bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Preoperative Platelet Count on Bleeding Risk and Allogeneic Transfusion in Multilevel Spine Surgery
Authors: Chow Jonathan H. , Chancer Zackary , Mazzeffi Michael A. , McNeil John S. , Sokolow Michael J. , Gaines Tyler M. , Reif Michaella M. , Trinh Anthony T. , Wellington Ian J. , Camacho Jael E. , Bruckner Jacob J. , Tanaka Kenichi A. , Ludwig Steven 
Published: October 2020

Study Design.
This was an observational cohort study of patients receiving multilevel thoracic and lumbar spine surgery.

Objective.
The aim of this study was to identify which patients are at high risk for allogeneic transfusion which may allow for better preoperative planning and employment of specific blood management strategies.

Summary of Background Data.
Multilevel posterior spine surgery is associated with a significant risk for major blood loss, and allogeneic blood transfusion is common in spine surgery.

Methods.
A univariate logistic regression model was used to identify variables that were significantly associated with intraoperative allogeneic transfusion. A multivariate forward stepwise logistic regression model was then used to measure the adjusted association of these variables with intraoperative transfusion.

Results.
Multilevel thoracic and lumbar spine surgery was performed in 921 patients. When stratifying patients by preoperative platelet count, patients with pre-operative thrombocytopenia and severe thrombocytopenia had a significantly higher rate of transfusion than those who were not thrombocytopenic. Furthermore, those with severe thrombocytopenia had a higher rate of red blood cells, fresh frozen plasma, and platelet transfusion than those with higher platelet counts. Multivariate logistic regression found that preoperative platelet count was the most significant contributor to transfusion, with a platelet count ≤100 having an adjusted odds ratio (OR) of transfusion of 4.88 (95% confidence interval [CI] 1.58–15.02, P = 0.006). Similarly, a platelet count between 101and 150 also doubled the risk of transfusion with an adjusted OR of 2.02 (95% CI 1.01–4.04, P = 0.047). The American Society of Anesthesiologists classification score increased the OR of transfusion by 2.5 times (OR = 2.52, 95% CI 1.54–4.13), whereas preoperative prothrombin time and age minimally increased the risk.

Conclusion.
Preoperative thrombocytopenia significantly contributes to intraoperative transfusion in multilevel thoracic lumbar spine surgery. Identifying factors that may increase the risk for transfusion could be of great benefit in better preoperative counseling of patients and in reducing overall cost and postoperative complications by implementing strategies and techniques to reduce blood loss and blood transfusions.

Level of Evidence: 2
Endovenous Thermal Ablation of Prominent Central Forehead Veins (Supratrochlear Veins)
Authors: Pereira Charles Esteves , Rover Carlos Alberto , Whiteley Mark Steven 
Published: October 2020

BACKGROUND
Many patients complain of prominent vertical veins in the center of their forehead, worse when smiling, wrinkling the forehead in bright light, leaning forward, and when vasodilated in heat, when exercising, or with alcohol. Previous attempts to treat these with external laser, sclerotherapy, and phlebectomy have not been successful.

OBJECTIVE
To describe a new method of treating prominent vertical forehead veins and to report the early results.

MATERIALS AND METHODS
We used endovenous laser ablation with a 1470 nm diode laser in 15 patients (F:M 12:3; mean age 38.4 years range 24–69). A bare fiber was used once and a 400-μm single ring radial fiber (Biolitec, Vienna, Austria) in all other cases. Tumescence was placed around the vein and a power of 2 to 3 W with a pullback of 7 to 10 seconds per centimeter.

RESULTS
Twelve of the 15 patients (80%) ended up with a good cosmetic result and were satisfied, although 2 needed redo treatment. One patient had minor skin tethering, and 2 (13%) suffered burns—one was the only bare fiber case and the other, the only one where 4 W was used.

