bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sensor-guided Knee Balancing in Posterior-stabilized Total Knee Arthroplasty: A Surgical Description and Report of Medium-term Patient Outcomes
Authors: Cohen Daniel A. , Wood Jil A. , MacDessi Samuel J. 
Published: October 2021

Background:
Intraoperative pressure sensors provide the ability to quantify soft tissue balance (STB) and guide balancing interventions in total knee arthroplasty (TKA). The purpose of this study was to validate a sensor-guided knee balancing algorithm for posterior-stabilized TKA and then report medium-term patient-reported outcome measures from a consecutive series of surgeries using this algorithm.

Materials and Methods:
An algorithm is described for sensor-guided soft tissue releases and bone recuts aiming for quantitative knee balance. The coprimary endpoints were the proportion of TKAs in which quantitative STB was achieved using the sensor-guided balancing algorithm and the number of balancing interventions required. Secondary outcomes included change in Knee injury and Osteoarthritis Outcome Score (KOOS) components, rates of manipulations for stiffness, and revision surgery.

Results:
In a consecutive series of 210 knees, quantitative STB was achieved in 91.9% of cases. Balancing procedures were required in 57.2% (n=120), with 84.3% (n=177) requiring up to 2 balancing interventions to achieve balance. Angular bone recuts were required in 22.9% (n=48) of TKAs. At a minimum of 2 years, there was a statistically significant, clinically meaningful increase in mean KOOS4 of 40.8 (SD=17.5). All ΔKOOS subscales improved. The incidence of manipulation for stiffness and revision surgery at up to 4 years were 3.3% (7/210) and 1.4% (3/210), respectively.

Conclusions:
Quantitative sensor-guided assessment allows precise attainment of STB using a balancing algorithm of both bone recuts and soft tissue releases. Excellent medium-term improvement in patient-reported outcome measures was achieved with posterior-stabilized TKA using intraoperative sensor-guided balancing interventions.
SMOKING, RURAL RESIDENCE AND DIABETES AS RISK FACTORS FOR PRESUMED OCULAR HISTOPLASMOSIS SYNDROME
Authors: Richey Brad F. , Obrock Rachel S. , Gee Zachary M. , Lu David Y. , Jacobsen Gordon , Richards Scott C. 
Published: October 2021

Purpose:
To investigate the relationship of smoking, urbanicity, and diabetes to presumed ocular histoplasmosis syndrome (POHS) and associated choroidal neovascularization (CNV).

Methods:
Medical records of 751 adult patients with POHS were reviewed, including 603 patients without CNV and 148 patients with CNV. Age-matched and gender-matched controls were randomly selected from the same practice for comparison. Statistical comparisons of smoking history, urbanicity, and diabetic history were performed using chi-square and conditional logistic regression analyses.

Results:
Increased rates of current or former smoking, rural residence, and diabetes were found in patients with POHS compared with controls. POHS patients with CNV had increased rates of current or former smoking and rural residence as compared with controls.

Conclusion:
A history of current or past smoking is associated with an increased risk of developing both POHS alone and POHS with CNV. We did not find a significant additional risk of smoking on the development of CNV in patients with POHS. Patients living in rural locations are more likely than those in urban locations to develop both POHS and POHS with CNV. Diabetics may be more likely to develop POHS than nondiabetics.
Surgical Techniques and Adjuvants for the Management of Pterygium
Authors: Patel Ekta D. , Rhee Michelle K. 
Published: October 2021

Objective:
To provide an updated review of surgical techniques and adjuvants for the management of pterygium.

Methods:
A literature search was conducted in PubMed for studies published since January 2011. “Pterygium surgery” and the MeSH term “Pterygium/surgery” was used. The results were filtered for randomized controlled trials in English, yielding 60 citations.

Results:
One study compared topical anesthetic agents. One study compared methods of corneal polishing of the corneoscleral bed after pterygium excision. Numerous studies evaluated the use of conjunctival autograft versus amniotic membrane, superior versus inferior conjunctival autograft, and conjunctival versus limbal–conjunctival autograft. Many studies evaluated graft fixation methods. Several studies evaluated the adjuvant use of mitomycin C, 5-fluorouracil, and bevacizumab. A few studies evaluated the adjuvant use of steroids. Eleven studies evaluated various methods of postoperative management.

