bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Management of Pseudoexfoliative Glaucoma: A Review of Current Clinical Considerations and Surgical Outcomes
Authors: Gillmann Kevin , Meduri Enrico , Niegowski Laëtitia J. , Mermoud André 
Published: November 2020

Introduction:
Pseudoexfoliative glaucoma (PEXG) is the most common cause of secondary open-angle glaucoma worldwide. It is more aggressive and often more resistant to conventional treatments than primary open-angle glaucoma, yet there is currently no clear consensus on best management practices. This review explores current literature on PEXG to assess the safety and efficacy of currently available surgical techniques, and discusses clinical considerations on the diagnosis and management of the disease.

Methods:
A PubMed and Google Scholar search identified 2271 articles. These were reviewed to exclude irrelevant or duplicate data. A total of 47 studies reporting specifically on PEXG were retained and analyzed.

Review:
One of the most significant ophthalmic consequences of pseudoexfoliative (PEX) syndrome is the compromising of the blood-aqueous barrier resulting in the leakage of inflammatory cytokines and extracellular matrix material into the anterior chamber. Considering the high risk of developing PEXG and the aggressive nature of this type of glaucoma, accurate and timely diagnosis of PEX is critical. Therefore, systematic attentive examination for PEX deposits is crucial. Patients diagnosed with PEX need frequent glaucoma assessments. Patient information is key to improving compliance. Gonioscopy and diurnal tension curves or 24-hour intraocular pressure (IOP) monitoring are integral part of the diagnostic work-up and risk-assessment of PEXG. Because of the lability of IOP in PEX, clinical decisions on the basis of single IOP measurements should be avoided. Cataract extraction was shown to provide persistent IOP-lowering effect in the order of 10% in PEXG. A number of other surgical options may offer wider IOP reduction, and both XEN 45 gel stents and angle-based glaucoma procedures were suggested to achieve better outcomes in PEXG than in primary open-angle glaucoma. Yet, more significant IOP reductions may be achieved with filtering surgery or glaucoma drainage device. Same day postoperative IOP monitoring is recommended to treat the frequent IOP spikes following surgery, and more aggressive anti-inflammatory therapy may reduce the rates of postoperative adverse events in PEXG.

Conclusion:
Specific studies of the surgical management of PEXG remain scarce in the medical literature, and more long-term and comparative studies are warranted to define more robust recommendations.
Stratification of patients based on the Neuropathic Pain Symptom Inventory: development and validation of a new algorithm
Authors: Bouhassira Didier , Branders Samuel , Attal Nadine , Fernandes Ana Mercia , Demolle Dominique , Barbour Julio , Ciampi de Andrade Daniel , Pereira Alvaro 
Published: November 2020

Abstract
The personalization of neuropathic pain treatment could be improved by identifying specific sensory phenotypes (ie, specific combinations of symptoms and signs) predictive of the response to different classes of drugs. A simple and reliable phenotyping method is required for such a strategy. We investigated the utility of an algorithm for stratifying patients into clusters corresponding to specific combinations of neuropathic symptoms assessed with the Neuropathic Pain Symptom Inventory (NPSI). Consistent with previous results, we first confirmed, in a cohort of 628 patients, the existence of a structure consisting of 3 clusters of patients characterized by higher NPSI scores for: pinpointed pain (cluster 1), evoked pain (cluster 2), or deep pain (cluster 3). From these analyses, we derived a specific algorithm for assigning each patient to one of these 3 clusters. We then assessed the clinical relevance of this algorithm for predicting treatment response, through post hoc analyses of 2 previous controlled trials of the effects of subcutaneous injections of botulinum toxin A. Each of the 97 patients with neuropathic pain included in these studies was individually allocated to one cluster, by applying the algorithm to their baseline NPSI responses. We found significant effects of botulinum toxin A relative to placebo in clusters 2 and 3, but not in cluster 1, suggesting that this approach was, indeed, relevant. Finally, we developed and performed a preliminary validation of a web-based version of the NPSI and algorithm for the stratification of patients in both research and daily practice.
Changes in Appetite During the Heart Failure Trajectory and Association With Fatigue, Depressive Symptoms, and Quality of Life
Authors: Andreae Christina , van der Wal Martje H.L. , van Veldhuisen Dirk J. , Yang Bei , Strömberg Anna , Jaarsma Tiny 
Published: November 2020

Background
Decreased appetite can contribute to malnutrition in patients with heart failure (HF). Little is known about the trajectory of appetite over time in patients with HF and the factors associated with decreased appetite after discharge from the hospital.

