bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microvasculature of the Optic Nerve Head and Peripapillary Region in Patients With Primary Open-Angle Glaucoma
Authors: Nascimento e Silva Rafaella , Chiou Carolina A. , Wang Mengyu , Wang Haobing , Shoji Marissa K. , Chou Jonathan C. , D’Souza Erica E. , Greenstein Scott H. , Brauner Stacey C. , Alves Milton R. , Pasquale Louis R. , Shen Lucy Q. 
Published: December 2018

Purpose:
To assess optic nerve head (ONH) and peripapillary microvasculature in primary open-angle glaucoma (POAG) of mild to moderate severity using swept-source optical coherence tomography angiography (OCTA).

Materials and Methods:
In a cross-sectional study, swept-source OCTA images were analyzed for 1 eye from each of 30 POAG patients with glaucomatous Humphrey visual field loss and 16 controls. The anatomic boundary of ONH was manually delineated based on Bruch’s membrane opening and large vessels were removed from en face angiography images to measure vessel density (VD) and the integrated OCTA by ratio analysis signal (IOS), suggestive of flow, in the ONH and peripapillary region. POAG subgroup analysis was performed based on a history of disc hemorrhage (DH) matched by visual field mean deviation (MD).

Results:
POAG (mean MD±SD, −3.3±3.0 dB) and control groups had similar demographic characteristics and intraocular pressure on the day of imaging. Groups did not differ in superficial ONH VD or flow indicated by IOS (P≥0.28). POAG eyes showed significantly lower VD (39.4%±4.0%) and flow (38.8%±5.6%) in deep ONH, peripapillary VD (37.9%±2.9%) and flow (43.6%±4.0%) compared with control eyes (44.1%±5.1%, 44.7%±6.9%, 40.7%±1.7%, 47.8%±2.5%, respectively; P≤0.007 for all). In the subgroup analysis, POAG eyes with (n=14) and without DH (n=16) had similar measured OCTA parameters (P>0.99 for all).

Conclusions:
The image processing methodology based on the anatomic boundary of ONH demonstrated compromised microvasculature in the deep ONH and peripapillary region in eyes with mild to moderate POAG, regardless of the history of DH.
Comparative Therapeutic Assessment of Atrial Fibrillation in Heart Failure With Reduced Ejection Fraction—A Network Meta-Analysis
Authors: Malik Aaqib H. , Aronow Wilbert S. 
Published: December 2018

Background:
Catheter ablation (CA) continues to prove to be an intriguing therapeutic option for the management of atrial fibrillation (AF) especially in patients with heart failure with reduced ejection fraction (HFrEF). Recent data have suggested that CA may be a viable first-line strategy for these patients.

Study Question:
Is CA more effective in managing patients with AF with HFrEF compared to optimal medical treatment and anti-arrhythmic drugs?

Data Sources:
Randomized controlled trials (RCTs) comparing CA, medical treatment, or antiarrhythmic drugs to each other or a placebo group for the treatment of AF in HFrEF. We performed a comprehensive search in PubMed, Embase, and Cochrane library to identify relevant RCTs.

Study Design:
Our primary outcomes of interest were all-cause mortality, hospitalization for heart failure, and the percentage change in left ventricular ejection fraction. Also, we looked at functional outcomes such as Minnesota Living with Heart Failure Questionnaire and 6-minute walking distance. We used event rates for categorical variables and mean differences between the groups for the continuous variables. We used a frequentist approach employing a graph theory methodology to construct a network meta-analysis model.

Results:
We ended up with 17 RCTs with 5460 participants and 5 different treatments in our network meta-analysis. Compared to optimal medical therapy, CA was effective in reducing all-cause mortality odds ratio (OR) 0.44 (95% confidence interval, 0.27–0.74; P-value: <0.001) and hospitalization for heart failure OR 0.41 (0.28–0.59; P-value: <0.001). CA also resulted in improvement in left ventricular ejection fraction OR 9.34 (7.13–11.55; P-value: <0.001), Minnesota Living with Heart Failure Questionnaire OR −7.75 (−13.98 to −1.52; P-value: <0.01), and 6MWT OR 27.30 (5.27–49.33; P-value: <0.02).

