bluuebunny/crossref_metadata_2025_split huggingface dataset:
Confidence gap between men and women in medicine: a systematic review
Authors: Vajapey Sravya P. , Weber Kristy L. , Samora Julie Balch 
Published: August 2020

Background:The aim of this study was to examine the existing data on disparities between men and women in the field of medicine in terms of self-confidence, self-efficacy, impostor syndrome, and other self-assessment factors.Methods:A systematic review of the literature was performed using keywords “confidence gap,” “male female residents,” “self-perception,” “self-confidence,” “self-worth,” “self-assessment,” “impostor syndrome,” “medicine self-esteem,” and “gender differences medicine.” Articles meeting the inclusion criteria were sorted and reviewed. Type of study, outcome measures, and results were recorded in Excel. Qualitative analysis was performed on the data collected.Results:Of the 31 studies included in this review, 24 studies demonstrated that men’s self-reported scores in clinical knowledge, skills, procedural confidence, operative experience, and other competencies were higher than women’s self-reported scores. Women at graduate and post-graduate training levels rated themselves lower in perceived clinical skills, performance, confidence in procedures, identification with the role of doctor, interpersonal/communication skills, and preparedness for leadership positions. Furthermore, the rate of identification with impostor syndrome, stress, and burnout are higher in women than men. Evidence did not demonstrate any objective differences in actual performance or skills between men and women at any level of training in medicine.Conclusions:Even though women and men do not differ in their clinical performance, women in healthcare fields may perceive deficiencies in their abilities more often than their male counterparts. However, these results are tempered by the fact that the level of evidence of the studies included in the review is low.Level of Evidence:Level III.
Effect of medial meniscal posterior horn tears on tibial translation in ACL-intact knees: a case control study based on MRI
Authors: Ulusoy Gökhan Ragip , Kizilgöz Volkan 
Published: August 2020

Background:
This aim of this study was to determine the relationship between medial meniscal tear and tibial translation in the anterior cruciate ligament (ACL)-intact knees.

Methods:
MRI of 278 patients, ages 18 to 50 yr, with medial meniscus posterior horn tears were evaluated. Two reviewers independently measured lateral and medial anterior tibial translation (ATT). Intraclass correlation coefficient (ICC) analysis was used to compare the results.

Results:
The ICC values of measurements of lateral ATT and medial ATT were 0.995 and 0.998, respectively; these values demonstrated almost perfect agreements. Age showed no significant difference between the control and patient groups (P>0.05). Lateral ATT values were lower in the patient group than those in the control group; however, there were no statistically significant differences between the groups (P=0.81). Medial ATT values were significantly lower in the patient groups than in the controls (P<0.05).

Conclusions:
Our results demonstrated significantly lower medial ATT values in patients with medial meniscus posterior horn tear in ACL-intact knees. However, most studies are dynamic and performed with ACL-ruptured knees or after meniscectomies in either ACL-intact or ACL-ruptured knees.

Level of Evidence:
Level III.
Cervicothoracic fixation using a tapered rod with posterior en bloc multilevel laminectomy for treatment of cervicothoracic pathology: a prospective case series
Authors: Ibrahim Fady Michael , Ibrahim Mohammed Zayan 
Published: August 2020

Background:
Cervicothoracic junction pathologies are difficult to treat because of the biomechanical and anatomical considerations of this area. Anterior approaches in this area are highly demanding and often result in long-term morbidities. Posterior fixation of the cervicothoracic junction is difficult because of the change in anatomy of the vertebrae between the cervical and thoracic vertebrae. Traditional laminectomy may be hazardous to the spinal cord. The purpose of this study was to evaluate the results of cervicothoracic fixation using tapered rods and en bloc multilevel laminectomy for treatment of different pathologies in terms of effectiveness, neurological improvement, and complications.

Methods:
A prospective study was done between 2013 to 2016 on 17 patients with cervicothoracic pathologies. The mean age was 50.05±16.48 yr. There were seven patients with tumors, five patients with traumatic fractures (including one patient with ankylosing spondylitis), and five patients with cervicothoracic myelopathy due to degenerative disorders. The patients underwent a detailed history and clinical examination, and they were investigated with radiographs, CT scans, and MRI. The patients’ neurological functions were classified according to Frankel grades of paraplegia. All patients had preoperative neurological impairment.

