bluuebunny/crossref_metadata_2025_split huggingface dataset:
Late-Onset Sterile Peripheral Ulcerative Keratitis Post-Corneal Collagen Crosslinking
Authors: Chanbour Wassef , Mokdad Israa , Mouhajer Abdallah , Jarade Elias 
Published: December 2018

Purpose:
To report the incidence, characteristics, clinical presentations, risk factors, and the available treatment modalities of sterile peripheral ulcerative keratitis (PUK) post-corneal collagen crosslinking (CXL).

Methods:
This study is a retrospective study including 771 eyes of 474 patients operated for keratoconus or ectasia after LASIK between January 2010 and June 2017 at Beirut Eye & ENT Specialist hospital. The average follow-up period was 4.2 years with a minimum of 1 year post-CXL.

Results:
Eleven eyes (1.4%) of 8 patients developed late-onset PUK with or without corneal haze and sterile infiltrates. The complications occurred between 3 months and 6 years postoperatively. Their mean age of 39.6 ± 7.1 years was higher than the age of the noncomplicated patients 21.9 ± 8.8 years (P = 0.0001). Four affected patients had inflammatory and autoimmune conditions. Sex, presence of intrastromal ring segments, mean keratometry, and the thinnest pachymetry were found to be insignificantly different between groups, and photorefractive keratectomy was performed more in patients with keratitis. Duration of ultraviolet light exposure was related to sterile ulcerative keratitis development. All patients responded to steroid treatment, and only one had a relapse which resolved with topical cyclosporine 1% drops.

Conclusions:
PUK is a rare but serious complication after CXL. Long-term follow-up is necessary to detect late-onset PUK. It is a treatable condition associated with older age and autoimmune conditions but has a good visual outcome.
Outcomes of Micropulse Transscleral Cyclophotocoagulation in Uncontrolled Glaucoma Patients
Authors: Zaarour Karen , Abdelmassih Youssef , Arej Nicolas , Cherfan Georges , Tomey Karim F. , Khoueir Ziad 
Published: December 2018

Purpose:
This study aimed at evaluating the intermediate-term efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in cases of uncontrolled glaucoma.

Methods:
Patients with moderate to advanced glaucoma and uncontrolled intraocular pressure (IOP) despite maximally tolerable antiglaucoma medications were selected to undergo MP-TSCPC using the MP3 handpiece with the Iridex Cyclo G6 (IRIDEX Laser Systems). Follow-up examinations took place on a regular basis until 15 months postoperatively.

Results:
Seventy-five eyes of 69 patients (53.6% male patients) were included. Mean age was 55.5±22.9 years. Primary open-angle glaucoma was the most common diagnosis. Corrected distance visual acuity at baseline ranged between 0 and 2.1 logMAR. Mean prelaser IOP was 26.0±7.91 mm Hg. This was reduced significantly to 13.8±5.6 mm Hg (44.0% reduction, P<0.001) at week 1, and to 18.0±7.7, 18.4±7.1, 16.7±6.2, 15.1±4.1, 15.7±5.32, and 14.8±5.50 mm Hg at months 1, 3, 6, 9, 12, and 15, respectively. The mean number of antiglaucoma drops decreased significantly up to 12 months of follow-up (P=0.008) and that of oral acetazolamide tablets decreased significantly up to 15 months (P<0.001). The success rate decreased progressively with time, reaching 81.4% at 6 months and 73.3% at 1 year. No major postoperative complications were encountered, and no eye lost vision completely.

Conclusions:
MP-TSCPC is an efficient noninvasive glaucoma treatment that achieves sustained IOP reduction and reduced need for ocular antihypertensive medications for up to 15 months. The optimal laser parameters to achieve the best success rate with the least side effects still need to be determined.
Effects of Exercise Interventions on Breast Cancer Patients During Adjuvant Therapy
Authors: Lee Junga , Lee Man-Gyoon 
Published: December 2018

Background
Effects of exercise interventions on patients with breast cancer (BC) have shown benefits regardless of the measured variables, although the type of exercise and its duration during adjuvant therapy are unclear.

