bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Postsurgical Scars Between Vegan and Omnivore Patients
Authors: Fusano Marta , Fusano Isabella , Galimberti Michela Gianna , Bencini Matelda , Bencini Pier Luca 
Published: August 2020

BACKGROUND
Postsurgical skin healing can result in different scars types, ranging from a fine line to pathologic scars, in relation to patients' intrinsic and extrinsic factors. Although the role of nutrition in influencing skin healing is known, no previous studies investigated if the vegan diet may affect postsurgical wounds.

OBJECTIVE
The aim of this study was to compare surgical scars between omnivore and vegan patients.

METHODS AND MATERIALS
This is a prospective observational study. Twenty-one omnivore and 21 vegan patients who underwent surgical excision of a nonmelanoma skin cancer were enrolled. Postsurgical complications and scar quality were evaluated using the modified Scar Cosmesis Assessment and Rating (SCAR) scale.

RESULTS
Vegans showed a significantly lower mean serum iron level (p < .001) and vitamin B12 (p < .001). Wound diastasis was more frequent in vegans (p = .008). After 6 months, vegan patients had a higher modified SCAR score than omnivores (p < .001), showing the worst scar spread (p < .001), more frequent atrophic scars (p < .001), and worse overall impression (p < .001).

CONCLUSION
This study suggests that a vegan diet may negatively influence the outcome of surgical scars.
Is Opioid Use Safe in Women Trying to Conceive?
Authors: Flannagan Kerry S. , Mumford Sunni L. , Sjaarda Lindsey A. , Radoc Jeannie G. , Perkins Neil J. , Andriessen Victoria C. , Zolton Jessica R. , Silver Robert M. , Schisterman Enrique F. 
Published: August 2020

Background:
Opioids are commonly prescribed to women of reproductive age, including after delivery and miscarriage. However, to our knowledge, opioid use has not been frequently studied in relation to the common reproductive complications of impaired fecundability and pregnancy. We examined the association of opioid use during the critical window of pregnancy establishment with fecundability and pregnancy loss.

Methods:
We measured opioid use by urine screening and self-report at multiple time points during preconception and early pregnancy in a prospective cohort of women attempting conception (n = 1228). The main outcomes included time to hCG-detected pregnancy and incidence of live birth and pregnancy loss. We estimated fecundability odds ratios and risk ratios (RR) with 95% confidence intervals (CI) adjusting for sociodemographic characteristics, reproductive characteristics, and use of antidepressants, tobacco, alcohol, and marijuana.

Results:
Prevalence of preconception opioid use was 18% (n = 226 of 1228), and in early pregnancy was 5% (n = 33 of 685). Opioid use while attempting pregnancy was associated with reduced fecundability (fecundability odds ratios: 0.71; 95% CI = 0.50, 1.0). Risk of pregnancy loss increased as opioid exposure was detected later in gestation, from the beginning of the cycle of conception (RR: 1.5; 95% CI 0.85, 2.6), to week 4 of pregnancy (RR: 2.1; 95% CI = 1.1, 4.1), and to week 4 and 8 of pregnancy (RR: 2.5; 95% CI = 1.3, 5.0).

Conclusions:
Our results are consistent with the hypothesis that opioid exposure while trying to conceive may be harmful, even among healthy, non-opioid-dependent women. Possible risks to fecundability and pregnancy viability are relevant to patients and providers when evaluating pain management approaches.
Advances in abortion care technology and management
Authors: Peterson Sarah F. , Lerma Klaira 
Published: August 2020

Purpose of review
To review emerging evidence specific to abortion care, including diagnostic testing and pain management.

Recent findings
Recent advances in abortion care include improvements in gestational age dating, Rh status testing, and pain management methods. When ultrasound technology is available, the use of crown-rump length (CRL)-based dating is more accurate up to 13 weeks and composite CRL and biometry between 13 and 14 weeks. Evidence supports using updated fetal foot length-to-gestational age reference ranges for postprocedure gestational age confirmation. Serum tests for two placental proteins, pregnancy-associated plasma protein A and a disintegrin and metalloproteinase 12, show potential for identifying pregnancies with gestational age more than 70 days. Early research using flow cytometry demonstrates that fetal RBC exposure after first-trimester uterine aspiration is insufficient to cause maternal Rh-sensitization, supporting elimination of Rh testing and anti-D-immunoglobulin provision prior to 8 weeks gestation. Recent studies exploring pain management strategies have not generated a standardized approach. Auricular acupuncture appears to be promising.

