bluuebunny/crossref_metadata_2025_split huggingface dataset:
LONG-TERM VISUAL OUTCOMES AND CLINICAL FEATURES AFTER ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTION–RELATED ENDOPHTHALMITIS
Authors: Rayess Nadim , Obeid Anthony , Storey Philip P. , Juliano Joseph , Rahimy Ehsan , Moshfeghi Andrew A. , Garg Sunir , Hsu Jason 
Published: August 2018

Purpose:
To determine long-term visual outcomes in patients who developed endophthalmitis after intravitreal anti–vascular endothelial growth factor injections and to correlate visual outcomes with clinical features.

Methods:
This is a retrospective, multicenter, consecutive case series of patients diagnosed with anti–vascular endothelial growth factor injection–related endophthalmitis who were treated at Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, PA, and the University of Southern California Roski Eye Institute, Los Angeles, CA. Patients were included if they had at least 1 year of follow-up. Primary outcome was to evaluate long-term visual outcomes up to 5 years of follow-up. The secondary outcome was to determine clinical features (e.g., culture results) that may predict long-term visual acuity outcomes.

Results:
A total of 56 cases of endophthalmitis from 168,247 anti–vascular endothelial growth factor injections were identified (0.033%, 1/3,004 injections), from which 51 eyes met inclusion criteria. Mean follow-up period was 3.3 years (median 4 years; range 1–5 years). A total of 24 patients (47%) reached a maximum final follow-up of 5 years. Mean Snellen visual acuity at the causative injection visit was 20/102 and decreased to counting fingers at diagnosis (P < 0.001). At 6-month follow-up, mean visual acuity improved to 20/644 (P < 0.001) and remained stable up to 5 years (20/480, P = 0.003) follow-up compared with diagnosis. At the final follow-up, 20 eyes had visual acuity that returned to within one line of baseline visual acuity (visual recovery group), whereas 31 patients' visual acuity was at least one line worse than initial visual acuity (visual deterioration group). The cultures for the visual recovery group were more likely to grow coagulase-negative Staphylococcus, whereas the visual deterioration group primarily grew Streptococcus species, Staphylococcus aureus, and Enterococcus faecalis (P = 0.002, comparing organisms isolated in the visual recovery and deterioration group).

Conclusion:
Visual outcomes after anti–vascular endothelial growth factor injection–related endophthalmitis seem to reach peak improvement by 6 months and remain stable up to a median of 4-year follow-up. Patients who develop culture-negative endophthalmitis or endophthalmitis secondary to coagulase-negative Staphylococcus are more likely to regain baseline visual acuity compared with cases secondary to Streptococcus species.
LATE-ONSET OCULAR HYPERTENSION AFTER VITRECTOMY
Authors: Reibaldi Michele , Avitabile Teresio , Russo Andrea , Bonfiglio Vincenza , Mariotti Cesare , Romano Mario R. , Boscia Francesco , Cennamo Gilda , Fallico Matteo , Parisi Guglielmo , Castellino Niccolò , Bucolo Claudio , Li Volti Giovanni , Longo Antonio 
Published: August 2018

Purpose:
To determine the incidence and risk factors for late-onset ocular hypertension (LOH) after vitrectomy.

Methods:
From the electronic medical records of consecutive patients who underwent primary vitrectomy, from January 2010 to December 2015, at 5 tertiary vitreoretinal centers in Italy, patient demographics, systemic, ophthalmic, operative, and postoperative data were drawn. Main outcome measure was the presence of LOH, defined as intraocular pressure >21 mmHg detected more than 2 months after vitrectomy on at least 2 consecutive visits.

Results:
Among 6,048 patients, LOH was found in 294 (4.9%) vitrectomized eyes and in 87 (1.4%) fellow eyes, (chi square; P < 0.001). Multivariable logistic regression showed that significant risk factors for developing LOH included intraoperative triamcinolone use (odds ratio [OR], 7.62; P < 0.001), longer axial length (OR, 1.55; P = 3.023), preoperative higher intraocular pressure (OR, 1.81; P = 0.003), and postvitrectomy pseudophakic/aphakic status (OR, 2.04; P < 0.001). Decision-tree analysis showed that the stronger predictor of LOH was intraoperative triamcinolone use (P < 0.001). Secondary predictors were a preoperative intraocular pressure more than 15 mmHg (P < 0.001) in eyes that use triamcinolone, and postvitrectomy pseudophakic/aphakic status (P = 0.007) in eyes that did not use triamcinolone.

