bluuebunny/crossref_metadata_2025_split huggingface dataset:
OCULAR INVOLVEMENT IN HEMOPHAGOCYTIC SYNDROME: A NOVEL FUNDUSCOPIC MANIFESTATION AND REVIEW OF THE LITERATURE
Authors: Suhr Kristin S. , Chiang Michael F. , Flynn John T. , Engelbert Michael 
Published: January 2016

Purpose:
Hemophagocytic syndrome (HS) is a rare disease with a spectrum of ocular findings. The authors report a unique funduscopic presentation of HS in a neonate and a discussion of diagnosis, typical features, management, and outcome.

Methods:
Single case report with retrospective analysis of the published literature of patients with HS and ocular findings from 1950 to present using the key terms hemophagocytic, lymphohistiocytosis, ocular, and ophthalmic. Literature search from 1950 to the present was performed through PubMed/MEDLINE and the Cochrane database. Requirement for inclusion was that the article or abstract was written in English.

Results:
A 4-week-old neonate with HS demonstrated bilateral discrete white dots within the retina, which resolved incompletely over the course of the next months but showed increased pigmentation.

Conclusion:
With so few documented ophthalmic cases of HS in existence, the ocular findings at this point can be seen as diverse and variable. However as more cases are reported, hopefully this will allow for increased recognition of the ophthalmic manifestations and sequelae and in turn lead to improved treatment of this disease.
SPONTANEOUS REGRESSION OF SEROUS RETINAL DETACHMENT ASSOCIATED WITH CIRCUMSCRIBED CHOROIDAL HEMANGIOMA AFTER CHILDBIRTH
Authors: Sayman Muslubas Isil , Arf Serra , Hocaoglu Mumin , Ozdemir Hakan , Karacorlu Murat 
Published: January 2016

Purpose:
To report a case of circumscribed choroidal hemangioma complicated by retinal detachment and regressed spontaneously after childbirth.

Methods:
Clinical examination, fundus photography, spectral domain optical coherence tomography with enhanced depth imaging, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and microperimetry.

Results:
A 41-year-old woman was referred with a 2-week history of decreased vision and scotoma in the left eye. She was in her sixth month of pregnancy. Fundus examination revealed a circumscribed choroidal hemangioma appearing as a solitary orange-red mass in the upper peripapillary area and neurosensory retinal detachment of the macula. After the birth, spontaneous regression of the retinal detachment was observed.

Conclusion:
Pregnancy may cause exacerbation of choroidal hemangioma, and regression of the exudation may occur spontaneously after delivery. Treatment is not indicated when symptoms or signs of exudation disappear.
Improved Vision and Contact Lens Wear Time With Piggy-Back Contact Lens Systems in Children After Penetrating Corneal Trauma
Authors: Cromelin Caroline , Russell Buddy , Lambert Scott R. 
Published: January 2016

Objective:
Consecutive case series of children treated successfully with “piggy-back” (PB) contact lens systems after corneal trauma.

Methods:
We reviewed the medical record of all children ages 4 to 14 years treated at the Emory Eye Center between January 11, 2003 and January 11, 2013 with PB contact lens systems.

Results:
Four children with a history of corneal penetrating trauma were treated with a PB lens system, with a mean age of 7±0.08 (range: 6–8) years. Best-corrected spectacle vision was count fingers in two children and logMAR +0.70 (Snellen equivalent 20/100) and logMAR +0.6 (Snellen equivalent 20/80) in the remaining two. The PB lens system was introduced with a mean of 15.7±6.5 (range: 9–22) months after the injury. All patients were initially fitted with gas-permeable (GP) lenses. Each child achieved 11 or more hours of daily contact lens wear time in PB systems. The mean best-corrected logMAR visual acuity using the PB system was 0.26±0.21 (Snellen equivalent 20/36). The mean improvement in best-corrected logMAR between GP and PB lens systems was +0.21±0.11, which corresponds to an improvement of greater than two lines on the Snellen chart.

