bluuebunny/crossref_metadata_2025_split huggingface dataset:
TUBERCULOUS CHORIORETINITIS: A CHALLENGING CASE OF AN OPHTHALMIC MIMIC
Authors: Dedina Liana , Little Matthew , Durkin Shane 
Published: December 2021

Purpose:
To report a challenging case of tuberculous chorioretinitis.

Methods:
Case report of a 51-year-old woman from the Middle East, who was referred from an optometrist with a suspicious retinal lesion in her right eye.

Results:
Clinical examination showed multifocal, pale, elevated lesions temporal to the right macula with no vasculitis or hemorrhages. Infective and inflammatory workup showed unremarkable results. B-scan ultrasound confirmed an 8 mm × 3 mm × 10 mm right focal chorioretinal thickening. Computed tomography scanning showed calcified lung hilar nodes supporting a prior granulomatous process, along with an enhancing nodule in the right globe. Magnetic resonance imaging of the brain and obits showed retinal thickening of the temporal surface of the right globe with subtle enhancement without retrobulbar extension or evidence for cerebral vasculitis. Subretinal lesion biopsy showed mononuclear inflammatory cells with granulomatous inflammation, including multinucleated giant cells but no neoplastic features. Interferon-gamma release assay testing for tuberculosis showed negative result, but a high index of suspicion lead to tuberculin skin testing and subsequent treatment for tuberculous chorioretinitis.

Conclusion:
Ocular tuberculosis presents in a variety of ways, making it a challenging diagnosis. Herein, we describe such case of tuberculous chorioretinitis.
Descemet Stripping Only for Fuchs Endothelial Corneal Dystrophy: Will It Become the Gold Standard?
Authors: Colby Kathryn 
Published: December 2021

Abstract:
Descemet stripping only (DSO) has become a viable treatment option for certain cases of Fuchs Endothelial Corneal Dystrophy (FECD). This article describes the history of the development of DSO, its current status, and what successful DSO tells us about the pathophysiology of FECD. Remaining questions and future directions are also highlighted.
Astigmatic Vectorial Analysis in Pediatric Keratoconus After Unilateral Cross-Linking Treatment
Authors: Kesim Cem , Öztürkmen Cem , Şahin Afsun 
Published: December 2021

Purpose:
The aims of this study were to evaluate the treatment response of pediatric keratoconus (KC) patients to unilateral corneal collagen cross-linking (CXL) in treated eyes, disease progression in untreated eyes, and define the predictive value of astigmatic parameters by astigmatic vectorial analysis.

Methods:
Pediatric patients with KC with CXL-treated progressive eye and untreated fellow eye were included. Patients with other ocular conditions and a history of previous ocular surgery were excluded. Astigmatic changes in anterior and posterior corneal surfaces were evaluated with vectorial analysis. The receiver operating characteristic curves were analyzed to detect the best parameter that discriminates treated and untreated groups.

Results:
Thirty-two eyes of 16 patients with at least 2-year follow-up were analyzed. The maximum keratometry (K) in CXL-treated eyes remained stable (from 53.51 ± 2.86–53.41 ± 2.84 diopter (D), P = 0.84) while the steepest K increased in untreated eyes (from 47.82 ± 1.71–49.59 ± 3.32 D, P = 0.03). The oblique components of corneal astigmatism in CXL-treated eyes were higher than those of fellow eyes (all P < 0.05), which significantly decreased in the anterior 3-mm zone after treatment (P = 0.048). The mean differential astigmatism magnitudes were significantly higher in treated eyes (all P < 0.05). The refractive centroid remained unchanged in treated eyes (P = 0.553) and shifted in the oblique direction in untreated eyes (P = 0.04). The oblique differential astigmatism in the anterior 7-mm zone showed the highest area under the curve value in predicting treatment efficacy (0.813, 95% confidence interval: 0.646–0.981, P < 0.001).

Conclusions:
Astigmatic vectorial analysis is an objective tool for longitudinal assessment of clinical outcomes in KC. Changes in the oblique components of corneal astigmatism might predict progression and treatment efficacy.
Scheimpflug Versus Optical Coherence Tomography to Detect Subclinical Corneal Edema in Fuchs Endothelial Corneal Dystrophy
Authors: Augustin Victor A. , Köppe Max K. , Son Hyeck-Soo , Meis Jan , Yildirim Timur M. , Khoramnia Ramin , Auffarth Gerd U. 
Published: December 2021

Purpose:
The purpose of this research was to compare the ability of Scheimpflug and anterior segment optical coherence tomography (OCT) in detecting subclinical corneal edema in patients with Fuchs endothelial corneal dystrophy (FECD) without clinical corneal edema.

