bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Epidemiology of Chronic Critical Illness After Severe Traumatic Injury at Two Level–One Trauma Centers*
Authors: Mira Juan C. , Cuschieri Joseph , Ozrazgat-Baslanti Tezcan , Wang Zhongkai , Ghita Gabriela L. , Loftus Tyler J. , Stortz Julie A. , Raymond Steven L. , Lanz Jennifer D. , Hennessy Laura V. , Brumback Babette , Efron Philip A. , Baker Henry V. , Moore Frederick A. , Maier Ronald V. , Moldawer Lyle L. , Brakenridge Scott C. 
Published: August 2017

Objective:
To determine the incidence and risk factors of chronic critical illness after severe blunt trauma.

Design:
Prospective observational cohort study (NCT01810328).

Setting:
Two level–one trauma centers in the United States.

Patients:
One hundred thirty-five adult blunt trauma patients with hemorrhagic shock who survived beyond 48 hours after injury.

Interventions:
None.

Measurements and Main Results:
Chronic critical illness was defined as an ICU stay lasting 14 days or more with evidence of persistent organ dysfunction. Three subjects (2%) died within the first 7 days, 107 (79%) exhibited rapid recovery and 25 (19%) progressed to chronic critical illness. Patients who developed chronic critical illness were older (55 vs 44-year-old; p = 0.01), had more severe shock (base deficit, –9.2 vs –5.5; p = 0.005), greater organ failure severity (Denver multiple organ failure score, 3.5 ± 2.4 vs 0.8 ± 1.1; p < 0.0001) and developed more infectious complications (84% vs 35%; p < 0.0001). Chronic critical illness patients were more likely to be discharged to a long-term care setting (56% vs 34%; p = 0.008) than to a rehabilitation facility/home. At 4 months, chronic critical illness patients had higher mortality (16.0% vs 1.9%; p < 0.05), with survivors scoring lower in general health measures (p < 0.005). Multivariate analysis revealed age greater than or equal to 55 years, systolic hypotension less than or equal to 70 mm Hg, transfusion greater than or equal to 5 units packed red blood cells within 24 hours, and Denver multiple organ failure score at 72 hours as independent predictors of chronic critical illness (area under the receiver operating curve, 0.87; 95% CI, 0.75–0.95).

Conclusions:
Although early mortality is low after severe trauma, chronic critical illness is a common trajectory in survivors and is associated with poor long-term outcomes. Advancing age, shock severity, and persistent organ dysfunction are predictive of chronic critical illness. Early identification may facilitate targeted interventions to change the trajectory of this morbid phenotype.
Relationship Between the CYP2C19 Phenotype Using the Voriconazole-to-Voriconazole N-Oxide Plasma Concentration Ratio and Demographic and Clinical Characteristics of Japanese Patients With Different CYP2C19 Genotypes
Authors: Niioka Takenori , Fujishima Naohito , Abumiya Maiko , Yamashita Takaya , Ubukawa Kumi , Nara Miho , Fujishima Masumi , Takahashi Naoto , Miura Masatomo 
Published: August 2017

Background:
Although voriconazole (VRCZ) is metabolized to VRCZ N-oxide principally by CYP2C19, VRCZ clearance is affected by multiple factors. In this study, we investigated the relationship between the CYP2C19 phenotype using the VRCZ-to-VRCZ N-oxide plasma concentration ratio (VRCZ/N-oxide) and demographic and clinical characteristics of Japanese patients taking VRCZ.

Methods:
A total of 65 Japanese patients taking VRCZ for prophylaxis or treatment of fungal infection were enrolled in this study. Stepwise selection multiple linear regression analysis was performed to investigate the effect of factors on the VRCZ/N-oxide ratio.