Objective
The aims of this study were to investigate changes in appetite over time and explore how fatigue, depressive symptoms, and quality of life are associated with decreased appetite.

Methods
Data from the multicenter randomized Coordinating study evaluating Outcomes of Advising and Counseling in Heart Failure were used. Logistic regression and mixed-effects logistic regression were used to investigate changes in appetite over time and to explore the relationship between appetite and fatigue, depressive symptoms, and quality of life.

Results
A total of 734 patients with HF (mean age, 69 years) were included. Decreased appetite was present at all follow-up measurements; however, decreased appetite was significantly lower at the 1-month (odds ratio [OR], 0.43; confidence interval [CI], 0.29–0.63), 6-month (OR, 0.31; CI, 0.20–0.47), 12-month (OR, 0.22; CI, 0.14–0.34), and 18-month (OR, 0.24; CI, 0.15–0.37) follow-ups compared with baseline. Decreased appetite was associated with fatigue (OR, 3.09; CI, 1.98–4.84), depressive symptoms (OR, 1.76; CI, 1.35–2.29), and low quality of life (OR, 1.01; CI, 1.01–1.02) across all measurement points adjusted for covariates.

Conclusions
Appetite improved after discharge; however, at all time points, at least 22% of patients reported decreased appetite. Fatigue, depressive symptoms, and low quality of life are factors associated with decreased appetite. Decreased appetite is a long-standing problem in that it does not disappear spontaneously after an acute HF deterioration.
Telehealth Physical Therapy as an Innovative Clinical Education Model With Positive Patient Impact: A Case Report in the Context of the COVID-19 Pandemic
Authors: Hong Sarah M. , Olson-Kellogg Becky J. , North Sara E. , Davis Jackson L. , Staker Justin L. 
Published: November 2020

Background and Purpose.
The potential benefits of telehealth physical therapy on patient access and outcomes have been explored in previous research. However, little is known regarding its role in physical therapist education and its impact on patient quality of life during a public health crisis. The purpose of this case report is to illustrate the twofold benefit of telehealth physical therapy as (1) a novel clinical education model that emphasizes adaptive learning and develops innovative physical therapists and, (2) a flexible care delivery model that has the potential to positively affect patient satisfaction and outcomes.

Case Description.
During the 2020 COVID-19 pandemic, students and faculty in the University of Minnesota Division of Physical Therapy education program rapidly established an innovative pro bono telehealth physical therapy clinic (TeleMNPT) in response to limited access to outpatient clinics for both patient physical therapy service provision and student physical therapist clinical education needs. This case report details the use of TeleMNPT services by a patient presenting with vertigo and the role telehealth played in facilitating student clinical learning while also improving patient outcomes and quality of life.

Outcomes.
The telehealth format offered challenges and benefits in student clinical education, including promotion of adaptive learning and role modeling, and produced positive functional outcomes and symptom reduction in the patient.

Discussion and Conclusion.
New insights were formed regarding telehealth's potential contributions to the development of future physical therapists and the profession's approach to serving patients. This case report serves as a stepping stone for examining the potential role telehealth can play as both a mode of care and as an educational tool.
Is urinary β2-microglobulin a reliable marker for assessment of renal tubular dysfunction in chronic hepatitis B patients receiving tenofovir therapy?
Authors: Atef Mira , Zayed Naglaa , Salama Rabab , Abdel Alem Shereen , Yousof Hanaa , Saber Mohammad , Hamed Mai , Yosry Ayman 
Published: November 2020

Background and aim
Urinary β2-microglobulin (β2-M) is a marker for renal tubular dysfunction. The current study aimed to assess urinary β2-M as a reliable marker for early prediction of tenofovir disoproxil fumarate (TDF)-related nephrotoxicity among hepatitis B virus (HBV) patients.

Methods
Forty-two HBV patients who were a candidate for TDF therapy or have recently started it (for less than 6 months) were enrolled and subjected to demographic, clinical, laboratory assessment, abdominal ultrasound and transient elastography. The glomerular filtration rate (GFR) was estimated using the Cockcroft–Gault equation. Also, urinary β2-M was measured by the ELISA method within 6 months after the introduction of TDF treatment and 6 months later.

