bluuebunny/crossref_metadata_2025_split huggingface dataset:
EFFECTIVENESS OF EN BLOC REMOVAL OF FIBRINOGEN-RICH COMPONENT OF CYSTOID LESION FOR THE TREATMENT OF CYSTOID MACULAR EDEMA
Authors: Imai Hisanori , Otsuka Keiko , Tetsumoto Akira , Miki Akiko , Nakamura Makoto 
Published: October 2018

Purpose:
To introduce the methodology and outcomes of en bloc removal of the component of cystoid lesion during pars plana vitrectomy as a novel approach for the treatment of cystoid macular edema and show evidence that the component is an aggregation of fibrinogen by mass spectrometry analysis.

Methods:
The surgical en bloc extraction of the component of cystoid lesion was performed for cystoid macular edemas secondary to diabetic retinopathy and retinal vein occlusion. Perioperative change of best-corrected decimal visual acuity, and the central retinal thickness and the continuity of subfoveal ellipsoid zone and external limiting membrane on optical coherence tomography were evaluated. Mass spectrometry was performed for the identification of protein constituting the component.

Results:
Six eyes from six patients were included in the study. In all cases, central retinal thickness was improved after the surgery and remained stable during the follow-up period. Best-corrected decimal visual acuity and the continuity of ellipsoid zone and external limiting membrane were kept in all cases during the follow-up period. The mass spectrometry analysis disclosed that the component was composed of fibrinogen.

Conclusion:
The en block removal of the component of cystoid lesion combined with pars plana vitrectomy may be a promising option for treatment of cystoid macular edema. The component of cystoid lesion is presumably a fibrinogen aggregate.
Management Algorithm for Fungal Keratitis: The TST (Topical, Systemic, and Targeted Therapy) Protocol
Authors: Sharma Namrata , Sahay Pranita , Maharana Prafulla K. , Singhal Deepali , Saluja Gunjan , Bandivadekar Pooja , Chako Jacob , Agarwal Tushar , Sinha Rajesh , Titiyal Jeewan S. , Satpathy Gita , Velpandian Thirumurthy 
Published: October 2018

Purpose:
To evaluate the efficacy of the topical, systemic and targeted therapy (TST) protocol in management of fungal keratitis.

Method:
All cases of treatment-naive smear- or culture-proven fungal keratitis presenting between June 2013 and May 2017 were recruited. The TST protocol included initial treatment with topical natamycin 5% with addition of oral ketoconazole or voriconazole in ulcers with size >5 mm, depth >50%, or impending perforation. Topical voriconazole 1% was included in case of poor response at 7 to 10 days. Intrastromal or intracameral antifungal injections were administered in case of poor response to combination therapy. Penetrating keratoplasty was performed in case of poor response to any of the regimen.

Results:
The study included 223 cases of fungal keratitis with a mean age of 43.6 ± 15.3 years and a male-to-female ratio of 1.8:1. The mean area of the ulcer and infiltrate at presentation was 25.52 ± 19 and 25.7 ± 14.4 mm2, respectively. Corrected distance visual acuity at presentation was 2.05 ± 0.43 logMAR that improved to 1.6 ± 0.4 logMAR at 3 months. Fusarium (42.2%) was the most common microorganism isolated, followed by Aspergillus (32.8%). The mean healing time was 41.5 ± 22.2 days, with a final scar size of 14.6 ± 8.2 mm2. The treatment success rate with the TST protocol was 79.8%. Corneal perforation developed in 7% of cases (n = 15), and keratoplasty was performed for 20.2% of cases (n = 45).

Conclusions:
The TST protocol provides a stepwise treatment algorithm for management of cases of fungal keratitis with varying severity.
Descemet Membrane Endothelial Keratoplasty (DMEK) Graft Dislocation Into the Vitreous Cavity
Authors: Vasquez-Perez Alfonso , Brennan Nicholas , Ayoub Tariq , Allan Bruce , Larkin Daniel F. P. , da Cruz Lyndon 
Published: October 2018

Purpose:
To present our experience of Descemet stripping endothelial keratoplasty (DMEK) graft luxation into the vitreous cavity in 2 cases.