Summary
Emerging data on improvements in gestational age dating and eliminating laboratory testing prior to early abortion procedures could have important implications for expanding access to early abortion care and telemedicine. Person-centered, novel pain management modalities, such as auricular acupuncture, help to improve client experience, by addressing both pain and anxiety.
Why Won't Emergency Physicians Discharge Patients With a Low HEART Score From an Observation Unit Without Further Evaluation?
Authors: Pena Margarita , Tsao Joseph , Falaiye Tunde , Kazan Viviane , Li Mitchell , Daouk Fadi , Pearson Claire 
Published: August 2020

Background:
The History, Electrocardiogram, Age, Risk Factors, Troponin (HEART) score is a prospectively validated risk stratification tool for patients presenting to the emergency department (ED) with chest pain. Data demonstrate that patients with low HEART scores (0–3) can be safely discharged from the ED. ED physicians, however, may be reluctant to discharge patients based on the score.

Objective:
To identify specific factors why ED physicians are reluctant to discharge patients with low-risk HEART scores from an ED observation unit (EDOU) without further evaluation.

Methods:
This was a single-center prospective, cross-sectional analysis of ED patients from an urban ED placed in an EDOU for evaluation of chest pain, from July 1, 2016, to August 31, 2016. ED physicians completed a questionnaire that included documentation of patient HEART score and if the patient would or would not be a good candidate for outpatient stress testing or follow-up within 72 hours without further EDOU testing or consultant evaluation. Providers selected reasons why patients were not a good candidate for outpatient stress testing/follow-up.

Results:
There were 279 patient questionnaires completed, 42% (117/279) had a HEART score of 0–3. Within this group, 54.7% (64/117) of the patients were identified as not being good candidates for outpatient stress testing/follow-up within 72 hours because of concerns for poor follow-up (n = 14), concerning risk factors (n = 14), concerning symptoms (n = 11), and other (n = 7).

Conclusions:
ED physicians in this urban ED felt that over half of patients with a low-risk HEART score were not good candidates for discharge from the EDOU without further evaluation due to poor follow-up, concerning risk factors or symptoms, or coexisting conditions.
Concussion Symptom Treatment and Education Program: A Feasibility Study
Authors: Simpson Tess S. , Peterson Robin L. , Patrick Kristina E. , Forster Jeri E. , McNally Kelly A. 
Published: August 2020

Objective:
To evaluate the feasibility and potential benefits of a manualized, brief cognitive-behavioral therapy–based intervention program for children and adolescents with persistent postconcussive symptoms.

Setting:
Two outpatient pediatric concussion programs in the United States.

Participants:
Patients aged 8 to 17 years who sustained concussions between 2 and 12 months prior to enrollment.

Design:
Pre-/postretrospective study.

Main Measures:
SCAT-3; HBI; PedsQL 4.0 Generic Core Scales; and RCADS.

Results:
Thirty children and adolescents completed the treatment program. Self- and parent-reported postconcussive symptoms, quality of life, and internalizing symptoms significantly improved with treatment. Mixed-effects models revealed a significant decline in self-reported postconcussive symptoms across treatment sessions, a = −2.07, SE = 0.25, P < .001. The largest change occurred between sessions 2 and 3, following the session focusing on concussion psychoeducation and sleep hygiene (estimated mean change between sessions 2 and 3 = −4.72, P < .0001).

Conclusions:
Our findings indicate that a 6-session manualized cognitive behavioral intervention is feasible to initiate in an outpatient clinic 1 to 12 months following a pediatric mild traumatic brain injury. With a manualized format, clinicians at most levels of training should be able to implement this treatment manual and flexibly adapt as needed when working with children and adolescents who are experiencing delayed symptom recovery following concussion.
Predictors of Intervention Adherence in Compensatory Cognitive Training for Veterans With a History of Mild Traumatic Brain Injury
Authors: Mahmood Zanjbeel , Clark Jillian M. R. , Jak Amy J. , Huckans Marilyn , O'Neil Maya E. , Roost Mai S. , Williams Rhonda M. , Pagulayan Kathleen F. , Turner Aaron P. , Storzbach Daniel , Twamley Elizabeth W. 
Published: August 2020

Objective:
The purpose of this study was to determine modifiable predictors of intervention adherence in a study of group-based Compensatory Cognitive Training (CCT) for Iraq/Afghanistan War veterans with a history of mild traumatic brain injury (mTBI).

