus −0.07 and 0.72 for eyes with WTW distances of ≤11.50 mm versus >11.50 mm, respectively.

Conclusions:

According to the results of this study, the IOLMaster 700 may overestimate the WTW distance measurements by up to 0.78 mm compared with the Pentacam HR, so these 2 devices should not be used interchangeably for this purpose. The agreement is somehow weaker for eyes with WTW distances of 11.50 mm or less than those with WTW distances greater than 11.50 mm.
Quantitative Analysis of Endothelial Cell Loss in Preloaded Descemet Membrane Endothelial Keratoplasty Grafts
Authors: Wolle Meraf A. , DeMill David L. , Johnson Lauren , Lentz Stephen I. , Woodward Maria A. , Mian Shahzad I.
Published: August 2017

Purpose:

Availability of preloaded Descemet membrane endothelial keratoplasty (pDMEK) tissue may increase acceptance of DMEK in surgical management of endothelial disease. The goal of this study was to determine the safety of pDMEK grafts for 24 hours before surgery by analyzing endothelial cell loss (ECL) using 2 image analysis software programs.

Methods:

A total of 18 cadaveric corneas were prepared for DMEK using a standardized technique and loaded in a modified Jones tube injector. Nine of the corneas were injected into Calcein AM vital dye after 1 minute (controls), and the remaining 9 corneas were left preloaded for 24 hours before injection into vital dye for staining. The stained corneas were imaged using an inverted confocal microscope. ECL was then analyzed and quantified by 2 different graders using 2 image analysis software programs.

Results:

The control DMEK tissue resulted in 22.0% ± 4.0% ECL compared with pDMEK tissue, which resulted in 19.2% ± 7.2% ECL (P = 0.31). Interobserver agreement was 0.93 for MetaMorph and 0.92 for Fiji. The average time required to process images with MetaMorph was 2 ± 1 minutes and with Fiji was 20 ± 10 minutes. Intraobserver agreement was 0.97 for MetaMorph and 0.93 for Fiji.

Conclusions:

Preloading DMEK tissue is safe and may provide an alternative technique for tissue distribution and surgery for DMEK. The use of MetaMorph software for quantifying ECL is a novel and accurate imaging method with increased efficiency and reproducibility compared with the previously validated Fiji.
Self-Retained Amniotic Membrane Combined With Antiviral Therapy for Herpetic Epithelial Keratitis
Authors: Cheng Anny M. S. , Tseng Scheffer C. G.
Published: August 2017

Purpose:

To evaluate the therapeutic benefit of self-retained cryopreserved amniotic membrane in conjunction with oral antiviral therapy in herpetic epithelial keratitis.

Methods:

Retrospective review of 4 patients with primary (1 eye) and recurrent (3 eyes) unilateral herpetic epithelial keratitis treated with cryopreserved amniotic membrane through the placement of the PROKERA Slim (PKS) (Bio-Tissue, Inc) in conjunction with oral acyclovir. Their symptoms, conjunctival inflammation, corneal staining, and visual acuity were compared before and after treatment.

Results:

Herpetic epithelial keratitis presented as dendritic (3 eyes) and geographic (1 eye) epithelial lesions. After epithelial debridement and placement of the PKS for 5 ± 3.7 days, all patients reported significant relief of symptoms, rapid corneal epithelialization, and reduction of ocular surface inflammation. The visual acuity was also improved in all eyes from 0.7 ± 0.7 to 0.4 ± 0.7 logarithm of the minimum angle of resolution (P = 0.2). They remained symptom-free during a follow-up period of 2.7 to 50.8 (20.3 ± 21.7) months.

Conclusions:

The PKS in conjunction with oral acyclovir facilitates the ease of early intervention to accelerate restoration of a normal corneal epithelium in herpetic epithelial keratitis.
Preparation and Biomechanical Properties of an Acellular Porcine Corneal Stroma
Authors: Li Qing , Wang Hongmei , Dai Zhenye , Cao Yichen , Jin Chuanyu
Published: August 2017

Purpose:

To construct an acellular porcine corneal stroma (aPCS) as a human corneal stroma alternative and to further explore its biomechanical properties.

