bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evidence Gaps in the Use of Spinal Cord Stimulation for Treating Chronic Spine Conditions
Authors: Provenzano David A. , Amirdelfan Kasra , Kapural Leonardo , Sitzman B. Todd 
Published: April 2017

Study Design.
A review of literature.

Objective.
The aim of this study was to define and explore the current evidence gaps in the use of spinal cord stimulation (SCS) for treating chronic spine conditions.

Summary of Background Data.
Although over the last 40 years SCS therapy has undergone significant technological advancements, evidence gaps still exist.

Methods.
A literature review was conducted to define current evidence gaps for the use of SCS. Areas of focus included 1) treatment of cervical spine conditions, 2) treatment of lumbar spine conditions, 3) technological advancement and device selection, 4) appropriate patient selection, 5) the ability to curb pharmacological treatment, and 6) methods to prolong efficacy over time. New SCS strategies using advanced waveforms are explored.

Results.
The efficacy, safety, and cost-effectiveness of traditional SCS for chronic pain conditions are well-established. Evidence gaps do exist. Recently, advancement in waveforms and programming parameters have allowed for paresthesia-reduced/free stimulation that in specific clinical areas may improve clinical outcomes. New waveforms such as 10-kHz high-frequency have resulted in an improvement in back coverage. To date, clinical efficacy data are more prevalent for the treatment of painful conditions originating from the lumbar spine in comparison to the cervical spine.

Conclusion.
Evidence gaps still exist that require appropriate study designs with long-term follow-up to better define and improve the use of this therapy for the treatment of chronic spine pain in both the cervical and lumbar regions.

Level of Evidence: N/A
Predictive Impact of Clinical Benefit in Chemotherapy-treated Advanced Pancreatic Cancer Patients in Northern Alberta
Authors: Kim Christina A. , Chu Quincy S.C. , Fassbender Konrad , Ghosh Sunita , Spratlin Jennifer L. 
Published: April 2017

Objectives:
Patients with advanced pancreatic cancer (APC) have a poor prognosis and experience a large burden of disease-related symptoms. Despite advancements in the treatment of APC, survival is dismal and controlling disease-related symptoms and maintaining quality of life is paramount. We hypothesize that an improvement in disease-related symptoms, and therefore, a clinical benefit, while on chemotherapy is a predictive marker in APC.

Materials and Methods:
Patients 18 and older with APC diagnosed between January 1, 2005 and December 31, 2010 and treated at the Cross Cancer Institute were identified using the provincial cancer registry. Disease symptoms were assessed at baseline and clinical benefit while on chemotherapy was defined using a composite endpoint of improvement in patient-reported pain, opioid consumption, Eastern Cooperative Oncology Group performance status, and/or weight. Best radiologic response, progression-free survival (PFS), and overall survival (OS) were recorded.

Results:
Of 103 patients, the median age was 64, 58% were male and 66% had metastatic disease. At baseline, the majority of patients reported pain (80%), opioid use (61%), or weight loss (71%). In total, 35 (34%) patients received a clinical benefit with treatment but only 6 (17%) of these patients experienced a radiologic response. The median PFS and OS were improved in patients who experienced a clinical benefit (6.6 vs. 4.6 mo; P=0.03 and 11.7 vs. 6.1 mo; P<0.0001, respectively).

Conclusions:
In patients with APC treated with chemotherapy, experiencing a clinical benefit was associated with improved PFS and OS. However, it did not appear to correlate with radiologic response to chemotherapy. Prospective studies are warranted to further investigate the prognostic and predictive value of clinical benefit and improvement in quality of life as measured by standardized tools, in APC.
Efficacy of Triaging Direct Immunofluorescence in Intraepidermal Bullous Dermatoses
Authors: Tjarks Brian J. , Billings Steven D. , Ko Jennifer S. 
Published: April 2017

Background:
Direct immunofluorescence (DIF) is considered pivotal in diagnosing autoimmune blistering diseases. Our goal was to examine the necessity of DIF in intraepidermal bullous cases, of which pemphigus vulgaris (PV) is the prototype.

Methods:
Sixty-six cases from 2010 to 2014 submitted for DIF with an intraepidermal blistering disease listed in the differential diagnosis were reviewed by 2 board-certified dermatopathologists to see if they would order DIF based on routine histologic findings. If either pathologist requested DIF, it was considered required.