Conclusion:
Piggy-back contact lens systems can be helpful to improve vision and contact lens wearing time in children with irregular astigmatism after corneal trauma, who are intolerant of GP contact lenses.
Changes in Peripheral Refraction, Higher-Order Aberrations, and Accommodative Lag With a Radial Refractive Gradient Contact Lens in Young Myopes
Authors: Pauné Jaume , Thivent Solène , Armengol Jesús , Quevedo Lluisa , Faria-Ribeiro Miguel , González-Méijome José M. 
Published: January 2016

Purpose:
To evaluate changes in the peripheral refraction (PR), visual quality, and accommodative lag with a novel soft radial refractive gradient (SRRG) experimental contact lens that produces peripheral myopic defocus.

Methods:
59 myopic right eyes were fitted with the lens. The PR was measured up to 30° in the nasal and temporal horizontal visual fields and compared with values obtained without the lens. The accommodative lag was measured monocularly using the distance-induced condition method at 40 cm, and the higher-order aberrations (HOAs) of the entire eye were obtained for 3- and 5-mm pupils by aberrometry. Visual performance was assessed through contrast sensitivity function (CSF).

Results:
With the lens, the relative PR became significantly less hyperopic from 30° to 15° temporally and 30° nasally in the M and J0 refractive components (P<0.05). Cylinder foci showed significant myopization from 30° to 15° temporally and 30° to 25° nasally (P<0.05). The HOAs increased significantly, the CSF decreased slightly but reached statistical significance for 6 and 12 cycles per degree (P<0.05), and the accommodative lag decreased significantly with the SRRG lens (P=0.0001). There was a moderate correlation between HOAs and CSF at medium and high spatial frequencies.

Conclusion:
The SRRG lens induced a significant change in PR, particularly in the temporal retina. Tangential and sagittal foci changed significantly in the peripheral nasal and temporal retina. The decreased accommodative lag and increased HOAs particularly in coma-like aberration may positively affect myopia control. A longitudinal study is needed to confirm this potential.
Contact Lens–Induced Discomfort and Inflammatory Mediator Changes in Tears
Authors: Masoudi Simin , Zhao Zhenjun , Stapleton Fiona , Willcox Mark 
Published: January 2016

Purpose:
Studies indicate that contact lens (CL) discontinuation mostly occurs because of dryness and discomfort symptoms. This study aimed to investigate relationships between changes in the concentration of tear inflammatory mediators with subjective comfort ratings with CL wear and no contact lens wear between morning and evening.

Method:
Forty-five subjects collected tears twice daily in the morning and in the evening with or without lenses. Comfort was rated subjectively on a scale from 1 to 100 (where 100 was extremely comfortable) just before each tear collection. Tear samples were assayed for complement components (C3 and C3a), leukotriene B4 (LTB4), secretory phospholipase A2 (sPLA2), secretory immunoglobulin A (sIgA), and bradykinin using commercially available immuno-based assay kits.

Results:
Comfort ratings showed a statistically significant decline from morning to evening both with CL (89.0±10.1 am vs. 76.7±15.2 pm; P<0.001) and without CL (89.1±10.2 am vs. 84.2±12.6 pm; P<0.005) wear. The decline was steeper with lens wear (P<0.001). Bradykinin and sPLA2 levels did not change between morning and evening or with CL wear (P>0.05). Leukotriene B4 levels were slightly higher in CL (CL 43.4±12.6 pg/ml vs. No CL 39.4±13.4 pg/mL; P=0.034), whereas the concentration of LTB4, C3, C3a, and sIgA dropped by the end of the day in the presence or absence of lens wear (P<0.001). For most mediators, tear levels were not correlated with comfort ratings in any of the conditions. Leukotriene B4 had a higher concentration in the evening, and when measured as a ratio to sIgA, there was a trend for increased concentration of this mediator during CL wear.

Conclusion:
Although specific mediators showed changes from morning to evening with and without lens wear, most of these were not correlated with subjective comfort ratings in lens wear. The only mediator that showed an increase in concentration during the day and during lens wear was LTB4, and further studies on this mediator are warranted.
Comparative Evaluation of Use of 400-μm and 350-μm Microkeratome Head to Prepare Donor Tissue in Cases of Descemet Stripping Automated Endothelial Keratoplasty
Authors: Jain Srheyans , Sharma Namrata , Maharana Prafulla K. , Agarwal Tushar , Sinha Rajesh , Vajpayee Rasik B. 
Published: January 2016

Purpose:
To compare the outcomes of 400-μm microkeratome head with 350-μm microkeratome head Descemet stripping automated endothelial keratoplasty (DSAEK) in a prospective comparative study.