Methods:

A combination of DNA-RNA enzymes and ultrasound technology was used to strip the native porcine corneal cells. The microstructure of aPCS was observed by H&E staining, DAPI staining, and α-Gal tests. The mechanical properties were detected by a tension machine. Cytotoxicity of aPCS was measured by the MTT assay. The subcutaneous embedding experiment in rats was also used to detect immunity and degradation. The aPCS was transplanted into the rabbit cornea by lamellar keratoplasty, general observations were made at 3 days, 1 week, 1 month, and 3 months after implantation, respectively.

Results:

The microstructure and mechanical properties of aPCS were not damaged during the decellularization process. The aPCS extracts had no significant cytotoxicity on human corneal stroma cells. Moreover, the subcutaneous embedding experiment in rats demonstrated that aPCS could not be degraded and induced no immune reaction in and around the transplanted discs. More important is that the aPCS reconstructed normal corneal stroma and maintained corneal transparency and thickness, with almost no neovascularization and inflammation at 3 months after surgery.

Conclusions:

The aPCS prepared in this study had good biocompatibility, safety, and low antigenicity, which has great potential for corneal disease treatment.
Systematic Review and Meta-Analysis of Clinical Outcomes of Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Endothelial Keratoplasty/Descemet Stripping Automated Endothelial Keratoplasty
Authors: Singh Abhimanyu , Zarei-Ghanavati Mehran , Avadhanam Venkata , Liu Christopher
Published: August 2017

Purpose:

To review and compare the published reports of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty/Descemet stripping automated endothelial keratoplasty (DSEK/DSAEK) procedures with regard to endothelial cell density/loss, best spectacle-corrected visual acuity, central corneal thickness, subjective outcomes (patient's reported satisfaction/preference), and postoperative complications.

Methods:

A thorough search was conducted in the databases including AMED, EMBASE, Cochrane Database of Systematic Reviews, and MEDLINE without date restrictions. Systematic reviews, meta-analysis, randomized controlled trials, case series, and audits comparing DMEK and DSAEK were included.

Results:

DMEK is superior to DSAEK for the following outcomes: visual acuity, central corneal thickness, and patient satisfaction. There was a statistically significant difference in the mean spectacle-corrected visual acuity at 6 months for DMEK (mean = 0.161, SD = 0.129) and DSAEK eye (mean = 0.293, SD = 0.153) conditions; t (297) = 8.042, P < 0.0001. The pooled mean difference was −0.13 (95% confidence interval, −0.16 to −0.09) and I
2 = 44%, indicating better visual acuity for DMEK. Mean postoperative endothelial cell density showed statistically no significant difference in the mean values for DMEK (mean = 1855, SD = 442) and DSAEK eye (mean = 1872, SD = 429) conditions; t (336) = 0.375, P = 0.708. A higher proportion of patients prefer DMEK to DSAEK. However, DSAEK is superior to DMEK with respect to the need for rebubbling as the rebubbling rate was higher in the DMEK group.

Conclusions:

Although DMEK is associated with a higher rate of rebubbling, better visual outcomes were seen in DMEK.
Prestained and Preloaded DMEK Grafts: An Evaluation of Tissue Quality and Stain Retention
Authors: Zeidenweber Dorian A. , Tran Khoa D. , Sales Christopher S. , Wehrer Stephen W. , Straiko Michael D. , Terry Mark A.
Published: August 2017

Purpose:

To examine endothelial cell damage and stain retention of prestained preloaded Descemet membrane endothelial keratoplasty (DMEK) grafts.

Methods:

DMEK grafts were stained with trypan blue or left unstained before loading into a Straiko modified Jones tube. A protocol to stain preloaded grafts inside the modified Jones tube and resulting cell loss was also examined. Endothelial cell loss was determined by vital dye staining after 3 days of cold storage and compared between the 3 groups. Eight additional grafts were stained, loaded, and shipped from Oregon to New York to assess stain stability. Stain retention and the ability to successfully inject and open these “prestained preloaded” grafts in cadaveric donor eyes were also evaluated.

Results:

Unstained preloaded DMEK grafts showed an overall cell loss of 15% ± 3% [95% confidence interval (CI), 11%–18%]. Prestained grafts had a cell loss of 16% ± 4% (95% CI, 10%–22%) and were not significantly different from unstained grafts (P = 1). Grafts stained while inside the modified Jones tubes had an average cell loss of 18% ± 2% (95% CI, 16%–20%, P
prestained = 0.15, P
unstained = 0.09). All grafts shipped across the country and examined 3 days after preparation showed a decrease in stain intensity but were still deemed suitable for transplantation by an experienced DMEK surgeon.