Conclusions:
Current evidence supports pterygium excision with conjunctival autograft fixation using fibrin glue, followed by patching until the first postoperative visit. Surgical adjuvants and postoperative use of artificial tears and topical cyclosporine 0.05% may further reduce recurrence. Postoperative use of topical steroids is highly variable because there is no consensus regarding the optimal dose, frequency, and duration of treatment.
Medium-Term Failure of Descemet's Stripping Only and Fuchs’ Dystrophy With Pancorneal Guttae
Authors: Arsiwalla Tasneem , Trinh Tanya , Goolam Saadiah , Benito-Pascual Blanca , Devasahayam Raj N. , Moloney Gregory 
Published: October 2021

Purpose:
The purpose of this study was to report the medium-term outcome of our index case of Descemet stripping only (DSO) in the clinical setting of Fuchs endothelial corneal dystrophy with pancorneal guttae.

Methods:
This was a retrospective case report.

Results:
A 44-year-old woman with bilateral Fuchs endothelial corneal dystrophy was referred for consideration of DSO. At initial slit-lamp examination, widespread guttae were observed with no clear zone visible. Confocal microscopic examination also failed to isolate a population of undisturbed endothelial cells. DSO with supplemental ripasudil was performed with corneal clearance achieved at 2.5 months. A stable result was obtained for 18 months with a subsequent slow decline in vision and return of diurnal fluctuation. At 3.5 years after DSO, DMEK was performed with resolution of symptoms.

Conclusions:
Medium-term failure in this clinical setting is further evidence that DSO is likely best offered to patients with central guttae but a clear corneal periphery, indicative of a healthy cell reservoir.
Infectious Keratitis Isolates and Susceptibility in Southern California
Authors: Gupta Kishan , Unhale Rutuja , Garner Omai B. , Deng Sophie X. , M Fung Simon S. 
Published: October 2021

Purpose:
The purpose of this study was to determine longitudinal trends in prevalence and resistance profiles for infectious keratitis at referral centers in Southern California.

Methods:
Cultured infectious keratitis cases from January 1, 2006, through December 31, 2009, and January 1, 2016, through December 31, 2019, at the University of California, Los Angeles, were evaluated. Outcome measures included microbial isolate prevalence and antibiotic/antifungal susceptibility and resistance patterns.

Results:
One hundred thirty-nine and 315 culture-positive isolates were obtained between 2006–2009 and 2016–2019, respectively. Gram-positive organisms accounted for 65% (2006–2009) and 74% (2016–2019) of bacterial isolates (P = 0.076). Staphylococcus infections, the most common gram-positive and bacterial isolate in both study epochs, demonstrated increased prevalence from 2006–2009 to 2016–2019 (41% vs. 53%, P = 0.019). Although coagulase-negative Staphylococcus (CoNS) increased from 40% to 58% (P = 0.0012), the prevalence of methicillin-resistant Staphylococcus aureus was unchanged (28% vs. 28%, P = 0.99). Pseudomonas aeruginosa, the most common gram-negative organism, demonstrated decreased prevalence from 18% to 10% (P = 0.027). Candida species comprised 3.5% of culture-positive isolates in both epochs. All gram-positive isolates were susceptible to vancomycin, and all Staphylococcus isolates were susceptible to linezolid. Pseudomonas aeruginosa remained susceptible to tested fluoroquinolones (>93%) and aminoglycosides (100%) over time.

Conclusions:
In southern California between 2006 and 2019, there was a shift toward Staphylococcus species, with increased CoNS, decreased methicillin-sensitive Staphylococcus aureus, and decreased prevalence of P. aeruginosa. Empiric therapy of vancomycin and a fluoroquinolone or aminoglycoside provides effective antibacterial coverage for predominant bacterial species when culture sensitivities are pending.
Fungal Infectious Interface Keratitis Presenting 2 Years After Descemet Membrane Endothelial Keratoplasty
Authors: Vaidya Neel S. , Epstein Rachel H. , Majmudar Parag A. 
Published: October 2021

Purpose:
The purpose of this study was to describe infectious interface keratitis after Descemet membrane endothelial keratoplasty (DMEK) more than 2 years after surgery.

Methods:
A case study.

Results:
In this study, we report a case of fungal infectious interface keratitis occurring 2 years after uncomplicated Descemet membrane endothelial keratoplasty. The donor corneal rim culture at the time of surgery grew a single colony of Candida albicans/dubliniensis, but the patient was not treated with antifungals at that time. At the onset of clinical infection, more than 2 years postoperatively, the patient was treated with systemic antifungals and adjuvant intrastromal amphotericin-B injection. The patient subsequently required penetrating keratoplasty with ultimately well-preserved visual acuity.

