bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Bronchopleural and Alveolopleural Fistulas in Acute Respiratory Distress Syndrome With Extracorporeal Membrane Oxygenation, a Case Series and Literature Review
Authors: Odish Mazen F. , Yang Jenny , Cheng George , Yi Cassia , Golts Eugene , Madani Michael , Pollema Travis , Owens Robert L. 
Published: May 2021

OBJECTIVES:
To describe a ventilator and extracorporeal membrane oxygenation management strategy for patients with acute respiratory distress syndrome complicated by bronchopleural and alveolopleural fistula with air leaks.

DESIGN, SETTING, AND PARTICIPANTS:
Case series from 2019 to 2020. Single tertiary referral center—University of California, San Diego. Four patients with various etiologies of acute respiratory distress syndrome, including influenza, methicillin-resistant Staphylococcus aureus pneumonia, e-cigarette or vaping product use-associated lung injury, and coronavirus disease 2019, complicated by bronchopleural and alveolopleural fistula and chest tubes with air leaks.

MEASUREMENTS AND MAIN RESULTS:
Bronchopleural and alveolopleural fistula closure and survival to discharge. All four patients were placed on extracorporeal membrane oxygenation with ventilator settings even lower than Extracorporeal Life Support Organization guideline recommended ultraprotective lung ventilation. The patients bronchopleural and alveolopleural fistulas closed during extracorporeal membrane oxygenation and minimal ventilatory support. All four patients survived to discharge.

CONCLUSIONS:
In patients with acute respiratory distress syndrome and bronchopleural and alveolopleural fistula with persistent air leaks, the use of extracorporeal membrane oxygenation to allow for even lower ventilator settings than ultraprotective lung ventilation is safe and feasible to mediate bronchopleural and alveolopleural fistula healing.
Chrysiasis: Gold Aggregates Around a Nevus and Osteoma Cutis
Authors: Ravi Vignesh , Cohen Brandon , Kim Gene , Abraham Jerrold L. , Sanyal Soma , Tran Danielle , Ngo Binh 
Published: May 2021

Abstract:
Parenteral gold has historically been used to treat several conditions, including rheumatoid arthritis. Gold administration leads to a variety of cutaneous reactions, including chrysiasis, which is a permanent blue–grey hyperpigmentation of the skin due to dermal gold deposition. In this report, we describe the case of a patient who received parenteral gold injections 22 years before the onset of her chrysiasis for the treatment of rheumatoid arthritis. Biopsy of the macules showed dermal gold deposits aggregating around a melanocytic nevus, as well as around preexisting osteoma cutis. To the authors' knowledge, this is the first report in the literature describing a case of chrysiasis with gold deposits concentrated around a melanocytic nevus and an area of osteoma cutis.
Advances in corneal graft rejection
Authors: Yin Jia 
Published: May 2021

Purpose of review
Immune rejection after corneal transplantation is a major risk for graft failure. We aim to summarize recent advances in the understanding and management of graft rejection.

Recent findings
Immune rejection remains the leading cause of graft failure in penetrating keratoplasty (PKP). While ABO blood type and sex match between donor and recipient may reduce rejection, human leucocyte antigens class II matching in a randomized study did not reduce the risk of rejection in high-risk PKP. Compared with PKP, deep anterior lamellar keratoplasty, descemet stripping automated endothelial keratoplasty, and descemet membrane endothelial keratoplasty have lower immune rejection rates of 1.7–13%, 5–11.4%, and 1.7–2.8%, respectively, based on long-term (5 years and more) studies. Whether immune rejection is a major risk factor for graft failure in these lamellar keratoplasties is unclear. While there have not been major advances in the systemic management of graft rejection, topical nonsteroid agents such as tacrolimus and anti-vascular endothelial growth factor have shown promise in high-risk cases.

Summary
Immune rejection remains the leading cause of graft failure in PKP. Lamellar keratoplasties have significantly lower rejection rates compared with PKP. The significance of rejection in the failure of lamellar grafts warrants further investigation.
The role of imaging technologies for ocular surface tumors
Authors: Venkateswaran Nandini , Sripawadkul Wathanee , Karp Carol L. 
Published: May 2021

Purpose of review
This review will discuss the utility of high-resolution anterior segment optical coherence tomography (HR-OCT), in-vivo confocal microscopy (IVCM) and ultrasound biomicroscopy (UBM) in characterizing and diagnosing various ocular surface tumors, namely ocular surface squamous neoplasia (OSSN), conjunctival lymphoma and conjunctival melanoma. The strengths and limitations of each imaging modality will be discussed along with the characteristics findings of each lesion on each imaging platform.

