bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Evaluation of Children with Autism Spectrum Disorders: Clinician Compliance with Published Guidelines
Authors: Tchaconas Alexis , Adesman Andrew 
Published: December 2016

ABSTRACT:

Objective:
To assess to what extent child neurologists (CNs) and developmental-behavioral pediatricians (DBPs) order diagnostic tests that are not recommended/indicated and/or fail to order tests that are recommended/indicated when evaluating children with an autism spectrum disorder (ASD).

Method:
CNs and DBPs in the United States were asked which laboratory tests they would “routinely order” for a preschool child with ASD and IQ = 58 (ASD + Intellectual Disability (ID)), and a preschool child with ASD and IQ = 85 (ASD-ID). Chi-square tests were performed to identify differences (CNs vs DBPs) in laboratory testing.

Results:
The sample consisted of 267 respondents (127 CN's; 140 DBPs). When evaluating ASD + ID or ASD − ID, inappropriate tests (≥1) were ordered by 76.8% and 76.4% of MDs, respectively. There was no significant difference between specialties in compliance with evaluation guidelines for ASD + ID (CN = 20.5% vs DBP = 16.4%; χ2 = 0.73). No significant differences were noted (DBP vs CN) regarding the percent ordering inappropriate tests for either clinical case or within each specialty when comparing testing for ASD + ID versus ASD − ID. Relative to DBPs, CNs were more likely to order EEGs and MRIs when evaluating children with ASD + ID or ASD − ID. 10% and 40% of respondents did not order any recommended genetic tests when evaluating ASD + ID and ASD − ID, respectively.

Conclusion:
When evaluating children with ASD, many CNs and DBPs fail to order tests that should be routinely performed and often order tests that are not routinely indicated yet are neither benign nor inexpensive. Recommended molecular genetic tests are often not ordered. Clinical guidelines must be updated and better promulgated.
SEMIAUTOMATED QUANTITATIVE APPROACH TO CHARACTERIZE TREATMENT RESPONSE IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Roberts Philipp K. , Nesper Peter L. , Gill Manjot K. , Fawzi Amani A. 
Published: December 2016

Purpose:
To perform a quantitative study of the vascular microstructure in actively treated choroidal neovascularization by optical coherence tomographic angiography.

Methods:
Patients undergoing individualized anti–vascular endothelial growth factor therapy of minimum 12 months duration were included in this cross-sectional observational study and imaged using optical coherence tomographic angiography. En face optical coherence tomographic angiography images were analyzed for quantitative features, such as junction density, vessel length, and lacunarity using validated software (Angiotool). Patients were divided into 2 groups depending on their individualized treatment interval: “good responders, treated less frequently than 6 weeks” versus “poor responders, treated every 6 weeks or more frequently.” Nonparametric testing was used to assess differences between these groups.

Results:
Twenty-five eyes of 23 consecutive patients with a median 58-month history of choroidal neovascularization, treated by median of 34 anti–vascular endothelial growth factor injections, were included in the analysis. There was no significant difference between any of the microvascular choroidal neovascularization features between the 2 groups (P > 0.05).

Conclusion:
The semiautomated vessel segmentation software provides an objective and quantitative approach for choroidal neovascularization characterization. The consistently nonsignificant outcomes between the groups may provide evidence to support the “normalization hypothesis.” This would suggest that regardless of treatment interval, individualized therapy in these eyes established vessel stability.
ACUTE RETINAL NECROSIS AFTER ADMINISTRATION OF ADALIMUMAB, A SYSTEMIC ANTITUMOR NECROSIS FACTOR ANTIBODY
Authors: Schechet Sid A. , Garff Kevin , Klima Karen , Campbell Wayne , Schocket Lisa S. 
Published: December 2016

Purpose:
To report a case of acute retinal necrosis in a patient on anti–tumor necrosis factor α immunosuppressive therapy.

Methods:
Case report.

Results:
A 47-year-old man with psoriasis presented with blurred vision and floaters in the left eye 4 days after receiving his fourth dose of adalimumab, a tumor necrosis factor α antagonist. He was diagnosed with acute retinal necrosis and was treated with intravenous acyclovir as well as prophylactic laser barricade. Seven years later, he is 20/20 with no history of a retinal detachment.

