bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of astigmatism correction between anterior penetrating and intrastromal arcuate incisions in eyes undergoing femtosecond laser–assisted cataract surgery
Authors: Ganesh Sri , Brar Sheetal , Reddy Arra Raghavender 
Published: February 2020

Purpose:
To compare the safety, efficacy, and predictability of femtosecond laser–enabled anterior penetrating and intrastromal arcuate incisions for the correction of preoperative astigmatism at the time of cataract surgery.

Setting:
Nethradhama Super Speciality Eye Hospital, Bangalore, India.

Design:
Prospective randomized comparison study.

Methods:
This study included 50 eyes of 50 patients who had femtosecond laser–assisted cataract surgery with the CATALYS Precision System (Johnson & Johnson Vision Care, Inc.). Twenty-five eyes received anterior penetrating and 25 eyes received intrastromal arcuate incisions for the correction of corneal astigmatism in the range of 0.75 to 2.00 diopters (D). Six months postoperatively, vector analysis of astigmatism was performed using the Alpins method with the ASSORT software.

Results:
The mean preoperative keratometric astigmatism and target-induced astigmatism were 1.07 D and 1.16 D in the anterior penetrating group and 1.23 D and 1.50 D in the intrastromal group, respectively. There was no statistically significant difference between the postoperative keratometric astigmatism (anterior penetrating = 0.65, intrastromal = 0.90, P value = .13) and surgically induced astigmatism (anterior penetrating = 1.23, intrastromal = 1.08, P value = .55) at 6 months postoperatively. The correction index was 0.95 in the anterior penetrating group and 0.55 in the intrastromal group, signifying an undercorrection of 5% and 45% of eyes in the anterior penetrating and intrastromal group, respectively. Eighty percent of eyes in the anterior penetrating group and 72% of eyes in the intrastromal group were within ±0.5 D of refractive astigmatism.

Conclusions:
Both anterior penetrating and intrastromal incisions were effective in reducing preoperative astigmatism using the femtosecond laser technology. However, the anterior penetrating incisions showed comparatively better correction, whereas the intrastromal incisions resulted in significant undercorrection at 6 months.
Real-time intraoperative dynamics of white cataract—intraoperative optical coherence tomography–guided classification and management
Authors: Titiyal Jeewan S. , Kaur Manpreet , Shaikh Farin , Goel Siddhi , Bageshwar Lalit M. S. 
Published: February 2020

Purpose:
To evaluate morphological characteristics and intraoperative dynamics of different types of white cataract using intraoperative optical coherence tomography (iOCT).

Setting:
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Design:
Prospective interventional study.

Methods:
Fifty eyes with white cataract undergoing phacoemulsification were evaluated. The primary outcome measure was the classification of white cataract based on morphology and intraoperative dynamics on iOCT. The secondary outcome measure was rhexis-related complications.

Results:
Four types of white cataract were identified based on iOCT—type I (9 eyes), type II (3 eyes), type III (24 eyes), and type IV (14 eyes). Type I had regularly arranged lamellar cortical fibers, type II had continuous hyperreflective bands of cortical fibers with intralenticular clefts, type III had intralenticular clefts combined with areas of homogenous ground-glass appearance, and type IV had homogenous ground-glass appearance of the anterior lens cortex. Capsulorhexis in type I cataract was uneventful. In type II cataract, cortical bulge was observed in the anterior chamber on creating the initial nick, indicating raised intralenticular pressure (ILP) with an imminent risk of rhexis extension. A bimanual irrigation/aspiration was performed until lowering of ILP was observed on iOCT. In types III and IV, fluid release was observed on initiation of rhexis leading to partial (type III) or complete (type IV) lowering of ILP, with a mild-moderate risk of capsulorhexis extension. A continuous curvilinear capsulorhexis was achieved in all cases, with no case of posterior capsular tear or vitreous loss.

Conclusions:
Intraoperative OCT helped elucidate intraoperative dynamics of the spectrum of white cataracts and facilitates completion of capsulorhexis.
Clinical outcomes of cataract surgery with implantation of a continuous transitional focus intraocular lens
Authors: Royo Mariano , Jiménez Ángel , Piñero David P. 
Published: February 2020

Purpose:
To evaluate the clinical outcomes obtained after cataract or crystalline lens surgery with implantation of a new continuous transitional focus intraocular lens (IOL).

Setting:
San Rafael Hospital, Madrid, Spain.

Design:
Nonrandomized prospective case series.

Methods:
Uncomplicated phacoemulsification cataract surgery was performed with bilateral implantation of the continuous transitional focus IOL Precizon Presbyopic. Visual, refractive, and contrast sensitivity outcomes were evaluated during a 6-month follow-up. Likewise, the incidence of postoperative disturbing photic phenomena was recorded.

