bluuebunny/crossref_metadata_2025_split huggingface dataset:
Simulation Versus Interactive Mobile Learning for Teaching Extracorporeal Membrane Oxygenation to Clinicians: A Randomized Trial
Authors: Gannon Whitney D. , Stokes John W. , Pugh Meredith E. , Bacchetta Matthew , Benson Clayne , Casey Jonathan D. , Craig Lynne , Semler Matthew W. , Shah Ashish S. , Troutt Ashley , Rice Todd W. 
Published: October 2021

OBJECTIVES:
Extracorporeal membrane oxygenation has become integral to critical care. Data informing optimal extracorporeal membrane oxygenation education modalities are lacking. We aimed to compare the effect of high-fidelity simulation versus interactive mobile learning on extracorporeal membrane oxygenation knowledge acquisition and retention among clinicians.

DESIGN:
Observer-blinded, randomized controlled trial.

SETTING:
A single academic medical center.

SUBJECTS:
Forty-four critical care clinicians with limited extracorporeal membrane oxygenation experience.

INTERVENTIONS:
Participants were randomized to receive: 1) simulation: three high-fidelity training scenarios, 2) QuizTime: 15 total multiple-choice questions delivered over 3 weeks via mobile device, or 3) experiential: no formal training. Participants completed a survey, written knowledge examination, and simulation assessment prior to randomization, immediately following the intervention, and 4 month postintervention.

MEASUREMENTS AND MAIN RESULTS:
The primary outcome was knowledge about extracorporeal membrane oxygenation assessed by score on the immediate postintervention written examination. Secondary outcomes included performance in extracorporeal membrane oxygenation simulation postintervention and 4 months later assessed by a rater blinded to group assignment. Clinicians randomized to simulation (n = 15), QuizTime (n = 14), and experiential (n = 15) had similar baseline characteristics. Adjusting for baseline knowledge, postintervention examination scores were higher in the simulation group (90.0%; interquartile range, 85.0–90.0%) than the QuizTime group (70.0%; interquartile range, 65.0–80.0%; p = 0.0003) and the experiential group (75.0%; interquartile range, 65.0–80.0%; p = 0.001). Scores did not differ between the groups at 4 months (p > 0.05 in all analyses). In postintervention extracorporeal membrane oxygenation simulations, the simulation group demonstrated shorter time to critical action compared with QuizTime (80.0 s [interquartile range, 54.0–111.0 s] vs 300.0 s [interquartile range 85.0–300.0 s]; p = 0.02) and compared with both QuizTime (45.0 s [interquartile range, 34.0–92.5 s] vs 255.5 s [interquartile range, 102.0–300.0 s]; p = 0.008) and experiential (300.0 s [interquartile range, 58.0–300.0 s]; p = 0.009) at 4 months.

CONCLUSIONS:
Simulation was superior to QuizTime and experiential learning with regard to extracorporeal membrane oxygenation knowledge acquisition. Further studies are needed to ascertain the effect of these interventions on knowledge retention, clinical performance, and patient outcomes.
Prevalence and Characteristics of Dupilumab-Induced Ocular Surface Disease in Adults With Atopic Dermatitis
Authors: Felfeli Tina , Georgakopoulos Jorge R. , Jo Christine E. , Mimouni Michael , Piguet Vincent , Drucker Aaron M. , Yeung Jensen , Chan Clara C. 
Published: October 2021

Purpose:
Dupilumab-induced ocular surface disease (DIOSD) is a common reaction among patients treated for atopic dermatitis. This study aimed to identify the clinical characteristics, associated risk factors, treatment strategies, and long-term outcomes of DIOSD.

Methods:
We conducted a multicenter retrospective cohort study of consecutive adult outpatients treated with dupilumab for moderate-to-severe atopic dermatitis from 2017 through 2021 at 2 tertiary care centers. We used stepwise multivariable logistic regression to assess the association between patient characteristics and development of DIOSD.

Results:
Among 210 patients treated with dupilumab, 37% (n = 78) developed DIOSD over the 52-week follow-up period. Vision-threatening complications including corneal scarring and cicatricial ectropion were noted in 1% (n = 3) of patients. Clinical features were blepharoconjunctivitis (68%, n = 53), burning/stinging/dryness (14%, n = 29), epiphora (13%, n = 10), pruritus (13%, n = 10), blurred vision (3%, n = 2), and photophobia (1%, n = 1). DIOSD was associated with a history of asthma (odds ratio: 2.94, 95% confidence interval: 1.26–6.87, P = 0.01) and a family history of atopic dermatitis (odds ratio: 2.58, 95% confidence interval: 1.08–6.17, P = 0.03). Interventions were initiated for 63% of patients with DIOSD, with artificial tears (56%) and corticosteroid drops (29%) most commonly used. Dupilumab was discontinued because of DIOSD in 4% of patients.

