bluuebunny/crossref_metadata_2025_split huggingface dataset:
POSTERIORLY INSERTED VITREOUS BASE
Authors: Sohn Elliott H. , Strohbehn Austin , Stryjewski Tomasz , Brodowska Katarzyna , Flamme-Wiese Miles J. , Mullins Robert F. , Eliott Dean 
Published: March 2019

Purpose:
To determine the preoperative characteristics, intraoperative and postoperative complications, and outcomes of eyes with posteriorly inserted vitreous base.

Methods:
In this retrospective, observational, consecutive case series at 2 academic centers, 37 patients were studied who had posteriorly inserted vitreous base noted during vitrectomy. Posteriorly inserted vitreous base was defined as the insertion of the posterior hyaloid membrane being located posterior to the vortex veins. Fifteen eyes were analyzed in a histopathologic study of donor eyes to determine the average distance of the ora serrata from the vortex veins as this distance is uncertain.

Results:
Posteriorly inserted vitreous base was identified during vitrectomy in 31 eyes with rhegmatogenous retinal detachment (84%), 4 with macular hole (11%), 1 with vitreous hemorrhage, and 1 with epiretinal membrane. Adjunctive buckle was used in 24%; 54% had 360° laser. Average number of tears seen preoperatively in those with rhegmatogenous retinal detachment was 3.1. Thirty percent had new breaks identified intraoperatively. Forty-one percent had lattice degeneration; new breaks were found in 40% of eyes with lattice. Thirteen percent of rhegmatogenous retinal detachments developed proliferative vitreoretinopathy. Average distance from the ora serrata to the vortex veins was 7.6 mm.

Conclusion:
Any eye undergoing vitrectomy may have posteriorly inserted vitreous base, but those with a high number of retinal breaks and lattice near the equator may be at highest risk. Redetachment and proliferative vitreoretinopathy still occur despite knowledge of the disorder and adjuvant treatments.
Peripheral Endothelial Cell Density in Descemet Membrane Endothelial Keratoplasty Grafts
Authors: Lee Brian A. , Qureshi Saima , Lee Sung , Hou Gene J. , Bedard Peter , Hou Joshua H. 
Published: March 2019

Purpose:
To compare the variation in corneal endothelial cell density (ECD) from the center to the periphery in unpeeled and peeled donor corneas and to determine the impact of eccentric trephining on total endothelial cells in Descemet membrane endothelial keratoplasty (DMEK) grafts.

Methods:
Mated donor cornea pairs were obtained. One cornea from each pair was peeled for DMEK, whereas the other was left unpeeled. Alizarin Red was used to stain the endothelial cells. High-resolution images at fixed magnification were obtained for the center, midperiphery (2.5 mm from the center), and the periphery (5 mm from the center). The cells were then counted, and ECD was calculated by a masked evaluator using ImageJ software. Regression analysis was then performed to evaluate the change in ECD as a function of radius (distance from the corneal center). The impact of eccentric trephining on total endothelial cells in a given DMEK graft was then calculated using numerical integration.

Results:
Ten pairs of corneas were evaluated. ECD increased by 1.4% (40.0 cells/mm2) (P = 0.03) for peeled corneas and 1.8% (51.5 cells/mm2) (P < 0.01) for unpeeled corneas for each millimeter from the center. There was no difference between peeled and unpeeled corneas in the mean central (P = 0.98) or peripheral (P = 0.35) ECD. Based on the increase in ECD as a function of radius, eccentric trephining of a 7.5-mm DMEK graft by 2.25 mm yields 0.95% more total endothelial cells per graft.

Conclusions:
Corneal ECD increases from the center to the periphery in both peeled and unpeeled corneas. Eccentric trephining increases the number of transplanted endothelial cells per graft.
Natural Course of Mild Graves Orbitopathy: Increase of Orbital Fat But Decrease of Muscle Volume With Increased Muscle Fatty Degeneration During a 4-Year Follow-Up
Authors: Potgieser Peter W. , de Win Maartje M. M. L. , Wiersinga Wilmar M. , Mourits Maarten P. 
Published: March 2019

Purpose:
To describe the natural course of orbital fat volume and extraocular muscle volume in mild Graves orbitopathy during a 4-year follow-up. To describe fatty changes within the extraocular muscles.

Patients:
Twenty-five patients with mild Graves orbitopathy, who did not require any therapeutic intervention other than supportive therapy, were followed for 4 years.

