bluuebunny/crossref_metadata_2025_split huggingface dataset:
3D-printed Patient-specific Spine Implants
Authors: Wallace Nicholas , Schaffer Nathaniel E. , Aleem Ilyas S. , Patel Rakesh 
Published: June 2020

Study Design:Systematic review.Objective:To review the current clinical use of 3-dimensional printed (3DP) patient-specific implants in the spine.Summary of Background Data:Additive manufacturing is a transformative manufacturing method now being applied to spinal implants. Recent innovations in technology have allowed the production of medical-grade implants with unprecedented structure and customization, and the complex anatomy of the spine is ideally suited for patient-specific devices. Improvement in implant design through the process of 3DP may lead to improved osseointegration, lower subsidence rates, and faster operative times.Methods:A comprehensive search of the literature was conducted using Ovid MEDLINE, EMBASE, Scopus, and other sources that resulted in 1842 unique articles. All manuscripts describing the use of 3DP spinal implants in humans were included. Two independent reviewers (N.W. and N.E.S.) assessed eligibility for inclusion. The following outcomes were collected: pain score, Japanese Orthopedic Association (JOA) score, subsidence, fusion, Cobb angle, vertebral height, and complications. No conflicts of interest existed. No funding was received for this work.Results:A total of 17 studies met inclusion criteria with a total of 35 patients. Only case series and case reports were identified. Follow-up times ranged from 3 to 36 months. Implant types included vertebral body replacement cages, interbody cages, sacral reconstruction prostheses, iliolumbar rods, and a posterior cervical plate. All studies reported improvement in both clinical and radiographic outcomes. 11 of 35 cases showed subsidence >3 mm, but only 1 case required a revision procedure. No migration, loosening, or pseudarthrosis occurred in any patient on the basis of computed tomography or flexion-extension radiographs.Conclusions:Results of the systematic review indicate that 3DP technology is a viable means to fabricate patient-matched spinal implants. The effects on clinical and radiographic outcome measures are still in question, but these devices may produce favorable subsidence and pseudoarthrosis rates. Currently, the technology is ideally suited for complex tumor pathology and atypical bone defects. Future randomized controlled trials and cost analyses are still needed.Level of Evidence: IV—systematic review.
Evaluating the Clinical Impact of Rapid Response Electroencephalography: The DECIDE Multicenter Prospective Observational Clinical Study*
Authors: Vespa Paul M. , Olson DaiWai M. , John Sayona , Hobbs Kyle S. , Gururangan Kapil , Nie Kun , Desai Masoom J. , Markert Matthew , Parvizi Josef , Bleck Thomas P. , Hirsch Lawrence J. , Westover M. Brandon 
Published: June 2020

Objectives:
To measure the diagnostic accuracy, timeliness, and ease of use of Ceribell rapid response electroencephalography. We assessed physicians’ diagnostic assessments and treatment plans before and after rapid response electroencephalography assessment. Primary outcomes were changes in physicians’ diagnostic and therapeutic decision making and their confidence in these decisions based on the use of the rapid response electroencephalography system. Secondary outcomes were time to electroencephalography, setup time, ease of use, and quality of electroencephalography data.

Design:
Prospective multicenter nonrandomized observational study.

Setting:
ICUs in five academic hospitals in the United States.

Subjects:
Patients with encephalopathy suspected of having nonconvulsive seizures and physicians evaluating these patients.

Interventions:
Physician bedside assessment of sonified electroencephalography (30 s from each hemisphere) and visual electroencephalography (60 s) using rapid response electroencephalography.