Conclusions:
DIOSD is a common adverse event that is usually mild but may lead to treatment interruption and vision-threatening complications. A personal history of asthma and family history of atopic dermatitis may be associated with a higher risk of developing DIOSD.
Clinical Utility of COVID-19 Real Time-Polymerase Chain Reaction Testing of Ocular Tissues of Non–COVID-19 Cornea Donors Deemed Suitable for Corneal Retrieval and Transplantation
Authors: Chaurasia Sunita , Rudraprasad Dhanwini , Senagari Jalandhar Reddy , Reddy Sunitha Linga , Kandhibanda Srinivas , Mohamed Ashik , Basu Sayan , Garg Prashant , Joseph Joveeta 
Published: October 2021

Purpose:
The purpose of this study was to evaluate the prevalence of SARS-CoV-2 in human postmortem ocular tissues of asymptomatic donors and its implications on our eye banking protocols.

Methods:
The expression of SARS-CoV-2 RNA was assessed by reverse transcription–polymerase chain reaction in corneal rims and conjunctival tissues from 100 donors who were found suitable for transplantation as per the donor screening guidelines of the Global Alliance of Eye Bank Associations. The donor's clinical history and cause of death were assessed for secondary analysis.

Results:
Of 200 ocular tissues (100 corneal and 100 conjunctival) from the same 1 eye of 100 surgical-intended donors, between September 2020 and April 2021, the overall positivity rate for SARS-CoV-2 was ∼1% (2/200). Both the ocular samples that tested positive were conjunctival biopsies (2/100, 2%), whereas corneal samples were negative (0/100, 0%) in both donors. The causes of donor death were trauma in 51 donors, suicide in 33, cardiac arrest in 7, electric shock in 5, metabolic cause in 2, malignancy in 1, and snake bite in 1. None of the donors had a medical history suggestive of COVID infection or possible contact. None of the recipients from the donors were reported to have any systemic adverse event after keratoplasty until the follow-up of 6 weeks.

Conclusions:
The overall prevalence of SARS-CoV-2 was 1% (2% for conjunctival and 0% for corneal samples, P value = 0.5) in the donors who were found suitable for cornea recovery and transplantation. The findings of exceptionally low positive rates in our samples validate the criticality of history-based donor screening and do not support the necessity of postmortem PCR testing as a criterion for procurement and subsequent use for corneal transplantation.
Diabetes Mellitus and Keratoconus: A Systematic Review and Meta-Analysis
Authors: Dong Xing-Xuan , Liu Kai-Fan , Zhou Miao , Liang Gang , Pan Chen-Wei 
Published: October 2021

Purpose:
Although previous studies have assessed the relationship between diabetes and keratoconus, the findings were controversial and warranted further clarifications. The objective of this study was to investigate the association between diabetes and keratoconus by conducting a systematic review and meta-analysis.

Methods:
A comprehensive literature search was performed to identify eligible studies reporting the association of diabetes with keratoconus from their inception to April 2021 through PubMed, Embase, and Web of Science. The quality of included studies was assessed using the Newcastle–Ottawa scale. Combined odds ratios (ORs) and 95% confidence intervals were calculated using a random-effects model.

Results:
In all, 8 case–control studies and 3 cohort studies reporting the association between diabetes and keratoconus were included in the meta-analysis. Diabetes was not associated with keratoconus in the overall analysis (combined OR = 0.85, 95% confidence interval: 0.66–1.10). The associations were found to be nonsignificant in subgroup analysis when stratified by study quality, design, source, types, and population. No publication bias was detected from either the Egger test (P = 0.46) or Begg test (P = 0.16). Sensitivity analysis revealed that differences between groups were not statistically significant.

