bluuebunny/crossref_metadata_2025_split huggingface dataset:
TEMPORAL VASCULAR ARCADE WIDTH AND ANGLE IN HIGH AXIAL MYOPIA
Authors: Jonas Jost B. , Weber Pascal , Nagaoka Natsuko , Ohno-Matsui Kyoko 
Published: August 2017

Purpose:
Axial myopia is associated with elongation of the posterior ocular segment. The authors measured posterior fundus landmarks and assessed their associations with axial length.

Methods:
Using fundus photographs, the authors measured the vertical distance between the temporal superior and temporal inferior arterial arcade (VDA) and the angle kappa between the temporal arterial arcades among other morphometric variables.

Results:
The study included 456 eyes with a mean age of 61.2 ± 14.2 years (range: 13–88 years) and mean axial length of 29.4 ± 2.1 mm (range: 23.2–35.3 mm). Mean angle kappa was 91.3 ± 17.2° (range: 39–161°), and mean VDA was 7.93 ± 1.71 mm (range: 2.72–12.85 mm). In multivariate regression analysis, wider angle kappa was associated (regression coefficient r: 0.47) with shorter axial length (P = 0.002; beta: −0.17; B: −1.37; 95% confidence interval [CI]:−2.23 to −0.51), longer VDA (P < 0.001; beta: 0.27; B: 2.70; 95% CI: 1.85–3.54), shorter disk–foveola distance (P < 0.001; beta: −0.22; B: −4.76; 95% CI: −7.05 to −2.46), shorter vertical optic disk diameter (P = 0.002; beta: −0.14; B: −6.83; 95% CI: −11.1 to −2.56), lower number of any chorioretinal lesions (P = 0.007; beta: −0.13; B: −2.11; 95% CI: −3.63 to −0.58), and longer maximal vertical chorioretinal lesion diameter (P = 0.05; beta: 0.09; B: 0.92; 95% CI: −0.02 to 1.86). A longer VDA was associated (r: 0.31) with longer axial length (P < 0.001; beta: 0.22; B: 0.18; 95% CI: 0.10–0.25), wider angle kappa (P < 0.001; beta: 0.28; B: 0.03; 95% CI: 0.02–0.04) and higher number of chorioretinal lesions (P = 0.03; beta: 0.10; B: 0.16; 95% CI: 0.02–0.31). If eyes with chorioretinal lesions were excluded, the association between longer VDA and longer axial length was no longer statistically significant (P > 0.10).

Conclusion:
Axial elongation was correlated with decreasing angle kappa, caused by an elongation of the disk–foveola distance because of an enlargement of the gamma zone, whereas VDA remained constant. By contrast, horizontal length of macular Bruch membrane and vertical length of macular Bruch membrane were independent of axial elongation. Axial elongation did not lead to lengthening of Bruch membrane in the macular region in eyes without macular chorioretinal lesions.
Scleral Pneumatonometry in Penetrating Keratoplasty: A Clinical Study
Authors: Magalhaes Otavio A. , Aldave Anthony J. 
Published: August 2017

Purpose:
To evaluate the reliability between pneumatonometry intraocular pressure (IOP) measurement in different scleral locations and corneal IOP in a penetrating keratoplasty (PK) setting. Our aim is to validate a method that can potentially be used for patients with keratoprostheses.

Methods:
This is a prospective observational study of 40 patients who underwent monocular PK by a single surgeon and had no significant anterior segment condition in the contralateral eye. Participants were recruited during routine visits to the Cornea Clinic at the Stein Eye Institute, between November 2016 and February 2017. Goldmann applanation tonometry, central corneal pachymetry, and inferior, inferotemporal, and temporal scleral pneumatonometry of both eyes were collected.

Results:
The correlation coefficient between corneal Goldmann applanation tonometry IOP and inferior, inferotemporal, and temporal scleral pneumatonometry IOP in the transplanted eye found that all locations were significantly and strongly correlated (r = 0.76, r = 0.80, and r = 0.75, respectively; P < 0.001). The correlation coefficient was higher for inferior and inferotemporal scleral measurements when the contralateral eye was used to predict the PK corneal IOP (r = 0.85 and r = 0.79, respectively; P < 0.001) and weaker for temporal measurement (r = 0.72; P < 0.001). Central corneal thickness correction formulas did not improve the correlation between scleral and corneal IOPs. All linear regression analyses were statistically significant (P < 0.001).

