bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiographic Fusion Rates Following a Stand-alone Interbody Cage Versus an Anterior Plate Construct for Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion
Authors: Gandhi Sapan D. , Fahs Adam M. , Wahlmeier Steven T. , Louie Philip , Possley Daniel R. , Khalil Jad G. , Park Daniel K. 
Published: January 2020

Study Design.
Case–control.

Objectives.
The aim of this study was to evaluate fusion rates and compare a stand-alone cage construct with an anterior-plate construct in the setting revision anterior cervical discectomy and fusion (ACDF) for adjacent segment disease.

Summary of Background Data.
Anterior cervical discectomy and fusion are considered the criterion standard of surgical treatment for cervical myelopathy and radiculopathy. One common consequence is adjacent segment disease. Treatment of adjacent segment disease is complicated by the previous surgical implants, which may make application of an additional anterior cervical plate difficult. Stand-alone cage constructs obviate the need for removal or revision of prior implants in the setting of adjacent segment disease.

Methods.
All patients undergoing surgery for adjacent segment disease in a 2-year period were identified and separated into groups based on implant construct. A control group of patients undergoing primary, single-level ACDF were selected from during the same 2-year period. Demographic variables, fusion rate, and reoperation rate were compared between groups. Continuous variables were compared using Student t test, fusion, and revision rates were compared using Pearson χ
2 test.

Results.
Patients undergoing primary ACDF had lower age and American Society of Anesthesia score as well as shorter operative time. Fusion rate was higher for primary ACDF compared to all patients who underwent ACDF for adjacent segment disease (95% vs. 74%). When compared to primary ACDF, patients with a stand-alone cage construct had significantly lower fusion rate (69% vs. 95%) and higher reoperation rate (14% vs. 0%). There were no significant differences in anterior plate construct versus stand-alone cage construct in terms of fusion and reoperation.

Conclusion.
Symptomatic adjacent segment disease can be managed surgically with either revision anterior plating or a stand-alone cage constructs, although our results raise questions regarding a difference in fusion rates that requires further investigation.

Level of Evidence: 3
Advances in the development of chimeric antigen receptor-T-cell therapy in B-cell acute lymphoblastic leukemia
Authors: Zhang Xian , Li Jing-Jing , Lu Pei-Hua 
Published: January 2020

Abstract
CD19-targeted chimeric antigen receptor T-cell (CAR-T) therapy is effective in refractory/relapsed (R/R) B-cell acute lymphoblastic leukemia (B-ALL). This review focuses on achievements, current obstacles, and future directions in CAR-T research. A high complete remission rate of 68% to 93% could be achieved after anti-CD19 CAR-T treatment for B-ALL. Cytokine release syndrome and CAR-T-related neurotoxicity could be managed. In view of difficulties collecting autologous lymphocytes, universal CAR-T is a direction to explore. Regarding the high relapse rate after anti-CD19 CAR-T therapy, the main solutions have been developing new targets including CD22 CAR-T, or CD19/CD22 dual CAR-T. Additionally, some studies showed that bridging into transplant post-CAR-T could improve leukemia-free survival. Some patients who did not respond to CAR-T therapy were found to have an abnormal conformation of the CD19 exon or trogocytosis. Anti-CD19 CAR-T therapy for R/R B-ALL is effective. From individual to universal CAR-T, from one target to multi-targets, CAR-T-cell has a chance to be off the shelf in the future.
Systematic Review and Meta-Analyses: Motor Skill Interventions to Improve Fine Motor Development in Children Aged Birth to 6 Years
Authors: Strooband Karel F. B. , Rosnay Marc de , Okely Anthony D. , Veldman Sanne L. C. 
Published: January 2020

ABSTRACT:

Objective:
The objective of this study was to systematically review the evidence of motor skill intervention programs on typically developing children's fine motor development aged birth to 6 years.

Methods:
Six electronic databases were searched with no date restrictions. Inclusion criteria were any school-, community-, or home-based intervention targeting the development of fine motor skills of children aged birth to 6 years; randomized controlled trials using quasiexperimental, experimental, or single group prepost designs with a minimum sample size of 15 participants per group; and statistical analyses of fine motor skill development at both preintervention and postintervention or addressing the intervention effects on fine motor skill development. Data were extracted on design, participants, intervention components, methodological quality, and efficacy.