Conclusions:
This meta-analysis indicates that current literature does not support a significant association between diabetes and keratoconus. Further studies with more definite control for confounders and well-designed cohorts or interventions are warranted.
Therapeutic Corneal Transplantation in Acanthamoeba Keratitis: Penetrating Versus Lamellar Keratoplasty
Authors: Di Zazzo Antonio , Varacalli Giuseppe , De Gregorio Chiara , Coassin Marco , Bonini Stefano 
Published: October 2021

Purpose:
The purpose of this article was to compare clinical outcomes between therapeutic penetrating keratoplasty (TPK), therapeutic deep anterior lamellar keratoplasty (TDALK), and optical penetrating keratoplasty (OPK) in Acanthamoeba keratitis.

Methods:
A literature search was conducted in online libraries from 1980 to 2021. The primary end points were best-corrected visual acuity (VA), graft survival, and infection recurrence. In addition, we enrolled 35 consecutive patients with AK from our practice evaluating best-corrected VA and high-order aberrations.

Results:
A total of 359 AK eyes from 33 published studies were retrieved from 175 publications screened. One hundred sixty-five eyes (73%) that underwent TPK and 39 eyes (84%) treated with TDALK had a clear graft at the last follow-up visit. Only the patients treated with OPK had 82 clear grafts (94%) during the follow-up period. Forty-seven (21%) of TPK patients reached VA ≥20/30, compared with 11 (25%) of TDALK patients and 35 (40%) of OPK patients. Acanthamoeba infection recurrence occurred in 38 eyes (16.8%) that underwent TPK, 9 (19%) that underwent TDALK, and 8 (9.5%) that underwent OPK. In our series, best-corrected visual acuity in nonsurgically treated patients was 1 ± 0.50 logMAR compared with 0 logMAR of surgically treated patients. High-order aberrations were significantly lower in surgically treated eyes after AK resolution, particularly in TDALK when compared with TPK patients. Best-corrected visual acuity was better in TDALK patients compared with TPK patients.

Conclusions:
After AK resolution by 6 to 12 months of medical treatment, OPK seems to be the best surgical choice in patients with AK. If AK could not be eradicated by medical therapy, TDALK may be chosen in the early disease stage and TPK in later stages.
Late-Onset Nontuberculous Mycobacterial Keratitis After Small Incision Lenticule Extraction
Authors: Wan Kelvin H. , Lam Julia T. W. , Lam Nai Man , Chow Vanissa W. S. 
Published: October 2021

Purpose:
The purpose of this article was to report a case of unilateral late-onset nontuberculous mycobacterial keratitis after small incision lenticule extraction (SMILE).

Methods:
This was a case report.

Results:
A 27-year-old woman presented with Mycobacterium chelonae keratitis 3 weeks after uncomplicated SMILE with a solitary interface infiltrate. The keratitis worsened after an initial response to topical fortified and interface antibiotic irrigation. Despite repeated interface irrigation and topical and oral antibiotics, progressive, diffuse stromal infiltrates followed by melting of the cap ensued over the next 6 weeks. Cap amputation and intrastromal antibiotic injection followed by prolonged topical and oral antibiotics usage for the following 5 weeks led to infiltrate resolution and re-epithelization of the residual stromal bed. All medications were tapered off over 6 months after initial presentation without recurrence, but anterior stromal scarring and corneal neovascularization persisted.

Conclusions:
Cap amputation and intrastromal antibiotic injection for intractable post-SMILE keratitis can prevent the need for therapeutic keratoplasty.
Acute Corneal Transplant Rejection After Severe Acute Respiratory Syndrome Coronavirus 2 mRNA-1273 Vaccination
Authors: Yu Suyeon , Ritterband David C. , Mehta Isha 
Published: October 2021

Purpose:
The purpose of this article was to report a case of full-thickness corneal transplant rejection 3 days after immunization with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Moderna mRNA-1273 vaccine.

Methods:
Case Report.

Results:
A 51-year-old man with a history of keratoconus and penetrating keratoplasty underwent repeat penetrating keratoplasty for graft failure. The patient had an uncomplicated intraoperative and postoperative course with improved vision and a healthy graft. The patient received the SARS-CoV-2 Moderna vaccine on postoperative week 3, and within 3 days, the patient began developing eye pain, photophobia, and blurred vision. The patient was found to have graft rejection with corneal edema and endothelial keratic precipitates. The rejection did not improve despite a trial of increased topical steroids and ultimately evolved into graft failure.