Conclusion:
Physicians prescribing tumor necrosis factor α antagonist immunosuppressive therapy should be aware of the potential of developing acute retinal necrosis.
Laboratory Diagnosis of Breakthrough Varicella in Children
Authors: Watanabe Masahiro , Ochiai Hitoshi , Ito Masahiro , Negoro Manami , Suga Shigeru , Ihara Toshiaki 
Published: December 2016

Background:
Breakthrough varicella (BV) develops in vaccinated persons as a result of infection by wild-type varicella-zoster virus more than 42 days after varicella vaccination. The clinical symptoms are atypical, and clinical diagnosis can be difficult. We investigated laboratory-based diagnostic methods that are relatively simple and highly precise to conduct accurate surveillance.

Subjects and Methods:
We enrolled 42 patients with suspected BV at 2 pediatric hospitals and performed a real-time polymerase chain reaction (PCR) on the skin lesions to confirm the BV diagnosis. We performed PCR on saliva and blood collected during the acute phase, as well as direct fluorescent antibody (DFA) imaging on lesions, and measured varicella-zoster virus immunoglobulin (Ig) G and IgM during the acute and convalescent phases.

Results:
We confirmed the BV diagnosis in 31 of 42 enrolled patients. The sensitivity of DFA imaging of the lesion, and PCR of saliva and blood were 93.5%, 87.1% and 61.3%, respectively. IgM was detected in 12.9% of patients during the acute phase and in 65.5% during the convalescent phase. IgG increased more than 4-fold in 86.2% of patients between the acute and convalescent phases. The sensitivity and specificity of the assay were 83.9% and 81.8%, respectively, when the diagnostic criteria for IgG were set to greater than 20 during the acute phase.

Conclusions:
The gold standard of laboratory-based diagnosis of BV has been the PCR of samples taken from lesions. However, DFA of the lesion showed equivalent sensitivity when compared with PCR. PCR using saliva samples is an effective, noninvasive method of diagnosis. We found that high values of IgG during the acute phase can aid in the diagnosis of BV.
Biomarkers of neuropathic pain in skin nerve degeneration neuropathy: contact heat-evoked potentials as a physiological signature
Authors: Wu Shao-Wei , Wang Yi-Chia , Hsieh Paul-Chen , Tseng Ming-Tsung , Chiang Ming-Chang , Chu Chih-Pang , Feng Fang-Ping , Lin Yea-Huey , Hsieh Sung-Tsang , Chao Chi-Chao 
Published: December 2016

Abstract
Contact heat-evoked potentials (CHEPs) have become an established method of assessing small-fiber sensory nerves; however, their potential as a physiological signature of neuropathic pain symptoms has not been fully explored. To investigate the diagnostic efficacy in examining small-fiber sensory nerve degeneration, the relationship with skin innervations, and clinical correlates with sensory symptoms, we recruited 188 patients (115 men) with length-dependent sensory symptoms and reduced intraepidermal nerve fiber (IENF) density at the distal leg to perform CHEP, quantitative sensory testing, and nerve conduction study. Fifty-seven age- and sex-matched controls were enrolled for comparison of CHEP and skin innervation. Among patients with neuropathy, 144 patients had neuropathic pain and 64 cases had evoked pain. Compared with quantitative sensory testing and nerve conduction study parameters, CHEP amplitudes showed the highest sensitivity for diagnosing small-fiber sensory nerve degeneration and exhibited the strongest correlation with IENF density in multiple linear regression. Contact heat-evoked potential amplitudes were strongly correlated with the degree of skin innervation in both patients with neuropathy and controls, and the slope of the regression line between CHEP amplitude and IENF density was higher in patients with neuropathy than in controls. Patients with evoked pain had higher CHEP amplitude than those without evoked pain, independent of IENF density. Receiver operating characteristic analysis showed that CHEP had better performance in diagnosing small-fiber sensory nerve degeneration than thermal thresholds. Furthermore, CHEPs showed superior classification accuracy with respect to evoked pain. In conclusion, CHEP is a sensitive tool to evaluate pathophysiology of small-fiber sensory nerve and serves as a physiological signature of neuropathic pain symptoms.
Reasons for discontinuation of long-term opioid therapy in patients with and without substance use disorders
Authors: Lovejoy Travis I. , Morasco Benjamin J. , Demidenko Michael I. , Meath Thomas H.A. , Frank Joseph W. , Dobscha Steven K. 
Published: December 2016

