bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ex-PRESS Miniature Glaucoma Shunt Versus Ahmed Glaucoma Valve in the Surgical Treatment of Glaucoma in Pseudophakic Patients
Authors: Rabkin-Mainer Zoya , Wolf Alvit , Mathalone Nurit , Melamud Alina , Buckman Gila , Edmunds Beth , Stein Nili , Steinberg David M. , Geyer Orna 
Published: August 2018

Purpose:
The aim of this study was to compare the 3-year outcome of Ex-PRESS miniature glaucoma shunt versus Ahmed glaucoma valve in pseudophakic patients.

Patients and Methods:
We retrospectively reviewed the records of patients with a history of clear corneal phacoemulsification alone, or failed trabeculectomy following phacoemulsification, who subsequently underwent Ahmed glaucoma valve (AGV) implantation or Ex-PRESS shunt surgery. The main outcome measure, surgical success, was defined as an intraocular pressure between 5 and 21 mm Hg and a 20% intraocular pressure reduction from baseline (with/without glaucoma medications) without glaucoma reoperation.

Results:
In total, 92 patients (92 eyes) were included (43 AGV, 49 Ex-PRESS). Overall success at 3 years was 92.7% for AGV and 66.1% for Ex-PRESS (P=0.006). AGV had a higher success rate in patients with prior phacoemulsification and failed trabeculectomy (96% AGV vs. 64.1% Ex-PRESS; P=0.023). There was no difference in success rate for patients with only previous phacoemulsification (87.5% AGV vs. 69.4% Ex-PRESS; P=0.205). Glaucoma reoperation rates were 4.6% and 30.6% in the AGV and Ex-PRESS group, respectively (P=0.001). Both procedures had similar complication rates.

Conclusions:
AGV compared with Ex-PRESS shunt, had a higher success rate for secondary surgeries but not primary surgeries, in patients with prior clear corneal phacoemulsification. The AGV surgery also had a lower overall glaucoma reoperation rate.
Safety and Efficacy of Diode Laser Transscleral Cyclophotocoagulation in Eyes With Good Visual Acuity
Authors: Shah Parth , Bhakta Amitabha , Vanner Elizabeth A. , Kishor Krishna S. , Greenfield David S. , Maharaj Arindel S.R. 
Published: August 2018

Background/Aims:
The main aim of this study was to evaluate the safety and efficacy of diode laser transscleral cyclophotocoagulation (TSCPC) in eyes with good visual acuity.

Patients and Methods:
A retrospective chart review identified patients who underwent TSCPC for uncontrolled intraocular pressure (IOP) from 2014 to 2016. Enrollment criteria included pretreatment best-corrected visual acuity (BCVA) of 20 of 40 or better, and a minimum of 6 months of postoperative follow-up.

Results:
Thirty-three eyes of 33 patients(mean age, 72.1±16.0 y) were enrolled (mean follow-up 12.6±6.1 mo). The mean (SD) IOP was reduced 48.3% from 27.1 mm Hg (7.8) at baseline to 13.1 mm Hg (4.2) at last follow-up. Reduction of ≥1 glaucoma medications was achieved in 17 eyes (51.5%) at last follow-up. The cumulative probability of complete success (BCVA loss <2 Snelling lines, 20% reduction IOP, no reoperation for glaucoma, no IOP<5 mm Hg) was 78.8% and 50% at months 6 and 12, respectively. The cumulative probability of qualified success (BCVA≥2 lines with ≥20% reduction IOP, no reoperation for glaucoma, no IOP<5 mm Hg) was 90.1% and 81.3% at month 6 and 1 year, respectively. Significant vision loss, defined as BCVA≥2 lines, occurred in 33% of patients. The most common complications were postoperative iritic (56.3%) and cystoid macular edema (12.5%).

Conclusions:
TSCPC demonstrates a strong reduction in IOP and glaucoma medication use. However, with significant vision loss in 33% of patients, future prospective studies with a comparison group receiving traditional glaucoma surgery are needed to determine comparative safety and efficacy.
The Effect of Body Weight Changes on Total Plasma Clozapine Concentrations Determined by Applying a Statistical Model to the Data From a Double-Blind Trial
Authors: Diaz Francisco J. , Josiassen Richard C. , de Leon Jose 
Published: August 2018

Abstract

Purpose/Background
Some therapeutic drug monitoring studies suggest that increased weight is associated with small increases in clozapine concentrations. The goal of this study was to reanalyze a US double-blind study using a sophisticated statistical model to test whether weight gains from baseline or increases in percentage of body fat from baseline, computed from a published equation, are associated with increased total plasma clozapine concentrations after controlling for the effects of smoking and sex.