Conclusions:
Fungal infectious interface keratitis (IIK) is a rare complication associated with lamellar keratoplasty. Although most common in the early postoperative period, this complication can occur several years after successful transplantation. Management may require a combination of systemic and stromal antifungal therapy. However, some patients may eventually require penetrating keratoplasty for definitive treatment.
Corneal Biometric Parameters and Refractive Properties in Microcornea With Normal Axial Length
Authors: Jiang Zhaoxin , Wang Fangyu , Chen Zidong , Fan Yanmei , Xu Jiangang , Yu Minbin 
Published: October 2021

Purpose:
The purpose of this study was to evaluate the features of and relationships among corneal diameter, central corneal thickness (CCT), endothelial cell density (ECD), and corneal refractive properties in cases of microcornea (MC) with normal axial length.

Methods:
We included 22 patients (35 eyes) with MC and cataracts and 41 patients (48 eyes) with isolated cataracts as age-matched controls. They were divided into patients with MC younger than 18 years (MC-child), patients with MC 18 years or older (MC-adult), children with congenital cataracts (CCs), and adults with senile cataracts (SCs). Corneal diameter, axial and anterior chamber length, and keratometry were measured; central corneal endothelial cell imaging was performed.

Results:
The mean horizontal corneal diameter was 7.71 ± 1.51 and 8.78 ± 0.52 mm in MC-child and MC-adult groups, respectively, and 11.89 ± 0.59 and 11.52 ± 2.42 mm in child and adult controls, respectively. The mean CCT was 641.26 ± 63.37 (MC-child) and 617.38 ± 45.40 mm (MC-adult), and 554.92 ± 34.64 (CC) and 551.58 ± 28.47 mm (SC). The mean ECD was 2898.47 ± 443.90 (MC-child) and 2825.81 ± 484.65 cells/mm2 (MC-adult), and 3155.13 ± 372.67 (CC) and 2749.33 ± 399.63 cells/mm2 (SC). The average keratometry was 44.22 ± 3.14 D (MC-child) and 43.86 ± 2.59 D (MC-adult), and 44.19 ± 1.44 D (CC) and 43.94 ± 1.34 D (SC).

Conclusions:
Patients with MC and normal axial length possess specific parameters, including significantly smaller corneal diameter and thicker CCT than the patients in the control groups. There were no significant differences in ECD and average keratometry. These parameters should be taken into account in the follow-up and treatment.
Evaluation and quality improvement of Doctor of Nursing Practice-Family Nurse Practitioner scholarly projects
Authors: Donovan Erin C. , Holvoet Janice A. , Hall Kathleen N. 
Published: October 2021

ABSTRACT

Background:
The Commission on Collegiate Nursing Education's accreditation standards require nursing programs to demonstrate that students acquire doctoral-level knowledge and competencies beyond that expected at the baccalaureate and/or masters levels. The purpose of this article was to describe a quality improvement (QI) project for Doctor of Nursing Practice-Family Nurse Practitioner (NP) scholarly projects.

Local problem:
Nurse practitioner faculty inquired about whether students' scholarly projects were of the quality and rigor expected at the doctoral, rather than masters, level.

Methods:
This project was conducted as a QI initiative and was designated as such by the institutional review board. Methods were based on Deming Plan-Do-Study-Act QI process model.

Interventions:
Two doctorally prepared nursing faculty evaluated nine doctoral scholarly projects using the Roush DNP-PCAT instrument. This instrument evaluates 16 components, and key elements within each component, for completeness. The DNP-PCAT tool was evaluated for interrater reliability and content validity in an earlier study.

Results:
Strengths and weaknesses were identified using quantitative and qualitative data analyses. Floor effects were seen in strategic planning, ethical concerns, data collection, results, discussion, and limitations. Qualitative findings identified weaknesses across all 16 components. Findings were similar to the results reported in a prior study. Results were reviewed and action plans were developed to improve the rigor of scholarly projects.

Conclusions:
The nursing faculty plan to incorporate routine evaluation of scholarly projects into their program evaluation. Other NP programs may benefit from instituting a similar process.
Clinical efficacy of Danzhi Xiaoyao Powder in the treatment of post-stroke depression
Authors: Ding ChunQin , Xu MingYang , Gao Li , Wang XiaoRong , Xu Wu , Guo MinWang , Yao Jun 
Published: October 2021

Abstract

Background:
Depression is a common complication after stroke and is closely related to the poor prognosis of stroke. Antidepressants are the priority drug in the treatment of post-stroke depression (PSD), but there are dependence and adverse reactions. Danzhi Xiaoyao Powder has a good effect on depression without obvious adverse reactions. At present, there is a lack of rigorous randomized controlled trials to evaluate the clinical efficacy of Danzhi Xiaoyao Powder in the treatment of PSD.