Recent findings
HR-OCT can consistently be utilized in the clinic setting to distinguish between epithelial ocular surface tumors such as OSSN as compared with subepithelial tumors such as conjunctival lymphoma and conjunctival melanoma given their distinctive findings. IVCM can be used as an adjunct to HR-OCT to obtain cellular and surface characteristics, whereas UBM can be used to assess tumor depth and thickness for larger and highly pigmented lesions as well as to detect intraocular invasion.

Summary
HR-OCT, IVCM and UBM are all helpful imaging modalities to diagnose and characterize various ocular surface tumors and can serve as valuable adjuncts to monitor treatment response and assess for recurrence ocular surface tumors.
A Case of Endocarditis Following Endophthalmitis After XEN45 Gel Stent Implantation
Authors: Wisdorf Martin , Kowalski Radoslaw , Kiessling David , Roessler Gernot F. , Widder Randolf A. 
Published: May 2021

Introduction:
We report a case of endophthalmitis and endocarditis that developed after stent perforation following a XEN45 Gel Stent implantation 10 months ago.

Case Report:
A 79-year-old man was referred to our hospital because of endophthalmitis of the right eye. The patient had undergone XEN45 Gel Stent implantation in the same eye 10 months ago. On examination, the conjunctiva was perforated by the stent, and it was no longer covered by the conjunctiva. A 27-G pars plana vitrectomy with intravitreal antibiotic injection was performed. Moreover, the patient received intravenous antibiotic treatment and local anti-inflammatory and anti-infectious therapy. Streptococcus gordonii was identified as a bacterial cause of the endophthalmitis. Therefore, transesophageal echocardiography was performed, which revealed aortic valve endocarditis.

Discussion:
Although not proven, it is possible that the exposed XEN45 Gel Stent served as an entry point for S. gordonii, which caused the exogenous endophthalmitis and subsequent endocarditis. S. gordonii belongs to the viridans group streptococci, which is the etiological agent for endocarditis which is a severe and potentially life-threatening infection. Ophthalmologists should therefore consider the risk of systemic infections as endocarditis after endophthalmitis, particularly caused by the viridans group streptococci, which are known etiological agents of endocarditis.
Reliability of iCare ic100 Rebound Tonometry and Agreement With Goldmann Applanation Tonometry in Healthy and Post-myopic LASIK Patients
Authors: Gómez-Gómez Alicia , Talens-Estarelles Cristian , Alcocer-Yuste Pablo , Nieto Juan C. 
Published: May 2021

Precis:
Rebound tonometry offers excellent reliability for obtaining intraocular pressure (IOP) measurements in healthy and post-myopic laser-assisted in situ keratomileusis (LASIK) patients regardless of corneal parameters and axial length and regardless of the instillation of ocular topical anesthesia.

Purpose:
The purpose of this study was to assess the reliability of rebound tonometry, its agreement with Goldmann applanation tonometry (GAT) and its concordance after topical anesthesia in a group of nonoperated healthy patients and a group of post-myopic LASIK patients.

Patients and Methods:
Fifty-four patients were included in this prospective observational, case-control study. Patients were divided into 2 groups: control (n=32, 26.7±6.1 y) and LASIK (n=22, 35.8±7.6 y). Measurements of IOP were carried out using the iCare ic100 tonometer and GAT. The repeatability, intersession and interobserver reproducibility, GAT interchangeability and concordance after topical anesthesia of the iCare ic100 tonometer were assessed.

Results:
Clinical reliability of the iCare ic100 was excellent in terms of repeatability [intraclass correlation coefficient (ICC)=0.909 and 0.951 in control and ICC=0.938 and 0.961 in LASIK] as well as interobserver reproducibility (ICC=0.896 in control and 0.916 in LASIK) and concordance after anesthesia (ICC=0.910 in control and 0.972 in LASIK) in both groups. Intersession reproducibility was clinically good in nonoperated patients (ICC=0.758 and 0.849) and excellent in LASIK patients (ICC=0.878 and 0.904), although statistically significant differences were obtained in the control group for both examiners (P=0.003 for examiner 1 and P=0.04 for examiner 2). Agreement with GAT was good in both groups (ICC=0.805 in control and 0.790 in LASIK), although statistically different (P<0.001 and P=0.02, respectively). Finally, the iCare ic100 reliability was independent of corneal parameters and axial length in both groups (P>0.05 for all parameters).