Methods:
DMEK was performed in 2 patients with aphakic bullous keratopathy. The indications for keratoplasty were endothelial failure caused by chronic intermediate uveitis and glaucoma in 1 case and decompensated previous penetrating keratoplasty in the other. Both cases had enlarged pupils and had previously undergone pars plana vitrectomy. In both cases, the DMEK graft dislocated into the vitreous cavity during unfolding maneuvers and could not be retrieved during the same procedure.

Results:
No signs of retinal detachment were observed during follow-up (6 months and 1 year). Although visualization of the graft was not possible on examination, B-scan confirmed the presence of the lenticule lying over the retina. One case underwent repeat DMEK, and 1 case underwent repeat penetrating keratoplasty. In 1 case, the graft was retrieved after a month and sent for histopathology. In both cases, corneal transparency and corrected visual acuity improved to full potential after the final procedure. Histopathology of the retrieved graft showed only endothelial cell loss and no fibrocellular proliferation.

Conclusions:
The risk of fibrous proliferation and retinal detachment after posterior dislocation of DMEK grafts may be less than in grafts including corneal stroma, but pars plana vitrectomy and retrieval of the dislocated corneal transplant are still indicated after revision corneal transplant surgery where visual symptoms or signs of fibrotic change around the dislocated graft are evident.
Secukinumab-Associated Crystalline Corneal Deposition
Authors: Power Barry , Pilson Qistina , Fulcher Timothy 
Published: October 2018

Purpose:
To describe the first reported case of corneal crystalline deposition associated with the monoclonal antibody secukinumab (Cosentyx; Novartis, Basel, Switzerland) and the subsequent follow-up of the case.

Methods:
Case report.

Results:
An 18-year-old man was referred for a corneal opinion 1 year after commencing secukinumab monoclonal antibody therapy for ankylosing spondylitis. Crystalline corneal deposits were identified at a routine optometrist appointment. The same optometrist had documented normal anterior segment examination 2 years earlier. On examination, anterior stromal refractile crystals were visible in both corneas extending out to the limbus. The patient's best-corrected distance visual acuity was 20/20 bilaterally, and he was asymptomatic. Family history and systemic workup for other causes of crystal deposition were negative. By a process of elimination of other etiologies, we concluded that the monoclonal antibody secukinumab was responsible for the deposition. At the 1-year point of treatment with secukinumab, the patient remains asymptomatic and is still undergoing therapy.

Conclusions:
To the best of the authors' knowledge, this is the first report of corneal crystal deposition attributed to secukinumab. The number of monoclonal antibodies in use across multiple medical disciplines is increasing, and corneal specialists may see this presentation more frequently in the future. These drugs provide critical disease-modifying treatment to patients with debilitating systemic pathology. It is important that we understand the natural history of their side effects to allow their full utilization.
Challenges in Conducting Ethnography Among Hidden Populations in Rural South India
Authors: von Gaudecker Jane R. 
Published: October 2018

ABSTRACT
International qualitative researchers confront many challenges while conducting studies among hidden populations. This article describes challenges experienced as a US-based researcher and native Indian woman conducting a focused ethnography among women with epilepsy in rural south India. The 5 challenges encountered during this research were (1) obtaining ethical approvals to conduct the study, (2) recruiting hidden participants, (3) being a halfie, (4) addressing a sensitive topic with a vulnerable population, and (5) managing researcher distress and intrapersonal conflicts. The article also details strategies used to confront these challenges.
Unique Stroke Symptoms in Women: A Review
Authors: Colsch Renee , Lindseth Glenda 
Published: October 2018

