bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of a Novel Zigzag Application Pattern for Micropulse Transscleral Cyclophotocoagulation for the Management of Glaucoma
Authors: Sami Ahmed , Aboulnasr Tarek T. , El-Shahed Ahmed F. 
Published: August 2022

Précis:
A zigzag mode of application effectively lowered IOP in glaucoma patients at 6 months with a low incidence of complications despite the longer application time. Comparative studies to assess the potential advantages of treating a larger area of ciliary body with this approach are needed.

Purpose:
The purpose of this study is to evaluate the clinical outcome of micropulse transscleral laser cyclophotocoagulation with zigzag mode of application in adult glaucomatous patients.

Subjects and Methods:
A prospective single-arm clinical trial included a series of 34 eyes of 30 consecutive patients who underwent micropulse transscleral cyclophotocoagulation (MP-TSCPC) with zigzag technique at a private ophthalmology center. The trial was conducted from March 16, 2021 to April 12, 2021. Patients who had at least 6 months of follow-up were included. MP-TSCPC probe was moved for 2 mm perpendicular to a line 3 mm parallel to the cornea. This aims to cover the largest circumference of the area supposed to hinder the cilliary body. The probe is moved over 3 quadrants for 90 seconds for each quadrant (total 270 s). Defined as an intraocular pressure (IOP) of 6 to 21 mm Hg or a reduction of IOP by 30%. Failure was defined as an inability to meet the criteria for success or need for retreatment.

Results:
The mean age of involved patients was 52.9 (±SD: 3.9) years old. The mean IOP before MP-TSCPC was 37.47 (±SD: 11.08) mm Hg, which was significantly reduced to 17.7 (±SD: 7.4) mm Hg in the last follow-up visit at 6 months. Number of medications showed significant reduction from mean 3.44 (±SD: 0.99) to 1.91 (±SD: 1.26) in the last follow-up. Success rate was found to be 88% (30 out of 34 eyes) at the final follow-up, where 9 cases showed complete success (26.5%), whereas 21 (61.8%) cases showed qualified success. Despite the relatively higher parameters used in our study, no cases reported postoperative complications apart from only 1 case of reduced visual acuity by 1 line.

Conclusions:
A zigzag mode of application effectively lowered IOP in glaucoma patients at 6 months with a low incidence of complications despite the longer application time. Comparative studies to assess the potential advantages of treating a larger area of ciliary body with this approach are needed.
Risk Factors for Trabeculotomy Failure in Primary Congenital Glaucoma
Authors: Aktas Zeynep , Ucgul Ahmet Y. , Boluk Ceyda E. , Atalay Hatice T. 
Published: August 2022

Précis:
This study demonstrates that a baseline corneal diameter >12.25, initial age <4 months at diagnosis, higher baseline IOP than 24 mm Hg, bilaterality, or inability to perform circumferential trabeculotomy, increases the risk of surgical failure of trabeculotomy in patients with primary congenital glaucoma (PCG).

Purpose:
The aim of this study was to identify clinical predictive factors for surgical failure and to evaluate potential prognostic factors affecting surgical success in patients with PCG who underwent trabeculotomy.

Patients and Methods:
The medical charts of 123 eyes of 75 patients who underwent trabeculotomy surgery for the treatment of PCG were retrospectively reviewed. At baseline and each visit, intraocular pressure (IOP), corneal diameter, cup to disc ratio, axial length, number of medications, and need for further glaucoma surgery were noted. Surgical success was defined as an IOP ≤18 mm Hg and 20% IOP reduction from baseline with (qualified) or without (complete) medication and without any further IOP-lowering surgery.

Results:
The mean age at surgery was 4.2±6.6 months and the mean follow-up time was 60.0±37.6 months. The receiver operating characteristic curve showed 4 following best cutoff values to predict surgical failure: the first for age at surgery was 4.5 months; the second baseline IOP was 24.0 mm Hg; the third for baseline cup to disc ratio was 0.4; and the fourth for baseline corneal diameter was 12.25 mm. Multivariate logistic regression analysis revealed that baseline IOP more than 24 mm Hg increased the risk of surgical failure by 2 times, baseline mean corneal diameter >12.25 mm did by 4.2 times, younger age than 4 months did by 2.5 times, bilaterality did by 1.5 times.

