bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lipoprotein(a): is it more, less or equal to LDL as a causal factor for cardiovascular disease and mortality?
Authors: Langsted Anne , Nordestgaard Børge G. 
Published: April 2020

Purpose of review
To summarize the recent studies directly comparing LDL and lipoprotein(a) as causal factors for cardiovascular disease and mortality.

Recent findings
In approximately 100,000 individuals from the Copenhagen General Population Study for risk of myocardial infarction, in observational analyses per 39 mg/dl (1 mmol/l) cholesterol increase, the hazard ratio was 1.3 (95% confidence interval: 1.2–1.3) for LDL cholesterol and 1.6 (1.4–1.9) for lipoprotein(a) cholesterol. In corresponding genetic analyses, the causal risk ratio was 2.1 (1.3–3.4) for LDL and 2.0 (1.6–2.6) for lipoprotein(a). Also, a 15 mg/dl (0.39 mmol/l) cholesterol increase was associated with a hazard ratio for cardiovascular mortality of 1.05 (1.04–1.07) for LDL cholesterol and 1.18 (1.12–1.25) for lipoprotein(a) cholesterol. Corresponding values for all-cause mortality were 1.01 (1.00–1.01) for LDL cholesterol and 1.07 (1.04–1.10) for lipoprotein(a) cholesterol. In genetic, causal analyses, the mortality increases for elevated lipoprotein(a) appeared to be through apolipoprotein(a) kringle IV-2 rather than through lipoprotein(a) levels per se.

Summary
On cholesterol scales, lipoprotein(a) and LDL appeared equal as causal factors for myocardial infarction; however, lipoprotein(a) was most important for mortality. Lipoprotein(a) effects may not only be due to cholesterol content but could also be due to the structure of lipoprotein(a) resembling plasminogen.
Update on pediatric lung transplantation: mir-ando into the mechanisms of chronic lung allograft dysfunction in children
Authors: Conrad Carol 
Published: April 2020

Purpose of review
Lung transplantation (LTx) is a worthwhile treatment for children with end-stage lung diseases who have no practicable medical or surgical solutions. But the long-term survival remains the lowest in all solid-organ transplant, with a median survival of 5.7 years, limited by the onset of chronic lung allograft dysfunction (CLAD). This reviews a recent publication in pediatric patients that focuses on translational regulation by microRNA.

Recent findings
The mechanisms that cause transplanted lung allografts have been difficult to identify. This review discusses pertinent findings in the first and largest observational prospective study of pediatric lung transplant recipients. The review discusses the relevance of microRNA that distinguish stable patients from those who can be predicted to display graft dysfunction on a molecular panel.

Summary
The article under review detected highly specific and sensitive markers of both acute rejection and CLAD in pediatric LTx recipients. With the use of next-generation sequencing techniques, biomarkers may soon provide the basis for earlier detection of graft function and stimulate development of therapeutic interventions to impact outcomes and survival. The review touches on the relevance of these findings and how future research can build on them.
Bladder-preserving strategies for Bacillus Calmette-Guérin unresponsive non-muscle invasive bladder cancer; where are we and what will be expected?
Authors: Sari Motlagh Reza , Pradere Benjamin , Mori Keiichiro , Miura Noriyoshi , Abufaraj Mohammad , Shariat Shahrokh F. 
Published: April 2020

Purpose of review
Bacillus Calmette-Guérin (BCG) unresponsive non-muscle invasive bladder cancer (NMIBC) is a new definition including patients who failed intravesical BCG therapy and should not receive more BCG because of the very low efficacy and disproportionately poor prognosis. Radical cystectomy as the standard of care for these patients is associated with significant morbidity and altered quality of life. Therefore, the FDA has accepted phase II single-arm studies as a threshold to approve new agents in this setting.

Recent findings
Efforts to find an effective and safe bladder sparing strategy for BCG unresponsive patients have not been successful yet. Studies that assess nanoparticle-bound, combination or device-assisted intravesical chemotherapy to increase drug delivery and efficacy have been partly promising but suffer from limitations. Systemic immunotherapy such as checkpoint inhibitors therapy PD1/PDL1 and intravesical immunotherapy such as rAd-IFN/Syn3 have shown satisfactory efficacy so far.