Results:
Twenty-five of the total 31 studies reported positive intervention effects on fine motor skills. The meta-analyses included 19 studies and revealed moderate effect sizes of motor skill programs on fine motor, visual motor, and manual dexterity outcomes. There were substantial differences between intervention settings, facilitators, length, and content with most studies implemented in school settings and facilitated by teachers.

Conclusion:
Fine motor skill development in the early years is an extensive upcoming field of interest for many international researchers. This review study presents evidence on the positive effects of intervention programs that aim to enhance fine motor skills for young children. The findings are promising but need to be interpreted with caution because of the high risk of bias in many of the studies.
Wandering Among Preschool Children with and Without Autism Spectrum Disorder
Authors: Wiggins Lisa D. , DiGuiseppi Carolyn , Schieve Laura , Moody Eric , Soke Gnakub , Giarelli Ellen , Levy Susan 
Published: January 2020

ABSTRACT:

Objectives:
(1) Report the occurrence of wandering, or leaving a supervised space, among children with confirmed autism spectrum disorder (ASD), other developmental delay (DD) with a previous but unconfirmed ASD diagnosis (DDprevASD), DD without a previous ASD diagnosis, and a population comparison group (POP) at an age when wandering is no longer expected and (2) explore whether ASD status is associated with wandering independent of behavioral, developmental, and maternal factors.

Method:
Parents and children aged 4 to 5 years enrolled in the Study to Explore Early Development Phase-1+2. All children were screened for ASD symptoms upon enrollment. Those with ASD symptoms and/or a previous ASD diagnosis received the Mullen Scales of Early Learning (MSEL) to determine their developmental level and 2 ASD diagnostic tests to determine their ASD status. All other children were evaluated with the MSEL alone. Mothers completed the Child Behavior Checklist/1½-5, which includes an item on whether the child wanders away (categorized as at least sometimes true vs not true) and items assessing behavior problems.

Results:
Children with ASD (N = 1195) were significantly more likely to wander than children classified as DDprevASD (N = 230), DD (N = 1199), or POP (N = 1272) (60.4%, 41.3%, 22.3%, and 12.4%, respectively, p < 0.01). ASD status, very low developmental level, and affective, anxiety, attention, and oppositional problems were each independently associated with wandering behavior.

Conclusion:
Wandering is significantly more common among children with ASD and those with behavioral and developmental problems compared with other children. These findings can be used to increase the awareness of wandering among children with atypical development.
Postoperative Infections in Dermatologic Surgery: The Role of Wound Cultures
Authors: Ken Kimberly M. , Johnson Mariah M. , Leitenberger Justin J. , Neal Donald E. , Etzkorn Jeremy R. , Govas Panayiota , Carroll Bryan T. , Badawi Ahmed H. , Mudigonda Tejaswi , Council M. Laurin , Avila Christina , Carr David R. , Sasaki Jodie , Blalock Travis W. , Golda Nicholas J. 
Published: January 2020

BACKGROUND
Dermatologic surgery is associated with low postoperative infection rates, averaging from approximately 1% to 4.25%. Often, postoperative infections are treated empirically based on clinical diagnosis of infection, given it can take 48 to 72 hours for a wound culture to identify a pathogen.

OBJECTIVE
We aimed to evaluate the efficacy of empiric antibiotics in dermatologic surgery postoperative infections and if wound cultures change postoperative antibiotic therapy.

METHODS
A 7-center, retrospective analysis of postoperative infections, with culture data, in dermatologic surgery patients was performed.

RESULTS
Of 91 cases of clinically diagnosed postoperative infection, 82.4% (n = 75) were successfully treated with empiric oral antibiotics (95% confidence interval [0.73–0.89], p < .0001). In 16 (17.6%) cases, initial empiric antibiotics were unsuccessful, and wound culture results altered antibiotic therapy in 9 cases (9.9%) with 6 (6.6%) of these cases requiring additional coverage for methicillin-resistant Staphylococcus aureus (MRSA).