Objective
We investigated the effects of exercise interventions on each measurement, physical fitness, quality of life (QL), fatigue, depression, anxiety, and body compositions and found effective exercise interventions during adjuvant therapy for BC.

Methods
Twenty-nine studies were found by searching the databases of MEDLINE and EMBASE from January 2000 to February 2018. Randomized controlled trials that investigated the effects of exercise on physical and psychological outcomes in BC patients during adjuvant therapy were selected in this meta-analysis. The size of the effect for each variable from the selected studies considered the method of measurement and was calculated using the standardized mean difference statistic.

Results
A total of 2989 BC patients were included. Exercise interventions had positive outcomes in physical fitness, handgrip strength, QL, fatigue, depression, anxiety, self-esteem, % body fat, and body mass index. Exercise interventions were an average of 150 minutes, 3 times per week, for 17 weeks and consisted of moderate to vigorous (~60% of VO2peak), aerobic, resistance, or combined exercises.

Conclusions
Interventions that involve moderate to vigorous exercise 150 minutes for 3 times per week and in any modality may provide a better outcome for BC patients during adjuvant therapy.

Implications for Practice
Empowering BC patients to implement these exercise interventions could not only improve their health and QL, but also reduce fatigue, depression, and anxiety during adjuvant therapy.
Childhood Trauma Predicts Cancer Treatment–Related Pain in Breast Cancer Survivors
Authors: Kanzawa-Lee Grace A. , Knoerl Robert , Williams David A. , Clauw Daniel J. , Bridges Celia M. , Harte Steven E. , Kolarik Ellen , Houghtby Janet , Lavoie Smith Ellen M. 
Published: December 2018

Background
Childhood trauma has been linked to neuropathic pain in noncancer populations, but its relationship with cancer treatment-related neuropathic pain is unknown.

Objective
This secondary data analysis of a prospective, longitudinal, observational study aimed to explore the relationship of childhood trauma experience with pain severity, pain interference, and neuropathic symptom severity (NSS) 12 months after surgery in women receiving treatment for stage 0 to III breast cancer.

Methods
Women (N = 44) recruited from a comprehensive cancer center self-reported childhood trauma experience, pain severity, pain interference, NSS, co-occurring symptoms, and pain beliefs via questionnaires. Descriptive statistics were used to describe childhood trauma experience. Linear regression was used to model childhood trauma and other predictors on pain variables 12 months after surgery.

Results
Childhood trauma predicted pain severity and pain interference 12 months after surgery (P < .05), as did baseline pain severities and helplessness-pain catastrophizing. Age predicted only NSS. Together, the best models predicted 31.6% to 40.9% of the variance in pain severities at 12 months (P < .001).

Conclusions
Childhood trauma exposure was a significant predictor of pain 12 months after breast cancer surgery and adjuvant treatment. Younger and helplessness-pain catastrophizing women are also at risk. Research is needed to identify preventive neuropathic pain interventions for high-risk women.

Implications for Practice
Women receiving breast cancer treatment should proactively be assessed for childhood trauma history, possibly by using discreet previsit questionnaires. Childhood trauma survivors may be at high risk for poor pain outcomes and may benefit from tailored pain interventions.
Accuracy of Messenger RNA Human Papillomavirus Tests for Diagnostic Triage of Minor Cytological Cervical Lesions: A Systematic Review and Meta-Analysis
Authors: Macedo Ana Cristina L. , Bavaresco Daniela Vicente , Gonçalves João Carlos N. , Grande Antônio José , da Rosa Maria Inês 
Published: December 2018

Objectives
The main objective of this systematic review and meta-analysis is to specify the accuracy of messenger RNA human papillomavirus (HPV) tests among women with previous minor cervical lesion cytology to detect high-grade squamous intraepithelial lesions (CIN2+ and CIN3+) compared with a histopathological reference standard. The secondary objective is to compare messenger RNA HPV test accuracies and the DNA high-risk HPV test among these women.

Methods
Eligible studies were identified by searching the electronic databases with medical subject headings.

