bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variation in Treatment Approaches to Adolescent Midshaft Clavicle Fractures in Pediatric Versus Adult Hospitals
Authors: Zhang Dafang , Heyworth Benton E. , Liotta Elizabeth S. , Hergott Katelyn A. , Earp Brandon E. 
Published: October 2020

Objective:
The primary objective of this study was to identify differences in the treatment approach for isolated, displaced midshaft clavicle fractures in adolescent patients 15–18 years of age at adult versus pediatric hospitals. The secondary objective of this study was to identify factors associated with the surgical treatment of these fractures in this age group.

Design:
Retrospective cohort study.

Setting:
Two adult and one pediatric tertiary care referral hospitals.

Patients/Participants:
Adolescent patients 15–18 years of age with isolated, displaced midshaft clavicle fractures treated at 2 adult tertiary care referral hospitals and one pediatric tertiary care referral hospital were identified. A total of 214 patients, 105 from the adult hospitals and 109 from the pediatric hospital, were included.

Intervention:
Nonoperative versus surgical treatment of clavicle fractures.

Main Outcome Measurement:
Surgical treatment.

Results:
A multivariable logistic regression analysis showed that superior–inferior fracture displacement [odds ratio (OR) 1.13, 95% confidence interval (CI) 1.06–1.20], dominant upper extremity injury (OR 2.60, 95% CI 1.19–5.67), and treatment at an adult hospital (OR 5.28, 95% CI 2.28–12.2) were independently associated with the surgical treatment of adolescent displaced midshaft clavicle fractures.

Conclusions:
After controlling for relevant demographic and fracture characteristics, adolescent patients treated at adult hospitals for displaced midshaft clavicle fractures have more than 5 times the odds of surgical treatment than those treated at a pediatric hospital. Significant practice variation across institutions reflects ongoing controversy in surgical indications and underscores the need for high-quality prospective outcome studies.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Relationship Between Pulmonary Function and Thoracic Morphology in Adolescent Idiopathic Scoliosis
Authors: Deng Zhipeng , Luo Ming , Zhou Quan , Yang Xi , Liu Limin , Song Yueming 
Published: October 2020

Study Design.
A retrospective study.

Objective.
The aim of this study was to investigate the relationship between thoracic morphology (TM) and pulmonary function (PF) in patients with adolescent idiopathic scoliosis (AIS) and the feasibility of the “apical vertebra deviation ratio (AVDR)” as a predictor of PF impairment.

Summary of Background.
The PF of AIS is one of the key focuses of clinicians’ attention. Early identification of AIS patients who are at risk of developing impaired PF is important for improving patient management.

Methods.
Preoperative PF and radiographic examination data of 108 patients with thoracic AIS were collected. The following TM data were collected: the costophrenic angle distance (CAD), distance between T1 and mean diaphragm height (T1-diaphragm), T1-T12 height, and AVDR. The correlation coefficient between PF and TM measurements was analyzed, and univariable and multivariable linear regressions were used to determine whether the TM measurements could predict PF.

Results.
The CAD, T1-diaphragm, and T1-T12 height were significantly positively correlated with forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), vital capacity, and total lung capacity (r = 0.54–0.74, P < 0.01). A linear equation between CAD and pulmonary volume could be established: FVC (L) = −3.46 + CAD (cm) × 0.27 (R
2 = 0.54). If T1-T12 height is included, the correlation is further enhanced (R
2 = 0.68). There was a significant negative correlation between the AVDR and predicted values of forced vital capacity (FVC%), FEV1%, predicted values of vital capacity, and predicted values of total lung capacity (r = −0.46 to −0.52, P < 0.01). The AVDR could predict the value of each of these variables. One of the linear equations is as follows: FVC% = 110.70–99.73 × AVDR (R
2 = 0.272).

Conclusion.
The two novel, two-dimensional TM measurements, CAD and AVDR, can be used as moderate to strong predictors of PF outcome in statistical terms. An AVDR >0.2 suggests that the patient may suffer from moderate or severe PF damage.

Level of Evidence: 4
The Politics of Chronic LBP
Authors: Gabel Charles Philip , Mokhtarinia Hamid Reza , Melloh Markus 
Published: October 2020

Study Design.
Retrospective review of the literature.