CONCLUSION
Empiric antibiotic treatment is usually appropriate for patients with postoperative surgical-site infections with wound cultures altering antibiotic management in a minority of cases. When empiric antibiotics fail, lack of MRSA coverage is usually the cause; therefore, providers should be aware of local MRSA prevalence and susceptibilities.
Botulinum Toxin Injections for Leg Contouring in East Asians
Authors: Cheng Judy , Chung Hye Jin , Friedland Matthew , Hsu Sarah Hahn 
Published: January 2020

BACKGROUND
A common aesthetic concern among East Asian women is enlarged calves. Although surgical resection has been a traditional treatment option, botulinum toxin injections into the gastrocnemius muscle are an emerging, noninvasive alternative.

OBJECTIVE
To perform a literature review on botulinum toxin injections for leg contouring.

MATERIALS AND METHODS
A literature review was conducted using PubMed, Web of Science, Embase, and Cochrane's CENTRAL database to identify articles relating to combinations of the terms botulinum toxin, gastrocnemius, calves, and leg contouring.

RESULTS
Based on the limited publications to date, the authors prepared a review on how to treat an enlarged calf with botulinum toxin including injection techniques, anticipated efficacy, outcome monitoring, and potential side effects.

CONCLUSION
Botulinum toxin injections for calf reduction are an emerging, noninvasive treatment option. Studies to date suggest that it is an efficacious method with few immediate side effects. Future areas for investigation include defining the criteria for calf hypertrophy, minimum effective dosage of botulinum toxin, and the potential long-term effects of injections.
Perception of Beauty in the Visually Blind: A Pilot Observational Study
Authors: Dayan Steven H. , Cristel Robert T. , Gandhi Nimit D. , Fabi Sabrina G. , Placik Otto J. , Montes Jose R. , Kalbag Arjun 
Published: January 2020

BACKGROUND
Blind individuals have demonstrated the ability to detect danger and facial expressions without conscious awareness of visual stimuli. These embodied sensations are believed to be the result of primitive neural networks refined by evolutionary adaptations. We postulate that similar embodied sensations may have evolved to allow blind individuals to perceive beauty.

OBJECTIVE
To determine whether the visually blind can detect physical beauty.

PATIENTS AND METHODS
This observational study consisted of 8 blind and 10 nonblind test subjects and 6 models that were categorized into predetermined beauty categories. Test subjects were individually asked to rate 6 models on a 1 to 10 numerical beauty scale. This process was repeated in both groups while blindfolded (masked). All groups' mean model beauty scores underwent multivariate and univariate analysis.

RESULTS
All groups rated preselected (greater than 8) more beautiful models, higher except for the masked, nonblind group. Intraclass correlation was good in the blind raters with a score of 0.751, whereas poor in the nonblind masked raters with a score of 0.458.

CONCLUSION
This is the first pilot study demonstrating with supporting evidence that blind individuals can detect beauty and supports that beauty may rely on primal forms of messaging that are subconsciously appreciated.
High-quality chest compressions are possible during intra-hospital transport, but depend on provider position
Authors: Jansen Gerrit , Kipker Kristin , Latka Eugen , Borgstedt Rainer , Rehberg Sebastian 
Published: January 2020

BACKGROUND
Treatment of reversible causes of cardiac arrest often requires intrahospital transportation during ongoing resuscitation. But high-quality chest compression with minimal interruption is the most essential prerequisite for an optimal outcome after cardiac resuscitation.

OBJECTIVE
We aimed to evaluate chest compression quality according to the provider position during intrahospital transportation.

DESIGN
Manikin observational study.

SETTING
German Tertiary Care Hospital.

PARTICIPANTS
A total of 20 paramedics (eight female, 12 male); average professional experience 4.8 ± 3.1 years since their initial enrolment for training.

INTERVENTION(S)
Participants performed chest compressions during simulated intrahospital transportation in four groups: provider kneeling beside manikin on the floor (control group), walking next to the bed (group 1), kneeling on the bed beside the manikin (group 2), kneeling astride the manikin on the bed (group 3).

MAIN OUTCOME MEASURES
Quality metrics as European Resuscitation Council Guidelines 2015. Subsequently, the participants were asked to assess their own subjective feelings of safety, comfort and strain, and to recommend one position.

