bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and validation of radiomics model built by incorporating machine learning for identifying liver fibrosis and early-stage cirrhosis
Authors: Qiu Qing-Tao , Zhang Jing , Duan Jing-Hao , Wu Shi-Zhang , Ding Jia-Lin , Yin Yong 
Published: October 2020

Abstract

Background:
Liver fibrosis (LF) continues to develop and eventually progresses to cirrhosis. However, LF and early-stage cirrhosis (ESC) can be reversed in some cases, while advanced cirrhosis is almost impossible to cure. Advances in quantitative imaging techniques have made it possible to replace the gold standard biopsy method with non-invasive imaging, such as radiomics. Therefore, the purpose of this study is to develop a radiomics model to identify LF and ESC.

Methods:
Patients with LF (n = 108) and ESC (n = 116) were enrolled in this study. As a control, patients with healthy livers were involved in the study (n = 145). Diffusion-weighted imaging (DWI) data sets with three b-values (0, 400, and 800 s/mm2) of enrolled cases were collected in this study. Then, radiomics features were extracted from manually delineated volumes of interest. Two modeling strategies were performed after univariate analysis and feature selection. Finally, an optimal model was determined by the receiver operating characteristic area under the curve (AUC).

Results:
The optimal models were built in plan 1. For model 1 in plan 1, the AUCs of the training and validation cohorts were 0.973 (95% confidence interval [CI] 0.946–1.000) and 0.948 (95% CI 0.903–0.993), respectively. For model 2 in plan 1, the AUCs of the training and validation cohorts were 0.944, 95% CI 0.905 to 0.983, and 0.968, 95% CI 0.940 to 0.996, respectively.

Conclusions:
Radiomics analysis of DWI images allows for accurate identification of LF and ESC, and the non-invasive biomarkers extracted from the functional DWI images can serve as a better alternative to biopsy.
Single-arm Trials with Historical Controls
Authors: Suissa Samy 
Published: October 2020

Background:
Regulatory agencies now recognize single-arm trials with external historical controls, particularly common in oncology, to assess promising treatments for rare or specific indications. When a new treatment indication depends on events over time, such as treatment failures, this design can introduce time-related biases in comparisons with external controls.

Methods:
We describe two potential biases resulting from calendar time and choice of time zero. We illustrate these biases using simulated data, emulating those from a single-arm trial of the effectiveness of blinatumomab in treating relapsed or refractory acute lymphoblastic leukemia on the outcome of mortality.

Results:
The trial compared 189 patients treated with blinatumomab with 1112 external historical control patients. First, calendar time was not concurrent, with the blinatumomab arm diagnosed during 2010–2014 and the control cohort during 1990–2013. The median survival under blinatumomab was 6.1 months compared with 3.3 months in the control arm, though for the latter it increased from 2.4 to 4.2 months over the 24-year period. Second, using the latest line of salvage treatment as cohort, entry for the control cohort introduces selection bias. The corresponding hazard ratio of death with blinatumomab compared with control was 0.56 (95% CI = 0.47, 0.67) but became 0.98 (95% CI = 0.83, 1.15) after redefining cohort entry by the matched line of salvage treatment rather than the latest line.

Conclusion:
While single-arm trials with external historical controls are gaining recognition, a proper understanding of time-related sources of bias is essential if such trials will be used to provide valid evidence for drug approval from regulatory agencies.
Time Since Infection and Risks of Future Disease for Individuals with Mycobacterium tuberculosis Infection in the United States
Authors: Menzies Nicolas A. , Swartwood Nicole , Testa Christian , Malyuta Yelena , Hill Andrew N. , Marks Suzanne M. , Cohen Ted , Salomon Joshua A. 
Published: October 2020

Background:
Risk of tuberculosis (TB) declines over time since Mycobacterium tuberculosis infection, but progression to clinical disease is still possible decades later. In the United States, most TB cases result from the progression of latent TB infection acquired over 2 years ago.

Methods:
We synthesized evidence on TB natural history and incidence trends using a transmission-dynamic model. For the 2020 US population, we estimated average time since infection and annual, cumulative, and remaining lifetime risks of progression to TB, by nativity and age.