Methods:
One hundred twenty-three veterans enrolled in a randomized controlled trial of a 10-week CCT intervention (54 assigned to CCT) and were evaluated at baseline, 5 weeks, 10 weeks, and 15 weeks. CCT adherence was determined by the number of CCT sessions attended, with more sessions indicative of greater adherence. Baseline demographic and clinical characteristics, and subjective and objective neuropsychological performance, were examined in relation to CCT session attendance.

Results:
Older age and worse attention performance at baseline were associated with higher CCT attendance rates.

Conclusions:
This study generates preliminary evidence for potential modifiable neuropsychological factors that may improve engagement in CCT interventions.
The Search for Antifungal Prophylaxis After Artificial Corneal Surgery—An In Vitro Study
Authors: Kim Sarah , Bispo Paulo J. M. , Tanner Eden E. L. , Mitragotri Samir , e Silva Rafaella N. , Gipson Ilene , Chodosh James , Behlau Irmgard , Paschalis Eleftherios I. , Gilmore Michael S. , Dohlman Claes H. 
Published: August 2020

Purpose:
To evaluate the antifungal properties of topical antibiotics (already being used successfully to prevent bacterial endophthalmitis) and some promising antiseptics for antifungal prophylaxis in the setting of artificial corneal implantation.

Methods:
Several commonly used antibiotics for antimicrobial prophylaxis after artificial corneal implantation, in addition to antiseptics [benzalkonium chloride (BAK), povidone-iodine (PI), and some ionic liquids (ILs)], were tested in vitro against Candida albicans, Fusarium solani, and Aspergillus fumigatus. The time–kill activity was determined. Toxicity was assayed in vitro on human corneal epithelial cultures using trypan blue. Adhesion and tissue invasion experiments were also carried out on porcine corneas and commonly used contact lenses, with or without gamma irradiation, and by analysis with fluorescence microscopy.

Results:
Polymyxin B (PMB)/trimethoprim/BAK (Polytrim), PMB alone, gatifloxacin with BAK (Zymaxid), and same-concentration BAK alone exhibited antifungal activity in vitro. Moxifloxacin (MOX) or gatifloxacin without BAK—as well as trimethoprim, vancomycin, and chloramphenicol—had no effect. 1% PI and ILs had the highest efficacy/toxicity ratios (>1), and Polytrim was species dependent. Subfungicidal concentrations of Polytrim reduced adhesion of C. albicans to Kontur contact lenses. Gamma-irradiated corneas showed enhanced resistance to fungal invasion.

Conclusions:
Of antibiotic preparations already in use for bacterial prophylaxis after KPro surgery, Polytrim is a commonly used antibiotic with antifungal effects mediated by both PMB and BAK and may be sufficient for prophylaxis. PI as a 1% solution seems to be promising as a long-term antifungal agent. Choline-undecanoate IL is effective and virtually nontoxic and warrants further development.
Diagnostic Value of Corneal Epithelial and Stromal Thickness Distribution Profiles in Forme Fruste Keratoconus and Subclinical Keratoconus
Authors: Toprak Ibrahim , Vega Alfredo , Alió del Barrio Jorge L. , Espla Elias , Cavas Francisco , Alió Jorge L. 
Published: August 2020

Purpose:
To assess the diagnostic values of corneal epithelial and stromal thickness distribution characteristics in forme fruste keratoconus (FFKC) and subclinical keratoconus (KC).

Methods:
This cross-sectional study was conducted at VISSUM Innovation and Miguel Hernandez University, Alicante, Spain. Twenty-seven eyes (27 subjects) with FFKC, 50 eyes (50 subjects) with subclinical KC with a best spectacle corrected distance visual acuity ≥20/20 (Snellen) (grade zero KC according to the Red Temática de Investigación Cooperativa en Salud classification), and 66 control eyes (66 subjects) were included. Epithelial and stromal thicknesses and epithelium/stroma (E/S) thickness ratio at center, thinnest point, 5-, and 8-mm circles obtained from the MS-39 device (CSO, Firenze, Italy) were compared among the control, FFKC, and subclinical KC groups.

Results:
The FFKC group had thinner 8-mm superior-nasal epithelium and higher central E/S ratio compared with the control group (P < 0.05). In the subclinical KC group, the E/S ratios in the 5-mm temporal and superior zones were higher than those in the control group (P < 0.05). The FFKC and subclinical KC groups had thinner stroma compared with the control group (P < 0.05). A two-parameter formula correctly classified 94% of the eyes with subclinical KC and 98.5% of the normals, whereas another three-parameter model had 75% sensitivity and 94.3% specificity for discriminating FFKC from normals.