Conclusions:
The inferotemporal sclera was the optimal location for pneumatonometry IOP measurement. The contralateral eye could be used to more accurately predict the IOP in the eye of interest. Scleral pneumatonometry is an intuitive and reliable method to monitor IOP when corneal measurement is not available.
Ocular Gossypiboma: Ultrasound B-Scan Assessment of Retained Surgical Sponge After Ahmed Valve Surgery: A Case Report
Authors: Babic Kelly , Siguan-Bell Christine , Hee Michael , Lin Shan C. 
Published: August 2017

Purpose of the Study:
To present the first documented case of an ocular gossypiboma (retained foreign body) of a mitomycin-C-soaked sponge confirmed echographically using diagnostic ultrasound B-scan after Ahmed valve surgery.

Patients and Methods:
A patient who underwent phacoemulsification with Ahmed valve implantation surgery had a retained Weck-Cels sponge soaked with mitomycin-C. With the use of ocular ultrasound B-scan, the retained sponge was localized and a second procedure was performed to explant it.

Conclusion:
In cases of ocular gossypiboma the use of ultrasound modalities can be a valuable tool especially because B-scan access is common and can be cost-effective.
Optic Disc Drusen and Family History of Glaucoma—Results of a Patient-directed Survey
Authors: Gramer Gwendolyn , Gramer Eugen , Weisschuh Nicole 
Published: August 2017

Purpose:
Prospective evaluation of family history (FH) of glaucoma and FH of optic disc drusen (ODD) in patients with sonographically confirmed ODD.

Patients and Methods:
A total of 87 patients with ODD interviewed all their first-degree and second-degree relatives using a detailed questionnaire on whether an ophthalmologist had diagnosed or excluded glaucoma or ocular hypertension (OH). Using a second questionnaire, 62 of these patients also provided information about ODD in their FH. Control groups for FH of glaucoma consisted of 2170 patients with glaucoma or OH evaluated with the same methods and identical questions for FH of glaucoma in a previous study, and of 176 healthy individuals without glaucoma or ODD who were interviewed on family history of glaucoma.

Results:
Glaucoma in FH was significantly more frequent in patients with ODD with an incidence of 20.7% compared with healthy controls with an incidence of 2.8%, and half as frequent as in glaucoma patients with an incidence of 40%. ODD in FH were found in 9.7% of patients with ODD.

Conclusions:
As there is a high frequency of family history of glaucoma in patients with ODD, evaluation of FH of ODD and FH of glaucoma is essential in patients with ODD. Glaucoma in FH of ODD patients requires intraocular pressure monitoring and whenever deemed beneficial timely initiation of intraocular pressure–lowering therapy.
Electromagnetic Navigational Bronchoscopy Reduces the Time Required for Localization and Resection of Lung Nodules
Authors: David Bolton William , Cochran Thomas , Ben-Or Sharon , Stephenson James E. , Ellis William , Hale Allyson L. , Binks Andrew P. 
Published: August 2017

Objective The aims of the study were to evaluate electromagnetic navigational bronchoscopy (ENB) and computed tomography–guided placement as localization techniques for minimally invasive resection of small pulmonary nodules and determine whether electromagnetic navigational bronchoscopy is a safer and more effective method than computed tomography–guided localization. Methods We performed a retrospective review of our thoracic surgery database to identify patients who underwent minimally invasive resection for a pulmonary mass and used either electromagnetic navigational bronchoscopy or computed tomography–guided localization techniques between July 2011 and May 2015. Results Three hundred eighty-three patients had a minimally invasive resection during our study period, 117 of whom underwent electromagnetic navigational bronchoscopy or computed tomography localization (electromagnetic navigational bronchoscopy = 81; computed tomography = 36). There was no significant difference between computed tomography and electromagnetic navigational bronchoscopy patient groups with regard to age, sex, race, pathology, nodule size, or location. Both computed tomography and electromagnetic navigational bronchoscopy were 100% successful at localizing the mass, and there was no difference in the type of definitive surgical resection (wedge, segmentectomy, or lobectomy) ( P = 0.320). Postoperative complications occurred in 36% of all patients, but there were no complications related to the localization procedures. In terms of localization time and surgical time, there was no difference between groups. However, the down/wait time between localization and resection was significant (computed tomography = 189 minutes; electromagnetic navigational bronchoscopy = 27 minutes); this explains why the difference in total time (sum of localization, down, and surgery) was significant ( P < 0.001). Conclusions We found electromagnetic navigational bronchoscopy to be as safe and effective as computed tomography–guided wire placement and to provide a significantly decreased down time between localization and surgical resection.
Robotic versus Conventional Coronary Artery Bypass Grafting
Authors: Kofler Markus , Stastny Lukas , Johannes Reinstadler Sebastian , Dumfarth Julia , Kilo Juliane , Friedrich Guy , Schachner Thomas , Grimm Michael , Bonatti Johannes , Bonaros Nikolaos 
Published: August 2017