Results:
For a newly infected adult with no other risk factors for progression to TB, estimated rates of progression declined from 38 (95% uncertainty interval: 33, 46) to 0.38 (0.32, 0.45) per 1000 person–years between the first and 25th year since infection. Cumulative risk over 25 years from new infection was 7.9% (7.0, 8.9). In 2020, an estimated average age of individuals with prevalent infection was 62 (61, 63) for the US-born population, 55 (54, 55) for non-US-born, and 57 (56, 58) overall. Average risks of developing TB over the remaining lifetime were 1.2% (1.0, 1.4) for US-born, 2.2% (1.8, 2.6) for non-US-born, and 1.9% (1.6, 2.2) for the general population. Risk estimates were higher for younger age groups.

Conclusions:
Our analysis suggests that, although newly infected individuals face appreciable lifetime TB risks, most US individuals with latent TB infection were infected long ago, and face low future risks of developing TB. Better approaches are needed for identifying recently infected individuals and those with elevated progression risks.
Risk Factors for Contact Lens–Related Microbial Keratitis and Associated Vision Loss in a South Indian Population
Authors: Konda Nagaraju , Garg Prashant , Sharma Savitri , Willcox Mark D. P. 
Published: October 2020

Objectives:
To identify risk factors associated with contact lens–related microbial keratitis (CL-MK) and subsequent vision loss in a south Indian population.

Methods:
A retrospective study of medical records at the LV Prasad Eye Institute in Hyderabad, India, of patients diagnosed with CL-MK and of controls who had no history of corneal inflammation during contact lens wear was undertaken. Variables such as demographic data, contact lens wear details, duration of the event, visual acuity, epithelial defect and infiltrate size, and microbiology of the cornea during the event were collected. Differences between cases and controls were analyzed using parametric and nonparametric tests. Logistic regression was used to calculate the odds ratio (OR) and associated 95% confidence intervals in univariate and multivariate analyses for cases vs. controls and for factors associated with vision loss.

Results:
One hundred sixty-seven cases of CL-MK and 153 controls were included in the analyses. Risk factors associated with the greatest increased OR for CL-related MK were: being in professional employment vs. a student (OR=3.9), disposing lenses yearly versus monthly or biweekly (OR=2.2), and any overnight wear (OR=2.8). Risk factors associated with vision loss were: high myopia (OR=3.6), severe vs. mild severity (OR=16.0), and hypopyon (OR=4.3).

Conclusions:
Identification of these risk factors may help inform safe contact lens wear habits and management strategies.
Clinical Outcome of Hybrid Contact Lenses in Keratoconus
Authors: Kloeck Dave , Koppen Carina , Kreps Elke O. 
Published: October 2020

Objectives:
To report the clinical outcome of hybrid contact lens fitting in keratoconus.

Methods:
A retrospective chart review was performed of keratoconus patients who had been fitted with hybrid contact lenses in one or both eyes. Patients with a history of previous intraocular surgery (except for corneal crosslinking) and relevant concurrent ocular disease limiting visual outcome were excluded. The outcome data at 6-month follow-up included hybrid lens-corrected visual acuity, wearing time, and lens discontinuation.

Results:
Fifty-four keratoconus patients (102 eyes) were included. Mean visual acuity with habitual correction before hybrid lens fitting was 0.63±0.29 (decimal Snellen). Eyes were fitted with Eyebrid lenses (LCS Laboratories, Caen, France) and SynergEyes lenses (SynergEyes Inc., Carlsbad, CA). Refits were necessary in 13 eyes, because of poor fitting (76.9%) or suboptimal refraction (23.1%). Visual acuity had significantly improved with hybrid lenses (0.93±0.14; P<0.0001). In 37 eyes (37.8%), hybrid lens wear was discontinued within 6 months after lens fitting. Reported issues were discomfort in 27 eyes (73%), handling difficulties in 14 eyes (37.8%) and poor vision in 1 eye (2.7%). Success rate of lens fitting was significantly correlated to cone morphology (P=0.01).

Conclusions:
New generation hybrid lenses are an appropriate, safe therapeutic option for keratoconus patients. Excellent visual outcomes are achieved in successful fittings, yet a dropout rate of 37.8%—mainly occurring in sagging, more peripheral, cones - still limit their clinical success.
The Relationship Between Vision and Comfort in Contact Lens Wear
Authors: Diec Jennie , Naduvilath Thomas , Tilia Daniel , Bakaraju Ravi C. 
Published: October 2020

Objective:
Understand relationship between vision and comfort in contact lens (CL) wear.