Methods:
Twenty cases of pseudophakic bullous keratopathy were randomly allocated into two groups. Group 1 underwent slow, single-pass 400-μm microkeratome head, whereas group 2 underwent the standard technique of DSAEK using a 350-μm microkeratome head. The primary outcome measures were best-corrected visual acuity (BCVA) at 6 months.

Results:
Groups were comparable in baseline characteristics. The mean central graft thickness (GT) at 6 months in group 1 was significantly thinner than group 2 (90.44±28.67 vs. 165.60±62.74 μm; P=0.003). The BCVA and contrast sensitivity were significantly better in group 1 than in group 2 (BCVA: 0.34±0.15 vs. 0.53±0.19 logMAR units, P=0.02; contrast sensitivity: 1.48±0.13 vs. 1.06±0.22, P=0.001). A significant correlation was found between both postoperative BCVA and contrast sensitivity, with the postoperative GT using Spearman rho correlation analysis (R=0.534, P=0.01 for BCVA and R=−0.522, P=0.02 for contrast sensitivity). The percentage endothelial cell loss was comparable between the 2 groups at the last follow-up (P=0.3). No major complications were observed during the study period.

Conclusions:
The use of a 400-μm microkeratome head instead of 350-μm head can improve the visual outcomes in DSAEK without increasing the risk of complications. The thickness of the DSAEK graft can affect the visual acuity and contrast sensitivity.
The Mechanics of Brow-Suspension Ptosis Repair: A Comparative Study of Fox Pentagon and Crawford Triangle Techniques
Authors: Kwon Kyung-Ah , Shipley Rebecca J. , Edirisinghe Mohan , Best Serena M. , Cameron Ruth E. , Poitelea Cornelia , Rose Geoffrey E. , Ezra Daniel G. 
Published: January 2016

Purpose:
To perform quantitative analysis of the most commonly used brow-suspension configurations.

Methods:
The inflection positions for Fox pentagon and Crawford triangle configurations were marked on 49 healthy volunteers (male and female) and photographs taken in 3 states: “normal,” “closed,” and “raised.” The skin marks were measured vectorially with respect to the medial canthus, and displacement changes were evaluated for “normal-to-closed” (“blinking”) and from “closed-to-raised” (“eye-opening”) states. The distance between a pair of inflection marks, representing the approximate path of sling configurations, were also measured and analyzed in relation to the mechanical properties of a variety of synthetic brow-suspension materials.

Results:
“Blinking” resulted in the greatest displacement in the medial eyelid incision, resulting in the greatest strain on the line connecting the medial eyelid and medial brow inflections. No significant differences in the strains for individual lines were found between the Fox and Crawford techniques, although the former shows a significantly lower overall strain in the whole loop than the latter. The displacements of some inflections and of the strains of a few lines differed significantly in men and women.

Conclusions:
Within the scope of this study, the blinking action was shown to result in the maximum strain of ~40%, which lies within the elastic region of stress–strain curves for some commonly used synthetic brow-suspension materials. No one method was statistically superior, although the Fox pentagon gave a significantly lower overall strain when the sling material was assumed to move somewhat around the inflections within a closed loop.
Levator Muscle Enlargement in Thyroid Eye Disease-Related Upper Eyelid Retraction
Authors: Davies Michael J. , Dolman Peter J. 
Published: January 2016

Purpose:
To identify levator palpebrae superioris enlargement in thyroid eye disease (TED)-related upper eyelid retraction (ULR).

Methods:
Retrospective case–control. Subjects included 50 consecutive patients with unilateral thyroid eye disease-related ULR ≥ 2 mm and no previous eyelid surgery. The contralateral side was used as control. Clinical information was recorded from charts. CT scans were assessed by investigators blinded to the clinical data. A prediction of retracted side was made based on CT scan appearance and on basis of measured levator palpebrae superioris cross-sectional area at 2 defined points. Statistical analysis determined correlation between levator palpebrae superioris size and presence of ULR. The study was approved by the institutional ethics committee.