Conclusions:
This study identified different epithelial distributional and behavioral patterns in eyes with FFKC and subclinical KC. Eyes with FFKC seem to have increased central E/S ratio and asymmetric superior-nasal epithelial thinning, whereas keratometric and volumetric alterations seem to be more prominent in subclinical KC.
The Effects of Trabecular Bypass Surgery on Conventional Aqueous Outflow, Visualized by Hemoglobin Video Imaging
Authors: Lusthaus Jed A. , Meyer Paul A.R. , Khatib Tasneem Z. , Martin Keith R. 
Published: August 2020

Precis:
Hemoglobin Video Imaging (HVI) provides a noninvasive method to quantify aqueous outflow (AO) perioperatively. Trabecular bypass surgery (TBS) is able to improve, and in some cases re-establish, conventional AO.

Purpose:
The purpose of this study was to use HVI to illustrate and quantify effects of TBS on AO through the episcleral venous system.

Design:
This is a prospective observational cohort study.

Participants:
Patients were recruited from Sydney Eye Hospital, Australia. The study included 29 eyes from 25 patients, 15 with glaucoma and 14 normal controls. TBS (iStent Inject) was performed on 14 glaucomatous eyes (9 combined phacoemulsification/TBS and 5 standalone TBS). Cataract surgery alone was performed on the remaining eye from the glaucoma group and 2 eyes from the control group.

Methods:
We used HVI, a novel clinic-based tool, to visualize and quantify AO perioperatively during routine follow-up to 6 months. Angiographic blood flow patterns were observed within prominent aqueous veins on the nasal and temporal ocular surface. Aqueous column cross-section area (AqCA) was compared before and after surgery.

Main Outcome Measures:
AqCA, number of aqueous veins, intraocular pressure (IOP) before and after surgery, and number of IOP-lowering medications.

Results:
Patients with glaucoma had reduced AqCA compared with normal controls (P=0.00001). TBS increased AqCA in 13 eyes at 1 month (n=14; P<0.002), suggesting improved AO. This effect was maintained at 6 months in 7 eyes (n=9, P≤0.05). All patients with unrecordable AO before surgery (n=3; 2 standalone TBS, 1 combined cataract/TBS) established measurable flow after TBS. IOP and/or medication burden became reduced in every patient undergoing TBS. Cataract surgery alone (n=3) increased AqCA in nasal and temporal vessels at 4 weeks after surgery.

Conclusions:
HVI provides a safe method for detecting and monitoring AO perioperatively in an outpatient setting. Improvement of AO into the episcleral venous system is expected after TBS and can be visualized with HVI. TBS is able to improve, and in some cases re-establish, conventional AO. Cataract surgery may augment this. Some aqueous veins were first seen after TBS and these patients had unstable postoperative IOP control, which possibly suggests reorganization of aqueous homeostatic mechanisms. HVI may confirm adequacy of surgery during short-term follow-up, but further work is required to assess the potential of HVI to predict surgical outcomes and assist with personalized treatment decisions.
Is Netrin-1 Deficiency Responsible for Inflammation and Systemic Diseases Related to Pseudoexfoliation?
Authors: Okutucu Murat , Findik Hüseyin , Aslan Mehmet Gökhan , Arpa Medeni 
Published: August 2020

Precis:
Serum netrin-1 levels are significantly lower in patients with pseudoexfoliation syndrome (PES) and pseudoexfoliative glaucoma (PEG) compared with the control group.

Purpose:
To investigate serum netrin-1 levels in PES and PEG patients and to determine the relevance of this molecule in the etiopathogenesis of PES-related and PEG-related diseases.

Materials and Methods:
This prospective study included 29 PES and 17 PEG patients in the study groups and age-sex matched 47 cataract patients without pseudoexfoliative accumulation as a control group. Serum netrin-1 levels were measured by enzyme-linked immunosorbent assay.

Results:
Serum netrin-1 level was significantly lower in the PES and PEG groups compared with the control group (P=0.007). Multinominal logistic regression analysis was performed in terms of netrin-1 levels ≤712.9 pg/mL, >712.9 pg/mL and sex which may affect PES and PEG. It were found that netrin-1 was a significant negative predictor for PES (odds ratio, 3.45; 95% confidence interval, 1.230-9.716; P=0.019) and PEG (odds ratio, 3.57; 95% confidence interval, 1.008-12.669; P=0.049), respectively.

