bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Measurement Center Shift on Ganglion Cell–inner Plexiform Layer Thickness Measurements
Authors: Kim Kyoung-Nam , Shin Il-Hwan , Kwak Baek-Soo , Sung Jae-Yun , Lim Hyung-Bin , Jo Young-Joon , Kim Jung-Yeul 
Published: August 2018

SIGNIFICANCE
Our authors studied the effects of measurement center shift on ganglion cell–inner plexiform layer (GCIPL) thickness measurements in Cirrus spectral-domain optical coherence tomography (SD-OCT). The measurement center shift affects the GCIPL thickness measurement depending on the distance of shift.

PURPOSE
The purpose of this study was to explore changes in macular GCIPL thicknesses measurements after manual shifting of the measurement center using SD-OCT.

METHODS
A prospective study was conducted. A total of 30 normal eyes of 30 subjects were included in the study. An experienced examiner obtained two consecutive measurements of GCIPL thickness using SD-OCT. Coefficients of repeatability were calculated for the average, minimum, and sectoral (superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal) thicknesses. Next, the measurement center was manually shifted from the foveal center. Three measurement centers were horizontally placed at 59-μm intervals from the foveal center, and two further centers were placed 176 μm apart. Also, three measurement centers were vertically placed at 47-μm intervals from the foveal center, and two further centers were placed 142 μm apart. The thickness of GCIPL was measured again at each shift point, and the changes of thickness before and after movement were analyzed.

RESULTS
When the measurement centers were shifted to positions 59 μm horizontally or 47 μm vertically from the fovea, no significant changes in GCIPL thicknesses were evident. However, upon more pronounced shifting, the average GCIPL thickness of the direction of the shift region was significantly lower than baseline, whereas the GCIPL of the diametrically opposite sector was thicker than baseline.

CONCLUSIONS
The impact of changes associated with shifting of the measurement center should be taken into consideration when measuring GCIPL thickness in patients with retinal diseases, glaucoma, or neuro-ophthalmological conditions.
Case Report: Post-keratoplasty Filamentary Keratitis Managed with Scleral Lens
Authors: Bhattacharya Pradipta , Mahadevan Rajeswari 
Published: August 2018

SIGNIFICANCE
This case report details a unique case of filamentary keratitis after penetrating keratoplasty managed with a scleral contact lens. The positive effect on vision and comfort are reported, and the challenges related to hypoxia are discussed.

PURPOSE
The purpose of this study was to report the outcome of scleral lens use in the treatment of filamentary keratitis post–penetrating keratoplasty.

CASE REPORT
A patient who underwent penetrating keratoplasty twice in both eyes for keratoconus presented with filamentary keratitis in the left eye. The prosthetic replacement of the ocular surface ecosystem scleral lens trial was performed for improving vision and comfort. After 6 hours of wearing prosthetic replacement of the ocular surface ecosystem device, the left eye showed complete resolution of filaments with an improved visual acuity and better comfort in both eyes. Corneal swelling indicating hypoxia was noticed in both eyes with scleral lenses and was managed accordingly.

CONCLUSIONS
Scleral lenses are a viable treatment option for patients with corneal filamentary keratitis after penetrating keratoplasty for achieving better vision and improved comfort. However, the risk of hypoxia cannot be undermined, which necessitates careful evaluation, follow-up, and management for safe lens wear.
Case Series: Management of Neurotrophic Keratitis from Familial Dysautonomia
Authors: Scanzera Angelica C. , Shorter Ellen 
Published: August 2018

SIGNIFICANCE
Familial dysautonomia is a rare genetic disorder that affects the sensory and autonomic nervous systems. Affected individuals have decreased corneal sensation and can develop serious complications from neurotrophic keratitis. Scleral devices are an excellent option for the long-term management of patients with familial dysautonomia and neurotrophic keratitis.

PURPOSE
In this series, we describe three patients with familial dysautonomia and classic ocular complications fit with scleral devices. No identifiable health information is included in this case report.