Results:
Side with ULR predicted from CT scan review in over 85% of cases. Mean cross-sectional area of levator palpebrae superioris on retracted side was significantly larger than nonretracted side at 2 separate sites. Levator palpebrae superioris area was larger on retracted side compared with nonretracted side in over 85% of subjects. More than 30% of subjects had no enlargement of other extraocular muscles. Only 6% of patients had enlargement of the ipsilateral inferior rectus muscle.

Conclusions:
Levator palpebrae superioris enlargement from inflammation or scar is a factor in thyroid eye disease-related ULR. Upper eyelid retraction can be predicted from CT scan appearance in over 85% of cases. Ipsilateral inferior rectus enlargement is rare. Levator palpebrae superioris is the most commonly targeted muscle in thyroid eye disease.
Acinetobacter ursingii Bacteremia From a Peripherally Inserted Central Catheter in a Woman With Hyperemesis Gravidarum
Authors: Holloman Conisha , Franco Arielle , Carlan Stephen J. , Busowski Mary , Busowski John 
Published: January 2016

Background
Hyperemesis gravidarum is defined as severe nausea and vomiting of pregnancy associated with weight loss and dehydration if left untreated. Treatment will sometimes require the placement of a peripherally inserted central catheter line for the administration of intravenous antiemetics, total parenteral nutrition, and rehydration. Acinetobacter ursingii is a nonmotile, aerobic, gram-negative coccobacilli that are widespread in natural moist environments and are rarely isolated as a definitive human pathogen.

Case
We present a case of a previously healthy immunocompetent pregnant woman in the second trimester with a peripherally inserted central catheter line placed for the management of hyperemesis gravidarum who subsequently developed bacteremia with A. ursingii. The patient was treated with intravenous meropenem and oral ciprofloxacin.

Conclusions
Central catheters are a risk factor for sepsis with A. ursingii in immunocompetent pregnant women, and aggressive treatment with appropriate antibiotics should be implemented.
Initial Therapy for Mild to Moderate Clostridium difficile Infection
Authors: Siegfried Justin , Dubrovskaya Yanina , Flagiello Thomas , Scipione Marco R. , Phillips Michael , Papadopoulos John , Chen Donald , Safdar Amar 
Published: January 2016

Background
Oral vancomycin is being increasingly used for treatment of Clostridium difficile infection (CDI), although the feasibility for such approach and avoidance of currently recommended oral metronidazole for mild to moderate (mm)-CDI remain uncertain. We sought to assess treatment response in hospitalized patients with mm-CDI at our university medical center.

Methods
Standard Infectious Diseases Society of America and Society for Healthcare Epidemiology of America definitions were used. Primary outcomes included rate of treatment response and infection recurrence following therapy.

Results
Among 513 total cases of CDI between 2011 and 2013, 168 were mm-CDI and were further analyzed. Overall treatment responses to oral vancomycin were 97% versus 82% in patients given metronidazole (P = 0.002). Overall rate of CDI recurrence was 13% following vancomycin versus 9% following metronidazole treatment (P = 0.4). In 85 patients with NAP1 (North American PFGE type 1) CDI, vancomycin and metronidazole yielded similar response (97% vs 98%, P = 0.13), whereas in 83 patients with non-NAP1 CDI, rate of treatment response to vancomycin was higher (98% vs 78% with metronidazole, P = 0.007). In a regression analysis, initial therapy with metronidazole was an independent predictor of treatment failure (odds ratio, 8.4; 95% confidence interval, 1.75–40; P = 0.007) after controlling for hypoalbuminemia (<3 g/dL), concurrent use of proton pump inhibitors, chronic liver disease, community-onset CDI, age older than 65 years, and presence of more than 3 comorbidities. In the subset of 91 patients treated with metronidazole, presence of chronic liver disease (odds ratio, 4.4; 95% confidence interval, 1.19–16.4; P = 0.027) was associated with treatment failure.

Conclusions
Oral metronidazole therapy for mm-CDI in hospitalized patients might not be optimal and needs further reassessment.
Validation of Molecular Pathology Codes for the Identification of Mutational Testing in Lung and Colon Cancer
Authors: Vachani Anil , Wong Yu-Ning , Israelite Jennifer , Mitra Nandita , Hin Sakhena , Yang Lin , Smith-McLallen Aaron , Armstrong Katrina , Groeneveld Peter W. , Epstein Andrew J. 
Published: January 2016

Background:
Targeted therapy for patients with lung and colon cancer based on tumor molecular profiles is an important cancer treatment strategy, but the impact of gene mutation tests on cancer treatment and outcomes in large populations is not clear. In this study, we assessed the accuracy of an algorithm to identify tumor mutation testing in administrative claims data during a period before test-specific Current Procedural Terminology codes were available.