Objective.
To update recent trends in the use of magnetic resonance spectroscopy (MRS) analysis for CLBP.

Summary of Background Data.
The lumbar multifidus (MF) muscle has drawn sustained interest for some time, particularly related to its structure, role in spinal stability, and its association and clinical significance with CLBP. Additionally, the presence of MF-arthrogenic muscle inhibition (AMI) and its relation to induced CLBP, through depleted lumbar stabilization, has gained increased recognition. In contrast, the differential diagnostic use of MRS analysis has suggested specific links between the presence of MF myo-cellular lipid (MCL) infiltration and CLBP patients.

Methods.
Review of the literature related to CLBP with the keywords MCL, MRS analysis, and MF-AMI.

Results.
No articles discussed CLBP using the three key concepts in a single context. The use of MRS analysis has the capacity to distinguish between Extra-MCL (EMCL) and intra-MCL (IMCL) infiltration within the lumbar MF. It is suggested that EMCLs are more likely to be associated with age-related change, while the IMCLs appear more likely to be associated with the presence of CLBP. The increased recognition of MF-AMI as a primary cause of CLBP, and the potential that AMI parallels the presence of IMCLs, facilitates possible use of MRS as a means to quantify the basis of lumbar MF-AMI CLBP, and that proportional IMCL changes in the MF could serve as a ‘proxy’ to indicate the effectiveness of interventions directed at MF activation.

Conclusions.
It may be possible for IMCLs to serve as a ‘proxy’ prognostic marker of lumbar MF-AMI in CLBP patients. Further, if this assertion were correct, then reductions in IMCLs could potentially quantify recovery and the efficacy of rehabilitation management strategies directed at lumbar MF activation.

Level of Evidence: 5
Impact of Fellows-as-Teachers Workshops on Teaching Rounds: An Observational Study in an ICU
Authors: Bergl Paul A. , Franco Rose M. , Patel Jayshil J. , Khan Marium , Fletcher Kathlyn E. , Nanchal Rahul S. 
Published: October 2020

Objective:
During training, fellows serve as teachers and role models for junior colleagues. Fellows-as-teachers curricula may support these roles, but little is known about their effectiveness and durability. We sought to measure the long-term effects on ICU rounds after administering fellows-as-teachers workshops.

Design:
Prospective pre-/postintervention observational study of ICU rounds.

Setting:
Tertiary-care medical ICU with both pulmonary critical care and critical care medicine fellowships.

Subjects:
ICU teaching teams.

Interventions:
Fellows attended immersive workshops on promoting clinical reasoning, managing the learning environment, teaching bedside skills, and developing situational awareness on ICU rounds. After the workshops, faculty physicians were encouraged to have fellows routinely lead afternoon rounds.

Measurements and Main Results:
We gathered data from direct observations of ICU rounding activities, residents’ evaluations of rounds from surveys, and faculty physicians’ written comments on fellows’ performance in the ICU from end-of-rotation evaluations. Data were analyzed using descriptive statistics, nonparametric comparative tests, and chi-square tests for categorical data. A total of 61 ICU rounding sessions were observed with 501 discrete provider-patient interactions. Survey responses were collected from a total of 53 residents preintervention and 34 residents postintervention. We reviewed 72 open-ended faculty comments on fellows’ end-of-rotation evaluations, with 22 occurring postintervention. During the postintervention period, fellows were significantly more likely to make clinical decisions, explain their reasoning, provide teaching points, and ask questions on rounds. Additionally, we observed significantly higher quality written feedback on end-of-rotation evaluations by faculty physicians. However, residents generally harbored neutral or negative perceptions about the educational value of fellow-led rounds postintervention.

Conclusions:
Fellows’ contributions to patient care and teaching on ICU rounds increased for several months after our fellows-as-teachers workshops. Despite limitations and contamination in our design, our data suggest that similarly designed curricula may promote fellow engagement, possibly at the expense of residents’ education.
Vaginal elasticity is significantly decreased in vaginal atrophy: a strain elastography study
Authors: Pákozdy Krisztina , Sipos Attila G. , Bombicz Mariann , Lampé Rudolf , Póka Róbert , Takacs Peter , Kozma Bence 
Published: October 2020

Abstract

Objectives:
Strain elastography is a novel method to assess the elasticity of tissues. We aimed to evaluate the value of vaginal strain elastography in women with vulvovaginal atrophy (VVA).

