bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optical Coherence Tomography Angiography Macular Vascular Density Measurements and the Central 10-2 Visual Field in Glaucoma
Authors: Penteado Rafaella C. , Zangwill Linda M. , Daga Fábio B. , Saunders Luke J. , Manalastas Patricia I.C. , Shoji Takuhei , Akagi Tadamichi , Christopher Mark , Yarmohammadi Adeleh , Moghimi Sasan , Weinreb Robert N. 
Published: April 2018

Purpose:
To evaluate the association between macula vascular density assessed by optical coherence tomography angiography (OCT-A) and central visual field (VF) threshold sensitivities in healthy, glaucoma suspect, and glaucoma patients.

Methods:
A total of 185 eyes from 38 healthy participants, 31 glaucoma suspects, 72 mild glaucoma patients, and 44 moderate/severe glaucoma patients from the Diagnostic Innovations in Glaucoma Study who underwent OCT-A images of the macula and 10-2 VF testing were enrolled in this observational cross-sectional study. The relationship between central VF mean sensitivity (MS) and superficial macula whole-image vessel density (wiVD), and the relationship between the MS of the 4 central points of the 10-2 VF (MS4) and parafoveal vessel density (pfVD), were assessed using linear regression models.

Results:
Mean wiVD (52.5%, 49.8%, 49.4% and 45.2%, respectively) and mean pfVD (54.9%, 52.1%, 51.8% and 47.7%, respectively) were found to be significantly higher in healthy eyes and glaucoma suspect eyes compared with glaucoma eyes with mild and moderate/severe disease [analysis of covariance (ANCOVA) P<0.001]. The univariate associations between 10-2 MS and wiVD (R
2=26.9%) and between 10-2 MS4 and pfVD (R
2=16.8%) were statistically significant (P<0.001 for both). After adjusting for scan quality, age, sex and intraocular pressure, superficial macula wiVD and pfVD were still independently associated with central VF loss. Macula wiVD performed better [area under the receiver operator characteristic (AUROC)=0.70] than ganglion cell complex thickness (AUROC=0.50) for differentiating between glaucoma suspect and healthy eyes (P=0.010).

Conclusions:
Loss of OCT-A macula vessel density is associated with central 10-2 VF defects. Macula vessel density is a clinically relevant parameter that may enhance monitoring of glaucoma suspects and patients.
Azelaic Acid in Acne Vulgaris
Authors: Young Mary Caroline , Zito Patrick M. 
Published: April 2018

ABSTRACT
By definition, a drug is a medicine or substance that exerts a physiologic effect on an organism. In dermatology, various medications and substances are utilized on a daily basis, ranging from topical treatments to anesthetics in micrographic surgery. The purpose of this section was to focus on some of the more common substances, specifically how they work, how they are utilized, and routine alternatives (if available). The mechanism of action, usage, and alternative options of the medication azelaic acid are discussed.
Effect of Routine Clopidogrel Use on Bleeding Complications After Endobronchial Ultrasound-guided Fine Needle Aspiration
Authors: Webb Tracey N. , Flenaugh Eric , Martin Ralitza , Parks Christopher , Bechara Rabih I. 
Published: April 2018

Background:
Endobronchial ultrasonography has proven to be highly sensitive and specific in the diagnoses of patients with mediastinal and hilar adenopathy. Many of these patients are on a combination of clopidogrel (a compound that inhibits adenosine diphosphate–induced platelet aggregation) and aspirin due to neurological and/or cardiac-related comorbidities, and stopping anticoagulation may place these patients at high risk for potential complications. Our group has previously showed that thoracentesis with an 8-french catheter is safe in patients receiving clopidogrel and aspirin with low risk of complications. In this manuscript, we report the outcomes of the largest prospective multicenter series of patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) while receiving clopidogrel.

Methods:
Patients presenting to our institutions with mediastinal/hilar adenopathy, requiring EBUS-TBNA, and actively taking clopidogrel and aspirin were included in the study. If the medication could be held for 5 to 7 days before the procedure, the patient was excluded. EBUS-TBNA was performed by an interventional pulmonology faculty on a total of 42 patients. All patients received total intravenous anesthesia, and a total of 92 nodes were sampled. First, 3 passes were performed with a 22-G needle. If no complications were encountered, we followed with additional 3 passes with a 21 G. Rapid onsite evaluation was performed in all patients. Bleeding at the puncture site was considered significant if it required cold saline, topical sympathomimetic, or balloon tamponade for hemostasis. Bleeding was considered nonsignificant if no interventions were required to achieve hemostasis.

