bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scheduled Postoperative Ripcord Removal in Baerveldt 350 Implants: A Prospective, Randomized Trial
Authors: An Selena J. , Wen Joanne C. , Quist Michael S. , Mathenge Elizabeth W. , Vin Anita , Herndon Leon W. 
Published: December 2018

Purpose:
Many surgeons remove the ripcord in the Baerveldt glaucoma drainage device to better control tube opening and intraocular pressure (IOP) lowering postoperatively. However, complications following Baerveldt implant surgery with or without ripcord removal are not well-characterized. We performed a prospective, randomized trial to test the hypothesis that scheduled ripcord removal decreases complications and final IOP.

Methods:
Eighty-one patients were enrolled and randomized to scheduled ripcord removal at postoperative week 3 or to observation. They were followed for 6 months, and outcomes were compared between the 2 groups.

Results:
Forty-four patients were randomized to scheduled ripcord removal and 37 to observation. The intervention group had a similar rate of total complications after ripcord removal (36% vs. 24%, P=0.24), a lower rate of tube fibrin obstruction (2.3% vs. 13.5%, P=0.05), and a larger decrease in the number of medications (1.3 vs. 0.49 fewer medications, P=0.01). The removal group’s mean IOP decrease was 8.6 mm Hg and success rate was 59%, defined as 5 mm Hg<final IOP≤15 mm Hg without further surgical intervention. Neither differed significantly from those of the control group.

Conclusions:
This study suggests that scheduled ripcord removal is correlated with similar overall recovery in comparison with spontaneous tube opening. This technique leads to similar IOP decrease and success rate and is also associated with a greater decrease in the number of medications, which may improve quality of life for patients. Additional studies could be useful in clarifying this technique’s role in the postoperative course among different patient populations.
Incidence of Open-angle Glaucoma in Newly Diagnosed Retinal Vein Occlusion: A Nationwide Population-based Study
Authors: Na Kyeong Ik , Jeoung Jin Wook , Kim Young Kook , Lee Won June , Park Ki Ho 
Published: December 2018

Purpose:
The purpose of this study was to compare the incidence of open-angle glaucoma (OAG) in patients with newly diagnosed retinal vein occlusion (RVO) with that in the general population in order to determine the association between OAG and RVO.

Methods:
The Korean Health Insurance Review and Assessment (HIRA) data from 2011 through 2015 was analyzed in order to determine the incidence rates of OAG in the general population and in patients with newly diagnosed RVO based on the diagnostic code. The standardized incidence ratios (SIRs) of OAG in patients with RVO were determined with respect to the age- and sex-matched general population.

Results:
The incidence rate of OAG in the general population during the 3 years (2013 to 2015) was 233.98 per 100,000 person-years (95% CI, 233.21-234.76). A total of 31,722 patients with newly diagnosed RVO were identified in 2012 as the population at risk. The incidence rate of OAG in patients with RVO during the 3-year follow-up period was 1829.43 per 100,000 person-years (95% CI, 1745.49-1917.42). The expected incidence of OAG in patients with RVO was 433.69 during the 3-year follow-up period. On the other hand, the observed incidence of OAG was 1,741. The SIR of OAG in patients with RVO with reference to the general population was 4.01 (95% CI, 3.83-4.20).

Conclusions:
The incidence rate of OAG in patients with RVO is significantly higher than that in the general population.
The Relationship of Self-Report and Medication Possession With Glaucoma Medication Administration Success
Authors: Hein Aaron M. , Rosdahl Jullia A. , Bosworth Hayden B. , Woolson Sandra L. , Olsen Maren K. , Kirshner Miriam A. , Muir Kelly W. 
Published: December 2018

Purpose:
Many glaucoma eye drop users cannot successfully self-administer drops, and observing patients’ drop technique can be time-consuming. We sought to examine the association of patient self-reported efficacy of eye drop technique and medication possession data as potential surrogate measures for actual drop administration success.

Patients and Methods:
In total, 137 adults with medically treated glaucoma were enrolled from a University eye clinic (n=54) or a Veteran Affairs (VA) eye clinic (n=83). All participants were asked, “How confident are you that you can get the medication into your eye?” Medication possession ratio (MPR), defined as the amount of eye drop available divided by the amount prescribed, was calculated for VA study site participants for 6 months. The main outcome was the correct eye drop technique, defined as the ability to get drops into the eye and to put only 1 drop into the eye at a time.