Abstract
Several factors may accelerate opioid discontinuation rates, including lack of information about the long-term effectiveness of opioids for chronic pain, heightened awareness about opioid-related adverse events, closer monitoring of patients for opioid-related aberrant behaviors, and greater restrictions around opioid prescribing. Rates of discontinuation may be most pronounced in patients deemed to be at “high risk.” The purpose of this study was to compare reasons for discontinuation of long-term opioid therapy (LTOT) between patients with and without substance use disorder (SUD) diagnoses receiving care within a major U.S. health care system. This retrospective cohort study assembled a cohort of Veterans Health Administration patients prescribed opioid therapy for at least 12 consecutive months who subsequently discontinued opioid therapy for at least 12 months. From this cohort, we randomly selected 300 patients with SUD diagnoses and propensity score–matched 300 patients without SUD diagnoses. A comprehensive manual review of patients' medical records ascertained reasons for LTOT discontinuation. Most patients (85%) were discontinued as a result of clinician, rather than patient, decisions. For patients whose clinicians initiated discontinuation, 75% were discontinued because of opioid-related aberrant behaviors. Relative to patients without SUD diagnoses, those with SUD diagnoses were more likely to discontinue LTOT because of aberrant behaviors (81% vs 68%), most notably abuse of alcohol or other substances. This is the first study to document reasons for discontinuation of LTOT in a sample of patients with and without SUD diagnoses. Treatments that concurrently address SUD and chronic pain are needed for this high-risk population.
Anti–nerve growth factor therapy increases spontaneous day/night activity in mice with orthopedic surgery–induced pain
Authors: Majuta Lisa A. , Guedon Jean-Marc G. , Mitchell Stefanie A.T. , Ossipov Michael H. , Mantyh Patrick W. 
Published: December 2016

Abstract
Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are 2 of the most common and successful surgical interventions to relieve osteoarthritis pain. Control of postoperative pain is critical for patients to fully participate in the required physical therapy which is the most influential factor in effective postoperative knee rehabilitation. Currently, opiates are a mainstay for managing postoperative orthopedic surgery pain including TKA or THA pain. Recently, issues including efficacy, dependence, overdose, and death from opiates have made clinicians and researchers more critical of use of opioids for treating nonmalignant skeletal pain. In the present report, a nonopiate therapy using a monoclonal antibody raised against nerve growth factor (anti-NGF) was assessed for its ability to increase the spontaneous activity of the operated knee joint in a mouse model of orthopedic surgery pain–induced by drilling and coring the trochlear groove of the mouse femur. Horizontal activity and velocity and vertical rearing were continually assessed over a 20 hours day/night period using automated activity boxes in an effort to reduce observer bias and capture night activity when the mice are most active. At days 1 and 3, after orthopedic surgery, there was a marked reduction in spontaneous activity and vertical rearing; anti-NGF significantly attenuated this decline. The present data suggest that anti-NGF improves limb use in a rodent model of joint/orthopedic surgery and as such anti-NGF may be useful in controlling pain after orthopedic surgeries such as TKA or THA.
Examination of an internet-delivered cognitive behavioural pain management course for adults with fibromyalgia: a randomized controlled trial
Authors: Friesen Lindsay N. , Hadjistavropoulos Heather D. , Schneider Luke H. , Alberts Nicole M. , Titov Nikolai , Dear Blake F. 
Published: December 2016

Abstract
Fibromyalgia (FM) is a common and often debilitating chronic pain condition. Research shows that symptoms of depression and anxiety are present in up to 3 quarters of individuals with FM. Of concern, most adults with FM cannot access traditional face-to-face cognitive behavioural pain management programs, which are known to be beneficial. Given known difficulties with treatment access, the present study sought to explore the efficacy and acceptability of a previously developed Internet-delivered cognitive behavioural pain management course, the Pain Course, for adults with FM. The five-lesson course was delivered over 8 weeks and was provided with brief weekly contact, via telephone and secure email, with a guide throughout the course. Participants were randomized either to the Pain Course (n = 30) or to a waiting-list control group (n = 30). Symptoms were assessed at pre-treatment, post-treatment and 4-week follow-up. Completion rates (87%) and satisfaction ratings (86%) were high. Improvements were significantly greater in treatment group participants compared to waiting-list group participants on measures of FM (Cohen's d = 0.70; 18% reduction), depression (Cohen's d = 0.63-0.72; 20%-28% reduction), pain (Cohen's d = 0.87; 11% improvement) and fear of pain (Cohen's d = 1.61; 12% improvement). Smaller effects were also observed on measures of generalized anxiety and physical health. The changes were maintained at 4-week follow-up. The current findings add to existing literature and highlight the specific potential of Internet-delivered cognitive behavioural pain management programs for adults with FM, especially as a part of stepped-care models of care. Future research directions are described.
Baseline Functional Mobility in Hospitalized Persons With Anorexia Nervosa: A Retrospective Study of Inpatient Physical Therapy During Medical Stabilization
Authors: Laging Michelle A. , Brinton John T. , Sabel Allison L. , Gaudiani Jennifer L. , Mehler Philip S. 
Published: December 2016

Purpose:
This study evaluates potential associations of baseline physical function measures with anthropometrics and clinical outcomes in persons hospitalized with anorexia nervosa.

