bluuebunny/crossref_metadata_2025_split huggingface dataset:
Corneal Higher-Order Aberrations in Eyes With Corneal Scar After Traumatic Perforation
Authors: Shimizu Eisuke , Yamaguchi Takefumi , Tsubota Kazuo , Shimazaki Jun 
Published: July 2018

Objectives:
To evaluate corneal higher-order aberrations (HOAs) in eyes with corneal scar after traumatic perforation and their correlation with visual acuity.

Methods:
This retrospective consecutive case study included 40 eyes of 40 consecutive patients (mean age, 39.2±21.6 years), treated for traumatic corneal perforation at Tokyo Dental College, and 18 normal control eyes. Higher-order aberrations of anterior and posterior corneal surfaces and total cornea were analyzed by swept-source optical coherence tomography. Correlations between corneal HOAs and visual acuity were analyzed.

Results:
Higher-order aberrations within 4-mm diameter were significantly larger in eyes with corneal perforation (anterior surface, 0.51±0.54 μm; posterior surface, 0.20±0.14; and total cornea, 0.52±0.50) as compared to normal controls (0.10±0.02, 0.02±0.01, and 0.09±0.02, respectively; all P<0.001). Higher-order aberrations within 6-mm diameter were significantly larger in eyes with corneal perforation (anterior surface, 1.15±1.31; posterior surface, 0.31±0.23; and total cornea, 1.09±1.28) as compared to normal controls (0.21±0.06, 0.06±0.01, and 0.19±0.06, respectively; all P<0.001). The most common topography pattern observed was the minimal change pattern (37.5%), followed by asymmetric pattern (30.0%). Visual acuity significantly correlated with corneal HOAs (anterior surface: R=0.646, P<0.001; posterior surface: R=0.400, P=0.033; and total cornea: R=0.614, P<0.001).

Conclusions:
Corneal scar after traumatic perforations not only induces corneal opacity, but also increases corneal HOAs, which indicates a direct effect on visual acuity.
A Study of Corneal Biomechanics in Delayed-Onset Mustard Gas Keratopathy Compared to Cases With Corneal Scarring and Normal Corneas
Authors: Jadidi Khosrow , Mohazzab-Torabi Saman , Pirhadi Shiva , Naderi Mostafa , Yekta Abbasali , Sardari Sara , Khabazkhoob Mehdi 
Published: July 2018

Purpose:
This study compares the corneal biomechanical properties, as measured with Corvis ST, in three groups of cases with delayed-onset mustard gas keratopathy (DMGK), chronic corneal scarring (CCS), and those with normal corneas.

Methods:
Forty-five eyes were enrolled in the DMGK, CCS, and normal groups (15 eyes each). All patients were examined with the slitlamp and Corvis ST. Extracted corneal biomechanical parameters included first and second applanation time (AT1, AT2), first and second applanation length (AL1, AL2), first and second applanation velocity (AV1, AV2), deformation amplitude (DA), highest concavity time, peak distance, highest concavity radius (HCR), central corneal thickness, corrected intraocular pressure (IOP), and noncorrected IOP.

Results:
The mean age of the participants in the DMGK, CCS, and normal groups was 49.20±5.16, 60.40±22.92, and 44.60±8.32 years, respectively. Comparison between DMGK and CCS groups showed significant differences in AT1, AT2, corrected IOP, and noncorrected IOP. There were also significant differences in AT1, AT2, HCR, DA, and noncorrected IOP between the DMGK and normal groups. None of the parameters were significantly different between the CCS and normal groups.

Conclusion:
There seems to be reduced corneal rigidity and stiffness in cases exposed to mustard gas, which causes the cornea in the DMGK group to become applanated more easily and take longer to rebound compared with the other two groups. Also, IOP was lower than normal in the DMGK group, and thus, misdiagnosis of glaucoma is likely for these patients.
Effect of Cataract Surgery on the Refractive Index of the Cornea Estimated by Optical Pachymetry
Authors: Tutchenko Larysa , Patel Sudi , Horak Olha , Sanin Volodymyr , Kosuba Serhii 
Published: July 2018

Purpose:
To noninvasively estimate the refractive index (RI) of the central cornea along the antero–posterior direction before and after routine phacoemulsification.