Methods:
Retrospective analysis of five trials using similar protocols with nonpresbyopic (NP) myopes or presbyopic participants (Px) wearing various simultaneous-image designs (SM) and single-vision (SV) CL (NP only). Questionnaires (vision satisfaction, vision clarity: distance/intermediate/near, comfort) on 1 to 10 scale were administered 1 week after fitting. Vision/comfort relationship was analyzed using linear mixed model and presented as regression coefficient with 95% confidence intervals (CIs).

Results:
Vision ratings correlated with comfort ratings, although this varied depending on type of vision rating and Px category. Vision satisfaction influenced comfort for the NP-SV group (slope: 0.8; 95% CI: 0.58–1.01, P≤0.001), but was significantly lower in the presbyopic group (slope: 0.38; 95% CI: 0.33–0.42; P≤0.001). Controlling for lens material obtained similar results. In the reverse relationship, comfort had a significant impact on vision satisfaction, although again at varying levels for each Px group. NP-SV demonstrated the weakest relationship (slope: 0.47; 95% CI: 0.35–0.59, P≤0.001) in comparison to NP-SM and P-SM groups.

Conclusion:
Vision and comfort in CL wear are inter-related. Consideration of Px characteristics, visual stimulus, and CL comfort needs to be accounted for when assessing overall CL experience.
Descemet Membrane Endothelial Keratoplasty in Toxic Anterior Segment Syndrome: A Case Series
Authors: Necip Kara , Oltulu Refik , Levent Dogan , Osman Gundogan Ali 
Published: October 2020

Purpose:
To evaluate the outcomes of Descemet membrane endothelial keratoplasty (DMEK) in patients with toxic anterior segment syndrome (TASS).

Methods:
Thirteen eyes of 13 patients who underwent DMEK for endothelial decompensation secondary to TASS were retrospectively reviewed. A comprehensive ocular examination including best-corrected visual acuity (BCVA), slitlamp biomicroscopy, intraocular pressure measurement, fundus evaluation, and measurement of central corneal thickness were performed in all patients at preoperatively and postoperatively.

Results:
There were 8 men and 5 women, with an average age of 56 ± 19 years. The mean follow-up was 8.7 ± 3.5 months. The time interval between the onset of TASS and DMEK was 4.9.±6.6 months (range, 1.5–26 months). Twelve of 13 grafts were clear at last visit. The mean preoperative BCVA was 20/666 (range, hand motion to 20/200), and the mean BCVA was 20/36 (range, hand motion to 20/20) at the postoperative last visit (P = 0.003). The decrease in mean pachymetry from preoperative (768 ± 69 μm) to postoperative last visit (523 ± 71 μm) was statistically significant (P < 0.001).

Conclusions:
DMEK seems to be a safe and an effective treatment option in eyes with TASS-related endothelial decompensation.
Effect of Anticoagulant Therapy on the Outcome of Descemet Membrane Endothelial Keratoplasty
Authors: Loreck Niklas , Geries Carla , Schrittenlocher Silvia , Siebelmann Sebastian , Matthaei Mario , Bachmann Björn , Hayashi Takahiko , Cursiefen Claus 
Published: October 2020

Purpose:
To analyze the effect of anticoagulant therapy (ACT) for systemic diseases on the outcome of Descemet membrane endothelial keratoplasty (DMEK).

Methods:
Consecutive eyes with Fuchs endothelial dystrophy that underwent DMEK between August 4, 2011, and July 15, 2016, were retrospectively analyzed. Data were obtained from the Cologne DMEK database at the University of Cologne, Germany. Best spectacle-corrected visual acuity (logMAR), endothelial cell density (at baseline and postoperatively up to 12 months), and rebubbling rates were compared between patients receiving ACT (ACT group) and those with no anticoagulant treatment (NCT group).

Results:
In this study, 329 eyes of 329 patients were included (ACT group n = 97, NCT group n = 232; mean age 69.9 ± 9.1 years). Bleeding was more common in the ACT group (P < 0.001). Preoperative best spectacle-corrected visual acuity was 0.59 ± 0.44 and 0.48 ± 0.35 logMAR for the ACT and NCT groups, respectively, which improved to 0.13 ± 0.08 and 0.08 ± 0.16 logMAR, respectively, at 12 months postoperatively. No significant difference in endothelial cell density loss at 12 months was found between the groups (ACT group 36.2% ± 14.7%, NCT group 38.5% ± 15.1%; P = 0.467). Rebubbling rate was 19.6% in the ACT group and 28.9% in the NCT group (P = 0.08).