Results
Mean age was 41.8 (9.55) years, 27 were males and 59.5% of patients have elevated urinary β2-M after 6 months follow-up of TDF therapy. Urinary β2-M was 0.07 ± 0.07 μg/ml at baseline and insignificantly increased up to 0.09 ± 0.08 μg/ml after 6 months follow-up. Despite the insignificant increase in serum creatinine from 0.85 ± 0.23 mg/dl at baseline to 0.9 ± 0.21 mg/dl after 6 months and the insignificant decrease in eGFR from 126.2 ± 39.72 ml/min at baseline and 117.64 ± 42.23 ml/min at 6 months follow-up. No correlation was found between the changes in urinary β2-M and the changes in other renal function indices at baseline and 6 months follow-up.

Conclusions
Short-term TDF therapy is associated with nonsignificant changes either in eGFR or urinary β2-M; these changes are not clinically relevant that indicates disease progression. Therefore, the suitability of urinary β2-M as a screening tool for tenofovir induced tubular dysfunction should be further.
Is there an association between peptic ulcer disease and osteoporosis: a systematic review and cumulative analysis
Authors: Zhao Shankun , Ding Lingzhi , Xie Qiang , Zhang Jingsheng , Yang Suqing , Xu Weifang , Yang Jianhong , Xu Yan , Zheng Changjun 
Published: November 2020

Background
Mounting studies have emerged indicating that patients with peptic ulcer disease (PUD) are at a high risk of developing osteoporosis, but the evidence has not been previously synthesized. The present study aims to examine whether patients with PUD have a significantly higher prevalence of osteoporosis than the healthy normal subjects.

Methods
Four electronic databases were systematically searched for eligible studies up to February 2020. The association between PUD and osteoporosis was evaluated by calculating the relative risk (RR) with a 95% confidence interval (CI).

Results
Six observational studies were finally included, enrolling a total of 216 122 individuals. Synthetic results from the six included studies providing the number of cases for both sexes demonstrated that PUD was significantly associated with an increased risk of osteoporosis (95% CI, 1.37–1.89; P < 0.001). In line with this finding, the combined effect from the three studies independently reporting the male subjects also yielded to a positive relationship between PUD and osteoporosis (RR = 2.08; 95% CI,1.10–3.93; P = 0.023). However, when restricted to female participants, pooled results indicated that women patients with PUD would not suffer significantly more risk of osteoporosis than the general women population (RR = 1.36; 95% CI, 0.84–2.21, P = 0.212).

Conclusions
This is the first study for quantifying the positive association between PUD and the risk of osteoporosis by conducting a meta-analysis. In clinical practice, assessment of the bone mineral density and antiosteoporosis treatments are recommended for those potential patients with PUD.
The Impact of Terbutaline as Adjuvant Therapy in the Treatment of Severe Asthma in the Pediatric Emergency Department
Authors: Adair Erik , Dibaba Daniel , Fowke Jay H. , Snider Mark 
Published: November 2020

Objective
Parenteral β-agonists are often used as adjuvant treatment for severe asthma exacerbations in pediatric patients. We wanted to determine if the addition of a single dose of parenteral terbutaline to our asthma protocol resulted in fewer pediatric intensive care unit (PICU) admissions.

Methods
Patients were identified using a retrospective cohort analysis from a single, tertiary care, urban children's hospital. Patients presenting directly to our emergency department aged 2 to 18 years were included if they had a diagnosis of severe asthma exacerbation, defined by an initial Respiratory Clinical Score (RCS) of 9 or higher. A total of 787 patients were identified during the study timeframe (December 16, 2017, to December 31, 2018), and of those, 651 patients met study criteria and were included in the analysis. The χ2 test was used to establish P values for categorical variables. For normally distributed variables, a t test was used. For nonnormally distributed variables, the Kruskal-Wallis test was used. A P value of 0.05 or less was interpreted as statistically significant.

Results
Patients who received terbutaline had an increased risk of admission to the PICU (P < 0.001). This association was lost after controlling for age, sex, continuous albuterol use, and intramuscular epinephrine use (P = 0.362). Patients receiving terbutaline in the emergency department also had a higher risk of admission to the hospital (odds ratio, 1.55; confidence interval, 1.08–2.22; P = 0.020) as compared with their nonterbutaline counterparts. Overall, patients in the terbutaline group had a higher initial RCS at presentation. Upon further analysis, patients with the same RCS at presentation were more likely to be admitted if they received terbutaline than those who did not. There was no statistically significant difference in length of stay (P = 0.298) and BiPAP/CPAP use (P = 0.107). The patients on terbutaline were relatively more likely to require oxygen (P = 0.003) and intramuscular epinephrine (P = 0.010) than the patients not on terbutaline.

