bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concomitant Aspirin and Anticoagulation Is Associated With Increased Risk for Major Bleeding in Surgical Patients Requiring Postoperative Intensive Care*
Authors: Rayes Hamza A. , Subat Yosuf W. , Weister Timothy , Johnson Madeline Q. , Hanson Andrew , Schulte Phillip J. , Trivedi Vrinda , Gajic Ognjen , Warner Matthew A. 
Published: April 2020

Objectives:
Critically ill surgical patients may receive concomitant aspirin and therapeutic anticoagulation postoperatively, yet the safety of this practice remains unknown. We evaluated the risk of major bleeding with concomitant therapy compared with anticoagulation alone.

Design:
Observational cohort study. Inverse probability of treatment weighting was used to assess the association between concomitant therapy and a primary outcome of major bleeding.

Setting:
Postoperative ICUs at an academic medical center.

Patients:
Adults (≥ 18 yr old) receiving anticoagulation during postoperative ICU admission between 2007 and 2016.

Interventions:
None.

Measurements and Main Results:
Nine thousand five hundred eighteen anticoagulated patients were included, including 3,237 (34%) receiving aspirin. A total of 1,874 unique patients (19.7%) experienced a major bleeding event. In inverse probability of treatment weighting analyses, concomitant therapy was associated with increased odds for major bleeding (odds ratio, 1.20; 95% CI, 1.05–1.36; p = 0.006) compared with anticoagulation alone. An interaction test suggested a differential relationship between aspirin use and major bleeding based on aspirin use in the 7 days prior to anticoagulation, such that a strong association between aspirin and major bleeding was observed for recent initiators of aspirin (1.40; 1.13–1.72;p = 0.002) but not for those continuing prior aspirin use. Aspirin use prior to anticoagulation did not modify the relationship between concomitant therapy and new myocardial infarction or stroke (i.e., rates were not increased with aspirin discontinuation prior to anticoagulation).

Conclusions:
Concomitant aspirin and anticoagulation in critically ill surgical patients was associated with an increased rate of major bleeding. Future investigations are warranted to further define optimal management of antiplatelet therapy during anticoagulation in surgical patients.
Respiratory Dialysis—A Novel Low Bicarbonate Dialysate to Provide Extracorporeal Co 2 Removal
Authors: Cove Matthew E. , Vu Lien Hong , Ring Troels , Federspiel William J. , Kellum John A. 
Published: April 2020

Objectives:
We designed a novel respiratory dialysis system to remove Co
2 from blood in the form of bicarbonate. We aimed to determine if our respiratory dialysis system removes Co
2 at rates comparable to low-flow extracorporeal Co
2 removal devices (blood flow < 500 mL/min) in a large animal model.

Design:
Experimental study.

Setting:
Animal research laboratory.

Subjects:
Female Yorkshire pigs.

Interventions:
Five bicarbonate dialysis experiments were performed. Hypercapnia (Pco
2 90–100 mm Hg) was established in mechanically ventilated swine by adjusting the tidal volume. Dialysis was then performed with a novel low bicarbonate dialysate.

Measurements and Main Results:
We measured electrolytes, blood gases, and plasma-free hemoglobin in arterial blood, as well as blood entering and exiting the dialyzer. We used a physical-chemical acid-base model to understand the factors influencing blood pH after bicarbonate removal. During dialysis, we removed 101 (±13) mL/min of Co
2 (59 mL/min when normalized to venous Pco
2 of 45 mm Hg), corresponding to a 29% reduction in Paco
2 (104.0 ± 8.1 vs 74.2 ± 8.4 mm Hg; p < 0.001). Minute ventilation and body temperature were unchanged during dialysis (1.2 ± 0.4 vs 1.1 ± 0.4 L/min; p = 1.0 and 35.3°C ± 0.9 vs 35.2°C ± 0.6; p = 1.0). Arterial pH increased after bicarbonate removal (7.13 ± 0.04 vs 7.21 ± 0.05; p < 0.001) despite no attempt to realkalinize the blood. Our modeling showed that dialysate electrolyte composition, plasma albumin, and plasma total Co
2 accurately predict the measured pH of blood exiting the dialyser. However, the final effluent dose exceeded conventional doses, depleting plasma glucose and electrolytes, such as potassium and phosphate.