Results:
We were able to perform all procedures successfully using both the 21 and 22-G needles. One patient required 30 mL cold saline installation to accomplish hemostasis with the 21 and 22-G needles. Our yield was comparable with the current literature. No statistically significant complications occurred during the procedure. All patients were contacted within 24 hours, and none reported bloody sputum.

Conclusion:
We suggest that EBUS-TBNA, using 22 and 21-G needles, is safe with high yields in patients with mediastinal/hilar adenopathy, actively taking clopidogrel and aspirin, and are at high risk for thrombotic complications if the medication is discontinued.
Gabapentin Improves Symptoms of Functional Dyspepsia in a Retrospective, Open-label Cohort Study
Authors: Staller Kyle , Thurler Andrea H. , Reynolds Justin S. , Dimisko Laurie R. , McGovern Ryan , Skarbinski Kristina F. , Kuo Braden 
Published: April 2018

Goals:
We sought to determine the efficacy of gabapentin in the treatment of functional dyspepsia among an observational cohort of patients.

Background:
Gabapentin has an established role in the treatment of neuropathic pain, with evidence supporting a benefit in visceral hypersensitivity. There is currently no data on the use of gabapentin for the treatment of functional dyspepsia.

Study:
Consecutive patients presenting to a tertiary motility clinic for the evaluation of functional dyspepsia without concurrent gastric emptying delay completed a baseline Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) before evaluation and were started on gabapentin for functional dyspepsia by their providers. The primary endpoint was change in total PAGI-SYM score between initial and subsequent visits.

Results:
Of 110 patients enrolled, 62 patients with functional dyspepsia completed pregabapentin and postgabapentin surveys. Subjects’ mean PAGI-SYM score decreased by 0.44 (P<0.0001) with significant changes in all subscales (including upper abdominal pain, lower abdominal pain, postprandial fullness) except for bloating. Multivariable analysis showed that worsening pretreatment symptom severity was independently associated with improvement. Seven (11.3%) patients discontinued gabapentin with 5 (71.4%) discontinuing due to side effects. Using the minimum significant PAGI-SYM score change threshold, ≥50% of the cohort had significant improvement in their overall, postprandial fullness, and upper abdominal pain subscores.

Conclusions:
In a retrospective, open-label cohort of patients treated with gabapentin for functional dyspepsia, there were significant improvements in dyspeptic symptoms interpreted within the limitations of an open-label study design. Further studies are needed to place gabapentin in the functional dyspepsia treatment algorithm.
Anemia in Pediatric Inflammatory Bowel Disease
Authors: Aljomah Ghanim , Baker Susan S. , Schmidt Kenneth , Alkhouri Razan , Kozielski Rafal , Zhu Lixin , Baker Robert D. 
Published: April 2018

ABSTRACTObjectives:Anemia is the most frequent extra‐intestinal finding in inflammatory bowel disease (IBD). The aim of this study is to determine the prevalence and types of anemia in pediatric patients with IBD at diagnosis and at approximately 1 year follow‐up.Methods:This is a retrospective chart review of patients diagnosed with IBD from 2005 to 2012, ages 1 to 18 years. Patients who had hemoglobin, hematocrit, mean corpuscular volume, and iron indices obtained at the time of diagnosis and at approximately 1 year follow‐up were included in the study. The prevalence of anemia at the beginning and the end of the study was recorded. Using the soluble transferrin receptor index the type of anemia was determined.Results:At diagnosis, 67.31% of patients were anemic. Overall, 28.85% of patients had either iron deficiency anemia (IDA) or a combination of IDA and anemia of chronic disease (ACD), whereas 38.46% had ACD alone. At follow‐up, 20.51% were anemic. 15.38% had either IDA or a combination of IDA and ACD; 5.13% had ACD alone. The pattern of anemia and response to therapy differed among the IBD phenotypesConclusions:Anemia is frequent in inflammatory bowel disease. The prevalence was higher in Crohn disease (CD). At 1 year, the prevalence of anemia decreased significantly, but persisted. Anemia of chronic disease predominated in CD. Iron deficiency anemia continued to be present in CD and ulcerative colitis.
Transjugular Intrahepatic Portosystemic Shunt Insertion for the Management of Portal Hypertension in Children
Authors: Johansen Lauren C. , McKiernan Patrick J. , Sharif Khalid , McGuirk Simon P. 
Published: April 2018