Methods/Procedures
Using data from a multidosage randomized double-blind US clozapine trial previously published, a random intercept linear model of steady-state total plasma clozapine concentrations was fitted to 424 concentrations from 47 patients.

Findings/Results
After adjusting for sex and smoking, (1) a 1-kg gain in body weight during clozapine treatment was significantly associated with a 1.4% increase in total plasma clozapine concentrations (95% confidence interval = 0.55 to 2.3) and (2) a 1-point increase in percentage of body fat during clozapine treatment was significantly associated with a 5.4% increase in total clozapine concentration (2.5 to 8.3) in females and 1.4% (−1.1 to 4.0) in males.

Implications/Conclusions
As hypothesized, weight increases during clozapine treatment, which probably reflect increases in fat tissue, were associated with increases in total plasma concentrations. Pending further replication in other samples, it seems likely that clozapine may deposit in body fat and that this may decrease clozapine clearance. This change may be small in most patients but may be clinically relevant in females with major gains in body fat.
Tranylcypromine Plus Amitriptyline for Electroconvulsive Therapy–Resistant Depression
Authors: Ferreira-Garcia Rafael , da Rocha Freire Rafael Christophe , Appolinário José Carlos , Levitan Michelle N. , Halkjær-Lassen Roseane Dorte , Bueno João Romildo , Nardi Antonio E. 
Published: August 2018

Abstract

Background
Few therapeutic options are available for patients with electroconvulsive therapy–resistant major depressive disorder (ECT-r MDD), leaving a substantial proportion of this population beyond treatment possibilities. The combination of monoamine oxidase inhibitors and tricyclic antidepressants could be a potential strategy for managing ECT-r MDD, and the specific association of amitriptyline and tranylcypromine may offer additional tolerability advantages. Although promising, in our knowledge, no studies have examined until now the effectiveness of this combination in ECT-r MDD.

Methods
We report a retrospective cohort of 31 patients with ECT-r MDD treated in an open-label fashion with the combination of amitriptyline and tranylcypromine.

Results
Overall, 80.6% of the sample met response criteria at the end of the first 12 weeks of treatment. Seventy-six percent (19 of 25) of the responders were followed for a mean of 9.37 ± 3.86 years. During this follow-up period, none of the patients had a recurring depressive episode. The combination was well tolerated, whereas minor adverse effects were common, and no severe or life-threatening events were reported throughout the study.

Conclusions
These findings indicate that the combination tranylcypromine and amitriptyline is a potentially safe and effective candidate for future investigation in the treatment and long-term maintenance of ECT-r MDD.
Effect of Immediate Loop Electrode Excisional Procedure for High-Grade Cervical Cytology in an Urban Academic Clinic Setting
Authors: McGregor Ali E. , Gecsi Kimberly 
Published: August 2018

Objective
The aim of the study was to determine whether treating all patients older than 25 years with high-grade squamous intraepithelial lesion (HSIL) Paps with immediate loop electrode excisional procedure (LEEP) improves rates of receiving indicated treatment and evaluating whether this practice results in overtreatment (defined by excisional pathology less than cervical intraepithelial neoplasia 2).

Materials and Methods
This was a retrospective cohort study at an urban, Medicaid-based clinic, which evaluated women older than 25 years with HSIL Pap results seen from June 2011 to December 2016. In June 2013, the clinic practice was restructured and management of HSIL Pap results in patients older than 25 years was standardized to immediate LEEP procedure, without intermediate colposcopic examination. Our primary outcome is the number of women who received LEEPs before and after this clinical practice change. The secondary outcome evaluated the number of women who received overtreatment. The χ2 test with a p value of 0.05 as significant was used to compare the results between groups.

Results
Twenty-three (82%) of the 28 women treated before clinical practice change received indicated treatment, with 19 receiving LEEPs. Twenty-four (96%) of the 25 women treated after the clinical practice change received indicated LEEPs (p = .11). Seven (37%) of the 19 women in the initial group had LEEP pathology results less than CIN 2, whereas only 4 (17%) of the 24 women in the immediate LEEP group had results less than CIN 2 (p = .13).

