bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do estimated 24-h pulse pressure components affect outcome? The Ohasama study
Authors: Bursztyn Michael , Kikuya Masahiro , Asayama Kei , Satoh Michihiro , Gavish Benjamin , Ohkubo Takayoshi 
Published: February 2020

Objective:
Twenty-four-hour ambulatory pulse pressure (PP) is a powerful predictor of outcome. We attempted to apply the recently described PP components, an elastic (elPP), and systolic stiffening (stPP) components from 24-h ambulatory blood pressure (BP) monitoring (AMBP), and examine their influence on outcome in the Ohasama study population.

Design and methods:
Included were participants of the Ohasama study without history of cardiovascular disease (CVD), who were followed-up for total and CVD mortality, and for stroke morbidity. The PP components were derived from 24-h SBP and DBP using a model based on the nonlinear pressure--volume relationship in arteries expressing pressure stiffness relationship. Outcome predictive power was estimated by Cox regression models; hazard ratio with 95% confidence interval (CI), applied to elPP, and stPP, adjusted for age, sex, BMI, smoking, alcohol drinking, diabetes mellitus, total cholesterol, antihypertensive treatment, and mean arterial pressure (MAP), whenever appropriate.

Results:
Of 1745 participants (age 61.4 ± 11.6, 65% women), 580 died, 212 of CVD, and 290 experienced a stroke during 17 follow-up years. PP was strongly correlated with elPP (r = 0.89) and less so with stPP (r = 0.58), and the correlation between the two components was weak (r = 0.15). After the adjustment, hazard ratio of PP per 1 SD increment for total mortality, CVD mortality, and stroke morbidity were 1.095 (95% CI 0.973–1.232), 1.207 (1.000–1.456), and 0.983 (0.829–1.166), respectively. Corresponding hazard ratios and 95% CIs were nonsignificant for elPP, and stPP. However, among participants with median pulse rate 68.5 bpm or less (median, n = 872), total (327 deaths) and CVD (131 deaths) mortality were predicted by elPP (per 1 SD increment), hazard ratio 1.231 (95% CI, 1.082–1.401), and 1.294 (95% CI, 1.069–1.566), respectively. In the subgroup of treated participants with hypertension and pulse rate 68.5 or less bpm (n = 309), total (177 deaths) and CVD (77 deaths) mortality were predicted by elPP, hazard ratio of 1.357 (95% CI, 1.131–1.628), and 1.417 (95% CI, 1.092–1.839), respectively. Stroke morbidity was not predicted by either PP or the PP components.

Conclusion:
In a rural Japanese population, elPP but not stPP was predictive of total and CVD mortality even when adjusted for MAP and conventional risk factors in the subpopulation with slower pulse rate. This was mostly among the treated hypertensive patients.
PREVALENCE OF MISMATCH REPAIR GENE MUTATIONS IN UVEAL MELANOMA
Authors: Toomey Christopher B. , Protopsaltis Nicholas J. , Phou Samantha , Bakhoum Mathieu F. , Thorson John A. , Ediriwickrema Lilangi S. , Korn Bobby S. , Kikkawa Don O. , Goldbaum Michael H. , Lin Jonathan H. 
Published: February 2020

Purpose:
Uveal melanomas are associated with characteristic genetic changes. Germline mutations in mismatch repair (MMR) genes and microsatellite instability have been implicated in the development of numerous malignant neoplasms such as colon and ovarian cancers. The frequency of MMR defects in uveal melanomas has yet to be determined.

Methods:
Here, we analyzed the frequency of MMR gene mutations in uveal melanoma specimens from the University of California, San Diego (UCSD), The Cancer Genome Atlas (TGCA), and the Catalogue of Somatic Mutations in Cancer (COSMIC).

