bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE EFFECT OF ENDOPHTHALMITIS ON RECURRENCE OF MACULAR EDEMA IN EYES RECEIVING INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR
Authors: Uhr Joshua H. , Storey Philip P. , Kuley Brandon , Patel Samir N. , Wibbelsman Turner D. , Pancholy Maitri , Spirn Marc J. 
Published: November 2020

Purpose:
Visual outcomes after postinjection endophthalmitis have been well-studied, but the effect of endophthalmitis on the underlying exudative disease process remains unclear. We investigate the need for continued anti–vascular endothelial growth factor injections after endophthalmitis.

Methods:
Eyes that developed endophthalmitis after intravitreal injection of anti–vascular endothelial growth factor between January 1, 2016, and May 31, 2018, at a single academic retina practice were identified. Retrospective chart review was performed to determine 1) the proportion of eyes without recurrence of macular edema or subretinal fluid after endophthalmitis and 2) the proportion achieving a 12-week or greater interval between anti–vascular endothelial growth factor injections or exudation after endophthalmitis compared with internal controls before endophthalmitis.

Results:
Of 50 eyes with endophthalmitis, seven (14.0%) had no fluid recurrence at a mean of 98.1 week. Of 43 eyes with recurrence, 48.0% achieved a >12-week recurrence-free interval after endophthalmitis (vs. 8.3% before endophthalmitis; P < 0.0001). Eyes with compared to those without choroidal neovascularization were more likely to achieve this interval (60.5% vs. 8.3%, respectively; P = 0.002).

Conclusion:
Endophthalmitis after anti–vascular endothelial growth factor injection is associated with relative stability of the underlying exudation. Further research is necessary to elucidate the mechanism, which may be useful in developing strategies and targets for the treatment of exudative macular diseases.
Three-year outcomes of mixed astigmatism correction with single-step transepithelial photorefractive keratectomy with a large ablation zone
Authors: Kaluzny Bartlomiej J. , Verma Shwetabh , Piotrowiak-Słupska Ilona , Kaszuba-Modrzejewska Magdalena , Rzeszewska-Zamiara Jagoda , Stachura Joanna , Arba-Mosquera Samuel 
Published: November 2020

Purpose:
To evaluate refractive and visual outcomes of single-step transepithelial photorefractive keratectomy (transPRK) in the treatment of mixed astigmatism with the use of an aberration-neutral profile and large ablation zone.

Setting:
Nicolaus Copernicus University and Oftalmika Eye Hospital, Bydgoszcz, Poland.

Design:
Retrospective, observational case series.

Methods:
This study included patients who underwent transPRK to correct mixed astigmatism and completed the 3-year follow-up. Procedures were performed with an Amaris 750S excimer laser using an aberration-neutral profile and optical zone of 7.2 mm or more.

Results:
A total 48 eyes of 39 patients were included. Preoperatively, mean spherical manifest refraction was +1.37 ± 0.98 diopter (D) (0.25 to 4.00 D), and astigmatism was −4.00 ± 0.76 D (−2.25 to −6.00 D). Three years postsurgery, it was −0.17 ± 0.26 D and −0.41 ± 0.44 D, respectively. Attempted spherical equivalent correction within ±0.50 D was achieved in 45 eyes (94%) and cylindrical correction in 34 (71%). Preoperative corrected distance visual acuity (CDVA) was 20/20 or better in 38 eyes (79%), and postoperative uncorrected was 20/20 or better in 29 eyes (60.0%). No eye had lost 2 or more Snellen lines of CDVA, whereas 3 eyes (6%) gained 2 or more lines. In 4 eyes (8%), haze of low intensity was observed at the periphery, with scores between 0.5 and 1.0, and only 1 eye getting a score of 2 in 0- to 4-degree scale.

Conclusions:
Mixed astigmatism correction with large-ablation-zone transPRK provided good results for efficacy, safety, predictability, and visual outcomes in a 3-year follow-up.
Corneal endothelial damage in phacoemulsification using an anterior chamber maintainer compared with using an ophthalmic viscosurgical device
Authors: Mayali Huseyin , Baser Esin Fatma , Kurt Emin , Ilker Suleyman Sami 
Published: November 2020

Purpose:
To compare the effects of phacoemulsification surgery (PE) using an anterior chamber maintainer (ACM) and conventional PE using an ophthalmic viscosurgical device (OVD) on corneal endothelial cells.

Setting:
Department of Ophthalmology, Celal Bayar University, Manisa, Turkey.