Methods:
This is a prospective, randomized, double-blind, parallel controlled trial to explore the efficacy and safety of Danzhi Xiaoyao Powder in the treatment of PSD. The participants were randomly divided into treatment group and control group. The treatment group used Danzhi Xiaoyao Powder combined with escitalopram oxalate, and the control group used Danzhi Xiaoyao Powder simulant combined with citalopram oxalate. The two groups were both treated for 8 weeks and followed up for 3 months. Observational index includes: Total response rate, Hamilton depression scale, Barthel index, national institutes of health stroke scale, the modified Edinburgh-Scandinavian stroke scale, Incidence of adverse reactions. Finally, SPASS 22.0 software was used for statistical analysis of the data.

Discussion:
This study will evaluate the clinical efficacy of Danzhi Xiaoyao Powder in the treatment of PSD. The results of this study will provide reliable evidence for the clinical use of Xiaoyao Powder in the treatment of PSD.

Trial registration:
Open Science Framework Registration number: DOI 10.17605/OSF.IO/5V926
Factors associated with liver cancer prognosis after hepatectomy
Authors: Yuan Yutao , Yang Fangnian , Wang Yuanyuan , Guo Yusong 
Published: October 2021

Abstract
This article was to investigate risk factors influencing liver cancer prognosis after hepatectomy.
Patients undergoing hepatectomy after being diagnosed with liver cancer in Zhongshan Hospital Affiliated to Xiamen University were collected in the retrospective cohort study between January 2012 and December 2017, and divided into disease progression and non-progression groups based on their prognostic status. Univariate analysis was performed on the patients’ baseline and laboratory test data, with multivariate logistic regression further conducted to investigate the independent risk factors for liver cancer progression after hepatectomy.
Among the 288 subjects, 159 had adverse outcomes (death or cancer recurrence). Hepatitis B and high levels of aspartate aminotransferase, gamma-glutamyltransferase, alkaline phosphatase (ALP), direct bilirubin, and total bilirubin as well as low level of lymphocyte (LYM) were found to be associated with disease progression in the univariate analysis, and were introduced into the multivariate logistic regression. The results indicated that patients with high ALP level (odds ratio [OR] = 1.004, 95%CI: 1.002–1.007, P = .003) and with a history of hepatitis B (OR = 2.182, 95%CI: 1.165–4.086, P = .015) had a higher risk of liver cancer progression compared with those of lower ALP level and those without hepatitis B respectively, whereas the elevated level of LYM (OR = 0.710, 95%CI: 0.516–0.978, P = .034) had favorable progression.
The elevated ALP level and a history of hepatitis B may increase the risk of death or cancer recurrence, whereas high LYM level may decrease poor progression among liver cancer patients after hepatectomy. More importance should be attached to the improvement of the liver function and treatment of hepatitis B to enable a better outcome for the patients.
The validation of oxygen uptake efficiency slope in patients with stroke
Authors: Han Sheng-Chieh , Fu Tieh-Cheng , Hsu Chih-Chin , Huang Shu-Chun , Lin Hsin-Yu , Wang Jong-Shyan 
Published: October 2021

Abstract
To evaluate the real aerobic capacity is difficult due to impaired limbs function in stroke patients. Oxygen uptake efficiency slope (OUES) could represent the aerobic capacity in submaximal exercise test. Hence, we designed this observational study to investigate the application of the OUES for evaluating aerobic capacity in these patients.
Thirty-seven stroke patients were classified into 2 groups according to their Brunnstrom stage of affected lower limbs. Patients underwent cardiopulmonary exercise testing to assess cardiorespiratory fitness. Minute ventilation and oxygen consumption were measured, and OUES was calculated, compared with healthy reference values, and correlated with the peak oxygen consumption. The predictive validity of submaximal OUES was derived.
Study participants’ OUES (median 566.2 [IQR, 470.0-711.6]) was 60% of healthy reference values and correlated positively with the peak oxygen consumption (r = 0.835) (P < .01). The predictive validity of oxygen uptake efficiency slope at 50% of maximal exercise duration (OUES50) and oxygen uptake efficiency slope at 75% of maximal exercise duration (OUES75) for oxygen uptake efficiency slope at 100% of maximal exercise duration (OUES100) was 0.877 and 0.973, respectively (P < .01). The OUES50, OUES75, and OUES100 groups were not significantly different; agreement of submaximal and maximal OUES values was strong.
OUES is a valuable submaximal index for evaluating cardiorespiratory fitness in stroke patients. Moderate-to-high concurrent validity of this parameter with peak oxygen consumption and the high predictive validity of OUES50 and OUES75 for OUES100 suggest maximal exercise testing in stroke patients who cannot reach maximal exercise is unnecessary.
Influence of ketamine versus fentanyl on pain relief for pediatric orthopedic emergencies
Authors: Qiu Jin , Xie Mian 
Published: October 2021

