bluuebunny/crossref_metadata_2025_split huggingface dataset:
SPONTANEOUS RESOLUTION OF OPTIC DISK PIT MACULOPATHY IN A CHILD AFTER A SIX-YEAR FOLLOW-UP
Authors: Benatti Eleonora , Garoli Elena , Viola Francesco 
Published: August 2018

Purpose:
Optic disk pit (ODP) is a rare congenital abnormality of the optic nerve head that can lead to a maculopathy characterized mainly by serous retinal detachment. Optic disk pit maculopathy (ODP-M) in children is rare, and at present, the best management is still unknown. Long-lasting ODP-M can lead to organic amblyopia and photoreceptor damage, whereas surgical treatments are invasive and have an uncertain prognosis. We present a case of spontaneous resolution of ODP-M in a child who was monitored morphologically and functionally during a 6-year follow-up.

Methods:
Between January 2010 and January 2016, we conducted follow-up examinations by fundus photography, optical coherence tomography, and microperimetry.

Results:
At the first visit, a 12-year-old girl was asymptomatic with a visual acuity of 20/20 in both eyes. Optic disk pit maculopathy was observed, and the progression was monitored by follow-up optical coherence tomography. A progressive anatomical improvement with a spontaneous resolution of ODP-M occurred over a 2-year period. However, at the last follow-up visit, microperimetry showed a loss of threshold values of visual sensitivity.

Conclusion:
The combination of morphologic and functional evaluation over time can be useful to determine the best management of ODP-M, particularly in children for whom the conservative approach seems to be a valid alternative to surgery.
The Glaucoma Italian Pediatric Study (GIPSy): 3-Year Results
Authors: Quaranta Luciano , Biagioli Elena , Riva Ivano , Galli Francesca , Poli Davide , Rulli Eliana , Katsanos Andreas , Longo Antonio , Uva Maurizio G. , Oddone Francesco , Torri Valter , Weinreb Robert N. 
Published: August 2018

Purpose:
To investigate the efficacy and safety of a treatment strategy with latanoprost and dorzolamide in primary pediatric glaucoma patients partially responsive to surgery.

Patients and Methods:
Children with primary pediatric glaucoma with postsurgical intraocular pressure (IOP) between 22 and 26 mm Hg were eligible. At baseline, patients were administered latanoprost once daily. Depending on IOP reduction, patients were allocated to continuation of latanoprost monotherapy or addition of dorzolamide twice daily, or switch to dorzolamide monotherapy 3 times daily. Patients in the dorzolamide monotherapy group with IOP reduction <20% from baseline were considered nonresponders. The primary endpoint was the percentage of responders. Study treatment continued for 3 years or until treatment failure.

Results:
A total of 37 patients (61 eyes) were analyzed. The mean age of the patients was 4.1 years (SD: 3.8). In total, 43 eyes were included in the efficacy analysis. A total of 33 eyes (76.7%; 95% confidence interval, 61.4-88.2) were considered responders: 19 on latanoprost monotherapy, 11 on the latanoprost/dorzolamide combination, and only 3 on the dorzolamide monotherapy. The efficacy of pharmacological treatment was inversely related to central corneal thickness at the time of surgery and the age at the time of surgery. IOP reduction was 9.7 mm Hg (SD: 2.6) for latanoprost, 8.4 mm Hg (SD: 1.5) for the latanoprost/dorzolamide combination, and 9.3 mm Hg (SD: 2.5) for the dorzolamide monotherapy. None of the patients was withdrawn because of adverse events.

Conclusions:
Latanoprost alone or in combination with dorzolamide is safe and highly effective in lowering IOP in children after surgery. Nonresponders were mainly patients with early presentation of the disease.
Inner Retinal Changes in Primary Open-Angle Glaucoma Revealed Through Adaptive Optics-Optical Coherence Tomography
Authors: Wells-Gray Elaine M. , Choi Stacey S. , Slabaugh Mark , Weber Paul , Doble Nathan 
Published: August 2018

Purpose:
To examine the microstructural changes in the inner nuclear layer (INL) and ganglion cell layer (GCL) in a primary open-angle glaucoma (POAG) subject at 2 timepoints, 4 months apart.

Patients and Methods:
This case-control study (1 POAG subject and 1 normal control) used the single cell, 3-dimensional volumetric imaging capability of an adaptive optics-optical coherence tomography-scanning laser ophthalmoscopy system to examine the inner retina.