Results:
All patients were operated through posterior approach. En bloc laminectomy and posterior fixation of at least the lower 3 cervical and upper 3 thoracic vertebrae were done using a tapered rod. The mean operative time was 164.40 min. The mean operative blood loss was 960.6 mL. One case had superficial infection that was treated with antibiotics and daily dressings until wound healing. Patients with spinal metastases received postoperative radiation 1 mo after surgery. No neurological deterioration occurred. The improvement in patients was gradual throughout the follow-up but started in some patients from 2 days postoperatively. Gait improved in all patients. No case of metal failure was observed during follow-up.

Conclusions:
Multilevel en bloc laminectomy is a safe technique that provides adequate decompression of the spinal cord and neurological improvement for patients suffering from cervicothoracic myelopathy due to various pathologies. The use of a tapered rod is a good alternative for connection of screws across the cervicothoracic region, with easy handling and minimal complications.

Level of Evidence:
Level IV.
Advances in immunotherapy for cervical cancer
Authors: Wendel Naumann R. , Leath Charles A. 
Published: August 2020

Purpose of review
Novel therapies are needed for the treatment of recurrent cervical cancer. The best chemotherapy regimen to date has a response rate of 48% with an overall survival of 17 months, with limited options for second-line chemotherapy. Immunotherapy can induce a strong immune response in cervical cancer due to retained viral antigens and is reviewed in this article.

Recent findings
Current clinical trials include treatment with Listeria that elicits an immune response against the E7 oncoprotein and active vaccines against the E7 oncoprotein. Although the response rates to programmed cell death 1 (PD-1) inhibition alone have been modest, the landmark survival reported in these trials suggests the activity of these agents may not be measured by RECIST criteria. The KEYNOTE-158 trial has led to the approval of pembrolizumab in recurrent programmed cell death ligand 1 (PD-L1) positive cervical cancer. Combinations of programmed cell death 1 and anticytotoxic T-lymphocyte-associated protein 4 inhibitors (CTLA4) inhibitors have shown promising and durable activity. There is active research with new combinations of checkpoint inhibitors, as well as combinations of these drugs with chemotherapy and radiation, and other novel approaches.

Summary
Immune therapy has broad activity in cervical cancer. Responses to immunotherapy can be dramatic and durable. Continued work to find the optimal combination and setting for immunotherapy is ongoing.
Long-term Outcomes After Definitive Radiation Therapy for Solitary Plasmacytoma
Authors: Curry Jayden , O’steen Lillie , Morris Christopher G. , Kirwan Jessica M. , Mendenhall William M. 
Published: August 2020

Objective:
Definitive radiotherapy (RT) with or without surgery is the standard of care for solitary plasmacytoma. Here, we report clinical outcomes for this rare malignant neoplasm.

Patients and Methods:
We retrospectively reviewed the medical records of adults with solitary plasmacytoma treated with definitive RT between 1963 and 2015 at a single institution, and assessed disease control, survival, and toxicity per Common Terminology Criteria for Adverse Events (CTCAE), version 4.

Results:
A total of 42 patients with solitary plasmacytoma of the bone (SPB, n=27) or extramedullary plasmacytoma (EMP, n=15) were treated with definitive RT with (n=11) or without (n=31) surgical resection. The median age at diagnosis was 59 years (range: 28 to 76 y).Twenty-two patients had tumors ≥5 cm and 20 had tumors <5 cm. Immunoglobulins were elevated in 23 patients and M-protein in 14. The median RT dose was 45 Gy (range: 15 to 54 Gy) over a median 25 fractions (range: 1 to 38 fractions) with 3 patients receiving twice-daily fractionation and 6 received elective nodal irradiation. No patients received adjuvant chemotherapy. The median follow-up was 10.3 years. The 10-year local control rate after RT was 88%. Five patients who developed a local recurrence had SPB ≥5 cm. The 10-year multiple myeloma-free survival rates were: overall, 47%; SPB, 24%; and EMP, 87% (P=0.0012). The 10-year cause-specific survival rate was 75%: 64% for SPB versus 93% for EMP (P=0.0116). The 10-year overall survival rate was 60%. Three patients experienced late grade 2+ toxicity.

