bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Cornea and Anterior Chamber Morphologic Changes After Penetrating Keratoplasty in Patients With Keratoconus
Authors: Ort Abdulkadir , Gunes Alime , Kandemir Baran , Calısır Kenan , Kalaycı Mustafa , Genc Oguzhan , Ozerturk Yusuf 
Published: April 2016

Objectives:
To evaluate changes of the cornea and anterior chamber after penetrating keratoplasty in eyes with keratoconus.

Methods:
Medical records of 68 eyes of 68 patients with keratoconus who experienced penetrating keratoplasty at the Eye Clinic of Dr. Lütfi Kirdar Kartal Research and Training Hospital between 2010 and 2012 were studied. Records were retrospectively evaluated with regard to anterior chamber depth, iridocorneal angle, central corneal thickness, thinnest corneal thickness, maximum keratometric value, and mean keratometric value. Patients who developed complications and required additional surgery were excluded.

Results:
A total of 68 eyes of 68 patients were included in this study. There were 40 (58.8%) male and 28 (41.2%) female patients. The mean age was 24.5±8.19 years (range: 11–42 years). The graft diameter was 7.5 mm and the recipient bed diameter was 7.0 mm in all patients. The preoperative anterior chamber depth decreased from 3.92±0.47 mm to 3.01±0.55 mm (23% decrease). No significant postoperative change was observed in the mean iridocorneal angle values. Keratometric values decreased by 30% and corneal thickness increased by 50% (P<0.001 for both).

Conclusion:
Anterior chamber depth decreased significantly, but no change was observed in iridocorneal angle after penetrating keratoplasty in patients with keratoconus. Also, a decrease in the keratometric values and an increase in corneal thickness were observed. Understanding, estimating, and managing changes in the anterior chamber after penetrating keratoplasty, which induces significant changes in anterior chamber morphology, might increase the success of surgery.
Glaucoma Surgery Outcome in Rwanda
Authors: De Smedt Stefan K. , Fonteyne Yannick S. , Muragijimana Felicienne , Palmer Katie , Murdoch Ian 
Published: April 2016

Purpose:
To assess long-term intraocular pressure (IOP) outcome after adult trabeculectomy surgery in Central Africa.

Patients and Methods:
All adult glaucoma patients who underwent trabeculectomy surgery in the Kabgayi Eye Unit, Rwanda between August 2003 and March 2008 were invited for a follow-up visit. Surgical and clinical data were collected from medical records. At the study visit, best-corrected visual acuity was measured and Goldmann applanation tonometry and biomicroscopy were done. Good IOP outcome was defined as both an IOP<21 mm Hg and achieving ≥30% reduction from the preoperative IOP. Considering first operated eyes, univariate and multivariate logistic regression was used to investigate risk factors for failure.

Results:
Of 163 individuals operated 3 had died, 118 (74%) participated. Preoperatively, the mean IOP was 31 mm Hg (SD=11; range, 12 to 60). At the time of the follow-up study visit the mean postoperative IOP was 13 mm Hg (SD=5; range, 4 to 35). Good IOP outcome was achieved in 132 eyes (84%). Univariate analysis suggested a protective effect against failure of use of antimetabolites [odds ratio (OR)=0.39; 95% confidence interval (CI), 0.14-1.11; P=0.07] and a decrease in success with length of follow-up (OR=3.57; 95% CI, 1.09-12.50; P=0.03). The latter remained borderline significant with multivariate analysis. Seven eyes went from previously better vision (at least hand movements) down to perception of light or no perception of light after trabeculectomy. Particularly a flat anterior chamber in the first postoperative week (OR=0.07; 95% CI, 0.01-0.49; P<0.001) and late hypotony (OR=0.04; 95% CI, 0.002-0.99; P=0.004) were significant risk factors for severe visual loss.

Conclusions:
Trabeculectomy with antimetabolites is one of the best available options for glaucoma management in Africa. However, the IOP control reduced at a follow-up duration beyond 2 years, highlighting the importance of regular long-term follow-up.
A Randomized Controlled Trial to Determine the Effect of Inhaled Corticosteroid on Intraocular Pressure in Open-Angle Glaucoma and Ocular Hypertension: The ICOUGH Study
Authors: Moss Edward B. , Buys Yvonne M. , Low Stephanie A. , Yuen Darana , Jin Ya-ping , Chapman Kenneth R. , Trope Graham E. 
Published: April 2016

Purpose:
The purpose of this study was to determine the risk of a steroid pressure response from inhaled corticosteroids.

