bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Contact Lens Care Solutions in Removing Cholesterol Deposits From Silicone Hydrogel Contact Lenses
Authors: Walther Hendrik , Subbaraman Lakshman N. , Jones Lyndon 
Published: September 2018

Purpose:
To determine the efficacy of multipurpose solutions (MPSs) on the removal of cholesterol deposits from silicone hydrogel (SH) contact lens materials using an in vitro model.

Materials and Methods:
Five SH lens materials: senofilcon A, comfilcon A, balafilcon A, lotrafilcon A, and lotrafilcon B were removed from the blister pack (n=4 for each lens type), incubated for 7 days at 37°C in an artificial tear solution containing 14C radiolabeled cholesterol. Thereafter, lenses were stored in a preserved saline solution control (Sensitive Eyes Saline Plus) or cleaned with 1 of the 5 MPSs incorporating different preservatives (POLYQUAD/ALDOX, polyquaternium-1/alexidine, polyquaternium-1/PHMB, and 2 based on PHMB alone) using a rub and rinse technique, according to the manufacturer's recommendations, and stored in the MPS for a minimum of 6 hr. Lenses were then extracted with 2:1 chloroform:methanol, analyzed in a beta counter, and μg/lens of cholesterol was determined.

Results:
Balafilcon A and senofilcon A lens materials showed the highest amounts of accumulated cholesterol (0.93±0.02 μg/lens; 0.95±0.01 μg/lens, respectively), whereas lotrafilcon A and lotrafilcon B deposited the lowest amounts (0.37±0.03 μg/lens; 0.47±0.12 μg/lens, respectively). For all lens materials, the MPS preserved with POLYQUAD/ALDOX removed more deposited cholesterol than any other test solution; however, the amount of removed cholesterol contamination from the individual contact lenses was only statistically significant for balafilcon A and senofilcon A (P=0.006 and P=0.042, respectively). Sensitive eyes and the other evaluated MPSs showed no significant effect on cholesterol removal (P>0.05).

Conclusion:
Cholesterol-removal efficacy varies depending on the combination of lens material and solution. Only 1 MPS showed a statistically significant reduction of cholesterol deposit for only 2 of the 5 tested lens materials.
Acute Chemical Eye Injury and Limbal Stem Cell Deficiency—A Prospective Study in the United Kingdom
Authors: Ghosh Saurabh , Salvador-Culla Borja , Kotagiri Ajay , Pushpoth Sreekumari , Tey Adrian , Johnson Zoë K. , Figueiredo Francisco C. 
Published: September 2018

Purpose:
To analyze the incidence, nature, outcomes, and complications of acute chemical eye injuries, including the incidence of limbal stem cell deficiency (LSCD) and to compare the 2 main classifications for ocular chemical injuries: Roper-Hall (RH) and Dua.

Methods:
This is a prospective, consecutive, interventional single-center study between April and October 2009 of all new patients with acute chemical eye injury presenting to the Royal Victoria Infirmary eye emergency department (EED).

Results:
Of 11,683 patients who attended the EED, 98 patients (110 eyes) presented with acute chemical eye injury (60% male). This represents an estimated annual incidence of 5.6 new cases per 100,000 population. Mean age was 36.5 years (1–78; SD 17.1 years), including 7 children (age <10 years). Fifty-one patients (52%) had work-related injuries. The most common chemical agent was alkali (78%). All 4 RH grade IV cases were unilateral, assault with ammonia, and required early amniotic membrane transplantation as per the protocol, but despite full treatment, they developed total LSCD in the affected eye.

