bluuebunny/crossref_metadata_2025_split huggingface dataset:
Placement of Guide-Wireless Sharp Percutaneous Pedicle Screws Utilizing Computed Tomography-Navigation and Sentinel Fluoroscopy: 2-Dimensional Operative Video
Authors: Martirosyan Nikolay L , Wewel Joshua T , Uribe Juan S 
Published: December 2019

Abstract
Many established techniques exist for minimally invasive pedicle screw placement. Nearly all techniques incorporate the use of a Kershner wire (K-wire) at various points in the work-flow. The use of a K-wire adds an additional step. If its position is lost, it requires repeating all previous steps, and placement is not without complication. The use of a guide-wireless sharp screws allows the surgeon to place a pedicle screw in 1 step with several fluid maneuvers.
1
The patient underwent Institutional Review Board-approved consent for this study. Following traditional computed tomography-based navigation, a stab incision is made, followed by fascial dissection with monopolar cautery. The sharp screw is placed percutaneously at the facet-transverse process junction. The precise entry point is confirmed with navigation, followed by a sentinel anterior-posterior fluoroscopic image, verifying the accuracy of the navigation. The cortical bone is traversed by malleting the sharp tip through the cortex. When the cancellous bone is engaged, the screw is then advanced through the pedicle. This set of steps allows for safe, efficient placement of percutaneous pedicle screws without the need for a guidewire. Mal-placement regarding sharp pedicle screw insertion is similar to K-wire-dependent screw placement. Surgeons must be cognoscente of exceptionally sclerotic bone, which can prove difficult to cannulate. Conversely, osteoporotic bone that is liable to a cortical pedicle breach, transverse process fracture, and/or maltrajectory are all considerations when placing a K-wireless, sharp pedicle screw. Anterior-posterior fluoroscopy is utilized to confirm accuracy of image-guided navigation and mitigate malplacement of pedicle screws.
Evaluating the Role of Self-Esteem on Differential Career Outcomes by Gender in Academic Medicine
Authors: Manne-Goehler Jennifer , Freund Karen M. , Raj Anita , Kaplan Samantha E. , Terrin Norma , Breeze Janis L. , Carr Phyllis L. 
Published: December 2019

Purpose
Gender differences in faculty advancement persist in academic medicine. Understanding of what drives these differences remains limited. The relationship among self-esteem, gender, and career outcomes has not previously been explored.

Method
The authors evaluated the association between gender and 2012–2013 career outcomes, specifically, the number of publications, academic rank, leadership positions, and retention, and whether self-esteem as measured in the 1995 National Faculty Survey mediates this relationship. They measured self-esteem using the modified Rosenberg Self-Esteem Scale. The authors used multivariable logistic regression analysis to understand the association among gender, self-esteem, and the outcomes of rank, leadership, and retention, and negative binomial models for number of publications. Models were adjusted for race, specialty, effort distribution, and years since first faculty appointment. The authors performed a mediation analysis to understand whether self-esteem mediates the relationship between gender and these career outcomes.

Results
Overall, self-esteem scores were high. Women had lower self-esteem in 1995 than their male colleagues. In adjusted models, female gender was associated with lower performance on all 4 career outcome metrics. While self-esteem scores were positively associated with all 4 outcomes, the authors’ mediation analysis suggested that self-esteem did not mediate the relationship between gender and these 4 career metrics.

Conclusions
Female medical faculty members lag behind men on traditional metrics of faculty achievement. While higher self-esteem is positively associated with faculty achievement, it did not mediate the relationship between gender and career advancement over the 17 years of follow-up and, thus, may not be an ideal target for programs and policies to increase gender parity in academic medicine.
Intraoperative Transcranial Motor-evoked Potential Stimulation Does Not Seem to Cause Seizures
Authors: Burbridge Mark A. , Nguyen Viet , Min Jung Gi , Jaffe Richard A. , Ahuja Brian , Shah Amit D. , Lee Leslie H. , Cho Charles , Sandoval Breanna , López Jaime R. 
Published: December 2019

Background:
Intraoperative neurophysiological monitoring is of critical importance in evaluating the functional integrity of the central nervous system during surgery of the central or peripheral nervous system. In a large recent study, transcranial motor-evoked potentials (TcMEPs) were found to be associated with a 0.7% risk of inducing a seizure as diagnosed by clinical observation and electromyography in patients having general anesthesia with intravenous anesthetics. The gold standard for seizure diagnosis, however, is electroencephalography (EEG). The aim of this single-institution retrospective study is to ascertain the risk of intraoperative seizures detected using EEG during surgeries in adult patients undergoing intraoperative monitoring with TcMEPs.

