bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Nomogram and a Risk Classification System Predicting the Cancer-Specific Survival of Patients With Initially-Diagnosed Osseous Spinal and Pelvic Tumors
Authors: Zhou Qiang , Li A-bing , Lin Zhong-qin , Zhang Hong-zhen 
Published: February 2020

Study Design.
Retrospective analysis.

Objective.
Our goal was to provide a predictive model and a risk classification system that predicts cancer-specific survival (CSS) from spinal and pelvic tumors.

Summary of Background Data.
Primary bone tumors of the spinal and pelvic are rare, thus limiting the understanding of the manifestations and survival from these tumors. Nomograms are the graphical representation of mathematical relationships or laws that accurately predict individual survival.

Methods.
A total of 1033 patients with spinal and pelvic bone tumors between 2004 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate Cox analysis was used on the training set to select significant predictors to build a nomogram that predicted 3- and 5-year CSS. We validate the precision of the nomogram by discrimination and calibration, and the clinical value of nomogram was assessed by making use of a decision curve analyses (DCA).

Results.
Data from 1033 patients with initially-diagnosed spinal and pelvic tumors were extracted from the SEER database. Multivariate analysis of the training cohort, predictors included in the nomogram were age, pathological type, tumor stage, and surgery. The value of C-index was 0.711 and 0.743 for the internal and external validation sets, respectively, indicating good agreement with actual CSS. The internal and external calibration curves revealed good correlation of CSS between the actual observation and the nomogram. Then, the DCA showed greater net benefits than that of treat-all or treat-none at all time points. A novel risk grouping system was established for CSS that can readily divide all patients into three distinct risk groups.

Conclusion.
The proposed nomogram obtained more precision prognostic prediction for patients with initially-diagnosed primary spinal and pelvic tumors.

Level of Evidence: 3
REAL-COLOR VERSUS PSEUDO-COLOR IMAGING OF FIBROTIC SCARS IN EXUDATIVE AGE-RELATED MACULAR DEGENERATION
Authors: De Rosa Irene , Ohayon Avi , Semoun Oudy , Miere Alexandra , Jung Camille , Capuano Vittorio , Cirafici Paola , Souied Eric H. 
Published: February 2020

Purpose:
To compare the morphological characteristics of subretinal fibrosis in late age-related macular degeneration using multicolor (MC) imaging, color fundus photography (CFP), and ultra-widefield CFP (UWFCFP).

Methods:
Thirty-two eyes of 31 patients diagnosed with subretinal fibrosis complicating exudative age-related macular degeneration were included. Included eyes were imaged by MC, CFP, and UWFCFP. The overall ability to visualize fibrosis, its margins, and dissimilarity with surrounding atrophy was graded using a score (0: not visible, 1: barely visible, 2: mostly visible, and 3: fully visible) by two readers. Area of fibrosis was calculated. Scaling, lesion colocalization on all three imaging techniques, and area measurements were performed using ImageJ.

Results:
Ninety-six images of 32 eyes were graded. The average area of fibrosis was 14.59 ± 8.94 mm2 for MC, 13.84 ± 8.56 mm2 for CFP, and 13.76 ± 8.79 mm2 for UWFCFP. Fibrosis was fully visible in 87.5% of cases using MC and 50% using CFP and UWFCFP. Fibrosis' margins were sharply defined in 40.6% of eyes with MC, 15.6% and 9.4% with CFP and UWFCFP, respectively. Multicolor imaging provided superior distinction between fibrosis and atrophy (100% for MC vs. 13.4% for CFP and 33.3% for UWFCFP). The inter- and intra-reader agreement was high for all measurements (P < 0.0001).