Conclusions:
Acute chemical eye injuries are rare. Male patients in the working age group are more prone to work-related chemical injuries, whereas young children tend to have domestic injuries. Grade I, II, and III RH and Dua chemical injuries had a very good prognosis with topical treatment only, whereas RH grade IV (Dua grade IV-VI), mainly assaults with ammonia, progressed to total/severe LSCD despite appropriate management including early amniotic membrane transplantation. The Dua classification includes conjunctival involvement, having a greater value in predicting the final clinical outcome when grading chemical eye injuries.
Long-term Safety and Efficacy of Conjunctival Pedicle Graft Revision Combined With Repeated Pericardium Allograft for Exposed Glaucoma Drainage Devices
Authors: Guajardo José M. , Lim Kin S. 
Published: September 2018

Purpose:
To investigate the safety and long-term results of conjunctival pedicle graft (CPG) technique for revision of exposed glaucoma drainage device (GDD).

Design:
Retrospective noncomparative case series.

Patients and Methods:
All patients with exposed GDD between 2011 and 2016 who underwent tube revision with CPG were included. Data from demographic variables, glaucoma subtype, previous surgeries, GDD type and location, patch graft nature, intraocular pressure, and intraoperative and long-term complications were collected.

Results:
Eight eyes from 7 patients met the inclusion criteria. Median age was 61 years old (range, 51 to 80), median time to erosion was 23.4 months (range, 5 d to 45.1 mo), median number of operations before exposure was 3 (range, 1 to 5), and 6 tubes had an inferior location (75%). Average follow-up after repair was 24.3 months (range, 5.2 to 59.8 mo). No significant intraoperative adverse events were noted and visual acuity, intraocular pressure, and number of medications remained unchanged at 1 month after repair in all cases. We report 1 case of repeated tube exposure 24 months after CPG in a 51-year-old Afro-Caribbean woman with 5 previous operations.

Conclusions:
With an average follow-up of >2 years, we provide additional long-term evidence that CPG is a safe and effective technique for treating exposed tubes. We did not experience any complications and report 1 reexposure case in a young Afro-Caribbean patient with extensive previous conjunctival scarring.
Effect of Antiplatelet/Anticoagulant Use on Glaucoma Progression in Eyes With Optic Disc Hemorrhage
Authors: Lee Jiyun , Sung Kyung R. , Kwon Junki , Shin Joong W. 
Published: September 2018

Purpose:
To assess whether the use of antiplatelets (APs)/anticoagulants (ACs) affects glaucoma progression in eyes with optic disc hemorrhage (DH).

Methods:
One hundred and nineteen eyes from 119 patients with primary open-angle glaucoma in whom a DH was observed at least once during the follow-up period (mean follow-up duration: 6.2 y) were included in this retrospective observational study. Cox proportional hazard models were used to identify the association between putative factors, including AP/AC use, and glaucoma progression. Glaucoma progression was assessed on the basis of changes noted on serial optic disc and retinal nerve fiber layer photographs or changes in the visual field.

Results:
Nineteen of the 119 patients took AP/AC drugs daily [AP/AC use group (AG)], while the others did not [no use group (NG)]. The follow-up period to progression was significantly different between the 2 groups (61.2±23.5 mo for the AG and 47.6±22.0 mo for the NG; P=0.016). Kaplan-Meier analysis revealed a greater cumulative probability of glaucoma progression in the NG than in the AG, with borderline statistical significance (P=0.081). Higher mean intraocular pressure during the follow-up period was a risk factor for glaucoma progression (hazard ratio, 1.107; P=0.014), while AP/AC drug use protected against glaucoma progression (hazard ratio, 0.576; P=0.046).

Conclusions:
According to our result, use of AP/AC drugs was associated with lower risk of glaucoma progression in eyes with DH.
Interocular Asymmetry of Minimum Rim Width and Retinal Nerve Fiber Layer Thickness in Healthy Brazilian Individuals
Authors: Zangalli Camila e Silva , Reis Alexandre S. C. , Vianna Jayme R. , Vasconcellos José P. C. , Costa Vital P. 
Published: September 2018

Purpose:
To determine interocular differences in Bruch’s membrane opening minimum rim width (BMO-MRW) and retinal nerve fiber layer thickness (RNFLT) in healthy Brazilian individuals.