Methods:
Women with or without VVA were enrolled in this prospective study. Participants underwent vaginal cytology and vaginal wall elastography. Vaginal Health Index (VHI) was calculated. Based on Vaginal Maturation Value (VMV), participants were divided into atrophic and nonatrophic groups. Elastography parameters of the vaginal walls were measured in nine regions of interest (ROI). Elastography Index (EI) was defined by the average color score of nine ROIs. Groups were compared with unpaired t test or Mann-Whitney U test. Pearson correlation was used to determine the strength of association between EI and selected parameters. Multiple regression was used to evaluate the association between EI and age, VMV, and vaginal atrophy.

Results:
Ten women were diagnosed with VVA, and twenty had no cytological signs of vaginal atrophy (age-range 38-79 y). VHI score was significantly lower in the atrophic group (mean ± SD, 9.4 ± 2.011 vs 16.6 ± 4.22, P < 0.0001). In the atrophic group, EI was significantly lower than in nonatrophic group (mean ± SD, 20 ± 21 vs 47 ± 4, P < 0.01). We found a strong negative correlation between EI and vaginal atrophy (r =  −0.706, P < 0.0001; 95% CI: 0.8501 to −0.4639). In the multiple regression model, only atrophy remained statistically significant for the prediction of EI (P = 0.004).

Conclusions:
Vaginal elasticity is significantly decreased in women with vaginal atrophy, measured by EI. Our results suggest that strain elastography might be useful in the diagnosis of vaginal atrophy.
Menopause symptoms delineated by HIV clinical characteristics in African American women with HIV
Authors: Garbose Rebecca A. , Wu John , Christianson Mindy S. , Robinson Takeyra , Gaines Tyler , Shen Wen 
Published: October 2020

Abstract

Objective:
To obtain data on prevalence and severity of climacteric symptoms in women with HIV (WWH) during the menopausal transition and early menopause and to evaluate for any differences in symptoms by CD4 count and viral load.

Methods:
We conducted an in-person survey of female patients attending the Johns Hopkins HIV clinic, ages 40 to 50 years with at least one menstrual period within 6 months before the survey. Interviews utilized the Greene Climacteric scale, a validated menopause questionnaire. We also queried patients, (1) if they were informing their primary care physician of menopause symptoms and (2) if their menopause symptoms were being treated. The study used nonparametric Mann-Whitney rank sum tests with significance defined as P < 0.05 to perform symptom severity comparisons of distributions and Fischer exact tests for comparisons of categorical variables such as comparing prevalence of anxiety and depression in the population.

Results:
Twenty-three women aged 40 to 50 years were interviewed with a median age of 47 years [25 percentile = 46, 75 percentile = 49]. All were African American with median length of HIV diagnosis of 12 years [25 percentile = 7, 75 percentile = 20.5]. Most of the patients, 87% (n = 20), reported experiencing at least one menopause symptom with intense frequency and extreme detrimental effects on quality of life. All women interviewed, 100% (n = 23), reported hot flashes, ranging from infrequent to persistent. Sleeping difficulty was reported by 78% (n = 18) of women. Most women, 78% (n = 18), reported feeling tired or lacking energy with moderate frequency. The majority of the women, 87% (n = 20), said they reported menopause symptoms to their primary care provider. Of these, only 20% received treatment for menopause symptoms.

Conclusions:
These findings suggest that WWH undergoing the menopausal transition experience intense symptoms severely impacting quality of life. Although the majority of women reported experiencing menopause symptoms to medical providers, most remained untreated. An opportunity exists to educate providers caring for WWH on menopause medicine.
INTRAOCULAR LENS IMBRICATION FOR RECURRENT PUPILLARY CAPTURE AFTER SUTURELESS INTRASCLERAL FIXATION
Authors: Patel Saagar N. , Stem Maxwell S. , Todorich Bozho 
Published: October 2020

Purpose:
To demonstrate a novel surgical technique (intraocular lens imbrication) for persistent postoperative pupillary capture after sutureless scleral intraocular lens fixation.