Results:
DIF was “required” in 29% (19/66) (94% intraobserver concordance) and was positive in 16% (3/19) of those “required,” leading to a diagnosis of PV (2/3) or pemphigus foliaceus [(PF) 1/3]. DIF was “not required” in 71% (47/66). Of these, 37/47 had negative/nonspecific DIF findings (79%). Of the 10 DIF+ cases, 8 were accurately diagnosed as PV based solely on the hematoxylin and eosin (H&E) findings. Three of 47 “not required” cases were misdiagnosed. Two (2/10 DIF+) were called “spongiotic dermatitis” by H&E interpretation yet had DIF consistent with PF. One case of acantholytic pityriasis rubra pilaris was diagnosed as PV on H&E, an error that may have been avoided with real-time clinical correlation.

Conclusions:
H&E diagnosis was 80% sensitive and 97% specific for intraepidermal blistering diseases. Positive predictive value was 89%; negative predictive value was 95%. H&E triaging could significantly reduce the need for DIF, especially in PV. If PF is in the differential diagnosis, DIF is necessary. In certain settings, triaging by H&E can obviate the need for DIF, resulting in significant savings.
Parent-Reported Strengths in Children with Autism Spectrum Disorders at the Time of an Interdisciplinary Diagnostic Evaluation
Authors: Sabapathy Thusa , Madduri Nirupama , Deavenport-Saman Alexis , Zamora Irina , Schrager Sheree M. , Vanderbilt Douglas L. 
Published: April 2017

ABSTRACT:

Objective:
Parents of children with autism spectrum disorders (ASD) often focus on concerns in discussions with health care providers. However, studying child strengths and positive parental attributions is an emerging area of focus and not often highlighted in many studies with children with ASD. The objective of this study was to identify parent-reported strengths in a sample of children with ASD.

Methods:
This was a qualitative study of parent report of strengths in clinical notes with children between the ages 3 and 8 presenting for a team diagnostic evaluation and meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-Text Revision (TR) or DSM-V diagnostic criteria for ASD. The reported child's strengths were qualitatively analyzed, coded, and clustered into themes.

Results:
Ninety-eight charts were reviewed. Five meta-themes of strengths were identified: Personality Characteristics, Social Personality, Cognitive Functioning, Behavioral Characteristics/Coping Mechanisms, and Skills. On average, parents reported more strengths in the Cognitive Functioning and Personality Characteristics meta-themes.

Conclusion:
Pediatricians have a unique opportunity to discuss parental positive perceptions of children with ASD and to learn about their strengths.
Revisiting the Cornea and Trabecular Meshwork Junction With 2-Photon Excitation Fluorescence Microscopy
Authors: Marando Catherine M. , Park Choul Yong , Liao Jason A. , Lee Jimmy K. , Chuck Roy S. 
Published: April 2017

Purpose:
To investigate the collagen and elastin architecture at the junction of the human cornea and trabecular meshwork (TM).

Methods:
The cornea, TM, and ciliary body (CB) tendons of unfixed human corneal buttons were imaged with an inverted 2-photon excited fluorescence microscope (FluoView FV-1000; Olympus, Central Valley, PA). The laser (Ti:sapphire) was tuned to 850 nm for 2-photon excitation. Backscatter signals of second harmonic generation and autofluorescence were collected through a 425/30-nm emission filter and a 525/45-nm emission filter, respectively. The second harmonic generation signal corresponds to collagen fibers, and the autofluorescence signal corresponds to elastin-containing tissue. Tissue structure representations were obtained through software-generated reconstructions of consecutive and overlapping (z-stack) images through a relevant sample depth.

Results:
Collagen-rich CB tendons insert into the cornea between Descemet membrane (DM) and posterior stroma along with elastin fibers originating from the TM. The CB tendons directly abut DM, and their insertion narrows as they course centrally in the cornea, giving a wedge appearance to these parallel collagen fibers. Approximately 260 μm centrally from the edge of DM, the CB tendons fan out and merge with pre-DM collagen. As the CB tendons enter the cornea, they form a dense collagenous comb-like structure orthogonal to the edge of DM and supported by a delicate elastin network of interwoven fibers originating from the TM.

Conclusions:
Two-photon excited fluorescence microscopy has improved our understanding of the peripheral corneal architecture. CB tendon insertions in this region may contribute to the radial tears encountered when preparing DM endothelial keratoplasty grafts.
Validation of an Objective Keratoconus Detection System Implemented in a Scheimpflug Tomographer and Comparison With Other Methods
Authors: Ruiz Hidalgo Irene , Rozema Jos J. , Saad Alain , Gatinel Damien , Rodriguez Pablo , Zakaria Nadia , Koppen Carina 
Published: April 2017

Purpose:
To validate a recently developed program for automatic and objective keratoconus detection (Keratoconus Assistant [KA]) by applying it to a new population and comparing it with other methods described in the literature.