CONCLUSION
We present a novel technique to treat prominent vertical forehead veins, with apparently good early results.
Deep Anterior Lamellar Keratoplasty After Previous Anterior Lamellar Keratoplasty to Improve the Visual Outcomes
Authors: Sarnicola Caterina , Sarnicola Enrica , Cheung Albert Y. , Panico Edoardo , Panico Claudio , Sarnicola Vincenzo 
Published: October 2020

Purpose:To describe a series of patients who underwent deep anterior lamellar keratoplasty (DALK) after previous anterior lamellar keratoplasty (ALK) to improve their visual outcomes.Methods:This is a retrospective case series of 9 DALK eyes (9 patients) with a history of previous ALK and an unsatisfactory visual outcome. Surgery was performed in all cases at least 3 years after ALK. Cannula big bubble, air viscobubble, and manual dissection techniques were performed. Preoperative and postoperative best-corrected visual acuity, residual recipient bed thickness, and endothelial cell count were evaluated. Follow-up was at least 24 months for all eyes.Results:Two subtotal anterior lamellar keratoplasties (through 1 type 1 big bubble and 1 air viscobubble) and 7 manual dissection DALKs were achieved. A small rupture of the residual recipient bed occurred during 1 case, and it was managed without penetrating keratoplasty conversion. Mean best-corrected visual acuity improved from 0.64 to 0.09 logMAR. Postoperative residual recipient central bed thickness was less than 80 μm in all cases. No postoperative complications were recorded at the last follow-up (24–36 months postoperatively).Conclusions:Different DALK techniques can be successfully used to improve visual acuity in previous ALK eyes with an unsatisfactory visual outcome.
Validation of a Novel Confocal Microscopy Imaging Protocol With Assessment of Reproducibility and Comparison of Nerve Metrics in Dry Eye Disease Compared With Controls
Authors: Takhar Jaskirat S. , Joye Ashlin S. , Lopez Sarah E. , Marneris Athanasios G. , Tsui Edmund , Seitzman Gerami D. , Keenan Jeremy D. , Gonzales John A. 
Published: October 2020

Purpose:
The purposes of this study were to assess the reproducibility of a novel standardized technique for capturing corneal subbasal nerve plexus images with in vivo corneal confocal microscopy and to compare nerve metrics captured with this method in participants with dry eye and control participants.

Methods:
Cases and controls were recruited based on their International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnoses. Participants completed the following 3 ocular symptom questionnaires: the Ocular Surface Disease Index, Neuropathic Pain Symptom Inventory, and Dry Eye Questionnaire 5. A novel eye fixation-grid system was used to capture 30 standardized confocal microscopy images of the central cornea. Each participant was imaged twice by different operators. Seven quantitative nerve metrics were analyzed using automated software (ACCmetrics, Manchester, United Kingdom) for all 30 images and a 6-image subset.

Results:
Forty-seven participants were recruited (25 classified as dry eye and 22 controls). The most reproducible nerve metrics were corneal nerve fiber length [intraclass correlation (ICC) = 0.86], corneal nerve fiber area (ICC = 0.86), and fractal dimension (ICC = 0.90). Although differences were not statistically significant, all mean nerve metrics were lower in those with dry eye compared with controls. Questionnaire scores did not significantly correlate with nerve metrics. Reproducibility of nerve metrics was similar when comparing the entire 30-image montage to a central 6-image subset.

Conclusions:
A standardized confocal imaging technique coupled with quantitative assessment of corneal nerves produced reproducible corneal nerve metrics even with different operators. No statistically significant differences in in vivo corneal confocal microscopy nerve metrics were observed between participants with dry eye and control participants.
Odontogenic Cutaneous Fistula: A Case in Aged Patient With Delayed Diagnosis
Authors: Borbon Claudia , Gallesio Cesare , Ramieri Guglielmo 
Published: October 2020

Abstract
Odontogenic cutaneous fistula is a pathologic communication between the cutaneous surface of the face and the oral cavity and it is a rare entity frequently misdiagnosed.
Therefore, the lesion may persist for a long period before the correct diagnosis is made and odontogenic source is treated appropriately. Delay in diagnosis adds to the chronicity of the lesion and if not diagnosed in times fistula can even leave deforming scars.
Considering the scarceness and diagnostic predicament of odontogenic cutaneous fistulas, the authors report a significant case of 80 years old female.
A Patient With Traumatic Upper Eyelid Ectropion and Their Management by Canthopexy
Authors: Louca Milton , Dusseldorp Joseph R. 
Published: October 2020

Abstract
Upper eyelid ectropion is rare. When it does occur, the cicatricial subset of upper eyelid ectropion is its most common manifestation. Due to its rarity, little has been published regarding its treatment. Herein, we present the case of a 27-year-old patient who suffered significant left sided facial trauma in a high-velocity motor vehicle accident, resulting in a soft tissue defect in the left lateral supra-orbital region, including loss of the lateral half of the left eyebrow. The defect was left to heal by secondary intention causing severe cicatricial upper eyelid ectropion. Several reconstructive techniques were subsequently utilized including recreating the defect and replacing like with like tissues according to the facial sub-units. Right sided upper eyelid skin was used to replace the deficient left upper eyelid skin and a scalp composite graft was harvested to replace the deficient left lateral eyebrow. Temporary tarsorrhaphy, and steroid injections were used on multiple occasions to counteract the cicatricial forces. Ultimately, permanent lateral tarsorrhaphy and upper eyelid canthopexy was needed to obtain a satisfactory functional and cosmetic result.
A Rare Paranasal Sinus Abnormality: Maxillary Sinus Hypoplasia
Authors: Erdogan Banu Atalay 
Published: October 2020