Design:
Prospective randomized controlled trial.

Methods:
Eyes in the OVD group (n = 50) underwent conventional PE, whereas eyes in the ACM group (n = 50) underwent PE using an ACM. Endothelial cell density (ECD), coefficient of variation (CV), hexagonality (HEX), and noncontact central corneal thickness (CCT) measurements were performed by specular microscopy before and at 1 month, 3 months, and 6 months after PE.

Results:
This study included 100 eyes of 97 patients undergoing PE. The mean age was 64.7 ± 10.6 years in the OVD group, 64.0 ± 12.6 years in the ACM group (P > .05). The groups did not differ significantly in preoperative ECD, CV, HEX, and CCT or total PE time (P > .05 for all). ECD was significantly lower in the ACM group compared with the OVD group at postoperative 1 month, 3 months, and 6 months (P = .002, P = .002, and P = .001, respectively). Similarly, ECD loss compared with preoperative value was greater in the ACM group at all postoperative timepoints (P = .003, P = .001, and P = .001, respectively). CV increased and HEX decreased in both groups postoperatively (P > .05 for both). CCT showed a transient increase of less than 10 μm at postoperative 1 month in both groups (P = .296).

Conclusions:
PE with ACM was associated with greater corneal ECD loss compared with conventional PE. ACM should not be used during PE in patients with limited corneal endothelial reserve.
Return of phacoemulsification after emergency status related to COVID-19: experience of a tertiary referral center
Authors: Vieira Rita , Baptista Pedro , Castro Catarina , Leite João , Menéres Maria João , Menéres Pedro 
Published: November 2020

Purpose:
To present a protocol of priority criteria for phacoemulsification after the backlog due to severe acute respiratory syndrome coronavirus (SARS-CoV)-2 pandemic status.

Setting:
Ophthalmology department of Centro Hospitalar e Universitário do Porto (CHUP), Oporto, Portugal.

Design:
Cross-sectional, nonrandomized, retrospective study.

Methodology:
Data of all patients waiting for cataract surgery were analyzed at the beginning of May 2020, after 2 months without performing elective surgery. The waiting time since surgical inscription was considered an independent and overriding factor. In addition, higher priority was given to patients with white or brunescent cataracts and patients with low visual acuity: corrected distance visual acuity (CDVA) of 20/200 or less in binocular patients or CDVA of 20/63 or less in monocular patients. Criteria of medium priority included patients who remained with anisometropia and patients with glaucoma or low to moderate risk for chronic angle closure. Data of scheduled surgeries in the following months were then analyzed.

Results:
A total of 717 patients were waiting for phacoemulsification. One hundred ninety-one patients (26.64%) were on the waiting list more than 4.5 months; the medium waiting time was 3.51 ± 1.57 months. According to both priority criteria and waiting time, 348 (48.6%) were categorized as priority cases. A total of 158 patients (22.0%) met the highest priority; 61 patients (8.5%) met the medium priority criteria. In 129 patients (18.0%), priority was considered based solely on higher waiting time. This algorithm allowed surgeons to operate on all priority cases within the first 3 months.

Conclusions:
The presented protocol showed to be effective, providing a timely surgical opportunity for priority cases.
Neuropathic pain generates silent synapses in thalamic projection to anterior cingulate cortex
Authors: Wang Yao Q. , Wang Junshi , Xia Sun-hui , Gutstein Howard B. , Huang Yanhua H. , Schlüter Oliver M. , Cao Jun-Li , Dong Yan 
Published: November 2020