Methods:
We conducted a retrospective study in a single hospital on 176 seriously ill persons with anorexia nervosa who required definitive medical stabilization. Licensed physical therapists assessed functional transfers and ambulation using the Functional Independence Measure. Walking speed, Tinetti Performance-Oriented Mobility Assessment, demographic, and anthropometric measures were also collected.

Results:
Ninety-one percent of the participants were female (N = 161), with a median age of 28 years (interquartile range, 22-39) and mean body mass index upon admission of 12.7 kg/m2 (standard deviation, 1.8). Significant positive correlations were observed between all 3 in-room measures of physical function and admission weight, percent ideal body weight, and body mass index (all P < .02). Age was inversely correlated with ambulation per the FIM score (r =−0.15; P = .05). After adjusting for age and admission weight, in-room physical function measures were inversely associated only with length of hospitalization (R
2 = 0.30). For every 1.0-unit increase in bed mobility, the length of hospitalization decreased by 2.9 days (95% confidence interval, −5.0 to −0.8).

Conclusion:
A sizable proportion demonstrated modified dependence, or required assistance, in functional mobility skills. Lower initial bed mobility scores are associated with longer hospitalization.
Physical Therapy Intervention During a Red Blood Cell Transfusion in an Oncologic Population: A Preliminary Study
Authors: Rosenfeldt Anson B. , Pilkey Lauren M. , Butler Robert S. 
Published: December 2016

Purpose:
There is little evidence to guide physical therapists regarding the safety of administering therapeutic intervention to individuals receiving a red blood cell (RBC) transfusion. The purpose of this preliminary study was to examine the number of adverse events that occurred among individuals with an oncologic diagnosis receiving physical therapy intervention during an RBC transfusion.

Methods:
Chart reviews were conducted, and physical therapy sessions were classified into the following groups: (1) physical therapy intervention alone (PT) (n = 26 events); (2) physical therapy intervention during an RBC transfusion (PT + RBC) (n = 26 events); and (3) RBC transfusion without physical therapist intervention (RBC) (n = 26 events).

Results:
There were 3 adverse events, all in the PT group: 2 episodes of symptomatic drop in systolic blood pressure of more than 10 mm Hg with position change, and 1 episode of the individual requesting to stop the therapy intervention. The difference in adverse events between the groups was not statistically significant (P = .10).

Conclusion:
This study provides preliminary evidence that participation in a well-monitored physical therapy session may be safe for individuals with hematologic malignancies who are receiving an RBC transfusion and that adverse events related to RBC transfusion are not influenced by physical therapy intervention.
Mixing It Up
Authors: Bishwakarma Raju , Shah Shiwan , Frank Luba , Zhang Wei , Sharma Gulshan , Nishi Shawn P.E. 
Published: December 2016

Background:
A recent randomized controlled trial showed 12 serial doses of tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) is safe and effective in managing complicated parapneumonic pleural effusions and empyema (CPEE). However, this regimen is laborious, requiring trained personnel to open/close the chest tube 8 times daily for 3 days. We present our observational data using a simplified regimen of coadministered tPA/DNase.

Materials and Methods:
This is a retrospective observational study of patients who received coadministered tPA/DNase for CPEE from January 2012 to April 2015 at the University of Texas Medical Branch. Patient demographics, pleural fluid, radiologic and treatment characteristics, and outcomes were collected. Data are presented as proportions and percentages. Our primary outcome was successful treatment without need of surgery and discharge home alive. Secondary outcomes were dose and length of treatment and hospital stay, treatment complications, and 90-day mortality.

Results:
The study included 39 patients. All pleural effusions were loculated, 59% macroscopically purulent, 50% had a positive organism in Gram stain, and 40% were culture positive. A median of 6 (interquartile range, 3.5 to 6) doses were coadministered mainly via small bore chest tube (≤14 Fr in 79%) with a median of 14.5 (interquartile range, 9.5 to 21.5) hospital days. Overall, 85% were successfully treated without need for surgery. Treatment failures occurred in 15%: 3/39 (7%) received surgery; 3/39 (7%) died. Only 1 (2.5%) complication of hemorrhagic pleural effusion resolved after discontinuation of intrapleural treatment.