Main Results
Among the 2052 studies identified, 20 primary studies were included. Two tests were mainly identified: Aptima and PreTect HPV-Proofer. Aptima, with 10 studies, had better performance, considering atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion together, with a pooled sensitivity of 90.5% (95% confidence interval [CI], 88.1–92.6) and specificity of 55.1% (95% CI, 53.5–56.8) for CIN2+. For the ASC-US sample, Aptima had a pooled sensitivity of 90.1% (95% CI, 87.1–92.7) and specificity of 59.3% (95% CI, 57.5–61.1).

Conclusions
Messenger RNA HPV tests, mainly Aptima assay, can be recommended to triage women with ASC-US and low-grade squamous intraepithelial lesion because it has higher specificity with a small loss of sensitivity than Hybrid Capture 2 assay; this finding is promising as a means to reduce the overmanagement of minor cytological abnormalities.
Fixation Stability with Bessel Beams
Authors: Bhattarai Dipesh , Suheimat Marwan , Lambert Andrew J. , Atchison David A. 
Published: December 2018

SIGNIFICANCE
Ophthalmic imaging instruments that require stable fixation can benefit by using Bessel beams in the form of monitor-based Bessel images.

PURPOSE
The purpose of this study was to investigate fixation stability using laser Bessel and Gaussian beams and monitor-based images of these targets.

METHODS
The right eyes of 16 participants were presented with seven fixation targets: monitor-based images of a bull's eye/cross hair, a Gaussian beam, a Bessel beam with four rings and a Bessel beam with three rings; laser Gaussian beam, laser Bessel beam with four rings, and laser Bessel beam with three rings. Participants fixated target centers for five runs, in which each run presented the seven targets for 20 seconds each. An Eye Tribe tracker sampled eye positions at 30 Hz. Standard deviations along horizontal (σx) and vertical meridians (σy) and areas of bivariate contour ellipses (BCEAs) of fixation positions were calculated, and statistical significances of target differences for these parameters were determined.

RESULTS
Average σx, σy, and BCEAs ranged from 0.26 to 0.35°, 0.38 to 0.55°, and 0.78 to 1.31 degrees2, respectively. Target differences in σx (χ2
6 = 13.0, P = .04), (σy) (χ2
6 = 36.819, P < .001), and BCEA (χ2
6 = 34.406, P < .001) were statistically significant. There were significant post hoc differences between some of the target pairs for σy and BCEA, but not for σx. Monitor-based Bessel beam targets provided significantly smaller σy and BCEAs than the bull's eye/cross hair combination and the monitor- and laser-based Gaussian beam targets.

CONCLUSIONS
Monitor-based images of Bessel beams provided better fixation targets than did a bull's eye/cross hair combination, monitor-based Gaussian images, and laser Gaussian beams, but no claim can be made that laser Bessel beams provide better fixation targets than do laser Gaussian beams. Monitor-based Bessel images should be useful for ophthalmic imaging instruments requiring stable fixation.
Case Report: Management of Corneal Clouding from Lecithin:Cholesterol Acyltransferase Deficiency
Authors: Zemsky Christine J. , Sherman Suzanne W. , Schubert Hermann D. , Suh Leejee H. 
Published: December 2018

SIGNIFICANCE
Given that there are few reported cases of lecithin:cholesterol acyltransferase (LCAT) deficiency, recognition of the condition with proper management is notable. Long-term follow-up and contact lens fitting after penetrating keratoplasty provide best possible outcomes.

PURPOSE
The purpose of this study was to report a case of LCAT deficiency successfully treated with penetrating keratoplasty and longer-term follow-up with contact lens fitting.

CASE REPORT
A 43-year-old white woman of Italian descent presented with corneal clouding and trouble with night vision. The patient had a history of LCAT deficiency, irritable bowel syndrome, gastroesophageal reflux disease, osteoporosis, and hemolytic anemia. Slit-lamp examination demonstrated corneal haze throughout the corneal layers. The corneas had normal pachymetry. Given the opacity of each cornea (right greater than left) and decreased night vision, penetrating keratoplasty was performed on the right eye. At post-operative month 16, the corneal graft remained clear. The patient was able to achieve a best-corrected visual acuity of 20/30+ with a scleral lens.