Conclusions:
Rebound tonometry offers good or excellent clinical reliability in both healthy and post-myopic LASIK patients. This article highlights the efficacy of iCare ic100 rebound tonometry as a reliable tool for the measurement of IOP and the management of glaucoma in healthy patients and patients undergoing myopic LASIK surgery.
Long-term Results of Ahmed Valve Implantation With Mitomycin-C in Pediatric Glaucoma
Authors: Promelle Veronique , Lyons Christopher J. 
Published: May 2021

Precis:
Mitomycin was used with Ahmed valve implantation in 81 eyes of 63 children. After 5 years, probability of intraocular pressure (IOP) control without glaucoma medication was 35±6%; 57% achieved IOP control with topical medications after 10 years.

Purpose:
The purpose of this study was to determine the long-term outcomes of Ahmed glaucoma valve (AGV) implantation with intraoperative application of mitomycin-C (MMC) for the treatment of childhood glaucoma.

Methods:
Retrospective review of children undergoing AGV implantation with subtenon application of MMC between 2000 and 2019. We defined surgical success as a final IOP of 5 to 21 mm Hg with no glaucoma medication, no subsequent glaucoma surgery, and no severe complication. Qualified success was defined if the above criteria were met with topical antiglaucoma medication.

Results:
Eighty-one eyes of 63 patients were included. The probability of complete success was 72±5% (63% to 83%) at 1 year, 58±6% (48% to 70%) at 2 years, and 35±6% (25% to 48%) at 5 years. The probability of qualified success was 92±3% (87% to 98%) at 1 year, 79±5% (70% to 89%) at 5 years, 57±7% (44% to 73%) at 10 years, and 39±9% (24% to 62%) at 14 years. The IOP was reduced by an average of 10.7±9 mm Hg from preoperative visit to the last follow-up, and the number of medications decreased from 3.0±1.4 to 1.5±1.4 after implantation.

Conclusions:
A significant proportion of patients achieved long-term IOP control without glaucoma medication. The majority achieved IOP control with additional topical antiglaucoma medications. When compared with existing AGV implantation in childhood literature, the use of MMC appears to lengthen the drop-free (complete success) duration, as well as the long-term IOP control with topical medications.
Intraocular Pressure According to Eye Gaze by iCare Rebound Tonometry in Normal Participants and Glaucoma Patients
Authors: Kim Yu Jeong , Moon Yeji , Kwon Amy M. , Lim Han Woong , Lee Won June 
Published: May 2021

Precis:
We investigated changes of intraocular pressure (IOP) according to eye gaze. IOP was significantly elevated in adduction, abduction, and supraduction. However, there was no significant difference between glaucoma and control groups.

Purpose:
We assessed changes in IOP according to eye gaze and identified their correlations with various risk factors of glaucoma.

Patients and Methods:
In this prospective observational study that included 56 glaucoma patients and 34 healthy participants, we measured IOP in the primary position with a Goldmann applanation tonometry and rebound tonometer. Then, this IOP was measured in abduction, adduction, supraduction using a rebound tonometer. IOP changes according to eye gaze were measured based on the baseline IOP, and IOP changes between glaucoma and the control groups were compared. Correlations between IOP changes and risk factors of glaucoma were evaluated.

Results:
The baseline IOP was not significantly different between glaucoma and the control groups. Compared with the IOP in the primary position, a significant increase in IOP was 2.3±2.7 mm Hg during abduction (P<0.0001), 0.7±2.7 mm Hg during adduction (P<0.0001), and 1.2±2.8 mm Hg during supraduction (P<0.0001). However, there was no significant difference in the amount of IOP elevation or the ratio of IOP change between glaucoma and the control groups in all gazes. The baseline IOP measured by Goldmann applanation tonometry and IOP changes according to eye gaze showed a significant negative correlation in all gazes.

Conclusions:
IOP was significantly elevated in adduction, abduction, and supraduction than in the primary position in both the normal and glaucoma groups. However, there was no significant difference of IOP changes between glaucoma and normal groups.
Surgical Results of Ahmed Glaucoma Valve Implantation in One-chamber Eyes
Authors: Tanito Masaki , Tsutsui Aika , Manabe Kaoru , Matsuoka Yotaro 
Published: May 2021

Precis:
Ahmed glaucoma valve (AGV) implantation in eyes with damaged iris-lens diaphragms (“1-chamber” eyes) resulted in mean intraocular pressure (IOP) and antiglaucoma medications decreases of 66% and 59% (P<0.0001 for both), respectively, at the mean 23-month follow-up.