Methods:
Using 2 setups for a standard optical pachymeter, the ratio of observed optical section widths (OSWs) is a function of the RI. Thus, the corneal RI could be estimated using a calibration equating OSW ratios with known RI values. The OSW was measured by 2 observers for 1) normal subjects for estimating interoperator errors and effects of sex and age on the RI and 2) before and after patients underwent routine phacoemulsification.

Results:
First, the average interoperator difference (ΔRI) was +0.0005 (SD = ±0.0044, 95% confidence limit, −0.0002 to +0.0012). The root mean square difference between measurements obtained by the observers was 0.0032. There was a significant correlation between the ΔRI and the mean of each pair of measured values (r = −0.172, n = 153, P = 0.003). The mean RI (±SD) was 1.435 (±0.005, n = 82) for females and 1.429 (±0.005, n = 71) for males. There was no significant between-sex difference or association between the RI and age (mean age, ±SD, and range, 44.31, 20.38, and 19–88 years, respectively). Second, the difference (y) between the preoperative (x) and postoperative RI was, y = 0.844x − 1.203 (r = 0.694, n = 31, P ≤ 0.001) according to observer 1 and according to observer 2, y = 0.755x − 1.108 (r = 0.681, n = 31, P ≤ 0.001).

Conclusions:
The RI of the human cornea along the antero–posterior axis can be estimated using a modified application of traditional optical pachymetry. The average values for the corneal RI were higher compared with those reported in previous reports. The change in the RI after phacoemulsification could be predicted from the preoperative value.
Effect of the Meibomian Gland Squeezer for Treatment of Meibomian Gland Dysfunction
Authors: Wang Da-Hu , Liu Xin-Quan , Hao Xiao-Jun , Zhang Yin-Jian , Zhu Hua-Ying , Dong Zhi-Guo 
Published: July 2018

Purpose:
To investigate the effect of the meibomian gland squeezer for treatment of meibomian gland dysfunction (MGD).

Methods:
Seventy patients (140 eyes) with MGD were randomly divided into 2 groups: 36 patients who were treated by the meibomian gland squeezer as the treatment group and 34 patients were selected as the control group. Patients were evaluated at baseline, and 2-week and 1-month visits for subjective symptoms, objective signs and pain assessments, including ocular symptom scores, Ocular Surface Disease Index, tear breakup time, corneal fluorescein staining, Schirmer scores with no anesthetic (Schirmer I test), meibum quality, meibum expressibility, and Numeric Rating Scale-11.

Results:
Sixty-five patients were followed in the study, and mean (±SD) age was 57.0 (±12.6) years. Compared with baseline, the 2 groups had varying degrees of improvement in ocular symptom scores and Ocular Surface Disease Index at the 2-week and 1-month visits; there was a statistically significant difference between groups (P < 0.001). At the 1-month visit, the treatment group showed a greater improvement in the breakup time (3.8 ± 1.6 vs. 1.8 ± 1.0 seconds, P < 0.001), corneal fluorescein staining (−2.1 ± 2.13 vs. −0.9 ± 1.3, P = 0.03), Schirmer I test (5.3 ± 2.9 vs. 2.3 ± 2.8 mm, P < 0.001), meibum quality (−7.5 ± 2.9 vs. −5.3 ± 2.4, P = 0.004), and meibum expressibility (−1.2 ± 0.8 vs. −0.7 ± 0.4, P = 0.007). In the treatment group, the mean (±SD) of total pain scores was 2.4 ± 1.0, which indicated that mild pain was still predominant under topical anesthesia.

Conclusions:
The meibomian gland squeezer may be safe, effective, and helpful for treatment of MGD and may offer an attractive treatment option for some patients with MGD, although it can cause mild pain or discomfort.
Multicenter Study of Intense Pulsed Light Therapy for Patients With Refractory Meibomian Gland Dysfunction
Authors: Arita Reiko , Mizoguchi Takanori , Fukuoka Shima , Morishige Naoyuki 
Published: July 2018

Purpose:
To evaluate the efficacy of intense pulsed light (IPL) therapy combined with meibomian gland expression (MGX) for refractory meibomian gland dysfunction (MGD) in a prospective study conducted at 3 sites in Japan.