Abstract

Introduction:
The comparison of ketamine with fentanyl for pain control of pediatric orthopedic emergencies remains controversial. We conduct a systematic review and meta-analysis to explore the influence of ketamine versus fentanyl on pain management among pediatric orthopedic emergencies.

Methods:
We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials assessing the effect of ketamine versus fentanyl on pain management for pediatric orthopedic emergencies.

Results:
Five randomized controlled trials are included in the meta-analysis. Overall, compared with fentanyl for pediatric orthopedic emergencies, ketamine led to similar change in pain scores at 15 to 20 minutes (standard mean difference = -0.05; 95% confidence interval [CI] = -0.38 to 0.28; P = .77) and 30 minutes (standard mean difference = 0.11; 95% CI = -0.20 to 0.42; P = .49), as well as rescue analgesia (RR = 0.90; 95% CI = 0.54 to 1.51; P = .69), but revealed the increase in nausea/vomiting (RR = 2.65; 95% CI = 1.13 to 6.18; P = .02) and dizziness (RR = 3.83; 95% CI = 1.38 to 10.60; P = .01).

Conclusions:
Ketamine may be similar to fentanyl in terms of the analgesic efficacy for pediatric orthopedic emergencies.
Phase 1b dose-escalation, safety, and pharmacokinetic study of IC14, a monoclonal antibody against CD14, for the treatment of amyotrophic lateral sclerosis
Authors: Henderson Robert D. , Agosti Jan M. , McCombe Pamela A. , Thorpe Kathryn , Heggie Susan , Heshmat Saman , Appleby Mark W. , Ziegelaar Brian W. , Crowe David T. , Redlich Garry L. 
Published: October 2021

Abstract

Background:
The primary objective was to demonstrate the safety and tolerability of monoclonal antibody against CD14 (IC14) (atibuclimab) in amyotrophic lateral sclerosis patients. The secondary objectives were pharmacokinetics, pharmacodynamics, and preliminary effects on disease status and biomarkers.

Methods:
In this open-label, dose-escalation trial, IC14 was administered at 2 mg/kg intravenous (IV) followed by 1 mg/kg/d IV × 3 (n = 3) and in subsequent patients at 4 mg/kg IV followed by 2 mg/kg/d IV × 3 (n = 7) (NCT03487263). Disease status was measured using the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale, forced vital capacity, sniff nasal pressure, Edinburgh Cognitive and Behavioural ALS Screen, and Revised ALS-Specific Quality-of-Life Score. Disease biomarkers included cerebrospinal fluid and serum levels of neurofilament light chain (NfL) and urinary p75 neurotrophin receptor.

Results:
IC14 was safe and well tolerated. No antidrug antibodies were detected. The drug target saturation of monocyte CD14 receptors was rapid and sustained through day 8. There was no significant change in Revised Amyotrophic Lateral Sclerosis Functional Rating Scale, forced vital capacity, sniff nasal pressure, or Revised ALS-Specific Quality-of-Life Score following a single cycle of treatment. Cerebrospinal fluid NfL levels decreased in 6 of 9 patients sampled with declines of 15% to 40% between baseline (not significant [ns]) and day 8 in 3 patients. Serum NfL modestly decreased in 5 of 10 patients (ns) at day 8 and was sustained in 4 (4%-37%, ns) over 33 days of follow up.

Conclusion:
IC14 quickly and durably saturated its target in all patients. This study demonstrated safety and tolerability in patients with amyotrophic lateral sclerosis. Even though only a single cycle of treatment was given, there were promising beneficial trends in the neurofilament light chain, a disease biomarker. The emerging understanding of the role of systemic inflammation in neurodegenerative diseases, and the potential for IC14 to serve as a safe, potent, and broad-spectrum inhibitor of immune dysregulation merits further clinical study.

Clinical Trial Registration:
NCT03487263