Methods:
CT scans were performed in all patients at baseline and follow-up. A validated technique using Mimics (Materialise) was used to calculate fat and muscle volumes. Outcomes were compared with previously collected data. The amount of intramuscular fat was assessed on CT scans in a semi-quantitative way by two blinded observers according to a four-point scale.

Results:
After a median follow-up of 4.3 years, the median fat to orbital volume ratio increased with 0.08 from 0.57 to 0.65 (p = 0.000), whereas the median muscle volume to orbital volume ratio decreased with 0.03 from 0.17 to 0.14 (p = 0.000). In this control group in patients between 49 and 54 years old, the changes were 0.01 and −0.002, respectively. The Clinical Activity Score decreased to zero (p = 0.000), and the median eyelid aperture decreased from 12 to 10 mm (p = 0.007). A significant increase of intramuscular fat was found in patients with Graves orbitopathy.

Conclusions:
The natural course of mild Graves orbitopathy, as observed over 4 years, is characterized by an increase of orbital fat volume, a decrease in muscle volume, and an increased intramuscular fatty degeneration.
Altered Surfactant Protein Expression in Primary Acquired Nasolacrimal Duct Obstruction
Authors: Ali Mohammad Javed , Bráuer Lars , Schicht Martin , Paulsen Friedrich 
Published: March 2019

In cases of primary-acquired nasolacrimal duct obstruction, the expression of multiple surfactant proteins was either deranged or lost in the lining epithelium of the lacrimal sac and nasolacrimal ducts.

Purpose:
To investigate the presence and distribution patterns of 6 surfactant proteins in lacrimal drainage tissues of patients with primary acquired nasolacrimal duct (NLD) obstruction.

Methods:
The presence and distribution of surfactant proteins (SP)-G and SP-H was first assessed in normal cadaveric lacrimal systems. The study was then performed in 10 samples of lacrimal sac and the respective NLDs obtained from patients suffering from primary acquired NLD obstruction who underwent either a dacryocystorhinostomy or a dacryocystectomy. The lacrimal sac samples were further divided into fundus and body, soon after their removal. Immunohistochemical labeling was performed for assessing the presence and distribution of SPs: SP-A, SP-B, SP-C, SP-D, SP-G/SFTA2, and SP-H/SFTA3. The results were then scored as positive or negative and the distribution pattern, if any, within the lacrimal sac and NLDs was assessed. Human lung tissues were used as controls.

Results:
SP-H was demonstrated in the lining epithelia of the normal lacrimal drainage systems, whereas SP-G was uniformly negative. Immunohistochemical labeling revealed wide variations in the staining patterns of different SPs in different regions of the lacrimal sac and the NLD. SP-D and SP-G revealed uniformly negative immunoreactivity. Variable staining patterns were also noted between the superficial and basal layers of the lining epithelia. However, the goblet cells and intraepithelial mucous glands did not express any of the SPs.

Conclusions:
This study provides a proof of principle for the presence of SP-H and absence of SP-G in the normal lacrimal drainage systems. In cases of primary acquired nasolacrimal duct obstruction, there were alterations or loss of SP expression in the lining epithelia of the lacrimal sac and NLDs, reflecting their possible role in the etiopathogenesis of primary acquired nasolacrimal duct obstruction.
Clinical Scenarios for Which Spinal Mobilization and Manipulation Are Considered by an Expert Panel to be Inappropriate (and Appropriate) for Patients With Chronic Low Back Pain
Authors: Herman Patricia M. , Hurwitz Eric L. , Shekelle Paul G. , Whitley Margaret D. , Coulter Ian D. 
Published: March 2019

Background:
Spinal mobilization and manipulation are 2 therapies found to be generally safe and effective for chronic low back pain (CLBP). However, the question remains whether they are appropriate for all CLBP patients.

Research Design:
An expert panel used a well-validated approach, including an evidence synthesis and clinical acumen, to develop and then rate the appropriateness of the use of spinal mobilization and manipulation across an exhaustive list of clinical scenarios which could present for CLBP. Decision tree analysis (DTA) was used to identify the key patient characteristics that affected the ratings.

Results:
Nine hundred clinical scenarios were defined and then rated by a 9-member expert panel as to the appropriateness of spinal mobilization and manipulation. Across clinical scenarios more were rated appropriate than inappropriate. However, the number patients presenting with each scenario is not yet known. Nevertheless, DTA indicates that all clinical scenarios that included major neurological findings, and some others involving imaging findings of central herniated nucleus pulposus, spinal stenosis, or free fragments, were rated as inappropriate for both spinal mobilization and manipulation. DTA also identified the absence of these imaging findings and no previous laminectomy as the most important patient characteristics in predicting ratings of appropriate.