Conclusion:
Multicolor technology allows for improved visualization and analysis of subretinal fibrosis when compared with CFP and UWFCFP, especially when surrounding atrophy is present.
Recovery from nerve injury induced behavioral hypersensitivity in rats parallels resolution of abnormal primary sensory afferent signaling
Authors: Boada M. Danilo , Martin Thomas J. , Parker Renee , Houle Timothy T. , Eisenach James C. , Ririe Douglas G. 
Published: February 2020

Abstract
Pain and hypersensitivity months after peripheral injury reflect abnormal input from peripheral afferents likely in conjunction with central sensitization. We hypothesize that peripheral changes occur in defined sensory afferents and resolve as behavioral response to injury resolves. Male Sprague–Dawley rats underwent sham or partial L5 spinal nerve ligation, and paw withdrawal threshold (PWT) was sequentially measured during recovery. At 2, 4, 8, and 12 weeks after injury, randomized animals underwent electrophysiologic assessment of L4 fast-conducting high- and low-threshold mechanoreceptors, and individual neuronal mechanical thresholds (MTs) were contrasted with PWTs in the same animals. Paw withdrawal thresholds decreased after injury and resolved over time (P < 0.001). Similarly, MTs of fast-conducting high-threshold mechanoreceptors decreased after injury and resolved over time (P < 0.001). By contrast, MTs of low-threshold mechanoreceptors increased after injury and resolved over time (P < 0.001). Distributions of recordings from each afferent subtype were perturbed after injury, and this too resolved over time. After resolution of behavioral changes, several electrical abnormalities persisted in both neuronal subtypes. These data extend previous findings that mechanically sensitive nociceptors are sensitized, whereas tactile, largely Aβ afferents are desensitized after nerve injury by showing that the time course of resolution of these changes mirrors that of behavioral hypersensitivity in a surgical injury including neural damage. These data support a role of abnormal peripheral input, from both nociceptor and tactile afferents, during recovery from peripheral injury and underscore the potential importance of both classes of afferents as potential targets for pain treatment.
Improving attitudes toward poverty among DNP students: Implementing a Community Action Poverty Simulation©
Authors: Ehmke Melissa , Sanner-Stiehr Ericka 
Published: February 2020

ABSTRACT
Poverty has detrimental effects on health outcomes. Doctorally prepared nurse practitioners are in a position to promote health for patients and communities experiencing poverty. To do so, they must be aware of their own attitudes and to have empathy toward the condition of poverty. Specialized poverty simulations have been successfully used to improve attitudes toward poverty among prelicensure nursing students, but there is a paucity of evidence exploring the effects of poverty simulations among Students in a Doctor of Nurse Practice (DNP) program. The purpose of this study was to evaluate the impact of a poverty simulation for students enrolled in a DNP program on their attitudes toward poverty. A quasi-experimental, pre-test and post-test survey design was used in this curriculum improvement project. A total of 29 DNP students participated in a 1-time, 4-hour Community Action Poverty Simulation© (CAPS). The simulations presented various challenges faced during 1 month of living in poverty. The Attitudes toward Poverty Scale-Short Form (ATPS-SF) was used to measure attitudes toward poverty both before and after the CAPS© experience. Descriptive statistics and paired t-tests were used to describe the participant group and measure the impact of the simulation on attitudes toward poverty. Attitudes toward poverty improved overall on all dimensions of the ATPS-SF after the CAPS© experience as compared to the pre-test, with particular improvement regarding stigmas related to poverty. Statistically significant improvements were detected on four items, and the overall favorable shift in attitudes presents clinically significant results. This poverty simulation experience should be considered for adoption into DNP curricula.
Bundling Rapid Human Immunodeficiency Virus and Hepatitis C Virus Testing to Increase Receipt of Test Results
Authors: Frimpong Jemima A. , Shiu-Yee Karen , Tross Susan , D’Aunno Thomas , Perlman David C. , Strauss Shiela M. , Schackman Bruce R. , Feaster Daniel J. , Metsch Lisa R. 
Published: February 2020

Background:
The overlapping human immunodeficiency virus (HIV) and hepatitis C virus (HCV) epidemics disproportionately affect people with substance use disorders. However, many people who use substances remain unaware of their infection(s).

Objective:
The objective of this study was to examine the efficacy of an on-site bundled rapid HIV and HCV testing strategy in increasing receipt of both HIV and HCV test results.

Research Design:
Two-armed randomized controlled trial in substance use disorder treatment programs (SUDTP) in New York City. Participants in the treatment arm were offered bundled rapid HIV and HCV tests with immediate results on-site. Participants in the control arm were offered the standard of care, that is, referrals to on-site or off-site laboratory-based HIV and HCV testing with delayed results.