Methods:
KA uses machine learning and 25 Pentacam-derived parameters to classify eyes into subgroups, such as keratoconus, keratoconus suspect, postrefractive surgery, and normal eyes. To validate this program, it was applied to 131 eyes diagnosed separately by experienced corneal specialists from 2 different centers (Fondation Rothschild, Paris, and Antwerp University Hospital [UZA]). The agreement of the KA classification with 7 other indices from the literature was assessed using interrater reliability and confusion matrices. The agreement of the 2 clinical classifications was also assessed.

Results:
For keratoconus, KA agreed in 92.6% of cases with the clinical diagnosis by UZA and in 98.0% of cases with the diagnosis by Rothschild. In keratoconus suspect and forme fruste detection, KA agreed in 65.2% (UZA) and 100% (Rothschild) of cases with the clinical assessments. This corresponds with a moderate agreement with a clinical assessment (κ = 0.594 and κ = 0.563 for Rothschild and UZA, respectively). The agreement with the other classification methods ranged from moderate (κ = 0.432; Score) to low (κ = 0.158; KISA%). Both clinical assessments agreed substantially (κ = 0.759) with each other.

Conclusions:
KA is effective at detecting early keratoconus and agrees with trained clinical judgment. As keratoconus detection depends on the method used, we recommend using multiple methods side by side.
Diagnostic Ability of Wide-field Retinal Nerve Fiber Layer Maps Using Swept-Source Optical Coherence Tomography for Detection of Preperimetric and Early Perimetric Glaucoma
Authors: Lee Won June , Na Kyeong Ik , Kim Young Kook , Jeoung Jin Wook , Park Ki Ho 
Published: April 2017

Purpose:
To evaluate the diagnostic ability of wide-field retinal nerve fiber layer (RNFL) maps with swept-source optical coherence tomography (SS-OCT) for detection of preperimetric (PPG) and early perimetric glaucoma (EG).

Methods:
One hundred eighty-four eyes, including 67 healthy eyes, 43 eyes with PPG, and 74 eyes with EG, were analyzed. Patients underwent a comprehensive ocular examination including red-free RNFL photography, visual field testing and wide-field SS-OCT scanning (DRI-OCT-1 Atlantis; Topcon, Tokyo, Japan). SS-OCT provides a wide-field RNFL thickness map and a SuperPixel map, which are composed of the RNFL deviation map of the peripapillary area and the deviation map of the composition of the ganglion cell layer with the inner plexiform layer and RNFL (GC-IPL+RNFL) in the macular area. The ability to discriminate PPG and EG from healthy eyes was assessed using sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for all parameters and criteria provided by the wide-field SS-OCT scan.

Results:
The wide-field RNFL thickness map using SS-OCT showed the highest sensitivity of PPG-diagnostic and EG-diagnostic performance compared with the other SS-OCT criteria based on the internal normative base (93.0 and 97.3%, respectively). Among the SS-OCT continuous parameters, the RFNL thickness of the 7 clock-hour, inferior and inferotemporal macular ganglion cell analyses showed the largest AUC of PPG-diagnostic and EG-diagnostic performance (AUC=0.809 to 0.865).

Conclusions:
The wide-field RNFL thickness map using SS-OCT performed well in distinguishing eyes with PPG and EG from healthy eyes. In the clinical setting, wide-field RNFL maps of SS-OCT can be useful tools for detection of early-stage glaucoma.
Initial Trabeculectomy With Mitomycin-C for Secondary Glaucoma-associated With Uveitis in Behçet Disease Patients
Authors: Komae Keiko , Takamoto Mitsuko , Tanaka Rie , Aihara Makoto , Ohtomo Kazuyoshi , Okinaga Kimiko , Matsuda Junko , Nakahara Hisae , Fujino Yujiro , Kaburaki Toshikatsu 
Published: April 2017

Purpose:
To examine clinical outcomes following an initial trabeculectomy with mitomycin-C for secondary glaucoma associated with uveitis in Behçet disease (BD) patients.

Design:
Retrospective interventional case series.