Abstract
Pain experience can change the central processing of nociceptive inputs, resulting in persistent allodynia and hyperalgesia. However, the underlying circuit mechanisms remain underexplored. Here, we focus on pain-induced remodeling of the projection from the mediodorsal thalamus (MD) to the anterior cingulate cortex (ACC), a projection that relays spinal nociceptive input for central processing. Using optogenetics combined with slice electrophysiology, we detected in male mice that 7 days of chronic constriction injury (CCI; achieved by loose ligation of the sciatic nerve) generated AMPA receptor (AMPAR)-silent glutamatergic synapses within the contralateral MD-to-ACC projection. AMPAR-silent synapses are typically GluN2B-enriched nascent glutamatergic synapses that mediate the initial formation of neural circuits during early development. During development, some silent synapses mature and become “unsilenced” by recruiting and stabilizing AMPARs, consolidating and strengthening the newly formed circuits. Consistent with these synaptogenic features, pain-induced generation of silent synapses was accompanied by increased densities of immature dendritic spines in ACC neurons and increased synaptic weight of GluN2B-containing NMDA receptors (NMDARs) in the MD-to-ACC projection. After prolonged (∼30 days) CCI, injury-generated silent synapses declined to low levels, which likely resulted from a synaptic maturation process that strengthens AMPAR-mediated MD-to-ACC transmission. Consistent with this hypothesis, viral-mediated knockdown of GluN2B in ACC neurons, which prevented pain-induced generation of silent synapses and silent synapse-mediated strengthening of MD-to-ACC projection after prolonged CCI, prevented the development of allodynia. Taken together, our results depict a silent synapse-mediated mechanism through which key supraspinal neural circuits that regulate pain sensitivity are remodeled to induce allodynia and hyperalgesia.
Evolution of robotic-assisted kidney transplant: successes and barriers to overcome
Authors: Matthew Ashley N. , Hampton Lance J. , Autorino Riccardo , Bhati Chandra S. 
Published: November 2020

Purpose of review
The aim of this study was to provide an updated review of robotic-assisted kidney transplant (RAKT) with an emphasis on advantages over the open kidney transplant (OKT), utility in special populations and resources available to overcome the learning curve of robotic surgery.

Recent findings
The majority of the reported studies showed that RAKT and OKT have similar functional outcomes including similar ischemia times and time to postoperative normalization of creatinine. However, RAKT results in fewer wound complications, decreased estimated blood loss and pain. Given these benefits, RAKT is a promising approach for obese patient across BMI subtypes and several studies showed decreased wound complications in this population compared with the open approach. Moreover, new 3D-print techniques are promising resources for robotic simulation, which may decrease the learning curve of robotic surgery.

Summary
Overall, RAKT is a feasible approach especially in obese patients. However, more data with long-term follow-up are needed to fully elucidate the advantages over OKT before universal implementation of this approach is possible.
Advanced ureteroscopic techniques for the management of kidney stones
Authors: Falagario Ugo Giovanni , Calò Beppe , Auciello Mario , Carrieri Giuseppe , Cormio Luigi 
Published: November 2020

Purpose of review
Recent years witnessed significant changes in the endourological management of renal tones because of the development of new, more advanced instruments. Retrograde intrarenal surgery (RIRS) has gained particular advantage from such technological progress and now tends to be considered the gold standard treatment for uncomplicated less than 20 mm renal stones. Using a step-by-step approach, this review aims to highlight current achievements but also unsolved problems in RIRS.

Recent findings
Several technical details of RIRS, including preoperative stenting, use of ureteral access sheets, lithotripsy method, and renal drainage, remain open to discussion and linked to surgeon's preference. Moreover, there is a wide range of variation in efficacy and safety data, with major complications being episodic but often under-reported.

Summary
RIRS has gained increased popularity among the urological community. This is certainly because of the continuous technological advancements, which have continuously improved the RIRS performance but also to the perception of ease and safety of this procedure when compared with the other available treatment modalities, particularly percutaneous nephrolitotomy. Indeed, the reported advances in RIRS technique have significantly improved the outcomes of this procedure but care should be taken not to underestimate its potential challenges.
Clinical Outcomes Following Therapeutic Endoscopic Retrograde Cholangiopancreatography in Children With Pancreas Divisum
Authors: Lin Tom K. , Pathak Sagar J. , Hornung Lindsey N. , Vitale David S. , Nathan Jaimie D. , Abu‐El‐Haija Maisam 
Published: November 2020

ABSTRACTObjectives:Pancreas divisum (PD) is a risk factor in children for the development of acute pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (mPES) may be of clinical benefit, however, the clinical outcomes from endotherapy remain unclear. We sought to review the outcomes and safety of therapeutic ERCP in children with PD.Methods:We performed a retrospective chart of children with PD who underwent an ERCP between February 2012 and December 2018. Pertinent patient, clinical and procedure information was collected including procedure‐related adverse events. A follow‐up questionnaire of the parent was conducted to determine the clinical impact from endotherapy.Results:Fifty‐eight ERCPs were performed in 27 patients (14 boys; mean age: 9.7 years, range 2‐19) with PD. All patients underwent a successful mPES. A genetic variant was identified in 19/26 (73%) tested patients. Post‐ERCP pancreatitis (PEP) was the only observed adverse event; 21% (12/58). Median follow‐up interval from first ERCP intervention to questionnaire completion was 31.5 months (range: 4‐‐72 months). Of the 20 questionnaire responders, 13 reported clinical improvement from endotherapy.Conclusions:The majority of children from our PD cohort possessed at least 1 genetic variant. Most questionnaire responders had a favorable response to endotherapy. PEP rate was comparable with that of prior reports in adult patients.
Clinical Experience With Performing Esophageal Function Testing in Children
Authors: van Lennep Marinde , Leijdekkers Marin L. , Oors Jac M. , Benninga Marc A. , van Wijk Michiel P. , Singendonk Maartje M.J. 
Published: November 2020