Conclusions:
Although ACT increases the risk for preoperative and intraoperative bleeding in DMEK, there seems to be no negative effect on DMEK outcome. Thus, it is not advisable to stop ACT for DMEK surgery.
Use of Panel-Reactive Antibody Testing in the Planning and Management of Ocular Surface Stem Cell Transplantation
Authors: Jeffrey Joseph H. , Denny Matthew R. , Cheung Albert Y. , Sarnicola Enrica , Wright Elizabeth , Govil Amit , Holland Edward J. 
Published: October 2020

Purpose:
Panel-reactive antibody (PRA) testing has been widely adopted in solid organ transplantation for risk assessment in potential allograft recipients but has not been studied in the context of ophthalmic transplantation. The purpose of this study is to evaluate outcomes in patients undergoing ocular surface stem cell transplantation (OSST) for limbal stem cell deficiency (LSCD) relative to preoperative PRA level.

Methods:
This is retrospective chart review of all eyes with documented PRA level that underwent OSST for LSCD between May 2000 and March 2019 at a single institution. Eyes with stable ocular surface but <1 year of follow-up and eyes without updated PRA before repeat OSST were excluded. Eyes were grouped by PRA <80% and ≥80%. The primary outcome was ocular surface failure, whereas the secondary outcome was clinical allograft rejection.

Results:
Sixty-nine surgeries met inclusion criteria, consisting of 54 living-related conjunctival limbal allografts, 5 keratolimbal allografts, and 10 combined living-related conjunctival limbal allografts/keratolimbal allografts (Cincinnati procedure). The most common etiologies for LSCD were aniridia (33%), chemical/thermal injury (28%), and contact lens associated (14%). Surface failure occurred in 5 of 12 eyes (58%) with PRA ≥80% versus 12 of 57 eyes (21%) with PRA <80% (P = 0.01). The relative risk for surface failure with PRA ≥80% was 2.8 [confidence interval (CI), 1.38–5.55]. There was no significant difference in acute rejection (P = 1).

Conclusions:
Pretransplant PRA level is an important prognostic factor for ocular surface stability in eyes undergoing OSST for LSCD, with implications for donor selection, perioperative management, and systemic immunosuppression.
Pilot Study of Videos to Deliver Mindfulness-Based Art Therapy for Adults With Multiple Sclerosis
Authors: Newland Pamela , Miller Rebecca , Bettencourt B. Ann , Hendricks-Ferguson Verna 
Published: October 2020

ABSTRACT

BACKGROUND: Mindfulness-based art therapy (MBAT) has been shown to provide a strategy for adults with multiple sclerosis (MS) to self-manage their symptoms. There is a need for the use of an MBAT intervention that can be delivered in any setting for adults with MS. The purpose of this pilot feasibility study was to test the feasibility and acceptability of an MBAT intervention delivered via videoconference. METHODS: We developed an MBAT intervention to be delivered by videoconference to adults with MS recruited from an academic center registry. We also conducted phone interviews to collect acceptability data. RESULTS: Most of the participants (n = 5) were very positive about the MBAT video sessions and stated content as clear and easy to follow and understand. The time and delivering method were acceptable. CONCLUSION: Mindfulness-based art therapy sessions delivered through videoconference are acceptable and feasible for adults with MS.
Caregiver Burden and Associated Factors Among Informal Caregivers of Stroke Survivors
Authors: Achilike Saviour , Beauchamp Jennifer E. S. , Cron Stanley G. , Okpala Munachi , Payen Samuel S. , Baldridge Lyric , Okpala Nnedinma , Montiel Tahani Casameni , Varughese Tina , Love Mary , Fagundes Christopher , Savitz Sean , Sharrief Anjail 
Published: October 2020