Results:
We identified only two mutations in a MMR gene: one premature stop codon in the PMS gene within the UCSD cohort (0.5% frequency) and one in-frame deletion in MSH3 within the COSMIC database (0.8% frequency). We report copy number variation of MLH1 in monosomy 3 and show decreased mRNA expression of MLH1 in uveal melanoma specimens with monosomy 3. Expression levels of MLH1 were not found to correlate with the observed number of total mutations.

Conclusion:
Overall, we show that mutations in MMR genes in uveal melanoma specimens are exceedingly rare, and although one copy of MLH1 is lost in monosomy 3, it does not seem to have pathologic consequences in uveal melanoma pathogenesis.
MORTALITY OF PATIENTS WITH UVEAL MELANOMA DETECTED BY DIABETIC RETINOPATHY SCREENING
Authors: Hussain Rumana , Czanner Gabriela , Taktak Azzam , Damato Bertil , Praidou Anna , Heimann Heinrich 
Published: February 2020

Purpose:
To investigate whether early detection and treatment of uveal melanoma by screening was associated with a lower mortality rate.

Methods:
Retrospective assessment of prospectively collected data comparing 132 patients with uveal melanoma referred by the National Diabetic Screening Service with 608 control patients referred through other means.

Results:
Mean tumor diameter was smaller in the diabetic screening group (11.1 mm vs. 12.5 mm) as was tumor thickness (3.4 mm vs. 5.4 mm). The prevalence of high-risk monosomy 3 was also lower (17/40, 43% vs. 62/110, 56%). Despite a higher rate of systemic comorbidities in the patients diagnosed through screening and despite older age at diagnosis, the 5-year all-cause mortality was similar in both groups (17% vs. 20%); however, the metastatic mortality was lower in the diabetic screening group (11/132, 8% vs. 95/608, 16%).

Conclusion:
Despite higher rates of comorbidities, the patients detected at diabetic screening had a lower 5-year mortality rate. The diabetic screening programme enabled detection and treatment of posterior uveal melanomas at an earlier stage. However, the confounding factors of lead and length time bias are not to be ignored.
VENOUS STASIS RETINOPATHY SECONDARY TO MYELIN OLIGODENDROCYTE GLYCOPROTEIN ANTIBODY-POSITIVE OPTIC NEURITIS
Authors: Lukewich Mark K. , Micieli Jonathan A. 
Published: February 2020

Purpose:
To report a case of a 38-year-old woman with venous stasis retinopathy secondary to myelin oligodendrocyte glycoprotein-IgG optic neuritis.

Methods:
Observational case report.

Results:
We report a unique case of venous stasis retinopathy secondary to myelin oligodendrocyte glycoprotein-IgG optic neuritis with significant optic disc edema, tortuous and dilated retinal venules, and retinal hemorrhages, which resolved promptly with high-dose corticosteroids. The retinal changes were likely secondary to severe inflammation of the optic nerve and optic nerve sheath, which exhibited significant postcontrast enhancement on magnetic resonance imaging. Despite aggressive treatment with high-dose corticosteroids and plasmapheresis, the patient had a significant generalized visual field defect at 6 months.

Conclusion:
Venous stasis retinopathy may be secondary to myelin oligodendrocyte glycoprotein-IgG optic neuritis due to reduced venous outflow from significant optic nerve edema. This may be a poor prognostic factor and a marker for more severe optic nerve inflammation.
MULTIMODAL IMAGING IN ACUTE RETINAL NECROSIS PRESENTING WITH MACULAR INVOLVEMENT
Authors: Wang Jay C. , Lu Yifan , Sobrin Lucia , Husain Deeba 
Published: February 2020

Purpose:
To report an unusual case of early macular necrosis in acute retinal necrosis and its features on multimodal imaging.

Methods:
Findings on fundus examination, laboratory workup, fluorescein angiography, autofluorescence, optical coherence tomography, and optical coherence tomography angiography.