Measurements and Main Results:
Physicians (29 fellows or residents, eight attending neurologists) evaluated 181 ICU patients; complete clinical and electroencephalography data were available in 164 patients (average 58.6 ± 18.7 yr old, 45% females). Relying on rapid response electroencephalography information at the bedside improved the sensitivity (95% CI) of physicians’ seizure diagnosis from 77.8% (40.0%, 97.2%) to 100% (66.4%, 100%) and the specificity (95% CI) of their diagnosis from 63.9% (55.8%, 71.4%) to 89% (83.0%, 93.5%). Physicians’ confidence in their own diagnosis and treatment plan were also improved. Time to electroencephalography (median [interquartile range]) was 5 minutes (4–10 min) with rapid response electroencephalography while the conventional electroencephalography was delayed by several hours (median [interquartile range] delay = 239 minutes [134–471 min] [p < 0.0001 using Wilcoxon signed rank test]). The device was rated as easy to use (mean ± sd: 4.7 ± 0.6 [1 = difficult, 5 = easy]) and was without serious adverse effects.

Conclusions:
Rapid response electroencephalography enabled timely and more accurate assessment of patients in the critical care setting. The use of rapid response electroencephalography may be clinically beneficial in the assessment of patients with high suspicion for nonconvulsive seizures and status epilepticus.
Trans-cranial Doppler predicts early neurologic deterioration in anterior circulation ischemic stroke after successful endovascular treatment
Authors: He Yan-Bo , Su Ying-Ying , Rajah Gary B. , Zhang Ying-Bo , Fan Lin-Lin , Liu Gang , Chen Hong-Bo 
Published: June 2020

Abstract

Background
Early neurologic deterioration (END) may occur in patients with anterior circulation ischemic stroke (ACIS) after receiving endovascular treatment (EVT). Hemodynamic insufficiency, re-occlusion, and post-re-canalization hyper-perfusion are likely to play a critical role in END. We hypothesized that hemodynamic changes can predict END in patients with ACIS post-successful EVT using trans-cranial Doppler (TCD).

Methods
We utilized a prospectively maintained database of ACIS patients treated with EVT between September 2016 and June 2018 in the Xuanwu Hospital, Capital Medical University. TCD parameters including peak systolic velocity (PSV), bilateral mean flow velocity (MFV), and pulse index (PI) were determined via the middle cerebral arteries within 72 h post-EVT. A logistic regression model was applied to detect independent predictors for END.

Results
Totally, 112 EVT patients were included in this study and 80/112 patients experienced successful re-canalization with <50% residual stenosis, while 17/80 (21.3%) patients suffered END, for which vasogenic cerebral edema (11/17) was considered as a leading role and followed by symptomatic intra-cranial hemorrhage (4/17) and ischemia progression (2/17). For the 80 patients, the PSV (median: 127 cm/s vs. 116 cm/s, P = 0.039), the ratio of ipsilateral-MFV/contra-lateral-MFV (iMFV/cMFV) (median: 1.29 vs. 1.02, P = 0.036) and iMFV/mean blood pressure (MBP) (median: 0.97 vs. 0.79, P = 0.008) in END patients were higher than those of non-END. Using the receiver-operating characteristic curve to obtain cut-off values for PSV, PI, iMFV/cMFV, and iMFV/MBP for END, we found that PI ≥0.85 (odds ratio: 11.03, 95% confidence interval: 1.92–63.46, P = 0.007) and iMFV/MBP ≥0.84 (odds ratio: 9.20, 95% confidence interval: 2.07–40.84, P = 0.004) were independent predictors of END in a multivariate logistic regression model, with a sensitivity of 82.4% and 76.5% and a specificity of 42.9% and 66.7%, respectively, and had the positive predictive values of 29.0% and 38.2%, and negative predictive values of 90.0% and 91.3%, with an area under the receiver-operating characteristic curve of 0.57 and 0.71, respectively.