Conclusions:
To the best of our knowledge, this case of full-thickness graft rejection after the Moderna SARS-CoV-2 mRNA vaccination is the first to be reported worldwide. The temporal relationship between vaccination and subsequent rejection is highly suggestive of causation due to the short interval (3 days) between vaccination and rejection and the lack of other inciting factors in an otherwise healthy graft. Patients with corneal transplants who plan to take the COVID-19 vaccinations should be counseled on symptoms and closely monitored, and an individualized plan should be made in discussion with the ophthalmologist.
Importance of Corneal Angiography in Subclinical Limbitis in a Case of Atopic Keratoconjunctivitis
Authors: Romano Davide , Coco Giulia , Borgia Alfredo , Kaye Stephen B. , Romano Vito 
Published: October 2021

Purpose:
The aim of this study was to report corneal angiography features in subclinical limbitis in a patient with atopic keratoconjunctivitis.

Methods:
This is a case report.

Results:
A 22-year-old woman with a medical history of atopic keratoconjunctivitis was referred for bilateral corneal neovascularization with scarring. On examination, no signs of active disease were noticed at the slit lamp. Ocular surface angiography detected active corneal limbitis, showing as limbal leakage at fluorescein angiography in the early phase and leakage after indocyanine green angiography in the late phase. The patient was treated with topical corticosteroid. At follow-up, the fluorescein angiography and indocyanine green angiography no longer showed limbal leakage, whereas the slit lamp examination was unchanged.

Conclusions:
Active allergic corneal limbitis may present as subclinical inflammation, with no signs of activity at the slit lamp examination. Therefore, its diagnosis can be challenging without the use of corneal angiography.
Severe Infant Meningoencephalitis Caused by Salmonella Apeyeme: A Case Report
Authors: Srisingh Klaita , Srijuntongsiri Sarunya , Apiraknapanon Yasinee , Chuenkeson Tanatporn , Chinnarakbumrung Raksit , Phuaksaman Chutima 
Published: October 2021

Abstract

Salmonella enterica serovar Apeyeme is a rare pathogen that primarily affects poultry. However, there are limited data about this infection in humans. In this case, a 7-month-old infant presented with high-grade fever without diarrhea for 12 hours prior to admission. Upon admission, he developed seizures and was referred for further intervention. He was diagnosed with meningoencephalitis with complications of subdural effusion, empyema, and abscesses. Salmonella Apeyeme was found in cerebrospinal fluid culture, but no growth was detected in either blood or stool cultures. He was given meropenem, vancomycin, and ciprofloxacin, but later developed disseminated intravascular coagulation. His clinical condition deteriorated over time, and he died 18 days after admission. To conclude, Salmonella Apeyeme infection should be considered if a patient is diagnosed with meningoencephalitis and has a history of poultry exposure.
A protective effect of morning radiotherapy on acute skin toxicity in patients with breast cancer
Authors: Fuzissaki Marceila A. , Paiva Carlos E. , Oliveira Marco A. , Maia Marcelo A. , Canto Paula P.L. , Maia Yara C.P. 
Published: October 2021

Abstract
The focus of this prospective cohort study was to evaluate the risk factors of severe acute skin toxicity (grade ≥2) in 100 patients with breast cancer (BC) during radiotherapy (RT).
The patients were evaluated weekly during RT and 3 months after treatment. The endpoint included the occurrence of skin toxicity grade ≥2, according to Radiation Therapy Oncology Group (RTOG). Survival analysis was conducted by univariate and multivariate Cox regression analysis.
In the multivariate analysis, RT in the afternoon (0–3 pm) (hazard ratios [HR] = 1.566, P = .042) was significantly associated with the early occurrence of skin toxicity, indicating a potential effect of chronotherapy related to this adverse event. In the univariate and multivariate analysis, skin phototype moderate brown (HR = 1.586, P = .042; HR = 1.706, P = .022, respectively) and dark brown or black (HR = 4.517, P < .001; HR = 5.336, P < 0.001, respectively) was significantly associated with the skin toxicity. Tangential field separation >21 cm (HR = 2.550, P = .009, HR = 2.923, P = .003), in women that were submitted to conservative surgery indicates indirectly that large breast size was also significantly associated with skin toxicity.
Women with large breasts and dark brown or black skin should be followed more carefully during RT, which should be undergone in the morning, especially when submitted to conventional RT techniques, common in developing countries.
Ocular chemical burn associated with gel type alcohol-based hand sanitizer
Authors: Lee Jaekyoung , Jun Jong Hwa 
Published: October 2021

Abstract

Introduction:
Alcohol-based hand sanitizers (ABHS) are widely used for hand hygiene due to the coronavirus disease pandemic. However, risk awareness regarding its adverse effects is lacking. We aim to report a case of ocular chemical burn that showed severe clinical presentation associated with ABHS.