Abstract
Maxillary sinus hypoplasia is a rare condition. The majority of patients are asymptomatic but in some cases, they suffer from headaches and facial pain. Awareness of this condition is important because of misdiagnosis and possible complications during endoscopic sinus surgery. This is a presentation of 24-year-old women with unilateral maxillary sinus hypoplasia who presented with headache and nasal blockage.
Women in Maxillofacial Surgery and Otolaryngology; Career Obstacles and Success Factors
Authors: Al Ryalat Nosaiba , Ryalat Soukaina , Al-Abdalla Mariam , Al-Shayyab Mohammad H. , Samara Osama , Taimeh Dina , Khreesha Lubna , Abu-Hammad Osama A. , Malkawi Ziad , Dar-Odeh Najla S. 
Published: October 2020

Abstract
Little is known on career factors and expectations for female oral and maxillofacial surgeons (OMFS) in developing countries. The study aimed to explore career perceptions of females in 2 related surgical specialties: oral and maxillofacial surgery and otolaryngology (ENT) with a focus on career obstacles and success factors. A structured questionnaire was distributed to female surgeons working in Jordan in the 2 surgical specialties. Questions addressed socio-professional characteristics and career-promoting and hindering factors. All surgeons registered in both specialties were invited. A total of 56 surgeons participated in the survey. Age range was 29 to 55 years (mean = 38.55 ± 5.799). Significantly more OMFS surgeons were single (P = 0.000) younger (P = 0.003), and had fewer years of experience (P = 0.01) than ENT surgeons. Significantly more ENT surgeons perceived the “hard working” attribute and “better communication skills” as career-promoting factors (P = 0.04, P = 0.015, respectively). Further, significantly more ENT surgeons believed that females in the surgical profession help in changing the traditional surgical stereotype linked with the male gender (93.8% ENT in contrast to 75% OMFS, P = 0.047), and expressed a preference for female mentors (48% ENT in contrast to 0% OMFS, P = 0.000). The results of this study indicate that female OMFS surgeons have different socio-professional characteristics and perceptions to their peers in ENT surgery, and this mainly manifested in professional experience, marital status, and important career perceptions. They seem to lack confidence in female participation and promotion of the surgical career, and they show preference for having exclusively male mentors.
Comparison of the Biomechanical Stiffness of Titanium and Sonic Weld RX Osteofixation Systems for Monoblock Zygomaticomaxillary Complex Fractures
Authors: Iwanaga Hiroyuki , Nuri Takashi , Ueda Koichi 
Published: October 2020

Abstract
Resorbable osteosynthesis systems are widely used for the fixation of zygomaticomaxillary complex (ZMC) fractures instead of titanium systems, because they do not have postoperative hardware-related complications. However, the strength of conventional resorbable systems is inferior to that of titanium systems. Recently, ultrasound-aided resorbable osteosynthesis systems, which have higher fixation than conventional resorbable osteosynthesis systems, have become available.
The purpose of this study was to compare the mechanical stiffness of the ultrasound-aided resorbable and titanium osteosynthesis systems in a cadaveric monoblock ZMC fracture model. Three human cadaveric monoblock ZMC fracture models (6 zygomas) were created. The fixation materials included the titanium (Level One Fixation; KLS Martin, Germany) and ultrasound-aided resorbable osteofixation systems (SonicWeld RX; KLS Martin). The fixation methods included the 3-point (zygomaticofrontal [ZF], zygomaticomaxillary buttress, and inferior orbital rim [Group I]) and the 2-point (ZF + inferior orbital rim [Group IIa] and ZF + zygomaticomaxillary buttress [Group IIb]) fixations. Each fixation model was mechanically tested with a load of up to 100 N, based on the previously reported postoperative masseter muscle strength, and the stiffness was calculated. Titanium was found to be stiffer than SonicWeld RX, though not significantly different. The fixation points in decreasing order of stiffness were Group I, Group IIa, and Group IIb, though the differences were not significant. In conclusion, the 2-point fixation, including the ZF fixation with SonicWeld RX, can be used as an alternative to the 3-point titanium fixation, which is considered to be stronger and stiffer.
Anesthesia-Associated Periodic Discharges
Authors: Husari Khalil S. , Ritzl Eva K. 
Published: October 2020