Results:
At the area of greatest glaucomatous change in the POAG subject [3-degrees temporal (T), 3-degrees inferior (I), right eye], the GCL was greatly thinned at both timepoints, yet retinal ganglion cell soma remained visible amid a meshwork of capillaries. Microcystic lesions in the INL were visible at both timepoints, ranging in diameter from 8 to 43 μm on day 1 to 11 to 64 μm at 4 months, with an average diameter increase of ∼124%. Small hyperreflective features (not seen in the contralateral eye or control subject) at a depth midway through the INL seemed correlated to the development of microcysts.

Conclusions:
We demonstrate the ability to image microcystic lesions early in their development and have quantified longitudinal changes. The presence of small hyperreflective structures at a layer midway through the INL seems to be a precursor to their formation and is a potential biomarker for assessing POAG severity and progression. The adaptive optics imaging system is also able to visualize retinal ganglion cells in this subject, despite severe thinning of the GCL.
Prospective Evaluation of XEN Gel Implant in Eyes With Pseudoexfoliative Glaucoma
Authors: Mansouri Kaweh , Gillmann Kevin , Rao Harsha L. , Guidotti Jacopo , Mermoud André 
Published: August 2018

Purpose:
The main purpose of this study was to compare the safety and efficacy of XEN gel implant surgery in patients with pseudoexfoliative glaucoma (PEXG) and primary open-angle glaucoma (POAG).

Setting:
This was a prospective, interventional study in a tertiary glaucoma center.

Methods:
Fifty-seven eyes (43 patients) with POAG and 53 eyes (42 patients) with PEXG with uncontrolled intraocular pressure (IOP) despite medical treatment underwent combined XEN+cataract surgery or standalone XEN surgery. Mean IOP, mean number of medications at 1-year follow-up, needling rates, and incidence of adverse effects (AEs) were analyzed. Complete success, defined as an IOP <16 mm Hg without medications at 1 year, was also analyzed.

Results:
Combined XEN+cataract surgery was performed in 72% of POAG and 75% of PEXG eyes (P=0.674), the remainder underwent standalone XEN surgery. Patient characteristics were similar between the 2 groups except for higher age for the PEXG patients (78.5±8.5 vs. 71.3± 8.7 y; P<0.001). Mean medicated IOP was 19.8±5.8 (POAG) and 19.7±8.2 (PEXG) at baseline (P=0.98) and 13.9±4.6 (−29.8%) and 13.6±4.3 mm Hg (−31%) at 1 year (P=0.87), respectively (P<0.01). Mean medications dropped from 1.9±1.6 (POAG) and 2.0±1.3 (PEXG) preoperatively to 0.4±0.8 and 0.5±0.8, respectively at 1 year (P<0.001). A total of 42% (POAG) and 63% (PEXG) eyes achieved complete success (P=0.06) at 1 year. Needling was performed in 36.8% (POAG) versus 37.7% (PEXG) (P=0.923).

Conclusions:
The XEN gel implant as a standalone or combined procedure demonstrated similar efficacy and safety results in PEXG and POAG eyes.
Multi-OMICS analyses of frailty and chronic widespread musculoskeletal pain suggest involvement of shared neurological pathways
Authors: Livshits Gregory , Malkin Ida , Bowyer Ruth C.E. , Verdi Serena , Bell Jordana T. , Menni Cristina , Williams Frances M.K. , Steves Claire J. 
Published: August 2018

Abstract
Chronic widespread musculoskeletal pain (CWP) and frailty are prevalent conditions in older people. We have shown previously that interindividual variation in frailty and CWP is genetically determined. We also reported an association of frailty and CWP caused by shared genetic and common environmental factors. The aim of this study was to use omic approaches to identify molecular genetic factors underlying the heritability of frailty and its genetic correlation with CWP. Frailty was quantified through the Rockwood Frailty Index (FI) as a proportion of deficits from 33 binary health deficit questions in 3626 female twins. Common widespread pain was assessed using a screening questionnaire. OMICS analysis included 305 metabolites and whole-genome (>2.5 × 106 SNPs) and epigenome (∼1 × 106 MeDIP-seq regions) assessments performed on fasting blood samples. Using family-based statistical analyses, including path analysis, we examined how FI scores were related to molecular genetic factors and to CWP, taking into account known risk factors such as fat mass and smoking. Frailty Index was significantly correlated with 51 metabolites after correction for multiple testing, with 20 metabolites having P-values between 2.1 × 10−6 and 4.0 × 10−16. Three metabolites (uridine, C-glycosyl tryptophan, and N-acetyl glycine) were statistically independent and thought to exert a direct effect on FI. Epiandrosterone sulphate, previously shown to be highly inversely associated with CWP, was found to exert an indirect influence on FI. Bioinformatics analysis of genome-wide association study and EWAS showed that FI and its covariation with CWP was through genomic regions involved in neurological pathways. Neurological pathway involvement accounts for the associated conditions of aging CWP and FI.
Admissions Variables: Predictors of Physician Assistant Student Success
Authors: Honda Trenton , Patel-Junankar Dipu , Baginski Robert , Scott Rebecca 
Published: August 2018