Methods:
The authors retrospectively reviewed the intraoperative EEG records of 1175 patients anesthetized with a variety of anesthetic agents, including volatile and intravenous anesthetics, to ascertain the rate of EEG-diagnosed seizures attributable to TcMEPs.

Result:
Our analysis did not reveal a single seizure event attributable to TcMEPs in 1175 patients.

Conclusion:
The intraoperative use of TcMEPs does not seem to cause seizures.
Ergonomics in Dermatologic Surgery: Lessons Learned Across Related Specialties and Opportunities for Improvement
Authors: Chan Justin , Kim Dong Joo , Kassira-Carley Sama , Rotunda Adam M. , Lee Patrick K. 
Published: December 2019

BACKGROUND
As the practice of dermatology becomes increasingly procedurally based, there is a concordant rise in musculoskeletal injury (MSI) risk. Dermatologic surgeons are most susceptible and, although the majority suffer from MSI, few have received any formal ergonomics training. This stems from a lack of awareness of this troubling trend and a paucity of research and education on the ergonomics of dermatologic surgery.

OBJECTIVE
To highlight pertinent ergonomics principles and strategies from other specialties that could be translated into dermatology, and to synthesize general recommendations aimed at reducing MSI among dermatologic surgeons.

MATERIALS AND METHODS
A comprehensive search of the PubMed and Cochrane Reviews databases from 1975 to 2019 was conducted, using a combination of ergonomics-related search terms, generating 6 publications from the dermatology literature and 58 from the fields of dentistry, medicine, and select surgical subspecialties.

RESULTS
This multidisciplinary approach yielded multiple interventions that could be applied directly (i.e., adequate lighting, adjustable operating tables, and surgical seat heights) or indirectly pending further investigation into their feasibility (i.e., video displays of the surgical field to allow neutral head and neck postures).

CONCLUSION
Although much can be learned from decades of prior ergonomics research from other specialties, considerations that are unique to dermatology remain and must be addressed with specialty-specific research.
The Unhappy Cosmetic Patient: Lessons From Unfavorable Online Reviews of Minimally and Noninvasive Cosmetic Procedures
Authors: Watchmaker Lauren E. , Watchmaker Jacqueline D. , Callaghan Daniel , Arndt Kenneth A. , Dover Jeffrey S. 
Published: December 2019

BACKGROUND
The number of patients receiving minimally and noninvasive cosmetic procedures is increasing. Often, patients turn to online review forums to gain and share advice regarding cosmetic procedures. Understanding and discussing patient-reported outcome data can help align physician and patient expectations and ultimately help improve the patient experience.

OBJECTIVE
To determine the most common reasons patients are dissatisfied with a selection of minimally and noninvasive cosmetic procedures.

MATERIALS AND METHODS
Negative patient reviews from the RealSelf.com website were analyzed, and the reason for patient discontent was recorded for the following treatments: tissue stabilized-guided subscision, cryolipolysis, electromagnetic therapy, deoxycholic acid injections, energy-induced thermolysis, radio thermoplasty, threadlifts, and ultrasound therapy.

RESULTS
One thousand two hundred four reviews were included in analysis. For all treatments analyzed, the most common reason for patient dissatisfaction was ineffectiveness (n = 782, 65.0%), followed by complications (n = 301, 25.0%). The most common complications were as follows: lumps for tissue stabilized-guided subscision (n = 6, 50.0%), treated area enlargement for cryolipolysis (n = 23, 22.1%), swelling for deoxycholic acid injections (n = 9, 47.4%), numbness for energy-induced thermolysis (n = 6, 35.3%), fat loss for radio thermoplasty (n = 26, 53.1%) and ultrasound therapy (n = 32, 48.5%), and indentations for threadlifts (n = 10, 30.3%).