ABSTRACT

Background: Research suggests that there is a delay in recognizing unique stroke symptoms in women by both healthcare professionals and the general population. The purpose of this review was to identify and summarize the most relevant literature regarding recognition and assessment of unique stroke symptoms in women. Methods: Literature review using PubMed, CINAHL, ERIC, MEDLINE, PsycINFO, and Google Scholar was used to search literature describing unique stroke symptoms. Results: Unique stroke symptoms, female sex, and race are associated with delayed recognition, treatment, misdiagnosis, and outcomes. Women experience unique symptoms of nausea/vomiting, headache, dizziness, and cognitive dysfunction more often than men. Stroke assessment tools and registries recognize 1 to 4 of the 11 unique stroke symptoms in women, no study directly assesses the sensitivity and specificity of these unique symptoms, and all studies included women and men. Conclusions and Nursing Implications: Current assessment tools and registries are not sensitive and specific to measuring unique stroke symptoms in women. Accurately identifying unique stroke symptoms in women may reduce presentation and treatment time, minimizing misdiagnoses and poor patient outcomes.
Tissue perfusion alterations correlate with mortality in patients admitted to the intensive care unit for acute pulmonary embolism
Authors: Urbina Tomas , Bigé Naïke , Nguyen Yann , Boelle Pierre-Yves , Dubée Vincent , Joffre Jérémie , Abdallah Idriss , Baudel Jean-Luc , Maury Eric , Guidet Bertrand , Ait-Oufella Hafid 
Published: October 2018

Abstract
We aimed to assess the relationship between alterations of tissue perfusion parameters at admission (highly predictive of mortality in septic shock) and outcome in patients admitted to the intensive care unit (ICU) for acute pulmonary embolism (PE). We conducted a retrospective study to analyze the association between arterial lactate level, skin mottling and urinary output, and 28-day mortality.
Over a 22-year period, 317 patients with PE were identified but we finally analyzed 108 patients whose main diagnosis for ICU admission was acute PE. At admission, the sequential organ failure assessment score was 2 (0–6) and the simplified acute physiology score II was 29 (16–43). Thirty patients (28%) received vasopressors and 37 patients (34%) received thrombolytic therapy. Day 28 mortality rate was 25% (n = 27). When compared to 28-day survivors, nonsurvivor patients had higher lactate level (4.5 [2.3–10.3] mmol/L vs 1.4 [1–2.9] mmol/L, P < .0001), more frequent mottling around the knee area (56% vs 25%, P = .003) and a lower urinary output (during the first 6 hours) (0.35 [0–1] mL/kg/h vs. 0.88 [0.62–1.677] mL/kg/h, P = .0002). Mortality increased with the number of tissue perfusion alterations present upon admission, 8% for none, 21% for 1, 28% for 2, and finally reached 85% for 3 tissue perfusion alterations (P < .0001). In a multivariate analysis, the relationship between the number of tissue perfusion alterations and 28-day mortality was maintained after adjustment on the presence of shock and right ventricular dilation at admission.
In ICU patients admitted for acute PE, tissue perfusion alterations correlated with 28-day mortality independently of blood pressure and right ventricular dilation.
The clinical and economic consequences of practice style variations in common surgical interventions
Authors: Nouhi Mojtaba , Hadian Mohamad , Olyaeemanesh Alireza 
Published: October 2018

Abstract

Background:
Surgical intervention is one of the common therapeutic interventions applied to a vast class of diseases. Unwarranted variation in practice style in different locations is considered as practice style variations (PSVs), which cause undesirable effects on patient health status and economic consequences. The magnitude of the variations in surgical interventions and its effects on clinical outcomes of patients and also utilization of resources have been investigated in recent years. But the findings show considerable heterogeneities in magnitude and consequences. We develop a protocol to systematically review the current literature of PSV to explain the magnitude of PSV and its clinical and economic consequences.

Method:
This systematic review will include observational and experimental studies to investigate magnitude and consequences of PSV in common surgical interventions, cardiovascular disease, urological, and ophthalmological diseases. Source of information is scientific databases, theses, clinical trials registrations website, and grey literature. A comprehensive electronic search will be conducted through PubMed, Web of Science, EBSCO, EMBASE, and Scopus databases. Studies are assessed systematically by 2 investigators. Methodological quality of the included studies is evaluated by the STROBE and CONSORT checklists. In case of data availability, we will pool findings of included studies by meta-analysis techniques in the CMA software. Subgroup analyses are based on the type of the interventions and selected diseases.

Results:
This study has ethical approval from ethical committee of Iran University of Medical Sciences, ethic code: IR.IUMS.REC1395.9221504203. The results will be published in a peer-reviewed journal.