Conclusions:

It is possible to prestain and preload DMEK grafts without inducing additional endothelial cell loss. Consideration should be given to the interval between staining and surgery because stain can fade.
Minimizing Graft Preparation Failure in Descemet Membrane Endothelial Keratoplasty
Authors: Livny Eitan , Groeneveld-van Beek Esther A. , Lie Jessica T. , Mangundap Kristin M. , Bruinsma Marieke , Birbal Rénuka S. , van der Wees Jacqueline , Melles Gerrit R. J.
Published: August 2017

Purpose:

To report the failure rate of 2 graft preparation techniques for Descemet membrane endothelial keratoplasty (DMEK) and to evaluate how to minimize graft preparation failure.

Methods:

Retrospective, nonrandomized study at an eye bank specialized in graft preparation for lamellar keratoplasty. For 1416 donor corneas, the DMEK graft preparation failure rate was evaluated for 2 different techniques, technique I: “Standardized traditional technique” (n = 341) and technique II: “Standardized no-touch technique” (n = 933), and for grafts that were converted from technique II to technique I during preparation (n = 142).

Results:

The overall failure rate averaged 3.9% (55/1416): 7.0% (24/341) for technique I and 2.9% (31/1075) for technique II (P < 0.05). Tissue preparations which were converted from technique II to technique I failed in 13.4% (19/142), whereas for grafts that were entirely prepared by technique II, the failure rate was only 1.3% (12/933). The endothelial cell density decrease (before compared with after preparation) did not differ for both techniques (1.1% vs. 0.2%, P > 0.05).

Conclusions:

Various DMEK graft preparation techniques may provide failure rates of <4%. A “no-touch preparation” approach (technique II) may combine good graft quality (completely intact endothelial cell layer, ie, negligible preparation-induced endothelial cell density decrease) with low risk of dissection failure, leaving the possibility of conversion to “traditional preparation” (technique I) as a backup method.
Comparison of the Center and Flex-Center Methods of Corneal Endothelial Cell Analysis in the Presence of Guttae
Authors: Huang Jianyan , Liu Xuan , Tepelus Tudor C. , Nazikyan Tigran , Chopra Vikas , Sadda Srinivas R. , Lee Olivia L.
Published: August 2017

Purpose:

To compare endothelial cell analysis by the center and flex-center methods in corneas with guttae of differing severity and to determine the minimum countable cell number for using only the flex-center method.

Methods:

Forty-seven eyes with corneal guttae and 50 age-matched normal controls were enrolled in the study. Three images were captured in each central cornea with the noncontact specular microscope. Endothelial cell density (ECD), coefficient of variation (CV), and percentage of hexagonal cells (HEX) were analyzed by trained graders, using both center and flex-center methods.

Results:

Consistent ECD and HEX values were obtained in normal eyes by both methods (P > 0.05). In corneas with guttae, ECD values obtained by the center method were 2.4% higher than those obtained with the flex-center method (P < 0.001). ECD values derived by both methods disagreed only when <30 cells were identified or <20 cells were analyzed. CV values obtained by the center method were 17.1% (P < 0.001) lower than those obtained by the flex-center method. HEX values obtained with both methods (P > 0.05) agreed. Regardless of guttae density, the ECD, CV, and HEX values of 3 images of each eye were in agreement (P > 0.05).

Conclusions:

In corneas with guttae, both center and flex-center methods can reliably determine ECD. Although current practice recommends the center method when at least 100 cells can be counted, our study suggests that the center method can provide a reliable ECD value when there are ≥30 contiguous countable cells in a central cornea endothelial image. The flex-center method is recommended when <30 contiguous cells are identified.
Promotion of Corneal Epithelial Wound Healing in Diabetic Rats by the Fibronectin-Derived Peptide PHSRN
Authors: Morishige Naoyuki , Uemura Aiko , Morita Yukiko , Nishida Teruo
Published: August 2017

Purpose:

Topical application of the fibronectin-derived peptide PHSRN facilitates corneal epithelial wound healing in healthy animals and in patients with nonhealing epithelial defects. We have now examined the effect of PHSRN eye drops on the healing of corneal epithelial wounds in diabetic rats.