Results:
Sixty-two eyes of 31 patients (mean age: 61.3 years) were enrolled. Mean 6-month postoperative binocular uncorrected distance (UDVA), intermediate (UIVA), and near visual acuity (UNVA) were 0.01 ± 0.03, 0.17 ± 0.04, and 0.02 ± 0.04 logarithm of the minimum angle of resolution (logMAR), respectively. A total of 98.4% (61) and 93.5% (58) of eyes achieved 20/25 monocular UDVA and UNVA or better, respectively, whereas all eyes (100%) achieved 20/30 UIVA or better. Mean corrected visual acuity of 0.14 ± 0.05, 0.15 ± 0.06, and 0.19 ± 0.02 logMAR were obtained for the defocus levels of −1.00, −1.50, and −2.00 diopters. Mean 6-month postoperative log contrast sensitivity was 1.22 ± 0.18 and 0.75 ± 0.10 for 12 and 18 cycles per degree, respectively. A total of 9.7% (3) and 6.5% (2) of patients reported disturbing halos and glare.

Conclusions:
This presbyopia-correcting IOL provided a complete visual rehabilitation after cataract surgery, maintaining excellent levels of visual quality. Specifically, the IOL generated a continuous range of functional vision from distance to near, with minimal levels of photic phenomena associated.
Epithelial photorefractive keratectomy vs mechanical epithelial removal followed by corneal crosslinking for keratoconus: the Tel-Aviv Protocol
Authors: Rabina Gilad , Mimouni Michael , Kaiserman Igor 
Published: February 2020

Purpose:
To compare the Tel-Aviv Protocol, epithelial photorefractive keratectomy (ePRK) combined with corneal crosslinking (CXL), to CXL with alcohol-assisted epithelial removal (Alc-CXL) for progressive keratoconus.

Setting:
Care-Vision Laser Centers, Tel Aviv, Israel.

Design:
Retrospective study.

Methods:
All patients underwent Alc-CXL or ePRK, a 50 μm laser ablation of the epithelium with a myopic spherical component and an astigmatic component, followed by CXL. All patients completed at least 1 year of follow-up.

Results:
A total of 131 eyes of 131 patients were included in the study. Fifty patients (38%) were included in the Tel-Aviv Protocol group, and 81 patients (62%) were included in the Alc-CXL group. There was a significant improvement in uncorrected distance visual acuity (UDVA) (from 1.22 ± 0.75 logarithm of the minimum angle of resolution [logMAR] to 0.49 ± 0.44 logMAR, P < .001), corrected distance visual acuity (CDVA) (from 0.29 ± 0.17 logMAR to 0.16 ± 0.12 logMAR, P < .001), Kmax (from 48.50 ± 3.00 diopters [D] to 46.50 ± 3.00 D, P < .001), and cylinder (from −3.31 ± 1.70 D to −2.32 ± 1.66 D, P < .001) in the Tel-Aviv Protocol group in comparison with nonsignificant changes in the Alc-CXL group in UDVA (from 0.89 ± 0.62 logMAR to 0.81 ± 0.65 logMAR, P = .23), CDVA (from 0.25 ± 0.21 logMAR to 0.21 ± 0.17 logMAR, P = .10), Kmax (from 46.50 ± 4.50 D to 46.00 ± 4.40 D, P = .08), and cylinder (from −2.99 ± 2.05 D to −2.80 ± 1.75 D, P = .39) at the end of the follow-up period.

Conclusions:
The Tel-Aviv Protocol for progressive keratoconus patients provided good improvement in visual acuity and astigmatism while halting the progression of keratoconus.
Low-dose interleukin-2 reverses behavioral sensitization in multiple mouse models of headache disorders
Authors: Zhang Jintao , Czerpaniak Katherine , Huang Liang , Liu Xuemei , Cloud Megan E. , Unsinger Jacqueline , Hotchkiss Richard S. , Li Daizong , Cao Yu-Qing 
Published: February 2020