Purpose
Physician assistant (PA) programs have heterogeneous admissions processes, but limited information is available as to which preadmission variables are associated with the greatest PA program success. We assessed the associations between preadmission criteria and PA program outcomes while accounting for numerous potential confounders and potential cohort effects.

Methods
In a sample of 147 students from a single New England PA program, we used random intercept multiple regression models to examine the associations between 2 PA program outcomes—Physician Assistant National Certifying Examination (PANCE) scores and PA program grade point averages (GPAs)—and multiple predictors of interest, including undergraduate GPA; hours of paid, hands-on patient care experience; and undergraduate institution rank. Fully adjusted models additionally controlled for age and educationally or economically disadvantaged background.

Results
In fully adjusted models, a 1-unit increase in undergraduate GPA (54.55 ± 20.32, P = .012) and a 10% increase in preadmission clinical experience hours (18.32 ± 8.50, P = .033) were significantly associated with increased PANCE scores. When PA program GPA was examined as an outcome, only undergraduate GPA was significantly associated (0.15 ± 0.05, P = .004). Undergraduate institution rank was not a significant predictor in any model.

Conclusions
Undergraduate GPA and preadmission clinical experience hours were significant predictors of student outcomes in this small, retrospective cohort study. Undergraduate institution rank was highly nonsignificant in all models. These findings add to the burgeoning literature on admissions predictors of PA program success.
Tiotropium for asthma: A summary of current guidelines and a case study
Authors: Shedd Glenn Clinton , Blenis Robert Colin 
Published: August 2018

ABSTRACT

Background and purpose:
The long-acting muscarinic antagonist tiotropium received an indication for the treatment of asthma from the FDA in 2015.

Methods:
This paper summarizes much of the published findings on tiotropium and asthma and explores the heterogeneity of the asthma population vis-à-vis recent changes in guidelines for management of COPD. The accompanying case study provides an illustration of how tiotropium might be added to a patient's regimen appropriately.

Conclusions and implications for practice:
Tiotropium has been shown in many studies to be beneficial to patients with asthma as an add-on medication. It should be considered as an agent by the clinician managing patients with both allergic and non-allergic asthma.
Insecure Attachment and Hypothalamus-Pituitary-Adrenal Axis Functioning in People With Eating Disorders
Authors: Monteleone Alessio Maria , Patriciello Giuseppina , Ruzzi Valeria , Fico Giovanna , Pellegrino Francesca , Castellini Giovanni , Steardo Luca , Monteleone Palmiero , Maj Mario 
Published: August 2018

ABSTRACT

Objective
Childhood attachment experiences affect adult emotion regulation and ability to cope with stressors. Therefore, insecure attachment may influence the functioning of the hypothalamic-pituitary-adrenal (HPA) axis and a dysregulation of HPA axis has been found in insecure attached healthy individuals. The effects of attachment on HPA axis activity have never been investigated in eating disorders (EDs). Therefore, we assessed the relationships between insecure attachment and the cortisol awakening response (CAR) in adults with EDs.

Methods
Seventy-eight patients with EDs (43 with anorexia nervosa, 35 with bulimia nervosa) were recruited. They completed the Experience in Close Relationships questionnaire, which provides a rating of two insecure attachment dimensions (anxiety and avoidance) and collected saliva samples to measure the CAR. Differences in the CAR between groups with high and low attachment anxiety and between groups with high and low attachment avoidance were evaluated by repeated measures two-way analysis of variance.

Results
Patients with high attachment anxiety showed a reduced CAR compared with those with low attachment anxiety (F
1,76 = 7.31, p = .008). The CAR did not differ between the groups with high and low attachment avoidance (F
1,76 = 0.01, p = .93). Patients with high levels of insecure attachment showed a more severe eating-related psychopathology.