Conclusions:
A higher baseline IOP, younger age, larger corneal diameter, and bilaterality were identified as risk factors for trabeculotomy failure in congenital glaucoma. The presence of one or more of these should be considered in the decision-making process when considering surgical options to manage glaucoma in these patients.
Association of Ultra-Short-Term Intraocular Pressure Fluctuation With Disease Progression in Primary Angle Closure Glaucoma: The CUPAL Study
Authors: Tan Shaoying , Yu Marco , Baig Nafees , Chan Poemen P. , Tang Fang Yao , Cheung Carol Y. , Tham Clement C.Y. 
Published: August 2022

Précis:
This study demonstrated significant differences in ultra-short-term IOP fluctuations, measured by a contact lens sensor between progressive and stable PACG eyes, during the first one hour after falling asleep.

Purpose:
To identify the most sensitive period for detecting significant ultra-short-term intraocular pressure (IOP) fluctuation associated with disease progression in primary angle closure glaucoma (PACG).

Materials and Methods:
PACG eyes, which had been followed up for over 2 years under the CUHK PACG Longitudinal (CUPAL) Study, were recruited. Eyes with or without functional or structural glaucomatous progression were classified into ‘progressive’ or ‘stable’ groups on the basis of serial visual field and retinal nerve fiber layer (RNFL) thickness documentations, respectively. Ultra-short-term IOP fluctuations were recorded by Sensimed Triggerfish sensors (Sensimed AG, Lausanne, Switzerland) with 288 readings over 30 seconds, at 5-minute intervals, over a 24-hour period. In each of 7 activity-related 1-hour periods during the examining day, the mean value of the amplitude-frequency profiles of the signal fluctuations in twelve 30-second intervals was calculated by semivariogram/semi-variance. The ‘progressive’ and ‘stable’ groups were compared by permutation tests on functional t-statistics.

Results:
Among the 25 recruited PACG eyes, 16 eyes were classified as RNFL ‘progressive’ group (the mean rate of change in global RNFL thickness: -0.199 ±0.128 μm/mo). Higher signal fluctuations, in terms of amplitude-frequency, were found during the first 1-hour period of sleeping in the RNFL ‘progressive’ group compared with the RNFL ‘stable’ group (P=0.028).

Conclusions:
Between RNFL ‘progressive’ and ‘stable’ PACG eyes, significant differences in ultra-short-term IOP fluctuation at the 1-hour period after falling asleep were identified. The first hour of sleeping may be the most sensitive period for detecting significant ultra-short-term IOP fluctuation in PACG eyes.
Patterns of Optical Coherence Tomography Imaging in Preperimetric Open Angle Glaucoma: A Comparative Study With Young-Age-Onset and Old-Age-Onset Eyes
Authors: Bak Eunoo , Sun Sukkyu , Wy Seoyoung , Kim Yong Woo , Kim Young Kook , Park Ki Ho , Kim Hee Chan , Jeoung Jin Wook 
Published: August 2022

Précis:
Optic coherence tomography imaging in preperimetric open angle glaucoma (OAG) differed between young-age-onset and old-age-onset eyes. Inferior and superior quadrants were thinner in young and old-age-onset eyes, respectively. Understanding the specific patterns of early glaucomatous damage based on age-at-onset may improve glaucoma diagnosis and monitoring.

Purpose:
To investigate the patterns of retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) thinning in preperimetric OAG by optical coherence tomography based on age at onset (“young-age onset (<40 y)” vs. “old-age onset (≥40 y)”.

Materials and Methods:
The RNFL and GCIPL deviation images were acquired by Cirrus HD-optical coherence tomography, and overlaid, thus converted to a “deviation frequency map”, respectively. The topographic thinning patterns and parameters of RNFL and GCIPL thickness measurements were compared.

Results:
A total of 194 eyes of 194 patients with preperimetric OAG and 97 eyes of 97 age-matched normal subjects were analyzed. Young-age-onset eyes of preperimetric OAG mainly had RNFL defects inferotemporally (264–296 degrees) with GCIPL defects in the inferior region (213–357 degrees). Old-age-onset preperimetric OAG eyes had RNFL defects inferotemporally (266–294°) and superotemporally (33–67 degrees), with GCIPL defects in the inferior and superior regions (206–360 degrees, 0–22 degrees). The inferior quadrant of RNFL and GCIPL thicknesses were significantly thinner in young-age-onset eyes compared with old-age-onset eyes (P=0.012, 0.016), while the superior quadrant of those were significantly thinner in the old-age-onset eyes (P=0.003, 0.005).

Conclusion:
Young-age-onset and old-age-onset eyes of preperimetric OAG present different specific patterns of RNFL and GCIPL thinning.
Healthcare-associated Infections in Very Low Birth–weight Infants in a South African Neonatal Unit: Disease Burden, Associated Factors and Short-term Outcomes
Authors: Lloyd Lizel Georgi , Bekker Adrie , Van Weissenbruch Mirjam M. , Dramowski Angela 
Published: August 2022

Background:
Infection is a leading cause of death among very low birth–weight (VLBW) infants in resource-limited settings.