Conclusions:
Definitive RT with moderate doses results in excellent local control. We observed a higher rate of progression to multiple myeloma and lower survival in patients with SPB compared with EMP.
Diagnostic Biopsy via In-Office Frozen Sections for Clinical Nonmelanoma Skin Cancer
Authors: Mulvaney Patrick M. , Piris Adriano , Besaw Robert J. , Schmults Chrysalyne D. 
Published: August 2020

BACKGROUND
Treatment of nonmelanoma skin cancer (NMSC) by Mohs surgery has traditionally relied on previous pathologic evaluation of paraffin-embedded tissue. Tissue processing by frozen sections allows for expedited diagnosis and treatment; however, data on its accuracy are limited.

OBJECTIVE
To measure the accuracy and outcomes of biopsy via frozen sections for clinical NMSC.

METHODS
Biopsies of clinical NMSCs processed via frozen sections with in-office diagnosis rendered by one Mohs surgeon were retrospectively reviewed by one board-certified dermatopathologist. Discordant diagnoses were re-read in blinded fashion by both physicians. If still discordant, final diagnosis was determined by consensus discussion. Inter-rater reliability was calculated using Cohen's kappa statistic.

RESULTS
Two hundred ninety-seven lesions from 208 patients were included. Correlation between in-office and final diagnosis was 0.876 indicating “almost perfect” concordance. Sensitivity and specificity of in-office diagnosis for detecting malignancy were 98.1% and 94.4%. Seven cases (2.0%) had a clinically relevant change in final diagnosis, but appropriate treatment had been rendered. Two benign lesions (0.7%) initially diagnosed as malignant underwent excision.

CONCLUSION
In-office biopsy via frozen sections is highly accurate in confirming NMSC. This practice may speed diagnosis and treatment thus improving outcomes and patient satisfaction.
Potency and Quality of Reconstituted Botulinum Neurotoxin Type A According to Storage Temperatures
Authors: Park Kui Young , Han Hye Sung , Kim Jong Hee , Kim Han Byul , Seo Seong Jun 
Published: August 2020

BACKGROUND
In clinical practice, one of the most important issues regarding the use of botulinum neurotoxin A (BoNT-A) is the proper storage conditions and the change in potency and quality over time after reconstitution.

OBJECTIVE
This study aimed to investigate the change in potency and quality of reconstituted prabotulinumtoxin A (PraBoNT-A) over time when stored at different storage temperatures.

MATERIALS AND METHODS
ICR/CD-1 mice and PraBoNT-A were used for the mouse intraperitoneal lethal dose 50% (LD50) test. A thorough quality evaluation of the product was performed.

RESULTS
All of the reconstituted PraBoNT-A stored at different temperatures met the evaluation criteria for the suggested limits of estimated potency and for the quality assessment at every evaluated time point. When the stability of reconstituted PraBoNT-A was evaluated by regression analysis, the shelf life of reconstituted PraBoNT-A was found to be 99.24, 73.80, and 16.34 weeks in the case of PraBoNT-A stored at freezing, refrigeration, or room temperatures, respectively.

CONCLUSION
Based on the results, the authors conclude that the efficacy and quality of the reconstituted PraBoNT-A product are not compromised at least for a certain period of time and that the shelf life of reconstituted PraBoNT-A is longest when stored at the freezing temperature.
Tomography of the Forehead Arteries and Tailored Filler Injection for Forehead Volumizing and Contouring
Authors: Hong Wei-Jin , Liao Zhi-Feng , Zeng Li , Luo Cheng-En , Luo Sheng-Kang 
Published: August 2020

BACKGROUND
The forehead is a challenging area for filler injection because of the risk of serious complications. Anatomy-based filler injection techniques help to avoid severe vascular complications.

MATERIALS AND METHODS
Sixty-six cadaver heads were infused with adequate lead oxide contrast through the external carotid arteries, internal carotid arteries, facial artery, and superficial temporal artery. Three-dimensional computed tomography scans were reconstructed using validated algorithms. We measured the length and arc length of “beautiful” foreheads evaluated by 3 skilled surgeons.

RESULTS
The frontal branch of the superficial temporal artery (FBSTA) was classified based on the main trunk as follows: Type I FBSTA (89.72%) took a sudden turn (89.56° ± 11.76°) once passing through the temporal crest, whereas Type II FBSTA (10.28%) barely turned (52.26° ± 6.81°) at the temporal crest. A total of 319 arteries passed through the midline in 48 cadaver heads. There were more superficial arteries (292 of 319) than deep arteries (27 of 319). The difference in the length and arc length of the forehead was 19.66 ± 4.35 mm.