Conclusions
Implementation of a standardized management of HSIL Pap with immediate LEEP did not statistically increase the amount of patients who received indicated LEEPs; however, implementation of this practice did not result in overtreatment.
Osteoradionecrosis of the Temporal Bone: An Evidence-Based Approach
Authors: Yuhan Brian T. , Nguyen Brandon K. , Svider Peter F. , Raza Syed N. , Hotaling Jeffrey , Chan Eleanor , Hong Robert S. 
Published: August 2018

Objectives:
To perform a systematic review evaluating etiologies, associated complications, and management of osteoradionecrosis of the temporal bone (ORNTB).

Methods:
The authors searched the PubMed, Embase, and Cochrane Library databases for relevant literature. Patient demographics, etiologies, treatments, and other clinical characteristics were obtained. Treatment success was defined as resolution of symptoms at last follow-up. Results were reported using the preferred reporting systems for systematic reviews and meta-analysis (PRISMA) guidelines.

Results:
Thirty-eight studies encompassing 364 patients with ORNTB were identified. The most common etiologies necessitating radiotherapy included: nasopharyngeal carcinoma (n = 133 [36.8%]), parotid tumors (n = 73 [20.2%]), and external auditory canal pathology (n = 59 [16.3%]). The mean dose of radiation was 58.0 Gy. The mean lag time between radiotherapy and osteoradionecrosis (ORN) symptoms was 7.9 years. The most common presenting symptoms were purulent otorrhea (33.3%), hearing loss (29.1%), and otalgia (17%). ORNTB complications included tympanic membrane perforation (n = 102 [63.8%]) and chronic otitis media (n = 16 [10%]). Treatments included lateral temporal bone resection (n = 99 [28.3%]), conservative treatment (n = 92 [26.3%]), and mastoidectomy (n = 82 [23.5%]) with 90.9, 89.13, and 59.76% considered successful, respectively.

Conclusions:
ORNTB is a rare complication of radiotherapy that may present years after initial radiation exposure. Management should be aimed at relief of presenting symptoms and treatment of ORNTB associated complications. Both conservative and surgical measures may adequately control the disease process and symptomatology; however, randomized controlled studies comparing treatments would serve to further corroborate these findings.
The Performance of Patient-reported Outcome Measures as Diagnostic Tools for Eustachian Tube Dysfunction
Authors: Smith Matthew E. , Cochrane Isabelle L. , Donnelly Neil , Axon Patrick R. , Tysome James R. 
Published: August 2018

Objective:
To develop and validate a novel patient-reported outcome measure (PROM) to distinguish patulous from obstructive Eustachian Tube Dysfunction (ETD). To determine accuracy of PROMs and ET function tests as diagnostic tools for ETD.

Study Design:
1) PROM development and validation. 2) Test case-control diagnostic accuracy study.

Interventions:
Cambridge ETD Assessment (CETDA) and ETDQ-7 PROMs, sonotubometry and tubomanometry ET function tests.

Setting:
Tertiary referral center.

Patients:
Cases with patulous (n = 7) or obstructive (n = 60) ETD, controls with either no ear symptoms (n = 33), or symptoms arising from hearing loss or Menière's disease (n = 24).

Main Outcome Measures:
PROMs were assessed in terms of internal consistency, ceiling and floor effects, test–retest reliability and content, structural and criterion validity. PROMs and function test sensitivity and specificity was determined as diagnostic tests for ETD.

Results:
The 10-item CETDA was developed. CETDA validity and performance were good, though five items suffered floor effects. There was no difference in scores for either PROM in the patulous ETD, obstructive ETD, and symptomatic control groups. Both PROMS had excellent diagnostic accuracy using only healthy controls as comparator for ETD, but specificity was very poor when controls with other otological disorders were included. Both objective tests had sensitivity and specificity of 63% and 79% for obstructive ETD.

Conclusions:
The CETDA and ETDQ-7 are not disease-specific and cannot distinguish obstructive from patulous ETD subtypes. A relatively weak correlation between sonotubometry and tubomanometry results, PROM scores, and the clinical diagnosis suggests that a varied core set of outcome measures is required to monitor response to treatments for ETD.
Impact of Colonoscopy Bowel Preparation Quality on Follow-up Interval Recommendations for Average-risk Patients With Normal Screening Colonoscopies
Authors: Butterly Lynn F. , Nadel Marion R. , Anderson Joseph C. , Robinson Christina M. , Weiss Julia E. , Lieberman David , Shapiro Jean A. 
Published: August 2018

Background and Aims:
National guidelines for colonoscopy screening and surveillance assume adequate bowel preparation. We used New Hampshire Colonoscopy Registry (NHCR) data to investigate the influence of bowel preparation quality on endoscopist recommendations for follow-up intervals in average-risk patients following normal screening colonoscopies.