Purpose:
Anesthetic agents have been widely used in the treatment of refractory status epilepticus and the medical management of increased intracranial pressure whenever the goal is therapeutic burst suppression. Periodic patterns typically consisting of generalized periodic discharges (GPDs) following emergence from anesthesia have been described in several case reports. However, their clinical significance and in particular whether these patterns are epileptiform remains unclear.

Methods:
This is a single-center, retrospective, observational study examining EEG patterns following emergence from pharmacologically induced burst suppression. Clinical and EEG data were collected. Patients who developed GPDs following anesthetic wean were compared with those who did not.

Results:
Over 4.5 years, 14 patients developed GPDs related to anesthetic withdrawal. The GPDs had a frequency between 0.5 and 2.5 Hz. Generalized periodic discharges related to anesthetic withdrawal were transient, with a median duration of 40 hours (interquartile range, 24–48 hours). Notably, in all patients, the pattern was stimulus dependent. When compared with a control group of 19 consecutive patients who did not develop a generalized periodic pattern in the context of the anesthetic wean, there was no significant difference in the status epilepticus relapse between the two groups (29% vs. 44%; P = 0.63). Patients in the GPD group were more likely to be on pentobarbital (93% vs. 58%; P = 0.05) and were more likely to have concomitant systemic infection treated with antibiotics compared with the control group (86% vs. 42%; P = 0.02).

Conclusions:
Generalized periodic patterns are common following the wean of intravenous anesthetics (particularly pentobarbital) and likely represent a transitional encephalopathic state in a subset of patients. Their morphology is distinct and can be differentiated from the reemergence of status epilepticus (if the latter was the indication for anesthetic treatment). Failure to recognize this pattern may lead to prolonged unnecessary treatments if it is mistaken for the emergence of seizure activity. The presence of concomitant systemic infection and associated antibiotic treatment may be risk factors for the development of this pattern.
Exosome-LncPICALM-AU1 regulates endothelial–mesenchymal transition in hepatopulmonary syndrome
Authors: Yang Congwen , Yang Yihui , Chen Yang , Huang Jian , Li Yujie , Zhi Hongyu , Tang Xi , Wang Xiaobo , Belguise Karine , Xia Zhengyuan , Ning Jiaoling , Gu Jianteng , Yi Bin , Lu Kaizhi 
Published: October 2020

AbstractAs important mediators of intercellular communication, exosome have can modulate various cellular functions by transferring a variety of intracellular components to target cells. However, little is known about the role of exosome-mediated communication between distant organs. Hepatopulmonary syndrome (HPS) is a severe lung injury caused by chronic liver disease. A new long noncoding RNA (lncRNA) PICALM-AU1 was found and upregulated in the liver of HPS. It was located in the cholangiocytes of liver and then, secreted as exosome into the serum. PICALM-AU1 carrying serum exosomes induced endothelial-mesenchymal transition (EndMT) of PMVECs and promoted lung injury in vivo and in vitro. Furthermore, overexpression of PICALM-AU1 significantly suppressed miR144-3p and subsequently induced ZEB1 expression. Taken together, our findings identified cholangiocyte-derived exosomal lncRNA PICALM-AU1 plays a critical role in the EndMT of HPS lung. And PICALM-AU1 represents a noninvasive biomarker and potential therapeutic target for HPS.
Extra-cellular Matrix in cell aggregates is a proxy to mechanically control cell proliferation and motility
Authors: Dolega Monika E. , Monnier Sylvain , Brunel Benjamin , Joanny Jean-François , Recho Pierre , Cappello Giovanni 
Published: October 2020