Conclusions:
A well-validated expert panel-based approach was used to develop and then rate the appropriateness of the use of spinal mobilization and manipulation across the clinical scenarios which could present for CLBP. Information on the clinical scenarios for which these therapies are inappropriate should be added to clinical guidelines for CLBP.
Synadenium umbellatum and the Ehrlich's solid tumor treatment
Authors: da Silva Emerson B. , Chagas Camila S. , Fonseca Alexandre L. A. , Alves Beatriz da C. A. , Bagatin Izilda , Perazzo Fábio F. , Rosa Paulo , Feder David , Fonseca Fernando Luiz A. 
Published: March 2019

Abstract

Introduction:
Studies have been attributed to cancer treatment, including the potential of several plants with putative anticancer activity. Among these is “Cola-note” (Synadenium umbellatum).

Methods:
We evaluated the effects of macerated S umbellatum at a concentration of 10 mg/kg in Bagg albino strain c mice and its myelotoxic, hepatotoxic, and antitumor activity as well as the expression of inflammatory genes (TGF-β1 and TNF-α). Cells from Ehrlich tumor were implanted in the dorsolateral region of 8 mice of the Bagg albino strain c mice; these animals were divided into control (treated with NaCl 0.9%) and treatment group (treated with macerated Cola-Nota 10 mg/kg).

Results:
Treatment group animals showed no hepatotoxicity, but a potential myelotoxicity. The results suggest that treatment with Cola-Note macerate causes a decrease in expression of TNF-α and an increased expression of TGF-β1.

Discussion:
The S umbellatum (10 mg/kg) is shown to be effective in reducing the concentration of neoplastic cachexia, but there was no antitumor activity.
The Medical Resuscitation Committee
Authors: Mittiga Matthew R. , Frey Mary , Kerrey Benjamin T. , Rinderknecht Andrea S. , Eckerle Michelle D. , Sobolewski Brad , Johnson Laurie H. , Oehler Jennifer L. , Bennett Berkeley L. , Chan Steven , Frey Theresa M. , Krummen Kelly M. , Lindsay Claire , Wolfangel Kelsey , Richert Alison , Masur Tonya J. , Bria Corinne L. , Hoehn Erin F. , Geis Gary L. 
Published: March 2019

Abstract
Provision of optimal care to critically ill patients in a pediatric emergency department is challenging. Specific challenges include the following: (a) patient presentations are highly variable, representing the full breadth of human disease and injury, and are often unannounced; (b) care team members have highly variable experience and skills and often few meaningful opportunities to practice care delivery as a team; (c) valid data collection, for quality assurance/improvement and clinical research, is limited when relying on traditional approaches such as medical record review or self-report; (d) specific patient presentations are relatively uncommon for individual providers, providing few opportunities to establish and refine the requisite knowledge and skill; and (e) unscientific or random variation in care delivery. In the current report, we describe our efforts for the last decade to address these challenges and optimize care delivery to critically ill patients in a pediatric emergency department. We specifically describe the grassroots development of an interprofessional medical resuscitation program. Key components of the program are as follows: (a) a database of all medical patients undergoing evaluation in the resuscitation suite, (b) peer review and education through video-based case review, (c) a program of emergency department in situ simulation, and (d) the development of cognitive aids for high-acuity, low-frequency medical emergencies.
Colorectal Cancer Screening in People With and Without HIV in an Integrated Health Care Setting
Authors: Lam Jennifer O. , Hurley Leo B. , Udaltsova Natalia , Alexeeff Stacey E. , Klein Daniel B. , Corley Douglas A. , Silverberg Michael J. 
Published: March 2019

Background:
As people with HIV (PWH) live longer, age-appropriate colorectal cancer (CRC) screening is increasingly important. Limited data exist on CRC screening and outcomes comparing PWH and persons without HIV.

Setting:
Large integrated health care system.

Methods:
This study included PWH and demographically matched persons without HIV who were aged 50–75 years during 2005–2016 and had no previous CRC screening. We evaluated time to first CRC screening (fecal test, sigmoidoscopy, or colonoscopy). We also assessed detection of adenoma and CRC with sigmoidoscopy or colonoscopy by HIV status, accounting for CRC risk factors including sex, age, race/ethnicity, number of outpatient visits, smoking, body mass index, type-2 diabetes, and inflammatory bowel disease. Among PWH, we evaluated whether CD4 count (<200/200–499/≥500 cells/µL) was associated with adenoma and CRC.