Methods:
The analysis included 9170 normal screening colonoscopies performed on average risk individuals aged 50 and above between February 2005 and September 2013. The NHCR Procedure Form instructs endoscopists to score based on the worst prepped segment after clearing all colon segments, using the following categories: excellent (essentially 100% visualization), good (very unlikely to impair visualization), fair (possibly impairing visualization), and poor (definitely impairing visualization). We categorized examinations into 3 preparation groups: optimal (excellent/good) (n=8453), fair (n=598), and poor (n=119). Recommendations other than 10 years for examinations with optimal preparation, and >1 year for examinations with poor preparation, were considered nonadherent.

Results:
Of all examinations, 6.2% overall received nonadherent recommendations, including 5% of examinations with optimal preparation and 89.9% of examinations with poor preparation. Of normal examinations with fair preparation, 20.7% of recommendations were for an interval <10 years. Among those examinations with fair preparation, shorter-interval recommendations were associated with female sex, former/nonsmokers, and endoscopists with adenoma detection rate ≥20%.

Conclusions:
In 8453 colonoscopies with optimal preparations, most recommendations (95%) were guideline-adherent. No guideline recommendation currently exists for fair preparation, but in this investigation into community practice, the majority of the fair preparation group received 10-year follow-up recommendations. A strikingly high proportion of examinations with poor preparation received a follow-up recommendation greater than the 1-year guideline recommendation. Provider education is needed to ensure that patients with poor bowel preparation are followed appropriately to reduce the risk of missing important lesions.
Early Enteral Nutrition Prevent Acute Pancreatitis From Deteriorating in Obese Patients
Authors: Jin Zhouxiang , Wang Zhaohong , Wang Jisheng 
Published: August 2018

Goals:
The aim of this study was to determine a potential strategy to prevent acute pancreatitis (AP) from deteriorating in obese patients.

Background:
Nutritional support plays a critical role in the treatment of AP. Early enteral nutrition (EEN) is considered to be able to protect mucosa of AP patients and alleviate inflammatory reactions. Obesity worsen AP prognosis. However, little is known about the effects of EEN in obese patients.

Study:
Prospective randomized control trial. Subjects with moderately severe AP or severe AP were divided into the visceral fat obesity (VFO) group and the non-VFO group by obesity index VFO. The patients received “delayed” enteral nutrition (started enteral nutrition feeding after the first 48 hours after admission to the hospital: group A: patients of non-VFO, n=108; group B: VFO patients, n=88) or EEN (in the VFO subgroup, group C: n=91).Occurrence of complication, clinical outcomes, plasma levels of cytokines, and intestine gut barrier index were measured at different timepoints after admission.

Results:
VFO was a risk factor for aggravating of AP. EEN prevented the VFO patients from developing pancreatic necrotic infection, the mechanism of which might be related with inhibiting excessive inflammatory reactions, adjusting the imbalance of inflammatory response, and alleviating ischemia of intestine mucosa.

Conclusions:
The potential strategy, EEN, was able to prevent AP from deteriorating in obese patients.
Fibroscan Reliably Rules Out Advanced Liver Fibrosis and Significant Portal Hypertension in Alcoholic Patients
Authors: Salavrakos Melissa , Piessevaux Hubert , Komuta Mina , Lanthier Nicolas , Stärkel Peter 
Published: August 2018

Background/Goals:
To date, there is no consensus on optimal cut-off values and timing of transient elastography (TE, Fibroscan) for fibrosis staging and prediction of portal hypertension in alcoholic liver disease. We evaluated the accuracy of Fibroscan for the diagnosis of fibrosis and clinically significant portal hypertension in alcoholic patients.

Study:
Heavy drinkers admitted to our standardized alcohol withdrawal program were evaluated by Fibroscan, by transjugular hepatic venous pressure gradient (HVPG) measurement and liver biopsy if significant fibrosis was suspected and by upper gastrointestinal endoscopy. All investigations were performed within 3 days of admission. Patients who had remained abstinent for 2 weeks underwent a second Fibroscan.

Results:
A total of 118 patients were included. Fibroscan correlated well with histology and HVPG. Negative predictive value of 92% and 93% for ruling out severe fibrosis (≥F3) and cirrhosis, and optimal cut-offs at ≥11.7, ≥15.2, and ≥21.2 kPa for F2, F3, and F4, respectively, were found. In abstinent patients, a mean decrease of 2.7 kPa improved concordance between Fibroscan and histology. A TE value of 30.6 kPa predicted a HVPG>10 mm Hg with 94% specificity and showed a good negative predictive value of 84% for ruling out the presence of varices at endoscopy. Steatosis, alcoholic hepatitis, sinusoidal fibrosis, cholestasis, and high transaminases did not influence TE values.