ABSTRACTObjectives:the aim of the study was to describe our 20‐year experience with transjugular intrahepatic portosystemic shunt (TIPSS) procedures for children with resistant portal hypertension (PHTN).Methods:Retrospective review of all children that had a TIPSS performed at Birmingham Children's Hospital from January 1, 1995 to January 1, 2015.Results:Forty children underwent 42 attempted TIPSS for resistant PHTN with recurrent variceal bleeding (n = 35), refractory ascites (n = 4), and hypersplenism (n = 1). Median age at operation was 12 years (range 7 months–17 years). Thirty‐four procedures were elective and 8 were emergency cases. TIPSS was established in 33 cases (79%). Median portal venous pressure reduction was 10 mmHg. Variceal bleeding ceased in 27 (96%) and ascites improved in all. Clinical improvement following TIPSS enabled 7 children to be bridged to transplantation and 7 others to become suitable for transplantation. The 1‐year and 5‐year survival with TIPSS was 57% and 35%, respectively. Child‐Pugh score C was an independent risk factor for adverse outcome (Likelihood ratio (LR) = 8.0; 95% confidence interval (CI) 2.7 to 23.5; P = 0.001). There were 6 major complications: hepatic artery thrombosis and infarction (n = 1), hepatic artery pseudoaneurysm (n = 1), bile leak (n = 1), and hepatic encephalopathy (n = 3). Encephalopathy was resistant to medical treatment in 2 cases, necessitating staged closure in 1. Ten patients (30%) required intervention to maintain TIPSS patency. The 1‐year and 5‐year freedom from reintervention was 71% and 55%, respectively.Conclusions:A TIPSS is highly successful in controlling symptoms in children with resistant PHTN and facilitating liver transplantation. It is technically demanding and not without risk. Patients must be appropriately selected and counselled.
Value of Serum Zinc in Diagnosing and Assessing Severity of Liver Disease in Children With Wilson Disease
Authors: Sintusek Palittiya , Kyrana Eirini , Dhawan Anil 
Published: April 2018

ABSTRACTObjectives:Wilson disease (WD) is a rare inborn error of copper metabolism with diverse manifestations. There has been no study of zinc (Zn), the copper's antagonist, in WD diagnosis and severity so far. Our aims were to evaluate serum Zn in WD and its correlation with the disease severity score (revised WD index). Although the ATP7B mutation analysis is highly accurate for WD diagnosis, it may not be readily available in a resource‐limiting setting. We proposed a disease diagnostic score (Proposed WD diagnostic score) which incorporates serum Zn.Methods:Medical records of WD and non‐WD children seen at King's College Hospital from 2005 to 2015 were reviewed for the selected parameters using the Proposed WD diagnostic score. Available serum Zn data in WD children before disease diagnosis and the calculated severity score were statistically analyzed. Diagnostic values of the Proposed WD diagnostic score were evaluated.Results:Serum Zn level was significantly lower in 8 WD‐acute liver failure (ALF) (5.8 [4.1–8.3] μmol/L) compared to 18 WD‐non‐ALF (13.5 [6.1–22.2] μmol/L) and 9 ALF from indeterminate cause (9.8 [7.0–12.1] μmol/L) (P < 0.001). Serum Zn significantly correlated with the revised WD index (r = −0.554, P = 0.004). The Proposed WD diagnostic score that included serum Zn level as 1 of the parameters had sensitivity and specificity of 87% and 99.2%, respectively.Conclusions:Serum Zn is a novel parameter for diagnosis and correlates with severity of WD. The Proposed WD diagnostic score is useful while awaiting ATP7B mutation analysis.
Effects of a PICU Status Asthmaticus De-Escalation Pathway on Length of Stay and Albuterol Use*
Authors: Brennan Steven , Lowrie Lia , Wooldridge Jamie 
Published: April 2018

Objectives:Evaluate the effects of an asthma de-escalation clinical pathway on selected outcomes for patients admitted to a PICU with status asthmaticus.Design:Time series quality improvement trial.Setting:PICU in a tertiary care children’s hospital.Patients:Children age 2–18 years old with a known diagnosis of asthma presenting with status asthmaticus.Intervention:One-hundred five admissions to a PICU for status asthmaticus were treated according to a new de-escalation pathway between August 15, 2015, and August 30, 2016. This group was compared with a prepathway group of 141.Measurements and Main Results:Primary outcome was variability in PICU length of stay. Secondary outcomes were median PICU length of stay, median hospital length of stay, and median duration a patient received continuous nebulized albuterol. The effectiveness of the intervention was tracked using control charts. The postpathway group demonstrated decreased variability of PICU length of stay and time receiving continuous albuterol. Statistically significant decreases were seen in median PICU length of stay (16 vs 13 hr;p= 0.0009), median duration a child spent receiving continuous nebulized albuterol (10.8 vs 7.3 hr;p= 0.0008), and median hospital length of stay (37 vs 31 hr;p= 0.02). Total number of asthma assessments completed by respiratory therapists increased from 741 to 1,087.Conclusions:Implementation of a PICU asthma de-escalation pathway demonstrated statistical decrease in the reported measures for children with status asthmaticus. Although the clinical significance of these changes may be debatable, the results demonstrate that efforts to standardize asthma care in the PICU setting is an area in need of further study.
Initiation of Disease-Modifying Therapies in Rheumatoid Arthritis Is Associated With Changes in Blood Pressure
Authors: Baker Joshua F. , Sauer Brian , Teng Chia-Chen , George Michael , Cannon Grant W. , Ibrahim Said , Cannella Amy , England Bryant R. , Michaud Kaleb , Caplan Liron , Davis Lisa A. , O'Dell James , Mikuls Ted R. 
Published: April 2018