CONCLUSION
Ineffectiveness and complications were the most common reasons for dissatisfaction among all treatments analyzed. Patient-reported outcome data may offer insight into how physicians can improve their patient's satisfaction with cosmetic procedures.
Effect of Intensive and Standard Lipid-Lowering Therapy on the Progression of Stroke in Patients With Coronary Artery Syndromes: A Meta-Analysis of Randomized Controlled Trials
Authors: Xie Chengjuan , Zhu Mingyu , Hu Ying , Wang Kai 
Published: December 2019

Abstract:
This meta-analysis demonstrated the effect of intensive versus standard statins on the risk of stroke in patients with coronary artery syndromes (CAS). PubMed, Embase, the Cochrane library, and clinicaltrials.gov were searched, and the retrieved studies were undertaken for randomized controlled trials (RCTs) throughout September 2018. Studies that were designed as RCTs and recruited at least 1000 CAS patients followed up greater than 1 year were eligible for this study. The summary relative risk with the 95% confidence interval was used as an effect estimate and calculated using the random-effects model. Five RCTs comprising a total of 39,612 coronary syndrome patients with reported 1236 stroke events were included in this meta-analysis. The summary result indicated a 14% reduction in the risk of stroke in CAS patients receiving intensive statin therapy as compared to standard statin therapy. The significant differences mainly occurred in mean age ≥60 years (P = 0.007), percentage of males ≥80% (P = 0.011), percentage diabetes mellitus ≥ 15% (P = 0.018), percentage hypertension ≥50% (P = 0.030), percentage of current smokers <30% (P = 0.011), percentage of prior myocardial infarction ≥50% (P = 0.011), percentage of peripheral arterial disease ≥10% (P = 0.030), patients with stable CAS (P = 0.011), patients using atorvastatin (P = 0.015), follow-up duration ≥3 years (P = 0.011), and study with moderate quality (P = 0.013). Intensive statin therapy should be considered for CAS patients at high risk of stroke events. Further large-scale RCT should be conducted to verify the results of stratified analysis in this study.
SPECTRAL FUNDUS AUTOFLUORESCENCE EXCITATION AND EMISSION IN ABCA4-RELATED RETINOPATHY
Authors: Müller Philipp L. , Dysli Chantal , Hess Kristina , Holz Frank G. , Herrmann Philipp 
Published: December 2019

Purpose:
To systematically and longitudinally investigate the characteristics of flecks in ABCA4-related retinopathy under different fundus autofluorescence (AF) excitation and emission spectra.

Methods:
A total of 132 eyes of 66 patients with ABCA4-related retinopathy were investigated using multimodal AF imaging and spectral domain optical coherence tomography. Autofluorescence imaging with blue (BAF), green (GAF), and near-infrared (NIR-AF) excitation wavelengths obtained by a confocal scanning laser ophthalmoscope was compared with AF imaging obtained by an innovative confocal light-emitting diode-based retinal imaging system (Color-AF) that allows for separation of short (green emission fluorescent component) and long (red emission fluorescent component) autofluorescence emission components.

Results:
Color-AF, BAF, and GAF, overall, revealed similar presentation of hyperautofluorescent flecks. Flecks that showed predominantly red emission fluorescent component matched with hyperautofluorescent flecks in NIR-AF. Over the observation time of 5 to 14 months, flecks showed a transition in the AF emission spectrum to shorter wavelengths (red emission fluorescent component to green emission fluorescent component), associated with a progressed disruption of overlaying outer retinal bands in optical coherence tomography. Newer hyperautofluorescent flecks usually revealed predominantly red emission fluorescent component.