Methods:

Wistar rats were injected intraperitoneally with streptozotocin to induce diabetes or with a vehicle as a control. Four weeks after confirmation of the corresponding presence or absence of glycosuria, a 3-mm-diameter portion of the corneal epithelium of the right eye was excised and eye drops containing PHSRN (200 μM) or phosphate-buffered saline (PBS) vehicle were administered to the injured eye every 6 hours.

Results:

The area of the epithelial defect did not differ significantly among the 4 experimental groups (diabetic or nondiabetic rats treated with PHSRN or vehicle) at 12 hours after wounding. At 18 hours, however, the area of the defect in diabetic rats treated with PHSRN (0.50 ± 0.34 mm2) was significantly (P < 0.05) smaller than that in diabetic rats treated with PBS (1.06 ± 0.42 mm2) and was similar to that in nondiabetic rats treated with PBS (0.60 ± 0.23 mm2). The decrease in the size of the epithelial defect in diabetic rats treated with PHSRN was also found to be dependent on the dose of the peptide.

Conclusions:

Administration of PHSRN significantly facilitated healing of corneal epithelial wounds in diabetic rats, which suggests that PHSRN eye drops warrant further investigation as a treatment option for patients with diabetic keratopathy.
Comparison of Central Corneal Thickness Measurements Using Ultrasonic Pachymetry, Anterior Segment OCT and Noncontact Specular Microscopy
Authors: Scotto Riccardo , Bagnis Alessandro , Papadia Marina , Cutolo Carlo Alberto , Risso Domenico , Traverso Carlo Enrico
Published: August 2017

Purpose:

To evaluate and compare central corneal thickness (CCT) values measured with anterior segment optical coherence tomography (AS-OCT), noncontact specular microscopy (NCSM), and ultrasound pachymetry (USP).

Materials and Methods:

CCT was measured in 182 healthy eyes without ocular abnormalities other than refractive errors. Three consecutive measurements of CCT by the same examiner were obtained during the same session. The testing sequence of AS-OCT and NCSM was randomly selected. The USP always was performed after the noncontact examinations.

Results:

The average CCT measured by AS-OCT, NCSM, and USP were 535.8±35.5, 547.7±38.2, and 537.4±37.5 μm, respectively. The mean differences between modalities were 11.8±14.7 μm (P<0.01) between NCSM and AS-OCT, 10.3±17.7 μm (P<0.01) between NCSM and USP and 1.6±8.6 μm (P=0.02) between USP and AS-OCT.

Conclusions:

AS-OCT, NCSM, and USP showed an overall strong agreement in measuring CCT. However, CCT measurements with AS-OCT showed a good correlation to those obtained by USP, NCSM tended to give statistically significant higher CCT readings than either alternative and showed the worse repeatability indices. On the basis of our results, CCT measurement obtained with different instruments cannot be considered directly interchangeable.
Change in Visual Field Progression Following Treatment Escalation in Primary Open-angle Glaucoma
Authors: Aptel Florent , Bron Alain M. , Lachkar Yves , Schweitzer Cédric
Published: August 2017

Purpose:

To evaluate the effect of treatment escalation on the rate of visual field progression in patients with primary open-angle glaucoma (POAG).

Patients and Methods:

Multicenter database study. We reviewed the electronic records of 171 patients with POAG under medical hypotensive treatment who underwent 5 consecutive visits 6 months apart before and after medical treatment escalation or additive laser trabeculoplasty. We calculated the rate of visual field progression (mean deviation change per year) before and after treatment escalation.

Results:

The mean duration of follow-up was 5.1±0.5 years and the mean number of visual field examinations was 10.2±0.2. In 139 eyes with medical treatment escalation, the rate of progression was significantly reduced [from −0.57 to −0.29 dB/y; P=0.022; intraocular pressure (IOP) reduction 11.1%]. In detail, the rate of progression was significantly reduced after escalation from mono to dual therapy, dual to triple therapy, and from mono to triple therapy (−0.35 to −0.24 dB/y, P=0.018; −1.01 to −0.48 dB/y, P=0.038; −1.04 to −0.35 dB/y, P=0.020, respectively). In 32 eyes with additive laser trabeculoplasty, the rate of progression was significantly reduced (−0.60 to −0.24 dB/y; P=0.014; IOP reduction 9.4%).