Patients and Methods:
This randomized, double-masked, placebo-controlled trial included 22 adults with well-controlled open-angle glaucoma or ocular hypertension. Consenting participants were randomized to a 6-week course of twice-daily fluticasone propionate 250-μg metered-dose inhaler or saline placebo metered-dose inhaler. Biweekly clinic visits included masked Goldmann applanation tonometry and assessment to identify adverse effects. Primary outcome was mean intraocular pressure (IOP) at week 6. Secondary outcomes included IOP elevation of >20% at 2 consecutive visits, adherence, side effects, and logMAR visual acuity.

Results:
A total of 10 patients in each arm completed the study. There were no statistically significant differences in IOP between groups at baseline (14.3±3.0 and 15.6±3.6 mm Hg in steroid and placebo groups, respectively, P=0.39) or at week 6 (14.7±2.4 and 14.8±3.8 mm Hg in steroid and placebo groups, respectively, P=0.92). Adherence was >80% for all participants. There were no statistically significant differences between groups in any secondary measures. One patient in the steroid group met the secondary end point of >20% elevation in IOP (IOP increased from baseline of 9 to 11 mm Hg at weeks 2 and 4).

Conclusions:
We found no clinically significant increase in mean IOP in patients with well-controlled open-angle glaucoma and ocular hypertension after 6 weeks of twice-daily inhaled fluticasone propionate compared with inhaled placebo. No participants exceeded their individualized target IOP. There were no differences in secondary outcomes.
User-centered Design of the eyeGuide: A Tailored Glaucoma Behavior Change Program
Authors: Killeen Olivia J. , MacKenzie Chamisa , Heisler Michele , Resnicow Ken , Lee Paul P. , Newman-Casey Paula Anne 
Published: April 2016

Purpose:
We employed user-centered design to refine a prototype of the eyeGuide, a novel, tailored behavior change program intended to improve medication adherence among glaucoma patients.

Patients:
Glaucoma patients age 40 years and above prescribed ≥1 glaucoma medication were included.

Methods:
The eyeGuide consists of tailored educational content and tailored testimonials in which patients share how they were able to overcome barriers to improve their medication adherence. A hybrid of semistructured diagnostic and pretesting interviews were used to refine the content of the eyeGuide. Purposeful sampling was used to recruit a study population representative of the glaucoma patient population. Interviews were conducted until thematic saturation was reached. Interviews were audiorecorded and transcribed verbatim. Three researchers analyzed the transcripts, generated a codebook, and identified key themes using NVivo 10.0 to further refine the eyeGuide.

Results:
Twenty-one glaucoma patients were interviewed; mean age 72±12.4 years, 5 (24%) African Americans, 9 (43%) with poor self-reported adherence, 10 (47.6%) age 75 years and above, 10 (47.6%) with poor vision, and 9 (42.9%) women. Qualitative analysis identified 5 important themes for improving glaucoma self-management: social support, patient-provider relationship, medication routine, patients’ beliefs about disease and treatment, and eye drop instillation. All participants expressed satisfaction with in-person delivery of the eyeGuide and preferred this to a Web-based module. Participant feedback resulted in revised content.

Conclusions:
User-centered design generated improvements in the eyeGuide that would not have been possible without patient input. Participants expressed satisfaction with the tailored content.
Endoscopic Medial Rectus Sling: A Window Into the Intraconal Orbital Apex
Authors: Shafi Fariha , Zaidi Syed , Mehta Purnima , Ahluwalia Harpreet Singh , Ahmed Shahzada K. 
Published: April 2016

Purpose:
Surgical approaches to the medial orbit especially within the cone of orbital muscles necessitate great precision and care to avoid damage to surrounding structures—most importantly the optic nerve. The authors present a novel technique in which access to the medial orbital contents was achieved through an entirely endoscopic approach.

Methods:
A 72-year-old Caucasian female presented with loss of vision in the right eye and reduced extraocular movements. Baseline blood tests were within normal limits. Inflammatory markers were slightly elevated. CT scan revealed bilateral medial orbital apex masses. Biopsy of the right orbital apex lesion was performed through an exclusively endoscopic approach in which the medial rectus muscle was retracted infero-medially.