Methods:
In this single-center, consecutive case series, 47 eyes of 29 patients with FECD were analyzed. The main outcome measures were anterior/posterior keratometry and central/thinnest corneal thickness. The criteria for subclinical corneal edema were loss of regular isopachs, displacement of the thinnest point of the cornea, and presence of posterior surface depression. Tomographic analyses were performed using Scheimpflug imaging (Pentacam HR) and OCT (anterior segment swept-source optical coherence tomography).

Results:
The measurement of the continuous variables revealed a significant difference between the 2 devices. The anterior curvature was steeper and the posterior curvature was flatter when measured with OCT (P < 0.001). The OCT showed a lower central corneal thickness and thinnest corneal thickness (P < 0.001). The agreement between both devices to detect subclinical corneal edema was high. The interdevice reliability for loss of parallel isopachs as measured by Cohen kappa coefficient was 0.84; for the displacement of the thinnest point of the cornea, it was 0.6, and for the focal posterior corneal surface depression, it was 0.62. Subclinical corneal edema was detected in 72.3% of the patients with both devices. In only 2 cases (4.3%), subclinical corneal edema was detected by one of the devices.

Conclusions:
Scheimpflug and OCT imaging were both able to detect tomographic patterns of subclinical corneal edema. Therefore, both devices can help decision-making, favoring early endothelial keratoplasty in symptomatic patients with FECD without clinical corneal edema.
The Impact of the COVID-19 Pandemic on Corneal Transplantation in Brazil
Authors: Moriyama Aline Silveira , Erbs Pessoa João Luís , Silva Bessa Taciana Ribeiro , Pereira Nicolas Cesário , Mehta Jodhbir Singh , Hofling-Lima Ana Luisa , dos Santos Forseto Adriana 
Published: December 2021

Purpose:
The purpose of this study was to evaluate the impact of the coronavirus disease 2019 pandemic on corneal transplantation (CT) in Brazil.

Methods:
Data from patients who underwent CT at the Hospital Oftalmológico de Sorocaba (HOS), Brazil, were analyzed. National and state numbers of keratoplasties, patients added to the CT waiting list, and total patients on the waiting list were also obtained. Baseline prepandemic (from January 1, 2019, to March 31, 2020) data were compared with 2 time frames of the coronavirus disease 2019 pandemic: elective CT suspension period (between April 1, 2020, and September 31, 2020) and after elective CT resumption (between October 1, 2020, and April 30, 2021).

Results:
Despite elective CT resumption after the moratorium, the monthly CT rates did not return to baseline at HOS (−14.7%, P = 0.007), São Paulo state (−19.1%, P = 0.001), or Brazil (−30.1%, P < 0.001). The waiting list increased significantly regionally (P < 0.001) and nationally (P < 0.001). Among optical keratoplasties performed at HOS after resuming elective CTs, the proportion of endothelial keratoplasties declined from 38.2% to 30.0% (P < 0.001), whereas penetrating keratoplasties increased from 33.2% to 39.5% (P < 0.001) when comparing with prepandemic data.

Conclusions:
Keratoplasty numbers dropped significantly locally, regionally, and nationally. Hence, the CT waiting lists had a progressive increase, with significant long-term implications. An estimated increment on monthly CT rates of approximately 34% in São Paulo state, and 91% in Brazil, is required for the CT waiting list to get back to prepandemic numbers over the next 2 years.
Bilateral Corneal Ectasia 3 Years After Small Incision Lenticule Extraction in a Borderline Case
Authors: Hernández-Chavarría César , Benedetti S Mónica , García de Oteyza Gonzalo , García-Albisua Ana Mercedes , Hernández-Quintela Everardo 
Published: December 2021

Purpose:
The purpose of this study was to report a case of bilateral ectasia 3 years after small incision lenticule extraction (SMILE) in a patient with normal preoperative topography of the right eye and abnormal topography of the left eye.

Methods:
This study was a case report.