Materials and Methods:
Both eyes of 220 healthy individuals were included in this observational, cross-sectional study. All individuals had normal clinical examination and visual fields. Global and sectorial interocular BMO-MRW and RNFLT differences, acquired and regionalized relative to the fovea to BMO center (FoBMO) axis, were calculated. The effect of age, axial length, and BMO area asymmetry on the parameters’ asymmetry was evaluated.

Results:
The 95th limits for interocular BMO-MRW and RNFLT global differences were 49 and 9 μm, respectively. BMO-MRW asymmetry was negatively correlated (β=−33.87 μm/mm2, R
2=0.06, P<0.001), whereas RNFLT asymmetry was positively correlated (β= 6.13 μm/mm2, R
2=0.09, P<0.001) with BMO area asymmetry. Neither BMO-MRW nor RNFLT asymmetries were correlated with axial length asymmetry (β=−16.90 μm/mm, R
2=0.00, P=0.15; β=−1.18 μm/mm, R
2=0.00, P=0.52, respectively). Similarly, BMO-MRW and RNFLT asymmetries were not correlated with age (β=0.17 μm/y, R
2=0.01, P=0.22; β=0.02 μm/y, R
2=0.00, P=0.19, respectively).

Conclusions:
Our results suggest that global BMO-MRW and RNFLT interocular differences exceeding 49 and 9 μm, respectively, may indicate statistically abnormal asymmetry, which may suggest early structural damage. Asymmetry in BMO area should be accounted for when considering interocular asymmetry in BMO-MRW and RNFLT.
Heritability of Anterior Chamber Indices in Rural Population
Authors: Hashemi Hassan , Yekta AbbasAli , Heydarian Samira , Ostadimoghaddam Hadi , Aghamirsalim Mohamadreza , Derakhshan Akbar , Khabazkhoob Mehdi 
Published: September 2018

Objective:
To examine the heritability of the anterior chamber depth, angle, and volume as well as the corneal volume and diameter using Pentacam in households living in underserved rural areas of Iran.

Materials and Methods:
This cross-sectional population-based study was conducted in randomly selected households living in 2 rural districts in the south and north. The data of subjects above 5 years and households in which at least 2 members (father or mother and a child) had Pentacam data were analyzed. Each subject underwent a comprehensive ophthalmic examination, with emphasis on the measurement of visual acuity and refraction, biomicroscopy, and Pentacam imaging. Heritability was estimated to investigate familial aggregation of anterior chamber indices, and the effects of age, sex, and living area were controlled for as confounding factors.

Results:
Of the 3851 selected individuals, 3314 participated in the study. After applying the exclusion criteria, the data of 1383 subjects from 382 households were included in the analysis. The mean age of the participants was 37.23±19.35 years (range, 6 to 93 y). The highest and lowest heritability estimates were related to the anterior chamber angle (72%) and corneal diameter (28%), respectively. The heritability percentages of the anterior chamber depth, anterior chamber volume, and corneal volume were 47%, 39%, and 57%, respectively.

Conclusions:
The high heritability of the anterior chamber angle points to a high correlation between this phenotype and genetic factors. Further genetic and molecular investigations are suggested to find the related genes and understand the etiology of glaucoma.
Is Polymerase Chain Reaction in Neonatal Dried Blood Spots Reliable for the Diagnosis of Congenital Cytomegalovirus Infection?
Authors: Vives-Oñós Isabel , Codina-Grau María Gema , Noguera-Julian Antoni , Blázquez-Gamero Daniel , Fortuny Claudia , Baquero-Artigao Fernando , Frick Marie Antoinette , Saavedra-Lozano Jesús , Goycochea-Valdivia Walter , Rives-Ferreiro María Teresa , Montesdeoca-Melián Abián , Calavia-Garsaball Olga , Ferreras-Antolin Laura , Marín-Soria José Luís , Dulín-Íñiguez Elena , Soler-Palacín Pere 
Published: September 2018

Background:
Detection of cytomegalovirus (CMV) DNA by real-time polymerase chain reaction (rt-PCR) in dried blood spots (DBSs) collected for newborn screening has been assessed for retrospective diagnosis of congenital CMV (cCMV) infection, with variable results (sensitivities ranging from 34% to 100%). We aimed to assess the accuracy of this technique in Spain in a large patient series.

