bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterization of the Activity of Croton tiglium Oil in Hetter's Very Heavy Phenol–Croton Oil Chemical Peels
Authors: Justo Aline S. , Lemes Bruna M. , Nunes Bruna , Antunes Kevin A. , Capote Anna Claudia M. O. , Lipinski Leandro C. , Campagnoli Eduardo B. , Emiliano Janaina , Meurer Eduardo C. , Ezemma Ogechi , Miot Helio A. , Beltrame Flávio L. , Wambier Carlos G. 
Published: March 2021

BACKGROUND
Croton oil (CO) is used by dermatologists and plastic surgeons in deep chemical peels. It is mixed with phenol, water, and a soap in Baker–Gordon's or Hetter's formulas. There is controversy as to whether CO or phenol is the active agent in the dermal effect of deep chemical peels.

OBJECTIVE
To better clarify the role of CO in deep peels, by identification of active compounds in commercially available CO in the United States and biological effects in vivo.

MATERIALS AND METHODS
Liquid chromatography–tandem mass spectrometry on CO and a domestic pig model experiment using 3 different formulas: G1: 5% Septisol (SEP), G2: 1.6% croton oil in 35% phenol with 5% SEP, and G3: 35% phenol with 5% SEP.

RESULTS
Liquid chromatography–tandem mass spectrometry indicated the presence of phorbol esters. G1 was null overall. Extent of the coagulative necrosis: G2 > G3. Vascular ectasia: G2 > G3. Inflammation pattern: intense neutrophilic inflammatory band in G2 versus mild, sparse, perivascular mononuclear cell infiltrate in G3. Neocollagenesis: pronounced in G2, negligible in G3.

CONCLUSION
Coagulative necrosis of the epidermis, superficial fibroblasts, and vasculature can be attributed to the action of phenol. Phorbol esters on CO could be responsible for the dense deep acute inflammation and the distinctive neocollagenesis.
QUANTIFICATION OF VESSELS OF HALLER'S LAYER BASED ON EN-FACE OPTICAL COHERENCE TOMOGRAPHY IMAGES
Authors: Shiihara Hideki , Sonoda Shozo , Terasaki Hiroto , Kakiuchi Naoko , Shinohara Yuki , Tomita Masatoshi , Sakamoto Taiji 
Published: March 2021

Purpose:
To quantify the vessels of Haller's layer of normal subjects in en-face optical coherence tomographic images.

Methods:
One hundred and seventy-two normal eyes were studied. En-face images of the top 25% slab of Haller's layer was analyzed. The vessel area, vessel length, and mean vessel diameter were calculated. The vessel running pattern was quantified for the degree of symmetry and designated as the “symmetry index.” The coefficient of correlation between each choroidal parameter and the age, sex, axial length, and central choroidal thickness was determined.

Results:
The vessel area was 23.4 ± 3.6 mm2, vessel length was 164.6 ± 24.1 mm, mean vessel diameter was 0.143 ± 0.019 mm, and the symmetry index was 58.6 ± 6.1%. Multiple regression analysis showed that the vessel area was significantly correlated with the age (R = −0.421, P < 0.001) and central choroidal thickness (R = 0.315, P < 0.001). The vessel length was significantly correlated with the age (R = −0.391, P = 0.024) and central choroidal thickness (R = −0.410, P < 0.001). The mean vessel diameter was significantly correlated with the age (R = −0.107, P = 0.024) and central choroidal thickness (R = 0.775, P < 0.001). The correlation between the symmetry index and any clinical findings was not significant.

Conclusion:
Quantification of en-face images of Haller's layer provide new biomarkers of the choroid.
NATURAL HISTORY AND PREDICTORS OF VISION LOSS IN EYES WITH DIABETIC MACULAR EDEMA AND GOOD INITIAL VISUAL ACUITY
Authors: Lent-Schochet Daniella , Lo Therlinder , Luu Kieu-Yen , Tran Steven , Wilson Machelle D. , Moshiri Ala , Park Susanna S. , Yiu Glenn 
Published: March 2021

Purpose:
To identify clinical and anatomic factor–associated vision loss in eyes with treatment-naïve diabetic macular edema and good initial visual acuity.