Results:
A 22-year-old man developed bilateral corneal ectasia after SMILE. The preoperative corneal topography of the right eye was unremarkable, with a minimum corneal thickness of 511 μm in the right eye, and the abnormal corneal topography of the left eye revealed a risk factor for developing ectasia, with a minimum corneal thickness of 514 μm in the left eye. The refractive error was −4.50 to 3.50 × 10 degrees in his right eye and −4.25 to 3.50 × 0 degrees in his left eye with a best-corrected visual acuity of 20/20. An uncomplicated SMILE was performed; after his last follow-up visit at 1 month, the patient was lost to follow-up for 3 years. After that time, he presented with visual loss with left predominance. Bilateral ectasia was diagnosed through corneal topography, and crosslinking was performed in both eyes.

Conclusions:
There are a very few reports of corneal ectasia after SMILE with normal preoperative topography.
U-Net Convolutional Neural Network for Segmenting the Corneal Endothelium in a Mouse Model of Fuchs Endothelial Corneal Dystrophy
Authors: Okumura Naoki , Yamada Shohei , Nishikawa Takeru , Narimoto Kaito , Okamura Kengo , Izumi Ayaka , Hiwa Satoru , Hiroyasu Tomoyuki , Koizumi Noriko 
Published: December 2021

Purpose:
The purpose of this study was to assess the U-Net–based convolutional neural network performance for segmenting corneal endothelium and guttae of Fuchs endothelial corneal dystrophy.

Methods:
Twenty-eight images of corneal endothelial cells and guttae of Col8a2
L450W/L450W knock-in mice were obtained by specular microscopy. We used 20 images as training data to develop the U-Net for analyzing guttae and cell borders. The proposed network was validated using independent test data of 8 images. Cell density, hexagonality, and coefficient of variation were calculated from the predicted cell borders and compared with ground truth.

Results:
U-Net allowed the prediction of cell borders and guttae, and overlays of those segmentations on specular microscopy images highly corresponded to ground truth. The average number of guttae per field was 6.25 ± 8.07 for ground truth and 6.25 ± 7.87 when predicted by the network (Pearson correlation coefficient 0.989, P = 3.25 × 10−6). The guttae areas were 1.60% ± 1.79% by manual determination and 1.90% ± 2.02% determined by the network (Pearson correlation coefficient 0.970, P = 6.72 × 10−5). Cell density, hexagonality, and coefficient of variation analyzed by the proposed network for cell borders showed very strong correlations with ground truth (Pearson correlation coefficient 0.989, P = 3.23 × 10−6, Pearson correlation coefficient 0.978, P = 2.66 × 10−5, and Pearson correlation coefficient 0.936, P = 6.20 × 10−4, respectively).

Conclusions:
We demonstrated proof of concept for application of U-Net for objective analysis of corneal endothelial cells and guttae in Fuchs endothelial corneal dystrophy, based on limited ground truth data.
The Role of Macrophage-Derived Exosomes in Liver Diseases
Authors: Lu Wang , Bai Li , Chen Yu 
Published: December 2021

Abstract
Exosomes (exos) widely distributed in a variety of biological fluids, including blood, urine, saliva, sputum, breast milk, cerebrospinal fluid, and ascites, contain specific bioactive contents which are involved in physiological and pathological processes, such as signal molecular transfer, substance metabolism, gene regulation, and immune regulation. Macrophages are important innate immune cells which usually act as the first line of defense against infection, and can switch between different functional phenotypes in response to the changes around the microenvironment. Evidence suggests that macrophage-derived exos exert a crucial effect on infection, inflammation, regeneration, tumors, fibrosis, and other lesions in multiple human diseases. However, the role and mechanism of macrophage-derived exos in liver diseases remain to be explored. This review summarizes the current researches on the role and possible mechanism of macrophage-derived exos in liver diseases, with the purpose of providing new potential targets and directions for diagnostic biomarker and clinical treatment of liver diseases.
Structural and functional alterations in corneal nerves after single-step transPRK
Authors: Liu Chang , Yu Aomiao , Zhang Chen , Li Fei , Huang Yue , Zhao Shaozhen 
Published: December 2021

Purpose:
To evaluate the relationship between structural and functional changes of corneal subbasal nerves after single-step transepithelial photorefractive keratectomy (TransPRK).

Setting:
Tianjin Medical University Eye Hospital.

Design:
Prospective observational study.