Results:
In patients not undergoing concurrent treatment with a drug influencing CYP2C19 activity (n = 54), the VRCZ/N-oxide ratio with definite thresholds for CYP2C19 genotypes, CYP2C19*1/*1, *1/*2 + *1/*3 + *2/*17, and *2/*2 + *2/*3, was specifically identified in patients taking VRCZ (<0.48, ≥0.48 < and <0.82 and ≥0.82). However, the VRCZ/N-oxide ratio could not be predicted based solely on the CYP2C19 genotype (R
2 = 0.053). The route of VRCZ administration, C-reactive protein concentration determined on the same day as VRCZ plasma concentration measurement, CYP2C19 extensive metabolizer, and patient age were independent factors influencing the VRCZ/N-oxide ratio (R
2 = 0.489, standardized regression coefficient = 0.385, 0.380, −0.231, and 0.231; P = 0.001, 0.001, 0.032, and 0.036, respectively).

Conclusions:
It is possible to comprehensively evaluate CYP2C19 activity using the actual measured value of the VRCZ/N-oxide ratio in patients taking VRCZ. The predictive performance of the VRCZ/N-oxide ratio was improved by including the route of administration, C-reactive protein level, and patient age in addition to the CYP2C19 genotype as predictive factors.
MACULAR TELANGIECTASIA TYPE 2
Authors: Okada Mali , Egan Catherine A. , Heeren Tjebo F. C. , Tufail Adnan , Fruttiger Marcus , Maloca Peter M. 
Published: August 2017

Purpose:
To investigate retinal microcystoid spaces in macular telangiectasia type 2 with spectral domain optical coherence tomography.

Methods:
Retrospective review of 135 patients enrolled in the MacTel Natural History Observation and Registry Study at Moorfields Eye Hospital, United Kingdom. One hundred seventy-two eyes from 86 patients who had a comparable scan protocol of at least 30 μm interval were included for analysis. Retinal microcystoid spaces were identified and segmented and metrics analyzed.

Results:
From 172 eyes of 86 patients, microcystoid spaces were found in 11 eyes (6.4%) from 8 patients (9.3%). The mean number of microcystoid spaces per eye was 12.9 ± 18.2. Most were located in the inner nuclear layer. The inferonasal quadrant of the macula was the least commonly affected region. Microcystoid spaces were distributed entirely within the assumed macular telangiectasia area on blue light reflectance in all but 2 eyes (4 of 142 microcysts). The median diameter of the microcystoid spaces was 31 μm (range 15 μm–80 μm).

Conclusion:
Microcystoid spaces as a phenotype of macular telangiectasia should be considered in the differentials for microcystic edema. Understanding the pathogenesis of these lesions may provide further insight into the role of Müller cell dysfunction in this disorder.
BENEFIT OF INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY FOR VITREOMACULAR SURGERY IN HIGHLY MYOPIC EYES
Authors: Bruyère Elsa , Philippakis Elise , Dupas Bénédicte , Nguyen-Kim Pauline , Tadayoni Ramin , Couturier Aude 
Published: August 2017

Purpose:
To report the feasibility and information provided by intraoperative optical coherence tomography (iOCT) during vitreomacular surgery in highly myopic eyes.

Methods:
Retrospective observational case series on consecutive highly myopic eyes that underwent vitreomacular surgery with iOCT for epiretinal membrane (ERM), macular hole, and myopic foveoschisis. The main outcome was the qualitative and quantitative assessment of retinal changes: detection of persistent epiretinal structures, new openings, central macular thickness, and macular hole diameters after each step of the surgical procedure. Quantitative measurements (in pixels) were manually obtained on iOCT video screen captures.

Results:
Twenty-two eyes were included: six ERMs, 10 macular holes, and 6 with myopic foveoschisis. An unsuspected postpeeling macular opening was detected by iOCT in 2/22 eyes. Intraoperative optical coherence tomography also allowed for detecting the presence of residual fragments of the vitreous cortex in 6/12 eyes after surgically induced posterior vitreous detachment. Intraoperative optical coherence tomography detected residual fragments of the internal limiting membrane in 5/21 eyes after internal limiting membrane peeling, and residual fragments of ERM in 3/15 eyes with ERM. Quantitative analysis did not find any significant change in central macular thickness and macular hole diameters before and after ERM and internal limiting membrane peeling.