Methods:
Retrospective cohort study after long-term history of eyes with untreated center-involving diabetic macular edema and baseline visual acuity ≥ 20/25 seen at the University of California, Davis Eye Center between March 2007 and March 2018. We collected characteristics including diabetes type, hemoglobin A1c, presence of visual symptoms, visual acuity, and diabetic retinopathy severity; and spectral-domain optical coherence tomography biomarkers including central subfield thickness, intraretinal cyst size, intraretinal hyperreflective foci, disorganization of retinal inner layers, and outer layer disruptions to determine factors associated with vision loss as defined by DRCR Protocol V as threshold for initiating aflibercept therapy.

Results:
Fifty-six eyes (48 patients) with untreated diabetic macular edema and mean baseline visual acuity of logMAR 0.05 ± 0.05 (Snellen 20/22) were followed for an average of 5.1 ± 3.3 years, with a median time to vision loss of 465 days (15 months). Older age (hazard ratio [HR] 1.04/year, P = 0.0195) and eyes with severe NPDR (HR 3.0, P = 0.0353) or proliferative diabetic retinopathy (HR 7.7, P = 0.0008) had a higher risk of a vision loss event. None of the spectral-domain optical coherence tomography biomarkers were associated with vision loss except central subfield thickness (HR 0.98, P = 0.0470) and cyst diameter (HR 1.0, P = 0.0094).

Conclusion:
In eyes with diabetic macular edema and good initial vision, those with older age and worse diabetic retinopathy severity should be monitored closely for prompt treatment initiation when vision loss occurs.
ENDOGENOUS ENDOPHTHALMITIS IN THE SETTING OF COVID-19 INFECTION
Authors: Bilgic Alper , Sudhalkar Aditya , Gonzalez-Cortes Jesus H. , March de Ribot Francesc , Yogi Rohit , Kodjikian Laurent , Mathis Thibaud 
Published: March 2021

Purpose:
To describe endogenous endophthalmitis in the setting of COVID-19 pneumonia.

Methods:
Patients recovering from COVID-19 pneumonia who presented to our department with any or all of the following complaints: pain, watering, redness, and decreased vision were identified. All relevant data were collected for analysis.

Results:
Three patients with endogenous endophthalmitis were identified. All patients had been treated for COVID-19 pneumonia and therefore had received remdesivir and systemic steroids; 2 of the 3 patients received tocilizumab. All patients received vitreous biopsy, vitrectomy, and intraocular antibiotic injection. Patient 1 demonstrated Klebsiella pneumoniae in blood culture, K. pneumoniae and Escherichia coli in urine culture, and K. pneumoniae in vitreous fluid, whereas Patients 2 and 3 demonstrated Stenotrophomonas maltophilia and methicillin-resistant Staphylococcus aureus in the blood and nasopharyngeal culture, respectively. Correspondingly, the same organism was cultured from vitreous in Patients 2 and 3. The visual acuity at the last follow-up in Patients 1 to 3 was 20/100, 20/80, and 20/40, respectively. The probable source of infection was identified in each as renal calculi, dental caries, and the pharynx, respectively. Real-time polymerase chain reaction demonstrated the presence of Severe Acute Respiratory Syndrome Coronavirus 2 in the vitreous fluid of Patient 1.

Conclusion:
We report good outcomes of early intervention for endogenous endophthalmitis in the setting of COVID-19 infection. We also document the presence of SARS-CoV-2 in vitreous.
PRESUMED INTRARETINAL TUBERCULOSIS: CASE REPORT WITH MULTIMODAL IMAGING INCLUDING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Alsberge Joseph B. , Safi Mustafa , Peng Michelle Y. , Jumper J. Michael 
Published: March 2021

Purpose:
To report a case of presumed intraretinal tuberculosis evaluated with optical coherence tomography angiography.

Methods:
Case report.

Results:
A 61-year-old woman recently immigrated from China presented with round yellow-white retinal lesions in the left eye. The lesions were evaluated with multimodal imaging, including optical coherence tomography angiography. Subsequent serologic testing revealed a positive QuantiFERON-TB Gold test, whereas workup for other entities was negative. The patient was diagnosed with presumed intraretinal tuberculosis. She was started on systemic antitubercular therapy and the lesions regressed. The regression was documented with optical coherence tomography angiography.

Conclusion:
Case reports of primary intraretinal tuberculosis are uncommon. To the best of our knowledge, this is the first case to demonstrate optical coherence tomography angiography findings of presumed intraretinal tuberculosis.
SUBRETINAL AIR USED AS A BALL VALVE TO STABILIZE A RETINAL BLEB
Authors: Garg Sunir J. , Gekeler Florian 
Published: March 2021

Purpose:
To describe a technique of using subretinal air to create and stabilize a neurosensory detachment performed during placement of a subretinal implant.

