bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of ciliary body morphology and position of the implantable collamer lens in low-vault eyes using ultrasound biomicroscopy
Authors: Yiming Ye , Xi Chen , Huan Yao , Liming Chen , Na Yu , Pei Chen , Ying Yang , Yan Li , Keming Yu 
Published: August 2023

Purpose:
To investigate the ciliary body anatomy and position of the implantable collamer lens (ICL) in low-vault eyes and analyze factors related to insufficient vault.

Setting:
Zhongshan Ophthalmic Center, Guangzhou, China.

Design:
Retrospective case–control observational study.

Methods:
In this study, 73 eyes of 73 patients with an insufficient vault (<250 μm) were matched with 73 eyes with an ideal vault (250 to 750 μm). Ultrasound biomicroscopy was used to determine the ciliary body morphology and ICL position. The biometric parameters acquired by Scheimpflug tomography were compared. The correlation between the vault and these factors was analyzed, and the least absolute shrinkage and selection operator method was used to screen the risk factors for low vault.

Results:
The low-vault group had a steeper corneal curvature, thicker lens thickness (LT), higher crystalline lens rise, and shorter axial length (AL) (all P < .005). The ciliary process length (CPL) and maximum ciliary body thickness (CBTmax) were significantly smaller, and the trabecular–ciliary angle (TCA), iris–ciliary angle (ICA), and ciliary sulcus width (CSW) were significantly greater in the low-vault eyes (all P < .005). The low-vault group had more ICL haptics below the ciliary process, and TCA, ICA, CPL, CBTmax, CSW, and haptic position were related to the postoperative vault (all P < .05). CPL, AL, and LT were identified as predictors of a low vault.

Conclusions:
Malposition of ICL haptics behind the ciliary process is a risk factor for low vault. A shorter CPL, thicker LT, and shorter AL are significant risk factors for the postoperative low vault.
Angle, anterior chamber parameters, and intraocular pressure changes after early phacoemulsification in acute angle-closure glaucoma
Authors: Anbar Mohamed A. , Mahmoud Hany A. , Abdellah Marwa M. 
Published: August 2023

Purpose:
To evaluate the safety and efficacy of phacoemulsification as a first line treatment of acute angle closure glaucoma (AACG) and to evaluate the preoperative and postoperative anterior chamber angle width and anterior chamber parameters using anterior segment OCT(AS-OCT) and Pentacam.

Sittings:
Sohag University Hospital, Sohag city, Egypt.

Design:
Prospective comparative interventional case series study.

Methods:
Patients presented with AACG. After control of high intraocular pressure (IOP), all participants were scheduled for phacoemulsification within a week after the attack. Preoperative and postoperative angle width, anterior chamber volume and anterior chamber depth was measured by AS-OCT and Pentacam to evaluate angle changes.

Results:
Fifty eyes with AACG were enrolled in the study. The mean IOP was lowered significantly from 40.23 ± 10.4 mmHg preoperatively to 11.4 ± 3.3 mmHg 3 months after surgery. The mean preoperative temporal angle widened from 18.13 ± 3.65 degree to 36.16 ± 4.46 3 months after phacoemulsification. Also, the mean preoperative nasal angle widened from 17.80 ± 3.45 preoperatively to 36.18 ± 4.47 3-month postoperative. The mean preoperative AC volume was 49.4 ± 5.73 μL. After surgery the AC volume increased significantly to 138.2 ± 29.78 μL. The mean preoperative ACD was 1.58 ± 0.12 mm that deepened significantly after surgery to 3.19 ± 0.43 mm.

Conclusion:
Early phacoemulsification is very effective in treatment of AACG cases immediately after medical control of high IOP and resolution of corneal oedema. This was proved by imaging and measuring the angle width, anterior chamber volume and anterior chamber depth using AS- OCT and Pentacam.
Central Application Service for Physician Assistants Fifteen-Year Data Report 2002–2016
Authors: Hussaini Sobia Shariff , Coplan Bettie , Gillette Chris , Russell Gregory B. , McDaniel M. Jane 
Published: August 2023

Purpose
This study highlights trends in available physician assistant (PA) applicant and matriculant data over the first 15 years of the Central Application Service for Physician Assistants (CASPA) service (2002–2016). This study expands knowledge identified in the CASPA 10-year data report.

Methods
This was a retrospective analysis of CASPA data from all CASPA-participating PA programs between 2002 and 2016. Central Application Service for Physician Assistants staff verified all applicant academic information. In addition, beginning in 2007, the online CASPA admissions portal linked matriculant data with applicant data.