Materials and Methods:
We used Pennsylvania Cancer Registry data to select patients with lung or colon cancer diagnosed between 2007 and 2011 who were treated at the University of Pennsylvania Health System, and we obtained their administrative claims. A combination of Current Procedural Terminology laboratory codes (stacking codes) was used to identify potential tumor mutation testing in the claims data. Patients’ electronic medical records were then searched to determine whether tumor mutation testing actually had been performed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Results:
An algorithm using stacking codes had moderate sensitivity (86% for lung cancer and 81% for colon cancer) and high specificity (98% for lung cancer and 96% for colon cancer). Sensitivity and specificity did not vary significantly during 2007–2011. In patients with lung cancer, PPV was 98% and NPV was 92%. In patients with colon cancer, PPV was 96% and NPV was 83%.

Conclusions:
An algorithm using stacking codes can identify tumor mutation testing in administrative claims data among patients with lung and colon cancer with a high degree of accuracy.
A Detailed Exploration Into the Association of Prescribed Opioid Dosage and Overdose Deaths Among Patients With Chronic Pain
Authors: Bohnert Amy S. B. , Logan Joseph E. , Ganoczy Dara , Dowell Deborah 
Published: January 2016

Background:
High opioid dosage has been associated with overdose, and clinical guidelines have cautioned against escalating dosages above 100 morphine-equivalent mg (MEM) based on the potential harm and the absence of evidence of benefit from high dosages. However, this 100 MEM threshold was chosen somewhat arbitrarily.

Objective:
To examine the association of prescribed opioid dosage as a continuous measure in relation to risk of unintentional opioid overdose to identify the range of dosages associated with risk of overdose at a detailed level.

Methods:
In this nested case-control study with risk-set sampling of controls, cases (opioid overdose decedents) and controls were identified from a population of patients of the Veterans Health Administration who were prescribed opioids and who have a chronic pain diagnosis. Unintentional fatal opioid analgesic overdose was measured from National Death Index records and prescribed opioid dosage from pharmacy records.

Results:
The average prescribed opioid dosage was higher (P<0.001) for cases (mean=98.1 MEM, SD=112.7; median=60, interquartile range, 30–120), than controls (mean=47.7 MEM, SD=65.2; median=25, interquartile range, 15–45). In a ROC analysis, dosage was a moderately good “predictor” of opioid overdose death, indicating that, on average, overdose cases had a prescribed opioid dosage higher than 71% of controls.

Conclusions:
A clear cut-point in opioid dosage to distinguish between overdose cases and controls was not found. However, lowering the recommended dosage threshold below the 100 MEM used in many recent guidelines would affect proportionately few patients not at risk for overdose while potentially benefitting many of those at risk for overdose.
Investigation of a Suicide Ideation Risk Profile in People With Co-occurring Depression and Substance Use Disorder
Authors: Handley Tonelle E. , Kay-Lambkin Frances J. , Baker Amanda L. , Lewin Terry J. , Kelly Brian J. , Inder Kerry J. , Attia John R. , Kavanagh David J. 
Published: January 2016

AbstractDisengagement from services is common before suicide, hence identifying factors at treatment presentation that predict future suicidality is important. This article explores risk profiles for suicidal ideation among treatment seekers with depression and substance misuse. Participants completed assessments at baseline and 6 months. Baseline demographics, psychiatric history, and current symptoms were entered into a decision tree to predict suicidal ideation at follow-up. Sixty-three percent of participants at baseline and 43.5% at follow-up reported suicidal ideation. Baseline ideation most salient when psychiatric illness began before adulthood, increasing the rate of follow-up ideation by 16%. Among those without baseline ideation, dysfunctional attitudes were the most important risk factor, increasing rates of suicidal ideation by 35%. These findings provide evidence of factors beyond initial diagnoses that increase the likelihood of suicidal ideation and are worthy of clinical attention. In particular, providing suicide prevention resources to those with high dysfunctional attitudes may be beneficial.