Methods:
51 eligible candidates who underwent TransPRK for moderate myopia were included. The regeneration of corneal subbasal nerves were evaluated by in vivo confocal microscopy (IVCM) prior to surgery and at 1 week and 1 month, 3 months, 6 months, and 12 months postoperatively. The corneal sensitivity was measured by Cochet-Bonnet esthesiometer. The number of complete and incomplete blinks were recorded by LipiView interferometer. A correlation analysis was performed between these variables.

Results:
51 eyes of 51 patients were enrolled in this study. IVCM revealed that the density and length of corneal nerve decreased immediately and did not return to preoperative levels by 12 months post-TransPRK (P < .01). The mean corneal sensitivity was slightly lower compared with preoperative levels at 1 week postoperatively (P = .001) and then increased to baseline preoperative level within 1 month postoperatively. Mean total blink frequency and the partial blink rates had no statistically significant change postoperatively (P = .087). There was no direct correlation between postoperative recovery of corneal sensitivity, changes in blink frequency, and regeneration of subbasal corneal nerve.

Conclusions:
The significant and prolonged decrease in corneal subbasal nerve morphology was accompanied by only a slight and transient reduction in corneal sensitivity to mechanical stimuli within 1 month after TransPRK. The results demonstrated that the structural changes of subbasal nerves were not parallel to their functional changes after TransPRK.
Mobilizing Ventilated Neurosurgery Patients: An Integrative Literature Review
Authors: Lall Adrianna , Behan Deborah 
Published: December 2021

ABSTRACT

BACKGROUND: Lack of mobilization in ventilated neurosurgery patients is problematic due to significant consequences. Although early mobility addresses these complications, few studies have been conducted in this population, resulting in infrequent mobilization efforts. Nurses prioritize and implement patient care interventions, including mobilization, with multidisciplinary teams. This integrative literature review examines what is known regarding nursing perceptions on mobilization and their role within a multidisciplinary team for mobilization in ventilated neurosurgery patients. METHODS: A comprehensive literature search was conducted using online databases to identify research articles on early mobility studies in ventilated critically ill and neurosurgical patients from 2010 to 2020. RESULTS: Twenty studies were identified and indicated a paucity of research specific to mobilizing ventilated neurosurgery patients. Nurses understand the purpose and benefits of early mobility in critically ill and mechanically ventilated patients. Mixed perceptions exist regarding the responsibility for prioritizing and initiating mobilization. Main barriers include patient safety concerns, untimeliness due to limited resources, unit culture, lack of nursing knowledge, and need for improved teamwork. Associations between teamwork-based interventions and decreased length of stay, increased rates of mobility, and faster time to early mobilization exist. Nurse-led interventions showed additional benefits including positive perceptions such as empowerment, confidence, increased knowledge, and a progressive shift in unit culture. CONCLUSION: This review demonstrates a continued need for understanding nursing perceptions and role in teamwork to mobilize ventilated neurosurgery patients. Future research should focus on testing nurse-led mobility interventions so higher rates of mobilization and provision of holistic patient care can be achieved.
Oral health in primary care: Integration of enhanced oral health education in a nurse practitioner residency program
Authors: Phillips Lori A. , Coan Lorinda L. , Wijesuriya Uditha A. 
Published: December 2021

ABSTRACT
Access to oral health care is challenging, especially for vulnerable populations and those in rural and underserved areas. The purpose of this brief report is to discuss the implementation strategies of enhanced content in oral health educational materials and share results of acquisition of knowledge and confidence in oral health content by residents in a nurse practitioner residency program. The method included the use of 3 surveys of 34 questions administered at different time points measuring confidence levels and sustainability. Results showed the average level of confidence obtained in Posttest1 and in Posttest 2 after 6 months is greater than the pretest. The paired-sample t-test provides significant evidence of improving mean responses for Questions 10, 11, 16, and 32 in Posttest 1 (p-values: .04 each) and Questions 10, 17, 25, and 31 in Posttest2 (p-values: .04 each) compared with the pretest. In conclusion, the addition of enhanced oral health educational materials in our program resulted in improved knowledge and confidence in the residents to incorporate oral health care in their practices.
Cultivating diversity in the advanced practice registered nurse workforce: An exemplar from an advanced practice registered nurse fellowship program
Authors: Raghu Natalie , McNamara Mary , Bettencourt Emily , Yingling Charles 
Published: December 2021