AbstractHeadache disorders are highly prevalent and debilitating, with limited treatment options. Previous studies indicate that many proinflammatory immune cells contribute to headache pathophysiology. Given the well-recognized role of regulatory T (Treg) cells in maintaining immune homeostasis, we hypothesized that enhancing Treg function may be effective to treat multiple headache disorders. In a mouse model of chronic migraine, we observed that repeated nitroglycerin (NTG, a reliable trigger of migraine in patients) administration doubled the number of CD3+T cells in the trigeminal ganglia without altering the number of Treg cells, suggesting a deficiency in Treg-mediated immune homeostasis. We treated mice with low-dose interleukin-2 (ld-IL2) to preferentially expand and activate endogenous Treg cells. This not only prevented the development of NTG-induced persistent sensitization but also completely reversed the established facial skin hypersensitivity resulting from repeated NTG administration. The effect of ld-IL2 was independent of mouse sex and/or strain. Importantly, ld-IL2 treatment did not alter basal nociceptive responses, and repeated usage did not induce tolerance. The therapeutic effect of ld-IL2 was abolished by Treg depletion and was recapitulated by Treg adoptive transfer. Furthermore, treating mice with ld-IL2 1 to 7 days after mild traumatic brain injury effectively prevented as well as reversed the development of behaviors related to acute and chronic post-traumatic headache. In a model of medication overuse headache, Ld-IL2 completely reversed the cutaneous hypersensitivity induced by repeated administration of sumatriptan. Collectively, this study identifies ld-IL2 as a promising prophylactic for multiple headache disorders with a mechanism distinct from the existing treatment options.
Effects of Exercise Intervention on Adults With Both Hypertension and Type 2 Diabetes Mellitus
Authors: Park Seojin , Kim Jinhee , Lee Jina 
Published: February 2020

Background
The positive effect of exercise on blood pressure has been reported in studies that investigated mostly patients with hypertension but without diabetes mellitus. However, the effect of exercise in adults with both hypertension and type 2 diabetes mellitus (T2DM) is unclear, and no systematic review and meta-analysis has been conducted to clarify this effect.

Objective
This study was a systematic review and meta-analysis designed to investigate the effects of exercise on adults with both hypertension and T2DM.

Methods
Studies were selected using electronic databases. Data were extracted using a standardized protocol. The risk of bias was assessed using Cochrane Collaboration's tool. To estimate the effect size, a meta-analysis of the studies was conducted.

Results
Of 3207 publications identified, 8 trials were used to estimate the effect size of exercise. Effect sizes (weighted mean difference [WMD]) were heterogeneous, and random-effects models were used. Exercise was effective for systolic blood pressure (WMD, −5.25 mm Hg; 95% confidence interval [CI], −8.39 to −2.12), diastolic blood pressure (WMD, −3.16 mm Hg; 95% CI, −4.91 to −1.40), body mass index (WMD, −1.47 kg/m2; 95% CI, −2.39 to −0.55), and waist circumference (WMD, −2.91 cm; 95% CI, −5.68 to −0.15). In subgroup analyses, aerobic exercise seemed to be the most effective intervention for lowering systolic (WMD, −9.43 mm Hg; 95% CI, −13.63 to −5.23) and diastolic (WMD, −5.90 mm Hg; 95% CI, −7.69 to −4.11) blood pressure.

Conclusions
Exercise seemed effective in reducing systolic and diastolic blood pressure, with subgroup analyses indicating that this effect was most profound with aerobic exercise.
Molecular biomarkers in the neurological ICU: is there a role?
Authors: Diaz-Arrastia Ramon , Shahim Pashtun , Sandsmark Danielle K. 
Published: February 2020

Purpose of review
The aim of the article is to summarize recent advances in the field of molecular biomarkers in neurocritical care.

Recent findings
Advances in ultrasensitive immunoassay technology have made it possible to measure brain-derived proteins that are present at subfemtomolar concentrations in blood. These assays have made it possible to measure neurofilament light chain (NfL) in serum or plasma, and early studies indicate that NfL is a promising prognostic and pharmacodynamic biomarker across a broad range of neurologic disorders, including cardiac arrest and traumatic brain injury. However, as acquired brain injury is a complex and heterogeneous disorder, it is likely that assays of panels of biomarkers will ultimately be needed to maximally impact practice. Micro-RNAs are a novel but exciting class of molecules that also show potential to provide clinically actionable information.

Summary
Although not yet ready for adoption into routine clinical practice, several molecular biomarkers are on the cusp of clinical validation. The availability of such tests likely will revolutionize the practice of neurocritical care.
Comparative Analysis of 3-Year Persistence With Vedolizumab Compared With Antibodies Against Tumor Necrosis Factor-Alpha in Patients With Inflammatory Bowel Disease in Germany
Authors: Helwig Ulf , Kostev Karel , Schmidt Carsten 
Published: February 2020

Aims:
The goal of the study was to compare persistence with vedolizumab versus adalimumab, golimumab, and infliximab in biologics-naïve patients with inflammatory bowel disease treated in gastroenterological practices and outpatient clinics in Germany.