Conclusion:
In highly myopic eyes, iOCT could help assess undetected macular openings and otherwise posterior vitreous status and epiretinal structure peeling.
ACUTE PSEUDOPHAKIC CYSTOID MACULAR EDEMA IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Chetrit Mardoche , Bonnin Sophie , Mané Valérie , Erginay Ali , Tadayoni Ramin , Gaudric Alain , Couturier Aude 
Published: August 2017

Purpose:
To study macular capillary changes and vessel density in acute pseudophakic cystoid macular edema (PCME) before and after treatment using optical coherence tomography angiography.

Methods:
Retrospective observational case–control study of seven consecutive patients (eight eyes) with PCME and eight age-matched control eyes imaged with optical coherence tomography angiography (RTVue XR Avanti; Optovue, Inc, Fremont, CA) using Projection Removal Artifacts software. Vessel density was calculated.

Results:
The mean time to diagnosis of PCME was 2.3 ± 0.9 months after surgery. At initial examination, the superficial capillary plexus pattern was near-normal in all PCME eyes, although it was attenuated in the deep capillary plexus. The mean vessel density of the superficial capillary plexus in PCME eyes was slightly but significantly lower than in control eyes (47.8 ± 3.8% vs. 52.9 ± 4.0%, P = 0.01), the difference being greater in the deep capillary plexus (44.1 ± 7.4% vs. 54.2 ± 3.2%, P = 0.007). After resolution of the edema, the deep capillary plexus completely recovered its normal pattern and the vessel density in both plexuses was no longer different from that observed in control eyes.

Conclusion:
Macular vessel density after resolution of an acute PCME did not differ from that of normal control eyes in both the superficial capillary plexus and deep capillary plexus, unlike macular edema in retinal vaso-occlusive diseases.
A CASE OF NEUROFIBROMATOSIS TYPE 2 WITH UNUSUAL CLINICAL FEATURES
Authors: Zarei Mohamma , Hamzeloui Parisa , Rooipoor Ramak , Fard Masoud Aghsaei 
Published: August 2017

Purpose:
To report a case of a neurofibromatosis Type 2 with unusual clinical features.

Methods:
Observational clinical case report.

Results:
A 22-year-old woman was referred with bilateral blurred vision and macular “scars.” Ocular examination revealed bilateral posterior subcapsular and cortical cataract, optic disk swelling, hyperpigmented macular lesions, epiretinal membrane, and macular temporal dragging. Spectral-domain optical coherence tomographic imaging showed bilateral epiretinal membranes, peripapillary nerve fiber layer thickening, and vitreoretinal tractional bands. In the right eye, focal choroidal excavation was noted at the site of the macular lesion. In fluorescein angiography, mild vascular leakage, capillary nonperfusion, and ground glass hyperfluorescence was seen in temporal periphery of the right eye. Brain imaging showed intracranial calcification and vestibular schwannoma, which was removed by a neurosurgeon. A clinical diagnosis of neurofibromatosis Type 2 was made.

Conclusion:
A case of neurofibromatosis Type 2 with some possibly novel or rare findings, namely, focal choroidal excavation, ash leaf spots, and intracranial calcifications was presented.
Agreement of Corneal Diameter Measurements Obtained by a Swept-source Biometer and a Scheimpflug-based Topographer
Authors: Salouti Ramin , Nowroozzadeh Mohammad Hossein , Tajbakhsh Zahra , Bagheri Mansoureh , Ghoreyshi Maryam , Azizzadeh Monir , Razeghinejad Mohammad Reza 
Published: August 2017

Purpose:
To assess the agreement between a swept-source optical biometry device (IOLMaster 700) and a Scheimpflug-based topography device (Pentacam HR) in measuring the corneal diameter.