Methods:
Case report and supplemental digital content demonstrating salient steps of a novel surgical technique.

Results:
The patient did not suffer any further episodes of pupillary capture after intraocular lens imbrication with aforementioned surgical technique five months after the procedure. Postoperative best-corrected visual acuities were 20/40 in both eyes.

Conclusion:
Intraocular lens imbrication is an effective method to address persistent postoperative pupillary capture after sutureless scleral intraocular lens fixation.
Association of Collagen Gene (COL4A3) rs55703767 Variant With Response to Riboflavin/Ultraviolet A-Induced Collagen Cross-Linking in Female Patients With Keratoconus
Authors: Abdelghany Ahmed A. , Toraih Eman A. , Abdelaziz Eman Z. , El-Sherbeeny Nagla A. , Fawzy Manal S. 
Published: October 2020

Purpose:To investigate for the first time the association of collagenCOL4A3(rs55703767),COL5A1(rs7044529), andCOL4A4(rs2229813) variants with response to corneal collagen cross-linking (CXL) with riboflavin and ultraviolet A in patients with keratoconus (KC).Methods:A total of 147 eligible patients with KC were genotyped for the specified collagen variants using real-time TaqMan-based polymerase chain reaction. Adjusted odds ratio (OR) with 95% confidence interval (CI) was applied to assess the strength of the association with response to CXL for a decrease in maximum keratometry and/or an increase in corneal thickness.Results:Eighty-two patients (55.8%) had post-CXL successful outcomes. The overall analysis revealed that minor allele frequencies ofCOL4A3,COL5A1, andCOL4A4variants were 0.22, 0.22, and 0.38, respectively. The G/T genotype of theCOL4A3variant was more prevalent in the successful group (43%) compared with the failure group (23%) (P< 0.001).COL4A3(rs55703767) was associated with a good response under heterozygote (OR: 2.19, 95% CI, 1.04–4.59,P< 0.001) and overdominant (OR: 2.59, 95% CI, 1.25–5.38,P= 0.008) models. By contrast,COL5A1andCOL4A4variants were not associated with the effective response after CXL treatment. Interestingly, stratification analysis by sex revealed that CXL was more successful in female patients with KC under heterozygote (OR: 4.71, 95% CI, 1.74–12.75), dominant (OR: 3.16, 95% CI, 1.29–7.78), and overdominant (OR: 5.18, 95% CI, 1.92–13.95) models forCOL4A3(rs55703767) variant.Conclusions:TheCOL4A3(rs55703767) variant, among other study variants, could be implicated in CXL riboflavin/ultraviolet A treatment response in patients with KC in the study population. Large-scale replication and follow-up studies in different ethnic groups are warranted.
Phenotypic Characterization of Corneal Epithelium in Long-Term Follow-Up of Patients Post-Autologous Cultivated Oral Mucosal Epithelial Transplantation
Authors: Prabhasawat Pinnita , Chirapapaisan Chareenun , Jiravarnsirikul Anuwat , Ekpo Pattama , Uiprasertkul Mongkol , Thamphithak Ranida , Matamnan Sutthicha , Boonwong Chawikan 
Published: October 2020

Purpose:
To analyze the phenotype of the corneal epithelium in patients with long-term follow-up who underwent autologous cultivated oral mucosal epithelial transplantation (COMET) using in vivo confocal microscopy (IVCM) and impression cytology with immunofluorescence staining (ICIF).

Methods:
Thirteen eyes from patients with severe limbal stem cell deficiency, who underwent COMET at least 48 months before, were recruited in this noncomparative cohort study. After eye examination, IVCM and ICIF were performed. Clinical manifestations of the cornea were evaluated and compared with epithelial findings detected by IVCM and ICIF [cytokeratin (CK) 3, CK7, and CK12]. Two corneal buttons derived from patients receiving the corneal transplantation post-COMET were sent for immunohistochemistry (CK3, CK6, CK7, CK12, paired box gene 6, p63, zonula occludens-1, and integrin β -1).