Conclusions:

Medical treatment escalation or additive laser trabeculoplasty significantly reduced the rate of visual field progression in POAG. Larger IOP reduction has a greater probability of reducing glaucoma progression.
Within-Hospital Variation in 30-Day Adverse Events: Implications for Measuring Quality
Authors: Burke Robert E. , Glorioso Thomas , Barón Anna K. , Kaboli Peter J. , Ho P. Michael
Published: August 2017

Novel measures of hospital quality are needed. Because quality improvement efforts seek to reduce variability in processes and outcomes, hospitals with higher variability in adverse events may be delivering poorer quality care. We sought to evaluate whether within-hospital variability in adverse events after a procedure might function as a quality metric that is correlated with facility-level mortality rates. We analyzed all percutaneous coronary interventions (PCIs) performed in the Veterans Health Administration (VHA) system from 2007 to 2013 to evaluate the correlation between within-hospital variability in 30-day postdischarge adverse events (readmission, emergency department visit, and repeat revascularization), and facility-level mortality rates, after adjustment for patient demographics, comorbidities, PCI indication, and PCI urgency. The study cohort included 47,567 patients at 48 VHA hospitals. The overall 30-day adverse event rate was 22.0% and 1-year mortality rate was 4.9%. The most variable sites had relative changes of 20% in 30-day rates of adverse events period-to-period. However, within-hospital variability in 30-day events was not correlated with 1-year mortality rates (correlation coefficient = .06; p = .66). Thus, measuring within-hospital variability in postdischarge adverse events may not improve identification of low-performing hospitals. Evaluation in other conditions, populations, and in relationship with other quality metrics may reveal stronger correlations with care quality.
Effects of a Novel Microprocessor-Controlled Knee, Kenevo, on the Safety, Mobility, and Satisfaction of Lower-Activity Patients with Transfemoral Amputation
Authors: Mileusnic Milana P. , Hahn Andreas , Reiter Sebastian
Published: August 2017

Introduction

Lower-activity persons with transfemoral amputation experience many comorbidities that limit their ability to satisfactorily use prosthetic knees and safely conduct their life activities. Kenevo is a novel microprocessor-controlled knee designed specifically to accommodate the needs of lower-activity individuals with transfemoral amputation.

Materials and Methods

A prospective observational study was conducted to collect first clinical experiences with Kenevo. Patient-reported measures were conducted to assess patient safety, mobility on level walking, stairs and ramps, as well as preference. In addition, feedback from certified prosthetists/orthotists was collected regarding fitting process, acclimation, and patient benefits.

Results

A total of 29 persons with amputation were fitted with Kenevo. Most of them had unilateral amputations and belonged to the K2 mobility group. Fitting the Kenevo resulted in a positive trend in the Locomotor Capabilities Index 5, Prosthetic Limb Users Survey of Mobility, and Houghton scores (p > 0.05). Kenevo use resulted in a significant reduction of wheelchair dependence for many subjects. Most subjects reported improvements in level walking during various speeds and on uneven ground as well as when walking and standing on ramps and traversing stairs. More than two-thirds of the subjects reported reduction in necessary concentration and perceived exertion when walking with Kenevo. Fear of falling was reduced in 50% of the subjects, whereas the number of subjects who never fell increased from 45% to 72% (p = 0.161) and those who never stumbled from 8% to 50% (p = 0.044). Finally, 89% of the subjects preferred Kenevo to their previous fitting.

Conclusions

First routine fittings of the new Kenevo microprocessor-controlled knee suggest that it offers numerous advantages to lower-activity persons with amputation. Improvements in functional mobility and safety were observed. Of the subjects, 89% preferred Kenevo over their previous knee. Higher-quality research is needed to confirm the conclusions reached in this observational study.
Allogeneic stem-cell transplantation for myelofibrosis
Authors: Lavi Noa , Rowe Jacob M. , Zuckerman Tsila
Published: August 2017

Purpose of review

Allogeneic hematopoietic stem-cell transplantation (HSCT) remains the only curative therapy for myelofibrosis. The number of HSCTs performed for this indication has been steadily increasing over the past years, even after the approval of the Janus kinase (JAK) inhibitor, ruxolitinib. This increase may be attributed to improved patient selection based on new prognostic molecular markers, more frequent use of matched unrelated donors, secondary to better (high-resolution) human leukocyte antigen typing and supportive care. Ruxolitinib approval raises new questions regarding the role of JAK inhibitors in the transplant setting.