Conclusions:
CA is the most effective and safe treatment for AF patients with HFrEF. We should consider this as a first-line therapy for the management of these patients.
Management of Peutz‐Jeghers Syndrome in Children and Adolescents
Authors: Latchford Andrew , Cohen Shlomi , Auth Marcus , Scaillon Michele , Viala Jerome , Daniels Richard , Talbotec Cecile , Attard Thomas , Durno Carol , Hyer Warren 
Published: December 2018

ABSTRACTPeutz‐Jeghers syndrome (PJS) is a well‐described inherited syndrome, characterized by the development of gastrointestinal polyps, and characteristic mucocutaneous freckling. Development of small bowel intestinal polyps may lead to intussusception in children may require emergency laparotomy with potential loss of bowel. Gastrointestinal polyps may lead to bleeding and anemia. This European Society for Paediatric Gastroenterology Hepatology and Nutrition position paper provides a guide for diagnosis, assessment, and management of PJS in children and adolescents and guidance on avoiding complications from PJS or from the endoscopic procedures performed on these patients.This is the first position paper regarding PJS published by European Society for Paediatric Gastroenterology Hepatology and Nutrition. Literature from PubMed, Medline, and Embase was reviewed and in the absence of evidence, recommendations reflect the opinion of pediatric and adult experts involved in the care of polyposis syndromes. Because many of the studies that form the basis for the recommendations were descriptive and/or retrospective in nature, some of the recommendations are based on expert opinion. This position paper will be helpful in the appropriate management and timing of procedures in children and adolescents with PJS.
Facial Onset Motor and Sensory Neuronopathy Syndrome With a Novel TARDBP Mutation
Authors: Zhang Qin , Cao Bei , Chen Yongping , Liang Yan , Wei Qianqian , Zhou Dong , Shang Huifang 
Published: December 2018

Introduction:
Facial onset sensory and motor neuronopathy (FOSMN) syndrome was a rare and slowly progressive neurodegenerative disorder, which heralded by sensory symptoms within the face, and followed by evolution of sensory and motor deficits in the face and limbs. The underlying pathogenesis of FOSMN remains to be fully elucidated.

Case Report:
A 40-year-old man was admitted to our hospital with facial sensory deficits spreading in a rostral-caudal manner. He then developed diffuse fasciculation, bulbar signs, atrophy and weakness of facial, neck, and limb muscles progressively, a process resembling amyotrophic lateral sclerosis. Neurophysiological studies demonstrated abnormal blink reflexes and some denervation-reinnervation changes in electromyogram. He was diagnosed with FOSMN syndrome clinically. A novel heterozygous Gly386Glu mutation in the transactive response DNA-binding protein (TARDBP) gene was found. The patient had no response to immunologic treatment and finally died of respiratory failure.

Conclusions:
This is the first time that a novel mutation in TARDBP gene was identified in a patient with FOSMN syndrome, which further suggested a link between FOSMN and amyotrophic lateral sclerosis. Our findings widen the spectrum of TARDBP-related motor neuron diseases.
Generalized Convulsive Status Epilepticus Secondary to Jarisch-Herxheimer Reaction in Neurosyphilis
Authors: Rissardo Jamir P. , Caprara Ana L.F. , Silveira Juliana O.F. 
Published: December 2018