Results
During the first 15 years of the CASPA service, there was a 194% increase in the number of CASPA-participating programs (from 68 to 200) and a 409% increase in the number of total applicants. Several trends identified in the CASPA 10-year report persisted, including increasing grade point averages among applicants and matriculants and lower matriculation rates among underrepresented minority applicants and applicants who reported economic disadvantage.

Conclusion
This 15-year comprehensive analysis of the CASPA data will benefit the profession by providing historical information that faculty and policymakers can use as a basis for developing and evaluating future admissions policies and practices.
Personal health behaviors and physical activity and nutrition counseling by nurse practitioners: An online survey
Authors: McCormick Sherry J. , Smith-Holmquist Natasha , Benton Melissa J. 
Published: August 2023

ABSTRACT

Background:
Healthy lifestyle counseling improves nutritional intake and participation in exercise, yet the rate of patient counseling varies and clinicians' personal behaviors can influence counseling practices.

Purpose:
This cross-sectional study evaluated lifestyle counseling by nurse practitioners (NPs) and the relationship between their personal behaviors and patient counseling.

Methodology:
Practicing NPs (N = 1,220) completed an online survey regarding personal behaviors and counseling for healthy body weight, moderate-vigorous physical activity, muscle strengthening, fruit and vegetable consumption, and dietary protein.

Results:
The majority reported counseling “usually” or “often” for healthy weight (54%), moderate-vigorous physical activity (53%), and fruits/vegetables (57%), whereas only 44% and 17% reported “usually” or “often” counseling for dietary protein and muscle strengthening. When NPs did not personally engage in the behavior, the odds for counseling were significantly reduced: NPs were 21% less likely to counsel for moderate-vigorous physical activity (odds ratio [OR] = 0.79 [0.65–0.97], p = .026), 27% less likely to counsel for muscle strengthening (OR = 0.73 [0.60–0.90], p = .004), 57% less likely to counsel for fruit/vegetable consumption (OR = 0.43 [0.35–0.54], p < .001), and 72% less likely to counsel for dietary protein (OR = 0.28 [0.18–0.45], p < .001). Personal body mass index did not predict counseling for a healthy weight.

Conclusion:
Although NPs report regular patient counseling regarding healthy lifestyle behaviors, the odds for counseling are increased approximately 20–75% when they engage in the behaviors themselves.

Implications:
Promotion of healthy behaviors during professional education may have long-term implications for preventive health counseling.
Speak-Up Behavior of Oncology Nurses
Authors: Gencer Ozge , Duygulu Sergul 
Published: August 2023

OBJECTIVEThe aim of this study is to examine the mediating roles of organizational trust and structural empowerment on the speak-up behavior of oncology nurses.BACKGROUNDOrganizational trust can create opportunities for a good working environment. Structural empowerment is an important factor affecting the speak-up behavior of nurses. The intermediary roles of organizational trust and structural empowerment on speak-up behavior are not specific.METHODSA correlational descriptive research design was used, and 232 nurses from 2 different hospital levels (the Ministry of Health hospital and university hospital) responded to 4 questionnaires.RESULTThe results reflect that organizational trust and structural empowerment are a factor on nurses' speak-up behavior.CONCLUSIONThe findings demonstrate that a work environment where organizational trust is developed and a structural empowerment framework is in place contributes to nurses' speak-up behavior among oncology nurses.
Systemic Immune-Inflammation Index is a Prognostic Predictor for Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis
Authors: Wei Chan-Juan , Xue Juan-Juan , Zhou Xiao , Xia Xiao-Shuang , Li Xin 
Published: August 2023

Objective:
To investigate whether baseline systemic immune-inflammation index (SII) is associated with 3-month poor prognosis and early neurological outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis.

Patients and Methods:
A total of 221 consecutive patients were enrolled in the retrospective study. The primary endpoints were poor functional outcomes or death at 3 months. Secondary endpoints were early neurological deterioration (END) or symptomatic intracerebral hemorrhage within 24 hours. Receiver operating characteristic curve analyses was performed to assess the overall discriminative ability of SII in predicting the 4 endpoints. We also performed the Spearman correlation test to evaluate the relationship between SII and stroke severity. Univariable and multivariable logistic regression analyses were performed to evaluate the associations between SII and endpoints.

Results:
The cutoff values of SII were 504.99×109/L for predicting a 3-month poor prognosis (sensitivity, 70.9% and specificity, 69.6%), 524.47×109/L for predicting 3-month death (sensitivity, 78.9% and specificity, 59.9%) and 504.99×109/L for predicting END (sensitivity, 70.7% and specificity, 62.6%), respectively. A positive association between SII and the National Institutes of Health Stroke Scale was observed (r
s = 0.306, P < 0.001). Multivariable analyses indicated that SII was independently associated with 3-month poor prognosis [odds ratio (OR) = 5.384; 95% CI: 2.844-10.193; P < 0.001], 3-month death (OR = 2.592, 95% CI: 1.046-6.421, P = 0.040) and END (OR = 3.202, 95% CI: 1.796-5.707, P < 0.001).