Objective Robotic coronary artery bypass grafting (CABG) was shown to be a safe and feasible method for the treatment of coronary artery disease in highly selected patients. However, long-term outcome data comparing robotic CABG with conventional CABG are still missing. Therefore, we aimed to compare robotic with conventional CABG in terms of perioperative and long-term outcomes. Methods Of 2947 consecutive elective patients with coronary artery disease operated at a single center between 2001 and 2013, 280 underwent robotic CABG. After propensity score matching, 134 pairs of robotic versus conventional CABG (age = 62 ± 10 years, log EuroScore = 2.4 ± 2.4% vs. mean ± SD age = 63 ± 10 years, log EuroScore 2.5 ± 1.7%, respectively; all P > 0.05) were formed. The mean ± SD follow-up was 6.6 ± 3.2 years. Results There was no difference in perioperative mortality (robotic = 0% vs. conventional = 1.5%, P = 0.154), myocardial infarction (robotic = 0% vs. conventional = 2.2%, P = 0.08), and stroke rate (robotic = 0% vs. conventional = 0.7%, P = 0.318) between the groups. Longer cardiopulmonary bypass (robotic = 112 ± 100 minutes vs. conventional = 67 ± 48 minutes, P < 0.0001) and cross-clamp times (robotic = 68 ± 54 minutes vs. conventional = 38 ± 27 minutes, P <0.0001) were observed in robotic patients. Long-term follow-up yielded equivalent results in terms of survival (1, 5, and 10 years: robotic = 99.3%, 96.9%, and 81.3% vs. conventional = 96.3%, 92.2%, and 82.6%, respectively; log-rank P = 0.187) and freedom from major adverse cardiac and cerebral events at 1, 5, and 10 years after procedure (robotic = 90.6%, 77.7%, 70.1% vs. conventional = 94.1%, 82.2%, 66.6%; log-rank P = 0.790). Conclusions Long-term outcomes of robotic CABG are comparable with conventional CABG for selected patients. Longer operative times of robotic CABG do not influence the excellent long-term outcomes.
Pneumonia with bacterial and viral coinfection
Authors: Cawcutt Kelly , Kalil Andre C. 
Published: August 2017

Purpose of review
We aim to review the epidemiology of pneumonia with bacterial and viral coinfection, the pathogenesis and clinical impact of coinfection along with the current state of treatment and outcomes.

Recent findings
Emphasis is given to the pathogenesis of bacterial and viral co-infection including specific highlighting on influenza, rhinovirus, respiratory syncytial virus and cytomegalovirus. Updates on the current state of diagnosis and management are included, as well as on areas where future research can be directed to improve patient clinical outcomes regarding viral and bacterial coinfection.

Summary
Bacterial and viral coinfection is increasingly recognized as an underlying etiology for community- and hospital-acquired infections. Coinfections may be a risk factor for ICU admission, severity of disease, and mortality. Clinicians must be aware of these coinfections for appropriate management and prognostication, as well as for the prevention of nosocomial spread of viral illness.
ICU admission after surgery: who benefits?
Authors: Ghaffar Sadia , Pearse Rupert M. , Gillies Michael A. 
Published: August 2017

Purpose of review
Death following surgery remains a major cause of death worldwide, and ICU admission following major surgery is considered a standard of care in many healthcare systems. However, ICU resources are finite and expensive, thus identifying those most likely to benefit is of great importance.