CONCLUSION
This study introduces an effective technique for forehead filler injection that minimizes the risk of filler injection and improves patient satisfaction.
The Current State of Mohs Surgery for the Treatment of Melanoma: A Nationwide Cross-Sectional Survey of Mohs Surgeons
Authors: Siscos Spyros M. , Neill Brett C. , Seger Edward W. , Hooton Tyler A. , Hocker Thomas L. H. 
Published: August 2020

BACKGROUND
The increased use of Mohs micrographic surgery (MMS) to treat melanoma has been accompanied by wide variations in practice patterns and a lack of best practice guidelines.

OBJECTIVE
The present study was a nationwide cross-sectional survey of Mohs surgeons to elucidate commonalities and variations in their use of MMS to treat melanoma.

MATERIALS AND METHODS
A cross-sectional analysis was performed using survey responses of Mohs surgeons with membership in the American College of Mohs Surgery.

RESULTS
A total of 210/513 (40.9%) participants used MMS to treat melanoma of any subtype and 123/210 (58.6%) participants within this group treated invasive T1 melanoma (AJCC Eighth Edition) with MMS. A total of 172/210 (81.9%) participants debulked melanoma in situ (MIS). Average margin size of the first Mohs stage for MIS was 4.96 ± 1.74 mm. A total of 149/210 (71.0%) participants used immunohistochemical stains, with 145/149 (97.3%) using melanoma antigen recognized by T-cells 1 (MART-1) in 96.5% of melanoma cases treated with MMS.

CONCLUSION
Over half of surveyed Mohs surgeons treating melanoma with MMS are treating early invasive melanoma with MMS. Most Mohs surgeons treating melanoma with MMS debulk MIS and virtually all use MART-1 when excising invasive melanoma with MMS.
Fractionally Ablative Er:YAG Laser Resurfacing for Thermal Burn Scars: a Split-Scar, Controlled, Prospective Cohort Study
Authors: Sipprell William H. , Bell Derek E. , Ibrahim Sherrif F. 
Published: August 2020

BACKGROUND
Thermal burn scars can have catastrophic impact on the quality of life and personal image, and over time can lead to profound physical and psychological debilitation. There are no established treatments to significantly improve burn scars.

OBJECTIVE
To demonstrate the safety, efficacy, and tolerability of fractionally ablative Er:YAG resurfacing of mature burn scars.

METHODS
Sixteen subjects were enrolled and received 3 treatments of fractionally ablative Er:YAG resurfacing at monthly intervals. Twelve completed the study. Scars were scored with the Vancouver Scar Scale (VSS) by the patient and physician before and after treatment. Blinded photographic analysis (Visual Analog Scale [VAS]) and blinded histologic analysis of tissue before and after treatment was also performed.

RESULTS
Significant Improvement in VSS scores were seen in all 12 patients, reported by patients and the evaluating physician alike. Photographic analysis demonstrated subjective improvement in all 12 patients. Histologically, there was significant improvement in collagen architecture and the number of vessels per high-power field. The treatments were tolerated well by patients, and 1 superficial skin infection occurred.

CONCLUSION
Fractionally ablative Er:YAG laser resurfacing is a safe and effective modality in the treatment of thermal burn scars with subjective and objective improvement as seen from the patient and physician.
Periocular Mohs Reconstruction by Lateral Canthotomy With Inferior Cantholysis: A Retrospective Study
Authors: Mori Westley S. , Behshad Ramona , Shahwan Kathryn T. , Fiessinger Lori A. , Farah Ronda S. , Maher Ian A. 
Published: August 2020

BACKGROUND
Most eyelid defects after Mohs micrographic surgery are referred to oculoplastic surgery or plastic surgery for reconstruction, but growing evidence suggests the safety of such repairs performed by dermatologic surgeons is equivalent if not better. Lateral canthotomy with inferior cantholysis may be used by the dermatologic surgeon to reconstruct larger lower eyelid defects.

OBJECTIVE
To demonstrate lateral canthotomy with inferior cantholysis performed by the dermatologic surgeon can result in safe, functionally and cosmetically acceptable surgical outcomes.

MATERIALS AND METHODS
An institutional review board-approved retrospective study of repairs performed by a single dermatologic surgeon between January 2013 and August 2019. Patient demographics, operative and follow-up notes were reviewed. Two cosmetic dermatologists assessed aesthetic results based on final follow-up photographs using a visual analogue scale.