Summary
Although this is much effort and enthusiasm, no bladder-sparing strategy has met the criteria set for the successful alternative to radical cystectomy in BCG unresponsive NMIBC. For BCG unresponsive patients who refuse or are unfit for radical cyctectomy, there is new hope arising with novel strategies limiting the threshold for clinical use and a multitude of promising agents in clinical trials.
Clinical Characteristics and Long‐term Outcomes of Children With Fibrosing Pancreatitis
Authors: Scheers Isabelle , Chavhan Govind B. , Chami Rose , Carman Nicholas , Scaini Vikki , Gaisano Herbert , Marcon Margaret , Gonska Tanja 
Published: April 2020

ABSTRACTObjectives:Fibrosing pancreatitis (FP) shares clinical features with autoimmune pancreatitis (AIP), although both entities have not been definitely linked. This study aimed to assess the presence of AIP criteria in an historic FP patient cohort and investigate the clinical features, management, and long‐term outcomes of pediatric FP (P‐FP).Methods:Clinical data of 14 P‐FP patients from Toronto and 42 P‐FP cases from a literature review were collected and compared to pediatric AIP (P‐AIP). Toronto P‐FP patients were recontacted to assess their current health status using a brief questionnaire.Results:Jaundice and abdominal pain were the symptoms at presentation in 44 of 56 (79%) and 50 of 56 (89%) P‐FP patients, respectively. Common findings on cross sectional imaging were an enlarged pancreas head with narrowing of the distal common bile duct (51/54, 94%). Histopathology mainly showed gland fibrosis (39/39, 100%). Three of twelve (25%) P‐FP patients had elevated IgG4 in serum. None of the patients were treated with corticosteroids, but some underwent surgical or endoscopic intervention. Toronto patients were followed for a median of 13.6 years (interquartile range: 2.9–22.8). Complications during follow‐up included exocrine pancreatic insufficiency (3/14, 21%) and pancreatic gland atrophy (5/13, 38%); but none of the patients had disease relapse or developed diabetes type 3c. Five (5/14, 36%) patients developed other immune‐mediated diseases over time.Conclusions:Clinical features of patients with P‐FP resembled those recently described in a subgroup of P‐AIP presenting with jaundice. Long‐term outcome of these patients is generally good, with or without invasive interventions. As some patients may develop exocrine pancreatic insufficiency and/or other immune‐mediated diseases, ongoing clinical monitoring is recommended.
On the Chromatic Dispersion of Hydrophobic and Hydrophilic Intraocular Lenses
Authors: Eppig Timo , Rawer Antonia , Hoffmann Peter , Langenbucher Achim , Schröder Simon 
Published: April 2020

SIGNIFICANCE
There is a high variation of chromatic dispersion with contemporary intraocular lens (IOL) materials. It is well known that chromatic aberration limits the optical performance especially with high-power lenses. Lens manufacturers, however, rarely provide data on the chromatic dispersion of their materials, limiting the comparability of available materials.

PURPOSE
This study aimed to analyze chromatic dispersion of hydrophobic and hydrophilic IOLs without prior knowledge of the IOLs' geometries.

METHODS
We adapted Bessel's method for measuring focal length by placing the IOL in a wet cell. The chromatic dispersion of several hydrophobic and hydrophilic IOLs was characterized by measuring their focal lengths at multiple wavelengths. From the measured focal lengths, the refractive indices and the Abbe numbers were obtained. We measured four hydrophobic and two hydrophilic IOL models with a nominal power of 21 to 29.5 D.

RESULTS
The hydrophobic IOLs had lower Abbe numbers (Abbe numbers <41) than did the hydrophilic IOLs (Abbe numbers >50). Most Abbe numbers were in agreement with the values provided by the IOL manufacturers, and the measurements were independent from IOL power. The repeatability for the Abbe number was better than ±3.5% for all lenses and better than ±2% for lenses between 21 and 26.5 D. The dispersion could be described by a Conrady model (R
2 > 0.997).