Conclusions:
Our study shows intrapleural coadministration of tPA/DNase was effective and safe in management of CPEE.
Conventional Transbronchial Needle Aspiration Versus Endobronchial Ultrasound–guided Transbronchial Needle Aspiration, With or Without Rapid On-Site Evaluation, for the Diagnosis of Sarcoidosis: A Randomized Controlled Trial
Authors: Madan Karan , Dhungana Ashesh , Mohan Anant , Hadda Vijay , Jain Deepali , Arava Sudheer , Pandey Ravindra M. , Khilnani Gopi C. , Guleria Randeep 
Published: December 2016

Background:
Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) as a standalone modality is superior to conventional TBNA (c-TBNA) for the diagnosis of sarcoidosis. However, the overall yield is not different if combined with endobronchial biopsy (EBB) and transbronchial lung biopsy (TBLB). The utility of rapid on-site evaluation (ROSE) in a comparative evaluation of EBUS-TBNA versus c-TBNA for the diagnosis of sarcoidosis has not been previously evaluated.

Methods:
Eighty patients with suspected sarcoidosis were randomized 1:1:1:1 into 4 groups: c-TBNA without ROSE (TBNA-NR), c-TBNA with ROSE (TBNA-R), EBUS-TBNA without ROSE (EBUS-NR), and EBUS-TBNA with ROSE (EBUS-R). EBB and TBLB were performed in all patients. Primary objective was detection of granulomas for combined procedure. Secondary objectives were individual procedure yields, sedation dose, and procedure duration. Patients without a diagnosis following c-TBNA subsequently underwent EBUS-TBNA.

Results:
A total of 74 patients were finally diagnosed with sarcoidosis. Overall, granuloma detection was not significantly different between the 4 groups (68% in TBNA-NR, 89% in TBNA-R, 84% in EBUS-NR, and 83% in EBUS-R groups, P=0.49). The yield of c-TBNA in the TBNA-NR group was lower compared with that in TBNA-R group and EBUS-TBNA in EBUS groups (32%, 72%, 68%, and 67% for TBNA-NR, TBNA-R, EBUS-NR, and EBUS-R groups, respectively, P=0.04). Additional 20% patients were diagnosed when EBUS-TBNA was performed following a nondiagnostic bronchoscopy procedure in the TBNA-NR group. Sedation requirement and procedure duration were significantly lower with c-TBNA as compared with EBUS-TBNA (P<0.001).

Conclusion:
When performing TBNA in the setting of suspected sarcoidosis, we found c-TBNA with ROSE and EBUS-TBNA (with or without ROSE) to be superior to c-TBNA alone. Whether c-TBNA with ROSE is equivalent to EBUS-TBNA cannot be determined from our study due to small sample size/low power.
SD-OCT and Adaptive Optics Imaging of Outer Retinal Tubulation
Authors: King Brett J. , Sapoznik Kaitlyn A. , Elsner Ann E. , Gast Thomas J. , Papay Joel A. , Clark Christopher A. , Burns Stephen A. 
Published: December 2016

ABSTRACT

Purpose
To investigate outer retinal tubulation (ORT) using spectral domain optical coherence tomography (SD-OCT) and an adaptive optics scanning laser ophthalmoscope (AOSLO). To document the frequency of ORT in atrophic retinal conditions and quantify ORT dimensions versus adjacent retinal layers.

Methods
SD-OCT images were reviewed for the presence of retinal atrophy, scarring, and/or exudation. The greatest width of each ORT was quantified. Inner and outer retinal thicknesses adjacent to and within the area of ORT were measured for 18 patients. AOSLO imaged ORTs in five subjects with direct and scattered light imaging.

Results
ORT was identified in 47 of 76 subjects (61.8%) and in 65 eyes via SD-OCT in a wide range of conditions and ages, and in peripapillary atrophy. ORTs appeared as finger-like projections in atrophy, seen in the en face images. AOSLO showed some ORTs with bright cones that guide light within atrophic areas. Multiply scattered light mode AOSLO visualized variegated lines (18–35 μm) radiating from ORTs. The ORTs’ width on OCT b-scan images varied from 70 to 509 μm. The inner retina at the ORT was significantly thinner than the adjacent retina, 135 vs.170 μm (P = .004), whereas the outer retina was significantly thicker, 115 vs. 80 μm (P = .03).

Conclusions
ORTs are quite common in eyes with retinal atrophy in various disorders. ORTs demonstrate surviving photoreceptors in tubular structures found within otherwise nonsupportive atrophic areas that lack retinal pigment epithelium and choriocapillaris.