Methods:
Patients with refractory obstructive MGD were enrolled and underwent 4 to 8 IPL-MGX treatment sessions at 3-week intervals. Clinical assessment included the Standard Patient Evaluation of Eye Dryness questionnaire; noninvasive breakup time of the tear film and interferometric fringe pattern as determined by tear interferometry; lid margin abnormalities, fluorescein breakup time of the tear film, corneal and conjunctival fluorescein staining (CFS), and meibum grade as evaluated with a slit-lamp microscope; meibomian gland morphology (meiboscore); and tear production as measured by the Schirmer test without anesthesia.

Results:
Sixty-two eyes of 31 patients (17 women, 14 men; mean age ± SD, 47.6 ± 16.8 years) were enrolled. The Standard Patient Evaluation of Eye Dryness score (P < 0.001), noninvasive breakup time (P < 0.001), and interferometric fringe pattern (P < 0.001) were significantly improved after therapy, with 74% of eyes showing a change in the interferometric fringe pattern from 1 characteristic of lipid deficiency to the normal condition. Meibum grade, lid margin abnormality scores, fluorescein breakup time, and CFS were also significantly improved (P < 0.001, P < 0.001, P < 0.001, and P = 0.002, respectively) after treatment, whereas the meiboscore and Schirmer test value remained unchanged.

Conclusions:
IPL-MGX ameliorated symptoms and improved the condition of the tear film in patients with refractory MGD and is therefore a promising treatment option for this disorder.
Infectious Keratitis After Ocular Surface Stem Cell Transplantation
Authors: Cheung Albert Y. , Sarnicola Enrica , Eslani Medi , Kurji Khaliq H. , Genereux Brad M. , Govil Amit , Holland Edward J. 
Published: July 2018

Purpose:
To describe the rate, clinical/microbiological characteristics, and outcomes of infectious keratitis in eyes with limbal stem cell deficiency after ocular surface stem cell transplantation (OSST).

Methods:
In this retrospective chart review of 278 eyes that underwent OSST between January 2006 and December 2016, eyes treated for previous infectious keratitis (bacterial, fungal, or viral) were included. Demographics, risk factors, course, microbiological characteristics, and outcomes were assessed.

Results:
A total of 52 eyes (18.7%) of 48 patients (28 men and 20 women) developed 75 episodes (culture-proven or presumed) of infectious keratitis (range 1–4 episodes) with mean follow-up of 5.3 ± 3.6 years after OSST. The most common limbal stem cell deficiency etiologies included chemical/thermal (27 episodes), Stevens-Johnson syndrome (19 episodes), aniridia (8 episodes), and mucous membrane pemphigoid (8 episodes). There were 44 (58.7%) bacterial keratitis episodes, 24 (32%) fungal keratitis episodes, and 7 (9.3%) HSV keratitis episodes. Gram-positive bacteria (79%) and Candida species (73%) were the most common bacterial and fungal pathogens. Before infection, 33% had an epithelial defect, 69% had a bandage contact lens, 91% were on systemic immunosuppression, and 25% recently had undergone ocular surgery (<3 months). Although 75% resolved with antimicrobial treatment, 25% required a therapeutic keratoplasty (TPK; 2 cases needed multiple TPK).

Conclusions:
Despite successful OSST surgery, infectious keratitis is relatively common, and aggressive medical/surgical therapy is warranted. Prophylactic topical antibiotics and a cicatrizing conjunctivitis diagnosis may account for the high proportion of fungal keratitis in this population.
Short Axial Length and Iris Damage Are Associated With Iris Posterior Synechiae After Descemet Membrane Endothelial Keratoplasty in Asian Eyes
Authors: Shimizu Toshiki , Hayashi Takahiko , Yuda Kentaro , Takahashi Hidenori , Oyakawa Itaru , Yamazaki Kenichiro , Mizuki Nobuhisa , Kato Naoko 
Published: July 2018

Purpose:
To evaluate the frequency and severity of iris posterior synechiae after Descemet membrane endothelial keratoplasty (DMEK) and to investigate possible causes of iris posterior synechiae.

Methods:
Twenty-three eyes were investigated in 20 Asian patients who underwent DMEK 1 month after phacoemulsification and intraocular lens implantation surgery. A preexisting iris damage score was defined by iris damage and classified into 5 grades. Six months after DMEK, the iris posterior synechiae severity score was evaluated based on the extent of posterior synechiae, according to every 45 degrees of the pupillary rim (posterior synechiae score, 0–8). Correlations were analyzed between the posterior synechiae score and preexisting factors (preexisting iris damage score, axial length [AXL], anterior chamber depth, and anterior chamber volume, both before and after cataract surgery).