Participants:
A total of 162 clients with unknown or negative HIV and HCV status.

Measures:
The primary outcome was the percentage of participants with self-reported receipt of HIV and HCV test results at 1-month postrandomization.

Results:
Over half of participants were Hispanic (51.2%), with 25.3% being non-Hispanic black and 17.9% non-Hispanic white. Two thirds were male, and 54.9% reported injection as method of drug use. One hundred thirty-four participants (82.7%) completed the 1-month assessment. Participants in the treatment arm were more likely to report having received both test results than those in the control arm (69% vs. 19%, P<0.001). Seven participants in the treatment arm received a preliminary new HCV diagnosis, versus 1 in the control arm (P=0.029).

Conclusion:
Offering bundled rapid HIV and HCV testing with immediate results on-site in SUDTPs may increase awareness of HIV and HCV infection among people with substance use disorders.
Black Feminist Thought
Authors: Armour-Burton Teri , Etland Caroline 
Published: February 2020

Background
African American women (AAW) are diagnosed with more aggressive forms of breast cancer when compared to White women and are more likely to die before the age of 45 years. Researchers have suggested that psychological stress could be a precursor to breast cancer. AAW experience a unique form of stress that is a result of living at the intersection of socially constructed roles of race, gender, and class (intersectionality). No studies have used the paradigm of Black Feminist Thought to examine breast cancer disparities among AAW.

Objective
The purpose of this study was to examine how the intersection of race, gender, and class influences mental and physiological well-being among AAW with breast cancer.

Methods
A phenomenological design was used. Ten AAW ages 45–60 years were recruited from across the United States. Semistructured interviews were conducted and analyzed using a modified Husserlian approach of descriptive phenomenology. The interviews were audiotaped and transcribed verbatim, and themes were identified using Giorgi’s method.

Results
Four themes emerged: (a) altruism (selfless giving and caring for others), (b) silent strength (strength in silence while enduring life in the intersection), (c) existential invisibility (an essential, obscured presence in society), and (d) marginalization (living at the margins of society). Marginalization manifested in two forms: (a) passive marginalization (circumstances in which women removed themselves mentally or physically from societal adversity) and (b) active marginalization (circumstances in which women were overlooked, devalued, or ostracized by others).

Discussion
This study supports the use of Black Feminist Thought to garner knowledge that adds to the discussion of breast cancer disparities. The themes identified suggest other upstream psychosocial risk factors for the development of breast cancer in AAW that stem from life within the societal intersection.
The State of Burn Care Training During Plastic Surgery Residency
Authors: Vrouwe Sebastian Q. , Pham Christopher H. , Minasian Raquel A. , Yenikomshian Haig A. , Garner Warren L. , Gillenwater T. Justin 
Published: February 2020

Introduction
There is an ongoing shortage of burn specialists, and workforce reports suggest possible hurdles attracting plastic surgeons into burn care. The purpose of this study was to (1) determine the state of burn care in plastic surgery residency and (2) identify what barriers might exist for plastic surgeons pursuing a practice that involves burn care.

Methods
Surveys were distributed to North American plastic surgery program directors and residents, respectively, during the 2018–2019 academic year.

Results
Fifty-eight program directors (response, 54%) and 320 plastic surgery residents (response, 30%) participated. Burn care was felt to be an important component in training by most program directors (USA, 88%; Canada, 100%) and residents (USA, 87%; Canada, 99%). The majority of program directors included a burn unit rotation (USA, 88%; Canada, 90%). Rotations for integrated residents averaged 2.5 months and most commonly occurred during second year; independent residents spent 1.2 months on rotation, usually in first year. Three-quarters of American residents were interested in a career that involves burn care in some capacity, primarily burn reconstruction (40%). Factors that would discourage a trainee from practicing burn care in the future included the nature of burn care (60%) and burn operations (45%), the on-call commitment (39%), and a narrow scope of practice (38%).