Conclusion:
Increased baseline SII was associated with END and 3-month poor outcomes, and may act as a potential prognostic predictor for acute ischemic stroke patients treated with intravenous thrombolysis.
Venous Thromboembolism Prophylaxis After Spontaneous Intracerebral Hemorrhage
Authors: Dong Chang , Li Ying , Ma, MD Zhuang 
Published: August 2023

Background:
Patients with spontaneous intracerebral hemorrhage (sICH) are at high risk for venous thromboembolism (VTE). The administration of mechanical and pharmacological VTE prophylaxis after sICH is important but challenging. The safety and efficacy of the optimal anticoagulant dose, timing, and type of VTE chemoprophylaxis in cases of sICH are still unclear, and clinicians are concerned that it may lead to cerebral hematoma expansion, which is associated with poor prognosis. Through this literature review, we aim to summarize the latest guidelines, recommendations, and clinical research progress to support evidence-based treatment strategies.

Review Summary:
It has been proven that intermittent pneumatic compression can effectively reduce the risk of VTE and should be used at the time of hospital admission, whereas gradient compression stockings or lack of prophylaxis in sICH cases are not recommended by current guidelines. Studies regarding pharmacological VTE prophylaxis in patients with ICH were reviewed and summarized. Prophylactic anticoagulation for VTE in patients with ICH seems to be safe and was not associated with cerebral hematoma expansion. Meanwhile, the prophylactic efficacy of anticoagulation for pulmonary embolism seems to be more obvious than that of deep vein thrombosis in patients with ICH.

Conclusions:
Clinicians should pay attention to the prevention and management of VTE after sICH. Intermittent pneumatic compression should be applied to patients with sICH on the day of hospital admission. After documentation of bleeding cessation, early initiation of pharmacological VTE prophylaxis (24 h to 48 h from sICH onset) seems to be safe and effective in pulmonary embolism prophylaxis.
Late-Onset COL4A1 Mutation with Recurrent Ischemic and Hemorrhagic Strokes
Authors: Lee Jenny J. , Patel Smit , Hinman Jason D. 
Published: August 2023

Introduction:
Mutations in type IV collagen gene COL4A1 are identified as a cause of autosomal dominant cerebrovascular disease. We report an unusual late-onset presentation.

Case Report:
A 64-year-old male was found to have an ischemic stroke and diffuse white matter changes. Genetic testing revealed COL4A1 gene mutation of heterozygous Alu insertion at intron 16. Alu elements are known as “jumping genes,” and Alu insertion is not previously reported in COL4A1 genetic syndromes. Our case has attributes consistent with a heritable leukoencephalopathy: (1) late-onset presentation, (2) intracerebral hemorrhages and microbleeds, (3) bilateral symmetrical leukoencephalopathy, (4) recurrence over a short period of time, (5) bilateral retinopathy, and (6) family history notable for brain aneurysm, kidney diseases, and early-onset stroke.

Conclusions:
Although the majority of COL4A1 genetic syndromes featuring cerebral small vessel disease are in children, this case highlights a late-onset patient with key features of COL4A1 syndromes associated with a heterozygous Alu intronic insertion.
Recurrent Cerebral Infarction Due to Moyamoya Disease Complicated With Systemic Lupus Erythematosus
Authors: Wang Qisong , Yao Qiang , Yuan Si , Shen Yan , Feng Yang , Liu Luji , Zhu Yipu , Zhao Yanying , Cui Junzhao , Qin Jin , Tian Jing , Zhao Ruijie , Liu Lijuan , Zhou Yicong , Liu Xiaoyun 
Published: August 2023

Introduction:
We report a rare case of moyamoya disease caused by an RNF213 mutation, complicated with systemic lupus erythematosus.

Case Report:
A 32-year-old woman experienced 4 cerebral ischemia stroke events within 6 months. The main symptom was left limb weakness with blurred vision in the right eye. Results of digital subtraction angiography conducted at another hospital were consistent with moyamoya disease. On genetic testing, we found that the patient carried 2 mutations in the moyamoya disease-related gene RNF213 (p.R4810K, p.T1727M). On the basis of the laboratory immunologic indicators, such as positive antibodies and abnormal immunoglobulin levels and imaging examinations, the patient was finally diagnosed as moyamoya disease complicated with systemic lupus erythematosus. She was treated with aspirin, butylphthalide, urinary kallidinogenase, and sodium methylprednisolone.