CASE REPORTS
Case 1: A 35-year-old white male presented with blurred vision without complaint of pain or dryness. He had moderate punctate corneal staining and central stromal corneal scarring in both eyes despite use of artificial tears, punctal plugs, and therapeutic soft lenses. He was fit with 18.2-mm commercial scleral devices, which improved vision and protected the ocular surface. Case 2: A 20-year-old cognitively impaired white female presented with history of frequent eye rubbing and self-mutilation. She had recurrent corneal abrasions with corneal scarring in both eyes and was fit with 16-mm gas-permeable prosthetic replacement of the ocular surface ecosystem devices. Case 3: An 18-year-old white male with history of frequent corneal abrasions and blurred vision was referred by his medical doctor. He and his mother were trained in the safe handling of 16- and 16.5-mm gas-permeable prosthetic replacement of the ocular surface ecosystem devices in the right and left eyes. Corneal epithelial defects healed and vision improved with daily use.

CONCLUSIONS
Individuals with familial dysautonomia present unique clinical challenges owing to severe ocular surface disease and inability to perceive pain. Initial therapy for neurotrophic keratitis includes lubrication, punctal occlusion, and therapeutic lenses. Additional therapies include autologous serum tears, amniotic membrane treatment, scleral devices, and tarsorrhaphy. In this series, scleral devices are an excellent option to protect the ocular surface and prevent common ocular complications.
2017 Glenn A. Fry Award Lecture: Establishing an Evidence-based Literature for Vision Therapy — A 25-year Journey
Authors: Scheiman Mitchell M. 
Published: August 2018

ABSTRACT
In this article, I summarize the 2017 Glenn A. Fry Award Lecture and my journey from student, to clinician, to optometric educator, and finally researcher/vision scientist. Although content for many years of teaching and practicing vision therapy, the era of evidence-based health care created a level of discomfort, as it became evident that my area of interest, vision therapy, had minimal quality evidence to support its use. Joining forces with a group of exceptional colleagues, we established the Convergence Insufficiency Treatment Trial Investigator group, and we were able to achieve funding from the National Eye Institute for multiple randomized clinical trials. The results of our studies demonstrate that vision therapy is an effective treatment option for convergence insufficiency in children, and office-based therapy is more effective than home-based therapy. These studies also demonstrated that home-based pencil push-ups commonly used by both optometrists and ophthalmologists are no more effective than placebo therapy. More recently, working in a new arena of objective recording of vergence, accommodative, and versional eye movements, my research has demonstrated that objective outcome measures of vergence are feasible for future randomized clinical trials. In pilot studies with both naturally occurring convergence insufficiency and concussion-related convergence insufficiency, statistically significant and clinically meaningful changes have been found in both disparity vergence peak velocity and response amplitude after office-based vision therapy. With new evidence about the high prevalence of concussion-related convergence insufficiency, there is much work to be accomplished to study the effectiveness of vision therapy for convergence insufficiency as well as the underlying mechanisms for how and why vision therapy is effective.
Comparisons of Two Microperimeters: The Clinical Value of an Extended Stimulus Range
Authors: Arango Tiffany , Morse Alan R. , Seiple William 
Published: August 2018

SIGNIFICANCE
Fundus-guided perimetry is a common clinical tool used to measure visual field sensitivities. Comparisons between perimeters are often made despite relative differences in hardware parameters. We directly compared two perimeters using Weber contrast, which allowed us to assess the clinical gain associated with the extended stimulus range of the macular integrity assessment (MAIA).

PURPOSE
The purpose of this study was to directly compare sensitivity thresholds for two microperimeters, the MAIA and Optos optical coherence tomography/scanning laser ophthalmoscope, using Weber contrast values. We also examined the clinical utility of the extended stimulus range of the MAIA.

METHODS
Six normally sighted adults with no visual field loss and 16 adults with low vision were recruited. Thresholds were measured on the MAIA and Optos using the same threshold algorithm and test points. To compare equivalent units, decibel thresholds were converted to light increments in apostilbs and then to delta increment intensities relative to each instrument's background luminance. Repeatability was assessed for normally sighted adults by testing both instruments on 3 separate days.

RESULTS
For normally sighted observers, mean thresholds were similar on both instruments, and repeatability within microperimeters was high. The MAIA has a 0.3-log lower contrast range and 1.37 higher contrast range. The lower contrast values did not result in lower thresholds for the normally sighted observers on the MAIA. There was a 25% increase in the number of measurable thresholds owing to the higher contrast values in low-vision observers.

CONCLUSIONS
The higher contrast range in the MAIA yielded only a small increase in detectable thresholds for participants with visual field loss.
Postextubation Dysphagia in Children: The Role of Speech-Language Pathologists*
Authors: da Silva Paulo Sergio Lucas , Lobrigate Nádia Lais , Fonseca Marcelo Cunio Machado 
Published: August 2018

Objectives:
Postextubation dysphagia is common and associated with worse outcomes in the PICU. Although there has been an increased participation of speech-language pathologists in its treatment, there is limited evidence to support speech-language pathologists as core PICU team member. We aimed to assess the impact of speech-language pathologists interventions on the treatment of postextubation dysphagia.