Results:
Among 117 participants who were “very confident” they could administer eye drops correctly, 95 participants (81%) displayed the correct drop technique. Of those who reported being less than “very confident” (n=18), 11 participants (61%) displayed correct drop technique (the Fisher exact test, P=0.07). For the VA sample, 20 participants with MPR<1.2, 20 participants with MPR=1.2 to 1.8, and 23 participants with MPR>1.8 displayed correct eye drop technique (the Fisher exact test, P=0.18).

Conclusions:
Self-reported administration success and MPR are not strongly associated with successful eye drop administration. Thus, direct observation of patients’ drop instillation may be the most effective means of determining patient efficacy.
Robotic Thoracic Surgery Training for Residency Programs
Authors: Raad Wissam N. , Ayub Adil , Huang Chyun-Yin , Guntman Landon , Rehmani Sadiq S. , Bhora Faiz Y. 
Published: December 2018

Objective Robotic-assisted surgery is increasingly being used in thoracic surgery. Currently, the Integrated Thoracic Surgery Residency Program lacks a standardized curriculum or requirement for training residents in robotic-assisted thoracic surgery. In most circumstances, because of the lack of formal residency training in robotic surgery, hospitals are requiring additional training, mentorship, and formal proctoring of cases before granting credentials to perform robotic-assisted surgery. Therefore, there is necessity for residents in Integrated Thoracic Surgery Residency Program to have early exposure and formal training on the robotic platform. We propose a curriculum that can be incorporated into such programs that would satisfy both training needs and hospital credential requirements. Methods We surveyed all 26 Integrated Thoracic Surgery Residency Program Directors in the United States. We also performed a PubMed literature search using the key word “robotic surgery training curriculum.” We reviewed various robotic surgery training curricula and evaluation tools used by urology, obstetrics gynecology, and general surgery training programs. We then designed a proposed curriculum geared toward thoracic Integrated Thoracic Surgery Residency Program adopted from our credentialing experience, literature review, and survey consensus. Results Of the 26 programs surveyed, we received 17 responses. Most Integrated Thoracic Surgery Residency Program directors believe that it is important to introduce robotic surgery training during residency. Our proposed curriculum is integrated during postgraduate years 2 to 6. In the preclinical stage postgraduate years 2 to 3, residents are required to complete introductory online modules, virtual reality simulator training, and in-house workshops. During clinical stage (postgraduate years 4–6), the resident will serve as a supervised bedside assistant and progress to a console surgeon. Each case will have defined steps that the resident must demonstrate competency. Evaluation will be based on standardized guidelines. Conclusions Expansion and utilization of robotic assistance in thoracic surgery have increased. Our proposed curriculum aims to enable Integrated Thoracic Surgery Residency Program residents to achieve competency in robotic-assisted thoracic surgery and to facilitate the acquirement of hospital privileges when they enter practice.
Selective optogenetic inhibition of medial prefrontal glutamatergic neurons reverses working memory deficits induced by neuropathic pain
Authors: Cardoso-Cruz Helder , Paiva Pedro , Monteiro Clara , Galhardo Vasco 
Published: December 2018

AbstractStability of local medial prefrontal cortex (mPFC) network activity is believed to be critical for sustaining cognitive processes such as working memory (WM) and decision making. Dysfunction of the mPFC has been identified as a leading cause to WM deficits in several chronic pain conditions; however, the underlying mechanisms remain largely undetermined. Here, to address this issue, we implanted multichannel arrays of electrodes in the prelimbic region of the mPFC and recorded the neuronal activity during a food-reinforced delayed nonmatch to sample (DNMS) task of spatial WM. In addition, we used an optogenetic technique to selectively suppress the activity of excitatory pyramidal neurons that are considered the neuronal substrate for memory retention during the delay period of the behavioral task. Within-subject behavioral performance and pattern of neuronal activity were assessed after the onset of persistent pain using the spared nerve injury model of peripheral neuropathy. Our results show that the nerve lesion caused a disruption in WM and prelimbic spike activity and that this disruption was reversed by the selective inhibition of prelimbic glutamatergic pyramidal neurons during the delay period of the WM task. In spared nerve injury animals, photoinhibition of excitatory neurons improved the performance level and restored neural activity to a similar profile observed in the control animals. In addition, we found that selective inhibition of excitatory neurons does not produce antinociceptive effects. Together, our findings suggest that disruption of balance in local prelimbic networks may be crucial for the neurological and cognitive deficits observed during painful syndromes.
Widened QRS-T Angle May Be a Measure of Poor Ventricular Stretch During Exercise Among On-duty Firefighters
Authors: Dzikowicz Dillon J. , Carey Mary G. 
Published: December 2018

Background:
The spatial QRS-T angle is a measure of repolarization heterogeneity and may be a predictor of poor ventricular health. It is unknown whether a relationship exists between QRS-T angle and blood pressure (BP) during exercise.