Methods:
Ambispective, multicenter study including patients with confirmed cCMV from the Spanish Registry of cCMV patients. cCMV was established on the presence of CMV DNA in any body fluid, by positive culture findings or by molecular techniques during the first 2 weeks of life. Children in whom cCMV had been excluded were used as negative controls. Neonatal DBS samples were collected from both groups. The presence of CMV DNA was assessed by rt-PCR (RealStar CMV, Altona, Germany) in a central laboratory.

Results:
One-hundred three patients and 81 controls from 10 hospitals were included. The performance of CMV DNA determination in DBS for the diagnosis of cCMV was as follows (95% confidence interval): sensitivity 0.56 (0.47–0.65), specificity 0.98 (0.91–0.99), positive likelihood ratio 22.81 (5.74–90.58) and negative likelihood ratio 0.45 (0.36–0.56). Sensitivity increased with the birth viral load (bVL) log category. In cCMV patients, lower bVL was the single variable associated with a negative DBS rt-PCR result (P = 0.017).

Conclusions:
The sensitivity of CMV rt-PCR in DBS in our series was low and correlated with the bVL. Thus, a negative DBS result would not rule out cCMV infection, especially in patients with a low viremia level at birth.
Advanced Practice Nurse Phone Follow-Up Initiative to Reduce Unplanned Returns for Perforated Appendicitis Patients
Authors: Micalizzi Rosella A. , Phinney Caitlin , Lemire Lindsay , O’Donnell Ellen A. 
Published: September 2018

Introduction: Perforated appendicitis is a high-volume diagnosis managed by advanced practice nurses (APNs) in the general pediatric surgery department at an urban hospital in the northeast. This APN-led quality improvement project aimed to determine the impact of APN phone follow-up to prevent unplanned return visits and readmission. Methods: Before June 2015, all patients with perforated appendicitis discharged home on antibiotic therapy were provided with APN phone follow-up. The patients were followed for 30-day outcomes regarding unplanned returns to care. The goal was to attempt to identify patients at a higher risk for returns based on symptom analysis so that preventative measures may be instituted. The process of phone follow-up for patients with perforated appendicitis changed in June 2015 because of the decreased number of patients discharged home on intravenous antibiotic therapy, and therefore the phone follow-up was discontinued. This allowed the data from the first cohort (December 2014 to May 2015) to be reviewed by a retrospective chart review and analyzed. Outcomes: The preliminary data between the two cohorts, which have comparable patient volumes and return rates, have revealed that the APN phone follow-up did not necessarily change the rate of unplanned return-to-care visits after patient discharge, perhaps because of the call being conducted too soon after discharge. Our findings suggested that the APN phone follow-up call may have been more impactful in reducing unplanned return-to-care visits if completed after the 48-hour time frame.
Compound heterozygous mutations in IL10RA combined with a complement factor properdin mutation in infantile-onset inflammatory bowel disease
Authors: Jung Eun Suk , Petersen Britt-Sabina , Mayr Gabriele , Cheon Jae Hee , Kang Yunkoo , Lee Seok Joo , Che Xiumei , Kim Won Ho , Kim Seung , Schreiber Stefan , Franke Andre , Koh Hong 
Published: September 2018

Objectives
Inflammatory bowel diseases (IBDs) are chronic and multifactorial diseases resulting from a complex interaction of host genetic factors and environmental stimuli. Although many genome-wide association studies have identified host genetic factors associated with IBD, rare Mendelian forms of IBD have been reported in patients with very early onset forms. Therefore, this study aimed to identify genetic variants associated with infantile-onset IBD.