Discussion
This study challenges the belief that plastic surgery trainees are disinterested in burn care. Burn surgery remains an important component of training programs, and we propose several steps to encourage greater interest and participation in the burn surgery workforce.
Plastic Surgery Patient Expectations for Postoperative Opioid Prescriptions
Authors: Long Emily A. , Johnson Shepard P. , Valmadrid Al , Wormer Blair A. , Drolet Brian C. , Perdikis Galen 
Published: February 2020

Background
The opioid epidemic is a healthcare crisis perpetuated by analgesic overprescribing. Despite public health attention on this issue, expectations for pain management and opioid use by plastic surgery patients are poorly understood. This study aimed to evaluate patient expectations of postoperative pain, concern for opioid dependence, and anticipated analgesic plan after plastic surgery.

Methods
New patients presenting to an academic plastic surgery clinic were prospectively enrolled from November 2017 to September 2018. These patients completed a preconsultation survey regarding their pain history and anticipated postoperative pain and analgesics regimens. Responses between cohorts expecting and not expecting postoperative opioids were compared using descriptive and univariate analyses.

Results
A total of 168 patients (63.9% female, 36.1% male; mean ± SD age 46 ± 17 years) completed the survey before breast (21.9%), cosmetic (5.3%), craniofacial (3.0%), general reconstruction (13.0%), hand (3.0%), and skin and soft tissue (49.1%) surgeries. Twenty-eight percent of patients expected opioid prescriptions. On a standard visual analog scale, patients who expected opioids anticipated greater postoperative pain (6.9 vs 4.6, P < 0.05). They were more concerned about experiencing pain (5.8 vs 4.9, P < 0.05), expected a longer duration of opioid use (63.0% vs 37.0%, P < 0.05), and were less interested in nonnarcotic analgesic alternatives (57.9% vs 19.8%, P < 0.05).

Conclusions
Less than one-third of plastic surgery patients in this study expect opioid pain medications after surgery. This supports broader use of nonopioid, multimodal pain regimens. Identification and management of patient pain expectations, especially among those anticipating a need for opioids, provide a critical opportunity for preoperative education on the benefits of nonopioid analgesics, thus minimizing opiate prescribing.
Immediate Latissimus Dorsi and Prosthetic Reconstruction in the Setting of Postmastectomy Radiation
Authors: Chiasson Katherine F. , Kumbla Pallavi A. , Restrepo Ryan D. , Soto Edgar , Cohn Alvin B. 
Published: February 2020

Background
In immediate breast reconstruction, the plastic surgeon must strive to create an aesthetically pleasing result while minimizing complications. The latissimus dorsi (LD) myocutaneous flap has long been used a workhorse flap in breast reconstruction. Often times, it is used a salvage flap after other methods of breast reconstruction have failed. In this study, we review the use of this flap in conjunction with prosthetic devices, regardless of the need for adjuvant radiation, to determine the safety and efficacy of this approach as a primary method of reconstruction.

Methods
A single surgeon practice with a standardized reconstructive algorithm was reviewed. This compromises a 2-stage approach involving the use of LD myocutaneous flaps and tissue expanders for immediate reconstruction after mastectomy, followed by exchange for implants at a secondary surgery. A retrospective chart review was performed on 201 patients (376 breast reconstructions) who met inclusion criteria. Patient demographics and outcomes were compared based on radiation status. The primary outcome, reconstructive success, was defined as no need for further autologous reconstruction beyond the 2-stage approach utilized.

Results
Statistical analysis was performed on both patient demographics, complications, and reconstructive outcomes. Demographics were equivalent between the 2 groups. When analyzing complications and outcomes, there was no difference between nonradiated patients and radiated patients except when looking at reconstructive loss, which was 3.6% in the nonradiated group and 16.6% in the radiated group (P = 0.03). However, one third of the patients in the radiated group who had reconstructive losses were due to reasons not related to radiation therapy. Taking this into account, overall reconstructive success showed no statistical significance between the 2 groups.