Introduction:Jarisch-Herxheimer reaction (JHR) is defined as a transient immunologic reaction, classically seen in patients during syphilis treatment. JHR is a rare cause of status epilepticus (SE) in neurosyphilis. We describe a case of generalized convulsive SE (GCSE) probably secondary to JHR in a patient with neurosyphilis.Case Report:A 23-year-old man presented with progressive behavioral changes with 4 months of onset and pupillary alteration with 9 months of onset. He had experienced blurred vision and had noticed mydriasis in the left eye. Brain magnetic resonance imaging was normal; however, sexually transmitted infections were not investigated. After 1 month, the blurred vision disappeared, but mydriasis remained. Three months passed, and he reported progressive behavioral changes. Laboratory tests were within the normal limits, except by positive blood venereal disease research laboratory. Later, the cerebrospinal fluid analysis was requested, which revealed a positive venereal disease research laboratory. Electroencephalogram and brain magnetic resonance imaging were normal. Treatment was started with crystalline penicillin G. A GCSE began 12 hours after the first dose of penicillin. He did not develop classic signs and symptoms of the JHR. An EEG showed periodic lateralized epileptiform discharges.Conclusions:To the author’s knowledge, there are 3 cases in the literature of nonconvulsive SE with JHR in neurosyphilis, and the present report was the first to describe the occurrence of GCSE secondary to JHR in neurosyphilis. Another important finding, in this case, was the isolated unilateral mydriatic tonic pupil, rarely reported as an early isolated symptom of neurosyphilis. In this way, it is essential that patients presenting with isolated unilateral tonic pupil receive an adequate investigation for syphilis.
Changes in the Properties of the Preferred Retinal Locus with Eccentric Viewing Training
Authors: Hassan Shirin E. , Ross Nicole Christie , Massof Robert W. , Stelmack Joan 
Published: December 2018

SIGNIFICANCE
This study explores whether eccentric viewing training (EVT) changes the properties of the retinal area used for fixation in subjects with bilateral macular disease. The data presented demonstrate the feasibility of conducting a randomized controlled trial on EVT.

PURPOSE
Patients with bilateral central scotomas adopt other retinal area(s) called preferred retinal locus to substitute the blind fovea. EVT is offered with the goal to improve functional vision by learning how to identify and use a more useful retinal area for fixation—a trained retinal locus—and/or to improve fixation stability with their existing preferred retinal locus. An observational study was conducted to determine whether patients change and adopt a new trained retinal locus location and/or if fixation stability improves after EVT.

METHODS
Seventy-six patients with bilateral central scotomas received EVT from an experienced rehabilitation therapist. Retinal locations for repeated fixations and sizes of central scotomas of the better eye were recorded before and after EVT with a scanning laser ophthalmoscope. The position and area of the 95% confidence bivariate ellipse that defines the retinal area in which 95% of fixations occur were analyzed.

RESULTS
We observed no significant difference between the size of the area of the fitted ellipses before (mean [SD], 26.4° [19.7°]) and after (mean [SD], 24.8° [20.9°]) EVT (P = .54). However, we observed a shift in the preferred retinal locus location after EVT (P < .0001). The mean (SD) shift in the position of the center of fixation after EVT was 7.5° (5.2°; range, 0.45 to 23°). This mean difference was larger than would be expected from average within-subject fixation stability.

CONCLUSIONS
The location of the retinal area used for fixation changes after EVT. Fixation stability does not change after EVT. These preliminary data are yet to be confirmed with the use of a control group.
Enhanced Recovery after Surgery Pathway for Microsurgical Breast Reconstruction: A Systematic Review and Meta-Analysis
Authors: Sebai Mohamad E. , Siotos Charalampos , Payne Rachael M. , Stone Jill P. , Seal Stella M. , Habibi Mehran , Broderick Kristen , Sacks Justin M. , Manahan Michele A. , Rosson Gedge D. 
Published: December 2018

Background:
The enhanced recovery after surgery pathway was introduced in 1997 as a multimodal approach to reduce preventable postoperative harm and shorten hospital length of stay. However, there is yet no widely accepted enhanced recovery after surgery protocol for microsurgical breast reconstruction. The authors conducted a systematic review and meta-analysis of the current literature on enhanced recovery after surgery for microsurgical breast reconstruction with regard to postoperative length of stay and morbidity.

Methods:
The PubMed, Embase, Cochrane, Scopus, and Web of Science databases were searched for all studies published before June of 2016 containing original data on enhanced recovery after surgery in microsurgical breast reconstruction in relation to postoperative length of stay and morbidity. Studies were screened using eligibility criteria. Meta-analysis, odds ratio, and 95 percent confidence interval were used to pool acquired data.

Results:
The initial search identified 86 studies. Two independent screeners identified four original articles with a total of 676 patients. Length of stay was significantly shorter for patients on an enhanced recovery after surgery pathway (mean difference, −1.23; 95 percent CI, −1.50 to −0.96; p < 0.001; I
2 = 0 percent; random effects model). Enhanced recovery was not associated with changes in 30-day postoperative morbidity; specifically, no significant difference was observed in rates of partial flap loss (p = 0.44), total flap loss (p = 0.91), breast hematoma (p = 0.69), donor-site infection (p = 0.53), urinary tract infection (p = 0.29), and pneumonia (p = 0.42).