Conclusion
TCD examination of EVT patients may be used as a real-time tool to detect END predictors, such as the higher PI and iMFV/MBP, allowing for better post-thrombectomy management in ACIS patients.
Evaluation of Long-Term Outcome and Patient Satisfaction Results After Tumescent Liposuction
Authors: Lipp Michael B. , Butterwick Kimberly , Angra Kunal , Chunhara Chatchadapon , Goldman Mitchel P. 
Published: June 2020

BACKGROUND
Liposuction is one of the most common cosmetic surgery procedures around the world. Tumescent liposuction using local anesthesia has been shown to be the safest technique. Few long-term studies of results and satisfaction have been published on tumescent liposuction.

OBJECTIVE
To evaluate long-term results and patient satisfaction of tumescent liposuction in a single-center institution.

METHODS
Patients (n = 600) who had tumescent liposuction performed in our practice from 2002 to 2014 were contacted through letter, email, or phone to complete a questionnaire survey and in-office follow-up visit regarding their past liposuction procedures.

RESULTS
Thirty-two patients (n = 32) completed the patient questionnaire survey and followed up in the office. Surgeon and blinded evaluators saw significant differences in both the neck volume (surgeon evaluator: 2.42 vs. 0.71, p < .01; blinded evaluator: 2.8–1, p = .02) and Investigator Assessment Skin Laxity scales (blinded evaluator: 1.14 vs. 0.77, p < .01 for laxity and 1.33 vs. 0.75, p < .01 for firmness; surgeon evaluator: 1.17 vs. 0.83, p = .01 for laxity and 1.31 vs. 0.83; p < .01 for firmness). The mean follow-up period was 8.9 years overall and 9.9 years for the neck. Overall, 85.7% of the patients would recommend liposuction to their friends and family members.

CONCLUSION
Tumescent liposuction is a safe procedure with long-lasting results and high patient satisfaction.
An updated guide to the diagnosis and management of cesarean scar pregnancies
Authors: Liu Lucy , Ross Whitney T. , Chu Amanda L. , Deimling Timothy A. 
Published: June 2020

Purpose of review
To review the current literature on the diagnosis and management of cesarean scar pregnancies

Recent findings
The incidence of cesarean scar pregnancies (CSPs) is increasing as a result of the increasing cesarean section rate, improved diagnostic capabilities, and a growing awareness. CSPs are associated with significant morbidity and early diagnosis is key. Diagnosis is best achieved with transvaginal ultrasound. Sonographic diagnostic criteria have been developed over decades and recently endorsed by the Society for Maternal-Fetal Medicine and other professional societies. The current categorization system differentiates CSPs that are endogenic or ‘on the scar’ from those that are exogenic or ‘in the niche’. Following diagnosis, the challenge remains in determining the optimal management as multiple modalities can be considered. Studies have demonstrated the favorable outcomes with combined local and systemic methotrexate, surgical excision through multiple routes, and adjunctive therapies, such as uterine artery embolization or uterine balloons. The current evidence is insufficient to identify a single best treatment course and a combined approach to treatment is often required.

Summary
Successful outcomes while minimizing complications can be achieved with a multidisciplinary, collaborative effort. Guidelines for cesarean scar pregnancies will continue to evolve as the published reports grow.
Modified Intrascleral Fixation for Repositioning the Dislocated Single-Piece, Rigid PMMA Intraocular Lens
Authors: Zong Yuan , Wu Kaicheng , Fang Wangyi , Yu Jian , Jiang Chunhui , Xu Gezhi 
Published: June 2020

Purpose:
To describe a modified intrascleral fixation technique for repositioning single-piece rigid polymethyl methacrylate intraocular lenses (IOLs).

Methods:
Four patients with dislocated IOLs were enrolled. Surgical modifications included using ≤1-mm scleral incision for haptic externalization, placing the IOL haptic placement in scleral tunnels, and using 8-0 absorbable sutures. Patients were followed up for 6 months with routine ophthalmic examinations, corneal endothelial cell counts, and ultrasound biomicroscopy (UBM).