Purpose
This study reports the effect of disease-modifying therapies for rheumatoid arthritis (RA) on systolic and diastolic blood pressure (SBP, DBP) over 6 months and incident hypertension over 3 years in a large administrative database.

Methods
We used administrative Veterans Affairs databases to define unique dispensing episodes of methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, tumor necrosis factor inhibitors, and prednisone among patients with RA. Changes in SBP and DBP in the 6 months before disease-modifying antirheumatic drug initiation were compared with changes observed in the 6 months after initiation. The risk of incident hypertension within 3 years (new diagnosis code for hypertension and prescription for antihypertensive) was also assessed. Multivariable models and propensity analyses assessed the impact of confounding by indication.

Results
A total of 37,900 treatment courses in 21,216 unique patients contributed data. Overall, there were no changes in SBP or DBP in 6 months prior to disease-modifying antirheumatic drug initiation (all P > 0.62). In contrast, there was a decline in SBP (β = −1.08 [−1.32 to −0.85]; P < 0.0001) and DBP (β = −0.48 [−0.62 to −0.33]; P < 0.0001) over the 6 months following initiation. The greatest decline was observed among methotrexate and hydroxychloroquine users. Methotrexate users were 9% more likely to have optimal blood pressure (BP) after 6 months of treatment. Patients treated with leflunomide had increases in BP and a greater risk of incident hypertension compared with patients treated with methotrexate (hazard ratio, 1.53 [1.21–1.91]; P < 0.001).

Conclusions
Blood pressure may improve with treatment of RA, particularly with methotrexate or hydroxychloroquine. Leflunomide use, in contrast, is associated with increases in BP and a greater risk of incident hypertension.
Role of Interleukin 37 as a Novel Proangiogenic Factor in Juvenile Idiopathic Arthritis
Authors: El-Barbary Amal Mohamad , Hussein Manal Shawky , Almedany Samah Hamdy , Rageh Elsayed Mohamad , Alsalawy Alaa Mohamed , Aboelhawa Marwa Ahmed , Elkholy Radwa Mostafa , Shafik Noha Mohamed , Elharoun Ahmed Shukry 
Published: April 2018

Objective
The aim of this study was to investigate interleukin 37 (IL-37) levels in the serum and synovial fluid of patients with juvenile idiopathic arthritis (JIA), its expression in peripheral blood mononuclear cells, and correlation with disease activity and angiogenesis.

Methods
Seventy JIA patients and 50 control subjects were examined. The Juvenile Arthritis Disease Activity Score in 27 joints (JADAS-27) was calculated. Immunoassays were used to measure the serum and synovial fluid levels of IL-37, vascular endothelial growth factor (VEGF), soluble VEGF receptor 1 (sVEGF-R1), and sVEGF-R2. Relative expression of IL-37 mRNA in peripheral blood mononuclear cells and the power Doppler ultrasound score of the affected joint were measured.

Results
Patients with JIA were subdivided as 20 systemic-onset, 20 polyarticular, and 30 oligoarticular (10 persistent, 20 extended) cases. Serum levels of IL-37, VEGF, VEGF-R1, and VEGF-R2 and relative IL-37 mRNA expression were significantly higher in JIA patients when compared with the control subjects (p < 0.001). These concentrations were significantly higher in systemic-onset JIA compared with those in polyarticular and oligoarticular JIA, and in polyarticular JIA when compared with oligoarticular JIA (p < 0.001). Serum, synovial, and mRNA expression levels of IL-37 were positively correlated with C-reactive protein, erythrocyte sedimentation rate, Juvenile Arthritis Disease Activity Score in 27 joints, power Doppler ultrasound score (p < 0.001), and the serum and synovial VEGF and VEGF-RI and -R2 levels (p < 0.05).