Methods:
A total of 100 eyes from 100 cataract surgery candidates were enrolled. The white-to-white (WTW) distance measurements provided by both devices were recorded and analyzed. A paired t test was performed to compare the mean values of the WTW distance between the IOLMaster 700 and Pentacam HR. The Bland–Altman analysis was used to evaluate the agreement between the measurements of both devices.

Results:
Mean age (±SD) of the participants was 65.9 ± 3.3 years, and 58 (58%) were men. The mean WTW distances measured by the IOLMaster 700 and Pentacam HR were 11.72 ± 0.45 mm and 11.41 ± 0.42 mm, respectively (P < 0.001). The overall 95% limits of agreement were −0.17 and 0.78 mm. The 95% limits of agreement between the measurements of the 2 devices were −0.30 and 0.84 versus −0.07 and 0.72 for eyes with WTW distances of ≤11.50 mm versus >11.50 mm, respectively.

Conclusions:
According to the results of this study, the IOLMaster 700 may overestimate the WTW distance measurements by up to 0.78 mm compared with the Pentacam HR, so these 2 devices should not be used interchangeably for this purpose. The agreement is somehow weaker for eyes with WTW distances of 11.50 mm or less than those with WTW distances greater than 11.50 mm.
Quantitative Analysis of Endothelial Cell Loss in Preloaded Descemet Membrane Endothelial Keratoplasty Grafts
Authors: Wolle Meraf A. , DeMill David L. , Johnson Lauren , Lentz Stephen I. , Woodward Maria A. , Mian Shahzad I. 
Published: August 2017

Purpose:
Availability of preloaded Descemet membrane endothelial keratoplasty (pDMEK) tissue may increase acceptance of DMEK in surgical management of endothelial disease. The goal of this study was to determine the safety of pDMEK grafts for 24 hours before surgery by analyzing endothelial cell loss (ECL) using 2 image analysis software programs.

Methods:
A total of 18 cadaveric corneas were prepared for DMEK using a standardized technique and loaded in a modified Jones tube injector. Nine of the corneas were injected into Calcein AM vital dye after 1 minute (controls), and the remaining 9 corneas were left preloaded for 24 hours before injection into vital dye for staining. The stained corneas were imaged using an inverted confocal microscope. ECL was then analyzed and quantified by 2 different graders using 2 image analysis software programs.

Results:
The control DMEK tissue resulted in 22.0% ± 4.0% ECL compared with pDMEK tissue, which resulted in 19.2% ± 7.2% ECL (P = 0.31). Interobserver agreement was 0.93 for MetaMorph and 0.92 for Fiji. The average time required to process images with MetaMorph was 2 ± 1 minutes and with Fiji was 20 ± 10 minutes. Intraobserver agreement was 0.97 for MetaMorph and 0.93 for Fiji.

Conclusions:
Preloading DMEK tissue is safe and may provide an alternative technique for tissue distribution and surgery for DMEK. The use of MetaMorph software for quantifying ECL is a novel and accurate imaging method with increased efficiency and reproducibility compared with the previously validated Fiji.
Self-Retained Amniotic Membrane Combined With Antiviral Therapy for Herpetic Epithelial Keratitis
Authors: Cheng Anny M. S. , Tseng Scheffer C. G. 
Published: August 2017

Purpose:
To evaluate the therapeutic benefit of self-retained cryopreserved amniotic membrane in conjunction with oral antiviral therapy in herpetic epithelial keratitis.

Methods:
Retrospective review of 4 patients with primary (1 eye) and recurrent (3 eyes) unilateral herpetic epithelial keratitis treated with cryopreserved amniotic membrane through the placement of the PROKERA Slim (PKS) (Bio-Tissue, Inc) in conjunction with oral acyclovir. Their symptoms, conjunctival inflammation, corneal staining, and visual acuity were compared before and after treatment.