Recent findings

The current review summarizes recent updates on HSCT in myelofibrosis. Predictors for transplant outcomes, and specific considerations related to myelofibrosis patient selection for HSCT (e.g. molecular risk stratification) are reviewed. In addition, this review will consider management of myelofibrosis patients in the peritransplant period, including the role of ruxolitinib in the pretransplant period, pre and posttransplant splenomegaly, transplant protocols, posttransplant follow-up of minimal residual disease and interventions in the event of poor engraftment.

HSCT remains a highly relevant treatment option for myelofibrosis in the era of JAK inhibitors. Recent advances may contribute to a refined definition of HSCT eligibility and identification of the optimal transplantation time, conditioning protocols and posttransplant management.
Prehospital hemostatic resuscitation to achieve zero preventable deaths after traumatic injury
Authors: Spinella Philip C. , Cap Andrew P.
Published: August 2017

Purpose of review

To describe how hemostatic resuscitation can be used in the prehospital phase of resuscitation to reduce preventable deaths after traumatic injury.

Recent findings

Hemorrhagic shock is the leading cause of death that is preventable after injury. The National Academy of Sciences, recently, recommended that achievement of zero preventable deaths after traumatic injury should be the goal of a national trauma system. In the United States, there are an estimated 25 000 preventable deaths per year in the prehospital phase of resuscitation because of traumatic hemorrhagic shock. Therefore, to achieve the goal of zero preventable deaths after injury, both shock and hemostatic dysfunction need to be addressed rapidly in the prehospital phase of resuscitation. This review will highlight the epidemiology and outcomes of traumatic hemorrhagic shock, and explore potential solutions such as group O whole blood and platelets stored at 2–6°C. Trauma research receives the lowest funding relative to the burden of morbidity and mortality it creates when compared with all other diseases. Increased resources are required to achieve zero preventable deaths after injury.

Prehospital hemostatic resuscitation has the potential to significantly reduce preventable death from hemorrhage.
Suicidal Ideation Among Medical Students
Authors: Torres Albina R. , Campos Luana M. , Lima Maria Cristina P. , Ramos-Cerqueira Ana Teresa A.
Published: August 2017

Suicide is one of the leading causes of death among medical students, second to car accidents. We investigated the prevalence and predictors of suicidal ideation (SI) among medical students in Brazil. This is a cross-sectional study with 475 medical students of a public university. The research protocol included data on sociodemographics and academic life, and structured instruments to assess social support and psychopathological symptoms, including the Beck Depression Inventory (BDI). The outcome was evaluated using the BDI suicide item. Bivariate analyses were followed by logistic regression. SI was present in 34 participants (7.2%). In the logistic regression, SI remained associated with living alone, thoughts of abandoning the course, moderate or severe depressive symptoms, and probable obsessive-compulsive disorder. SI is frequent among medical students and can be identified with a simple screening question. Special attention should be given to students living alone, with thoughts of abandoning the course, and relevant depressive or obsessive-compulsive symptoms.
Teaching Informatics to Prelicensure, RN-to-BSN, and Graduate Level Students
Authors: Vottero Beth
Published: August 2017

Teaching nursing informatics to students in associate, baccalaureate, RN-BSN, and graduate nursing programs poses challenges for curriculum design, as well as developing appropriate instruction and assessment methods. The current state of nursing informatics education provides opportunities for unique instructional design and assessment techniques. Key course content is provided with suggestions for teaching informatics that focus on leveling for prelicensure, RN-BSN, and graduate nursing programs.
Integration of Quality and Safety Education for Nurses Into Practice
Authors: Koffel Chris , Burke Kathleen G. , McGuinn Kathy , Miltner Rebecca S.
Published: August 2017

There is a trend to adopt the Quality and Safety Education for Nurses (QSEN) competencies into nursing practice’s organizational activities. Incorporating the competencies has created unique challenges for the practice setting. The purpose of this article is to identify the different types of academic-practice partnerships that promote quality and safety, including a specific focus on how the QSEN competencies are being incorporated into practice settings.
Multifractality, Interactivity, and the Adaptive Capacity of the Human Movement System: A Perspective for Advancing the Conceptual Basis of Neurologic Physical Therapy
Authors: Cavanaugh James T. , Kelty-Stephen Damian G. , Stergiou Nicholas
Published: August 2017

Background and Purpose:

Physical therapists seek to optimize movement as a means of reducing disability and improving health. The short-term effects of interventions designed to optimize movement ultimately are intended to be adapted for use across various future patterns of behavior, in potentially unpredictable ways, with varying frequency, and in the context of multiple tasks and environmental conditions. In this perspective article, we review and discuss the implications of recent evidence that optimal movement variability, which previously had been associated with adaptable motor behavior, contains a specific complex nonlinear feature known as “multifractality.”