CONCLUSIONS
Penetrating keratoplasty may be necessary to provide better quality of vision in LCAT deficiency patients, specifically to enhance one's contrast sensitivity, despite relatively good Snellen visual acuity.
Gait Velocity and Joint Power Generation After Stroke
Authors: Mentiplay Benjamin F. , Williams Gavin , Tan Dawn , Adair Brooke , Pua Yong-Hao , Bok Chek Wai , Bower Kelly J. , Cole Michael H. , Ng Yee Sien , Lim Lek Syn , Clark Ross A. 
Published: December 2018

Objective
The aim of the study was to assess the degree to which isometric strength of multiple lower limb muscle groups and balance is associated with gait velocity and joint power generation during gait after stroke.

Design
Sixty-three participants in a multisite, multinational, cross-sectional, observational study underwent assessment of gait velocity (10-m walk test), standing balance (computerized posturography), and isometric strength (hand-held dynamometry). Twenty-seven participants had joint power generation assessed (three-dimensional gait analysis). Bivariate associations were examined using Spearman’s correlations. Regression models with partial F tests were used to compare the contribution to gait between measures.

Results
Although all muscle groups demonstrated significant associations with gait velocity (ρ = 0.40–0.72), partial F tests identified that ankle plantar flexor and hip flexor strength made the largest contribution to gait velocity. Ankle plantar flexor strength also had strong associations with habitual and fast-paced ankle power generation (ρ = 0.65 and 0.75). Balance had significant associations with habitual and fast gait velocity (ρ = −0.57 and −0.53), with partial F tests showing that the contribution was independent of strength.

Conclusions
Ankle plantar flexor and hip flexor strength had the largest contribution to gait velocity. Future research may wish to refocus strength assessment and treatment to target the ankle plantar flexors and hip flexors.

To Claim CME Credits
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives
Upon completion of this article, the reader should be able to: (1) Differentiate the contribution that lower limb strength of each muscle group has on gait velocity after stroke; (2) Appraise the relationship between isometric strength and joint power generation during gait; and (3) Interpret the contribution of both strength and balance to gait after stroke.

Level
Advanced

Accreditation
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)
TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Within-Assessment Variability of the GAITRite System in People With Stroke
Authors: Scully Aileen , Tan Dawn 
Published: December 2018

Objectives
The GAITRite is a validated tool for measuring gait. However, no information is available regarding the number of trials required. This study investigated the within-assessment variability of the GAITRite to establish the recommended number of trials.

Design
People with stroke undergoing inpatient rehabilitation were assessed on the GAITRite. Data of individuals admitted from January 2014 to January 2015 were extracted. Five trials were performed. A repeated-measures analysis of variance was used to investigate within-subject differences across the trials. Group means of each variable were plotted against trials. Significance was set at 0.05.

Results
Thirty-six people with stroke (mean [SD] age = 59.6 [13.3] yrs, 61.1% male) were assessed. Significant differences across trials were found for gait speed (P < 0.01), step length on the paretic (P < 0.01) and nonparetic sides (P < 0.01), stance phase time on the nonparetic side (P < 0.01), and single-limb support time of the paretic side (P = 0.02). The differences were found between the first two trials and the other trials.

Conclusions
Depending on the gait variable of interest, the use of two warm-up trials and taking the average of two assessment trials could reduce the within-assessment variability of this instrument in people with stroke.
Exploring assessment of medical students' competencies in pain medicine—A review
Authors: Shipton Elspeth Erica , Steketee Carole , Bate Frank , Visser Eric John 
Published: December 2018

Abstract

Introduction:
Considering the continuing high prevalence and public health burden of pain, it is critical that medical students are equipped with competencies in the field of pain medicine. Robust assessment of student expertise is integral for effective implementation of competency-based medical education.

Objective:
The aim of this review was to describe the literature regarding methods for assessing pain medicine competencies in medical students.

Method:
PubMed, Medline, EMBASE, ERIC, and Google Scholar, and BEME data bases were searched for empirical studies primarily focusing on assessment of any domain of pain medicine competencies in medical students published between January 1997 and December 2016.