Purpose:
The purpose of this study was to report the results of AGV implantation with pars plana tube insertion to control IOP in glaucomatous eyes with damaged iris-lens diaphragms (“1-chamber” eyes).

Methods:
The medical records of 52 consecutive glaucomatous 1-chamber eyes (48 Japanese patients, mean age±SD, 76.0±11.2 y) were retrospectively reviewed. Other than aphakic eyes, eyes were defined as having 1 chamber if intraocular lenses (IOLs) were sclerally or intrasclerally fixated, IOLs were fixed on-the-bag due to posterior capsular defects, vitreous collapse into the anterior chamber resulted from Zinn zonular dialysis, and phacodonesis or IOL-donesis required lens/IOL explantation during AGV implantation. The data collected were preoperative/postoperative IOPs, numbers of antiglaucoma medications, visual acuity, anterior chamber flare, visual field mean deviation, corneal endothelial cell density, and surgical complications/interventions.

Results:
The preoperative IOP (28.5±9.4 mm Hg) and a number of antiglaucoma medications (3.2±1.2) decreased significantly (P<0.0001 for both) to 9.8±3.3 mm Hg and 1.3±1.3, respectively, at the final visit (mean follow-up, 23 mo). The success rates of IOP control (6 to 21 mm Hg and >20% reduction irrespective of medication use) were 82.5% and 79.0%, respectively, at postoperative years 1 and 2. The most common postoperative complications were macular edema (n=9, 17%), choroidal detachment (n=8, 15%), vitreous hemorrhage (n=7, 13%), and hyphema (n=7, 13%). The most common postoperative intervention was tubal repositioning/reopening (n=6, 12%). Compared with preoperative values, the visual acuity, anterior chamber flare, mean deviation, corneal endothelial cell density remained unchanged postoperatively.

Conclusion:
Choice of pars plana AGV tube insertion with simultaneous vitrectomy is reasonable to achieve IOP reduction and minimize vision-threatening complication in glaucomatous eyes with a damaged iris-lens diaphragm.
Are diabetes microvascular complications risk factors for fragility fracture?
Authors: Almutlaq Nourah , Neyman Anna , DiMeglio Linda A. 
Published: May 2021

Purpose of review
We describe relationships between microvascular complications and bone fragility fracture in the context of diabetes. We highlight gaps in knowledge and suggest areas of further study.

Recent findings
Evidence in type 1 diabetes (T1D) demonstrates that low bone mineral density (BMD) is associated with microvascular complications and linked to increased fracture risk. Of note, the low BMD does not solely explain bone fragility. Microvascular disease also has been linked to compromised bone microarchitecture and poorer bone quality. Moreover, microvascular complications may indirectly increase the rate of fragility fracture through increasing fall propensity; however, to date no conclusive studies have assessed microvascular disease and fracture risk independent of falls.
In the other hand, individuals with type 2 diabetes (T2D) have increased fracture risk despite high BMD. Data suggest microvascular disease mediates microarchitectural changes by increasing cortical porosity and is associated with lower bone turnover. There is no direct evidence linking microangiopathy to fracture incidence.

Summary
Taken together present evidence suggests associations between diabetic bone disease, fragility fracture, and microvascular disease. Data are more convincing for T1D than T2D. Further studies are required to confirm whether microvascular disease is itself causative of fracture or merely a contributory factor to fragility fracture for persons with diabetes.
Impact of COVID-19 on New Graduate Nurses' Transition to Practice
Authors: Smith Susan M. , Buckner Martha , Jessee Mary Ann , Robbins Veronica , Horst Tessa , Ivory Catherine H. 
Published: May 2021

Background
The COVID-19 pandemic disrupted nursing education and required modification of instructional methods and clinical experiences. Given the variation in education, rapid transition to virtual platforms, and NCLEX-RN testing stressors, this cohort faced unique losses and gains influencing their transition into clinical practice.

Purpose
This study examined the impact of COVID-19 and preparedness for professional practice of 340 new graduate nurses (NGNs) at an academic medical center.