Conclusions:
This was a 32-year-old young patient diagnosed with moyamoya disease carrying RNF213 gene mutation and accompanied by lupus with cerebral ischemic event as the first occurrence. The patient’s condition was complex; therefore, comprehensive analysis and in-depth consideration were needed to avoid a missed diagnosis and misdiagnosis. When the primary disease cannot be identified, genetic testing can help to clarify the diagnosis of moyamoya disease.
Sporadic Creutzfeldt-Jakob Disease Initially Presenting With Posterior Reversible Encephalopathy Syndrome
Authors: Mikhaiel John P. , Parasram Melvin , Manning Thomas , Al-Dulaimi Mohammed W. , Barnes Erin C. , Falcone Guido J. , Hwang David Y. , Prust Morgan L. 
Published: August 2023

Introduction:
Sporadic Creutzfeldt-Jakob disease (sCJD) is a fatal neurodegenerative condition caused by prion proteins. Cortical and subcortical diffusion-weighted imaging restriction on magnetic resonance imaging (MRI) is associated with sCJD. Posterior reversible encephalopathy syndrome (PRES) results from impaired vessel autoregulation due to an identifiable trigger, which is associated with subcortical fluid-attenuated inversion recovery changes on MRI. We report a case of sCJD initially presenting with PRES.

Case Report:
A 70-year-old woman presented to an outside hospital with progressive confusion and difficulty in managing activities of daily living. Initial examination revealed stuporous mental state and stimulus-induced myoclonus. MRI revealed bilateral subcortical occipital lobe T2-fluid-attenuated inversion recovery hyperintensities without contrast enhancement suggestive of PRES. Electroencephalogram (EEG) revealed frequent generalized periodic discharges meeting criteria for nonconvulsive status epilepticus. Clinical examination and EEG did not improve despite escalating antiseizure medications. Initial lumbar puncture was unremarkable. She was transferred to our hospital with a presumptive diagnosis of PRES, although there was no clear trigger. Continuous EEG revealed ongoing generalized periodic discharges with myoclonic activity meeting criteria for myoclonic seizures that were refractory to multiple antiseizure medications. Repeat MRI showed resolution of PRES but revealed subtle diffuse cortical diffusion-weighted imaging restriction. Repeat lumbar puncture was performed and 14-3-3 and real-time quaking-induced conversion returned positive, confirming sCJD.

Conclusions:
This case reports highlights that sCJD can present with neuroimaging consistent with PRES. The diagnosis of sCJD should be considered in patients with PRES who continue to show neurological decline despite optimal management and radiographic improvement of PRES on MRI. Further research is needed to identify a pathophysiological relationship between these clinical phenotypes.
Clinical Profile and Outcome of Young Infants With Hypernatremic Dehydration Presenting to the Emergency Department
Authors: Tanwar Priya , Kapoor Kanika , Kumar Ajay , Gangopadhyay Sukanya , Gera Rani 
Published: August 2023

Objectives
The aim of this study was to evaluate the clinical profile and outcome of young infants presenting to the pediatric emergency department with hypernatremic dehydration.

Methods
A prospective observational study was conducted at a tertiary care teaching hospital over a period of 18 months. All outborn sick young infants aged 2 months or younger who presented to the emergency department with symptoms and signs of possible sepsis and/or dehydration were screened, and those with hypernatremia were enrolled in the study. Those infants born at less than 37 weeks of gestation and gross congenital anomaly were excluded. Hypernatremic dehydration was defined as serum sodium levels (Se Na+)higher than 145 mEq/L. Variables used in the study were defined as per standard definitions. Acute kidney injury was defined and staged using serum creatinine as per modified neonatal Kidney Disease Improving Global Outcome guidelines. Clinical presentation, laboratory parameters, and comorbidities were compared among outcome groups (survived and died).

Results
Of 1124 outborn young infants who met the eligibility criteria for screening, 63 were diagnosed to have hypernatremic dehydration and 55 were enrolled. The hospital-based period prevalence of hypernatremic dehydration in young infants was 4.89%. The median age of presentation was 17 days (10–30). Male-to-female ratio was 1.1:1. Seventy-three percent were first in birth order. Feeding pattern showed 61.8%, 30.9%, and 7.3% of infants were exclusively breastfed, top fed, and mixed fed, respectively. The median serum sodium at the time of admission was 160 (153.5–167) mg/dL. Three (5.5%) infants had mild, 39 (70.9%) had moderate, and 13 (23.6%) had severe hypernatremic dehydration. There was statistically significant correlation between median platelet count with severity of hypernatremic dehydration. The mean time taken to correct serum sodium level was 3.30 ± 1.60 days. The case fatality rate was 41.8%. Those who died had statistically more severe hypernatremic dehydration, acute kidney injury, sepsis, and need for ventilation.