Conclusions:
Bicarbonate dialysis results in Co
2 removal at rates comparable with existing low-flow extracorporeal Co
2 removal in a large animal model, but the final dialysis dose delivered needs to be reduced before the technique can be used for prolonged periods.
Do trends of adiposity and metabolic parameters vary in women with different ovarian reserve status? A population-based cohort study
Authors: Amiri Mina , Ramezani Tehrani Fahimeh , Rahmati Maryam , Firouzi Faezeh , Azizi Feriedoun 
Published: April 2020

Abstract

Objective:
To investigate whether trends of adiposity and glucose metabolism parameters in women with low ovarian reserve status based on their anti-Mullerian hormone (AMH) levels differ from those with high ovarian reserve.

Methods:
In this population-based prospective study, eligible women, aged 20 to 50 years, were selected from among participants of the Tehran Lipid and Glucose Study (TLGS). Generalized estimating equation (GEE) models were applied to compare changes in various adiposity and metabolic parameters across time between women in the first and fourth quartiles of age-specific AMH, after adjustment for confounders. Pooled logistic regression was used to compare progression of prediabetes mellitus (pre-DM) and diabetes mellitus (DM) between the women of these two age-specific AMH quartiles.

Results:
In this study of a total of 1,015 participants and with a median follow-up of 16 years, we observed that over time, both groups of women in the first and fourth quartiles of age-specific AMH experienced significant positive trends in their adiposity indices including central obesity, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), a body shape index (ABSI), and a negative trend in visceral adiposity index (VAI), whereas there was no significant difference in these parameters between the two groups. This study revealed that odds ratios of diabetes and prediabetes in women in the first quartile of age-specific AMH were not significantly different, compared with those in the fourth quartile.

Conclusion:
Women with lower ovarian reserve do not experience different over time trends of adiposity and glucose metabolism parameters during their reproductive life span.
Telemedicine Home-Based Cardiac Rehabilitation
Authors: Berry Robert , Brawner Clinton A. , Kipa S. George , Stevens Courtney , Bloom Charles , Keteyian Steven J. 
Published: April 2020

Details of the Clinical Case:
In this case series report, we review 2 patients who were among the first to participate in the Henry Ford telemedicine home-based cardiac rehabilitation (TM-HBCR) program. These patients had barriers to full participation in a facility-based cardiac rehabilitation (CR) program due to return to work and access to transportation. However, they were willing and able to participate in the TM-HBCR program.

Discussion:
The two cases discussed herein are examples of individuals who likely would not have fully participated in CR if the only option available was a facility-based program. While HBCR is not an option for all patients, it does address several barriers that are known to limit participation in facility-based CR for some individuals.

Summary:
Technology has made it possible to provide the key components of a facility-based CR program through a TM-HBCR model using a secure connection to the patients via their personal mobile device.
FIVE-YEAR INCIDENCE AND VISUAL ACUITY OUTCOMES FOR INTRAVITREAL THERAPY IN BILATERAL NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Cornish Elisa E. , Teo Kelvin Y. , Nguyen Vuong , Squirrel David , Young Stephanie , Gillies Mark C. , Barthelmes Daniel 
Published: April 2020

Purpose:
To compare treatment intensity and mean visual acuity gains for first- and second-affected eyes with age-related macular degeneration nAMD over 5 years of treatment. The cumulative incidence of second-eye involvement was assessed.

Method:
We analyzed data from the Fight Retinal Blindness! project database, a prospectively designed registry of “real-world” outcomes from Australia, New Zealand, Switzerland, and Singapore. Patients with bilateral age-related macular degeneration with ≥5 years of follow-up on treatment were included.

Results:
Six thousand five hundred and forty-two eyes being treated for age-related macular degeneration were tracked from 2005 to 2017. Thousand two hundred and sixty-one patients had bilateral age-related macular degeneration; of whom, 302 had 5 years of follow-up. Of these, 170 patients started treatment for each eye at least 2 months apart. The mean baseline visual acuity of second-affected eyes was significantly higher than that of first-eyes (20/50 + 2 vs. 20/80; P < 0.01). Second-affected eyes lost a mean of 5.8 (−9.1 to −2.6) logarithm of the minimum angle of resolution letters after 5 years of treatment, whereas the vision of the first-affected eyes remained stable (P = 0.01). Second-affected eyes received fewer injections than the first-affected eyes after the first year of treatment (6.2/year vs. 7.8/year; P < 0.01) and reactivated earlier (376 vs. 507 days; P = 0.04). The cumulative incidence of second eye involvement was 54% over 5 years.