Conclusions
Terbutaline administration given to pediatric patients experiencing a severe asthma exacerbation was not associated with decreased PICU or general hospital floor admission. The study is limited given that it was a retrospective analysis. Further randomized controlled trials are needed to assess the role of terbutaline in severe acute asthma exacerbations in pediatric patients.
Health-Related Quality of Life in Patients With ANCA-Associated Vasculitis and Sinonasal Involvement
Authors: Cazzador Diego , Padoan Roberto , Colangeli Roberta , Pendolino Alfonso Luca , Felicetti Mara , Zanoletti Elisabetta , Emanuelli Enzo , Martini Alessandro , Doria Andrea , Nicolai Piero , Schiavon Franco 
Published: November 2020

Background/Objective
The aim of this study was to assess the impact of sinonasal morbidity on quality of life (QoL) in antineutrophil cytoplasmic antibody–associated vasculitis (AAV).

Methods
This cross-sectional case-control study enrolled 71 patients—44 AAV cases with (ear, nose, and throat [ENT]–AAV) or without ENT involvement (non–ENT-AAV) undergoing multidisciplinary evaluations and 27 chronic rhinosinusitis (CRS) cases. Three validated QoL questionnaires (Sino-Nasal Outcomes Test-22 [SNOT-22], Nasal Obstruction Symptom Evaluation [NOSE], and Short-Form 36) were administered, and the 3 groups were compared.

Results
The ENT-AAV patients were significantly younger (p = 0.01), with less antineutrophil cytoplasmic antibody positivity frequency (p = 0.035) and lower renal involvement (p = 0.003) than the non–ENT-AAV patients.
The SNOT-22 questionnaire demonstrated significantly greater sinonasal morbidity in ENT-AAV patients compared with CRS patients (p < 0.001). The NOSE score of ENT-AAV patients was comparable to those of CRS patients, but higher than that of non–ENT-AAV patients (p < 0.001). The SNOT-22 and NOSE scores positively correlated with disease activity (p = 0.037; p = 0.004, respectively). Short-Form 36 domain-by-domain analysis revealed a significantly poorer QoL in ENT-AAV patients, especially with physical functioning being progressively impaired in CRS, non–ENT-AAV, and ENT-AAV patients (p < 0.001). No significant differences in QoL came to light when AAV patients were stratified according to current systemic o local treatments.

Conclusions
The QoL in AAV patients is significantly reduced, especially in the presence of ENT involvement. The AAV-related nasal morbidity is consistent and comparable to that reported by CRS patients. It significantly affects patients' QoL and in particular social functioning, leading to limitation in daily/work activities. Organ-focused questionnaires and multidisciplinary management are warranted to pursue a treat-to-target approach in these patients.
Importance of Ultrasound Education in Undergraduate Medical Curriculum
Authors: Zervides Constantinos , Kefala-Karli Pelagia , Sassis Leandros 
Published: November 2020

Abstract
Ultrasound imaging modality is a tool used in clinical practice and is being introduced gradually in the undergraduate curriculum of several medical schools worldwide. This study aims to assess medical students' perception regarding the integration of ultrasound training as part of undergraduate education. A questionnaire was given to first-year medical students after a 2-hour-long session, which was developed to introduce them in the fundamental physics theory and function of ultrasound equipment in the clinical practice. Analysis of the results indicated that students acknowledged that ultrasound training would improve their knowledge of internal medicine (P = 0.027) and of different diagnostic modalities (P = 0.019), and enhance their medical decision making (P = 0.0004). Moreover, students found beneficial the ultrasound education regarding correlating clinical knowledge with basic sciences (P = 0.0004). The study pointed out that the majority of first-year students have the opinion that the integration of ultrasound training in the medical program is valuable in medical education and patient care. However, work is needed to determine how to provide an optimal learning environment and to assess the competency of the training sessions.
Posterior Cranial Vault Distraction (PCVD): Common Complication Rates and Strategies of Prevention and Management
Authors: Hassan Abbas M. , Chappell Ava G. , Murthy Nikhil , Stoehr Jenna R. , Alden Tord , Gosain Arun K. 
Published: November 2020

Background:
Posterior cranial vault distraction (PCVD) is a well-established procedure to treat infants with craniosynostosis. Craniofacial surgeons have seen an evolution in the complications following PCVD. This report aims to demonstrate the rates of common complications from PCVD, and to identify strategies for prevention and management of these complications.