Design:
A quasi-experimental prospective study. In the historical group (controls), patients received a standard care management for dysphagia whereas the intervention group was routinely treated by speech-language pathologists.

Setting:
PICU of a tertiary hospital.

Patients:
Children who were endotracheally intubated for a period greater than 24 hours with greater oral intake limitation as defined by a Functional Oral Intake Scale less than or equal to 3.

Intervention:
Routine speech-language pathologist assessment.

Measurements and Main Results:
A total of 74 patients were enrolled to receive intervention (January 2015 to December 2016) and 41 patients to the historical group (January 2014 to December 2014). There were no differences in the demographic and clinical characteristics. The historical group had both longer time to initiate oral intake (7 vs 4 d; p = 0.0002; hazard ratio, 2.33) and to reach full oral intake compared with intervention group (9 vs 13 d; p < 0.001; hazard ratio, 2.51). A total of 32 controls (78%) and 74 intervention patients (100%) were on total oral intake at discharge (p ≤ 0.001). Three of nine control patients were feeding tube dependent at hospital discharge. Also, controls had a longer length of hospital stay (25 vs 20 d) and a higher rate of reintubation when compared with those patients of intervention group (10% vs 2%).

Conclusions:
Incorporating speech-language pathologists in the routine management of postextubation dysphagia can result in faster functional improvement and favorable patient outcomes. Yet, further and larger studies in pediatric dysphagia are required to support the related interventions and strategies to guide clinical practice.
Brief Report: Pulmonary Tuberculosis Is Associated With Persistent Systemic Inflammation and Decreased HIV-1 Reservoir Markers in Coinfected Ugandans
Authors: Olson Alex , Ragan Elizabeth J. , Nakiyingi Lydia , Lin Nina , Jacobson Karen R. , Ellner Jerrold J. , Manabe Yukari C. , Sagar Manish 
Published: August 2018

Background:

Mycobacterium tuberculosis (TB) infection induces systemic inflammation that could impact HIV-1 persistence.

Setting:
HIV-1–seropositive individuals either with or without pulmonary TB disease were recruited in Kampala, Uganda.

Methods:
Plasma cytokines, HIV-1 DNA, and cell-associated (ca)-RNA were compared among those coinfected with TB (cases) to those without TB (controls). TB-coinfected cases and controls were compared at presentation (n = 15 and n = 16, respectively) and at around 6 months after HIV-1 treatment initiation among those who had achieved virologic suppression (n = 6 and n = 8, respectively). At follow-up, the TB-coinfected cases had also finished TB treatment.

Results:
Before treatment, the TB-coinfected cases as compared to the controls had higher levels of soluble(s)-CD163 (P = 0.0002) and interleukin-6 (P = 0.006) but lower levels of macrophage chemoattractant protein-1 (P = 0.04). After treatment, the TB-coinfected cases as compared to controls still had higher plasma s-CD163 levels (P = 0007). Controls as compared to the coinfected cases had higher ca-RNA per DNA template both at baseline (P = 0.03) and at follow-up (P = 0.07). Levels of ca-RNA per DNA copy at follow-up showed a negative correlation with baseline plasma s-CD163 (P = 0.008) and interleukin-6 (P = 0.05) levels.

Conclusions:
TB disease is associated with inflammation and decreased HIV-1 RNA expression relative to the number of infected cells, both before and after viral suppression. Infections present before antiretroviral initiation impact HIV-1 latency.
Importance of Stem Cell Transplantation in Cleft Lip and Palate Surgical Treatment Protocol
Authors: Mazzetti Marcelo Paulo Vaccari , Alonso Nivaldo , Brock Ryane Schmidt , Ayoub Alexandre , Massumoto Sally Mizukami , Eça Lilian Piñero 
Published: August 2018