CONCLUSIONS
The hydrophobic materials showed larger dispersion than did the hydrophilic IOL materials resulting in increased chromatic aberration. The method allowed for an estimation of the IOL's Abbe number without prior knowledge of IOL geometry.
Perception of Gaze Direction in Glaucoma: A Study on Social Cognition
Authors: Denoyelle Aude , Rouland Jean François , Goual Naima , Boucart Muriel 
Published: April 2020

SIGNIFICANCE
Discriminating quickly where another person's gaze is directed is a key component of social interaction, as gaze direction conveys information about others' intentions (approach or avoidance) and shift in gaze is used in group conversation. This study shows that patients with glaucoma are delayed in their discrimination of gaze direction.

PURPOSE
The purpose of this study was to investigate whether glaucoma affects the perception of gaze direction.

METHODS
Twenty-four patients with open-angle glaucoma, 24 age-matched controls, and 20 young normally sighted controls were presented with faces displayed centrally for 200 milliseconds. The gaze could either be direct or averted, and the head could be a frontal view or a rotated view. Half of the participants in each group were asked to press a key only for faces with a direct gaze. The other half responded for a face with an averted gaze. The orientation of the head had to be ignored.

RESULTS
Accuracy was greater than 90% correct for all three groups. We found no difference in performance between young and older controls, except for shorter response times for the frontal view than for the rotated face in young participants. Patients with glaucoma needed on average 140 milliseconds longer to decide if the gaze was averted than for the direct gaze, and they were less accurate than controls in perceiving the gaze as direct when the head was rotated.

CONCLUSIONS
Patients with glaucoma often experience impaired vision due to a reduced sensitivity in central vision. Although lower central sensitivity had little effect on their ability to discriminate gaze orientation, they required on average 140 milliseconds longer than age-matched controls to perceive an averted gaze.
Effects of Blood Flow Restriction at Different Intensities on IOP and Ocular Perfusion Pressure
Authors: Vera Jesús , Jiménez Raimundo , Redondo Beatríz , García-Ramos Amador 
Published: April 2020

SIGNIFICANCE
The use of blood flow restriction allows obtaining beneficial physical adaptions when combined with low-intensity exercise or even when used alone. We found that using blood flow restriction may be a potential strategy to avoid IOP and ocular perfusion pressure fluctuations provoked by strength and endurance training.

PURPOSE
The purpose of this study was to assess the influence of bilateral blood flow restriction in the upper and lower body at two different intensities on IOP and ocular perfusion pressure, as well as the possible sex differences.

METHODS
Twenty-eight physically active university students (14 men and 14 women) took part in the study, and blood flow restriction was bilaterally applied with two pressures in the legs and arms. There were five experimental conditions (control, legs-high, legs-low, arms-high, and arms-low). IOP was measured by rebound tonometry before, during (every 4 seconds), and immediately after blood flow restriction. Ocular perfusion pressure was measured before and after blood flow restriction.

RESULTS
We found that only the arms-high condition promoted a statistically significant IOP rise when compared with the rest of the experimental conditions (all Bayes factors10, >100; effect sizes, 1.18, 1.06, 1.35, and 1.73 for the control, arms-low, legs-high, and legs-low conditions, respectively). For ocular perfusion pressure, there was strong evidence for the null hypothesis regarding the type of blood flow restriction (Bayes factor10, 0.012); however, men showed an ocular perfusion pressure reduction after blood flow restriction in the arms-high condition (Bayes factor10, 203.24; effect size, 1.41).

CONCLUSIONS
This study presents preliminary evidence regarding the safety of blood flow restriction in terms of ocular health. Blood flow restriction may be considered as an alternative training strategy to reduce abrupt fluctuations in IOP and ocular perfusion pressure because its use permits a considerable reduction of exercise intensity.
The Use of Autologous Serum Eye Drops after Epithelium-off Corneal Collagen Crosslinking
Authors: Kirgiz Ahmet , Akdemir Mehmet Orcun , Yilmaz Ahu , Kaldirim Havva , Atalay Kursat , Asik Nacaroglu Senay 
Published: April 2020

SIGNIFICANCE
After epithelium-off crosslinking (CXL), epithelial closure time and post-operative pain are an important issue in terms of possible complications and patient comfort. We report a prospective randomized study about the use of autologous serum eye drops after CXL.