RESULTS
Eight cases were included in the analysis. Seventy-five percent of patients were men, with a mean age of 74.1 years old. All tumors were basal cell carcinoma; the mean defect size was 2.4 cm2. No serious complications or postoperative interventions occurred. The median cosmetic score was 85.6 ± 11.5.

CONCLUSION
Dermatologic surgeons can safely perform repairs of lower eyelid defects with lateral canthotomy with inferior cantholysis, achieving satisfactory functional and cosmetic outcomes.
Effects of vascular compression on the rostral ventrolateral medulla for blood pressure variability in stroke patients
Authors: Nezu Tomohisa , Hosomi Naohisa , Kuzume Daisuke , Naito Hiroyuki , Aoki Shiro , Morimoto Yuko , Kinboshi Masato , Shiga Yuji , Kinoshita Naoto , Ueno Hiroki , Maruyama Hirofumi 
Published: August 2020

Backgrounds:
Vascular compression of the rostral ventrolateral medulla (RVLM) has been associated with hypertension or blood pressure (BP) variability. For acute ischemic stroke patients, increased BP variability may cause poor functional outcomes. We tested the hypothesis that RVLM compression was associated with increased BP variability or stroke outcome in acute ischemic stroke patients.

Methods:
Acute ischemic stroke patients (n = 622) with 24-h ambulatory BP monitoring during the subacute phase of stroke (median 9 days from onset) were retrospectively studied. Variability in BP was evaluated with the SD and coefficient of variation of SBP and DBP. The morning surge was also evaluated. The presence of RVLM compression was evaluated using time-of-flight three-dimensional MRI. A poor outcome was defined as a modified Rankin Scale score of 3–6 at 3 months.

Results:
Patients with RVLM compression (n = 213) had significantly higher 24-h SBP mean, 24-h SBP SD, 24-h SBP coefficient of variation, 24-h DBP mean, 24-h DBP SD, and 24-h DBP coefficient of variation values and a higher prevalence of morning surge than those without (n = 409). Multiple regression analysis revealed that RVLM compression was associated with increased SBP variability, DBP variability, and morning surge. Despite the significant association between RVLM compression and BP variability, RVLM compression was not associated with poor stroke outcome.

Conclusion:
Although RVLM compression was closely associated with BP variability in the subacute ischemic stroke phase, an effect of RVLM compression on stroke outcome was not observed.
Association between circulating vascular-related microRNAs and an increase in blood pressure: a 5-year longitudinal population-based study
Authors: Suzuki Koji , Yamada Hiroya , Fujii Ryosuke , Munetsuna Eiji , Ando Yoshitaka , Ohashi Koji , Ishikawa Hiroaki , Yamazaki Mirai , Maeda Keisuke , Hashimoto Shuji , Hamajima Nobuyuki 
Published: August 2020

Objective:
MicroRNAs (miRNAs) are small noncoding RNAs that regulate gene expression and play essential roles in the pathogenesis of cardiovascular disease. Previous cross-sectional studies showed that the levels of several circulating miRNA are associated with hypertension, but there are no prospective longitudinal studies using a general population. The aim of this study is to evaluate the impact of circulating vascular-related miRNA (miR-126, miR-221, and miR-222) on changes in blood pressure and new-onset hypertension in a Japanese population.

Methods:
We conducted a 5-year longitudinal study using 192 health examination participants (87 men and 105 women). Serum miRNAs were measured using quantitative reverse transcription-PCR. Information regarding lifestyle and health condition was obtained using a self-administered questionnaire. Logistic regression analyses were performed to calculate odds ratios and 95% confidence intervals for new-onset hypertension in the 5-year period between the low and high group of serum miRNAs.

Results:
Serum levels of miR-126, miR-221, and miR-222 were significantly and negatively associated with changes in SBP and the rate of change of SBP. Serum miR-126, miR-221, and miR-222 levels were significantly lower in new-onset hypertensive patients compared with normotensive individuals. The confounding factors adjusted odds ratios of each 1 increment in serum miR-126, miR-221, and miR-222 levels were 0.82 (95% confidence interval: 0.69–0.98), 0.79 (0.68–0.91), and 0.61 (0.46–0.81) for new-onset hypertension, respectively.

Conclusion:
Low serum levels of miR-126, miR-221, and miR-222 were associated with increased blood pressure and new-onset of hypertension. These circulating miRNAs are potential candidate biomarkers for the prediction of hypertension.