Abstract
Cleft lip and palate is a congenital malformation that requires a multidisciplinary treatment that evolves pediatrician, obstetrics, fetal medicine, genetics, plastic surgery, orthodontics, speech therapist, nursery, and psychology. Actually, the authors believe that it could be possible to ad protocols to use stem cells.
The intrauterine diagnosis leads to preborn parental orientation and better parental collaboration to accept a precocious multidisciplinary treatment. After birth the authors’ protocol is: orthodontic devices, phonoaudiology, and surgical procedures.
The authors’ cleft lip and palate reconstructive surgery protocol demands several steps and begins at 4 to 6-month old with rhinocheiloplasty and soft palate closure at the same moment. The treatment sequence involves the hard palate surgery (8–18 months after the first surgical step), alveoloplasty (after 10 years old), and secondary rhinoplasty (after 14 years old).
New ideas to use stem cells and blood from the umbilical cord and also blood from placenta are discussed to improve final surgical results. Maternal stem cells are easy to collect, there are no damage to the patient and mother, it is autologous and it could be very useful in the authors’ protocol.
Nine patients with clef lip and palate were operated and had stem cells from umbilical cord blood and placenta blood injected into the bone and soft tissue during the primary procedure (rhinocheiloplasty).
The stem cells activity into soft tissue and bone were evaluated. Preliminary results have shown no adverse results and improvement at the inflammatory response. A treatment protocol with stem cells was developed. It had a long time follow-up of 10 years.
Resuscitative Endovascular Balloon Occlusion of the Aorta in Experimental Cardiopulmonary Resuscitation: Aortic Occlusion Level Matters
Authors: Dogan Emanuel M. , Beskow Linus , Calais Fredrik , Hörer Tal M. , Axelsson Birger , Nilsson Kristofer F. 
Published: August 2018

ABSTRACT

Introduction:
Aortic occlusion during cardiopulmonary resuscitation (CPR) increases systemic arterial pressures. Correct thoracic placement during the resuscitative endovascular balloon occlusion of the aorta (REBOA) may be important for achieving effective CPR.

Hypothesis:
The positioning of the REBOA in the thoracic aorta during CPR will affect systemic arterial pressures.

Methods:
Cardiac arrest was induced in 27 anesthetized pigs. After 7 min of CPR with a mechanical compression device, REBOA in the thoracic descending aorta at heart level (zone Ib, REBOA-Ib, n = 9), at diaphragmatic level (zone Ic, REBOA-Ic, n = 9) or no occlusion (control, n = 9) was initiated. The primary outcome was systemic arterial pressures during CPR.

Results:
During CPR, REBOA-Ic increased systolic blood pressure from 86 mmHg (confidence interval [CI] 71–101) to 128 mmHg (CI 107–150, P < 0.001). Simultaneously, mean and diastolic blood pressures increased significantly in REBOA-Ic (P < 0.001 and P = 0.006, respectively), and were higher than in REBOA-Ib (P = 0.04 and P = 0.02, respectively) and control (P = 0.005 and P = 0.003, respectively). REBOA-Ib did not significantly affect systemic blood pressures. Arterial pH decreased more in control than in REBOA-Ib and REBOA-Ic after occlusion (P = 0.004 and P = 0.005, respectively). Arterial lactate concentrations were lower in REBOA-Ic compared with control and REBOA-Ib (P = 0.04 and P < 0.001, respectively).

Conclusions:
Thoracic aortic occlusion in zone Ic during CPR may be more effective in increasing systemic arterial pressures than occlusion in zone Ib. REBOA during CPR was found to be associated with a more favorable acid–base status of circulating blood. If REBOA is used as an adjunct in CPR, it may be of importance to carefully determine the aortic occlusion level.
The study was performed following approval of the Regional Animal Ethics Committee in Linköping, Sweden (application ID 418).
The Value of the Inferior Vena Cava Area Distensibility Index and its Diameter Ratio for Predicting Fluid Responsiveness in Mechanically Ventilated Patients
Authors: Yao Bo , Liu Jian-yu , Sun Yun-bo , Zhao Yu-xiao , Li Lian-di 
Published: August 2018

ABSTRACT

Introduction:
It is necessary to evaluate fluid responsiveness before fluid resuscitation. We evaluated the value of inferior vena cava (IVC) area respiratory variation and the IVC diameter ratio (IVC DR) for predicting fluid responsiveness in mechanically ventilated patients.

Methods:
A prospective observational study was performed in the intensive care unit between December 2017 and March 2018. Mechanically ventilated patients were enrolled and received ultrasound monitoring. IVC diameter distensibility index from the subxiphoid area (IVC-sx DDI), IVC diameter distensibility index from the right midaxillary line (IVC-rm DDI), IVC area distensibility index (IVC ADI), and IVC DR in cross-section were calculated by ultrasound monitoring IVC parameters. The enrolled patients were classified as nonresponders group and responders group according to whether the cardiac output increased by >10% after passive leg raising.