Methods:
Patients aged 18 or older who had initiated a biological therapy (vedolizumab, infliximab, adalimumab, or golimumab) were included in the present study. Prescriptions between July 2014 and March 2017 of the respective biological drug emerging from gastroenterological practices or outpatient clinics in Germany were retrieved from the longitudinal prescription (LRx) database. Patients treated with vedolizumab were matched with patients treated with infliximab, adalimumab, or golimumab on the basis of age, gender, medication before biologic therapy, and index year. The primary outcome variable of the study was the rate of persistence with vedolizumab compared with antitumor necrosis factor biologics (infliximab, adalimumab, and golimumab) within 3 years of the first prescription in outpatient settings.

Results:
Kaplan-Meier analysis was performed in 15,984 patients naïve to biologics revealing the statistically lower risk of discontinuation for vedolizumab compared with adalimumab, golimumab, or infliximab. In matched-pairs analyses, within 3 years after the first prescription, 39.5% of 2076 patients were persistent to vedolizumab compared with 33.5% of matched patients persistent to adalimumab (P<0.001). 37.6% of 716 patients were persistent to vedolizumab compared with 24.7% of matched patients persistent to golimumab (P<0.001). 35.7% of 2055 patients were persistent to vedolizumab compared with 30.2% of matched patients persistent to infliximab (P=0.119). Vedolizumab was associated with a significantly lower risk of therapy discontinuation compared with adalimumab [hazard ratio (HR)=0.86; 95% confidence interval (CI), 0.81-0.93] and golimumab (HR=0.60; 95% CI, 0.54-0.67), respectively; the vedolizumab risk of therapy discontinuation was numerically lower than infliximab but statistical significance was not achieved (HR=0.93; 95% CI, 0.85-1.02).

Conclusion:
In biologics-naïve IBD patients treated in outpatient settings in Germany, matched-pair analyses showed that vedolizumab was associated with significantly improved drug persistence compared with adalimumab or golimumab, whereas numerical improvement was shown in comparison with infliximab.
10-Day Versus 14-Day Quadruple Concomitant Nonbismuth Therapy for the Treatment of Helicobacter pylori Infection
Authors: Apostolopoulos Periklis , Ekmektzoglou Konstantinos , Georgopoulos Sotirios , Chounta Eleni , Theofanopoulou Antonia , Kalantzis Chrisostomos , Vlachou Erasmia , Tsibouris Panagiotis , Alexandrakis Georgios 
Published: February 2020

Goals:
The aim of this study was to investigate the implementation of a 14-day quadruple nonbismuth concomitant regimen, as proposed by recent Guidelines and Consensus Statements.

Background:
In Greece, a region with >20% clarithromycin resistance where bismuth is unavailable, the 10-day quadruple concomitant scheme has already been adopted as the accepted first-line Helicobacter pylori eradication treatment.

Study:
Our prospective randomized study included 364 patients with newly diagnosed H. pylori infection, randomized to receive a 10-day or a 14-day nonbismuth quadruple concomitant scheme. Treatment outcome was assessed by C13-urea breath test and/or histology at least 4 weeks after therapy. Intention to treat and per protocol analyses of the eradication rates were performed. Secondary endpoints included patient adherence, safety, and the impact of prior antibiotic exposure in treatment efficacy.

Results:
The overall eradication rates of the 2 treatments were 87.9% versus 87.4% in the intention to treat analysis, P=1.000, and 93% versus 94.1%, P=0.859, in the per protocol analysis for the 10-day and the 14-day treatment group, respectively. Both groups displayed excellent compliance rates (99.5% for the 10-day vs. 96.2% for the 14-day treatment duration, P=0.067). As regards treatment safety, serious adverse events that led to the discontinuation of both regimens were few, with no statistical difference between the 2 groups (0.5% in the 10-day group and 2.2% in the 14-day group, P>0.05). Previous antibiotic exposure was not significant with regard to treatment efficacy.

Conclusion:
In Greece, the 10-day concomitant nonbismuth quadruple regimen for first-line treatment remains the most efficient strategy for H. pylori eradication.
Evaluating the TARGET and EAT-ICU trials: how important are accurate caloric goals? Point-counterpoint: the pro position
Authors: Singer Pierre , Pichard Claude , Rattanachaiwong Sornwichate 
Published: February 2020

Purpose of review
Controversies about the adequate amount of energy to deliver to critically ill patients are still going on, trying to find if hypocaloric or normocaloric regimen is beneficial in this population. Our purpose is to review recent publications using or not indirect calorimetry.