Patient concerns:
A 5-year-old girl presented with severe left eye pain after 62% gel-type ABHS splashed into her eye.

Diagnosis:
On slit lamp examination, a near total corneal and conjunctival epithelial defect with limbal pale on the lower half of the cornea was noted. Severe ocular burn by ABHS was prominent with suspected limbal stem cell damage.

Interventions:
She was hospitalized and was prescribed topical medications including antibiotics, steroid eye drops with preservative-free artificial tears, and oral nonsteroidal anti-inflammatory drugs.

Outcomes:
Despite intensive medical treatments, the corneal and conjunctival epithelial defects showed no improvement up to the 4th hospital day. After additional instillation of autoserum eye drops to promote epithelial healing, the corneal epithelium barely recovered from the temporal limbus. On the third week of admission, the epithelial defect was completely resolved without corneal opacity, although with minimal symblepharon in the lower fornix.

Conclusions:
Gel-type ABHS can cause severe form of ocular chemical burn such as delayed ocular surface healing. In clinical setting, immediate and thorough rinsing of alcohol-based gel and early intensive treatment are crucial.
Association between the transtheoretical model approach and sustained intradialytic pedaling exercise
Authors: Murakami Minoru , Aoki Takuya , Sugiyama Yoshifumi , Takeuchi Minori , Yui Tomoko , Koyama Miyuki , Ichikawa Yuhei , Yanagisawa Kazuki , Furuhata Shunichi , Ikezoe Masaya , Ota Tadashi , Matsushima Masato 
Published: October 2021

Abstract
The transtheoretical model (TTM) is a promising approach to the promotion of behavior change, but it remains to be established whether there is an association between the TTM approach and intradialytic exercise among patients on hemodialysis (HD) with low motivation to exercise in a real-world setting.
This retrospective cohort study, conducted in a regional hospital in Japan, included adult outpatients receiving HD 3 times per week who had never participated in intradialytic pedaling exercise despite the encouragement of the HD personnel. Patients were divided into 2 groups according to HD weekday. Patients undergoing HD on Tuesday, Thursday, and Saturday were encouraged by the HD unit team to exercise during HD based on the TTM (exposure group) and those receiving HD on Monday, Wednesday, and Friday were encouraged to exercise as usual (control group). The primary outcome was sustained intradialytic exercise using a leg ergometer, defined as a total of 72 sessions of 30-minute pedaling exercise (duration of at least 6 months).
Overall, 85 patients were included in the analysis (mean age: 67.1 ± 11.9 years, 22% female). Of 33 patients in the exposure group, 10 (30%) maintained intradialytic exercise, compared with 2 of 52 patients (4%) in the control group. Log-binomial regression models with stabilized inverse probability of treatment weighting showed a significant association between the TTM approach and sustained intradialytic exercise (adjusted risk ratio 9.23 [95% confidence interval 2.13–40.00]). There were no exercise-related cardiovascular events.
Among patients with low motivation to exercise during HD, use of the TTM approach in clinical practice was associated with sustained intradialytic exercise compared with usual care.
Evaluation of efficacy and safety of vertebroplasty in the treatment of osteoporotic vertebral compression fracture
Authors: Li Jie , Huang Xin , Zhong Guo 
Published: October 2021

Abstract

Background:
Osteoporosis is a common condition that affects bones. Osteoporotic vertebral compression fracture (OVCF) is a highly prevalent complication related to osteoporosis. Each year, OVCF affects nearly 700,000 individuals. Nowadays, there are many surgical methods to treat OVCF, and each has distinct advantages. Among them, the efficacy and safeness of vertebroplasty are yet to be established. The present article will systematically ascertain the effectiveness and security of using vertebroplasty to treat OVCF.

Methods:
All articles related to the research topic published from establishment to July 2021 will be retrieved from the following e-databases Medline, Cochrane library, PubMed database, China National of Knowledge Infrastructure, Web of Science, Embase database, and WanFang database. The collected articles will be related to the use of vertebroplasty to treat OVCF. All included articles will adhere to the standards, and will be screened by 2 independent authors. After extracting the data in the article, Review Manager 5.3 software will be used for data analysis.

Results:
This study will assess the efficacy and safety of using vertebroplasty to treat OVCF by pooling the results of each study.

Conclusion:
Our findings will present strong evidence to help determine whether vertebroplasty therapy is efficient and safe for OVCF patients.