Recent findings
Advances in surgical and perioperative management have moved the focus of postoperative care to preventing complications and reducing duration of hospitalisation. Recent health services research has failed to find association between ICU admission and improved outcome in many types of elective major noncardiac surgery. Use of alternatives to ICU such as post anaesthesia care units (PACUs), high dependency units (HDUs) or specialist wards with enhanced nursing care are able to perform some elements of ICU monitoring in a less intensive environment, and may provide a better alternative to the traditional model of ICU admission for many patients having major surgery. ICU admission should still be considered for very high-risk patients and those having complex or emergency surgery. Improved triage tools are required to identify those at the highest risk of death or complications.

Summary
Identifying those most at risk of death and complications following surgery and preventing them is the major challenge of perioperative care in the coming decades. Future research should focus on how postoperative care can best be structured to provide optimum care to patients within available resources. Incidence of complications or failure to rescue (FtR) may provide useful metrics in future research.
Time to ditch HDL-C as a measure of HDL function?
Authors: Ronsein Graziella E. , Heinecke Jay W. 
Published: August 2017

Purpose of review
Epidemiological and clinical studies link low levels of HDL cholesterol (HDL-C) with increased risk of atherosclerotic cardiovascular disease (CVD). However, genetic polymorphisms linked to HDL-C do not associate consistently with CVD risk, and randomized clinical studies of drugs that elevate HDL-C via different mechanisms failed to reduce CVD risk in statin-treated patients with established CVD. New metrics that capture HDL's proposed cardioprotective effects are therefore urgently needed.

Recent findings
Recent studies demonstrate cholesterol efflux capacity (CEC) of serum HDL (serum depleted of cholesterol-rich atherogenic lipoproteins) is an independent and better predictor of incident and prevalent CVD risk than HDL-C. However, it remains unclear whether therapies that increase CEC are cardioprotective. Other key issues are the impact of HDL-targeted therapies on HDL particle size and concentration and the relationship of those changes to CEC and cardioprotection.

Summary
It is time to end the clinical focus on HDL-C and to understand how HDL's function, protein composition and size contribute to CVD risk. It will also be important to link variations in function and size to HDL-targeted therapies. Developing new metrics for quantifying HDL function, based on better understanding HDL metabolism and macrophage CEC, is critical for achieving these goals.
Variation in Bariatric Surgery Episode Costs in the Commercially Insured
Authors: Kelsall Alexander C. , Cassidy Ruth , Ghaferi Amir A. 
Published: August 2017

Objective:
To describe hospital-level variation in roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Michigan.

Background:
Bariatric surgery is an increasingly prevalent elective surgical procedure that will likely be considered for future bundled payment programs, both public and private. Past research in the Medicare population found that the index hospitalization is responsible for the majority of payment variation among hospitals. However, this research largely excluded SG, now the most commonly performed bariatric surgery procedure nationally.

Methods:
We used data from a state-wide quality collaborative to calculate the average risk and price-adjusted 30-day episode payment for patients undergoing RYGB and SG procedures at Michigan hospitals between January 2009 and October 2014. We organized hospitals into quintiles and compared the variation in payments between highest and lowest-cost quintiles, and also the payment categories that drove this variation.

Results:
We identified 9035 patients undergoing RYGB (n = 4194) or SG (n = 4841) procedures at 31 hospitals. The average price and risk-adjusted episode payment ranged from $11,874 in the lowest hospital quintile to $13,394 in the highest quintile, representing a difference of $1519 (12.8%). Payments for the index hospitalization accounted for the largest share of total episode costs for both procedure types. Despite representing 2.7% to 6.0% of payments across quintiles, postdischarge payments explained 22.6% of hospital variation in SG. Similarly, readmissions explained 24.5% of payment variation for SG episodes, despite representing between 1.2% and 4.4% of payments.

Conclusions:
Collectively, our findings suggest that there are previously underappreciated differences in episode payment variation between bariatric surgery procedures. SG may be more amenable to cost containment under bundled payment initiatives by virtue of the greater share of variation explained by readmission and postdischarge payments, components of episode payment more likely to be influenced by provider discretion.
The role of splenic angioembolization as an adjunct to nonoperative management of blunt splenic injuries: A systematic review and meta-analysis
Authors: Crichton James Charles Ian , Naidoo Kamil , Yet Barbaros , Brundage Susan I. , Perkins Zane 
Published: August 2017

BACKGROUND
Nonoperative management (NOM) of hemodynamically normal patients with blunt splenic injury (BSI) is the standard of care. Guidelines recommend additional splenic angioembolization (SAE) in patients with American Association for the Surgery of Trauma (AAST) Grade IV and Grade V BSI, but the role of SAE in Grade III injuries is unclear and controversial. The aim of this systematic review was to compare the safety and effectiveness of SAE as an adjunct to NOM versus NOM alone in adults with BSI.