AbstractImposed deformations play an important role in morphogenesis and tissue homeostasis, both in normal and pathological conditions. To perceive mechanical perturbations of different types and magnitudes, tissues need appropriate detectors, with a compliance that matches the perturbation amplitude. By comparing results of selective osmotic compressions of cells within multicellular aggregates with small osmolites and global aggregate compressions with big osmolites, we show that global compressions have a strong impact on the aggregates growth and internal cell motility, while selective compressions of same magnitude have almost no effect. Both compressions alter the volume of individual cells in the same way but, by draining the water out of the extracellular matrix, the global one imposes a residual compressive mechanical stress on the cells while the selective one does not. We conclude that, in aggregates, the extracellular matrix is as a sensor which mechanically regulates cell proliferation and migration in a 3D environment.
Two-tiered SARS-CoV-2 seroconversion screening in the Netherlands and stability of nucleocapsid, spike protein domain 1 and neutralizing antibodies
Authors: Garritsen Anja , Scholzen Anja , van den Nieuwenhof Daan W.A. , Smits Anke P.F. , Datema E. Suzan , van Galen Luc S. , Kouwijzer Milou L.C.E. 
Published: October 2020

AbstractSerological testing in the COVID-19 pandemic is mainly implemented to gain sero-epidemiological data, but can also retrospectively inform about suspected SARS-CoV-2 infection. We verified and applied a two-tiered testing strategy combining a SARS-CoV-2 receptor-binding domain (RBD)-specific lateral flow assay (LFA) with a nucleocapsid protein (NCP) IgG ELISA to assess seroconversion in n=7241 individuals. The majority had experienced symptoms consistent with COVID-19, but had no access to RT-PCR testing. Longitudinal follow-up in n=97 LFA+ individuals was performed up to 20 weeks after initial infection using NCP and spike protein S1 domain (S1) IgG ELISAs and a surrogate virus neutralization test (sVNT). Individuals reporting symptoms from January 2020 onwards showed seroconversion, as did a considerable proportion of asymptomatic individuals. Seroconversion for symptomatic and asymptomatic individuals was higher in an area with a known infection cluster compared to a low incidence area. Overall, 94% of individuals with a positive IgG result by LFA were confirmed by NCP ELISA. The proportion of ELISA-confirmed LFA results declined over time, in line with contracting NCP IgG titers during longitudinal follow-up. Neutralizing antibody activity was considerably more stable than S1 and NCP IgG titers, and both reach a plateau after approximately 100 days. The sVNT proved to be not only highly specific, but also more sensitive than the specificity-focussed two-tiered serology approach. Our results demonstrate the high specificity of two-tiered serology testing and highlight the sVNT used as a valuable tool to support modelling of SARS-CoV-2 transmission dynamics, complement molecular testing and provide relevant information to individuals.
Distinct serum anti-Aβ antibody patterns in hemorrhagic and inflammatory cerebral amyloid angiopathy manifestations
Authors: Chantran Yannick , Capron Jean , Doukhi Diana , Felix Johanna , Féroul Mélanie , Kruse Florian , Chaigneau Thomas , Dorothée Guillaume , Allou Thibault , Ayrignac Xavier , Barrou Zina , de Broucker Thomas , Cret Corina , Turc Guillaume , Peres Roxane , Wacongne Anne , Sarazin Marie , Renard Dimitri , Cordonnier Charlotte , Alamowitch Sonia , Aucouturier Pierre 
Published: October 2020

AbstractObjectiveTo study blood anti-Aβ antibodies in the context of spontaneous inflammatory or hemorrhagic CAA manifestations, which are similar to complications occurring after monoclonal anti-Aβ antibody immunotherapies.MethodsIn this case-control study, serum anti-Aβ antibody isotype, concentration, avidity, and reactivity toward soluble or fibrillary Aβ1-40 and Aβ1-42 isoforms were assessed using an ELISA-based multiplex analysis. Anti-Aβ serologic patterns were defined in CAA and CAA subgroups using multivariable logistic regression analyses.ResultsFourty-one healthy aged controls and 64 CAA patients were recruited: 46 with hemorrhagic features (CAA-he) and 18 with CAA-related inflammation (CAA-ri). As compared to controls, the most striking features of CAA-related serological profiles were the following: i) both CAA-he and CAA-ri patients displayed lower binding diversity of anti-soluble Aβ1-40 IgM; ii) CAA-he patients displayed higher anti-soluble Aβ1-40 / fibrillary Aβ1-42 IgG4 concentrations ratio and higher anti-soluble Aβ1-42 IgG4 and IgA avidity; iii) CAA-ri patients displayed higher binding diversity of anti-soluble Aβ1-40 IgG3 and higher anti-fibrillary/soluble Aβ1-42 IgG4 dilution curve steepness ratio.ConclusionThis proof-of-concept study revealed anti-Aβ antibody variations in CAA patients, some of which were associated to CAA clinical phenotypes, unveiling pathophysiological insights regarding CAA-hemorrhagic and inflammatory related events.