Conclusion:
Second-affected eyes received fewer treatments and reactivated earlier. Care should be taken to avoid undertreating second-affected eyes.
COMPARISON OF THE INTERNAL LIMITING MEMBRANE INSERTION TECHNIQUE AND THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE WITH VITRECTOMY TO TREAT MACULAR HOLE–ASSOCIATED RETINAL DETACHMENT
Authors: Zhu Ke , Lei Boya , Wong Wenghang , Zhang Juan , Guo Yue , Chen Han , Song Fang , Chang Qing , Xu Gezhi , Zhang Yanqiong 
Published: April 2020

Purpose:
To compare the anatomical and functional outcomes of macular hole (MH)-associated retinal detachment after vitrectomy with the internal limiting membrane (ILM) insertion technique or the inverted ILM flap technique.

Methods:
In this retrospective observational study, we reviewed the medical records of 49 eyes with MH-associated retinal detachment that underwent vitrectomy with the ILM insertion (26 eyes) or ILM flap (23 eyes) technique.

Results:
The MH closure rate at 12 months was greater in the ILM flap group versus the ILM insertion group (95% vs. 73%, respectively, P = 0.059). The postoperative best-corrected visual acuity (BCVA) at 12 months was significantly better in the ILM flap group (P = 0.014). All eyes (100%) showed an improvement in the BCVA of ≥0.3 logarithm of the minimum angle of resolution (15 Early Treatment Diabetic Retinopathy Study letters) in the ILM flap group versus 20 eyes (77%) in the ILM insertion group (P = 0.026). The preoperative BCVA and the ILM flap technique were significantly correlated with the postoperative BCVA (P = 0.028 and 0.027, respectively) and BCVA improvement (≥0.3 logarithm of the minimum angle of resolution [15 Early Treatment Diabetic Retinopathy Study letters]; P = 0.003 and 0.026, respectively).

Conclusion:
The inverted ILM flap technique was more effective in improving the postoperative BCVA in patients with MH-associated retinal detachment when compared with the ILM insertion technique. The preoperative BCVA and the ILM flap technique were independent prognostic factors for visual outcomes in patients with MH-associated retinal detachment.
Performance of New Hypothermic Corneal Storage Media With an Antimycotic Tablet in Comparison to Traditional Hypothermic Media During Simulated Eye Bank Processing
Authors: Perry Isaac , Peterson Kristen , Tóthová Jana D'Amato , Tramber Mike , Botsay Sara , Tremblay David 
Published: April 2020

Purpose:
To compare the performance of Kerasave (AL.CHI.MI.A. S.R.L., Ponte San Nicolò, Italy) containing 2.5 μg/mL of amphotericin B and Optisol-GS (Bausch & Lomb, Bridgewater, NJ) cold corneal storage media on donor corneas during routine eye bank procedures.

Methods:
Forty-four paired donor corneas were preserved after swab sample collection and povidone-iodine decontamination. Right and left corneas were immersed in Kerasave and Optisol-GS, respectively, and stored at 4°C before the initial evaluation. Paired corneas were assigned to processing subgroups for penetrating keratoplasty (n = 20), Descemet stripping automated endothelial keratoplasty (n = 14), or Descemet membrane endothelial keratoplasty (n = 10). Endothelial cell density, central corneal thickness, slit-lamp examination, and endothelial cell damage were assessed at different intervals. Sterility testing was performed on media samples.

Results:
At the initial evaluation, after 25.6 ± 3.2 hours of storage, the mean central corneal thickness of all corneas in Kerasave (n = 22) was greater than those in Optisol-GS (n = 22) (571 ± 12 μm vs. 526 ± 10 μm, respectively; P = 0.006). All other metrics were comparable between Kerasave and Optisol-GS in processing subgroups at all time intervals. Corneal swabs were positive in 90% of corneas before decontamination with povidone-iodine. At the initial evaluation, fungal contamination was detected in 24% and 19% of Kerasave and Optisol-GS, respectively. At the final evaluation, no fungi was detected in Kerasave and 1 Optisol-GS sample was positive (P = 0.999).