Conclusions
Our results demonstrate that IL-37 levels and mRNA expression were significantly increased in JIA patients, and their levels were positively correlated with disease activity and markers of angiogenesis (VEGF and VEGF receptors), suggesting that IL-37 may be correlated with angiogenesis.
Obesity Impacts Swelling of Ankle and Foot Joints in Early Rheumatoid Arthritis Patients
Authors: Ranganath Veena K. , Duffy Erin L. , Garg Vikram K. , Woodworth Thasia , Taylor Mihaela , Paulus Harold E. , Altman Roy D. , Elashoff David A. 
Published: April 2018

Objective
The evaluation of disease activity in obese rheumatoid arthritis (RA) patients presents challenges particularly in the clinical assessment of swollen joints. This study examines the effect of obesity on the American College of Rheumatology (ACR) core set measures used in assessing RA disease activity with specific focus on the swollen joint count (SJC).

Methods
We examined a cross-sectional cohort of 323 early seropositive RA patients (symptom duration ≤15 months). Patients were biologic-naive with equal to or more than 6/44 SJC and equal to or more than 9/44 tender joint count. The ACR core set measures, components of Disease Activity Score (DAS) 44/erythrocyte sedimentation rate (ESR), DAS28/ESR4 item, Clinical Disease Activity Index (CDAI), and body mass index (BMI) were collected. Disease activity measures were compared between BMI categories. Multivariable linear regression models assessed the relationship between high BMI (≥30 kg/m2) and lower-extremity (LE) SJC and SJC44 while accounting for other ACR measures.

Results
Disease Activity Score 44/ESR4 item, Health Assessment Questionnaire Disability Index, physician global, and SJC44 differed across BMI categories (p < 0.05). Of the SJC44, metacarpophalangeal joints and LE joints (knees, ankles, metatarsophalangeal joints) were associated with increased swelling in all BMI groups (P < 0.05). Obesity was significantly associated with LE SJC after adjusting for ACR core set measures.

Conclusions
There is a direct association between increased BMI and increased swelling of LE joints in RA patients. Increases in DAS44–measured disease activity are higher in obese RA patients because of increased LE swollen joints. Disease Activity Score 28 and Clinical Disease Activity Index, which emphasize upper-extremity joint assessment, are not significantly influenced by obesity.
Subacute Infarct Volume With Edema Correction in Computed Tomography Is Equivalent to Final Infarct Volume After Ischemic Stroke
Authors: Broocks Gabriel , Faizy Tobias Djamsched , Flottmann Fabian , Schön Gerhard , Langner Sönke , Fiehler Jens , Kemmling Andre , Gellissen Susanne 
Published: April 2018

Objectives
Final infarct volume is regularly used as an end point of tissue outcome in stroke trials; however, the reported volumes are most commonly derived from early follow-up imaging. Those volumes are significantly impaired by ischemic edema, which causes an overestimation of the true final lesion volume. As net water uptake within ischemic brain can be quantified densitometrically in computed tomography (CT) as recently described, we hypothesized that the final lesion volume can be better estimated by correcting the lesion volume in early follow-up for the corresponding proportion of edema.

Materials and Methods
After retrospective consecutive screening of the local registry, 20 patients with acute middle cerebral artery large vessel occlusion met the inclusion criteria with early and late follow-up CT; the latter acquired at least 4 weeks after admission. In early follow-up imaging 24 hours after onset, the proportion of edema contributing to the infarct lesion was calculated by quantifying the total volume of ischemic net water uptake. Edema volume was then subtracted from the total lesion volume to obtain edema-corrected lesion volumes. Finally, these corrected lesion volumes were compared with the final lesion volume on late follow-up serving as ground truth.

Results
The median lesion volume in the early follow-up was 115.1 mL (range, 21.9–539.9 mL) and significantly exceeded the median final lesion volume in the late follow-up CT, which was 86.6 mL (range, 11.2–399.0 mL; p < 0.001). The calculated mean proportion of edema within the early lesion volume was 25.8% (±5.9%; range, 11.1%–35.9%. The median edema-corrected lesion volume measured after 24 hours was 87.1 mL (range, 18.2–376.3 mL). The estimation of final lesion volume in the early follow-up CT was therefore improved by a mean of 31.4% (±2.1%) when correcting for the proportion of edema and did not differ significantly from the true final infarct volume (p = 0.2).

Conclusions
Edema-corrected volumes of early follow-up infarct lesion in CT were in close agreement with the actual final infarct volumes. Computed tomography–based edema correction of subacute infarct lesions improves the estimation of final tissue outcome. This could especially improve the comparability of imaging end points and facilitate patient recruitment in clinical trials.