Methods:
We performed a retrospective review of healthcare-associated infection (HAI) episodes among VLBW infants from January 1, 2016, to December 31, 2017. The epidemiology, causative organisms and short-term outcomes were analyzed. Logistic regression was used to investigate for factors associated with development of HAI.

Results:
During the study period, 715 VLBW infants with suspected HAI were investigated, including 162/715 (22.7%) proven and 158/715 (22.1%) presumed HAI. Of the proven infections, 99/162 (61.1%) contained at least one Gram-negative organism per blood culture; 84/162 (51.9%) single Gram-negative organisms and 15/162 (9.3%) polymicrobial growth. Independent factors associated with development of any HAI included low gestational age, small for gestational age, indwelling central venous catheter and invasive ventilation. Compared with infants in whom HAI had been excluded, infants with HAI were more likely to be diagnosed with necrotizing enterocolitis (5.6% vs. 23.1%; P < 0.001) and bronchopulmonary dysplasia (1.0% vs. 4.4%; P = 0.007). Infants with any HAI also had a longer hospital stay [44 (25–65) vs. 38 (26–53) days; P < 0.001] and increased mortality [90/320 (28.1%) vs. 21/395 (5.3%); P < 0.001] compared with infants who did not develop HAI episodes.

Conclusions:
Proven and presumed HAI are a major contributor to neonatal morbidity and mortality; further research is urgently needed to better understand potential targets for prevention and treatment of HAI in resource-limited neonatal units.
The role of gut-derived oxidized lipids and bacterial lipopolysaccharide in systemic inflammation and atherosclerosis
Authors: Wang Huan , Reddy Srinivasa T. , Fogelman Alan M. 
Published: August 2022

Purpose of review
This review explores mechanisms by which gut-derived bacterial
lipopolysaccharide (LPS) and oxidized phospholipids contribute to chronic systemic inflammation and atherosclerosis.

Recent findings
Gut-derived LPS enters through the small intestine via two distinct pathways that involve high density lipoproteins (HDL) and chylomicrons. Gut-derived LPS can bind to the LPS-binding protein (LBP) and to HDL3 in the small intestine and travel through the portal vein to the liver where it does not elicit an inflammatory reaction, and is inactivated or it can bind to HDL2 and travel through the portal vein to the liver where it elicits an inflammatory reaction. Alternatively, in the small intestine, LPS can bind to LBP and chylomicrons and travel through the lymphatics to the systemic circulation and enhance inflammatory processes including atherosclerosis. Oxidized phospholipids formed in the small intestine regulate the levels and uptake of LPS in small intestine by regulating antimicrobial proteins such as intestinal alkaline phosphatase. Gut-derived LPS and oxidized phospholipids may be responsible for the persistent inflammation seen in some persons with human immunodeficiency virus on potent antiretroviral therapy with undetectable virus levels.

Summary
By targeting gut-derived oxidized phospholipids, the uptake of gut-derived LPS may be reduced to decrease systemic inflammation and atherosclerosis.
Prognostic Value of Regular Nutritional Treatment in Patients With Amyotrophic Lateral Sclerosis
Authors: Altinkaynak Mustafa , Gok Gokhan Kerim , Ozmen Bahar , Buyukdemir Serpil , Akpinar Timur Selcuk , Erten Sebile Nilgun , Saka Bulent 
Published: August 2022

Background:
Malnutrition adversely affects the prognosis of amyotrophic lateral sclerosis (ALS). The aim of this study was to evaluate the effect of regular nutrition treatment and follow-up in clinical nutrition outpatient clinic (CNOC) on survival in ALS patients.

Materials and Methods:
The study included 55 ALS patients who were admitted and followed up in CNOC. Malnutrition was diagnosed using ESPEN criteria and nutrition treatment was planned according to needs of each patient. Nutritional status was followed up by body mass index (BMI), bioelectrical impedence analysis, and serum albumin. During the follow-up, survivors and nonsurvivors were compared according to their nutrition treatment success and changes in the anthropometric and laboratory measurements.

Results:
Body weight, BMI, and fat free mass were decreased during the follow-up in both survivors and nonsurvivors (P<0.01). The decrease in the serum albumin and BMI were significantly higher in nonsurvivors (P<0.01). Mortality rate was lower in those with higher adherence to nutrition treatment (P<0.01) and patients with lower adherence to nutrition treatment showed more significant decrease in serum albumin levels (P<0.01).