Results:
Among 3177 PWH and 29,219 persons without HIV, PWH were more likely to be screened (85.6% vs. 79.1% within 5 years, P < 0.001). Among those with sigmoidoscopy or colonoscopy, adenoma was detected in 161 (19.6%) PWH and 1498 (22.6%) persons without HIV, and CRC was detected in 4 (0.5%) PWH and 69 (1.0%) persons without HIV. In adjusted analyses, we found no difference in prevalence of either adenoma or CRC by HIV status (adjusted prevalence ratio = 0.97, 95% confidence interval: 0.83 to 1.12). Lower CD4 count did not increase likelihood of adenoma or CRC.

Conclusions:
Within an integrated health care system with an organized CRC screening program, we found no disparities in CRC screening uptake or outcomes among people with and without HIV, and CD4 count did not influence CRC risk among PWH.
Issues in the future development of new analgesic drugs
Authors: David-Pereira Ana , Dickenson Anthony H. 
Published: March 2019

Purpose of review
There is a clear unmet need for either the development of new drugs for the treatment of painful pathologies or the better use of the existing agents denoted by the lack of efficacy of many existing drugs in a number of patients, limitations of their use due to severity of side effects, and by the high number of drugs that fail to reach clinical efficacy from preclinical development. This account considers the efforts being made to better validate new analgesic components and to improve translational efficacy of existing drugs.

Recent findings
A better use of the available models and tools can improve the predictive validity of new analgesic drugs, as well as using intermediate steps when translating drugs to clinical context such as characterizing drugs using stem cell-sensory derived neurones. Profiling patient sensory phenotypes can decrease the number of failed clinical trials and improve patient outcome.

Summary
An integrative approach, comprising the use of complementary techniques to fully characterize drug profiles, is necessary to improve translational success of new analgesics.
Drug-Induced Parkinsonism Manifesting as Gait Freezing in a Patient With Traumatic Brain Injury: A Case Report
Authors: Yoo Ho Sang , Kim Yong Wook , Kim Na Young 
Published: March 2019

Background
Among the neuropsychiatric complications commonly induced by traumatic brain injury (TBI), behavioral disorders, such as agitation and aggression, can hinder neurological recovery and deteriorate rehabilitation outcomes. Pharmacological treatment for behavioral disorders might be beneficial but could lead to drug-induced parkinsonism. We report a case of a patient with drug-induced parkinsonism manifested as freezing of gait after TBI, which improved with the cessation of the offending drugs and comprehensive rehabilitation.

Case Presentation
A 35-year-old male patient left with a TBI after a car accident was referred to our hospital. He had been on many neuropsychiatric medications, including atypical antipsychotics, for his agitated behaviors. He could walk independently but showed freezing of gait at the initiation of his gait, when turning to the side, when reaching his destination, and passing through narrow corridors. Under the impression of drug-induced parkinsonism, we gradually tapered the patient off his neuropsychiatric medications. He also underwent comprehensive rehabilitation, including gait training under visual and auditory cues and balance training. Five weeks after admission to the hospital, the patient's freezing of gait improved, with disappearance of his hesitation at gait initiation and a decreased freezing duration while turning around.

Conclusions
This is a rare report of drug-induced parkinsonism manifested as freezing of gait, which showed improvement after discontinuation of the causative drugs and subsequent rehabilitation.
Sertraline-Related Amenorrhea in an Adolescent
Authors: Ekinci Nuran , Güneş Serkan , Kalinli Merve , Ekinci Özalp 
Published: March 2019

Abstract
Amenorrhea is one of the clinical consequences of hyperprolactinemia. Although symptomatic hyperprolactinemia is among the well-described adverse reactions of antipsychotic agents, it may also be reported with the use of selective serotonin reuptake inhibitors. Hereby, we present a case of sertraline-related hyperprolactinemic amenorrhea in an adolescent. Amenorrhea occurred 2 months after starting sertraline, and menstrual cycle restored after stopping the treatment.
Video Game-Induced Theta Rhythm
Authors: Sener Ugur , McKay Jake H. , Feyissa Anteneh M. , Tatum William O. 
Published: March 2019