Recent findings
Numerous studies have compared hypocaloric to normocaloric regimen using predictive equations. However, these equations have been demonstrated to be inaccurate in most of the cases. Some recent PRCT using indirect calorimetry are finding some advantages to isocalorie regimens, but others not. Timing of the nutrition respecting or not the early substrate endogenous production, use of an adequate amount of protein, respect of the daily variability of needs may explain the divergent results observed.

Summary
Indirect calorimetry should be used to define the energy expenditure of the patient and to determine its requirements. More studies comparing isocalorie to hypocalorie regimens with fixed protein intake are necessary to confirm the observational and some of the PRCT-positive studies.
Fatal fulminant hemolysis-associated pulmonary embolism in mixed-type autoimmune hemolytic anemia
Authors: Imataki Osamu , Iseki Kikuo , Uchida Shumpei , Uemura Makiko , Kadowaki Norimitsu 
Published: February 2020

Abstract

Rationale:
Autoimmune hemolytic AQ5 anemia (AIHA) is an immune disorder caused by antibodies directed against unmodified autologous red blood cells. In rare cases, AIHA is comorbid with other immunological disorders; for instance, when AIHA is complicated with immunologic thrombocytopenic purpura (ITP) it is called Evans Syndrome (ES). These multiple autoimmune mechanisms are referred to as “immunological tolerance loss,” which is known as a characteristic autoimmunity specific for AIHA. And there are no estimation of the risk for thromboembolism in the “immunological tolerance loss” case.

Patient concerns:
A 66-year-old man was diagnosed with ES after autologous stem cell transplantation for malignant lymphoma. His background immunological status was complicated because AIHA was mixed-type (warm and cold antibody type). The direct/indirect Coombs tests were positive. The anticomplement antibody was positive and his cold hemagglutinin level had increased. Anticardiolipin antibodies were negative: anticardiolipin β2GPI antibody ≤1.2 U/mL (<3.5), anticardiolipin immunoglobulin G antibody ≤8 U/mL (<10), and anticardiolipin immunoglobulin M antibody ≤5 U/mL (<8).

Diagnoses:
ITP and mixed-type AIHA.

Interventions:
The patient achieved complete response by initial prednisolone therapy; however, he did not respond to corticosteroid therapy after AIHA recurrence. He required the red blood cell transfusion due to the progression of hemolytic anemia.

Outcomes:
On the fourth day of refractory treatment following AIHA recurrence, the patient had acute respiratory failure with severe hypoxia and died. The cause of death was identified as pulmonary embolism (PE) based on the laboratory data and echocardiography findings, and a literature search suggested rapidly progressive hemolysis-induced PE.

Lessons:
Although infrequent, comorbid thromboembolism to AIHA is well documented; however, a mixed-type AIHA case complicated with thromboembolism has not been previously reported. The combined pathophysiology of AIHA and thromboembolism should be considered in the clinical course of hemolysis. Our case suggested multiple immunological background, ITP, and mixed type AIHA, could be associated to a risk for thromboembolism (TE).
Does the Encounter Type Matter When Defining Diabetes Complications in Electronic Health Records?
Authors: Hong Dongzhe , Shen Yun , Monnette Alisha , Liu Shuqian , Shao Hui , Nauman Elizabeth , Price-Haywood Eboni , Hu Gang , Shi Lizheng 
Published: February 2020

Background:
Electronic health records (EHRs) and claims records are widely used in defining type 2 diabetes mellitus (T2DM) complications across different types of health care encounters.

Objective:
This study investigates whether using different EHR encounter types to define diabetes complications may lead to different results when examining associations between diabetes complications and their risk factors in patients with T2DM.

Research Design:
The study cohort of 64,855 adult patients with T2DM was created from EHR data from the Research Action for Health Network (REACHnet), using the Surveillance Prevention, and Management of Diabetes Mellitus (SUPREME-DM) definitions. Incidence of coronary heart disease (CHD) and stroke events were identified using International Classification of Diseases (ICD)-9/10 codes and grouped by encounter types: (1) inpatient (IP) or emergency department (ED) type, or (2) any health care encounter type. Cox proportional hazards regression was used to estimate associations between diabetes complications (ie, CHD and stroke) and risk factors (ie, low-density lipoprotein cholesterol and hemoglobin A1c).

Results:
The incidence rates of CHD and stroke in all health care settings were more than twice the incidence rates of CHD and stroke in IP/ED settings. The age-adjusted and multivariable-adjusted hazard ratios for incident CHD and stroke across different levels of low-density lipoprotein cholesterol and hemoglobin A1c were similar between IP/ED and all settings.

Conclusion:
While there are large variations in incidence rates of CHD and stroke as absolute risks, the associations between both CHD and stroke and their respective risk factors measured by hazard ratios as relative risks are similar, regardless of alternative definitions.