Results:
The mean follow-up time was 13.5 ± 5.45 months. The IOL was well centered and the spherical refraction improved (+10.25 ± 2.21 vs. −0.81 ± 1.59 D, P < 0.05), whereas the best-corrected visual acuity (pre 20/43 Snellen, 0.42 ± 0.33 logarithm of the minimum angle of resolution equivalent and post 20/36 Snellen, 0.31 ± 0.22 logarithm of the minimum angle of resolution equivalent; P = 0.235), intraocular pressure (pre 13.8 ± 3.21, post 13.55 ± 5.14 mmHg), corneal endothelium density (pre 2,423.8 ± 279.6/mm2, post 2,280.25 ± 350.7/mm2), and total astigmatism (pre −1.94 ± 0.43, post −1.69 ± 0.59 D) remained unchanged. The average horizontal and vertical IOL tilt was 0.33 ± 0.22° and 0.81 ± 0.38°, respectively. Intraocular lens decentration was 0.10 ± 0.03 mm horizontally and 0.13 ± 0.06 mm vertically.

Conclusion:
The modified intrascleral fixation technique shows encouraging midterm results in patients with dislocated single-piece, rigid polymethyl methacrylate IOLs. Larger samples and longer follow-up are required to confirm the outcomes of this technique.
In Vivo Confocal Microscopy Morphometric Analysis of Meibomian Glands in Patients With Graves Ophthalmopathy
Authors: Vagge Aldo , Bernabei Federico , Del Noce Chiara , Pellegrini Marco , Giannaccare Giuseppe , Senni Carlotta , Scotto Riccardo , Traverso Carlo E. 
Published: June 2020

Purpose:
To characterize meibomian glands (MGs) features in patients with Graves ophthalmopathy (GO) by in vivo confocal microscopy (IVCM) and to further investigate possible correlations with ocular surface characteristics.

Methods:
Consecutive patients with GO and controls were enrolled. The following ocular surface parameters were measured: tear break-up time, Schirmer test, and corneal fluorescein staining (Oxford score) were performed on each subject. IVCM of MGs was performed, and the scans were analyzed with ImageJ software for the calculation of the following: acinar unit density, total gland area, total lumen area (TLA), acinar longest diameter, and acinar shortest diameter. A nonparametric Mann–Whitney U test was used to compare variables between patients with GO and controls. The Spearman correlation analysis was used to evaluate the correlations between ocular surface and IVCM parameters.

Results:
Twenty-one patients with GO and 24 sex- and age-matched healthy controls were included. Acinar unit density was significantly lower in patients with GO compared with controls (24.5 ± 8.1 vs. 34.2 ± 7.5 U/mm2; P < 0.001). In addition, patients with GO showed significantly higher values of TLA, acinar longest diameter, and acinar shortest diameter compared with controls (respectively, 3104.7 ± 1713.3 vs. 1393.8 ± 448.0 μm2, 94.4 ± 21.2 vs. 64.3 ± 10.1 µm and 56.6 ± 15.3 vs. 42.2 ± 12.3 μm; always P < 0.05). In patients with GO, TLA showed a significant inverse correlation with Schirmer test (Rs = −0.467; P = 0.038).

Conclusions:
IVCM allowed to detect distinctive features of MGs in patients with GO and could represent a surrogate tool for the assessment of MG status in these patients.
Visian Implantable Collamer Lens Behavior in Descemet Membrane Endothelial Keratoplasty Surgery
Authors: Alió del Barrio Jorge L. , D'Oria Francesco , Alió Jorge L. 
Published: June 2020