Methods
This was a mixed-methods descriptive study focusing on how clinical experience loss or gains in the final semester affected the fears, concerns, and recommendations for NGNs.

Results
More than half (67.5%, n = 295) of NGNs reported changes to clinical experiences, ranging from 0 to 240 hours transitioned to virtual (n = 187; median, 51; interquartile range, 24-80). NGNs fear missing important details or doing something wrong in providing patient care. They identified the need for preceptor support, guidance, teaching, and continued practice of skills.

Conclusion
Recommendations are clear communication with leadership, advocacy from the nurse residency program, and targeted clinical and emotional support for NGNs.
Laboratory Markers of Acidosis and Mortality in Cardiogenic Shock: Developing a Definition of Hemometabolic Shock
Authors: Jentzer Jacob C. , Kashani Kianoush B. , Wiley Brandon M. , Patel Parag C. , Baran David A. , Barsness Gregory W. , Henry Timothy D. , Van Diepen Sean 
Published: May 2021

ABSTRACT

Background:
Acidosis and higher lactate predict worse outcomes in cardiogenic shock (CS) patients. We sought to determine whether overall acidosis severity on admission predicted in-hospital mortality in CS patients.

Methods:
This retrospective descriptive analysis included CS patients admitted to a single academic tertiary cardiac intensive care unit from 2007 to 2015. Admission arterial pH, base excess, and anion gap values were used to generate a Composite Acidosis Score (range 0–5, with a score ≥2 defining Severe Acidosis). Adjusted in-hospital mortality was analyzed using multivariable logistic regression.

Results:
We included 1,065 patients with median age of 68.9 (59.0, 77.2) years (36.4% females). Concomitant diagnoses included cardiac arrest in 38.1% and acute coronary syndrome in 59.1%. Severe Acidosis was present in 35.2%, and these patients had worse shock and more organ failure. In-hospital mortality occurred in 34.1% and was higher among patients with Severe Acidosis (54.9% vs. 22.4%, adjusted odds ratio [OR] 2.01, 95% CI 1.43–2.83, P < 0.001). Increasing Composite Acidosis Score was associated with higher in-hospital mortality (adjusted OR 1.25 per point, 95% CI 1.11–1.40, P < 0.001). Severe Acidosis was associated with higher hospital mortality at every level of shock severity and organ failure (all P < 0.05). Admission lactate level had equivalent discrimination for in-hospital mortality as the Composite Acidosis Score (0.69 vs. 0.66; P = 0.32 by De Long test).

Conclusion:
Given its incremental association with higher in-hospital mortality among CS patients beyond shock severity and organ failure, we propose Severe Acidosis as a marker of hemometabolic shock. Lactate levels performed as well as a composite measure of acidosis for predicting mortality.
The effect of long-term awareness on active and passive tobacco smokers
Authors: Köksoy Serkan , Kara Fatih 
Published: May 2021

Background and objectiveTobacco addiction is a major public health problem. Numerous scientific studies have been conducted on the harms of tobacco products. However, the number of intervention studies investigating the effect of long-term awareness of the harm of tobacco products on the Fagerström nicotine addiction test (FTND), carbon monoxide (CO), carboxyhemoglobin (COHb) and respiratory function test (RFT) are limited. Our goal is to investigate the impact of long-term scientific awareness on these parameters.Participant and MethodThe study was designed an intervention study on active and passive smoking participants and their control groups. Intervention groups were given seminar program (up-to-date literature information and images on the harms of tobacco products) for eight weeks. Control groups were not given any training on the harms of tobacco products. Intervention groups were measured 8 times (FNBT, CO, COHb and SFT). Control groups were measured only in the first and last week.ResultWhen comparing the first and last weeks in active smoker intervention group (ASIG), the difference between FTND, FEV1, CO, and COHb parameters was observed to be statistically significant. The highest decrease in ASIG was in CO (60%) parameter and the highest increase was in the FEV1(%10) parameter. There was a significant difference between FEV1, FVC, FEV1/FVC, and CO parameters of passive smokers intervention group (PSIG). The highest decrease in PSIG was in the CO parameter (%65.8) and the highest increase was in the FVC (%10) parameter.ConclusionAwareness programs may reduce the severity of addiction in active smokers and may help protect passive smokers. In the absence of any awareness, it may not positively change. As awareness increases, positive changes in some vital parameters may be possible. Up-to-date programs and policies are needed to make easy and sustainable awareness of both active and passive smoking.