ABSTRACTObjectives:Pediatric high‐resolution manometry (HRM) and 24‐hour pH‐impedance with/without ambulatory manometry (pH‐MII+/‐mano) tests are generally performed using adult‐derived protocols. We aimed to assess the feasibility of these protocols in children, the occurrence of patient‐related imperfections and their influence on test interpretability.Methods:Esophageal function tests performed between 2015 and 2018 were retrospectively analyzed. All tests were subcategorized into uninterpretable or interpretable tests (regardless of occurrence of patient‐related imperfections). For HRM, the following patient‐related imperfections were scored: patient‐related artefacts, multiple swallowing and/or inability to establish baseline characteristics. For pH‐MII(+/‐mano), incorrect symptom registration and/or premature catheter removal were scored. Results were compared between age‐groups (0–3, 4–12, and >12 years).Results:In total 106 HRM, 60 pH‐MII, and 23 pH‐MII‐mano could be fully analyzed. Of these, 94.8% HRM, 91.9% pH‐MII, and 95.7% pH‐MII‐mano were interpretable. Overall, HRM contained imperfections in 78.3% overall and in 8/8 (100%) in the youngest age group, 36/42 (85.7%) in 4 to 12 years and in 37/56 (66.1%) in children above 12 years; P = 0.011. These imperfections led to uninterpretable results in 4 HRM (3.8%), of which 3 were in the youngest age group (3/8, 37.5%). Imperfections were found in 10% of pH‐MII and 17.4% of pH‐MII‐mano. These led to uninterpretable results in 5.0% and 4.3%, respectively. No age‐effect was found.Conclusions:Esophageal function tests in children are interpretable in more than 90% overall. In children under the age of 4 years, all patients had imperfect HRM and 3/8 tests were uninterpretable. HRM in older children and pH‐MII+/‐mano were interpretable in the vast majority.
Ferric Carboxymaltose Across All Ages in Paediatric Gastroenterology Shows Efficacy Without Increased Safety Concerns
Authors: Sasankan Natasha , Duncan Hazel , Curtis Lee , McGuckin Christina , Shannon Claire , Barclay Andrew , Fraser Simon , Nair Mridula , Russell Richard K. , Hansen Richard 
Published: November 2020

ABSTRACTObjectives:The aim of the study was to assess the efficacy, safety and side‐effect profile of ferric carboxymaltose (FCM) for correcting IDA in children and adolescents in paediatric gastroenterology, hepatology, and nutrition.Method:This was a retrospective study of all gastroenterology patients <18 years who had FCM (October 2015 to October 2017). Haematological and biochemical parameters were recorded pre‐infusion, at 4 weeks, 3 months, 6 months, and 1 year post‐infusion. Recognised side‐effects were documented.Results:Sixty‐six children received FCM during this period. Data was analysed on 61 children, 5 excluded because of inadequate data. The median age at administration was 14 years (IQR 7). Thirty‐two (52%) were boys. Twenty‐six (42%) were <14 years old. Seven (11.5%) were <5 years old. Seventeen (28%) were switched from oral iron supplements to FCM. The median dose of FCM delivered was 19 mg/kg. The median haemoglobin increased from 108 to 126 g/L at 1 month post‐infusion (P value <0.00001). The mean cell volume also improved from 80 to 84 fL at 1 month post‐infusion (P value = 0.0007). Forty‐eight (94%) children corrected their anaemia after receiving FCM. Two patients (3%) reported side‐effects with skin bruising and staining.Conclusions:FCM appears to be effective in correcting IDA in children across a wide range of gastroenterology indications and all ages. It is effective and generally well tolerated including in very young patients. Potential side‐effects can be avoided by careful monitoring during infusions.
Treatment of Primary Central Nervous System Germinomas With Short-course Induction Chemotherapy Followed by Low-dose Radiotherapy Without a Tumor Bed Boost: Prognostic Impact of Human Chorionic Gonadotropin
Authors: Chou Yung-Chih , Wu Yao-Yu , Hung Sheng-Ping , Tsang Ngan-Ming , Pai Ping-Ching , Jaing Tang-Her , Lin Chien-Yu , Hsieh Cheng-En , Fan Kang-Hsing , Kao Wei-Heng , Tseng Chen-Kan 
Published: November 2020

Objective:
To investigate the clinical utility of short-course induction chemotherapy followed by low-dose radiotherapy without a tumor bed boost in patients with primary central nervous system (CNS) germinomas.