ABSTRACT
Diversity in the nursing workforce is an important driver of patient satisfaction, adherence to care, and quality outcomes. Systemic barriers exist that prevent individuals from underrepresented minority groups entering and advancing in the nursing workforce. To advance the health of the community we serve and with grant support from the Health Resources and Services Administration, we developed a postgraduate advanced practice registered nurse (APRN) fellowship in community health. This program is a partnership between a federally qualified health center and a college of nursing. We developed a deliberate plan to recruit and admit diverse applicants who would continue to practice in our community at the conclusion of their fellowship year. Using targeted recruitment outreach, we identified new-graduate APRNs who were representative of the community we serve. Using holistic review methodology, we interviewed applicants with explicit efforts to mitigate the effects of bias towards race, ethnicity, gender, and academic affiliation. We embraced a quality-improvement ethos that enabled evolution and growth with each iteration of the program. Understanding that intention does not translate to outcomes, we undertook ongoing critique of our methods and engaged diverse resources to improve our processes. Over two admission cycles, our fellowship in community health for new graduate APRNs has demonstrated improvements in strategies to diversify the community health workforce. We will describe our process of nonjudgmental self-critique and a quality-improvement framework that can serve as a strategy to promote diversity, equity, and inclusion in the community health workforce.
Evaluation of the Utility of Liquid-based Cytology, Cell-blocks, and Flow Cytometric Immunophenotyping on Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Samples in the Diagnosis of Sarcoidosis
Authors: Mohapatra Dibyanshu S. , Gupta Parikshaa , Gupta Nalini , Dhooria Sahajal , Singh Sehgal I. , Sharma Shelly , Bal Amanjit , Rohilla Manish 
Published: December 2021

Background:
There is little information on the value of different processing methods for samples obtained during endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) in suspected sarcoidosis. We evaluated the role of conventional smears, liquid-based cytology (LBC), cell-blocks and flow cytometric immunophenotyping in the diagnosis of sarcoidosis using EBUS-TBNA samples.

Methods:
This was a prospective study of consecutive EBUS-TBNA samples from clinically suspected cases of sarcoidosis. In addition to conventional smears, we prepared LBC smears, cell-blocks, and performed flow cytometric evaluation of the CD4:CD8 ratio. The final diagnosis of sarcoidosis was made based on the relevant clinical details and laboratory investigations including the results of transbronchial and endobronchial biopsies (TBLB and endobronchial biopsy).

Results:
We included 60 subjects [mean age: 45.2 y; 29 (48.3%) men]. The sensitivity of conventional smears, LBC, and cell-blocks for diagnosing sarcoidosis was found to be 75.5%, 37.8%, 35%, respectively, when used alone. However, on combining conventional and LBC smears, the sensitivity increased to 84.4% and on combining all three techniques, the sensitivity was 86.7%. The CD4:CD8 ratio on flow cytometric immunophenotyping of EBUS-TBNA samples ranged from 0 to 11.5 with a mean of 3.17±2.78 in confirmed cases of sarcoidosis and 70% of these cases had CD4:CD8 ratio of more than 2.

Conclusion:
Cell-blocks and liquid-based preparations add to the yield of conventional preparation of EBUS-TBNA samples in the diagnosis of sarcoidosis. A combination of conventional and LBC works well in detecting almost 85% of the cases of sarcoidosis. Higher CD4:CD8 ratio favors a diagnosis of sarcoidosis.
Chest imaging in patients with acute respiratory failure because of coronavirus disease 2019
Authors: Di Meglio Letizia , Carriero Serena , Biondetti Pierpaolo , Wood Bradford J. , Carrafiello Gianpaolo 
Published: December 2021

Purpose of review
This review aims to explore the different imaging modalities, such as chest radiography (CXR), computed tomography (CT), ultrasound, PET/CT scan, and MRI to describe the main features for the evaluation of the chest in COVID-19 patients with ARDS.

Recent findings
This article includes a systematic literature search, evidencing the different chest imaging modalities used in patients with ARDS from COVID-19. Literature evidences different possible approaches going from the conventional CXR and CT to the LUS, MRI, and PET/CT.

Summary
CT is the technique with higher sensitivity and definition for studying chest in COVID-19 patients. LUS or bedside CXR are critical in patients requiring close and repeated monitoring. Moreover, LUS and CXR reduce the radiation burden and the risk of infection compared with CT. PET/CT and MRI, especially in ARDS patients, are not usually used for diagnostic or follow-up purposes.