PURPOSE
This study aims to evaluate the effect of autologous serum eye drops on epithelial healing and post-operative pain after CXL.

METHODS
Sixty patients diagnosed as having progressive keratoconus and treated with accelerated CXL (9 mW/cm2 for 10 minutes) randomly received 20% autologous serum eye drops (autologous serum group, n = 30) or artificial tears (control group, n = 30). Patients were evaluated every day after the surgery, and the day of epithelial closure was recorded. All patients were asked to report the maximum pain level using the Wong-Baker FACES Pain Rating Scale at the end of each day until the epithelial closure was completed. The change in topographic parameters and haze were recorded at 6 months.

RESULTS
The mean epithelial closure time was significantly lower in the autologous serum group than in the control group (2.37 ± 0.49 and 2.67 ± 0.47 days, respectively; P = .02). There was a statistically significant difference between the pain scores in the first and second days of surgery between the two groups (first-day autologous serum autologous serum group: 2.80 ± 0.66 and control group: 3.50 ± 0.82, P = .01; second-day autologous serum group: 1.73 ± 0.69 and control group: 2.20 ± 0.76, P = .02). Pre-operative and post-operative topographic parameters and haze at 6 months were similar between the two groups (P > .05 for all).

CONCLUSIONS
Use of autologous serum eye drops after CXL accelerates epithelial healing and reduces post-operative pain. Shortening the duration of epithelial closure would be beneficial in reducing possible complications and increasing patient comfort.
Feasibility of Social Distancing Practices in US Schools to Reduce Influenza Transmission During a Pandemic
Authors: Uscher-Pines Lori , Schwartz Heather L. , Ahmed Faruque , Zheteyeva Yenlik , Tamargo Leschitz Jennifer , Pillemer Francesca , Faherty Laura , Uzicanin Amra 
Published: April 2020

Background:
Schools are socially dense environments, and school-based outbreaks often predate and fuel community-wide transmission of seasonal and pandemic influenza. While preemptive school closures can effectively reduce influenza transmission, they are disruptive and currently recommended only for pandemics. We assessed the feasibility of implementing other social distancing practices in K-12 schools as a first step in seeking an alternative to preemptive school closures.

Methods:
We conducted 36 focus groups with education and public health officials across the United States. We identified and characterized themes and compared feasibility of practices by primary versus secondary school and region of the United States.

Results:
Participants discussed 29 school practices (25 within-school practices implemented as part of the school day and 4 reduced-schedule practices that impact school hours). Participants reported that elementary schools commonly implement several within-school practices as part of routine operations such as homeroom stay, restriction of hall movement, and staggering of recess times. Because of routine implementation and limited use of individualized schedules within elementary schools, within-school practices were generally felt to be more feasible for elementary schools than secondary schools. Of reduced-schedule practices, shortening the school week and the school day was considered the most feasible; however, reduced-schedule practices were generally perceived to be less feasible than within-school practices for all grade levels.

Conclusions:
Our findings suggest that schools have many options to increase social distance other than closing. Future research should evaluate which of these seemingly feasible practices are effective in reducing influenza transmission in schools and surrounding communities.
Application of Fabric-Type Spinal Orthosis for Flexible Neuromuscular Scoliosis
Authors: Shin Hyun Iee , Shin Hyung-Ik 
Published: April 2020