Results:
A 31-year-old healthy woman presented with 1 week of photophobia and central scotoma of the right eye. Initial examination revealed vitritis, hyperemia of the optic disc, and a yellow-white macular lesion without any peripheral findings. Peripheral involvement was first noted only 4 days later. The patient was diagnosed with acute retinal necrosis secondary to varicella zoster virus and was successfully treated with intravitreal and oral antiviral medications. Optical coherence tomography imaging of the macular lesion showed involvement of both the inner and outer retina. Optical coherence tomography angiography revealed a large flow void in the choriocapillaris, which has not been previously demonstrated.

Conclusion:
Multimodal imaging offers valuable information in the evaluation of patients with acute retinal necrosis.
DIAGNOSIS OF VORTEX VARIX USING OPTICAL COHERENCE TOMOGRAPHY AND SCLERAL INDENTATION
Authors: Spiess Karina , Elgohary Mostafa A. 
Published: February 2020

Purpose:
We report a case of a vortex vein varix diagnosed with optical coherence tomography under globe compression.

Methods:
To illustrate the dynamical behavior of a vortex vein varix, optical coherence tomography was performed with and without gentle globe indentation with a cotton swab.

Results:
A 51-year-old woman was referred by her optician for an incidental finding of a nonpigmented choroidal mass in the right eye. The patient was asymptomatic with a best-corrected visual acuity of 20/16 in both eyes. On fundoscopy, a prominent smooth pink lesion at the level of the superonasal equatorial retina could be observed in the right eye. Peripheral optical coherence tomography over the area revealed dilated choroidal vessels with an overlying healthy retina. Optical coherence tomography scan was repeated applying gentle globe indentation under which the lesion completely collapsed.

Conclusion:
This case illustrates that the diagnosis of a vortex vein varix can be made in clinics using noninvasive tools such as optical coherence tomography. The anatomical localization of the lesion and the pressure-evoked fluctuation of size and shape are important clues which lead to the diagnosis.
Angle alpha orientation and magnitude distribution in a cataract surgery population
Authors: Mahr Michael A. , Simpson Michael J. , Erie Jay C. 
Published: February 2020

Purpose:
To report normative angle alpha orientation and magnitude distribution in a cataract surgery patient population.

Setting:
U.S. academic medical center.

Design:
Retrospective review.

Methods:
A total of 11 871 wavefront aberrometer/corneal topographer angle alpha measurements were performed over 40 months, yielding 8773 bilateral measurements (73.9%) with zero bad wavefront datapoints. The analysis was limited to the first right-eye scan for 3382 unique patients. The angle alpha magnitudes (millimeters) and orientations (degrees) were analyzed for these unique right eyes.

Results:
For the 3,382 unique patients, the mean angle alpha magnitude was 0.44 ± 0.15 mm (median, 0.44 mm; 25th and 75th percentiles 0.34 mm, 0.53 mm). Angle alpha orientation was predominantly horizontal (P < .01), with a mean of 186 ± 32 degrees. The expected point of intraocular lens (IOL) centration (EPIC) based on the geometric center of the corneal limbus was temporal to the visual axis in 3212 eyes (95%), nasal in 92 eyes (2.7%), inferior in 56 eyes (1.7%), and superior in 22 eyes (0.6%). The mean angle alpha magnitude was 0.3 mm or less in 607 eyes (18%) and 0.5 mm or greater in 1089 eyes (32%).

Conclusions:
Angle alpha is a predominantly horizontal phenomenon with a mean EPIC of 0.44 mm temporal to the visual axis. This information may assist in determining eligibility for patients in multifocal IOL implantation.
Refractive outcomes comparing small-incision lenticule extraction and femtosecond laser–assisted laser in situ keratomileusis for high myopia
Authors: Han Tian , Shang Jianmin , Zhou Xueyi , Xu Ye , Ang Marcus , Zhou Xingtao 
Published: February 2020

Purpose:
To compare the long-term refractive effects of small-incision lenticule extraction (SMILE) and femtosecond laser–assisted laser in situ keratomileusis (FS-LASIK) on the correction of high myopia and astigmatism.