Patients and Methods:
Twenty-two eyes in 18 patients with uveitic glaucoma (UG) associated with Behçet disease who underwent an initial trabeculectomy with mitomycin-C between January 1996 and August 2014 were retrospectively reviewed. The main outcome measures were intraocular pressure (IOP) control, persistence of a filtering bleb, incidence of postoperative complications, and preopertaive and postoperative frequency of uveitic attacks. We analyzed persistence rates using Kaplan-Meier life tables based on 3 definitions of target IOP control (≤21, ≤18, ≤15 mm Hg) and filtering bleb persistence.

Result:
The persistence rates of postoperative IOP at ≤21, ≤18, and ≤15 mm Hg at 5 years after surgery were 76.1%, 71.5%, and 68.1%, respectively, whereas that of a filtering bleb was 54.4%. Hypotony as a postoperative complication was observed in 4 (18.2%) cases. No significant difference was observed between the preoperative and postoperative frequency of uveitic attacks (1.36±1.15 vs. 0.95±1.49 times/y, P=0.16). There was 1 case in which recurrence of uveitis after surgery caused a loss of filtering bleb, which required a reoperation.

Conclusions:
At 5 years after surgery, the persistence rate of postoperative IOP control (≤21 mm Hg) was 76.1% and that of a filtering bleb was 54.4%. The frequency of uveitis recurrence did not significantly increase after surgery. Attention must be paid to avoid such recurrence to maintain the filtering bleb.
Use of Ocular Hypotensive Medications in Portugal: PEM Study: A Cross-sectional Nationwide Analysis
Authors: Sousa David Cordeiro , Leal Inês , Nascimento Nilton , Marques-Neves Carlos , Tuulonen Anja , Abegão Pinto Luís 
Published: April 2017

Purpose:
There is scarcity of European data about intraocular pressure (IOP)-lowering prescribing patterns. We aimed to describe and discuss the nationwide prescription of these medications in Portugal.

Materials and Methods:
This was a cross-sectional study including all patients who were prescribed at least 1 IOP-lowering medication in 2015 in Portugal. All ocular hypotensive drug prescriptions were gathered from the common electronic drug prescription system used by all hospitals and clinics in Portugal. Demographic data, medications prescribed (number and formulation), physician specialty, and costs of medications were provided in an encrypted and anonymous form. Statistical analyses were performed using STATA.

Results:
A total of 231,634 participants (57% women) were prescribed IOP-lowering medications in 2015, representing 4.0% of the population older than 40 years of age and 2.2% of the Portuguese total population. Mean age was 72±13 years. Topical IOP-lowering therapy accounted for a total of 26 million euros (M€) in costs, shared between patients and the national health system. General practitioners (GPs) accounted for 52% of all prescriptions. The most prescribed drugs were latanoprost (28%), timolol/dorzolamide (19%), and brimonidine (14%). Among all, 72% of patients were on monotherapy. Compared with ophthalmologists, GPs presented qualitative differences in their prescription pattern, such as a lower proportion of unit dose prescription.

Conclusion:
A significant percentage of the Portuguese population is currently treated with IOP-lowering medications, and the majority of them are on monotherapy. Although GPs are responsible for most prescriptions, their prescription pattern is different from that of ophthalmologists. This nationwide study revealed prescription patterns and disclosed the burden of the disease in terms of its medical management.
Evaluation of a Novel Visual Field Analyzer Application for Automated Classification of Glaucoma Severity
Authors: Germano Renato A.S. , de Moraes Carlos Gustavo , Susanna Remo , Dantas Daniel O. , Neto Edson d.S. 
Published: April 2017

Purpose:
To describe the Glaucoma Staging Application (GSA), a new application for automated classification of visual field (VF) severity that can be used in any Humphrey perimeters. We also tested and validated its performance in staging glaucomatous VFs defects and assessed its reproducibility.

Materials and Methods:
The GSA is based upon the modified University of São Paulo Glaucoma Visual Field Staging System, and consists of 3 sections: severity based on the visual field index; defect location based on eccentricity; and extent of topographic damage by hemifields. We analyzed 612 VFs of 32 patients. VFs were analyzed by a glaucoma expert and then compared with the output of the GSA. To evaluate the repeatability, the same search criteria were repeated 1 week later using the same GSA. The classification given by the software was considered correct if it completely agreed in all variables (severity, location, and extent of topographic damage) with the classification performed manually by the glaucoma expert.

Results:
One hundred seventy-eight eyes were classified as early VF damage, 148 moderate, and 156 severe. One hundred thirty-one VFs were classified as normal. When repeated, 1 week later, the GSA showed excellent repeatability. The automated classification agreed with the expert’s grading in 100% of cases.