Conclusions:
Metrics of corneas stored in Kerasave and Optisol-GS were comparable. Kerasave might be considered an antifungal-possessing alternative to Optisol-GS.
High Fluence Increases the Antibacterial Efficacy of PACK Cross-Linking
Authors: Kling Sabine , Hufschmid Fong Siang , Torres-Netto Emilio A. , Randleman J. Bradley , Willcox Mark , Zbinden Reinhard , Hafezi Farhad 
Published: April 2020

Purpose:Photoactivated chromophore for keratitis cross-linking (PACK-CXL) is used as an adjunct therapy to antibiotic medication in infectious keratitis. This experimental study aimed at quantifying the PACK-CXL efficacy as a function of UV fluence using several bacterial strains and irradiated volumes.Methods:Six distinct bacterial strains, including standardized strains and clinically isolated strains from patients with keratitis, were analyzed. Bacterial concentrations between 102and 108cells/mL were used (simulating small corneal ulcers). Volumes of either 11 μL (≈285 μm stromal thickness) or 40 μL (≈1000 μm stromal thickness) were irradiated within a microtiter plate at different fluences (5.4–27 J/cm2) and irradiances (3, 9 and 18 mW/cm2). The ratio of bacterial killing (B†) was determined to evaluate the antimicrobial efficacy of PACK-CXL.Results:B† was similar (51 ± 11%) in bacterial concentrations between 103and 105per ml. In 11 μL volume,Staphylococcus aureus(SA) 8325-4 ATCC 29213,Bacillus subtilis(BS) 212901, andPseudomonas aeruginosa(PA) 2016-866624 were most sensitive to PACK-CXL at 5.4 J/cm2(on average B† = 49 ± 8%), whereasKlebsiella oxytoca(KO) 2016-86624 (B† = 25%) was least sensitive. When irradiating a larger volume, B† was on average lower in 40 μL (19 ± 18%), compared with 11 μL (45 ± 17%,P< 0.001). By contrast, applying a higher UV fluence increased B† of SA ATCC 29213, from 50% at 5.4 J/cm2to 92% at 10.8 J/cm2, to 100% at 16.2 J/cm2and above.Conclusions:Applying higher UV fluences substantially increases the bacterial killing rates. Safety limits for clinical application require further investigation.
Comparative Evaluation of Central Corneal Thickness in Cross-Linked Keratoconic Eyes
Authors: Kosekahya Pinar , Koc Mustafa , Yalcinsoy Kubra Ozdemir , Kocabas Dilara Ozkoyuncu , Toker Mustafa Ilker 
Published: April 2020

Purpose:
To compare the central corneal thickness (CCT) measurements measured by using the Pentacam Scheimpflug system with the CCT measured using ultrasound pachymetry (UP) and to compare the compatibility between the methods in normal, keratoconic, and cross-linked keratoconic corneas.

Methods:
The study included 50 eyes of 50 patients with keratoconus (keratoconus group), 50 eyes of 50 patients with progressive keratoconus who underwent corneal cross-linking treatment (CCL group), and 50 eyes of 50 healthy subjects (control group). Patients in the keratoconus and CCL groups were further classified into mild (mean keratometry [Km] ≤ 47 D) and moderate keratoconus subgroups (47.0 < Km < 52.0 D). CCT values were noted from the Pentacam Scheimpflug and UP.

Results:
The difference between the Pentacam and UP values was largest in the CCL group (−20.9 0.21.5 μm), followed by the keratoconus and control groups (−10.6 0.20.3 and 0.4 0.6.8 μm). The Pentacam and UP measurements were not comparable in the keratoconus and CCL groups (P = 0.001 and P < 0.001), whereas they were comparable in the control group (P = 0.62). In subgroup analysis, the 2 methods were comparable in the mild keratoconus subgroup (P = 0.12) and not comparable in the moderate keratoconus subgroup and in both mild and moderate subgroups of the CCL group (P = 0.001, P < 0.001 and P < 0.001).

Conclusions:
Pentacam Scheimpflug tomography and UP can be used interchangeably in normal and mild keratoconic eyes, but not in moderate keratoconic and cross-linked keratoconic eyes. Pachymetry measurements from Scheimpflug must be interpreted with extreme caution with different methods before planning an invasive procedure in these eyes.
Implementation of Point-of-Care Ultrasound in a Physician Assistant Curriculum
Authors: Perdue Mark , Bosse Bobby , Pasha Jabraan , Davison Meredith 
Published: April 2020

Purpose
This study evaluated the benefits and challenges of implementing point-of-care ultrasound (POCUS) training in a physician assistant program curriculum.