Results:
Herpetic epithelial keratitis presented as dendritic (3 eyes) and geographic (1 eye) epithelial lesions. After epithelial debridement and placement of the PKS for 5 ± 3.7 days, all patients reported significant relief of symptoms, rapid corneal epithelialization, and reduction of ocular surface inflammation. The visual acuity was also improved in all eyes from 0.7 ± 0.7 to 0.4 ± 0.7 logarithm of the minimum angle of resolution (P = 0.2). They remained symptom-free during a follow-up period of 2.7 to 50.8 (20.3 ± 21.7) months.

Conclusions:
The PKS in conjunction with oral acyclovir facilitates the ease of early intervention to accelerate restoration of a normal corneal epithelium in herpetic epithelial keratitis.
Preparation and Biomechanical Properties of an Acellular Porcine Corneal Stroma
Authors: Li Qing , Wang Hongmei , Dai Zhenye , Cao Yichen , Jin Chuanyu 
Published: August 2017

Purpose:
To construct an acellular porcine corneal stroma (aPCS) as a human corneal stroma alternative and to further explore its biomechanical properties.

Methods:
A combination of DNA-RNA enzymes and ultrasound technology was used to strip the native porcine corneal cells. The microstructure of aPCS was observed by H&E staining, DAPI staining, and α-Gal tests. The mechanical properties were detected by a tension machine. Cytotoxicity of aPCS was measured by the MTT assay. The subcutaneous embedding experiment in rats was also used to detect immunity and degradation. The aPCS was transplanted into the rabbit cornea by lamellar keratoplasty, general observations were made at 3 days, 1 week, 1 month, and 3 months after implantation, respectively.

Results:
The microstructure and mechanical properties of aPCS were not damaged during the decellularization process. The aPCS extracts had no significant cytotoxicity on human corneal stroma cells. Moreover, the subcutaneous embedding experiment in rats demonstrated that aPCS could not be degraded and induced no immune reaction in and around the transplanted discs. More important is that the aPCS reconstructed normal corneal stroma and maintained corneal transparency and thickness, with almost no neovascularization and inflammation at 3 months after surgery.

Conclusions:
The aPCS prepared in this study had good biocompatibility, safety, and low antigenicity, which has great potential for corneal disease treatment.
Systematic Review and Meta-Analysis of Clinical Outcomes of Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Endothelial Keratoplasty/Descemet Stripping Automated Endothelial Keratoplasty
Authors: Singh Abhimanyu , Zarei-Ghanavati Mehran , Avadhanam Venkata , Liu Christopher 
Published: August 2017

Purpose:
To review and compare the published reports of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty/Descemet stripping automated endothelial keratoplasty (DSEK/DSAEK) procedures with regard to endothelial cell density/loss, best spectacle-corrected visual acuity, central corneal thickness, subjective outcomes (patient's reported satisfaction/preference), and postoperative complications.

Methods:
A thorough search was conducted in the databases including AMED, EMBASE, Cochrane Database of Systematic Reviews, and MEDLINE without date restrictions. Systematic reviews, meta-analysis, randomized controlled trials, case series, and audits comparing DMEK and DSAEK were included.

Results:
DMEK is superior to DSAEK for the following outcomes: visual acuity, central corneal thickness, and patient satisfaction. There was a statistically significant difference in the mean spectacle-corrected visual acuity at 6 months for DMEK (mean = 0.161, SD = 0.129) and DSAEK eye (mean = 0.293, SD = 0.153) conditions; t (297) = 8.042, P < 0.0001. The pooled mean difference was −0.13 (95% confidence interval, −0.16 to −0.09) and I
2 = 44%, indicating better visual acuity for DMEK. Mean postoperative endothelial cell density showed statistically no significant difference in the mean values for DMEK (mean = 1855, SD = 442) and DSAEK eye (mean = 1872, SD = 429) conditions; t (336) = 0.375, P = 0.708. A higher proportion of patients prefer DMEK to DSAEK. However, DSAEK is superior to DMEK with respect to the need for rebubbling as the rebubbling rate was higher in the DMEK group.