Conclusions
Acute kidney injury stage 3, shock, and need for ventilation are associated with poor outcome in infants with hypernatremic dehydration
Reconstructing Pinch Strength after Ulnar Nerve Injury by Transferring the Opponens Pollicis Motor Branch
Authors: Bertelli Jayme Augusto 
Published: August 2023

Background:
With ulnar nerve injuries, paralysis of the first dorsal interosseous and adductor pollicis muscle weakens the patient’s pinch. In the palm, we transferred the opponens pollicis motor branch to the deep terminal division of the ulnar nerve for pinch reconstruction.

Methods:
Sixteen patients with ulnar nerve injuries around the elbow underwent reconstruction and were followed up postoperatively for a minimum of 14 months. Their mean age was 41 ± 16 years, and the mean interval between injury and surgery was 134 ± 126 days (range, 2 to 390 days). Preoperatively and postoperatively, grasp, key, and subterminal key pinch strength were measured using dynamometers.

Results:
Reinnervation of the first dorsal interosseous muscle was observed in 15 of the 16 patients. Mean grasp strength improved from 15.5 ± 8.5 kg preoperatively to 24 ± 10 kg postoperatively, achieving 57% ± 16% of contralateral hand strength. Preoperatively, terminal key pinch averaged 3 ± 1 kg, which improved postoperatively to 5.5 ± 2 kg, achieving 71 ± 24% of the strength measured contralaterally. Preoperatively to postoperatively, subterminal key pinch force increased from 0 to 2.4 ± 1.3 kg, achieving 61% ± 27% that of the unaffected side. Patients who underwent surgery within 6 months of their injury showed a mean subterminal key pinch strength recovery of 63% ± 27% of the normal side, whereas those who underwent surgery between 7 and 13 months after injury showed a mean subterminal key pinch strength recovery of 51% ± 29%.

Conclusion:
Transferring the opponens pollicis motor branch to the deep terminal division of the ulnar nerve improved pinch and grasp strength without jeopardizing thumb function.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Improvement of 1-Stage Comprehensive Operation Technique for Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome
Authors: Zhao Mingyu , Wu Lehao , Li Wuyan , Wang Qianwen , Wang Tailing , Wang Jiaqi 
Published: August 2023

Background:
This retrospective case series presents the clinical results of a modified 1-stage comprehensive surgical method for blepharophimosis-ptosis-epicanthus inversus syndrome (BPES).

Methods:
A total of 25 patients with BPES underwent a modified reverse Z-plastic surgery method to bisect the epicanthus into 2 unequal V-shaped flaps and suture them alternately. The medial canthus ligament was partially incised, shortened, and sutured; the outer canthus was opened with a V-Y flap. The gray line of the outer canthus was cut to extend the eyelid margin length. Ptosis was corrected using the orbicularis oculi–frontalis composite flap technique. We studied the inner intercanthal distance (IICD), interpupillary distance (IPD), horizontal palpebral fissure length (HPFL), marginal reflex distance 1 (MRD-1), IICD/IPD ratio, IICD/HPFL ratio, Vancouver Scar Scale, and overall postoperative satisfaction.

Results:
The 25 patients included 12 girls and 13 boys (mean age, 8.3 ± 6.8 years), 19 of whom had a family history of BPES. The mean IPD value was 50.15 ± 7.43 mm. IICD decreased from 39.38 ± 2.39 mm preoperatively to 31.64 ± 2.37 mm postoperatively, IICD/IPD from 0.8 ± 0.1 preoperatively to 0.6 ± 0.1 postoperatively (P < 0.05), and IICD/HPFL from 1.98 ± 0.33 preoperatively to 1.22 ± 0.10 postoperatively (P < 0.01). HPFL increased from 20.08 ± 3.53 mm preoperatively to 26.04 ± 1.36 mm postoperatively (P < 0.01), and MRD-1 from −1.12 ± 0.71 mm preoperatively to 3.24 ± 0.47 mm postoperatively (P < 0.01). The postoperative Vancouver Scar Scale score was 3.68 ± 1.07. Patient satisfaction was rated as 8.8 ± 1.08, with a relatively high overall satisfaction rate.

Conclusions:
The corrective effect on BPES was noticeable, improving the IICD/HPFL and IICD/IPD ratios. Postoperative scars were not evident, and patient satisfaction was high.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.