Conclusion:
A systematic review is considered as an appropriate scientific method for reaching a consensus on magnitude as well as consequences of PSV. Results of this study will help clinical experts to attain more knowledge about PSV and encourage them to use some tools such as clinical guidelines and shared decision making to alleviate its consequences.
Right main bronchial pleomorphic adenoma
Authors: Zhu Zhixing , Lian Xihua , Yang Dongyong 
Published: October 2018

Abstract

Rationale:
Tracheobronchial benign tumors are uncommon; particularly, bronchial pleomorphic adenoma is one of the rarest benign tumors that develop in bronchus (only 7 reported cases, among which only 4 cases of pleomorphic adenoma were seen arising from right main bronchus).

Patient concerns:
In this report, a 38-year-old woman suffered from progressive shortness of breath for 5 years due to right main bronchial pleomorphic adenoma.

Diagnoses:
The patient was diagnosed as right main bronchial pleomorphic adenoma based on chest computed tomography enhanced scan, bronchoscopy, and histological examination.

Interventions:
An electrosurgical snare was performed to resect the neoplasm and several APC were administered at the sites of the resection to provide hemostasis and further coagulate for the residual neoplasm.

Outcomes:
The patient was free of symptoms and the lumen of right main bronchus was clear during the follow-up period for 10 months without any procedure-related complications.

Lessons:
Bronchial pleomorphic adenoma is extremely rare, however, we should take it into consideration if a patient suffered from shortness of breath without an exact cause.
Pancreatectomy for a secondary metastasis to the pancreas
Authors: Madkhali Ahmad Abdullah , Shin Sang-hyun , Song Ki Byung , Lee Jae Hoon , Hwang Dae Wook , Park Kwang Min , Lee Young Joo , Kim Song Cheol 
Published: October 2018

Abstract
The aim of the present study was to evaluate the short- and long-term outcomes of secondary metastasis to the pancreas in terms of overall survival (OS) and disease-free survival (DFS) after pancreatectomy.
This retrospective study included 29 patients who underwent pancreatectomy for secondary metastasis to the pancreas between December 1995 and August 2016.
The study group was divided into renal cell carcinoma (RCC) (17 patients) and non-RCC (12 patients). The non-RCC group had 5 cases of colorectal cancer and 7 of another primary origin. The OS for the whole cohort was 86.2% at 1 year, 63.2% at 3 years, and 46.7% at 5 years. There was no significant difference between the 2 groups at 1, 3, and 5 years survival and OS. In subgroup analysis of patients who underwent curative resection, there was no significant difference in OS between the 2 groups at 1, 3, and 5 years. However, there was a significant difference in recurrence rate at 3 years (P = .035). Pathologic analysis showed that the non-RCC group had significantly more positive lymph node metastasis than the RCC group (P = .002).
Pancreatectomy for secondary metastasis has promising short- and long-term outcomes in terms of OS and DFS.
Modulation of macrophage polarization by level-1 Yo-Yo intermittent recovery test in young football players
Authors: Chiu Chen-Jan , Chi Chih-Wen , Hsieh Hui-Ru , Huang Yu-Chuen , Wu Huey-June , Chen Yu-Jen 
Published: October 2018

Abstract
The aim of this study was to examine the effect of the level-1 Yo-Yo intermittent recovery test (YYIRT1) on polarization of macrophages in young football players.
Fourteen male football players (19.9 ± 1.4 years old) were enrolled in this study. YYIRT1 was performed with 20-meter shuttle runs at increasing speeds and 10-second active recovery in a 5-meter distance between runs till exhaustion. Fasting blood samples were collected before and immediately after YYIRT1. Analysis for macrophage polarization by flow cytometry, reactive oxygen species (ROS) by flow cytometry, biochemical parameters by chemical reactions, and serum cytokines by ELISA were performed. The rating of perceived exertion (RPE) and cardiovascular parameters were recorded.
The time to exhaustion was 714.1 ± 114.4 seconds. The oxygen uptake (

JOURNAL/medi/04.03/00005792-201810190-00021/inline-graphic2/v/2023-09-14T035032Z/r/image-tiff