ABSTRACT

BACKGROUND: Informal caregiving of stroke survivors often begins with intensity compared with the linear caregiving trajectories in progressive conditions. Informal caregivers of stroke survivors are often inadequately prepared for their caregiving role, which can have detrimental effects on their well-being. A greater depth of understanding about caregiving burden is needed to identify caregivers in most need of intervention. The purpose of this study was to examine caregiver burden and associated factors among a cohort of informal caregivers of stroke survivors. METHODS: A cross-sectional study of 88 informal caregivers of stroke survivors was completed. Caregiver burden was determined with the Zarit Burden Interview, caregiver depressive symptoms were measured with the Patient Health Questionnaire-9, and stroke survivor functional disability was assessed with the Barthel Index. Ordinal logistic regression was used to identify independent factors associated with caregiver burden. RESULTS: Forty-three informal caregivers (49%) reported minimal or no caregiver burden, 30 (34%) reported mild to moderate caregiver burden, and 15 (17%) reported moderate to severe caregiver burden. Stroke survivor functional disability was associated with informal caregiver burden (P = .0387). The odds of having mild to moderate caregiver burden were 3.7 times higher for informal caregivers of stroke survivors with moderate to severe functional disability than for caregivers of stroke survivors with no functional disability. The presence of caregiver depressive symptoms was highly correlated with caregiver burden (P < .001). CONCLUSION: Caregivers of stroke survivors with functional disabilities and caregivers experiencing depressive symptoms may have severer caregiver burden. Trials of interventions aimed at decreasing informal caregiver burden should consider the potential impact of stroke survivors' functional disability and the presence of depressive symptoms.
“Mushroom” Autologous Partial Ossicular Replacement Prosthesis: Long-term Results
Authors: Malhotra Manu , Priya Madhu , Bhardwaj Abhishek , Tyagi Amit Kumar , Kumar Amit , Varshney Saurabh , Malhotra Rashmi 
Published: October 2020

Objective:
Evaluate a new autologous mushroom-shaped cortical bone partial ossicular replacement prosthesis (MPORP) for cost-effective and sustainable hearing results.

Study Design:
Prospective study.

Setting:
Tertiary care center.

Patients:
Forty-two patients suffering from chronic otitis media with intact superstructure of the stapes and partially or completely eroded incus.

Interventions:
Group-1 (n = 24) underwent only tympanoplasty with MPORP; group-2 (n = 18) underwent intact canal wall mastoidectomy (ICW) with MPORP.

Main Outcome Measures:
Hearing results were evaluated using a four frequency average (measured at 0.5, 1, 2, 3 kHz) pure tone air conduction (PTA), air-bone gap (ABG), and word recognition scores (WRS) after 3, 6, and 12 months and compared with preoperative results.

Results:
Overall, successful rehabilitation of ABG to 20 dB or less was achieved in 92% of patients. Mean postoperative ABG was 15.35 ± 4.18 dB showing mean improvement of 23.89 ± 5.95 dB. In group-1, mean postoperative ABG was 18.47 ± 3.65 dB, showing an improvement of 25.92 ± 5.3 dB. In group-2, mean postoperative ABG was 18.47 ± 3.65 dB showing an improvement of 20.14 ± 4.96 dB. Hearing improvement in all the cases together and both the groups checked separately was statistically significant (paired t test, p < 0.001). Group 1 had, on average, 5 dB better hearing than group 2 (unpaired t test, p > 0.05).

Conclusion:
The MPORP is obtainable from the local site, easily constructed, bio-compatible, cost-effective, less bulky, adequately rigid for sound transmission, magnetic resonance imaging (MRI) compatible, and provides sustainable hearing gain because it has better chances of integration with the head of stapes.
Using Digital Storytelling to Reduce Unplanned Health Care Encounters
Authors: Lacey Susan R. , Craighead Debra V. 
Published: October 2020

Background:
There is a growing body of literature establishing digital storytelling as an efficacious strategy to improve hypertension outcomes. The purpose of this nurse-led project was to explore the use of digital storytelling to reduce unplanned health care encounters and to determine whether the approach was feasible.

Problem:
Half of adults in the United States have hypertension. However, only 1 in 4 has his or her condition under control. In addition, the annual economic burden is more than $51 billion.

Approach:
Digital storytelling was employed with residents in northeast Louisiana. Videos of individuals with well-managed hypertension shared success stories with less well-managed individuals over a 16-month long program.

Outcomes:
The study found that 55 (93%) of listeners had no unplanned provider visits, 57 (94.9%) had no emergency department room visits, and 57 (94.9%) were not hospitalized over the study period.

Conclusions:
Digital storytelling reduced unplanned encounters, and the program was deemed feasible.