Methods:
A case report of an experiment in a live porcine model.

Results:
Creation of a neurosensory detachment may be facilitated by instillation of subretinal air. We use a small-gauge cannula to infuse approximately 0.1 mL of subretinal air to create a neurosensory detachment. We then expand the bleb using an additional 0.1 cc to 0.2 cc of subretinal air followed by balanced salt solution and stabilize it further with installation of viscoelastic. The small-gauge retinotomy should be created on the anterior and superior aspect of the bleb so that the air can tamponade the retinotomy both during surgery and postoperatively.

Conclusion:
This technique may be useful for some newer procedures, such as subretinal implants and perhaps administration of subretinal gene therapy or cell therapy, that require access to the subretinal space.
Evaluation of Retinal Nerve Fiber Layer, Ganglion Cell-Inner Plexiform Layer, and Optic Nerve Head in Glaucoma Suspects With Varying Myopia
Authors: Miller Gregg D. , Abu-Qamar Omar , Salim Sarwat 
Published: March 2021

Précis:
Myopic glaucoma suspects, particularly with high myopia, experience thinning of nontemporal parameters of retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL), without change in optic nerve head (ONH) parameters.

Purpose:
The aim was to assess the effect of myopia on RNFL, GCIPL, and ONH parameters in glaucoma suspects.

Materials and Methods:
Seventy-six eyes of glaucoma suspects studied with Cirrus high definition optical coherence tomography were divided into low (n=27), moderate (n=25), and high myopia (n=24) groups. Optical coherence tomography parameters were correlated with spherical equivalent (SE) and evaluated with areas under the receiver operating characteristic curve for quantifying diagnostic ability to differentiate high myopia from nonhigh myopia.

Results:
In high myopia, SE was positively correlated with thinning of average, minimum, and nontemporal GCIPL and thinning of average and nontemporal RNFL (P<0.05 for all), but not for inferior RNFL (P=0.28). In moderate myopia, SE was correlated with thinning of inferonasal and minimum GCIPL as well as superior and inferior RNFL (P<0.05 for all). SE was not correlated with ONH parameters in moderate or high myopia (P>0.05). The largest areas under the receiver operating characteristic curve for RNFL and GCIPL parameters were for superior (0.82) and superonasal (0.80) regions, respectively, with comparable diagnostic ability (P=0.74).

Conclusion:
High myopia, in particular, is associated with thinning of average RNFL, average and minimum GCIPL, and nontemporal parameters of both RNFL and GCIPL, warranting consideration of refractive status in glaucoma suspects.
Seven-year observation of posterior corneal elevation after small-incision lenticule extraction in patients with moderate and high myopia
Authors: Chen Zhuoyi , Zhao Yu , Zhou Xueyi , Xia Fei , Zhao Jing , Zhou Xingtao 
Published: March 2021

Purpose:
To investigate the long-term changes in posterior corneal elevation in moderate and high myopia after small-incision lenticule extraction (SMILE).

Setting:
Eye & ENT Hospital, Fudan University, Shanghai, China.

Design:
Prospective case series.

Methods:
33 eyes of 20 patients (30.1 ± 9.5 years, 7 men and 13 women, spherical equivalent [SE] range −4.00 to −8.75 D, mean SE −6.25 ± 1.29 D) who underwent SMILE were included. Changes in the posterior corneal elevation at central points (PCE), the thinnest point (PTE), the maximal point (PME), and an additional 20 points within the 4 mm area of the best-fit sphere were evaluated with a Pentacam (Oculus Optikgeräte GmbH) during a 7-year follow-up period. Mixed linear models were used to evaluate changes with P values less than 0.05. Correlations of elevation changes and residual bed thickness (RBT) were also evaluated.

Results:
No ectasia was observed among the 33 eyes studied. The safety index was 1.08, and the efficacy index was 1.03. The mean change in PCE at 1 year, 3 years, 5 years, and 7 years was −1.42 ± 0.95 μm, −2.67 ± 0.98 μm, −2.44 ± 1.06 μm, and −1.91 ± 0.92 μm, respectively. Statistically significant differences were found at 3 years, 5 years, and 7 years (P = .007, .023, and .040, respectively). PTE reduced significantly at each time point compared with baseline. The mean change was −2.82 ± 1.19 μm, −3.55 ± 1.22 μm, −3.47 ± 1.32 μm, and −2.39 ± 1.15 μm, respectively (P = .019, .004, .010, and .039, respectively). PME changed in 2.45 ± 1.02 μm at 7 years compared with baseline (P = .017). The changes in PCE and PME negatively correlated with the RBT.