Conclusions
The findings from this study show that immediate reconstruction with LD myocutaneous flaps in conjunction with prosthetic devices is a reliable and safe option, even in the setting of adjuvant radiation therapy, as the autologous tissue mitigates many sequelae of radiation therapy. Not only does this type of reconstruction provide an aesthetically pleasing result in 2 stages, but also has a favorable complication profile and success rate.
Shaping an Anatomical Breast Using Extended Latissimus Dorsi Flap and Lipofilling in Immediate Breast Reconstruction
Authors: Cha Han Gyu , Kwon Jin Geun , Kim Eun Key 
Published: February 2020

Background
Although many attempts have been made to augment the volume of the latissimus dorsi (LD) myocutaneous flap in breast reconstruction, only a few studies on the shaping of the LD flap to achieve a natural native breast have been conducted. We introduce our novel method to reconstruct a naturally shaped breast by combining an extended LD myocutaneous flap with immediate lipofilling.

Methods
The patients who underwent an immediate unilateral breast reconstruction with an extended LD myocutaneous flap and lipofilling were retrospectively reviewed. The extended LD myocutaneous flap in 180-degree rotation was combined with an immediate lipofilling procedure followed by suturing to reproduce the constant dimensions of a neobreast.

Results
A total of 45 patients with a mean age of 46 years and an average body mass index of 23.1 kg/m2 were enrolled. The average weight of the mastectomy specimens was 299.0 g. An average 18.8 × 8.7-cm skin paddle within the flap was harvested, and 71.0 mL of fat was injected into the flap. Donor site seroma was found in 9 patients, and no flap or fat necrosis was found.

Conclusions
Our technique of extended LD muscle flap with lipofilling reproduced breasts with constant dimensions and appropriate width, height, and projection. Shaping the LD muscle flap is not difficult or unpredictable. This is a simple and easy technique to shape the LD flap and will provide surgeons with an additional autologous option for breast reconstruction.
Intracranial Pure Germinoma With Optic Nerve Infiltration
Authors: Cohen Devon A. , Bhatti M. Tariq , Giannini Caterina , Eckel Laurence J. , Garrity James A. , Chen John J. 
Published: February 2020

Abstract:
A 19-year-old man presented with a 3-year history of episodic headaches, right hemiparesis, and progressive vision loss in both eyes. Initially, extensive laboratory testing was unrevealing. MRI later demonstrated progressive enlargement and enhancement of the left optic nerve poorly correlated with the timing of his clinical manifestations. There was no clinical or radiological response to treatment with corticosteroids, mycophenolate mofetil, or rituximab administered empirically for possible inflammatory processes. Later in the disease course, he developed diabetes insipidus (DI), worsening vision to light perception bilaterally, severe cognitive decline, and spastic quadriparesis. Cerebrospinal fluid (CSF) beta human chorionic gonadotropin (β-hCG) was elevated. Eventually, a left optic nerve biopsy was performed, which was consistent with an intracranial pure germinoma with infiltration of the optic nerve and disseminated leptomeningeal disease. Although rare, intracranial germ cell tumors can primarily involve the anterior visual pathways and should be considered in the setting of DI and elevated CSF β-hCG.
Deafferentation as a cause of hallucinations
Authors: Marschall Theresa M. , Brederoo Sanne G. , Ćurčić-Blake Branislava , Sommer Iris E.C. 
Published: February 2020

Purpose of reviewThe association between hallucinations and sensory loss, especially vision- and hearing-impairment, has been firmly established over the past years. The deafferentation theory, a decrease of the threshold for activation in the brain and the consequential imbalance between excitatory and inhibitory brain networks, is hypothesized to underly this relationship. Here we review the studies investigating this theory with a focus on the most recent literature to better understand the contribution of sensory loss to hallucinations.Recent findingsA large cross-sectional study has recently confirmed the relationship between auditory impairment and deafferentation. However, the underlying mechanisms of deafferentation are still under debate, with hyperexcitability and deviations in bottom-up and top-down processes being the most likely explanations. Social isolation following sensory impairment increases the risk for hallucinations. Better knowledge and awareness about the contribution of deafferentation and loneliness would benefit diagnosis and treatment of hallucinations.SummaryStudies imply activity in higher order areas, corresponding to the functional mapping of sensory system, and a general state of higher excitability as neurobiological explanation. Auditory deafferentation, tinnitus and other auditory hallucinations, likely lie on a continuum. Social isolation mediates psychotic symptoms in sensory-impaired individuals. Currently, there is no standard treatment for deafferentation hallucinations.