Setting:
The Eye and ENT Hospital of Fudan University, Shanghai, China.

Design:
Retrospective case series.

Methods:
Patients had SMILE or FS-LASIK for high myopia. Subgroup analyses of high myopia (–6.00 to –8.75 diopters [D]) and extremely high myopia (≥–9.00 D) were performed. The main outcome measure was refractive predictability, compared between SMILE and FS-LASIK groups. Secondary outcomes included efficacy, safety, and residual astigmatism.

Results:
This study included 121 patients (121 eyes: 75 in the SMILE group and 46 in the FS-LASIK group). No differences were found in terms of refractive predictability between SMILE and FS-LASIK in eyes with high myopia: 56% vs 58.7% achieved ± 0.50 D of attempted correction (P = .771) and 81.3% vs 76.1% achieved ± 1.00 D of attempted correction (P = .489). Efficacy indices of the SMILE and FS-LASIK groups were 1.02 ± 0.24 and 1.03 ± 0.24 (P = .742), respectively; safety indices were 1.23 ± 0.22 and 1.20 ± 0.24 (P = .324), respectively. Logarithm of the minimum angle of resolution uncorrected distance visual acuity and spherical equivalent in the high myopia subgroup were better than in the extremely high myopia subgroup after both SMILE and FS-LASIK (P < .01).

Conclusions:
SMILE and FS-LASIK were both effective in correcting high myopia and myopic astigmatism. However, both techniques may require further nomogram adjustments when treating eyes with extremely high myopia.
Accelerated corneal crosslinking in children with keratoconus: 5-year results and comparison of 2 protocols
Authors: Ağca Alper , Tülü Beril , Yaşa Dilek , Kepez Yıldız Burçin , Sucu Mehmet E. , Genç Selim , Fazıl Korhan , Yıldırım Yusuf 
Published: February 2020

Purpose:
To evaluate long-term clinical results of 2 different accelerated corneal crosslinking (CXL) protocols in pediatric patients with keratoconus.

Setting:
Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey.

Design:
Retrospective case-control study.

Methods:
Patients who were younger than 18 years were included in the study. Group 1 received 4 minutes of illumination at 30 mW/cm2, and Group 2 received 5 minutes of illumination at 18 mW/cm2. Uncorrected and corrected distance visual acuities, manifest refraction, corneal topographic parameters, and corneal higher-order aberrations (HOAs) were evaluated at baseline and during 1-, 3-, and 5-year follow-up visits.

Results:
A total of 143 eyes from 86 patients were included in the study. There were 30 eyes in Group 1 and 113 eyes in Group 2. The mean follow-up time was 4.15 ± 0.99 years. Mean keratometry (K) and/or maximum K progressed ≥1.00 diopter (D) in 7 eyes (23.3%) in Group 1 and 19 eyes (16.8%) in Group 2 (P = .411). Mean K and/or maximum K decreased ≥2.00 D in 2 eyes (6.7%) in Group 1 and 24 eyes (21.2%) in Group 2 (P = .06). In Group 1, there were no statistically significant differences in topographic parameters during follow-up. In Group 2, there was a statistically significant reduction in total HOA and coma during the 5-year visit when compared with the preoperative visit (P = .005 and P = .045, respectively).

Conclusions:
Accelerated CXL is beneficial in terms of halting the progression of keratoconus in pediatric patients throughout 5 years of follow-up examinations. An increased irradiance with a reduced application time reduces the topographic effects of CXL.
Comparison of visual and refractive outcomes of 2 trifocal intraocular lenses
Authors: Ribeiro Filomena J. , Ferreira Tiago B. 
Published: February 2020

Purpose:
To compare clinical outcomes after cataract surgery and bilateral implantation of 2 diffractive trifocal toric intraocular lenses (IOLs).

Setting:
Hospital da Luz, Lisbon, Portugal.

Design:
Double-arm, randomized, prospective case series.