Conclusions:
Long-term posterior corneal elevation was stable in moderate and high myopia after SMILE.
Selective transepithelial ablation with simultaneous accelerated corneal crosslinking for corneal regularization of keratoconus: STARE-X protocol
Authors: Rechichi Miguel , Mazzotta Cosimo , Oliverio Giovanni William , Romano Vito , Borroni Davide , Ferrise Marco , Bagaglia Simone , Jacob Soosan , Meduri Alessandro 
Published: March 2021

Purpose:
To evaluate the changes in refractive outcomes and corneal aberrations in central and paracentral keratoconus after selective transepithelial topography-guided photorefractive keratectomy combined with accelerated corneal crosslinking (STARE-X).

Settings:
Centro Polispecialistico Mediterraneo, Siena Crosslinking Center, and University of Messina, Italy.

Design:
Prospective, interventional, multicentric study.

Methods:
Patients were subdivided into 2 groups: Group 1 with cone located within the central 3 mm zone (50 eyes) and Group 2 (50 eyes) with cone located outside the central 3 mm zone. Follow-up was 2 years at least for all eyes. Outcome parameters included uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). Corneal tomography and corneal wavefront aberrations were assessed and compared before and 2 years after the treatment.

Results:
100 eyes of 100 patients underwent STARE-X protocol. At 2 years, UDVA and CDVA improved, and sphere, cylinder, and Kmax reduced after treatment in both groups (P < .001, respectively). Moreover, a statistically significant reduction was observed of total higher-order aberrations root main square (RMS), coma RMS, and spherical aberration RMS in both groups (P < .001, respectively). However, CDVA improved more in Group 1 than in Group 2 (P < .02).

Conclusions:
The STARE-X protocol demonstrated effective results in halting keratoconus progression and improving corneal regularity with a safe and effective profile. STARE-X improved both visual acuity and corneal aberration at 2 years. Longer follow-up studies are warranted to observe further long-term CXL flattening effect on the cone.
Flipped learning: A shift in graduate nursing education
Authors: Murphy Nancy , Strong Caron , Jones Gloria 
Published: March 2021

ABSTRACT
The coronavirus (COVID-19) pandemic has caused a shift in education. Nursing education must respond to these changing times by redesigning classroom instruction. Flipped learning (FL) is a proposed method for teaching advanced practice nurses that is student-centered and engaging, both critical areas for contemporary learners. This qualitative study explored the perspectives and experiences of the family nurse practitioner faculty and the family nurse practitioner nursing students who participated in FL. The type and level of FL practices faculty can apply to support students coming to class prepared to engage in active learning activities was also investigated. The study used an insider action research design. There were two arms of the study, faculty and student. Ten faculty-led learning circles with four faculty and three family nurse practitioner student focus groups, each with six students, were held over the course of the study. Thematic findings were developed from both student and faculty data. The results revealed that family nurse practitioner students had a positive attitude toward FL. Many expressed FL provided perceptions of gained confidence, personalized learning, increased engagement, and preparedness for classroom instruction. Overall, faculty preferred FL over traditional teaching approaches. Several active learning activities were used by faculty with clinical case studies being the most preferred by student participants. This study confirms FL is a plausible and promising approach to traditional classroom instruction. However, more robust studies are needed to determine its benefits in advanced practice nursing education.
Approach to pulmonary embolism: A clinical care pathway
Authors: El Hussein Mohamed Toufic , Bayrouti Ali 
Published: March 2021

ABSTRACT
Acute pulmonary embolism (PE) is a potentially fatal condition that is often underdiagnosed due to its ambiguous and generalized symptoms. As such, nurse practitioners (NPs) may struggle to respond in a timely and accurate manner to clients presenting with acute PE. Given the complexities of diagnosing and managing PE, we propose a visual clinical care pathway to support NPs in recognizing and stratifying clients' risks of PE. The article provides guidance regarding PE diagnostic testing and offers a summary of effective, evidence-based treatment options for adult clients, including those with cancer.
Update your “sore throat” differential list: A case report and discussion of oral chlamydia
Authors: Cunningham Jodi L. , Pilati Claudia D. , Cotler Karen F. 
Published: March 2021