Conclusions:
Although DMEK is associated with a higher rate of rebubbling, better visual outcomes were seen in DMEK.
Prestained and Preloaded DMEK Grafts: An Evaluation of Tissue Quality and Stain Retention
Authors: Zeidenweber Dorian A. , Tran Khoa D. , Sales Christopher S. , Wehrer Stephen W. , Straiko Michael D. , Terry Mark A. 
Published: August 2017

Purpose:
To examine endothelial cell damage and stain retention of prestained preloaded Descemet membrane endothelial keratoplasty (DMEK) grafts.

Methods:
DMEK grafts were stained with trypan blue or left unstained before loading into a Straiko modified Jones tube. A protocol to stain preloaded grafts inside the modified Jones tube and resulting cell loss was also examined. Endothelial cell loss was determined by vital dye staining after 3 days of cold storage and compared between the 3 groups. Eight additional grafts were stained, loaded, and shipped from Oregon to New York to assess stain stability. Stain retention and the ability to successfully inject and open these “prestained preloaded” grafts in cadaveric donor eyes were also evaluated.

Results:
Unstained preloaded DMEK grafts showed an overall cell loss of 15% ± 3% [95% confidence interval (CI), 11%–18%]. Prestained grafts had a cell loss of 16% ± 4% (95% CI, 10%–22%) and were not significantly different from unstained grafts (P = 1). Grafts stained while inside the modified Jones tubes had an average cell loss of 18% ± 2% (95% CI, 16%–20%, P
prestained = 0.15, P
unstained = 0.09). All grafts shipped across the country and examined 3 days after preparation showed a decrease in stain intensity but were still deemed suitable for transplantation by an experienced DMEK surgeon.

Conclusions:
It is possible to prestain and preload DMEK grafts without inducing additional endothelial cell loss. Consideration should be given to the interval between staining and surgery because stain can fade.
Minimizing Graft Preparation Failure in Descemet Membrane Endothelial Keratoplasty
Authors: Livny Eitan , Groeneveld-van Beek Esther A. , Lie Jessica T. , Mangundap Kristin M. , Bruinsma Marieke , Birbal Rénuka S. , van der Wees Jacqueline , Melles Gerrit R. J. 
Published: August 2017

Purpose:
To report the failure rate of 2 graft preparation techniques for Descemet membrane endothelial keratoplasty (DMEK) and to evaluate how to minimize graft preparation failure.

Methods:
Retrospective, nonrandomized study at an eye bank specialized in graft preparation for lamellar keratoplasty. For 1416 donor corneas, the DMEK graft preparation failure rate was evaluated for 2 different techniques, technique I: “Standardized traditional technique” (n = 341) and technique II: “Standardized no-touch technique” (n = 933), and for grafts that were converted from technique II to technique I during preparation (n = 142).

Results:
The overall failure rate averaged 3.9% (55/1416): 7.0% (24/341) for technique I and 2.9% (31/1075) for technique II (P < 0.05). Tissue preparations which were converted from technique II to technique I failed in 13.4% (19/142), whereas for grafts that were entirely prepared by technique II, the failure rate was only 1.3% (12/933). The endothelial cell density decrease (before compared with after preparation) did not differ for both techniques (1.1% vs. 0.2%, P > 0.05).

Conclusions:
Various DMEK graft preparation techniques may provide failure rates of <4%. A “no-touch preparation” approach (technique II) may combine good graft quality (completely intact endothelial cell layer, ie, negligible preparation-induced endothelial cell density decrease) with low risk of dissection failure, leaving the possibility of conversion to “traditional preparation” (technique I) as a backup method.