Objective:
The purpose of this study was to evaluate the potential relationship between QRS-T angle and BP during exercise, which may be indicative of ventricular stretch.

Methods:
Ambulatory 12-lead 24-hour Holter electrocardiographic monitoring for QRS-T angle measurement was followed by exercise testing with BP (mm Hg) recordings taken preexercise, maximum achieved BP during exercise, and 2 minutes postexercise. Blood pressure recovery was calculated by subtracting the maximal and 2-minute postexercise BPs. Means (± standard deviation) and percentages are presented. Pearson correlations (r) among all QRS-T angles and all BP measures were performed. One-way analysis of variance was conducted on classification of QRS-T angle and all BP measures.

Results:
One hundred eleven firefighters (95.5% male; mean age, 44 years) were included in this analysis. Twenty-seven percent of the firefighters had either a borderline (100°–139°) or widened (≥140°) QRS-T angle. Although the analysis of variance was not statistically significant, a near–statistically significant negative correlation existed between QRS-T angle and maximum diastolic BP (r = −0.190, P = .05), and a statistically significant relationship existed between QRS-T angle and postexercise diastolic BP (r = −0.261, P = .008).

Conclusions:
A negative correlation existed between QRS-T angle and maximal diastolic BP and postexercise diastolic BP. Lower maximum diastolic BP during and after exercise may be a sign of poor ventricular stretch. A widened spatial QRS-T angle may represent poor ventricular stretch.
Switching to Imipramine Versus Add-on Mirtazapine in Venlafaxine-Resistant Major Depression
Authors: Navarro Víctor , Boulahfa Ilham , Obach Amadeu , Jerez Dídac , Diaz-Ricart Maribel , Gastó Cristóbal , Guarch Joana 
Published: December 2018

Abstract

Purpose/Background
Newer-generation antidepressants used in monotherapy or in combination with other newer-generation antidepressants or other psychotropic drugs are usually preferred as first- or second-step treatment options in resistant depression. According to our clinical experience, tricyclic antidepressants still are one of our preferred first choices in treatment-resistant moderate to severe unipolar major depressive episodes.

Methods
This 10-week open-design randomized study assessed the effectiveness of switching to imipramine (adjusted to plasma levels) compared with add-on mirtazapine (30 mg/d) for treatment of moderate to severe unipolar major depressive episodes after a 10-week unsuccessful venlafaxine regimen (225–300 mg/d). Efficacy analyses examined the change in depressive symptoms severity from baseline visit to endpoint and the comparative remission rate between treatment subgroups.

Findings/Results
The randomized sample consisted of 112 venlafaxine-resistant moderate to severe unipolar major depressed patients. Both the percentage of remitters (71.43% vs 39.28%) and the mean reduction of the Hamilton Depression Rating Scale score (76.94% vs 50.72%) were significantly larger in the imipramine subgroup.

Implications/Conclusions
Even though we should be cautious about generalizing these results to patients with a less severe unipolar major episodes, our study suggest that switching to imipramine is a very effective treatment option in unipolar major depressive episodes after an unsuccessful venlafaxine regimen.
Comparison of Paliperidone Palmitate and Second-Generation Oral Antipsychotics in Terms of Medication Adherence, Side Effects, and Quality of Life
Authors: Sağlam Aykut Demet 
Published: December 2018

Abstract

Purpose
Although schizophrenia can be treated effectively, acute aggravations and relapses occur often. Antipsychotic drug therapies are fairly effective for decreasing the rate of relapses in patients with schizophrenia. This study aimed to compare paliperidone palmitate and the second-generation oral antipsychotic drugs used to treat patients with schizophrenia in terms of medication adherence, side effects, and quality of life.