Summary:
Smartphones and other personal electronic devices present novel cortical processing tasks with potential for identification of novel EEG waveforms. A 17-year-old patient with epilepsy manifested as recurrent myoclonic seizures, absence seizures, and a single generalized tonic–clonic seizure was hospitalized to undergo video-EEG monitoring for seizure quantification and classification of the epilepsy syndrome. During the monitoring session, a frontocentral predominant 5 to 6 Hz theta rhythm was identified only when the patient was actively texting or playing a video game on his smartphone. Previously, patients with focal epilepsy have been found to have a frontocentral theta rhythm on EEG while texting on mobile devices. We report similar EEG findings in a patient with genetic generalized epilepsy during smartphone gaming to expand the population and triggers for this theta waveform. Given the young age and type of epilepsy, we suggest that the waveform represents the EEG manifestation of the attention–visuomotor pathway that is stimulus independent.
Multiple Point Stimulation MUNE in ALS: Toward a Faster Modification
Authors: Oliveira Santos Miguel , Jacobsen Anna Bystrup , Tankisi Hatice 
Published: March 2019

Purpose:
Multiple point stimulation is a well-established motor unit number estimate method that can be used in all EMG machines, but it is time-consuming. We investigated whether a faster modification of multiple point stimulation using five surface motor unit action potentials (sMUAP) had similar reproducibility, sensitivity, and specificity as 10.

Methods:
Twenty-two motor neuron disease patients and 20 healthy controls were prospectively examined by two physicians twice in the thenar muscles.

Results:
A total of 168 multiple point stimulation motor unit number estimate recordings were obtained. Mean motor unit number estimate was significantly lower in patients in contrast to the controls, whether using 5 (53 ± 55 [1–170] vs. 150 ± 64 (51–325), P < 0.001] or 10 sMUAP [52 ± 51 (1–162) vs. 151 ± 50 (75–274), P < 0.001]. No significant differences (P > 0.05) were found between mean motor unit number estimate obtained from 5 or 10 sMUAP in both patients and controls. Intra-rater coefficient of variation (CV) for patients (17% vs. 15%) and controls (16% vs. 13%) and inter-rater coefficient of variation for patients (25% vs. 24%) did not differ between five and 10 sMUAP (P > 0.05), whereas interrater coefficient of variation was higher for five sMUAP in controls (21% vs. 16%, P = 0.004). An excellent intraclass correlation coefficient (≥0.78) was found, sampling either 5 or 10 sMUAP, for both groups. Receiver operating characteristic curves collecting 5 or 10 sMUAP showed excellent accuracy in distinguishing between patients and controls.

Conclusions:
The faster modification of Multiple point stimulation by sampling five sMUAP had similar reproducibility, sensitivity, and specificity as 10 and may be suggested in future research and clinical practice.
Dosing regimen of gentamicin and the effect of antenatal steroids on clearance in preterm infants
Authors: Santos Roberto P. , Chang Yin , Oliveira Carlos R. , Adams-Huet Beverly , Gard John , Sanchez Pablo J. 
Published: March 2019

ABSTRACTObjectiveDetermine the gentamicin pharmacokinetic and pharmacodynamic (PK/PD) profiles of once daily dosing (ODD) versus every 18-hour (q18h) regimens and to characterize the effect of antenatal steroid on gentamicin clearance (GentCL).Study DesignRetrospective cohort of preterm infants (≤34 weeks gestation; ≤7 days) who received gentamicin for >48 hours from January 2005 to June 2007. Serum gentamicin peak and trough concentrations were determined, and PK/PD profiles calculated using standard noncompartmental methods.Result122 (63%) infants received ODD and 73 (37%) received q18h regimen. Desired gentamicin peak (5 to 12 mcg/mL) and trough (<2 mcg/mL) concentrations were achieved in 80% (95%CI, 72-86) on ODD vs. 47% (95%CI, 36-58) on q18h (p<0.001). Target drug exposure (AUC >72 mcg/mL/hr) was achieved in 73% (89/122) of infants on ODD vs. 22% (16/73) on q18h (p < 0.001). GentCLwas significantly lower in those who receive antenatal steroid (37+/-8 mL/kg/hr vs. 42+/-13 mL/kg/hr,p=0.04)but not affected by postnatal indomethacin treatment (p>0.86).ConclusionPK/PD profile of gentamicin is improved by ODD in preterm infants. GentClwas significantly less in infants exposed to antenatal steroids but not in those treated with indomethacin.