RESULTS
The quality of chest compression in the control group and groups 2 and 3 did not differ significantly. Group 1 performed significantly worse in terms of the correct hand placement on the chest (P = 0.044 vs. control group) and compression depth (P = 0.004 vs. control group, P = 0.035 vs. group 2, P = 0.006 vs. group 3). Transport speed was faster in groups 2 and 3 vs. group 1 (P < 0.05 vs. group 1, P < 0.05 vs. group 2). The majority of participants rated position 1 as unsafe (90%), unpleasant (100%) and exhausting (100%). They predominantly favoured position 3 (70%).

CONCLUSION
Performing guideline-compliant chest compressions during intra-hospital transportation is feasible with an appropriate provider position. Our results suggest, kneeling beside or astride the patient on the bed enables high-quality chest compressions, faster transport and is perceived by the providers as more pleasant. ‘Walking next to the bed’ while performing chest compressions should be avoided.
Postoperative residual neuromuscular blockade after reversal based on a qualitative peripheral nerve stimulator response
Authors: Lee Yea-Ji , Oh Ah-Young , Koo Bon-Woo , Han Ji-Won , Park Jae-Hee , Hong Jung-Pyo , Seo Kwang-Suk 
Published: January 2020

BACKGROUND
Incomplete recovery of neuromuscular blockade is a common postoperative adverse event in the postanaesthesia care unit.

OBJECTIVE
We examined and compared the incidence of residual neuromuscular blockade when the recommended dose of neostigmine or sugammadex was administered according to a qualitative nerve stimulator response.

DESIGN
A randomised controlled trial.

SETTING
A tertiary care hospital in South Korea from September 2017 to November 2017.

PATIENTS
Eighty patients aged between 18 and 69 years were included in this study. All were patients scheduled to undergo elective laparoscopic cholecystectomy and who had an American Society of Anaesthesiologists physical status of one or two were eligible.

INTERVENTIONS
Patients were allocated randomly to receive neostigmine or sugammadex at the end of surgery. The doses of the reversal agents were based on the response to peripheral nerve stimulation, which was discontinued after administration of the reversal agent.

MAIN OUTCOME MEASURES
The primary outcome was the incidence of postoperative residual neuromuscular blockade. The secondary outcomes were the incidences of symptoms or signs of residual neuromuscular blockade such as hypoxaemia, inability to maintain head-lift for 5 s and diplopia.

RESULTS
The incidence of residual neuromuscular blockade on arrival in the recovery room was 44.4% in the neostigmine group and 0% in the sugammadex group (P < 0.0001, relative risk = 1.80, 95% confidence interval 1.36 to 2.41). The incidences of adverse events in the recovery room were low and comparable between the groups.

CONCLUSION
The incidence of residual neuromuscular blockade on arrival in the recovery room was significantly higher in the neostigmine group than that in the sugammadex group. However, the incidence of adverse events was similar in the neostigmine and sugammadex groups.

TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT03292965.
Management of Sural Nerve Neuromas with Targeted Muscle Reinnervation
Authors: Fracol Megan E. , Dumanian Gregory A. , Janes Lindsay E. , Bai Jennifer , Ko Jason H. 
Published: January 2020

Summary:
Neuromas are a debilitating peripheral nerve problem due to aberrant axon sprouting and inflammation after nerve injury. The surgical management of neuromas has for a long time been up for debate, largely due to lack of consistent, reliable outcomes with any one technique. We have found success utilizing targeted muscle reinnervation, a technique originally described in amputees that re-routes the proximal ends of cut sensory nerve stumps into the distal ends of motor nerves to nearby muscles. In doing so, the sensory nerve ending can regenerate along the length of the motor nerve, giving it a place to go and something to do. In this report, we describe our technique specifically for targeted muscle reinnervation of sural nerve neuromas that is applicable to both amputees and to patients with intact limbs. Sural nerve neuromas can occur after sural nerve harvest for reconstructive procedures and particularly after lateral malleolar incisions for orthopedic access to the calcaneus. By re-routing the sural nerve into a motor nerve of the lateral gastrocnemius muscle, we are able to manage a variety of sural nerve neuromas presenting anywhere along the course of the sural nerve and in a variety of clinical settings.
Gender Bias in the Integrated Plastic Surgery Residency: A Snapshot of Current Trends
Authors: Karamanos Efstathios , Julian Bao-Quynh , Wampler Mallory , Sippel Michael , Shah Amita , Wang Howard 
Published: January 2020

Introduction:
According to the American Society of Plastic Surgeons, the male to female ratio of plastic surgeons is approximately 5:1. As more surgical specialties are recruiting female residents, there has been an increase in the amount of females. We set out to examine the current trends in residency recruitment and whether a quantifiable gender bias exists.