Results:
A total of 41 studies met the inclusion criteria. Most assessments were performed for low-stakes summative purposes and did not reflect contemporary theories of assessment. Assessments were predominantly undertaken using written tests or clinical simulation methods. The most common pain medicine education topics assessed were pain pharmacology and the management of cancer and low-back pain. Most studies focussed on assessment of cognitive levels of learning as opposed to more challenging domains of demonstrating skills and attitudes or developing and implementing pain management plans.

Conclusion:
This review highlights the need for more robust assessment tools that effectively measure the abilities of medical students to integrate pain-related competencies into clinical practice. A Pain Medicine Assessment Framework has been developed to encourage systematic planning of pain medicine assessment at medical schools internationally and to promote continuous multidimensional assessments in a variety of clinical contexts based on well-defined pain medicine competencies.
Survival after Digit Replantation and Revascularization Is Not Affected by the Use of Interpositional Grafts during Arterial Repair
Authors: Lee Z-Hye , Klifto Christopher S. , Milone Michael T. , Cohen Joshua M. , Daar David A. , Anzai Lavinia , Thanik Vishal D. , Hacquebord Jacques H. 
Published: December 2018

Background:
Interpositional grafts can be used to reconstruct the digital artery during revascularization and replantation when primary repair is not possible. The purpose of this study was to determine the effect of using interpositional grafts on the rate of digit survival.

Methods:
A retrospective review of all patients from 2007 to 2016 that required revascularization and/or replantation of one or more digits was performed.

Results:
One hundred twenty-seven patients were identified with 171 affected digits (118 digital revascularizations and 53 digital replantations). A graft was used to repair the digital artery in 50 percent of revascularizations (59 of 118) and in 49 percent of replantations (26 of 53). There was no difference in digit survival with use of an interpositional graft for arterial repair versus primary repair in revascularization (91.5 percent in both groups) or replantation (48.1 percent versus 46.2 percent; p = 0.88). Regression analysis demonstrated no association between the use of interpositional grafts and digit survival. Interpositional grafting was more likely to be used in crush (62.5 percent) and avulsion injuries (72.2 percent) compared with sharp laceration injuries (11.1 percent), with a relative risk of 5.6 (p = 0.01) and 6.5 (p = 0.006), respectively.

Conclusions:
There was no difference in the survival rate of amputated digits that required interpositional grafting for arterial repair. The need for an interpositional graft in a large zone of injury should not be considered a contraindication to performing revascularization or replantation. Furthermore, hand surgeons should have a low threshold for using interpositional grafts, especially in crush or avulsion injuries.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Multimodal Characterization of the Mature Septal Deformity and Airspace Associated with Unilateral Cleft Lip and Palate
Authors: Marcus Jeffrey R. , Brown David A. , Carpenter David , Glener Adam , Allori Alexander , Frank-Ito Dennis 
Published: December 2018

Background:
The nasal deformity that accompanies cleft conditions is often acknowledged as the most difficult obstacle to restoring facial balance in affected children. Despite considerable progress in the treatment of cleft lip and palate, the outcomes of cleft septorhinoplasty have proven variable and difficult to predict, possibly because of incomplete understanding of the underlying anatomical deformities. The authors sought to characterize unilateral cleft septal and dorsal deformities through a detailed morphologic model based on photogrammetric, qualitative, and quantitative computerized tomographic image analysis.

Methods:
Twenty-five consecutive patients with a unilateral cleft nasal deformity without prior septorhinoplasty were included.

Results:
Dorsal angulation, as measured by the nasal dorsal angle, consistently deviated away from the cleft side at a mean angle of 8.9 degrees. In a majority of patients, the septal deformity was complex and consistent in the anterior and middle regions of the airspace, but variable in the posterior region. Finally, discrete sites of potential nasal obstruction were noted in the anterior, middle, and posterior regions along the acoustic axis. Considerable variation was seen in the anterior and posterior regions, with potential obstructions variably on both the cleft and noncleft sides.

Conclusion:
The authors’ results underscore the importance of subject-specific analysis in cleft septorhinoplasty to address multiple potential sites of nasal obstruction.