Methods
The study included 33 patients diagnosed with schizophrenia who were treated with paliperidone palmitate and 51 patients who were treated with second-generation oral antipsychotics. All the patients were administered the Positive and Negative Syndrome Scale, the Clinical Global Impression, the Extrapyramidal Symptom Rating Scale, the UKU (Ugvalg for Kliniske Undersgelser) Side Effect Rating Scale, the Short Form 36, the Morisky Medication Adherence Scale, and the Schedule for Assessing the Three Components of Insight.

Results
The medication adherence and perceived general health scores of the patients treated with paliperidone palmitate were significantly higher than those of the patients treated with second-generation antipsychotics, and the side effects of the medication on the patients' daily performance were significantly lower.

Conclusions
This study demonstrated that long-acting paliperidone palmitate therapy was associated with more favorable results in terms of medication adherence, drug side effects, and quality of life compared with second-generation oral antipsychotics. However, there is a need for further, more specific, and larger-scale studies in this field.
Tanning Beds
Authors: Roebuck Heather L. , Leever Martin , MacDonald Douglas A. , Shumer Steven 
Published: December 2018

ABSTRACT
Tanning salons were first introduced in the United States in 1978 and were not regulated until the 1980s. Studies have determined that use of a tanning bed before the age of 35 years increases the risk of developing melanoma by 75%. The appropriate use of these devices has been met with many opposing views from the Tanning Bed Association, policy makers, parents, and healthcare providers as well as adolescents. This article utilizes a multidisciplinary approach to provide an overview of the history, use, and health impact of adolescents utilizing tanning beds. A rule utilitarian approach is utilized to provide research-based recommendations for decision making to determine if adolescent tanning bans are indeed ethical.
Diaphragm-protective mechanical ventilation
Authors: Schepens Tom , Dres Martin , Heunks Leo , Goligher Ewan C. 
Published: December 2018

Purpose of review
Diaphragm dysfunction is common in mechanically ventilated patients and predisposes them to prolonged ventilator dependence and poor clinical outcomes. Mechanical ventilation is a major cause of diaphragm dysfunction in these patients, raising the possibility that diaphragm dysfunction might be prevented if mechanical ventilation can be optimized to avoid diaphragm injury – a concept referred to as diaphragm-protective ventilation. This review surveys the evidence supporting the concept of diaphragm-protective ventilation and introduces potential routes and challenges to pursuing this strategy.

Recent findings
Mechanical ventilation can cause diaphragm injury (myotrauma) by a variety of mechanisms. An understanding of these various mechanisms raises the possibility of a new approach to ventilatory management, a diaphragm-protective ventilation strategy. Deranged inspiratory effort is the main mediator of diaphragmatic myotrauma; titrating ventilation to maintain an optimal level of inspiratory effort may help to limit diaphragm dysfunction and accelerate liberation of mechanical ventilation.

Summary
Mechanical ventilation can cause diaphragm injury and weakness. A novel diaphragm-protective ventilation strategy, avoiding the harmful effects of both excessive and insufficient inspiratory effort, has the potential to substantially improve outcomes for patients.
Falsification Tests for Instrumental Variable Designs With an Application to Tendency to Operate
Authors: Keele Luke , Zhao Qingyuan , Kelz Rachel R. , Small Dylan 
Published: December 2018

Background:
Instrumental variable (IV) methods are becoming an increasingly important tool in health services research as they can provide consistent estimates of causal effects in the presence of unobserved confounding. However, investigators must provide justifications that the IV is independent with any unmeasured confounder and its effect on the outcome occurs only through receipt of the exposure. These assumptions, while plausible in some contexts, cannot be verified from the data.

Methods:
Falsification tests can be applied to provide evidence for the key IV assumptions. A falsification test cannot prove the assumptions hold, but can provide decisive evidence when the assumption fails. We provide a general overview of falsification tests for IV designs. We highlight a falsification test that utilizes a subpopulation of the data where an overwhelming proportion of units are treated or untreated. If the IV assumptions hold, we should find the intention-to-treat effect is zero within these subpopulations.

Results:
We demonstrate the usage of falsification tests for IV designs using an IV known as tendency to operate from health services research. We show that the falsification test provides no evidence against the IV assumptions in this application.
Bempedoic acid: effects on lipoprotein metabolism and atherosclerosis
Authors: Burke Amy C. , Telford Dawn E. , Huff Murray W. 
Published: December 2018

Purpose of review
Bempedoic acid has emerged as a potent inhibitor of ATP-citrate lyase (ACLY), a target for the reduction of LDL cholesterol (LDL-C). We review the impact of bempedoic acid treatment on lipoprotein metabolism and atherosclerosis in preclinical models and patients with hypercholesterolemia.