Conclusions:
The GSA allows an automated, fast, reproducible, and objective classification system for multiple 24-2 VFs of Humphrey perimetry. This study is a proof-of-concept that could translate into a useful tool to analyze and stage VFs more objectively and thus help detecting progression of different types of VFs defects.
Evaluation of a New Rebound Self-tonometer, Icare HOME: Comparison With Goldmann Applanation Tonometer
Authors: Takagi Daisuke , Sawada Akira , Yamamoto Tetsuya 
Published: April 2017

Purpose:
To compare measurements from an Icare HOME rebound self-tonometer compared with those from a Goldmann applanation tonometer (GAT).

Materials and Methods:
A total of 130 subjects with suspected or confirmed glaucoma in our outpatient clinic were examined. Intraocular pressure (IOP) was measured using both an Icare HOME unit, by an ophthalmologist and by each participant, and again using a GAT, by an ophthalmologist. The Icare HOME self-measurement [Icare HOME performed by the patients (HOMEp)] was compared with those taken by the specialist using that unit and a GAT.

Results:
In total, 128 participants (98%, 128/130) were able to correctly conduct self-measurement. Of the 128 participants, the mean IOP was 12.2±2.8 mm Hg (range, 7 to 20 mm Hg) via GAT, 12.8±3.7 mm Hg (range, 6 to 24 mm Hg) with HOMEp and 13.1±3.8 mm Hg (range, 6 to 25 mm Hg) by Icare HOME specialist measurement [Icare HOME performed by the ophthalmologist (HOMEo)]. The mean difference between HOMEp and HOMEo was 0.21 mm Hg (P=0.068; paired t test). The mean difference between the HOMEp and GAT measurements was 0.70 mm Hg (P<0.001; paired t test), and between the HOMEo and GAT measurements it was 1.00 mm Hg (P<0.001; paired t test). The IOP difference between the HOMEp and GAT measurements was >3 mm Hg in 9.4% of cases (12/128), and >5 mm Hg in 2.3% of cases (3/128). A positive correlation was found between the central corneal thickness (CCT) and each of the 3 IOP values (HOMEp, HOMEo, and GAT: r=0.405, P<0.001; r=0.424, P<0.001; and r=0.400, P<0.001, respectively; Spearman correlation coefficient). The difference between HOMEp and GAT values was significantly increased with increasing CCT (P=0.024; Spearman correlation coefficient), indicating that a 10% increase in CCT predicted a 1.2% increase in the difference.

Conclusions:
The Icare HOME tonometer is feasible for use in self-monitoring of IOP. Icare HOME tonometry measurements tend to overestimate IOP relative to GAT measurements.
Effect of Lateral Decubitus Body Posture on Anterior Chamber Angle in Healthy Subjects: An Anterior Segment Optical Coherence Tomography Study
Authors: Park Ji-Hye , Yeon Dong Yun , Yoo Chungkwon , Kim Yong Yeon 
Published: April 2017

Purpose:
To investigate the effect of the lateral decubitus (LD) position on the anterior chamber (AC) angle in healthy subjects.

Materials and Methods:
Twenty-three healthy young subjects were included in this prospective observational study. We measured AC angle parameters in the sitting and the left LD positions using anterior segment optical coherence tomography (Visante OCT): trabecular-iris angle (TIA), angle opening distance (AOD500), trabecular-iris space area (TISA500), anterior chamber width, lens vault, and anterior chamber depth. The Wilcoxon signed-rank test was used to compare the parameters between different body positions. Interobserver reproducibility of AC angle measurements was assessed by intraclass correlation coefficients.

Results:
Postural alterations from sitting to the left LD position significantly reduced the AC angle on the temporal side in right eyes (TIA: 39.53±2.38 to 38.31±3.47 degrees; AOD500: 0.72±0.13 to 0.65±0.08; TISA500: 0.25±0.06 to 0.22±0.04; all P<0.05), whereas no significant changes were noted on the nasal side. Contrastingly, a significant decrease in the AC angle on the nasal side was noted for left eyes (TIA: 39.49±2.24 to 38.17±2.76 degrees; AOD500: 0.68±0.09 to 0.64±0.10; TISA500: 0.23±0.04 to 0.21±0.03; all P<0.05). Anterior chamber width and anterior chamber depth were unaffected by postural alterations, but lens vault significantly was reduced following a shift to the left LD position.

Conclusions:
The AC angle parameters on the nondependent side of the eye in the LD position were significantly reduced compared with those in the sitting position. Therefore, postural shift from sitting to the LD position may induce alterations in the AC angle.