METHODS
A systematic literature search (Medline, Embase, and CINAHL) was performed to identify original studies that compared outcomes in adult BSI patients treated with SAE or NOM alone. Primary outcome was failure of NOM. Secondary outcomes included morbidity, mortality, hospital length of stay, and transfusion requirements. Bayesian meta-analyses were used to calculate an absolute (risk difference) and relative (risk ratio [RR]) measure of treatment effect for each outcome.

RESULTS
Twenty-three studies (6,684 patients) were included. For Grades I to V combined, there was no difference in NOM failure rate (SAE, 8.6% vs NOM, 7.7%; RR, 1.09 [0.80–1.51]; p = 0.28), mortality (SAE, 4.8% vs NOM, 5.8%; RR, 0.82 [0.45–1.31]; p = 0.81), hospital length of stay (11.3 vs 9.5 days; p = 0.06), or blood transfusion requirements (1.8 vs 1.7 units; p = 0.47) between patients treated with SAE and those treated with NOM alone. However, morbidity was significantly higher in patients treated with SAE (SAE, 38.1% vs NOM, 18.6%; RR, 1.83 [1.20–2.66]; p < 0.01). When stratified by grade of splenic injury, SAE significantly reduced the failure rate of NOM in patients with Grade IV and Grade V splenic injuries but had minimal effect in those with Grade I to Grade III injuries.

CONCLUSION
Splenic angioembolization should be strongly considered as an adjunct to NOM in patients with AAST Grade IV and Grade V BSI but should not be routinely recommended in patients with AAST Grade I to Grade III injuries.

LEVEL OF EVIDENCE
Systematic review and meta-analysis, level III.
Time to aortic occlusion: It’s all about access
Authors: Romagnoli Anna , Teeter William , Pasley Jason , Hu Peter , Hoehn Melanie , Stein Deborah , Scalea Thomas , Brenner Megan 
Published: August 2017

INTRODUCTION
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less invasive method of proximal aortic occlusion compared with resuscitative thoracotomy with aortic cross-clamping (RTACC). This study compared time to aortic occlusion with REBOA and RTACC, both including and excluding time required for common femoral artery (CFA) cannulation.

METHODS
This was a retrospective, single-institution review of REBOA or RTACC performed between February 2013 and January 2016. Time of skin incision to aortic cross-clamp for RTACC, time required for CFA cannulation by percutaneous and open methods, and time from guide-wire insertion to balloon inflation at Zone 1 for REBOA, were obtained from videographic recordings.

RESULTS
Eighteen RTACC and 21 REBOAs were performed. Median (Q1, Q3) time from skin incision to aortic cross-clamping was 317 seconds (227, 551 seconds). Median (Q1, Q3) time from start of arterial access to Zone 1 balloon occlusion was 474 seconds (431, 572 seconds) (vs. RTACC, p = 0.01). All REBOA procedures were performed with the same device. The median time to complete CFA cannulation was 247 seconds (range, 164–343 seconds), with no difference between percutaneous or open procedures (p = 0.07). The median (Q1, Q3) time to aortic occlusion in REBOA once arterial access had been established was 245 seconds (179, 295.5 seconds), which was significantly shorter than RTACC (p = 0.003).

CONCLUSIONS
Once CFA access is achieved, time to aortic occlusion is faster with REBOA. Time to aortic occlusion is less than the time required to cannulate the CFA either by percutaneous or open approaches, emphasizing the importance of accurate and expedient CFA access. Resuscitative endovascular balloon occlusion of the aorta may represent a feasible alternative to thoracotomy for aortic occlusion. Time to aortic occlusion will likely decrease with the advent of newer REBOA technology. The rate-limiting portion of REBOA continues to be obtaining CFA access.

LEVEL OF EVIDENCE
Therapeutic, level V.