Conclusions
Our data show, for the first time, a specific association of the anxious attachment with the HPA axis activity in EDs and suggest a possible role of attachment in the biological vulnerability to stress of adult patients with EDs.
Fully Automated 10-Minute 3D CAIPIRINHA SPACE TSE MRI of the Knee in Adults
Authors: Del Grande Filippo , Delcogliano Marco , Guglielmi Riccardo , Raithel Esther , Stern Steven E. , Papp Derek F. , Candrian Christian , Fritz Jan 
Published: August 2018

Objectives
The aim of this study was to test the hypothesis that magnetic resonance imaging (MRI) of the knee with 10-minute 3-dimensional (3D) controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) sampling perfection with application optimized contrast using different flip angle evolutions (SPACE) turbo spin echo (TSE) protocols can replace 20-minute 2-dimensional (2D) TSE standard-of-reference protocols for the diagnosis of internal derangement.

Materials and Methods
After internal review board approval and prospective informed consent, 100 symptomatic subjects underwent MRI of the knee at 3 T and 50 symptomatic subjects at 1.5 T, consisting of 10-minute 3D CAIPIRINHA SPACE TSE and 20-minute standard-of-reference 2D TSE protocols. Two fellowship-trained musculoskeletal radiologists assessed the studies in an anonymized and randomized fashion for structural abnormalities. Descriptive statistics, interreader reliability, intermethod concordance, diagnostic definitiveness, and interchangeability tests were applied. P values equal to or smaller than 0.01 were considered significant.

Results
The interchangeability analysis showed that the 3D MRI can replace the 2D MRI protocols, whereas a superiority of 3D MRI was suggested statistically for the detection of medial and lateral meniscal tears, cartilage defects, and bone marrow edema by significantly higher common pair exact match proportions of readers (P < 0.01, respectively).The overall interreader reliabilities were 89% of exact matches for 2D TSE (κ, 0.842) and 96% of exact matches for 3D TSE (κ, 0.941) (P < 0.01). There was good intermethod concordance (κ, 0.736; range, 0.579–1.000). The interreader reliability (2D TSE: κ, 0.748 [0.603–1.000]; 3D TSE: κ, 0.901 [0.797–1.000]) and diagnostic definitiveness were significantly higher for the 3D than 2D MRI (P < 0.01).

Conclusions
10-minute 3D CAIPIRINHA SPACE TSE MRI protocols can replace 20-minute 2D TSE standard-of-reference MRI protocols for the evaluation of internal derangement of the knee by producing similar results in individual patient diagnoses, whereas interpretations of 3D CAIPIRINHA SPACE TSE MRI examinations resulted in an overall higher interreader reliability, intermethod concordance, and reader definitiveness.
Organ-specific changes in vascular reactivity and roles of inducible nitric oxide synthase and endothelin-1 in a rabbit endotoxic shock model
Authors: Zhang Zi-Sen , Chen Wei , Li Tao , Liu Liang-ming 
Published: August 2018

BACKGROUND
Hemorrhagic shock-induced changes in vascular reactivity appear organ-specific. In the present study, we examined the hypothesis that vascular reactivity induced by septic shock similarly displays organ-specific differences and is regulated by inducible nitric oxide synthase (iNOS) and endothelin-1 (ET-1).

METHODS
Endotoxic shock was induced in rabbits by administration of lipopolysaccharide (LPS) (1 mg/kg), and organ specificity of vascular reactivity of superior mesenteric artery (SMA), celiac artery (CA), and left renal artery (LRA) as well as the potential involvement of iNOS and ET-1 examined.

RESULTS
Vascular reactivity of SMA, CA, and LRA was increased at the early stages and decreased at the late stages after LPS administration. Superior mesenteric artery showed the greatest decrease in vascular reactivity in response to norepinephrine (NE) (34.9%) and acetylcholine (Ach; 32.3%), followed by LRA (NE, 33.7%; Ach, 30.5%) and CA (NE, 16.2%), whereas the relaxation reactivity of CA in response to Ach was increased to 159%. The mRNA and protein levels of iNOS and ET-1 in SMA, CA, and LRA were not affected at the early stages of endotoxic shock after LPS administration but significantly increased at the late stages. Expression levels were higher in SMA than CA and LRA and negatively correlated with the decrease in vascular reactivity. The iNOS and ET-1 inhibitors, aminoguanidine (20 mg/kg) and PD-142893 (0.02 mg/kg), respectively, induced significant improvements in vascular reactivity and organ perfusion and stabilized the hemodynamic parameters in rabbits subjected to endotoxic shock.