Methods
Physician assistant students were introduced to POCUS during 2 semesters of Physical Diagnosis. The students were assessed for understanding of applications, effectiveness in obtaining images of target anatomy, and the time required to obtain those images. Student attitudes and the cost of implementation were also recorded.

Results
After 13 hours of training, the 24 students were able to obtain all the target anatomy images and describe the associated structures with an average accuracy rating of 97%. Understanding of POCUS in clinical applications, including recognition of abnormal scan images, was assessed at an average of 85%. Student attitudes toward POCUS were assessed with 88.69% affirming “strongly agree.” Although the costs associated with implementation might vary depending on the setting, they were feasible in our program.

Conclusion
Our study confirmed that POCUS training can be effectively implemented with faculty time burdens and costs that are not prohibitive.
Validation of a Novel Fecal Incontinence Scale
Authors: de la Portilla Fernando , Ramallo Irene , Maestre Maria V. , Roig José V. , Devesa Manuel , Padillo Francisco J. 
Published: April 2020

Objective:
The development and validation of a new version of the fecal incontinence (FI) scale “Rapid Assessment Fecal Incontinence Score” (RAFIS) incorporating domains for severity, type of stool loss, and global perception of the effect of incontinence on quality of life (QoL).

Background:
FI negatively impacts on QoL. Currently used incontinence questionnaires have outstanding limitations on the global assessment of the impact of the disease on QoL that patients perceive. We developed a new version of RAFIS with a more complete questionnaire.

Materials and Methods:
A 3-phase study was performed to evaluate the applicability and reliability of our questionnaire as a tool for assessing FI. Our score was completed by 98 patients (78 women; mean age: 57±13 y) who presented with FI and who were referred from 4 colorectal surgery centers. The RAFIS was assessed for internal consistency, test-retest reliability, and sensitivity to change. A multivariate analysis was performed. Comparisons were made with the Wexner Cleveland Clinic Incontinence Score and the Fecal Incontinence Quality of Life Scale.

Results:
The RAFIS showed good internal consistency and test-retest reliability, differentiating the severity of incontinence but not the etiology. There was a moderate-high correlation between the new scale and the reference scales. Sensitivity to change, compared with the Wexner Score, was moderate. Comparison with established QoL instruments showed a moderate negative correlation. Logistic regression of the RAFIS discriminated between mild and moderate-severe impact on QoL. No correlation was detected with the new score to the presence of an anal sphincter defect or sphincter hypotonia.

Conclusion:
The RAFIS scale is easy to administer and compares well with other validated incontinence instruments.
Esophagogastric Junction Outflow Obstruction
Authors: Csucska Máté , Masuda Takahiro , Bremner Ross M. , Mittal Sumeet K. 
Published: April 2020

Goals:
The authors aimed to compare preperistaltic distal esophageal pressure in patients with esophagogastric junction outflow obstruction (EGJOO) with and without reported dysphagia.

Background:
Manometric EGJOO is characterized by elevated integral relaxation pressure (>15 mm Hg) without achalasia. The nomenclature inherently implies that it should be associated with impaired food bolus transit and should theoretically present clinically as dysphagia.

Study:
The authors queried an esophageal functional test database to identify patients diagnosed with EGJOO. They excluded patients who presented with ≥2 swallows with abnormal (ie, weak, failed or hypercontractile) esophageal body motility. To elucidate differences in manometric findings, the authors formed 2 cohorts of patients on the basis of a standard esophageal symptom questionnaire: those without dysphagia and those with severe or very severe dysphagia. All studies were reanalyzed to determine the distal esophageal pressure before each peristaltic wave (ie, the preperistaltic pressure) for individual swallows. The Mann-Whitney U test was used to compare categorical variables between groups. The level of significance was set to P<0.05.

Results:
In total, 149 patients were diagnosed with EGJOO during the study period. Of these, 42 patients with ≥9 (out of 10) peristalsis (20 without dysphagia and 22 with severe/very severe dysphagia) formed the study cohorts. Patients with severe dysphagia had significantly higher median preperistaltic pressures in the distal esophagus. Preperistaltic pressure measurements showed better sensitivity and specificity for dysphagia than integral relaxation pressure.

Conclusions:
Elevated preperistaltic pressure is noted in symptomatic EGJOO patients. Inclusion of preperistaltic pressure in the diagnostic criteria for EGJOO may increase the clinical relevance of manometric classification.