Conclusion:
Late-onset ocular hypertension occurred in 4.9% of vitrectomized eyes. The main risk factors were intraoperative use of triamcinolone and postvitrectomy pseudophakic/aphakic status.
Clinical Outcomes of Descemet Membrane Endothelial Keratoplasty in Eyes With Previous Radial Keratotomy
Authors: Parker Jack S. , Parker John S. , Melles Gerrit R. J. 
Published: August 2018

Purpose:
To evaluate the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) performed in eyes with corneal endothelial decompensation and previous radial keratotomy (RK).

Methods:
Five consecutive eyes of 3 patients with previous RK underwent DMEK for endothelial decompensation; best spectacle-corrected visual acuity, maximum keratometry (Kmax), central corneal thickness, and intraoperative and postoperative complications were assessed.

Results:
By 6 months postoperative, all eyes had achieved a best spectacle-corrected visual acuity of ≥20/40 (≥0.5), 4/5 (80%) were ≥20/25 (≥0.8), and 2/5 (40%) were ≥20/20 (≥1.0). On average, central corneal thickness decreased by 122 μm, and Kmax decreased by 4.2 diopters. Successful rebubbling was performed on 1 eye at 3 weeks postoperatively; another eye experienced gaping of an old RK wound, that spontaneously resolved.

Conclusions:
DMEK is technically feasible in eyes with previous RK and may provide excellent outcomes. A significant change in the anterior corneal contour and associated refractive power of the eye may be anticipated depending on the amount of preoperative corneal edema and the number of RK incisions.
The Fovea-BMO Axis Angle and Macular Thickness Vertical Asymmetry Across The Temporal Raphe
Authors: Ghassabi Zeinab , Nguyen Andrew H. , Amini Navid , Henry Sharon , Caprioli Joseph , Nouri-Mahdavi Kouros 
Published: August 2018

Purpose:
To test the hypothesis that the fovea-Bruch’s membrane opening (FoBMO) axis angle influences the thickness symmetry of the macular ganglion cell/inner plexiform layer (GCIPL) across the temporal horizontal meridian in normal subjects.

Design:
Cross-sectional diagnostic study at a tertiary academic center.

Methods:
One hundred sixteen eyes of 60 normal subjects aged 40 to 85 years underwent spectral domain optical coherence tomography(SD-OCT) imaging. The FoBMO angle was estimated on en face infrared SD-OCT images. Posterior Pole algorithm images acquired with Spectralis SD-OCT were used to define vertical asymmetry as follows. The average thickness difference between the 3 most temporal superpixels above and below the horizontal meridian, the second row of superpixels from the horizontal meridian, and 3 central superpixels above and below the horizontal meridian were calculated. Factors influencing GCIPL thickness asymmetry were explored and changes in thickness asymmetry as a function of FoBMO angle were investigated.

Results:
No demographic or clinical factors affected temporal GCIPL asymmetry (P>0.05 for all). A more (negatively) tilted FoBMO angle was associated with relatively thinner inferior compared with superior GCIPL thickness in superpixels immediately adjacent to the temporal raphe (P<0.001). The second row of temporal superpixels from the horizontal meridian (P=0.349) or central superpixels (P=0.292) did not show this tendency.

Conclusions:
Vertical GCIPL symmetry across the horizontal meridian is influenced by the FoBMO angle. SD-OCT algorithms using vertical asymmetry as a diagnostic index should be adjusted for the FoBMO angle.
Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Analysis of Unreadable Fundus Images
Authors: Hark Lisa A. , Myers Jonathan S. , Rahmatnejad Kamran , Wang Qianqian , Zhan Tingting , Hegarty Sarah E. , Leiby Benjamin E. , Udyaver Sanika , Waisbourd Michael , Leite Stela , Henderer Jeffrey D. , Pasquale Louis R. , Lee Paul P. , Haller Julia A. , Katz L. Jay 
Published: August 2018

Purpose:
The purpose of this study was to ascertain determinants of unreadable fundus images for participants enrolled in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study.