Results:
Data from 67 mechanically ventilated patients were analyzed. 55.2% of patients had positive fluid responsiveness. The area of receiver operating characteristic curves evaluating the ability of the IVC-sx DDI, IVC-rm DDI, IVC ADI, and IVC DR to predict the fluid responsiveness were 0.702, 0.686, 0.749, and 0.829, respectively. IVC DR level of 1.43 was predictive of positive fluid responsiveness with 90.0% specificity and 67.6% sensitivity. IVC ADI level of 10.2% was predictive of positive fluid responsiveness with 40.0% specificity and 97.3% sensitivity.

Conclusions:
IVC ADI and its diameter ratio in cross-section had more value than IVC diameter distensibility index for predicting fluid responsiveness in mechanically ventilated patients.
Analysis of Gender-based Differences in Surgery Faculty Compensation, Promotion, and Retention
Authors: Hoops Heather E. , Brasel Karen J. , Dewey Elizabeth , Rodgers Sally , Merrill Jenny , Hunter John G. , Azarow Kenneth S. 
Published: August 2018

Objectives:
The objectives of this study were to evaluate gender-based differences in faculty salaries before and after implementation of a university-wide objective compensation plan, Faculty First (FF), in alignment with Association of American Medical Colleges regional median salary (AAMC-WRMS). Gender-based differences in promotion and retention were also assessed.

Summary Background Data:
Previous studies demonstrate that female faculty within surgery are compensated less than male counterparts are and have decreased representation in higher academic ranks and leadership positions.

Methods:
At a single institution, surgery faculty salaries and work relative value units (wRVUs) were reviewed from 2009 to 2017, and time to promotion and retention were reviewed from 1998 to 2007. In 2015, FF supplanted specialty-specific compensation plans. Salaries and wRVUs relative to AAMC-WRMS, time to promotion, and retention were compared between genders.

Results:
Female faculty (N = 24) were compensated significantly less than males were (N = 62) before FF (P = 0.004). Female faculty compensation significantly increased after FF (P < 0.001). After FF, female and male faculty compensation was similar (P = 0.32). Average time to promotion for female (N = 29) and male faculty (N = 82) was similar for promotion to associate professor (P = 0.49) and to full professor (P = 0.37). Promotion was associated with significantly higher retention for both genders (P < 0.001). The median time of departure was similar between female and male faculty (P = 0.73).

Conclusions:
A university-wide objective compensation plan increased faculty salaries to the AAMC western region median, allowing correction of gender-based salary inequity. Time to promotion and retention was similar between female and male faculty.
Favorable Outcomes After Liver Transplantation With Normothermic Regional Perfusion From Donors After Circulatory Death: A Single-center Experience
Authors: Ruiz Patricia , Gastaca Mikel , Bustamante Francisco Javier , Ventoso Alberto , Palomares Ibone , Prieto Mikel , Fernández Jose Ramón , Salvador Patricia , Pijoan Jose Ignacio , Valdivieso Andres 
Published: August 2018

Background.
Controlled donation after circulatory death (cDCD) has been associated with a high incidence of ischemic cholangiopathy and other perioperative complications. In an attempt to avoid these complications, we implemented an active protocol of cDCD liver transplant (LT) with normothermic regional perfusion (NRP) preservation.

Methods.
This is a descriptive analysis of data collected from a prospective date base of cDCD LT preserved with NRP from January 2015 to June 2017 with a minimum follow up of 9 months.

Results.
Fifty-seven potential cDCD donors were connected to the NRP system. Of these, 46 livers were transplanted over a 30-month period (80% liver recovery rate). The median posttransplant peak in alanine transaminase was 1136 U/L (220-6683 U/L). Seven (15%) patients presented postreperfusion syndrome and 11 (23%) showed early allograft dysfunction. No cases of ischemic cholangiopathy were diagnosed, and no graft loss was observed over a medium follow-up period of 19 months. Of note, 13 donors were older than 65 years, achieving comparable perioperative and midterm results to younger donors.

Conclusions.
As far as we know, this represents the largest published series of cDCD LT with NRP preservation. Our results demonstrate that cDCD liver grafts preserved with NRP appear far superior to those obtained by the conventional rapid recovery technique.