Methods:
A total of 60 patients were randomly allocated to receive bilateral implantation of either the FineVision Pod FT toric IOL (PhysIOL) or the AcrySof IQ PanOptix toric IOL (Alcon). Visual and refractive outcomes, contrast sensitivity, IOL misalignment, and quality of vision outcomes (QoV questionnaire) were evaluated at 3 months postoperatively. Surgically induced astigmatic changes were evaluated by vector analysis.

Results:
Each group (FineVision toric and AcrySof IQ PanOptix toric) comprised 30 patients (60 eyes). No significant differences between groups were found regarding uncorrected and corrected distance and near visual outcomes (P ≥ .333). Mean postoperative distance-corrected intermediate visual acuity at 60 cm was 0.04 ± 0.09 logarithm of the minimum angle of resolution (logMAR) and 0.09 ± 0.11 logMAR in the PanOptix and Pod FT group, respectively (P = .032). Mean IOL axis misalignment was 1.59 degrees ± 2.15 degrees (PanOptix group) and 1.89 degrees ± 3.31 degrees (Pod FT group) (P = .821). Mean magnitude of error of astigmatic correction was −0.09 diopters (D) and −0.11 D in the PanOptix group and Pod FT group, respectively (P = .333). Contrast sensitivity, QoV scores for the presence of photic phenomena, and the level of spectacle independence were similar in both groups (P > .05).

Conclusions:
Both trifocal toric IOLs allowed complete patient visual restoration, and good spectacle independence and good visual quality outcomes. The PanOptix IOL provided superior intermediate visual acuity for distances around 60 cm.
Clinical outcomes of immediate transepithelial photorefractive keratectomy after suction loss during small-incision lenticule extraction
Authors: Chung Byunghoon , Kang David Sung Yong , Kim Joon Hyun , Arba-Mosquera Samuel , Jean Seung Ki , Jun Ikhyun , Kim Eung Kweon , Seo Kyoung Yul , Kim Kang Yoon , Kim Tae-im 
Published: February 2020

Purpose:
To investigate the surgical outcomes of immediate transepithelial photorefractive keratectomy (PRK) after suction loss during small-incision lenticule extraction (SMILE) and compare the outcomes with those of uneventful SMILE.

Setting:
Eyereum Eye Clinic, Seoul, South Korea.

Design:
Retrospective case series.

Methods:
This study included 24 eyes of 12 patients who had uneventful SMILE in one eye and immediate transepithelial PRK after the development of suction loss during the lenticule cut in the contralateral eye. Visual acuity assessments, manifest refraction, and measurements of corneal wavefront aberrations were performed preoperatively and 6 months postoperatively.

Results:
At 6 months, the mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and spherical equivalent were −0.04 ± 0.05, −0.09 ± 0.05, and −0.02 ± 0.24 diopter (D), respectively, in the transepithelial PRK group and −0.10 ± 0.07, −0.06 ± 0.07, and −0.04 ± 0.17 D, respectively (P = .036, P = .109, and P = .671, respectively), in the uneventful SMILE group. The 6-month Snellen UDVA was better than 20/20 for 11 (92%) and 12 (100%) of eyes in the transepithelial PRK and uneventful SMILE groups, respectively. All 24 eyes showed unchanged or improved CDVA and a significant increase in the total corneal higher-order aberrations postoperatively. Corneal spherical aberrations exhibited a significant postoperative increase only in the transepithelial PRK group.

Conclusions:
Immediate transepithelial PRK after early suction loss during SMILE might be safe and effective, with refractive outcomes that are comparable with those after uneventful SMILE.
Mobile Electrocardiogram Monitoring and Health-Related Quality of Life in Patients With Atrial Fibrillation
Authors: Caceres Billy A. , Hickey Kathleen T. , Bakken Suzanne B. , Biviano Angelo B. , Garan Hasan , Goldenthal Isaac L. , Koleck Theresa A. , Masterson-Creber Ruth , Turchioe Meghan Reading , Jia Haomiao 
Published: February 2020

Background
Atrial fibrillation (AF) is associated with high recurrence rates and poor health-related quality of life (HRQOL) but few effective interventions to improve HRQOL exist.