Conclusion:
The authors’ review suggests that enhanced recovery after surgery in microsurgical breast reconstruction is associated with a reduced length of stay, and is not associated with increased postoperative morbidity.
Feasibility of Simulation-Based Medical Education in a Low-Income Country
Authors: Bulamba Fred , Sendagire Cornelius , Kintu Andrew , Hewitt-Smith Adam , Musana Fred , Lilaonitkul Maytinee , Ayebale Emmanuel T. , Law Tyler , Dubowitz Gerald , Kituuka Olivia , Lipnick Michael S. 
Published: December 2018

Summary Statement
Simulation is relatively new in many low-income countries. We describe the challenges encountered, solutions deployed, and the costs incurred while establishing two simulation centers in Uganda. The challenges we experienced included equipment costs, difficulty in procurement, lack of context-appropriate curricula, unreliable power, limited local teaching capacity, and lack of coordination among user groups. Solutions we deployed included improvisation of equipment, customization of low-cost simulation software, creation of context-specific curricula, local administrative support, and creation of a simulation fellowship opportunity for local instructors. Total costs for simulation setups ranged from US $165 to $17,000. For centers in low-income countries trying to establish simulation programs, our experience suggests that careful selection of context-appropriate equipment and curricula, engagement with local and international collaborators, and early emphasis to increase local teaching capacity are essential. Further studies are needed to identify the most cost-effective levels of technological complexity for simulation in similar resource-constrained settings.
A Systematic Review of the Educational Effectiveness of Simulation Used in Open Surgery
Authors: Heskin Leonie , Simms Ciaran , Holland Jane , Traynor Oscar , Galvin Rose 
Published: December 2018

Summary Statement
The role of simulation to teach and access open surgical skills has become more prevalent in recent years. This systematic review synthesizes the totality of evidence with respect to the educational effectiveness of simulators used in open surgical training. A systematic literature search was conducted in PubMed, Embase, CINAHL, Scopus, and Web of Science. Only randomized controlled trials were included that explored the educational efficacy of theses simulators. Six randomized controlled trials were included from the 9934 studies found. The methodological quality of the included studies was variable. Overall, the use of the simulators was more educationally effective compared with standard teaching of the skill without a simulator (P < 0.05). Two studies showed that the simulator was as good as an animal model of much higher fidelity. Further studies are needed to secure higher evidence for the educational value, validity, and transferability of the skills to the hospital setting for all simulators.
Doxycycline Reduces Scar Thickness and Improves Collagen Architecture
Authors: Moore Alessandra L. , desJardins-Park Heather E. , Duoto Bryan A. , Mascharak Shamik , Murphy Matthew P. , Irizarry Dre M. , Foster Deshka S. , Jones Ruth E. , Barnes Leandra A. , Marshall Clement D. , Ransom Ryan C. , Wernig Gerlinde , Longaker Michael T. 
Published: December 2018

Objective:
To investigate the effects of local doxycycline administration on skin scarring.

Background:
Skin scarring represents a major source of morbidity for surgical patients. Doxycycline, a tetracycline antibiotic with off-target effects on the extracellular matrix, has demonstrated antifibrotic effects in multiple organs. However, doxycycline's potential effects on skin scarring have not been explored in vivo.

Methods:
Female C57BL/6J mice underwent dorsal wounding following an established splinted excisional skin wounding model. Doxycycline was administered by local injection into the wound base following injury. Wounds were harvested upon complete wound closure (postoperative day 15) for histological examination and biomechanical testing of scar tissue.

Results:
A one-time dose of 3.90 mM doxycycline (2 mg/mL) within 12 hours of injury was found to significantly reduce scar thickness by 24.8% (
∗

P < 0.0001) without compromising tensile strength. The same effect could not be achieved by oral dosing. In doxycycline-treated scar matrices, collagen I content was significantly reduced (
∗

P = 0.0317) and fibers were favorably arranged with significantly increased fiber randomness (
∗

P = 0.0115). Common culprits of altered wound healing mechanics, including angiogenesis and inflammation, were not impacted by doxycycline treatment. However, engrailed1 profibrotic fibroblasts, responsible for scar extracellular matrix deposition, were significantly reduced with doxycycline treatment (
∗

P = 0.0005).