Methods:
Individuals were screened for glaucoma at 7 primary care practices and 4 Federally Qualified Health Centers using telemedicine. Screening (visit 1) included fundus photography, assessing family history of glaucoma, and intraocular pressure (IOP) measurements. Participants with an unreadable image in at least one eye were deemed unreadable and invited to return for a confirmatory eye examination (visit 2).

Results:
A total of 906 participants completed the visit 1 eye screening and 17.1% (n=155/906) were “unreadable.” In the multivariable logistic regression analysis, older age, male sex, smoking, and worse visual acuity were significantly associated with an unreadable fundus image finding at the eye screening (P<0.05). Of the 89 participants who were invited for the confirmatory eye examination solely for unreadable images and attended visit 2, 58 (65.2%) were diagnosed with at least one ocular pathology. The most frequent diagnoses were cataracts (n=71; 15 visually significant, 56 nonvisually significant), glaucoma suspects (n=27), and anatomical narrow angle (n=10).

Conclusions:
Understanding the causes of unreadable fundus images will foster improvements in telemedicine techniques to optimize the predictive accuracy, efficiency, and cost in ophthalmology. A high proportion of participants with unreadable images (65.2%) in our study were diagnosed with some ocular pathology, indicating that the finding of an unreadable fundus image warrants a referral for a comprehensive follow-up eye examination.
Investigating Serious Adverse Drug Reactions in Patients Receiving Erythropoiesis-Stimulating Agents: A Root Cause Analysis Using the “ANTICIPATE” Framework
Authors: Jacob Sony , Nichols Judy , Macdougall Iain C. , Qureshi Zaina , Chen Brian , Yang Y. Tony , Norris LeAnn B. , Bennett Charles L. 
Published: August 2018

Background:
Unexpected serious adverse drug reactions (sADRs) affecting patients with chronic kidney disease (CKD) who received erythropoiesis-stimulating agents were identified by study co-authors. These included pure red cell aplasia (PRCA) after administration of the Eprex formulation of epoetin or the epoetin biosimilar HX575 and fatal anaphylaxis associated with peginesatide, an erythropoietin receptor agonist. We developed and applied a structured framework to describe these sADRs, including root cause analyses and eradication efforts.

Methods:
A 10-step framework termed “ANTICIPATE,” focusing on signal identification, incidence, causality, and eradication guided our evaluations.

Results:
Initial cases were identified by a hematologist (Eprex), clinical study monitors (HX575), and 4 nurses (peginesatide). The number of persons with individual ADRs was 13 PRCA cases for epoetin, 2 antibody-mediated PRCA cases for HX575, and 5 fatal anaphylaxis cases for peginesatide. Initial incidence estimates per 1000 treated persons were 0.27 for Eprex-associated PRCA, 11 for HX575-associated PRCA, and 0.38 for peginesatide fatalities. Likely causes were subcutaneous administration of epoetin formulated with polysorbate 80 (Eprex), tungsten leaching from pins included in product syringes (HX575), and inclusion of a phenol stabilizer (peginesatide). Eradication strategies included restricting Eprex administration to the intravenous route, excluding tungsten from HX575 syringes, and for peginesatide, proposed eradication was to return to single-dose vials without preservatives.

Conclusion:
Although the number of cases of each sADR was small, eradication was successful for 2 sADRs, and a proposed eradication was developed for a third sADR. The structured framework used to describe the above 3 sADRs in patients with CKD can also be used in other clinical settings.
Is Patent Foramen Ovale Closure More Effective Than Medical Therapy in Preventing Stroke Recurrence in Patients With Cryptogenic Stroke?
Authors: Valencia-Sanchez Cristina , Fortuin F. David , Sweeney John P. , Ingall Timothy J. , Marks Lisa A. , Wingerchuk Dean M. , O’Carroll Cumara B. 
Published: August 2018

Background:
The clinical benefit of patent foramen ovale (PFO) closure in patients with cryptogenic stroke (CS) for recurrent stroke prevention has been a subject of extensive debate. Prior clinical trials failed to show superiority of PFO closure versus medical therapy. Meta-analyses suggested a possible benefit of PFO closure in select patients.