Results:
Iris posterior synechiae appeared in 20 of 23 eyes (87.0%). Best spectacle-corrected visual acuity significantly improved at 6 months after DMEK (P < 0.001). Endothelial cell density was 1596 ± 530 cells/mm2 (P < 0.001); loss of cell density was 37.8 ± 19.9% at 6 months. Single regression analysis showed that the onset of iris posterior synechiae was correlated with the preexisting iris damage score (P = 0.006, r = 0.55), AXL (P < 0.001, r = −0.71), anterior chamber depth (P < 0.001, r = −0.70), and anterior chamber volume before cataract surgery (P < 0.001, r = −0.79).

Conclusions:
Iris posterior synechiae after DMEK frequently appeared in Asian eyes with shorter AXLs or a damaged iris.
Nurse Practitioner Practice Environments in Primary Care and Quality of Care for Chronic Diseases
Authors: Poghosyan Lusine , Norful Allison A. , Liu Jianfang , Friedberg Mark W. 
Published: July 2018

Background:
The chronic disease burden in the United States represents a significant challenge for the primary care system. The nurse practitioner (NP) workforce can help meet the demand for care; however, organizational barriers such as poor practice environments prevent NPs from delivering high quality care.

Objectives:
We investigated the relationship between NP practice environments and quality of care for chronic diseases.

Research Design:
We fit regression models to assess cross-sectional associations between claims-based quality measure performance and survey data on NP practice environments in Massachusetts.

Subjects:
We used survey data from 221 primary care NPs from 118 practices. We obtained quality of care data for patients with asthma, diabetes, and cardiovascular disease.

Measures:
The Nurse Practitioner Primary Care Organizational Climate Questionnaire was used to measure practice environments with its following 4 subscales: NP-Physician Relations, Independent Practice and Support, Professional Visibility, and NP-Administration Relations. Three Healthcare Effectiveness Data and Information Set measures were used to evaluate the quality of care.

Results:
A 1-SD increase in the organizational-level NP-Administration Relations subscale score was associated with a near doubling of the odds of receiving medication management for asthma. A 1-SD increase in the organizational-level Independent Practice and Support subscale score was associated with a 60% increase in the odds of receiving recommended screening for cardiovascular disease. There was no impact on diabetes care measure.

Conclusions:
NP practice environment affected the quality of care for 2 chronic conditions. Efforts should be implemented to improve NP practice environment to potentially improve care quality.
Does Providing Positive Airway Pressure for Sleep Apnea Change Health Care Utilization?
Authors: Derose Stephen F. , Zhou Hui , Huang Brian Z. , Manthena Prasanth , Hwang Dennis , Shi Jiaxiao M. 
Published: July 2018

Background:
Sleep apnea is underdiagnosed and thus undertreated. If therapy for sleep apnea results in reduced health care utilization in an entire treated population, then decision-makers will have key information for allocating limited health care resources.

Objectives:
To determine whether positive airway pressure (PAP) for sleep apnea was associated with reduced health care utilization in an entire treated population.

Research Design:
This was a retrospective cohort; propensity score-matched cases and noncases; pre-post analyses of individual subject utilization.

Subjects:
Electronic health records were used to identify adult subjects diagnosed with sleep apnea and dispensed PAP therapy (cases) and those without either diagnosed sleep apnea or dispensed PAP therapy (noncases).

Measures:
Acute care hospital days and dispensed medication days supply were compared in cases and noncases. Negative binomial regression was used to model utilization for up to 5 years before and 7 years after PAP dispensation (cases) or a random date (noncases). The association of PAP with changing annual utilization was estimated.

Results:
There were 13,271 cases and 13,271 matched noncases from 2008 to 2012 for analyses. Trends in the annual rate of acute care utilization were no different between cases and noncases (rate ratio, 0.98, P=0.543). Trends in the annual rate of medication utilization were no different between cases and noncases (rate ratio, 1.008, P=0.112).