Participants and methods
We obtained genomic DNA from whole blood samples of a male patient with infantile-onset IBD and nonconsanguineous Korean parents. Whole-exome sequencing was performed using trio samples. Then, we analyzed the data using susceptibility genes for monogenic forms of IBD and various immunodeficiencies and protein structural analysis.

Results
The patient who presented with oral aphthous ulcers at the age of 14 days suffered from severe colitis and was refractory to medical treatment. Compound heterozygous mutations in IL10RA (p.R101W; p.T179T) were found in the patient. In addition, a hemizygous mutation in complement factor properdin (CFP) (p.L456V) located on the X-chromosome was detected, inherited from the patient’s mother. Protein structural modeling suggested impaired properdin subunit interactions by p.L456V that may hamper protein oligomerization required for complement activation.

Conclusion
This study identified compound heterozygous mutations in IL10RA combined with a hemizygous CFP mutation in infantile-onset IBD by using whole-exome sequencing. CFP p.L456V may exacerbate symptoms of infantile-onset IBD by disturbing oligomerization of properdin.
Baseline risk assessment of patients with ulcerative colitis: does initial treatment selection influence outcomes?
Authors: Mosli Mahmoud , Alfaer Sultan , Almalaki Turki , Albeshry Abdulrahman , Aljehani Saja , Alshmrani Bashaer , Habib Zaineb , Jawa Hani , Qari Yousif 
Published: September 2018

Background and aims
Treatment of ulcerative colitis (UC) typically follows a step-up approach and targets colonic mucosal healing. Although mucosal healing reduces the risk of colectomy, whether or not early treatment of patients with ‘high-risk’ features using tumor necrosis factor (TNF) antagonists reduces the risk of colectomy is not clear. Accordingly, we aim to evaluate the effect of baseline treatment selection according to the risk profile on 5-year outcomes and identify predictors of poor outcomes.

Patients and methods
Adult patients with confirmed UC were retrospectively identified. Baseline clinical and endoscopic data were collected. Patients were assigned a risk profile on the basis of the presence or absence of ‘high-risk’ features within the first 6 months of diagnosis including moderate to severe endoscopic disease, frequent need for steroids, steroid dependency, and disease involving the entire colon according to endoscopy. Treatment discordance was defined as treating ‘high-risk’ patients with medications other than anti-TNF therapy during the first 6 months after diagnosis or treating ‘low-risk’ patients with anti-TNF therapy within 6 months of diagnosis. The associations between discordance and 5-year colectomy and hospitalization rates were statistically calculated through regression analysis, as were predictors of outcomes.

Results
A total of 108 patients were identified and studied. The median age was 36 years (interquartile range=27–50) and the average duration of disease was 6.6 (±3.1) years. Females comprised 62% of the cohort and 30% reported cigarette smoking. Seventy three percent of the patients were placed in the ‘high-risk’ category. The 5-year risk of colectomy was not statistically significantly higher in patients identified as ‘high-risk’ compared with those who were ‘low-risk’ (risk ratio=0.86, 95% confidence interval=0.24–3.1, P=0.81), nor was the 5-year risk of hospitalizations (risk ratio=1.63, 95% confidence interval=0.81–3.30, P=0.15). On the basis of stepwise model selection, colectomy was significantly predicted by discordance (P=0.039), arthritis (P=0.007), baseline stool frequency (P=0.019), Adalimumab use within the first 6 months of diagnosis (P=0.006), and pyoderma gangrenosum (P=0.049); hospitalization was predicted by discordance (P=0.018), baseline albumin concentrations (P=0.005), thromboembolism (P<0.005), thiopurine use within the first 6 months of diagnosis (P<0.005), Adalimumab use within the first 6 months of diagnosis (P=0.003), nationality (P=0.016), endoscopic severity (P=0.007), arthritis (P=0.005), and pyoderma gangrenosum (P=0.025).