ObjectiveThis study used a 3-point pressure spinal orthosis made of fabric material in neuromuscular scoliosis patients with flexible spinal curve to evaluate the in-brace correction of the spinal curve and to estimate changes in pulmonary function associated with brace wearing.DesignTwenty-eight children with neuromuscular scoliosis with spinal curve flexibility of more than 50% were enrolled. A custom-made 3-point pressure spinal orthosis was fitted for each patient. The Cobb angles in sitting and supine positions, forced vital capacity, forced expiratory volume in the first second, and peak cough flow were measured before and after applying spinal orthoses. Each participant recorded the brace wearing duration, and questionnaires on brace tolerance were collected.ResultsCobb angles after application of orthosis decreased from 31.0 degrees (interquartile range = 21.9–45.0 degrees) to 16.6 degrees (interquartile range = 10.0–34.0 degrees) in the sitting position and from 13.3 degrees (interquartile range = 4.0–21.0 degrees) to 1.4 degrees (interquartile range = 0.0–19.0 degrees) while supine (P< 0.01,P= 0.04, respectively). Preorthosis and postorthosis application forced vital capacity, forced expiratory volume in the first second, and peak cough flow were unaffected. Caregivers reported improved sitting postures and manual activities.ConclusionsIn children with flaccid-type neuromuscular scoliosis, curve correction can be achieved using a simple fabric-type spinal orthosis when applied to patients with flexible scoliosis, without compromising lung function.To Claim CME CreditsComplete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCMECME ObjectivesUpon completion of this article, the reader should be able to: (1) Describe the factors associated with the effects of spinal braces in neuromuscular scoliosis; (2) Discuss the characteristics of flaccid-type neuromuscular scoliosis; and (3) Discuss the benefits of fabric-type orthosis regarding pulmonary function and patient compliance.LevelAdvanced.AccreditationThe Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Activation Profile of Scapular Stabilizing Muscles in Asymptomatic People
Authors: Tooth Camille , Schwartz Cédric , Croisier Jean-Louis , Bornheim Stephen , Brüls Olivier , Denoël Vincent , Forthomme Bénédicte 
Published: April 2020

Objective
The aim of the study was to assess the activation profile of scapular stabilizing muscles in dyskinetic asymptomatic people.

Design
This is a noninterventional observational study. Two groups of 20 people were included in the study. The first group involved asymptomatic athletes with scapular dyskinesis. The second one included athletes without scapular dysfunction. Muscle activation of upper trapezius, lower trapezius, and serratus anterior were recorded by a surface electromyography during shoulder flexion and shoulder abduction, in unloaded and loaded conditions.

Results
A significant increase of the activity of the upper trapezius (between 23% and 31%) and a significant decrease of the activity of the lower trapezius (between 32% and 65%) were observed in the dyskinetic group in comparison with the nondyskinetic group in asymptomatic athletes. A significant increase between 17% and 31% of the activity of the serratus anterior was also observed in dyskinetic people. Likewise, a significant increase approximately 24%–61% and 23%–70% was noted respectively in upper trapezius/lower trapezius and upper trapezius/serratus anterior ratio’s in the dyskinetic group.

Conclusions
An alteration of periscapular muscular activation exists in dyskinetic asymptomatic people. Future studies will be needed to know whether those alterations increase the risk of shoulder injuries.
The Effect of Virtual Reality on the Ability to Perform Activities of Daily Living, Balance During Gait, and Motor Function in Parkinson Disease Patients
Authors: Lina Chen , Guoen Cai , Huidan Weng , Yingqing Wang , Ying Chen , Xiaochun Chen , Qinyong Ye 
Published: April 2020

Objective
The study aimed to evaluate the effect of virtual reality on balance, motor function, gait, and the ability to perform activities of daily living in patients with Parkinson disease.

Methods
We searched Cochran Central Register of Controlled Trials, Embase, PubMed, Wanfang Data, VIP Database, and China National Knowledge Infrastructure from their inception to June 2019. Two authors independently screened articles for inclusion, extracted data, and evaluated quality.

Results
Twelve randomized clinical trials involving 360 patients were included. It demonstrated that virtual reality can improve balance, measured by the Berg Balance Scale (fixed model weighted mean difference = 2.28, 95% CI = 1.39 to 3.16, P < 0.00001); strengthen motor function, assessed by the Timed Up and Go test (fixed model weighted mean difference = −1.66, 95% CI = −2.74 to 0.58, P = 0.003); enhance gait ability, assessed by the 10-Meter Walk Test Time (fixed model weighted mean difference = 0.13, 95% CI = 0.02 to 0.24, P = 0.02) in patients with Parkinson disease. It also showed that virtual reality can improve individuals’ ability to perform activities of daily living, assessed by modified Barthel Index (fixed model weighted mean difference = 2.93, 95% CI = 0.8 to 5.06, P = 0.007).

Conclusions
The findings suggest that virtual reality rehabilitation may be valuable in improving the balance, motor function, gait, and ability to perform activities of daily living in patients with Parkinson disease.