Recent findings
The liver-specific activation of bempedoic acid inhibits ACLY, a key enzyme linking glucose catabolism to lipogenesis by catalyzing the formation of acetyl-CoA from mitochondrial-derived citrate for de novo synthesis of fatty acids and cholesterol. Adenosine monophosphate-activated protein kinase activation by bempedoic acid is not required for its lipid-regulating effects in vivo. Mendelian randomization of large human study cohorts has validated ACLY inhibition as a target for LDL-C lowering and atheroprotection. In rodents, bempedoic acid decreases plasma cholesterol and triglycerides, and prevents hepatic steatosis. In apolipoprotein E-deficient (Apoe

−/−
) mice, LDL receptor-deficient (Ldlr

−/−
) mice and LDLR-deficient miniature pigs, bempedoic acid reduces LDL-C and attenuates atherosclerosis. LDLR expression and activity are increased in primary human hepatocytes and in Apoe

−/−
mouse liver treated with bempedoic acid suggesting a mechanism for LDL-C lowering, although additional pathways are likely involved. Phase 2 and 3 clinical trials revealed that bempedoic acid effectively lowers LDL-C as monotherapy, combined with ezetimibe, added to statin therapy and in statin-intolerant hypercholesterolemic patients. Treatment does not affect plasma concentrations of triglyceride or other lipoproteins.

Summary
The LDL-C-lowering and attenuated atherosclerosis in animal models and reduced LDL-C in hypercholesterolemic patients has validated ACLY inhibition as a therapeutic strategy. Positive results from phase 3 long-term cardiovascular outcome trials in high-risk patients are required for bempedoic acid to be approved for prevention of atherosclerosis.
Increased Ascertainment of Transgender and Non-binary Patients Using a 2-Step Versus 1-Step Gender Identity Intake Question in an STD Clinic Setting
Authors: Tordoff Diana M. , Morgan Jennifer , Dombrowski Julia C. , Golden Matthew R. , Barbee Lindley A. 
Published: December 2018

Background
Transgender inclusive and gender affirmative healthcare includes asking patients about gender identity and sex assigned at birth through what is known as the “2-step” methodology. In May 2016, the sexually transmitted disease (STD) clinic in Seattle, WA switched from using a 1-step to a 2-step gender identity question. We aimed to determine if the updated questions increased ascertainment of transgender and gender nonconforming (TGNC) patients and used the improved gender identity data to describe the human immunodeficiency virus/STD risk profile of TGNC patients.

Methods
We conducted a pre-post analysis comparing the proportion of patients that identified as TGNC during the year before and after implementation of the 2-step questions. Gender identity and medical history questions were ascertained using a computer-assisted self-interview. The 2-step question included 2 new gender response options: non-binary/genderqueer and write-in.

Results
Institution of the 2-step question resulted in a 4.8-fold increase in patients who were identified as TGNC: 36 (0.5%) of 6635 to 172 (2.4%) of 7025 patients (P < 0.001). After implementation, 89 patients identified as non-binary/genderqueer (51.7% of TGNC patients). The proportion of patients identified as transgender men and women increased from 0.2% to 0.5% (P = 0.002) and 0.4% to 0.6% (P = 0.096), respectively. Non-binary patients' human immunodeficiency virus/sexually transmitted infection risk profile was distinct from that of transgender and cisgender men who have sex with men, suggesting that distinguishing subpopulations within the TGNC population is important for risk stratification.

Conclusions
Using a 2-step gender identity question and including non-binary/genderqueer options increased our clinic's ascertainment of TGNC patients and more accurately captured gender identity among STD clinic patients.
A Case of Asymptomatic Syphilitic Proctitis
Authors: Allan-Blitz Lao-Tzu , Beaird Omer E. , Dry Sarah M. , Kaneshiro Marc , Klausner Jeffrey D. 
Published: December 2018

Abstract
The incidence of syphilis is increasing. Syphilitic proctitis involving the rectal mucosa often presents with pain on defecation, rectal bleeding, or ulceration. We present a case of asymptomatic syphilitic proctitis diagnosed upon a routine screening colonoscopy.