Conclusions:
Decreased serum netrin-1 levels were detected in PES and PEG patients, similar to atherosclerosis and Alzheimer disease. Inflammation lays behind in the common pathogenesis of these diseases. Therefore, netrin-1 promises a potential anti-inflammatory role.
The Relationship Between Asymmetries of Corneal Properties and Rates of Visual Field Progression in Glaucoma Patients
Authors: Estrela Tais , Jammal Alessandro A. , Mariottoni Eduardo B. , Urata Carla N. , Ogata Nara G. , Berchuck Samuel I. , Medeiros Felipe A. 
Published: August 2020

Précis:
In this study, asymmetries in corneal hysteresis (CH) between eyes of glaucoma patients were significantly associated with asymmetries in rates of visual field loss, suggesting a role of hysteresis as a risk factor for disease progression.

Purpose:
The purpose of this study was to investigate the relationship between asymmetries in rates of glaucoma progression and asymmetries of corneal properties between eyes of subjects with primary open-angle glaucoma.

Participants and Methods:
This prospective study followed 126 binocular subjects with glaucoma for an average of 4.3±0.8 years. CH was measured at baseline using the Ocular Response Analyzer. Standard automated perimetry (SAP) and intraocular pressure were measured at baseline and every 6 months. Rates of visual field progression were calculated using ordinary least square regression of SAP mean deviation (MD) values over time for each eye. Eyes were defined as “better” and “worse” based on the slopes of SAP MD. Pearson correlation test, and univariable and multivariable regression models were used to investigate the relationship between inter-eye asymmetry in CH and central corneal thickness and inter-eye differences in rates of visual field progression.

Results:
Only asymmetry of CH was significantly associated with the asymmetry in SAP MD rates of change between eyes (r=0.22; P=0.01). In a multivariable model adjusting for age, race, central corneal thickness, mean intraocular pressure and baseline disease severity, CH asymmetry remained significantly associated with asymmetric progression (P=0.032).

Conclusion:
CH asymmetry between eyes was associated with asymmetry on rates of visual field change, providing further support for the role of CH as a risk factor for glaucoma progression.
Factors Associated With Unqualified Success After Trabecular Bypass Surgery: A Case-control Study
Authors: Paletta Guedes Ricardo A. , Gravina Daniela M. , Paletta Guedes Vanessa M. , Chaoubah Alfredo 
Published: August 2020

Precis:
An older age, a low number of baseline glaucoma medications, an early glaucoma stage, lower intraocular pressure (IOP) values during the first postoperative month, and combined surgery are possible predictors of unqualified success after a trabecular by-pass microinvasive glaucoma surgery (MIGS) procedure.

Purpose:
The purpose of this study was to identify the potential predictors of unqualified success (IOP<18 mm Hg with no glaucoma medication) after trabecular by-pass MIGS.

Materials and Methods:
We designed a case-control study using logistic regression modeling that included all trabecular by-pass surgeries with at least 3 months of follow-up, performed at a single center from June 2017 to December 2019. Eyes that achieved an endpoint of unqualified success (dependent variable) were considered cases. All other eyes were used as the controls. Cases and controls were paired by sex and postoperative time. We tested the following independent variables: age, race, laterality (right eye or left eye), glaucoma stage, type of surgery (combined or stand-alone), type of trabecular bypass, intraoperative complications, baseline number of medications, baseline IOP, and postoperative IOP on days 1, 15, and 30. Additional analysis using IOP <15 mm Hg as a threshold and including eyes with at least 12 months of follow-up were performed.

Results:
One hundred ninety-four eyes were included in the analysis. We observed complete success in 56.7% of eyes. The mean follow-up time for the entire population was 12.3±6.8 months. All variables were considered in the first step of the modeling process; however, only age, day-15 IOP, day-30 IOP, baseline number of medications, glaucoma stage, and type of surgery remained until the completion of our model, with adequate significance (P<0.05). The additional analysis confirmed our results.

Conclusion:
We identified that an older age, a low number of baseline glaucoma medications, an early glaucoma stage, lower IOP values during the first postoperative month, and combined surgery were associated with a higher chance of unqualified success at 12 months after a trabecular by-pass MIGS procedure.