Results:
This exclusively endonasal approach to the medial intraconal space provided excellent access to the orbital apex, thus allowing successful biopsy of the medial orbital apex lesion. A video of the surgical technique demonstrates its use in this patient (see Video, Supplemental Digital Content 1, available at http://links.lww.com/IOP/A123).

Conclusions:
Similar reports of endonasal medialization of the medial rectus for accessing intraconal orbital lesions have been previously described in the rhinological literature. The authors describe a modification that allows for a safe and less invasive approach to the medial intraconal space and intraorbital optic nerve. There is minimal trauma to the surrounding tissues and no further damage to the optic nerve along with no associated adverse clinical sequelae. In addition, this negates the need for an adjuvant external or transconjunctival approach.
Clinical Features and Treatment Outcomes of Orbital Inflammatory Disease in Singapore: A 10-Year Clinicopathologic Review
Authors: Young Stephanie M. , Chan Anita S. Y. , Jajeh Issam Al , Shen Sunny , Seah Lay-Leng , Choo Chai-Teck , Lang Stephanie S. , Looi Audrey L. G. 
Published: April 2016

Purpose:
1) To assess the clinical profile and treatment outcomes of orbital inflammatory disease in the local population, and 2) classify patients using current histopathological criteria.

Methods:
Ten-year retrospective clinicopathologic review of patients diagnosed with orbital inflammatory disease who underwent tissue biopsy from January 2001 to December 2011 at a tertiary referral centre in Singapore. Data collection included patient demographics, clinical presentation, investigations, systemic disease, histopathology review, clinical classification, medical and surgical management, response to treatment and recurrence rates.

Results:
The study comprised 70 patients. Thirty-seven (52.9%) had nonspecific inflammation distributed as follows: lacrimal (n = 23), diffuse (n = 5), anterior (n = 5), myositic (n = 4). Thirty-three (47.1%) had specific inflammation of the following subtypes: idiopathic sclerosing inflammation (n = 9), granulomatous disorders (n = 8), transitional lesions (n = 5), vasculitis (n = 4), and others (n = 7). A total of 76.8% of patients received oral prednisolone, with a median duration of three months. Response to treatment was good in 71.9% of patients. Recurrence occurred in 22 (32.8%) patients at a mean interval of 20 months after completion of treatment, and was higher in myositic and vasculitic subtypes. There was no significant correlation between duration of treatment and recurrence.

Conclusions:
This study has re-emphasized the importance and utility of orbital biopsy and histopathologic typing for optimal management of orbital inflammatory disease. It has also improved the knowledge of the rate and response to treatment of its various subtypes.
N-acetyl-cysteine attenuates neuropathic pain by suppressing matrix metalloproteinases
Authors: Li Jiajie , Xu Lujie , Deng Xueting , Jiang Chunyi , Pan Cailong , Chen Lu , Han Yuan , Dai Wenling , Hu Liang , Zhang Guangqin , Cheng Zhixiang , Liu Wentao 
Published: April 2016

Abstract
The treatment of neuropathic pain remains a clinical challenge because of its unclear mechanisms and broad clinical morbidity. Matrix metalloproteinase (MMP)-9 and MMP-2 have previously been described as key components in neuropathic pain because of their facilitation of inflammatory cytokine maturation and induction of neural inflammation. Therefore, the inhibition of MMPs may represent a novel therapeutic approach to the treatment of neuropathic pain. In this study, we report that N-acetyl-cysteine (NAC), which is a broadly used respiratory drug, significantly attenuates neuropathic pain through a unique mechanism of MMP inhibition. Both the in vitro (0.1 mM) and in vivo application of NAC significantly suppressed the activity of MMP-9/2. Orally administered NAC (50, 100, and 200 mg/kg) not only postponed the occurrence but also inhibited the maintenance of chronic constrictive injury (CCI)-induced neuropathic pain in rats. The administration of NAC blocked the maturation of interleukin-1β, which is a critical substrate of MMPs, and markedly suppressed the neuronal activation induced by CCI, including inhibiting the phosphorylation of protein kinase Cγ, NMDAR1, and mitogen-activated protein kinases. Finally, NAC significantly inhibited CCI-induced microglia activation but elicited no notable effects on astrocytes. These results demonstrate an effective and safe approach that has been used clinically to alleviate neuropathic pain through the powerful inhibition of the activation of MMPs.
Characterization of a mouse model of headache
Authors: Huang Dongyue , Ren Lynn , Qiu Chang-Shen , Liu Ping , Peterson Jonathan , Yanagawa Yuchio , Cao Yu-Qing 
Published: April 2016