Conclusion:
By separation of the AF spectra, the remodeling of fluorophores and associated structural changes can be monitored over time indicating a novel and susceptible surrogate marker for disease progression and potential therapeutic effects.
Systematic Review and Meta-analysis of Postlicensure Observational Studies on Human Papillomavirus Vaccination and Autoimmune and Other Rare Adverse Events
Authors: Willame Corinne , Gadroen Kartini , Bramer Wichor , Weibel Daniel , Sturkenboom Miriam 
Published: December 2019

Background:
Because of the limited number of subjects in prelicensure studies, autoimmune diseases and other rare adverse effects of vaccines may go undetected. Since 2006, millions of human papillomavirus (HPV) vaccine doses have been distributed and a considerable amount of postlicensure safety data has been generated. The objective of this study was to review available HPV postlicensure safety studies and to summarize risk estimates of autoimmune and other rare diseases.

Methods:
For this systematic review and meta-analysis, we searched literature databases to identify any postlicensure safety studies related to HPV vaccination and autoimmune adverse events from inception to April 16, 2019. Pooled risk estimates were computed using fixed- or random-effects models if at least 2 estimates per disease and per HPV vaccine were available.

Results:
Twenty-two studies met our inclusion criteria. The studies applied various methodologies and used different types of data sources and outcome definitions. Quadrivalent HPV vaccine (4vHPV) was most commonly assessed. Type 1 diabetes mellitus, immune thrombocytopenia purpura and thyroiditis diseases were most frequently reported. The meta-analysis was conducted on 35 diseases corresponding to 48 pooled risk estimates. Majority of the pooled estimates showed no significant effect (n = 43). Three negative (paralysis, immune thrombocytopenia purpura and chronic fatigue syndrome) and 2 positive (Hashimoto and Raynaud diseases) associations were detected.

Conclusion:
Our study demonstrated an absence of clear association between HPV vaccines and autoimmune and other rare diseases. The review also highlights the need for more systematic collaborations to monitor rare safety adverse events.
Temporo-Parietal Flap Incorporated Into a Modified Osteo-Odonto Keratoprostheses Protocol for Longevity of the Dental Lamina
Authors: Rao Anupam C. A. , Toalster Nicholas , Moloney Greg , Webber Shannon 
Published: December 2019

Purpose:
To describe a novel pedicled temporo-parietal flap to delay laminar resorption in a modified osteo-odonto keratoprosthesis (MOOKP) and measure resorption of the dental lamina by an objective method.

Methods:
A retrospective case series was performed on patients who received an osteo-odontokeratoprosthesis for Steven-Johnson-Syndrome. Surgeries were performed between October 2016 and November 2017 by the same surgical team (G.M. and S.W.). A modified temporo-parietal flap was incorporated into stage 1 of the MOOKP procedure. CT Scans were performed post op and on follow up. Volumetric evaluation was achieved by automated software analysis of 3D reconstructed CT images (Vitrea, Software Version 6.7.6, Cannon Medical Systems ANZ Pty Ltd).

Results:
The procedure was performed in 3 eyes from 3 patients. Patients were followed up for stage 2 review at 9.6 months on average (22–55 weeks). One case was complicated by early postoperative hematoma of the buccal graft; however, this was managed conservatively. Another case required relaxing incisions at the time of flap creation due to increased vascularized collagenous tissue. On follow up, volume changes in the dental lamina were minimal.

Conclusions:
Loss of laminar volume can potentially jeopardize the success of the MOOKP, and consequently cause significant visual, graft or globe complications. The long-term success of this method needs further evaluation; however, initial results suggest a possible role for pedicle grafts in maintenance of the dental lamina. Furthermore, objective CT-based calculation of laminar volume may reduce inter-study variability and standardize comparison of techniques.
Examining the Role of Retrobulbar Hyaluronidase in Reversing Filler-Induced Blindness: A Systematic Review
Authors: Paap Michael K. , Milman Tatyana , Ugradar Shoaib , Goldberg Robert , Silkiss Rona Z. 
Published: December 2019

Purpose:
To provide a systematic review of the literature concerning retrobulbar hyaluronidase injections as a treatment for hyaluronic acid gel filler-induced blindness and evaluate the level of evidence for this proposed therapy.

Methods:
The authors performed a search of English language articles published on the use of retrobulbar hyaluronidase to reverse vision loss precipitated by hyaluronic acid gel fillers. Articles reviewed included case reports/series, experimental investigations, expert opinion commentaries, and major reviews. To date, there have been no case–control, cohort, or randomized control studies to evaluate this treatment. Five anecdotal descriptions of hyaluronic acid gel filler blindness treated specifically with retrobulbar hyaluronidase were identified, for a total of 9 patients. One hundred twelve articles in total on this treatment and related topics, including filler-induced blindness and alternative treatments, were identified and reviewed.