CONCLUSION
Changes in vascular reactivity during endotoxic shock are organ-specific. Differential expression patterns of iNOS and ET-1 in different blood vessels contribute to the organ specificity of vascular reactivity.

LEVEL OF EVIDENCE
Therapeutic study, level II.
Effects of driving distance and transport time on mortality among Level I and II traumas occurring in a metropolitan area
Authors: Karrison Theodore G. , Philip Schumm L. , Kocherginsky Masha , Thisted Ronald , Dirschl Douglas R. , Rogers Selwyn 
Published: August 2018

BACKGROUND
The purpose of this study was to evaluate the effects of ambulance driving distance and transport time on mortality among trauma incidents occurring in the City of Chicago, a large metropolitan area.

METHODS
We studied individuals 16 years or older who suffered a Level I or II injury and were taken to a Level I trauma center. The outcome was in-hospital mortality, including those dead on arrival but excluding those deemed dead on scene. Driving distance was calculated from the scene of injury to the trauma center where the patient was taken. Transport time was defined as the time from scene departure to arrival at the trauma center. Covariates included injury severity measures recorded at the scene. Logistic regression and instrumental variable probit regression models were used to examine the association between driving distance, transport time, and mortality, adjusting for injury severity.

RESULTS
A total of 24,834 incidents were analyzed, including 1,464 deaths. Median driving distance was 3.9 miles, and median transport time was 13 minutes. Our findings indicate that increased driving distance is associated with a modest increase in mortality, with a covariate-adjusted odds ratio of 1.12 per 2-mile increase in distance (95% confidence interval [CI], 1.05–1.20). This corresponds to an increase in overall mortality of 0.26 percentage points per 2 miles (95% CI, 0.11–0.40). Using distance as an instrumental variable, we estimate a 0.51 percentage point increase in mortality per 5-minute increase in transport time (95% CI, 0.14–0.89).

CONCLUSION
We find a modest effect of distance on mortality that is approximately linear over a range of 0 to 12 miles. Instrumental variables analysis indicated a corresponding increase in mortality with increasing transport time. Limitations of the study include the possibility of unmeasured confounders and the assumption that distance affects mortality only through its effect on transport time.

LEVEL OF EVIDENCE
Prognostic study, level III.
Patient Functional Status at Transplant and Its Impact on Posttransplant Survival of Adult Deceased-donor Kidney Recipients
Authors: Bui Kevin , Kilambi Vikram , Rodrigue James R. , Mehrotra Sanjay 
Published: August 2018

Background.
Recorded at the time of transplant and reported to the Organ Procurement and Transplantation Network, patient’s functional status is measured using the Karnofsky performance score (KPS), ranging 0 to 100. Functional status analysis may provide insights on candidate listing and posttransplant survival outcomes for deceased-donor kidney transplants.

Methods.
The cohort consisted of adult deceased-donor kidney transplant recipients transplanted beginning January 2007. One-year and 3-year Cox models for posttransplant survival were fitted with current Scientific Registry of Transplant Recipients (SRTR) variables and KPS. Comparative analyses were performed between the SRTR model without KPS and augmented model with it. Using the augmented model, we examined the impact of Kidney Donor Profile Index on posttransplant survivals for 5 different KPS strata: 10 to 30, 40 to 50, 60 to 70, 80 to 90, and 100.

Results.
Comparative analyses showed that KPS was a statistically significant predictor for posttransplant survival: it improved model calibration, discrimination, and predictive accuracy. From the augmented model, the survival curves illustrated that recipients with KPS 40 to 50 and kidneys with Kidney Donor Profile Index as high as 99 have expected survival probabilities of above 90% in 1 year and above 80% in 3 years. The expected survival probabilities improve as KPS increases. Recipients with KPS 10 to 30 have the worst survival probability, even if they received high-quality kidneys.

Conclusions.
Insights from the survival analyses recommend possible inclusion of functional status into SRTR’s risk-adjusted models. Moreover, they invite further examination of its use to improve current listing and transplantation strategies at transplant centers and potentially reduce deceased-donor kidney discard rate.