Methods:
We retrospectively reviewed the clinical records of patients with primary CNS germinomas who received short-course induction chemotherapy (2 cycles of cisplatin 20 mg/m2 plus etoposide 40 or 100 mg/m2 for 5 days) followed by low-dose radiotherapy (dose: 2340 cGy) without a tumor bed boost. Disease-free survival and overall survival served as the main outcome measures.

Results:
Between February 2002 and June 2018, 24 patients (20 males and 4 females; median age: 14.1 y; age range: 7.9 to 21.2 y) with pathology-proven CNS germinomas were included. The median follow-up time was 106 months (range: 17 to 169 mo). Isolated and multifocal lesions were identified in 13 and 11 patients, respectively. Tumor location was as follows: pineal gland (n=17), suprasellar region (n=13), periventricular region (n=7), and basal ganglia (n=2). Five patients had increased levels (>5 mIU/mL) of beta-human chorionic gonadotropin (β-hCG), whereas alpha-fetoprotein concentrations were within the reference range in all participants. A total of 16 patients achieved remission after induction chemotherapy. The complete response rates of patients with increased and normal β-hCG levels were 40.0% and 72.2%, respectively (P=0.208). Low-dose radiotherapy without a tumor bed boost was subsequently delivered to either the whole ventricle (n=16) or the whole brain (n=8), resulting in complete remission in all participants. Compared with patients without increased β-hCG levels, those with β-hCG-secreting germinomas had less favorable 5-year disease-free survival rates (100% vs. 60%, respectively, P=0.000115).

Conclusions:
Some children with primary CNS germinoma may benefit from short-course induction chemotherapy followed by low-dose radiotherapy to the whole ventricle without a tumor bed boost. The validity of our findings needs to be confirmed in a randomized phase II study for children with β-hCG levels <5 mIU/mL.
Accuracy of Mandible-First versus Maxilla-First Approach and of Thick versus Thin Splints for Skeletal Position after Two-Jaw Orthognathic Surgery
Authors: Borikanphanitphaisan Thatchawee , Lin Cheng-Hui , Chen Ying-An , Ko Ellen Wen-Ching 
Published: November 2020

Background:
The aim of this study was to investigate the accuracy of bimaxillary orthognathic surgery regarding different sequencing (maxilla-first or mandible-first surgery) and different thicknesses of intermediate splints.

Methods:
This retrospective cohort study evaluated the accuracy of postoperative outcome in accordance with virtual planning in 57 patients requiring bimaxillary osteotomies with different operation sequence: maxilla-first (n = 31) or mandible-first (n = 26) surgery. The effect of different splint thicknesses (i.e., thick, n = 22; and thin, n = 35) was also evaluated. The 1-week postoperative cone-beam computed tomographic craniofacial images were superimposed onto preoperative simulated images to measure the discrepancy of the three-dimensional cephalometric landmarks.

Results:
Neither sequencing approach differed in overall accuracy (1-week postoperative to preoperative simulated image discrepancy): maxilla-first, 1.69 ± 0.53 mm; versus mandible-first, 1.44 ± 0.52 mm. In detailed comparison, mandible-first surgery resulted in more accuracy in the vertical dimension. Thick intermediate splints provided better control (less error) of upper central incisors in the sagittal position (thick splint, 1.38 ± 1.17 mm; thin splint, 2.13 ± 1.38 mm). However, overall accuracy was not affected by splint thickness. Conditions affecting sequencing predilection included skeletal class III with vertical excess, maxillary down-grafting, counterclockwise rotation of the maxillomandibular complex, and simulated mandibular opening for splint fabrication clearance.

Conclusions:
Despite both means of sequencing being performed similarly, mandible-first surgery was more precise in the vertical dimension. Thick intermediate splints seemed to yield better control of central incisors in the sagittal position. However, under appropriate selection of intermediate splints to maintain interim condylar position, splint thickness has no effect on overall accuracy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.