Conclusions:
Fibroscan is an accurate non-invasive method for the diagnosis of fibrosis in alcoholic patients. TE values below 11 and 30 kPa likely rule out significant fibrosis and varices, respectively.
Association of smoking with liver fibrosis and mortality in primary biliary cholangitis
Authors: Mantaka Aikaterini , Koulentaki Mairi , Samonakis Dimitrios , Sifaki-Pistolla Dimitra , Voumvouraki Argyro , Tzardi Maria , Kouroumalis Elias 
Published: August 2018

Background
The outcome of primary biliary cholangitis (PBC) is affected by both genetic and environmental factors.

Objective
The aim of this study was to study the effect of smoking on liver histology and mortality in a genetically homogeneous population having PBC.

Patients and methods
Smoking and drinking habits at diagnosis (based on standard criteria) were recorded in 171 Cretan patients with PBC (163 women). A total of 148 patients had a liver biopsy. Odds ratios were calculated with logistic regression analysis. Kaplan–Meier curves were used for mortality estimation.

Results
Smoking was associated with alcohol consumption of more than 20 g/day [adjusted odds ratio (AOR)=2.20, 95% CI: 1.029–4.099], severe steatosis (AOR=5.31, 95% CI: 2.019–9.919), and fibrosis stage F3–F4 (AOR=1.21, 95% CI: 1.015–3.031). Heavy smoking, years of passive smoking, and serious necroinflammatiοn were independent factors associated with advanced fibrosis after adjustment for sex, age, BMI, and alcohol consumption in multivariate analysis. For every pack-year increase in smoking intensity, there was a 3.2 times higher likelihood of advanced fibrosis (95% CI: 2.018–6.294). Increased mortality was found in smokers with advanced PBC.

Conclusion
There is an association between smoking, whether active or passive, and advanced fibrosis in PBC. Mortality is increased in smokers with advanced disease at presentation.
Hemolysis During Pediatric Extracorporeal Membrane Oxygenation: Associations With Circuitry, Complications, and Mortality
Authors: Dalton Heidi J. , Cashen Katherine , Reeder Ron W. , Berg Robert A. , Shanley Thomas P. , Newth Christopher J. L. , Pollack Murray M. , Wessel David , Carcillo Joseph , Harrison Rick , Dean J. Michael , Meert Kathleen L. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN)
Published: August 2018

Objectives:To describe factors associated with hemolysis during pediatric extracorporeal membrane oxygenation and the relationships between hemolysis, complications, and mortality.Design:Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014.Setting:Three Collaborative Pediatric Critical Care Research Network-affiliated hospitals.Patients:Age less than 19 years and treated with extracorporeal membrane oxygenation.Interventions:None.Measurements and Main Results:Hemolysis was defined based on peak plasma free hemoglobin levels during extracorporeal membrane oxygenation and categorized as none (< 0.001 g/L), mild (0.001 to < 0.5 g/L), moderate (0.5 to < 1.0 g/L), or severe (≥ 1.0 g/L). Of 216 patients, four (1.9%) had no hemolysis, 67 (31.0%) had mild, 51 (23.6%) had moderate, and 94 (43.5%) had severe. On multivariable analysis, variables independently associated with higher daily plasma free hemoglobin concentration included the use of in-line hemofiltration or other continuous renal replacement therapy, higher hemoglobin concentration, higher total bilirubin concentration, lower mean heparin infusion dose, lower body weight, and lower platelet count. Using multivariable Cox modeling, daily plasma free hemoglobin was independently associated with development of renal failure during extracorporeal membrane oxygenation (defined as creatinine > 2 mg/dL [> 176.8 μmol/L] or use of in-line hemofiltration or continuous renal replacement therapy) (hazard ratio, 1.04; 95% CI, 1.02–1.06;p< 0.001), but not mortality (hazard ratio, 1.01; 95% CI, 0.99–1.04;p= 0.389).Conclusions:Hemolysis is common during pediatric extracorporeal membrane oxygenation. Hemolysis may contribute to the development of renal failure, and therapies used to manage renal failure such as in-line hemofiltration and other forms of continuous renal replacement therapy may contribute to hemolysis. Hemolysis was not associated with mortality after controlling for other factors. Monitoring for hemolysis should be a routine part of extracorporeal membrane oxygenation practice, and efforts to reduce hemolysis may improve patient care.