Objective:
The objective of this study was to critically assess current evidence regarding the efficacy of PFO closure compared with medical therapy for recurrent stroke prevention in patients with CS.

Methods:
The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a clinical question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, medical librarian, and vascular neurology and interventional cardiology content experts.

Results:
A randomized, controlled trial was selected for critical appraisal. This trial compared the efficacy of PFO closure and medical therapy in recurrent stroke prevention. A total of 663 patients who had a recent CS attributed to PFO, with a large interatrial shunt or with an associated atrial septal aneurysm were included. No stroke occurred among the 238 patients in the PFO closure group, whereas 14 of the 235 patients in the antiplatelet therapy group had recurrent strokes.

Conclusions:
Among patients who had a recent CS attributed to PFO with a large interatrial shunt or with an associated atrial septal aneurysm, the rate of stroke recurrence was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone.
A Vision Enhancement System to Improve Face Recognition with Central Vision Loss
Authors: Calabrèse Aurélie , Aguilar Carlos , Faure Géraldine , Matonti Frédéric , Hoffart Louis , Castet Eric 
Published: August 2018

SIGNIFICANCE
The overall goal of this work is to validate a low vision aid system that uses gaze as a pointing tool and provides smart magnification. We conclude that smart visual enhancement techniques as well as gaze contingency should improve the efficiency of assistive technology for the visually impaired.

PURPOSE
A low vision aid, using gaze-contingent visual enhancement and primarily intended to help reading with central vision loss, was recently designed and tested with simulated scotoma. Here, we present a validation of this system for face recognition in age-related macular degeneration patients.

METHODS
Twelve individuals with binocular central vision loss were recruited and tested on a face identification–matching task. Gaze position was measured in real time, thanks to an eye tracker. In the visual enhancement condition, at any time during the screen exploration, the fixated face was segregated from background and considered as a region of interest that could be magnified into a region of augmented vision by the participant, if desired. In the natural exploration condition, participants also performed the matching task but without the visual aid. Response time and accuracy were analyzed with mixed-effects models to (1) compare the performance with and without visual aid and (2) estimate the usability of the system.

RESULTS
On average, the percentage of correct response for the natural exploration condition was 41%. This value was significantly increased to 63% with visual enhancement (95% confidence interval, 45 to 78%). For the large majority of our participants (83%), this improvement was accompanied by moderate increase in response time, suggesting a real functional benefit for these individuals.

CONCLUSIONS
Without visual enhancement, participants with age-related macular degeneration performed poorly, confirming their struggle for face recognition and the need to use efficient visual aids. Our system significantly improved face identification accuracy by 55%, proving to be helpful under laboratory conditions.
Childhood Idiopathic Pulmonary Arterial Hypertension Complicated by Esophageal Intubation
Authors: Balmert Nathaniel J. , Prahlow Joseph A. 
Published: August 2018

Abstract
Childhood idiopathic pulmonary arterial hypertension (CIPAH) represents a rare disorder of childhood characterized by dyspnea, exercise limitation, and syncope. Common organ-specific pathology includes right ventricular myocardial hypertrophy. The case presented represents a classic case of CIPAH, where death was partially attributable to an unrecognized esophageal intubation, which was placed during emergency transport to an emergency department. The features of CIPAH are presented, along with a discussion related to esophageal intubation and death.
Horticultural Homicide
Authors: Hlavaty Leigh , Sung LokMan 
Published: August 2018