Conclusion:
A personalized nutrition treatment combined with increased nutritional adherence in CNOC can decrease mortality in ALS patients.
TSC/MTOR-associated Eosinophilic Renal Tumors Exhibit a Heterogeneous Clinicopathologic Spectrum
Authors: Xia Qiu-yuan , Wang Xiao-tong , Zhao Ming , He Hui-ying , Fang Ru , Ye Sheng-bing , Li Rui , Wang Xuan , Zhang Ru-song , Lu Zhen-feng , Ma Heng-hui , Wang Zi-yu , Rao Qiu 
Published: August 2022

Background:
Several TSC1/2- or MTOR-mutated eosinophilic renal tumor subsets are emerging, including eosinophilic solid and cystic renal cell carcinoma (ESC RCC), eosinophilic vacuolated tumors (EVTs) and low-grade oncocytic tumors (LOTs). “Unclassified renal tumors with TSC/MTOR mutations” (TSC-mt RCC-NOS) do not meet the criteria for other histomolecular subtypes. Whether these tumors represent a continuum of 1 TSC/MTOR-mutation-associated disease is unknown.

Design:
We evaluated the clinicopathologic and IHC profiles of 39 eosinophilic renal tumors with targeted DNA sequencing-confirmed TSC/MTOR mutations. Twenty-eight of these, plus 6 ChRCC, 5 RO, 5 ccRCC, 7 MiT RCC and 6 normal renal tissues, were profiled transcriptionally by RNA-seq.

Results:
The 39 cases were reclassified based on morphological and IHC features as ESC RCC (12), EVT (9), LOT, (8) and TSC-mt RCC-NOS (10). The mutation profiles demonstrated consistency; ESC RCCs (12/12) had TSC mutations, and most LOTs (7/8) had MTOR mutations. Ten TSC-mt RCC-NOSs exhibited heterogeneous morphology, arising a differential diagnosis with other renal tumors, including MiT RCC, PRCC and epithelioid PEComa. RNA sequencing-based clustering segregated ESC RCC, EVT and LOT from each other and other renal tumors, indicating expression profile-level differences. Most TSC-mt RCC-NOSs (6/7) formed a mixed cluster with ESC RCC, indicating similar expression signatures; one TSC-mt RCC-NOS with unusual biphasic morphology clustered with EVT.

Conclusions:
We expanded the TSC/MTOR-associated eosinophilic renal tumor morphologic spectrum, identified gene mutation characteristics, and highlighted differential diagnosis challenges, especially with MiT RCC. ESC RCC, EVT, and LOT having distinct expression profiles. TSC-mt RCC-NOS may cluster with recognized TSC/MTOR-associated entities.
Characteristics of a Pediatric Emergency Psychiatric Telephone Triage Service
Authors: Cancilliere Mary Kathryn , Ramanathan Amrita , Hoffman Pamela , Jencks Jennifer , Spirito Anthony , Donise Kathleen 
Published: August 2022

Objectives
Caregivers of youth in psychiatric crisis often seek treatment from hospital emergency departments (EDs) as their first point of entry into the mental health system. Emergency departments have struggled over the last decade with growing numbers and now, because of the pandemic, have experienced a deluge of mental health crises. As one approach to divert unnecessary ED admissions, pediatric emergency psychiatric telephone triage services have been created. This study aimed to define the characteristics and utilization of a pediatric triage service and to examine clinician documentation of calls to identify the assessment of risk and disposition.

Methods
This study included 517 youth (2–18 years; mean, 12.42 years; SD, 3.40 years) who received triage services in the winter of 2 consecutive years. Triage calls were received from caregivers (>75%), schools (17.0%), and providers (6.6%) regarding concerns, including suicidal ideation (28.6%), school issues (28.6%), and physical aggression (23.4%).

Results
Dispositions were for acute, same-day evaluation (9.7%), direct care service (28.8%), further evaluation (within 48–72 hours, 40.0%), and resource/service update information (21.5%). Findings revealed that most clinical concerns were referred for further evaluation. Both adolescent females and males were referred for emergency evaluations at high rates.

Conclusions
A dearth of information on pediatric crisis telephone triage services exists; thus, developing an evidence base is an important area for future work. This information assists not only in our understanding of which, why, and how many youths are diverted from the ED but allows us to extrapolate significant costs that have been saved because of the utilization of the triage service.
Willingness to use nonpharmacologic treatments for musculoskeletal pain in the emergency department: a cross-sectional study
Authors: Eucker Stephanie A. , Foley Shawna , Peskoe Sarah , Gordee Alexander , Risoli Thomas , Morales Frances , George Steven Z. 
Published: August 2022

Abstract

Objectives:
Pain is an individual experience that should incorporate patient-centered care. This study seeks to incorporate patient perspectives toward expanding nonpharmacologic treatment options for pain from the emergency department (ED).