AbstractMigraine and other primary headache disorders affect a large population and cause debilitating pain. Establishing animal models that display behavioral correlates of long-lasting and ongoing headache, the most common and disabling symptom of migraine, is vital for the elucidation of disease mechanisms and identification of drug targets. We have developed a mouse model of headache, using dural application of capsaicin along with a mixture of inflammatory mediators (IScap) to simulate the induction of a headache episode. This elicited intermittent head-directed wiping and scratching as well as the phosphorylation of c-Jun N-terminal kinase in trigeminal ganglion neurons. Interestingly, dural application of IScap preferentially induced FOS protein expression in the excitatory but not inhibitory cervical/medullary dorsal horn neurons. The duration of IScap-induced behavior and the number of FOS-positive neurons correlated positively in individual mice; both were reduced to the control level by the pretreatment of antimigraine drug sumatriptan. Dural application of CGRP(8-37), the calcitonin gene-related peptide (CGRP) receptor antagonist, also effectively blocked IScap-induced behavior, which suggests that the release of endogenous CGRP in the dura is necessary for IScap-induced nociception. These data suggest that dural IScap-induced nocifensive behavior in mice may be mechanistically related to the ongoing headache in humans. In addition, dural application of IScap increased resting time in female mice. Taken together, we present the first detailed study using dural application of IScap in mice. This headache model can be applied to genetically modified mice to facilitate research on the mechanisms and therapeutic targets for migraine headache.
Acute Treatment of an Atypical Benign Paroxysmal Positional Vertigo Variant Postsevere Traumatic Brain Injury
Authors: Stam Daniel 
Published: April 2016

Background and Purpose:
The differential diagnosis and treatment of peripheral vestibular disorders in persons with traumatic brain injury presents a complex set of challenges. In the acute rehabilitation setting, orthopedic and medical restrictions, agitation, and/or the inability of the patient to verbalize current symptoms present barriers to many traditional means of assessment and intervention. The purpose of this article is to present a case report of 2 patients successfully treated in the acute inpatient rehabilitation setting postsevere traumatic brain injury with an atypical variant of horizontal canal benign paroxysmal positional vertigo in which both examination and intervention modifications were required in a novel context when applied to this patient population.

Case Description:
Two patients were consulted to have a vestibular rehabilitation examination performed given interdisciplinary reports of nystagmus and in 1 case significant emesis associated with bed mobility. Both patients presented as Rancho Los Amigos classification 3 to 4, were nonverbal, and presented with multiple comorbidities.

Intervention:
Both patients were treated for apogeotropic horizontal canal benign paroxysmal positional vertigo using a sequence of bedside canalith repositioning maneuvers safely and efficiently accommodating the clinical brain injury presentation.

Outcomes:
Both patients demonstrated complete remission of horizontal nystagmus and remission of associated emesis in the 1 case allowing for increased interdisciplinary rehabilitation participation.

Discussion:
This case report illustrates how application of recent scientific and clinical evidence may be applied within the early acute brain injury population. Vestibular rehabilitation may be an important component to acute neurological rehabilitation posttraumatic brain injury, even when the patient cannot actively verbalize symptoms. In these cases, the clinician must then use a collaborative approach as well as a clinical decision-making model on the basis of an understanding of the neurological underpinning of eye movements and nystagmus.
Development and Psychometric Evaluation of the Caring Scale for Institutionalized Elders
Authors: Hwang Huei-Lih , Tu Chin-Tang , Wang Hsiu-Hung 
Published: April 2016

ABSTRACT

Background:
A scale that measures the efficacy of care from the perspectives of institutionalized older adults is needed to meet the growing need for better caring knowledge and skills among nurses and caretakers working in long-term care facilities. The currently available tools are insufficient for measuring the caring-related interactions of caretakers with institutionalized older adults.

Purpose:
The aim of this study was to develop and explore the psychometric structure of a caring scale for institutionalized older adults.

Methods:
The scale development process took place in two stages. In the first stage, a 34-item Caring Scale for Institutionalized Elders was generated using literature reviews and interviews with institutionalized older adults. Twenty-nine items were retained after item analysis and content validity testing, and then 19 items were retained after an exploratory factor analysis of 300 institution-dwelling older adults. The factor structure and reliability were further tested in 216 older adults using confirmatory factor analysis. The second stage provided evidence of the validity and reliability of the developed scale. This study was conducted between 2011 and 2013 in Taiwan.