AbstractInstruments that create stab wounds are required to possess tips of sufficient strength and rigidity to breach the integrity of the skin. Knives, the most common weapons used to create stab wounds, have cutting edges that cleave the skin, leaving unabraded margins. On rare occasions, blunt objects are driven with sufficient force to pierce the skin and become impaled within the body. The morphologic differences between the cutaneous injuries and wound tracks of stab wounds from sharp objects and impalement with blunt ones provide clear delineation of the two. However, elements from the scene and obscuring hemorrhage can make initial differentiation difficult. The authors report the death of a 59-year-old woman found near the entryway steps of her home with a stab wound to her chest. Law enforcement did not discover any weapons. Investigation focused on blood around and on a broken rose bush planted near the steps with the belief that the decedent had fallen upon the vegetation. When presented with information that conflicts with autopsy findings, careful consideration of proposed weapons and thorough examination of the wound are required to discount confounding material.
Recommendations on RBC Transfusion in General Critically Ill Children Based on Hemoglobin and/or Physiologic Thresholds From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Authors: Doctor Allan , Cholette Jill M. , Remy Kenneth E. , Argent Andrew , Carson Jeffrey L. , Valentine Stacey L. , Bateman Scot T. , Lacroix Jacques 
Published: August 2018

Objectives:To present the consensus recommendations and supporting literature for RBC transfusions in general critically ill children from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.Design:Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children.Methods:The panel of 38 experts developed evidence-based and, when evidence was lacking, expert-based recommendations and research priorities regarding RBC transfusions in critically ill children. The subgroup on RBC transfusion in general critically ill children included six experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases from 1980 to May 30, 2017, using a combination of keywords to define concepts of RBC transfusion and critically ill children. Recommendation consensus was obtained using the Research and Development/UCLA Appropriateness Method. The results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method.Results:Three adjudicators reviewed 4,399 abstracts; 71 papers were read, and 17 were retained. Three papers were added manually. The general Transfusion and Anemia Expertise Initiative subgroup developed, and all Transfusion and Anemia Expertise Initiative members voted on two good practice statements, six recommendations, and 11 research questions; in all instances, agreement was reached (> 80%). The good practice statements suggest a framework for RBC transfusion in PICU patients. The good practice statements and recommendations focus on hemoglobin as a threshold and/or target. The research questions focus on hemoglobin and physiologic thresholds for RBC transfusion, alternatives, and risk/benefit ratio of transfusion.Conclusions:Transfusion and Anemia Expertise Initiative developed pediatric-specific good practice statements and recommendations regarding RBC transfusion management in the general PICU population, as well as recommendations to guide future research priorities. Clinical recommendations emphasized relevant hemoglobin thresholds, and research recommendations emphasized a need for further understanding of physiologic thresholds, alternatives to RBC transfusion, and hemoglobin thresholds in populations with limited pediatric literature.
Use of Simulation to Improve the Comfort of Pediatric Residents Managing Critically Ill Emergency Department Patients
Authors: Saavedra Heather R. , Turner Joseph S. , Cooper Dylan D. 
Published: August 2018

Objectives
The aims of this study were to identify the needs for further critical care experience for pediatric and internal medicine–pediatric residents, to describe a multidisciplinary approach to education, and to assess the impact of high-fidelity simulation on critical care comfort and perceived competence in pediatric residents. In addition, this study assessed pediatric residents' attitudes toward simulation as a means of providing additional education with critically ill patients.

Methods
Residents on their pediatric emergency medicine (PEM) rotation voluntarily participated in a 2-hour simulation session. Each session involved the evaluation and management of 3 critically ill pediatric patients with emergency medicine and pediatric/PEM faculty facilitating and debriefing as a team. All resident participants were asked to complete a presession and postsession survey including questions rating their comfort level with common emergent pediatric disease processes and procedures on a 5-point Likert scale.

Results
Overall, the participants reported a significant improvement in comfort level in most categories with P < 0.05. The majority of the resident participants rated the simulation program as a valuable learning tool for managing pediatric emergencies and felt that it would be beneficial to have additional simulation experiences in the PEM curriculum.

Conclusions
This simulation program improved resident comfort in important aspects of the care of critically ill pediatric patients. The use of simulation as an educational tool for pediatric emergencies is considered valuable to residents in our program. In addition, simulation provides an opportunity for educational collaboration between academic departments.