Methods:
In this cross-sectional study of adult patients in ED with musculoskeletal neck, back, or extremity pain, patient-reported outcomes were collected including willingness to try and prior use of various nonpharmacologic pain treatments, sociodemographics, clinical characteristics, functional outcomes, psychological distress, and nonmusculoskeletal symptoms. Least absolute shrinkage and selection operator regression identified variables associated with (1) willingness to try and (2) having previously tried nonpharmacologic treatments.

Results:
Responses were analyzed from 206 adults, with a mean age of 45.4 (SD 16.4) years. The majority (90.3%) of patients in ED were willing to try at least one form of nonpharmacologic pain treatment, with 70.4%, 81.6%, and 70.9% willing to try respective subcategories of active (eg, exercise), passive (eg, heat), and psychosocial (eg, prayer) modalities. Only 56.3% of patients had previously tried any, with 35.0%, 52.4%, and 41.3% having tried active, passive, and psychosocial modalities, respectively. Patient-level factors associated with willingness included pain in upper back, more severe pain-related symptoms, and functional impairments. The factor most consistently associated with treatment use was health care provider encouragement to do so.

Conclusions:
Patients in ED report high willingness to try nonpharmacologic treatments for pain. Higher pain severity and interference may indicate greater willingness, while health care provider encouragement correlated with treatment use. These findings may inform future strategies to increase the introduction of nonpharmacologic treatments from the ED.
Associations of Polypharmacy With Clinical Parameters, Function, and Health-Related Quality of Life in Psoriatic Arthritis
Authors: Erdem Gürsoy Didem , Gezer Halise Hande , Acer Kasman Sevtap , Duruöz Mehmet Tuncay 
Published: August 2022

Objective
The aim of this study was to assess predictors of polypharmacy and its effect on health-related quality of life in patients with psoriatic arthritis (PsA).

Methods
This cross-sectional study was performed between February and December 2019. The number of medications was grouped into minor (2–4) and major (≥5) polypharmacy. Functional status and quality of life were assessed using the Health Assessment Questionnaire and Short-Form 36, respectively. Clinical and demographic characteristics, physical function, and quality of life of the polypharmacy group were compared. Predictive factors for major polypharmacy were evaluated using a logistic regression analysis.

Results
The mean age of the 100 patients (70 females and 30 males) with PsA was 48.43 ± 12.94 years. The proportion of patients with major polypharmacy was 19%. The physical function subscale of Short-Form 36 was lower in the major polypharmacy group (p = 0.009). Univariable analysis revealed that sex, body mass index, disease duration, disease activity, psoriasis severity, dactylitis, enthesitis, PsA subtypes, smoking, and Health Assessment Questionnaire were not associated with major polypharmacy (p > 0.10). In the multivariable model, the number of comorbidities (odds ratio, 3.151; 95% confidence interval, 1.828–5.429; p < 0.001) and age ≥60 years (odds ratio, 4.864; 95% confidence interval, 1.159–20.418; p = 0.031) were significantly associated with major polypharmacy.

Conclusions
The number of comorbid diseases and age ≥60 years were the factors associated with major polypharmacy in patients with PsA. Although physical function was not associated with polypharmacy, patients with major polypharmacy had poorer quality of life.
Does Cancer Masquerade as Sarcoidosis?
Authors: Albert Daniel 
Published: August 2022

Background/Objective
Sarcoidosis is a granulomatous disorder. Rarely, malignancy is accompanied by a granulomatous reaction. This retrospective study addressed whether cancer can masquerade as sarcoidosis.

Methods
TriNetX identified 1029 newly diagnosed cases of sarcoidosis between October 2015 and September 2020, of whom 50 had a subsequent diagnosis of malignancy.

Results
In 36 cases, the malignancy was unrelated to sarcoidosis. In 7 cases, the diagnosis of sarcoidosis delayed the eventual cancer diagnosis by a range of 1 month to 2 years. In 7 cases, the subsequent diagnosis of cancer might have been related to the therapy for sarcoid.

Conclusions
Cancer masquerading as sarcoidosis is very rare occurring in 7 (0.7%) of our 1029 cases. In no case was lung cancer masquerading as sarcoidosis. Searching for occult malignancy in patients with a known diagnosis of sarcoidosis is rarely indicated.