Results:
Of the 9 documented cases of patients treated with retrobulbar hyaluronidase for hyaluronic acid-induced blindness, visual improvement was demonstrated in 2 cases. The successes, however, are undermined by inconsistent pretreatment ophthalmic assessment and documentation. Animal studies demonstrate mixed results. Laboratory studies document the inability of hyaluronidase to cross the optic nerve sheath.

Conclusions:
There is not currently enough evidence to support retrobulbar hyaluronidase as a treatment for filler-induced blindness. Additional studies are needed to further evaluate its efficacy and explore alternative treatments.
Evaluating Adherence to Return to School and Activity Protocols in Children After Concussion
Authors: DeMatteo Carol A. , Lin Chia-Yu A. , Foster Gary , Giglia Lucia , Thabane Lehana , Claridge Everett , Noseworthy Michael D. , Hall Geoffrey B. , Connolly John F. 
Published: December 2019

Objective:
The need to have a pediatric-specific concussion management protocol on Return to School (RTS) and Return to Activity (RTA) after concussion has been recognized internationally. The first step to evaluate the protocol effectiveness is to establish whether children and youth are adhering to these recommendations. The objective of this study was to explore the prevalence and predictors of adherence to RTS and RTA concussion management protocols for children/youth.

Design:
A prospective cohort of children/youth with concussion.

Setting:
Childhood Disability Research Centre.

Participants:
One hundred thirty-nine children/youth aged 5 to 18 years, diagnosed with concussion and symptomatic upon enrollment, were followed for up to 6 months. Primary recruitment occurred from a Children's Hospital Emergency Department.

Intervention:
Provision of RTS/RTA guidelines.

Main Outcome Measures:
Measurement of adherence came from multiple sources, including the child's and parent's knowledge of protocols, research personnel evaluations, and self-reported stages of RTS/RTA and Post-Concussion Symptom Scale (PCSS) scores.

Results:
Spearman correlations and logistic regression were used, investigating the relationship between PCSS and progression of protocols and determining predictors of adherence. Significant negative associations between total PCSS score and stage of RTS/RTA protocols were found. Fifty-three percent and 56% of the participants adhered to the RTS and RTA protocols, respectively.

Conclusions:
Children's knowledge of protocols and total PCSS scores significantly predicted adherence to RTS/RTA and may be the most important factors in predicting adherence during recovery from concussion.
Lipid keratopathy and septal abscess
Authors: Heo Sung Jae , Kim Jung Soo , Kwon Sam Hyun , Kim Jong Seung 
Published: December 2019

Abstract

Rationale:
Epistaxis is a common otorhinolaryngological emergency, but septal abscess has not been reported before as a complication of epistaxis.

Patient concerns:
We report a case of a 51-year-old man complaining of nasal obstruction and facial numbness for 3 weeks. He had a history of epistaxis, and had been treated with electrocauterization of the left nasal septum at a local clinic 1 month earlier.

Diagnoses:
On nasal endoscopy, swelling of the septum was noticed; computed tomography (CT) was performed, and revealed a septal abscess.

Interventions:
The patient was treated with incision and drainage under local anesthesia. A left vertical hemitransfixion incision was made and 4 mL of purulent material was drained. There was no quadrangular septal cartilage.

Outcomes:
On the 5th postoperative day, the patient complained of blurred vision in his right eye. Visual acuity of the left eye was 0.5, but acuity of the right eye was finger count at 50 cm. Examination of the right eye revealed a whitish fan-shaped corneal opacity on the medial side with neovascularization, diagnostic of lipid keratopathy.

Conclusion:
Electrocautery of epistaxis should be performed carefully during hemostasis, and there should be careful follow-up after the procedure to detect the occurrence of septal hematoma or septal abscess. These conditions should be treated as early as possible to avoid further serious complications. Since lipid keratopathy is difficult to treat once it occurs, care should be taken to avoid a septal abscess.