Results:
Confirmatory factor analysis indicated that a 12-item scale with a two-factor structure best fits the data (χ2 =106.990, df = 53, p < .001, χ2/df ratio = 2.019, goodness-of-fit index = .926, comparative fit index = .958, Tucker–Lewis index = .948, root mean square error of approximation = .069). This scale had acceptable Cronbach’s α values (range = .827–.907).

Conclusions:
This scale has satisfactory validity and reliability for measuring the efficacy of care that is provided to institutionalized older adults. Further studies are necessary to test the applicability of this scale to other populations.
mHealth to Train Community Health Nurses in Visual Inspection With Acetic Acid for Cervical Cancer Screening in Ghana
Authors: Asgary Ramin , Adongo Philip Baba , Nwameme Adanna , Cole Helen V.S. , Maya Ernest , Liu Mengling , Yeates Karen , Adanu Richard , Ogedegbe Olugbenga 
Published: April 2016

Objective
There is a shortage of trained health care personnel for cervical cancer screening in low-/middle-income countries. We evaluated the feasibility and limited efficacy of a smartphone-based training of community health nurses in visual inspection of the cervix under acetic acid (VIA).

Materials and Methods
During April to July 2015 in urban Ghana, we designed and developed a study to determine the feasibility and efficacy of an mHealth-supported training of community health nurses (CHNs, n = 15) to perform VIA and to use smartphone images to obtain expert feedback on their diagnoses within 24 hours and to improve VIA skills retention. The CHNs completed a 2-week on-site introductory training in VIA performance and interpretation, followed by an ongoing 3-month text messaging–supported VIA training by an expert VIA reviewer.

Results
Community health nurses screened 169 women at their respective community health centers while receiving real-time feedback from the reviewer. The total agreement rate between all VIA diagnoses made by all CHNs and the expert reviewer was 95%. The mean (SD) rate of agreement between each CHN and the expert reviewer was 89.6% (12.8%). The agreement rates for positive and negative cases were 61.5% and 98.0%, respectively. Cohen κ statistic was 0.67 (95% CI = 0.45–0.88). Around 7.7% of women tested VIA positive and received cryotherapy or further services.

Conclusions
Our findings demonstrate the feasibility and efficacy of mHealth-supported VIA training of CHNs and have the potential to improve cervical cancer screening coverage in Ghana.
The relationship between liver histology and noninvasive markers in primary biliary cirrhosis
Authors: Olmez Sehmus , Sayar Suleyman , Avcioglu Ufuk , Tenlik İlyas , Ozaslan Ersan , Koseoglu Hasan T. , Altiparmak Emin 
Published: April 2016

Background
Primary biliary cirrhosis (PBC) is a disease that affects liver with various severity and progression rates. It is important to diagnose advanced stage of the disease to lower liver-related morbidity and mortality. Since liver biopsy is an invasive method, liver biopsy tends to be replaced by noninvasive methods. In this study, we aim to show the role of aminotransferase to platelet ratio index (APRI) and fibrosis index on the basis of the four factors (FIB-4) scores, laboratory values, and their effectiveness in predicting advanced disease.

Materials and methods
PBC patients diagnosed pathologically at Numune Education and Research Hospital were included in the study between the years 1995 and 2013. Patients were grouped according to their fibrosis level: group 1 (early stage) included 18 patients with F1 and F2 fibrosis and group 2 (advanced stage) included 22 patients with F3 and F4 fibrosis. APRI and FIB-4 scores, routine laboratory values, and their proportions were compared. The effectiveness of parameters showing advanced stage was further compared.

Results
There were statistically significant differences in APRI, FIB-4 scores, and aspartate aminotransferase (AST) levels between the groups with early and advanced stages of disease. Receiver operating curve analysis was used to determine APRI, FIB-4 and AST levels. The most effective parameters for diagnosing an advanced stage were APRI, AST levels, and FIB-4 scores, respectively.

Conclusion
In conclusion, APRI and FIB-4 scores can be calculated simply and easily by routine laboratory tests at low cost and also these scores may be a predictor of advanced stage of the disease in PBC. These tests may be reproducible and may be used to monitor disease progression.