Methods:
A review of all the integrated plastic surgery programs within the United States was conducted. Data were collected regarding department or division status, the gender of the chairman and the program directors, the number of residents per year and gender of residents per year. The ratio of male to female residents was calculated.

Results:
A total of 62 residency programs were identified. The vast majority had a male program director with only 8 female program directors identified. The mean ratio of female/male (F/M) residents overall was 1/1.2. Female program directors selected residents in the same ratio as their male counterparts [F/M ratio: 1/1.26 versus 1/1.18, p:0.813]. A linear logistic regression failed to identify the geographic location, department status, gender of the department chairman or the number of residents selected per year as predictors of higher F/M ratio.

Conclusions:
There are still fewer female program directors and residents in plastic surgery overall. However, neither was more likely to select a resident of their own gender. This analysis does not rule out the possible self-selection factor.
Remote Ischemic Preconditioning in Microsurgical Head and Neck Reconstruction: A Randomized Controlled Trial
Authors: Krag Andreas E. , Hvas Anne-Mette , Hvas Christine L. , Kiil Birgitte J. 
Published: January 2020

Background:
The free flap failure rate is 5% in head and neck microsurgical reconstruction, and ischemia–reperfusion injury is an important mechanism behind this failure rate. Remote ischemic preconditioning (RIPC) is a recent intervention targeting ischemia–reperfusion injury. The aim of the present study was to investigate if RIPC improved clinical outcomes in microsurgical reconstruction.

Methods:
Head and neck cancer patients undergoing tumor resection and microsurgical reconstruction were included in a randomized controlled trial. Patients were randomized (1:1) to RIPC or sham intervention administered intraoperatively just before transfer of the free flap. RIPC was administered by four 5-minute periods of upper extremity occlusion and reperfusion. Clinical data were prospectively collected in the perioperative period and at follow-up on postoperative days 30 and 90. Intention-to-treat analysis was performed.

Results:
Sixty patients were randomized to RIPC (n = 30) or sham intervention (n = 30). All patients received allocated intervention. No patients were lost to follow up. At 30-day follow-up, flap failure occurred in 7% of RIPC patients (n = 2) and 3% of sham patients (n = 1) with the relative risk and 95% confidence interval 2.0 [0.2;20.9], P = 1.0. The rate of pedicle thrombosis was 10% (n = 3) in both groups with relative risk 1.0 [0.2;4.6], P = 1.0. The flap failure rate did not change at 90-day follow-up.

Conclusions:
RIPC is safe and feasible but does not affect clinical outcomes in head and neck cancer patients undergoing microsurgical reconstruction.
Massive Localized Abdominal Lymphedema Treatment Challenges
Authors: Al-Tarrah Khaled , Ashour Tarek , Rao Rajashankar , Rayatt Sukhbir , Thomas Sunil S. 
Published: January 2020

Summary:
Massive localized lymphedema of the abdomen is a rare condition resulting from a neglected lower abdominal pannus associated with significant disability and morbidity. Compared to other surgical procedures, postbariatric surgery is usually considered a financial drain. In the United Kingdom, this requires National Health Service approval and delays may lead to sequelae that adversely impact on patients’ quality of life with increased morbidity. We present a wheelchair-bound patient whose body mass index increased from 53 to 82, while awaiting funding approval increasing her anesthetic and surgical risks. A multidisciplinary approach is mandatory for preoperative, intraoperative, and postoperative care for these patients including anesthetic input and high dependency unit care. Managing this patient was a significant anesthetic and surgical challenge with 47-kg resected tissue. The planning and perioperative measures to minimize morbidity are discussed.