Abstract:
Endothelial damage is one of the leading causes for anterior chamber phakic intraocular lens (AC-pIOL) explantation. In young patients, where the pIOL is explanted alone without lensectomy, an important anisometropia is left, unless an exchange with a posterior chamber (PC) pIOL is performed. However, in the event of corneal decompensation, there is no published evidence about the potential influence of a collamer-based PC-pIOL [implantable collamer lens (ICL)] on endothelial keratoplasty surgery. We report a case of severe endothelial damage after AC-pIOL implantation managed by the exchange of the AC-pIOL by an ICL, followed by Descemet membrane endothelial keratoplasty. Collamer-based PC-pIOLs seem to not affect Descemet membrane endothelial keratoplasty outcomes. ICL did not show any transparency loss. These results cannot be extrapolated to other non-collamer–based PC-pIOLs. Further studies with larger samples are necessary to confirm these outcomes.
DSAEK Centration and Interface Folds: Surgical Management
Authors: Gadhvi Kunal , Pagano Luca , Menassa Nardine , Borroni Davide , Kaye Stephen B. , Levis Hannah J. , Romano Vito 
Published: June 2020

Purpose:
To describe a method to center a Descemet stripping automated endothelial keratoplasty lamellar graft and address interface folds.

Methods:
A novel technique to center a Descemet stripping automated endothelial keratoplasty graft without undue manipulation of endothelial surface using a STC-6 needle passed obliquely through the anterior corneal surface to engage and progress the lenticule along the posterior surface after injection of air.

Result:
Centration of graft achieved and macroscopic folds resolved.

Conclusions:
Here, we describe an atraumatic and reproducible method for graft centration.
Questionnaire Development of a Good Nurse and Better Nursing From Korean Nurses' Perspective
Authors: PARK Mihyun , PARK Eun-Jun 
Published: June 2020

ABSTRACT

Background
The concepts of “good nurse” and “better nursing” have changed over time and should be investigated from the perspective of nurses.

Purpose
The aim of this study was to develop and assess the psychometric properties of two questionnaires used to assess “good nurse” and “better nursing.”

Methods
The interview data of 30 registered nurses (RNs) from a previous study were reviewed to develop the questionnaire items, and content validity was examined. One hundred seventeen RNs participated in a pilot survey for pretesting the constructs, 469 RNs participated in a main survey to explore these constructs using exploratory factor analysis (EFA), and 468 RNs participated in model refining and validation using confirmatory factor analysis.

Results
After a critical review of RN interview data and content validity evaluation, 73 of 124 statements on “good nurse” and 56 of 57 statements on “better nursing” were selected. In the pilot survey, the number of items was reduced to 45 for both questionnaires using an EFA. In the main survey, EFA was used to load 34 items on the five factors of the good nurse questionnaire and 26 items on the three factors of the better nursing questionnaire. In the confirmatory factor analysis, to obtain better fitting models, the good nurse questionnaire consisted of 17 items on the five factors of collaboration, professional competency, self-efficacy, a sense of achievement, and compassion, whereas the better nursing questionnaire consisted of 16 items on the three factors of person-centered nursing, proactive nursing, and expertise in caring. The construct reliability, convergent validity, and discriminant validity of the questionnaires were achieved.

Conclusions/Implications for Practice
The concept of “good nurse” from the perspectives of the nurses in this study was similar with those of patients in previous studies, while including individual traits such as sense of achievement. Better nursing is conceptualized with the exemplary performance of nursing focusing on the nature of nursing and leading excellence and power in clinical practice. The study findings inform what nursing education and workforce development should focus on for nursing to continuously progress. Furthermore, it is recommended that the concepts of a good nurse and better nursing be compared across different countries using the questionnaires.
Ice Capades
Authors: Seashore Justin , Nishi Shawn P.E. 
Published: June 2020

Background:
Transbronchial lung cryobiopsy (TBLC) has been proposed as a potentially safer alternative in the diagnosis of interstitial lung disease. The current practice of TBLC is unknown as most published data come from case reports, case series, and a few trials. The authors report the practice patterns of TBLC on the basis of survey responses.

Methods:
The authors created an anonymous online survey to assess how proceduralists evaluate patients, perform, and manage complications of TBLC. Surveys were distributed through social media and e-mail distribution lists from the American Association of Bronchology and Interventional Pulmonology and the Society of Advanced Bronchoscopists. Aggregated responses are reported as counts, percentages, and averages.