Conclusions:
Due to the substantial improvement in skin scarring and well-established clinical safety profile, locally administered doxycycline represents a promising vulnerary agent. As such, we favor rapid translation to human patients as an antiscarring therapy.
Intraoperative Evaluation of Urinary Tract Injuries at the Time of Pelvic Surgery: A Systematic Review
Authors: Siff Lauren N. , Hill Audra J. , Jallad Karl , Harnegie Mary Pat , Barber Matthew D. 
Published: December 2018

Objective
The aim of this study was to determine the safety and efficacy of methods for intraoperative evaluation of urinary tract injury during pelvic surgery.

Methods
PubMed, EMBASE, CINAHL, Web of Science, Scopus, ProQuest, the Cochrane Library, and Clinicaltrials.gov were searched from 1947 to February 2018. Articles or abstracts describing the routine evaluation of urinary tract injuries during pelvic surgery in adults were included, surgical indications of urinary tract anomaly, stones, or malignancy were excluded. There were no restrictions on study design or language. Outcomes included injuries diagnosed intraoperatively, delayed diagnoses, adverse effects, subjective assessments, time to use, and cost. Data were extracted in duplicate at an individual-participant level. Prevalence of injuries, sensitivity, specificity, and predictive values of each diagnostic method were calculated. A combination of generalized linear models and a Bayesian approach were used to separately pool diagnostic accuracy measures.

Results
There were 5303 titles, 527 abstracts, and 164 full-text articles assessed for eligibility; 69 articles were analyzed. Diagnostic methods retrieved were cystoscopy using saline, dextrose or unspecified distention media, oral phenazopyridine and vitamin B, intravenous (IV) methylene blue, IV sodium fluorescein, IV indigo carmine, prophylactic retrograde ureteral stents, and transabdominal Doppler ultrasound. Prevalence of urinary tract injury ranged from 0.3% to 2.8%. Sensitivity ranged 63% to 91%, and specificity, 99.7% to 100%, with no significant differences suggested between methods.

Conclusions
All evaluable methods of intraoperative urinary tract assessment during pelvic surgery are safe and effective with specificity of greater than 99% and low rates of complications. Larger, more rigorous studies are required to evaluate the diagnostic accuracy of some newer methods.
Recognizing Congenital Pressure Injuries
Authors: Johnson Deanna E. 
Published: December 2018

BACKGROUND:
Soft tissue injuries recognized at birth are a common occurrence and well described in the medical literature. Despite this, there has been no discussion of congenital pressure injuries. In this Clinical Challenges article, I describe 3 cases in which congenital skin injuries have occurred, all of which meet the National Pressure Ulcer Advisory Panel definition for a pressure injury and are demonstrably not the result of other etiologies.

CASES:
Over a 6-month period, in a 44-bed level III-IV neonatal intensive care unit, 3 patients were identified and diagnosed with congenital pressure injuries. All were born to mothers who presented with significantly diminished or a near-absence of amniotic fluid. The amniotic fluid provides essential cushioning for the developing fetus. A number of well-described conditions result from alterations in the character and volume of the amniotic fluid during gestation. Among these is a correlation between severely diminished fluid volume and congenital contractures resulting from immobility of the fetus as it is compressed against the uterine wall. Therefore, it is not unreasonable to speculate that this immobility and pressure could be the very same mechanism that created our congenital pressure injuries noted in these patients. The stages of the congenital pressure injuries noted were a stage 1, a stage 2, and also a deep tissue pressure injury. One infant succumbed to conditions related to extreme prematurity prior to healing, while the other 2 patients' injuries healed without complication or apparent long-term sequelae.

CONCLUSIONS:
Despite their absence in the medical literature, I assert that congenital pressure injuries occur and are clinically relevant. This lack of recognition and description risks unnecessary diagnostic procedures and inappropriate or delayed treatment.