Objective
The aim of this study was to examine the impact of the “iPhone Helping Evaluate Atrial Fibrillation Rhythm through Technology” (iHEART) intervention on HRQOL in patients with AF.

Methods
We randomized English- and Spanish-speaking adult patients with AF to receive either the iHEART intervention or usual care for 6 months. The iHEART intervention used smartphone-based electrocardiogram monitoring and motivational text messages. Three instruments were used to measure HRQOL: the Atrial Fibrillation Effect on Quality of Life (AFEQT), the 36-item Short-Form Health survey, and the EuroQol-5D. We used linear mixed models to compare the effect of the iHEART intervention on HRQOL, quality-adjusted life-years, and AF symptom severity.

Results
A total of 238 participants were randomized to the iHEART intervention (n = 115) or usual care (n = 123). Of the participants, 77% were men and 76% were white. More than half (55%) had an AF recurrence. Both arms had improved scores from baseline to follow-up for AFEQT and AF symptom severity scores. The global AFEQT score improved 18.5 and 11.2 points in the intervention and control arms, respectively (P < .05). There were no statistically significant differences in HRQOL, quality-adjusted life-years, or AF symptom severity between groups.

Conclusions
We found clinically meaningful improvements in AF-specific HRQOL and AF symptom severity for both groups. Additional research with longer follow-up should examine the influence of smartphone-based interventions for AF management on HRQOL and address the unique needs of patients diagnosed with different subtypes of AF.
Characteristics of Effective Continuing Medical Education for Physician Assistants and Nurse Practitioners in Hospital Medicine
Authors: Breunig Michael J. , Herber Andrew J. , Jenkins Sarah M. , Newman James S. , Beckman Thomas J. , Wittich Christopher M. , Ratelle John T. 
Published: February 2020

Purpose
The purpose of this study was to describe participant characteristics and effective teaching methods at a national continuing medical education (CME) conference on hospital medicine for physician assistants (PAs) and nurse practitioners (NPs).

Methods
In this cross-sectional study, participants provided demographic information and teaching effectiveness scores for each presentation. Associations between teaching effectiveness score and presentation characteristics were determined.

Results
In total, 163 of 253 participants (64.4%) completed evaluations of 28 presentations. Many of the participants were younger than 50 years (69.0%), had practiced for fewer than 5 years (41.5%), and worked in nonacademic settings (76.7%). Teaching effectiveness scores were significantly associated with the use of clinical cases (perfect scores for 68.8% of presentations with clinical cases vs. 59.8% without; P = .04).

Conclusion
Many PAs and NPs at an HM CME conference were early-career clinicians working in nonacademic settings. Presenters at CME conferences in hospital medicine should consider using clinical cases to improve their teaching effectiveness among PA and NP learners.
Evaluating the Clinical Implications of an Innovative Anatomy Lab Suturing Curriculum for Physician Assistant Students
Authors: Fankhanel Courtney , Talwalkar Jaideep S. , Rienzo Rita 
Published: February 2020

Purpose
The purpose of this study was to evaluate the outcomes of a new suturing curriculum incorporated throughout the anatomy lab for Yale Physician Associate (YPA) students.

Methods
This controlled before-and-after study evaluated the class of 2017 (n = 39) as the control group and the class of 2018 (n = 37) as the intervention group. Suturing competency data were collected on all students from their clinical preceptor evaluations. Students completed surveys to measure perceived confidence in suturing skills.

Results
Preceptor evaluations showed a 14.98% increase in suturing competence between the control and intervention groups (P < .05). Student surveys showed no significant difference in self-perceived confidence in suturing skills between the 2 cohorts.

Conclusions
After initiation of an innovative anatomy lab suturing curriculum, YPA students demonstrated improvement in preceptor-perceived suturing competency during clinical rotations.