) was 48.7 ± 5.6 mL/min/kg, RPE scale was 19 ± 1, resting heart rate and maximal heart rate were 64.9 ± 8.8 beat/min and 181.9 ± 9.3 beat/min, respectively, indicating a high level of cardiopulmonary fitness. The expression of macrophage-specific CD14 and M1 marker HLA-ABC, but not M2 marker CD206, was down-regulated after YYIRT1. The intracellular ROS levels in macrophages had no significant change. In biochemical profile, the serum levels of lactic dehydrogenase (LDH), a marker of muscle damage, increased after YYIRT1 whereas no significant alteration was noted in creatine phosphokinase (CPK), blood urine nitrogen, creatinine, aspartate transaminase (AST), alanine transaminase (ALT), and C-reactive protein. The serum levels of interleukin (IL)-6, IL-10 and tumor necrosis factor (TNF)-α had no significant change.
The YYIRT1 may induce muscle damage accompanied by modulation of macrophage polarization toward suppression of M1 phenotype in young football players.
Randomized study of intravesical pirarubicin chemotherapy with low and intermediate-risk nonmuscle-invasive bladder cancer in Japan
Authors: Naya Yoshio , Mikami Kazuya , Takaha Natsuki , Inoue Yuuta , Fujihara Atsuko , Kanazawa Motohiro , Nakanishi Hiroyuki , Miyashita Hiroaki , Ukimura Osamu 
Published: October 2018

Abstract

Purpose:
The objective of this study was to evaluate the efficacy, defined by the 3-year tumor recurrence-free survival rate, of intravesical chemotherapy using pirarubicin (THP) in patients with low or intermediate-risk nonmuscle-invasive bladder cancer (NMIBC).

Patients and methods:
Between October 2010 and January 2015, 206 patients were enrolled, and finally 113 were randomized to receive either a single immediate postoperative intravesical instillation of THP (30 mg) (Group A), or 8 additional weekly intravesical instillations of THP (30 mg) after a single postoperative instillation (Group B). The patients were examined by performing cystoscopy and urine cytology every 3 months after transurethral resection to determine bladder tumor recurrence. The primary endpoint was 3-year-recurrence-free survival rate.

Results:
All 113 patients were bacillus Calmette–Guérin (BCG)-naïve. The 3-year recurrence free survival rate was 63.7% for Group A and 85.3% for Group B (log-rank test, P = .0070). In patients with intermediate recurrence risk, the 3-year recurrence-free survival rate was 63.4% in Group A and 86.1% in Group B (log-rank test, P = .0036). Cox regression analysis revealed that only additional instillation of THP was a significant independent factor for recurrence-free rate in patients with intermediate risk. No patient with progression was noted during this period. Frequent adverse effects (AEs) were frequent urination and micturition pain, and no severe AEs (Grade 3 or more) occurred.

Conclusion:
Additional instillation of THP (30 mg) weekly for 8 weeks reduced the risk of tumor recurrence without severe AEs in BCG-naïve NMIBC patients with intermediate risk.
The effect of nursing intervention on preoperative cataract
Authors: Gong Dan-hui , Liu Jia-feng , Zhao Xin , Zhang Li 
Published: October 2018

Abstract
This retrospective study investigated the effect of nursing intervention (NIV) in Chinese patients under preoperative cataract (PC). A total of 70 eligible patients with PC were included. Thirty-five patients in an intervention group received regular clinical treatment and NIV before the surgery, while the other 35 patients received regular clinical treatment only. The NIV was applied 4 sessions, 1 week before the surgery. The primary outcome of satisfaction was measured by 11-points visual analog scale. The secondary outcomes were measured by the functional impairment caused by cataract (the VF-14), cooperativeness during the surgery period, and sleep quality. All the outcome measurements were assessed before and after the surgery. After NIV, patients in the intervention group exerted better outcomes in decreasing anxiety (P < .01), increasing current experience with satisfaction (P < .01), and enhancing the cooperativeness during the surgery period (P < .01), compared to those outcomes in the control group. The results of this study showed that NIV may help increase satisfaction in experience and cooperation, and decrease anxiety in Chinese patients with PC.