Methods:
A formal literature review of studies on postoperative complications from PCVD was conducted to identify the breadth of reported complications from PCVD and rates of occurrence.

Results:
A total of 776 articles were captured by our search strategy. Nineteen original articles met inclusion criteria, with a total of 342 patients. The average rate of reported complications was 25%, range (0%–100%). The most commonly reported complication was postoperative infection (23.7%), followed by cerebrospinal fluid leak (20.3%) and device failure (15.3%). Postoperative infection, device exposure, iatrogenic vascular injury, cerebrospinal fluid leak, and other complications have the potential to disrupt distraction and increase morbidity and mortality.

Conclusions:
By continuing to identify and evaluate complications, prevention strategies can be determined and standardized to decrease complications from PCVD. These efforts uphold the ultimate goal for surgeons involved in the treatment of craniosynostosis: to provide safe, effective surgical care.
A Novel IRF6 Variant Detected in a Family With Nonsyndromic Cleft Lip and Palate by Whole Exome Sequencing
Authors: Wang Yanyang , Ma Cui , Jiang Chanyuan , Zhang Yongbiao , Wu Di 
Published: November 2020

Abstract
Nonsyndromic cleft lip with or without cleft palate (NSCL/P) is the most common congenital craniofacial malformation, and its harmful effects on affected individuals and families are apparent. The causative genes and their mechanisms are not completely clear, although several studies have been conducted. Accordingly, in the present study, we recruited a Han Chinese family with hereditary NSCL/P to explore the possible causative variants of this disease using whole exome sequencing. Bioinformatics screening and analysis, mutation function prediction, species conservation analysis, and homology protein modeling were used to identify the variants and evaluate their influence. A mutation in the interferon regulatory factor 6 (IRF6) gene (c.961C>T; p.Val321Met) was detected as a candidate causative variant and predicted to be deleterious. The codon was found to be conserved in many species, and the residue change caused by this mutation changed the structure of IRF6 to a certain degree. The findings suggest that this IRF6 variant is probably the pathogenic cause of NSCL/P in this family. Our results further provide evidence that IRF6 variants play a role in the etiology of NSCL/P.
Usefulness of Tranexamic Acid Administration During Sagittal Split Ramus Osteotomy
Authors: Yoshida Mitsuhiro , Ono Shigehiro , Shimizu Yoshitaka , Oue Kana , Mukai Akari , Doi Mitsuru , Irifune Masahiro 
Published: November 2020

Abstract
Tranexamic acid has been used to reduce intraoperative bleeding; however, its effect on anti-inflammation and the amount of drainage after orthognathic surgery is yet to be determined. Therefore, we aimed to examine the effect of tranexamic acid on intraoperative bleeding volume and operation time, amount of drainage, and anti-inflammation after orthognathic surgery. Forty healthy women who underwent bilateral sagittal split ramus osteotomy under general anesthesia participated in this study. The amount of intraoperative bleeding, the operation time, the amount of drainage, and the C-reactive protein level were compared between patients intravenously administered with tranexamic acid before surgery (before-surgery group) and those administered with the drug after surgery (after-surgery group). All data were analyzed using the Student t-test. Results were considered to be statistically significant when P < 0.05. Although no significant difference was found in the amount of drainage between the groups (P > 0.05), significant variations were detected in the amount of bleeding during surgery (before-surgery group: 161.7 ± 45.3 mL versus after-surgery group: 270.2 ± 24.0 mL; P = 0.0009), operation time (before-surgery group: 141.3 ± 16.8 min versus after-surgery group: 166.8 ± 24.9 min; P = 0.03), and postoperative C-reactive protein level (before-surgery group: 3.77 ± 0.40 mg/dL versus after-surgery group: 5.02 ± 0.75 mg/dL; P = 0.012) between the groups. In conclusion, administering tranexamic acid before surgery was found to significantly decrease bleeding, reduce operation time, and suppress postoperative inflammation.