Conclusions:
PAP dispensation for sleep apnea did not appear to reduce the rate of acute care and medication utilization over several years of follow-up in a large integrated health care system.
Pathophysiology of immune thrombocytopenia
Authors: Li June , Sullivan Jade A. , Ni Heyu 
Published: July 2018

Purpose of review
Immune thrombocytopenia (ITP) is a common autoimmune bleeding disorder with as of yet, no established clinical prognostic or diagnostic biomarkers. Patients frequently experience a markedly decreased quality of life and may be at risk for severe/fatal haemorrhage. Here, we address discoveries in the pathogenesis of ITP, and novel therapeutic strategies in mouse models and human patients. Consolidation of these findings should be important in providing insight to establish future prognostic protocols as well as cutting-edge therapeutics to target refractory ITP.

Recent findings
It is unknown why a significant portion of ITP patients are refractory to standard treatments. Recent findings suggest distinct heterogeneity in ITP including antibody-mediated platelet activation, Fc-independent desialylated platelet clearance, attenuation of platelet-mediated hepatic thrombopoietin generation, and decreased CD8+ T-suppressor generation. These mechanisms may partially explain clinical observations of increased refractoriness to standard therapies targeting classical Fc-dependent pathways. Moreover, these have initiated investigations into platelet desialylation as a diagnostic/prognostic marker and therapeutic target.

Summary
Recent evidence of distinct ITP pathophysiology has opened new exploratory avenues for disease management. We will discuss the utility of investigations into these mechanisms of ITP and its potential impact in our understanding of pathogenesis and future treatment strategies.
Adaptive Quizzing Improves End-of-Program Exit Examination Scores
Authors: Presti Carmen Rosa , Sanko Jill S. 
Published: July 2018

Background
A third of nursing schools use a standardized, end-of-program exit examination requiring minimum passing scores for student progression. Student failures on high-stakes tests have negative implications for students and schools of nursing. Adaptive quizzing has increased grades, graduation rates, and NCLEX-RN passing rates and reduced test anxiety in nursing students.

Purpose
To diminish the negative effects of high-stakes testing and increase standardized exit examination scores, an undergraduate nursing program incorporated customized adaptive quizzing for nursing students in their final nursing course before graduation.

Methods
End-of-program exit examination scores were compared in a preintervention cohort of students and postintervention cohort assigned individualized adaptive quizzing.

Results
Statistically significant increases in end-of-program exit examination scores were evident in groups of students completing the customized adaptive quizzing assignments.

Conclusion
The use of tailored adaptive quizzing increased exit examination scores, supporting the implementation of customized assignments for remediation.
Evaluation of Clinical Plus Imaging Features and Multidetector Computed Tomography Texture Analysis in Preoperative Risk Grade Prediction of Small Bowel Gastrointestinal Stromal Tumors
Authors: Yan Jiayi , Zhao Xuesong , Han Shuai , Wang Ting , Miao Fei 
Published: July 2018

Objective
This study aimed to evaluate the prediction roles of clinical plus imaging features and multidetector computed tomography (MDCT) texture analysis in preoperative risk grade classification of small bowel (SB) gastrointestinal stromal tumors (GISTs).

Methods
This study included 213 SB GIST patients. Clinical features and MDCT imaging findings were reviewed. Tumor risk stratifications were determined according to modified National Institutes of Health criteria. Random forest models were performed to evaluate the correlation of risk stratification.

Results
The model of clinical plus imaging findings showed an area under receiver operating characteristic curve (AUC) of 92.0%. The AUC of texture analysis based on MDCT portal phase was 93.3%, without statistical difference from that of clinical plus imaging model (P = 0.378). The AUC of the model combined clinical plus imaging features and MDCT texture analysis was 94.3%, which was significantly higher than the AUC of clinical imaging model (P = 0.042).

Conclusion
Texture analysis may become an important comprehensive tool for preoperative risk stratification of SB GISTs.
Diagnosis of Multiple Primary Intestinal-Type Adenocarcinoma in the Lung by 18F-FDG PET/CT
Authors: Hu Yujing , Wu Dayong , Tian Congna , Wei Qiang , Bian Yanzhu 
Published: July 2018

Abstract
A 74-year-old man with multiple soft tissue lesions in the lung, which were suspected to be metastatic neoplasms, underwent 18F-FDG PET/CT scan to detect primary malignancy. The images demonstrated that the lung and 2 retroperitoneal lymph nodes were the only affected organ or tissues with suspected primary lung neoplasms. Multiple intestinal-type adenocarcinoma was eventually diagnosed by CT-guided transthoracic needle aspiration biopsy.