ABSTRACT
There has been an exponential increase in sexually transmitted infections (STIs) in the United States, causing the Centers for Disease Control and Prevention to declare an epidemic. Current evidence demonstrates that extragenital STIs of the oropharynx and rectum are often asymptomatic and may not be associated with concurrent positive urogenital infections. As a result, these infections are often missed in primary care. Furthermore, guidelines only recommend extragenital site testing in men who have sex with men, excluding oropharyngeal chlamydia, despite evidence that extragenital STIs are occurring in other high-risk populations as well. A case report is provided to enhance primary health care providers' knowledge of extragenital STIs and promote early recognition and testing to improve patient outcomes.
Diagnostic Yield of Digital Tomosynthesis-assisted Navigational Bronchoscopy for Indeterminate Lung Nodules
Authors: Katsis James , Roller Lance , Aboudara Matthew , Pannu Jasleen , Chen Heidi , Johnson Joyce , Lentz Robert J. , Rickman Otis , Maldonado Fabien 
Published: March 2021

Background:
Navigational bronchoscopy is commonly used to sample lung nodules, with a better safety profile but lower diagnostic yield than computerized tomography-guided transthoracic needle biopsy. The addition of digital tomosynthesis to electromagnetic navigation, using intraprocedural images obtained from a C-arm fluoroscope to identify target lesion location and update navigational guidance, may improve diagnostic yield.

Methods:
Consecutive bronchoscopies using tomosynthesis-assisted fluoroscopic electromagnetic navigational bronchoscopy (F-ENB) at a single institution over a 1-year period were included. The primary outcome was diagnostic yield. A bronchoscopy was defined as diagnostic if pathologic examination revealed malignancy or specific histological findings indicative of lesional sampling with confirmatory 6-month follow-up for benign lesions.

Results:
A total of 324 patients with 363 nodules underwent F-ENB between April 25, 2018 and April 29, 2019. The average nodule size was 1.9±1.1 cm, 65% of the nodules were located in the peripheral third of the lung. A bronchus sign was present in 24% of cases. Of the 363 nodules, 299 (82.4%) had lesional findings. At 6-month follow-up, among these 299 nodules, 6 were found to be false negatives and 12 nodules were lost to follow-up. Considering all nodules lost to follow-up as false negatives, the 6-month diagnostic yield was 77.4%. Pneumothorax complicated 8 (2.5%) of cases. There was 1 episode of respiratory failure.

Conclusion:
This retrospective study suggests the diagnostic yield of F-ENB may exceed that of traditional ENB. Future prospective and comparative studies are needed to confirm these promising data.
Validation of the Microlife BP B3 AFIB upper arm blood pressure monitor in adults and adolescents according to the ANSI/AAMI/ISO 81060-2:2019 protocol
Authors: Beime Beate , Bramlage Carsten , Krüger Ralf , Deutsch Cornelia , van Mark Gesine , Bramlage Peter , Botta Beate 
Published: March 2021

Objective
Aim of this study was to validate the Microlife BP B3 AFIB/enterprise resource planning (ERP) No: BP3KT1-3 N blood pressure (BP) monitor according to the American National Standards Institute (ANSI)/Association for the Advancement of Medical Instrumentation (AAMI)/International Organization for Standardization (ISO) 81060–2:2019 in adolescents and adults from a general population.

Methods
BP measurements on the upper arm were performed in 85 subjects (age range 12–88 years), using the Microlife BP B3 AFIB and a standard mercury reference sphygmomanometer.

Results
A total of 255 valid BP comparisons were performed for the present validation analysis. The mean ± SD difference between the test and the reference device was 0.70 ± 7.05 mmHg for SBP (pass criterion ≤5 mmHg) and −0.85 ± 4.70 mmHg for DBP (pass criterion ≤5 mmHg) with the SD below the required value of ≤8 mmHg. The mean ± SD of the intraindividual differences between the test and the reference device was 0.70 ± 5.87 mmHg for SBP (pass criterion for the SD ≤6.90 mmHg) and −0.85 ± 4.19 mmHg for DBP (pass criterion for the SD ≤6.88 mmHg).

Conclusion
The Microlife BP B3 AFIB/ERP No: BP3KT1-3 N has passed the criteria of the ANSI/AAMI/ISO 81060–2:2019 protocol and can be recommended for home BP measurements in adolescents and adults.