Results:
The mean age of patients was 51.2 ± 20.6 years, and the mean follow-up time since COMET was 78.7 ± 16.3 months. Six of 13 eyes showed clinically successful COMET. In these eyes, IVCM demonstrated predominant cornea-like epithelium and ICIF reported positivity for CK3 and CK12, confirming the presence of oral mucosal and corneal epithelium. Meanwhile, 7 eyes showed total conjunctivalization, corresponding with substantial conjunctival epithelium detected by IVCM and positivity for conjunctival (CK7) and oral mucosal epithelial (CK3) markers detected by ICIF. The immunohistochemistry of corneal buttons stained positive for oral mucosal, corneal epithelial, and stem cell markers (CK3, CK12, and p63).

Conclusions:
In long-term follow-up of COMET, epithelium of successful patients demonstrated cornea-like phenotype, whereas failed cases revealed mainly conjunctival phenotype. However, there were evidences that oral mucosal epithelial cells remained across the cornea in both successful and failed COMET as detected by IVCM and ICIF.
Cross-Linking Assisted Infection Reduction (CLAIR): A Randomized Clinical Trial Evaluating the Effect of Adjuvant Cross-Linking on Bacterial Keratitis
Authors: Prajna N. Venkatesh , Radhakrishnan Naveen , Lalitha Prajna , Rajaraman Revathi , Narayana Shivananda , Austin Ariana F. , Liu Zijun , Keenan Jeremy D. , Porco Travis C. , Lietman Thomas M. , Rose-Nussbaumer Jennifer 
Published: October 2020

Purpose:
To determine whether there is a benefit to adjuvant corneal cross-linking (CXL) for bacterial keratitis.

Methods:
This is an outcome-masked, randomized controlled clinical trial. Consecutive patients presenting with a smear-positive bacterial ulcer at Aravind Eye Hospitals at Madurai, Pondicherry, and Coimbatore in India were enrolled. Study eyes were randomized to topical moxifloxacin 0.5% or topical moxifloxacin 0.5% plus CXL. The primary outcome of the trial was microbiological cure at 24 hours on repeat culture. Secondary outcomes included best spectacle corrected visual acuity at 3 weeks and 3 months, percentage of study participants with epithelial healing at 3 weeks and 3 months, infiltrate and/or scar size at 3 weeks and 3 months, 3-day smear and culture, and adverse events.

Results:
Those randomized to CXL had 0.60 decreased odds of culture positivity at 24 hours (95% confidence interval [CI]: 0.10–3.50; P = 0.65), 0.9 logarithm of the minimum angle of resolution lines worse visual acuity (95% CI: −2.8 to 4.6; P = 0.63), and 0.41-mm larger scar size (95% CI: −0.48 to 1.30; P = 0.38) at 3 months. We note fewer corneal perforations or need for therapeutic penetrating keratoplasty in the CXL group.

Conclusions:
We were unable to confirm a benefit to adjuvant CXL in the primary treatment of moderate bacterial keratitis. However, CXL may reduce culture positivity and complication rates; therefore, a larger trial to fully evaluate this is warranted.

Trial Registration:
NCT02570321.
In Vivo Confocal Microscopy Findings in Bowman Layer Transplantation
Authors: García de Oteyza Gonzalo , Vazquez-Romo Kristian Alfonso , Hernández-Quintela Everardo , de Wit Carter Guillermo , García-Albisua Ana Mercedes 
Published: October 2020

Purpose:
To report the in vivo confocal microscopy (IVCM) findings of a case who underwent femtosecond laser-assisted Bowman layer transplantation (BLT).

Methods:
This is a case report.

Results:
In a 25-year-old man with previous diagnosis of keratoconus in whom a BLT was performed using the femtosecond laser-assisted technique, IVCM (Confoscan 4; Fortune Technologies, Vigonza, Italy) was performed 3 months after surgery, obtaining a sequence of 4 digitalized images of the total thickness of the cornea, from the epithelium to the endothelium, and then backward. The images were analyzed with the Navis v. 3.5.0. system (NIDEK, Multi-Instrument Diagnostic System, Japan). In the anterior stroma, before arriving to the graft interphase, activated keratocytes could be observed with higher reflectivity. In this first image of the anterior interphase, a homogenous hyporreflective image could be observed. In the interior of the graft, no keratocytes were found and some hyperreflective particles were present. In addition to the anterior, the posterior interphase presented bright particles.

Conclusions:
This is the first report that documents a BLT using IVCM.