Conclusion
Among other clinical parameters, discordance between baseline risk and treatment selection appears to be a significant predictor of outcomes in UC.
Tumor behavior of hepatocellular carcinoma after hepatitis C treatment by direct-acting antivirals: comparative analysis with non-direct-acting antivirals-treated patients
Authors: Abdelaziz Ashraf O. , Nabil Mohamed M. , Abdelmaksoud Ahmed H. , Shousha Hend I. , Hashem Mohamed B. , Hassan Eman M. , Salah Ayman , Omran Dalia A. , Elbaz Tamer M. 
Published: September 2018

Introduction
Scarce reports have commented on hepatocellular carcinoma (HCC) behavior after direct-acting antivirals (DAAs).

Aim
To analyze differences in tumor behavior between patients with hepatitis C virus (HCV)-induced HCC and were either treated or not using DAAs.

Patients and methods
This case–control study includes patients with HCV-related HCC who received generic DAAs (group I) and all non-DAA treated patients with HCC who presented to our clinic during the same period (group II). Patient and tumor characteristics, treatment types and outcome were compared between the two groups.

Results
Group I included 89 patients and group II included 207 patients. No significant difference was detected between groups regarding HCC number or size. Group I showed a more infiltrative HCC pattern, whereas group II had more circumscribed and delineated lesions. The incidence of portal vein thrombosis and significant lymphadenopathy was significantly higher in group I (P=0.03 and 0.03, respectively). Serum levels of α-fetoprotein were significantly higher in group I (P=0.02). These factors significantly affected the response to HCC management (P=0.03). Incidence of complete responses were 47.2 and 49.8% for groups I and II, respectively, whereas incomplete responses were 12.4 and 25.1%, respectively. Supportive treatment was applied to 40.4% in group I and 25.1% in group II.

Conclusion
HCC behavior was more aggressive in DAA-treated patients regarding portal vein thrombosis, malignant lymphadenopathy, and HCC imaging characteristics, which affected the chance of ablation and the treatment response.
Increased Cancer Screening for Low-income Adults Under the Affordable Care Act Medicaid Expansion
Authors: Hendryx Michael , Luo Juhua 
Published: September 2018

Background:
We tested whether Medicaid expansion under the Affordable care Act was associated with increased screening for cervical, breast, and colorectal cancer among low-income adults.

Methods:
We analyzed Behavioral Risk Factor Surveillance System data, identifying 2012 as preexpansion and 2016 as postexpansion (2014 was treated as a wash-out, and 2013 and 2015 had missing screening data from most states). States (including District of Columbia) either expanded Medicaid in 2014 (n=28) or not (n=18); five states that expanded after 2014 were excluded. Participants included low-income adults aged 18–64 without dependent children. A difference-in-difference approach tested whether expansion was significantly associated with screening, controlling for time, state effects, age, sex, race/ethnicity, education, and urban/rural population. For comparison, we also conducted analyses among the low-income Medicare (aged 65 and above) population, and a higher income population.

Results:
There was a significant expansion effect for women aged 18–64 for cervical cancer screening (N=29,059; odds ratio, 1.04; 95% confidence interval, 1.01–1.08), and for adults 50–64 for colorectal cancer screening (N=32,290; odds ratio, 1.12; 95% confidence interval, 1.03–1.22). Effects for mammography for women aged 40–64, or aged 50–64, were not significant. As expected, there were no significant improvements associated with expansion among the Medicare population, or among a population ineligible due to higher income.

Conclusions:
Medicaid expansion under the Affordable Care Act was associated with increased screening for cervical and colorectal cancer for low-income adults. It will be important to monitor possible adverse cancer outcomes in nonexpansion states among vulnerable populations over time.