Summary of Key Points:

Multifractal movement fluctuation patterns reflect robust physiologic interactivity occurring within the movement system across multiple time scales. Such patterns provide conceptual support for the idea that patterns of motor behavior occurring in the moment are inextricably linked in complex, physiologic ways to patterns of motor behavior occurring over much longer periods. The human movement system appears to be particularly tuned to multifractal fluctuation patterns and exhibits the ability to reorganize its output in response to external stimulation embedded with multifractal features.

Recommendations for Clinical Practice:

As a fundamental feature of human movement, multifractality opens new avenues for conceptualizing the link between physiologic interactivity and adaptive capacity. Preliminary evidence supporting the positive influence of multifractal rhythmic auditory stimulation on the gait patterns of individuals with Parkinson disease is used to illustrate how physical therapy interventions might be devised to specifically target the adaptive capacity of the human movement system.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A183).
Performance of Commercial Enzyme-Linked Immunoassays for Diagnosis of Herpes Simplex Virus-1 and Herpes Simplex Virus-2 Infection in a Clinical Setting
Authors: Agyemang Elfriede , Le Quynh-An , Warren Terri , Magaret Amalia S. , Selke Stacy , Johnston Christine , Jerome Keith R. , Wald Anna
Published: August 2017

Background

US Food and Drug Administration-approved enzyme-linked immunoassays (EIA) for determining type-specific herpes simplex virus (HSV) serostatus are widely used in clinical practice. We compared the performance of such assays with the University of Washington Western blot (UW WB) in patients who sought confirmation of their HSV serology result.

Methods

We reviewed charts of all persons evaluated at the Westover Heights Clinic in Portland, Oregon, from July 2010 through September 2015, who had a HSV EIA, followed by UW WB.

Results

Of 864 persons, 47% were women. The median age was 36 years (range, 18–73 years). Using UW WB to define infection status, 286 (33%) persons were HSV-1 seropositive only, 104 (12%) were HSV-2 seropositive only, 134 (16%) were both HSV-1 and HSV-2 seropositive, 235 (27%) were HSV seronegative, and 105 (12%) had indeterminate results. Compared with the UW WB as the criterion standard, EIA was 70.2% sensitive and 91.6% specific for HSV-1, and 91.9% sensitive and 57.4% specific for HSV-2.

Among 278 persons who were HSV-1 seropositive by EIA, 255 were confirmed by the UW WB (positive predictive value [PPV], 91.7%). Of the 360 persons that were HSV-1 seronegative by the EIA, 252 were seronegative by UW WB (negative predictive value [NPV], 70.0%). Among 381 persons with HSV-2 EIA seropositivity, 193 tested HSV-2 seropositive by the UW WB (PPV, 50.7%). Of the 270 persons HSV-2 seronegative by EIA, 17 were seropositive with the UW WB (NPV, 93.7%). Among 261 persons with an EIA HSV-2 index value = 1.1–2.9, 39.8% of results were confirmed by UW WB, compared with 78.6% of the 70 persons with an EIA index value of 3 or greater (P < 0.001). The risk of false-positive HSV-2 EIA results was higher in those with HSV-1 antibody (47.1% vs 37.1%, P = 0.036).

Conclusions

US Food and Drug Administration-approved EIAs have poor PPV for HSV-2 and poor NPV for HSV-1 in clinical practice. More accurate rapid type-specific HSV antibody tests are needed.
Prevalence of Gonorrhea and Chlamydia Testing by Anatomical Site Among Men Who Have Sex With Men in HIV Medical Care, United States, 2013–2014
Authors: Patel Monita R. , Brooks John T. , Tie Yunfeng , Garg Shikha , Bradley Heather
Published: August 2017

Fewer than one-third of men who have sex with men were tested for Neisseria gonorrhoeae or Chlamydia trachomatis as part of HIV medical care in the United States in 2013 to 2014, and only 11.6% were tested for either sexually transmitted disease at an extragenital site.