Results:
Surveys show significant variation in parameters providers use to assess appropriate patients for procedures, how specific aspects of TBLC are performed, and how complications and results are managed.

Conclusion:
This is the first and largest survey of providers describing the current large variation in the use of cryobiopsy for the evaluation of interstitial lung disease. The standardized practice is essential to understand the true diagnostic accuracy or rate of complications related to TBLC.
Serum HBV RNA Dynamic and Drug Withdrawal Predictor Value in Patients With Chronic HBV Infection on Long-term Nucleos(t)ide Analogue (NA) Therapy
Authors: Liu Yayun , Xue Jianya , Liao Wei , Yan Hongli , Liang Xuesong 
Published: June 2020

Aims:
This study aimed to investigate the dynamic pattern of serum hepatitis B virus (HBV) RNA in chronic hepatitis B (CHB) patients on long-term nucleos(t)ide analogue (NA) therapy and evaluate predictor value of end-of-treatment (EOT) serum HBV RNA status on drug-withdrawal durability.

Methods:
We carried out a real-life cohort study of 326 CHB patients on NA treatment between February 12, 2016 and February 21, 2018. Thirty of these patients discontinued NA treatment after enrollment, and were included in 2-year off-therapy follow-up. Serum HBV RNA levels were determined using the RNA simultaneous amplification testing method.

Results:
Both serum HBV RNA and DNA levels declined significantly in long-term antiviral progress. When the treatment duration was longer than 3 years, the undetectable rates of HBV RNA and DNA were 55.10% and 97.0%, respectively. The serum HBV RNA-negative rate was 39.5%. The cumulative 2-year off-therapy viral and clinical relapse rate was 40.56%; 95% confidence interval (95% CI), 21.51-59.61 and 31.31%; 95% CI, 11.32-51.29 in all patients, respectively. Patients with EOT hepatitis B surface antigen (HBsAg)≤1000 IU/mL plus HBV RNA negativity had a relatively lower cumulative 2-year off-therapy viral relapse rate (23.01%; 95% CI, 0.17-45.99). EOT HBsAg≤1000 IU/mL plus HBV RNA negativity showed obvious superiority for the EOT HBsAg≤1000 IU/mL single in drug withdrawal durability prediction, with better specificity (18.18% vs. 72.73%, P=0.03), and the positive predictive value and negative predictive value were 76.92% and 47.06%, respectively.

Conclusions:
In the long-term antiviral process, both serum HBV RNA and DNA levels declined significantly. EOT serum HBV RNA negativity was not an independent drug withdrawal marker, but can complement the HBsAg titer to monitor drug withdrawal in CHB patients on long-term NA therapy.
Considerations for the otolaryngologist in the era of COVID-19: a review of the literature
Authors: Miller Lauren E. , Shaye David A. , Lee Linda N. 
Published: June 2020

Purpose of reviewThe SARS-CoV-2 coronavirus pandemic, referred to as COVID-19, has spread throughout the globe since its first case in China in December 2019, leaving a significant number of people infected and clinically ill. The purpose of this review is to provide the current known clinical characteristics of and management for COVID-19 as it relates to otolaryngology.Recent findingsCOVID-19 is a highly transmissible respiratory disease with common presenting symptoms of fever, cough, and fatigue. In the absence of available vaccines or antiviral therapies, symptomatic and respiratory support is the current standard of therapy. Measures to prevent further transmission have been enacted globally including social distancing and cancellation of public events. Given elevated viral load in the upper aerodigestive tract, extra precautions in patients with otolaryngology needs have been recommended for protection of both healthcare workers and patients.SummaryOtolaryngologists face unique risk from COVID-19. Maintaining appropriate preventive health measures and remaining updated on institutional clinical guidelines is paramount for both caretaker safety and patient care.